trust board meeting to be held on wednesday 27 july … papers... · 2017-09-18 · trust board...

TRUST BOARD MEETING TO BE HELD ON WEDNESDAY 27th

JULY 2011 AT 15:00PM IN THE CLINICALSCIENCES BUILDING, UNIVERSITY HOSPITAL, CLIFFORD BRIDGE ROAD, COVENTRY CV2 2DX

PUBLIC AGENDA

Resolution of Items Heard in PrivateIn accordance with the provisions of Section 1(2) of the Public Bodies (Admission to Meetings) Act 1960, and the Public Bodies(Admissions to Meetings) (NHS Trusts) Order 1997, it has been resolved that the representatives of the press and other members of thepublic are excluded from the first part of the Trust Board meeting on the grounds that it would be prejudicial to the public interest due to theconfidential nature of the business transacted. This section of the meeting has been held in private session.

1 General Business Paper Presenter Category1.1. Apologies for Absence Verbal Chairman N/A1.2. Minutes of Meeting held on 29/06/2011* Enc 1 Chairman N/A1.3. Actions Enc 2 Chairman N/A1.4. Matters Arising Verbal Chairman N/A1.5. Declarations of Interest Verbal Chairman N/A1.6. Chairman’s Report Verbal Chairman N/A

1.7Private Trust Board Meeting SessionReport – 06/06/2011 & 29/06/2011*

Enc 3 ChairmanN/A

1.8 Chief Executive’s Report Verbal Chief Executive Officer NA

2Delivering safe, high quality andevidenced patient care

Paper Presenter Category

2.1Quality Governance Meeting Report – 14

th

June 2011*Enc 4

Mr T Sawdon,Non-Executive Director

Governance

2.2Infection Prevention and Control Reportincluding Joint Cleaning Update with ISSMediclean*

Enc 5Mrs J Foster,Acting Chief Nursing Officer

Quality &Safety

2.3 QPS Report Enc 6Mrs J Foster,Acting Chief Nursing Officer

Quality &Safety

2.4 Quality Account – monitoring Enc 7Mrs J Foster,Acting Chief Nursing Officer

Quality &Safety

2.5Patient Safety First Update – ProgressReport*

Enc 8Mrs J Foster,Acting Chief Nursing Officer

Quality &Safety

2.6 Radiation Protection ReportEnc 9 Mrs J Foster,

Acting Chief Nursing OfficerQuality &

Safety

2.7CQC Dignity and Nutrition for Older People– Review of Compliance

Enc 10 Mrs J Foster,Acting Chief Nursing Officer

Quality &Safety

3Developing excellence in research,innovation and education


3.1 HIEC Enc 11Mrs C Watts,Chief Marketing Officer

Strategy

3.2Modern Apprenticeships Pilot Programme2010/2011

Enc 12 Mr I Crich, Chief HR OfficerStrategy

3.3Developing Relationships with the PartnerTrust Foundation School, Foxford

Enc 13 Mr I Crich, Chief HR OfficerStrategy

4Improving the business and serviceframework


4.1 Finance Report Enc 14Mr A Jones,Acting Chief Finance Officer

Governance

4.2 Performance Report Enc 15Mr A Jones,Acting Chief Finance Officer

Performance

4.3Audit Committee Meeting Report – 9

th

May 2011 & 6th

June 2011*Enc 16

Mr T Robinson,Non-Executive Director

Governance

5Building a positive reputation andidentity

PresenterCategory

5.1 Patient Story Enc 17 Mrs C Watts, Chief Marketing officer Governance

5.2 Engagement Report* Enc 18 Mrs C Watts, Chief Marketing OfficerQuality &Strategy

5.3 Foundation Trust Application Update* Enc 19 Mr A Hardy, Chief Executive Officer Strategy5.4 Freedom of Information Act* Enc 20 Mr A Hardy, Chief Executive Officer Governance5.5 ICT Report* Enc 21 Mrs C Watts, Chief Marketing Officer Strategy5.6 PR Report* Enc 22 Mrs C Watts, Chief Marketing Officer Strategy

TRUST BOARD MEETING TO BE HELD ON WEDNESDAY 27th

JULY 2011 AT 15:00PM IN THE CLINICALSCIENCES BUILDING, UNIVERSITY HOSPITAL, CLIFFORD BRIDGE ROAD, COVENTRY CV2 2DX

PUBLIC AGENDA

Resolution of Items Heard in PrivateIn accordance with the provisions of Section 1(2) of the Public Bodies (Admission to Meetings) Act 1960, and the Public Bodies(Admissions to Meetings) (NHS Trusts) Order 1997, it has been resolved that the representatives of the press and other members of thepublic are excluded from the first part of the Trust Board meeting on the grounds that it would be prejudicial to the public interest due to theconfidential nature of the business transacted. This section of the meeting has been held in private session.

6 Any Other Business

7 Questions from the Public up to 15 minutes

8 Date of Next Meeting:3pm, Wednesday 28

thSeptember 2011

Please note: asterisked items (*) are for noting and, in general, do not require discussion.

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST

MINUTES OF THE PUBLIC MEETING OF THE UNIVERSITY HOSPITALS COVENTRYAND WARWICKSHIRE NHS TRUST BOARD HELD ON WEDNESDAY

29th

JUNE 2011 AT 3.00PM

1

AGENDA ITEMDISCUSSION ACTION

HTB 11/276PRESENT

Dr AM Cannaby, Chief Nursing and Operating OfficerMr B Connor, Non-Executive DirectorMrs W Coy, Non-Executive DirectorMr A Hardy, Chief Executive OfficerMr A Jones, Acting Chief Finance OfficerMr R Kennedy, Chief Medical OfficerMr T Robinson, Non-Executive DirectorMr T Sawdon, Non-Executive DirectorMr N Stokes, Non-Executive DirectorMr P Townshend, ChairmanMrs C Watts, Chief Marketing Officer

HTB 11/277IN ATTENDANCE

Mrs C Bonniger, Divisional Nurse Director, Medicine (HTB 11/287)Mr B Claire, Associate Non-Executive DirectorMr I Crich, Chief Human Resources OfficerMrs J Foster, Acting Chief Nursing Officer (HTB 11/287)Mr S Krikler, Consultant Orthopaedic SurgeonMrs J Gardiner, Trust Board SecretaryMs C Hughes, Interim Divisional Nurse Director, (HTB 11/287)Mr FT Lam, Divisional Medical Director, Surgical ServicesMs S Tubb, Associate Non-Executive DirectorMrs Paula Young, Executive Assistant (note taker)

HTB 11/278APOLOGIES

Mrs C McCalmont, Divisional Director, Women’s & Children’s who wouldotherwise have been in attendance.

HTB 11/279MINUTES23/02/2011*

The Trust Board APPROVED the minutes of the meeting held onWednesday 25

thMay 2011 as a true record of the meeting.

HTB 11/280ACTIONS

The actions completed and actions in progress were NOTED.

HTB 11/281MATTERS ARISING

There were no matters arising.

HTB 11/282DECLARATIONS OFINTEREST

There were no declarations of interest.

HTB 11/283CHAIRMAN’SREPORT

The Chairman announced the sad death of Mr J Harrison, MBE, and Non-Executive Director of UHCW NHS Trust (UHCW) for four years. TheChairman had the privilege of working with Mr J Harrison for fourteenyears and his presence will be sorely missed. He brought a differentdimension to the Trust Board and offered unique and valuable insight. Heserved the city of Coventry with incredible dedication as a City Councillor,Justice of the Peace, Cabinet Member, Lord Mayor and Non-ExecutiveDirector of UHCW. The Trust Board wish to convey their sympathies to MrJ Harrison’s wife and son. The Chairman asked all to join him in a minutessilence as tribute to Mr J Harrison.

In accordance with the provisions of Section 1(2) of the Public Bodies (Admission to Meetings) Act 1960, andthe Public Bodies (Admissions to Meetings) (NHS Trusts) Order 1997, it is resolved that the representatives ofthe press and other members of the public are excluded from the first part of the Trust Board meeting on thegrounds that it is prejudicial to the public interest due to the confidential nature of the business about to betransacted. This section of the meeting will be held in private session.



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JUNE 2011 AT 3.00PM

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The Chairman noted that the Chair of NHS Coventry, Alison Gingell wasvery impressed during her recent visit to UHCW NHS Trust (UHCW). Thisincluded a visit to the ward area during protected meal times, whichdemonstrated the immense work undertaken by the nursing staff andhighlighted issues in relation to capacity. It was noted that much of thefood served to patients was returned uneaten which suggests that theamount of food served is either too much, particularly as all three coursesare served together, and raises the question of nutritional provision forpatients who require support with eating.

The Chairman noted that he had met with Councillor David Welsh, Chair ofthe Coventry Health and Social Care Scrutiny Board. The Chairmanemphasised the importance of maintaining collaborative partnerships andnoted that he and Chief Executive Officer are shortly both to meet withCouncillor D Welsh to engage in public health issues.

The Chairman noted that the first meeting of the Health and WellbeingBoard was held yesterday, of which the Chief Executive Officer is amember but who was unable to attend due to existing work commitments.

HTB 11/284PRIVATE TRUSTBOARD MEETINGSESSION REPORT– 25/05/2011*

The Chairman advised that the purpose of the report are to advise of theprivate Trust Board Session meeting agenda held on 25

thMay 2011 and

any key decisions or outcomes made by the Trust Board.

The Board NOTED the contents of the report.

HTB 11/285CHIEF EXECUTIVESREPORT

The Chief Executive Officer noted that the details of part 1 of the NHSFuture Forum were detailed in a letter of 20

thJune 2011. Key speeches

are expected to be delivered next week by Andrew Lansley, Secretary ofState at the NHS Confederation Conference.

During the last month the Trust has audited and signed off the 2010/2011annual accounts and quality account, which will be shared at the AnnualGeneral Meeting on Wednesday 27

thJuly 2011 in room 20063/20064

commencing at 5.00pm.

HTB 11/286QUALITYGOVERNANCECOMMITTEEMEETING REPORT– 10/05/2011*

The Trust Board NOTED the Quality Governance Committee meetingreport of 10

thMay 2011.

HTB 11/287NURSING ANDMIDWIFERYANNUAL REPORT

The purpose of the report is to brief the Trust Board on the Nursing andMidwifery annual report for 2010/11.

Dr AM Cannaby noted that the annual report celebrated the work acrossnursing and midwifery at UHCW and commended her colleagues; Mrs JFoster, Acting Chief Nursing Officer, Mrs C Bonniger, Divisional NurseDirector and Ms C Hughes, Interim Divisional Nurse Director for theircontribution. She added that the Trust continues to develop many newroles in nursing that are traditionally undertaken by doctors; this includesthe appointment of a Consultant Nurse in A&E and the implementation of anurse-led clinics. A Professor of Nursing has been appointment which is agreat accolade for UHCW and this position has secured a lot of researchmoney. UHCW has affiliations with Hospitals in Europe and have



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undertaken an exchange programme with a Hospital in Holland.

The impetus now is to continue to focus on the development of skills forsupport workers and the breadth of nursing roles to cope with demand.The plan is to develop a research portfolio for nursing that is equivalent tothe research portfolio for doctors.

Mr T Robinson congratulated Dr AM Cannaby on an excellent report whichclearly demonstrates the continued efforts to maintain the quality ofnursing care. He added that the report does not detail how junior doctorswill work with and recognise the significance of nursing roles. Dr AMCannaby responded that the work currently being undertaken by theProfessor of Nursing who is working closely with pre-registration and newlyqualified doctors is going well.

Mr R Kennedy noted that the GMC has reviewed the curriculum for thefinal year at medical school to integrate new doctors into multidisciplinaryways of working. He added that he welcomed the increased scope ofnursing practice and has witnessed fantastic contribution to servicedelivery.

Procedural Note: Mr T Sawdon left the meeting room at 3.25pmHTB 11/287NURSING ANDMIDWIFERYANNUAL REPORT

The Chairman commended the report and acknowledged that nursing andmidwifery is a vital component of the organisation that provides a servicebeyond measure. There have been many examples of staff going aboveand beyond the call of duty. UHCW has a good reputation in research anddevelopment as evidenced by the close links with both Warwick andCoventry Universities. The Trust has a duty to continue to recruit, retainand develop staff.

The Trust Board NOTED the contents of the report.

HTB 11/288FINANCE REPORT

The purpose of the report is to provide a summary of the Trust’s financialposition and actions being taken to address the year to date deficit and thecost improvement programme (CIP).

Mr A Jones noted that the Trust reported a year to date deficit against planof just under £1.5m. The key issues are the shortfall on CIPs of £0.9m;made up of £0.5m corporate workstreams & £0.4m divisional schemes.Divisional overspends of £0.6m arise from cost pressures associated withadditional activity; non-elective activity in particular is continuing toincrease – 4.1% above 2010/11 and 5.3% above plan, and continuingexpenditure on bank/agency staffing c.£1.3m per month to cover vacantposts. Other activity slightly above plan for year, down compared to2010/11 is elective +1% (-16.7%), daycase +3% (-8.4%) and outpatients+4.2% (+4.0%)

In terms of CIP the full year target is £28m (split £15m traditional divisionalbased schemes and £13m of Trust-wide initiatives). Divisional basedschemes are now almost fully worked up with mostly green rated schemes(£12.5m), with a small proportion still rated amber (£2.5m). Regularmeetings are taking place with Divisions to review progress againstschemes in delivering savings and to ensure no adverse impact on qualityand patient safety. Divisions have been tasked with developing clear plansby the end of July to tackle other cost pressures (of around £300k permonth). Corporate workstreams have been identified covering 9 key areasand a presentation was given to the Finance and Performance Committeeon Monday 27

thJune 2011 outlining the key projects which include major



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whole system reviews for theatres and out-patients, pathway redesignschemes, workforce efficiency projects and a review of corporatefunctions. Each project is being led by an Executive Director with externalsupport where required. It is proposed that progress will be reported ateach Finance and Performance Committee meeting. The Trust’s planassumes that significant savings from these projects will start to flow fromSeptember.

It is noted that the Trust has a reasonable cash balance of £4.3m, workingcapital movements are as expected (receivables up £7.5m mainly as aresult of prepayments, including the PFI). Capital expenditure (against aplan of £14.3m) in the first two months is negligible.

The Chairman thanked Mr A Jones for providing a detailed report. Heexhorted the Executive Team to manage the action taken to address theshortfall in CIP’s. The Trust has delivered CIP’s in previous years andavoided job losses. However, if the Trust does not deliver the CIP there willbe no alternative but to review the option of redundancies. It was notedthat if the Trust does not maintain a position of financial balance, it will notachieve foundation trust status.

Ms S Tubb noted that following the meeting of the Finance Committee onMonday 27

thJune 2011, there was a real feeling of steer and change in

terms of CIP approach and actions agreed to address the cross divisionalissues.

The Trust Board NOTED and ENDORSED the actions being taken toaddress the financial position which will be reviewed again next month ingreater detail.

HTB 11/289PERFORMANCEREPORT

The purpose of the report is to inform the Trust Board of the Trust’sperformance against national targets and key performance indicators forthe period 1

stApril 2011 to 31

stMay 2011.

Mr A Jones noted that on the whole the Trust’s performance againstnational targets and key performance indicators remains good. However,in May the performance against the Monitor Compliance Frameworkdropped from green to amber/green. Four indicators in exception are;

data quality/completeness for time to treatment in A&E. The Trustmust achieve 95% completeness or 5% incomplete; we are at46.6% incomplete. Actions have been taken to address this andtowards the end of the month we were down to around 11%incomplete. It was noted that there are many Trust’s currentlystruggling with this new data requirement.

Total time in A&E – target for 95th

percentile is 240 minutes (4hours). The Trust were at 257 minutes (non-admitted 229 mins,admitted 475 mins). The Trust continues to see extremely highnumbers of patients in A&E. A number of actions are beingimplemented or considered to improve performance in A&E.

62 day referral to treatment for cancer; one urology patient(transferred from another specialist) breached this target. Thecase is being reviewed by the clinical teams to ensure no futuredelays.

MRSA; the National target for year is only 4 cases. In May UHCWhad one case which puts the Trust above trajectory; however,assuming there are no more cases in June, the Trust will be back



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on target for quarter 1.

The Chief Executive Officer noted that the report does not highlight whattargets are performing well such as 18 week-wait target or actualperformance against the 4 hour wait target in A&E. These two indicators inparticular are monitored by the Executive Leadership Team, and as such itwould be helpful to specifically highlight these within the main body offuture reports. The Chairman added that the Trust’s continuedachievements in meeting the cancer waiting times should also be praisedwithin the report. Mr A Jones explained that the performance reporthistorically has been pulled together as an exception report and thereforehighlights only those targets that are not being met and require action.

The Chairman asked that the issue in relation to the urology cancer patientbe referred to the Quality Governance Committee. Mr R Kennedy advisedthat the Quality Governance Committee will have already been in receipt ofthe report. He acknowledged that the patient should not have breached thereferral to treatment target but emphasised that this was an isolated case.

Mr N Stokes asked that the report figures are presented as percentage toget a better representation of the Trust’s position.

The Trust Board NOTED the contents of the report and ENDORSED thekey actions being taken by management to address the exceptionshighlighted in the report.

Mr A Jones

HTB 11/290HEALTH CARECONTRACTS WITHCOMMISSIONERS

The purpose of the report is to brief the Trust Board on the Trust’s2011/2012 contracts with health care commissioners to provide health careservices and to recommend that the Trust Board approves the agreementsmade.

Mr A Jones noted that the heads of agreement on the main contracts forthe 2011/12 were finally signed with Commissioners on 16

thJune 2011.

The Trust is finalising the contract documentation for full sign-off for 8th

July 2011. The total value £372m is compared with outturn of £375m for2010/11 (0.7% less). Contracted activity is generally significantly less than2010/11 outturn with the exception of outpatients and reflects the QIPPschemes, including demand management, agreed with PCTs to reducehospital based activity.

Pricing is based upon national tariff, although there are a number of localprices which the commissioners have agreed to increase where thesewere demonstrably lower than cost and comparative prices in other heatheconomies. Quality and key performance indicators have also been agreedalthough a key change for the CQUIN payments, which represent 1.5% ofthe contract value or £5.1m, is the inclusion of quarterly targets andmilestones which will guarantee partial payment for partial achievementrather than the fixed target agreed in prior years

Discussion ensued in relation to the variety of schemes available includinga low priority scheme that has been adopted by NHS Warwickshire andNHS Coventry to identify patients who have been declined funding forspecific conditions. Mr R Kennedy noted that the Department of Healthhave taken an interest in how this scheme is implemented, which couldinform the national model. Mr FT Lam noted that if there is a significantchange in provision there will be a requirement to go to public consultation.Mr R Kennedy advised that Mr FT Lam was confusing the low priority



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scheme with the fast, slow stop model adding that the low priority schemeis in line with NICE guidelines and that Commissioners are complyingbroadly with NICE guidance.

The Chairman thanked Mr A Jones for a very good report andacknowledged the difficulties in negotiating contracts given the pressureswith the NHS reforms.

The Trust Board NOTED the contents of the report and APPROVED the2011/2012 contract agreements made. The Trust Board AGREED todelegate responsibility to the Chief Executive Officer and Acting ChiefFinance Officer to sign-off the final contracts with Commissioners.

HTB 11/291FOUNDATIONTRUSTAPPLICATIONUPDATE*

The purpose of the report is to update the Trust Board on the progress andtimeline for Foundation Trust status application.

The Chief Executive Officer noted that the full Integrated Business Planhas been submitted to the West Midlands Strategic Health Authority withinthe last 24 hours. Copies will be circulated to all Board members inpreparation for the Board to Board with the West Midlands Strategic HealthAuthority on 29

thSeptember 2011.

HTB 11/292FOUNDATIONTRUSTMEMBERSHIPENGAREMENTREPORT*

The purpose of the report is to provide an update to the Trust Board on thecurrent position regarding foundation trust (FT) membership, to report on2010/2011 membership communication and to outline the plannedmembers communication and engagement activities.

Mrs C Watts was pleased to report that the Trust has surpassed 6500public members. The charts contained within the report demonstrate arepresentation of the community we serve and the number of activitieswhere the Trust has engaged with FT members i.e. utilising local schoolsto ask pupils to review the Trust website and provide feedback forimprovement. There is currently a lot of practical and pragmatic work beingundertaken.

Ms S Tubb commended the report and acknowledged that the charts arevery useful but queried the under representation in Stratford and Warwick.Mrs C Watts responded that this is likely to be related to distance and thefact that South Warwickshire already has a FT hospital.

In response to a question from the Chairman, Mrs C Watts confirmed thatGovernors elections would be taking place at the end of the calendar year.She added that a number of individuals have already expressed a keeninterest. In addition, Governors from other Trusts have come forward toshare information in relation to their role.


HTB 11/293PR REPORT*

The purpose of the report is to share the Trust’s performance relating topublic and media relations for November 2010 – January 2011.

Mrs C Watts reported that the Trust maintains good relations with local,regional and national media and continues to have a balance which isincreasingly positive.

The Chairman congratulated Mrs C Watts on the superb work undertakenby the Communications Team, which has been transformational on a local



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and national level.


HTB 11/294FREEDOM OFINFORMATIONREPORT*

The purpose of the report is to advise the Trust Board of the freedom ofinformation act requests and compliance for January to March 2011.

Mrs C Watts noted that the nature of the requests are increasinglybecoming wider in scope. It would be interesting to see how much timeand resources are used to deliver the requests. Mr N Stokes confirmedthat he receives in his office approximately one request each week. TheChairman acknowledged these comments and confirmed that it is nowcommonplace across all public sector bodies to receive an increase inthese requests.


HTB 11/295NATIONALCANCER PATIENTEXPERIENCEPROGRAMMES –2010 NATIONALSURVEY*

The purpose of the report is to inform the Trust Board of the recentlypublished survey and to make the Board aware of the overall feedback tothe Trust.

Mrs C Watts was pleased to report that the Trust had primarily receivedvery positive feedback. She emphasised the importance for patients toreceive these surveys, which help shape the cancer strategy in the future.

Following a suggestion from Mrs W Coy, Mrs C Watts agreed to provide areport detailing the Trust’s position in comparison against its peers at afuture public session of the Trust Board.

The Trust Board enthusiastically NOTED the contents of the report andthat the survey will be repeated next year.

Mrs C Watts

HTB 11/296PATIENT STORY

The purpose of the report is to inform the Trust Board of the main points ofa patient story delivered to a pre-meeting of Trust Board representativeson Wednesday 20

thApril 2011.

Mrs C Watts noted that this particular piece of work helped to improve thepatient experience on ward 32 and is evidence of how we share and takeon board patient feedback.

Mr N Stokes queried what the outcome of the first meeting of the steeringgroup was held on 15

thJune 2011. Mrs C Watts noted that she was not

present at the meeting. Dr AM Cannaby confirmed that she would liaisewith the team and provide an action plan to a future public session of theTrust Board. Mr I Crich applauded the initiative which provides a realinsight into patient stories. The Chairman concurred with Mr I Crich’scomments.

Mrs W Coy queried how the patient story manifested i.e. through PALS orvia patient feedback. Mrs C Watts confirmed that the patient contactedPALS and requested that a meeting with Executive Team members as anopportunity to share his experience and provide constructive comments,rather than make a formal complaint. Mrs W Coy queried whether the Trustcontinues to offer this to patients. Mr R Kennedy responded that where wecan, the Trust always offers the opportunity to meet with a member of theExecutive Team. Mrs C Watts added that the Executive Team often meetwith patients but that the details are not always published in the public

Dr AM Cannaby



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domain, at the request of the patient.

The Trust Board NOTED the contents of the report and the actions beingtaken on ward 32 to improve the patient experience.

HTB 11/297ANY OTHERBUSINESS

Following the sad passing of Mr J Harrison, the Chairman confirmed Mr TSawdon as Chair of the Quality Governance Committee meetings.

HTB 11/298QUESTIONS FROMTHE PUBLIC

In response to a question from the public in relation to dischargearrangements; Mr R Kennedy acknowledged that delays incurred awaitingdischarge due to medical staff not being available to authorise take homemedications are unacceptable. He added that following the implementationof the European Working Times directive junior doctors have difficultygetting round all the places necessary in order to get medications signedoff, and the Trust is currently looking at ways to improve it. Historically thePharmacist would write up the take home medications for patients due tobe discharged; however, the new procedure in place devoids this. TheTrust is looking to revise the arrangements in place to enable thePharmacist to once again authorise take home medications and thusimprove the process. The Chairman apologised unreservedly for thedelays encountered in the hospitality lounge and thanked the gentlemanfor bringing this matter to the attention of the Trust Board.

Mr S Krikler noted that the wording contained within the Nursing andMidwifery Annual report should be amended to non medical prescribing asopposed to non prescribing, adding that there is opportunity to expand thescope of the nursing role to include some of the very straightforwardprocedures that doctors currently undertake.

In response to a question from Mr S Krikler regarding best practice tariff forhip and knee replacements, Mr R Kennedy responded that the BritishOrthopaedic Association introduced guidelines for knee arthroscopy andCommissioners are keen to deliver best practice tariff.

In response to a question from a member of the public in respect ofconsultant allocation for patients presenting to A&E, Mr R Kennedyresponded that patients are assessed by the A&E consultant onpresentation who makes an assessment and identifies what the particularissue is and the patient is then directed to the speciality area of expertisei.e. medical or surgical team. A further assessment is then made at thispoint to manage the specific problem. Patients presenting with symptomsof stroke or heart attack are immediately fast tracked to the relevant areaof expertise and managed appropriately.

In response to a question from a member of the public in relation to theavailability of gastrointestinal doctors, Mr R Kennedy responded that theA&E consultant would contact the gastrointestinal consultant on-call forany patients presenting to A&E with gastrointestinal symptoms. The on-callconsultant is available 24 hours a day, 7 days each week.

In response to a question from the public in relation to what specialities arehoused on ward 32, Mr FT Lam responded that ward 32 is a surgical wardand the type of surgery performed specialises in head and neck, ear noseand throat and plastic surgery.

In response to a question from the public in relation to hospital food and



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the cost per patient per day, Mr I Crich offered to take the details andwould respond to this enquiry directly.

HTB 11/299DATE OF NEXTMEETING

The date of the next meeting is Wednesday 27TH

July at 3.00pm atUniversity Hospitals Coventry & Warwickshire NHS Trust.

HTB 11/300APPROVAL OFMINUTES

These minutes are approved subject to any amendments agreed at thenext Trust Board meeting.

SIGNED……………………………………………..

CHAIRMAN

DATE……………………………………………..

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUSTACTIONS UPDATE: PUBLIC TRUST BOARD MEETINGS

27th

July 2011

NB Items in blue have been completed

- 1 -

AGENDA ITEM ACTION LEAD COMMENTACTIONS IN PROGRESS

HTB 10/578(27/10/10)RISKMANAGEMENT(HEALTH &SAFETY) ANNUALREPORT*

Mr I Crich reported that the Annual report isrequired to assist in improving performance and islinked with the Quality Patient Safety Report. Thereis more up-to-date data and Mr I Crich and Mr RKennedy will work together and devise a format toinform the Board for future reports.

Mr I Crich/Mr R Kennedy

In progress

HTB 11/289 (29.6.11)PERFORMANCEREPORT

The Chief Executive Officer noted that the reportdoes not highlight what targets are performing wellsuch as 18 week-wait target or actual performanceagainst the 4 hour wait target in A&E. These twoindicators in particular are monitored by theExecutive Leadership Team, and as such it wouldbe helpful to specifically highlight these within themain body of future reports. The Chairman addedthat the Trust’s continued achievements in meetingthe cancer waiting times should also be praisedwithin the report.

Mr A Jones Performance reportto be updated toincorporate the CEOand Chairman’scomments from July2011.

ACTIONS COMPLETE

HTB 11/223 (25.5.11)ANNUAL FINANCIALPLAN 2011/12REVENUE

The Chairman requested that the Board will take adecision following the meeting of the Finance andPerformance Committee in July 2011 as to whetherit is necessary to convene a further Board meetingin relation to cost improvement programmes.

Mr A Jones No furtherextraordinary Boardmeeting required

HTB 10/571 27/10/10)ROYAL COLLEGEOF PSYCHIATRISTSPUBLICATION – NOHEALTH WITHOUTMENTAL HEALTH*

The Chairman commented on the need to raiseawareness by facilitating partnership events,charitable groups, inviting guest speakers to raisethe profile along with liaising with PCT andpartners. Mr R Kennedy and Mr A Anwar todiscuss this outside of Board and back a progressreport to Trust Board in 6 months time

Mr R Kennedy Scheduled for AprilTrust Board –deferred to May 2011and again to June2011. Item referred toQuality GovernanceCommittee

HTB 11/219 (25.5.11)INFECTION,PREVENTION ANDCONTROL ANNUALREPORT ANDANNUAL PLAN

The Trust Board NOTED the contents of the reportand ENDORSED the work plan for 2011/2012. TheChairman requested that the Chief MarketingOfficer conveys thanks to all staff throughout theTrust and ensures that appropriate media coverageis given in respect of this achievement.

Mrs C Watts Completed – pressrelease uploaded toTrust website andsent to local mediaJune 23, 2011.

HTB 10/642(24.11.10)PATIENT SAFETYFIRST UPDATE –PROGRESSREPORT

The programme focuses on a portfolio of projectswhich will have a significant impact on reducingavoidable patient harm and mortality. It wasAGREED that a progress report will be discussed atthe public meeting of the Trust Board on a sixmonthly basis.

Mr R Kennedy May 2011 TrustBoard – deferred toJune 2011 – deferredto July 2011

HTB 11/104 (23.2.11)HIEC REPORT*

The Board requested a third recommendation thatan updated report be brought back to a futurepublic meeting of the Trust Board on or before 29

th

September 2011.

Mrs C Watts On or beforeSeptember 2011Trust Board -scheduled for July2011.

REPORTS SCHEDULED FOR NEXT MEETINGHTB 11/093 (23.2.11)CHAIRMAN’SREPORT

The Chairman advised that he was delighted toaccept the invitation to be a Key Speaker at theCoventry Muslin Forum held on Friday 18

th

February 2011. At that event Dr Shehu raised the

Mr R Kennedy May 2011 TrustBoard – deferred toJune 2011 – protocolto be progressed

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUSTACTIONS UPDATE: PUBLIC TRUST BOARD MEETINGS

27th

July 2011

NB Items in blue have been completed

- 2 -

AGENDA ITEM ACTION LEAD COMMENTissue of the timely release of bodies for people ofIslamic and Jewish faiths and the Chairmanadvised that the Trust would do everything possibleto respect these wishes and support this request.The Chairman asked that Mr R Kennedy produce aprotocol to present to the public meeting of theTrust Board in May 2011.

through theappropriate Trustprocess prior topresenting to TrustBoard in September2011

REPORTS SCHEDULED FOR FUTURE MEETINGS

HTB 11/029(26.01.11)THEMED REVIEWOF UHCW RISKMANAGEMENTPROCESSES

The Chairman noted the report and the threerecommendations and he asked that the M RKennedy bring a further report on the how therecommendations are being implemented to theSeptember Board and report progress back to NHSWarwickshire.

Mr R Kennedy September 2011

HTB 11/027(26.01.11)QPS REPORT

A report to be presented to the Trust Board on staffinjury.

Mr R Kennedy To be scheduled.

HTB 11/295 (29.6.11)NATIONAL CANCERPATIENTEXPERIENCEPROGRAMMES –2010 NATIONALSURVEY*

Following a suggestion from Mrs W Coy, Mrs CWatts agreed to provide a report detailing theTrust’s position in comparison against its peers at afuture public session of the Trust Board.

Mrs C Watts Future Board session

HTB 11/296 (29.6.11)PATIENT STORY

Mr N Stokes queried what the outcome of the firstmeeting of the steering group was held on 15

thJune

2011. Mrs C Watts noted that she was not presentat the meeting. Dr AM Cannaby confirmed that shewould liaise with the team and provide an actionplan to a future public session of the Trust Board.

Dr AM Cannaby Future Board session

ACTIONS REFERRED TO TRUST BOARD SUB-COMMITTEES


REPORT TO THE TRUST BOARD: PUBLIC

27th

July 2011

I/\trust board\templates\revised header public\Version 2\January 2010

Subject: Private Extraordinary Trust Board Meeting Session Report of6

thJune 2011

Report By: Philip Townshend, ChairmanAuthor: Jenny Gardiner, Trust Board SecretaryAccountable Executive Director: Philip Townshend, Chairman

GLOSSARY

Abbreviation In FullCQC Care Quality CommissionPWC PricewaterhouseCoopers

WRITTEN REPORT (provided in addition to cover sheet)? Yes No

POWERPOINT PRESENTATION? Yes NoNB Presentations need to be submitted for inclusion in Board papers

TitleApprox. Length

PURPOSE OF THE REPORT / PRESENTATION:

To advise the Board of the private Trust Board Session meeting agenda for 6th

June 2011, and of any keydecisions/outcomes made by the Trust Board.

SUMMARY OF KEY ISSUES:

Adoption of the Annual Accounts: Mr A Jones, Acting Chief Finance OfficerThe Chairman formally proposed for the Trust Board to adopt the annual accounts for 2010/11. The TrustBoard formally APPROVED the proposal to adopt the annual accounts for 2010/11.Schedule Of Key Documents To Be Authorised To Be Signed: Mr A Jones, Acting Chief Finance OfficerThe Chairman proposed authority be given to the signing of the key documents at the end of the meeting. TheTrust Board APPROVED the proposal to sign the key documents at the end of the meeting.Quality Account 2011:Mr R Kennedy, Chief Medical OfficerThe Chairman proposed the Quality Account be approved by the Trust Board in its current form subject to thenecessary amendments. The Trust Board unanimously APPROVED the proposal to approve the QualityAccount.Annual Report (Unbranded Near Final Draft) 2010/11: Mr A Jones, Acting Chief Finance OfficerThe Chairman proposed that the Trust Board approve the Annual Report subject to the necessaryamendments. The Trust Board unanimously APPROVED the proposal to approve the Annual Report.Annual General Meeting: Mr A Hardy, Chief Executive OfficerIt was noted that the Annual General Meeting (AGM) is scheduled to take place on Wednesday 27

thJuly 2011

to commence at 5.00pm in the Clinical Sciences Building at UHCW NHS Trust.

The Chairman asked Mrs C Watts to invite all Foundation Trust members to a “mini” FT member event thatshould be incorporated within the format of the AGM as an opportunity to encourage public engagement. Mrs CWatts added that free car parking will be available to members attending the meeting.



27th

July 2011


SUMMARY OF KEY RISKS:

No risks were identified.

RECOMMENDATION / DECISION REQUIRED:

For Noting.

IMPLICATIONS:

Financial: N/A

HR / Equality & Diversity: N/A

Governance: N/A

Legal: N/A

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee Remuneration CommitteeFinance and Performance Committee Executive MeetingAudit Committee



27th

July 2011


Subject: Private Trust Board Meeting Session Report of 29th

June 2011Report By: Philip Townshend, ChairmanAuthor: Jenny Gardiner, Trust Board SecretaryAccountable Executive Director: Philip Townshend, Chairman

GLOSSARY

Abbreviation In FullCQC Care Quality CommissionPWC PricewaterhouseCoopers



TitleApprox. Length


To advise the Board of the private Trust Board Session meeting agenda for 29th

June 2011, and of any keydecisions/outcomes made by the Trust Board.


Chairman’s Report: Mr P Townshend, ChairmanNo key Board actions/decisions to report onChief Executive’s Report: Mr A Hardy, Chief Executive OfficerNo key Board actions/decisions to report onRisk Register Report*Mr R Kennedy, Chief Medical OfficerThe Trust Board NOTED and ACCEPTED the risk management report.Serious Incident Group & Mortality Report: Mr R Kennedy, Chief Medical OfficerThe Trust Board NOTED the contents of the report.Risk Register Report: Mr R Kennedy, Chief Medical OfficerThe Trust Board NOTED the risks as identified on the register.Quality Governance Committee Meeting Minutes – 10/05/2011 & 14/06/2011*: Mr T Sawdon, Non-Executive DirectorThe Trust Board NOTED the minutes of the Quality Governance Committee meetings held on 10

thMay 2011

and 14th

June 2011.CQC Quality Risk Profile: Mr R Kennedy, Chief Medical OfficerThe Trust Board NOTED the contents of the report.Audit Committee – Meeting Of The Extraordinary Meeting – 06/06/2011*: Mr T Robinson, Non-ExecutiveDirectorThe Trust Board NOTED the minutes of the Extraordinary Audit Committee meeting held on 6

thJune 2011.

