1. Chief Operating Officer’s Report
BOD 93/2016
(agenda item: 7)
Chief Operating Officer’s Report
Dominic Hardisty
July 2016

2. Issues of Potential Concern
Adult Directorate
Areas of Excellence
Issues of Potential Concern
Quality
(safe, effective, caring)
DToCs for adult service remain low.
CQC revisit no outcome as yet.
The Directorate supported Service User “celebrating Lives” event took place on the 15th of July and was reported to be a great success.
Oxfordshire CCG was a winner in the national Healthcare Transformation Awards for the MHOBC partnership.
A carers BBQ was held in Oxford in June with attendees from OH and the third sector.
Feedback from the Board presentations last week was positive particularly over improvements within the inpatient services
Kennet Ward won the Brookes University student placement of the year award
OATS remain high in Buckinghamshire, we are working with RESPONSE who have leased a 10 bed house in Aylesbury which should be available in a few months to assist patient flow in Bucks
PTP waiting lists remain fairly static (high) but treatment waits are starting to reduce
Finance/CIPs
Forensic services consortium bid was successful, with a value around £80m (tbc). Directorate is contributing £25m annually to the Trust
Finance: £386K overspend in the directorate at end Q1, mainly OATS, Drugs and cost per case income below plan and CQC costs related pressures. Pay spend is £2.5m underspent.
Workforce
Appointments made:
2 x Head of Nursing
3 x Service Managers
Modern Matron for Ashurst
Key roles at interview: 
2 x Senior Modern Matron
Professional Lead for O/T for the Directorate
31 staff cleared to start roles in the Adult Directorate
Turnover figure reduced below 15% for the first time since January
Sickness rate has reduced each month since March. Currently 4.17%
Kingfisher and Kestrel wards continue to have a worrying level of vacancies despite the directorate investing in dedicated senior HR business partner time to lead on recruitment and retention.. Ros Alstead set up a quality summit meeting which has made some suggestions for action, there will be a follow-up meeting in 2 weeks.
Performance
(against key trust targets)
Monitor targets are being met on CPA, EIP, IAPT, & day follow-up. Internal CPA target on 4 measures is at 100% in Forensic and is improving in low 90%s in adults.
IG performance is at 91%
Some concern over performance against meeting the physical health outcome measures in the MHOBC

3. Children and Young People Directorate
Areas of Excellence
Areas of Concern
Quality
(safe, effective, caring)
School Health Nursing have undertaken an annual review of the service. School health plans are in place across all state secondary schools in Oxfordshire.
Young people supported the review by making films and giving feedback about their experience of the SHN service.
A very successful workshop with SHN’s and CAMHS has taken place, focus on self harm & suicide and emotional resilience
Waiting times for routine referrals in Oxfordshire to CAMHS are starting to come down with the current average wait now at 11 weeks although this is an improvement an increase in referrals (12% increase in Q compared to Q1 in 1516) means that there continues to be pressure across the service and subsequently on staff working in the service.
Finance/CIPs
CIPs 1.1 M identified within the Directorate for 16/17 against target 1.3M CIP.
Long lines of agency in place to help improve waiting times in CAMHS and also covering sickness. We have negotiated costs and reduced spend in agency use.
Cost of locum and agency medical staff & use of agency off framework is impacting adversely on the directorates ability to maintain a balanced financial position - 313K adverse position at month 3.
Workforce
We continue to appoint to key clinical posts in all services.
We have updated the nurse prescribing protocols for CAMHS to enable us to appoint non medical prescribers in the service with plans to have nurse led clinics where appropriate.
We will have 5 consultant posts vacant by end of this year but are actively planning recruitment for all of these posts.
The directorate is actively taking part in the Trusts recruitment and retention group
Performance
(against key trust targets)
Risk training has been given with more than 100 CAMHS staff across 5 counties as part of our CQC action plan
Health Visiting have achieved all KPI’s with the exception of the New Birth Visit
School Nursing have achieved all their contractual KPI’s for Q1
The National Childhood Measurement service has completed all measurements/weights and achieved their contractual targets.
Dental services have achieved the incentive KPI’s for Q1.
Waiting times for routine referrals in CAMHS in Oxfordshire not met – target 75% in 12 weeks
Not meeting PPST targets ( at 90% ) Resus, Infection control and fire awareness are low - Target re 6 month CPA review not met target - we are targeting teams and training for improvement

4. Older People’s Directorate
Areas of Excellence
Issues of Potential Concern
Quality
(safe, effective, caring)
Pressure ulcer action plan progressing well: preparation phase completed, and training to teams due to commence during May
Sustainability and Transformation Plans for frailty / long term care / urgent care in Oxfordshire progressing well
Number of DN teams providing named nursing (as opposed to risk stratification only) continues to increase: now at 81%
Well attended community hospital workshop on quality and effective delivery; wards presented on their recent quality improvements, and their impact on patient care
Acquired pressure ulcer damage variation in community nursing teams
Diabetes – rise in numbers of unstable patients in community settings: actions to mitigate underway
Bed pressures in OAMH, driven by spike in demand, and difficulties securing EMI placements for patients ready for discharge
GP OOH – difficult last two weeks in securing sufficient GP capacity (reflects wider pressures on primary care). However, good support from PML to help mitigate.
Finance/CIPs
Month 2 position is £98.5k adverse; however, once C&V income for Podiatry is reconciled with CCG, expect balance position fro M3
CIP planning progressing well, with clear objectives for consultancy support / critical review
Risk that circa £300k of directorate CIP will be non-recurrent this year – actions in place to reduce this as far as clinically possible
Workforce
New recruitment approach for ORS is proving effective; with higher numbers of applicants, and more appointments. Open day recruitment fairs will continue during July
Good number of GPs coming forward to work in GP OOH service
Discharge liaison co-ordinators appointed to support community hospital length of stay and DTOC reduction trajectories
Interface medical capacity
Podiatry recruitment
Peaks in staff vacancies in some areas: Abingdon ward 1, City DN team
Underperformance on St&M targets – whilst the directorate has made significant improvements in the last quarter, there is still improvement to be made. Trajectories in place for safeguarding and information governance; others in progress
Performance
(against key trust targets)
Maintaining compliance with new 48 hour ASLT urgent swallow assessment in community settings
69% compliance with CCG contractual KPIs
GP OOH NQRs underperformance
Reablement contract currently in tender process