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Appendices - East Lancashire Hospitals NHS Trust

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					       EAST LANCASHIRE HOSPITALS NHS TRUST BOARD MEETING
              29th JULY 2008, PENDLE COUNCIL CHAMBER
                                 13:00
                                AGENDA

                                          PART 1
Introduction
   1 Chairman's Report & Welcome           Verbal Report     Mr A Green
   2 Apologies                                               Mr A Green
   3 Minutes of the Previous Meeting       Enclosed          Mr A Green
   4 Matters Arising/ Action Matrix        Enclosed          Mr A Green
   5 Minutes of Extraordinary Trust        Enclosed          Mr A Green
     Board
   6 Declaration of Interests                                Mrs F Murphy




Strategy
   7 Chief Executive’s Report              Verbal Report     Ms M Burnham
   8 Response to Complaints Dossier       Enclosed           Mr G Graham
   9 Annual Plan 08/09                     Enclosed          Mr M Walkingshaw
  10 Estates Strategy                      Enclosed          Mr C Hodgson
  11 IM& T Strategy                        Enclosed          Mr S Brookfield
  12 Healthier Horizons for the North West Enclosed          Mr M Walkingshaw


Operational Performance
  13 - Quality of Services Key Trends &      Enclosed        Mrs L Wissett
    Forecasts
  14 - Use of Resources Key Trends &         Enclosed        Mr S Brookfield
    Forecasts

Monitoring
  15 Assurance Framework Update              Enclosed        Mrs L Wissett
  16 Annual Report of the Finance            Enclosed        Mr A Green
     & Performance Committee
  17 Foundation Trust Progress Report        Verbal Report   Mr M Walkingshaw
  18 Reports from Sub Committees             Enclosed        Mrs F Murphy
  19 Corporate Schedule of Meetings          Enclosed        Mrs F Murphy
Conclusion
   20 Any Other Business                                      Mr A Green
   21 Questions/ Comments from the Public
   22 Date and Time of Next Meeting
      24th September 2008 13:00, Burnley Town Hall, preceded by the Trust Annual
     General Meeting at 12:00
Resolution:   That publicity will be prejudicial to the public interest by reason of the
              confidential nature of the business to be transacted and that the public
              should be excluded.




                                         Part II
   23 Minutes of the Previous Meeting     Enclosed            Mr A Green
   24 Matters Arising/ Action Matrix      Enclosed            Mr A Green
   25 Chief Executive’s Report            Verbal Report       Ms M Burnham
   26 Use of the Common Seal              Enclosed            Mrs F Murphy
   27 CIP Assurance Framework             Enclosed            Mr S Brookfield
   28 IBP and LTFM Sign Off               Previously Circulated
   29 Executive Director’s Progress       Verbal Report       Ms M Burnham
       Against Objectives
  30 Serious Untoward Incidents           Enclosed            Mrs L Wissett
   31 Report on Excluded Medics Under     NTR                 Mrs C Schram
      NCAS Guidelines
   32 Reports from subcommittees          Enclosed            Mrs F Murphy
   33 Any Other Business
                     REPORT TO TRUST BOARD PART ONE
Meeting Date:                 Report Purpose:               Agenda Item: 1
29th July 2008          For Decision                 □
                        Performance Monitoring □
                        For Information
Report        Submitted Report Approved By:                 Report Title:
By:
Frances Murphy          Alan Green                          Chairman’s Report
Company Secretary       Chairman
Date Considered By      Divisional     Board     Chair Declaration of
Divisional Board/       Approval:                           Confidentiality Required:
Reason Not                                                  Yes              No
Considered By
Divisional Board:
NA                      NA


Implications For Partners:           NA
Related to key risks identified on   NA
Assurance Framework &
Consequences:
Related to Corporate Objective:      All
Related to HCC Standard:             NA
Related to Standards for Better NA
Health Domain:
Executive Summary:                   This   report       summarises    the    activities
                                     undertaken by the Chairman since the last
                                     report to the Board.
Recommendation/        What       Is Members receive the report
Required From The Committee:




Page 1 of 4
1.    Background/ Content/ Impact on the Organisation/ (Fit with Strategic
Direction/ Vision and Values/ Compliance with National Agendas)/ Impact on
Organisation of Doing Nothing:............................................................................... 3
2.    Options (If Any) ................................................................................................. 3
3.    Costs (Including Identified Source of Funding)/ VFM.................................... 4
4.    Conclusion/Recommendations........................................................................ 4




Page 2 of 4
1. Background/ Content/ Impact on the Organisation/ (Fit with Strategic
   Direction/ Vision and Values/ Compliance with National Agendas)/ Impact
   on Organisation of Doing Nothing:
1.1 I would like to take the opportunity to welcome Marie Burnham to her first Trust
   Board meeting. The energy, drive and enthusiasm she has shown in her first few
   weeks in post together with the support of a strong Executive Team will, I am
   sure, ensure the Trust continues on the journey to become an exceptional
   provider of Health Care Services for our local population.
1.2 I would also like to take the opportunity on behalf of the whole Trust Board to
   offer our sincere congratulations to Gary Graham who has secured the position of
   Chief Executive for the newly formed Dudley and Walsall Mental Health
   Partnership Trust. We wish him every success in the future.
1.3 As part of the Trust Board’s ongoing commitment to dialogue with staff, during
   June and July I held a number of open forums, “Talkback” sessions, for staff at all
   our sites. I was both grateful and pleased to see the number of staff who took
   time out to feedback their views of the way in which our Trust was changing and
   the impact this had on themselves and our patients. As always staff commitment
   to our patients was exemplary. A number of issues were raised, particularly with
   regard to the Meeting Patients’ Needs service changes and the impact this had
   on staff. There were also positive messages from some teams about how they
   had formed new ways of working which were proving successful.
    An action plan to address the common themes will be drawn up and more
   information about ways forward will be produced. More sessions will be planned
   and widely publicised
1.4 I was honoured to attend the Long Service Awards last week, with other Trust
   Board members, for our colleagues who have given over 25 years service to the
   NHS. It is particularly appropriate in the year that the NHS celebrates 60 years of
   service to the people of England and Wales that we also remember those in our
   own community who have dedicated their lives to working for the benefit of
   others.
1.5 I attended the NHS Confederation Annual Conference and exhibition that took
   place from 18th to 20th June where both the Secretary of State for Health and the
   Chief Executive of the NHS provided keynote addresses. The conference both
   looked back over 60 years of the NHS and forward to future challenges including
   the future of service commissioning.
1.6 The Chairman of Blackburn with Darwen Primary Care Trust and I have met to
   discuss ways in which we may gain a better understanding of each other’s


Page 3 of 4
      organisations and work more closely in the future. I have invited Mr Kennedy to
      visit the Trust at the end of the month and we will also visit the new health centre
      in Darwen together in August.
1.7 In early June we held our first Foundation Trust members’ event at both
      Blackburn and Burnley Hospitals focussing on diabetes services. We had an
      excellent turn out from patient and public members who greatly valued the
      insights this provided into our services. The next events are planned for
      September concentrating on cardiology services and our first members’
      newsletter will be issued before the end of this month.
Options (If Any)
2.1      NA


2. Costs (Including Identified Source of Funding)/ VFM
3.1      NA




3. Conclusion/Recommendations
4.1      NA




Page 4 of 4
                    REPORT TO THE TRUST BOARD PART ONE
Meeting Date:                   Report Purpose:             Agenda Item: 3
  th
29 July 2008               For Decision
                           Performance Monitoring □
                           For Information            □
Report Submitted By:       Report Approved By:              Report Title:
Frances Murphy             Alan Green                       Minutes    of      Previous
Company Secretary          Chairman                         Meetings
Date Considered By         Divisional         Board   Chair Declaration of
Divisional Board/          Approval:                        Confidentiality Required:
Reason Not                                                  Yes              No
Considered By
Divisional Board:
NA                         NA


Implications For Partners:              Not applicable
Related to key risks identified on      Not applicable
Assurance Framework &
Consequences:
Related to Corporate Objective:         All
Related to HCC Standard:                C7
Related to Standards for Better Governance
Health Domain:
Executive Summary:                      The paper contains the Minutes of the Trust
                                        Board Meetings that took place on 4th June
                                        2008
Recommendation/        What       Is Members are requested to approve or amend
Required From The Committee:            the minutes as appropriate




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                                                                             Page 1 of 15
        EAST LANCASHIRE HOSPITALS NHS TRUST BOARD MEETING
                  HASLINGDEN COMMUNITY LINK, HASLINGDEN
                           WEDNESDAY 4TH JUNE 2008
                                  MINUTES – PART 1


PRESENT
Mr A Green            -         Chairman
Mr G Graham           -         Acting Chief Executive
Mr G Boyer            -         Non Executive Director
Mr P Fletcher         -         Non Executive Director
Mr C Mellor           -         Non Executive Director
Mr S Brookfield       -         Director of Finance, Capital, Planning and Information
Mrs V Bertenshaw      -         Director of Operations
Mrs L Wissett         -         Director of Clinical Care and Governance
Dr G Jones            -         Medical Director Clinical Services
Mr E Foolat           -         Non Executive Director


IN ATTENDANCE
Mr M Walkingshaw      -         Director of Strategy and Productivity
Mr S Hill             -         Clinical Head of Division Women & Children
Mr P Dales            -         Partnership Officer
Mrs F Murphy          -         Company Secretary
Matron K Bonney       -         Matron Rehabilitation Services (for item 2008/007)
Mrs M Davey           -         Service Manager Medicine (for item 2008/009)
Ms C Sculthorpe       -         Press Officer
Mr T Armstrong (Board observer)
1 member of the public
2 members of the press


APOLOGIES
Mrs R Schram          -         Medical Director Governance and Education
Mr M Hill             -         Non Executive Director
Mr A Hook             -         Staff Side Representative


TCF/2008/001         CHAIRMAN’S REPORT AND WELCOME
Mr Green welcomed attendees to the meeting and welcomed Mr Tony Armstrong
who was observing the Trust Board meeting.
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Mr Green advised that the Trust had received a dossier from the Liberal Democrat
party and asked Mr Graham as Acting Chief Executive to provide the Trust’s
response.
Mr Graham advised that a draft version of the dossier had been supplied in February
2008 and that a full version had now been supplied through the East Lancashire
Primary Care Trust. He advised that the contents had been investigated as
thoroughly as possible and of the 46 issues raised 35 were either unsubstantiated or
too vague to enable further investigation. Upon exploration of the remaining issues, 8
were unable to progress due to lack of information and 3 have been referred through
the Trust’s formal complaints process.
The key themes from the dossier were that the Emergency Department/ Urgent Care
Centre implementation was flawed, that Emergency transport could not cope, that
non emergency transport for patients and staff was insufficient and issues relating to
the release of bodies following death. Mr Graham advised that a report on these
themes had been provided to the Overview and Scrutiny Committee in July and that
the themes are continually reviewed. He reported that performance in the Emergency
Department and the Urgent Care Centres had significantly improved and continues to
do so. Three new ambulances, 14 new paramedics and 30 new technicians have
been recruited by North West Ambulance Services and the organisation has
exceeded national targets since the MPN changes were implemented in November
2007. He reminded those present that a regular shuttle bus is available for patients
and staff running over 15 hours per day and this is a well used service. He advised
that the timetable is continually reviewed based on usage and demand.
Mr Graham advised that a detailed review of the full document will be presented to
the next Trust Board meeting and that as the main commissioner of services from the
Trust the East Lancashire Primary Care Trust would also undertake an independent
review. The Trust wishes to encourage all those with concerns or complaints to use
official channels to raise them to enable full investigations to be undertaken. He
advised if individuals were concerned about raising issues with the Trust directly they
should contact either Lancashire County Council or Blackburn with Darwen Overview
and Scrutiny Committees.
Mr Green concluded by advising those present that the Trust was not willing to
become embroiled in any political campaign and will be held to account by the
Overview and Scrutiny Committees but was willing to engage with politicians of all
parties. He added that the Trust had approved investment of £30 million in cancer,
cardiology and family services and this demonstrated the commitment to provide the
highest possible standards of care for all local communities.
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TCF/2008/002           APOLOGIES
Apologies were received as recorded above.


TCF/2008/003           MINUTES OF THE PREVIOUS MEETING
Members having had the opportunity to review the minutes of the meeting of 26th
March 2008 previously circulated approved them as a true and accurate record.
Members noted the incorrect date on the front sheet of the minutes presented.
RESOLVED: Members received the minutes of the meeting of 26th March 2008
               as a true and accurate record of the meeting.


TCF/2008/004           MATTERS ARISING/ ACTION MATRIX
2007/126       Quality of Services Key Trends and Forecast
               Mrs Wissett advised members that the report from the Healthcare
               Commission on the unannounced inspection had not yet been
               received.
All other items on the action matrix were reported as completed, on today’s agenda
or due for review at subsequent meetings.
There were no other matters arising
RESOLVED: Members noted the current position of the action matrix.


TCF/2008/005           MINUTES OF THE EXTRAORDINARY TRUST BOARD
                       MEETING ON 16TH APRIL 2008
Members having had the opportunity to review the previously circulated minutes of
the meeting approved them as a true and accurate record with the amendment that
Mr Martin Hill should be shown as chairing the meeting.
Mr Dales queried who was invited to attend extraordinary Trust Board meetings. It
was confirmed that only members of the Trust Board were invited to attend these
meetings but in future regular invitees would also be invited to attend.
Mr Dales queried why full assurance was not able to be given in relation to gagging
clauses as referred to in the minutes. Mr Graham responded that assurance was
required for the full year and the Trust was unable to give this level of assurance. He
advised that gagging clauses would not be used in the future.
RESOLVED: With the amendment detailed above members received the
               minutes of the extraordinary Trust Board meeting of 16th April
               2008 as a true and accurate record.


TCF/2008/006           DECLARATIONS OF INTEREST
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In accordance with the Code of Accountability for NHS Boards, members were
requested to make any relevant declarations of interest. No declarations were made.
Members were asked to declare any interest in the items on the agenda. No
declarations were made.


TCF/2008/007          DIVISIONAL      REPORT      ON    THE    MANAGEMENT          OF
                      INFECTION CONTROL
Mrs Wissett introduced Matron Kathy Bonney as the Matron for Rehabilitation
Services within the Medical Division and advised members that she had attended the
Board to provide members with assurance on the management of infection control
within the Division and as an opportunity, in accordance with the Chief Medical
Officer’s recent letter, for the Matrons to raise any issues of concern directly with
Trust Board members.
Matron Bonney advised members that the issue of infection control was the
responsibility of all members of staff and that Senior Infection Control Matrons were
supported by an infection control team in ensuring the key role of helping prevent and
control infections was carried out. She provided members with details of infection
control measures in place including handwashing audits and high impact
interventions and the regularity with which these prevention and control measures
were carried out, audited and action plans implemented. She updated members on
the mandatory training programme and the use of weekly cleaning checklists, PEAT
assessments and root cause analysis to identify themes and investigate incidents
and the use of the patient tracker to monitor patient satisfaction with the measures
implemented. The results of audits and action plans were highlighted to provide
assurance to the Board that appropriate measures were in place to monitor and
implement infection control measures throughout rehabilitation services.
In response to Mr Boyer’s question Matron Bonney assured members that patients
and visitors were aware of the handwashing measures in place and that signage was
very good. She emphasised the ongoing process of education for patients and
visitors. Mr Green remarked that he had a degree of comfort following the
presentation but queried what assurances could be given that the measures were in
place across the organisation. Matron Bonney responded that every matron carried
out the same work in relation to infection control and good and poor practice were
shared at the Matron’s forum so that improvements could be sustained and
embedded across the organisation. Mr Green asked if there was anything else the
Trust Board should be doing to assist in infection prevention and control to exceed
the national standards. Matron Bonney responded that the issue was one of
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 maintaining momentum and that there were new developments in aseptic techniques
 coming into practice all the time and the Board’s continued support for training was
 appreciated.
 Dr Jones asked for assurance that the same staff were not being audited and Matron
 Bonney advised that the audits were carried out at different times of day so that
 different staff were audited and Mrs Wissett added that the High Impact Interventions
 were also carried out with differing staff groups.
 RESOLVED: Members noted the presentation on the management of infection
                control within the rehabilitation services.


 ELHT/2008/008          BREAST CARE SERVICES MODEL
 Mrs Bertenshaw provided a verbal update on the progress of the business case for
 the establishment of the breast care service. She advised that there had been
 significant progress to date but further work on the establishment of options and
 funding streams was required. She advised that an outline business case would be
 submitted to the next meeting of the Trust Board and a full business case to the
 November meeting. Mr Green queried whether Mrs Bertenshaw was satisfied with
 the speed of progress and she responded that she would have liked the paper to be
 presented today but it was not sufficiently clarified at this stage and confirmed that it
 will be available for the next meeting. Mr Graham supported Mrs Bertenshaw’s
 comments and advised that there was awareness that there could not be a significant
 gap between approval of the plans for this service and the women’s and newborn
 services. Mr Green responded that it was imperative that this issue was addressed
 quickly as the clinical skills to deliver this service for the local population were in
 place. Dr Jones added that he will also expedite the report to submit to the July
 meeting.
 RESOLVED: Members noted the verbal update provided.
                Members will receive the outline business case at the July
                meeting.
                Members will receive the full business case at the November
                meeting.


ELHT/2008/009           NATIONAL SENTINEL STROKE AUDIT
Mrs Bertenshaw introduced the report and Mrs Davey who had prepared the detailed
report with Dr N Roberts. She advised members that the national audit is undertaken
every two years to measure the effectiveness of stroke services. In April 2007 the
results of the most recent audit were published and indicated that there was variable
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performance across the sites against the indicators measured. As part of the
reconfiguration of services in accordance with the Meeting Patient Needs programme
stroke services are now provided at the Royal Blackburn Hospital with 16 designated
beds available. Members were referred to the paper for details of the current stroke
service and progress against the indicators to date particularly in relation to the
admission of stroke patients to a dedicated stroke ward. Members were also advised
that the next audit will however concentrate on those patients who have not been
admitted to the ward and as they did not fall within the monitoring tool predictions
against the key indicators were not currently available. Members were referred to
Appendix A of the report for a full list of the performance indicators and progress
against them to date.
Mr Mellor referred to the establishment level referred to in the paper and queried what
standards they were being measured against. Mrs Davey responded that the 16 beds
were very high dependency and there had needed to be some adjustment to the
staffing levels. Currently only three remaining posts were out to recruitment. Mr Boyer
queried whether the ring fenced beds for stroke patients were lost when the Trust
came under pressure for beds. Mrs Davey responded that this had not happened to
date as bed managers did not allocate to these beds but where necessary a non stroke
patient would be moved to admit a stroke patient to the appropriate bed. Mr Boyer
queried whether there was any difficulty in meeting the recommendation that a brain
scan should be undertaken within 24 hours and Mrs Davey confirmed that there were
no issues in this area. In response to Mr Green’s query Mrs Davey advised members
that there were three stroke wards at Pendle Community Hospital and Rakehead
Rehabilitation Centre was used for those patients with very complex needs.
Mr Green asked for clarification on the support from Primary Care Trusts referred to in
the paper and Mrs Davey advised that progress was being made with the
establishment of the East Lancashire Primary Care Trust team and it should be in
place for August 2008. Mr Green asked whether the clinicians felt they were receiving
the appropriate support to enable them to deliver excellence. Mrs Davey responded
that the stroke strategy was under development and work with the Cumbria and
Lancashire network continued to identify any gaps in provision. She assured members
that key challenges will be brought to their attention. Mr Green added that he had been
very impressed with the staff when he had visited stroke services and asked Mrs
Davey to convey the Board’s thanks to the team.
RESOLVED:       Members received the report noting progress against the
                National Sentinel Stroke Audit standards within the Trust.


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ELHT/2008/010          ANNUAL STAFF SURVEY
Mr Graham introduced the report detailing the key positive and development trends of
the 2007 national staff survey and the key actions proposed by the Trust in response.
He advised members that the survey had been conducted in October and November
last year at a time when the Trust was undertaking a significant change process which
may explain both the extreme positives and areas of further development highlighted
within the survey results. He reminded members of the agreement to conduct an
internal quarterly staff survey which would be piloted in July and would be fully
implemented in September.
Mr Green queried how the key theme of valuing staff and providing management
support was integrated into the action plan and queried whether the right behaviours
were being demonstrated throughout the organisation to support and develop staff. Mr
Graham responded that the quarterly survey would be useful in identifying areas of
good practice in this regard to share within the organisation at a wider level. Mr
Fletcher queried whether any suggestions had been received from staff on how
communications might improve. Mr Walkingshaw outlined the ways in which
suggestions and interactions were sought within the organisation, including team brief
and email contact, and advised that little response was received. Members went on to
discuss the way in which Trades Unions might contribute to this process and Mr Dales
remarked that he had been involved in the development of the survey and that
feedback was encouraged by the unions.
Mr Graham added that the main area of concern was the engagement of management
and staff and the main positive issue arising from the report was the significant
progress that had been made on the widespread use of personal development reviews
and personal development plans. Mr Green concluded by encouraging trade union
representatives to encourage staff to provide feedback to managers.
RESOLVED:       Members received the report and noted the contents.
                Members approved the action plan presented and reporting
                against it to the Finance and Performance Committee on a
                quarterly basis.


 ELHT/2008/011         ADVANCING QUALITY PROGRAMME
 Mrs Wissett introduced the report which outlined the North West Strategic Health
 Authorities Advancing Quality Programme which aimed to improve the quality of
 services to patients. She advised that the programme aimed to reduce mortality, re-
 admission rates, complications in procedures and the time patients spent in hospital.
 It is anticipated that the programme could reduce by 141 the number of avoidable
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deaths in the North West region and of the 5 clinical areas selected for the
programme in the North West the Trust will participate in 4 as coronary artery bypass
grafts are not performed within the Trust. She advised members that subject to Trust
Board approval of the initiative a clinical and a nursing lead will be identified for each
of the clinical areas. Members were referred to the quality measures provided in
Appendix 1 of the report which were such that patients already expected the
standards of care to be measured and would therefore not be an add on to the work
of staff in caring for patients.
Mrs Wissett went ion to outline the incentives available to the upper quartile
performing Trusts within the region and advised that the Primary Care Trusts had
indicated they were supportive of the project and would provide the resource for a
project lead in the short term.
Mr Simon Hill observed that introduction of this project had been declined at Strategic
Management Board some time ago and Mrs Wissett responded that since that time
the project had developed significantly and now had the support both of the Strategic
Health Authority and the Primary Care Trusts and was now a very different project to
that presented previously. Mr Hill queried whether the US company that had
developed the programme would be involved in the delivery and Mrs Wissett
confirmed that they would facilitate training for staff. Mr Graham expressed
confidence that the Trust would perform in the upper quartile and Mr Green added
that the measures used were those that the Primary Care Trusts should be using to
measure performance against contracts with the Trust. Mrs Wissett added that it
would enable the Trust to accurately measure its performance against the standards
and Dr Jones added that previous audits had demonstrated the quality of services
being delivered.
Members then discussed the financial incentives for performance in the upper
quartile which would amount to approximately £300,000. Mr Green emphasised that
the aim was delivery of continually improving services of the highest standards to our
patients.
RESOLVED: Members received the paper and noted the contents
                Members approved the approach taken to improve patient
                outcomes through the Advancing Quality Programme.


ELHT/2008/012           QUALITY OF SERVICES KEY TRENDS AND FORECASTS
Mrs Wissett introduced the report highlighting the new format of the report and the
performance framework. Members were referred to the additional papers they had
received outlining the key targets for each performance measure and the degree of
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tolerance available. Members were advised that this would be added to throughout
the year as information on standards and targets became available.
Mrs Wissett advised that a number of the Healthcare Commission targets had
changed and these were highlighted in paragraphs 2.1 and 2.3 of the report. She
also advised members that full details were not yet available on some of the new
indicators against which the Trust would be measured and full year assurance would
be sought and this remained a risk for the organisation.
Mrs Wissett advised that the Trust was above trajectory for incidence of MRSA
however as further guidance on the assessment criteria for the new indicators was
not available at present an indication of overall performance could not be given.
She advised members that the performance framework was included at Appendix A
of the paper and performance risks and exceptions were detailed in section 3 of the
report and section 4 outlined actions being taken to bring exception areas back on to
plan.
Mrs Bertenshaw updated members on the performance in month for cancelled
operations which continued to under perform against the agreed tolerance and was
being closely monitored. She advised that new controls had been introduced to
authorise the cancellation of operations at short notice by the Director of Operations,
the Director on Call or the Divisional Director of Surgery and on each occasion this
occurred a root cause analysis was being undertaken to determine the cause and
learn any lessons for the future. She advised that since 9th May the rate had declined
to 1.1% of operations being cancelled form 1.5% previously and since 9th May this
had reduced further to 0.6% which was below the national tolerance of 0.8%.
Mrs Bertenshaw then went on to outline the close monitoring of elective activity in
key specialties that was being undertaken to ensure the Trust met its agreed activity
plan. She advised that orthopaedics were significantly below their plan at the current
time and this was reflected in the financial position of the Trust.
In relation to achievement of the 18 week referral to treatment target Mrs Bertenshaw
reported that there had been a recent breach of the milestone but that the agreed
trajectory was being maintained.
Mr Mellor remarked that the performance against the standard for cancelled
operations had been an issue for some time and asked for assurance that the
measures would remain in place. Mrs Bertenshaw confirmed that this would happen.
Mr Foolat asked for clarification of short notice cancellations and Mrs Bertenshaw
referred him to the pack issued today and advised that it referred to cancellations on
the day of surgery. Mr Boyer queried whether non clinical reasons for cancellations
included lack of bed availability and Mrs Bertenshaw confirmed this and that clinical
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reasons were when the patient was not fit to undergo surgery. It was agreed that a
report would be presented to the next Finance and Performance Committee meeting
tracking the causes of cancelled operations. Members discussed the need for staff to
understand the impact of cancelled operations on patients and the need to
understand what is happening on an individual case basis.
Mr Fletcher queried when the information on the new targets would be circulated and
Mrs Wissett responded that those that were available had been downloaded from the
Healthcare Commission website in June and that a check was made for outstanding
information on a daily basis.
Members then discussed the format of the key performance indicators presented in
Appendix 1 of the report and the need for clinicians to fully understand the indicators
on an individual department and corporate basis.
RESOLVED: Members received the report and noted the contents and the
               assurances provided.
               The Finance and Performance Committee will receive a report at
               its next meeting on the causes of cancelled operations.


ELHT/2008/013         USE OF RESOURCES KEY TRENDS AND FORECASTS
Mr Brookfield introduced the report providing a detailed explanation of the new format
of the report which had been amended to reflect the way in which Foundation Trusts
reported financial activity. He advised members that observations on the format of
the report would be welcome outside the meeting and that the way in which the
report was structured provided members with significant detail and emphasised the
importance of income and expenditure to the overall financial position of the Trust.
He advised members that an income surplus of £100,000 had been predicted at the
end of month 1 and that the actual position was a deficit of £340,000. The actual
deficit for the month was £442,000 which had arisen due to shortfalls in orthopaedic
activity, failure to deliver against agreed cost improvement programmes (CIP) and
spending above budget for the month. He advised that the Acting Chief Executive
had called budget holders to account for the overspend and a revised and re-profiled
plan for orthopaedic activity was being developed. All Divisions and Directorates had
been informed that timescales for delivery of CIP must be reviewed for accuracy
immediately.
He informed members that the Theatres budget was notoriously difficult to control
and a new theatre manager had been appointed to commence with the Trust on 1st
August 2008. In the meantime the budget was receiving special attention and
supervision from both the Director of Operations and the Director of Finance. Mrs
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Bertenshaw advised that this had been received well by the clinicians as had the
theatre utilisation work which had been implemented.
Mr Brookfield added that the recovery plan for the Emergency Department was in
place and was being closely monitored by the Chief Executive and that the issue of
recruitment to Anaesthetics department had been resolved by the Strategic
Management Board. He added that the final recovery plan for Pharmacy would be
available within the fortnight.
Mr Brookfield reported that the situation was disappointing given the steps taken to
have approved budgets agreed and assurances provided by Divisional Directors and
Clinical Heads of Division and that this issue will be taken up by the Executive
Directors with the new Chief Executive at the first opportunity.
Mr Mellor echoed the concern raised by Mr Brookfield and pointed out that if the
Trust had achieved Foundation Trust status at this time it would be required to report
on a monthly basis to Monitor and emphasised the need for a very rapid turn around
in financial performance. Mr Graham responded that the performance in the first
quarter was critical to the success of the Trust’s application and fortnightly meetings
were scheduled to ensure that performance was recovered by July Trust Board. Mr
Fletcher expressed concern that Executive Director involvement was required to
resolve the situation and Mr Graham responded that this involvement also assisted in
the development of capabilities among staff. Mr Mellor added that the question
whether the management structure to support delivery of the Trust Board’s objectives
would be raised in the Foundation Trust application. Mrs Bertenshaw responded that
a very clear management structure had been developed by the Chief Executive
designate.
Mr Mellor advised that the management of theatres had been raised as an issue in
August and the situation had not yet been resolved. Dr Jones responded that the
reasons were well founded and that the original successful applicant had declined to
take up the post and the recruitment process had to be restarted.
Mr Foolat added that significant resources had been invested in Emergency
Department and theatres and this appeared to have had little effect. He stated that
management capability appeared to be the issue and that they needed to be
supported. Mr Graham responded that the Trust faced a challenging year in
implementing MPN and the CIP and that the commitment, passion and belief were
apparent in the staff to recover the blip in performance in the first month. Mr Boyer
added that the commitment needed to be transferred into action and he felt let down
following the assurances received previously. Mr Green stated that the message
from the Trust Board was that it was not satisfied with performance and that the
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Board was not prepared to wait and see much longer. He added that the Trust had
agreed a tough plan in the previous year and staff had worked very hard to achieve it
and that it was a tremendous achievement to staff that a break even position had
been achieved. He welcomed the open and honest debate that had been had and
emphasised the need to deliver the agreed plan.
Mr Dales added that staff were working extremely hard to deliver the plan but he was
not certain that the impact of individual CIP and the actions necessary to achieve
them were understood in every department.
RESOLVED: Members received the report and noted performance to date and
               the assurances provided.


ELHT/2008/014         DIVERSITY AND EQUALITY ACTION PLAN UPDATE
Mr Graham introduced the report reminding members that the draft strategy had
been presented to the Trust Board and approved previously. He advised that
consultation with internal and external stakeholders was ongoing and that a steering
and operational group would be implemented shortly. Members having had the
opportunity to review the previously circulated report had no further observations.
RESOLVED: Members received the report and noted the assurances provided
               and approved the action plan presented including key milestones
               and timescales.


ELHT/2008/015         ASSURANCE FRAMEWORK UPDATE
Mrs Wissett introduced the report advising members that the assurance framework
had been revised and that 7 new additions had been made to the framework as new
risks had been identified. She assured members that robust risk assessments had
been carried out and mitigation plans were in place and would be monitored through
the Trust’s governance arrangements.
Mrs Wissett referred members to section 3 of the report outlining the top risks by
theme which included delivery of the next stage of the Meeting Patient Needs
programme, financial management and consistently meeting requirements to achieve
Foundation Trust status.
Mrs Wissett confirmed that the assurance framework was mapped to the core
standards of the Healthcare Commission and that there had been no significant lapse
to date against the core standards. She advised that the Assurance Framework was
continuously monitored through the Audit and Governance Committee.
Mr Green added that the Trust had developed an excellent framework and there was
confidence that the Trust was appropriately identifying and managing risk. He
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commended the work in developing the framework and advised members that other
external organisations were now seeking assistance from the Trust to adopt the
model developed here.
RESOLVED: Members received the report and noted the controls and
               assurances in place and the actions required to reduce the risks
               recorded.
               Members supported the actions in place to ensure delivery of the
               Trust’s strategic objectives.


ELHT/2008/016          ANNUAL REPORT OF THE AUDIT AND GOVERNANCE
                       COMMITTEE
Mr Brookfield introduced the report presented on behalf of Mr Martin Hill. He advised
that the report provided a very comprehensive review of the work undertaken by the
Committee during the course of the year and referred members to the action plan
that had been developed to improve the effectiveness of the Committee year on year.
RESOLVED: Members received the annual report of the Committee and noted
               the action plan adopted to improve effectiveness.


ELHT/2008/017          FOUNDATION TRUST PROGRESS REPORT
Mr Walkingshaw provided a verbal update to members advising that the revised
Foundation Trust timeline had been agreed with the Strategic Health Authority in the
last few days and that a Board to Board practice session had been arranged for 24th
June with the Strategic Health Authority. He reminded members that the revised
Integrated Business Plan and long term financial model would be presented to the
Finance and Performance Committee meeting on 25th June where changes to
previous versions would be highlighted. The models would then be presented to
commissioners on 11th July to enable them to confirm their support of the financial
plans of the Trust and their commissioning intentions. An extraordinary Trust Board
meeting would be convened at the conclusion of the Audit and Governance
Committee meeting on 23rd July to formally approve the documents and to confirm
the Trust’s final submission.
Mr Mellor queried what would be discussed at the Board to Board on 24th June as the
model and final IBP were still being revised. Mr Walkingshaw responded that the
Strategic Health Authority had indicated at this stage that the previous version of the
IBP would be discussed and Mr Graham added that the changes would be
summarised and that further clarification was being sought from the SHA. Members
then discussed the development of the IBP.
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RESOLVED: Members noted the verbal update provided and the next steps in
               the process.


ELHT/2008/018         MEETING PATIENTS NEEDS IMPLEMENTATION REPORT
Mr Graham advised members that the MPN changes had been highlighted in the
previous information given in response to the dossier earlier in the meeting. He
confirmed that the Women and Newborn steering group had been established and
was chaired by him and that the outline business case had been submitted to the
Strategic Health Authority and further feedback was awaited.
RESOLVED: Members noted the verbal update provided.


ELHT/2008/019         REPORTS FROM SUBCOMMITTEES
Mr Green introduced the report detailing the decisions and actions of the Trust Board
subcommittees. The Chair of each Committee confirmed that there were no issues
they wished to raise with the Trust Board.
RESOLVED: Members received the report and noted the contents.
               Members ratified the decisions of the subcommittees.


ELHT/2008/020         USE OF THE COMMON SEAL
Mrs Murphy introduced the report advising members that the seal had been affixed to
the lease of the Prairie Car Park as previously authorised.
RESOLVED: Members noted the use of the Seal


ELHT/2008/021         ANY OTHER BUSINESS
No further items of business were presented.


ELHT/2008/022         QUESTIONS / COMMENTS FROM THE PUBLIC
There were no questions or comments from members of the public or press.


ELHT/2008/023         TIME AND DATE OF NEXT MEETING
The next meeting will take place on TUESDAY 29th July 2008 at 13:00 in the Pendle
Borough Council Chamber.


RESOLVED: That publicity will be prejudicial to the public interest by reason
               of the confidential nature of the business to be transacted and
               that the public should be excluded.


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                                                                        Page 15 of 15
                        REPORT TO TRUST BOARD PART ONE
Meeting Date:                         Report Purpose:           Agenda Item:
  th
29 July 2008                  For Decision            □         4
                              Performance Monitoring
                              For Information         □
Report Submitted By:          Report Approved By:               Report Title:
Frances Murphy                Alan Green                        Action Matrix
Company Secretary             Chairman


Date Considered By            Divisional     Board        Chair Declaration of
Divisional Board/             Approval:                         Confidentiality Required:
Reason Not                                                      Yes              No
Considered By
Divisional Board:
NA                            NA



Implications For Partners:              NA
Key Risks & Consequences:               Failure to ensure previously agreed actions are
                                        carried out
Related         to      Corporate All
Objective:
Related to HCC Standard:                C7
Related    to    Standards         for Governance
Better Health Domain:
Executive Summary:                      These are the agreed actions arising from the
                                        previous meetings
Recommendation/             What    Is Members are requested to note progress against
Required             From          The the action matrix and agree further actions as
Committee:                              appropriate




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                                                                                      Page 1 of 2
                                           TRUST BOARD PART ONE ACTION MATRIX            Action Matrix
Minute No               Action                                                     By   When            Agenda Item
2007/125 Staff          Quarterly action plan to be presented to Trust Board       GG   Immediately     September 08
Survey 08/09

2007/126 Quality of     Action plan to be developed on receipt of HCC              LW                   Verbal Update
Services Key Trends     unannounced inspection report
& Forecast
2008/001 Chairman's     Detailed review of MPN issues dossier to be presented to   GG   Immediately     Agenda Item
 Report                 next Trust Board meeting

2008/005 Minutes of     Minutes to be amended                                      FM   Immediately     Verbal Update
Extraordinary Trust
Board
2008/008 Breast         Full Business Case to be presented to November meeting     VB   November 2008   November Item
Care Service Model

2008/008 Breast         Outline Business Case to be presented to next meeting      VB   Immediately     Agenda Item
Care Service Model

2008/012 Quality of     Report to be presented to next Finance and Performance     VB   Immediately     Verbal Update
Services                Committee on cancelled operations




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                                                                                                                      Page 2 of 2
                    REPORT TO THE TRUST BOARD PART ONE
Meeting Date:                   Report Purpose:             Agenda Item: 5
  th
29 July 2008               For Decision
                           Performance Monitoring □
                           For Information            □
Report Submitted By:       Report Approved By:              Report Title:
Frances Murphy                                              Minutes of Extraordinary
Company Secretary                                           Trust Board Meeting
Date Considered By         Divisional         Board   Chair Declaration of
Divisional Board/          Approval:                        Confidentiality Required:
Reason Not                                                  Yes              No
Considered By
Divisional Board:
NA                         NA


Implications For Partners:              Not applicable
Related to key risks identified on      Not applicable
Assurance Framework &
Consequences:
Related to Corporate Objective:         All
Related to HCC Standard:                C7
Related to Standards for Better Governance
Health Domain:
Executive Summary:                      The paper contains the Minutes of the
                                        Extraordinary Trust Board Meeting that took
                                        place on 9th July 2008
Recommendation/        What       Is Members are requested to approve or amend
Required From The Committee:            the minutes as appropriate




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                                                                             Page 1 of 4
   EAST LANCASHIRE HOSPITALS NHS EXTRAORDINARY TRUST BOARD
                                        MEETING
        BOARD ROOM, ROYAL BLACKBURN HOSPITAL 9TH JULY 2008
                                        MINUTES


PRESENT
Mr E Foolat (Chair)   -         Vice Chairman
Ms M Burnham          -         Chief Executive
Mr G Graham           -         Deputy Chief Executive
Mr P Fletcher         -         Non Executive Director
Mrs L Wissett         -         Director of Clinical Care and Governance
Mr M Hill             -         Non Executive Director
Mrs R Schram          -         Medical Director Governance and Education


IN ATTENDANCE
Mrs V Bertenshaw      -         Director of Operations
Mr M Walkingshaw      -         Director of Strategy and Productivity
Mrs F Murphy          -         Company Secretary
Ms N Orton            -         Head of Human Resources, Operations and
                                Organisational Development
APOLOGIES
Mr S Brookfield       -         Director of Finance, Capital, Planning and Information
Dr G Jones            -         Medical Director Clinical Services
Mr C Mellor           -         Non Executive Director
Mr A Green            -         Chairman
Mr G Boyer            -         Non Executive Director


TCF/2008/032          CHAIRMAN’S REPORT AND WELCOME
Mr Foolat welcomed everyone to the meeting and formally welcomed Ms Burnham to
the Trust on behalf of the Non Executive Directors. Mrs Wissett introduced Ms Orton
to Trust Board members.


TCF/2008/033          APOLOGIES
Apologies were received as recorded above.


TCF/2008/034          PROPOSED ORGANISATIONAL STRUCTURE


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                                                                             Page 2 of 4
Ms Burnham introduced a power point presentation outlining the proposed
management and assurance structure for the Trust which linked performance and
governance and established a new way of linking clinical leadership with professional
leads and business managers in each division. She advised that the structure would
enable clear roles and accountability for delivery of performance ensuring staff were
clear who they were responsible to.
She outlined proposals for Executive Director structures and explained the concept of
triangular management where the clinical, business and governance aspects of the
organisation would be brought to bear in consideration of any issue. Members were
advised that the proposed structure had engaged the enthusiasm of many clinicians
throughout the Trust who had assisted in its development and who supported the
concept of earned autonomy which would be introduced within the Trust to enable
innovation in service developments while ensuring all quality and performance
indicators were met. Members were informed that although a scoping exercise was
still underway initial indications were that the restructure would be cost neutral.
Members received an update on the proposed delivery boards and the functioning of
the Clinical Policy Group and the assurance structures within the organisation.
Mr Hill queried whether the Associate Medical Directors proposed in the structure
would have sufficient time to undertake their clinical and managerial duties and Ms
Burnham advised that clinical time would not be taken up with management duties
for which a management allowance would be payable. She advised that all
prospective Associate Medical Directors had volunteered to take up the role. Mrs
Schram added that the management duties would be undertaken in the time
allocated for additional duties in the consultants’ job plan.
Members went on to discuss the Divisional General Manager and Business Manager
posts within the proposed structure and the clear commitment to avoid redundancies
was reiterated by members.
Mrs Wissett updated members on the matron roles indicated within the proposed
structure and members discussed the way in which the roles may develop.
Ms Orton provided members with an outline for the implementation of the proposed
structure and a timeline for recruitment to the posts. Members discussed the required
period of consultation and how the proposals fitted in with current policies. Members
were assured that the process of recruitment should be largely completed by 1st
September and that vacancies would be advertised externally if any roles were not
filled at that stage.
Following further discussion members unanimously approved the proposed
organisational structure and the timescale for implementation.
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                                                                               Page 3 of 4
RESOLVED: Members unanimously approved the proposed organisational
              structure and timescale for implementation.




