Meeting of the Board of Directors
10.00am on Thursday 31 October 2013
Boardroom, Worthing Hospital, Lyndhurst Road,
Worthing, West Sussex, BN11 2DH
AGENDA – MEETING IN PUBLIC
1 10.00
Welcome and Apologies for Absence
(Cathy Stone and Martin Phillips)
Chair
2 10.00
Declarations of Interests
All
3 10.00
Minutes of Board Meeting held on 3 October 2013
To approve
Enclosure
Chair
4 10.05
Matters Arising from the Minutes
To note
Enclosure
Chair
5 10.10
Chief Executive’s Report
To receive and agree any necessary action
Enclosure
MG
Enclosure
CS/WR
PATIENT SAFETY/EXPERIENCE ITEMS
6 10.20
Quality Report
To receive and agree any necessary action
OPERATIONAL ITEMS
7 10.40
Performance Report
To receive and agree any necessary action
Enclosure
JF
8 11.00
Organisational Development and Workforce
Performance
To receive and agree any necessary action
Enclosure
DF
9 11.10
Financial Performance
To receive and agree any necessary action
Enclosure
SP
Annual Plan Progress Report / Quarterly Review of
Board Assurance Framework
To receive and agree any necessary action
Enclosure
DF
Enclosure
JF
10 11.20
STRATEGIC ITEMS
11 11.30
Endoscopy Outline Business Case
To approve
12 11.50
Other Business
13 11.55
Resolution into Board Committee
To pass the following resolution:
Chair
Verbal
Chair
“That the Board now meets in private due to the
confidential nature of the business to be transacted.”
14 12.00
Date of Next Meeting
Chair
The next meeting in public of the Board of Directors is
scheduled to take place on 28 November 2013 in the
Bateman Room, Chichester Medical Education Centre,
St.Richard’s Hospital, Spitalfield Lane, Chichester, West
Sussex, PO19 6SE
12.00
Close of Meeting
12.05
to
12.05
Questions from the Public
Following the close of the meeting there will be an
opportunity for members of the public to ask questions
about the business considered by the Board.
Ann Merricks
Interim Company Secretary
Chair
Western Sussex Hospitals
NHS Foundation Trust
Minutes
Minutes of the Board meeting held (in public) at 10.00am on 3 October 2013 in the
Bateman Room, Chichester Medical Education Centre, St Richard’s Hospital,
Spitalfield Lane, Chichester, West Sussex, PO19 6SE
Jane Farrell
Jon Furmston
Marianne Griffiths
Martin Phillips
Spencer Prosser
William Roche
Cathy Stone
Chairman
Non-executive Director
Non-executive Director
Director of Organisational Development and
Leadership
Chief Operating Officer
Non-executive Director
Chief Executive
Non-executive Director
Director of Finance
Interim Medical Director
Director of Nursing & Patient Safety
In Attendance:
Dr R Albertyn (Item 6)
Dr D Melville (Item 6)
Janet Coverdale(Item14)
Melanie Cousins
Clinical Lead Organ Donation (CLOD)
CLOD for SRH campus
Deputy Director of Facilities & Estates
Minute Secretary
TBP/09/13/1
WELCOME AND APOLOGIES FOR ABSENCE
1.1
The Chairman welcomed all those present to the meeting.
1.2
Apologies for absence were received from Bill Brown, Non-executive
Director.
TBP/09/13/2
DECLARATIONS OF INTERESTS
2.1
There were no interests to declare.
TBP/09/13/3
MINUTES OF THE BOARD MEETING HELD ON 1 AUGUST 2013
3.1
The Committee received the minutes of the meeting held on
1 August 2013. The following amendments were agreed:
 Pages 3 and 7 TBP/08/13/6 6.5 & 6.6 and TBP/08/13/12 12.1
Reference to be amended to read “Interim Medical Director”;
 Questions asked by members of the public Page 10 No. 6 to be
amended to refer to the question about Southlands being raised by “a
Member of the Public”.
3.2
The Committee resolved that subject to the amendments set out above,
the minutes of the meeting held on 1 August 2013 would be approved
as an accurate record of the meeting and signed by the Chairman.
TBP/09/13/4
MATTERS ARISING FROM THE MINUTES
4.1
The Board received and noted the report of matters arising from its meeting
held on 1 August 2013.
Present:
Mike Viggers
Tony Clark
Joanna Crane
Denise Farmer
TBP/09/13/5
CHIEF EXECUTIVE’S REPORT
5.1
The Chief Executive presented the report and the main points of the
discussion were as follows:
5.2
The Chief Executive said that excellent feedback had been received on this
year’s Staff Conference – ‘How we care – Delivering Excellent Customer
Care for Patients and Staff’. Comments from some of the 175 Trust staff
who had attended the Fontwell event included “brilliant”, “morale-boosting
and uplifting”, “inspirational” and “motivating”. Inspiring speakers had
discussed caring for patients and had engaged particularly well with the
audience.
5.3
The Chief Executive congratulated the Trust’s two specialist dementia
nurses, Heather Pennicott and Caroline Betsworth, who had led a workshop
at the Dementia National Conference on how patient information can be used
to improve care.
5.4
The Chief Executive highlighted the public launch of Healthwatch England on
Friday, 11 October in Horsham. The event had been designed to raise
awareness of this new independent consumer champion for health and social
care. The Trust was planning to be represented.
5.5
The Chief Executive paid tribute to a former colleague, Richard Bate, who
had sadly passed away on Friday, 2 August aged only 42. Richard had
worked at St Richard’s for more than 25 years, initially as a porter and then
as an anatomical pathology technician. He was a very well-known and
popular member of staff and his death was particularly tragic in view of his
young age. A memorial service would take place on Friday, 11 October.
5.6
The Chief Executive noted the winners of the Employee of the Month awards
– for September the winners were Katie Skinner and Matthew Smith,
reception staff at main outpatients, Worthing, who had been nominated by
their manager, Aileen Phillips (Worthing Outpatients Reception Manager).
Aileen had described Katie and Matthew as demonstrating “kindness and
action beyond their years” and had outlined a recent incident when they had
gone out of their way to help an elderly patient who had become distressed
on missing her transport home. The certificates would be presented to Katie
and to Matthew the following day in the reception area at main outpatients,
Worthing.
5.7
The winners of the July Employee of the Month award were the Customer
Relations Team led by Tracey Nevell, incorporating Complaints and Patient
Advice and Liaison Service (PALS), nominated by Cathy Stone, Director of
Nursing and Patient Safety. Cathy had described the sensitive manner in
which bereavement complaints are handled and praised the team’s
willingness to take on additional duties in order to cover a team member on
maternity leave by often working late and during weekends. The team
members had received their certificates during August in the Washington
Suite during a gathering with colleagues.
5.8
Finally, the Chief Executive and Chairman were pleased to present the
certificate for the August Employee of the Month award to Sam Coombes, a
member of the Pharmacy staff. Sam had been nominated by Sue Taylor,
Antimicrobial Pharmacist, who had described how Sam had developed a
software application known as an app giving colleagues instant access to the
Page 2 of 12
right guidelines, dosages and advice. Sam had researched the original
concept 2 years ago and had been instrumental in pushing forward the
Antimicrobial app, which had been launched throughout the Trust recently.
Sue said that the app “is of vital importance when we consider the C.Difficile
risk with antibiotic prescribing and contributes significantly to patient care.”
Sam had carried out close work with the numerous committees and bodies
within the Trust and the Chief Executive said that tremendous feedback on
the app had been received from the Antimicrobial Committee
5.9
The Board resolved to note the report.
TBP/09/13/6
6.1
ANNUAL ORGAN DONOR REPORT
The Interim Medical Director introduced Dr Rick Albertyn, Trust Clinical Lead
Organ Donation (CLOD) and Dr Dom Melville, newly appointed Consultant
Anaesthetist/Intensivist, who has joined the committee in the role of CLOD
for the St Richard’s campus. The newly appointed Trust Specialist Nurse
Organ Donation (SNOD) is Jason Howell. Angela Fisher is the non-clinical
lead and Chair of the strong, progressive Organ Donation Committee. Each
donation is handled with extreme sensitivity with the relatives of the donors.
An initiative was underway for a redesign of the St Richard’s family room on
ITU – this would be greatly appreciated by relatives, who often spend long
periods of time waiting for news in the current small room.
6.2
Dr Albertyn gave a presentation on organ donation activity over the previous
year (01/04/12-31/03/13), with comparative figures for the year 01/04/1131/03/12. It was noted that there had been a small drop in brain stem death
(BSD) referral from critical care this year but referral and consent rates
continue to be above the national average. Also, Dr Albertyn emphasised
that numbers are small so the loss of one potential donor results in a large
percentage change. The number of DBD donors in 2012/13 was 3 as
compared with 5 the previous year, a drop of 40%.
6.3
Dr Albertyn explained that identification and referral of potential Donation
after Circulatory Death Donors (DCD) continues to be problematic. Referral
rates have dropped and although approach rates approximate the national
and regional averages, the consent rates have dropped substantially. There
had been 3 “missed” potential donors at both the Worthing and the St
Richard’s sites for the period, indicating the need for increased awareness
training of medical staff to recognise timely referral. There had been one
DCD donor in the year 2012/13, with 3 patients transplanted. In answer to a
query from the Chief Executive over the low numbers of referrals, it was
noted that but the age limit is 75 and there are often difficulties in allocating
space on ITU. It is planned to hold a half-day’s training session as part of the
Clinical Governance programme.
6.4
Organs transplanted by type (kidney, pancreas, liver, heart, lung) were
shown for the period, showing substandard DCD activity. It was noted that
the 7 kidneys donated from WSHFT patient in 2012/13 will save the NHS
£245,000 a year or £2,450,000 over ten years assuming an average
transplanted kidney lifespan of 10 years.
6.5
Finance for 2011/12 was shown as follows: Income: £12,000; Expenditure:
£9,417; Balance: £20,268.
6.6
Additional activities are organised, such as the Organ Donation Study Day
held at the Hilton Avisford Park Hotel and the thanksgiving services held at
both Worthing and at St Richard’s. Dr Albertyn displayed a model of a
Page 3 of 12
commissioned piece of brass resin artwork of a pair of seated figures. This
was to be placed in Chichester Cathedral by the end of March 2014 and it
was hoped that it would bring great comfort to the families of donors.
6.7
The Interim Medical Director asked if centralisation of major trauma had
impacted on the number of donations. Dr Albertyn said this would be true for
DBDs but collapses often involved young patients.
6.8
The Director of Finance asked if attitudes to organ donation had changed in
the last 2 years; Dr Albertyn said that the Trust continued to have one of the
highest consent rates in the country and this was because the right approach
was taken from the outset. It is not a specialty where a deputy can be
appointed; Jason Howell is from ITU in Brighton and as SNOD he works with
the excellent link nurses at the Trust.
6.9
The Chairman thanked Dr Albertyn and Dr Melville for the presentation and
all the work that takes place throughout the year on organ donation.
6.10
The Board resolved to note the report and that the Director of Finance SP
would follow up the project to redesign the St Richard’s Family Room.
TBP/09/13/7
QUALITY REPORT
7.1
The Director of Nursing & Patient Safety and the Interim Medical Director
presented the report and the main points of the discussion were as follows:
7.2
The Director of Nursing & Patient Safety advised the Board that the Trust
had reported 1 case of Methicillin-resistant Staphylococcus Aureus (MRSA)
bacteraemia in August. This was a highly complex case, involving a long
stay patient. The Root Cause Analysis (RCA) had been chaired by the Chief
Executive; no problems had been identified, all aspects of care had been
provided and the case had been recorded as unavoidable.
7.3
The Trust reported 7 cases of C. Difficile during August, 4 cases on the
Worthing site and 3 cases on the St Richard’s site. 5 of the cases had been
found to be avoidable and the key had been the antibiotic compliance in the
management of complex patients. This is now being taken forward by the
Chiefs of Service with all senior doctors. The Director of Nursing & Patient
Safety advised that there had been 35 cases reported of hospital attributable
C.Difficile with a reduction in numbers during Quarter 2. The Board would
receive a report next month from the Trust’s Infection Control Consultant.
7.4
The Patient Environment Action Team (PEAT) initiative is being replaced this
year by the Patient Lead Assessment of the Care Environment (PLACE).
The national PLACE scores for 2013/14 have been published and both the
Worthing and St Richard’s sites have scored better than the national average
for all 4 of the individual measures. All staff were commended on such a
significant achievement.
7.5
The Interim Medical Director advised that the rebased Hospital Standardised
Mortality Ratio (HSMR) for 2012/13 is now 100.5 (where 100 is the national
average) and the Trust reported a level of mortality ‘as expected’ based on
the patient group seen, reflecting an improvement in mortality and
performance. An improvement in mortality figures had been seen in August.
It was noted that there would be an update in the next quarterly report on the
analysis carried out on the crude non-elective mortality for renal failure.
WR
Page 4 of 12
7.6
In response to a question about the CQUIN target on dementia screening, it
was noted that technical and cultural issues were being addressed and the
Chief Operating Officer was chairing a monthly CQUIN board.
7.7
The Board resolved to note the report.
TBP/09/13/8
QUARTERLY COMPLAINTS AND PATIENT ADVICE AND LIAISON
SERVICE (PALS) REPORT QUARTER 1 (01 APRIL – 30 JUNE 2013
8.1
The Director of Nursing & Patient Safety advised that the report covered the
positive outcomes following receipt of complaints and enquiries received by
PALS. The report made reference to compliance with the recommendations
of the Francis Inquiry. The report identified the forthcoming Prime Minister’s
response to the Francis Inquiry and the report by Ann Clwyd, which was not
yet published.
8.2
It was noted that Accident & Emergency is the only area to fall outside the
national benchmark for complaints received. The Clinical Director for A&E
had given a presentation to the Patient Experience & Feedback Committee
on the approach taken to learn from complaints by sharing them with staff
and taking action over staff attitude and communications. The Chairman
commented that 3 A&E Consultants had recently been recruited, which
would benefit the work of the department. Also, the Friends and Family test
had placed A&E among the highest in the country. The Chair of the Patient
Experience & Feedback Committee said that an in-depth discussion had
been held with the Clinical Lead for A&E. Members had been reassured by
the commitment to learn from complaints and this was reinforced on
reviewing the files and noting the responses from staff, which were
exemplary and showed a genuine wish to learn and improve following receipt
of a complaint. The Director of Nursing & Patient Safety would discuss with CS
the team setting measurable reduction within A&E for complaints.
8.3
Key issues raised by complaints and PALS comments relate to
communications, staff attitude and access to appointments. Work now takes
place with staff on the front-line and the Trust engages with patients in the
right way, for example, by text message if that is right for them.
8.4
Plaudits were also mentioned in the report – during Q1 the Trust received
1,234 plaudits across the organisation from patients and relatives to the
Chief Executive’s office and various wards and departments.
8.5
It was noted that the improvements to the PALS office at Worthing were still
in progress; the Director of Finance said that the scheme was being
progressed in partnership with the complaints and PALS teams.
8.6
The number of complaints and comments concerning access to the Trust
continued to increase. The Chair of the Patient Experience & Feedback
Committee said that outpatient complaints and access complaints would be
presented to the next Patient Experience & Feedback Committee.
8.7
The Board resolved to note the report and that a trajectory for CS
improvement be taken forward with A&E and a review of complaints
relating to Outpatients be carried out.
TBP/09/13/9
9.1
ANNUAL REPORT ON RESEARCH AND INNOVATION
The Interim Medical Director advised that the report was generic and activity
for patient research was not reflected within the Trust. There were
opportunities for further research to be undertaken in clinical areas, such as
Page 5 of 12
Oncology. The Director post is vacant and will be advertised shortly; once an
appointment has been made this will help to drive the pathway from research
to innovation to clinical care.
9.2
Claire Meachin, Lead Research Manager, said that the previous year the
CLRN had reduced the budget by 20% but by September the full budget had
been restored. There is a need for a Director to lead the Trust forward and
join the departments of Clinical Audit with the clinical teams.
9.3
The Interim Medical Director said that the new post title is Director of
Effectiveness, Research & Innovation and the emphasis will be on spreading
and energising innovation through the organisation.
9.4
The Board resolved to note the report.
TBP/09/13/10
10.1
ACTION PLANS ARISING FROM MID-STAFFS INQUIRY
The Chief Executive gave a presentation on the 2nd formal update on the
Trust’s response to the recommendations. The presentation is attached to
the minutes. Each lead Director has action plans for their action areas.
10.2
Listening event key action areas:
1. 24 hour service, 7 days a week – Emergency response required at
weekends. A Consultant review is underway – Salford has installed
an assessment village (the Trust equivalent is the emergency floor).
2. Culture of caring and leadership – Staff with back problems receive
an appointment with a Physiotherapist; a stress workshop is available
for staff.
3. Nursing leadership/workforce – There is a new programme at the
University of Chichester for senior nurses.
4. Outlying patients – Work in progress.
5. Ownership of patients – Work in progress.
6. The discharge process accounting for patient frailty – A multi-agency
group is working on this.
7. The IT infrastructure challenge - - Ongoing
8. Learning organisation/learning from complaints/use of Datix – Review
of Datix carried out with good results; regular learning from incidents;
clinical leaders’ event video.
9. Implementation of key process changes directly relevant to the
Francis Inquiry – This is being taken forward.
10.3
An update on the work would be brought to the Board on a quarterly basis.
PIDs would be circulated to Board members.
MG
10.4
The Board resolved to note the report.
TBP/09/13/11
PERFORMANCE REPORT
11.1
The Chief Operating Officer presented the report and the main points of the
discussion were as follows.
11.2
The Board noted that the Trust had had a challenging time in Month 5.
Efficiency gains had been offset by increasing complexity of cases. Key
indicators of operational pressure during August included an increase in the
number of A&E attendances in all age groups (12,008 A&E attendances in
August 2013 compared to 11,793 in August 2012 (+1.8%).
11.3
There had been a drop in the number of emergency admissions compared to
August 2012: 3849 emergency admissions compared to 4187 in August 2012
Page 6 of 12
(-8.1%). When scrutinised by age group, there was a 3.4% decrease in the
65-84 year age group and a 0.1% decrease in the >85 year age group
compared to August 2012.
11.4
There had been an abatement in June and July in the number of >85 year
old patients attending A&E, but this had reversed in August, with the increase
in A&E attendances up on August 2012; there had been a disproportionately
high increase in Worthing in particular 4% increase on 2012).
11.5
Elective referrals had risen from all sources by 2.8% on plan. There had
been increases in Orthopaedics (17% up on plan), Respiratory Medicine
(33.6% up on plan); Cardiology (14.5% up on plan). Increased referrals
places significant pressure on the Trust’s ability to meet both RTT and
cancer pathway commitments.
11.6
The Chief Operating Officer advised the Board that there was active
consultation with neighbouring services to plan for the winter months, asking
what could be done to stem the demand and not to increase the referrals to
the Trust’s services. Stabilising A&E performance is critical, with the
maximum of 4 hours waiting time from arrival in A&E to
admission/transfer/discharge being the measure of pressure on the whole
system. The last 10 days had placed significant pressure on the Trust, with
>200 attendances per day for 10 days in Worthing, resulting in delays and
loss of flexibility. Clinicians indicated that the majority of the problem is the
number of frail, elderly patients. The pressures are being raised externally
with the Clinical Commissioning Group as the situation is likely to worsen.
11.7
The report also covered the Monitor Risk Assessment Framework in some
detail for the Board’s information.
11.8
The Chairman asked for the Board’s thanks to be passed to staff for their JFar
dedication and commitment.
11.9
The Board resolved to note the report.
TBP/09/13/12
ORGANISATIONAL DEVELOPMENT AND WORKFORCE REPORT
12.1
The Director of Organisational Development & Leadership presented the
report and the main points of the discussion were as follows:
12.2
The key area of concern was the sickness absence rate and divisions had
been asked to do more work on the reasons for this. There had been an
increase in July of staff attributing sickness absence to stress; this is a cause
for concern and the Trust is targeting this.
12.3
The Board noted that there had been a dip in attendance on training
modules, which was seasonal. Departments remained determined to send
staff for their training, despite wards and departments being so busy. .
12.4
It was noted that positive feedback had been received from the 44
apprentices. These had been a success within a variety of fields and were
making a contribution in many areas.
12.5
The national staff survey for 2013 was launched on 23 September and the
Board was asked to encourage staff to complete the Staff Survey as so far
the response was only 11%. A good response rate would give the Trust a
body of information and it is also the first time that the survey will link to the
CQUINS.
Page 7 of 12
12.6
The Board resolved to note the report and that the next report would
include some granularity around sickness levels by division and DF
department and whether short or long-term.
TBP/09/13/13
FINANCIAL PERFORMANCE REPORT (MONTH 5)
13.1
The Director of Finance presented the report and the main points of the
discussion were as follows:
13.2
The Trust’s financial position against the control total for August was a
surplus of £220k against the budgeted in-month figure of £654k, providing an
undershoot of £434k against plan. The year-to-date plan is a surplus of
£1,950k and the actual position is a deficit of £1,320k excluding the impact of
the increased annual leave accrual of £959k.
13.3
The year-end forecast out-turn remains at £5.2m surplus, but this is
dependent on achieving the Cost Improvement target and the quality and
patient safety targets. The targets carry heavy financial penalties if they are
not achieved.
13.4
The in-month pay costs exceeded budget by £524k. Locum medical staff
agency costs are high and there are some vacancies that remain unfilled.
13.5
The non-pay costs had increased due to the pressures on the Trust and the
favourable variance on clinical supplies and services is technical. A high
level of stock is held and expenditure on utilities has been estimated for
much of the year in the absence of invoices received. These invoices have
been reviewed in the light of actual invoices received in month, which has
produced a favourable non-recurrent benefit. A better understanding of the
situation would inform the report for September.
13.6
The Trust’s Financial Risk Rating remains at 2, the same as for last month.
13.7
The Board noted the financial position, which had been reviewed in detail at
the Finance & Investment Committee. Further work is taking place with
divisions to reconcile Income & Expenditure.
13.8
The Board resolved to note the report.
TBP/09/13/14
ANNUAL SECURITY REPORT
14.1
The Director of Finance introduced Janet Coverdale, Deputy Director of
Facilities & Estates (Security Management Lead). The Director of Finance is
the Security Management Director. Also on the Security Executive Group
are Bill Brown (NED), the Director of Organisational Development &
Leadership and the Director of Nursing & Patient Safety. It was noted that
the Trust had outsourced for one year the Local Security Management
Specialist Services (LSMS) to Oakhill and would be going out to tender in
Quarter 4.
14.2
The Security Management Lead presented the report and the main points of
the discussion were as follows:
14.3
To ensure the governance arrangements are in place the Security Executive
Group meets every quarter to review the security reports. In January 2013
the Board had ratified the Security Policy; this outlined the responsibility for
Page 8 of 12
all divisions to meet the requirement for risk assessment for physical security
and lone working arrangements. In February 2013 the security services
were assessed as part of the Trust’s NHSLA Level 2 application and the
security services achieved Level 2. The division is now on track for the Level
3 application in 2013/14,
14.4
In March 2013 the Board approved delivery of Conflict Resolution Training to
75% of front line staff across the Trust. Improvements in attendance and
availability of sessions has brought Trust compliance to 42.75% compliance
in 2012/13. Staff who had received the training can now manage the Datix
incident reporting and share lessons learned across the Trust. Relationships
with the police have improved and the Trust is known locally as a body that
will prosecute, bringing greater safety and security to the Trust.
14.5
In response to a query about reaching 75% staff trained, the Director of
Organisational Development & Leadership explained that this is an evolving
picture, with groups of staff being targeted. An update on the numbers and
cohorts of groups trained would be included in the Organisational DF
Development & Workforce report in future.
14.6
It was noted that there had been 130 Violence against staff (CVAS) reported
incidents the previous year, only 10% of which were as a result of the
patient’s condition. Once staff had received training they would also be more
confident about challenging someone if they are not wearing a name badge,
thereby reducing the opportunity for a breach of security.
14.7
The Chairman thanked the Deputy Director of Facilities & Estates for
attending.
14.8
The Board resolved to note the report and that the Organisational
Development & Workforce report would include an update on training,
as well as noting the Trust Annual Security Report 2012/13.
TBP/9/13/15
BOARD AUTHORISATION MINUTE ON THE EMERGENCY FLOOR
CAPITAL INVESTMENT LOAN
15.1
Spencer Prosser reminded the board that it approved the application for a
capital investment loan of £6.314m for the Emergency Floor at its meeting of
27th September 2012. To complete the approval of the loan the Trust Board
is required to restate its approval and provide some specific assurances and
confirmations to the Department of Health.
15.2
In respect of the £6.314million working capital loan from the Department of
Health the board resolved to:
a) approve the terms of, and the transactions contemplated by, the Finance
documents to which the Trust is a party; and
b) execute the Finance Documents to which the Trust is a party;
c) authorise Spencer Prosser to execute the Finance Documents to which
the Trust is a party on its behalf; and
d) authorise Mike Viggers and/or Spencer Prosser, on its behalf, to sign
and/or despatch all documents and notices (including, if relevant, any
Utilisation Request and) to be signed and/or despatched by the Trust
under or in connection with the Finance Documents to which the Trust is
a party.
Page 9 of 12
TBP/09/13/16
OTHER BUSINESS
16.1
There were no items of other business.
TBP/09/13/17
RESOLUTION INTO BOARD COMMITTEE
17.1
The Board resolved to meet in private due to the confidential nature of
the business to be transacted.
TBP/09/13/18
DATE OF NEXT MEETING
18.1
The next meeting in public of the Board of Directors would take place at
10.00am on Thursday, 31 October 2013, in the Board Room, Worthing
Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2DH.
Melanie Cousins
Assistant Company Secretary
October 2013
Signed as an accurate record of the meeting
………………………………………………….
Chair
…………………………………………………
Date
Page 10 of 12
WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST
BOARD MEETING HELD ON 3 OCTOBER 2013
QUESTIONS ASKED/COMMENTS MADE BY MEMBERS OF THE PUBLIC ATTENDING THE MEETING
No.
1
2
Question/Comment
Barbara Porter (Shadow Public Governor for Adur) asked
what jurisdiction the Trust had over the management of the
car park at Worthing Hospital
Richard Farmer (Governor) commented that the locum
medical staff agency costs had doubled during the year since
August 2012 and yet the usage of agency staff had
decreased.
3
Richard Farmer (Governor) asked whether the WTE figures in
the Workforce Capacity Report represented the number of
staff as the figure varied from month to month.
4.
Richard Farmer (Governor) queried whether the sickness
absence rate was really s alarming as stated in the Workforce
report.
5-8
Margaret Bamford (Shadow Public Governor for Arun) said
that she had 4 questions and did not expect a response that
day, but would like to receive a comment at a later date:
1. She said it had been a truly inspirational staff
conference at Fontwell but she asked whether staff
would be written to asking if their practice had changed
as a result and, if so, how?
2. She did commend Healthwatch, Care Quality
Commission and the data collection. She is concerned
that these regulatory bodies are not integrated and
Response
Action
The Director of Finance said that he would follow up with the
contractor the comments about the attitude of the car park
attendants.
The Director of Finance explained that some invoices had not
been included initially and there was a retrospective reporting
error. A new general ledger had been installed at divisional
level at the beginning of the year and a catch up process was
underway.
The Director of Organisational Development & Leadership
explained that ‘staff in post’ was the number of staff being
paid. The variance represented the figure the Trust has
budgeted for. The plan is to make a reduction in some
services.
The Director of Organisational Development & Leadership
explained that the sickness absence rate is too high
considering the number of staff and although the Trust was at
the better end of the scale, more could be done to try to
reduce sickness absence.
The Chairman thanked Ms Bamford her valid points, which
would be followed up with her at a later date.
No.
9.
Question/Comment
wondered if there could be a report on how they do
integrate?
3. She commented that she could not see an
improvement in the report on the dementia strategy or
why there was optimism about the target at the end of
the year.
4. She noted in the Performance Report that the doctors
are working with the CCG but she is not convinced that
the CCG is really concerned. She would like to have
some detail on what the CCG is saying.
John Gooderham (Shadow Public Governor for Horsham)
asked whether item 15 (Emergency Floor) referred to the
Worthing site, the completion date and why there us a need
for DoH assurances
Response
Action
The Director of Finance explained that the project is on the
Worthing site, with completion planned for approximately
November 2013. The loan had been authorised prior to
01/07/13 so technically it lay with the DoH.
Page 12 of 12
MATTERS ARISING FROM BOARD MEETINGS HELD IN PUBLIC
MATTERS ARISING FROM THE MEETING HELD ON 3 OCTOBER 2013
Minute Ref
Description of Action
Responsible
Person
TBP/09/13/6.10
TBP/09/13/7.6
Follow up the project to redesign the
family room at St Richard’s
SP
Deadline
Report
November
RAG
Status
A
WR
Include analysis on the crude nonelective mortality for renal failure in the
next quarterly report
December
To be included in December agenda plan
G
TBP09/13/8.2
Discuss with the team setting
measurable reduction within A&E of
complaints
CS
December
To be reported within the next quarterly
complaints report
G
TBP09/13/8.6
Review of outpatient/patient access
complaints to be undertaken at next
Patient Experience and Feedback
Committee
JF
December
On agenda for December meeting of Patient
Experience & Feedback Committee
G
TBP09/13/10.3
Report to Board quarterly on the work
related to the Mid Staffs enquiry
MG
January
Added to agenda forward look
G
Circulate Project Initiation Documents
to Board members
CS
October
Completed
G
TBP09/13/11.8
The Chairman asked for the Board’s
thanks to be passed to staff for their
dedication and commitment.
JF
October
Completed
G
TBP09/13/12.6
Include some granularity around
sickness levels by division and
DF
October
Will be included in next month’s report
A
Page 1 of 2
MATTERS ARISING FROM THE MEETING HELD ON 3 OCTOBER 2013
Minute Ref
Description of Action
Responsible
Person
department and whether short or longterm in the next report
TBP09/13/14.5
Key
R
A
G
An update on the numbers and cohorts DF
of groups trained to be included in the
Organisational Development &
Workforce report in future.
Deadline
Report
November
Will be included in next month’s report
RAG
Status
A
No action has been taken to address the action
The action is partially complete or has been added to the agenda plan for a future meeting
The action has been completed
Page 2 of 2
To:
Trust Board
Date: 31 October 2013
From: Marianne Griffiths, Chief Executive
Agenda Item: 5
FOR INFORMATION
CHIEF EXECUTIVE’S BOARD PAPER
1.0
External factors
CQC’s new surveillance model for NHS acute and specialist trusts
On 24 October the CQC published, for the first time, information which they hold on each of the
161 acute and specialist trusts and which they use as the basis of their new surveillance
model.
The new reports give an overall view of every trust and how they arrive at that view. This helps
them to decide when, where and what to inspect under CQC’s new model. The reports draw
together a range of information to give their inspectors a clear picture of the areas of care that
may need to be followed up.
The surveillance model is built on a large number of indicators which relate to the five key
questions they ask of all services – are they safe, effective, caring, responsive, and well led?
The indicators will be used to raise questions about the quality of care but will not be used on
their own to make final judgements.
Over the next few months the CQC will continue to develop the new surveillance model for
mental health, ambulance and community services.
Mothers to have their say on maternity services in new Friends and Family Test
NHS England has this month begun asking the Friends and Family Test (FFT) question in
every NHS maternity unit. The first results of FFT for maternity services will be announced
towards the end of January 2014 when three months’ worth of feedback has been gathered
and analysed. The test, where patients are asked if they would recommend the same service
to a friend or family member – is already an integral part of A&E and acute inpatient units,
providing patients with a platform to give their views and help shape better NHS services.
All women having babies at Worthing or St Richard’s, are now able to have their say in a new
initiative aimed at identifying what the trust is doing well and what aspects of maternity care it
should focus on improving.
A free text messaging service is being used to ask that question at four key points during the
time women spend in their midwives’ care: at around 36 weeks of pregnancy, after the birth of
their baby, after leaving hospital and after being discharged from community care. They are
asked to select one of six possible responses ranging from ‘extremely likely’ to ‘extremely
unlikely’, and have the opportunity to give a brief reason for their rating.
In maternity, the Delivery Suite at Worthing Hospital was given a £350,000 upgrade at the
beginning of 2013 in response to a survey of local mums, who prioritised the installation of a
second birthing pool and changes to the layout of the labour ward to give more privacy to
women and be more welcoming for their partners. This is a great example of the women who
use our service being able to shape the way it develops, and the Friends and Family Test is an
opportunity for even more of them to do that. We hope that mums will give us their mobile
number and let us know what they think when they receive the text.
Foundation Trust Network (FTN), Liverpool
I attended the FTN conference with our Chairman Mike Viggers and Cathy Stone, Director of
Nursing and Patient Safety.
We heard Helene Donnelly, the person who raised the alarm at Mid Staffordshire. Even though
the story of Mid Staffs is now so familiar to all of us, it is still shocking to hear from someone
who was working on the wards as the Trust disastrously lost its way, and who faced such
resistance when she tried to speak out on behalf of her patients and colleagues. Her account
of bullying, intimidation, and a failing culture was compelling, just as her obvious determination
to provide strong leadership to those around her was inspiring.
I have invited Helene to come to our Trust to talk to colleagues taking part in our new Clinical
and Nurse Leaders programme. Strong leaders – not necessarily those with the loudest voice,
but people who inspire, set an example, and enable others to shine – are an essential part of
keeping standards high, and ensuring that concerns are addressed, not ignored. We are
determined to invest in leadership, at all levels, and I am sure that Helene can offer valuable
support to our leaders of the future.
Also speaking at the conference was Dr Mark Britnall, the head of global health for KPMG. Dr
Britnall, a former NHS Trust chief executive, was one of several speakers talking about the
need for greater co-operation and integration within the NHS and warning of the limitations of
competition. I think that, locally, we have already achieved a great deal in terms of
strengthening the links between ourselves and the rest of the health and social care sector, but
I also believe that patients can benefit from still greater levels of co-operation.
Dr Britnall also kindly accepted my invitation to West Sussex, and will spend a morning with us
next month.
2.0
Flu campaign
Our annual flu immunisation campaign for staff began at the beginning of the month. Our
Occupational Health teams have more than 42 clinics or visits to departments in Worthing, 50
at St Richard’s and one at Southlands.
Page 2 of 4
3.0
Nurse recruitment
Next month we are hosting a recruitment open day on 8 November in the Chichester Medical
Education Centre at St Richard’s aimed at nurses who qualify in February and those with more
than a year’s experience. Candidates are invited to complete an online application form which
may result in an invitation to attend an interview on the day. Alternatively anyone interested in
finding out more can talk to a matron or ward manager on the day between 10am-3pm. Please
contact [email protected] for more information.
4.0
Appointment of Medical Director
I am delighted to announce that Dr George Findlay was appointed to the post of Medical
Director and will be joining us in January 2014.
Dr Findlay is an intensive care consultant, at one of the largest integrated NHS organisations in
Wales, Cardiff and Vale University Health Board, where he is Managing Director of the Women
and Children’s Board.
Dr Findlay is an experienced clinical leader at national as well as regional level, having been
Lead Clinical Coordinator of the National Confidential Enquiry into Patient Outcome and Death
(NCEPOD) for the last 10 years and Chair of the Welsh Transplantation Advisory Committee
since 2008.
Our Interim Medical Director, Professor William Roche, will continue in the role until the end of
December.
5.0
New appointments
We extend a warm welcome to the following Consultant colleagues who join us this month:
Dr Sarah Hall (GMC: 4611653) to post of Consultant Emergency Medicine, based at Worthing.
Dr Carl Moran (GMC: 6027380) Consultant in Gastroenterology based at St Richard’s.
Dr Susanne Bell (GMC: 4640536) Fixed term Consultant in Obstetrics and Gynaecology based
at Worthing for 6 months.
6.0
Employee of the Month
The winner for October is Emma Carter, Occupational Therapist (OT), Dementia at Worthing
Hospital. Emma was nominated by Jane Brothers, Occupational Therapy Professional Lead,
who explained how Emma has undergone specific training and subsequently supported four
OT staff and one member of the Physiotherapy team to successfully complete the University of
Stirling Dementia Service Development Centre – Best Practice in Dementia Care.
Jane said that Emma was repeating the Stirling course with a new group of five Physiotherapy
staff and in addition to that commitment, she was developing training for our Housekeeping
and Portering teams on top of her regular HCA training sessions. Jane added that Emma also
works with patients who have a dementia on a one-to-one basis to support their needs and has
regularly hosted the Carers’ Hub at Worthing and supported other staff with this patient group.
Page 3 of 4
7.0
Trust events
This month we were delighted to host the formal opening of the second Cardiac
Catheterisation Lab at Worthing. Among the people there were staff, patients, our Love Your
Hospital charity team, the Friends of Worthing Hospitals who gave £450,000 for equipment,
and some of the many individuals whose fundraising contributed towards the £800,000 cost of
the lab and adjacent recovery area.
It was especially nice that we were joined by Yvonne Helps, who had been treated in the new
lab literally just a few hours earlier. Yvonne, who popped home after her planned angiogram
before returning to the hospital, was full of praise for the skill and compassion shown by the
team caring for her. Her presence was a perfect reminder of why the fundraising efforts
towards the second cath lab matter so much. The second lab means more patients, receiving
more treatments from Trust staff, in a superb environment, and Yvonne was just the latest
person to benefit from that.
Earlier this month we held a Stakeholder Forum in Worthing which included a news update
from Cathy Stone, Director Nursing and Patient Safety, an update on dementia, a proposal to
harmonise the name for radiology/medical imaging services across the Trust and an update on
our call centre. The next meeting will take place on 20 January 2014, 2pm-4pm at St Richard’s
Hospital.
A service for staff was held in Worthing Chapel on 18 October, the feast of St Luke, to give
thanks for the gift of medicine and also to celebrate the Trust's achievement in gaining
Foundation Trust status. St Luke is an apostle and is remembered as the patron of physicians
and surgeons, artists and students.
A Medicine for Members meeting took place this week at St Richard’s on the topic of prostate
cancer. Mr James Hicks, Consultant Urological Surgeon, spoke about the symptoms,
treatment of the disease and how we care for patients and their relatives. It was a wellattended session and his presentation received outstanding feedback.
The next Medicine for Members meeting is on the topic of diabetes and will take place on
Tuesday 19 November, from 2pm-3.30pm in the Training room, Homefield, Worthing Hospital.
In order to reserve a place at a Medicine for Members presentation or to request information
about the Stakeholder Forum, please email [email protected] . The Medicine for
Members
meetings
are
videoed
and
are
available
to
be
viewed
on
www.westernsussexhospitals.nhs.uk
Page 4 of 4
To: Trust Board
Date of Meeting: 31 October 2013
Agenda Item: 6
Title
Month 6, 2013/14 Quality Report
Responsible Executive Director
Professor William Roche (Interim Medical Director) and Cathy Stone (Director of Nursing and Patient Safety)
Prepared by
Jamie Cochrane (Planning and Performance Manager), Mark Dennis (Head of Information Services), Sandie
Ellard (Deputy Director of Nursing).
Status
Disclosable
Summary of Proposal
Not applicable
Implications for Quality of Care
Describes performance against quality outcome KPIs, including safety, infection control, experience,
effectiveness and mortality.
Link to Strategic Objectives/Board Assurance Framework
The WSHT Quality Strategy 2011-2013 set out the strategic objectives for the Trust in relation to quality.
This report pulls together key national, regional and local quality indicators relating to quality and safety
providing assurance for the board and (if necessary) highlighting issues.
Financial Implications
Describes KPIs that have potential financial impact (e.g. CQUIN)
Human Resource Implications
Describes KPIs linked to workforce
Recommendation
The Board is asked to: Note the contents of this report.
Communication and Consultation
Not applicable
Appendices
Appendix I: Quality Scorecard
Appendix II: Infection Control Dashboard
Appendix III: Fracture Neck of Femur Dashboard
1
INTRODUCTION
1.1
This report brings together key national, regional and local quality indicators relating to quality and
safety. The purpose of the report is to bring to the attention of the Trust Board quality performance within
Western Sussex Hospitals Foundation Trust (WSHFT).
1.2
The paper describes performance on an exceptional basis determined by RAG (red/amber/green)
ratings based on national, regional or local targets. Further quality items are shown as dashboards in the
appendices.
2.
KEY QUALITY OBJECTIVES
2.1
Dashboard Definitions
2.1.1
The full Clinical Quality Dashboard is presented as Appendix II. This includes measures identified in the
Trust Quality Strategy. Figures are in month figures (e.g. the number of falls reported in September)
unless otherwise stated. The dashboard shows 13 months to allow trends to be identified, although
some data items are reported retrospectively. Year to date actuals/targets are based on financial years
unless otherwise stated (e.g. standardised mortality ratios are recorded as 12 month positions). A subset
of the key measures from the report is presented at 2.2.
2.1.2
Exception reports are included under the relevant section of this report (i.e. under the broad headings
Effectiveness, Safety and Experience).
2.1.3
Targets are based on national or regional benchmarks where available. In the absence of established
benchmarks, locally agreed targets or levels have been defined. Where there has been no specific
agreement on a target, an improvement on 2012/13 baseline has been used. The list of the targets and
whether benchmarks are national, regional or local is available on the Trust’s public website:
http://www.westernsussexhospitals.nhs.uk/about-us/trust-board/trust-board-meetings/boardpapers/quality-scorecard-targets/
2
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
2.2
Overview of Key Quality Objectives
2.2.1
The following table shows performance against key, top level quality objectives.
Indicator
Jul 2013
Aug 2013
Sep 2013
2013/14
2013/14
to date
Target /
limit
E01 Trust crude mortality rate (non-elective)
3.50%
E02 Hospital Standardised Mortality Ratio for top
2.66%
2.80%
98.3
3.13%
3.24%
-
<100
56 diagnoses (Dr Foster, based on rolling 12
months)
S01 Patient Aggregate Safety Score (PASS)
96.8
98.3
81.8
90.1
<100
3
4
4
14
26
97.0%
96.0%
96.5%
95.7%
95%
S14 Numbers of hospital attributable MRSA
1
1
0
2
0
S15 Numbers of hospital attributable C. diff
2
7
3
37
46
79
73
76
75
TbC
X02 The Friends and Family Test Score: A&E
77
74
74
73
TbC
X15 Mixed Sex Accommodation breaches (for
0
0
0
0
0
37
35
30
241
562
S05 Number of Serious Incidents Requiring
Investigation (number reported in month)
S09
VTE:
Compliance
with
the
DoH
risk
assessment tool
X01
The
Friends
and
Family
Test
Score:
Inpatients
clarity the number of breaches is reported here,
but in the scorecard, in line with the reporting of
this metrics in other Trust scorecards this is
expressed
as
a
proportion
of
Consultant
Episodes)
X20 Number of complaints
3
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
3.
EFFECTIVENESS
3.1
Crude Trust Mortality
3.1.1
Due to the low level of mortality experienced in elective care, the Trust measures mortality in relation to
non-elective activity. The Trust Quality Strategy set out an objective to reduce its mortality rate by 10%
(relative to the year 2010/11) by the end of 2012. The Trust achieved this objective and for 2012/13 nonelective mortality was 3.24% compared to 3.30% in 2012/13. An appropriate new trajectory will be
agreed shortly following the rebasing of Dr Foster’s model for risk adjusted mortality which has now
occurred, however pending this agreement the trust will seek to demonstrate an improvement against
the previous financial year (see the graph below). In addition to this the Trust will seek to reduce the 12
month rolling average (as shown as E02 on the scorecard).
3.1.2
Crude non-elective mortality rose from 2.66% in August to 2.80% in September, lower than that month in
2012. The 12 month rolling average remained at 3.35%, above the 2012/13 financial year level of
3.24%. The 2.8% mortality related to 132 deaths out of a total of 4715 non-elective admissions.
4.50%
4.00%
3.50%
12 month rolling average
3.00%
Limit (2012/13 actual)
2.50%
In-month mortality rate
4
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr-13
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr-12
2.00%
3.2
Hospital Standardised Mortality Ratio (HSMR)
3.2.1
As reported last month Dr Foster have now rebased their model for to take account of improving
mortality rates nationally. The rebased HSMR for WSHFT for the financial year 2012/13 is 100.5 (where
100 is the national average) and as such the Trust reported a level of mortality ‘as expected’ based on
the patient group seen.
3.2.2
There is a two month delay with Dr Foster data (to allow for coding and processing of data). As such
July 2013 is the most recent data available. WSHFT HSMR for the twelve months to July 2013 was 98.3
(within the expected range).
3.2.3
The twelve month HSMR to July 2013 split by site is higher for Worthing / Southlands Hospitals (98.6)
than St Richards (97.6), although both are below 100.
3.2.4
A further report is available to the Trust Quality Board showing the clinical diagnostic areas with high
actual versus expected mortality and any mortality CuSum alerts.
3.3
Summary Hospital-Level Mortality Indicator (SMHI)
3.3.1
The Summary Hospital Level Mortality Indicator for April 2012 to March 2013 was published on 24
October. The value for WSHFT was 1.02 (where 1.00 represents the national average), with the Trust
banded as ‘as expected’.
3.4
Exception Reports Relating to Effectiveness
3.4.1
Exception Report - Indicators E05 to E08 Mortality in Specific Conditions: These measures reflect the
pledge set out in the 2011/12 Trust Quality Account to reduce mortality in four key areas amenable to
mortality by 10% against 2011/12 levels. Performance against the agreed trajectories is shown below.
5
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
COPD mortality
Pneumonia mortality
12.0%
30.0%
Baseline
10.0%
Baseline
25.0%
8.0%
20.0%
6.0%
15.0%
Trajectory
Actual mortality
4.0%
Trajectory
10.0%
Actual mortality
5.0%
0.0%
0.0%
Ap
M
M
Ap
r-1
2
ay
-1
Ju 2
n12
Ju
l-1
Au 2
gSe 1 2
p1
O 2
ct
-1
N 2
ov
D 12
ec
-1
Ja 2
n1
Fe 3
b1
M 3
ar
-1
Ap 3
r-1
M 3
ay
-1
Ju 3
n13
Ju
l-1
Au 3
gSe 1 3
p1
O 3
ct
-1
N 3
ov
D 13
ec
-1
Ja 3
n1
Fe 4
b1
M 4
ar
-1
4
r-1
2
ay
-1
Ju 2
n12
Ju
l-1
Au 2
g1
Se 2
p1
O 2
ct
N 12
ov
-1
D 2
ec
-1
Ja 2
n1
Fe 3
b1
M 3
ar
-1
Ap 3
r-1
M 3
ay
-1
Ju 3
n13
Ju
l-1
Au 3
gSe 1 3
p1
O 3
ct
-1
N 3
ov
-1
D 3
ec
-1
Ja 3
n1
Fe 4
b1
M 4
ar
-1
4
2.0%
Acute renal failure mortality
Heart failure mortality
50.0%
30.0%
45.0%
Baseline
25.0%
40.0%
35.0%
Baseline
20.0%
30.0%
25.0%
15.0%
20.0%
Trajectory
15.0%
10.0%
Trajectory
Actual mortality
10.0%
Actual mortality
5.0%
5.0%
0.0%
3.4.2
Ap
M
M
Ap
r-1
2
ay
-1
Ju 2
n12
Ju
l-1
Au 2
gSe 1 2
p1
O 2
ct
-1
N 2
ov
D 12
ec
-1
Ja 2
n1
Fe 3
b1
M 3
ar
-1
Ap 3
r-1
M 3
ay
-1
Ju 3
n13
Ju
l-1
Au 3
gSe 1 3
p1
O 3
ct
-1
N 3
ov
D 13
ec
-1
Ja 3
n1
Fe 4
b1
M 4
ar
-1
4
r-1
2
ay
-1
Ju 2
n12
Ju
l-1
Au 2
g1
Se 2
p1
O 2
ct
N 12
ov
-1
D 2
ec
-1
Ja 2
n1
Fe 3
b1
M 3
ar
-1
Ap 3
r-1
M 3
ay
-1
Ju 3
n13
Ju
l-1
Au 3
gSe 1 3
p1
O 3
ct
-1
N 3
ov
-1
D 3
ec
-1
Ja 3
n1
Fe 4
b1
M 4
ar
-1
4
0.0%
In September, performance for three of the four areas (COPD, pneumonia and heart failure) were
beneath trajectory. Acute renal failure mortality was above trajectory, although the level remained below
that seen earlier in the year.
3.4.3
Exception Report – C-Section rate: The C-Section rate for September was 26.9% against an indicative
target of 24.7% (based on 2012/13). This breaks down to 11.8% of women electing to have C-sections
and 15.1% having unplanned C-sections. Root cause analysis is carried out following all C-sections to
ensure decisions were taken in the best interests of mother and infant.
3.4.4
Exception Report – E18 to E20: Dementia screening is a key CQUIN target for Western Sussex
Hospitals Foundation Trust in 2013/14. The Trust is required to screen all emergency patients aged 75
or over with the national screening question (‘have you been more forgetful in the last twelve months?’)
during the first 72 hours. Performance against this indicator (indicator E15) continues to increase month
by month.
6
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
4.
SAFETY
4.1
Patient Aggregate Safety Score (PASS): Background and Methodology
4.1.1
The PASS is an aggregate score comparing performance against a baseline for a total of 15 measures.
These vary in polarity (i.e. whether a high score indicates a safer environment or not). The methodology
was presented to the board in full with worked examples in August 2011:
Group
Measure
Polarity
Weighting
VTE
VTE Prophylaxis given (syringe packs prescribed)
Positive
0.50
Baseline
(2012/13)
1943
VTE risk assessments done
Positive
1.00
93%
MRSA
Negative
1.00
0.1
C. diff
Negative
1.00
6.0
SIRIs
SIRIs
Negative
2.00
2.2
Patient safety
Total incidents
Positive
1.00
674
incidents
Moderate, severe and death
Negative
1.00
7.1
Complaints
Complaints about nursing care
Negative
0.67
3.4
Complaints about communications
Negative
0.67
6.3
Complaints about staff attitude
Negative
0.67
4.7
Tissue viability
Total grade 2 or higher pressure ulcer incidents
Negative
1.50
10.3
Falls
Falls resulting in harm
Negative
1.50
40.1
Prescribing
Total incidents involving prescribing and drug
Positive
0.50
91.3
Negative
1.50
0.33
Positive
1.00
85.8%
HCIA
errors
Moderate, severe and death errors involving
prescribing / drug errors
Nutrition
4.1.1
Nutritional Assessments in 24 hours
The measures are unchanged for 2013/14, but all baselines have been updated to 2012/13 figures so
that the PASS score for 2013/14 is an indication of whether the Trust in the current month is more or
less safe (based on these measures) than 2012/13. All individual elements of the PASS score are also
reported in the Quality Scorecard.
4.1.2
Scores can range from 0 to 200, with a lower score indicating a safer Trust and 100 being the equivalent
of the Trust last year.
7
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
4.2
PASS Performance 2012/13 to Date
Apr
May
Jun
Jul
Aug
Sep
Year
to date
PASS
4.2.1
89.9
88.9
85.0
96.8
98.3
81.8
90.1
The PASS score for the year as a whole is calculated based on the averages of each of the individual
months (this is a change to how this has been calculated in previous years).
4.3
Central Alert System (CAS) Safety Alerts
4.3.1
There are no outstanding alerts for the Trust relating to September 2013 or earlier.
8
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
4.4
Infection control
4.4.1
During September the Trust reported zero cases of Methicillin-resistant Staphylococcus Aureus (MRSA)
bacteraemia.
4.4.2
The Trust reported 4 cases of Meticillin-sensitive Staphylococcus Aureus (MSSA) bacteraemia, 2 of
which were attributable to the Acute Trust. The Root Cause Analysis (RCA) highlighted that both
MSSAs were unavoidable.
4.4.3
During September the Trust reported 3 cases of clostridium difficile (C. diff). The RCA highlighted that 2
of the cases were unavoidable, whilst the third case was reported as avoidable. This was as a result of
a missed opportunity to test a sample prior to 72 hours.
15
Monthly C. diff
10
Trajectory (maximum)
5
4.4.4
Mar-14
Feb-14
At the end of quarter 2 the Trust reported 12 cases of C. diff. This is a significant decrease against the
25 cases reported for quarter 1.
4.4.5
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
May-13
Apr-13
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
0
The Trust Infection Control Doctor will be presenting to the Committee Trust Board.
9
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
4.5
Falls
4.5.1
Following the completion of the SHA Safer Smarter Nursing Programme, the Trust has continued to aim
to reduce the number of falls resulting in harm. The target for 2013/14 seeks a further improvement
against the 2012/13 level. As such the limits for 2013/14 are 481 or less falls resulting in harm and 2 falls
resulting in severe harm or death.

