Birmingham Community Healthcare NHS Trust Quality and Performance

Birmingham Community Healthcare NHS Trust Quality and Performance Reporting Period: March 2016 Report Date: 28 th April 2016

Contents Section Page Executive Summary 2 Trust Balanced Scorecard 4 Summary of performance 6 Summary of issues to report 7 Quality Performance 8 Quality Priorities 9 CQUIN - Dementia Carers Bi-annual Report 16 CQUIN - Dementia training Q 4 report 18 CRES Quality Indicators 19 Domain 1: Patient Safety 21 Domain 2: Quality Service 24 Domain 3: Patient Experience 27 Use of Resources Performance 33 NHS Improvement - Agency Workers 34 Domain 4: Workforce and Efficiency 36 Domain 5: Finance 47 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Executive Summary Overall the Safety, Quality and Patient Experience domain performance remains very good. • The Trust maintains its good performance in terms of preventing patients developing pressure ulcers and ends the year having reported zero inpatient avoidable grade 3 or 4 pressure ulcers. Community Services report an end year position of sixteen, grade 3 or 4 pressure ulcers (YTD), a reduction of 22 on last year’s performance. • Twenty Two patients have experienced falls with severe harm at the end of the year and while this is 4 less than last year, further work is being progressed in the form of a local falls summit to review the root causes and themes of these incidents and to identify further actions to reduce the number of falls further. • For March 2016, the Inpatient Essential Care Indicators (ECIs) achieved the 95% target and Community ECIs have been maintained at 96%. • For customer experience, the percentage of patients noting that they had a very good or excellent experience of the Trust remains over 85%. The workforce and efficiency domain remains a challenge in a number of areas. • Staff appraisal rates have improved slightly whilst remaining in the amber range. All areas continue to have individual reporting and targeting of staff appraisals. • Sickness Absence remains a challenge and we are currently breaching the annual target by 1. 4%. • Vacancies have improved slightly but we end the year at 11. 9% against a 9% target. Staff consultations are taking place and will result in some at risk staff moving into vacant posts. • Overall temporary staff spending has deteriorated and remains above target at 14. 22%. NHS Improvement will pay particular attention to agency spend in 16/17 and the Trust will be challenged to achieve significant reductions on spend in this area. • DTOC has improved slightly to 11. 98% and remains a focus of activity and partnership working with Social Care colleagues. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 2

Executive Summary Financial Performance – A year end position in line with plan achieving a £ 3. 6 m surplus control total. The Trust achieved its year end target of £ 3. 6 m surplus. Within this position the Trust carried a limited number of variances to plan – • Income – A favourable variance of £ 0. 9 m –largely relating to final agreement of year end balances across our contracts improving a previously reported prudent forecast. • Expenditure – An offsetting adverse variance of £ 0. 9 m – vacancies in a number of areas, non payment of the Dental LPA costs originally planned to start in July, offset by CRES slippage. Cash at month end totalled £ 26. 5 m, which was above the plan of £ 24. 9 m. The variance largely relates to a small number of outstanding payments (creditors including capital creditors) as at 31 st March 2016. The Trust achieved the Public Sector Payment Policy (PSPP) target of 95% at the end of March. Our CRES programme ended the year a £ 2. 5 m adrift from the original target of £ 15. 2 m. This was primarily caused by schemes written off in October 2015 relating to our Care in Focus stretch target and various corporate programmes. Offsetting mitigations reduced overall plans by circa £ 0. 8 m. Further slippage of our inpatient work programme into 2016/17 worsened the shortfall by £ 1. 1 m. Additional pressure at year end has been caused by a small number of corporate programmes failing to achieve targets including car parking. Key risks emerging and remaining in 2016/17 include the following – • Recurrent surplus pressure – significant pressure on our surplus plan for the coming year has been caused by a rebasing of inpatient budgets to reflect current spend. Further slippage in this area will have a direct impact on achievement of our planned surplus. Our plan is predicated on some non-recurrent savings including a £ 1 m discretionary spend control. This is a key challenge for the Trust. • Our contracts remain largely Block arrangements. We remain clear with all commissioners that where this exists, volume pressure is a Commissioner issue, however we must at all times be well sighted on activity levels to ensure that we communicate emerging pressure to Commissioners in a timely manner. • City Council consultation plans remain a challenge for the Trust to deliver especially across Under 5 and Lifestyle services. Quality and Performance Report – Birmingham Community Healthcare NHS Foundation Trust – Report period March 2016 3

Trust Scorecard – March 2016 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 4

Trust Scorecard – March 2016 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 5

Executive Summary of performance Commentary Overall, the Trust has achieved the following performance for March 2016: Achieved 38 67. 86% Not achieved 8 14. 29% Amber 4 7. 14% No Target 6 10. 71% No data 0 0% Total 56 Combined Total of Achieved/ Amber/ No target / No data 48 85. 71% Not achieved 8 14. 29% Total 56 6 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Executive Summary % of sickness absence (1 month in arrears) W&E Bank and agency spend as % of total staff spend YTD W&E Agency spend as % of total staff spend YTD W&E Contractual KPI breaches – RAP / financial penalty W&E Total Delayed Transfer Days as % of OBDs W&E Children and Families • • • • Corporate Division A&C Specialist • • • IPR Page No. W&E Rehab Percentage of vacancies Learning Disabilities 18 week pathway consultant led services ( non-admitted) Quality • • Dental Services Quality Specialist Services (aggregated) 18 week pathway consultant led (admitted) A&C Community Clusters Trustwide underperformance A&C Inpatients/ Urgent Care Outlier Adults & Communities Trust Domain Summary of issues to report – TRUSTWIDE & LOCAL UNDERPERFORMANCE • • • 26 26 • • 39 41 • • • • 43 44 45 • • 46 • • • 23 Local underperformance Falls with severe injury or death (cumulative) Safety DNA rates W&E % staff appraised (12 month rolling average) W&E Net income and expenditure Finance CRES achievement - % YTD actual compared to YTD plan Finance • • Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 • • • 38 • • • 42 49 50 7

Quality Performance Quality Priorities Quality Indicators CRES Safety Domain Quality Service Domain Patient Experience Domain Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Executive Summary MARCH 2016 Quality Update 1. 1 Implementation of Safety Express • Patient Safety supports the NHS Outcomes Framework Domain 5: Treating and caring for people in a safe environment; and protect them from avoidable harm. It also forms a key element of the Key Lines of Enquiry (KLOE) • The Patient Safety Programme is a quality priority for 2015/16 and maintaining 95% Harm Free care is a key deliverable. • 100% of relevant patients are surveyed, at point of care, in accordance with the national requirements. • The prevalence data for March is 98. 14% harm free care. – 42/2264 patients experienced ONE harm – 0/2264 patients experienced TWO harms – 12/2264 (0. 53% prevalence) patients experienced a new harm in March, compared to 11 in February (0. 49% prevalence) – Harm free care for new harms is 99. 47% as 30 patients experienced harms acquired outside BCHC (total 42) • The Tables below split the Harm Free care information into the numbers of teams surveyed and the percentage of harm free care. • • • Harm Free/Total Sample Number of Teams % Harm Free Care Trust wide 2222/2264 55 teams 98. 14% Adults & Communities 2148/2190 52 teams 98. 08% Own home 1880/1912 40 teams 98. 33% Inpatients 245/255 10 teams 96. 08% Prison 23/23 2 teams 100% Harm Free/Total Number of Sample Teams % Harm Free Care Rehab (INRU) 22/22 1 team 100% Learning Disabilities 2/2 1 team 100% Children’s & Families 50/50 1 team 100% Inpatients: 10 inpatients on the day surveyed had one of the 4 harms, 3 of which were new harms. These were a catheter associated urinary tract infection (Ca. UTI), a VTE (DVT) and a low harm fall. Community: 32 patients experienced a harm on the day, of which 9 were new harms. Of these, 7 were patients with a new pressure ulcer and 2 were low harm. Rehabilitation Service: 22 patients were surveyed on the day and all were harm free. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 9

