1. society
2. welfare
3. healthcare
4. hospital

A meeting of the Board of Directors will be held on Friday 8 November 2013 at 8.30am in the Committee
Room, Trust Management Suite, Royal Bournemouth Hospital.
If you are unable to attend on this occasion, please notify me as soon as possible on 01202 704777.
Karen Flaherty
TRUST SECRETARY
AGENDA
1.
2.
APOLOGIES FOR ABSENCE
Helen Lingham
MINUTES OF THE PREVIOUS MEETING 8.30 – 8.35am
(a) To approve the minutes of the meeting held on 11 October 2013
(b)
DECLARATIONS OF INTEREST
4.
MATTERS ARISING 8.35 – 8.50am
(a) Stroke Performance Action Plan (105/13(a))
5.
6.
7.
8.
A
To provide updates to the Actions Log
3.
(b)
APPENDIX
Protocol for Beds in Community Settings (106/13(f))
QUALITY 8.50 – 9.20am
(a) Patient Story
B
Tony Spotswood
C
Richard Renaut
Verbal
Paula Shobbrook
Verbal
(b)
CQC Intelligent Monitoring Report
Paula Shobbrook
D
(c)
Feedback from CQC Inspection
Tony Spotswood/
Paula Shobbrook
E
(d)
Breast Care Service Patient Recall
Paula Shobbrook
PERFORMANCE 9.20 – 9.50am
(a) Performance Report
(b)
Quality Performance Report
(c)
Financial Performance
STRATEGY 9.50 – 10.10am
(a) Proposed merger:
i.
Competition Commission Decision
ii.
Next Steps
INFORMATION 10.10 – 10.15am
(a) Keogh Review Learning
BoD/Agenda 08.11.2013
Verbal
Richard Renaut
F
Paula Shobbrook
G
Stuart Hunter
H
Tony Spotswood
Deborah Matthews
I
Tony Spotswood
Verbal
J
Page1 of 2
9.
(b)
Core Brief (October)
(c)
Communications Update (inc October RAAI)
(d)
Board of Directors Forward Programme
Tony Spotswood
K
Deborah Matthews
L
Karen Flaherty
M
NEXT MEETING
Friday 13 December 2013 at 8.30am in the Committee Room, Royal Bournemouth Hospital
10. ANY OTHER BUSINESS
Key Points for Communication
11. COMMENTS AND QUESTIONS FROM THE GOVERNORS 10.15 – 10.30am
Board Members will be available for 10-15 minutes after the end of the Part I meeting to take
comments or questions from the Governors on items received or considered by the Board of
Directors at the meeting.
12. EXCLUSION OF PRESS AND PUBLIC AND OTHERS
To resolve that under the provision of Section 1, Sub-Section 2, of the Public Bodies
Admission to Meetings Act 1960, representatives of the press, members of the public and
others not invited to attend be excluded on the grounds that publicity would prove prejudicial
to the public interest by reason of the confidential nature of the business to be transacted.
BoD/Agenda 08.11.2013
Page2 of 2
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS
NHS FOUNDATION TRUST
(the Trust)
U
U
Minutes of a Meeting of The Royal Bournemouth and Christchurch Hospitals NHS Foundation
Trust Board of Directors (the Board) held on Friday 11 October 2013 in the Committee Room,
Royal Bournemouth Hospital
Present:
In attendance:
Apologies:
Jane Stichbury
Tony Spotswood
Karen Allman
David Bennett
Brian Ford
Basil Fozard
Stuart Hunter
Ian Metcalfe
Steven Peacock
Alex Pike
Richard Renaut
Deborah Matthews
Paula Shobbrook
Ken Tullett
Karen Flaherty
Peter Gill
Sarah Allaway
Tracey Hall
Lesley Kingsley
(JS)
(TS)
(KA)
(DB)
(BF)
(BaF)
(SH)
(IM)
(SP)
(AP)
(RR)
(DM)
(PS)
(KT)
(KF)
(PG)
(SA)
(TH)
(LK)
Dily Ruffer
Caroline Tandy
Divya Tiwari
Mike Allen
Jayne Baker
Glenys Brown
Sue Bungey
Derek Chaffey
Eric Fisher
Lee Foord
Bob Gee
Doreen Holford
Keith Mitchell
Richard Owen
Chloe Cozens
(DR)
(CT)
(DT)
(MA)
(JB)
(GB)
(SB)
(DC)
(EF)
(LF)
(BG)
(DH)
(KM)
(RO)
(CC)
Margaret Neville
Helen Lingham
(MN)
(HL)
BOD/Part 1MINS 11.10.13
Chairman (in the chair)
Chief Executive
Director of Human Resources
Non-Executive Director
Non-Executive Director
Medical Director
Director of Finance
Non-Executive Director
Non-Executive Director
Non-Executive Director
Acting Chief Operations Officer
Interim Director of Service Development
Director of Nursing and Midwifery
Non-Executive Director
Trust Secretary
Director of Informatics
eNEWS Clinical Project Manager
Head of Communications
Jigsaw Appeal Enquiries & Fundraising
Office
Governor Co-ordinator
Ward Sister, Ward 17 (for item 5(c) only)
Consultant, Medicine For the Elderly
Public Governor
Public Governor
Public Governor
Public Governor
Public Governor
Public Governor
Appointed Governor
Public Governor
Public Governor
Public Governor
Staff Governor
Reporter, New Milton Advertiser and
Lymington Times
Chairman, Friends of the Eye Unit
Chief Operating Officer
PAGE 1 OF 14
102/13
MINUTES OF THE MEETING HELD ON 13 SEPTEMBER 2013 (Appendix
A)
0B
The minutes of the meeting held on 13 September 2013 were taken as read
and were accepted as a true record of the meeting, subject to one change
to reflect that there had been a reduced incidence of Clostridium Difficile in
the Trust in 2012/13.
103/13
ACTIONS LOG (Appendix B)
1B
(a)
Trolley Assessments(89/13)
U
KF agreed to speak with DC outside of the meeting to see if there
were any questions which remained outstanding.
(b)
CQC Quality and Risk Profile (94/13)
U
PS noted that the Care Quality Commission (CQC) had not
published a Quality and Risk Profile in advance of the meeting.
(c)
Monitor’s Risk Assessment Framework (98/13)
U
SH confirmed that the notification from Monitor of the Trust’s risk
rating had been included in the papers.
104/13
DECLARATIONS OF INTEREST
U
There were no new interests declared.
105/13
MATTERS ARISING
U
(a)
Update on Stroke Performance (Appendix C)
U
TS presented the paper, noting that this had been prepared by the
Stroke physicians whom he had met with to discuss some of the
concerns that the Board had previously raised. He highlighted:
 that the Stroke physicians had confirmed that there were
enough beds on the Stroke Unit;
 that performance against the indicators in this area was
improving;
 there were still concerns around brain imaging within in one
hour and further investment was being made in CT
scanning out of hours and he needed to ensure that this
resulted to patients having access to scanning within an
hour in all cases;
 the changes to improve the flow of patients into the Stroke
BOD/Part 1MINS 11.10.13
PAGE 2 OF 14
KF




Unit;
the increase in seven day services;
the appointment of a new Clinical Leader and the focus on
leadership;
that staffing levels were appropriate; and
that there was complete engagement from the Stroke
physicians to ensure that the Stroke service works well and
genuine disappointment that its performance against the
targets had dipped.
JS asked about the time it would take to recruit to the consultant
positions given the importance of medical leadership in improving
performance. TS explained that it could be about five months until
the successful candidate would take up the position. KA confirmed
that interviews were taking place the following week for two locum
consultants for the Stroke Unit and Medicine For the Elderly to
provide a senior medical presence in the interim. PS confirmed
that there was strong leadership in place good levels of
engagement from staff on the ward which would enable
improvement in the areas highlighted in the plan.
SP requested that timescales be ascribed to the actions in the
plan and the revised report was presented to the Board. KT
requested that the Board was provided with more information on
Stroke outcomes for as long as the performance of the Stroke Unit
was below the national indicators in order to provide assurance to
the Board that patients were receiving good quality care. PS
confirmed that clinical outcome indicators were now included in
Performance Dashboard and for Stroke this included the
percentage of Stroke patients discharged to their original
residence and Stroke mortality rates. TS added that the Stroke
physicians who had previously attended the Board meeting,
Damien Jenkinson and Joseph Kwan, had confirmed that patients
were receiving a good service once on the Stroke Unit and the
feedback from patients was very good
(b)
Response to CQC Mortality Alerts (Appendix D)
TS explained that he had wanted the Board and Governors
present to see the correspondence from the CQC relating to
recent mortality outlier alerts. He reported that the CQC had
confirmed that a data anomaly had resulted in the mortality outlier
alert in relation to pneumonia and the CQC had also asked
whether the mortality outlier alerts in three other areas relating to
congestive heart failure, senility and organic mental disorders and
chronic obstructive pulmonary disease and bronchiectasis could
also be the result of data anomalies. TS added that there was
more detailed information on the work which the Trust had done in
relation to the mortality outlier alerts later in the private part of the
Board meeting.
BOD/Part 1MINS 11.10.13
PAGE 3 OF 14
TS
RR
DB questioned the extent to which the CQC had relied on this data
in determining the trusts to be inspected in first wave of its new
inspection regime. IM acknowledged that it was useful for the
Board to see this information as it does give assurance on the
work of the Trust in relation to mortality reviews. SP clarified that
the Board had not and should not focus on the data as the issue
but on the quality of the care provided to patients. DT clarified that
the Trust was not suggesting that data was incorrect.
106/13
QUALITY
U
(a)
Patient Story (Verbal)
U
PS introduced the patient story which was presented by a
member of staff, the Deputy Director of Nursing and Midwifery,
and related to the care which had been received by her mother as
a patient at the Royal Bournemouth Hospital at a time before the
Deputy Director of Nursing and Midwifery had joined the Trust.
The story described her mother’s symptoms and eventual
diagnosis with sepsis and the care which she had received from
her GP, the ambulance service and the Hospital. She described
her experience as a member of a patient’s family about the care
her mother received, the initial delay in referral to the Hospital and
that staff at the Hospital had not been very helpful in the face of
her concerns about her mother. She highlighted the importance of
early recognition and treatment for sepsis and how she had gone
to the Patient Advice and Liaison Service in order to get
information about her mother’s consultant. She also explained that
the care that her mother had received on the Ward was excellent
and the staff there had been very helpful and once diagnosed, her
mother had started to improve and was discharged home.
PS noted the work which had gone on in the Trust since these
events took place to raise awareness of sepsis and the treatment
of sepsis including the use of the Simulation Suite.
SP added that the use of this story demonstrated a degree of
maturity in the Trust’s approach in that it was willing to listen to the
feedback and learn from it. AP added that this would be a very
useful training tool as it was very powerful and quite distressing in
places and BF added that it could be used in primary care too.
BOD/Part 1MINS 11.10.13
PAGE 4 OF 14
(b)
Patient-Led Assessment of the Care Environment (Appendix
E)
PS presented the paper and thanked the volunteers and
Governors who took part in the inspection. She highlighted
however that the Trust had performed poorly when compared to
other trusts locally and with reference to its performance under the
predecessor assessment process, Patient Environment Action
Team, when the Trust had rated been good or excellent. PS
added that an external assessor who had taken part in the
process had confirmed that the final scores did not reflect their
assessment of the Trust.
JS expressed how it was difficult to explain the deterioration in the
results of the assessment when there was no evidence of
deterioration in the various elements of the patient environment
assessed. PS confirmed that the Trust accepted the results and
was reviewing the feedback in detail. In response to a question
from SP about ensuring consistency, JS confirmed that she was
not aware of any moderation process for the assessments carried
out by different teams at each trust. SH also noted the difference
in the scores between the two Hospitals.
TS requested that this was included on the agenda for the
meeting of the Council of Governors later that month in order to
get an understanding, particularly from those Governors who took
part in the inspection process, whether there were issues which
had not been identified in previous assessment or whether there
had been a change in approach. JS agreed.
(c)
National Early Warning Scorecard
deteriorating patient (Presentation)
(eNEWS)
and
the
PS introduced SA and CT to the meeting. SA explained that she
had worked with Richard Byrom, a consultant, on the introduction
of eNEWS. She explained the reasons for the introduction of
eNEWS and the Trust’s commitment to reduce harm from
deterioration which had led to its introduction. She also described
the process for entering observations and demonstrated this using
a test database. She also highlighted the automated process for
escalation to doctors when a patient was deteriorating which
would be introduced from January 2014, although the data was
already available to doctors. In response to a question from IM
she confirmed that this would be completed within six months.
SA explained that the Trust was now easily able to monitor
performance of observations and that 100% of observations were
being completed. In response to a question from TS, she also
BOD/Part 1MINS 11.10.13
PAGE 5 OF 14
JS
explained how the data was very rich and could be used to
monitor the reduction in harm to patients and other elements of
performance and they were reviewing how to make best use of
the data. She also gave an example of a patient who had
suddenly deteriorated and was in theatre within 30 minutes.
CT explained the benefits of the system for the patient and in
supporting staff by providing them with prompts and alerts. She
also highlighted the benefits for doctors in assessing which
patients to see first and for other specialist teams in the Trust,
such as the pain and end of life care teams.
In response to a question from DB about a business review, BaF
believed that there would be an improvement on mortality from
sepsis as a result of the introduction of VitalPAC.
The Board discussed the automated escalation process and how
this would improve and allow monitoring of response times and
provided real-time data which was updated and available on the
intranet in a daily basis. PS added that the clinical outreach team
had access to the information too.
BaF congratulated SA on her hard work. He added that he was
not as concerned about monitoring response times as having the
information available would enable the clinician to respond.
JS thanked SA and CT for their presentation and asked that SA
attend the Board meeting in six months’ time to provide an update
on progress. SA and CT left meeting.
(d)
Monitor’s Quality Governance Framework Self-Assessment
(Appendix F)
PS presented the report for information in order to provide
assurance around progress against the actions. She reported that
approach had been validated by PricewaterhouseCoopers (PwC)
post-implementation. She presented the update of the
assessment and the improvements and actions.
In response to a question from SP about areas on which progress
could be faster, PS highlighted the principal issue related to
presentation and monitoring of performance at Directorate level
which was now being addressed using the Performance
Dashboard.
The Board noted and approved the scores and the actions.
BOD/Part 1MINS 11.10.13
PAGE 6 OF 14
KF
(e)
Mortality Data Review (Presentation)
BaF and DT delivered the presentation. BaF assured the Board
that the intention was not to have a debate on the data but to
provide an understanding on why the Trust scored differently
using the Hospital Standardised Mortality Ratio (HSMR) produced
by Dr Foster and the Healthcare Evaluation Data produced by
University Hospitals Birmingham NHS Foundation Trust used by
PwC and the CQC.
DT explained that there were nine trusts where the scores were
significantly different using the two measures and the Trust was
one of those and was the only trust in this group which would be
out of range based on the CQC data which obviously caused
problems for the Trust. BaF highlighted that the key difference
was the inclusion of day cases in the denominator for Dr Foster as
the number of deaths under both measures was the same.
He highlighted:
 the work to improve mortality through the various Mortality
Improvement through Clinical Engagement workstreams;
 the mortality outlier alerts which had been flagged by PwC,
the and the reviews which had been conducted by the
Trust in response to the CQC mortality outlier alerts as well
the reviews conducted by the Trust itself, led by the
Mortality Group, when it was identified that the Trust was
outside expected mortality levels using the data it received
from Dr Foster;
 the introduction of eMortality Review Forms which would
ensure that every death in the Hospital would be reviewed
by the individual consultant responsible for that patient and
any learning and actions were documented, prior to review
at Mortality and Morbidity meetings, which had been in
place for many years, and involved junior doctors, clinical
leads and ward sisters as well;
 that he was introducing a standard form for the Mortality
and Morbidity meetings to record any actions and the
deadlines for their completion.
TS requested that the Mortality Group commission a review of
notes in relation to the PwC alerts to identify if there were any
issues which could come back to the Board in stages. DT agreed,
noting that the review would use a mixed sample as the data used
by PwC was not available to Trust.
RR added there was a large amount of data analysis taking place,
the Trust’s performance was improving and more could be done
to further improve performance.
BOD/Part 1MINS 11.10.13
PAGE 7 OF 14
BaF/DT
SP asked whether the format used by PwC to present the
mortality data could be used for the Board. BaF cautioned on the
use of the subset analysis as these were small numbers and the
Trust may not be able to establish any learning from this.
PS highlighted that the mortality data presented to the Board
showed the HSMR separately for the Royal Bournemouth Hospital
and Christchurch Hospital.
AP was concerned that some of the discussions could give an
inaccurate impression of the Board’s focus and wanted to give
assurance that the Board saw the CQC inspection as an
opportunity to raise standards and supported the focus on the
work to reduce avoidable mortality.
(f)
Emergency
and
(Presentation)
Urgent
Care
Capacity
Planning
RR noted that the slides had been included in the papers for
information. He highlighted:
 that the emergency pathway was likely to be an area of
focus for the CQC;
 the work on urgent care which was part of a whole system
approach;
 that the Trust needed to implement good practice internally
on a consistent basis;
 the additional bed capacity which would be available;
 the changes to way the Trust managed patient care
including commissioning interim care packages directly
which allowed patients to be assessed at home;
 the increase in levels of staffing; and
 that the last escalation bed on the main Medical wards had
been closed with only the three escalation beds in the
Acute Medical Unit (AMU) remaining which were still being
used.
In response to a question from JS about the recruitment of two
new acute physicians RR replied that the consultant ward rounds
in AMU in the evenings were being covered by existing physicians
pending recruitment.
In response to question from KT, RR confirmed that Dorset
Healthcare University NHS Foundation Trust would manage the
additional beds in St Leonards Community Hospital with the Trust
providing medical support as was the case currently. The Board
discussed the funding and ongoing responsibility of the Trust in
relation to the other beds in the community for first two weeks
following discharge before the responsibility transferred to social
services. JS suggested that the protocol in relation to these beds
could be circulated to the Board for agreement.
BOD/Part 1MINS 11.10.13
PAGE 8 OF 14
RR
(g)
Ward Staffing Review (Appendix G)
PS referred to the paper which had been provided to the Board.
She highlighted the progress on the Ward Staffing Review and the
six monthly review which was taking place. PS demonstrated how
staffing on the Wards was managed and monitored with leave,
training, vacancies and reasons for use of bank and agency staff
all recorded. She added that the six month reviews involved the
Ward Sister, a finance representative and other staff, including
consultants, to ensure the key elements were aligned.
PS also highlighted the use of patient safety indicators around
harm-free care and the quality dashboard at ward level in these
reviews review to emphasise that these reviews were about the
quality of care being provided on the wards.
PS assured the Board that the templates were correct and
recruitment of qualified and unqualified staff to these templates
was continuing. She added that AMU had recruited above
template and staff were being used on other wards and the
individual who was working with the Human Resources
Department on an interim basis on the recruitment of nursing staff.
KA provided some information about the preceptorship
programme for new nurses which was starting in November
JS asked whether this information could be used as background
information for the patient safety walkrounds. SP reported that this
information had been reviewed by the Audit Committee and gave
an extremely useful overview of each ward.
In response to a question from KT, PS confirmed that the staff on
the wards received the data every month.
107/13
PERFORMANCE
U
(a)
Performance Report (Appendix H)
U
U
RR presented the report, noting:
 the clinical outcome indicators in relation to Stroke which
appeared on the performance Dashboard;
 that the Trust had met the 4 hour waiting time target in the
Emergency Department but failure to meet this in two
quarters out of four would automatically result in red
governance risk rating from Monitor;
 that the focus on discharge by senior nurses had improved
the flow of patients through the Hospital but was not
sustainable and therefore an easier process was being
developed to ensure that patients were discharged
appropriately and safely to replace this;
BOD/Part 1MINS 11.10.13
PAGE 9 OF 14





more ambulances were coming to Trust and the reason for
this was being investigated as this was not as a result of
transfers from other hospitals and cardiology patients only
represented a small element of the increase;
the increase in the number of Delayed Transfers of Care
which highlighted formal delays rather than all delays with
the interim beds slightly masking the full extent of the
increase;
that the Trust was still significantly below its trajectory on
Clostridium Difficile although there had been one case of
MRSA in August;
that the Trust was in a positive position overall on 18 week
referral to treatment times but there were issues with
general surgery, urology, orthopaedics and ophthalmology
which would make this a challenging target going forward;
and
that there was a lot of pressure at the front end of the
urology pathway and a new awareness campaign was
about to start which was putting performance on the 62 day
wait for treatment for cancer at risk as well as putting
pressure on the two week cancer referral target.
The Board discussed the increase in fast track referrals, with
referrals doubling over three years for most specialities and
forming a larger proportion of the overall number of referrals. It
was noted that there was capacity but these referrals were very
resource-intensive. TS added that there may be other things a GP
could be doing before they refer as a surge in patients could risk
delaying referrals for those patients who did need to be seen.
SP left the meeting.
(b)
Quality Performance Report (Appendix I)
PS presented the report and highlighted:
 the mortality ratios on both sites;
 the serious incidents in month which included three
category 3 avoidable pressure ulcers, three falls and one
case of MRSA;
 that there was an improvement in the levels of harm-free
care compared to the previous month when the data was
first collected using iPads;
 the number of pressure ulcers was stable;
 that the Trust was above average in the national scores on
the Friends and Family Test for inpatients, the Emergency
Department and the Trust overall; and
 that the inpatient survey had shown an improvement in
privacy and dignity scores.
BOD/Part 1MINS 11.10.13
PAGE 10 OF 14
JS highlighted the issues around poor documentation in the
serious incidents relating to pressure ulcers.
(c)
Financial Performance (Appendix J)
U
The report was noted for information.
(d)
Monitor Quarter 1 Results (Appendix K)
The report was noted for information.
(e)
Monitor Risk Ratings under Risk Assessment Framework
(Appendix L)
The report was noted for information.
108/13
STRATEGY
U
(a)
Proposed Merger between Poole Hospital and RBCH
(Appendix M)
U
TS presented the report. He added that he had written to two local
MPs in Poole after the recent media coverage about the closure of
one A&E department to provide assurance that the plans were
that there would be an A&E department at each site if the merger
was approved.
DM noted that the Trusts were unlikely to hear anything from the
Competition Commission before 21 October.
109/13
DISCUSSION
U
(a)
Board Objectives (Appendix N)
U
TS provided and update on performance against the Board
objectives and the key milestones for delivery of these, focussing
on those which were rated red. He noted that progress had been
delayed as a result of the delays in the merger process and due to
undertakings relating to joint working required by the Competition
Commission. He added that the performance against the Trust
cost improvement plans had already been reflected in the risk
register.
RR explained that the development of an independent charity was
dependent on a change in legislation which had been deferred.
BOD/Part 1MINS 11.10.13
PAGE 11 OF 14
PS noted that the performance against the objectives
demonstrated good alignment with the Assurance Framework and
the risks which had been highlighted.
(b)
Review of the Quality of Trust Services by
PricewaterhouseCoopers (Presentation)
TS reported that the Board had made the decision in May to
engage PwC following their involvement in the mortality reviews of
14 organisations by Sir Bruce Keogh. He noted that the purpose of
the review was:
 to get an independent verification of the quality of care
provided by the Trust;
 to seek some credible feedback in the areas of focus for
improvement; and
 to get an independent review of mortality.
TS added that the key findings had been discussed previously and
suggested that the slides were circulated to the Governors for
information and focussed on the actions.
KF
He highlighted in particular:
 the development of the eMortality Review Forms, which the
Trust understood from its work with other organisations in
NHS QUEST was unique;
 the work to improve the flow of patients through the
Hospital and the need to do this in conjunction with working
with health and social care partners to reduce inappropriate
admissions and to create a stronger pull mechanism to
draw patients out of hospital when they no longer required
cute care;
 the removal of the escalation beds;
 medical cover out of hours and the additional work required
to deliver a proper service to patients seven days a week,
adding that the Trust was looking to recruit ED consultants
from southern Europe; and
 sharing best practice across the Trust.
He added that he was working with PwC to finalise the final report
which would then be shared with the CQC prior to its visit.
KT asked if there was a mechanism to help share learning across
the Trust. TS responded that Directorate leadership was required
to deliver this and emphasised PS’s work in getting the right
leadership on Wards which had already led to improvements.
JS added that the actions would act as a major springboard to
improve the quality of services in the Trust.
BOD/Part 1MINS 11.10.13
PAGE 12 OF 14
110/13
INFORMATION
U
(a)
Core Brief (September) Appendix O)
U
The report was noted for information.
(b)
Communications Update (inc RAAI September) (Appendix P)
U
The report was noted for information.
(c)
Board of Directors Forward Programme (Appendix Q)
U
The report was noted for information.
111/13
DATE OF NEXT MEETING
Friday 8 November 2013 at 8.30am, Committee Room, Royal Bournemouth
Hospital.
112/13
2B
ANY OTHER BUSINESS
U
There was no other business.
101/13
Key Communications points for staff
U
1. Actions on mortality and capacity.
2. VitalPAC/eNEWS/deteriorating patient and sepsis.
102/13
QUESTIONS FROM GOVERNORS
U
1. DC asked about community hospital provision and linking the
community hospital provision to the home addresses of the patients.
PS explained that the Trust was looking at developing locality based
wards and cohorting patients in order to assist social services in
working with these patients.
2. RO highlighted that a number of staff in the area where he works had
passed 25 years, service in the NHS and had only received
recognition for long service through their own perseverance. KA
explained that there was a Trust policy and this was a management
responsibility and added that recognition was also an area being
discussed by change leaders about recognition following the staff
excellence awards. JS suggested that the Human Resources
Department may need to provide a reminder to managers to ensure
that it happens in future and she would be willing to apologise
BOD/Part 1MINS 11.10.13
PAGE 13 OF 14
personally for this to the individuals concerned.
3. DC noted comments at a previous meeting that the Trust would not
sub-contract cancer services to other providers and suggested that
this could be reconsidered given the issues with cancer waiting times
discussed earlier in the meeting. He cited an example of an
individual who may not have required a skin graft if they had been
seen earlier.
There being no further business the meeting was declared closed at
11.30am.
BOD/Part 1MINS 11.10.13
PAGE 14 OF 14
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS
NHS FOUNDATION TRUST
U
U
Actions carried forward from a Meeting of The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Board of
Directors held on Friday 11 October 2013.
103/13
ACTIONS LOG
U
(e)
Trolley Assessments (89/13)
U
KF agreed to speak with DC outside of the meeting to see if there
were any questions which remained outstanding.
105/13
Meeting
November.
w/c
4
TS
Included
in
Board
papers.
Included in
Performance Report.
MATTERS ARISING
U
(b)
Update on Stroke Performance (Appendix C)
SP requested that timescales be ascribed to the actions in the plan
and the revised report was presented to the Board. KT requested
that the Board was provided with more information on Stroke
outcomes for as long as the performance of the Stroke Unit was
below the national indicators in order to provide assurance to the
Board that patients were receiving good quality care.
106/13
KF
RR
QUALITY
(b)
Patient-Led Assessment of the Care Environment (Appendix E)
TS requested that this was included on the agenda for the meeting
of the Council of Governors later that month in order to get an
understanding, particularly from those Governors who took part in
the inspection process, whether there were issues which had not
been identified in previous assessment or whether there had been a
change in approach. JS agreed.
Completed/
JS
__________________________________________________________________________________________________________________
BOD Actions Log 11.10.13
PAGE 1 OF 2
(c)
National Early Warning Scorecard
deteriorating patient (Presentation)
(eNEWS)
and
the
JS thanked SA and CT for their presentation and asked that SA
attend the Board meeting in six months’ time to provide an update
on progress. SA and CT left meeting.
(e)
Mortality Data Review (Presentation)
TS requested that the Mortality Group commission a review of
notes in relation to the PwC alerts to identify if there were any
issues which could come back to the Board in stages. DT agreed,
noting that the review would use a mixed sample as the data used
by PwC was not available to Trust.
(f)
109/13
BaF/DT
Emergency and Urgent Care Capacity Planning (Presentation)
JS suggested that the protocol in relation to these beds could be
circulated to the Board for agreement.
DISCUSSION
RR
Include on agenda.
KF
Completed
U
(b)
Performance Report (Appendix D)
U
TS added that the key findings had been discussed previously and
suggested that the slides were circulated to the Governors for
information and focussed on the actions.
__________________________________________________________________________________________________________________
BOD Actions Log 11.10.13
PAGE 2 OF 2
BOARD OF DIRECTORS
Meeting Date and Part:
8 November 2013, Part 1
Subject:
Stroke Action Plan
Section:
Matters Arising
Executive with Overall
Responsibility
Tony Spotswood, Chief Executive
Author of Paper:
Tom Smith, Interim Deputy Manager, Medical Directorate
Details of previous
discussion and/or
dissemination:
Board 11 October 2013
Patient Safety
Health & Safety
Performance Strategy
Key Purpose:
X
X
Action required by BoD:
To consider the action plan to improve Stroke Services
Executive Summary:
Proposals to improve the quality of Stroke Services
Strategic Goals &
Objectives:
Maintaining high quality Stroke services
Links to CQC
Registration: (Outcome
reference)
Links to Assurance
Framework/Key Risks:
Outcome 4: Care and welfare of service users
Outcome 16: Quality of Service provision
Outcome 13: Staffing/Skill mix
Quality and Safety
Internal
Type of Assurance:
X
External
Board of Directors Part 1
8 November 2013
Stroke Action Plan
Following discussions at the last Board, I enclose details of a more granular plan to
address the specific issues considered by the Board aimed at improving Stroke
Services. This includes details of all timescales relevant to implementation of the
required action.
The Board is asked to consider and agree this.
Tony Spotswood
Chief Executive
Stroke Action Plan
Matters Arising
Page 1 of 1
Stroke Unit Board Report – Stroke Action Plan Timescales
Background
The Board meeting of 11th October received a paper from the Stroke team outlining the
current position of the Stroke Unit. The Board requested a further short paper confirming
action plan timescales.
Attached is the latest update of the Stroke Performance Action Tracker dated 14th October
2013. The recent Board report mirrors the arrangement of the Action Tracker.
Direct Admission Plan
The actions are either complete or will be complete by 31st October. A new action (4a) has
been added (on 14th October) this will be complete on 31st October also. This involves
agreeing a new combined pathway which will be disseminated for agreement.
A regular interdepartmental meeting is to be held monthly (second Thursday) involving
Acute Medicine, ED, Radiology and Stroke. Mutual shadowing of staff has been arranged
and the recruitment of the staff grade has been approved on a non-recurrent basis.
90% Stay in Stroke Unit Plan