Finance & Performance Committee Meeting – 23/05/2011*: Mr B Connor, Non-Executive DirectorThe Trust Board NOTED the minutes of the Finance and Performance Committee meeting held on 23

rdMay

2011.Waiting Times Report::Dr AM Cannaby, Chief Operating and Nursing OfficerThe Trust Board NOTED the contents of the report and asked that Mrs C Watts present an updated report tothe Trust Board in September 2011 in relation to the work currently being undertaken in relation to theatres.Quality Account : Mr R Kennedy, Chief Medical OfficerThe Trust Board APPROVED the contents of the report and delegated authority to the Chairman and Chief



27th

July 2011


Executive Officer to sign the statement of directors responsible in respect of the quality account.Expansion Of Trauma & Orthopaedics Consultant Numbers – Business Case: Dr AM Cannaby, ChiefOperating and Nursing OfficerThe Trust Board unanimously APPROVED the report in principle subject to the financial figures beingamended/corrected.Contract Award Approval – Cytology Department: Mr A Jones, Acting Chief Marketing OfficerThe Trust Board APPROVED the award of a contract to Hologic for a period of five years under the NationalFramework Agreement Ref JR/TYC/0604.Pathology Services Governance Arrangements: Mr A Hardy, Chief Executive OfficerThe Chief Executive Officer noted that the Trust is approaching the end of the three year agreement. A reviewis being undertaken by Mr P Martin, Director of Governance the results of which will be presented to a futuremeeting of the Quality Governance Committee.Quality Governance Framework Action Plan: Mr A Hardy, Chief Executive OfficerThe Trust Board NOTED the contents of the report and AGREED the action plan leads. A further report will bepresented to the Trust Board in July 2011.


No risks were identified.


For Noting.

IMPLICATIONS:

Financial: N/A


Governance: N/A

Legal: N/A

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee 10/05/2011

&14/06/2011

Remuneration Committee

Finance and Performance Committee 23/05/2011 Executive MeetingAudit Committee 06/06/2011



27th

July 2011

I/\trust board\templates\revised header private\Version 2\January 2010

Subject: Quality Governance CommitteeReport By: Mr T Sawdon, Non-Executive DirectorAuthor: Mr P Martin, Director of GovernanceAccountable Executive Director: Mr R Kennedy, Chief Medical Officer



TitleApprox. Length


To advise Trust Board of the details of the Quality Governance Committee meeting on 14 June 2011


National Sentinel Stroke Clinical Audit Report was noted by the Committee. Quality Governance Committee Terms of Reference were agreed. Human Resources, OD, Research, Training & Education Committee – amendments to

Terms of Reference to be presented at July meeting. Patient Experience Committee – Synopsis of achievements and Terms of Reference

amendments were presented to the meeting. Patient Safety Committee – a number of issues were discussed and an explanation of

Patient Safety Committee and Risk Committee to be supplied to the Committee. Information & IT Committee – report to be submitted next month. Quality Account Final – this will be submitted in its final form at next Trust Board. Audit Plan – the audit plan was explained and it was felt that a report of resultant actions

would be helpful. Quality & Patient Safety Dashboards – Diagnostics & Services, and Pathology reports

were presented to the Committee.


Identified within individual reports


For consideration by the Board



27th

July 2011

I/\trust board\templates\revised header private\Version 2\January 2010

NATURE OF MATTER RESERVED FOR PRIVATE TRUST BOARD:

IMPLICATIONS:

Financial: None

HR / Equality & Diversity: None

Governance: None

Legal: None

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee 12/07/2011 Remuneration CommitteeFinance and Performance Committee Executive MeetingAudit Committee



27th

July 2011


Subject: Infection Prevention and Control and Cleaning Report – April to June2011

Report By: Dr Mike Weinbren, Director and Kate Prevc, Modern Matron (InfectionPrevention and Control)Jill Foster, Acting Chief Nursing Officer

Authors: Dr Mike Weinbren, Director and Kate Prevc, Modern Matron (InfectionPrevention and Control)Mark Gough and Amanda Fletcher, ISS Mediclean

Accountable Executive Director: Dr Ann-Marie Cannaby, Chief Nurse and Operating Officer

GLOSSARY

Abbreviation In FullMRSA Meticillin Resistant Staphylococcus AureusC Diff Clostridium difficileDH Department of HealthRCA Root cause analysisHSE Health & Safety ExecutiveSSI Surgical site infectionsKPI Key performance indicatorsMSSA Meticillin Sensitive Staphylococcus Aureus



TitleApprox. Length


To brief the Trust Board on the Infection Prevention & Control and Cleaning Report for the quarter Aprilto June 2011.


MRSA – one acquired to date, with a performance target for the year of 4. Emergency screening for MRSA continuing; compliance needs to improve. Clostridium difficile – 22 cases acquired to date, with a performance target for the year of 86. Current laboratory testing methodology to be changed to a two stage test. A deep clean of the Emergency Department, ward 12 and Clinical Decisions Unit to be carried out. Attendance by junior doctors for training on skills such as collecting blood cultures poor.


Ongoing challenging national and local targets for 2011/12. Increased incidence of multi-resistant organisms.


To note the Infection Prevention and Control and Cleaning Report for the quarter April to June 2011.



27th

July 2011


IMPLICATIONS:

Financial: Financial penalty for none achievement of targets


Governance: Care Quality Commission Registration to practice

Legal: None

REVIEW:


1

University Hospitals Coventry and Warwickshire NHS Trust

QUARTERLY INFECTION PREVENTION & CONTROL andCLEANING REPORT

April to June 20111. Introduction

The purpose of this report is to brief the Trust Board on;

o the progress of the Trust for the first quarter of the year in relation to the InfectionPrevention and Control Team’s “Annual Plan” of work 2011/12 and

o to present the Cleaning report for the same quarter.

A. INFECTION PREVENTION AND CONTROL

2. Progress against National Performance Targets (Criterion 1)

2.1 MRSA

MRSA Bacteraemia Comparative Chart by Quarter and Year

(post 48 hours from admission only)

0

2

4

6

8

10

12

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Quarter

No

of

cases 2008/09

2009/10

2010/11

2011/12

Fig. 1

Figure 1 indicates the number of bacteraemias acquired within the Trust by year/quarter andmeasured against target.

One post 48 hour from admission MRSA bacteraemia has been acquired to date. The Trustperformance target for the year is 4.

Figure 2 below indicates the number of bacteraemias acquired within 48 hours and post 48 hoursfrom admission. (The Trust is monitored only on post 48 hours.)

2

Monthly Chart showing MRSA bacteraemia cases against Trajectory

0

1

2

3

Apr-

11

May-

11

Jun-

11

Jul-

11

Aug-

11

Sep-

11

Oct-

11

Nov-

11

Dec-

11

Jan-

12

Feb-

12

Mar-

12

Month

No

ofcases

Trust Apportioned cases

Non Trust Apportioned cases

2011 / 12 Trajectory

Fig. 2 graph is no good in terms of trajectory

Elective MRSA Screening

The Trust continues to screen all elective patients undergoing surgery for MRSA and is meetingthe Department of Health’s guidance in this area.

Emergency MRSA Screening

Emergency screening began at the end of September 2010 and was monitored internally duringthis quarter. This continues to provide challenges and our average compliance is 69%, the rate ofpositive pick up 1%.

The Trust took part in a national audit of MRSA screening both emergency and elective toevaluate the implementation, clinical and cost-effectiveness, and impact on patient managementof the national MRSA screening programme. This was undertaken by University College Londonand the Health Protection Agency but commissioned by the Department of Health. Results arenot yet available.

2.2 Clostridium difficile

C. Diff cases Comparative Chart by Quarter and Year

(apportioned cases only)

0

10

20

30

40

50

60

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Quarter

Noofcases 2008/09

2009/10

2010/11

2011/12

Fig. 3

Figure 3 indicates the Trust’s performance on Clostridium difficile (C. diff)against trajectory targetagainst previous years by quarter.

To date the Trust has acquired 22 C. diffs set against local trajectory target 86 and is one abovetrajectory.

3

The table below indicates the number of C. diffs assigned by specialty, Medicine & Surgerypredominately featuring as the specialities which have acquired the most C. diffs.

DIVISION WARD

Daily

Beds

Open

No of C.

diff cases

C. Diff Rate

per 1000

beds open

20 Gastro Unit - Medical 54 5 1.03

31 Medical 48 1 0.23

40 Care of the Elderly 42 5 1.32

41 Stroke 36 1 0.31

22a Vascular 14 1 0.79

53 T&O 43 2 0.52

35 Oncology 30 1 0.37

43 Neurosurgery Ward 36 1 0.31

50 Renal 24 3 1.39

Total 1097 20 0.20

Hoskyn 24 1 0.46Mulberry 20 1 0.56

Total 133 2 0.17

C. Diffs Total 22

St. Cross

Medicine andEmergency

Surgery

Specialised

Up until now the Trust has been very successful in reducing its rates of C. diff infection. Howeverwith each successive year the national targets set for the Trust have been increasingly difficult tomeet. The target for this year is 86 cases. The financial risk should this target not be met is a finein the order of £5 million. Aside from the financial risk the Trust has a duty to ensure the safestlevel of care to patients.

The advice from the C. diff Performance Group and from Infection Prevention and Control is thatthe following measures are instituted as soon as practically possible:

1. Change current laboratory testing methodology to a two stage test.2. Implement a deep clean of the front end of the hospital without delay. It is appreciated that

this has been very difficult to organise because of the unusually high bed pressures, but thismust proceed without delay.

3. Consider implementing a system of regular terminal/deep cleans of high-risk wards on anongoing basis. Addenbrookes Hospital in Cambridge have utilised such a system within thepast year, prior to which their rates of C. diff were higher than here (similar sized hospital),but are now appreciably lower than our rates since the introduction of the new cleaningsystem.

Good cleaning is a very important measure in controlling this organism. Analysis of C. diffincidents had shown that the current cleaning audit system, the ISS Quality Control tool, was notidentifying all cleaning issues including nurses cleaning standards and general environmentalissues at an early stage in order to prevent cross infection. Thus a series of comparative auditshave been undertaken in conjunction with ISS and Infection Prevention and Control using bothaudit tools. Over 80 comparative audits have been carried out and this data will now be analysedand presented to both ISS and the Trust. The audit results showed common areas that wererecurring failures i.e. dust under beds and the cot sides. A meeting was held with ISS prior to theOperational Cleaning meeting and ISS have reminded their staff of the importance of dailycleaning and it was highlighted to health care staff that this was to be undertaken frequentlyduring the day. Initial results seem to indicate that areas that fall jointly between healthcareworker and ISS responsibility receive less attention. Now this has been highlighted both groupswill endeavour to tackle this issue.

4

As reported in the annual report the Trust will continue to use the Infection Control NursingAssociation environmental audit tool to reduce risk of healthcare associated infection. Thisprocess has been handed over for Matrons to complete on a monthly basis and at theirdiscretion, should they have concerns. The Infection Prevention and Control team will conductquarterly environmental audits to quality control the standard of auditing. Action plans areformulated following each audit, these are the responsibility of the Modern Matron who will liaisewith cleaning partners etc to ensure that failures in processes are addressed and amended, thiswill then be monitored locally by the Matron. Trust wide the Saving Lives Group will discuss theaction plans and escalate any concerns either to the Operational Cleaning Group, InfectionPrevention and Control Committee or to Trust board.

C. diff Performance Group Feedback

This performance group meet every two weeks. The group have recommended a change to thecurrent methodology of laboratory testing (at least 10 to 40% of cases may be missed withcurrent system used - this is a national problem) and also have recommended that a deep cleanof the Emergency Department, Observation ward and ward 12 be undertaken. Finances have justbeen approved for this.

2.3 E Coli Bacteraemia

Data collection for E coli bacteraemia began on the 1st June 2011 in line with DH mandatoryrequirements. There were 24 bacteraemias reported during this month. E Coli is the organismthat is most commonly the cause of bacteraemia. It is anticipated that the enhanced surveillancewill elucidate the factors underlying the increase in Gram-negative bacteraemias in Englandproviding the information to target education at potential areas for intervention and reduction.

2.4 Glycopeptide Resistant Enterococci (VRE)

Two VRE Bacteraemias has been reported for the first quarter of 2011

2.5 Meticillin Sensitive Staphylococcus Aureus ( MSSA) bacteraemias

The Trust had begun an RCA process for MSSA bacteraemias to understand the potential factorsinvolved in MSSA bacteramia acquisition. This was successful in renal but slow to gainacceptance across the Trust. In April of this year the DH asked for RCA s to be mandatory.Compliance with this has increased across the Trust.

2.6 Reporting of data

All C.diff and MRSA data is cascaded to Chief Executive Officer, Executive Team, ClinicalDirectors, Infection Prevention & Control Committee, Quality Governance Committee and ModernMatrons. It is also available for individuals at ward level and is displayed on the Infection Controlnotice boards of all wards and departments. Information regarding the Trust’s performanceagainst national targets is also available on the Trust’s intranet site and is updated monthly.Information is cascaded via the Infection Prevention and Control bulletin to the PCT, HealthProtection Agency and Regional Director of Infection Prevention & Control meetings. Anyuntoward incidents or outbreaks are reported to Strategic Health Authority and Health PreventionAgency via Clinical Governance and the SUI process. We are compliant with all mandatory datacollection, C. diff, MRSA., MSSA E coli.

3. Cleaning (Criterion 2)

Good cleaning has a vital role to play in protecting against infection. In the last quarter theinfection control team has used the additional ICNA environmental audit tool alongside the ISStool. The results of the ICNA tool have been valuable alongside the ISS quality control tool indriving up cleaning standards throughout the Trust. It is essential that the Trust continue toundertake such audits in order to maintain standards. Within a month of introducing the ICNA toolthe Trust had its lowest ever rates of C. diff in a month. It is too early to say whether this ischance or causally related.

5

The performance management team continue to provide an invaluable service to the Trust inoverseeing the standard of cleaning both by Trust staff and ISS. The Infection Prevention andControl team (and Trust) increasingly rely on them to ensure the quality of cleans especially whenthis is critical i.e. following an outbreak / incident. They have also been particularly flexible in theirresponse thereby permitting maximum utilisation of beds.

4. Providing suitable and sufficient information to patients and public (Criterion 3)

The Infection Prevention and Control team continue to include as many public groups as possiblein our awareness training. We actively participate in work experience training with schools acrossCoventry, we attend job fairs at local universities and schools. Seven senior schools have hadhand hygiene sessions including Foxford, Caludon Castle, Cardinal Newman, Cardinal Wisemanand others. We have offered hand hygiene training to partners such as TNT and these haveproven to be very popular sessions and it has given us the chance to explain initiatives such as“bare below the elbows” and tackle issues such as when wards are affected by Norovirus. The 5

th

May was world hand hygiene day and the Infection Prevention and Control team, set up in themain reception area along with a glow box to educate and answer any questions around handhygiene.

5. Outbreaks/incidents of Infection

5.1 Norovirus

The Trust had a small outbreak on Ward 2 which resulted in a temporary closure of the Ward.There was no secondary spread to other wards.

5.2 Water Quality - Legionella (Criterion 5)

Legionella at University Hospital

There is a comprehensive system of monitoring water for legionella on the University Hospitalsite. A small percentage of water samples are culture positive for legionella, a not unexpectedfinding in a building of this size. Each positive is investigated and any remedial actions taken.Meetings are being held to close out any positive findings.

Legionella at Rugby

This incident has been running for some time and it is anticipated that it will draw to a successfulclose within the next few months. The water systems on the site have been extensively re-engineered with most of the old cast-iron pipe work removed. The number of outlets testingpositive for legionella has dropped substantially. Routine water testing during the month of Juneidentified two outlets positive for Legionella pneumophila serogroup one. Prompt action from theEstates Department (Paul Phillips, Bruce Mills, Martin Kent) identified the likely cause, led to theremoval of unused outlets, identification of a dead leg, installation of PALL filters and chlorinationof the affected water circuit. Levels of chlorine dioxide are being reduced to one part per million inboth the day surgery and A&E/pathology areas. Following reduction water samples will be takenfor testing for legionella. There have been no cases of hospital acquired legionella to date.

Legionella at Stratford

UHCW manages a satellite renal unit at this site. The building is owned by a private landlord.Estate functions are carried out by a private facilities management company. A number of tenantsoccupy the building including a private company that specialises in renal dialysis. Contaminationof the water systems with Legionella was first detected in March 2009. The risk within the renalunit has been reduced by the installation of PALL filters.

The Trust paid for an independent expert to review the arrangements for legionella control on thissite. His report found the situation to be unsatisfactory. The Health & Safety Executive (HSE)subsequently became involved. At a meeting chaired by the landlord’s representative everyonewas assured that action would be taken. The HSE by way of serving improvement notices

6

instructed the landlord/estates management to produce a plan with timescales on how thesituation was to be rectified.

A separate mains water supply to the renal RO plant has been completed, thereby allowingappropriate concentrations of biocide to be safely added to the water system supplying the rest ofthe hospital.

In essence the problem at Stratford is much less about the legionella contamination (which couldhave been rectified very quickly if the Trust had full control over the buildings). This situation ismore about contractual relationships with other parties.

To date there have been no cases of human legionella associated with the water system. TheHSE is fully involved with the situation with one of their senior inspectors regularly attendingmeetings.

5.2 Multi resistant organisms

A patient who had been with the Trust for six months, since transfer from abroad as anemergency, had extremely resistant organisms including Multi Resistant Acinetobacter and ahighly resistant Pseudomonas, was transferred successfully to Leamington Rehabilitation Unit,where the patient is able to continue his rehabilitation.

5.3 ESBL producing organisms and resistant enterobacter on Neonatal unit

Screening has revealed numerous strains of a resistant Enterobacter on the neonatal unit.However there has been no case of clinical infection. Since the screening process was initiatedonly one isolate has been detected in clinical specimens. The impression is that throughscreening one is potentially capturing a natural phenomenon which would otherwise gounrecognised. The decision therefore needs to be made as to whether it is useful from a clinicalperspective to carry on the screening programme.

5.4 Measles

The number of cases of measles has increased significantly nationally together with outbreaks ofinfection in other countries (France) which has also resulted in cases being imported.

Measles is highly contagious and carries a significant morbidity/mortality. Within the hospitalsetting the risk is even higher due to the presence of highly susceptible individuals.

A number of cases of measles presented to the hospital during the month of April. Incidentmeetings were held at which the Health Protection Agency attended. There were no secondarycases of infection. A systematic system of testing staff for immunity and immunising whereappropriate was set up in the Trust under the auspices of Occupational Health. Since then therehave been few cases of measles presenting as emergencies.

6. Audit programme Surgical Site Infection (SSI) Surveillance (Criterion 8)

6.1 Orthopaedic surveillance

SSI surveillance for orthopaedics is mandatory and has to be performed for at least six months ofthe year. The data below indicates the rates of infection for Rugby site for the 1

stquarter. This

fulfils the mandatory requirement but it is felt that a full and ongoing programme of audit fromorthopaedics would be more beneficial.

Surveillanceperiod

Type ofsurgery

No. ofoperations

No. ofinfections

Infectionrate

Nationalaverage

Jan- March2011

Kneereplacements

114 0 0% 2.7%

Jan- March2011

Hipreplacements

75 2 2.7% 1.7%

7

6.2 Tuberculosis

This quarter the team have not been involved in any look back exercises involving patients notbeing isolated appropriately.

6.4 Audit programme

The Infection Prevention & Control team continue to conduct audits each quarter. However onewill be undertaken Trust wide each quarter to enable the feedback to be disseminated and actionplan drawn up. It is proposed to undertake more ad hoc audits where there is perceived to be anissue or if issues are reported, this will allow the team to evaluate practice and efficacy ofintervention. Ward staff will continue to undertake monthly KPI audits of hand hygiene, sharpsetc. C. diff and MRSA compliance is monitored monthly by Infection Prevention and Control andfed back to the Saving Lives Group. Infection Prevention and Control continue to audit for periodsof increased incidence.

During the first quarter of this year 89 environmental audits were completed either by the InfectionPrevention & Control Team or Modern Matron. The overall compliance for the Trust was 77%compliance. This is being addressed by the escalation of ICNA audits as described above.Particular areas of concern were bed frames, 72% of bed frames were not clean or free fromdust; this is being addressed with ISS and Nursing staff.

Audits 2011MRSA compliance audit 79%

Cdt Compliance audit 95%

Hand hygiene audit 88%

The quarterly hand hygiene audit undertaken by the Infection Prevention and Control teamshowed 100% compliance with availability of hand hygiene facilities and soap, gel etc. Somework remains to be done with Medical staff that had weaknesses around compliance with barebelow the elbows and hand washing technique.

C. diff compliance against the quick action guide (C. diff policy) remains consistently highreflecting the high level of recognition and prompt action to isolate amongst staff.

MRSA compliance reflects a failure for medical staff to document their interventions on the quickaction guide. The required actions have been undertaken.

The Trust was the subject of an external hand hygiene audit which was undertaken by Coventry& Warwickshire Audit Services. This audited a number of aspects of hand hygiene includingcompliance with bare below the elbows. The initial verbal report was very positive with the Trustobtaining the highest level of assurance of “Significantly reassured”. A written report will beforwarded to the executive team from Internal Audit.

7. Training (Criterion 9)

Mandatory training programme continues weekly at the moment in accordance with the TrustMandatory training plan, and is a requirement for all clinical staff annually. Practical hand hygieneis also included in both mandatory and on Trust induction for non clinical and medical staff. Thisquarter’s training figures indicate that Infection Prevention and Control training and hand hygienetraining are on target for year end compliance as they sit at 76% for clinical staff and 85% for nonclinical at the end of June 2011.

Attendance by junior doctors for training on skills such as collecting blood cultures has beenextremely poor. Poor technique when collecting a blood culture leads to contamination whichresults in unnecessary expenditure of time by laboratory staff/clinical staff within the organisation.Contamination is also dangerous because it can lead to mismanagement of the septic patient. It

8

is essential that a form of training is introduced which engages with junior doctors and producesimproved rates of contamination.

7.1 Infection Control Team training

Infection Prevention and Control are looking to replace the band 6 audit and surveillance nurse.The data analyst for the team has completed his studies for a BSc in health studies. A band 7specialist practitioner continues to study for a BSc in health studies. Staff are encouragedwhenever possible to attend national study days and conferences to update our knowledge in linewith national initiatives.

8. Pathology services – (Criterion 8)

Pathology services have commenced emergency MRSA screening and we are working closelywith them for compliance monitoring. A business case is being put forward to change the currentmethod of testing Clostridium difficile infection which lacks sensitivity and specificity.Improvements in diagnosis should mean that patients are treated earlier, therefore with a betteroutcome, and symptomatic patients are detected earlier on the wards therefore reducing the riskof cross infection.

B. CLEANING REPORT9. Introduction

The Department of Health’s circular PL/CNO/2007/6 dated 1st

November 2007 “ImprovingCleanliness and Infection Control” requires Matrons and cleaning service providers to reportquarterly to the Trust Board to ensure that appropriate joint working arrangements are in placeand assure the Board of the quality of the cleaning standards.

10. Work to Date

The National Cleaning Standards have been in place at University Hospitals Coventry andWarwickshire NHS Trust since April 2008. Cleaning audits continue to be jointly carried out byMatrons and ISS, and then reviewed at the bi-weekly Infection Prevention & Control andOperational meetings along with any other factors that impact on cleaning. These meetingsbring together all relevant input and feedback relating to the cleaning service.

During the first quarter of 2011 (April, May and June) ISS conducted a total of 281 audits. Ofthese, 99% were verified by Modern Matrons. The audits include all aspects of the ward areasincluding patient areas, day rooms and offices. The Modern Matrons are totally committed to theauditing process, despite the demands of their role within the nursing environment. The auditingprocess has clearly demonstrated continuous improvement in all areas. The collaborationbetween the Matrons and ISS Managers has continued to bring added benefits to the standard ofcleanliness within the hospital.

All aspects of cleanliness are monitored and reported. The average score for the quarter was98.2%, an improvement on last quarter’s average of 97.8%. The areas identified as “very highrisk” continue to be audited on a weekly basis and results remain broadly consistent with previousquarters at 98.4%.

All audit reports are forwarded to the Modern Matrons and identify any rectification required.These are followed through by the Healthcare Cleaning Management Team who ensures thatappropriate action is taken in a timely manner.

11. Monitoring

Whilst the responsibility for the ICNA audits has been handed over to the Modern Matrons,Infection Prevention and Control continue to carry out random audits and also attend auditswhere there are multiple cases of C. diff. The ISS auditing tool purely focuses on the ISS cleaningtasks, whereas the ICNA tool includes environment issues in addition to items cleaned by nursesand some of the ISS tasks.

9

ISS and the Trust Director of Infection Control are in agreement that both systems are of benefitin the monitoring of hospital cleaning standards, although it is not practical to attempt to comparethe results of these two different audit systems. All parties remain committed to our common goalof continual improvement of cleanliness.

12. People

ISS continue to develop the Healthcare Cleaning Team. All Healthcare Cleaning Supervisorshave successfully completed CIEH Level 2 Management of Health and Safety at Work and allmanagers have now completed or are scheduled to complete Level 3. This confirms the ISScommitment to Health and Safety in the workplace and the provision of a safe environment for all.

ISS continue to offer Healthcare Cleaners the opportunity to register for level 2 NVQ’s in Cleaningin Support Services and are also working with supply partners and local colleges to offer KeySkills and ESOL qualifications. Regular ‘Open Days‘ are held where staff can register theirinterest and meet local assessors.

13. Achievements

ISS are delighted to announce that the ISS Healthcare Cleaning department have beenshortlisted for the Kimberly Clark Golden Service Award for ‘Best Cleaned Hospital Premises’ Theaward recognises excellence in cleaning and support services industry.

Nomination for this national award is a major achievement, being a reflection on the overallstandards of cleanliness throughout the hospital and joint commitment to ongoing improvement.

14. Working in Partnership

The ISS Healthcare Cleaning Team, have further developed their working relationship with theInfection Prevention and Control Team. The Healthcare Cleaning Manager meets with theModern Matron from the Infection Prevention and Control Team bi weekly. The purpose of thismeeting is to share knowledge, improve communication and develop joint strategic working, topromote a proactive response to meet the needs of the Trust.

ISS have demonstrated their commitment to the Infection Prevention and Control Team throughthe initiative to fund a Control of Infection Link Nurse. UHCW is the first Trust to recognise thisopportunity. There has been collaboration between both parties regarding the job description forthis crucial position, and the recruitment and selection process will be a joint exercise. This rolewill further improve communications and relationships between Infection Prevention and Controland ISS and help to identify further opportunity for service development. ISS would welcomefurther dialogue with the Trust to move this forward.

C. RECOMMENDATION

The Trust Board asked to note the Infection Prevention & Control and Cleaning report for April toJune 2011.



27th

JULY 2011

Trust board/templates/header sheet (public) version 4 – July 2011

Subject: QPS Annual Trust Board Report - July 2011Report By: Mr R Kennedy, Chief Medical OfficerAuthor: QPS DepartmentAccountable Executive Director: Mr R Kennedy, Chief Medical Officer

GLOSSARY

Abbreviation In FullCAE/CAEs Clinical Adverse Event/sFCEs Finished Consultant EpisodesSUS Secondary User ServicesSHA Strategic Health AuthoritySIG Significant Incident GroupHES Hospital Episode StatisticsHSMR Hospital Standardised Mortality RateRR Relative Risk



TitleApprox. Length


To appraise the Trust Board of the quality and patient safety issues for year: April 2010 – March 2011


Please refer to the content of the report, summarised on the “key points” page


Please refer to the content of the report


To receive Annual QPS Report April 2010 – March 2011



27th

JULY 2011


IMPLICATIONS:

Financial: N/A


Governance: Patient Safety

Legal: N/A

REVIEW:


Annual Quality & Patient Safety Report April 2010 – March 2011

Prepared for Trust Board July 2011

CONTENTS & KEY POINTS

1.0 PATIENT SAFETY REPORT Prepared by: Yvonne Gatley – Associate Director of Governance (Patient Safety) Page 6

This report is based on the latest information available to the Quality & Patient Safety Unit. As there is a time lag with receiving some information (such as clinical adverse events, clinical activity and mortality data), the reporting periods within the report differ between sections. Please refer to the section headings for the data period used within each dashboard report. Where information is presented as quarterly trends the data is capped at the last full quarter so that the analysis is not skewed by missing or incomplete data. For the purposes of this report, quarters are shown according to calendar year.

Annual report on Clinical Adverse Events received: April 2010 – March 2011 • The incident reporting rate continues to increase, the majority of reports now being made online, which helps to streamline the whole process.

Reporting rates compare favourably with other large teaching trusts (7th highest out of 26 similar organisations in the latest NPSA publication). With regard to “degree of harm” to patients, UHCW once again had a higher proportion of “no harm” incidents reported than the rest of the acute teaching cluster. This is encouraging as it indicates that the Trust is reporting near misses and this has been sustained in the last five feedback reports.

The following trends were specifically identified: • Patient falls remains the highest reported category and the number of reports has actually started to rise again this calendar year. The Falls Steering

Group is reviewing this apparent trend to ascertain the reason for this. A NPSA alert “Essential Care after an Inpatient Fall” has been actioned in the Trust and is due for completion on 14th July 2010.

• Pressure ulcers are reported as clinical adverse events and root cause analysis (RCA) is performed for all those that are grade 3 or 4 in order to identify learning points, with the aim of reducing the numbers of preventable hospital-acquired pressure ulcers. The RCAs have identified specific clinical conditions/client groups, e.g. patients wearing a specific cervical collar post spinal injury/surgery, patients wearing anti-embolic stockings. Over half of the incidents reported were patients admitted with community-acquired pressure ulcers.

• A number of reports has been received relating to equipment missing on Theatre trays. This was as a result of incomplete trays going into Theatre or equipment not being replaced on its correct tray following procedures in Theatre. These are NOT instruments being left inside patients. Meetings have been held to identify the problems and to ensure patients are not at risk and as a consequence the number of reports has decreased.

• Medication incidents continue to be targeted for action as part of the Trust’s Patient Safety First Campaign. A project involving Pharmacy and the Nurse Practice Facilitators is underway to reduce the number of omitted doses of Enoxaparin. Other “critical” medicines are also being targeted for specific action and all specialties receive details of their medication incidents on their Quality & Patient safety dashboards.

• Significant incidents are monitored weekly by the Significant Incident Group and a monthly update is presented to Trust Board. There has been no upward trend in SUIs over the year.

Claims • This year the NHSLA has started to issue solicitors’ risk management reports relating to specific claims against organisations. The Trust has therefore

developed a process to ensure that these are reviewed, actioned and monitored so that responses can then be collated and returned to the NHSLA. The Legal and Governance departments have also revised internal processes to track all new claims and ensure that specialties are taking actions to address the issues as well as learning any lessons.

NPSA • All NPSA alerts have been allocated Trust leads and action plans are in place for each of them to deliver the requirements to the specified deadlines.

Progress is monitored via monthly reports to the Patient Safety Committee.

Page 2 of 27

2.0 MORTALITY REPORT Prepared by: Richard Kennedy – Chief Medical Officer Page 9

3.0 CLINICAL AUDIT & EFFECTIVENESS REPORT Prepared by: Victoria Brownsword – Quality & Effectiveness Co-Ordinator Page 12

Annual Report: April 2010 – March 2011 • HSMR for the trust continues to be below 100 and will stay remain 100 following Dr Foster re-basing later this year • The Trust HSMR is a little better than the peer group and national comparators, and will remain so after rebasing later this year • The Mortality Review Group continues to meet monthly and has no systemic concerns about mortality in the Trust.

Report at 5 April 2011: Clinical Audit: • This report details the end of year position for clinical audit, and progress made with the delivery of the 2011/12 Clinical Audit and Effectiveness

Programme. • UHCW continues to participate in 100% of relevant National Confidential Enquiries. Of the current studies, data collection for Peri-operative Care and

Cardiac Arrest is now complete and UHCW has no qualifying cases for the Bariatric Surgery study. • There are seven NCEPOD reports with some recommendations that have yet to be addressed within UHCW. A process designed to improve

implementation of recommendations going forward is being proposed. • Action plans resulting from clinical audits are monitored for completion and reported via Specialty and Divisional Dashboards. During 2011/12 a process

to report this, and the benefits realised from clinical audits, will be developed. Clinical Guidelines • 2010/11 has seen a dramatic decrease in the number of expired clinical guidelines on the elibrary system from 276 in April 2010 to 109 as at 22/3/11. • Review of clinical guidelines is ongoing concentrating on reducing the number of expired guidelines in Nursing & Gynaecology folders the 2 specialties

with the highest number of expired guidelines • In 2011/12 the focus will be on improving the quality of the content of clinical guidelines held on elibrary. Corporate Business Records • Towards the last part of 2010/11 there has been a consistent decrease in the number of expired and under review Corporate Business Records (CBRs)

on the elibrary system. • An expiry timeline document has been created to keep on top of all CBRs on a monthly basis to ensure that they are updated before they expire. • In 2011/12 the focus will be on continuing improvement which will result in a continuing decrease of expired and under review CBRs. Patient information • 2010/11 has seen a steady decrease in the number of expired patient information documents on the elibrary system due to collaboration with staff in

certain specialties (Cardiac, Endoscopy, Oncology, Obs & Gynae). This work will continue and expand to other specialties as required. • Some Specialties are making some of their patient information leaflets available on the Trust website. Until there is a live link from elibrary to the website

this needs close control to ensure that the PDF documents are the latest version. • In 2011/12 the focus will be on improving the coverage within certain patient information directories, such as Neurology and Orthopaedics

Page 3 of 27

4.0 COMPLAINTS REPORT Prepared by: Sharon Wyman - Complaints Manager Page 15 5.0 IMPRESSIONS REPORT Prepared by: Julia Flay - PPI Facilitator Page 19

Annual report on Complaints received: April 2010 – March 2011 • For the financial year April 2010 – March 2011 there was an increase in the number of formal complaints from 484 to 512. This was the second year

that we saw an increase. • 93% of complaints received a formal response within our internal target of 25 working days compared with 99% the previous year

Annual report period: April 2010 – March 2011 • Trust:

2010/11: 89% of all respondents had mainly good impressions of the Trust. 11% had mainly bad impressions of the Trust. 2009/10: 70% of all respondents had mainly good impressions of the Trust. 30% had mainly bad impressions of the Trust. Top two scoring categories of service 2010/11: Cleanliness / Safeguarding & Wellbeing Lowest two scoring categories of service 2010/11: Parking / Visiting times Top two scoring categories of service 2009/10: Cleanliness / Premises & Facilities Lowest two scoring categories of service 2009/10: Parking / Smoking Diagnostics and Service Division: Top two scoring categories of service 2010/11: Cleanliness / Our staff Lowest two scoring categories of service 2010/11: Getting to & from Hospital / Parking Top two scoring categories of service 2009/10: Privacy & Dignity / Our staff Lowest two scoring categories of service 2009/10: Written & Spoken Information / Parking

• Medicine & Emergency Division Top two scoring categories of service 2010/11: Cleanliness / Premises & Facilities Lowest two scoring categories of service 2010/11: Discharge / Parking Top two scoring categories of service 2009/10: Cleanliness/ Premises & Facilities Lowest two scoring categories of service 2009/10: Discharge / Parking

• Specialised Networks Division: Top two scoring categories of service 2010/11: Cleanliness / Safeguarding & Wellbeing Lowest two scoring categories of service 2010/11: Discharge / Parking Top two scoring categories of service 2009/10: Food / Privacy & Dignity Lowest two scoring categories of service 2009/10: Parking / Discharge

• Surgery Division: Top two scoring categories of service 2010/11: Safeguarding & Wellbeing / Cleanliness Lowest two scoring categories of service 2010/11: Parking / Visiting times Top two scoring categories of service 2009/10: Cleanliness / Premises & Facilities Lowest two scoring categories of service 2009/10: Discharge / Parking

• Women & Children’s Division: Top two scoring categories of service 2010/11: Privacy & Dignity / Safeguarding & Wellbeing Lowest two scoring categories of service 2010/11: Timeliness / Parking Top two scoring categories of service 2009/10: Cleanliness / Premises & Facilities Lowest two scoring categories of service 2009/10: Safeguarding & Wellbeing / Parking

Page 4 of 27

6.0 NON-CLINICAL RISK REPORT: Prepared by: Keith Higgs – Health & Safety Adviser & Risk Manger Page 26

Annual report on Non-Clinical Incidents received: April 2010 – March 2011 • Trend over one year: There were 1911 non-clinical incidents between April 2010 and March 2011 which compares with 2048 for the previous year, a

7% reduction which is probably not significant due to the large monthly variability in reporting (up to 100%). The fitted line has a very low R2 and so the slight downward trend is not significant. Where there are large variations between months (e.g. Nov to Dec) these tend to be dominated by security issues (over 50% of the total).

