Apr 2016 May 2016 Jun 2016 Jul 2016 Aug 2016 Sep 2016 …...Apr 2016 May 2016 Jun 2016 Jul 2016 Aug...

Integrated Performance Report September 2016

10 Sustainability and Transformation Fund Apr 2016 May 2016 Jun 2016 Jul 2016 Aug 2016 Sep 2016 Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 2016/17

Value Value Value Value Value Value Value Value Value Value Value Value Value

STF Cancer 62 day wait trajectory 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

Cancer 62 Day Waits (aggregate measure) - Total Treated < 62 Days from Urgent GP Referral

100% 88.1% 92.6% 81.8% 92.7% 90.2%

Cancer 62 Day Waits (Open Exeter) Overall Total Treated < 62 days from urgent GP referral

92.2% 84.8% 90.4% 89.6%

STF RTT Incomplete trajectory 95.4% 95.4% 95.2% 95.2% 95.2% 95.2% 95.2% 95.2% 95.2% 95.2% 95.2% 95.2%

RTT Incomplete % <18wks TOTAL 94.2% 94.2% 94.0% 93.8% 92.7% 93.8%

RTT >52wk Waiters - Incomplete pathway 1 2 0 1 0 4

STF Diagnostics trajectory 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

Diagnostic Waiting Times (Patients waiting at month end - DM01)

99.2% 98.7% 98.4% 98.0% 96.4% 98.2%

STF A&E 4 hour waits trajectory 95% 95% 95% 95% 95% 95% 96.9% 96.2% 95% 95% 95% 95.7%

A&E, MIU & WIC Attendances and 4 Hour Breaches

96.5% 95.3% 93.7% 94.8% 95.4% 95.1%

A&E waiting time - Number of patients spending over 12 hours in A&E (trolley waits)

0 0 0 0 0 0

Ambulance Handovers % > 30 mins 5% 3% 7% 4% 6% 5%

Ambulance Handovers > 1 hour 5 3 3 2 4 17

Financial schedules will be included on a quarterly basis showing achievement against the fund criteria, following publication of guidance in July 2016. All requirements have been met in Q1.

35


11 Ambulance Handovers

2015-16 Quarterly Totals Monthly Totals Year to

Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17

Trend Chart Data Quality

Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value

Ambulance Handovers % > 15 mins

20% 39% 36% 38% 48% 49% 40% 35% 39% 40% 47% 45% 52% 48% 47% 52% 49% 47% 48%

Ambulance Handovers % > 30 mins

10% 4% 4% 3% 5% 5% 3% 2% 2% 3% 5% 3% 6% 5% 3% 7% 4% 6% 5%

Ambulance Handovers > 1 hour

0 46 8 9 21 11 7 5 1 3 10 4 7 5 3 3 2 4 18

Ambulance Handovers > 2 hours

0 2 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0

36


Indicator: Ambulance Handovers Executive Lead: Robert Sainsbury, Director of Operations Description of how the standard is measured: The percentage of ambulance handovers greater than 30mins. Performance in the period: There continues to be a steady reduction in the number of 30 minute and 1 hour handover delays since the completion of the additional bays in Majors and the introduction of daily validation. During August 2016 there were 1255 Ambulance Handovers, of which 78 were delayed by 30 minutes (6.2%). Of the 78, 38 (3%) were chargeable 30 minute delays. There were 4 handovers of more than one hour in August. The South Western Ambulance Trust introduced a new Operating Procedure for Ambulance Handover Delays from 1 November 2014. This included a new threshold of 3hrs for the total lost time over 15mins within a 24 hour period for all handover delays. The Trust has reviewed the potential impact of this as part of our resilience planning and to date this has only occurred twice since implementation.

Actions taken: The Trust continues to validate Ambulance Handover delays of over 30 minutes daily. Work is progressing with SWAST on effective use of IT systems to support validation. There is a monthly meeting between NDHT and SWAST to discuss operational issues, and a daily call to update each respective organisation on any pressures in the system Local action plan has been reviewed and the Trust has signed up to the Concordat. The Transforming Emergency Care Programme has been launched - planned changes to the ways of working in relation to the front door of the Trust, increase in MAU clinic capacity, appropriate sign-posting of patients and implementation of frailty model which will help to ensure there is capacity within the ED to enable more timely ambulance off-load.

