FINANCE, PERFORMANCE AND INFORMATION DIRECTORATE INTEGRATED PERFORMANCE MANAGEMENT FRAMEWORK

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1 1. Introduction FINANCE, PERFORMANCE AND INFORMATION DIRECTORATE INTEGRATED PERFORMANCE MANAGEMENT FRAMEWORK Coventry and Warwickshire Partnership NHS Trust (the Trust) recognises that the Integrated Performance Management Framework encompasses performance, safety, quality and service user experience activity and information (hereafter referred to as the Performance Management Framework). This document outlines the Trusts Performance Management Framework for 2016/17 and beyond. The framework will ensure that there is a robust structure in place, across all levels of the organisation, to identify and correct performance issues and ensure delivery of the Trust s strategic aims and objectives. 2. Background The Trust s current Performance Management Framework has been developed over a number of years, taking account of key national recommendations for NHS organisations, including guidance for Trusts that deliver mental health and community health services on how the intelligent use of information can deliver efficient and effective services. Significant publications such as the NHS Performance Framework, and more recently the Monitor Risk Assessment Framework and NHS Outcomes Framework, have influenced the Trust s approach and shape performance reporting and monitoring. In addition, regulatory frameworks such as those used by the CQC, on which the frequency and intensity of inspection are based, have also set the parameters for Trusts to assess whether they are performing to the highest standards of safety and quality, encouraging the use of more sophisticated monitoring and measurement processes. As a result, Early Warning systems and Peer Review procedures are thus now embedded within our Trust s routine governance arrangements. Performance management has, to date, been focussed primarily on establishing the underlying processes and procedures to support robust performance monitoring. Considerable progress has been made to improve the content and quality of performance reports across the Trust and a comprehensive reporting structure has been implemented across all levels of the organisation. This has included: the integrated reporting of performance information with safety and quality information the development of outcomes frameworks and associated outcomes reports enhanced reporting of performance data at Directorate level continued refinement of the Ward and Team to Board reports implementation of the Executive Performance Group and the sub-committee of the Board (the Integrated Performance ) Moving forwards, and in common with many other forward-thinking NHS organisations, the Trust is embarking on an ambitious programme to implement Business Intelligence across all of its key business areas. The benefits of such an approach will be to assist its leaders in making more informed business decisions based on optimised data Performance Management Framework Nov 2015 Page 1 of 11

2 recording and reporting processes and efficient use of analytical resources. Information flows up and down the organisation will continue to be strengthened, so that managers have access to the right information at the right time, with a renewed focus on challenge and accountability at all levels. The implementation of Business Intelligence throughout 2015, as outlined in the Trusts Information and Business Intelligence Strategy, will enable the joining together of key management information from across the business to produce integrated reports that are Consistent, Accurate, Timely, Appropriate and Relevant (Business Intelligence Project Goals, 2014). The priority for the medium term will be to build on this foundation by continuing to instil a culture of performance achievement across all areas of the business. Effective performance management will be the means by which the Trust uses data intelligently to identify performance issues early and respond accordingly, and demonstrate an ability to continually improve. 3. Objectives The Trust recognises that in order to be best in class, to deliver high quality and safe services for less cost, and provide services that meet the needs of clients and the local population, performance management processes must be fit for purpose and consistently embedded across the organisation. It is critical that operational performance is monitored and scrutinised across all levels within the Trust. Without robust management of performance, and a culture of commitment to succeed, efforts to drive continuous improvement will be diminished. A positive performance culture will ensure that behaviours and activities that improve performance are encouraged and acknowledged, resulting in observable and measurable performance improvement. Similarly, those behaviours which restrict or prevent improvement will be discouraged. This Framework describes the processes and structures that underpin our approach, and which will create the environment for achieving the Trust s vision of Improving the wellbeing of the people we serve and being recognised for always doing the best we can.. One of the most important challenges will be to support the Trust s application process for becoming a Foundation Trust. To fulfil requirements of Monitor s Risk Assessment Framework and maintain compliance post- authorisation, there is a need to provide assurance that the Trust has robust management and governance processes, requiring minimal intervention from Monitor (low risk) and the ability to operate as an autonomous organisation. This will include the requirement for: a. Robust processes for self-certification of performance b. Targets and standard performance being reported with clear explanations for areas of underperformance and/or projected future performance expectations c. Addressing performance issues within a reasonable timeframe d. Addressing recommendations within Historical Due Diligence reports The development and implementation of a trust-wide Performance Management Framework will ensure that such scrutiny and review of trust-wide performance can be achieved thereby supporting both the operational and strategic delivery of key performance requirements. Performance Management Framework Nov 2015 Page 2 of 11