Seven Day Services
o The weekend Stroke Unit ward round is planned to commence in January
2014 combining with other rotas. The rota is to be agreed with Medicine For
the Elderly (MFE) colleagues.
Senior Presence in ED
o The staff grade recruitment is underway as above.
o Two consultant physician posts will be advertised including MFE and Stroke
sessions. One of these posts is a replacement, one new.
o This increase in senior presence will directly benefit Stroke patients at the
“front door”.
CT in 1 hour Plan


Information pertaining to the month of September reveals that all breaches of the 1
hour target occurred out of hours and the radiology team has been advised and a
plan requested. This will be reviewed by 31st October.
The Stroke Consultant Nurse has arranged education sessions to highlight the
importance of the 1 hour brain scan with the radiology team
Timely Transfer of Care Plan

4 interim care beds have now been allocated at St. Leonards, medically stable
Stroke patients can be considered for transfer to these beds.
Consultant Team
Professor Joseph Kwan, Dr Divya Tiwari, Dr Owen David, Dr Damian Jenkinson
Action Area
Stroke Services
Item
Ref
Direct Admission to
Stroke Unit
1
Action
Lead
Progress Update
Action
by…
Review
Date
Status
Agree new pathway at meeting 2 September 2013
Agreed at meeting on 2nd Sept, including COO
2
Ensure ED staff capable of identifying stroke symptoms (CMA
and DJ to pick up with lead nurse in ED|). Note the need to
concentrate on nursing staff as rotation of doctors presents a
significant risk
TS
To arrange meeting with Lead Nurse in ED
TS to contact CMA, CMA is to email the Lead Nurse in A and E
TS
Complete
3
Ensure ED staff are familiar with the pathway and their
responsibilities within it (CMA topic up with lead nurse in ED)
TS
To arrange meeting with Lead Nurse in ED
DJ and CMA to agree "Pathway" TS to follow up with CMA.
Nurses from ED are invited to Stroke to exchange information.
DJ
Complete
Arrange a meeting with representatives from ED, AMU,
Radiology and Stroke to ratify the new pathway.
4a Develop combined pathway
TS
Stroke pathway (non-thrombolised) sent for agreement and comments
included. This action is complete and will be incorporated into Action 4a
DJ/TS Combined pathway to include non-thrombolised, GP and FAST +ve
paths DJ and TS to produce draft and circulate to ED, CT, AMU for
agreement.
To agree job plan
Advertise post
Start date for appointee
TS to follow up with Divya Tiwari. Awaiting confirmation from COO that
this recruitment can proceed. TS contact Donna Parker.
Complete
TS
TS
Complete
TS/DJ
31.10.13
On Track
TS
31.10.13
On Track
5
Recruit an additional trust grade doctor (MFE and Stroke) to
increase ability to respond rapidly to 'front door'. Note that a
majority of stroke patients present during the day time. DT to
conclude job plan.
DT
6
Distribute to group agreed new pathway agreed at 2nd Sept
meeting - CMA to conclude
TS
TS to make sure that the pathway is distributed to all. Feedback has
been received - this is the "non-thrombalised" pathway.
TS
7
Ensure communication of new pathway to Trust
TS
TS
31.10.13
On-going
8
To consider options to develop an Outreach Team for new
stroke patients
Establish the number of CT's required within 1 hour out of hours
TS
Proceed when the pathway has been ratified. Action 4a has been
introduced. New completion date.
Meeting held - TS to distribute bullet points.
TS
31.10.13
On Track
CG/DJ
10.09.13
Complete
DJ
31.10.13
On Track
TS/DJ
31.10.13
On Track
TS
31.10.13
On Track
TS/NM
31.10.13
On-going
9
90% Stay in Stroke
Unit
Date
Raised
14.10.2013
DJ
4
CT in 1 hour
Updated
10 Explore options of CT in 1 hour out of hours with Radiology
11 Develop pathway and criteria for directly admitting GP referrals
Clare CG to document how many on average for a month and DJ is to liaise
Gordon with the Consultant Radiologists
DJ
As above
TS
to the Stroke Unit (avoiding AMU)
12 See action reference 5
TS to contact Divya Tiwari
13 Create assessment trolley in Stroke Unit
NM
14 Continue development of green dot system (patients who no
NM
longer require a Stroke Unit bed)
TS/DJ arrange to meet to develop pathway. Now subsumed into 4a
NM and Tom Smith to establish the inter-dependencies and then confirm
time frame. Bed availability needs to be looked at. The "Pathway" is
needed first. TS to check re. "mixed sex" option.
This is done routinely every day and is emailed to clinical site. An audit
is being done by Aime Martin and Louise is to liaise with her about the
results. The Audit results will then be shared
\\rbhfile12\T:\BOARD OF DIRECTORS\BOARD PACKS\2013\11. November 2013\Working Papers\Part 1\Copy of Stroke Performance Action Tracker 14.10.2013
LJ
Complete
On-going
Printed: 30/10/2013
Action Area
Item
Stroke Services
Ref
Action
15 Develop a 7 day Senior Clinical decision making rota
16 To revisit the scope for starting the CHC process prior to PEG
Updated
Date
Raised
Lead
Owen
David/
Tom
Smith
care arrangements.
Owen David developed proposal. Tom Smith has written business case.
OD discussed this with the MFE team on 20/9/13. This rota will be
combined with the developing MFE rota (and other rotas).
LJ to contact SALT team (Heidi Feld)
TS to contact Donna Parker re. commissioning Priorities.
Action
by…
DJ/OD
CHC process cannot be started prior to PEG insertion. PEG tubes are
being inserted on Friday afternoons, TS is to liaise with Jo Blackwell re
the reasons why not on other days. Also explore percentage and time
process for this from referral to time of PEG insertion
TS
VM
VM update - 4 beds secured for Stroke at St Leonard's - available from
mid October.
VM/TS
\\rbhfile12\T:\BOARD OF DIRECTORS\BOARD PACKS\2013\11. November 2013\Working Papers\Part 1\Copy of Stroke Performance Action Tracker 14.10.2013
Review
Date
30.09.13
On-going
31.10.13
Complete
Status
LJ
TS
HL
insertion for patients in whom a PEG is inevitable.
17 Secure interim care beds for patients awaiting CHC or social
Progress Update
14.10.2013
Complete
Printed: 30/10/2013
BOARD OF DIRECTORS
Meeting Date:
8th November 2013 – Part 1
Subject:
CQC Intelligent Monitoring Report – October 2013
Section:
Quality
Executive Director with
overall responsibility:
Paula Shobbrook, Director of Nursing and Midwifery
Author of Paper:
Joanne Sims, Associate Director Clinical Governance
Details of previous
discussion and/or
dissemination:
Trust Management Board, 1st November 2013
Key Purpose:
Patient
Safety
X
Action required by BoD:
Health &
Safety
Performance
Strategy
X
For Information
Executive Summary:
The CQC Intelligent Monitoring Report replaces the Quality and Risk Profile which the
CQC will no longer be producing for acute and specialist trusts.
This report presents the CQC’s analysis of the key indicators (called ‘tier one indicators’)
for The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust. The
indicators relate to the five key questions which the CQC is asking in relation to all services
(are they safe, effective, caring, responsive, and well-led?) and look at a range of
information including patient experience, staff experience and performance. There are two
possible levels of risk for each indicator: "risk" and "elevated risk". All acute and specialist
trusts have been categorised into one of six summary bands, with Band 1 representing
highest risk and Band 6 the lowest risk, based on the proportion of indicators that have
been identified as ‘risk’ or ‘elevated risk’. If there are known serious concerns with trusts
(for example, trusts in special measures) they are also categorised as Band 1.
The bandings are a guide to the number of issues which both the CQC and the hospitals
need to look into in more depth. Based on the current indicators RBCH is categorized Band
1.
The CQC has subsequently written to the Medical Director on 25th October 2013 in
relation to the following mortality outlier alerts, which relate to 4 of the 6 categorised as
elevated risk:
 Senility and organic mental disorders
The CQC have reviewed the information and actions which have been provided. As a
result, they do not feel that we need to undertake additional enquiries at this time.
 Acute cerebrovascular disease
 Congestive heart failure; nonhypertensive
 Chronic obstructive pulmonary disease and bronchiectasis
The response states that the CQC have reviewed the outputs from the Dr Foster
Intelligence Quality Investigator system, which confirm that these outlier alerts are the
result of an anomaly due to the way the data has been coded. As a result, the CQC not
feel that they need to undertake additional enquiries at this time.
These updates should be reflected in the next report from the CQC which is anticipated in
3 months.
All
Strategic Goals &
Objectives:
Links to CQC
Registration: (Outcome
reference)
Links to Assurance
Framework/Key Risks:
All Essential Standards of Quality and Safety
All
Internal
External
Type of Assurance:
X
Intelligent Monitoring Report
Report on
The Royal Bournemouth and Christchurch Hospitals
NHS Foundation Trust
21 October 2013
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Intelligent Monitoring: Report on 21 October 2013
RDZ
CQC has developed a new model for monitoring a range of key indicators about NHS acute and specialist hospitals. These indicators relate to the five key
questions we will 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. They will not be used on their own to make judgements. Our judgements will always be based on the result of an inspection, which will take
into account our Intelligent Monitoring analysis alongside local information from the public, the trust and other organisations.
What does this report contain?
This report presents CQC’s analysis of the key indicators (which we call ‘tier one indicators’) for The Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust. We have analysed each indicator to identify two possible levels of risk.
We have used a number of statistical tests to determine where the thresholds of "risk" and "elevated risk" sit for each indicator, based on our judgement of
which statistical tests are most appropriate. These tests include CUSUM and z scoring techniques. For some data sources we have applied a set of rules to
the data as the basis for these thresholds - for example concerns raised by staff to CQC (and validated by CQC) are always flagged in the model.
Further details of the analysis applied are explained in the accompanying guidance document.
What guidance is available?
We have published a document setting out the definition and full methodology for each indicator. If you have any queries or need more information,
please email [email protected] or use the contact details at www.cqc.org.uk/contact-us
Page 2 of 11
RDZ
133 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Trust Summary
Risks
Elevated risks
Count of 'Risks'
and 'Elevated risks'
Overall
3
6
Risks
Overall
Elevated risks
0
Elevated risk
Elevated risk
Elevated risk
Elevated risk
Elevated risk
Elevated risk
Risk
Risk
Risk
1
2
3
4
5
6
7
8
9
10
Composite indicator: In-hospital mortality - Cardiological conditions and procedures
Composite indicator: In-hospital mortality - Cerebrovascular conditions
Composite indicator: In-hospital mortality - Conditions associated with Mental health
Composite indicator: In-hospital mortality - Nephrological conditions
Composite indicator: In-hospital mortality - Neurological conditions
Composite indicator: In-hospital mortality - Respiratory conditions and procedures
Proportion of reported patient safety incidents that are harmful
Composite indicator: In-hospital mortality - Vascular conditions and procedures
Serious Education Concerns
Page 3 of 11
Band
Number of 'Risks'
Number of 'Elevated risks'
Overall Risk Score
Number of Applicable Indicators
Proportional Score
Maximum Possible Risk Score
1
3
6
15
82
0.09
164
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Tier One Indicators
Section
ID
Indicators
Observed
Expected
Risk?
-
-
No evidence of risk
30
0
34.35
2.45
No evidence of risk
No evidence of risk
-
-
No evidence of risk
Never Events
STEISNE
Never Event incidence
Avoidable infections
CDIFF
MRSA
Incidence of Clostridium difficile (C.difficile)
Incidence of Meticillin-resistant Staphylococcus aureus (MRSA)
Deaths in low risk
conditions
MORTLOWR
Dr. Foster: Deaths in low risk diagnosis groups
NRLSL03
Proportion of reported patient safety incidents that are harmful
0.47
0.28
Risk
NRLSL04
Potential under-reporting of patient safety incidents resulting in death or severe harm
1.35
1.49
No evidence of risk
NRLSL05
Potential under-reporting of patient safety incidents
224.11
235.27
No evidence of risk
VTERA03
Proportion of patients risk assessed for Venous Thromboembolism (VTE)
0.93
0.95
No evidence of risk
SHMI01
Summary Hospital-level Mortality Indicator
Trust's mortality rate
is 'As Expected'
-
No evidence of risk
HSMR
HSMRWKDAY
HSMRWKEND
Dr. Foster: Hospital Standardised Mortality Ratio
Dr. Foster: Hospital Standardised Mortality Ratio (Weekday)
Dr. Foster: Hospital Standardised Mortality Ratio (Weekend)
-
-
No evidence of risk
No evidence of risk
No evidence of risk
COM_CARDI
Composite indicator: In-hospital mortality - Cardiological conditions and procedures
-
-
Elevated risk
COM_CEREB
COM_DERMA
COM_ENDOC
-
-
Elevated risk
No evidence of risk
No evidence of risk
-
-
No evidence of risk
COM_GENIT
COM_HAEMA
COM_INFEC
Composite indicator: In-hospital mortality - Cerebrovascular conditions
Composite indicator: In-hospital mortality - Dermatological conditions
Composite indicator: In-hospital mortality - Endocrinological conditions
Composite indicator: In-hospital mortality - Gastroenterological and hepatological conditions
and procedures
Composite indicator: In-hospital mortality - Genito-urinary conditions
Composite indicator: In-hospital mortality - Haematological conditions
Composite indicator: In-hospital mortality - Infectious diseases
-
-
No evidence of risk
No evidence of risk
No evidence of risk
COM_MENTA
Composite indicator: In-hospital mortality - Conditions associated with Mental health
-
-
Elevated risk
COM_MUSCU
COM_NEPHR
COM_NEURO
Composite indicator: In-hospital mortality - Musculoskeletal conditions
Composite indicator: In-hospital mortality - Nephrological conditions
Composite indicator: In-hospital mortality - Neurological conditions
Composite indicator: In-hospital mortality - Paediatric and congenital disorders and perinatal
mortality
-
-
No evidence of risk
Elevated risk
Elevated risk
-
-
No evidence of risk
Composite indicator: In-hospital mortality - Respiratory conditions and procedures
-
-
Elevated risk
Composite indicator: In-hospital mortality - Trauma and orthopaedic conditions and
procedures
Composite indicator: In-hospital mortality - Vascular conditions and procedures
-
-
No evidence of risk
-
-
Risk
Patient safety incidents
Venous Thromboembolism
Mortality: Trust Level
COM_GASTR
Mortality
COM_PAEDI
COM_RESPI
COM_TRAUM
COM_VASCU
Page 4 of 11
Section
ID
Indicators
Observed
Expected
Risk?
-
-
No evidence of risk
No evidence of risk
No evidence of risk
1080
3606
1138.68
3374.1
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
Maternity and women's
health
MATELECCS
MATEMERCS
MATSEPSIS
Maternity outlier alert: Elective Caesarean section
Maternity outlier alert: Emergency Caesarean section
Maternity outlier alert: Puerperal sepsis and other puerperal infections
Re-admissions
MATMATRE
MATNEORE
HESELRE
HESEMRE
Maternity outlier alert: Maternal readmissions
Maternity outlier alert: Neonatal readmissions
Emergency readmissions following an elective admission
Emergency readmissions following an emergency admission
PROMs
PROMS19
PROMS20
PROMS22
PROMS24
PROMs EQ-5D score: Groin Hernia Surgery
PROMs EQ-5D score: Hip Replacement
PROMs EQ-5D score: Knee Replacement
PROMs EQ-5D score: Varicose Vein Surgery
1.29
1.05
0.98
Not included
1
1
1
Not included
No evidence of risk
No evidence of risk
No evidence of risk
Not included
Not included
Not included
Not included
SINAP14
The number of cases assessed as achieving compliance with all nine standards of care
measured within the National Hip Fracture Database.
Key Indicator 1: Number of patients scanned within 1 hour of arrival at hospital
Not included
Not included
Not included
SINAP15
Key Indicator 8: Number of potentially eligible patients thrombolysed
Not included
Not included
Not included
SURGHIPREV
SURGKNEREV
Surgical revisions outlier alert: Hip revisions
Surgical revisions outlier alert: Knee revisions
Not included
Not included
Not included
Not included
Not included
Not included
Inpatient Survey 2012 Q34 "Did you find someone on the hospital staff to talk to about your
worries and fears?”
Inpatient Survey 2012 Q35 “Do you feel you got enough emotional support from hospital staff
during your stay?”
5.73
-
No evidence of risk
6.78
-
No evidence of risk
Inpatient Survey 2012 Q23 "Did you get enough help from staff to eat your meals?"
Inpatient Survey 2012 Q32 "Were you involved as much as you wanted to be in decisions about
your care and treatment?"
Inpatient Survey 2012 Q39 "Do you think the hospital staff did everything they could to help
control your pain?"
7.86
-
No evidence of risk
7.23
-
No evidence of risk
8.33
-
No evidence of risk
NHFD01
Audit
Surgical revisions outlier
IPSurTalkWor
Compassionate care
IPSurSupEmot
IPSurHelpEat
Meeting physical needs
IPSurInvDeci
IPSurCntPain
Overall experience
IPSurOverall
FFTNHSEscore
Inpatient Survey 2012 Q68 "Overall..." (I had a very poor/good experience)
NHS England inpatients score from Friends and Family Test
7.82
-
-
No evidence of risk
No evidence of risk
Treatment with dignity
and respect
IPSurRspDign
Inpatient Survey 2012 Q67 "Overall, did you feel you were treated with respect and dignity
while you were in the hospital?"
8.81
-
No evidence of risk
IPSurConfDoc
Inpatient Survey 2012 Q25 "Did you have confidence and trust in the doctors treating you?"
8.70
-
No evidence of risk
IPSurConfNur
Inpatient Survey 2012 Q28 "Did you have confidence and trust in the nurses treating you?"
8.69
-
No evidence of risk
Trusting relationships
Page 5 of 11
Section
Access measures
ID
Indicators
Observed
Expected
Risk?
A&E waiting times more than 4 hours
Referral to treatment times under 18 weeks: admitted pathway
Referral to treatment times under 18 weeks: non-admitted pathway
Diagnostics waiting times: patients waiting over 6 weeks for a diagnostic test
All cancers: 62 day wait for first treatment from urgent GP referral
All cancers: 62 day wait for first treatment from NHS cancer screening referral
All cancers: 31 day wait from diagnosis
The proportion of patients whose operation was cancelled
The number of patients not treated within 28 days of last minute cancellation due to nonclinical reason
Proportion of ambulance journeys where the ambulance vehicle remained at hospital for more
than 60 minutes
0.05
0.91
0.99
0
0.86
1
0.97
0
0.05
0.9
0.95
0.01
0.85
0.9
0.96
0.01
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
0.09
0.07
No evidence of risk
Not included
Not included
Not included
0.01
0.02
No evidence of risk
6 months of reporting
-
No evidence of risk
0.36
0.26
No evidence of risk
No evidence of risk
Green
-
No evidence of risk
Not included
Not included
Not included
Within Q2/IQR
-
No evidence of risk
0.65
0.64
No evidence of risk
NHSSTAFF04
NHSSTAFF06
NHS Staff Survey - Percentage of staff who would recommend the trust as a place to work or
receive treatment
NHS Staff Survey - KF7. % staff appraised in last 12 months
NHS Staff Survey - KF9. Support from immediate managers
0.84
0.67
0.82
0.65
No evidence of risk
No evidence of risk
NHSSTAFF07
NHS Staff Survey - KF10. % staff receiving health and safety training in last 12 months
0.78
0.74
No evidence of risk
NHSSTAFF11
NHS Staff Survey - KF15. Fairness and effectiveness of incident reporting procedures
0.65
0.63
No evidence of risk
NHSSTAFF16
NHS Staff Survey - KF21. % reporting good communication between senior management and
staff
0.28
0.27
No evidence of risk
AD_A&E12
RTT_01
RTT_02
DIAG6WK01
WT_CAN26
WT_CAN27
WT_CAN22
CND_OPS02
CND_OPS01
AMBTURN06
Discharge and Integration
Reporting culture
Partners
DTC40
Ratio of the total number of days delay in transfer from hospital to the total number of
occupied beds
NRLS14
Consistency of reporting to the National Reporting and Learning System (NRLS)
SUSDQ
FFTRESP02
Data quality of trust returns to the HSCIC
Inpatients response rate from NHS England Friends and Family Test
MONITOR01
Monitor - Governance risk rating
TDA01
TDA - Escalation score
NTS12
GMC National Training Survey – Trainee's overall satisfaction
STASURBG01
Staff survey
Page 6 of 11
Section
ID
Indicators
Staffing
ESRSIC
ESRReg
ESRTO
ESRSTAB
ESRSUP
ESRSTAFF
FLUVAC01
Composite risk rating of ESR items relating to staff sickness rates
Composite risk rating of ESR items relating to staff registration
Composite risk rating of ESR items relating to staff turnover
Composite risk rating of ESR items relating to staff stability
Composite risk rating of ESR items relating to staff support/ supervision
Composite risk rating of ESR items relating to ratio: Staff vs bed occupancy
Healthcare Worker Flu vaccination uptake
Qualitative intelligence
WHISTLEBLOW
GMCconcerns
Safeguarding
SYE
NHSchoices
P_OPINION
CQC_COM
PROV_COM
Whistleblowing alerts
Serious Education Concerns
Safeguarding concerns
Your Experience
NHS Choices
Patient Opinion
CQC complaints
Provider complaints
Page 7 of 11
Observed
Expected
Risk?
0.47
0.48
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
-
-
No evidence of risk
Risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Appendix of indicators used in the composite mortality indicators
Section
ID
Indicators
Risk?
Cardiological Conditions
and Procedures
HESMORT24CU
MORTAMI
MORTARRES
MORTCABGI
MORTCABGO
MORTCASUR
MORTCATH
MORTCHF
MORTDYSRH
MORTHVD
MORTPHD
In-hospital mortality: Cardiological conditions
Mortality outlier alert: Acute myocardial infarction
Mortality outlier alert: Cardiac arrest and ventricular fibrillation
Mortality outlier alert: CABG (isolated first time)
Mortality outlier alert: CABG (other)
Mortality outlier alert: Adult cardiac surgery
Mortality outlier alert: Coronary atherosclerosis and other heart disease
Mortality outlier alert: Congestive heart failure; nonhypertensive
Mortality outlier alert: Cardiac dysrhythmias
Mortality outlier alert: Heart valve disorders
Mortality outlier alert: Pulmonary heart disease
Elevated risk
No evidence of risk
No evidence of risk
Not included
Not included
Not included
No evidence of risk
Elevated Risk
No evidence of risk
No evidence of risk
No evidence of risk
Cerebrovascular
Conditions
HESMORT21CU
MORTACD
In-hospital mortality: Cerebrovascular conditions
Mortality outlier alert: Acute cerebrovascular disease
No evidence of risk
Elevated Risk
Dermatological
Conditions
HESMORT35CU
MORTSKINF
MORTSKULC
In-hospital mortality: Dermatological conditions
Mortality outlier alert: Skin and subcutaneous tissue infections
Mortality outlier alert: Chronic ulcer of skin
No evidence of risk
No evidence of risk
No evidence of risk
Endocrinological
Conditions
HESMORT29CU
MORTDIABWC
MORTDIABWOC
MORTFLUID
In-hospital mortality: Endocrinological conditions
Mortality outlier alert: Diabetes mellitus with complications
Mortality outlier alert: Diabetes mellitus without complications
Mortality outlier alert: Fluid and electrolyte disorders
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
Page 8 of 11
Section
ID
Indicators
Risk?
Gastroenterological and
Hepatological
Conditions and
Procedures
HESMORT27CU
MORTALCLIV
MORTBILIA
MORTGASHAE
MORTGASN
MORTINTOBS
MORTOGAS
MORTOLIV
MORTOPJEJ
MORTPERI
MORTTEPBI
MORTTEPLGI
MORTTEPUGI
MORTTOJI
In-hospital mortality: Gastroenterological and hepatological conditions
Mortality outlier alert: Liver disease, alcohol-related
Mortality outlier alert: Biliary tract disease
Mortality outlier alert: Gastrointestinal haemorrhage
Mortality outlier alert: Noninfectious gastroenteritis
Mortality outlier alert: Intestinal obstruction without hernia
Mortality outlier alert: Other gastrointestinal disorders
Mortality outlier alert: Other liver diseases
Mortality outlier alert: Operations on jejunum
Mortality outlier alert: Peritonitis and intestinal abscess
Mortality outlier alert: Therapeutic endoscopic procedures on biliary tract
