and Annual Meetings Monday 16 September 2019 Welcome Dr Adam - - PowerPoint PPT Presentation

Fylde Coast Health Event and Annual Meetings

Monday 16 September 2019

Welcome

Dr Adam Janjua, Acting Chair NHS Fylde and Wyre Clinical Commissioning Group

NHS Fylde and Wyre CCG Annual General Meeting 2018/19

Apologies for absence

Minutes of the previous meeting held on 5 July 2018

Annual report and accounts 2018/19

Andrew Harrison Chief Finance Officer

Revenue control total Each CCG is empowered to spend the resources allocated to it based on population need in an effective and efficient manner, but no more. Additionally included in this target NHS England sets ‘Business Rules’ to determine levels of surplus (unspent resource) for each CCG. Cash limit Each CCG is required to ensure that it manages the cash associated with the above control total effectively. Better payment practice code (BPCC) A CCG is required to pay its suppliers within 30 days of being invoiced (or receipt of goods and services where invoices are in advance).

Key statutory financial targets

Revenue control total

2013/14 Achieved 2014/15 Achieved 2015/16 Achieved 2016/17 Achieved 2017/18 Achieved 17/18 Target 17/18 Actual 2018/19 Achieved 18/19 Target 18/19 Actual Blackpool

P P O P P

£300.9m £300.9m

P

£310.2m £310.2m £5.87m surplus £5.87m surplus £5.87m surplus £5.87m surplus Fylde and Wyre

P P P P P

£246.5m £246.5m

P

£294m £294m £6m Surplus £6m Surplus £6m Surplus £6m Surplus

Cash limit and BPPC

13/14 Achieved 14/15 Achieved 15/16 Achieved 16/17 Achieved 17/18 Achieved 17/18 Target 17/18 Actual 18/19 Achieved 18/19 Target 18/19 Actual

Cash limit

Blackpool CCG

P P P P P

£302.0m £296.9m

P

£314.1m £314.1m Fylde & Wyre CCG

P P P P P

£250.2m £250.2m

P

£293.9m £292.0m

BPPC

Blackpool CCG

P P P P P

95% 99.70%

P

95% 99.80% Fylde & Wyre CCG

P P P P P

95% 98.70%

P

95% 99.30%

Welcome

Helen Williams, Lay Member Blackpool Clinical Commissioning Group

NHS Blackpool CCG Annual General Meeting 2018/19

Apologies for absence

Minutes of the previous meeting held on 5 July 2018

Annual report and accounts 2018/19 Andrew Harrison Chief Finance Officer This item was taken in conjunction with the presentation given at the Fylde and Wyre CCG AGM

Blackpool Teaching Hospitals NHS Foundation Trust Annual Members Meeting 2018/19

Apologies for absence

Minutes of the previous meeting held on 5 July 2018

Annual report and accounts 2018/19

Tim Bennett Deputy Chief Executive / Director of Finance

2018/19 – Financial headlines

• Trust reported an operating deficit of £10.9m including Provider Sustainability

Fund (PSF) Incentive of £2.8m (£11.0m loss after exceptional items).

• Deficit excluding PSF Incentive of £12.6m.
• The operating deficit equates to -2.9% of turnover.
• The exceptional item relates to a loss on transfer by absorption of community

services to University Hospitals of Morecambe Bay NHS FT which is a non cash item.

• Cash position £15.6m positive balance, after receiving an £20.9m Interim

Revenue Support loan from the Department of Health & Social Care (DHSC)

2018/19 – Financial headlines

• Full details in the group accounts - https://www.bfwh.nhs.uk/wp-

content/uploads/2019/07/BTH6014-Annual-Report-and-Accounts- 2018-19-v1.5-eProof.pdf

• Auditors Report (published with the Council of Governors agenda for

the meeting on 11th September 2019) https://www.bfwh.nhs.uk/wp- content/uploads/2019/09/Council-of-Governors-11th-September-Full- Papers.pdf

• Annual Report - https://www.bfwh.nhs.uk/wp-

content/uploads/2019/07/BTH6014-Annual-Report-and-Accounts- 2018-19-v1.5-eProof.pdf

Efficiencies

• Cost savings of £17.0m.
• Equivalent to 3.9% of our cost

base.

• Delivered through:
• Transformational schemes.
• Transactional schemes and

increased expenditure controls.

£0.0 £5.0 £10.0 £15.0 £20.0 £25.0

£m

CIP

Recurrent Non- Recurrent

Investments

• Improvements in clinical quality and safety including:
• Implementation of primary care streaming.
• Investments in medical staff.
• Haematology collaboration with Lancashire Teaching Hospitals NHS

Foundation Trust (LTH).