3 4. Key Principles A number of key principles have been adopted to support the Trust s approach to delivering effective performance management: a) Reporting levels The two main strands of performance reporting within our organisation are: strategic performance reporting and operational performance reporting Strategy is the remit of the Trust Board, and in developing and implementing a robust strategy, a Trust Board need to be able to: a) set the right level of ambition and communicate those goals widely b) understand which services are performing well and which require improvement c) create an environment of appropriate challenge and holding to account d) understand current and future challenges and plan for those In line with this, operational performance management must be embedded to generate alignment of all Directorates across the Trust, so that all are working together to achieve the organisational objectives. In order to facilitate this, structures exist within the Trust that support both the strategic and operational reporting to the Board, and the comprehensive detail required for management of performance at the operational level. Reporting structures have been designed to accommodate the differing needs of managers at all tiers of the organisation, and the information flow across these levels mirrors the Trust s management and governance structure. This is illustrated in Figure 1 below. Figure 1: Information Flow Holding to Account Performance Management Framework Nov 2015 Page 3 of 11

4 A key aspect of this approach is that operational performance measures are identified at as low a common denominator as possible. Measures made at a team level are summarised to create a service level and can then be further summated, if appropriate, to a directorate level. Directorate level performance measures are then summated to give a Trust-wide picture of performance. Regular reporting and review of key performance indicators occurs at all levels of the Trust. However, there are four main performance reports produced monthly to support the organisation in effectively delivering the performance agenda and these are: Strategic Reporting The Trust s Integrated Performance, Safety, Quality and Service User Experience Report provides a summary of the business critical indicators for the Partnership Trust. It is issued to the Trust Board on a monthly basis in real time. The report highlights key areas of success or concern and actions being taken to address the issues. Performance is also visually displayed in the form of tables and charts which show historic performance and future trends. Operational Reporting Directorate Level The Directorate Performance Scorecard report is the top-level report for monitoring Operational Performance. Following a similar format to the strategic report, it contains performance and quality targets disaggregated to Directorate and Integrated Practice Unit (IPU) level. Its purpose is to provide an insight into the contribution of individual Directorates to performance of the business critical indicators, as well as furnishing the Directorates with performance data more specific to their area of activity. The Performance Outcomes Report contains a range of performance metrics that enable monitoring of the Trust s Outcome Frameworks. The outcome measures include performance indicators already in use across the Trust, together with a range of local indicators designed to monitor service-specific outcomes for patients. The outcome frameworks will continue to be revised and enhanced in line with the implementation of service redesign. This programme of work is supported by a Quality Improvement Goal. The Directorate S&Q Dashboard contains a range of indicators that reflect national, regional and locally derived standards of safety and quality, supporting directorates and IPU management teams to maintain the safe delivery of quality care to patients. These reports are then combined with financial, service line reporting and contracting information to produce a Directorate Integrated Performance Report for the Executive Performance Group Performance Management Framework Nov 2015 Page 4 of 11

5 Ward and Team Level Reporting The Ward and Team 2 Board dashboards and Matron s S&Q Dashboards are a smaller sub-set of the key performance and quality indicators. They are issued in chart and table format to wards and teams across all localities on a monthly basis for display in operational areas. The indicators included within the Ward and Team 2 Board dashboards were agreed in conjunction with the operational services and represent a core set of performance indicators that are considered fundamental to the individual settings. Current reports include performance relating to agency spend, appraisal rate, sickness and absence alongside indicators of activity and efficiency such as length of stay, caseload, and admissions and discharges. The indicators included within the Matron s S&Q Dashboards were agreed in conjunction with the Matrons and Lead Nurses and represent a core set of safety and quality indicators important to local settings. In recognition of the different operational priorities existing within Trusts services, the Ward and Team 2 Board and Matron s S&Q Dashboards will continue to develop so that the indicators remain relevant in the context of the Trust s Transformational Change programme. b) Reporting by Exception A key aspect of the Trust s approach to performance management is the principle of reporting by exception. Exception reporting ensures that significant deviations from expected performance levels are quickly identified and corrective action initiated. Exceptions identifying significant over-performance can also aid the organisation in learning what works well and sharing good practice across teams. This principle is reliant upon managers using information intelligently, and distinguishing between: Issues or indicators that need to be reported routinely to a certain level of detail (Key Performance Indicators); Issues that need to be reported only if there is demonstrably a problem, where performance diverges from agreed tolerances or peer performance; and, Issues that change relatively slowly, therefore merit being looked at on a quarterly or six-monthly basis. To facilitate this approach, key performance indicators at Trust level have been identified and included in the Integrated Performance, Safety, Quality and Service User Experience Report. The content of the report is reviewed at least annually to take account of new and emerging priorities at local and national level, thereby ensuring that the indicators being monitored reflect pertinent areas of the business. In addition, all performance reports at Trust and Directorate levels include exception summaries which highlight any performance indicators falling outside of targeted levels. The exception Performance Management Framework Nov 2015 Page 5 of 11