Quality Priorities 1. 2 Safe Staffing March 2016 - DAY SHIFTS Day Ward Number of Red patient 1: 1 Flags activities Required Hours (Establishment) Nursing Hours Fill rate (% of the establishment) Ward 5 3, 047 95. 8% 0 8 3120. 4 Ward 6 3, 174 107. 7% 0 41 Ward 7 3, 047 92. 2% 0 Ward 8 3, 355 107. 3% Ward 9 5, 136 Ward 14 Day Nursing Hours Required Hours Fill rate (% of (acuity) % Bank % Agency 93. 5% 9. 1% 20. 9% 5347. 9 63. 9% 21. 9% 24. 6% 20 3711. 5 75. 7% 17. 7% 20. 9% 0 48 4526. 2 79. 5% 17. 4% 18. 0% 97. 8% 0 207 4731. 7 106. 1% 18. 6% 31. 7% 3, 047 105. 0% 0 45 3217. 7 99. 5% 30. 7% 10. 6% Willows 2, 438 99. 9% 0 55 2677. 4 91. 0% 20. 4% 18. 7% Sheldon 3, 565 99. 8% 0 23 3177. 6 111. 9% 17. 4% 21. 9% CU 27 3, 461 92. 3% 0 10 4473. 0 71. 4% 17. 9% 13. 9% Perrytrees 4, 883 79. 6% 0 0 4101. 8 94. 7% 19. 4% 8. 8% AMH 4, 883 81. 0% 0 26 4494. 9 88. 0% 19. 4% 16. 0% Kingswood * 1, 724 82. 8% 20. 4% 0. 0% Sayer House* 1, 372 78. 7% 1. 1% 0. 0% Elliott Lodge* 1, 372 129. 2% 55. 4% 0. 0% Hobmoor Road* 1, 536 127. 1% 30. 2% 0. 0% * The Learning Disabilities Business Unit has been part of a national project developing a suitable dependency scoring methodology for LD patients. Outputs from this have now been received and LD bedded units are testing the new tool from Jan – April 2016. It will then be included in the Safe Care reports. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 10

Quality Priorities 1. 2 Safe Staffing March 2016 - NIGHT SHIFTS Night Number of Red Flags Ward Number of patient 1: 1 activities Required Hours (Establishment) Nursing Hours Fill rate (% of the establishment) Ward 5 1, 426 131. 6% 0 8 2109. 9 Ward 6 1, 783 132. 5% 0 41 Ward 7 1, 426 147. 5% 0 Ward 8 1, 426 142. 5% Ward 9 3, 912 Ward 14 Night Nursing Hours Required Hours Fill rate (% of (acuity) % Bank % Agency 88. 9% 13. 5% 23. 2% 1740. 4 135. 7% 20. 1% 37. 4% 20 2173. 0 96. 8% 23. 7% 38. 9% 0 48 1891. 5 107. 5% 23. 5% 33. 3% 97. 9% 0 207 3401. 5 112. 6% 38. 9% 18. 8% 1, 426 141. 5% 0 45 1813. 0 111. 3% 20. 5% 33. 3% Willows 1, 212 128. 9% 0 55 1587. 2 98. 5% 17. 1% 13. 8% Sheldon 1, 996 151. 5% 0 23 2854. 4 106. 0% 37. 1% 25. 2% CU 27 1, 783 127. 4% 0 10 2023. 9 112. 2% 19. 5% 10. 9% Perrytrees 1, 783 105. 6% 0 0 1884. 0 99. 9% 12. 9% 6. 3% AMH 1, 783 123. 2% 0 26 2053. 3 107. 0% 14. 8% 16. 9% Kingswood * 680 124. 1% 17. 8% 0. 0% Sayer House* 680 105. 3% 1. 6% 0. 0% Elliott Lodge* 1, 032 137. 7% 61. 0% 0. 0% Hobmoor Road* 1, 032 126. 5% 35. 4% 0. 0% Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 11

Quality Priorities 1. 2 Safe Staffing March 2016 The March 2016 Safe Staffing report shows data from the Safe Care module of the E-roster system for all adult bedded units alongside the fill rate of actual staffing versus planned establishment. The adjusted hours are calculated using the Safe Care module of E-roster and adjusting the nursing hours needed for each shift on the basis of nurses’ clinical judgement including factors such as: • number of patients becoming medically unwell • the number of patients who needed two staff to provide care such as toileting • the number of incidents of one to one supervision The Board should note that one to one supervision numbers are calculated as episodes where patients required additional supervision e. g. if three patients required one to one supervision on a shift, this is counted as three episodes. The Quality Governance and Risk Committee (QGRC) receives a detailed narrative from each ward on safe staffing, including triangulation with serious incidents and information on training and PDR compliance levels and daily staffing levels for each ward. Further work is progressing to maintain consistency of process when developing Ward Rotas, including the allocation of leave, sickness/absence management, training and bank and agency usage. The aim will be to develop this work further in the next 6 months Adult Bedded Units For Day shifts: The actual staffing versus planned establishment was within the 10% tolerance for all wards apart from Perry Trees and Anne Marie Howes where the fill rate was below the 10% threshold. This is an improvement from February’s report. In addition, Wards 6, 7 and 8 at Moseley Hall Hospital, C 27 and Anne Marie Howes showed day shift levels below that required for the dependency/acuity of patients as calculated using the Safer Nursing Care Tool. At Ward 6 there was a high level of patients requiring increased supervision and the ward staff cared for two patients who required 1: 1 supervision over the whole 24 hour period throughout the whole month. These patients were cohort nursed in 2 bays to maintain safety. For Night Shifts: The actual staffing versus planned establishment for night shifts exceeded the 10% tolerance for all wards apart from Ward 9 and Perry Trees unit. This reflects the lower staffing levels planned for units on night shifts and that small increases in staffing to meet patient needs results in higher percentage fill rates for these shifts. On Ward 6, an additional Health Care Assistant (HCA) was rostered, over and above that indicated by safecare in order to manage the challenging behaviour of one patient, this was a clinical judgement decision by the Clinical Team Leader which results in an apparent overfill of staff for this ward for nights. Bank and Agency staffing for day shifts continues to be at high levels for the majority of units utilising a high percentage of agency staff on day shifts. This reflects the increased nursing needs of patients on these wards as well as vacancy and sickness levels. Ward 9 also has high use of bank and agency. The report shows the number of patients requiring one to one supervision. This continues to be high, particularly on wards 6, 8, 9, 14 and Willows and is reflected in their actual staffing levels. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 12

