BCHC Quality and Performance Report Final Jun_Jul 2012.pdf

8/14/2019 BCHC Quality and Performance Report Final Jun_Jul 2012.pdf

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Birmingham Community Healthcare NHS

Trust

Quality and Performance Report

Reporting Period:

June 2012

Report Date:19th July 2012


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Contents

Section Page

Executive Summary: Quality Update 3

Executive Summary: Summary of Issues to Report 6

Trust Scorecard 7

Domain 1: Patient Safety 9

Domain 2: Use of Resources 14

Domain 3: Patient Experience 21

Domain 4: Clinical Effectiveness 25

Domain 5: Efficiency and Productivity 30

Appendix 1: Finance Report 34

2Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012


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Executive Summary



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Executive Summary

Quality Update


Overview

Birmingham Community Healthcare NHS Trust is committed to providing high quality care to the communities that it serves.

Ensuring the highest standards of patient care and patient safety is one of the fundamental responsibilities of the Boards of all

NHS organizations and we continue to strive to make improvements in the quality of the care that we provide, at the same time

as ensuring that it is clinically effective, person-focused and safe.

Essential to meeting this objective is strong clinical leadership and the monitoring of the strategies that are put in place, and

although the Board retains ultimately accountability, the work is driven and monitored through the C linical Governance

Committee and the Quality Governance and Risk Committee.

The integrated performance report, which is driven by the delivery of safe and effective care, has been developed to provide the

Trust Board with assurance that quality is being carefully monitored and that improvement measures are being identified and

implemented where necessary. It also enables the Trust to demonstrate its commitment to encouraging a culture of continuousimprovement and accountability to patients, the community that it serves, the commissioners of its services and other key

stakeholders.

Some of the targets that form the balanced scorecard are targets that the Trust is mandated to report on, but a number of

additional targets that provide evidence of the quality of the services that we provide have been identified by the Trust Board

and feature on the balanced scorecard.

Of particular note this month is the publication of the Patient Environment and Action Scores (PEAT) PEAT is an annual

assessment of inpatient healthcare sites in England that have more than 10 beds. It is a benchmarking tool to ensure

improvements are made in the non-clinical aspects of patient care including environment, food, privacy and dignity.

The assessment results help to highlight areas for improvement and share best practice across healthcare organisations in

England. PEAT provides a framework for inspecting standards to demonstrate how well individual healthcare organisations

believe they are performing in key areas including: food, cleanliness , infection control, patient environment (including bathroom

areas, lighting, floors and patient areas) .


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Commentary

Overall, the Trust has achieved the following performance for June 2012:

The breakdown of the indicators the Trust did not achieve is as follows:

Executive Summary

Summary of issues to report


Trust wide underperformance refers to any indicator which

the Trust has not achieved. For June these are all in the Use of

Resources Domain:

Contractual KPI breaches (p.16)

Commissioner Contract Deadlines Missed (p.18)

Staff appraisals (p.19)

Local underperformance refers to any indicator which the

Trust has achieved but which has been breached by individual

divisions and is being managed locally and through PPMB.

Watching Briefs refers to any indicator which the Trust is

achieving but PPMB feels important to monitor more closely.

Recovery Mode refers to any indicator where the original

target has not been achieved in one of the previous month and

therefore a revised trajectory has been agreed.


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Trust Scorecard June 2012

7

As had been detailed in the May report, actual reported percentage of sickness absence for June of is invalidated, while the previous month outturn (May 2012) is

validated.

Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012


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Trust Scorecard June 2012



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Domain 1:

Patient Safety



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Domain Summary Patient Safety

Ref Indicators with no areas of concern

1.1 Attendance at Mandatory Training 71%

1.2 Medical appraisals 16%

1.3 MRSA new bacter ia 0

1.4 C. Diff new cases 7

1.5 MSSA new cases 0

1.6 E. Coli new cases 3

1.7 Elective MRSA screening 100%

1.8 VTE risk assessment on admission 98.8%

1.9 Falls resulting in serious injury or death 4

1.11 100% compliance with WHO surgical checklist 100%

1.12 No. of serious incidents reported in 48 hours 100%

1.13 No. of never events 0

1.14 Percentage of SI RCAs completed in timescale 100%

1.15 No. of serious incidents 29

1.16 Patient Safety Thermometer 100%

1.17 Spend on Temporary Staffing 6.1%

1.18 NHS Safety Thermometer 91.4%

Ref Indicators with no data and comment

1.10 Grade 3 or 4 pressure ulcers Available in August

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Commentary

In this summary, we have outlined the overall performance for the Trust for all of the Patient Safety indicators. Where the Trust

has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve

the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the

subsequent pages.

