annual general meeting 2016 - item 5... · 2016. 9. 21. · healthcare associated infections •...
TRANSCRIPT
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www.cddft.nhs.uk
Annual General
Meeting
14 September 2016
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www.cddft.nhs.uk
Chief Executive’s
Review 2015/16 and the
Year Ahead
Sue Jacques
Trust Chief Executive
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www.cddft.nhs.uk
We are the largest integrated
NHS provider in the
North East
Acute and planned hospital care
Health and wellbeing services
Community services
We provide care from…
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www.cddft.nhs.uk
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• Right person
• Right place
• Right time
• Every time
• 24/7
Our vision for services: Right first time, every
time
our commitment to put
patients at the centre of
everything we do
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We embrace
the values
outlined in
Means…
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A warm welcome from staff
To be treated as we would like to be treated
Respecting privacy, dignity and confidentiality
To be looked after by staff who inspire
confidence
An excellent standard of service, always
revolving around patient and carer needs
Means…
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…at the heart of driving
services forward for our
patients and communities.
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We ended the year having
performed well against most of our
operational targets and within plan
financially.
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2,034,389 patient contacts
387,939
radiology scans
42,810
operations
67,524
emergency
admissions
129,670
A&E
attendances
160,058
urgent care
attendances
578,646
out-patient
appointments
5,275
births
662,467
district nurse visits
& appointments
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www.cddft.nhs.uk
In 2015 / 16:
We were top
10 performers
nationally for
C Difficile
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www.cddft.nhs.uk
In 2015 / 16:
A&E 4 hour
performance
was 93.19%,
against a
target of 95%
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www.cddft.nhs.uk
In 2015 / 16:
We performed well
on cancer access
standards
In Q4, 1 of only 4
Trusts regionally to
meet 62-day target
for beginning
treatment following
screening
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In 2015 / 16:
We achieved
18 weeks
access
standards
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Inspected in February 2015
Over 80% of ratings ‘Good’
Positive progress on action areas during 2015/16
Care Quality Commission
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www.cddft.nhs.uk
Highlights in 2015 / 16
Building work on new
state-of-the-art
operating theatres at
Darlington Memorial
Hospital started. An
investment of £27m is
creating a high quality
environment for surgery.
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www.cddft.nhs.uk
Highlights in 2015 / 16
The Trust opened a
Clinical Simulation
Centre based at Bishop
Auckland Hospital
offering the very latest
equipment to create an
effective, immersive
simulation environment.
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www.cddft.nhs.uk
Highlights in 2015 / 16
Launched specialist
children’s radiology
service at UHND &
DMH. Dedicated waiting
areas, children-only lists,
longer appointment and
pictures and colours are
projected onto the scan
room walls, and
radiographers wear
colourful uniforms, to
help children feel
comfortable and calm.
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www.cddft.nhs.uk
Highlights in 2015 / 16
Innovative screening
programmes are
improving care for
hundreds of patients who
are now self-monitoring
from the convenience of
their homes. The
programmes are
supporting patients at risk
of under-nutrition and
patients taking Warfarin.
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Highlights in 2015 / 16
Invested £2.3million in
mobile technology for
community clinicians &
nursing teams.
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Highlights in 2015 / 16
Nurses in the Trust’s Centre for Research
and Innovation recruited the first patient to
a global study aimed at providing better
information on the management and
treatment patterns of patients with
prostate cancer.
Consultant’s work to minimise the risks
faced by allergy patients, earned a national
award from Imperial College London.
ReDi slide developed into a commercial
product & ‘Highly Commended’ in Royal
College of Nursing awards.
Research & Innovation
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www.cddft.nhs.uk
Looking ahead
2016/17….