Mortality outlier alert: Therapeutic endoscopic procedures on lower GI tract
Mortality outlier alert: Therapeutic endoscopic procedures on upper GI tract
Mortality outlier alert: Therapeutic operations on jejunum and ileum
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
Genito-Urinary
Conditions
HESMORT31CU
MORTUTI
In-hospital mortality: Genito-urinary conditions
Mortality outlier alert: Urinary tract infections
No evidence of risk
No evidence of risk
Haematological
Conditions
HESMORT28CU
MORTDEFI
In-hospital mortality: Haematological conditions
Mortality outlier alert: Deficiency and other anaemia
No evidence of risk
No evidence of risk
Infectious Diseases
HESMORT26CU
MORTSEPT
In-hospital mortality: Infectious diseases
Mortality outlier alert: Septicaemia (except in labour)
No evidence of risk
No evidence of risk
HESMORT33CU
In-hospital mortality: Conditions associated with Mental health
Not included
MORTSENI
Mortality outlier alert: Senility and organic mental disorders
Elevated Risk
HESMORT36CU
MORTPATH
In-hospital mortality: Musculoskeletal conditions
Mortality outlier alert: Pathological fracture
No evidence of risk
No evidence of risk
MORTSPON
Mortality outlier alert: Spondylosis, intervertebral disc disorders, other back problems
No evidence of risk
Conditions Associated
With Mental Health
Musculoskeletal
Conditions
Page 9 of 11
Section
ID
Indicators
Risk?
Nephrological
Conditions
HESMORT30CU
MORTRENA
MORTRENC
In-hospital mortality: Nephrological conditions
Mortality outlier alert: Acute and unspecified renal failure
Mortality outlier alert: Chronic renal failure
No evidence of risk
No evidence of risk
Elevated Risk
Neurological Conditions
HESMORT34CU
MORTEPIL
In-hospital mortality: Neurological conditions
Mortality outlier alert: Epilepsy, convulsions
Elevated risk
No evidence of risk
HESMORT32CU
In-hospital mortality: Paediatric and congenital disorders
No evidence of risk
MATPERIMOR
Maternity outlier alert: Perinatal mortality
No evidence of risk
HESMORT25CU
MORTASTHM
MORTBRONC
In-hospital mortality: Respiratory conditions
Mortality outlier alert: Asthma
Mortality outlier alert: Acute bronchitis
No evidence of risk
No evidence of risk
No evidence of risk
MORTCOPD
Mortality outlier alert: Chronic obstructive pulmonary disease and bronchiectasis
MORTPLEU
MORTPNEU
Mortality outlier alert: Pleurisy, pneumothorax, pulmonary collapse
Mortality outlier alert: Pneumonia
No evidence of risk
No evidence of risk
HESMORT37CU
MORTCRAN
MORTFNOF
MORTHFREP
MORTHIPREP
MORTINTINJ
MORTOFRA
MORTREDFB
MORTREDFBL
MORTREDFNOF
MORTSHUN
In-hospital mortality: Trauma and orthopaedic conditions
Mortality outlier alert: Craniotomy for trauma
Mortality outlier alert: Fracture of neck of femur (hip)
Mortality outlier alert: Head of femur replacement
Mortality outlier alert: Hip replacement
Mortality outlier alert: Intracranial injury
Mortality outlier alert: Other fractures
Mortality outlier alert: Reduction of fracture of bone
Mortality outlier alert: Reduction of fracture of bone (upper/lower limb)
Mortality outlier alert: Reduction of fracture of neck of femur
Mortality outlier alert: Shunting for hydrocephalus
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
Paediatric and
Congenital Disorders
and Perinatal Mortality
Respiratory Conditions
and Procedures
Trauma and
Orthopaedic Conditions
Page 10 of 11
Elevated Risk
Section
Vascular Conditions and
Procedures
ID
HESMORT23CU
MORTAMPUT
MORTANEUR
MORTCLIP
MORTOFB
MORTPVA
MORTREPAAA
MORTTOFA
Indicators
In-hospital mortality: Vascular conditions
Mortality outlier alert: Amputation of leg
Mortality outlier alert: Aortic, peripheral, and visceral artery aneurysms
Mortality outlier alert: Clip and coil aneurysms
Mortality outlier alert: Other femoral bypass
Mortality outlier alert: Peripheral and visceral atherosclerosis
Mortality outlier alert: Repair of abdominal aortic aneurysm (AAA)
Mortality outlier alert: Transluminal operations on the femoral artery
Page 11 of 11
Risk?
Risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
No evidence of risk
Care Quality Commission
Finsbury Tower
103 – 105 Bunhill Row
London
Basil Fozard, Medical Director
The Royal Bournemouth and Christchurch Hospitals
NHS Foundation Trust
Post Point B31
Castle Lane East
Bournemouth
BH7 7DW
EC1Y 8TG
www.cqc.org.uk
25 October 2013
Our reference: A733/TG; A713/LF; A723/TG; A745/TG
Dear Mr Fozard
Re: Care Quality Commission mortality outlier alerts at The Royal Bournemouth and
Christchurch Hospitals NHS Foundation Trust
We are writing in relation to the following mortality outlier alerts at your trust:
• Senility and organic mental disorders (our ref: A733/TG)
• Acute cerebrovascular disease (our ref: A713/LF)
• Congestive heart failure; nonhypertensive (our ref: A723/TG)
• Chronic obstructive pulmonary disease and bronchiectasis (our ref: A745/TG)
As you are aware, analysis performed by the Care Quality Commission has indicated
significantly high mortality rates for each of these primary diagnosis groups. We wanted to
be certain that the high mortality rates in these areas had been recognised, explanations
explored and appropriate actions taken by the trust in a timely manner to ensure the future
safety of patients.
Senility and organic mental disorders (our ref: A733/TG)
Thank you for your letter, dated 27 September 2013, regarding the above alert.
We have reviewed the information you have provided. We note that the Dementia Delivery
Group has developed a number of actions relating to the Royal College of Nursing Dementia
Principles (SPACE) and that you also put an action plan in place in 2012/13 in order to meet
all of the Royal College of Physicians National Dementia Audit targets.
Registered office: Finsbury Tower, 103-105 Bunhill Row, London EC1Y 8TG
As a result, we do not feel that we need to undertake additional enquiries at this time.
However the team carrying out the inspection at your trust, commencing on 23 October
2013, will follow up on your progress with implementing both the on-going actions from the
meetings of the Dementia Delivery Group and the Dementia Strategy Committee: Action
Plan 2012/13. Should you become aware of any further issues relating to this alert, we would
ask you to let us know.
Acute cerebrovascular disease (our ref: A713/LF)
Congestive heart failure; nonhypertensive (our ref: A723/TG)
Chronic obstructive pulmonary disease and bronchiectasis (our ref: A745/TG)
Thank you for your letters, dated 24 September 2013 and 27 September 2013, regarding the
above mortality alerts.
We have reviewed the outputs you provided from your Dr Foster Intelligence Quality
Investigator system, which confirm that these outlier alerts are the result of an anomaly due
to the way your data has been coded. As a result, we do not feel that we need to undertake
additional enquiries at this time. However, should you become aware of any further issues
relating to these alerts, we would ask you to let us know.
This letter will be shared with your Care Quality Commission regional contacts, NHS
England, Monitor, your local Clinical Commissioning Group and Area Team for their
information.
If you would like to discuss the content of this letter in more detail, please do not hesitate to
contact me.
Yours sincerely
Mr Chris Sherlaw-Johnson
Surveillance Manager
020 7448 4547
[email protected]
2
BOARD OF DIRECTORS
Meeting Date and Part:
8 November 2013 Part 1
Subject:
Feedback from the CQC Inspection
Section:
Quality
Executive with Overall
Responsibility
Tony Spotswood, Chief Executive
Author of Paper:
Tony Spotswood, Chief Executive
Details of previous
discussion and/or
dissemination:
N/A
Patient Safety
Health & Safety
Performance Strategy
Key Purpose:
X
X
Action required by BoD:
To note feedback from the Inspection
Executive Summary:
This report includes details of our presentation
Strategic Goals &
Objectives:
All
Links to CQC
Registration: (Outcome
reference)
Links to Assurance
Framework/Key Risks:
All
Internal
External
Type of Assurance:
X
Board of Directors Part 1
8 November 2013
Feedback from the CQC Inspection
The Board meeting will provide an opportunity to offer some feedback to the Board
following the CQC Inspection scheduled for the 24/25 October (with a subsequent
unannounced inspection pending). As a pre-cursor to this I have attached a copy of
the presentation made to the Inspection Team on Wednesday 23 October.
Some Board members will also have had sight of the material gathered prior to the
visit by the CQC to help brief the Inspection Team. We have worked closely with
the Inspection Co-ordinators to agree factual changes to the pack. Once these are
agreed I will ensure a copy of this is circulated to the full Board for its consideration.
I would like to take this opportunity of thanking everyone for their work in preparation
of the visit, in particular, I wanted to draw the Board’s attention to the outstanding
contribution that Paula Shobbrook has made in leading this work.
Tony Spotswood
Chief Executive
Feedback from CQC Inspection
Quality
Page 1 of 1
The Royal Bournemouth and Christchurch
Hospitals NHS Foundation Trust
CQC Announced Inspection
24 and 25 October 2013
Content
• Context
• Our strengths
• Our challenges and how we are
addressing them
Quality Strategy
Patient Population
Patient Profile
Age
years of age or older, none of
which were over 100. This is
typical for the UK.
•75% of patients had significant
risk factors, the most prevalent
of which were co-occurring
conditions and multiple drug
therapy. 9% of patients lived
Number of Patients
•Age: 70% of patients were 70
140
120
100
80
60
40
20
0
alone.
130
75
60
2
0-10
7
11-20
19
5
3
21-30
13
4
2
31-40
18
12
8
24
22
7
41-50
51-60
43
29
23
34
61-70
71-80
89
67
Bournemouth Hospital
58
27
18
Poole Hospital
Dorset County Hospital
81-90 91-100
•Early identification of risk
factors and the use of this
information for discharge
•There are no significant
differences among the facilities
regarding age distributions or
patient complexity
•Other complexities include:
substance misuse, decreased
ADLs, depression, alcohol detox,
learning disabilities, and blind.
Patient Complexity
Number of Patients
planning purposes can reduce
length of stay.
250
200
150
52
100
66
50
80
0
26
59
90
21
42
47
19
37
36
19
26
42
Dorset County Hospital
10
23
24
5
6
12
12
19
28
Poole Hospital
Bournemouth Hospital
Activity
The continued rise in non-elective admissions since 2008
3500
3000
2500
2000
1500
1000
500
0
Emergency
Non-elective
Hospital Activity
Inpatient and Day Case
Elective Inpatients
20,310
Elective Day Cases
53,810
Non-elective
36,537
Outpatients
First attendance
131,807
Follow-up attendance
259,232
Accident and Emergency Attendances
67,435
Diagnostic Radiology Activity
67,155
Inpatient Day Care Service provision
General & Acute Surgery
General Medicine
Rheumatology
Elderly Care
Dermatology
Medical Sub-specialties
Anaesthetics
Gastroenterology
Respiratory
Critical Care
Stroke
Accident & Emergency
Maternity
Diabetes & Endocrinology
Haematology
Gynaecology
Acute Medicine
Oncology
Cardiology
(
)
We do not provide Paediatrics, Trauma, Obstetrics, ENT and Oral MaxilloFacial Surgery
Staff Survey
NHS South West 2012 Staff Survey Key Findings
R
G
A
G
G
-
A
+
G
+
G
+
+
A
-
-
G
G
+
G
A
R
+
+
A
A
G
-
G
+
-
A
A
A
A
A
+
+
A
-
+
1
58%
A
+
+
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
56%
A
-
G
Great Western Hospitals NHS Foundation Trust
63%
-
A
+
+
Oxford University Hospitals NHS Trust
46%
-
G
-
A
Salisbury NHS Foundation Trust
53%
+
-
+
+
R
University Hospitals Bristol NHS Foundation Trust
55%
A
G
-
G
A
Yeovil District Hospital NHS Foundation Trust
52%
+
G
+
G
-
University Hospital Southampton NHS Foundation Trust
57%
R
A
R
+
South Devon Healthcare NHS Foundation Trust
56%
+
A
+
A
Royal Berkshire NHS Foundation Trust
49%
G
+
G
A
+
-
-
+
+
R
G
+
+
-
Royal Devon and Exeter NHS Foundation Trust
49%
R
R
+
A
A
A
-
R
A
A
G
+
R
+
Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
60%
-
-
-
-
+
-
A
-
-
A
-
+
+
+
Taunton and Somerset NHS Foundation Trust
52%
-
A
A
G
-
G
G
A
G
R
+
A
R
-
Portsmouth Hospitals NHS Foundation Trust
56%
R
-
R
A
G
-
+
A
A
G
A
+
-
+
Weston Area Health NHS Trust
53%
R
-
R
+
A
+
G
+
A
+
A
+
-
A
Hampshire Hospitals NHS Foundation Trust
45%
-
G
-
+
R
A
-
-
R
A
+
+
-
Royal United Hospital Bath NHS Trust
56%
-
+
R
A
R
A
A
A
A
-
A
R
-
Dorset County Hospital NHS Foundation Trust
54%
R
R
-
A
R
+
R
-
G
-
-
Plymouth Hospitals NHS Trust
46%
A
-
R
R
G
R
G
R
R
+
-
-
R
+
Poole Hospital NHS Foundation Trust
51%
R
-
R
A
A
+
R
R
A
R
-
A
R
-
North Bristol NHS Trust
54%
R
-
R
R
-
-
G
A
R
A
R
-
R
+
-
-
+
+
Gloucestershire Hospitals NHS Foundation Trust
59%
R
R
-
-
A
R
G
-
-
+
A
R
R
A
-
A
A
A
-
R
R
R
R
R
R
Royal Cornwall Hospitals NHS Trust
48%
R
A
R
-
+
-
A
R
R
G
R
A
R
-
R
R
-
R
R
R
R
R
R
R
R
G
-
A
A
-
A
-
+
+
A
A
2
3
4
5
6
G
+
A
+
+
G
A
R
+
G
+
+
A
A
G
+
+
+
-
A
G
+
A
+
A
A
G
G
G
G
+
+
R
A
R
-
+
G
-
R
-
G
+
G
-
-
A
G
+
G
A
-
R
+
-
+
A
+
A
R
+
-
R
+
+
A
A
A
+
+
R
R
G
-
G
G
A
-
G
G
A
+
+
A
R
A
+
+
G
G
A
R
-
A
+
+
A
A
+
R
R
-
A
-
-
G
G
G
-
A
-
A
+
+
+
A
A
R
R
R
A
-
G
-
-
+
A
R
-
R
A
-
A
A
+
-
R
-
R
A
+
-
A
R
R
-
A
-
A
R
R
-
A
A
-
R
-
-
G
-
G
-
R
R
R
R
-
-
R
R
-
R
-
G
A
-
A
-
R
R
+
7
8
9
-
10
+
-
11
12
+
G
15
22
23
24
25
-
+
G
A
A
A
A
G
A
G
A
G
G
106
R
A
A
G
G
G
G
105
G
G
A
+
G
A
+
98
Best 20%
+
G
G
G
+
G
+
+
96
A
G
+
+
G
-
+
-
95
G
A
+
G
G
R
-
-
95
Worse Than Average
-
2
+
+
G
+
A
-
+
G
A
94
Worst 20%
R
1
A
A
-
A
G
-
+
A
-
89
+
+
+
G
G
R
R
R
87
R
A
-
A
R
A
+
G
81
A
-
-
-
+
A
+
81
between 75 & 99
G
A
+
+
A
R
A
A
81
74 & below
-
-
-
-
R
+
A
+
79
-
G
-
R
R
A
A
+
78
-
-
+
+
+
R
A
74
+
A
-
-
A
-
-
65
R
R
G
R
R
+
R
+
64
A
-
R
G
G
63
R
A
+
62
G
A
A
61
R
+
52
+
A
-
-
-
R
-
26
+
27
% experiencing discrimination at work in last 12 months
21
Response
Rate
Acute Trusts
Northern Devon Healthcare NHS Trust
% believing Trust provides equal opportunities for career
progression or promotion
20
% having equality and diversity training in last 12 months
19
Additional Theme Equality and Diversity
Staff motivation at work
18
Staff job satisfaction
% reporting good communication between senior
management and staff
17
Staff recommendation of the Trust as a place to work or
receive treatment
% feeling pressure in last 3 months to attend work when
feeling unwell
16
% able to contribute towards improvements at work
% experiencing harassment, bullying or abuse from staff in
last 12 months
Staff Pledge 4 Additional Theme - Staff
Staff
Satisfaction
Engagement
% experiencing harassment, bullying or abuse from
patients/relatives in last 12 months
% experiencing physical violence from staff in last 12 months
14
% experiencing physical violence from patients/relatives in
last 12 months
13
Fairness and effectiveness of incident reporting procedures
% reporting errors, near misses or incidents witnessed in
last month
% saying hand-washing materials are always available
% witnessing potentially harmful errors, near misses or
incidents in last month
% suffering work-related stress in last 12 months
% receiving health and safety training in last 12 months
Support from immediate managers
% having well structured appraisals in last 12 months
% appraised in last 12 months
% working extra hours
% receiving job-relevant training, learning or development in
last 12 months
Effective Team working
Work pressure felt by staff
% agreeing that their role makes a difference to patients
% feeling satisfied with the quality of work and patient care
they are able to deliver
Staff Pledge 2 - to provide all staff
with personal development,
Staff Pledge 1 - to provide all staff with
Staff Pledge 3 - to provide support and opportunities for staff to maintain their health, wellclear roles, responsibilities and rewarding access to appropriate training for
being and safety
jobs
their jobs, and line management
support to succeed
G
+
28
G
+
Total Score
107
64
Mental Health Trusts
Oxford Health NHS Foundation Trust
51%
G
R
-
A
A
-
G
+
G
G
+
+
-
Avon and Wiltshire Mental Health Partnership NHS Trust
56%
-
-
-
+
A
+
A
-
A
+
R
A
-
-
-
R
-
R
R
R
R
-
A
R
-
A
-
-
61
2Gether NHS Foundation Trust
50%
R
-
R
+
R
A
+
R
A
R
+
A
R
A
+
-
-
A
-
-
-
A
R
R
-
R
+
R
R
A
-
58
91
KEY:
score
G
5
Better Than Average
+
4
Average
A
Total Score Key:
3
100 & above
Maximum Score Possible = 140
ED – Pre-April 2013
Treated &
discharged
GP admissions
Spec 180
admission
CDU Spec 180 admission
Ambulance 999s
Transfer to
medical specialty
ED – Post April 2013
AMU
GP admissions
Spec 300
admission
Cardiac Patients
(STEMI)
Treated &
discharged
Transfer to medical
specialty
Catheter Lab
Treated &
discharged
Ambulance 999s
Majors ED
attendance
Specialty 300
admission
Specialty 180 (ED
obs) admission
Non – elective data, leading
to specialty split
Access to Community Hospital Beds
Royal Bournemouth
Hospital Patients
*13 St Leonards Hospital
3 Alderney Hospital
Poole Hospital Patients
9 St Leonards Hospital
Dorset County Hospital
Patients
34 Weymouth Hospital
15 Swanage Hospital
39 Bridport Hospital
16 Wareham Hospital
19 Shaftesbury Hospital
48 Alderney Hospital
22 Wimborne Hospital
16
110
92
* 12 Extra over Winter plus 13 Nursing Home Beds + 6/7 Broadwater Interim Care
Beds
Some of our Strengths
• Culture – open, transparent, caring, responsive
• Outstanding Services
Cardiology
Older Persons Assessment/Liaison
Radiology/Interventional Radiology
Orthopaedic Surgery
Diabetes
Ophthalmology
Gastroenterology
Complex Surgery (Colorectal/Upper GI/Urology)
Haematology
Critical Care
• Pride and passion to provide the best care for our
patients
• Capability and focus to improve care
Our Challenges
• Improving the patient journey (flow), strengthening the
emergency care pathway and facilitating discharge
• Reducing avoidable mortality
• More community provision and enhanced choice for endof-life care
• Reducing variability amongst our wards
• Recruitment
• Enhanced 7 day working
• Impact of the merger: Next Steps
Improving the patient journey (flow), Strengthening the
Emergency care pathway and facilitating discharge
King’s Fund Review 2013
• No pull of patients from Community Services or Local Authority
• Insufficient packages of care, delays in complex care packages
• Limited admission avoidance
• Need for further integration
• Stronger discharge planning within the Trust
Medical patients outlying
Additional patient moves
Escalation beds
Privacy and dignity
Less efficient, internal pressures
What are we doing to address the issues?
•
•
•
•
•
Expanding capacity
Future inward and community based investments
King’s Fund Review – Phase 2
Urgent Care Board – Winter Planning
Trust working with Emergency Care Integrated Support
Team
What are we doing to address the issues?
•
•
•
•
•
Expanding capacity
Future inward and community based investments
King’s Fund Review – Phase 2
Urgent Care Board – Winter Planning
Trust working with Emergency Care Integrated Support
Team
Quality Investments 2013/14
•
•
•
•
•
•
•
Treatment & Investigation Unit
Medicine Wards
Additional ward staffing –
Stroke Unit
CCU
Surgical Admissions Unit
Ward 3
Extension of winter pressure funding
OPAL outreach supported discharge
ED 24/7 doctor cover & 6th ED consultant
ED prospective cover for above (additional 4 posts)
Two additional SPR’s out of hours
£k
650
591
199
208
110
299
300
274
283
300
200
Continues….
Quality Investments 2013/14
• Cardiology staffing
• Medical emergency team
• Additional Consultants
£k
144
250
– General Surgery x 2
– Gastroenterology
– Elderly Care
450
_______
• Total Quality Investments
4,258
Funded Quality Investments 2013/14
£k
•
•
•
•
•
•
•
•
•
•
•
GP led community based interim beds
2 ACM consultants, evening AMU ward rounds & MFE cover (PYE)
GP’s in majors and weekends and support for self funders
OPAL/ESD team 7 day virtual MDT and additional hours
Alcohol liaison service
Outsourcing elective activity
Funding to keep beds open during early summer
Virtual wards support from primary care
7 day support for Radiology
Backdoor model to support earlier discharge
Other smaller schemes
• Total
1,005
223
234
305
34
55
356
101
85
372
231
3,001
What are we doing to address the issues?
• Expanding capacity
• Future inward and community based
investments
• King’s Fund Review – Phase 2
• Urgent Care Board – Winter Planning
• Trust working with Emergency Care Integrated
Support Team
Reducing Avoidable Mortality
Hospital Standardised Mortality Ratio (HSMR)
2012/13, Dr Foster (PwC/HED)
Royal Bournemouth & Christchurch
Hospitals
RBH
97.59
166.52
Elective
83.98 (93)
105.37 (116)
XCH
164.20
96.53
XCH (All)
104.60 (115)
Non Elective
RBH (All)
Non – elective data, leading
to specialty split
Mortality Improvement through Clinical
Engagement (MICE)
Mortality Improvement through Clinical Engagement
Executive Leads – Paula Shobbrook, Director of Nursing; Basil Fozard, Medical Director
Project Support – Sandy Edington
Mortality Working
Group
Deteriorating
Patient
Specialist Clinical
Review – Sepsis / Fluid
management
Appropriate End of
Life Care
7 Day Working
Supported Discharge
Community Services.
Mortality Working
Group
Mortality Working Group
• Statistical interpretation, analysis and clinical
care review
• Monitor trends for overall and disease
specific groups, in house data monitoring
and Dr Foster tool (proactive approach)
• CQC and Dr Foster alerts and responses
• Formulate action plan following case notes
review.
• Advise Trust Management Board and the
Board of Directors
• Review results of e-Mortality, learning and
changes in practice
PWC / CQC / Dr Foster Alerts
PWC / HED Alerts
Diagnostic Group
Not Reviewed
Senility and organic mental disorders
Under Review*
Congestive Heart Failure
Under Review*
Secondary Malignancies
Under Review*
Cancer of the bronchus
Under Review*
Peripheral and visceral atherosclerosis
Under Review*
Other and ill-defined cerebro-vascular disease
Under Review*
COPD and bronchiectasis
Under Review*
Internal obstruction without hernia
Under Review*
Other nervous system disorders
Under Review*
Diverticulosis and diverticulitis
Under Review*
* Not replicated in Dr Foster data
RBCH – Other Reviews
Mortality Working
Group
eMortality Reviews
• All specialities have identified an Morbidity & Mortality (M&M)
lead
• All specialities set up with eMortality workflows
– Consultants set with up ImageNow Icon and eMortality system
– Training provided
– Consultants linked to M&M chair/workflow
• System currently in use in all specialities
• August deaths now validated and distributed
• Leading Improvement in Patient Safety (LIPS) Team to follow up
with all consultants and M&M chairs to support implementation
• System reports in development with Information Team
Deteriorating
Patient
Deteriorating Patient
• MEWS to NEWS to eNEWS (VitalPac )
• VitalPac – nurse implementation NOW,
escalation system in the New Year
• Medical Emergency Team (MET), including ICU
consultants + 2 outreach nurses
• Other opportunities for using VitalPac
information
• Simulation training
©
©
©
Specialist Death Review
– Sepsis / Fluid
management
Acute Medical Unit (AMU) audit of
antibiotic prescribing
Average time from 'time to be given' to 'time administered’ for Abx (where noted)
140
120
100
80
60
40
20
0
w/c 8th Jul
w/c 15th Jul
w/c 22nd Jul
w/c 12th Aug
w/c 19th Aug
Specialist Death Review
– Sepsis / Fluid
management
Septicaemia (except in labour)
2009 onwards
Greater choice for patients at
the end of their life
Appropriate End of
Life Care
Appropriate End of Life Care
• Actions completed
– Moved from Liverpool Care Pathway to Personalised Care
Plan for End of Life
– Introduced Rapid Discharge Home to Die Service
– Piloted AMBER care bundle
– Introducing “End of Life Care for All” – an elearning
package on Mac Unit in November
– Specialist Palliative Care using Poole EPR to record
community and hospital assessments – available to anyone
with EPR access
Appropriate End of
Life Care
Fast Track CHC Process
Reducing variability of Wards
Two wards we regard as areas for focus:
Ward 3
Ward 26
•
•
•
•
More Serious Incidents
Historically nursing staff vacancies higher
Leadership needs strengthening
Patient feedback has been critical
How are we addressing
variability on Wards?
Ward staffing
• In-patient wards reviewed by the Director of
Nursing
• Benchmarking used: RCN safe staffing guidance
2012/ Hurst Nurse Per Occupied Bed Day (NPOB)
• Quality Data sets utilised
• 6 monthly reviews
• Annual report reviews produced internally for
each ward
E-roster
•
•
•
•
