Integrated Quality and Performance Board Report April 2018

Integrated Quality and Performance Board Report - Contents

SOF segment score (page 3)

This comprises the trust’s Single Oversight Framework current segment scoring.

Quality Metrics (pages 4-11)

This section provides overviews of the measures relating to Quality of Care , and largely coincide with the measures identified by the Single Oversight Framework. They include: • Quality (Safe & Caring) Hotspot report • Friends and Family recommended rates, complaints, and mixed sex accommodation • C-diff and MRSA infections • Emergency caesarean section rates, pressure ulcers, and falls • Never Events, Serious Incidents, Duty of Candour, and VTE risk assessment

Mortality (page 12) This dashboard provides an overview of how the Trust is performing against mortality measures.

Dashboards (pages 13-16)

In order to provide a comprehensive picture of the Trust’s performance in the major areas in which it is measured, the following dashboards give an in-depth overview of how the Trust is faring against the four major Operational Performance Metrics identified by the Single Oversight Framework: • Accident & Emergency – 4 Hour Standard • 18 Week Referral to Treatment • Cancer Waiting Times – 62 Day Standard • Diagnostic Tests – 6 Week Standard

Workforce (pages 17-19)

This is a summary commentary on hotspots within workforce, along with accompanying measures.

Estates (pages 20-23)

This section contains dashboards on: • Domestic services & catering • DATIX & MEMS • Estates maintenance & capital programmes • CQUIN 1b Healthier Food

Finance (pages 24-35)

This is the finance performance report, complete with risks, mitigations, and actions.

Appendices (pages 36 to 56)

• A: Domain Scorecards • B: Extra charts for measures in ‘Safe’ Domain • C: Extra charts for measures in ‘Caring’ Domain • D: Extra charts for measures in ‘Responsive’ Domain • E: Extra charts for measures in ‘Effective’ Domain

Integrated Quality and Performance Board Report

Single Oversight Framework current segment score

The Single Oversight Framework places Providers into “Segments” based on NHS Improvement’s judgement of the seriousness and complexity of issues faced by each Provider.


14th May 20184

Providers in special measures: there is actual or suspected breach of licence w ith very serious and/or complex

issues. The Provider Regulation Committee has agreed it meets the criteria to go into special measures.

Single Oversight Framework – Current SegmentLatest Position Segment Description

31

Providers with maximum autonomy: no potential support needs identif ied. Low est level of oversight;

segmentation decisions taken quarterly in the absence of any signif icant deterioration in performance.

2Providers offered targeted support: there are concerns in relation to one or more of the themes. We've identif ied

targeted support that the provider can access to address these concerns, but w hich they are not obliged to take up.

For some providers in segment 2, more evidence may need to be gathered to identify appropriate support.

3Providers receiving mandated support for significant concerns: there is actual or suspected breach of

licence, and a Regional Support Group has agreed to seek formal undertakings from the provider or the Provider

Regulation Committee has agreed to impose regulatory requirements.

Quality (Safe & Caring) Hotspot report


Serious Incidents - There were eight serious incidents reported in April 2018: • A patient moved during surgery and sustained trauma to her eye; a drug was administered via the incorrect route with no patient harm;

outpatient treatment on the incorrect side; a baby was transferred to a level 3 Neonatal Unit for on-going care following birth; two patients had delayed diagnosis - ligament injury and stroke; a patient developed a grade 3 pressure ulcer and a patient fell from bed and sustained harm.

• All delays greater than 60 minutes in ambulances offloading in the Emergency Department are incident reported. During April 2018, there were no reports.

Duty of Candour - Verbal compliance was 100% in April 2018. Harm Free Care Falls - In April there were 84 adult inpatient falls equating to 5.6 falls per thousand bed days. There were no Extreme, High ,or Moderate severity falls. Pressure Ulcers - The April data for preventable pressure ulcers has not yet been finalised as reviews are still being carried out. In March there were 9 G2s and 1 G3 pressure ulcers. Of these 8 G2s were preventable and 1 G2 and 1 G3 were unpreventable. The same themes are occurring which include failure to adequately reposition patients and lack of appropriate mattress provision. Further actions are being taken to reduce preventable pressure ulcers includes holding the first SSKIN Champion meeting on 16th May, having a named link tissue viability nurse for each ward, embedding the new pressure ulcer reporting process, reviewing documentation as part of a wider project focussing on pressure relieving equipment and re-introducing the pressure ulcer safety cross. In addition, there is a series of new pressure ulcer related posters/resource packs which are being developed that will be available for use on the Wards. Maternity The caesarean section rates continue to fluctuate, however for the last financial year the total caesarean section rate was 30.5%, which is a reduction from the previous year. The Consultant body and Head of Midwifery are building on the valuable work achieved over the last year to maintain and further reduce caesarean section rates over the coming year. The action plan remains in place and in progress.

