ORBIT Reporting Trust Board Integrated Performance Report November 2013 At A Glance report Data Quality Indicator Escalation report Graph Legend The data quality rating has 2 components. The first component is a 5 point rating which assesses the level and nature of assurance that is available in relation to a specific set of data. The levels are described in the box below. Rating Required Evidence 1 Standard operating procedures and data definitions are in place. 2 As 1 plus: Staff recording the data have been appropriately trained. 3 As 2 plus: The department/service has undertaken its own audit. 4 As 2 plus: A corporate audit has been undertaken. As 2 plus: An independent audit has been undertaken (e.g. by the Trust's internal or external auditors). 5 Underachieving Standard Plan/ Target Performance The second component of the overall rating is a traffic‐light rating to include the level of data quality found through any auditing / benchmarking as below Rating Green Data Quality Satisfactory Amber Data can be relied upon but minor areas for improvement identified. Red Unsatisfactory/significant areas for improvement identified. OUH ‐At A Glance 2013‐14
ORBIT Reporting
Operational
RTT ‐ admitted % within 18 weeks
Access RTT admitted ‐ median wait
Standards
YTD 90% 11.1 Nov‐13
Nov‐13
88.06% 7.62 91.1% 7.12 89.4% 7.5 3
2
23 0 Nov‐13
Nov‐13
26.61 6 23.35 25.1 5.7 3
95% 6.6 18.3 0 92% NA
1% 95% Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Q3 13‐14
95.24% 5.68 17.9 3 91.34% 38523 1.41% 94.7% 96.6% 5.18 17.13 92.9% 8.1% 94.2% 96.1% 5.5 17.4 2.3 91.8% 39441 1.7% 2
2
3
Number of attendances at A/E depts in a month
95% NA
Nov‐13
Nov‐13
89.84% 10305 81.9% 87500 Last min cancellations ‐ % of all elec admissions
0.8% Nov‐13
1.93% 0.8% RTT 95th centile for admitted pathways
RTT ‐ # specialties not delivering the admitted standard
RTT ‐ non‐admitted % within 18 weeks
RTT ‐ non‐admitted ‐ median wait RTT ‐ 95th percentile for non‐admitted RTT
RTT ‐ # specialties not delivering the non‐admitted standard
RTT ‐ incomplete % within 18 weeks
RTT ‐ #waiting on incomplete RTT pathway
% Diagnostic waits waiting 6 weeks or more
% <=4 hours A&E from arrival/trans/discharge
Ambulance Handovers within 15 minutes
Activity Current Standard Data Period Period Actual
Forecast Data next period Quality
Quality
Outcomes
Current Data Standard Period Period Actual
Hospital Standardised Mortality ratio*
Monthly YTD HSMR at weekends for emergency admission*
Summary Hospital‐level Mortality Indicator**
Proportion of Assisted deliveries
Proportion of C‐Section deliveries
Proportion of normal deliveries
Total # of deliveries
Maternal Deaths
2
2
2
5
30 day emergency readmission
83.7% 11155.7 2
1.5% 2
Dementia CQUIN patients admitted who have had a dementia screen
Medication reconciliation completed within 24 hours of admission Monthly numbers of complaints received
Medication errors causing serious harm
Number of CAS Alerts received by Trust during the month
Number of CAS alerts that were closed having breached during the month
Number of CAS Alerts with a deadline during the month
YTD Forecast next Data period Quality
NA
NA
Sep‐13
Sep‐13
93.78 98.38 5
5
NA
15% Mar‐13
Nov‐13
1.9 16.04% 15.2% 23% 62% NA
NA
0% 0 NA
0 Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
21.72% 62.24% 686 0 3.08% 0 15 0 22.2% 62.5% 5641 0 3.7% 1 120 6 NA
90% Nov‐13
Oct‐13
13 60.81% 118 51.2% 52.3% 5
2
80% Nov‐13
80.27% 78.5% 81.6% 4
4
5
14.6% 21.9% 63.5% 731.3 0 3.5% 5% Nov‐13
2.22% 14.6% 17.1% 2
NA
Nov‐13
59 573 67.7 Total on Inpatient Waiting List
NA
Nov‐13
12342 12342 3
