Enclosure 8 INTEGRATED PERFORANCE REPORT for period ending 31 st December 2010 Performance EXECUTIVE RESPONSIBLE AUTHOR (if different from above) CORPORATE OBJECTIVE BUSINESS PLAN OBJECTIVE NO(S) Tina Cookson Interim Chief Operating Officer Paul Hodson Head of Contracts & Performance Pete Gordon Head of Continuous Improvement William Wraith Head of Human Resources Tony Brown Assistant Director Financial Performance Enhancing Patient Experience, Safety and Effectiveness, Achieving NHS Foundation Trust 6.1 - Establish a new Quality Framework for the Trust. 6.1.1 - Develop an integrated performance management framework that includes a balanced set of quality metrics across the domains of safety, effectiveness and patient experience. KEY FACTS Daycase rate decreased in December. Elective length of stay increased at RSH but decreased at PRH. Non elective length of stay decreased at both sites. The number of staff employed was 4,242 WTE at the end of December. Validated sickness absence rate for September was 4.7%. EXECUTIVE SUARY This paper reports current performance against a number of KPIs for the period up to the end of December 2010. As detailed in previous papers this reports includes KPIs identified as suitable for both and Quarterly reporting as December represents the completion of the 3 rd Quarter. RECOENDATIONS The Board is asked to NOTE: performance against a range of Key Performance Indicators covering Quality, Delivery and Foundations. 1
Integrated Performance Report: Delivery (CO2, CO3 & CO4) Foundations (CO5 & CO6) Performance Direction of Travel Frequency Increasing productivity and encouraging innovation Theatre Utilisation % Utilisation of funded theatre sessions ABER = ABER Length of Stay (LOS) Elective - To achieve upper 20th percentile performance within five years from 2009 Reduce total number of surgical pre-operative bed days per month GREEN GREEN GREEN Non Elective - To achieve upper 20th percentile performance within five years from 2009 GREEN ABER ABER = ABER Overall theatre performance remains constant but revised action plan should improve performance Decrease at PRH of 0.6 days and an increase at RSH of 0.2 days Decrease of 68 bed days at PRH and a decrease of 50 bed days at RSH Decreased by 0.1 days at PRH and decreased by 0.3 days at RSH Daycases aintain a daycase rate above 78% GREEN = GREEN GREEN Decreased to 78.3% during December Outpatient Utilisation % of patients booked in the capacity available (CO2.4) FD GREEN = GREEN GREEN GREEN GREEN ABER Overall DNA rate in December was 7.80%, representing an increase from last month Supporting and developing our workforce in a learning Workforce Numbers All staff Whole Time Equivalent (WTE) employed on permanent & fixed contracts Sickness % Sickness Absence and WTE Days Lost DCR ABER GREEN DCR RED = RED RED ABER Currently 91.8% of establishment. The target is to reach at least 96% of establishment AND to remain within budget Validated absence level 0.6% higher than this month last year Ensuring a clinically viable & financially sustainable organisation Financial Risk Rating aintain onitor Governance Risk Rating at Amber or above FD RED = RED RED Risk Score = 2 (Below target) Governance Risk Rating Assess performance against onitor Governance Risk COO RED = RED RED onitor Governance Risk Rating of Red Q Achieving NHS Foundation Trust status Foundation Trust To achieve NHS Foundation Trust status in 2011 RED = RED ABER Subject to the completion of ambitious plans for restructure/reconfiguration, a revised trajectory for the Trust s FT application was submitted by the Chairman to the DH in November 2