In September there were 40 falls resulting in harm against a monthly trajectory of 40.

There was one serious fall. This was reported as a Serious Incident Requiring Investigation
(SIRI) and is therefore the subject of a separate report to Board Committee.
60
50
Trajectory (maximum)
40
30
Monthly falls
20
10
4.5.2
Feb 14
Dec 13
Oct 13
Aug 13
Jun 13
Apr 13
Feb 13
Dec 12
Oct 12
Aug 12
Jun 12
Apr 12
0
The 40 falls equate to 1.61 falls resulting in harm per 1000 occupied bed days compared to the national
benchmark of 2.5 (Royal College of Physicians Report of the 2011 Inpatient Falls Pilot Audit).
4.5.3
As part of our CQUIN goal for 2013/14 the Trust is undertaking an analysis of all the patients who are
identified as fallers on the NHS Patient Safety Thermometer (see indicator S24). A trajectory for the
reduction in preventable falls has now been agreed with commissioners. The Trust achieved this
trajectory for September. Note: the agreed improvement period for this measure was from June 2013
10
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
onwards (April and May formed part of the baseline), and as such the year to date figure in the
scorecard reflects June onwards.
4.6
Tissue Viability
4.6.1
The number of pressure ulcers in the Trust has fallen over the last two years from 283 in 2010/11 to 226
in 2011/12 and further to 124 in 2012/13. The Trust has set a stretch target for 2013/14 of a further 5%
reduction against the 2013/14 value. This gives a limit for grade 2 pressure ulcers of 114 (see trajectory
below). The Trust will also try to maintain or reduce the number of grade 3 or 4 ulcers (i.e. a limit of 4).

In September the Trust reported 5 patients with grade 2 pressure damage (below the in-month
trajectory).

There were no hospital acquired grade 3 or 4 pressure ulcers. The Trust has been free of new
grade 3 or ulcers for 8 months.
4.6.2
The incidence of pressure ulcers (developing 72 hours after admission) per 1000 bed days in September
was 0.20.
4.6.3
95 patients were admitted from the community with pressure damage, of whom 70 (74%) patients were
admitted from their own home, 6 (6%) patients from residential care, 12 (13%) patients from nursing
homes and 7 (7%) patient from another hospital. This is reported back to the Clinical Commissioning
Group and Local Area Team.
11
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
4.6 NHS Patient Safety Thermometer
4.7.1
The NHS Patient Safety Thermometer is now used across all relevant wards. This tool looks at point
prevalence of four key harms (falls, pressure ulcers, urinary tract infections and deep vein thrombosis
(DVT) and pulmonary embolism (PE)) in all patients on a specific day in the month. A dashboard
showing Trust-wide and ward-level data for each individual harm as well as the harm-free care score is
available to each ward.
4.7.2
The harm-free care score for the Trust in September was 95.2% (indicator S02). This is better than the
national average for that month of 93.1%.
4.7.3
The Safety Thermometer includes harms suffered by the patient in health care settings prior to
admission. The actual number of patients with no new harms during their inpatient stay at WSHFT
(indicator S03) was 98.8%
4.8
Exception Reports Relating to Safety:
4.8.1
Exception Report: Indicator S05: Total moderate or above patient safety incidents: There were 10
incidents reported in September resulting in moderate or above harm. 3 of these were SIRIs (see
indicator S06 below). The remaining 7 were all moderates. The root cause analyses (RCAs) are
currently in progress and the results from which will be included in the Incident Report to the Quality and
Risk Committee, however no underlying themes or trends have been identified.
4.8.2
Exception Report: Indicator S06: Total Serious Incidents Requiring Investigation (SIRIS): There were 4
SIRIs reported in September. These are the subject of a separate report to the committee part of the
board.
12
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
5.
PATIENT EXPERIENCE
5.1
PALS and Complaints
5.1.1
All complaints are responded to by the Trust Office. The process is administered by the Customer
Relations Team. The Quarterly Complaints Report provides an in depth analysis of trends and lessons
learned. This is reviewed by the Patient Experience and Feedback Committee and is presented to the
Trust Board.
5.1.2
During September 2013 the Trust received 30 complaints. One complaint was graded as high, resulting
in further investigation.
5.1.3
Worthing
Southlands
Chichester
Total
All complaints
21
0
9
30
High grade complaints
1
0
0
1
The majority of complaints in September related to clinical treatment. These were not attributable to one
clinical site or area.
5.1.4
In September there were no complaints received where nursing care was the primary issue.
5.2
Friends and Family Test
5.2.1
Data collection for the Government’s Friends and Family test is currently underway in A&E and the
inpatient wards, with maternity due to commence in October.
5.2.2
National guidance details how this question will be scored nationally as follows: The proportion of
respondents who would be extremely likely to recommend (response category: ‘extremely likely’) MINUS
the proportion of respondents who would not recommend (response categories: ‘neither likely nor
unlikely’, ‘unlikely’ and ‘extremely unlikely’) (the response ‘likely’ is included in the percentage but does
not have a positive or negative impact). This results in scores with a possible range of -100 to 100.
5.2.3
Friends and family scores have been included in the scorecard from June 2013 onwards (scores for
April and May were felt to be based on too few responses to be accurate indicators, although they have
been included in the year to date figures).
13
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
5.2.4
Immediate feedback is provided to wards on a continuous basis to ensure staff can address problems or
get positive feedback as quickly as possible. In addition to this a dashboard has been launched giving
wards access to their individual scores.
5.2.5
National Friends and Family data is published on the NHS England website. August is the most recent
data available nationally. In August WSHFT ranked 17th nationally (of 144) for its A&E score of 74 and
87th (of 171) for its inpatient score of 73.
5.2.6
Although national data is not yet available, locally feedback remained positive for September. The Trust
achieved its largest response rate so far, achieving over 15% for both inpatients and A&E. The overall
score for the Trust was 74 based on 1579 responses. The inpatient score was 76 based on 547
responses and the A&E score was 74 based on 1032 responses.
5.2.7
The Friends and Family data collection for maternity services is due to be implemented in October 2013
this will include using text messaging to allow women to feedback on the quality of their care.
5.3
Feedback from Hospital Experience Questionnaires
5.3.1
Detailed results from the Real-Time Patient Experience (RTPE) project are routinely fed back to
divisions and wards and aggregate scores are included in the Quality Scorecard within the Experience
section (indicators X03 to X07). Targets for these measures for 2013/14 are based on an improvement
against 2012/13.
5.3.2
All five of these measures (indicators X03 to X07) were above target for September and for the year to
date position.
5.3.3
319 inpatients gave their views on the Trust using the RTPE system in September.
5.3.4
Real-time data collection is now underway in Maternity and Paediatrics.
5.4
Exception Reports Relating to Experience
5.4.1
Exception Report: Indicator X11 PALS contacts in relation to appointment problems: The number of
PALS contacts in September relating to problems with outpatient appointments remained higher than
14
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
our target. As previously identified to the Board, more than a third of the contacts related to the specialty
Ophthalmology, reflecting capacity pressure in the specialty is resulting in patients being booked on
clinics that are subsequently cancelled. To resolve, a new call-centre system to support partial booking
from Quarter 4 is currently being implemented, which will in practically eliminate the cancellation of
booked clinics. In addition, support is being offered to the Specialty in the interim to facilitate speedy
rebooking of cancelled Ophthalmology appointments and therefore improve the experience of these
patients. The composite these actions introduced to date are forecast to reduce the cumulative
compliance score for Q3 to 0.11% or less, as per the Trust corporate objectives, the commitment in the
2013/14 CQUINs
5.4.2
Exception Report: Indicator X22 and X23: Feedback from care and compassion reviews: The annual
peer review visit has now taken place. The Trust is awaiting formal feedback and these figures will be
reported to the Board when available. Verbal feedback was highly positive: the Trust demonstrated
100% commitment to care and compassion from the ward to the Board.
6
CARE QUALITY COMMISSION (CQC)
6.1
CQC Compliance:
Nothing to report
6.2
CQC Intelligent Monitoring Reports
6.2.1
The CQC have developed Intelligent Monitoring Reports for all NHS Acute Trusts. The report contains
analysis of key indicators called “Tier One” indicators. Tier one indicators are those that the CQC
consider to be the most important for monitoring risks to the quality of care in acute hospital services.
They have been selected because they measure things that have a high impact on people and because
they can alert the CQC to changes in those areas. Tier one indicators are generated using data and
evidence such as mortality rates, ‘never events’, information from whistleblowers and comments from
members of the public. A detailed description of the indicators and methodology has been published in
the CQC document “NHS Acute Hospitals – Indicators and Methodology.
6.2.2
The CQC will use these indicators to raise questions about the quality of care, but will not use them on
their own to make final judgments. Judgments on Trusts will only be made based on a combination of
what is found during inspection, intelligent monitoring and local information from the Trust and other
organisations.
15
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
6.2.3
The Intelligent Monitoring Report categorises Trust’s into bands. Band 1 represents the highest risk and
Band 6 the lowest risk. The bands are assigned based on the proportion of indicators that have been
identified as risk or elevated risk.
6.2.4
All NHS Acute Trusts have had Intelligent Monitoring reports published and available to the public from
24th October 2013. The CQC will be publishing these reports on a quarterly basis.
6.2.5
The CQC have banded Western Sussex NHS Foundation Trust as Band 6 – within the lowest risk band.
The full report is available on the CQC website:
http://www.cqc.org.uk/sites/default/files/media/reports/RYR_101_WV.pdf
7
7.1
NATIONAL AND LOCAL REPORTS
Nothing to report
8
8.1.1
COMMISSIONING FOR QUALITY AND INNOVATION (CQUIN)
Since 2009/10 a proportion of the money the Trust receives has been payable on achievement of
agreed quality metrics. A detailed agreement has been reached with commissioners for 2013/14.
8.1.2
In addition to the national CQUINS (Friends and Family, VTE, NHS Safety Thermometer and Dementia)
and the regional Enhancing Quality Programme, goals have been agreed in relation to the redesign of
the musculoskeletal service, the One Call One Team, anti-biotic prescribing, outpatient experience and
assistance with feeding.
8.1.3
A separate section has been added to the scorecard, pulling together CQUIN indicators. Currently this
only includes the national CQUIN goals.
9.0
RECOMMENDATION
9.1 The Board is asked to note the contents of this report.
16
Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
QUALITY SCORECARD
SEPTEMBER 2013
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SEP
YTD Actual
YTD Target
Target
E01 Trust crude mortality rate (non‐elective)
2.88%
3.01%
3.01%
3.49%
4.13%
3.69%
4.10%
3.76%
3.18%
2.83%
3.51%
2.66%
2.80%
3.13%
2.96%
3.24%
E02 Crude mortality rate (non‐elective): 12 month rolling
3.22%
3.19%
3.21%
3.21%
3.20%
3.18%
3.24%
3.26%
3.28%
3.29%
3.37%
3.35%
3.35%
3.35%
3.24%
3.24%
E03 Trust Hospital Standardised Mortality Ratio (HSMR)
104.1
102.9
103.4
102.9
101.4
99.4
100.5
99.2
99.0
97.9
98.3
#N/A
#N/A
98.3
100
100
E04 Summary Hospital‐level Mortality Indicator (SHMI) (rolling 12M)
1.06
1.02
1.00
1.00
Trend
EFFECTIVENESS
1.05
1.02
#N/A
#N/A
Improve mortality in specific conditions
E05 Crude non‐elective mortality for Pneumonia
21.3%
18.8%
14.6%
24.3%
18.4%
15.9%
18.1%
15.8%
13.8%
15.3%
17.1%
17.9%
18.6%
16.3%
18.7%
18.0%
E06 Crude non‐elective mortality for COPD
6.4%
4.5%
5.7%
9.1%
8.7%
8.7%
6.3%
6.7%
3.4%
6.2%
11.3%
4.8%
4.4%
6.1%
6.0%
6.7%
E07 Crude non‐elective mortality for Renal failure
15.4%
20.0%
40.6%
29.2%
40.6%
24.2%
40.0%
45.9%
20.0%
30.0%
14.8%
0.0%
17.4%
25.0%
17.7%
20.4%
E08 Crude non‐elective mortality for Chronic heart failure
17.0%
14.8%
13.5%
16.3%
18.9%
11.1%
22.8%
26.5%
16.7%
12.2%
19.1%
19.6%
14.0%
18.6%
18.1%
18.7%
128.6
120.8
119.8
124.4
123.9
129.0
125.2
127.3
125.4
121.5
119.1
#N/A
#N/A
119.1
100
100
Reduce mortality following hip fracture
E09 SMR for hip fracture (all diagnoses/procedures)
E09a Worthing SMR for hip fracture (all diagnoses/procedures)
‐
‐
‐
‐
111.8
119.3
113.6
111.0
114.6
113.7
113.1
#N/A
#N/A
113.1
100
100
E09b St Richard's SMR for hip fracture (all diagnoses/procedures)
‐
‐
‐
‐
143.4
144.4
143.2
152.1
141.4
132.9
128.1
#N/A
#N/A
128.1
100
100
15.4%
6.9%
11.1%
13.5%
12.5%
14.9%
5.5%
15.5%
8.0%
3.3%
6.9%
#N/A
#N/A
8.4%
8.3%
8.3%
12.8%
12.0%
13.5%
11.2%
12.3%
12.6%
11.9%
11.7%
11.3%
12.4%
12.4%
12.5%
11.6%
12.1%
12.2%
12.2%
574
675
646
715
669
668
686
677
655
652
601
581
#N/A
3,166
3309
7,942
E13 C‐Section Rate
24.7%
24.0%
25.6%
24.4%
23.0%
26.3%
26.9%
27.9%
23.8%
23.9%
28.6%
23.5%
26.9%
25.8%
24.7%
24.7%
E14 % Mothers requiring forceps for delivery
12.2%
9.0%
11.8%
11.4%
9.0%
11.7%
9.7%
10.5%
10.5%
12.5%
10.8%
13.0%
11.2%
11.4%
<15%
<15%
E15 % Deliveries complicated by post‐partum haemorrhage
E10 30 day mortaliy rate following hip fracture
Reduce the rate of readmission following discharge from the Trust
E11 Emergency readmissions within 30 days %
E12 Emergency admissions not usually requiring admission
To improve maternity care by encouraging natural chilbirth
0.62%
0.80%
1.10%
0.21%
0.90%
1.10%
1.00%
0.70%
0.90%
0.90%
0.00%
0.20%
0.70%
0.60%
1%
1%
E16 Maternal deaths
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
E17 Admission of term babies to neonatal care
‐
‐
‐
‐
‐
‐
‐
2.50%
2.20%
3.30%
3.70%
4.20%
2.40%
3.10%
<10%
<10%
E18 % Emergency admissions staying over 72h screened for dementia
‐
‐
‐
‐
‐
‐
‐
10.2%
20.4%
31.0%
37.9%
54.8%
68.7%
37.2%
90%
90%
% Patients identified as at risk of dementia for whom further E19
investigations are carried out
‐
‐
‐
‐
‐
‐
‐
61.5%
80.9%
72.7%
77.5%
77.9%
74.6%
74.2%
90%
90%
E20 % Patients with identified dementia referred to specialist services
‐
‐
‐
‐
‐
‐
‐
75.0%
95.5%
93.1%
93.8%
91.5%
95.2%
90.7%
90%
90%
E21 Patients recruited to interventional studies within CRN portfolio 54
72
46
21
24
33
45
49
24
27
22
31
30
183
n/a
n/a
E22 Patients recruited to observational studies within CRN portfolio 40
47
34
29
26
25
41
30
35
8
13
12
13
111
n/a
n/a
E23 CLRN Score
310
410
264
134
146
190
266
275
155
143
123
167
163
1026
653
1305
94.9
95.8
95.8
96.6
96.8
#N/A
96.8
96
96
Caring for the elderly patient
Ensure active engagement with research
Data Quality
E24 NHS IC Data validity summary (YTD)
6b Quality scorecard M06_v3.Quality scorecard
Page 1 of 4
Printed 24/10/2013 16:35
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
QUALITY SCORECARD
SEPTEMBER 2013
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SEP
YTD Actual
YTD Target
Target
89.9
88.9
85.0
96.8
98.3
81.8
90.1
<100
<100
Trend
SAFETY
S01 Patient Aggregate Safety Score (PASS)
General Safety
S02 Safety Thermometer: % of patients harm‐free
94.8%
95.9%
94.4%
94.0%
93.2%
93.4%
92.0%
93.0%
92.5%
93.9%
93.0%
95.4%
95.2%
93.8%
S03 Safety Thermometer: % of patients with no new harms
97.0%
98.3%
98.2%
97.9%
97.7%
96.9%
97.8%
97.1%
98.1%
98.4%
97.3%
98.3%
98.8%
98.0%
640
694
737
657
693
714
765
711
722
773
744
680
692
4322
3034‐5057
6068 ‐ 10,114
S05 Total moderate, severe or death incidents
4
10
9
5
9
3
8
6
8
9
12
6
10
51
43
85
S06 Total serious incidents (SIRI)
1
3
3
1
2
2
3
2
1
0
3
4
4
14
13
26
S07 Number of outstanding CAS alerts
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
S08 Total incidents involving drug/prescribing errors
95
109
85
64
72
95
92
79
80
87
78
79
78
481
413‐688
826 ‐1376
S09 Moderate/severe incidents involving drug/prescribing errors
0
0
0
1
1
0
0
0
2
1
0
0
0
3
2
4
47%
48%
76%
80%
80%
S11 95% compliance with the DoH risk assessment tool
93.1%
93.5%
94.7%
93.4%
95.0%
95.0%
94.0%
94.4%
95.2%
95.6%
97.0%
96.0%
96.5%
95.7%
95%
95%
S12 Prescriptions for VTE prophylaxis
1773
1946
2049
1980
1999
2007
2069
1998
2184
1778
1913
2113
2160
12146
11660
23320
31
24
30
29
25
23
23
33
34
24
31
28
29
179
167
334
S04 Total incidents
Improve safety of prescribing
S10 Reduced errors on zero tolerance anti‐microbial prescribing audits
67%
63%
76%
61%
Reduce incidence of healthcare associated VTE
S13 Incidence of VTE
Reduce incidence of healthcare acquired infections
S14 Number of hospital attributable MRSA cases
0
0
0
0
0
1
0
0
0
0
1
1
0
2
0
0
S15 Number of hospital attributable C.diff cases
3
10
7
4
5
4
9
13
5
7
2
7
3
37
22
46
S16 Number of reportable MSSA bacteraemia cases
4
4
6
6
6
1
10
6
4
6
7
7
4
34
tbc
tbc
S17 Number of reportable E.coli cases
22
34
23
22
14
12
21
25
30
23
25
30
17
150
tbc
tbc
100%
100%
100%
100%
100%
100%
100%
100%
100%
Improve theatre safety for patients
S18 Full compliance with WHO Surgical Safety Checklist
100%
100%
100%
S19 NEVER events
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
0
S20 Theatre related SIRIs
0
0
0
0
0
0
0
0
0
0
1
0
1
2
0
0
S21 Falls resulting in harm
32
34
41
37
53
36
45
46
29
36
37
26
40
214
241
481
S22 Falls resulting in severe harm or death
0
0
1
0
0
0
1
2
0
0
0
2
1
5
1
2
91.0%
88.5%
92.5%
91.5%
93.5%
90.0%
91.5%
92.0%
93.5%
94.5%
93.7%
95.5%
90.0%
93.2%
80%
80%
2.27%
1.49%
1.70%
1.46%
1.42%
0.89%
0.85%
0.64%
0.48%
0.72%
1.41%
1.41%
Reduce number of falls in hospital
S23 Falls assessment within 24hrs of admission
S24 Avoidable falls identified on the Safety Thermometer
Pressure damage
S25 Grade 2 pressure sores
8
12
9
15
11
6
13
12
9
7
9
9
5
51
56
114
S26 Grade 3 & 4 pressure sores
1
1
0
0
1
0
0
0
0
0
0
0
0
0
2
4
6b Quality scorecard M06_v3.Quality scorecard
Page 2 of 4
Printed 24/10/2013 16:35
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
QUALITY SCORECARD
SEPTEMBER 2013
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SEP
YTD Actual
YTD Target
X01 Trust Friends and Family Score: Inpatient (reported from Q2)
‐
‐
‐
‐
‐
‐
‐
‐
‐
75
79
73
74
78
Base‐line Base‐line
X02 Trust Friends and Family Score: A&E (reported from Q2)
‐
‐
‐
‐
‐
‐
‐
‐
‐
79
77
74
74
73
Base‐line Base‐line
Target
Trend
EXPERIENCE
Friends and family test
Use of feedback from the real time patient experience project
X03 Realtime feedback on the hospital environment
77
76
74
76
75
73
76
75
77
76
76
76
77
76.167
75
75
X04 Realtime feedback on assistance
88
87
86
89
88
86
88
91
90
90
90
92
91
91
87
87
X05 Realtime feedback on compassion
89
88
87
88
87
87
88
89
90
90
89
89
90
90
88
88
X06 Realtime feedback on communication
78
77
75
77
76
79
79
75
79
79
79
76
79
78
77
77
X07 Overall experience of the Trust
93
92
90
91
91
91
92
91
93
93
93
92
93
93
92
92
9.2%
10.1%
10.1%
11.0%
10.9%
10.8%
10.0%
9.9%
8.8%
9.8%
9.0%
8.2%
7.8%
9.0%
9.8%
9.8%
33
18
29
15
47
17
18
19
26
41
16
25
20
147
188
376
Reduction in patients suffering a bad experience dealing with the Trust
X08 Percentage of re‐booked outpatient appointments
X09 Clinics cancelled with less than 6 weeks notice
X10 Average number of ward stays per non‐elective admission
1.71
1.76
1.75
1.73
1.77
1.82
1.73
1.78
1.78
1.82
1.80
1.75
1.74
1.78
1.75%
1.75%
0.11%
0.11%
0.14%
0.11%
0.10%
0.11%
0.11%
0.12%
0.14%
0.16%
0.16%
0.21%
0.19%
0.16%
0.10%
0.10%
28
42
27
11
46
26
45
31
17
21
16
26
16
127
228
455
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0
0 X14 Compliance with MUST tool after 24 hours
89.0%
84.0%
91.0%
86.0%
86.5%
87.5%
83.0%
84.0%
85.9%
86.7%
86.7%
89.5%
88.4%
86.9%
80%
80%
X15 Compliance with MUST tool after 7 days
97.0%
95.5%
98.0%
95.0%
95.5%
92.0%
93.5%
97.5%
98.0%
98.4%
97.5%
96.5%
98.6%
97.8%
95%
95%
X16 Internal PLACE compliance : St Richard's Hospital
94%
96%
95%
97%
96%
97%
96%
97%
94%
95%
96%
98%
99%
97%
85%
85%
X17 Internal PLACE compliance : Worthing Hospital
91%
95%
96%
96%
93%
96%
95%
95%
92%
97%
96%
92%
91%
94%
85%
85%
X18 Number of complaints
55
39
54
39
46
36
40
39
46
54
37
35
30
241
281
562
X19 Complaints where staff attitude or behaviour is an issue
8
4
4
4
4
5
7
6
6
4
2
2
5
25
28
56
X20 Complaints where staff communication is an issue
7
9
12
2
3
4
5
3
5
2
4
4
2
20
38
75
X21 Complaints about nursing
2
0
3
1
3
3
6
3
1
4
3
3
0
14
21
41
X11 PALS contacts relating to appointment problems (% of total appts)
X12 Reduce patients cancelled on the day of surgery for non‐clinical reasons
X13 Breaches of mixed sex accommodation arrangements
Nutritional Assessment
Cleanliness / PEAT Survey
Improve our customer service and become a more caring organisation
X22 Positive care and compassion observations in general care
87%
88%
80%
80%
n/a
n/a
X23 Positive care and compassion observations in patient / visitor interactions
72%
92%
79%
79%
n/a
n/a
6b Quality scorecard M06_v3.Quality scorecard
Page 3 of 4
Printed 24/10/2013 16:35
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
QUALITY SCORECARD
SEPTEMBER 2013
Apr
May
Jun
Jul
Aug
SEP
YTD Actual
YTD Target
Target
E18 % Emergency admissions staying over 72h screened for dementia
10.2%
20.4%
31.0%
37.9%
54.8%
68.7%
37.2%
90%
90%
% Patients identified as at risk of dementia for whom further E19
investigations are carried out
61.5%
80.9%
72.7%
77.5%
77.9%
74.6%
74.2%
90%
90%
E20 % Patients with identified dementia referred to specialist services
75.0%
95.5%
93.1%
93.8%
91.5%
95.2%
90.7%
90%
90%
94.4%
95.2%
95.6%
97.0%
96.0%
96.5%
95.7%
95%
95%
From Q2
From Q2
From Q2
From Q2
From Q2
From Q2
From Q2
From Q2
From Q2
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Trend
CQUIN SCHEMES
National CQUINS
S11 95% compliance with the DoH risk assessment tool
93.1%
93.5%
94.7%
93.4%
95.0%
95.0%
94.0%
S27 Root cause analyses carried out for VTE (from Q2)
S24 Avoidable falls identified on the Safety Thermometer
1.49%
1.70%
1.46%
1.42%
0.89%
0.85%
0.64%
0.48%
0.72%
1.41%
1.41%
X24 Trust Friends and Family Response Rate: Inpatient
7.8%
6.6%
12.3%
13.6%
16.1%
26.0%
17.8%
16.5%
17.1%
15%
20%
X25 Trust Friends and Family Response Rate: A&E
0.9%
0.7%
1.4%
1.9%
6.8%
12.0%
9.8%
15.3%
7.9%
15%
20%
6b Quality scorecard M06_v3.Quality scorecard
2.27%
Page 4 of 4
Printed 24/10/2013 16:35
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
INFECTION CONTROL SCORECARD
SEPTEMBER 2013
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
YTD Actual YTD Target
Target
Trend
Compliance with high impact intervention care bundles (HII)
Renal
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
95%
95%
Central line
100%
100%
100%
100%
100%
100%
100%
100%
96%
100%
100%
99%
100%
99%
95%
95%
Ventilation
97%
99%
100%
96%
97%
100%
100%
100%
100%
99%
83%
100%
100%
97%
95%
95%
Hand hygiene
97%
97%
97%
97%
98%
96%
97%
97%
98%
99%
98%
99%
98%
98%
95%
95%
Peripheral IV Line
97%
98%
99%
98%
98%
98%
97%
99%
96%
97%
97%
97%
97%
97%
95%
95%
Catheter care
99%
99%
100%
99%
100%
99%
100%
100%
100%
100%
100%
100%
100%
100%
95%
95%
Compliance with elective MRSA screening
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Compliance with non‐elective MRSA screening
98%
98%
98%
98%
97%
98%
98%
98%
98%
99%
98%
98%
98%
98%
100%
100%
Screening
Hospital cleanliness
Very high risk
99%
99%
99%
99%
98%
99%
99%
99%
99%
99%
99%
99%
99%
99%
98%
98%
High risk
98%
98%
98%
98%
98%
98%
97%
97%
97%
98%
98%
98%
98%
98%
95%
95%
Significant risk
96%
95%
97%
97%
97%
97%
97%
96%
96%
97%
96%
96%
95%
96%
85%
85%
Low risk
100%
91%
92%
92%
90%
92%
91%
93%
97%
94%
94%
97%
94%
95%
75%
75%
99%
99%
99%
97%
100%
100%
98%
98%
98%
99%
100%
97%
99%
99%
Decontamination of equipment
Decontamination of equipment
6c Infection Control Scorecard M06.Infection Control
Page 1 of 1
Printed 24/10/2013 16:35
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
FRACTURED NECK OF FEMUR DASHBOARD
Site: St Richard's Hospital
Data for period: August 2013
version 1.5
% Patients operated on within 36 hours of A&E attendance (source: NHFDb)
% op < 36 hrs ‐ All patients
Mortality in hospital and within 30 days of admission (source: NHFDb/Sema Helix)
% op < 36 hrs ‐ Medically fit
% Deaths within 30 days of admission
% Deaths in hospital
95% CI (Overall Nat. 30 day mortality)
30%
100%
90%
25%
80%
70%
20%
60%
15%
50%
40%
10%
30%
20%
5%
10%
% Patients who saw Consultant Physician Pre‐op (source: NHFDb)
Apr 10
May 10
Jun 10
Jul 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
0%
Apr 10
May 10
Jun 10
Jul 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
0%
% Patients mobilised within 24 hours post‐op
Total LOS and LOS on post‐op ward (source: NHFDb)
Average LOS
6d #NOFDashboard_1308_Aug_v1.St Richard's Hospital
Average post‐op LOS
40
35
20
Page 1 of 3
Jun 13
Printed 24/10/2013 16:35
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Jun 10
Aug 10
0
Apr 10
Jun 13
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Jun 10
Aug 10
15
Apr 10
Jun 13
Aug 13
Apr 13
0%
Feb 13
5
0%
Oct 12
10
10%
Dec 12
20%
10%
Jun 12
20%
Aug 12
30%
Apr 12
30%
Feb 12
40%
Oct 11
40%
Dec 11
50%
Jun 11
25
50%
Aug 11
30
60%
Apr 11
70%
60%
Feb 11
70%
Oct 10
80%
Dec 10
90%
80%
Aug 10
90%
Jun 10
100%
Apr 10
100%
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
FRACTURED NECK OF FEMUR DASHBOARD
Site: Worthing Hospital
Data for period: August 2013
version 1.5
% Patients operated on within 36 hours of A&E attendance (source: NHFDb)
% op < 36 hrs ‐ All patients
Mortality in hospital and within 30 days of admission (source: NHFDb/Sema Helix)
% op < 36 hrs ‐ Medically fit
% Deaths within 30 days of admission
100%
40%
90%
35%
80%
% Deaths in hospital
95% CI (Overall Nat. 30 day mortality)
30%
70%
60%
25%
50%
20%
40%
15%
30%
10%
20%
0%
% Patients who saw Consultant Physician Pre‐op (source: NHFDb)
Apr 10
May 10
Jun 10
Jul 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
5%
0%
Apr 10
May 10
Jun 10
Jul 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
10%
% Patients mobilised within 24 hours post‐op
Total LOS and LOS on post‐op ward (source: NHFDb)
Average LOS
6d #NOFDashboard_1308_Aug_v1.Worthing Hospital
Average post‐op LOS
40
35
20
Page 2 of 3
Jun 13
Printed 24/10/2013 16:35
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Jun 10
Aug 10
0
Apr 10
Jun 13
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Jun 10
Aug 10
15
Apr 10
Jun 13
Aug 13
Apr 13
0%
Feb 13
5
0%
Oct 12
10
10%
Dec 12
20%
10%
Jun 12
20%
Aug 12
30%
Apr 12
30%
Feb 12
40%
Oct 11
40%
Dec 11
50%
Jun 11
25
50%
Aug 11
30
60%
Apr 11
70%
60%
Feb 11
70%
Oct 10
80%
Dec 10
90%
80%
Aug 10
90%
Jun 10
100%
Apr 10
100%
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
FRACTURED NECK OF FEMUR DASHBOARD
Site: Western Sussex Hospitals
Data for period: August 2013
version 1.5
% Patients operated on within 36 hours of A&E attendance (source: NHFDb)
% op < 36 hrs ‐ All patients
Mortality in hospital and within 30 days of admission (source: NHFDb/Sema Helix)
% op < 36 hrs ‐ Medically fit
% Deaths within 30 days of admission
% Deaths in hospital
95% CI (Overall Nat. 30 day mortality)
35%
100%
90%
30%
80%
70%
25%
60%
20%
50%
40%
15%
30%
10%
20%
5%
10%
% Patients who saw Consultant Physician Pre‐op (source: NHFDb)
Apr 10
May 10
Jun 10
Jul 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
0%
Apr 10
May 10
Jun 10
Jul 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
0%
% Patients mobilised within 24 hours post‐op
Total LOS and LOS on post‐op ward (source: NHFDb)
Data between June and December 2012 relates to SRH only. Data collection recommenced at Worthing in December 2012 and is reflected in reported performance from January 2013
Average LOS
100%
100%
90%
90%
80%
80%
70%
70%
25
60%
20
60%
50%
Average post‐op LOS
35
30
50%
40%
30%
20%
40%
15
30%
10
20%
5
10%
6d #NOFDashboard_1308_Aug_v1.Western Sussex Hospitals
Page 3 of 3
Jun 13
Printed 24/10/2013 16:35
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Jun 10
Aug 10
Jun 13
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Jun 10
0
Aug 10
0%
Apr 10
Jun 13
Aug 13
Apr 13
Feb 13
Oct 12
Dec 12
Jun 12
Aug 12
Apr 12
Feb 12
Oct 11
Dec 11
Jun 11
Aug 11
Apr 11
Feb 11
Oct 10
Dec 10
Aug 10
Jun 10
Apr 10
0%
Apr 10
10%
To: Trust Board
Date of Meeting: 31st October 2013
Agenda Item: 8
Title
Month 6, 2013/14 Performance Report
Responsible Executive Director
Jane Farrell, Chief Operating Officer/Deputy Chief Executive
Prepared by
Adam Creeggan, Director of Performance
Giles Frost, Head of Operational Planning and Performance
Status
Public Domain
Summary of Proposal
The purpose of this paper is to inform the Trust Board of organisational compliance against national and local key
performance metrics. The report summarises both in year and projected year end performance for Western Sussex
Hospitals NHS Foundation Trust, as detailed in dedicated performance scorecards relating to Quality Board indicators
aligned to the Quality Strategy, the Monitor Compliance Framework, and when relevant, other efficiency indicators. This
paper describes performance on an exceptional basis determined by RAG rating, national significance, or in year trend
analysis.
Implications for Quality of Care
Describes Quality Outcome KPIs
Link to Strategic Objectives/Board Assurance Framework
Trust Strategic Theme B - Provide the highest possible quality of care to our patients. This we will do through focusing
on a range of measures to improve clinical effectiveness.
Trust Strategic Theme G - Ensure the sustainability of our organisation by exceeding our national targets and financial
performance and investing in appropriate infrastructure and capacity
Trust Strategic Theme F - Improve our performance against a range of quality, access and productivity measures
through the introduction and spread of best practice throughout the organisation.
Financial Implications
Describes KPIs linked to financial performance
Human Resource Implications
Describes KPIs linked to workforce
Recommendation
The Board is asked to: NOTE
Communication and Consultation
Not applicable
Appendices
Appendix 1: Key Performance Deliverables, Operational Performance Scorecard, Monitor Compliance Framework
Scorecard.
1
Western Sussex Hospitals Trust – Performance Report for Trust Board
To:
From:
Date: 31st October 2013
Trust Board
Jane Farrell, Chief Operating Officer, Deputy Chief
Executive
Agenda Item: 8
FOR INFORMATION
WSHT PERFORMANCE REPORT: MONTH 6, 2013/14
1.
INTRODUCTION
1.1
This report summarises both in year and projected year end performance for Western Sussex
Hospitals NHS Foundation Trust, detailed in dedicated performance scorecards relating to:

The Monitor Compliance Framework (effective until 30 September 2013) under
which the Trust is performance managed following authorisation as a Foundation
Trust effective July 1st 2013.

1.2
Other efficiency indicators, where relevant.
This paper describes performance on an exceptional basis determined by RAG rating, national
significance, or in year trend analysis.
1.3
In addition to the performance exception narrative, each exception is examined in detail in the
Key Performance Deliverables section of this report. Each metric under review examines
detailed trending, prevailing cause and effect, and summarises recovery programme actions.
2.
SUMMARY PERFORMANCE
2.1
The Trust generated a notional Monitor Compliance Framework score of 1 point cumulatively to
September, relating to C.difficile variance to trajectory. The Trust had 3 cases against the inmonth trajectory for September, the cumulative volume of breaches at that point (37 cases) is
greater than the aggregate in year target for the end of Quarter 2 (23 cases), therefore a
Quarter 2 score of 1 is triggered.
2.2
There were no MRSA cases in September.
2
Western Sussex Hospitals Trust – Performance Report for Trust Board
2.3
Key indicators of operational pressure during September include:

11,056 A&E attendances compared to 11,214 in September 2012 (-1.4%).

When scrutinised by age group: there was a 0.3% increase in 65-84 years and a
3.5% decrease in >=85 years September 2013 compared to September 2012

3798 emergency admissions compared to 4015 in September 2012 (-5.4%)

When scrutinised by age group: there was a 0.2% increase in 65-84 years and a 7%
decrease in >=85 years September 2013 compared to September 2012

Delayed transfers of care were 2.8% for September.
3.
PERFORMANCE EXCEPTIONS
3.1
A&E
3.1.1
Compliance in September was 95.54% of patients waiting less than four hours from arrival at
A&E to admission, transfer, or discharge.
3.1.2
For context and comparison, weekly national data for the period 2nd to 29th September relating
to Type 1 (Major A&E) departments, shows compliance of 93.63%, therefore WSHT operated
1.9% ahead of the national average during the month. Compliance for Surrey and Sussex Area
providers (excluding WSHT) for the same period showed 94.38% for Type 1 A&E attendances,
with WSHT being third best performer within the sector.
3.1.3
While total admissions have been reduced in 2013, the percentage of admissions relating to the
frail elderly proxy of >85 years have increased from 17.0% of admissions April-September 2012,
to 18.4% April – September 2013.
There has been a corresponding step change for the
proportion of over 85 admissions with a length of stay greater than 1 day from 24.6% of
admissions greater than 1 day April – August 2012, to 5.9%. Therefore, while there has been an
overall reduction of emergency admissions, the extension in length of waiting indicated
proportionately richer casemix complexity. This has generated an inability to reduce capacity in
line with CCG system QIPP planning assumptions, and moreover, recourse to additional
unfunded capacity to meet demand.
3.2
Cancer
3.2.1
The Trust achieved compliance across five of the seven relevant cancer metrics in September
2013. The Monitor Compliance Framework assesses compliance on an aggregated basis for
each financial quarter, and the Trust achieved full compliant for Quarter 2.
3.2.2
Provisional performance for September shows compliance of 84.1% against a target of 85% for
patient waiting for treatment in 62 day following referral under the 2 week rule, due to the
3
Western Sussex Hospitals Trust – Performance Report for Trust Board
continued demand pressure noted in the July board paper.
Referrals per week over the
preceding two years have increased by c30% during the period, with a significant element of this
growth occurring in 2013/14 year to date. This referral pathway is only available to GPs, and
within national guidance the receiving provider organisation cannot refuse or downgrade any
referral received. The Trust was fully compliant for this metric in Quarter 2 at 85.7%.
3.2.3
Provisional performance for September 62 days from screening patients was 88.7% against a
target of 90%, however The Trust was fully compliant in aggregation for Quarter 2 at 92.1%
3.2.4
This increase in crude referrals is reflected in a 40% increase in patients diagnosed and/or
starting treatment under a cancer pathway in September 2013 compared with the same period of
2012.
3.3
Referral to Treatment (18 Weeks)
3.3.1
The Trust maintained full compliance against both admitted and non admitted aggregate RTT
pathway targets in September with reported positions of 90.88% (2631 of 2895 completed
pathways) and 96.28% (5734 of 6004 completed pathways) respectively. The Trust also
delivered full compliance against the requirement of >92% aggregate compliance for incomplete
pathways with 93.13% reported for the month (24,696 of 26,519 patients waiting).
3.3.2
Compliance against these aggregate metrics fully meets all RTT elements of the Monitor
Compliance Framework with 90.35% reported for admitted pathways, 95.99% for non-admitted
pathways, and 93.55% for incomplete pathways in Quarter 2.
3.3.3
Referral variance observed April to September 2013 is as follows:
Total referrals from all sources are up by 2.1% on plan

Total referrals from A&E are up by 9.7% on plan (predominately orthopaedic
trauma)

Total referrals from GPs and MSK are up by 1.8% on plan

GP/MSK referrals to Orthopaedics are up 20.6% on plan

A&E referrals to Orthopaedics (trauma) are up 9.6% on plan

GP referrals to Ophthalmology are up 17.3% on plan

GP referrals to Respiratory Medicine are up 30.2% on plan

GP referrals to Cardiology are up 13.6% on plan

GP referrals to Dermatology are -8.2% below plan, contrary to the planned 60%
reduction in CWSCCG QIPP plans for 2013/14
3.3.4
Increased referral pressure places significant pressure on the Trust ability to meet both RTT and
cancer pathway commitments, and these have eliminated the ability to sustain the specialty level
compliance achieved in T&O, Cardiology, Respiratory Medicine, ENT and Rheumatology in
4
Western Sussex Hospitals Trust – Performance Report for Trust Board
generating ten non-compliant specialty lines across the three admitted, non-admitted and
incomplete pathways for September.
3.3.5
Linked to these variances to planned demand, the Trust has formally enacted the Utilisation
Review process of the national contract, through which the Trust and CWSCCG must formally
develop and enact recovery actions, being a composite of referral demand and increased
capacity. Specialties named with the immediate scope of the Utilisation Review are: Urology,
Trauma and Orthopaedics, Ophthalmology, Cardiology, and Respiratory Medicine. While this
process has not been concluded, the Trust has indicated the following :

In order to absorb the above plan demand in the year to date, each specialty within
scope will be required to increase throughput, hence in most cases would exceed the
indicative activity plan, and;

Should the demand levels remain unchanged, the immediate activity uplifts to recover
demand in the year to date, would have to become baseline throughput requirements,
further extending the level of over activity against the indicative activity plan.