Quality Priorities 1. 2 Safe Staffing March 2016 The following Serious incidents were reported for adult bedded units in March: Adults & Communities Fall with fracture on Ward 7 – A full review of this incident is required to identify the root causes and any issues which may have been a causative factor. This review will incorporate an assessment of the ward staffing levels, skill mix and Bank/Substantive staff mix, as well as any environmental, care issues. The outcome of the RCA will be reported to QGRC and the family, should any issues be identified. Fall with Fracture on Ward 14 - Staffing levels were within the 10% tolerance compared with establishment and Safecare requirements on this day, and staffing is not indicated as a root cause. Fracture at Anne Marie Howes - This has been identified as a pathological fracture, not associated with a fall or other incident. Fall with fracture – ward 6. There was a delay in reporting this as a serious incident until March, as the patient showed no fracture on x-ray immediately after the fall, but a subsequent MRI scan showed a fractured pubic ramus which was attributed to the fall. The Root Cause analysis is underway and early indications suggest that staffing levels or skill mix were not a factor. The patient who fell did not require 1: 1 supervision. There have been no red flags reported for March and Essential Care indicators have improved compared with February. Learning Disabilities units Sayer House – no safety concerns have been highlighted by the unit manager and reduced staffing levels are appropriate for the lower than capacity occupancy rate in this facility. Elliot Lodge – is showing an overfill rate as there was additional nursing staff provided for one service user who receives a specialised package. This additional nursing support is funded but not part of the establishment. Kingswood Rd – There have been some cancellations of periods of respite in March, which has led to fewer staff being used for the day shifts. There have been a number of new service users to the service who have required additional support during their introduction phase to the unit, particularly for night shifts. An incident was raised on Datix at Kingswood on 10 th March as a bank staff member was unable to fill the shift at short notice. A substantive member of staff worked for an additional hour until bank cover could be arranged. Hobmoor Rd – Increased fill rate seen in March. Additional nursing staff have been utilised due to patient health needs and to ensure patient safety. Short breaks (Kingswood & Hobmoor) – both services show an apparent overfill rate, which has fluctuated depending on needs of patients who are receiving respite care. As a result the pilot of a bespoke LD safe staffing tool is commencing in a respite service to align safe staffing levels to patient dependency. 13 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Quality Priorities 1. 3 Care Plans • In the last quarter of 2015/16 Adults and Communities (A&C) division have undertaken a 3 month project with regard to care planning. There will be a planned review in June of the assessment process and care plans as the new documentation has now been in place for 6 months. • The Essential care indicators (ECIs) at the end of March reflect an improvement in the standard of record keeping. • A focus on care planning will continue through the Quality Priorities programme 16/17 and the key deliverables have been agreed with A&C. This will be based on two parallel approaches, firstly the development of a clinical education and supervision programme on individualised patient assessment, care planning and evaluation of care to increase nurse skill and knowledge - this will be clinically based rather than require attendance at training. Secondly a transformation day at the end of April will provide an additional focus on admission documentation. Nursing and Therapies and Adults and Communities division will continue to work in partnership to improve care planning. • Learning Disability (LD) community teams have seen an improvement in the number of care plans recorded on RIO. There is a live dashboard in place which allows staff to have over sight. All patients within the bedded units have care plans in place. Monthly ECIs and weekly review is taking place by team leaders. The service has some dedicated administration to support data entry onto the Ri. O system. 1. 4 Clinical Outcomes • Gastroenterology Dietetics presented the results of their outcomes work for patients with Irritable Bowel Syndrome to the Trust Clinical Effectiveness Committee. This included qualitative patient feedback on the improvement to their quality of life. Additional quantitative improvements were also noted. The report included an estimate of the savings made due to reduced medication. • Learning Disabilities services have received the first tranche of Ho. NOS (Health of the Nation Outcome Score) direct from Ri. O, with support from Informatics. • The Speech and Language service is waiting for the confirmation of national outcomes, which would allow benchmarking against other services in the future. • A number of services are presenting their outcome results as posters for the Trust Clinical Effectiveness Day in April. 1. 5 Patient Experience Priorities in relation to patient experience are as follows: • Record and report the new Friends and Family Test results. • Undertake at least one full patient story for each division each month and utilise patient stories to measure and improve services. • Present information on changes made as a result of patient feedback through 'you said, we did' boards in all relevant Trust premises and on the Trust website. This work is continuing. • Develop and Implement a Patient Experience Dashboard for staff to have access to data in a timely way. The dashboard is complete and has now been shared with clinical colleagues. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 14

Quality Priorities 1. 6 Information Technology Optimisation Activities The Optimisation team continue to support the Information Technology (IT) service by offering specialist skills in Ri. O. Assistance has been provided with complex support calls, the transfer of knowledge to internal support staff, as well as offering further support to streamline processes for product testing that will enable the introduction of new functionality. In recent weeks, efforts have allowed documentation to be tailored for use with a remote printing service. This reduces administrative effort and postage costs. MSK and Podiatry services will soon use the modified letter with partial booking letters and thereafter the optimisation efforts will look into developing scripted elements that will lead to further dynamic enhancements. Improvements continue to be made to reports, assessment forms and letters for an increasing number of services across the Trust. Subject Access Requests can now be delivered from Ri. O due to the efforts of the optimisation team and will be the foundation for customisable discharge summary reports in the future. Adults & Community Division The Division continues to benefit from the activities of the Optimisation team, especially with letter formatting for the remote printing solution (Synertec). Children & Families The Staffordshire School Nursing team (Tranche 11) was handed over to the Division on 2 nd March 2016 as an IPM replacement. Data migration has been deemed a requirement for Go Live and resources are being explored to deliver this and further configuration. Once funding has been confirmed the Electronic Patient Record go-live is scheduled for September 2016. A breakthrough has been achieved with the delivery of the Bloodspot interface with the Children's Hospital, with messages now able to move between BCHC and BCH. Further testing will continue to ensure all issues have been resolved before configuration in the live environment. Specialist Division Tranche 9 with the Rehabilitation service went live on 29 th March 2016 with a TRIMS replacement, with significant challenges to delivery. The challenges remain with integration of existing applications with Ri. O which are being explored by the division, the project team and 3 rd party suppliers. Go-live is scheduled for July/August 2016. Engagement has started with the Dental Hospital (Tranche 12) to move from IPM to Ri. O by the end of June 2016. As with Tranche 9, there will be significant challenges to integrate existing applications with Ri. O, particularly with the move to the new hospital and the short timescales involved. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 15

Quality Priorities CQUIN - Dementia Carers Bi-annual Report Overview The ‘Ensuring Carers of People with Dementia Feel Adequately Supported ‘ CQUIN, for 2015/16, looks at the information provided for carers and assesses whether this is appropriate. It was agreed between the Commissioners and the Trust that carers would be sent a survey and that other local processes would be identified for surveying carers of people with dementia. Part of the CQUIN requirement is also for the findings of the survey to be presented biannually to the Provider Board. Year to date findings The year to date results are from 58 carer support surveys completed either on the ward with the carer, by post or by staff who are carers for persons with dementia accessing the intranet. Q: How likely are you to recommend our ward/ unit to family and friends if they needed similar care or treatment? Extremely likely: 80. 36% Likely: 14. 29% Action → It is very positive to note only 1. 79% were unlikely to recommend our wards to their family or friends and this accounted to one carer. Q: Do you think that the person you care for has been treated with dignity and their privacy respected, while in our care? Yes: 98. 18% Q: When you visit the person you care for on our wards/units do the staff acknowledge you? Yes: 90. 91% Q: Have you found staff to be helpful, friendly and polite? Yes always: 76. 79% Yes most of the time: 12. 5% Yes some of the time: 8. 93% Rarely: 1. 79% Q: Do you as a carer feel supported by the service and staff working in our wards / units? Yes: 89. 29% Action → The score is positive but it would be interesting to understand what ‘supported’ would look like for those who said they didn’t feel supported Q: What kind of support, advice and information do you feel is important/you need as a Carer? Sample comment received: Action → to address this a Staff Uniform Guide has been produced and also a new welcome pack for in-patient units will include information on what takes place on the ward (including Rehab) and the roles of staff that provide care. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 I think it would be nice to be advised of what happens on the ward re: rehabilitation, also what staff do what. They all appear to be very nice but no one has really asked me our background. 16