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Continuing work on our Clinical
Services Strategy Delivering on our Quality Matters
Strategy and our Quality Accounts
Supporting our talented workforce
Building strong relationships
Recruiting and retaining quality staff
Improving our communications
Managing our finances Making best use of IT
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… looking at the
care we provide and how we
can best deliver quality,
sustainable services which
meet the needs of our
populations into the future
Continuing work on our
Clinical Services Strategy
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… improving safety, using best
practice, improving your experience
Delivering on our Quality
Matters Strategy and our
Quality Accounts
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Supporting our talented workforce
… supporting our workforce to
achieve their potential and be fully
engaged with the Trust through
meaningful appraisals and
organisational development strategy
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… with our partner organisations
across the health and social care
economy
Building strong relationships
Sustainability
and
Transformation
Plans
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… empowering our workforce to have a
voice in shaping and developing
services for the future, promoting
strong clinical leadership and investing
in our physical environments
Recruiting and retaining quality staff
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… communicating and engaging through
regular information updates and different
forums and events so that we can work
collectively for the benefit of our communities
Improving our communications
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… providing safe, effective and
efficient services within the funding
available to us, delivering on cost
improvement programmes and
meeting national requirements
Managing our finances
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… implementing an IT strategy which
supports us in delivering safe, quality
care with accessible information and
integrated technology and systems
Making best use of IT
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And finally….
THANK YOU Patients
Fam
ilies
Fri
en
ds o
f th
e H
osp
itals
Volunteers
Governors
FT
Mem
bers
C
are
rs
Local communities
Colleagues across health & social
care
Our Staff
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Quality Accounts
Noel Scanlon Executive Director of Nursing & Patient Experience Director of Infection Prevention and Control
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Quality Account 2015/16
2015/16 in review
Three quality domains: Patient Safety
Clinical Efficiency/Effectiveness
Patient Experience
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How we agree our priorities
Past Performance
Development Requirements
National Priorities
Staff Involvement
Stakeholder Input
Council of Governors
Board
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Principle
It’s important that we set ourselves
challenging and stretching targets in order
to improve and be the best at what we do.
As such, we will not always meet these
objectives.
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Safety Domain
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Falls
• Patient Falls (reduction in incidence per
1,000 bed days community hospitals)
- Ambition met/achieved
= Ambition: 8.0 Achieved: 6.8
• Patient Falls (reduction in incidence per
1,000 bed days acute hospitals)
- Trust ambition not achieved but
improvements made
= Ambition: 5.6 Achieved: 5.9
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Falls
• Introduce Sensory Training
- Ambition met/achieved
= Ambition: 720 Achieved: Over 720
• Follow Up Patients with Fragility Fracture
- Ambition met/achieved = Ambition: 50% Achieved: 89.9%
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Falls
• Complete Root Cause Analysis for
Falls Resulting in Fractured Neck of
Femur
- Ambition met/achieved
= Ambition: 100% Achieved: 100%
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Care of Patients with Dementia
• Development of Dementia Pathway and
Audit of Compliance
- Ambition met/achieved - Complete
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Healthcare Associated Infections
• MRSA Bacteraemia
• - Goal not met but
improvements made
• = Ambition: Zero Outcome:
3
• Clostridium difficile
• - Ambition not
met/achieved
• = Ambition: 19
Outcome: 21 0
5
10
15
20
25
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2012/13 2013/14 2014/15 2015/16
C-D
iffi
cile i
nfe
cti
on
rate
s
(per
100,0
00 b
ed
-d
ays)
C-Difficile infection rates (per 100,000 bed-days) NHS England Trusts v. Co. Durham & Darlington NHSFT
2012/13 Q2 - 2015/16 Q3
NHS England Trust apportioned rates CDD FT apportioned reports
0
1
2
3
4
5
6
7
8
9
2012/13* 2013/14 2014/15 2015/16
MR
SA
Bacte
raem
ia I
nfe
cti
on
Rate
s (
per
100,0
00
bed
days )
MRSA Bacteraemia Infection Rates ( per 100,000 bed days ) NHS England Trusts v. Co. Durham & Darlington NHS FT
2013/14 - 2015/16
NHS England Trust apportioned rates CDD FT apportioned reports
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Pressure Ulcers - Grade 3 & 4
• Assessment
- Goal not
met but
improvements
made
Ambition: Zero
Outcome: 5
UK & International comparison data
2015/2016
• 4-10% patients admitted to hospital
in the UK will develop a pressure
ulcer (NICE 2015)
• International data
– 8.2% Spain
– 8.9% France
– 8.3% Italy
– 12.5% Portugal
– 21% Belgium
– 5-10% Uk
– 0.01% CDDFT
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www.cddft.nhs.uk
Venous Thromboembolism (floating blood clots)
• Assessment
- Ambition met/achieved
Ambition: 95% Achieved: 95.9%
94.00%
94.50%
95.00%
95.50%
96.00%
96.50%
97.00%
% Adult Inpatients with VTE Risk Assessment on Admission to Hospital
VTE Target
2012/13 93.6%
2013/14 95.1% 2014/15 96.2%
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Discharge Summaries
• Percentage GP discharge
summaries arriving within 24
hours
• - Ambition not
met/achieved
• = Ambition: 95%
Achieved: 89.1%
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Incidents
• Rate of patient safety incidents resulting in severe injury or death from the National Reporting and Learning System (NRLS)
• Within national average for rates resulting in severe injury or death however number of incidents reported remains low, as below
- Goal not met but improvements made
Ambition: 75th percentile Achieved: 50th percentile (April to September 2015 data)
0
1000
2000
3000
4000
5000
6000
7000
8000
90 91 92 93 94 95 96 97
HIGH
MED
LOW
British airways risk reporting rates 1990-97
CDD FT cf.
