Chief Operating Officers Report Paper BOD 122/2016 (agenda item: 6) October 2016

Older People’s Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) August saw the lowest number of controlled drug-related incidents reported (2) since January 2015. This is, however, still within statistical control limits The rate of in-patient falls that result in harm (moderate to death) has been below the mean of 3% for the past 6 months Continued improvement on compliance with NICE guidance across the directorate (78 compliant, 41partial, 0 non compliant) Despite significant progress on many of the pressure damage reduction actions, there is limited impact in reduction of pressure damage prevalence (safety thermometer) DTOCs in community hospitals had risen as long term placements availability reduced over August; have now reduced just below mean to 23. Patient flow co-ordinators making good progress on standardising discharge planning – however, risk to planned DTOC reduction as reablement service transition. Finance/CIPs Month 6 position is £389k Adverse; this reflects pressures on agency costs in M6 in community hospitals, especially Abingdon. This will be mitigated by planned bed reductions (e.g. as Henley OSJ beds come on line). CIP delivery for FY17 confirmed Currently £402k of CIP delivery this year is marked as non-recurrent. Actions continue to secure recurrent funding to reduce risk for next financial year Potential cost pressure in agency costs (community hospital staffing) may affect CIP delivery at year end – actions in place to investigate and then mitigate Workforce Second Planning the Future education for B8 and B7 staff has been completed – evaluated very positively by attendees. Third cohort to commence in January. Review of impact of matrix leadership on delivering integration underway – workshops for B7 & B8 staff, with survey out to all staff in directorate. Staffing vacancies in community hospitals; mitigation plan in place to maintain safer staffing ratios and patient flow OAMH recruitment, especially in south Buckinghamshire (all professions) and in inpatient leadership roles Performance (against key trust targets) Business planning for next step integration (to achieve neighbourhood / locality MDTs supporting GP practice clusters) underway. Good ideas coming from teams which will need to be worked up with local GPs. Delivery against GP OOH national quality requirements much improved; actions in place to address 2/3 NQR performance (triage for walk-in patients). GP OOH NQR 12; 82% against standard of 95% (seen at base within 2 hours). Whilst this is a significant improvement on recent months, the challenge in GP availability continues to have adverse impact on patient experience. Of 193 patients seen later than 2 hours, 116 were seen within 3 hours.

Issues of Potential Concern Adult Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) Dailyi calls including inpatient and community lead staff initiated planning each day admissions and discharges from acute wards. Partnership represented on calls to ensure supported housing involved as well as engaging patients in meaningful activity on discharge from hospital. 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. Number of unfunded posts in place across directorate, including SW posts, and project posts – put in place as part of CQC and management of bed pressures The directorate is not on track to meet CIP target in 17/17. and is predicting an overspend – Financial Recovery plan meeting week on 17/10 to review current position and to discuss unfunded posts Workforce New posts to lead on elements of clinical governance about to be advertised. This includes a role of patient experience and involvement coordinator and a clinical practice lead who will oversee the SI, complaints and audit processes ensuring learning from incidents and complaints across the directorate. New partnership manager appointed to ensure the further development of the recovery colleges and partnerships to improve outcomes for patients. Kingfisher and Kestrel wards continue to have a worryingly high level of vacancies. There are acting or interim staff in leadership roles in most of the acute wards – although we are in process of recruiting this remains a concern. Vacancies across community mental health teams are also leading to increased pressure on existing staff Performance (against key trust targets) 7 day follow-ups – 100% EIP referral to treatment – achieved 74% (target = 50%) Letters sent to GPs within 10 days (Oxon AMHTs) – achieved 98% Discharge summaries to GPs within 24 hours (Oxon and Bucks Adult MH Wards) – achieved 96% Referral response time (AMHTs) emergency referrals (4 hours) – 93% Urgent referrals (7 days) – 87% Routine referrals (28 days) – 85% Clusters reviewed in timescale – 71% Mental capacity act training (Oxon) – 73% Prevent training  (Oxon) – 58%

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) FGM app nominated for IT innovation award. Via White October (app company) The Thames Valley L and D service nominated for The Howard League for Penal Reform's annual Community Awards 2016 Re-connect highly commended in the Diversity and Equality in Service Delivery at the Positive Mental Health Awards Safeguarding Annual report. Impact of OCC changes to children's centre model and available space to deliver service. Challenges around IG for the IESO Online CBT therapy for 12-18 year olds (resulting in delayed rollout) Finance/CIPs 0-5 Universal procurement completed- outcome due end November. Opportunity for all CAMHS services to bid for waiting list initiative monies Bucks Integrated therapy service tender delayed to end October- SWB and Oxon CAMHS tenders due out in next 4 weeks all expected to have 4 week turn around HPU tender due 18/10/16 Delivery of CIPs Workforce Flu delivery programme commenced W/B 10/10/16 good media coverage and good uptake for week one! Exploring options to work more closely with Adviza group in Buckinghamshire around delivery counselling mainly volunteer workforce. 40% maternity leave in qualified CCNs=impact on service delivery capacity. Staff recruitment and retention- esp CAMHS community/ in patient and Medical staff Performance (against key trust targets) Q2 HV, SHN & College nursing KPI’s achieved, ED Inpatient bed days & Day-care Exceeding contractual activity Q2 HV, SHN & College nursing KPI’s achieved, (NBV still below target for Q2 & 2 ½ year review) Over achieving on activity in Wilts, Banes & Swindon CAMHS LAC Assessment KPI below expected level YTD CPA Metrics remain below target, (this is attributed to the 6 month review element) CAMHS waits significantly below expected levels for Oxon YTD, but are improving month on month PPST/CCCS Training below in some areas