Theatre Utilisation Direction of Travel Theatre Utilisation % Utilisation of funded theatre sessions. ABER = ABER GREEN Overall theatre performance remains constant but revised action plan should improve performance 300 250 200 150 100 50 0 100% 80% 60% 40% 20% 0% Theatre Utilisation at PRH & RSH (December 2009 - December 2010) Dec Jan Feb ar Apr ay June July Aug Sep Oct Nov Dec PRH 66% 67% 87% 82% 84% 84% 79% 76% 72% 78% 81% 85% 68% RSH 65% 73% 74% 73% 76% 81% 77% 78% 68% 79% 75% 79% 70% Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% Number of Theatre Non Attenders by Three ost Frequent Reasons (December 2009 - December 20 10 ) Dec-09 Jan-10 Feb-10 ar -10 Apr -10 ay-10 Jun-10 Jul -10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 DNA Not f it No Bed Theatre Utilisation: Theatre Utilisation for PRH in December was 68% and in RSH 70% which is a reduction at both sites compared to the previous month. The key reasons for under utilisation resulting in lost activity at both sites remain the amount of closed sessions and unused theatre time. Overall this is an increase on last year s position, especially at RSH which was at 65%. This is a result of the impact of the Trust s Escalation Policy. Performance anagement: Data is available for each Centre split by speciality. Speciality data is split by Consultant. Percentage data is converted into number of theatre sessions lost. Data is broken down into cancelled operations and the reasons why. Data is broken down into late starts and the reasons why. Data is available for unfunded sessions, majority funded by WLI. Report findings to Clinical s and Divisional General anagers. Agree an action plan with above to deliver improved results. Benchmark data. arch 2011 Working Group to be set up to review the outcomes of The Productive Operating Theatre Visioning Workshop linked to the Flow anagement Process. 3
Elective Length of Stay (LOS) Direction of Travel Length of Stay (LOS) Elective To achieve upper 20th percentile performance within five years from 2009 GREEN ABER GREEN Decrease at PRH of 0.6 days and an increase at RSH of 0.2 days PRH - Elective Length of Stay (December 2009 - December 2010) 4.0 LOS 3.0 2.0 1.0 0.0 Dec-09 Jan-10 Feb-10 ar-10 Apr-10 ay-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct -10 Nov-10 Dec-10 PRH Elective LOS Decreased by 0.6 days between November and December. The median elective length of stay remained at 1 day during December. ean 2.9 2.5 2.9 2.8 3.5 3.1 2.7 2.8 3.3 2.6 2.8 3.6 3.0 ean Target 3.0 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 edian 1 2 1 2 1 1 1 1 1 1 1 1 1 RSH - Elective Length of Stay (December 2009 - December 2010) 4.0 LOS 3.0 2.0 1.0 0.0 Dec - 09 J an- 10 Feb- 10 ar - 10 Apr - 10 ay - 10 J un- 10 J ul - 10 Aug- 10 Sep- 10 Oct - 10 Nov - 10 Dec - 10 RSH Elective LOS Increased by 0.2 days between November and December. The median length of stay increased to 2 days during December. ean 3.3 3.2 3.1 2.8 3.0 3.5 3.3 3.4 3.8 3.3 2.9 3.0 3.2 ean Target 3.1 2.9 2.9 2.9 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 edian 2 2 2 2 2 2 2 2 2 2 1 2 2 Increase usage of Surgical Admission Suite at RSH. Capital work to expand the Surgical Admission Suite and pre-operative assessment areas completed January 11th 2011, which will enable more elective surgical patients to be admitted on the day of surgery. Convert inpatients to daycase where possible using BADS (British Association Day Surgery) criteria. Continued implementation of the Enhanced Recovery Programme. 4
Elective Surgical Pre Operative Bed Days per onth Direction of Travel Elective Surgical Pre Operative Length of Stay (LOS) Reduce total number of surgical preoperative bed days per month GREEN GREEN GREEN Decrease of 68 bed days at PRH and a decrease of 50 bed days at RSH 250 Elective Surgical Pre Operative Bed Days per onth (December 2009 - December 2010) 200 150 100 50 The number of elective surgical pre-operative bed days decreased at PRH by 68 from November and decreased by 50 at RSH. The median number of elective surgical pre-operative bed days per month over the last 12 months at PRH is 111 and 135 at RSH. Dec Jan Feb ar Apr ay June July Aug Sept Oct Nov Dec PRH RSH The data is generated from edeanalytic and is subject to amendment with subsequent data revisions Increase the number of patients being admitted via the Surgical Admission Suite at RSH. Provision of monthly Elective Surgical Pre-operative Length of Stay information for clinical and managerial staff. Increase day of surgery admission for elective Orthopaedic Inpatients at PRH. 5
