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Board Development Session Wednesday 31 August 2016

08:30am Boardroom, Sceptre Point

Board of

Directors

Quality Committee

Finance & Performance Committee

Nomination / Remuneration

Committee

Audit Committee

Board of Directors

Meeting Board Development Session

Location Boardroom, Sceptre Point, Walton Summit, PR5 6AW

Date Wednesday, 31st August 2016

Time 08:30am

Reference Item Lead Enc FOIA

exempt

BDS 001/16 Welcome David Eva Verbal

BDS 002/16 Our Health Our Care Update Sarah Jayne Presentation

BDS 003/16 Chief Executive’s Report Heather Tierney-Moore

Paper

BDS 004/16 Quality and Performance Report Sue Moore Paper

BDS 005/16 Finance Report Bill Gregory Paper

BDS 006/16 Well Led Report Jo Alker Paper

BDS 007/16 Recovery Plan and Financial Improvement Measures

Bill Gregory Paper

Close David Eva

Board of Directors

Agenda Item BDS 003/16 Date: 31/08/2016Report Title Chief Executive’s Report FOIA Exemption Part Exemption Business Development Report Prepared by Heather Tierney-Moore, Chief Executive Presented by Heather Tierney-Moore, Chief Executive Action required Discussion Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose The purpose of this report is to provide Board members with an overall summary of the Trust position and highlight areas for further discussion.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 2.1 – The Trust does not receive assurance of the accuracy, timeliness and consistency of data and reporting with the potential to compromise decision making and service quality

CQC domain Well-led

Introduction This report aims to give Board members an overview of the activity undertaken since the last Board meeting, both within the Trust and externally.

QUALITY AND SAFETY

Delivering the Quality Plan The Building Blocks to Effective continuous quality improvement The Quality Plan embraces the Health foundation and the Institute for Healthcare Improvement model for improvement which is a systematic approach using methodologies and enablers to improve quality. This reflects setting clear aims and measures, with a Plan Do Study Act methodology underpinning the changes and supporting action orientated learning ensuring implementation which is embedded and spreads.

The Building Blocks Framework identifies the twelve key components of a quality improvement focused organisation.

Quality improvement initiatives are built on the knowledge of those working within a service about where the opportunities to improve value lie, as well as hearing feedback from people who use the service and those close to them about the services that they receive and how they could be improved and in doing so increase value from the limited resources.

A group of colleagues from across Support Services and the Networks have been invited to a thinking space session in late September to determine where we need to focus our collective efforts to achieve our key areas of focus for remainder of the year using the Building Blocks framework and associated AQUA resources to help us.

The Frontier Framework We have been successful as an organisation in being accepted to work with NHS England and colleagues from Coventry University to test the application of an economics based model the Production Possibility Frontier (PPF) Framework to plan, deliver and measure improvement activities. We are in the process of establishing our ‘Frontier Implementation Team’ involving colleagues from Performance, Finance, Procurement, Human Resources, Nursing and Quality.

We believe that The Frontier Framework can support the achievement of Our Vision and the Quality Plan, and believe the PPF relates to our outcome - to always be the best that we can be. We would be interested in the Frontier Framework informing this through:

Supporting us to further develop the team to Board Quality Dashboard by framing the feedback from people who use and provide / support service provision using the Frontier Framework. This in turn will support data being used as a question to drive quality improvement rather than

viewing data as the answer and merely describing the issue Co-produce a best experience story for people who provide / support service provision and

utilise Experience Mapping to support this. This will complement our existing aspirational experience vision for people who use services

Opportunity to build on our quality improvement focus, utilising co-design and Always Event methodologies

Opportunity to shape how stories are told and heard within the organisation, so that we have stories with 2 voices (those of the people who use and provide/ support service provision)

Inform the delivery of the People Plan Developing and sharing our learning through the Frontier Faculty

Always Events update Lancashire continue to participate in the national Always Event pilot with NHS England, Institute for Health Care Improvement and Picker Europe. During Q1 LCFT have continued to support the national roll out of the Always Event Programme and have shared our experiences and learning at a number of national events including:

Always be the best

we can be

Valued motivated and engaged staff

People at the heart of

everything we do

Speaking at an NHS England Always Event Conference in London Poster Presentation at Q Event Leeds Presentation to Learning Disability Commissioning Meeting Chorley House, Leyland with NHS

England Lancaster Learning Disability Team co-design work in progress East Lancashire Learning Disability Team co-design work in progress Thinking Time for staff focused ‘Always Event’ at The Harbour Preparatory Thinking Time Hearing Feedback in Specialist Services Preparatory Thinking Time Hearing Feedback in HMP Liverpool

The Blackburn Adult Learning Disability Always Events co-design team have been shortlisted as finalists in the Positive Practice in Mental Health Experience Awards. The award ceremony will take place in October 2016. Health Education England Nurse Associate Bid Submission Lancashire Care Foundation Trust, in partnership with the University of Central Lancashire, East Lancashire Hospitals NHS Trust, Blackpool Teaching Hospitals Foundation Trust and Fylde and Wyre CCG Vanguard have submitted a joint bid to become a test pilot for the Nurse Associate Role. The successful organisations will be notified in October 2016. Quality Improvement Good Practice visits Two Good Practice Visits having taken place during this reporting period. A summary of each is provided below: Dental Team in Bacup visited on 30th June 2016 The visiting team: Dr. Richard Morgan, Deputy Medical Director Peter Ballard, Non-Executive Director Alan Ravenscroft, Public Governor Helen Scott, Public Governor Michelle Prescott, Quality Assurance and Improvement Lead Julie Garlick, Quality Officer The Bacup Dental Team is one of six specialist community dental services. The team provides continuing care, urgent care and specialist services; they currently have over 2000 people accessing the service based in Bacup Health Centre. The team use their regular ‘huddle’ time to discuss the flow of work from reception to the dental surgery and work together to resolve any challenges. For example it was noted that feedback from people using the service is generally positive however a theme reflected in complaints related to cancelled or postponed appointments due to the availability of Dentists. The team work together to ensure that people needing urgent treatment are prioritised ensuring that people who remain waiting are communicated with. The team were commended for their collective resilience and commitment to the service. They were encouraged to explore the health and well-being opportunities on offer to support them to stay healthy and well at work. The Hearing Feedback Team visited on 5th July 2016 The visiting team: Damian Gallagher: Director of Human Resources Naseem Malik, Non-Executive Director Ashok Khandelwal, Public Governor