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                                                            Page 4 of 4
                        REPORT TO TRUST BOARD PART ONE
Meeting Date:                         Report Purpose:                 Agenda Item: 8
  th
29 July 2008                   For Decision
                               Performance Monitoring
                               For Information
Report Submitted By:           Report Approved By:                    Report Title:
Steph Long, Head of Marie Burnham,                                    Review   of     the    Liberal
Communications              & Chief Executive                         Democrat Dossier – “What
Engagement                                                            People have Told Us”
Date Considered By             Divisional     Board      Chair Declaration of
Divisional Board/
                               Approval:                              Confidentiality Required:
Reason Not
Considered By                                                         Yes             No
Divisional Board:


Implications For Partners:             Response involves partner agencies as MPN
                                       commissioners.
Key Risks & Consequences:              Perceptions      of    Trust     services    and     risk    to
                                       reputation.
Related         to      Corporate All
Objective:
Related to HCC Standard:               All
Related    to    Standards         for All
Better Health Domain:
Executive Summary:                     This paper outlines the key findings of the review
                                       of the Liberal Democrat Dossier “What people
                                       have told us”.
                                       It summarises how the dossier contents have been
                                       reviewed, provides assurance to the Board and
                                       identifies any further actions necessary.
Recommendation/             What    Is Trust Board is asked to:
Required             From          The i)    consider        the   report,     conclusion          and
Committee:                             recommendations
                                       ii) highlight any issues for continued assurance.




                                                                                      Page 1 of 12
               REVIEW OF THE LIBERAL DEMOCRAT DOSSIER
                         ‘WHAT PEOPLE HAVE TOLD US’
                                   TRUST BOARD
                                      JULY 2008


1. INTRODUCTION
This paper outlines to the Trust Board the key findings of a review of the Liberal
Democrat Dossier – “What people have told us” issued to East Lancashire Primary
Care Trust and presented to the Press of East Lancashire on the 30th May 2008. It
seeks to provide the Trust Board with assurance on the emerging themes and issues
within the dossier that are attributed to the reconfiguration of acute services across
East Lancashire –‘Meeting Patients’ Needs’.
The report will address the following:
            Context of the Dossier
            Background to Meeting Patients’ Needs
            How the Dossier has been reviewed
            Interpretation of the Dossier and assurance to the Trust Board
            Conclusion
            Recommendations


2.      CONTEXT OF THE DOSSIER
The Trust takes very seriously the allegations contained within the ‘dossier’.
However, TB Members need to note the documents own assertion that “No claim is
made that this dossier is complete, thorough or constitutes a piece of
comprehensive research” and is a ‘campaign document’. Nevertheless, the Trust
is clear that it takes all issues seriously in relation to services whether perception or
fact, and as a result we have examined this Dossier and emerging themes, in order
that we can act where appropriate to improve patient experience.


3 BACKGROUND TO ‘MEETING PATIENTS NEEDS’
Identified below are key points in relation to the first phase of the clinical re-
configuration introduced on the 1st November 2007 were:


3.1 PCT commissioned
The decision to commission the reconfiguration of services (Meeting Patients’ Needs)
across East Lancashire was made by East Lancashire and Blackburn with Darwen
Primary Care Trusts and followed a public consultation carried out by our PCTs. It
                                                                               Page 2 of 12
was based on the PCTs assessment of how acute services could better respond to
the health care needs of the population of East Lancashire within an agreed financial
envelope.


3.2 Clinician led
The service models adopted were developed by clinicians across primary and
secondary care based on the best possible clinical evidence of how to ensure the
best possible outcomes for patients.


3.3 Overview and Scrutiny Committee supported and concerns addressed
At its meeting on the 7th November 2006, the Lancashire and Blackburn Joint Health
Overview and Scrutiny Committee fully supported MPN Service Model A as the
preferred option. This followed the outcome of the public consultation and evidence
provided by Professor Sir George Alberti (further details below). The six monthly post
MPN report to Lancashire County Council OSC on the 17th April 2008 was accepted
and the OSC stated that better acute services are now being offered after MPN first
stage implementation.


3.4 Subject to independent review by leading national clinical expert
Professor Sir George Alberti (National Director of Emergency Access) reviewed the
proposed changes to emergency services across East Lancashire and delivered the
key messages of his subsequent report in person to the Joint East Lancashire OSC
for Health. His report strongly supported the plan to introduce urgent care facilities
and centralised emergency department with 24 hour senior doctor cover and state of
the art diagnostic facilities. Board members are asked to note that Professor Alberti,
revisited East Lancashire on the 4th July 2008 and provided written comment that the
Urgent Care Centre in Burnley was working extremely well and runs in an integrated
way with the Emergency Department in Blackburn.


3.5 In line with NHS Next Stage Review
Professor Lord Darzi’s vision for health and healthcare for the next ten years has
identified eight areas of care. This is very much in line with the models of care
adopted through our MPN approach – planned care, acute care and long-term
conditions with unscheduled care being delivered close to peoples’ neighbourhoods
via a network of local walk-in centres. It is encouraging to note that the approach we
are taking, with our primary care partners, is in line with the best possible evidence
nationally with clinical decision-making at the heart of the future of healthcare in East
Lancashire.
                                                                            Page 3 of 12
4.     HOW THE DOSSIER HAS BEEN REVIEWED
4.1 Methodology
The Dossier, received at the end of May 2008, is attached at Appendix 1. On receipt
of the Dossier the Trust undertook a systematic review in relation to the document. A
line by line review was undertaken to establish the basis of issues raised and to
identify any factual accuracies. This section will assure Trust Board Members of the
following:
              Analysis of the themes.
              Trust prior knowledge of these themes and issues.
              Assurance and action the Trust will take.


4.1.1 Analysis of themes

        Identified Themes within texts provided                 No of cases
        Concerns Re Service/Care                                         65
        Capacity Related Issues                                          45
        Transport Issues                                                 42
        Poor Communication                                               32
        Appointment /Admission                                           26
        Explicit MPN Apprehension                                        21
        Records Problems                                                 17
        Management Issues                                                17
        Staffing Problems                                                16
        Ambulance Related Issues                                         10
        Expense                                                          10
        Discharge                                                         9
        Diagnosis                                                         8


4.1.2 Trust prior knowledge of these issues
 Trust Prior knowledge of these issues

 Formal Complaints                                                  9
 MP Enquiry                                                         2
 Choices Website Replies                                            8
 Inquest /Complaint Pending                                         1

In essence, as evidenced above there were 181 specific references made of which
the Trust had prior knowledge of only 20 which are currently being addressed.
However, to reassure Board Members and the public the whole Dossier has been
analysed based on key themes which can be found in Appendix 2.



                                                                        Page 4 of 12
4.1.3   Assurance and action the Trust will take
The themes that the Trust has used to analyse the Dossier as identified in Appendix
2 are described in detail below.




MPN Apprehension
Issue/Perception                      Assurance/Further Action
       Denied treatment at BGH.             Thrombolysis offered at BGH from 1
       (go to RBH)                          July 2008.
       Savings versus Service.              Increased staffing base as a result of
       Expenses and travel costs            MPN – plus £30M investment over next
                                            5 years on Burnley site.
       Inconvenience of travel
       issues and time.                     Second Cath Lab on RBH site as a
                                            result of MPN.
       Safety fears over transport
       time.                                Free inter-site Shuttle bus with
                                            extended timetable in response to
       Closure of Burnley
                                            public demand.
       perception to address debt.
                                            Parking costs have remained the same
       Temporary moves will
                                            since before service change.
       become permanent.
                                            Trust-board approved Estates Strategy
       FT powers = ability to
                                            and is in public domain.
       ignore patient concerns
       more.                                FT allows more and greater financial
                                            freedom and local accountability
       All changes in MPN not
                                            through a council of governors and
       published eg hearing aid
                                            membership base made up from local
       services.
                                            community.
                                            Business case for development of
                                            integrated Breast Unit at BGH to be
                                            considered in July / August 2008.




                                                                      Page 5 of 12
Appointments/Admissions

 Issue/Perception                        Assurance/Further Action
        Cancelled operations.                  Improved performance on cancelled
        Cancelled appointment not              operations resulting from root cause
        communicated.                          analysis and executive director only
                                               sanctioning cancellations.
        Cancelled Holiday for
        treatment, treatment
        cancelled due to lack of time.          Extreme winter pressures led to some
        Queues at OPD RBH.                      cancellations but whilst local hospitals
                                                closed their doors, ELHT remained
        No follow up appointment.
                                                open.
        HDU Bed availability.
        Management of +
                                                Additional HDU beds available at
        communication with patient –
                                                BGH to allow more elective surgery to
        Availability of HDU beds.
                                                take place.
        Out patient responses-
        Phone messages being left
        and not answered.                       Introduced electronic patient tracking
                                                to improve case note availability.
        Staff not returning
        calls/attitude.
        Delays due to transfer                  Outpatient Booking Team now fully
        between consultants.                    staffed and a robust training
                                                programme in place.
        GP comment delay in getting
        beds when referring not
        acceptable.                             GP Assessment Area has been
        GP referral unable to                   introduced in the Emergency
        transport form home until bed           Department at RBH, using 4 cubicles,
        available.                              so that patients could go direct to
                                                there.

                                                GP Clinical Decisions Unit on MAU
                                                where a 4 bed bay is utilised to
                                                support improved flow.

                                                No patients wait at home unless there
                                                is an agreement between the
                                                referring clinician and receiving
                                                hospital doctor that other patients are
                                                more urgent and must come sooner.




                                                                           Page 6 of 12
Expense
 Issue/Perception                           Assurance/Further Action
        Cost of travel to Blackburn Vs
        Burnley and Time taken.                   Figures show shuttle bus well-
        Round trip costs.                         used.
        Additional trip to Blackburn to
        pick up prescriptions. (TTO)              Charges for car parking the same
        Cost of empty bus service.                as before the change.
        Who can and lack of info /
        knowledge of reclaiming travel
        expenses.




Capacity
 Issue/Perception                          Assurance/Further Action
        Equity of Bed usage at BGH +
        RBH.                                     72% of trust elective surgery taking
        Red Vs Green status.                     place at BGH with plans to
        Delay to get a bed. (GP                   increase to 75%.
        comment)
        Bed availability leading to              RBH never been permanently on
        cancelled ops.                           red alert.
        Consolidation of wards. (Beds)
        Cutbacks in staff mean beds              Winter pressures meant a small
        are unused.                              number of patients sent to most
        Theatre utilisation.                     suitable, available bed locally.
        Availability of Paediatric beds.
        Patients asked to come back              Patients transferred due to medical
        tomorrow at BGH UCC.                     need.
        Alleged 24 hr wait for bed to
        receive treatment .                      Four hour target being met and
        Empty beds Use of BGH.                   isolated cases where it is not are
        Movement of Patients at night.           reviewed for lessons learnt.
        Waiting times in ED - ordeal
        with # arm ( 6 years old) arm            NHS Choice means that patients
        set needed readmission and               have option to use a private
        operation.                               provider.
        Private sector used for
        Operations.                              No instances of paediatric beds
        Care reactive no proactive.              unavailable – paediatric beds
                                                 available on both BGH and RBH.




                                                                         Page 7 of 12
Discharge
 Issue/Perception                                 Assurance/Further Action
        Discharge without relatives knowledge           Readmission rate
        sent on shuttle bus to BGH.                     performance - good
        Discharge on shuttle bus in                     indicator of appropriate
        inappropriate clothing and with out             discharge.
        money.
        Late discharges of elderly to home in             Patient transport arranged
        inappropriate clothing.                           for those who need it.
        Allegations of misdiagnosis.
        Medication delay on discharge.(wait in            Discharge lounge available.
        café)
        GP comment unsafe early discharge.


 Communications
 Issue/Perception                        Assurance/Further Action
        Patients told ops cancelled            Level of cancelled ops continues to
        every day of the week by staff         fall.
        Switchboard response times
                                                 Centralisation of the two case note
        Different message to patients            libraries within the Trust.
        from Doctors and nurses
        Different messages on                    Case note availability has significantly
        different sites                          improved.
        Outpatient appointment
        system                                   Audited and monitored on a monthly
        Patients being told by staff             basis and prompt action is taken if
        their dissatisfaction                    necessary to ensure that case notes
                                                 are available for all patients’
        Communications issues with               attendances.
        “next of Kin” problems as they
        are not relatives but friends            The scale of the changes in the first
        Use of voicemail                         Phase of MPN was unprecedented.
        Incorrect phone numbers
        given/ on stationary                     The position has considerably
                                                  improved with staffing having
                                                  returned to appropriate levels.

                                                 introduction of Choose and Book
                                                 on-line referral review to consultants
                                                 all of which has led to patients
                                                 experiencing an improved service.




                                                                           Page 8 of 12
Referral, records and results
Issue/Perception                            Assurance/Further Action
       Use of own transport BGH –
       RBH with Fracture not allowed           Patient Transport Service in place
       to take records.                        between sites. (supported by shuttle
       Death in transit - declaration          bus service)
       process NWAS.
       Management of GP
       Admissions and transport
                                               Deaths recorded as DOAs by a doctor
       process.
                                               at hospital – not by paramedic in
       Bus does not drop off except on         Ambulance.
       Hospital site - not the service
       required.
       Traffic flow into out of RBH site.
                                               DOAs decreased as compared with
       Delay in transport using bus
                                               same period 12 months previously.
       from BGH UCC to RBH.
       Patients not booked in MAU –
       Unknown location in hospital.
       Poor records transferred from           Shuttle Bus designed to alleviate traffic
       BGH to RBH.                             congestion as staff and visitors
                                               encouraged to use it.
       No records appointment
       cancelled.
       Previous records not available
       in A&E. ( ? case notes)                 Improved patient tracking / records
       No notes available for 6 month          system.
       review appointment.
       Not being given correct
       diagnosis resulting in
                                               Inappropriate  referrals  -   more
       readmission.
                                               information needed to allow further
       Length of time to receive results       investigation.
       + then more tests.
       In appropriate referral from St
       Peters.
       Inappropriate referral from BGH
       UCC to RBH for scan (Patient
       sent home without scan)
       In appropriate advice from
       BGH UCC by phone at night




                                                                           Page 9 of 12
Concerns over service or care
 Issue/Perception                              Assurance/Further Action
      Availability of products/ supplies –           Very specific concerns which
      incontinence, Linen.                           would need further investigation.
      Nursing care – found in wet bed.
      Patient communications.
      Privacy and dignity.                            PEAT action plan to be
      Production line.                                implemented to improve patient
                                                      environment – including £125K
      Unattended (2-3 hrs) post triage.
                                                      investment.
      Reception.
      Directions.
      Movement of wards because of
                                                      Some ward movement in early
      shortage of beds.
                                                      2008 to temporarily assist with
      Time taken to attend when buzzer                winter pressures Ward 11 at
      pressed.                                        BGH. (planned admissions ward)
      No assistance with eating.
      “cancer” ops cancelled.
      Patients from outside East                      Some staff volunteered to
      Lancashire using beds.                          temporarily move over to RBH to
                                                      open additional beds to assist in
      Uniforms being worn in public                   the winter pressures for 1 month
      places.
      GP appointment availability.
      Length of time bodies in beds.                  Not aware of any problems with
      Quality of food.                                registering deaths - on site
      Standard of diet. ( 5 portion of fruit          facilities to be provided.
      and veg per day )
      GP appointment availability.
      Registering of deaths. (all at                  No preference given to patients
      Blackburn)                                      from outside East Lancashire –
      Cold wards BGH. ( insufficient                  decisions made on clinical
      blankets)                                       evidence – not residence.
      Hand washing Medics.
      Number of visitors allowed.
      Dirty ward. ( for 2 days )                      Hand hygiene audits.
      Discharged with Venflon in situ.
      Delayed Pain relief.
      Medication advice sort from relative            More HDU bed availability at BGH
      in the middle of the night at home.             and increased intensive care
      HDU beds availability.                          staffing.




                                                                          Page 10 of 12
Ambulance/Transport

 Issue/Perception                         Assurance/Further Action
        NWAS staff knowledge of                 NWAS performance exceeding
        area – SAT NAV usage not                national targets
        quickest route                          Not aware of any delays in patient
        Availability of ambulances for          transfer
        discharges afternoon/evening            We have an extra discharge
        Delays in patient transfer from         ambulance from May 2008 running
        BGH to RBH                              until 2pm
        Transport time to ED in                 Discharge lounge now in place and
        Ambulance                               improved co-ordinated transport in
                                                place.
                                                Performance targets are being met –
                                                extra investment in ambulances,
                                                paramedics and technicians

Management Issues
 Issue/Perception                             Assurance/Further Action
        Not using elective BGH site to full         Plans to move more services over
        potential – See also capacity.              to BGH.
        Complaints process awareness                Hospitals recently underwent
        and response times.                         ‘Deep Clean’.
        Dirty RBH site.                             Ward redecoration programme
        Clean BGH site.                             planned.
        Environment concerns - Flood.               Introduction of Shuttle Bus
                                                    intended to alleviate pressures on
        Object found in clean linen.
                                                    parking.
        Parking bad. (RBH)
                                                    PEAT scores.
        Distance to cars from front doors.
                                                    Top 10 in country on compliant
        No assistance/ wheelchairs                  responses by HCC.
        available near front door.


 Staff Perceptions
 There have been a number of issues within the Dossier where it is alleged that staff
 find it difficult to raise their concerns. Trust Board Members are assured there are
 mechanisms in place for example, staff briefings, whistle blowing policy and others,
 where staff can raise their concerns. Nevertheless, it is the Executive Team’s
 intention to continue to actively seek the views of staff through, for example, the
 rolling out of the Trust’s quarterly staff survey by September 2008 and through the
 introduction, of staff champions. All initiatives will be monitored and actioned via the
 divisional structures and performance reported to the Trust’s Governance Committee


 5.     CONCLUSION
 In conclusion, the Trust has undertaken a detailed review of all the issues within the
 Dossier, identifying 181 perceptions/issues that have systematically been assessed
                                                                          Page 11 of 12
to assure the Trust Board of any required action to improve the quality of care to
patients. The action identified will be monitored by the Governance Committee to
ensure an open and transparent process.


6.     RECOMMENDATIONS
Members are asked to:


          i)        note the report.
          ii)       approve the list of actions relating to the Dossier themes.
          iii)      Approve the suggestion that the Governance Committee overseas
                    any action identified in this report.




Author and Title:                        Steph Long
Author Contact Details:                  Extn. 82390
Press Paper Supplied:                    no
Date of Submission:                      23.07.08
Date Accepted for Committee:




                                                                           Page 12 of 12
Appendix 2 Analysis of Documented events




                                                           Appoint/Admis
                                            Apprehension




                                                                                                                                               poor comms

                                                                                                                                                            service/care
                                                                                                                                                            concerns re
                                                                           ambulance
                                awareness
     Reference




                                                                                                                  Discharge
                                                                                                  Diagnosis




                                                                                                                                                                                                transport
                                                                                                                              Expense
                                                                                       Capacity




                                                                                                                                                                           Records

                                                                                                                                                                                     Staffing
      Dossier




                       Source




                                                                                                                                        mgmt
                                  Trust



                                                MPN



                                                               sion
S1          15 family/friend                                                                                  y
S1       122 family/friend                                 y                           y
S1       122 staff                                                         y                                                                                y                        y
S1       123 staff                                                         y
S1       124                                                                           y
S1       125 patient                                                       y                                                                                y
S1       126                                                                                                                  y
S1       127                                                                           y
S1       128 family/friend                                                                                                                                  y
S1       129 various                                                                                                                                                                 y          y
S1       130 staff                                                                     y                                                       Y
S1       131 staff                                                                     y
S1       132 staff                                                                                                                      Y                                            y
S1       133 family/friend                                                             y                                                                    Y                        y
S1       134 staff                                                                                                                      y                                            y
S1       135                                                                                                                            y
S1       136 patient                                                                   y
S1       137 staff                                                                     y                                                                                             y
S1       137 staff                                                                                                                      y
S1       138                                                                                                                                   Y
S1       139 staff                                                                                                                      y
S1       140 staff                                                                                                                      y                                            y
S1       141 staff                                                                                                                      y

                                                                                                                                                                                                                                    Page 1 of 8
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                                                      Apprehension




                                                                                                                                                             poor comms

                                                                                                                                                                          service/care
                                                                                                                                                                          concerns re
                                                                                     ambulance
                                      awareness
     Reference




                                                                                                                                Discharge
                                                                                                                Diagnosis




                                                                                                                                                                                                                  transport
                                                                                                                                            Expense
                                                                                                 Capacity




                                                                                                                                                                                             Records

                                                                                                                                                                                                       Staffing
      Dossier




                         Source




                                                                                                                                                      mgmt
                                        Trust



                                                          MPN



                                                                         sion
S1       142                                                                                                                                                 y                                                    y
S1       143                                                                                     y                                                    y                                                y
S1       144 various                                                                                                                                  y
S1       145 staff                                                                                                                                    y
S1       146 patient                                                 y                                                                                       Y            y
S1       147 patient                                                                             y                                                                                                                Y
S1       148 staff                                                                               y                                                           Y                                         y
S1       149 staff                                y                                  y
S1       150 family/friend                                                                                                                                   y            y
S1       151 GP                                                      y                                                                                                    y                                       Y
S1       152 family/friend                                           y                           y
S1       153 staff                                                                               y
S1       154 staff                                                                               y                                                                                                     y
S1       156 patient                                                 y
S1       157 staff                                                                                                                                    Y                                                y
S1       158 patient                                                                                                                                                      y
S1       159 patient                                                 y
S1       160 patient                                                 y
S1       161 staff                                                                                                                                                                                     y
S1       162 family/friend                                                                                                                  Y
S1       163 patient                                                                                        y               y                                             Y
S1     162a staff                                                                                                           y
S1 DOS43                                                                                                                                                                  Y
                                  cannot
S2          99 patient            identify                           y                                                                                                    y              y
S2       100 patient                                                 y
                                                                                                                                                                                                                                                  V2 Page 2 of 8
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                                                Apprehension




                                                                                                                                                   poor comms

                                                                                                                                                                service/care
                                                                                                                                                                concerns re
                                                                               ambulance
                                    awareness
     Reference




                                                                                                                      Discharge
                                                                                                      Diagnosis




                                                                                                                                                                                                        transport
                                                                                                                                  Expense
                                                                                           Capacity




                                                                                                                                                                                   Records

                                                                                                                                                                                             Staffing
      Dossier




                       Source




                                                                                                                                            mgmt
                                      Trust



                                                    MPN



                                                                   sion
S2       101 family/friend                                                                                                                                      y
S2       102 family/friend                                                                 y                                      y                             y
                                cannot
S2       104 patient            identify                                                                                                                                       y

S2       105 patient            CS0803167                                      y                                  y                                             y
S2       106 family/friend                                                     y                                  y                                             y
S2       107 family/friend                                                     y                                                                                y
                                cannot
S2       108 family/friend      identify                                       y

S2       109 family/friend                                                     y           Y                                                                    y
S2       110 patient                                                                                                              y                             y                                       y
S2       111 patient                                           y                                                                                                               y
                                cannot
S2       112 family/friend      identify                                                                                                                        y

S2       113 family/friend      CM080406                                                                          y

S2       114 patient            CM080421                                                   y                                                                    y
S2       115 patient                                                                       y                                                                    y
S2       116 family/friend      CS080517                                                                                                           y            y
S2       117 family/friend                                                     y
S2       118 patient                                                                                                                                            y
S2       119 patient                                           y                                                                  Y                y
S2       120 family/friend      CS0801 136                                                                        Y                                Y            y              y
S2       121 patient                                                                       y                                                       y
S2       200                                                                                                                                                                                 y          y
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                                                                                                                                                        poor comms

                                                                                                                                                                     service/care
                                                                                                                                                                     concerns re
                                                                                    ambulance
                                     awareness
     Reference




                                                                                                                           Discharge
                                                                                                           Diagnosis




                                                                                                                                                                                                             transport
                                                                                                                                       Expense
                                                                                                Capacity




                                                                                                                                                                                        Records

                                                                                                                                                                                                  Staffing
      Dossier




                         Source




                                                                                                                                                 mgmt
                                       Trust



                                                         MPN



                                                                        sion
S2       213 patient                                                                            y                                                       y                           y
S3          53 staff                                                                                                                             y
S3          54 family/friend                                                                                                                                                        y
S3          55 family/friend                                                                                           y                                y                                                    y
S3          56 family/friend                                                                                                                                                                                 y
S3          57 patient                                                                                                                                                                                       y
S3          58                                   y                                                                                                                                                           y
S3          59                                   y
S3          60 patient                                                                                                                                                                                       y
S3          61 patient                           y
S3          62 patient                                                                                                                                  y                           y
S3          63 family/friend                                                                    y                                                       y
S3          65 family/friend                                                                                           y                                                                                     y
S3          66 family/friend                                                                                                                                                                                 y
S3          67 patient                           y
S3          68 patient                                                                                                                                                                            y          y
S3          70 family/friend                                                                    y                                                       y
S3          72 family/friend                     y
S3          73 family/friend      via MP enq                                                                                                            y            y                                       y
S3          74 patient
S3          75 patient                                                                                                                                               y
                                  Inquest/com
                                  plaint
S3          76 family/friend      pending                                                                                                                            y
S3          77 patient                                                                                                                 y
S3          78 patient                                                                                                                                                              y
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                                                  Apprehension




                                                                                                                                                 poor comms

                                                                                                                                                              service/care
                                                                                                                                                              concerns re
                                                                                 ambulance
                                  awareness
     Reference




                                                                                                                    Discharge
                                                                                                        Diagnosis




                                                                                                                                                                                                  transport
                                                                                                                                Expense
                                                                                             Capacity




                                                                                                                                                                             Records

                                                                                                                                                                                       Staffing
      Dossier




                         Source




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                                    Trust



                                                      MPN



                                                                     sion
S3          79 patient                                                                                                                    y                                                       y
S3          80
S3          80 patient                        y
S3          81
S3          81 patient                                                                       y
S3          82 patient                                                                       y                                                                                                    y
S3          83 patient                        y
S3          84 patient                                           y
S3          87                                y
S3          88                                y                                                                                                                                                   y
S3          89 family/friend                                                                                                                                  y
S3          90 patient
S3          91 patient                                                                                                                                        y                                   y
S3          92 patient                                                                                                                           y                                     y          y
S3          93 patient                                                                                                                                                                            y
S3          94 patient                                                                                                                                                                            y
S3          95 family/friend                                     y
S3          96 patient                                                                                                          y                                                                 y
S3          97 patient                                                                                                                                                                            y
S3          98 gp                                                                                                                                y                                                y
S3       202 patient                                                                                                                      y
S3       203 patient
S3       204 patient                                             y                                                              y                                                                 y
S3       205 patient                                             y                           y
S3       206 ?                                y
S3       207 family/friend                                                                                                                                    ?                                   y

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                                                                                                                                                      poor comms

                                                                                                                                                                   service/care
                                                                                                                                                                   concerns re
                                                                                      ambulance
                                       awareness
     Reference




                                                                                                                         Discharge
                                                                                                             Diagnosis




                                                                                                                                                                                                           transport
                                                                                                                                     Expense
                                                                                                  Capacity




                                                                                                                                                                                      Records

                                                                                                                                                                                                Staffing
      Dossier




                         Source




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                                         Trust



                                                           MPN



                                                                          sion
S3       208 patient                                                  y                                                                                            y
S3       209 patient                                                  y
S3       212 family/friend                                                                                                                                                                                 y
S3       213 patient                                                                              Y                                                                y
S3       215 patient                                                                                                                                                              y
S3       216 patient                                                                                                                                               y                                       y
S3       217 patient                                                                                                                                                                                       y
S3 ?64            family/friend                    y                                              y
                                     choices
S4          43 family/friend         website                                                                                                          y                           y
                                     choices
S4          44 patient               website                                                                                                                       y
                                     CM0802181j
S4          45 patient               p                                                                                                                y            y
                                     choices
S4          46 family/friend         website                                                                                                   y
                                     choices
S4          47 patient               website                          y                                                                                                           y
                                     choices
S4          48 patient               website                                                                                                          y                           y
                                     choices
S4          49 patient               website                          y                                                                                                           y
                                     choices
S4          50 patient               website                                                                                                                       y
                                     choices
S4          51 family/friend         website                                                                                                                       y
                                     choices
S4          52 patient               website                                                                                                                       y
S5               1 Burnley express                 y

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                                                                                                                                                        poor comms

                                                                                                                                                                     service/care
                                                                                                                                                                     concerns re
                                                                                    ambulance
                                     awareness
     Reference




                                                                                                                           Discharge
                                                                                                               Diagnosis




                                                                                                                                                                                                             transport
                                                                                                                                       Expense
                                                                                                Capacity




                                                                                                                                                                                        Records

                                                                                                                                                                                                  Staffing
      Dossier




                         Source




                                                                                                                                                 mgmt
                                       Trust



                                                         MPN



                                                                        sion
S5               2 Burnley express mp Enq surg                                                  y                                                       y            y
S5               3 Burnley express                                                                                                                                   y                                       y
S5               4 Burnley express                                                              y                                      y                             y              y                        y
S5               5 Burnley express                                                                                                                                   y                            y          y
S5               6 Burnley express                                  y                           y                                                                    y
S5               7 Nelson leader cs0712123                                                      y                                                                    y                                       y
S5               8 Nelson leader                                                                y
S5               9 LET                                                                          y                                                       y            y
S5          10 Burnley express                                      y                           y                                                       y            y
S5          11 Nelson leader                                        y                                                                                   y
S5          12 Burnley express                                      y                                                                                                y                                       y
S5          14 Nelson leader                                                                    y                                                                    y              y
S5          15 Burnley express                                                                  y                                                y
S5          16 Burnley express                                                                  y                                                                    y                                       y
               Clitheroe
S5          17 Advertiser                                                                       y                                                                    y
S5          18 Burnley express                   y                  y                           y                                                       y
S5          19 Burnley express                                                                             y                                                         y
S5          20 Burnley express CW080147                                                                    y                                                         y
S5          21 Burnley express                                      y                                                                                   y            y
S5          22 LET                                                                                         y                                                                                                 y
S5          23 Burnley express           y                          y                                                                                                               y
S5          24 Burnley express                                                                             y                                            y            y
S5          25 Burnley express cm0802181                                                                   y                                                         y              y
S5          26 Burnley express cm0802197                                                        y                                                                    y
S5          27 patient             CM0802184                                                                                                            y            y

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                                                                                                                                                                   service/care
                                                                                                                                                                   concerns re
                                                                                  ambulance
                                   awareness
     Reference




                                                                                                                         Discharge
                                                                                                             Diagnosis




                                                                                                                                                                                                       transport
                                                                                                                                     Expense
                                                                                              Capacity




                                                                                                                                                                                  Records

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      Dossier




                      Source




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                                     Trust



                                                       MPN



                                                                      sion
S5          28 Burnley express                                                                y                                                                    y
S5          29 patient                         y                                                                                     y                y                                                y
S5          30 Burnley express                 y
S5          31 Nelson leader                   y
S5          32 Nelson leader                   y
S5          33 Burnley express                                                                                                                        y            y
S5          34 Burnley express                                                                                                                                     y                                   y
S5          35 LET                                                                            Y
S5          36 Burnley express                 y
               Pendle today
S5          37 news
S5          38 Burnley express                                                                                                                                     y                                   y
S5          39 Burnley express                                                                y
S5          40 Burnley express                                                                y                                                                    y
S5          41 Burnley express                                                                           y                                                         y
S5          42 Mail on line                                                                              y                                                         y
S5       218 patient             cm080538                                                     y                                                y      y            y                                   y
S5       219 family/friend                     y                                                                                                                                                       y




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                    REPORT TO TRUST BOARD PART ONE
Meeting Date:                  Report Purpose:               Agenda Item: 9
  th
29 July 2008              For Decision
                          Performance Monitoring □
                          For Information            □
Report Submitted By:      Report Approved By:                Report Title:
Mark Walkingshaw          Stephen                Brookfield Annual Business Plan
Director of Planning & Director of Finance                   2008/9
Strategic Development


Date Considered By        Divisional         Board   Chair Declaration of
Divisional Board/         Approval: N/A                      Confidentiality Required:
Reason Not                                                   Yes             No
Considered By
Divisional Board: N/A




Implications For Partners:             Our partners will be impacted by our annual
                                       plan
Related to key risks identified on     Failure to deliver agreed corporate priorities.
Assurance Framework &
Consequences:
Related to Corporate Objective:        All
Related to HCC Standard:               All
Related to Standards for Better All
Health Domain:
Executive Summary:                     The Board agreed 2008/9 corporate objectives
                                       at the June 2008 meeting. This document is
                                       the final version of the Trust’s Annual Business
                                       Plan for 2008/9 and sets out in particular our
                                       plans to deliver against:
                                             −   Corporate must dos
                                             −   Quality and governance objectives
                                             −   Corporate objectives
Recommendation/         What      Is Trust Board members are asked to consider
Required From The Committee:   and approve the final version of the Annual
                               Business Plan for 2008/9.
                               Quarterly reports on progress will be presented
                               to the Board.
Annual Business Plan




                       ANNUAL BUSINESS PLAN


                                2008/09




                            Annual Business Plan 2008/9 – Final version July 2008   1
1.        BACKGROUND AND CONTEXT
East Lancashire Hospitals NHS Trust (ELHT) provides health services for a population
of approximately 520,000 across East Lancashire.

East Lancashire Hospitals NHS Trust provides acute hospital services predominantly
from our two main hospital sites; Burnley General Hospital and Royal Blackburn
Hospital. In addition to a full range of acute hospital services we are a growing centre for
emergency hospital services, Hepato Biliary, Head and Neck and Urological cancer
services, a growing centre for Cardiology services and a network provider of Level III
Neonatal Intensive Care.

Our main commissioners are East Lancashire tPCT and Blackburn with Darwen tPCT
which incorporate locality based Practice Based Commissioning Groups.

The health economy in East Lancashire faces a number of challenges which include
growing health needs and health inequalities experienced by the population of East
Lancashire and the next stages of the implementation of the Meeting Patients’ Needs
service model.

The financial impact of sustaining the previous model of secondary care led to a historic
deficit which was addressed during 2007/8 and will continue to be a key area of focus
during 2008/9 through the agreed Cost Improvement Programme.

The Trust faces a challenging but exciting year as we:

      -   implement our key service changes in line with our drive towards clinical
          excellence;

      -   make the changes vital to deliver the next stage of the agreed Meeting Patients
          Needs service model;

      -   continue to reduce our cost base in line with our agreed Cost Improvement
          Programme;

      -   complete our journey to becoming a Foundation Trust.

1.1       Vision and Values

The Trust has agreed the following vision and values which inform all our plans for
2008/9.

ELHT vision

            - Our aim is to be a great Trust providing the best possible healthcare for our
              population.

            - We want to have a reputation for clinical excellence, providing clinical
              services of the highest standards, benchmarked with the best in the country
              with a particular emphasis on emergency care, cancer, cardiology and
              women’s and newborn’s services.




                               Annual Business Plan 2008/9 – Final version July 2008      2
      - We want to be outward looking and business like in all our activities
        working in partnership with a wide range of public, private and third sector
        agencies.

      - We want to transform services in response to the changing health needs of
        our population.

      - We want to be operationally excellent, delivering services at or beyond
        national quality standards.

      - We want to devolve decision making closer to the ‘shop floor’ through a
        system of ‘earned autonomy’.

      - We want to continue to develop a modern infrastructure, through ongoing
        investment in our estate and information management and technology.

      - We want to be a training provider of excellence and choice for health care
        professionals, supporting research of national and international importance
        in clearly defined areas.

      - We will have excellent governance arrangements in place for service
        delivery and for supporting research.

      - We want to develop a strong profile, locally and nationally for the quality of
        our clinical services and our contribution to training and research. We want
        to establish a reputation for delivery, safety and innovation.

ELHT Values

      - We will view all our actions from the perspective of the patient and
        encourage constructive challenge from our membership/governors.

      - We will invest in clinical leadership and engage in meaningful clinical
        involvement in our decision making at all levels.

      - We will continue to put in place a devolved organisational structure with
        clarity of responsibility and flexibility to allow innovative change.

      - We will seek to constantly work more efficiently and manage our finances
        effectively to deliver the best possible value for money for the population
        we serve.

      - We will work in partnership with all organisations that have a part to play in
        improving the health of the population we serve.

      - We will work hard to reflect the needs of the ethnically and socially diverse
        populations we serve.

      - We want to be environmentally and socially responsible, actively
        contributing to the regeneration of East Lancashire.




                         Annual Business Plan 2008/9 – Final version July 2008      3
2.        STRATEGIC DIRECTION
The development of our Strategic Direction in 2008/9 is very much influenced by our
Integrated Business Plan for 2009/10 – 2014/15 which reflects the emerging factors
within our local health economy – these include:

      -   The need to continue our progress in delivering the Meeting Patients’ service
          model specified by our commissioners with a particular emphasis on ‘Care
          Closer to Home’.

      -   The strategies agreed by our PCTs to tackle health inequalities and the detailed
          commissioning plans under development (due Autumn 2008) and the aspirations
          of our Commissioners to become World Class Commissioners.

      -   The opportunities to provide new integrated services with primary care.

      -   The continuing development of Practice Based Commissioning.

      -   The impact of ‘free choice’ on patient flow.

      -   The North West NHS response to the Darzi review (‘Healthier Horizons for the
          North West’).

In addition, having completed our consultation process on becoming a Foundation Trust
in 2007/08 one of our key strategic aims is to develop our state of readiness and meet all
the Monitor criteria for assessment within the next twelve months. This will be achieved
by developing the Trust Board competencies and finalising our five year Integrated
Business Plan and our Long Term Financial Model.

2.1       Local Health Economy Context

The Trust currently delivers approximately 90% of the secondary care provision of the
population of East Lancashire. Whilst the majority of the remaining amount is tertiary
care from regional and sub-regional services there is a small amount of drift to out of
area providers at the boundary of our catchment area as well as a small flow to private
sector providers within East Lancashire.

Travel times to neighbouring competitor Trusts range between 30 minutes to 1 hour for
the majority of our population. Because of good transport links the Trust’s peripheral
market is considerable. Our strategic plans need to reflect the opportunities this provides
within a free choice arena particularly within elective surgery.

2.2       National Context

The publication of the NHS Operating Framework for 2008-2011 has set the national
priorities and targets referred to as “vital signs” for the next 3 years.

The five national priorities are as follows:

      -   Cleanliness and reducing healthcare associated infections incorporating targets
          for the reduction of MRSA and C Difficile infections.
      -   Improving access including sustainable delivery of the 18 week target by
          December 2008.




                                 Annual Business Plan 2008/9 – Final version July 2008   4
      -   Reducing health inequalities including implementation of national strategies for
          Stroke and Cancer services, palliative “end of life care” and improving choice and
          access to maternity services.
      -   Patient experience, satisfaction and engagement focusing on improving patient
          experience (assessed through the national patient survey) and systematic
          approach to engagement in service change.
      -   Emergency preparedness reflecting requirements of the civil contingency act and
          robust planning for a pandemic flu outbreak.

      In terms of assessing performance and delivery against local and national priorities
      all “vital signs” will be:

      -   Incorporated into the Healthcare Commission regime.
      -   Benchmarked and published annually.
      -   Subject to evaluation (including through patient satisfaction surveying).
      -   Incorporated into the Monitor compliance framework for Foundation Trusts.

The operating framework identifies a number of enabling strategies which will be used
over the next three years to facilitate continuous improvement and service
transformation across the NHS. These strategies represent further development of the
healthcare market in line with the principles of patient choice, responding to local health
needs and moving towards “world class” commissioning.

Financial allocations for all PCTs for 2008/09 include an uplift of 5.5% in revenue. In
addition PCTs will be allocated a proportion of central budgets taking the proportion of
NHS revenue directly managed by PCTs to 82%. For providers this will result in a 2.3%
tariff uplift for 2008/09 which incorporates a 3% efficiency requirement applicable to all
public sector organisations in line with the Comprehensive Spending Review (CSR).

Whilst this figure should be used as the benchmark for contract arrangements for
services currently out of the scope of the national tariff, it will be for commissioners to
determine legitimate additions or deductions from this figure. Efficiency strategies will
therefore be required from all organisations reflecting quality improvement as well as
cost reduction.

2.3       NHS North West

In conjunction with the Operating Framework the publication of the NHS North West
regional response to the NHS Next Stage Review led by Lord Darzi (‘Healthier Horizons
for the North West’) sets the future strategic direction for NHS services with the aim of
providing fair, personalised, safe, effective and locally accountable services.

The key priorities identified from this programme have now been published within the
‘Healthier Horizons for the North West’ document. Key recommendations from each
Clinical Pathway Group are summarised below:

Staying Healthy: Commitment to reducing overall gap in life expectancy for men and
women.

Birth: Promoting normal birth at the centre of responsive and equitable care. Women
should have a range of informed choices during prenatal, antenatal, labour, birth and
postnatal stages of their care.

Children: Commitment to reducing health inequalities for children and young people.



                                Annual Business Plan 2008/9 – Final version July 2008     5
Urgent care: High quality streamlined access to urgent care across health and social
care so that a fully integrated service is delivered close to home.

Planned care: A set of key standards for all planned care – care provided by the
provider best able to meet the needs of the patient – irrespective of whether they are an
NHS organisation.

Long term conditions: Focussing on personalising care – with key role for advocate
and care co-ordinator.

Mental Health: Mental well being of the population embedded in all services.

End of Life Care: High quality, integrated system of health and social care support –
informed by integrated commissioning framework based on North West end of life care
model.

The NHS North West is one of the top performing SHAs in relation to finance and use of
resources. Performance in relation to service quality however has been less positive and
as a result of this the SHA has made a major commitment to improving service quality
and outcomes across the North West.

ELHT will participate in a number of strategic programmes which have been developed
by NHS North West including ‘Advancing Quality’. This programme brings together
commissioning priorities in terms of both efficiency and quality improvement with
appropriate incentives for providers based around delivering and monitoring compliance
against an agreed set of quality standards.



3.        PAST YEARS PERFORMANCE
3.1       Financial Outturn 2007/08

The Trust year end position for income and expenditure was a small surplus of £223k on
a turnover of £305m.

Trust capital expenditure was £12.8m against a plan of £13.3m.

3.2       Cost improvement Programme 2007/08

In order to deliver this position the Trust delivered cost improvements of £15.8m during
2007/8; this was achieved through a number of measures including:

      -   Programme of individual schemes across divisions and corporate directorates to
          deliver both staff and non staff savings.
      -   Implementation of Meeting Patients’ Needs service model (removing service
          duplication and efficiencies of economies of scale).
      -   Skill mix reviews and further staff reductions.
      -   Procurement savings programme.
      -   Realising additional income for services provided to commissioners.




