Chairpersons Report N/A

Transcription

1 Chairpersons Report Chairpersons Name Robert Armstrong Committee Name Finance & Investment Committee Date of Meeting 19 th June 2013 Name of Receiving Committee Trust Board Date of Receiving Committee July 2013 meeting Refer to Trust Board Chair: N/A Key success or achievement discussed at the meeting 1. Good CIP performance to date 2. Achievement of a reduction in cancelled ops 3. Delivery of theatres 9 and 10 on schedule Details of the top three risks identified during the course of the meeting and initials of primary member of staff actioning 1. Specialist Services financial position 2. MRSA and C Diff 3. Capital run rate 4. Deferment of the NHSLA assessment Attendance at the meeting (please highlight): Excellent (well attended) X Acceptable (some apologies) Unacceptable (quorate) Unacceptable (not quorate) Was the agenda fit for purpose and reflective of the committee s terms of reference? Yes Narrative report of the key issues of the meeting The committee spent considerable time on the robustness of the Specialist Services Division plans. It was noted that SS has considerable work to do to pull their plan back on trajectory this will be closely monitored by F&I. Significant concern raised over the performance in respect of Monitor compliance ( C Diff and A&E ). Whilst it was noted that both C Diff and A&E performance were related the issues could not be seen in isolation The committee will keep governance issues around performance under review. NHSLA provided the committee with sufficient information to provide an informed recommendation to the Trust Board. Financial performance in month 2 is challenging and will continue to be monitored and auctioned, in particular all Medical Divisions will be presenting their plans and actions to remain within their Quality and Financial budgets. Shared Service Sterile Services are to re submit their CIP paper to appraise the committee of the requirement and challenges and what they are wanting the committee to look at. Overall a very challenging meeting with respect to time, and topic, good Committee papers helped the decision making process and scrutiny aspects of the committee Agreed actions from the meeting Name of primary lead for the actions F Noden to look at the disparity in cancelled ops F Noden data in the performance report Page 1 of 2

2 A CQUIN report will be brought to the August Committee meeting A safeguarding update will be taken to the Q&S Committee S Dobson to attend the next meeting to present on the IM&T CIP gap A further paper on the shared services CIP position to come to the next Committee meeting S Nicholls to bring a report on site rationalisation to the next meeting for consideration F Noden P Jones / P Law H Hand J Carter S Nicholls Page 2 of 2

3 PRIVATE & CONFIDENTIAL Minutes of a meeting of the Finance and Investment Committee held at 10 am on 19 th June 2013 in the Boardroom, Trust HQ PRESENT Mr R Armstrong, NED (Chair) Ms L Barnes, SID A Mr G Bean, NED A Mr R Collinson, NED Mr R Forster, DOF Mr A Foster, CEO A A Mr L Higgins, Chairman A A Mr D Hughes, Assoc. DOF Mr J Lenney, ED HR Mr S Nicholls, ED Strategy & Planning Dr U Prabhu, MD A Mr Neil Turner, NED A Mrs Christine Parker Stubbs, NED Mrs Pauline Jones, Director of Nursing A A A Ms Fiona Noden, Director of Performance A IN ATTENDANCE Mr D Evans, Assoc. Director E&F Mrs H Hand, TB Sec Mrs L Hancock, Corporate Services A Administrator Ms M Fleming, DDoP Surgery - - Mr S Aspinall, DDoP Medicine Mrs A Cushion, Acting Deputy Director of HR Mrs P Law, Acting Deputy Director of Nursing - Mr T Clayson, DMD Specialist Services A Mr I Bett, DDOP Specialist Services A A 1. Apologies for absence As noted in the table above. 2. Committee Chairs opening remarks R Armstrong welcomed all to the meeting and noted that there would be some rescheduling of the agenda as Tom Fothergill from NHSLA was only due to arrive at 11am. 3. Declaration of interests None were declared. 4. Matters arising a. Action log from All actions were noted as completed or on the agenda. b. Work plan 2013/14 This was received and noted by the Committee. 5. Minutes of the meeting on These were agreed as accurate Page 1 of 6