It was made clear that WSHFT is committed to working with CWSCCG to support any
local demand mitigation schemes, but did not support referral deflection to providers
outside our catchment, as has been the initial response from the CCG. If longer term
investment in additional activity above contracted levels is the CCGs preferred response,
these developments should occur within the boundaries of the West Sussex populations
served.

All recovery actions would dictate an increased level of non-compliant pathway
completions; hence the Trust would be pushed into heightened levels of non-compliance
by this enforced recovery process. As a result, the Trust would be exposed to increased
financial risk relating to RTT fines. Consequently, the Trust is seeking CWSCCG support
via reinvestment of fines during any period of enforced RTT recovery.
3.3.6
The Trust was fully compliant in September against the maximum waiting time for diagnostic tests
in which no greater than 1% of diagnostic patients wait greater than 6 weeks for their test. 0.65%
of patients waiting for diagnostic tests were waiting less than 6 weeks (35 of 5,394 patients).
3.4
Fractured Neck of Femur (#NOF) operation within 36 hours of admission.
3.4.1
During September 100% of medically fit Fractured Neck of Femur patients were operated on
within 36 hours of admission against a target of 90%. As of the time of writing, October
performance is 96.55%.
5
Western Sussex Hospitals Trust – Performance Report for Trust Board
5
RECOMMENDATION
5.1
The Board is asked to receive and note the notional score of 1 point against the Monitor
Compliance Framework for September.
5.2
The Board is asked to receive and note the confirmed Quarter 2 score of 1 point against the
Monitor Compliance Framework.
Adam Creeggan, Director of Performance
Giles Frost, Head of Operational Planning and Performance
24th October 2013
6
Western Sussex Hospitals Trust – Performance Report for Trust Board
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
SEPTEMBER 2013
Key Performance Deliverables Report
A&E 4‐hour waiting time target
Description / Comments / Actions
Target
Month
YTD
Projected O/T
95%
95.54%
96.68%
>95%
Patients can expect to be admitted, tranfered or discharged in 4 hours from arrival in A&E
Significant increase in crude demand and underlying acuity observed in 2012/13.
100%
Actions:
1. Enhanced discharge planning arrangements 2. Augmented patient flow arrangements in conjunction with external partners
3. Dedicated operational delivery plan in place under the leadership of the Chief Operating Officer
95%
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Aug
Sep
90%
Cancer ‐ Two weeks from urgent GP referral to first appointment
Description / Comments / Actions
Target
Month
YTD
Projected O/T
93.0%
98.08%
97.95%
>93%
Patients can expect to be seen within 2 weeks following an urgent GP referral for suspected cancer. This target is part of the NHS and Monitor performance frameworks for 2011/12.
Significant increases in demand level observed in 2012/13. 100%
95%
90%
Actions:
1. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Officer
2. Mitigation actions agreed with health partners including enhanced advice and guidance for GP's from WSHT consultant staff prior to referral, improved feedback mechanism for GP on appropirateness of referral, and real time access to referral data by GP practice, conversion to a cancer pathways and volumes recieving definative treatment for malignancy. 85%
80%
75%
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Aug
Sep
70%
Cancer ‐ Two weeks from urgent GP referral to first appt ‐ Breast symptoms
Description / Comments / Actions
Target
Month
YTD
Projected O/T
93%
100.00%
97.89%
>93%
Patients with breast symptoms can expect to be seen within 2 weeks following an urgent GP referral.
Increase in demand level, and heightened rate of patients exercising choice to wait beyond 14 day maximum. 100%
95%
90%
Actions:
1. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Officer
2. Mitigation actions agreed with health partners including enhanced advice and guidance for GP's from WSHT consultant staff prior to referral, improved feedback mechanism for GP on appropirateness of referral, and real time access to referral data by GP practice, conversion to a cancer pathways and volumes recieving definative treatment for malignancy. 85%
80%
75%
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Aug
Sep
70%
Cancer ‐ 62 days from referral to treatment following screening contact
Target
Month
YTD
Projected O/T
90%
88.68%
92.81%
>90%
Description / Comments / Actions
Patients with cancer can expect to commence treatment within 62 days following referral after a positive screening test.
Delays in receipt of onward referral from screening which reduces the time to secure capacity to treat patients.
100%
95%
90%
85%
80%
75%
Actual
7b Key deliverables report M06_v1.Exception Report
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
70%
Actions:
1. Transitional leadership for MDT/tracking passed to GM ‐ Access. 2. Augmented pathway management/tracking with enhanced oversight through DCS led Cancer Delivery Group
3. Close working with the screening service to maximise the time available to the Trust to secure capacity
4. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Officer
Target
Page 1 of 2
Printed 24/10/2013 16:36
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
SEPTEMBER 2013
Key Performance Deliverables Report
Cancer ‐ 62 days from referral to treatment following urgent referral by a GP.
Description / Comments / Actions
Target
Month
YTD
Projected O/T
85%
84.07%
87.18%
>85%
Patients with cancer can expect to commence treatment within 62 days following urgent referral by a GP.
Demand pressure exposing pathway efficiencies. Reduces the time to secure capacity to treat patients.
100%
95%
90%
85%
80%
75%
70%
65%
60%
55%
50%
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Aug
Sep
Actions:
1. Transitional leadership for MDT/tracking passed to GM ‐ Access. 2. Augmented pathway management/tracking with enhanced oversight through DCS led Cancer Delivery Group
3. Close working with the screening service to maximise the time available to the Trust to secure capacity
4. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Officer
Referral to treatment ‐ Admitted patients
Description / Comments / Actions
Target
Month
YTD
Projected O/T
90.0%
90.88%
90.27%
> 90%
All patients can expect to commence treatment within 18 weeks of a referral to consultant. This standard continues to be monitored within the 2011/12 NHS Performance Framework.
An imbalance of demand and capacity has resulted in an increase in the backlog of patients waiting over 18 weeks. Detailed recovery options submitted to SECSHA, NHS Sussex and CWS CCG.
100%
95%
90%
Actions:
1. Short term increase in internal capacity
2. Additional capacity commissioned by CWSCCG in private sector
3. Further mitigation actions agreed with health partners including further roll of of enhanced triage 4. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Office
85%
80%
75%
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Aug
Sep
70%
Referral to treatment ‐ Non Admitted patients
Description / Comments / Actions
Target
Month
YTD
Projected O/T
95.00%
95.50%
96.31%
> 95%
All patients can expect to commence treatment within 18 weeks of a referral to consultant. This standard continues to be monitored within the 2011/12 NHS Performance Framework.
An imbalance of demand and capacity has resulted in an increase in the backlog of patients waiting over 18 weeks. Detailed recovery options submitted to SECSHA, NHS Sussex and CWS CCG.
100%
95%
90%
85%
80%
75%
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Aug
Sep
70%
Actions:
1. Short term increase in internal capacity
2. Launch of Triage + to enhance orthopaedic referral routing to appropriate treatment options in LHE
3. Further mitigation actions agreed 14 August 2012 with health partners including further roll of of enhanced triage options in Colorectal Surgery, Gastroenterology and Upper GI surgery. 4. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Office
% Medically fit hip fracture patients going to theatre within 36 hours
Description / Comments / Actions
Target
Month
YTD
Projected O/T
90%
100.00%
94.68%
>90%
To ensure the best possible outcomes, hip fracture patients who are medically fit should be operated on within 36 hours of admission. This standard is part of the 'Best Practice' payment process under PbR.
Increased levels of demand have impacted sustained compliance. Mitigating actions implemented by the Surgical Division have significantly improved performance.
100%
98%
96%
94%
92%
90%
88%
86%
84%
82%
80%
7b Key deliverables report M06_v1.Exception Report
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Actions:
1. 60% increase in trauma capacity to mitigate demand pressure. 2. Improved tracking and escalation processes in place to manage fluctuations in demand on daily basis
3. Dedicated weekly action focused delivery meeting under the leadership of the Chief Operating Officer
Page 2 of 2
Printed 24/10/2013 16:36
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
SEPTEMBER 2013
OPERATIONAL PERFORMANCE
SCORECARD
PATIENT EXPERIENCE
O01
O02
O03
O04
O05
O06
O07
O08
Cancer: 2 week GP referral to 1st outpatient ‐ breast symptoms
Cancer: 31 day second or subsequent treatment ‐ surgery
Cancer: 31 day second or subsequent treatment ‐ drug
Cancer: 31 day diagnosis to treatment for all cancers
Cancer: 62 day referral to treatment from screening Cancer: 62 day referral to treatment from hospital specialist 2013/14
Target
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SEP
FOT
96.91%
96.45%
96.08%
95.73%
94.00%
95.26%
97.65%
95.99%
97.78%
97.24%
97.44%
96.02%
95.54%
96.68%
95%
>95%
97.31%
98.31%
98.09%
98.15%
96.30%
97.41%
98.25%
96.89%
97.83%
97.34%
98.84%
98.42%
98.08%
97.95%
93%
>93%
98.48%
94.12%
94.15%
96.15%
96.08%
97.84%
96.84%
98.77%
97.69%
94.89%
98.88%
97.06%
100.0%
97.89%
93%
>93%
97.67%
95.45%
100.0%
97.14%
100.0%
100.0%
93.8%
100.0%
100.0%
97.06%
100.0%
100.0%
100.0%
99.44%
94%
>94%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.00%
98%
100%
97.14%
99.57%
98.58%
99.16%
99.10%
97.75%
99.43%
99.48%
100.0%
100.0%
99.6%
96.4%
97.2%
98.69%
96%
>96%
100.0%
92.68%
84.91%
92.68%
89.80%
84.00%
96.77%
97.62%
89.36%
92.86%
97.67%
91.07%
88.68%
92.81%
90%
>90%
100.0%
88.89%
96.43%
93.18%
74.19%
76.00%
85.71%
77.78%
80.00%
92.86%
93.10%
75.00%
84.44%
85.00%
N/A
>85%
85%
>85%
Trend
NB
A&E : Four‐hour maximum wait from arrival to admission, transfer or discharge
Cancer: 2 week GP referral to 1st outpatient
Sep
2013/14 YTD
1
1
1
1
1
1
1
1
O09
Cancer: 62 days urgent GP referral to treatment of all cancers 86.12%
86.35%
86.61%
89.86%
83.94%
89.81%
91.11%
92.73%
87.13%
87.56%
85.66%
87.66%
84.07%
87.18%
O10
Number of complaints relating to staff attitude or behaviour/10,000 admissions
8.13
3.74
3.95
4.16
4.02
5.45
7.35
6.21
6.08
4.23
2.02
2.07
5.08
4.28
O11
Number of nursing complaints per 10,000 bed days
0.80
0.00
1.15
0.38
1.07
1.16
2.26
1.12
0.38
1.65
1.25
1.22
0.00
0.93
4.35
O12
RTT ‐ Admitted ‐ 90% in 18 weeks
92.56%
91.72%
91.37%
90.13%
90.19%
90.01%
90.04%
90.11%
90.22%
90.11%
90.12%
90.06%
90.88%
90.27%
90%
>90%
O13
RTT ‐ Non‐admitted ‐ 95% in 18 weeks
95.87%
96.03%
96.61%
96.28%
96.64%
97.28%
97.40%
96.43%
96.56%
96.90%
96.19%
96.28%
95.50%
96.31%
95%
>95%
O14
RTT ‐ Incomplete ‐ 92% in 18 weeks
92.29%
92.59%
92.72%
92.10%
92.27%
92.17%
92.91%
93.69%
94.34%
94.43%
94.39%
93.14%
93.13%
93.84%
92%
>92%
O15
RTT delivery in all specialties
12
14
12
9
9
9
6
4
5
3
7
9
10
6
0
0
O16
Diagnostic Test Waiting Times
0.04%
0.10%
0.17%
0.31%
0.22%
0.09%
0.39%
0.16%
0.86%
0.57%
1.21%
0.92%
0.65%
0.74%
<1%
<1%
O17
Cancelled operations not re‐booked within 28 days
1
1
1
2
1
6
1
4
2
0
0
0
0
6
‐
O18
Urgent operations cancelled for the second time
0
0
0
0
0
0
0
0
0
0
0
0
0
0
‐
O19
Mixed Sex Accommodation breaches
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
OUTCOMES
O20
Crude mortality (Trust‐wide) rate
2.88%
3.01%
3.01%
3.49%
4.13%
3.69%
4.10%
3.76%
3.18%
2.83%
3.51%
2.66%
2.80%
3.13%
3.24%
3.29%
O21
HSMR (Trust‐wide)
104.1
102.9
103.4
102.9
101.4
99.4
100.5
99.2
99.0
97.9
98.3
#N/A
#N/A
98.3
100
<100
O22
SMR #NOF
128.6
120.8
119.8
124.4
123.9
129.0
125.2
127.3
125.4
121.5
119.1
#N/A
#N/A
119.1
100
<100
O23
% hip fracture repair within 36 hours
98.3%
94.1%
94.1%
95.5%
96.9%
89.8%
86.9%
93.4%
90.5%
100.0%
92.1%
90.6%
100.0%
94.7%
90%
>90%
O24
Patients that have spent more than 90% of their stay in hospital on a stroke unit+
88.1%
84.4%
86.8%
87.0%
87.9%
79.3%
78.3%
78.2%
81.7%
76.6%
80.5%
80.0%
#N/A
79.3%
80%
>80%
68.8%
73.9%
76.5%
77.8%
68.4%
85.7%
70.0%
58.8%
75.0%
81.8%
29.2%
34.6%
83.3%
52.4%
60.0%
>60%
12.8%
12.0%
13.5%
11.2%
12.3%
12.6%
11.9%
11.7%
11.3%
12.4%
12.4%
12.5%
11.6%
12.1%
12.2%
>90%
O25
% Higher risk TIA patients scanned & treated within 24 hrs+
O26
30 day emergency readmissions
7c Operational performance scorecard M06_v3.SCORECARD
1
1
Page 1 of 2
Printed 24/10/2013 16:36
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
SEPTEMBER 2013
OPERATIONAL PERFORMANCE
SCORECARD
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SEP
2013/14 YTD
2013/14
Target
12.82
13.28
16.09
14.01
18.89
13.90
17.30
17.87
11.12
14.87
15.47
11.37
16.20
14.50
15.41
< 12/13 baseline
FOT
Trend
SAFETY
O27
Number of reported patient falls per 10,000 bed days
O28
Incidence of C Diff.
3
10
7
4
5
4
9
13
5
7
2
7
3
37
46
46
O29
Incidence of MRSA
0
0
0
0
0
1
0
0
0
0
1
1
0
2
2
<2
O30
Number of prescribing‐associated incidents graded moderate or severe
0
0
0
1
1
0
0
0
2
1
0
0
0
3
8
<8
O31
Pressure Ulcer Incidence per 1000 occupied bed days
0.36
0.51
0.34
0.57
0.43
0.23
0.49
0.45
0.35
0.29
0.38
0.37
0.20
0.34
0.36
<0.36
93.09%
93.45%
94.70%
93.40%
95.03%
95.00%
94.01%
94.40%
95.23%
95.60%
97.02%
96.00%
96.51%
95.72%
95%
>90%
2.5%
1.9%
2.2%
2.8%
3.1%
2.7%
3.4%
3.9%
3.8%
3.2%
2.1%
2.1%
2.8%
3.1%
3.5%
<3.5%
4,014
4,171
3,931
4,094
4,002
3,638
4,005
3,863
3,876
3,668
3,804
3,849
3,798
22,858
<12/13
<11/12
O32
% inpatients assessed for VTE risk using national tool
2
BEING JOINED UP
O33
Delayed transfers of care
O34
Number of Emergency admissions
2
IMPROVEMENT
O36
Average length of stay ‐ Elective
3.10
3.36
3.12
3.49
3.28
3.03
3.43
3.04
3.27
3.16
3.06
3.05
2.99
3.10
3.72
3.6
O37
Average length of stay ‐ Non‐elective Surgery
5.07
6.14
5.44
5.43
5.48
5.77
5.03
5.22
5.58
5.21
5.60
5.22
5.33
5.36
6.07
6.0
O38
Average length of stay ‐ Non‐elective Medicine
7.13
7.11
7.66
7.50
7.92
8.01
7.87
8.02
8.01
7.90
7.63
7.37
7.23
7.70
7.80
7.8
O39
Day case surgery rate (BADS Directory source: Dr Foster)
80.39%
81.97%
82.49%
82.29%
84.10%
82.13%
81.85%
82.49%
81.71%
82.83%
81.80%
#N/A
#N/A
82.20%
75.0%
80%
O40
Elective day of surgery rate (DOSR)
94.7%
94.8%
95.9%
95.7%
95.6%
95.4%
96.4%
96.1%
96.5%
97.1%
97.0%
97.2%
96.4%
96.7%
90.0%
95%
O41
Did not attend rate (outpatients)
6.21%
6.21%
5.80%
6.14%
6.71%
6.26%
6.89%
6.25%
6.39%
6.31%
6.42%
6.63%
6.81%
6.43%
7.65%
6.0%
O42
HSCIC Data validity summary (YTD)
‐
‐
97.5
97.5
97.5
97.5
97.2
94.9
95.8
95.8
96.6
96.8
#N/A
96.8
96.0
97.0
SUSTAINABILITY
O43
Bank staff ‐ % of all staff pay
‐
‐
‐
‐
‐
‐
‐
6.93%
4.54%
4.78%
6.35%
6.96%
6.11%
5.95%
7%
O44
Agency staff ‐ % of all staff pay
‐
‐
‐
‐
‐
‐
‐
2.70%
3.96%
3.84%
5.30%
4.81%
5.94%
4.43%
2%
O45
Nurse:bed ratio
‐
‐
‐
‐
‐
‐
‐
1.847
1.852
1.853
1.854
1.842
1.857
1.851
‐
O46
% nurses who are registered
‐
‐
‐
‐
‐
‐
‐
73.80%
73.93%
74.15%
73.85%
73.76%
73.62%
73.85%
‐
O47
% Staff appraised
88.10%
85.50%
86.06%
86.53%
87.42%
87.79%
85.14%
84.90%
86.70%
85.00%
81.56%
79.37%
79.41%
79.41%
95%
3.02%
3.80%
4.33%
4.18%
4.06%
3.70%
3.5%
3.64%
3.46%
3.43%
3.65%
3.73%
#N/A
3.55%
3.3%
8.79%
8.82%
8.74%
8.92%
8.80%
8.57%
8.54%
8.63%
8.48%
8.10%
8.12%
7.74%
7.63%
7.63%
11%
O48
Sickness Absence: % Sickness (reported one month in arrears)
O50
Staff Turnover: Turnover rate (YTD position)
3
Notes
1
National reporting for these performance measures is on a quarterly basis. Data are subject to change up to the final submission deadline due to ongoing data validation and verification. 2
Data are provisional best estimates and will be amended to reflect the position signed‐off in the relevant statutory returns in due course. 3
Staff sickness is reported one month in arrears. 7c Operational performance scorecard M06_v3.SCORECARD
Page 2 of 2
Printed 24/10/2013 16:36
Mark Dennis, Head of Information Services
t: 01903 285273 (ext 5273)
SEPTEMBER 2013
Monitor Compliance Framework
Threshold
Apr
May
Jun
Q1
Weighted
Score
Jul
Aug
Sep
Q2
Weighted
Score
90%
90.11%
90.22%
90.11%
90.15%
0.0
90.12%
90.06%
90.88%
90.35%
0.0
0.0
0.0
95%
96.43%
96.56%
96.90%
96.63%
0.0
96.19%
96.28%
95.50%
95.99%
0.0
0.0
0.0
92%
93.69%
94.34%
94.43%
94.16%
0.0
94.39%
93.14%
93.13%
93.55%
0.0
0.0
0.0
95%
95.99%
97.78%
97.24%
97.01%
0.0
97.44%
96.02%
95.54%
96.36%
0.0
0.0
0.0
85%
92.73%
87.13%
87.56%
88.96%
85.66%
87.66%
84.07%
85.71%
0.0
0.0
0.0
97.67%
91.07%
88.68%
92.11%
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Oct
Nov
Dec
Q3
Weighted
Score
Jan
Feb
Mar
Q4
Weighted
Score
ACCESS
M1
M2
M3
M5
M6a
M6b
M7a
M7b
Maximum time of 18 weeks from point of referral to treatment in aggregate – admitted
Maximum time of 18 weeks from point of referral to treatment in aggregate – non‐admitted
Maximum time of 18 weeks from point of referral to treatment in aggregate – patients on an incomplete pathway
A&E: maximum waiting time of four hours from arrival to admission/transfer/discharge
All cancers : 62‐day wait for first treatment following urgent GP Referral
All cancers : 62‐day wait for first treatment following consultant screening service referral
All cancers : 31‐day wait for second or subsequent treatment ‐ surgery
treatments
All cancers : 31‐day wait for second or subsequent treatment ‐ drug treatments
0.0
90%
97.62%
89.36%
92.86%
93.57%
94%
100.00% 100.00% 97.06%
98.92%
100.00% 100.00% 100.00% 100.00%
0.0
98%
100.00% 100.00% 100.00% 100.00%
M8
All cancers : 31‐day wait from diagnosis to first treatment
96%
99.48% 100.00% 100.00% 99.84%
M9a
Cancer : two week wait from referral to date first seen ‐ All patients
93%
96.89%
M9b
Cancer : two week wait from referral to date first seen ‐ Symptomatic breast patients
97.83%
97.34%
100.00% 100.00% 100.00% 100.00%
0.0
97.37%
99.59%
96.35%
97.21%
97.73%
98.84%
98.42%
98.08%
98.47%
98.88%
97.06% 100.00%
98.53%
0.0
93%
98.77%
97.69%
94.89%
97.25%
OUTCOMES
M17
Clostridium Difficile – meeting the Clostridium Difficile objective
46
13
5
7
25
1.0
2
7
3
12
1.0
0.0
0.0
M18
MRSA – meeting the MRSA objective
0
0
0
0
0
0.0
1
1
0
2
0.0
0.0
0.0
M27
Certification against compliance with requirements re access to healthcare for people with a learning disability
YES
YES
YES
YES
YES
0.0
YES
YES
YES
YES
0.0
0.0
0.0
1.0
0.0
0.0
Monitor Compliance Framework Score
1.0
Green : 0 Amber/Green : 1
Amber : 2
Amber/Red : 3
Red : 4 or more
Risk Assessment Indicators (subject to outocme of consultation)
M4
Diagnostic waits
99%
99.84%
99.14%
99.43%
99.46%
98.79%
99.08%
99.35%
99.07%
M19
30 Day readmissions %
tbc
11.7%
11.3%
12.4%
11.9%
12.37%
12.51%
11.55%
12.27%
M20
Incidence of newly acquired pressure ulcers
tbc
12
9
7
28
9
9
5
23
M21
Medication errors causing serious harm
tbc
0
2
1
3
0
0
0
0
M22
Admission of term babies to neonatal care
tbc
2.5%
2.2%
3.3%
2.7%
3.7%
4.2%
2.4%
3.4%
M23
Incidence of health care‐related venous thromboembolism
tbc
33
34
24
91
31
28
29
88
7d Monitor scorecard M06_v2.SCORECARD
Page 1 of 1
0.0
0.0
0.0
Printed 24/10/2013 16:36
WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST
To: Board
Date of Meeting: 31st October 2013
Agenda Item: [insert agenda item]
Title:
Report on Organisational Development and Workforce performance
Responsible Executive Director
Denise Farmer, Director of OD and Leadership
Prepared by
Jennie Shore, Deputy Director of HR
Status
Disclosable
Summary of Proposal
The report describes the organisations performance against the delivery of the Workforce and OD
strategies
Implications for Quality of Care
Supports the delivery and sustainability of safe, high quality care through investment in the
development of the workforce and a culture of staff engagement
Financial Implications
Supports good financial performance
Human Resource Implications
As described
Recommendation
The Board is asked to NOTE the report
Consultation
N/A
Appendices
Workforce data report
This report can be made available in other formats and in other languages. To discuss your requirements please
contact Graham Lawrence, Company Secretary, on [email protected] or 01903 285288.
To: Trust Board Date: 31 October 2013 From: Denise Farmer, Director of Organisational Development and Leadership Agenda Item: XXX FOR INFORMATION ORGANISATIONAL DEVELOPMENT AND WORKFORCE REPORT 1.00 INTRODUCTION 1.01 This sets out the key performance indicators relating to the Trust’s workforce at 30 September 2013. 2.00 SUMMARY OF PROPOSAL 2.01 Workforce Capacity The total workforce capacity used during September increased to 99.8%. This reflects the increase in supply of bank staff and an increase in joiners to the Trust (46 wte). Workforce capacity exceeded 100% in corporate and medicine divisions, with high volumes of bank useage. The total amount of temporary staff used accounted for 10.1%, with a range of 3.6% in Women and Children to 20.3% in Facilities and Estates. Temporary staff use in Medicine accounted for 14% of its workforce capacity despite an in month increase in substantive staff of 16 wte. The Trust was represented at a recruitment fayre for nursing staff on 17 October in Glasgow. Attendance from prospective applicants was disappointing and only resulted in 9 offers being made. The recruitment fayre attracted more interest from student nurses due to qualify at the end of 2014 and a register of individuals has been generated to follow up next year. An open day aimed at experienced qualified nurses and local newly qualified nurses due to complete their training in February 2014 has been scheduled for 8 November. Current ‘bank only’ nurses are also being actively encouraged to fill identified vacancies, both permanently and through short term contracts if more desirable. A matron has been seconded to work with the recruitment and temporary staffing teams to liaise with wards and departments to ensure that all opportunities to recruit and retain nursing staff, both substantively and on ‘bank’ arrangemnts are maximised. 2.02 Workforce Efficiency Sickness absence increased again marginally in month to 3.7%. The cumulative year to date rate remains 3.5%. Concern remains at the sickness rate within the Facilities and Estates Division which increased in month to 7% with a cumulative rate of 5.9%. Whilst absence fell in month, long term sickness within the Corporate division represented 70% during August. A detailed report of actions being taken across the Divisions will be available to the Board next month. Turnover fell for a third consecutive month during September to 7.6%. Staff turnover within Corporate and Core remains the highest at over 10.5% although this continues to be within the Trust’s ceiling of 11%. Appraisal levels remained at marginally below 80% during September. 2.03 Workforce Skills and Development 2.04 Real time Staff Feedback During September 214 staff gave feedback against the two ‘Family and Friends’ questions. Whilst the number of staff agreeing or strongly agreeing to the questions fell in month to around 80%, the year to date position remained high. These metrics, and comments made, are now being reported as part of the Divisional workforce reports and will need to inform future interventions to improve staff satisfaction and standards of care. 2.05 Staff Survey 2013 The national staff survey for 2013 was launched on 23 September. At the time of writing, the Trust’s response of over 40% is in the top 20% of acute Trusts in England. This follows a high profile communication campaign encouraging its completion and giving staff feedback on actions taken following previous surveys, a detailed manager’s briefing pack and the publication of FAQ’s. The chair of the Trust’s Staff Side has also written an open letter to staff in support of the survey and reinforcing the confidentiality and anonymity of the results. This is very timely given that the first reminders have now been sent out. 2.06 Service changes Clinical Local Research Network (CLRN) – it has recently been confirmed by DH that the Royal Surrey County Hospital NHS Foundation Trust will be the new host for the CLRN from 1 April 2014. It is not yet clear whether TUPE will apply: this may result in a significant financial risk to the Trust, as well as uncertainty for staff. 2.07 Executive Director Appointments 2.08 Appointment to the Medical Director has now been confirmed and I am pleased to report that Dr George Findlay will be joining the Trust on 27 January 2014. Recruitment to the post of Director of Finance has commenced and an advertisement has been placed in the HSJ and NHS jobs. It is anticipated that selection will take place on 26 November and follow a similar format to that used for the Medical Director. Flu Vaccine The flu vaccination programme has commenced in the Trust and all staff are being actively encouraged to take up the vaccine being administered via the Occupational Health and Page 2 of 4
Practice Development teams. The programme will be delivered through until end of December and at the end of week 2, 930 staff had been vaccinated. This represents approximately 14 % of the workforce. 2.09 Workforce Skills and Development Statutory and Mandatory Training The Audit Committee has agreed that the targets for training attendance on all Statutory and Mandatory training should be changed to 90% , with a specific focus on the absolute numbers of staff who are out of date by >6 months or whom have no training recorded. Attendance on all of the training remains high and is currently just below or just over the target as detailed below: Fire 87.5% (decrease of 0.7% since August) Infection Control 87.9% (decrease of 0.1% since August) Back Awareness/ Patient Handling 92.7% (increase of 5.4% since August) Child Protection 95.5% (decrease of 0.1% since August) Information Governance 87.4% (decrease of 1.0% since August) Reports detailing staff who have still not attended all or part of their mandatory training have been provided to Management Board and appropriate action agreed. The Board will receive details of the position in January. Apprentices A taster day for level 2 Health Care Apprentices was held at St Richards Hospital. Following this, those who attended will be invited to interview for 10 apprentice posts across the Trust. One apprentice in Learning and Development was appointed. Senior Nurse Development Programme A Senior Nurse Development programme was launched in October. The programme, run by the University of Chichester follows the success of a similar programme for Clinical Leaders in 2012‐2013. Twenty senior nurses will complete the leadership programme, which will develop their skills in clinical decision making, service‐management, performance improvement and leading their teams to deliver even better standards of care. 3.0 Communications and Engagement Proactive media releases this month included the promotion of the extension of the Friends and Family test to maternity services. Coverage included BBC South Today, Splash FM and Herald and Observer newspapers. Publicity also included news of the progress made by ward staff to reduce the amount of noise at night, designed to stop patients suffering disturbed sleep. In the past month 64% of inpatients reported being able to get a good night’s sleep, compared to fewer than 50% when the surveys first started in early 2012. Page 3 of 4
Engagement activities included the latest stakeholder forum meeting on October 10 at Worthing hospital. Members were given the opportunity to hear about a new call handling system for patients booking and rearranging appointments as well as the latest on dementia care, and general news from the trust. The Medicine for Members events continued with a presentation on prostate cancer on October 22 at St Richard’s. There will be a talk on diabetes from Sara Da Costa, the Trust’s nurse consultant for diabetes, on November 19 at Worthing Hospital. Anyone interested in attending should email [email protected] or call Lyn Gaylor on 01903 205111 84038. The Communications team is currently working on improvements to the Trust’s intranet in order to ensure it is as helpful and useful as possible for its users – our staff. In order to inform the development, staff have been asked to provide their views on what they like and don’t like about the current system as well as provide any suggestions for improvement. It’s anticipated that the redeveloped site will be launched in the New Year. 4.0 Health and Safety Following a RIDDOR related to a needle stick injury the Health and Safety Executive are carrying out a review of the incident. Improving the safety of processes reacted to Sharps has been a focus for the Health and Safety committee for some time but we will of course be proactive in addressing any areas of concern the HSE may raise 5.00 RECOMMENDATIONS The Board is asked to note the report. Page 4 of 4
Key performance Indicators
1) WORKFORCE CAPACITY
WC‐BF
Total FTE Used
WC‐VB
Total FTE Used Variance from Budget
WC‐TV
Total FTE Used Vacancy Factor
WC‐SF
Substantive Contracted FTE
WC‐SV
Substantive FTE Used Vacancy Factor
WC‐BP
Bank Usage As % Of Total FTE Used
WC‐AP
Agency Usage As % Of Total FTE Used
2) WORKFORCE EFFICIENCY
WE‐SA
In Month Sickness Absence %
WE‐ML
In Month Maternity Leave %
WE‐OA
In Month Other Absence %
WE‐TA
In Month Total Absence %
WE‐LT
% Total Sickness Days Lost Due To Long Term Sickness Absence (28 Days Or More)
WE‐SR
% Of Total Sickness Attributed To Stress
WE‐MS
% Of Total Sickness Attributed To Musculo Skeletal
WE‐RT
Rolling 12 Month Turnover
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
SEP
2013/14 YTD
2013/14
Target/ Ceiling
5972.3
5965.6
5992.9
5989.6
5995.8
5995.8
5988.8
6038.0
6038.8
6041.6
6134.2
6136.7