Patient Satisfaction‐ Response rate (friends & family ‐ED)
0% Nov‐13
8.45% 10.8% 9.1% # on Inpatient Waiting List dates less than 18 weeks
NA
Nov‐13
10460 10460 3
Patient Satisfaction ‐Response rate (friends & family ‐Inpatients)
0% Nov‐13
22.52% 20.5% 21.5% # on Inpatient Waiting List waiting between 18 and 35 weeks
NA
Nov‐13
1274 1274 Net promoter (friends & family ‐ED)
NA
Nov‐13
132 85 # on Inpatient Waiting List waiting 35 weeks & over
NA
Nov‐13
608 608 3
Net promoter (friends & family ‐Inpatients)
NA
Nov‐13
154 NA
11691 7823 8539 15083 5707 1967 6305 0 3.5% 75% Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Q3 13‐14
Nov‐13
24.45% 12050 7487 9406 16367 5568 2019 7232 103 10.34% 76.41% 24.5% 101901 12767.7 61999 7696.3 78142 10521.3 135803 17888 44493 5584.7 16172 2020.7 54750 7004.3 903 115.3 10.7% 10.7% 75.7% 76.2% 3
3
3
2
2
2
3
3
2
Same sex accommodation breaches 80% 70% Nov‐13
Nov‐13
79.3% 66.35% 78.6% 66.3% 3
2
% Planned Inpat WL patients with a TCI date
No of GP written referrals
Other refs for a first outpatient appointment 1st outpatient attends following GP referral Total number of first outpatient attendances Non‐elective FFCEs
Number of Elective FFCEs ‐ admissions
Number of Elective FFCEs ‐ daycases
Delayed transfers of care: number (snapshot)
Delayed transfers of care as % of occupied beds
Theatre Utilisation ‐ Total
Theatre Utilisation ‐ Elective
Theatre Utilisation ‐ Emergency
79.2% 66.2% # patients spend >=90% of time on stroke unit
Safety
HCAI ‐ MRSA bacteraemia
HCAI ‐ Cdiff
% adult inpatients have had a VTE risk assess
Number SIRIs
Number of Patient Falls with Harm
Patient Falls per 1000 bed days
Incidents per 100 admissions
# acquired, avoidable Grd 3/4 pressure Ulcers
2
% of Patients receiving Harm Free Care (Pressure sores, falls, C‐UTI and VTE)
Never Events
0 Q3 13‐14
4 80% Nov‐13 87.69% 0 Nov‐13
0 6 Nov‐13
6 95% Q3 13‐14 95.41% NA
Nov‐13
1 8 Oct‐13
8 NA
Nov‐13
5.47 NA
Oct‐13
12.31 NA
Oct‐13
4 0% Nov‐13 92.93% NA
Nov‐13
0 5
5
5
% patients not rebooked within 28 days
Patient 3
99.7 4 90% 3 37 95.5% 32 29 5.47 11.74 24 92.7% 1.3 91.5% 0.7 5.7 95.5% 3.3 5 5.7 12.1 4 93.3% 2
5
5
5
5
5
2
2
2
5
2
2 0.3 5
Operational
Cancer Waits %patients cancer treatment <62‐days urgt GP ref
Current Standard Data Period Period Actual
%patients cancer treatment <62‐days ‐ Screen
% patients treatment <62‐days of upgrade
%patients 1st treatment <1 mnth of cancer diag
%patients subs cancer treatment <31days ‐ Surg %patients subs cancer treatment <31‐days ‐ Drugs
%patients subs treatment <31days ‐ Radio
%2WW of an urgt GP ref for suspected cancer %2WW urgent ref ‐ breast symp YTD Forecast Data next period Quality
85% Oct‐13
73.99% 82.5% 81% 5
90% 0% 96% 94% 98% 94% 93% 93% Oct‐13
95.65% 0% 95.97% 94.44% 100% 88.26% 97.38% 94.12% 94% 93.8% 97.5% 97.1% 99.6% 95.4% 95.3% 95.1% 97.5% 97.2% 100% 92.8% 95.4% 95.5% 5
5
5
5
5
5
5
5
Oct‐13
Oct‐13
Oct‐13
Oct‐13
Oct‐13
Oct‐13
Finance
Balance Current Standard Data Period Period Actual
Worked WTE against Plan
Bank usage (Displayed in 000s)
Agency usage (Displayed in 000s)
Total costs of staff (000s)
Staff Experience
Vacancy rate
Sickness absence***
Turnover rate
10108.94 NA
NA
£ ‐38366 7.2% 2.9% 11% Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Nov‐13
Debtors > 90 Days as % of Total debtors
BPPC by value (%) All
Capital Programme Compared to Plan
Cash Held at Month End cf. Plan (£000s)
Capital
Liquidity Ratio (Score)
Net Income Compared to Plan (Displayed in £000s)
Cash & Pay Compared to Plan (Displayed in £000s)
CIP Performance Compared to Plan EBITDA Compared to Plan
