Weston Area
Health NHS Trust
Integrated Performance Report
February
2015
1
Section 1 Executive Summary
January and February have been a challenging period across the organisation, this has in the
main been due to the prolonged period of Norovirus within the Trust which has caused the
closure of a number of wards for periods since September 2014. The Director of Infection,
Prevention & Control has been closely involved in the decision making during these
outbreaks, ensuring the Trust meets, or goes beyond, national guidance in re-opening
affected areas.
These outbreaks have unavoidably caused a reduction in discharges and difficulties with
patient flow, as a result during January additional bed capacity was opened to assist in
providing safe clinical care during a particular period of escalation in the New Year. Our
staff have worked extremely hard during what has been a challenging few months and we
thank them for their co-operation and dedication. Over the escalation periods the Trust
have worked closely with partners across the health community and acknowledges the
support provided by North Somerset CCG, North Somerset Community Partnership, North
Somerset Council and the Hospice, who all worked flexibly to provide additional support
during this time.
In January we welcomed eight new registered nurses to the Trust who have joined us from
Italy as part of our European recruitment drive; these staff will be joined by seven further
overseas nurses in March.
A project to refurbish the main theatres at the hospital was approved during January; this
£2.2 million project will run over the current and next financial years and will bring the
environment within the four main theatres to modern standards. Work to some areas has
begun on site with the major construction work being completed from May to November
2015.
The Trust remains on track to deliver its savings plan during for 2014/15 and achievement
of the quality CQUINS are forecast to be delivered at 97%. The Trust has also reported an
improved financial position for this year with a reduction in the overall deficit of
£0.95 million.
2
1.0 Monitor Scorecard
3
1.1 Summary Scorecard

Data Reported in arrears
4
5
6
7
8
Section 2 Quality & Patient Safety
continues
falls prevention
with
an increase
noted inand
August
andequates
September.
Staff
 The on
number
of complaints
received
in December
January
to 2.8%
of all
education
regarding
remains
an ongoing
commitment and all nursing
inpatients
over falls
theseprevention
months or 0.25%
against
all activity
staff onInwards
wherethe
significant
harm
is a result
of a fall
willthe
receive
a letter of
December,
Department
of Health
confirmed
that
Net Promoter
score would
no longer beto
used
as theSWARM
headline
measure,
and instead the
respondents
recommendations
follow.
has
been reinvigorated
onpercentage
Kewstoke of
ward,
and the
who
or wouldn’t
recommend
the service
highlighted.
During
January
outcome
is would
reflected
in the reduction
of patient
fallswould
in thatbearea.
As a result,
Hutton
and
the Emergency
scored very
favourably
with 95% saying they would
Uphill wards
have beenDepartment
invited to complete
SWARM
documents
recommend the services.
In September the Trust improved performance and achieved the national target of 95%

Confirmed outbreaks of Norovirus had a major operational impact on the Trust
with 97.2% of appropriate patients receiving a VTE risk assessment.
throughout December and the majority of January; this was compounded by the
unprecedented
on Trust
services
The management
of demand
complaints
across
the during
Trust this
has period.
recently undergone a period of
 Additional
December
January
winter patient
resilienceexperience.
planning
change
brought beds
into were
effectdeployed
by the in
Director
of and
Nursing
to for
improve
and is
to re-provide
beds closed
due to Norovirus
outbreaks.
anto
associated
increase
The Trust
currently trialling
a process
where concerns
areWith
sent
the relevant
area
in temporary staff, quality and safety were more closely monitored to minimise any
with a 48 hour resolution time.
impact on patient experience and outcomes.
2.1. Patient Story
An incident was reported by staff that a patient had become aggressive, paranoid and wishing to
leave the ward. On leaving the ward staff followed the patient and requested that security attend
the front of the hospital. In the car park opposite the hospital the patient took an aggressive
stance towards the security guards.
At this time staff were joined by a policeman who during
the struggle, to restrain the patient for his own safety, used his taser. Further police assistance
was requested and the patient was returned to the ward wearing handcuffs.
The patient
attempted to run to the internal door of Uphill ward where he was restrained on the floor by four
policemen.
Due to the nature of the incident the Trust reported the incident as a “Serious
Incident Requiring Investigation”.
A complaint was also received from the patient’s wife raising concerns she had with the care the
patient had received in Weston Area Healthcare Trust. The complaint details that the patient had
an emergency operation to remove his bowel on the 24th November due to ulcerative colitis.
Following surgery the patient was taken to recovery and not taken back to the ward until the
afternoon of the 25th November. On visiting the patient the wife explains that he seemed quite
pleased that the operation had been completed and was looking forward to being pain free.
9
The wife then explains that she received a call the next morning to inform her that her husband
had become agitated and could she attend the ward. On arrival to the ward and waiting for the
patient to be treated the wife was informed by staff that the patient was refusing treatment and
could she help in making him co-operate. She was informed that this was her decision but staff
would appreciate if she could help. The wife then details that when she saw her husband for the
first time she was shocked as he was covered in blood and surrounded by so many people. She
states that “how would you like to see your loved one surrounded by 2 Security Guards, 2 Police
Officers, Doctors and 2 Nurses”.
The wife then explains that she was advised by a staff member that the events of the day were
most probably caused by the withdrawal of the steroid medication her husband was taking. He
had been prior to his hospital admission on a week’s course of steroid tablets (6 a day for a
week) with a plan of reducing the dosage over 10 days. Since his admission he was also on
steroids up until the operation.
The wife then details that the implications of the events have been enormous for the family and
her husband now has to live with the fact that he went into hospital to sort his ulcerative colitis,
which led to unexpected major surgery and an admission to a mental health ward. Her husband
has not only got to recover from the physical aspects of bowel surgery but now has the added
worries of mental health issues and he is very negative about having the operation reversed in 12
months especially if it means he will end up on a mental health ward. The wife concludes that “It
has certainly been a most unpleasant and traumatic experience for him and one he will never
forget unfortunately and neither will she”.
ACTION TAKEN
The incident/complaint has been thoroughly investigated through both the serious incident
process and the complaints process. The Executive Medical Director and Director of Nursing are
scheduled to meet with the wife at a being open meeting in March 2015. The implications for
practice from this incident are that Irritable Bowel Disease patients needing surgery require joint
care (Surgical and Medical) and the time prior to surgery should be used to gain a holistic view of
the patient and this then transmitted to the Surgical Team to aid in post-operative management.
2.2 Registration with Care Quality Commission (CQC)
The Trust is compliant with all five of the CQC’s essential core standards of:
1. Treating people with respect and involving them in their care
2. Providing care, treatment and support the meets people’s needs
3. Caring for people safely and protecting them from harm
4. Staffing
5. Quality & suitability of management
10
The essential standards of quality and safety set by the CQC government body are central to our
work as a Trust.
The July 2014 Intelligent Monitoring Report, produced by the Care Quality
Commission, places the Trust in priority banding 6 for inspection, with a banding of 1 being high
priority for inspection and 6 being low priority for inspection, based on analysis of a number of
quality and safety measures.
Quarterly monitoring of Trust compliance with CQC standards occurs via reporting to our Quality
& Governance Committee.
The CQC inspection of the Trust, scheduled for 6th January 2015, has been postponed due to the
closure of three wards at the Trust due to infection outbreak. The CQC continued to hold their
listening event on the 5th January 2015 and have provisionally advised a rescheduled visit date of
19th May 2015.
2.3 Nursing Metrics
The use of agency nurses increased in December 2014 and January 2015 due to the opening of
an additional 20 beds on Cheddar Ward for winter capacity planning and the need to open further
escalation beds on Stroke Unit and Ashcombe Unit.
The Registered Nurse and overall nursing numbers for Berrow, Uphill and Kewstoke Wards were
less than the planned establishment to reflect lower nursing numbers required for a reduced
number of patients on these wards due to Norovirus outbreaks.
There were a total of three Nurse staffing incidents reported through Datix in December 2014
and January 2015. One incident related to a period of high escalation for the Trust with two
further patients requiring artificial ventilation in addition to the five patients already in ITU; this
required the Critical Care Outreach Nurse to care for these patients. The two other incidents
were reported for the Surgical Assessment Unit/Clinical Decision Unit on two separate days a
week apart, with insufficient temporary staffing cover arranged for the ward. The Ward Sisters
and Matrons are meeting daily to review deficits and reallocate staff to ensure patient safety. The
Ward Sister of SAU/CDU has also worked clinically within the nursing numbers to ensure the
safety of the ward during this period.
NHS England is defining methodology to RAG rate nursing metrics data on NHS Choices. Trusts
will be assigned to a rating based on:
11

Staff sickness rate (taken from Electronic Staff Record)

The proportion of mandatory training completed (taken from the national staff survey)

Completion of an appraisal in the last 12 months (taken from the national staff survey)

Staff views on staffing (taken from the national staff survey)

Patient views on staffing (taken from the national patient survey)
A draft composite indicator has been shared in confidence with NHS Trusts in February 2015 with
publication on NHS Choices in spring 2015 (date yet to be announced).
12
Figure 1:
NB. Agency (WTE) and Statutory Mandatory Training Compliance as above encompass nurse staffing Trust-wide
13
Figure 2:
Figure 3:
December 2014
January 2015
14
2.4 Incident Reporting
Incident reporting systems and policies are integral to patient safety and enable the Trust to
analyse the type, frequency and severity of incidents that occur. The Trust’s open and honest
reporting demonstrates a commitment to our patients and their safety.
The information arising
from these reports is used to make active changes to improve our provision of quality care and to
safeguard the wellbeing of our staff and patients.
Figure 4 depicts the number of patient incidents reported each month, compared to previous
years.
Figure 4:
Since August 2014 the reporting of incidents within the Trust has remained fairly stable, with the
number of reported incidents fluctuating between 350 to 400 per month. There were a total of
718 patient incidents reported in December/January, 354 in December and 364 in January and
the top 3 themes of incidents were pressure ulcers, falls and medication. There is an increase in
incidents reported under a) Pressure Ulcers (both community and hospital acquired), 221
compared to 181 for October/November and b) Slips, trips and falls, 115 compared to 93 for
October/November.
On closer inspection:

The increase in the pressure ulcer reported incidents has been due to the number of
community acquired pressure ulcers the Trust has reported. This has increased from a
142 in October/November to 174 in December /January.
15

