Item. 15 (i) Name of. Finance. Committee. Dr John. limit. leading to. follows: attendances. care. Review. financial performance An.

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Item 15 (i) Summary Exception Report off the Finance e meeting minutes for April 2018 EXCEPTION REPORTS Name of Chair of Senior Officer Supporting Date s Held Finance Dr John Lander, Non Executive

The key headlines were as follows: An improvement to the t Trust s year end deficit position had occurred ( 2.6m instead of 5.

1 Item 15 (i) Summary Exception Report off the Finance e meeting minutes for April 2018 EXCEPTION REPORTS Name of Chair of Senior Officer Supporting Date s Held Finance Dr John Lander, Non Executive Director Sally May, Chief Finance Officer 26 April 2018 Key Decisions and Matters Considered by thee 1. Month 12 Finance Report and Savings The e received and reviewed the Month 12 finance report. The key headlines were as follows: An improvement to the t Trust s year end deficit position had occurred ( 2.6m instead of 5.21m) as a result of changes to the rules regarding Sustainabilityy & Transformation Funding ( STF) and an incentive scheme distributed to Trusts. The capital programme had been delivered which maximised the use of f the capital resource r limit. Substantive pay levelss had increased as a result of an improved position on vacancy gaps, leading to less expenditure on variable pay going forward. 2. Contractual Performance Month 12 Key headlines noted in Month 12 were as follows: Improvement in A&E performance e during the latter half of March, M attributed to a drop in ED attendances. Elective operations had increased. Actions arising from the implementation of Gold Command were being reviewed and retained to ensure sustainability inn flow. RCHT achieved 90% against thee national average of 85% 8 against the Whole System Emergency Access Standard. Delayed Transfers of Care (DTOC) had marginally increased due to increases in social care package demand. A large numberr of beds had since been released by the Council for social care. The number of patients waiting forr community beds had increased in March. 3. Key Issues from Performance Review Meetings The received a report summarising the key outcomes from Performance Review meetings, the content of which was noted. A key piece of work was being undertaken in relation to the RTT Recovery Plan /OOH Update including financial performance An update was received on performance against the contract and the noted that the service continued to perform well. The Contract Assurance Group continued to review performance against KPI s which were inn the processs of being reviewed. 5. Operational Plan 2018/19 and Financial Planning Update (2018/19 Budget) The Operational Plan was presented too the Finance. The plan continued to focus f on quality, safety, tackling delays, patient flow, addressing capacity and further development in respect of the RTT recovery plan. Work remained ongoing within the Trustt in order to achieve 1

2 the plan s aims including additional funding for elective surgery, some ward moves and potential changes to pathways. A check and challenge process was in place in order to monitor delivery of the plan. The ability to recruit and retain staff was pivotal to the plan s achievement. Staff related initiatives were being developed in order to address gaps, including nurse associates and working with Cornwall Partnership NHS Foundation Trust on clinical fellows. With regard to the financial plan, discussions continued with NHSI regarding approval of a control total for the Trust. The finance part of the Operational Plan would be updated ahead of the Trust Board meeting once a meeting with Chief Executive s to secure agreement had been held. 6. Capital Programme 2018/19 The received the Capital Programme for 2018/19 and recommended approval by the Trust Board. 7. Cornwall Food Production Unit (CFPU) Business Case The received a business case relating to CFPU and received information on the current activity undertaken by the unit whose core business was providing food to the healthcare market. Plans were afoot to increase activity at the unit, whilst also improving quality of products produced. The approved the Business Case and would receive quarterly progress reports. 8. Contracts over 1m There were no contracts to report. 9. Beyond a Place of Safety Grant The were advised that the local Crisis Care Concordant Group had produced a system bid to co locate an Integrated Multi Agency Prevention and Assessment of Crisis Team (IMPACT) on the RCH site. A bid had been submitted by NHS Kernow and agreement provided in principle. Discussions would occur with the Executive Team prior to formal approval by the Finance. 10. Model Hospital Demonstration/Presentation The was provided with a demonstration on the Model Hospital system which had been developed following recommendation arising from Lord Carters report. The noted the work being undertaken by the Deputy Director of Finance with operational managers in order to review priority areas with a view to refining down metrics. Concerns identified and being managed at /Sub level Nothing specific. Matters Requiring Board Consideration Approval of the Capital Programme for 2018/19 Date of Next Meeting 31 st May

