NHSB

Performance Report
July 2010

Delivering Better Health in Barnet

1
 Overall Summary
This report covers performance in the period to June 2010. This executive summary provides a high level summary of performance of the PCT
and the situation within the local NHS. The report concentrates on ‘exceptions’ and therefore the actions that the PCT needs to take to further
improve its performance and the level of healthcare for all our patients. The report focuses on the performance of the PCT in relation to the key
objectives set.

The year to date and forecast financial positions are in line with the plan to breakeven at year end. Net risks to this position of £2.2m have been
identified.

Growth in the acute sector is currently below the 7% assumed in the financial plan. If this position continues it presents an opportunity for NHS
Barnet to deliver a financial position that exceeds the control total set.

A risk adjusted assessment of the financial recovery programme has identified that a shortfall of £10,474k is currently likely, representing 35% of
the programme. This is reflected in the forecast outturn of breakeven and the net risk position of £2.2m. It is critically important that this shortfall
is addressed, and the management team both recognises this and is focused on delivery. Mitigating actions being taken are:
• programme management training is being provided to all NHSB staff and the programme management office will go live on 2 August
• all red rated schemes have been reviewed. Limited opportunities have been identified to date but further work to identify projects is being
undertaken
• sector wide schemes have been agreed and are being managed through the programme management office at NHS Camden
• the sector commissioning unit has taken responsibility for identifying additional schemes to mitigate the risk of acute supply side savings and a
meeting to identify further opportunities is scheduled for 22 July. This however remains the area of greatest risk
• opportunities to increase the engagement of GPs in commissioning through the setting of indicative budgets are being explored.

50 risks have been identified in relation to delivery of the business plan. Of these, 23 have a current red risk rating.

Members are asked to note that a full assessment of the implications of the White Paper is being carried out by the Executive team and its
implications on objectives and risk to delivery considered.

Quality accounts have been published for major providers and they are contained in the main Board agenda.

Two enabling projects have been placed at risk: Finchley Memorial Hospital business case has been referred to treasury and for ministerial
approval; government funding has been withdrawn from the co-location project at Brunswick Park.

2
 Performance Areas

1. Finance and Activity

The year to date and forecast financial positions are in line with the plan to breakeven at year end. Net risks to this position of £2.2m have
been identified.
Growth in the acute sector is currently below the 7% assumed in the financial plan. If this position continues it presents an opportunity for
NHS Barnet to deliver a financial position that exceeds the control total set.
Weekly lead indicator information from Barnet and Chase Farm indicates that for quarter 1 year on year there is minimal growth in activity in
inpatients or A&E, and growth in outpatients is 7.7%. Some overperformance in orthopaedics during June is anticipated due to the
outsourcing of elective activity to the private sector to improve the Trust’s performance against the 18 week admissions target. This risk is
included in the risks and opportunities log.

2. Financial Recovery Programmes

At month 3, savings of £2.46m against a plan of £3.58m have been confirmed, with the status of further savings of £565k not yet known. This
gives a range of achievement of 69% to 85%. The confirmed savings are included in the year to date position.
A risk adjusted assessment of the financial recovery programme has identified that a shortfall of £10,474k is currently likely, representing 35%
of the programme. This is reflected in the forecast outturn of breakeven and the net risk position of £2.2m. It is critical that this shortfall is
addressed. Mitigation of the risks associated with these programmes will both remove the net risk to the forecast outturn and provide a reserve
in case of increased acute performance later in the year. Mitigating actions are being taken.

3. Quality outcomes
.
Quality accounts from the main acute providers are on the main Board agenda, as it an implementation plan for the quality strategy. Indicators
within contracts to measure access, safety and improving outcomes will be reported on in future reports as the contract review data is analysed.
Key areas for the Board in this report are:
•Care quality commission conducted an inspection of inpatient areas at NHSBs two community hospitals. Against 14 measures, 3 improvement
areas were identified: fabric of building at Finchley Memorial Hospital; minimising risk of legionella; audit on antimicrobial prescribing nit being
conducted. A detailed action plan is in place to address these issues.
•A rise in MRSA rates
•A review of mortality rates (previously requested by the Board following the Mid Staffs review).
These two issues are detailed in this report
3
 Performance Areas

4. Annual Health Check

The Annual Health Check for 2009/10 will not be published by CQC in October 2010 as previously expected. Instead benchmarking data will be
published.
The 18 weeks target and patient access to primary care will no longer be performance managed.
The new operating framework guidance requires us to continue with plans submitted unless guidance is issued otherwise.
Further changes following the publication of the white paper are being assessed.
Data for the majority of indicators is not published until the end of July and thus cannot be reflected in this report.