4 6. Presentation Specialist Services Performance Update Modular theatres I Bett advised that the modular theatres would be going live in 12 days time. He noted the tremendous effort that had gone into making this possible and thanked the E&F team for their support. The recruitment plan connected to this has gone well although there are risks around the recruitment of theatre nurses. P Law explained that this is a national issue at the moment and the Trust were looking to solve this short term by use of a recruitment agency and in the long term by looking to perhaps train existing nursing staff into the roles. It was noted that vacancies in Anaesthetics have now been recruited to although there is some delay to start dates due to the recruitment process. 5 new MSK Consultants have been appointed with 3 of them starting with the Trust in June. All MSK job plans have been re-shaped and will take effect from the 1 st August. All necessary equipment has been ordered and will be in place in good time. Finance The Division were proud to have achieved an EBITDA of 9% and a contribution to the Trust of 3m in profit last year. However, the current financial position is not as strong with the Division recording a significant deficit in M2 but action plans are in place to counter this. T Clayson believed that the deficit was in part due to the down turn in pelvic and private patient activity. Areas of overspend, such as theatres, will be looked at and processes changed where necessary to bring costs down. I Bett assured the Committee that individual budget holders are regularly challenged on any overspend on their budgets. It is anticipated that the Division will be back on plan by the end of June although the deficit will not be recovered at this point. CIP plans are slightly behind plan but this was explained as being due to phasing and the Division were confident that these would ultimately deliver. 18 weeks / Outpatient follow up backlogs I Bett advised that these areas remained a significant challenge to the Division though it was anticipated that the opening of the modular theatres would start to reduce the 18 weeks backlog. An action plan has been put in place to look at the outpatient follow up backlog and timescales will be added to this. The action plan will also look at Rheumatology. I Bett noted the need to engage with the CCG on this issue although T Clayson advised that this has been difficult. U Prabhu will take this forward with T Dalton and ensure that a meeting is arranged with the CCG to discuss. I Bett and T Clayson remain confident that the plan for T&O can be delivered but highlighted key risks to the plan as the reduction in pelvic and private work. R Armstrong thanked I Bett and T Clayson for their presentation and the honest responses to the debate that followed. 7. Risk escalations from REMC The Committee received and discussed the risk escalations from REMC around income and surplus and land sale. Income and surplus Resolved: The Income and Surplus risk will be returned to REMC for monitoring The Committee agreed that these issues were already discussed and scrutinised on a monthly basis by the Committee. The information currently received to support this monthly discussion was agreed to provide sufficient assurance and opportunity to identify Page 2 of 6

5 risks early. Areas which could be improved were identified as being around the evaluation of business cases and transformational change to identify if outlined benefits have been achieved. It was agreed that this risk would be deferred back to REMC for monitoring. L Barnes noted that the Specialist Service presentation focused very much on the MSK side of business and asked that future presentations looked specifically at the other areas of Specialist Services such as radiology, healthcare ops etc. Land sale Resolved: The land sale risk will be returned to REMC for monitoring D Evans reported that the process continues in terms of the sale of the Billinge site. He noted that although there was some risk that this was controlled and there was no cause for concern in terms of the process at this stage. It was agreed that this would be deferred back to REMC for monitoring. 8. Performance report M2 P Law advised that C Diff remained an ongoing challenge with 11 cases year to date against a trajectory of 25. There had also been an incidence of MRSA against a trajectory of 0 although this had been found to be due to a contaminated sample. F Noden reported that the figure for cancelled ops in May was the best ever achieved by the Trust. The Friends and Family target is not being achieved, particularly in A&E. This will be looked at. A Foster reported that, in March, the Trust had experienced the worst HSMR figures for 5 years. Reasons behind this have been explored but nothing has been identified and it is thought that this could be due to a statistical variation. Concern was expressed at the disparity between the cancelled ops data reported in the document. F Noden will look at this. Increases in harmful falls are being scrutinised by the Falls Scrutiny Committee. P Law felt that the increased number of falls was due to better reporting. L Barnes raised some concerns with regard to CQUINs, in particular for dementia. F Noden additionally noted the breastfeeding CQUIN as being a concern but advised that all of the CQUINs will be discussed in a report due to come to the August F&I Committee. R Armstrong thanked all concerned for the report and noted that the start to the year had been relatively good. ACTION: FN to look at disparity in cancelled ops data CQUIN report to come to the August meeting Safeguarding update to go to the Q&S meeting 9. Finance report M2 R Forster advised that M2 performance had not been as good as the same time last year. The Trust recorded a deficit in month due to a shortfall in income and over spend in expenditure. CIP is making good progress and is a stronger position than the same time last year. Cash balance continues to be good although capital expenditure has increased. The Trust achieved an FRR 2 in M2 and it was agreed that this needed to return to FRR 3 quickly. The decision to remove the Nurse Director CIP to enable strengthening of the Governance structure was discussed as well as the additional resource requirements for pharmacy staffing and the collaborative working projects with Bolton. R Forster advised that, even with these additional pressures, the Trust was still forecasting a 4m surplus at the end of the year. He had no real concerns at this stage but noted that constant vigilance was needed. Page 3 of 6