Non Elective Length of Stay (LOS) Direction of Travel Length of Stay (LOS) Non Elective To achieve upper 20th percentile performance within five years from 2009 ABER = ABER ABER Decreased by 0.1 days at PRH and decreased by 0.3 days at RSH PRH - Non Elective Length of Stay (December 2009 - December 2010) 8.0 LOS 6.0 4.0 2.0 0.0 Dec - 09 J an- 10 Feb- 10 ar - 10 Apr - 10 ay - 10 J un- 10 J ul - 10 Aug- 10 Sep- 10 Oct - 10 Nov - 10 Dec - 10 PRH Non Elective LOS Decreased by 0.1 days between November and December. The median length of stay remained at 2 days during December. ean 6.4 6.8 6.0 6.7 5.9 5.8 5.9 5.6 5.7 6.0 6.3 5.7 5.6 ean Target 5.4 5.1 5.1 5.1 5.0 5.0 5.0 4.9 4.9 4.9 4.9 4.9 4.9 edian 2 2 2 2 2 2 2 2 2 2 2 2 2 RSH - Non Elective Length of Stay (December 2009 - December 2010) 8.0 LOS 6.0 4.0 2.0 0.0 Dec-09 Jan-10 Feb-10 ar-10 Apr-10 ay-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct -10 Nov-10 Dec-10 RSH Non Elective LOS Decreased by 0.3 days between November and December. The median length of stay remained at 2 days during December. ean 5.4 5.3 5.2 5.1 4.7 4.5 5.1 5.1 5.2 5.1 5.2 5.3 5.0 ean Target 4.0 3.8 3.8 3.8 3.7 3.7 3.7 3.6 3.6 3.6 3.6 3.6 3.6 edian 2 2 2 2 2 2 2 2 2 2 2 2 2 Continue monthly Joint Discharge Transformation Team meetings with local health & social economy staff focussing upon significant areas of delay for patients with continuing healthcare needs. New model of Consultant Working commenced December 2010 at RSH. Review impact of the change. Live visual SQL reporting for admissions, discharges and Discharge Lounge utilisation available via intranet to all SATH staff. Confirm Clinical for unscheduled care to enable improved flow management within the local health economy. 6
Daycases Direction of Travel Daycases aintain a daycase rate above 78% GREEN = GREEN GREEN Decreased to 78.3% during December 85% Day Case December 2009 - December 2010 80% 75% 70% Dec Jan Feb ar Apr ay Jun Jul Aug Sep Oct Nov Dec This key performance indicator measures the percentage of daycase procedures as a total of all elective procedures. Daycase rate for December decreased by 0.1% to 78.3%. Perf ormance 74.7% 78.2% 77.8% 78.3% 78.4% 77.3% 79.5% 77.9% 80.9% 79.2% 76.5% 78.4% 78.3% Target 78% 78% 78% 78% 78% 78% 78% 78% 78% 78% 78% 78% 78% Convert inpatients to daycase where possible. Disseminate new BADS (British Association of Day Surgery) report within edeanalytics for Consultants. 7
Outpatient Utilisation Direction of Travel Outpatient Utilisation % of patients booked in the capacity available (CO2.4) FD GREEN = GREEN GREEN Overall DNA rate in December was 7.80%, representing an increase from last month 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2010/11 OP DNA Rate Compared with 2009/10 Apr 10 ay 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 ar 11 Act ual 5.70% 5.90% 6.10% 5.70% 5.90% 6.60% 6.30% 6.10% 7.80% Profile 6.30% 6.30% 6.10% 6.30% 5.90% 6.20% 6.00% 5.90% 6.50% 7.30% 5.60% 5.90% In December, the total OP attendances were 48,165 (19,1928 new and 28,237 follow-up). This represents a drop in attendances of 7,854 compared with November. The Scheduling Team were asked to book an additional 35 OP clinics in December, 15 at PRH and 20 at RSH arranged at short notice in order to meet national standards. Recorded total DNAs in December were 3,761 (7.80%), an increase of 1.7% compared with November. Whilst the increase in DNA rate is in line with 2009/10, it was higher this year and the adverse weather conditions may have had an impact. DNA rate in Ophthalmology was 10.75 % for new appointments and 10.18 % for follow-up and in T&O, 8.03% for new appointments and 11.60 % for follow-up (increase in both specialties from November). SQL reports were to be made available in December, which are providing additional information for OP clinic bookings. The data is currently being validated. DNA rate for December will be analysed further to assist with contingency planning. 8