• Divisional trend over 6 months: The bulk of non-clinical incidents were reported by Medicine & Emergency division with most incidents (71%) being security-related.

• Injuries by person type: Staff suffered the majority of incidents (73%) and 19% were trust-related (no person affected but loss to the trust). Patients and public shared 7% of the non-clinical incidents which fell into three main categories: theft (14%), security [other than theft] (28%) and falls (20%) [these percentages are of the total for patients and public only].

• Top 5 incident types for 12 months: More than 50% of the reports in the top 5 incident types were security-related. Slips, trips and falls were largely: slips on level ground (71%) followed by falls from height (11% – mainly from chairs) and trips (14%). The category of “exposure to hazards substances” is a blunt category which includes exposure to biological agents and chemicals as well as burns and struck/struck by incidents – the latter were 38% of the total for this category.

• Top 5 incident types – trends: As noted in 6.1 the amount of reports are dominated by the two main security categories but when linear trend lines are fitted the only two reasonably significant trends (R2 = 0.134 for each) are for slips and hazardous exposure – each of which has a slight upward trend over the period. Security related to premises occurs mostly at St Cross, being a mix of doors/windows unsecured and intruders, most of whom are children. Abuse is minimal at St Cross (12%) as the majority of incidents (88%) are at University Hospital. To understand why these types of incidents occur requires more detailed analysis than these graphs can show.

• Overall conclusions: Security issues dominate at each of the two main hospitals, but each for different reasons. Slips on vinyl floors continue to receive much concentrated attention since the move in 2006 but with little gain. Needlestick/sharps incidents have been under greater scrutiny for the past year, particularly following the EU direction on use of safer sharps and an HSE incident investigation at UH. Any reductions in sharps injuries will probably be reflected in future analyses following introduction of newer devices and rigorous investigations of why incidents occur. However, sharps incidents are probably more to do with culture and individual poor practices than devices.

Page 5 of 27

1.0 PATIENT SAFETY REPORT - FINANCIAL YEAR (All reports based on Clinical Adverse Event (CAE) incident dates) April 2010 – March 2011

1.1 CAEs reported by month – Trend over 12 months

T o ta l n u m b e r o f C A E s r e p o r te d - 9 4 0 8

9 0 4

7 6 5

8 3 9

7 4 0

7 5 56 9 9

8 1 3 7 8 5

7 7 2

7 9 58 5 4

6 8 7

0

1 0 0

2 0 0

3 0 0

4 0 0

5 0 0

6 0 0

7 0 0

8 0 0

9 0 0

1 0 0 0

A p r 1 0 M a y 1 0 J u n 1 0 J u l 1 0 A u g 1 0 S e p 1 0 O c t 1 0 N o v 1 0 D e c 1 0 J a n 1 1 F e b 1 1 M a r 1 1

No

of C

AEs

1.2 CAEs reported by Division – Trend over 12 months

0

50

100

150

200

250

300

350

Apr 10(765)

M ay 10(854)

Jun 10(813)

Jul 10(795)

Aug 10(687)

Sep 10(699)

O ct 10(839)

Nov 10(740)

Dec 10(755)

Jan 11(785)

Feb 11(772)

M ar 11(904)

Hotel & Core Services Division

Diagnostics & Service D ivision

M edicine & Em ergency D ivision

Not applicable

Coventry & W arw ickshire PathologyServices

Specialised Netw orks Division

Surgical Services Div ision

W om en & Children's D ivision

Page 6 of 27

1.6 CAEs reported by Grade – last 12 months

0

100

200

300

400

500

Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11

High - Red

Low - Amber

Moderate - Blue

Very low - Green

1.4 Top 5 Types of CAEs – Trend over 12 months

0

20

40

60

80

100

120

140

160

180

200

220

240

Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11

Postponed orcancelled surgery

Delay

Slips, trips, falls andcollisions

Missing equipment /device

Pressure sore /decubitus ulcer

1.3 Top 5 Types of CAEs – Financial year Apr 10 – Mar 11 Types of CAEs

Slips, trips, falls and collisions 1865 Pressure sore / decubitus ulcer 1138 Missing equipment / device 321 Delay- majority being treatment/procedure delays, 26 – transfer and 22 - discharge 194 Postponed or cancelled surgery – 107 relating to Cardiothoracic surgery 139

Pressure ulcers – over half of the incidents were patients admitted with community acquired pressure ulcers. Missing equipment – Sterile Services Department were reporting incidents where equipment was missing from original trays when returned from theatres. These numbers have now decreased following management actions.

1.5 Top 5 Types of Medication CAEs – Financial year Apr 10 – Mar 11 Dose or strength was wrong or unclear – 77 were prescribing, 21- administration, 13 - dispensing 111

Medicine not administered 87 Other medication incident- of these 33 were administration, 15 – prescribing 81

Delay in administering medication 46

Medication/drug not prescribed 39

Page 7 of 27

1.7 Clinical Activity Table FCE's by Division Apr 10 - Mar 11 (These figures are fasttrack)

Sum of CountOfPID ActivityMonth

No of CAEs for Division during the Financial

year

CAEs as % of in-patient activity

Division Activity Type

Apr-10

May-10

Jun-10

Jul-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Grand Total

Diagnostic & Service Daycase 193 203 205 277 74 285 196 292 214 263 259 218 2679 Elective 37 40 45 40 36 43 44 25 20 47 65 44 486

Non Elective 78 81 105 102 90 86 93 91 78 76 81 82 1043

Total 308 324 355 419 200 414 333 408 312 386 405 344 4208 1635 38.85% Medicine & Emergency Daycase 813 858 914 896 749 835 834 843 790 748 786 1021 10087 Elective 62 46 58 61 61 49 45 54 38 39 48 47 608

Non Elective 3421 3246 3237 3359 3342 3263 3392 3634 3753 3660 3343 3705 41355

Total 4296 4150 4209 4316 4152 4147 4271 4531 4581 4447 4177 4773 52050 2441 4.69% Specialised Networks Daycase 1141 1067 1218 1267 1300 1413 1400 1376 1326 1264 1147 1337 15256 Elective 385 375 406 412 366 318 366 346 293 284 321 326 4198

Non Elective 712 703 779 786 708 777 731 753 767 749 706 793 8964

Total 2238 2145 2403 2465 2374 2508 2497 2475 2386 2297 2174 2456 28418 1763 6.20% Surgical Services Daycase 1901 2030 2024 2098 2058 2012 1936 2025 1398 1540 1663 1727 22412 Elective 944 950 873 936 913 850 995 877 774 734 835 914 10595

Non Elective 1042 1069 1089 1184 1063 1121 962 1071 1018 1048 911 1044 12622

Total 3887 4049 3986 4218 4034 3983 3893 3973 3190 3322 3409 3685 45629 1281 2.81% Womens & Childrens Daycase 262 276 197 277 295 276 303 278 216 255 250 295 3180 Elective 110 119 112 137 145 129 118 129 100 120 104 129 1452

Non Elective 2036 2149 2141 2209 2182 2133 2324 2219 2382 2093 2103 2186 26157

2408 2544 2450 2623 2622 2538 2745 2626 2698 2468 2457 2610 30789 1939 6.29%

Grand Total 13137 13212 13403 14041 13382 13590 13739 14013 13167 12920 12622 13868 161094 9059 5.62%

** Diagnostics & Services Division – Please note that in-patient activity recorded against this Division is comparatively very low, producing a high percentage of CAEs per in-patient.

Performance Indicator: Results of a UK pilot study of adverse events in hospitalised patients Proportion of inpatient episodes leading to harmful events

10% (around half preventable)

Source: Vincent C. A. (2000). Presentation at BMJ Conference ‘Reducing Error in Medicine’. London. In DH (2000). An Organisation with a memory: Report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer.

Page 8 of 27

2.0 MORTALITY REPORT This report is based on data extracted from Dr Foster Real Time Monitoring – April 2010 – March 2011

2.1 HSMR by Calendar Quarter: April 2010 – March 2011

0

20

40

60

80

100

120

140

Apr-1

0

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Feb-

11

Mar

-11

Rel

ativ

e R

isk

Relative RiskLower C ontrol Lim itUppe r C ontrol LimitNational Be nchma rk

2.2 Non-Elective HSMR by Calendar Quarter: April 2010 – March 2011

0

20

40

60

80

100

120

140

Apr-1

0

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Feb-

11

Mar

-11

Rel

ativ

e R

isk

Relative RiskLower C ontrol Lim itUppe r C ontrol LimitNational Be nchma rk

Page 9 of 27

2.3 Fully risk-adjusted HSMR: April 2010 – March 2011

Fully Risk-Adjusted HSMR All Admissions 89.4

Fully Risk-Adjusted HSMR Non-Elective Admissions 90

2.4 HSMR All Ages: April 2010 – March 2011 (Using 99.8% Control Limits)

HS

MR

- A

llA

dmis

sion

s (8

9.4)

HS

MR

- N

on-

Ele

ctiv

e (9

0)

Gen

eral

Med

icin

e(8

9.5)

Gen

eral

Sur

gery

(68.

9)

Acu

te M

I (73

.1)

CO

PD

(94.

9)

FN

OF

(79

.5)

Hea

rt F

ailu

re(8

4.3)

Pne

umon

ia (9

8.5)

Str

oke

(99.

5)

HSMR in brackets

Page 10 of 27

2.6 End of Life Care: April 2010 – March 2011

End of Life Care % of deaths with palliative care code Z515 UHCW = 19.1% SHA Average = 14.4%

2.5 HSMR Under 75’s: April 2010 – March 2011 (Using 99.8% Control Limits)

HSM

R -

All

Adm

issi

ons

(94.

5)

HS

MR

- N

on-

Ele

ctiv

e (9

6.2)

Gen

eral

Med

icin

e(1

00.4

)

Gen

eral

Sur

gery

(42.

4)

Acut

e M

I (7

7.2)

CO

PD (

134.

6)

FN

OF

(45.

9)

Hea

rt Fa

ilure

(92.

3)

Pneu

mon

ia (

105.

6)

Stro

ke (

109.

5)

HSMR in brackets

Page 11 of 27

3.0 QUALITY & EFFECTIVENESS REPORT

3.1 Status of 2010/11 Forward Plan

The graph below shows a summary of the 2010/11 clinical audits and their status as at 28/06/2011.

The 2010/11 forward plan contained 109 clinical audits.

● The graph excludes an additional 58 clinical audits that were continuous data collection.

● A breakdown of the initiated status highlights:

Scoping/work up 4 10%

Proforma design 0 0%

Data collection 7 18%

Analysis/report writing 19 49%

Awaiting presentation 9 23%

Overall:

● 51% of the clinical audits are at a completed stage.

● 37% of the clinical audits are at an initiated stage.

● 12% are awaiting results from national audits.

● The Quality & Effectiveness Department has had a significantly reduced staffing level for part of 2010/11.

● During 2010/11 59 national clinical audits and three national confidential enquiries covered NHS services that UHCW provides. UHCW participated in 76% of national

clinical audits and 100% of national confidential enquiries of which it was eligible to participate in.

● It is the intention for the department to review the reporting structure for clinical audit projects, along with a process for consistently implementing action plans and the

benefits realised as a result.

6 6

3

3

3

4

2

5

1

2 1

2

92

3

0

0

2

2 5

1

1

1

314

16

11

0

36

0 0 0

1

0

0%

20%

40%

60%

80%

100%

Initiated Awaiting Local Action Plan Action Plan Agreed,

Recommendations Not Fully

Implemented

Action Plan Completed and

Recommendations

Implemented

No Action Plan Required

(Fully Compliant)

National project - data

submitted / awaiting report

Core

Diagnostics & Services

Womens & Childrens

Specialised Networks

Surgery

Medicine & Emergency

Page 12 of 27

3.2 Progress Against the 2011/12 Forward Plan

The graph below shows a summary of the 2011/12 clinical audits and their status as at 28/06/2011.

● The 2011/12 forward plan was approved by the Quality Governance Committee on 14th June 2011.

● The two projects at risk and therefore on hold are:

1 National Cardiac Arrest Audit (Resuscitation) - recommended for specialty to develop a business case to gather resource to undertake audit.

2 HQIP National Pain Database (Anaesthetics & Theatres) - discussions with leads to participate and submit a full 3 months of data.

● A trajectory for delivery of the 2011/12 plan is to be devised for periodic monitoring and analysis.

● The department has been tasked to present a proposal for reporting actions in a timely manner to the Quality Governance Committee. The proposal will also include a process for

identifying the benefits realised from clinical audits.

6

1722

17

9

17

2 0

8

9

5

0

1

15

10

0

0 0

0

1

0

1

0

4

4 3

2

3

31

0 10

0

10

20

30

40

50

60

70

Core Diagnostics &

Services

Medicine &

Emergency

Specialised Networks Surgery Women & Childrens Education & Post

Graduate

Joint specialties

Completed

Continuous Data Collection

On Hold

Initiated

Not Initiated

Page 13 of 27

3.4 elibrary status report

Trust Report Month: July 2011 (Data as at 04/7/11)

Current Under Review Expired

All Directories 1783 81% 148 7% 274 12%

Corporate Business Records 100 73% 11 8% 26 19%

Clinical Guidelines 763 82% 69 7% 99 11%

Patient Information Leaflets 920 82% 68 6% 138 12%

Trust Approved TOR 0 0% 0 0% 11 100%

* Duplicates have been removed before calculating the data

Page 14 of 27

4.0 COMPLAINTS FINANCIAL YEAR REPORT (All reports based on date First Received) April 2010 – March 2011 4.1 Complaints received by month – Trend over 12 months

3 7

4 34 4

4 13 9

4 4

4 03 9

36

39

5 4

5 6

0

5

10

15

20

25

30

35

40

45

50

55

60

A p r 1 0 M a y 1 0 J u n 1 0 J u l 1 0 A u g 1 0 S ep 1 0 O c t 1 0 N o v 1 0 D e c 10 J an 1 1 F e b 1 1 M a r 1 1

4.2 Complaints received by Division – Trend over 12 months

0

5

1 0

1 5

2 0

A p r 1 0

( 3 7 )

M a y 1 0

(4 3 )

J u n 1 0

(4 4 )

J u l 1 0

(4 1 )

A u g 1 0

(3 9 )

S e p t 1 0

(5 6 )

O c t 1 0

(5 4 )

N o v 1 0

(4 4 )

D e c 1 0

( 4 0 )

J a n 1 1

(3 9 )

Fe b 1 1

( 3 6 )

M a r 1 1

(3 9 )

H ot e l & C ore S e rv ic e s D iv is io n

D ia g n os tic s & S e rv ic e D iv is io n

M e d ic in e & E m e rg e n c y D iv is ion

C ov e n try & W a rw ic k s h ireP a th o lo g y S e rv ic e s

S p e c ia l is e d N e t w ork s D iv is io n

S u rgic a l S e rv ic e s D iv is io n

W o m e n & C h ildre n 's D i vis ion

Page 15 of 27

Activity by Division

No of Complaints for patient activity

Complaints as % of patient activity

Division Action type Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Total

Diagnostic & Service Daycase 193 203 205 277 74 285 196 292 214 263 259 218 2679

Elective 38 40 46 40 36 43 44 25 20 47 65 44 488

Non Elective 77 81 104 102 89 87 93 91 78 76 81 82 1041

Outpatient 364 335 307 376 158 431 339 460 332 309 277 380 4068

Diagnostic & Service Total 672 659 662 795 357 846 672 868 644 695 682 724 8276** 38 0.5%

Medicine & Emergency Daycase 812 858 913 896 749 835 834 843 790 748 786 1021 10085

Elective 63 47 60 61 61 49 45 54 38 39 48 47 612

Non Elective 3420 3245 3235 3359 3341 3264 3392 3635 3752 3660 3343 3705 41351

Outpatient 8597 8521 9470 9427 8890 9301 8474 9654 7716 8882 8102 9120 106154

A&E Emergency Assessment 7290 7681 7352 7735 7261 7170 7673 7099 7485 7380 6706 7831 88663

Rugby A&E 2282 2445 2428 2488 2145 2252 2112 1869 2057 1830 1705 2091 25704

Medicine & Emergency Total 22464 22797 23458 23966 22447 22871 22530 23154 21838 22539 20690 23815 272569 156 0.05%

Specialised Networks Daycase 1141 1066 1218 1267 1300 1413 1400 1376 1326 1264 1147 1337 15255

Elective 385 375 406 412 366 318 366 346 293 284 321 326 4198

Non Elective 713 703 779 786 709 778 731 751 765 749 706 793 8963

Outpatient 9724 9797 10678 10386 9518 10758 9382 12436 12182 11711 9235 10517 126324

Specialised Networks Total 11963 11941 13081 12851 11893 13267 11879 14909 14566 14008 11409 12973 154740 83 0.05%

Surgery Daycase 1899 2023 2024 2098 2058 2012 1936 2023 1399 1540 1663 1727 22402

Elective 946 951 875 936 913 850 995 877 773 734 835 914 10599

Non Elective 1041 1068 1087 1184 1063 1120 962 1068 1017 1048 911 1044 12613

Outpatient 22312 22425 24163 22787 21684 24099 21960 24768 19338 21166 19726 22995 267423

A&E Eye Unit 1002 1001 1119 1220 1045 1196 941 1028 911 956 993 1214 12626

Surgery Total 27200 27468 29268 28225 26763 29277 26794 29764 23438 25444 24128 27894 325663 165 0.05%

Womens and Childrens Daycase 262 276 195 277 295 276 303 278 216 255 250 295 3178

Elective 110 119 111 137 145 129 118 129 100 120 104 129 1451

Non Elective 2020 2128 2138 2209 2183 2133 2325 2218 2381 2093 2103 2186 26117

Outpatient 7173 7071 7561 7563 7353 8189 7416 8213 7106 7513 7268 8269 90695

A&E Childrens Emergency 2568 2869 2540 2388 1926 2361 2397 2640 2785 2376 2320 2887 30057

A&E Gynae Short Stay 387 360 358 403 369 353 378 364 335 366 361 381 4415

Womens and Childrens Total 12520 12823 12903 12977 12271 13441 12937 13842 12923 12723 12406 14147 155913 66 0.04%

Grand Total 74819 75688 79372 78814 73731 79702 74812 82537 73409 75409 69315 79553 917161 508 0.06%

Total complaints excluding Hotel and Core Services Division (2 complaints) and Coventry & Warwickshire Pathology Services (2 complaints) ** Reflects data captured on PAS only

Page 16 of 27

4.6 Complaints received by Profession – Apr 10 - Mar 11

Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Total

Medical (including surgical) 18 21 30 24 28 36 24 26 30 21 20 20 298

Professions supplementary to medicine 2 2 0 0 3 1 1 2 0 2 1 2 16

Nursing, midwifery and health visiting 16 17 10 14 6 16 21 15 10 13 13 11 162

Scientific, technical and professional 0 1 1 0 0 1 1 0 0 0 0 0 4

Maintenance and ancillary staff 0 0 0 0 0 0 0 0 0 0 0 1 1

Trust administrative staff/members 1 2 3 3 2 2 7 1 0 3 2 5 31

Totals: 37 43 44 41 39 56 54 44 40 39 36 39 512

4.4 Types of Complaints received based on primary issue – Apr 10 – Mar 11

Types of Complaints received Total

Admissions, discharge and transfer arrangements 15

Aids and appliances, equipment, premises (including access) 3

Appointments, delay/cancellation (out-patient) 12

Appointments, delay/cancellation (in-patient) 16

Attitude of staff 71

All aspects of clinical treatment 298

Communication/information to patients (written and oral) 66

Consent to treatment 2

Patients' privacy and dignity 3

Patients' property and expenses 1

Personal records (including medical and/or complaints) 3

Failure to follow agreed procedure 18

Patients' status, discrimination (eg racial, gender, age) 1

Policy and commercial decisions of trusts 3

Totals: 512

4.5 Complaints Referred for Independent Review Parliamentary and Health Service Ombudsman (PHSO) We continued to work with the PHSO who became the second tier in the NHS Complaints Procedure in April 2009. This year we had 24 cases assessed by the PHSO, 2 of which went forward for investigation compared with 21 cases assessed the previous year, with 1 case investigated. At the end of the financial year 9 complaints were awaiting a decision.

Page 17 of 27

Complaints Performance Summary by Division (April 2010 – March 2011) No of complaints completed in 25 working days – Trust target (performance shown as traffic light indicator)

Division (primary) Received Re-opened Acknowledged Acknowledged Replied Replied to Replied to Open for

_ in 3 Days in 25 Days over 25 Days 25 Days

_ Count Count Count % Count % Count % Count % Count % Count %

Core Services Division 2 0 2 100% 2 100% 2 100% 2 100% 0 0% 0 0%

Diagnostics & Service Division 38 0 38 100% 38 100% 38 100% 38 100% 0 0% 0 0%

Medicine & Emergency & Rugby Divis 155 0 155 100% 155 100% 155 100% 146 94% 9 6% 0 0%

Coventry &Warwickshire Pathology S 2 0 2 100% 2 100% 2 100% 2 100% 0 0% 0 0%

Specialised Networks Division 83 0 83 100% 83 100% 83 100% 74 89% 9 11% 0 0%

Surgical Services Division 166 0 166 100% 166 100% 166 100% 153 92% 13 8% 0 0%

Women & Children's Division 66 0 66 100% 66 100% 66 100% 62 94% 4 6% 0 0%

TOTALS 512 0 512 100% 512 100% 512 100% 477 93% 35 7% 0 0%

Page 18 of 27

5.0 IMPRESSIONS ANNUAL REPORT: April 2010 – March 2011

5.2 Annual Trend: April 2010 – March 2011 Overall Impressions of Trust:

The above graph shows responses from respondents telling us if their impression of the Trust was mainly good (shown in green) or mainly bad (shown in red). This is represented as a percentage on the line and the actual count in the columns before

5.1 Annual Trends - Overall impression of the Trust:

Page 19 of 27

5.3 Comparison of Categories of Service causing good or bad impressions within the Trust (2010/11 top graph and 2009/10 bottom graph)

Page 20 of 27

5.4 Diagnostic & Service Division – Categories of Service causing good or bad impressions (2010/11 top graph and 2009/10 bottom graph)

Page 21 of 27

5.5 Medicine & Emergency Services Division – Categories of Service causing good or bad impressions (2010/11 top graph and 2009/10 bottom graph)

Page 22 of 27

5.6 Specialised Networks Division – Categories of Service causing good or bad impressions (2010/11 top graph and 2009/10 bottom graph)

Page 23 of 27

5.7 Surgery Division – Categories of Service causing good or bad impressions (2010/11 top graph and 2009/10 bottom graph)

Page 24 of 27

5.8 Women & Childrens Division – Categories of Service causing good or bad impressions (2010/11 top graph and 2009/10 bottom graph)

Page 25 of 27

6.0 NON-CLINICAL RISK REPORT: Trust Board Report for April 2010 to March 2011

122

174 170 172165

207196

189

108

136127

145

0

50

100

150

200

250

Apl2010

May2010

June2010

July2010

Aug2010

Sept2010

Oct2010

Nov2010

Dec2010

Jan2011

Feb2011

Mar2011

No.

/Mon

th

6.1 Non-Clinical Incidents – Trend over 12 months

1911 incidents

0

10

20

30

40

50

60

Oct 2010 Nov 2010 Dec 2010 Jan 2011 Feb 2011 Mar 2011

No.

/Mon

th

Core Services Division

Diagnostics & ServiceDivision

Medicine &Emergency & RugbyDivisionNot applicable

Coventry&WarwickshirePathology ServicesSurgical ServicesDivision

Women & Children'sDivision

6.2 Non-Clinical Incidents by Division (6 months)

80 66

1384

6

372

0

200

400

600

800

1000

1200

1400

Patients Visitors,Public

Staff Third Party Trust

Num

ber

6.3 Injury by Person Type (12 months)

Page 26 of 27

Abuse of Staff by patients 425

Needlestick/ sharps 198

Security related to Premises 185

Slips, trips, falls 169

Exposure to hazardous substances etc. 168

0

10

20

30

40

50

60

Apl 2

010

May 2

010

June

201

0Ju

ly 20

10Au

g 20

10Se

pt 2

010

Oct 2

010

Nov 2

010

Dec 2

010

Jan

2011

Feb

2011

Mar 2

011

No.

/Mon

th

Abuse etc of Staff bypatients

Needlestick injury orother incidentconnected withSharpsSecurity incidentrelated to Premises,Land or Real Estate

Slips, trips, falls andcollisions

Exposure toelectricity, hazardoussubstance, infectionetc

6.4 Top 5 types of incidents for 12 months

6.5 Top 5 Incident types reported – Trends over 12 months

Page 27 of 27



27th

July 2011


Subject: Quality Account Monitoring and ProductionReport By: Richard Kennedy, Chief Medical OfficerAuthor: Anita Kane, Associate Director of GovernanceAccountable Executive Director: Richard Kennedy, Chief Medical Officer

GLOSSARY

Abbreviation In FullQA Quality AccountHOSC Health Overview and Scrutiny CommitteeLINKs Local Improvement NetworksQGC Quality Governance CommitteeELT Executive Leadership Team



TitleApprox. Length


To inform the Trust Board of the timescales and plan for monitoring progress against the QualityPriorities published in the 2010/2011 Quality Account and the plan for publication of the 2011/2012Quality Account.


Feedback from external stakeholder’s highlights they wish to be involved at a much earlier stage in the QAproduction process. Therefore in the attached plan, consultation begins as early as Oct/Nov 2011. There arealso more frequent reports to ELT, QGC and Trust Board.


The Department of Health publishes a Quality Account Toolkit annually. This has been in the past not releaseduntil Q3 of the year. When this document is published timescales and format of production may be subject tochange.


Approval of the 2011/2012 Monitoring and Production PlanBased on approval of the Plan, the Quality Account is built into agendas for ELT, QGC and TrustBoard accordingly to avoid lack of space on the agenda at the appropriate reporting time.



27th

July 2011


IMPLICATIONS:

Financial: N/A


Governance: N/A

Legal: Quality Account Regulations 2011

REVIEW:


of 4

Quality Account 2011/2012

Framework and Timeline for Monitoring and Production

This document details the process and timelines to achieve production of the 2011/2012 Annual Quality Account.

Quality Account Executive Lead: Richard Kennedy, CMO, and Quality Account Operational Lead: Anita Kane, ADG

Quality Account Information Leads, as per Table 2.

Table 1 - Timeline

Activity ResponsiblePeople

June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June

Publish Quality Account 10/11 on UHCWWebsite and NHS Choices

CommunicationsTeam

30

Agree QA 10/11 Summary at ELT and publish ELT/Communications

5

Communicate Quality Account at AGM and toStaff via the intranet, chat with the Chief

CommunicationsTeam

27

Respond to 3rd

party commentaries Anita Kane 13

Ensure QA is presented to Patients Council / FTMembers and circulated to ‘Trust Groups’

Anita Kane/ JuliaFlay/ Janet White

Progress Report to ELT and Trust Board on 10/11Account

Anita Kane andSection Leads

Meetings with LINKs, Patient Council, HOSCs rePriorities for 2011/2012 QA

Paul Martin/AnitaKane

Presentation to ELT & QGC on outcome ofmeetings with stakeholders , ELT agrees inprinciple Trust Priorities for inclusion

Paul Martin/ AKane

of 4



Trust Board agrees priorities for 11/12 QA Trust Board

Trust Board receives Progress report on2010/2011 QA

Trust Board

Section leads are emailed 2011/12 frameworkand timetable for action

Anita Kane

Deadline for Draft Sections back to A Kane inreadiness for ELT paper

Section Leads

Present 1st

Draft Quality Account at ELT & QGC Richard Kennedy

Presentation on Draft to Patients Council, LINKs,HOSCs

Paul Martin/Anita Kane

Trust Board receives monitoring report on 10/11QA

Section leads refine relevant sections Section leads/Anita Kane

Final Draft sent to PCTs/ LINks and HOSC to allowfor statutory 30 days review and to prepare 3

rd

party mandatory statement

Anita Kane

NHSC Board meet to discuss Jacqueline Barnes

NHSW Board Meet to discuss Chris Day

Proof Reading QPS/Communications

Deadline for 3rd

Party Commentaries Section Leads

Final Draft submitted to ELT & QGC Anita Kane

Final Draft of QA 11/12 presented at Trust Board

Approval at Trust Board and signing ofStatement of Directors Responsibilities

Trust Board

Deadline for publication on NHS Choices andUHCW internet Site

Communications 30

of 4



Agree QA 11/12 Summary at ELT and publish ELT/Communications

Table 2 - Content and Section Leads

Content Section Section Lead Deadline date for 1st Draft Deadline date 2nd Draft Deadline Date for Finalversion

Chief ExecutivesStatement on Quality

Kerry Beadling/ AndyHardy

Introduction to 2011/2012Quality Account

Anita Kane

Account of 2011/2012Performance

Simon Reed

Quality ImprovementPriority 1

TBA

Quality Improvementpriority 2

TBA

Quality Improvementpriority 3

TBA

TBC TBC TBC

Statements from the Trust Board

Review of services Anthony Hobbs

Participation in clinicalaudits

Joanne Kinborough Mata

Participation in ClinicalResearch

Ceri Jones

of 4

Content Section Section Lead Deadline date for 1st Draft Deadline date 2nd Draft Deadline Date for Finalversion

Goals Agreed withCommissioners

Anita Kane

Care Quality Commission Paula Moody

Data Quality Debbie Finch

Information GovernanceToolkit

Deirdre Nicholls

Clinical Coding Results Helen Allen

Statements from 3rd Parties

Coventry LINk Anita Kane

Warwickshire LINk Anita Kane

Coventry OSC Jen Gardiner

Warks OSC Jen Gardiner

NHSC Jacqueline Barnes

NHSW Chris Day

Providing Feedback Anita Kane

Appendix Anita Kane



27th

July 2011


Subject: Patient Safety First ProjectReport By: Mr R Kennedy, Chief Medical OfficerAuthor: Mrs Y Gatley, Associate Director of GovernanceAccountable Executive Director: Mr R Kennedy, Chief Medical Officer

GLOSSARY

Abbreviation In FullQUIPP Quality, Improvement, Innovation, Productivity & PreventionUHCW University Hospitals Coventry and Warwickshire



TitleApprox. Length


To update the Trust Board on the progress of the Patient Safety First project and its evolution into the SafetyExpress programme in 2011.


The key goals of the Patient Safety First program have been largely achieved. A new national safetyprogramme (Safety Express) has since begun:

In January 2011one of the Department of Health’s QUIPP (Quality, Improvement, Innovation, Productivity &Prevention) workstreams, “Safe Care” established a quality improvement programme called ‘Safety Express’ tohelp the NHS to develop safer systems in hospitals and community settings. Its aim is to dramatically reduceharm from:

Hospital and community acquired pressure ulcers

Blood clots (DVT and pulmonary embolism)

Urinary tract infections in patients with catheters

Falls in care settings

UHCW is working in collaboration with our local health economy, led by NHS West Midlands as well as twoother strategic health authorities (East Midlands and East of England)

The report provides an introduction to this new programme of safety work and progress to date.



27th

July 2011



Please refer to the detail of the report.The measurement tool (Safety thermometer) is currently unreliable – this is a national issue and not attributableto UHCW.


Board to note the content of the report

IMPLICATIONS:

Financial: N/A


Governance: Patient safety

Legal: N/A

REVIEW:


University Hospitals Coventry and Warwickshire NHS TrustQuality Improvement Programme Patient Safety First.

__________________________________________________________________________

Yvonne Gatley, Associate Director of GovernancePage 1 of 5

Quality Improvement Programme

Patient Safety First

FirstSafety

Patient

Progress Report – July 2011


__________________________________________________________________________


1. Introduction

In November 2008, University Hospitals Coventry and Warwickshire NHS Trust launched the

Patient Safety First campaign. This is a Quality Improvement Programme aimed at providing

the highest quality and safest care to patients.

The programme focuses on a portfolio of projects which will have a significant impact on

reducing avoidable harm and mortality. There were a number of key goals identified to be

achieved over the following 2 years:

Mortality (HSMR) reduced by 5% Health Associated Infections: exceed our target reduction Reduce surgical site infections by 50%. Introduce a drug error reduction programme. Wrong site – Zero rate Thromboprophylaxis – 100% compliance with Trust Policy Reduce incidence of falls by 10% Avoidable Hospital acquired pressure sores – reduce by 30% Reduce cardiac arrests on general wards by 10% Reduce ward transfers to critical care by 20%. Reduce falls by 10%

The goals were further categorised under themes, these being

1. Healthcare Associated Infections (MRSA, C Difficile, Saving Lives Campaign)2. Safe Surgical Patients (Thromboprophylaxis compliance, wrong site surgery, surgical site

infections)3. Medication Errors4. Acutely ill patient5. Patient falls6. Pressure ulcers7. People and processes (Executive safety walkrounds. Human Factors training)

The key goals were reviewed in March 2010 and the programme was re-aligned as

necessary.

A progress report was made to Trust Board in November 2010, since when the key goals of

the program have been achieved. A new safety programme (Safety Express) has since

begun as described below.


__________________________________________________________________________


Safety Express

In January 2011one of the Department of Health’s QUIPP (Quality, Improvement, Innovation,

Productivity & Prevention) workstreams, “Safe Care” established a quality improvement

programme called ‘Safety Express’ to help the NHS to develop safer systems in hospitals and

community settings. Its aim is to dramatically reduce harm from:

Hospital and community acquired pressure ulcers Blood clots (DVT and pulmonary embolism) Urinary tract infections in patients with catheters Falls in care settings

The programme objective is to eliminate harm from these conditions in 95% of patients by

2012, though the intention was to develop a similar approach to other related areas as well.

Safety Express has been working in 100 settings across England since January 2011 with

Foundation Trusts and other acute providers, Community providers, Mental Health Trusts and

Care Homes.

UHCW is working in collaboration with our local health economy, led by NHS West Midlands

as well as two other strategic health authorities (East Midlands and East of England) so that

we come together to learn from and share good practice with each other.

The Safety Thermometer

The “safety thermometer” is a measurement instrument that is being developed by the Safe

Care workstream to measure prevalence of these various harms at specific times as well as

the proportion of patients who are "harm free" at any given time. This is so that organisations

can repeatedly measure a sample of their patients to get a picture of the improvements they

are making and how rapidly this is happening.

The data collected monthly via the monthly safety thermometer will signal the number of

patients 'free from harm'. Clinically it is well known that patients who suffer from one of the

four key harms:

Pressure ulcers Catheter acquired urinary tract infection Falls VTE


__________________________________________________________________________


have a high probability of developing one of the others and may indeed have two or more of

these harms. It is these patients for whom the burden, dependency and cost of suffering is

greatest.

It is also possible that a focused programme of improvement to reduce harm in one of these

areas has the potential to cause other harm. This can be avoided by measuring all four harms

at the same time.

Progress to date

In practice, the safety thermometer has proved very difficult to use due to national IT problems

and all participating organisations have been feeding this back to the main programme. At

UHCW it has been piloted in 4 clinical areas but with the difficulties encountered the data so

far is unreliable.

Representatives from UHCW have attended the Safety Express workshops and shared ideas

and learning with the other participants. At the June workshop we presented on nutrition,

highlighting our use of risk assessments and assistance given to patients, which provoked a

lot of interest from attendees.

UHCW had already done a huge amount of work on the four key areas for improvement

before the new programme evolved. Trust Board will be aware of the progress on pressure

ulcers, falls and VTEs.

In addition, this earlier work led to crucial learning and action in the use of anti-embolic

stockings – an example of how a measure introduced to reduce one risk (VTE) resulted in an

increase in another (pressure ulcers). These findings have been widely shared with other

organisations.

Catheter acquired urinary tract infection is a new focus, which the Infection Prevention &

Control team is reviewing in order to benchmark and track progress. Work had already

commenced on catheter care and catheter pathways as part of the Saving Lives bundles and

this is being expanded to include catheter related infections.

It is intended to collate progress reports from these four areas and present them at the Trust’s

Patient Safety Committee.


__________________________________________________________________________


Tissue viability, falls and VTE were all monitored as part of the Trust’s CQUIN scheme for

2010/11.

The Safety Express Programme is now included in the Trust’s 2011/12 Quality Schedule as

part of the contract.