Bernadette Ashton, Public Governor David Rintoul, Performance and Quality Manager (Commissioning Support Unit) Michelle Prescott, Quality Assurance & Improvement Lead Julie Garlick, Quality Officer People are encouraged to give feedback about Lancashire Care NHS Foundation Trust services in a number of ways including expressions concerns of complaints and satisfaction as compliments. The Hearing Feedback Team formally known as the Customer Care Department is a central contact point and provides support and guidance through the compliments and complaints processes for staff and people who use our services. As part of their Quality Improvement Framework initiatives focus on having people at the heart of improvements are being made to the complaints process and to the feedback given. For example, a training package has been developed, tested and is now in place offering complaint investigators a better understanding of how to conduct an investigation and how to translate the outcomes to produce a good response letter. The aim relating to improved response letters is currently being measured. In addition the team are currently testing a “case management” approach to managing complaints with a single contact person from the team maintaining oversight of the case from the initial contact to its end. This helps members of staff to build up a rapport with a person making a complaint and/or member of staff dealing with the investigation thus creating a better understanding of the complaint, timelines, reduces repetition and should lead to a better and speedier overall outcome which is one of the Quality improvement Framework measures. It was noted that the Hearing Feedback Team are creating effective cooperation, communications and relationships across the Networks and Support Services Departments and are working with Lead Commissioners to continuously improve reporting. The team are committed to having conversations with people and have the courage to move from a bureaucratic process model to a person centred approach whilst ensuring that national requirements can still be met. Hearing Feedback; from people in secure mental health services The mapping of the Friends and Family Test responses to six of the Quality Plan’s eight Quality Commitments (care, choice, collaboration, communication, compassion and competence) across 2015/16 caused us to be curious about the feedback from people using Specialist Services. Feedback from April 2015-March 2016, when mapped against the Quality Commitments as of 25/7/16 is:

The Head of Hearing Feedback led a thinking space session in July involving people using our Secure Mental Health Services at Guild. People using services shared that they are reluctant to give feedback as ‘nothing happened as a result’. A thinking space using Appreciative Inquiry (the 4d model) resulted in the co-design of an Always Event Vision: ‘My voice always matters’. Ideas to support this were shared and are now being implemented to test the vision. Process, outcome and balancing measures will be progressed with the outcomes and will be reported as part of the quarterly Hearing Feedback Report to the Quality and Safety Sub-Committee with regular updates in the Quality Matters Bulletin.

Hearing Feedback from the Community Mental Health Survey 2016 The Community Mental Health Survey is based on a sample of people using services aged 18 years and over who were receiving specialist care or treatment for a mental health condition and had been seen by the Trust between September and November 2015. The purpose of the survey is to understand what people think of healthcare services provided by the Trust, a standard survey methodology and standard questions are used. The questions are based upon what is most important from the perspective of people using the services. Lancashire Care along with 6 other NHS Trusts commissioned the Picker Institute Europe to undertake the 2016 survey. The findings of the survey are for internal use only until the national publication by the CQC. The findings have now been forwarded to the CQC by Picker. The CQC will benchmark the data and provide the national overview which will be published in October/November 2016. The initial report can be used as the starting point and evidence base for any quality improvement work undertaken. To support this a feedback session and action workshop is planned and being facilitated by Picker on 19th September, to which all Network leads have been invited. These sessions will be interactive so that Network teams can begin to identify their improvement actions during the session with the support of the Quality Team and Picker. Quality improvements will then become part of network QIF plans to ensure robust improvement plans and measures to improve the experiences of people receiving community mental health services are in place. A feedback session and action workshop is planned and being facilitated by Picker on 19th September, to which all network leads have been invited. These sessions will be interactive so that network teams can begin to identify their improvement actions during the session with the support of the Quality Team and Picker. Quality improvements will then become part of network QIF plans to ensure robust improvement plans and measures to improve the experiences of people receiving community mental health services are in place. Investigations and Learning Team The Trust has now completed recruitment to its new Investigations and Learning Team, with full implementation of the new team in September. This follows a small team being in place for the last 12 months. The new team will undertake all serious incident investigations and other complex safety investigations, with a focus on ensuring that we identify all areas for improvement and effectively embed learning. The new team reinforces our commitment to improving quality by effectively learning from serious incidents, and a key priority for their work will be engaging staff in learning and fully involving patients and families in investigations. Coroner’s Letters The Trust recently received two letters from local Coroners in conclusion of recent inquests. These were not formal Regulation 28 Notices but set out concerns that the coroner had identified during the inquest. The first related to the application of the Observation Policy (relating to an incident in July 2015) and we were able to assure the Coroner that the revised Observation Policy has been implemented during quarter 1 of 2016/17. The second letter related to the evidence of the Practitioner at the inquest and this matter is being addressed by the Network. Care Quality Commission (CQC) Re-Inspection As the Board will be aware, the CQC are re-inspecting the Trust in September 2016. A large volume of data has already been submitted and during the first two weeks of September a number of focus groups, interviews and some inspection visits will take place. The main inspection activity will take place during the week of the 12th September 2016. The action plan developed following the last inspection has now been closed and any outstanding work, such as long term infrastructure projects,

have been clearly recorded on business plans and the Risk Register. The Trust has been supporting teams to ready themselves for the inspection through regular communication, engagement visits and focus groups. Over 100 visits to teams have taken place and a toolkit for teams and leaders has been developed with over 800 packs distributed.

CQC Review of Child Safeguarding The Board will be aware of the recent CQC Review of Health Services for Children Looked After and Safeguarding in Lancashire. The final report has now been received by the Trust and published. The Trust is currently developing the action plan in response to the report and will participate in an NHS England-led action plan oversight group. The same procedures and systems used for the recent full CQC inspection of the Trust will be utilised to provide internal governance and assurance. The main areas of focus for the Trust:

Strengthening our approach to identifying risks to children of parents with mental ill-health toensure effective initial and ongoing review of risks and sharing of expertise to informpartnership working

Ensuring children looked after care records provide a complete picture of previousassessments and care plans in line with the required standards of record-keeping to supportthe development of a comprehensive health history for young people leaving care.

Ensuring records of actions discussed in supervision are routinely recorded on the caserecords of children and young people to provide assurance about the effectiveness and impactof work to address risks and support improved outcomes.

FOIA Exempt under section 22 – Information intended for future publication HMP Liverpool – CQC Re-inspection

FINANCE AND PERFORMANCE

Quality and Performance Report A summary of the Month 4 performance information has been pulled out as a separate agenda within the Board pack and can be viewed here.

Financial Position

Month four sees a year to date deficit of ‐£2.4m, £1.9m behind plan. £0.7m relates to Sustainability and Transformation funding which can be recovered when the Trust achieves its financial targets. It is projected that the full year deficit after mitigations would be £1.3m, but this is not without risk and without mitigation the Trust is in line for a £7.7m overspend. The month to month position shows some improvement – Month 4 ‐£0.4m Month 3 ‐£0.6m, however the in year position remains

undermined primarily by the use of temporary staffing particularly in ward areas to cope with the level and acuity of the types of patients accessing these services but the position also includes some slippage on sexual health contracts, CIP plans and Out of Area Treatments.

A Finance Recovery Group has been established to allow the Board to scrutinise this in more detail. The first meeting will take place on 24th August 2016.

More detail can be seen in the Finance Report which can be viewed here.

PEOPLE AND LEADERSHIP

Chance2Shine Programme – Update July 2016 Following a Board to Board meeting between the Trust and Blackpool Council early last year 2015, Lancashire Care Foundation Trust were delighted to commission and work in partnership in supporting a 12 month joint role to deliver the Council’s Chance2Shine initiative to be piloted at the Harbour. The Chance2Shine was set up by the Council to tackle long-term unemployment by offering unemployed people to gain up-to-date work experience across a range of local employers. The programme provides suitable unemployed candidates with a 4 week work placement opportunity working up to 16 hours per week to help improve their employability prospects. Placements can be extended up to 8 weeks where appropriate.

