Recovery Plan

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Transcript Recovery Plan

Recovery Plan Version 6.0

18 th March 2013

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Executive Summary Context

1. As at February 2013, The Rotherham NHS Foundation Trust (“TRFT”) is facing a number of significant challenges. These were highlighted in the Monitor letter dated 15

Feb 2013:

1. A challenged financial position resulting from a failure historically to deliver savings plans – TRFT has made a net loss in each of the past 3 financial years. Given reducing top line income in future years, unless action is taken this position will worsen. Clearly, this trend is not sustainable; 2. A poorly executed IT implementation – the implementation of a new electronic patient record (“EPR”) system in FY 2013 has not gone well. As a result, the accuracy of information around clinical activities has declined, there is clear evidence of decreased clinical productivity and increased pressure on front line staff. In addition, the ability to recover income for activity performed has been hampered. A significant amount of work is required to rectify the position; and 3. A weak governance environment – outdated Board governance arrangements and management structures have resulted in a lack of clear accountability and weak links into front line staff, resulting in a repeated failure to deliver plans.

2. This Recovery Plan outlines a proposed path forward.

The Recovery Plan - Objectives

1. This High Level Recovery Plan (“the Plan”) has been compiled in February and March 2013. It aims to address the key concerns raised in the Monitor letter, specifically:

1. To outline a path to sustainable Financial Recovery – this Plan forecasts at a detailed level the result for FY 2014, together with the savings plans in progress/ to be taken to reduce operating costs by £13m in that year. In order to mitigate risk to patient quality, initial actions are focused on “corporate overhead” and other areas deemed “lower risk” to patient care. For future years (FY2015/2016), savings plans are at a higher level. The detail will be worked up for the strategic plan due 30 September 2013; 2. To outline the current EPR position with the steps required to rectify this – this plan provides an update on EPR together with the key issues faced and the timetable to develop a plan to resolve these issues; and 3. To start the process of remedying governance issues – one of the key factors behind the failure to deliver previous plans is likely to have been the lack of clear accountability in the management structure. Through steps already initiated, the structure has been slimmed down and new clear lines of reporting introduced. However, further work is required.

2. It aims to do this in a logical and sequenced manner while at all times preserving the high quality of patient care.

The Plan - Overview 12 months Phase 1 – 4 Months “Stabilisation and Control” Phase 2 – 4 months “Operational Excellence” Phase 3 – 4 months “Strategic Initiatives” Phase 1 - Key Activities

Build functioning executive team and cohesive board with appropriate clinical input and with transparent provision of information.

Focus on rapidly driving cost reduction from targeted “lower-risk” non patient facing areas, with overall target of £13m in Year 1: 1.

Corporate overhead of £21.9m. Target reduction of £5m in Year 1; Tactical control areas . Target reduction of £4m in Year 1; and CSU and divisional plans of £4m in Year 1.

3. Establish underlying EPR position and options. Develop plan for rectification with costings.

4. Build infrastructure to drive clinical productivity.

Phase 2 - Key Activities

Work through key operational areas to improve patient processes and efficiency (e.g. theatre utilisation, length of stay, admissions, delayed discharges), patient safety and QIA.

Review clinical productivity by specialty and individual and work with clinical leadership to drive improved operational and financial performance.

Work on synthesizing community and acute services and review divisional linkages.

Review and initiate larger scale opportunities (e.g. outsourcing).

Set-up savings and productivity opportunities for Years 2/3 of the plan (target £13 - £15m).

Phase 3 - Key Activities

Work through strategic planning issues (e.g. estates; portfolio of services; alliances and JVs).

Prepare and submit detailed 3 year plan to Monitor.

Review longer term strategic opportunities for the Trust.

Recruitment of permanent CEO.

The Plan – Initial Financial Projections

TRFT Financial Performance FY 2013 - 2016 Operating Revenues

Income from Activities Other Income

Operating Expenses

Pay Non-Pay FY 2013

forecast outturn

Trading Perform ance (£m )

FY 2014

forecast

FY 2015

forecast

210.3

20.8

231.1

206.2

19.6

225.8

196.1

19.6

215.7

FY 2016

forecast

193.8

19.6

213.4

Key messages

1. The forecast outturn for the current financial year (FY 2013) is a deficit of £6.5m after restructuring costs of £4m. The recovery plan starts from this point.

The Recovery Plan targets savings of £13m in FY 2014

, underpinned by Phase 1 activities focused on “lower risk” savings targets. These are: i.

A significant reduction in corporate overhead (£5m); ii. Tactical controls around pay / non pay expenditure (£4m); and iii.

CIPs schemes put forward by CSUs of £4m (£2.5m against current run rates).

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC

Surplus / (def) before Restruct.

Surplus / (def) after Restruct.

-152.3 -67.7

-220.0 11.1

4.8%

-4.0

7.1

-0.6 -8.9 -2.0 -2.1

-13.6 -2.5 -6.5

-147.9 -67.2

-215.1 10.7

4.7%

-5.0

5.7

-0.4 -7.7 0.0

-2.4

-10.6 0.2

-4.8

-140.4 -65.0

-205.4 10.3

4.8%

0.0

10.3

-0.3 -6.8 0.0

-2.4

-9.5 0.7

0.7

-134.8 -64.3

-199.1 14.3

6.7%

0.0

14.3

-0.3 -6.8 0.0

-2.4

-9.5 4.7

4.7

On current planning assumptions, savings at this level will ensure that the Trust breaks even (prior to restructuring costs) in FY 2014.

This forecast assumes further EPR costs of £350k

(should the final EPR report show a materially higher amount, then the Plan will need to be updated). The Plan also incorporates increased spending (Francis report) and other identified cost pressures.

3. Savings in FY 2015 are based on delivering an additional £13m of efficiencies

- The critical piece of work in driving this will be the strategic planning process, which will need to include all key constituents such as Governors, Board, execs, CDs, consultants, specialist, matrons, CCG Board and GPs, and LA’s.

Key Risks and Mitigations

1. Ensuring that Savings Initiatives do not Risk the Quality or Safety of Patient Care – this initial Recovery Plan has been specifically designed to drive a rapid improvement in financial position while minimising risk to patient care. Specifically: 1.

The Plan has deferred any closure of wards or removal of outpatients capacity, until EPR is functioning more effectively and until more reliance can be placed on performance statistics. Ward closures were previously planned for December 2012 and outpatients capacity was also scheduled to be removed – these actions have been delayed and will only be progressed once it is demonstrably safe to do so; The Plan initially focuses on “non-patient” facing areas (e.g. corporate overhead) where cost can be removed without a direct impact on patient care. Given stresses on front line operations and the impact of EPR, further detailed review will be undertaken before implementing changes in front line services; There is clinical and front line representation into all tactical controls – actions will only be taken in conjunction with the front line staff in each area. In many cases, the tactical controls simply represent application of suitable financial controls (e.g. negotiating down supplier rates, ensuring that basic reconciliation processes are followed); The Plan specifically assumes that all wards and other clinical areas are recruited to establishment. This was not the case at the end of the last financial year when a significant number of vacancies had been allowed to build up. In addition, an investment of £1m is provided in the Plan for additional investment in nursing staff as a result of the Francis Report; and The only CSU schemes included in this Recovery Plan have been QIA’d at the end of 2012 and have been put forward by the clinical leads in each area. This has been confirmed with the Executive Directors of Nursing and Medicine.

2. Governance and Management Arrangements - The Trust has historically suffered from ineffective governance and consequently poor delivery of major projects in recent years (e.g. EPR, staff consultation, delivery of savings).

As a starting point, a simplified Executive structure with enhanced representation of Clinicians and other staff groups is in the process of being implemented. There will need to be significant ongoing work on re-engaging and listening to staff, simplifying management structures, improving information reporting and board governance over the coming year to ensure a more effective Governance environment is established. Specifically, a cohesive management team and Board relationship must be established.

3. EPR – issues with EPR in FY 2013 have resulted in lost activity and income as well as creating a barrier to implementing operational efficiency improvements. The precise approach, timing and costs to fix EPR are yet to be finalised.

An EPR expert has now been engaged by the Trust specifically to identify the major issues faced, to outline the potential solutions and to provide a plan of rectification with timings and costings . The current plan includes estimated “rectification” expenditure on EPR of £350k. Should the final EPR report require a significantly higher investment, the Plan will need to be updated.

4. Cash and Capex – there is no immediate risk to cash and liquidity at TRFT. However, in the strategic plan, there will need to be a consideration of the longer term financial position of the Trust and funding of appropriate investment in the longer term.

This will be covered in the strategic plan.

Monitor Letter (15 tH February 2013) - Next Steps Ref

6.1 6.2 6.3

6.4

Requirement

“The Trust is required to report regularly on progress toward delivery of its turnaround plan, the specific milestones set out in Appendix 2 and described below and to meet with Monitor on a monthly basis until we are assured that the Trust is returning to full and sustainable compliance with its terms of Authorisation” “Monitor will agree with TRFT a programme of assurance to ensure that the Recovery Plan is both feasible and likely to deliver sustainable turnaround without compromising on patient safety. The Trust’s Recovery Plan should detail clear deliverables and accountabilities with defined timescales so progress can be tracked on a timely basis by the Trust including the Trust’s board and kept under review by Monitor ” “The Trust is required to resolve outstanding issues relating to EPR, including undertaking a diagnostic review of the EPR system and the related issues and necessary solutions. The diagnostic and related action plan to be shared with Monitor (with clear deliverables and accountabilities…” “Monitor has residual concerns relating to Board Governance. We are aware that the Trust has undertaken a review of the Board and Management Reporting structures. You are required to send us details of and timescales of the actions from this work and provide Monitor with the assurance that the capacity and capability of the management team has been strengthened such that it can deliver its turnaround plan. We will expect further updates on progress at subsequent progress review meetings.”

Actions (x Ref)

Peter Lee (“PL”), TRFT Chair, is in regular dialogue with Monitor (PL) 2. Turnaround (“Recovery”) Plan to be provided to Monitor 18 th March 2013 (TB) 3. Monthly meetings to be set up with Monitor (KR) 1. External review of Recovery Plan to be scoped, commissioned and copied to Monitor (TB) 2. Overall plan timings (included) 3. Key deliverables timings (included) 1. External review of EPR initiated (PB/ LB) 2. Report due April (PB/LB) 3. Report to Monitor 30 April (PB/LB) 1. Evidence of initial actions taken in this Recovery Plan (MM/TB) 2. Residual risks identified (MM/TB) 3. Updates to be provided (MM/TB)

Monitor Milestones 2013 – Control Schedule (Appendix 2) – high level timetable

Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1. Financial underperformance leading to concerns over financial viability Monthly Financial Reporting (incl. CIPS Reporting) Recovery plan 18 th March External Assurance Review April Strategic Plan 30 th Weekly 13 week / 26 week cash flow shared with Monitor Sept 2. Deteriorating liquidity 3. EPR Implementation Issues (Identification and Resolution) Appointment of CIO or equivalent Initial Diagnostic Report 4. Weakness in Board Governance Develop plan to implement TD recommendations Regular reporting of Progress External Assurance over Effectiveness of new Structure and effective clinical engagement + Peer Support for Chair

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Overview of TRFT

• • • • •

TRFT

Provider of Acute and Community Services from one main site: ~450 beds across 20 wards Revenue of ~ £230m Loss making for last 3 years 85% of clinical revenue from local commissioner (Rotherham) ~3,600 WTE staff including ~150 consultants

Clinical Services Elective Care

• • • Revenue of ~£82m ~1,000 WTE staff CSUs: (i) Anaesthetics & Theatres (ii) General Surgery (iii) Obs & Gynae (iv) Orthopaedics (v) Specialist Surgery (vi) Urology (vii) Ophthamology

Urgent Care

• • • Revenue of ~£67m ~1,000 WTE staff CSUs: (i) Radiology (ii) Lab Medicine (iii) Pharmacy (iv) Therapies (v) Photopheresis (vi) Specialist Medicine (vii) Integrated Medicine (viii) A&E (ix) Medicine (x) Specialist Medicine

Community Services

• • • Revenue of ~£53m ~900 WTE staff CSUs: (i) Adults LTC/ Urgent Care/ Re Ablement (ii) Adults – planned care (iii) Adults – Staying Healthy (iv) Children & Young People

Facilities & Estates Infrastructure

• • Net cost base of £15m (£18m gross cost base offset by £3m revenue) ~ 250 WTE staff

Corporate Infrastructure

• • Net cost base of £22m (£24m gross cost base offset by £2m revenue) ~ 400 WTE staff including Finance (49), HR (63), Medical (55), Nursing (18), IT (34), Corporate Affairs (31), Patient Services (110) and Business Information (25)

Elective Care

Urology £4.2m

5% Specialist Surgery £6.7m

8% Ophthalmology £13.7m

17% Anaesthetics & Theatres £4.4m

5% General Surgery £15.6m

19% Orthopaedics £19.3m

23% Obstetrics & Gynaecology £18.7m

23%

Context

Elective Care includes all standard DGH specialties as well as a full Maxillofacial service. In summary it employs 1,070 WTEs based at the main hospital including 75 consultants, has 11 theatres and 162 beds across 8 wards.

Anaesthetics and Theatres

Dedicated day surgery facility, but run together with Main Theatres to maximise usage. Centralised pre op assessment/theatre scheduling and in-house service provision of Sterile Services.

11 theatres 23 consultants 2 wards, ITU (6 beds) and HDU (8 beds) Dedicated JAG accredited Endoscopy Unit

Obstetrics and Gynaecology

Dedicated Outpatient facility Currently in deficit against plan, which in the main can be attributed to issues surrounding EPR particularly around volumes in outpatients and consequently in elective admissions, also had some 18ww breaches.

Obstetrics includes the community midwifery services, covering around 3,000 births per annum. Midwives to births around 1 to 28 (within CNST recommended parameters). Bookings and births around 4% above last year.

1 theatre 10 consultants Gynaecology has dedicated early pregnancy/TOP facility and ward area for inpatients (14 beds)

Ophthalmology

Currently responding to changes in demands on their service, decreased cataract demand, increased demand in ARMD Ward facility is combined day care area and some outpatient facilities (no beds).

TRFT runs the Barnsley service at the BFT site and there are 4 consultants at each site.

Elective Care Context (continued)

Orthopaedics

85% compliance to #NOF best practice tariff, above national averages 2 wards configured between Elective and Non Elective with 60 beds 13 consultants Daily dedicated trauma lists, weekly lists extended into the evening Structure includes Orthotics, and recently integrated Podiatry services Has lost income mainly attributed to EPR implementation difficulties. Since EPR implementation waits for outpatients increased from around 4 weeks to 12 resulting in lost referrals. This has also led to some 18ww breaches

General Surgery

Facilities cover breast, general, colorectal and satellites clinics provided by Sheffield for vascular conditions 2 wards with 60 beds (including 6 surgical admission beds) 9 consultants Case mix issues on non-elective admissions (partly EPR related)

Urology

Recently completed a refurbishment, providing an integrated outpatient/inpatient (14 beds)/chemotherapy facility 1 ward with 14 beds 4 consultants Has lost income mainly attributed to issues around EPR, both in volumes and capturing the activity done i.e. Outpatient procedures

Specialist Surgery (made up of ENT and OMFS & Orthodontics)

Has had issues surrounding EPR particularly around volumes in outpatients in PMFS and consequently in elective admissions, also had 18ww breaches

ENT

Day Case and Outpatients service provision, inpatient facility at Doncaster Royal Infirmary, but care provided by RFT consultant 3 consultants

OMFS & Orthodontics

RFT provide inpatient facility for Doncaster Royal Infirmary Inpatients for cancer patients treated at Chesterfield by RFT consultant 5 consultants

Urgent Care

Medicine Division £0.0m

0% Specialist Medicine CSU £3.0m

4% Clinical Radiology and Medical Physics £2.0m

3% Laboratory Medicine £3.1m

5% Pharmacy £0.7m

1% Therapies £0.0m

0% Photopheresis £2.9m

4% Accident & Emergency £8.5m

13% Specialist Medicine £10.6m

16% Integrated Medicine £35.7m

54%

Context

The Urgent Care division employs 981 WTE staff and encompasses a diverse range of services with main emphasis on the Non Elective pathway – A & E, assessment, admissions unit and specialty beds. Direct clinical support departments such as radiology, pathology labs and pharmacy are managed within Urgent Care. In addition, relevant Elective, Outpatient and Community care pathways are provided. Urgent Care has 58 consultants and 225 beds across 12 wards. There are also 46 surge beds.

Overall, the division’s financial performance is close to plan, although additional Non Elective activity has triggered 70% threshold tariff loss and additional unfunded bed costs, whilst Outpatient activity has performed under plan since EPR system go-live. Specific issues are: • •

A & E

77,000 attendances planned. Actual trend +3% more.

Spend budgets on plan, following previous investment.

• • • •

Integrated Medicine

(General & Elderly Medicine) NEL activity 13,500 planned. Actual trend +10% more.

Devolved 70% NEL Threshold loss forecast at Outpatients 34,000 planned. Actual is -8% less (post-EPR).

Cost pressures £1m.

– sustained unfunded beds open & locum medics.

