1. Council of Governors Performance Report
Summary
Committees
NHS Improvement
Quality
Finance
Council of Governors Performance Report
19 July 2018 meeting
April 2018 and May 2018 Data
1.2 NHS Improvement
Segment
1.3 NHS Improvement
Use of Resources
1.1 CQC Rating
Requires
Improvement 2 3 1
Agenda Item: 11
Lead Director: Non-Executive Directors
Presented For: Discussion 1
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2. NHS Improvement Indicators Summary and Recommendations
Committees
NHS Improvement
Quality
Finance
The purpose of this Performance Report is to assist the Council of Governors in seeking assurance against the Trust’s performance and progress in delivery of a broad range of key targets and indicators.
Key Highlights
Slides
NHS Improvement Indicators
Information
NHS Improvement finance score is 3, in line with the 2018/19 plan approved by the Trust Board.
For 2018/19, the Trust has agreed a trajectory that maintains Psychiatric care Unit (PICU) inappropriate out of area placements at the 2017/18 baseline of 41 days per quarter, with review of PICU capacity across West Yorkshire and Harrogate resulting in elimination of inappropriate out of area placements by 2020/21. 1 11
Quality
Whilst there were four serious incidents reported in April 2018 and eight serious incidents reported in May 2018, no themes or trends have been identified. Serious incidents continue to be monitored closely.
Mandatory training compliance is now shown separately for fire safety, infection prevention, moving and handling and information governance, with an increased target of 95% for fire safety training.
Staff receiving an appraisal is slightly below the 80% target. The Business Unit Performance Meetings considered further actions and support required to increase appraisal rates.
There were three duty of candour incidents in April and May 2018 relating to: an overdose; an assault by a patient on a patient; the assault by a patient in the community on their flat mate.
Finance
Assurance
Control Total Performance – 2018/19 Performance: Surplus/(Deficit) Position: With a deficit of £547k at Month 2, control total performance is £41k ahead the planned deficit of £588k. The underlying plan for 2018/19 includes £1.195m of non recurrent Cost Improvement Programme (CIP) plans that require recurrent plans to be identified, including a deferred bed occupancy scheme.  In addition the in year CIP position includes non recurrent mitigations of £1.762m, reflecting ongoing cost pressures relating to inpatient staffing and medical locums.  This means that the Trust still has an overall underlying £2.957m recurrent challenge to address. 15
Summary and Recommendations
The report shows good overall performance in April and May 2018.
Correlation of quality information (including patient experience and safety related measures), performance, finance, workforce and health and safety information has taken place at the Board Committees (see highlights at slides 3 to 9). 2
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3. Finance, Business and Investment Committee – 11 June 2018
Summary
Committees
NHS Improvement
Quality
Finance
Finance, Business and Investment Committee – 11 June 2018
Assurances
Good progress has been made in the work to fully understand the issues involved in providing a responsive, reliable, and appropriate interpretation service for us in service-user contacts. The work is not complete, but progressing well under the oversight of a working group. The committee asked that the next update summarise the desirable characteristics of an Interpretation Service Framework, for full development and adoption at the end of the review.
Good progress has been made against most of the Worksmart programme strands. The Committee suggested that the overall programme should be reviewed and renewed as it reached its second anniversary, and as Sustainability and Transformation Plan digital strategy intentions became clearer.
At this early stage in the financial and operating year, the Committee was in general assured by progress in delivering the Annual Plan and Transformation programmes, although there remain significant challenges in implementing some Cost Improvement Programme strands.
The committee approved the Health and Safety and Fire Safety annual reports. It was clear that both were well led and well managed but it discussed the apparent under reporting of smoking related incidents outside of a ‘tally’ system pilot operating in the first quarter of 2017/18. It noted that further consideration of the Trust’s policy on e-cigarettes had been pursued via the Quality and Safety Committee with a proposal to revise the smoke free policy due for consideration by Board. The committee requested that this take into account the reporting of smoking related incidents, ensuring these arrangements are sufficiently flexible and time efficient to support full reporting.
Issues considered at the meeting
The committee considered: 
An update on the progression of the Trust’s Digital Strategy, including its approach to cyber security.
The current progress of Lord Carter’s review of Community and Mental Health services and on the related development of supporting Model Hospital toolkits.
Updates on Market Development challenges and opportunities, where key issues are the continuing uncertainty over NHS England’s next steps over community and unscheduled dental services, and the approach Bradford Council is taking to 0-19 public health services including the impacts on affected staff.
Work on the Costing Transformation Programme.
Work on Corporate Benchmarking Information.
Exceptions carried forward
Issue:
2018/19 Control Total – the last report highlighted the Trust did not anticipate achieving the £1,652k surplus Control Total and that planning guidance was awaited from NHS Improvement.
Status:
The Trust agreed a revised Control Total with NHS Improvement of £288k surplus in April representing a reduction of £1,364k from the original proposal. This included adjustments in respect of lower Clinical Negligence premiums, a share of the deployment of national risk reserve across provider organisations and some non-recurrent technical adjustments. If the Trust achieves this new target it will attract additional Provider Sustainability Funding of £793k leading to an overall surplus of £1,081k. 3