6 summaries are used to direct discussions by senior managers in holding their direct reports to account. c) Accountability Accountability for performance improvement is dependent upon having clearly assigned responsibilities at all levels of the organisation and measurable outcomes to demonstrate achievement. The Trust regularly reviews the lines of accountability for performance management to ensure consistency and rigour. Strategic accountability within the Trust exists ultimately at Trust Board through the Non Executive Directors holding the Chief Executive and Directors to account via the Board Sub, the Integrated Performance. The Chief Executive and Directors then hold the clinical Directorates to account via the Executive Performance Group. The remit of the Executive Performance Group encompasses the business areas of Estates and Information Technology, to provide increased assurance that the enabling sections of the Trust are providing the expected high levels of support to facilitate operational delivery. Operational accountability takes place at Divisional, Service and Team / Ward level via the Directorate Business Meetings, the Safety and Quality Operational Group and service management team meetings. Within these levels, accountability is assigned to individual managers to deliver performance improvement and this is tested through a combination of performance scrutiny (of reports, dashboards and key management information) and performance review (action planning, implementation and evaluation). The ability to aggregate and disaggregate performance information enables focussing of accountability on areas which require improvement and where objectives are not being met. The Executive Performance Group receives all Directorate level performance and quality information referred to above, in addition to other financial and contracting reports, thereby providing a comprehensive overview of the performance of individual directorates. This suite of reports is used to hold Associate Directors and their management teams to account, through identification of significant issues and assigning responsibility for action. 5. Strategies for Data Quality and Capture In order to provide assurance to the Board and the organisation that the reporting of performance is robust and valid a number of key strategies are employed. a) Glossary To ensure all key performance indicators are reported in line with the technical definitions a Performance Glossary is maintained. This Glossary outlines the following information for key performance indicators contained within the Integrated Performance, Safety, Quality and Service User Experience Report: Description of indicator Numerator Performance Management Framework Nov 2015 Page 6 of 11

7 Denominator Exclusions Rationale for Inclusion Data Source Frequency of Reporting Final Indicator Value Origin of Target RAG Rating Thresholds Consequence of Delayed Achievement Similar glossaries are in place for the Directorate Performance Scorecard and Ward and Team to Board Reports. b) Standard Operating Procedures To provide further assurance to the organisation that all performance indicators are reported in a consistent and robust manner and can be readily replicated, Standard Operating Procedures (SOPs) have been produced to guide the calculation of each indicator. The SOPs identify the data source, method and process of calculation, any data checks that are required and key personnel involved in the reporting process. These are designed to be understood by any member of staff and are key reference documents in the reporting process. Ready access to these documents has been created through their inclusion on a central SOP register that is available to all staff via the Trust s Intranet pages. c) Data Quality Audits As a final check of validity and robustness Internal Audit are commissioned to undertake a comprehensive programme of data quality and performance indicator reviews on an ongoing basis. The main focus of this programme is to validate and check the reporting of performance indicators from patient source to the Board. Internal Audit Reports are then produced and presented to the Audit, a subcommittee of the Trust Board, with clear action plans for areas of improvement. The Audit monitors delivery of the action plans. d) Business Rules Development A Business Rules work-stream was established and continues to meet on a regular basis. The on-going Business Rules programme of work is aimed at providing consistency and structure to the inputting of electronic patient level data as the building blocks for establishing reliable performance measures and includes representation from key corporate departments, Contracting and Performance, Information, and service representation. It is recognised that data quality is the responsibility of everyone within the organisation and cannot be delivered by any one individual or team. Performance Management Framework Nov 2015 Page 7 of 11