• Enhancement to the Diabetic Foot Service.
• Investment in Radiology out of hours service.

Investments

• Major capital investments totalling £11.2m including:
• Medical equipment - £1.9m.
• Electronic information projects - £5.7m.
• Building infrastructure improvements - £1.9m.
• Bed replacement scheme - £1.7m.
• Successful bid for £13m for critical care and emergency village

Outlook for 2019/20

• Continued financial pressure
• Increases in costs due to actions to improve the quality and safety of care we

provide.

• Also activity increases and pay pressures.
• Provider Sustainability fund of £6.3m dependent upon achievement of the NHSI

control total.

• Marginal Rate Emergency Tariff funding of £4.2m.
• Cost Improvement Programme (CIP) target of £17.5m
• NHSI control total £5.6m surplus
• Cash position by year end – positive group cash balance of

£1.9m

Outlook for 2020/21 onwards

• Single improvement plan drawing all areas of improvement together
• On-going investments in services
• Should start to see some positive returns on those investments
• However, significant savings will still be required and we will need to

prioritise our efforts

• In addition, we need to continue to work closely with partners across both

the Fylde Coast and the whole of Lancashire and South Cumbria

• NHS Long Term Plan (LTP) see next slide

LTP Implementation Framework Overview

LTP commitments that are critical foundations to wider change LTP commitments systems have freedom to define pace of delivery

• Moving to ICSs everywhere – ICS maturity matrix

Trust Constitution

Pearse Butler – Chair

• In November 2018, the Council of Governors approved

the following amendment to the Trust Constitution:

• An update to the Chair/Non-Executive Director recruitment process in
• rder to transparently comply with paragraph 140.
• In May 2019, the Council of Governors approved the

following changes to the Trust Constitution:

• The removal of Community Health Services (North Lancashire) from

paragraphs 31 and 59.2 (due to these services transferring to the University Hospitals of Morecambe Bay NHS FT). The remaining 40 members have been consolidated into the remaining Staff Constituencies.

• The removal of Governor from the eligibility criteria in paragraph 60.1 (to

allow for greater flexibility in appointing Governors by removing the criterion that prevents a Governor being on more than one Council of Governors).

• An amendment to paragraph 124 relating to the Board Composition to align

to the Model Constitution and NHS Act 2006 allowing ‘not less than four directors but not more than seven directors’ to be the composition of the Board, rather than between five and seven.

Membership report 2018/19

Pearse Butler – Chair

Membership

• There has been a decrease in public membership during 2018/19 (from

5,114 at 1st April 2018 to 4,931 at 31 March 2019) and a decrease in staff membership (from 8,964 at 1st April 2018 to 7,178 at 31 March 2019).

Membership Committee achievements/initiatives 2018/19

• Use of the Trust’s Facebook social network site to engage with, and inform,

members and the wider public of developments, seminars and events at the Trust.

• Use of the Trust’s Twitter social network page to attract new members

(the Trust has over 8,700 followers).

• Continuation of the Youth Health leaders Project which is now within 11

schools.

• A Trust Volunteer to help with membership engagement.
• A dedicated Membership and Governors Officer who acts a link

between the members, the Council of Governors and the Trust.

• A dedicated membership email address (bfwh.members@nhs.net) and

telephone line (01253 956673).

• Further information relating to membership can be found at:

www.bfwh.nhs.uk

Looking forward 2019/20

• To review and implement the Membership Strategy
• To increase engagement with the membership via the App
• To increase young people’s membership

Council of Governors and Board of Directors

Pearse Butler – Chair

Council of Governors

• A by-election to the Council of Governors took place during 2018/19 and

Christina McKenzie Townsend was newly elected to the Wyre Constituency.

• Elections to the Council of Governors have recently taken place and the

results are as follows:

– Public – Blackpool:

• Lisa Robins (newly elected)
• Zacky Hameed (re-elected)
• Graham Curry (newly elected)
• Jeannette Beckett (newly elected)

– Public – Fylde:

• Steven Gratrix (newly elected)

− Public – Wyre:

• Patricia Greenhough (newly elected)
• Sue Crouch (re-elected)
• Ian Owen (re-elected)

− Public – North West Counties :

• Stephen Cross (elected unopposed)

─ Staff – Nursing and Midwifery:

• Sharon Vickers (re-elected)

─ Staff – Clinical Support :

• Jenny Gavin (re-elected unopposed)

─ Thank you to Governors not re-elected:

• Beverley Clark
• Heather O’Hara

─ Thank you to Governors not re-standing:

• Bob Hudson
• Tony Winter

• There have been five Governor resignations during 2018/19 –

Betty Ray, Revd David Crouchley, Michael Phillips, Steve Winterson and Michelle Smith.