                               Annual Business Plan 2008/9 – Final version July 2008   6
3.3     Capital Investment 2007/8

In 2007/8 the Trust invested capital funds as outlined in the following table:


 Summary Capital Expenditure 2007/08


                                                               £'000
 2006/07 Schemes (c/fwd)                                           90
 Medical equipment                                             1,244
 Estates staff                                                   529
 Bleeps                                                          128
 Backlog maintenance                                             243
 MPN schemes                                                   5,449
 Helipad                                                         403
 Pharmacy                                                        258
 Motorway signage                                                  58
 Fire Precautions                                                477
 Land purchase (Rakehead)                                        120
 Booking centre                                                  159
 Ward conversion (ward 7 BGH)                                    106
 St Peters Audiology                                             182
 PFI capitalisation of tariff                                  1,404
 PFI change requests                                               38
 IM & T                                                        1,290
 NICU                                                              74
 Eprescribing                                                    131
 Demolitions (BGH)                                               129
 Site services survey (BGH)                                        62
 Nurse change (RBH)                                                51
 Medical records                                                   81
 DDA car parking                                                   50
 Other (various)                                                   61
 Total Capital Expenditure                                    12,817


 Note: Excludes £10k donated assets




                                Annual Business Plan 2008/9 – Final version July 2008   7
3.4    Activity 2007/8

The Trust achieved its elective activity plan for 2007/8 despite underperformances in
General Surgery, Gynaecology and ENT.

Non-elective activity for 2007/8 outturned at 2% below planned levels with activity levels
comparable with levels of activity in the previous year. A&E attendances outturned down
on 2006/7 levels, but with a significant shift in casemix, with a 10% increase in high cost
complex attendances.

3.5    Performance 2007/8

The Trust achieved all the targets set within the Healthcare Commission’s Assessment
Framework in full with the exception of the Cancelled Operations and Thrombolysis
indicators.

The Trust full met both the 18 week referral to treatment target milestones:

Target:      To achieve over 85% for admitted pathways.
Achievement: 87%

Target:      To achieve over 90% performance for non-admitted pathways.
Achievement: 91%

The table below details the Trust’s position against existing Healthcare Commission
targets and standards through self-assessment at the end of 2007/8.

 Ref    Description                                      Applicable to Predicted
                                                         ELHT          Points
   1    All cancers: one month diagnosis to treatment          YES              3
   2    All cancers: two month urgent GP referral to           YES              3
        treatment
   3    All cancers: two week wait                             YES              3
   4    Cancelled Operations and those not admitted            YES              2
        within 28 days
   5    Convenience & Choice: provider information on          YES              3
        nhs.uk & availability of slots
   6    Delayed Transfers of Care                              YES              3
   7    Number of Inpatients waiting longer than               YES              3
        standard (20wks)
   8    Number of Outpatients waiting longer than              YES              3
        standard (11wks)
   9    Patients waiting no longer than 3 months for           NO             n/a
        revascularisation
  10    Thrombolysis: 60 minute call to needle time            YES              2
  11    Total Time in A&E: 4 hours or less                     YES              3
  12    Waiting Times for Rapid Access Chest Pain              YES              3
        services
 Total                                                                         31
 Number of Targets: 11        Fully     Almost      Partially Met      Not Met
 Maximum Points               Met       Met         >=24               <24
 Available: 33                >=30      >=27




                              Annual Business Plan 2008/9 – Final version July 2008      8
The table below details the Trust’s position at the end of 2007/8 against the new
Healthcare Commission targets and standards launched during this year.

 Ref    Description                                      Applicable to Predicted
                                                         ELHT          Points
   1    Infection Control: Reductions in MRSA & Data         YES                 3
        Quality Indicator for Clostridium Difficile
   2    Drug Misusers: Information, screening & referral     YES                 3
   3    Inequalities: Data Quality: Ethnic Group data        YES                 3
        collection & Infant Health: Smoking During
        Pregnancy & Breast-Feeding Initiation
   4    GUM Clinic Access                                    YES                 3
   5    Experience of Patients                               YES                 3
   6    Participation in Audit                                      YES                    3
   7    Self Harm: Compliance with NICE Guidelines                  YES                    3
   8    18 Week Referral to Treatment Milestones                    YES                    3
   9    Reductions in Emergency Bed-Days                            YES                    3
  10    Obesity: Compliance with NICE Guidance                                             3
                                                              Total                       30
 Number of Targets: 10         Excellent   Good      Fair                      Weak
 Maximum Points                >=28        >=25      >=22                      <22
 Available: 30

3.6    Quality Improvement 2007/8

The Healthcare Commission’s annual performance ratings for 2006/7 for ELHT rated the
Trust overall as ‘fair’ for quality of services and ‘fair’ for use of resources.

In addition the Trust achieved NHSLA Level 2 and CNST Maternity Level 2 in January
2008. Feedback from these assessments was very positive and performance in a
number of areas was picked up to share with other organisations.

3.7    Human Resources and Organisational Development 2007/8

Key achievements 2007/8:

Meeting Patients’ Needs

Major changes to service models in order to deliver services in an appropriate setting
with appropriate person were implemented. Examples include the development of
Urgent Care Centres and Acute Rehabilitation; with new roles and skill mix to ensure
right care by right person and development of new roles e.g. general worker roles.

Being with Patients

Achieved target that by March 2008 20% of the workforce will have been through the
Being with Patients’ Programme.




                             Annual Business Plan 2008/9 – Final version July 2008    9
Lean Principles

The development of lean principles to drive out efficiencies within the organisation has
been aligned to two key themes over the last 12 months – developing awareness within
the organisation and developing capability.

KSFs,PDRs PDPs & Mandatory Training

In 2004/05, despite having introduced training for Knowledge and Skills Framework only
0.8% of staff had a completed KSF. Figures in the 2007 staff survey showed this as
96%.

Personal Development Reviews and Personal Development Plans have also been put in
place for all staff.

Over the last year the Trust has focused on mandatory training to embed a safety culture
and to minimise risk, building strong foundations for the future and to ensure clear
governance arrangements. In 2004/05, 17% of staff had completed Mandatory Training.
By the end of March 2008, 90-95% of staff are forecast to have attended mandatory
training – the balance of 5% accounted for by in service training, medical staffing
training, sickness absence and maternity leave.

Oscars (Excellence Awards)

A key objective in 2007/8 was to find better and more appropriate ways of recognising
and valuing the achievements of staff. The Excellence Awards identified, recognised and
rewarded excellence in the provision of care by direct contact staff who are delivering
services to our patients.

Talent Development (Top150)

In order to identify the true potential of many key clinicians and managers Potentia
Profiling was initially completed for an initial group of 80 individuals. A further 70
completed the potential profile in December 2007 and January 2008.

Of the original 80:

11 were promoted during 2007/8 (3 externally);
8 have had significant role enhancements during the year.

Band 7 Management Development Programme

The Band 7 Management Development Programme continued to develop in 2007/8 to
support key middle managers and clinicians with management responsibilities to
understand and deliver the Trusts organisational goals, priorities and key objectives.
Attendees completed a service improvement project supported by facilitated action
learning aimed at increasing their awareness of organisational context of change,
applied leadership principles and consideration of working differently through action
learning. To date 52% of Band 7 staff have completed the Programme.

Embedded HR Business Partner Model

To develop the personnel function into a fit for purpose HR function which supports the
transformational change agenda HR business Partners were ‘out-sourced’ to Divisions
and are intrinsically part of the management team actively negotiating, supporting and


                             Annual Business Plan 2008/9 – Final version July 2008   10
delivering change within the Divisions towards the Trusts objectives. We have
experienced the highest levels of change, individual consultations and disciplinaries the
Trust has ever seen during 2007/8.

Staff survey

The annual NHS National Staff Survey results have been received by the Trust and
show some very positive outcomes particularly, that team working is actively encouraged
and well received and line managers are actively supportive of their team. Staff generally
are also clear about their individual responsibilities and have clear individual and team
goals and objectives with the freedom to direct their own work. The survey also provided
positive feedback on infection control and we remain consistently high with these
standards.

There appears to be some work needed in the areas of communication, staff feeling
valued, engagement and the KSF/appraisal process. These themes are consistent with
trends across the NHS.

The Trust is now focused on these areas of development and an action plan to ensure
these areas are progressed and improved will be implemented and monitored by the
Divisions and HR Department.

3.8    Estates and Facilities 2007/8

Meeting Patients’ Needs:

Both soft and hard FM were a fundamental part to the MPN transition process during
2007/8, providing a project management approach to logistics and commissioning and
the coordination of a number of capital schemes that were vital to the MPN programme
across all of the Trusts sites.

This work also included developing the plan for the Women’s and New born centre on
the Burnley site and the introduction of the shuttle bus service.

Deep Clean

The Deep Clean programme was completed within a 4 month period. The success of the
deep clean has contributed to the reduction of MRSA and C-Diff infections within the
organisation since the start of the programme in December 2007. As part of the
investment plan we were able to purchase additional cleaning equipment, an automated
cleaning monitoring system, increase stock of curtains to enable a six monthly curtain
change programme and to introduce a 24/7 Isolation Discharge team.

Other key developments within Estates & Facilities during 2007/8

Other developments during 2007/8 included:

  - Installation of bed side entertainment systems across 80% of the Trust
  - Introduction of a Patient Experience Manager to lead on PEAT issues
  - Additional security in Urgent Care Centres.

PEAT results

Patient Environment Action Team (PEAT) results for 2007/2008 for environment, food
and privacy and dignity for our hospitals were as follows:


                             Annual Business Plan 2008/9 – Final version July 2008     11
   Site name                 Environment                 Food            Privacy & Dignity
 Burnley General              Acceptable                 Good                  Good
    Hospital
 Royal Blackburn              Acceptable                 Good                   Good
    Hospital
Pendle Community              Acceptable              Acceptable                Good
    Hospital



4.        BUSINESS PLAN 2008/09
4.1       Corporate “Must Dos” 2008/9

The Corporate “Must Do” objectives are those which must be delivered and owned
through the organisation if the Trust is to achieve its principle aims of clinical
sustainability and financial viability.

These objectives apply to all aspects of the Trust’s business and were effective
immediately from 1 April 2008.

      -   Deliver the Trust’s financial targets and deliver the SLA activity agreed
          with our Commissioners.
      -   Deliver £14m Cost Improvement Programme.
      -   Achieve full compliance against Healthcare Commission Standards and
          achieve the highest possible rating in the Annual HealthCheck.
      -   Deliver all national targets (including ‘vital signs’ set out in the
          Operating Framework).

These objectives reflect the mandatory national requirements and vital signs for
achieving performance, quality and financial targets.

4.2       Quality and Governance 2008/9

Our staff are committed to providing high quality health care. Public and patient
confidence and our reputation is based on our ability to demonstrate that our services
are safe, effective and high quality. We will therefore implement action plans to achieve
the following objectives:

     - Reduce overall levels of infection by ensuring application and maintenance of
       prevention of infection control measures.

     - Ensure full compliance with Healthcare Commission Standards and Annual Health
       Check.

     - Further develop the culture of responding to and learning from incidents,
       complaints and claims.

     - Move towards NHSLA level 3.

     - Progress the ‘Advancing Quality’ Initiative.

     - Maintain and improve patient focus and patient/public engagement.



                                Annual Business Plan 2008/9 – Final version July 2008   12
4.3    Meeting Patients’ Needs service model 2008/9

In partnership with commissioners we will deliver the next phase of the Meeting Patients’
Needs changes in particular:

   - Continuing to establish Burnley as our elective centre and Blackburn as our
     emergency centre.

   - Developing our new Women’s and Newborn’s centre on the Burnley site (to be
     completed 2010).

   - Agreeing plans for new Birthing Centres.

   - Working with commissioners on developing new pathways of care for long term
     conditions management as part of ‘Care Closer to Home’.

4.4    Efficiency

The development of our services is dependent on our ability to use our resources to
maximum effect taking into consideration the impact of the PbR tariff as well as
maximising non PbR income.

We have therefore set efficiency objectives for the year as follows:

   - Directorates: Programme of demand management and lean schemes to support
     delivery of Cost Improvement Programmes. We will also agree a set of ‘stretch’
     performance targets as part of the new earned autonomy arrangements.

   - Trustwide: We are undertaking comprehensive trust wide reviews to deliver
     efficiency in theatres and outpatient services. We are also working through with
     commissioners payment arrangements for services outside of PbR.

   - Service models: We are reviewing the service and financial models for emergency
     care and the birthing centre model for low risk births.

4.5    Service Developments

The Trust has identified a number of service developments for 2008/9 which form a key
part of the delivery of our wider Integrated Business Plan.

These focus on:

Cross Divisional              Developing excellence in emergency care.
Medicine:                     Development of cardiology services.
Surgery:                      Development of cancer services.
Women’s and Children’s:       Development of birthing centres and office based
                              gynaecology model.
Diagnostics:                  Development of pathology services.




                              Annual Business Plan 2008/9 – Final version July 2008   13
5.        CORPORATE ENABLERS
5.1       Financial controls

The Trust seeks to continue to improve its business and associated decision making
processes and to strengthen financial control. Over time this will be achieved through a
new system of earned autonomy. However the move to this system will be gradual
based on proven success in delivering a range of quality and financial targets. It is
recognised that during the 2007/8 there are a number of areas that require additional
central corporate support to ensure financial targets are delivered.

Service Line Reporting will act as a key analytical tool to support the delivery of service
line management and operational delivery at Divisional and Directorate level.

Business planning processes need to continue to be strengthened during 2008/9 to
ensure that where services are developed the organisation understands the full impact
and its return on investment.

5.2       Workforce and Organisational Development 2008/9

Detailed workforce planning has already been undertaken within divisions and will
continue to be refined during 2008/9.

This includes considering staffing establishment, skill mix and the development of
professional roles reflecting new ways of working. There is also a requirement as part of
our IBP to deliver a planned reduction in the workforce during the five years of the plan.

Another key task for 2008/9 will be to continue to reduce levels of sickness absence
through targeted action.

As for most acute trusts implementation of the European Working Time Directive and
Modernising Medical Careers also requires significant medical workforce changes during
2008/9.

In 2008/9 we will also produce and implement a revised Organisational Development
plan.

5.3       Quality and Performance Improvement 2008/9

In 2008/9 the Trust will focus on continuing to deliver its performance improvement plans
in order to achieve the highest quality rating possible in the Healthcare Commissions
Annual Health Check and to deliver the national ‘vital signs’.

The Trust will also build upon the excellent achievements in meeting the March 2008
milestones for 18 week Referral to Treatment Time delivery by implementing plans to
improve performance even further in order to achieve and sustain December 2008
targets of:

      -   90% of admitted patients pathways being completed within 18 weeks.

      -   95% of non-admitted patient pathways being completed within 18 weeks.




                               Annual Business Plan 2008/9 – Final version July 2008    14
The Trust will fully engage in the NHS North West Advancing Quality programme –this
will be progressed as part of the wider clinical quality agenda.

Local implementation of the programme will commence in July 2008 with project
planning and data verification.

5.4        Estates and Facilities 2008/9

The Trust estate will be developed in line with the agreed Estate strategy which focuses
in particular on:

     - Delivering changes necessary to deliver Meeting Patients’ Needs.

     - Specifically delivering Women’s and Newborn’s capital development within a
       coherent strategy for the whole Burnley site.

     - Addressing estate related patient safety issues (including cross infection risks).

     - Addressing patient quality issues.

     - Eliminating high and significant backlog maintenance.

     - Addressing shortfalls in Estate KPIs.

     - Addressing energy and sustainability agenda.

5.5        Procurement 2008/9

The work plan agreed with the procurement department includes the following key areas
of focus for 2008/9:

     -    Medical and Surgical consumables
     -    Radiology and imaging management
     -    Pharmacy supply chain review
     -    Theatre Supply chain review
     -    Document Management Services
     -    Mail outsourcing


6.         FINANCIAL PLAN 2008/9
The Trust continues to face significant financial challenges, starting from a position of a
high RCI of 112. In addition the Trust is required to deliver against the national target of
a 3% reduction in costs annually.

The financial plan for 2008/9 incorporates a cost improvement plan of £14m which will
be achieved through a divisional and corporate programme encompassing 130 different
schemes. Key areas of focus include:

      -    Maximising theatre efficiency.
      -    Skill mix and staff savings.
      -    Procurement savings programme.
      -    Reducing temporary and agency staffing spend.
      -    Demand Management and Lean initiatives.



                                Annual Business Plan 2008/9 – Final version July 2008       15
In addition the Trust will seek to realising additional income for services provided to
commissioners outside of Payment by Results.

During 2008/9 there also continues to be a need to manage financial pressures through
strengthening budgetary management across the Trust.

6.1    SLA activity profile 2008/9

The Trust has agreed an SLA activity position for 2008/9 with our commissioners as set
out in the table below.

                                     Income        Unit      Activity
                                       £000       charge

PBR elective inpatient                 23,255    £1,640.22    14,178
PBR elective day case                  29,529     £658.12     44,869
PBR non elective                       88,912     £592.72    150,008
Total PBR spells                      141,696                209,055
PBR excess bed days                      5,743    £147.99     38,806
Total spell related (spell + EBD)     147,439                247,861
Outpatient first                       19,338     £153.95    125,611
Outpatient follow up                   22,426       £74.79   299,867
Outpatient procedures                    1,153    £213.76       5,394
Total outpatient related               42,917                430,872
Pathology                                1,743      £35.52     49072
Radiology                                6,271       £2.74 2287970
Total Diagnostic related                 8,014
A&E                                    10,860       £77.12   140,826
Other Non PBR                          46,682
Total SLA Income                      247,898                819,559




                             Annual Business Plan 2008/9 – Final version July 2008   16
6.2    Capital

As with revenue budgets there is considerable pressure on capital resources in 2008/9,
particularly given the prioritisation of capital over the next five years for the development
of facilities on the Burnley site.
                                                             2008/09
                                                               £'000
Service Developments/Improvements
St. Peters Audiology                                                    260.0
BGH/RBH/PCH Ward Improvements (single
rooms etc.)
BGH Wilson Hey improvements                                             200.0
BGH Orthopaedic theatre 1 UCV upgrade                                     80.0
RBH Environmental improvements                                            30.0
BGH Environmental improvements                                          100.0
PCH Environmental improvements                                            15.0
RBH B6/B9 Paediatrics
BGH/RBH Modifications to kitchen                                          25.0
RBH Old Bank Lane barrier                                                 15.0
RBH/BGH Medical Equipment Library                                       540.0
BGH Nurse change                                                          20.0
BGH Ophthalmology                                                         90.0
BGH Rakehead car park                                                   460.0
BGH Car parking                                                         150.0
Infrastructure
BGH replacement boiler plant                                            650.0
BGH replacement roofs                                                   100.0
BGH replacement electrical infrastructure                               450.0
BGH replacement heating systems                                         175.0
BGH replacement fire alarm,/CCTV/control
systems                                                                   50.0
BGH replacement macerators
BGH replacement ventilation systems/chillers
BGH category B                                                          100.0
BGH Medical gas alarms/plant                                              35.0
BGH Demolitions                                                         800.0
BGH Enabling works/moves                                                100.0
RBH/BGH/RH Capitalisation                                               765.0
BGH Garage closure and sewer repairs                                    250.0
BGH Back office accommodation
BGH Theatre fire precautions                                              30.0
RBH Blueline                                                              75.0
RBH Redline                                                             100.0
RBH Minor works (PFI)                                                   100.0
RBH Electrical high risk infrastructure                                 100.0
Replacement vehicles



                              Annual Business Plan 2008/9 – Final version July 2008       17
RBH Blueline accommodation rationalisation                        65.0
RBH External works improvements                                   15.0
MPN
RBH Pathology                                                    420.0
RBH Old Mortuary alterations                                     100.0
RBH Pharmacy                                                     260.0
RBH MADS                                                          15.0
RBH UCC canopy                                                    50.0
RBH Student common room                                           30.0
RBH Catering additional works                                     10.0
RBH Tunnel washer                                                440.0
RBH Switchboard centralisation                                    36.5
BGH Critical care beds infrastructure                             10.0
Business Cases
RBH Additional medical beds                                    1,012.5
RBH Cath lab 2                                                   100.0
BGH Women and Newborn                                          8,000.0
RBH Haemo - Chemo
SUB-TOTAL                                                     16,429.0
Plus Non Estates Schemes
Histology equipment                                               35.3
Medical equipment                                                750.0
IM & T                                                           500.0
Revenue to capital                                               500.0
PFI capitalisation of tariff                                   1,512.0
SUB-TOTAL                                                    19,726.3
Planned over commitment (10%)                                (1,960.3)
TOTAL                                                         17,766.0



7.     PARTNERSHIP AND PATIENT AND PUBLIC INVOLVEMENT
The people who use our services have higher expectations than ever before. They want
to make informed choices about their care and the treatment they receive. We need to
be able to respond to increasing consumerism and rising expectations by empowering
patients and listening to their views. We have a track record of good engagement with
our Patients’ Forum and Health Overview and Scrutiny Committees.

Our patient and public membership (currently comprising approximately 7,000 members)
will become our key area of focus for patient and public involvement. The Trust will
further build on this during 2008/9 by forging a positive partnership with Local
Involvement Networks (LINks) once established and support our staff in improving
patient experience through systematically responding to feedback received through
National Patient Survey, Patient Experience Tracker, PALS and formal complaints and a
range of other feedback mechanisms.




                            Annual Business Plan 2008/9 – Final version July 2008   18
We will also work closely with commissioners on informing their Joint Strategic Needs
Assessment, delivery of their health inequalities strategies and detailed commissioning
plans.

We will also fully participate in external partnerships across health organisations and
local government and the third sector playing a supportive role where appropriate in
delivering Local Area Agreements (LAA).

8.       RISK ANALYSIS
The executive management team will undertake a comprehensive risk assessment of
the corporate objectives described in the business plan for 2008/9. This process will
include the likelihood and impact of not achieving individual objectives and defining the
management controls required to manage and/or mitigate risk.

The Trust Board will receive regular reports on the organisations performance in
achieving its corporate objectives as laid out in this plan.

9.       PERFORMANCE MANAGEMENT
Delivery of key corporate objectives will be monitored and reviewed through the Trust’s
performance management system:

     - Weekly Executive Management Team review of activity, finance and performance.

     - Weekly Divisional review of activity, finance and performance.

     - Monthly joint divisional review of activity, finance and performance.

     - Quarterly individual divisional review of activity, finance and performance.

During 2008/9 we will continue to strengthen performance management arrangements
with the appointment of a new Head of Performance Management and the introduction
of the new system of earned autonomy.

10.      CORPORATE GOVERNANCE
During 2008/9 the Trust will introduce a new organisational structure which will
strengthen corporate governance arrangements. In particular this will put in place
governance triangles at all key levels within the divisional structure to ensure a clear
focus on clinical leadership, business management and service quality.

Building on this we will introduce a new system of earned autonomy, introduced at
divisional and individual clinical directorate level this will reward high performing clinical
teams with autonomy to develop their services and devolve decision making downwards
to clinical teams.




                                Annual Business Plan 2008/9 – Final version July 2008      19
11.      SUMMARY
The summary that follows sets out:

A        Corporate Must dos
B        Quality and governance objectives
C        Corporate objectives

Each objective has:

    -   identified lead
    -   summary of key milestones
    -   planned delivery date
    -   assessment method




                              Annual Business Plan 2008/9 – Final version July 2008   20
A. CORPORATE MUST DOs
Ref   Description                                                                  Lead             Planned           Assessment
No                                                                                 Director(s)      Delivery          Method
                                                                                   Senior           Date
                                                                                   Manager

A1    To deliver all national targets (and ‘vital signs’)                           Director of     March 2009        Mly reports to Trust
                                                                                    Operations &                      Board
                                                                                    Medical
                                                                                    Director
                                                                                    (Clinical
                                                                                    Services)
A2    To achieve full compliance against all Healthcare Commission Standards Director of            March 2009        Mly reports to Trust
      and achieve the highest possible rating in the annual healthcheck.            Clinical Care                     Board
                                                                                    and
                                                                                    Governance
                                                                                    & Medical
                                                                                    Director
                                                                                    (Governance
                                                                                    & Education)
A3    To deliver the £14m Cost Improvement Programme                                Director of     March 2009        Mly    reports    to
                                                                                    Finance,                          Finance         and
                                                                                    Information,                      Performance Cttee
                                                                                    Planning and
                                                                                    Capital
                                                                                    Director of
                                                                                    Operations
A4    To deliver the agreed activity, financial and workforce plan as signed off by Associate       March 2009        Reports to Finance
      Divisional teams                                                              Medical                           and    Performance
                                                                                    Directors,CDs                     Cttee
                                                                                    & Divisional
                                                                                    General
                                                                                    Managers



                                                                                   Annual Business Plan 2008/9 – Final version July 2008   21
B. QUALITY & GOVERNANCE OBJECTIVES
Ref   Description                                                           Lead                     Planned         Assessment
No                                                                          Director(s)              Delivery        Method
                                                                            Senior                   Date
                                                                            Manager
B1    To ensure consistent application and maintenance of prevention of Medical                                      Mly report to SQMT
      infection measures:                                                   Director                                 and Trust Board
      • Ensure compliance with the 11 duties of the hygiene code.           Governance &             Ongoing
                                                                            Education
B2    To ensure compliance with the Healthcare Commission Standards and the Director of              All ongoing but Mly report to SQMT;
      Annual Health Check:                                                  Clinical Care &          key milestones Qly report to Audit &
                                                                            Governance               by Mar 09       Gvnce & Trust Board
                                                                                                                     Mly report to SQMT
      • To continually review HCC requirements and ensure they are
        incorporated into Trust assurance structures.                Head of                                         Mly report to SQMT
      • To maintain the Trust assurance framework ensuring control Assurance &
        mechanisms include HCC requirements.                         Safety                                          Reports to relevant
      • Ensure action plans from HCC reports and service reviews are                                                 sub-committees,
        implemented and monitored.                                                                                   F&P, A&G

B3    To further develop the culture of responding to and learning from incidents, Director of       Ongoing but Mly report to SQMT
      complaints and claims:                                                       Clinical Care &   key milestones
                                                                                   Governance        by Mar 09
      • Continually maintain the incidents, complaints and claims reporting Head of                  Ongoing        Mly report to SQMT
          process.                                                                 Assurance &
                                                                                   Safety
      • Ensure aggregated learning reports are disseminated to staff through Head of                 Ongoing         Mly report to SQMT
          Governance structures.                                                   Assurance &
                                                                                   Safety
      • Implement roll out plan across the Trust for DATIX Web Risk Gvnce Systems                    Mar 09          Mly report to SQMT
          management system.                                                       Dvpt Mgr




                                                                                  Annual Business Plan 2008/9 – Final version July 2008   22
Ref   Description                                                           Lead              Planned           Assessment
No                                                                          Director(s)       Delivery          Method
                                                                            Senior            Date
                                                                            Manager
B4    Maintain assurance for the NHSLA risk management standards ensuring Director of
      monitoring mechanisms meet the requirements of NHSLA level 3:         Clinical Care &
                                                                            Governance
      • Implement health and safety action plan.                            Head of           Mar 09            Report to Audit &
      • Implement NHSLA level 3 action plan.                                Assurance &       Mar 09            Governance
                                                                            Safety
      • Implement annual clinical audit programme.                          Clinical          Mar 09
                                                                            Effectiveness
                                                                            Mgr
B5    To progress the Advancing Quality initiative across the Trust meeting Director of                         Reports to
      required milestones:                                                  Clinical Care &                     Trust Board
                                                                            Governance                          Audit and
      • Agree project plan.                                                                   Sept 09           Governance
      • Implementation of initiative.                                       Clinical          October 09
      • Monitor and evaluate key actions and milestones.                    Effectiveness     Ongoing
                                                                            Manager
B6    To maintain and improve patient focus and patient/public engagement:  Director of
                                                                            Clinical Care &                     Mly reports to
                                                                            Governance                          Nursing & Midwifery
      • Monitor and evaluate the Patient Experience Tracker.                Matrons           Ongoing           forum & SQMT
      • Monitor and evaluate the Practice Review Programme.                 Matrons           Ongoing
      • Develop relationships with LINKS and Trust Membership.              Membership        Ongoing
                                                                            Mgr




                                                                             Annual Business Plan 2008/9 – Final version July 2008    23
                                                 CORPORATE OBJECTIVES

C1.   DELIVER KEY DIVISIONAL SERVICE PRIORITIES

C1    MEDICINE KEY SERVICE PRIORITIES
Ref   Description                                                         Lead Director(s)     Planned             Assessment
No                                                                        Senior Manager       Delivery            Method
                                                                                               Date
C1a Development of cardiology services - 2nd Cath Lab to be operational   Div Gen Mgr                              Bi-Monthly report to
    by March 2009:                                                        Medicine                                 SMB
    • Finalise business case for 2nd cath lab and submit to SMB           Bus Mgr Cardio,      June 08
    • Develop detailed plans for implementation                           Resp, Gastro         October 08
    • Commence capital works                                              Capital & Estates    January 09
    • Lab operational                                                     Mgr                  March 09
C1b New medical model for managing acute medical patients to support      Div Gen Mgr                              Bi-Monthly report to
    improved flow to be in place by September 2008:                       Medicine                                 SMB
    • Undertake baseline assessments                                      Assoc Med Director   May 08
    • Develop vision                                                      Business Manager     May 08
    • Undertake gap analysis                                              Critical Care &      June 08
    • Facilitate/hold 2 flow days                                         Anaesthetics         July 08
    • Outline strategic options                                                                July 08
    • Develop action plan                                                                      August 08
    • Implement action plan                                                                    September 08
C1c Agree wider strategy for emergency care with commissioners by         Div Gen Mgr                              Bi-Monthly report to
    September 2008 (including putting in place enablers to improve        Medicine/                                SMB
    emergency flow and agreeing plans with commissioners for              PCT
    enhanced Care Closer to Home).                                        Representatives/
    • Initial programme structure agreed                                  Business Managers    May 08
    • Project groups initiated                                                                 July 08
    • Agree joint strategy                                                                     Sept 08



                                                                                Annual Business Plan 2008/9 – Final version July 2008     24
Ref   Description                                                          Lead Director(s)     Planned             Assessment
No                                                                         Senior Manager       Delivery            Method
                                                                                                Date
C1d Increase critical care provision                                                                             Bi-Monthly report to
    • Open 4 additional beds                                               Bus Mgr & Clinical   19/05/08         SMB
    • Recruit additional consultant staff                                  Director             July 08 (in post
                                                                           Anaesthetics &       Nov 08)
      •   Recruit additional nursing staff                                 Critical Care        July 08
      •   Implementation of critical care outreach team                                         August 08
      •   Review/agree arrangements for additional 2 beds in relation to                        September 08
          surgical activity




                                                                                 Annual Business Plan 2008/9 – Final version July 2008   25
C1 SURGERY KEY SERVICE PRIORITIES
Ref   Description                                                       Lead Director(s)       Planned           Assessment
No                                                                      Senior Manager         Delivery          Method
                                                                                               Date
C1e Development of cancer services:                                     Div Gen Mgr & Assoc                      Bi-Monthly report to
                                                                        Med Director                             SMB
                                                                        Surgery                                  Reports to Cancer
                                                                                                                 Steering Group
      •   Hold stakeholder away day to gain input to cancer strategy    Bus Mgr Cancer         August 08
      •   Agree health economy wide cancer strategy by September 2008   Services               September 08

      •   Develop bowel screening services                              Nurse-lead             BGH - Sept 08
                                                                        Endoscopy              RBH – subject
                                                                                               to JAG accred
                                                                                               August 09
      •   Continue to develop pancreatic service to       complement Bus Mgr Surgery           Ongoing
          Hepatobiliary service.
      •   Development of Head and Neck cancer services.                 Bus Mgr ENT            Ongoing
      •   Development of Urology cancer service.                        Sub Mgr Urology        Ongoing
      •   Development of Specialist Breast Unit.                        Bus Mgr Surgery        2010

C1f   Continue work needed to fully establish BGH as ELHT elective
      centre – target levels agreed Sept 2008/March 2009:
      • Achieve MPN metric of 75% of elective work to be undertaken at Div Gen Mgr Surgery     30/09/08
         BGH                                                                                                     Mly report to SMB
      • Complete job plan reviews for general surgery                  Assoc Med Director      31/07/08
      • Implement new theatre schedule                                 Div Gen Mgr Surgery     31/08/08




                                                                              Annual Business Plan 2008/9 – Final version July 2008     26
Ref   Description                                                   Lead Director(s)          Planned      Assessment
No                                                                  Senior Manager            Delivery     Method
                                                                                              Date
C1g Improve theatre utilisation across both main sites – detailed   Dir of Ops                All by March Mly report to SMB
    implementation plan in place July 2008:                                                   2009
    • Implementation of action plan to improve booking processes    Clinical lead for Group
    • Implementation of action plan to improve pre-operative        Clinical lead for Group
       assessment
    • Implementation of action plan to improve processes from       Clinical lead for Group
       admission to theatre
    • Implementation of action plan to improve theatre              Clinical lead for Group
    • Implementation of action plan to provide meaningful key       Assoc Med Director
       performance indicators




                                                                          Annual Business Plan 2008/9 – Final version July 2008   27
C1 WOMEN’S AND CHILDREN’S KEY SERVICE PRIORITIES
Ref   Description                                                         Lead Director(s)     Planned             Assessment
No                                                                        Senior Manager       Delivery            Method
                                                                                               Date
C1h Continue implementation of MPN women’s and children’s service                                                  Bi-Monthly report to
    model:                                                                                                         SMB
    • Staff engagement on detailed plan                           Divisional Gen Mgr           Ongoing
    • Workforce plan agreed                                       Business Mgrs                15/07/08

      •   Demolition work commences                                       Director of Estates June 08
      •   Building work commences                                         and Facilities      Nov/Dec 08

C1i   Agree strategy with commissioners for development of birthing Divisional Gen Mgr                             Bi-Monthly report to
      centres (off hospital sites):                                 Associate Medical                              SMB
      • Engage with commissioners in developing detailed plans for Director                    July 08
         birthing centres model



C1j   Implement new ‘office based’ Gynaecology model in primary care:       Business Mgr and                       Bi-Monthly report to
      • Finance/business managers to meet with commissioners to Clinical Director              July 08             SMB
         negotiate activity levels and tariffs to ensure cost effectiveness Gynae and Sexual
      • Present proposals to strategic commissioning meeting                Health             July 08
      • Agree implementation plans                                                             Aug/Sept 08
      • Implement service                                                                      In accordance
                                                                                               with plans




                                                                                Annual Business Plan 2008/9 – Final version July 2008     28
C1 DIAGNOSTICS AND TREATMENT SERVICES KEY SERVICE PRIORITIES
Ref   Description                                                     Lead Director(s)       Planned            Assessment
No                                                                    Senior Manager         Delivery           Method
                                                                                             Date
C1k   Develop and implement ‘hub and spoke’ model for Pathology                                              Bi-Monthly report to
      services by January 2009:                                                                              SMB
      • Estate modifications complete                           MPN Project Lead             December 08     Pathology    Service
                                                                Pathology Bus Mgr                            Quality Management
                                                                and Clinical Director                        Team
      • Workforce reprofiling                                   Heads of Dept                April 08 to Mar MPN project Team
                                                                                             ’11
      •   Staff consultation                                          Divisional General     June 08
                                                                      Mgr
      •   Unite operational policies                                                         July 08
      •   Implement change                                                                   January 09

C1l   Introduce ‘Order Comms’ – electronic ordering and reporting of
      pathology tests by March 2009:
      • Agree implementation programme                               CLM IT Mgr/Bus          August 08          Pathology   Service
      • Agree pilot site for acute phase                             Mgr Pathology/          June 08            Quality Management
      • Implement pilot                                              Blood Scientist Mgr/    October 08         Team
      • Evaluate pilot                                               Service Quality         November 08        MPN project Team
      • Rollout system to acute site                                 Lead                    December 08 to
                                                                                             September 09

C1m Agree Consultant work plans and productivity improvements by July                                           Reports to SMB and
    2008:                                                                                                       DMB
    • Determine capacity and demand                                   Clinical Director/     August 08
    • Qualify current attainment                                      Business Manager/      August 08
    • Undertake gap analysis                                          Divisional Gen Mgr/    October 08
    • Staff consultation/agree baseline output                        Associate Medical      November 08
    • Implement revised ways of working                               Director               January 09




                                                                             Annual Business Plan 2008/9 – Final version July 2008   29
C2.   ACHIEVE FT STATUS
To achieve Foundation Trust status by March 2009 and begin to realise the benefits of FT status.

Ref   Description                                                      Lead Director(s)      Planned             Assessment
No                                                                     Senior Manager        Delivery            Method
                                                                                             Date
C2a  Achieve FT license by March 2009:                              Director of Finance,                         Monthly reports to
    • Complete work on revised IBP and LTFM                         Planning,                17/07/08            Trust Board
    • Achieve internal sign off and commissioner support of plans   Information and          23/07/08
    • Submit IBP and LTFM to NHS NorthWest                          Capital &                01/08/08
    • Complete Monitor assessment phase                             Director of Planning     Oct to Dec 08
    • Achieve FT license                                            and Strategic Dvpt       By March 2009
C2b Do groundwork necessary to deliver Integrated Business Plan and Director of Finance,                         Report    to    Trust
    Long Term Financial Model:                                      Planning,                                    board
       • Finalise activity model                                    Information and          July 08
       • Finalise Divisional IBPs (detail years 1 & 2)              Capital &                July 08
       • Finalise workforce plans                                   Director of Planning     July 08
                                                                    and Strategic Dvpt




                                                                              Annual Business Plan 2008/9 – Final version July 2008   30
C3.   MEETING PATIENTS’ NEEDS SERVICE MODEL IMPLEMENTATION
To progress implementation of the Meeting Patients’ Needs service model.

Ref   Description                                                      Lead Director(s)     Planned             Assessment
No                                                                     Senior Manager       Delivery            Method
                                                                                            Date
C3a Continue work needed to fully establish BGH as ELHT elective
    centre – target levels agreed Sept 2008/March 2009:
    • Achieve MPN metric of 75% of elective work to be undertaken at   Div Gen Mgr          30/09/08
       BGH                                                             Surgery                                  Mly report to SMB
    • Complete job plan reviews for general surgery                    Assoc Med Director   31/07/08
    • Implement new theatre schedule                                   Div Gen Mgr          31/08/08
                                                                       Surgery

C3b Begin work on implementing the changes to women’s and children’s   Director of Ops
    services - including commencing building of New Women and New
    Born centre on BGH site in November/December 2008.
    • Staff engagement on detailed plan                                Div Gen Mgr W&C      Ongoing             Bi-monthly report to
    • Workforce plan agreed                                            Bus Mgrs W&C         15/07/08            SMB
    • Demolition work commences                                        Dir of Estates and   August 08
    • Building work commences                                          Facilities           Nov/Dec 08




                                                                             Annual Business Plan 2008/9 – Final version July 2008     31
C4.   EMERGENCY CARE STRATEGY
Agree strategy for emergency care with commissioners.

Ref   Description                                                    Lead Director(s)      Planned            Assessment
No                                                                   Senior Manager        Delivery           Method
                                                                                           Date
C4a Agree wider strategy for emergency care with commissioners by    Director of Ops                          Bi-Monthly report to
    September 2008 (including putting in place enablers to improve   Medical Director                         SMB
    emergency flow and agreeing plans with commissioners for         (Clinical Services)
    enhanced Care Closer to Home).                                   Div Gen Mgr
    • Initial programme structure agreed.                            Medicine/             May 08
    • Project groups initiated.                                      PCT                   July 08
    • Agree joint strategy.                                          Representatives/      Sept 08
                                                                     Business Managers




                                                                           Annual Business Plan 2008/9 – Final version July 2008     32
C5.   CONTINUE COST REDUCTION
To continue to reduce our cost base.

Ref   Description                                                      Lead Director(s)       Planned           Assessment
No                                                                     Senior Manager         Delivery          Method
                                                                                              Date
C5a Deliver 2008/09 Cost Improvement Programme in full by March        Director of Finance,   31/3/09
    2009:                                                              Planning,                                Monthly reports to
    • Finalise CIP schemes                                             Information and        May 08            Finance        and
    • Corporate     and      Divisional performance management         Capital &              June 08           Performance
        arrangements in place                                          Director of Planning                     Committee
                                                                       and Strategic Dvpt
                                                                       Director of Ops
      •   Weekly monitoring                                            Divisional General     Ongoing
                                                                       Managers &
                                                                       Corporate Directors

C5b Implement actions necessary to reduce RCI from 112 (07/08) to 102 Director of Finance,    31/03/10          RCI index 09/10
    by March 2010.                                                    Planning,
    • Establish RCI as interim measure for 08/09                      Information and         Aug 08
    • Agree plans to reduce RCI                                       Capital                 Sept 08




                                                                             Annual Business Plan 2008/9 – Final version July 2008   33
C6.    ACTIVITY, WORKFORCE AND FINANCIAL PLANS
To deliver agreed levels of activity and agreed workforce and financial plans.

Ref   Description                                                          Lead Director(s)      Planned            Assessment
No                                                                         Senior Manager        Delivery           Method
                                                                                                 Date
C6a Implement agreed Divisional activity, workforce and financial plans in Director of Ops and
    full by March 2009 (including agreed activity profiles):               Divisional General
    • Agree Divisional CIP and activity plans                              Managers              May 2008           Monthly reports to
    • Ongoing monitoring of achievement of plans                                                 Ongoing            F&P and qly
    • Develop remedial action plans as appropriate                                               As necessary       performance
                                                                                                                    meeting




                                                                                 Annual Business Plan 2008/9 – Final version July 2008   34
C7.    TO CONTINUE TO FOCUS ON IMPROVING EMERGENCY FLOW.
Implement plan to improve emergency flow

Ref   Description                                                      Lead Director(s)      Planned             Assessment
No                                                                     Senior Manager        Delivery            Method
                                                                                             Date
C7    New medical model for managing acute medical patients to support Director of Ops                           Bi-Monthly report to
a     improved flow to be in place by September 2008:                  Medical Director                          SMB
      • Undertake baseline assessments                                 (Clinical Services)   May 08
      • Develop vision                                                 Div Gen Mgr           May 08
      • Undertake gap analysis                                         Medicine              June 08
      • Facilitate/hold 2 flow days                                    Assoc Med Director    July 08
      • Outline strategic options                                      Business Manager      July 08
      • Develop action plan                                            Critical Care &       August 08
      • Implement action plan                                          Anaesthetics          September 08




                                                                              Annual Business Plan 2008/9 – Final version July 2008     35
C8.    IMPLEMENT CHANGES TO DIV’L AND CORPORATE STRUCTURES
To refine divisional and corporate structures in response to the changing needs of the service/FT.