Quality (Safe & Caring) Hotspot report


Infection Prevention Control • C Diff - In April there were no cases reported against a ceiling of 29. • MRSA Bacteraemia - There were no reported cases for April. • MRSA Screening - The provisional screening compliance for April is 89.2%. Codes and exclusion criteria and coding for procedures and

admissions continue to be scrutinised on a monthly basis to identify exclusions that should not be included in the screening data. • NHSi Action Plan - An action plan is in place and all actions are on track. A re-visit is planned for May 2018. • IPC Outbreaks - There were no outbreaks reported in April. Patient Experience • Complaints - There were 82 complaints in the backlog at the end of April. In 60 of these cases the complaints team were waiting for advice from

the directorates. The majority of the cases in the backlog were 0-3 months overdue and 5 were over 6 months old. The complaint with the longest delay at this time was originally raised in August 2017. The Complaints and Patient Experience Team Leader and Head of Patient Experience meet weekly to discuss those cases which are delayed more than 6 months and an action plan is devised for each case to ensure that a response is expedited within the Directorates.

• Friends and Family - The response rate for ED and Outpatients are both above the national average. The percentage of ED patients that would recommend the trust has increased to 85.6% in April from 83.8% in March (target 90%). The Trust’s internal target recommender score for inpatient and day cases is 95%, in April the score was 92.8% (2.2% off target) which is an improvement of 2% since last month. Maternity’s response rate decreased to 23.94% in April compared to 55.51% in March and 99% of patients would recommend the service. In March we had observed a significant increase in response rate following the introduction of FFT postcards to the waiting area used by patients attending for scans, the uptake has since plateaued in April showing a more consistent result in line with the national average.

Dashboard: Quality of Care Monitoring Metrics


Feb-18 Mar-18 Apr-18

IP Friends & Family Recommended 91.4% 90.9% 92.8%

IP Friends & Family Recommended

85.0%

90.0%

95.0%

100.0%

Previous Year Rate Target


A&E Friends & Family Recommended 86.0% 83.8% 85.9%

A&E Friends & Family Recommended

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%



Mat Friends & Family Recommended 98.1% 100.0% 98.8%

Mat Friends & Family Recommended

80.0%

85.0%

90.0%

95.0%

100.0%



OP Friends & Family Recommended 94.2% 92.7% 93.1%

OP Friends & Family Recommended

85.0%

90.0%

95.0%

100.0%





Monthly Complaints Compliance 87 56 59

Monthly Complaints Compliance

0102030405060708090

100

Previous Year Rate


Incidents of C-Diff 3 0 0

Incidents of C-Diff

0

1

2

3

4

5

6

7

8



C Diff YTD (Cumulative) 33 33 0

C Diff YTD (Cumulative)

0

5

10

15

20

25

30

35



Complaints YTD compliance % 3.30% 2.02% 5.36%

Complaints YTD compliance %

-20.0%

-10.0%

0.0%

10.0%

Rate Target




Direct lapse in care resulting in C Diff infection 0 0 0

Direct lapse in care resulting in C Diff infection

0

1



Incidents of MRSA 1 0 0

Incidents of MRSA

0

1

2



MRSA Cumulative 5 5 0

MRSA Cumulative

0

1

2

3

4

5

6



Maternity - Emerg LSCS (lower segment c. section) 20.0% 14.2% 15.1%

Maternity - Emerg LSCS (lower segment c. section)

0%

5%

10%

15%

20%

25%





Serious Incidents 8 7 8

Serious Incidents

0

5

10

15

20

Previous Year Rate


Never Events 0 1 0

Never Events

0

0.2

0.4

0.6

0.8

1

1.2



Mixed Sex Accomodation 0 0 0

Mixed Sex Accomodation

0

1



Duty of Candour - Failure to Notify 2 1 0

Duty of Candour - Failure to Notify

0%

20%

40%

60%

80%

100%

120%


0.0%

20.0%

40.0%

60.0%

80.0%

100.0%


0%

20%

40%

60%

80%

100%

120%


0

2

4





No. Falls (Moderate) 2 0 0

No. Falls (Moderate)

0

1

2

3

4

5



No. Falls (High/ Extreme) 1 2 0

No. Falls (High/ Extreme)

0

2

4



Falls per 1000 OBD (occupied bed days) 6.0 4.9 5.6

Falls per 1000 OBD (occupied bed days)