•

Radiology & Medical Physics

Cost pressures in sustaining access times & 7 day working •

Specialist Medicine Foundation Unit

(Rheum, Dermatology, Haem) Outpatients 35,000 plan. Actual Follow Ups -16% down (post-EPR)

Community Revenue

Other income (mainly MBC), £5m 9% GUM, £2.3m

4% Direct Access (Therapies/Dietetics) , £1.5m

3% Child Health, £4.1m

8% Dental, £2.8m

5% Audiology, £1.3m

2% Critical Care (Paediatrics), £3.7m

7% Other PCTs, £3.5m

7% NHSR, £29.5m

55%

Context

Community Services transferred to TRFT in April 2011 in response to the national Transfer of Community Services directive. Services are provided in a variety of locations including Health Centres, clinics, GP practices, Schools, Children’s Centres, Care Homes and patients’ own homes. These services are in the form of individual contacts, case management and ongoing care for patients which provide care closer to home and alternatives to a hospital admission. The division has a funded establishment of 969 WTEs (made up of 50 Medical Staff, 468 Nurses, 232 AHPs, 149 admin and clerical and 70 other). Following a programme of integration the overall Community Division now incorporates a number of Acute services, these being Children and Young People, Therapies, Dietetics, Audiology and Sexual Health.

Adults-LTC/ Urgent Care and Re-ablement

Mainly funded by NHSR and other PCTs which is mainly block income (estimated 96%). A number of services are jointly commissioned with the local authority RMBC, with c.£800k of income associated.

2 consultants

Adults – Planned Care

Includes Direct Access, Dental and Audiology plus £1m of RMBC funding. Activity contract delivery pressures in Physiotherapy both in the community and in the hospital.

1 Dental consultant

Adults – Staying Healthy

GUM made up of £1.3m PbR, £0.9m Non-PbR (Excluded Drugs). Out-Patient activity up 5% on plan.

2 consultants

Children and Young People

Made up of Child Health and Critical Care (Paediatrics) 14 Paediatric Critical Care Beds, 24 Ward Based Beds and 8 assessment beds. Out-patient activity down on plan linked to EPR and vacant Consultant post, but not anticipated to be an issue when vacancy filled. Still on-going issue with Medical staff Job Plans and future Clinical Service Model required going forward. 8 consultants

Management Structure – 1 st Jan 2012 Observations

Executive Structure – “Current”

Rotherham NHS Foundation Trust

Interim Transformation Director

Tim Bolot

Acting Director of PMO

Michelle Kemp

Acting Chief Executive

Matthew Lowry

Director of IT & Service Improvement

Kim Ashall

EPR, SystmOne, IT Services, Service Improvement

1. TRFT has, in recent years, had an outdated Management structure with unclear accountabilities and responsibilities. It is likely that the complexity of the structure has directly impacted the ability of the organisation to deliver to its plans. Evidence:

Chief Financial Officer

John Somers

Chief Nurse

Juliette Greenwood

Medical Director

George Thomson

Chief of Legal and Corporate Affairs

Kerry Rogers

Chief Human Resources Officer

Jacqui Bate

Acting Chief Operating Officer

Mike Dennis

Acting Chief of Business Intelligence

Tricia Bain*

Financial Management Contracting Business Planning & Investment Procurement Business Development Professional Leadership, Development and Integration of Nursing and AHP Patient Experience Safeguarding Dementia Strategy Patient Services (incl. complaints) Clinical Quality, Safety & Risk Quality Accounts Infection Prevention & Control Public Health Caldicott Guardian Medical Workforce Planning Clinical Education & PGME R&D, Clinical Effectiveness Cancer Services Governance & Assurance Legal & regulatory Compliance QAS (self assessment) Legal Services, Claims and Litigation Communications, Marketing & Graphics Governors / Members / PPI Volunteering, Charity, CSR Patient & Health Info Human Resource Management MAST Workforce Planning Payroll Learning & Development Occupational Health Operational Management of all Clinical Directorates and Services Outpatients / Patient Access Estates and Facilities Business Resilience Screening Services Business Intelligence including Information & Performance Monitoring

*Tricia will continue to fulfil her role as Director of Quality & Standards

1. Failure to synthesize community services with the acute organisation; 2. Failure to deliver savings plans; 3. Failure to successfully implement EPR and then to respond to the challenges faced; and 4. A poor consultation process around proposed redundancies.

2. Features of the structure were numerous reporting lines into the CEO (19), a very heavy executive level (9 direct non clinical reports into the CEO) and a very fragmented approach to managing 3. Actions have already been taken to simplify the top level structure (included later).

Financial Performance – Recent Years

TRFT Financial Performance FY 2011 - 2013 Trading Perform ance (£m )

FY 2011

actual

FY 2012

actual

FY 2013

forecast

Operating Revenues

Income from Activities Other Income 167.3

17.2

184.5

Operating Expenses

Pay Non-Pay

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC

Surplus / (def) before Restruct.

Surplus / (def) after Restruct.

-123.3 -52.0

-175.3 9.3

5.0%

-1.7

7.6

-0.6 -6.3 0.0

-2.2

-9.1 0.2

-1.5

210.0

22.7

232.7

-151.6 -66.0

-217.5 15.2

6.5%

-4.5

10.7

-0.6 -7.5 -6.7 -2.3

-17.0 -1.8 -6.3

210.3

20.8

231.1

-152.3 -67.7

-220.0 11.1

4.8%

-4.0

7.1

-0.6 -8.9 -2.0 -2.1

-13.6 -2.5 -6.5

Grow th

forecast

25.7% 20.7%

25.2%

23.5% 30.4%

25.5% 19.2%

Observations

1. In each of the last 3 years including FY 2013, TRFT has made a net loss (i.e. spent more than it has received in revenue). In the last 2 years, the loss has been in excess of £6m.

2. In FY 2012, TRFT significantly expanded its size through the acquisition of Community Services (remunerated on a “block” basis of ~£29m). One of the key challenges facing TRFT is assessing the scope of community services that it currently provides and the relationship of these services to acute. 3. Operating expenditure has been stable over the past 2 years at ~£218m (comprising £152m of pay costs and £66m of non-pay costs). While costs have not increased (which would have been expected given inflation and incremental drift), no significant progress has been made on cost reduction or improvement of clinical productivity.

4. Impairments in FY 2014 mainly relate to EPR, the Mental Health Unit together with other items such as the Mortuary.

Financial Performance – Current Year

Rotherham Foundation Trust Consolidated Trading Results (Month 10) Year to Date (Month 10)

actual plan variance

Revenue

Clinical Income Education and Training Other Operating Income 175.3

3.8

13.7

192.8

173.5

3.5

10.9

187.9

1.8

0.4

2.8

4.9

Expenditure

Pay Non Pay

EBITDA (pre Exceptionals)

Restructuring Costs

EBITDA (post Exceptionals)

Depreciation Asset Impairment Interest PDC -126.3 -56.9 -183.2

9.7

5.0%

-2.9

6.8

-7.3 -2.0 -0.6 -1.8 -11.6 -123.8 -52.9 -176.7

11.2

6.0%

0.0

11.2

-6.5 -3.1 -0.5 -2.0 -12.1 -2.5 -3.9 -6.4

-1.5

-0.9%

-2.9

-4.4

-0.8 1.1

-0.1 0.2

0.4

Net surplus/(deficit) -4.9 -0.9 -4.0

Observations

1. In the current financial year (FY 2013), as at month 10, TRFT had lost £4.9m vs a planned loss of £0.9m (i.e. £4m worse than planned).

2. The following observations can be made: i.

The poor financial performance is a cost issue – operating expenditure is £6.4m higher than planned with £2.9m restructuring costs on top. This partly reflects the failure of the organisation to deliver its cost saving plans. Costs in total are £9.3m higher; and ii.

Commissioners have been supportive – revenue is £4.9m higher than plan, and while this has included significant non-recurrent support (as PbR income has fallen short), indications are that commissioners are attempting to support RTFT through a difficult period.

Income analysis

(Month 10 YTD)

M10 YTD Income and Activity analysis Specialty

A & E Attend Assess ments Elective Elective Excess Beddays

Incom e by activity £'000

Non Elective Non-elective Excess Beddays NON PBR Outpatient procedure Outpatients

Total

Integrated Medicine Trauma and Orthopaedics General Surgery Central Income Obstetrics and Gynaecology A & E Rheumatology Paediatrics Ophthalmology Barnsley Ophthalmology Urology Adult Critical Care Clinical Haematology ENT Oral Surgery Community Midw if ery Dermatology Pathology Therapy Services Audiology Radiology GUM Rehabilitation Anti - Coagulation Clinic Orthodontics Anaesthetics

Grand Total Non-SLAM recorded activity

Community Block Dental Barnsley & Doncaster Dental OOH / DAC Photopheresis Other Community Central Non Recurrent f unding Other (a/c code 10500)

PbR / Non-PbR incom e Other

Other Clinical Income Educations and Training Other Operating Income

Total incom e

6,175 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6,175

0 0 0 0 0 0 0 0 0 0 437 0 123 0 0 955 380 325 0 0 0 0 0 0 0 0

2,220

0 0 0 0 0 0 0 0 0 0 2,545 8,551 4,741 43 439 0 2,585 42 2,254 1,925 1,962 1 936 1,358 1,361 1 384 1 0 0 0 0 0 0 2 0

29,130

52 93 100 16 2 0 53 4 111 0 26 0 0 0 0 0

520

31 0 23 0 9 0 0 0 0 0 20,316 2,698 4,934 2,128 6,028 0 678 2,023 92 1 317 88 477 291 342 2 17 0 0 0 0 1 0 0 1 18

40,452

(RTA and deferred income) 2,476 246 385 244 101 0 24 216 13 0 7 10 0 0 0 0

3,747

9 14 1 0 3 0 0 0 0 0 12 372 124 8,847 25 0 143 2,633 937 657 23 3,206 683 0 14 0 0 1,758 1,260 1,153 1,149 0 1,067 0 0 0

24,061

(£1m accelertated dep'n + 10/12 of £4m Restructuring) 21 48 208 0 199 0 724 3 263 478 167 0 1 580 43 2 452 0 0 0 0 0 0 0 124 0

3,315

3,793 3,325 1,790 0 1,230 6 1,762 1,002 2,357 2,265 928 0 761 538 510 1,884 1,003 72 0 38 0 1,133 36 233 43 0

24,711 2,897 2,781 2,295 1,889 1,869 1,831 1,260 1,191 1,149 1,135 1,103 233 170 18 134,332 29,651 15,333 12,405 11,279 8,024 7,137 6,349 6,248 6,026 5,326 3,430 3,305

27,336 1,487 629 2,427 43 4,333 -150

170,437

4,891 3,831 13,687

192,846 %

Observations

15.4% 8.0% 6.4% 5.8% 4.2% 3.7% 3.3% 3.2% 3.1% 2.8% 1.8% 1.7% 1.5% 1.4% 1.2% 1.0% 1.0% 0.9% 0.7% 0.6% 0.6% 0.6% 0.6% 0.1% 0.1% 0.0%

69.7%

14.2% 0.8% 0.3% 1.3% 0.0% 2.2% -0.1%

88.4%

2.5% 2.0% 7.1%

100%

1. The mix of income / activity is in-line with a typical DGH with a concentration around large specialties such as Medicine, T&O, and General Surgery. There does not appear to be any reason why such a mix of business could not be delivered on an economically viable basis from a one-site acute provider, without PFI commitments.

2. There are a few specialties which do appear to be larger than average for a Trust this size. These include: 1. Ophthalmology; and 2. Rheumatology.

In Phase 2 of the Recovery Plan, detailed service by service reviews (based on SLR) will be conducted to assess the productivity and quality improvement initiatives potentially available in each specialty.

3. It will also be necessary to review in detail the community services provided to understand their linkage with acute services and to understand the best manner in which to manage patient pathways.

Activity analysis

(Month 10 YTD)

Specialty

Integrated Medicine Trauma and Orthopaedics General Surgery Central Income Obstetrics and Gynaecology A & E Rheumatology Paediatrics Ophthalmology Barnsley Ophthalmology Urology Adult Critical Care Clinical Haematology ENT Oral Surgery Community Midw ifery Dermatology Pathology Therapy Services Audiology Radiology GUM Rehabilitation Anti - Coagulation Clinic Orthodontics Anaesthetics

Grand Total

A & E Attend Assess ments 0 63,658 0 0 0 0 0 0 0 0 0 0 0 0

63,658

0 0 0 0 0 0 0 0 0 0 0 0 1,206 0 341 0 0 2,639 1,477 841 0 0 0 0 0 0

6,504

0 0 0 0 0 0 0 0 0 0 0 0 Elective

Activity by attendences, spells and OBDs

Elective Excess Beddays Non Elective Non-elective Excess Beddays NON PBR Outpatient procedure Outpatients

Total

3,557 3,158 5,082 14 246 0 3,466 46 3,534 3,006 3,679 1 1,832 1,181 2,136 1 592 2 0 0 0 0 0 0 2 0

31,535

228 397 429 70 4 0 204 13 407 0 116 0 131 0 92 0 40 0 0 0 0 0 0 0 0 0

2,131

11,228 1,012 2,933 1,223 6,264 0 782 2,670 54 1 206 32 195 229 207 3 8 0 0 0 0 1 0 0 1 7

27,056

11,308 1,037 1,670 1,081 249 0 94 723 46 0 31 46 36 57 3 0 14 0 0 0 0 0 0 0 0 0

16,395

1,612 371,547 689 block 25,137 0 79,172 71,563 44,434 879 9,907 3,473 682,562 0 13,904 0 0 1,451,412 50,677 42,497 588,533 0 56,089 0 0 0

3,494,088

133 362 1,317 0 1,600 1 3,987 13 1,795 3,174 454 0 4 4,606 313 16 4,367 0 0 0 0 0 0 2 933 0

23,077

26,647 32,698 14,073 0 17,101 76 15,757 5,966 28,386 27,291 7,537 0 5,855 6,740 4,952 27,984 11,689 280 0 2,775 0 14,399 330 17,412 323 2

268,273 55,919 410,211 26,534 2,388 50,601 66,374 104,939 81,835 78,656 34,351 21,930 3,552 690,615 12,813 21,607 28,004 16,710 1,451,694 50,677 45,272 588,533 14,400 56,419 17,414 1,259 9 3,932,717

Observations

In respect of activity levels, clearly the “non elective excess beddays ” is a major operational issue for the Trust (as identified by PwC).

2. In Phase 2 of the Recovery, a major target will be ensuring an appropriate bed base is established for the Trust so that elective activity does not continue to be “crowded out” by non-elective activity.

3. In addition, as specialty by specialty reviews are conducted and as EPR is stabilised, outpatient attendances and capacity will need to be reviewed (again identified by PwC).

Consolidating

analysis (Month 10 YTD)

Rotherham Foundation Trust Consolidating P&L (Month 10)

Urgent Care

Revenue

Clinical Income Education and Training Other Operating Income 52.5

0.0

3.7

56.2

Expenditure

Pay Non Pay

EBITDA (pre Exceptionals)

Restructuring Costs

EBITDA (post Exceptionals)

Depreciation Asset Impairment Interest PDC

Net surplus / (deficit)

-38.2

-16.9

-55.0

1.2

2.1%

0.0

1.2

-0.2

0.0

-0.0

0.0

0.9

Elective

Year to Date (Month 10) Actuals

Community

CSUs

OSUs

66.6

0.0

1.8

68.4

-39.4

-18.1

-57.5

10.9

15.9%

0.0

10.9

-0.0

0.0

-0.0

0.0

10.9

39.7

0.1

4.2

43.9

-29.3

-6.5

-35.8

8.1

18.4%

0.0

8.1

0.0

8.1

158.8

0.1

9.7

168.5

-106.9

-41.4

-148.4

20.2

12.0%

0.0

20.2

-0.2

0.0

-0.0

0.0

19.9

0.0

0.4

4.0

4.4

-19.4

-14.7

-34.1

-29.7

0.0

-29.7

-0.4

0.0

-0.1

-0.0

-30.2

Corporate

16.6

3.3

0.1

19.9

0.0

-0.7

19.3

-2.9

16.3

-6.7

-2.0

-0.4

-1.8

5.5

Total

175.3

3.8

13.7

192.8

-126.3

-56.9

-183.2

9.7

5.0%

-2.9

6.8

-7.3

-2.0

-0.6

-1.8

-4.9

Urgent Care

1.2

0.0

1.5

2.8

-0.2

-2.6

-2.9

-0.1

-3.3%

0.0

-0.1

-0.0

0.0

-0.0

0.0

-0.1

Elective

Year to Date (Month 10) Variance from Plan

Community

CSUs

OSUs Corporate

-4.3

0.0

0.1

-4.2

-0.1

-0.0

0.2

0.0

1.1

-0.3

0.7

-3.4

82.3%

0.0

-3.4

-0.0

0.0

-0.0

0.0

-3.4

0.8

-0.2

0.6

1825.0%

0.0

0.6

0.0

0.6

-3.2

0.0

1.8

-1.4

1.6

-3.2

-1.6

-2.9

217.0%

0.0

-2.9

-0.0

0.0

-0.0

0.0

-3.0

0.0

0.8

-0.6

-0.7

-1.2

-0.4

0.0

-0.4

-0.0

0.0

-0.0

-0.4

5.0

0.3

0.1

5.5

-3.5

-0.1

-3.6

1.8

-2.9

-1.1

-0.8

1.1

-0.1

0.3

-0.6

Total

1.8

0.4

2.8

4.9

-2.5

-3.9

-6.5

-1.5

-30.4%

-2.9

-4.4

-0.8

1.1

-0.1

0.2

-4.0

Key messages

1 The Trust has made the first significant actual surplus in 2012/13 of £1.1m in M10 which is £0.2m better than plan.

2 The main contributions to the Trust's £4.0m shortfall vs plan YTD are Elective Care (£3.4m) and Corporate £0.6m). 3 Elective Care is the largest contributor (£10.9m) to Corporate overheads after taking account of YTD shortfalls versus plan (£3.4m).

4 EBITDA actual is 5% but this is inflated due to £3.3m NHSR transitional support shown "above the line" and matching expenditure "below the line".