5. Business Plan
Implementation of the business plan is progressing and is detailed in this report. The Board should note the following threats to delivery
Objective 1 (finance and recovery programme) has 14 high and medium level risks identified
Objective 4 (delivery of operating plan) is now under review following the white paper publication
Finchley Memorial Hospital project has been referred to ministerial approval and is the timescale places the commercial framework of the project
at risk
The co-location funding for Brunswick Park project has been withdrawn by central government and urgent meetings are being held to look at
alternative options.

6. Workforce and Development

The Workforce Committee are considering the requirements for this section of the report at their meeting of 7 September. The
development of targets for this area will also be reviewed.

We are required to review the ethnic make up of our workforce on at least an annual basis and this metric is included in the report.
The Use of Resources elements that relate to workforce will be reported but this is currently being revised by the Audit Commission .

4
 Financial Performance – Key Performance Indicators – Clare Parker

Indicator Plan Actual Variance RAG Measurement

£000s £000s from plan rating
£000s
Headline indicators RAG based on percentage of income

Year to date position 361 451 90 Actual spend to date

Forecast outturn 0 0 0 Forecast spend

Net risks / (opportunities) 0 2,190 2,190 Difference between the risks &
opportunities that are not included in
forecast outturn

Run rate Not set Difference between recurrent income and

expenditure in month
Underlying indicators RAG based on percentage of savings
plan
Recovery programme year to (3,577) (2,459) 1,118 Actual savings confirmed as achieved –
date included in ytd position
Recovery programme forecast (30,026) (19,552) 10,474 Forecast savings at year end. £15,050k
outturn included in FOT, £4,502k included in
opportunities

RAG rating:
Green – in line with or better than plan
Amber – less than 0.5% above plan
Red – more than 0.5% above plan

5
Financial Performance – year to date position Clare Parker

Issues to be discussed
The year to date position is overspent by £90k, less than 0.1% of budget. Contingency of £575k has been released to offset non recurrent pressures.
There are overspends in community and high cost placements but due to the size and nature of these budgets the impact on the forecast outturn is
relatively small.
Acute contracts were underspent by £524k at month 2, the latest month for which we have information. However this masks a range of performance.

M2 (under)/over performance against acute contracts UCLH expenditure - Pbr and non PbR against plan

300

Monthly expenditure £000s

1800
(under) / over performance £000s

200 1600
1400
100 A ctual PbR
1200
0 1000 A ctual Non PbR
800 Plan PbR
H
LH

H
ee

r
SH

EH
F

-100

to
to

U
C

Fr

ec
C

600
B&

NM
N
ng

M
U

Plan Non PbR

fs
R

t ti

-200

o
hi

400

ut
W

O
-300 200
0
-400

-500
Trust Month

Royal Free is currently showing the largest underspend in sector.
Key risks relate to Barnet & Chase Farm (B&CF), UCLH and the
Whittington. The B&CF overspend is driven by outpatients (7.7%
activity overperformance), high cost drugs and new best practice
tariffs. Outpatient increases are not currently converting into elective
activity.
UCLH is overspent at m2, driven by an increase in PbR spend that
is not in line with trend. Again, the main driver is outpatients with
an activity overperformance of 26%. Unlike B&CF, this is also
converting into elective activity which is the main driver of the
financial overperformance. This may indicate an element of patient
choice rather than changing clinical behaviours.

Actions undertaken
The following actions are being taken to mitigate the year to date position:
• the referral management service is now fully operational and is reviewing all referrals other than those such as cancer referrals which
are clinically urgent. Consultants will be introduced from August to provide management plans to GPs to enable patients to be more
appropriately managed in primary care, and will be undertaking audits to identify options for establishing community services
• options for increased GP engagement in budget management are being explored,
6 including joint work with the Royal Free in South
Barnet
Financial Performance - Year to date performance Clare Parker
An nual YTD YTD YTD YTD  YTD YTD
Budget Actual Budget  Variance Varian ce Variance Var iance 
Non 
recurrent Recurrent Recu rrent
£000's £000's £000's £000's £000's £000's %
 