0

1

2

3

4

5

6

7

8

Previous Year Rate

Jan-18 Feb-18 Mar-18

Pressure Ulcers (avoidable) Cumulative 0.12% 0.13% 0.14%

Pressure Ulcers (avoidable) Cumulative

0.0%

0.1%

0.2%

0.3%





VTE risk assessment testing 98.8% 98.5% 98.8%

VTE risk assessment testing

0%

20%

40%

60%

80%

100%

120%


0.0%

20.0%

40.0%

60.0%

80.0%

100.0%


0%

20%

40%

60%

80%

100%

120%


92%

94%

96%

98%

100%



Pressure Ulcers: Avoidable (Grade 2) 1 2 6

Pressure Ulcers: Avoidable (Grade 2)

0

2

4

6

8

10


0

1

2

3

4

5

6

7





0

1

2

3

4

5





0%

20%

40%

60%

80%

100%

120%


0

1


Dashboard: Mortality

Performance Commentary Actions / Mitigations

Q4 - Mortality Review Quarter 4 data is reported above. This data does not include deaths in Paediatrics. The number of reviews completed is reduced in Q4 due to the classification of a ‘mortality review’.

The data presented for Q4 by the directorates highlights no potentially avoidable deaths; however, for a number of directorates there are still deaths that occurred in Q4 for which reviews have not yet finished. This is due to the delay of CRAB triage. From 1 May 2018, SUHFT are no longer using CRAB for initial screen and are reviewing deaths based on the criteria set by the national Learning from Deaths guidelines (“the LFD guidelines”).

The May Mortality Surveillance Group is due to take place on 30 May 2018. Directorate attendance and input is being monitored via the QSC meeting.

The reporting template has been amended again to reflect the changes in reporting and to move away from quantitative data collection to a focus on explicit statements on care and learning for group consideration.

The Mortality Working Group continues to meet monthly and their focus includes monitoring the mortality improvement action plan.

The next SHMI is expected to be published in June 2018 for the period covering January 2017 to January 2018. The current hospital SHMI from March 2018 is 1.13. This is just above the expected range (0.89 – 1.12) but is a significant improvement in our position.

Crude mortality rates have decreased in April 2018 to 2.7%. This is a reduction from the 3.4% reported in March 2018 and is in line with the crude mortality in the previous year, which also saw a crude mortality of 2.7%. There has been a marked improvement in ED crude mortality. Of particular interest, crude mortality for ED in April 2018 is 0.08%. This is down from 0.15% in March 2018 and an improvement on the crude mortality in April 2017 of 0.12%.

The 2018 CRAB annual report showed that the Risk adjusted mortality for the Trust is below the expected range with no speciality higher than expected.

A new ‘Monthly bulletin’ was shared Trust-wide which communicated the key matters, key learning from mortality reviews and a mortality message of the month. This was circulated via the Friday round up and is available on the intranet.

Good progress has been made with outlier reviews into AKI and Pneumonia diagnostic groups.

From 1 May 2018, the Medical Examiners are providing scrutiny to all inpatient adult deaths and there is increased engagement with bereaved families.

The Trust shared our progress with the implementation of the LFD guidelines regionally at the Patient Safety Collaborate forum together with Mid Essex and Basildon Hospitals.

There has been excellent consultant engagement across all directorates with a high uptake of SJR training and a great appetite for extracting quality improvement from mortality reviews.

Learning from Deaths information has been written for publication in the 2017/2018 annual quality account.


Measure owner: Neil Rothnie, Medical Director


Crude Mortality Rate 3.2% 3.4% 2.7%

Crude Mortality Rate

0%1%2%3%4%5%

Apr

-18

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

Nov

-18

Dec

-18

Jan

-19

Feb

-19

Mar

-19


Mar-17 Jun-17 Sep-17

SHMI 1.194 1.167 1.128

SHMI

1.000

1.050

1.100

1.150

1.200

1.250

Jun-17 Sep-17 Dec-17 Mar-18


Dashboard: Accident and Emergency 4 Hour Standard


• Performance improved during April to 89.5%. This was higher than the trajectory value for the period.

• There were 19 days during the month where the Trust achieved performance over 90%.

• There were 13 days where performance was above 95%, all in the second half of the month.

• ED conversion rate remains at around 28% – once adjusted to remove patients using the ambulatory care pathway.

• ED attendances dropped back in April in total but there were 30 days in the month, so the daily rate was very similar. In the first week of May the daily attendance was in the 320 – 350 range.

• The Primary Care Streaming unit has taken slightly increasing numbers at 43 – 45 patients per day on average.

• As previously reported, there was a decreasing trend black breaches for ambulance delays through April and there were none recorded in the first half of May.

• The noticeable change in April was the reduced number of patients attending ED categorised as Major or Resuscitation. The increase in volume is in Minor patients.

• In April there was also a decrease in the number of delayed patients.