The increase in the number of falls has been due to there being more reported falls from
a height, bed or chair (31 compared to 26) and suspected falls (11 compared to 6). On
closer inspection the Stroke unit has reported 18 falls for December/January compared to
6 in October/November. On a positive note all of the incidents were reported with no or
low harm.
A total of 218 pressure sores were reported in December and January (total number of
community and hospital acquired), accounting for 31% of all patient incidents.
The Trust
reported 47 hospital acquired pressure sores, which is an increase of 8 from October/November.
The Trust reported 7 hospital reported grade 3 and 4 pressure ulcers.
All relevant external
organisations were notified in December/January and a full investigation was commenced.
115 slips, trips, falls & collisions were reported in December and January, which is slightly up on
the numbers reported in October and November (93). Kewstoke (18), Stroke unit (18), Harptree
(13) and Uphill reported the highest number of falls incidents. 1 fall was reported as moderate
harm due to the patient sustaining a fractured neck of femur (a full investigation was
undertaken).
87 medication incidents were reported in December/January, slightly up from 75 in
October/November.
These errors included administration (meaning medication administered
orally or intravenously) from a clinical area (such as ward areas), medication error during the
prescription process and preparation of medicines/dispensing in pharmacy. Further review of
incidents revealed no identified theme.
Further detail on actions to address falls, pressure ulcers and medication errors is outlined in the
Harm Free Care Report.
2.4.1 Staff Incidents
The Trust Health and Safety Committee reviews incident trends and receives reports on incidents
reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
(RIDDOR) 1995. Figure 5 depicts the number of staff incidents reported each month, compared to
previous years.
16
Figure 5:
There were 34 staff incidents reported in December and 47 incidents reported in January; a total
of 81. Incidents reported involving abuse of staff has decreased again with 20 incidents reported
in December/January. During December and January the Trust has seen an increase in reported
staff incidents around adverse events that affect levels of staffing on the wards, an increase to 25
from 20 for October/November and Staff falls with an increase to 15 from 11 for
October/November.
2.4.2 Serious Incidents (SIRIs)
A Serious Incident is defined in the http://www.england.nhs.uk/ourwork/patientsafety/ (2013) as
an incident that occurred in relation to NHS-funded services and care resulting in:

Unexpected or avoidable death of one or more patients, staff, visitors, or members of the
public.

Serious harm to one or more patients, staff, visitors, or members of the public or when the
outcome requires life saving intervention, major surgical/medical intervention, permanent
harm or will shorten life expectancy or result in prolonged pain or psychological harm (this
includes incidents graded under the NPSA definition of severe harm).

A scenario that prevents or threatens to prevent a provider organisations ability to continue to
deliver healthcare services, for example, acute or potential loss of personal/organisational
information, damage to property, reputation or the environment, IT failure or incidents in
population programmes like screening and immunisation where harm potentially may extend
to a large population.
17

Allegations of abuse

Adverse media coverage or public concern about the organisation or the wider NHS.

One of the core set of Never Events
Figure 6 depicts the number of serious incidents reported by the Trust
Figure 6:
Resultant investigation reports are reviewed by the local Clinical Commissioning Group and, for
the most serious cases, also reviewed by the NHS Trust Development Authority. Between the 1st
December and 31st January 12 serious incidents.
The 12 investigations are classified as follows:
Category
Operational (e.g. unit closure)
Adverse media attention
Information Governance (e.g. loss of data)
Clinical Care of patient (e.g. pressure ulcer,
delayed diagnosis, avoidable severe harm)
Safeguarding (e.g. allegation of abuse)
Avoidable severe harm to staff
Grade 1
2
0
0
18
Grade 2
0
0
0
10
0
0
0
0
0
2.5 Patient Feedback
2.5.1 Complaints
Complaints management is critical to ensuring the Trust not only responds to the complainant in
a timely manner, but to ensure the learning from complaints is translated into action. Complaints
data enables the Trust to determine if there are any trends in subject matter, location or
personnel. Figure 7 portrays that the total number of complaints received in December 2014 and
January 2015 as 39. The number of complaints received equates to 3.0% of all inpatients over
this period or 0.29% against all activity. (This is against inpatient activity of 1,283, Emergency
Department attendance of 3601, Outpatient Department attendance of 7,597 and Day case
activity of 960).
Figure 7:
2014
Jan
Complaints
PALS
Compliments
2015
May Jun
Jul
Aug Sept Oct
Nov
Dec
16
22
38
15
27
23
23
20
5
15
12
16
111
114
107
102
91
100
97
140
166
140
111
107
83
137
153
106
84
60
89
84
103
152
180
189
Jan
Complaints
Feb Mar Apr
Feb Mar Apr May Jun Jul
Aug
Sept Oct Nov Dec
23
PALS
101
Compliments
118*
*At the time of writing this report, there have been 118 compliments logged for January. The full figure will
be available in next month’s report.
Figure 8:
Complaint
Planned
Response
Care
rates
Emergency
2014
Overall response rate
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
72%
40%
33%
38%
55%
69%
33%
89%
85%
100%
40%
75%
83%
82%
63%
42%
25%
85%
100%
75%
92%
85%
66%
85%
66%
90%
77%
50%
36%
37%
73%
88%
48%
82%
90%
80%
50%
73%
88%
19
Figure 9:
The number of days taken to resolve complaints that were closed
in December and January
0 - 30
31 - 60
61 - 89
90 plus
Re-opened
Planned Care Division
7
2
0
0
1
Emergency Division
2
3
0
0
1
Facilities
2
0
0
0
0
The Trust aims to provide a full response to all complainants within 30 working days. The
response time for complaints as shown in Figure 8 demonstrates the commitment of the Trust to
resolve complaints in a timely manner.
The response rate of 73% in December and 88% in
January achieved by the Trust, met the 80% standard required in January only.
The Heads of Nursing regularly meets with the Team to discuss target dates. This enables the
complaints team to keep complainants up to date and provide reasons should there be a delay to
their response. There have been 5 cases that have taken longer than the Trust target of 30 days.
In each case the complainant was kept informed of the delay.
There were 6 complaints linked to safety incidents in December and January. During this period
the Trust has received 3 requests of further information relating to complaints already raised.
One complainant has contacted the Trust to raise concern that the subject of a previous
complaint has reoccurred. The concern relates to a Do Not Attempt Resuscitation instruction, this
is currently being investigated by the Head of Nursing for the Emergency Division as a new
complaint.
All complainants are offered the opportunity to meet with relevant staff should they wish. Five
complaint resolution meetings were held during December and January resulting in satisfactory
resolution for the complainant. Should complainants remain unsatisfied with the final response
from the Trust, and all options for internal resolution have been exhausted, complainants are
advised of the option to refer their complaint to the Complaints Ombudsman. One new complaint
was referred to the Complaints Ombudsman in January.
20
Complaints Themes
Figure 10:
a) Medical treatment - was a significant theme for complaints in January however the number for
December was significantly lower than the previous 8 months. 19 out of a total of 39 complaints
mentioned medical treatment. It should be noted that 2 out of the 4 complaints received by the
Orthopaedic team related to care in 2012 and 2013. Further concerns raised include:

Patient did not feel that appropriate investigations were undertaken before discharge