E-roster implementation completed
Developed KPI’s/Policy/EWTD compliance
Integral ward staffing reviews
Developing analytical historical reports
– Staffing resource utilised
– KPI’s
• Developing forecast reports
– Daily staffing, weekend and holiday cover
Post Ward staffing review WD3
Current Budget and Ward Establishment
Template Budget Requirement
Ward
(No of
beds)
RN Early
Nurse/beds
RN Late
Nurse/Beds
RN Nights
Nurse/Beds
Ward
3 (28)
1:5.6
1:7
1:14
Skill Mix
Reg/Unreg
(Early)
60/40
63/37
NPOB
Vs. Hurst
Average
(1:1.21)
1:1.25
Budget
align
Yes
7.5 wte Vacancies recruited to commence by Dec 13. Recruitment
continues to fill remaining 0.9WTE band5 and 1.0WTE band2
ER KPIs from ward staffing review wd3
Ward 3 use of bank and agency to fill shifts
– 65%bank, 22%Agency
Following uplift 7.5 wte Vacancies
recruited to commence by Dec 13.
Recruitment continues to fill remaining
0.9WTE band5 and 1.0wte band2
Resource KPIs: ward staffing review wd3
Bank/Agency Hours by Reason Given
1200.0
Vacancy
1000.0
Special
800.0
Annual Leave
Hours 600.0
Sickness Short Term
400.0
Workload
200.0
Sickness Long Term
0.0
Secondment
Compassionate Leave
Annual Staff Expenditure Qualified / Unqualified
£600,000
£560,461
£503,776
£375,819
£400,000
£244,058
£200,000
Budget
Actual
£0
Qualified
Unqualified
Quality KPIs: ward staffing review wd3
NHS Safety Thermometer ward level dashboard
Select indicator:
Select ward:
NHS Safety Thermometer ward level dashboard
Select indicator:
Select ward:
Ward staffing – quality dashboard WD3
Ward
METRIC
Update
RB03
Avg Per
Month
(2012/2013)
2013/
2014
Plan
13/14 YTD
Total
Avg Per
Month
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
(2013/2014)
PATIENT SAFETY
Patient Safety Incidents
19
124
21
26
11
16
22
19
30
8
90
55
9
14
4
9
6
7
15
Falls (Harm) per 1000 Bed
Days
10.7
116
65
11
16.41
4.55
10.43
6.92
8.68
17.86
Patient Falls (Moderate &
Severe AIRS)
0.1
1
1
0
0
0
1
0
0
0
Medication Administration
AIRs
0.8
9
11
2
2
2
0
3
0
4
Medication Prescription
AIRs
0.3
4
2
0
0
0
0
0
1
1
Omitted Medication AIRs
0.3
3
4
1
2
0
0
1
0
1
Medication AIRs (harm
events) - Moderate &
Severe
0.0
0
0
0
0
0
1
0
0
0
0
1
0
0
Number of Hospital
Acquired Pressure Ulcers
Category 1 & 2
1.9
18
12
2
0
2
2
1
4
3
Number of Hospital
Acquired Category 3 or 4
Pressure Ulcers
0.1
1
1
0
0
0
0
1
0
Staff Accidents (ALL)
0.4
4
2
0
0
0
0
0
2
0
Staff Accidents (SHARPS)
0.2
2
1
0
0
0
0
0
1
0
Infection Control Incidents
(ALL)
0.7
6
1
0
0
0
0
0
1
0
Hospital Acquired
Infections
0.3
2
0
0
0
0
0
0
0
Number of Safeguarding
Events
0.0
1
0
0
1
0
0
Patient ALL Falls
Number of Serious
Untoward Incidents
Reported
0
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
ER KPIs from ward staffing review wd26
Ward 26 use of bank and agency to fill shifts – Bank 71% Agency 16%
Current vacancies x5 band 5s and x2 band 2s. 2 RNS now recruited starting Nov/Jan
Interviews set for remaining vacancies
Quality KPIs: ward staffing review wd26
NHS Safety Thermometer ward level dashboard
Select indicator:
Select ward:
NHS Safety Thermometer ward level dashboard
Select indicator:
Select ward:
Actions in place
• New band 7 ward sisters have been appointed
– ‘mentors’ from high performing peers
– sharing good practice
• Staff recruitment has improved
– Ward 3 vacancy band 5 – 0.9 WTE /band 2 - 1 WTE
– Ward 26 vacancy band 5 – 3.0 WTE /band 2 - 2 WTE
• Monthly review and support of quality KPIs
Compassion In Practice
• ‘The Board including the Director of
Nursing has a real time view of staffing;
sickness/training staffing by band
permanent/agency staffing in order to
proactively identify staffing “hot spots” for
immediate action’
Recruitment
• Absence of Paediatrics and Trauma means the
Trust is not allocated SPRs for ED
• Reliance on Non-Training grade Doctors and
Consultants
• Further 4 Non-Training grade Doctors and 1 ED
Consultant
• Nursing vacancies
How are we addressing recruitment needs?
• Targeted approach to recruiting overseas
– Southern Europe
– India/Pakistan
– Eastern Europe
• Recent recruitment 56 trained nurses – now
in post. Further tranche 35 scheduled for 30
October
• Enhanced roles
How are we addressing 7 day working?
• New Medicine and Elderly Care working
arrangements at the week-end (October 2013)
• Extended Acute Medical input
• Strengthened junior medical input
• Radiologist and Therapy week-end working
• More senior nurse week-end input
• Greater senior management presence
7 Day Working
Mortality by Day of Admission RBH / Trust, 2011/12
140
120
100
80
RBH
All
60
40
20
0
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
7 Day Working
Mortality by Day of Admission RBH / Trust, 2012/13
140
120
100
80
RBH
All
60
40
20
0
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Impact of the proposed merger
• Merger work has focused on clinical
integration of services
• Held some posts – pending merger to
allow for integration
• Created some disengagement due to the
much longer than anticipated review by
the Competition Commission and OFT
How are we addressing it’s impact?
• New Strategy for the Trust
• Investment in clinical leadership and
capacity
– King’s Fund Development Programmes
• Strengthening engagement
– Action Plan PwC Quality Review
BOARD OF DIRECTORS
Meeting Date and Part:
8th November 2013 Part 1
Subject:
Performance Report
Section:
Performance
Executive Director with
overall responsibility
Richard Renaut, Acting Chief Operating Officer
Author of Paper:
David Mills/Donna Parker
Details of previous discussion
Performance Management Group
and/or dissemination:
Key Purpose:
Action required by BoD:
Patient
Safety
Health &
Safety
Performance
Strategy
X
Information
Executive Summary:
This report accompanies the Performance Indicator Matrix and outlines the Trust’s performance
exceptions against key access and performance targets for the month of September 2013, as set out
in the Monitor Compliance Framework, ‘Everyone Counts’ planning guidance and contractual
requirements. The report now also incorporates the Trust’s new Balanced Dashboard for Quality,
Performance, Productivity and Efficiency, including the overarching Trust-wide dashboard. Further
work continues on the dashboard and ‘drill down’ elements to refine the reporting.
Strategic Goals & Objectives:
Performance
Links to CQC Registration:
(Outcome reference)
Section 2 – Outcome 4: Care and welfare of people who
use services.
Outcome - 6 Co-operating with others.
Links to Assurance
Framework/Key Risks:
Performance
Internal
Type of Assurance:
X
External
Board of Directors
8th November 2013
Performance Exception Report
2013/14 - November
1 Purpose of the Report
This report accompanies the Performance Indicator Matrix and outlines the Trust’s
performance exceptions against key access and performance targets for the month
of September 2013, as set out in Everyone counts: Planning for Patients 2013/14,
the Monitor Compliance Framework and in our contracts.
2 Cancer
62 Day Wait for First Treatment from Urgent GP Referral for Suspected Cancer
The Trust achieved 75.8% in August, against the trajectory of 85%. This is
predominantly as a result of the previously reported pressures in Urology. The
impact has been driven in particular, by a combination of the continued increase in
fast track referrals, unplanned medical staff absence, patient choice to defer
treatments and investigation and the wider impact of urgent care pressures. Having
reached maximum service capacity, these additional pressures have led to an
increased number of breaches. The impact of this is expected to continue through
Q2 with the result being a below threshold performance for the Quarter.
Implementation of our action plan continues which includes: appointment of a 6th
consultant, substantive establishment of additional haematuria clinic sessions, a
further review of the clinical/administrative pathways, increased TRUS capacity and
joint work with the CCG on GP referrals and use of robotic surgery. In addition, the
MDT has been involved in managing clinical need and priority.
3 Stroke Indicators
Performance against Stroke Best Practice Tariff and Network indicators
Total Patients (September) Number of Patients Failing Target (September) September 2013 TIA High Risk Patients (60%) TIA Low Risk Patients (100%) 33 26 18 1 65% 96% Alteplase (Thrombolysis) (100%) 6 0 100% Stroke (Target) Performance Monitoring
For Information
Page 1 of 4
Board of Directors
8th November 2013
90% Time Spent on Stroke Ward (80%) 53 9 83% Direct Admission to Stroke Unit within 4 hours (90%) 42 11 74% Brain Imaging – urgent within 1 hour (95%) 12 4 67% Brain Imaging – other within 24 hours (100%) 51 5 90% 83% of patients spent 90% of their time on the Stroke Unit; this is an improvement
on previous months and is above the 80% target threshold.
74% of patients were directly admitted to the Stroke Unit within 4 hours, an
improvement on 61% in August. The achievement of this indicator depends on the
speed of initially identifying a stroke, and how quickly the Stroke Unit are informed
about a potential admission. Bed availability on the Stroke Unit is improving and it
is expected that the appointment of a Trust Grade doctor will assist with early
identification and assessment. The ward also received 8 admissions within a short
period during one day and such peaks can lead to delays.
67% of patients received imaging within 1 hour. All four delays were out of hours,
with three of these being at or around 1 hour and 30 minutes. Delays are
experienced with bringing the radiographer to site and starting up the equipment,
however, the extended and seven day working being implemented in radiology from
January is expected to assist improvement with the scanning targets.
There were a number of failures to achieve brain imaging within 24 hours. These
were largely due to these being complex diagnoses.
“Front of House” care and identification of stroke, requesting imaging and coordinating admissions to the Stroke Unit is the focus of the Stroke Team’s action
plan. The Team is developing a consolidated pathway and the recruitment of a
Trust Grade doctor to cover the Stroke Unit and MFE in hours is being progressed.
Risks going forward are the replacement of Professor Kwan, which in the first
instance will be via a locum.
4 Venous Thromboembolism
Risk assessment for hospital-related venous thromboembolism (95%)
Performance Monitoring
For Information
Page 2 of 4
Board of Directors
8th November 2013
94.1% of patients received a VTE assessment in September against our CQUIN
threshold of 95%. The action plan is continuing in order to improve against this
challenging target.
5 Attendance
Sickness absence rate (4% current; 3% stretch)
The Trust achieved an absence rate of 3.48% in September, compared to 3.50% in
August. The Trust cumulative absence rate is 3.71%, which continues to be below
the current target of 4% although above the stretch target of 3%.
6 Appraisals
90% of appraisals completed within one year
The Trust achieved 80.97% compliance with the annual appraisal target in
September, compared to 82.34% in August. The launch of the revised policy and
forms has commenced and a report on appraisals that are due over the winter
months has been provided to directorates to assist with management.
7 Admitted RTT – Speciality Level
90% of patients on an admitted pathway treated within 18 weeks
The overall performance was achieved, however admitted RTT performance
continued to be below threshold in General Surgery and Urology in line with the
planned trajectory outlined to our commissioners. The ability to achieve threshold in
Orthopaedics in September was also compromised by patient availability and more
restricted list availability for certain procedures.
It is expected that Urology and Orthopaedics will return to trajectory in October
though the impact of elective cancellations due to urgent care pressures will continue
to be a risk to manage. Increased activity to reduce outpatients and diagnostic waits
will also help patients on admitted pathways. Ophthalmology will also remain a
specialty at risk, due to high levels of referrals and medical vacancies. Recruitment
and extra activity is underway.
Performance Monitoring
For Information
Page 3 of 4
Board of Directors
8th November 2013
8 Recommendation
The Board is requested to note the performance exceptions
to the Trust’s compliance with the 2013/14 Monitor and
‘Everyone Counts’ planning guidance requirements.
DONNA PARKER
DEPUTY CHIEF OPERATING OFFICER
Performance Monitoring
For Information
Page 4 of 4
2013/14 PERFORMANCE INDICATOR MATRIX FOR BOARD OF DIRECTORS
Area
Indicator
Measure
Target Monitor
Jan-13 Feb-13 Mar-13
RAG Thresholds
Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13
Monitor Governance Targets & Indicators
Infection
Control
MRSA Bacteraemias
Number of hospital acquired MRSA cases - Monitor de-minimis
6
1.0
0
0
0
0
0
1
0
> trajectory
<= trajectory
Clostridium difficile
Number of hospital acquired C. Difficile cases
29
1.0
13
2
1
2
0
1
2
> trajectory
<= trajectory
RTT Admitted
18 weeks from GP referral to 1st treatment – specialty level
90%
1.0
91.5%
90.5%
91.5%
91.7%
90.9%
91.1%
90.5%
<90%
>=90%
18 weeks from GP referral to 1st treatment – specialty level
95%
1.0
98.6%
98.6%
98.8%
98.5%
98.8%
98.6%
98.0%
<95%
>=95%
18 weeks from GP referral to 1st treatment – specialty level
92%
1.0
95.3%
96.3%
96.1%
96.7%
96.8%
97.0%
96.7%
<92%
>=92%
Referral to
RTT Non Admitted
Treatment
RTT Incomplete pathway
Cancer
A&E
LD
2 week wait
From referral to to date first seen - all urgent referrals
93%
2 week wait
From referral to to date first seen - for symptomatic breast patients
93%
31 day wait
From diagnosis to first treatment
96%
31 day wait
For second or subsequent treatment - Surgery
94%
0.5
0.5
1.0
91.4%
94.5%
93.1%
93.9%
95.3%
95.0%
<93%
>=93%
93.1%
100.0%
92.0%
97.6%
94.7%
100.0%
<93%
>=93%
97.1%
97.1%
97.0%
97.1%
97.2%
97.4%
<96%
>=96%
100.0%
100.0%
100.0%
100.0%
94.4%
100.0%
<94%
>=94%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
<98%
>=98%
N/A
N/A
N/A
<94%
>=94%
31 day wait
For second or subsequent treatment - anti cancer drug treatments
98%
31 day wait
For second or subsequent treatment - radiotherapy
94%
62 day wait
For first treatment from urgent GP referral for suspected cancer
85%
62 day wait
For first treatment from NHS cancer screening service referral
90%
4 hr maximum waiting time
From arrival to admission / transfer / discharge
95%
1.0
96.8%
Patients with a learning disability
Compliance with requirements regarding access to healthcare
n/a
0.5
Yes
1.0
85.6%
86.5%
89.2%
85.9%
76.3%
75.8%
<85%
>=85%
100.0%
100.0%
100.0%
100.0%
92.9%
100.0%
<90%
>=90%
97.0%
93.2%
<95%
>=95%
No
Yes
94.0%
98.3%
96.4%
95.8%
Indicators within the Operating Framework / Key Contractual Priorities
Stroke
MSA
IC
Cancer
VTE
TIA High Risk Patients
High risk TIA cases investigated and treated within 24hrs
60%
BPT
47%
61%
40%
61%
75%
71%
73%
74%
65%
< 50%
50% - 60%
> 60%
TIA Low Risk Patients
% of patients seen, assessed & treated by stroke specialist < 7 days
100%
BPT
83%
77%
81%
86%
91%
97%
86%
84%
96%
< 80%
80% - 90%
>90%
Brain Imaging – as per indications
Patients with acute stroke meeting the indications receive brain imaging
within 1 hr
95%
BPT
82%
71%
95%
94%
80%
59%
100%
69%
67%
< 80%
80% - 90%
>90%
Brain Imaging – other stroke
Other stroke patients receive brain imaging within 24 hrs
100%
BPT
95%
91%
92%
90%
92%
84%
95%
93%
90%
< 80%
80% - 90%
>90%
Direct admission to stroke unit
Percentage of patients with suspected stroke admitted to a specialist stroke
unit within 4 hrs of arrival
90%
BPT
54%
44%
44%
54%
52%
40%
61%
61%
74%
< 80%
80% - 90%
>90%
Alteplase (Thrombolysis)
Percentage of appropriate patients receiving thrombolysis
100%
BPT
100%
100%
100%
100%
100%
100%
100%
100%
100%
< 80%
80% - 90%
>90%
90% time spent on stroke ward
Percentage of patients spending 90% or more of their time on the stroke ward
during their inpatient stay
80%
BPT
65%
33%
57%
62%
62%
50%
74%
71%
83%
< 70%
70% - 80%
>80%
Mixed Sex Accommodation
No of patients breaching the mixed sex accommodation requirement
0
0
0
0
0
0
0
0
0
>0
MRSA Bacteraemias
Number of hospital acquired MRSA cases - national stretch
0
0
0
0
0
0
0
0
62 day – Consultant upgrade
Following a consultant’s decision to upgrade the patient priority *
90%
100.0%
100.0% 100.0%
Venous Thromboembolism
Risk assessment of hospital-related venous thromboembolism
95%
93.7%
94.2%
94.2%
92.2%
93.3%
Less than 1% of patients to wait longer than 6 wks for a diagnostic test
<1%
0.3%
0.3%
0.5%
0.5%
Achieve at least one of the Patient Impact Indicators
Y
Y
Y
Achieve at least one of the Timeliness Indicators
Y
Y
Y
3.1%
2.6%
Diagnostics Six week diagnostic tests
Patient Impact Indicator
E.D. Quality
Timeliness Indicator
Indicators
Ambulance Handovers
Cancelled Elective cancelled operations
Operations 28 day standard
Sickness absence
Workforce Sickness absence
Appraisals
No of breaches of the 30 minute handover standard
Cancelled Ops on day of admission as % of elective admissions
0
tbc
0
1
90.0%
100.0%
93.9%
94.2%
93.8%
0.3%
0.4%
0.3%
Y
Y
Y
Y
Y
Y
3.3%
1.1%
0.4%
0
>= 1
0
< 90%
>=90%
94.1%
<95%
>95%
0.9%
0.7%
>= 1%
Y
Y
Y
No
Yes
Y
Y
Y
No
Yes
1.3%
0.6%
2.8%
1.1%
100.0%
0.9%-0.99%
< 0.8%
0.7%
0.6%
0.8%
0.4%
0.3%
0.2%
0.6%
0.5%
0.3%
>0.7%
0
2.44%
2.41%
2.55%
4
1
0
0
4
0
>0
Percentage of monthly sickness
4%-3%
4.41%
3.58%
3.55%
3.58%
3.26%
3.43%
3.62%
3.50%
3.48%
> 4%
3% - <4%
Percentage of cumulative sickness (rolling 12 months)
4%-3%
3.76%
3.74%
3.72%
3.75%
3.74%
3.75%
3.73%
3.72%
3.71%
> 3.5%
3% - 3.5%
< 3%
90%
74.71%
73.14% 70.58%
68.51%
72.46%
79.80%
81.48%
82.34%
80.97%
< 70%
70% - 89.9%
>= 90%
Number of patients not offered a date within 28 days of cancellation
Percentage compliance with annual appraisals
vrbhinfo / performance management / board tmb / 2013-2014 / Performance Indicator Matrix for November 13 Board
0.65%-0.7%
<0.9
<0.65%
0
< 3%
Page 1 of 2
Area
RTT
Specialty
Indicator
Measure
Target Monitor
Jan-13 Feb-13 Mar-13
100 - General Surgery
90%
RTT Admitted
101 - Urology
90%
92.8%
90.0%
85.9%
82.7%
86.2%
85.3%
83.4%
RTT Admitted
110 - Orthopaedics
90%
91.5%
86.8%
83.6%
89.4%
91.0%
91.3%
90.3%
RTT Admitted
130 - Ophthalmology
90%
91.0%
91.3%
90.5%
92.3%
92.2%
93.6%
91.2%
RTT Admitted
140 - Oral surgery
90%
100.0%
92.3%
100.0%
97.2%
100%
95.7%
RTT Admitted
300 - General medicine
90%
98.3%
99.7%
99.2%
97.9%
98.9%
98.0%
97.0%
99.2%
RTT Admitted
320 - Cardiology
90%
92.9%
92.1%
95.1%
94.0%
93.6%
96.5%
95.3%
RTT Admitted
330 - Dermatology
90%
94.5%
95.8%
93.3%
96.2%
95.6%
94.7%
RTT Admitted
410 - Rheumatology
90%
98.1%
94.6%
100.0%
95.8%
96.9%
RTT Admitted
502 - Gynaecology
90%
94.8%
90.2%
85.8%
81.9%
RTT Admitted
Other
90%
96.9%
98.1%
96.9%
RTT Non admitted
100 - General Surgery
95%
98.7%
98.3%
RTT Non admitted
101 - Urology
95%
99.0%
92.9%
88.6%
RAG Thresholds
Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13
RTT Admitted
77.4%
<90%
>=90%
87.2%
89.5%
<90%
>=90%
88.4%
88.6%
<90%
>=90%
90.3%
90.7%
<90%
>=90%
<90%
>=90%
99.1%
<90%
>=90%
93.6%
91.7%
<90%
>=90%
96.4%
97.4%
94.7%
<90%
>=90%
95.2%
90.5%
97.6%
100.0%
<90%
>=90%
92.5%
90.6%
93.5%
92.3%
90.4%
<90%
>=90%
98.3%
97.6%
98.5%
99.2%
100%
99%
<90%
>=90%
96.6%
97.6%
99.0%
97.5%
98.5%
98.1%
97.1%
<95%
>=95%
99.1%
98.9%
98.8%
98.8%
96.1%
98.4%
97.6%
97.4%
<95%
>=95%
90.5%
85.5%
82.7%
80.5%
82.4%
82.7%
RTT Non admitted
110 - Orthopaedics
95%
98.1%
98.5%
100.0%
100.0%
97.1%
100%
100%
100%
99%
<95%
>=95%
RTT Non admitted
120 - ENT
95%
99.1%
98.9%
95.3%
99.0%
100%
100%
99%
96%
97%
<95%
>=95%
RTT Non admitted
130 - Ophthalmology
95%
100.0%
100.0%
99.8%
100.0%
100%
99.8%
100%
99.8%
100.0%
<95%
>=95%
RTT Non admitted
140 - Oral surgery
95%
95.0%
98.3%
95.1%
95.0%
95.1%
95.1%
97.1%
97.0%
95.7%
<95%
>=95%
RTT Non admitted
300 - General medicine
95%
97.9%
95.9%
96.2%
96.3%
97.6%
96.3%
98.4%
98.1%
95.2%
<95%
>=95%
RTT Non admitted
320 - Cardiology
95%
98.1%
98.3%
97.8%
97.6%
96.4%
98.8%
98.9%
98.3%
97.8%
<95%
>=95%
RTT Non admitted
330 - Dermatology
95%
99.7%
99.6%
100.0%
99.2%
99.6%
100%
98.2%
99.7%
99.2%
<95%
>=95%
RTT Non admitted
340 - Thoracic medicine
95%
100.0%
100.0%
98.8%
99.1%
100%
98.9%
99.5%
98.0%
99.5%
<95%
>=95%
RTT Non admitted
400 - Neurology
95%
97.1%
100.0%
98.5%
98.9%
100%
100%
95.0%
97.4%
95.0%
<95%
>=95%
RTT Non admitted
410 - Rheumatology
95%
97.1%
97.0%
96.9%
98.0%
97.5%
97.2%
96.5%
97.6%
99.3%
<95%
>=95%
RTT Non admitted
502 - Gynaecology
95%
99.1%
99.1%
98.9%
99.0%
99.1%
98.0%
99.4%
98.1%
97.0%
<95%
>=95%
RTT Non admitted
Other
95%
99.6%
99.7%
99.3%
100.0%
99.1%
99.7%
99.7%
99.5%
98.4%
<95%
>=95%
vrbhinfo / performance management / board tmb / 2013-2014 / Performance Indicator Matrix for November 13 Board
Page 2 of 2
Trust Balanced Dashboard
Quality, Performance, Clinical Outcomes,
Productivity and Efficiency
Reporting Month: Sep 2013
Trust Performance Dashboard: Sep 2013
Report produced: 25/10/2013 11:48:56
Clinical Indicators
Quality
KPI
Last
Month
Last
Year
Rolling 12
Month Trend
Units Actual
Plan
HSMR - RBH (2)
Ratio
100.0 109.0 104.8
Medication administration
incidents
HSMR - MAC (2)
Ratio
100.0 155.7 154.7
IP cardiac arrest calls / 1,000
bed days
Ratio
90.5% 95.0% 88.4% 91.7%
Acute Kidney Injuries / 1,000
bed days
Ratio
Returns to theatre / 1,000 bed
days
Ratio
60
Unplanned IP admissions to
ITU or HDU / 1,000 bed days
Ratio
75
Dementia CQUIN (step 1
compliance)
%
61%
% of CHC fasttrack patients that
die on a ward
%
23%
% Harm Free Care (Patient
Safety Thermometer)
%
Serious incidents
No.
Emergency Department Friends
Score
& Family Test
Inpatient Friends & Family Test
Delayed Transfers of Care
30 day readmissions
5
66
Score
69
No.
19
No.
3
10
424
7
17
454
0
15
594
Performance
KPI
Units Actual
Plan
Last
Month
Last
Year
MRSA Bacteraemias
No.
0
0
1
0
Clostridium difficile
No.
2
2
1
1
RTT metrics (below plan)
No.
0
0
0
0
Cancer metrics (below plan) (1)
No.
1
0
1
0
Stroke metrics (below plan)
A&E 4 hr maximum waiting time
Patients with a learning disability
(Monitor compliance)
No.
%
Y/ N
3
0
5
1
Rolling 12
Month Trend
KPI
Units Actual
No.
Plan
24
1.2
90%
Productivity & Workforce
Last
Month
Last
Year
Rolling 12
Month Trend
27
23
0.41
0.26
Average length of Stay
8.5
Theatre session utilisation
2.2
1.5
Average follow-ups per new
Ratio
attendance
0.66
2.4
2.1
Sickness absence
%
3.5%
3.0%
3.5%
3.3%
Vacancy
%
7.6%
15.0%
8.0%
6.6%
Appraisals
%
81%
90%
82%
84%
Mandatory training
compliance
%
81%
80%
75%
Last
Month
Last Year
62%
41%
14%
Time to antibiotics for patients
with severe sepsis
hh:mm TBC
Hospital at Night Average
Response Time - Amber Calls
hh:mm 02:56 04:00 02:42 02:36
Hospital at Night Average
Response Time - Red Calls
hh:mm 01:13 01:00 01:09 01:12
TBC
TBC
TBC
Y
Y
Last Year
Units
Actual
Average number of Outliers
No.
29.5
40.0
Days
5.1
4.7
4.6
%
87.6%
85.4%
87.2%
85.0%
Rolling 12
Month Trend
0.65
Activity & Finance
KPI
% of Stroke patients discharged
to usual residence
%
Stroke mortality rate
%
60%
62%
22%
15%
Actual
Plan
ED Attendances
No.
6,736
6,592
7,577
5,757
Elective admissions
No.
5,406
5,149
5,411
4,891
Non-elective admissions
No.
2,256
2,266
2,415
2,892
GP OP Referrals
No.
5,213
4,845
5,379
4,845
Risk ratings
Rating
3
3
Surplus
£000s
£ 634
£ 132 -£
598
£
114
Transformational plans
£000s
£ 685
£ 594
668
£
803
Rolling 12
Month Trend
3
3
18%
Y
(1) Metric reported 1 month in arrears in monthly views; quarterly values are unadjusted
(2) Metric reported 3 months in arrears in monthly views; quarterly values are unadjusted
Units
62%
95.8% 95.0% 93.2%
Y
Plan
Last
Month
KPI
•
(3) MRSA – de minimums of 6 applies
£
2
BOARD OF DIRECTORS
Date and Part of Meeting:
8th November 2013 – Part 1
Subject:
Patient Safety and Experience Indicators:
Performance and Quality Report
Section:
Performance
Executive Director with
overall responsibility:
Paula Shobbrook, Director of Nursing and Midwifery
Key Purpose
Joanne Sims, Associate Director Clinical Governance
Simon Dursley, Complaints & PALs Manager
Sue Mellor, Head of Patient Engagement
Quality
x
Performance
x
Previously discussed at:
Trust Management Board, 1st November 2013
Author of Paper:
Action required by BoD
To note the report
Executive Summary:
This report provides a summary of information and analysis on new key performance and quality
(P&Q) indicators agreed by the Board for 13/14. The Trust level dashboard provides information on
patient safety and patient experience indicators including:

Patient safety incidents

Never events
Patient falls


Medication AIRS
Pressure ulcers


Safety Thermometer – Harm Free Care (CQUIN standard)

Patient experience performance
Complaints & PALS

The detail is provided in the dashboard front screen and ‘drill down’ pages. The reporting timetable
for patient safety indicators is in line with standard performance and financial reporting.
Strategic Goals & Objectives
All
Links to CQC Registration
Outcome 1, 4, 9, 10, 16
Links to Assurance
Framework/Key Risks
Type of Assurance
All
Internal quality
assurance
External
Quality & Patient Safety Performance Exception Report – September 2013
1
Purpose of the Report
This report accompanies the Quality/Patient Performance Dashboard and outlines the Trust’s performance
exceptions against key quality indicators for patient safety and patient experience for the month of
September 2013
The report includes the 2012/13 baseline for each indicator and the improvement trajectories and targets for
2013/14
2.
Patient Safety
Performance against Patient Safety Indicators
New Serious Incidents reported – Sept 13
5 Serious Incidents were confirmed and reported on STEIS in September 13
The incidents were as follows:
1 patient fall resulting in injury
3 hospital acquired category 3 pressure ulcers
1 security breach
1 incident meets the classification of a “Never Event”. This involved the insertion of the incorrect prosthesis
during surgery which has been replaced. An investigation is underway.
Safety Thermometer
All inpatient wards collect the monthly Safety Thermometer “Harm Free Care” data. The survey, undertaken
for all inpatients the first Wednesday of the month, records whether patients have had an inpatient fall within
the last 72 hours, a hospital acquired category 2-4 pressure ulcer, a catheter related urinary tract infection
and/or, a hospital acquired VTE. If a patient has not had any of these events they are determined to have
had “harm free care”. The results for the April – Sept 13 data collection are as follows:
April
May
June
July
Aug
Sept
88.4
88.5
90.7%
87.50%
88.4%
90.54%
Monthly survey using Safety
Thermometer (Number of patients with
Harm Free Care)
522
512
524
420
463
488
Number of eligible patients to be
surveyed
626
619
624
624
561
590
590
578
578
480
524
539
94
93
92%
76%
93%
91%
NHS SAFETY THERMOMETER
Monthly survey using Safety
Thermometer (%Harm Free Care)
Number of patients actually surveyed
% of patients submitted in the
organisation
This month risk assessment compliance has been recorded as part of the Safety Thermometer data
collection. Results are as follows:
July 13
Aug 13
Sept 13
Number of old pressure ulcers
(i.e. acquired prior to hospital admission)
Number of new pressure ulcers
48
47
35
6
6
6
New falls by severity
 No harm
 Low harm
 Moderate harm
 Severe harm or Death
4
2
0
0
7
2
3
0
6
1
0
0
New VTE
New Catheter UTI
1
1
3
3
4
1
85.6%
90.6%
74.7%
82.9%
90%
84%
69%
84%
Risk assessment compliance
 Falls
 Waterlow
 MUST
 Mobility

Bedrails
93%
88%
73%
82%
95%
3. Patient Experience
September 2013 Friends and Family Test (FFT) net promoter scores
Internal data reports indicate the following results;
FFT
Trust-wide FFT
In- patient FFT
Emergency dept.
August 2013
FFT Score
71
75
60
Sept 2013
FFT Score
68
69
66
Data compliance %
17%
40%
8%

The overall net promoter score of 68 in September is a decrease from August.

ED score has increased to 66 in September. The number of “Extremely Unlikely” in August was 10
and has reduced to 9 in September.

Trust-wide compliance rate is 17% against the 15% national target and remains the same as last
month.

In patient compliance rate is 40%, significantly exceeding the 15% national target (based on 746
completed in patient PECs compared with 1860 discharges) a slight dip from 43% last month. ED
compliance is 8% against the 15% national target and a 1% increase from last month. This is an
amalgamated response from the Eye Unit ED with a compliance rate of 19% (based on 1221
discharges) and an FFT score of 73 and the main ED with a compliance rate of 3% (based on 2986
discharges) and an FFT score of 43.
This table below provides a compliance result comparison August to September. Please note that not all
patients who complete a PEC also complete the FFT question causing a disparity in the number of cards
completed and the number of FFT responses.
Acute Inpatients
Aug-13
Total number eligible to respond
1923
Total responses
824
Overall response rate
43%
Accident and Emergency
Type 1 and 2
Aug-13
Total number eligible to respond
4,778
Total responses
314
Overall response rate
7%
Grand Total Overall response rate
Grand Total number eligible to respond
Grand Total responses
Sep-13
1860
746
40%
Sep-13
4558
357
8%
6,418
1103
17.0%
NB. Type 1 = Main ED
Type 2 = Eye Unit ED
Action to improve FFT data compliance
Refined methodology to increase uptake for FFT in Emergency areas
The token system has arrived in the Trust. This has been adopted as the best performing Trust re data
compliance were using token systems; Identified areas for implementation are;
 Main ED
 Eye ED
 AMU
 Main Out Patients (not yet a requirement).
The token systems are in the process of these being placed on the walls at strategic points to improve
compliance rates. The tokens will be collected twice per week by the Patient Experience Team and they are
working with the CSSD to confirm that the tokens can be autoclaved on a weekly basis to reduce infection.
Once confirmed the SOP will be finalised and implemented.
A hospital radio interview has been broadcast incorporating encouragement to complete the PEC, giving
examples of improvements and the Trust commitment to responding to patient feedback
Maternity
Implementation of the FFT in the maternity services with four touch points was initiated from the 1st October
2013. Staff have been briefed and the unit is using an adapted Patient Experience Card. They are now
included in the twice weekly collection and will receive weekly prediction tables to identify their compliance
rate.
Patient experience cards feedback on CQUIN questions (PEC)
Trust-wide there has been 1701 completed PEDC in comparison to the 288 Real Time Patient feedback
surveys completed by the volunteers.
It is important to note the CQUIN questions are populated on the Dashboard from the in-house real time
feedback patient survey. The results are collated from the PEC cards which contain the FFT question.
Volume of cards far exceeds the RTPF currently, so it is relevant that both sets of results are displayed for
transparency.
The table below compares the number of RTPF surveys collected in the month of September with the
Number of completed PEC for each CQUIN question.
No.
September ‐ RTPF
September ‐ PEC
Yes,
Yes, to some
definitely
extent
Yes,
Yes, to some
definitely
extent
No
No.
No
Were you involved as much
as you w anted to be in
288
decisions about your care
and treatment?
71%
22%
7%
1500
83%
15%
2%
Did you find someone on
the hospital staff to talk to
about your w orries and
fears?
197
59%
18%
22%
1409
82%
15%
2%
Were you given enough
privacy w hen discussing
296
your condition or treatment?
86%
8%
6%
1505
91%
7%
2%
Yes,
Yes, to some
complete
extent
Did a member of staff tell
you about medication side
66
effects to w atch for w hen
you w ent home?
61%
14%
Did hospital staff tell you
w ho to contact if you w ere
77
w orried about your
condition or treatment after
you left hospital?
62%
38%
Yes,
Yes, to some
complete
extent
No
26%
1252
77%
14%
1358
92%
8%
No
8%
Without exception every CQUIN question received a more favourable response in the PEC feedback with
the worries and fears question showing an improvement of 23%. Given the higher volume of cards this is a
significant response. There is also a 30% improvement of the response in the PEC for the “who to contact
after discharge question”.
Carers Cards
In response to the CQUIN for carers feedback, this month has seen only 13 cards completed by carers in the
Trust, of which 9 had positive comments places in the free text box, all of which was very complimentary.
The FFT score for the 13 carers produced a score of 83. Of the 13 completed cards 6 identified themselves
as carers of patients with dementia and they provided a score of 100.
In-house inpatient survey Trust-wide (RTPF)
There is no change in the overall RAG performance from the RTPF for the CQUIN questions, ‘privacy’ is
essentially stable at 93%, involvement in decisions has marginally improved and both are RAG rated green.
Finding ‘someone to talk to about worries and fears’, remains amber but is deteriorating, as are the
remaining two questions, ‘providing information on who to contact on discharge’, and ‘medication side
effects’, which are both RAG rated red on the dashboard.
Both feedback methods demonstrate an improving or upheld picture on privacy, one of the main actions for
improvement from the last CQC published survey. Appropriate actions are in place or under review for the
remaining questions.
Patients Opinion and NHS Choices
Patients Opinion and NHS Choices are monitored daily from Monday – Friday and responses are provided
with a 24-hour working day timescale, using the criteria set and monitored by Patients Opinion.
During September, 6 comments were posted of which 5 were positive reinforcement of high quality care and
recognition of staff commitment. However 1 comment was received with negative feedback regarding poor
customer care. All feedback is shared with relevant clinical staff and senior nurses are included in the
response process.
Healthwatch and other partnership organisations
We have received a request from Healthwatch to meet and discuss partnership working. This meeting is to
take place in November. In addition we have been asked to develop some focus groups in partnership with
Southampton CCG to review service that their patients use including audiology. The aim is for December.
Patient and carers feedback
There is a developing bank of patient stories now available on the Trust intranet accessed through the front
page. In addition 1-1 in depth interviews have taken place as part of the bariatric service review,
incorporating the Experience Based Design methodology. How we share these details is under review.
Stakeholder
The Trust annual stakeholder event was held on the 3rd September 2013, attended by patients, carers,
Healthwatch, CCG and other partnership organisations. A presentation was given on improvements made
following last year’s event and small group work was facilitated by internal coaches to elicit





What the Trust does well
What the Trust needs to improve and how that may be accomplished
How we may manage Patients property affectively
How we could improve communication with carers and family.
How can we work more effectively in partnership
The event was welcomed by those who attended and the actions will be reviewed by the PECC
Patient experience summary
 Net promoter scores remain largely unchanged.
 Maternity FFT has been implemented
 The call bell audit has been recommenced with the methodology of being completed in the morning,
afternoon and evening/overnight.
As part of the Privacy and Dignity action plan, two main actions have been implemented; a Butterfly sign has
been disseminated across the Trust as an example of best practice from the ED department to highlight by
placing on a door that a patient / relatives have received sensitive news and appropriate noise levels without
interruption should be maintained. Screen savers have been implemented to hide confidential information in
clinical areas. The action plan continues, and areas are adding any extra local actions to the overall Trustwide action plan as appropriate from their local results. Returns are being monitored.
Recommendations
The Board of Directors is invited to note the report.
BOARD OF DIRECTORS
Meeting Date and Part:
08 November 2013 - Part I
Subject:
Financial Performance
Section:
Performance
Executive Director with
overall responsibility
Stuart Hunter, Director of Finance
Author of Paper:
Pete Papworth, Deputy Director of Finance
Details of previous discussion
Finance Committee and Trust Management Board
and/or dissemination:
Key Purpose:
Patient
Safety
Health &
Safety
Performance
Strategy
X
Action required by BOD:
Executive Summary:
For Information
Review of the financial performance for Month 06 2013
Strategic Goals & Objectives:
Goal 7 – Financial Stability
Links to CQC Registration:
(Outcome reference)
Outcome 26 – Financial Position
Links to Assurance
Framework/Key Risks:
Internal
Type of Assurance:
X
External
Board of Directors
November 2013
Financial Performance
1.
Introduction
This report summarises the Trust’s financial performance for the period to 30
September 2013. A financial overview is attached at Annex A.
2.
Overview
At the end of September, whilst still behind plan the Trust reports an improved financial
position. This reflects the contractual agreement with NHS England which has
provided much needed clarity in relation to the income attributable to the provision of
commissioned specialist services.
Despite this improved position, the national tariff consultation document released in
early October presents a significant financial challenge for the Trust going into the next
financial year. This will be even more challenging following the Competition
Commission’s disappointing decision to prohibit the proposed merger with Poole
Hospital NHS Foundation Trust.
The tariff deflator for 2014/15 has been confirmed at 1.9%. In addition, the marginal
rate for emergency activity will continue at 30%, and the non payment for 30 day
emergency readmissions will also remain. This means the Trust will get paid less for
seeing the same number of patients, resulting in a further efficiency requirement of 4%.
As a result, further significant transformational savings will be required in order to
support improved patient outcomes through a well managed and sustainable financial
position.
3.
Key Financials
Net Surplus
Despite an improved position during September, the Trust remains behind plan at the
end of September, with an adverse variance of £250,000.
Earnings Before Interest, Taxation, Depreciation and Amortisation (EBITDA)
The EBITDA ratio is one of the key performance indicators the Foundation Trust is
currently monitored against. As at 30 September the Trust returned 5.6%, against a
plan of 6%. The full year plan is for an EBITDA margin of 5.5%.
Transformation Programme
Savings recorded to date total £3.8 million against a target of £4.1 million, meaning
that the Trust is currently under delivering by £300,000. Whilst some additional
schemes are currently being finalised before sign-off and inclusion within the
programme; the Trust is currently forecasting to under deliver against the full year
target by over £1 million.
Financial Performance
For information
Page 1 of 3
Board of Directors
November 2013
The Service Improvement and Transformation Team is currently supporting those
directorates who are forecasting an under delivery to ensure that all potential
opportunities have been identified.
Capital expenditure
Capital expenditure currently stands at £3.711 million against a plan of £4.132 million.
The under spend to date is mainly due to a delay in the commencement of the Trusts
IT network upgrade and Electronic Document Management System. Despite the
current slippage, however, the Trust continues to forecast total capital expenditure of
£9.475 million during the current financial year.
4.
Financial Risk Rating
The Trust’s overall financial risk rating as at the end of September was a rating of 3,
consistent with the planned rating. Members will be aware that the new Continuity of
Service Risk Rating comes into effect from 1 October, replacing the current Financial
Risk Rating. The Trust reports a rating of 4 against the new metrics, being the best
possible (lowest risk) rating.
5.
Activity
To date, activity has exceeded budgeted levels by an aggregate 3%. This continues
the upward trend seen throughout 2012/13 and is consistent with the pressures faced
across the acute sector and recognised at a national level.
Whilst elective activity is currently 6% above budget, a reduction in high value
orthopaedic activity and an increase in minor surgical procedures mean that this
activity is not resulting in additional income to the Trust.
The pressures facing the Emergency Department are significant, and have increased
further during the summer months, with activity now being 8% above budget. Even
following significant investment at the start of the financial year, this increased demand
is placing pressure on expenditure budgets; particularly due to the increased costs
associated with using a flexible workforce, which is essential to ensure that appropriate
medical and nursing cover is maintained.
6.
Income and Expenditure
As at 30 September the Trust has earned income of £127.5 million against a budget of
£127.4 million, being a favourable variance of £0.1 million. Expenditure during the
same period totalled £126.6 million against a budget of £126.2 million, being an
adverse variance of £0.4 million.
The Trust continues to undertake a range of additional activities to support the
exceptional level of emergency demand experienced by the Trust; however following
formal agreement with commissioners, these have now been reflected within the
Trust’s budget, reducing the previously reported income and expenditure variances.
Financial Performance
For information
Page 2 of 3
Board of Directors
November 2013
The remaining adverse expenditure variance mainly relates to cost and volume drugs,
for which additional income is received. Members will also note that clinical supplies
are below plan due to a reduction in complex orthopaedic activity and the
corresponding prosthesis costs; with pay and non pay pressures within clinical
directorates being broadly off-set by savings within corporate areas.
7.
Workforce
Recorded sickness reduced marginally in month from 3.50% in August to 3.48% in
September; with the rolling twelve month cumulative sickness level currently standing
at 3.71%. Whilst this is above the Trust’s internal stretch target, it remains a strong
position when benchmarked nationally; particularly given the current demand
pressures faced by the Trust.
8.
Recommendation
The Trust is planning the delivery of all financial duties, with a planned surplus of £1.25
million demonstrating that financial budgetary control is well embedded within the day
to day activities of the organisation.
It is recognised, however, that to continue to deliver the level of savings required is
becoming ever more difficult. As a result, directorate savings plans require close
monitoring to ensure that the current shortfall is addressed promptly; and plans are
progressed to support future year’s efficiency requirements.
Members are asked to note the Trust’s financial performance for the period to 30
September 2013.
Pete Papworth
Deputy Director of Finance
October 2013
Financial Performance
For information
Page 3 of 3
ANNEX A
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST
FINANCIAL PERFORMANCE FOR THE PERIOD TO 30 SEPTEMBER 2013
KEY FINANCIALS
NET SURPLUS/ (DEFICIT)
EBITDA
TRANSFORMATION PROGRAMME
CAPITAL EXPENDITURE
FINANCIAL RISK RATING
EBITDA Margin
EBITDA Achievement of Plan
Net Return after Financing
I&E Surplus Margin
Liquidity
FINANCIAL RISK RATING
%
%
%
%
Days
2012/13
YTD ACTUAL
£'000
PLAN
£'000
1,081
7,878
3,950
2,974
1,219
7,589
4,148
4,132
2012/13
YTD ACTUAL
METRIC
PLAN
METRIC
6.5%
103.3%
0.8%
0.6%
54.8
3.3
CONTINUITY OF SERVICE RISK RATING
2012/13
YTD ACTUAL
METRIC
Debt Service Cover
Liquidity
CONTINUITY OF SERVICE RISK RATING
2.87x
54.8
4
6.0%
100.0%
1.1%
1.0%
56.8
PLAN
METRIC
3.05x
56.8
2013/14 YEAR TO DATE
ACTUAL
VARIANCE
£'000
£'000
VARIANCE
%
PLAN
£'000
(249)
(427)
(306)
(421)
(20%)
(6%)
(7%)
(10%)
1,250
13,745
10,379
9,475
2013/14 YEAR TO DATE
ACTUAL
RISK
METRIC
RATING
WEIGHTED
RATING
PLAN
METRIC
0.8
0.4
0.6
0.4
1.0
3.2
5.5%
94.3%
0.5%
0.5%
56.4
WEIGHTED
RATING
PLAN
METRIC
2
2
4
2.79x
56.4
970
7,162
3,842
3,711
5.6%
94.4%
0.9%
0.6%
56.5
2013/14 YEAR TO DATE
ACTUAL
RISK
METRIC
RATING
3.37x
56.5
PLAN
NUMBER
30,997
153,087
17,271
35,386
236,741
31,137
139,262
13,825
40,212
224,437
2012/13
YTD ACTUAL
£'000
PLAN
£'000
35,051
18,724
27,240
3,217
26,822
9,973
863
202
122,092
36,513
15,597
25,674
3,807
32,546
12,263
917
75
127,392
2012/13
YTD ACTUAL
£'000
PLAN
£'000
69,911
16,505
11,826
14,549
863
4,805
2,551
121,011
75,399
17,112
12,013
14,102
917
4,306
2,323
126,173
2012/13
YTD ACTUAL
£'000
PLAN
£'000
Non Current Assets
Current Assets
Current Liabilities
Non Current Liabilities
TOTAL ASSETS EMPLOYED
147,509
62,250
(23,933)
(3,024)
182,802
144,934
67,088
(25,257)
(2,591)
184,174
144,980
70,891
(28,742)
(2,600)
184,529
Public Dividend Capital
Revaluation Reserve
Income and Expenditure Reserve
TOTAL TAXPAYERS EQUITY
78,674
68,498
35,630
182,802
78,674
64,488
41,012
184,174
78,674
64,485
41,370
184,529
2012/13
YTD ACTUAL
PLAN
3,566
3.51%
3,788
3.00%
Elective
Outpatients
Non Elective
Emergency Department Attendances
TOTAL PbR ACTIVITY
INCOME
Elective
Outpatients
Non Elective
Emergency Department Attendances
Non PbR
Non Contracted
Research
Interest
TOTAL INCOME
EXPENDITURE
Pay
Clinical Supplies
Drugs
Other Non Pay Expenditure
Research
Depreciation
PDC Dividends Payable
TOTAL EXPENDITURE
STATEMENT OF FINANCIAL POSITION
WORKFORCE
Staff (Whole Time Equivalents)
Sickness (rolling twelve months)
4
4
2013/14 YEAR TO DATE
ACTUAL
VARIANCE
NUMBER
NUMBER
2012/13
YTD ACTUAL
NUMBER
ACTIVITY
3
4
3
2
4
2013/14 FULL YEAR
FORECAST
VARIANCE
£'000
£'000
1,250
13,745
9,221
9,475
VARIANCE
%
0
0
(1,158)
0
0%
0%
(11%)
0%
2013/14 FULL YEAR
FORECAST
RISK
METRIC
RATING
WEIGHTED
RATING
5.5%
94.3%
0.5%
0.5%
56.4
3
4
3
2
4
2013/14 FULL YEAR
FORECAST
RISK
METRIC
RATING
2.79x
56.4
4
4
2013/14 FULL YEAR
FORECAST
VARIANCE
NUMBER
NUMBER
0.8
0.4
0.6
0.4
1.0
3.2
WEIGHTED
RATING
2
2
4
VARIANCE
%
PLAN
NUMBER
1,806
1,117
183
3,167
6,272
6%
1%
1%
8%
3%
62,275
278,524
27,575
80,204
448,578
2013/14 YEAR TO DATE
ACTUAL
VARIANCE
£'000
£'000
VARIANCE
%
PLAN
£'000
(490)
26
109
129
467
(154)
53
(1)
139
(1%)
0%
0%
3%
1%
(1%)
6%
(1%)
0%
73,025
31,195
51,208
7,593
65,086
24,626
1,834
150
254,717
2013/14 YEAR TO DATE
ACTUAL
VARIANCE
£'000
£'000
VARIANCE
%
PLAN
£'000
(30)
122
(595)
(16)
(53)
148
36
(388)
(0%)
1%
(5%)
(0%)
(6%)
3%
2%
(0%)
148,627
33,990
23,948
31,811
1,834
8,611
4,646
253,467
2013/14 YEAR TO DATE
ACTUAL
VARIANCE
£'000
£'000
VARIANCE
%
PLAN
£'000
46
3,803
(3,485)
(9)
355
0%
6%
14%
0%
0%
146,266
67,593
(26,691)
(2,357)
184,811
146,266
67,593
(26,691)
(2,357)
184,811
0
0
0
0
0
0%
0%
0%
0%
0%
0
(3)
358
355
0%
(0%)
1%
0%
78,674
64,488
41,649
184,811
78,674
64,488
41,649
184,811
0
0
0
0
0%
0%
0%
0%
VARIANCE
%
PLAN
0.8%
(23.7%)
3,773
3.00%
32,943
140,379
14,008
43,379
230,709
36,023
15,623
25,783
3,936
33,013
12,109
970
74
127,531
75,429
16,990
12,608
14,118
970
4,158
2,287
126,561
2013/14 YEAR TO DATE
ACTUAL
VARIANCE
3,759
3.71%
29
(0.71%)
66,288
282,453
28,000
88,223
464,964
VARIANCE
%
4,013
3,928
425
8,019
16,386
6%
1%
2%
10%
4%
2013/14 FULL YEAR
FORECAST
VARIANCE
£'000
£'000
VARIANCE
%
71,986
31,254
51,495
7,858
66,140
24,271
1,939
146
255,089
(1,039)
59
287
265
1,054
(355)
105
(4)
372
(1%)
0%
1%
3%
2%
(1%)
6%
(3%)
0%
2013/14 FULL YEAR
FORECAST
VARIANCE
£'000
£'000
VARIANCE
%
148,720
33,842
25,169
31,154
1,939
8,439
4,576
253,839
(93)
148
(1,221)
657
(105)
172
70
(372)
(0%)
0%
(5%)
2%
(6%)
2%
2%
(0%)
2013/14 FULL YEAR
FORECAST
VARIANCE
£'000
£'000
VARIANCE
%
2013/14 FULL YEAR
FORECAST
VARIANCE
3,773
3.50%
0
0.50%
VARIANCE
%
0.0%
16.7%
BOARD OF DIRECTORS
Meeting Date and Part:
8 November 2013 Part 1
Subject:
Competition Commission decision on the proposed merger
Section:
Strategy
Executive with Overall
Responsibility
Tony Spotswood, Chief Executive
Author of Paper:
Tony Spotswood, Chief Executive
Details of previous
discussion and/or
dissemination:
Ongoing discussions regarding the merger
Patient Safety
Health & Safety
Key Purpose:
Performance Strategy
X
X
Action required by BoD:
To note progress
Executive Summary:
To update the Board on the Competition Commission’s final
decision
Strategic Goals &
Objectives:
Maintaining local services
Links to CQC
Registration: (Outcome
reference)
Links to Assurance
Framework/Key Risks:
Outcome 4: Care and welfare of service users
Outcome 16: Quality of Service provision
Quality and Safety
Internal
External
Type of Assurance:
X
Board of Directors Part 1
8 November 2013
Decision on the proposed merger of The Royal Bournemouth and
Christchurch Hospitals NHS FT and Poole Hospital NHS FT
Please find appended the final summary report issued by the Competition
Commission confirming their decision to prohibit the proposed merger. Despite the
substantial information provided to the Competition Commission by the Trusts which
included:



provision of in excess of half a billion fields of data
answers to well over of 1000 questions
provision of tens of thousands of pages of evidence to support the merger
and the benefits that would flow to patients
the Competition Commission still felt it needed greater certainty that the benefits
which they accepted as substantial would be realised. This requirement for greater
assurance in the context of the need for the new merged organisation to first consult
on its proposals to reconfigure services demonstrates the constraints of the
untested process we followed and the need to review the process. The recent
announcement which accompanied the Competition Commission’s decision of a
much more prominent role for Monitor in working with organisations prior to issues
of competition being considered by the OFT or Competition Commission is to be
welcomed. With specific regard to the future of The Royal Bournemouth and
Christchurch Hospitals NHS FT and Poole Hospital NHS FT I attach a copy of a
letter sent to Roger Witcomb as Chair of the Competition Commission following his
comments in a radio interview immediately following the decision to prohibit the
merger. In that interview Mr Witcomb clearly indicated that the Competition
Commission were prepared to reconsider their decision if the additional information
they requested was provided to them. He also indicated that should they receive
the necessary information they would make a speedy decision to authorise the
merger. Following our request for clarification I attach a copy of his response which
effectively describes a very different scenario to that articulated in his radio
interview. In essence any proposal to merge the two organisations under the
present legislation will mean that we have to start the process again.
Moving forward the Trust has been undertaking work to develop a revised plan and
strategy based on continuing to work closely with Poole Hospital and other parties,
but operating in the short to medium term as an independent organisation. This
strategy is covered elsewhere within the agenda and via Jane Stichbury, our Chair,
we have also written to David Bennett, Chief Executive of Monitor, asking that we
consider the future of The Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust as part of a wider piece of work to develop a new coherent
strategy for the population of Dorset engaging both commissions and other provider
organisations. This strategy will need to focus on a revised acute strategy for the
county of Dorset as well as the realisation of opportunities to secure the effective
integration of services where there are clear benefits to patients, particularly with
regard to care pathways including the treatment and care provided to the frail
elderly. Discussions are also taking place between Monitor, Dorset CCG and local
commissioners regarding the immediate future of Poole Hospital NHS Foundation
Trust.
Proposed Merger – CC Decision
Strategy
Page 1 of 2
Board of Directors Part 1
8 November 2013
With regard to the ongoing application of undertakings the process is as follows:

The Competition Commission will typically send draft final undertakings within
one to two weeks after their final decision. We will then have an opportunity
to comment prior to it going out for public consultation.