• The Patient Flow Board has considered the range of plans currently under development, and identified five areas which are considered to offer the maximum benefit. These are:

A. Clinical Criteria for Discharge B. Implementation of SWIFT (rapid

response) C. Internal Professional Standards D. Demand and Capacity modelling

• Additional building work commences in early June in ED to rectify deficiencies in drugs storage and to create an additional 6 bays Rapid Assessment area.

• The Clinical Criteria for Discharge paperwork has been updated the next step is to undertake an audit of compliance.

• Medicine’s Capacity and Demand is expected to be completed end May, with subsequent discussions about reducing or redirecting demand likely.

• A programme of system-wide reviews is now underway to prepare the system for Winter 18/19.

• The new ambulance handover and cohorting protocol remains in place and is working well to reduce ambulance delays.

• The Trust is currently developing a proposal for the longer term future of GP Streaming which may involve tendering the service.


Measure owner: Clive Walsh, interim Director of Operations, Emergency and Unscheduled Care


Attendances 7,469 8,753 8,245

- Seen within 4 hours 6,284 6,908 7,383

- Seen outside 4 hours 1,185 1,845 862

% Seen within 4 hours 84.1% 78.9% 89.5%


Trajectory 91.0% 91.0% 80.0%

Performance 84.1% 78.9% 89.5%

70%

80%

90%

100%

Ap

r-16

Jul-

16

Oct

-16

Jan

-17

Ap

r-17

Jul-

17

Oct

-17

Jan

-18

Ap

r-18

Jul-

18

Oct

-18

Jan

-19

A&E 4 hour performance vs trajectory

Actual Target Trajectory

Dashboard: 18 Weeks Referral to Treatment (RTT) – Incomplete Pathways



• Insourcing programme for Ophthalmology continued through April.

• Theatre utilisation increased in month to 76.27%.

• Elective day case admissions achieved 85.76% (national target 85%).

• Out patient clinic utilisation improved to 74.11%.

• Revised theatre schedules being developed.

• Optimisation of Urology theatre lists is being reviewed with clinical teams.

• Out patient DNA rates (currently 6.45%) are being reviewed within specialties.

Measure owner: Clare Burns, Director of Operations, Elective Care


All patients 26,404 26,809 26,345

- Waiting within 18 wks 22,227 22,716 22,629

- Waiting outside 18 wks 4,177 4,093 3,716

% Waiting within 18 wks 84.2% 84.7% 85.9%


Trajectory 85.3% 87.6% 84.6%

Performance 84.2% 84.7% 85.9%

80%

90%

100%

Ap

r-16

Jul-

16

Oct

-16

Jan-

17

Ap

r-17

Jul-

17

Oct

-17

Jan-

18

Ap

r-18

Jul-

18

Oct

-18

Jan-

19

RTT Incompletes


Note: latest month’s data is provisional.

Dashboard: Cancer Waiting Times – 62 Day Treatment Standard following Urgent GP Referral




• Urology service has seen a high rate of referrals requiring increased demand on theatre capacity.

• Upper GI and Lung are also increased referrals resulting in high demand for diagnostic services.

• Delays in pathology reporting have decreased.

• Theatre schedule review is in progress which will allow for increased cancer lists.

• One stop Head and Neck service is on plan to commence in May.


All treatments 80.5 76.5 74.0

- Treated within target 57.0 54.0 56.0

- Treated outside target 23.5 22.5 18.0

% Treated within target 70.8% 70.6% 75.7%


Trajectory 85.3% 85.3% 75.9%

Performance 70.8% 70.6% 75.7%

60%

70%

80%

90%

100%

Ap

r-16

Jul-

16

Oct

-16

Jan-

17

Ap

r-17

Jul-

17

Oct

-17

Jan-

18

Ap

r-18

Jul-

18

Oct

-18

Jan-

19

Cancer 62 day 2ww First Treatment


Note: latest month’s data is provisional.

Dashboard: Diagnostics – 6 Week Wait for Diagnostic Procedures




• The national standard of 99.0% has been achieved for the 3rd consecutive month.

• Nurse Endoscopist now performing independent procedure sessions.

• All processes in place for electronic bookings.

• IT systems to support electronic bookings delayed due to competing priorities.

• Nurse recruitment ongoing.