6134.6
6087.3
N/A
N/A
5915.0
5927.2
6003.7
6013.3
5954.9
6058.2
6052.7
6002.2
5880.5
5928.0
6142.3
6016.5
6124.7
6015.7
N/A
N/A
‐57.2
‐38.4
10.8
23.7
‐40.9
62.4
63.9
‐35.8
‐158.3
‐113.7
8.1
‐120.1
‐9.9
N/A
N/A
N/A
Amber Limit
NB
Budgeted FTE
WC‐FU
September 2013
x
WSHT WORKFORCE SCORECARD
1
1
1
1
1
1.0%
0.6%
‐0.2%
‐0.4%
0.7%
‐1.0%
‐1.1%
0.6%
2.6%
1.9%
‐0.1%
2.0%
0.2%
1.2%
N/A
N/A
5375.9
5374.3
5433.9
5416.7
5425.1
5448.1
5426.4
5434.2
5440.6
5442.0
5446.8
5461.3
5507.2
5455.3
N/A
N/A
10.0%
9.9%
9.3%
9.6%
9.5%
9.1%
9.4%
10.0%
9.9%
9.9%
11.2%
11.0%
10.2%
10.4%
N/A
N/A
7.6%
7.5%
7.5%
7.8%
6.8%
7.8%
8.2%
8.3%
5.5%
6.0%
9.0%
6.4%
7.5%
7.1%
N/A
N/A
1.5%
1.9%
2.0%
2.1%
2.1%
2.3%
2.1%
1.2%
2.0%
2.2%
2.4%
2.9%
2.6%
2.2%
N/A
N/A
3.2%
3.8%
4.4%
4.2%
4.2%
3.9%
3.6%
3.8%
3.5%
3.4%
3.6%
3.7%
3.5%
3.3%
3.3%
2.7%
2.8%
2.8%
2.7%
2.6%
2.6%
2.5%
2.4%
2.4%
2.3%
2.4%
2.5%
2.4%
N/A
N/A
1.0%
1.1%
1.4%
0.8%
0.8%
1.0%
1.1%
1.1%
1.1%
1.1%
1.1%
0.8%
1.0%
N/A
N/A
NB
2
2
2
2
2
6.8%
7.7%
8.5%
7.7%
7.6%
7.4%
7.2%
7.3%
6.9%
6.8%
7.1%
7.0%
7.0%
N/A
N/A
55.8%
52.6%
49.0%
47.5%
47.8%
48.4%
50.2%
51.4%
51.3%
41.8%
46.9%
51.1%
48.6%
N/A
N/A
13.9%
13.3%
14.4%
13.3%
10.8%
13.4%
15.6%
15.7%
16.5%
15.1%
18.8%
20.8%
17.4%
N/A
N/A
24.0%
22.4%
20.3%
18.1%
19.7%
18.7%
18.3%
16.4%
21.4%
21.3%
20.3%
18.8%
8.8%
8.8%
8.7%
8.9%
8.8%
8.6%
8.5%
8.6%
8.5%
8.1%
8.1%
7.7%
19.6%
N/A
N/A
7.6%
N/A
11.0%
11.0%
3) TRAINING AND PERSONAL DEVELOPMENNB
TD‐AP
% Appraisals Up To Date
TD‐MP
% In Date ‐ All Mandatory Training
TD‐FP
% In Date ‐ Fire
83.6%
81.7%
82.1%
84.3%
85.5%
85.3%
86.0%
88.0%
87.8%
89.7%
88.8%
88.2%
TD‐IC
% In Date ‐ Infection Control
85.5%
84.1%
84.0%
85.8%
87.1%
86.8%
84.3%
86.4%
86.7%
88.3%
87.3%
88.0%
TD‐BT
% In Date ‐ Role Specific Back Training
86.9%
86.2%
85.0%
86.8%
87.5%
86.5%
90.1%
91.7%
91.9%
92.9%
92.5%
92.5%
TD‐CP
% In Date ‐ Child Protection
93.2%
93.5%
93.9%
94.8%
95.4%
95.2%
95.2%
95.6%
95.2%
96.1%
95.6%
95.7%
TD‐IG
% In Date ‐ Information Governance
81.7%
80.6%
81.0%
83.6%
85.1%
85.0%
85.7%
TD‐AP
% In Date ‐ Adult Protection
4) REAL-TIME STAFF FEEDBACK
SF‐TR
SF‐Q1
SF‐Q2
3
88.1%
85.5%
86.1%
86.5%
87.4%
87.8%
85.1%
84.9%
85.7%
85.0%
81.6%
79.4%
79.4%
N/A
95.0%
85.0%
77.1%
75.1%
74.1%
76.8%
78.8%
77.7%
76.7%
79.8%
80.4%
82.2%
81.9%
81.3%
81.3%
N/A
95.0%
85.0%
87.5%
N/A
95.0%
85.0%
87.9%
N/A
95.0%
85.0%
92.7%
N/A
95.0%
85.0%
95.5%
N/A
95.0%
85.0%
3
87.5%
89.3%
88.4%
87.9%
87.4%
N/A
95.0%
85.0%
76.1%
75.0%
73.6%
73.8%
73.9%
N/A
95.0%
85.0%
NB
Total Respondents To Survey
% Respondents who would recommend this trust as a place to work % Respondents happy with standard of care if a friend or relative needed treatment
87.7%
75.8%
4
4
88
85
85
59
39
52
58
68
127
177
127
214
771
N/A
N/A
71.6%
43.5%
74.1%
72.9%
82.1%
82.7%
75.9%
76.5%
85.8%
77.4%
89.0%
80.4%
81.3%
N/A
N/A
70.5%
74.1%
75.3%
79.7%
79.5%
84.6%
75.9%
75.0%
81.1%
81.4%
83.5%
79.4%
80.2%
N/A
N/A
Notes
1
Bank FTE used figures are not available for April and May and been approximated as follows: Monthly Bank Spend / June Average Cost Per Bank FTE
2
Absence data is available one month in arrears
3
Adult Protection is not currently included in the criteria when determining whether an employee is up to date with their mandatory training
4
% of staff who responded "Agree" or "Strongly Agree" to the question
Trend
To: Trust Board (Public)
Date of Meeting: 31st October 2013
Agenda Item 9
Title
Financial Performance Report (Month 6)
Responsible Executive Director
Spencer Prosser, Director of Finance
Prepared by
Chris Nevell, Assistant Director of Finance
Status
Public
Summary of Proposal
The Trust’s in-month financial position is a surplus of £323k against a planned surplus of £602k.
The year-to date position is a deficit of £996k against a planned surplus of £2,552k.
The Trust’s Financial Risk Rating remains at 2, the same as last month.
Implications for Quality of Care
Not applicable
Link to Strategic Objectives/Board Assurance Framework
G1: Maintain an acceptable Financial Risk Rating
Financial Implications
Financial Performance Report
Human Resource Implications
Not applicable
Recommendation
The Board is asked to note the financial performance report for September 2013
Communication and Consultation
Not applicable
Appendices
None
-1-
To:
Date: 31st October 2013
Trust Board (Public)
From: Spencer Prosser, Director of Finance
Agenda Item:
FOR INFORMATION
Financial Performance Report
1
Introduction
1.1.
The Board is presented with the Trust’s Financial Performance for September 2013.
2
Summary
2.1.
The financial position against the Trust’s control total for September is a surplus of
£1,283k against the budgeted in-month figure of £602k, providing a surplus of £680k
against plan. However the impact of the increased annual leave accrual of £959k earlier
in the year has been reassessed at quarter end and reversed. Consequently the Trust’s
underlying financial position is an in-month surplus of £323k, providing an undershoot of
£279k against plan.
2.2.
The year-to-date plan is a surplus of £2,552k and the actual position is a deficit of £996k.
2.3.
The year-end forecast remains at £5.2m surplus but this is dependent upon achieving the
cost improvement target. It is also dependent upon achieving the patient and quality
safety targets. These targets carry heavy financial penalties if they are not achieved. The
forecast is subject to regular review as risks are re-evaluated. As the year proceeds and
risks begin to crystallise, the assumptions underpinning the forecast are subject to
change.
2.4.
The position by division is shown below:
Annual
Budget
£000s
Operations
Core Services
Medicine
Surgery
Women and Children
Performance & Access
Operations Total
Budget
£000s
In Month
Actual
£000s
Variance
£000s
Budget
£000s
Year to Date
Actual
£000s
Variance
£000s
(48,546)
(72,459)
(71,494)
(36,011)
(5,165)
(233,675)
(4,215)
(6,094)
(5,876)
(2,967)
(409)
(19,563)
(4,168)
(6,501)
(6,036)
(2,907)
(385)
(19,997)
47
(406)
(160)
60
25
(434)
(24,165)
(35,898)
(35,875)
(17,676)
(2,551)
(116,166)
(25,001)
(37,646)
(36,562)
(17,564)
(2,481)
(119,254)
238,875
20,164
21,199
1,033
118,718
118,651
(67)
5,200
602
1,202
599
2,552
(603)
(3,155)
81
81
()
(393)
(393)
1,283
680
2,552
(996)
(3,548)
(959)
(959)
323
(279)
2,552
(996)
(3,548)
Corporate Total
Trust Total
(837)
(1,748)
(686)
112
70
(3,088)
Add back:
Impact of Donated Asset Accounting
Impact of Impairments
Performance against Control Total
5,200
602
Add back: reversal of increase in annual leave accrual
Underlying position excluding the in-month reversal of increase
in annual leave accrual
602
Note : The adjustment for the increase in annual leave accrual which occurred in June (Month 3) has been removed. A recalculation carried out
this month has shown that the increase is likely to reverse.
-2-
2.5.
The Trust’s performance against the financial risk rating metrics within the Compliance
Framework is shown below.
Year to Date
Actual
Actual
Rating
4.8%
2
63.7%
2
(0.6%)
3
(0.3%)
2
27 days
4
EBITDA Margin
EBITDA % Achieved
Net Return after Financing
I&E Surplus Margin
Liquidity Ratio
Overall Risk Rating (after over-riding rules)
2
The liquidity ratio includes the Working Capital Facility
2.6.
The overall year-to-date risk rating of the existing metrics remains unchanged from the
previous month. Despite a weighted average score of 2.7, there are three individual
metrics that score at 2, invoking an overriding criterion that sets an overall score of 2.
2.7.
From 1st October, Monitor’s Risk Assessment Framework replaces the Compliance
Framework. The Board has been briefed on the changes resulting from this, including the
introduction of the Continuity of Services rating which will be reported from next month.
2.8.
On current month data under the new framework, the Trust has a score of 4 on liquidity
and 2 on capital service capacity, producing an overall score of 3 on the 4 point scale.
3
Recommendation
3.1
The Board is asked to note the financial performance report for September 2013.
4
Financial Performance
4.1.
The following table shows the income and expenditure account for September 2013,
including the underlying position.
-3-
Western Sussex Hospitals NHS Foundation Trust
Income and Expenditure Account
for the period ending
30 September 2013
Annual
Budget
£000s
Income
Income from Activities
Other Income for Patient Care
Education Training and Research
Other Operating Income
Total Income
In Month
Actual
£000s
Budget
£000s
Variance
£000s
Budget
£000s
Year to Date
Actual
£000s
Variance
£000s
325,857
8,507
17,948
21,462
373,773
27,056
726
1,502
1,748
31,032
27,280
697
1,514
1,709
31,201
224
(29)
12
(39)
169
162,251
4,093
8,963
10,566
185,874
161,263
3,891
8,984
10,940
185,079
(989)
(202)
21
375
(795)
Pay
Medical Staff
Nursing Staff
Professions Allied to Medicine
Professional and Technical Staff
Admin and Managerial Staff
Estates Staff
Agency Staff
Other Pay Costs
Total Pay Costs
(66,720)
(94,611)
(17,811)
(16,432)
(33,156)
(15,423)
(538)
4,768
(239,923)
(5,643)
(7,703)
(1,458)
(1,368)
(2,782)
(1,285)
(42)
420
(19,862)
(4,783)
(7,259)
(1,393)
(1,206)
(2,693)
(1,189)
(1,186)
(33,335)
(46,907)
(8,919)
(8,203)
(16,757)
(7,708)
(288)
1,921
(120,196)
(31,493)
(44,584)
(8,453)
(7,729)
(16,405)
(7,535)
(5,840)
(19,709)
860
444
66
162
89
96
(1,144)
(420)
153
(122,039)
1,842
2,323
465
475
352
174
(5,551)
(1,921)
(1,843)
Non-Pay
Drugs
Clinical Supplies and Services
General Supplies and Services
Establishment Expenses
Premises Costs
Services from NHS Bodies
Services from Non NHS Providers
Other Operating Costs
Total Non-Pay Costs
(26,913)
(34,580)
(3,783)
(6,801)
(15,344)
(10,081)
(1,811)
(5,850)
(105,164)
(2,184)
(3,231)
(312)
(555)
(1,260)
(846)
(145)
(80)
(8,611)
(2,199)
(2,719)
(276)
(610)
(1,297)
(709)
(175)
(576)
(8,561)
(16)
511
36
(56)
(37)
137
(30)
(496)
50
(13,498)
(16,904)
(1,871)
(3,442)
(7,565)
(5,055)
(869)
(2,179)
(51,382)
(14,276)
(16,791)
(1,930)
(3,242)
(7,218)
(4,918)
(1,053)
(3,836)
(53,263)
(778)
113
(59)
200
347
137
(185)
(1,657)
(1,881)
28,687
2,559
2,931
372
14,296
9,777
(4,519)
(14,986)
(1,249)
(1,038)
211
(7,493)
(6,241)
21
1,252
21
(1,029)
(86)
(623)
(1,957)
11
5
()
227
(514)
(7,472)
(23,487)
(75)
5
(623)
(1,730)
(3,736)
(11,744)
(453)
29
(3,736)
(10,380)
62
29
()
1,363
5,200
602
1,201
599
2,552
(604)
(3,156)
(1,048)
1,048
0
0
(87)
87
81
81
87
(6)
81
(524)
524
()
0
(883)
490
(393)
(359)
(34)
(393)
5,200
602
1,282
680
2,552
(996)
(3,548)
(959)
(959)
323
(279)
2,552
(996)
(3,548)
EBITDA
Non Operating Items
Depreciation and Amortisation
Profit/(Loss) on Disposal
Impairment of fixed assets
Finance Costs
Interest Receivable
Public Dividend Capital Dividend
Total Non-Operating Items
Net Surplus/(Deficit)
Add back:
Donated Asset Income
Donated Asset Depreciation
Impact of Donated Asset Accounting
Impairment of Fixed Assets
Performance against Control Total
0
Add back: reversal of increase in annual leave accrual
Underlying position excluding the in-month reversal of increase in
annual leave accrual
602
4.2.
Income: The income from activities position reflects actual activity in the year to date.
4.3.
Other operating income reflects adverse variances on car park receipts (£21k) and
catering income (£13k).
4.4.
Pay: At the end of Quarter 1, in line with accounting standards, a calculation was made to
determine the extent of any liability in relation to annual leave not taken by staff for the
year to date. At that point, prior to the summer holidays, an adjustment of £959k to the
existing balance was made for the purposes of accounts reporting. At the end of Quarter
2 a similar exercise has confirmed that staff have now taken leave in line with
expectations. The adjustment has now been reversed and central pay budgets credited.
Therefore although the pay position in month looks to be in balance it includes this
technical adjustment. The in-month underlying position is that pay budgets were
exceeded by £806k (August: £524k), with agency costs incurred to cover vacancies.
-4-
Agency Expenditure
1,600
1,400
1,200
£000s
1,000
800
600
400
200
Apr
May
Jun
Jul
Aug
2010/11
Sep
2011/12
Oct
Nov
2012/13
Dec
Jan
Feb
Mar
2013/14
Agency Expenditure by Staff Group
1,000
900
800
700
600
£000s
500
400
300
200
100
Sep-12
Oct-12
Medical
4.5.
Nov-12
Dec-12
Nursing
Jan-13
Feb-13
Mar-13
Other Clinical
Apr-13
May-13
Jun-13
Admin and Clerical
Jul-13
Aug-13
Sep-13
Estates
The use of agency is to predominantly cover vacancies. The following table reallocates
year to date agency costs reported in the income and expenditure account (section 4.1)
across the different staff classifications. To clarify it, the impact of the reversal of the
increase in annual leave has been removed:
Medical Staff
Nursing Staff
Professions Allied to Medicine
/Professional and Technical
Admin & Managerial
Estates Staff
Other Pay Costs
Budget
£000s
5,685
7,703
2,826
2,782
1,285
20,282
(420)
19,862
In Month
Actual
Variance
£000s
£000s
5,912
(227)
7,848
(145)
0
2,821
6
2,800
(17)
1,288
(2)
20,668
(386)
0
(420)
20,668
(806)
Year-to-Date
Budget
Actual
Variance
£000s
£000s
£000s
33,530
34,546
(1,016)
46,907
46,155
751
17,122
16,757
7,708
122,024
(1,921)
120,103
16,990
16,663
7,684
122,039
0
122,039
132
94
24
(15)
(1,921)
(1,936)
4.6.
The table highlights that the greatest adverse variance is for medical staff where there are
a number of vacancies that are proving to be difficult to fill.
4.7.
Non-Pay: The favourable variance on clinical supplies and services reflects, in part,
increases in budget in line with the trauma and orthopaedics business case and for the
-5-
purchase of additional sets. Accruals made in previous months have been reviewed and
released where no longer applicable.
4.8.
Services from NHS bodies shows a favourable variance due to reclassification of
expenditure relating to the Care Quality Commission (£100k). It also includes a
favourable variance relating to dementia costs (£28k).
4.9.
The favourable variance against Plan on depreciation and amortisation (£211k) is, as
previously stated, due to the extension of some asset lives during the revaluation exercise
carried out at the end of last financial year.
5
Statement of Financial Position
5.1
The Statement of Financial Position is shown below.
Opening
Balance
£000s
Non-Current Assets
Property, Plant and Equipment
Intangible Fixed Assets
Trade and Other Receivables
Total Non-Current Assets
In Month
Closing
Balance
£000s
Movement
£000s
Opening
Balance
£000s
Year to Date
Closing
Balance
Movement
£000s
£000s
243,487
1,197
243,359
1,153
(128)
(44)
241,139
1,413
243,359
1,153
2,220
(260)
244,684
244,512
(172)
242,552
244,512
1,960
6,768
14,919
8,789
20,250
50,726
48
(1,437)
261
(7,658)
(8,786)
3,908
(4,878)
6,060
11,889
4,279
12,528
34,756
50,726
6,817
13,482
9,050
12,591
41,940
3,908
45,849
34,756
6,817
13,482
9,050
12,591
41,940
3,908
45,849
757
1,593
4,771
63
7,184
3,908
11,093
(37,137)
(3,421)
(900)
(59)
(508)
(42,026)
(29,827)
(3,421)
(1,158)
(90)
(508)
(35,003)
7,310
7,022
(26,921)
(2,421)
(900)
(239)
(640)
(31,121)
(29,827)
(3,421)
(1,158)
(90)
(508)
(35,003)
(2,906)
(1,000)
(258)
149
132
(3,882)
8,701
10,845
2,145
3,635
10,845
7,210
Non Current Liabilities
Working Capital Loan
Capital Investment Loan
Borrowings
Provisions for Liabilities and Charges
Total Non Current Liabilities
(11,413)
(13,271)
(2,493)
(2,574)
(29,751)
(10,203)
(15,284)
(2,463)
(2,574)
(30,525)
1,210
(2,013)
30
(773)
(2,413)
(13,271)
(2,493)
(2,574)
(20,751)
(10,203)
(15,284)
(2,463)
(2,574)
(30,525)
(7,790)
(2,013)
30
()
(9,774)
Net Assets
223,633
224,833
1,200
225,436
224,833
(603)
Taxpayers' Equity
Public Dividend Capital
Retained Earnings
Revaluation Reserve
237,784
(42,883)
28,732
237,784
(41,683)
28,732
1,200
237,785
(41,082)
28,733
237,784
(41,683)
28,732
(1)
(601)
(1)
Total Taxpayers's Equity
223,633
224,833
1,200
225,436
224,833
(603)
Current Assets
Inventories
Trade and Other Receivables
Prepayments & Accrued income
Cash and Cash Equivalents
Sub Total Current Assets
Non-Current Assets Held for Sale
Total Current Assets
Current Liabilities
Trade and Other Payables
Working Capital Loan
Capital Investment Loan
Borrowings
Provisions for Liabilities and Charges
Total Current Liabilities
Net Current Assets/(Liabilities)
(258)
(30)
5.2
The capital position is set out overleaf. In month expenditure is £792k behind Plan with
year to date slippage being £2,953k.
5.3
As reported last month, although delays to the procurement of breast clinic equipment
(£1m) and general medical equipment (£708k) have occurred, orders have now been
placed and expenditure will be incurred during this quarter. A delay has also occurred
with the new Medical Records building at Southlands (£300k), however this is now
commencing in October. Also at Southlands, the delayed infrastructure scheme (£371k)
will commence now that approval has been granted for the new boiler. All of these
schemes are still forecast to be delivered by the end of the financial year.
-6-
CAPITAL PROGRAMME 2013/14: as at 30th September 2013
Capital Resource
Capital Programme "core" resource
2013/14 Plan
£000s
13,837
Capital resource brought forward
6,402
Capital resource brought forward - Breast Unit
6,286
New Capital Investment Loan - Emergency Floor
4,224
less: Capital Investment Loan Repayments on:
0
Existing loans
(900)
New loans
(169)
Improving the birthing environment (PDC receivable in 13/14)
350
Donations - Love Your Hospital
375
Donations - Friends
375
Donations - CT Scanner (Friends/Love Your Hospital)
828
545
Net receipts from disposal of surplus assets - Thakeham House
32,153
-7-
In Month
Expenditure
2013/14 Plan
£000s
Budget
£000s
Year to Date
Actual
£000s
Variance
£000s
Budget
£000s
Actual
£000s
Variance
£000s
Charitable additions
Charitable donation expenditure
(750)
(100)
0
100
(150)
(55)
95
CT Scanner
CT Scanner & Equipment
CT Scanner - Building works
(1,017)
0
(2)
(2)
(850)
(838)
12
(300)
0
(1)
(1)
(300)
(101)
199
(1,317)
0
(3)
(3)
(1,150)
(938)
212
(4,224)
(423)
(397)
26
(721)
(851)
(130)
Emergency Floor
Emergency Floor
Breast Care Centre
Breast Screening - New Build
(4,187)
(450)
(576)
(126)
(2,520)
(2,787)
(267)
Breast screening - New Build Equipping
(2,500)
(1,000)
0
1,000
(1,000)
0
1,000
(6,687)
(1,450)
(576)
874
(3,520)
(2,787)
733
408
Medical equipment
(1,508)
(100)
(17)
83
(589)
(181)
Theatre high priority capital items
(258)
0
(34)
(34)
(258)
(239)
19
Equip a theatre at Worthing (proposed CIP to increase T&O income)
(173)
0
0
0
(173)
(68)
105
General medical equipment
Endoscopy scopes
Ultrasound (obstetric) equipment replacement
(17)
0
0
0
(17)
0
17
(240)
0
(76)
(76)
(240)
(76)
164
(139)
0
0
0
(139)
(144)
(5)
(2,335)
(100)
(128)
(28)
(1,416)
(708)
708
Day Surgery Conversions - pre admission Chanctonbury
(825)
(250)
(41)
209
(420)
(366)
54
MFU / ENT consolidation
(267)
0
(220)
(220)
(267)
(407)
(140)
SSD - centralisation of ENT probes
Pre-Admissions
Day Surgery dependency - Refurb ENT for DOME offices
(357)
(27)
(3)
24
(330)
(229)
101
(1,449)
(277)
(264)
13
(1,017)
(1,002)
15
-8-
In Month
Expenditure
2013/14 Plan
£000s
Budget
£000s
Year to Date
Actual
£000s
Variance
£000s
Budget
£000s
Actual
£000s
Variance
£000s
Southlands
Southlands Ophthalmology
(600)
(300)
0
300
(370)
0
Southlands Infrastructure
(660)
(200)
(26)
174
(460)
(89)
370
371
(1,260)
(500)
(26)
474
(830)
(89)
741
Interventional Room - Equipping
(589)
(200)
0
200
(289)
0
289
Interventional Room - Reporting rooms
(903)
(108)
(46)
62
(903)
(743)
160
Interventional Rroom - Build costs
(500)
0
0
0
0
0
0
Interventional Room - Equipping
(489)
0
0
0
0
0
0
(2,481)
(308)
(46)
262
(1,192)
(743)
449
Endoscopy
(600)
0
0
0
0
11
11
Endoscopy
(642)
0
0
0
0
0
0
Pre-assessment relocation (dependency for Endoscopy programme Worthing
(350)
0
0
0
0
0
0
(1,592)
0
0
0
0
11
11
(250)
0
(87)
(87)
(25)
(122)
(97)
Diagnostic Block Roofs
(150)
(50)
0
50
(150)
9
159
Move Chemistry into Haematology Lab, incl. consultants & secretaries
(100)
0
(1)
(1)
0
(1)
(1)
(50)
0
0
0
0
0
0
0
0
0
0
0
0
0
(70)
0
0
0
0
0
0
Imaging - Interventional Radiology
Endoscopy
Worthing Health Education Centre
Education Centre
Pathology
Order Comms: Tablets / hardware only
Worthing refurbishment
Worthing Maintenance
Purchase of Blood Track Courier Fridge Control System
Pathology re-modelling of vacant space
(26)
0
0
0
0
0
0
(124)
56
(8)
(64)
(124)
(9)
115
(520)
6
(9)
(15)
(274)
(1)
273
-9-
In Month
Expenditure
2013/14 Plan
£000s
Budget
£000s
Actual
£000s
Year to Date
Variance
£000s
Budget
£000s
Actual
£000s
Variance
£000s
Forecast
Outturn
£000s
Estates enabled schemes
Sustainability Initiatives
(550)
(100)
(15)
85
(350)
(80)
SRH Additional Infrastructure - Path MES
(784)
0
0
0
0
0
270
0
West Wing Refurbishment - Infrastructure
(978)
(250)
(18)
232
(573)
(14)
559
Main Ward Block upgrades (lighting upgrades etc)
(320)
(50)
(100)
(50)
(100)
(118)
(18)
Lift refurbishment programme
(270)
(25)
0
25
(45)
0
45
Outpatient department
(345)
(100)
(11)
89
(200)
(54)
146
(50)
0
0
0
0
0
0
Targeted Backlog: High risk remedial
(290)
0
(85)
(85)
(265)
(276)
(11)
Targeted Backlog: Built environment infrastructure
(200)
(95)
(8)
87
(200)
(47)
153
Targeted backlog: M&E backlog
(270)
0
0
0
0
(3)
(3)
Fire: Compliance with standards
(434)
(50)
2
52
(130)
(21)
109
ITU refurbishment
(50)
0
0
0
0
0
0
Catering Project
(240)
(40)
(17)
23
(180)
(247)
(67)
Minor works and small schemes
(803)
(100)
(103)
(3)
(564)
(672)
(108)
(15)
0
0
0
0
0
0
(120)
0
0
0
(50)
0
50
Bicycle Racking
(45)
0
0
0
0
0
0
Non Medical Equipment
(50)
0
0
0
(20)
0
20
(5,814)
(810)
(355)
455
(2,677)
(1,533)
1,144
(1,640)
(1,560)
(2,626)
(1,066)
(1,640)
(2,691)
(1,051)
0
(257)
(257)
0
(257)
(257)
(80)
0
0
0
0
0
PACS
(287)
0
0
0
(287)
(288)
(1)
IT maintenance / PC refresh etc
(377)
(25)
0
25
(97)
0
97
(19)
0
0
0
(19)
(25)
(6)
(150)
0
0
0
0
0
0
(416)
0
0
0
0
0
0
(2)
Residential Accommodation improvements
Security
PLACE (was PEAT)
IM&T enabled solutions
IM&T infrastructure and resilience (procurement)
Call Management System
IT Server Location
Clinical systems
Medical Revalidation and Appraisal
E-prescribing
Maternity Information system (community solution)
Critical Care Information System
Theatre system
Unallocated
(75)
0
0
0
(40)
(42)
(312)
0
0
0
0
0
0
(20)
(20)
0
20
(20)
0
20
(3,376)
(1,605)
(2,883)
(1,278)
(2,103)
(3,304)
(1,201)
(5,567)
(4,775)
792
(15,075)
(12,122)
2,953
(98)
(32,153)
- 10 -
To: Board
Date of Meeting: 31 October 2013
Agenda Item: 10
Title
Annual Plan and Board Assurance Framework 2013/14: Quarter 2 Review
Responsible Executive Directors
Marianne Griffiths, Chief Executive
Denise Farmer, Director of Organisational Development & Leadership
Prepared by
Oliver Philips, Head of Strategic Planning
Ann Merricks, Company Secretary
Status
Disclosable
Summary of Paper
At its meeting in April 2013 the Board approved the Trust’s Annual Plan for 2013/14, which detailed how the
Trust would achieve the corporate objectives it had set itself for the year, delivered through a range of
programmes, each with key aims, work-streams, milestones and measures of success identified.
The Board also approved a Board Assurance Framework (BAF) for the financial year. The BAF sets out and
rates the principal risks to the achievement of the Trust’s corporate objectives for the year, together with the
controls and sources of assurance through which the risks are managed. The BAF states that it will be
subject to review following the end of each quarter and that in-depth risk reviews will be undertaken through
a schedule approved by the Board.
This paper jointly presents a review at the end of quarter two of the Annual Plan delivery, reviewing progress
against delivery of the corporate objectives, and the BAF which assesses the risks to the achievement of
these objectives
Implications for Quality of Care
A number of the risks within the register extract present implications for care. The BAF is an inherent part of
the arrangements through which management addresses those implications.
Link to Strategic Objectives/Board Assurance Framework
The BAF forms an important part of the Trust’s risk management arrangements, linked to the Risk Register.
Financial Implications
A number of the risks within the BAF present financial implications. The BAF is an inherent part of the
arrangements through which management addresses those implications.
Human Resource Implications
A number of the risks within the BAF present human resource implications. The BAF is an inherent part of
the arrangements through which management addresses those implications.
This report can be made available in other formats and in other languages. To discuss your requirements please
contact Graham Lawrence, Company Secretary, on [email protected] or 01903 285288.
Recommendation
The Board is asked to:
a) REVIEW and NOTE progress against the Annual Plan 2013/14;
b) REVIEW and NOTE the Board Assurance Framework.
Communication and Consultation
Chief Executive, Executive Directors, Directors of Clinical Services
Appendices
Corporate Objectives Progress Report
Board Assurance Framework
This report can be made available in other formats and in other languages. To discuss your requirements please
contact Graham Lawrence, Company Secretary, on [email protected] or 01903 285288.
WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST
To:
Board
From: Oliver Phillips, Head of Strategic Planning
Date: 31 October 2013
Agenda Item: 10
Ann Merricks, Interim Company Secretary
FOR DECISION
ANNUAL PLAN AND BOARD ASSURANCE FRAMEWORK 2013/14: QUARTER 2 REVIEW
1.00
INTRODUCTION
1.01
At its meeting in April 2013 the Board approved the Trust’s Annual Plan for 2013/14, which
detailed how the Trust would achieve the corporate objectives it had set itself for the year,
delivered through a range of programmes, each with key aims, work-streams, milestones and
measures of success identified.
1.02
The Board also approved a Board Assurance Framework (BAF) for the financial year. The BAF
sets out and rates the principal risks to the achievement of the Trust’s corporate objectives for the
year, together with the controls and sources of assurance through which the risks are managed.
The BAF states that it will be subject to review following the end of each quarter and that in-depth
risk reviews will be undertaken through a schedule approved by the Board.
1.03
This paper jointly presents a review at the end of quarter four (year-end) of the Annual Plan
delivery, reviewing progress against delivery of the corporate objectives, and the BAF which
assesses the risks to the achievement of these objectives.
2.00
RECOMMENDATIONS
The Board is asked to:
a) REVIEW and NOTE outcomes against the Annual Plan 2013/14;
b) REVIEW and NOTE the Board Assurance Framework.
3.00
PROGRESS ON DELIVERING THE ANNUAL PLAN
3.01
Every year the Trust publishes its Annual Plan, which outlines how the Trust will achieve its
corporate objectives for the year. For 2013-14 the Trust agreed corporate objectives for the year,
linked back to the strategic themes of patient experience, outcomes, safety, providing local
services, being joined-up, improvement and sustainability.
3.02
Corporate delivery programmes were put in place to ensure that these corporate objectives were
delivered. Each of these corporate delivery programmes were detailed in the Annual Plan,
outlining the aims of the programme, the key work streams, the measures of success to be used
and the corporate objectives supported. Where appropriate, quarterly milestones were also
identified.
3.03
This report will be provided to Board quarterly to update the Board on progress against each of the
corporate delivery programmes. This report (Appendix 1) summarises the key aims and work-
streams of each programme to the end of quarter 2, reporting on progress and the programme
status. Please refer to the Trust’s Dashboards where outcome measures are reported.
4.00
CORPORATE OBJECTIVES - AT A GLANCE
4.01
This quarterly report is structured against our seven strategic objectives ‘We Care’. There are 14
corporate objectives (labeled A1 to G3) – which in turn are supported by 25 groups of delivery
programmes. Each group of delivery programmes has been RAG rated.
4.02
Good progress has been made across the range of objectives. There is only 1 Red rating where
progress is significantly behind expectation. This relates to corporate objective C1 - Deliver the
patient safety gains specified in the Quality Strategy. The Trust has reported a C.Difficle rate at
the end of Q2 of 37 cases. The upper limit is 46 for the 2013-14 year. A number of actions and
improvements have been put into place during Q2 to improve performance and there has been a
reduction in reporting during the quarter to 12 from 25 in Q1.
5.00
REVIEW OF THE BOARD ASSURANCE FRAMEWORK
5.01
Executive Directors have reviewed the risks assigned to them, assessing the validity of the risks,
their gross and net ratings, and the effectiveness of the controls and sources of assurance used to
manage the risks.
5.02
Changes to the net and gross ratings, the effectiveness of controls and actions required are shown
in the BAF in bold and summarised below:
A1.1We incur adverse feedback regarding patient experience from our patients and the public and
media
Net risk rating reduced in light of positive friends and family results to date
B1.1 We fail to implement care pathways adequately in order to improve mortality
Net risk increased in light of #neck of femur reports
C1.2 Financial penalties due to failure to maintain appropriate standards and thresholds
Gross and net risks both increased in light of numbers of Clostridium Difficile
D1.1 the trust does not have capacity to deliver changes at the scale and pace envisaged.
Net risk increased due to pace of change
F1.3 External approval for business cases not granted in timescale anticipated
Risk no longer applicable as foundation trust status achieved
F3.2 The Executive Team does not have the capacity to deliver an agreed IM&T strategy
Risk reduced as Executive team have approved the strategy
F3.3 There is insufficient internal capacity to support IT infrastructure changes
Risk increased due to pace of change
G1.1 We fail to deliver the CIP programme
Net risk increased in light of current financial position
G1.2 FT application process diverts focus from financial management and control
Risk no longer applicable