4. Quality and Safety Committee – 3 May 2018 and 14 June 2018
Summary
Committees
NHS Improvement
Quality
Finance
Quality and Safety Committee – 3 May 2018 and 14 June 2018
Assurances
Children’s Services:  
Significant improvements include the transformation of Wakefield services, and the award of contracts for strategic breast feeding services and flu immunisation.
The teams continue to score highly on the Friends and Family test.
Virtual safety huddles have been developed by Health Visiting and Looked After Children teams which have helped re-establish communication and support alongside agile working.
An audit of use of clinical time has identified the potential for a significant shift of tasks from clinical to administrative staff.
Adult Physical Health:  
The decommissioning of the Complex Care team is being carefully managed with patients already placed with other services and the redeployment of staff being addressed on an individual basis.
“Grow your own” clinical staff continues to progress well with the development of an apprenticeship scheme, supported by the Open University, to support Health Care Workers (HCWs) aspiring to nursing training. Four HCWs have already secured student nurse places.  
Clinical time savings have been made through the use of “the perfect boot” and changes to primary care medication processes.
Committee Dashboard:  
The dashboard presented a generally positive picture in the face of a demanding year.
The clinical audit section of the dashboard now includes narrative slides from the project lead for each priority clinical audit summarising results, potential impact on care and planned improvements.
The number of patients waiting for psychological therapy services remains high but is falling. 
KPIs for the Single Point of Access are all at or near 90% achievement. The committee asked for more detail to assist understanding of the impact of the remaining 10%.
The majority of quality indicators in 2017/18 have been achieved. The committee will continue to monitor the small number not achieved.
Other Assurances
Complaints and compliments: the committee was assured regarding the investigation and response to complaints. Apparent “hot spots” in community mental health teams will be highlighted in the next business unit report. There was mixed feedback (in small numbers) from service users. The committee asked that this be considered after the second meeting of the complaints panel.
Research: a very positive report showing the Trust beginning to attract higher profile studies and funding has been secured to develop facilities suitable for commercial research. 4