All patients 4,439 4,686 5,019

- Waiting within 6wks 4,395 4,640 4,975

- Waiting outside 6wks 44 46 44

% Waiting within 6wks 99.0% 99.0% 99.1%


Trajectory 98.3% 99.0% 99.1%

Performance 99.0% 99.0% 99.1%

85%

90%

95%

100%

Ap

r-16

Jul-

16

Oct

-16

Jan-

17

Ap

r-17

Jul-

17

Oct

-17

Jan-

18

Ap

r-18

Jul-

18

Oct

-18

Jan-

19

6-week wait for diagnostic procedures


Well led: Workforce Hotspots


Vacancy Rate

The establishment reduced slightly to 88.64% in April 2018 towards our target of 93% of staff in post. Vacancies for April increased to 11.35% (39.9 FTE) due to the

realigning of the budgets in the new financial year – increased FTE numbers in brackets. The vacancy rate for Nurses and Midwives has increased to 14.43% from 12.81%

(12.47), Clerical and Admin 7.03% (10.3FTE), 16.59% (17.34 FTE) for Doctors and 23.86% (1.5) for Estates & Facilities (due to the Atom contract). Overseas nursing

recruitment efforts are now coming on line with 3 new starters that arrived in April with a further 7 due to start in June. Overseas Doctors recruitment resulted in 151 offers

made in 2017. Total number of overseas medical staff offered in 2018 is 35 and increase from 14 since last report. Open days for nurses planned, further engagement with

Lot 2 suppliers for Doctors expanding with 2 further agencies. Focus on recruitment of PAs (Personal Assistants) and use of Social Media for direct hire.

Bank and Agency Spend

Total agency spend was 9.74% of the total pay bill in April 2018, a slight reduction from 9.84% (0.1%). In addition bank spend reduced to 8.56% in April from 10.82% (-

2.26%) of the total pay bill. Nursing agency spend increased by £12,638 to £268,999 in April from March (£256,361). Consultant agency spend reduced by £83,170. High

agency spending areas for Medical Staff include; General Medicine (£474,766), Emergency Services (£116,121) and Surgery (£113,020). Agency controls in place include

– strict prior authorisation by senior managers, weekly financial control meetings, weekly agency rule breaches approval meeting, weekly review of top 20 highest cost

agency, tracking of Medical Staffing vacancy progress against agency spend and mitigation plans. A revised SOP is being issued this month, supported by an action plan

to tighten controls.

Staff Turnover

Voluntary turnover increased slightly by 0.12% to 12.66%. This figure includes those retiring (voluntary retirement and ill-health retirement), which when subtracted reduces

the voluntary turnover to 10.56%. The monthly Retention Committee reviews turnover hotspots, leaver reasons and action planning to ensure there are controls in place to

improve the attrition rate. As part of the NHSI Retention Programme we have commenced a programme of ‘Stay Interviews’ with new starters in nursing & midwifery

hotspot areas, ‘Stay Plans’ monitored at ward/department level and have launched the streamlined retire and return programme to retain staff who may otherwise retire in

24 months. Retention Skills Training for managers will shortly be launched and our health, wellbeing, recognition and engagement programme action plans are also in

place with initiatives due for implementation during Q1 2018.

Stat Man Training

Overall compliance for April is 86.43%, which is an increase of 0.14% and up 2.21% on last year. While we continue to meet the Trust target, we are currently working with

the speciality leads and Directorates to review actions and trajectories to ensure the compliance level is reached in hot spot areas. A review of the induction process for

Junior Doctors has also begun this month, with the plan to move to a process that mirror’s BUHT, along with a review of the bank stat man process to ensure this is

streamlined.

Appraisal

Appraisals have reduced by 3.71% to 74.34%. This is up on last year’s compliance rate of 68%. Feedback from managers remains positive about the interim appraisal

form launched on 9 March 2018 and the appraisal team have reported an uptake in the volume of appraisals received. It is expected therefore that this will translate into an

improvement in appraisal rates in May 2018. Aged appraisals (18 month +) continue to be a focus. The April appraisal report highlighted 27 outstanding. This will be

reported on monthly and escalated to Directorate Boards by the HR Business Partners. The HRBP’s are currently working with Directorates to agree revised trajectories

with the aim of reaching 90% compliance by the end of October 2018 (before winter pressures).

Sickness

The sickness rate has remained static at 3.84% in April 2018. This is below last year’s rate of 4%. HR continue to work with managers to focus on hot spot areas. From

April 2018 the HR Support Officer has been providing dedicated support to managers to ensure that correct processes are being followed when staff are off sick. It is

hoped that this work along with exiting winter operational pressures an improvement will be seen in the sickness rates going forward. In addition the HRBP’s are currently

conducting an audit on Medical and Dental sickness absence to ensure this is being managed appropriately, particularly due to the impact on agency spend in certain

areas.