Report completed by: Jill Canning, Divisional Director, Unscheduled Care Last updated: 20 September 2016

37

Integrated Performance Report September 2016 12 A&E Indicators


Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



A&E waiting time- Patients waiting 4 hours or less in A&E

95% 88.1% 89.9% 88% 84.1% 87.1% 85.1% 91.2% 89.2% 83.6% 86.1% 82.9% 83.3% 91.8% 85.2% 85.1% 86.1% 88.8% 87.3%

A&E, MIU & WIC Attendances and 4 Hour Breaches

95% 96% 96.6% 96% 94.6% 95.2% 95.4% 96.7% 97.1% 94% 95.3% 94.6% 93.8% 96.5% 95.3% 93.7% 94.8% 95.4% 95.1%

A&E % admitted from A&E

31.1% 29.2% 32.5% 33.1% 30.2% 30% 33.2% 31.4% 32.9% 34.5% 33.3% 31.7% 30.8% 30.3% 29.6% 26.8% 27.6% 28.9%

A&E waiting time- Unplanned re-attendance at A&E within 7 days

5% 5.8% 6.2% 5.5% 5.8% 3.2% 6.6% 6.3% 5.3% 4.9% 7.1% 4.9% 5.3% 2.3% 6.1% 1.3% 7.3% 0.3% 3.3%

A&E waiting time - Total time spent in dept 95th percentile (admitted)

4 6.5 6.24 6.51 7.26 6.69 7.37 6.11 6.09 7.33 7.1 7.21 7.47 5.53 7.32 7.22 6.54 6.06 6.45

38



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



A&E waiting time - Number of patients spending over 6 hours in A&E (admitted)

0 1213 243 285 479 360 140 72 67 146 152 133 194 51 167 142 125 71 575

A&E waiting time - Total time spent in dept 95th percentile (non-admitted)

4 3.89 3.8 3.83 4.37 4.21 4.31 3.58 3.59 4.31 4.17 4.5 4.43 3.59 4.51 4.54 4.59 4.37 4.32

A&E waiting time - Number of patients spending over 6 hours in A&E department - 95th percentile (non-admitted)

0 346 74 82 131 147 36 21 21 40 39 48 44 24 60 63 54 45 256

A&E waiting time- Patients left department without being seen rate

5% 1.9% 2% 1.8% 2.3% 2.7% 2.9% 1.6% 2% 1.9% 1.6% 2.2% 2.9% 2.1% 3% 2.9% 4% 3.6% 3.2%

A&E waiting time - Time to initial assessment 95th percentile (ambulance arrivals only)

0.15 0.14 0.13 0.14 0.14 0.15 0.13 0.13 0.15 0.14 0.14 0.14 0.15 0.14 0.15 0.15 0.14 0.13 0.14

A&E waiting time - Time to treatment (median)

0.6 0.43 0.42 0.45 0.49 0.51 0.47 0.45 0.44 0.45 0.45 0.53 0.5 0.46 0.55 0.53 0.61 0.62 0.56

39



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



A&E waiting time - Number of patients spending over 12 hours in A&E (trolley waits)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12a A&E Numbers

Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-

15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-

15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun 16 Jul-16 Aug-

16

Attendances at A&E Type 1 3,557 3,413 3,271 3,346 3,189 3,009 3,370 3,585 3,764 3,639 4,053 4,172 3,699 3,658 3,315 3,473 3,509 3,380 3,901 3,589 4,065 4,242 4,379 4,328

4 hour Breaches at A&E Type 1 261 355 291 457 556 461 418 365 404 336 273 377 553 322 359 568 487 578 651 294 603 634 609 484

4 hour % 92.7% 89.6% 91.1% 86.3% 82.6% 84.7% 87.6% 89.8% 89.3% 90.8% 93.3% 91.0% 85.1% 91.2% 89.2% 83.6% 86.1% 82.9% 83.3% 91.8% 85.2% 85.1% 86.1% 88.8%

Admissions from A&E Type 1 1106 1205 1073 1215 1187 1053 1135 1015 1190 1081 1180 1192 1111 1213 1042 1143 1210 1126 1237 1105 1233 1256 1175 1196

Conversion Rate 31.1% 35.3% 32.8% 36.3% 37.2% 35.0% 33.7% 28.3% 31.6% 29.7% 29.1% 28.6% 30.0% 33.2% 31.4% 32.9% 34.5% 33.3% 31.7% 30.8% 30.3% 29.6% 26.8% 27.6%

Av atts/day 119 110 109 108 103 107 109 120 121 121 131 135 123 118 111 112 113 117 126 120 131 141 141 140

40

Integrated Performance Report September 2016 Indicator: Percentage of patients waiting for 4 hours or less in A&E before treatment or discharge

Executive Lead: Robert Sainsbury, Director of Operations

Description of how the standard is measured: The percentage of patients who are treated or admitted in 4 hours or less in the Emergency Department at North Devon District Hospital (Type 1). Performance in the period: Performance against the 4 hour standard was 88.8% for Type 1 during August. All type performance for the month was 95.4%. There were 4328 attendances in ED with 1196 admissions, a conversion rate of 27.6%. In total there were 484 breaches in August; 9.3% of these were awaiting medical bed, 9% were awaiting surgical beds,16% were for ongoing care, and 6.2% awaiting specialty review.