The Trust was successful in receiving Health Education England funding for 12 months to support the implementation of the Talent for Care agenda, and subsequently the joint role of Work Placement Co-ordinator (2 days per week). The Co-ordinator Aimi O’Donnell supports each referred candidate and matches them to a suitable work placement within the Harbour.

The Quality Academy is working closely with the Blackpool Council and managers at the Harbour to provide appropriate and safe work placements. Risk assessments are carried out in advance of each candidate starting their placement. Candidates have so far been matched within reception/administrative roles, wellbeing/physio roles and OCS catering/cleaning roles. Some of the funding was also used to provide candidates with an ‘identifiable’ polo shirt, magnetic Quality Academy badges and lanyards.

To date, managers at the Harbour have been very pleased with the calibre of candidates wanting a work placement and the candidates have enjoyed the experience. The programme has already had some job start successes from the first and second cohort of candidates.

The feedback from both the candidates and managers has been excellent so far. This is a superb opportunity for everyone concerned to help improve people’s aspirations; in turn, improving our local economy and helping break down barriers, providing better prospects and a higher calibre of job ready applicant.

Apprenticeship Levy Event In spring 2017 the way the government funds apprenticeships in England is changing. Some employers including Lancashire Care will be required to contribute to a new apprenticeship levy, and there will be changes to the funding for apprenticeship training for all employers. This is a mandatory Levy placed on all large employers which will be used to fund the Apprenticeship programme. Based on Lancashire Care Trust 2014-15 wage bill as a baseline the financial implications of these changes are in excess of £1.2 million.

Maximising the opportunities presented through these changes is a key priority of the Trust and the wider Lancashire and South Cumbria Sustainability Transformation Plan (STP). Given this, Lancashire seized the opportunity to maximise partner working opportunities by hosting an Apprenticeship Levy Event for partners across the STP footprint. The event was held in July 2016 and the purpose of which was to fully understand the implications, the impact and the potential

collective benefits of strengthening existing working partnerships across traditional organisational boundaries. The event was over-subscribed and well received by partner organisations who evaluated the day extremely positively.

Further partnership working across the STP is scheduled over the remainder of the 2016/17 financial year in order to maximise training and learning opportunities of staff in 2017/18.

GOVERNANCE AND ASSURANCE

Well-Led Review The final Well-Led Report has been circulated to the Board and at the last Board meeting consideration was given to the recommendations made within that report. Board members were asked to feed any further comments back for inclusion in the action plan and this can be seen at agenda item BDS 006/16.

New Published Guidance Strengthening Financial Performance and Accountability in 2016/17 This report was published jointly by NHS England and NHS Improvement in July 2016. The report describes the measures to restore financial discipline and to help ensure ongoing financial stability for the NHS.

The key points to note are: The allocation of £1.8m Sustainability and Transformation Fund Agreed financial control totals with trusts and CCGs New intervention regime of special measures Launch of a two-year planning and contracting round for 2017/18 and 2018/19, linked to

agreed STPs

The Strengthening Financial Performance and Accountability in 2016/17 report can be viewed here.

Single Oversight Framework The Single Oversight Framework has been consulted on and we await the final version of the document. The Framework replaces the current Risk Assessment Framework (Monitor) and the TDA’s Accountability Framework. The Framework will apply to both FTs and NHS Trusts and describes NHS Improvements main areas of focus of oversight, their information requirements, how concerns will be identified and how any necessary support will be tailored dependant on the level of challenge the organisation faces.

The Single Oversight Framework consultation document can be viewed here.

BUSINESS DEVELOPMENT

FOIA Exempt Under Section 43 – Commercial Interest Chorley A&E

http://www.lancashirecare.nhs.uk/media/Umme/31.08.16/Strengthening_financial_performance_and_accountability_in_2016-17_-_Final_2.pdf

http://www.lancashirecare.nhs.uk/media/Umme/31.08.16/Single_Oversight_Framework_consultation_-_final_draft_28_06_update_CC.pdf

FOIA Exempt Under Section 43 – Commercial Interest Harvey House

Lancashire Prisons Further to the informal Board Briefing that took place on the 4th August 2016 we did not submit a bid for the Lancashire Prisons. All staff have now been briefed along with NHS England as the Lead Commissioner.

Crisis House Further to the discussion at the last Board meeting and for those in attendance at the Financial Recovery Group, the business case for the Crisis House was presented to the Business and Development Sub-Committee held on 19th August 2016. The proposal detailed a two year pilot with Richmond Fellowship whereby they would, with support from the Trust, establish a Crisis House for up to five people to stay for up to seven nights. Support will be available to individuals 24 hours per day, every day of the year using a co-produced, person centred recovery approach working closely with clinical teams. The service would be accessed via the Crisis Resolution and Home Treatment teams (CRHTT) with referral facilitated 24/7 by waking night staff provision. Following discussions further clarity was requested around how this will positively affect the OATS position and 85% occupancy factored in with over performance. The Trust will continue to proceed in line with the agreed timescales. Updates will be provided to the Board through the Quality and Performance Report.

Lancashire and North Cumbria Sustainability and Transformation Plan The Board are reminded that the first STP was submitted to NHS England and NHS Improvement in April 2016. A second submission was then made in June 2016. The STPs will be finalised by October 2016 and those plans must set out how individual organisations will play their part in delivering their locally agreed STP objectives including sustainable financial balanced across the health economy.

On 16th September 2016, STP Programmes need to submit a clear set of financial returns demonstrating plans for sustainability. Delivery plans will form the starting point for two-year, organisation level operating plans for 2017/18 and 2018/19. Joint guidance will be published mid-September to help each STP move swiftly from finalising its STP to agreeing two-year operational plans and contracts by the end of December 2016.

Test Beds The Lancashire and Cumbria Alliance (LCIA) Test Bed programme has made some significant progress over the last few months. We have now received Health Research Authority and University Ethics Approval for the research and evaluation arm of the programme, the first of all the test beds across the country to achieve this. The programme was also involved in the recent Academy of Fab Stuff visit at The Harbour in Blackpool which saw Roy Lilley and his colleague Dr Terri Porrett take a seat in the mock front room where they received a practical demonstration of some of the technology on offer. This was well received and we are working to provide them some more information about the overall project to go on their website which will provide some positive awareness of the good work

taking place. A meeting was held with NHS England who confirmed they were happy with the progress made within quarter one and are happy with the direction and targets in place to achieve within quarter two.

FOIA Exempt Under Section 43 – Commercial Interest

Blackburn with Darwen Alternative Provider Medical Services (APMS) team

FOIA Exempt Under Section 43 – Commercial Interest Business Development Report

Board of Directors

Agenda Item BDS 004/16 Date: 31/08/2016

Report Title Executive Summary for the Quality and Performance Report for Month Four

FOIA Exemption No Exemption Not Applicable

Prepared by Louise Corlett and Ian Cheung

Presented by Sue Moore, Chief Operating Officer

Action required Noting

Supporting Executive Director Chief Operating Officer


Report purpose To provide the Board with an executive Summary of the quality Performance Report and NHSI Indicators for month four.