6 10. Presentation from NHSLA Tom Fothergill R Armstrong welcomed Tom Fothergill to the meeting and thanked him for agreeing to attend. He noted that the presentation had been deferred on a number of occasions. T Fothergill began by noting that the NHSLA had seen an increase in the number of claims due to the rise in no win no fee litigation. He noted that this was having a huge impact on the NHS. Obs and Gynae was identified as the area of most spend in terms of claims, in particular compensation awarded for harm to babies. NHSLA have become under increasing pressure to re-look at their premiums and assessment arrangements. This is due to a number of Trusts with much lower claim histories being left feeling that they are over-contributing whilst other Trusts aren t contributing as much but claiming more. There is a real threat that good risk Trusts will opt to leave NHSLA which would not be good for the remaining Trusts left in the pool. He advised that NHSLA had reviewed the Trusts claim history and concluded that the monthly contribution needed to be increased. This was due to a couple of high value claims that had occurred a few years ago. He emphasised that NHSLA want to work with the Trust to enable quality changes to be made in order to bring this contribution back down again over time. He reassured that Committee that the NHSLA were not under the impression that the Trust provided poor quality care and are aware that the opposite is true, but that past claims had to be considered. He advised that the NHSLA were keen to work with the Trust to ensure that the contribution increases were as manageable as possible. The Committee thanked T Fothergill for his presentation and noted the offer of early assistance in terms of inquests that the Trust feel will lead to a claim and that in the future it will be possible for WWL to benchmark itself with other organisations via NHSLA information. 11. NHSLA Level 3 option appraisal Resolved: It was agreed that the Trust would not undertake NHSLA Level 3 assessment but the level 3 work streams would continue An amended version of the paper was circulated to the Committee. In light of the earlier presentation from NHSLA and the confirmation that the assessment arrangements will be changing, the Committee agreed not to proceed with assessment at this time. However, it was agreed that there would be benefit to continuing with the NHSLA level 3 work stream with focus on particular areas of concern such as Obs and Gynae, Surgery, A&E and data quality. 12. CIP / Service Transformation S Nicholls reported that M2 had been a good month in terms of CIP but cautioned that there was still a long way to go. He highlighted a couple of key areas of concern to the Committee: Shared Services how realistic is CIP delivery? Bed reconfiguration further reconfiguration is planned but requires more analysis following the recent bed pressures Nurse Director CIP the decision to remove the Nurse Director CIP to enable investment into the governance arrangements means that the CIP must be picked up elsewhere IM&T a significant gap that needs to be closed He advised that the PMO were looking at other schemes such as cost avoidance, VAT and reduction of run rates in temp spend although it was noted that the effect of these was limited. He felt that it would be important to look at site rationalisation as a means of Page 4 of 6

7 releasing significant savings. The Committee noted these concerns and it was agreed that S Dobson would be invited to the next meeting to present on the IM&T CIP gap. ACTION: S Dobson to attend the next meeting to present on the IM&T CIP gap a. Shared Services CIP position The Committee received and noted the paper that had been submitted however agreed that it was not clear from the paper what was required of the Committee. It was agreed that a revised paper would be submitted to the next Committee which would include: The likely position going forward A realistic understanding of the gap What can be achieved in year and recurrently The contribution from Salford ACTION: A further paper on the Shared Services CIP position to come to the next Committee meeting 13. Capital programme delivery Resolved: The Committee agreed to both proposals put forward in the capital programme paper S Nicholls noted that overall this was making good progress. The Committee were asked if it would support the delay of the final business case by 1 month to January This was to ensure the best price possible could be agreed with IHP. He also asked for the Committees support in identifying development zones on RAEI and Leigh. The zones would be cleared in preparation for future works. The Committee agreed to both of these proposals. S Nicholls noted that need to accelerate site rationalisation to release savings and advised that he would bring a paper around this to the next Committee meeting. ACTION: S Nicholls to bring a report on site rationalisation to the next meeting for consideration 14. BAF objectives Zero points on MCF : the Committee resolved to score this at 20 The Committee agreed to score this at 20 due to the continued challenges around C Diff and A&E targets. Quarterly and full year FRR of 3: the Committee resolved to score this at 20 Following discussion the Committee agreed to retain the score at k investment with 2:1 payback: the Committee resolved to score this at 9 R Forster advised that the dragons den process was being set up. Maintain a financially balanced 10 year plan and meet milestones for 13/14: the Committee resolved to score this at 12 Following discussion the Committee agreed to score this at 12 as the plans were on track. Achieve Service Transformation (CIP) targets: the Committee resolved to score this at 20 Following earlier discussion on the CIP challenge the Committee agreed to score this at 20. Page 5 of 6

8 15. Minutes received for information The Committee received and noted the following minutes: SSI Committee 16. Any other business No further items for discussion. 17. Key successes / key risks Key successes were agreed to be: Good CIP performance to date Achievement of a reduction in cancelled ops Delivery of theatres 9 and 10 on schedule Key risks were agreed to be: Specialist Services financial position MRSA and C Diff Capital run rate Deferment of the NHSLA assessment 18. Date and time of the next meeting 24 th July 2013, 9.40am, THQ Boardroom Page 6 of 6