Resource limit (560,118) (137,874) (137,671) (203) 0 (203) ‐0.1%
Income (13,040) (3,552) (3,218) (334) 0 (334) ‐10.4%

Total Income (573,158) (141,426) (140,888) (537) 0 (537) 0.4%

Commissioning Expenditure

Acute Services 307,747 76,786 76,789 (3) 476 (479) ‐0.6%

Community Services 45,208 11,340 11,047 293 87 206 1.9%
Mental Health 37,344 8,529 9,280 (751) (606) (145) ‐1.6%
Continuing Care 22,025 5,539 5,581 (42) 0 (42) ‐0.8%
Learning Disabilities 11,489 2,918 2,872 46 24 22 0.8%
Palliative Care 1,076 270 270 1 0 1 0.2%
Primary care 123,807 31,577 30,932 644 535 109 0.4%
Specialist commissioning 21,816 5,465 5,528 (62) (130) 68 1.2%
Other Commissioning 7,917 2,557 2,181 376 195 181 8.3%

Costs of commissioning 6,776 1,692 1,725 (34) 0 (34) ‐7.3%

Total Commissioning Expenditure 585,205 146,674 146,205 468 581 (113) 2.5%

Corporate Expenditure 21,766 7,015 6,885 130 (6) 136 9.4%

Unallocated Reserves 6,842 0 575 (575) (575) 0 0.0%

Total Ex penditure 613,813 153,689 153,665 23 0 23 0.0%

Commissioning (Surplus)/Deficit 40,655 12,263 12,777 (514) 0 (514) ‐4.2%

Provider (surplus) deficit (247) 530 (74) 604 604 816.0%

PCT Total (Surplus)/Deficit (pre support) 40,408 12,793 12,703 90 0 90 0.7%

Non recurrent financial support (40,408) (12,342) (12,342) 0 0 0 0%

PCT Total (Surplus)/Deficit  0 451 361 90 0 90 42.0%

7
Financial Performance - forecast outturn Clare Parker
Issues to be discussed
The forecast outturn position is breakeven. Acute budgets are currently forecasting an underspend of £2m, driven by a small overspend against
contract values per the sector commissioning unit’s analysis, a benefit from the budget slightly exceeding contract values and the inclusion of £1.6m
savings based on delivery at month 3. The key risk to this forecast is whether the phasing assumption used to generate the forecast is accurate.
Primary care is forecasting an overspend of £1.7m driven by prescribing. This represents a mid range forecast and there is a substantial risk of
further deterioration in this budget.
The forecast outturn for BCS is breakeven. This is a better position than they are forecasting internally, where risks totalling £1.8m have been
recognised in their position. Of those risks, £400k are internal and do not affect the overall PCT position. The remaining balance has been risk
assessed by the Director of Finance and included in the risks and opportunities log.

Forecast year end over / (under) performance Monthly prescribing expenditure

1,000 4400
4200

Spend £000
500
performance £000

4000
Over / (under)

0 3800
3600

H
H
H
LH
ee
F

SH

r
to

E
O
C

to
Fr

M
C

(500)
O
ng

N
B&

ec
3400
U

N
G
R

tti

s
hi

of
W

3200
ut
O
(1,000)

9
08

09

10
7

9
07

08

09

10
l-0

l-0

l-0
-0

-0

-0
n-

n-

n-
r-

r-

r-

r-
ct

ct

ct
Ju

Ju

Ju
Ja

Ja

Ja
Ap

Ap

Ap

Ap
(1,500)

O
Trust Month

The key overspends continue to be B&CF, UCLH and the Whittington.
As an absolute value and percentage the Whittington is forecast to be
the greatest by year end. There is no single driver of this spend as
there is overperformance against all main points of delivery, notably
elective, non elective and outpatients. Expenditure at the Whittington
has increased substantially over the last two years.
Prescribing is a volatile budget that is difficult to forecast. The graph
above shows trends over the last 3 years. Prices are out of the
control of NHSB as they are negotiated nationally, and changes in
prices, notably for generics, can have large positive or negative
impacts. Forecasting methodologies are currently being reviewed.