Actions taken: • Following the launch of the Transforming Emergency Care Programme we have

initiated two workstreams : o ED Streaming – to ensure patients are directed to the most appropriate

setting for the management of their condition, which may be out of the hospital environment.

o Management of GP Expected Patients – ensuring patients are able to go to the Medical Assessment Unit or – when developed – the Surgical Assessment Unit rather than via ED (unless clinically indicated).

o Project management support will be available at the beginning of September

• Operational/clinical discussions scheduled with Devon Doctors to minimise the impact on 4 hour target from the change in contract.

• We are continuing to work with Devon Partnership Trust in relation to psychiatric patients requiring assessment. Psychiatric Liaison service hours have recently increased which has had a positive impact. Advice from colleagues at the SRG has been that having the Crisis Team based in ED has led to an increase in attendance as patients bypass usual process for accessing support – this will be fed into the streaming project.

• The Trust has had senior medical staff undertaking discharge rounds at weekends.

• The Trust has continued with the ‘Breaking the Cycle’ methodology and this has now become mainstream across the Acute and Northern community hospitals

• Further analysis of ‘Ongoing Care’ breaches has commenced in an effort to identify if there are solutions to the challenge this poses.

Report completed by: Jill Canning, Divisional Director, Unscheduled Care Last updated: 20 September 2016

41

Integrated Performance Report September 2016 13 Cancer Standards

2015-16 Quarterly Totals Monthly Totals

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016 Jul 2016 Aug

2016 Trend Chart Data Quality

Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value


85% 89.2% 84.6% 92.8% 90.4% 93% 89.2% 96.4% 93.8% 89.8% 94.9% 83.3% 92.5% 100% 88.1% 92.6% 81.8% 92.7%

Cancer 62 Day Waits (Open Exeter) Overall Total Treated < 62 days from urgent GP referral

85% 84% 78.2% 88% 85.9% 89.6% 80.6% 88.4% 87.9% 88% 90.7% 75.9% 90% 92.2% 84.8% 90.4%

Cancer 62 Day Waits (aggregate measure) - Total Treated < 62 Days Screening Service

90% 85.7% 100% 71.4% 100% 100% 100% 80% 100% 0% NA NA 100% 100% NA 100% 100% NA

Cancer 62 Day Waits (aggregate measure) - Total Treated < 62 Days Consultant Upgrade

90% 87.2% 94.7% 75% 87.9% 96.4% 100% 66.7% 66.7% 85.7% 66.7% 90.9% 100% 100% 100% 88.9% 100% 100%

Cancer 31 Day Waits - Total Treated < 31 Days from Diagnosis - (Decision to treat)

96% 97.4% 95.9% 97% 100% 99.2% 92.8% 94.4% 96.7% 100% 100% 100% 100% 98.6% 100% 98.9% 98.7% 97.6%

42



Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016




Cancer 31 Day Waits - Total Treated < 31 Days Subsequent Surgical Treatment

94% 91.2% 91.5% 86.8% 93.1% 97.6% 92.9% 83.3% 81.3% 100% 91.7% 85.7% 100% 100% 100% 94.1% 100% 94.7%

Cancer 31 Day Waits - Total Treated < 31 Days Subsequent Drug Treatment

98% 99.3% 98.7% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Cancer 2 Week Waits (aggregate measure) - Total Seen within 14 Days of Urgent GP Referral

93% 93.9% 91.8% 95.2% 96.5% 88.1% 94.7% 96% 95.3% 94.3% 96.1% 96% 97.3% 90.4% 93.3% 80.5% 77.5% 83.6%

Cancer 2 Week Waits (aggregate measure) breast symp

93% 88.4% 87.7% 93.9% 91.5% 69.4% 90% 92.6% 94.7% 95% 92.3% 93.8% 88.9% 91.3% 100% 35.5% 10.5% 36.8%

43

Integrated Performance Report September 2016 13a Cancer 62 Day Referral to Treatment by Tumour Site


Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016





85% 89.2% 84.6% 92.8% 90.4% 93% 89.2% 96.4% 93.8% 89.8% 94.9% 83.3% 92.5% 100% 88.1% 92.6% 81.8% 92.7%

Cancer 62 Day Waits - Breast Treated < 62 Days from Urgent GP Referral

85% 97.8% 100% 100% 96% 100% 100% 100% 100% 100% 100% 100% 88.9% 100% 100% 100% 87.5% 100%

Cancer 62 Day Waits - Lung Treated < 62 Days from Urgent GP Referral

85% 89.5% 80% 100% 75% 75% 100% 100% 100% 100% 100% 50% 100% NA 50% 100% 100% 50%

Cancer 62 Day Waits - Haem Treated < 62 Days from Urgent GP Referral

85% 100% 100% 100% 100% 80% 100% NA 100% 100% 100% 100% 100% 100% 66.7% 100% 66.7% 100%

Cancer 62 Day Waits - UGI Treated < 62 Days from Urgent GP Referral

85% 78.3% 83.3% 75% 100% 71.4% 50% 100% 80% 50% 100% NA 100% 100% 100% 33.3% 50% 100%

44



Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016




Cancer 62 Day Waits - LGI Treated < 62 Days from Urgent GP Referral

85% 76.2% 75% 54.5% 75% 76.9% 75% 50% 60% 50% 100% 50% 100% 100% 50% 75% 100% 100%

