barnet hospital

8/7/2019 barnet hospital

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NHSB

Performance ReportJuly 2010

Delivering Better Health in Barnet


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Performance Areas

5. Business Plan

4. Annual Health CheckThe Annual Health Check for 2009/10 will not be published by CQC in October 2010 as previously expectedpublished.The 18 weeks target and patient access to primary care will no longer be performance managed.The new operating framework guidance requires us to continue with plans submitted unless guidance is issuFurther changes following the publication of the white paper are being assessed.Data for the majority of indicators is not published until the end of July and thus cannot be reflected in this re

6. Workforce and DevelopmentThe Workforce Committee are considering the requirements for this section of the report at their meeting ofdevelopment of targets for this area will also be reviewed.

We are required to review the ethnic make up of our workforce on at least an annual basis and this metric i

The Use of Resources elements that relate to workforce will be reported but this is currently being revised

Implementation of the business plan is progressing and is detailed in this report. The Board should note the Objective 1 (finance and recovery programme) has 14 high and medium level risks identifiedObjective 4 (delivery of operating plan) is now under review following the white paper publicationFinchley Memorial Hospital project has been referred to ministerial approval and is the timescale places the at riskThe co-location funding for Brunswick Park project has been withdrawn by central government and urgent malternative options.


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Financial Performance Key Performance Indicato

Indicator Plan

000s

Actual

000s

Variance

from plan

000s

RAG

rating

Mea

Headline indicators RAG

Year to date position 361 451 90 Actu

Forecast outturn 0 0 0 Fore

Net risks / (opportunities) 0 2,190 2,190 Diffeoppo

fore

Run rate Not set Diffeexpe

Underlying indicators RAGplan

Recovery programme year todate

(3,577) (2,459) 1,118 Actuinclu

Recovery programme forecast

outturn

(30,026) (19,552) 10,474 Fore

incluoppo

RAG rating:

Green in line with or better than planAmber less than 0.5% above planRed more than 0.5% above plan


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ssues to be discussed

Actions undertaken

The following actions are being taken to mitigate the year to date position:

the referral management service is now fully operational and is reviewing all referrals other than those such aare clinically urgent. Consultants will be introduced from August to provide management plans to GPs to enaappropriately managed in primary care, and will be undertaking audits to identify options for establishing com

options for increased GP engagement in budget management are being explored, including joint work with theBarnet

UCLH is overspent at m2, driven bis not in line with trend. Again, thean activity overperformance of 26%converting into elective activity whfinancial overperformance. This mchoice rather than changing clinica

inancial Performance year to date position

Royal Free is currently showing the largest underspend in sector.Key risks relate to Barnet & Chase Farm (B&CF), UCLH and theWhittington. The B&CF overspend is driven by outpatients (7.7%activity overperformance), high cost drugs and new best practicetariffs. Outpatient increases are not currently converting into electiveactivity.

The year to date position is overspent by 90k, less than 0.1% of budget. Contingency of 575k has been releThere are overspends in community and high cost placements but due to the size and nature of these budgets relatively small.

Acute contracts were underspent by 524k at month 2, the latest month for which we have information. Howev

M2 (under)/over performance against acute contracts

-500

-400

-300

-200

-100

0

100

200

300

B&CF

RFree

UCLH

Whittingto

nRN

OH

GOSH

NMUH ME

H

Outo

fsector

Trust

(under)/overperformance000s

UCLH expenditure - Pbr and

0200

400

600

800

1000

1200

1400

1600

1800

Month

Monthlyexpenditure000s


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inancial Performance - Year to date performance

An nual YTD YTD YTD YTDBudget Actual Budg et Va ri an ce V ar ian ce

Nonrecurrent

000's 000's 000's 000's 000's

Resource limit (560,118) (137,874) (137,671) (203) 0

Income (13,040) (3,552) (3,218) (334) 0

TotalIncome (573,158) (141,426) (140,888) (537) 0 CommissioningExpenditure

AcuteServices 307,747 76,786 76,789 (3) 476

CommunityServices 45,208 11,340 11,047 293 87

MentalHealth 37,344 8,529 9,280 (751) (606)

ContinuingCare 22,025 5,539 5,581 (42) 0

LearningDisabilities 11,489 2,918 2,872 46 24

PalliativeCare 1,076 270 270 1 0

Primarycare 123,807 31,577 30,932 644 535

Specialist commissioning 21,816 5,465 5,528 (62) (130)

OtherCommissioning 7,917 2,557 2,181 376 195

Costsofcommissioning 6,776 1,692 1,725 (34) 0

TotalCommissioningExpenditure 585,205 146,674 146,205 468 581 Corporate Expenditure 21,766 7,015 6,885 130 (6)

