Chief Operating Officers Report BOD 27/2017 (Agenda item: 6) Chief Operating Officers Report March 2017

Issues of Potential Concern Adult Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) Nokuthula Ndimande the Matron on Allen ward was awarded psychiatric nurse of year award for her work on reducing AWOLS. She was commended for work that has made a very real difference to the safety and wellbeing of patients and it is important to note that this work is now taking place in other Trusts. The readmission rate into acute inpatient wards at 90 days has increased by 15% in month (13 people) – we are reviewing to see why this has happened and to check whether this is an unintended consequence of patient flow work to reduce OATs. Finance/CIPs There is a positive trend emerging in terms of financial control in the directorate which shows that work taking place across all pathways is starting to have an impact. An increase in bank and agency in January meant we spent more on staffing (because of agency premiums) than budgeted vacancies in some areas for first time. Workforce We are reviewing model of care in AMHTs and seeking to move away from generic roles – in order to improve outcomes for patients and staff morale. Feedback has been that by becoming too generic staff are losing some of their core professional skills Message from service and clinical director to all staff thanking them for all their hard work and for setting out key priorities for the directorate. We continue to have vacancies across services with reliance on bank and agency staff to deliver services. Performance (against key trust targets) Step 3 hidden waits improving, date required for resolution. 7 day & 28 day referral timeframes for Chiltern have seen a huge improvement. Target date 31st April for resolution. Bucks Recovery Star target has been achieved. Forensics registered GPs has seen a significant improvement Aylesbury risk assessment target not met. To be resolved by 31/03/17 Chiltern 7 day follow up not achieved. Plan & date required to manage this target alongside high number of discharges. Oxon Wellbeing satisfaction figures have reduced. Plan & date required to achieve target. Bucks cluster review date not achieved. Target date 31st March. 15% readmission rate into wards after 90 days Forensics: no discharge summaries provided within the 24hr target. See performance reports for details on individual measures

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) SWB CAMHS awarded preferred bidder. Contract award due in July 2017 Oxon CAMHS final outcome due in April 2017 0-5 Universal service implementation of new contract on track- very positive feedback from commissioners about robustness of process. Cotswold House QED accreditation confirmed. Dentistry-Care home preventive pilot commencing for oral screening and dental signposting on track Bucks CAMHS annual review paper and stakeholder undertaken with excellent feedback. Access to adolescent PICU beds across whole patch and acuity on the Highfield Bucks SLT transfer- capacity and capability of BHT causing huge concern. Likely extension until 01/07/17 for IT support to service to enable BHT to be ready to operate. Adult ED-Waiting times for CBT-E 18 months in Oxfordshire /10 months in Bucks. Referral rates for the community ED team have increased this year. Tribunal work for Therapists in Oxfordshire continues to cause concern and impacting workload, working with commissioners for a solution. Finance/CIPs Additional £57k awarded by Wiltshire CCG to trial Sleepio in partnership with Bath University with under 18s Further £50k investment by Wiltshire LA to place a senior CAMHS practitioner in Wiltshire College Underspend in CCN due to vacancy factor/maternity leaves. Catering contract at CHM – still unresolved since May 16, working closely with Estates. Swindon CCG – commissioning arrangements. Concern over investment of CAMHS transformation funds to date and the limited view of the requirements for whole system change Workforce CYP Staff survey overall very positive. Developing plan to address our areas of concern. Agreement to appoint substantively for a Consultant 0.5 WTE for ED service. Staff dealing with significant traumatic incidents- such as the case in Farringdon- supporting them is rightly taking priority. Performance (against key trust targets) Universal public health services meeting KPIs except New Birth Visits for which we are developing a SOP to include exemptions to address this. Incentivised KPIs on track CAMHS - 4 & 8 week waiting times. (In particular in Swindon, Wiltshire & BaNES). Action to be taken as part of the implementation of the new contract. ED waiting times. See performance reports for details on individual measures

Older Peoples Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) Number of compliments to the community care service supporting patients at life end through Fast track “the family would not have got through the last few weeks without you.” 77 days without a category 3 or 4 pressure ulcer Continued reduction in incidents in web-holding Continued reduction in overdue Serious Incident actions Patient survey 95.5% positive results and 321 compliments Despite a reduction in the number of incidents in web-holding, this remains above target at 156 incidents 3 Serious Incidents reported: 2 inpatient falls (fracture) and 1 unexpected death relating to the Out-of Hours Service in Witney. Finance/CIPs Identified £1 million of recurring CIP opportunities for FY 2017/18 Year end forecast as £1.5m adverse due to agency usage in community hospitals (maintaining additional beds in community hospitals and funding 8 beds in care homes); incentives to fill out of hours GP rotas; cost pressures resulting from the reablement contract. There is continued operational scrutiny of agency requests and trajectory for reducing community hospital beds in March and April is planned Workforce Improvements to 87% overall for PPST Training (target 90%) Sickness has continued to reduce in Continuing Care from 7.5% to 6.2% and in the City and South DN teams from 9.4-5.1%. Turnover has remained at similar levels at 14.9% (target 12%) Prevent training compliance 15% (target 90%) OPD is targeting non-compliant individuals and supporting staff with time to complete training Reduction to 83% compliance ( from 84% in M10) with all CCCS training against a target of 90%. Staff annual PDR completions at 74% Performance (against key trust targets) The Older People’s Directorate reported against 79 indicators in month 11 with 82% of indicators achieved Good progress to fill out of hours rotas for Easter with exception of Banbury OOH urgent triage (walk in) - time to triage; <20 mins of arrival at 45% (target 95%) OOH percentage of unfilled shifts; ability to match capacity with demand 11% (threshold 2%) Delayed transfers of care on community hospitals 51 (threshold 15) – ongoing system wide discussions to increase home care capacity See performance reports for details on individual measures