To provide high quality services

Board Assurance Framework risk 7.1 The Trust does not comply with Monitor Licence and other regulatory requirements under NHS Improvements

CQC domain Safe

INTRODUCTION

The Board are asked to note the Quality and Performance Report attached for month 4 with particular points of note highlighted below.

The full Quality and Performance Report (QPR) can be viewed here.

All NHSI indicators were met for Quarter 1 and Month 4

Individual CCG analysis of the NHSI indicators shows a breach of the 7 day CPA follow up measure in Blackpool -93.75% and Fylde and Wyre CCG 88.89%- this relates to 2 patients, there is no overall reduction in the performance trend and so reporting is for note only.

Greater Preston CCG fell just below the standard of 75% within 6 weeks for IAPT and again this not cause for concern at this stage.

There have been a number of changes to the QPR format in Month 4 that the Board are asked to note:

- Addition of a rolling 12 month position for all NHSI indicators, with ‘Sparkline’ trends. Grey-shaded boxes illustrate where the measure is shadow reported prior to going live.

- Removal of MR04 – EIS for New Psychosis as this is no longer required as part of the UNIFY submission.

- Inclusion of target description / NHSI / Stretch / Commissioner / NHSE / Bench/ for all NHSI and Network Performance Summary sheets.

http://www.lancashirecare.nhs.uk/media/Umme/31.08.16/QPR%20M4%20Final.pdf

Adult Mental Health

Points of note in relation to the Adult Mental Health Network performance are as follows with the relevant section of the QPR identified for ease of reference:

ADHD (Section 1.1 P26) remains of concern with breaches against the 18 week RTT standard of 95%. The overall percentage of patients treated within 18 weeks has continued to deteriorate over the past 12 months with increased demand and a reduction in capacity due to vacancy. The vacant post is now filled and a recovery plan will be presented to the next Business Development and Delivery (BDD) sub-committee.

A&E Liaison services (Section 1.1 P27) remain under close scrutiny across the Lancashire health economy and it is important to note that work to standardise and improve the quality of data capture by the teams went live on the 1st August 2016. This will allow the QPR in September to include the following measures: 4 Hour target performance for A&E Patients referred to Lancashire Care Mental Health Liaison Team, 12 Hour target performance for A&E Patients referred to Lancashire Care Mental Health Liaison Teams, performance against the 2 Hour standard for Attendance at A&E to referral to Lancashire Care Mental Health Liaison Team, performance against the 1 Hour standard from A&E referral to patient being seen by Lancashire Mental Health Liaison Team.

Patient flow (Section 1.2 P50) remains a challenge to the Adult Mental Health Network. The key measures of concern are high bed occupancy and an increase in length of stay which is as a result of a number of complex PICU patients who have a long length of stay. In addition, OATS (Section 1.2 P51) remain high and were at an average of 40 for July. The July position is line with the network plan but over the BBSC plan of 15, August data shows that we remain over plan at this stage. Additional capacity has been opened within the female assessment unit but a balance needs to be achieved between staffing, agency usage and OATS reduction.

More positively, readmission rates (Section 2.2 P79), for the first time in 2016/17, have fallen to below NHSE threshold, for both 30 day and 90 day readmissions. The 30 day readmission rate was reported at 8.42%, below the target of 8.70% which is good measure of safe discharge. The 90 day readmission rate is at 13.16%, which is below the target of 15%.

PBR clustering performance (Section 1.3 P58) has improved to 68.90% against the target of 95%. The network is slightly below trajectory but the network remains confident of hitting the target of 95% by September.

Overall contract activity (Section 2.2 Contract Activity P79) is showing 18% over-performance year to date across OAMH and AMH. This is mainly due to the doubling in contact activity by the Crisis teams. Investigation into this variance has highlighted that some teams have been recording contacts in iPM which wasn’t previously being reflected in reported contacts. The process for recording has now been standardised and a full refresh for the year has taken place.

The overall over-performance masks some areas of under-performance, the most notable of which is the CCTT service. CCTT has been underperforming since the start of 2016/17, with a year to date 16% negative variance against plan and a 7198 shortfall in contacts. Initial investigation by the Adult Mental Health team has highlighted some errors in the way that activity is recorded. This has led to a significant under-reporting of contacts. A refresh of activity will be undertaken once the investigation is complete at the end of September 2016.

Children’s and Families

Points of note in relation to the Children’s and Families Network are as follows:

There are a number of areas of underperformance in relation to waiting times. In particular, Child Psychology (Section 1.1 P32) continues to underperform against the 18 week RTT standard of 95% and has failed to achieve the standard over the last calendar year. In Month 4, we have seen a further deterioration in the position from 71.81% to 68.59%. A detailed recovery plan is being monitored through Business Development and Delivery Sub-committee.

In relation to Contract Activity (Section 2.2 P78), Children and Families are showing a 3.97% positive variance against activity plan at month 4, with Children’s Learning Disabilities service showing the biggest variance of +16.09% against plan.

Adult Community Services

Adult Community are now in special measures for the Financial and Operational position within the Network, in relation to CIP delivery and operational control.

Points of note in relation to Adult Community Services Network performance are as follows:

Memory Assessment Service (MAS) (Section 1.1 P31) remains a key focus for the network given the significant deterioration in the performance against the 70% target for memory assessment within 6 weeks. Current performance is 38.20%. A full recovery plan is being produced with a capacity and demand profile to establish the key issues and actions, which are currently conveyed as cancellation rates, vacancy and demand.

Dental waits within the prison services (Section 1.1 P29) remain non-compliant (although please note that reporting is 1 month in arrears). In month 3, 65.31% was achieved against the standard of 95% people treated within 18 weeks for Lancashire prisons and 68.4% achieved against the standard of 95% of people treated within 12 weeks for Liverpool and Kennet. Data for July will be refreshed in September’s QPR as data was not transitioned by the system provider in time for reporting.

Rheumatology services (Section 1.1 P20) are currently compliant against both NHSI consultant-led 18 week RTT standards for complete and incomplete pathways. However, the position against the RTT incomplete pathway target of 92% has deteriorated monthly from 100% in April, to 96.4% in July. This is matched with an over-performance in activity against contract of 11% and represents an increase in demand that is not currently matched with available/funded capacity. The position is being closely monitored as it expected that both the 92% and 95% measure may be jeopardised if capacity cannot meet demand.

Overall the community contract (Section 2.2 P74) is showing a 9.75% positive variance against plan in July. The largest proportion of activity for the community contracts is the District Nursing and District Nursing Out of Hours (OOH) teams. The overall service is up 12% against plan, although this is not consistent across all CCG’s. Chorley and South Ribble CCG and Blackburn with Darwen are but up +37% and +5% respectively. Greater Preston CCG however is -5% against plan.

CCG Service activity split with be added from Month 5 QPR and exception reports for services under performing by 10% or more against plan have now been included.

Specialist Services Contract

The performance measures within the report have been further amended to show all contract measures. For prison specific measures, we will be presenting data split by each of the 7 prisons with additional measures added relating to medicines management.

We have significant performance improvements to deliver in each of the prisons, the specifics are being managed via the weekly special measures meeting and weekly SITREPs.