3 Item 15 (ii) Summary Exception Report of the Quality Assurance meeting minutes of the May 2018 meeting EXCEPTION REPORTS Name of Chair of Senior Officer Supporting Date Held Quality Assurance C Margaret Schwarz, Non N Executive Director Thomas Lafferty, Director of Corporate Affairs 22 May 2018 Key Decisions and Matters Considered by thee 1. Quality Improvement Programme A stocktake on progress had been undertaken which noted that some workstreams were very large and further consideration of the activities was required. The T discussed the link between quality improvement and training and development and a it was agreed that Executive SRO s must have a clear grip on the progress being made in all areas within the workstreams. 2. Ward Performance Key exception areas were noted to be Surgical Admissions Lounge and Wheal Coates across the quality standards reviewed. It was noted that theree had been unusably u highh level of demand on SAL due to the increased number of medical outliers and staff absence. The received r assurance thatt the recent international nurse recruitment campaign was progressing. 3. Ward Accreditation Ward Accreditation had been rolled outt to seven wards and the received information and assurance on the process associated with the initiative and how staff were positively engaged. The were informed that the Trust was looking to align all aspects of internal quality assessment processes. The supported the roll out of wardd accreditation across the Trust. 4. Risk report The noted thatt the Risk Management Strategy would be presented to the Audit and Risk Assurance in May, and the Board thereafter. The noted the presentational change to the risk reportt following feedback fromm the, and highlighted a number of specific risks for f further review. The asked for a review of the maternity culture risk and they further discussed the high risk rating attributed to fire and ventilation. The sought further assurance and it was agreed that the score s would be re assessed. 5. Incident Report The Trust s incident reporting rate was at the national averagee but the noted that there was a backlog of incidents and were assured that actions were w in placee to address this in a timely way. With regards to Duty of Candour, the were w informed that the Trust was calculating compliance, but were nott assured with the current compliance position. The requested further information and assurance at the next n meeting.. 6. Legal Services Quarterly Report 1

4 The quarterly report highlighted the volume and value of clinical negligence claims and that the number of referrals made to the Coroner was in line with national average, but had seen a recent increase in the last few months. The discussed the report in detail and agreed to receive a 6 monthly report. 7. Annual Dementia Care Report The report highlighted the steps taken over the last 12 months to improve dementia care and the Trust priorities to reduce clinical delay associated with treatment of patients with dementia. The noted that the Trust continued to work with health and care partners to support nonacutely ill patients with dementia being accommodated within an acute environment. 8. Health and Safety Report The received information on the implementation on the Trust smoke free policy as well as matters escalated through Health and Safety. 9. Sub Reports 9.1 Quality Governance Report and Clinical Effectiveness TOR The received the Clinical Effectiveness TOR, noting that both meetings were fully operational and that the would routinely receive assurance in respect to all patient safety and clinical effectiveness workstream KPI s. 9.2 Safeguarding Report The received the report, noting that there were no matters of concern. 10. Harm Review Panel Report The noted that the Harm Review Panel covered both prospective and retrospective harm review assessments and agreed to receive a report three times a year. The debated the correlation to the Trusts harm review process and the RTT backlog and sought further information and assurance at the next meeting. 11. Divisional Performance The noted and received the report. There were no matters of concern. Date of Next Meeting 26 June