Break Even Surplus Compared to Plan Workforce
Head count/Pay Current Data Standard Period Period Actual
YTD Forecast Data next period Quality
9850.79 £ ‐738 £ ‐5446 £ ‐706 £ ‐2362 £ ‐15601 £ ‐2095 £ ‐40261 £ ‐321132 £ 38391 7.1% 3.24% 3.2% 11.35% 11.4% 4
5
5
5
3
3
3
I&E
EBITDA Margin (Score)
EBITDA Achieved (Score)
NRaF net return after financing
I&E Surplus Margin (Score)
5% 95% 1357 63528 3 1563.98 ‐38366 4075 7016 1772 3 5 3 2 Nov‐13
20% YTD Forecast next Data period Quality
5% Nov‐13
72.4% 84.5% 95% Nov‐13
650 5573 1357 Nov‐13
85142 63489 Nov‐13
3 3 Nov‐13 1019.54 7136.73 ‐1521 Nov‐13 ‐40261.16 321131.89 38391 Nov‐13
3644.6 27062.67 4036 Nov‐13 6547.22 49856.88 3908 Nov‐13 1251.91 8994.54 ‐1313 Nov‐13
3 3 5
5
5
5
5
5
5
5
5
Nov‐13
Nov‐13
Nov‐13
5
5
5
4 3 3 4 3 2 * This measure is collected on a year to date basis and displays the latest available values
** This measure is collected for a 12 month period preceding the latest period shown
*** Sickness absence figures shown in period actual reflect the financial year to date
Year: 2013‐14
Division: Division of Cardiac, Vascular & Thoracic,Division of Children's & Women's,Division of Corporate Services,Division of Critical Care, Theatres, Diagnostics and Pharmacy,Division of Emergency, Medicine, Therapies & Ambulatory,Division of Musculoskeletal and Rehabilitation,Division of Neurosciences, Trauma & Specialist Directorate: Ambulatory,Anaesthetics, Critical care & Theatres,Assurance,Biomedical Research,Cardiac Medicine,Cardiac, Vascular & Thoracic Surgery,Central Trust Services,Children's,CRS Implementation,Division of Cardiac, Vascular & Thoracic,Division of Children's & Women's,Division of Corporate Services,Division of Critical Care, Theatres, Diagnostics and Pharmacy,Division of Emergency, Medicine, Therapies & Ambulatory,Division of Musculoskeletal and Rehabilitation,Division of Neurosciences, Trauma & Specialist Surgery,Division of Operations & Service Improvement,Division of Research & Development,Division of Surgery & Oncology,Emergency Medicine & Therapies,Estates and Facilities,Finance and Procurement,Gastroenterology, Endoscopy and Theatres (CH),Generic Strategic Change,Generic Teaching Training and Research,Horton Management,Human Resources and Admin,MARS ‐Research & Development,Medical Director,Networks,Neurosciences,Nursing Midwifery,OHIS Telecoms & Med Records,Oncology,Orthopaedics,Pathology & Laboratories,Pharmacy ,Planning & Communications,Private Patients,Radiology & Imaging,Rehabilitation & Rheumatology,Renal, Transplant & Urology,Specialist Surgery,Strategic Change,Surgery,Teaching Training and Research,Trauma,Trust wide R&D,Trust‐wide only,Uknown,Unknown,Women's
IPF Red Escalation Report FY 2013‐14
Debtors > 90 Days as % of Total debtors
What is driving the reported underperformance?
What actions have we taken to improve performance
Steady progress has been made in Debt Recovery Clinic continues to maintain reducing the level of debt in finance team focus on historic debt and rigor in excess of 90 days with the process improvements. exception of Private Patient debt .
which is now subject to a targeted process and systems review. Expected date to meet standard
Lead Director
Director of Finance and Procurement
The focus remains on steady progress on historic debt whilst maintaining low levels of current debt, resulting in the standard not being achieved until 2014/15
Standard
Current Data Period
Period Actual
YTD Forecast next period
5% Nov‐13
20% 5% IPF Red Escalation Report FY 2013‐14
BPPC by value (%) All
What is driving the reported underperformance?