Ref   Description                                                           Lead Director(s)       Planned            Assessment
No                                                                          Senior Manager         Delivery           Method
                                                                                                   Date
C8a Develop detailed plan and implement agreed changes by Sept 2008:
    • Develop new structure proposals                                       Executive team         May 2008           Wkly reports to
    • Consult on new structure proposals                                    Executive team         June 2008          Comms
    • Undertake process for slotting in/competitive selection to fill all
       posts to include:
          o Associate Medical Directors/Clinical Directors                  Medical Directors      July 2008
          o Divisional General Managers/Business Managers                   Director of Ops        July 2008
          o Service Quality Leads/Matrons                                   Director of Clinical   July 2008
                                                                            Care &
                                                                            Governance
      •   Introduce new structure                                           Executive Team         Sept 2008




                                                                                   Annual Business Plan 2008/9 – Final version July 2008   36
C9.   TO CONTINUE TO ROLL OUT INTRODUCTION OF SERVICE LINE MANAGEMENT.
Continue to roll out introduction of service line reporting and management.

Ref   Description                                                       Lead Director(s)       Planned         Assessment
No                                                                      Senior Manager         Delivery        Method
                                                                                               Date
C9a Continue roll out early implementer sites:                          Director of Clinical   Waves 1-3 to Reports to Major
    • Wave 1: Orthopaedics, Rheumatology, Radiology, Pathology.         Care &                 completed    by Projects Board
    • Wave 2: Cardiology, General Surgery, Obstetrics, Gynaecology,     Governance             October 2008
       Emergency Medicine.                                              Deputy Director of
    • Wave 3: TBC (to be reviewed/agreed in light of restructure and    Finance (Finance
       trust priorities).                                               Business Centre)




                                                                               Annual Business Plan 2008/9 – Final version July 2008   37
C10. TO REVISE THE ORGANISATIONAL DEVELOPMENT PLAN
To develop and implement revised organisational development plan.

Ref    Description                                                         Lead Director(s)     Planned             Assessment
No                                                                         Senior Manager       Delivery            Method
                                                                                                Date
C10a To revise the Organisational Development plan to make sure it fully   Deputy Chief                             Mly reports to SMB
     reflects the needs of the organisation and FT requirements:           Executive
     • Undertake stakeholder engagement and information gathering          Head of HR           July 08
     • Refine the vision and undertake gap analysis                        Operations and OD    September 08
     • Revise/finalise the plan                                                                 November 08
     • Begin implementation                                                                     As per plan




                                                                                 Annual Business Plan 2008/9 – Final version July 2008   38
C11. IMPLEMENT FT BOARD AND ENGAGE MEMBERSHIP
To implement a new foundation trust board and fully engage our patient/ public and staff/volunteer membership.
Ref   Description                                                     Lead Director(s)         Planned         Assessment
No                                                                    Senior Manager           Delivery        Method
                                                                                               Date
C11a Deliver agreed programme of events with membership and hold Director of Planning                          Mly reports to SMB
      governor elections:                                             and Strategic
                                                                      Development

      Deliver programme of communications and events in line with Membership Manager          July 08
      agreed strategy.

      Governor elections:

      •   Appoint independent external consultants                    Company Secretary       May 08


      •   Conduct elections                                           Company              October 08
                                                                      Secretary/Membership
                                                                      Manager

      •   Establish council of governors                              Company              November 08
                                                                      Secretary/Membership
                                                                      Manager

      •   Deliver agreed training programme                           Company              Nov to Dec 08
                                                                      Secretary/Membership
                                                                      Manager




                                                                            Annual Business Plan 2008/9 – Final version July 2008   39
C12. CLINICAL ENGAGEMENT.
To strengthen and support clinical engagement.

Ref   Description                                                  Lead Director(s)     Planned             Assessment
No                                                                 Senior Manager       Delivery            Method
                                                                                        Date
C12a Agree ongoing programme with Assoc Med Dirs, CDs and Medical Directors                                 Reports to SMB
     identified future clinical leaders and ensure strong clinical Head of HR
     leadership is at the core of refined divisional and corporate Operations and OD
     structure. Annual programme to be in place by July 2008.
     • Engage HoCDs, CDs to define vision/requirements                                  July 08
     • Undertake gap analysis to include training needs analysis                        July 08
     • Agree development programme                                                      August 08
     • Commission training                                                              August 08
     • Commence programme                                                               September 08




                                                                         Annual Business Plan 2008/9 – Final version July 2008   40
C13. IMPROVE ENGAGEMENT OF KEY STAKEHOLDERS
To map and improve engagement of key stakeholders.

Ref   Description                                                 Lead Director(s)        Planned            Assessment
No                                                                Senior Manager          Delivery           Method
                                                                                          Date
C13a Develop a key stakeholder plan and commence implementation by Head of                                   Monthly reports to
     August 2008:                                                  Communications &                          Comms meeting.
     • Map all key stakeholders                                    Marketing              August 08
     • Agree stakeholder engagement plan                                                  August 08
     • Implement agreed approach                                                          September 08




                                                                        Annual Business Plan 2008/9 – Final version July 2008   41
C14. TO IMPLEMENT THE IM&T STRATEGY
To implement agreed IM&T strategy.

Ref   Description                                                     Lead Director(s)         Planned         Assessment
No                                                                    Senior Manager           Delivery        Method
                                                                                               Date
C14a Deliver IM&T strategy in line with agreed timescales set out in Director of IM&T          March 09        Project Performance
     IM&T strategy:                                                                                            managed by IM&T
     • Replacement of Radiology Information System                   Bus Mgr Radiology/        December 08     board
                                                                     Gvnce Syst Dvpt Mgr
     • Implementation of Clinical Documentation System               Director of IM&T/ IM&T    March 09
                                                                     Prog Mgr
     • Upgrade of pharmacy system                                    Clinical Director         January 09
                                                                     pharmacy/ IM&T Prog
                                                                     Mgr/ Gvnce Syst Dvpt
                                                                     Mgr
     • Development of Electronic Single Assessment (eSAP)            Gvnce Syst Dvpt Mgr       March 09        Health   Economy
                                                                                                               Board with Social
                                                                                                               Services




                                                                            Annual Business Plan 2008/9 – Final version July 2008    42
C15. TO IMPLEMENT THE ESTATE STRATEGY
Implement agreed estate strategy.

Ref   Description                                                  Lead Director(s)      Planned            Assessment
No                                                                 Senior Manager        Delivery           Method
                                                                                         Date
C15a Implement agreed Estate Strategy with emphasis on BGH site    Director of Estates                      Progress reports to
     development:                                                  & Facilities                             Capital Board
     • Approval of FBC for Women and new born development at       Capital & Estates     Sept 09
        BGH                                                        Manager
     • Demolition of wards 1 and 3 and Old Trust HQ at BGH                               Aug/Sept 09
     • Provision of additional carparking at Rakehead                                    Autumn 08
     • Construction of 2nd cardiac catheter lab                                          Jan 09
                                                                                         (commence)
C15b Improve the patient experience and environment through the Head of Facilities       March 09           Progress reports to
     expenditure of £145k PEAT money:                                                                       PEAT sub-group
     • Agree schemes in conjunction with clinical teams                                  June 09
     • Implementation of schemes                                                         March 09




                                                                         Annual Business Plan 2008/9 – Final version July 2008    43
C16. TO DEVELOP AND IMPLEMENT TRUST RESPONSE TO THE DARZI REGIONAL PLAN
To develop and implement Trust response to the Darzi regional plan.

Ref   Description                                                     Lead Director(s)      Planned            Assessment
No                                                                    Senior Manager        Delivery           Method
                                                                                            Date
C16a Agree by August 2008 Trust response to priorities identified in Director of Planning                      Quarterly report to
     ‘Healthier Horizons for the North West (May 2008):              and Strategic                             Trust board
     • Work through key implications in relation to service plans    Development            August 08
     • Prepare Trust-wide response                                                          August 08
     • Ensure consistency with commissioner plans                                           October 08




                                                                            Annual Business Plan 2008/9 – Final version July 2008    44
C17. FUNDRAISING APPEALS
To engage the local community through establishing two major fund raising appeals.

Ref    Description                                                       Lead Director(s)       Planned            Assessment
No                                                                       Senior Manager         Delivery           Method
                                                                                                Date
C17a    Work with the local press and other key stakeholders to launch a Director of Planning                      Reports to SMB
       major fundraising appeal for key items of clinical equipment:     and Strategic
       • Establish fundraising cttee and agree project plan              Development            August 08
       • Identify fundraiser(s)                                          Communications         August 08
       • Launch appeal                                                   and Marketing          September 08
                                                                         Manager




                                                                                Annual Business Plan 2008/9 – Final version July 2008   45
                    REPORT TO TRUST BOARD PART ONE
Meeting Date:                    Report Purpose:         Agenda Item:
29th July 2008               For Decision                10
                             Performance Monitoring
                             □
                             For Information       □
Report Submitted By:         Report Approved By:         Report Title:
Chris Hodgson                Stephen Brookfield          Estates Strategy 2008-
Director of Estates and Director of Finance              2013
Facilities

Date Considered By           Divisional Board Chair Declaration of
Divisional Board/            Approval:                   Confidentiality Required:
Reason Not Considered                                    Yes             No
By Divisional Board:
Not applicable               Not Applicable


Implications For Partners:           None
Related to key risks identified on   All
Assurance Framework &
Consequences:
Related to Corporate Objective:      Developing a positive approach to service
                                     growth - Failure to transform the Estate and
                                     supporting infrastructure
Related to HCC Standard:             C21,C20
Related to Standards for Better Care Environment and Amenities
Health Domain:
Executive Summary:                   The paper outlines the approvals process for
                                     estate strategy of the Trust , 2008-2013
Recommendation/        What       Is Approve the Estate Strategy 2008-2013
Required From The Committee:




Chris Hodgson                                                         Version No1.0
Created on 22/07/2008 4:25 PM                                            Page 1 of 4
1.        Background/ Content/ Impact on the Organisation/ (Fit with Strategic
Direction/ Vision and Values/ Compliance with National Agendas)/ Impact on
Organisation of Doing Nothing:............................................................................... 3
2 Format and Approvals ........................................................................................... 3
3 Conclusion/Recommendations ............................................................................ 3




Chris Hodgson                                                                                   Version No1.0
Created on 22/07/2008 4:25 PM                                                                      Page 2 of 4
1. Background/ Content/ Impact on the Organisation/ (Fit with Strategic
      Direction/ Vision and Values/ Compliance with National Agendas)/ Impact
      on Organisation of Doing Nothing:
1.1       Following an internal consultation programme an Estates Strategy for the
          Trust for the period 2008-2013 has been developed to ensure the Trust is
          able to make best use of the hard infrastructure resources it has available to
          it, to deliver the best possible hospital services in facilities that are fit for
          purpose and support the ongoing development of services in line with our
          aspirations and those of the public we serve.
1.2       The Trust’s business plan has been utilised as the primary means of
          reconciling business objectives to the estate strategy. Due cognisance has
          also been taken of:

      •   The “needs” of the divisions above and beyond the current business plans -
          all of the Divisional directors and other key individuals have been consulted in
          compiling this strategy.

      •   the existing condition of estates and maintenance needs

      •   the impact of the built environment on clinical care e.g. healthcare acquired
          infections.


2 Format and Approvals
3.1       A CD-ROM with the estates strategy has been circulated to Trust board
          members and the executive team.

3.2       An informal presentation was made to Trust board members on 7th May
          2008.

3.3       The strategy was approved by the Strategic Management Board on 14th May
          2008.
3.4       The estate strategy will be available via the intranet.



3 Conclusion/Recommendations
The Board is requested to:

      •   Approve the Trust estate strategy and the principles contained within for the
          period 2008-2013

.


Chris Hodgson                                                              Version No1.0
Created on 22/07/2008 4:25 PM                                                 Page 3 of 4
Author and Title:               Chris Hodgson
Author Contact Details:         RBH ext 82071
Press Paper Supplied:           No
Date of Submission:             14/07/08
Date Accepted for Committee:    18/07/08




Chris Hodgson                                   Version No1.0
Created on 22/07/2008 4:25 PM                      Page 4 of 4
                     REPORT TO TRUST BOARD PART ONE
Meeting Date:                   Report Purpose:                Agenda Item: 11
29th July 2008            For Decision
                          Performance Monitoring □
                          For Information            □
Report Submitted By:      Report Approved By:                  Report Title:
John Fletcher             Stephen Brookfield                   IM&T Strategy
Information               Director       of        Finance,
Governance       Systems Capital,      Planning          and
Development Manager       Information
Date Considered By        Divisional     Board       Chair Declaration of
Divisional Board/         Approval:                            Confidentiality Required:
Reason Not                                                     Yes             No
Considered By
Divisional Board:
Approved by SMB           NA


Implications For Partners:             Based on Funding agreed with PCT’s
Related to key risks identified on     Delivery     of   MPN    and   clinically    effective
Assurance Framework &                  services
Consequences:
Related to Corporate Objective:        Developing a positive approach to service
                                       growth
                                       Developing a strong ELHT leadership culture
Related to HCC Standard:               C9 and C13
Related to Standards for Better
Health Domain:
Executive Summary:                     The paper sets out a revised IM&T strategy
                                       and work plan which takes into account the
                                       developments that have been achieved in the
                                       year.
Recommendation/        What       Is The Board are requested to adopt the updated
Required From The Committee:           strategy.




Author & Contact Details                                                       Version No:
Created on 21/07/2008 6:22 PM                                                  Page 1 of 13
1. Background/ Content/ Impact on the Organisation/ (Fit with
Strategic Direction/ Vision and Values/ Compliance with National
Agendas)/ Impact on Organisation of Doing Nothing:....................................3
    1.1.1. Background ........................................................................................3
    1.1.2. 2007/08 Strategic Objectives .........................................................3
    1.1.3. Purpose................................................................................................3
    1.1.4. Organisational Arrangements .......................................................4
    1.2    CURRENT STATUS...............................................................................4
    1.2.1    Infrastructure......................................................................................4
    1.2.2    Application..........................................................................................5
    1.2.3    Training................................................................................................5
    1.2.4    Management Information systems...............................................5
  1.3    Strategic Drivers........................................................................................6
  1.4    APPROACH.................................................................................................8
  1.5    ENABLING AND ENSURING CHANGE ................................................8
    1.5.1    Defining and owning the clinical vision......................................8
    1.5.2    Benefits Realisation .........................................................................9
    1.5.3    INFORMATION PROVISION ............................................................9
    1.5.4    TRAINING ..........................................................................................10
  1.6    CURRENT AND PLANNED IMPLEMENTATION ACTIVITY ...........11
  1.7    FINANCIAL IMPLICATIONS ..................................................................13
2 RECOMMENDATIONS....................................................................................13




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1. Background/ Content/ Impact on the Organisation/ (Fit with Strategic
    Direction/ Vision and Values/ Compliance with National Agendas)/ Impact
    on Organisation of Doing Nothing:
1.1.1.     Background

This document sets out the IM&T (Information Management and Technology)
strategy of the East Lancashire Hospitals Trust. It replaces the previous version,
published in April 2006. Since publication of the previous version, the Trust has
undergone a major revision of its estate, service provision, and its information
systems.

This revision and updating of the strategy is needed to reflect the revised needs of
the organisation and has been developed in the context of the organisational
objectives and strategic drivers for the Trust and the information needs of the
organisation as it progresses towards Foundation Trust status. The strategy has
additionally been informed and reinforced by the feedback obtained in the IM&T
survey undertaken in January 2008.

The document, wherever possible, focuses on "themes" as opposed to individual
systems or technologies. We believe that this makes the document both easier to
navigate and more clearly targeted on the relevant areas for action.

1.1.2.     2007/08 Strategic Objectives

    •    Developing a positive approach to service growth
    •    Learning to manage in a choice environment
    •    Developing a strong ELHT leadership culture


1.1.3.     Purpose

The document identifies the Trust vision for IM&T over the next three to five years.
This vision is formulated in the context of the strategic objectives set by the Trust
board in 2007/08, and the national IM&T strategy, and focussed on the delivery of the
information requirements of the organisation. In 2009/10 a significant review will be
required to evaluate whether to adopt the National Care Record Systems (NCRS)
applications or redevelop a local IM&T strategy

These requirements should

•   Provide Safe, timely and confidential information provision.

•   Enable effective and timely communication and sharing of information         with
    partner organisations

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•   Provide the information to undertake     monitoring, evaluation    and revision of
    service provision

•   Enable service transformation.

•   Provide appropriate assurance to the board and external agencies.



1.1.4.    Organisational Arrangements

The Trust has an IM&T Board which oversees strategic developments relating to
IM&T and monitors the delivery of key developments and any project sub groups. It
also has a responsibility to develop, review and enforce policy. The group is a sub-
committee of the Strategic Management Board, giving it a formally approved role and
status within the Trust’s corporate governance arrangements.
In order that a health economy wide approach to IM&T development can take place,
an East Lancashire IM&T Board is in place, as part of a wider review of joint planning
across health and social care in East Lancashire, the governance arrangements for
this group are being re-established in the context of the new National Programme for
IT Local Ownership Programme (NLOP), and the roles of the Strategic Health
Authority and Primary Care Trusts. These will be formalised in an Annual Operating
Framework agreed by the East Lancashire IM&T board.



1.2 CURRENT STATUS

1.2.1    Infrastructure

The Trust currently operates on a network infrastructure that is part of a community
of interest network (COIN) which spans the East Lancashire health economy and
links to other COIN’s covering most of the health economies in Lancashire. These
networks carry a mixture of voice and data, and enable applications to be accessed
across organisational boundaries and where appropriate sharing of information to be
done securely. The COIN also provides access to the N3 national NHS network.
The Trust desktop equipment is PC based, running either Windows 2000 and XP
operating systems and that standard applications provided by MS office 2003.
The Trust maintains a server infrastructure to support the range of applications in use
by the organisation. This is currently being rationalised and a “virtualisation” project
being commenced.




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1.2.2   Application

The Trust has a range of systems currently implemented. These systems can be
categorised as clinical and non clinical systems. In the last 12 months for both
Clinical and Non clinical systems major revisions have taken place with the
implementation of the merged Patient Administration system (PAS) and the
implementation of the national Electronic staff record (ESR). These two systems act
as the primary source of personal demographic information for patients and staff
within the Trust. These systems are therefore critical for provision of consistency
information being provided to other applications across the organisation.
The implementation of the revised PAS system has enabled a reduction in the
number of duplicate systems in operation and has allowed the use of a standard
Hospital Number across all electronic and paper patent records.
Whilst the Trust still believes in the strategic approach adopted by the connecting for
Health and the National Programme for IT, our commitment to the systems procured
and implemented through this route will be reviewed once the delivery of the Lorenzo
application has been delivered and implemented successfully in other Acute Trusts,
currently expected to be in 2010.
The implementation of the ESR system has provided the platform to develop the use
of the AT Learning management systems to be used to develop comprehensive
recording of training activity


1.2.3   Training

IT Training provision is predominantly application based and focussed on system
implementation.


1.2.4   Management Information systems

The Application systems provide the raw data for the finance and performance data
requirements of the organisation. However, specifically for the clinical systems the
ability to bring this data together for analysis from multiple has required the
development of a data warehouse. This allows detailed analysis to take place “off
line” of aggregated data form multiple applications, and provides for more
comprehensive reporting than can be provided by individual applications.




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1.3 Strategic Drivers

In setting out and executing our implementation plans, we have taken account of a
number of key strategic drivers. The background to the strategic issues are
documented in the Integrate Business Plan, and are all requirements of a successful
Foundation Trust so have not been reproduced here. The table below sets out the
identified drivers for change and then sets out the IM&T elements required to ensure
delivery.

Strategic Issue    IM&T Requirements

Meeting Patient     •   Provision of Information systems which enable service
Needs                   redesign

                    •   Delivering flexible information systems that will provided for
                        access to information as close to patient care as possible

                    •   Provide accurate and timely information recording

                    •   Effective and Timely information flows to GP’s, Primary Care
                        and other partner agencies

                    •   Integrated primary and secondary care disease registers to
                        promote data sharing (within appropriate controls) and more
                        joined up management of this group of patients

Delivering          •   Provide simpler access to information that you are able to
clinically              access (e.g. Single sign On )
effective
                    •   Provide      a    comprehensive   source   of    clinical    and
services
                        administrative data, which can be easily analysed, is readily
                        available and can be quickly shared

                    •   Improve communication between wards and departments,
                        for example, in the requesting of services and transmission
                        of results

                    •   Provide a regular supply of clinician specific information on
                        priority issues




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Strategic Issue      IM&T Requirements

Choice               •   Choose and Book compliant systems

                     •   Provide information to patients and referrers that provides
                         the information required to maximise ELHT being the
                         organisation of choice

18 weeks             •   Provision of information to enable service planning, delivery
                         and monitoring within 18 weeks target

                     •   Ability to analyse, model and present information at
                         Directorate level

PbR                  •   Comprehensive, accurate and timely data capture of           to
                         ensure that full income is received

                     •   Access to and use of, a robust source of comparative
                         information to identify optimum performance levels

Service       Line   •   Ability to analyse, model and present information at all levels
Reporting                including patient

                     •   Consistency      of data capture and further Integration of
                         information systems

Information          •   Provide increased level of information sharing whilst
Governance               maintaining      and   enhancing   security     the    security
                         infrastructure

                     •   Provide increased resilience of information systems and
                         business continuity

Transforming         •   Integrated Electronic Staff Record which allows planning and
the           NHS        monitoring for staff training and development as well as the
workforce                basic information re pay and personal details

                     •   Implementation of E-KSF and tools to assist in workforce
                         planning

                     •   Enable generic and system specific training to enable the
                         best use of the resources available




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1.4 APPROACH

The continued development of the IM&T infrastructure is critical to the development
of the organisation and our ability to continue the transformation of services and the
delivery efficient, effective patient care.
Therefore our approach to implementation will follow the following principles:-
    •   Our organisational strategic drivers will drive the implementation

    •   When achievable we will adopt technologies that can be used across all
        disciplines of the organisation whilst providing a consistent yet secure
        environment.

    •   Work with clinicians to implement the new clinical systems, focussing on the
        increased efficiencies and benefits to patient care they can deliver whilst
        understanding the risks and benefits of the new clinical system anticipates
        and realised.

    •   Work with all staff groups to ensure our “back office” systems support our
        business processes, particularly important as we move towards foundation
        Trust status.

    •   Review the potential of Connecting for Health supplied solutions wherever
        available, that match the proposed service development, or when major
        system changes are being planned by the Trust.



1.5 ENABLING AND ENSURING CHANGE

The successful delivery of the organisational IM&T strategy must deliver
organisational benefits and act as an enabler to change. The IM&T Board and
Strategic Management Board need to ensure that benefits of IM&T developments are
clearly anticipated, realised and recognised in the successful implementation of
projects.


1.5.1   Defining and owning the clinical vision

Our vision and approach to the delivery of the Clinical strategy, emphasizes our
commitment to working with clinicians to set the direction and ensure the appropriate
functionality is provided. It is anticipated this will be achieved in a number of ways,
some of which are set out below:-




Author & Contact Details                                                     Version No:
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   •    The Trust’s IM&T Board will continue to have strong clinical representation.
        We have encouraged clinical membership of this group and this approach has
        proved successful to date. The IM&T Board is a sub-committee of the
        Strategic Management Board so there is a direct link back to the key
        management group within the organisation.

   •    The review of any clinical information systems should have an appropriate
        clinical lead

   •    When implementing new systems or changing processes, a clinical champion
        will be identified where appropriate to lead the process and ensure that the
        required clinical focus is maintained to ensure delivery of the benefits and
        appropriate representation and advice will are available to the project.



1.5.2   Benefits Realisation

The delivery of benefits, either qualitative or quantative, is the reason we are
embarking upon this change programme. Therefore, ensuring their realisation is the
key to the programmes success, both in terms of ensuring that the improvements
and efficiencies are made and in demonstrating that value for money has been
obtained. It is recognised across the NHS, that an integrated approach to benefits
management is required which goes beyond individual projects. For national
applications the benefits realisation will form part of the national plan, however
benefits form implementation of local applications are likely to feature as part of a
Local Divisional Plan, Trust development plan or as part of the health economy,
Meeting Patient needs programme.


1.5.3   INFORMATION PROVISION

Many of our so called “legacy” information systems have lacked the ability to facilitate
the flexible production of information required to support effective decision making,
service improvement or operational service delivery. In some cases this relates to the
now outdated technology employed and in others, the fact that we do not have the
data capture systems in place to collect the required information. The new
technologies we will be employing in our future implementations, together with our
strategy to bridge any gaps with integrated Trust wide systems will significantly
enhance our information production capacity. This, coupled with an organisational
initiative to devolve information analysts to divisions, will mean that we will the


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organisation will be far better served with information than has been the case in the
past. Specific initiatives planned include:-
   •    In parallel with the implementation of the revised PAS, the trust has
        developed a Data warehouse to enable more effective reporting and quality
        control systems.

   •    The CHKS Signposting project providing detailed comparative information at
        specialty and consultant level.

   •    The provision of corporate reporting tools to allow high level monitoring of a
        range of indicators

   •    The Electronic Staff Record will provide us with access to benchmarking data
        for Human Resources



1.5.4   TRAINING

The Trust has an excellent track record in providing system specific training for its
staff, (i.e. instruction in using a particular system such as PAS, ESR and PACS).
However, this has historically been done at implementation of new systems rather
than as an ongoing programme of development and has meant that the full
functionality of the applications may not have been exploited.         These needs are
apparent in the review of training requirements identified within the Personal
Development Review (PDR) process. In 2008/09 the learning and development
department have received funding to support the provision and delivery of a range of
IT skills courses. These will be aimed predominantly at Level 1 and Level 2
competencies, but a range of packages will be sourced from external agencies. The
use and benefits of this training will be reviewed to establish of this provision need to
be maintained in subsequent years
This equally applies to the MS office applications where general training has been
made available in areas such as PC awareness or use of e-mail. During the lifetime
of this strategy continuing focus will be given to ensuring that system users are
properly trained and supported but an additional effort will be made in focussing on
training staff in the use, analysis and presentation of information. Additionally, we will
focus on raising awareness of maximising the use of our infrastructure, e.g. in
improving personal productivity or delivering organisational improvements via the use
of e-mail and electronic diaries.




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Wherever possible, use will be made of new technologies to deliver the required
training and the implementation of new systems will always jointly consider training
and redesign to ensure that we do not simply replicate existing processes.



1.6 CURRENT AND PLANNED IMPLEMENTATION ACTIVITY

The implementation activity will be reviewed on an annual basis, but currently
comprises of areas that are currently in the table identified as 2007/08 and 2008/09.

The detailed development plan will be reviewed by the IM&T Board, and specific
projects will report to the IM&T Board. The activity identified consists of those areas
where schemes have been agreed by SMB or funded in conjunction with and been
agreed with the East Lancashire IM&T board in line with the previous strategy.

The implementation activity will be approved by the Strategic Management Board
and they will receive quarterly updates on progress with the implementation activity
monitored by the IM&T Board

Year Started/     Area             Proposed Development
Planned

2007/08           Clinical         Completion of casenote number & remerge

                  Clinical         Replacement Maternity system

                  Clinical         Trust rollout of discharge letter system

                  Clinical         Complete ELHT consolidation of Continuum for
                                   AHP system

                  Infrastructure   Provision of centralised Admissions Discharge
                                   Team

                  Infrastructure   Pilot implementation of Sharepoint

                  Information      Rollout of CHKS Signpost Systems
                  Management       Implementation

2008/09           Clinical         Replacement of Radiology Information system

                  Clinical         Implementation of ELHT Clinical Documentation
                                   system

                  Clinical         Expansion of existing systems to provide Order
                                   communications systems within ELHT

                  Clinical         Replacement/upgrade of Pharmacy system



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Year Started/   Area             Proposed Development
Planned

                Clinical         Development of AHP system

                Clinical         Implementation of additional integration projects
                                 for existing clinical systems in line with service
                                 line reporting needs

                Infrastructure   Extension of IT support towards 7 day cover

                Infrastructure   Additional Business Change function to
                / Information    undertake Process review/use of new and
                management       existing information systems and functionality

                Infrastructure   Implementation of Single Sign On Technology

                Infrastructure   Pilot implementation of Wireless networking for
                                 production of Clinical Documentation

                Infrastructure   Deployment of Digital Dictation system to
                                 support revised clinical work practices

                Infrastructure   Commence clinical document scanning

                Infrastructure   Review IM&T training requirements

                Infrastructure   Server virtualisation project

                Infrastructure   PC upgrade programme

                Information      Service Line reporting
                management

                Non Clinical     Implement ESR service level management

                Non Clinical     Implement e-KSF

2009/10         Clinical         Implementation of e-prescribing
Currently       Clinical         Replacement/upgrade of Pathology system
anticipated
                Clinical         Review/ implementation of Lorenzo PAS, A&E
activity
                                 Order and Results reporting and clinical
                                 documentation

                Infrastructure   Expansion of Wireless network technology

                Infrastructure   Continue Trust wide clinical document scanning

20010/11        Clinical         NCRS Advanced bed management

20011/12        Clinical         Review / implement NCRS Maternity and


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Year Started/      Area              Proposed Development
Planned

                                     Theatre systems

                   Clinical          Review/ Implement NCRS In patient prescribing
                                     and medicines administration

2012/13            Clinical          Review/ implement NCRS Multi resource
                                     scheduling

                   Clinical          Review/ implement Advanced clinical
                                     functionality

2013/14            Clinical          Document integration



1.7 FINANCIAL IMPLICATIONS

For this strategy to be delivered, its affordability must be proved. In essence, there
are four ways in which delivery can be funded as follows:-
    o   From the pooled IM&T investment agreed by the East Lancashire IM&T board
    o   Capital investment and use of existing revenue funding
    o   Provided for from generation of Cost improvement programmes
    o   Through the Payment by Results (PbR) tariff
For the period up to and including 2008/09 funding has been agreed within the East
Lancashire IM&T Board to fund a range of the projects listed above, and to make
repetitive funding for ongoing projects. Additionally, some organisational capital
funding will be available to initiate other projects identified as a priority. An annual
review of funding requirements will take place to review use of available funding to
support the delivery of this strategy.


2   RECOMMENDATIONS

The Board are requested to adopt the strategy.




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                    REPORT TO TRUST BOARD PART ONE
Meeting Date:                     Report Purpose:        Agenda Item: 12
29th July 2008               For Decision           □
                             Performance Monitoring
                             □
                             For Information
Report Submitted By:         Report Approved By:         Report Title:
Frances Murphy               Mark Walkingshaw            Healthier   Horizons     for
Company Secretary            Director of Planning and the North West
                             Strategic Development
Date Considered By           Divisional Board Chair Declaration of
Divisional Board/            Approval:                   Confidentiality Required:
Reason Not Considered                                    Yes             No
By Divisional Board:
NA                           NA


Implications For Partners:           The report will have implications for all health
                                     care providers and commissioners within the
                                     Strategic Health Authority
Related to key risks identified on   All
Assurance Framework &
Consequences:
Related to Corporate Objective:      All
Related to HCC Standard:             All
Related to Standards for Better All
Health Domain:
Executive Summary:                   The report summarises the recently published
                                     “Healthier Horizons for the North West” which
                                     is the North West Strategic Health Authority’s
                                     response to Lord Darzi’s challenges in the
                                     national Our NHS Our Future review of NHS
                                     services, to put NHS doctors, nurses and other
                                     front-line staff at the heart of decision about
                                     NHS services; to improve patient care and


Frances Murphy                                                           Version No: 1
                                                                          Page 1 of 8
                                  safety; make services easier to access; and
                                  produce a 10 year vision for NHS services.


                                  It calls for NHS services in the community and
                                  in hospitals to: “raise their game” in terms of
                                  the quality of care they provide; to listen more
                                  to their patients and the public they serve; to
                                  shift their focus much more towards the
                                  promotion of health and the prevention of
                                  illness:
                                  The report goes on to outline the implications
                                  for the Trust.
Recommendation/    What        Is The Board is requested to receive the report
Required From The Committee:      and note the key themes emerging from the
                                  recommendations and enablers detailed in the
                                  publication.
                                  The Board is requested to encourage staff to
                                  respond to the consultation by the Strategic
                                  Health Authority which closes on 31st August
                                  2008 via their website.
                                  The Board is requested to consider whether a
                                  corporate response should be submitted by the
                                  Trust Board.




Frances Murphy                                                       Version No: 1
                                                                      Page 2 of 8
1. Background/ Content/ Impact on the Organisation/ (Fit with Strategic
   Direction/ Vision and Values/ Compliance with National Agendas)/ Impact
   on Organisation of Doing Nothing:
1.1 Background
   In his interim report in October last year, Lord Darzi stated that NHS services
   should be fair, personal, accessible, safe and locally accountable. The “Healthier
   Horizons for the North West” is the Strategic Health Authority’s response to the
   interim report upon which it is seeking the views of staff working within the NHS
   through their website www.northwest.nhs.uk.
1.2 Content
   Healthier Horizons details the main recommendations from each of the eight
   clinical pathway groups made up of front-line doctors, nurses, therapists and
   others from the North West region, set up to look at all the available evidence on
   how services can be delivered to get the best outcomes. It calls for NHS services
   in the community and in hospitals to:
         •   “raise their game” in terms of the quality of care they provide;
         •   to listen more to their patients and the public they serve;
         •   to shift their focus much more towards the promotion of health and the
             prevention of illness.
   It details the case for change by comparing the poor health indicators for the
   region to those nationally and setting out its assessment of the features that the
   population are likely to value in the future including the need for personalised
   services and offering people the opportunity to take responsibility for their own
   health.
   The vision from the Strategic Health Authority is that a new relationship will be
   formed between the NHS and the population it serves in this region which seeks
   to:
         •   Understand their experiences, expectations and standards
         •   Take decisions with them instead of for them at every level of the NHS
         •   Take every opportunity to prevent ill health and disease
         •   Create a personal experience that will help people to change their
             relationship with their health and care
   A set of 10 common themes has been distilled from each of the clinical pathway
   groups:
         1. Wellbeing, prevention and self care is increasingly important both on a
         population and individual basis


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                                                                                 Page 3 of 8
         2. Quality standards and evidence based practice should be agreed fro all
         our services
         3. Everyone should receive the same access to treatment, regardless of
         where they live
         4. Bold inspirational leadership both clinical and managerial is required to
         deliver change
         5. Organisational boundaries and funding incentives can hinder high quality
         pathway care
         6. Commissioning across sectors needs to be more flexible to allow changes
         in service provision
         7. Information and data systems need to allow data to be shared across
         organisations and sectors
         8. Our workforce needs to be more flexible, so that it can operate across
         care pathways not organisations
         9. We should break down any barriers between professions and care
         settings to create a more personalised and tailored service
         10. Changing pathways of care are inevitable
      The report emphasises the need for changes within the service to be led by
      clinicians and for developing evidence based practice that can be used across
      organisations and sectors, to achieve high standards of services, safety and
      patient satisfaction. A strategic framework is being introduced to deliver against
      the 9 recommendations introduced in the report which is supported by 7
      enablers. These are examined in greater detail below.
1.3      Impact on the Organisation.
      The table below sets out the key themes being considered by the Trust that
      support the seven enablers identified to achieve the recommendations of the
      report. These will now be developed into a full response by the end of August
      2008 with identified leads and timescales.
                   Enabler                                    Key Themes
Getting beyond service reconfiguration        Focussing on embedding new ways of
                                              working to ensure delivery of quality
                                              indicators.
                                              Focussing on      patient experience    to
                                              measure our success.
                                              Introduction of the Advancing Quality
                                              programme.



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                                                                            Page 4 of 8
                                        Using technology to continue to improve
                                        the patient experience and improve
                                        efficiency and effectiveness.
Raising our game on safety, quality, Introduction of Earned Autonomy system
governance; becoming world class        Continued           implementation             and
                                        development         of      risk   management
                                        strategy, policy and plan.
                                        Continuous development of performance
                                        indicators to measure improvements in
                                        quality,   safety     and     governance       and
                                        introduction of service line management.
                                        Use of Practice Reviews and Essence of
                                        Care to measure improvements and
                                        monitor achievements.
Strengthening leadership and strategic Introduction     of        new      management
capability                              structures          strengthening           clinical
                                        leadership    and        linking   performance,
                                        governance and business skills for the
                                        delivery of patient care.
                                        Continued            implementation              of
                                        organisational development and human
                                        resources strategies including business
                                        skills and leadership development.
                                        Developing national and international
                                        links with providers of world class quality
                                        services .
Listening, understanding and tailoring Strengthening staff and patient feedback
what we offer                           mechanisms.
                                        Full implementation of Meeting Patient
                                        Needs.
                                        Continued      engagement            with       our
                                        members and the local community as
                                        part of our membership development
                                        programme.
                                        Continuous reporting and liaison with
                                        commissioners, other service providers,



Frances Murphy                                                             Version No: 1
                                                                            Page 5 of 8
                                          local    government        and      social        care
                                          providers.
 NHS North West Strategic Objectives                         Key Themes
Being innovative                          Implementation of our programme to
                                          learn from the best health care providers
                                          across    the      world     by    pairing         with
                                          international centres of excellence.
                                          Continued development of our clinical
                                          research programmes.
Partnerships with meaning                 Continuing to develop relationships with
                                          commissioning partners.
                                          Developing         and     implementing            our
                                          membership strategy.
                                          Engagement with stakeholders through
                                          formal and informal meetings.
Managing the system in the interests of Trust quarterly staff survey
people                                    Patient feedback mechanisms
                                          PALS service
                                          Complaints and Compliments analysis
                                          Continued       development          of         patient
                                          pathways
                                          Care closer to Home programme
Ensure people live longer                 Introduction and continued development
                                          of services designed to address local
                                          health       inequalities,        e.g.          cancer,
                                          cardiology,     women’s        and        newborn’s
                                          development.
Reduce the impact of illness on people’s Care Closer to Home Programme.
quality of life                           Continuing         to      work          with      our
Reduce lifestyle related illnesses        commissioner partners in their strategies
                                          to reduce health inequalities by focussing
                                          on empowering the community to adopt
                                          healthy lifestyles and to better manage
                                          long term conditions.
Deliver quality health and health services Continue to work more efficiently and
efficiently                               manage       our    finances      effectively        to


Frances Murphy                                                                 Version No: 1
                                                                                Page 6 of 8
                                        deliver the best possible value for
                                        money.
                                        Continue     to    develop     a    modern
                                        infrastructure,      through       ongoing
                                        investment in our estate and information
                                        management and technology.
NHS North West Strategic Objectives                   Trust Actions
Identify health needs better and respond We continue to work with commissioners
creatively                              to identify and meet the health needs of
                                        our communities.
                                        We continue to develop new patient
                                        pathways to ensure our patients receive
                                        personalised services where appropriate.
Balance collaboration and competition in We continue to assess and respond to
the delivery of health services         the current health care market and
                                        engage with commissioners and GP’s to
                                        ensure we can deliver the right service at
                                        the right time in the right place for the
                                        benefit of our patients.
Improve the efficiency of the health We continue to work hard to reduce our
service and value for money             costs each year to ensure we are able to
                                        provide value for money services.
Secure the necessary skills and lead by We will build on the national and
example                                 international reputation of some of our
                                        clinicians and our reputation as a training
                                        provider.
                                        Our      Organisational        Development
                                        Strategy commits us to continue to build
                                        upon the improvements we have made to
                                        date
Work closely with partners to ensure We continue to develop and maintain our
delivery of health service objectives   relationships with many stakeholders


2. Options (If Any)
2.1    NA




Frances Murphy                                                         Version No: 1
                                                                        Page 7 of 8
3. Costs (Including Identified Source of Funding)/ VFM
3.1      NA


4. Conclusion/Recommendations
4.1 That the Board receives the report and notes the key themes the Trust is
      addressing in line with the recommendations and enablers detailed within the
      Healthier Horizons publication
4.2 That the Board encourages staff to respond to the consultation by the Strategic
      Health Authority which closes on 31st August 2008 via their website.
4.3 The Board to agree that a corporate response should be submitted by the Trust
Board.




Frances Murphy                                                               Version No: 1
                                                                              Page 8 of 8
Meeting Date:                         Report Purpose:             Agenda Item: 13
29th July 2008                     For Decision               □
                                   Performance
                                   Monitoring
                                   For Information        □
Report Submitted By:               Report Approved By:            Report Title:
Emma Birchall                                                     Performance Report
Director of IM&T                                                  June 2008
Date Considered By       Divisional Board Chair Declaration of
Divisional Board/
                         Approval:                  Confidentiality
Reason Not
Considered By            N/A                        Required:
Divisional Board:
                                                    No
N/A
Implications For Partners:    Performance Monitoring

Key               Risks            & Failure to respond to areas of under performance
Consequences:                          impacting upon the Trust’s ability to deliver its
                                       strategic objectives
Related          to       Corporate All
Objective:
Related to HCC Standard:               All
Related to Standards for All
Better Health Domain:
Executive Summary:                     The report provides:
                                              •   Details of performance against a range
                                                  of indicators contained within the
                                                  Organisational Dashboards
                                              •   Self-Assessment against Healthcare
                                                  Commission standards
                                              •   Key Performance Risks


Recommendation/ What Is                Members are asked to receive this report.
Required From The Committee:




Emma Birchall – Director of IM&T
Created on 22/07/08                                                                Page 1 of 8
                                   PERFORMANCE REPORT
                                        JUNE 2008


1.       Introduction…………………………………………………………………………3

2.       Performance Summary…………………………………………………………...3

3.       Performance Risks & Exceptions………………………………………………6

4.       Key Actions…………………………………………………………………………8




Emma Birchall – Director of IM&T
Created on 22/07/08                                     Page 2 of 8
1.0      Introduction

1.1      This report aims to summarise the current position of the Trust in terms of key
         performance indicators and assess performance against the Healthcare
         Commission standards.