Cancer 62 Day Waits - Skin Treated < 62 Days from Urgent GP Referral

85% 97.7% 93.8% 100% 100% 97.2% 100% 100% 100% 100% 100% 100% 100% 100% 91.7% 100% 100% 93.8%

Cancer 62 Day Waits - Gynae Treated < 62 Days from Urgent GP Referral

85% 87.5% 100% 100% 80% 100% NA 100% NA 100% 100% 75% NA 100% 100% 100% NA 100%

Cancer 62 Day Waits - Urol Treated < 62 Days from Urgent GP Referral

85% 77.8% 65.4% 93.5% 78.6% 96.4% 75% 100% 100% 86.7% 66.7% 71.4% 86.7% 100% 90% 100% 75% 90%

Cancer 62 Day Waits - Head/Neck Treated < 62 Days from Urgent GP Referral

85% 66.7% NA 100% 100% NA NA 100% NA NA 100% NA NA NA NA NA NA NA

Cancer 62 Day Waits - Other Treated < 62 Days from Urgent GP Referral

85% 100% NA 100% 100% NA NA NA 100% NA NA 100% NA NA NA NA NA NA

45


Indicator: 2 week cancer referrals Executive Lead: Robert Sainsbury, Director of Operations Description of how the standard is measured: 93% of patients seen within 14 days from date referral received for suspected cancer. Performance in the period: August 2016

Source : SCR

Target 93% Referrals Within target

% Achieved

Outside of target

Pt choice Capacity Other Issues

2WW 457 382 83.59 75 2 57 0

Breast 76 17 22.37 59 2

57 0 2 x Patient choice

57 x Capacity

Target 93% Referrals

Seen in target

% Achieved

Outside of target

Pt choice

Capacity Other Capacity issues

Symptomatic Breast 19 7 36.84 12 0 12 0 12 x Capacity

Actions taken: Report is being shared with CCG outlining patient choice breaches by GP Practice. Ad hoc Breast Radiology Clinics are set up as requested to improve capacity. Action plan developed to improve Breast capacity. Breast radiology cover began in mid-August. Advanced Practitioner in Breast Mammography completes training November 2016. Continued work is ongoing to explore options to improve Breast radiology capacity. Work is being undertaken against new NICE guidance and further demand and capacity work is also in progress. Work is continuing on Urology pathways.

Report completed by: Nathan Brasington, Cancer Manager and Service Manager Haematology & Oncology Last updated: 19 September 2016

46


Indicator: 31 day Decision to Treat to Treatment Executive Lead: Robert Sainsbury, Director of Operations Description of how the standard is measured: 96% of patients with a definitive first treatment for cancer are treated within 31 days 94% of patient with a definitive subsequent treatment of surgery/radiotherapy are treated within 31 days 98% of patients with a definitive subsequent treatment of chemotherapy are treated within 31 days Performance in the period:

Decision to treat to treatment (96%)

Numbers treated

Treated in target

% Achieved

Outside of target

Patient Choice

NDHT Breach reason

Total pathways 84 82 97.61 2

Skin 25 23 92 2 0 1 x Trust capacity

1 x Other – medical delay due to INR

Subsequent treatment (94% surgery, 98% Chemo)

Numbers treated

Treated in target

% Achieved

Outside of target

Patient

Choice

NDHT Breach reason

Total pathways 75 74 98.66 1 0 Surgery 20 19 95 1 0 1 x Trust: Admin error

Actions taken: • On-going pathway

reviews • Patients now being

discussed at weekly Cancer PTL meeting to improve escalation processes

• On-going discussion with Skin Service Manager/team re capacity: Locum now secured

Report completed by: Nathan Brasington, Service Manager Haematology/Oncology Last updated: 19 September 2016

47


Indicator: 62 Day Target (RTT) Target : 85% Executive Lead: Robert Sainsbury, Director of Operations Description of how the standard is measured: Patients to receive 1st treatment for Cancer before 62 days after receiving GP referral for suspected Cancer diagnosis. Performance in the period: August 2016

Total Number

treated Treated in

target %

Achieved Outside of target

Shared breaches

Patient choice

H/care provider Other Details

48 42 87.5 6

Lung 2.5 1.5 60 1 0 0 1 0 1 x Trust/Complex

Skin 16 15 93.75 1 0 0 1 0 1 x Capacity

Urology 13.5 9.5 70.37 4 6 0 5 2

2 x Trust/Patient 3 x Trust 1 x Medical/Trust 1 x Medical

Source : SCR Actions taken & on-going : • Weekly Cancer Performance reports made available to all teams which provides performance updates • Weekly validation of PTL data by Service Managers before submission to Unify • Improved visibility of patients on pathway amongst teams • Baseline pathway work undertaken, meetings established with teams where pathway exceeds 62 days