27th

July 2011


Subject: CQC Dignity and Nutrition for Older people – Review of ComplianceReport By: Jill Foster, Acting Chief Operating and Nursing OfficerAuthors: Care Quality Commission

Paula Moody, Compliance ManagerGillian Arblaster, Divisional Nurse Director - Core

Accountable Executive Director: Dr Ann-Marie Cannaby, Chief Operating and Nursing Officer

GLOSSARY

Abbreviation In FullUHCW University Hospitals Coventry and WarwickshireCQC Care Quality Commission



TitleApprox. Length


To inform the Board of the final report of the Care Quality Commission review of dignity and nutrition for olderpeople at UHCW published on 24

thJune 2011 and the Trust response to the report.


This review was part of a targeted inspection programme in acute NHS hospitals to assess how well olderpeople are treated during their hospital stay. In particular, on whether they were treated with dignity andrespect and whether their nutritional needs were met.

Outcome 1 – people should be treated with respect, involved in discussions about their care and treatment andable to influence how the service is run. Overall UHCW was meeting this essential standard.

Outcome 5 – food and drink should meet people’s individual dietary needs. Overall UHCW was meeting theessential standard but, to maintain this, CQC suggested that some improvements be made.


Need to continue programme of work which manage compliance with assisted feeding on an ongoingbasis.

Improvement actions to address minor concern needs to be agreed and delivered in order to maintainessential standards.


To seek Board approval for the Trust’s response to the final CQC report and to continue theprogramme of work, including the action plan, to maintain essential standards in supportingnutrition.



27th

July 2011


IMPLICATIONS:

Financial: -

HR / Equality & Diversity: -

Governance: CQC Registration

Legal: -

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee Remuneration CommitteeFinance and Performance Committee Executive Meeting 20.7.11.Audit Committee

Dignity and nutrition for older people

Review of compliance


University Hospital

Region: West Midlands

Location address: University Hospital

Clifford Bridge Road

Coventry

West Midlands

CV2 2DX

Type of service: Acute Services

Publication date: June 2011

Overview of the service: University Hospital provides a wide range of acute services for patients requiring planned and unplanned care including specialist services in cardiology, neurosurgery, stroke, IVF,

Page 1 of 17

diabetes, cancer care and kidney transplants. University Hospital is one of two hospital sites managed by University Hospitals Coventry and Warwickshire (UHCW) NHS Trust, serving a population of 1,000,000 people.

Page 2 of 17

Summary of our findings for the essential standards of quality and safety

What we found overall

We found that University Hospital was meeting both of the essential standards of quality and safety we reviewed but, to maintain this, we suggested that some improvements were made.

The summary below describes why we carried out the review, what we found and any action required. Why we carried out this review This review was part of a targeted inspection programme in acute NHS hospitals to assess how well older people are treated during their hospital stay. In particular, we focused on whether they were treated with dignity and respect and whether their nutritional needs were met.

How we carried out this review We reviewed all the information we held about this provider, carried out a visit on 16 March 2011, observed how people were being cared for, talked with people who use services, talked with staff, checked the provider’s records, and looked at records of people who use services. Prior to making the visit we looked at the feedback provided by patients on the NHS Choices website, the findings of the Patient Environment Action Team assessment and patient survey results.

The inspection teams were led by CQC inspectors joined by a practising, experienced nurse. The inspection team also included an ‘expert by experience’ – a person who has experience of using services (either first hand or as a carer) and who can provide the patient perspective. During the course of the day, the team spoke with eight patients, one relative and five staff from different disciplines. The patients we talked to were all older people.

Page 3 of 17

What people told us Overall people were satisfied with the care they received at University Hospital. People told us that staff were friendly, polite and treated them with respect. People felt that their dignity was upheld and they felt informed about their condition and treatment. Their comments included, ‘The staff are polite and respectful.’ ‘My only concerns have been about my health and when I can go home. I have always had my concerns listened to. They tell me a lot of up to date things about my health.’ ‘Staff always explain what they’re doing and ask if it’s alright’ Most people said their nutritional needs and dietary preferences were met. Their positive comments included, ‘The food’s great. I always get the correct order and staff help me where I need it. There is always more food than I can eat. It is always warmed nicely but not too hot. We are offered biscuits lots during the day. However, people who required assistance with eating or drinking sometimes have to wait. People told us, ‘I don’t need any support with my meals, but I do feel that someone needs to sit with some of the patients who do need help’ ‘The staff do not ask anyone if they have finished or if they’ve had enough.’

Page 4 of 17

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What we found about the standards we reviewed and how well University Hospital was meeting them Outcome 1: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Overall, we found that University Hospital was meeting this essential standard. Outcome 5: Food and drink should meet people’s individual dietary needs Overall, we found that University Hospital was meeting this essential standard

but, to maintain this, we suggested that some improvements were made. Action we have asked the service to take We have asked the provider to send us a report within 28 days of them receiving this report, setting out the action they will take to improve. We will check to make sure that the improvements have been made.

What we found for each essential standard of quality and safety we reviewed

Page 6 of 17

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The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential standard. Compliant means that people who use services are experiencing the outcomes relating to the essential standard. A minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard. A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary improvements are made. Where there are a number of concerns, we may look at them together to decide the level of action to take. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety.

Outcome 1: Respecting and involving people who use services What the outcome says This is what people who use services should expect. People who use services: Understand the care, treatment and support choices available to them. Can express their views, so far as they are able to do so, and are involved in

making decisions about their care, treatment and support. Have their privacy, dignity and independence respected. Have their views and experiences taken into account in the way the service is

provided and delivered. What we found

Our judgement

The provider is compliant with outcome 1: Respecting and involving people who use services.

Our findings

What people who use the service experienced and told us People told us they were treated respectfully and their dignity was upheld. People said they were well informed about their treatment and felt they had an opportunity to offer their opinion about the service they received. ‘The staff are all very respectful and the consultants spend a lot of time explaining things.’ ‘Staff have been very good in making sure I don’t feel embarrassed or uncomfortable.’ ‘I have been given enough information about my care.’ ‘I know that I will be given a questionnaire when I leave so I can tell them what I thought of it’.

Page 8 of 17

Other evidence The information we held about University Hospital prior to our visit showed that there was a low risk that they were not meeting this standard. People were accommodated in single sex bays or single rooms. Men and women do not have to share bathrooms. We observed privacy curtains in place, reinforced with signs promoting privacy awareness. Some single rooms faced a bay accommodating people of the opposite gender. We observed that staff were polite and respectful towards patients and made sure care was delivered in private. People told us that staff called them by their preferred names. Staff were knowledgeable about the needs of the people they were caring for. ‘Getting to know you’ booklets have recently been introduced to make sure people who have difficulty communicating have their preferences recorded. For example, the relatives of people with dementia care needs were asked to provide information about employment history, family, important relationships, food preferences and spiritual beliefs. Staff told us that the trust provide training courses in promoting equality and diversity which helped them promote people’s individual needs. Promotion of dignity is included in the induction training of new staff. The trust has a ‘Privacy and Dignity in Patient Care’ Policy. Staff told us that overall, people get the care they need in a dignified and respectful way, but it can be frustrating when there are staff shortages or a busy period because it is difficult to sit with patients when they need comfort or reassurance. All the staff we spoke to were aware of their roles and responsibilities in safeguarding vulnerable people and recognised that failures to uphold a person’s privacy and dignity does not promote their well being. Information about the hospital was made available patients in the form of a bedside manual in each person’s locker, available in different languages.

Nursing staff told us that people are usually given information about their medical condition and treatment by a doctor with a nurse present to make sure patients understand the course of treatment and risks and benefits. Ward staff refer patients to nurse specialists where appropriate to give further opportunity ask questions and would refer to other agencies if necessary. For example, a stroke nurse specialist holds a ‘surgery’. Patients told us they knew how to raise a concern about their care and felt confident that something would be done about it. They knew the names of staff members on the ward that they felt they could approach and who would listen to them. The trust uses questionnaires to survey patient satisfaction and opinion. The patients were aware that they would be asked about their experience. Surveys can

Page 9 of 17

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be completed on line, using a hand held device taken around the wards by volunteers or by completing a paper copy. Our judgement People were treated respectfully at University Hospital and their dignity was promoted. Most people were kept informed about their condition and course of treatment. People were able to give feedback about their experiences.

Outcome 5: Meeting nutritional needs What the outcome says This is what people who use services should expect. People who use services: Are supported to have adequate nutrition and hydration. What we found

Our judgement

There are minor concerns with outcome 5: Meeting nutritional needs

Our findings

What people who use the service experienced and told us Most people were satisfied with the way their nutritional needs were met while some others told us there were some areas that could be improved upon. Their comments included: ‘I am not on a special diet but I am always asked what I would prefer to eat and drink. The nurses sit and read my menu to me as I have very poor eyesight. They are always very patient as I sometimes forget what the first choice was. They ask in an evening when we have a supper drink if we would like anything to eat.’ ‘Mealtimes vary depending on which staff are on duty. If you are given a meal soon after the trolley has arrived then it is warm. Some staff offer to wipe hands or suggest it, but others do not. ‘The food’s great. I always get the correct order and staff help me where I need it.’ ‘The choice is good but I do not always get what I have ordered. It is never changed. There is always too much.’ ‘I don’t need any support with my meals, but I do feel that someone needs to sit with some of the patients rather than walk up and down.’

Page 11 of 17

Other evidence We observed the lunchtime meal on two wards to see what patients experienced. Practices were variable on different wards. On one ward we saw that time was taken before meal times to prepare people for their meal. Staff offered hand wipes to people in bed and made sure they were sitting comfortably before their meal was served. On another ward we saw that meals were brought to people without any preparation. For example, the meal for one patient was left by their bedside while staff woke them and assisted them to move into a chair to eat their meal. We observed most people had their meals by their bed although we saw a group of people with dementia care needs sit at a dining table together, which enhanced their social experience of eating. Protected mealtimes are in place, but we saw domestic staff cleaning the floors with a noisy machine during lunchtime in one area of a ward. Staff told us a ‘red napkin’ system for identifying people who need support with their meals was tried but was not successful. People who need help with eating are identified to ward staff during the handover between shifts. More than half of all patients on the wards we visited needed support with their meals. Staff told us they were not always enough staff to give people the support they needed at mealtimes. At mealtimes staff firstly served meals to people who did not need support in an effort to make sure meals were still warm when they are eaten by people who needed assistance. Although it was quite hectic while staff collected meals from the trolley and delivered them to patients, we observed that when staff sat with people they gave sensitive assistance without rushing. We observed a person who had suffered a stroke struggling to eat a pureed meal because the plate was sliding off the table and the person could only use one hand. A staff member noticed but was busy so could not assist immediately. When the staff member returned to help, the person had finished their meal. Staff told us they have access to aids such as non slip mats and adapted cutlery through the occupational therapists, but this equipment was not immediately accessible for people who would benefit. A staff nurse told us that risk assessment tools were used to assess people’s nutritional needs on admission. We saw evidence of this when we looked at people’s records. We saw food and fluid intake charts to monitor people at risk. There was evidence of review of needs in the care records we looked at. Staff told us that 90% of nurses are trained to ‘swallow screen’ people to identify their risk of choking. We saw evidence in people’s records that dietician and speech and language therapists are involved when people have an identified risk.

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The information we held about University Hospital prior to our visit showed that there was a low risk that they were not meeting this standard.

The trust’s Nutritional Steering Group meets monthly to deliver improved outcomes and to promote a consistently high level of practice in this area. We saw evidence that practice is reviewed and action plans are developed and implemented when shortfalls are identified.

Patient experience feedback from the trust’s survey for the quarter ending in December 2010 showed that 84% of respondents had a good impression of food and nutrition.

Our judgement People had their nutritional needs assessed when they were admitted to University Hospital and action was taken to meet their identified needs and preferences. People who required assistance to eat and drink did not always receive timely support. Overall, we found that University Hospital was meeting this essential standard but to maintain this we suggested some improvements were made.

Action we have asked the provider to take

Improvement actions

The table below shows where improvements should be made so that the service provider maintains compliance with the essential standards of quality and safety.

Regulated activity Regulation Outcome

14 Outcome 5 - Meeting Nutritional needs.

Treatment of disease, disorder or injury

Surgical procedures

Diagnostic and screening procedures

Why we have concerns: People who required assistance to eat and drink did not always receive timely support.

The provider must send CQC a report about how they are going to maintain compliance with these essential standards. This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider’s report should be sent within 28 days of this report being received. CQC should be informed in writing when these improvement actions are complete.

Page 14 of 17

What is a review of compliance? By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. When making our judgements about whether services are meeting essential standards, we decide whether we need to take further regulatory action. This might include discussions with the provider about how they could improve. We only use this approach where issues can be resolved quickly, easily and where there is no immediate risk of serious harm to people. Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actions or compliance actions, or take enforcement action: Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying with essential standards, but we are concerned that they will not be able to maintain this, we ask them to send us a report describing the improvements they will make to enable them to do so. Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Adult Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people.

Page 15 of 17

Dignity and nutrition reviews of compliance The Secretary of State for Health proposed a review of the quality of care for older people in the NHS, to be delivered by CQC. A targeted inspection programme has been developed to take place in acute NHS hospitals, assessing how well older people are treated during their hospital stay. In particular, we focus on whether they are treated with dignity and respect and whether their nutritional needs are met. The inspection teams are led by CQC inspectors joined by a practising, experienced nurse. The inspection team also includes an ‘expert by experience’ – a person who has experience of using services (either first hand or as a carer) and who can provide the patient perspective. This review involves the inspection of selected wards in 100 acute NHS hospitals. We have chosen the hospitals to visit partly on a risk assessment using the information we already hold on organisations. Some trusts have also been selected at random. The inspection programme follows the existing CQC methods and systems for compliance reviews of organisations using specific interview and observation tools. These have been developed to gain an in-depth understanding of how care is delivered to patients during their hospital stay. The reviews focus on two main outcomes of the essential standards of quality and safety:

Outcome 1 - Respecting and involving people who use the services

Outcome 5 - Meeting nutritional needs.

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Information for the reader

Document purpose Review of compliance report

Author Care Quality Commission

Audience The general public

Further copies from 03000 616161 / www.cqc.org.uk

Copyright Copyright © (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified.

Care Quality Commission

Website www.cqc.org.uk

Telephone 03000 616161

Email address [email protected]

Postal address Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

Trust Report in response to:

Care Quality Commission (CQC)Dignity and Nutrition for Older People – Review of Compliance 16.3.11

1. Introduction

The Care Quality Commission on 16th March 2011 completed a review of compliance at UHCW onDignity and Nutrition for Older People, following which a final report was published on 24th June 2011.

As a result of this review, the CQC identified a minor concern relating to “Outcome 5: MeetingNutritional Needs” and “people who required assistance to eat and drink did not always receive timelysupport”.

The CQC have therefore requested a report from the Trust to confirm how we are going to maintaincompliance with these essential standards and also include any improvement actions required.

The CQC require this report within 28 days of the final report being issued, the deadline for which istherefore 22nd July 2011.

The Trust’s response is therefore focused on the specific concern highlighted around assistance, andhas been separated into two sections, firstly the on-going compliance processes the Trust has in placeand secondly the actions the Trust has put in place to provide further improvements. See below.

2. Maintenance of Compliance with the Essential Standards

UHCW has a number of processes already in place which manage compliance with assisted feedingon an on-going basis, namely:

On-going education and training for relevant Trust staff. This includes, for example: Essence ofCare Practices for Healthcare Support Workers, Preceptorship training for registered staff andhostess training.

Essence of Care clinical practice benchmarking, observations at mealtimes conducted by ModernMatrons and Divisional Nurse Directors.

Access and use of appliances for assisted feeding. Protected Mealtimes process and policy, and monitoring of compliance. Patient risk assessments and audits. Impressions survey – for patient / carer feedback. Trust Board reports.

Examples of the above were provided to the CQC as part of the initial review.

3. Improvement Actions Following Review (see Appendix A)

A number of improvement actions have been planned / put in place, following the review, includinguse of volunteers to assist with mealtimes, changes to handover arrangements, observations ofpractice and use of a mealtime warning bell, which are detailed in the action plan in Appendix A.

If you require any further information or clarification, do not hesitate to contact me.

Jill FosterActing Chief Nursing Officer

13th July 2011

Appendix AUHCW - Improvement Action Plan for Outcome 5

CQC Concern - “people who required assistance to eat and drink did not always receive timely support”.

Improvement Action Action Plan Why action willdemonstrate compliance

Action Lead(name and title)

Action By Date ActionCompleted

Developing voluntaryservices to includeassisting & feeding patients

Liaise with voluntary services to recruitsuitable volunteers for specific wards.

Develop and implement educationprogramme.

Support and monitor volunteers in theward area.

Volunteers will be availableto assist on identified clinicalareas to assist patients withfeeding.

Gillian Arblaster –Divisional NurseDirector

September 2011

A new system of tapedhandover is currently beingrolled out though the Trustas part of the Productiveseries.This includesidentification of patientswho require assistancewith feeding in the tapedpatient handover.

A check list has been developed tocontent list the taped handover as partof the productive ward module. Thehandover will include if patients are “Nilby mouth”, if they need assistance witheating & drinking and if the patientsneed soft or special diet and / orthickened fluids & a meal co-ordinator.

To be implemented in 10 more clinicalareas.

Observe handover practice in areasimplemented.

Patients who needassistance to eat & drink areidentified clearly athandover.


December 2011

Observation of mealtimepractices

Conduct a monthly walk round in wardareas observing co-ordination &delivery of meals and assistance givento patients with representation from ISSManagement, Catering ServicesManager, Non Executive - LayRepresentative, Divisional NurseDirector & Modern Matron and WardManager to participate. Feedback to beprovided to monthly OperationalCleaning Meeting.

Link nurses to observe practice e.g.assistance given to patients atmealtimes and feed back at quarterlylink nurse forum and to ward

Observation of practice andactioning of any issues thatmay arise.


July 2011

Improvement Action Action Plan Why action willdemonstrate compliance

Action Lead(name and title)

Action By Date ActionCompleted

managers.

Preparation for mealtimes– roll out of mealtimewarning bell to relevantareas.

Liaise with staff to implement Provide staff with information &

education regarding its use Monitor effectiveness of use for wards

currently using mealtime warning bells.

Facilitate preparation of theenvironment of patients byalerting staff for mealtime


March 2012



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July 2011


Subject: Annual Report of the Radiation Protection AdviserReport By: Mrs J Foster, Acting Chief Nursing OfficerAuthor: Mr R Aukett, Radiation Protection AdviserAccountable Executive Director: Dr AM Cannaby, Chief Nurse and Operating Officer

GLOSSARY

Abbreviation In FullHSE Health and Safety ExecutiveICRP International Commission on Radiological ProtectionEVAR Endovascular aneurism repair



TitleApprox. Length


For the Trust Board to note the Annual Report of the Radiation Protection Adviser which includes patient safety,staff and visitor safety, and environmental impact.


The required engineering controls, procedures and monitoring systems are in place. The frequency of adverseevents is at or below national averages. There have been no significant incidents.

The recent increase in the number of Endovascular Aneurism Repairs may require: shielding one operatingtheatre and obtaining a specifically designed mobile x-ray machine.

The recent attention of the HSE to the hand doses of medical staff involved in interventional radiologicalprocedures requires the future regular purchase of ring type dosemeters, in addition to existing dosemeters.The proposal of the ICRP to reduce the occupational dose limits for the eyes may require action in the next fewyears.


Risk of prosecution for exceeding staff dose limits if the number of EVARs continues to increase and shieldingis not provided for one of the operating theatres.

Risk of civil liability for radiation induced skin damage to EVAR patients if a specifically designed mobile x-raymachine is not obtained.

Risk of HSE enforcement action if ring type dosemeters are not introduced.Future risk of expenditure to reduce staff eye does.


Approval of Report and of planned actions described.

IMPLICATIONS:



27th

July 2011


Financial: Shielding for operating theatre (if number of EVARs is allowed to continue toincrease). Obtaining new mobile x-ray machine.Regular purchase of ring type dosemeters.


Governance: Risk of HSE enforcement action as described.

Legal: Risk of prosecution under HSW Act and of civil liability as described..

REVIEW:


University Hospitals Coventry & Warwickshire NHS TrustReport of the Radiation Protection Adviser

April 2010 - March 2011

1 Introduction and Summary

This report includes: patient safety, staff and visitor safety, and environmental impact. In allthese areas the required engineering controls, procedures and monitoring systems are all inplace. The frequency of adverse events is at or below national averages. There have beenno significant incidents.

All of the actions required during 20010-11 will be covered by established practice within theDepartment of Clinical Physics & Bio-Engineering.

2 Patient Safety

This is governed by the Ionising Radiation (Medical Exposures) Regulations 2000 andenforced by the Care Quality Commission.

2.1 Adverse Events

There were 5 instances of exposures “much greater than intended” in Diagnostic Radiology.and 1 in Breast Screening. These were reported to the CQC in accordance with the IRMERregulations. In common with most events reported across the country, these were due to themisidentification of a patient or were exposures of the wrong part of the body. The incidentin Breast Screening was an unintended repeat scan. Ongoing action continues to be takento attempt to reduce the numbers of similar occurrences.

There were no instances of exposures “much greater than intended” in Cardiology, NuclearMedicine or Radiotherapy.

The CQC in their regular reports still state that they do not yet possess sufficient data tocreate league tables. They also still believe that there is wide-scale under-reporting in otherparts of the country. These numbers probably put the Trust in a position better than, or atleast close to, the true national average.

2.2 Dose Reference Levels

One of the surgeons has started to carry out an increasing number of EndovascularAneurism Repairs. Sufficient measurements have not yet been carried out to reach a finalconclusion, but so far it appears that it is likely to be necessary to take a number actions inorder to ensure that patient skin doses are within current accepted guidelines. These arelikely to include obtaining a new mobile x-ray machine specifically designed for this kind ofprocedure.

2.3 Procedures

IRMER procedures in both Diagnostic Radiology and Cardiology have were revised lastyear. Those in Radiology have been reviewed recently and a few minor changes areplanned. Cardiology are due to be reviewed before the end of the year.

Radiotherapy conform to an ISO9000 Quality Assurance system. Their procedures aretherefore reviewed at least annually. Nuclear Medicine operate to similar but less formalstandards.

2.4 Training

Only one training course is now provided locally. The most used is a two hour lecture and/ortutorial session for non-medical staff on the effects of radiation exposure on patients and thelegal requirements for requesting x-rays.

2.5 Equipment

As previously reported, testing by Clinical Physics is currently within the recommendedfrequency range. However, there is still a national shortage of trained staff in this specialty.Although this is not affecting the Department at present, it remains possible that it might doso in the next few years.

The testing of Nuclear Medicine and Radiotherapy equipment is dealt with in the reports ofthe related departments and is not included here.

3 Staff & Visitor Safety

This is governed by the Ionising Radiations Regulations 1999 and enforced by the Healthand Safety Executive.

3.1 Personal Monitoring

No significant changes have been observed since last year. Almost all staff still receivewhole body doses of 0.6 milli-Sievert /year or less. A few staff, mostly in Radio-Pharmacyand Cardiac Cath Lab, still receive slightly more than 1 mSv/year. Considerable effort hasbeen put into reducing doses in these areas over the past few years and in my view they arenow as low as reasonably practicable in most cases.

There is one particular exception. This increasing number of EVARs (described in 2.2above). Although sufficient monitoring has not yet been carried out to reach a finalconclusion, so far it appears that it is likely to be necessary to take a number of actions inorder to keep whole body, eye and hand doses within currently recommended doseconstraints. These are likely to include the installation of ceiling mounted lead-Persexscreens (similar to those currently used in the Cath Lab) and changes to radiographypractice.

In the past year the International Atomic Energy Agency and the European Union haveexpressed concern about radiation doses to the hands of medical staff involved ininterventional procedures. This is increasingly being reflected in the day to day practice ofHSE Inspectors. Increased monitoring of hand doses of Cardiologists and a small group ofother medical staff is therefore necessary in order to demonstrate that these are within legallimits. The “finger strap” dosemeters provided by our current supplier cannot be adequatelysterilised or worn under surgical gloves for any length of time. It is therefore necessary topurchase “ring” dosemeters from an alternative supplier.

There is recent scientific evidence that there may be no threshold for sub-clinical radiationinduced cataract and that the threshold dose for clinically observable cataract may be lowerthan previously believed. The International Commission on Radiation Protection hastherefore proposed a reduction in the occupational dose limits for the eye. Although this hasnot yet been put into either an EU Directive or UK law, it would be wise for the Trust to beginto plan for any necessary reductions to staff eye doses, particularly those of medical staffinvolved in interventional procedures.

3.2 Environmental Monitoring

The programme of measuring doses at fixed points near areas where radiation is used wascompleted in the previous year. This needs to be repeated once every 3 to 5 years. Nomajor surveys have therefore taken place this year.

The increasing number of EVARs has necessitated one minor survey. Although sufficientmeasurements have not yet been carried out to reach a final conclusion, it is likely to benecessary to provide shielding to one of the operating theatres if this increase continues.

3.3 Risk Assessments

All of the risk assessments required by the Health and Safety at Work legislation are in placeand most were reviewed and updated during the previous year. This needs to be repeatedonly once every 3 to 5 years. Following the events reported last year the risk assessmentfor the Oncology Ward was updated and substantial changes were made. These werecompleted early in the year.

3.4 Training

Small groups of staff who need to receive training in personal radiation safety do not soduring their basic professional training. There are a number of such groups, of which thelargest are nurses in Oncology and Nuclear Medicine. It was reported last year that, with 1exception, all regularly receive training, either from the Clinical Physics staff who work withthem or from Radiation Protection staff.

This exception was security staff. Any of them may need to respond to incidents inRadiotherapy or Nuclear Medicine where radioactive hazards are present. Training is now inplace and has been given to most of the current staff.

4 Environmental Impact

This is governed by the Radioactive Substances Act 1993 and the conditions of the Trust’sregistration under that act. It is enforced by the Environment Agency.

4.1 Discharges

The required engineering controls, procedures and monitoring systems are all still in place.

The long term upward trend in the numbers of thyroid cancer patients has now flattened out.The anticipated need for the Trust to apply for an increase in its discharge limit forIodine-131 is therefore no longer present in the medium term. The application has beenpostponed indefinitely.

4.2 Security

Matters related to the security of radioactive sources are not included here.

R J Aukett BA MSc CRadP MIPEM MSRPRadiation Protection Adviser9th May 2011



27TH July 2011

Page 1 of 12

GLOSSARY

Abbreviation In Full

WM(S) HIEC or HIEC West Midlands South Health Education and Innovation Cluster

SHA Strategic Health Authority



TitleApprox. Length

PURPOSE OF THE REPORT:

To update the Board on current funding and activity of WM(S) HIEC

To identify what the WM(S) HIEC will deliver to the local health economy by March 2012

To highlight the risk to the ongoing sustainability of the HIEC from March 2012


WM(S) HIEC comprises 12 organisations from the public, private and charitable sectorsworking together under the terms of a Partnership Agreement. It provides a strategic forum forthe 12 partners to work collaboratively in support of system-wide change and the delivery ofshared objectives

UHCW is the largest HIEC partner, it is the host employer for the NHS-seconded HIEC staffand is leading and contributing to a number of clinical workstreams funded by the HIEC.

WM(S) HIEC has invested £850k in innovation-to-practice projects locally since 2010.

UHCW is directly involved in the following funded projects:

o Developing a networked ambulatory care delivery framework – HIEC funding £85k

o Healthcare Portal for diabetic patients – HIEC funding £16K

o Improved management of diabetic patients at high risk of hospital admittance - HIECfunding £70K

Subject: West Midlands (South) Health Innovation and EducationCluster - Update for UHCW Trust Board: July 2011

Report By: Amanda Royston: Director WM(S) HIEC

Author: Amanda Royston: Director WM(S) HIEC

Accountable Executive Director: Christine Watts



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o Advanced Care Planning for patients at the end-of-life - HIEC Funding £85k

o Care for stroke survivors - HIEC Funding £84k


1. From 2012 there will be no central allocation of funding to HIECs therefore WM(S)HIEC needsto become self-funding to ensure sustainability.

2. Risk of HIEC funding projects not delivering required outputs – this is mitigated against by therobust performance management processes in place across the HIEC.


WM(S) HIEC should be retained beyond March 2012 as a mechanism to facilitate cross-organisational, system-wide working, which is critical to the delivery of the £349m recurrentsavings required by 2014/15 across the Coventry and Warwickshire health care system andthe £3.2b required across the West Midlands.

HIEC Partners should extend the model of shared-resourcing and risk management to coverthe full infrastructure and staffing costs of the HIEC to ensure its sustainability beyond March2012.

IMPLICATIONS:

Financial: No central funding beyond march 2012

HR / Equality &Diversity:

HIEC currently employs a director and a manager who are at risk if theHIEC is not sustained beyond March 2012

Governance: N/A

Legal: N/A

REVIEW:

Trust Standing Committee Date Trust Standing Committee Date

Clinical Governance Committee Remuneration Committee

Finance Committee Executive Meeting

Audit Committee



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Midlands (South) Health Innovation and Education Cluster:

Update on Activity July 2011

AUTHOR: Amanda Royston, WM(S) HIEC Director

WM(S) HIEC is a partnership of local health, higher education and industry leaders workingtogether to promote the uptake at scale of proven innovation and in support of system-wide changeto address local health priorities.

1. Background

WM(S) HIEC comprises seven NHS organisations, two commercial organisations, one charitableorganisation and two universities. All public sector partners formally signed a PartnershipAgreement in 2010 and work is at an advanced stage on implementing a similar PartnershipAgreement, in line with ABPI guidance for the Private and Third Sector partners. See Appendix 1.0for a List of Partners

The purpose of WM(S) HIEC is to provide a strategic forum for the twelve partner organisations towork collaboratively in support of system-wide change and the delivery of shared objectives,specifically targeted to:

enhance the quality of care and the productivity of services

support the delivery of integrated, patient-centric health and social care services

support the development of the workforce to deliver the change

empower patients/citizen in the management of their own health supported by NHS-approved tools and techniques

reduce clinical variation and health inequalities

deliver value for money

UHCW, initiated by Martin Lee, was one of the founder partners of WM(S) HIEC, which is one of17 HIECS established across England in 2009/10 by the Department of Health. WM(S) HIEC wasawarded £1.85m over two years to support the establishment of the partnership and pump-primeinnovation projects across the health economy.

The influence of WM(S) HIEC spreads beyond the Coventry and Warwickshire boundaries. A keystrength is our partnership with Birmingham and Solihull Mental Health Foundation Trust inaddition to Coventry and Warwickshire Partnership Trust. These two trusts are responsible fordelivering mental health services to c.40% of the population in the West Midlands and having bothorganisations as partners enriches our ability to facilitate innovation within mental health care.HIEC sponsored projects in this area have a significant impact across the healthcare system as awhole, as it is estimated that 11.17% of non elective patients accessing acute care also havemental health care needs.



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From April 2012, HIECs are not expected to receive any central funding; therefore in order tosustain an alternative funding route must be identified.

2. WM(S) HIEC Goals

The HIEC Board has identified the following goals for the WM(S) HIEC for delivery during theperiod 2010/12.

GOAL ONE: Identify and expand the use of proven e-health and e-selfcare technologies atscale to enable the delivery of integrated care.

GOAL TWO: Identify and develop interventions to tackle the human factors of change acrossthe workforce in particular address barriers to e-health adoption.

GOAL THREE: To be a source of collective knowledge on the use of e-health and e-self caretechnologies, with expertise in tackling the human factors of change.

GOAL FOUR: To be recognised locally, nationally and internationally as leaders in facilitatingsystem-wide change and the continuous development of practice and practitioners.

3. Investment in the Health Economy

To date WM(S) HIEC has invested £850k in 14 locally-led innovation- into- practice projects, whichare all due to complete by March 2012 at the latest. These projects were selected by the HIECBoard as priority areas for the health economy and with outcomes which are achievable by theSHA-set deadline of March 2012. They all align to either or both of our goals of expanding the useof e-health/e-selfcare technology and tackling the human factors needed to change behaviours andclinical practice. Table 1.0 gives details of the project mapped against local priorities. SeeAppendix 2 for full details of all projects, including partners involved, scale of the innovation andkey deliverables.



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Table 1.0: Project Themes

*Priorities Areas identified by HIEC Partner CEOs: - these headings were agreed with CEOs ofPartner Organisations in 2010 and 2011 as priority areas for investment

*Priorities Areas identified by HIEC Partner CEOs

Clinical AreaProject Objectives

delivery deadlineMarch 2012

Carefor thefrail &elderly

Managementof long-termconditions

Reducingemergency

admissions &capacity

management

Qualityin

mentalhealth

Qualityin

primarycare

Acute Care

1. Implementation ofa networkedambulatoryemergency careframework

√ √

Cardiac Care

2. Implementation ofan on-line cardiacrehabilitationprogramme for GPreferral.

√ √ √

3. Implementation ofearly interventionprogramme forpatients with earlydiagnoseddementia

√ √ √ √ √

Dementia Care

4. Implementation ofweb-based selfmanagementprogramme

√ √ √ √ √

5. Implementation ofa healthcare portalfor primary andsecondary carestaff, communitypharmacist andpatients.

√ √ √

Diabetes Care

6. Improvedmanagement ofhigh risk patientsin primary care byGP-based teams

√ √ √

End of LifeCare

7. Implementation ofAdvanced CarePlanning acrossCoventry andWarwickshire

√ √ √ √ √

Mental Health8. Introduction of a

youth mentalhealth service

√ √ √ √

9. Implementation ofintervention forCOPD patientswith co-morbidityanxiety anddepression

√ √ √ √ √ Physical/MentalHealth

10.Implementation of √ √ √ √ √



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intervention forheart failurepatients with co-morbidity anxietyand depression

11.Implementation ofa Sex &RelationshipSerious Game forpatients andchildren

√ √

12. Implementation ofa Sex &RelationshipSerious Game foruse in school.

√ √Sexual Health

13. Implementation ofa Smart-phoneAPP for sexualhealth services

√ √

Stroke Care

14. Implementation ofa primary careprogramme forstroke survivors toimprove ongoinghealth andwellbeing

√ √ √ √ √

It should be noted that the relatively tight-time scale demanded by the SHA has limited the HIECsability to systematically demonstrate system-wide change within this early work. Successfuldelivery of the current projects will however demonstrate proof of the HIEC concept and thusprovide evidence that WM(S) HIEC should be retained beyond March 2012 as a mechanism tofacilitate cross-organisational, system-wide working to support the dissemination of proveninnovation into practice. This ambition is central to the vision of the HIEC Partners and is critical tosupport delivery of the £349m recurrent savings required by 2014/15 across the Coventry andWarwickshire health care system and the £3.2b required across the West Midlands as a whole.

4. Evaluation

Plans are being developed for an independent evaluation of the clinical and economic impact ofthe 14 innovation-into-practice projects to be commissioned in order to establish both the short andlonger term value for money of the investment made.

5. HIEC Infrastructure

WM(S) HIEC is a lean operation working within a deliberate policy of minimising infrastructurecosts. As a consequent, the HIEC only has two directly employed staff and pays a notional fee tothe HIEC Chair. Therefore the fixed costs against the HIEC budget account for less that 10% ofcurrent revenue.

From the outset, all Partners agreed to share the provision of professional services through goodwill with no cross charging in order to support the development of WM(S) HIEC.



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Specifically:

HR Support provided by UHCW as employing agent for the salaried HIEC Staff

Financial Management provided by Warwick Medical School

Legal support provided by from University of Warwick

Web site & Communications support provided by the Arden Cluster

All Partners provide office facilities on request

This arrangement has proved successful in facilitating partnership working which has directlyresulted in the investment of £850k into the health economy. The HIEC has additional fundsavailable until March 2012 and is working with Partners to commission further work and bid for newinnovation funds to support delivery of the HIEC goals.

6. Future Direction

Beyond March 20112, the future of WM(S) HIEC remains uncertain; however the need for system-wide collaboration to address the local health challenges within the context of financial austerityremains critical. The added value that the HIEC brings is that it provides a forum for NHS, highereducation and industry leaders to work in collaboration to deliver shared objectives focussed onenhancing the quality and efficiency of care locally. The lean-structure of WM(S) HIEC is proving tobe a cost effective mechanism of facilitating this activity, however in the absence of central funding,partner organisations must assess whether WM(S) HIEC has a viable future and if so agree afunding mechanism locally to secure this. Indeed within a number of regions of England, HIECs arebeing retained within the new NHS architecture which is emerging.