Once the final undertakings are in place, but not until then, the interim
undertakings which we regard as particularly restrictive will fall away.

Once in place the undertakings may be released on a material change of
circumstances; it is worth noting that if the Trusts do not give undertakings
the Competition Commission has the power to make a final order. This
clearly has the potential to seek to constrain work to reconfigure services
even though the Competition Commission has accepted there is a benefit to
be gained from that reconfiguration. We would wish to work closely with
Monitor, and indeed, local MPs and others, early on should we feel that there
is any move to restrict the two Trusts working together in a way that promotes
the interests of patients.
Finally, can I thank the Board and, other colleagues for their work and support as we
have moved through assessment by the competition authorities. Although the
decision is very disappointing, we have to move forward from here with a positive
approach to the consolidation of services ensuring that the quality of care is at the
centre of all we do. Our new strategy will focus very much on enhancing the quality
of services provided to patients.
Tony Spotswood
Chief Executive
Proposed Merger – CC Decision
Strategy
Page 2 of 2
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS
FOUNDATION TRUST/POOLE HOSPITAL NHS FOUNDATION TRUST
Summary of report
Notified: 17 October 2013
1.
On 8 January 2013, the Office of Fair Trading (OFT) referred the anticipated merger
of The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
(RBCH) and Poole Hospital NHS Foundation Trust (PH) to the Competition
Commission (CC) for investigation and report under the Enterprise Act 2002 (the
Act). We are required to publish our final report by 21 October 2013. 1
2.
The reference requires us to determine:
• whether arrangements are in progress or in contemplation which, if carried into
effect, will result in the creation of a relevant merger situation; and
• if so, whether the creation of that situation may be expected to result in a substantial lessening of competition (SLC) within any market or markets in the UK for
goods or services.
3.
On 29 November 2011, RBCH and PH (the parties) announced their intention to
merge. RBCH and PH both provide a range of healthcare services in the Dorset area
including hospital-based elective care, hospital-based non-elective care, outpatient
services, specialised services, community services and private services.
4.
RBCH and PH are both NHS foundation trusts and this is the first merger between
two NHS foundation trusts to be referred to the CC. It follows the enactment of the
Health and Social Care Act 2012 (HSCA 2012), which confirmed the OFT and CC’s
roles in assessing the competition aspects of mergers involving foundation trusts.
Foundation trusts are independent organizations which have a significant degree of
autonomy in managing their affairs.
5.
In carrying out our inquiry we were conscious that, whilst there are important aspects
of the NHS that distinguish it from other sectors, health policy has for some time
been that patient choice is in itself an important aim and has an important role in
incentivizing hospitals to maintain and increase quality. The fact that they stand to
gain or lose revenues from patients exercising choice is important. We were also
conscious of the significant changes taking place in the industry due to the HSCA
2012 and of the financial constraints faced by the NHS.
6.
This is the first merger involving NHS foundation trusts to be considered by the CC.
We note that the inquiry took longer than we would have wished. Our hope is that in
future, merging NHS hospitals will ensure that they are able to provide us with timely,
accurate and consistent information regarding their activities and proposals, and that
1
The original deadline for our report was 24 June 2013. On 9 April 2013 we extended the period of the reference because
RBCH and PH had each been unable to supply information and documents specified by us in notices issued to them under
section 109 of the Act. On 11 June 2013 we ended the period of extension. The period within which the report on the reference
was to be prepared and published was revised to end on 26 August 2013. We issued a further notice of extension on 5 August
2013 and the period within which the report on the reference was to be prepared and published was revised to end on
21 October 2013.
1
they will carefully consider the rationale for the merger and their post-merger
reconfiguration plans from the perspective of patients. This should assist that the CC
will be able to deal with NHS hospital mergers more expeditiously in future.
7.
We found that the proposed merger, if carried into effect, would result in the creation
of a relevant merger situation because it would result in the parties ceasing to be
distinct pursuant to section 79(1) of the HSCA 2012 and because the turnover of
each of RBCH and PH exceeded £70 million in the UK and the turnover test was
therefore met.
Industry background
8.
The parties provide publicly-funded healthcare services to NHS patients. In our
approach to this merger, we took account of the regulatory frameworks within which
the parties must operate when providing services. We considered a number of
questions relevant to how foundation trusts operate including the powers and
obligations of foundation trusts and the extent to which these provide foundation
trusts with an ability and incentive to compete in supply of NHS services; how
foundation trusts receive funding; quality and governance of foundation trusts;
competition policy and law in supply of NHS services; the extent to which foundation
trusts have incentives to compete; and Monitor’s supervision of foundation trusts.
9.
We noted that foundation trusts are hospitals which are required to provide certain
NHS services but are also afforded a degree of operational autonomy. Their principal
purpose is the provision of goods and services for the health service in England.
They can retain their surpluses and borrow to invest in new and improved services
for patients and service users. This gives them an incentive to maximize their income
by taking steps to attract patients for profitable specialties, for example by
maintaining and improving service quality.
10.
We noted that the primary commissioner for RBCH and PH was the Dorset Clinical
Commissioning Group (Dorset CCG). One of the areas West Hampshire Clinical
Commissioning Group (West Hampshire CCG) is responsible for commissioning for
is West New Forest and Totton & Waterside, which is served by hospitals including
RBCH. For the purposes of our analysis we referred to the areas covered by Dorset
CCG and the relevant areas covered by West Hampshire CCG (West New Forest
and Totton & Waterside) as the wider Dorset area. The Wessex Area Team of NHS
England (NHS England (Wessex)) commissions specialised services (which treat
either rare conditions or those that need a specialised team working together at a
centre) from the parties.
11.
We considered the framework within which competition in the provision of NHS
healthcare services has been considered in the past, for example by the Cooperation
and Competition Panel (CCP). We noted that there are, broadly speaking, two different models of competition in the provision of NHS healthcare services:
(a) Competition in the market (ie competition for patients), which occurs where
patients have a choice between providers of the same service. Payments for
these services are commonly made according to the PbR tariffs that are set
centrally. The initiatives related to patient choice are relevant to competition in the
market, which occurs mainly in respect of routine elective (planned) services as
well as maternity services. Hospitals are motivated to compete on quality in order
to attract patient referrals and hence income.
2
(b) Competition for the market, which occurs where the commissioning entity uses a
competitive process to choose between different providers for the right to provide
services to patients.
12.
We noted that in some respects competition in the provision of NHS services is still
developing and that in some circumstances commissioners have a level of discretion
as to how and when to use competition as a driver to achieve their objectives. When
reviewing various aspects of the relevant markets there was uncertainty as to how
any changes would be implemented and we therefore considered whether
commissioners would make changes in the foreseeable future on a case-by-case
basis in relation to the relevant services considered.
13.
We noted that patients have a choice of provider in respect of their first consultant-led
outpatient appointment for elective care and for maternity services. We considered
the extent to which foundation trusts have incentives to compete for patients and
found that the patient choice and payment by results (PbR) regimes incentivize acute
service providers to compete for patients. The PbR regime sets tariffs for procedures
and providers are paid according to the number of procedures which they carry out.
National PbR tariffs cover the majority of acute healthcare (elective and non-elective)
in hospitals. Through the regulatory framework that has been set up, including the
PbR regime and the commissioning of services by Clinical Commissioning Groups
(CCGs), foundation trusts may compete to provide healthcare services to commissioners, GPs and patients. The remuneration system set out under the PbR regime
incentivizes providers of acute elective services to win additional patients. However,
tariffs do not always accurately reflect costs of provision and this may affect these
incentives. The extent to which these incentives work according to policy in the wider
Dorset area are considered in detail in our competitive effects assessment.
14.
We noted Monitor’s supervision of foundation trusts, in particular its ability to determine whether or not a foundation trust is failing and the mechanisms it has to reduce
the likelihood and impact of failure. Foundation trusts are incentivized to be
financially healthy via the Monitor regulatory framework, one aspect of which rates
foundation trusts on the basis of their financial stability. Monitor can put failing trusts
into special administration, a process which may result, in extreme circumstances, in
a provider (but not necessarily all of the services it provides) exiting the market.
Rationale for the merger
15.
The parties told us that they faced financial and clinical challenges, many of which
were common to acute NHS hospitals, but that PH faced more significant financial
challenges than most. RBCH told us it believed that a merger with PH would achieve
economies of scale, improve its consultant cover, realize synergies and make both
trusts more financially resilient. PH told us it concluded that a merger with RBCH
would provide them with greater financial stability and enable them to meet Royal
Colleges’ guidance in relation to some aspects of their service provision.
16.
The parties told us that the merger of RBCH and PH would involve a reconfiguration
of some of the services provided by the hospitals but that the detailed planning for
any such reconfiguration had not yet been done. The parties provided us with plans
in relation to reconfiguration proposals for maternity, cardiology, haematology,
accident and emergency (A&E) and emergency surgery services, which we
considered in detail in our analysis of whether the merger would be likely to result in
benefits to patients. Some of these reconfigurations would have to be consulted on to
test that the reconfiguration had GP leads and commissioner support; would sustain
or improve choice; and had a sound evidence base.
3
Counterfactual
17.
We considered the situation that would have prevailed absent the merger (the
counterfactual).
18.
The parties submitted that the appropriate counterfactual was one in which PH exited
the market. Based on our analysis of the financial situations of RBCH and PH and
our analysis of the manner in which the Monitor failure regime (including the special
administration process) operates, our conclusion is that, without the merger, neither
party would have exited the market.
19.
The parties had considered a number of alternatives to the merger. We reviewed the
evidence and found that the most likely alternative, absent the merger, was that the
hospitals remained as stand-alone entities.
20.
We considered the extent to which the parties’ service offerings might change in the
counterfactual, in particular in the case of PH, due both to financial constraints and in
light of information we received regarding service reconfigurations. We found that
their service offerings were likely to remain broadly similar to their current offerings.
21.
For the purposes of our competitive assessment, our conclusion is that in the
counterfactual both parties would remain as stand-alone entities, providing broadly
similar service offerings to their current offerings.
The relevant markets
22.
RBCH and PH both provide a wide range of hospital-based services including
elective and non-elective secondary inpatient care, specialised clinical services and
community and outpatient services. These services can be classified as specialties,
which can be further divided into sub-specialties. We found that as there is typically
only one treatment that is appropriate for a specific healthcare problem, there is
effectively no demand-side substitutability.
23.
We then considered whether different services could be aggregated into broader
markets on the basis that suppliers may switch easily and in a timely fashion
between the provision of certain services in response to changes in demand, or on
the basis that the same suppliers compete to supply the services concerned and the
conditions of competition are the same for each service.
24.
We concluded that:
(a) Each specialty constitutes a separate market. Where there are limits to supplyside substitution within specialties we took constraints at sub-specialty level into
account in our competitive effects assessment.
(b) Within each specialty:
(i)
We treated outpatient and inpatient activities as separate markets and we
noted that there is an asymmetric constraint between inpatient and outpatient, with inpatient providers readily capable of providing outpatient
services but not vice versa. We considered day cases as part of the relevant
inpatient market.
(ii) Outpatient (and to a lesser extent inpatient) services should not be further
separated according to whether or not the services can be provided in
4
community settings, but certain services are provided only in the community
and should be viewed as separate markets.
(iii) Non-elective and elective activities are separate markets, although the
provision of elective activities may be constrained to some extent by nonelective providers.
(c) Private services are separate markets from NHS services. Within private
services, each specialty constitutes a separate market and within each specialty,
markets can be defined along inpatient and outpatient lines (as with NHS
services).
25.
We considered the relevant geographic market in which to conduct our analysis. The
evidence indicated that the merging trusts attract most of their patients from within a
drive-time (or isochrone) of 17 minutes for RBCH and of 22 minutes for PH. We used
the isochrones based on our catchment area analysis as the starting point for our
competitive assessment. As part of the assessment we also considered the constraints posed on the parties by rivals located further away than implied by these
isochrones.
Competitive effects
26.
We considered the likely effects of the proposed merger in relation to six groups of
services in turn: elective services (including overlap elective specialised services),
non-elective services (excluding maternity services and including non-elective
overlap specialised services); maternity services—these are non-elective services
but we considered them separately as they have many aspects (such as how
patients choose) which make them more similar to elective services; community
services; competition for the market in elective, non-elective, specialised and
community services; and private services.
27.
In order to assess whether the merger would give rise to a loss of competition in the
provision of the relevant NHS acute services in the wider Dorset area, we considered: the relevant markets; the competitive effects of the proposed merger; and
whether countervailing factors such as buyer power, entry and expansion or rivalryenhancing efficiencies existed which would constrain the parties from reducing
quality in relation to services where we found that unilateral effects were likely to
occur as a result of the merger.
28.
Unilateral effects are effects that may arise in horizontal mergers where the merger
involves two competing entities and removes the rivalry between them. In relation to
competition in the market for provision of NHS acute services, competition is almost
always on quality, rather than on price, as the majority of services are covered by the
PbR regime. From our assessment of the way in which competition in the market
works in the NHS, we understood that the role of competition is to focus providers’
strategic decisions such that they take account of those factors that matter to patients
and their GPs when they decide which hospital to attend. For this reason, when
analysing the likely unilateral effects of the merger in relation to quality competition,
we assessed which quality factors were relevant to patient and GP choice such as
clinical outcomes, location, waiting times, accessibility, quality of care and other
issues identified by patients.
29.
We noted that RBCH is 8 miles by road and 18 minutes’ drive-time from PH and they
are each other’s closest geographical competitor. Both trusts are acute hospitals
providing a comprehensive range of inpatient and outpatient healthcare services. In
addition to providing general services, both trusts provided maternity services and
5
consultant-led emergency services. RBCH and PH both perform well against a
number of quality indicators.
30.
Figure 1 below shows the locations of NHS foundation trusts in the region and the
GP practices within the wider Dorset area. Much of our economic analysis also
included data on activities provided in the area by NHS community hospitals.
However, as we found that these hospitals only overlapped with the parties to a
limited extent in the provision of acute services, we do not include them in Figure 1.
FIGURE 1
Foundation trusts in the wider Dorset area
Source: CC calculations.
Note: The green dots indicate the locations of GP practices in the Dorset CCG region and purple dots, GP
practices in the West Hampshire CCG region. The coloured line around each hospital shows its catchment
area.
31.
The parties told us that they were not close competitors because they provided a
different range of services and because they did not have incentives to compete
(because of their funding arrangements, capacity constraints and the degree of
cooperation between them in the form of shared consultants).
Overlaps
32.
We analysed overlaps between the parties at specialty level. We found that the
parties overlapped in provision of:
• inpatient services in 19 elective specialties;
• inpatient services in 21 non-elective specialties; and
• outpatient services in 36 specialties.
6
These specialties represented a significant proportion of the parties’ income, whether
calculated at specialty level or at treatment level. We estimated that the parties
overlapped in specialties that represented a significant proportion of their total clinical
revenues (61–70 and 61–70 per cent for RBCH and PH respectively).
33.
However, on the basis that there may be a degree of differentiation within specialties,
we took constraints at sub-specialty level into account by analysing the extent to
which the parties overlapped within specialties at treatment level.
34.
We considered specialised services within our analysis of elective, non-elective and
outpatient services and found that they overlapped in 17 specialised services in
2013/14 and a further four in the recent past.
Elective services
35.
We examined whether the merger might lead to unilateral effects in relation to the
provision of outpatient and inpatient elective services. We considered the views of
the parties and third parties; the effects of the merger on actual competition in the
relevant markets; and finally the effects of the merger on potential competition in the
relevant markets. We considered competition for the relevant elective services
markets separately later in our report.
36.
Having established that the parties overlap to a significant degree in the provision of
elective services, to determine whether a lessening of competition in relation to provision of elective services could arise, we analysed whether all of the following
conditions apply to the overlap elective services:
(a) patients and/or GPs have and exercise choice of provider;
(b) quality influences that choice;
(c) the parties would have an incentive to compete to attract patients absent the
merger; and
(d) the parties are close competitors.
37.
We then considered whether the merger would likely give rise to adverse effects in
any elective services, due to a removal of rivalry between the parties.
The nature of competition in elective services
38.
As providers of publicly-funded NHS services for patients, foundation trusts have
many different objectives. Healthcare professionals and managers, in general, want
to deliver high-quality care for their patients. However, these organizations also have
the objective of ensuring they receive sufficient revenue to cover the costs of provision of healthcare services. Foundation trusts can retain any surplus for investment
in new or improved services for patients, so they have an incentive to generate
surpluses. As there is a fixed price for each elective treatment under the PbR regime,
this means that foundation trusts have an incentive to compete on quality to attract
patients to their profitable elective services.
39.
There are many different aspects of quality, including clinical factors such as infection
rates, mortality rates, ratio of nurses or doctors to patients, and compliance with best
practice (eg Royal Colleges’ guidance); and non-clinical factors such as waiting
times, food and environment, choice of location (if services can be provided on more
7
than one site), quality of non-clinical staff and parking facilities. Some aspects of
quality, such as mortality rates or waiting times, are directly observable. In other
ways, quality can only be judged once the patient has received treatment. This
means that patients and GPs will assess quality in a number of different ways, including by reference to the general reputation of a hospital.
40.
We found that GPs and patients both contribute to the choice of provider and will
have access to different sources of information. Hospital services tend to be
experience or credence goods, ie quality does not necessarily or entirely take the
form of qualities that can be measured or observed ex ante (or even ex post), and
while patients may rely to some extent on their own or friends’ personal experience,
GPs are well placed to observe the quality of services and to interpret published
information on quality. Therefore, we considered that GPs act appropriately as
advisers in patients’ decisions about choice of hospital. Unlike price or quantity, many
aspects of quality cannot be set directly. The quality of a product or service is the
outcome of many different decisions that are made at many different levels across an
organization. In the case of hospital services, these decisions are taken by clinicians
and managers. In doing so, we understand that they trade off different factors.
41.
The effect of competition is to focus these decisions such that account is taken of the
factors that matter to patients and GPs. The greater the number and quality of
alternative hospitals in the local area, the stronger the trusts’ incentives will be to
focus on delivering those aspects of quality that are important to the trusts’ patients
and their GPs. In this way, we expected competition between hospitals to lead them
to make spending decisions in a way that best reflects the factors that matter to
patients and their GPs.
Extent of patient/GP choice
42.
Patients have a right to choice of provider for their first consultant-led outpatient
appointment for routine elective services, which is enshrined in the NHS Constitution.
Even where patients do not exercise this choice themselves (either with or without
the advice of their GP), their GP will take the decision as to where the patient should
be referred, and similar factors may be relevant to the GP’s choice. We found that,
where there are realistic alternatives available, choice will be exercised by patients
and/or GPs in relation to first outpatient appointments. This choice will affect both
outpatient and inpatient parts of the pathway, and the exercise of this choice
generates scope for hospitals to compete against one another in relation to both
outpatient and inpatient services.
The influence of quality on patient and GP choice
43.
We considered the extent to which quality of elective services influences patient
and/or GP choices. We considered the views of RBCH, PH and third parties on the
role of quality competition in the NHS. We also considered evidence from economic
literature on choice and competition in the NHS; the evidence obtained via our survey
of patients and GPs in the Dorset area on the role of quality in their choice of which
hospital to attend; our analysis of GP referral patterns and what this tells us about the
role of quality in their choice of which hospital to attend; and the marketing strategies
of the parties.
44.
The survey indicated that a significant proportion of patients do exercise choice in
relation to hospitals; that quality influences choice; and that if quality (using waiting
times as a quality indicator) were to decrease, a proportion of patients would
consider switching. We also found that a significant proportion of patients attended
8
their nearest hospital, indicating that proximity plays an important role in patients’
decisions. We also analysed the evolution of hospital shares over time at the GP
practice level, which showed some variation over time, indicating that factors other
than location were likely to be influencing patients’ choices.
Incentives to compete
45.
A fundamental principle of the NHS policy framework (including the PbR framework,
the introduction of foundation trusts with their ability to retain surpluses and changes
to the regime for competition enforcement), is that there are incentives for the parties
to compete to attract patients in order to earn income.
46.
We reviewed (a) information provided by the parties on their approaches to marketing
and (b) their internal documents, with a view to establishing whether these were consistent with them competing on quality in the past and, if so, what quality measures
were relevant. Some of RBCH’s documents indicated that, at least in the past, it had
(or believed it had) the incentive and ability to affect referral patterns and the number
of patients it treated, and that it competed with other healthcare providers (including
PH, other hospitals in the wider area, and providers in the community for certain
services). The parties’ post-merger plans showed their awareness of the role of
competition and provided some examples of the benefits of competition.
47.
We assessed the extent to which the parties’ incentives might have been affected by:
(a) the profitability of increasing elective activity given the tariffs and cost structure;
(b) the contracts the parties have in place with each other for sharing of clinical staff;
(c) capacity constraints;
(d) the relationships the parties have with CCGs; and
(e) regulatory factors relevant to quality standards.
48.
We concluded that although their incentives are weakened to some extent by
uncertainty over payment for extra activity and, at the aggregate level, by constraints
on expanding overall capacity, incentives to compete remain. We considered that the
parties’ incentives to compete for patients could be stronger in the future.
Closeness of competition
49.
We considered the extent to which the parties are close competitors compared with
other hospitals in and around the wider Dorset area. We found that:
(a) There is little overlap between the catchment areas of the parties and those of
any other acute hospital.
(b) Location is important in patients’ choice of hospitals, which implied that the
parties could be expected to be each other’s closest competitor and that other
competitors could exert significantly less constraint.
(c) Our survey found that for patients who had chosen one of the parties, the other
merging party was the most likely to be discussed with GPs and the most likely
second choice, although not always a close second. It also showed that a large
proportion of patients did not know where else they would go, and of those who
9
did, a majority strongly preferred the other merging party to a third-choice
hospital.
(d) Looking at GP referral patterns, the parties were the best ranked alternative to
each other at the majority of GP practices from which they drew patients, and
more so at practices from which they drew the bulk of their referrals.
(e) The merger would significantly reduce the proportion of the parties’ revenue
earned from referrals by GP practices where they currently face competition and
therefore we expected the merger would significantly alter their competitive
incentives.
50.
We found that the parties are the closest alternative to one another for patients and
GPs in the local area and they are likely to face limited constraints from other
healthcare providers in the area for a large proportion of their services. Our analysis
indicated that the merger would significantly reduce the proportion of the parties’
revenue earned from referrals by GP practices where they currently face competition
and therefore we expected that the merger would significantly alter their competitive
incentives.
51.
We received evidence that the parties competed with each other prior to the decision
to merge, in so far as they engaged in marketing and strategic behaviour to some
degree. Evidence from the parties’ internal documents provided examples of the
benefits of competition and the parties’ intent to attract patients by emphasizing
aspects of quality. The examples include focusing on waiting times, implementing
best practice guidance, delivering innovative models of care, extending expertise and
enhanced service provision and improving facilities to attract patients. The parties
were aware of the role of competition and the importance of quality in maintaining or
growing share of patient referrals.
Conclusion on the effect of the merger on actual competition in elective services
52.
In summary, we found that the parties overlapped in relation to 19 elective inpatient
and 36 outpatient specialties (although two related only to follow-ups to emergency
treatments and one to maternity). We found that patients (and/or GPs) would be