1.2      The report is split into three sections:
         •    Performance Summary Commentary
         •    Performance Risks and Exceptions
         •    Key Actions


1.3      The integrated performance framework that can be found at Appendix A.
         This details the current performance for the Trust against a range of
         indicators.


2.0      Performance Summary
2.1      The table below details the Trust’s current position against the Healthcare
         Commission Existing Commitments through self-assessment.                       The final
         assessment criteria has now been released, and the changes are reflected
         below.
Fig. 1
 Ref     Description                                          Applicable to    Predicted
                                                                 ELHT           Points
 1       Access to GUM Clinics (Offer of Appt within 48hrs)       Yes              3
 2       Cancelled Operations and those not admitted              Yes              3
         within 28 days
 3       Data Quality on Ethnic Group                             Yes             2
 4       Delayed Transfers of Care                                Yes             3
 5       Number of Inpatients waiting longer than standard        Yes             3
         (26wks)
 6       Number of Outpatients waiting longer than                Yes             2
         standard (13wks)
 7       Patients waiting no longer than 3 months for              No             n/a
         revascularisation
 8       Total Time in A&E: 4 hours or less                       Yes             3
 9       Waiting Times for Rapid Access Chest Pain                Yes             3
         services
 Total                                                                           22
 Number of Targets: 8               Fully Met    Almost Met    Partially Met   Not Met
 Maximum Points Available:            >=22          >=20           >=17         <17
 24




Emma Birchall – Director of IM&T
Created on 22/07/08                                                                      Page 3 of 8
2.2      Using these indicators, the Trust would fully meet the Healthcare Commission
         requirements for the Existing Commitments. Data Quality on Ethnic Group
         has deteriorated, and details can be found in section three.


2.3      The table below details the Trust’s current position against the new
         Healthcare Commission National Priorities through self-assessment.                       The
         final assessment criteria has now been released, and the changes are
         reflected below.
Fig. 2
 Ref     Description                                            Applicable to ELHT       Predicted Points
 1       18 Week Referral to Treatment Times                           Yes                       3
 2       All Cancers: One Month Diagnosis to Treatment                 Yes                      3
         (including new cancer strategy commitment)
 3       All Cancers: Two Month GP Urgent Referral to                  Yes                          3
         Treatment (including new cancer strategy
         commitment)
 4       All Cancers: Two Week Wait                                    Yes                      3
 5       Engagement in Clinical Audits                                 Yes              Seeking Assurance

 6       Experience of Patients: Clinical Quality Domain(s)            Yes                   Annual Survey
 7       Experience of Patients: Health & Wellbeing                    Yes                   Annual Survey
         Domain(s)
 8       Experience of Patients: Patient Focus & Access                Yes                   Annual Survey
         Domain(s)
 9       Experience of Patients: Safety Domain(s)                      Yes                   Annual Survey
 10      Incidence of Clostridium Difficile                            Yes                        3
 11      Incidence of MRSA                                             Yes                        3
 12      Infant Health & Inequalities: smoking during                  Yes
         pregnancy and initiation of breastfeeding
 13      Maternity Hospital Episode Statistics: Data Quality           Yes                   In Development
         Indicator
 14      NHS Staff Satisfaction                                        Yes                Annual Survey
 15      Participation in Heart Disease Audits                         Yes              Seeking Assurance
 16      Stroke Care                                                   Yes              Seeking Assurance
 Total
 Number of Targets: 16                          Fully Met      Almost Met    Partially Met         Not Met
 Maximum Points Available: 48                     >=45            >=42           >=39               <39


2.4      The Trust is awaiting assurance on a number of newly released indicators,
         and also there is some developmental work to be done in order to ensure that
         robust monitoring is in place for all the standards listed above.


2.5      The Trust continues to be over trajectory for incidence of MRSA, and further
         details can be found at section three, however the position is expected to
         recover by the end of July and therefore maximum points have been
         awarded. The graphs below demonstrates the current year’s position against
         trajectory and a comparison with the previous year for both MRSA and
         Clostridium Difficile, which is under trajectory.



Emma Birchall – Director of IM&T
Created on 22/07/08                                                                          Page 4 of 8
 Fig. 3

                                         MRSA Bacteraemia - Year on Year Comparison

                   5




                   4




                   3




                   2




                   1




                   0
                            Apr    May      Jun      Jul      Aug     Sep      Oct     Nov      Dec    Jan        Feb        Mar
MRSA 08/09                  4       3        0
MRSA 07/08                  4       2        3        0        2       1        2          4     3         4          1         4
MRSA 08/09 Trajectory       2       2        2        2        2       2        2          2     2         2          2         2




               Fig. 4

                                         Clostridium Difficile - Year on Year Comparison

                   70



                   60



                   50



                   40



                   30



                   20



                   10



                        0
                             Apr   May       Jun      Jul     Aug     Sep     Oct     Nov      Dec    Jan        Feb      Mar
  Cdif 08/09                  15    17       10
  Cdif 07/08                  60    43       27       39      24      25       35      21      26     31         28       22
  Cdif 08/09 Trajectory       24    24       24       24      24      24       24      24      24     24         24       24




 Emma Birchall – Director of IM&T
 Created on 22/07/08                                                                                           Page 5 of 8
2.6      The new performance framework at Appendix A gives further details of the
         other indicators monitored by the Trust.

2.7      Cancelled operations have continued to reduce and at the end of June
         represented 0.86% of admissions against a 0.8% tolerance.              However,
         improvements have continued and at the time of writing, the position has
         been recovered back to tolerance.


2.8      There continues to be breaches to key stage of treatment milestones with a
         number of breaches of the 13 week outpatient waiting time commitment.
         Combined with the breaches from last month, this has now put the Trust over
         the Healthcare Commission tolerance for the maximum points available for
         this indicator. No further breaches will now be tolerable without putting the
         Trust at risk of failing this indicator. Despite these breaches, which again are
         mainly in Dermatology, progress towards the 18 week targets continues to be
         positive.

2.9      The Trust has achieved its elective activity plan for the quarter, although there
         is considerably more activity to deliver during the last six months of the year
         compared to the first two quarters.        Maxillo-facial surgery continues to
         underperform, and investigations are underway to understand this reduction
         in activity.

3.0      Performance Risks and Exceptions
3.1      As detailed in Section Two, there are some exceptions to the current
         standards monitored both locally and nationally, and some potential risks to
         performance.


3.2      Cancelled Operations is still recovering well, as illustrated in the graph below,
         and it is envisaged that this improvement will be maintained in order to keep
         the Trust within the accepted tolerance.




Emma Birchall – Director of IM&T
Created on 22/07/08                                                              Page 6 of 8
            Fig. 5

                                         Cancelled Operations - Healthcare Commission Standard

6.0%



           28 Day Threshold - 5%
5.0%


                                                                                                      The Healthcare Commission Cancelled
                                                                                                      Operations standard covers the percentage of
4.0%
                                                                                                      cancelled operations as a proportion of
                                                                                                      elective admissions, and of those
                                                                                                      cancellations how many patients were not
                                                                                                      readmitted within 28 days.
3.0%




2.0%




          Elective Cancellations Threshold - 0.8%
1.0%




0.0%
       Apr-07   May-07    Jun-07    Jul-07   Aug-07   Sep-07   Oct-07   Nov-07   Dec-07   Jan-08   Feb-08    Mar-08    Apr-08    May-08    Jun-08

                  % Elective Admission        % Not Readmitted within 28 Days      28 Day Threshold         % Elective Admissions Threshold




            3.3          Incidence of MRSA has been flagged as Amber, with a performance over
                         trajectory in June 2008. However no further bacteraemia have occurred since
                         the end of May, and at the time of writing the Trust was on target to for it
                         cumulative trajectory at the end of July.


            3.4          Non-elective activity continues to underperform, however the profile of the
                         activity plan has been amended in light of historic trends. This presents a
                         position of 3% below plan, excluding obstetrics where a contract variation is
                         awaited.


            3.5          Data quality on ethnic group has deteriorated from over the previous months.
                         The Trust is 100% compliant with the collection of ethnicity data however this
                         indicator monitors the percentage of patients where ‘Unknown’ has been
                         recorded for this data item. A training plan is being worked up in order to
                         raise awareness of the importance of collecting this information and this will
                         be monitored monthly from July in the corporate Performance Pack.


            3.6          Sickness levels continue to be high, although there has been a slight
                         reduction from the previous month. The Trust has now adopted a revised
                         Sickness Absence policy with tighter trigger points for action. Awareness
                         sessions with managers have begun, and regular monthly audits are being
                         put in place in order to ensure compliance with the new policy. HR support

            Emma Birchall – Director of IM&T
            Created on 22/07/08                                                                                            Page 7 of 8
                   has also been improved in terms of the systems available to support
                   managers in managing staff sickness absence, with increased professional
                   support from within HR.


          4.0      Key Actions


          4.1      The table below details the key ‘hot-spots’ for focus and close monitoring.
          Fig. 6
                                      Expected     Out-turn
Performance Exception                 Standard     Position                        Actions                              Lead
Cancelled Operations (% of                                       •   Monitoring through Daily Bed              Director of
Elective Admissions)                    0.8%        0.86%            Meeting & new reporting                   Operations
                                                                     mechanism
                                                                 •   Director authorisation required for
                                                                     all cancellations
                                                                 •   Weekly monitoring of HCC
                                                                     standards at Weekly Performance
                                                                     Meeting to ensure corrective action
                                                                     taken where necessary
Non-Elective Activity               Achievement     Under        •   Pursue the required contract              Director of IM&T &
                                       of Plan    performance        variation with PCTs in relation to        Deputy Director of
                                                  against plan       Obstetric activity                        Finance


MRSA                                         6         7         •   Reinforcement of Saving Lives             Divisional Directors
                                                                     action plan
                                                                 •   Zero tolerance relating to hand-
                                                                     washing and challenge to non-
                                                                     compliant staff
Outpatient 13 Week Breaches             0.03%                    •   Divisional monitoring to prevent          Divisional
                                                                     further breaches of standard              Information &
                                                                                                               Performance Mgrs


                                                                 •   Additional routine capacity in            Director of
                                                                     pressure areas                            Operations
                                                                 •   Increased slot availability on
                                                                     Choose & Book
Data Quality on Ethnic Group             90%         83%         •   Establish monthly monitoring              Director of IM&T
                                                                     through Performance Pack at
                                                                     specialty and site level
                                                                 •   Establish training and awareness
                                                                     programme to improve data
                                                                     completeness




          Emma Birchall – Director of IM&T
          Created on 22/07/08                                                                             Page 8 of 8
APPENDIX A - PERFORMANCE REPORT - JUNE 2008


                       Getting                                                                                                                                                                                        Red      Off plan - significant
                       Better                                                                                                                                                                                                          issues
                       Staying                                                                                                                                                                                      Amber         Issues - within
                       the Same                                                                                                                                                                                                      tolerance

                       Getting                                                                                                                                                                                       Green     No issues - on plan
                       Worse

PERSPECTIVE            KEY PERFORMANCE INDICATOR                     ACTUAL INDICATOR SETS                                                      LEAD            PERFORMANCE       PERIOD       MOVEMENT IN OUTURN WITH OUTTURN WITHOUT
                                                                                                                                                                                              PERFORMANCE    ACTION        ACTION
Overarching                                1 Productivity & Access        1.1    Performance against plan                                       Director of                      Cumulative
                                                                                                                                                Operations
                                                                                        1.1.1    Elective Activity                                                    0%         to Month 3                            n/a            n/a
                                                                                        1.1.2    Non-Elective Activity                                              -11%                                             On Plan       Under Plan
                                                                                        1.1.3    ED & UCC Activity                                                  +4.8%                                              n/a            n/a
                                                                                        1.4.4    New Outpatient Activity                                             +7%                                               n/a            n/a
                                                                                        1.4.5    Review Outpatient Activity                                          +8%                                               n/a            n/a
                                                                          1.2    Consultant delivery against individual plan                                                                Monitored at Divisional Level
                                                                          1.3    18 Week target                                                                                   Month 3
                                                                                 1.3.1 % achieved for admitted pathway                                              86%                                               n/a               n/a
                                                                                 1.3.2 % achieved for non- admitted pathway                                         90%                                               n/a               n/a
                                                                          1.4    Waiting times                                                                                    Month 3
                                                                                        1.4.1    Current maximum inpatient waiting time                           19 Weeks                                            n/a               n/a
                                                                                        1.4.2    Current maximum outpatient waiting time                          13 Weeks                                            n/a               n/a
                                                                                        1.4.3    Current maximum Diagnostic waiting time                          5 Weeks                                             n/a               n/a
                                                                                        1.4.4    Access to GUM clinics – 48 hr target offered                       99%                                               n/a               n/a
                                                                                        1.4.5    48 hr target seen                                                  79%
                                                                          1.5    Cancelled operations rate                                                         0.86%         Cumulative                         <=0.8%            >0.8%
                                                                                                                                                                                 to Month 3
                                                                          1.6    Re-admission within 28 days                                                        100%         Cumulative
                                                                                                                                                                                 to Month 3
                                                                          1.7    Cancer targets
                                                                                 1.7.1 14 days                                                                      100%                                              n/a               n/a
                                                                                 1.7.2 31 days                                                                      100%                                              n/a               n/a
                                                                                 1.7.3 62 days                                                                      100%                                              n/a               n/a
                                                                          1.8    Theatre Utilisation                                            Divisional                                        In Development
                                                                                                                                                Director
                                                                                 1.8.1 % used v% available
                                                                                                                                                Surgery
                                                                                 1.8.2 list start on time %
                                                                                 lists finish on time %
                                                                                 1.8.3 % cancelled on day
                                                                          1.9    Thrombolysis target                                            Director of         77%                                               n/a               n/a
                                                                                                                                                Operations
                                                                          1.1    % of Suspended Patients (excluding 18wk Clock Pauses)                              2.50%                                             n/a               n/a
                                                                          1.11    Rapid Access Chest Pain – 2 wk wait                                               100%                                              n/a               n/a
                                                                          1.12   Delayed Transfers of Care                                                          1.12%                                             n/a               n/a
                                                                          1.13   Outliers out of Division                                                              4                                              n/a
                                           2 Finance & Efficiency         2.1    I & E Performance                                              Director of
                                                                                                                                                Finance
                                                                          2.2    CIP Performance
                                                                          2.3    EBITDA Margin                                                                  In Development                      n/a
                                                                          2.4    Delivery of Financial Plan
                                                                          2.5    Meet ALE requirement
                                                                          2.6    Asset Utilisation                                              Director of     In Development
                                                                                                                                                Estates &                                           n/a
                                                                                                                                                Facilities
                                                                            2.7 Risk Rating                                                     Director of
                                                                                                                                                Finance
                                                                            2.8 Bank/Agency expenditure                                         Director of
                                                                                                                                                Finance
Overarching                      3 Standards for Better Health            3.1    Core Standards                                                 Director of
                                                                                                                                                Clinical Care
                                                                                                                                                & Governance
                                                                          3.2    HCC Reviews
                                 4 Governance                             4.1    Assurance Framework
PERSPECTIVE               KEY PERFORMANCE INDICATOR        ACTUAL INDICATOR SETS                                      LEAD             PERFORMANCE          PERIOD       MOVEMENT IN OUTURN WITH OUTTURN WITHOUT
                                                                                                                                                                        PERFORMANCE    ACTION        ACTION
                                                                4.2    Corporate Risk Register
                                                                4.3    Serious Untoward Incidents
                                                                4.4    Incident Trends
                                5 Public Health                 5.1    Implementation of Public Health Strategy       Director of
                                                                                                                      Clinical Care
                                                                                                                      & Governance


Quality & Patient Focus         6 Compliments/Complaints        6.1    Formal Compliments                             Director of       PALS Comment
                                                                                                                      Clinical Care
                                                                                                                                            cards
                                                                                                                      & Governance


                                                                6.2    Patient Feedback Questionnaires                                 Under development
                                                                6.3    PALS Contacts
                                                                6.4    Patient Experience Tracker Trends
                                                                6.5    Patients Survey
                                                                6.6    Litigation Trends
                                7 Outcome Indicators            7.1    Risk Adjusted Mortality                        Medical                 79           Cumulative
                                                                                                                      Director
                                                                                                                                                           to Month 3
                                                                                                                      Governance
                                                                7.2    Elective Length of Stay                        Medical                2.74          Cumulative
                                                                                                                      Director
                                                                                                                                                           to Month 3
                                                                                                                      Operations
                                                                7.3    Non Elective Length of Stay                                           3.86          Cumulative
                                                                                                                                                           to Month 3
                                                                7.4    Day Case Rate                                                      64.5%             Month 3
                                                                7.5    Bed Occupancy                                                Under development
                                                                7.6    MRSA                                           Director of    Above Trajectory Cumulative
                                                                                                                      Infection P&C
                                                                                                                                                      to Month 3

                                                                7.7    C. Diff                                        Director of       Below Trajectory   Cumulative
                                                                                                                      Infection
                                                                                                                                                           to Month 3
                                                                                                                      Prevention &
                                                                                                                      Control

                                                                7.8    Re-admission Rates                             Medical               4.40%           Month 3
                                                                                                                      Director
                                                                                                                      Operations
                                                                7.9    4 hour Emergency Dept.                         Director of            98%           Cumulative
                                                                                                                      Operations
                                                                                                                                                           to Month 3
                                                                7.10   DNA Rates (% new NW average 9.7%)              Director of           10.50%         Cumulative
                                                                                                                      Operations
                                                                                                                                                           to Month 3
                                                                7.11   DNA Review Rate (% NW average 11.8%)                                 11.50%         Cumulative
                                                                                                                                                           to Month 3
                                                                7.12   Infant Health, Breastfeeding & Smoking                                                Quarter
                                                                                                                                                              One
Workforce                       8 Recruitment                   8.1    Turnover % (Voluntary turnover by headcount)   Director of OD        15.47%

                                                                       Staff in post wte                                                     5085
                                                                8.2    ESR
                                9 Staff Morale                  9.1    Sickness Absence Rate                          Director of OD        5.41%

                                                                       Sickness Absence Rate (average days lost)                             19.46
                                                                9.2    Staff Survey
                               10 Model Employer                10.1   Diversity & Equality Strategy Implementation   Director of OD


                                                                10.2   Mandatory Training
                                                                10.3   PDP Completion Rate                                             Under development
                                                                10.4   Consultant Appraisal Rates                                      Under development
                                                                10.5   New Staff Induction
                                                                10.6   Compliance with EWTD/HAN
APPENDIX A - PERFORMANCE REPORT - JUNE 2008


                       Getting                                                                                                                                                                                        Red      Off plan - significant
                       Better                                                                                                                                                                                                          issues
                       Staying                                                                                                                                                                                      Amber         Issues - within
                       the Same                                                                                                                                                                                                      tolerance

                       Getting                                                                                                                                                                                       Green     No issues - on plan
                       Worse

PERSPECTIVE            KEY PERFORMANCE INDICATOR                     ACTUAL INDICATOR SETS                                                      LEAD            PERFORMANCE       PERIOD       MOVEMENT IN OUTURN WITH OUTTURN WITHOUT
                                                                                                                                                                                              PERFORMANCE    ACTION        ACTION
Overarching                                1 Productivity & Access        1.1    Performance against plan                                       Director of                      Cumulative
                                                                                                                                                Operations
                                                                                        1.1.1    Elective Activity                                                    0%         to Month 3                            n/a            n/a
                                                                                        1.1.2    Non-Elective Activity                                              -11%                                             On Plan       Under Plan
                                                                                        1.1.3    ED & UCC Activity                                                  +4.8%                                              n/a            n/a
                                                                                        1.4.4    New Outpatient Activity                                             +7%                                               n/a            n/a
                                                                                        1.4.5    Review Outpatient Activity                                          +8%                                               n/a            n/a
                                                                          1.2    Consultant delivery against individual plan                                                                Monitored at Divisional Level
                                                                          1.3    18 Week target                                                                                   Month 3
                                                                                 1.3.1 % achieved for admitted pathway                                              86%                                               n/a               n/a
                                                                                 1.3.2 % achieved for non- admitted pathway                                         90%                                               n/a               n/a
                                                                          1.4    Waiting times                                                                                    Month 3
                                                                                        1.4.1    Current maximum inpatient waiting time                           19 Weeks                                            n/a               n/a
                                                                                        1.4.2    Current maximum outpatient waiting time                          13 Weeks                                            n/a               n/a
                                                                                        1.4.3    Current maximum Diagnostic waiting time                          5 Weeks                                             n/a               n/a
                                                                                        1.4.4    Access to GUM clinics – 48 hr target offered                       99%                                               n/a               n/a
                                                                                        1.4.5    48 hr target seen                                                  79%
                                                                          1.5    Cancelled operations rate                                                         0.86%         Cumulative                         <=0.8%            >0.8%
                                                                                                                                                                                 to Month 3
                                                                          1.6    Re-admission within 28 days                                                        100%         Cumulative
                                                                                                                                                                                 to Month 3
                                                                          1.7    Cancer targets
                                                                                 1.7.1 14 days                                                                      100%                                              n/a               n/a
                                                                                 1.7.2 31 days                                                                      100%                                              n/a               n/a
                                                                                 1.7.3 62 days                                                                      100%                                              n/a               n/a
                                                                          1.8    Theatre Utilisation                                            Divisional                                        In Development
                                                                                                                                                Director
                                                                                 1.8.1 % used v% available
                                                                                                                                                Surgery
                                                                                 1.8.2 list start on time %
                                                                                 lists finish on time %
                                                                                 1.8.3 % cancelled on day
                                                                          1.9    Thrombolysis target                                            Director of         77%                                               n/a               n/a
                                                                                                                                                Operations
                                                                          1.1    % of Suspended Patients (excluding 18wk Clock Pauses)                              2.50%                                             n/a               n/a
                                                                          1.11    Rapid Access Chest Pain – 2 wk wait                                               100%                                              n/a               n/a
                                                                          1.12   Delayed Transfers of Care                                                          1.12%                                             n/a               n/a
                                                                          1.13   Outliers out of Division                                                              4                                              n/a
                                           2 Finance & Efficiency         2.1    I & E Performance                                              Director of
                                                                                                                                                Finance
                                                                          2.2    CIP Performance
                                                                          2.3    EBITDA Margin                                                                  In Development                      n/a
                                                                          2.4    Delivery of Financial Plan
                                                                          2.5    Meet ALE requirement
                                                                          2.6    Asset Utilisation                                              Director of     In Development
                                                                                                                                                Estates &                                           n/a
                                                                                                                                                Facilities
                                                                            2.7 Risk Rating                                                     Director of
                                                                                                                                                Finance
                                                                            2.8 Bank/Agency expenditure                                         Director of
                                                                                                                                                Finance
Overarching                      3 Standards for Better Health            3.1    Core Standards                                                 Director of
                                                                                                                                                Clinical Care
                                                                                                                                                & Governance
                                                                          3.2    HCC Reviews
                                 4 Governance                             4.1    Assurance Framework
PERSPECTIVE               KEY PERFORMANCE INDICATOR        ACTUAL INDICATOR SETS                                      LEAD             PERFORMANCE          PERIOD       MOVEMENT IN OUTURN WITH OUTTURN WITHOUT
                                                                                                                                                                        PERFORMANCE    ACTION        ACTION
                                                                4.2    Corporate Risk Register
                                                                4.3    Serious Untoward Incidents
                                                                4.4    Incident Trends
                                5 Public Health                 5.1    Implementation of Public Health Strategy       Director of
                                                                                                                      Clinical Care
                                                                                                                      & Governance


Quality & Patient Focus         6 Compliments/Complaints        6.1    Formal Compliments                             Director of       PALS Comment
                                                                                                                      Clinical Care
                                                                                                                                            cards
                                                                                                                      & Governance


                                                                6.2    Patient Feedback Questionnaires                                 Under development
                                                                6.3    PALS Contacts
                                                                6.4    Patient Experience Tracker Trends
                                                                6.5    Patients Survey                                                 Under development
                                                                6.6    Litigation Trends
                                7 Outcome Indicators            7.1    Risk Adjusted Mortality                        Medical                 79           Cumulative
                                                                                                                      Director
                                                                                                                                                           to Month 3
                                                                                                                      Governance
                                                                7.2    Elective Length of Stay                        Medical                2.74          Cumulative
                                                                                                                      Director
                                                                                                                                                           to Month 3
                                                                                                                      Operations
                                                                7.3    Non Elective Length of Stay                                           3.86          Cumulative
                                                                                                                                                           to Month 3
                                                                7.4    Day Case Rate                                                      64.5%             Month 3
                                                                7.5    Bed Occupancy                                                Under development
                                                                7.6    MRSA                                           Director of    Above Trajectory Cumulative
                                                                                                                      Infection P&C
                                                                                                                                                      to Month 3

                                                                7.7    C. Diff                                        Director of       Below Trajectory   Cumulative
                                                                                                                      Infection
                                                                                                                                                           to Month 3
                                                                                                                      Prevention &
                                                                                                                      Control

                                                                7.8    Re-admission Rates                             Medical               4.40%           Month 3
                                                                                                                      Director
                                                                                                                      Operations
                                                                7.9    4 hour Emergency Dept.                         Director of            98%           Cumulative
                                                                                                                      Operations
                                                                                                                                                           to Month 3
                                                                7.10   DNA Rates (% new NW average 9.7%)              Director of           10.50%         Cumulative
                                                                                                                      Operations
                                                                                                                                                           to Month 3
                                                                7.11   DNA Review Rate (% NW average 11.8%)                                 11.50%         Cumulative
                                                                                                                                                           to Month 3
                                                                7.12   Infant Health, Breastfeeding & Smoking                                                Quarter
                                                                                                                                                              One
Workforce                       8 Recruitment                   8.1    Turnover % (Voluntary turnover by headcount)   Director of OD        15.47%

                                                                       Staff in post wte                                                     5085
                                                                8.2    ESR
                                9 Staff Morale                  9.1    Sickness Absence Rate                          Director of OD        5.41%

                                                                       Sickness Absence Rate (average days lost)                             19.46
                                                                9.2    Staff Survey
                               10 Model Employer                10.1   Diversity & Equality Strategy Implementation   Director of OD


                                                                10.2   Mandatory Training
                                                                10.3   PDP Completion Rate                                             Under development
                                                                10.4   Consultant Appraisal Rates                                      Under development
                                                                10.5   New Staff Induction
                                                                10.6   Compliance with EWTD/HAN
                      REPORT TO TRUST BOARD PART ONE
Meeting Date:                    Report Purpose:        Agenda Item: 14
29 July 2008                For Decision           □
                            Performance
                            Monitoring             □
                            For Information
Report Submitted By:        Report Approved By:         Report Title:
Mr. S Brookfield            Mr. S Brookfield            Finance Report for the
Director     of    Finance, Director    of   Finance, period to 30 June 2008
Capital, Planning and IT    Capital, Planning and IT
Date Considered By          Divisional Board Chair Declaration of
Divisional Board/
                            Approval:                   Confidentiality
Reason Not
Considered By                                           Required:
Divisional Board:
                            NA                          Yes             No
NA

Implications For Partners:        NA
Related      to     Key   Risks All
identified    on     Assurance
Framework                    &
Consequences:
Related       to     Corporate All
Objective:
Related to HCC Standard:          All
Related to Standards for All
Better Health Domain:
Executive Summary:                Finance report for the three month period to
                                  30 June 2008
Recommendation/ What Is To note the content of the report and support
Required           From    The the proposed actions.
Committee:




                                                                                 Page 1 of 30
CONTENTS


1.0   INTRODUCTION              3

2.0   KEY ISSUES               3-4

3.0   KEY MEASURES & ACTIONS    4

4.0   SUMMARY                   4

5.0   RECOMMENDATIONS           4

      APPENDICES                5




                                     Page 2 of 30
1.0   Introduction

      The Trust has a deficit on plan of £0.850m for the 3 month period ending 30th June 2008 as summarised in Table 1 below.
      This represents an improvement in the underlying performance compared to the first two months, however the Trust still
      remains in a difficult financial position.

      Table 1


        Table 1. Summary Financial Performance for the year to June 2008

                                          Previous       Performance    Forecast              RAG
                                           period          to date

          Surplus / (Deficit) £’m              -0.8              -0.8         0.5             Red

          Cash Balance £’m                     10.6              8.5          0.9            Amber

          Monitor risk assessment                    3             2               2          Red




2.0   Key Issues

      The key issues in financial performance are:

         •   Overall income has a small surplus with underperformance in non elective activity being offset by an overachievement
             on out-patient income.
         •   The issues within the surgical division are:
             o management of the theatre budget
             o payment for capacity lists to deliver extra activity
             o plan to deliver orthopaedic activity.
         •   The issues within the medical division are:
                                                                                                                         Page 3 of 30
             o Delivery of CIP
             o Locum and agency expenditure within the emergency department
             o Management of general nurse staffing budget
             o Pharmacy budget management
         •   The issue within Women and Children is:
             o delivery of CIP
         •   The forecast cash flow assumes that the fund flow in respect of the previous year’s impairment funding will be actioned
             in September 2008 which will give a sharp drop in cash this month.

3.0   Key Measure & Actions

      The key measures and actions being taken to address these issues are:

         •   Fortnightly meetings with the Chief Executive, Director of Operations and Director of Finance for key budget holders that
             are overspent.
         •   In the surgical division the theatre budget is currently being reviewed, along with a plan to deliver the orthopaedic
             activity.
         •   Good progress has been made within the medical division to tackle the overspending with action plans in place in each
             area to address the overspending.
         •   The Womens and Children division are currently reviewing all areas in order to secure additional CIP’s however to date
             limited short-term opportunities have been identified.
         •   Continue to manage cash on a daily basis in order to ensure that there is a sufficient cash holding to make the
             repayment in respect of the funds flow.

4.0   Summary

      Overall the financial position remains critical however some progress has been made during June in addressing the adverse
      performance for April and May. A separate paper will be presented to the Finance and Performance Committee on the
      forecast outturn position following the first quarter figures. In order to meet our financial duties the Trust must:

         •   Deliver the agreed recovery plans.
         •   Ensure that the surgical division develops a recovery plan.
         •   Develop a robust plan to deliver the commissioned orthopaedic activity.

                                                                                                                           Page 4 of 30
          •   Continue to monitor CIP delivery.

      Further details of the financial performance for the period is attached in appendices 2 – 8.

5.0   Recommendation

         •    The Trust Board are asked to receive this report.




                                                                                                     Page 5 of 30
                                                        Appendices
                                                                                                                      Appendix 1

                                                            Glossary

Amortisation              The systematic allocation of the cost of an intangible asset over a predetermined
                          timeframe
BPPC                      The Better Payment Practice Code performance
Capital expenditure       Expenditure on capital assets
Cash balance              The amount of cash held at bank and in hand
Creditors                 Suppliers to whom the Trust owes money
Creditor days             The average number of days the Trust takes to pay its creditors
Debtors                   Customers who owe money to the Trust
Debtor days               The average number of days it takes the Trust to receive payment from its debtors
Depreciation              The systematic allocation of the cost of a capital asset over a predetermined timeframe
EBITDA                    Earnings before interest, tax, depreciation and amortisation
EBITDA margin             EBITDA as a proportion of income
I & E surplus margin      The surplus / deficit after financing expressed a a percentage of total income
Liquidity                 A measure of a Trust’s ability to meet its immediate financial obligations
Liquidity ratio           The metric used to assess liquidity, expressed as the number of days operating costs
                          (excluding depreciation) that could be covered by the available cash and current assets
Monitor risk assessment   The numerical indicator of the (financial) risk of the Trust used by the Foundation Trust
                          regulator Monitor
Net surplus/deficit       The difference between total income & total expenditure, including non-operational
                          costs and non-recurrent items
Non-recurrent items       Items of income/ expenditure which are abnormal and not expected to reoccur in the
                          future
Normalised surplus /      The net surplus / deficit after adjusting for non-recurrent items
deficit
PDC                       Public Dividend Capital. Long term government financing provided to fund capital
                          assets
PDC Dividend              The dividend payment on the Public Dividend Capital.
Working Capital           The amount of day-to day operating liquidity available to the Trust
                                                                                                                       Page 6 of 30
                                                                                                                                                                              Appendix 2
                                                                East Lancashire Hospitals NHS Trust

                                                                            Finance Report

                                                   Income & Expenditure Statement for the period to 30th June 2008


                                               Month 3           Month 3               Month 3                                    Monthly actual and forecast performance
                                                Plan             Actual                Variance                                             Actual performance
                                                £'m               £'m                    £'m                   0.5                          Forecast performance

Income                                                                                                         0.0

Clinical income                                     61.77              61.91                 0.14




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Other income                                        11.30              11.36                 0.06




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Total operational income                            73.07              73.27                 0.20              -1.0


Expenditure                                                                                                    -1.5

Pay costs                                           49.81              50.06                 0.25              -2.0
Drug costs                                           4.10               4.11                 0.01
Other non-pay costs (excluding depreciation)        16.04              16.89                 0.85
Total operational costs                             69.95              71.06                 1.11
                                                                                                                                 Cumulative actual and forecast performance
                                                                                                                                           Actual performance
EBITDA                                               3.12               2.21                 -0.91             0.5                         Forecast performance

                                                                                                               0.0
Depreciation                                         -2.99             -2.99                 0.00
PDC dividend                                         -1.83             -1.83                 0.00              -0.5




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Interest payable                                      -                 -                    0.00




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Interest receivable                                   0.24              0.30                 0.06




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                                                                                                               -1.5




                                                                                                       £'000
Unwinding of discount                                -0.01             -0.01                 0.00
                                                                                                               -2.0
Net surplus/(deficit)                                -1.47             -2.32                 -0.85
                                                                                                               -2.5
Non recurrent items                                      -              -                     -                -3.0
                                                                                                               -3.5
Normalised surplus/(deficit)                         -1.47             -2.32                 -0.85
                                                                                                               -4.0




                                                                                                                                                                               Page 7 of 30
                                                                                                                Appendix 3a

                                         East Lancashire Hospitals NHS Trust

                                                   Finance Report

                         Clinical Income Recovery by Division for the period to 30th June 2008



                                                                                                 Forecast      2007/08
                                     Budget to date    Actual to date    Variance to date        Full Year     Outturn
                                         £'m                £'m           £'m         %            £'m           £'m

Payment by Results

Medical                                        14.90            15.51        0.61        4%            61.64        58.36
Surgical                                       16.90            16.14       -0.76       -4%            69.57        64.58
Women's and Children's                          7.60             7.82        0.22        3%            32.39        30.97
NEL Threshold                                   9.59             9.59        0.00        0%            38.37        39.15

Total PbR income                               48.99            49.06        0.07       0.00          201.96       193.07

Other clinical income

Diagnostics                                     2.00             2.00        0.00        0%             8.01         8.69
Private Patients                                0.20             0.18       -0.02      -10%             0.80         0.71
Non protected income                            0.48             0.57        0.09       19%             1.93         2.02
Non PbR Income                                 10.10            10.10        0.00        0%            40.40        40.00

Total other clinical income                    12.78            12.85        0.07           1%         51.14        51.43

Total clincial income                          61.77            61.91        0.14        0%           253.10       244.50




                                                                                                                   Page 8 of 30
                                                                                                                Appendix 3b
                                     East Lancashire Hospitals NHS Trust

                                                  Finance Report

                   Clinical Income Recovery by Commissioner for the period to 30th June 2008



                                      Budget to      Actual to                             Forecast        2007/08
                                        date           date        Variance to date        Full Year     performance
                                        £'m             £'m         £'m        %             £'m             £'m

Payment by Results

East Lancashire PCT                        32.26           32.22     -0.04        0%            132.68         128.20
Blackburn with Darwen PCT                  14.87           14.97      0.10        1%             61.57          57.59
Other contracted PCTs                       1.19            1.09     -0.10       -9%              4.60           4.63
Non contract activity                       0.27            0.27      0.00        0%              1.09           1.09
Specialist Commissioning                    0.40            0.51      0.11        0%              2.02           1.57
Other                                       0.00            0.00      0.00        0%              0.00           0.00

Total PbR income                           48.99           49.06      0.07        0%            201.96         193.07

Other clinical income

East Lancashire PCT                         7.39            7.39      0.00       0%              30.25          31.70
Blackburn with Darwen PCT                   4.43            4.43      0.00       0%              17.72          16.83
Other contracted PCTs                       0.11            0.11      0.00       0%               0.43           0.09
Compensation Recovery Unit                  0.46            0.51      0.05      10%               1.80           1.88
Other                                       0.39            0.41      0.02       0%               0.93           0.92

Total other clinical income                12.78           12.85      0.07        1%             51.14          51.43

Total clincial income                      61.77           61.91      0.14        0%            253.10         244.50



                                                                                                                   Page 9 of 30
Appendix 3c




 Page 10 of 30
                                     East Lancashire Hospitals NHS Trust

                                                  Finance Report

                 Clinical Income Recovery by Point of Delivery for the period to 30th June 2008



                                        Budget        Actual                                Forecast       2007/08
                                        to date       to date      Variance to date         Full Year      Outturn
                                          £'m           £'m         £'m        %              £'m            £'m

Payment by Results

Non-elective inpatients                     22.03         21.21      -0.82       -4%               89.64        87.18
Daycases and elective inpatients            12.36         12.55       0.19        2%               52.59        49.00
Excess bed days                              1.42          1.19      -0.23      -16%                5.77         5.43
Outpatient procedures                        0.29          0.29       0.00        1%                1.16         1.21
Outpatient attendances                      10.16         10.89       0.73        7%               41.87        39.38
A&E                                          2.73          2.93       0.20        7%               10.92        10.86

Total PbR income                            48.99         49.06       0.07        0%              201.96       193.07

Other clinical income

Non-elective inpatients                      0.00          0.00       0.00       0%                 0.00         0.00
Daycases and elective inpatients             0.20          0.18      -0.02       0%                 0.80         0.71
Excess bed days                              0.00          0.00       0.00       0%                 0.00         0.00
Outpatient procedures                        0.00          0.00       0.00       0%                 0.00         0.00
Outpatient attendances                       0.00          0.00       0.00       0%                 0.00         0.00
A&E                                          0.48          0.57       0.09      19%                 1.93         2.02
Other                                       12.10         12.10       0.00       0%                48.41        48.70

Total other clinical income                 12.78         12.85       0.07        1%               51.14        51.43

Total clincial income                       61.77         61.91       0.14        0%              253.10       244.50



                                                                                                                     Page 11 of 30
                                                                                                                   Appendix 3d

                                      East Lancashire Hospitals NHS Trust

                                                Finance Report

                   Non-clinical Income Recovery by Category for the period to 30th June 2008



                                           Budget       Actual to                              Forecast      2007/08
                                           to date        date      Variance to date           Full Year     Outturn
                                             £'m           £'m       £'m        %                £'m           £'m

MFF                                              1.87        1.87      0.00        0%                 7.47         7.40
Non-Patient Care services                        1.69        1.69      0.00        0%                 7.14         7.00
Educational Income                               2.19        2.19      0.00        0%                 8.53         9.00
PFI Support                                      0.31        0.31      0.00        0%                 1.25         1.90
Divisional Income *                              5.16        5.23      0.07        1%                14.28        15.57
Transfer from donated asset reserve              0.08        0.07     -0.01        0%                 0.30         0.30
Impairments funding                              0.00        0.00      0.00                           0.00         9.95

Total non-clinical income                      11.30        11.36      0.06        1%                38.97        51.12


* Divisional Income Analysis

Medical                                          1.64        1.62     -0.02      -1%                  4.08         4.97
Surgical                                         1.00        1.07      0.07       7%                  3.38         2.38
Women's and Children's                           1.26        1.31      0.05       4%                  2.71         3.78
Diagnostics                                      0.23        0.27      0.04      17%                  0.54         0.91
Facilities                                       0.80        0.73     -0.07      -9%                  2.83         2.44
Corporate                                        0.23        0.23      0.00       0%                  0.74         1.09

                                                 5.16        5.23      0.07        1%                14.28        15.57



                                                                                                                       Page 12 of 30
                                                                                                             Appendix 4a

                                   East Lancashire Hospitals NHS Trust

                                                Finance Report

                    Budgetary Performance by Division for the period to 30th June 2008



                                      Budget        Actual                               Forecast      2007/08
                                      to date       to date      Variance to date        Full Year     Outturn
                                        £'m           £'m         £'m         %            £'m           £'m

Medical                                   22.66         22.96       0.30        1%             85.09        87.79
Surgical                                  15.29         16.09       0.80        5%             58.92        61.26
Women's and Children's                     9.42          9.68       0.26        3%             35.51        36.89
Diagnostics                                6.21          6.23       0.02        0%             24.20        24.91
Facilities                                10.93         10.92      -0.01        0%             42.76        41.58
Corporate                                  5.13          5.18       0.05        1%             20.41        23.81
Reserves                                   0.31          0.00      -0.31        0%              6.54         0.00

Total operational expenditure             69.95         71.06       1.11        2%            273.43       276.24




                                                                                                                 Page 13 of 30
Appendix 4b




 Page 14 of 30
                                    East Lancashire Hospitals NHS Trust

                                                Finance Report

          Budgetary Performance by Division (by Expenditure Type) for the period to 30th June 2008



                                    Budget       Actual                              Forecast        2007/08
                                    to date      to date    Variance to date         Full Year       Outturn
                                      £'m          £'m       £'m         %             £'m             £'m

Pay

Medical                                 18.26       18.30         0.04     0%              72.37          70.89
Surgical                                12.05       12.38         0.33     3%              47.06          46.66
Women's and Children's                   8.71        8.71         0.00     0%              32.98          33.35
Diagnostics                              4.37        4.21        -0.16    -4%              17.55          17.07
Facilities                               3.39        3.50         0.11     3%              13.33          13.83
Corporate                                3.03        2.96        -0.07    -2%              12.10          12.16
Reserves                                 0.00        0.00         0.00                      0.00           0.00