Full drug list was not taken on admission

Undiagnosed fracture was discovered 3 weeks after admission

Consultant dismissed patient in pain as being anxious
The Executive Medical Director has taken a proactive role in the management of complaints since
coming into post in April 2014.
With effect from 1st December more detailed information is
being provided to doctors by the Complaints Team with the aim of enabling the doctors to
provide a more patient focused and timely response.
b) Communication - The number of concerns raised linked to communication through December
and January has remained consistent with the previous 2 months and remains high. 17 out of a
total of 39 complaints mentioned communication. ED received the highest number of complaints
linked to communication which is consistent with previous months.
21
The complaints Manager has delivered a session for Junior Doctors to discuss emerging themes
and how best to resolve or prevent these complaints. The issues that Doctors have raised with
the Complaints Manager are as follows; lack of space on wards for Doctors to work at a
computer, on call Doctors asked to speak with relatives of patients of whom they may not know
the background, nurses do not appear to be making appointments with Consultants to discuss
concerns with families, no smart card reader in the Doctor’s mess. The issues are being reviewed
by the Matron for Patient Safety and the Medical Education Coordinator for the Trust.
2.5.2 Patient Advice & Liaison Service
The total number of cases dealt with by the team in December and January was 208. The top 4
themes were Appointments, Care, Communication and Information.
Information was the highest theme across the Divisions with 52 out of 208 cases requiring
information. Appointment was the highest theme within the Planned Care Division with 22 PALS
cases. Lengthy wait remains the highest sub-theme and is consistent with previous months.
Other sub-themes for Appointment are Cancelled by Hospital, Change Appointment and Texting.
The care of patients was another main theme for the Trust; 17 out of 208 cases. The subthemes
for Care were evenly split between Nursing Care and Medical Care with 8 and 7 respectively. A
PALS awareness session is now being delivered on the preceptorship training for newly qualified
nurses.
As with formal complaints, communication was a significant theme over the past two months; 37
out of 208 cases. The cases highlighted communication concerns both with nursing and medical
staff across varied areas with ED receiving the highest number of PALS related to Communication.
The PALS department is working closely with the Matron and newly appointed ED Lead Consultant
and to ensure they are made aware of all the concerns being raised.
An action plan has been developed by the Complaints Manager in partnership with Heads of
Nursing to focus learning on the main themes identified from complaints and concerns; Medical
Treatment, Communication and Communication linked to Medication. This action plan will be
monitored by Heads of Nursing through the Divisional Governance process. The action plan will
be updated and shared with the Quality and Governance Committee every three months.
2.5.3 Compliments
The number of compliments received in December was 189. At the time of writing this report
January has received 118 compliments, though this figure is incomplete.
22
Wards are continuing to focus on gathering patient feedback and it is hoped that reviewing the
exit cards weekly will encourage staff to make sure patients are given the opportunity to provide
feedback before leaving the hospital. The Compliments formally recorded are received via email
or letter. Figure 11 depicts three examples of compliments received by the Trust in December
and January. Where appropriate each compliment receives a letter to thank the individual for
taking time to comment.
Figure 11:
COMPLIMENTS
A thank you from
Throughout his 3-hour stay, the discomfort of the procedure was
the relative of a
significantly eased by the wonderfully caring and professional staff. Waiting
patient treated in
during the procedure, I was helped and supported by the reception staff.
the Endoscopy
Suite
Every time I met a member of staff in the hospital corridors, they took time
to ask if I needed help, where I was going, etc.
We are both really impressed with Weston General Hospital, and would like to
thank everyone who helped us today.
A thank you from
I would just like to thank all your teams at the hospital today; I needed to
a patient treated
attend the AEC department. I first went to have a ultrasound were the whole
in AEC and
team were very helpful and caring, I then had a bit if a wait in your very busy
Radiology
AEC department were everyone was very cheerful and attentive, everyone
was working as hard as they could and a really nice touch was that a nurse
noticed that there was a build up of people waiting for results etc, she went
off and brought back a tea trolley and handed out teas and Christmas cake,
and a few sandwiches for some older patients what a hero, I needed to go to
x Ray and needed to be portered, again the porters and the girls in x Ray
were all great, under such pressure as you are under at this time of year it's
fantastic to see such a customer focused team. My thanks to you all keep up
the great work.
A thank you from
a recently
bereaved relative
This extremely difficult time was made bearable by the outstanding care and
support of the staff on the unit. Under very difficult circumstances with extra
beds on the ward the staff offered care that was second to none. I am sorry
but I can't remember the names but the without exception we were met with
kindness and understanding, nothing was too much effort. He was kept
comfortable and his dignity respected. The family were supported, given
cups of tea and kindness which helped and relieved the pressure on us.
Thank you from the bottom of my heart, Without the support of the night
staff this difficult day would have been much harder. Your staff are amazing!
23
2.6 Patient Feedback
As a national requirement Weston Area Health NHS Trust is engaging in the delivery of the
Friends and Family Test (FFT). This test has been implemented successfully across all areas. The
Friends and Family Test is a single question survey which asks patients whether they would
recommend the NHS service they have received to friends and family who need similar treatment
or care.
The FFT is offered to all patients at the point of discharge and when patients attend the
Emergency Department.
In December, the Department of Health released a statement that confirmed the Net Promoter
score would no longer be used as the headline measure, and instead the percentage of
respondents who would or wouldn’t recommend the service would be highlighted.
This is a
positive move in more accurately reflecting patient and visitor’s experience.
Each Division and all wards receive a breakdown of the outcome of their survey results to ensure
they can take relevant action to sustain improvements already made and proactively develop
actions to deliver further improvement.
Figure 12 provides a detailed report of December’s
Friends & Family Test results, whilst Figure 13 shows January’s breakdown.
Figure 12:
24
Figure 13:
Emergency Care should be praised for an increase in the percentage of people who would
recommend and a decrease in the percentage of people who wouldn’t recommend in January.
Both Acute Ward and Emergency Care are achieving the National CQUIN standard in maintaining
or increasing response rates.
Monthly meetings are being set up to allow leads for Exit Cards from all areas to network and
share ideas and best practice.
“Mobile boxes” exist in some areas but are being standardised to give a recognisable “brand” and
greater visibility for FFT. Trust volunteers are helping with this.
2.7 Mortality Data
Mortality data remains overall within expected limits. Further details on mortality review and
actions is included in the Harm Free Care report.
2.8 Infection Prevention and Control Performance
Clostridium Difficile
Weston Area Health NHS Trust has a local threshold of 17 hospital attributable cases of
Clostridium difficile for the financial year 2014/15. Prevention of avoidable hospital attributed
cases continues to be high on the agenda for the Infection Prevention and Control Team. To date
there have been 18 cases of hospitable attributed Clostridium difficile reported; 5 of those cases
25
have been associated with a lapse in care, for example, inappropriate antibiotic prescribing. The
remaining 13 cases have been scrutinised and assessed as unavoidable.
One case of hospital attributable Clostridium difficile was reported in December and four in
January. A root cause analysis meeting and thorough investigation into each case has been
undertaken involving both the medical and nursing staff on the respective clinical areas. Three
of the January cases were reported on the same day; all had been/were inpatients on Kewstoke
ward. A period of increased incidence was declared at this time; subsequent ribotyping results
showed no evidence of cross transmission or a link between cases.
MRSA/MSSA Bacteraemia
The Trust has a zero trajectory for MRSA bacteraemia and has reported two cases in the financial
year 2014/15. No cases were reported in December 2014 or January 2015.
No cases of MSSA bacteraemia were reported in December 2014; one case was reported in
January 2015. The Trust has reported a total of eight cases for 2014/2015 against our trajectory
of three cases. A rapid improvement plan is being implemented to urgently address concerns
around cannula care, standard infection control precautions and isolation practice. A programme
of ward based training in Aseptic Non-Touch Technique (ANTT) with competency assessment is
due to be launched. A policy to support this practice will be completed by the end of February
2015.
Outbreaks
Confirmed outbreaks of Norovirus had a major operational impact on the Trust throughout
December and the majority of January; this was compounded by the unprecedented demand on
Trust services during this period.
There were seven confirmed outbreaks of Norovirus in December and one in January. The
outbreaks were located in Harptree, Kewstoke (x2), Uphill (x2), Berrow (x2) and Cheddar wards.
Analysis of these outbreaks has demonstrated that the Trust was operating within the national
Norovirus prevention and management guidelines. A post-outbreak review has highlighted the
following areas for further improvement:

Quality of documentation

Analysis of airflows in wards

Closure of whole ward as opposed to bays
26
Ebola Virus Disease (EVD)
The EVD working group continues to meet twice a month and is responsible for ensuring that the
Trust is as prepared as possible for a case of EVD. The Viral Haemorrhagic Fever policy has been
updated as changes to guidance have been released by Public Health England. Operation
Diamond - a planned exercise to test our preparedness in the Emergency Department was
undertaken in December. The exercise proved very successful and generated some key learning
to enable our processes to be improved. Further exercises are planned. The majority of staff
within the Emergency Department have now had specific training in the donning and doffing of
Personal Protective Equipment (PPE) at the level required for EVD cases.
2.9 Maternity
The maternity team achieved variable results in both its national targets for initiating
breastfeeding in-hospital and mothers not smoking at the time of delivery in December and
January. The Matron would highlight again that the data does not give a true picture of the
achievements of the service, and has suggested that additional data including all women booked
for antenatal care be considered.
The referrals to the Stop Smoking Service have increased again following communication to staff
from the Matron after the dip in November 2014.
The closure of the Birth Centre for 3 days, and the restricted beds for a further 7 days in January,
as escalation due to intense service pressure, has impacted on the birth numbers and the
availability of inpatient postnatal care. Three women are known to have been redirected for
labour care, and there may be others who did not contact ABC in labour as they knew of the
closure.
An unknown number of women were unable to be admitted to ABC for postnatal care and feeding
support. This impacted on the bed availability for Maternity care at UHBristol, and staff with
contracts across both Trusts were redeployed on 3 of the days. The Head of Midwifery estimates
that there may have been up to 5 women per day who would have been able to be admitted to
ABC for postnatal care from UHBristol.
The total births in 2015-16 to the end of January are 194. Projected births for the year are
therefore 233, compared to 237 actual births in the year 2013-14. If the redirected women are
taken into account the projected number would be almost identical to 2013-14. This is an
improvement from previous years where there has been an ongoing reduction in births.
27
The Matron plans to produce some additional patient information from the updated NICE
Intrapartum Care guideline which supports uncomplicated women giving birth at freestanding
midwife-led units.
Maternity bookings for women living in the area covered by the service are comparable to last
year, with 1499 bookings in 2013-14, and projected bookings for 2014-15 at 1520.
2.10 Venous Thrombo-Embolism (VTE)
VTE risk assessment compliance is achieving the required standard. Further information
on VTE prevention and management is outlined in the Harm Free Care report.
28
Section 3 Operational Performance
3.1 Executive Summary Headlines
Performance against the four hour ED target has fallen to 91.8% during January 2015,
with a year to date position of 92.9%
Delays in ambulance handovers have increased significantly
Length of stay has increased to 3.0 days
All eight cancer targets were achieved in December for the first time in over twelve
months (reported in arrears)
The 18 week referral to treatment and 6 week diagnostic targets remain consistent in
achievement
3.2 Operational Performance
The following sections detail the Trust performance against a number of key indicators.
The report is divided into:

Clinical Indicators

Clinical Pathways

Emergency Access

Elective Access

Patient Flow
3.3 Clinical Indicators
3.3.1 Emergency Readmissions
An emergency readmission is defined as an unplanned readmission within an identified
time of leaving the hospital.
The ideal readmission rate is zero however this is not
always possible as patients can have multiple co-morbidities or long-term conditions
which require frequent medical attention.
29
Monitoring emergency readmission rates is important to the Trust as it can help to
prevent or reduce unplanned readmissions to hospital.
The Trust monitors emergency readmissions within 14 days and 30 days. As illustrated
in Figure 14, performance of readmissions within 14 and 30 days continued to improve
in December and January, and the Trust have noted the lowest readmission percentages
in twelve months, over the last quarter.
Figure 14:
Trust Action:
To provide additional assurance that emergency readmissions are not related to the
original episode of care, the Emergency & Urgent Care Division are undertaking regular
audits of the readmissions to provide assurance that patients are not being readmitted as
a result of the Trusts treatment and care.
3.3.2 Average Length of Stay
The average length of stay (ALOS) refers to the average number of days that patients
spend in hospital. The Trust strives to have a length of stay below the Trust target as it
demonstrates proactive planning of the whole process of care, as well as active discharge
planning. In December and January the average LOS increased to 3.0 days which reflects
the higher acuity levels of patients.
30
Figure 15:
The Trust also monitors the percentage of patients with a length of stay (LOS) over 10
days.
The programme of work to improve patient pathways and the level of care
alongside the focus on the Green to Go list has enabled the Trust to work to a reduction
plan in the percentage of patients with a LOS over 10 days.
Figure 16:
31
Trust Action:
In addition to the work streams already underway as part of the Trust’s business plan,
the operational teams are focussing on optimising the ward board rounds. A ward board
round takes place twice during the day and is where the multi-disciplinary clinical teams
review each of the patient in detail using the rounding tool.
This will ensure that
throughout the patients stay all necessary actions are undertaken on time and in line
with the clinical pathway for the patient.
Each ward has also been allocated a senior
manager to support the teams to deliver and unblock any difficulties that arise.
Daily monitoring of delays to discharge takes place at ward level with any barriers to a
timely discharge being escalated through the divisions. It is important that work to
reduce length of stay is linked with feedback from patient complaints and surveys;
therefore a discharge work stream is being established which will be responsible for both
progressing timeliness and quality of discharge.
3.4 Clinical Pathways
This section sets out performance indicators related to key clinical pathways, including
cancer and stroke.
3.4.1 Cancer Services
The Trust strives to achieve the national cancer waiting times as they are important to
patients clinical outcomes, are a measure of how the Trust is responding to demands for
services, and highlights where there are delays in the system. In December the Trust
achieved all of the eight national cancer targets for the first time in over twelve months.
3.4.2 Cancer Two Week Wait
The two week wait target was achieved in both November and December with a score of
97.9% and 98% respectively. This was matched by the Breast Symptomatic two week wait
target, which also achieved above 93% for November and met the quarter three target.
32
3.4.3 Day Target
The Trust achieved all three of the 31 day targets in November and December and
achieved Quarter Three, demonstrating the Trusts ability to effectively treat patients once
diagnosed with cancer.
3.4.4 Day Target
The Trust achieved the 62 days standard for December and in fact, Quarter three, which
is a significant improvement for the Trust. The Trust did not meet the 62 Day Upgrade
standard during the same period.
The 62 Day standards are fragile owing to the
numbers of complex pathways to neighbouring tertiary centres however the Trust
continues to work with these centres to achieve the targets. The Trust is pleased to note
that the 62 Day Upgrade standard was met in December.
Trust Action:
Daily monitoring of performance by the MDT Coordinator and cancer team leader.
Weekly monitoring at the Waiting List Forward Planning meeting.
Close liaison with tertiary centres to streamline patient pathways to ensure timely referral
and treatment.
Work with primary care to develop information to be provided to patients to improve the
availability of patients for appointment.
3.4.5 Stroke
The Trust achieved the stroke target of patients diagnosed with a stroke spending 90% of
their time on the Stroke Unit in December and January (Figure 17).
The Trust continues to focus on patient flow and bedding patients in the most
appropriate place.
33
Figure 17:
Trust Action:
The patient flow team have been instructed to create and keep a stroke hot bed for both
sex’s available at all times. This will ensure that patients diagnosed with a Stroke or TIA
in the Emergency Department can be transferred straight to the unit to start their care
and treatment.
Use of the hot bed during times of escalation and/or outbreak must be with Executive
approval only.
During January, there was an unprecedented number of Stroke patients admitted. In
order to best care for these patients, six additional beds were opened on the Stroke Unit.
34
3.5 Emergency Access
35
36
3.5.1 Emergency Department (ED) Performance
The NHS constitution set the national standard wherein 95% of all patients
attending NHS Emergency Department’s spend a maximum of four hours in
the department before being discharged, referred/transferred to other
services or admitted to the hospital and transferred to an inpatient bed. The
target was not achieved in December (90.41%) or in January (91.83%) as
illustrated in Figure 18. This as a result of two key factors:
1. Outbreaks of Norovirus and increased length of stays causing issues
with patient flow throughout the Trust.
2. Throughout December and January the Trust has been experiencing
not only an increase in activity out of hours but a pattern of activity
arriving together causing peaks, which put significant pressure on the
Emergency Department.
This activity is a mixture of both walk-in
patients and ambulance arrivals.
Figure 18:
37
Trust Action:

The Trust has undertaken a detailed review of internal and external
performance and activity data to understand the causes behind the
sudden drop in performance.
The review has been shared with key
staff internal and external to the Trust to support the development
and implementation of the necessary actions to bring about positive
change.

North Somerset CCG has increased the daily calls from three to five
days per week to ensure that performance across the health and social
care system is reviewed in detail to ensure all capacity is maximised to
manage patients the most effective and caring manner.

Trust has increased the number of site meetings throughout the day
and increased the seniority of attendance, particularly when the Trust
is in red escalation to ensure appropriate actions are taken and
barriers escalated both internally and externally.

A programme of work within the Emergency Department to bring
about closer working with colleagues in Acute Medicine to support the
department together with the introduction of Rapid Assessment and
Treatment.

Opening hours of the Ambulatory Emergency Centre have been
extended to help assist with peaks in demand.

Additional senior nurse cover has been put in place over the weekends
to ensure more senior support.
38
3.6 Elective Access
This section reviews the key elective access targets to understand the
effectiveness and the quality of care throughout the elective care pathways.
3.6.1 Referral to Treatment (RTT)
The NHS constitution states that patients have the legal right to start their
NHS consultant-led treatment within a maximum of 18 weeks from referral,
unless the patient chooses to wait longer or it is clinically appropriate to wait
longer.
For the months of October and November the following sub-
sections will review the Trust performance against the three national 18
week targets.
3.6.2 Referral to Treatment (RTT) Admitted
The Trust achieved the admitted 18 week target in December and January at
95.57% and 95.51%.
Figure 19:
39
Trust Action:
The Trust continues to undertake weekly waiting list forward planning
meetings where the waiting list for each specialty and the theatre timetable
is reviewed by the Divisional Manager of Planned Care, Access Manager and
Theatre Manager with the Director of Operations in attendance.
3.6.3 Referral to Treatment (RTT) Non-Admitted
The Trust continued to achieve the non-admitted target in December and
January as illustrated in Figure 20.
Figure 20:
Trust Action:
The Trust will continue to undertake waiting list forward planning meetings
where the waiting list for each specialty and the theatre timetable is reviewed
on a weekly basis.
As a result of some patient cancellations during January due to a lack of
beds, additional theatre sessions will be organised to ensure delivery into
the new financial year.
40
3.6.4 Referral to Treatment (RTT) Incomplete
The 92% target was achieved for December and January as illustrated in
Figure 21. This was expected according to plan. The Trust has undertaken a
rigorous validation of its waiting list supported by a team from the Trust
Development Authority, this has driven new algorithms to be put in place to
ensure the current validated waiting list position maintains at a manageable
level on an ongoing basis.
Figure 21:
Trust Action:
The Trust will continue to undertake waiting list forward planning meetings
where the waiting list for each specialty and the theatre timetable is reviewed
on a weekly basis.
41
3.6.5 Choose and Book
The Trust achieved the 96% National target for Choose and Book slots in
December and January. This is depicted in Figure 22.
Figure 22:
Trust Action:
Work is ongoing to continue to maintain the 96% requirement now it has
been achieved and met for the last two months by:
Review of capacity and demand required, particularly as we have experienced
a continued increase in two week wait referrals resulting in choose and book
slots being used to provide additional urgent appointments
Work with neighbouring Trusts who provide some visiting services where
capacity fails to match demand leading to no slots being available for
patients.
42
3.7 Patient Flow
To support the delivery of key operational targets, it is vital that the Trust
has good patient flow. An important aspect of ensuring good patient flow is
the level of discharges throughout the day and at the weekend.
3.7.1 Delayed Transfer of Care
A delayed transfer of care is defined as when a patient is ready for transfer
from acute care, but is still occupying an acute bed. Patients can be delayed
for the following reasons:

Further assessment required before their discharge destination can be
decided

Lack of capacity in local nursing/residential homes

They may require a specialist placement

Patient or their family/carer needs more time to make a decision about a
long-term placement
The Trust monitors performance daily against delayed transfers of care as
high levels can have a big impact on the daily numbers of discharges,
causing delays in allocating beds for emergency admissions or planned
operations. Performance in December improved at 0.80% then dipped again
during January (Figure 23). There is still considerable work to undertaken
with partner organisations and the use of the ‘Green to Go’ list.
Figure 23:
43
Trust Action:
The Trust continues to work with health and social care partners in North
Somerset to manage the ‘Green to Go’ list, and where gaps in services are
discovered, work with the Clinical Commissioning Group to identify how
future commissioning can be organised to close these gaps, providing
higher quality joined up care between all partners.
Agencies and other care providers are invited in regularly to assess patients,
particularly those who may have complex needs with a view to discharging
as soon as possible.
Daily Green to Go meetings held with all North Somerset organisations
represented physically or by conference call.
Daily Alamac calls, which includes senior representatives from across the
health community, addresses the performance indicators on a daily basis
with escalation of particularly challenging areas as necessary.
3.7.2 Bed Stock
The Trust has a usual funded bed base of 234. As part of the winter ORCP,
this funded base was increased from October 2014 – to March 2015 and
allows a further 20 inpatient beds, currently located on Cheddar ward. There
have been six unfunded beds in use consistently on the Stroke Unit during
January.
During January, the Trust experienced periods of reduced flow and declared
internal black escalation – this was the pattern for many Trusts across the
region and indeed the UK. During this period, fourteen maternity beds were
made available to medical admissions. All fourteen beds were returned back
to maternity services within a fortnight.
44
Section 4 Workforce
Executive Summary Headlines
4.1
The temporary staffing cost in December was 11.85% of the total pay bill
compared to 12.74% in January.
Sickness rates were 4.30% in December and decreased to 4.26% in January.
The appraisal rate increased to 86.61% in December and increased further in
January to 88.11%.
The training compliance rate increased to 83.51% in December and slightly
decreased to 83.11% in January.
4.2
Workforce
Figure 24 below shows the pay expenditure for contracted staff, for agency staff.
Figure 24:
Staff Pay Bill
7000
6000
4000
Agy/Bank/Locum Pay bill
3000
(000s)
2000
Contracted Staff Pay bill
1000
Months
45
Jan
Dec
Nov
Oct
Sept
Aug
Jul
Jun
May
Apr
Mar
Feb
0
Jan
£000's
5000
Figure 25 shows the temporary staffing usage as a month on month
comparator. Cost of temporary staff continues to be high, with there being
particular pressure across the Trust during December and January, which
resulted in unplanned usage of extra capacity, therefore increasing the
temporary staffing requirements.
As previously reported the planned induction and orientation for overseas
nurses commenced on 12th January 2015, with 8 new appointments starting
employment.
Local and national recruitment is ongoing with short listing
and interviews taking place weekly. Whilst the volume of applicants is not at
the level we would like these appointments help to reduce the number of
vacancies in the Trust and maintain an effective nursing workforce.
Some progress has been made with medical recruitment with NHS
appointments being made to two Consultant posts one in Upper GI and
another in Gynaecology. However posts in Gastroenterology, Radiology and
Community
Paediatrics
continue
to
be
46
difficult
to
recruit
to.
Bank and Agency Spend
800
Bank Nurses
Agency Nursing
Other Agency
Medical Agency
Winter
700
600
24.33 WTE
10.43 WTE21.82 WTE
13.76 WTE
£000's
500 17.21 WTE
12.10 WTE
13.94 WTE
3.19 WTE
400
13.63 WTE
8.14 WTE 8.55 WTE
12.65 WTE
10.66 WTE
41.41 WTE
31.32 WTE
200
29.23 WTE
27.87 WTE
31.44 WTE
29.66 WTE29.88 WTE
33.60 WTE
22.13 WTE
17.60 WTE
17.17 WTE
6.54 WTE
15.30 WTE
100
12.49 WTE
9.63 WTE
11.98 WTE
13.78 WTE
5.81 WTE
300
15.68 WTE
76.10 WTE81.33 WTE
61.50 WTE
61.49 WTE
53.20 WTE47.67 WTE48.56 WTE47.34 WTE51.33 WTE78.97 WTE47.57 WTE39.31 WTE49.38 WTE
0
Jan
Feb
Mar
April
May
Jun
Jul
Months
47
Aug
Sept
Oct
Nov
Dec
Jan
4.2.1 Sickness
Sickness remains high although in December and January the sickness rates
were lower when compared to the same two months last year. During January
particularly short tern sickness has increased which is the main contributor to
the Trust sickness, with high sickness in a small number of areas which
impacts staffing in these operational areas.
Figure 26:
Sickness Absence Rates
5.00%
4.50%
4.00%
3.50%
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Jan 13 - Jan 14
4.76%
4.34%
4.00%
3.67%
3.00%
3.11%
3.10%
3.47%
4.06%
3.73%
3.90%
4.32%
4.39%
Jan 14 - Jan 15
4.39%
4.34%
4.18%
3.93%
4.26%
3.88%
4.53%
4.36%
4.52%
4.39%
4.12%
4.30%
4.26%
Nat Avg Jan 14 - Oct 14
4.53%
4.38%
4.12%
4.04%
3.93%
4.03%
4.17%
3.90%
4.07%
4.33%
* Trust target ≤ 3.0%
4.2.2 Statutory/Mandatory Training
The training compliance rate increased to 83.51% in December and slightly decreased
to 83.11% in January. Formal action is being taken against staff who remain non
compliant with training.
48
4.2.3 Appraisal
The appraisal compliance rate was 86.61% in December and increased further in
January to 88.11%.
Appraisal compliance continues to be closely monitored, to
ensure compliance is maintained and improved further.
4.2.4 Industrial Action
As part of the ongoing trade dispute between a number of NHS Unions and the
government over a demand for fair pay for NHS workers employed under agenda for
change terms and conditions. The Trade Unions followed the necessary procedures
to ballot their members on two questions, these questions were:

Are you prepared to take part in a strike?