5 NEL threshold loss (mainly in Urgent Care) is £1.0m.

Balance sheet

(Month 10 FY 2013)

Balance sheet summary at January 2013

Fixed assets

Tangible Intangible

Working capital

Inventories Trade and other debtors / prepayments Accrued income Trade and other creditors / accruals Tax and NI Deferred income

Financing

Cash and cash equivalents FTFF loans Finance leases Other financial liabilities

Provisions Net assets

PDC Retained deficit Revaluation Reserve

Equity

£m 85.9

12.7

3.2

8.0

4.4

-11.6

-4.9

-2.3

5.0

-22.1

-1.2

-2.3

£m 98.6

-3.1

-20.6

-3.2

71.6

72.7

-2.5

1.4

71.6

Observations

1. The Recovery Plan is based on the balance sheet as presented (i.e. it assumes no significant further provisions / write-offs are required in relation to fixed assets, stocks or debtors / accrued income); 2.

Fixed assets currently includes £12.6m relating to EPR; 3. Trade and other debtors / accrued income have significant accruals in relation to other NHS bodies including a outstanding £0.4m owed by Doncaster and Bassetlaw; 4.

Trade and other creditors / accruals includes £1.6m owed to Doncaster and Bassetlaw of which £0.3m is in dispute. Other than Doncaster and Bassetlaw there are no significant arrears of any creditors; 5. FTFF loans are being paid over 10 and 20 years ending in 2019 (EPR £20m) and 2029 (general estates £10m) - no arrears at present; 6.

Provisions are mainly restructuring of £2.6m.

Liquidity – weekly cash flow to August

Short term cash flow Daily cash forecast to 30 August

30,000 25,000 20,000 15,000 10,000 5,000 14 Mar forecast Sensitised after mitigation Actual

Key issues

Q4 2012/13 Trend Risks At the end of this current week the cash position is £25.3m, £2.0m better than forecast, mainly due to the receipt of £1.9m from NHSR for the year end forecast adjustment which has been agreed this week and not in any previous forecasts. The forecast position at year end £13.3m, £2m higher than last week due to the additional payment of £1.9m from NHSR as noted above. There are no other significant changes.

Following discussions with the CFO around Payroll & restructuring costs the payroll has been reduced to £6.6m with restructuring costs factored in for April, May & June, thus giving an improved cash position from last week.

The forecast continues to reflect redundancy payments of £2.4m phased over Q1 (£0.6m, £1.0m and £0.8m) but it still does not reflect any non recurrent income supporting the first quarter, cash management or drawdown of FTFF. It is possible that some redundancy payments will be made pre year end in which case the forecast year end balance could be lower (although this would just be a timing difference).

The forecast does not include settlement of Doncaster and Bassetlaw (net accrual of £1.1m) who are now looking to make a settlement.

In April the key contract receipt will be via SBS and could move to mid-month. The forecast assumes that this potential issue can be resolved but the sensitivity highlights the potential im pact. Contract income is yet to be agreed but the forecast assumes income at current levels. However, from April c. £1m will come from SCG, LA and NBS and it is currently unknown when it will be received (currently prudently forecast for the end of the months).

Sensitivity after mitigations 2013/14 The sensitivity for the SBS timing risk has the impact of elongating the period of minimum cash balance but the other risks should be offset by cash management (delayed creditor payments and capex). Longer term trend remains downwards in the absence of CIPs / tactical controls and FTFF drawdown although there is no imminent risk to cash. The forecast month end balances have all improved by £2.0m with a minimum point of £7.4m on 28 June following both payroll, restructuring and the half yearly £1.1m loan repayment. We now have credit approval from Lloyds for a £17m WCF although this was on the basis of FTFF drawdown but if FTFF is not to be pursued, Lloyds may need to return to credit.

Weekly summary £'m Income

NHS block contract income NHS non contract income Other *

Payments

Salaries/Wages Tax & NI & Superannuation PRL Payments Capital expenditure Loan repayment Loan interest PDC Dividend Other **

w/e Actual 01-Mar 08-Mar 15-Mar 22-Mar 29-Mar 05-Apr 12-Apr

14.1

0.4

0.1

14.6

0.5

0.4

0.7

1.6

3.4

2.6

0.1

6.0

0.2

0.4

0.2

0.3

0.5

13.2

0.0

13.3

0.4

0.2

0.6

Operating cash flow

Off /(onto) deposit

Net cash movement

Current a/c b/f

Current a/c c/f

Cash on deposit Cash and cash equivalents b/f

Cash and cash equivalents c/f

* Income other - Non NHS income, chip & pin, cash collections, returned BACS and VAT refunds ** Payments other - NHSLA payments, bank charges & petty cash

19-Apr 26-Apr Forecast 03-May 10-May 17-May 24-May 31-May 07-Jun 14-Jun

1.0

0.8

0.1

1.9

13.2

0.2

13.6

0.2

0.4

2.0

0.2

2.5

0.4

0.1

0.5

0.2

1.0

1.4

13.2

0.4

0.0

13.7

0.2

0.4

21-Jun 28-Jun

2.0

0.4

0.2

2.7

1.0

0.2

0.3

1.5

05-Jul

13.2

13.7

12-Jul

0.2

0.4

19-Jul

2.0

0.4

0.2

2.6

26-Jul 02-Aug 09-Aug 16-Aug 23-Aug 30-Aug

1.0

0.2

0.1

1.3

13.2

13.5

0.4

0.1

0.5

2.0

0.2

2.4

0.4

0.2

0.6

1.0

0.2

0.3

1.5

(6.9) (1.5) (0.1) (0.0)

(8.6)

(1.2) (0.1) (0.0)

(1.3)

(1.2) (0.1) (0.3) (0.1) (0.9) (0.0)

(2.6)

(4.8) (0.5) -

(5.3)

(7.1) (0.5) -

(7.6)

(4.0) -

(4.0)

(1.0) (0.5)

(1.5)

(1.9) (2.0) -

(3.9)

(7.2) (2.9) (1.0) -

(11.1)

(1.5) -

(1.5)

(1.5) -

(1.5)

(1.9) (1.5) (0.5)

(3.9)

(7.6) (3.0) (1.0) -

(11.6)

(1.0) -

(1.0)

(1.5) -

(1.5)

(1.5) (0.5)

(2.0)

(5.2) (1.5) (1.1) (0.2) -

(7.9)

(7.4) (1.5) -

(8.9)

(1.5) -

(1.5)

(1.2) (0.5)

(1.7)

(2.0) (1.2) -

(3.2)

(6.6) (3.0) (1.5) -

(11.2)

(1.5) -

(1.5)

(1.2) -

(1.2)

(1.8) (1.0) (0.5)

(3.3)

(2.7) (1.5) -

(4.2)

(6.6) (1.3) -

(7.9) 6.1

(6.4)

(0.3)

0.5

0.2

0.3

0.2

0.5

3.4

0.5

3.9

(4.9) (7.1)

3.9

(1.0)

3.9

2.9

7.0

(0.1)

2.9

2.7

9.3

(9.8) 1.4

(0.5)

2.7

2.2

(0.9) 0.4

2.2

2.6

(1.5) (9.3) 12.1

(0.1)

10.4

1.2

2.6

3.7

(12.5)

(0.4)

3.7

3.3

(1.1)

1.2

0.1

3.3

3.4

(1.5)

1.5

0.0

3.4

3.4

(11.1)

10.6

(0.5)

3.4

2.9

0.4

2.9

3.3

12.2

(12.2)

0.0

3.3

3.3

(1.6)

1.5

(0.1)

3.3

3.1

(5.3) (1.0)

4.3

3.1

2.2

(7.5) 12.2

10.6

3.1

2.2

5.3

(13.7)

(1.4)

0.5

3.8

2.9

(0.6)

1.1

(1.5) (0.9) 0.5

2.9

3.5

(9.9) 12.0

10.5

0.5

3.5

4.0

(13.2)

(1.2) (0.8)

1.2

0.4

2.8

3.3

(0.9) (0.0)

0.9

3.3

3.3

(3.6) (6.5)

3.6

0.0

3.3

3.3

7.0

0.5

3.3

3.8

21.4

15.5

21.6

21.4

21.6

21.9

21.4

21.9

25.3

17.5

25.3

20.4

10.5

20.4

13.3

20.3

13.3

22.5

19.0

22.5

21.6

17.6

21.6

20.1

7.2

20.1

10.9

19.7

10.9

23.0

18.5

23.0

21.8

17.0

21.8

20.3

6.4

20.3

9.2

6.4

9.2

9.6

18.5

9.6

21.8

17.0

21.8

20.1

12.7

20.1

14.9

2.1

14.9

7.4

15.8

19.6

15.3

19.6

18.2

14.2

18.2

17.7

3.8

17.7

7.8

16.9

19.7

15.7

19.7

19.0

14.8

19.0

18.0

11.2

18.0

14.4

4.2

14.4

8.0

EPR Context

The Trust has made a significant investment in EPR, both capital and revenue costs that are now forecast to be in the order of £40m (compared to the original forecast of £30m).

The project ran late but went live on 1 July 2012. There have been difficulties with implementation leading to inaccurate coding of case mix and data recording, duplication and possibly lost activity. This has impacted financial performance through lost referral activity and income (estimated at £2.2m for YTD). Detailed financial impact analysis is incorporated on page 28.

Root causes of financial and data quality impacts:

• Impacts – remediable in the short term • Merging of data files from Choose & Book to Contact Centre, affecting patient referrals, patient call response times, clinic bookings, duplicate entries. This impacted on 18 week and cancer targets; and • Data quality issues - relating to activity reduction, backlog of coding cases, cross mapping error in relation HRG assignment. Thus creating significant validation workload within specialties and the Information Team.

Short term remedial actions:

• Postponed different module implementation within EPR until options appraised.

• Redirection of resources to data validation and analysis.

• Targeted training for end users – specifically in relation to 18 week validation.

• Review of Contact Centre systems and processes, new leadership and introduction of new Standard Operating Procedures.

• Comprehensive data quality analysis, including financial impact.

Current outcomes in relation to the Contact Centre:

• Call times from an average of 9 minutes in December 2012, reduced to an average of 1 minute in February 2013.

• Duplicate entries reduced from 50 per week in November 2012, to 2 per week in February 2013 (lower than pre go-live levels).

• Additional clinic sessions, to reduce backlog, have positively influenced 18 week targets, cancer targets are now being met – GP referrals also reflect an increase (see page 25).

Data Quality validation (see pages 26-27):

• Data quality benchmarking is comparable with peers, both Nationally and Regionally.

• Review of user error origins has resulted in focussed training, financial impact assessed and meeting with commissioners suggest some re imbursement – to be agreed.

Quality Impact Status

The Rotherham NHS Foundation Trust - MONITOR Scorecard - Position for Month 11 QTR 4 12/13

Finance & Governance Compliance Framework Rated on Qtr Position Rating Score QTR Target QTR Value YTD Month Change Apr-12 Quarter 1 May-12 Jun-12

Cancer 2 week wait from referral to date first seen, all urgent referrals (cancer suspected) Cancer 2 week wait from referral to date first seen, sympomatic breast patients (cancer not initally suspected) Cancer 31 day wait from diagnosis to 1st treatment

0 0 0

93% 93% 96% 96.2% 96.0% 100.0% 95.2% 91.0% 99.1% 95.2% 93.7% 100.0% 96.8% 98.2% 97.4% 96.4% 94.2% 100.0%

Jul-12 Quarter 2 Aug-12 Sep-12 89.7%

93.3% 94.6%

84.8% 92.2% 89.4%

98.8% 100.0%

Oct-12 Quarter 3 Nov-12 Dec-12 Quarter 4 Jan-13

96.1%

92.6%

95.8%

76.6%

97.8% 96.8% 96.2% 96.0% 98.4% 100.0% 100.0% 97.2% 100.0%

Trend

Cancer 31 day wait for 2nd or subsequent treatment - surgery Cancer 31 day wait for second or subsequent treatment - anti cancer drug treatments Cancer 62 Day Waits for first treatment (urgent GP referral for suspected cancer) Cancer 62 Day Waits for first treatment (from NHS cancer screening service referral) Maximum time of 18 weeks from point of referral to treatment in aggregate, admitted patients Maximum time of 18 weeks from point of referral to treatment in aggregate, non-admitted patients Maximum time of 18 weeks from point of referral to treatment in aggregate, patients on incomplete pathways Switchboard

0 0 0 1 0 0 0

94% 98% 85% 90% 90% 95% 92% 100.0% 100.0% 95.6% 75.0% 91.2% 97.0% 95.4%

Rating Period Change

Total number of GP referrals

- Rotherham - Non Rotherham

Total number of New outpatients Out patient New to Follow up ratio Out patient DNA rates Diagnostic waiting times - ensure nobody waits 6 weeks or over for 15 Key diagnostic tests 0.00% 0.00% 0.00% 6.56% -15.00% 40.20% 48.59% 99.0% 100.0% 92.6% 94.2% 94.2% 98.0% 93.1%

Target

TBC TBC TBC 72624 3.10

7.7% 1.0%

YTD

49642 36929 12713 67859 2.63

10.8% 1.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.0% 99.6% 4717 3706 1011 6777 2.58

8.3% 3.9%

85.7%

92.4%

75.0%

99.1% 99.8% 5344 4197 1147 8139 2.52

7.4% 0.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 91.1%

83.3%

97.9% 98.7% 4605 2879 1726 5051 2.92

13.0% 0.3% 86.5%

88.9%

95.8% 98.3% 5930 3698 2232 5311 2.89

13.8% 0.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 89.6% 92.2% 97.9% 5018 3767 1251 6815 2.75

12.8% 3.5% 96.2% 100.0% 100.0% 90.3% 97.2% 4819 3715 1104 6209 2.51

11.0% 3.4% 87.8% 100.0% 100.0% 100.0% 91.0% 96.8% 5487 4256 1231 7993 2.41

11.5% 1.2% 98.6% 90.3% 97.4% 97.6% 94.8%

92.0% Apr-12 Quarter 1 May-12 Jun-12 89.9% 87.8%

94.0%

Jul-12 Quarter 2 Aug-12 Sep-12

95.1%

Oct-12

93.6% 94.3%

Quarter 3 Nov-12 Dec-12

95.4%

Quarter 4 Jan-13 Trendline

4958 3862 1096 7014 2.47

11.5% 1.9% 90.7% 91.8% 97.2% 3798 2965 833 6632 2.75

11.1% 0.9% 95.6%

75.0%

91.2% 97.0% 4966 3884 1082 7918 2.69

9.7% 0.2%

24 2 5

SUS Data Quality Dashboard for Apr-Nov Data – All data items

Rotherham compared to other SHA trusts

SUS Data Quality Dashboard for Apr-Nov Data – Inpatient data items

SUS Data Quality Dashboard for Apr-Nov Data – Outpatient data items

Financial Impact of EPR (in addition to planned spend)

Electronic Patient Records costs FY1213 Forecast Outturn (£m)

Observations

Plan Actual Variance Capital Scheme

Summary costs

Other Costs

Cost pressures - Staff Staff currently charged to capital no budget Interest on Loan (1) Interest on Loan(2) Maintenance External Consultant 5.7

4.3

1.4

0.3

0.1

0.2

0.3

0.1

0.4

0.0

0.6

- 0.2

- 0.0

- 0.2

Excludes £2.16m of deferred capital invoice payments, these are planned to be paid in FY 2014.

2. Re-validation of data impacted on both corporate teams and also CSU service managers. This equated to approximately £0.8m additional overtime and implementation costs.

Income Issues

Loss of income 18ww Commissioner Fine 3.3

0.3

3.6

- 3.3

- 0.3

- 3.6

3. Due to the additional time taken to log information into the system, the number of patients in clinics had to be reduced, this led to loss of income due to the drop in activity levels.

Loss of Opportunity for Cost Savings

O-P Review (cost retraction) A&C Review

Overspends - extended implementation pressures

IT Medical Records Other Departments IT Overtime New authorised spend - 1.6

- 0.5

- 2.1

1.2

1.4

0.1

0.0

0.1

0.0

1.5

- 1.6

- 0.5

- 2.1

- 0.2

- 0.1

- 0.0

- 0.1

- 0.0

- 0.4

4. Commissioner fines were also incurred due to missing 18 week targets (£0.3m).

5. Financial impact of data quality recording issues currently being reviewed by commissioners, it is hoped we will recover at least half of the £1.3m in lost income.

6. Options appraisal of training needs plus additional staff resource has been estimated at £350k to cover the next six months of the Recovery Plan. Any further cost requirements will be considered as part of the April report.

Total of all spend/deficits against plan 5.2

10.0

- 4.8

Annual Cost of repayment on the capital of the loan Loan (1) Loan (2) 1.5

0.3

1.8

1.5

0.3

1.8

7. These figures relate to known costing – it is unlikely that we can calculate confidently all costs but we feel we have captured the vast majority.

EPR Medium to long term issues

System and implementation specific root causes:

• Configuration of system not based on clinical user needs; • Training limited, insufficiently proximate to go-live so as to ensure effective use; • Testing was a unit based approach, failing to assess ‘whole system’ efficacy; • Configuration and architecture overly complex, not tailored to meet mandatory reporting functions; • Clinical engagement limited; • Implementation was not phased in as granular fashion as might have been - thereby reducing risk; • Financial governance – systems and processes – weak; • Change management controls were not administered effectively; • IT, Information and EPR project teams working in silos, not coordinating activities; and • Purchased a development system with inherent issues, implemented based on a time frame rather than functional outcome.

