Chief Operating Officers Report Dominic Hardisty February 2017

Issues of Potential Concern Adult Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) We are delighted that Noki Ndimande the Matron on Allen ward is a finalist in British Journal of Nursing Mental Health Nurse of the Year 2017. Noki has been nominated for her work to reduce AWOLS. We have reduced OATS ( 2 since December – both for 1 night only) Successful “get me home week” with 18 admissions and 25 discharges. Learning identified being brought into on-going work in managing patient flow. There is a need to increase expertise in caring for and recognising physical health care needs of acute mental health inpatients. Learning from Serious Incident reports indicates this is an area where we need to improve. An action plan is being drawn up to address training needs as well as to ensure active on-going support to staff from senior colleagues. Finance/CIPs Despite improvement in OATS We are forecasting an overspend of £3.2m - This is because of increasing agency costs to meet demand with high levels of vacancies The spend on agency staff whilst still below the total cost of vacancies is increasing month on month resulting in an increased forecast overspend Workforce We are in the early stages of developing clinical / academic nursing posts in partnership with Brookes University and supported by Prof Geddes. We are actively encouraging HCA’s to apply for associate nurse roles and engaging positively in the scheme for apprentices across the Trust. We are actively recruiting into posts and have appointed to ward manager posts on Ruby and Sapphire wards. Retention and recruitment of staff remains our highest rated risk with vacancies on inpatient and community teams impacting on staff morale and ability to meet all demands despite using long term agency staff to fill gaps Performance (against key trust targets) Currently in the process of reviewing and aligning all KPIs Meaningful Activity and Recovery Star figures shown significant improvement for Outcome Based Contract (OBC) Significant improvement in Recovery Stars in Buckinghamshire High numbers of patients unclustered - financial implications Chiltern EIP target not met EDPS initial assessment targets continue to be missed Decline in Urgent referral timeframes (7 day) for Oxon and Chiltern See performance reports for details on individual measures

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) Directorate Audit day 31/01/17 good feedback and shared learning Positive clinical and young people’s engagement with 136 protocol development across BNSSG, BaNES, Swindon and Wiltshire CCHC been chosen to lead on mentoring other nearby CCGs with rolling out PHBs. 50K awarded to support which will contribute towards a CIP Corporate Parenting Bucks very complimentary of new CAMHS LAC service and interventions available OUH asking dental to change from usual operating theatres but air pressures sub optimal for operating surgical drills. Ongoing debate with OUH to resolve. Marlborough House, Swindon has been managing a young person with complex and challenging needs on a 2:1 since November. National shortage of PICUs for under 18s. Impact on staff morale. NHSE involved. Helen & Douglas house CQC inspection outcome - offer made to support their improvement plan. Further increase in Oxfordshire LAC- now 668 children- a 16% increase since February 2016. National Data Sets – Data Quality and reporting issues Night time staffing levels at Cotswold House – Oxford. Finance/CIPs Confirmation of award of Preferred Provider status for SWB CAMHS. Directorate forecasting surplus at end of the year Lack of CIPs identified for 17/18 Workforce Exam success for several dental nurses in sedation and radiography Attracting internal Band 5 staff into CCN service. Development of Deputy FNP supervisor-B7 role- first in the country! Internal recruitment underway. Second SHN invited to address National SHN conference in the USA. Implementation of Oxon Public Health 0-5 contract on track. Dental Nurse recruitment challenging to cover maternity leave Ongoing challenge to recruit qualified nurses at Cotswold House, Marlborough. Continuing use of long lines of agency to maintain stability and quality of care Consultants posts in Swindon. High agency costs Impact of Bucks therapy tender and work to transfer staff to BHT Performance (against key trust targets) Incentivised KPIs on target for Oxfordshire Special Care New contracts for Berkshire Oral health promotion and Epidemiology Good performance against 12 week waiting times continues across SWB and Buckinghamshire CAMHS Public health KPIs remain solid performance in most areas. Prevent Training – currently 124 out of 176 identified staff trained Mental Capacity Training – 65 out of 85 identified staff trained CAMHS Letters – delays continuing but action plans in place CAMHS ASD Waits – New model will address this CAMHS SWB 4 week & 8 week waiting times See performance reports for details on individual measures