8 6. Responsibilities Management of performance is led within the organisation by the Finance, Performance and Information Directorate. The Contracting, Performance and Information Team oversees the implementation of the Performance Management Framework and also the production and dissemination of all performance reports. Accountability for performance ultimately rests with the Trust Board, who are supported in this role by the Executive Performance Group and the Integrated Performance. The specific roles and responsibilities of these groups have been outlined in their Terms of Reference, but can be summarised as follows: a) Sub s of the Trust Board Integrated Performance The Integrated Performance receives and reviews performance on behalf of the Trust Board. The obtains assurance on Trust performance, assesses progress against key performance targets, makes recommendations to Trust Board on actions to address performance issues and undertakes reviews of the Performance Management Framework. Safety and Quality Whilst the Integrated Performance retains primary delegated responsibility from Trust Board for monitoring and review of performance related matters, intelligence is also shared with the Safety and Quality in recognition of their role to ensure that standards of safety and quality are maintained. b) Trust Management Groups Executive Performance Group The Executive Performance Group (EPG) is chaired by the Chief Executive and has among its membership Executive Directors. The role and function of this Group is to hold Associate Directors (both clinical and corporate) and their management teams to account for the performance of their services. In so doing, the group is able to provide the required assurances to the Trust Board on achievement of key performance measures. Through the establishment of appropriate action-planning and escalation procedures, the EPG addresses issues of performance improvement. Furthermore, the Group supports Executive Directors, Board s and the Trust Board in developing the performance culture of the organisation, ensuring that all staff understand their individual contributions to achievement of the Trust s Strategic Objectives. The EPG reports to the Integrated Performance. Safety and Quality Operational Group Performance Management Framework Nov 2015 Page 8 of 11

9 The Safety and Quality Operational Group receives and reviews Safety and Quality reports escalated from the Directorate Safety and Quality Groups. The Group obtains assurance on Directorate action to maintain safety and quality compliance and shares intelligence with the Executive Performance Group. c) Directorate Management Groups Each Directorate holds a monthly Business Meeting and Safety and Quality Group, which includes representation from key corporate departments and operational and clinical staff. The Business Meetings review and monitor performance against Directorate and service specific indicators, via the Directorate performance scorecards and Directorate Outcomes Reports and takes responsibility for actions to deliver improvement at ward and team level. The Safety and Quality Groups review and monitor performance against Directorate and service specific indicators, via the Safety and Quality Dashboard and take responsibility for actions to deliver improvement. These meetings also continue to develop a performance culture across the operational teams. The Performance Management and Safety and Quality Governance Structures can be seen in Appendix A. 7. Striving for Continuous Improvement Whilst a focus on managing the numbers is important, planning and reporting on performance are only part of the performance management cycle: plan, do, review, revise. Closing the loop in terms of delivering the organisation s priorities will require engaging the hearts and minds of the workforce too as the key to success. The Trust needs to continue developing a performance culture by identifying what preferred behaviours are needed to get us where we need to be, and how these can be encouraged and instilled across individuals, teams and Directorates. This will require a holistic approach to performance management, where the purpose of managing performance shifts from just counting to bringing systems and people together to generate results. In this context, the implementation of Business Intelligence will reenforce this cultural development by consolidating knowledge and generating a unified approach to sharing information across the organisation. Emphasis on identifying and developing specific performance management skills within the workforce will also be required. This will be supported through the implementation across the workforce of recognised business methodologies such as project management, Lean working and process mapping, to focus attention on activities that add value and encourage an ethos of continuous improvement. Alongside this, all staff are encouraged to strive for continuous improvement in the clinical services we provide. The means to achieving this is outlined in the Trust s clinical strategy, with a focus on review and refinement using the VALUE based care approach. This model encompasses a number of key principles for care delivery and service transformation, aimed at delivering patient-centred care by high functioning Performance Management Framework Nov 2015 Page 9 of 11