Avoidable Grade 3 and 4 pressure ulcers are monitored and

reported on a monthly basis to determine whether the pressure

ulcer was avoidable or unavoidable. A root cause analysis is

completed. Further details on pressure ulcers have been

included on slides 12 and 13.

The Trust has recorded 7 cases of C. Diffto date. This is slightly

over the YTD plan of 6 cases by the end of June so we have

reviewed this area in more detail.



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Patient Safety watching brief

1.4 C. Diff new casesOverall Trust position

Breakdown by Division

11

Indicator Goal: Place

This indicator reports the total number of incidences of ClostridiumDifficile for the month indicating if the Organisation is managing its

overall target of equal to or less than 24 cases per annum. This is a

target set out in the Operating Framework for 2012/13.

As with MRSA, this demonstrates our standard of practice in relation

to Control of Infection, links to quality of patient care and to

managing our reputation as a healthcare provider and can affect our

registration with the Care Quality Commission.

The Director of Infection Prevention and Control has reported that

there appears to be no link between the cases and that there is the

usual proactive approach from the clinical team in order to monitor

any potential causal factors.

Patient safety visits:

The number of visits between April 2012 and June 2012 was 5:

Rapid response team

Perry Tree Centre

Physiotherapy (Musculo-skeletal), Walmley Health Centre

Combined Community Dental Services, Stockland Green PrimaryCare Centre

Speech & Language Therapy, Stockland Green PCC

The quarterly report will be submitted to QGRC in August.



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Patient Safety service update

1.10 Grade 3 or 4 pressure ulcers

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Commentary

The final data for avoidable pressure ulcers for April has now been

confirmed as 12 and the table opposite has been amendedaccordingly. Of the 21 grade 3 and 4 Pressure Ulcers originally

reported in April, 2 were re-classified as the root cause analysis

identified that the wound was not due to pressure damage, and 7

were classified as unavoidable using the SHA definitions.

There were 27 grade 3 and 4 pressure ulcers attributable to BCHC

reported in June. These are currently undergoing a root cause

analysis investigation to determine factors of causation and whether

any were unavoidable. It is noted that overall the numbers of

Pressure ulcers occurring in our care increased in June. Detailedanalysis has been undertaken to examine the rise in overall numbers

and this has been escalated to the Adults and Communities Division

for action. Three Community teams were identified as potential

hotspots in June.

Detailed analysis shows that all 3 teams have had an increase in

training and the prevention of pressure ulcers emphasised. In

addition the demographics of the geographical area covered by one

of the teams shows a high percentage of older adults with a number

of retirement communities located in the area. This team also have alarger number of grade 2 pressure ulcers reported, showing that skin

damage is being identified and managed at an earlier stage.


Source: Serious Incident Data

Location June

Inpatients Grade 3 1

Inpatients Grade 4 0

Community Grade 3 13

Community Grade 4 13

Total 27


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Patient Safety service update

1.10 Grade 3 or 4 pressure ulcers

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Commentary

The prevalence graphs are based on the percentages identified

through the monthly NHS Safety Thermometer data collection. Junescollection was based on a total of 2,302 patients (April n=2,168, May

n = 2,146). This data is providing an excellent baseline to show

improvement in reducing pressure ulcer prevalence.

Midlands & East SHA data forAllPressure ulcers showed 7% (April)

6.9% (May) prevalence data. BCHC prevalence in June is 6.6% for

Allpressure ulcers. For new pressure ulcers (acquired in our care)

Safety Thermometer showed 10 (0.44%) grade 3 and 4 pressure

ulcers in June (April 15 (0.69%), May 14 (0.66%)). There is a

programme of work being monitored by the Pressure UlcerReference Group that is reviewing staff competency, accessibility of

equipment and actions arising from all root cause analyses

investigations


Source: Serious Incident Data


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Domain 2:

Use of Resources



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Domain Summary Use of Resources

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Commentary

In this summary, we have outlined the overall performance for the Trust for all of the Use of Resources indicators. Where the Trust

has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the

required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent

pages.

The Monitor Governance Rating for June is expected to be 0, the

same as in April and May. Since the indicator is based on a number

of individual elements, one of which might only be available by the

27th July, the rating will either be reported verbally to the Trust

Board or included as the previous months data on the scorecard for

July.

The YTD target was not met for the delivery of contractual KPI (KPIbreaches). An analysis into this is carried out overleaf.

In June, the Trust did not meet the revised trajectory for Percentage

of staff appraised. Children and Families and Specialist Services

both showed red ratings against their recovery trajectories which

have been further analysed overleaf.

One commissioner contract deadline was missed for June which

turned the indicator to show as red due to the zero tolerance target.