Total pay costs                         49.81       50.06        0.25      1%             195.39         193.96

Drugs costs

Medical                                  3.25        3.23        -0.02    -1%               9.52          11.88
Surgical                                 0.58        0.59         0.01     2%               2.21           1.84
Women's and Children's                   0.22        0.24         0.02     9%               0.88           1.03
Diagnostics                              0.04        0.04         0.00     0%               0.16           0.19
Facilities                               0.01        0.01         0.00     0%               0.04           0.00
Corporate                                0.00        0.00         0.00     0%               0.01           0.00
Reserves                                 0.00        0.00         0.00                      0.00           0.00

Total drugs costs                        4.10        4.11        0.01      0%              12.82          14.93

Other non-pay costs

Medical                                  1.15        1.44         0.29     25%              3.21           5.13
Surgical                                 2.68        3.12         0.44     16%              9.65          12.75
Women's and Children's                   0.49        0.73         0.24     49%              1.65           2.52
Diagnostics                              1.79        1.98         0.19     11%              6.49           7.65
Facilities                               7.53        7.41        -0.12     -2%             29.40          27.75
Corporate                                2.09        2.21         0.12      6%              8.28          11.71
Reserves                                 0.31        0.00        -0.31   -100%              6.54           0.00

Total other non-pay costs              16.04        16.89        0.85      5%              65.22          67.51

Total operational costs                69.95        71.06        1.11      2%             273.43         276.40

                                                                                                               Page 15 of 30
Appendix 4c




 Page 16 of 30
                                      East Lancashire Hospitals NHS Trust

                                                   Finance Report

                       Subjective Analysis of Expenditure for the period to 30th June 2008



                                         Budget        Actual                                Forecast      2007/08
                                         to date       to date      Variance to date         Full Year     Outturn
                                           £'m           £'m         £'m         %             £'m           £'m

Pay

Consultants                                   8.35         8.21       -0.14       -2%              32.08        30.81
Junior medical                                7.43         6.37       -1.06      -14%              29.05        25.81
Dental                                        0.00         0.02        0.02        0%               0.00         0.00
Nursing & midwifery                          19.13        18.99       -0.14       -1%              75.27        74.04
Scientific, therapeutic & technical           6.47         5.84       -0.63      -10%              26.00        22.72
Non clinical                                  9.55         9.01       -0.54       -6%              38.04        35.23
Pay Other                                     0.05         0.00       -0.05     -100%               0.04         0.02
Agency                                        0.27         1.62        1.35      500%               0.68         5.33
Vacancy factor                               -1.44         0.00        1.44     -100%              -5.77         0.00

Total pay costs                              49.81        50.06        0.25        1%             195.39       193.96

Drugs costs                                   4.10         4.11        0.01        0%              12.82        14.93

Other non-pay costs

Clinical supplies & services                  4.51         4.96        0.45       10%              17.27        20.09
General supplies & services                   0.78         0.81        0.03        4%               2.79         3.02
Establishment expenditure                     1.09         1.26        0.17       16%               4.15         4.76
Premises & fixed plant (incl PFI)             6.23         6.44        0.21        3%              25.23        23.99
Other                                         3.12         3.42        0.30       10%               9.24        15.65
Reserves                                      0.31         0.00       -0.31     -100%               6.54         0.00

Total other non-pay costs                    16.04        16.89        0.85        5%              65.22        67.51

Total operational costs                      69.95        71.06        1.11        2%             273.43       276.40
                                                                                                                        Page 17 of 30
                                                                                                                                                           Appendix 4d
                                                                East Lancashire Hospitals NHS Trust

                                                                              Finance Report

                                                                     Cost Improvement Delivery


                                                                     Plan         Actual                                     Forecast       2007/08
                                                                    to date       to date      Variance to date              Full Year      Outturn
                                                                      £'m           £'m         £'m         %                  £'m            £'m

                             Medical                                    1.01          0.86            0.15   15%                    3.80           4.32
                             Surgical                                   0.59          0.51            0.07   13%                    4.00           1.62
                             Womens and Childrens                       0.53          0.46            0.07   14%                    1.70           0.69
                             Diagnostics                                0.14          0.15           -0.01   -6%                    1.00           1.15
                             Facilities                                 0.32          0.22            0.10   31%                    1.30           0.00
                             Corporate                                  0.36          0.36            0.00    0%                    1.40           1.42
                             Other - recurrent                          0.00          0.00            0.00    0%                    0.00           2.97
                             Other - non recurrent                      0.00          0.20           -0.20    0%                    0.80           3.02

                             Total cost improvement                     2.94          2.76           0.18     6%                   14.00          15.19


                         Monthly actual and forecast CIP delivery                                            Cumulative actual and forecast CIP delivery

      4.0
                                                                                                     16.0
      3.5
                                                                                                     14.0
      3.0
                                                                                                     12.0
                                                                                                     10.0
      2.5



                                                                                               £'m
                                                                                                      8.0
£'m




      2.0
                                                                                                      6.0
      1.5
                                                                                                      4.0
      1.0
                                                                                                      2.0
      0.5
                                                                                                      0.0
      0.0

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                                                                                                                                                            Page 18 of 30
Appendix 5a




 Page 19 of 30
                                East Lancashire Hospitals NHS Trust

                                          Finance Report

                     Cash Flow Statement for the period to 30th June 2008


                                                                   Actual       Forecast
                                                                  30.06.08      31.03.09
                                                                    £'m           £'m

EBITDA                                                                   2.21        19.30

Non cash I&E items                                                      -0.31        -0.30

Movement in working capital:
Stocks                                                                  -0.04         0.00
Debtors and Prepayments                                                 -1.56         4.70
Creditors and Accruals                                                  -0.77        -1.30
Provision and Liabilities                                                0.03        -0.20

Movement in working capital                                             -2.34         3.20

Cash flow from operations                                               -0.44        22.20

Capital expenditure                                                     -2.92       -17.80
PFI residual interest                                                    0.00         0.00
Cash receipt from asset sales                                            0.00         0.00

Cash flow before financing                                              -3.36         4.40

Interest received on cash balance                                        0.32         0.60
Public dividend capital received                                         0.00         0.00
Public dividend capital repaid                                           0.00        -9.60
Dividends paid                                                           0.00        -7.30

Net cash inflow/(outflow) in month                                      -3.04       -11.90

                                                                                             Page 20 of 30
Appendix 5b




 Page 21 of 30
                                                                  East Lancashire Hospitals NHS Trust

                                                                            Finance Report

                                                Cash Actuals for the month and 12 month Rolling Forecast for 2008/09


                                     June 08        July 09     Aug 08      Sept 08     Oct 08         Nov 08         Dec 08        Jan 09      Feb 09     March 09    April 09     May 09     June 09
                                      Actual       Forecast    Forecast    Forecast    Forecast       Forecast       Forecast      Forecast    Forecast    Forecast    Forecast    Forecast    Forecast
                                       £'m           £'m         £'m         £'m         £'m            £'m            £'m           £'m         £'m         £'m         £'m         £'m         £'m

Balance b/f                             10.63           8.48       12.01       12.91          2.98            2.68          4.06        4.24        4.21        4.78        2.05        2.04        2.00

Cash inflows

PCTs contract income                    20.28          23.25       21.19       21.19         21.25           21.24         21.26       21.25       21.25       21.46       24.59       22.83      23.21
SHA & DoH income                         1.37           1.47        1.34        1.33          1.33            2.59          1.33        1.33        1.34        1.30        0.73        0.73       0.73
Interest received                        0.10           0.09        0.10        0.10          0.09            0.07          0.05        0.07        0.07        0.07        0.00        0.00       0.00
PDC drawdown                             0.00           0.00        0.00        0.00          0.00            0.00          0.00        0.00        0.00        0.00        0.00        0.00       0.00
Other                                    2.92           3.89        2.00        5.96          2.00            2.04          2.02        2.01        2.16        2.14        2.47        2.47       2.47

Total cash inflow                       24.67          28.70       24.64       28.58         24.66           25.94         24.66       24.65       24.82       24.98       27.79       26.03      26.40

Cash outflows

Pay                                     15.69          15.37       15.32       15.37         15.35           15.33         15.20       15.39       15.35       15.28       16.77       16.77      16.74
Non-pay                                 10.91           8.64        7.69        8.40          7.40            7.38          7.48        7.45        6.74        6.89        9.02        8.24       9.52
Capital expenditure                      0.22           1.15        0.73        1.12          2.22            1.85          1.80        1.84        2.16        1.87        2.00        1.06       0.61
Other                                    0.00           0.00        0.00       13.61          0.00            0.00          0.00        0.00        0.00        3.66        0.00        0.00       0.00

Total cash outflow                      26.83          25.16       23.74       38.51         24.96           24.56         24.48       24.69       24.25       27.71       27.80       26.07      26.87

Balance c/f                              8.48          12.01       12.91        2.98          2.68            4.06          4.24        4.21        4.78        2.05        2.04        2.00        1.53

Planned balance c/f                     10.32          10.59       11.59        1.90          1.74            2.88          3.04        3.29        3.74        0.90        2.04        2.00        1.53


                                                                Monthly actual and forecast cash position to June 2009

                          14.0
                          12.0
                          10.0
                           8.0
                    £'m




                           6.0
                           4.0
                           2.0
                           0.0
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                                                                Actual performance       Forecast performance

                                                                                                                                                                                                 Page 22 of 30
                                                                                                                                                           Appendix 5c
                                                      East Lancashire Hospitals NHS Trust

                                                                      Finance Report

                                                        Cash Forecast - Rolling 12 months




      14.0

      12.0

      10.0

       8.0
£'m




       6.0

       4.0

       2.0

       0.0
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  The Trust Debt Remuneration payment is paid in two instalments and is due in September 2008 and March 2009.




                                                                                                                                                            Page 23 of 30
                                                                                                                                   Appendix 5d
                                    East Lancashire Hospitals NHS Trust

                                               Finance Report

                                Better Payment Practice Code Performance



                                              Cumulative Postion                             Forecast
                                               By value   By number                    By value   By number

                     NHS payments                     96.4%          87.0%                  95.0%          95.0%
                     Non-NHS payments                 93.8%          94.3%                  95.0%          95.0%

                     Combined                         94.4%          94.0%                  95.0%          95.0%




98%
                                                                                            Target Performance - 95%
96%

94%                                                                                                                          By value
92%                                                                                                                          By number
                                                                                                                             Target
90%
                                                                         `
88%

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                                                                                                                                     Page 24 of 30
                                                                                                                                                                    Appendix 5e

                                                            East Lancashire Hospitals NHS Trust

                                                                        Finance Report

                                                                      Capital Expenditure



                                                                 Budget      Actual                                            Forecast
                                                                 to date     to date     Variance to date                      Full Year
                                                                   £'m         £'m        £'m         %                          £'m


                             Infrastructure                           0.40        0.25            -0.15        -37%                   2.00
                             Strategic Development                    0.60        0.14            -0.46        -77%                   3.40
                             Business Cases                           0.00        0.00             0.00          0%                   9.10
                             Medical Equipment                        0.25        0.25            -0.01         -2%                   0.80
                             I M& T                                   0.27        0.12            -0.15        -57%                   1.00
                             Capitalisation of PFI Tariff             0.38        0.38             0.00          1%                   1.50

                             Total                                    1.90        1.13            -0.76        -40%                  17.80


                    Monthly actual and forecast capital expenditure                                            Cumulative actual and forecast capital expenditure

      2.5                                                                                         20.0
                                                                                                  18.0
      2.0                                                                                         16.0
                                                                                                  14.0
      1.5                                                                                         12.0
£'m




                                                                                            £'m
                                                                                                  10.0
      1.0                                                                                          8.0
                                                                                                   6.0
      0.5                                                                                          4.0
                                                                                                   2.0
      0.0                                                                                          0.0
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                    Forecast                                                                                        Forecast




                                                                                                                                                                     Page 25 of 30
Appendix 6




Page 26 of 30
                           East Lancashire Hospitals NHS Trust

                                         Finance Report

                            Balance Sheet as 30th June 2008


                                                                  Actual       Forecast
                                                                 30.06.08      31.03.09
                                                                                 £'m

Tangible & intangible assets                                          216.51       215.43
PFI residual interest                                                   3.13         4.27

Total fixed assets                                                    219.64       219.70

Stocks                                                                  3.74         3.60
Trade debtors                                                           5.91         5.10
Prepayments and Other Debtors                                           4.24         3.80
Cash at bank and in hand                                                8.53         0.90

Total current assets                                                   22.42        13.40

Trade creditors                                                        -4.23        -5.50
Other non-trade creditors                                             -12.10       -15.40
Accruals and deferred income                                           -3.18        -3.20

Creditors: amounts falling due within one year                        -19.51       -24.10

Net current assets (liabilities)                                        2.91       -10.70

Long term debtors                                                       8.90         7.50

Net assets (liabilities)                                              231.45       216.50

Provisions for liabilities and charges                                 -2.53        -2.00

Total assets employed                                                 228.92       214.50

Public Dividend capital                                               159.74       149.80
Income & expenditure reserve                                           -1.21         3.00
Revaluation reserve                                                    68.10        59.60
Donated asset reserve                                                   2.29         2.10

Total Taxpayers' equity                                               228.92       214.50
                                                                                          Page 27 of 30
                                                                                                          Appendix 7a

                                East Lancashire Hospitals NHS Trust

                                             Finance Report

                                        Key Ratio Performance



                                                                          Target                       Actual
     Financial criteria                        Metric                  performance   Actual 30.06.08   rating


Achievement of plan       EBITDA achieved (% of plan)                 >70%                    70.8%      2

Underlying performance    EBITDA margin (%)                           >5%                      3.0%      2

Financial efficiency      Return on assets excluding dividend (%)     >3%                     -0.9%      1
                          I&E surplus margin net of dividend (%)      >1%                     -3.2%      1

Liquidity                 Liquidity ratio (days)                      >15 days                  -20      3


                          Overall financial risk rating                                                  2




                                                                                                             Page 28 of 30
                                                                                               Appendix 7b

                           East Lancashire Hospitals NHS Trust

                                     Finance Report

                                 Key Ratio Performance



                                                      Target                        Forecast
                                                   performance    Actual 30.06.08   31.03.09


Maximum debt/asset ratio                                  <15%           -             -

Minimum dividend cover                                       >1               1.4          1.8

Minimum interest cover                                       >3          -             -

Minimum debt service                                         >2          -             -

Maximum debt service to revenue                            <3%           -             -



The Trust does not currently hold any long term debt




                                                                                                Page 29 of 30
                                                               Appendix 8

Pay Costs Information for the 3 month Period to 30 June 2008




                                                               Page 30 of 30
                       REPORT TO TRUST BOARD PART ONE
Meeting Date:                      Report Purpose:               Agenda Item: 15
29th July 2008               For Decision               □
                             Performance Monitoring


                             For Information           □
Report Submitted By:         Report     Approved         By: Report Title:
Lynn Wissett Director of Lynn Wissett Director of Assurance Framework
Clinical        Care      & Clinical         Care            &
Governance                   Governance
Date Considered By           Divisional Board Chair Declaration of
Divisional Board/
                             Approval:                           Confidentiality Required:
Reason Not Considered
By Divisional Board:         N/A                                 Yes           No
N/A


Implications For Partners:         Failure   to     fulfil   contractual   obligations   to
                                   commissioners.
Related to key risks identified All Risks on the Framework.
on Assurance Framework &
Consequences:
Key Risks & Consequences:          Risk that organisation does not manage risks
                                   which result in not achieving strategic objectives
                                   leading to failure to reach FT status and be a
                                   sustainable organisation for the future.
Related         to     Corporate 1.      Develop a positive approach to service
                                         growth.
Objective:
                                   2.    Learn to manage in a choice environment.
                                   3.    Develop a strong leadership culture.

Related to HCC Standard:           All 24 core standards
Related    to    Standards   for All 7 domains
Better Health Domain:
Executive Summary:                 The Assurance Framework is the main tool by
                                   which the Trust Board members monitor the risks
                                   to the organisation of not achieving the strategic
                                   objectives.

Lynn Wissett                                                                 Version No: 1
Director of Clinical Care & Governance                                         Page 1 of 7
Created on 17/07/2008 12:11 PM
                                  The framework maps the organisations objectives
                                  to principal and subordinate risks, controls and
                                  assurances.
                                  This paper highlights the top scoring risks which
                                  can be themed and the supporting assurances and
                                  controls to mitigate the risks.
Recommendation/       What    Is It is recommended that the Trust Board supports
Required       From          The the actions in place to ensure delivery of the
Committee:                        strategic objectives.




Lynn Wissett                                                         Version No: 1
Director of Clinical Care & Governance                                 Page 2 of 7
Created on 17/07/2008 12:11 PM
1.   Background ....................................................................................................... 4
2.   Changes to the Framework Since Last Report............................................... 4
3.   Top Risks by Theme ......................................................................................... 6
4.   Conclusion/Recommendations........................................................................ 7

     Appendices

     ELHT Assurance Framework 2008-09




Lynn Wissett                                                                                        Version No: 1
Director of Clinical Care & Governance                                                                Page 3 of 7
Created on 17/07/2008 12:11 PM
1.      Background


1.1     The Assurance framework was formulated in March 2008 following approval by
        the Trust Board of the strategic objectives. Trust Board members and senior
        mangers within the organisation were instrumental in identifying the key risks to
        the organisation delivering its objectives.


1.2     The key risks have been mapped across the framework and risk rated in
        accordance with the Trust scoring matrix. Examples of positive assurances and
        controls and highlighted with the framework, as are areas where further controls
        and assurances are required.


2.      Changes to the Framework Since Last Report


2.1     Risks have been assessed on a monthly basis along with the action plans. The
        table below illustrates changes to the framework since the last report to the
        Trust Board in June.


Risk           Page    Description                                   Previous     New
Number                                                               Score        Score
1.1.2          1       Failure to ensure that the Trust meets 15                  20
                       mandatory financial targets and delivers
                       value for money services.
1.1.2.1        1       Failure to deliver a financially balanced 15               20
                       organisation / failure to deliver financial
                       efficiencies - including management of
                       increased costs.
1.1.2.3        1       Failure to control individual budgets 15                   25
                       adversely affecting Trust performance –
                       obtain agreement and commitment of
                       budget holders.




Lynn Wissett                                                                 Version No: 1
Director of Clinical Care & Governance                                         Page 4 of 7
Created on 17/07/2008 12:11 PM
Risk       Page    Description                                          Previous     New
Number                                                                  Score        Score
1.1.2.4    2       Failure to meet CIP thus affecting Trust 15                       25
                   performance.
1.1.4.2    4       Failure to ensure care is provided in 10                          15
                   environments that promote patient and
                   staff wellbeing and respect for patients
                   needs and preferences in that they are
                   designed for the effective and safe
                   delivery of treatment, care or a specific
                   function. They provide as much privacy
                   as possible and are maintained and
                   cleaned to optimise health outcomes for
                   patients.
1.1.5      4       Failure to achieve FT Status in Financial 15                      20
                   year 2008/09.
1.1.5.3    4       Failure     to   achieve       the     necessary 15               20
                   organisational        requirements       for    FT
                   status.
2.2.A      6       Failure     to   deliver    planned        targets 15             20
                   consistently each quarter resulting in half
                   year ' and final quarter catch up'.
2.2.2.2    9       Failure to ensure that patient services 20                        15
                   are       available     when         required    –
                   contingency & business continuity plans.
3.3.1a     9       Risk description revised - July 2008             - 5              10
                   CEO appoint substantively commenced
                   01 July 2008 - Potential failure to sustain
                   organisational performance requirements
                   during revisions to Organisational




Lynn Wissett                                                                    Version No: 1
Director of Clinical Care & Governance                                            Page 5 of 7
Created on 17/07/2008 12:11 PM
Risk          Page       Description                                 Previous     New
Number                                                               Score        Score
                         Management structure.                       5            10
3.3.2.20      12         Failure to manage medical workforce 10                   20
                         changes - MMC, EWTD and impact on
                         service delivery e.g. Hospital at Night
                         Initiative.


       Risk treatment plans containing the actions required to reduce the risk score
       are in place for all the above. The top 5 risks to the Trust are identified in the
       shaded boxes above.


3.     Top Risks by Theme


3.1    The high scoring risks can be placed into themes, these are risks scoring 15 or
       above. The top 10 themes are listed below.


      • Delivery of the next stage of MPN
      • Financial Management
      • Consistently meeting requirements to achieve FT status
      • Provision   of    services     in   community   to   accommodate   ELHT    service
       reconfiguration
      • Care environment
      • Performance against national and local targets
      • Diversity and Equality strategy
      • Working differently/new ways to working
      • Management of Medical Workforce Initiatives and the impact of these on
       service
      • Internal morale/management of change


3.2    These themes link directly to further Trust Board agenda items which are
       presented in the performance report to provide further assurance of the
       management of these risks.




Lynn Wissett                                                                 Version No: 1
Director of Clinical Care & Governance                                         Page 6 of 7
Created on 17/07/2008 12:11 PM
3.3   The Healthcare Commission Core Standards have been aligned to the
      assurances contained within the Framework and currently there are no
      significant lapses against any of the Core Standards.


4.     Conclusion/Recommendations


4.1    The Assurance Framework is in place in the Board are informed of the current
       risk scoring. The Framework has highlighted the controls and assurances in
       place and where further actions are required to reduce the risk. Once the
       actions are completed the impact on non-delivery of the strategic objectives
       will be reduced. Ten scores have increased and one reduced since the last
       report in the light of Quarter 1 performance.


4.2    Risk Treatment Plans are in place against the risks identified and will be
       continuously monitored to ensure actions take place to reduce risk.


4.3    Changes in risk ratings or additional risks added to the Framework will be
       reported to the Trust Board throughout the year.


4.4    It is recommended that the Trust Board supports the actions in place to
       ensure delivery of the strategic objectives.


Author and Title:                      Lynn Wissett
                                       Director of Clinical Care & Governance
Author Contact Details:
Press Paper Supplied:                  No
Date of Submission:                    26.5.08
Date Accepted for Committee:           26.5.08




Lynn Wissett                                                           Version No: 1
Director of Clinical Care & Governance                                   Page 7 of 7
Created on 17/07/2008 12:11 PM
                    REPORT TO TRUST BOARD PART ONE
Meeting Date:                      Report Purpose:         Agenda Item: 16
  th
29 July 2008                  For Decision           □
                              Performance Monitoring


                              For Information        □
Report Submitted By:          Report Approved By:          Report Title:
Frances Murphy                Alan Green                   Annual Report of Finance
Company Secretary             Chairman                     and             Performance
                                                           Committee
Date Considered By            Divisional Board Chair Declaration of
Divisional Board/             Approval:                    Confidentiality Required:
Reason Not Considered                                      Yes              No
By Divisional Board:
NA                            NA



Implications For Partners:         NA
Related to key risks identified NA
on Assurance Framework &
Consequences:
Related        to   Corporate All
Objective:
Related to HCC Standard:           Governance
Related   to    Standards     for C7 Health care organisations
Better Health Domain:              a) apply the principles of sound clinical and
                                   corporate governance;
Executive Summary:                 The report attached is annual report of the Finance
                                   and Performance Committee to the Trust Board. It
                                   provides an overview of the work undertaken by
                                   the Committee in 07/08, a schedule of the reports
                                   received by the Committee and the attendance of
                                   members and an action plan to improve the
                                   effectiveness of the Committee in 08/09.
Recommendation/        What    Is The Board is requested to receive the report and



                                                                            Page 1 of 18
Required     From   The note the contents and approve the action plan
Committee:               proposed.




                                                           Page 2 of 18
Finance and Performance Committee


Annual Report 07/08




Mr Alan Green
Chairman East Lancashire Hospitals NHS Trust
Finance and Performance Committee Chair
17th June 2008




                                               Page 3 of 18
Table of Contents

Introduction ....................................................................................................5
Constitution....................................................................................................5
Delegated Duties............................................................................................5
Reporting Arrangements...............................................................................6
Workplan Set by the Board ...........................................................................6
Meetings and Attendance .............................................................................7
Effectiveness..................................................................................................7
Leadership......................................................................................................8
Conclusion .....................................................................................................8
Appendix One:             Reports to the Committee ..............................................10
Appendix Two:             Members Attendance Schedule.....................................12
Appendix Three:              Committee Action Plan to Improve Effectiveness.....14
Appendix Four:              Committee Terms of Reference ...................................16




                                                                                                  Page 4 of 18
Introduction
As required by the Trust Board the Finance and Performance Committee reports on
an annual basis on the manner in which it has fulfilled its delegated duties and its
general effectiveness. The last report was presented to the Trust Board in September
2007 and covered the activities of the Committee for the period 06/07. This report
presents a summary of the year 07/08.



Constitution
The Terms of Reference were last approved by the Trust Board in December 2007.
The members are the Executive and Non Executive Directors of the Trust. The
Director of Operations and the Company Secretary are normally in attendance
together with representatives from departments whose financial position or
performance is under review by the Committee. The Committee has also invited
Divisional Directors to attend meetings on a rotational basis to assist with their
development and enable them to gain a better understanding of the work of the
Committee and the way in which it provides assurance to the Trust Board when
analysing the performance and finances of the organisation.
The Committee has overarching responsibility for financial and performance issues
within the organisation and throughout the year the agenda has been structured
around the key risks to the organisation, exceptions to agreed performance
measures and providing assurance with regard to matters arising at Trust Board
meetings.



Delegated Duties
   •   To support the Trust Board in the analysis and review of Trust financial and
       performance plans, providing advice and assurance to the Board on financial
       and performance issues.
   •   The Committee is authorised by the Board to investigate any activity within its
       terms of reference and to manage the principal risks detailed in the
       Assurance Framework.
   •   The Committee is authorised by the Board to obtain outside independent
       professional advice and to secure the attendance of non members with
       relevant experience and expertise if it considers this necessary.
In accordance with the Terms of Reference the Committee has received assurance
on and examined the processes and policies for ensuring the management of the



                                                                           Page 5 of 18
principal risks related to finance and performance detailed on the Assurance
Framework. In addition the Committee has approved the engagement of and
monitored the performance of external independent professional advisors for specific
time limited tasks and considered developments in national and local policies and
how they may impact on the finances, financial reporting and performance of the
Trust. A table of the Reports received by the Committee enabling it to fulfil these
functions is attached at Appendix 1.



Reporting Arrangements
The Committee reports to the Trust Board. Each Trust Board meeting receives a
summary of the decisions and actions arising out of each Committee meeting and all
Trust Board members receive a copy of the minutes and actions arising from the
meetings. The Chair of the Committee will bring to the attention of the Trust Board
any issues of concern arising out of the meetings when the summary report is
presented in public session.
The Committee receives the minutes and actions arising out of the Strategic
Management Board, the minutes from the contract monitoring meetings with Private
Finance Initiative partners and the Major Projects Board. The Divisional Boards also
report to the Committee through the minutes of the Divisional Board meetings and
the Committee receives a summary of the discussions and decisions of the Quarterly
Performance Meetings of each of the Divisional Boards.


Workplan Set by the Board
The Terms of Reference clearly outline the duties of the Committee and the manner
in which it will carry out its responsibilities. In addition the Committee has regard to
the Standing Orders and Standing Financial Instructions of the Trust.
The Committee has an annual cycle of business which is included in the Trust’s
Committee Handbook and is approved by the Trust Board on an annual basis and
updated on a quarterly basis. The Director of Finance and the Company Secretary
assist the Chair of the Committee in ensuring that agendas are appropriately
structured to cover the Committee’s workplan, are received in a timely manner and
are of an appropriate standard to enable the Committee members to undertake their
responsibilities.
As can be seen from the schedule of reports received at Appendix 1 the Committee
has completed the work required within the year and has had sufficient meetings to
enable the plan to be completed.


                                                                           Page 6 of 18
Meetings and Attendance
The Committee schedules its meetings to take place on a monthly basis. Additional
meetings can be arranged at short notice and are limited to consideration of specific
issues. A schedule of dates and attendance at the meetings is provided in Appendix
2.


Effectiveness
During the course of the year the Committee has requested and received reports on
the financial and operational performance of the organisation and assisted in and
approved the development of forward plans, particularly in the area of procurement
savings plans. The Committee has monitored progress against the approved
procurement plan on a quarterly basis.
The Committee received a monthly report summarising the financial and operational
position of the Trust and exceptions to the agreed plans together with actions to
recover the position. These have been monitored on a monthly basis to ensure the
agreed actions have been effective.
Divisional Directors and Heads of Department have been called before the
Committee on a regular basis to account for fulfilment of the action plans and provide
assurance on the future financial and operational performance of the areas for which
they have direct responsibility.
The Committee has closely monitored progress against achievement of the
organisation’s savings programmes which resulted in a saving of £13.9 millions in the
financial year, although £2 million of the programme was not achieved. Members
have through the work of the Committee been able to monitor achievement of the
plan and be aware at the earliest possible opportunity of the shortfall position.
The Committee has closely monitored the performance of the Divisional Boards and
ensured that appropriate arrangement for attendance and compliance with their
Terms of Reference is achieved. The Committee has particularly noted the
development of the Boards as key operational management forums directing and
evaluating the work of the Divisions.
The Committee has had responsibility for monitoring on behalf of the Trust Board the
progress of the Trust’s application for Foundation Trust status and has received a
report at each meeting enabling members to be kept up to date with the development
of the Integrated Business Plan and the long term financial model and the progress




                                                                             Page 7 of 18
of the formal application through the development of the membership to the Historic
Due Diligence process.
During the course of the year, as outlined in the previous annual report, the
Committee has received operational and financial reports within the developing
performance framework for the Trust which has enabled clearer presentation of the
progress of the organisation against national and local targets and the benchmarking
of the Trust against other similar organisations. In addition there has been a greater
link in the analysis of performance at a specialty level linked with financial information
in reports provided to the Committee and the Trust Board.
The Committee has monitored the performance of corporate departments in an
increasingly structured way, with the analysis of the performance of the Human
Resources Department in supporting the management of sickness absence and the
development of policies being particularly evident in the work of the Committee
throughout the year.
A further aim of the Committee outlined in the previous annual report was to
encourage the development of a business orientation within the Trust as a whole.
The Committee has provided a strong lead in this regard with the commissioning of
particular projects to be undertaken in partnership with external bodies to enable the
transfer of business skills to staff.


Leadership
The Chair of the Committee has responsibility for ensuring that the work of the
Committee is effective, that the Committee is appropriately resourced and is
maintaining effective communication. The Committee has been led throughout the
year by Alan Green, Chairman of the Trust. Mr Green has attended the following
courses to update his skills:
    Institute of Directors Training on

    •   Leading Strategic Change

    •   Finance for non Financial Directors

    •   Role of the Company Director and the Board.


Conclusion
The Trust has undergone a significant period of change during the last twelve months
with the implementation of the first stage of the Meeting Patient Needs Programme
and the continuation of the journey towards the achievement of Foundation Trust




                                                                             Page 8 of 18
status. The work of the Committee in enabling a detailed analysis of the performance
and finances of the Trust to be undertaken on a monthly basis has ensured that any
deviations from agreed plans have been reported quickly and effective action plans
have been developed and monitored to ensure recovery has occurred as soon as
possible. The practice of openly holding officers of the Trust to account for the
performance of their areas of responsibility has assisted in the development of a
business orientated culture that enables staff to focus on patient satisfaction and
quality of patient care as key indicators of business success.
Looking to the year ahead the Trust continues to face the challenge to achieve
Foundation Trust status, ensure it meets its statutory duty to break even and to
consistently achieve the highest possible standards of care for the communities we
serve. I would like to take this opportunity to thank all staff for their dedication and
commitment to our patients and our Trust and the magnificent contribution they have
made to the achievement of a Declaration of Full Compliance with the Healthcare
Commission Standards and the attainment of a small surplus for the last financial
year without financial support from other bodies.
I would also like to thank those who have served on the Committee and those
members of staff who have attended the meetings for their insights, challenges and
commitment throughout the year. I look forward to continuing the development of this
Committee in partnership with you over the next twelve months.


                                                                        Mr Alan Green
                                                                             Chairman
                                                                              17/06/08




                                                                            Page 9 of 18
Appendix One: Reports to the Committee
The following reports are received on a monthly basis by the Committee:
    •   Minutes of the previous meeting for ratification
    •   Matters Arising and Action Matrix to monitor completion of Committee work
    •   Apologies from those members unable to attend
    The following additional reports have been received by the Committee:
                           Report                              Date Received
Performance Reports                                        Monthly
Control of Infection                                       01/05/07
Sickness Absence Report                                    01/05/07
Finance Reports                                            Monthly
Divisional Budget Monitoring Reports                       01/05/07, 28/11/07
MPN Implementation Update                                  Monthly
Divisional Budget Sign Off                                 17/05/07
Child Health Update on Sickness Absence                    30/05/07
Procurement Plan Update                                    30/05/07, 29/08/07,
                                                           31/10/07, 2502/08
Divisional Performance Meeting Reports                     30/05/07, 01/08/07,
                                                           31/10/07, 29/01/08
Analysis of Agency Spend                                   01/08/07
Suspension Rates Action Plan                               01/08/07, 28/11/07
Foundation Trust Project Report                            Monthly since August 07
4 Hour Sustainability Action Plan                          01/08/07
Annual Report of Committee and Review of Terms of 01/08/07
Reference and Effectiveness
Divisional Board Minutes                                   Monthly since August 07
SMB Minutes                                                Monthly since August 07
CHKS Presentation                                          29/08/07
Analysis of A&E Attendances by GP                          31/10/07
Divisional Board Terms of Reference                        31/10/07
Organisational Development Strategy                        28/11/07
Sickness Absence and Workforce Briefing                    28/11/07
Financial Sustainability                                   28/11/07
Demand Management                                          29/01/08, 25/02/08
Analysis of Redeployment of Staff                          29/01/08, 25/02/08




                                                                          Page 10 of 18
Assurance Arrangements in relation to Productivity 29/01/08
Project
Major Project Board Minutes                        29/01/08
Audit of Medical Records                           29/01/08
Occupational Health Update                         25/02/08
Partnering Arrangements for Development of Women 25/02/08
and Newborn Services
Review of Financial Plans and 08/09 budgets        25/02/08




                                                              Page 11 of 18
Appendix Two: Members Attendance Schedule
                                 01/05/07   17/05/07   30/05/07   01/08/07   29/08/07   31/10/07   28/11/07   29/01/08   25/02/08


Mr A Green (Chairman)                                                                                            A


Mr G Boyer (Non Executive                      A          A
Director)
Mr P Fletcher (Non Executive                   A          A          A
Director)
Mr E Foolat (Non Executive                     A                     A                                A                     A
Director)
Mr C Mellor (Non Executive           *          *          *          *
Director)
Mr M Hill (Non Executive                                                                                                    A
Director)
Mrs J Cubbon (Chief Executive)                                       A


Mr G Graham (Deputy Chief                      A          A
Executive)
Mr S Brookfield (Director of
Finance)
Mrs L Wissett (Director of
Clinical Care & Governance)




                                                                                                                                Page 12 of 18
Mrs R Schram (Medical Director                        A
Governance and Education) / Dr
G Jones (Medical Director
Clinical Services)
  Denotes attendance in person or authorised deputy
 A Denotes apologies
- Denotes not a member




                                                          Page 13 of 18
Appendix Three:                   Committee Action Plan to Improve Effectiveness


                            What                                                Why                                       When          Who
To more closely link the schedule of Non Executive Director   •   To enable Non Executive Directors to          Immediately      FM
visits to those areas identified through the integrated           gain a first hand understanding of the
performance report at extremes of performance                     issues affecting performance in any
                                                                  area and offer support and
                                                                  congratulations to staff as appropriate
                                                              •   To ensure Non Executive Director have
                                                                  sufficient knowledge of the organisation
                                                                  to identify key risk areas and to
                                                                  challenge on critical and sensitive
                                                                  matters
The Committee will consider whether, and if so, what          •   To ensure members feel sufficiently well                       Members
background information would enable members to better             informed about background issues,
undertake their duties on the Committee (e.g. summary of          current internal and external
local health economy board meetings)                              developments, strategy and policy
The Chairman and Chief Executive will evaluate the            •   To ensure members have the                    By July 2009     MB & AG
performance and development needs of the members as               appropriate skills, training and attributes
appropriate and identify and meet any development needs.          to contribute most effectively to the
                                                                  work of the Committee.
To continue to oversee the development of reporting           •   To ensure the Committee and the Trust         Ongoing          SB/LW/VB




                                                                                                                                      Page 14 of 18
processes in line with Foundation Trust requirements             Board receive reports of sufficient
                                                                 quality and detail to contribute to the
                                                                 development and analysis of financial
                                                                 and operational performance of the
                                                                 Trust
To develop a tool to analyse the impact of the work of the   •   To measure the effectiveness of the       Ongoing   AG/ MB/ FM
Committee on the wider organisation                              Committee’s work in a structured
                                                                 manner




                                                                                                                        Page 15 of 18
Appendix Four:                  Committee Terms of Reference

Constitution
The Trust Board has established this Sub Committee to be known as the Finance
and Performance Committee. The Committee will report to the Trust Board and will
receive reports from the Divisional Boards and Strategic Management Board as
standing agenda items. The Committee has overarching responsibility for financial
and performance issues including within the organisation.


Delegated Responsibilities
   •   To support the Trust Board in the analysis and review of Trust financial and
       performance plans, providing advice and assurance to the Board on financial
       and performance issues.
   •   The Committee is authorised by the Board to investigate any activity within its
       terms of reference and to manage the principal risks detailed in the
       Assurance Framework.
   •   The Committee is authorised by the Board to obtain outside independent
       professional advice and to secure the attendance of non members with
       relevant experience and expertise if it considers this necessary.


Membership
Chairman
Chief Executive
Non Executive Directors
Director of Finance
All Executive Directors (part time Medical Director – see Committee Handbook re
accepted level of attendance)


In attendance
Company Secretary


Quorum
Three members one of which will be a Non Executive Director.


Attendance
A quorum must be maintained at all meetings. The Chairman of the Trust will attend
at least 60% of meetings. At least one other Non Executive Director will attend each


                                                                                   16
meeting of the Committee. The Non Executive Directors, other than the Chairman of
the Trust may deputise for each other. Executive Director members who are unable
to attend will arrange for the attendance of a nominated deputy whose attendance
will be recorded in the minutes, making clear on whose behalf they attend. The Trust
Secretary, or whoever covers these duties, shall be Secretary to the Committee and
shall attend to take minutes of the meeting and provide appropriate support to the
Chairman and committee members.


Frequency and Format of Meetings
Monthly


Regular Reports
Savings and Recovery Plan
Budgetary Monitoring Reports
Trust Performance Report
Activity Report
(The preceding three reports form part of the integrated performance report)
Divisional Performance Meeting Minutes
PFI Performance and Contract Monitoring Group Minutes
Marketing Strategy
Major Projects Board Minutes
Strategic Management Board Minutes
Divisional Board Minutes


Servicing the Committee
Non Executive Director Lead & Chair         -      Trust Chairman
Secretary                                   –      Company Secretary
Lead Director                               –      Director of Finance


Committees reporting
Strategic Management Board
Divisional Boards
Major Projects Board


Agenda preparation
Company Secretary




                                                                                 17
Preparation of Minutes
Company Secretary


Monitoring Arrangements
The effectiveness of the Committee will be reviewed on an annual basis as part of
the Trust Board Business Cycle. The Committee will provide an annual report on its
activities to the Trust Board as part of this review. The functioning of the Committee
may be assessed within the normal annual cycle of reporting by internal and external
auditors and external regulatory bodies.


Nominated Deputy Arrangements
                   Member                              Nominated Deputy
Chairman                                    Vice Chairman or Non Executive Director
Chief Executive                             Deputy Chief Executive or Executive
                                            Director
Deputy Chief Executive or Executive A           non    member     Executive   Director,
Director                                    Director of Operations, Divisional Director
                                            or Senior Manager within Executive
                                            Director’s own structure
Medical Director                            Clinical Head of Division or Clinical
                                            Operations Director




                                                                                    18
                           REPORT TO TRUST BOARD PART ONE
Meeting Date:                              Report Purpose:            Agenda Item: 17
                                     For Decision                 □
   th
29 July 2008                         Performance Monitoring
                                     □
                                     For Information
Report Submitted By:                 Report Approved By:              Report Title:
Mark Walkingshaw                     Marie Burnham                    Foundation      Trust   (FT)
Director     of   Planning      & Chief Executive                     Application Update
Strategic Development                                                 (July 2008)


Date Considered By                   Divisional Board Chair Declaration of
Divisional Board/
                                     Approval:                        Confidentiality Required:
Reason Not Considered
By Divisional Board:                 N/A                              No
N/A
Implications For Partners:                  Partner support of FT application is vital.
Key Risks & Consequences:                   Failure to meet requirements of FT status.
Related           to       Corporate All
Objective:
Related to HCC Standard:                    All
Related      to     Standards        for All
Better Health Domain:
Executive Summary:                          The report provides members with a brief update
                                            on our application to become a Foundation Trust -
                                            concentrating on key areas of progress since the
                                            last Trust Board meeting.

Recommendation/ What Is                     Members are asked to receive this report.
Required From The
Committee:




Mark Walkingshaw – Director of Planning & Strategic Development                                      Page 1 of 4
                       FOUNDATION TRUST APPLICATION UPDATE



                                            TRUST BOARD
                                              JULY 2008


1.0       Introduction

The Trust is in the process of applying for Foundation Trust status as a Category A
applicant.


The Trust has already completed the entry and pre-application phases and is
currently in the process of completing the application phase before progressing to the
final assessment and authorisation phases.

This brief report updates members on progress since the last meeting of the Board.


2.0       FT application update – July 2008

Since the last meeting of the board the following progress has been made:


      -   Work on revising and updating Our Integrated Business Plan (IBP) and Long
          Term Financial Model (LTFM) has been completed.


      -   A number of Board development sessions have been held. In particular these
          covered our approach to corporate governance, quality, activity, workforce
          and financial planning.