UnallocatedReserves 6,842 0 575 (575) (575)

TotalExpenditure 613,813 153,689 153,665 23 0 Commissioning(Surplus)/Deficit 40,655 12,263 12,777 (514) 0

Provider(surplus) deficit (247) 530 (74) 604

PCTTotal(Surplus)/Deficit (pre support 40,408 12,793 12,703 90 0 Non recurrent financialsupport ( 40 ,4 08 ) (1 2, 34 2) (1 2,3 42 ) 0 0

PCTTotal(Surplus)/Deficit 0 451 361 90 0


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inancial Performance - forecast outturn position before rClare Parker

Annua l Fore ca st Fo reca st Fore cas t Fore

B udge t Outturn Va rianc e V aria nc e Va ria

Recu

00 0 's 0 0 0's 0 00 's % 0 0

Resource lim it (5 6 0 ,1 1 8) (5 60 ,1 18 ) 0 0.0 % 0

In com e (1 3 ,04 0 ) (1 3,0 14 ) 26 0.2 % 26

TotalIncom e (5 7 3 ,1 5 8) (5 73 ,1 32 ) 26 0 .0 % 26CommissioningExpenditure

Acute Se rvice s 3 0 7 ,7 4 7 3 05 ,6 96 (2 ,0 51 ) 0 .7 % ( 2,5

CommunitySe rvices 4 5 ,20 8 4 5,9 39 73 1 1.6 % 6 4

MentalH ea lth 3 7 ,34 4 3 6,5 50 (79 4 ) 2 .1 % (1 8

ContinuingCare 2 2 ,02 5 2 2,0 25 0 0.0 % 0

Learning D isab ilitie s 1 1 ,48 9 1 1,6 25 13 6 1.2 % 1 1PalliativeCare 1 ,07 6 1,0 7 6 0 0.0 % 0

Primaryca re 1 2 3 ,8 0 7 1 25 ,5 87 1 ,7 80 1.4 % 1,2

Specialistcom m is sion ing 2 1 ,81 6 2 1,7 26 ( 90 ) 0 .4 % 40

Other Com m issionin g 7 ,91 7 8,6 3 3 71 6 9.0 % 5 2

Costsofco m m ission ing 6 ,77 6 6,7 8 4 8 0.1 % 8

TotalCommissioningExpe nditure 5 8 5 ,2 0 5 5 85 ,6 41 43 6 0 .1 % ( 1 4Corporate Expenditure 2 1 ,76 6 2 1,8 09 43 0.2 % 49

Unallocated Re se rves 6 ,84 2 6,0 9 0 ( 75 2 ) 1 1 .0% (1 7

TotalEx penditure 6 1 3 ,8 1 3 6 13 ,5 40 ( 27 3 ) 0 .0 % ( 2 7Commissioning(Surplus)/Deficit 4 0 ,65 5 4 0,4 08 (247) 0 .6 % (2 4

Provider (surplus) d e ficit (2 4 7 ) 0 24 7 1 00 .0 % 2 4

PCT Total(Surplus)/Deficit(pre support 4 0 ,40 8 4 0,4 08 0 0 .0 % 0No n recurrentfinancial support (4 0,40 8) (4 0,4 08 ) 0 0.0 % 0

PCT Total(Surplus)/Deficit 0 0 0 0 .0 % 0


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Issues to be discussed

Actions undertaken

The following actions are being taken to mitigate the net risks and to reduce the forecast range month on mont

The risks & opportunities log is updated weekly by budget holders

The Programme Management Office is being put in place to manage savings risks through strengthened proce

A paper to improve forecasting has been agreed and directors are putting in place actions to implement the agr

The Director of Finance is leading joint work with the sector to improve information and agree a common forecacute contracts.

inancial Performance - risks and opportunities

There are three key drivers of risks to the financial position: acute growth; delivery of savings and prescribing egenerally either too small or not sufficiently volatile to have a material impact on the forecast at an individual lev

Base case net risks / (opportunities)

(10,000)

(5,000)

0

5,000

10,000

acute

prescribin savin

gs

reserves

other

BCS

Total

Netrisk/(opportunity)000

Best case net risks / (opportunities)

(20,000)

(15,000)

(10,000)

(5,000)

0

acute

prescr

ibinsavings

reserv

es other BC

STotal

Netrisk/(opportunity)000

(5,0

5,010,015,020,025,030,0

Netris

k/(opportunity)000

In the base case scenario, net risks total 2.1m. In the best case, net opportunities total 15.8m and in theWith the current forecast outturn of breakeven, the realisation of net risks or opportunities would directly imtherefore a possibility that NHSB could underspend by 15.8m or overspend by 25.6m. The aim is to redmonth.