5.03
Alongside the review of the BAF, in accordance with the schedule approved by the Board, one risk
has been subject to an in-depth review:

5.04
E2: We don’t reap the benefits of a Council of Governors as part of our development as an FT
The in-depth review report is presented for discussion alongside the amended BAF.
Page 2 of 12
Corporate Objectives 2013-14 – Quarter 2 Progress Report
We care about….
…You
Corporate
Objective
Measures of success
Primary delivery
programmes
1. National Maternity
survey & Action Plan
[A1] Increase the
number of staff and
patients who would
recommend the Trust
to family and friends
Executive Lead:
DNPS
1. Improved score for patient rating of overall
quality of care in national surveys (outpatient and
inpatient), with the longer-term aim of being in the
2. National Inpatient
top 20%
survey & Action Plan
2. Maintain excellent rating in Care and
Compassion peer review
3. National Cancer
3. Overall quality of service for cancer services
Patient Experience
4. Improved continuity of care in the antenatal
Survey
period (2010 - 34%)
5. Reduced time taken between birth and suturing
4. National
of the perineum (2010 - 58%)
Chemotherapy Patient
6. Increased signposting of women to the NHS
Experience Survey
choices website (2010 - 26%)
Real-time patient
7. Improved patient experience feedback using
feedback programmes to real-time feedback for overall quality of service
include:
[2013-14 Improvement targets agreed in Q1 at
1. Inpatient
Quality Board]
2. Outpatient
3. Maternity & Children's
services
4. Cancer experience
pilot
Quarter 2
Commentary
1. National Inpatient improvement plan
implemented in line with approved schedule
1. National Inpatient survey improvement plan implemented in line with
approved schedule.
2. National Cancer & Chemotherapy Surveys
published - improvement areas identified and
improvement plan approved
2. National Cancer & Chemotherapy Surveys published - improvement
areas identified and improvement plan approved.
RAG
Amber
1. Incorporate Friends & Family responses into
standing Quarterly Clinical Governance agendas
2. Include safety thermometer findings into
standing Quarterly Clinical Governance agendas
3. Review provider options of real-time patient
experience portals
4. Evaluation of cancer experience real-time
feedback pilot to determine effectiveness, and
develop approach for future programme
1. New Head of Patient Experience recruited and working with Head of
Clinical governance to ensure that Friends & Family responses are
incorporated into standing Quarterly Clinical Governance agendas.
Trust has been one of the best performing Trusts in the south east for
the Friends & Family test.
2. Safety thermometer findings to be included into standing Quarterly
Clinical Governance agendas as from Q3. Trust has always positively
exceeded national benchmarks with inhospital harm free care
consistently greater than 98%.
Green
3. Evaluation of cancer experience real-time feedback pilot being
undertaken by Lead Nurse for Cancer.
1. Inpatient Friends &
Family survey
programme
8. Improved Friends and Family national survey
results with the aim of achieving upper quartile
performance
1. Review nationally published comparative data 1. Nationally published comparative data reviewed and Trust is
to identify improvement potential relative to peers performing in the upper quartile for Net Promoter scores.
2. Development & implementation of Divisional
2. A&E Friends & Family 2013-14 Improvement targets agreed in Q12 at
improvement plans
survey programme
Quality Board when comparative data is available
2. Development & implementation of Divisional improvement plans in
place in respect of response rate %'s.
3. Maternity Friends and Familty ahead of implementation plan.
Amber
We care about….
…You
Corporate
Objective
Measures of success
[A1] Increase the
number of staff and
patients who would
recommend the Trust
to family and friends
Executive Lead:
DLOD
Primary delivery
programmes
1. Staff survey action
9. Improved staff survey results – top 20% for
plan (refreshed for 13/14) national surveys
10. 10% improvement in staff who know how to
2. Management &
raise a concern (2012-13 baseline 70%) and are
Leadership Development confident to do so (2012-13 baseline 55%)
Programme (MDP)
11. Improved staff sickness and retention rates by
supporting health & wellbeing
12. Reduced number of staff to staff complaints
from 2012 baseline
13. 20% reduction in number of formal behaviour
management, discipline and capability cases
(2012 baseline - 53 cases)
1. Improving the
Outpatient Experience
2. Referral to Treatment
[A1] Increase the pathway management
number of staff and
patients who would
recommend the Trust
to family and friends
Executive Lead: COO
Quarter 2
Commentary
1. Quarterly reporting to Quality Board by
Divisions
1. Family and Friends tests reported to Trust Board on a monthly basis
2. Health Improvement Plan - key milestones
from the plan to be reported
3. Refreshed MDP implemented in line with
agreed schedule
14. Outpatient contact rate reduced to 0.098 per 1. IT testing concluded for outpatient partial
10,000 outpatient attendances (from 0.10 in 2012- booking for ophthalmology patients; implemented
13), against an agreed demand plan and resource in line with agreed schedule
allocation
2. Procurement and implementation of call
15. Improve perception of staff attitude and
handling system; training to appropriate staff
behaviour resulting in a reduced number of
delivered
complaints in hotspot areas from 2012-13
baseline, with a focus on Ophthalmology and
3. Review of 18 week solution and resultant
Trauma & Orthopaedic appointments in the first performance, triangulated against the number of
instance
complaints/enquiries
RAG
2. Series of staff engagement events held within divisions . Health and
Wellbeing programmes agreed including Fit2Work, Rapid Access to
Physiotherapy, Stress Management and Awareness Training.
3. MDP updated and revised programme delivered from July 2013.
Green
4. Real time staff feedback extended to all Health and Safety days and
by Division. Results demonstrating an improving position
1. Partial booking roll out to be piloted in late Q3, with extended role
out in Q4.
2. Business case, and resultant procurement process completed in Q2.
Roll out of preferred call handling system due to complete in November
2013.
3. In addition to partial booking solution to reduce negative patient
experience through the rescheduling of patient appointments, a
dedicated phone line staffed by Access Management has been
established to pick up calls routed to PALs. From October 2013, this
dedicated resource will have the facility to book/rebook the patient to
resolve the call in real time. In addition, this function with collate key
themes for patient enquiries, and engage the Surgical Divisional team
to ensure mitigation plans are developed and enacted.
Green
Page 2 of 12
We care about….
Primary delivery
Corporate Objective
programmes
1. CQUIN delivery
…Quality
Measures of success
Quarter 2
1. Achieve a HSMR or <100 by the end of 201314.
2. CQUIN indicators achieved that relate to
2. Enhanced Recovery
quality of care (as agreed by commissioners)
Programmes
3. Most significant areas of care resulting in high
[B1] Deliver the
mortality targeted, through pathway specific
quality outcome gains 3. Enhancing Quality
standardisation using the care bundle approach,
specified in the
focusing on hip fracture, pneumonia, COPD and
4. Implementing care
Trust’s Quality
heart failure, monitored through HSMR
bundles
Strategy, and
4. Acute Kidney Injury care bundle implemented
demonstrate full
in line with agreed programme
compliance against 5. Fractured Hip
Monitor’s Quality Improvement Programme 5. Reduced 30-day mortality following hip fracture
so that the trust lies within the middle two
Governance
quartiles of mortality in the National Hip Fracture
6.Mortality & Morbidity
Framework
Database
Reviews
6. Continued achievement of maternity CNST
Executive Lead: MD
level 2 indicators
7. Safe Maternity Care
(CNST Level 2)
1. CQUIN / EQ: integrated dashboard developed
and implemented; delivered in line with agreed
schedule
Implementation of the
[B1] Deliver the
quality outcome gains Trust’s Quality
Governance Action Plan
specified in the
Trust’s Quality
Strategy, and
demonstrate full
compliance against
Monitor’s Quality
Governance
Framework
1. Quality Strategy refreshed
7. Continue to improve our assessment score
against the ten areas in Monitor's Quality
Governance Framework
2. Introduce telemedicine supported 24/7
thrombolysis across WSHT
3. Implement all actions from Moran Report
regarding fractured hip pathway
Commentary
RAG
1. EQ CQUIN Measures are being closely monitored and managed
through the CQUIN Delivery Board and the risks of non-delivery have
been reduced since the beginning of the year.
2. Introduction of telemedicine thrombolysis progressing and testing of
remote IT systems have been undertaken. Constraints exist around job
planning and changes to consultant rotas which are being actively
reviewed. Proposed implementation of the service at SRH (to bring
inline with Worthing) during Q3.
Amber
4. M&M revised ToR implemented
5. Maintained CNST level 2 indicator
3. Actions from the Moran report have been adopted into the Divisional
plans and are monitored for delivery as part of the monthly DIP meeting.
4. Revised ToR for M&M meetings have been approved and are being
implemented across the Trust.
5. CNST - monitoring of clinical practice via audits continued and
meeting scheduled with the NHSLA assessor in October to review
progress.
2. QRC to review clinical audit (6 monthly)
3. Improve benchmarking available to Divisions
1. The Trust's Quality strategy is to be refreshed alongside the
refreshed clinical strategy, which will go to the Board for final approval
in the 4th quarter of 2013/14. The strategy will not be finalised until the
newly appointed Medical Director is in place and can help influence the
direction of the strategy.
Amber
2. QRC in September received a 6-monthly clinical audit review.
Executive Lead: MD
1. Readmissions Service 1. Reduced 30-day readmission rate in line with
Improvement Programme our agreement with Commissioners
2. Enhancing quality
[B2] Reduce our rates
3. Implementing care
of avoidable
bundles
readmissions
Executive Lead: COO
2. Demonstrated improvements in readmission
rates for focused patient cohorts (e.g. by
diagnosis chapter or group)
1. Audit to identify improvements in patient
pathways for specific patient cohorts completed
2. Improvement plan developed and agreed
3. Commence development of business case, as
appropriate, to reinvest any financial penalties
from the Local Health Economy to prevent future
readmissions
Clinical review of emergency re-admissions was completed July 2013;
191 case notes were reviewed. From this sample, 31 episodes were
classified as ‘avoidable re-admissions’. This figure has been agreed by
the clinical leads & CCG for this programme.
Feedback presentation for review participants held at Fontwell Park
Racecourse in September 2013 to promote discussion for potential
solutions. Fifteen themes were identified to explore further, and the
Trust is working with the CCG to identify potential solutions and
reinvestment.
Green
Page 3 of 12
We care about….
Corporate Objective
Primary delivery
programmes
Safety Thermometer
Programme:
Catheter care
VTE
Falls
Pressure Ulcers
[C1] Deliver the
patient safety gains
specified in the
Quality Strategy
Executive Lead:
DNPS
…Safety
Measures of success
Quarter 2
1. Internal Safety Thermometer - 95% harm free,
97% no new hospital acquired harms
2. Improved Trust Patient Aggregate Safety Score
(PASS) score, of <100 compared to 13-14
baseline
3. No Never Events recorded
1. Progress reported against catheter
improvement plan
2. Update on national falls programme benchmarking with peers. Refresh our plans
accordingly based on priorities.
5. Safety thermometer newsletter published
within the Trust
6. Develop guidelines for care of moisture sores
to ensure reduced incidents of - reduce catheter
use, pr exp & skin care
7. agree baseline figures and set a target
Implement promotional drive to improve sore
caused by
8. Develop a pressure ulcer incident improvement
plan for maternity services
1. Tender responses received and evaluated
4. Improved safety of prescribing by making
demonstrable improvement in three specific
Electronic Prescribing aspects of prescribing, as identified in the annual 2. Full business case submitted to Trust Board
and Medicines
baseline full prescribing audit and implementation for approval to award
Management
of an Electronic Prescribing and Medicines
Management system
Infection Control
programme
5. Zero avoidable MRSA bloodstream infections
that are hospital acquired, taking measures to
protect the patient and aiming to remain free of
avoidable MRSA
6. Reduced Clostridium Difficile cases to within a
revised limit of 46 for 2013/14 (from a limit of 75 in
2013/14)
1. Continue to demonstrate high Infection Control
standards
2. Environment audits continued and results
reviewed, with improvement plans developed
where appropriate
3. Continue visibility and communication of
Infection Control team
4. Infection Control video clip created to share
across the Trust
Commentary
RAG
1. Integrated plan of implementation regarding catheter care underway.
2. Falls Link Nurse programme implemented across Trust with 23
wards having nominated link nurses. Incidence of falls causing harm
remains below national average. Falls assessment compliance above
90% through Q2.
3. Safety Thermometer monthly report reviewed at Heads of Nursing
meetings, regular newsletter in place to support these reports.
4. Safety Thermometer new harms target achieved through quarter ,
CQUIN target relating to falls agreed during quarter - Q2 robustly
achieved.
Maternity pressure ulcer action plan agreed and implemented through
Q2 . Effectiveness being monitored through Q3
1. Procurement process commenced as planned - although supplier
responses were not as anticipated. Tender process re-started using
OJEU process (not framework) with responses due during Q3. FBC
submission due in Q4.
1. MRSA bacteraemia - two cases for 2013/14 to date. One case
deemed to be avoidable and one case unavoidable.
2. C.difficile rates above trajectory - 25 cases for Q1 & 12 cases for Q2.
3. Weekly C.difficile task force meetings in place since March. Ongoing focus on the environment , antimicrobial prescribing and isolation
practice.
4. Significant reduction in C.difficle reporting during Q2 to 12 from 25 in
Q1.
Amber
Amber
Red
Page 4 of 12
We care about….
Corporate Objective
Primary delivery
programmes
…Safety
Measures of success
7. Demonstrated compliance with national water
Facilities and estates standards & guidance on water sampling
environment
assessments
1. Food Strategy
Group programme
2. Intentional
[C1] Deliver the
patient safety gains Rounding
specified in the
3. Catering facilities
Quality Strategy
programme
Executive Lead:
DNPS
8. Achieved MUST scores of 80% at 24 hours &
95% at 7 days
9. Demonstrated improvements in recording
patient weights at appropriate points in their
pathway
10. 100% compliance with World Health
Organisation (WHO) Theatre Checklist
11. 100% theatres maintained in a rolling 12month period
12. Theatre staff sickness < 3.5%
Theatres Action Plan 13. >95% eligible theatre staff have an up-to-date
appraisal
14. 95% compliance with high impact
interventions
15. 85% theatre utilisation (list utilisation)
Quarter 2
1. Mitigation plan implemented in line with agreed
schedule
Commentary
RAG
Water hygiene requirements achieved.
Green
1. Review performance against MUST screening 1. Full compliance with 24hrs and 7 days targets for MUST (including
indicators and develop improvement plans where weights) through Q2.
appropriate
2. Intentional rounding implemented across all areas , audit of
compliance embedded within matron documentation rounds.
3. Dining companions implemented Trust-wide.
1. Report progress against Phase II Theatre
Service Improvement Plan
2. Leadership development programme evaluated
against agreed competency framework
3. Theatre tray tracking software implemented
4. Audit programme on track
1. Booking and list management processes currently under scrutiny
and review. Following process mapping a new pre-operative pathway
has been tested on both sites.
2. Senior nurse competency programme completed.
3.Tray tracking saction plan in place.
4. High Impact Innovations audit programme in place
Green
Green
Page 5 of 12
We care about….
Corporate Objective
Primary delivery programmes
Emergency Floor development
Breast Screening Unit development
…Serving local people
Quarter 2
Interventional Radiology
Executive Leads:
COO / DODL
Theatre pre-admission environment
Endoscopy services
Deliver alignment between the Clinical
Services Strategy and Capital Investment
Programme
RAG
1. Review of Job Plans to assess 7 day working
opportunity. Development of OBC
2. Review of equipment to ascertain transfers and
new items
1. 7-day working Programme Development Group established in Q2 and
initial scoping due to be complete in Q3.
2. Construction of the Emergency Floor at Worthing underway and on
schedule for completion winter 2014. Operational planning including
transfer of equipment has commenced.
Green
1. Construction in line with agreed schedule
2. Staff recruitment drive
1. Construction of unit nearing completion, and opening planned for
early New Year.
2. Service development in preparation for transition underway including
recruitment.
Green
1. Strategy for Southlands Hospital under development. Ophthalmology
market assessment completed and timeline for business case
development drafted.
2. OBC anticipated for Board review in Q4; progress slower than
anticipated due to complex nature of the development and dependency
with sale of surplus estate on the site to support the required
investment.
Amber
Southlands ambulatory care development 1. Strategic partnerships explored to determine
benefits of collaboration
2. OBC approved by Trust Board
[D1] Implement our
long-term Clinical
Services Strategy
Commentary
1. Complete construction at SRH & commission
new IR room
2. Develop and implement Standard Operating
Procedures for new IR equipment at SRH
3. Trust Board approval to proceed with Worthing
IR solution
1. SRH reporting rooms completed in Q2 with the Interventional room
due for completion in mid October 2013. Delayed due to problems
encountered with the structural integrity of the existing building.
2. SOP's being developed and training of staff planned.
3. Scope of IR business case for Worthing has increased to incorporate
improvements to A&E department. This change has resulted in delays
developing the business case. Options appraisal undertaken and OBC
scheduled for Q3.
1. Construction in line with agreed schedule
1. First major phase of the scheme was complete during Q2 as per
schedule. Remaining 2 phases due for completion during Q3.
Amber
Green
1. Business case approved for capital investment 1. A draft OBC was presented to Finance & Investment Committee in
at SRH
July 2013. Since then, detailed planning has been underway to develop
2. Commence construction at SRH
solutions for both SRH & Worthing. OBC scheduled for Board
consideration October 2013 proposing immediate commencement of
works at SRH and a detailed FBC for Worthing for Board consideration
January 2014.
Amber
1. Quarterly capital expenditure reviewed against
forecast
2. Quarterly Strategy Group review of capital
programme
Amber
1. Capital expenditure monitored monthly by Finance & Investment
Committee. Capital programme for 2013-16 being developed in line with
Clinical Services Strategy refresh; due for Board consideration
December 2013.
Page 6 of 12
We care about….
Corporate Objective
…Being stronger together
Primary delivery
Measures of success
programmes
1. Unscheduled care 1. Achieve agreed milestones in line with
programme Plans
pathways
Quarter 2
Green
2. Trust actively engaged with CCG's plans to commission Dermatology
AQP provision and MSK prime provider model.
Executive Lead: COO
Executive Lead: DODL
RAG
1. OCOT programme and implementation plan in place and monitored
weekly, Performance improving month on month. Evaluation, service
specifications and prime provider contractual arrangements ready to be
finalised in Q3. CCG to develop a programme budget approach with a
lead provider for the whole "Reactive Care" pathway. Planning to
commence in 2014/15 Q1
[E1] In partnership with our
emerging CCG, develop our 2. Planned care
lead role in the local health pathways
economy for unscheduled
and planned care pathways
[E2] Ensure a successful
and engaged Council of
Governors
Commentary
1. Deliver agreed programme plan milestones
Council of Governors 1. Induction Programme delivered with positive
Development
evaluation
Programme
2. Council of Governors development schedule
3. Membership engagement and recruitment
events held in line with agreed 13-14 schedule.
4. Positive evaluation feedback from the Annual
Member Event
5. Improvements in feedback from governors
1. Lead Governor appointed and ratified by
Council in July.
2. Skills review of Council completed.
3. Nomination and Remuneration Committee
established - ToR approved
1. Membership engagement and recruitment events have continued in
this quarter in line with the agreed 2013-14 schedule and include taking
part in an open event organised by the newly formed HealthWatch
Sussex.
2. Annual Members' Meeting went ahead as planned in July with
positive feedback from the vast majority of attendees.
3. Council have agreed to election of Lead Governor in October, and to
set up Nomination and Remuneration Committee in November.
Green
Page 7 of 12
We care about….
Primary delivery
Corporate Objective
programmes
1. Capital investment
programme
2. Refurbishment
[F1] Continue to
improve the patient programme
environment through 3. PLACE
net investment in the programme
Trust’s Estate
…Improvement
Measures of success
Commentary
RAG
1. Commencement of pre-admission area on
Chanctonbury ward, Worthing
1. Pre-admission improvements underway and major phase complete in
2. Commencement of Endoscopy development at line with agreed schedule.
SRH
2. Endoscopy development at SRH delayed due to further development
3. Delivery of refurbishment programme in line
required of the business case. OBC planned for Board consideration
with agreed schedule
October 2013.
4. PLACE - undertake a formal at Southlands
3. Refurbishment plan underway as per plan e.g. outpatients at SRH,
Hospital
West Wing at Worthing and sustainability improvements.
4. PLACE scores returned for Worthing & SRH; all areas scored higher
than the national average.
1. Increased Staff Engagement indicator in the
national staff survey from 3.68 to 3.75, with the
longer-term aim of achieving upper quartile
performance
2. Improved staff retention rates
3. Improved patient feedback (national surveys &
real-time) regarding their experience
1. Set of staff standards and behaviours
developed following survey
1. Standards of behaviours established and agreed. Appraisal policy to
be updated.
2. Improving Customer Care Staff Conference
held
2. Staff Conference held on 17 September with over 190 delegates
Hospital Hero for Customer Care awarded and presented at Staff
Conference
Executive Lead: DoF
Improving Customer
Care Service
Improvement
Programme
Quarter 2
1. Improved condition of the Trust’s Estate by
raising standards to category B through
investment into routine maintenance and the
Trust’s Capital programme
2. Achieved standards for 'Patient-led
Assessments of our Care Environment' (PLACE)
covering food, environment and privacy & dignity
3. Set of staff standards and behaviours approved
by SIB
3. Staff Survey 2013 launched 23 September.
Green
Green
4. Hospital Hero for Customer Care awarded (part 4. Staff turnover rates fell to 7.7% at end of August 2013.
of star awards)
1. Reduced 30-day readmission rate in line with
our agreement with Commissioners
2. Demonstrated improvements in readmission
rates for specific patient cohorts (by diagnosis
chapter or group)
[F2] Deliver
coordinated service 2. OneCall OneTeam 3. Improvement plan agreed and implemented to
coordinate reductions in readmissions across the
lead provider
improvement
local health economy
programmes across programme
the Trust
1. Reducing avoidable
readmissions Service
Improvement
Programme|
Executive Lead:
DODL
Improving Imaging
and Diagnostic
pathways Service
Improvement
Programme
1. Active clinical engagement through the
appointment of clinical leads acting within an
agreed governance structure
2. Improved operational performance relative to
peers
3. Integrated business meetings held for all
modalities
4. Demonstrated achievement of efficiencies
5. Workforce reviewed to ensure skills and
capacity match demand forecasts
1. Identification of service improvement areas
2. Support to programme manage available:
Development of future
initiatives delivered on time and within allocated
initiatives and
resources; timely escalation of risk
programme
management function
1. Audit to identify improvements in patient
pathways for specific patient cohorts completed
2. Improvement plan developed and agreed
3. Business case developed, as appropriate, to
reinvest any financial penalties from the Local
Health Economy to prevent future readmissions
4. IT systems reviewed to identify readmitted
patients
Clinical review of emergency re-admissions was completed July 2013;
191 case notes were reviewed. From this sample, 31 episodes were
classified as ‘avoidable re-admissions’. This figure has been agreed by
the clinical leads & CCG for this programme.
Feedback presentation for review participants held at Fontwell Park
Racecourse in September 2013 to promote discussion for potential
solutions. Fifteen themes were identified to explore further, and the
Trust is working with the CCG to identify potential solutions and
reinvestment.
1. Implementation of service improvement plan in Service improvement programme has made significant progress since
line with agreed schedule
commencement in July. Focus on MRI modality currently and key
themes include implementation of a new referral process, review of
clinical protocols, review of booking processes, establishment of regular
Trust meetings to assist integration, review of duty radiologist.
Strong clinical leadership and engagement for the programme, with
interim change programme management support extended until
December during Q2 .
1. Benchmarking and scoping undertaken to
ascertain potential service improvement areas
2. Programme management arrangements
implemented
1. Surgical breast pathways identified for review which commenced
during Q2; initial findings due early Q3.
2. Service change team recruitment process commenced during Q2
with appointments due in Q3. Change programme managed through
Service Change Executive.
Green
Green
Green
Page 8 of 12
We care about….
Primary delivery
Corporate Objective
programmes
Procurement
programme to replace
the current IT core
server hardware and
software
infrastructure
Develop a portal to
enable a single point
of access called
'Gateway'
[F3] Develop a
comprehensive
Information
Management &
Technology strategy Electronic Document
& Records
and start
Management and a
implementation
Clinical Portal
Executive Lead: DoF procurement
…Improvement
Measures of success
1. Provision of a resilient IT environment capable
of adequate disaster recovery
2. Fast & reliable user access to core systems
(e.g. PAS, email, files)
3. 100% of all users have a single sign-on by Q3
4. Availability of scalable IT infrastructure to
support additional systems e.g. Paper Light,
Clinical Portal and Electronic Prescribing and
Medicines Management
Commentary
RAG
1. Work on computer room delayed due to difficulties with location.
Containerised computer room now specified and tendering exercise
completed. Board approved procurement in October and order placed.
Estimated delivery date Jan 2014.
2. Servers ready for delivery by supplier. Programme estimated 6 - 9
months from delivery of containerised computer room.
3. Basic single sign on now planned for late Q3 with existing
infrastructure supporting the 'follow me' desktop functionality once new
servers are in place.
Amber
1. Implementation of a portal to enable reporting 1. Integrate data from EPMA, Pathology MES
through a single point of access
and ITU system into data warehouse in-line with
2. Simplified access control and security based their deployment schedules
on users login
3. 100% of users have appropriate portal access
in Q2
1. Awaiting Clinical Informatics Strategy to develop the gateway further
but data from available core applications including Patientrack now
complete.
Amber
1. Clinical efficiency benefits realised from
1. Evaluate tender submissions received
2014/15 Q1 as documents migrate from paper to 2. Submit a Full Business Case to Trust Board in
electronic storage.
September 2013 for approval
2. In 2013/14, maintenance (i.e. no expansion) of
medical records storage requirements, with the
long-term view of reducing medical records
storage reduced to zero capacity over the 4-year
contract term.
4. Treasury funding secured, in partnership with
local partners to procure and subsequently
successfully deploy the system in line with
agreed schedule
1. Timescales have been delayed to accommodate mandated central
process. Procurement documentation completed and awaiting OGC
and DOH approval which is due in November.
2. Full OJEU process due to start in November looking to select
preferred supplier late Q4.
Amber
1. Development of
1. Improved data quality metrics and a data
agreed quality
quality audit tool developed
metrics and audit tool 2. Improved data quality across 3 areas: 1)
‘Outpatients not arrived’, 2) ‘To come in dates in
the past’, 3) ‘Ward spot checks’
3. Improved SUS quality data reports
4. Reduced number of duplicate patient
registrations from 2012 baseline
1. Increased Staff Engagement Indicator from
1. Staff appraisal
3.68 to 3.75, with the longer-term aim of
achieving upper quartile performance
2. Medical
Revalidation
2. Increased Staff Survey Response rate from
47% (2012) to 55% (2013)
3. Management &
Leadership
Development
Programmes
[F4] Optimise the
contribution of our
staff in the planning
and delivery of our 4. Strategic planning
of services including
services
Clinical Services
Executive lead: DODL Strategy
implementation
Quarter 2
1. Migration of clinical systems and email
2. 50% of clinical users have a single sign-on
3. Access to top 4 major applications available
through single sign-on
4. IT systems supported
1. Reports and audit tool go-live
2. First report to Quality Board
1. Ward spot checks commenced and DQ reports now being
generated. This process is still largely manual but spec for automated
reports completed and awaiting development.
Green
2. Generation of monthly quality reports commenced in Q2.
1. Evaluate take-up rate of Staff Forums
2. Update content of Management Development
Programme
3. Evaluate Staff Engagement Toolkit as part of
Medical Revalidation and implement
improvements if appropriate
4. Trust Brief Social medical delivery plan
implemented
5. Staff conference season held
6. Regular staff briefing sessions held at
Southlands with senior leaders
7. CEO meetings (bi-monthly) with employees at
6-months service, improvement actions/themes
identified each quarter
8. OCOT regular briefing updates for multi-prof
group via email
1. Staff forums attended by 40-50 staff at a time.
2. MDP updated during Q2.
3. Staff Engagement Toolkit reviewed and decision made to invest in
time out.
4. Stage 1 of intranet development completed. (Moving away from
licensed software to a license-free environment. The move will enable
the development of a new look intranet designed to support greater staff
engagement. Consultation with staff groups to inform the design and
functionality of the new intranet will begin in Q3.
5. Staff conference season successfully held with over 190 delegates to
the main event.
6. Southlands briefings between staff and Executive team continued
during Q2.
7. CEO meetings with employees continuing. Monthly Leaders Network
established and attendance improving. Q3 will see Execs/Non Execs
attending Trust Brief meetings at Southlands, Worthing and St.
Richard's.
8. OCOT team meetings continue along with monthly email update for
team and service users.
9. Clinical strategy being refreshed and events with specialities being
organised during Q3.
Green
Page 9 of 12
We care about….
Corporate
Objective
Primary delivery
programmes
[G1] Maintain an
acceptable Financial
CIP Programme
Risk Rating
…The future
Measures of success
Quarter 2
1. Required year end financial position of £5,2m
surplus achieved
2. Trust’s Cost Improvement Programme target of
£18m achieved
3. Trust’s Cost Improvement Programme
delivered within acceptable Clinical Quality
Impact thresholds
4. Repayment of debt in line with agreed
schedule
1. Achieve required financial risk score
2. Achievement of CIP programme against agreed
phasing profile
3. Achievement of CIP programme within
approved quality metric parameters
4. Repayment of debt against agreed schedule
Commentary
RAG
1. As at M6 (September 2013) the Trust is showing an
underperformance against plan. The planned surplus at this point of the
year is £2,552k and the M6 actual is a deficit of £996k – an adverse
variance of £3,548k. The overall risk rating, after overriding rules, is a 2.
An internal recovery plan is being progressed to deliver the planned
£5,200k surplus by year end. Achievement of this will deliver the
planned overall risk rating of 3.
2. The CIP position at M6 is showing a delivery of £3,345k against a
plan of £4,893k, an adverse variance of £1,548k. The Trust is still
forecasting to deliver the £5.2m CIP surplus, with use of supplementary
CIP schemes where original schemes are falling short, have a delayed
start, or have been superseded.
Executive Lead: DoF
Amber
3. The Finance & Investment Committee and the Quality and Risk
Committee are regularly reviewing the financial and quality performance
of the CIP’s to ensure there are no adverse impacts on quality, and to
date no concerns have been identified.
4. Repayment of debt as planned in September was made on time and
in full. The full year repayment schedule is planned to be met.
[G2] Maintain a
Monitor Governance
rating of no worse
than Amber Green
throughout the year
Executive Lead: COO
Divisional
performance
monitored through
Divisional Integrated
Performance
meetings
1. Perform consistently well across all of Monitor 1. Ensure performance against key metrics
Governance rating criteria
(A&E, MRSA, Cdiff, 18 weeks, Diagnostics and
Cancer waits)
1. Development of SLM information and
infrastructure in line with agreed programme
[G3] Continue the
development and
implementation of
Service Line
Management (SLM)
Executive Lead: COO
SLM Programme
assured through SLM
Board and supported
by SLM Technical
Group
1. Continuation of piloting of financial information
at DIP meetings, rolled out to all Divisions
2. Start of second year of Clinical Leadership
programme
3. Testing of single information portal with wider
group of users
Against the Compliance Framework, the Trust performed in all
categories other than for Cdiff. This meant that the Trust reported 1.0
points against the Compliance Framework for Q2, giving the Trust an
Amber-Green status
Green
1. An SLM workshop was held with members of the Executive Team,
DCS and Chiefs to review the programme and make recommendations
for taking forward. An revised agreement was reached to ensure we are
in a position to pilot SLM with a representative line from each Division
by April 2014. A work programme is being developed to deliver this.
2. The second year of the Clinical Leadership programme has been
designed, with a new cohort of consultant leads, a nurse leadership
programme and a 2nd year for those completing the course in year 1.
Green
3. The single information portal is still under development and is being
managed through the development of the Trust's information strategy.
Page 10 of 12
Reference
Corporate Objective
We care about you
A1
Increase the number of staff and patients who would
recommend the Trust to family and friends
Executive Lead Risk(s)
DNPS
Gross Risk Rating
Ref
Description
1
We incurr adverse feedback regarding patient experience
from our patients and the public and media.
Controls
Sources of Assurance
Likelihoo Impact Total
4
4
16
Net Risk Rating
Areas for Improvement and Action
Required
Risk Register
Reference
Note: RTPE = Real-time Patient Experience
132, 151, 159, 275,
338, 383, 430, 440,
463
Likelihood Impact Total
Provision of patient monthly safety metrics to provide National in-patient and out-patient surveys, and
monitoring of action plans at Board and/or Quality &
public assurance.
Risk Committee
Monthly review of RTPE feedback to ensure that
public concerns are identified and resolved in a timely Monthly Quality report and Board, including RTPE
data
fashion.
Monthly Divisional Integrated Performance Review
Panel meetings
Reports to Management Board and Quality & Risk
Committee about CQC Quality Risk Profile
Stakeholder engagement and feedback
Patients’ stories to the Trust Board
Peer reviews of Care & Compassion
CQC visits
Uptake of the Safety Thermometer.
Activity trends variations
Partnership working with the Patients Association.
Increased referrals into the organisation through the
choose and book process or other routes
The Communications Team work closely with the
local press in the handling of media relating to the
Trust.
2
4
8
Enhanced roll-out of RTPE.
Improved information to public regarding
complaint process.
Improved partnership working with public
regarding discharge information and
medication.
Review and improvements in the Outpatient
and booking service.
Further development of engagement strategy,
including through Council of Governors
Enhanced roll-out of the National Family and
Friends Test.
Informal meetings with Shadow Governors.
Introduction of the Care Challenge by Patients
Association and CNO England.
Partnership working with the Patients Association.
National Staff survey results
Review the recommendations of the Patient
Associations complaints campaign.
RTPE and real time staff survey responses.
Sit & See review
CQC Insight report
We care about quality
B1
Deliver the quality outcome gains specified in the
Trust’s Quality Strategy, and demonstrate full
compliance against Monitor’s Quality Governance
Framework
MD
1
We fail to implement care pathways adequately in order to
improve mortality
3
4
12
Care bundle progress monitored at monthly Divisional Feedback data from Enhancing Quality (EQ)
Integrated Performance Review Panel meetings.
programme to Board
Development of site-specific metrics to demonstrate
processes in place and working
Reporting of site specific care pathway data to
Board
Reporting of care bundle process metrics to Board.
Monthly diagnosis group-specific mortality reporting
to Board
3
4
12
Timeliness of data needs improving through
increased automation of data capture.
MD review of notes and care pathway
None
None
MD
2
We fail to produce timely and adequate information in
relation to Enhancing Quality and other CQUIN payments
3
4
12
Programme management approach to EQ / CQUIN Monthly board report on CQUIN and EQ to show
and enhanced recovery programmes through Service timeliness of data
Improvement Team
2
4
8
Information capture systems, for example
through Patientrack or other near to patient
databases need prioritisation in development
MD
3
We fail to programme manage the quality improvements
relating to CQUIN & other quality improvement initiatives
3
4
12
Strengthen capacity within Information Team
2
4
8
MD
4
We fail to engage broad clinical leadership in outcome
improvement work
3
4
12
All clinical leaders' objectives include quality
improvement goals
2
4
8
None
PMO function needs to be recruited and
embedded.
Action to implement electronic discharge
summaries
None
Need to ensure adequate infrastructure for
quality improvement work as well as showing
compliance
Objectives for Chiefs of Service and Clinical
Directors
Regular communications re outcomes as a measure Attendance by Chiefs of Service at monthly Board
Committee meetings
of quality to all staff, especially medical staff
Undertake Patient Safety Culture questionnaire in
three priority areas
B2
Reduce our rates of avoidable readmissions
COO
1
We fail to improve access and discharge arrangements
4
3
12
Formalise work programme under Service
Improvement Executive.
We care about safety
C1
Deliver the patient safety gains specified in the Quality DNPS
Strategy
1
Delivery of sub-optimal patient care and / or patients have a
poor experience
3
4
12
Quality Account priorities agreed by Board
Manage Divisional unscheduled care programmes to Coastal Cabinet meeting papers.
improve access and discharge arrangements
Quarterly review of Annual Plan progress at
Progress the development of the Emergency Floor at Divisional Integrated Performance Review Panel
Worthing
and at Board meetings.
Utilise Lead Provider role to strengthen control and
delivery
Need to develop and implement patient safety
culture questionnaire.
Radiology Review
3
3
9
2
4
8
None
Approval of business case for Emergency Floor.
Exception reports via both One Call, One Team
Delivery Board and Service Improvement Executive.
Provision of patient monthly safety metrics to Quality Quality Board report.
Board provides public assurance.
SHA patient safety metrics.
Achievement of internal V.T.E. benchmark.
132, 136, 239, 275,
348, 355, 383, 403,
Theatre safety programme, 100% compliance 404, 446, 447, 463
DNPS
2
Financial penalties due to failure to maintain appropriate
standards and thresholds
5
4
20
4
4
16
Monthly RTPE to ensure that public concerns are
identified and resolved in a timely fashion.
Quality performance scorecard.
Monthly integrated performance reviews.
NRLS reporting framework.
Implementation of zero tolerance for
prescribing incidents.
Stakeholder feedback.
SHA peer reviews
Theatre Safety action plan
Quarterly Care & Compassion reviews
CQC unannounced visit.
Theatre Improvement Plan, incorporating Never
Event Action Plan
Infection Control Operational Group
Insight report
Reporting of theatre improvement plan
(incorporating Never Event Action Plan) reports to
Board, and NED attendance at the Theatre Patient
Safety Group and all divisional Clinical Governance
Reviews.
NHSLA Level 2 achievement.
with WHO checklist.
We care about serving local people
D1
Implement our long-term Clinical Services Strategy
COO / DLOD
1
The Trust does not have capacity to deliver changes at the
scale and pace envisaged.
3
4
12
Greater integration of corporate and divisional
planning functions to maximise resource.
Clinical strategy agreed by the Board and shared
with external partners
3
4
12
Initial review of current strategy underway. None
Timescale to be determined
COO / DLOD
2
The Trust does not secure the external and internal support
for the changes it is proposing.
3
4
12
Secure additional ad-hoc resource on specific
projects when necessary.
Emergency Floor Business Case approved by the
Board.
2
4
8
None
Service Improvement Executive will strengthen
oversight of delivery for major developments.
Board approved plans for the R&R Block in place.
4
4
16
338, 345, 348, 422,
438, 410, 440
2
3
6
2
3
6
None
Quarterly capital progress reports to F&I Committee
3
3
9
Quarterly capital progress reports to F&I Committee
3
3
9
52, 79, 126, 127,
132, 146, 180, 214,
233, 423, 297, 252,
288, 309, 319, 338,
377, 365, 382, 383,
396, 421, 433, 450,
456, 457
Approval notifications received and reported to
Board.
Quarterly annual plan progress report to Board
1
1
1
2
3
6
3
5
15
A business case has been developed to deliver
improvements to the infrastructure
1
1
1
The component parts of the strategy need to
be agreed by the Executive Team. Strategy
has been approved
Coastal Cabinet meeting papers.
We care about being stronger together
E1
In partnership with our emerging CCG, develop our
lead role in the local health economy for unscheduled
and planned care pathways
COO
1
External partners fail to help deliver demand management
programmes (LHE) and capacity / demand alignment is
compromised.
5
4
20
Ongoing engagement with our commissioners
through Coastal Cabinet and Single Performance
Conversation to ensure success of integrated
workstreams including the Lead Provider
development.
Manage Divisional planned and unscheduled care
programmes to improve access and discharge
arrangements.
Revised Accountability Agreement between LHE
partners outlining responsibilities for each
organisation (pending).
Coastal Cabinet and Service Delivery Board
meeting papers.
Review of Annual Plan progress at Divisional
Integrated Performance Review Panel and Board
meetings.
Reporting to Coastal Cabinet monthly and to Service
Delivery Boards weekly to monitor the delivery and
effectiveness of planned and unscheduled care
demand management schemes.
E2
Support our Council of Governors to fulfil its role
We care about improvement
F1
Continue to improve the patient environment through
net investment in the Trust’s Estate.
F2
DLOD
1
Co Sec
2
DoF
1
We don't reap the benefits of a Council of Governors as part
of our development as an FT
The Council of Governors fails to discharge its
formal/statutory duties
Clinical areas are unavailable due to operational activity
levels being higher than planned.
2
4
8
Council of Governors development plan
2
4
8
Foundation Trust Constitution, Terms of Reference,
Role Descriptions
4
3
12
DoF
2
Large number of simultaneous projects stretch internal
project management capacity.
4
3
12
DoF
3
External approval for Business Cases not granted in
timescale anticipated.
Inappropriate or insufficient focus and resourcing causes us
to fail to deliver the appropriate pace and scale of
improvements needed
3
3
9
4
4
16
Deliver coordinated service improvement programmes DLOD
across the Trust
1
Projects timetabled through plans to be undertaken
during less busy periods.
Operational Capital Group for engagement between
Estates and clinical Divisions
Projects spaced over the year through plans.
Additional capacity secured where required.
Correspondence with (former) Strategic Health
Authority and with Trust Development Authority
Service improvement priorities and resources agreed
at Service Improvement Board, based on Annual
Plan
Resources to be flexed as necessary to deliver
priorities
Feedback from Governors; from Board; from
members
Development and implementation of plans
None
Minutes of Council and Committee meetings
No longer applicable
None
CIP delivery reports to F&I Committee and Board
Patient survey results (re priority relating to
customer care)
Monthly performance reports to Board
F3
Develop a comprehensive Information Management & DoF
Technology strategy and start implementation
1
Pre / mid implementation the Trust's IT system fail, thus
compromising clinical services and business continuity
4
5
20
IT systems monitored continuously
Service Improvement Board minutes
Monthly report on progress to the Finance &
Investment Committee
63, 141, 151, 225
Backup systems in place
F4
Optimise the contribution of our staff in the planning
and delivery of our services
Board review and approval of proposals, ie.
Maintenance contracts in place for key systems
business case
Executive Team agreement of the components of the Paper setting out components of IM&T Strategy
IM&T Strategy
IM&T strategy presented to Board.
DoF
2
The Executive Team does not have the capacity to deliver
an agreed IM&T strategy
3
3
9
DoF
3
There is insufficient Internal capacity to support IT
infrastructure changes.
3
4
12
Business case includes resources to manage
implementation
Business Case to April Board
3
4
12
DLOD
1
We fail to implement culture changes required to improve
staff engagement
3
4
12
Engagement strategy inc. Trust Brief, Appraisals
Staff survey and regular real time surveys
2
4
8
Development and implementation of revised
engagement plan
None
2
3
6
Revisions to planning and business case
process
None
Regular staff meetings inc Board walkabouts and
attendance at Trust Briefs
DLOD
2
The personal and professional impact of service change
disengages staff
3
3
9
Engagement strategy inc. Trust Brief, Appraisals
Organisational Development reports to Board
Staff survey and regular real time surveys
Regular staff meetings inc Board walkabouts and
attendance at Trust Briefs
Organisational Development reports to Board
Evidence of staff engagement in service
changes/business cases: impact assessment of
planned service changes on staff
We care about the future
G1
Maintain an acceptable Financial Risk Rating
DoF
1
We fail to deliver CIP programme
3
5
15
Divisional Integrated Performance Review Panel
meetings
Reports to F&I Committee and Board
3
5
15
402
Reports to F&I Committee and Board
1
1
1
3
5
15
None
2
4
8
338, 345, 348, 387,
422, 440
2
4
8
Budget holder meetings
G2
DoF
2
DoF
3
Maintain a Monitor Governance rating of no worse than COO
Amber Green throughout the year
1
FT application process diverts focus from financial
management and control.
The financial constraints in the local health economy impact
the Trust's ability to realise its income expectations
3
5
15
4
5
20
A mismatch between demand and capacity leads to access
targets not being met
3
4
12
Service Development office scrutiny.
FT application process neraring conclusion.
Regular monitoring of contract information within the Monthly to F&I Committee and Board
Trust
Monthly Executive-led meetings with commissioners
Regular dialogue with commissioners
Financial Risk Ratings
Swift resolution of areas of disagreement
Single Performance Conversation meeting papers.
Ongoing engagement with our commissioners
through Coastal Cabinet and Single Performance
Coastal Cabinet and Service Delivery Board
Conversation to ensure success of integrated
meeting papers.
workstreams including the Lead Provider
development.
Daily and weekly reporting of high-risk areas.
Reporting to Coastal Cabinet monthly and to Service
Daily heat map reporting.
Delivery Boards weekly to monitor the delivery and
effectiveness of planned and unscheduled care
Monthly reports to the Board.
demand management schemes.
Process complete
None
Exception reports from Directors of Clinical Services
to Chief Operating Officer.
COO
G3
Continue the development and implementation of
Service Line Management (SLM)
2
COO
1
COO
2
The planned productivity and efficiency improvements do not
deliver the required capacity.
1. A failure to secure the necessary capacity to deliver
Service Line Management, including IT infrastructure,
information management and training.
2. Ownership and leadership of the programme throughout
the organisation.
3
4
12
3
4
12
3
4
12
Monitoring and management of performance through Divisional Integrated Performance Review Panel
Divisional Integrated Performance Review Panel
and Board meeting papers.
meetings and the Board.
Daily and weekly monitoring of access targets and
enhanced risk mitigation measures.
Clear programme plan owned and managed by the
SLM Programme Board.
Papers from SLM Board and Divisional Integrated
Performance Review Panel meetings.
2
4
8
None
Service Line review at Divisional Integrated
Performance Review Panel meetings.
Quarterly report to Finance & Investment
Committee.
2
4
8
None
BOARD ASSURANCE FRAMEWORK 2013/14
RISK REVIEW REPORT: QUARTER 1, 2013/14
Guidelines for completion: Please complete each of the sections below, ensuring that the entries are
concise but sufficiently descriptive to facilitate a Board/Committee discussion about the risk. The report
should be no longer than two A4 pages.
Risk Description:
Corporate Objective:
E2: Support our Council of Governors to fulfil its role.
We don’t reap the benefits of a Council of Governors as part of
our development as an FT.
BAF Risk:
Last reporting date:
Risk review
The Council of Governors fails to discharge its formal/statutory
duties
Report submitted in Q1.
Work is progressing to develop the Council of Governors to be able to fully discharge its roles.
Impact
No specific risk has emerged
Controls
Controls are appropriate and will now be expedited.
Since authorisation the Council of Governors has agreed the role description for governors,
undertaken a process to elect a lead governor, and agreed membership of the Nomination and
Remuneration Committee and Membership Committee. At its first meeting the Council agreed
the appointment of external auditors. A development day was held with governors, facilitated by
Deloitte, on 1 October 2013.
Assurance
Assurance appears adequate, but will be further developed as the Council starts to operate.
Risk Owner:
Date:
Denise Farmer, Director of OD & Leadership
23 October 2013
To: Trust Board
Date of Meeting: 31 October 2013
Agenda Item: [insert agenda item]
Title
Endoscopy Strategic Development Programme: Outline Business Case
Responsible Executive Director
Jane Farrell, Chief Operating Officer
Prepared by
Toy Boness, Strategic Planning Manager
Status
Disclosable
Summary of Proposal
The paper sets out the case for change and investment in Endoscopy services across the Trust. It illustrates
the benefits to patients, staff and the Trust, seeks approval for capital investment and signals the likely
revenue costs of the service in future years.
Implications for Quality of Care
Directly related to improving patient care
Link to Strategic Objectives/Board Assurance Framework
Links to We Care About: You, Quality, Safety, Improvement & the Future
Financial Implications
Financial Implications noted within the case
Human Resource Implications
Workforce implications included within the case
Recommendation
The Board/Committee is asked to: approve the recommendations within the business case
Communication and Consultation
Consultation of this service change has been undertaken with stakeholders over the past 12 months.
Appendices
Endoscopy Business Case + appendices as detailed within it
This report can be made available in other formats and in other languages. To discuss your requirements please
contact Ann Merricks, Company Secretary, on [email protected] or 01903 285288.
Endoscopy Strategic Development Programme
Outline Business Case
An outline business case to recommend capital development to
ensure a sustainable and high quality Endoscopy service across
Western Sussex Hospitals NHS Foundation Trust
October 2013
Version 2.0
1
Version Control
Version
1.1
1.2
1.3
Date
Issued
18th June
2013
20th June
2013
Description of revisions with Authors
page numbers
First draft limited issue
Julie Flower
Position
Project
Consultant
Incorporation of further factual Julie Flower Project
Consultant
detail
and
inclusion
of (narrative)/
Senior Finance
Becky
comments from Tony Boness
Manager
Caldicott
First draft for issue to Steering (financial)
and Operational Groups for
comment, with financial model
27th June Procurement comments/input Julie Flower Project
Consultant
2013
from Andrew Boxall, Head of (narrative)/
Senior Finance
Becky
Procurement
Manager
Caldicott
General
comments
from (financial)
Operational Group members
Additional manpower inputs
Service and JAG information
from
Richard
Fowler,
Operations
Manager
–
Specialist Medicine
Updated financial model and
case with additional inputs,
including income projections
1.4
1.5
1.6
1.7
Comments
from
Steering
Group review
Julie Flower
2nd
July Additional financial inputs
(narrative)/
2013
Additional factual inputs from Becky
Caldicott and
further Steering Group review
Karen
Seabridge
(financial)
8th
July Updated financial inputs to Julie Flower
2013
reflect amended SRH estates (narrative)/
Becky
estimates
Caldicott and
Minor
amendments
and Karen
changes to reflect comments Seabridge
from Steering Group and (financial)
Oliver Phillips
9th
July Addition of Clinical Quality Julie Flower
2013
Impact Assessment
14th
Minor amendments to reflect
comments from Sally Smith
July Amendments to the narrative Julie
Flower
2
2013
and financial model following (narrative)/
comments from Business Case Mike
Scrutiny Panel
Jennings/
Karen
Seabridge
(financial)
25th July Incorporation of Sensitivity Oliver
2013
Analysis into Business case
Phillips/Mike
Jennings
August – Significant
revisions Tony Boness
8th Oct
throughout the document
18th
Comments incorporated from Tony Boness
October
Peter Sibley
Appendices
included
plus
general revisions
22nd
Financial scenario planning Tony Boness
October
incorporated
&
CIP Peter Sibley
requirements included
24th
Final completion of business Tony Boness
October
case
Peter Sibley
1.8
1.9
1.10
1.11
2.0
Review & Governance
Version
v1.2
v1.4
v1.6
v1.7
v1.8
Date
Approved
26th June
2013
5th
July
2013
10th July
16th July
31st July
v1.10
22nd
October
v2.0
30th
October
31st
October
v2.0
Group
Recommendation
Endoscopy
Programme
Operational Group
Endoscopy
Programme
Steering Group
Business Case Scrutiny Panel
Executive Team
F&I Committee
Approve subject to suggested
minor additions and amendments
Approve subject to suggested
minor changes and additions
Discussion at ET
Discussion at F&I
Development of options in light of
investment required and forecast
activity profiles
Business Case Scrutiny Panel Approved for Trust Board review
/ Service Change Executive
subject to additional financial
scenario planning to model CIP in
order to maintain contribution
F&I Committee
Presented for approval
Trust Board
Presented for approval
3
Executive Summary
This business case provides the case for the strategic development of the Endoscopy
Service across the Trust. The maintenance and development of full endoscopy services
at both St Richard’s and Worthing is fundamental to the Trust’s Clinical Services
Strategy.
The Executive Team gave outline support in principle for the proposal in
February 2013 and since then detailed planning has been undertaken at both St
Richard’s and Worthing Hospitals to identify preferred solutions intended to achieve the
programme objectives.
Demand for endoscopy services is expected to increase significantly over the coming
five years and continue to increase thereafter, driven by the extension of the bowel
cancer screening programme, an ageing population, greater self-awareness and earlier
presentation, pathway changes and increasing range of endoscopic interventions. This
is expected to generate approximately £5.6m of total additional income by 2018-19,
including Best Practice Tariff and bowel screening income, and make a strong
contribution to overall Trust finances. The proposed development scheme is estimated
to give an internal rate of return of 1.17%, with a payback of between years 9 & 10.
The current service capacity, which comprises four endoscopy rooms at St Richard’s
Hospital (SRH), three at Worthing Hospital (WH) and limited sessional activity at
Southlands Hospital, is insufficient to meet future demand.
The service is currently
under significant operational pressure due to increasing demand, with additional
sessions being provided over and above funded capacity.
Capacity has been a
particular constraint at Worthing, which has been unable to fully age-extend as part of
the national faecal occult blood testing (FOBT) bowel screening programme for 70-75
year olds due to capacity limitations. Flexible sigmoidoscopy screening for 55 year olds
is due to be introduced, which will also require additional capacity at both sites.
Quality is also a significant driver for strategic change. The service at Worthing does not
comply with the national Joint Advisory Group on GI Endoscopy (JAG) accreditation
requirements on same sex facilities, impacting on patient privacy and dignity. Without
major remodelling, the service will fail its JAG accreditation in 2014, resulting in loss of
Best Practice Tariff (BPT) income and a likely detrimental impact on patient and referrer
perception, demand, recruitment and retention. It will also mean that WSHFT would be
unlikely to be awarded Bowel Cancer Screening Centre status and may lose its overall
JAG accreditation as a Trust, resulting in a loss of all bowel screening activity, a loss of
4
BPT, an inability to train, and adverse impacts on other services, reputation, recruitment
and retention.
The Trust has recently made an application to become the West Sussex Bowel Cancer
Screening Centre, which is expected to improve the financial contribution of existing and
planned screening activity to the Trust. Achieving Centre status will enable the Trust to
offer a higher quality, more sustainable screening service, attracting and retaining high
quality staff. Without improvements at both sites, this initiative and the intended benefits
to patients would be jeopardised.
At SRH, the decontamination facilities are out-dated and operate using a cleaning
solution that is highly corrosive, resulting in high service and maintenance costs and
shorter than expected scope lifespan. The scope manufacturer has formally written to
the Trust to indicate that they will withdraw from the existing maintenance contract
unless the washer equipment is replaced, enabling use of a different cleaning chemical.
This presents a significant financial risk as the current actual costs of repairs as a direct
result of corrosion are estimated up to £555k per annum. The Trust may be liable to
meet this financial recurrent cost if changes are not delivered at SRH. Through
negotiations with the manufacturer, the date of withdrawal has been delayed from
October 2014 to March 2015, pending the outcome of this business case. The Trust
receives loan scopes when others are being maintained; the manufacturer will cease this
facility from December 2013 until the washers are replaced.
To demonstrate the Trust’s commitment to a high-quality sustainable Endoscopy service,
it is crucial that improvements to the department are made at Worthing to improve
patient experience, meet the JAG accreditation standards and provide the additional
capacity the service requires in the immediate future. To achieve the minimum
requirements of the service and additional capacity an increased footprint is required.
Moving the Surgical Pre-Assessment service from the West Wing at Worthing to the new
Outpatient Department is an essential scheme to release the footprint required for the
Worthing development; approval to proceed with this discrete element is recommended
within this business case.
At SRH, it is proposed that the washers are replaced immediately and the opportunity
taken to provide minor modifications to the decontamination pods whilst the works are
underway. This will predominantly provide enhanced cleaning facilities and new flooring
to the pods.
5
Delivering screening and flexible sigmoidoscopy activity in an outpatient setting is a
primary service aim of the service as it will unlock capacity in the main endoscopy
department. To achieve this, it is proposed that minor modifications are made to the
Bracklesham Suite to achieve two procedure rooms for this purpose (one is existing but
requires modifications) and re-provide a displaced consulting room.
In the longer term at SRH, washing capacity is likely to become a limiting factor to
providing additional scoping activity. Within this business case, a vision for the SRH
department is presented that will centralise decontamination and remodel the
department to improve patient flow and experience, whilst simultaneously improving
efficiency and reduce running costs. It has been ascertained through recent planning
that it is not possible to remodel the department and increase the number of pods
without closing the entire department for at least 10 weeks. Under current
circumstances, this would have a significant detrimental impact on service performance.
This overall programme is a significant and complex scheme of work with a number of
dependencies. In order to present this recommendation, high-level operational planning
has been undertaken to ensure the solutions are deliverable and practical without
intolerable compromise to service performance during implementation, or significant
non-recurrent costs to deliver the changes. The developments at SRH & WH can be
complamentary where critical milestones are scheduled to maximise service resilience
and flexibility Trust-wide during implementation.
The Worthing department has a scheduled JAG accreditation visit for October 2014 and
the Trust has been notified that it will not achieve compliance without changes to the
department. The programme of works is expected to commence in May 2014 and
therefore the Trust would be able to demonstrate full commitment to improvement. The
JAG is being informed of our plans on a regular basis. Not achieving accreditation will
result in the Trust not being eligible to be paid at BPT for endoscopy scoping until the
works are complete. BPT income is estimated at an annual sum of £307k.
This business case proposes a total capital allocation of approximately £8.582m over the
financial years 2014 – 2019 to support this major development of the Trust’s endoscopy
service, including:

Remodelling at Worthing to meet JAG requirements and increase room capacity
from three to six endoscopy rooms (10 across the Trust)
6

Replacement of decontamination washers at SRH and minor improvements to
the decontamination pods

Minor modifications to the Bracklesham Suite at SRH (adjacent to the Endoscopy
department) to provide an outpatient scoping facility (increase to two procedure
rooms)

Purchase of new equipment (scopes and clinical equipment) for the additional
and remodelled capacity

