Annual Health Check 2007/08 Summary of Trust Action Plan

Overview MTW had been making good progress to achieve improved performance in the quality of services rating, moving from ‘zero star’ in 2004/05 to ‘fair’ in 2005/06. The Trust was on track to deliver ‘fair’ in 2006/07 but this was reduced to ‘weak’ following a Health Care Commission (HCC) investigation into outbreaks of the clostridium difficile infection. The HCC ruled that 5 core standards (C1a, C7a/c, C8a, C13a and C21) could not be deemed to be met following their investigation. MTW had already declared 5 core standards (C4a, C5b, C8b, C11 and C20b) as not met, so taken together this led to a ‘fail’ in the core standards, and therefore a ‘fail’ in the quality of services rating. Good progress had been made to reduce an historic deficit (£17m) and an in-year deficit in 2006/07 of £4m. However, scores on the Key Lines of Enquiry (KLOE) assessment mean that any deficit automatically reduces the financial standing standard to ‘not met’. Any Trust not meeting this standard is then automatically declared ‘weak’ in the use of resources rating. Health Care Commission Investigation – Action Plan A full action plan will be signed off by MTW Board, the SHA Board and the HCC in December 2007 All recommendations and each issue raised has a detailed action, led by a named director, with a managerial lead The Annual Health Check action plan must be read along side the HCC action plan – both will be published on the web Changes to Board Leadership New chief executive, Glenn Douglas Interim chair, George Jenkins 5 new non-executive directors to be appointed New nurse director to be appointed Interim chief operating officer, Matthew Kershaw Major changes of leadership have taken place to ensure a new drive for patient safety and performance Improvements will take time to embed and sustain Executive Summary – Assessment of Current Position

Executive Summary – Finance Small surpluses achieved in 2004/05 and 2005/06, £4.9m deficit in 2006/07 (£3.2m after prior year adjustment) Trust is on target to deliver savings of £14.5m to achieve break-even in current year Demonstrable progress made on financial run rate (break even month on month from October 2007) Trust will be rated as ‘adequate’ on finance in 2007/08 because of the 2006/07 deficit which will not be repaid in the current year State-of-the-art (£228m) hospital planned for 2010/11 with strong Ministerial and DoH support which will be Kent’s flagship hospital New hospital is a key ingredient to addressing the quality of clinical services and improving the Trust’s future financial position through the reduction from 3 to 2 sites. Current year performance includes £9.4m impairment costs to support the clearance of the Pembury site to support the project - £8.1m of enabling capital works underway

Executive Summary – Operational Performance Operational Performance The Trust is driving to achieve a ‘fair’ quality rating in 2007/08 This will require performance against the Annual Health Check components as follows as a minimum: –Existing targets – end year forecast is ‘partly met’ (> 24 points) –New targets – end year forecast is ‘fair’ (>20 points); –Core standards – end year forecast is ‘almost met’ Key challenges remain: –A & E (4 hour wait) –18 week target (joint work with MTW, West Kent PCT and the Kent & Medway Acute Commissioning Team mean that this target is on track for significant delivery by 2007/08 year end, orthopaedics being the main exception) –Delayed transfers of care –Cancelled operations Progress being made, but many of the standards require joint working across the local health economy MTW aims to minimise the number of core standards which are not met at the end of the year, and significant work is being undertaken as part of the action plan in response to the HCC clostridium difficile investigation, that will ensure compliance – this should lead to a score of a ‘good’ quality rating in 2008/09 The use of resources rating is on course to deliver ‘fair’ or ‘good’ – but requires break even in 2007/08 and assumes the HCC will review the criteria of requiring a 3-year period of break even

Operational Performance Progress – New & Existing Targets Existing national targets - Overall score of Partly Met AchievedUnder achieved 13 week waitersDelayed transfers of care 2 week wait – cancer(3.8%/3%) 31 day wait – cancerThrombolysis (61%/68%) 62 day wait – cancer Booking patientsFailed RACPCCancelled operations (3.8%/1.5%) A&E6 month breaches (0.2%/0.15%) New National Targets - Overall score of Weak AchievedUnder achieved MRSA (41/38)Experience of patients Treating drug users(below average) Smoke-free environment Mental Health in A&E and MaternityFailed GUM access (17%/49%)Ethnic coding (48%/85%) Emergency bed days18 weeks O/P, I/P and RACPC18 weeks I/P A&E18 weeks diagnostic (85%/97%) Stroke (no unit)

Financial Progress

2007/08 End of Year Summary for Key Risk Areas

Appendix Action Plan

Action Plan Areas In April 2007 MTW declared non compliance in five core standards C4a MRSA C5b Clinical leadership and supervision C8bAppraisals and PDPs C11bMandatory training C21Privacy and dignity This gave the Trust a score of Partly Met (up to 8 non compliant) Healthcare Commission found MTW non compliant on C21 Health Act 2006 (following cross checking of other sources of data). This led to a qualification (minus 2) giving a score of minus 7 – Partly Met Following the Healthcare Commission report into C.diff, the Trust have been declared non compliant in a further four areas: C1aActing on patient incidents C7a Sound clinical and corporate governance C8aSupport staff to raise concerns over patient care C13aTreating patients with dignity and respect Qualification in these four core standards leads to a score of minus 8, added to the minus 7 gives MTW a score of minus 15 = Not Met (more than 9 areas non compliant) Action plan addresses key areas of risk as at October 2007 Existing national targets –4 hour wait in A&E –Cancelled operations –Delayed transfers of Care New national targets –Infection control –18 week milestones

Action Plan – Core Standards (1/5)

Action Plan – Core Standards (2/5)

Action Plan – Core Standards (3/5)

Action Plan – Core Standards (4/5)

Action Plan – Core Standards (5/5)

Action Plan – New & Existing Standards (1/3)

Action Plan – New & Existing Standards (2/3)

Action Plan – New & Existing Standards (3/3)