10 multi-disciplinary teams and focussed on achieving the best outcomes for patients at individual, team and service level. Measurement and monitoring of health outcomes and patient experience is therefore a key component of the Trust s performance reporting portfolio. Outcome frameworks, with associated metrics and dashboards, have been developed for each Directorate and will continue to be reviewed and refined over the next 3-5 years as the Trust develops experience and understanding of the impact on outcomes of the many and varied clinical activities and interventions in use across the organisation. 8. Summary The structures and processes already established for performance monitoring provide a strong foundation for the Trust to judge the success of its work programmes and assess the impact of the large scale service transformation in the short and medium term. Further embedding of a performance culture will ensure that the organisation builds workforce support for the new structures, and creates new ways of working to achieve the organisation s objectives in a challenging economic climate where there is an ongoing requirement to deliver more with less. Delivery of the key principles and strategies of performance management will focus Trust activity on what matters most, delivering measurable improvement in health outcomes and quality of care for patients. Gale Hart Director of Finance, Performance and Information Tracey Wrench Executive Director of Nursing & Quality November 2015 Performance Management Framework Nov 2015 Page 10 of 11

11 Appendix A TRUST BOARD Remuneration Integrated Performance Financial Planning & Investment Audit Safety & Quality Integrated Workforce Transformational Change Board DIRECTORATE BUSINESS GROUPS Executive Performance Group Acute Services Integrated Children s Services Enabling Sub Programme Board Business Rules MH & Community Services Contracting & Performance Operational Meetings Task & Finish Groups Integrated Community Services Integrated Capital Group Performance Strategy Nov 2015 v2.0 Page 11 of 11

12 TRUST BOARD Safety & Quality Remuneration Audit Integrated Workforce Group Integrated Performance Financial Planning & Investment Transformational Change Board Safety & Quality Groups Safety & Quality Operational Group Acute Services Safety & Quality Sub-Groups Integrated Community Services Equality & Diversity Significant Incident Group (SIG) Drugs, Therapeutics & Non-Medical Prescribing Mental Health Act Clinical Audit & Effectiveness Infection Control Policy Review Group Clinical Policies & Procedures Approval Group Fire Safety Children and Family Services Health, Safety & Security Violence & Personal Safety Safeguarding Resuscitation Information Governance Equal Partners Research & Innovation Patient Environment

13 EPB52/805 Board Assurance Report - Integrated Performance Date of Meeting - 10 November 2015 Key items of assurance obtained on behalf of Board Decisions/actions to be taken by Trust Board Acute Services The welcomed the sustained improvement in performance of the Delayed Transfer of Care (DTOC) indicator and the recognition of the Trust s proactive management of patients through the care pathway. Performance in Month 6 was 4.14% against a target of 7.5%. A performance notice had been received in relation to the Improving Access to Psychological Therapies (IAPT) service for Coventry and Rugby Clinical Commissioning Group (CRCCG) reflecting an underperformance of 0.3% against target. A remedial action plan is in development although it was noted that many of the actions sit with the Commissioners. The was assured that the Trust is currently on track to achieve the new national year end access targets. The noted that Waiting Times for the Memory Assessment Clinic (MAC) have been achieved for Quarter 2, a significant improvement from Quarter 4. The Trust has been advised that despite a significant increase in referrals, no additional funding will be available and alternative options involving primary care will need to be considered to manage the demand. Registered Nurse night cover remains a challenge particularly within Learning Disability inpatient settings, although this has marginally improved through recruitment. However the was assured that wards remain safe and noted that a proposal reflecting more appropriate minimum levels will be submitted to November Board. The welcomed improvements in the Staff Friends and Family Test results for both Mental Health (MH) and Learning Disability (LD) services. However it was agreed that the low base for MH services remains a particular concern. The requested further analysis of the results to identify whether there was any difference between MH inpatient and community settings and requested that the data was benchmarked against other Trusts. Board to note sustained performance against target and positive feedback. Board to note receipt of performance notice and action in progress Board to note performance and achievement of target. Board to note performance and assurance provided. Board to note performance and action in progress. PB52 24 November 2015 Page 1 of 4