Further details regarding this missed contract deadline have been

provided overleaf.

Ref Indicators whichdid not meet YTD target

2.1 Delivery of contractual KPI (KPI breaches) 4 X

2.2 Commissioner contract deadlinesmissed for

month

1 X

2.3 Percentage of staff appraised (within 18 months) 69% X



2.4 Monitor GovernanceRating 0

2.5 Totalworkforce (WTE) 4,410

2.6 Turnover rolling total 13.9%

2.7 Total pay costs 14.8M

2.8 Percentage of vacancies 6.61%

2.9 Percentage of sickness absence for month 5.04%

2.10 Monitor Financial Rating 3

2.11 Del ivery of QIPP 95.96%


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Patient Safety area of underperformance

2.1 Delivery of Contractual KPI (KPI breaches)

Overall Trust position


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Indicator Goal: Partnership

This is the number of Key Performance Indicators agreedwith commissioners for 2012/13 which were in breach of

contract in the month. This measure encourages proactive

management of areas of risk across the organisation and

identifies areas where the trust may be financially

penalised.

The annual target is to have no breaches. This was achieved

by all divisions in month 1 but was breached in months 2

and 3.

The Contractual KPI breach position has improved this

month from a Trust total of 6 breaches last month to 4 this

month. The improvement relates to breaches of the MLA

contract requiring levels of staff training in a range of topics.

Discussions between the Contracting team and the

Commissioners have clarified that whilst there are a

number of failing areas, these are grouped contractually

into Infection Control, Universal Mandatory Training and

Essential to Role Training. As a result of this clarification the

number of KPIs at risk has been adjusted accordingly.

The three breaches in Adults and Communities and the

three breaches in Children and Families relate to the same

contract (MLA). The Specialist breach relates to the Dental

contract. Hence, the Trust has breached 4 contractual KPIs

overall.



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Commentary

MLA Contract - 3x Training KPI breaches

Three breaches for Adults and Communities and Children and

Families:

Infection Control Training KPI

Mandatory Training KPI

Essential to Role Training KPI

Both Divisions continue to work with Learning and Development

to improve performance.

In addition, The Nursing Director proposed a recovery trajectory

to the Commissioner against the indicators within the contract.

2.1 Delivery of Contractual KPI (KPI breaches)


Dental Contract - Percentage of Elective Care operations

cancelled for non-clinical reason.

Performance against this indicator was 0.95% against a threshold

of 0.5% for May.

The BMI Edgbaston Daystay session for the 7th June was

cancelled as both of the dentists that usually provide cover for

the session were unavailable.

However subsequently two patients were booked on the session,and as a result both bookings required cancelling. In line with

policy, both patients were rebooked within five days for

appointments within 28 days of the cancellation (one within 7

days, the other within 14 days).

To prevent further occurrence, clinical and support staff

availability has been rechecked, a rota compiled and forwarded

to all involved, and a monthly review of the service

administration will be undertaken at which the cover rota will be

confirmed and circulated.


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2.2 Commissioner Contract Deadlines Missed


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Indicator Goal: Partnership

This measure reports the number of contractual reportingdeadlines missed in the month. This measure encourages

proactive management of areas of risk across the

organisation, gives the Board assurance on the Trusts

ability to be timely and responsive to commissioners and

identifies areas where the trust may be financially

penalised.

The monthly reports to the commissioner on the financial

impact of activity are provided by a reporting system called

SLAM.

Reports covering April, May and June activity were due on

the 3rd July 2012, and were provided on the 4th July 2012.

The delay was due to a late resolution of a query around

phasing of activity. The issue has been resolved, and we do

not expect a recurrence in future months.

This will result in no financial penalty for the Trust as

remedial action was applied immediately.



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2.3 Percentage of staff appraised (within 18 months)



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Indicator Goal: People

This measures the percentage of staff recorded as receiving anappraisal within the past 18 months. This indicator demonstrates

a commitment to developing staff and is linked to evidence

required for Investors in People/Improving Working Lives and the

Organisational Development Strategy.

If the majority of staff have had a personal development review

in the past eighteen months it shows that the organisation takes

the personal development of its workforce very seriously and is

endeavouring to develop staff and deal with any performance

issues in a timely manner.

In addition it demonstrates that we ensure staff are competent

to deliver their role by equipping them with the skills needed to

perform their job and builds the foundations for succession

planning. It should also improve the outcomes of the annual

Staff Survey.

This indicator follows a recovery trajectory Trust wide and in all

Divisions apart from Corporate and Rehab Services within

Specialist.



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2.3 Percentage of staff appraised (within 18 months)


Commentary

Due to the indicator being based on an 18 month rolling total,the Divisions had been asked to review their trajectories with the

Head of Learning and Development in order to achieve a better

understanding of the numbers of PDRs necessary each month to

achieve the target.