      -   A full response to the issues identified from the Historic Due Diligence
          exercise undertaken earlier in the year has been submitted to the North West
          Strategic Health Authority (SHA).


      -   Our revised IBP and LTFM have been submitted to the SHA team with initial
          feedback planned for 24th July 2008.


      -   We have completed our self assessment against the Monitor FT assessment
          framework which shows we are currently meeting each of the targets in full.


Mark Walkingshaw – Director of Planning & Strategic Development                          Page 2 of 4
      -   Meetings have been held with colleagues from both the East Lancashire
          Teaching and Blackburn with Darwen Teaching PCTs to update on and gain
          commissioner support for the underpinning activity and financial assumptions.


3.0       Key next steps in the application process


In terms of the next stages in the process these have been confirmed as follows:


      -   The full revised IBP and LTFM will be formally approved by the Board under
          part II of this meeting.

      -   An Historic Due Diligence refresh (assessment carried out by an independent
          accountancy firm) is planned for early August (date to be confirmed).

      -   A finalised version of the IBP and LTFM will be submitted to the SHA in early
          August.

      -   A Board to Board with the North West Strategic Health Authority will be held
          on 26th August (this forms an important further part of the assurance to the
          SHA that the Trust is ready to become a Foundation Trust).

      -   Subject to the successful outcome of the above the Trust’s application will be
          presented by the SHA to the September Department of Health applications
          committee.

      -   Following Department of Health submission of our application to Secretary of
          State our Monitor (FT regulator) phase is due to start in October 2008.

      -   Subject to the successful outcome of the Monitor assessment our earliest
          potential authorisation date is January 2009.


4.0       Our Foundation Trust Membership


Our Patient and Public Membership as at 14 July 2008 now stands at 6,847 patient
and public members and 6,049 staff and volunteers. This gives a total Foundation
Trust membership of 12,896.


Our second members event is planned to take place in September 2008 and will
concentrate on cardiology services (one of our four key areas of service focus within

Mark Walkingshaw – Director of Planning & Strategic Development                            Page 3 of 4
the IBP). The first of our regular member newsletters also goes out to members later
this month.


4.0      Conclusion


The Trust has made good progress with our application since the last meeting.


5.0      Recommendation


Members are asked to note this progress to date.




Mark Walkingshaw – Director of Planning & Strategic Development                        Page 4 of 4
                        REPORT TO TRUST BOARD PART ONE
Meeting Date:                           Report Purpose:             Agenda Item: 18
  th
29 July 2008                       For Decision             □
                                   Performance Monitoring


                                   For Information          □
Report Submitted By:               Report Approved By:              Report Title:
Frances Murphy                     Alan Green                       Reports       from        Sub
Company Secretary                  Chairman                         Committees
Date Considered By                 Divisional Board Chair Declaration of
Divisional Board/                  Approval:                        Confidentiality Required:
Reason Not Considered                                               Yes                No
By Divisional Board:
NA                                 NA


Implications For Partners:              NA
Key Risks & Consequences:               NA
Related         to      Corporate NA
Objective:
Related to HCC Standard:                C7
Related    to    Standards         for Governance
Better Health Domain:
Executive Summary:                      The attached report contains a summary of the
                                        minutes and decisions of Trust Board Sub
                                        Committees approved since the last report to Trust
                                        Board. Further details from the minutes are
                                        available    upon       request   from   the     Company
                                        Secretary.
Recommendation/             What    Is Trust Board is requested to receive the report and
Required             From          The note the contents.
Committee:




Frances Murphy, Company Secretary, 82110 RBH                                              Version 1
Created on 23/06/2008 3:18 PM                                                          Page 1 of 15
            Audit and Governance Committee Meeting 16th April 2008
                                Chair: Mr Martin Hill
         Subject                      Decision                     Action
                                        Part 1
Minutes of Previous         The previous minutes
Meeting                     were accepted as a true
                            and accurate record
Action Matrix               The action matrix was        Further actions were
                            amended to reflect the       agreed during the course
                            current position             of the meeting
NHSLA Update                Quarterly updates will be    Reports will be received
(National Health Service    provided to the Committee    on a quarterly basis
Litigation Authority)       and exceptions provided
                            to Service Quality
                            Management Team
                            monthly. Members
                            confirmed that an
                            application for level 3
                            assessment should be
                            made in September 2009
Risk Register Update        Members reviewed the         Risk mitigation plans will
                            corporate Risk Register,     be implemented in relation
                            noting new additions and     to new risks identified and
                            exceptions to risk           monitored for exceptions
                            treatment plans. Members     to these and other risks on
                            received assurance on the    the register
                            progress and contents of
                            risk mitigation plans and
                            discussed the process for
                            the reflection of risks
                            identified by non Trust
                            staff
Policy Ratification and     No report received as
Policy Council Minutes      Council reported fully to
                            the Committee at its last
                            meeting
Corporate Homicide and      Members received an          Report circulated through
Manslaughter Act            update on the impact of      Divisional structures.
                            the implementation of the    Ongoing work in relation to
                            Act. Members received        contents of job
                            assurance on the             descriptions will continue.
                            alignment of Trust           Mandatory training
                            strategies and policies      programme will be
                            with the Act and it was      reviewed and amended
                            agreed that the report       where necessary to
                            would be circulated          remind staff of personal
                            through Divisional           responsibilities under the
                            structures. Members noted    Act
                            that job descriptions will
                            be reviewed to reflect the
                            provisions of the Act.
                            Members received further
                            assurance on compliance

Frances Murphy, Company Secretary, 82110 RBH                                Version 1
Created on 23/06/2008 3:18 PM                                           Page 2 of 15
                            through the NHSLA
                            standards and the
                            proposed amendments to
                            the mandatory training
                            programme.
Human Tissue Authority      Members received a              Members received and
Site Inspection             summary of the outcome          approved the action plan
                            of the recent inspection        and its monitoring by
                            visit. Members were             SQMT
                            assured that the Authority
                            were happy to continue
                            the licence with
                            implementation of an
                            action plan. Members
                            noted the establishment of
                            the Human Tissue
                            Committee across the
                            Trust and discussed the
                            retention of tissue samples
                            within the NHS. Members
                            noted that the Authority
                            did not intend to revisit the
                            Trust. Members agreed
                            the action plan would be
                            monitored by Service
                            Quality Management
                            Team (SQMT).
Standards for Better        Members received a
Health Update               report from Internal Audit
                            providing an opinion that
                            there was full assurance
                            on the processes
                            underpinning the
                            declaration of compliance
                            with the Standards for
                            Better Health
Service Quality             Members received the            Patient Experience
Management Team             minutes and actions from        Tracker will be explained
Minutes                     the February SQMT               in full detail to Trust Board
                            meeting                         through the balanced
                                                            scorecard.
Annual Report of the        Members received and            Report to be presented to
Committee                   discussed the draft report      Trust Board incorporating
                            to the Trust Board              agreed amendments
Terms of Reference          Members reviewed the            Amended Terms of
Review                      Terms of Reference for          Reference to be presented
                            the Committee and had a         to Trust Board for
                            detailed discussion.            ratification.
                            Amendments to the Terms
                            of Reference were agreed
                            and will be presented to
                            Trust Board for ratification.
Any Other Business          No further items were
                            received

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                                        Part II
Previous Minutes             The minutes of the
                             previous meeting were
                             received as an accurate
                             record with minor
                             amendments
Action Matrix                Members received an              Further actions were
                             update on outstanding            agreed
                             items.
                             Mr Hill confirmed his
                             agreement of the Counter
                             Fraud Annual Plan
Your Business at Risk        Members received and
Action Plan                  noted the updated action
                             plan
Internal Audit Medium        Members received an              The plan will be
Term Plan                    updated plan and                 implemented and
                             approved its                     reviewed at each meeting
                             implementation
North West Internal Audit    Members received the
Service High Level Review    review for information and
                             noted the quality
                             assurance processes at
                             NWIAS
Internal Audit Progress      Members received a               Members will receive an
Report                       report of overall progress       update at each meeting
                             against the plan and
                             executive summaries of
                             final reports
External Audit Annual Plan   Members received a               The plan will be presented
                             verbal update on progress        to the next meeting
                             towards presenting the
                             Annual Plan
External Audit Progress      Members received an              Work will continue to
Report                       update on the work               complete the annual plan
                             undertaken by External
                             Auditors and discussed
                             the submission of Auditors
                             Local Evaluation evidence
Any Other Business           Members received the             Members will receive the
                             draft Head of Internal           final version at the next
                             Audit Opinion                    meeting
Declarations of              Members discussed                The declarations will be
Confidentiality              potential declarations of        recorded
                             confidentiality in relation to
                             the papers presented




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            Audit and Governance Committee Meeting 9th June 2008
                                Chair: Mr Clive Mellor
         Subject                       Decision                       Action
                                         Part 1
Declarations of Interest     Members had no
                             declarations to make in
                             relation to the agenda or
                             the Register of Interests
Minutes of Previous          The previous minutes
Meeting                      were accepted as a true
                             and accurate record
Action Matrix                Members received an            Further actions were
                             update on outstanding          agreed during the course
                             items. The action matrix       of the meeting
                             was amended to reflect
                             the current position
Service Quality              Members received the
Management Team              minutes and actions from
Minutes                      the March and April SQMT
                             meetings
Standards for Better         Members received a             Work to continue to
Health Update                report confirming the          monitor the standards will
                             Declaration to the             continue as they become
                             Healthcare Commission          available.
                             had been made within the
                             deadline and outlining the
                             changes to the process for
                             the current financial year.
                             Members noted that some
                             standards had not yet
                             been provided.
Risk Register Update         Members reviewed the           Risk mitigation plans will
                             corporate Risk Register,       be implemented in relation
                             noting new additions and       to new risks identified and
                             exceptions to risk             monitored for exceptions
                             treatment plans. Members       to these and other risks on
                             received assurance on the      the register
                             progress and contents of
                             risk mitigation plans and
                             discussed the risks
                             identified
Policy Ratification and      Members received the           The Policy Council will be
Policy Council Minutes       minutes of the February        asked to provide more
                             and April meetings and         detailed minutes to the
                             ratified policies presented.   Committee
                             Members discussed the
                             process for approval of
                             policies
Patient Advice and Liaison   Members received the           The report is to be
and Complaints Activity      annual report on behalf of     published on the Trust
Annual Report                the Trust Board                website. The Committee
                             incorporating the last         will receive a report on the
                             quarter complaints activity.   review of complaint

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                            Members discussed in          reporting processes.
                            detail the contents of the
                            report and the response to
                            complaints and PALS
                            contacts throughout the
                            year and received
                            assurance on the
                            processes and manner in
                            which complaints and
                            contacts were handled
                            and recorded. Members
                            approved proposals for
                            continued monitoring and
                            reporting. Members
                            approved the publication
                            of the report on the Trust
                            website
Any Other Business          No further items were
                            received
                                       Part II
Previous Minutes            The minutes of the
                            previous meeting were
                            received as an accurate
                            record
Action Matrix               Members received an           Further actions were
                            update on outstanding         agreed during the course
                            items.                        of the meeting

Statement of Internal       Members received on
Control, Annual Financial   behalf of the Trust Board a
Statements, Annual          detailed presentation on
Report and Letter of        the annual accounts and
Representation              financial statements noting
                            an amendment to the
                            notes to the accounts.
                            Members discussed the
                            financial performance of
                            the Trust as reflected in
                            the accounts in detail and
                            examined the annual
                            report, letter of
                            representation, financial
                            statements and statement
                            on internal control.
External Audit Annual       Members received the
Governance Report           annual governance report
                            from the External Auditors
                            which provided an
                            unqualified opinion on the
                            accounts and value for
                            money and confirmed that
                            there were no matters to
                            report to those charged
                            with Governance in the

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                             organisation.
                             Members discussed
                             financial reporting and
                             queries to the Trust
                             balance sheet and the
                             changes required to
                             reporting processes as
                             part of the Foundation
                             Trust application. On
                             behalf of the Board the
                             members adopted the final
                             accounts and approved
                             the annual report and
                             statement on internal
                             control, authorised the
                             submission of the letter of
                             representation and the
                             signing of Trust certificates
Head of Internal Audit       Members received the
Opinion                      final Head of Internal Audit
                             Opinion noting that
                             significant assurance had
                             been given overall.
Variation of Standing        Members received a draft        A final report to be
Orders and Standing          report and will receive a       provided to the next
Financial Instructions       final report at the next        meeting
                             meeting
Counter Fraud Annual         Members received the            Members will receive a
Report                       annual report and noted         report on the management
                             the contents. Members           of the Counter Fraud
                             discussed management            Service at the next
                             arrangements for the            meeting.
                             Counter Fraud Service           Members will receive an
                             and the reporting of            assurance report on the
                             incidents of potential          reporting of potential fraud
                             fraud. Members also             at the next meeting
                             discussed the Counter
                             Fraud Indicators
Internal Audit Progress      Members received a              Members will receive an
Report                       report of overall progress      update at each meeting
                             against the plan and
                             executive summaries of
                             final reports. Members
                             noted and discussed the
                             proposed merger of North
                             West Internal Audit
                             Services with a
                             neighbouring Consortium
External Audit Annual Plan   Members received and            A progress report will be
                             approved the annual plan        received at each meeting
                             and audit fee following
                             discussion
External Audit Progress      Members received an
Report                       update on the work

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                            undertaken by External
                            Auditors and noted the
                            progress of the Auditors
                            Local Evaluation
Any Other Business          No further items were
                            presented
Declarations of             Members discussed                The declarations will be
Confidentiality             potential declarations of        recorded
                            confidentiality in relation to
                            the papers presented




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                  Trust and Charitable Funds Meeting 4th June 2008
                                CHAIR: Mr A GREEN
         Subject                        Decision                        Action
Minutes of Previous           The previous minutes             The minutes will be
Meeting                       were accepted as a true          amended
                              and accurate record with
                              minor amendments
Action Matrix                 Members received an              Further actions were
                              update on outstanding            agreed
                              items.
Performance Update            Members received an              Model strategies will be
Report                        update on the                    circulated and a workshop
                              performance of charitable        will be held at the start of
                              funds since the last report      the next meeting to
                              to the Committee.                develop the Trust’s
                              Members noted the                strategy
                              decrease in the value of
                              holdings due to market
                              conditions and the overall
                              return of 5% Members
                              discussed the
                              development of the
                              Charitable Funds Strategy
                              and agreed model
                              strategies would be
                              circulated
Fundraising Activities        No applications to fund
Report                        raise had been received
Applications for Use of       Members reviewed two             Further information to be
Funds                         applications for funds. A        sought from NHS
                              grant was agreed in              Retirement Fellowship
                              principle to the NHS
                              Retirement Fellowship. An
                              application for support for
                              the Summer Ball was
                              refused.
Use of Learning and           Members received a
Development Funds             report outlining the way in
                              which funds had been
                              expended and plans for
                              further developments
Declarations of               Members discussed                The declarations will be
Confidentiality               potential declarations of        recorded
                              confidentiality in relation to
                              the papers presented
Any other business            Members discussed                An outline strategy will be
                              development of the               prepared for the next
                              Charitable Funds Strategy        meeting




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           Finance and Performance Committee Meeting 7th MAY 2008
                                CHAIR: MR E FOOLAT
         Subject                       Decision                      Action
Minutes of Previous          The previous minutes
Meeting                      were accepted as a true
                             and accurate record
Action Matrix                Members received an           Further actions were
                             update on outstanding         agreed during the course
                             matters                       of the meeting
Demand Management            Members received a            A further report will be
                             detailed report updating      presented to the next
                             progress on the demand        meeting. A subgroup will
                             management project.           be formed to undertake
                             Members noted areas of        the Gateway Review and
                             progress and potential        report to the next meeting
                             blockers and areas for
                             further work identified.
                             Members discussed
                             changes in the approvals
                             process for Wave 2
                             projects and the
                             forthcoming Gateway
                             Review of the project
Surgical Division Activity   Members sought                Strategic Management
and Workforce Plans          assurance from the            Board will consider bed
                             Divisional Director that      plans for all Divisions.
                             plans to deliver activity     An exception report will be
                             and the workforce to          presented to the Executive
                             support activity were in      Comms meeting on any
                             place in line with income     variation from the capacity
                             and expenditure budgets.      list plans.
                             A detailed discussion took
                             place particularly with
                             regard to commissioning
                             intentions, bed plans,
                             length of stay, theatre
                             utilisation and the
                             progress of cost
                             improvement
                             programmes. Members
                             received details of
                             workforce changes.
Women, Children &            Members sought                Implementation of the
Diagnostics Activity &       assurance from the            plans will continue to be
Workforce Plans              Divisional Directors and      monitored
                             Head of Clinical Division
                             that plans to deliver
                             activity and the workforce
                             to support activity were in
                             place in line with income
                             and expenditure budgets.
                             A detailed discussion took
                             place particularly with

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                            regard to commissioning
                            intentions, bed plans,
                            exceptions to activity
                            projections, cost
                            improvement programmes
                            and changes to clinical
                            rotas and the
                            measurement of
                            consultant productivity.
                            Members discussed
                            coding of clinical activity in
                            some detail
Medical Division Activity   Members sought                   A subgroup will be formed
and Workforce Plans         assurance from the               to receive further detailed
                            Divisional Director that         assurance and report back
                            plans to deliver activity        to the Committee.
                            and the workforce to
                            support activity were in
                            place in line with income
                            and expenditure budgets.
                            A detailed discussion took
                            place particularly with
                            regard to commissioning
                            intentions, acceptance of
                            income and activity plans
                            at a departmental level ,
                            bed plans and recruitment
                            of additional staff.
                            Members were not
                            sufficiently assured to
                            approve the plans.
Estates and Facilities      Members received a
Division Cost               report detailing savings
Improvement and             programmes for the year
Workforce Plans             and wider draft workforce
                            development plans.
                            Members approved the
                            plans.
Procurement Savings         Members received the
Annual Plan                 annual savings plan and
                            approved the schemes
                            detailed and the
                            appointment of an addition
                            member of staff for the
                            Department for a period of
                            6 months
Sickness Absence Policy     This item was removed            A subgroup of the
Update                      from the agenda                  Committee will receive the
                                                             report
Procure 21 Appointments     Members received a
                            report on the appointment
                            of a principal supply chain
                            partner, cost advisor and
                            project manager.

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                             Members approved the
                             appointments
Income & Expenditure         Members were updated on       Upon receipt of
Budget Update                the national pay awards       appropriate assurances
                             and noted provision for       from the Medical Division
                             payments. Members             the activity reserve would
                             received the agreed           be used to offset cost
                             income, expenditure and       improvement programmes
                             cost improvement
                             programmes signed by
                             Divisional Directors and
                             Clinical Heads of Division.
                             Members received an
                             update on the Capital
                             programme and how it
                             would be funded.
                             Members received an
                             update on the
                             development of financial
                             risk mitigation plans.
Meeting Patient Needs        Members received an
Implementation Report        update on the assurances
                             being provided to Trust
                             Board Sub Committees
                             and the Strategic
                             Management Board
Divisional Board Minutes     Members reviewed the          Monthly reports will
                             minutes of the Divisional     continue to be presented.
                             Board meetings and noted      Further detail on the
                             the assurances provided       results of the outpatient
                             in relation to the            survey will be provided to
                             management of risks.          the next meeting
Private Finance Initiative   Members received the
Contract Monitoring Group    latest minutes from the
Minutes                      groups and noted the
                             contents
Annual Accounts              Members received the
Submission Update            financial review of 07/08
                             which will be incorporated
                             in the annual report and
                             were updated on the
                             progress of the annual
                             audit of financial
                             statements.
Integrated Business Plan     Members received a
and Financial Modelling      verbal update on the
                             progress of the
                             Foundation Trust
                             application and were
                             advised that the Trust
                             would not need to
                             undertake Historic Due
                             Diligence a second time
Integrated Performance       Members received an           Further monthly reports

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Report                      update on the financial        will be presented.
                            and operational
                            performance of the
                            organisation receiving
                            assurance reports,
                            exception reports and
                            further details of specific
                            areas being considered
Any Other Business          Members discussed              An alternative provider will
                            suppliers for international    be sought.
                            reporting standards work
                            and agreed that a conflict
                            of interest existed with the
                            current proposed supplier
Declarations of             Members considered the         The declarations made will
Confidentiality             declarations proposed in       be recorded.
                            relation to the papers
                            presented




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            Finance and Performance Committee Meeting 25th June 2008
                                CHAIR: MR A GREEN
         Subject                     Decision                      Action
Minutes of Previous         The previous minutes          The minutes will be
Meeting                     were accepted as a true       amended
                            and accurate record with
                            minor amendments
IBP Update                  Members received, noted       Members will receive an
                            and discussed in detail an    updated version on 17th
                            update to the draft           July
                            integrated business plan
Apologies                   No apologies were
                            received
Action Matrix               Members received an
                            update on items due for
                            review
Medical Division and        Members received and          Actions will be transferred
Sickness Absence            noted the minutes from the    to the main action matrix
Assurance Meeting           assurance group               for the Committee
Minutes
Decisions of the Gateway    Members noted and
Review Subgroup             approved the decision to
                            continue the Demand
                            Management project to the
                            next gateway review
Integrated Performance      Members received an           Further monthly reports
Report                      update on the financial       will be presented.
                            and operational
                            performance of the
                            organisation receiving
                            assurance reports,
                            exception reports and
                            further details of specific
                            areas being considered
Cancelled Operations        Members received and          Members will receive an
Update                      discussed a report            update on progress in
                            examining performance         theatre efficiencies.
                            against the cancelled
                            operations indicator.
                            Members noted the
                            continuing actions to
                            deliver against the target.
PFI Contract Monitoring     Members reviewed the          Regular reports will
Minutes                     minutes presented and         continue to be presented
                            noted the assurances
                            provided in relation to the
                            management and
                            performance of PFI
                            contracts
Divisional Board Minutes    Members reviewed the          Monthly reports will
                            minutes of the Divisional     continue to be presented.
                            Board meetings and noted
                            the assurances provided

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                            in relation to the
                            management of risks.
Quarterly Performance       Members received the          Members will continue to
Review Meeting Minutes      minutes of the most recent    receive the minutes.
                            quarterly performance
                            meetings and noted the
                            assurances provided
Meeting Patient Needs       Members received an           Members will continue to
Implementation Report       update on the progress of     receive updates on
                            the outline business case     progress.
                            for Women and Newborn
                            Developments and the
                            visit of Professor Alberti,
                            and the work of the MPN
                            Steering Group
Strategic Management        Members reviewed the          Regular reports will
Board Minutes               minutes of the Strategic      continue to be presented
                            Management Board
                            meetings since the last
                            report to the Committee
                            and noted the assurances
                            provided in relation to the
                            management of
                            operational risks
Annual Review of            Members considered the        Report to be submitted to
Effectiveness and Terms     draft report presented and    Trust Board
of Reference                asked for amendments to
                            be made and that the
                            documents should then be
                            submitted to the Trust
                            Board
Amendments to Strategic     Members noted the             Strategic Management
Management Board Terms      request for amendments        Board Terms of Reference
of Reference                and approved them             to be amended
Any Other Business          No further items were
                            presented
Declarations of             Members considered the        The declarations made will
Confidentiality             declarations proposed in      be recorded.
                            relation to the papers
                            presented




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                    REPORT TO TRUST BOARD PART ONE
Meeting Date:                  Report Purpose:              Agenda Item: 19
  th
29 July 2008              For Decision
                          Performance Monitoring □
                          For Information            □
Report Submitted By:      Report Approved By:               Report Title:
Frances Murphy                                              Corporate              Meeting
Company Secretary                                           Schedule


Date Considered By        Divisional         Board   Chair Declaration of
Divisional Board/         Approval: N/A                     Confidentiality Required:
Reason Not                                                  Yes               No
Considered By
Divisional Board: N/A




Implications For Partners:             NA
Related to key risks identified on     NA
Assurance Framework &
Consequences:
Related to Corporate Objective:        All
Related to HCC Standard:               NA
Related to Standards for Better NA
Health Domain:
Executive Summary:                     The paper contains the updated committee
                                       handbook and a proposed schedule of meeting
                                       for 2009. Amendments to the Terms of
                                       Reference of the Audit and Governance
                                       Committee and the Strategic Management
                                       Board are included for consideration together
                                       with the terms of reference and reporting
                                       structures for the clinical policy group
Recommendation/         What      Is Members are asked to approve and note the
Required From The Committee:           amended terms of reference for the audit and
                                       governance        committee      and        strategic
management Board and formally approve the
establishment of the Clinical Policy Group and
note its terms of reference.
EAST LANCASHIRE HOSPITALS NHS TRUST
       COMMITTEE HANDBOOK
               2008




                                      Version 4
              23/07/08
                                                CONTENTS
FORWARD ......................................................................................................5
Public Sector Values .....................................................................................6
NHS Code of Conduct for Managers ............................................................7
Role of Observers / Non Members At Meetings. .......................................10
Confidentiality ..............................................................................................10
Trust And Charitable Funds Committee Terms of Reference ..................11
Audit And Governance Committee Terms of Reference ..........................19
Finance and Performance Committee........................................................33
Remuneration Committee ...........................................................................46
Trust Board Terms of Reference ................................................................49
Major Projects Board Terms of Reference.................................................58
Trust Board Members’ Strategy & Development Days .............................60
Strategic Management Board Terms of Reference ...................................61
Clinical Policy Group Terms of Reference.................................................65
Report Template...........................................................................................67
Committee Meeting Dates 2008 .................................................................68
Committee Meeting Dates 2009                                                                                   69
Trust Board Committee Structure ..............................................................71
Revisions:.....................................................................................................72
                                     FORWARD
This Committee handbook is designed to provide members of the Trust Board and its
Sub Committees with an easy reference to the dates of Committee meetings in this
year together with the items to be dealt with at each meeting of the Committee in
accordance with the Trust’s business cycle.
Each Committee has committed to undertaking an annual review of its effectiveness
and terms of reference and will present an annual report to the Trust Board on its
business, effectiveness and attendance throughout the year together with any
proposals for development. The functioning of the Committee may be assessed
within the normal annual cycle of reporting by internal and external auditors and
external regulatory bodies.
I would like to take this opportunity to remind members of the importance of ensuring
they are well briefed for meetings and that apologies are sent in good time so that all
meetings can remain quorate. There is a Trust standard that members of
Committees attend 60% of the Committee’s meetings in the year and that where
members are unable to attend an authorised deputy attends on their behalf as
agreed with the Chairman of the Committee. If you do experience any difficulty in
accessing papers or require any further information in advance of a meeting please
do not hesitate to contact me.


                                                                      Frances Murphy
                                                                  Company Secretary
                                 Public Sector Values
In performing their duties the Board members will observe the following principles:
Selflessness
Holders of public office should take decisions solely in terms of the public interest.
They should not do so in order to gain financial or other material benefits for
themselves, their family, or their friends.
Integrity
Holders of public office should not place themselves under any financial or other
obligation to outside individuals or organisations that might influence them in the
performance of their official duties.
Objectivity
In carrying out public business, including making public appointments, awarding
contracts, or recommending individuals for rewards and benefits, holders of public
office should make choices on merit.
Accountability
Holders of public office are accountable for their decisions and actions to the public
and must submit themselves to whatever scrutiny is appropriate to their office.
Openness
Holders of public office should be as open as possible about all the decisions and
actions that they take. They should give reasons for their decisions and restrict
information only when the wider public interest clearly demands.
Honesty
Holders of public office have a duty to declare any private interests relating to their
public duties and to take steps to resolve any conflicts arising in a way that protects
the public interest.
Leadership
Holders of public office should promote and support these principles by leadership
and example.
                             NHS Code of Conduct for Managers
As an NHS manager, I will observe the following principles:
    •       make the care and safety of patients my first concern and act to protect them
            from risk;
    •       respect the public, patients, relatives, carers, NHS staff and partners in other
            agencies;
    •       be honest and act with integrity;
    •       accept responsibility for my own work and the proper performance of the
            people I manage;
    •       show my commitment to working as a team member by working with all my
            colleagues in the NHS and the wider community;
    •       take responsibility for my own learning and development.
This means in particular that:


1 I will:
    •       respect patient confidentiality;
    •       use the resources available to me in an effective, efficient and timely manner
            having proper regard to the best interests of the public and patients;
    •       be guided by the interests of the patients while ensuring a safe working
            environment;
    •       act to protect patients from risk by putting into practice appropriate support
            and disciplinary procedures for staff; and
    •       seek to ensure that anyone with a genuine concern is treated reasonably and
            fairly.


2 I will respect and treat with dignity and fairness, the public, patients, relatives,
carers, NHS staff and partners in other agencies. In my capacity as a senior manager
within the NHS I will seek to ensure that no one is unlawfully discriminated against
because of their religion, belief, race, colour, gender, marital status, disability, sexual
orientation, age, social and economic status or national origin. I will also seek to
ensure that:
    •       the public are properly informed and are able to influence services;
    •       patients are involved in and informed about their own care, their experience is
            valued, and they are involved in decisions;
    •   relatives and carers are, with the informed consent of patients, involved in the
        care of patients;
    •   partners in other agencies are invited to make their contribution to improving
        health and health services; and
    •   NHS staff are:
    •   valued as colleagues;
    •   properly informed about the management of the NHS;
    •   given appropriate opportunities to take part in decision making.
    •   given all reasonable protection from harassment and bullying;
    •   provided with a safe working environment;
    •   helped to maintain and improve their knowledge and skills and achieve their
        potential; and
    •   helped to achieve a reasonable balance between their working and personal
        lives.


3 I will be honest and will act with integrity and probity at all times. I will not make,
permit or knowingly allow to be made, any untrue or misleading statement relating to
my own duties or the functions of my employer.
I will seek to ensure that:
    •   the best interests of the public and patients/clients are upheld in decision-
        making and that decisions are not improperly influenced by gifts or
        inducements;
    •   NHS resources are protected from fraud and corruption and that any incident
        of this kind is reported to the NHS Counter Fraud Services;
    •   judgements about colleagues (including appraisals and references) are
        consistent, fair and unbiased and are properly founded; and
    •   open and learning organisations are created in which concerns about people
        breaking the Code can be raised without fear.


4 I will accept responsibility for my own work and the proper performance of the
people I manage. I will seek to ensure that those I manage accept that they are
responsible for their actions to:
    •   the public and their representatives by providing a reasonable and reasoned
        explanation of the use of resources and performance;
    •   patients, relatives and carers by answering questions and complaints in an
        open, honest and well researched way and in a manner which provides a full
       explanation of what has happened, and of what will be done to deal with any
       poor performance and, where appropriate giving an apology; and
   •   NHS staff and partners in other agencies by explaining and justifying
       decisions on the use of resources and give due and proper consideration to
       suggestions for improving performance, the use of resources and service
       delivery. I will support and assist the Accountable Officer of my organisation
       in his or her responsibility to answer to Parliament, Ministers and the
       Department of Health in terms of fully and faithfully declaring and explaining
       the use of resources and the performance of the local NHS in putting national
       policy into practice and delivering targets.


For the avoidance of doubt, nothing in paragraphs two to four of this Code requires or
authorises an NHS manager to whom this Code applies to:
   •    make, commit or knowingly allow to be made any unlawful disclosure;
   •   make, permit or knowingly allow to be made any disclosure in breach of his or
       her duties and obligations to his or her employer, save as permitted by law.
If there is any conflict between the above duties and obligations and this Code, the
former shall prevail.


5 I will show my commitment to working as a team by working to create an
environment in which:
   •   teams of frontline staff are able to work together in the best interests of
       patients;
   •   leadership is encouraged and developed at all levels and in all staff groups;
       and
   •   the NHS plays its full part in community development.


6 I will take responsibility for my own learning and development. I will seek to:
   •   take full advantage of the opportunities provided;
   •   keep up to date with best practice; and
   •   share my learning and development with others.
                                                 Department of Health October 2002
                  Role of Observers / Non Members At Meetings.
Observers at meetings will not normally express their views to the Committee unless
invited to do so by the Chairman.
Presenters at meetings will normally attend to present their item at the beginning of
the agenda where possible and will not normally remain unless invited to do so by
the Chair of the Committee.
Those intending to attend as observers or invited to attend as a presenter should
contact the Committee secretary to confirm arrangements for the meeting at least a
week before the meeting.




Confidentiality
The Freedom of Information Act introduced a presumption that all information should
be disclosed upon request unless the information falls within a narrow range of
exceptions. At each sub Committee of the Trust Board as a matter of course
members are invited to decide whether any items on the agenda ought to remain
confidential to the members. A schedule of confidential items is maintained by the
Company Secretary together with the period of time during which they are
considered to be confidential. All requests for disclosure of information will be made
to the Company Secretary under the terms of the Freedom of Information Act.
           Trust And Charitable Funds Committee Terms of Reference

Constitution
The Trust Board has established this Sub Committee to be known as the Trust and
Charitable Funds Committee. The Committee will report to the Trust Board. The
Committee has overarching responsibility for the monitoring and approval of activities
relating to charitable fund raising and the uses to which charitable funds are applied
providing assurance to Trust Board members in their role of Trustees of the
organisation’s Charitable Funds. The Committee has the authority to appoint short
term, outcome focused sub committees but does not routinely receive reports from
other sub committees.


Delegated Responsibilities
The Trust receives funds for charitable purposes from a number of sources. The
Trust as a corporate body is the Trustee of these funds. The Trust Board must
therefore ensure that its duties as a Trustee are discharged correctly taking advice as
necessary. The Trust Board appoints this Committee to discharge this function. In
addition the Trust Board delegates to this Committee the authority to examine and
approve the annual accounts of funds held on trust.
The Committee will oversee the management of funds held on trust and charitable
funds. In particular the Committee will:
   (a) Set a corporate strategy for the management of funds
   (b) Assure the Trust Board that the policies and procedures for the management
       and administration of Trust funds are adequate, effective and observed
   (c) Review the investments held by the Trust at regular intervals
   (d) Review the performance of funds on a regular basis
   (e) Approve and review the application of funds
   (f) Approve, accredit and support fundraising activities in accordance with the
       Trust’s Guidelines for Fund Raising Activities
   (g) Approve and review the appointment of those managing investments on
       behalf of the Trustees
   (h) Make recommendations to the Trust Board regarding the management and
       performance of funds
   (i) Provide an annual report to the Trust Board on the Committee’s activities


Membership
2 Non Executive Directors
2 Executive Directors including the Director of Finance, Capital, Planning and
Information (or the Deputy Director of Finance in his absence)


Quorate
1 Non Executive Director and 1 Executive Director


Frequency of Meetings
Meetings will take place on a quarterly basis.


Attendance
A quorum must be maintained at all meetings. Each member will attend a minimum
of 60% of the meetings throughout the year. Executive Director members who are
unable to attend will arrange for the attendance of a nominated deputy whose
attendance will be recorded in the minutes, making clear on whose behalf they
attend.


Regular Reports
Investment Update Report
Performance Update Report
Fund Raising Activities Report
Applications for the use of funds


Board Services
Chair          -      Chairman
Lead Director -       Director of Finance, Capital, Planning and IT
Secretary      -      Company Secretary


Agenda and Minute Preparation
Company Secretary


Monitoring Arrangements
The effectiveness of the Committee will be reviewed on an annual basis as part of
the Trust Board Business Cycle. The Committee will provide an annual report on its
activities to the Trust Board as part of this review. The functioning of the Committee
may be assessed within the normal annual cycle of reporting by internal and external
auditors and external regulatory bodies.
Nominated Deputy Arrangements
                Member                            Nominated Deputy
Chairman                               Vice Chairman or Non Executive Director
Executive Directors                    A   non   member     Executive    Director,
                                       Director of Operations, Divisional Director
                                       or Senior Manager within Executive
                                       Director’s own structure
Finance Representative (normally Deputy Senior Manager within East Lancashire
Director of Finance)                   Hospitals Finance Structure
                                         Trust And Charitable Funds Committee Meeting
                                 23rd January 2008, Seminar Room 9, Learning Centre, RBH, 13.00
                                                           AGENDA
Trustees Annual Report                                          External Audit
Fund Raising Activities Update                                  Company Secretary
Applications for Use of Funds                                   Company Secretary
Performance Update Report                                       Director of Finance, Capital, Planning and Information
Use of Learning and Development Funds                           Deputy Chief Executive




                                                                                                                         12
                                       Trust And Charitable Funds Committee Meeting
                                 5th March 2008, Seminar Room 9, Learning Centre, RBH, 13.00
                                                          AGENDA
Fund Raising Activities Update                                 Company Secretary
Applications for Use of Funds                                  Company Secretary
Performance Update Report                                      Director of Finance, Capital, Planning and Information




                                                                                                                        13
                                        Trust And Charitable Funds Committee Meeting
                                 4th June 2008, Seminar Room 9, Learning Centre, RBH, 10.00
                                                         AGENDA


Fund Raising Activities Update                                Company Secretary
Applications for Use of Funds                                 Company Secretary
Performance Update Report                                     Director of Finance, Capital, Planning and Information
Use of Learning and Development Funds                         Deputy Chief Executive




                                                                                                                       14
                                         Trust And Charitable Funds Committee Meeting
                                        24th September 2008, Seminar Room 9, RBH, 10.00
                                                           AGENDA


Fund Raising Activities Update                                   Company Secretary
Applications for Use of Funds                                    Company Secretary
Performance Update Report                                        Director of Finance, Capital, Planning and Information
Use of Learning and Development Funds                            Deputy Chief Executive
Trust and Charitable Funds Strategy




                                                                                                                          15
                                 Trust And Charitable Funds Committee Meeting
                                 5th December 2008, Seminar Room 9, RBH, 10.00
                                                   AGENDA
Fund Raising Activities Update                           Company Secretary
Applications for Use of Funds                            Company Secretary
Performance Update Report                                Director of Finance, Capital, Planning and Information




                                                                                                                  16
             Audit And Governance Committee Terms of Reference


Constitution
The Board hereby resolves to establish a sub Committee of the Board to be known
as the Audit and Governance Committee (The Committee). The Committee has no
executive powers, other than those specifically delegated in these Terms of
Reference. The Committee will report to the Trust Board and will receive reports from
the Service Quality Management Team, the Policy Council and Internal and External
Auditors as standing agenda items.


Membership
The Committee meetings will be in two parts. The first part will address Governance
issues and the second part will address audit issues.
a) Membership of Governance:
       Chairman
       Any Non Executive Director
       Chief Executive
       Director of Finance
       Director of Clinical Care and Governance
       Medical Director (part time – see Committee Handbook re accepted level of
       attendance)
b) Membership of Audit
       Any Non Executive Director with the exception of the Trust Chairman
A quorum shall be two Non Executive members and two Executive members in
Governance and two Non Executive members in Audit. A Non Executive Director,
other than the Trust Chairman, will be the Chair of the Committee. The Chairman of
the Committee will attend a minimum of 60% of all meetings. The Chairman of the
Trust will attend at least 60% of Governance meetings. At least one other Non
Executive Director will attend each meeting of the Committee. The Non Executive
Directors, other than the Chairman of the Trust and the Chairman of the Committee
may deputise for each other.
Attendance
The Director of Finance, appropriate Internal and External Audit representatives and
appropriate Governance Unit representatives shall normally attend meetings.
However, at least once a year the Audit members should meet privately with the
External and Internal Auditors.



                                                                                  17
The Chief Executive should at least annually discuss with the Committee the process
for assurance that supports the Statement on Internal Control.
A quorum must be maintained at all meetings. Executive Director members who are
unable to attend will arrange for the attendance of a nominated deputy whose
attendance will be recorded in the minutes, making clear on whose behalf they
attend. The Trust Secretary, or whoever covers these duties, shall be Secretary to
the Committee and shall attend to take minutes of the meeting and provide
appropriate support to the Chairman and committee members.


Frequency
Meetings shall be held not less than three times a year. The External Auditor or Head
of Internal Audit may request a meeting if they consider that one is necessary.


Authority
The Committee is authorised by the Board to investigate any activity within its terms
of reference. It is authorised to seek any information it requires from any employee
and all employees are directed to co-operate with any request made by the
Committee. The Committee is authorised by the Board to obtain outside legal or
other independent professional advice and to secure the attendance of outsiders with
relevant experience and expertise if it considers this necessary.


Duties
The duties of the Committee can be categorised as follows:
Overarching responsibility for Governance, Risk Management and Internal Control
The Committee shall review the establishment and maintenance of an effective
system of integrated governance, risk management and internal control, across the
whole of the organisation’s activities (both clinical and non-clinical), that supports the
achievement of the organisation’s objectives. In particular, the Committee will review
the adequacy of:
o all risk and control related disclosure statements (in particular the Statement on
Internal Control and declarations of compliance with the Standards for Better Health),
together with any accompanying Head of Internal Audit statement, external audit
opinion or other appropriate independent assurances, prior to endorsement by the
Board
o the underlying assurance processes that indicate the degree of the achievement of
corporate objectives, the effectiveness of the management of principal risks and the
appropriateness of the above disclosure statements

                                                                                       18
o the policies for ensuring compliance with relevant regulatory, legal and code of
conduct requirements
o the policies and procedures for all work related to fraud and corruption as set out in
Secretary of State Directions and as required by the Counter Fraud and Security
Management Service
In carrying out this work the Committee will primarily utilise the work of Internal Audit,
External Audit and other assurance functions, but will not be limited to these audit
functions. It will also seek reports and assurances from directors and managers as
appropriate, concentrating on the overarching systems of integrated governance, risk
management and internal control, together with indicators of their effectiveness.
This will be evidenced through the Committee’s use of an effective Assurance
Framework to guide its work and that of the audit and assurance functions that report
to it.