All Networks

All areas are reporting significant vacancies and whilst recruitment is ongoing we are waiting for newly qualified staff to join, many of whom will have a period of induction as this will be their first role. The Business Development and Delivery Sub-committee have asked for additional reporting regarding inter-network transfers and promotion, as the current turnover rate is exclusive of this measure.

We have seen high occupancy in all areas with increased acuity, largely as a result of long stays within PICU capacity. Therefore, the overall balance of achieving agency reduction, reduced occupancy and delivery of new care models is very challenging in the current climate.

Each network is seeking to apply consistency in the context of e-rostering and this is being fully supported via the Director of Nursing and Corporate Nursing team.

Board of Directors

Agenda Item BDS 005/16 Date: 31/08/2016

Report Title Finance Report

FOIA Exemption Part Exemption

Prepared by Shannon Carroll – Financial Services Director

Presented by Dominic McKenna – Financial Management Director

Action required Noting

Supporting Executive Director Executive Director of Finance


Report purpose To summarise and analyse actual and forecast financial performance and standing of the Trust, the implications and any proposed management action.


To provide excellent value for money in a financially sustainable way.

Board Assurance Framework risk 5.1 – The Trust does not achieve financial performance sufficient to maintain resilience and sustainability. 5.2 – The Trust does not achieve the required efficiency savings whilst delivering and improving quality.

CQC domain Effective

Section 43: Commercial Interest

Summary

Actual Plan Var Forecast Plan VarSustainability

EBITDA 1 2,562 4,434 ‐1,872 1 13,504 13,257 247Operational Deficit 1 ‐2,358 ‐464 ‐1,894 1 ‐1,342 ‐1,390 48

CIPs (against Trust Plan) 3 3,503 3,736 ‐233 3 12,286 12,286 0Cash and Liquidity 3 13,067 18,355 ‐5,288 3 12,353 11,561 792Capex 3 1,462 3,750 ‐2,288 3 10,001 10,001 0FSRR

Capital Service 1 1 3 1 2 2Liquidity 5 4 4 3 3 3I&E Margin 1 1 2 1 2 2I&E Variance 1 2 3 2 3 3Overall 1 2 3 2 3 3

Sustainability

Liquidity

Capital and Financing

Financial Sustainability Risk rating (FSRR)

Key Actions

#• Maintain focus on OATs and delivery of mitigations.

Overall the draft FSRR is rated at 2 against plan of 3 primarily as a result of the I&E position. The rating is also constrained by both Surplus Margin and Debt Service rating which are rated at 1 ‐ any score of 1 limits score to 2.

The Trust has made progress on the programme (Month 4 £1.5m, Month 3 £0.8m), primarily in relation to precommitments. The Trust is currently expecting a Capital Control total that may well reduce the availability of capital, this coupled with other delays sees Capital expenditure behind plan. A full review and reforecast will be conducted in quarter 2. Capital expenditure forecasts remain at 100%, see Capital Expenditure for more details.

Should conditions persist and costs not be managed within the control total then the resulting deterioration might attract regulatory attention (a rating of 2 can trigger a regulatory review of the Trust's position).

• Key focus on delivering the Recovery Plan.

• Maintain focus on delivery of CIPs and increase focus on stretch targets.• Increase focus on addressing bank and particularly agency use.

Current Out‐Turn

Month 4 sees a year to date operating deficit of ‐£2.4m (Month 3 ‐£1.9m), £1.9m behind plan for the year. £0.7m relates to Sustainability and transformation funding which can be recovered when the Trust achieves its financial targets. It is projected that the full year operating deficit after mitigations would be £1.3m, but this is not without risk and without mitigation the Trust is in line for a £7.7m overspend (details in the Forecasting section). The month to month position shows some improvement – Month 4 ‐£0.4m month 3 ‐£0.6m, however the in year position remains undermined, primarily, by the use of temporary staffing particularly in ward areas to cope with the level and acuity of the types of patients accessing these services but the position also includes some slippage on sexual health contracts, CIP plans (further details in the CIPs section) and OATs (further details in the OATs section). The Board Balanced Scorecard demonstrates an EBITDA (earnings before interest, taxes, depreciation and amortisation) of £2.6m against a plan of £4.4m. The upside projection is £14.2m £1m ahead of plan. FSRR is rated at 2, but will rise to a 3 should the Trust meet its financial plans and targets, see below.

Cash is currently £5.3m behind plan. This is mainly as a result of changes to Working Capital (primarily c£3.8m with councils which is not disputed, and of which c£2m was settled in August) and current I&E performance as offset by the current capital expenditure position. See Cash and Liquidity for more details.

Forecast ForecastYTD YTD Out‐turn Out‐turn

Jul 2016 Jun 2016 at Jul 2016 at Jun 20164 3 Note 12 12 Note

Plan ‐0.464 ‐0.348 Plan ‐1.390 ‐1.390

Major Variances Major VariancesCIP Slippage ‐0.233 ‐0.435 ‐ See CIP section CIP Slippage 0.000 0.000 ‐ See CIP sectionOATs ‐0.075 0.000 ‐ See OATs section OATs 0.000 0.000 ‐ See OATs sectionStaffing ‐3.004 ‐2.390 ‐ See also Bank and Agency section Staffing ‐3.891 ‐4.545 ‐ See also Bank and Agency sectionOther Bud Vars ‐0.243 0.238 ‐ See Services section Other Bud Vars 0.151 ‐0.268 ‐ See Services sectionReserves 2.306 1.523 ‐ See Reserves section Reserves 3.088 2.717 ‐ See Reserves sectionAddl SS Activity ‐0.670 ‐0.503 ‐ Addl SS Activity 0.700 2.112Minor Variances 0.025 0.000 Minor Variances 0.000 0.000

Variance ‐1.894 ‐1.567 Variance 0.048 0.016

Actual ‐2.358 ‐1.915 Actual Forecast ‐1.342 ‐1.374

‐‐

Surplus ‐ YTD (£m) Surplus ‐ Out‐turn (£m)

This month sees an operating deficit of £2.4m, £1.9m behind plan, of which £0.7m is STF funding not yet accrued.The full year projection is an operating deficit of £1.3, accounting for the STF funding in the plan. The position models the mitigations included in the recovery plan (£6.2m) and includes provision £0.7m (OATs costs of £0.4m, staffing costs of £0.3m).

