Chief Operating Officer’s Report PAPER BOD 33/2016 (Agenda item: 7 Chief Operating Officer’s Report Dominic Hardisty March 2016

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) Launch of Horizon, a new service for children who have been sexually abused. Development of specialist community eating disorder services for children across five counties. Dental service offering CBT to dental phobic patients. Waiting times for routine referrals across CAMH services. High caseloads in some CAMHS being reviewed. Reduction in theatre availability at the Horton will impact on ability to provide dental surgery for children. Impact of CareNotes on risk assessment, care plans and ability to maintain full contemporaneous records, plus increased time it takes staff to record clinical care. Finance/CIPs Directorate continues to manage its financial position rigorously and contribute significantly to the Trust’s overall financial position. Opportunities in 2017 to gain new services. Cost of locum and agency medical staff (vacancies and sickness). Forecast £576k adverse position at year end. Number of competitive tenders in 16/17 need to be resourced to ensure we retain current business (HV) and gain new opportunities. Workforce In the process of developing consultant and nurse prescriber posts within CAMHS. In partnership with Barnardos developing a volunteer work force across Buckinghamshire CAMHS. Further appointment of apprentices planned. Difficulty recruiting CAMHS consultants. Difficulty recruiting suitably qualified Children’s Community Nurses (vacancies and maternity leave). Significant concerns that recruitment and retention require development to ensure we are attractive to potential candidates and reduce turnover. Performance (against key trust targets) HV service reaching target for breastfeeding in last two quarters. All secondary schools have school health improvement plans in place. Waiting times for routine referrals in CAMHS in Oxfordshire – target of 8 weeks by end of March – unlikely to meet target within timeframe. Directorate unable to report against all targets due to difficulties accessing data and reporting on group contacts following move to CareNotes.

Adult Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) Project 10 with 3rd sector for stepdown from acute care progressing well. Stakeholder event on the partnership OBC and IAPT with 250 attendees well received. ConnectionFS and MIND workers in Oxon AMHTs agreement to continue and expand to all three Oxon teams. Talking Space Plus preparing for launch. Responsiveness in terms of complaints unacceptable, directorate is funding 2x WTE 8a staff dedicated to complaint and SI investigations. S75 agreement in Buckinghamshire at risk. Timely access to acute inpatient beds remains a concern. Finance/CIPs Directorate still contributing significantly to Trust overheads. Current forecast £718k adverse and under-delivery of CIPs by £800k. Plans for FY17 still being worked through. Workforce Centralising recruitment function starting to show dividends in attracting staff, reducing duplication and managing processes. Leading the Way cohort with the 3rd sector has just completed with much positivity from partners on the benefits of this shared leadership development programme. Vacancy levels and turnover. Performance (against key trust targets) Monitor targets being met on CPA, EIP, IAPT, & day follow-up. CareNotes issues continue to affect quality and accuracy of central reports leading to a huge burden on directorate resources to check and recheck data quality.

Older Peoples Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) Venous leg ulcer time to heal. NICE guidance updates to staff (and process to manage) highlighted as good practice. To be rolled out Trust-wide. Progress in defining single reablement pathway, & introduction of single pathway flow oversight (Oxon). Training for recognising deteriorating patient in community hospitals being rolled out (including work with AHSN). Acquired pressure ulcer damage variation in community nursing teams. Diabetes – rise in numbers of unstable patients in community settings: pressure on diabetes service and community nursing. Bed pressures in OAMH, driven in part by single sex accommodation needs and DTOCs (few but lengthy). Finance/CIPs Forecast to deliver on budget this year. Achieved all this year’s CIPs - £500k is non-recurring. Agency spend contained. Delay in major public consultation affecting FY17 transformation plans. Overspend in urgent care services (GP OOH and EMUs). Workforce Agreement with CCG on how to progress new model of care for community nursing. High vacancy/sickness factor in city community nursing. Good attendance at community hospital recruitment open days. Interface medical capacity. SLT recruitment. Emergency practitioner and GP availability to work in OOH urgent care. Podiatry recruitment. . Performance (against key trust targets) Community therapy waiting times now consistently under 12 weeks in each locality. Services moved into new Henley Townlands building within contracted timescales. GP OOH NQRs underperformance. Memory clinic waiting times (driven by delay in accessing scans). Reduced hours in Witney EMU due to medical staffing constraints.