Workforce Measures



Vacancy Rate based on Establishment 10.8% 10.5% 11.4%

Vacancy Rate based on Establishment

0%

5%

10%

15%



Average Agency Ceiling (as a percentage) 9.6% 9.8% 9.7%

Average Agency Ceiling (as a percentage)

0%

5%

10%

15%



Bank Spend as % of Pay Bill 7.5% 8.0% 7.9%

Bank Spend as % of Pay Bill

0%

5%

10%

Previous Year Rate


Statutory Mandatory Training 86.5% 86.3% 86.4%

Statutory Mandatory Training

80%

100%


Workforce Measures



Sickness Absence Rate 3.8% 3.8% 3.8%

Sickness Absence Rate

0%

5%



Appraisals 78.5% 78.1% 74.3%

Appraisals

0%

20%

40%

60%

80%

100%



Turnover FTE % - Voluntary (ex jr drs) 13.2% 12.5% 12.7%

Turnover FTE % - Voluntary (ex jr drs)

0%

5%

10%

15%



% of Leavers Left Within 2 Years 46.3% 44.5% 45.6%

% of Leavers Left Within 2 Years

20%

40%

60%

Previous Year Rate

Estates: Domestic Services & Catering



April 2018 Performance: • All performance targets are all being met.

• Very High Risk e.g. Theatres 35 managerial cleaning audits undertaken.

• High Risk e.g. Wards 16 managerial cleaning audits undertaken.

• Significant Risk e.g. Clinics 14 managerial cleaning audits undertaken.

1. N/A all targets have been met. Cleanliness Monitor Scores Audit % by risk category

2018/19

• Patient catering service is measured with set

KPIs that are categorised into Very high risk, high risk, significant risk and low risk based /weighted on the impact it has on the service.

• In April, Medirest met all required contractual KPI targets.

• There is also an upward trend on patient satisfaction survey that is conducted every month.

1. N/A all targets are being met. Patient Catering Patient Satisfaction Survey %

2018/19

Estates: DATIX and MEMS



• Total DATIX raised for April 18 – (57) of

which (28) were closed down. • Trust Governance to consider 80-85%

Incident closure target . Reason: Where additional Trust processes are necessary (i.e. violence and aggression security process) closure delay will be ensue.

• Incidents are being assigned to Estates Directorate when they should be assigned to another Directorate.

1. Overdue closure of incidents. • Datix training to be organised and

completed by 31st July.

Datix Reporting % Datix reports closed vs. raised in month

2018/19

• 14 Critical reactive calls. • Require response and closure within 7.5

hours.

• 9 High reactive calls. Require response and closure of no more than 3 days (22.5hrs).

• Repair turnaround times- from moment that repair is reported to when the medical device is repaired and returned to patient use.

1. All performance targets are being met. Medical Equipment Management Reactive % achieved within target timescale

2018/19

Estates: Estates Maintenance & Capital Programmes



• Priority 1 – 47 reactive calls.

Repairs completed within 4 hours. Performance below target.

• Priority 2 – 560 reactive calls. Repairs completed within 24 hours. Performance below target.

• Condition of the estate requires high levels of reactive maintenance input.

1. Priority 1 & 2 target not being met. • Reduced performance due to

impact of extreme weather conditions, leaks as a consequence of pipe burst and failed joint leading to loss of heating and hot water through the building.

2. Sickness levels having an impact on staff availability.

• Improvement to attendance due to management actions. On-going.

Estates Maintenance Reactive % achieved within target timescale

2018/19

Estates Capital Programme The capital allocation has not yet been agreed for 2018-19. Medical Equipment Replacement Programme (MERP) The Medical Equipment Replacement Programme allocation has not yet been agreed for 2018-19.

Capital Expenditure Planned vs. Actual £M's

2018/19

Estates: CQUIN 1b Healthier Food


Compliance Evidence Includes: • NHS England Strategy Group have confirmed that Compass Medirest &, Delimarche*, Compass Retail* and WH Smith have achieved compliance for 2017/8 based on

detailed submissions ( * just missed 31/3 deadline on removal of all HFSS sandwiches from meal deal due to packaging and procurement issues- achieved 70%, will be fully compliant shortly ).

• Trust has received signed letters from providers with action plans confirming their ongoing commitment to further improve nutritional value of food and drink sold on NHS sites.

• CCG are being presented with evidence of compliance with Cquin 1b) for their review and assessment. • EFM soft services manage catering and retail contracts: CQUIN compliance is standing agenda item at Gentian lease and Medirest contracts meetings.