• On-going discussions with RD&E and within South West Pathway Group to improve pathways for diagnostics and treatment

• RCA’s being completed and sent to teams for review/input • Improved validation processes in-month • Regular review by CMT of patients across all pathways • Joint pathway work with RD&E on prostate pathway – to be commenced. •

Report completed by: Nathan Brasington, Service Manager Haematology and Oncology Last updated: 19 September 2016

48


14 RTT and Elective Waiting Times


Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



RTT Admitted % <18wks TOTAL

90.0% 88.7% 89.3% 86.9% 83.7% 86.6% 86.4% 87.7% 86.4% 86.7% 86.9% 80.4% 84.1% 83.2% 88.3% 88.4% 84.7% 86.2% 86.2%

RTT Admitted Median 11.10 9.00 9.00 8.60 9.70 8.90 10.10 9.60 9.40 8.10 8.10 8.40 9.00

Not measured for Years

RTT Admitted 95th Percentile 23.00 23.60 23.10 23.40 23.00 22.00 26.60 24.10 26.60 23.90 24.70 23.90 24.60

Not measured for Years

RTT Non-Admitted % <18wks TOTAL

95.0% 97.2% 97.4% 96.3% 97.1% 97.2% 97.5% 96.2% 96.1% 96.8% 97.4% 96.5% 97.3% 96.4% 97.6% 97.4% 96.5% 96.9% 97.0%

RTT Non-admitted Median

6.60 4.40 4.30 3.90 3.30 4.10 3.30 3.40 4.10 4.00 4.10 4.10 4.40 Not

measured for Years

49



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



RTT Non-admitted 95th Percentile

18.30 15.10 17.00 16.50 15.50 15.00 15.60 14.90 15.40 13.30 15.00 16.10 15.90 Not

measured for Years

RTT Incomplete % <18wks TOTAL

92.0% 94.8% 95.0% 94.7% 94.4% 94.2% 95.1% 94.7% 95.0% 94.4% 94.0% 95.1% 94.1% 94.2% 94.2% 94.0% 93.8% 92.7% 93.8%

RTT Incomplete Median

7.20 5.30 5.40 5.00 5.40 5.90 4.70 4.40 4.30 5.00 5.30 5.60 5.90 Not

measured for Years

RTT Incomplete Pathways 95th Percentile

36.00 17.70 18.30 18.00 18.40 18.90 18.00 18.90 19.10 18.90 19.10 19.60 20.40 Not

measured for Years

RTT Admitted Pathways - Specialties that failed 18 week target

0 49 11 17 19 15 5 6 5 6 7 6 6 6 5 4 6 7 28

50



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



RTT Non-Admitted Pathways - Specialties that failed 18 week target

0 34 7 12 12 11 1 6 4 2 3 6 3 4 3 4 4 3 18

RTT Incomplete Pathways - Specialties that failed 18 week target

0 7 0 1 4 6 0 0 0 1 2 0 2 2 2 2 1 2 9

RTT >52wk Waiters - Admitted pathway

0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0

RTT >52wk Waiters - Non-Admitted pathway

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

RTT >52wk Waiters - Incomplete pathway

0 7 3 3 0 3 1 1 1 1 0 0 0 1 2 0 1 0 4

51



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Outpatient Waiting List TOTAL

2049 2235 2114 1892 1855 1704 1839 1863 2108 2123 2150 2299 2366 Not

measured for Years

GP referrals to Outpatients waiting more than 11 weeks

2 321 70 85 86 104 22 35 26 24 35 32 19 27 35 42 53 46 203

Elective Waiting List TOTAL

1131 1858 1942 2067 2142 1792 2051 1794 1791 1887 1950 1929 1990 Not

measured for Years

Elective patients waiting more than 20 weeks

2 387 77 82 154 179 15 29 23 30 27 62 65 56 49 74 95 111 385

Diagnostic Waiting Times (Patients waiting at month end - DM01)

99.0% 99.1% 98.9% 99.8% 99.3% 98.8% 99.3% 100.0% 99.9% 99.6% 99.5% 99.2% 99.3% 99.2% 98.7% 98.4% 98.0% 96.4% 98.2%

52


15 Endoscopy


Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Endoscopy patients urgent waiting < 2 weeks

95% 71.5% 71.1% 74.7% 82.5% 75.4% 72.4% 74% 76% 74% 82.1% 89.9% 75.8% 75% 73.3% 78.3% 73.1% 66.2% 73.4%

Endoscopy patients routine waiting < 6 weeks

95% 93.4% 88.9% 96.9% 96.1% 95.5% 86.5% 100% 95.7% 95.3% 94.9% 98.2% 95.1% 99% 92.7% 95.3% 86% 77.1% 89.9%

53


16 Emergency Readmissions 2015-

16 Quarterly Totals Monthly Totals Year to Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Re admission 28 day from Elective RY RR from Dr Foster

100.00 86.49 87.04 85.79 84.58 83.20 87.59 88.21 85.95 83.21 84.67 84.96 84.12 83.27 83.12 83.20

Re admission 28 day from Non-Elective RY RR from Dr Foster

100.00 92.29 91.48 92.63 93.41 92.50 91.74 92.85 92.42 92.62 92.69 93.87 93.67 92.25 92.75 92.50

17 Long Length of Stay

The Relative Risk for Long Length of Stay for the time period June 2015 to May 2016 was 94.44; this is statistically lower than expected.