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inancial Recovery - Risks and opportunities 2010/11 Moinancial Recovery - Risks and opportunities summary

M1 M2 M3 M

M1 M2 M3 M4

Base case m -1.5 -3.52 -4.5 -2.2

Best case m 3 12.1 10.9 15.8

Worst case m -11 -23.4 -24.4 -25.7

-30

-25

-20

-15

-10

-5

0

5

1015

20

Net(risks)/opportunitiesm

Base case Best case Worst case


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inancial Performance - Assumptions

AcuteMonth 2 has been reported on the basis of information on actual expenditure provided by the agency, includThere is a risk that the accrual for uncoded activity may be less than the final amount billed.

No assumption has been included regarding the achievement of savings to date, although since the position that savings of 113k have been achieved from M1 challenges to trusts. Extrapolating this for the three mon339k.No data has yet been received for month 3. The position therefore is accrued to the budget before savings, been achieved.The budget has been phased locally based on the profile of actual expenditure in 2009/10. This has not yet agency to get a shared view of the expected expenditure profile. If the profile is incorrect it could over or undThere is little variance between the Barnet & Chase Farm profile and ours at month 2.

The forecast outturn is based on the forecast from the agency with local adjustments for non contract activityrecognised in the position with the rest included in the net risks and opportunities.

Prescribing

Information has been received for month 1 and 2 from the Prescription Pricing Division (PPD) and the monththese.

Specialist commissioningNo information about performance has been received other than for forensics. The position is therefore accbeen assumed that the planned savings of 50k for month 3 have not yet been delivered. The forecast outtubut 90% of this has been included as at risk in the base case risks and opportunities.

Savings

Individual savings were reviewed with lead directors and lead commissioning managers as part of the month

actual position was reflected accordingly within the ledger. Post month end reviews allowed for the savings tmanage delivery as part of the Corporate Recovery initiative and also to feedback into the reporting cycle.


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inancial Recovery - savings delivery

Achieved

Awaiting

confirmation

Not Delivered

Total for month

Achievement of savings to month 3

0

500

1000

1500

2000

Apr-10 May-10 Jun-10

Month

Saving

s000s Not Delivered

Awaiting confirmation of

data

Achieved

Issues to be discussedThe percentage and value of savings not delivered in month 3 has increased compared to prior months. Gsavings programme, this represents a serious risk to delivery of the programme and the financial plan of N

by the lower than expected level of acute growth but there should not be a reliance that this trend will contin

Using a risk adjusted methodology, the current forecast is that the recovery plan will deliver 19.5m agains

Actions undertakenThe Management Team is fully sighted on the risks to delivery and the need to reverse the shortfall. Mitigataken. The Programme Management Office will continue to review and support the delivery of green scheinsufficiently robust or there are not enough milestones, this will be addressed with the scheme owners. Nperformance indicators are being identified to give early indications of the success of projects.

Additional savings plans to mitigate slippage in the existing programme are being developed and more det


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inancial Recovery - savings delivery


Actions undertakenThe concerns regarding the acute savings have been escalated to the sector delivery Board. The NHS Camanagement office will be used to provide a robust process for developing PIDs and monitoring progress. mitigation of the risk as delivery could be improved across many schemes by putting robust plans into placon 22 July to identify further savings options.

The current assessment of likely delivery was made by the Director of Finance. The recovery board has apartnership with the NHSB programme management office, will undertake a risk based assessment of theimilestones and key performance indicators to ensure that benefits are maximised.

The main driver of the underachievement both year to date and for the forecast outturn is the acute supply by the sector. An assessment by the Director of Finance indicates that only 34% of plans are likely to be d

assessment is that 55% is currently achievable, but this is not supported by robust plans in every area.

Year to date underachievement of recovery plan

0

50

100

150

200

250

300

350

Acute Community Care

pathways

Estates

utilisation

Other

Schemes

000

Forecast underachieveme

01,0002,0003,0004,0005,0006,0007,0008,000

Acute

Referralmgt

Prescribing

Highcost

placements

Community

C

Schemes

000

forecast outturn %

A prudent assessment of the year end position has currently been made. There are robust processes in such as referral management, but until monthly savings figures are delivered and confirmed it is not assubenefits will be obtained.


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Actions undertaken

The Programme Management Office will continue to review and support the development of PIDs for red schenumber of schemes being developed at sector level that have not yet been factored into the above figures but sin 2010/11 and 2011/12.