Medium to long term actions, already in place include:

• Implementation of clinical engagement strategy, we are already seeing increased clinical engagement; • Governance processes reviewed, strengthened and aligned to corporate governance structures with agreed Terms of Reference; • Change control process reviewed and strengthened via weekly Change Advisory Board meetings, sign off and agreement prior to actions; • Financial governance has been reviewed and strengthened – with regular budgetary reporting; • Reconfiguration and integration of IT, Information teams and EPR staff into Health Informatics Directorate – to be complete by April 2013; • Informatics Project Management Team aligned to chosen options, going forward – this will include provision of appropriate training resource; • Implementation using a phased approach, will be piloted and fully integration tested within the clinical setting, prior to application in the live environment; • System configured to acknowledge mandatory (CDS) and operational reporting needs is currently under review; and • Clinical sign off of usability - for any new developments, will be made prior to going live, via the Clinical User Group (CUG).

• • • •

Further medium to longer term actions / developments

Integration of the Health Informatics Directorate will provide a more stream lined and integrated services with savings of approximately £1m.

Following systems options appraisal, a further financial impact will be costed (excluding the training costs already highlighted). Immediate training programmes will focus on data quality impact that also affect financial activity payments i.e. • Not creating follow-up attendances accurately; • Outpatient summary, day case incompletion - means activity not logged; • • Failing to record co-morbidity, cross mapping errors SNOWMED; and Procedures not recorded.

Specific programmes of work that will bring immediate resolution to quality of data and activity will be: • • • Single sign off process for clinicians, currently time consuming; De-construct some of the functionality, ambulatory orders to reduce the time for clinicians data entering in clinics; and Time to complete discharge summaries to be reduced. Additional options appraisal currently underway via external expert, this report will be completed by April 2013.

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

The Plan - Overview 12 months Phase 1 – 4 Months “Stabilisation and Control” Phase 2 – 4 months “Operational Excellence” Phase 3 – 4 months “Strategic Initiatives” Phase 1 - Key Activities

Build functioning executive team and cohesive board with appropriate clinical input and with transparent provision of information.

Focus on rapidly driving cost reduction from targeted “lower-risk” non patient facing areas, with overall target of £13m in Year 1: 1.

Corporate overhead of £21m. Target reduction of £5m in Year 1; Tactical control areas . Target reduction of £4m in Year 1; and CSU and divisional plans of £4m in Year 1.

3. Establish underlying EPR position and options. Develop plan for rectification with costings.

4. Build infrastructure to drive clinical productivity.

Phase 2 - Key Activities

Work through key operational areas to improve patient processes and efficiency (e.g. theatre utilisation, length of stay, admissions, delayed discharges), patient safety and QIA.

Review clinical productivity by specialty and individual and work with clinical leadership to drive improved operational and financial performance.

Work on synthesizing community and acute services and review divisional linkages.

Review and initiate larger scale opportunities (e.g. outsourcing).

Set-up savings and productivity opportunities for Years 2/3 of the plan (target £13 - £15m).

Phase 3 - Key Activities

Work through strategic planning issues (e.g. estates; portfolio of services; alliances and JVs).

Prepare and submit detailed 3 year plan to Monitor.

Review longer term strategic opportunities for the Trust.

Recruitment of permanent CEO.

Phase 1 – Summary of savings target FY 2014

Category Executive Structure Initiative

1) Cancellation of Community Consulting Engagement (Capita) 2) Removal of 5 agency, admin & clerical (offset by YR) 3) Removal of 2 executive directors + 2 additional executives 4) Identification of other corporate savings targets (non pay; etc) 5) Balance for Executive to reduce corporate from £21m to £16m

Total Savings to Date

£50,000 0 0 1,000,000 0

£1,050,000 Annual Savings

£50,000 1,300,000 500,000 1,000,000 2,150,000

£5,000,000

Cancellation of project.

Notes

Removal ofmost temps in HR, BI, finance, etc.

Reduction in executive team (COO; SI; PMO; HR) Reduction of spend incurred in FY13 (professional fees; "one-offs" Reduction in people; professional fees; vacancies when they arise.

Tactical Controls (Pay) Tactical Controls (Non Pay)

(1) Agency. Reduction in spend from £3.2m to £2.0m.

(2) Overtime. Reduction in spend from £1.3m to £0.7m.

(3) Additional Sessions. Reduction in spend from £1.2m to £0.9m

(4) Non Medical Overtime Rates. Reduction in spend from £0.2 to £0.15m

(5) VR implementation

Sub-Total

(1) Taxis. Tightening of controls to reduce spend from £230k to £130k (2) Interpreters. Tightening of controls to reduce spend from £120k to £80k (3) IT. Tightening of controls to reduce spend (from £7m cash down) (4) Consolidation of other budgets (printing, telephone, etc) (5) Examination of other significant non pay areas (weekly)

Sub-Total Total Category CSUs

Elective Care Urgent Care Community Services Other reviews (Nursing; A&C; AHP)

Total cost reductions identified Area Additional cost reductions (to be identified and delivered) Total

160,000 0 0 0 115,000

£275,000

£10,000 2,000 tbd 0 0

£12,000 £287,000

1,200,000

Rates renegotiated (reduction of 5-10%). Weekly reporting. Controls.

600,000

Analysis circulated to resp. Executives. Tightening of controls.

300,000

Controls tightened. Weekly reporting.

50,000

Analysis circulated to resp. Executives. Tightening of controls.

115,000

Reduced VR list has now been implemented. No replacements.

£2,265,000

£100,000

Controls tightened. Weekly reporting. Evidence of reduction.

40,000

Rates renegotiated. Controls tightened. Weekly reporing.

tbd

Weekly reporting. Clearer structure and accountability.Included in corporate

500,000

Consolidation and clear accountability nderway.

500,000

Weekly review of BACS runs. Removal of non-compliant suppliers.

£1,140,000 £3,405,000 Budget CIPs

1,765,384 1,230,700 1,068,476 0

£4,064,560 Incremental savings Notes

1,082,932

Previously identified CSUs. Quality assessed and signed off by Chief Nurse; MD in 2012.

867,000

Previously identified CSUs. Quality assessed and signed off by Chief Nurse; MD in 2012.

559,901

Previously identified CSUs. Quality assessed and signed off by Chief Nurse; MD in 2012.

676,700

Nursing consultation and other CR.

£3,186,534 £11,591,534

£1,408,466

Phase 1 – Corporate Overhead Reduction SUMMARY

1. Executive Medical Director 2. Executive Nurse Officer 3. Executive Director Health Informatics 4. Executive Director of Corporate Affairs 5. Executive Financial Officer 6. Chief Executive Officer

Total

"As-Is" (FY 13)

WTE

166.85

29.85

120.55

102.08

59.83

2.00

481.16

Budget

4.304

1.983

5.366

4.573

3.688

0.257

20.171

Forecast Outturn

4.041

2.220

6.743

4.503

4.116

0.257

21.880

Executive Structure – “Current”

Rotherham NHS Foundation Trust

Interim Transformation Director

Tim Bolot

Acting Director of PMO

Michelle Kemp

Acting Chief Executive

Matthew Lowry

Director of IT & Service Improvement

Kim Ashall

EPR, SystmOne, IT Services, Service Improvement Chief Financial Officer

John Somers

Chief Nurse

Juliette Greenwood

Medical Director

George Thomson

Chief of Legal and Corporate Affairs

Kerry Rogers

Chief Human Resources Officer

Jacqui Bate

Acting Chief Operating Officer

Mike Dennis

Acting Chief of Business Intelligence

Tricia Bain*

*Tricia will continue to fulfil her role as Director of Quality & Standards

Overview

RFT corporate overheads (excluding facilities and estates and financing costs) are currently running at

£21.9 m per annum

(as per the table opposite). This represents ~10% of revenue and excludes a significant amount of overhead that is included at the CSU level.

A rapid and significant reduction in corporate overheads has been targeted for the following reasons: 3.

Low risk to clinical quality and patient safety - given the impact of EPR and the operational challenges currently being faced by TRFT, Management believe that there is significant operational risk attached to some of the previous CIPS schemes (e.g. ward closures, outpatient clinic capacity). By contrast a reduction in corporate overhead is seen as possible in the short term with relatively little impact on clinical quality or patient safety; Practically achievable – significant progress on reducing the corporate structure has already been made. Over the past 3 months, 6 senior executives have departed TRFT and there has been a consolidation to 5 direct reports to the CEO. The next level of corporate restructuring is well-advanced (detail next page); and 3.

Improving governance and accountability – the streamlining of corporate functions is seen as an important step in improving accountability and governance in the Trust. The absence of clear reporting lines and overlapping responsibilities is seen as a key reason for some of the failures in governance in recent years.

The cost of restructuring corporate overhead is estimated at £2-2.5m. This cost is included in the £4m restructuring cost for FY 2013 and has been agreed with commissioners. Given timings, it is assumed that, on average, 10 months benefit will be obtained in FY 2014 .

Phase 1 – Simplification of Top Level Structure New Corporate Structure

CEO

• Cost = £0.35 m • WTE = 2.0

• •

Includes:

CEO + PA Small budget for professional fees

Executive Medical Director

• Cost = £3.87 m • WTE = 163.34

• • • • • •

Includes

Corporate MD function (2 WTE) + Clinical Effectiveness (10 WTE) PGME (18 WTE) Patient Access (116 WTE) Cancer Services (3 WTE) R&D (6 WTE) FT docs (7 WTE )

Executive Nurse Officer

• Cost = £1.52 m • WTE = 24.69

• • •

Includes

Corporate Nursing function (9 WTE) Patient Services Centre (Complaints) (5 WTE) Quality (10 WTE)

Executive Director of Health Informatics

• Cost = £5.08 m • WTE = 89.12

• •

Includes

• • • • Computing support (49 WTE) Also includes: Coding EPR Service improvement Planning & Info

Executive Director of Corporate Affairs

• Cost = £3.2 m • WTE = 29.25

• • • •

Includes

HR Corporate Affairs Legal Affairs Community Involvement

Executive Financial Officer

• Cost = £2.7m

• WTE = 59.33

• • • •

Includes

Management Accounts Financial Control PMO Reporting Payroll 1

SUMMARY

1. Executive Medical Director 2. Executive Nurse Officer 3. Executive Director Health Informatics 4. Executive Director of Corporate Affairs 5. Executive Financial Officer 6. Chief Executive Officer

Total WTE

163.34

24.69

89.12

79.25

59.33

2.00

417.73

"To-Be" (FY 14)

Reduction WTE Reduction Budget from Budget

3.51

5.16

31.43

22.83

0.50

0.00

63.43

3.865

1.518

5.075

3.156

2.720

0.350

16.684

0.380

0.465

0.291

1.417

0.968

-0.093

3.428

Reduction from Outturn

0.188

0.702

1.656

1.347

1.414

-0.093

5.214

Overview

Following a Board decision in February 2013, the top level executive structure is in the process of being greatly simplified. There has been a reduction in 4 senior executives (from 9 to 5) reporting directly to the CEO.

Management of several corporate functions has been merged to reduce the number or executives (e.g. HR and corporate affairs; Finance and PMO). As a result of this activity, 4 executives have or are in the process of being exited with no replacement. This will bring to 6, the number of senior executives that have left the organisation since October 2012.

The new Executive team have been working through the corporate budget areas in detail over February and March with a view to reducing the overall cost of this structure from £21.8m (outturn in FY2013) to £16.7m in FY 2014. This will be achieved through the following actions: 1.

Elimination of “one-off” spend incurred in FY 2013 relating to professional fees, staff in post, agency usage. This figure is estimated to be in excess of £2m (details are currently being finalised); 2.

A restructure of staff within Corporate (with proposed consultation by the end of March) which will result in additional staff leaving the organisation; and 3.

Re-negotiation and tighter control over other non-pay categories (e.g. audit fees, graphics, legal fees).

The new budgets will be finalised over the coming weeks and the consultation will commence prior to 31 March 2013.

Phase 1 – Tactical controls - Pay TRFT - Expenditure review

Pay Update Meeting - 28 February 2013 Annual Trust Expenditure FY11/12 (£'000) Pay Annualised Value (£'000) expenditure 2,151 % of total

1.0%

Future Savings secured to date (annualised basis) Further savings being pursued

215 Nursing (Bank) Nursing (Agency) Admin (Bank) Admin (Agency) AHP (Agency)

209 497 1,543 119

Additional Hours / Overtime Extra Sessions (Medical) Locum and agency (Medical)

1,255 1,236

Additional sessions (Non-Medical)

177

On-call

TBC 3,236 10,423

0.1% 0.2% 0.1% 0.0% 96 0.0%

4.1% 3,175

105 50 0.7% 1,300 24 0.6% 105 112 0.0% 124 277 1.5% 1,550 717

1,500

From 1 April

Progress on Spend on Locum and Agency (Medical)

Monthly run rate

500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 353,109 Apr-12 424,642 May-12 435,148 Jun-12 353,851 Jul-12 184,302 Aug-12 231,192 Sep-12 £ 211,615 Oct-12 207,560 Nov-12 175,979 157,452 Dec-12 Jan-13 155,003 Feb-13

£152,001 69%

Mar-13

Phase 1 – Tactical controls – Headcount

10,600 10,400 10,200 10,000 9,800 9,600 9,400 All Payroll 4,000 3,500 3,000

Phase 1 – Tactical controls – Non-pay

Non-pay

Interpreters Taxis Telecoms Computer and IT consumables Lab equipment and consumables Business Administration Services Procurement - orthopaedics M&S

Annualised Value (£'000)

0 234 845 7,883 2,854 4,650 2,865

19,331 % of total expenditure Future Savings secured to date (annualised basis)

0.1% 0.1% 10 19

Further savings being pursued

25 12 35 0.4% 4.2% 1.3% 2.1% 2.1% 10.3% 50 207 64

350

39 40 24 -

175 Annual Trust Expenditure FY11/12 (£'000) £69,150 31% £152,001 69%

Pay (£'000) Non-pay (£'000)

Non-pay tactical controls - examples

Interpreting cost

3500 3000 2500 2000 1500 1000 500 0

Taxi costs by week

6000 4000 2000 0

IT spend by type (YTD FY12/13)

2000 1500 1000 500 0 Total TI F2F Software Licenses Peripherals Consumables Contracted services Maintenance Equip repair Equip rental Equip lease Equip purchase 3.

Actions

Interpreting

New control in place to move from face to face interpreting to telephone interpreting.

Negotiated a rates reduction on both telephone and face to face interpreting.

Access to online records system to reduce staff cost of managing service.

Taxis

New Standard operating procedure to reduce use of taxis.

New agreement to move some services to alternative transport suppliers.

IT expenditure

New control process to monitor IT expenditure trust wide requiring executive level approval.

On going program to renegotiate cost of software licences and maintenance contracts as they fall due or find alternative suppliers.

Switch from colour to black and white printing as a default.

Double sided printing as default wherever possible.

Process underway to replace desktop printers with communal print devices.

New software to manage and reduce printing outputs costs.

Program of recycling existing equipment more efficiently.

Phase 1 – CSU cost reductions FY 2014 CSU cost reduction summary

Budget CIPs £'000 Incremental cost reductions £'000

Elective Care

Anaesthetics & Theatres General Surgery & Specialist Surgery Urology Obstetrics & Gynaecology Orthopaedics Ophthalmology 297 354 75 393 406 240

1,765

152 192 40 218 388 92

1,083 Urgent Care

Radiology Pathology & Labs Pharmacy Integrated Med Spec Med F.U. A & E 255 248 110 331 169 118

1,231

243 207 35 156 109 118

867 Community Services

Adults - LTC/Urgent Care and Re-ablement Adults - Planned Care Ear Care /Audiology Adults - Staying Healthy Integrated Sexual Health CSU Management Planned Care - Hospital Therapies Planned Care - Dietetics Children & Young People

Total CSU cost reductions

293 105 43 32 83 18 131 25 339

1,068 4,065

76 55 34 32 18 1 125 20 199

560 2,510

Observations

As part of the normal budgeting process, CSUs are requested to identify CIPs as a saving against prior year budget (which are then removed from the CSU budget for the following year).

The items opposite are a summary of the 10s of individual savings schemes for the CSUs and are a mixture of WTE or PA reductions together with specific non-pay savings identified.

These schemes have been QIA’d and signed off by the Nursing and Medical Directors.

The Recovery Plan is based on current cost run rates and therefore only recognises the element of cost reduction which is incremental (i.e. no vacancy releases). As shown the second column, an assessment has been made of the truly incremental savings as opposed to cost budgets that are already underspending.

The Plan - Overview 12 months Phase 1 – 4 Months “Stabilisation and Control” Phase 2 – 4 months “Operational Excellence” Phase 3 – 4 months “Strategic Initiatives” Phase 1 - Key Activities

Build functioning executive team and cohesive board with appropriate clinical input and with transparent provision of information.

Focus on rapidly driving cost reduction from targeted “lower-risk” non patient facing areas, with overall target of £13m in Year 1: 1.

Corporate overhead of £21m. Target reduction of £5m in Year 1; Tactical control areas . Target reduction of £4m in Year 1; and CSU and divisional plans of £4m in Year 1.

3. Establish underlying EPR position and options. Develop plan for rectification with costings.

4. Build infrastructure to drive clinical productivity.

Phase 2 - Key Activities

Work through key operational areas to improve patient processes and efficiency (e.g. theatre utilisation, length of stay, admissions, delayed discharges), patient safety and QIA.

Review clinical productivity by specialty and individual and work with clinical leadership to drive improved operational and financial performance.

Work on synthesizing community and acute services and review divisional linkages.

Review and initiate larger scale opportunities (e.g. outsourcing).

Set-up savings and productivity opportunities for Years 2/3 of the plan (target £13 - £15m).