Based on this review, Adults and Communities adjusted their

trajectory accordingly and are achieving their recovery plan

target.

Children and Families and Specialist Division (Dental and

Learning Disabilities) did not achieve their recovery plan targets

in June due to a deterioration in performance in May.

Children and Families :

The Division is using data detailing the performance against the

indicator at service level to enforce performance against the

target.

Learning and Development provide monthly reports which helps

to inform service managers monitor the 18 months rolling target.

PDRs are being cascaded from Divisional Director to ADs andHeads of Service.

Specialist Services:

Services are meeting with the Head of Learning and

Development over the next 2 weeks to identify further actionsthat need to be adopted in order to improve the compliance in

the future.

LD services have a significant programme of PDRs in June and

July and Rehabilitation over the summer through to September,

it is aimed that this will improve the Divisions overall

performance against this indicator.

Adults and Communities:

Although achieving their current recovery plan target, the

Division has taken further measures to improve performance

throughout all service areas which should have a positive impact

on Trust performance over the next months:

In Patient Services - all staff have dates for PDRs, including both

General Managers.

Community Services- Sets of core objectives have been

produced to support line managers undertake PDRs. All line

managers will have specific objectives regarding PDR

achievement in their areas/ team responsibilities.

Specialist services are in excess of target and all PDRs have been

scheduled for 2012/13.


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Domain 3:

Patient Experience



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Domain Summary Patient Experience


3.1 Number of Complaints 13

3.2 Number of Complaints acknowledged

within 3 days

100%

3.3 Percentage of complaints responded to

within 6 months or as agreed100%

3.4 18 week pathway (admitted patients) 96.7%

3.5 18 week pathway (non-admitted patients) 97.5%

3.6 18 week pathway (incomplete pathway) 98.6%

3.7 Cancer Referrals (Urgent 2WW) 100%

3.8 Customer experience patient surveys

completed in all areas in past 12 months96%

3.9 Net Promoter Score (in patient only) 45

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Commentary

In this summary, we have outlined the overall performance for the Trust for all of the Patient Experience indicators. Where the Trust

has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the

required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequentpages.


Net promoter: This Indicator is being reported for the first time

this month and its implementation is driven by a regionally

mandated CQUIN target. More commentary follows overleaf.


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Patient Experience service update


Net Promoter Overview

The Net Promoter Score (NPS) is also known as the Friends and

Family Test / question

Introduced by Midlands and East SHA as regional CQUIN

Implemented in Acute settings to gain feedback from 10%

of footfall

Part of the CQUIN requires that scores are discussed at Board

Our target is to show an improvement on Q1 baseline scores

by the end of the year

Scoring System

Patient asked a specific question how likely is it on a scale

of 1 to 10 that you would recommend this service to friends

and family?

Promoter: Scores of 10 or 9

Passive: Scores of 8 or 7

Detractor: Scores of 6 and below

To establish the NPS, the percentage of detractors (i.e.

patients scoring 6 or below) is subtracted from the

percentage of promoters (i.e. scoring 9 or 10). Passive

scoresare not considered.

Next Steps

In Q1 we achieved a NPS of 45 for in patient discharges and a score of 49.2 for all patients in BCHC who were surveyed

Nationally scores are reported to vary from 20 to 89

Concerns have been expressed nationally about the use of the question, and there may well be amendments before roll out

next year

We are part of a group of community trusts who have agreed to benchmark (anonomysed data) to assess the scoring in

community settings

We feel there are challenges around when, who and how the question is asked, which may influence scores

Our target is to show an improvement on Q1 baseline scores by the end of the year


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PEAT SCORES

Site Name

Environment Score Food Score Privacy & Dignity Score

Community Unit 3 Good Hope

Hospital

3 Acceptable 3 Acceptable 4 Good

Community Unit 29 at Heartlands

Hospital

4 Good 5 Excellent 5 Excellent

Intermediate Care Rehabilitation

Unit Ann Marie

4 Good 5 Excellent 5 Excellent

Perry Trees Care Centre 5 Excellent 5 Excellent 5 Excellent

Riverside Lodge 5 Excellent 5 Excellent 5 Excellent

Sheldon Nursing Home 4 Good 5 Excellent 5 Excellent

Moseley Hall Hospital 4 Good 5 Excellent 4 Good

West Heath Hospital 4 Good 5 Excellent 4 Good

Norman Power Centre 5 Excellent 5 Excellent 5 Excellent

Patient Experience service update

PEAT Scores

Commentary

The annual Patient Environment Action Team (PEAT) scores have been added to this months reports as they have now beennationally published. There is a positive performance in all areas, noting that CU3 have now moved to much improved ward (CU 27).