5. Quality and Safety Committee – continued
Summary
Committees
NHS Improvement
Quality
Finance
Quality and Safety Committee – continued
Other assurances (continued)
Serious Incidents: Robust investigation processes are in place and potential for learning and beneficial change have been identified.
Quality and Safety Committee and Governance Improvement: All actions on the Governance Improvement plan have been completed.
Clinical Audit: the committee approved the dissolution of the Clinical Audit Steering Group and was assured that support would in future be provided directly to staff undertaking audits. The committee approved the clinical audit plan for the 2018/19 year.
Quality Report: The committee reviewed the report and complimented the thorough approach to developing this. The reports of other organisations will be reviewed as part of next year’s work programme.
CQC Update: The `Should Do’ action plan continues to be delivered to time. Work is being undertaken to produce a themed, and therefore more succinct, Must Do/Should Do plan for the attention of staff.
CQC action plan: the new themed iteration of the plan was approved by the committee. The plan will be further populated by the time of the next committee.
Trust Wide Involvement Group (TWIG): the committee received assurances from our Service-User/carers members that the refreshed TWIG is working well with good participation from a wide range of service users supported by the various training activities available to them.
Annual reports received
Incident management: the Trust continues to be “high reporting” (generally recognised as a good thing). A record number of incidents this year were associated with reports of smoking related incidents.
Freedom to Speak Up: the Guardian and champions are now well established with the number of reports increasing and a robust response to each report.
Infection Prevention: the Trust continues to achieve high standards with minimal levels of reportable infections, the highest rate nationally for flu immunisation within mental healthcare and an antibiotic management programme in place to minimise the risk of antibiotic resistance. 
Safeguarding: the numbers of staff trained have increased across both Bradford and Wakefield services and both services now have robust safeguarding leadership and support in place. The Board is aware that a cluster of suicides of young people occurred in the Wakefield district. The Committee was assured that a thorough review of these deaths has taken place, with a wide range of actions taken in response to the review, across social care, education and health services for young people.  
Medicines Management: Staffing pressures are somewhat ameliorated and medicines management support is now in in place for a wide range of medicines management activities including the redesign of the clozapine initiation pathway to remove the need for admission and increasing the efficiency and effectiveness of dispensing medications on wards. Medicines management is nationally a hot spot for incidents and concerns. The committee was assured that there are no unusual sources of concern within the Trust and that where high numbers of incidents are noted, work is undertaken to understand and address associated risks. 5

6. Quality and Safety Committee – continued
Summary
Committees
NHS Improvement
Quality
Finance
Quality and Safety Committee – continued
Annual reports received
(continued)
Emergency Preparedness: All services have robust plans in place. The effectiveness of these plans has been tested over the year by a table top exercise and a variety of real-life incidents. In all cases there has been an excellent response and improvement potential noted and integrated into service plans.  
Internal audit reports
Internal Audit reports were received by the committee for the first time:
Key Performance Indicators (High assurance)
Medicines Management (Significant assurance)
Learning from Deaths (Limited assurance). This work is relatively new to Mental Health Trusts (and even more so to Community Trusts). The committee was assured that issues identified by the audit are being addressed. The membership of the Mortality Review Group has been extended and also its remit, to include Duty of Candour incidents. Good practice is supported by regular attendance at the regional network for Learning from Deaths.
Exceptions
Issue:
The Bradford public health 0-19 children’s service procurement is expected to commence in June There are likely to be other competitors for this contract.
Status:
It has been confirmed that the procurement process will commence on 20 July 2018.
Significant pressure on school nursing capacity continues.
A redesign process is under way.
Adult Physical Health and Children’s Services Business Units reported challenges arising from agile working.
The committee will seek a Deep Dive into the “people” aspects of agile working in discussion with the Finance, Business and Investment Committee and the Informatics Board.
Targets for timely communication of discharge information to GPs have not so far been achieved.
Benefits are expected from the introduction of SystmOne.
The committee expressed concern at the level of reporting of incidents of violence and aggression - above the national average in our staff survey, and well above the best mental health trust.
A Deep Dive has been commissioned to further understand these figures.
Timely implementation of NICE guidelines continues to prove to be a challenge, particularly for mental health services.
Additional support is being provided by the library team to address this situation.
Staffing pressures: continue to be a frequent source of discussion. The Safeguarding team is particularly concerned about the reduced budgets within the service specifications to be released in the Autumn.
It is hoped that the impact will not be felt until next year. 6