• Three appointed Governors have joined the Council –

Councillor Charlie Edwards, Paul Bibby and Margaret Bamforth.

• Thank you to all Governors for their contribution to the Trust.

Board of Directors

• Special thanks to the following Directors who have either resigned or

their term of office has ended during 2018/19:

• Karen Crowshaw (Non-Executive Director)
• Pat Oliver (Director of Operations)
• Paul Renshaw (Interim Director of HR)
• Alan Roff (Non-Executive Director)
• Steve Finnigan (Non-Executive Director)
• and, since the end of the financial year: Wendy Swift (Chief

Executive), Marie Thompson (Director of Nursing and Quality) and Professor Mark O’Donnell (Medical Director)

• Welcome to the following Directors who have joined the Board during

the year:

• Janet Barnsley (Interim Director of Planned Care)
• Pearse Butler (Chair)
• Dr Jim Gardner (Non-Executive Director)
• Kevin Moynes (Joint Director of HR & OD)
• Berenice Groves (Interim Director of Urgent and Emergency Care)
• James Wilkie (Non-Executive Director)
• Mark Beaton (Non-Executive Director)
• and, since the end of the financial year, Kevin McGee (Interim Chief

Executive, Peter Murphy (Interim Director of Nursing and Quality) and Dr Grahame Goode (Acting Medical Director)

Primary Care Networks

Dr Amanda Doyle OBE Chief Clinical Officer

‘Healthier Lancashire and South Cumbria’ Lancashire and South Cumbria Integrated Care System is a partnership made up of NHS, local authority, voluntary, community and faith sector

• rganisations, public sector, and

local communities.

Lancashire and South Cumbria Integrated Care System (ICS)

‘Healthier Fylde Coast’ The Fylde Coast ICP is one of five within the system across Lancashire and South Cumbria.

Fylde Coast Integrated Care Partnership (ICP)

Neighbourhoods are geographical areas across which groups of GP practices (primary care networks) and other health and care services work together to ensure joined-up care tailored to the needs of their local populations.

Neighbourhoods

Primary Care Networks

• Population health management
• Each primary care network has a clinical director
• Additional roles will include:
• Clinical pharmacist
• Social prescribing link workers
• First contact physiotherapists
• Paramedics
• Physician associates

• Blackpool Central West population health management

programme (34,500 population)

• People living with depression in houses of multiple
• ccupancy (3,125 people and 4,000 houses)
• Physical condition of homes has direct impact on health
• Health and Wellbeing worker engaged with a cohort of

people to understand underlying reasons and bring together various partners to improve their health and wellbeing, for example:-

• Substance misuse support
• Stop smoking service
• Voluntary work
• Housing providers
• Mental health support

Primary Care Networks

• Healthier Fleetwood resident-led partnership approach to improving the

health and well being of each and every resident of the town, parts of which are significantly disadvantaged

Primary Care Networks

What people will see

A year in focus and quality improvement plan

Kevin McGee, Interim Chief Executive

Challenges

• NHS Improvement Enforcement Undertaking

Letter – Royal College of Physicians Mortality Review – Warwick – Medical Engagement Survey

• Health Education Visit – July 2019

– One Level 3 risk remains regarding the Acute Care pathway - Trust to remain in GMC enhanced monitoring for Acute Medicine and Emergency Medicine programmes. – Eleven Level 1 risks raised – Action plan being developed regarding all risk areas.

• CQC Report – March 2018

– Action Plan in place (8 on-going)

• CQC Emergency Department Report – January

2019 – Action Plan in place (10 on-going)

• CQC Report – June 2019

– Expecting a draft in September 2019 and an announcement in October 2019

• Coroners’ Concerns

– Regulation 28 letters concerning documentation

Successes

• Civic Trust Award for WW1 Centenary displays
• National NHS 70 Award for young people’s panel
• New organ donation statue opened
• New £30,000 dementia garden at Clifton Hospital
• IT award for patient tracker information system
• Several awards for supporting Armed Forces personnel
• PLACE results amongst the best in the country
• More than 500 entries for the Staff Celebrating Success Awards

Governance action plan

Purpose

• Single version of the ‘truth’
• Collate all regulatory, advisory and internal

reviews/reports

• Provide evidence of recommendations being

addressed

• Provide assurance for the Board of Directors
• Provide assurance for Trust regulators

Reporting

• Executive Directors
• Board Committees
• Board of Directors
• Quality Improvement Board

Quality improvement strategy

The Board of f Direct ctors approved our new w Quality ty Improvement t Strategy on 3 September 2019. This strategy brings togeth ther programmes of work that t have been ongoing in the organisation and key issues we we need to address over the next t three years.

