BOD 138/2016 Agenda Item 6 Chief Operating Officers Report December 2016

Children and Young People Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) BlueIce App for DSH- Health Foundation reporting positive feedback. The App has been shortlisted by NHS digital for additional funding. (interview next week). Fabulous user involvement for recent interview process- including young people, babies, and adult ED patients. High use of agency staff, esp. Highfield Unit Finance/CIPs Have confirmation that we will receive 50% CAMHS waiting list monies now, the rest in January once plan successfully implemented. Public health 0-5 contract award notification received. (HV and Family nurse partnership) Volume of tenders/ re-procurement exercises for current business across Directorate. CAMHS Oxon/ SWB CAMHS / Bucks SLT. Awaiting outcome of the Health promotion tender interview. CIPS for this year still -28% and most non recurring. Workforce Celebration event for Buckinghamshire CAMHS with partners to mark the first year of delivery. There is a danger we may lose staff during the organisational change process as contracts, projects and performance posts are centralised. Performance (against key trust targets) Achieving the highest % of patients assessed within 4 weeks within SWB CAMHS within FY. 7 out of 8 KPI’s for Healthy Child Programme achieved in Q2 NHSE ED Inpatient C&V Contract achieving target. Bucks SLT Achieved CQUIN for Contract year 15/16 (Nov-Oct) 17 out of 18 KPIs for School Health Nursing achieved in Q2 See selection of new (draft) performance reports for details on individual measures Bucks CAMHS Mandatory training (plan in place) Over performance in Oxon ED Community Team and patients still waiting 12 months + for Treatment Oxon CAMHS Waits not achieving 75% assessed within 12 weeks

Issues of Potential Concern Adult Directorate Areas of Excellence Issues of Potential Concern Quality (safe, effective, caring) Thames Valley & Wessex forensic network new model has begun shadow form from October 1st. Final business case to NHSE in December following board sign off. On plan to move to new arrangements out of shadow form from 1st April. Successful workshop held with clinical and operational leaders to review inpatient services to address issues of patient flow – work streams being finalised with clinical and operational leads in place for each. There continues to be OATs where no local bed is available this is a quality issue and is financially unsustainable at current rate – we are projecting a 1.2M overspend against budget if no action taken. Finance/CIPs We are working closely with finance to ensure that going forward realistic budgets are set as far as is possible against actual spend. We have identified all cost pressures and are addressing them through close monitoring of trend against actions taken We have achieved 55% recurrent CIPs against target Workforce The directorate had strong representation at the recent workshop re workforce across the Trust to put forward suggested actions that may help in both recruiting to posts and retaining staff. Sustainable workforce remains the key risk for the directorate We have 283 vacancies across the directorate – 101 of these are at offer of job accepted stage – rest are in various stages of recruitment Performance (against key trust targets) 7 day follow-ups, 98% achieved (target = 95%) EIS referral to treatment, 89% achieved (target = 50%) PIRLS - all targets met Bucks IAPT -  all targets met Letter to GP in 10 days (Oxon) - 99% achieved (target = 95%) See selection of new (draft) performance reports for details on individual measures Reporting EDPS - JR 1hr target met but Horton 90min target not met (87% achieved, target = 95%) Routine Referral response - 84% achieved across Oxon and Bucks AMHTs  (target =  95%). Meaningful Activity still an area of concern. Work underway to improve from November onwards. Cluster reviews: Aylesbury 83%, Chiltern 78% Recovery Star: Aylesbury  62%, Chiltern 35% (largely due to backlog and capacity - a dedicated piece work currently is on going to support the team)

Older Peoples Directorate Areas of Excellence Areas of Concern Quality (safe, effective, caring) The CQC inspection in Out of Hours services has been completed; while some areas of improvement were identified (in particular prescription handling and fridge temperature monitoring) the inspectors were satisfied work was already underway and there were no further specific areas of concern. The CQC are reviewing whether or not to provide an official rating as the Trust as a whole has already received a rating of Good overall. The directorate is not yet achieving its trajectory for reduction of avoidable pressure damage. The pressure damage prevention group has agreed to review its approach in the context of challenges with capacity in community nursing and agree a set of deliverable actions to make progress Finance/CIPs Successfully reduced the falls service spend within the new cost envelope from OCCG as of October 1st 2016. A CIP of £1.7m has now been allocated and budgets have been removed from FY16/17. Agency spend has increased and a full review of spend will be carried out including reviewing controls and authorisation processes, in particular for community hospital staffing. Workforce An open day for district nursing recruitment was held in Abingdon – 12 people attended with 5 offers being made and a further 4 candidates shortlisted for interview. The plan is to hold quarterly open recruitment days. Monthly turnover within community hospitals has stabilised Improved trajectory for out of hours staffing: 7 band 7 practitioners have been recruited and full recruitment projected for early 2017 Continuing capacity and recruitment challenges in district nursing in central and south west Oxfordshire; and in south Buckinghamshire community mental health teams; mental health inpatient and community areas and podiatry  There was an increase in sickness absence across the directorate from 3.79% to 4%. Sickness absence figures have remained fairly static since June of this year. Performance (against key trust targets) Community hospitals have increased the total number of available beds to 158. Increased focus on MDT planning and early assessment of rehabilitation potential to reduce length of stay. See selection of new (draft) performance reports for details on individual measures The ALOS exc. DTOC for all rehab patients in M7 is 27 which 6 below last month’s position. This is 3 above the agreed target of 24 (by March 2017), and is 2 above September’s planned trajectory of 25 There were 30 Delayed Transfers of Care (DTOC) at snapshot, an increase of 4 on the previous month. The Trust target is 15 by March 2017