‐6,000.0

‐5,000.0

‐4,000.0

‐3,000.0

‐2,000.0

‐1,000.0

0.0

Plan CIP Surplus OATs Staffing Other BudVars

Reserves SS Income MinorVariances

‐1,390.0 0.0 0.0 ‐3,891.1 151.2 3,088.1 700.0 0.0

‐4,500.0

‐4,000.0

‐3,500.0

‐3,000.0

‐2,500.0

‐2,000.0

‐1,500.0

‐1,000.0

‐500.0

0.0

Plan CIP Shortfall OATs Staffing Other BudVars

Reserves STF Funding MinorVariances

‐464.0 ‐233.0 ‐75.0 ‐3,004.2 ‐242.6 2,305.5 ‐670.0 25.0



Plan 110.785 83.150 Plan 333.286 333.286

Major Variances Major VariancesCommunity Services 0.712 0.716 ‐ Note 1 Community Services ‐1.068 ‐1.221 ‐ Note 1Mental Health 2.134 1.451 ‐ Note 2 Mental Health 3.925 3.807 ‐ Note 2Specialist Services 0.070 0.048 ‐ Note 3 Specialist Services 0.778 0.778 ‐ Note 3Non NHS Healthcare In ‐0.837 ‐0.203 ‐ Note 4 Non NHS Healthcare In ‐2.397 ‐2.100 ‐ Note 4R&D ‐0.061 ‐0.007 R&D ‐0.204 0.011ETR 0.559 0.193 ‐ Student Income ETR 0.607 0.597 ‐ Student IncomeMiscellaneous 0.270 0.110 ‐ Note 5 Miscellaneous 0.876 0.037 ‐ Note 5

Minor Variances 0.000 0.000 Minor Variances 0.000 0.000

Variance 2.847 2.309 Variance 2.517 1.908

Actual 113.632 85.459 Actual Forecast 335.803 335.194

1

2345 Major decreases in respect of IT funding ‐ see appendix for detailed impact.

Monthly Income Variances (£m) Cumulative Income Variances (£m)

Major decrease is due to the confirmation that the Community Equipment Service (CERS) will demise, realising a reduction of over £2m in year. Both CERS and Longridge Hospital funding contribute to year to date increase.Major increases include contractual settlement reached re CCGs, CAMHS, Early Intervention, Resilience and Acute Therapy Service funding.Major increase is in respect of funding for additional activity and increased acuity.Major decrease expected is respect of Healthier Lifestyles contracts, changes to inflation and sexual health.

0.000

5.000

10.000

15.000

20.000

25.000

30.000

35.000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Actual/Forecast

Plan

0.000

50.000

100.000

150.000

200.000

250.000

300.000

350.000

400.000


Actual/Forecast

Plan



Budget 97.804 73.724 Budget 287.987 288.680

Major Variances Major VariancesAdult Mental Health ‐1.639 ‐1.164 ‐ Note 1 Adult Mental Health ‐1.965 ‐2.412 ‐ Note 1Specialist Services ‐1.859 ‐1.526 ‐ Note 2 Specialist Services ‐2.056 ‐2.054 ‐ Note 2Property Services 0.000 ‐0.004 ‐ Note 3 Property Services 0.000 0.000 ‐ Note 3Corporate 0.459 0.319 ‐ Note 4 Corporate 1.024 0.847 ‐ Note 4Adult Community ‐0.635 ‐0.522 ‐ Note 5 Adult Community ‐1.282 ‐1.402 ‐ Note 5Children & Family ‐0.001 0.206 ‐ Note 6 Children & Family 0.358 0.048 ‐ Note 6Other Clinical 0.119 0.104 Other Clinical 0.181 0.161

Variance ‐3.555 ‐2.587 ‐3.740 ‐4.813

Actual 101.359 76.311 Actual Forecast 291.727 293.494

1

2

34

56 Children and Families in month overspend is a result of the loss of Sexual Health income. The forecast underspend is driven by a review of expenditure and cost control measures.

Adult Mental Health in year overspend is driven more acutely by excess staffing costs on wards. Actions to review the patients in inpatients setting, their appropriateness for the ward and levels of acuity are advanced and should furnish us with the appropriate information to discuss necessary action with the respective commissioners. Wards continue to operate at 100% capacity and there is some CIP slippage.Specialist Services are behind plan driven by high use of bank & agency on wards, particularly in male Medium Secure Services, where high levels of acuity are having to be dealt with and patients who should be in High Secure placements. Additionally, Prison services have struggled to recruit permanent staff and have therefore experienced high levels of agency staff and the associated cost pressures.Property Services are operating in line with plan.

YTD Service Net Expenditure Variance (£m) Forecast Service Net Expenditure Variance (£m)

Corporate Services forecast are contributing underspends, most significantly with regard to mental health drugs (in Medical Director) where year to date underspends of £0.2m and full year underspends of £0.5m are being returned. Most other areas are also returning underspends both in year and full year, driven by cost control and vacancies, however Human Resources continues to overspend (£0.1m full year), as does Chief Operating Officer (£0.1m) driven by short term staffing costs.Adult Community's position is also compromised by temporary staffing is ward areas, driven by acuity, which constitutes most of the adverse variance.

‐£4,000

‐£3,000

‐£2,000

‐£1,000

£0

£1,000

£2,000

Adult MentalHealth

SpecialistServices

PropertyServices Corporate

AdultCommunityServices

Children &Family

OtherClinical Total

Service Forecast Variance

‐£4,000‐£3,000‐£2,000‐£1,000

£0£1,000£2,000£3,000

Service Year to Date Variance

CIP Achievement (£)

NotesYear to Date PerformancePerformance against monitored and approved schemes is £233k behind plan. The Rehab gateway scheme is not delivering against plan, mitigations are in process.

Schemes to be TransactedThe majority of anticipated base 16/17 schemes have now been transacted through the PMG.Additional schemes continue to be identified and will be transacted when fully developed.

Changes from forecastThough currently behind Year to Date Plan CIPOutturn is currently expected to exceed Annual Plan ‐ Annual Plan is £12.3m and the target is £16m ‐ potential improvements have been prudently excluded from forecasts.

Note mapping of individual schemes to projects and programmes may be subject to change.

Delivering the Strategy ‐ 2016/17 PROGRAMMES

Programme No.

Programmes Project Ref ProjectsActual YTD Performance Plan YTD Var Annual Performance Annual Plan Var

T01A Central Lancashire Existing Business 156,757 156,757 ‐ 483,771 483,771 ‐ T01B CEHWB ‐ Tier 3 & 4 CAMHS 53,302 53,302 ‐ 159,906 159,906 ‐

T01CSkype/telemedicine/telehealth implementation incl. Test Beds (Trust wide)

16,667 16,667 ‐ 150,000 150,000 ‐

T02A B&A Efficiency (Trust Wide) ‐ ‐ ‐ ‐ ‐ ‐ T02B Admin Optimisation (Trust Wide) 95,082 95,082 ‐ 435,247 435,247 ‐

T02CConsultant Job Planning and rota efficiency (trust wide)

49,027 49,027 ‐ 147,082 147,082 ‐

T03A Specialist rehab gateway ‐ 251,000 251,000‐ ‐ 753,000 753,000‐ T03B Medicines optimisation and ePMA 86,000 86,000 ‐ 258,000 258,000 ‐ T03C Prison Health Redesign ‐ ‐ ‐ ‐ ‐ ‐ T03D Liaison and Diversion Criminal Justice 66,308 66,308 ‐ 198,924 198,924 ‐ T04A Monitor agency cap 183,261 165,171 18,090 418,090 400,000 18,090 T04B MARS 122,222 122,222 ‐ 611,109 611,109 ‐ T04C Direct Engagement Model 78,787 79,153 365‐ 250,000 250,000 ‐ T04D Finance ‐ Commissioning and Contracts 876,667 876,667 ‐ 2,630,000 2,630,000 ‐ T04E Procurement Incl nurse and benefit realisation 4,833 4,833 ‐ 14,500 14,500 ‐ T04F Estates ‐ Site rationalisation and efficiencies 316,672 316,672 ‐ 950,016 950,016 ‐ T04G Corporate overarching ‐ Travel savings 165,602 165,602 ‐ 496,807 496,807 ‐