14 EPB52/805 A trajectory for achievement of the new Early Intervention (EI) access target was received. Performance is currently at 29% with a target of 50% by year end. The was assured that an action plan to achieve the target is in place and will be monitored monthly. Board to note performance and assurance provided. Child & Family Services (CFS) The welcomed a further improvement in sickness absence with an inmonth performance of 3.59%, which is better than the Trust target. CFS also reported excellent progress in its Staff Friends and Family Test scores achieving significant improvements between Quarter 2, 2014/15 and Quarter 2, 2015/16. In-month performance against the Statutory and Mandatory Training target was better than the 8% per month target but remains significantly behind the cumulative target. The influx of a higher than normal number of new staff had an impact on the data. The noted some implementation issues with the new Immunisation and Vaccinations service but was assured that Commissioners recognise the progress being in made in the context of challenging implementation timescales. It was noted that CFS is undertaking a significant amount of activity to improve performance against the Level 3 Safeguarding Children training target and anticipates meeting the target by the end of Quarter 3. However the was not assured that this would be achieved given the ongoing challenge of staff whose training will expire in the same period. The noted that a Safeguarding Peer Review had been undertaken, commissioned by Coventry City Council. This had highlighted a number of issues pertinent to the Trust s services. A formal report is due to be published. The requested that CFS reviews the red-rated risks on the risk register relating to capacity and demand within its Occupational Therapy, Physiotherapy and CAMHS services. Board to note positive performance. Board to note performance. Board to note. Board to note limited assurance provided. Board to note. Board to note action requested. Integrated Community Services (ICS) The noted that ICS has maintained a better than target performance on Board to note positive performance. sickness absence this month and is only marginally short of its Statutory and PB52 24 November 2015 Page 2 of 4

15 EPB52/805 Mandatory Training target. The received an update on the status of the Transforming Care Fast Track Bid and noted that the Trust was still awaiting clarity regarding the funding available. An internal workshop is scheduled for 3 rd December to further develop models of care and there has been an appropriate focus on communicating with staff groups who may be affected. The noted that the management of MH Community Teams has now transferred to ICS but performance data relating to these IPUs will continue to be reported within the Acute Services report for the remainder of the financial year. Board to note. Board to note. Estates The questioned whether there was sufficient oversight of Estates issues that had safety and quality implications and recommended that this is considered by the Safety and Quality. The noted that the timescale for the Facilities Review had slipped and it was now due to report in December Integrated Workforce and HR Whilst Trust-wide sickness absence was above target in Month 6, there had been a small % decrease compared to the previous month and in-month performance was better than last year. 65% of absence remains long-term. The noted examples of where the application of sickness absence procedures had resulted in staff exiting the Trust and recognised the importance of the work underway to review and strengthen the Trust s Occupational Health provision. Board to refer matter to Safety and Quality. Board to note. Board to note performance. Safety & Quality The requested that Directorate reports include a greater focus on relevant Directorate risks. The noted that the Estates Team was reporting fire drill compliance at 96% although this was not reflected in the Safety & Quality Dashboard data. The noted that no formal complaints were received in-month. Board to note. Board to note performance. Board to note performance. PB52 24 November 2015 Page 3 of 4

16 EPB52/805 The received a report reviewing a spike in Absent Without Leave (AWOL) incidents during May and June 2015 and noted that the majority of incidents arose where patients had not returned from an agreed period of leave. Work is underway to strengthen information given to patients regarding the implications of failing to return from agreed leave. The was assured that on those wards where the highest numbers of incidents had occurred, the risks of AWOL had been considered prior to the decision being taken to grant leave. Board to note. Cost Improvement Programme 2015/16 (CIP) The noted that the Trust has underachieved against its year to date CIP target for Month 6 by 140,800 against a target of 2,838,200. Of the 76 original schemes, 54 met their target and 22 have incurred slippage. In order to partly mitigate the total slippage of 646,300, contingency schemes at a value of 505,500 have been implemented. These schemes related to specific vacancies and a reduction in payments for rates. The noted that the current forecast shortfall for the year is 590,300, a reduction from the previous forecast shortfall of 934,000. The was assured that further recurrent savings of 222,000 have been identified reducing the total shortfall to 368,300. A plan to bridge the remaining gap will be outlined at Board. Performance Management Framework The approved the Trust s Performance Management Framework with minor amendments. Annual Report The reviewed a draft annual report and agreed its submission to the Board subject to the addition of metrics for performance areas addressed and a minor amendment to attendance information. Board to note performance. Board to note action in progress. Board to receive and note amended document. Board to receive and approve. Signature of Chair: Crishni Waring Date: 15 November 2015 PB52 24 November 2015 Page 4 of 4