54


18 Stroke Care 2015-

16 Quarterly Totals Monthly Totals Year to Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Admitted direct to SU within 4 hours

90% 55% 59% 46% 56% 54% 41% 46% 59% 35% 63% 62% 35% 62% 61% 39% 56% 83% 60%

90% of stay on SU (Acute only, SSNAP calculation)

80% 77% 77% 71% 78% 75% 62% 49% 85% 82% 75% 94% 59% 76% 76% 74% 76% 90% 79%

90% of stay on SU (Superspell,SSNAP calculation)

80% 78% 78% 72% 74% 76% 68% 50% 86% 82% 73% 88% 59% 76% 79% 74% 80% 90% 80%

Urgent scans within 1 hour 90% 93% 100% 86% 92% 100% 100% 92% 94% 63% 67% 100% 100% 100% 100% 100% 91% 100% 98%

Routine scans within 24 hours 100% 92% 95% 92% 87% 92% 95% 93% 88% 94% 89% 84% 88% 88% 92% 96% 100% 100% 95%

55



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



90% of stay on SU (EASTERN HOSPITALS)

80% 81% 72% 86% 92% 88% 75% 100% 78% 88% 89% 100% 86% 80% 100% 82% 100% 92% 91%

Indicator: 90% Stay on the Acute Stroke Unit (Local CVD SCN target 85%) – SSNAP definition Executive Lead: Robert Sainsbury, Director

of Operations Description of how the standard is measured: Percentage of patient spending >90% of their hospital stay on the acute stroke unit at NDHT Performance in the period: Performance in August 2016 against the 90% stay target was 90%, representing an improving result when compared to July 2016 (76%). The table below now shows performance against both the nationally recognised target (80%) and the local CVD Strategic Clinical Network target (85%) for the 90% stay indicator. There were 4 acute breaches in August 2016 as follows: - 1 patient had a delayed diagnosis - 1 stroke team not made aware - 1 patient had a short length of stay - 1 patient had a complex diagnosis of stroke

Actions taken: August has seen has an improving result in terms of the number of breaches achieving the performance target of 90%. The one patient with a delayed diagnosis did not have an initial diagnosis of One patient was not notified to the stroke team – this has been discussed with the senior clinicians involved to establish a reason. The patient with a short length of stay was compounded by being a medically expected patient, who was discharged quickly due to minor symptoms. The patient with a complex diagnosis presented with various symptoms but was ultimately diagnosed with a stroke.

Report completed by: Lisa Wells, Service Manager – Medicine & Paediatrics Last updated: 20 September 2016 56


19 Community Activity

Year to Date Monthly Totals

Target 2016 Apr 2016 May 2016 Jun 2016 Jul 2016

Trend Data Quality Value Value Value Value Value

Community Activity, Total Hours - Total 5321h 40m 00s 5321h 40m 00s

Community Activity, Total Patients - Total 2,521 2,521

Community Activity, Total Visits - Total 8,139 8,139

CSD Acute (from NDDH or RDE) - Monthly Total

252 90 49 60 32

CSD Community Hospitals - Monthly Total

252 23 10 9 7

57


Year to Date Monthly Totals

Target 2016 Apr 2016 May 2016 Jun 2016 Jul 2016

Trend Data Quality Value Value Value Value Value

Prevention of Admission - Monthly Total

252 251 329 443 397

Therapy Waiting Times Total 90.0% 89.8% 87.2% 89.6% 92.7% 89.7%

58


20 Other Performance Indicators


Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016


2016 2016/17 Trend Data

Quality Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value

Compliance with WHO checklist

100% 95.4% 94.44% 91.3% 92.27

% 93.67

% 92.68% 92.13% 90.69% 91.09% 90.05% 92.62% 94.14% 93.63% 93.54% 93.89% 93.87% 96.16% 94.22%

Percentage of last minute cancelled operations

0.80% 0.91% 0.73% 1.02% 0.77% 0.83% 1.00% 0.48% 1.08% 1.50% 1.14% 0.64% 0.53% 0.77% 0.76% 0.97% 0.44% 0.31% 0.65%

Last minute cancelled operations for non-clinical reasons (monthly) - Rebooked within 28 days