7. Quality and Safety Committee – continued
Summary
Committees
NHS Improvement
Quality
Finance
Quality and Safety Committee – continued
Exceptions
Issue:
The Medicines Management team has an ongoing senior vacancy. They have not been able to recruit, although new approaches are being tried.
Status:
Ongoing.
Exceptions carried forward
Staffing on the Dementia Assessment Unit continues to be challenging despite a range of actions in place.
Move to 7 Day Working of the Trust’s Medicine Management Team – the last report highlighted the Medical Director had written to Bradford Teaching Hospitals Foundation Trust regarding the resultant impact of 7 day working on the quality of service provision to the Trust.
A response is awaited. 7

8. Board assurance framework/Governance – High assurance
Summary
Committees
NHS Improvement
Quality
Finance
Audit Committee – 23 May 2018
Assurances
The external auditors confirmed that there had been no adjustments identified to the 2017/18 Annual Accounts during the audit and that they would be providing a “clean” audit report. The Accounts were recommended to the Board for approval the following day.
The external auditors also reported on their work on the Quality Accounts. They confirmed that their work identified no exceptions and that they would be providing a “clean” limited assurance report. They confirmed that the report is “limited” due to the restricted scope of their review.
The Committee received the Annual Report and Head of Audit Opinion from the internal auditors and noted the Significant Assurance Opinion received.
The Committee received one "limited assurance" report from Internal Audit, along with four "significant assurance" reports and four “high assurance reports, covering:
Mortality review/Learning from deaths – Limited assurance (also considered by Quality and Safety Committee on 14 June 2018)
Clinical system migration project – Significant assurance (to be considered by Finance, Business and Investment Committee on 25 July 2018)
HR/Payroll – Significant assurance (also considered by Finance, Business and Investment Committee on 11 June 2018)
Medicines management – Significant assurance (also considered by Quality and Safety Committee on 14 June 2018)
Cyber security – Significant assurance (to be considered by Finance, Business and Investment Committee on 25 July 2018)
Financial systems – High assurance (also considered by Finance, Business and Investment Committee on 11 June 2018)
Board assurance framework/Governance – High assurance
Reporting to NHS Improvement – High assurance (also considered by Finance, Business and Investment Committee on 11 June 2018)
Key performance indicators – High assurance (also considered by Finance, Business and Investment Committee on 11 June 2018 and Quality and Safety Committee on 14 June 2018)
The Committee agreed the action plan proposed for the limited assurance report and agreed to receive a further report from internal audit during 2018/19.
Most Internal Audit actions arising from internal audit reports were being progressed in accordance with agreed timescales and, where not, there were good reasons for delay. 8

9. Audit Committee – continued
Summary
Committees
NHS Improvement
Quality
Finance
Audit Committee – continued
Other Assurances
Assurances were also received in relation to: 
The work of the Freedom to Speak Up Guardian (from the FTSUG annual report).
Data assurance, from the internal BDCFT annual report.
Local Counter Fraud activity, including the successful prosecution of a former member of staff found to be working elsewhere whilst claiming sick pay from the Trust.
Losses and special payments - no significant untoward items.
Waiver of standing orders – these are only used where necessary and in accordance with Standing Financial Instructions (SFIs).
Exceptions
No exceptions were identified nor carried forward. 9