Are you prepared to take part in industrial actions short of strike?
Upon completion of these ballots the following Unions provided notice of their
intention to take industrial action on 29th January 2015, followed by a period of
discontinuous industrial action in the form of industrial action short of strike. The
Unions involved included:

Unite

Unison

Royal College of Midwifes

Society of Radiographers

GMB
Communications regarding the proposed action was shared with staff and managers,
and the necessary contingency plans were put in place, although the projected
impact on the Trust was minimal, which is consistent with the impact of previous
industrial action taken by Trade Unions.
The evening before the strike, the Trade Unions cancelled the planned industrial
action following a pay proposal by Jeremy Hunt (Secretary of State for Health).
Details of these proposals are outlined below; however NHS Employers are currently
working on how these may be implemented in practice.

Abolition of the bottom point of AfC and increasing pay point 2 to £15,100. This
means an increase of 5.6% for staff on point 1 and 3.1% for staff on pay point 2

1% consolidated pay rise for all staff up to point 42 from April 2015.
49

A further consolidated pay rise of an additional £200 for staff on pay points 3-8.
This means staff on these pay points will receive an increase between 2.1% and
2.3%

An increment freeze in 2015/16 for staff on pay point 34 and above for one year
only.

Urgent talks to take place with a view to the proposed redundancy changes being
implemented from 1 April 2015, including a floor for calculation of redundancy
payments of £23,000 and a ceiling for calculation of £80,000 with an end to
employer top up for early retirement on grounds of redundancy.
Staff have been informed of the proposals over pay and will be provided with further
information as soon as the Trust is provided with further details.
4.2.5 Overseas Recruitment (Nursing)
Nurse recruitment is an ongoing challenge to ensure that the Trust sustains a stable
and effective workforce by maintaining a low number of vacancies, therefore
reducing the requirement for temporary workers.
Over the past year the Trust has recruited 22 nurses from overseas and plans to carry
out a further overseas recruitment campaign in March.
The Trust has made
arrangements to hold a recruitment event in Spain, with the aim of recruiting up to
35 nurses.
Whilst this is the intention, the European recruitment market is very
competitive with many Trusts competing in the same area.
4.2.6 Library Services
Healthcare Library and Knowledge Services provide knowledge and evidence to
support the delivery of excellent healthcare and the NHS Library Quality Assurance
Framework England enables the robust quality assessment of healthcare library and
knowledge services.
Weston’s Library Services have recently obtained a score of 98.94% against national
quality standards and coupled with an award from Health Education England
recognising good practice in introducing a ‘Roving Librarian’ service, the team are to
be congratulated for their hard work and innovation.
50
4.2.7 Leadership Qualifications
The Trust has been notified that 13 of its managers have recently passed the Mary
Seacole Postgraduate Certificate in Leadership offered through the NHS Leadership
Academy. We are pleased to announce that of the 13 passes, 6 passed with merit.
An award ceremony is being arranged through the Leadership Academy.
4.2.8 Apprenticeships
The Trust is keen to support the development of its Bands 1-4 workforce with 11
non-clinical staff recently signed up to complete an Apprenticeship with Weston
College in either Business Administration, Customer Service or Team Leading.
In
addition, 9 clinical staff are in the process of registering for a Level 2 or 3 Diploma in
Health and Social Care again delivered in conjunction with Weston College.
51
Section 5 - Finance Report
5.1 Executive Summary Headlines
The financial position at Month 10 is that the Trust is reporting a year
to-date deficit of £2,980k which is an improvement of £792k compared
to the plan.
Overall income is £1,369k over plan at the end of January.
Overall expenditure is £585k over plan at the end of January.
The Trusts plan for the year is a deficit budget of £4.95m. The Trust is
forecasting the delivery of a £950k improvement from the planned
position which would result in the deficit being reduced to £4m.
5.1.1 Statement of Comprehensive Income Position to Date
The financial position at Month 10 is that the Trust is reporting a £2,980k deficit
which is an improvement of £792k from the plan.
Revenue from patient activity is £581k over plan for the 10 months to the end of
January 2015. Other sources of income are £788k over plan.
Overall expenditure for pay, non pay and depreciation is £586k over plan for the 10
months to the end of January. Pay and non pay expenditure is £1,354k over plan and
this is offset by £769k of reserves.
The Trust’s Service Improvement Programme (SIP) is below target by £418k with a
year to date achievement of £3,238k against the target of £3,656k.
The adjusted run rate for expenditure has decreased by £162k in January when
compared with the December level.
52
5.1.2 Statement of Comprehensive Income Position in Month
Income from patient care activity is £10k more than plan whilst other sources of
income generated £211k more than plan.
Pay and non pay expenditure, including savings delivery, is £194k under plan for the
month of January. This includes a one-off £256k benefit from a balance sheet review
which was undertaken in month.
The Trust’s Service Improvement Programme (SIP) delivered £569k in January against
a plan of £419k and is now £418k below target for the year to date an improvement
of £150k compared with December.
5.1.3 Cash
The cash plan for 2014/15 is to hold a balance of £532k at 31st March 2015. The
cash balance of £6,085k, as at 31st January, is £5,553k higher than the planned
position of £532k.
The anticipated income and payment profiles have been forecast and updated until
the end of the year on the cash flow which results in an increased yearend cash
balance of £1,482k.
5.1.4 External Financing Limit
The Trust’s External Financing Limit will be achieved through the management of
cash and working balances along with the planned level of Public Dividend Capital.
5.1.5 Capital Resource Limit
The capital resource limit is £3,858k and in addition to this the Trust is due to
receive £124k matched funding from the NHS Safer Hospital, Safer Wards Technology
Fund for the implementation of a new Order Communications system. Therefore the
Trust’s anticipated forecast capital resource and spend on capital projects is £3,982k
at 31st March 2015.
As at the 31st January the programme has delivered capital expenditure of £920k
and this low level of spend significantly affects the cash balances reported in 5.1.3.
The Trust will operate within its Capital Resource Limit and continued capital
programme management will enable this to be achieved.
53
5.1.6 Capital Cost Absorption rate
The Trust’s Capital Cost Absorption (CCA) rate is fixed at 3.5% and this will be
calculated based on 3.5% of actual balance sheet values at the end of the financial
year.
5.1.7 Better Payment Practice Code (BPPC)
The Trust’s overall performance as at 31st January is 97.2% on the BPPC.
5.1.8 Forecast outturn
The Trust is forecasting the delivery of a financial position which reduces the deficit
by £950k from the plan of £4,950k to £4,000k.
The current financial forecast outturn includes an overspend against pay budgets for
the Medical and Nursing categories and a non pay overspend on drugs. The income
has been forecast based on current referral patterns and activity levels. There are
also significant favourable variances forecast against each of the sources of other
operating income.
5.1.9 Risk to delivery of financial forecast against plan
The major financial risks are the delivery of the £4.5m savings programme, the
management of Medical staffing to minimise locum agency expenditure, the higher
than planned use of agency nursing staff, and the delivery of NHS service income in
line with forecasts and with minimal contract penalties.
54
Financial Dashboards 2014/15: Month 10
November 2014
Level 1 Financial
Indicator
Calculation
Annual
Target
14/15
Plan /
Target
December 2014
Actual
Traffic Variance
Plan /
Light from Target Target
January 2015
Actual
Traffic Variance
Plan /
Light from Target Target
Actual
Forecast Forecast
Traffic Variance
Outturn Outturn
Light from Target Actual
Traffic Light
Financial duties
Cumulative
In month
Cumulative
Cumulative
Bottom line
Statement of
Bottom line
Comprehensive
Statement of
Income against plan
Comprehensive
Surplus/ (Deficit)
Income
before impairments
Bottom line
Statement of
Bottom line
Comprehensive
Statement of
Income against plan
Comprehensive
Surplus/ (Deficit)
Income
before impairments
Achievement of
Cash available
External Financing against planned cash
Limit
available
Achievement of
Capital Resource Capital Expenditure
Limit
against plan
-4950
-2596
-2596 Green
0
-3254
-3254 Green
0
-3772
-2980 Green
792
-4000 Green
-4950
45
45 Green
0
-658
-658 Green
0
-518
274 Green
792
-510 Green
532
42
3385 Green
3343
1897
5312 Green
3415
532
3456 Green
2924
532 Green
3982
433
433 Green
0
619
619 Green
0
920
920 Green
0
3982 Green
Subsidiary duties
Cumulative
Cumulative
Capital cost
absorption rate
Better Payment
Practice Code
3.50%
Year to date
performance against
the prompt payment
policy for Combined
NHS & Non-NHS
suppliers (by number)
95.0%
3.50% Green
95.0%
55
97.1% Green
3.50% Green
2.1%
95.0%
97.2% Green
3.50% Green
2.2%
95.0%
97.2% Green
3.50% Green
2.2%
95.0% Green
5.2 The Income and Expenditure Position of the Trust
5.2.1 The financial position at Month 10 is a deficit of £2,980k, which is an
improvement on the plan which is a deficit of £3,772k.
5.3 Expenditure
5.3.1 The main points are:

The position is that overall the Trust has overspent the expenditure budgets by
£1,354k which includes under delivery of Savings (SIP) of £418k. This has been
offset with £769k from reserves.

Pay expenditure is higher than budgeted with an overspend of £705k. The staff
category with the highest overspend at the end of January was Nursing (£697k)
followed by Medical Staff (£242k). These overspends were offset by
underspends in the following categories Admin and Clerical (£262k), AHP’s
(£215k) and Biomedical Scientists (£123k).