Workforce Numbers Direction of Travel Workforce Numbers All staff Whole Time Equivalent (WTE) employed on permanent & fixed contracts DCR RED = RED RED Currently 91.8% of establishment. The target is to reach at least 96% of establishment AND to remain within budget WTE 4650 4550 4450 4350 4250 4150 4050 3950 3850 3750 3650 Workforce Numbers WTE (Whole Time Equivalent) April ay June July Aug Sept Oct Nov Dec Jan Feb ar Actual Worked Agency Staff WTE 2010-11 83 68 69 70 56 55 62 87 106 Actual Bank Worked WTE 2010-11 221 183 174 193 204 214 223.1 222 235 Staff Utilised WTE 2010-11 67 19 38 37 6 2-9 25-20 Contracted Staff WTE 2010-11 4235 4239 4237 4237 4255 4240 4245 4240 4243 Total Staff 2010-11 (Excluding Bank WTE) 4220 4232 4239 4229 4231 4230 4231 4245 4242 Total Staff 2009-10 (Excluding Bank WTE) 3898 3914 3921 3923 3950 3985 4047 4122 4120 4169 4191 4196 Total Staff 2008-09 (Excluding Bank WTE) 3796 3805 3790 3789 3814 3835 3852 3847 3865 3882 3893 3895 Thresholds Descriptions: Green: WTE > 95.9% of establishment AND total workforce cost < budget Amber: WTE = 93.0-95.9% of establishment AND total workforce cost < budget Red: WTE < 93.0% of establishment AND total workforce cost > budget 4,242 WTE substantive staff, end of December 2010; decrease of 3 since end November (ESR). 91.8% of monthly budgeted establishment; 92.8% YTD average of monthly budgeted establishment. The contracted figure is 4,243 WTE. The budgeted establishment for December was 4,619 WTE ( 14.361). The chart illustrates total workforce for December from all sources was 4,564 WTE ( 16.025) - met through the use of permanent staff, overtime, bank and agency staff. Areas of highest use of agency (by cost): edical Staff Ophthalmology RSH ( 100,045), Escalation Paediatrics RSH ( 58,284), edical Staff A&E RSH ( 54,955), edical Staff General edicine RSH ( 46,742). Total Agency spend: 0.756. Agency use by WTE: October November December edics 38 44 50 Nursing 13 32 42 Other 11 11 13 The Approval to Appoint process has been revised to enable recruitment decisions to be made at SDU level which should speed up the process to appoint to established posts. However, sickness absence at management level and the need to check the regional redeployment pool will still impact on timely recruitment. A coordinated recruitment campaign for nursing staff is to developed. The use of Bank and Agency staff is continuously reviewed on a weekly basis by the Line-anagers and relevant executive. 9
Sickness Direction of Travel Sickness % Sickness Absence and WTE Days Lost DCR ABER GREEN ABER Validated absence level 0.6% higher than this month last year 6.0% 5.0% % Sickness Absence Overall validated absence level is 0.6% higher than for same month last year. date validated level is the same as last year s average. % 4.0% 3.0% 2.0% Benchmarking data provided by the West idlands for September 2010 showed SaTH to be 16 th lowest of all 44 Trusts in the West idlands. 1.0% 0.0% Apr ay Jun Jul Aug Sep Oct Nov Dec Jan Feb ar %2010-11 4.0% 4.1% 4.1% 4.5% 4.7% 4.8% 5.2% 5.1% %2010-11 Validated 3.8% 4.0% 4.1% 4.5% 4.5% 4.7% %20010-11 YTD Validated 3.8% 3.9% 4.0% 4.1% 4.2% 4.3% % 2009-10 Average 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% 4.3% % 2009-10 4.0% 4.0% 4.2% 4.7% 4.1% 4.1% 4.4% 4.3% 4.3% 4.5% 4.6% 4.5% WTE Days Lost 7000 6000 WTE Days Lost 5000 4000 3000 2000 1000 0 Apr ay Jun Jul Aug Sep Oct Nov Dec Jan Feb ar Certified (>7days) Lost WTE Days 5195 4899 Uncertified (1 to 7 days) Lost WTE Days 1585 1548 Validated Certified (>7days) Lost WTE Days 3666 4018 3947 4599 4825 4444 Validated Uncertified (1 to 7 days) Lost WTE Days 1124 1199 1273 1292 1111 1470 Total Lost WTE Days 2009-10 4627 4814 4890 5751 5038 4870 5554 5349 5554 5784 5358 5871 Green: Absence rate < 4.3% Amber: Absence rate = 4.3-4.7% Red: Absence rate > 4.7% SaTH's sickness absence for 2009/10 was 4.3% (0.1% lower than 2008/9). A target of 4.2% has been set for 2010/11. It should be noted that the DoH have set a target of 3.39% for the