Phase 3 - Key Activities

Work through strategic planning issues (e.g. estates; portfolio of services; alliances and JVs).

Prepare and submit detailed 3 year plan to Monitor.

Review longer term strategic opportunities for the Trust.

Recruitment of permanent CEO.

Phase 2 Overview Issues to be reviewed

Divisional structure and linkage with community services 2.

Specialty productivity opportunities based on solid KPIs 3.

Excess bed-days, bed base 4.

Outpatient capacity 5.

Outsourcing and re-contracting opportunities 6.

Development of comprehensive strategic plan working with all key stakeholders, including: 1.

Governors 2.

Board (Execs and Non Execs) Clinical and Non Clinical Leadership (CDs, Consultants, Specialists, Matrons) 4.

Commissioners (CCG, NCB) Other key external stakeholders (Local Authorities, Social Services, etc)

Phase 2 – Illustrative Operational Efficiency Analysis (1) Theatre Profitability by Procedure

Taking theatre time and LoS into consideration, we can see a range of profitability between procedures

Cost per Hour of Theatre £451 Cost per Night on Ward £109 HRG

Reconstruction Procedures Category 3 Reconstruction Procedures Category 1 Reconstruction Procedures Category 2 Major Hip Procedures Category 1 for Trauma Major Shoulder and Upper Arm Procedures for non Trauma Multiple trauma diagnoses, with interventions, score 9 - 18 Intermediate Hip Procedures for Trauma Major Knee Procedures for non Trauma Category 2 Major Skin Procedures category 1 Major Hip Procedures for non Trauma Category 1 Major Elbow and Lower Arm Procedures for Trauma Major Shoulder and Upper Arm Procedures for Trauma Intermediate Foot Procedures for non -Trauma Category 2 Intermediate Knee Procedures Category 2 for Trauma Major Knee Procedures Category 1 for Trauma Intermediate Elbow and Lower Arm Procedures for non Trauma Intermediate Hand Procedures for non Trauma Category 2 Intermediate Shoulder and Upper Arm Procedures for non Trauma Major Knee Procedures for non Trauma Category 1 Intermediate Hand Procedures for Trauma Category 2 Intermediate Hip Procedures for non Trauma Category 1 Intermediate Knee Procedures for non Trauma Intermediate Foot Procedures for Non -Trauma Category 1 Minor Foot Procedures for Non -Trauma Category 2 Minor Shoulder and Upper Arm Procedures for non Trauma Minor Foot Procedures for Trauma Category 1 Minor Hip Procedures for non Trauma Category 1 Intermediate Foot Procedures for Trauma Category 1 Minor Foot Procedures for Non -Trauma Category 1 Minor Elbow and Lower Arm Procedures for Trauma Minor Hand Procedures for Trauma Level Category 1 Minor Hand Procedures for non Trauma Category 2 Minor Hand Procedures for non Trauma Category 1 Intermediate Hand Procedures for non Trauma Category 1 Skin Therapies level 4 Minor Skin Procedures category 2 Minor Knee Procedures for non Trauma Category 1 Minor Knee Procedures for non Trauma Category 2 Skin Therapies level 3 Minor Pain Procedures Other Procedures for non Trauma Minor Hip Procedures for Trauma Other Procedures for Trauma

Avg Tariff

£10,321 £8,791 £9,707 £7,353 £5,186 £5,787 £6,348 £6,012 £3,530 £5,675 £3,665 £3,493 £3,140 £3,274 £3,773 £2,466 £2,498 £2,500 £2,448 £2,449 £2,391 £1,904 £1,640 £1,421 £1,401 £1,533 £1,014 £2,073 £950 £1,110 £1,006 £950 £826 £1,282 £776 £1,014 £1,037 £1,289 £576 £225 £331 £2,251 £1,222

Avg Time inTheatre

03:08 02:13 02:48 01:47 01:35 02:06 01:52 02:15 00:50 02:22 01:50 02:12 01:25 01:41 02:23 01:05 01:20 01:12 01:11 01:23 00:23 00:56 01:02 00:42 00:48 00:54 00:11 01:48 00:22 00:37 00:42 00:34 00:18 01:18 00:35 00:54 00:53 00:42 00:35 00:13 00:55 01:50 02:20 6 3 5 17 1 9 19 6 3 6 3 2 2 3 6 0 0 1 1 1 5 0 0 0 0 1 0 3 0 1 0 0 0 0 0 1 2 2 0 0 0 15 7

Cost of Theatre

£1,420 £1,000 £1,265 £811 £717 £951 £849 £1,018 £377 £1,069 £833 £993 £646 £761 £1,078 £492 £605 £545 £537 £625 £175 £422 £467 £318 £368 £411 £85 £816 £171 £285 £319 £262 £137 £592 £265 £408 £399 £317 £266 £101 £416 £834 £1,053

Avg LoS Cost of Stay Avg Component Cost "Profit per Procedure" Number of Patients per Year Total Profit per Year

£185 £255 £325 £602 £31 £27 £120 £87 £68 £554 £608 £286 £590 £1,807 £116 £1,024 £2,066 £602 £303 £648 £320 £40 £40 £50 £21 £137 £5 £379 £1 £70 £11 £7 £27 £41 £0 £109 £174 £167 £0 £0 £24 £1,631 £741 £0 £0 £0 £0 £0 £0 £0 £0 £0 £171 £260 £0 £1,290 £79 £0 £0 £0 £1,073 £0 £1,120 £0 £38 £0 £0 £0 £0 £0 £0 £11 £0 £0 £9 £0 £0 £0 £0 £0 £406 £0 £0 £0 £0 £0 £8,033 £7,504 £6,563 £4,656 £4,354 £3,812 £3,433 £3,319 £2,850 £2,838 £2,512 £2,315 £2,239 £2,189 £2,093 £1,942 £1,866 £1,835 £1,824 £1,756 £1,492 £1,403 £1,133 £1,054 £1,013 £986 £923 £877 £767 £755 £677 £672 £662 £649 £511 £497 £463 £399 £310 £124 -£109 -£214 -£572 18 26 26 36 142 34 168 340 34 282 130 26 36 56 28 28 40 64 58 16 34 240 66 150 42 16 40 56 226 44 20 222 32 32 38 24 44 46 42 32 18 38 26 £144,594 £195,112 £170,625 £167,619 £618,281 £129,592 £576,693 £1,128,352 £96,897 £800,294 £326,534 £60,181 £80,600 £122,582 £58,605 £54,386 £74,636 £117,436 £105,771 £28,092 £50,718 £336,838 £74,768 £158,109 £42,527 £15,770 £36,916 £49,128 £173,415 £33,229 £13,531 £149,078 £21,170 £20,768 £19,422 £11,921 £20,382 £18,373 £13,022 £3,968 -£1,967 -£8,135 -£14,880

NB: in the absence of e.g. PLICS, not all component costs will be included Source: Theatre Activity Data and Spell Analysis.xls

Note: Excludes procedures with less than 15 patients per year, Component Costs are for Knees and Hip procedures, , Time in Theatre is time from providing the Anaesthetic to the Patient going into Recovery

Theatre Income by Consultant – performing surgeon

There is a wide range of income based on surgeon performing the operation

Consultant B Consultant H Consultant A Consultant E Consultant C Consultant D Consultant F Consultant G

The numbers in brackets show the total income received per theatre PA and the number of theatre PAs for each consultant: e.g. Ashwood was the named surgeon for 279 patients in the year, generating a total income of £1,392k with 2.9 PAs of operating time. This gives an average of 96 patients per PA at an average tariff of £4,217, and generates on average £480k per theatre PA Blue isolines are for comparison purposes. Each line shows the range of variables resulting in that income per PA

Income per PA

Consultant I

Assumes all procedures carried out in recorded job plan time, WLI patients are removed from total

Theatre activity is based of the activity under the named consultant theatre PAs are those recorded in CRMS

Phase 2 – Illustrative Operational Efficiency Analysis (2) Breakdown of PAs by Consultant

Consultant G Categories Details

Clinic Attendances

High DNAs and initial bookings below capacity result in some clinics having low utilisation rates

Scheduled Frequency of Clinic

Weekly

Clinic Times

09:30 - 12:05

Total Clinic Hours

02:35

Total Capacity

Slot Length

00:07

Two Patients Seen at Once Average Number of Patients per Clinic

Yes 8.37

01/01/1900

AHMEDM - MONDAY FU CLINIC

01/01/1900

Utilisation %

42% 02/01/1900 01/01/1900 20 15 10 5 0 14 12 10 2 0 8 6 4

This clinic is underutilised, due to a high number of DNAs (up to 6 people per clinic), and high under booking. On average the clinic sees 8 patients, and never more than 14, which is significantly below the 20 patient capacity

Frequency Template Capacity

Number of Patients Seen in Clinic

Restructuring costs Restructuring costs analysis

Redundancy / termination costs VR / MAR reductions Executive structure changes Identified VR and CR posts Further Corporate Restructuring Professional fees Restructuring intiatives

Restructuring costs

FY 2013

£'000

FY 2014 1,109 784 589 1,518

4,000 Comments

1,250 3,750 47 WTEs have left via redundancy during the course of FY 2013 in addition to redundancies provided for in the FY 2012 accounts Since October, 6 Execs and Senior Managers have left the Trust This includes agreed VR proposals (6) and a further 15 identified posts Corporate Restructuring posts Additional posts being identified as part of the ongoing Corporate Restructuring Estimated costs associated with consultancy to support delivery of the Recovery Plan and resolution of EPR issues Expected costs associated with delivery of Phase 2 and 3 of the Recovery Plan

5,000 45

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Financial Performance – 3 year forecast summary

TRFT Financial Performance FY 2013 - 2016 Operating Revenues

Income from Activities Other Income

Operating Expenses

Pay Non-Pay

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC FY 2013

forecast outturn

Trading Perform ance (£m )

FY 2014

forecast

FY 2015

forecast

Surplus / (def) before Restruct.

Surplus / (def) after Restruct.

210.3

20.8

231.1

-152.3 -67.7

-220.0 11.1

4.8%

-4.0

7.1

-0.6 -8.9 -2.0 -2.1

-13.6 -2.5 -6.5

206.2

19.6

225.8

-147.9 -67.2

-215.1 10.7

4.7%

-5.0

5.7

-0.4 -7.7 0.0

-2.4

-10.6 0.2

-4.8

196.1

19.6

215.7

-140.4 -65.0

-205.4 10.3

4.8%

0.0

10.3

-0.3 -6.8 0.0

-2.4

-9.5 0.7

0.7

FY 2016

forecast

193.8

19.6

213.4

-134.8 -64.3

-199.1 14.3

6.7%

0.0

14.3

-0.3 -6.8 0.0

-2.4

-9.5 4.7

4.7

Observations

The Trust plans to return to surplus over a 2 year period.

Other than further non-recurrent support for restructuring of £5m in FY 2014, income reflects a gradual phasing out of non recurrent support from NHSR.

Costs are based on current underlying run rates of expenditure adjusted for cost pressures and cost reduction plans.

In addition to inflationary pressures, specific cost pressures include the ongoing resource for EPR and additional nurses in light of the Francis report recommendations.

Forecast includes cost reductions over the 3 years of £36m phased £13m, £13m and £10m in FY 2014 – FY 2016. Restructuring costs associated with the delivery of cost reductions are estimated to be £5m in FY 2014 in addition to the £4m in FY 2013.

Financial Performance – Current underlying performance

TRFT Financial Performance FY 2013 Operating Revenues

Income from Activities Other Income

Operating Expenses

Pay Non-Pay

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC

Net surplus / (deficit) Adjustm ent to current perform ance (£m ) Forecast outturn FY2013

Non recurrent adjustment Run rate adjustment

Current underlying

210.3

20.8

231.1

-152.3 -67.7

-220.0 11.1

-10.5 -0.7

-11.2

0.0

1.0

1.0

-10.3

0.0

0.0

2.3

1.0

3.2

199.8

20.1

219.8

-150.0 -65.8 -215.8 4.0

-4.0

7.1

-0.6 -8.9 -2.0 -2.1

-13.6 -6.5

4.0

-6.3

0.0

2.0

0.0

2.0

-4.3

0.0

3.2

0.0

0.0

3.2

0.0

4.0

-0.6 -8.9 0.0

-2.1 -11.6 -7.5

Observations

The forecast outturn for FY 2013 of deficit £6.5m has been adjusted for non-recurrent items that should not occur in perpetuity and also run rate cost changes that have already implemented in FY 2013 to assess the current underlying performance of the Trust (as a basis for comparison with its future forecast).

2. Non-recurrent income, Recovery Plan costs (e.g. Bolt Partners and PwC), Restructuring costs and the proposed EPR impairment have been removed. To the extent any of these may re-occur, they have been added back as non-recurrent income or cost pressures in FY 2014 (next page).

3. The run rate adjustments reduce the cost base to the ongoing level of expenditure seen in Q3 and Q4 (i.e. reflecting run rate savings (CIPs) that were achieved in Q1 / Q2). No run rate adjustment has been made in relation to lost income attributed to EPR issues.

4. This suggests that the underlying level of underperformance is currently c. £7.5m deficit.

Financial Plan FY 2014

TRFT Financial Performance FY 2013 - FY 2014 FY 2013 Current underlying

Grow th CQUIN

NHSR contract incom e

QIPP Inflation Baseline adjustments Non recurrent support

Operating Revenues

Income from Activities Other Income

199.8

20.1

219.8

2.1

2.1

-0.1

-0.1

-2.9

-2.9

-1.6

-1.6

1.3

1.3

6.6

6.6

Operating Expenses

Pay Non-Pay

-150.0 -65.8 -215.8 4.0

0.0

2.1

0.0

-0.1 0.0

-2.9 0.0

-1.6

-0.5

-0.5 0.8

0.0

6.6

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC

Net surplus / (deficit) 0.0

4.0

-0.6 -8.9 0.0

-2.1 -11.6 -7.5 2.1

0.0

2.1

-0.1 0.0

-0.1 -2.9 0.0

-2.9 -1.6 0.0

-1.6 0.8

0.0

0.8

-5.0

1.6

0.0

1.6

Inflation

Cost pressures

Incremental drift Specific pressures

Contingency Cost reductions Other

1.0

-0.5

0.5

0.0

-1.5 -1.3

-2.8 -2.8 0.0

-2.0

-2.0 -2.0 0.0

-1.9 -0.9

-2.8 -2.8 0.0

-2.5 -1.7

-4.2 -4.2 0.0

10.0

3.0

13.0

0.0

0.5

FY 2014 Forecast 206.2

19.6

225.8

-147.9 -67.2 -215.1 10.7

-2.8 0.0

-2.8 -2.0 0.0

-2.0 -2.8 0.0

-2.8 -4.2 0.0

-4.2 13.0

0.0

13.0

0.5

0.2

1.2

-0.3

1.0

1.5

-5.0 5.7

-0.4 -7.7 0.0

-2.4 -10.6 -4.8

Analysis of specific cost pressures included in the plan are set out on the next page .

Financial Performance – FY 2014

Specific cost pressure summary for FY 2014 Pay Items that are above and beyond current run rate £'m

Children and Young People - specific funding provided to increase specific resource 0.6

Increase in CNST and other insurance premiums Care Co-ordination Centre 0.1

Non-pay £'m

0.6

Total £'m

0.6

0.1

Medical staff and devices Carbon reduction commitment levy Impact of Francis report Other 0.1

1.0

0.1

1.9

0.2

0.1

0.0

0.9

0.2

0.1

1.0

0.2

2.8

Observations

1. The contract income adjustments are based on the 3 year framework agreement with NHSR together with non-recurrent support including £5m for Restructuring purposes and the re investment of FY 2014 tariff deflation.

2. Inflationary pressures have been included at 1% for pay and 2% for non-pay. Incremental drift is based on the last actual % calculated in March 2012.

Specific cost pressures totalling £2.8m are set-out opposite and a further 2% contingency against current costs has been included.

4. Other includes: i.

ii.

iii.

An element of recovery of underperformance against contract in FY 2014 (due to EPR); A more prudent assessment of other income for FY 2014; and Reduced depreciation on a reducing NBV and (depreciation and impairment exceeding capex).

Financial Performance – FY 2015

TRFT Financial Performance FY 2014 - FY 2015 FY 2014 Forecast

Grow th

Operating Revenues

Income from Activities Other Income

206.2

19.6

225.8

Operating Expenses

Pay Non-Pay

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC

-147.9 -67.2 -215.1 10.7

Net surplus / (deficit) -5.0 5.7

-0.4 -7.7 0.0

-2.4 -10.6 -4.8

2.1

2.1

0.0

2.1

0.0

2.1

NHSR contract income

QIPP Inflation Baseline adjustments Non recurrent support

Cost pressures

Inflation Incremental drift

Contingency Cost reductions Other

-2.9

-2.9 0.0

-2.9 -2.9 0.0

-2.9

-1.6

-1.6 0.0

-1.6 -1.6 0.0

-1.6

-1.2

-1.2 0.0

-1.2 -1.2 0.0

-1.2

-6.6

-6.6 0.0

-6.6

5.0

-1.6 0.0

-1.5 -1.3

-2.8 -2.8 -2.8 0.0

-2.8 0.0

-1.5

-1.5 -1.5 -1.5 0.0

-1.5 0.0

0.0

10.0

3.0

13.0

0.1

0.9

1.0

14.0

0.0

1.0

1.0

0.0

1.0

FY 2015 Forecast 196.1

19.6

215.7

-140.9 -64.5 -205.4 10.3

0.0

10.3

-0.3 -6.8 0.0

-2.4 -9.5 0.7

Observations

1. Contract income is in line with the 3 year framework agreement with NHSR and the remaining non-recurrent support (£5m restructuring and £1.6m tariff re investment) is assumed to drop away.