100% 96.92% 93.33% 100% 94.83

% 100% 90.48% 100% 100% 100% 92.31% 95.24% 100% 100% 100% 100% 100% 100% 100%

MSA Breaches - Sleeping Accommodation (exc ASU) (Acute)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Dementia Screening (Trust Total)

90% 66% 94% 36% 40% 36% 95% 43% 34% 30% 47% 30% 40% 33% 39% 37% 73% 44%

59


Dementia Risk Assessment (Trust Total)

90% 98% 100% 100% 98% 90% 100% 100% 100% 100% 100% 93% 100% 100% 50% 100% 100% 91%

Dementia Care Plan (Trust Total)

90% 92% 100% 89% 82% 88% 100% 94% 100% 63% 40% 0% 92% 93% 80% 79% 58% 84%

Dementia Referral for Specialist Diagnosis (Trust Total)

90% 94% 63% 92% 100% 63% 0% 100% 100% 100% 100% 100% 100% 100%

Unplanned Ward Transfers >1 transfer

30 302 57 60 85 132 24 11 17 32 30 24 31 12 50 70 63 48 243

DTC Delayed Transfers of Care Acute

3.5% 4.6% 3.36% 5.06% 6.19% 4.55% 4.55% 3.06% 2.2% 6.44% 4.75% 4.02% 4.57% 6.17% 7.88% 7.38% 6.35% Not measured

DTC Delayed Transfers of Care East Community

8% 15.77%

20.61%

21.01%

18.37% 16.47% 19.94% 21.08% 21.22% 21.89% 25.34% 15.12% 16.85% 20.54% 18.28% 20% 19.46% Not

measured

60


DTC Delayed Transfers of Care North Community

8% 14.88% 4.89% 12.8% 11.99

% 17.01% 5.82% 3.68% 4.62% 9.73% 14.13% 14.71% 12.58% 6.03% 16% 11.03% 9.38% Not measured

Percentage of Discharge Summaries sent within 24 hours of discharge (Acute)

100% 66.4% 66% 66.67%

70.33%

77.67% 68% 66% 68% 66% 68% 69% 74% 77% 77% 79% 80% 79% 78.4%

G U Medicine appointments offered in 48 hours Trust Total

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

61


21 Maternity Indicators


Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



% of women booked before 13 weeks gestation

90% 92.77% 93.64%

92.68%

92.14%

93.69% 89.81% 90.97% 91.97% 95.17% 91.24% 91.38% 93.51% 93.33% 92.65% 95.1% 90.44% 91.79% 92.72%

% Smokers at booking accepting referral to Smoking Cessation (denominator excludes women who refuse referral)

90.00% 98.77% 96.81%

100.00%

100.00%

95.00% 90.32% 100.00

% 100.00

% 100.00

% 100.00

% 100.00

% 100.00

% 94.44% 100.00% 95.00%

Maternity All Births 1524 410 369 390 388 135 133 126 110 139 119 132 127 133 128 123 125 636

Caesarean section rate (Elective & Non Elective) - Denominator all hospital deliveries >= 24 wks

24% 25.67% 27.37%

24.64%

25.74%

30.56% 30% 24.6% 24.14% 25.24% 23.13% 25% 29.13% 32.79% 29.13% 29.84% 25.42% 24.58% 28.41%

62



Date

Target 2015 Q2

2015 Q3

2015 Q4

2015 Q1

2016 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Caesarean section rate (Elective) - Denominator all hospital deliveries >= 24 wks

12% 11.14% 11% 12.17% 9.65% 12.6% 10% 9.52% 17.24% 9.71% 6.72% 9.82% 12.6% 13.11% 8.66% 16.13% 11.02% 10.17% 11.82%

Caesarean section rate (Non Elective) - Denominator all hospital deliveries >= 24 wks

12% 14.53% 16.37%

12.46%

16.09%

17.96% 20% 15.08% 6.9% 15.53% 16.42% 15.18% 16.54% 19.67% 20.47% 13.71% 14.41% 14.41% 16.58%

Maternity Monthly Breast feeding rate - Denominator All Del's by Dr or Midw in hosp or home

73.6% 76.23% 77.11%

75.28%

73.02%

78.01% 67.67% 79.55% 72.03% 73.58% 73.53% 74.56% 71.09% 78.4% 77.69% 77.95% 79.34% 74.79% 77.65%

Maternity % of all babies admitted to neonatal care

8.74% 14.43% 8.13% 0% 0% 16.3% 12.78% 10.32% Data unavailable for these months

63


22 Operational Effectiveness


Date

Target 2015 Q3

2014 Q4

2014 Q1

2015 Q2

2015 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Admitted Patient Care % Valid Data

95.9% 99.8% 99.8% 99.8% 99.8% 99.7% 99.7% 99.7% 99.7% 99.8% 99.8% 99.8% 99.8% 98.6% 99.3% 99.8% 99.8%