T04HCorporate overarching ‐ Corporate services business plans

385,970 385,970 ‐ 1,157,909 1,157,909 ‐

T04I Corporate overarching ‐ Network business plans 831,555 831,555 ‐ 2,298,085 2,298,085 ‐ T04J Corporate overarching ‐ Network redesign ‐ ‐ ‐ ‐ ‐ ‐

3,488,713 3,721,988 233,275‐ 10,659,446 11,394,356 734,910‐

Schemesd not yet transacted within the PMG 14,012 14,012 ‐ 1,627,554 892,644 734,910 ‐ ‐

Forecast Outturn 3,502,725 3,736,000 233,275‐ 12,287,000 12,287,000 0‐

2 Excellence in Patient Flow

1 Prevention and Community Wellbeing

4 Corporate Services

3 Specialist Services

Month Month Month MonthJul 2016 Jun 2016 Jul 2016 Jun 2016

4 3 Note 4 3 Note

Agency Spend 1,184 1,250 Bank Spend 1,391 1,712

Network Analysis Network AnalysisAdult Network 542 466 ‐ Note 2 Adult Network 797 979 ‐ Note 2Adult Community 155 216 ‐ Note 3 Adult Community 185 204 ‐ Note 3Children & Families 80 129 ‐ Note 4 Children & Families 42 57 ‐ Note 4Specialist Services 395 402 ‐ Note 5 Specialist Services 316 436 ‐ Note 5Corporate Services 12 36 ‐ Note 6 Corporate Services 51 37 ‐ Note 6

Actual 1,184 1,250 ‐ Note 1 Actual 1,391 1,712 ‐ Note 1

12

3

45

6

The Trust has been given a ceiling by NHS Improvement for agency spend. This target is £7.695m for the year. At the end of period 4, the trust is £1.29m, or 41% above it's trajectory. Failure to hit the ceiling could invite intervention by NHSI.

Specialist Services Network bank and agency costs are partly due to the contract for Liverpool and Kennet Prisons and partly to acuity on inpatient wards. Positions are being recruited to but getting staff in post is problematic. Measure have been put in place to improve internal temporary staffing controls.Corporate Services agency costs are almost exclusively in respect of the Human Resources Department and are considered short term in nature.

Agency Costs Over Time (£'000) Bank Costs Over Time (£'000)

A high level of vacancies is supported by bank and agency, total staffing deployed is well above establishment.Adult Networks bank and agency costs are primarily due to the level of acuity on inpatient wards being beyond the level established. The position has deteriorated this month in agency and is still above last year for bank although significant improvements have been made in month. An increase in acuity is causing much of the problem but work is an advanced stage to understand the full drivers of the pressure.Adult Community bank and agency costs are driven by acuity in Older Adult services. Several reviews are in place with a view to reducing temporary staffing, with particular emphasis on agency reduction, which has continued to see an improvement.Expenditure is fairly minor within Children and Families, with changes delivering an improved position.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2014/15 1050 929 928 1254 1250 1146 1125 939 1248 1146 1050 12542015/16 1030 988 1262 1242 909 1202 1149 939 1073 1077 978 11742016/17 1098 862 1250 1184

0

200

400

600

800

1000

1200

1400

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2014/15 1102 1004 1070 996 1108 1089 1063 1141 1015 899 988 11812015/16 935 1108 932 1180 1119 1176 1139 1183 1170 1072 1289 12092016/17 1534 1523 1720 1391

0200400600800

100012001400160018002000

Month Month YTD ForecastJul 2016 Jun 2016 Jul 2016 Out‐turn

4 3 Note 4 12 Note

Plan 0.5 ‐0.4 Plan 18.4 11.6Major Variances Major Variances

I&E ‐0.3 ‐0.8 ‐ Note 2 I&E ‐1.9 0.2 ‐ Note 2Capital & financing 0.4 0.8 ‐ Note 2 Capital & financing 1.8 ‐1.2 ‐ Note 2Contract Vars and Adjs 0.0 0.0 Contract Vars and Adjs ‐1.5Debtors ‐0.3 ‐1.2 ‐ Note 3 Debtors ‐3.7 0.4 ‐ Note 3Timing of settlements to suppliers ‐0.3 0.0 ‐ Note 4

Timing of settlements to suppliers ‐3.2 ‐0.7 ‐ Note 4

Provisions and deferred income ‐0.3 0.0 ‐ Note 5

Provisions and deferred income 1.8 0.5 ‐ Note 5

Opening cash 0.0 0.0 Opening adjustment 1.5 1.5

Minor Variances ‐0.4 ‐0.2 Minor Variances ‐0.2 0.0

Variance ‐1.2 ‐1.4 Variance ‐5.3 0.8

Actual ‐0.6 ‐1.9 Note 1 ForecastActual/Forecast 13.1 12.4 ‐ Note 1

1

2

3

45 Provisions and Deferred Income are currently generating gains of £1.8m over plan, a combination of unreleased MARs and redundancy provisions and higher than anticipated levels of deferred income. Future MARS and Redundancy settlements will reduce this gain.

Monthly Cash and Liquidity Variance (£m) Forecast Cash and Liquidity (£m)

Timing of settlements to suppliers is behind plan by c£3.2m, this similar to last month with low levels of both accruals and recharges.

Low levels of capital expenditure temporarily offset the accumulating impact of the deficit. This will not continue to be the case as capital spend achieves plan, however, the introduction of a Capital Control Total may limit the capital funds available, which in turn will support the cash position. Debtors remain high (c£3.7m), primarily as a result of late invoicing/late payments by local councils of c£3.8m. The Trust has engaged with the council senior management to address the issue of payment timing. Though some £2m of improvements were expected in M04, these were delayed by payment issues within the council financial service providers and were made in M05.

Cash is currently £5.3m behind plan partly as a result of the impact of the deficit position but mainly as a result of transient issues around working capital. The current year end forecast assumes that proposed management action to bring financial performance back in to line is achieved and also that the Trust, as a result, maintains eligibility for Sustainability Funding.

‐8.000

‐6.000

‐4.000

‐2.000

0.000

2.000

4.000

6.000

8.000


Opening cash balance

Financing and Other

Capital and Investment Activities

Changes to WC

Non Cash Flows

Surplus/(deficit) after tax

0.000

5.000

10.000

15.000

20.000

25.000


Forecast

Plan

YTD Plan YTD Act Annual ForecastJul 2016 Jul 2016 Variance Plan Out‐turn Variance£000 £000 £000 £000 £000 £000

IT Schemes 0.850 0.053 ‐0.797 3.600 3.616 0.016 ‐ Note 1

Estate and infrastructure SchemesPrecommitments 1.400 1.176 ‐0.224 1.612 1.778 0.166 ‐ Note 2

Large Schemes 0.533 0.047 ‐0.486 1.600 1.618 0.018 ‐ Note 3

High Priority Schemes 0.300 0.011 ‐0.289 1.076 1.063 ‐0.013 ‐ Note 4

General 0.667 0.175 ‐0.491 2.112 1.925 ‐0.187 ‐ Note 5

Total 3.750 1.462 ‐2.288 10.000 10.000 0.000

1

23

4

5

Capital Expenditure

The Trust has made progress on the programme (Month 4 £1.5m, Month 3 £0.8m), primarily in relation to precommitments. The Trust is currently expecting a Capital Control total that may well reduce the availability of capital, this coupled with other delays sees capital expenditure behind plan. Capital expenditure forecasts remain at 100%.Timings on the original plan were largely indicative, work remains on‐going to finalise detailed plans and forecasts. Schemes have been allocated budgets but work being finalised on profiling is expected to change phasing from original plan.