2. Inflationary cost pressures are assumed to be as for FY 2014 with any additional cost pressures assumed to be covered by contingency (built into FY 2014).

3. No further restructuring costs assumed.

Cost reductions of £13m assumed.

5. Other includes removal of additional Recovery costs (e.g. EPR, Bolt Partners).

Financial Performance – FY 2016

TRFT Financial Performance FY 2015 - FY 2016 FY 2015 Forecast

Grow th

Operating Revenues

Income from Activities Other Income

196.1

19.6

215.7

Operating Expenses

Pay Non-Pay

EBITDA (before Restructuring)

EBITDA (%)

Restructuring Costs

EBITDA (after Restructuring)

Net Interest Depreciation & Amortisation Impairments PDC

-140.4 -65.0 -205.4 10.3

Net surplus / (deficit) 0.0

10.3

-0.3 -6.8 0.0

-2.4 -9.5 0.7

2.0

2.0

0.0

2.0

0.0

2.0

NHSR contract income

QIPP Inflation Baseline adjustments Non recurrent support -2.4

-2.4 0.0

-2.4 -2.4 0.0

-2.4

-1.9

-1.9 0.0

-1.9 -1.9 0.0

-1.9 0.0

0.0

Cost pressures

Inflation Incremental drift

Cost reductions Other 0.0

-1.4 -1.3

-2.7 -2.7 -2.7 0.0

-2.7 0.0

-1.0

-1.0 -1.0 -1.0 0.0

-1.0 0.0

8.0

2.0

10.0

0.0

10.0

0.0

Observations

FY 2016 Forecast

1. Income has been adjusted for growth, QIPP and tariff deflation in line with prior years.

193.8

19.6

213.4

-134.8 -64.3 -199.1 14.3

0.0

14.3

-0.3 -6.8 0.0

-2.4 -9.5 4.7

2. Inflationary pressures have been reflected but no significant further cost pressures are assumed (bearing in mind the rolling contingency built into prior year forecasts).

Cost reductions of £10m are assumed, lower than in prior years but without the benefit of Restructuring costs or support to implement.

Income forecast summary FY2013 – FY2016

TRFT Financial Performance FY 2013 - 2016

FY 2013

forecast

Incom e analys is (£m )

FY 2014

forecast

FY 2015

forecast

FY 2016

forecast

Observations

Activity re late d NHS Rothe rham Re curre nt

Baseline (exc non-elective thres) Community Services

Non-re curre nt

Def erred Income Accelerated Depreciation Restructuring Costs Tarif f def lation re-investment Other items (eg w inter support) Discontinuing support Non-elective Threshold Community Services 136.4

29.5

166.0

3.2

1.0

4.0

2.4

10.5

1.4

2.0

13.9

135.3

29.5

164.8

5.0

1.6

6.6

1.4

2.0

10.0

131.8

29.5

161.3

0.0

1.4

2.0

3.4

129.5

29.5

159.0

0.0

1.4

2.0

3.4

1. NHSR provides nearly 80% of total income via contract income, community services and non-recurrent support. From 1 April, this income will largely be from the new CCG but elements of funding will move to the NCB (e.g. Specialised services such as Photopheresis) and RMBC (e.g. GUM).

2. NHSR income has been forecast forward on the basis of the 3 year framework agreement adjusted for latest expectations of tariff deflation and non-recurrent re-investment indicated by NHSR.

Total NHSR 179.9

174.8

164.7

162.4

3. Non recurrent support of £11.2m is forecast to drop away over FY 2014 and FY 2015 (activity related £10.5m and other income, £0.7m).

Othe r PCTs

Barnsley Shef f ield Doncaster Derbyshire Bassetlaw Wakef ield Other PCTs Community 11.2

5.8

5.4

0.8

0.7

0.6

2.8

0.8

28.1

11.2

5.8

5.4

0.8

0.7

0.6

2.8

0.8

28.1

11.2

5.8

5.4

0.8

0.7

0.6

2.8

0.8

28.1

11.2

5.8

5.4

0.8

0.7

0.6

2.8

0.8

28.1

4. Together with other growth and inflation adjustments, this has the impact of reducing overall income by some £18m (8%) over the next three years.

Othe r s e rvice s

Photopheresis RTA Income

Pe rform ance variance and othe r Total activity re late d incom e

2.7

1.4

-1.7

210.3

20.1

2.7

1.4

-0.8

206.2

19.6

2.7

1.4

-0.7

196.1

19.6

2.7

1.4

-0.7

193.8

19.6

5. In addition to RNHS, TRFT also receives income from a number of other local PCTs and income for other activities that sit outside contract. Aside from RNHS, income is assumed to remain relatively constant throughout the forecast (both a small risk (tariff deflation) and opportunity (increased activity)).

Othe r incom e Non-re curre nt

Merit f unding MADEL f unding Other

Total othe r incom e

0.1

0.5

20.8

19.6

6. Other income comes from many sources and includes Educational Income, Recharges to third parties, R & D and Car Park income.

Total incom e 231.1

225.8

215.7

213.4

Pay forecast summary – FY 2014

Pay bridge

180 160 140 120 100 80 60 40 20 150.0

1.5

2.0

3.0

1.5

-10.0

148.0

10,600 10,400 10,200 10,000 9,800 9,600 9,400 4,000 3,500

Observations

1. Pay has been forecast by reference to current run rates adjusted for inflation and other specific pressures (e.g. Capitalised EPR people coming back into I&E and extra nurses light of the Francis report recommendations) offset by savings / reductions.

2. At January 2013, the Trust had 3,560 WTE which is lower than average for the year to date reflecting reductions already achieved in the year (and shown as a run rate reduction in the assessment of current underlying performance).

3. To achieve the FY 2014 forecast implies a further net reduction from current WTE of 81 (based on average wages). It is expected that the majority will be from Corporate areas (and therefore not impacting on clinical delivery) through Phase 1 ‘Stabilisation and Control’. Actual reductions required may be smaller due to the mix being weighted to higher paid employees.

3,000 All Payroll

Balance sheet forecast summary

TRFT Financial Performance FY 2013 - 2016 Fixed assets

FY 2013

forecast

99.4

Working capital

Inventories Trade and other debtors Trade and other creditors 3.1

7.3

-20.2

-9.8 Financing

Cash and cash equivalents FTFF loans Finance leases 10.0

-21.8 -1.1

-13.0 Provisions (including Restructuring) -4.4 Other financial liabilities -2.3 Net assets 70.0

PDC Retained deficit Revaluation Reserve

Equity

72.7

-4.1 1.4

70.0

Balance sheet (£m )

FY 2014

forecast

FY 2015

forecast

97.8

95.2

3.1

7.3

-20.0

-9.6

2.3

-19.2 -0.6

-17.4 -3.4 -2.2 65.2

72.7

-9.0 1.4

65.2

3.1

7.3

-20.0

-9.6

1.0

-16.6 -0.2

-15.8 -1.8 -2.1 65.9

72.7

-8.2 1.4

65.9

FY 2016

forecast

94.4

3.1

7.3

-20.0

-9.6

3.6

-13.9 0.0

-10.4 -1.7 -2.0 70.7

72.7

-3.5 1.4

70.7

Observations

1. Fixed assets reduce over the period with residual capex only exceeded by annual depreciation. No major projects are assumed.

2. Working capital is assumed to remain relatively consistent throughout the period. No significant improvement in debtor collection or creditor extension is assumed.

FTFF falls by £8m over the 3 years reflecting scheduled half yearly repayments. No further drawdown or repayment holiday has been assumed (although consideration is being given to both as a solution to potential medium term funding issues).

4. Provisions for Restructuring are made in both FY 2013 and FY 2014 (funded by non-recurrent support from NHSR) to be paid during the year and early in the following year (FY 2014 and FY 2015).

5. Cash deteriorates over the period which is due to ongoing deficits in the short term allied to financing obligations. The effect of financial restructuring funding received in FY 2013 and FY 2014 partially being paid out in early FY 2014 and FY 2015 – this is highlighted on the cash flow summary on the next page – also has an impact.

Cash flow forecast summary TRFT Financial Performance FY 2014 - 2016

EBITDA (before Restructuring)

Working capital movements Capital expenditure Restructuring

Cash flow before financing

FTFF draw dow n Loan repayments Finance lease payments Net interest PDC

Net cash flow

Cash b/f

Cash c/f Cash assum ing repaym ent holiday

FY 2013

forecast

11.1

-1.5 -8.6 -2.6

-1.6

0.0

-2.6 -0.6 -0.6 -1.9

-7.4

17.3

10.0

Cash flow (£m )

FY 2014

forecast

FY 2015

forecast

10.7

-0.3 -6.1 -5.9

-1.7 10.3

-0.1 -4.2 -1.6

4.3

0.0

-2.6 -0.5 -0.4 -2.4

-7.6

10.0

2.3

0.0

-2.6 -0.4 -0.3 -2.4

-1.4

2.3

1.0

4.9

6.2

FY 2016

forecast

14.3

-0.1 -6.0 0.0

8.1

0.0

-2.6 -0.2 -0.3 -2.4

2.6

1.0

3.6

8.8

Non-recurrent support Restructuring FTFF drawdown

Underlying net cash flow

-11.2 2.6

0.0

-16.0

-6.6 5.9

0.0

-8.3

1.6

0.0

0.2

0.0

2.6

Observations

1. Capex includes a further £2.3m in relation to EPR in FY 2014 (full provision for the final stage payment in dispute) but capex is otherwise assumed to be kept to a minimum (although sufficient for critical requirements to maintain clinical and service standards) – see next page for further analysis.

2. Restructuring payments in FY 2014 and FY 2015 are funded through non-recurrent support in the prior year.

3. No FTFF draw down is assumed although the Trust plans to seek a 2 year repayment holiday to provide additional headroom.

Financing payments (excluding PDC) are currently £3.8m p.a. of which £2.6m relates to existing FTFF loans.

5. Despite the mitigating effects of the Recovery plan, the Trust is likely to continue losing cash over the next two years (effectively to £nil) and on a monthly basis (before new funding or cash management) is forecast to run into overdraft during FY2015 – see monthly chart and observations on page 58. This is largely due to the withdrawal of non-recurrent support which has been significant historically. As highlighted by the simple analysis opposite, the underlying net cash flow is actually forecast to significantly improve from a very low base.

Capex forecast

Estates General Schemes Electronic Patient Record Medical Equipment Other

Depreciation

FY 2013 1.0

4.3

1.3

2.1

8.6

8.9

Capex £m

FY 2014 FY 2015 1.6

2.3

1.0

1.2

6.1

1.6

0.4

1.0

1.2

4.2

7.7

6.8

FY 2016 2.5

0.0

1.5

2.0

6.0

6.8

Observations

1. Capex requirements will be reviewed as part of the strategic planning process. In the interim, the projections include the levels of capex in the table opposite.

2. Other than in relation to EPR, capex has been relatively restricted in recent years and as shown by the forecast (by comparison to annual depreciation) this is expected to continue over the forecast period (in the absence of further major projects) with an uplift in FY 2016.

3. Estates – the FY 2014 forecast covers essential schemes (£1.2m) plus a further allowance for schemes that should ideally go ahead which is assumed to continue at a similar level in FY 2015.

EPR includes a further £2.3m FY 2014 (full provision for the final stage payment in dispute) but further expenditure on EPR is to be kept to a minimum.

5. There is a long request list for medical equipment which will be assessed on a case by case basis through the normal investment committee (based on clinical need and pay back).

6. Other is to cover the further ad-hoc requirements that are likely to arise over time.

Monthly cash forecast

Monthly cash forecast

12 10 8 (2) 6 4 2 Base forecast With 2 year holiday

Observations

1. There is no immediate liquidity issue for the Trust on even the most pessimistic forecasting basis. However, clearly the Trust cannot continue to lose money. With active liquidity management and the addition of “contingency” (through a WCF and/or repayment holiday), the Trust is confident that liquidity can be managed through the planning period. The graph opposite illustrates this.

2. There is no discernible seasonality in the cash flow in relation to working capital movements and therefore movements in cash tend to relate to large income or payments including: i.

Non-recurrent income; ii.

iii.

iv.

Capex (EPR); Loan repayments; and PDC.

EPR final instalment (in dispute) of £2.3m is assumed to be paid in December 2013.

Loan repayments are half yearly, £1.1m in June and December and £0.25m in September and March for existing loans.

PDC is paid in September and March each year.

FRR forecast

FY 2013 FY 2014 FY 2015 FY 2016 Underlying Performance (EBITDA Margin)

EBITDA YTD Operating Incom e YTD 11.1

231.1

10.7

225.8

10.3

215.7

14.3

213.4

Score Risk Rating Achievement of Plan (EBITDA %)

EBITDA YTD Actual EBITDA YTD Plan

Score Risk Rating 4.8% 2

11.1

14.0

Financial Efficiency (Net Return after Financing)

EBITDA YTD Depreciation & Am ortis ation YTD Interes t Receivable Interes t & PDC Dividends Payable Net Return after Finance Cos ts Opening As s ets (Current & Non-Current) Opening Liabilities (Current) Clos ing As s ets (Current & Non-Current) Clos ing Liabilities (Current) 11.1

-8.9 0.2

-2.9 -0.5 131.0

-28.7 119.8

-27.3

4.7% 2

10.7

-7.7 0.3

-3.1 0.2

119.8

-27.3 110.6

-26.2

4.8% 2 6.7% 3

10.3

-6.8 0.3

-2.9 0.7

110.6

-26.2 106.6

-24.4 14.3

14.3

79.2% 3 100.0% 5 100.0% 5 100.0% 5

14.3

-6.8 0.3

-2.9 4.8

106.6

-24.4 108.3

-21.8

-0.5% 2 0.2% 3 0.9% 3 5.6% 5 Score Risk Rating Financial Efficiency (I&E Margin)

Surplus /(Deficit) YTD Profit/(Los s ) on As s et Dis pos als YTD Im pairm ents & Res tructuring Cos ts YTD Operating Incom e YTD

Score Risk Rating Liquidity

Cas h for Liquidity Purpos es Operating Expenditure YTD WCF in Term s of Operating Expenditure YTD

Score Risk Rating Calculated Total Weighted Risk Rating Rounded Total Risk Rating Adjusted Total Weighted Risk Rating

-6.5 0.0

-6.0 231.1

-0.2% 2 0.1% 2 0.3% 2 2.2% 4

-11.3 -220.0 27.8

-18.5

1 -29.9

1 -30.6

1 -22.2

1.9

-4.8 0.0

-5.0 225.8

-17.8 -215.1 28.5

2.3

0.7

0.0

215.7

-17.5 -205.4 29.8

2.3

4.8

0.0

213.4

-12.3 -199.1 30.7

3.3

Weighting 25% 10% 20% 20% 25% 100% 11% 5 9% 5% 1% 2 <1% 100% 5 85% 70% 50% 2 <50% 3% 5 2% -0.5% -5% 2 <-5% 3% 5 2% 1% -2% 2 <-2% 5 25 Criteria 2 <10

Observations

1. Based on the forecast the Trust is expected to be FRR 2 for FY 2013 (subject to Monitor override) and is likely to remain so until FY 2016 when it is forecast to improve to 3. 2. Financial efficiency shows a steady improvement over the period.

3. Liquidity rating is and remains an issue due to relatively low cash reserves. Calculation shown alongside excludes any WCF.

Service Risk Rating forecast

2 3 4

Service Risk Rating

1 Current assets Inventories Current liabilities Before WCF WCF Including WCF Operating expenditure EBITDA (pre-restructuring) PDC Dividends Paid Interest Paid Capital Paid on Finance Leases Interest Received Repayment of Non Commercial Loans FY 2013 FY 2014 FY 2015 FY 2016 (3.1) (27.3) (11.3) (11.3) (3.1) (26.2) (17.8) (17.8) (24.4) (17.5) (17.5) (21.8) (12.3) (12.3) (220.0) (215.1) (205.4) (199.1) (1.9) (0.8) (0.6) 0.2

(2.6) (5.7) (2.4) (0.7) (0.5) 0.3

(2.6) (6.0) 0.3

0.3

Liquidity ratio (before WCF) Capital servicing capacity

Continuity of Service Risk Rating (before WCF)

(18.5) 1 1.9

3 (29.9) 1 1.8

3 (30.6) 1 1.8

3 (22.2) 1 2.6

2.0

2.5

Observations

1. The new Service Risk Rating is in consultation although the SRR has been calculated on the guidance currently available. This assumes that a WCF will not meet the ‘committed’ facility criteria.

2. This suggests the Trust will reach 3 in FY 2016 (on the assumption of rounding – up.

3. If a FTFF loan repayment holiday is taken, the improvement to 3 may be accelerated with the improvement in Capital servicing capacity.

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Current Governance Arrangements

Meetings

Board of Directors Audit and Assurance Committee (A&A) Corporate Management Board (CMB) Nomination, Rumuneration and Terms of Service Committee (NRATS) Programme Steering Group (PSG) Corporate Informatics Committee (CIC) Corporate Business Planning and Investment Committee (CBPIC) Corporate People and Organisational Development Committee Corporate Safety and Experience Committee Various sub-committees Charitable Funds Committee Various Governor committees Other project boards / committees (e.g. EPR)

Attendees

Execs / NEDs Execs / NEDs Execs Execs / NEDs Execs and management Some execs and management Some execs and management Some execs and management Some execs and management Mainly management Some Execs / Trustees Governors and some execs Some execs and management

Observations

Period

Monthly (last Thursday) Monthly (last Tuesday) Monthly (last Monday) Bi-monthly Weekly Monthly Monthly Monthly Monthly Monthly Quarterly Typically quarterly As required 1. Along with the simplification in Executive Structures, there is a clear need to streamline the number of corporate meetings held and to clarify the roles and responsibilities of each of these meetings. The current governance structure is unwieldy and has not been effective in ensuring transparency and good governance (e.g. EPR, staff consultation, savings programmes).