Outpatients % Valid Data 96.1% 98% 97.9% 97.9% 97.7% 97.8% 97.8% 97.8% 97.9% 97.9% 97.9% 97.9% 98% 97.5% 97.6% 97.6% 97.6%

A&E % Valid Data 97.2% 98.1% 97.8% 97.9% 98% 97.9% 97.9% 98% 98% 98% 98.1% 98.1% 98.1% 97.8% 97.9% 98% 98%

APC % Records First Submitted with Valid HRG Code

96% 100% 99.8% 99.8% 99.8% 99.8% 99.8% 99.9% 99.7% 99.9% 99.9% 99.6% 100% 86% 96.3% 99.4% 99.4%

Clinical Coding 5 day coding complete %

95.00% 73.86% 77.37%

79.92%

83.04%

83.68% 81.05% 77.89% 68.46% 57.89% 52.77% 60.18% 68.97% 78.52% 55.98% 58.50% 73.89% 57.25% 63.10%

64



Date

Target 2015 Q3

2014 Q4

2014 Q1

2015 Q2

2015 Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016 2016/17



Clinical Coding Backlog 500 966 1182 888 730 749 1067 954 983 1353 1335 1394 1132 846 1330 1286 1018 1059 1096

Outpatients First to Follow-up Ratio

2.5 2 1.8 1.9 2 2 2 2 1.9 2 2 1.9 1.9 1.9 1.8 1.8

Outpatients First Appointment DNA Rate

5.9% 6.1% 6.3% 5.7% 5.9% 6.6% 6.1% 6.1% 5.6% 6% 6.4% 6.1% 5.9% 5.7% 5.7% 5.7%

Outpatients Follow-up Appointment DNA Rate

8% 8.7% 8.9% 8.3% 8.5% 8.6% 8.1% 9.2% 8.3% 8.5% 9.3% 9% 8.6% 8.1% 8.2% 8.1%

NB: The Valid Data and Outpatient indicators use external data from SUS and Dr Foster, which is published up to 3 months in arrears. This report will always contain the latest available data.

65

Integrated Performance Report September 2016 Performance Glossary of Terms

A&E Accident and Emergency Department ASU Acute Stroke Unit C.DIFF Clostridium Difficile CONS Consultant CQC Care Quality Commission CQUIN Commissioning for Quality & Innovation CUM Cumulative CWT Cancer Waiting Times DC Day Case DGH District General Hospital DIR Direction EM Emergency FST First (New Outpatient Attendance) FUP Follow Up (Outpatient Attendance) G&A General and Acute specialties only (excludes Obstetrics & Midwifery) GU Genito Urinary Medicine HSMR Hospital Standardised Mortality Ratio (56 Nationally defined Diagnoses) IP In Patient IT Information Technology KPI Key Performance Indicator LFY Last Financial Year LOS Length of Stay MAT Maternity MAU Medical Assessment Unit MRSA Methicillin Resistant Staphylococcus Aureus MSSA Methicillin-Sensitive Staphylococcus Aureus NDHT Northern Devon Healthcare NHS Trust NICE National Institute for Clinical Excellence #NOF Fractured Neck of Femur OP Out Patient Q1 Quarter 1 (IE April – June) Q of S Quality of Service RD&E Royal Devon & Exeter NHS Foundation Trust RTM Real Time Monitoring (Benchmarking System) RTT Referral To Treatment (Time) SHMI Summary Hospital Mortality Indicator SMR Standardised Mortality Ratio (All Diagnoses) SWAST South West Ambulance Services Foundation Trust TBC To Be Confirmed TYPE 1 A&E department located at main hospital VTE Venous-thromboembolism WL Waiting List YTD Year To Date

66

Integrated Performance Report September 2016 23 National CQUINs Target Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 2016/17 Latest Note

Value Value Value Value

Health and Wellbeing Initiatives Yes Yes Providers should have developed a plan to introduce and actively promote the three initiatives that is peer reviewed and signed off. - Plan submitted CCG - 22nd June 2016 CCG position = Met

Healthy food for NHS staff, visitors and patients Yes Yes The collection of the 11 data points outlined in part b and the submission via UNIFY - UNIFY submission - 21st June 2016 CCG position = Met

Improving the uptake of flu vaccinations for frontline clinical staff

Reporting required in Q4 CCG position = N/A

Sepsis - Timely identification and treatment of Sepsis

Yes A new proposal was submitted to the CCG. NHS England have approved a variation to the scheme. Scheduled is now finalised. CCG position = Met

Antimicrobial - Reduction in antibiotic consumption per 1000 admissions - submissions

Yes Yes Submission to PHE was completed on 30th June 2016

Antimicrobial - Reduction in antibiotic consumption per 1000 admissions - %

Antimicrobial - Empiric review of antibiotic prescriptions

25% 84% Submission to PHE was completed on 14th July 2016 CCG position = Met

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