West idlands, to be achieved by 31st arch 2013. Validated sickness average for April to September 2010 is 4.3%. Divisions continue to manage sickness absence in line with Trust policy and with support from HR, which includes using HR generated trigger lists to ensure early intervention in management of sickness absence, and completion of return to work interviews. The 5 Areas with the highest levels of sickness absence for September, based on WTE Days lost. Area Domestic Services Dept (RSH) Theatres Dept (RSH) Ward 25 General Surgery Ward 22 Cohort Ward 9 General edicine Absence Rate 13.80% 6.55% 12.19% 12.88% 27.54% WTE Lost 251 173 167 153 152 ain Absence Reason usculoskeletal usculoskeletal Not Known Not Known Not Known Sickness absence levels have been gradually increasing throughout the year despite intensive management of individual cases. There is a proposed new draft anagement Sickness Absence policy, which is currently subject to consultation with staff-side representatives. 10
Financial Risk Rating Direction of Travel Financial Risk Rating aintain onitor Governance Risk Rating at Amber or above FD RED = RED RED Risk Score = 2 (Below target) etric Value Rating 14.000 12.000 10.000 8.000 6.000 4.000 2.000 0.000 EBITDA margin 4.7% 2 EBITDA, % achieved 75.4% 3 ROA 2.8% 2 I&E surplus margin -0.3% 2 Liquid ratio 7.9 1 Weighted Average 2 2010/2011 EBITDA Apr '10 ay Jun Jul Aug Sep Oct Nov Dec Jan '11 Feb ar onth 9 EBITDA 1.363m (Plan 1.631m): shortfall to plan 0.268m. Cumulative EBITDA 9.540m (Plan 12.649m): shortfall to plan 3.109m. EBITDA excluding support: negative 0.137m in month ( 7.990m YTD). onth 9 I&E Trading Deficit 1.391m (Plan Surplus 503k) shortfall 1.894m. SHA support of 3.5m for 2010/11 confirmed. After adjusting for appropriate element of support onth 8 surplus is 109k. Cumulative Deficit 0.698m (Plan Surplus.2.474m): shortfall to plan 3.172m. Unfavourable Emergency Threshold adjustment 0.638m in onth 8 ( 2.332m cumulative). Pay overspend 1.666m ( 6.981m cumulative). Pay spend onth 9 16.025m including 0.5m reconfiguration costs provision. Agency spend onth 8 0.756m (onths 1 to 8 average 0.616m). Working capital and cash management pressure continues. Plan ( m) (cum) Actual ( m) (cum) Actual ( m) (cum) Exc SCR Divisions have identified schemes to reduce costs in the latter part of year, actioned from January. Recruitment to additional posts, review in progress. All non pay spend for non-clinical items continues to be reviewed by senior finance officers prior to approval. 11
Governance Risk Rating Target Direction of Travel Governance Risk Rating Assess performance against onitor Governance Risk DSD RED = RED RED onitor Governance Risk Rating of Red onitoring Period Q3 Performance Q3 Weighting onitor Compliance Framework - Service Performance Threshold Weighting Acute Targets - National Requirements Clostridium Difficile year on year reduction (to fit trajectory for the year as agreed with the PCT - assumes a 15% reduction if no contract agreed) 0 1 Quarterly 20 0 RSA - eeting the RSA objective (2) 0 1 Quarterly 2 0 All Cancers: 31 day wait for second or subsequent treatment (3), comprising either: 1 Quarterly 1 Surgery 94 90.00% Anti Cancer Drug Treatments 98 92.00% Radiotherapy (from Jan. 2011) 94 All Cancers: 62 day wait for the first treatment (4) comprising either: 1 Quarterly 1 from Urgent GP Referral to Treatment 85 80.00% from Consultant Screening Service Referral 90 93.00% Acute Targets - inimum Standards All Cancers 31 day wait from diagnosis to first treatment (6) 96 0.5 Quarterly 94.71% 0.5 Cancer: two week wait from referral to date first seen (7), comprising either: 0.5 Quarterly 0 All Cancers 93 96.34% for Symptomatic Breast Patients 93 95.36% Screening all elective inpatients for RSA (8) 100 0.5 Quarterly TBC aximum waiting time of four hours in A&E from arrival to admission, transfer or discharge (9) 95 0.5 Quarterly 96.2 People suffering heart attack to receive Thrombolysis within 60 minutes of call (where this is the preferred local treatment for