Non pay expenditure is £649k over budget at the end of January, including the
underachievement of savings. This is an improvement of £257k compared with
December. There are overspends on Linen & Laundry (£118k), Medical &
Surgical Equipment (£114k), Internal recharges (£108k), and NHS recharges
(£63k) offset by underspends on Drugs (£214k), Blood Products (£92k),
Training (£90k) and Catering (£59k).

Bank and agency expenditure on Nursing increased in January with agency
expenditure increasing to £236k from £228k in December, this included £97k
expenditure on winter resilience projects. Bank expenditure increased from
£174k in December to £239k in January, £84k of the expenditure was for
winter projects.

In recent months the Trust has had a significant number of Medical staff
vacancies which has led to an increase in the use of Agency locums to cover the
Trusts services; however some of these vacancies have now been filled.
In
November the Trust also increased its medical cover as part of the Operational
Resilience and Capacity Planning (ORCP) Programme which has resulted in
further Locum Medical Staffing being requested. In January £205k was spent,
down from £226k in December. In January £66k of the expenditure was
attributable to the ORCP project work. Some of this locum expenditure is offset
by the medical staff vacancy savings of £129k.
56
5.3.2 At Month 10 the main points for the Divisional and Corporate performance
are as follows:

The Emergency Division has overspent by £428k year to date, of which £8k was
in month 10. Of this, Pay expenditure is overspent by £508k whilst Non Pay is
underspent by £147k. There is SIP under delivery of £88k. The Pay overspend
is mainly due to Medical Staffing (£382k), Uphill (£169k), ED (£118k), and
Kewstoke (£82k), offset by an underspend on Pathology (£122k). The Non Pay
underspend is due to a saving on drugs (£141k), Pharmacy (£40k) & Blood
(£39k) offset by an overspend on Pathology (£129k).

The Planned care Division has overspent by £1,054k year to date, an increase
of £24k in January. The pay overspend is £301k whilst non pay is overspent by
a further £268k. The divisional income is £216k above the planned level. The
SIP underachievement is £701k. The pay overspend is in Theatres (£235k),
Hutton (£142k) and SAU (£112k), offset by underspends in Planned Care
Management (£88k), Hospital at Night (£43k), Medical Secretaries (£34k),
Access Team (£33k) and Radiography (£25k). The non pay overspend is mainly
on Theatres (£253k) with additional overspends in Radiology (£56k), Endoscopy
(£25k) and ITU (£43k), offset by underspends on Radiography (£124k), PPU
(£70k), Drugs (£23k), Blood (£19k) and GUM (£17k).

The Estates and Facilities Division has underspent by £23k at the end of month
10 which is an improvement of £39k. The non pay is underspent by £2k which
includes underspends against Residences (£19k) and Catering (£12k), offset by
overspends on HSSU (£16k), Linen & Laundry (£11k) and Housekeeping (£10k).

The Corporate Departments have underspent by £455k year to date.
Reserves have been deployed to cover spend where there are agreed allocations such
as the cover of Medical agency premiums and agreed waiting list initiatives. Further
monies have been made available to support the additional capacity for the
Operational Resilience and Capacity Planning (ORCP) Programme.
5.3.3 The Trust’s expenditure run-rate information has been rebased to neutralise
the effect on both expenditure and budgets for variations in monthly NICE funded
drugs expenditure which has no overall impact on the Trust’s net financial position.
There have also been some amendments for one-off exceptional items which include
the impact of any work undertaken as part of the RTT project and the Operational
Resilience and Capacity Planning Programme. The Trust’s expenditure run rate is
shown in the table below compared to the adjusted expenditure level for each month.
57
The budgeted adjusted run rate for January is £7.664m. The adjusted expenditure
run rate has decreased in January by £162k, from £7.933m in December 2014 to
£7.771m in January 2015.
The main decreases in spend were Non Pay expenditure where Medical & Surgical
Equipment reduced by (£88k), Clinical Supplies (£18k) and Estates Expenditure
(£30k) offset by increases in Pay expenditure including Nursing (£71k) and Ancillary
Staff (£14k).
5. 4 Savings Plans (SIP)
5.4.1 The Trust has a savings requirement of £4.5m for the year which represents
4.45% of expenditure budgets. Savings plans have delivered £3,238k against the
profiled plan of £3,656k for the ten months, an under-delivery of £418k. Of the SIP
savings delivered £2,027k is from recurrent schemes and £1,211k from nonrecurrent schemes. In month the Trust delivered £569k against the £419k required,
an overachievement of £150k in month. The Trust’s performance against its monthly
SIP savings requirement is shown below along with the monthly phased plan.
The Trust will continue to take actions to ensure that the savings plans are
implemented, with mitigating action taken where needed, to maximise the delivery of
savings. Progress of individual schemes is reviewed at the monthly Business Plan
Delivery Steering Group Meetings.
58
5.5 Activity and Income
5.5.1 Overall patient activity income is assessed at £581k over plan at the end of
January 2015.

Income related to North Somerset CCG contract is £189k over plan.