Quality Priorities Q: As a carer do you feel you are kept informed / involved and treated as an equal partner in the care and treatment of the person you care for? Overall score 85. 24% Action →Through engagement with carers as part of the development of a new Carers Strategy for the trust, other areas of advice, information and support may be identified. Q: Were you given enough time to talk to staff about any possible worries / concerns ? Overall score: 80. 36% Action → There is a need to better promote the Customer Service team who can work with carers to resolve worries and concerns. Q: Have staff on the ward/unit made you aware of the Trust’s Information and Advice service who specialise in working with the carers and families of our patients? Yes: 59. 26% Action → Need to further promote the service and also make carers aware of alternative support such as the Birmingham Carers Hub Q: Have you been provided with Information for Families and Carers leaflet and the Living Well Handbook? Yes: 59. 26% Action → The booklet needs to be disseminated more widely across all in-patient units. Q: 11 Are you happy the information is given to you in a way which you are able to understand meets your needs? Yes: 80% Action → All new information should include patient and carer views at the draft stage to ensure the information meets the needs of the end user. Q: Would you know who to speak to on the ward/unit if you had a query or concern? Yes: 90. 74% Q: Are you involved or have you been involved in the discharge planning process and discussion regarding discharge? Yes: 77% Action → Through the engagement process for the new trust Carers Strategy, carers will be asked how they want to be involved in this process Q: Do you know where to go for help and support as a carer once the cared for has been discharged? Yes: 69. 39% Action → The information booklet for families and carers includes information on who to contact post discharge. This will be disseminated more widely. Q: Overall , how would you rate your experience as a carer? Conclusion: While the results of the carer survey are generally very positive, there is a need to look at areas where we can make further improvements for carers and families. The Carers Strategy due to be developed during quarter one and quarter two of 2016/17 will play a key role in better understanding the needs of our carers through the engagement process that will help form the strategy. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 17

Quality Priorities CQUIN - Dementia training Q 4 report Overview BCHC’s Dementia training programme was developed within the parameters of the Health Education England dementia core skills and knowledge framework to ensure we are connected to the national and regional programmes and interventions, resulting in a dementia competent workforce. The Framework consists of 3 tiers: • Tier 1 Basic awareness ½ day: Dementia awareness in terms of knowledge, skills and attitude for all working in healthcare. • Tier 2 Enhanced awareness 1 day: Knowledge, skills and attitude for roles that have regular contact with people living with dementia. • Tier 3 Advanced intervention 2 days: Enhancing knowledge, skills and attitude for key staff working with people living with dementia, designed to support leadership. Dementia awareness training progress To ensure that all BCHC staff are aware of the Dementia agenda, a Dementia information leaflet was attached to the May 2015 payslip of all employees. The Trust has taken a focused approach to delivering dementia training, ensuring that in-patient areas and dementia friendly wards received the relevant level of training as a priority. Overall 88% of staff in these areas have completed dementia training as shown in the table below. Adult and Community Overall percentage for Tiers 1 -3 combined Matrons In-Patients 100% MHH Ward 5 85% MHH Ward 6 90% MHH Ward 7 100% MHH Ward 8 90% WHH Ward 14 83% Willow House - West Heath 100% Sheldon Unit 80% Ann Marie Howes Care Centre 77% Intermediate Care Ward 27 GHH 78% Perry Trees Care Centre 98% Overall 88% Training evaluation Verbal summarised feedback from staff to the trainer has been: “they have valued the training and that their clinical approach to patient assessments and planning care has changed with their increased knowledge. ” Suggestions for improvements included: • More on Dementia Nutrition • Interactions for people with dementia • More on communicating with patients/relatives • Hand-outs before training A selection of the feedback for the question “"What did you learn? ”: How environment & What good, How to make a unit communication Empathy, refreshed compassionate care dementia friendly effects outcomes that everyone counts is Recommendations for 2016 -2017 Training will continue in line with Health Education England dementia strategy and as part of the Dementia Charter Mark. The training will continue to be evaluated and amended based on feedback. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 18

Quality Indicators of CRES projects Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 19

CRES Quality Indicators Theme Main Issues Mobile Working Theme remains at Amber for March. The cause of the one red rating within Mobile Working is: • The most current staff survey reports staff are dissatisfied with the current mobile device in use. Actions Agreed Completion Updated Staff Satisfaction ratings for mobile devices will be captured during Q 1 of 16/17 as part of the new Community Mobilisation scheme. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 20

Domain Summary – Patient Safety Commentary In this summary, we have outlined the overall performance for the Trust for all of the Safety indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required performance to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref Indicators which met the YTD target 1. 1 Safe staffing - % fill rate 1. 2 97. 0% ✓ C. Diff new cases avoidable (cumulative)* 0 ✓ 1. 3 E. Coli bacteraemia new cases (cumulative) 12 ✓ 1. 4 MRSA bacteraemia new cases (cumulative) 0 ✓ 1. 5 MSSA bacteraemia new cases (cumulative) 0 ✓ 1. 6 Falls with severe injury or death (cumulative) 22 ✓ 1. 7 Falls with harm per 1, 000 OBDs 2. 69 ✓ 1. 8 a Grade 3 or 4 avoidable PUs community (cumulative)* 16 ✓ 1. 8 b Grade 3 or 4 avoidable PUs inpatient (cumulative)* 0 ✓ 1. 9 Patient safety thermometer (harm-free care) 98. 1% ✓ 1. 10 Patient safety thermometer (harm-free care – NEW HARMS ONLY) 99. 47% ✓ 1. 11 Percentage of deaths compared to all discharges 3. 23% ✓ 1. 12 % of SI and RCA action plans completed within agreed timescales 100% ✓ 1. 13 C. Diff – all cases (cumulative) 17 ✓ 1. 14 MRSA screening within 24 hours 96% ✓ 1. 15 Number of never events 0 ✓ 1. 16 Number of serious incidents 8 ✓ 1. 17 WHO surgical checklist compliance 100% ✓ 1. 18 % Patients at risk of VTE offered VTE prophylaxis 100% ✓ 1. 19 Estates – compliance with statutory requirements for freehold property 3 ✓ Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 * Indicators Reported 2 months in arrears to allow for root cause analysis to determine if pressure ulcer / C. Diff was avoidable. 21

Domain Trends – Safety The Safety Domain shows excellent performance this month at Trust level with all targets being achieved. A narrative for the Falls with severe injury or death indicator has been included because of local under performance in the Adults and Community division. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 22

Patient Safety – LOCAL underperformance 1. 6 Falls with severe injury or death (cumulative) Issue In March there were 3 falls with fracture on wards 7, 14 and 6. A Root Cause Analysis (RCA) has been completed for the fall on ward 7 and went to Assurance Panel on 12 th April 2016. The ward 6 and ward 14 RCA’s are underway. Actions being taken Action Date • Matrons continue to work with staff on completing documentation. The falls assessment ECI was at 97. 7% in March. Ongoing • Patient safety Manager is liaising with each Clinical Team Leader regarding the implementation of the Standard Operating Procedure for care rounding and specialling. April 16 • Two sensory mats now purchased for every ward. Completed • Visual prompts – “call don’t fall” signage and post falls prompt poster devised to use for patients at risk of falling to be used across all areas and inserted in welcome pack for patients and relatives to raise awareness. April 16 Related Performance Issues Safety Thermometer was 98. 1% for all harms March and 99. 47% for new harms only. This is good performance and the rate of harmful falls per 1, 000 OBDs also remains within target. Adults & Communities position Falls Breakdown by Division Falls resulting in serious injury or death Annual Target Forecast YTD 15/16 Outturn Target Actual Trust ≤ 22 22 22 Adults & Communities ≤ 19 ≤ 21 19 21 Rehabilitation ≤ 3 ≤ 1 3 1 Learning Disabilities 0 0 23 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Domain Summary – Quality Service Commentary In this summary, we have outlined the overall performance for the Trust for all of the Quality indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required performance to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref Indicators which met the YTD target 2. 1 Rapid Response cases requiring onward admission to acute hospital - 1 month in arrears 12. 10% ✓ 2. 2 Essential care indicators inpatients (aggregated measure) 95. 20% ✓ 2. 3 Essential care indicators community (aggregated measure) 96. 60% ✓ 2. 4 % Compliance with CQUINS (forecast) 99. 7% ✓ 2. 7 18 week pathway (incomplete pathway) 95. 42% ✓ 2. 8 Zero tolerance RTT waits over 52 weeks 0 ✓ 2. 9 Waiting times for diagnostic tests - % in 6 weeks 92. 86% ✓ 2. 10 Cancer referrals urgent 2 week wait 100% ✓ Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 Ref Indicators which did not meet the YTD target 2. 5 18 week pathway (admitted patients) 2. 6 18 week pathway (non-admitted patients) 88. 11% 92. 26% X X 24