Actions undertaken
The actions being taken to manage the acute position are the same as those for the in year position. For prescribing, delivery of
the existing savings project and identification of new areas to target, particularly through review of changes in spend year on year,
are key to mitigating the position. As with acute, the engagement of GPs in managing prescribing budgets is also an area that is
being explored. 8
Financial Performance - forecast outturn position before risks and opportunity
Clare Parker
A nnua l Fore ca st Fo reca st Fore cas t Foreca st Fore cas t
B udge t Outturn Va riance V aria nce Va riance V a ria nce
N on 
Re curre nt recurre nt
£00 0's £0 00's £ 000 's % £00 0's £00 0's

Res ource  lim it (5 60 ,1 1 8) (5 60 ,118 ) 0 0.0 % 0 0

Incom e (1 3,040 ) (13,014 ) 26 0.2 % 26 0

Tota l Incom e (5 73 ,1 5 8) (5 73 ,132 ) 26 0.0 % 26 0

Com m iss ioning E xpenditure

A cute  Se rvice s 3 07 ,7 4 7 3 05 ,696 (2,051 ) ‐0 .7 % ( 2,5 27) 4 76

Com m unity Se rvices 4 5,208 45,939 73 1 1.6 % 6 44 87
M ental Hea lth 3 7,344 36,550 ( 79 4) ‐2 .1 % (1 88 ) (6 06 )
Continuing Care 2 2,025 22,025 0 0.0 % 0 0
Lea rning  Disabilitie s 1 1,489 11,625 13 6 1.2 % 1 12 24
Palliative Care 1,07 6 1,0 76 0 0.0 % 0 0
Prim a ry ca re 1 23 ,8 0 7 1 25 ,587 1,780 1.4 % 1,2 45 5 35
Spe cia list com m is sioning 2 1,816 21,726 (90 ) ‐0 .4 % 40 (1 30 )
O the r Com m issioning 7,91 7 8,6 33 71 6 9.0 % 5 21 1 95

Cos ts of  com m issioning 6,77 6 6,7 84 8 0.1 % 8 0

Tota l Com m is sioning Expe nditure 5 85 ,2 0 5 5 85 ,641 43 6 0.1 % (1 45) 5 81

Corpora te  Expe nditure 2 1,766 21,809 43 0.2 % 49 (6)

Unallocate d Re se rves 6,84 2 6,0 90 ( 75 2) ‐1 1.0% (1 77 ) (5 75 )

Tota l Ex penditure 6 13 ,8 1 3 6 13 ,540 (27 3) 0.0 % (2 73) 0

Com m iss ioning ( Surplus )/De ficit 4 0,655 40,408 ( 24 7) ‐0 .6 % (2 47 ) 0

Provider (s urplus)  de ficit (2 47 ) 0 24 7 100 .0 % 2 47 0

PCT  Tota l (Surplus)/Deficit (pre  support) 4 0,408 40,408 0 0.0 % 0 0

Non re curre nt fina ncial s upport (4 0,408 ) (40,408 ) 0 0.0 % 0 0

PCT  Tota l (Surplus)/Deficit  0 0 0 0.0 % 0 0

9
Financial Performance - risks and opportunities Clare Parker

Issues to be discussed
There are three key drivers of risks to the financial position: acute growth; delivery of savings and prescribing expenditure. Other budgets are
generally either too small or not sufficiently volatile to have a material impact on the forecast at an individual level.

Base case net risks / (opportunities) Best case net risks / (opportunities) Worst case net risk / (opportunity)

Net risk / (opportunity) £000

Net risk / (opportunity) £000

Net risk / (opportunity) £000

10,000 0 30,000
25,000

l
r
e

ta
20,000

gs

he

BC
ng

es
ut
5,000 (5,000)

To
vin

ot
ac

rv
ibi
15,000

se
sa
cr

re
es
10,000

pr
0 (10,000) 5,000
0
S

l
r
ute

ta
gs

he

BC
ng

es

(5,000) (15,000) (5,000)

To
vin

ot
ac

rv
ibi

tal
se

er
sa

ute
cr

gs

BC
es
ng

oth

To
re
es

vin
ac

rv
ibi
pr

se
sa
cr
(10,000) (20,000)

re
es
pr
In the base case scenario, net risks total £2.1m. In the best case, net opportunities total £15.8m and in the worst case net risks total £25.6m.
With the current forecast outturn of breakeven, the realisation of net risks or opportunities would directly impact on the position. There is
therefore a possibility that NHSB could underspend by £15.8m or overspend by £25.6m. The aim is to reduce this range of risk month on
month.