last year in
bottom
quartile
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Sepsis
• Improve management
of patients identified
with sepsis by
implementing sepsis
care bundle and audit
effectiveness
- Ambition
met/achieved -
Complete
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www.cddft.nhs.uk
Duty of Candour
• To comply with the legal
duty to be open and
honest when things go
wrong
- Ambition
met/achieved -
Complete
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Patient Experience Domain
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www.cddft.nhs.uk
Nutrition and Hydration
• To review MUST audit tool
• To agree new indicators
• To audit against indicators
• Ambition achieved audit tool
now included in Quality Metrics
and indicators agreed
• Audit in pilot stage
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End of Life Care
• Ensure we recognise when a patient
may benefit from palliative care both
at the end of life and earlier in their
illness
• - Goal not met but
improvements made
• Work to continue
• 79% of palliative care patients
discussing their preferred place
of death.
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www.cddft.nhs.uk
End of Life Care Guidelines development - framework for the assessment of standards of End of
Life Provision.
The Specialist Palliative Care Education
18 Consultant/Senior Medical Staff in conjunction with the Cardiac Arrest
Team, 175 Registered Nurses and 99 Health Care Assistants.
Teesside University -15 Health Care Assistants - University Certificate
Professional Development (UCPD) in End of Life and Palliative care.
Documentation -individual plans of care & Prescribing of Anticipatory Drugs.
Education programme to support the provision of High Quality End of Life Care
across CDDFT.
Clinical Quality Improvement Framework (CQIF) /
Quality Assessment Tools and Comments Cards data can demonstrate that
in July 2016 100% of patients report that they would
recommend our services to Family and Friends and
rate the services 4.4-5 stars
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Development of a Learning Disability
Outreach Service • To follow up all patients with a learning
disability upon discharge into the community setting, initially with a telephone call, followed by a visit in their own home where appropriate
- Ambition met/achieved – Complete
• Monitor admission and readmission rates so that any recurring theme can be reported on and raised with the appropriate partner agencies
- Ambition met/achieved – Complete
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www.cddft.nhs.uk
Responding to Patients’ Personal Needs
• Responsiveness
- Ambition met/achieved Ambition: Improved positive responses from 2014/15 Achieved: Improved result for in all indicator questions
Patient Experience
Indicator Questions
201
4
Nat
In-pt
Q1
201
5
Q2
201
5
Q3
201
5
Q4
201
6
Ave
Did you feel involved
enough in decisions about
your care and treatment?
(Q11) 71
%
76
%
81
%
79
%
81
%
79%
Were you given enough
privacy when discussing
your condition or
treatment? (Q14 was 13) 81
%
88
%
89
%
86
%
88
%
88%
Did you find a member of
staff to discuss any worries
or fears that you had? (Q16
was 15) 50
%
81
%
82
%
78
%
83
%
81%
Did a member of staff tell
you about any medication
side effects that you
should watch out for after
you got home in a way that
you could understand?
(Q22 was 19)
49
%
64
%
70
%
63
%
62
%
65%
Did hospital staff tell you
who you should contact if
you were worried about
your condition or treatment
after you left hospital?