2. Specific issues noted: 1. The number of meetings – there is a need to greatly reduce the number of meetings required to “satisfy” governance and reduce the administrative burden these place on staff. As the organisational structure is simplified, the meeting structure needs to be greatly simplified so that execs and staff have time to deliver commitments; 2. The role and remit of meetings – at present, there are several meetings, which although they have theoretically clear Terms of Reference, it is not clear what their practical remit is (e.g. audit & assurance; NRATs; CMB). There is a need to ensure that executive, staff and non-executive time is used efficiently and that there are clear parameters and time limits to each meeting.

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Quality Governance Framework

Table 1: Overall risk rating in Q3 July to December 2012 (including all domains) Results from JULY to DEC 2012 review Q1 April to June

Strategy Capability & Culture Processes & structure Measurement

1A 1B

Does qua lity drive the trust’s strategy? Is the board sufficiently aware of potential risks to quality?

Does the board have the necessary leadership, skills and knowledge to ensure delivery of the quality agenda?

Does the board promote a quality focused culture throughout the trust?

Are there clear roles and accountabilities in relation to quality governance?

Are there clearly defined, well understood processes for escalating issues and managing quality performance?

Does the board actively engage patients, staff and other key stakeholders on quality?

Green Amber/ Green Amber/ Green Green Green Green 4A

Is appropriate quality information being analysed and challenged?

Is the board assured of the robustness of the quality information?

Is quality information used effectively?

Overall score (If below 4.0 then rating green as this allows sign off) Amber/ Green Amber/ Red Amber/ Green Amber/ Green 3.5 Q2 July to Sept Q3 Oct to Dec 0.0 0.0 0.5 0.5 0.5 0.0 0.0 0.0 0.0 1.0 0.5 0.0 0.0 0.0 0.0 0.5 0.5 0.5 3.0 1.0 0.5 3.0

Observations

The Trust Quality Governance Framework and Monitoring process, that includes non executive scrutiny has been identified as very favourable by KPMG.

The framework is assessed monthly by the Board to provide evidence for quarterly sign off to Monitor.

An evidence database has been developed and all documents, data and information relating to the framework are updated and stored on the system.

The end of year score will remain as those highlighted in the left hand diagram.

The data quality score has been impacted by EPR issues, although we now have evidence this is improving we will retain red score until Q1 FY 2014 assessment.

We anticipated changing 2a this quarter to 0, however we will await the feedback from Monitor in relation to the Recovery Plan before re-assessing this score.

Overall we have moved from a score of 3.5 Q1 FY 2013 to 3.00 at Q4. The target was 2.5 at year end however the data quality issues from EPR implementation have prevented this target being reached.

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Description

Forecast assumptions – Income

Comments £m FY 2014

£m FY 2015

£m FY 2016

Income and Expenditure I&E prior year Income -6.5

-4.8

0.7

Each years forecast is based on prior year rolled forward for key adjustments (inflation, CIPs etc) Based mainly on NHSR framework agreement with a phasing out of non-recurrent support

NHSR Other income Underperformance Activity growth CQUIN QUIPP Tariff deflation Other Non-recurrent support Baseline adjustments 1.0

2.1

-0.1

-2.9

-1.6

-4.7

0.8

-0.5

0.5% 1.0% 0.0% -1.4% -1.7% -2.4%

2.1

0.0

-2.9

-1.6

-1.2

-6.6

1.0% 0.0% -1.4% -1.7%

2.0

-2.4

-1.9

1.0% -1.2% -1.7%

FY 2013 is currently under contract for elective activity (EPR issues etc) which is assumed to recover nearer to contract levels Based on framework agreement with NHSR / no change in non-elective threshold (i.e. 2009 levels for short stay, same day and excess bed days) except where revisions already enacted Based on framework agreement with NHSR (excluding non-recurrent support - see below) - assumed to remain the same going forward Based on framework agreement with NHSR - mainly reductions through demand management (planned and non-elective) and reduced follow-ups National guidance of 4% efficiency target offset by 2.3% inflation applied to contract income Reduction in assessment tariff per framework agreement relating to ambulatory care Deferred income, accelerated depreciation, reablement, CQUIN FY 2012 accrual received FY 2013, chlamydia screening and workforce transformation assumed to drop away in 2014 £5m of restructuring support assumed to be available in FY 2014 (in addition to the £4m in FY 2013) before dropping away in FY 2015 Non-elective threshold and community service support totalling £3.4m is assumed to continue throughout For Montagu and Chlamydia & Estate charges based on PCT high level summary net of associated cost FY 2013 FOT includes a level of non-recurrent income (c.£2.5m (FOT vs plan) that was not identified when the budget was prepared). Forecast effectively £2m of currently unidentified income Whilst a level of unidentified income is likely to occur, a more cautious assumption has been adopted going forward

Description

Forecast assumptions – Expenditure

Comments FY 2014 £m

FY 2015 £m

FY 2016 £m

Income and Expenditure Pay Based on current run rates (Q3/Q4 FY 2013) subject to inflation and cost reductions

National inflation A4E Cost reductions

Non-pay

Inflation In-year CIPs

Other items

Interest / PDC Impairments Depreciation Restructuring Contingency - split between pay and non pay in the detailed forecast Run rate adjustments Specific cost pressures Other non recurrent items

I&E forecast

-1.5

-2.0

10.0

-1.3

3.0

-0.1

2.0

1.2

-1.0

-4.2

4.2

-2.8

-4.8

1.0% 1.3% -6.6% 2.0% -4.4% 1.0%

-1.5

10.0

-1.3

3.0

0.1

0.7

1.0% 1.0% -6.8% 2.0% -4.5%

-1.4

-1.0

8.0

-1.3

2.0

0.0

4.8

1.0% 0.8% -5.7% 2.0% -3.1%

Assumes national pay awards will remain minimal (given austerity etc) Calculated % applied in FY 2013 based on pay records and assumed to gradually reduce going forward Represents the pay proportion (roughly 3/4) of targeted cost reductions

Based on current run rates (Q3/Q4 FY 2013) subject to inflation and cost reductions

Aligned to BoE CPI target (includes drugs) Represents the non-pay proportion (roughly 1/4) of targeted cost reductions Interest based on original plan submitted to Monitor adjusted for interest on additional FTFF at 3% p.a. Impairment forecast for FY 2013 (EPR) assumed not to recur Based on original plan for FY 2014 and FY 2015 - depreciation calculated based on actual assets and depreciation rates - reduces due to assets being fully written down together with EPR impairment Effectively assumes £5m of restructuring costs in FY 2014 1% applied to total pay and non-pay costs in FY 2013 - effectively builds in £2.2m of contingency into each year due to the roll forward Add back of Recovery Plan costs (PwC and Bolt Partners) and adjustment for cost reductions already achieved in Q1/Q2 2012/13 EPR (£0.35m), Bolt Partners (£0.6m), EPR consultancy (£0.3m), CNST (£0.6m), Children and Young People Resources (£0.6m) and other various - Recovery elements assumed to reverse in FY 2015 Its probably optimistic that will be no unforeseen non-recurrent items but new non-recurrent items assumed to be covered by contingency

Description

Forecast assumptions – Cash flow

Comments £m FY 2014

£m FY 2015

£m FY 2016

Cash flow Net I&E

ITDA Working capital Capex

-4.8

15.6

-0.3

-6.1

0.7

9.5

-0.1

-4.2

4.8

9.5

-0.1

-6.0

Mainly depreciation (£7.7m reducing to £6.8m), PDC (£2.4m p.a.) and restructuring provision (£5m in FY 2014 and FY 2015) Based on a roll forward of the forecast balance sheet at March 2013 with no significant changes assumed FY 2014 includes the EPR final stage payment of £2.3m - might be lower pending dispute resolution (but fully provided at present) Other expenditure as per original plan subject to removal of surplus retention and contingency (totalling £1.0m p.a.) in each of FY 2014 and FY 2015 FY 2014 represents payment of £2.5m in relation to the FY2013 provision in Q1 together with ongoing restrucutring expenditure incurred in-year. FY 2015 reflects payment of residual FY 2014 provision Restructuring PDC FTFF Financing

Net cash flow

-5.9

-2.4

0.0

-3.6

-7.6

-1.6

-2.4

0.0

-3.3

-1.4

0.0

-2.4

0.0

-3.2

2.6

No FTFF draw down assumed although this remains an option with borrowing capacity of £10m Based on existing payment commitments against existing loans of £22m plus finance leases

I II III IV V VI

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Monthly Board scorecard – Exec Summary

Highlights & Escalations of metrics aligned to Trust performance areas & NHS Outcome Framework domains Highlighted Issue

A&E: maximum waiting times of 4 hours from arrival to admission/transfer/discharge.

Issue Description

The board are asked to note that the Trust is one of a very few that achieved nationally in Qtr 3 and continue to achieve year to date. However, in January the target of 95% has not been met achieving 92.74%. The quarterly position as at the 18th Feb is 94.15% C Diff: meeting the C Diff objective.

The monthly trajectory of 3 has been met with only 1 case reported in January, the year to date is also being met with 19 cases reported against the annual target of 31.

Management Actions Taken

Work is ongoing in the A&E department to sustain/improve performance as part of the emergency care pathway programme.

Messages regarding the importance of maintaining good hand hygiene and the use of hand gels continues to be communicated via different media sources to all staff, patients and visitors

Executive Action Required

The executive team are asked to support the emergency care review.

Page Ref

Monitor scorecard.

The executive team are asked to support the ongoing work to help reduce infections.

Monitor scorecard.

Cancer 2 week wait: from referral to date first seen, symptomatic breast patients (cancer not initially suspected).

GP Referrals Rotherham and non Rotherham Total number of New outpatients Elective Admissions Diagnostic waiting times: ensure nobody waits 6 weeks or over over for any 15 key diagnostic tests. Non elective admissions readmitted within 30 days The cancer targets are always reported a month behind due to the validation process undertaken. The 93% target has been met in December achieving 96.8%. Daily checking and appointing has now been implemented by the contact centre following a review of the choose and book system. The importance of patients accepting an appointment within 2 weeks is being promoted by the healthcare professionals in the hospital and community. The executive team need to note that the breast symptomatic target previously breached as a result of patient choice and a potential Choose and Book failure leading to ASI process issue.

The number of GP referrals has increased in January by 1,168 . The number referred by Rotherham GPs has increased by 919 and the Non Rotherham have increased by 249. Work is ongoing with the contact centre regarding the availability of slots on the choose and book system. Changes in the management arrangements of the contact centre have been recently undertaken. The number of new outpatients has increased in January by 1286 aptts which brings the total back in line with the pre christmas figures. Performance is still under the contract plan.

Activity now monitored weekly on the Flash report and is showing an increase since 27th December from 861 to 1797 week ending 14th February.

The executive team are asked to support the ongoing work in the contact centre.

The number of elective admissions has increased in January by 339 which brings the total back in line with the pre christmas figures. Performance is still slightly under the contract plan.

The Business and service managers are informed of their activity performance. The target has been met for January achieving 0.2% against a target of 1.0%, although currrently not meeting the target year to date 1.5%. Out of 1558 pts only 3 pts have waited over 6 weeks for diagnostic procedure. 1x Audiology 1xColonoscopy 1x Cystoscopy.

The polling range on choose and book has been lowered from 48 days to 42 days to give more time for appointments. This has resulted in the reduction in the number of sleep studies having to wait more than 6 weeks to zero. The executive team are asked to recognise the amount of work undertaken to reduce the historical long waits for sleep studies.

There has been a significant reduction in the number of emergency patients being re admitted within 30 days during January from 17.02% in December to 15.66% in January.

Now monitored weekly on the Flash report . Work is ongoing regarding urgent care pathways.

The executive team are asked to support the ongoing work around reducing non elective admissions.

Monitor scorecard.

Efficiency scorecard Efficiency scorecard Efficiency scorecard Efficiency scorecard Efficiency scorecard Average length of stay - TRUST (elective and non elective combined by discharging speciality) Non elective admissions readmitted within 7 days Cancelled operations - % of patients cancelled on day of operation for non clinical reasons The Trusts overall average length of stay is showing a reduction in January to 6.3 from 7.5 in December. Both the medical and surgical specialties show reductions with medicine being the better performer. The number of non elective admissions re admitted within 7 days shows a slight increase in January.

The number of cancellations during January significantly increased from 0.41% in Dec to 1.25% in January. The main reason for the cancellations was the availability of beds. Daily monitoring against the target of 5 discharges per day for the medical wards has been implemented and the findings shared with the medical management team and project leads. Daily information is available to specialties showing the most common causes for readmissions so action can be taken to manage re admissions for specific conditions.

Cancelled operations are reported daily to the DH on the sitrep report, bed management meetings occur throughout the day The executive team are asked to promote the use of information available to help manage processes.

Efficiency scorecard Efficiency scorecard Efficiency scorecard

Monthly Board scorecard – Finance and Governance

The Rotherham NHS Foundation Trust - MONITOR Scorecard - Position for Month 10 QTR 4 12/13 Finance & Governance Compliance Framework

Switchboard A&E: maximum waiting time of 4 hours from arrival to admission/transfer/discharge Clostridium Difficile - meeting the C.Diff objective MRSA - meeting the MRSA objective Cancer 2 week wait from referral to date first seen, all urgent referrals (cancer suspected) Cancer 2 week wait from referral to date first seen, sympomatic breast patients (cancer not initally suspected) Cancer 31 day wait from diagnosis to 1st treatment

Rated on Qtr Position Rating QTR QTR Score Target Value 1

95% 92.7%

0 0

5 0 1 0

93% 93% 96% -

YTD

95.2% 19 1 95.1% 90.2% 99.0%

Month Change Apr-12 Quarter 1 May-12 Jun-12

96.46% 4 0 95.2% 93.7% 100.0% 96.8% 98.2% 97.4% 96.4% 94.2% 100.0%

Jul-12 Quarter 2 Aug-12 Sep-12

95.18% 95.02% 1

0 0 96.13% 3 0

89.7%

93.3% 98.8% 95.15%

94.49%

97.44%

0 1 0 95.91% 3 0 94.6%

84.8%

100.0%

92.2% 89.4%

98.4%

Oct-12 Quarter 3 Nov-12 Dec-12

96.1%

92.6%

95.8%

76.6%

100.0% 100.0% 97.8% 96.8% 97.2%

Jan-13 Quarter 4 Feb-13 Mar-13 93.71% 92.74% 2

0 1 0 Cancer 31 day wait for 2nd or subsequent treatment - surgery Cancer 31 day wait for second or subsequent treatment - anti cancer drug treatments Cancer 62 Day Waits for first treatment (urgent GP referral for suspected cancer) Cancer 62 Day Waits for first treatment (from NHS cancer screening service referral) Maximum time of 18 weeks from point of referral to treatment in aggregate, admitted patients Maximum time of 18 weeks from point of referral to treatment in aggregate, non-admitted patients Maximum time of 18 weeks from point of referral to treatment in aggregate, patients on incomplete pathways Community care data completeness - referral to treatment information completeness Community care data completeness - referral information completeness Community care data completeness - activity information completeness Community care data completeness - patient identifier information completeness Community care data completeness - End of life patients deaths at home information completeness Income & Expenditure vs plan Cash vs plan Capex vs plan Cost Improvement Programmes vs plan

Financial Risk Rating vs Plan Monitor Governance Rating 0 0 0 0 0 0 0 0 1 1

94% 98% 85% 90% 90% 95% 92% 50% 50% 50% 50% 50% (878) 8,731 9,800 12,120 1 0 91.2% 97.0% 95.4% 100.0% 100.0% 100.0% 85.6% 100.0% N/A N/A N/A N/A 0 98.9% 100.0% 92.4% 95.5% 94.2% 98.0% 93.1% 100.0% 100.0% 100.0% 87.1% 100.0% (4,855) 4,974 6,230 8,435 1 0 100.0% 100.0%

85.7%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.0% 99.6% 97.6% 34% (25%) (33%) (34%) 2 92.4%

75.0%

99.1% 99.8% 94.8% 56% (15%) (32%) (30%) 3 91.1%

83.3%

97.9% 98.7%

92.0%

100.0% 100.0% 100.0% 87.5% 100.0% (12%) 3% (53%) (22%) 2 86.5%

88.9%

95.8% 98.3%

89.9%

(40%) 5% (25%) (22%) 2 89.6% 96.2% 87.8% 98.6% 100.0% 100.0% 100.0% 100.0% 90.7% 100.0% 92.2% 97.9%

87.8%

(53%) (24%) (32%) (21%) 2 90.3% 97.2% 94.0% (63%) (46%) (34%) (25%) 2 91.0% 96.8% 95.1% 90.3% 97.4% 93.6% 91.8% 97.2% 94.3% 91.2% 97.0% 95.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 91.1% 100.0% 88.0% 100.0% 85.0% 100.0% 100.0% 85.6% 85.6% 100.0% 100.0% 100.0% 100.0% 100.0% (139%) (23%) (44%) (26%) 2 (283%) (49%) (42%) (26%) 2 (232%) (32%) (36%) (25%) 1 (453%) (43%) (36%) (30%) 1

Trend 71

Monthly Board scorecard – Quality Governance

The Rotherham NHS Foundation Trust - MONITOR QUALITY GOVERNANCE FRAMEWORK Monitor Quality Governance Framework Scorecard

Switchboard

Rating Month Change Target Apr-12 Quarter 1 May-12 Jun-12 Jul-12 Quarter 2 Aug-12 Sep-12 Oct-12 Quarter 3 Nov-12 Dec-12 Jan-13 Quarter 4 Feb-13 Mar-13 Strategy

1A Does quality drive the trust’s strategy?