Actions undertaken
The following actions are being taken to mitigate the net risks and to reduce the forecast range month on month:
The risks & opportunities log is updated weekly by budget holders
The Programme Management Office is being put in place to manage savings risks through strengthened processes
A paper to improve forecasting has been agreed and directors are putting in place actions to implement the agreed process
The Director of Finance is leading joint work with the sector to improve information and agree a common forecasting methodology for
acute contracts.
10
Financial Recovery - Risks and opportunities 2010/11
summary – Month 4 status
Clare Parker

M1 M2 M3 M4

20
Net (risks) / opportunities £m 15
10
5
0
-5
-10
-15
-20
-25
-30

Base case Best case Worst case

M1 M2 M3 M4
Base case £m -1.5 -3.52 -4.5 -2.2
Best case £m 3 12.1 10.9 15.8
Worst case £m -11 -23.4 -24.4 -25.7

11
Financial Performance - Assumptions Clare Parker

Acute
Month 2 has been reported on the basis of information on actual expenditure provided by the agency, including assumptions for uncoded activity.
There is a risk that the accrual for uncoded activity may be less than the final amount billed.
No assumption has been included regarding the achievement of savings to date, although since the position was finalised it has been confirmed
that savings of £113k have been achieved from M1 challenges to trusts. Extrapolating this for the three months would improve the position by
£339k.
No data has yet been received for month 3. The position therefore is accrued to the budget before savings, i.e. assumes that no savings have
been achieved.
The budget has been phased locally based on the profile of actual expenditure in 2009/10. This has not yet been fully validated with trusts or the
agency to get a shared view of the expected expenditure profile. If the profile is incorrect it could over or understate the true variance at month 2.
There is little variance between the Barnet & Chase Farm profile and ours at month 2.

The forecast outturn is based on the forecast from the agency with local adjustments for non contract activity. £1.6m savings have been
recognised in the position with the rest included in the net risks and opportunities.

Prescribing
Information has been received for month 1 and 2 from the Prescription Pricing Division (PPD) and the month 3 position has been projected from
these.

Specialist commissioning
No information about performance has been received other than for forensics. The position is therefore accrued to budget for most areas. It has
been assumed that the planned savings of £50k for month 3 have not yet been delivered. The forecast outturn assumes the savings are delivered
but 90% of this has been included as at risk in the base case risks and opportunities.

Savings
Individual savings were reviewed with lead directors and lead commissioning managers as part of the month end financial close exercise. The
actual position was reflected accordingly within the ledger. Post month end reviews allowed for the savings to be reviewed again to monitor and
manage delivery as part of the Corporate Recovery initiative and also to feedback into the reporting cycle.

12
Financial Recovery - savings delivery Ian McNuff

Issues to be discussed
The percentage and value of savings not delivered in month 3 has increased compared to prior months. Given the back ended delivery of the overall
savings programme, this represents a serious risk to delivery of the programme and the financial plan of NHS Barnet. This risk is currently mitigated
by the lower than expected level of acute growth but there should not be a reliance that this trend will continue.
Using a risk adjusted methodology, the current forecast is that the recovery plan will deliver £19.5m against the plan of £30m.

Achievement of savings to month 3

Apr-10 May-10 Jun-10 Total
2000 £000s £000s £000s £000s
Not Delivered
Savings £000s

1500
Achieved 812 797 850 2,459

Awaiting confirmation of Awaiting

1000 confirmation 132 120 313 565
data
500 Achieved
Not Delivered 52 80 422 554
0
Apr-10 May-10 Jun-10 Total for month 996 997 1,585 3,578
Month

Actions undertaken
The Management Team is fully sighted on the risks to delivery and the need to reverse the shortfall. Mitigating actions are being
taken. The Programme Management Office will continue to review and support the delivery of green schemes. Where PIDs are
insufficiently robust or there are not enough milestones, this will be addressed with the scheme owners. Non financial key
performance indicators are being identified to give early indications of the success of projects.
Additional savings plans to mitigate slippage in the existing programme are being developed and more detail is provided later.

13
Financial Recovery - savings delivery Ian McNuff

Issues to be discussed
The main driver of the underachievement both year to date and for the forecast outturn is the acute supply side savings that are led
by the sector. An assessment by the Director of Finance indicates that only 34% of plans are likely to be delivered. The sector’s own
assessment is that 55% is currently achievable, but this is not supported by robust plans in every area.