Domain Trends – Quality Service There has been a slight deterioration in the Quality Domain. Both the RTT non-admitted and admitted have breached this month although the services have been able to improve performance against the 18 week incomplete pathways. There is an improving trajectory in Inpatients Essential Care Indicators, turning green from amber. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 25

Quality – Area of Underperformance Trust position Admitted 2. 5 18 week pathway consultant led (admitted patients) 2. 6 18 week pathway consultant led (non-admitted patients) Issue The Trust overall is underperforming in both RTT admitted and nonadmitted targets with current performance of 88. 11% versus the 90% target for admitted and 92. 26% versus the 95% target for non-admitted. Both are as a result of a breach in Specialist Division, specifically Dental services with a monthly performance of 88. 11% in admitted and 85. 09% in non-admitted. Dental Service has maintained performance on the incomplete pathway by prioritising patients waiting longest which has resulted in underperformance in both the admitted and non-admitted clock pathways. There has been a particular impact on performance during March as the hospital was closed for one week during the move to the new site. Actions being taken Action Date • The service continues to use all measures at its disposal to prioritise those patients waiting over 18 weeks as they Ongoing settle into the new Dental Hospital, to mitigate against any short term falls in activity that arise as a consequence of the move. Related Issues Trust position Non-Admitted Dental position Non-Admitted The KPI for Incomplete Pathways in Dental has achieved 93. 91% against a 92% target. This demonstrates that services have been able to control their waiting lists and are prioritising those patients who have waited longest during the disruption to service associated with the move to the new hospital. 26 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Domain Summary – Patient Experience Commentary In this summary, we have outlined the overall performance for the Trust for all of the Patient Experience indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required performance to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref Indicators which met the YTD target 3. 1 % Complaints responded to in agreed timescale 3. 2 100% ✓ Average response time to complaints 24 days ✓ 3. 3 Customer experience – % patients reporting very good and excellent 89. 00% ✓ 3. 4 Friends and family test 92. 00% ✓ 3. 5 Number of complaints per 10, 000 activity contacts (1 month in arrears) 1. 23 ✓ Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 27

Domain Trends – Patient Experience The Patient Experience Domain continues to maintain excellent performance with all KPIs achieving targets. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 28

Patient Experience – Service update March 2016 Complaints regarding quality of service: Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 14 17 15 13 24 20 19 23 23 16 21 21 12 A review of the key issues showed coordination of care (10/12) as the most common causes of complaints. A more detailed report on complaints is presented to the Quality Governance and Risk Committee (QGRC) each quarter. March Complaints - previous months complaints against activity Division Number of complaints March 16 Number of complaints shown as rate per 10, 000 contacts Feb 16 Jan 16 Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15 Mar-15 Feb-15 Jan-15 Adults & Communities 4 0. 83 1. 00 0. 62 1. 18 0. 45 0. 46 0. 83 0. 93 1 1. 02 0. 88 0. 91 1. 14 1. 09 Children & Families 2 1. 18 0. 87 0. 38 0. 79 0. 86 1. 07 1. 21 1. 4 1. 28 0 0. 95 0. 48 0. 91 Dental Services (BDH and CCDS) 5 2. 42 2. 44 4. 1 5. 56 7. 89 7. 78 4. 72 5. 43 4. 64 1. 88 6. 14 2. 2 4. 01 0. 82 Learning Disability Services 1 1. 59 0 1. 6 0 0 0 1. 57 2. 58 0 0 3. 23 Rehabilitation Services 0 6. 55 0 2. 89 0 8. 89 2. 37 10. 1 6. 36 5. 99 4. 98 2. 31 0 7. 69 2. 34 Overall Trust Total 12 1. 23 1. 05 0. 98 1. 32 1. 05 1. 33 1. 47 1. 43 0. 97 0. 82 1. 38 1. 28 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 29

Patient Experience – Service update 3. 4 Friends and Family Test results March 2016 Commentary The Trust wide Friends and Family Test score for March was 92%, 2% lower than last month. The inpatient score for Friends and Family Test increased by 8% to 97%; and the percentage of inpatients rating the service as excellent or very good also increased to 84% improving from red to amber score (1% from green). 89% of respondents across the Trust described the services as excellent or very good – a 1% increase on last month. Number of responses received via each mode of collection Number of Unique SMS/ Paper/ Patients Accessing Electronic Paper Text/ Postcard in Telephone Online Services During the tablet/ survey sent Smartphon care/at survey Month kiosk to home e app discharge 53657 192 980 Other 1172 Total responses in each category for Community Health 1 - Extremely Likely 2 - Likely 3 - Neither likely nor unlikely 4 - Unlikely 5 - Extremely unlikely 6 - Don't Know Community Inpatient Services 57 37 2 0 0 1 97 Community Nursing Services 34 12 1 0 0 1 48 Rehabilitation & Therapy Services 82 10 2 0 0 0 94 Specialist Services 229 58 6 7 16 0 316 Children & Family Services 392 150 23 14 10 9 598 18 1 0 0 19 812 268 34 21 26 11 1172 Community Healthcare Other Total Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 Total 30