5 Item 15 (iii) Summary Exception Report of the Audit & Risk Assurance meeting May 2018 EXCEPTION REPORTS Name of Chair of Senior Officer Supporting Date Held Audit & Risk Assurance Ms Margaret Schwarz, Non Executive Director Sally May, Chief Finance Officer 24 th May 2018 Key Decisions and Matters Considered by thee 1. Trust Financial Statements 2017/18 The received the draft annual financial statements, presentedd for review, prior to formal approval by the Trust Board. The accounts had been prepared in accordance with the Department of Health and Social Care Group Accounting Manual (GAM). Key performance metrics weree as follows: The Trust s outturn deficit was 2.6m for 2017/18 which included 2.61, of Sustainability and Transformation Funding (STF) incentive income. The Trust received notification of an SF incentive bonus on 20 th April The Trust spent 18.9m on capital assets in the year and operated within itss capital resourcee limit. Additionally the Trust operated within its External Financing Limit. The Trust was unable to meet its cumulative breakeven duty and recorded a cumulative deficit of 26m at 31 sts March A referral to the Secretary of State for Health and Social Care will be made by the Trust s external auditors under Section 30 as a result of the ncreasing cumulative deficit and deficit plan set for 2018/19. The financial statements had beenn prepared on a going concern basis. The approved the draftt financial and associated statements for 2017/ /18 and recommended approval by the Trust Board Annual Governance Statement (AGS) The AGS was received byy the who noted that the revised r version had been audited by the Trust s external auditors and the contents were also supported byy Audit South West. The recommended approval of the AGS to the Trustt Board. Head of Internal Audit Opinion (HOIAO) Limited assurance had been providedd for the year 2017/18 as a a result of weaknesses in the design, and inconsistent application of controls, which put the achievement of the organisation s objectives at risk in a number of areas reviewed. The received and approved the HOIAO Letter of Representation The received the letter of representation for review for 2017/18 prior to t being signed on behalf of the Trust Board, which contained information required by the external auditors and signature in advance of the issuing of the Audit Opinion on the financial f statements. The approved signature of the letter of o representation for 2017/18 on behalf of the Trust Board. 5. Annual Report As a result of changes to the annual timetable, and to facilitate good governance, the Trust is 1

6 required to submit its Annual Report in conjunction with its financial statements. The were advised that all comments from members of the Trust Board had been incorporated. The recommended approval of the Annual Report by the Trust Board. 6. Grant Thornton ISA 260 Audit Findings Report The received the audit findings report which highlighted key issues affecting the financial results of the Trust and the preparation of its financial statements for the year ended 31 st March No adjustments were required to the Trust s retained deficit position as a result of Grant Thornton s audit. The noted the contents of the report 7. Audit South West (ASW) Interim Report 7.1 Three internal audit reports had been issued since the last meeting, Payroll: Function (Significant Assurance), Payroll: Trust Management Information (Satisfactory Assurance), National Operating Standards: Data Quality of Ambulance Handover Times (Limited Assurance). 7.2 Two draft reports had also been issued and management responses are awaited in respect of Safeguarding Adults & Children (Part 1) and Staff Appraisals. The plan was to present Part 2 of the Safeguarding Adults and Children audit to the July. 7.3 Current work in progress reviews relate to Enhanced Financial Controls, Winter Escalation Plan and GDPR. ASW are also assessing whether the measures introduced as a result of Gold Command are embedded and sustainable. 8. Audit Recommendation Tracker The received the current live tracker results noting that the document was reviewed each month at the Executive Board meeting. It was noted that the tracker is not marked as green until the appropriate evidence has been reviewed. The asked that accountable officers, who do not respond to requests for updates (in excess of 2 3 times), be asked to attend the to provide an explanation going forward. 9. Strategic Audit & Assurance Plan 2018/19 to 2020/21 The received the draft Strategic Audit and Assurance Plan for 2018 to 2021 which set out how ASW would deliver audit and assurance services, undertake work to inform the HOIAO and AGS, providing a value added service to the Trust. The noted the contents of the draft plan and that amendments to its content would be made as priorities changed. 10. Audit South West Interim Report The draft Head of Internal Audit Opinion had been shared for consideration and would be presented to the next meeting. With regards to the Strategic Audit and Assurance Plan 2018/ /21, Internal Audit had met with each of the Executive Directors to agree the content. The noted that the IG Toolkit Review had been issued since the previous meeting and that a planned audit on GDPR had taken place to identify any gaps and ensure compliance with the May 2018 deadline. 11. Data Quality: Ambulance Handovers Following release of the final report with limited assurance the received a briefing from the Trust s Chief Operating Officer on the work that had been instigated in order to address the shortfalls identified. Significant improvements had been made in relation to ambulance handover times resulting in the Trust being identified as an exemplar site. 12. Single Tender Actions The report outlined that between 11 March 2018 and 20 April STAs were sought and approved. 13. Losses and Special Payments The received a report outlining the losses and special payments for the financial year ended 31 st March 2018 noting the contents. 14. Counter Fraud 2