1B Is the board sufficiently aware of potential risks to quality?

TBC TBC 0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

Capability & Culture

2A Does the board have the necessary leadership, skills and knowledge to ensure delivery of the quality agenda? 2B Does the board promote a quality focused culture throughout the trust?

Processes & structure

3A Are there clear roles and accountabilities in relation to quality governance? 3B Are there clearly defined, well understood processes for escalating issues and managing quality performance?

3C Does the board actively engage patients, staff and other key stakeholders on quality?

Measurement

4A 4B Is appropriate quality information being analysed and challenged? Is the board assured of the robustness of the quality information? 4C Is quality information used effectively?

TBC TBC 0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

TBC TBC TBC 0.0

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

0.5

0.0

TBC TBC TBC 1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

1.0

0.5

Overall Quality Score TBC

3.5

3.0

Monthly Board scorecard – Quality

The Rotherham NHS Foundation Trust - QUALITY Scorecard Review of MANDATORY Quality metrics

Switchboard

YTD Rating Period Change Safe

Serious Incidents per 1,000 bed days Never' events per 1,000 bed days -99.67% #######

Reliable

NHS Safety Thermometer - No Harm VTE (new) NHS Safety Thermometer - No Harm Falls (new) NHS Safety Thermometer - No Harm Pressure Ulcer (new) NHS Safety Thermometer - No Harm UTI (new) NHS Safety Thermometer - 'Harm Free Care' (new) Number of recorded patient safety incidents per 1,000 bed days Rate of patient safety incidents resulting in severe harm Pressure ulcers - Acute attributable (grade 2+) Pressure ulcers - Community attributable (grade 2+) Admissions of full term babies to neonatal care % of medication errors causing serious harm -4.32% -3.79% -2.74% -0.53% -0.45% -7.52% -33.48% 31.18% 77.73% 0.00% ####### RAMI (CHKS Live - last rolling year) SHMI (CHKS: In-hospital death only. Last rolling year) Weekend mortality (% of total in-hospital deaths) Neonatal mortality (Labour Ward & Neonatal Unit) Rate of stillbirths (Labour Ward) 2.97% 2.42% -7.44% -52.00% -41.60%

Percentage of dementia patients on FAST track Patients with dementia having Assessment/Investigation

Caring

Complaints - Overall Proportion of deceased patients on the EoL pathway Patient Experience Tracker (composite score of 3 surveys) -50.56% -20.75% -3.11%

Reliable

Percentage of admissions for a fragility fracture (=>55) Number of emergency admissions from care homes Rate of readmissions from care homes within 30 days -7.26% ####### ####### -

Target

0.093

0.005

95% 95% 95% 95% 95% 29.7

0.6% 170 220 110 0.2% 86.6

74.1

28.4% 8 0.76% 90.0% 90.0% 540 47.0% 86.7

0.9% 2 7.12%

YTD

0.000

99.1% 98.6% 97.6% 95.5% 95.4% 31.9

0.4% 223 391 110 0.0% 89.2

75.9

26.3% 4 0.44% 813 56.8% 89.4

0.9% 93 0.00%

Apr-12 Quarter 1 May-12 Jun-12

0.0001

0.0000

97.7% 97.7% 96.8% 93.9% 93.0% 30.0

0.2% 22 38 9 0.0% 86.4

74.1

24.7% 1 0.40% 47 82.9

0.7% 0 0.0001

0.0000

98.0% 97.1% 97.0% 94.8% 93.2% 33.9

0.0% 27 37 16 0.0% 87.1

73.6

16.9% 1 0.00% 70 85.3

1.1% 3 99.4% 98.7% 97.6% 93.7% 95.7% 0.4% 25 44 11 0.0% 88.8

75.2

29.9% 0 0.00% 96 56.7% 87.2

0.8% 9

Jul-12 Quarter 2 Aug-12 Sep-12 Oct-12 Quarter 3 Nov-12 Dec-12 Jan-13 Quarter 4 Feb-13 Mar-13 Trendline

98.2% 99.1% 97.1% 95.0% 94.7% 1.0% 28 38 11 0.0% 90.5

76.7

27.8% 0 0.85% 103 88.0

0.9% 6 99.0% 99.4% 97.6% 93.6% 94.7% 0.7% 18 32 14 0.0% 89.8

76.6

24.7% 0 0.71% 87 83.6

0.8% 5 99.6% 98.0% 98.0% 97.5% 96.8% 0.2% 16 40 11 0.0% 89.2

76.5

36.6% 2 0.38% 71 56.8% 92.3

0.9% 0 99.7% 98.8% 97.7% 96.3% 96.8% 0.0% 24 49 7 0.0% 90.5

77.4

24.7% 0 0.43% 84 89.5

0.7% 4 99.3% 98.9% 97.9% 96.5% 95.7% 0.5% 23 40 13 0.0% 91.4

77.3

21.3% 0 0.0% 134 91.5

0.9% 12 99.8% 99.3% 97.8% 96.2% 96.2% 0.4% 18 35 8 0.0% 29.6% 0 0.4% 60 91.7

1.3% 25 99.4% 98.0% 97.7% 96.2% 96.2% 0.5% 22 38 10 0 26.7% 0 61 91.8

0.7% 29 0.2%

Monthly Board scorecard – Efficiency

The Rotherham NHS Foundation Trust - Efficiency Scorecard Review of Key Strategic metrics

Switchboard

Rating Period Change

Total number of GP referrals

- Rotherham - Non Rotherham

0.00% 0.00% 0.00% Total number of New outpatients Out patient New to Follow up ratio Out patient DNA rates Diagnostic waiting times - ensure nobody waits 6 weeks or over for 15 Key diagnostic tests Access to GUM Clinics - the % of patients offered an appointment within 48hrs of contacting a service % of Stroke patients who spend at least 90% of their time on a stroke unit % of non-admitted higher risk TIA cases who are treated within 24 hours of first contact with any healthcare professional Unplanned hospitalisation for chronic ACS conditions rate (per 100,000) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19's rate (per 100,000) Delayed transfers of care - % of patients whose transfer of care from hospital was delayed Cancelled Operations - % of patients cancelled on day of operation 6.56% -15.00% 40.20% 48.59% 0.00% -10.04% -44.19% -11.47% -11.76% -54.20% 2.36% Number of Non Elective admissions Number of Elective admissions - % of ELECTIVE patients re admitted within 7 days - % of NON ELECTIVE patients re admitted within 7 days - % of ELECTIVE patients re admitted within 30 days - % of NON ELECTIVE patients re admitted within 30 days Bed utilisation - Trust Theatre Utilisation Average Length of Stay - Medical Average Length of Stay - Surgical Average Length of Stay - Trust The number of breaches of mixed sex accommodation 8.32% 2.08% -28.67% 0.81% 5.71% 12.66% -7.92% 0.00% 0.00% 0.00% 35.05% 0.00% The % of mothers defined as having initiated breast feeding 7.12% The % of women Smoking during Pregnancy -9.74% The % of women seeing a midwife/maternity healthcare professional by 12 weeks and 6 days of pregnancy MRSA screening - % of Non Elective patients screened MRSA screening - % of Elective patients screened 18.60% 3.61% Health visitor numbers against plan 737.51% % of A&E attenders that convert to admisisons % Unplanned re-attendance to A&E rate (within 7 days) % Patients leaving A&E without being seen 0.00% -41.64% -20.26%

Target

TBC TBC TBC 72624 3.10

7.7% 1.0% 100.0% 80.0% 60.0% 1700 170 3.5% 0.80% 25032 32578 1.40% 6.20% 3.00% 12.50% 82.0% TBC TBC TBC 4.1

0 66.0% 20.0% 90.0% 100.0% 100.0% 49.0

TBC 5.0% 5.0%

YTD

49642 36929 12713 67859 2.63

10.8% 1.5% 100.0% 88.0% 86.5% 1505 150 1.6% 0.82% 27114 31902 1.00% 6.25% 3.17% 14.08%

Apr-12

4717 3706 1011 6777 2.58

8.3% 3.9% 100.0% 85.3% 100.0% 158 20 1.4% 0.49% 2740 2878 0.84% 6.91% 2.86% 13.81% 88.3%

Quarter 1 May-12

5344 4197 1147 8139 2.52

7.4% 0.3% 100.0% 76.0% 88.9% 158 11 1.1% 0.58% 2730 3372 0.64% 6.51% 3.00% 14.58% 88.7%

Jun-12

4605 2879 1726 5051 2.92

13.0% 0.3% 100.0% 82.1% 75.0% 146 11 1.1% 0.91% 2604 2858 0.63% 6.10% 3.16% 13.09%

Jul-12

5930 3698 2232 5311 2.89

13.8% 0.9%

Quarter 2 Aug-12 Sep-12

5018 3767 1251 6815 2.75

12.8% 3.5% 4819 3715 1104 6209 2.51

11.0% 3.4% 100.0% 94.7% 70.0% 170 26 1.9% 0.84% 2775 3998 0.69% 5.44% 3.09% 11.19% 100.0% 83.3% 83.3% 170 5 2.0% 0.89% 2684 3207 0.65% 5.68% 2.71% 13.10% 100.0% 96.3% 81.8% 148 27 1.5% 0.82% 2537 2930 1.02% 6.13% 3.22% 12.27%

Oct-12

5487 4256 1231 7993 2.41

11.5% 1.2% 100.0% 93.8% 75.0% 118 15 2.8% 1.16% 2797 3530 1.09% 6.36% 3.23% 16.32%

Quarter 3 Nov-12

4958 3862 1096 7014 2.47

11.5% 1.9% 100.0% 87.9% 83.3% 125 10 1.7% 0.81% 2754 3418 1.52% 5.97% 2.82% 13.91%

Dec-12

3798 2965 833 6632 2.75

11.1% 0.9% 100.0% 89.7% 92.3% 169 16 1.3% 0.41% 2726 2686 1.34% 6.62% 4.23% 17.02%

Jan-13 Quarter 4 Feb-13 Mar-13

4966 3884 1082 7918 2.69

9.7% 0.2% 100.0% 92.6% 100.0% 143 9 1.5% 1.25% 2767 3025 1.63% 6.84% 3.54% 15.66% 5.5

5.2

5.5

0 61.3% 18.1% 87.5% 81.4% 96.4% 21.9% 2.9% 4.0% 0 57.20% 80.68% 83.46% 98.40% 37.7

22.53% 2.67% 3.15% 0 53.97% 89.43% 83.56% 98.41% 38.8

21.26% 3.09% 4.80% 6.3

5.6

6.1

0 62.72% 17.96% 85.65% 40.5

20.81% 3.16% 4.88% 4.8

5.0

0 63.43% 87.55% 61.04% 95.33% 40.5

21.25% 4.02% 6.61% 4.5

5.5

4.8

0 63.81% 91.32% 78.41% 96.40% 40.6

21.50% 2.75% 4.37% 4.7

4.8

0 60.17% 20.13% 91.29% 85.39% 95.41% 39.8

21.71% 3.19% 4.90% 4.3

4.7

4.6

0 63.48% 82.24% 86.98% 97.33% 43.2

21.00% 2.94% 3.20% 7.1

5.5

6.6

0 65.10% 89.63% 84.79% 96.70% 43.7

22.61% 2.67% 3.65% 9.1

5.3

7.5

0 63.57% 16.23% 93.81% 87.10% 94.47% 42.3

23.23% 3.25% 4.60% 6.8

5.2

6.3

0 59.38% 86.65% 82.31% 94.68% 43.2

23.10% 2.70% 3.14%

Monthly Board scorecard – People

The Rotherham NHS Foundation Trust - People and Organisational Development Scorecard Review of indicators aligned to Workforce Intelligence Quarter 1

Switchboard

Rating Month Change Target YTD Apr-12 May-12 Jun-12

Workforce

Head Count (HC) - Exc. Bank Head Count (HC) - Inc. Bank Full Time Equivalent (FTE) Turnover None None None None -

Jul-12 Quarter 2 Aug-12 Sep-12 Oct-12 Quarter 3 Nov-12 Dec-12 Jan-13 Quarter 4 Feb-13 Mar-13

4380 4644 3605 4357 4627 3586 4340 4603 3571 4326 4588 3566 4322 4593 3563 4305 4585 3561 4317 4587 3564 4306 4577 3555 4273 4545 3523 4247 4526 3498 12.28% 11.73% 11.47% 13.43% 11.83% 12.28% 12.08% 12.33% 12.46% 12.24% Sickness Absence None 4.25% 4.28% 4.28% 4.34% 4.37% 4.39% 4.41% 4.44% 4.42% 4.53% New Applications

Establishment Control

Applications Refused / Referred Approved applications

Learning & Development

MAST - overall completeness Information Governance Training completeness Personal Development Reviews Agency - Medical (£) Agency - Non Medical (£) Locum - Medical (£)

Contingent Labour Spend

Bank - Non Medical (£) Extra Sessions (£) On Call (£) Overtime (£) None None None None None None 778 95 673 137 23 114 115 24 91 128 5 123 129 9 120 89 3 9 48 17 98 132 14 118 78.00% 77.3% 83.00% 81.79% 82.00% 80.00% 81.53% 48.70% 49.61% 50.10% 52.39% 54.93% 77.2% 53.7% 77.5% 76.9% 74.0% 52.5% 74.4% 52.0% 77.1% 72.5% 50.9% 75.0% 65.9% 48.9% None None None None None None None 1.54m

265,306 253,057 243,663 225,949 366k 227k 28,368 19,061 39,083 17,435 40,504 25,951 48,437 32,874 79,069 36,430 19,521 101,175 111,891 98,644 57,304 27,640 50,341 31,020 44,531 18,613 93,379 20,712 22,787 1.84m

224,264 254,593 233,669 240,627 236,516 168,879 175,620 154,668 155,052 67,527 11,817 793k 1.13m

124,547 127,336 114,414 124,151 139,952 133,129 123,835 74,326 939k 126,529 92,916 65,179 81,731 47,852 83,506 98,076 132,574 71,098 90,005 68,258 90,009 52,980 93,446 46,668 97,291 163,255 84,527 89,608 53,052 87,085 88,236

Recovery Plan

Transcript Recovery Plan

Recovery Plan Version 6.0

18 th March 2013

I II III IV V VI

Contents

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Executive Summary Context

1. As at February 2013, The Rotherham NHS Foundation Trust (“TRFT”) is facing a number of significant challenges. These were highlighted in the Monitor letter dated 15

Feb 2013:

2. This Recovery Plan outlines a proposed path forward.

The Recovery Plan - Objectives

1.

This High Level Recovery Plan (“the Plan”) has been compiled in February and March 2013. It aims to address the key concerns raised in the Monitor letter, specifically:

The Plan - Overview 12 months Phase 1 – 4 Months “Stabilisation and Control” Phase 2 – 4 months “Operational Excellence” Phase 3 – 4 months “Strategic Initiatives” Phase 1 - Key Activities

Phase 2 - Key Activities

Phase 3 - Key Activities

The Plan – Initial Financial Projections

Key messages

Key Risks and Mitigations

Monitor Letter (15 tH February 2013) - Next Steps Ref

Requirement

Actions (x Ref)

Monitor Milestones 2013 – Control Schedule (Appendix 2) – high level timetable

I II III IV V VI

Contents

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

Overview of TRFT

TRFT

Clinical Services Elective Care

Urgent Care

Community Services

Facilities & Estates Infrastructure

Corporate Infrastructure

Elective Care

Context

Elective Care Context (continued)

Urgent Care

Context

Community Revenue

Context

Management Structure – 1 st Jan 2012 Observations

1. TRFT has, in recent years, had an outdated Management structure with unclear accountabilities and responsibilities. It is likely that the complexity of the structure has directly impacted the ability of the organisation to deliver to its plans. Evidence:

2. Features of the structure were numerous reporting lines into the CEO (19), a very heavy executive level (9 direct non clinical reports into the CEO) and a very fragmented approach to managing 3. Actions have already been taken to simplify the top level structure (included later).

Financial Performance – Recent Years

Observations

Financial Performance – Current Year

Observations

Income analysis

(Month 10 YTD)

Observations

Activity analysis

(Month 10 YTD)

Observations

Consolidating

analysis (Month 10 YTD)

Balance sheet

(Month 10 FY 2013)

Balance sheet summary at January 2013

Observations

Liquidity – weekly cash flow to August

EPR Context

Short term remedial actions:

Quality Impact Status

The Rotherham NHS Foundation Trust - MONITOR Scorecard - Position for Month 11 QTR 4 12/13

SUS Data Quality Dashboard for Apr-Nov Data – All data items

Rotherham compared to other SHA trusts

SUS Data Quality Dashboard for Apr-Nov Data – Inpatient data items

SUS Data Quality Dashboard for Apr-Nov Data – Outpatient data items

Financial Impact of EPR (in addition to planned spend)

Observations

EPR Medium to long term issues

Medium to long term actions, already in place include:

Further medium to longer term actions / developments

I II III IV V VI

Contents

Executive summary The Current Reality and Context The Plan – Overview Financial plan Governance Quality Appendices Forecast assumptions Monthly board scorecard 2 9 31 46 61 63

The Plan - Overview 12 months Phase 1 – 4 Months “Stabilisation and Control” Phase 2 – 4 months “Operational Excellence” Phase 3 – 4 months “Strategic Initiatives” Phase 1 - Key Activities

Phase 2 - Key Activities

Phase 3 - Key Activities