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Domain 4:

Clinical Effectiveness



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Domain Summary Clinical Effectiveness


4.1 CQC conditions or compliance concerns 0

4.2 Percentage of compliance with CQC standards 100%

4.3 Essential Care Indicators (aggregated

measure)93.6%

4.4 Acute admission avoidance (adults only) 14%

4.5 Percentage of compliance with CQUINs 100%

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Commentary

In this summary, we have outlined the overall performance for the Trust for all of the Clinical Effectiveness indicators. Where the

Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not

achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the

subsequent pages.

While the Trust was only slightly below its target for the Essential

Care Indicators (ECI) in June, achieving an Amber rating, we have

provided further analysis for each of the ECIs overleaf.



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Clinical Effectiveness watching brief

4.3 Essential Care Indicators

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Indicator Goal: Product

Essential Care Indicators are a set of metrics recordingquality of care. This indicator records the compliance with

assessment and care planning for Essential Care in bedded

areas. Reporting is based on an audit of 10 sets of care

plans per ward per month against an agreed set of care

standards.

The compliance scores are aggregated into an overall Trust

compliance. The expectation is for 95% compliance with

the standards. This demonstrates that appropriate care

standards are followed.



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Commentary

Patient Observations ECI Criteria

Wards at MHH and WHH are maintaining good compliance with

Wards 11, 12, 14, 4, 5 and 6 achieving 100% compliance. CU 29

has also achieved 100% compliance. The remaining intermediate

care units have improved compliance. Perry trees unit are

awaiting training and not yet using Modified Early Warning Signs

and this is reflected in their poor compliance score.

Falls Assessment ECI Criteria

A number of Units achieved 100% compliance Wards 11, 12, 14

and 4. Most of the remaining units showed good compliance

apart from reassessment of risk. Norman Power unit also needs

to improve compliance with care plans. Units CU 29 and CU 27

both need to improve compliance across a number of falls

standards and both have remedial plans in place.

Tissue Viability ECI Criteria

Ward 5 has achieved 100% compliance across all the Tissue

Viability standards. The majority of the remaining Wards at MHH

and WHH need to improve compliance in reassessment of risk.

Ward 6, Anne Marie Howes, Perry trees and CU 29 Units all needto improve compliance with care planning. Ward 8, Norman

Power unit and CU 27 showed poor compliance overall for Tissue

Viability. Action plans are already in place for Norman Power and

CU 27. The results from Ward 8 are being escalated for action and

will be closely monitored in month.




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Commentary

Nutritional ECI Criteria

The majority of units are showing good compliance with Nutritional standards, with Wards 14 and 4 and Norman Power and Anne

Marie Howes Units having 100% compliance. Wards 6,11,12, 8, and C29 need to improve compliance in re-screening and CU27 unit

is showing poor compliance across the majority of Nutritional standards which has been escalated for action.

Medicines Management ECI Criteria

The Intermediate Care Units and Wards 5 and 6 at MHH are all showing reduced compliance in some elements of Medicines

management documentation, particularly the use of full patient Identification, the signing of discontinued prescriptions and the use

of Capital letters for medicine names.

Environmental ECI Criteria

All units continue to perform well against these criteria apart from a number of the Intermediate Care Units which were not found

to be displaying Estimated Date of Discharge.




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Domain 5:

Efficiency and Productivity



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Domain Summary Efficiency and Productivity


5.1 Agency as a percentage of temporary staff

spend

36.7%

5.2 Average length of time to recruit (Date

Advertised to Offer)

89.7

5.3 CRES achievement - % YTD actual compared

to YTD Plan

84.38%

5.5 NHS DTOC SHA target snapshot percentage

of patients

2.11%

5.7 Percentage of patient ethnicity codes

recorded on PAS/Child Health System

89.4%

5.8 Availability of agreed services on Choose and

Book

100%

5.10 YTD % CRES milestones achievement position 95.15%

Ref Indicators with no data and comment

5.4 DNA rates Not available as at

report date

5.6 SUS data with a valid NHS number Not available as at

report date

5.9 Increase in funded health visitor WTE

establishment

Availabilityto be

confirmed

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Commentary

In this summary, we have outlined the overall performance for the Trust for all of the Efficiency and Productivity indicators. Where

the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not

achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the

subsequent pages.

The DNA rates and SUS data with a valid NHS number outturn are

not made available until the 20th and 25th July so the Trust Board will

be verbally updated on this area of performance at the Board

meeting.

While the recovery plan for CRES achievement - % YTD actual

compared to plan was met by the Trust, we have provided the Trust

Board with a financial update to reflect current CRES savings

overleaf.