Finance


Finance Performance ReportApril 2018

For the period April to April 2017-18

Southend University Hospital Foundation Trust Board 7 INDEX Page

Finance Summary 1Income 2Activity 3

Pay 4Pay analysis 5

Non Pay 6Financial summary trend forecast 7

CIPs - performance 8Capital 9

Cash Flow 10Risks, Mitigations & Actions 11

Internal Trust ReportingReporting Conventions Run Rate 11Adverse Variances = (Negative) Borrowings 12Favourable Variance = Positive Forecast Summary 13

Directorate Positions - YTD 14Income = Positive Directorate Positions - In Month 15Expenditure = (Negative) Directorate Performance Rating 16

Directorate Performance Rating Trend 17

Site DoF ReportingCIPS - governance dashboard 18

Pay WTE's 19Non Operating Expenditure 20

Risks and Opportunities 21Metrics 22

Finance


Monthly Financial Summary - Page 1

Budget Actual Variance Budget Actual Variance Budget Forecast Variance

£m £m £m £m £m £m £m £m £m £m

Income 24.921 25.349 0.428 24.921 25.349 0.428 309.001 309.001 0.000 305.4

Pay (16.726) (17.125) (0.399) (16.726) (17.125) (0.399) (202.290) (202.290) 0.000 (196.6)

Non Pay (9.080) (9.460) (0.380) (9.080) (9.460) (0.380) (112.909) (112.909) 0.000 (115.8)

Financing (1.261) (1.246) 0.014 (1.261) (1.246) 0.014 (15.127) (15.127) 0.000 (14.7)

Winter Funding 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.8

Pre STF Control Total (2.146) (2.482) (0.336) (2.146) (2.482) (0.336) (21.325) (21.325) 0.000 (20.9)

PSF Income 0.539 0.000 (0.539) 0.539 0.000 (0.539) 10.786 10.786 0.000 6.6

Surplus / (Deficit) (Control Total) (1.607) (2.482) (0.875) (1.607) (2.482) (0.875) (10.539) (10.539) 0.000 (14.3)

Impairments / Donated Asset I&E 0.000 (0.043) (0.043) 0.000 (0.043) (0.043) 0.000 0.000 0.000 (3.1)

PSF Incentive Bonus 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 6.3

Surplus / (Deficit) (1.607) (2.525) (0.918) (1.607) (2.525) (0.918) (10.539) (10.539) 0.000 (11.1)

Key Headlines - Commentary and Actions

Use of Resources metrics are not calculated as part of the NHSi month 1 Key Data return.

We would anticipate our overall measure to be a 4 Concern 4OVERALL SCORE

Description

Last Year

Actuals

In Month Year to Date Full Year

The pre-PSF position for month 1 (before donated asset income and expenditure ) was a deficit of £2.5m which was £336k adverse to the plan. PSF income has not been accrued in April, as both the financial position and the A&E performance were behind plan. However, the achievement of PSF is determined on a quarterly basis and so there is still an opportunity for the Trust to achieve both elements of the funding in Q1.

Clinical Income (excluding pass through) was ahead of plan by £136k in April due to high levels of outpatient actvity.

Other Income (excluding PSF) was higher than budget by £50k in April.

Pay budgets were overspent in the month by £399k, due to high bank and agency costs and a shortfall on CIPs.

Non-Pay budgets (excluding pass through) were over spent by £137k in the month, predominantly due to outsourcing of clincial activity.

Finance


Income - Page 2

Budget Actual Fav/(Adv) Budget Actual Fav/(Adv)

£ '000 £ '000 £ '000 £ '000 £ '000 £ '000

Elective 3,842 3,398 (444) 3,842 3,398 (444)

Non Elective 6,525 6,605 80 6,525 6,605 80

Outpatients 3,339 3,661 322 3,339 3,661 322

Critical Care 954 768 (186) 954 768 (186)

Accident & Emergency 1,109 1,090 (20) 1,109 1,090 (20)

Maternity Pathway 1,599 1,423 (176) 1,599 1,423 (176)

CQUIN 489 489 0 489 489 0

Fines 0 0 0 0 0 0

Other 1,511 1,990 479 1,511 1,990 479

Direct Access 1,170 1,248 79 1,170 1,248 79

Subtotal 20,537 20,673 136 20,537 20,673 136

High Cost Drugs & Devices 2,524 2,767 243 2,524 2,767 243

Grand Total 23,061 23,439 379 23,061 23,439 379

Budget ActualVariance

Fav/(Adv)Budget Actual

Variance

Fav/(Adv)

Private Patients 24 24 (0) 24 24 (0)

Injury Cost recovery (RTA) 56 49 (7) 56 49 (7)

Training & Education 641 658 17 641 658 17

Research & Development 130 136 6 130 136 6

Other Income 1,009 1,042 34 1,009 1,042 34

PSF 539 0 (539) 539 0 (539)

Total 2,399 1,910 (489) 2,399 1,910 (489)

Contracted Clinical Income

In Month Year to Date Commentary

In Month Year to DateOther Income

Clinical Income for April £379k favourable, with an over-achievement in pass-through income (£243k) and in acute activity (£136k).

Elective income is behind plan in Ophthalmology Daycases £128k -due to staff vacancies and Inpatient income in T&O £115k and across Surgery £109k.

Non Elective inpatients ahead of plan in Medicine £352k (no impact from QIPP schemes) but partly offset in Surgery £138k.