(Q25 was 22) 76
%
85
%
81
%
77
%
80
%
81%
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www.cddft.nhs.uk
Staff Experience (from Staff
Survey)
• Percentage of Staff who would
recommend the Trust as a
provider of care to their Friends
and Family
needing care
• - Goal not met but
improvements made
• Ambition: 3.71 Outcome:
3.60
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www.cddft.nhs.uk
Friends and Family Test
• To increase Friends and Family response
rates
- Ambition not met/achieved
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Friends and Family Test
To increase Friends and Family response
rates Work is continually on-going to try and increase response rates within the Trust which the
chart below shows from April 2015. Each ward/department are committed to improving their
response rate from the previous month.
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www.cddft.nhs.uk
Friends and Family Test
Recommended/Not recommended as hospital
of choice The Trust record the recommended/not recommended for each area as a whole which is
shown in the chart below from April 2015
the recommended score is going up for Inpatients and A&E, with Maternity fluctuating.
0
10
20
30
40
50
60
70
80
90
100
Perc
en
tag
e r
eco
mm
en
d /
no
t re
co
mm
en
d
Month Apr 2015 - Mar 2016
Friends & family test - In Patient - Recommend / don't recommend as hospital
of choice
In patient % Rec In patient % Not
0
10
20
30
40
50
60
70
80
90
100
Perc
en
tag
e r
eco
mm
en
d /
no
t re
co
mm
en
d
Month Apr 2015 - Mar 2016
Friends & family test - Accident & Emergency - Recommend / don't recommend as hospital
of choice
A&E % Rec A&E % Not
0
10
20
30
40
50
60
70
80
90
100
Perc
en
tag
e r
eco
mm
en
d /
no
t re
co
mm
en
d
Month Apr 2015 - Mar 2016
Friends & family test - Maternity - Recommend / don't recommend as hospital
of choice
Maternity % Rec Maternity % Not
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www.cddft.nhs.uk
Friends and Family Test – Themes
• There are many positive elements of praise within the comments provided
throughout Q1 2016/17.
• Data and comments recorded on the FFT have identified the following themes
from data received throughout Q1 2016/17 for areas of improvement:
• dignity and respect?
• involvement enough in decisions made about you? carer or family
member involved enough in decisions made about you?
• receiving timely information about your care and treatment?
• Was the location clean?
• treated well by the staff looking after you?
• “You said we did” posters and action plans displayed in prominent
areas of each ward and department.
•
Inpatients:
• Involvement (Q2)
• Information (Q3)
• Family Involvement (Q6)
A&E
• Cleanliness (Q4)
• Information (Q3)
• Family Involvement (Q6)
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www.cddft.nhs.uk
Clinical
Effectiveness
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www.cddft.nhs.uk
Risk Adjusted Mortality
• Reduction in Risk Adjusted Mortality Indices
to within ‘as expected’ range (Hospital
Standardised Mortality Ratio [HSMR] and
Standardised Hospital Mortality Indicator
[SHMI])
- Ambition: met/achieved
Mortality indicators remain within
expected levels
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HSMR Funnel Plot (April 2015 – March 2016)
HSMR
Expected Number of Deaths
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SHMI Funnel Plot (April 2015 – March 2016)
SHMI
Expected Number of Deaths
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Re-admission to hospital
• Reduction in re-admission rate to hospital
within 28 days
- Goal not met but improvements
made
Ambition: 7% rate Achieved: 7.98%
rate
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Emergency Department Indicators
• Time to initial assessment
- Ambition not met/achieved
Ambition: 15 mins max.