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Efficiency and Productivity watching brief

5.3 CRES achievement - % YTD actual compared to YTD plan

Breakdown by DivisionOverall Trust position

32

Indicator Goal: Price

The Trust is required to make financial efficiency savings and this indicator will show the Board the progress being made throughoutthe year to deliver these savings.

This is a new calculation. Previously the Trust reported cumulative CRES savings against the total target. The new indicator assesses

CRES savings each month against the cumulative Year to Date (YTD) planned savings. The target is to achieve 100% of the YTD plan.

Following month one outturns, the forecast has been revised to

achieve 82% overall compliance by June 2012. While the Trustexceeded its June recovery target, Dental Hospital fell behind their

YTD plan for the first time.

This does not affect the overall target which is to achieve 100%

compliance.



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Appendix 1:

Finance Report



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Finance Performance Report

Month 3

2012/13

353

35


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Finance Board Report Index

Page

Executive Summary 37

In Year Income & Expenditure Plan & Year End Performance 38

Corporate Financial Risks 39

CRES Delivery 40

Capital Plan 41

Working Capital Statement of Financial Position 42

Working Capital Cash Flow/Debtors/Creditors/PSPP 43

Working Capital Summary 44

Figure Explanations 45

Glossary 46

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Summary & Key Performance Indicators Executive Summary

Fig.1

Fig. 3

Fig. 2



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In Year Income & Expenditure Plan & Year End Performance

Fig.4

Rehabilitation Mth3 (73k), Mth2 (30k), Mth1 (102k)

YTD overspend of (73k) with continuing pressures in RTS which is consideredto be a non recurrent issue, special seating (67k), Rehab Engineers (55k) andFES (28k), offset by vacancies. The division has been asked to complete a fullreview of service line profitability.

CRES 5k adverse to recovery plan

Dental/PDS Mth3 62k, Mth 2 54k, Mth1 69k

As reported in previous months the favourable variance relates to continuing

vacancies, and slippage on non pay contracts .CRES 9k adverse to plan.

Corporate Mth3 15k, Mth 2 10k, Mth1 6k

Month 3 favourable variance is primarily due to slippage on vacancies, offset bynon pay cost pressures.

CRES 40k adverse to original plan

The net I & E position as at month 3 is a YTD surplus of 869k and is against an inyear planned surplus of 965k, demonstrating a 96k unfavourable variance

from target.

Through the newly created PPMB (Programmes & Performance Management

Board) the YTD and forecast outturn positions are reported and discussed

along with future planned recurrent positions and projections. Where divisions

continue to underperform recovery plans will also be closely monitored through

the Business and Finance Technical Committee.

Figure 4 shows the summary of the divisional YTD position currently reporting a

YTD unfavourable variance of 220k including income;

At Month 3 the forecast outturn position for the Trust remains at 2,948k.The main factors and risks influencing the divisions month 3 position including

income are:

Children's and Families Mth 3 165k, Mth2 72k, Mth1 (3k)

The YTD favourable variance relates to continuing slippage on vacancies

offset by pressures in drugs (66k)

Achievement of YTD CRES.

Adults and Communities Mth3 (252k),Mth2 (42k), Mth1 (24k)

The month 3 position relates mainly to the delay in Inpatient Service Redesign

(225k), now expected to complete in July, medical staffing locum cover (58k)

and underperformance (250k) relating to the phas ing of activity. The issue

has been resolved, and is expected to result in no financial penalty to the

Trust by year end.

Offset by continuing slippage on vacancies in the main within central services

and medical staffing.

Achievement of YTD CRES against recovery plan

Specialist

LD Mth3 (122k), Mth2 52k, Mth1 (15k)

The unfavourable movement in month relates to short t erm breaks (88k). Inaddition the YTD position as previously reported includes additional income,offset by continuing bank and agency spend and non pay cost pressures.

Achievement of YTD CRES against plan.

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Corporate Financial Risks

Financial Risk RegisterAll risks to the organisation are managed through the risk management committee, with all those attaining a score of 15 or above being escalated to

the corporate risk register, and presented to the Governance and Risk Management Committee and the Board. All financial risks with a score of 15

or above are presented below.

There are no Financial Risks with a score of 15 or above for this month.

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CRES Delivery

Fig 6 Fig 7.

CRES Delivery

Our CRES requirement for 2012/13 is (12.1m) and projects have been identified and developed through PIDs (Project Initiation Document). These plans have been

developed with Divisions and have been corporately overseen and clinica lly driven; each project is owned by an individual within the relevant division, and they are held

responsible for achievement of the savings requirements.