Ou Our amb mbition over er the e next three ee yea ears is to red educe e

• ur mo

mortality y rate e to one e that is bel elow the e national averag erage, e, saving over er 900 lives ves* across the e Fylde e Coast. Introducing our new Trust Quality Improvement Strategy

We will be putting Quality Improvement at the heart of everything we do, developing a portfolio of f Quality Improvement projects to ach chieve our overall ambition. Acr cross our hospitals and community services our staff, patients and partners will be empowered and supported to provide high quality, safe care fo for all, via a new w Quality Improvement Programme with the aim to reduce ce harm and mortality.

The Trust has been a national al outlier for mortal ality indices SHMI and HSMR since 20 2014 14 The Trust has received six mortal ality outlier alerts from the CQC QC since Januar ary 20 2019 19 The Trust has undergone a CQC QC inspection, with the results due in October 20 2019 19 Why are we trying to do this? “Delivering the Long Term Plan will rely on local health systems having the capability to implement change effectively. Systematic methods of Quality Improvement (QI) provide an evidence-based approach for improving every aspect of how the NHS operates. Through developing their improvement capabilities, including QI skills and data analytics, systems will move further and faster to adopt new innovations and service models and implement best practices that can improve quality and efficiency and reduce unwarranted variations in performance. A programme to build improvement capability is established in around 80% of the trusts rated ‘outstanding’ by the CQC.” NHS S Long Term Plan

Aim 1

Reduce Preventable Deaths

Aim 2

Reduce Avoidable Harms

Aim 3

Improve the last 1,000 days

• f life

Our Key Aims and Ambitions

Our ambit itio ion is to bring our observed deaths in line with our expect cted deaths over a three-year perio iod. . Setting g our ambit itio ion to save over 900 lives. Our ambit itio ion is to establis lish a true meanin ingf gful l metrics ics to understand our baseli line position for each ch harm group and develo lop init itia iativ ives to ensure our avoid idable harm instances are in line with our peers. Our ambit itio ion is to develo lop specif cific ic improvement project cts with

• ur partner organis

isatio ions that improve the lives of our patie ients and their ir familie ilies in the last 1,000 days ys of life.

Our Trust Improvement Plan

Across the organisatio ion we will l be focusin ing on both im immedia iate short term prio iorit itie ies alongs gsid ide longe ger term prio iorit itie ies to:  Support improvement  Improve patie ient outcomes  Deliv iver service ice efficie iciencie cies  Improve compassio ionate leadership ip  Develo lop a just cult lture Across all our proposed improvements we will l be embeddin ing a Qualit lity Improvement methodolo logy gy to support our staff to enable le change.

Driving Change on our Improvement Journey

Save Over 900 Lives By: Reducing Preventable Deaths Reducing Avoidable Harm

Leadership & Culture Meaningful Measurement Quality Improvement Projects Workforce Capability  Outstanding leadership at all levels  Evidence based optimal care  Fair & Just Culture  Strengthened communications internally & Externally  IT infrastructure for electronic patient records  Patient involvement in all improvements  Mortality (SHMI)  Failure to Rescue – Composite Score  Pressure Ulcers  Falls  VTE  Patient & Staff Satisfaction  Pathway Compliance – Sepsis, AKI, Pneumonia  Medication Errors  Mandatory Training as an indication of safety  Care of the Deteriorating Patient (recognition & escalation)  Pressure Ulcers, VTE and Falls  Last 1,000 days of life  High Medication Errors  End of Life Care  Sepsis, AKI, Pneumonia pathways  Ward Accreditation Standards  Integrated governance, redesign of SUI’s, Risk, Lessons learnt  Patient engagement and experience  Patients participate in all improvements  Build infrastructure and capability for improvement  Build a culture of continuous improvement  Celebrate successes and spread quickly

As part of our Qu Quality Initiatives to achieve our ambitious Go Goals we hav ave identified a number of key areas as we need to focus on and the projects we need to develop. Our first key projects will be:  Pr Pressure Ulcers  Care of the deteriorating g patient

Our Quality Improvement Methodology The QI QI methodology will underpin all our improvement plan ans using g QS QSIR principles.

Our Next Steps to Implementing this Strategy We will be developing a new Qu Quality Improvement Di Directorat ate who will host our expert advisors to help staff, patients and partner

• rganisations plan

an and carry

• ut improvement progr

gram ammes aligned to our priorities. As this is a new program amme we hav ave set out some high gh-level timescal ales and would like to start piloting g two key projects

• ver the next 3-6

6 months.

Questions and answer session

Pearse Butler – Chair Blackpool Teaching Hospitals NHS Foundation Trust

Closing remarks

Pearse Butler – Chair Blackpool Teaching Hospitals NHS Foundation Trust