Year to date underachievement of recovery plan Forecast underachievement of recovery plan

8,000 80.0%
350 7,000 70.0%
300 6,000 60.0%

Percentage
5,000 50.0%
250

£000
4,000 40.0%
200
£000

3,000 30.0%
150 2,000 20.0%
1,000 10.0%
100 0 0.0%

Referral mgt

Other
Acute

Prescribing

utilisation
placements

Community

pathways
50

Estates
High cost

Care
0
Acute Community Care Estates Other
pathways utilisation
Schemes
Schemes
forecast outturn % underachievement

A prudent assessment of the year end position has currently been made. There are robust processes in place in a number of areas,
such as referral management, but until monthly savings figures are delivered and confirmed it is not assumed that the full potential
benefits will be obtained.

Actions undertaken
The concerns regarding the acute savings have been escalated to the sector delivery Board. The NHS Camden programme
management office will be used to provide a robust process for developing PIDs and monitoring progress. This is the primary
mitigation of the risk as delivery could be improved across many schemes by putting robust plans into place. A meeting is being held
on 22 July to identify further savings options.
The current assessment of likely delivery was made by the Director of Finance. The recovery board has agreed that all directors, in
partnership with the NHSB programme management office, will undertake a risk based assessment of their plans and review
milestones and key performance indicators to ensure that benefits are maximised.
14
Financial Recovery – total schemes Ian McNuff

Issues to be discussed
The red schemes were reviewed by the recovery board on 22 July. As a result a small value was converted to green, and the range of opportunity
from the remaining schemes was significantly reduced. This puts at risk the achievement of the financial plan in both 2010/11 and 2011/12 as there is
insufficient in year mitigation against slippage and the level of savings required to close the remaining gap in the financial position next year have not
been identified.

70

60

50

40 Red
£m

30 Green

20

10

0
Jan Feb Mar Apr May Jun Jul

Actions undertaken
The Programme Management Office will continue to review and support the development of PIDs for red schemes. There are also a
number of schemes being developed at sector level that have not yet been factored into the above figures but should produce benefit
in 2010/11 and 2011/12.
In addition, the financial recovery programme board agreed that more radical savings opportunities now need to be explored. A
process for this will be agreed.

15
Quality Outcomes Alison Pointu

Issues to be discussed
The Sector will be using 54 KPI’s to determine quality outcomes. NHSB performance report will only exception report
these until CSL have established processes to publish these by July 2010.
There has been a rise in MRSA rates which shows that the number is over double the rate compared to this time last
year. There are risks to breaching our target of 10 cases for 2010/11if this rise continues.

MRSA - PCT assigned cases

14

Actual
12
cases
10

8 Monthly
Target
6

4
Annual
Target
2

0
39

39

40

40

40

40

40

40

40

40

40

40
96

99

02

11
05

08

14

17

21

23

26

29
5

9
Actions undertaken
There is no significant trend or link between the 6 reported cases. 3 were identified at BCF, 1 at RNOH and 2 at RFH.
Five of them fit the criteria of Community acquired cases (identified within 48 hours of admission) and 1 is a hospital
acquired case (RFH). NHSB public health and quality team are investigating these cases further. A breakdown by
provider is given on the next slide.

16
Quality Outcomes Alison Pointu

Issues to be discussed
The charts show the steady decline in MRSA in both of Barnet’s main providers. The increase reported in the previous
slide, if sustained as a trend, would be an anomaly.

MRSA - RHF MRSA - BCF

120 120
100 100
80 80
60 60
40 40
20 20
0 0

1
7

0
5

8
6
4
4 5 6 7 8 9 0 1

/0
/0

/1

/1
/0

/0
/0
/0
3 /0 4 /0 5 /0 6 /0 7 /0 8 /0 9 /1 0 /1

10
07

08

09
05

06
03

04
0 0 0 0 0 0 0 1
20 20 20 20 20 20 20 20

20

20

20

20
20

20
20

20
Target Actual Target Actual

Actions undertaken

This will need to be closely monitored in partnership with Sector.

17
Quality Outcomes Alison Pointu

Issues to be discussed
Following the mid Staffs review, the board had requested information on mortality rates as part of
assurance that this was not an issue for our two main providers.

