Annual Report and Accounts 2012/13 - Royal Bournemouth Hospital

Financial AccountsRisk that delays to the proposed mergercould lead to delayed decisions on therequired changes to inpatient serviceconfiguration, meaning that the Trust isnot able to respond in a timely way tothe need for centralisation, more 24/7consultant delivered care and associatedsavings. An action plan is in place toagree with Monitor and the CompetitionCommission, that allows the IntegratedBusiness Plan to be considered by theCouncil of Governors. A robust supportmechanism is in place to supporta granular Cost Improvement Plan,identifying the requisite savings.Potential for the demand for unscheduledcare exceeding projected levels setout in the commissioning contract,resulting in implications for meeting keytargets, including the 62 day cancerstandard, the 4 hour wait time in theEmergency Department and the 18 weekreferral to treatment time. In additionto these targets there is the potentialrisk to patients through treatmentdelays, escalated beds and delays todischarge. The other element of riskrelates to the ability to live within financialparameters. The Trust monitors activitymonthly through the commissioningprocess and performance targets arerigorously managed weekly throughthe Performance Management Group.The Trust has agreed with the ClinicalCommissioning Group a non-recurrentfunding source, whereby if non-electiveactivity continues, health economyactions will be funded outside of the maincontract.Risk of financial instability through tariffreduction. As the tariff will reduce year onyear, the Trust needs to meet the nationalmandated efficiency assumptions.Plans are place for 2013/14 and will bemonitored monthly through the FinanceCommittee and work is ongoing toidentify plans for the following two years.The cost improvement schemes are alsorobustly scrutinised through a qualityimpact assessment process to identifyany adverse impact on quality.Further risk of financial instability throughthe Clinical Commisioning Group’sambitions to move care out of thehospital setting and into the community,potentially leaving unviable services atthe Trust. The Trust is monitoring theimplications of the proposals closelythrough the various committees andexploring other opportunities.The Foundation Trust is fully compliantwith the registration requirements ofthe Care Quality Commission. There isa monitoring framework in place thatsets out each of the CQC outcomes andthe individuals and committees that areresponsible for monitoring the Trustscompliance with them. The Director ofNursing and Midwifery chairs a quarterlyreview meeting with CQC outcomeleads to monitor progress. The terms ofreference for the monitoring committeesinclude responsibilities for monitoringand reviewing CQC compliance.Provider Compliance Assessments arecompleted at least annually for eachoutcome and reviewed via the respectivemonitoring committee. A six monthlycompliance report is presented to theHealthcare Assurance Committee andAudit Committee. An annual review isalso incorporated within the InternalAudit programme and approved bythe Audit Committee. Compliance withCQC outcomes is also reviewed at adirectorate level at the executive-leddirectorate performance reviews.The Trust is in dialogue to activelymanage risks with public stakeholders.Examples of this dialogue include theChief Operating Officer attending thehealth economy urgent care board toensure stakeholders are involved inmanaging the risks of rising emergencyactivity at the trust. The merger process isbeing overseen by the Joint ProgrammeBoard which also incorporatesstakeholders from other organisations.The Director of Nursing and Midwiferyalso presents to the Council ofGovernors the quarterly significant risksand discusses mitigating actions. Thetrust also undertakes monthly contract10Annual Report and Accounts 2012/13