Patient Experience – Service update Patient Experience Comments - Comments received were a mix of positive feedback and areas for improvement including: Service Comments Allens Croft (Community Paediatricians) Dr H was brilliant very understanding Allens Croft (Community Paediatricians) Very happy with consultant was very helpful Allens Croft (Community Paediatricians) I have been waiting since 2015 for a physio appointment for my daughter Allens Croft C. D. C. Audiologist diagnosis takes too long. Ann Marie Howes (Podiatry) Good service on time. Very pleasant lady who treated me. Aston Dental Really happy and my daughter likes coming here (Paediatric Continence) (M) made my child comfortable and engaged with them and not just me. It was such a relief to talk to a professional that listened to what we said. My 12 year old has had 2 fillings and cleaning, he was very nervous as this was his first treatment. He was put at ease very quickly and was totally engaged with the treatment he was having. Finished ATS (Continence) Balsall Heath Dental Balsall Heath Health Centre (Paediatric Dietetics) I learnt so much where I was thinking I doing good but not realising the fat in the product. IBS causing me discomfort and loss of confidence at times when out and about. (JH) is very understanding and patient. Balsall Heath Health Centre (Paediatric Dietetics) (K) is easy to speak to, very helpful and gave us lots of very useful information. Balsall Heath Health Centre (Paediatric Dietetics) Fantastic advice and support - we feel that we've been listened to - thank you. BDH Clinical Practice always been very professional, friendly and advice extremely useful BDH oral med / perio the treatment I received has been good BDH Oral surgery friendly professional staff the last time I visited for extractions was treated by 2 unsupervised students and despite 5 injections my mouth was not numbed and they tried to extract one today with no anaesthetic working BDH Orthodontics treatment was great BDH Primary Care dentist was understanding spending more time with me BDH Primary Care Central and West (Therapy Hub) 2 hours waiting is far too long Because of progress and results achieved as a result of attending the classes. (SM) - her patience, her attention to detail and her kind and professional approach. Central and West (Therapy Hub) The staff take time to explain to you. 31 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Patient Experience – Service update Patient Experience Comments - Comments received were a mix of positive feedback and areas for improvement including: Service Comments Community Medical Assessment Unit (CMAU) Very efficient. East and North (Therapy Hub) Home visit from neuro physio always on time listens to my concerns very professional. Good Hope Ward 27 Yes its very good and better than Heartlands. Good Hope Ward 27 Nurses are wonderful LD Jaffray Brilliant, very good service LD Jaffray Really helpful and happy with advice and support Moseley Hall Hospital Ward 5 Mostly very good staff in ward 5. Moseley Hall Hospital Ward 5 "First class care". In ward 5 at Moseley Hall Hospital Ward 8 Lot to put up with. All do a good job considering the under-power (staff numbers) that you have Moseley Hall Hospital Ward 8 Short-staffed. Often not 2 physios available for practice. Northfield HC (Podiatry) Friendly, knowledgeable staff. Podiatrist was very gentle and reassuring as this was only my second visit. Great Service, good people who interact with the kids. (L, Northfield Centre) made our son feel safe and always made an effort to talk to him and get to know him. Always friendly approachable and professional. R always gives great advice caring approach and treats you personally not just as a number thank you. Northfield Health Centre (Paediatric Eye Service) Orchard HV Team Patient Experience Advice and Information Officers Very helpful - completion of DLA form. Gave advice about my autistic son and help I can receive (e. g. nappies) Patient Experience Advice and Information Officers Arranged my appointment for DLA form. I very caring / understanding of the difficulties an autistic child parent faces. Rehab Amputee Rehab Moor Green it is a very long process and no communication for expectation. Why is it taking long time. Professional in their field, their understanding of brain injury meant I was treated fairly and not made to feel unworthy or victimised. They always allowed you to take time to speak and tailored the programme according to individual need Sandwell Dental Friendly polite staff, my children felt very comfortable being treated Sandwell Dental The team are very good at their job and make you relaxed and well informed Sparkhill HV Team Greet HV friendly service Special School Nurses Wilson Stuart school fast and professional service Special School Nurses Wilson Stuart school quick and very caring with all children. Speech and Language Therapy (C&F) The staff I'd seen today with my son understood and heard what I had to say and understood my concerns that I had for my son. They have also provided me with more tips and strategies I can use at home. 32 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Use of Resources Performance Workforce and Efficiency Domain Finance Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

NHS Improvement restrictions for the use of agency Workers The Trust is now making weekly submissions to NHS Improvement reporting all known breaches either of price cap or of off framework bookings, as below: Total breaches using OFF FRAMEWORK agencies AND OVER PRICE CAP (shifts in month) Mar-16 Adults & Communities A&C Specialist A&C Communities A&C Inpatients Children & Families Specialist Dental Rehab Learning Disabilities Corporate Trust Total Registered Nursing 49 7 3 39 3 3 52 HCA and Support 37 7 3 27 3 3 40 12 12 12 Medical & Dental* Scientific, Technical Admin & &Therapeutic* Management* *Only nursing shifts are reportable as breaches for off framework agency use until April 2016 Total breaches for OVER AGENCY PRICE CAPS but within framework (shifts in month) Registered Nursing Total Mar-16 HCA and Support Medical & Dental Scientific, Technical Admin & &Therapeutic Management Adults & Communities A&C Specialist A&C Communities 724 10 276 368 8 254 34 0 0 258 0 0 24 2 22 A&C Inpatients Children & Families Specialist Dental Rehab Learning Disabilities Corporate Trust 438 49 67 21 16 30 435 1275 106 0 7 0 0 375 34 0 9 0 0 43 258 10 13 0 281 0 8 0 0 0 32 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 40 0 0 40 31 38 21 0 17 435 544 34

Supporting information relating to breaches Nursing For community services there is a shortage of bank community workers. The Trust is working with agencies and the Birmingham Cluster to reduce rates so that they are consistent with Band 5 price caps. A number of larger agencies have agreed to reduce rates immediately and there also a number of new suppliers who have been approached. It is therefore expected that the rate of noncompliant shifts in this area will reduce significantly. For the prison service we have to use one off framework Agency as the other Agencies cannot always supply us with NOMS (National Offender Management Service) and G 4 S security cleared staff which are needed for work in the Prison service. Admin and Management The main reasons for exceeding price is due to pre-existing contracts, which were entered into through the previously operating procurement framework, as existing contracts expire, new contracts will be negotiated to bring rates in line with the new rates. The majority of breaches are within Finance (where there was a locally agreed framework arranged prior to the caps to provide difficult to recruit vacancies) and IT (national shortage of specific skills relating to procured IT applications). Scientific, Technical and Therapeutic As with management breaches, the main reasons for exceeding price is due to pre-existing contracts, which will be reviewed as existing contracts expire. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 35

Domain Summary – Workforce and Efficiency Commentary In this summary, we have outlined the overall performance for the Trust for all of the Workforce and Efficiency indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required performance to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref Indicators which did not meet the YTD target 4. 5 Percentage of vacancies 11. 90% X 4. 6 Percentage sickness absence (1 month in arrears) 5. 73% X ✓ 4. 10 Bank and agency spend as a % of total staff spend YTD 14. 22% X 87. 45% ✓ 4. 11 9. 26% X 86. 7% ✓ Agency spend as a % of total staff spend YTD Average length of time to recruit (date advertised to offer) 59 days ✓ 4. 14 Contractual KPI breaches – RAP / financial penalty 3 X 4. 9 Data quality of scorecard metrics 96. 87% ✓ 4. 15 Total delayed transfer days as % of OBDs 11. 98% X 4. 12 Turnover – 12 month rolling total 10. 50% ✓ 4. 13 Commissioner contract deadlines missed (1 month in arrears) 0 ✓ 4. 16 Estates - % utilisation of space 56. 5% ✓ Ref Indicators which met the YTD target 4. 1 YTD % CRES/QIPP milestones achievement position 95. 52% ✓ 4. 2 DNA rates (clinical appointments) 6. 64% ✓ 4. 3 Mandatory training – contractual 90. 02% 4. 4 Mandatory training – non-contractual 4. 7 % staff appraised 4. 8 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 36

Domain Trends – Workforce and Efficiency Performance in the workforce and efficiency domain remains a challenge although four of the six red indicators report an improving position. The workforce performance indicators are inter connected and the Trust’s current vacancy rate is contributing to increases in temporary staffing spend whilst staff redeployment and recruitment is completed. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 37

Workforce & Efficiency – LOCAL underperformance 4. 2 Patient Did Not Attend (DNA) rates Issue Whilst the Trust continues to achieve the DNA target a breach is noted in the Adult Specialist Business Unit. Actions being taken Action Adults Specialist position Date • The Specialist division continues to roll out the Care in Focus Ongoing approach to other services including Diabetes. • Work on data quality continues. Particular issues to resolve include, for example, a DNA where two clinicians were due to see a patient is still only recorded as a single DNA. Ongoing • The service are running a pilot to call patients over a three week holiday period to understand reasons for DNAs and to Ongoing look for trends. • MSK are analysing data received in relation to specific GP practices and locality clinics from which a high number of referrals result in a DNA. • Podiatry are piloting a call reminding service, focussing on the worst attended clinics for 2 weeks, with initial good results. April 16 Ongoing • Reminders are being sent to service managers regarding the Ongoing Trust access policy which provides guidance on patients who repeatedly DNA being referred back to the referring professional. Related Performance Issues DNA Rates can impact on patient Waiting Times for appointments. The RTT performance in Adult’s Specialist is well over target levels at 99. 86% for non admitted and 100% for incomplete. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 38