10. Single Oversight Framework Operational Performance Metrics
Summary
Committees
NHS Improvement
Quality
Finance
Single Oversight Framework Operational Performance Metrics
Indicators M7, M10, M11: Reporting shows the 3 month rolling position, rather than traditional quarters, in order to match how NHS Improvement monitors these metrics under the Single Oversight Framework (updated November 2017).
Indicator M7: Data is provisional provided in relation to the waiting time element of the new standard for Early Intervention in Psychosis (EIP). This shows patients who started treatment in May 2018 within two weeks of referral. The number of incomplete pathways (patients waiting) at the end of May 2018 was 25; 14 of these patients have been waiting for more than two weeks.
In 2018/19, Clinical Commissioning Groups (CCGs) have made additional investment in Early Intervention in Psychosis staffing, enabling the Trust to meet the 53% target for people with a first episode of psychosis to begin treatment with a NICE-recommended package of care within 2 weeks of referral by quarter 4 of 2018/19. CCGs have confirmed that further funding will become available in following years to both maintain and increase capacity as per the 2020/21 target. 10
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11. Single Oversight Framework Operational Performance Metrics
Summary
Committees
NHS Improvement
Quality
Finance
Single Oversight Framework Operational Performance Metrics
Indicator M21: As forecast, Improving Access to Psychological Therapies (IAPT) recovery rate improved in quarter 4. Recovery rate was above 50% at Trust level and in Bradford Districts and Airedale, Wharfedale, Craven Clinical Commissioning Groups (CCGs), though remained below 50% in Bradford City CCG. Provisional data for April 2018 indicates that recovery rate in Bradford City CCG has increased to 51.5%. My Wellbeing College (City Team) have been working on a project to develop a model of improvement that is replicable across teams and services in the Trust and improve the access, experience and recovery rates of people from Black Asian and Minority Ethnic groups.  An action plan will developed once the final report and recommendations has been received by the Executive Management Team.
Indicator M23: The Trust has relatively few inappropriate out of area bed days; all relate to the Psychiatric Intensive Care Unit (PICU). The Trust’s local data for inappropriate out of area bed days are included in the Board integrated performance report,
rather than using the NHS Digital published data which suppresses small numbers. 11

12. Serious Incident Numbers
Summary
Committees
NHS Improvement
Quality
Finance
Serious Incident Numbers
Indicator No.
17/18 Out-turn
May 18
performance
18/19 Year to Date Q3 28 8 12
In April and May 2018, there were 8 ‘Serious Incidents other’. These related to 1 incident of self-harm; 2 under age admissions; 1 Information Governance; 1 pressure ulcer; 1 contamination incident; 1 allegation of abuse and 1 choking death.
This data is monitored in more detail via the Quality and Safety Committee on a quarterly basis. 12

13. Workforce – Appraisal & Mandatory Training
Summary
Committees
NHS Improvement
Quality
Finance
Workforce – Appraisal & Mandatory Training
Indicator No.
Indicator
17/18 Outturn
18/19 Target
Current Performance
18/19 Forecast
Graph
Q17
% Fire Training
90.00%
(80% target)
95%
89.20%
% Infection Prevention Training
88.22%
80%
86.50%
% Moving & Handling Training
87.33%
86.47%
Q17c
% Information Governance Training - All Staff Combined
98.28%
95.68% 13

14. Summary Committees NHS Improvement Quality Finance
Workforce – Appraisal, Labour Turnover, Sickness Absence, Recruitment Rate
Indicator No.
Indicator
17/18 Outturn
18/19 Target
Current Performance
18/19 Forecast
Graph
Q18
% Staff Receiving
Appraisal
79.01%
80%
78.67%
Q19
% Labour Turnover
11.30%
10% or less
11.14%
Q20
% Sickness absence rate
4.96% 4%
or less
4.66%
Indicator No.
Indicator
17/18 outturn
18/19 Target
Numer-ator
Denom-inator
Current Performance
18/19 Fore-cast
Graph
Q21
% Recruitment rate (Number of posts being actively recruited to as a percentage of staff in post)
7.48%
10% or less
227
3033 14

15. Finance Key Measures Summary Committees NHS Improvement Quality
Note for RAG for CIPs – 10% variance is Amber, over 10% is Red
Before taking into account the high risk CIP reserve performance is £121k behind plan. A key focus remains recurrent scheme delivery and/or substitution and is subject to Finance, Business and Investment Committee scrutiny. 15