In addition, the financial recovery programme board agreed that more radical savings opportunities now need tprocess for this will be agreed.

inancial Recovery total schemes

The red schemes were reviewed by the recovery board on 22 July. As a result a small value was converted tofrom the remaining schemes was significantly reduced. This puts at risk the achievement of the financial plan insufficient in year mitigation against slippage and the level of savings required to close the remaining gap in thbeen identified.

0

10

20

30

40

50

60

70

Jan Feb Mar Apr May Jun Jul

m

Red

Green


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Actions undertaken

Quality Outcomes

The Sector will be using 54 KPIs to determine quality outcomes. NHSB performance reportthese until CSL have established processes to publish these by July 2010.

There has been a rise in MRSA rates which shows that the number is over double the rate cyear. There are risks to breaching our target of 10 cases for 2010/11if this rise continues.

MRSA - PCT assigned cases

0

2

4

6

8

10

12

14

39965

39995

40026

40057

40087

40118

40148

40179

40210

40238

There is no significant trend or link between the 6 reported cases. 3 were identified at BCF, Five of them fit the criteria of Community acquired cases (identified within 48 hours of admisacquired case (RFH). NHSB public health and quality team are investigating these cases fuprovider is given on the next slide.


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Actions undertaken

This will need to be closely monitored in partnership with Sector.

Quality Outcomes

The charts show the steady decline in MRSA in both of Barnets main providers. The increaslide, if sustained as a trend, would be an anomaly.

MRSA - RHF

020406080

100120

2003

/0420

04/05

2005

/0620

06/07

2007

/0820

08/09

2009

/1020

10/11

Target Actual

MRSA

020406080

100120

2003/0

4

2004/0

5

2005/0

6

2006/0

7

Target Ac


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Actions undertaken

Actions and issues will be raised with the sector account managers Dr FosterRoyal Free as having the lowest mortality rate among all NHS trusts in England

Quality Outcomes

Following the mid Staffs review, the board had requested information on mortaassurance that this was not an issue for our two main providers.

Mortality And Morbidity Count April 2010 - June 2010 -

Royal Free And Barnet And Chasefarm

0

10

20

30

40

50

60

2010-Apr 2010-May 2010-Jun

Barne

Royal

B


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Actions undertaken

Reducing slot availability issues all acute trusts trained by end of June on how this couldto improve the Directory of Services (DOS) which will ensure patients are referred to the Locally the referral management service have met Barnet and Chase Farm to discuss hobe improved. This is likely to result in increased utilisation within the next few weeks. Thean improvement. 25% of referral to acute services were done through Choose and Book opposed to 14% in the week ending 11th July.

Annual Health Check Ratings

Data for most targets will not be available until the end of July. London ambulance targets hwith category b 19 minutes targets still performing below target level. MRSA are reported un

operating framework requires this target to be published and monitored weekly. The White pidentify Choose and Book as a continuing priority in the coming years.

London Ambulance Service: Ambulance call outs that achieved response

times as indicated by measure

0.733 0.735 0.7370.743 0.745

0.729

0.672

0.787

0.795 0.755 0.773 0.76

0.982 0.982 0.9840.985 0.986 0.989 0.98

0.99 0.987 0.997 0.995 0.994

0.899

0.802

0.8590.8530.8470.842

0.851

0.893

0.8690.854

0.910.923

0.65

0.7

0.750.8

0.85

0.9

0.95

1

.05

Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10

Cat A - 8 min Target Cat A & B - 19 min Target Cat A - 8 min

Cat A - 19 Min Cat B - 19 mins Trendline (Cat A - 8 min)

Choose &

0

0.1

0.20.3

0.4

0.5

0.6

0.7

April

May


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usiness Plan Neil McE

bjective 1 Finance and recovery programme - Please see finance section

bjective 2 Implementation of polysystems and associated care pathways - Governance streed for 3 out of 4 polysystems; Templates for submission to sector group completed for sub

bjective 3 Improve the health of the population of Barnet proceeding to plan

bjective 4 Delivery of operating plan - this is under review following publication of new fram

bjective 5 To deliver our aspirations on the development of competencies and ensure impr

s is under review following the white paper and an assessment of the OD plan is underway

bjective 6 Develop processes to embed a high performing culture in NHSB - Integrated reperformance meetings with individual Directors established; Performance improvement group wtablished; Development of performance accelerator established to include finance and recovview progress on recovery programme

bjective 7 To improve the quality and safety of commissioned services - Clinical lead direcresource objective; Quality implementation plan revised; Quality metrics established for all a

bjective 8 to deliver a firm direction of travel for BCS - Process to determine future directio