Amanda Royston

July 2011



27TH July 2011

Page 8 of 12

Appendix 1

WM(S) HIEC Composition

Title Name Organisation

Chair: Professor Neil Johnson West Midlands (South) HIEC

HIEC Director Mrs A. Royston West Midlands (South) HIEC

HIEC Manager Mrs J Mander West Midlands (South) HIEC

Public Sector Partners:

1. THE UNIVERSITY OF WARWICK

2. COVENTRY UNIVERSITY

3. UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST

4. COVENTRY TEACHING PRIMARY CARE TRUST

5. NHS WARWICKSHIRE:

6. COVENTRY AND WARWICKSHIRE PARTNERSHIP NHS TRUST

7. SOUTH WARWICKSHIRE NHS FOUNDATION TRUST

8. GEORGE ELIOT HOSPITAL NHS TRUST

9. BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST

Private Sector Partners:

1. GE MEDICAL SYSTEMS LTD:

2. NOVO NORDISK LTD:

Third Sector Partner:

MYTON HOSPICES



27TH July 2011

Page 9 of 12

Appendix 2: HIEC Sponsored Projects

DELIVERABLESCLINICALAREA

DESCRIPTIONLEAD

PARTNERCO - PARTNERS

HIEC GOAL ONE HIEC GOAL TWO

MEASURE - PROJECTDELIVERY

MEASURE -PROJECTIMPACT

MDHCO16Ambulatory

Care deliveryframework

Implementation of anetworkedambulatory

emergency caredelivery framework

UHCW

Arden Cluster InSpires, Godiva

& Rugby GPConsortia

CoventryCommunityServices

Design & implementa networkedambulatory careframework

Develop acute-careclinic workforce andGP in the newpathway

Delivery of ambulatorycare virtual ward totime and budget

Patient survey

Reduction inemergencyadmissions

Reduce LOS Utilisation of

pathways

MDHCO14Cardiac Care -On line cardiacrehabilitation

An on line cardiacrehabilitation

programme for GPsto refer cardiacpatients to in

addition to routinecare

CoventryUniversity

Arden Cluster University

Hospitals ofLeicester NHSTrust

An on-line cardiacrehabilitationprogramme for GPsreferral.

80 - 100 patientson the programmevia GP referral

Programme evaluationfrom professional anduser perspective.

Clinical riskfactors - trackingof primary andsecondary carevisits by users

MDHCO12Dementia

Project

People living withearly dementia -development and

evaluation of a webbased self

managementprogramme

including socialnetworking sites

Birmingham &Solihull Mental

Health FT(BSMHFT)

CoventryUniversity

Alzheimer’sSociety

Web and groupbased selfmanagementprogramme,including socialnetworking sites byAugust 2011

Train 10 tutors todeliver group andweb SMPs

Six week coursein using the webSMP for 20patients and theircarers

Availability of the webproduct to all partners.

Production of manualsfor tutors andhandbooks forparticipants

Programme usage Production of an e-

training programme Number of course

attendees Pre and post

evaluation audit

Patientsatisfactioninterviews andsurveys

Validated healthand self-managementoutcomemeasures

MDHCO6DementiaProject 2

Early intervention indementia care - a

six week course forpatients with early

CoventryUniversity

BSMHFT, CWPT Arden Cluster

Six week course forpatients with earlydiagnoseddementia.

Number of courseattendees.

Pre and post courseevaluation audit

Patientsatisfactionquestionnaire



27TH July 2011

Page 10 of 12

diagnoseddementia.

MDHCO2Diabetes Care

Project 1

A healthcare portalfor diabetic patient,communitypharmacists andspecialist nurses.

WarwickUniversity

UHCW Arden Cluster

Diabetes healthcareportal for patient,communitypharmacists andspecialist nurses.

An education toolfor patients toimprove diabetescontrol

Delivery of portal totime and budget.

Use of portal by targetgroups


DELIVERABLESCLINICAL

AREADESCRIPTION

LEADPARTNER

CO - PARTNERS

HIEC GOAL ONE HIEC GOAL TWO



MDHCO3Diabetes Care

Project 2

An intervention forpatients with a highrisk of admission tosupport them in the

management oftheir conditionacross 12 GP

practices

WarwickUniversity

UHCW George Elliot NHS

Trust (GEH) Arden Cluster

Improve themanagement ofhigh risk diabeticpatients througheducation andtraining for GPsand practice nurses

Diabetes knowledgequestionnaire pre andpost workshop

Improvement in riskfactor scores foridentified patients


MDHCO4End of Life

Care

Advanced CarePlanning- an

intervention for endof life patients and

carers aimed atimproving thequality of care.

Arden Cluster

Myton Hospice UHCW GEH South

WarwickshireNHS FoundationTrust ( SWFT)

NHS WestMidlands

Implement ACPacross C&W.

Train 80+practitioners



Audit of patientsand carers"VOICES".

Place of deathaudit

MDHCO9PsychologicalTherapies and

COPD

An intervention tosupport COPD

patients with co-morbidity anxiety

CoventryUniversity

CWPT University of

Warwick Arden Cluster

An intervention tosupport COPDpatients with co-morbidity anxiety

Deliver tutortraining to aminimum of 16IAPT workers.



Psychologicalmeasures fortrial group

Clinical outcome



27TH July 2011

Page 11 of 12

and depression and depression Production ofSPACE manuals

and healthcareuse measures

Cost savings

MDHCO17PsychologicalTherapies andHeart Failure

An intervention tosupport heart failure

patients with co-morbidity anxietyand depression

Coventry &WarwickshirePartnership

Trust

Coventry University

Online Tool forcardiac staff onIAPTs.

Online tool forIAPTs staff onheart failure

IAPT training forheart failure nurses

Delivery of web basedresource for IAPTworkers and heartfailure nurses

Pre and posttreatmentquestionnaires

Increasedreferral to IAPTService

Improvement inadmissions

CLINICALAREA

DESCRIPTIONLEAD

PARTNERCO - PARTNERS

DELIVERABLES

HIEC GOAL ONE HIEC GOALTWO



An interactiveserious game forchildren for use inschool in similar

settings

CoventryUniversity

Arden Cluster

Interactive seriouscomputer game forschools to addressthe effective andconsistentcontraceptive use

Delivery of game totime and budget.

Dissemination and use

Audit of teachersconfidence touse the teachingmaterials

Evaluation ofefficacy

MDHCO15Sexual HealthSmart Phone

APP

Development of aAPP for Smart

PhoneArden Cluster

Coventry CityCouncil

WarwickshireCounty Council

CoventryUniversity

Development andlaunch of SmartPhone APP andevaluation of impact

Evaluation ofimpact of APP onbehaviour

Delivering of APP andmarketing to timescaleand budget.

Number of downloadsof APP

Increaseduptake in sexualhealth services

Evaluation of"waiting-list"control



27TH July 2011

Page 12 of 12

MDHCO13 Stroke Care

Care for StrokeSurvivors - a 10week course for

stokes survivors toimprove their

ongoing health andwell being.

Arden Cluster(Cardiovascular

Network)

UHCW Coventry

University CWPT

10 week course for30 stoke survivorsto improve theirongoing health andwell being.

Number of courseattendees


Increase in the numberof health careprofessionalscompetent in theassessment ofindividualspsychological needs

Clinical and healthcareutilisation data

Patientevaluation

Psychologicaland physicalhealth measures

Reduction inappointments,admissions andLOS

MDHCO7Young personsmental health

The development ofa youth mental

health service foryoung people up to

the age of 25

Birmingham &Solihull Mental

Health FT

CWPT West Midlands

SHA Mental Health

Commissioners

The development ofa youth mentalhealth service foryoung people up tothe age of 25

An educationalprogramme basedon e-learning forstaff

Rates of userengagement

Number of courseattendees


Costeffectiveness ofthe service

Implementationacross the NHS



27th

July 2011


Subject: Modern Apprentices Pilot Programme 2010-11Report By: Ian Crich, Chief Human Resources OfficerAuthor: Diana Finlayson, Associate Director of HRAccountable Executive Director: Ian Crich, Chief Human Resources Officer

GLOSSARY




TitleApprox. Length


This Board report :-

Explains how and why the Trust undertook this training programme for the first time, and what anApprenticeship is for the 12 Young People

Summarises the positive outcomes and benefits for both Apprentices and the organisation Demonstrates that this programme is practical and worthwhile example of the Trust’s corporate

responsibility Outlines what the Trust will be doing during the next Modern Apprentices programme in 2011-12 based

on lessons learnt


This was a new and different way of recruiting and training a small number of young employees inBand 2 positions into the Trust with funding from the SHA

The programme required consistent high levels of cross functional working across the Trust The young people were provided with a comprehensive and personalised learning programme The baseline capability of the Apprentices resulted in considerable practical support as they were

commencing adult working life


This was a new approach by the Trust which was also untested in other Trusts, so mitigating actions wereagreed and implemented appropriately throughout the programme, to ensure its’ success


1. that the Board NOTE the report and in particular the positive outcomes of this training programmeand AGREE that this innovative approach should now become integral to our Band 2-4 workforceplanning in terms of recruiting, developing and retaining



27th

July 2011


IMPLICATIONS:

Financial: This programme was funded from SHA monies which will not be repeated.Therefore the next cohort of 24 will be funded from ring fenced Band 2 vacancieswhere there is demand from different parts of the Trust

HR / Equality & Diversity: The purpose of Modern Apprentices is to enable improved access to work andwork related learning for Young People who might otherwise have limitedwork/life opportunities or face unemployment.

Governance: Progress of the new scheme will be monitored by the HR Committee.

Legal: None

REVIEW:


1

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUSTREPORT TO THE TRUST BOARD

27th July 2011

NHS Modern Apprentices Pilot Scheme at UHCW 2010-11.

Background.

The Health sector has an ageing workforce, and the NHS urgently needs to recruityounger people in order to ensure that the future workforce is trained and able todeliver first-class health care. Apprenticeships are one of the main means ofachieving this whilst also fulfilling an important corporate responsibility by providingopportunities for engagement with the local community, and by contributing to areduction in unemployment, which ultimately benefits the wider community byimproving health outcomes and social unity.

NHS Apprenticeships have been designed around the needs of the Health sector todevelop the specialist skills required to keep pace with the latest technology andworking practices. More and more healthcare employers are realising thatapprenticeships offer a workforce development solution that supports new ways ofdelivering services and improving patient care.

The National Apprenticeship Service (NAS) was launched in 2009, and theyreported that the public sector had lagged far behind the private sector in taking onApprentices. The NAS has ultimate accountability for the national delivery oftargets and co-ordination of the funding for Apprenticeship places.

UHCW was in the process of rethinking its’ approach to Apprenticeships when theStrategic Health Authority made funds available to provide an incentive for Trusts todeliver Apprenticeship Programmes. It was therefore opportune and timely to pilotan Apprenticeship programme as the Trust now had the finances to offset the costsof this programme.

The pilot was two fold; one part was designed to attract a group of young peopleworking through an adult Apprenticeship programme, to recruit school-leavers fromlocal schools and colleges. This group are referred to as Modern Apprentices(MA’s). The second part was to encourage existing frontline UHCW NHS Truststaff to undertake an apprenticeship programme, to develop skills and improveconfidence.

This report will focus on the MAs as this was an innovative project for the WestMidlands. Although other Trusts were running Apprenticeships in BusinessAdministration for young people, UHCW NHS Trust was the only Trust in Coventryand Warwickshire who offered Health and Social Care Apprenticeships to newemployees.

What is an Apprenticeship?

The Apprenticeship framework consists of three nationally recognised qualificationswhich are a mixture of work-based training and education. These are:

NVQ + Technical Certificate + Key Skills = Apprenticeship Framework

2

Key Skills are the skills which are most commonly needed to succeed in arange of activities at work, in education and in everyday life. The main keyskill areas cover Communication, Application of Number and IT skills.

NVQs are vocationally-based qualifications which provide students with theknowledge and practical skills needed for a specific occupation.

Technical Certificate reinforces the underpinning knowledge andunderstanding of the Core Units of the NVQ.

The Pilot Programme

The aim was to recruit a maximum of 24 young people but due to delays in securingthe funding from the SHA, UHCW actually recruited 12 in January 2010 using theassessment centre model that we use for substantive Bands 2 and they commencedtheir employment in mid March.

Due to the timing of recruitment, we did not stipulate any specific entry levelrequirements for this group and some of those appointed had not achieved fiveGCSE’s at grades A to C. All undertook a skills scan at recruitment, so that we couldplan the level of support that they would require to achieve the apprenticeship (whichin some cases proved to be quite substantial).

The intention was that upon completion of the Apprenticeship Framework these MAswould be in an excellent position to apply for a post as a Band 2 Healthcare SupportWorker, or pursue a career in the Care sector. Although there were costimprovements across the Trust and reconfigurations taking place, there was still ademand for recruitment of HCSWs and the Trust was recruiting between 4 to 6HCSW’s per month, which continued throughout 2011. (see later section onoutcomes).

The 12 new MAs were employed on an 11-month fixed term training contract, with adedicated job description and person specification. They were paid a wage of £95per week for the duration of their 11-month contract, and were employed on asupernumerary basis. Apprentices were not required to work night or weekendshifts.

Divisional Nurse Directors identified suitable placements for the 12 staff whichincluded Renal, Outpatients on both sites, Gynaecology, Cardiology, Respiratory,Rheumatology and the Day Surgery Unit.

Critical Success Factors.

The MA programme proved to be a positive example of effective cross functionalworking in the Trust whereby a common corporate objective:- “to provide acomprehensive Health and Social Care apprenticeship” was achieved due to thefollowing :-

An Apprenticeship Steering Group for MA’s, made up of senior nurses,managers, training provider and Learning and Organisational Development(L&OD) staff. The purpose of the group included: ensuring a successfulapprenticeship programme for new staff, with attrition levels kept to aminimum by means of close monitoring of the programme and a proactiveapproach to addressing potential problems, providing clear advice andguidance on future career pathways and development opportunities.

3

The L&OD Team, including a dedicated Band 4 full time post, fixed term for12 months to specifically focus on the MAs, supported the delivery ofHealthcare and Administration Apprenticeship programmes across the Trust.L&OD liaised on a monthly basis with the training provider NTC Training, tomonitor progress against all aspects of the apprenticeship programme forMA’s. This also provided us with an opportunity to inform NTC of candidateprogress against the Care NVQ’s which we held responsibility for, andensured any extra support was made available.L&OD also coordinated the MA’s induction, bespoke Effective Care PracticeProgramme and orientation to the organisation.

Training for the MA’s was provided jointly by UHCW L&OD staff and NTCTraining which took place at the UHCW site. In addition to formal training,Apprentice Forums were set up for informal discussion and exchange of ideasbetween apprentices, and speakers provided the Apprentices with an insightinto other disciplines within the Health sector. Off-site visits were alsoarranged for the Apprentices, which included a tour of Coventry University’sSkills Lab, an activity day at TORC Healthtec in Tamworth and theopportunity to spend a day as a Student Nurse at Coventry University.

L&OD further supported the MA’s via regular meetings to discuss progresswith individual apprentices and their Line Manager and/or buddy. A L&ODAssessor was allocated to each new Apprentice to support completion ofcompetency assessments and the NVQ element of the ApprenticeshipFramework.

Ward Managers worked with L&OD to identify “ward buddies” to support theindividual apprentices on a day- to day basis, and training and guidance wasprovided for ward buddies in preparation for them working with these youngpeople. Ward buddies themselves were supported throughout theapprenticeship by L&OD staff when issues were escalated.

In addition to the above teams, there was also essential support/input from thePractice Development Team and specialist areas (e.g. Faith Centre), the workplaceswhere apprentices were based (e.g. multi disciplinary team support), and seniormanagers (e.g. line managers in the workplaces) and representatives on theworking/steering group

Each young apprentice was required to agree and sign a Learning Agreementbetween them, UHCW NHS Trust and NTC Training, and were also provided withresources which included an Apprentice Handbook, a timetable, Apprentice Forumagenda and a uniform.

Outcomes of the MA programme

Of the 12 MAs who initially commenced the programme 7 (58.3%) completed thise.g. achieved the full Level 2 Apprenticeship in Health & Social Care within theallotted timescale, despite not having the usual specific entry level requirements offive GCSE’s at grades A to C. This compares favourably with the national average forapprenticeship achievements of 57.2% in 2009/10.

Three apprentices left the programme prior to completion due to personal reasons,one resigned two weeks into the programme before being registered as anApprenticeship. One applied for a substantive role as a HCSW, left and returned and

4

is now continuing with the apprenticeship programme in her current position on OakWard at St. Cross.

2 of the 7 who completed their apprenticeship secured employment in the localcommunity due to their enhanced skills and qualifications: - one is working in achildren’s home and the other in the retail sector.

4 of the 7 who completed their apprenticeship have secured employmentwithin the Trust on Wards 52, 1, 32 and the Fracture Clinic.

At the end of the programme in February 2011, a celebration event was held in CSBfor the successful MAs, their families and internal supporters where our ChiefExecutive presented the awards. This was subsequently reported in the CoventryTelegraph as a positive example of a large local employer actively making adifference to employment prospects for a group of unskilled young people.

Summary Conclusions and Next Steps

The programme was evaluated from the outset by the participants, their buddies,members of the steering group, ward managers and the L&OD team whichconcluded that this programme had been worthwhile as it proved that we as Trustcould successfully deliver an excellent Health and Social Care ApprenticeshipProgramme, instil good working practices for young people entering employment,and secure well trained future substantive employees for the Trust.

All 7 successful MAs would recommend this Programme to their friends, peers andfamilies and have an improved understanding of what UHCW does and are thereforepositive ambassadors for the Trust in their communities.Similarly all the ward managers who took part commented that the Trust should run afuture MA programme again.

The financial costs of running this programme were underwritten by SHA funds,however the organisational time cost was considerable due to this being a pilot andnot tried anywhere else. On the other hand this time cost realised internal benefitssuch as improving cross functional working relationships and practices therebyreducing silo mentalities and approaches, and empowering ward staff as they werepositive role models and educators.

In April 2011 the HR Committee considered a comprehensive report about the MAprogramme and approved the recruitment of a future cohort of 24: this time a mixtureof Admin and Health and Social Care apprentices.

By using the lessons learnt from the earlier programme and the fact that there is nomore external funding available, it was agreed that a business driven approach betaken e.g. where replacement Band 2 posts are identified across the Trust, ratherthan recruiting like for like, these posts would be filled by a Modern Apprenticeinstead.

It was also decided to proactively recruit before the end of the school term so that wewould potentially attract a higher number of better qualified candidates, which hasproved effective.

As before, the intention is that the MAs will apply for Band 2 positions uponcompletion of their Apprenticeship because there are rolling vacancies.A substantive Band 2 post typically costs £15,444 p.a. whereas an MA will cost

5

£4, 888 which realises a cost saving of £10, 556 which reduces our staff costs shortterm. However, this needs to be set against the time cost for our staff to deliver thisprogramme and support the 24 MAs.

In May 2011 the new cadre of MAs were advertised resulting in over 80 applicantsand after shortlisting, an assessment day was held on the 17th June. The calibre andenthusiasm of these candidates was very high and the Resourcing team havecommenced the necessary pre- employment checks so that 24 MAs can start inSeptember.

Within the Trust, a wider range of areas are keen to have an Apprentice e.g. AHPsand legal services, thereby spreading the benefits more widely than previously.

If this next cohort proves more successful than the previous one (e.g. all 24 gain theirqualification with a far lower attrition rate) then the aim would be to continue andexpand this type of recruitment and retention approach, so that it becomesmainstream to our workforce planning and deployment.

The HR Committee will be regularly kept informed, and monitor progress of the newscheme after it has commenced in September 2011.

Diana FinlaysonAssociate Director HR- Learning and OD

.



27th

July 2011


Subject: UHCW’s partnership with Foxford School, CoventryReport By: Ian Crich, Chief Human Resources OfficerAuthor: Diana Finlayson, Associate Director HRAccountable Executive Director: Ian Crich, Chief Human Resources Officer

GLOSSARY




TitleApprox. Length


This Board report provides:-

An explanation of what type of partnership the Trust has with Foxford School since March 2010, thetypes of activities that have already taken place and future planned work

Evidence of how this partnership is benefiting both the Trust:- in terms of our Foundation Trustapplication, practical projects to benefit patients, as well as a wide range of students and Foxfordschool as whole

Another different and innovative approach that the Trust is taking to influence future career decisionsof young people and involve them practically in the work of the Trust, further improve our reputation asa large local employer and demonstrate our corporate citizen responsibilities


We have successfully commenced a strategic partnership with Foxford school which has involved awide ranges of students experiencing the Trust in different ways

The feedback from the students and teachers has been very positive including the impact on aspects ofthe educational curriculum and improving students motivation

The students have given inputs to and ideas for our Foundation Trust application The students’ contact with the Trust is enabling them to understand what our purpose is and to

influence them as potential users of our services.


By engaging with young people early, the Trust has the opportunity to seek their views and ideas on futureservice developments, and positively influence them in respect of career choices and consumers of ourservices.


1. That the Board welcome and NOTE

the range and success of the reciprocal activity being undertaken with its Partner Trustschool, Foxford School and Community Arts College



27th

July 2011


the Trust’s contribution (with Foxford) to a city wide consortium through the Business in theCommunity initiative

2. That the Board give their SUPPORT the continued pursuance of these two initiatives.

IMPLICATIONS:

Financial: Minimal and consisting of the contribution of UHCW staff time.

HR / Equality & Diversity: Both initiatives are concerned with the promotion of UHCW to young people andto the community and thus are positive indicators to future recruits to the Trust.Opportunities for engagement with the Trust are managed by the school who doso with their own clear policies on Equality and Diversity in place.

Governance: HR Committee have given approval to these activities.

Legal: None

REVIEW:



REPORT TO THE TRUST BOARD27th July 2011

UHCW - Trust Partner to Foxford School and Community Arts College, Coventry.

Introduction

This report outlines a positive example of a new strategic and successful partnership that theTrust has with a Coventry school and its’ community. This consistent and productive communityengagement (as detailed below) is realising mutual benefits for the school and the Trust.

UHCW has been a Trust Partner to Foxford School and Community Arts College since March2010 as Ian Crich, Director of HR is the Trustee from UHCW. He attends three Trust BoardMeetings a year, one during each term, and UHCW is one of six Trust partners of FoxfordSchool supporting them since they achieved Trust School status from 1 March 2010.

In addition, UHCW is a Business in the Community Partner (BIC) with the school and links withother BIC school / employer partnerships across the city of Coventry.

Partnership Working

Over the past year UHCW has partnered a number of activities with the school, which haveincluded providing work placements/shadowing, taster days and supporting careers events for awide range of student abilities. Table 1 shows the extent of the Trust’s inputs in this respect:-

Table 1.

Date Event YearGroup

No. ofstudentsattending

Purpose

Nov2010

HRshadowing

12 1 To give the student an insight in working in anHR office environment

29th

Sep-11th

Nov.2010

WiderHorizons(block 1)

11 6 The Wider Horizons Scheme is a project whichaims to provide students with a vocationalqualification. The placements provided atUHCW formed part of the assessed modulesfor the Certificate of Personal Effectiveness(COPE). Students attended each Wednesdaypm for a period of 8 weeks. Students wererotated through various departments, including:Outpatients, Endoscopy, Ward 40 and Renal.

9/11/2010 &16/11/2010

CurriculumInput

12Alevels

80 Request from the school for UHCW HealthProfessionals to talk to 6th-formers about theircareer pathway, job role etc. This event tookplace on 2 separate dates, and speakersincluded: Janet White, Richard Wellings, DianaFinlayson, Will Peasgood (clinical sciences)and Tom Hardy (junior doctor)

25/11/10-12/1/2011

Wider Horizons(block 2)

11 6 As for block 1 above.

14/2/11 MedicalShadowing

12 1

218/2/11 Theatres 13 1 Student’s ambition to become asurgeon. Provided anopportunity for her to watch anoperation.

19/1-9/3/11 Wider Horizons(block 3)


23/3/-11/5/11

Wider Horizons(block 4)


6/6/-18/7/11 WorkplaceChallenge(see below)

9 50 Provided a workplaceexperience for gifted & talentedYear 9 students whichchallenges them to complete areal-life project. The fourprojects are:

1) Record a radioprogramme aimed atyoung people. UHCWlead: Tara Court

2) Linked to 1) above, thisproject aims to publicisethe radio programme bymeans of leaflets/flyersand a radio jingle.UHCW leads: JackieWhite & MarilynChadwick

3) Web page aimed atyoung people for theTrust intranet site.UHCW lead: DanIbeziako

4) Information sheets andleaflets aimed at youngpeople, to be displayedin the information centre.UHCW lead: Lyn Wilson

16/6/2011 Taster Day 10 12 Taster day organised, for year 9students, by Janet White, whichincluded sessions on: theatres,infection control and healingarts.

In addition, representatives from UHCW’s HR team led sessions for the school’s ‘A’ levelBusiness Studies students on effective recruitment, with a particular focus on equal opportunities.

Since Easter 2011, a challenge was set by UHCW to 50 students who will be embarking on thenew English Baccalaureate from September 2011, as above. These students have been workingon their projects for the last six weeks, following an initial day at UHCW. A final presentation was

made by the students to invited guests, including staff from UHCW and parents on Tuesday 19th

July to showcase their projects.

In the last year alone over 200 students have benefited from this partnership working due toinputs from a wide range of UHCW employees and this will be continuing.

Students Feedback.

The following are comments received from the Foxford Students following their experience atUHCW. Theses show that their perspective of what the Trust does is positive and may positivelyinfluence their future career decisions :-

Very welcoming, hospitable, friendly and informative

This event was very useful and interesting and has given me a great insight into the NHS and allits’ careers. Also, it really helped me with ideas for our group project.

I think that it was a very good experience, and it helped me to understand the Trust in more detail.

I want to come back here because it was absolutely amazing. Hope to come back in the future.

Dan is the best ICT teacher in the world!

I really enjoyed coming. I liked learning about the NHS. In future I would love to work in the NHS.

I thought that it was really good, and you saw that there was more to the NHS than caring forpatients. It was well arranged and answered all our questions.

It was really good. I found out a lot more information about the NHS and the staff were reallywelcoming to all the questions we had. I am considering a job in the NHS.

Supporting our FT application.

This is the second main area of our partnership working with the school is aimed at to improvingthe patient experience.

During 2010 meetings with senior staff at the school and FT Project Director and FT membershipManager led to agreement that the School would support our FT membership work in thefollowing ways:

Promote FT membership to staff (posters and leaflets available and on display) Work with us to develop and test out our approach to engagement (away days) of young

people as members of our Youth Council Promote Youth Council membership to students

Help us access other schools to promote the Youth Council and FT membership

This has resulted in the following activity during 2011:

Input from school staff into Terms of Reference for UHCW Youth Council Presentation on NHS, UHCW and FT membership to all sixth form students at the school Away day with 10, 14 year olds at UHCW Workshop type activities to identify improvements in patient experience for young people

Healing Arts co-ordinator working with school on possible joint projects and exhibitions atUHCW

Future Work

Future plans include more away days, further patient experience workshops, the formation ofleadership team for the Youth Council and the development of communications materialsspecifically for young people.

In addition, we will be seeking Foxford’s staff and students ideas on environmental improvements,as well as involvement in specific projects (tree planting in outer space project, performance art aspart of dementia lounge opening and conference) and work on involving young people asvolunteers.

As a result, we currently have 22 young people signed up to be part of the leadership team of theYouth Council from Foxford and other schools across Coventry.

With regard to work experience we are already in the process of arranging 6 week workplacements for Year 11 students, 6 students per placement, in blocks of 4. In order toaccommodate these increasing numbers we are reviewing our current provision of NHSAmbassadors within the Trust and targeting recruiting more in specific areas where demand ishigh.

Conclusions

Although this strategic partnership is in the early stages of its’ evolution , it is already provingworthwhile for both parties and for a range of stakeholders, and is another effective means ofimproving our Trust’s reputation and our consumers’ knowledge and insights into what our Trust isdoing now and our future plans to be an FT. In this last respect Foxford is practically assisting uswith this and encouraging other schools to do so.

The experience gained is also enabling young people to consider a possible career choice withinthe NHS, improve their self belief and confidence which in turn is changing their expectations andaspirations.

Diana Finlayson,Associate Director HR- Learning and OD.



{27th

July 2011}


Subject: UHCW Finance Report for the Period to 30th June 2011

Report By: Mr A Jones - Acting Chief Finance Officer

Author: Mr Antony Hobbs - Associate Director of Finance - OperationsMiss Sarah Oakley – Senior Finance Manager

Accountable Executive Director: Mr A Jones Acting Chief Finance Officer

GLOSSARY

Abbreviation In FullBPPC Better Payments Practice CodeCIP Cost Improvement ProgrammeCLRN Comprehensive Local Research NetworkCQUIN Commissioning for Quality and InnovationCRL Capital Resource LimitDH Department of HealthEBITDA Earnings before Interest, Depreciation and AmortisationEFL External Financing LimitENT Ear, Nose and ThroatET&R Education, Training and ResearchGP General PractitionerHPC Healthcare Purchasing ConsortiumHR Human ResourcesI&E Income and ExpenditureIT Information TechnologyICT Information and Communications TechnologyIFRS International Financial Reporting StandardsPDC Public Dividend CapitalPFI Private Finance InitiativeROA Return on AssetsUHCW University Hospitals Coventry and Warwickshire NHS TrustVAT Value Added TaxWTE Whole Time EquivalentYTD Year to DateRAG Red, Amber, Green (Risk rating scoring system)



TitleApprox. Length


To provide a summary of the Trust’s financial position and actions being taken to address the year to date deficit and thecost improvement programme.


• The Trust reported a deficit against budget of £1.9m in Month 3.

• £1.5m of the deficit relates to slippage in CIP schemes. The remainder relates to other cost pressureswithin Division’s expenditure plans.

• Divisions over-spent by £1.9m in the three months to June 2011.



{27th

July 2011}



Shortfalls in the delivery of CIPs and other divisional cost pressures;

Operational risks concerning case-mix of patients and opening of additional capacity.

Risk of financial penalties if the Trust fails to meet CQUIN and other performance targets.


The Trust Board is asked to:

Note the content of the report in particular the Trust’s financial position in Month 3 for 2011/12.

Review and approve the actions being taken to address the financial position.

IMPLICATIONS:

Financial: Achieve statutory break-even duty and remain within CRL and EFL.

HR / Equality & Diversity: None identified

Governance: None identified

Legal: None identified

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee Remuneration CommitteeFinance and Performance Committee 25/07/2011 Executive MeetingAudit Committee

£000s Plan Actual Variance

Income £115,413 £115,949 £536 Favourable

Expenditure (£105,164) (£107,786) (£2,622) AdverseEBITDA £10,249 £8,163 (£2,086) Adverse

Financing Costs (£12,801) (£12,587) £214 FavourableTOTAL (£2,552) (£4,424) (£1,872) Adverse

£000s Plan Actual Variance

Income £460,867 £461,711 £844 Favourable

Expenditure (£408,358) (£409,202) (£844) Adverse

EBITDA £52,509 £52,509 (£0) Adverse

Financing Costs (£51,509) (£51,509) £0 On Plan

TOTAL £1,000 £1,000 (£0)

Non NHS NHS Combined

By Value 90% 65% 86%

By Volume 70% 43% 69%

WTEs In post M03

(excluding Path and

CLRN) Plan Actual Var

TOTAL 5,950 5,532 418 Favourable

Plan Actual Variance

Elective spells 3,575 3,527 (48) Adverse

Day Case 11,873 12,105 232 FavourableNon-elective spells 14,046 14,924 878 Favourable

Outpatient attends 133,339 131,216 (2,123) Adverse

1 2 3 4 5

EBITDA margin

EBITDA, % achieved

ROA

I&E surplus marginLiquidity ratio

Overall Risk Rating

Better Payments Practice Code (BPPC) Cumulative Year to date

Manpower

Activity Variance (June)

RISK RATING

Year-to-date Financial Position (Income and Expenditure)

Year-end Forecast Outturn

Financial Overview as at 30th June 2011

Income and Expenditure Balance Sheet Executive Summary

I&E Net Variance 2011-12

(£4,500)

(£3,500)

(£2,500)

(£1,500)

(£500)

500

£000s

Variance (1,460) (1,486) (1,872) 0 0 0 0 0 0 0 0 0

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

Analysis of Cash & Liquidity over last 6 months

-80

-60

-40

-20

0

20

40

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11

£m

Cash Debtors < 1 yearCreditors < 1 year loans & Borrowings<1yr

Identified Savings to M3 and

forecast savings from M4 - M12, 2011-2012

0

5,000

10,000

15,000

20,000

25,000

30,000


£000s

Plan

Actual

Capital Programme

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000E

sta

tes

Med

ical

Eq

uip

men

t

IT

PF

I

Co

nti

ng

en

cy

£'0

00 Annual Plan

YTD Spend

The Trust is reporting a £1.9m deficit against the financial plan in June 2011 (month 2). This positionis an adverese varaince of £0.4m from the previous month. The forecast at this stage of the financialyear is that the Trust will break-even against the target of £1m surplus at the end of March 2012.However, in order to meet this target, a significant improvement in the delivery of divisional CIPschemes and robust cost control measures will be required. In addition, rapid progress in theidentification, planning and delivery of strategic CIP workstreams must be made in the next month.

The Trust has identified efficiency savings of £26.0m against a target of £28m for 2011/12. The Trustis under achieveing its CIP programme by £1.5m up to the end of June 2011 against the targets set.

The Trust had a net cash balance of £1.9m at the end of June 2011.

The Trust's capital programme budget for 2011/12 is £14.3m, which includes £7.1m for PFIequipment and building lifecycle. The capital spend year to date at month 3 is £17k.

The Trust has seen more admitted patients than planned. Daycase activity over performed againstcontract by 2.0%, non-elective activity by 6.3%. Elective activity , however, underperformed by1.3%. The number of outpatients seen was 1.6% lower than planned.

The total number of patients on the waiting list has increased by 473 (8.0%) during the month, and thenumber of referrals has also increased by 250 (2.6%) patients. These continued increases will lead toa rise in the levels of patient activity later on in the financial year.

The Better Payments Practice Code requires the Trust to aim to pay all undisputed invoices by thedue date or within 30 days of receipt of goods or a valid invoice, whichever is later. The Trust has notmet this target, primarily due to payments in April for creditors deferred in 2010/11.

The risk ratings used when applying for, and when running as, a foundation trust are included below.These reflect the current forecast position from the Long Term Financial Model. The Trust needs tomaintain it's "3 star" forecast score to successfully apply for Foundation Trust status.

UNIVERSITY HOSPITALSCOVENTRY AND WARWICKSHIRE NHS TRUST

TRUST BOARD

FINANCE REPORT

FOR THE PERIOD ENDED 30th June 2011

1. KEY FINANCIAL PERFORMANCE INDICATORS

Table 1: Key Finance Performance Indicators

Plan

£'000

Actual

£'000

Variance

£'000

Plan

£'000

Actual

£'000

Variance

£'000Total I&E (2,552) (4,424) (1,872) 1,000 1,000 0 MEBITDA 10,249 8,163 (2,086) 52,509 52,509 0 MTrust Savings Plan 4,085 2,622 (1,463) 28,000 28,000 0 MCash in hand 999 1,943 944 881 881 0 L

Workforce-inpost WTE 5,950 5,532 418 LActivity (June 2011)

- Elective Spells 3,575 3,527 (48) L- Daycase 11,873 12,105 232 L- Non-Elective Spells 14,046 14,924 878 L- Outpatient Attendances 133,339 131,216 -2,123 L

Year to Date Forecast OutturnTarget Risk

2. SIGNIFICANT ISSUES / CHANGES IN-MONTH

2.1 The Trusts income and expenditure position for the year to 30th June shows adeficit of £4.4m which represents an adverse variance to budget of £1.9m (adeterioration of £0.4m from last month). The main reasons for the adversevariance against plan are slippage of £1.5m on CIP schemes continuing costpressures associated with activity over performance and expenditure on bankand agency staff and medical locums.

2.2 The Trust income and expenditure budget for the period ending June 2011 isa planned deficit of £2.6m. The plan reflects the phasing of the strategic work-stream CIP plans which are scheduled to be delivered from the secondquarter of 2011/12.

2.3 The achievement of the planned £1m surplus is a significant challenge,although, the Trust remains committed to delivering this target at the year-end.However, in order to meet this plan, a significant improvement in the deliveryof divisional CIP schemes and robust cost control measures will be required.In addition, rapid progress in the identification, planning and delivery ofstrategic CIP work-streams must be made in the next month.