likely to exercise choice in relation to elective services and that quality mattered to
patients and GPs and appeared to be a factor driving choice. We found that the
parties do have incentives to compete and are each other’s closest competitors. We
found evidence of competition between the parties and found that they would be
likely to compete more in the foreseeable future absent the merger.
53.
We therefore concluded that the merger would be likely to lead to unilateral effects in
these markets for 19 elective inpatient specialties and 33 outpatient specialties that
related to elective inpatient activity.
54.
We expected that the loss of actual competition between the parties would result in
less pressure to maintain and improve the quality of the services that they offer to
patients. We found examples of the benefits of competition including focusing on
waiting times, implementing best practice guidance, delivering innovative models of
care, extending expertise and enhanced service provision and improving facilities to
attract patients. We expected the loss of actual competition between the parties to
manifest itself in a reduction (or lack of improvement) in quality in the overlap
specialties in which competition would be removed. We also expected that the
reduction in competition could manifest itself in a reduction in quality at the hospital
level.
10
Conclusion on competition in non-elective services
55.
We found that there were areas of substantial overlap between the parties in the
provision of non-elective services. We found that many patients do not have a choice
of hospitals, because they are transported by emergency services according to
ambulance protocols. For those that are not, we noted that there is no guarantee of
choice (unlike in relation to elective services). We also noted that the link between
quality and choice was likely to be less clear than with elective services, because
there is less opportunity for patients to make a choice based on quality (because they
will have less opportunity to research it when they need emergency treatment and
may not have input from a GP). The parties, especially RBCH, were not strongly
incentivized to attract additional patients, and in some specialties may have no
incentive to do so at the margin, due to the 30 per cent marginal rate tariff for
emergency services 2 and, to a lesser extent, the reduced certainty over payments
reflecting activity due to managed contracts with commissioners. For these reasons,
we found that the proposed merger was unlikely to result in an SLC in relation to nonelective services.
Conclusion on competition in maternity services
56.
Maternity services are classified as non-elective services but not as emergency
services. The issues that arise are different from other non-elective services and
more similar to elective services (in the manner in which choice is exercised) and
therefore we have assessed them separately.
57.
We found that patients had choice between maternity services providers and aspects
of quality appeared important to their choices. RBCH attracted a significantly smaller
number of mothers compared with PH (and could only accommodate low-risk births),
but it nevertheless appeared to be the only provider other than PH with a substantial
number of births in the parties’ catchment areas. We therefore thought it was likely to
be the strongest constraint on PH. Finally, we found that PH had incentives to try to
attract more expectant mothers, and those incentives were likely to increase once
PH’s capacity had increased (which would happen absent the merger through a
planned refurbishment). Therefore we found that the merger could be expected to
lead to unilateral effects in maternity services (both inpatient and outpatient services).
Conclusion on competition in community services
58.
We considered whether the merger may be expected to result in unilateral effects in
the provision of community services supplied by both parties.
59.
With the exception of certain maternity services (which we considered separately),
and a general dermatology outpatient service (which is captured within the scope of
our outpatient analysis), there was no overlap between the parties’ activities in the
supply of community services. Therefore the merger would not reduce competition in
the market. Although it is possible that in the future more services will move into a
community setting, and that there could be less competition in provision of those
services as a result of the merger, we did not find evidence that there were any such
services that both parties would be likely to supply in the counterfactual; and we
2
Under this rule, only 30 per cent of the normal PbR tariff is paid on all services resulting from emergency admissions once the
total value of all these services in a given year exceeds the value or ‘baseline’ in 2008/09, and after 2008/09 prices have been
adjusted to current year prices (ie 2008/09 volumes are applied to current year prices and this gives the ‘baseline’ above which
the marginal tariff is 30 per cent). The intention of this tariff is to give an incentive to support the shift of care out of hospital
settings and keep the number of emergency admissions to a minimum.
11
considered that the relative ease of entry would be likely to offset any unilateral
effects.
Conclusion on competition ‘for the market’ in elective, non-elective, community and
specialised services
60.
We considered whether the merger would be likely to lead to reduced competition in
relation to services which commissioners may change or reconfigure, because the
merger would reduce the number of potential suppliers. We considered, in turn,
elective services, non-elective services, community services and specialised
services. The first three types of service are procured by CCGs (primarily Dorset
CCG in this case) and the fourth by NHS England (Wessex).
61.
There are generally two concerns in a merger when competition is ‘for the market’:
(a) in the event of a competitive tender the merger could lead to worse outcomes
because there would be fewer bidders (which may be reflected in commissioners
receiving reduced value for money, including lower quality or, if prices are not set
at national rates, higher prices); and
(b) suppliers on existing contracts might provide lower-quality services, knowing that
commissioners had fewer options to replace them post-merger than in the
counterfactual.
62.
Based on information provided to us by the commissioners, we did not find that the
merger would be likely to give rise to SLCs in relation to competition for the market
for elective, non-elective, community or specialised services.
Conclusion on private services
63.
We found that the parties overlapped in provision of a number of private services. In
relation to most of these services, we considered that the parties were likely to be
constrained by competing providers of private services, who offered the same
services in larger volumes than the parties and in close proximity to the parties.
64.
However, we found that there were no major alternative competing providers of
inpatient private cardiology services in the relevant area who would be likely to
constrain the merged entity. We therefore found that the merger would be likely to
give rise to unilateral effects in relation to the supply of private inpatient cardiology
services.
Countervailing factors
65.
We concluded that the unilateral effects in relation to elective, non-elective, maternity
and cardiology services outlined above were unlikely to be mitigated by countervailing buyer power or entry. The parties did not put forward any arguments in
relation to efficiencies and we did not consider that efficiencies were likely to
enhance rivalry in a way that would counteract any adverse merger impacts.
Conclusions on the SLC test
66.
We have concluded that the proposed merger may be expected to result in an SLC in
the wider Dorset area in the supply of the following services:
12
(a) 19 elective inpatient services: general surgery, breast surgery, colorectal surgery,
upper gastrointestinal surgery, pain management, 3 general medicine, gastroenterology, endocrinology, clinical haematology, hepatology, diabetic medicine,
rehabilitation service, palliative medicine, cardiology, dermatology, respiratory
medicine, rheumatology, geriatric medicine and gynaecology;
(b) 34 outpatient services: general surgery, urology, breast surgery, colorectal
surgery, hepatobiliary and pancreatic surgery, upper gastrointestinal surgery,
vascular surgery, trauma & orthopaedics, ENT, ophthalmology, oral surgery,
cardiothoracic surgery, anaesthetics, pain management, general medicine,
gastroenterology, endocrinology, clinical haematology, hepatology, diabetic
medicine, clinical genetics, rehabilitation service, palliative medicine, cardiology,
dermatology, respiratory medicine, medical oncology, neurology, rheumatology,
paediatrics, geriatric medicine, gynaecology, clinical oncology and maternity;
(c) one non-elective inpatient service: maternity; and
(d) one private service: cardiology.
67.
We found that the affected specialties together accounted for approximately 20 to
30 per cent of PH’s total clinical income and 20 to 30 per cent of RBCH’s total clinical
income.
Relevant customer benefits and remedies
68.
Having found that the merger may be expected to result in a substantial lessening of
competition (SLC) in 55 services, we considered whether the merger would be likely
to give rise to relevant customer benefits (RCBs) and whether any action should be
taken to remedy, mitigate or prevent the SLC or any adverse effect arising from it.
69.
The parties proposed to us that the merger would result in RCBs in five clinical areas:
maternity; cardiology; haematology; A&E and emergency surgery. More specifically,
the parties’ preferred options (subject to any and all necessary legally-compliant
clinical, stakeholder and public engagement and consultation on service change) are:
• For maternity, the hospitals have told us that the primary benefit is that they could
build a new maternity unit. Their current preferred option would be to build this unit
at the Poole hospital site.
• For cardiology, the hospitals have told us that they could combine cardiology rotas
which would mean that patients at Poole will have access to a cardiologist 24/7,
which they do not currently have.
• For haematology, the hospitals have told us that the merger would provide them
with the opportunity to consolidate the level 3 haematology services (these are
complex treatments for lymphoma and leukaemia) at Poole hospital, with a ‘spoke
service’ (including outpatient and day cases) at Bournemouth hospital. They have
told us this would allow improvements in quality and outcomes for patients.
• For A&E and emergency surgery, the hospitals have told us that services could be
reconfigured after the merger to have a major injury A&E unit at one site which
has consultant staff present 16 hours a day, seven days a week (rather than 12
hours a day during the week and 3 to 4.5 hours a day at weekends) and a minor
3
In relation to services other than persistent pain management.
13
injuries unit at the other hospital. Emergency surgery would be located with the
major injury A&E unit.
70.
In addition we considered the following benefits: other clinical benefits; financial
savings; merger-avoided costs; merger-enabled investments; balanced portfolio of
services and cost savings to commissioners.
71.
We assessed whether these were benefits to patients and whether they met the
statutory test for RCBs. This test requires the proposed benefit to be a benefit to
customers (in this case patients and commissioners) in the form of lower prices,
higher quality, greater choice or greater innovation. Also, we must believe that the
benefit may be expected to accrue within a reasonable period as a result of the
merger and is unlikely to accrue without the merger.
72.
We did not find that any of the benefits put forward by the parties met the statutory
test for RCBs, for the following reasons:
(a) Maternity: Monitor found that a reconfiguration of maternity services proposed by
the parties would be likely to be a benefit. This benefit proposal was withdrawn by
the parties in August 2013; we therefore did not consider this. The parties
proposed that the merger would allow them to combine midwife rotas but did not
explain how this would be a benefit to patients or how it would be implemented.
We therefore did not consider this to be a relevant customer benefit. The parties
proposed that the merger would allow them to build a new maternity unit which
would improve the patient environment at PH. We found that this would be a
benefit to patients. However, we did not find that this benefit could be expected to
accrue within a reasonable period, because:
(i)
The new unit will not need to be operational until 2018/19 (due to the current
investment occurring at PH in its existing maternity unit) and therefore a final
decision to proceed with the investment in a new unit is not required
immediately. The financial environment for all NHS hospitals over the next
two years is expected to be challenging. This is likely to put a strain on the
revenue budget of the merged entity, with a knock-on effect on the capital
budget.
(ii) The parties do not at this stage have a clear plan for the new maternity unit
and have not prepared their analysis of the proposed investment so the
issues of where clinically interdependent services should be located have not
yet been resolved and we would expect the plans to consider the
configuration of maternity services across the whole area.
(iii) RBCH and PH have not developed their plans in detail. There has been only
a very preliminary estimate of costs and revenues; the location of the new
unit has not been decided; and the impact of the plan on clinically
interdependent services has not been carried out.
(b) Cardiology: The parties put forward that the merger would result in: (i) a single
dedicated rota of cardiologists across the two sites; and (ii) acute cardiac
inpatient admissions being consolidated at RBCH. In line with Monitor findings,
we did not find admissions consolidation to be a benefit that would be unlikely to
accrue without the merger, particularly as this had in part already occurred since
Monitor’s assessment. Whilst we found that a single rota could be a patient
benefit, we did not find that this would be unlikely to accrue without the merger.
14
(c) Haematology: The parties told us that reconfiguration of haematology services,
whereby the most specialised (level 3) services would be located on one site,
would be a benefit to patients resulting from the merger. We received mixed
evidence from the parties and commissioners. In particular, NHS England
(Wessex) (the commissioner of these services) told us that the parties had both
recently assessed themselves as meeting the relevant standards for level 3
haematology and therefore it had no plans to reconfigure the services. We
therefore did not have sufficient confidence that the merged entity would proceed
with the reconfiguration of the services and therefore did not find it likely that the
benefits would accrue.
(d) A&E and emergency surgery: The parties told us that the merger would enable a
reconfiguration of A&E services which would result in better A&E consultant
cover. This would be achieved by reconfiguring the two A&E units of PH and
RBCH to a major injury A&E and a minor injury A&E, with the minor injury A&E
being staffed primarily with nurses with input from GPs and remote oversight by
A&E consultants situated at the major injury A&E unit. If A&E were reconfigured,
then emergency surgery would be consolidated on the major injury A&E site,
allowing that site to have a dedicated emergency theatre 24/7. We noted that
significant reconfiguration of this type would involve moving interrelated services
and that whilst such a reconfiguration could have benefits, it could also create
disbenefits. No detailed model of care had been developed on a local basis,
assessing the benefits and disbenefits of the proposal. Commissioners were
therefore unable to provide support for the specific reconfigurations proposed.
We thought that an A&E reconfiguration could create both benefits and
disbenefits locally and therefore could not conclude that the proposal was an
overall benefit to patients. We therefore did not find that the A&E benefit
proposed by the parties was a relevant customer benefit.
(e) Other clinical benefits; financial savings; merger-avoided costs; merger-enabled
investments; balanced portfolio of services; and cost savings to commissioners:
we did not find that any of the proposals would be likely to result in RCBs within
the meaning of the Act.
73.
In the Notice of possible remedies, we invited views on prohibition of the merger as
an appropriate remedy for the expected SLC in this case. The parties proposed a
behavioural remedy based on the friends and family test which they told us would
allow the quality of the merged trust to be monitored. If quality (as measured by this
test) decreased at the merged trust, the parties proposed that the remedy should
include a number of escalation arrangements. No other remedies were proposed by
any parties.
74.
We found that the proposed behavioural remedy is not likely to be an effective
remedy to the SLC we have identified and did not consider that it could be modified
to make it effective.
75.
We concluded that the benefits proposed by the parties were not RCBs within the
meaning of the Act and that it would not be appropriate to modify the only remedy
that we have found to be effective, namely prohibition
76.
We therefore concluded that prohibiting the merger was the only effective remedy
and that it was proportionate to the SLC.
15
Chief Executive’s Office
The Royal Bournemouth Hospital
Castle Lane East
Bournemouth
Dorset BH7 7DW
Tel: 01202 704242
Fax: 01202 704077
Email: [email protected]
Chief Executive’s Office
Longfleet Road
Poole
Dorset
BH15 2JB
Tel: 01202 442624
Fax: 01202 442743
Email: [email protected]
CB/TS/SJL
18 October 2013
Mr Roger Witcomb
Chairman
Competition Commission
Victoria House
Southampton Row
London WC1B 4AD
Dear Mr Witcomb
Royal Bournemouth and Christchurch Hospitals NHS FT / Poole Hospital NHS FT
We listened with interest to your interview on Wave FM yesterday in which you said that the
two Foundation Trusts "... are in their minds clearly committed to this merger but I think
if they were to go away to assemble the evidence we think is needed, it would be a
relatively simple matter I think to get clearance quickly."
You are correct that the parties are committed to the merger and, as you know, we have
invested a good deal of patient and other public money as well as management and clinical
time in seeking to pursue it.
Our boards will therefore be very interested in your indication that clearance on a fresh
notification could be achieved simply and quickly if further evidence were obtained. They will
though be most reluctant to sanction the spending of any further patient money without a
good deal of clarity about what evidence is required.
We would therefore be grateful for details of what evidence would enable us to obtain a
"simple" and "quick" approval. Would a detailed local model of care for example be
sufficient (a point we note that you raised in respect of A&E and Emergency Services) or
would more be required and if so what?
Finally, we should note that, whilst the parties are very disappointed with your decision and
disagree with it in fundamental respects, they have concluded that it would not be a proper
use of patient money for one public body to bring against another an application for a review
at the Competition Appeal Tribunal.
-2-
We are copying this letter to David Bennett as Monitor have been in active discussion about
the current system for review of hospital mergers and we are sure he would be interested
also to see your response.
Yours sincerely
Chris Bown
Chief Executive
Poole Hospital NHS Foundation Trust
cc:.
Tony Spotswood
Chief Executive
Royal Bournemouth &
Christchurch Hospitals NHS Foundation Trust
Dr David Bennett,
Chief Executive, Monitor, Wellington House, 133-155 Waterloo Road, London SE1 8UG
BOARD OF DIRECTORS
Meeting Date and Part:
8 November 2013 Part 1
Subject:
Keogh Review learning
Section:
Information
Executive with Overall
Responsibility
Tony Spotswood, Chief Executive
Author of Paper:
CQC, Monitor, NHS England and other parties
Details of previous
discussion and/or
dissemination:
Patient Safety
Health & Safety
Performance Strategy
Key Purpose:
X
X
Action required by BoD:
To note the proposals
Executive Summary:
Clarification of the need for whole system working to address
challenges in improving the quality of care in England
Strategic Goals &
Objectives:
Maintaining high quality services
Links to CQC
Registration: (Outcome
reference)
Links to Assurance
Framework/Key Risks:
Outcome 16: Quality of Service provision
Quality and Safety
Internal
External
Type of Assurance:
X
Board of Directors Part 1
8 November 2013
Learning from the Keogh Review of 14 Trusts
I attach a paper authored on behalf of the CQC, Monitor, NHS England, and other
parties, setting out how the system should work to support improvements in quality
post the Keogh Review.
This paper is provided to the Board for information.
Tony Spotswood
Chief Executive
Keogh Review learning
Information
Page 1 of 1
BOARD OF DIRECTORS
Meeting Date and Part:
8 November 2013, Part 1
Subject:
Core Brief
Section:
Information
Executive Director with
overall responsibility:
Tony Spotswood, Chief Executive
Author of Paper:
Tracey Hall, Head of Communications
Key Purpose
Patient
Safety
Action required by Board
of Directors:
Note for information
Executive Summary:
The Core Brief distributed within the Trust in October
2013
Health &
Safety
Performance
Strategic Goals &
Objectives
Links to CQC Registration
(Outcome reference)
n/a
Links to Assurance
Framework/Key Risks
n/a
Type of Assurance
Internal
External
Strategy
Core Brief
From: Tony Spotswood, Chief Executive
October 2013
Merger - moving forward
On 17 October the Competition
Commission announced its final
decision to prohibit the proposed
merger of the foundation
trusts. The decision is really
disappointing given the great
efforts we have made in focusing
on the benefits for the population
in east Dorset and the support
we have received from our
commissioners.
We began this process for the
right reasons and believe merger
would have been the best option
to ensure we can continue to
provide high-quality hospital
services to local people.
Despite the decision, our priority
and focus remain to provide the
very best quality health care that
we can for patients. This means
working closely with the wider
health community, which we are
committed to doing in earnest.
We have worked extremely
effectively with Poole Hospital
colleagues over the last two
years and we will continue
to build on this and explore
areas where we can work in
partnership.
For us, work starts now with you
to develop our clinical strategy,
vision and plans for the next
three years, with providing
quality care at the heart of every
decision we make. More detailed
planning of services including
changes to existing models of
provision, so as to enhance care,
is now underway and we will
ensure this is clinically-led and
consulted upon where necessary.
We will continue to ensure the
safety of our patients, a good
patient experience and clinical
effectiveness.
We would like to thank
you very much for your
hard work and support
over the last two years.
While contributing to
the merger, staff across
our hospitals have
worked extremely hard
to ensure we continued
to provide high-quality
services to our patients
throughout the process.
Colleagues have often
gone above and beyond
which shows great and
enduring commitment
to our patients.
Now that the merger
is not going ahead,
what will happen with
those departments that
have already started
the process of merger
e.g. health records,
estates, IT?
There are a number of
corporate and support areas
that have already merged
across the two trusts. These
were not dependent on the
merger of the two organisations
and would have happened
regardless of the Competition
Commission’s final decision.
There will, therefore, be no
change to areas that have
merged already.
Why did we start a
costly process that was
going to be difficult to
achieve?
The total cost for merger is
£5m, £4m of which was funded
by the South West Strategic
Authority before it dissolved in
April 2013. The remaining cost
is shared jointly between both
trusts.
A lot of work that has been
carried out on identifying
Continued on page 2
Please share this issue of Core Brief with colleagues
who do not have regular access to email
1
Continued from page 1
efficiencies and areas of
organisational development as
part of the merger process and
this will not be lost.
We began this process for the
right reason and believe merger
would have been the best option
for ensuring that we can
continue to provide high-quality
sustainable services in Dorset.
As the first foundation trusts
seeking to merge following
amendments to the Health and
Social Care Act provisions
implemented in April 2013 we
have been breaking new ground.
The assessment of the merger
was always weighted to put
competition ahead of benefits
to patients, and we do not
believe the NHS is best served
in this way.
There have been a number of
discussions with ministers
regarding the merger process -
the time taken and the
cost to the taxpayer - and we
have shared our learning from
this experience. There is
national recognition that
the competition process is
preventing joint working,
reconfiguration and service
improvements. We therefore
believe that we will see a greater
role for Monitor, the regulator
for health services, earlier in the
merger process for future health
organisations wishing to take
this approach.
As there is no merger
will this affect the
upgrade of Christchurch
Hospital?
The developments at
Christchurch Hospital ensure
the hospital remains a focal
point in the local community
and are going ahead regardless
of the outcome of merger.
What happens to the
director posts that
were appointed?
The board of director posts
identified for the new
organisation would only have
come in to effect if the merger
was successful. These were
shadow posts. Without merger
these posts will not be
progressed and both boards of
directors will remain individually
accountable for their
organisation.
Will the money put aside
for developments as a
merged organisation
now be invested in RBCH?
Yes, over the coming months
we will be working with you to
develop our clinical strategy,
which will includes our estates
strategy and how we will
develop services. We will also
be working with patients and our
health partners on this piece of
work.
Let’s talk about IT
As part of RBCH and Poole
Hospital’s IT Strategy, a new
Change Advisory Board (CAB)
has been created to help staff
make the most of IT capabilities
and to ensure that all new IT
developments, regardless of
their size, are considered and
evaluated by the IT Department.
CAB will consider all IT
requests for change or
development, which might
range from a small database
for an individual through to a
new smart phone app.
All IT requests should be
made by submitting an online
Request for Change form (RFC)
on the intranet. The new online
form replaces the previous
process of downloading the
RFC document, and will help
make sure submissions are
complete by validating the form
and highlighting mistakes or
missing information.
The progress of all projects and
developments will be tracked
on a project list. The project
list will soon be made available
on the intranet, where you will
be able to view the status of all
projects, listed by directorates.
IT requests will be considered
solely on the content of
the RFC form and the main
evaluation will focus on
technical issues, confirmation
that it is within IT policies,
and also the ability to provide
ongoing support.
2
Once CAB has approved the
request, it will either go to the
IT Senior Managers’ meeting to
prioritise or if the project costs
are over a certain value, the
request will be passed to the
Informatics Steering Board.
CAB consists of 10 permanent
members, representing services
across the Trust, including
information governance and
clinical safety, as well as a
variety of IT teams.
Names of CAB members, full
details of CAB meetings and
the online Request for Change
form can all be found on the
intranet: http://rbhintranet/
itservices/change_advisory_
board.shtml
CQC Visit have your new paperwork coming soon
say
Getting the most out
of your appraisal -
The CQC will be carrying out
an inspection of our services
on Thursday 24 and Friday
25 October. Unannounced
inspection/s will be carried
out following the announced
visit. Staff can contact the
CQC inspectors both before
and during the inspection.
As well as raising any issues
you may have, this is an
opportunity for you to speak
about the things you do well
that you would like to share.
If you would like to pass
on information to the
inspection team, you can
contact the CQC’s National
Customer Service Centre on
03000 616161, and give
reference number RDZ.
Alternatively, you can use its
‘share your experience’ form
on its website: www.cqc.org.
uk/public/sharing-your-exper
ience.
If you or your colleagues
would like to meet with the
inspectors during the visit
please send your name, job
title and contact details to
[email protected]
by 12noon on Tuesday
22 October.
Appraisals are designed for
everyone. They help to clarify your
current role, set objectives, provide
feedback on your performance and
identify any development needs.
Research also suggests there is a
direct link between the quality of
your appraisal and training, and
patient outcomes.
In the next few weeks we will be
relaunching the appraisal paperwork
which includes a simplified
Knowledge and Skills Framework
(KSF) process. There will be easier
to use forms and plenty of help
guides for both the appraiser and
appraisee to get the most from the
appraisal process.
A number of briefing sessions will
take place at RBH in November so
you can find out more about the
new appraisal paperwork. All staff
are welcome to attend and more
sessions will be provided to meet
demand.
It is important to remember that
appraisals are a two-way process,
giving you the opportunity to
comment on your progress and how
you think you are doing. If you feel
you have already got the most out of
your role, they are an opportunity for
you to discuss how you might
be able to share your knowledge
with your colleagues.
Appraisal briefing sessions
Managers session: this one-hour session will explain the new
appraisal paperwork and focus on the process for carrying out
appraisals and how to link in the KSF, values and the Quality
Strategy. Dates, times and venues:
•8 November: 10-11am, Conference Room, Education Centre
•14 November: 11-12noon, Seminar Rooms 3 and 4,
Education Centre
•15 November: 9.30-10.30am, Conference Room,
Education Centre
Employees session: this one-hour session will explain the new
paperwork and process and explain the importance of appraisals
and how to get the most out of them. Dates, times and venues:
•19 November: 10.30-11.30am, Lecture Theatre,
Education Centre
•22 November: 10-11am, Conference Room, Education Centre