Income related to the NHS Somerset contract is £84k over plan

Other CCG patient care activities is £91k over plan

The Specialist services contract is £310k over plan

Local authorities is £15k over plan

Private patients’ income is £111k under plan.
The actual activity for RTT catch up work is included in the respective elective day
cases, inpatients, etc. in month 10 there has been an adjustment between
Commissioners’ relating to Drugs which has accounted for the reduction in
Specialist services and an increase in North Somerset CCG.
59
10 Months ending January 2015 Activity and Income Report
Annual
Plan
£,000
YTD
Plan
£,000
YTD
YTD
Actual Variance Variance
%
£,000
£,000
Day cases
Elective Inpatients
RTT income
Non Elective Inpatients
Non Elective Excess Bed days
Emergency pathway reconfiguration
Excess Bed Days
First Outpatients
Follow up Outpatients
Outpatient procedures
Unbundle OP radiodiagnostic
ED attendances
Critical Care
Rehabilitation
Children Services
Direct Access
Maternity Services
NICE income
Private patients
Other
8,087
5,762
289
26,927
1,616
0
74
5,448
5,005
2,205
1,390
6,182
2,608
1,577
2,631
3,195
2,588
5,165
738
3,494
6,714
4,765
289
22,371
1,339
0
61
4,604
4,195
1,852
1,159
5,180
2,173
1,314
2,192
2,662
2,156
4,293
609
2,926
7,151
5,233
0
22,053
1,101
501
218
4,290
4,129
1,893
1,107
4,930
2,173
1,363
2,192
2,893
2,221
4,814
498
2,935
437
468
(289)
(318)
(238)
501
157
(314)
(66)
41
(52)
(250)
0
49
0
231
65
521
(111)
9
257.4%
-6.8%
-1.6%
2.2%
-4.5%
-4.8%
0.0%
3.7%
0.0%
8.7%
3.0%
12.1%
-18.2%
0.3%
Sub total
84,981
70,854
71,695
841
1.2%
Penalties
CQUINS
0
1,540
0
1,284
(227)
1,251
(227)
(33)
-2.6%
86,521
72,138
72,719
581
0.8%
Total
60
6.5%
9.8%
-1.4%
-17.8%
Significant volume variations in performance are shown in the table below:
Significant over & under perform ance areas
Volum e variances greater than 5% and m ore than 10 cases
Day cases
Over perform ing
Under perform ing
General Medicine
Elective inpatients
161% Breast Surgery
67% Urology
18%
Respiratory Medicine
54% Gynaecology
17%
General Surgery
27% Colorectal
14%
Colorectal
14% Trauma & Orthopeadics
Gastroenterology
13%
Upper GI Surgery
-47% Upper GI Surgery
Breast Surgery
-31%
Urology
-17%
Gynaecology
-13%
Non Elective inpatients
Over perform ing
Outpatient procedures
314%
Urology
15% Urology
294%
Paediatrics
22% General Medicine
260%
8% General Surgery
207%
Upper GI Surgery
119%
Colorectal Surgery
118%
Haematology
93%
Gynaecology
57%
Respiratory medicine
41%
7%
Gastroenterology
-85% Dermatology
-58%
Colorectal
-67% Rheumatology
-51%
Cardiology
-61% Breast surgery
-15%
Respiratory Medicine
-49% Ophthalmology
-5%
First Outpatient attendances
Geriatric Medicine
F/U Outpatient attendances
161% ENT
33%
General Surgery
53% Ophthalmology
32%
Ophthalmology
20% Haematology
19%
Urology
11% General Surgery
13%
Gastroenterology
General Medicine
Under perform ing
-53%
85% Chemical Pathology
Cardiology
Over perform ing
5%
Gynaecology
General Surgery
Under perform ing
27%
Paediatric
10%
8%
Dermatology
-71% Anticoagulation
-53%
Chemical Pathology
-48% Dermatology
-35%
General Medicine
-41% Neurology
-31%
Neurology
-29% Upper GI Surgery
-25%
Upper GI Surgery
-22% Colorectal Surgery
-25%
Respiratory medicine
-20% Vascular surgery
-24%
TIA
-17% Palliative Medicine
-21%
Paediatrics
-17% Urology
-17%
Trauma & Orthopeadics
-17% GUM
-14%
Diabetic medicine
-13% Paediatrics
-12%
Clinical oncology
-13% Respiratory medicine
-11%
Vascular surgery
-12%
Colorectal Surgery
-10%
61
5.5.2 The following table shows the overall activity for the period ended 31st
January 2015:
10 Months ending January 2015 Activity and Income Report
Annual
YTD
YTD
YTD
Activity Activity Activity Activity Volume
Volumes including ACC
Plan
Plan
Actual variance Variance
%
Elective Day Cases
13,211
10,968
11,364
396
3.6%
Elective Inpatients
1,635
1,354
1,459
105
7.8%
Non-Elective Inpatients
15,319
12,754
13,046
292
2.3%
First Outpatients
36,774
31,110
28,749
(2,361)
-7.6%
Follow Up Outpatients
57,140
47,910
46,537
(1,373)
-2.9%
Emergency department attendances
56,370
47,206
44,307
(2,899)
-6.1%
5.6 CQUINS
5.6.1 The latest assessment of CQUINs is that the Trust is on target to receive most
of the potential income, except for the Dementia (Find Assess Investigate and Refer)
scheme. This will be monitored on a monthly basis.
5.7 Penalties
5.7.1 A provision of £227k for penalties for the period ending 31st January 2015 has
been included for Referral to Treatment, Cancer access, waits and Ambulance
handovers. The detailed assessment is shown in the table below. This will be updated
as the validation of performance in these areas is finalised.
It is expected that there
will be no RTT penalties for July, August and September. It has been assumed in line
with the CCG contract that the Emergency Department 4 & 12 hour penalty will be
reinvested to help resolve the underlying performance issues and this has this has
now been agreed with NSCCG.
62
Quarter 1 Quarter 2 Quarter 3
£
£
£
RTT
18 w eeks - Admitted
£400 in respect of each excess breach above threshold
1,200
0
January
£
Estim ate
0
0
YTD
18 w eeks - Non Admitted
£100 in respect of each excess breach above threshold
2,000
0
0
0
2,000
18 w eeks - Incomplete
£100 in respect of each excess breach above threshold
1,300
0
0
0
1,300
1,200
RTT w aits over 52 w eeks
£5000 per patient
100%
5,000
0
0
0
5,000
6 w eek Diagnostics
£5000 per month
99%
0
0
0
0
0
£1000 per event
95%
100%
0
1,000
107,200
0
103,600
0
35,100
0
245,900
1,000
Ambulance handovers <15 minutes
Ambulance handovers <60 minutes
£200 per event
Additional £800 per event
100%
100%
4,000
10,000
11,200
34,000
20,000
63,500
6,800
21,000
42,000
128,500
Percentage of Service Users referred urgently w ith suspected cancer by a GP w aiting no more than tw o w eeks for first
outpatient appointment
Percentage of Service Users referred urgently w ith breast symptoms (w here cancer w as not initially suspected) w aiting no
more than tw o w eeks for first outpatient appointment
Percentage of Service Users w aiting no more than one month (31 days) from diagnosis to first definitive treatment for all
cancers
Percentage of Service Users w aiting no more than 31 days for subsequent treatment w here that treatment is surgery
£200 in respect of each excess breach above threshold
93%
0
0
0
0
0
93%
0
0
0
0
0
96%
0
0
0
0
0
94%
0
0
0
0
0
98%
0
0
0
0
0
94%
0
0
0
0
0
85%
3,000
7,000
0
6,000
16,000
£200 in respect of each excess breach above threshold
upto maximum of 8%
ED attendances w ithin 4 hrs
Trolley w ait<12 hrs
Percentage of Service Users
drug regimen
Percentage of Service Users
radiotherapy
Percentage of Service Users
for cancer
Percentage of Service Users
treatment for all cancers
£200 in respect of each excess breach above threshold
£1,000 in respect of each excess breach above threshold
£1,000 in respect of each excess breach above threshold
w aiting no more than 31 days for subsequent treatment w here that treatment is an anti-cancer £1,000 in respect of each excess breach above threshold
w aiting no more than 31 days for subsequent treatment w here the treatment is a course of
£1,000 in respect of each excess breach above that
threshold
w aiting no more than tw o months (62 days) from urgent GP referral to first definitive treatment £1,000 in respect of each excess breach above threshold
w aiting no more than 62 days from referral from an NHS screening service to first definitive
£1,000 in respect of each excess breach above threshold
90%
Mixed sex accommodation breaches
£250 per day per Service User affected
VTE
Where the number of breaches in the month exceeds the
tolerance permitted by the threshold, £200 in respect of
£10,000 in respect of each incidence in the relevant
month
£10,000 in respect of each excess breach above
threshold
MRSA
C-Diff
Total
0
0
0
0
0
3,000
7,000
0
6,000
16,000
0%
0
0
0
0
0
95%
360
0
0
0
360
100%
0
10,000
10,000
10,000
30,000
0
0
0
0
0
27,860
169,400
197,100
78,900
473,260
Reinvestment of ED Penalty
0
-107,200
-103,600
-35,100
-245,900
Total
0
62,200
93,500
43,800
227,360
63
Referral to Treatment penalty by specialty
Q ua rt e r 1
Q ua rt e r 2
Q ua rt e r 3
£
£
£
J a nua ry
Total £
RTT
18 weeks - Admitted
£400 in respect of each excess breach above
threshold
18 weeks - Admitted
£400 in respect of each excess breach above
18 weeks - Non Admitted
£100 in respect of each excess breach above
threshold
18 weeks - Non Admitted
£100 in respect of each excess breach above
18 weeks - Incomplete
£100 in respect of each excess breach above
threshold
18 weeks - Incomplete
£100 in respect of each excess breach above
64
90% Urology
Trauma & Orthopaedics
General Surgery
Reinvestment agreement
Total
95% Urology
Neurology
Reinvestment agreement
Cardiology
General Surgery
Dermatology
Gastroenterology
ENT
Total
92% Urology
Trauma & Orthopaedics
Neurology
Reinvestment agreement
Ophthalmology
General Medicine
Gastroenterology
General Surgery
Respiratory medicine
Rheumatology
Total
6,400
9,600
800
-16,000
0
0
0
0
0
0
0
0
0 6,400
0 9,600
0
800
0 -16,000
800
0
0
0
800
300
1,300
-1,600
900
200
200
300
400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
300
1,300
-1,600
900
200
200
300
400
2,000
0
0
0
2,000
7,700
18,500
3,400
-29,600
100
300
300
200
300
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 7,700
0 18,500
0 3,400
0 -29,600
0
100
0
300
0
300
0
200
0
300
0
100
1,300
0
0
0
1,300
5.8 Statement of Financial Position
5.8.1 The Trust’s main accounting statements are shown in the appendices of this
report and see Appendix B for the Statement of Financial Position as at 31st January
2015.
Cash
5.8.2 The External Financing Limit will be achieved by in year management of cash
and working balances. The cash balance of £6,085k, as at 31st January, is £5,553k
higher than the planned position of £532k.
The difference between actual cash balance held £6,085k and the reported £4,978k
on the Statement of Financial position relates to un-presented cheques and cash in
transit as at 31st January 2015.
The forecast balance as at 31st March 2015 is £1,482k which will ensure that the
Trust meets its requirement to remain within its External Financing Limit.
Debtors
5.8.3. The figures from the debtors system represent invoices raised for which cash
has yet to be received. The total outstanding debt as at 31st January is £1,320k,
which is divided between NHS £1,036k, Private Patients £102k and non NHS £182k.
Debts over 250 days represent £62k which is 4.7% of the total debt.
Creditors
5.8.4 The measure for the better payment practice code is to pay all NHS and nonNHS trade creditors within 30 calendar days of receipt of goods or a valid invoice
(whichever is later), unless other payment terms have been agreed. The compliance is
for at least 95% of invoices to be paid (by the bank automated credit system or date
and issue of a cheque) within thirty days, or within agreed contract terms. The year to
date performance against the target is:
Non-NHS
NHS
Combined
Number
%
97.6
85.8
97.2
Value
%
98.1
94.0
96.9
65
5.9 Capital Programme and Performance against Capital Resource Limit
5.9.1 The Trust will operate within its Capital Resource Limit and detailed capital