3. MONTH END SUMMARY

3.1 The key budgetary variances include the following:

a. Divisions had a net overspend of £1.9m against allocated budgets

(including a year to date £0.5m shortfall against cost improvementsprogramme targets). Key variances include:

i. All clinical divisions overspent against allocated budgets by acombined total of £2.2m year to date.

ii. Trust-wide services including corporate functions, PFI andeducation, training and research had a net underspend of£0.4m year to date.

iii. The Pathology network had a gross overspend of £0.2m yearto date. This position is taken after the partnership agreementthat only 66% is attributable to UHCW.

iv. Strategic Work-stream CIP’s shortfall of £1.0m.

A summary of the trusts income and expenditure is provided in Appendix A1and A2.

3.2 Savings –The Trust has achieved efficiency savings of £2.6m against thetarget of £4.1m up to the end of June 2011 resulting in an under achievementof £1.5m to date. The Trust has identified £15.0m of divisional schemes thatare green rated using the RAG rating system – this represents a significantimprovement compared with the position reported last month. In addition,outline plans for £11m of strategic work-streams (against the target of £12.9m)have been identified. However, further work is required on these schemes tofirm up expected savings and timescales for delivery in addition to the need toidentify further schemes. Work on implementing the strategic plans is ongoingand they are expected to deliver savings from the second quarter of thefinancial year. A summary of the savings plan is provided in Appendix B.

3.3 Cash – The net cash balance at the end of June is £1.9m. The Trust’sdetailed cashflow forecast for 2011/12 is shown in Appendix C.

3.4 Capital – The Trust's capital programme budget for 2011/12 is £14.3m, and ismade up of £7.2m of approved, prioritised Board schemes and £7.1m for PFIequipment and buildings lifecycled under the PFI contract. Significantpayments have been made in relation to paying capital creditors from the endof 2010/11, with only minimal capital spend accrued against this year’sprogramme so far. A break-down of the capital programme can be found inAppendix D.

3.5 Statement of Financial Position – the main year to date movement is inrelation to cash, which has reduced by £15.6m following the payment of year-end creditors at the start of this financial year. The Statement of FinancialPosition is shown in Appendix E.

3.6 Activity – The Trust has seen more admitted patients than planned. Day-caseactivity over performed against contract by 2.0%, non-elective activity by6.3%. Elective activity however, underperformed by 1.3%. The number ofoutpatients seen was 1.6% lower than planned. Whilst this increased activitydid result in an over recovery of contract income of £574k, the significant over-performance on non-elective activity was only funded at 30% of tariff whichwas insufficient to cover the costs of the additional capacity required to treatthese patients.

The total number of patients on the waiting list has increased by 473 (8.0%)

during the month, and the number of referrals has also increased by 250(2.6%) patients. These continued increases are expected to lead to a rise inthe levels of patient activity later on in the financial year.

A full breakdown of referral and waiting list numbers is provided forinformation in Appendix F.

4. CONCLUSIONS

o The Trust is reporting an adverse variance to budget of £1.9m in Month 3,which is a deterioration of £0.4m compared to the position reported in theprevious month.

o The Trust has identified all of the £15.0m of divisional schemes fully RAGrated green. In addition, it is working up detailed plans totalling £12.9m ofExecutive led corporate work streams. As at 30th June 2011 the Trust hasachieved a cumulative saving of £2.6m against the plan of £4.1m, underachieving to date by £1.5m.

o The Trust remains committed to delivering the planned year end surplus of£1m but recognises that a significant improvement in performance will berequired to achieve this.

5. MANAGEMENT ACTIONS

5.1 Strengthening divisional performance management arrangements to ensuredivisions meet their allocated budgetary targets. This is being undertakenthrough regular performance review meetings with key divisional staff(including technical review and challenge meetings).

5.2 Review divisional budgets in the light of agreed contract activity and year todate performance.

5.3 Ongoing work to identify, plan and deliver strategic CIP workstreams. Thiswork is being led by executive directors and progress will be regularly reportedto the Executive Leadership Team and to the Finance and PerformanceCommittee.

6. RECOMMENDATIONS

The Trust Board is asked to:

Note the content of the report in particular the Trust’s financial position for thethree months ended 30th June 2011.

Review and approve the actions being taken to address the financial position.

Alan JonesActing Chief Finance Officer

UHCW Financial Position Month 03 (June) 2011/12 Appendix A1

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

Income

Contract Income - Trust 378,175 94,600 95,174 574

Contract Income - Pathology 12,046 3,015 3,037 22

390,221 97,615 98,211 596

Other Income

Clinical Excellence Awards 1,092 273 273 0

Other Miscellaneous Income 795 199 199 0

Sub total - Other Income 1,887 472 472 0

Divisional Non Contract Income

Medicine, ED & Rugby 12,669 3,015 2,927 -88

Specialised Newtorks 2,268 602 663 61

Surgery 2,794 698 697 -1Women & Children 2,624 655 755 100

Diagnostics & Service 6,198 1,577 1,485 -92

E,T & R 26,224 6,819 6,711 -108

PFI & Facilities 2,643 661 648 -13

Core 5,779 1,454 1,460 6

Pathology Network 7,562 1,845 1,920 75

Sub total - Non Contract Income 68,759 17,326 17,266 -60

Total Income 460,867 115,413 115,949 536

Expenditure

Divisional Expenditure

Medicine, ED & Rugby -68,573 -17,196 -18,184 -988

Specialised Newtorks -71,042 -18,150 -18,483 -333

Surgery -49,964 -12,840 -12,873 -33

Women & Children -29,214 -7,366 -7,901 -535

Diagnostics & Service -79,812 -19,953 -20,271 -318

E,T & R -18,785 -4,959 -4,851 108

PFI & Facilities -47,939 -11,891 -11,759 132

Core -34,787 -8,793 -8,485 308

Pathology Network -19,607 -4,860 -5,108 -248

Strategic Workstreams 12,950 862 0 -862

Sub total - Divisional Expenditure -406,774 -105,146 -107,915 -2,769

Reserves & Other

Reserves - ICT Reserve -300 0 0 0

- Contingency -1,370 -55 0 55

- Developments 0 0 0 0

- Pay Inflation 0 0 0 0

- Non pay Inflation 0 0 0 0

- Activity Reserve -61 0 0 0

GRNI 0 0 0 0

Other provisions -191 -48 44 92

IFRS (Finance leases) 395 99 99 0

Unwinding of Discount -58 -14 -14 0

Sub total - Reserves -1,584 -18 129 147

TOTAL EXPENDITURE -408,358 -105,164 -107,786 -2,622

EBITDA 52,509 10,249 8,163 -2,086

Financing Costs

Interest Received 96 24 18 -6

Interest Charges -543 -136 -142 -6

Depreciation -23,293 -5,746 -5,544 202

PDC Dividend -5,654 -1,414 -1,414 0

IFRS (Finance costs) -22,115 -5,529 -5,505 24

Sub total - Financing Costs -51,509 -12,801 -12,587 214

Total Surplus/ (Deficit) 1,000 -2,552 -4,424 -1,872

Month 03 I&E Variance

from Plan 2011/12

I&E Annual Budgets /

Targets 2011/12

I&E Actuals Month 03

2011/12

I&E Budgets Month 03

2011/12

Divisional Positions - Month 03 (June) 2011/12 Appendix A2

June 2011

Net Budget

YTD £'000s

Actual YTD

£'000s

Variance

Surplus /

Deficit

£'000s

Medicine & Emergency (14,181) (15,257) (1,076)

Specialised Networks (17,548) (17,820) (272)

Surgery (12,142) (12,176) (34)

Women & Children (6,711) (7,146) (435)

Diagnostics & Service (18,376) (18,786) (410)

Clinical Divisions (68,958) (71,185) (2,227)

E,T&R 1,860 1,860 0

PFI & Facilities (11,230) (11,111) 119

Core Functions (7,339) (7,025) 314

Pathology Network 0 (151) (151)

Non-Clinical Divisions (16,709) (16,427) 282

Total (85,667) (87,612) (1,945)

CIP SUMMARY - MONTH 03 (JUNE) 2011/12 CUMULATIVE FORECAST Appendix B

Key Information

Key Financials

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Total April May June July August September October November December January February March Total REC NR

WTE £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

Saving profile

Divisional schemes 1,022 1,082 962 1,263 1,275 1,318 1,361 1,340 1,344 1,382 1,348 1,353 15,050 - -

Strategic work streams 267 267 486 486 937 1,395 1,435 1,435 1,561 1,561 1,561 1,561 12,950

1,289 1,348 1,448 1,749 2,212 2,713 2,796 2,775 2,905 2,943 2,909 2,914 28,000 - -

Actual saving to M2 + forecast savings from M3

Divisional schemes 765 922 935 1,245 1,211 1,366 1,434 1,434 1,435 1,486 1,487 1,488 15,208 - -

Strategic work streams - - - - 452 2,509 1,216 1,216 1,342 1,342 1,342 1,342 10,759

765 922 935 1,245 1,663 3,875 2,649 2,649 2,777 2,828 2,829 2,830 25,967 - -

Variance in-month (523) (426) (513) (504) (549) 1,162 (146) (126) (128) (115) (80) (84) (2,033) - -

Forecast Cumulative Savings 1,289 2,637 4,085 5,834 8,046 10,759 13,555 16,330 19,235 22,178 25,086 28,000 28,000 - -

Actual Cumulative Savings 765 1,688 2,622 3,867 5,530 9,405 12,055 14,704 17,481 20,308 23,137 25,967 25,967 - -

Cumulative Variance (523) (949) (1,462) (1,967) (2,516) (1,354) (1,500) (1,626) (1,754) (1,870) (1,950) (2,033) (2,033) - -

Further Information

Project Lead and Team Project Proposal

Trust Summary

Monthly Performance Monitoring Report

Workstream Draft CIP plans 2011/12

2011/12 Savings

Monthly Position

0

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Actual savings to M3 + forecast savingsfrom M4

Cumulative Position

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00


Actual Cumulative Savings to M3 + Forecastfrom M4

Appendix C

Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast

Apr-11

£'000

May-11

£'000

Jun-11

£'000

Jul-11

£'000

Aug-11

£'000

Sep-11

£'000

Oct-11

£'000

Nov-11

£'000

Dec-11

£'000

Jan-12

£'000

Feb-12

£'000

Mar-12

£'000

Total

£'000

Operating activities

Healthcare contract income 45,552 22,455 25,228 46,371 24,786 25,985 46,371 24,786 25,985 46,371 24,786 31,544 390,220

Other income 6,955 6,861 3,735 10,624 5,696 5,468 7,750 5,526 5,686 7,673 5,458 1,291 72,727

Net debtor movements (credit notes taken) 0 0 0 0 0 0 0 0 0 0 0 0 0

Salaries and wages -21,450 -21,557 -21,894 -22,300 -22,300 -22,300 -22,300 -22,100 -22,100 -22,100 -21,650 -21,679 -263,730

VAT reclaim 0 4,207 263 200 3,548 200 200 3,548 200 200 3,548 200 16,314

Other revenue payments -40,258 -13,837 -10,184 -32,072 -10,000 -7,000 -32,572 -12,000 -10,500 -31,074 -10,000 -5,716 -215,213

Cash inflow/outflow(-) from operating activities -9,201 -1,871 -2,852 2,823 1,730 2,353 -551 -240 -729 1,070 2,142 5,640 318

Investments and servicing of finance

Interest receivable 3 9 6 8 8 8 8 8 8 8 8 15 97

Interest payable 0 0 0 0 0 -361 0 0 0 0 0 -186 -547

Cash inflow/outflow(-) from investments and servicing of finance3 9 6 8 8 -353 8 8 8 8 8 -171 -450

Capital

Proceeds from sale of fixed assets 352 121 0 0 0 0 100 0 0 0 173 0 746

Capital payments -1,451 -193 -172 -100 -200 -585 -585 -585 -585 -585 -585 -1,971 -7,598

Cash inflow/outflow(-) from capital -1,099 -72 -172 -100 -200 -585 -485 -585 -585 -585 -412 -1,971 -6,852

Dividends payable 0 0 0 0 0 -1,778 0 0 0 0 0 -2,827 -4,605

Net cash inflow/outflow(-) before financing -10,297 -1,934 -3,018 2,731 1,538 -363 -1,028 -817 -1,306 493 1,738 672 -11,589

Financing

Temporary borrowing received(+) /repaid(-) 0 0 0 0 0 0 0 0 0 0 0 0 0

Finance lease repayments of principal -408 0 0 -408 0 0 -408 0 0 -406 0 0 -1,630

PDC receipts 0 0 0 0 0 0 0 0 0 0 0 0 0

PDC repaid 0 0 0 0 0 0 0 0 0 0 0 0 0

DoH capital investment loan 0 0 0 0 0 -750 0 0 0 0 0 -750 -1,500

DoH working capital Loan 0 0 0 0 0 -1,000 0 0 0 0 0 -1,000 -2,000

Cash inflow/outflow(-) from financing -408 0 0 -408 0 -1,750 -408 0 0 -406 0 -1,750 -5,130

Net cash inflow/outflow(-) for the period -10,705 -1,934 -3,018 2,323 1,538 -2,113 -1,436 -817 -1,306 87 1,738 -1,078 -16,719

Opening cash balance for the period 17,600 6,895 4,961 1,943 4,266 5,805 3,692 2,256 1,439 134 221 1,959 17,600

Closing cash balance for the period 6,895 4,961 1,943 4,266 5,805 3,692 2,256 1,439 134 221 1,959 881 881

Cummulative Temporary borrowing 0 0 0 0 0 0 0 0 0 0 0 0

External Financing Limit (EFL) outturn: £'000 £'000

Net cash inflow before financing 11,589

Finance leases taken out in the year 222

EFL Outturn 11,811

Forecast to be approved EFL 11,811

EFL undershoot 0


Cashflow Forecast 2011/12

Appendix D

Budget

Holder

2011/12

£'000Statutory Schemes

1 Legionella Improvements Estates 502 Disability Discrimination Act (St Cross) Estates 233 Neurosurgical Instruments for CJD Prevention Medical 5004 Blood Tracking ICT 20

Sub-Total: Statutory Schemes 593

Mandatory/Contractual Schemes5 LE2.2 MR5 Upgrade ICT 206 Oncoloy System Upgrade Medical 507 Hospital of St Cross Lifecycle Estates 200

Sub-Total: Mandatory Schemes 270

Donated/Grant/PDC/Lease Funded8 AAA Screening Equipment Medical 529 AV Equipment for Clinical Skills Suite Medical 130

10 Arden Cancer Estates 45011 Delfia Xpress Instrument Medical 3412 T3000 & T2000 Cytology Processors Medical 18813 Dementia Lounge Estates 60

Sub-Total: Donated/Grant/PDC/Lease Funded 914

Key Strategic Schemes14 Rear of Site - Access & Parking Estates 2,00015 Wi-Fi Network and Mobile Devices ICT 50016 Intranet/Web Content Management System ICT 10017 Gate 1 (Patient Kiosks) ICT/Estates 300

Sub-Total: Key Strategic Schemes 2,900

Health & Safety Schemes18 Hospital at Night ICT 5019 Bladder Scanner Medical 1020 Car Park Security Estates 23

Sub-Total: Health & Safety Schemes 83

In Progress Schemes21 CEBIS ICT 1222 e-Rostering ICT 5023 Generator Replacement Estates 2024 Business Intelligence ICT 20

Sub-Total: In Progress Schemes 102

Efficiency Schemes25 Digital Dictation ICT 20826 GP and Community Communications ICT 2527 Dendrite Upgrade ICT 25

Sub-Total: 258

28 Contingency (Medical/IT/Estates) 2,083Total of above schemes 7,203

PFI lifecycle expenditure in 11/12 7071

Total capital programme spend 11/12 14,274

Less: Donated assets -580Less: sale of assets -746

Capital Resource Limit for 11/12 submitted in

Trust FIMS plan to DH 12,948

NB: No significant in-year expenditure has been incurredThe majority of expenidture YTD has been used to clear yr-end creditors


Capital Programme 2011/12

Appendix E

University Hospitals Coventry & Warwickshire NHS Trust Statement of Financial Position

Restated 31st

March 2011

30th June

2011Year-to-Date

Movement

£000 £000 £000

Non-current assets

Property, plant and equipment 448,532 443,016 (5,516)

Intangible assets 43 32 (11)

Trade and other receivables 24,273 29,247 4,974

Total non-current assets 472,848 472,294 (554)

Current assets

Inventories 9,545 9,897 352

Trade and other receivables 15,081 19,425 4,344

Cash and cash equivalents 17,600 1,973 (15,627)

42,226 31,295 (10,931)

Non-current assets held for sale 746 279 (467)

Total current assets 42,972 31,574 (11,398)

Total assets 515,820 503,869 (11,951)

Current liabilities

Trade and other payables (43,345) (36,273) 7,072

Borrowings (1,636) (1,636) (0)

DH Working Capital Loan (2,000) (2,000) 0

DH Capital loan (1,500) (1,500) 0

Provisions (646) (644) 2

Net current assets/(liabilities) (6,155) (10,479) (4,324)

Total assets less current liabilities 466,693 461,815 (4,878)

Non-current liabilities:

Trade and other payables 0 0 0

Borrowings (286,436) (286,029) 407

DH Working Capital Loan (2,000) (2,000) 0

DH Capital loan (11,250) (11,250) 0

Provisions (2,232) (2,184) 48

Total assets employed 164,775 160,352 (4,423)

Financed by taxpayers' equity:

Public dividend capital 24,124 24,124 0

Retained earnings* 49,815 45,733 (4,082)

Revaluation reserve 90,836 90,495 (341)

Total Taxpayers' Equity 164,775 160,352 (4,423)

*Restated for PPA moving donated asset reserve to retained earnings

Appendix F

Waiting list numbers have increased from May to June by 473 (8.0%)

32.2% of total wait is made up of Trauma and Orthopaedics (T&O), 10.7%

General Surgery, 7.4% ENT, 7.2% General Medicine, 6.5% Urology and

5.9% Ophthalmology.

18 week Referral to Treatment.

Admitted Patient Pathways (adjusted for Suspensions).

During May 2011, 93.21% of patients achieved the 18 week target. Trauma &

Orthopaedics and General Surgery were low achieving specialties.

Non Admitted Patient Pathways.

During May 2011, 96.77% of patients achieved the 18 week target.

Gastroenterology, Trauma & Orthopaedics, Ophthalmology and Plastic

Surgery were low achieving specialties.

The data for June is not yet available

The graph shows the number of external referrals to UHCW for an Outpatient

service regardless of whether Consultant or Non-Consultant Led.

Total referrals have increased from May to June by 250 (2.6%)

GP/Dental referrals have increased by 281 (3.7%) while other referrals

have decreased by 31 (1.5%).

Total Number on Waiting List

5000

5200

5400

5600

5800

6000

6200

6400

6600

6800

10-11

11-12

10-11 6420 6289 6480 6331 6202 6566 6484 5912 5331 5679 5666 5459

11-12 5915 5908 6381

1 2 3 4 5 6 7 8 9 10 11 12

All External Referrals

0

2000

4000

6000

8000

10000

12000

GP/Dental

Other

Total

GP/Dental 7307 7697 7978

Other 1837 2021 1990

Total 9144 9718 9968 0 0 0 0 0 0 0 0 0

A M J J A S O N D J F M

Appendix F

First waiters have decreased by 576 from May to June (3.1%).

Of the 6,603 patients that have been waiting for <13 weeks, 1,119 have been

waiting for more than 5 weeks - 261 in Trauma & Orthopaedics, 185 in

Ophthalmology, 140 in General Medicine and 109 in Dermatology.

48 patients in Trauma & Orthopaedics and 5 patients in ENT have been

waiting for more than 11 weeks. 25 patients in Trauma & Orthopaedics, 1

patient in General Surgery, 1patient in Maxillo-facial Surgery and 1 patient in

Gynaecology have been waiting for more than 13 weeks.

Non Elective activity has over performed against internal plan by 6.3%.

Elective activity has under performed against internal plan by 1.3%.

Daycase activity has over performed against internal plan by 2.0%.

2011-12 targets are profiled in calendar and working days.

First GP Outpatient Waiters

0

1000

2000

3000

4000

5000

6000

7000

8000

10-11

11-12

10-11 7105 6659 6789 7124 7102 6661 6785 6022 5702 5445 6119 6678

11-12 6816 6607 6031

A M J J A S O N D J F M

Summary Activity for TrustJune 11/12

0

5000

10000

15000

20000

Sp

ell

s Plan 2011-12

2011-12

2010-11

Plan 2011-12 14046 3575 11873

2011-12 14924 3527 12105

2010-11 14259 4062 12915

Non Elective Elective Daycase

Appendix F

Outpatient activity has under performed against plan by 1.6%.Summary Activity for TrustJune 11/12

0

50000

100000

150000

Att

en

da

nc

es

Plan 2011-12

2011-12

2010-11

Plan 2011-12 129092 4248

2011-12 126241 4975

2010-11 130434 4283

Outpatient OPP



27th

July 2011


Subject: UHCW Operational Performance Report for the Period 1 April 11 to 30June 2011

Report By: Mr A Jones Acting Chief Finance OfficerAuthor: Mr Simon Reed Head of Performance ManagementAccountable Executive Director: Mr A Jones Acting Chief Finance Officer

GLOSSARY

Abbreviation In FullDoH Department of HealthUHCW University Hospitals Coventry and WarwickshireSHAs Strategic Health AuthoritiesPCTs Primary Care Trusts



TitleApprox. Length


To inform the Trust Board of Trust performance against national targets and key performance indicators for theperiod 1 April 2011 to 30 June 2011.


Performance against the Monitor Compliance Framework:

PERIOD April 2011 May 2011 June 2011 Quarter OneRATING Green Amber/Red Amber/Red Amber/Green

Performance against the NHS Performance Framework

PERIOD April 2011 May 2011 June 2011 Quarter OneRATING Performing Performing Performing Performing


TARGETS IN EXCEPTION

Performance against the time to treatment in department (median wait) – data quality measuretarget

Performance against the two week wait from referral to date first seen for symptomatic breastpatients target

Performance against the C-diff target

TARGETS POSING A CHALLENGE FOR 2011/12



27th

July 2011


Performance against the total time in A&E – 95% of patients should be seen within four hours target Performance against the total time in A&E (95th Percentile wait) target Performance against the time to initial assessment (95th percentile wait) target Performance against the time to treatment in department (median wait) target Performance against the delayed transfers of care target Performance against the MRSA target


The Trust Board are asked to agree to the revised format of the performance report and agree that anExecutive version will be presented to Trust Board on a monthly basis and a detailed version to Finance &Performance Committee on a monthly basis.

Trust Board are asked to endorse the following key actions being undertaken by management to addressthe exceptions highlighted in the report:

o Time to treatment in department (median wait) – data quality measure target: work is ongoingthroughout the Trust to improve the data quality in order to meet the required DH standard

o Two week wait from referral to date first seen for symptomatic breast patients target: The service isworking with the Access Team to proactively manage patients through the care pathway

o C-diff target: The C-Diff performance group continues to oversee performance Trust Board are asked to endorse actions being undertaken by management to address the challenging

targets highlighted in Section 4 of the report

IMPLICATIONS:

Financial: Financial penalties may be applied by PCTs if 2011/12 CQUIN and QualitySchedule targets and standards are not achieved. The worst case scenariois 2% of the 2011/12 contract value for Quality Schedule targets andstandards and 1.5% of the contract value for not achieving the CQUINtargets.


Governance: Performance against the Monitor Compliance Framework rating will impacton the trusts ability to move forward with its Foundation Trust application.

Performance against the DoH Performance Framework rating has significantconsequences for the Trust Board, if UHCW is rated as ‘Underperforming’ forthree consecutive quarters.

Legal: None identified

REVIEW:


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PERFORMANCE REPORT JUNE 2011

1. EXECUTE SUMMARY OF PERFORMANCE

An executive version of the 2011/12 Performance Report will be presented to Trust Board on amonthly basis and a detailed version of the report will be presented regularly to the Finance &Performance Committee (which is a sub-committee of the Trust Board). The executive version ofthe Performance Report will highlight performance against the two national performanceframeworks:

2011/12 Monitor Compliance Framework 2011/12 Department of Health NHS Performance Framework

The Performance Report will highlight targets in exception against required thresholds (Section 3)and targets which will pose the University Hospitals of Coventry and Warwickshire a challenge todeliver in 2011/12 (Section 4)

1.1. Monitor Compliance Framework Rating

Section 2 of this report shows monitoring by UHCW for June 2011 against the Monitor ComplianceFramework Indicators. Table 1 below provides the Trust’s assessment for the Monitor ComplianceFramework rating, based on the current level of performance.

Table 1PERIOD April 2011 May 2011 June 2011 Quarter 1RATING Green Amber/Red Amber/Red Amber/Green

If a target in the Monitor Compliance Framework is failed by a Trust a weighted penalty is levied byMonitor. The risk ratings above are based on the sum of the penalties against the thresholds inTable 2 below (a low penalty score is good)

Table 2Rating ScoreGreen < 1.0Amber-Green ≥ 1.0 and < 2.0Amber-Red ≥ 2.0 and < 4.0Red ≥ 4.0

1.2. Department of Health NHS Performance Framework Rating

The NHS Performance Framework Implementation Guidance sets out the Department of Health’s(DoH) approach to supporting Strategic Health Authorities (SHAs) and Primary Care Trusts(PCTs) to identify and tackle poor performance of NHS providers (non Foundation Trusts).

Organisations will be measured against a series of indicators, categorised under the two keydomains below:

Finance Quality of Services

The lowest score across these domains will determine the overall organisations performancecategory, which is based on a three point scale of: Performing, Performance under Review orUnderperforming, and the subsequent level of intervention and escalation.

Under the escalation process organisations with a rating of Underperforming for threeconsecutive quarters could be deemed as challenged.

Performance of Acute Trusts is communicated in the DoH publication The Quarter.

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Section 2 of this report shows monitoring by UHCW for June 2011 against the NHS PerformanceFramework Indicators in the Integrated Performance Measures domain. Table 3 below providesthe Trust’s assessment for the NHS Performance Framework rating, based on the current level ofperformance.

Table 3PERIOD April 2011 May 2011 June 2011 Quarter OneRATING Performing Performing Performing Performing

The DoH applies a score of 3 if a Trust achieves the “Performing” threshold specified for eachtarget, a score of 2 if a Trust fails against the “Performing” threshold but achieves the“Underperforming” threshold and 0 for failing a target. The ratings above are based on a weightedaverage of these scores against the thresholds in Table 4 below (a high score is good).

Table 4Rating ScorePerforming ≥ 2.4 Performance under review ≥ 2.1 and < 2.4Underperforming < 2.1

2. SNAPSHOT PERFORMANCE AGAINST TARGETS

Table 5 below shows a snapshot of performance against key targets. Where a target is inexception, the target number is preceded with a letter “E” and further commentary is provided inSection 3. Where a target is considered to be a significant challenge (although not in exception),the target number is preceded with a letter “C” and further commentary is provided in Section 4.

Table 5

NO TARGET

2011/1

2M

ON

ITO

RC

OM

PL

IAN

CE

FR

AM

EW

OR

K

2011/1

2N

HS

PE

RF

OR

MA

NC

EF

RA

ME

WO

RK

THRES-HOLD

JUNE-11(Quarter

One)

TR

EN

D(3

)

RAG RISK (4)

E1Clostridium Difficile – meeting theClostridium Difficile objective

0 22 R High

C2MRSA – meeting the MRSAobjective

0 1 G High

3Cancer: two week wait fromreferral to date first seen for allcancers (1)

≥ 93% 94.51% G Low

E4

Cancer: two week wait fromreferral to date first seen forsymptomatic breast patients(cancer not initially suspected) (1)

≥ 93% 90.79% R High

5All cancers: 31-day wait fromdiagnosis to first treatment (1) ≥ 96% 99.45% G Low

6All cancers: 31-day wait forsecond or subsequent treatmentfor surgery (1)

≥ 94% 100.00% G Low

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NO TARGET

2011/1

2M

ON

ITO

RC

OM

PL

IAN

CE

FR

AM

EW

OR

K

2011/1

2N

HS

PE

RF

OR

MA

NC

EF

RA

ME

WO

RK

THRES-HOLD

JUNE-11(Quarter

One)

TR

EN

D(3

)

RAG RISK (4)

7All cancers: 31-day wait forsecond or subsequent treatmentfor anti cancer drug treatments (1)

≥ 98% 100.00% G Low

8All cancers: 31-day wait forsecond or subsequent treatmentfor radiotherapy (1)

≥ 94% 98.52% G Low

9All cancers: 62-day wait for firsttreatment for urgent GP referral totreatment (1)

≥ 85% 85.33% G Low

10All cancers: 62-day wait for firsttreatment for consultant screeningservice referral (1)

≥ 90% 100.00% G Low

11All cancers: 62-day wait for firsttreatment for hospital specialist (1) ≥ 85% 81.82% A Medium

C12 RTT – admitted – 95th percentile (1) ≤ 23

weeks20.70 G High

C13RTT – non-admitted – 95th

percentile (1) ≤ 18.3 weeks

16.70 G High

C14RTT – incomplete – 95th percentile(1)

≤ 28 weeks

21.00 G High

C15RTT – admitted – 90% in 18weeks (1) ≥ 90% 93.21% G High

C16RTT – non-admitted – 95% in 18weeks (1) ≥ 95% 96.77% G High

C17Total time in A&E – 95% ofpatients should be seen withinfour hours

≥ 95% 95.09% G High

C18 Total time in A&E (95th percentile) ≤ 240

minutes240 G High

19Time to initial assessment (dataquality) (2) ≤ 5% 0.07% G Low

C20Time to initial assessment (95th

percentile) (2) ≤ 15

minutesN/A N/A High

E21Time to treatment in department(data quality) (2) ≤ 5% 34.62% R High

C22Time to treatment in department(median) (2)

≤ 60 minutes

N/A N/A High

23Unplanned reattendance rate(data quality) (2) ≤ 5% 0.00% G Low

24 Unplanned reattendance rate (2) ≤ 5% N/A N/A Low

25Left department without beingseen rate (data quality) (2) ≤ 5% 0.00% G Low

26Left department without beingseen rate (2) ≤ 5% N/A N/A Low

27 Cancelled Operations – breaches ≤ 5% 0.64% G Low

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NO TARGET

2011/1

2M

ON

ITO

RC

OM

PL

IAN

CE

FR

AM

EW

OR

K

2011/1

2N

HS

PE

RF

OR

MA

NC

EF

RA

ME

WO

RK

THRES-HOLD

JUNE-11(Quarter

One)

TR

EN

D(3

)

RAG RISK (4)

of 28 days readmission guaranteeas % of cancelled operations

28Patients that have spent morethan 90% of their stay in hospitalon a stroke unit

≥ 80% 88.69% G Medium

29 Stroke indicator (TBC) TBC N/A N/A N/AC30 Delayed transfers of care ≤ 3.5% 4.94% A High

31

Certification against compliancewith requirements regardingaccess to healthcare for peoplewith a learning disability

Comp-liance

N/A N/A Medium

Notes(1) Due to validation processes undertaken against this target the reported information is for theprevious month(2) For Quarter 1 the data completeness/quality measure will apply for the NHS PerformanceFramework. From Quarter 2 the NHS Performance Framework measure will be the same as theMonitor Compliance Framework Measure(3) Trend Key:

Improving performance

Performance remaining the same

Deteriorating performance(4) Risk Key:

HighDelivery of target assessed as high risk through regular performancemanagement meetings

MediumDelivery of target assessed as medium risk through regular performancemanagement meetings

LowDelivery of target assessed as low risk through regular performancemanagement meetings

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3. EXCEPTION REPORTS

The following indicators have been assessed as red across the two performance frameworks (seeSection 2).

INDICATORS REQUIRING IMPROVEMENT KEY ACTIONS/COMMENTS

This indicator is in exception in the followingperformance framework:

o 2011/12 Monitor ComplianceFramework

In June 2011 there were 9 C-Diff infections inUHCW. This is 2 infections or 28.6% abovethe trajectory of 7 for June 2011. Year-to-date, there have been 22 C-Diff infections.This is 1 or 4.8% above the cumulativetrajectory of 21 for the period 1 April 2011 to30 June 2011.

ACTIONS:

E1: C Diff

TRUST LEVEL - NUMBER OF C-DIFF INFECTIONS

0

50

100

Ap

r-1

1

Ma

y-1

1

Ju

n-1

1

Ju

l-1

1

Au

g-1

1

Se

p-1

1

Oc

t-1

1

No

v-1

1

De

c-1

1

Ja

n-1

2

Fe

b-1

2

Ma

r-1

2Number of monthly C-DiffInfections

Number of cumulative C-DiffInfections

TRUST CUMULATIVETARGET (Denominator)

Immediate remedial action plans whichreviewed cleaning, training and infectioncontrol practices have been implemented onappropriate wards. C-Diff performance groupcontinues to oversee performance


o 2011/12 NHS PerformanceFramework

The DH has confirmed that a datacompleteness/data quality measure will beused to monitor performance against thistarget for Quarter 1 2011/12

Historically the time to treatment has not beenrecorded however, during June 2011, therewere 1,457 out of 14,333 attendances wherethe time to treatment was unknown. This dataquality measure equates to 10.2% for June2011 and 34.6% for the year-to-date. This is29.6% above the target of 5% however, thisdemonstrates a marked improvement inperformance since April and May.

ACTIONS:

E21: Time to treatment in department(median wait) – data quality measure

%of A&E Attendances where The Time Unitl Seen/Treatment Is Unknown

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

Dec

-11

Jan

-12

Feb

-12

Mar

-12

Month

%U

nkn

ow

n Month %

YTD %

Target <= 5%

Awareness and teaching sessions haveoccurred for staff within Emergency Medicineand Acute Medicine and these areas havealso been working with other specialities whoadmit a number of emergency patientsdirectly (primarily Gynaecology andOphthalmology) as their patients will alsoaffect the 5% threshold. Within theEmergency Department all staff have beenwritten to individually outlining theirresponsibilities in relation to all the newquality indicators.

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INDICATORS REQUIRING IMPROVEMENT KEY ACTIONS/COMMENTS

Work is ongoing throughout the Trust toimprove the data quality in order to meet therequired DH standard

Actions were implemented fully towards theend of May. The Trust will continue to drivethese changes to further push the data qualityissues down below 5%. However, thisrepresents a significant progression thatmany trusts are still struggling with


o 2011/12 Monitor ComplianceFramework

During May 2011 there were 11 out of 124symptomatic breast patients who were notseen within two weeks. This equates to91.13% or 1.87% below the National targetthat at least 93% of patients will be seenwithin two weeks. Year-to-date, 217 out of239 patients (90.79%) were seen within twoweeks. This is 2.21% below the Nationaltarget.

ACTIONS:

E4: Cancer: two week wait from referral todate first seen for symptomatic breastpatients

DIVISIONAL LEVEL - PERCENTAGE OF PATIENTS SEEN WITHIN

2 WEEKS WHEN URGENTLY REFERRED BY THEIR GP WITH

BREAST SYMPTOMS

0102030405060708090

100

Apr-

11

May

-11

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Jan-1

2

Feb-1

2

Mar-

12

%

% Month % Cumulative TRUST TARGET %

The service is working with the Access teamto proactively manage patients through thecare pathway to offer patients an appointmentwithin 7 days of urgent GP referral.

4. CHALLENGESIn addition to the targets which are in exception (as discussed in Section 3 above), the followingtargets are considered to pose a challenge for the Trust to deliver during 2011/12:

Indicators Key Actions/Comments

Delivery against the five, 18-week, referral-to-treatment targets will pose a challenge forUHCW to deliver during 2011/12. These are:

o RTT – admitted – 95th percentileo RTT – non-admitted – 95th percentileo RTT – incomplete – 95th percentileo RTT – admitted – 90% in 18 weekso RTT – non-admitted – 95% in 18

weeks

ACTIONS:

18-week targets (C12, C13, C14, C15 andC16)

Additional short-term capacity has beenidentified and plans have been agreed for thelonger term to deliver these targets

C17: Total time in A&E – 95% of patientsshould be seen within four hours

During June 2011, 13,698 patients out of14,479 attendances at A&E were seen within4 hours. This means that UHCW’sperformance was at 94.61% for June or0.39% below the target of 95%. However,year-to-date, 41,878 or 95.09% patients out of

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44,039 were seen within 4 hours andtherefore UHCW achieved the target for thefirst quarter of 2011/12

ACTIONS:

UHCW 4hr Breach Performance

70.00

75.00

80.00

85.00

90.00

95.00

100.00

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

Dec

-11

Jan

-12

Feb

-12

Mar

-12

Month

%N

on

Bre

ac

h

UHCW % Month

UHCW % Cumulative

TRUST TARGET %

A Joint Action Plan between UHCW and theArden Cluster PCTs is being developed toimprove patient flow and therefore supportdelivery against this target.