Older Peoples Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) Perfect Week Extremely successful. Significant engagement from ward and community staff. In OAMH inpatients across Bucks and Oxfordshire we halved the number of patients who are delayed waiting for discharge – this was the target for the week.   In Community Hospitals in the first two days we exceeded the usual number of discharges for a whole week, with 15 available beds on Tuesday and we maintained a steady flow of discharges during the remainder of the week Clinical Audit All local audits completed by end of Q3 were presented at the OPD Clinical Audit and Effectiveness Group and were well received. The Directorate is on track with its audit programme NICE compliance The Directorate has no areas of non-compliance which is a significant achievement Patient Experience There are no exceptions to report from patient surveys received in January. Challenges experienced during perfect week include Patient transport not necessarily available at the time needed – no-one from PTS available at time needed Equipment processes create delays in transfers of care Lack of availability of placements for EMI patients Domcare failures & system-wide contingency plans Serious Incidents (SIs) There was 1 SI in January .This related to an inpatient fall leading to a fractured pubic rami and clavicle on Linfoot Ward. Incidents The number of incidents graded minor and above was 329, higher than expected in M10. There were data quality issues relating to the inclusion of inherited pressure ulcers and the grading of harm amongst various teams. 4 major harms for example were reported- including 1 fall leading to fracture; 1 incident relating to discharge arrangements from acute services, and 2 grade 4 pressure ulcers (the rest of the grade 4’s were rated as moderate). IG breaches A total of 6 information governance concerns were reported; there were no particular themes and local actions were taken to address any concerns for learning purposes. The Directorate is 86% compliant with PPST training against a target of 90%. Areas that require attention are: Health & Safety, Infection Prevention Control and Resuscitation Training. The Directorate is 84% compliant with CCCS training against a target of 90%. Areas that require attention are: Medicines, Mentoring and Pressure Ulcer Management.

Older Peoples Directorate Areas of Excellence Issues of Potential Concern Finance/CIPs Over £1 million CIP plans have been confirmed Further transformational plans underway linked to management and delivery of unscheduled care, including clinical coordination hub and locality duty functions Financial opportunities from bed based services will not be available until the conclusion of any public consultation Adverse position as a result of increased agency spend, medical cover costs and cost pressure relating to the new RACU Workforce The recruitment day for Community Hospitals took place on 21st January and 5 offers were made. The advertising for newly qualified staff is still live and it is hoped that this will result in successful recruitment of nurses. Recruitment are working with community therapy clinical leads to attract physiotherapy students Community Hospital and District Nursing staff are attending a range of university careers days. Sickness levels generally reduced across the Directorate. In particular – Management sickness has significantly decreased from just over 12% to 1.3% Agency has increased this month and remains above Trust target at 9.1%. The figures provided for December show particularly high agency usage in some Community Hospitals (particularly Didcot, Wallingford and Witney) and Older People’s Mental Health (Amber Ward and South Bucks CMHT). Turnover remains above Trust target at 16% PDR compliance was at 75% by end of January 2017 (this was 73% for M8) but the Trust target is 100%. It would require 418 staff members to complete a PDR to meet the target. Performance (against key trust targets) The Older People’s Directorate was required to report against 80 contractual performance indicators in month 10. 84% of indicators were achieved Areas of pressure include Out of hours indicators (triage and waiting times) for which we have an agreed improvement plan DTOCs – we continue to work with system partners to reduce delays waiting for reablement and choice delays A total of 6 complaints were received in M10; there was not particular theme and these cases are being investigation by the relevant services See performance reports for details on individual measures