Chief Operating Officer's Report on Adult and Older People's Services Quality and Financial Updates

BOD 45/2016 (agenda item: 5) Chief Operating Officer s Report Chief Operating Officer s Report Dominic Hardisty Dominic Hardisty April 2016 April 2016 Caring, safe and excellent

Adult Services Adult Services Areas Areas of Excellence of Excellence Issues Issues of Potential Concern of Potential Concern Quality Quality (safe, effective, (safe, effective, caring) caring) SiL Project 10 phase 2 is now in place, DToCs for adult service remain low. Away day for OMHP arranged for May to take stock of achievements of the partnership. Pre-CQC Visits to all AMHTs and Ward areas completed by Directorate Leadership team. Lots of evidence of improvements in patient centred care, environments and quality of documentation. Significant list of environmental issues has been shared with estates for action. Directorate Linking Leaders event will take place on 25th of April at AVDC, to celebrate achievements and in preparedness for the CQC visit in June. Finance/CIPs. There is an issue with OBC social care placement budget where OHFT is in dispute with OCC over eligibility of patients whom OHFT deem outside the specification ( 500k cost pressure). OCCG have agreed to fund these placements pro-tem whist agreement is sought, this has improved year end position for the Directorate. Finance/CIPs Finance/CIPs Directorate still contributing significantly to Trust overheads Directorate has been supporting the development of proposals to develop OHFT mental health developments within Oxfordshire, both for the STP and to give weight to contract negotiations for MH parity of esteem against the 5YFV. IAPT in Oxfordshire contract has now been signed (5 year contract). Directorate has had to order 60k of furniture to replace broken, damaged or missing items across wards and community areas. these will be delivered at the end of May. Workforce Workforce Recruitment initiatives are continuing and most ward areas now near full establishment Reconciliation of finance and HR data on staff against L&D training lists has been completed and new reports on training performance should now be accurate. Recruitment to Kingfisher and Kestrel is still progressing slowly, gaps are being covered by agency Performance Performance (against (against key trust key trust targets) targets) Monitor targets met on CPA, EIP, IAPT & follow-up. Internal CPA target on 4 measures is at 100% in Forensic and improving in low 90%s in adults. Carenotes new risk assessment ready for rollout, Recovery Star ready to be made live, new front sheet has been delivered for testing. CQUIN targets all met for 2015/16 excepting Recovery Star Bucks which is low and with Carenotes issues was taking more resource than the CQUIN was valued at (loss circa 16k) Waiting targets for adults all met (2hr, 7 day, 28day). PTP step 4 waits still large (circa 1000 patients waiting for treatment up to 1 year). Bids for increased resource to meet waits made to Oxon and Bucks (circa 550k). In interim additional resources being put into each AMHT to start process of reducing waits and improving therapy offering (8 wte additional posts being recruited to, to be in post by mid May) Caring, safe and excellent

Older Peoples Services Older People s Services Areas Areas of Excellence of Excellence Issues Issues of Potential Concern of Potential Concern Quality Quality (safe, effective, (safe, effective, caring) caring) Sustained increase in number of District Nursing teams offering named nursing model of care. Following a targeted piece of work on medicines management, the number of medication incidents in March was the lowest since its inception in April 2011 (39 incidents). The directorate s incident reporting processes have been streamlined. This means that inpatient incidents awaiting review have significantly reduced (from an average of 1,500 to a standard run rate of 420 live at any given time). Recent audit of patient and carer experience in both EMUs found 100% of patients and carers asked, reported that they felt involved in the decision making about their treatment. Continued instances of failure to rescue in community hospitals; limited impact to date of targeted training. Acquired pressure ulcer damage variation in community nursing teams. Diabetes rise in numbers of unstable patients in community settings: actions to mitigate underway. Bed pressures in OAMH, driven in part by single sex accommodation needs. GP OOH - at periods of high demand / limited clinical capacity, patient experience is reduced (slower response times for patients with non-urgent needs). Finance/CIPs Finance/CIPs Forecast to deliver on budget this year. Achieved all this year s CIPs - 500k is non-recurring. Agency spend contained. 700k of FY17 CIP to be determined once contract settlement confirmed. Overspend in urgent care services (GP OOH and EMUs). Workforce Workforce ASLT recruitment improving. Training in pressure damage prevention in community nursing: percentage trained has increased by 20% in the last two months, and is now just below target. Interface medical capacity. Emergency practitioner and GP availability to work in urgent care. Podiatry recruitment. High vacancy / sickness factor in city community nursing. Performance Performance (against (against key trust key trust targets) targets) Improvement in delivery of 48 hour access standards for urgent swallow assessment in community. Reduction in OAMH DTOCs in Buckinghamshire. Increased activity through both Abingdon and Witney EMUs. GP OOH National Quality Requirements underperformance. Caring, safe and excellent

Children & Young Peoples Services Children & Young People s Services Areas Areas of Excellence of Excellence Areas Areas of Concern of Concern Quality Quality (safe, effective, (safe, effective, caring) caring) School information pack re mental health developed by young people in South West. School nursing - 98% of children report good or excellent satisfaction scores with service. Speech & language therapy Bucks using Skype with children good outcome & children like seeing their therapist on the screen! Developing our website with children and young people across CAMHS in 5 counties. Waiting times for routine CAMHS referrals in Oxfordshire remain a concern. Car notes recording of childhood immunisations problematic with record of immunisation disappearing off system - risk alert has been issued to staff. Finance/CIPs Finance/CIPs Directorate continues to manage financial position rigorously and contribute significantly to the Trust s overall financial position. Cost of locum and agency medical staff (covering vacancies and sickness = cost pressure). Use of agency off framework reviewing all . Forecast adverse position at year end Circa 900K. CIPs for 15/16 under delivery by 435K - Plans in place and development for 16/17. Opportunities in 2017 to gain new services - entering & reviewing competitive tender opportunities to provide services Workforce Workforce Appointed 2 nurse prescribers in SW CAMHS. Increasing volunteer workforce in Bucks CAMHS area of development across services. Difficulty recruiting CAMHS consultants 7 vacancies across 5 counties. Significant development required to ensure we are attractive to potential candidates and reduce turnover across all areas. Performance Performance (against (against key trust key trust targets) targets) Met CQUIN targets against all contracts for 15/16. Met 7 day follow-up target for Adult Eating Disorder service. Met target for CPA care plan and risk assessment present. Waiting times for routine referrals in CAMHS in Oxfordshire not met target 75% in 12 weeks. Not meeting all PPST targets resus, infection control and fire awareness. Target re 6 month CPA review not met . Caring, safe and excellent