Delays in procurement of EPR delayed development of planning assumptions, planning assumptions are still being finalised. IT plans for expenditure are also impacted by capital restrictions in the system.Slippage at month 3 has now largely been caught up, with the finalisation of Ridge Lea scheme to be completed in month 5.Main variance is in relation to Ward 22 and is largely due to project redesign. The project has now been reprofiled and enabling works commenced, it is still expected to be completed within the year.Planning assumptions have now been reviewed with several schemes being reprofiled. The schedule is now skewed slightly but work is still expected to be completed within the year.Expenditure is behind plan but there are no concerns at present about delivering the programme.

Actual/Forecast represents weighted averageOverride represents Actual/Forecast Rating

YTD Forecast YTD Forecast YTD Forecast YTD Forecast YTD ForecastJul 2016 Out‐turn Jul 2016 Out‐turn Jul 2016 Out‐turn Jul 2016 Out‐turn Jul 2016 Out‐turn

4 12 4 12 4 12 4 12 4 12

Plan 3 3 Plan 3 2 Plan 4 3 Plan 2 2 Plan 3 3

Actual/Forecast 2 3 Actual/Forecast 1 2 * Actual/Forecast 4 3 Actual/Forecast 1 2 * Actual/Forecast 2 3

*Scoring a 1 on any metric will cap the weighted rating to 2, potentially leading to investigation.

Key Points

‐

‐ ‐ ‐

‐

Surplus Margin rating is currently 1 against a plan of 2, an increase in operating performance of c£1.2m would be required to increase the rating to 2 ‐ Note that the deficit of ‐£2.4m is 1.9m behind plan (£1.2m behind the RCT).Variance from Plan is currently 2 against a plan of 3, an increase in operating performance of c£750k would be required to increase the rating to 3.

FINANCIAL SUSTAINABILITY RISK RATINGS

Assuming the proposed management action to bring financial performance back in to line is achieved the Trust will maintain eligibility for Sustainability Funding and will achieve an FSRR of 3 in line with the revised plan.Should conditions persist and costs not be managed within the control total then the resulting deterioration might attract regulatory attention (a rating of 2 can trigger a regulatory review of the Trust's position).Capital Service is currently a 1 against a plan of 3, an increase in operating performance of c£560k would be required to increase the rating to 2.Liquidity is currently a 4 against a plan of 4, a deterioration in the liquidity metric of c£3.0m would be required to reduce the rating to 3.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Apr‐15 Jul‐15 Oct‐15 Jan‐16

FSRR ‐ Overall

Actual/Forecast Plan

0.0

0.5

1.0

1.5

2.0

2.5

3.0


FSRR ‐ Capital Service

Actual/Forecast 4 3 2 1

‐15.0

‐10.0

‐5.0

0.0

5.0

10.0


FSRR ‐ Liquidity


‐2.50%

‐2.00%

‐1.50%

‐1.00%

‐0.50%

0.00%

0.50%


FSRR ‐ Variance from Plan


‐2.5%‐2.0%‐1.5%‐1.0%‐0.5%0.0%0.5%1.0%1.5%


FSRR ‐ Surplus Margin


Reserves

Annual statement of Revenue Reserves

Budget Charge VariancePay Reserve 1,240 370 870 Assumed calls on funds to the end of the year.Non Pay Reserve 416 ‐748 1,164 Funds as yet unutilised, plus gains on year end redundancy and other provisionsPressures Reserve 935 708 227 Funds to be allocated by year endMARS Gain ‐135 ‐135 0 In year savings from MAR schemeCIP Reserve 705 ‐440 1,145 This represents the CIP schemes yet to be transacted, and assumed overachievementAgency Cost Savings ‐902 ‐884 ‐18 In year savings from Medical and clinical staff caps

2,260 ‐1,129 3,389

MATTERS

ID Meeting DaPaper Status

2016/07 Jul‐16 Matters Included

2016/08 Jun‐16 Matters Excluded

2016/01 May‐16 Matters Included



2016/04 May‐16 Matters Excluded



02/08 May‐14 MattersExcluded

The Trust is actively exploring the potential for land sales. Gains may crystallise in 16/17 dependent on timing.

Discussions continue around Harvey House.

The contract with SpecCom is now signed.

Income from contracts with LCC is now substantially agreed, but major contracts are as yet unsigned.

The Trust has been granted c£2m from the Sustainability and Transformation fund, this has now been included in the month 3accounts process. NHS Improvement have reviewed the Risk assessment Framework and published a consultation on a new "Single OversightFramework", initial indications are that this is in line with expectations.

Subject

On‐going Claims‐ Speculative VAT claims continue to be pursued in relation to older developments and changes in rulings. A recent ruling nowsupports our claim, but the claim is by no means certain to succeed. Up to £2m no gain assumed.

While the service remain confident of managing OATs within the £4m envelope there remains a risk of breach. An allowance hasbeen made in the forecast for demand change and further delays in mitigation of £0.4m.

NHS Improvement have yet to issue the anticipated Capital Control Total.

OUT OF AREA ACTIVITY

Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 TotalTotal Expected Cost 396 612 725 738 511 405 159 90 93 93 84 93 3,999

LCFT Funding 396 604 591 469 2,060CCG funding 8 725 207 42 405 159 90 93 93 84 33 1,939Variance 0 0 0 0Cumulative Variance 0 0 0 0

1234

5

Work is advanced in identifying patients within PICU capacity (both Trust and OATS) who should be covered by non‐Lancashire CCG contracts and this additional activity will form the basis of discussions with the relevant commissioners.

The Network has developed a trajectory against which we are monitoring performance. The forecast assumes slight delays in opening assessment beds.Although the trajectory, as currently envisaged by the Network will contain costs within the £4m envelope a provision of £0.4m has been made within the forecast.Commissioners have asked for, and are receiving, monthly actual performance against the profile.

The Trust provided £2m for OATs, which was the level deemed affordable at planning and not intended to remove all risk. Commissioners matched this to give a funding envelope of £4m. The £2m contribution from CCGs must be considered their maximum liability.

0

100

200

300

400

500

600

700

800

900

0

5

10

15

20

25

30

35

40

45

Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17

Cost / £K

Combine

d OAT

Bed

s ‐M

onthly Average

Adult Mental Health NetworkCombined OATS Recovery Trajectory: April 2016 ‐March 2017

Current Forecast Beds Total Actual Beds Current Forecast £ Total Actual cost £ Trajectory £

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