Chief Operating Officers Report BOD 03(i)/2017 (agenda item: 5) Chief Operating Officers Report January 2017

Issues of Potential Concern Adult Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) We have significantly improved acute inpatient flow which has led to a huge reduction in the number of OATs for patients. We are actively working with carers to improve how we receive feedback from them about service they and their loved ones receive. We gained investment in supporting health based places of safety for vulnerable individuals. Work in progress to now improve existing areas. Bed occupancy remains high so we continue to experience high levels of pressure across inpatient services. Finance/CIPs Outturn forecast for the directorate has improved by £1m because of tight control on spend and the reduction in OATS. As previously forecast we continue to under deliver against this year’s CIP target. Actions continue to identify opportunities and improve the position wherever possible. Difficulties in reporting OBC outcomes mean there continues to be some financial risk against delivery of activity. Workforce We are continuing to advertise and recruit into our vacancies as quickly as possible. We are temporarily using agency staff to bridge gaps and improve continuity for patients. Workforce recruitment and retention remains the highest rated risk within the Directorate. We are actively engaged with HR in working to minimise risks and improve both but this remains an area of concern which impacts on service users and staff Performance (against key trust targets) Exceeding access and waiting time for Early Intervention in Psychosis (EIP) services in Oxford: 60% (6/10) (target:50%) IAPT 6 week waits consistently and substantially ahead of 75% target in Bucks: Aylesbury: 99% (160/162); Chiltern 99% (220/223) IAPT 18 week waits consistently ahead of target: 99% in Bucks OHFT Meaningful Activity steadily increased to 46% over the year to date (target 50%) - and with newly added partnership data reaches 55% in December. Safeguarding training Forensics at 95% (target 90%) . 23 measures reported as well below target for December. Each target has a plan in place and we are monitoring improvement closely. Un-clustered activity under close scrutiny by Bucks CCG Carers data for December very low, comprehensive action plan in place to rectify. EDPS (Oxford) below target 83% (JR) and 79% (HGH) – looking at clarifying breach reporting and changing staff shifts to address. See performance reports for details on individual measures

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) Roll out of nationally accredited dental inhalation sedation training for dentists and dental nurses. 16,000 children immunised against flu - an uptake of 65%. SHN selected to present at international conference in USA. LAC performance - refusers pathway working well and commissioners keen that we promote as excellent practice (previous area of concern for CCG/ OSCB). Very positive visit by Lord O’Shaughnessy. High use of agency staff at Highfield. SPA in Bucks waits for targeted assessment have risen to 7 weeks. Impact on South Team of recent SIRI- learning and support on going (evidence of excellent practice between CAMHS and SHN services). Consultant cover for ED continues to be a concern due to long term sickness. Reviewing admissions on a case per case basis Finance/CIPs Successful bids for recurrent funding, Health and Youth Justice funding (SWB and OXON). Successful bids for acute hospital based CAMHS services at the RUH and SFT. NHSE have signed off all single tender actions in order to extend all dental contracts to April 2019. CIPs for next year- identified £300k against £1.8m target. Lack of Consultant Psychiatrists in North Oxon & Swindon. Transformation income still not received from Swindon CCG. Dentists – existing contracted capacity now consumed. Long waiting list developing. Negotiating with CCG & OUH for further funding. Workforce Attracting high calibre staff for new transformation posts across SWB. All 6 Dental KPIs for Oxford health Special Care delivered to date so on target for incentivised KPIs. Continue to employ agency staff to assist with waits and vacancies in Oxon CAMHS. Recruitment of Qualified staff to inpatient units remains problematic. Performance (against key trust targets) Oxon CAMHS, increase in achieving the 75% waiting time target, December reporting 70% seen within 12 weeks Both CIT and Bucks SLT are meeting 18 week waiting time targets. Performance on KPIs in Public health pathway remains solid. Waiting times for CBT-E 18 months with the waiting list growing. Referral rates for the community ED team up by 16% this year. Working with commissioners to address model See performance reports for details on individual measures

Older Peoples Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) Excellent initial evaluation received on integrated care home support service. The directorate had 100% positive results based on patient survey in M9; a total 164 compliments were received across services compared to a notably lower number of complaints YTD. CQC peer review exercise completed – conclusions will be carefully reviewed, but many positive elements already noted. Delayed Transfers of Care (DTOCs). Two SIs reported in M9; an inpatient fall leading to a fractured neck of femur and a grade 3 acquired pressure ulcer due to a lapse in care. Investigations underway A total of 31 acquired pressure ulcers grade 3 and above were reported in M9. Further project work is underway to achieve a reduction in acquired pressure damage and address data quality issues. Finance/CIPs Improved trajectory for year end. Continued improvements in controlling agency spend. Contribution to million pound challenge with several posts held as a vacancies. CIP plans for FY 18 underway. Continuing to forecast adverse position at year end. Cost pressure in community hospitals with system request to continue to fund an additional 8 beds in care homes at a cost of £8k per week. Workforce Fully recruited to AHP clinical lead roles. Increased interest in DN posts in South East which have traditionally been hard to fill. Continued management of sickness absence in community teams and now within Trust target despite winter pressures. Strong cover maintained in urgent care system over Xmas period. Continuing pressures in district nursing capacity particularly in the West. Increased short term sickness in Continuing Healthcare which has impacted on management of assessments, which has been mitigated with support from OCCG. Higher levels of sickness in older adult mental health services and urgent care. Turnover at 16.2% Performance (against key trust targets) 80% of reportable contractual indicators were achieved – 61 at target and 11 exceeding target. Able to open and maintain 153 community hospital beds. Increased levels of admissions and flow through community hospitals. Performance issues for urgent care – time to triage for urgent walk-in, time to base visit and % of unfilled shifts. DTOCs. Stroke therapy capacity in community hospitals. Declining MSK Physiotherapy 12 week wait performance. See performance reports for details on individual measures