Workforce & Efficiency – Area of underperformance 4. 5 Percentage of vacancies Issue Trust vacancies remain over target but have improved slightly to 11. 90%. Actions being taken Action Date • Across all divisions there are vacancies being held for delivery of planned efficiencies for 2016/17 and for redeployment of staff to avoid redundancy. April 16 Trust position Adults & Communities • A&C Community – Team shapes are being finalised as part of the Care in Focus work – vacancies suitable for active recruitment will be identified at this point. Adults & Communities position April 16 • 1: 1 discussions are continuing to taking place within a week with those staff stating an intention to leave or on Ongoing their resignation to explore if the Service can support the staff to stay with the Service/Trust. • Inpatients continue to treat HMP as a priority area for Ongoing recruitment activity and review of vacancies. Children & Families position • Vacancies inherited from Staffordshire school nursing are being actively recruited to. Other vacancies are being June 16 held in Birmingham School Health Advisory Service (BSHAS) and CHIS services following the recent successful tender and will be recruited to following appropriate consultation. 39 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

Workforce & Efficiency – Area of underperformance 4. 5 Percentage of vacancies cont’d Issue Trust vacancies remain over target but have improved slightly to 11. 90%. Actions being taken Action Corporate position Date Corporate • Vacancies continue to be held in Corporate Division Ongoing against plans for CRES for 2016/17. All managers have been asked to review remaining vacancies during April to ensure all appropriate recruitment is underway. Specialist • Rehab: Activity around Rehab recruitment continues and is proving successful in reducing vacancy percentages. April 16 • LD: Staff currently at risk will be reviewed throughout April to identify where they could be redeployed. When matching is complete a review of vacancies unfilled will April 16 be undertaken. Specialist position Related Performance Issues High vacancy rates lead to reliance on temporary staff which has seen an increase in month. It also potentially impacts on stress related sickness and clinical performance. Average Length of Time to Recruit highlights areas of slow recruitment. 40 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016

A&C Inpatients position Workforce & Efficiency – Area of underperformance 4. 6 Percentage sickness absence (1 month in arrears) Issue Trust sickness remains red this month and is 1. 16% over the YTD target of 4. 57%. Actions being taken Action Date • All Divisions report managers in areas of high sickness are attending sickness management training and also where relevant ‘Managers’ response to stress in the workplace’ training. May 16 • Children & Families are focusing on Occupational Health referrals and Return to Work interviews to improve attendance. A&C Communities position Ongoing • Across Adults & Communities services are having regular Ongoing meetings to assess and address long term sickness, focussing on cases over 120 days. • Adults & Communities -Shared Learning across the team May 16 from Team Leaders who have managed sickness cases through to Panel stage. HR will support this and develop a more in-depth management checklist/briefing sheet regarding responsibilities with managing sickness absence. • Inpatients also produce monthly posters for managers to display on staff notice boards on wards/units to Ongoing communicate absence rates and the impact on the team. Related Performance Issues Children's & Families position Corporate position High levels of absence can impact on clinical performance, Bank and Agency expenditure and mandatory training. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 41

Workforce & Efficiency – LOCAL underperformance 4. 7 Percentage staff appraised Issue Corporate position The Trust position has improved to 86. 7% this month against the internal target of 90%. It is therefore achieving the contractual target of 85%. Actions being taken Action Corporate Date • The Heads of Corporate departments are targeting all Ongoing individuals identified within their teams as non compliant to complete appraisals and to ensure that appraisals once completed are entered onto ESR in a timely manner. Learning Disabilities position Learning Disability • The Division has made significant improvements for the past three months and has now achieved 84. 5% performance. At the end of March there were a total of 34 staff in the service recorded as lacking a PDR, 15 of these had received a PDR in March which had yet to be entered onto the ESR system which is now being resolved. Related Performance Issues Ongoing Commissioners have closed the contractual remedial action plan which was in place for staff appraisals. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 42

Workforce and Efficiency – Area of underperformance 4. 10 Bank and agency spend as % of total staff spend YTD Issue The spend on temporary staff has again increased slightly continuing a trend of slight increases for 9 months. All areas of the Trust except A&C Specialist and Dental services are breaching their individual targets. Actions being taken Action Date • Children & Families anticipate spend will stay high due to issues covered in the vacancy response, pending the necessary recruitment. Ongoing • Adults and Communities report that the team planner will be used more effectively to ensure annual leave is taken periodically through the year and not saved to the end of financial year by staff. • In response to a recent audit into single tender waivers the PPMB have requested all medical locum bookings to move to purchase ordering in order to manage payments and also to improve controls over spend. • In Specialist Rehab – the service are currently working towards using 50% of the safer staffing budget into substantive posts based on the complexity increase. • LD – plans are in place to recruit to vacant posts as per the narrative on vacancies slide. Related Performance Issues Overall Trust position To March 17 April 16 Month 12 position Ongoing Staff sickness and high vacancies both drive increased use of agency and bank. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 43

Workforce and Efficiency – Area of underperformance 4. 11 Agency spend as % of total staff spend YTD Issue Overall Trust position The spend on Agency staff has again increased slightly and mirrors the trend noted in Bank & Agency Spend. All areas of the Trust except A&C Specialist and Dental services are breaching their individual targets. Actions being taken Action Date • The Dental hospital have also been using additional agency staffing to provide cover and continuity during the move to the new Dental Hospital. April 16 • Adults & Communities will work with the Bank Office to clarify long term requirements to determine Bank Recruitment plan (following implementation of new team shapes). May 16 • Divisional meetings arranged in response to the ‘Agency Rules and Ceiling’ issued by NHS Improvement, immediate actions to include: 1. Review of current controls and authorisations in place 2. Communication to staff regarding prohibiting direct bookings 3. Financial analysis of pressure spots 4. Establish current commitments in place Month 12 position April 16 • Temporary spend will continue to be a significant proportion of budget in corporate driven by the Community Wide Information System (CWIS) project and other specialist roles. April 16 Related Performance Issues Vacancy Rate as detailed in slide 4. 5 and sickness both contribute to increased agency spend. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 44

Workforce and Efficiency – Area of underperformance 4. 14 Contractual KPI breaches – RAP / financial penalty Overall Trust position Issue There were 3 contractual risks reported in March: 1. Wheelchair waiting times - Remedial Action Plan (RAP) (Rehab - potential £ 7 k per month) 2. Augmentative and Alternative Communication waiting times - RAP (Rehab) 3. Health Visiting contract – 1 year and 2. 5 year reviews – RAP (C&F) Actions being taken Related Performance Issues Action Date 1. Joint RAP with Commissioners, currently awaiting comments back from Commissioners. For 16/17 this remedial action plan will become a service development and Improvement plan (SDIP) as per national guidance. 2. The service is meeting all milestones within the Remedial Action Plan with no immediate concerns. This RAP will not continue in 2016/17 as agreed with commissioners. 3. The Commissioners have given verbal confirmation that the Remedial Action Plan will be withdrawn for the Health Visiting contract. 1 st April 2016 31 st March 2016 To be withdrawn Waiting Times. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 45

Workforce & Efficiency – Area of underperformance 4. 15 Total delayed transfer days (DTOC) as % of OBDs Overall Trust position Issue The Trust DTOC position has improved by 0. 4% in month. The delays are split across NHS at 5. 22%, Social Care 6. 46% and joint NHS and Social care 0. 3%. The service feedback suggests the main reason for social work delay is a delayed social work assessment. Actions being taken Action Date • Newton Europe are currently undertaking a diagnostic June 2016 assessment of inpatient services which will contribute to an over-arching action plan. Initial plans include additional focus on all delayed transfers which sit outside the top 20 patient delays. • Continue to raise social care capacity for timely assessment as Ongoing an issue with social care colleagues and commissioners. Adults & Communities position • Longer term measures to highlight discharge delays include Ongoing the Clinical Utilisation Review (CUR) tool across the local health economy which will be piloted within a MHH ward by the end of the first quarter. Related Performance Issues Delayed Transfer can negatively impact patient experience and clinical quality outcomes indicators. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 46