Re-provision of Surgical Pre-Assessment service from Worthing West Wing to
the new Outpatient Department building
The estimated capital requirements are summarised below which can be phased over
financial years as illustrated. The total estimated build cost for both WH and SRH is
£6.07m against an internal capital allocation of £5.978m. Equipment has been phased
according to when additional scoping room capacity is required at an additional
investment of £2.512m. There may be benefits in initially fully equipping the Worthing
department to provide operational flexibility; this would have the impact of bringing
forward £481k of capital investment from 2016/17 and £360k from 2018/19.
Figure 1a: Capital Investment requirements (£000’s)
13/14
14/15
15/16 16/17
17/18 18/19 Totals
Build
WH: Build including washers1
4,168
860
89
5,117
WH: Relocation of Pre-Assessment
527
527
SRH: Build including washers
426
426
Sub total
5,121
860
89
855
80
481
343
343
6,070
Equipment / IT
WH: Medical equipment2
SRH: Medical equipment
2
IT: Booking system
1
2
360
1,776
686
50
50
Sub total
1,248
423
481
360
2,512
TOTAL
6,369
1,283
570
360
8,582
Includes the cost of relocating Pre-Assessment at £527k
Higher cost estimates used for planning purposes
7
Figure 1b: Internal capital allocations (£000’s)
13/14
14/15
WH: Build
642
3,887
4,529
SRH: Build
600
400
1,000
Pre-Assessment
350
Pre-Assessment infrastructure
Total
1,592
15/16 16/17
17/18 18/19 Totals
350
99
99
4,386
5,978
If approved, internal capital allocations over and above current allocations – as illustrated
below - would need to be secured.
Figure 1c: Required capital allocations (£000’s)
13/14
14/15
15/16 16/17
17/18 18/19 Totals
Current capital allocation
1,592
4,386
Capital cost forecast
0
6,369
1,283
570
360
Additional capital allocation
0
391*
1,283
570
360
2,604
*Assumes 2013/14 allocation carried forward to 2014/15
The revenue implications are also outlined, including modelling of the expected
manpower and non-pay requirements and costs to meet future demand, year-on-year.
The majority of the additional revenue costs will be incurred incrementally, in line with
increasing demand, thus minimising the revenue risks, were demand and income to be
lower than expected.
This business case requests the Board APPROVE the:
1
Proceeding to tender for replacement of the washers at SRH; enabling works in the
decontamination pods and modifications to the Bracklesham Suite at SRH (total
value £426k)
2
Proceeding to tender for medical equipment / scopes at SRH (value £343k)
3
Proceeding to tender (following a finalised plan) to relocate the Surgical PreAssessment service (value £527k)
These three schemes will still need contract award approval following tender before financial
commitment, in-line with Standing Financial Instructions
8
4
Development of a Full Business Case for Worthing for submission in January 2014.
This will include an updated business case and financial model; details of the
required CIP programmes and a full design pack in anticipation of tender.
Finance & Investment approved expenditure in the region of £150k to £200k at July 2013 when
the draft business case was presented. No additional expenditure is predicted and this cost is
included within the total forecast capital investment for the programme.
The Board are asked to NOTE the:
1.
Forecast income benefits and revenue implications of this strategic development
2.
Likely future capital investment of £2.97m required to remodel the SRH department
and centralise decontamination (phasing of investment possible; £1.92m for phase 1
- decontamination).
9
Contents 1.0 The Strategic Case
12 1.1 Introduction
12 1.2 Organisational Overview
13 1.3 The National Strategic Context
13 1.4 The Local Strategic Context and Drivers For Change
14 1.5 The WSHFT Endoscopy Service
17 1.6 Service Demand: Projection Assumptions
20 1.6.1 Growth Assumptions
20 1.6.2 Productivity & Scheduling Assumptions
25 1.7 29 2.0 Clinical accommodation across the Trust
The Economic Case
30 2.1 Introduction
30 2.2 Key Features of Each Option
30 2.3 Non-Financial Option Appraisal
35 2.4 Preferred options
36 2.5 Detail of the Preferred Option
42 3.0 The Commercial Case
49 4.0 The Financial Case
50 4.1 Introduction
50 4.2 Assumptions
50 4.3 Financial Analysis
51 4.4 Sensitivity Analysis
55 4.5 Maintenance of financial contribution
60 4.6 Interpretation of scenario planning
60 4.7 Sensitivity analysis findings
61 4.8 Financial risks
61 5.0 6.0 The Management Case
62 5.1 Introduction
62 5.2 Programme Background
62 5.3 Mobilisation Period and Implementation Plan
62 5.4 Programme Management Arrangements
64 5.5 Stakeholder engagement and communication
65 5.6 Project Risks and Mitigations
67 5.7 Constraints and Dependencies
70 5.8 Benefits Realisation
70 Recommendation
71 Addendums
71 Appendices
71 10
11
1.0
The Strategic Case
1.1
Introduction
The aim of the Endoscopy development programme is to ensure that the Trust
Endoscopy service is able to:
 Offer a high quality JAG-accredited service which patients and clinical
commissioners choose, offering an excellent patient experience
 Meet future demand, which is expected to rise by more than 50% over the next 56 years and continue to increase thereafter, with suitable facilities, equipment
and workforce to meet those needs, avoiding the need for costly waiting list
initiatives
 Provide a good working environment, attracting and retaining high quality staff to
build skills within the team
 Build on the significant performance, productivity and quality improvements made
over recent months and years
 Offer modern facilities which ‘future-proof’ the service and are as efficient as
possible
 Be accredited as a Bowel Cancer Screening Centre, providing additional
recognition and kudos together with income to the service
 Offer a comprehensive and equitable service to patients across West Sussex and
beyond
WSHFT currently provides a wide range of inpatient and outpatient endoscopic
diagnostic and therapeutic procedures from facilities at St Richard’s Hospital (SRH) and
Worthing Hospital (WH). Some urology cystoscopy procedures and women’s health
hysteroscopy procedures are also provided from Southlands Hospital. Screening activity
is also provided under SLA for the two neighbouring Screening Centres: the Sussex
Bowel Cancer Screening Centre and the Solent & West Sussex Bowel Cancer
Screening Programmes. A commitment to the continued development of a sustainable
Endoscopy Service, operating from two main sites, is fundamental to the Trust’s Clinical
Services Strategy.
This business case objectively assesses the proposed options against maintaining the
status quo. A number of other options have been considered and discounted in the
development of the proposal and these are also briefly described. The financial analysis
has been undertaken based upon current activity (month 5, August, 2013/14) with
relevant assumptions around growth and productivity. A sensitivity analysis has been
modelled to demonstrate the impacts on activity and income when efficiency and growth
assumptions are varied. The drivers for the proposed solution include a number of
factors relating to quality, some of which cannot be financially quantified. These are
covered in both the non-financial appraisal and, where possible, in the Discounted Cash
Flow analysis. This case includes the implications of becoming a Bowel Cancer
Screening Centre and assumes the impact of doing so in the proposed option. However,
it does not seek to repeat the information within the Bowel Cancer Screening Business
Case and is designed to be read alongside it.
The Endoscopy Development Programme Steering Group has developed the overall
business case to outline the capital development (estates and equipment) implications,
together with workforce, non-pay revenue impacts and outline estates planning. More
work will be required to develop the detailed estates solution for Worthing, in preparation
for tender. A full business cases will be developed for Worthing to proceed to tender and
contract award presented for Trust approval to purchase the replacement washers at
12
SRH. A Trust-wide implementation plan will be included within the full business case for
Worthing to ensure continued delivery and to limit the impact on performance and quality
during the implementation period.
This business case demonstrates that there is a strong strategic case for the Trust to
carry out significant capital development within Endoscopy for a range of reasons
relating to strategic fit, financial sustainability, operational performance and quality.
It is on this basis that approval is sought from the Trust to the overall capital
development plan.
1.2
Organisational Overview
Western Sussex Hospitals NHS Foundation Trust operates principally from three sites,
St. Richard’s Hospital in Chichester, Worthing Hospital, and Southlands Hospital in
Shoreham-by-Sea, with a budget of around £350m. It was awarded Foundation Trust
status from 1st July 2013.
The Trust is the main provider of acute hospital services for a population of
approximately 490,000 people covering much of the area of West Sussex, in particular
the Coastal strip of the county.
With approximately 6,500 staff, the Trust is a major local employer. The services
provided include medicine, surgery, orthopaedics, trauma, paediatrics, obstetrics and
accident and emergency (A&E).
Endoscopy is a significant diagnostic and therapeutic service, providing almost 19,000
procedures in 2012-13. It directly employs 75 WTE (nurses, HCAs, decontamination
and administration staff), together with physicians and surgeons from a number of
specialties who deliver endoscopy lists, along with a number of sessions delivered by
nurse endoscopists. Endoscopy is provided on both an inpatient and outpatient basis,
with many referrals either directly from GPs or via outpatient clinics. The Trust also
provides a bowel screening service via Service Level Agreements with both Portsmouth
Hospitals NHS Trust and Brighton & Sussex University Hospitals NHS Trust.
1.3
The National Strategic Context
Endoscopy, as a key diagnostic procedure and therapeutic intervention, is a major part
of many patient pathways within the NHS. It has received significant national attention
over recent years, including its own NHS Improvement programme to address a range of
operational issues common to units around the country, such as alignment of capacity
and demand, process improvement and overall productivity. This has helped endoscopy
services to better meet national requirements with respect to diagnostic and referral to
treatment targets in all relevant pathways, including Cancer.
Endoscopy services will continue to face challenges in meeting demand in a timely,
efficient and high-quality way as demand is expected to continue to rise significantly. A
report from NHS Improvement in March 2012 suggested that demand for LGI endoscopy
was set to double over the coming 5 years.1 This increase will be driven by the
extension of the faecal occult blood testing (FOBT) screening programme for people
1
NHS Improvement (March 2012), Rapid Review of Endoscopy Services, Department of Health,
Leicester, Gateway Reference: 17167
13
aged 70-75 years and by the forthcoming flexible sigmoidoscopy screening programme,
aimed at people aged 55 years, from summer 2013. Demand for endoscopy for
symptomatic patients is also increasing alongside the need for surveillance of patients at
enhanced risk. Demand for UGI and other endoscopic procedures is also expected to
increase substantially due to an ageing population and clinical pathway developments.
Endoscopy is also a closely monitored and regulated area of activity with respect to
quality, meaning that providers of endoscopy services are required to meet ever higher
standards with respect to clinical quality, safety and patient experience, including
meeting single sex requirements and providing an excellent patient environment. This
includes annual submissions through the Global Rating Scale (GRS) and accreditation
through the Joint Advisory Group for Gastrointestinal Endoscopy (JAG). JAG is in the
process of changing their regime to include annual review and more on-site visits and
inspection to provide assurance of standards. Units that fail to comply with JAG are
ineligible for the national Best Practice Tariff (BPT), resulting in the loss of 5% of tariff
income, and are not permitted to carry out bowel screening programme activity.
Decontamination is also a field which is subject to significant regulation and forms part of
JAG accreditation.
1.4
The Local Strategic Context and Drivers For Change
Endoscopy Services are fundamental to the delivery of the Trust’s Clinical Services
Strategy. They play a central role in a large number of clinical pathways, enabling
patients to benefit from high quality, accessible care. The Trust agreed, as part of that
strategy, that a full Endoscopy Unit should be maintained at both SRH and WH. This
decision was driven by a number of factors, including the principle of offering local,
accessible and convenient care and supporting the full range of services offered across
the Trust. Many endoscopy patients are older and may have to undergo bowel
preparation prior to their visit; these factors can make travel difficult and potentially
undignified. Sedation is also often required, again making travel more of a challenge.
The Trust has submitted a proposal to become the West Sussex Bowel Cancer
Screening Centre, demonstrating its commitment to providing high quality, accessible
services to local people and to being recognised as a centre of excellence. The Bowel
Screening National Programme is supportive of this proposal and plans have been put
into action to achieve this status. As the Trust builds on its recent Foundation Trust
status, there may be opportunities to attract referrals from further afield for some
procedures, becoming a provider of choice for Endoscopy and associated pathways.
The Endoscopy Service at WSHFT has made significant progress during recent months
and years, including with respect to waiting times and productivity. This is outlined
further in Section 1.5 below and has been recognised by NHS Improvement. However,
a number of factors mean that significant strategic development is now required in order
to ensure that the Service can meet continuing growth in demand, conform to ever more
rigorous quality standards, provide an excellent patient experience and ensure
sustainability within the medium-term. The proposal is strongly aligned with the Trust’s
strategic aims and the Quality Strategy.
There are three main drivers for change, which support the current proposal.
Expected growth in demand:
The demand for endoscopic diagnostic and therapeutic procedures is expected to grow
significantly at both a national and local level over the coming five to ten years. This is
partially driven by the full age extension of bowel screening colonoscopies and the
14
introduction of flexible sigmoidoscopy screening as part of the screening programme.
Worthing is not yet delivering bowel screening to the full target age population due to
capacity constraints, and will be one of the last units in the country to do so.
Other endoscopic activity is also expected to grow as a result of population growth, an
ageing population and the increasing complexity of medical and surgical interventions.
The Department of Health advised the NHS to plan for 10-15% year-on-year growth for
five years from 2012 in Lower GI endoscopy (including screening).2 No national
estimates are available for Upper GI endoscopy and so local estimates have been made.
The Trust forecast endoscopy activity during 2012/13 to develop a 2013/14 activity plan,
in line with national recommendations. Having reconciled this forecast to month 5 actual
data for this year, the forecast generally appears optimistic in retrospect. Therefore, to
ensure activity modelling is representative of the local context, this business case has
considered a medium growth scenario based on national recommendations, and a more
conservative low growth scenario for the purpose of comparison. Growth based on these
assumptions suggest an increase between 52% and 60% in Upper and Lower GI
procedures (combined) over the next 5 years (to 2018-19). There are also expected to
be rises in other procedures carried out in the Endoscopy Units (bronchoscopies,
cystoscopies and transoesophageal echocardiograms).
These expected increases in demand mean that the current physical capacity,
equipment and staffing is insufficient to deliver a sustainable service in the future. An
effective Endoscopy service is vital to Cancer pathways and to achievement of the 18
Week Referral to Treatment (RTT) requirement in a range of other pathways throughout
the Trust and local health economy. Current capacity (rooms and manpower) is already
under significant pressure with reliance on additional sessions over and above funded
capacity to meet demand.
There may also be opportunities to attract existing and future patient flows from
neighbouring NHS acute providers, particularly where there are known capacity
problems. Local private providers also offer a number of weekly endoscopy sessions in
colorectal, Upper GI and urology. The provision of greater private endoscopy work, in
conjunction with the Trust’s existing private patient service, could also be a growth
opportunity.
Decontamination requirements:
Decontamination is a highly-regulated and ever-advancing field. Demand growth within
the Endoscopy decontamination facilities has increased at a higher rate than general
service demand as the decontamination service has taken on the responsibility for
cleaning scopes from theatres, in addition to those from the Endoscopy Units. This has
led to a four-fold increase in activity across the decontamination service from an average
of 112 scopes cleaned per week in 2006 to 450 per week in 2013.
The decontamination facilities at the Worthing endoscopy unit are modern and
centralised (installed in 2010) and provide a good service to the three endoscopy rooms
there, with the capacity to support some additional activity and the physical space to
install two new washers to support the three additional rooms planned at Worthing.
They are recognised nationally as excellent facilities and the centralised model is
accepted as best practice guidance.
2
Letter from Mike Richards, National Cancer Director to Trust Chief Executives, Department of
Health, December 2011, Gateway ref: 16973
15
St Richard’s has older washers, which require immediate replacement in order to avoid
the scope manufacturer withdrawing from their current scope service and maintenance
contract. The washers and associated generators suffer regular breakdowns and the
manufacturer of the cleaning solution - who must support the generators - has indicated
their intention to withdraw support. WSHFT is the last remaining Trust in England using
this cleaning solution and type of generators.
The decontamination facilities are decentralised with each decontamination facility or
‘pod’ supporting two endoscopy rooms. This decentralised configuration provides a
functional service although revenue costs are typically higher (approximately 1
technician per 2 pods) than a centralised version and the working environment more
challenging due to limited space. A decentralised model cannot achieve the same
degree of flex of capacity to manage demand as a centralised model, and the end to end
process includes additional steps that are eliminated in a centralised version, thus
improving efficiency and reducing unit cost for the centralised model.
The cleaning solution chemicals used by the St Richard’s washers are both expensive
and corrosive, resulting in additional chemical and scope service/maintenance costs.
They also reduce the useful life of the scoping equipment. Although the scoping
equipment at SRH is currently covered under an annual maintenance contract with the
scope manufacturer, they have formally indicated that they will not subsidise repair costs
associated with the use of the chemicals at SRH, resulting in a potential annual financial
risk up to £555k (the cost of corrosion-related repairs).
This proposal includes the replacement of the four washers at St Richard’s and minor
modifications to the environment to improve their utility; raise/lower sinks, new flooring,
drying cabinet monitors and minor local ventilation changes (dependent upon the washer
specification).
JAG accreditation
JAG sets quality standards to which all endoscopy units are required to adhere for
accreditation. Their compliance regime includes a range of measures and standards
relating to service (appropriateness of intervention and patient experience), quality and
safety, people (training and competency), finance, growth (commitment to service
development and sustainability).
Until recently, JAG accreditation ran on a five-year cycle. However, from the beginning
of 2012, JAG operates an annual accreditation scheme based on self-assessment and
site visits. If any hospital is not JAG-accredited, it will no longer be paid at Best Practice
Tariff and will lose the ability to train scopists and to participate in the Bowel Cancer
Screening Programme. It remains unclear whether, in the near future, this will also apply
to entire Trusts in which one site/hospital fails JAG-accreditation. This leaves WSHFT
open to significant risk.
St Richard’s Hospital had its last JAG inspection in April 2012. A number of minor policy
amendments were recommended and further evidence of scopist training was
requested. A further visit was made in January 2013 and accreditation was confirmed
shortly afterwards.
Worthing Endoscopy Department is due to next be inspected by JAG in October 2014.
The Trust has already been advised that Worthing Hospital will fail its accreditation
unless improvements with respect to gender separation are made. The required
changes are to ensure that single sex facilities are provided post-procedure; recovery
areas are currently mixed due to space constraints. The service would require
16
significant remodelling to achieve these requirements. Without a larger footprint for
expansion, this would not be possible. This option is explored further in Section 2.
The proposed approach in this business case is designed to enable Worthing to make
the changes required to meet JAG requirements, ensuring improved patient experience
and securing Best Practice Tariff income into the future, whilst also putting in place the
capacity and facilities required to meet future demand.
Although WH is currently denoted as ‘assessed – improvements required’ by JAG for
BPT, meaning it attracts the full tariff, the Trust will be required to make a compliance
submission in October 2013. It is unclear how JAG will respond with regard to failure to
comply with single sex requirements. The Trust is exploring making interim operational
changes at WH, such as single sex sessions, in order to comply in the short-term.
However, these may have a detrimental impact on capacity and productivity.
If WSHFT does not make changes to ensure continued sustainable compliance with JAG
accreditation requirements, it will be unable to become a Bowel Cancer Screening
Centre or to continue as a Unit, resulting in a significant loss of income and status.
1.5
The WSHFT Endoscopy Service
The Endoscopy Service at WSHFT provides a wide range of diagnostic and therapeutic
endoscopy procedures from two main units at St Richard’s and Worthing Hospitals and a
satellite unit providing cystoscopy at Southlands Hospital.
The Service provides general LGI (colonoscopy and flexible sigmoidoscopy), UGI
(oesophago-gastroduodenoscopy – OGD) as well as more specialist procedures such as
endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound.
These procedures support a range of pathways within colorectal surgery,
gastroenterology and UGI surgery, including Cancer pathways. Bowel screening is also
provided, with full age extension achieved at SRH but not yet at WH, due to capacity
constraints. The age 55 flexible sigmoidoscopy screening will begin at SRH once the
Trust has been a Bowel Cancer Screening Centre for at least 12 months and additional
outpatient procedure room capacity is made available; Worthing will become eligible to
begin the flexible sigmoidoscopy screening following the building of additional capacity,
remodelling to meet JAG and successful extension of the existing bowel screening
colonoscopy programme.
A number of other scoping procedures are also carried out from the endoscopy units,
including bronchoscopy, cystoscopy (urology) and transoesophageal echocardiography
(TOE – cardiology). There are no plans to move these procedures to other areas of our
hospital/s and the units plan to continue to provide the capacity to meet current and
future demand.
The Endoscopy Service, which is managed from within the Medical Division, directly
employs 75 WTE members of staff, including nurses, HCAs, administrators, managers
and decontamination staff. Scoping is carried out by a number of accredited consultant
practitioners from across the relevant medical and surgical specialties. The Trust has a
well-established team of four WTE nurse endoscopists, who are fully trained to carry out
general UGI and LGI endoscopy procedures.
The Service has experienced significant growth in demand over recent years, driven by
a range of factors, including an ageing population, pathway and access improvements,
17
the extension of bowel screening and national awareness-raising campaigns on the
signs and symptoms of Cancer.
Figure 2: Trend in Upper and Lower GI endoscopy activity at Western Sussex Hospitals NHS Trust
(Dr Foster), 2000-1 to 2012-13
Consultant episodes having primary upper or lower GI endoscopic procedure
source: Dr Foster Procedure Group 2000/01
Upper GI
Lower GI
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
3,879
4,732
5,566
5,831
5,654
5,575
5,946
5,692
6,208
6,649
7,219
7,493
7,443
3,227
3,484
4,046
4,453
4,822
4,847
5,141
4,386
4,828
4,808
5,962
6,685
7,125
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
Upper GI
Lower GI
0
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
*Note: The apparent dip in 2007/8 may be related to the use of a new data system
To cope with this additional demand, a number of measures, based on Lean
Management principles, have been taken to improve productivity and increase the
timeliness of access. These include increasing the number of points per list (each
procedure is allocated a number of ‘points’ based on its complexity), which has improved
productivity. A range of improvements have also been made in booking processes and
financial management, including cost improvement within decontamination at WH.
Productivity improvements have led to a significant reduction in the need to access
capacity through waiting list initiatives, but a small number continue to be required at
Worthing in order to meet demand in light of current weekday capacity constraints. An
interim endoscopy consultant is also employed.
Significant improvements have been achieved by the Endoscopy service to manage
additional demand without the need for otherwise required additional resources. Within
this business case, scenarios have been modelled to illustrate the benefits that can be
realised by further marginal increases to the number of points per list (from 11 to 12) and
providing a service into the evening and on weekends. It is acknowledged by the teams
that whilst further improvements may become increasingly more difficult to achieve, their
attainment will support increased demand within existing resources, and defer the need
for further capital investment at SRH until an appropriate time and provide sufficient
lead-in time for construction of subsequent phases.
18
Regular patient experience surveys are conducted to look at a number of aspects of the
patient’s visit, including:
 Ease of making an appointment
 Information received about their procedure
 Locating the endoscopy unit on the day
 If the staff are friendly and helpful
 How the patients rated their care
 How long they waited for their procedure
 Did the staff answer all their questions
 Was the environment clean
 Were the patient facilities adequate
 Was their privacy and dignity maintained
Reported patient experience at both sites is generally very good and each unit has an
action plan in place to address the aspects in which a small number of patients identified
issues, which primarily relate to patient information and communication.
The Endoscopy team from NHS Improvement worked with the Trust from May 2012 in
order to help the service tackle a number of concerns, including historically poor
compliance with waiting times targets, process inefficiency, regular use of expensive
waiting list initiatives and variable productivity.
The national team recognised that significant improvements have been made by the
service and praised the team in a final report in May 2013. Key metrics which
demonstrate some of the improvements made over the short to medium term include:
 An increase in service utilisation (usage of available/budgeted capacity) from
69.2% in 2010 to 87% in 2012 (the DH/NHS Improvement goal is 85%)
 An increase in the proportion of patients booked prior to their breach date from
46.7% in 2010 to 89.9% in 2012
 An increase in the number of delivered average points from 7.8 to 10.9 over the
last 18 months
 The service has met the diagnostic target within the 18 Week RTT over the last
12 months
The summary from NHS Improvement highlighted a range of achievements and also a
number of developments and improvements which are either in progress or due for
implementation, based on the aims agreed at the start of the work in May 2012. These
are summarised below and include the capital developments outlined in this business
case.
Figure 3: NHS Improvement summary of WSHFT Endoscopy Improvement Programme, 2012-13
Key aims
Current status
Estates upgrades to improve patient flow at St Richard’s
(sound proofing, single sex)
Start/ stop audit
Endoscopy User Group meets regularly
Completed
Reducing dropped lists/ appointment of an ‘office endoscopist’
JAG re-accreditation at St Richard’s
Cessation of Saturday Waiting List Initiatives
Understand and utilise demand and capacity data
Nurse consent
Increased points on lists (from 10 to 12 at Worthing Hospital)
Partially implemented
19
Key aims
Current status
Surgical Pre‐Assessment service (straight from OP clinic)
Electronic Scheduling System
Future implementation
Estates work at Worthing (recovery bay, increase to 6 rooms)
Estates work at St Richard’s (upgrade to 6 rooms, replace washers in decontamination)
A key dependency for the proposed capital development, and a project identified for
‘future implementation’, is the implementation of an electronic scheduling system.
Booking for endoscopy lists is currently carried out manually in paper ledgers, which
requires significant administrative intervention, continuous checking and crossreferencing and carries a high risk of booking errors and loss of productivity.
Implementation of an electronic scheduling system is not specifically covered within this
business case. However, the indicative required capital investment of £50k has been
included within the total Endoscopy capital allocation requested for approval (£8.582m).
This specific initiative will be subject to a separate business case and procurement
exercise, and will address a significant risk for the development.
The Operations Manager for Specialist Medicine is leading on the implementation of an
electronic booking system, which is expected to be in place to during 2014 to align with
the new developments. Any increase in rooms or sessions would become increasingly
difficult to achieve without an electronic system being in place and would carry significant
operational risk.
1.6
Service Demand: Projection Assumptions
Assumptions have been made about likely future service demand and productivity in
order to develop and validate the proposed approach. The Endoscopy Steering Group
worked with a range of colleagues in order to develop a number of potential growth and
productivity scenarios in order to aid planning and decision-making.
1.6.1
Growth Assumptions
The key factors that were taken into account were:
- National growth assumptions for LGI endoscopy, with the DH issuing guidance to
the NHS in December 2011 to plan on 10-15% per annum growth for the next 5
years (including screening), based on screening extension and associated impact
on other activity, an ageing population, more complex pathways and greater
public awareness
- Local estimates of screening age extension, introduction of age 55 flexible
sigmoidoscopy screening and expected uptake (incorporated into the LGI
estimates)
- Local estimates of likely UGI procedure growth
- The expected number of additional new and follow-up outpatient appointments
associated with these increases in activity
- Expected average productivity across the service, including historic DNA and onday cancellation figures
Following significant discussion at both a strategic and operational level, it was agreed
that a ‘medium’ growth scenario would be used as the base case for planning. Following
a review of the local growth experienced and considering the Finance & Investment
Committee’s comments following review of the draft business case in July 2013, a low
20
growth assumption has also been included. The key specific growth assumptions used
are that:
- Lower GI annual growth would be 8% until 2016/17 rising to 10% or 12.5%
(low/medium scenarios) for 2017-2019 (including the expected impact of the
actual uptake of bowel screening): this is based on the DH growth forecasts, but
applied across each of 6 years
- Upper GI annual growth would be 5%: there are no national forecasts of UGI
growth so a rate was taken above the historic growth of c.3%, to take into
account an ageing population and more complex pathways
- No growth was assumed for bronchoscopy, cystoscopy and TOE, although the
capacity model builds in some flexibility for such growth
21
Figure 4a: Endoscopy procedure activity forecast – low scenario growth summary
2013/14
Procedure
SRH
WASH
2014/15
WSHT
Colonos copy
Col onos copy
2015/16
2016/17
2017/18
2018/19
SRH
WASH
WSHT
SRH
WASH
WSHT
SRH
WASH
WSHT
SRH
WASH
WSHT
SRH
WASH
WSHT
1,883
3,202
5,085
1,883
3,202
5,085
1,883
3,202
5,085
1,883
3,202
5,085
1,883
3,202
5,085
1,806
2,398
4,204
1,896
2,518
4,414
1,991
2,644
4,635
2,091
2,776
4,867
2,300
3,054
5,353
2,530
3,359
5,889
Bowel Screeni ng col onos copy
353
276
629
418
332
750
483
417
900
622
536
1,158
630
544
1,174
701
609
1,310
Endos copic res ecti on of l es ion of col on
59
59
118
62
62
123
65
65
130
68
68
136
75
75
150
82
82
165
1,800
1,075
2,875
1,890
1,129
3,019
1,985
1,185
3,170
2,084
1,244
3,328
2,292
1,369
3,661
2,521
1,506
4,027
10
7
17
10
7
17
1,177
7
1,184
1,177
1,495
2,672
1,177
1,495
2,672
1,177
1,495
2,672
2
Fl exi bl e s igmoi dos copy
Bowel Screening Flexi s ig
Endos copic U/S
Other ‐ Colorectal
0
29
29
0
30
30
0
32
32
0
34
34
0
37
37
0
41
41
185
137
322
194
144
338
204
151
355
214
159
373
236
174
410
259
192
451
TOTAL Colorectal
4,213
3,981
8,194
4,470
4,222
8,692
5,904
4,501
10,405
6,256
6,312
12,567
6,709
6,748
13,457
7,271
7,284
14,554
TOTAL Colorectal EXC. Bowel Screening
3,850
3,698
7,548
4,042
3,883
7,925
4,244
4,077
8,321
4,457
4,281
8,737
4,902
4,709
9,611
5,393
5,180
10,572
3,644
3,183
6,827
3,826
3,342
7,168
4,018
3,509
7,527
4,218
3,685
7,903
4,429
3,869
8,298
4,651
4,062
8,713
268
268
536
281
281
563
295
295
591
310
310
620
326
326
652
342
342
684
245
180
425
257
189
446
270
198
469
284
208
492
298
219
517
313
230
542
0
151
151
0
159
159
0
166
166
0
175
175
0
184
184
0
193
193
Ga s tros copy
Gas tros copy (bleeds /dil ation/PEGS)
ERCP
Endos copic U/S (see breakdown)
Other ‐ Upper GI (see breakdown)
Total Upper GI
Bronchos copy
274
264
538
288
277
565
302
291
593
317
306
623
333
321
654
350
337
687
4,431
4,046
8,477
4,653
4,248
8,901
4,885
4,461
9,346
5,129
4,684
9,813
5,386
4,918
10,304
5,655
5,164
10,819
250
206
456
271
191
462
271
191
462
271
191
462
271
191
462
271
191
462
Cys tos copy
768
875
1,643
825
875
1,700
825
875
1,700
825
875
1,700
825
875
1,700
825
875
1,700
TOTAL
9,662
9,108
18,770
10,219
9,536
19,755
11,886
10,028
21,913
12,481
12,061
24,542
13,191
12,732
25,923
14,022
13,513
27,535
1
22
Figure 4b: Endoscopy procedure activity forecast – medium scenario growth summary
2013/14
Procedure
SRH
WASH
2014/15
WSHT
Colonos copy
Col onos copy
Bowel Screeni ng col onos copy
Endos copic res ecti on of l es ion of col on
2
Fl exi bl e s igmoi dos copy
Bowel Screening Flexi s ig
Endos copic U/S
Other ‐ Colorectal
2015/16
2016/17
2017/18
2018/19
SRH
WASH
WSHT
SRH
WASH
WSHT
SRH
WASH
WSHT
SRH
WASH
WSHT
SRH
WASH
WSHT
1,883
3,202
5,085
1,883
3,202
5,085
1,883
3,202
5,085
1,883
3,202
5,085
1,883
3,202
5,085
1,806
2,398
4,204
1,950
2,590
4,540
2,107
2,797
4,904
2,275
3,021
5,296
2,559
3,398
5,958
2,879
3,823
6,703
353
276
629
418
332
750
483
417
900
622
536
1,158
630
544
1,174
701
609
1,310
60
60
121
65
65
131
71
71
141
76
76
152
86
86
171
96
96
193
1,800
1,075
2,875
1,944
1,161
3,105
2,100
1,254
3,353
2,267
1,354
3,622
2,551
1,523
4,074
2,870
1,714
4,584
10
7
17
10
7
17
1,177
7
1,184
1,177
1,495
2,672
1,177
1,495
2,672
1,177
1,495
2,672
0
29
29
0
31
31
0
34
34
0
37
37
0
41
41
0
46
46
185
137
322
200
148
348
216
160
376
233
173
406
262
194
456
295
218
513
TOTAL Colorectal
4,214
3,982
8,197
4,588
4,334
8,922
6,152
4,739
10,891
6,651
6,691
13,342
7,265
7,282
14,547
8,019
8,002
16,021
TOTAL Colorectal EXC. Bowel Screening
3,851
3,699
7,551
4,160
3,995
8,155
4,492
4,315
8,807
4,852
4,660
9,512
5,458
5,243
10,701
6,141
5,898
12,039
3,644
3,183
6,827
3,826
3,342
7,168
4,018
3,509
7,527
4,218
3,685
7,903
4,429
3,869
8,298
4,651
4,062
8,713
268
268
536
281
281
563
295
295
591
310
310
620
326
326
652
342
342
684
245
180
425
257
189
446
270
198
469
284
208
492
298
219
517
313
230
542
0
151
151
0
159
159
0
166
166
0
175
175
0
184
184
0
193
193
Ga s tros copy
Gas tros copy (bleeds /dil ation/PEGS)
ERCP
Endos copic U/S (see breakdown)
Other ‐ Upper GI (see breakdown)
Total Upper GI
Bronchos copy
274
264
538
288
277
565
302
291
593
317
306
623
333
321
654
350
337
687
4,431
4,046
8,477
4,653
4,248
8,901
4,885
4,461
9,346
5,129
4,684
9,813
5,386
4,918
10,304
5,655
5,164
10,819
250
206
456
271
191
462
271
191
462
271
191
462
271
191
462
271
191
462
Cys tos copy
768
875
1,643
825
875
1,700
825
875
1,700
825
875
1,700
825
875
1,700
825
875
1,700
TOTAL
9,663
9,109
18,773
10,336
9,649
19,985
12,134
10,266
22,399
12,876
12,441
25,317
13,747
13,266
27,013
14,770
14,232
29,002
1
23
The Trust currently has 35 funded lists at SRH and 30 funded lists at Worthing. The additional endoscopy room requirements can therefore be calculated as follows:
Figure 5a: Endoscopy list and room requirements by site – low scenario growth
Year
Points 2013/14
Site
Points 2014/15
Points 2015/16
Points 2016/17
Points 2017/18
Points 2018/19
SRH
WASH
SRH
WASH
SRH
WASH
SRH
WASH
SRH
WASH
SRH
WASH
Lists required
36.0
35.0
38.0
36.0
43.0
38.0
46.0
44.0
47.0
46.0
50.0
50.0
Funded Lists
35.0
30.0
35.0
30.0
35.0
30.0
35.0
30.0
35.0
30.0
35.0
30.0
Additional lists required
1.0
5.0
3.0
6.0
8.0
8.0
11.0
14.0
12.0
16.0
15.0
20.0
Endoscopy rooms required
1.0
1.0
1.0
1.0
1.0
1.0
2.0
2.0
2.0
2.0
2.0
2.0
Notional spare capacity (10 lists pwk)
90%
50%
70%
40%
20%
20%
90%
60%
80%
40%
50%
0%
Figure 5a: Endoscopy list and room requirements by site – low scenario growth
Year
Points 2013/14
Site
Points 2014/15
Points 2015/16
Points 2016/17
Points 2017/18
Points 2018/19
SRH
WASH
SRH
WASH
SRH
WASH
SRH
WASH
SRH
WASH
SRH
WASH
Lists required
36.0
35.0
39.0
36.0
44.0
39.0
47.0
46.0
49.0
48.0
52.0
52.0
Funded Lists
35.0
30.0
35.0
30.0
35.0
30.0
35.0
30.0
35.0
30.0
35.0
30.0
Additional lists required
1.0
5.0
4.0
6.0
9.0
9.0
12.0
16.0
14.0
18.0
17.0
22.0
Endoscopy rooms required
1.0
1.0
1.0
1.0
1.0
1.0
2.0
2.0
2.0
2.0
2.0
3.0
Notional spare capacity (10 lists pwk)
90%
50%
60%
40%
10%
10%
80%
40%
60%
20%
30%
80%
24
The modelling demonstrates the significant expected growth in demand for endoscopy
over the next 5-6 years with an overall compound growth of more than 50%. The
summaries above illustrate that additional room requirements for WH are more pressing
those at SRH. SRH activity includes a significant amount of bowel screening activity, of
which the majority will be delivered out of hours to provide access to the target working
age population in line with the service specification. This growth is expected to generate
a requirement for up to 3 additional endoscopy rooms at WH and 2 additional rooms at
SRH.
The modelling suggests that in the medium growth scenario, WH would require 3
additional rooms and would have eight lists ‘spare’ per week (80%). SRH would require
two rooms and would have 3 lists or 30% capacity available.
1.6.2
Productivity & Scheduling Assumptions
This model incorporates an expected productivity of 10 sessions per room per week;
there is no reason why downtime for cleaning or maintenance can’t be delivered out of
hours. To derive at the summaries above, the model assumes that each list will deliver
11 points of activity per list and 10 sessions are delivered per week.
The table below presents, for both low and medium growth scenarios, assess the impact
of achieving an average of 12 points per session and / or delivering 12 sessions per
week.
Figure 6 - Room requirements varying productivity and schedules
Worthing
Growth asumptions Points*
Low growth
11
Low growth
12
Low growth
11
Low growth
12
Medium growth
11
Medium growth
12
Medium growth
11
Medium growth
12
Sessions pwk*
2013/14
10
10
12
12
10
10
12
12
2014/15
1
1
1
1
1
1
1
1
2015/16
1
1
1
1
1
1
1
1
2016/17
1
1
1
1
1
1
1
1
2017/18
2
2
1
1
2
2
2
1
2018/19
2
2
2
1
2
2
2
1
2
2
2
2
3
2
2
2
* all changes effective from 2015/16
SRH
Growth asumptions Points*
Low growth
11
Low growth
12
Low growth
11
Low growth
12
Medium growth
11
Medium growth
12
Medium growth
11
Medium growth
12
Sessions pwk*
2013/14
10
10
12
12
10
10
12
12
2014/15
1
1
‐1
‐1
1
1
1
‐1
2015/16
1
1
1
1
1
1
1
1
2016/17
1
1
1
1
1
1
1
1
2017/18
2
1
1
1
2
1
1
1
2018/19
2
1
1
1
2
2
2
1
2
2
1
1
2
2
2
1
* all changes effective from 2015/16
The model now suggests that if both sites can achieve increase to 12 points per list and
offer 2 additional sessions per week in the evenings or on weekends; Worthing would
require two rooms and SRH only one by 2018/19. There is the same requirement for
both low and medium growth scenarios.
Achieving these improvements would have a significant impact on the longevity of the
capital investment.
This business case takes a prudent approach to activity materialising whilst addressing
the immediate issues of JAG accreditation and decontamination resilience. It is proposed
that:
25





Investing in WH and increasing capacity to six endoscopy rooms will ensure the
service can meet demand until at least 2018/19 on a medium scenario growth
model and into future years on low scenario growth.
Assuming both productivity and scheduling improvements can be achieved, the
model would suggest only two additional endoscopy rooms would be required at
WH in 2018/19, delaying the need for a third endoscopy room for at least a
further two years. Providing the department with six endoscopy rooms would
appear to provide sufficient capacity under this model until at least 2022/23
(ceteris paribus)
Achieving both productivity and scheduling improvements at SRH would enable
the service to manage demand until at least 2018/19 without further expansion.
This assumes the provision of outpatient procedure rooms for screening that
would unlock capacity from the main endoscopy department (releasing
approximately 4 lists in 2013/14 rising to 8 in 2015/16 and negating the need for
an additional full endoscopy room).
The additional SRH capacity would at some point require additional
decontamination capacity; the trigger to implement the longer-term vision for the
department. This will be closely monitored following the procurement of the
replacement washers (that could themselves be relocated at a later date).
Whilst no growth has been assumed in the model for bronchoscopy, cystoscopy
or TOE, demand is likely to increase, not least as a result of an ageing
population. This will have an impact on capacity – however, with management of
this activity across the Trust to ensure lists are fully utilised, the impact of such
growth on physical capacity is expected to be mitigated. The activity model
inherently incorporates a degree of flexibility due to list requirements being
rounded-up.
The
26
Modelling has taken place broadly based on the current conversion rate from relevant outpatient attendances to endoscopy procedures in
order to estimate future outpatient growth associated with increasing demand within endoscopy. Existing new to follow-up ratio has been
applied. There may be some productivity opportunity in moving to the national median or upper quartile, in specialties and sites where it has
not yet been reached.
Figure 7: Outpatient activity and capacity modelling
Summary ‐ Outpatient Growth Modelling
For explanation of assumptions, see 'summary' sheet
WORTHING
Specialty
Gastroenterology
Colorectal Surgery
Upper GI Surgery
2012/13
Follow‐up
First Atts
Atts
2,313
2,665
3,133
1,863
522
674
ST RICHARDS
TOTAL
Atts
4,978
4,996
1,196
2012/13
Follow‐up Ratio
2012/13 11/12 Nat 11/12 Nat. Growth WASH
Median Top qrtl. factor p.a. First Atts
1.2
1.7
1.3
6.0% 2,452
0.6
1
0.7
8.8% 3,409
1.3
1.3
0.9
2.0% 532
Follow‐up Ratio
Specialty
Gastroenterology
Colorectal Surgery
Upper GI Surgery
First Atts
1,797
2,927
287
Follow‐up
Atts
2,674
3,175
406
TOTAL
Atts
4,471
6,102
693
2012/13
SRH
1.5
1.1
1.4
WESTERN SUSSEX
2012/13
Follow‐up
First Atts
Atts
4,110
5,339
6,060
5,038
809
1,080
TOTAL
Atts
9,449
11,098
1,889
Follow‐up Ratio
2012/13 11/12 Nat 11/12 Nat.
Median Top qrtl.
WSHT
1.3
1.7
1.3
0.8
1
0.7
1.3
1.3
0.9
Specialty
Gastroenterology
Colorectal Surgery
Upper GI Surgery
2013/14
Follow‐up TOTAL
Atts
Atts
First Atts
2,942 5,394 2,599
2,045 5,454 3,709
692 1,225 543
2013/14
11/12 Nat 11/12 Nat. Growth Median Top qrtl. factor p.a. First Atts
1.7
1.3
6.0% 1,905
1
0.7
7.8% 3,155
1.3
0.9
2.0% 293
4,357
6,564
825
2014/15
Follow‐up TOTAL
Atts Atts First Atts
2,857 4,762 2,019
3,471 6,626 3,433
410 703 299
5,799
5,516
1,102
2014/15
Follow‐up TOTAL
Atts
Atts
First Atts
3,119 5,718 2,755
2,225 5,934 4,035
706 1,249 554
10,156
12,080
1,927
24,163
4,618
7,142
842
2015/16
Follow‐up TOTAL
Atts Atts First Atts
3,029 5,048 2,140
3,776 7,209 3,735
418 717 305
6,147
6,001
1,124
2015/16
Follow‐up TOTAL
Atts
Atts
First Atts
3,306 6,061 2,920
2,421 6,456 4,390
720 1,274 565
10,765
13,143
1,966
25,874
4,895
7,770
859
2016/17
Follow‐up TOTAL
Atts Atts First Atts
3,210 5,351 2,269
4,109 7,844 4,064
426 731 311
6,516
6,530
1,147
2016/17
2017/18
Follow‐up TOTAL
Follow‐up
TOTAL
Atts
Atts
First Atts
Atts
Atts
First Atts
3,504 6,424 3,095 3,714 6,810 3,281
2,634 7,024 4,776 2,866 7,642 5,197
735 1,300 576 749 1,326 588
11,411
14,300
2,005
27,716
5,189
8,454
876
6,907
7,104
1,169
2018/19
2017/18
Follow‐up TOTAL
Atts Atts First Atts
3,403 5,672 2,405
4,470 8,534 4,421
435 746 317
12,096
15,558
2,045
29,699
5,500
9,198
893
Follow‐up TOTAL
Atts Atts First Atts
3,607 6,012 2,549
4,864 9,285 4,810
444 760 323
7,322
7,729
1,193
2018/19
Follow‐up TOTAL
Atts
Atts
3,937 7,218
3,118 8,315
764 1,352
12,822
16,927
2,086
31,835
5,830
10,007
911
Follow‐up TOTAL
Atts Atts 3,824 6,373
5,291 10,102
452 776
7,761
8,410
1,217
13,591
18,417
2,128
34,136
27
Market assessment and potential opportunities
There is a strong market for endoscopy services, screening services, diagnostic and
therapeutic procedures as part of medical and surgical pathways and for training and
development programmes. Having modern, JAG-accredited facilities will mean WSHFT
is well-placed to attract patient flows from neighbouring trusts and to gain a larger share
of future demand.
The map below shows the main NHS providers of endoscopic procedures to patients of
West Sussex and the known private providers offering such services within the locality.
Figure 8: Map showing the locations of the major providers of endoscopic procedures to residents
of West Sussex
Data for residents of Coastal West Sussex CCG area show that WSHFT currently has
approximately 56% of the share of patient endoscopy activity, with flows of this
population out to neighbouring Trusts. There may be an opportunity to increase this
market share over time. Data also show that only 3% of patient endoscopic activity from
residents of Brighton & Hove comes to the Trust. This may present a further
opportunity, as the historic capacity constraints on the Worthing service will be relieved
and the patient environment will be significantly improved.
Figure 9: Patient flows for West Sussex residents for diagnostic and therapeutic endoscopic
procedures 2012-13 (Dr Foster)
It is not known how many endoscopy procedures are carried out by local private
providers. However, both the Nuffield in Chichester and Goring Hall near WH offer a
28
number of lists per week.
Endoscopy Training Facilities
There are limited training facilities for endoscopy across the south coast with trainees
from Southampton to Kent (including WSHFT), typically travelling to London to receive
training. The development at WH includes a multi-functional space that can be used as a
seminar room for around 30 people. Adjacency to the endoscopy department is essential
to deliver effective endoscopy training, enabling lecturers and students to quickly and
easily move between video-linked and clinical environments.
The facility could deliver all aspects of endoscopy training from general observation of
basic endoscopy procedures to complex Endoscopic Ultrasound (EUS) and Endoscopic
Mucosal Resections (EMR) cases.
Standard delegate day rates are in the region of £200-£500 per doctor and £100-£200
per nurse. It is anticipated that a single days training for 30 delegates, including
company sponsorship, would generate revenue in the region of £20k - £40k. Prudently,
this potential income has been excluded from the financial model.
During the construction phase and depending upon the build programme, this training
facility could provide a temporary patient waiting area. Please see section 5 - The
Management Case - for further details.
1.7
Clinical accommodation across the Trust
The endoscopy unit at SRH currently comprises four endoscopy rooms and that at WH
has three. The units also include recovery bays, waiting areas and administration areas,
as well as decontamination facilities, as described above.
The proposal is to increase the endoscopy rooms from three to six at WH immediately,
and plan for future changes at SRH in the future to include a centralised
decontamination unit. As described in section 2 below, this would provide sufficient
additional capacity across the Trust beyond 2018/19.
Significant remodelling will also need to take place at WH in order to provide single sex
accommodation, improved waiting facilities and to make best use of a relatively confined
space, and ensure compliance with JAG requirements.
Manpower calculations to deliver the predicted increase in demand over the next 5-6
years have been estimated and are included in the financial case to assure the Trust
Board of the viability of this proposal.
29
2.0
The Economic Case
2.1
Introduction
The purpose of this section is to outline and appraise the proposed option versus the
current ‘status quo’ option. Listed below is a summary of the options with a more
detailed description of each within section 2.2.
Figure 10 – Options for change
Option
Description
A
Do nothing. Continuation of Endoscopy services
from the existing departments with no capital
investment
Do minimum. Management of key operational
risks - replacement of washers at SRH and
remodelling at WH within the existing footprint to
achieve JAG accreditation
Management of key operational risks and
increase capacity within existing department
footprints
Increase capacity and remodel the department
through refurbishment; centralise
decontamination
Increase capacity and remodel the department
through refurbishment
Increase and remodel both departments by
constructing new and bespoke standalone units
Single site model using a new build, either on or
off an existing hospital site
B
C
Di
Dii
E
F
2.2
Applicable to:
TrustSRH WH
wide
X
X
X
X
X
X
X
X
X
Key Features of Each Option
Option A. Do nothing - This option assumes the continuation of Endoscopy services
from the existing four endoscopy rooms at SRH and three at WH with no capital
development works.
Advantages:
 No additional capital investment required
 No disruption to the delivery of the current service
Disadvantages / Risks:
 Removal of JAG accreditation at WH and potential removal for whole Trust, with
loss of status and significant loss of income (Best Practice Tariff)
 Insufficient capacity to deal with anticipated demand across the Trust within the
next year, with very significant shortfall in 3-5 years
 Potential reliance on expensive out-of-hours working, waiting list initiatives and
outsourcing to meet demand, including age extension of screening at WH
30





A risk to the on-going achievement of waiting times indicators and quality and
performance indicators for key clinical pathways, including Cancer and
adherence to the Monitor compliance regime
Continuation of mixed sex recovery and poor patient environment at WH
Failure to achieve Bowel Cancer Screening Centre status (due to loss of JAG
status) and income or to be permitted to provide flexible sigmoidoscopy
screening at WH
Significantly increased service and maintenance costs for scoping equipment at
SRH with imminent effect
Poor recruitment and retention of staff
Option B: Do minimum. Management of key operational risks - replacement of
washers at SRH and remodelling at WH within the existing footprint to achieve JAG
accreditation
Advantages:
 Lowest capital investment of all options
 Negate SRH scope corrosion issue (with minimal lead-in time) and the potential
financial risk of up to £555k per year
 Improve SRH decontamination resilience
 Achieve JAG accreditation and be eligible for BPT tariff incentives
Disadvantages / Risks:
 Significant disruption to the delivery of the service at WH during remodelling
 Disruption to the delivery of the decontamination service at SRH, although
viewed as manageable
 Insufficient capacity to deal with anticipated demand across the Trust within the
next year, with very significant shortfall in 3-5 years
 Potential reliance on expensive out-of-hours working, waiting list initiatives and
outsourcing to meet demand, including age extension of screening at WH
 A risk to the on-going achievement of waiting times indicators and quality and
performance indicators for key clinical pathways, including Cancer and
adherence to the Monitor compliance regime
 Significant capital investment at WH with no improvements in activity constraints
 WH would result in a compromised configuration even after significant capital
investment due to the limited footprint and necessary additional requirements
Option C: Management of key operational risks and increase capacity within existing
department footprints. This option is only applicable to SRH by converting existing
outpatient space to enable delivery of procedures, thus improving capacity within the
main Endoscopy department as activity is transferred to this new setting.
Advantages:
 Modest capital investment required, over and above replacement of washers, to
upgrade existing outpatient area to enable delivery of outpatient procedures /
consulting
 Negate SRH scope corrosion issue (with minimal lead-in time) and the potential
financial risk of up to £555k per year
31