Critical Care behind plan due to deferred opening of new HDU £116k and less activity in NICU £107k.

Maternity deliveries behind plan, see correlation above in NICU.

Direct Access is up in the month across Diagnostic Imaging and Pathology.

High cost drugs ahead of plan but offset by reduced expenditure.

Provider Sustainability Funding (PSF) is £539k adverse to plan, as the Trust has not met either the A&E trajectory (30%) or the financial performance elements (70%).

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CLINICAL INCOME OTHER INCOME BUDGET Last Year

Finance


Activity - Page 3

Budget Actual Fav/(Adv) Budget Actual Fav/(Adv)

Currency Units Units Units Units Units Units

Elective spell 692 540 (153) 692 540 (153)

Day Case spell 3,025 2,944 (81) 3,025 2,944 (81)

Regular Day Patients spell 0 0 0 0 0 0

Non Elective spell 3,369 3,534 165 3,369 3,534 165

Outpatients attendance 28,362 31,166 2,804 28,362 31,166 2,804

Critical Care day 1,200 950 (250) 1,200 950 (250)

Accident & Emergency attendance 8,484 8,271 (213) 8,484 8,271 (213)

Maternity Pathway epidsode 962 875 (87) 962 845 (117)

Note: Activity in Elective & Non Elective excludes Excess Bed Days and Non Chargeable

SLA clinical activity by

Point of Delivery (POD)

In Month Year to Date Commentary and Actions

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The main year-to-date activity variances are: Elective Inpatients : 153 (22%) adverse to plan, largely in T&O £115k.

Day cases : 81 (2.6%) adverse largely in Surgery, mainly due to staff vacancies in Ophthalmology.

Non-Elective : 165 (4.9%) ahead of plan mainly in Medical specialties, reflecting pressures on the Trustand QIPP slippage.

Outpatients : 2,804 (9.9%) against all Points of Delivery, but mainly in Surgery (Ophthalmology), due to insourcing work (partly offset by additonal costs in expenditure).

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ACTUAL - DC ACTUAL - Elective BUDGET

Finance


Pay Expenditure - Page 4

Budget Actual Budget Actual

£ '000 £ '000 £ '000 % £ '000 £ '000 £ '000 % £ '000

Medical and Dental 5,289 5,451 (162) (3.1%) 5,289 5,451 (162) (3.1%) 4,797

Nurses and Midwives (inc. HCAs') 6,127 6,261 (134) (2.2%) 6,127 6,261 (134) (2.2%) 5,635

Scientific, Therapeutic & Tech 2,259 2,277 (17) (0.8%) 2,259 2,277 (17) (0.8%) 2,142

Other Pay 3,051 3,137 (86) (2.8%) 3,051 3,137 (86) (2.8%) 3,029

Total 16,726 17,125 (399) (2.4%) 16,726 17,125 (399) (2.4%) 15,603

Pay Expenditure

Commentary and ActionsLast Yrs

YTD

Actuals

In Month Year to Date

Fav/(Adv) Fav/(Adv) Total pay expenditure in April was £17.1m, which was £0.4m higher than plan. Bank costs in month 1 are £376k higher than the average for 17/18. This is due to a number of reasons:

a) The introduction of a weekly payroll for bank staff may have encouraged more staff to undertake bank shifts, as they will receive payment more quickly.b) Enhanced rates of bank pay are still in place for qualified nursesc) The enhanced rate of qualified nursing pay has encouraged more nurses to undertake bank shifts (increasing the volume of bank work)d) For some types of staff, bank work is not accrued on a monthly basis and therefore, the introduction of weekly bank pay has resulted in a non-recurring doubling up of cost in the month which accounts for most of the over spend for STT and Other pay)

Medical staff budgets overspent by £162k in the month. The overspends on medical staff occurred primarily in the Medicine and ED directorates.

AgencyAgency expenditure was £1.61m in April which is lower than the previous 2 months but still in excess of the NHSI ceiling. Medical agency continues to be the largest concern at 58% of total agency spend

Nursing agency decreased which is likely to be as a result of the higher bank payments and introduction of the weekly payroll. However, the increase in bank costs is higher than the agency reduction.

Expenditure on agency domestic staff was £107k in the month (17/18 average was £80k).

Trained nursing and midwifery vacancies increased to 185 in April, the highest level seen for over a year. However, trained nurse agency costs were £269k in the month, £46k lower than the 17/18 average.

HCA agency costs reduced to £150k in April, which was the lowest seen since October. This reflects the reduction in vacancies to 36 WTE (Mar :49, Feb: 57, Jan: 63, Dec: 70).

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Note: those months marked with "o" indicate a 5 week bank pay bill month

Integrated Quality and Performance Board Report April 2018 · Single Oversight Framework current...

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