Achieved: 63 mins
• Time to treatment decision
- Ambition met/achieved
Ambition: 60 mins
Achieved: 34 mins
• Unplanned ED re-attendance
- Ambition met/achieved
Ambition: less than 5%
Achieved: 0.6%
• Left without being seen
- Ambition met/achieved
Ambition: less than 5%
Achieved: 1.8%
• 95% of patients to be
treated/admitted/discharged from
the Emergency Department (ED)
within 4 hours
- Goal not met/achieved
Ambition: 95% Achieved: 93.13%
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Patient Handover
• To reduce length of time for ambulance services to hand
over patients to emergency department ( 2 hours
ambulance delays)
Baseline Measurement Q1 leading to reduction
throughout year
- Ambition not met/achieved
More patients had to wait for
ambulance handover
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www.cddft.nhs.uk
Patient Reported Outcome Measures
(PROM’s) • To gain a better
understanding of health
improvements/outcome
s following surgery
(hip, knee, hernia)
- Ambition not met
but improvements
made
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Summary
Lots of improvements continue to be seen
Still lots to do to build on current performance and to stretch ourselves further
Introduction of Quality Matters has helped to align all areas of monitoring within the strategy
A journey of continuous learning and improvements in order to improve patient care, safety and experience
Experience of emergency department patients a major concern
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Financial Accounts
and Performance
in 2015/16
Peter Dawson
Executive Director of Finance
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Financial Reporting and
Performance
Challenging Financial Environment
Auditors confirm Accounts
Financial Outturn: On Plan
Continuity of Service Risk Rating of 2
from Monitor – on plan
Formal Investigation by Regulator
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Challenging Financial Environment 220 NHS Provider Sector ended 2015/16 with a £2.45bn deficit
Net of £345m capital to revenue transfers
£461m worse than plan
£1.6bn worse than 2014-15
71% (157) of providers in deficit; 85% (118) of Acute providers in
deficit
Acute trust deficit % of revenue = 4.6% c/w 3.0% for CDDFT
Public Accounts Committee (March 2016):
“The targets set by NHS England and Monitor for providers
to make efficiencies were unrealistic and have caused long-
term damage to trusts’ finances”
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External Audit Opinion
Accounts:
Financial Statements give a True and Fair View of
Financial Affairs of CDDFT
Properly Prepared
Value for money: –
Except for matters leading to Monitor’s formal
investigation, satisfied that CDDFT has proper
arrangements in place to secure economy, efficiency
and effectiveness in use of resources.
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Financial Performance 2015/16
Capital spend of £17.9m
Cash balance of £26m
Directors confirm we are a ‘going concern’
Financial Performance vs Plan £m
Headline Group Financial Deficit 50.9
Less: Impairment in Land & Buildings -36.3
Less: Charitable Funds Deficit -0.1
Financial Deficit - Actual 14.5
Financial Deficit - Planned 14.7
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Monitor Assessment Risk Assessment Criteria Rating
Capital service cover 1
Liquidity 3
I&E Margin 1
I&E Variance from Plan 4
Continuity of service risk rating 2
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Regulator Formal Investigation
Site visit July 2015
2015/16 revised plan submitted October 2015
Site visit November 2015
Board level review December 2015
Formal investigation launched December 2015
Peer review of financial control environment undertaken by Northumbria
FT
PwC review of 2016/17 planning and cost improvement programme
management undertaken
2016/17 Plan submitted
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Staffing Trends 2011 - 2016
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Operations and
Performance
Carole Langrick
Executive Director of Operations
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PERFORMANCE
Transforming Emergency Care
Programme
18-week referral to treatment (RTT)
Cancer
Discharge letters
6-week diagnostics
KEY ACHIEVEMENTS in 2015-16
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NON-ELECTIVE CARE 2015-16
Commissioning plans
for 2015-16: reduce A&E
attendances by 3%
no change in
emergency admissions
We saw: 3,752 (3%) more patients in A&E
496 (1%) fewer ambulances
1912 (2.8%) fewer emergency
admissions (FFCEs)
Our Performance 93.2% of A&E patients
treated within 4 hours.
73.5% of ambulance patients
handed over to A&E within 30
minutes (slightly more than in
2014-15) On average our adult medical
patients stayed: 5.85 days
What happened? More patients attended A&E but fewer
came by ambulance. Fewer patients
needed an emergency admission but
those that did stayed slightly longer.
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ELECTIVE CARE 2015-16
Commissioning plans for
2015-16: reduce referrals by 1%
No change in elective
admissions.
More day cases, fewer in-
patients
Meet national waiting time
standards
What happened? Referrals, elective activity and
Day case rates rose. Achieved 18
week RTT. Fell short of
diagnostics target but now back
on track.