programme management will enable the capital expenditure to be delivered within
resources and the Trust’s cash plans for the year.
5.9.2 As at 31st January 2015 there has been £920k of capital expenditure.
5.9.3 The Capital Planning Committee continues to monitor the capital priorities and
projects and the detail is included on Appendix D.
5.9.4 During February 2015 the Capital Planning Committee has approved further
schemes in priority areas such as Estates Statutory Compliance and medical
equipment to utilise available funding. Following the evaluation of the final tenders
for the Theatre Refurbishment Project the total project cost for the revised scope is
£2,218k
which will be phased across three years as follows: 2014/15 £744k;
2015/16 £1,420k; 2016/17 £54k.
5.10 Foundation Trust Indicative Risk Rating
5.10.1 The Financial risk rating for the Trust, if operating as a Foundation Trust, as at
the 31st January 2015 is a Level 1, and the liquidity ratio is 18.6 days which achieves
a level 3.
5.10.2 The Continuity of Services risk metrics, if operating as a Foundation Trust, as
at the 31st January 2015 is a Level 1.
5.10.3 The calculation for the Financial risk rating, after applying the over-riding
rules, and for the Continuity of Services risk metrics, for the annual plan, year to date
and forecast outturn for the Trust is a 1, which is a result of the Trust’s overall
financial sustainability issues.
66
Plan 2014/15
Monitor Financial Measures
Achievement of Plan
Underlying performance
Financial Efficiency
Liquidity
EBITDA achieved
EBITDA margin
Return on assets
excluding dividend
I&E Surplus
Liquidity Ratio (days)
Weighting
10%
25%
Plan 2014/15
216.8
0.8
20%
20%
25%
Monitor
Rating
5
1
(8.7)
(5.2)
13.1
Year to date 2014/15 - Month 10
Year to date
Weighted
2014/15 Monitor
Weighted
rating
Month
Rating
rating
0.50
1,108.9
5
0.50
0.25
2.1
2
0.50
1
1
2
0.20
0.20
0.50
Monitor weighted criteria
Financial Efficiency
Liquidity Ratio (days)
Capital service capacity
0.20
0.20
0.75
2.15
1
1
EBITDA achieved (% of plan)
EBITDA Margin (% underlying income)
Return on asset excluding dividend (%)
I&E Surplus Margin
Cash plus trade debtors minus creditors expressed in number of days operating expenses. Ratio has been adjusted for 30
working days capital borrowing facility as would be available to a Foundation Trust.
Continuity of Services Risk metrics
Liquidity
1
1
3
1.65
Financial Risk rating after applying over-riding rules
Key
Achievement of Plan
Underlying Performance
(5.4)
(3.6)
18.6
Liquidity Ratio (days)
Revenue available for
debt service
Annual debt service
Weighting
50%
50%
Plan 2014/15
Monitor
Plan 2014/15
Rating
(16.9)
1
0.4
Continuity of Services Risk metrics
Weighted
rating
0.5
1
0.5
1
1.0
Year to date 2014/15
Year to date
Monitor
Weighted
2014/15
Rating
rating
(11.4)
2
1
1.1
1
0.5
1
1.5
5.11 Recommendation
The Board is asked to note the Trust’s Month 10 financial performance for 2014/15
regarding the revenue, capital and cash positions.
67
Appendix A – Statement of Comprehensive Income – Accumulated Variances as at Month 10 – January 2015
PERIOD PERIOD
PERIOD
JAN
JAN
VARIANCE
BUDGET ACTUAL Fav/ (Unfav)
£'000
£'000
£'000
ANNUAL
BUDGET
£'000
M10
REVISED
ANNUAL
BUDGET
£'000
M12 FC
REVISED
ANNUAL
BUDGET
£'000
YEAR TO DATE MONTH 10 ACTUAL
MONTH 12 FORECAST AS AT MONTH 10
YEAR TO
YEAR TO
YEAR TO
YEAR TO
FORECAST
DATE
DATE
VARIANCE
DATE
DATE
VARIANCE
BUDGET
ACTUAL
Fav / (Unfav)
BUDGET
ACTUAL
Fav / (Unfav)
£'000
£'000
£'000
£'000
£'000
£'000
INCOME
5,271
1,191
114
440
107
0
54
0
7,177
5,441
1,308
129
175
87
0
47
0
7,187
170
117
15
-265
-20
0
-7
0
10
CCGs - North Somerset
CCGs - Somerset
CCGs - Other
Specialist Services
Local Authorities
NICE
Private Patients
Overseas patients
Revenue from patient care activities
254
33
1,180
1,467
407
42
1,229
1,678
153
9
49
211
8,644
8,865
221 Total Income
5,714
2,596
378
8,688
5,777
2,339
0
8,116
-63
257
378
572
-44
749
-321
0
-1
-165
0
0
-531
-322
1
-1
-166
0
0
261
0
0
-531
261
13
13
-518
274
Education, Training & Research
Road Traffic Accident income
Other Income
Other operating revenue
62,963
13,980
2,372
4,973
1,239
230
738
1
86,496
63,025
14,177
2,368
4,973
1,239
0
738
1
86,521
63,025
14,177
2,368
4,973
1,239
0
738
1
86,521
52,428
11,873
2,058
4,130
1,039
0
609
1
72,138
52,617
11,957
2,149
4,440
1,054
0
498
4
72,719
189
84
91
310
15
0
-111
3
581
63,025
14,177
2,368
4,973
1,239
0
738
1
86,521
63,206
14,259
2,493
5,328
1,274
0
604
4
87,168
181
82
125
355
35
0
-134
3
647
3,044
400
6,087
9,531
3,044
400
9,017
12,461
3,044
400
9,167
12,611
2,537
333
6,998
9,868
2,690
467
7,499
10,656
153
134
501
788
3,044
400
9,167
12,611
3,229
548
9,830
13,607
185
148
663
996
96,027
98,982
99,132
82,006
83,375
1,369
99,132
100,775
1,643
65,877
23,388
6,025
95,290
65,912
28,588
3,745
98,245
67,156
29,170
2,069
98,395
55,263
25,006
769
81,038
55,968
25,655
0
81,623
-705
-649
769
-585
67,156
29,170
2,069
98,395
68,672
30,425
0
99,097
-1,516
-1,255
2,069
-702
737
737
737
968
1,752
784
737
1,678
941
-3,858
8
-12
-1,985
0
0
-5,110
-3,858
8
-12
-1,985
0
0
-5,110
-3,858
8
-12
-1,985
0
0
-5,110
-3,215
6
-10
-1,654
0
0
-3,905
-3,216
11
-10
-1,655
5
0
-3,113
-1
5
0
-1
5
0
792
-3,858
8
-12
-1,985
0
0
-5,110
-3,858
12
-12
-1,985
5
0
-4,160
0
4
0
0
5
0
950
0
0
-342
0
0
0
-342
-342
-5,110
-5,110
-5,452
-3,905
-3,113
792
-5,452
-4,502
950
160
160
160
133
133
160
160
0
-4,950
-4,950
-5,292
-3,772
-2,980
-5,292
-4,342
950
EXPENDITURE
Pay Expenditure
Non-Pay Expenditure
Reserves
Total Expenditure
793 Earnings before Interest and Depreciation
-1
1
0
-1
0
0
792
Depreciation
Interest Receivable
Interest Payable & Unwinding of Discount
Dividends Payments on PDC
Gain/ Loss on disposal
Fixed Asset Impairment
Retained deficit for Accounting purposes
0 Impairments
792 Net deficit after Impairments
0 Donated assets
792 Net deficit for NHS accountability
0
792
0
Appendix B – Statement of Financial Position as at 31st January 2015
As at 31
March 2014
Jan-15
£000's
£000's
64,387
1,738
368
66,493
1,178
3,904
750
5,832
Non-current assets
Property, plant and equipment
Intangible Assets
Trade and other receivables
Current assets
Inventories
Trade and other receivables
Cash and cash equivalents
Total current assets
Current liabilities
(9,298) Trade and other payables
(74) Provisions
(3,540) NET CURRENT ASSETS (LIABILITIES)
62,953
TOTAL ASSETS LESS CURRENT LIABILITIES
Non-current liabilities
(220) Provisions
62,733 TOTAL ASSETS EMPLOYED
62,084
1,745
421
64,250
1,120
2,962
4,978
9,060
(10,936)
(97)
(1,973)
62,277
(150)
62,127
Financed by taxpayers' equity:
62,983
(12,748)
12,591
(93)
62,733
Public dividend capital
Retained earnings
Revaluation reserve
Other reserves
65,496
(15,861)
12,585
(93)
62,127
Appendix C - 12 Month statement of rolling cash flow
APR
£'000s
MAY
£'000s
JUN
£'000s
JUL
£'000s
AUG
£'000s
SEP
£'000s
OCT
£'000s
NOV
£'000s
DEC
£'000s
JAN
£'000s
FEB
£'000s
MAR
£'000s
TOTAL
£'000s
Summary 2014/15 Plan
Inflows
9,137
9,251
8,015
8,012
8,014
9,768
8,034
8,072
10,055
8,061
9,302
8,813
104,534
Outflows
8,715
8,348
8,308
8,373
8,224
9,413
9,004
8,566
8,200
9,426
8,501
9,614
104,692
422
903
( 293)
( 361)
( 210)
( 970)
( 494)
1,855
( 1,365)
BALANCE B/FWD
BALANCE C/FWD
690
1,112
1,112
2,015
2,015
1,722
1,722
1,361
1,361
1,151
1,151
1,506
1,506
536
536
42
42
1,897
1,897
532
532
1,333
1,333
532
Summary 2014 15 Actual
Inflows
9,102
9,020
8,004
9,859
7,568
8,580
9,892
7,990
11,061
8,242
9,302
10,453
109,073
Outflows
7,769
8,535
7,972
8,130
8,595
9,205
8,529
8,585
9,134
7,469
11,705
12,653
108,281
MOVEMENT IN PERIOD
1,333
485
32
1,729
( 1,027)
( 625)
1,363
( 595)
1,927
773
( 2,403)
( 2,200)
BALANCE B/FWD
BALANCE C/FWD
690
2,023
2,023
2,508
2,508
2,540
2,540
4,269
4,269
3,242
3,242
2,617
2,617
3,980
3,980
3,385
3,385
5,312
5,312
6,085
6,085
3,682
3,682
1,482
Difference
911
( 418)
325
2,090
( 817)
( 980)
2,333
( 101)
72
2,138
CUMULATIVE CHANGE
911
493
818
2,908
2,091
1,111
3,444
3,343
3,415
5,553
2,349
950
29
2,337
0
0
0
0
0
1,640
0
MOVEMENT IN PERIOD
355
801
( 801)
( 158)
( 158)
( 3,204) ( 1,399)
Represented by:
INCOME
CCG INCOME
EDUCATION INCOME / EXCEPTIONAL
PERMANENT DIVIDEND CAPITAL
OTHER INCOME
( 97)
1,200
( 12) ( 1,249)
74
( 182)
( 32)
149
3
18
( 5)
1,703
( 409)
412
4 ( 1,753)
( 41)
153
( 1,182)
2,483
557
( 61) ( 2,039)
( 50)
708
447
( 885)
913
0
2,333
505
519
( 729) ( 1,564)
205
111
0
0
( 101)
72
( 60)
241
2,407
( 1,049)
3,181
EXPENDITURE
PAY COSTS
CREDITORS/ADVANCES
CAPITAL
LOAN / DIVIDEND
Total
283
313
350
0
911
349
( 292)
( 244)
0
( 418)
478
( 293)
151
0
325
486
( 404)
161
0
2,090
468
( 923)
84
0
( 817)
509
( 677)
317
59
( 980)
400
357
1,200
0
2,138
0
0
4,444
( 2,377) ( 1,912) ( 9,386)
( 827) ( 1,127)
1,294
0
0
59
( 3,204) ( 1,399)
950
Appendix D - Capital Programme 31st January 2015
Approved
Plan
£
FUNDING
Initial capital allocation
Technology Fund Safer Hospital, Safer Wards year 2
Book value of disposed assets
Donated Assets
In-year
allocations
£
Actual spend
to 31.01.15
£
Forecast
spend to
31.03.15
£
3,858,000
124,000
0
0
3,982,000
CAPITAL EXPENDITURE
1. Carry forward 2013/14 schemes
West switch room upgrade - Linking generators
STOR bringing generators on-line to reduce demand on grid
300,000
120,000
(300,000)
(120,000)
0
0
0
0
Sub totals
420,000
(420,000)
0
0
550,000
550,000
500,000
100,000
100,000
40,000
40,000
25,000
10,000
(550,000)
250,000
(500,000)
(58,500)
93,401
0
166,543
0
32,002
14,146
10,310
0
810
0
14,493
21,563
363,986
0
800,000
0
41,500
193,401
40,000
0
37,200
0
22,000
25,000
50,000
249,792
77,672
159,360
1,695,925
223,665
0
0
1,056,169
250,000
75,000
2. Capital Schemes - Estates Works
Ward refurbishment programme ITU
Ward refurbishment programme Theatres
Recovery space for Endoscopy
Legionella works including replacing water tanks
Compliance: (Fire, DDA)
Estates capital project manager
Theatres laminar flow/ventilation
Central Storage Area For Waste bins & Soiled Linen (by
Theatres electrical upgrade
Quantock procedure room works
Combine Discharge Lounge and Medical Day Unit
Refurbishment of Cardiology Department
Minor works
Regeneration Ovens for Preparing Patient Meals
Compliance Fixed wire testing, surveys, etc
Sub totals
1,915,000
3. Capital Schemes - Medical Equipment
Other medical equipment
Main ED & inpatient plain film room.
Replacement for obstetric ultrasound machine used by imaging
241,000
300,000
75,000
(40,000)
12,200
(10,000)
22,000
25,000
50,000
249,792
77,672
159,360
(219,075)
815,169
(50,000)
104,119
Sub totals
616,000
765,169
223,665
1,381,169
4. IM&T - Hardware / systems
IT Infrastructure / hardware
Refurbishment of IT workshop
Sub totals
60,000
167,400
15,185
182,585
29,826
12,695
42,521
227,400
15,185
242,585
275,141
(557,296)
48,311
260,027
5,028
17,481
7,673
523,141
50,000
50,000
48,311
290,210
671,452
60,000
5. IM&T - Software and systems development
Order Communications (n.b. £124,000 with 50% fund match
Intranet
Replacement PAS / EPR 2015
Systems and software development
248,000
50,000
607,296
Sub totals
905,296
(233,844)
65,704
(74,835)
Capital funding to be allocated / (reduced)
TOTAL
3,982,000
HIGHLIGHTS
1 - Confirmed capital available for 2014/15 £3,982,000.
2 - Capital spent to date 920k
3. Expenditure to date is 23 % of capital allocation of £3,982k.
71
0
(9,131)
920,381
3,982,000