Improve SRH decontamination resilience
Unlock capacity in the main endoscopy department by delivering screening in a
one-stop-clinic scenario
More appropriate setting for this screening activity which will improve patient
experience
Disadvantages / Risks:
 Disruption to the delivery of the decontamination service at SRH, although
viewed as manageable
 Without WH development for additional rooms, capacity would be insufficient to
deal with anticipated demand across the Trust
 Compromise required to 2nd stage recovery to accommodate a discrete exit from
a procedure room to the endoscopy department (loss of 1 recovery seat)
 No investment in the support services for the department; reception, patient
waiting, admin & back office functions
Option D: Increase capacity and remodel both departments through refurbishment; at
SRH, centralise decontamination; WH - single sex recovery, patient waiting; both sites
reception, storage etc.
Advantages:
 Provides the capacity to provide an accessible, high quality service to patients
across West Sussex in line with anticipated demand and in support of clinical
pathways and the achievement of quality and performance measures across the
Trust
 SRH decontamination delivered in line with best practice guidance
 Ensures that WH complies with JAG and that the Trust maintains its status as a
high quality service provider
 Support services have accommodation to welcome and book in patients, code
and count activity etc.
 More appropriate nurse accommodation, storage, staff facilities etc.
 Negate SRH scope corrosion issue (with minimal lead-in time) and the potential
financial risk of up to £555k per year
 Improve SRH decontamination resilience
 Unlock capacity in the main endoscopy department by delivering screening in a
one-stop-clinic scenario
 More appropriate setting for this activity which will improve patient experience
Disadvantages / Risks:
 Very significant capital investment required to remodel both departments
concurrently
 SRH would require a new build extension to achieve this longer term vision;
adding panning risk and construction time to the development
 Capacity not needed straight away at SRH; capital investment wouldn’t be fully
utilised
 Disruption to the delivery of the decontamination service at SRH, although
viewed as manageable
32
Option E: Increase and remodel both departments by constructing new and bespoke
standalone units.
This option has been reviewed strategically across the Trust. A potential site for an
Endoscopy Centre in a new build has been identified at both SRH & WH. At SRH, the
gravel staff car park located towards the back of the main hospital could provide a
suitable location as could Park Avenue at Worthing Hospital, parallel to the main
entrance from Lyndhurst Road. Please see Appendix 6 for sketch plans where new
builds could be situated.
Using the space requirements identified for WH as a base position for a new build, each
development would likely be in the region of at least 1850m2. Given the potential
locations identified and considering planning permissions and construction economies of
scale – two storey buildings would provide the optimal solution at a footprint of 1875m2
and 2518m2 at SRH & WH respectively. The capital investment required would be in the
region of £7.9m and £10.6m for SRH & WH respectively, before the purchase of medical
equipment or decontamination facilities. These costs have been based on NHS Health
Care Premises Cost Guidelines.
Advantages:
 Provides the capacity to provide an accessible, high quality service to patients
across West Sussex in line with anticipated demand and in support of clinical
pathways and the achievement of quality and performance measures across the
Trust
 Service configuration, patient flow can be optimised for maximum benefit to all
users; JAG accreditation at both sites
 May provide the opportunity of additional space for alternative services, at
marginal cost
 Fully compliant building in line with current building regulations, health building
notes and health technical standards and benefits realised from reduced energy
usage and carbon foot print
Disadvantages / Risks:
 Planning permissions required for each development that may delay or stop
proceedings
 Capital investment far in excess of that allocated from internal Trust funds;
external borrowing would be essential and phasing of each development may be
difficult to achieve
 New builds may utilise sought after space at each site, inhibiting other strategic
developments
 Existing redundant space may become underutilised and/or may need
refurbishment for the next user which currently has no capital allocation
Option F. Single site model using a new build, either on or off-site.
This option would involve the delivery of all endoscopy activity from a single site location.
As well as not being having an endoscopy presence on site for inpatients and urgent
referrals from A&E (essential to maintain a District General Hospital as illustrated in our
33
Clinical Services Strategy), the capital outlay could be in the region of £18m if a suitable
site could be located. There would be limited opportunity to phase the construction of the
building resulting in over capacity initially and underutilised resources. A single site
model is likely to be less convenient to patients than the two current sites from which
services are provided.
Advantages:
 Provides sufficient capacity to meet demand in a single location ensuring patient
equity from service and experience.
 Service configuration, patient flow can be optimised for maximum benefit to all
users; JAG accreditation at both sites
 May provide the opportunity of additional space for alternative services, at
marginal cost
 Fully compliant building in line with current building regulations, health building
notes and health technical standards and benefits realised from reduced energy
usage and carbon foot print
Disadvantages / Risks:
 Single site limits access for groups of the population which may result in reduced
activity, compliance with screening and Trust income
 Lack of access may present difficulties for patients and significantly impeded
patient experience. Travelling following bowel preparation and/or sedation may
compromise patients dignity
 Planning permissions required for the development that may delay or stop
proceedings; significant travel and infrastructure impacts
 Capital investment far in excess of that allocated from internal Trust funds;
external borrowing would be essential and phasing of the development may be
difficult to achieve. Greater financial exposure than alternative options
 New build may utilise sought after space at either site, inhibiting other strategic
developments, or require an off-site solution that could isolate the service from
Trust clinical and support services
 Existing redundant space may become underutilised and/or may need
refurbishment for the next user which currently has no capital allocation
34
2.3
Non-Financial Option Appraisal
A non-financial option appraisal has been undertaken in which the options have been
assessed against 10 key criteria developed to demonstrate achievement of the key aims
of the project which are:
 To improve patient experience and quality of care
 To improve service productivity and efficiency, in light of future demand
 To improve estate utilisation and condition
The outcome of this exercise indicates that:
 The new build and single site options rank the highest scoring as they will provide
bespoke facilities suited to Endoscopy. However, on the basis of affordability
and deliverability, these options must be discounted
 The remodelling of the existing sites and further expansion ranks highly
 Option C for SRH scores highly for patient experience and meeting JAG
accreditation – key programme objectives. The compromises are around support
services and lack of improvements to flow to the department (these are included
within the longer-term vision for the department)
 To do nothing or the minimum would provide low scores and would still require
significant capital investment at Worthing to achieve. These options must be
discounted.
35
Figure 11: Non-financial appraisal
Non-Financial Option Appraisal
Aims
of
proposal
the
Scoring
Criteria (across the Trust)
Weight
Option Option Option Option Option Option
A
B
C
D
E
F
Provides excellent patient facilities and environment
10.00% 3
4
7
9
9
9
Meets JAG accreditation requirements
12.50% 2
7
9
10
10
10
Improves patient Attracts and retains high-quality workforce
7.50% 6
safety, experience Supports bid to become Bowel Cancer Screening
10.00% 3
and quality of care Centre, with relevant benefits
6
7
9
9
9
8
9
10
10
10
10.00% 3
4
8
9
10
7
10.00% 3
3
8
10
10
9
10.00% 4
4
4
4
8
8
7.50%
3
3
5
7
7
5
Improved recovery and administration productivity
5.00%
through better space and flow
2
4
2
8
9
9
estate
Modernised estate with improved facilities, flow and
and
7.50%
use of clinical space
0
3
5
9
9
9
10.00% 0
4
9
6
3
2
100%
50
73
91
94
87
Offers effective patient flow, including from outpatients
for one-stop and screening clinics
Enables service to meet future demand in an efficient
and planned way
Provides efficient and modern decontamination
facilities, improving productivity and reducing
Improves service operational risks
productivity
and Supports the integration of the Worthing and
efficiency, in light Chichester sites through development of a shared
of future demand approach and comparable facilities as one Trustwide service
Improves
utilisation
condition
Affordability
Provides an affordable
investment context
Summary Scores
2.4
solution
within
current
29
Preferred options
Worthing Hospital. The option to remodel the existing department and not address the
imminent additional capacity requirements would not meet the objectives of this
development. Whilst remodelling within the existing footprint may be possible, there are
limited options and all of them would result in significant compromise. JAG accreditation
is a key driver and therefore taking appropriate steps to achieve compliance today, and
take a longer-term perspective to minimise future adaptations, is recommended.
A new build development carries significant capital investment over and above the total
capital allocation of £4.529m currently available. On the grounds of affordability and
deliverability, this option has been discounted.
The preferred and optimal option for Worthing Hospital Option Dii - to make best use of
the space available, and expand the footprint to include the following:
 Breast screening services area. This service will be relocated to the new Breast
Care Centre that is due to open in January 2014. This space will therefore
become available.
 League of Friends café. The Trust and the League of Friends are working
together to find an alternative interim solution to ensure our patients and staff
have retail and catering facilities. The League of Friends have been formally
notified of our intent and have been provided notice to vacate by April 20140.
 Surgical Pre-Assessment. This service is adjacent to the Endoscopy service and
currently has limited space available to provide the growing number of clinics.
The users are supportive of relocating to the new Outpatient Department.
36
St. Richard’s Hospital.
The longer term proposed solution is to remodel the department and centralise
decontamination – Option Di. Please see Appendix 3a. However, this would require a
capital investment cost of £1.92m for phase 1 (new build extension to accommodate a
centralised decontamination) and £1.05 for phase 2 (remodelling of the department). The
activity modelling also demonstrates that additional room capacity may not be required
at SRH until later than 2018/19 if further productivity and scheduling changes can be
made, and therefore it is proposed that this investment may well be required in the
future, but not immediately.
The recommended preferred option is Option C - to address the immediate operational
risk by replacing the decontamination washers, and to make minor improvements to the
pod arrangements and minor modifications to the outpatient area to be able to deliver
screening activity and subsequently release capacity within the main department. It is
proposed that the option to centralise decontamination be noted and internal capital
investment allocated as appropriate. Please see Appendix 3b presenting the possible
phases of this longer-term plan and note the lead-in time of up to 2 years from approval
to a fully commissioned and operational centralised decontamination facility.
This longer term plan includes the following improvements to the department:
 Dedicated reception area and improved waiting area
 Administration facilities co-located within the department
 Improved nursing accommodation
 Improved storage facilities
 Remodelling of recovery areas to improve patient flow and increase capacity
 Centralised decontamination facilities
 An outpatient consulting and procedure facility
In order to assist with the appraisal of the preferred options, Figure 12 compares current
circumstances (Option A) against the proposed solutions (Option C for SRH and Option
D for Worthing).
37
38
Figure 12: Comparison of each preferred option against a range of factors
Theme
Workforce
Option A – Do Nothing
Option C – Decontamination
replacement and minor changes
at SRH
Option D – remodel & increase
capacity at WH
Additional workforce/workforce costs
would be required to meet additional
demand but may need to be delivered
in a less cost-effective way e.g.
waiting list initiatives or outsourcing
Additional workforce requirements will be
relatively minimal to support the existing
capacity and new outpatient procedure
capacity from day one.
Additional workforce requirements will be
relatively minimal to support the new
capacity from day one.
Pressure on staff and lack of JAG
accreditation is likely to lead to poorer
recruitment and retention
Other workforce will then be brought
online incrementally on a sessional basis
as demand increases.
No change to recruitment and retention.
Access
Current strong diagnostic access
performance may be adversely
affected due to insufficient capacity to
meet rising demand
Activity
Demand will continue to rise but the
Trust may not be able to deliver
against the demand or will need to
outsource.
Failure to achieve JAG at Worthing
will mean a loss of screening activity
and it is likely that general referral
flows may be affected, with an
adverse impact on income.
Income
Worthing will lose Best Practice Tariff
associated with endoscopy income
due to no longer being JAGaccredited (5% of tariff) and this may
be removed from the Trust as a
whole (estimated at £300k in 14/15
and £400k by 18/19)
Strong performance on access is
expected to be maintained, with some
opportunity (albeit diminishing) to
respond quickly and flexibly to changes
in demand
Increasing demand will be met and
activity will be conducted in existing
facilities.
Bowel screening can be delivered from
appropriate outpatient procedure rooms,
releasing capacity in the Endoscopy
department.
Best Practice Tariff is achieved and
secured at both sites
The additional income associated with
being a Bowel Cancer Screening Centre
is assured. Flexible sigmoidoscopy
programme can be delivered from
2015/16
Other workforce will then be brought
online incrementally on a sessional basis
as demand increases.
Recruitment and retention is expected to
be improved.
Strong performance on access is
expected to be maintained, with the
opportunity to respond quickly and
flexibly to changes in demand
Increasing demand will be met and
activity will be conducted in modern and
suitable facilities. This will include full
age extension of bowel screening at
Worthing and the introduction of age 55
flexible sigmoidoscopy screening at both
sites.
There may be an opportunity to attract
local private patients and patients from
neighbouring units which have capacity
and quality shortfalls.
Best Practice Tariff is achieved and
secured at both sites
The additional income associated with
being a Bowel Cancer Screening Centre
is assured
Additional income opportunities from
39
Theme
Option A – Do Nothing
Bowel Cancer Screening Centre
income will be lost (estimated at
£150k in 14/15 and £300k by 18/19)
Option C – Decontamination
replacement and minor changes
at SRH
Potential cost to maintain corroded
scopes removed. Costs associated with
breakdowns and maintenance reduced
Option D – remodel & increase
capacity at WH
private patients and patients from other
parts of the region are explored
Additional costs will be incurred
through
increased
maintenance
charges for scopes at SRH
(estimated up to £555k per year)
Quality
There may be additional costs in
putting in place measures to address
increasing demand e.g. waiting list
initiatives or outsourcing
Worthing will fail its JAG accreditation
with and the whole Trust may lose
accreditation, with associated loss of
reputation, Best Practice Tariff
income and inability to be a
Screening Centre or Unit
The patient environment is and continues
to be JAG accredited
JAG quality markers will be achieved at
both sites
The patient flow around both units will be
improved
The patient environment at Worthing
will continue to be below the
standards that the Trust or JAG
would expect
Clinical pathway
impact/
interdependencies
Reliance on waiting list initiatives and
other measures to meet demand will
impact
adversely
on
patient
experience
There are risks that, as demand
increases, the Service is less able to
support clinical pathways in a timely
and effective way
Electronic booking is important to the
on-going efficiency of the service
The patient environment at Worthing will
be significantly improved, including the
waiting areas and the separation of the
sexes
JAG quality markers will be achieved at
both sites
The full range of clinical pathways
(inpatient and outpatient) continue to be
supported in a way that maintains and
improves waiting times performance and
clinical outcomes
The full range of clinical pathways
(inpatient and outpatient) continue to be
supported in a way that maintains and
improves waiting times performance and
clinical outcomes
Electronic booking is crucial to the ongoing efficiency of the service and to the
expansion into additional rooms
Electronic booking is crucial to the ongoing efficiency of the service and to the
expansion into additional rooms
40
Theme
Option A – Do Nothing
Option C – Decontamination
replacement and minor changes
at SRH
Option D – remodel & increase
capacity at WH
IM&T
No specific impact: electronic booking
system
is
expected
to
be
implemented in 1204/15
No specific impact: electronic booking
system is expected to be implemented in
2014/15. Option B is expected to enable
electronic booking to operate more
effectively as it will provide the capacity
and flexibility required to meet increasing
demand in an efficient way.
No specific impact: electronic booking
system is expected to be implemented in
2014/15. Option B is expected to enable
electronic booking to operate more
effectively as it will provide the capacity
and flexibility required to meet increasing
demand in an efficient way.
Estates
Increased pressure on existing estate
and facilities through increased
workload and on-going minor work to
attempt to maintain/improve the
environment
Manageable
disruption
during
replacement
of
washers
and
modifications to Bracklesham Suite
Significant short-term disruption to
endoscopy services and other services
displaced by the development works
Lack of administration, reception and
back
office
accommodation
compromises service efficiency and
patient experience
Improved use of space in the medium to
longer term, including fit-for-purpose
patient and decontamination facilities,
including single sex separation
No opportunity to provide an estates
solution to separation of the sexes
41
2.5
Detail of the Preferred Option
In order to deliver the preferred solutions, there are a number of workforce, estates and
other considerations, which are outlined briefly, below. More detail is also provided in
the Financial Model and Appendices. Further information on implementation planning
and programme management is provided in Section 5.
Workforce planning and development
The manpower plan for the proposed scheme falls into two main parts:
-
The overall expected requirements: number of posts/WTE and types of skills
-
The strategy/plan to meet those requirements: including job planning,
recruitment, training and development
The proposed manpower requirements per additional session and overall, for both
clinical and non-clinical staff, have been included in the financial model. The anticipated
requirements within each staff group, per year, are summarised in Figure 13.
Current manpower is under pressure with reliance on unfunded sessions over and above
existing capacity in order to meet RTT requirements.
42
Figures 13a and 13b: Expected change in manpower requirements by site by year
Figure 13a: The summary below outlines the estimated WTE or consultant PA implications of the increased endoscopy activity and the move to be a Bowel
Cancer Screening Centre and the other developments in the overall business case. Due to time constraints and the need to clarify certain existing staff
baselines, the information in the table below is subject to further refinement.
Staffing WTE Impact Summary Chichester
Worthing
WTE
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Director 1 PA
Lead Colonoscopist 1 PA
Bowel Screening Centre Lead PAs
Nursing Manager
Nursing - Lead SSP Band 7
Nursing - SSP Band 6
Nursing - Pre-assessment Band 6
Nursing - Band 6
Nursing - Band 5
Nursing - Band 3
Nursing
Admin - Band 6
Admin - Band 4
Admin - Band 3
Admin - Band 2
Admin
Decontamination Assistants - Band 2
Decontamination Band 3
Decontamination Band 6
Decontamination
Pathology (Consultant Histopathologist)
Band 6 BMS
MLA Band 2
Radiology
Consultant outpatient Sessions per week
Nursing - Outpatient Trained
Nursing - Outpatient Band 2
Admin - Outpatient Band 2
Medical Records
Endoscopists sessions per week required
Consultant Endoscopist
Nurse Endoscopist Wte
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.10
0.10
0.10
0.10
0.10
0.10
2.01
2.01
2.01
2.01
2.01
2.01
0.50
0.50
0.50
0.50
0.50
0.50
1.50
1.50
2.00
2.25
3.50
3.50
1.28
1.50
1.59
1.68
1.80
1.93
5.18
5.76
6.73
7.11
7.68
8.26
10.30
11.47
13.53
14.28 15.45 16.59
4.32
4.80
5.60
5.92
6.40
6.88
25.09
27.54
31.96
33.75 37.34 39.67
0.50
0.50
0.50
0.50
0.50
0.50
2.00
3.00
3.00
3.00
3.00
3.00
1.90
1.90
1.90
1.90
1.90
1.90
4.94
4.94
4.94
4.94
4.94
4.94
9.34
10.34
10.34
10.34 10.34 10.34
5.72
7.72
7.72
7.72
7.72
7.72
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
6.72
8.72
8.72
8.72
8.72
8.72
0.5
0.5
0.5
0.625
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.25
0.25
0.25
0.375
0.25
0.25
TBC
TBC
TBC
TBC
TBC
TBC
16.73
16.17
14.03 15.18 16.44 17.80
0.42
0.09
0.09
0.09
0.09
0.09
1.61
1.24
1.35
1.46
0.09
1.71
0.23
0.18
0.19
0.21
0.01
0.24
2.84
2.87
3.05
3.24
3.46
3.72
41.5
45.75
47.18
50.18 54.43 59.43
41.50
45.75
46.75
49.75 54.00 59.00
0.00
0.00
0.43
0.43
0.43
0.43
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.05
0.10
0.10
0.10
0.10
0.10
0.10
1.00
1.00
1.00
1.00
1.00
1.00
0.50
0.50
0.50
0.50
0.50
0.50
1.50
1.50
2.00
2.25
3.50
3.50
1.28
1.35
1.44
1.71
1.83
1.97
6.33
6.72
7.87
8.45
9.03
9.61
13.72 14.56 17.06
18.31
19.56
20.81
5.28
5.60
6.56
7.04
7.52
8.00
29.61 31.23 36.43
39.26
42.94
45.39
0.50
0.50
0.50
0.50
0.50
0.50
1.00
1.00
2.00
2.00
2.00
2.00
0.90
0.90
1.90
1.90
1.90
1.90
4.44
4.44
4.44
4.44
4.44
4.44
6.84
6.84
8.84
8.84
8.84
8.84
5.72
6.72
6.72
6.72
6.72
6.72
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
6.72
7.72
7.72
7.72
7.72
7.72
0.5
0.5
0.5
0.625
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.25
0.25
0.25
0.375
0.25
0.25
TBC
TBC
TBC
TBC
TBC
TBC
31.81
33.83
36.00
38.32 40.81 43.49
1.64
1.75
1.87
2.00
2.14
2.29
3.05
3.25
3.46
3.68
2.14
4.17
0.44
0.46
0.49
0.53
0.31
0.60
2.91
3.09
3.29
3.71
3.97
4.25
50.5
53.5
56.93
61.18
66.18
70.18
49.50 52.50 55.50
59.75
64.75
68.75
1.00
1.00
1.43
1.43
1.43
1.43
* To Note - Radiology costs will be calculated and included in a FBC
* Costs included in the main for support services are additional resources required, a manpower review of all support resources will be included in the FBC.
43
Figure 13b:
The table below provides an indicative summary of nursing and administrative headcount and cost against the current baseline. Further work is required,
however, in order to baseline other staff groups and to baseline administration at Worthing. It has been assumed that future HCAs will need to be Band 3 but
this is subject to confirmation.
Staffing Impact Summary WTE
Nursing Manager
Nursing - Lead SSP Band 7
Nursing - SSP Band 6
Nursing - Pre-assessment Band 6
Nursing - Band 6
Nursing - Band 5
Nursing - Band 3
Nursing - Band 2
Nursing
Admin - Band 6
Admin - Band 4
Admin - Band 3
Admin - Band 2
Admin
Pay
Nursing Team Leaders
Nursing - Lead SSP Band 7
Nursing - Band 7 Nurse Endoscopist
Nursing - SSP Band 6
Nursing - Pre-assessment Band 6
Nursing - Band 6
Nursing - Band 3
Nursing - Band 2
Nursing - Booking Band 5
Nursing - Recovery Band 5
Nursing
Admin - Band 6
Admin - Band 4
Admin - Band 3
Admin - Band 2
Admin
Chichester
2012/13 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Budget Outturn Plan
Plan
Plan
Plan
Plan
Plan
2.01
2.00
2.01
2.01
2.01
2.01
2.01
2.01
0.00
0.00
0.50
0.50
0.50
0.50
0.50
0.50
1.50
1.50
2.00
2.25
3.50
3.50
1.28
1.50
1.59
1.68
1.80
1.93
4.52
4.00
5.18
5.76
6.73
7.11
7.68
8.26
14.07
12.05
10.30
11.47
13.53
14.28
15.45
16.59
0.00
1.00
4.32
4.80
5.60
5.92
6.40
6.88
5.94
4.44
26.54
23.49
25.09
27.54
31.96
33.75
37.34
39.67
1.00
1.04
0.50
0.50
0.50
0.50
0.50
0.50
1.00
0.84
2.00
3.00
3.00
3.00
3.00
3.00
1.80
1.85
1.90
1.90
1.90
1.90
1.90
1.90
6.88
6.02
4.94
4.94
4.94
4.94
4.94
4.94
10.68
9.75
9.34
10.34
10.34
10.34
10.34
10.34
Worthing
2012/13 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Budget Outturn Plan
Plan
Plan
Plan
Plan
Plan
2.13
2.09
1.00
1.00
1.00
1.00
1.00
1.00
0.50
0.50
0.50
0.50
0.50
0.50
1.50
1.50
2.00
2.25
3.50
3.50
1.28
1.35
1.44
1.71
1.83
1.97
2.96
3.06
6.33
6.72
7.87
8.45
9.03
9.61
14.58
14.82
13.72
14.56
17.06
18.31
19.56
20.81
5.28
5.60
6.56
7.04
7.52
8.00
1.58
1.61
21.25
21.58
29.61
31.23
36.43
39.26
42.94
45.39
0.50
0.50
0.50
0.50
0.50
0.50
1.00
1.00
2.00
2.00
2.00
2.00
0.90
0.90
1.90
1.90
1.90
1.90
4.44
4.44
4.44
4.44
4.44
4.44
0.00
0.00
6.84
6.84
8.84
8.84
8.84
8.84
Chichester
2012/13 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Budget Outturn Plan
Plan
Plan
Plan
Plan
Plan
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
-97
-100
-101
-101
-101
-101
-101
-101
-21
-21
-21
-21
-21
-21
0
0
-22
-22
-22
-22
-54
-54
-72
-81
-125
-125
-46
-54
-57
-61
-65
-70
-175
-177
-187
-208
-243
-257
-278
-299
0
-25
-92
-102
-119
-126
-136
-146
-115
-59
-224
-214
-149
-166
-194
-205
-221
-238
-224
-214
-174
-193
-226
-244
-258
-277
-834
-789
-826
-901
-1,057 -1,119
-1,229
-1,301
-34
-37
-17
-17
-17
-17
-17
-17
-25
-19
-50
-74
-74
-74
-74
-74
-39
-36
-41
-41
-41
-41
-41
-41
-137
-137
-90
-90
-90
-90
-90
-90
-235
-230
-198
-223
-223
-223
-223
-223
Worthing
2012/13 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Budget Outturn Plan
Plan
Plan
Plan
Plan
Plan
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
-96
-103
-49
-49
-49
-49
-49
-49
-21
-21
-21
-21
-21
-21
-49
-49
-71
-71
-71
-71
-54
-54
-72
-81
-125
-125
-46
-49
-52
-62
-66
-71
-118
-121
-229
-243
-285
-306
-327
-348
-112
-119
-140
-150
-160
-170
-29
-28
-253
-288
-182
-193
-227
-243
-260
-277
-253
-288
-213
-226
-265
-284
-303
-322
-750
-828
-955
-1,003
-1,181
-1,267
-1,383
-1,455
-17
-17
-17
-17
-17
-17
-25
-25
-50
-50
-50
-50
-20
-20
-41
-41
-41
-41
-89
-89
-89
-89
-89
-89
0
0
-151
-151
-197
-197
-197
-197
44
Most of the manpower requirements increase incrementally, year-by-year. A delivery
plan for how the Service will meet the workforce requirements, both immediately and in
the future, will be developed in greater detail as the programme is implemented. This
will include a focus on training and development to ensure that new staff who do not
have endoscopy experience rapidly gain the knowledge and skills required.
At this stage, it is not proposed that an additional consultant be appointed. Other
options, such as greater use of existing nurse endoscopists to deliver sessions, will be
considered initially, as well as the potential opportunity to add PAs to existing contracts.
It will be crucial to ensure that all staff delivering endoscopy procedures complete the
requisite minimum number per year to maintain accreditation and a recommended safe
level of experience.
Estates
The table below provides a summary of the estates plans and known considerations at
each site. The proposed solution represents the minimum requirements deemed
necessary to ensure the service can meet demand and accreditation expectations over
the coming 5-6 years.
Each scheme will plan and manage the operational impacts to ensure as little disruption
to patient services and to performance and as little impact on cost as possible. The
Worthing scheme includes a number of dependencies relating to other services who
currently occupy part of the required site. This business case seeks approval to
commence relocation of Surgical Pre-Assessment as detailed in Addendum 1.
Figure 14: Key features of the proposed estates solution
St Richard’s Hospital
Key features







Replacement of the four
existing
decontamination
washers*
Validation
of
necessary
ventilation to meet required
national standards (10 air
changes)
Improvements to the existing
pods: raise/lower sinks, new
flooring, monitors for drying
cabinets (to comply with
standards), changes to local
ventilation where chemicals
are stored within the pods
Provision of a ventilated
external chemical store
Conversion of an OP
consulting
room
to
a
procedure room
Adaption to existing OP
procedure room to improve
ergonomics
Conversion
of
existing
[spare] office to a consulting
room
Worthing Hospital










Significant remodelling of the
extended footprint to include
a
contained
patient
environment (one side of the
hospital street) to include:
Patient reception and waiting
areas
Administration facilities
OP clinic / enema rooms
6 Treatment rooms (2 leadlined)
Single sex recovery areas
2nd stage recovery
Nurse accommodation
Storage
Decontamination
office
accommodation and storage
A separate support area to
include:




Administration facilities
Staff changing facilities
Staff room
Multi-functional
seminar
45

Minor changes to 2nd stage
recovery to facilitate OP
procedure rom
room
*Decontamination washers will be subject to formal procurement and are supported by a
national framework.
Equipment
The costs of scoping equipment to meet additional demand and kit-out the additional
rooms, including the extension of the screening programme, has always been
acknowledged but were not included in the original capital assessment for Endoscopy
(February 2013) or the Bowel Screening Business Case, as they were previously
unquantifiable.
There are currently two main incumbent providers of scoping equipment within the Trust.
The equipment at SRH is predominantly Olympus and at Worthing, Pentax. This
business case does not make any recommendation with respect to choice of provider or
the potential benefits and dis-benefits of standardisation of equipment.
The national market for scoping equipment is very competitive, with a number of key
players. The selection and purchase of new equipment must be subject to a formal
procurement process, in line with legal requirements and national frameworks, in order
to test the market. As part of the procurement process a range of information, including
relevant clinical evidence and the needs of the WSHFT service, will be taken into
account in order to build a suitable evaluation framework.
The scoping equipment requirements at each site are outlined in the table below. The
requirements have been based on the minimum number of scopes and associated
equipment required to meet the anticipated need and number of rooms, based on JAG
and British Society of Gastroenterology guidelines. Slim scopes will need to be
purchased at both sites in order to deliver the bowel screening flexible sigmoidoscopy
programme for people aged 55 years. Lists will be planned to make the most efficient
use of available equipment.
The table includes the overall scoping equipment requirements, phased over time in line
with the ‘medium scenario’ growth assumptions. This has the effect of mothballing the
additional room capacity at Worthing until such time as they are required; potentially
limiting operational flexibility but equally ensuring inefficiencies are not inadvertently
attained. The rooms will be finished and equipped to a basic level, but specialist
equipment for scoping will not be available until warranted by activity growth. Should a
low scenario growth assumption materialise, the opportunity to defer capital investment
into later years may arise.
46
Figure 15: Scoping equipment requirements
St Richard’s Hospital
Worthing Hospital
Current scoping equipment
49 scopes for LGI and UGI 50 scopes for LGI and UGI
endoscopy
endoscopy
Additional
scoping 12 slim colonoscopes
17 slim colonoscopes
equipment requirements
2 stack systems
20 gastroscopes
2 diathermy
3 stack systems
3 diathermy
Rationale for proposed Slim colonoscopes required Additional scopes required
investment
to enable delivery of flexible to support three additional
including
slim
sigmoidoscopy programme rooms,
colonoscopes for flexible
sigmoidoscopy screening
One stack system and one One stack system and one
diathermy required per diathermy required per
additional endoscopy room
outpatient procedure room
Opportunity
to
phase
requirements by bringing
rooms online in line with
rising demand (14/15 &
15/16 financial years)
Phasing:
+1 room: 8 colonoscopies &
10 gastroscopes
+2 rooms: 5 colonoscopies
& 6 gastroscopes
+3 rooms: 4 colonoscopies
& 4 gastroscopes
For indicative purposes, the estimated costs of purchasing the scoping equipment are
included in the detailed financial model, based on indicative quotes from the two major
incumbent suppliers.
Scopes have a seven-year lifespan, on average, although this can vary based on the
service and maintenance provided. The Trust does not run a formal rolling replacement
programme for scopes and, instead, additional capital investment is secured as and
when scopes approach the end of their useful lives through the Medical Devices and
Equipment Management Group. This business case only includes the additional scope
costs associated with expanding the physical capacity of the service and the delivery of
flexible sigmoidoscopy screening. However, a number of existing scopes are expected
to become due for replacement within the next three years and information is available to
inform further discussion.
Scoping equipment also incurs annual service and maintenance costs, which have been
indicatively included in the financial model. There may also be the opportunity to avoid
initial capital outlay by entering into leasing arrangements for the scopes. Any such
options will be explored at the procurement stage to ensure best value for money.
Other equipment costs which will be incurred include clinical equipment for the
endoscopy rooms and other patient areas and additional furniture and office equipment,
where expansion or significant remodelling takes place and existing equipment cannot
be used. Estimated requirements have been included in the financial model.
Decontamination washers will also be subject to a formal procurement process applying
local evaluation methodologies against national frameworks. An indicative cost has been
47
included for approval with a budget cost of 10% for enabling estates works within the
pods.
Pathology and Radiology requirements
The activity modelling for this business case has been shared with Pathology and
Radiology, who are working through the impacts in more detail. Draft information has
been included for Pathology but further work will be required in both services to identify
the impacts for the full business case.
Outcome of Bowel Cancer Screening Centre bid
This case assumes that the Trust will be successful in its bid to become a Bowel Cancer
Screening Centre. However, were the bid not to be successful, the expected levels of
bowel screening activity (but with alternative payment mechanisms) would still be
expected to flow to the Trust. However, were the Trust not to make changes to ensure
continued JAG status into the future, screening activity (as a Unit) and any Centre status
would be removed.
48
3.0
The Commercial Case
Endoscopy activity at the Trust is currently funded in a number of ways:
Figure 16: Funding flows for endoscopy activity
Type of activity
Outpatient
endoscopy activity
(direct access)
Outpatient
endoscopy activity
(referred
from
outpatients)
Inpatient
endoscopy activity
Screening
endoscopy activity
Current funding arrangements
Cost per Case PbR Tariff
Cost per Case PbR Tariff
Impact of proposed approach
Additional activity paid for on
cost per case, attracting BPT
due to compliance with JAG
Additional activity paid for on
cost per case, attracting BPT
due to compliance with JAG
Cost per Case PbR Tariff
Cost per Case PbR Tariff
It is expected that, for non-screening endoscopy activity, the Trust will continue to be
paid by Commissioners in line with activity and current contracts, attracting a Best
Practice Tariff for outpatient endoscopy procedures if the Trust remains JAG-approved.
The Trust has shared the forecast activity plans presented within this business case with
our primary Clinical Commissioning Group and more recently they have been raised
through formal contractual negotiations. At full business case stage, it is anticipated that
assurance from the CCG to fund the forecast additional activity and income will be
secured.
For screening activity, the Trust is actively involved in conversations with the national
team and local Centres to become the West Sussex Screening Centre. Whilst formal
agreements remain outstanding, it is anticipated that the service will commence for
2014/15. The Trust will contract with Public Health for England, exercised through the
NHS Commissioning Board; they are fully aware of our activity plan. The Trust will also
contract directly with the National Screening Programme for Age Extension provision
and FS until both elements are rolled out fully, when commissioning responsibility will be
delegated to Public Health for England. The screening programme has a national service
specification which clearly sets out the responsibility of Screening Units.
Payment for bowel screening would be contracted on a per capita basis, whilst flexible
sigmoidoscopy will be a price per scope. It is anticipated that contractual risk under the
proposed agreement will be reduced as income sources are diversified.
Contracts will need to be entered into for the estates works, the purchase of the
decontamination washers and the purchase of the scopes and associated equipment.
49
4.0
The Financial Case
4.1
Introduction
The financial appraisal has been considered for both options: retaining current
arrangements and providing the capital development in line with the preferred options for
either site. A full financial model has been developed for the proposed options and the
estimated financial implications of maintaining the status quo have been outlined
(through development of a Discounted Cash Flow).
4.2
Assumptions
General Assumptions
1. Growth in endoscopy procedures: ‘Low’ and ‘medium’ growth scenarios have
been modelled, which assumes an overall annual growth in LGI procedures of
10% and 12.5% respectively and UGI of 5%. This is explained further in Section
1.6.
Screening flexible sigmoidoscopy demand is calculated based on 40% uptake
among 55 year-olds within the local catchment area, using relevant population
data. This is congruent with the Trust approved business case for this activity.
2. Inflators / deflators. The model enables the effect of pay inflation and tariff
deflation to be incorporated within the model. Tariff deflator, pay inflation and
non-pay inflation for each of the years modelled have been separately identified
as below.
Income deflator pa
Pay Inflator pa
Non Pay Inflator pa
2013/14
1
1
1
2014/15 2015/16 2016/17 2017/18 2018/19
0.985
0.99
0.99
0.99
0.99
1.013
1.015
1.018
1.018
1.018
1.03
1.025
1.02
1.02
1.02
3. Productivity: Sessions will run for 49 weeks of the year with cross cover of lists.
Although work will continue to ensure all lists are booked (where relevant) to 12
points, the assumption used in the model is booking to 11 point lists with a 7.8%
DNA/on-day cancellation assumed. This is to be more reflective of current
productivity in practice, although 12 points have been modelled to demonstrate
the impact. The assumptions also take into account Bank Holidays, clinical
governance half days and other unavoidable downtime.
4. Outpatients: The expected growth in outpatient clinics has been modelled based
on the current conversion rate from outpatients to an endoscopy procedure and
current new to follow-up ratios, working backwards from the growth assumptions
for endoscopy procedures.
5. Staffing: Additional staff will be required on a per session basis as activity
increases, with different broad staffing profiles given for general LGI/UGI lists,
screening colonoscopy and screening flexible sigmoidoscopy. Some additional
support staffing needs have been identified for administration and
decontamination on completion of the capital development.
6. Decontamination: equipment and staff costs have been included in this
business case. Costs for decontamination of the scopes have been included on
a per scope basis.
7. Consumable costs: Based on the total endoscopy non-pay costs apportioned
for the number of lists.
50
8. Radiology costs: Costs included have been calculated based on initial feedback
from Departmental Heads. This will need further validation and confirmation in
working up the FBC.
9. Pathology costs: Costs included have been calculated at individual sample
costs for non-pay and staff costs provided by the Head of Pathology.
10. Equipment: The costs of equipment required for the new rooms and remodelled
areas have been included in the case. These are estimated based on recent
indicative quotes, which include a bulk purchase discount. However, the
purchase of scoping equipment will be subject to a competitive procurement
process using national frameworks which also usually attract volume purchase
discounts. Depreciation of existing equipment and replacement of equipment is
excluded from the model.
11. Estates requirement: The estimated costs of the estates works are outlined,
including the indicative costs of new decontamination washers at SRH. The
washers will be subject to formal procurement. These estates costs have been
calculated using the recognised Healthcare Premises Cost Guide formulae and
triangulated using two Quantity Surveyors who provided initial estimates. Cost
accuracy will be refined for Worthing between OBC and FBC – as the build
programme becomes clearer. Final costs will be known following a formal tender
exercise.
12. Income: Income has been calculated using an average tariff per procedure code
for inpatients, this is slightly higher than paid activity and has been calculated as
many scopes are counted as multiple procedures making it difficult to
disaggregate. Outpatient income has been calculated based on tariff.
13. Implementation costs: these are not currently included in the financial model for
WH. Feasibility has been reviewed for each of the preferred options; whilst they
remain unclear for WH, it is anticipated that limited costs will be necessary to
replace the washers at SRH or undertake the other minor works. An
implementation plan for WH will be included within the FBC.
4.3
Financial Analysis
The figures below show the expected income and expenditure changes as a result of the
proposed solution, at both an individual site and Trust level. Currently the Service
contributes approximately £7.4m to Trust overheads, which equates to 42% of
endoscopy related income. It is clear throughout the period modelled, that the Service
should be able to continue to make a significant contribution to Trust overheads. With
the growth in activity over the period if 42% contribution were maintained, the
contribution to overheads would rise as indicated below in section 4.4.
The sensitivity analysis in section 4.4 models the impact on contribution and identifies
future indicative cost improvement programme (CIP) requirements.
51
Figure 17: Income and Expenditure
Assumptions: Pay inflation and tariff deflation included, medium growth assumption, 11 points average per
session and 10 sessions per week.
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,929 15,630 16,336 17,133 18,785 19,962 2,754 2,710 2,863 3,025 3,203 3,394 Contribution to overheads
7,419 6,964 5,904 5,025 5,718 5,623 2013/14
(6,750)
(3,513)
Contribution margin
42.0%
including inflation/deflation & activity flexing
2014/15
2015/16
2016/17
2017/18
(7,007)
(4,369)
38.0%
(7,926)
(5,369)
30.8%
(9,127)
(6,006)
24.9%
(9,814)
(6,456)
26.0%
2018/19
(10,704)
(7,029)
24.1%
52
Figure 18: Discounted Cash Flow
The discounted cash flow summary demonstrates some of the financial risks of not proceeding with the proposed solution, including the loss of
Best Practice Tariff, the inability to act as a Bowel Cancer Screening Centre, service maintenance of equipment corroded due to the outdated
decontamination equipment at SRH and the potential increased operational costs of having to meet expected demand increases without
additional physical capacity.
Economic Analysis
Endoscopy Expansion
Item
Year
1
2
3
4
5
6
7
8
9
10
13/14
14/15
15/16
16/17
17/18
18/19
19/20
20/21
21/22
22/23
23/24
£000
£000
(6,369)
£000
(1,283)
£000
(570)
£000
£000
(360)
£000
£000
£000
£000
£000
657
859
959
1,830
1,368
(1,100)
Capital Investment payments
Change in Income
Totals
NPV
(8,582)
(79)
(79)
(79)
Change in Pay
(202)
(5)
(1,053)
(595)
(722)
(444)
(240)
(245)
(252)
(258)
Change in Non Pay
(358)
(689)
(541)
(461)
(538)
(162)
(167)
(171)
(176)
(181)
Change in Depreciation
(386)
(183)
(82)
-
(51)
-
I&E Sub Total
(289)
(18)
(716)
774
56
(1,707)
(486)
(496)
(506)
4,260
(76)
(515)
Opportunity Costs
Loss of Best Practice Tariff premium
307
342
360
379
406
387
386
385
384
383
Increased Scope Maintenance Costs
515
530
543
554
565
576
588
600
612
624
Loss of Bow el Screening service
146
197
306
303
300
297
294
291
288
285
Change in cost base
22
192
(466)
180
(41)
654
860
859
857
853
3,971
(5,690)
(232)
(77)
2,010
967
(447)
782
780
778
777
(351)
Sub Total - undiscounted
Disount factor at 0.035
Total Discounted
1
0.966184 0.933511 0.901943 0.871442 0.841973 0.813501 0.785991 0.759412 0.733731 0.708919 9.31661
(5,497)
(217)
(69)
1,752
814
(363)
614
592
571
551
NPV =
(1,252)
EAC =
(134)
This analysis has been undertaken across the five year period for which activity projections exist, plus an estimate of the next five years based on ONS growth,
53
Affordability - Cash Flow
Endoscopy Expansion
Item
M arginal changes
Year
1
2
3
4
5
6
7
8
9
10
13/14
14/15
15/16
16/17
17/18
18/19
19/20
20/21
21/22
22/23
23/24
£000
£000
(6,369)
£000
(1,283)
£000
(570)
£000
£000
(360)
£000
£000
£000
£000
£000
-
657
859
959
1,830
1,368
(1,100)
(79)
(79)
(79)
(76)
Capital Investment
Change in Income
Change in Pay
(202)
(5)
(1,053)
(595)
(722)
(444)
(240)
(245)
(252)
(258)
Change in Non Pay
(358)
(689)
(541)
(461)
(538)
(162)
(167)
(171)
(176)
(181)
Loss of Best Practice Tariff premium
307
342
360
379
406
387
386
385
384
383
Increased Scope Maintenance Costs
515
530
543
554
565
576
588
600
612
624
Loss of Bow el Screening service
146
197
306
303
300
297
294
291
288
285
Opportunity Costs
Add back Depreciation movements
Change in cost base
-
408
375
(385)
180
11
654
860
859
857
853
Cash Flow (out)/in
-
(5,304)
(49)
5
2,010
1,018
(447)
782
780
778
777
Internal Rate of Return
1.17%
Payback is indicated as happening betw een years 9 and 10
This analysis has been undertaken across the five year period for which activity projections exist, plus an estimate of the next five years besed on ONS growth,
54
4.4
Sensitivity Analysis
To assess possible financial risk within the business case a sensitivity analysis has been
run which include the following scenarios:

Modelling the impacts of inflation and deflation variables to maintain the current
contribution in absolute terms (£7.419m) and as a percentage of endoscopy
derived income (42%). This scenario includes the benefits of increased
productivity and efficiency and aims to identify the likely cost improvement
programme target for the service in future years. (please see Figure 19)
Downside planning scenarios on the following basis:
 Scenario A: 10% reduction in the activity projections, leading to less income and
some reduction in costs. This reduction in activity growth would represent a
growth much nearer to expected population growth, rather than the growth
signalled by national bodies. (please see Figure 20a)

Scenario B: Additional growth funded in line with population growth and not
demand as forecast. This scenario assumes the capital has been invested but
demand is managed to match a lower contracted activity plan in line with ONS
growth. The impact of this for the local health economy may be a growing
elective endoscopy waiting list but considers commissioner affordability. (please
see Figure 20b)
55
56
Figure 19 – Impacts of inflation and deflation and required CIP
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
Contribution to overheads
Contribution margin
To maintain 42% Margin
Required Margin
CIP required ‐ cumulative
CIP required ‐ annual change
CIP as a % of income
Average CIP over 3 years /5 years
To maintain absolute contribution
Original Contibution
CIP required to maintain 7,419 ‐ cumulative
CIP required ‐ annual change
CIP as a % of income
Average CIP over 3 years /5 years
Excluding inflation/deflation, medium growth scenario
11 points per list & 10 lists per week 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Excluding inflation/deflation, medium growth scenario
11 points per list & 10 lists per week from 2015/16
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
Including inflation/deflation, medium growth scenario
11 points per list & 10 lists per week from 2015/16
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
14,929 15,868 16,752 17,747 19,655 21,098 2,754 2,751 2,936 3,133 3,352 3,587 14,929 15,868 16,752 17,747 19,655 21,098 2,754 2,751 2,936 3,133 3,352 3,587 14,929 15,630 16,336 17,133 18,785 19,962 2,754 2,710 2,863 3,025 3,203 3,394 (6,750)
(6,916)
(7,708)
(8,719)
(9,210)
(9,868)
(3,513)
(4,256)
(5,128)
(5,643)
(5,958)
(6,374)
7,419 7,447 6,852 6,518 7,838 8,442 (6,750)
(6,863)
(6,766)
(7,653)
(8,074)
(8,598)
(3,513)
(4,256)
(5,128)
(5,643)
(5,958)
(6,374)
7,419 7,500 7,794 7,585 8,974 9,713 (6,750)
(6,952)
(6,957)
(8,010)
(8,604)
(9,326)
(3,513)
(4,369)
(5,369)
(6,006)
(6,456)
(7,029)
7,419 7,019 6,873 6,142 6,928 7,000 42.0%
40.0%
34.8%
31.2%
34.1%
34.2%
42.0%
40.3%
39.6%
36.3%
39.0%
39.3%
42.0%
38.3%
35.8%
30.5%
31.5%
30.0%
0.419562
7,812
365
365
2.0%
8,260
1,408
1,043
5.3%
8,760
2,242
834
4.0%
3.8%
9,652
1,814
(428)
(1.9%)
10,357
1,915
101
0.4%
2.0%
0.419562
7,812
312
312
1.7%
8,260
466
154
0.8%
8,760
1,175
709
3.4%
2.0%
9,652
678
(497)
(2.2%)
10,357
644
(34)
(0.1%)
0.7%
0.419562
7,695
676
676
3.7%
8,055
1,182
506
2.6%
8,457
2,315
1,133
5.6%
4.0%
9,225
2,297
(18)
(0.1%)
9,799
2,799
502
2.1%
2.8%
(28)
(28)
(0.2%)
566
595
3.0%
901
334
1.6%
1.5%
(419)
(1,320)
(5.7%)
(1,024)
(604)
(2.4%)
(0.7%)
(81)
(81)
(0.4%)
(375)
(294)
(1.5%)
(166)
209
1.0%
(0.3%)
(1,555)
(1,389)
(6.0%)
(2,294)
(738)
(3.0%)
(2.0%)
400
400
2.2%
546
145
0.8%
1,277
731
3.6%
2.2%
491
(786)
(3.6%)
419
(73)
(0.3%)
0.5%
7,419
57
Figure 20a – Downside planning scenarios
Scenario A: 10% reduction in activity projections
Excluding inflation/deflation, medium growth scenario
11 points per list & 10 lists per week 2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,929 14,451 15,246 16,147 17,865 19,163 2,754 2,751 2,936 3,133 3,352 3,587 (6,750)
(3,513)
Contribution to overheads
Contribution margin
(6,493)
(3,923)
(7,279)
(4,739)
(8,061)
(5,213)
(8,535)
(5,496)
(9,189)
(5,876)
7,419 6,787 6,164 6,006 7,185 7,685 42.0%
39.5%
33.9%
31.2%
33.9%
33.8%
Excluding inflation/deflation, medium growth scenario
12 points per list & 12 lists per week from 2015/16
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,929 14,451 15,246 16,147 17,865 19,163 2,754 2,751 2,936 3,133 3,352 3,587 Contribution to overheads
7,419 6,845 7,094 6,827 8,012 8,706 (6,750)
(3,513)
Contribution margin
42.0%
(6,434)
(3,923)
39.8%
(6,349)
(4,739)
39.0%
(7,240)
(5,213)
35.4%
(7,709)
(5,496)
37.8%
(8,168)
(5,876)
38.3%
Including inflation/deflation, medium growth scenario
12 points per list & 12 lists per week from 2015/16
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,929 14,234 14,867 15,588 17,074 18,132 2,754 2,710 2,863 3,025 3,203 3,394 (6,750)
(3,513)
Contribution to overheads
Contribution margin
(6,518)
(4,025)
(6,528)
(4,958)
(7,578)
(5,545)
(8,214)
(5,949)
(8,860)
(6,471)
7,419 6,401 6,243 5,491 6,114 6,194 42.0%
37.8%
35.2%
29.5%
30.2%
28.8%
58
Figure 20b – Downside planning scenarios
Scenario B: Capital invested and activity subsequently contracted at ONS growth levels
Excluding inflation/deflation, medium growth scenario
11 points per list and 10 lists per week 2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,923 15,125 15,219 15,366 16,056 16,153 2,754 2,751 2,936 3,133 3,352 3,587 Contribution to overheads
7,414 7,115 6,155 5,428 6,103 6,175 (6,750)
(3,513)
Contribution margin
41.9%
(6,677)
(4,085)
39.8%
(7,227)
(4,772)
33.9%
(7,982)
(5,090)
29.3%
(8,192)
(5,113)
31.4%
(8,358)
(5,206)
31.3%
Excluding inflation/deflation, medium growth scenario
12 points per list and 12 lists per week from 2015/16
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,923 15,125 15,219 15,366 16,056 16,153 2,754 2,751 2,936 3,133 3,352 3,587 (6,750)
(3,513)
Contribution to overheads
Contribution margin
(6,620)
(4,085)
(6,411)
(4,772)
(7,031)
(5,090)
(7,176)
(5,113)
(7,435)
(5,206)
7,414 7,172 6,972 6,379 7,118 7,098 41.9%
40.1%
38.4%
34.5%
36.7%
36.0%
Including inflation/deflation, medium growth scenario
12 points per list and 12 lists per week from 2015/16
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
Trust Position
Revenue £'000
Income
Inpatient Outpatient
Expenditure
Pay
Non Pay
14,923 14,899 14,841 14,834 15,346 15,283 2,754 2,710 2,863 3,025 3,203 3,394 Contribution to overheads
7,414 6,710 6,119 5,089 5,373 4,891 (6,750)
(3,513)
Contribution margin
41.9%
(6,707)
(4,193)
38.1%
(6,591)
(4,994)
34.6%
(7,358)
(5,412)
28.5%
(7,647)
(5,529)
29.0%
(8,065)
(5,721)
26.2%
59
4.5
Maintenance of financial contribution
The impacts of inflation and deflation on the model have a material impact on the
absolute contribution the service can make to Trust overheads. This will impact all Trust
services not just this endoscopy service.
Figure 19 illustrates that assuming the base case medium growth scenario and
productivity and efficiency changes to 12 points per list and 12 sessions per week, the
contribution moves from approximately £7.4m in 2013/14 to:
£9.7m in 2018/19 without the impacts of inflation; and,
£7.0m in 2018/19 with inflation/deflation included.
Therefore, in order to maintain an absolute contribution of £7.4m, the service would be
required to deliver a cost improvement programme (CIP) of 2.2% on average per annum
over the first 3 years (to deliver a 5-year CIP requirement).
To maintain a contribution equal to 42% of endoscopy related income, the CIP figure
rises to an average 4.0% per annum over the same period.
These CIP targets are within the typical Trust CIP programme requirements and
therefore are viewed as achievable through a range of initiatives which may include:
 Non-pay procurement savings
 Workforce skill mix reviews
 Increasing productivity and efficiency
 Delivering productivity and efficiency gains before 2015/16 as modelled
 Delivery of private patient activity and generation of income
 Delivery of seminar and training facilities at Worthing Hospital from the dedicated
seminar facility proposed to generate additional income
Details of these initiatives to deliver the required CIP will be developed for inclusion
within a full business case.
4.6
Interpretation of scenario planning
Either downside scenario is possible but both scenarios could not occur simultaneously;
if the CCG chose to contract at ONS growth, this would result in activity levels lower than
those currently modelled using a 10% reduction on forecast activity.
Assuming productivity increases to 12 points per list and 12 lists per week from 2015/16,
the findings are as follows:
Scenario A – 10% reduction in activity from forecast
 Absolute contribution to Trust overheads would still increase from £7.4m to
£8.7m (excluding the effects of inflation/deflation)
 Absolute contribution would decrease to £6.2m with inflation/deflation included.
This is an £800k reduction in 2018/19 against the equivalent model without the
10% reduction.
Scenario B – Growth in line with ONS, capital already invested
 Absolute contribution to Trust overheads would decrease slightly from £7.4m to
£7.1m (excluding the effects of inflation/deflation)
 Absolute contribution would decrease to £4.9m with inflation/deflation included.
This would be equal to 26% of endoscopy derived income.
60
4.7
Sensitivity analysis findings
The sensitivity analysis illustrates that the capital investment will support the service to
maintain a significant contribution towards Trust overheads, and mitigate potential costs
that may arise without the investment e.g. cost of scope maintenance, loss of bowel
screening activity etc. The impacts of inflation and deflation – which face the whole Trust
– will require the service to deliver a CIP programme within typical Trust expectations.
The impact on activity being lower than forecast would increase the potential CIP
requirement but the Service would still maintain a positive absolute contribution to Trust
overheads. The model includes capital which is phased in over future years; this
investment would not need to be made therefore mitigating an element of this decrease.
It would also have the positive impact of extending the longevity of the capacity delivered
by the capital investment at both sites, as activity would still be expected to grow and
require additional endoscopy rooms, albeit at a slower rate.
There is a catastrophic downside which has not been financially modelled in detail but is
described as follows: Without capital investment to not only increase capacity but
achieve and maintain JAG accreditation on both main hospital sites, it is likely that the
Trust would: a) lose JAG accreditation; b) the CCG would be required to find alternative
JAG approved supply (AQP or other means); c) The Trust would not qualify to hold
Bowel Screening Centre status with loss of income and kudos associated; d) a
detrimental impact to our district general hospitals as endoscopy provision would need to
cease jeopardising other clinical services that rely upon this fundamental clinical service.
4.8
Financial risks