•26 November: 9-10am, Seminar Rooms 1 and 2
Book a place: To book a place on one of the sessions,
email [email protected] or call ext 4158.
Coming soon!
The training pages on the intranet are being revamped, and
will include the new appraisal paperwork. We’ll let you know
when they are live.
3
Urgent care developments
A number of staff have asked what
the Trust is doing to manage the
continued increase in the number
of urgent care patients coming into
the hospital, particularly as winter
approaches.
Developments are in place
and new investment has been
made aimed at improving urgent
care and supporting increased
emergency pressures. These
include:
• schemes to secure clinical and
other staff cover to move toward
24/7 care
• additional bed capacity (internal
and within the community). The
equivalent of up to 35 more
beds will be available by the end
of November
• improving frail and elderly
clinical and locality pathways
• patient flow and discharge
process improvement
An Urgent Care Board has
also been set up, consisting of
NHS and Social Services chief
executives and other directors
across Dorset. This board
has agreed a further £1.1m in
funding to support urgent care
developments. These include:
• South West Ambulance
Emergency Practitioner support
vehicles
Staff Survey
questionnaires
The Staff Survey is sent to a random
selection of 850 staff and provides an
opportunity for those people to give their
views on a variety of topics, including:
• their job and personal development
• their managers
• the organisation
• their health, wellbeing and safety at
work
The response rate for return of Staff
Survey letters currently stands at 32.4%,
which is a fantastic uptake. However, if we
wish to improve on the Trust’s response
rate of 56.2% for last year we need more
people to return their forms by the closing
date of 2 December.
If you receive a questionnaire, please
make your opinions count by completing
and returning in the envelope provided.
Please be assured that all completed
questionnaires remain confidential.
Information about previous Staff Surveys
can be found on the intranet.
If you have any queries regarding the
survey please contact Vicky Douglas
on ext. 4460
• enhanced primary care service
in the Emergency Department
• integrated virtual ward
- supported by primary,
community, social and
secondary care
• extended and seven day
diagnostics
• increased integration of health
and social care
• multi-disciplinary support for
discharge, and improved access
to community beds and care
packages
• additional schemes - e.g.
therapy support to increase
community hospital discharges
New midwifery-led
birthing unit
The Trust is looking into options to create a new
midwifery-led unit on the RBH site, signalling our
future commitment to midwife-led births in the
conurbation.
The unit would still be located at RBH but with an
improved layout and located closer to the hospital’s
road, improving access for arriving mums. The
location would have dedicated car parking bays and
would also improve emergency transfers by
ambulance should mothers unexpectedly need
obstetric support, available at Poole Hospital.
The Trust has applied for planning permission for the
new unit to see if the option is viable and is working
with those in the Maternity Department on the plans.
If they are given the go ahead by Bournemouth
Council, the unit could be in use by Spring 2014.
The midwifery unit has always promoted normal birth
and will provide the same services that it currently
does but will be more suited to support the ethos of
‘home from home’ births. In line with other birthing
units up and down the country, post natal care is
provided more and more in the community.
4
New plated meal service
A new plated meal service has
been introduced at RBH to
improve the efficiency and quality
of food served to patients.
Instead of food being served from
catering trolleys on the wards, it
is now pre-plated in the hospital
kitchens and stored in heated units
before being delivered. Patients
are also able to choose what they
would like to eat just 90 minutes
before it is served and do not risk
their food of choice running out.
Ellen Bull, Deputy Director of
Nursing, said mealtimes are a
vital part of a patient’s recovery:
“Quality of care is integral to
patients and meals and nutrition
are no exception. Trials with the
new plated meal service were
well received, and we are hoping
that patients will review this
improvement positively, ensuring
meals provided are hotter and
more timely.”
Andy Whittingham, Catering
Manager at RBH, now oversees
the plating of more than 1,000
meals a day. He said: “The old
trollies were not giving the patients
the hot food they deserved, and
the wastage was too high. We
hope these very positive changes
will please our patients.”
Improving end of life care at RBCH
Education workshops which focus on improving end of life care at the Trust take place each month and
are open to all staff. The workshops take place on Wednesdays from 1-2pm and upcoming topics include:
End of life care planning
and AMBER care bundle.
DNAR/allow a natural
death
“Nurse! Am I dying?”
What tools are available to help with
end of life care? When should they
be used? How to explain them to
patients and their relatives?
Workshop leader: specialist
palliative care nurse
Date: Wednesday 22 January 2014
Venue: Seminar Room 2,
Postgraduate Centre
Workshop leader: Consultant in
palliative medicine and palliative
care nurse
Date: Wednesday 18 December
2013
Venue: Training Room 3,
Postgraduate Centre
How to manage those difficult
conversations when the doctor
has left the ward.
Workshop leader: specialist
palliative care doctor and nurse
Date: Wednesday 12 February
2014
Venue: Anaesthetics Seminar
Room, RBH
To book a place on the above sessions,
please email [email protected]
Please note that staff can attend more than one
session.
Help us fight the flu this winter and provide
high quality care to our patients
Having the flu jab not only helps
protect yourself from flu, but also
reduces the risk of spreading flu
to your patients, colleagues and
family members. So far more
than 1,500 members of staff have
been vaccinated against the flu so
why not encourage colleagues in
your department to do the same?
Vaccination can help reduce the
Symptom control:
nausea, vomiting, bowel
management and bowel
obstruction
level of sickness absences across
the Trust, keeping services running
smoothly and ensuring we can
offer the highest quality care to
our patients. Last year there was
a 46% uptake of the flu jab at the
Trust and we are aiming for higher
this year.
Walk in clinics will take place
on 18 and 25 October in
5
Occupational Health from 8.45am
- 4pm. Occupational Health is also
carrying out roaming clinics. You
can find out where the trolley is
located by calling 07920490427
or if you would like the trolley
to visit your department, email
[email protected]
Changes to staff car parking
A number of car parking changes
have come into effect to prepare
for ongoing construction work at
RBH:
• additional space for main permit
holders will be made available
elsewhere on the hospital site
and CP Plus attendants will be
on hand during the peak 7.308.30am period to direct staff to
available spaces
• occasional staff car park, S1
is closed to staff and is now a
temporary public car park
closed. This will enable the Trust
to minimise disruption to patients
and visitors using our services as
construction work gets underway.
There are a number of incentives
for individuals who wish to
suspend or give up their permits.
These include free bus passes
for seven days, three months
or a year.
• all staff should enter the hospital
site by the back entrance and
not by the route in front of the
hospital. Either route can be
used to exit the site at the end
of each day
• car park S2 is now for
occasional staff use, with only
a handful of spaces for main
permit holders
• public car park D has been
split between staff parking and
space for construction workers
(at commencement of Jigsaw
construction)
For more information about these
incentives or if you would like to
discuss your travel arrangements
further, please contact Alison
Visitor parking
Walters, the Trust’s Travel Advisor:
[email protected].
Occasional staff permits
Any questions regarding car
parking Main
shouldstaff
be directed
permitsto
[email protected].
Jigsaw Building
construction site
The entrance to the staff car park
at the Eye Unit has now been
New visitor
parking area
S1
Visitor parking
S2
Occasional staff permits
Main staff permits
Multi storey
D
C
Jigsaw Building
construction site
S3
Site of
Jigsaw Building
S4
lti storey
S4
B
A
F
Bus Hub
Map showing new car park layout
F
6
BOARD OF DIRECTORS Meeting Date and Part:
8 November 2013 – Part 1
Subject:
Communications Update and Read All About It
Section:
Information
Executive Director with
overall responsibility:
Deborah Matthews, Acting Director of Service
Development
Author of Paper:
Tracey Hall, Head of Communications and Fundraising
Details of previous
discussion and/or
dissemination:
Key Purpose:
Patient
Safety
Health &
Safety
Performance Strategy
X
X
Action required by Board of
Directors:
To note the report
Executive Summary:
The Communications Report provides a summary of key
communication activities over the past month, including a
summary of the Trust’s media coverage (Read All About
It).
Strategic Goals &
Objectives:
Links to CQC Registration:
(Outcome reference)
Section 1, Outcome 1,
Section 4, Outcome 13 and 14
Links to Assurance
Framework/Key Risks:
Internal
Type of Assurance:
External
X
Board of Directors – Part I
8 November 2013
Communications and fundraising activities
November 2013
1.
Introduction
The following paper sets out:
· recent and future communication and fundraising activities
· RAAI – media coverage from October 2013
2.
Recent activities
·
·
·
·
·
·
·
·
·
·
·
·
·
·
3.
Future activities
·
·
·
4.
launched new staff cascade briefing system for
CQC internal communications and media activity
merger decision communication
two staff vacancies - recruitment underway to replace two communications
officers
promoting Quality Strategy and good news stories
work on developing fundraising strategy and work plan
first Bournemouth Hospital Newsletter released – can be downloaded at
http://issuu.com/bournemouthhospitalcharity/docs/fonf_autumn_2013_fina
l_version
Bournemouth Hospital Charity brand being rolled out. Visits have been
made to over 100 local high street shops in Bournemouth and
Christchurch to raise profile.
new events calendar now established for 2014. Three flag ship events:
March for Men on Sunday 2nd March; Twilight Walk for Women – Friday
6th June and New Forest Bike Ride – date TBC
working with RBCH affiliated charities to develop a stronger relationships.
Combined event with MacMillan Caring Locally being investigated.
Brymore Contractors have now been appointed for the Jigsaw Building.
Hoardings and promotional material being designed.
Kay Kendall Trust released £150k pledge to be used for the Cancer and
Blood Disorder Unit.
notable charity award has been made to the value of £163k for brand new
orthopaedic theatre equipment.
all charity fund application enquiries to be made to the charity office.
Educating the staff to make charitable bids and to think of ways to
fundraise for their respective departments
fundraising strategy and developing FR Strategy and income stream plans
for 2014
reviewing staff awards
developing the Trust’s Communications Plan for 2014
Recommendation
The Board is asked to note the report.
Communications activity – November 2013
For information
Page 1 of 1
Read All About It...
October 2013
October’s media coverage predominantly focused on the Competition
Commission’s final decision on merger. This attracted coverage in local,
national and specialist media.
While there is an increase in negative coverage on last month, this predominantly
relates to merger coverage and patient transport.
The work of the fundraising team and hospital associated charities saw a good
amount of coverage, reflecting the proactive focus on demonstrating to supporters
where donations and funds are being spent.
Articles are published with the kind permission of the Daily Echo, Advertiser,
the New Milton Advertiser, the Stour and Avon Magazine and Seeker News.
Summary of media coverage:
October 2013
Online
17
Print
46
Radio
8
Television
3
October 2013 coverage
Positive
Negative
33
10
OK
October 2012
October 2013 l
1
21
Positive21
Negative 12
OK0
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
October 2013 l
2
14 September 2013
New Milton Advertiser
Forest ride for hospital scanner
Cyclists of all abilities will ride through New Forest
to raise £6,000 for an orthopaedic scanner at RBH.
6
Sixteenth of a page
£23.75
21 September 2013
New Milton Advertiser
Decision criteria on hospital merger ‘flawed’
claims trust
The Trust for RBCH claimed a watchdog’s
criteria for deciding on its proposed merger
with Poole was flawed.
4
Quarter of a page
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
3
28 September 2013
New Milton Advertiser
Study seeks volunteers to help assess cycling as
hip pain cure
Local residents invited to participate in a pioneering
study by RBH to assess the link between regular
cycling activity and reduced hip pain.
10
Two third of a page
£1242.50
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
4
28 September 2013
New Milton Advertiser
Annual meeting will be opportunity to hear hospital
trust’s plans for future
People can find out about RBCH Trust at it’s annual
members meeting.
7
Eighth of a page
£49.88
Date
Publication
Title
Information
Page number
Article size
Date
Publication
Title
Information
Page number
Article size
October 2013 l
5
2 October 2013
Daily Echo
Annual Members’ Meeting
Information about the Annual Members’ Meeting.
15
Eighth of a page
1 October 2013
Daily Echo
Worries of trust merger
Patient comments on why the merger should not
go ahead.
18
Eighth of a page
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
6
2 October 2013
Daily Echo
Understand radiology
Almost 150 people attended a health talk on
radiology at The Village.
20
Sixteenth of a page
£635
2 October 2013
Daily Echo
Chance to name robot
Chance to name the new Da Vinci robot
which is being used for prostate cancer
patients.
20
Sixteenth of a page
£635
3 October 2013
Daily Echo
Health talk on asthma
A health talk on asthma will take place
at 2pm in St Mark’s Church Hall on 5
November.
4
Sixteenth of a page
£635
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
7
4 October 2013
Daily Echo
Marathon is small fry for Cllr Phil
Bournemouth’s deputy major has been tucking
into hospital food in preparation for marathon.
3
Full page
£10,365
Date
Broadcast
Information
Date
Publication
Title
October 2013 l
4 October 2013
BBC News
Dorset hospital staff make kung-flu music
video.
4 October 2013
www.bbc.co.uk
Bournemouth and Poole hospitals make
kung-flu music video
8
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
9
4 October 2013
Stour & Avon Magazine
Get on your bike to reduce hip pain
Cycling against hip pain (CHAIN) is a
concept proposed by Rob Middleton. Asking
for participants to join a study which will be
completed Autumn 2014.
31
Quarter of a page
£180
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
10
5 October 2013
New Milton Advertiser
Plans afoot for new hospital birthing unit
Plans for a new birthing unit at RBH planning
application has been submitted.
3
Quarter of a page
£71.25
Date
Publication
Title
Information
Page numbers
Article size
October 2013 l
11
9 October 2013
Daily Echo
Farewell to Megan-Rose / Little Megan-Rose
loses battle for life
Baby Megan-Rose Gidley who battled
serious health problems lost her battle for life
last week in hospital.
1 and 2
Two pages
October 2013 l
12
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
13
10 October 2013
Daily Echo
£76,000 cash boost for homeless help scheme
New initiative has been set to prevent homeless
people being discharged from hospital bank on to
the streets.
14
Two thirds of a page
£7005
Date
Publication
Title
10 October 2013
www.bournemouthecho.co.uk
£76k funding to stop homeless
people being discharged from
hospital on to streets
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
14
11 October 2013
Daily Echo
October for awareness
October is Lupus awareness month and
members of the Dorset Lupus Group, will be
manning information stands.
7
Sixteenth of a page
£635
11 October 2013
Daily Echo
The NHS at its very best
.
18
Sixteenth of a page
£635
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
15
11 October 2013
Stour & Avon Magazine
Stoma care event at the Royal Bournemouth Hospital
Patients invited to stoma care event at RBH to find out
more about stoma product on 26 October.
18
Eighth of a page
£90
11 October 2013
Stour & Avon Magazine
Charity bike ride
Paul and James Heaton cycled from Barcelona
to Bournemouth raising £4,600 which will be split
between three charities, Bournemouth Hospital
Charity will be one of them.
19
Sixteenth of a page
£45
Date
Publication
Title
Information
Page number
Article size
October 2013 l
16
13 October 2013
Daily Echo
Technology matters
Advertorial Feature. By developing our IT systems and adopting
new technologies, we can significantly improve our patients
experience.
15
Full page
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
17
15 October 2013
Daily Echo
Lifetime of service honour for Phil, 93
Lifetime of service honour for Phil, 93
Phil Carey ex- governor of RBCH has been
honoured with an MBE for a lifetime service.
13
Two thirds of a page
£7005
Date
Publication
Title
15 October 2013
www.bournemouthecho.co.uk
Bournemouth stalwart Phil Carey collects
MBE from the Queen
16 October 2013
Daily Echo
Commission won’t allow this merger’
Hospital bosses at Bournemouth and Christchurch are
expecting their planned merger with Poole to be barred.
Page number 4
Two thirds of a page
Article size
Date
Publication
Title
Information
October 2013 l
18
Date
Publication
Title
16 October 2013
www.bournemouthecho.co.uk
Hospitals merger bid ‘likely to
be rejected’ chief tells staff in
letter
Date
Publication
Title
Information
Page number
Article size
October 2013 l
19
16 October 2013
Daily Echo
Patient transport ‘puts lives at risk’
Livesd being put at risk after the changeover
of Dorset’s non-emergency patient transport
contract, patients have claimed.
5
Two thirds of a page
Date
Publication
Title
16 October 2013
www.bournemouthecho.co.uk
New hospital transport service “putting
patient’s lives at risk”
Date
Publication
Title
Information
Page number
Article size
Value
16 October 2013
Stour & Avon Magazine
Focus on Francis
Advertorial: Poole, the Royal Bournemouth
and Christchurch hospitals provide respected
and highly regarded NHS care to hundreds of
thousands of patients in east Dorset every year.
21
Quarter of a page
£180
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
20
16 October 2013
Stour & Avon Magazine
Hotter, faster food at hospital
A new plated meal service has been introduced
at the Royal Bournemouth hospital to improve the
efficiency and quality of food.
21
Eighth of a page
£90
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
21
16 October 2013
Daily Echo
Information on lupus
Lupus awareness month member of the
Lupus group will be manning a stand at
Bournemouth Hospital on 29 October.
4
Sixteenth of a page
£635
17 October 2013
Daily Echo
Thanks to all hospital staff
Patient said thank you to all ED staff who
treated her daughter.
18
Sixteenth of a page
£635
Date
Publication
Title
October 2013 l
22
17 October 2013
www.bbc.co.uk
Dorset hospital trusts merger plan blocked
Date
Publication
Title
17 October 2013
www.hsj.co.uk
Navigating a competition minefield an HSJ roundtable
Date
Broadcast
Information
17 October 2013
Wave 105
Competition Commission decision on
merger. 11.30 - Pre-recorded interview
with Jason.
Date
Broadcast
Information
17 October 2013
BBC Radio Solent
Competition Commission decision on
merger.
Date
Broadcast
Information
17 October 2013
Radio 2
Competition Commission decision on
merger.
Date
Broadcast
Information
17 October 2013
BBC South Today
Competition Commission decision on
merger.
October 2013 l
23
Date
Publication
Title
17 October 2013
www.itv.com
NHS Trust ‘deeply disappointed’ merger
blocked
Date
Broadcast
Information
17 October 2013
Radio 4
Competition Commission decision on
merger.
Date
Broadcast
Information
October 2013 l
24
18 October 2013
Heart
NHS Trust Merger blocked in Dorset.
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
25
18 October 2013
Daily Echo
Hospital check-up
Public opinions are sought on care at
local NHS sites.
16
Two thirds of a page
£7005
Date
Publication
Title
18 October 2013
www.bournemouthecho.co.uk
Public opinions sought on care at
Bournemouth and Christchurch hospitals
Date
Publication
Title
Information
Page number
Article size
October 2013 l
26
18 October 2013
Daily Echo
‘No cuts’ pledge in face of merge woe
Hospital bosses promised that health
services won’t be axed.
6
Two thirds of a page
Date
Publication
Title
18 October 2013
www.bournemouthecho.co.uk
‘We won’t cut health services’ vow
hospital bosses after merger bid is
thrown out
Date
Publication
Title
October 2013 l
18 October 2013
www.thetimes.co.uk
Hospitals’ anger as merger is rejected
27
Date
Publication
Title
October 2013 l
18 October 2013
www.ft.com
Prospect of more UK hospital mergers
28
Date
Publication
Title
October 2013 l
18 October 2013
www.oxfordmail.co.uk
Hospital merger blocked by Competition
Commission
29
Date
Publication
Title
Information
Page number
Article size
October 2013 l
30
19 October 2013
Daily Echo
Waiting for an operation
Patient who talks about delay in waiting for
scans.
18
Eighth of a page
Date
Publication
Title
Information
Page number
Article size
October 2013 l
31
19 October 2013
New Milton Advertiser
Hospitals merger blocked over fears for patient
services / Hospital merger blocked
The proposed merger of two hospital trusts have been
blocked by the Competition Commission.
1 and 2
3 columns x 15cms, 4 columns x 20cm
October 2013 l
32
Date
Publication
Title
October 2013 l
33
22 October 2013
www.blackmorevale.co.uk
Bournemouth Hospital gets cataract simulator
for training
Date
Publication
Title
24 October 2013
www.hsj.co.uk
Timeline: Bournemouth and Poole merger
saga
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
34
24 October 2013
Daily Echo
Lupus group at hospital
Lupus awareness month and members of
the Dorset Lupus Group will be manning an
information stand at RBH.
12
Sixteenth of a page
£635
Date
Publication
Title
Information
Page number
Article size
Value
Date
Publication
Title
Information
Page number
Article size
October 2013 l
35
24 October 2013
Daily Echo
Medical simulator will help to train eye surgeons
State of the art cataract simulator has arrived at
RBH eye unit to improve training for surgeons.
14
Eighth of a page
£845
24 October 2013
Bournemouth Advertiser
Long wait for vital operations
Patients comments about the long wait her son
had waiting for ultrasound scan.
10
Eighth of a page
Date
Publication
Title
Information
Page number
Article size
Value
Date
Broadcast
Information
October 2013 l
36
24 October 2013
Bournemouth Advertiser
Christmas dip to help charity
Hundreds of swimmers are expected to take to the
icy seas on Christmas Day in aid of a local Cancer
unit the Macmillan at Christchurch Hospital.
9
Eighth of a page
£444.80
Date
Broadcast
Information
24 October 2013
Wave
CQC inspectors arrive at RBH.
Date
Broadcast
Information
24 October 2013
Fire
CQC inspectors arrive at RBH.
Date
Broadcast
Information
24 October 2013
Heart
CQC inspectors arrive at RBH.
24 October 2013
BBC South
CQC inspectors arrive at RBH.
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
37
24 October 2013
Bournemouth Advertiser
MBE honour for Phil
Phil Carey has been honoured with a MBE he a
former governor of RBCH.
10
Quarter of a page
£889.50
Date
Publication
Title
October 2013 l
24 October 2013
www.telegraph.co.uk
Vegware: sustainable packaging made
affordable
38
Date
Publication
Title
Information
Page number
Article size
Date
Publication
Title
Information
Page number
Article size
Value
October 2013 l
25 October 2013
Stour & Avon Magazine
Bournemouth Hospital gets cataract simulator
Bournemouth Hospital gets cataract simulator first in Wessex region.
21
Quarter of a page
£180
39
25 October 2013
Stour & Avon Magazine
NHS Merger stopped by CC
Highlighting Annette Brooke MP has questions
over money spent and will be meeting with Sec.
State for Health.
7
Quarter of a page
Date
Publication
Title
Information
Page number
Article size
October 2013 l
40
25 October 2013
Daily Echo
Inspection starts at ‘high risk’ hospital
Bosses say the Royal Bournemouth
Hospital is a safe place to be treated as a
major inspection began yesterday.
4
Two thirds of a page
Date
Publication
Title
25 October 2013
www.bournemouthecho.co.uk
Healthcare watchdogs launch inspection of
Royal Bournemouth Hospital
Date
Publication
Title
Information
Page number
Article size
25 October 2013
Daily Echo
An Inspector calls (on RBH)
CQC Inspectors visited the RBH to do inspection.
18
Sixteenth of a page
Date
Publication
Title
Information
26 October 2013
Daily Echo
inspection at hospital
Public expressing opinions on CQC
inspection and merger.
Page number
Article size
Eighth of a page
Date
Publication
Title
Information
Page number
Article size
Value
29 October 2013
Daily Echo
Prestigious prize won
Radiographers awarded team of the year.
3
Sixteenth of a page
£635
October 2013 l
41
Date
Publication
Title
Information
Page number
Article size
October 2013 l
42
29 October 2013
Daily Echo
Patients frustrated by transport delay
Patients waiting over two hours for E-zec and at times service not
turning up.
9
Two thirds of a page
Date
Publication
Title
Information
Page number
Article size
Value
30 October 2013
Daily Echo
Staff are recognised
Green Impact recognition.
24
Sixteenth of a page
£635
Date
Publication
Title
Information
30 October 2013
Daily Echo
Questions to be asked
Reader letter re. money spent on merger
proposal.
18
Eighth of a page
Page number
Article size
October 2013 l
43
Date
Publication
Title
Information
Page number
Article size
Value
31 October 2013
Daily Echo
Shaping the future
Public response to The big ask.
9
Third of a page
£2525
Date
Publication
Title
31 October 2013
Daily Echo
No further action needed on hospital
concerns
CQC inspection complete.
9
Eighth of a page
£845
Information
Page number
Article size
Value
October 2013 l
44
BOARD OF DIRECTORS
Meeting Date and Part:
8 November 2013, Part 1
Subject:
Directors Forward Programme
Section:
Information
Executive Director with
overall responsibility:
Tony Spotswood, Chief Executive
Author of Paper:
Karen Flaherty, Trust Secretary
Key Purpose
Patient
Safety
Action required by Board
of Directors:
Note for information
Executive Summary:
Update of the Board of Directors Forward Programme
Strategic Goals &
Objectives
Governance of the organisation
Links to CQC Registration
(Outcome reference)
n/a
Links to Assurance
Framework/Key Risks
n/a
Type of Assurance
Internal
Health &
Safety
X
Performance
External
Strategy
1
Board of Directors Business Programme 2013
What
Annual Plan
Board Objectives
Annual Plan - BoD approve Draft for Public Consultation
Annual Plan - Feedback from Consultation to BoD
Annual Plan - Final Draft for BoD Approval
Who
Where Before
Jan
Feb
Mar
Apr
May
Jun
Jul
Sep
Oct
Nov
Dec
Where After
TS
RR
RR
RR
Chief Executive
TMB/CoG
CoG
TMB
Budget
Budget for next financial year
Capital Plan for next financial year
Code of Conduct for Payment by Results
National Reference Cost Index
CCG Contract
SH
SH
RR
SH
RR
Finance Committee
CMG & Finance
Service Development
Finance
Service Development
N/A
N/A
N/A
N/A
PCT
Annual Report
Annual Report & Accounts First Draft
Annual Report - Audit Committee
Annual Report - Finance Committee
Annual Report - Healthcare Assurance Committee
Annual Report & Accounts - Final draft for approval
Annual Report & Accounts - Going Concern Statement
SH
SP
BF
PS
SH
SH
Finance Committee
Audit Committee
Finance Committee
HAC
Finance & Audit Cttees
Finance & Audit Cttees
N/A
N/A
N/A
N/A
Monitor
Report & A/Cs
Charitable Funds
Annual Report & Accounts
SH
Charity Cmtte
Charity Commission
Quality
Acute Trust Quality Dashboard
Annual Inpatient Survey Results
Annual Outpatient Survey Results
Adult Safeguarding and Child Protection and Safeguarding Report
Clinical Governance Quarterly Report
CQC Quality and Risk Profile
Mortality Quarterly Report
Patient Story
Quality Accounts - First Draft
Quality Accounts - Final Draft for Approval
Annual Progress Report on Francis Report
Risk and Assurance Report (including Assurance Framework)
Sepsis Deaths Case Note Review
HL
PS
PS
PS
PS
PS
MA
PS
PS
PS
PS
PS
MA
External
PEC
PEC
HAC
HAC
HAC
Medical Director
N/A
HAC
HAC
HAC/TMB
HAC
TMB
CoG
Publication?
Infection Control
Board Statement of Commitment to prevention of Healthcare Associated Infection
Infection Control - Annual Report
PS
PS
Infection Control
Infection Control
N/A
N/A
Monitor
Monitor Quarter 1 Report
Monitor Quarter 2 Report
Monitor Quarter 3 Report
Monitor Quarter 4 Results
Monitor Annual Risk Assessment
Monitor's FT Sector Overview - Annual Risk Assessment
Monitor Annual Self Certification - Board Statements
HL
HL
HL
HL
HL
HL
KF
COO
COO
COO
COO
External
Chief Executive
Trust Secretary
Monitor
Monitor
Monitor
Monitor
Monitor
N/A
Monitor
Staff
Part 1
Monitor
Public Consultation
Part 2
Publication
Part 2
Part 1
Part 2
Part 1
N/A
N/A
N/A
N/A
N/A
N/A
Publication
N/A
N/A
N/A
What
Staff Excellence Awards - Chairman's Prize
Staff Survey - Results
Local Clinical Excellence Awards
Local Clinical Excellence Awards - Annual Report
Who
RR
KA
MA
MA
Where Before
Awards Panel
Workforce
Remuneration
Remuneration
Jan
Feb
Mar
Apr
May
Jun
Jul
Sep
Oct
Governance
Register of Interests
Constitutional Documents - Annual Review
Code of Governance Disclosure Statement
Meeting Dates for Next Year
Forward Programme
NHS Constitution - Bi-annual Self-Assessment
IG Toolkit
Annual Members' Meeting
Winter Plan 2012/13
Board Performance
KF
KF
KF
KF
KF
KF
KF
CoG
COO
JS
Trust Secretary
Constitution Cttee
Trust Secretary
Trust Secretary
Trust Secretary
Trust Secretary
HAC
N/A
N/A
N/A
Minutes of Subordinate groups
Audit Committee
Charity Committee
Council of Governors
Finance Committee
Healthcare Assurance Committee
Infection Control Committee
Patient Experience and Communications Committee
Remuneration Committee
Trust Management Board
Workforce Committee
Cttee
Cttee
KF
Cttee
Cttee
Cttee
Cttee
Cttee
Cttee
Cttee
Audit
Charitable Funds
CoG
Finance
HAC
Infection Control
PEC
Remuneration
TMB
Workforce
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Review Performance & Terms of Reference subordinate Groups
Audit Committee
Charity Committee
Finance Committee
Healthcare Assurance Committee
Infection Control Committee
Patient Experience and Communications Committee
Remuneration Committee
Trust Management Board
Workforce Committee
SP
KT
SH
PS
PS
RR
SC
TS
KA
Audit
Charitable Funds
Finance
HAC
Infection Control
PEC
Remuneration
TMB
Workforce
File - KF
File - KF
File - KF
File - KF
File - KF
File - KF
File - KF
File - KF
File - KF
Communications
Core Brief
Dr Foster Hospital Guide
Communications Update (including Read All About It)
RR
RR
RR
N/A
TMB
Service Development
N/A
N/A
N/A
10th
Nov
Dec
Where After
Staff Awards
CoG
Rem Com
N/A
Trust Secretary
CoG
Monitor
N/A
N/A
PCT
Connecting for Health
N/A
PCT/SHA
CoG
2