Chief Operating Officers Report BOD 106/2016 (agenda item: 7) Chief Operating Officers Report September 2016

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) Launch of BlueIce App for DSH- greater than expected uptake. Developing IESO Online CBT therapy for 12-18 year olds. Talking Space level 2 and 3 is now available to 16 year olds. High use of agency, esp Highfield Unit Recruitment and retention issues across all pathways, especially CAMHS community and In patient Units. Finance/CIPs CV agreed with Public health to extend SHN contract by 200K. Reviewed CIP process across CYP, with projects identified in all pathways Volume of tenders/ re-procurement exercises for current business across Directorate. 0-5 Universal Oxon/ CAMHS Oxon/ SWB/ Bucks SLT Delivering CIPS Uncertainty about specialist dental commissioning. Workforce HETV have upgraded the dental service to excellent as a training provider for Special Care Dentistry. Fully recruited staff to deliver primary Flu imms- new contract starting Sept 16. Saturday clinics addressing waiting lists in SWB CAMHS. New Queens nurse awarded in School Health nursing. Staff recruitment and retention- esp CAMHS community/ in patient and Medical staff Significant posts vacant- eg DBT lead OSCA/ significant substantive posts vacant on in-patient units. Specialist Dentistry is of concern Performance (against key trust targets) ED Inpatient bed days & Day-care meeting contractual activity School Aged Immunisations achieved for academic year Q1 HV, SHN & College nursing KPI’s achieved, (NBV still below target for Q1) CQUINs achieved for Q1-HV, NHSE Inpatients, BaNES T2, Swindon, Wilts & BaNES, Oxon CAMHS activity CPA Metrics below target, (this is attributed to the 6 month review element) CAMHS waits significantly below expected levels for Oxon YTD PPST Training below in some areas LAC Assessment KPI below expected level YTD

Issues of Potential Concern Adult Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) The directorate was delighted to have been were rated as GOOD by the CQC following their inspection earlier this year. This outcome is testament to the hard work and dedication of staff within adult services and we aim to continue to build on this outcome to enable us to provide outstanding mental health services. Introduction of pharmacy technician posts into x2 AMHTs is proving very successful with reduction in medication waste and reported increased quality of experience by patients. Pressures on inpatient services remain acute. There continues to be OAT where no local bed is available. Many hours are taken up with locating appropriate beds. Plans being put in place to review the model. Finance/CIPs Forensic services consortium work in progress clarity about finance and process is still in progress. The directorate is not on track to meet CIP target in 17/17. and is predicting an overspend. Workforce The directorate is developing a heat map to show vacancies , type of staff and geographical location so we can focus recruitment efforts. We are keen to explore opportunities to develop clinical leadership roles for nurses within the directorate – which will both enhance the quality of service users experience and retain and attract excellent nursing staff to work with us. We will also be working with the Director of Nursing re MAGNET accreditation and how we proceed at directorate level Kingfisher and Kestrel wards continue to have a worrying level of vacancies. There are very experience nursing staff leaving the directorate and Trust. They are being attracted by specialist clinical nurse and consultant nurse posts elsewhere. There are acting or interim staff in leadership roles in most of the acute wards – although we are in process of recruiting this is of concern. Performance (against key trust targets) CPA metrics - 99% achieved in all 4 measures. EIS referral to treatment – 50% patients seen within 2 weeks – achieving 81% combined counties. 100 % in Aylesbury and Chiltern and 73% Oxon.. AMHT waiting times - Target 95% in each category 4 hours - 90% 7 days – 95% AMHT - 28 days routine referral Target 95% – achieved 89% in August - we are focussing on improvement IG training at 88% 7 day FU – 88% in August which is a drop. Issues reporting outcomes for OBC – this is being addressed at senior level to agree way forward.

Older Peoples Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) ASLT responding to all urgent swallow assessments within 2 days in line with KPI and Royal college of speech and language standard Introduction of standardised “kit bags” into all Out of Hours vehicles (Urgent care) Efficiencies identified in the Newton Europe project for district nursing are being realised and teams are starting to report time saved after implementing the changes. Preparation for forthcoming CQC inspection of Urgent and Ambulatory Care will lead to an increased take up of non-clinical time by Clinical Development Leads. This will reduce the amount of clinical time available. Finance/CIPs Podiatry - monthly income against target is improving month by month YTD and August was the first month that the service broke even in the last 24 months. Income set to continue increasing with new clinics coming on stream. Podiatry - delay in getting estates input is reducing our ability to increase our income further Delivering CIPs without reducing significantly reducing the workforce Out of area contracts being rolled over without involvement with service Heads and therefore out of date and income is not reflect true activity or costs. Workforce The first advertisement of an Advance Nurse Practioner post was met successfully. There has also been increased interest in the Nurse Practioner advertisement (Urgent care) Turnover in DN workforce in the across the County continues to provide challenges Difficulty recruiting good MH practitioners – high proportion of vacancies in the South CMHT Recruitment across MIUs and OOH continues to present challenges. This is particularly the case with GPs with continuing shortfalls in capacity in the OOH rota. The uncertainty around the funding next year for the specialist practitioner course (Trained District Nurse). the impact would mean cost pressure to training more team leaders Performance (against key trust targets) ASLT meeting all targets from stating the year achieving none PPST training below target in some services Continued increased clinical activity in many service areas is not being addressed.