Internal Audit
The Committee shall ensure that there is an effective internal audit function
established by management that meets mandatory NHS Internal Audit Standards
and provides appropriate independent assurance to the Committee, Chief Executive
and Board. This will be achieved by:
o consideration of the provision of the Internal Audit service, the cost of the audit and
any questions of resignation and dismissal
o review and approval of the Internal Audit strategy, operational plan and more
detailed programme of work, ensuring that this is consistent with the audit needs of
the organization as identified in the Assurance Framework
o consideration of the major findings of internal audit work (and management’s
response), and ensure co-ordination between the Internal and External Auditors to
optimise audit resources
o ensuring that the Internal Audit function is adequately resourced and has
appropriate standing within the organisation
o annual review of the effectiveness of internal audit


External Audit
The Committee shall review the work and findings of the External Auditor appointed
by the Audit Commission and consider the implications and management’s
responses to their work. This will be achieved by:
o consideration of the appointment and performance of the External Auditor, as far as
the Audit Commission’s rules permit

                                                                                       19
o discussion and agreement with the External Auditor, before the audit commences,
of the nature and scope of the audit as set out in the Annual Plan, and ensure
coordination, as appropriate, with other External Auditors in the local health economy
o discussion with the External Auditors of their local evaluation of audit risks and
assessment of the Authority/Trust/PCT and associated impact on the audit fee
o review all External Audit reports, including agreement of the annual audit letter
before submission to the Board and any work carried outside the annual audit plan,
together with the appropriateness of management responses


Other Assurance Functions
The Committee shall review the findings of other significant assurance functions,
both internal and external to the organisation, and consider the implications to the
governance of the organisation.
These will include, but will not be limited to, any reviews by Department of Health
Arms Length Bodies or Regulators/Inspectors (e.g. Healthcare Commission, NHS
Litigation Authority, etc.), professional bodies with responsibility for the performance
of staff or functions (e.g. Royal Colleges, accreditation bodies, etc) This external
review process is overseen by the Service Quality Management Team (SQMT) which
will provide assurance on an exception reporting basis to the Audit and Governance
Committee.
In addition, the Committee will review the work of other committees within the
organisation, whose work can provide relevant assurance to the Audit Committee’s
own scope of work. This will particularly include any Risk Management committees
that are established through SQMT.
In reviewing issues around clinical risk management, the Audit Committee will wish to
satisfy themselves on the assurance that can be gained from the clinical audit
function via SQMT.


Management
The Committee shall request and review reports and positive assurances from
directors and managers on the overall arrangements for governance, risk
management and internal control.
They may also request specific reports from individual functions within the
organisation (e.g. clinical audit) as they may be appropriate to the overall
arrangements.




                                                                                     20
Financial Reporting
The Committee shall review the Annual Report and Financial Statements before
submission to the Board, focusing particularly on:
o the wording in the Statement on Internal Control and other disclosures relevant to
the Terms of Reference of the Committee
o changes in, and compliance with, accounting policies and practices
o unadjusted mis-statements in the financial statements
o major judgemental areas
o significant adjustments resulting from the audit
The Committee should also ensure that the systems for financial reporting to the
Board, including those of budgetary control, are subject to review as to completeness
and accuracy of the information provided to the Board.


Reporting
The minutes of Audit and Governance Committee meetings shall be formally
recorded by the Trust Secretary and a summary submitted to the Board. The Chair of
the Committee shall draw to the attention of the Board any issues that require
disclosure to the full Board, or require executive action.
The Committee will report to the Board annually on its work in support of the
Statement on Internal Control, specifically commenting on the fitness for purpose of
the Assurance Framework, the completeness and embeddedness of risk
management in the organisation, the integration of governance arrangements and
the appropriateness of the self-assessment against the Standards for Better Health.


Other Matters
The Committee shall be supported administratively by the Company Secretary,
whose duties in this respect will include:
o Agreement of agenda with Chairman and attendees and collation of papers
o Taking the minutes & keeping a record of matters arising and issues to be carried
forward
o Advising the Committee on pertinent area


Monitoring Arrangements
The effectiveness of the Committee will be reviewed on an annual basis as part of
the Trust Board Business Cycle. The Committee will provide an annual report on its
activities to the Trust Board as part of this review. The functioning of the Committee


                                                                                   21
will also be assessed within the normal annual cycle of reporting by internal and
external auditors and external regulatory bodies.


Nominated Deputy Arrangements
                   Member                              Nominated Deputy
Chairman                                    Vice Chairman or Non Executive Director
Chairman of Committee                       Non Executive Director
Chief Executive                             Deputy Chief Executive or Executive
                                            Director
Director of Finance                         Deputy Director of Finance
Medical Director                            Clinical Head of Division or Clinical
                                            Operations Director / Chair of Patient
                                            Safety Group
Director of Clinical Care and Governance    Head of Assurance and Safety / Head of
                                            Patient    Experience/   or   Governance
                                            Systems Development Manager




                                                                                  22
                                                    Audit & Governance Committee Meeting
                                                 23rd January 2008, Seminar Room 9, RBH, 9.15


Proposed Variations of SFI and Standing Orders                                    Company Secretary
Standards For Better Health Update                                                Director of Clinical Care and Governance
Risk Register Update                                                              Director of Clinical Care and Governance
Quarterly Complaints Report                                                       Head of Assurance and Safety
Policy Ratification and Policy Council Minutes                                    Head of Assurance and Safety
NHSLA Update                                                                      Head of Assurance and Safety
SQMT Minutes and Actions                                                          Head of Assurance and Safety
Internal Audit Progress Report                                                    Internal Audit
External Audit Progress Report                                                    External Audit




                                                                                                                             23
                                                      Audit & Governance Committee Meeting
                                            5th March 2008, Seminar Room 9, Learning Centre, RBH, 9.15




Policy Ratification and Policy Council Minutes                                  Head of Assurance and Safety
NHSLA Update                                                                    Head of Assurance and Safety
SQMT Minutes and Actions                                                        Head of Assurance and Safety
Internal Audit Progress Report                                                  Internal Audit
Annual review of Effectiveness and Value for Money of Internal Audit            Internal Audit
External Audit Progress Report                                                  External Audit
Report on Losses Compensation and Bad Debts                                     Director of Finance, Capital, Planning and Information
Report on Waivers of Standing Orders and SFI                                    Director of Finance, Capital, Planning and Information
Risk Register Update                                                            Director of Clinical Care and Governance
Assurance Framework Update                                                      Director of Clinical Care and Governance




                                                                                                                                         24
                                                      Audit & Governance Committee Meeting
                                                 16th April 2008, Seminar Room 9, RBH, 9.15


Policy Ratification and Policy Council Minutes                             Head of Assurance and Safety
NHSLA Update                                                               Head of Assurance and Safety
SQMT Minutes and Actions                                                   Head of Assurance and Safety
Quarterly Complaints Report                                                Head of Assurance and Safety
Internal Audit Progress Report                                             Internal Audit
Internal Audit Annual Plan                                                 Internal Audit
External Audit Progress Report                                             External Audit
Counter Fraud Service Progress Report                                      Counter Fraud Service
Counter Fraud Service Annual Plan and Annual Report                        Counter Fraud Service
Risk Register Update                                                       Director of Clinical Care and Governance
Standards for Better Health Declaration                                    Director of Clinical Care and Governance
Terms of Reference Review                                                  Company Secretary
Draft Annual Report to Trust Board                                         Company Secretary




                                                                                                                      25
                                                 Audit & Governance Committee Meeting
                                                 9th June 2008, Seminar Room 9, RBH, 9.15


External Audit Opinion on Financial Statements                            External Audit
External Audit Value for Money Conclusion                                 External Audit
External Audit Opinion on Financial Standing and Management               External Audit
External Audit Annual Plan                                                External Audit
External Audit Progress Report                                            External Audit
Report on Waivers of Standing Orders and SFI                              Director of Finance, Capital, Planning and Information
ELHT Annual Accounts                                                      Director of Finance, Capital, Planning and Information
Head of Internal Audit Opinion                                            Internal Audit
Internal Audit Progress Report                                            Internal Audit
ELHT Annual Report                                                        Company Secretary
Statement of Internal Control                                             Chief Executive
Policy Ratification and Policy Council Minutes                             Head of Assurance and Safety
NHSLA Update                                                              Head of Assurance and Safety
SQMT Minutes and Actions                                                  Head of Assurance and Safety
Risk Register Update                                                      Director of Clinical Care and Governance




                                                                                                                                   26
                                                  Audit & Governance Committee Meeting
                                                 23rd July 2008, Seminar Room 9, RBH, 9.15


External Audit Progress Report                                              External Audit
Internal Audit Progress Report                                              Internal Audit
Assurance Framework Update                                                  Director of Clinical Care and Governance
Risk Register Update                                                        Director of Clinical Care and Governance
Standards for Better Health Update                                          Director of Clinical Care and Governance
Policy Ratification and Policy Council Minutes                              Head of Assurance and Safety
NHSLA Update                                                                Head of Assurance and Safety
SQMT Minutes and Actions                                                    Head of Assurance and Safety
Register of Interests Update                                                Company Secretary
In Patient Survey                                                           Director of Clinical Care and Governance
Results of HCC Hygiene Code Inspection                                      Director of Clinical Care and Governance
Report on losses, compensations and special payments                        Director of Finance




                                                                                                                       27
                                                 Audit & Governance Committee Meeting
                                              3rd September 2008, Seminar Room 9, RBH, 9.15


Report on Losses, Compensations and Bad Debts                               Director of Finance, Capital, Planning and Information
Report on Waivers of Standing Orders and SFI                                Director of Finance, Capital, Planning and Information
Internal Audit Progress Report                                              Internal Audit
ALE Scores                                                                  External Audit
External Audit Progress Report                                              External Audit
Infection Control Annual Report                                             Director of Clinical Care and Governance
Maternity Risk Management and Governance Processes                          Director of Clinical Care and Governance
Risk Register Update                                                        Director of Clinical Care and Governance
Policy Ratification and Policy Council Minutes                              Head of Assurance and Safety
NHSLA Update                                                                Head of Assurance and Safety
SQMT Minutes and Actions                                                    Head of Assurance and Safety
Variation of Standing Orders                                                Company Secretary
Review of Value for Money of Internal Audit                                 Internal Audit
Internal Audit Annual Report                                                Internal Audit




                                                                                                                                     28
                                                   Audit & Governance Committee Meeting
                                                 15th October 2008, Seminar Room 9, RBH, 9.15


Risk Register Update                                                           Director of Clinical Care and Governance
Standards for Better Health Update                                             Director of Clinical Care and Governance
Policy Ratification and Policy Council Minutes                                 Head of Assurance and Safety
NHSLA Update                                                                   Head of Assurance and Safety
SQMT Minutes and Actions                                                       Head of Assurance and Safety
Complaints Annual Report                                                       Head of Assurance and Safety
External Audit Final Accounts Memorandum                                       External Audit
External Audit Annual Audit Letter                                             External Audit
External Audit Progress Report                                                 External Audit
Internal Audit Progress Report                                                 Internal Audit
Counter Fraud Service Progress Report                                          Counter Fraud Service
Review of Theatres                                                             External Audit




                                                                                                                          29
                                                    Audit & Governance Committee Meeting
                                                 3rd December 2008, Seminar Room 9, RBH, 9.15


Policy Ratification and Policy Council Minutes                           Head of Assurance and Safety
NHSLA Update                                                             Head of Assurance and Safety
SQMT Minutes and Actions                                                 Head of Assurance and Safety
Risk Register Update                                                     Director of Clinical Care and Governance
Assurance Framework Update                                               Director of Clinical Care and Governance
External Audit Progress Report                                           External Audit
Internal Audit Progress Report                                           Internal Audit
Report on Waivers of Standing Orders and SFI                             Director of Finance, Capital, Planning and Information
Register of Hospitality                                                  Company Secretary
Register of Interests                                                    Company Secretary
Committee Effectiveness Review                                           Company Secretary




                                                                                                                              30
                      Finance and Performance Committee


Constitution
The Trust Board has established this Sub Committee to be known as the Finance
and Performance Committee. The Committee will report to the Trust Board and will
receive reports from the Divisional Boards as standing agenda items. The Committee
has overarching responsibility for financial and performance issues including within
the organisation.


Delegated Responsibilities
   •   To support the Trust Board in the analysis and review of Trust financial and
       performance plans, providing advice and assurance to the Board on financial
       and performance issues.
   •   The Committee is authorised by the Board to investigate any activity within its
       terms of reference and to manage the principal risks detailed in the
       Assurance Framework.
   •   The Committee is authorised by the Board to obtain outside independent
       professional advice and to secure the attendance of non members with
       relevant experience and expertise if it considers this necessary.


Membership
Chairman
Chief Executive
Non Executive Directors
Director of Finance
All Executive Directors (part time Medical Director – see Committee Handbook re
accepted level of attendance)


In attendance
Company Secretary


Quorate
Three members one of which will be a Non Executive Director.




                                                                                   31
Attendance
A quorum must be maintained at all meetings. The Chairman of the Trust will attend
at least 60% of meetings. At least one other Non Executive Director will attend each
meeting of the Committee. The Non Executive Directors, other than the Chairman of
the Trust may deputise for each other. Executive Director members who are unable
to attend will arrange for the attendance of a nominated deputy whose attendance
will be recorded in the minutes, making clear on whose behalf they attend. The Trust
Secretary, or whoever covers these duties, shall be Secretary to the Committee and
shall attend to take minutes of the meeting and provide appropriate support to the
Chairman and committee members.


Frequency and Format of Meetings
Monthly


Regular Reports
Savings and Recovery Plan
Budgetary Monitoring Reports
Trust Performance Report
Activity Report
(The preceding three reports form part of the integrated performance report)
Divisional Performance Meeting Minutes
PFI Performance and Contract Monitoring Group Minutes
Marketing Strategy
Major Projects Board Minutes
Divisional Board Minutes


Servicing the Committee
Non Executive Director Lead & Chair         -      Trust Chairman
Secretary                                   –      Company Secretary
Lead Director                               –      Director of Finance


Committees reporting
Divisional Boards
Major Projects Board


Agenda preparation
Company Secretary

                                                                                 32
Preparation of Minutes
Company Secretary


Monitoring Arrangements
The effectiveness of the Committee will be reviewed on an annual basis as part of
the Trust Board Business Cycle. The Committee will provide an annual report on its
activities to the Trust Board as part of this review. The functioning of the Committee
may be assessed within the normal annual cycle of reporting by internal and external
auditors and external regulatory bodies.


Nominated Deputy Arrangements
                   Member                              Nominated Deputy
Chairman                                    Vice Chairman or Non Executive Director
Chief Executive                             Deputy Chief Executive or Executive
                                            Director
Deputy Chief Executive or Executive A           non    member     Executive   Director,
Director                                    Director of Operations, Divisional Director
                                            or Senior Manager within Executive
                                            Director’s own structure
Medical Director                            Clinical Head of Division or Clinical
                                            Operations Director




                                                                                    33
                                              Finance & Performance Committee Meeting
                                            29th January 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                  Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments             Deputy Chief Executive
                      SMB Minutes                                                           Chief Executive
                      Divisional Board Decisions                                            Director of Operations
Performance
                      Integrated Performance Report                                         Director of Clinical Care and Governance




                                                                                                                                 34
                                              Finance & Performance Committee Meeting
                                            25th February 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                   Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments              Deputy Chief Executive
                      SMB Minutes                                                            Chief Executive
                      Divisional Board Decisions                                             Director of Operations
                      Procurement Plan                                                       Head of Procurement
Performance
                      Integrated Performance Report                                          Director of Clinical Care and Governance




                                                                                                                                  35
                                              Finance & Performance Committee Meeting
                                             25th March 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                 Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments            Deputy Chief Executive
                      SMB Minutes                                                          Chief Executive
                      Divisional Board Decisions                                           Director of Operations
Performance
                      Integrated Performance Report                                        Director of Clinical Care and Governance




                                                                                                                                36
                                         Finance & Performance Committee Meeting
                                         30th April 2008, Seminar Room 9, RBH, 13.00


Operational Updates
                      Surgical Division Budget Sign Off                                Divisional Director
                      Medical Division Budget Sign Off                                 Divisional Director
                      Women and Children Division Budget Sign Off                      Divisional Director
                      Corporate Divisions Budget Sign Off                              Executive Directors
                      Foundation Trust Project Board Minutes & IBP Developments        Deputy Chief Executive
                      SMB Minutes                                                      Chief Executive
                      Divisional Board Decisions                                       Director of Operations
                      Review of Quarterly Performance Minutes                          Director of Clinical Care and Governance
                      MPN Implementation Update                                        Deputy Chief Executive
Performance
                      Integrated Performance Report                                    Director of Clinical Care and Governance




                                                                                                                            37
                                              Finance & Performance Committee Meeting
                                              27th May 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments           Deputy Chief Executive
                      SMB Minutes                                                         Chief Executive
                      Divisional Board Decisions                                          Director of Operations
Performance
                      Integrated Performance Report                                       Director of Clinical Care and Governance




                                                                                                                               38
                               Finance & Performance Committee Meeting
                              25th June 2008, Seminar Room 9, RBH, 13.00


Operational Updates
                      Meeting Patient Needs Implementation                      Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments Deputy Chief Executive
                      Annual Review of Terms of Reference and Effectiveness     Company Secretary
                      IBP Update                                                Director of Finance
                      Minutes of Reporting Committees / Groups                  Various
                      Committee Annual Report                                   Company Secretary


Performance
                      Integrated Performance Report                             Director of Clinical Care and Governance




                                                                                                                     39
                                              Finance & Performance Committee Meeting
                                             6th August 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                 Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments            Deputy Chief Executive
                      Divisional Board Decisions                                           Director of Operations
Performance
                      Integrated Performance Report                                        Director of Clinical Care and Governance




                                                                                                                                40
                               Finance & Performance Committee Meeting
                             27th August 2008, Seminar Room 9, RBH, 13.00


Operational Updates
                      Surgical Division Budget Review                           Divisional Director
                      Medical Division Budget Review                            Divisional Director
                      Women and Children Division Budget Review                 Divisional Director
                      Corporate Divisions Budget Review                         Executive Directors
                      Foundation Trust Project Board Minutes & IBP Developments Deputy Chief Executive
                      Divisional Board Decisions                                Director of Operations
                      Review of Quarterly Performance Minutes                   Director of Clinical Care and Governance
                      MPN Implementation Report                                 Deputy Chief Executive
Performance
                      Integrated Performance Report                             Director of Clinical Care and Governance




                                                                                                                     41
                                              Finance & Performance Committee Meeting
                                             1st October 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                  Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments             Deputy Chief Executive
                      Divisional Board Decisions                                            Director of Operations
Performance
                      Integrated Performance Report                                         Director of Clinical Care and Governance




                                                                                                                                 42
                                            Finance & Performance Committee Meeting
                                          29th October 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                      Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments Deputy Chief Executive
                      Divisional Board Decisions                                Director of Operations
                      Procurement Plan                                          Head of Procurement
                      Budget Reforecast                                         Director of Finance, Capital, Planning and Information
Performance
                      Integrated Performance Report                             Director of Clinical Care and Governance




                                                                                                                                   43
                                              Finance & Performance Committee Meeting
                                           3rd December 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Meeting Patient Needs Implementation                                 Deputy Chief Executive
                      Foundation Trust Project Board Minutes & IBP Developments            Deputy Chief Executive
                      Divisional Board Decisions                                           Director of Operations
Performance
                      Integrated Performance Report                                        Director of Clinical Care and Governance




                                                                                                                                44
                               Finance & Performance Committee Meeting
                              December 2008, Seminar Room 9, RBH, 13.00
Operational Updates
                      Surgical Division Budget Review                           Divisional Director
                      Medical Division Budget Review                            Divisional Director
                      Women and Children Division Budget Review                 Divisional Director
                      Corporate Divisions Budget Review                         Executive Directors
                      Foundation Trust Project Board Minutes & IBP Developments Deputy Chief Executive
                      Divisional Board Decisions                                Director of Operations
                      Review of Quarterly Performance Minutes                   Director of Clinical Care and Governance
                      MPN Implementation Report                                 Deputy Chief Executive
Performance
                      Integrated Performance Report                             Director of Clinical Care and Governance




                                                                                                                     45
                                Remuneration Committee
Constitution
The Trust Board has established this Sub Committee to be known as the
Remuneration Committee. The Committee will report to the Trust Board. The
Committee has overarching responsibility for the remuneration of, arrangements for
the appointment of, and agreement of termination packages for, Executive Directors
and very senior management within the Trust. The Committee has the authority to
appoint short term, outcome focused sub committees but does not routinely receive
reports from other sub committees.


Delegated Authority
The Committee has authority to determine, in consultation with the Chairman and the
Chief Executive of the Trust;
   •   the policy on the remuneration of Executive Directors
   •   the specific remuneration packages for each of the Executive Directors
       including pension rights and any compensation payments
   •   the remuneration of other very senior employees who are considered by the
       Committee to hold key positions within the Trust and whose remuneration
       package is, or is considered appropriate to place, outside the provisions of
       the Agenda for Change framework
   •   the remuneration of other employees who are considered by the Committee
       to hold key positions within the Trust who are employed to perform specific
       short term functions on a semi consultancy basis
   •   the arrangements for the appointment of individuals outlined above
   •   the termination packages of any individual outlined above.
In determining the remuneration and termination packages and the remuneration
policy, the Committee shall keep in mind
   •   firstly, the desirability of the maintenance throughout the Trust of a
       competitive, fair remuneration structure which operates in the interests of and
       to the benefit of the financial and commercial health of the Trust
   •   secondly, ensuring the members of the executive management of the Trust
       are provided with appropriate incentives to encourage enhanced performance
       and are, in a fair and responsible manner, rewarded for their individual
       contributions to the success of the organisation
The Committee is authorised through the Secretary to seek any information it
requires from an employee of the company in order to perform its duties.


                                                                                   46
The Committee is authorised, in consultation with the Secretary, where necessary to
fulfil its duties, to obtain any outside legal or other professional advice including the
advice of independent remuneration consultants, to secure the attendance of
external advisors at meetings and to obtain reliable up to date information about
remuneration in other Trusts.
The Committee has authority to commission reports and surveys that it considers
necessary to fulfil its obligations.


Membership
· Trust Chairman
· All Non-Executive Directors


In Attendance
Chief Executive
Director of Organisational Development
Company Secretary
No individual will be involved in any part of a meeting at which decisions as to their
own remuneration will be taken.


Quorate
Board Chairman and two Non-Executive Directors.


Frequency & Format of Meetings
At least two meetings will be held annually. Additional meetings will be convened by
the Secretary at the request of any member of the Committee. Unless otherwise
agreed, notice of each meeting confirming the venue, time and date, together with an
agenda of items to be discussed and supporting papers, shall be sent to each
member and any other person required to attend, no later than 5 working days before
the date of the meeting.


Attendance
A quorum must be maintained at all meetings. Each member will attend a minimum
of 50% of the meetings throughout the year


Regular Reports
None.


                                                                                      47
Board Services
Chairman              –      Trust Chairman
Secretary              –     Company Secretary
Lead Director         –      Director of Organisational Development


Monitoring Arrangements
The effectiveness of the Committee will be reviewed on an annual basis as part of
the Trust Board Business Cycle. The Committee will provide an annual report on its
activities to Part 2 of the Trust Board as part of this review. The functioning of the
Committee may be assessed within the normal annual cycle of reporting by internal
and external auditors and external regulatory bodies.


Nominated Deputy Arrangements
                   Member                               Nominated Deputy
Chairman                                    Vice Chairman or Non Executive Director
Chief Executive                             Deputy Chief Executive or Executive
                                            Director
Deputy Chief Executive or Executive A           non     member    Executive   Director,
Director                                    Director of Operations, Divisional Director
                                            or Senior Manager within Executive
                                            Director’s own structure
Medical Director                            Clinical Head of Division or Clinical
                                            Operations Director




                                                                                    48
                            Trust Board Terms of Reference


Purpose
· To set the strategic direction of the organisation within the overall policies and
priorities of the Government and the NHS, define its annual and longer terms
objectives and agree plans to achieve them.
· To oversee the delivery of planned results by monitoring performance against
objectives and ensuring corrective action is taken when necessary.
· To ensure effective financial stewardship through value for money, financial control
and financial planning and strategy.
· To ensure that high standards of corporate governance and personal behaviour are
maintained in the conduct of the business of the whole organisation.
· To appoint, appraise and remunerate senior executives.
· To ensure that there is effective dialogue between the organisation and the local
community on its plans and performance and that these are responsive to the
community’s needs.


Membership
· Chairman
· Chief Executive
· Non-Executive Directors
· Executive Directors


Quorate
One third of whole number of Directors, including two Executive and two Non-
Executive Directors.


Regular Reports
A schedule of regular reports is attached. This will be subject to alteration and will be
regularly reviewed and updated. All business will be transacted in part I of the
meeting, unless due to the confidential nature of the business, publicity would be
prejudicial to the public interest.
A schedule defining the criteria for exclusion of the public is attached.




                                                                                       49
Frequency & Format of Meetings
Formal Trust Board meetings will be held bi monthly, on the last Wednesday of the
month.    There is an Annual General Meeting in accordance with the NHS Trust
(Public Meetings) Regulations 1991.


Board Services
Chair – Trust Chairman
Secretary – Company Secretary


Recognised Sub-Committees
The Trust has four recognised sub-committees. Each committee has delegated
powers as agreed by the Trust Board.
The sub-committees are:-
   •     Audit and Governance Committee
   •     Finance and Performance Committee
   •     Remuneration Committee
   •     Trust and Charitable Funds Committee
   •     Strategic Management Board
   •     Clinical Policy Group




                                                                              50
                                                             Trust Board Meeting
                                                    30th January 2008, Clayton Park, 13.00


Strategy                  Market and Business Development Report                         Director of Strategic and Market Planning
                          Key Trends and Forecasts                                       Director of Clinical Care and Governance
                          Draft Annual Plan and Budgets                                  Director of Finance, Capital, Planning and Information


Operational Performance
                          Exception Report on Quality of Services and Use of Resources Director of Clinical Care and Governance
                          Quarterly Staff Survey Results                                 Deputy Chief Executive
                          Review of Finance and Efficiency                               Director of Finance, Capital, Planning and Information
                          Reports from Committees                                        Company Secretary
                          Meeting Patient Needs Implementation Update                    Deputy Chief Executive
Risk
                          Assurance Framework Update                                     Director of Clinical Care and Governance
Other
                          Review of Sub Committee Effectiveness                          Company Secretary
                          Foundation Trust Update                                        Deputy Chief Executive




                                                                                                                                         51
                                                             Trust Board Meeting
                                         26th March 2008, Ribble Valley Council Chambers, 13.00


Strategy
                          Key Trends and Forecasts                                     Director of Clinical Care and Governance
                          Progress on Strategic Objectives                             Director of Strategic and Market Planning
                          Annual Plan and Budgets                                      Director of Finance, Capital, Planning and Information
Operational Performance
                          Exception Report on Quality of Services and Use of Resources Director of Clinical Care and Governance
                          Reports from Committees                                      Company Secretary
                          Annual Report of Trust and Charitable Funds Committee        Committee Chairman
                          Meeting Patient Needs Implementation                         Deputy Chief Executive
Risk
                          Review of Risk Register                                      Director of Clinical Care and Governance
                          Adoption of Assurance Framework                              Director of Clinical Care and Governance
Other
                          Foundation Trust Update                                      Deputy Chief Executive




                                                                                                                                       52
                                                           Trust Board Meeting
                                             4th June 2008, Hyndburn Community Link, 13.00


Strategy
                          Market and Business Development Report                       Director of Strategic and Market Planning
                          Key Trends and Forecasts                                     Director of Clinical Care and Governance
Operational Performance
                          Exception Report on Quality of Services and Use of Resources Director of Clinical Care and Governance
                          Quarterly Staff Survey Results                               Deputy Chief Executive
                          Reports from Committees                                      Company Secretary
                          Annual Report of Audit and Governance Committee              Committee Chairman
                          Diversity and Equality Report                                Deputy Chief Executive
                          Meeting Patients Needs Implementation                        Deputy Chief Executive
Risk
                          Assurance Framework Report                                   Director of Clinical Care and Governance
Other
                          Foundation Trust Update                                      Deputy Chief Executive




                                                                                                                                   53
                                                            Trust Board Meeting
                                               29th July 2008, Pendle Borough Council, 13.00


Strategy
                          Estates Strategy                                     Director of Estates and Facilities
                          IM&T Strategy                                        Director of Finance
                          Annual Plan 08/09                                    Director of Planning and Strategic Development
                          Healthier Horizons for the North West                Director of Planning and Strategic Development
Operational Performance
                          Report on Quality of Services and Use of Resources   Director of Clinical Care and Governance & Director of Finance
                          Reports from Committees                              Company Secretary
                          Meeting Patient Needs Implementation                 Deputy Chief Executive
Risk
                          Review of Assurance Framework                        Director of Clinical Care and Governance
Other
                          Foundation Trust Update                              Deputy Chief Executive
                          Annual Report of Finance and Performance Committee Chairman




                                                                                                                                      54
                                                       Annual General Meeting
                                           24th September 2008, Burnley Town Hall, 12.00
                          Chair's Welcome & Report                                  Chairman
                          Minutes of 2007 Annual General Meeting                    Chairman
                                                                                    Director of Finance, Capital, Planning and
                          Annual Statement of Accounts                              Information
                          Annual Report                                             Chief Executive
                          Questions/ Comments from the Public                       Chairman


                                                           Trust Board Meeting
                                           24th September 2008, Burnley Town Hall, 13.30


Strategy
Operational Performance
                          Report on Quality of Services and Use of Resources        Director of Clinical Care and Governance
                          Quarterly Staff Survey Results                            Deputy Chief Executive
                          Reports from Committees                                   Company Secretary
                          Meeting Patient Needs Implementation                      Deputy Chief Executive
Risk
                          Assurance Framework Report                                Director of Clinical Care and Governance




                                                                                                                                 55
Regulatory
                                       Director of Finance, Capital, Planning and
             ALE Scores Receipt        Information
Other
             Foundation Trust Update   Deputy Chief Executive




                                                                                    56
                                                             Trust Board Meeting
                                                    th
                                                26 November 2008, Clayton Park, 13.00


Strategy
                          Progress on Strategic Objectives                          Director of Strategic and Market Planning
Operational Performance
                          Report on Quality of Services and Use of Resources        Director of Clinical Care and Governance
                          Reports from Committees                                   Company Secretary
                          Diversity and Equality Report                             Deputy Chief Executive
                          Meeting Patient Needs Implementation                      Deputy Chief Executive
Risk
                          Review of Risk Register                                   Director of Clinical Care and Governance
Regulatory
                          Health Care Commission Report                             Director of Clinical Care and Governance




                                                                                                                                57
                     Major Projects Board Terms of Reference


Constitution
The Trust Board has established this Sub Committee of the Finance and
Performance Committee to be known as the Major Projects Board. The sub
committee will report to the Finance and Performance Committee. The sub
committee has overarching responsibility for monitoring and assuring the Finance
and Performance Committee on the strategic links between major development
projects undertaken by the Trust.


Delegated Responsibilities
The Committee has no delegated functions save those steps necessary to ensure
monitoring and assurance of the strategic links between the major projects
undertaken by the Trust. A specific focus will be the links between the areas of
financial sustainability, commercial development and performance improvement and
associated organisational development projects and initiatives
The Major Projects Board will update the Finance and Performance Committee on
the key outputs of major Trust projects.


Membership
Non Executive Director (Chair)
Deputy Chief Executive Officer
Director of Finance (Financial Sustainability Lead)
Director of Clinical Care and Governance (Commercial Development/Performance
                                             Improvement Lead)
Head of Organisational Development (Organisational Development Lead)
Medical Director (Clinical Services)
Director of Operations
1 Non Executive Director
Director of Strategy and Productivity
Deputy Director of Finance
Head of Service Improvement


Quorate
4 members one being an Executive Director and one Non Executive Director


Attendance
A quorum must be maintained at all meetings. Each member will attend a minimum
of 60% of the meetings throughout the year. Executive Director members who are
unable to attend will arrange for the attendance of a nominated deputy whose
attendance will be recorded in the minutes, making clear on whose behalf they
attend.


Frequency and Format of Meetings
Bi monthly


Regular Reports
Progress reports from all major projects.


Board Services
Chair                  Non Executive Director
Lead Director -        Deputy Chief Executive
Secretary              Company Secretary


Committees Reporting
Lean steering group


Monitoring Arrangements
The effectiveness of the Committee will be reviewed on an annual basis as part of
the Trust Board Business Cycle. The Committee will provide an annual report on its
activities to the Finance and Performance Committee as part of this review. The
functioning of the Committee may be assessed within the normal annual cycle of
reporting by internal and external auditors and external regulatory bodies.


Nominated Deputy Arrangements
Deputy Chief Executive                      An Executive Director
Director of Finance                         Deputy Director of Finance
Director     of    Clinical   Care    and Head of Assurance and Safety
Governance
Medical Director                            Clinical Head of Division or Clinical
                                            Operations Director
Director Of Operations                      Divisional Director
Director of Strategy and Productivity       Productivity Project Manager


                                                                               59
Deputy Director of Finance            Deputy Director of Finance
Head of Service Improvement
Head of Organisational Development
Non Executive Director                Non Executive Director



                             DATES FOR MEETINGS


09/06/08     - 14:00
06/08/08     - 10:00
15/10/08     - 14:00
03/12/08     - 14:00




                                                                   60
Trust Board Members’ Strategy & Development Days




Trust Board strategy and development days are an opportunity for members to
discuss and debate the strategic direction of the Trust enabling a common
understanding to be gained of the issues and challenges facing the Trust. The
development days are themed and are an opportunity for members to raise and
discuss issues arising since the last formal Trust Board meeting. Members of the
public and the press will not be invited to attend these meetings. Dates will be
provided as meetings are arranged.




                                                                             61
Strategic Management Board Terms of Reference


Constitution
The Trust Board’s vision is encapsulated in the Trust’s Business Plan. It is supported
by enabling strategies setting out what we aim to achieve over the next five years.
The Strategic Management Board will support the Trust’s vision and its values in its
aim to improve the health, life expectancy and quality of life of the residents of East
Lancashire.
The Committee will report to the Trust Board and will support the Chief Executive to
deliver the strategies agreed by the Trust Board and plan strategies for approval by
the Trust Board


Delegated Responsibilities
   •   The Strategic Management Board will agree and formulate key policies and
       strategies to ensure the effective strategic management of all Trust activities.
   •   The Board will formulate and approve key policy documents to ensure
       effective management of the finances and performance of the Trust
   •   The Board has the authority to appoint time limited subcommittees to assist it
       to achieve its delegated responsibilities. The minutes and/ or decisions of
       such subcommittees will be reported to the Board on a regular basis.
   •   The Board may seek assurances from appropriate Committees, departments
       or individuals within the Trust in relation to any aspect of financial, clinical or
       organisational controls to ensure that effective systems and processes are in
       place to enable the Trust to achieve the aims, strategies and objectives
       agreed by the Trust Board
   •   Receive internal and external reports on Trust activity and action the agreed
       recommendations


Membership
Chief Executive
Executive and Corporate Directors
Divisional Directors
Clinical Heads of Division
Company Secretary




                                                                                       62
Attendees
Clinical Operations Directors
Head of Human Resources, Operations and Organisational Development
Head of Service Improvement
Associate Medical Directors
Head of Information


Quorum
At least one third of the membership to include Chief Executive or Deputy Chief
Executive or Director of Finance and at least two Executive or Corporate Directors


Frequency of Meetings
Meetings will be held monthly – normally on the second Wednesday of each month.
Papers will be distributed in electronic format 7 days prior to the meeting and actions
will be issued within one week of the meeting. The format for papers will be
consistent and follow the corporate style.


Attendance
A quorum must be maintained at all meetings. Each member will attend a minimum
of 60% of the meetings throughout the year. Members who are unable to attend will
arrange for the attendance of a nominated deputy whose attendance will be recorded
in the minutes, making clear on whose behalf they attend. A nominated deputy for
this purpose will be treated as a member on any matter under debate or upon which
a vote is required and will count to the quorum.


Regular Reports/ Reporting Committees
Access, Booking and Choice Steering Group
Capital Planning Committee
IM&T Board
Care, Environment and Amenities Group
Hospital At Night/ EWTD Subgroup
4 Hour Sustainability Group
Consultant Appointments


Board Services
Chair          -      Chief Executive
Secretary      -      Company Secretary

                                                                                     63
Nominated Deputy Arrangements
                   Member                           Nominated Deputy
Chief Executive                          Executive Director
Executive Director                       Corporate Director or Senior Manager
                                         within Executive Director’s own structure
Medical Director                         Clinical Head of Division
Corporate Director                       Senior Manager within own structure
Clinical Heads of Division               Clinical Operations Director within own
                                         Division
Divisional Director                      Senior Manager within own structure


Terms of Reference Review
The Terms of Reference will be reviewed on at least an annual basis. All proposed
amendments to the Terms of Reference will be submitted to the Trust Board for
ratification.




                                                                                64
Clinical Policy Group Terms of Reference


Purpose:
To provide a forum for Clinical Leaders / Managers with the Executive Team to
provide advice, guidance and assurance to the Trust Board on clinical business
decisions and standards of care within East Lancashire Hospitals NHS Trust and to
form an integral part of the corporate governance system of the Trust.


Delegated Responsibilities:
•   To performance monitor all Trust activity against the Annual Business Plan and
    ensure the care stream approach is actively pursued.
•   Ensure on-going delivery of a complex programme of service reviews in order to
    ensure compliance with the MPN service model, whilst standardising,
    modernising and delivering care.
•   To advise the Trust Board on clinical investment issues
•   Monitor care service standards across the Trust thereby ensuring standards are
    adhered to.
•   Ensure complete clinical/professional ownership of the Trust’s investment and
    development agenda.
•   Direct clinical governance by encouraging a participative culture in which
    education, research, sharing of good practice and learning from mistakes is fully
    embedded in all processes.
•   Work closely with health and social care organisations to ensure a whole
    economy approach is applied.


Reports To:
Trust Board


Receives Minutes of/ Reports from:
Strategic Management Board


Members:
Chief Executive
Medical Directors
Associate medical Directors
Clinical Directors

                                                                                  65
Executive Directors
PEC Representative Consultant


Quorum/ Attendance:
Chair or Deputy and 1/3 of membership
Minimum attendance required per annum per member or Nominated Deputy =
75%


Meeting Frequency:
Monthly


Board Services:
Chair                 -    Chief Executive
Minutes and Agenda -       Executive PA to Chief Executive




                                                                     66
Report Template


                                       REPORT TO
Meeting Date:                  Report Purpose:           Agenda Item:
                          For Decision             □
                          Performance Monitoring □
                          For Information          □
Report Submitted By:      Report Approved By:            Report Title:


Date Considered By        Divisional      Board    Chair Declaration of
Divisional Board/         Approval:                      Confidentiality Required:
Reason Not                                               Yes              No
Considered By
Divisional Board:




Implications For Partners:
Related to key risks identified on
Assurance Framework &
Consequences:
Related to Corporate Objective:
Related to HCC Standard:
Related to Standards for Better
Health Domain:
Executive Summary:
Recommendation/        What       Is
Required From The Committee:




                                                                               67
1. ...... Background/ Content/ Impact on the Organisation/ (Fit with Strategic Direction/
Vision and Values/ Compliance with National Agendas)/ Impact on Organisation of
Doing Nothing: .....................................................................................................
2. ................................................................................................. Options (If Any)
...........................................................................................................................
3. ............................................. Costs (Including Identified Source of Funding)/ VFM
...........................................................................................................................
4. ........................................................................... Conclusion/Recommendations
...........................................................................................................................




                                                                                                                       68
1. Background/ Content/ Impact on the Organisation/ (Fit with Strategic
      Direction/ Vision and Values/ Compliance with National Agendas)/ Impact
      on Organisation of Doing Nothing:
1.1
1.2
1.3


2. Options (If Any)
2.1
2.2
2.3


3. Costs (Including Identified Source of Funding)/ VFM
3.1
3.2
3.3


4. Conclusion/Recommendations
4.1
4.2
4.3


Author and Title:
Author Contact Details:
Press Paper Supplied:
Date of Submission:
Date Accepted for Committee:




                                                                          69
                                                            Committee Meeting Dates 2008
                         Jan       Feb             Mar      Apr     May     Jun       Jul    Aug      Sept   Oct    Nov    Dec
Trust Board
(13.00)                  30th                      26th                     4th       29th            24th          26th
Audit & Governance
(9.30 Seminar Room 9)    23rd **                   5th      16th            9th       23rd            3rd    15th          3rd
Finance & Performance                                                                        6th             1st
(13.00 Seminar Room 9)   29th      25th            25th     30th            25th             27th            29th          TBC
                                                                             4th
                         23rd                      5th                      (Exec
Trust & Charities        (13.00                    (13.00                   Meeting
(10.00 Seminar Room 9)   Start)                    Start)                   Room)                     24th                 5th
Remuneration
(after Trust Board)
                                                                                             6th
                                       th
MPB                                4                                                         (10:00
(14:00 Seminar Room 9)   15th      25th            19th     16th            9th              am)             15th          3rd
Trust Board Strategy &
Development Days
(09.30 Seminar Room 9)   30th                      26th     30th                             27th            29th          TBC
                                            th &
                                   27
IOD Development
71
                      Trust Board Committee Structure

                                                                       CLINICAL POLICY
                                                                           GROUP
                                 TRUST BOARD




  AUDIT &      FINANCE &          TRUST &               REMUNERATION        STRATEGIC
GOVERNANCE   PERFORMANCE         CHARITABLE              COMMITTEEE        MANAGEMENT
 COMMITTEE    COMMITTEE            FUNDS                                      BOARD
                                 COMMITTEE




                                                                                    72
Revisions:
                       Revision                              Date       Author
Amended ToR for Major Projects Board                    January 2008   FM
Amendments to ToR Trust and Charitable Funds            May 2008       FM
Amendments to dates for Trust and Charitable May 2008                  FM
Funds
Amendments to Audit & Governance TOR                    May 2008       FM
Correction of Meeting Dates                             May 2008       FM
Updated ToR Major Projects Board to include OD May 2008                FM
Lead and dates for meetings
Insertion of SMB Terms of Reference                     May 2008       FM
Insertion of Sub Committee Structure Diagram            May 2008       FM
Amendment of SMB Terms of Reference                     June 2008      FM
Amendment of SMB Terms of Reference                     July 2008      FM
Insertion   of   Clinical   Policy   Group   Terms   of July 2008      FM
Reference
Amendment of Sub Committee Structure Diagram            July 2008      FM
Insertion of 2009 Meeting Dates                         July 2008      FM




                                                                             73

				
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