We saw: 1% more referrals including 2.6%
more GP referrals and 1.5% fewer
non-GP referrals
2,227 (2.9%) more patients (2667
more Day cases; 440 fewer in-
patients)
Our Performance 94.2% of patients treated within 18
weeks (target – 92%)
97.8% of patients had diagnostic tests
within 6 weeks (target – 99%)
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www.cddft.nhs.uk
CANCER 2015-16
Our Performance Target 2015-16
Cancer: 2 week waits 93% 94.3%
Cancer: 2 weeks waits (breast only) 93% 92.3%
Cancer: 31 day from diagnosis to treatment 96% 99.7%
Cancer: 62 day from GP referral to first treatment 85% 86.7%
Cancer: 62 day from NHS screening to first treatment 90% 92.1%
What happened? Cancer referrals of all types
grew. New national strategy
introduced. All targets
achieved except 2-week
breast.
We saw: >12% more cancer 2-week wait
referrals
26% more breast cancer 2-week wait
referrals (mainly from Easington and
Sunderland)
9% more cancer referrals in total
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www.cddft.nhs.uk
2016-17 CHALLENGES
Workforce: Consultant recruitment in some
service areas creates capacity challenges.
Breast Surgery: significant continuing
pressures across the Region.
Sustainability Transformation Fund targets
A&E 4-hour wait
Referral to Treatment (18 weeks)
Diagnostics (6 weeks)
62-day Cancer
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Council of Governors
and Membership
Warren Edge Senior Associate Director of Assurance and Compliance
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Membership
Public Membership 2015/16 Number of
Members
Start of year 11,004
New members 143
Members leaving (see below) 400
At year end 10,747
• Audit and Data Cleanse during 2015/16
• Net 232 new members in the last five months
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Public Constituencies
Constituency Membership at 31 March 2016:
Chester-Le-Street (7%)
Darlington (19%)
Derwentside (15%)
Durham City (17%)
Easington (2%)
Gateshead, South Tyneside, Sunderland & Beyond (1%)
Sedgefield (15%)
Tees Valley, Hambleton, Richmondshire & Beyond (1%)
Wear Valley & Teesdale (22%)
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www.cddft.nhs.uk
Our Membership Goals
What do we want?
Growth in numbers with real engagement
A strong ‘membership voice’ to inform our
plans and services
More younger members
How will we get there?
Active recruitment and engagement, on our
sites and by social media
Colleges and schools
Active governor support
‘Meet the Chairman’ and ‘Medicine for
Members’ events
Join us and tell all your
friends!
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www.cddft.nhs.uk
Election Turnout
Council of Governors Annual Election (December 2015):
Wear Valley and Teesdale (18%)
Chester-le-Street (26%)
Durham City (24%)
Staff: Medical (19%)
Public governors were elected unopposed in: Darlington,
Derwentside, Easington, Gateshead and Hambleton and
Richmondshire
Staff governors were elected unopposed for: Admin, Clerical
and Managers; AHPs and Professionals; Nursing &
Midwifery and Community staff
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Changes to
Our constitution
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www.cddft.nhs.uk
Introduction
Dr Ken Davison, Chair of the Council of Governors’ Audit and
Governance Committee
Amendments to that Constitution must be agreed by the
Board, and the Council of Governors
And then be ratified by members at the AGM
The Board and Council of Governors have approved the
amendments in accordance with the Constitution and I
recommend them to our members on behalf of the Council
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www.cddft.nhs.uk
The Resolutions
Update to number and name of Governor Committees
Addition of agreed Dispute Resolution Procedure
Adoption of 2014 Model Election Rules
Recognition of the Governors’ role as per the Health and
Social Care Act 2012
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www.cddft.nhs.uk
Voting Procedure
Complete your ballot form, voting separately for each
individual resolution
Boxes will be passed along each block from the centre
aisle – fold and place your ballot form in the box provided
Boxes will be collected from the end of each block in the
outer aisle
The Trust Secretary’s Office will count the number of votes
registered and the number for and against and the result
will be announced at the end of public questions.
Approval of amendments requires a majority from those
voting
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Public
Questions
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Not a member yet?
Want to know more?
Why not ask for more details at our
Membership Desk and pick up an
Application Form.