During June 2011, the 95th percentile totalwaiting time for all A&E attendances was 260minutes. This is 20 minutes above the targetof 240 minutes (4 hours). However, the 95th

percentile for Quarter One was at 240minutes. Performance for June can bebroken down further to show that the 95th

percentile wait for non-admitted patients was232 minutes. This was 8 minutes below thetarget. However, the 95th percentile wait foradmitted patients was 436 minutes. This was196 minutes above the target.

Performance management of this measurewill start from Quarter Two. However, forQuarter One the data completeness/qualitymeasure will be performance managed whichUHCW is achieving.

ACTIONS:

C18: Total Time in A&E (95th Percentile)

%of A&E Attendances where The Time Unitl Seen/Treatment Is Unknown

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

Dec

-11

Jan

-12

Feb

-12

Mar

-12

Month

%U

nkn

ow

n Month %

YTD %

Target <= 5%


During June 2011 the 95th percentile waitingtime to initial assessment was 18 minutes.This is 3 minutes above the target of 15minutes.

Performance management of this measurewill start from Quarter Two. However, forQuarter One the data completeness/qualitymeasure will be performance managed whichUHCW is achieving.

ACTIONS:

C20: Time to initial assessment (95th

percentile)95th Percentile Time Until Triage for Ambulance Arrivals

0

2

4

6

8

10

12

14

16

18

20

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

Dec

-11

Jan

-12

Feb

-12

Mar

-12

Month

95

thP

erce

nti

leTi

me

95th Percentile

Target <= 15 mins

Active Triage Management is beingimplemented to improve performance againstthis target.

C22: Time to treatment in department(median)

During June 2011 the median waiting time totreatment in the Department was 62 minutes.This was 2 minutes above the target of 60minutes.

Performance management of this measurewill start from Quarter Two. However, forQuarter One the data completeness/qualitymeasure will be performance managed (see

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E21)

ACTIONS:

Median Wait Until Seen/Treatment for A&E Attendances

0

10

20

30

40

50

60

70

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

Dec

-11

Jan

-12

Feb

-12

Mar

-12

Month

Med

ian

Wa

it

Median

Target <= 60 mins

Data quality against this target is beingimproved and staff are receivingcommunication to highlight the importance ofrecording the time to treatment

During June 2011 there were 211 or 5.45%delayed transfers of care out of 3,875admissions. This is 1.95% above the targetof 3.5%. Year-to-date, there have been 621or 4.94% delayed transfers of care out of12,567 admissions. This is 1.44% above thetarget of 3.5% but below the underperformingthreshold of 5% by 0.06% and therefore thistarget has an amber performance rating

ACTIONS:

C30: Delayed transfers of careTRUST LEVEL - DELAYED TRANSFERS OF CARE AS A PERCENTAGE OF ADMISSIONS

0.00

1.00

2.00

3.00

4.00

5.00

6.00

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r-1

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%

% Month % Cumulative TRUST TARGET %


During June 2011, there were no MRSAbacteraemia Infections and year-to-date therehas been only 1 case. The cumulative targetfor June 2011 was 1. This target isconsidered to be a challenge because thetarget for the whole of 2011/12 is only 4MRSA cases.

ACTIONS:

C2: MRSA

TRUST LEVEL - NUMBER OF MRSA BACTERAEMIA

0

2

4

6

8

10

Ap

r-1

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Number of monthlyMRSA bacteraemiasInfections

Number of cumulative MRSA bacteraemiasInfections

TRUST CUMULATIVE TARGET (Denominator)

Delivery against this target is being closelymonitored by the Infection Control Team andthe Divisions

5. RECOMMENDATIONS

The Trust Board are asked to agree to the revised format of the performance report and agree that anExecutive version will be presented to Trust Board on a monthly basis and a detailed version to Finance& Performance Committee on a monthly basis.

Trust Board are asked to endorse the following key actions being undertaken by management toaddress the exceptions highlighted in the report:

o Time to treatment in department (median wait) – data quality measure target: work is ongoingthroughout the Trust to improve the data quality in order to meet the required DH standard

o Two week wait from referral to date first seen for symptomatic breast patients target: The serviceis working with the Access Team to proactively manage patients through the care pathway

o C-diff target: The C-Diff performance group continues to oversee performance Trust Board are asked to endorse actions being undertaken by management to address the challenging

targets highlighted in Section 4 of the report



27th July 2011


Subject: Minutes of Audit Committee meeting 9th May 2011 (approved)Report By: Mr T Robinson, Non-Executive DirectorAuthor: Mrs S Bence, Senior Finance ManagerAccountable Executive Director: Mr Al Jones, Chief Finance Officer

GLOSSARY

Abbreviation In FullPFI Private finance initiative



TitleApprox. Length


To update the Trust Board on the meeting of the Audit Committee 9th May 2011 (approved).


The key issues raised at the 9th

May meeting were:-o Follow up reports were received in respect of risk management; security arrangements; consultant job

planning; health and safety management arrangements; health tourism and the recovery of accommodationcharges. Where appropriate, a follow up report or briefing is required at a subsequent meeting of the AuditCommittee to ensure implementation of the required actions;

o The Committee reviewed the accounting policy to be used in the annual accounts 2010/11 in relation to thetreatment of value added tax on the PFI asset; the draft statement on internal control and the draft goingconcern report relating to 2010/11;

o The Committee reviewed the counter fraud annual report for 2010/11 and the proposed plan for 2011/12;o The Internal Audit year end report and audit opinion for 2010/11 were reviewed;o The Committee received 1 report from Internal Audit which had a significant level of assurance;o The Trust’s external auditors presented the progress report for the audit of the 2010/11 annual accounts.

The report highlighted a number of key points in relation to the interim audit including those relating to thelifecycle costs for PFI medical equipment. The Committee was also asked to consider the Charitable Fundsaudit plan for 2010/11;

o The Committee considered the first draft of the standing financial instructions and scheme of reservationand delegation for foundation status;

o There was no private meeting with the auditors on this occasion.



27th July 2011



Where risks were identified through limited assurance internal audit reports, a progress report hasbeen requested for the next meeting of the Audit Committee which includes the following:-o None identified on this occasion.


It is recommended that the Trust Board review and note the approved minutes of the scheduled AuditCommittee meeting held on the 9

thMay 2011

IMPLICATIONS:

Financial: N/A


Governance: The Audit Committee continues to seek assurance that risk is appropriatelymanaged and controlled within the organisation.

Legal: N/A

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee Remuneration CommitteeFinance and Performance Committee Executive MeetingAudit Committee 04/07/11



27th

July 2011


Subject: Audit Committee report 6th June 2011Report By: Mr T Robinson, Non-Executive DirectorAuthor: Mrs S Bence, Senior Finance ManagerAccountable Executive Director: Mr A Jones, Chief Finance Officer

GLOSSARY

Abbreviation In FullSIC Statement on Internal ControlCRL Capital Resource LimitEFL External Financing Limit



TitleApprox. Length


To update the Trust Board on the extra-ordinary meeting of the Audit Committee 6th June 2011 (approved).


The key issues discussed at the 6th

June meeting were:-

Members of the committee confirmed that they had received a detailed report on the Trust’s accountsfrom the Trust’s finance team in a meeting prior to the formal Audit Committee

It was noted that the Trust had met its key financial duties to breakeven and to remain with its externalfinancing limit (EFL) and its capital resource limit (CRL). It was noted that the requirement to achieve a3.5% cost of capital absorption rate was missed because of a late change in accounting guidance issuedby the Department of Health

The committee received the External Auditor’s report to those charged with governance in relation to theannual report and accounts for 2010/11

The committee debated the progress made in identifying schemes to deliver the Trust’s savings target for2011/12 which would be reviewed again at a meeting of the Finance and Performance Committee on 27June 2011

The committee considered the going concern report prepared by the Trust in support of its annualaccounts and agreed that the accounts should be prepared on that basis

The committee reviewed the Trust’s Quality Account for 2010/11.

The Audit Committee agreed to: Confirm that the annual accounts should be prepared on a going concern basis Approve the updated Statement on Internal Control for inclusion with the annual accounts Approve the Remuneration Report for inclusion in the annual report Approve the proposal to recommend the Quality Account to the Trust Board and Recommend the adoption of the annual accounts (including the Statement on Internal Control) to the

Trust Board at its meeting later on the 6th June 2011.



27th

July 2011



None


It is recommended that the Trust Board review and note the approved minutes of the extraordinary AuditCommittee meeting held on the 6

thJune 2011 for the sole purpose of reviewing the annual report and accounts

and quality account and recommending their adoption to the Trust Board.

IMPLICATIONS:

Financial: The annual accounts record the financial performance of the Trust for thefinancial year and demonstrate the achievement of key financial targets


Governance: The Audit Committee is required to review the annual accounts (including theSIC) and the external auditor’s report before recommending their adoption by theTrust Board. In addition it is good practice for the Audit Committee to review theQuality Account.

Legal: Production of the annual accounts and examination by the external auditor is astatutory requirement.

REVIEW:

Trust Standing Committee Date Trust Standing Committee DateQuality Governance Committee Remuneration CommitteeFinance and Performance Committee Executive MeetingAudit Committee 04/07/11



27th

July 2011


Subject: Patient Story – Impressions return and Patient Opinion postingReport By: Janet White, Director of Engagement & Foundation Trust Project

Director & Jill Foster, Acting Chief Nursing OfficerAuthor: Patients’ own storiesAccountable Executive Director: Christine Watts, Chief Marketing Officer

GLOSSARY




TitleApprox. Length


In line with good practice as outlined in The Intelligent Board – Patient Experience and following the Mid Staffreport, and as agreed previously by the Board, a patient story is to be provided periodically to the Board.Depending on the particular patient story, this may take a variety of formats including; film, face to face, readingof a patient letter and verbatim comments from impressions. This report will be presented verbally at the TrustBoard meeting.


We will share, in a patient’s own words, their experience on a specific ward.The issues around privacy, dignity and safe care will be highlighted.Immediate actions taken by the Trust will be described as the level of care delivered was not acceptable &lessons have been learned.Follow up actions to ensure a repeat does not happen can also be described/discussed.


Patient privacy & dignityPatient safetyStaff awarenessMechanisms established to prevent reoccurrence


For noting and assurance of effective preventative action

IMPLICATIONS:

Financial: None


Governance: Patient stories form part of good governance around the patient experience

Legal: None



27th

July 2011


REVIEW:



REPORT TO THE TRUST BOARD: PUBLIC27

thJuly 2011


Subject: Patient Engagement & Experience

Report By: Christine Watts, Chief Marketing Officer

Author: Janet White, Director of Engagement & Foundation Trust ProjectDirector

Accountable Executive Director: Christine Watts, Chief Marketing Officer

GLOSSARY

Abbreviation In FullPEEG Patient Engagement & Experience Group

DDA Disability Discrimination ActUH University Hospital

FT Foundation Trust

CEO Chief Executive OfficerCSB Clinical Sciences BuildingPFI Private Finance Initiative



TitleApprox. Length


To keep the Board updated on activities associated with our patient experience work as per the strategypresented at the Board Seminar in August 2010.


A selection of activities are reported here, by way of an update to the last report and in line with the reportsto the Quality Governance Committee

This is because it is impractical to report on the whole programme of work in a single report. Future reports will focus on other items of interest within the Engagement Directorate’s activities.


Non-delivery against future plans (by UHCW or external partners) External changes to priorities Resource constraints


None – for noting


REPORT TO THE TRUST BOARD: PUBLIC27

thJuly 2011


STRATEGIC PRIORITIES (please tick all that apply)

IMPLICATIONS:

Financial: Cost associated with activities have either already been agreed or can be metfrom existing budgets.

HR / Equality & Diversity: DDA compliance

Governance: Embedding of the Patient Experience and Engagement Group into theappropriate governance pathway, alongside additional activities, to bring us in toline with best practice around the governance of patient experience.

Legal: None

REVIEW:


Delivering safe, high quality and evidence based patient careDeveloping excellence in research, innovation and educationImproving the business and service frameworkBuilding a positive reputation and identity

Patient Engagement & ExperienceProgress Report

July 2011

Complaints reporting In line with the new reporting and governance arrangements for patient safety, a complaints report is now to go to the Patient Safety

Committee, alongside quarterly complaints reporting to the Trust Board as part of the Quality Dashboard report and any complaints reportsto the PEEG and Quality Governance Committee.

Patient feedback issues Recent feedback via a posting on patient opinion and Impressions returns have indicated an issue with “toileting” practices. This case forms the basis of the Board patient story. This trend has been raised with the Acting Chief Nurse and appropriate action has been taken to raise awareness around acceptable

practice, investigate further and take appropriate action where necessary. We shall continue to monitor patient postings and Impressions returns for similar issues over the next few months to check the actions

taken have been effective.

Access Audit An audit against the DDA requirements was conducted in 2010. Actions were signed off at the end of 2010. Most actions have been completed (e.g. dropped curbs, access improvements). All high risk actions at Hospital of St Cross had been completed. 2 areas remain outstanding at UH- High contrast internal colour schemes (differentiation between floors and walls, walls and doors etc. using highlighting colours). Current

colour contrasts are not satisfactory and can cause confusion to patients with mental or visual impairments- Improved signage- Colour schemes will be picked up via incorporation into the hospital lifecycle programme and the colours chosen will be approved by

PEEG- Signage will be costly and will take some time to scope, plan and put into place so it has been agreed that it will be taken up with the

Director of Estates for incorporation into longer term plans/budgets

Patients’ Council Patients’ Council membership has dwindled somewhat and is no longer representative. The council is valued by the Trust and has proved a good sounding board and source of feedback on many issues. There is to be a recruitment drive including FT members to increase numbers and widen representation within the Patients’ Council. This is important, as we do not include a patients’ constituency in our FT Constitution, as we have a Patients’ Council, so we must make

sure it is as effective as possible. Director of Engagement is to attend a future Council meeting to explain our FT application progress and arrangements for Members and

Governors going forward, providing reassurance around the Patients’ Council’s on-going role. CEO will attend a Council meeting once recruitment drive is underway.

PictoCom launch The launch of the communications tool for patients with communications and/or language difficulties has been launched with an event that

was attended by representatives of trust staff, local authority staff, local community representatives and staff from other NHS Trusts. This is joint venture with the company who helped us develop the tool and future sales will bring income into the Trust. The PictoCom folder is being rolled out across the Trust. A stand (funded by the commercial partner) at the NHS Confederation Conference proved successful, attracting much interest from other

NHS organisations.

Better Patient Environment Car parking- Extensive communications activity around new parking charges announcement- Information available for staff and patients/visitors- Positive feed back so far Seating- Outdoor seating is ordered and should be installed in late July/early August- This has been funded by the UHCW charity- Seats will be to the rear and front of CSB Wheelchair provision- Despite all the improvements thus far, we continue to receive negative feedback about wheelchair provision from patients, carers, staff

and volunteers- Addition wheelchair stations (internal) have been identified and signage will be installed shortly Bereavement facilities (UH)- This is now well underway with funding being provided by UHCW Charity- Sponsorship is being sought but any promotional or acknowledgement material will be discreet and appropriate- Décor, furnishings and room dressings have been selected in accordance with Enhancing the Healing Environment principles- A folder of information to support bereaved relatives is being produced. A CD of the information within it will also be available for those

who cannot easily access the written information and ensuring we meet DDA requirements. Dementia facilities (forget me not lounge) at UH- Work on this is on schedule- 3 artists are involved- The memory lane facility, leading up to the lounge, is to be called Forget me Not way- Again the artworks, style, layout, décor and furnishings are in accordance with Enhancing the Healing Environment principles- Preparations for the opening and conference in December are on track Better Patient Environment work plan- Several other areas of the UH site have either been identified, or have approached us, for development or refurbishment using

Enhancing the Healing Environment principles- Examples include the Discharge Lounge, Cardiothoracic waiting area, side entrance (ambulance and staff) to UH- To ensure focus and proper completion of projects, a work plan is to be developed, so rolling programme of work can be established- Discussions are being initiated around embedding the Enhancing the Healing Environment principles into the Trust, working with our

PFI partners, to ensure future refurbishments meet the highest standards in this respect

1

TFA document

Supporting all NHS Trusts to achieve NHS Foundation Trust status by April 2014

Tripartite Formal Agreement between:

− University Hospitals Coventry & Warwickshire NHS Trust − NHS West Midlands − Department of Health

Introduction This tripartite formal agreement (TFA) confirms the commitments being made by the NHS Trust, their Strategic Health Authority (SHA) and the Department of Health (DH) that will enable achievement of NHS Foundation Trust (FT) status before April 2014. Specifically the TFA confirms the date (Part 1 of the agreement) when the NHS Trust will submit their “FT ready” application to DH to begin their formal assessment towards achievement of FT status. The organisations signing up to this agreement are confirming their commitment to the actions required by signing in part 2a. The signatories for each organisation are as follows:

NHS Trust – Andrew Hardy, Chief Executive Officer SHA – Ian Cumming, Chief Executive Officer DH – Ian Dalton, Managing Director of Provider Development

Prior to signing, NHS Trust CEOs should have discussed the proposed application date with their Board to confirm support. In addition the lead commissioner for the Trust will sign to agree support of the process and timescales set out in the agreement. The information provided in this agreement does not replace the SHA assurance processes that underpin the development of FT applicants. The agreed actions of all SHAs will be taken over by the National Health Service

2

Trust Development Authority (NTDA)1 when they take on the SHA provider development functions. The objective of the TFA is to identify the key strategic and operational issues facing each NHS Trust (Part 4) and the actions required at local, regional and national level to address these (Parts 5, 6 and 7). Part 8 of the agreement covers the key milestones that will need to be achieved to enable the FT application to be submitted to the date set out in part 1 of the agreement. Standards required to achieve FT status The establishment of a TFA for each NHS Trust does not change, or reduce in any way, the requirements needed to achieve FT status. That is, the same exacting standards around quality of services, governance and finance will continue to need to be met, at all stages of the process, to achieve FT status. The purpose of the TFA for each NHS Trust is to provide clarity and focus on the issues to be addressed to meet the standards required to achieve FT status. The TFA should align with the local QIPP agenda. Alongside development activities being undertaken to take forward each NHS Trust to FT status by April 2014, the quality of services will be further strengthened. Achieving FT status and delivering quality services are mutually supportive. The Department of Health is improving its assessment of quality. Monitor has also been reviewing its measurement of quality in their assessment and governance risk ratings. To remove any focus from quality healthcare provision in this interim period would completely undermine the wider objectives of all NHS Trusts achieving FT status, to establish autonomous and sustainable providers best equipped and enabled to provide the best quality services for patients.

1 NTDA previously known as the Provider Development Authority – the name change is

proposed to better reflect their role with NHS Trusts only.

3

Part 1 - Date when NHS foundation trust application will be submitted to Department of Health

October 2011

Part 2a - Signatories to agreements By signing this agreement the following signatories are formally confirming:

− their agreement with the issues identified; − their agreement with the actions and milestones detailed to support

achievement of the date identified in part 1; − their agreement with the obligations they, and the other signatories, are

committing to; as covered in this agreement.

Andrew Hardy Chief Executive Officer University Hospitals Coventry and Warwickshire NHS Trust

Signature Date: 25 May 2011

Ian Cumming OBE Chief Executive NHS West Midlands

Signature

Date: 25 May 2011

Name, Job Title (Ian Dalton)

Signature

Date: 8 July 2011

Part 2b – Commissioner agreement In signing, the lead commissioner for the Trust is agreeing to support the process and timescales set out in the agreement.

Stephen Jones Chief Executive of Arden Cluster

Signature

Date: 25 May 2011

4

Part 3 – NHS Trust summary

Short summary of services provided, geographical/demographical information, main commissioners and organisation history.

Required information Current CQC registration (and any conditions): Registered without conditions Financial data (figures for 2010/11 should to be based on latest forecast)

2009/10 £m

2010/11** £m

Total income 465.2 472.0

EBITDA 55.9 49.8

Operating surplus\deficit* 10.2 3.3

CIP target 14.9 25.0

CIP achieved recurrent 12.9 22.9

CIP achieved non-recurrent 0 0

*Breakeven performance adjusted for impairments and IFRIC 12 **Based on draft accounts The NHS Trust’s main commissioners See below: NHS Coventry NHS Warwickshire West Midlands Specialised Commissioning Group Summary of PFI schemes (if material) At the end of December 2002 we signed a PFI contract to finance and build the new University Hospital in Coventry and also provide certain equipment, hard facilities management and soft facilities management services to both the University Hospital and the existing Hospital of St Cross. We took possession of the new hospital in July 2006 and are proud to provide such a top quality facility for our community.

The primary PFI contractor is Coventry and Rugby Hospital Company (CRHC or often known as Project Co.) which owns the building and subcontracts the provision of non-clinical support services to:

• ISS Mediclean Limited – (Soft Facilities Management)

• Skanska Facilities Services – (Hard Facilities Management).

• Skanska Construction – (Construction)

• GE Medical Systems – (Equipment provider).

The primary term of the contract is 37 years; in December 2042 the ownership of the hospital will be transferred in full to UHCW.

The unitary payment is an expenditure charge of approximately £69 million per annum, payable quarterly in advance.

Further information UHCW is located in the West Midlands and is one of the largest teaching hospitals in England housing one of the UK’s largest PFI hospitals. It provides both general acute hospital services to approximately 500,000 people from Coventry and Rugby and tertiary/specialist hospital services to over one million people from Coventry, Warwickshire and beyond (mainly West Midlands but also including Leicestershire and Northamptonshire). The University Hospital in Coventry is one of the most modern healthcare facilities in Western Europe, whilst the Hospital of St Cross in Rugby is important in sustaining a local service to local people.

5

In 2009/10 the Trust employed 5,942 staff (WTE), managed 1,362 beds (1,077 inpatient beds and 142 day case beds at University Hospital and 143 beds at the Hospital of St Cross) and 32 operating theatres. It had a turnover of £465 million and a retained surplus of £158,000 (after impairments). Approximately 94% of referrals originated from within Coventry and Warwickshire with c.59% of referrals from NHS Coventry. For 2010/11 NHS Coventry hold the contract for themselves and Associates, which include all other remaining West Midlands PCTs plus Northamptonshire PCT, Leicestershire County and Rutland PCT and Leicester City PCT. NHS Warwickshire holds a separate contract. The West Midlands Specialised Commissioning Group is our coordinating commissioner for specialised services, co-ordinating the contract on behalf of all the West Midlands PCTs and the four West Midlands LCCBs. The other main Associate to this contract is the East Midlands Specialised Commissioning Group. In total, the value of our healthcare contracts in 2010/11 is £369 million with Coventry and Warwickshire acute and specialised services commissioners being responsible for 88% of our contract income. The Trust has had a programme/project management approach to its FT application for two years, with an established FT Office and a Foundation Trust Project Director, supported by a dedicated FT Finance Manager and Membership Manager, alongside administrative support. An FT Steering Committee, chaired by the Chief Executive Officer and that includes all Trust Executive Directors, the Trust’s Solicitor, Trust Board Secretary and SHA representation has been in operation and will continue, overseeing all aspects of the Trust’s FT application work. A project team, populated by appropriate business work stream leads and clinical leads for Medical, Nursing and other Healthcare professions has been in place similarly. The Trust’s Chief Executive Officer is the Executive Lead for the FT Project. All usual programme management tools (timelines, programme and project plans with appropriate dependencies and milestones identified, risk & issue logs, appropriate action plans, communications and engagement plans & logs etc. etc.) have been and will continue to be utilised. There is monthly reporting to the public session of the Trust Board and updated, RAG rated action plans, with mitigation actions where necessary, go to all Board members on a fortnightly basis.

6

Part 4 – Key issues to be addressed by NHS trust

Key issues affecting NHS Trust achieving FT

Strategic and local health economy issues Service reconfigurations

Site reconfigurations and closures Integration of community services

Not clinically or financially viable in current form Local health economy sustainability issues

Contracting arrangements

Financial Current financial Position

Level of efficiencies / QIPP PFI plans and affordability

Other Capital Plans and Estate issues Loan Debt

Working Capital and Liquidity

Quality and Performance Quality and clinical governance issues

Service performance issues

Governance and Leadership Board capacity and capability, and non-

executive support

7

Please provide any further relevant local information in relation to the key issues to be addressed by the NHS Trust: Service reconfigurations The management of paediatric services at GEH is in the process of being transferred to the UHCW Trust during early 2011/12 but this is only a short-term solution. NHS clinicians in Coventry and Warwickshire are looking at new longer-term service models to provide a high quality, sustainable, accessible women’s and children’s service for Coventry and Warwickshire, which offers patient choice. The Trust needs to make sure any additional risks to UHCW arising as a result are minimised and any issues identified by due diligence exercises are addressed. Commissioning Strategy/intentions Local commissioners are developing a new clinical service strategy, the implications of which will need to be taken into account. The SLA between the PCT and Trust is nearing agreement. In the event that an agreement is not achieved then this will impact on the FT timeline. Level of efficiencies/QIPP The Trust has a CIP requirement of £28m for 2011/12 which it is currently working to define. This is significantly larger than the 4% defined in the operating framework for a number of reasons. This represents a significant challenge for 2011/12. PFI Plans and Affordability Our liquidity is currently susceptible to movements in PFI balance sheet charges, specifically the short term PFI finance lease creditor, that are out of the Trust’s control. These movements occur as a direct consequence of adopting IFRS. This is likely to require a solution specific to all Trusts with PFIs that will need national co-ordination. The adoption of IFRS meant increased depreciation and PDC charges for the Trust. The relatively fixed nature of the Unitary Payment means that the Trust has a reduced cost base to target for efficiency meaning finding further CIPs is challenging. Our PFI Unitary Payment is due quarterly in advance which causes a high cash requirement at these times. Other Capital Plans and Estate issues There are currently a number of pre-commitments on the Trust’s internally generated funds:

• Working Capital and Capital Investment Loan repayments

• PFI finance lease principal repayments

• PFI life-cycling costs This means there are reduced internally generated funds to spend on other capital projects. Loan Debt The Trust currently has two outstanding loans that have helped to maintain liquidity in prior years :

• Working Capital Loan

• £4m outstanding as at 31st March 2011

• Loan fully paid as at 31st March 2013

• Capital Investment Loan

• £12.75m outstanding as at 31st March 2011

• Loan fully paid as at 31st March 2020

Working Capital and Liquidity Liquidity is currently forecast to improve in 2011/12 due to asset sales and balance sheet movements.

8

Part 5 – NHS Trust actions required

Key actions to be taken by NHS Trust to support delivery of date in part 1 of agreement

Strategic and local health economy issues Integration of community services

Financial

Current financial position

CIPs

Other capital and estate Plans

Quality and Performance Local / regional QIPP

Service Performance

Quality and clinical governance

Governance and Leadership

Board Development

Other key actions to be taken (please provide detail below)

9

Describe what actions the Board is taking to assure themselves that they are maintaining and improving quality of care for patients.

• Board Assurance Framework in place

• Incident and risk management processes embedded in the organisation

• Board reporting programme includes Quality and Patient Safety reports and quality is on every agenda

• Board approve the Quality Account

• Board is carrying out the Quality Governance Framework Assessment

• Trust regularly participates in national audits and action from surveys

• Board members regularly take part in patient safety walk-arounds

• Patient stories told at Trust Board Please provide any further relevant local information in relation to the key actions to be taken by the NHS Trust with an identified lead and delivery dates:

• Management transfer of GEH paediatric services The management of the paediatric services at GEH is in the process of being transferred to the Trust during early 2011/12 and NHS Warwickshire will be going to public consultation during spring 2011 on the delivery of these services in the future. The aim of these changes is to provide a high quality, sustainable, accessible women’s and children’s service for Coventry and Warwickshire, which offers patient choice.

The Trust needs to make sure any additional risks to UHCW, from the management transfer and any subsequent changes are minimised and any issues identified by due diligence exercises are addressed. Chief Executive Officer is identified lead. Timescale is to be agreed with NHS Warwickshire post public consultation.

• Appointment and development of Chief Finance Officer The recent selection and interview process for a Chief Finance Officer did not result in an appointment. A key action for the Trust is to appoint into this post as soon as possible and then complete appropriate development for that individual. Chief HR Officer is identified lead. Timescale is CFO appointed by Q2 2011/12.

• PFI payments The Trust needs to work to ensure the current arrangement with commissioners, that allows the Trust make these payments, continues with the advent of GP Consortia, in order to fulfil its Unitary payment obligations. Further work may be required, with regards to this TFA when the result of the national review by DH is available to assess whether it has, and include if necessary, any impact on the milestones within it. Chief Finance Officer is identified lead. Timescale is ongoing and awaiting further clarification around Local Health Economy financial arrangements in the future

10

• Level of Efficiencies/CIPs The Trust needs to put in place appropriate service transformation measures with robust performance management to ensure these efficiencies/CIPs are achieved.

The Trust is pursuing a two pronged approach to CIP delivery involving traditional cost

improvements within clinical divisions and a number of cross-cutting organisation wide

schemes. Progress against delivery will be reported to an Executive Group.

Chief Nursing & Operating Officer is identified lead. Timescale is ongoing throughout the 2011/12 year to enable full and thorough system change and performance management.

• Programme management The Trust will maintain and strengthen as appropriate its programme management approach in respect of actions associated with its FT application.

Chief Executive Officer is identified lead. Timescale is ongoing through to achievement of FT status.

11

Part 6 – SHA actions required

Key actions to be taken by SHA to support delivery of date in part 1 of agreement

Strategic and local health economy issues Local health economy sustainability issues

(including reconfigurations)

Contracting arrangements

Transforming Community Services

Financial CIPs\efficiency

Quality and Performance

Regional and local QIPP

Quality and clinical governance

Service Performance

Governance and Leadership Board development activities

Other key actions to be taken (please provide

detail below)

Please provide any further relevant local information in relation to the key actions to be taken by the SHA with an identified lead and delivery dates.

• The SHA is working closely with the Trust to ensure delivery of its FT trajectory within a challenging financial context within the Arden cluster.

• The SHA is contributing to the national work on PFI and will work with the Trust in resolving the outstanding PFI issues as a result of the national financial review.

12

Part 7 – Supporting activities led by DH

Actions led by DH to support delivery of date in part 1 of agreement

Strategic and local health economy issues Alternative organisational form options

Financial

NHS Trusts with debt

Short/medium term liquidity issues

Current/future PFI schemes

National QIPP workstreams

Governance and Leadership Board development activities

Other key actions to be taken (please provide

detail below

Please provide any further relevant local information in relation to the key actions to be taken by DH with an identified lead and delivery dates: A national financial review of Trusts with a PFI hospital is taking place to gain a common understanding of any issues that might be an obstacle to passing the financial elements of the FT assessment process. The dates contained within the TFA will be subject to the outcome of this review in enabling any issues outlined in this agreement to be resolved.

13

Part 8 – Key milestones to achieve actions identified in parts 5 and 6 to achieve date agreed in part 1

Date Milestone

Completed Consultation (no significant changes so no further consultation required)

May/June 2011 Model for new financial assumptions

June 2011 First draft of refreshed IBP and LTFM

June 2011 Final IBP and LTFM

June 2011 Incorporate results of DH PFI review and remodel as necessary

June 2011 Commissioners’ letters – support for IBP

June/July 2011 SHA Approval review

Q2 2011 FT Quality & Safety Assessment

July/August 2011 Historical Due Diligence refresh (stage 1 & 2)

Q2 2011 Chief Finance Officer in post

September 2011 Board to Board, Recommendation to SHA Exec Board

October 2011 Submission to DH

Provide detail of what the milestones will achieve\solve where this is not immediately obvious. For example, Resolves underlying financial problems – explain what the issue is, the proposed solution and persons\organisations responsible for delivery.

• Progress against plan and timeline is reviewed by the Trust’s FT Steering Committee, chaired by the Trust CEO and where there is a senior SHA presence.

• Reports of FT progress, along with an updated action plan, go the Trust Board monthly.

Describe what actions\sanctions the SHA will take where a milestone is likely to be, or has been missed. The SHA will follow its normal escalation process if an improvement is not achieved and there is a risk to delivery of the trajectory

Key Milestones will be reviewed every quarter, so ideally milestones may be timed to quarter ends, but not if that is going to cause new problems. The milestones agreed in the above table will be monitored by senior DH and SHA leaders until the NTDA takes over formal responsibility for this delivery. Progress against the milestones agreed will be monitored and managed at least quarterly, and more frequent where necessary as determined by the SHA (or NTDA subsequently). Where milestones are not achieved, the existing SHA escalation processes will be used to performance manage the agreement. (This responsibility will transfer to the NTDA once it is formally has the authority).

14

Part 9 – Key risks to delivery Risk Mitigation including named lead

PFI / legacy debt issue not addressed

Some local mitigation possible. Awaiting outcome of DH commissioned review. Chief Finance Officer is lead.

Chief Finance Officer not in post for 6 months prior to Monitor Assessment

Recruitment being progressed as a matter of urgency. Alternative candidates being approached. Chief HR Officer is lead.

Due diligence on Paediatric management transfer identifies significant risks

All parties involved (PCT, UHCW and GEH) work to reduce risk/s being transferred. Chief Operating Officer is lead.

Achievement of required levels of efficiencies

Appropriate service transformation measures with robust performance management. Chief Nursing & Operating Officer is lead.

Impact of Commissioning Strategy/intentions

The preparation and agreement of the commissioning strategy will be clinically led through the Arden Cluster Clinical Senate. This will therefore involve UHCW as a key major stakeholder in its formulation and agreement. This strategy will require public consultation and the full support of stakeholders. UHCW`s internal planning processes will proactively influence the agreement of the strategy and will then ensure UHCW`s internal Annual Plan is updated to ensure continued compliance with quality standards and financial duties. This Arden Cluster strategic review is not a short term project and the earliest implementation date will be April 2013; giving time to prepare and implement revised UHCW plans. Chief Executive Officer is the lead. In the event that the current SLA is not agreed between the Trust and Commissioners this will impact on the FT timeline. Mitigation: Trust CEO to Commissioner CEO negotiations scheduled for 4/4/11. SHA arbitration if necessary.



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Trust board/templates/header sheet (public) version 3 – March 2011

Subject: Foundation Trust Project

Report By: Andrew Hardy, Chief Executive Officer

Author: Janet White, Director of Engagement & Foundation Trust ProjectDirector

Accountable Executive Director: Andrew Hardy, Chief Executive Officer

GLOSSARY

Abbreviation In FullPCT Primary Care TrustIBP Integrated Business PlanCF Compliance FrameworkSHA Strategic Health AuthorityHDD Historic Due DiligenceAGM Annual General MeetingFT SC Foundation Trust Steering CommitteeFT Foundation TrustCEO Chief Executive OfficerCHRO Chief Human Resources OfficerCMgO Chief Marketing OfficerLTFM Long Term Financial ModelDH Department of HealthPFI Private Finance InitiativeSoS Secretary of StateLHE Local Health EconomyCIP Cost Improvement ProgrammeLTSM Long Term Sustainability ModelPWC Price Waterhouse CooperQs QuartersCIPs Cost Improvement Programmes



TitleApprox. Length


To provide an update on the progress and timeline for Foundation Trust status application.

To provide Board members with a copy of our Ft application Tripartite Formal Agreement with DH and SHA.

To formally record the distribution of the refreshed FT Integrated Business Plan (IBP) to Boardmembers for their information, and in preparation for the Board development activities over the comingweeks.


Current progress and priorities for the coming month Updated timeline



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July 2011



Changes to assessment criteria Assessment period is longer than 3 months UHCW fails to meet national targets Fail to demonstrate to Monitor that Trust is on a sound financial footing for FT status Board development is not completed and Board are not performing as if an FT and so to SHA

satisfaction Changes in make up of Board & timely appointment of substantive CFO Management of labour spend over the next 5 years Do not gain formal commissioner support from PCTs DH review of PFI issues does not report until end of June Local commissioners are developing a new clinical service strategy


None – for noting only

IMPLICATIONS:

Financial: Importance of achievement of CIPs

HR / Equality & Diversity: Recruitment of a representative and diverse membership

Governance: Earliest date of achieving Foundation Trust status is Q3 of 2011/12

Legal: Legal constitution and completion of necessary assessment phases

REVIEW:


Foundation Trust Project11th July 2011 for July 2011 Trust Board

Progress since last report Planning activities & IBP- LTFM, IBP and supporting documentation submitted to SHA on 28th June. IBP sent to Cluster. Electronic

copies sent to Exec Directors. Bound hardcopies to be available w/c 11th July. Finance/LTFM – Month 2 figures adjusted in line with SHA recommendations in LTFM before submission of IBP. This has improved our

financial risk ratings. HDD/IBP CF action plan – Latest update of action plan completed and circulated. Membership campaign and public communications – Issue 5 of newsletter going out. Market stalls at AGM being organised. Youth

Council activities commences (see membership report). Risks and Issues log – Updated with risks identified at last FT SC and team meetings. All FT risks updated on Datix. Board development – Feedback on Board observations by SHA provided to Chairman and CEO. Board development programme

agreed. Tripartite Formal Agreement – This has had further modifications following suggestions from DH. Copy attached for Board

information. Governance – PWC work is completed and we have their feedback.