We have developed a rigid gateway acceptance that ensures all PIDs accepted are monitored through PPMO (Performance Management Office). Regular monitoring ofprogress against CRES schemes will be reported to the PPMB (Programmes and Performance Management Board).

Figure 6 above details the planned YTD savings and the identified YTD savings by division. It shows that currently there is an m inor under achievement of savings, in yearrelating to Corporate, Rehab and Dental and small overachievement of revised plan by Adults & Communities Division. Divisions are confident that savings will be

achieved, and the Business, Finance and Technical Committee and PPMO will continue to monitor progress .

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Capital Plan

Fig.8

Capital Update 2012/13Sources of funds - The forecast outturn has been revised in Month 3 to reflect that currently the expected transfer of Estates has not taken place. The

Trust expects this to be updated later in the year, when the transfer is certain. It can be noted, that in order to maintain the Trust s capital plans morefunds will need to be found from surplus / PDC Loan if the t ransfer does not take place.

As at the end of June 2012 capital expenditure totalled 149k. New scheme codes have been issued to managers relating to the 2012/13 capital plan

and are now in use following the migration of shared services to SBS.

The Trust continue to manage the building schemes for all buildings that will transfer during the financial year and the placing of orders commenced

during May 2012. A detailed plan for the expenditure is almost complete with managers and will provide accurate capital profiling for the remainder of

the year.

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Working Capital Statement of Financial Position

Fig.

10Non Current Assets

Non current assets have increased by 77k due to expenditure in m onth being in

excess of depreciation.

Current assets

Overall current assets - excluding cash and cash equivalents have increased by

1,662m due to an increase in accrued income and prepayments during the month.

Financial assets - accrued income There is an increase in accruals and

prepayments in month of 1,706k. The increase in accruals is mainly due toinvoices not raised on time

Trade and other receivables (invoiced debtors) There is a decrease in

outstanding debtors in month of 44k

Cash and Other Financial Assets

Cash has decreased in month (5,558k). The decrease is mostl y due to thecontinued effort in reducing aged creditors migrated from the old payment systems

and some correction by SBS to the ledger relating to the cashbook

Current Liabilities

Current liabilities have decreased by 3,780k in month

Trade and other payables / other financial liabilities accruals

There has been a decrease of 3,907k in outstanding trade and other payablesduring the month as a result of continued work to clear aged creditors .

Non Current Liabilities

The Trust has no non current liabilit ies.

Liquidity Position

The Trust has cash totalling 30,758k which represents the Trust s cash

requirement for more than one month.

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Working Capital

Fig.13

Fig.12

Fig.15

Fig.14

Fig 11.

Aged Credi to rs Cur rent 31-60 Days 61-90 Days 91-120 Days > 120 Days > 180 Days

ont

Total

ont

Total Variance

'000 '000 '000 '000 '000 '000 '000 '000 '000

NHS 2,993 3,543 247 308 -35 509 7,565 6,799 766

Non NHS 911 772 463 337 176 118 2,777 5,233 (2,456)

Total 3,904 4,315 710 645 141 627 10,342 12,032 (1,690)

Aged Debt Current 31-60 Days 61-90 Days 91-120 Days > 120 Days > 180 Days

Month 3

Total

Month 2

Total Vari ance

'000 '000 '000 '000 '000 '000 '000 '000

Total 2,044 536 74 1,222 289 232 4,397 4,439 (42)

m m m m m m m m m m m m m m m m

Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

Plan balance 27.4 28.0 28.4 26.3 27.1 27.9 28.7 29.5 30.2 31.0 31.8 32.6 33.3 34.1 34.9 35.7

Actual balance 29.6 31.2 30.3 28.7 29.3 36.3 30.7

Cash Flow Analysis 2011/12 - 2012/13 Plan vs Actual

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Working Capital

CashCash in hand and in the bank totalled 30,758k as at the end of June 2012 which is a decrease of 5,558k in month. This was due to the continued effort in reducing aged

creditors migrated from the old payments systems and corrections to the ledger carried out by SBS.

Debtors

The total debts outstanding at the end of Month 3 is 4,397k, which is a reduction of 41k from Month 2, with debts exceeding 120 days totalling524k - an equivalent of 11.92% (refer table below) The total debts include both NHS and NON-NHS and are actively being chased for payment

A summary of debts over 120 days mainly relates to the following customers:

Birmingham East and North - 151k - 72k of the outstanding debt has been received in July, plus the requested credit note for 58k re: charges over the agreed

maximum 57k charge has been raised. This leaves a balance of 21k outstanding which will be paid on receipt of the credit note.

South Staffordshire PCT - 113k The Division is actively pursuing payment for the outstanding invoices, Copies of requested signed SLA documentation has being

forwarded to South Staffordshire, who has confirmed that payment will be forthcoming within the next 2 weeks.