Mortality And Morbidity Count April 2010 - June 2010 -

Royal Free And Barnet And Chasefarm

60

50

40
B Barnet and Chase Farm
30
Royal Free
20

10

0
2010-Apr 2010-May 2010-Jun

Actions undertaken

Actions and issues will be raised with the sector account managers –Dr Foster hospital guide ranked the
Royal Free as having the lowest mortality rate among all NHS trusts in England.

18
Annual Health Check Ratings Neil McElduff

Issues to be discussed
Data for most targets will not be available until the end of July. London ambulance targets have been maintained since April
with category b 19 minutes targets still performing below target level. MRSA are reported under quality outcomes The new
operating framework requires this target to be published and monitored weekly. The White paper July 2010 appears to
identify Choose and Book as a continuing priority in the coming years.

London Ambulance Service: Ambulance call outs that achieved response

times as indicated by measure Choose & Book Utilisation
1.05
0.982 0.984 0.985 0.986 0.989
0.98
0.99 0.987 0.997 0.995 0.994 0.7 Barnet
1 0.982

0.95 0.923 0.6

0.899 0.91
0.9 0.853 0.859
0.893
0.5
0.842 0.847 0.854
0.85 0.869
0.4 National
0.851 0.802
0.8
0.743 0.745
0.787
0.795
0.755 0.773 0.76 0.3 Average
0.733 0.735 0.737 0.729
0.75
0.2
0.7
0.672 0.1 London
0.65
Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 0 Average

Ju
Ap

Ma
Cat A - 8 min Target Cat A & B - 19 min Target Cat A - 8 min

ne
r il

y
Cat A - 19 Min Cat B - 19 mins Trendline (Cat A - 8 min)

Actions undertaken
Reducing slot availability issues all acute trusts trained by end of June on how this could be done. The next step will be
to improve the Directory of Services (DOS) which will ensure patients are referred to the right clinic first time around.
Locally the referral management service have met Barnet and Chase Farm to discuss how appointment booking could
be improved. This is likely to result in increased utilisation within the next few weeks. The activity line already indicates
an improvement. 25% of referral to acute services were done through Choose and Book in the week ending 18th July as
opposed to 14% in the week ending 11th July.

19
Business Plan Neil McElduff

Issues to be discussed

Objective 1 – Finance and recovery programme - Please see finance section

Objective 2 – Implementation of polysystems and associated care pathways - Governance structure established; Clinical leads
agreed for 3 out of 4 polysystems; Templates for submission to sector group completed for submission to sector group

Objective 3 – Improve the health of the population of Barnet – proceeding to plan

Objective 4 – Delivery of operating plan - this is under review following publication of new framework

Objective 5 – To deliver our aspirations on the development of competencies and ensure improvement in our WCC assessment -
this is under review following the white paper and an assessment of the OD plan is underway

Objective 6 – Develop processes to embed a high performing culture in NHSB - Integrated report being developed; Monthly
performance meetings with individual Directors established; Performance improvement group with second in line managers
established; Development of performance accelerator established to include finance and recovery projects; FRB established to
review progress on recovery programme

Objective 7 – To improve the quality and safety of commissioned services - Clinical lead director now in place and structure altered
to resource objective; Quality implementation plan revised; Quality metrics established for all acute contracts

Objective 8 – to deliver a firm direction of travel for BCS - Process to determine future direction carried out

20
Business Plan Neil McElduff
Objective 9 Strategic development of NCL sector - Ongoing attendance by the Chair and CEO at the Sector Board; CEO
attendance at the Sector fortnightly Delivery Board meetings to assist in co-ordinating Sector business; Deputy CEO continuing to
act as project director for Sector wide Polysystems
Director of Public Health assisting the implementation of low clinical priority treatments across the Sector; Director of Finance
attending the weekly business meetings to review financial performance across the Sector; CEO chairing the mental health
Service and Organisation Review meetings – a revised mental heath plan is being prepared; CEO urgent care lead – a new
pathway for urgent care is being devised across the Sector; CEC Chair and GP Clinical chairs invited to a Sector wide GP
engagement event to consider the views of GPs into Sector commission business and future methods of engagement
Directors and next in lines attended Sector OD workshops in strategy, communications, performance, finance, public health and
commissioning Head of Performance leading the NHS Barnet acute activity information requirements
Due to the election the NCL acute service strategy is to be reviewed. This will influence the strategic approach for Barnet.
The wide ranging input by NHS Barnet staff into the development of plans and approaches across the Sector will continue in
Quarter 2.