As the majority of income is on a cost per case basis there is a risk that activity
growth is not translated into income or future changes to the tariff impact on the
contribution margin.
As a significant proportion of the costs are fixed in purchasing equipment or
building additional space there is a risk that the payback period is longer than
that planned.
Further risks are concerning whether staff can be recruited in the numbers
required, all pay costs are at substantive rates and if recourse to agency is
required this premium has not been factored into the figures.
Depreciation of equipment risks include the financial impact of writing off existing
equipment if replacement items are purchased. With depreciation of buildings
there is a risk that values are revised on an annual basis following a revaluation.
The required CIP value needs specific schemes developed. This is planned
before full business case and final approval to proceed to tender for the Worthing
development.
Productivity and efficiency gains assumed for later years are not realised as
planned resulting in reduced contribution to Trust overheads. However, the
clinical teams support these assumptions and national benchmarks suggest they
are realistic and deliverable. The team are currently working towards the level of
improvement modelled, supported by the NHS Improvement team.
61
5.0
The Management Case
5.1
Introduction
This section of the business case seeks to confirm ‘achievability’ of the proposal. Its
purpose is to set out the actions that will be required to ensure the successful delivery of
the programme in accordance with best practice. The programme at both sites is
outlined at a high level, greater detail will be provided for WH in the full business case.
5.2
Programme Background
The Endoscopy Strategic Development Programme has been in place for approximately
the last year, overseen by a Steering/Strategy Group and supported by an Operational
Group drawing together clinical and managerial colleagues across both sites.
Following initial work to set out a strategic case for change, a paper was presented to
the Executive Team in February 2013 outlining the proposed option at a high level and
estimating the capital costs to be £5.9m over two years (£1m at SRH, £4.5m at Worthing
& £350k for Pre-Assessment relocation), excluding scoping equipment. Although this
capital allocation was approved, it was acknowledged that the specific investment
required would not become clear until planning had been undertaken for both sides.
Much of the work of the Steering Group has focused over the last few months on
validating the initial work and developing it in order to inform the business case. This
has included:
 The revisiting and validation of activity growth and productivity assumptions
 The more detailed costing and work-up of estates plans at SRH and the revisiting
of a future centralised decontamination model
 The identification and modelling of workforce requirements
 The identification of equipment requirements and likely associated costs and
issues
 Detailed financial modelling and analysis
 More robust programme management, governance and communication,
including part-time support from an external consultant to support the process
5.3
Mobilisation Period and Implementation Plan
The timetables below illustrate the key milestones to be achieved with indicative
timescales. The SRH development is relatively less complex although highly dependent
upon the choice of washer and the supplier lead-in times for installation.
Figure 20a: Worthing Development
Milestone
Period
OBC Trust Board approval
October 2013
FBC Trust Board approval
January 2014
Tender period
February ‐ April 2014
Contract award
May 2014
Mobilisation period
May ‐ June 2014
Construction period
July 2014 ‐ June 2015
New department opens
July 2015
62
Figure 20b: St. Richard’s Development
Milestone
Period
OBC Trust Board approval
October 2013
Enabling works commence: Bracklesham
November 2013
Decontamination washers: procurement period
November 2013 ‐ January 2014
Decontamination washers: contract award
February 2014
Decontamination washers: mobilisation period
February ‐ April 2014
Pod 1 installation, minor works and commissioning
May ‐ July 2013
Pod 2 installation, minor works and commissioning
July ‐ September 2014
The Worthing development presents challenges and opportunities regarding the phasing
of the development to ensure minimal disruption to the existing service. These aspects
have been reviewed by the user group in recent weeks, supported by the Trust
appointed architect. The ideal scenario would be to deliver the development in three
major phases as detailed below and illustrated on sites plans in Appendix 1b.
1. Phase 1. Conversion of vacated breast screening area and café/shop area to
provide 3 treatment rooms and recovery areas. Conversion of the support
services accommodation opposite to provide a temporary reception and waiting
area. Existing decontamination and endoscopy department remains fully
functional.
2. Phase 2. Conversion of the existing endoscopy department to create the
reception, patient waiting, consulting areas and 3 treatment rooms.
3. Phase 3. Completion of the department by connection of services/infrastructure.
Minimal conversion of support services to permanent use.
This would potentially enable the service to continue to function within the existing
Endoscopy area during construction of the three new scoping rooms and recovery areas.
The service could then transfer to the new facility to deliver continued activity, whilst the
existing department is then remodelled. Infrastructure would need to be capped and
reconnected to achieve this. Decontamination facilities would remain uncompromised
during the entire development, albeit with altered clean and dirty routes that would be
less efficient for the interim period.
Assuming Board approval, a contractor will be immediately procured for the sole purpose
of advising the Trust how this programme can be built and recommend any alternative
solutions. A detailed mobilisation plan can then be developed and included within the
full business case, based on these estates planning dependencies.
The mobilisation plan will identify a number of key work streams with milestones and
actions:
-
Estates (building works, decant of services, procurement and installation of
decontamination equipment)
-
Operational (service continuity – including quality and performance, scheduling,
overall planning and mobilisation of additional sessions)
-
Workforce (manpower planning, recruitment, training and development)
-
Equipment (procurement of scopes and other equipment)
63
5.4
Engagement and communication (with staff and patients)
Programme Management Arrangements
The programme is complex, involving significant input and involvement from clinical and
managerial staff and different specialist disciplines, particularly Estates and operational
management, during the implementation period. One of the most significant risks is the
maintenance of acceptable levels of operational productivity and high quality service
delivery during the implementation period.
It is crucial that ownership and accountability for delivery sits within the Medical Division.
However, as the programme spans the Surgical and Core Divisions, a range of clinical
and managerial colleagues are expected to input at different levels to ensure the
success of the project.
The programme will be managed in accordance with recognised project management
principles and methodology under the overall leadership of a Senior Responsible Officer
and the day-to-day leadership of an identified Programme Lead from within the Service.
They will be supported by some dedicated Programme Manager support from within the
organisation.
It is proposed that the existing programme governance structure will be developed to
reflect the next phase of the development and provide robust oversight of the
programme as it is implemented. A proposed structure is outlined below.
Figure 21: Proposed programme structure
The membership of the groups will comprise clinical and managerial colleagues from
across the Trust, along with relevant technical experts, as required. They will each be
co-ordinated and led by the nominated work stream lead:
Endoscopy Programme Board: Director-level representatives of relevant Divisions and
disciplines, such as Estates, to ensure strong accountability and effective decisionmaking.
Endoscopy Implementation Group: Work stream managerial and clinical leads
meeting with Programme Lead and Manager to ensure overall programme co-ordination,
operational delivery and delivery assurance.
64
Task and finish groups: Provide day-to-day leadership of each work stream, with
relevant clinical, managerial and other specialist/technical input. Led by work stream
leads.
Successful implementation will require input from a range of clinical and non-clinical staff
at different levels and in different parts of the organisation. Key named roles,
responsible for co-ordinating and mobilising relevant colleagues will be:
Programme Sponsor: Executive director acting as senior responsible owner
Clinical Lead: Overall divisional accountable clinical lead
Programme Lead: Overall divisional accountable management lead
Senior Work Stream Owners: Senior (director-level) leads accountable for delivery of
identified work streams; members of Programme Board
Programme Manager: Internal resource (part-time) to co-ordinate programme, including
overall planning and programme-level reporting
Work Stream Leads: Accountable senior managers with responsibility for delivering and
reporting on progress in own work stream (delegated responsibility from senior work
stream owners)
Named, dedicated support will also be required from colleagues with specific expertise,
including:
-
Decontamination
-
Estates
-
Finance
-
Workforce planning
-
HR
-
JAG and quality assurance
Significant liaison will also be required with the team responsible for developing the
Bowel Cancer Screening Centre (if approved nationally).
Implementation costs have not been included within the case as it is expected that most
of the requirements will be met from within existing teams. However, the cost of part-time
programme management has been included in the financial model. Should specific
service downtime be identified or costly decant arrangements, as a result of detailed
estates implementation planning, these costs and implications will be identified in the full
business cases for each site.
5.5
Stakeholder engagement and communication
Strong and active clinical engagement will be maintained throughout the implementation.
This will include clinician involvement within specific work streams and at senior levels
within the governance structure.
Attention will also be paid to wider communication with staff throughout the Trust, as part
of the work stream focused on communication and engagement. This will include
regular progress updates and specific communication to ensure that services or areas of
the hospital potentially adversely affected during the implementation process are
engaged in the planning from an early stage.
65
Patient experience and quality are strong drivers for the programme as a whole. The
attainment of the JAG requirements with respect to privacy and dignity is a key expected
outcome. Patients will be engaged during the detailed estates design process to ensure
that the environment is made as pleasant and patient-friendly as possible.
Communication to patients, carers and other hospital users throughout the process of
implementation, in order to minimise any disruption to patient care, will be carefully
handled at an operational level. On completion of the capital works, the Trust is
expected to be able to generate local awareness of a significant and positive
development in local services.
Other key external stakeholders, such as JAG and the National Bowel Cancer Screening
Programme, will also be actively engaged, as required, to support the programme.
66
5.6
Project Risks and Mitigations
The project risks and mitigations are outlined below:
Figure 22: Project Risks
Post mitigation risk
assessment
Risk assessment
Risk
1. Lack of clinical and managerial capacity
to lead and implement the programme
leads to delays in implementation and
poor patient experience
Likelihood
Impact
Score
Mitigation
Likelihood
Impact
Score
 Clear governance structure with identified
clinical and managerial leads and senior
accountability
4
5
20
 Identification of additional
management support
programme
3
4
12
2
4
8
2
4
8
2
5
10
 Effective risk management and escalation
procedures
 Quantity Surveyor
submission of OBC
2. Unforeseen requirements add additional
costs to the programme
4
4
16
appointed
priori
to
 Procurement of contractor to test buildability
prior to FBC
 Continued objective appraisal of need for all
elements included within the proposal
 Regular monitoring of actual vs. expected
demand
3. Lower than expected general demand or
higher
than
expected
screening
compliance result in risks to income
3
4
12
 Exploration of opportunities to attract flows
from other NHS providers and from the
private sector
 Sensitivity analysis included within case to
demonstrate potential impacts
4. Failure to find alternative accommodation
for existing services affected by the plans
results in delays to implementation
 Early discussions with services affected by
the proposals
3
5
15
 Clear
phasing
dependencies
and
identification
of
 Director-level Estates input to Programme
67
Post mitigation risk
assessment
Risk assessment
Risk
Likelihood
Impact
Mitigation
Score
Likelihood
Impact
Score
Delivery Board
5. Delays in finding, recruiting and training
suitable staff result in failure to be able to
deliver the expected activity
6. Delays
in
estates
work,
the
commissioning
of
decontamination
equipment,
ventilation
or
poor
operational planning result in a
degradation of operational performance
during implementation
 Development of detailed workforce strategy
4
4
16
 Implementation of nurse/HCA endoscopy
training programme
 Robust
programme
management
management and escalation of risk
4
5
20
 Contingency
arrangements
decontamination transition
3
3
9
3
4
12
3
4
12
2
3
6
and
for
 Detailed operational planning with use of
alternative facilities in the event of planned
downtime within implementation
 Approval of capital allocation requested within
OBC; approval to proceed subject to separate
OBC and FBC for the system in line with
Trust governance
7. Failure to implement an electronic
booking system prior to building of
additional capacity results in lower
productivity, additional administration and
potential confusion for patients
4
4
16
 Exploration, testing
different systems
and
comparison
of
 Site visits to Trusts with electronic booking to
enable effective implementation planning
 Project team established with formal reporting
to Medicine Division
8. WSHFT fails to be approved as a Bowel
Cancer Screening Centre, resulting in
lower than expected income and lack of
kudos
 Capital development approval expected to
demonstrate clear commitment to Endoscopy
3
4
12
 Maximisation of other opportunities to attract
patient activity and income
 Consideration of any further changes that
68
Post mitigation risk
assessment
Risk assessment
Risk
Likelihood
Impact
Score
Mitigation
Likelihood
Impact
Score
could be made to ensure success
9. JAG remove formal accreditation at
Worthing prior to November 2014,
resulting in lack of kudos and poor
morale (Best Practice Tariff already
removed until works completed)
10. Failure to secure contracted activity
equal to forecast demand resulting in a
lower return on investment
4
5
20
 Early senior-level discussion with JAG to
outline proposals and Trust commitment to
achieving compliance
3
4
12
2
4
8
2
4
8
 Clear and on-going communication with staff
 Downside modelling conducted
3
4
12
 Early engagement with
commenced and ongoing
commissioners
 Diversification of income streams; bowel
screening & endoscopy
11. Failure to conduct a robust procurement
process for scoping equipment results in
legal challenge, delays to implementation
and/or lack of clinical engagement
 Involvement of Trust Procurement Team in
business case development
4
4
16
 Trust Procurement Team and national
support to be provided to co-ordinate the
equipment
procurement
and
provide
nationally-available evidence
 Clear clinical engagement in development of
specification and evaluation criteria
69
5.7
Constraints and Dependencies
This is a complex programme with a number of key constraints and dependencies, which
are summarised below and relate back to the risk plan. However, these will be explored
in greater detail as part of the estates and operational implementation planning in the full
business cases.
Figure 23: Summary constraints and dependencies
Constraints
Mitigation/action
1. Limited operational and 
clinical capacity to lead
and
manage 
implementation

2. Constrained
physical 
space at each site

3. Limited
capital 
resources

Dependencies
1. Relocation of existing
services at Worthing
affected by the estates
works
2. Completion of estates
phased works to time
to limit impact on
operational delivery
Clear governance structure with identified clinical
and managerial leads and senior accountability
Identification of additional, part-time programme
management support
Effective risk management and escalation
procedures
Iterative process of estates planning with prioritised
schedule of requirements
Use of extensions at SRH to provide further space
Key priorities achieved with limited capital available
Future priorities and requirements signposted within
this case for SRH
Mitigation/action





3. JAG
agreement
to 
delay reaccreditation/
acknowledge
work
being undertaken at 
Worthing
4. Implementation
of 
electronic booking


Further
conversations
to
find
acceptable
alternatives for those services affected by the plans
Agreed phased programme of relocation
Dedicated estates programme management, as
part of wider programme
Contingency planning to reduce/avoid disruption to
operational delivery
Detailed planning with respect to key areas of risk
(such as ventilation and decontamination
equipment commissioning)
Early senior conversations with JAG to demonstrate
commitment to improvement and outline phasing
plans (once known)
Regular updates to JAG on progress
Gain agreement to investment as part of IT capital
plan
Develop implementation programme
Agree contingency arrangements to enable manual
booking of new rooms
5.8
Benefits Realisation
The delivery of the expected benefits of this proposal will be monitored during the
implementation period as part of programme management and sign-off of the
implementation and, post implementation, as part of on-going service management
within the division.
70
6.0
Recommendation
The Board are asked to support the recommended preferred options for Western Sussex
NHS Foundation Trust to develop its Endoscopy service to provide six endoscopy rooms
at Worthing Hospital and remodel the unit to meet JAG requirements and improve
patient experience. To replace the decontamination washers at SRH with modest
improvements to the pods and minor modifications to the Bracklehsam Suite to enable
outpatient screening activity, thus unlocking capacity in the Endoscopy department and
provide a best practice pathway for that cohort of patients.
The Board are asked to note the potential future capital investment for SRH to deliver a
centralised decontamination unit and achieve improvements throughout the department.
Addendums
Addendum 1 – Surgical Pre-Assessment relocation; rationale & outline estate plan
Appendices
Appendix 1a – Worthing Hospital Endoscopy department estate plan
Appendix 1b – Worthing Hospital Endoscopy department draft programme
Appendix 2 – St. Richard’s Hospital: immediate Endoscopy department modifications
Appendix 3a – St. Richard’s Hospital: longer-term Endoscopy department concept
Appendix 3b – St. Richard’s Hospital: longer-term estate department programme
Appendix 4 – Worthing Hospital Pre-Assessment estate plan
Appendix 5 – Strategic options for change: new build developments
Appendix 6 - Clinical Quality Impact Assessment
Appendix 7 - Equality & Diversity Impact Assessment
Attachments
Attachment 1 - Financial Model
Useful Links
Bowel Cancer Screening Programme,
<www.cancerscreening.nhs.uk/bowel/index.html>
NHS Improvement
Rapid Review of Endoscopy Services, January 2012
http://www.improvement.nhs.uk/documents/endoscopyreview.pdf
71
Addendum 1 – Surgical Pre-Assessment
Background
The pre-operative assessment of patients awaiting planned surgical procedures is
essential both to inform and prepare the patient, and to identify any issues that might
compromise their safety during and after the procedure.
At Worthing Hospital, adult patients complete a paper questionnaire about their health
and home situation immediately after the decision to carry out the procedure. They then
attend a nurse-led clinic, in the dedicated Pre-Assessment Unit, in the weeks or days
preceding their admission.
The pre-assessment consultation involves a face to face interview with a nurse, or
occasionally a training grade doctor, to identify any issues that might affect outcome or
recovery, and to ensure the most appropriate arrangements for discharge. At this point
blood tests are carried out together with screening for infection risks. Patients classified
as higher risk might be referred on to the specialist anaesthetist-led service.
Children are pre-assessed within the paediatric wards and clinics.
The Worthing Pre-Assessment Unit currently occupies 1142 m2 on the ground floor of
the North Wing and comprises consulting rooms, waiting area, and patient WCs. The
waiting area is inadequate for the numbers of patients using the unit and overflow space,
which is used on a daily basis, has been provided in the very busy north wing corridor.
The number of rooms is considered insufficient for the activity levels and does not
support the attendance of specialist nurses to provide support and advice to patients
awaiting surgery for major conditions and illnesses.
The Unit is currently located adjacent to the Worthing Endoscopy Suite; an area within
the expansion footprint in order to deliver the endoscopy solution. The relocation of the
Pre-Assessment Unit is essential to enable the required expansion of the Endoscopy
Service and improve the facility and efficiency of the service.
Proposal
Alternative locations have been reviewed by an internal project group. Worthing Hospital
is a particularly constrained site. To provide a facility with suitable patient access the
preferred option for relocation is on the second floor of the new Outpatient Department
Block at Worthing.
This accommodation has remained empty since the completion of the block in 2011.
Relocating Pre-Assessment to this area would enable the service to increase room
capacity to eight or ten rooms, has the potential to improve patient waiting area and
provide suitable training facilities. There are no revenue implications for increasing the
assessment rooms but will enable the service to improve efficiency and co-locate
currently disparate clinics.
Please see Appendix 4 for concept drawings of the new facility.
Capital Requirements
The Trust allocated £350k for this scheme within the Trust’s internal 2013/14 capital
programme. The capital costs have been estimated at £427,340 for the Pre-Assessment
works and £99,254 for the necessary infrastructure works and fitting out of the ingress
and egress corridors – essential for the works but not directly attributable to the pre-
72
assessment scheme. The infrastructure works will be funded from the Estates enabled
Minor Works 2013/14 capital allocations.
The cost of this capital investment is included within the financial model within the
Endoscopy business case.
73
Appendix 1ai – 1aii – Worthing Hospital Endoscopy department draft programme
74
Appendix 1bi – Worthing Hospital Endoscopy department draft programme
75
Appendix 2 – St. Richard’s Hospital: immediate Endoscopy department
modifications
76
Appendix 3a – St. Richard’s Hospital: longer-term Endoscopy department concept
77
Appendix 3bi – 3biii – St. Richard’s Hospital: longer-term estate department
programme
78
Appendix 4 – Worthing Hospital Pre-Assessment estate plan
79
Appendix 5 – Strategic options for change: new build developments
80
Appendix 6 - Clinical Quality Impact Assessment
Service Change Outline – 2013/14 – Plan Summary
Clinical Quality Impact Assessment
for Service Changes including CIP schemes and Cost Pressure Bids
Scheme Title:
Endoscopy strageic development programme
Service development Value per annum in £k:
Risk Impact :
Ref No
See business case for financial 10
If Value >£100,000 or Risk Rating >9 tick here
Clinical Lead:
Roy Holman
Additional clinicians involved in developing the proposal
Name
Name
Name
Name
of Clinician
of Clinician
of Clinician
of Clinician
Rob Haigh, CoM
Paul Carter, CoS
Neil Cripps, Consultant
Jackie Hole, Chris Barker. Jo Senior Nurses
What will be different as a result of this change ? How does it change or reduce cost ?
Describe the Case in simple terms.
Development of business case to extend the Trust Endoscopy Service to meet the predicted increase in demand over the
next five years, including age extension of bowel cancer screening and JAG requirements. This case identifies the
additional manpower required to manage the extra demand in out patients and endoscopy as well as the capital allocation of
approximately £9.4m to support the major development, which includes:
• Additional staffing, phased as per plan
• Two additional Endoscopy rooms at St Richard’s and three at Worthing (bringing the total to 12 across the Trust)
• Replacement of decontamination washers at SRH
• Remodelling at Worthing to meet JAG gender requirements
• Equipment (scopes, clinical equipment and furniture) for the additional and remodelled capacity
Does it change staff numbers ?
yes
Does it affect staffing ratios for nursing, midwifery, or therapy staff ?
no
Could there be an impact on staff working in clinical areas ?
yes
If answering yes to any of the above: please describe:
Additional nursing, decontamination admin and endoscopy staff will be required to support the predicted growth in demand
over the next five years.
Staff may be affected during the build as it is likely that there will be some interruptions to the service.
What clinical risks might occur as a result of this programme ?
Consider : 1 patient experience, 2 Patient Safety, including Infection Control, 3 Clinical Outcomes
The estimated length of the capital programme including installation of ventilation and commissioning of the
decontamination units will be approx 7 – 8 months at SRH. During this time endoscopy services will be maintained at SRH
to the current level of provision, as the additional decontamination pod will be commissioned separately.
How will these clinical risks be mitigated ?
There will be no risks to patient safety. However, a detailed implementation plan will be developed to support the
programme once business case approval has been given. Project management arrangements for delivery will be established
and suitable temporary out patient facilities will be factored into the implementation plan. Notices will be erected
apologising to patients and visitors for any disruption caused by the building works
What metrics will be captured and monitored to assure the risks have not occurred ?
The department will continue to capture and measure compliance to patient safety and JAG metrics which include:
• Patient satisfaction surveys
• Capturing adherence to waiting times
• Training audits
• Infection control audits
What other means will be used for early identification of adverse impacts from the CIP ?
This is a development not a CIP scheme.
Clinical Risk Rating of not undertaking the service improvement
A : What is the sum of the risks to Quality:
1
Insignificant/None
2
Minor
3
Moderate
4
Major
5
Severe
B What is the likelihood of the risk occurring as a result of this CIP
1
Very unlikely/None
2
Unlikely
3
Possible
4
Likely
5
Almost Certain
Risk Assessment
A =
B=
2
5
Risk Impact ( A x B ) =
10
81
Appendix 7 - Equality Impact Assessment
Name of Policy, Service, Function, Project or Proposal
Department
Lead Officer for Assessment
What
is
the
main
Purpose
Policy/Service/Function/Project/Proposal?
of
the
List the main activities of the policy or service re-design
(e.g. Manual Handling would relate to health and safety
of patients; health and safety of staff; compliance with
NHS and Government legislation or standards etc.)
Endoscopy
Development
Programme
Endoscopy (Division of Medicine)
Sally Smith, Director of Clinical
Services - Medicine
The provision of additional and
improved estate and facilities to
enable patient quality to be
improved, to improve sustainability
and to meet expected future
demand
Direct clinical patient care –
diagnostic and therapeutic
National accreditation standards
(JAG)
NHS diagnostic and pathway
targets – Cancer and 18 Weeks
National Bowel Cancer Screening
Programme
Is the policy or service relevant to:
Promoting Good Relations between different people?
Eliminating discrimination?
Promoting Equality of Opportunity?
Which groups of the population do you think may be
affected by this proposal?
Minority Ethnic People
Women and Men
People in religious/faith groups
Disabled people
Older people
Children and young people
Lesbian, gay, bisexual and transgender people
People of low income
People with mental health problems
Homeless people
Staff
Any other group (please detail)
Not specifically, although estate
improvements to ensure gender
separation throughout the service
will promote dignity and respect
with respect to gender
No
Yes
No
No
Yes
No
No
No
No
No
Yes
Using the information above, please complete the grids below:
Do you have any information that tells you of the current use of this service?
Yes
(if yes please detail)
Detailed demand and activity information
Is it broken down by ethnicity, gender, disability, age, religion and sexual orientation?
Age and gender
Does this information reflect the proportions from the 2001 Census?
Yes
If there is no information available or if this is patchy, specify the arrangements that will
make this available
What effects does it have on the following groups?
82
Gender
Race
Disability
Age
Sexual Orientation
Religious Belief
Human Rights
Positive +
/ Negative







Reason Given for Impact
Enhanced service for the population of West Sussex
with improved access, particularly among older
people, who are most likely to undergo endoscopy
and to benefit from bowel screening.
The introduction of gender separation at Worthing
Hospital will improve patient experience will respect
to dignity and respect for men and women.
Has there been any consultation about this Policy etc.? If there has, what were the key
issues identified?
Staff consultation will follow approval of proposal, if relevant
What does local / regional / national research show with regards to these groups and the
likely impact?
Positive impact – National Screening Programme is designed for early intervention to improve
mortality from bowel cancer. Becoming a screening centre enables greater control of this vital
service.
Ensuring sufficient capacity and appropriate estate to meet growing demand will ensure improved
access and gender separation, maintaining a quality service for local people.
As a result of consultation / information gathering, what changes do you intend to make to
the policy etc.? If ‘None’, please state as relevant:
Issue
Gender
Race
Disability
Sexual
Orientation
Religious
belief
Age
Action
Required
None
None
None
None
Lead
Officer
Timescale
Outcome
Measure
Review
Date
None
None
83
New Endoscopy Facility
ID
Worthing Hospital
Task Name
Start
Finish
1
Finalise OBC submission
Mon 07/10/13
Fri 25/10/13
2
Submit OBC to Board
Thu 31/10/13
Thu 31/10/13
3
Board decision to proceed
Fri 01/11/13
Fri 01/11/13
4
Appoint Design Team
Fri 01/11/13
Fri 01/11/13
5
DTM 01
Mon 04/11/13
Mon 04/11/13
6
Commence detail design
Tue 05/11/13
Mon 18/11/13
7
DTM 02
Tue 19/11/13
Tue 19/11/13
8
Refine design
Wed 20/11/13
Tue 03/12/13
9
Liaison with Contractor
Wed 20/11/13
Tue 26/11/13
10
DTM 03
Wed 04/12/13
Wed 04/12/13
11
CHRISTMAS
Mon 23/12/13
Fri 27/12/13
12
Finalise tender submission
Thu 05/12/13
Wed 22/01/14
13
Board approval of FBC
Wed 22/01/14
Wed 22/01/14
14
Issue Tender Docs
Mon 27/01/14
Mon 27/01/14
15
Tender period
Mon 27/01/14
Fri 21/03/14
16
Tender return
Fri 21/03/14
Fri 21/03/14
17
Tender review and report
Mon 24/03/14
Fri 11/04/14
18
Board Approval
Thu 01/05/14
Thu 01/05/14
19
Appoint Contractor
Thu 01/05/14
Thu 01/05/14
20
Contractor Mobilisation
Thu 01/05/14
Wed 11/06/14
21
Start on site
Tue 01/07/14
Tue 01/07/14
22
Site Operations
Wed 02/07/14
Tue 23/06/15
23
Hand Over
Wed 24/06/15
Wed 24/06/15
Project: worthing-hospital
Date: Thu 17/10/13
October
30/09
07/10
14/10
21/10
November
28/10
04/11
11/11
18/11
25/11
Draft Delivery Programme
December
02/12
09/12
16/12
23/12
January
30/12
06/01
13/01
20/01
February
27/01
03/02
31/10
01/11
22/01
27/01
Task
Progress
Summary
External Tasks
Split
Milestone
Project Summary
External Milestone
Page 1
Deadline
10/02
17/02
March
24/02
03/03
10/03
New Endoscopy Facility
17/03
24/03
April
31/03
Worthing Hospital
07/04
14/04
21/04
May
28/04
05/05
12/05
19/05
26/05
June
02/06
09/06
16/06
23/06
July
30/06
07/07
14/07
Draft Delivery Programme
21/07
August
28/07
04/08
11/08
18/08
25/08
September
01/09
08/09
21/03
01/05
01/05
Project: worthing-hospital
Date: Thu 17/10/13
Task
Progress
Summary
External Tasks
Split
Milestone
Project Summary
External Milestone
Page 2
Deadline
15/09
22/09
October
29/09
06/10
13/10
20/10
November
27/10
03/11
New Endoscopy Facility
10/11
17/11
24/11
Project: worthing-hospital
Date: Thu 17/10/13
Worthing Hospital
December
01/12
08/12
15/12
22/12
January
29/12
05/01
12/01
19/01
26/01
February
02/02
09/02
16/02
23/02
March
02/03
09/03
Draft Delivery Programme
16/03
23/03
April
30/03
06/04
Task
Progress
Summary
External Tasks
Split
Milestone
Project Summary
External Milestone
Page 3
13/04
20/04
May
27/04
04/05
Deadline
11/05
18/05
25/05
June
01/06
08/06
15/06
22/06
July
29/06
CHICHESTER TREATMENT CENTRE
EXISTING GROUND FLOOR LAYOUT
SCALE 1:100
G03/14
5.15 m2
assist
wc
G04/01
6.06 m2
enema room
2000x900mm
trolly
svp
extract
fan
extract
fan
Scale in Metres
0
existing hospital street
4.86 m2
STAFF BASE
70.57 m2
RECOVERY
AREA 2
28.14 m2
DISCHARGE
LOUNGE
For highlighted
Areas see
Dwg 2
1
2
1:100
3
4
5
10
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
WESTERN SUSSEX HOSPITALS
PROJECT
CTC
Endoscopy Assessment Area
Refurbishment
DRAWING DETAILS
CTC
Existing Ground Floor Layout
PROJECT No
REV No
DWG No
1
SCALE
1:100 @ A1
DRAWN
MEC
A
CHK'D
AS
CHICHESTER TREATMENT CENTRE
EXISTING GROUND FLOOR LAYOUT
SCALE 1:100
INTERNAL WALL WALLING
DETAIL A
SCALE 1:10
11.59 m2
ENDOSCOPY
ADMIN
Scale in Metres
1:10
0
Scale in Metres
0
1
0.5
1
1:50
NOTES:
2
3
4
5
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
22.26 m2
DISCHARGE
LOUNGE
22.26 m2
DISCHARGE
LOUNGE
WESTERN SUSSEX HOSPITALS
3.37 m2
assist
wc
PROJECT
CTC
Endoscopy Assessment Area
Refurbishment
3.30 m2
assist
wc
DRAWING DETAILS
CTC
Proposed area layout & wall
details
PROJECT No
REV No
DWG No
2
70.57 m2
SCALE
1:10/1:50 @ A1
DRAWN
MEC
CHK'D
AS
GROUND FLOOR
SCALE 1:250
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
For highlighted
Area see Dwgs
2, 3 & 4
WESTERN SUSSEX HOSPITALS
PROJECT
Outpatients Dept
Pre Assessment
Proposed Second Floor Layout
DRAWING DETAILS
East Wing
Second Floor Layout
General Details
PROJECT No
REV No
DWG No
1
SCALE
1:250
DRAWN
MEC
F
CHK'D
CB/ADC
PROPOSED SECOND
FLOOR LAYOUT
10 UNIT OPTION
SCALE 1:100
STAIRS
Smoke vent 1m2
at high level
Quench Pipe
2/L/01
8.03 m2
LIFT
OURTYARD 7b
apanese garden)
INTERNAL WALL WALLING
DETAIL A
SCALE 1:10
ACCESS
HATCH
Disabled
Refuge
ACCESS
HATCH
2/L/03
20.36 m2
STAIR 1
LOUVRE
Smoke vent 1m2
at high level
2/L/02
37.89 m2
LOBBY
2/L/31
19.08 m2
STAIR 2
GREEN
ROOF
GREEN
ROOF
EXTERNAL PLANT
Disabled
Refuge
2/L/30
15.41 m2
LOBBY
LOUVRE
Access
onto roof
2/L/04
15.38 m2
CORRIDOR
Gravel
1.52 m2
VOID
1.36 m2
VOID
2/L/29
3.98 m2
IT NODE
2/L/06
3.98 m2
IT NODE
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
COURTYARD
COURTYARD
2/L/07
22.20 m2
PLANT ROOM
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
2/L/05
19.94 m2
CORRIDOR
2/L/27
19.94 m2
CORRIDOR
2/L/07
4.08 m2
CLEAN
UTILITY
'pass through
hatch' c/w sliding
doors
2/L/08
4.15 m2
MALE WC
2/L/10
6.36 m2
FEMALE
WC
500mm shelving
500mm shelving
2/L/24
2.65 m2
STORE
NOTE PIGEON HOLES
2/L/25
3.88 m2
CLEANERS
CUP'D
Roof
Access
Gravel
Sub
wait
2/L/28
22.23 m2
PLANT ROOM
2/L/26
12.30 m2
2 PERS. OFFICE
'pass through
hatch' c/w sliding
doors
2/L/09
3.77 m2
DIRTY
UTILITY
Access
onto roof
AMENDMENTS:-
2/L/11
9.53 m2
RECEPTION
Gravel
2/L/22
29.87 m2
WAITING AREA
side table
LIFT UP
ACCESS
Access
onto roof
2/L/23
5.15 m2
PANTRY
2/L/06
92.76 m2
CIRCULATION SPACE
2/L/12
12.19 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/13
8.31 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
2/L/14
8.31 m2
TREAT.
CUBICLE
2/L/15
8.31 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/16
8.31 m2
TREAT.
CUBICLE
2/L/17
8.31 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/18
8.31 m2
TREAT.
CUBICLE
2/L/19
8.31 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/21
12.19 m2
TREAT.
CUBICLE
2/L/20
8.31 m2
TREAT.
CUBICLE
2/L/14
8.89 m2
TREAT.
CUBICLE
WESTERN SUSSEX HOSPITALS
PROJECT
Scale in Metres
1:10
ROOM SCHEDULE:
0
Scale in Metres
0
1
2
0.5
1
5
10
1:100
3
4
1
1
1
1
1
1
1
1
1
1
1
10
2 Person office
Store
Reception desk
Main Waiting Area (28 person)
Sub-wait (6 person)
Pantry
Cleaners Cup'd
Accessable WC (male)
Accessable WC (female)
Dirty Utility
Clean Utility
Treatment Cubicles
Outpatients Dept
Pre Assessment
Proposed Second Floor Layout
DRAWING DETAILS
Proposed Second Floor Layout
(10 Unit Option) & Detail A
PROJECT No
REV No
DWG No
2
SCALE
1:10/1:100 @ A1
DRAWN
MEC
G
CHK'D
CB/ADC
2/L/22
2/L/26
2/L/25
2/L/23
2/L/06
2/L/20
office
pantry
store
circulation
space
treatment
cubicle
existing
plant
room
waiting
area
2/L/06
2/L/17
circulation
space
treatment
cubicle
void/storage?
cup'd
void/storage?
1/L/28
1/L/C1
1/L/31
1/L/C2
1/L/38
1/L/35
single bed
corridor
5 bed bay
corridor
nurses
base
5 bed bay
SECTION A-A
SECTION B-B
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
SECTIONS A-A, B-B & C-C
SCALE 1:50
2/L/22
waiting
area
2/L/06
2/L/06
2/L/21
circulation
space
circulation
space
treatment
cubicle
WESTERN SUSSEX HOSPITALS
1/L/31
1/L/35
5 bed bay
5 bed bay
PROJECT
Outpatients Dept
Pre Assessment
Proposed Second Floor Layout
DRAWING DETAILS
Scale in Metres
0
1
Sections A, B & C
1:50
2
3
4
5
SECTION C-C
PROJECT No
REV No
DWG No
3
SCALE
1:50 @ A1
DRAWN
MEC
G
CHK'D
CB/ADC
PROPOSED SECOND
FLOOR LAYOUT
8 UNIT OPTION
SCALE 1:100
STAIRS
Smoke vent 1m2
at high level
Quench Pipe
2/L/01
8.03 m2
LIFT
OURTYARD 7b
apanese garden)
INTERNAL WALL WALLING
DETAIL A
SCALE 1:10
ACCESS
HATCH
Disabled
Refuge
ACCESS
HATCH
2/L/03
20.36 m2
STAIR 1
LOUVRE
Smoke vent 1m2
at high level
2/L/02
37.89 m2
LOBBY
2/L/30
19.08 m2
STAIR 2
GREEN
ROOF
GREEN
ROOF
EXTERNAL PLANT
Disabled
Refuge
2/L/29
15.41 m2
LOBBY
LOUVRE
Access
onto roof
2/L/04
15.38 m2
CORRIDOR
Gravel
1.52 m2
VOID
1.36 m2
VOID
2/L/28
3.98 m2
IT NODE
2/L/06
3.98 m2
IT NODE
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
COURTYARD
COURTYARD
2/L/07
22.20 m2
PLANT ROOM
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
2/L/05
19.94 m2
CORRIDOR
2/L/26
19.94 m2
CORRIDOR
2/L/07
4.08 m2
CLEAN
UTILITY
'pass through
hatch' c/w sliding
doors
2/L/08
4.15 m2
MALE WC
2/L/10
6.36 m2
FEMALE
WC
500mm shelving
500mm shelving
2/L/23
2.65 m2
STORE
NOTE PIGEON HOLES
2/L/24
3.88 m2
CLEANERS
CUP'D
Roof
Access
Gravel
Sub
wait
2/L/27
22.23 m2
PLANT ROOM
2/L/25
12.30 m2
2 PERS. OFFICE
'pass through
hatch' c/w sliding
doors
2/L/09
3.77 m2
DIRTY
UTILITY
Access
onto roof
AMENDMENTS:-
2/L/11
9.53 m2
RECEPTION
Gravel
2/L/21
29.87 m2
WAITING AREA
side table
LIFT UP
ACCESS
Access
onto roof
2/L/22
5.15 m2
PANTRY
2/L/06
92.76 m2
CIRCULATION SPACE
2/L/12
12.19 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/13
8.31 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
2/L/14
8.31 m2
TREAT.
CUBICLE
2/L/15
8.31 m2
TREAT.
CUBICLE
2/L/16
20.49 m2
WAITING AREA
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/17
8.31 m2
TREAT.
CUBICLE
2/L/18
8.31 m2
TREAT.
CUBICLE
CLINICAL
COUCH
1990x635
CLINICAL
COUCH
1990x635
2/L/20
12.19 m2
TREAT.
CUBICLE
2/L/19
8.31 m2
TREAT.
CUBICLE
2/L/14
8.89 m2
TREAT.
CUBICLE
WESTERN SUSSEX HOSPITALS
PROJECT
Scale in Metres
1:10
ROOM SCHEDULE:
0
Scale in Metres
0
1
2
0.5
1
5
10
1:100
3
4
1
1
1
1
1
1
1
1
1
1
1
1
8
2 Person office
Store
Reception desk
Main Waiting Area (28 person)
Sec Waiting area (14 person)
Sub-wait (6 person)
Pantry
Cleaners Cup'd
Accessable WC (male)
Accessable WC (female)
Dirty Utility
Clean Utility
Treatment Cubicles
Outpatients Dept
Pre Assessment
Proposed Second Floor Layout
DRAWING DETAILS
Proposed Second Floor Layout
(8 Unit Option) & Detail A
PROJECT No
REV No
DWG No
4
SCALE
1:10/1:100 @ A1
DRAWN
MEC
G
CHK'D
CB/ADC
PROPOSED BUILDING: (all in m2)
WORTHING HOSPITAL
MANAGED AREAS
GROUND FLOOR LEVEL
NOT TO SCALE
Gnd Fl
1st Fl
1259
1259
TOTAL
2518
16-G-01
14-G-01
29-G-01
28-G-01
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
27-G-01
26-G-01
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
15-G-01
25-G-01
24-G-01
WESTERN SUSSEX HOSPITALS
23-G-01
22-G-01
21-G-01
PROJECT
Worthing Hospital
Managed Areas
DRAWING DETAILS
Ground Floor Level
Blocks 14,15,16 & 21-29
PROJECT No
REV No
DWG No
6
SCALE
NTS @ A0
DRAWN
MEC
CHK'D
ADC/AVLB
LEGEND (Areas to nearest m2)
WORTHING HOSPITAL
EXISTING
GROUND FLOOR LEVEL
SCALE 1:500
GIA
33-G-01
32-G-01
01-G-01
01-G-02
01-G-03
01-G-04
01-G-05
01-G-06
02-G-01
02-G-02
02-G-03
02-G-04
02-G-05
02-G-06
02-G-07
02-G-08
04-G-01
05-G-01
06-G-01
06-G-02
06-G-03
06-G-04
06-G-05
06-G-06
06-G-07
06-G-08
06-G-09
07-G-01
08-G-01
09-G-01
10-G-01
11-G-01
12-G-01
12-G-02
13-G-01
14-G-01
15-G-01
16-G-01
17-G-01
18-G-01
19-G-01
20-G-01
21-G-01
22-G-01
23-G-01
24-G-01
25-G-01
26-G-01
27-G-01
28-G-01
29-G-01
30-G-01
31-G-01
32-G-01
33-G-01
34-G-01
35-G-01
36-G-01
37-G-01
38-G-01
39-G-01
40-G-01
41-G-01
42-G-01
43-G-01
44-G-01
45-G-01
46-G-01
37-G-01
36-G-01
31-G-01
30-G-01
34-G-01
35-G-01
DAY SURGERY
07-G-01
06-G-05
01-G-02
06-G-04
01-G-01
06-G-02
01-G-03
06-G-01
01-G-06
11-G-01
01-G-05
06-G-06
06-G-03
01-G-04
12-G-02
12-G-01
13-G-01
02-G-02
02-G-01
06-G-08
04-G-01
08-G-01
02-G-07
05-G-01
02-G-03
North Wing
North Wing
North Wing
North Wing
North Wing
North Wing
West Wing
West Wing
West Wing
West Wing
West Wing
West Wing
West Wing
West Wing
640
86
452
144
853
259
410
224
369
159
309
221
205
142
194
42
2157
257
923
1059
259
1223
406
1490
1189
175
30
595
142
329
472
562
668
111
724
383
135
209
724
350
81
38
37
37
38
58
58
48
48
44
44
44
44
44
44
44
44
Generator
Store/Transformer
East Wing
East Wing
East Wing
East Wing
East Wing
East Wing
East Wing
East Wing
East Wing
East Wing Oil Tank
VIE Compound
South Wing
Link Corridor
Squirrels Nursery
Washington Suite
Washington Suite
Childrens Centre
Portacabin
Holmfield
Greenacres
Parkview
Lister House
Horton Court
22 Lyndhurst Road
75/77 Lyndhurst Road
2 Park Avenue
4 Park Avenue
6 Park Avenue
8 Park Avenue
10 Park Avenue
12 Park Avenue
14 Park Avenue
16 Park Avenue
33 Park Avenue
35 Park Avenue
37 Park Avenue
39 Park Avenue
41 Park Avenue
43 Park Avenue
45 Park Avenue
47 Park Avenue
DELETED
DELETED
DELETED
DELETED
DELETED
DELETED
DELETED
DELETED
Outpatients Dept
For highlighted
Area 1 see
Dwg 2
06-G-09
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
06-G-07
02-G-08
Gnd Fl area stated
1107
46-G-01
02-G-06
Comments
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
02-G-04
02-G-05
AMENDMENTS:-
17-G-01
16-G-01
10-G-01
14-G-01
29-G-01
28-G-01
09-G-01
27-G-01
26-G-01
15-G-01
25-G-01
24-G-01
23-G-01
22-G-01
20-G-01
21-G-01
18-G-01
WESTERN SUSSEX HOSPITALS
19-G-01
PROJECT
Worthing Hospital
Proposed Endoscopy Building
DRAWING DETAILS
Site Layout
Ground Floor Level
Scale in Metres
0
5
10
PROJECT No
1:500
15
20
REV No
DWG No
1
30
40
50
SCALE
1:500 @ A0
DRAWN
MEC
CHK'D
AS
PROPOSED BUILDING: (all in m2)
WORTHING HOSPITAL
PROPOSED ENDOSCOPY
BUILDING LOCATION
NOT TO SCALE
Gnd Fl
1st Fl
1259
1259
TOTAL
2518
16-G-01
14-G-01
29-G-01
28-G-01
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
27-G-01
26-G-01
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
15-G-01
25-G-01
24-G-01
WESTERN SUSSEX HOSPITALS
23-G-01
22-G-01
21-G-01
PROJECT
Worthing Hospital
Proposed Endoscopy Building
DRAWING DETAILS
Proposed Building Location
PROJECT No
REV No
DWG No
2
SCALE
NTS @ A0
DRAWN
MEC
CHK'D
AS
MAIN WARD CAR PARK (north)
SCALE 1:200
Area: 4386.18 sq.m
PROPOSED BUILDING: (all in m2)
Gnd Fl
1875
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
WESTERN SUSSEX HOSPITALS
PROJECT
Proposed Endoscopy Building
DRAWING DETAILS
Proposed Site Location
PROJECT No
REV No
DWG No
1
SCALE
1:200
DRAWN
MEC
CHK'D
AS
ST RICHARDS HOSPITAL
EXISTING SITE LAYOUT
SCALE 1:1250
For highlighted
Area 1 see
Dwg 2
W
H
H
AMENDMENTS:
KEY:
PROJECT
DRAWING DETAILS
NOTES:
St Richards Hospital
General Site Layout
Generally:
The design and construction of this project shall be in
accordance with the current Building Regulation and
NHBC Standards.
Do not scale from this drawing unless for Planning
purposes. All dimensions to be checked on site and any
alterations to be approved by Project Manager and/or
Client prior to any work commencing
PROJECT No
REV No
DWG No
1
SCALE
1:1250 @ A1
DRAWN
MEC
CHK'D
AS
PROPOSED ENDOSCOPY
BUILDING LOCATION
SCALE 1:200
PROPOSED BUILDING: (all in m2)
Gnd Fl
1875
NOTES:
Generally:
The design and construction of this project shall be in accordance with the
HBN's & HTN's and current Building Regulations.
Do not scale from this drawing unless for Planning purposes. All
dimensions to be checked on site and any alterations to be approved by
Project Manager and/or Client prior to any work commencing
AMENDMENTS:-
PROJECT
Proposed Endoscopy Building
DRAWING DETAILS
Proposed Endoscopy Building
Location
PROJECT No
REV No
DWG No
1
SCALE
1:200 @ A1
DRAWN
MEC
CHK'D
AS