Domain Summary – Finance Commentary In this summary, we have outlined the overall performance for the Trust for all of the Finance indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required performance to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref Indicators which met the YTD target £ 3, 617. 00 ✓ 99. 73% ✓ 4 ✓ Cash balance (£million) 26. 5 ✓ Capital programme 99% ✓ 5. 1 Net income and expenditure (£ 000) 5. 2 CRES achievement - % YTD actual compared to YTD Plan 5. 3 Continuity of services risk rating 5. 4 5. 5 Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 47

Domain Trends – Finance The Finance Domain has improved in month with the Capital Programme indicator no longer breaching. However CRES achievement against plan has deteriorated slightly. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 48

Finance 5. 1 Net Income and Expenditure YTD Position At month 12 the trust is reporting a £ 3, 617 k surplus against a plan of £ 3, 600 k. Summary of Variances The main factors and risks influencing the divisional positions are: Income – M 12 £ 926 k Favourable, M 11 £ 1, 262 k favourable, M 10 (£ 76 k) adverse • Due to the finalisation of income through the agreement of balances exercise as part of the annual accounts process. Corporate including reserves – M 12 (£ 2, 256 k) adverse, M 11 (£ 2, 331 k) adverse, M 10 (£ 671 k) adverse • Provisions have been finalised as part of the annual accounts process. • Delay in delivery of some schemes means shortfall of YTD CRES against plan. Planned YTD Surplus M 12 M 11 M 10 M 9 M 8 M 7 M 6 M 5 M 4 M 3 Specialist – M 12 £ 1, 696 k Favourable, M 11 £ 1, 733 Favourable, M 10 £ 1, 598 k Favourable • YTD favourable variance is due to vacancies and non recurrent income. Classification of this as early CRES is now complete. • Activity figures in Dental have been adversely impacted by the level of vacancies. • Achievement of YTD CRES above with plan. M 2 (4, 000) (3, 500) (3, 000) (2, 500) (2, 000) (1, 500) (1, 000) (500) 0 M 1 Expenditure Adults & Communities –M 12 (£ 3, 618 k) adverse, M 11 (£ 2, 965 k) adverse, M 10 (£ 2, 366 k) adverse • YTD Adverse variance is due to delays in bed reconfiguration following decommissioning of inpatients services. The inpatient sub division is currently showing an adverse variance of £ 5, 096 k (£ 4, 434 k @ M 11). • YTD CRES has slipped from Plan due to the lack of bed reconfiguration. Children's and Families – M 12 £ 2, 348 k Favourable, M 11 £ 1, 963 Favourable, M 10 £ 1, 598 k Favourable • Favourable variance is as a result of vacancies being held. There has been no impact on activity. Classification of this as early CRES is now complete. • Achievement of YTD CRES above with plan. YTD Surplus Financing Costs – M 12 £ 920 k Favourable, M 11 £ 370 k Favourable, M 10 £ 326 k Favourable • Full year impact of asset life review taken in month (£ 836 k). Forecast Outturn The Trust has delivered a surplus of £ 3, 617 k against its plan of £ 3, 600 k. Related Issues The Trust achieved its adjusted surplus target of £ 4, 789 k. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 49

Finance 5. 2 CRES achievement - % YTD actual compared to YTD plan Issue Year to Date Risks Corporate CRES under delivery: £ 42 k • Car parking changes – £ 300 k ytd slippage. Implementation delay. • Annual leave buy back – £ 137 k ytd slippage. Take up of scheme below target. • Corporate CRES – £ 245 k ytd slippage. • Procurement - £ 171 k ytd slippage. • Estates - £ 811 k – over performance includes DTZ mitigation. Adults CRES under delivery: £ 830 ytd slippage. Implementation Delay - Care in focus / Inpatients. Mitigations Included in year end position • Asset Life review – (£ 850 k) • Children and Families – (£ 492 k) • Tendered Services – (£ 100 k) • Learning Disabilities – (£ 400 k) • Use of Recurrent Reserves approved By October Board – (£ 750 k) Other Considerations The Recurrent shortfall of £ 2, 570 k includes: • £ 758 k agreed by the trust board to be covered by reserves • £ 1, 125 k agreed by the trust board to be carried forward into 16/17 Actions being taken Related Performance Issues Action Date Schemes not delivered in 15/16 will continue to be pursued in 16/17 unless written off by the Board. Commencing April 2016. The YTD Cash Savings position includes the Mitigations achieved YTD. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 50

Finance 5. 3 Continuity of Service YTD Position Summary of Variances At M 12 the Trust is rated as 4 on Monitor’s Risk Assurance Framework. The Trust’s Capital service capacity ratio is 5. 6, anything above 2. 5 is scored 4. The trust is reporting a liquidity ratio of 1. 19, per Monitor’s thresholds any ratio between 0 and -7 should score 4. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 51

Finance Rolling Cash Flow Performance 2015/16 - 2016/17 5. 4 Balance Sheet Notes Non Current assets: Non current assets have increased by £ 23, 048 k in month. This is mainly due to a £ 19 m revaluation (£ 15 m Dental, £ 4 m other premises) as part of the annual revaluation exercise. Other changes included an in increase in assets under construction in month. Current assets: Overall current assets - excluding cash and cash equivalents have decreased by £ 862 k in month. Financial assets – : Trade & Other Receivables – have increased in month 12 by £ 2, 309 k as a result of invoices raised in month. Accrued Income – has decreased by £ 1, 535 k in M 12 mostly as a result of income previously accrued for being received or invoices raised. Prepayments – have decreased by £ 1, 599 k in M 12. 35. 0 30. 0 25. 0 20. 0 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 At month 12 the trust is reporting cash position of £ 26. 5 k. £ m YTD Position 40. 0 Plan balance Actual balance Cash and Other Financial Assets: Cash has decreased by £ 7, 213 k in March. Payments have been made to BCC (£ 1. 6 m), NHSBSA (£ 2. 8 m) Bas. Lift (£ 1 m) and other NHS suppliers in month, as well as normal expenditure with suppliers. Current Liabilities: Overall, current liabilities have decreased in month 12 by £ 1, 045 k. Deferred Income – has decreased in March by £ 1, 914 k contributing to the overall decrease in current liabilities. It related to previously deferred LD Q 4 income which has been released in month. Non Current Liabilities: The Trust has non current liabilities of £ 33. 0 m. This relates to the Greenfields lease and the Dental Hospital LIFT. Liquidity Position The Trust has cash totalling £ 26, 485 k which represents the cash requirement for more than one month. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 52

£ 000 Finance 10, 000 5. 5 Capital Plan YTD Position Summary of Variances At month 12 the trust is reporting expenditure of £ 7, 663 k against a finalised plan of £ 7, 769 k. 8, 000 6, 000 4, 000 2, 000 • The final outturn for the year was £ 7, 663 k which was an underspend against CRL of £ 106 k. • There were small overspends on Mobile working and the Prosthetics workshop scheme which will reduce the pre-commitments against the 16/17 capital plan. Quality and Performance Report – Birmingham Community Healthcare NHS Trust – Report period March 2016 0 MTH 1 MTH 2 MTH 3 MTH 4 MTH 5 MTH 6 MTH 7 MTH 8 MTH 9 MTH MTH 10 11 12 Actual Original Plan Revised Plan 53