7 14.1 Counter Fraud Progress Report The received a progress report outlining counter fraud activity against the work plan which included the status of ongoing and new investigations and other matters pertinent to the. The noted the contents of the report Counter Fraud Annual Report 2017/18 The Annual Report for 2017/18 provided the with a brief summary of counter fraud activity and outcomes during the 2017/18 operational year. The approved the Counter Fraud Annual Report for 2017/ Risk Management Report The received a report which contained the revised Risk Management Strategy, the principal risks that may impact on the achievement of strategic objectives in 2018/19 (to be included in the Board Assurance Framework (BAF)), together with the updated Corporate Risk Register. The Director of Corporate Affairs advised that a two page version of the Risk Management Strategy was being compiled which could be used by staff. The recommended approval to the Trust Board of the revised Risk Management Strategy, the principal risks and noted the updated Corporate Risk Register. Concerns identified and being managed at /Sub level Matters Requiring Board Consideration Financial and associated statements for 2017/18 Annual Governance Statement Annual Report Risk Management Strategy and Principal Risks Date of Next Meeting 11 July

8 Item 15 (iv) Summary Exception Report of thee Charitable Funds meetingg minutes for June 2018 EXCEPTION REPORTS Name of Chair of Senior Officer Supporting Date Held Charitable Funds Paul Hobson, Non Executive Director Adam Wheeldon, Deputy Director of Finance June 7 th 2018 Key Decisions and Matters Considered by thee 1. Introduction / Background This provides the Trust Board with a summary report of the key matters/ /issues discussed at the Charitable Funds on 30 th April Communications and Fundraising Update 3. Friends Update 4. Charitable Funds Strategy Update The received a health check report prepared byy external assessors and has since recruited additional team members in response to the recommendations. The appeal total is now 105k. The BABA appeal is the chosen c charity for the Royal Cornwall Show. The bags of help initiative from Tesco has generated 4k. The 70 challenge is now open andd 7 teams will be selectedd and given 70 to grow over 70 days. Teams will be encouraged to utilise their entrepreneurial skills to increase funds and the winners will receive up to 1000 of matched fundingg for their nominated fund. The team have been working with Mark Scallan in advance of o the new General Data Protection Regulation to ensure compliance and the Charity Privacy policy is available to view online. The Friends have granted 30k for a portable fibroscan and 3 toilet aids for visually impaired patients to aid with dignity. They are scheduled be installed across the Trust. The Friends 22 nd June of the Royal Cornwall Hospital Annual General Meeting M will take place on Friday Thank a Volunteer week is taking place from Monday 25 th June The Fundraising is to be reinstated. 5. Finance report The income figures for unrestrictedd funds have decreasedd since last have been gains on investments. year however there 1

9 The year on year spend has increased. It is anticipated that with the addition of new team members, the focus will be on generating general funds income. Concerns identified and being managed at /Sub level Nothing specific. Matters Requiring Board Consideration No specific issues to raise. Date of Next Meeting 20 th June

Summary Exception Report of the Finance Committee meeting minutes 11 th September 2017

Summary Exception Report of the Finance Committee meeting minutes 11 th September 2017 EXCEPTION REPORTS Name of Committee Chair of Committee Senior Officer Supporting Committee Audit & Risk Assurance