Objective 10 – BEH Clinical strategy - Review of strategy underway following election and new policy

Enabling Projects - FMH project approved by SHA capital group but has now been referred for ministerial approval; Brunswick
Park project funding is at risk due to review of central projects; externally led review for Health Informatics Service underway

Actions undertaken

The delivery of objectives will be managed through the programme management office. Risks to delivery are contained
within the corporate risk assurance framework.

21
Workforce Development Alison Pointu

Issues to be discussed
NHSB is required to publish workforce data annually. Following the announcements within the White Paper having an
oversight in relation to workforce trends, especially sickness, will be pertinent. The charts indicate that sickness rates are
highest for estates and ancillary workers and turnover rates are high for administrative and clerical workers.

NHS Barnet - Turnover Rate June 2009 - May - 2010 NHS Barnet - Sickness Absence June 2009 - June 2010
%HeadCount
% FTE Days Sickness
25.00
20.31 4.50 4.07
20.00 4.00
3.50
15.00 2.85
3.00
9.93 2.50 2.30
10.00 8.33 7.69 2.00
1.50 1.27
5.00 0.89 0.87
1.00
0.00 0.00 0.00 0.25
0.00 0.50
Add Prof Additional Administrative Allied Health Estates and Medical and Nursing and 0.00
Scientific and Clinical and Clerical Professionals Ancillary Dental Midwifery Add Prof Scientific Additional Clinical Administrative and Allied Health Estates and Ancillary Medical and Dental Nursing and
and Technic Services Clerical Professionals Midw ifery Registered
Technic Services Registered

Actions undertaken

More detailed discussion will take place in the workforce and remuneration committee to agree what further
performance measures will used for reporting. Data will also have to be separated between BCS and NHSB.

22
Workforce Development Alison Pointu
Issues to be discussed

The average age band in NHSB is 36-55 years old.

23
Workforce Development Alison Pointu
Issues to be discussed
This data includes BCS staff.
The vacancy rate is highest among the nursing and midwifery category and administrative and clerical category.

NHSB Vacancy Rate June 2009 to May 2010 Total

45.00
38.50 41.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00 7.00
5.00 2.20 1.00
0.00
Administrative and Estates and Ancillary Medical and Dental Nursing and Midw ifery NULL
Clerical Registered

24
Workforce Development Alison Pointu
Issues to be discussed

NHS organizations are required to review the ethnicity profiles of their workforce on annual basis. The number of NHSB
employees in the ‘Black’ and ‘Asian’ categories has increased year on year since 2007/08.
The proportion of ‘Not stated’ employees has reduced, in line with increased data collection efforts.

25
 Report to NHS Barnet Board – 29 July 2010

Title: Performance report

Agenda item: 13 Document no. 10-068

Purpose of the Noting, discussion and information

paper:

The paper supports, or has implications for:

NHSB’s strategic 1. First things first: getting the basics right;

goals 2. Improving health;
3. Local & accessible;
4. Best outcomes from the best centre;
5. Building resilience.

NHSB’s strategic 1. Improving health and reducing health Inequalities;

initiatives 2. Ensuring the most appropriate settings of care for all our patients;
3. Developing care pathways;
4. Focus on the processes of commissioning & contracting in order to
improve quality, safety & patient experience;
5. Managing the PCT’s finances effectively & efficiently

NHSB’s values  Make the greatest difference;

 Value people;
 Be transparent and accountable;
 Work together;
 Support staff.

World class 8. Promote and specify continuous improvements in quality and

commissioning outcomes through clinical and provider innovation and configuration:
competencies 10. Effectively manage systems and work in partnership with
providers to ensure contract compliance and continuous
improvement in quality and outcomes and value for money:
11. Ensuring efficiency and effectiveness of spend:

Use of resources All

Targets & vital signs All

NHS Constitution All

Secretary of State’s Not applicable

test for service re-
configuration

1
Darzi principles 1. Fairness;
2. Personalised;
3. Effective;
4. Safe;
5. Local accountability.

Link to NCL sector Not applicable

and agency

Link to London Not applicable

Borough of Barnet

Equality impact Not applicable

assessment

Other relevant Not applicable

supporting policies,
plans & strategies

Route of paper Executive Management Team and Resources and Performance

Committee

Authors Anjum Fareed, Head of Performance

and Neil McElduff, Corporate and Commercial Director
sponsor directors Clare Parker, Finance Director