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Actions undertaken

The delivery of objectives will be managed through the programme management office. Riswithin the corporate risk assurance framework.

usiness Plan Neil McE

Objective 9 Strategic development of NCL sector - Ongoing attendance by the Chair and Cattendance at the Sector fortnightly Delivery Board meetings to assist in co-ordinating Sectact as project director for Sector wide PolysystemsDirector of Public Health assisting the implementation of low clinical priority treatments acro

attending the weekly business meetings to review financial performance across the SectorService and Organisation Review meetings a revised mental heath plan is being preparepathway for urgent care is being devised across the Sector; CEC Chair and GP Clinical chaengagement event to consider the views of GPs into Sector commission business and futuDirectors and next in lines attended Sector OD workshops in strategy, communications, pecommissioning Head of Performance leading the NHS Barnet acute activity information reqDue to the election the NCL acute service strategy is to be reviewed. This will influence thThe wide ranging input by NHS Barnet staff into the development of plans and approachesQuarter 2.

Objective 10 BEH Clinical strategy - Review of strategy underway following election and

Enabling Projects - FMH project approved by SHA capital group but has now been referrPark project funding is at risk due to review of central projects; externally led review for Hea


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Actions undertaken

NHSB is required to publish workforce data annually. Following the announcements within toversight in relation to workforce trends, especially sickness, will be pertinent. The charts in

highest for estates and ancillary workers and turnover rates are high for administrative and

Workforce Development

More detailed discussion will take place in the workforce and remuneration committee to a

performance measures will used for reporting. Data will also have to be separated betwee

NHS Barnet - Sickness Ab

0.891.27

2.30

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

Add Prof Scientific

and Technic

Additional Clinical

Services

Administrative and

Clerical

NHS Barnet - Turnover Rate June 2009 - May - 2010

8.33

0.00

20.31

0.00

9.93

0.00

7.69

0.00

5.00

10.00

15.00

20.00

25.00

Add Prof

Scientific and

Technic

Additional

Clinical

Services

Administrative

and Clerical

Allied Health

Professionals

Estates and

Ancillary

Medical and

Dental

Nursing and

Midwifery

Registered

%HeadCount


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The average age band in NHSB is 36-55 years old.


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This data includes BCS staff.The vacancy rate is highest among the nursing and midwifery category and administrative

NHSB Vacancy Rate June 2009 to May 2010

38.50

7.00

2.20

41.00

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.0040.00

45.00

Adm inistrative and

Clerical

Esta tes and Ancillary Medical and Dental Nursing and Midw i

Registered

T


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NHS organizations are required to review the ethnicity profiles of their workforce on annual bemployees in the Black and Asian categories has increased year on year since 2007/08.The proportion of Not stated employees has reduced, in line with increased data collection



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Report to NHS Barnet Board 29 July 2010

Title: Performance report

Agenda item: 13 Document no. 10-068

Purpose of thepaper:

Noting, discussion and information

The paper supports, or has implications for:

NHSBs strategicgoals

1. First things first: getting the basics right;2. Improving health;3. Local & accessible;4. Best outcomes from the best centre;

5. Building resilience.

NHSBs strategicinitiatives

1. Improving health and reducing health Inequalities;2. Ensuring the most appropriate settings of care for all our patients;3. Developing care pathways;4. Focus on the processes of commissioning & contracting in order toimprove quality, safety & patient experience;5. Managing the PCTs finances effectively & efficiently

NHSBs values Make the greatest difference;

Value people; Be transparent and accountable; Work together;

Support staff.

World classcommissioningcompetencies

8. Promote and specify continuous improvements in quality andoutcomes through clinical and provider innovation and configuration:10. Effectively manage systems and work in partnership withproviders to ensure contract compliance and continuousimprovement in quality and outcomes and value for money:11. Ensuring efficiency and effectiveness of spend:

Use of resources All

Targets & vital signs All

NHS Constitution All

Secretary of Statestest for service re-configuration

Not applicable

1


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Darzi principles 1. Fairness;2. Personalised;3. Effective;4. Safe;5. Local accountability.

Link to NCL sectorand agency

Not applicable

Link to LondonBorough of Barnet

Not applicable

Equality impactassessment

Not applicable

Other relevantsupporting policies,

plans & strategies

Not applicable

Route of paper Executive Management Team and Resources and PerformanceCommittee

Authorsandsponsor directors

Anjum Fareed, Head of PerformanceNeil McElduff, Corporate and Commercial DirectorClare Parker, Finance Director

barnet hospital

Documents

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