Priorities for coming month. IBP activities – Respond to SHA questions and requests for further information. Conform and challenge meeting with Commissioners

prior to production of Cluster letter of support. Finance – Perform against CIPs. HDD refresh - Planning and preparation for HDD refresh in mid-August. Quality Governance Assessment – Action planning following PWC report and planning and for SHA visit and assessment on 17th

August. Board development – Plan agreed with Deloitte and in place. Actions against SHA feedback underway. Communications & membership– AGM Market stalls, planning and preparation for next newsletter.

Current red risks Changes to assessment criteria - May impact on achievability of planned timescales Assessment period is longer than 3 months - Will not achieve FT Status for April 2012 UHCW fails to meet national targets - FT application will not go ahead Fail to demonstrate to Monitor that Trust is on a sound financial footing for FT status - FT application will not go ahead Board development is not completed to SHA satisfaction - Will not achieve FT Status for Q1 2012/13 Changes in make up of Board & timely appointment of substantive CFO Management of labour spend over the next 5 years due to the uncertain economic climate and the period of NHS financial austerity. Do not gain formal commissioner support from PCTs - FT application will not go ahead Local commissioners are developing a new clinical service strategy – implications for FT application are not yet known DH review of PFI issues does not report until end of July – impact on our timeline

TimelineCurrent/Future actions Completed actions

Key stages Timing CommentsBoard development Phase 1 April – June 09

Phase 2 January 2010 onwardsPhase 3 Late 10 onwards

2011

Deloitte workBoard to Board with SHA.Board development sessionsBoard to Board with DeloitteBuild on feedback from external NHS organisationRevisit previous board development programme (audit trail and records)Self assessmentDeloitte to provide external supportNew Board development programmeAccommodate recent and future Board changes

GeneralCommunications

Phase 1 - April– September 09(Awareness)Phase 2 – Sept - December(Consultation & membershiprecruitment)Phase 3 – January 2010 onwards(Recruitment and management)Summer 10 onwards2011End Sept 11End Dec 11Jan – Feb 2012

Q1 2012/13

JNCC in April and monthly onwards, staff communications starting in May with Team Brief and ongoing throughout the applicationprocess, public communications starting in late September with launch of consultation.Consultation activities Sept – Dec 09.Communication of consultation outcome - Dec 09/Jan 10.

Ongoing - See monthly membership reports and members’ newsletters.

Staff communication via InTouch and Chat with the ChiefMore intensive staff communication and clinical engagementAnnounce SHA decisionAnnounce SoS sign off and Monitor involvement/assessmentGovernor elections – Minimal 40 day process. Cannot start until after SoS approval. So this date dependant on SoS sign off at end ofDec 2011.Earliest possible date for authorisation.

IBP preparation April - Dec 09

Jan– April 10

May – July 10

Summer 10

Dec10Dec 10 (before Christmas)Jan 11 – Feb 11June 11June 11Late May/early June 11Mid June 11Late June 11JulyJuly

Including reiterations after SHA feedback and post consultation. Also following PCT strategic reviews during Summer 09 and PCTconfirmation of activity assumptions and service developments during October 09. This has been delayed and discussions are ongoingwith PCTs.HDD Phase 2 version of IBP to SHA by beginning of January 10.Final iteration of IBP to SHA by 15th March 10.Locked-down IBP and assurance documentation to SHA by 29th March for SHA to put in their Board papers on 13th April for theirApril Board meeting.Updating for full year figures and 09 -10 accounts, outcomes of further modelling with Commissioners and strengthening of riskchapter. SHA advise cannot go back to their Board until end July.Further work postponed due to liquidity issues, awaiting SHA/DH/Monitor decision of potential fix for this, otherwise must wait until20011/12.Produce and agree plan for IBP rewriteLetter from CEO to PCT CEOs setting out expectations around timeline, milestones and work requiredWork on content (not dependant on contracts /LTSMs– money & activity)Updated IBP (delayed from March because of delay in agreeing contracts with commissioners)Activity and money agreed (contracts year 1 ; LTSMs years 2 to 4; future forecast years 5 to 10)LTFM modelling, financial elements, activity, risk and service development contentDraft of updated IBP to Trust Board members for informationSubmission to SHAPCT sign off, PCT letters of supportRedraft and discuss with PCTs and SHA

Consultation Sept – Dec 09Jan 10March 10June 11July 11

CompletedReport to SHA & HDD teamDH Consultation and staff engagement and Governance templates went to SHAReview and revise DH Consultation and staff engagement and Governance templatesResubmit completed templates to SHA

Membershiprecruitment &engagement

Staff June 09 onwardsPublic Sept 09 onwards

Spring 10 onwardsSept 10Dec 10Dec 10

Jan 11April 11 onwardsOct –Dec 11Jan - Feb 12

Review at end of consultation and do targeted recruitment and road shows if necessary. Review monthly ongoing.Membership communications – Welcome letters/packs Oct/Nov 09 onwards, Newsletter - March 10 and ongoing quarterly,membership events Summer 2010. Engagement opportunities Jan 10 onwards. Achieved end of 2010 target of 5000 public membersduring late April 10. Event involving members (patient information postcard workshop) on 5th July.Ongoing members involvement.Members’ eventMembers’ eventReview and revise governor term dates in constitution and timings of annual membership targets (due to 1 year’s slippage inapplication process)Repeat initial Members’ eventOngoing targeted recruitment and programme of engagementGovernor election preparationsElections

Historical DueDiligence &QualityGovernanceAssessment

Phase 1 Oct –Feb 10, Phase 2Jan 10Actions Jan 10 onwardsDec 10

Jan 11August 2011August 11

Phases 1 & 2 completed.Action plan completion Dec 09 through to authorisation.

Assess risk of a repeat HDD being necessary given. If so, could add 2 – 3 months to timeline. Revisit and update HDD actions in actionplan.SHA decision on HDD refreshQuality Governance Assessment (Moved from June by SHA)HDD refresh (TBC by SHA)

Formal SHAassessment

July 09 to end July 10

Early 2011

Jan 2011April – August 11

June/July 11Sept 11

IBP went to SHA by 15th March, locked-down IBP, LTFM and all other assurance documentation went to SHA by 29th March.Application did not go to SHA Board on 24th April. Next available SHA slot for consideration at end July. Cancelled due to liquidityrating issue.Assess risk of affect on timeline of any dip in performance over last 3 months. SHA to use LHE LTSM for additional assurance.Self assessments to SHA.Locked-down IBP, LTFM and all other assurance documentation to SHA by late June. Need to factor in time for clinical qualityassessment by SHA clinical team , completed further modelling and editing IBP to satisfaction of commissioners and SHA scrutinyand HDD refresh, action planning and adequate progress, before papers go to SHA Board for formal consideration.The SHA still advises 6 weeks to consider/prepare all papers and put to their Board in Sept 2011.SHA recommend to SHA Board and 2nd Board to Board

SHA approval End of Sept 11 Dependant on Quality Governance Assessment outcome and progress against action plan, HDD refresh risk outcome and progressagainst action plan, PCTs delivering contracting work and letters of support to timeline, Board capacity & capability/developmentprogress, performance and financial assurances.

DH submission Oct 11 Papers need submitting 6 weeks before applications committee to allow for NHS Medical Director consideration of clinicalquality/performance issues.

SoS approval Dec 11 Applications Committee pass the application to SoS (usually) within 2 weeks who will then ask Monitor to assess the Trust – Monitorwill then batch and start the assessment.

Monitor batchingand assessment

Jan - March 12 Minimum of 3 months for assessment post-batching process but experience would suggest that a Trust with a PFI would require amore intensive assessment from Monitor and this can take up to 6 months (4 months allowed in this timeline).

Authorisation Q1 2012/13 Dependent on length of Monitor assessment and outcome.Operating as FT Q1 2012/13 First of calendar month following authorisation. This reflects a realistic length of Monitor assessment.

Board development Phase 1 April – June 09Phase 2 January 2010 onwardsPhase 3 Late 10 onwards

Throughout 2011

Deloitte workBoard to Board with SHA.Board development sessionsBoard to Board with DeloitteBuild on feedback from external NHS organisationRevisit previous board development programme (audit trail and records)Self assessmentDeloitte to provide external supportNew Board development programmeAccommodate recent and future Board changes



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July 2011


Subject: Freedom of Information requestsReport By: Mrs J Midgley, Head of Legal DepartmentAuthor: Mrs J Midgley, Head of Legal DepartmentAccountable Executive Director: Mr A Hardy, Chief Executive Officer

GLOSSARY

Abbreviation In FullFOIA Freedom of Information Act



TitleApprox. Length


To advise on FOIA requests and compliance for May 2011.


The Trust received 30 requests and answered all within the 20 day period.


As above


To be noted

IMPLICATIONS:

Financial: None


Governance: As noted

Legal: As noted



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July 2011


REVIEW:


1

FREEDOM OF INFORMATION REPORT TO TRUST BOARD FOR PERIODMay 2011

The Freedom of Information Act 2000 affords a general right of access to informationheld by public authorities subject to a number of exemptions.

Number of requests received

The Act came into effect on 1st January 2005. For the first three years the number ofrequests received by the Trust averaged 50 per year. In 2008 the number ofrequests totalled 138, rising in 2009 to 249. The Trust received 272 requests in2010.

Compliance

Requests should be responded to within 20 working days, although extensions canbe granted in certain circumstances. For the last month that deadline was met in allcases.

Source of request

In the last month period 30 requests were received, broken down as:9 - Media10 - Private11 - Companies

Complaints/Appeals

One complaint has been made to the Information Commissioner’s office, which iscurrently investigating the matter.

Trust-wide Staff Awareness and Training

As part of the Trust wide Information Governance programme, training sessions forall staff groups are scheduled throughout the year to ensure that staff are aware ofthe relevant aspects of the Freedom of Information Act.

Summary

The Trust adopts the spirit and the letter of the Freedom of Information Act and seeksto disclose as much information as it can, whilst at the same time having due regardto the necessary constraints imposed by the Act’s exemptions. It is recognised withinthe Trust that whilst the number and nature of the requests imposes a significant andincreasing burden upon resources, it does serve to build public trust in publicauthorities and affords greater public accountability.

The Trust Board are asked to note the report.

Julie MidgleyHead of Legal Department - July 2011



27th

July 2011


Subject: Information and Communication Technologies (ICT) ReportReport By: Mrs C Watts – Chief Marketing OfficerAuthor: Mr R Arnold – Director of ICTAccountable Executive Director: Mrs C Watts – Chief Marketing Officer

GLOSSARY

Abbreviation In FullICT Information and communication technologiesPCT Primary Care TrustCSCA Computer Sciences Corporation AlliancePFI Private Finance InitiativePAS Patient administration systemPACS Picture archiving and communication system (typically used for Radiology imaging)LIMS Laboratory information management system (Pathology)



TitleApprox. Length


To note the progress of ICT developments at the Trust, in the local health community and nationally.


A new Trust ICT strategy will need to be in place for 2012/14. The development of this is underway. The ICT project portfolio for 2011/12 has been agreed. This may need to be reviewed to include

emerging projects. The ICT Services team play an important role in supporting ICT at the Trust. Clinical care is

increasingly dependent on good and resilient IT. ICT leads in the local health community agree that more use should be made of data sharing to

underpin clinical care, and of joint procurements to reduce costs. Christine Connelly, the NHS Chief Information Officer, has resigned. She will be replaced by Katie

Davies from the Cabinet Office. Robin Arnold has joined the Trust as Director of ICT. He joins us from the Department of Health, having

worked previously on the National Programme for IT and at two other acute trusts.


The ICT technology refresh expenditure has not yet been agreed. This may affect key systems and projectsincluding the Clinical Results Reporting System (CRRS).



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July 2011



To note progress.

IMPLICATIONS:

Financial: Many of the projects listed in the body of the ICT report will provide opportunitiesfor cash releasing benefits. These must be driven out by stronger local(departmental) ownership of projects and IT systems

HR / Equality & Diversity:

Governance: Information governance will be enhanced through the improved identification ofstaff, and amendments to the ICT Security Policy.

Legal:

REVIEW:




27th

July 2011

Page 1 of 4

ICT Report – July 2011

Strategy

The Trust’s current ICT strategy covers the period from 2009 to 2011. In building astrategy for 2012/4, two of the core components will be to describe how we will implementan electronic patient record system to support patient care at the Trust, and how we willuse IT to enable shared clinical services across the health community. There are optionsfor both. Options and recommendations for the electronic record component will bedeveloped during the summer and presented as part of the ICT report in October. Thesecond component will be subject to discussion and agreement across the local healthcommunity. Another emerging theme is to encourage departmental leadership of ICTprojects and local ownership of ICT systems. This will help establish, and drive out, thebenefits of these projects and systems.

It is anticipated that the Trust’s ICT strategy for 2012/14 will form part of the ICT report atthe Board meeting in January 2012.

Programmes

ICT will deliver an extensive portfolio of projects in 2011/12. This will include fourteenmajor schemes, as set out below.

Title Description UpdateBlood Tracking Introduction of a system to

support blood tracking inline with Europeanlegislation.

This project is requiring significantlymore effort than originallyanticipated. This is principally due tothe high risk nature of the processesinvolved.

Digital Dictation A computerised dictationsystem to support cliniciansand their secretarial teamsto improve the efficiency ofthe production of clinicalletters.

The system has been piloted. Thefeedback from users has beenextremely positive. The findings arecurrently being evaluated and thebusiness case is being updated.

GP and CommunityCommunications

This will provide electronictransfer of clinical letters,including dischargesummaries, to GPs

This project is in partnership withCoventry PCT. The project is beingimplemented now.

PatientAdministrationSystem (PAS)upgrade

This upgrade will introducea number of fixes for knownproblems in the currentversion of the software

A date has yet to be confirmed forthis upgrade, as it is subject toagreement with George EliotHospital and Coventry PCT.

Hospital at Night(Task Management)

Enables clinical tasks to berecorded and distributedelectronically to clinical staff,and then tracked tocompletion.

The system has been demonstratedto the project’s clinical leads andaccepted by them. Animplementation plan is beingprepared.



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Page 2 of 4

E-Rostering Computer support for nurserostering.

The project has been extended untilthe end of the financial year toinclude bank staffing.

Electronic PatientRecord

Introduction of an electronicrecord to support clinicalcare

The development and appraisal ofthe Trust’s options is underway.Discussions have opened withsuppliers and NHS colleagues todevelop more detail on these options

WirelessInfrastructureUpgrade

Upgrade to the Trustwireless infrastructure toimprove coverage, and toenable mobile telephonywithin Trust buildings.

The team are working with Estates toidentify and cost the work requiredby Skanska. A business case isbeing prepared.

Web ContentManagement

Introduce new webtechnology to improve theTrust’s web services, suchas the Trust intranet.

A business case has beensubmitted. A procurement exercise isunderway, and a preferred supplierexpected to be identified by August.

Theatres systemupgrade

Introduces a number ofenhancements, includingsupport for materialsmanagement and bar codescanning

This project has been completed.

Multi-disciplinaryteam (MDT) support(Dendrite upgrade)

Software to supportimprovement to multi-disciplinary team meetings.This software also supportsmandatory reportingrequirements for Oncology,Stroke and Cardiacservices.

The project is underway. Thesoftware will be introduced to twoMDTs as a pilot, with full roll out tobe delivered by the IMPaCT serviceimprovement team.

Chaplaincy andBereavement(Ulysses)

Software to supportchaplaincy andbereavement services

A governance issue has been raisedregarding chaplaincy access to Trustpatient administration records. Thesystem will not now be connected tothe PAS until this can be resolved.

Gate 1 Self service kiosks forpatients attending outpatientclinics. This will improvepatient experience and thequality of patient data heldby the Trust.

The programme is being set up, anda business case is being prepared.The team are specifying the Trust’srequirements prior to these being putout to tender.

Oncology Expansion An extension of theoncology system intoWorcestershire to supportthe Trust’s oncology servicethere. This project willinclude an upgrade of theoncology system.

This is a low intensity, long durationproject.



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Page 3 of 4

Two of the Trust’s major systems, Radiology imaging (PACS) and the Pathologyinformation system (LIMS), are due for replacement in 2013. These projects will need tobe underway soon to ensure delivery by the contract end dates. Both projects are likely tobe the subject of collaboration with local health community partners.

Other projects that may also need to be considered are those for Maternity andOphthalmology, and the use of electronic prescribing across the Trust.

These five potential projects will be prioritized by the Trust’s Information and ICTCommittee against existing commitments and resources available.

Key Risk – Currently there is no funding for this year’s ICT technology refresh. Thisrefresh includes key items such as addition capacity for the Trust’s Clinical ResultsReporting System (CRRS) and underpins several of the projects listed above. This isbeing raised through the Capital Planning Review Group.

ServicesThe ICT Services team support computer users in every area of the Trust. In addition tothe day to day activity of resolving issues logged by users each section is deliveringimprovements to the way in which the ICT support service is delivered.

The ICT Service Desk team has just completed a software upgrade to include moreadvanced features, such as call queuing and real time reporting. The new software alsoenables customer surveys to be conducted. The first of these was sent to over 600 people.The results have shown a positive appreciation for the work of the Services team.However there was a request that the ICT Service Desk was available for more of eachday to support an increasing clinical dependence on IT systems. The Service Deskreceives over 4800 calls per month. The engineering support team that visit users toresolve computer problems across the Trust take over 2000 of these calls.

The ICT Training team completed over 7300 episodes of training for Trust staff during2010/11. The team also now support both Coventry and North Warwickshire GPs in theuse of the Clinical Results Reporting System (CRRS) and Radiology imaging (PACS).Much of the team’s resource has been dedicated over the past few months to the deliveryof the Information Governance Training toolkit which is now a mandatory requirement forall NHS staff each year.

The Information Governance team have been working closely with Human Resources tointroduce user identity management to the Electronic Staff Record (ESR) system, inaccordance with national guidance. This will help ensure that only authorised people haveaccess to Trust systems. A review of the ICT Security Policy is currently underway to pickup all of the new guidelines and technologies that have been introduced recently. This willinclude the encryption of emails and other electronic data transfers, and mobile working.

The major activity for the Voice (telephony) team has been the replacement of thetelephone switch at Rugby St Cross. This has been a significant programme of work whichhas also delivered new infrastructure cabling to the Rugby site providing faster networkconnections for all users. The team are also reviewing the use of mobile devices such asphones and long range pagers to take back those not being used. These voice services



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Page 4 of 4

fall within the remit of the PFI providers but it appears that mobile devices have not beenmanaged, and the Trust is paying for many units not being used. To date 68 mobile phoneaccounts have been ceased, and over 200 pagers have been identified as inactive.

Local Health CommunityAs part of his induction tour, Robin Arnold has met with a number of ICT leads within thelocal community, including Colin Bexley, the PCT Chief Information Officer. There isagreement that more use should be made of ICT to underpin clinical services across thecommunity, working both horizontally with other acute providers, and vertically with GPs,and other care services. The George Eliot NHS Trust team is also keen to explore withUHCW joint procurements and implementation of ICT systems to reduce overall costs.

National PictureChristine Connelly, Director General Informatics and NHS Chief Information Officer, hasresigned her post and will leave in September 2011. Katie Davis from the Cabinet Officewill replace her in an interim role. Katie had previously worked with Accenture and theNational Programme for IT, and is known to NHS IT colleagues. Amongst her immediatechallenges will be to agree, or not, changes to the CSCA contract with the NHS in theNorth, Midlands and East of England. It is possible that she may decide to dissolve thecontract, given her Cabinet Office background and any brief she may bring from there.This could leave the Trust marginally exposed on its Patient Administration and MaternityInformation systems procured under the CSCA contract, but it is unlikely that anydissolution would be undertaken without protection for existing systems.

Katie will also need to have completed and published the NHS information and technologystrategies due originally earlier this year. The Trust ICT Strategy for 2012/4 should bedrafted in the light of these strategies and the Government ICT strategy published earlierthis year.

Robin ArnoldDirector of ICT



27th July 2011


Subject: Public Relations Quarterly ReportReport By: Mrs C Watts, Chief Marketing OfficerAuthor: Mrs C Watts, Chief Marketing OfficerAccountable Executive Director: Mrs C Watts, Chief Marketing Officer

GLOSSARY

Abbreviation In FullNone



TitleApprox. Length


Share our performance relating to public and media relations for February – April 2011


Over the last three months we have managed a range of challenging issues. In addition, during a climate ofnational speculation about NHS cuts, we handled the announcement that savings of around £23m will need tobe made in the next year at UHCW, and hosted an unannounced visit from Labour leader Ed Miliband.

Nevertheless, the effect of these issues, combined with the fact that media relations activities had to besuspended during the pre-election period in Coventry and Warwickshire, has resulted in a lower overall volumeof coverage than in previous quarters.

Highlights include: Channel 4 documentary featuring UHCW’s Dr Richard Wellings on the potential of 3D printing to

revolutionise certain aspects of healthcare

Feature in the Coventry Telegraph about a revolutionary treatment for babies with club feet beingpioneered at UHCW

Promoted the fact that UHCW has been awarded Equality and Diversity Partner status for 2011/12,making it one of 17 partners that will contribute to a programme led by NHS Employers to improveequality and diversity by March 2012

Laurence Wood, Consultant Obstetrician at UHCW, was shortlisted for the ‘Getting Evidence intoPractice’ category of the BMJ Awards, resulting in coverage in the British Medical Journal

Secured coverage of UHCW as a case study for a double-page feature in the HSJ about efforts toimprove patient flow through the cardiology department at UHCW

Coverage in the Coventry Times of the news that nearly all women in Coventry and Warwickshire nowget their cervical screening results within a fortnight since UHCW began a pilot scheme to cut waitingtimes




27th July 2011


Failure to proactively engage and manage public relations including media and online can lead to reputationdamage.


Trust Board to note the contents of the report.

IMPLICATIONS:

Financial: Negative media potentially damages revenues by impacting patient choice

HR / Equality & Diversity: Negative media impacts morale, pride and staff retention

Governance: N/A

Legal: N/A

REVIEW:


University Hospitals Coventry & WarwickshireNHS Trust

Public Relations Activity Report

February – April 2011

2

Contents

01 Objectives and Approach...….………………..………….….

02 Activity for February…….…..………………..….…………...

03 Activity for March...………………………..........…………....

04 Activity for April…..…………………….………..…………....

05 Conclusion………………………………………………….….

06 Appendices…………………………………………………....

3

01 Objectives and Approach

Over the past three months, University Hospitals Coventry & Warwickshire (UHCW) NHS Trust’scommunications team has continued to develop and implement a proactive public relationscampaign. This has three key objectives, to:

1 Build a positive reputation and identity for the Trust2 Position the Trust as delivering excellence in patient care3 Handle issues that may pose a threat to the Trust’s reputation

As part of this process we have created a strong narrative that focuses on our organisationalstrategy and seeks to use clear evidence to illustrate success and achievements of the Trust andour teams.

This report summarises the activity undertaken over the past three months to realise our ambitionand outlines our success to date.

We have continued to highlight the many areas of excellence which set us apart from otherhospital Trusts, identifying comment and feature opportunities in selected media outlets aroundUHCW’s key areas of specialism. Key examples this quarter included the broadcast of a Channel4 documentary about potential healthcare applications of 3D printing, featuring Dr RichardWellings and a double-page spread in Health Service Journal (HSJ) on Anne Mawson, Head ofProductivity Improvement at the Trust.

We have continued to enter national awards as a means of boosting the positive profile of theTrust. Entries based on the case of Steve Nixon, the ‘Man Who Died 28 Times’ were submittedto the ‘Budget Campaign’ category of the CIPR Excellence Awards, and the ‘Best DigitalCampaign’ category of the Digi CorpComms Awards during the past quarter. In March, LaurenceWoods, Consultant Obstetrician at UHCW, was shortlisted for the ‘Getting Evidence into Practice’category of the British Medical Journal (BMJ) Awards.

Over the last three months we have also managed a range of challenging issues includingnegative media coverage over the cost of car parking at the Trust and the assault of twomidwives on the maternity ward.

In addition, during a climate of national speculation about NHS cuts, we handled theannouncement that savings of around £23m will need to be made in the next year at UHCW, andhosted an unannounced visit from Labour leader Ed Miliband.

To meet these challenges we prepared and issued statements to ensure the Trust’s viewpointwas fairly represented and also arranged interviews with key figures from the Trust whereappropriate. We have also been successful in using social media to identify and addressconcerns expressed by patients online (see appendix).

Nevertheless, the effect of these issues, combined with the fact that media relations activities hadto be suspended during the pre-election period in Coventry and Warwickshire, has resulted in alower overall volume of coverage than in previous quarters. Over the next quarter we willcontinue to develop an integrated media relations strategy, supported by digital and social media,to reinforce the long-term positive profile of the Trust.

Highlights:

4

Channel 4 documentary featuring UHCW’s Dr Richard Wellings on the potential of 3Dprinting to revolutionise certain aspects of healthcare

Feature in the Coventry Telegraph about a revolutionary treatment for babies with clubfeet being pioneered at UHCW

Widespread regional coverage about UHCW’s partnership with Worcestershire AcuteHospitals NHS Trust on a new satellite radiotherapy unit in Worcestershire

Hosted a visit by Labour leader Ed Miliband to the Trust on 14 April, during which he metwith hospital staff and patients

Promoted the fact that UHCW has been awarded Equality and Diversity Partner status for2011/12, making it one of 17 partners that will contribute to a programme led by NHSEmployers to improve equality and diversity by March 2012

Laurence Wood, Consultant Obstetrician at UHCW, was shortlisted for the ‘GettingEvidence into Practice’ category of the BMJ Awards, resulting in coverage in the BritishMedical Journal

Held an event at UHCW to recognise 65 long serving staff in roles ranging from surgeryto cleaning who have clocked up 1,600 years of NHS experience between them

Secured coverage of UHCW as a case study for a double-page feature in the HSJ aboutefforts to improve patient flow through the cardiology department at UHCW

Coverage in the Coventry Times of the news that nearly all women in Coventry andWarwickshire now get their cervical screening results within a fortnight since UHCWbegan a pilot scheme to cut waiting times

5

02 Activity for February

Positioned UHCW’s specialists as thought leaders within their fields:

Secured interview for Rina Agrawal, CRM, Obstetrics and Gynaecologist Consultant atUHCW, on BBC Coventry & Warwickshire Radio.

Interview with Dr Richard Wellings and Professor Abrahams on Channel 4 discussinghow 3D printing technology could eventually be used to print off parts of the human bodyand save crucial time in an emergency. The news was also covered by the CoventryTelegraph

Arranged an interview for Sue Montgomery, Embryologist, CRM at UHCW on BBC RadioCoventry & Warwickshire on the importance of sperm donation

Highlighted case studies to demonstrate the dedication and skill of staff at UHCW:

Gained positive coverage of the story of a six month old who was admitted to UHCW withswine flu after being sent home from Leicester’s urgent care centre. The LeicesterMercury reported that Mackenzie was seen at UHCW within five minutes by a paediatricconsultant and admitted within an hour

Secured a feature in the Coventry Telegraph about a treatment for babies with club feetbeing pioneered at UHCW

Publicised a campaign by nurses in UHCW’s paediatric unit to raise money for a patientmade infertile by cystic fibrosis to have fertility treatment which he is too young to receiveon the NHS

Raised awareness of new services available at UHCW:

Publicised the announcement that Worcestershire Acute Hospitals NHS Trust will workwith UHCW to develop a new satellite radiotherapy unit in Worcestershire, leading tocoverage in the Coventry Telegraph, Worcester News and current affairs website TopNews Online

Managed issues affecting the reputation of UHCW:

Responded to a media campaign around car parking charges at UHCW. Arranged aninterview with Richard Kennedy, UHCW’s Chief Medical Officer, with BBC RadioCoventry & Warwickshire to address concerns

Escalated an issue raised via the Rugby Advertiser of patient records from UHCW beingfound in a public litter bin. This issue was raised with the SHA and NHS Warwickshire

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03 Activity for March

Raised the positive profile of the Trust in target media outlets:

Publicised a new one-stop-clinic in Coventry to minimise waiting times between thediagnosis and treatment of prostate cancer. UHCW consultants Kieren Jefferson andDonald MacDonald were quoted in the Coventry Telegraph and Coventry Times

Secured an interview with Andy Hardy on BBC Coventry & Warwickshire regarding theUHCW Baby Care Appeal, his charity of choice for the London Marathon

Gained further coverage of the BBC 3 documentary on Human Papilloma Virus (HPV)screened in January 2011 that featured UHCW consultant Hisham Mehanna. Thedocumentary was also reported in The Lancet

Secured a double-page feature in the Coventry Telegraph about the potential of 3Dprinting to revolutionise healthcare, including comment from Dr Richard Wellings (UHCW)and Dr Greg Gibbons at Warwick Manufacturing School

Raised awareness of key developments in the services available at UHCW:

Monitored patient feedback on patient websites and online forums, including thecomment from one patient on NHS Choices who wrote, “Absolutely the best care anyonecould have wished for. Treated for bowel cancer, pre and post (major) op, could not havebeen better. The NHS I read about in the papers and on sites like this is not the NHS Ihave experienced”

Gained positive coverage in HSJ with comment from UHCW breast care clinical specialistnurses who provide support to patients and their families after discharge from hospital

Engaged with staff to boost internal pride and motivation:

Held an event to recognise long serving staff at UHCW who have clocked up 1,600 yearsof NHS experience between them. The 65 health workers, whose duties range fromsurgery to cleaning, were celebrated at a ceremony in the hospital’s Clinical SciencesBuilding that was covered by the Coventry Telegraph

Raised the positive profile of the Trust by entering national awards:

Laurence Wood, Consultant Obstetrician at UHCW, was shortlisted for the ‘GettingEvidence into Practice’ category of the BMJ Awards, resulting in coverage in the BMJ

UHCW was a finalist in this year’s HSJ awards brochure for the Patient Safety category


Liaised with media following an incident at UHCW in which two midwives were assaultedon the ward. The story was reported in the Daily Mail and the Coventry Telegraph

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04 Activity for April

Publicised UHCW as a case study for a double-page feature in the HSJ. The articlediscussed a programme led by Anne Mawson, Head of Productivity Improvement at theTrust, to improve patient flow through the cardiology department

Secured positive coverage in PSL Group Online of a study conducted by UHCW’sconsultant Satyajit Das and his colleagues on the risk of cardiovascular disease inpatients with HIV

Publicised UHCW cervical screening service in regional media

Engaged with Coventry and Warwickshire residents over the access of healthcareservices bank holiday period by arranging an interview for Gary Ward, Consultant inEmergency Medicine at UHCW, with Mercia Radio

Strengthened UHCW’s profile within the political sphere:

Hosted a visit by Labour leader Ed Miliband to the Trust on 14 April,

Promoted the fact that UHCW has been awarded Equality and Diversity Partner status for2011/12, making it one of 17 partners that will contribute to a programme led by NHSEmployers to improve equality and diversity by March 2012. UHCW’s involvement in theinitiative, was covered by HR Magazine, Equality Law and Health Business UK


Responded to a story in the Coventry Telegraph about a patient who discharged himselfwithout medical approval. Issued a detailed response to clarify why the patient was inhospital for longer than expected and the level of care and treatment he received

Issued an announcement regarding the spending cuts that have to be made by the threeacute hospitals in Coventry and Warwickshire. The statement expressed the Trust’sintention to make the majority of this reduction through efficiency savings

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05 Conclusion

In total, there were 158 mentions of UHCW in media outlets over the past three months. UHCWwas represented in a positive or neutral manner in 106 pieces of media coverage. In comparison,in the last quarter (Nov 2010 - Jan 2011), UHCW was mentioned in 235 media outlets, with 207pieces of media coverage presenting UHCW in a positive or neutral way. In part, the loweroverall number of articles can be attributed to restrictions on media activity during the pre-electionperiod in Coventry and Warwickshire.

Coverage levels were also affected by the high number of potentially damaging issues whichhave arisen during the past quarter. Over the past three months we have successfully developedand implemented strategies to respond to negative coverage around issues such as:

- A series of negative publicity in relation to the cost of car parking at the Trust- The announcement that UHCW will need to make savings of around £23m in the next

year

The breakdown of media coverage for the period February to April 2011 can be found below:

National (6)Positive – 2 pieces of coverageNegative – 4 pieces of coverage

Regional (107)Positive – 67 pieces of coverageNegative – 36 pieces of coverageNeutral – 4 pieces of coverage

Specialist (22)Positive – 17 pieces of coverageNeutral – 3 pieces of coverageNegative – 2 piece of coverage

Broadcast (16)Positive – 10 pieces of coverageNegative – 6 pieces of coverage

Blogs (1)Negative – 1 pieces of coverage

Online (6)Positive – 3 pieces of coverageNegative – 3 pieces of coverage

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Chart to show tenor of media coverage Feb - April

2011

67%

33%

Positive or neutral

Negative

In February, UHCW was covered in 56 media articles with around two thirds of stories beingpositive or neutral. In comparison, Addenbrooke’s was the focus of just 20 articles during themonth of February. This indicates that other major Trusts have also seen a reduction in mediacoverage in recent months.

It is very positive to see that the number of articles appearing in specialist media outlets, such ashealth and employment trade magazines and NHS websites, has more than doubled since lastquarter, from ten articles to 24. This includes mentions in The Lancet, the HSJ, NHS Choicesand HR Magazine. This is very encouraging, as it will help to boost the profile of UHCW its peersand among its key decision makers in the health sector.

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06 Appendices

Twitter Highlights:

Coverage highlights

Publication: Channel 4 NewsDate: 12 February 2011

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At one print shop in London they don't do calendars and wedding invites they trade in threedimensions.

Any 3-D scan or computer drawing of an object can be literally printed off as a single object,no assembly required.

Born out of specialist manufacturing the 3-D Printing is now cheap enough to hit the highstreet.

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A 3-D printer works just like an ordinary inkjet printer, converting a digital file into lines on aflat surface.

Only instead of ink it lays down a solid substance like plastic, metal, or plaster. With each passthe printer adds a layer while the surface moves down. The result: a 3-D object.

3-D printing has now evolved to a point where you can now walk in off the street with any ideayou can imagine and within a matter of hours they can make it real.

Medical value

At the University of Warwick they're printingparts of the human body, including thehuman heart. Using this technology they canreproduce any part of any person's anatomy.

So what start's out virtually as a digital scanon a computer is sent to the 3-D printerwhere it becomes reality that you can hold inyour hands.

For several years engineers at the universityhave been tinkering with the powers of 3-Dprinting.

But late last year the neighbouring hospitalcalled. An accident victim had just arrivedwith a badly crushed pelvis - a lifethreatening injury. They had a simplequestion:

"Could we reproduce for them the pelvis in 3-D that the surgeon could then use to plan hissurgery?"

Dr Greg Gibbons, University of Warwick

Based on a CT scan engineers printed-off a copy of the damaged pelvis - the first time doctorshave used the technology to save crucial time in an emergency.

"What we wanted to see if this could allow the surgeons to understand this, so they could workout where to make the incision and had already planned the operation."

Dr Richard Wellings, University Hospital Coventry

And here in the brand new West Midlands Surgical Training Centre 3-D printing could find apermanent home. Preserved human organs like this heart, used to teach anatomy to surgeons,are very precious objects.

"The idea that we could scan this and make an exact replica means we could make lots of theseand give them to the students for learning."Prof Peter AbrahamsWarwick Medical School

Now doctors and engineers here at Warwick want to replace this 3D printing powder with thechemical constituents of human bone - so they can print perfectly matched bionic components

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to replace broken or damaged bones.

As manufacturers explore new ways to print truly working parts one day it doctors could beprinting spares for the human body.

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Publication: NHS Local OnlineDate: 24 February 2011

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Publication: BMJ OnlineDate: 15 March 2011