Sandwell and West Birmingham Hospitals NHS Trust - 57k Credit notes are in the process of being raised to clear the disputes on these invoices. On receipt of the

credit notes, payment of the outstanding balance will be imminent.

Cape Hill Medical Centre - 32k The Division is actively liaising with Cape Hill to try resolve the disputes on the 2 outstanding invoices.

CreditorsAged Creditors at the end of month 3 is currently showing a balance of 10,342k, which is a decrease of 1,690k in month. Over 120 days past due date creditors

have increased to 768k in month 3 from 639k in month 2 which represents 7.43% of total creditors.

PSPP

The Public Sector Prompt Payment Policy target is 95% of bills to be paid within 30 days and will be reported in the annual accounts.The cumulative performance for the year is 73.48% (M2 75.61%) with 71.47% (M2 71.64%) of invoices within the month being paid within the PSPP target timescale.

Work is on-going to ensure that the cumulative performance is improved and it is being reported at PPMO.

Note : The SHA has asked organisations to provide turnaround plans where debtors and creditors exceed 90 days past due. The newly established monthly performance

management meeting (Performance and Programme Management Board, PPMB) will oversee local delivery of the 90 day and 30 day targets in the future.

Aged Debt Month 3 Current 31-60 Days 61-90 Days 91-120 Days >120 Days >180 Days Grand Total

'000 '000 '000 '000 '000 '000 '000

NHS 1,733 276 69 1,082 277 149 3,586

NON NHS 311 260 5 140 12 83 811

Non NHS - Excl L/Cars & Sal O/P 305 256 5 136 9 51 762

leaseCars 5 4 0 2 3 7 21

Salary Overpayment 1 0 0 2 0 25 28

Grand Total 2,044 536 74 1,222 289 232 4,397

Total number of Invoices 279 114 30 98 58 122 701

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Figure Explanation

Figure 10. The balance sheet shows prior month, current month,

movement in month. It also shows the balances as if we

were operating as an FT for comparison

Figure 11. Shows the cash balance on a rolling basis. A full cash

forecasting model supports this data.

Figure 12. Graph showing the Cash Flow Analysis of actual vs. plan

Figure 13. Provides an analysis of aged debt within the period.

Figure 14. Provides an analysis of aged creditor within the period.

Figure 15. Shows the in month and Cumulative PSPP compared to

the annual target

Figure 1. Demonstrates the current I&E position compared to both

the in year planned position and full year plan.

Figure 2. Assesses financial risk and looks at four criteria:

achievement of plan, underlying performance; financial

efficiency; and liquidity and is scored from 5 to 1. A

weighted average of these scores is then used to

determine the overall financial risk rating

Figure 3. Key performance indicators

Figure 4. Demonstrates the current I&E position

Figure 5. Corporate Financial Risks of rating 15 or over

Figure 6. CRES Performance illustrating Recurrent & Non

Recurrent, the forecast and the actual achieved.

Figure 7. Graph illustrating the CRES Performance YTD

Figure 8. Provides an analysis of Capital budget by directorate

Figure 9. Provides an analysis of capital sources and applications

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Glossary

ALE Auditors Local Evaluation MADEL Medical and Dental Education Levy

BCC Birmingham City Council MHH Moseley Hall Hospital

BDC Business Development Centre NPSA Named Patient Service Agreement

BFM Business Finance Manager OBC Outline Business Case

CDM Centre for Defence Medicine OOH Out of Hours

CRES Cost Releasing Efficiency Savings PBR Payment by Results

CRL Capital Resource Limit PFI Private Finance Initiative

EBITDA Earnings Before Interest, Tax, Depreciation and Amortization PL Project Lead

ESR Electronic Staff Record PLD People with Learning Disabilities

FDC Financial Delivery Committee PSC Public Sector Consulting

FBC Full Business Case PSPP Public Sector Payment Policy

FOT Forecast Outturn QTR Quarter

FPMG Finance & Performance Management Group R&D Research & Development

FT Foundation Trust RMHN Registered Mental Health Nurse

HoEFT Heart of England NHS Foundation Trust RPL Revenue Resource Limit

HOS Heads of Services SBCH South Birmingham Community Health

HR Human Resource SHA Strategic Health Authority

I&E Income & Expenditure SFIs Standing Financial Instructions

IT Information Technology YTD Year to Date

LDP Local Development Programme ZBB Zero Based Budgeting

LTFM Long Term Financial Model

46

BCHC Quality and Performance Report Final Jun_Jul 2012.pdf

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Transcript of BCHC Quality and Performance Report Final Jun_Jul 2012.pdf