heart attack) (10) 68 0.5 Quarterly 0% 0.5 All Acute and ental Health NHS Foundation Trusts Self certification against compliance with requirements regarding access to healthcare for people with learning disability (19) N/A 0.5 Annually N/A Total Socre 3 onitor Governance Risk Ratign Score Q2 Red Foundation Trusts are required to report performance against the governance risk rating to onitor on a quarterly basis. Each target is given a weighted score and the total assessed against the following thresholds: 0-0.9 Green 1-1.9 Amber-Green 2-2.9 Amber-Red 3 or above Red For consistency a onitor rating of either Amber-Green or Amber-Red will map to a SaTH RAG status of Amber. As the rating applied increases there is an associated increase in the level of reporting, actions plans and potential onitor intervention that is mandated. If SaTH were submitting Q3 data to onitor we would be rated as Red, primarily due to performance against Cancer Targets (2.5 of 3 points relate to Cancer). Further information for those areas identified as underachieving is included on the relevant IPR slide. Slide reported quarterly in line with onitor requirements Further information for those areas identified as underachieving is included on the relevant IPR slide. 12
Foundation Trust Direction of Travel Foundation Trust To achieve NHS Foundation Trust status in 2011 RED = RED ABER Subject to the completion of ambitious plans for restructure/reconfiguration, a revised trajectory for the Trust s FT application was submitted by the Chairman to the DH in November onitor Compliance Framework In addition to an Annual Plan, periodic reporting against the criteria set out in onitor s Compliance Framework is mandatory for Foundation Trusts, and is a self-regulatory component to assess ongoing financial and governance risks. A financial risk rating (FRR) uses a number of indicators to assess the level of financial risk to provide an overall assessment in a weighted metric rated 1 (highest risk) to 5 derived from: delivery of plan; operating margin; return on assets; and liquidity. For governance risk, onitor uses a graduated system from green (lowest risk) through to red (highest risk), derived from a number of factors including: performance against national targets and indicators; Care Quality Commission registration and ongoing performance against registration requirements; and provision of mandatory goods and services. If SaTH were reporting to onitor as a Foundation Trust, risks would be rated as follows: FRR score of 1 (Red) Governance risk score of 3 (Red) Finance Governance The Chairman has written to the Department of Health confirming that the Trust Board intends to achieve FT status by December 2013. In support of this aspiration, a programme of work has been detailed in order that the Trust can fulfil the compliance requirements of to the independent regulator, onitor. The SHA is assessing the Trust s proposed FT trajectory, and preparedness for Foundation Trust status. In December 2010, the SHA s Director of Performance and Provider Development wrote to the CE, setting out the next steps in the process to become a Foundation Trust, asking for: a declaration relating to the quality and safety of the organisation; a self assessment of Board capacity and capability to manage the organisation through to FT; and the submission of the latest draft Long Term Financial odel. Responses are being led by the Team, and submissions will be made to the SHA by 31 January 2011. The three assessments will be used to guide any support needed which will be included in the proposed contract between the Trust, the Department of Health and the SHA to be signed by the end of arch 2011. The contract will cover the arrangements, support required, final form and milestones for the organisation to achieve FT status. onitor is consulting on amendments to the Compliance Framework for 2011/12. The Director of Compliance and Risk anagement will collate an organisational response if necessary. Comments are invited by 31 January 2011. 13