What actions have we taken to improve performance
A significant focus was applied to clear legacy invoices on hold in the finance system through joint working between Procurement and Finance. As these are old invoices this positive action has resulted in the large performance reduction in November. As of 1 November 2013 the Trust has communicated to all suppliers that purchase invoices will not be paid without a purchase order number. It is expected that this may be detrimental to performance initially as the Trust and its suppliers go through this period of change but once fully operational this should improve the performance overall. The Trust will continue to aim toward the 95% target by further extension of the use of purchase orders and review at individual invoice level with the divisions to improve the authorisation process. The Trust has an audit finding to review of the calculation methodology and this work is underway and will report to the Audit Committee as part of the year end accounts planning. Expected date to meet standard
Lead Director
Performance improved during 2012/13 and the aim is to build further towards the target during 13/14
Director of Finance and Procurement
Standard
Current Data Period
Period Actual
YTD Forecast next period
95% Nov‐13
72.4% 84.5% 95% IPF Red Escalation Report FY 2013‐14
Net Income Compared to Plan (Displayed in £000s)
What is driving the reported underperformance?
Although income was above plan in the month expenditure remained at the high level reached in Month 7. Costs are largely being driven by high levels of activity. What actions have we taken to improve performance
Divisions have been challenged at performance meetings to control their costs. In addition, the Director of Clinical Services and Director of Finance & Procurement have written to each Division setting them an expenditure target, based on their Month 7 forecasts, which they should not plan to exceed. Divisions will be monitored against this target for the remainder of the year and they are expected to take further action to control their costs should it appear that they will spend more than their limit. Expected date to meet standard Lead Director Q4 2013/14 Director for Finance & Procurement Standard
Current Data Period
Period Actual
YTD Forecast next period
1564 Nov‐13
1019.5 7136.7 ‐1521 IPF Red Escalation Report FY 2013‐14
Pay Compared to Plan (Displayed in £000s)
What is driving the reported underperformance?
What actions have we taken to improve performance
Pay costs are being driven by the continuing high use of bank & agency staff, and additional payments made to medical staff to work weekend sessions that is required to meet waiting list and activity targets. It is estimated that the Trust has paid £6.5m in additional premium payments on bank & agency staff in the first seven months of the year, whilst sessional payments and overtime have cost £4.9m to date. The Trust has introduced a number of workforce measures to reduce the usage and cost of agency staff, and has also initiated recruitment drives to replace temporary staff with permanent employees. In addition, the Director of Clinical Services and Director of Finance & Procurement have written to each Division setting them an expenditure target, based on their Month 7 forecasts, which they should not plan to exceed. Divisions will be monitored against this target for the remainder of the year and they are expected to take further action to control their costs should it appear that they will spend more than their limit. Expected date to meet standard
Lead Director
Director for Finance & Procurement
Pay is likely to continue to overspend while activity remains above plan, with the funding from over‐performance being used to cover the additional cost incurred.
Standard
Current Data Period
Period Actual
YTD Forecast next period
‐38366 Nov‐13
‐40261.2 ‐321131.9 38391 IPF Red Escalation Report FY 2013‐14
CIP Performance Compared to Plan What is driving the reported underperformance?
What actions have we taken to improve performance
Higher than planned activity levels Performance is monitored regularly by the CIP are resulting in slippage on some Programme Board. Where it is believed that savings schemes some schemes may not deliver the full level of planned savings then schemes originally due to start in 2014/15 are being re‐evaluated to see whether they can be brought forward into 2013/14. The Trust has still delivered 95% of its planned savings to date and forecasts it will still generate £42.7m total savings in the year, with only £2.9m of this being non‐recurrent. Expected date to meet standard
Lead Director
Q4 2013
Director for Finance & Procurement
Standard
Current Data Period
Period Actual
YTD Forecast next period
4075 Nov‐13
3644.6 27062.7 4036 IPF Red Escalation Report FY 2013‐14
EBITDA Compared to Plan
What is driving the reported underperformance?
What actions have we taken to improve performance
Although the Trust was slightly behind plan in the achievement of its EBITDA target in Month 8, its year‐to‐date “bottom line” position is on plan and “green”. This is due to “technical” reasons and it is believed that these technical reasons will remain for most of the rest of the year. The Trust currently believes it will meet its key financial targets for the year but that there are key risks which, if they materialise, could change this assessment. It will be important for the Trust to maintain a tight grip on its expenditure over the remainder of the year and Divisions have been set expenditure targets against which their performance will be monitored. Expected date to meet standard
Lead Director
Q4 2013
Director for Finance & Procurement
Standard
Current Data Period
Period Actual
YTD Forecast next period
7016 Nov‐13
6547.2 49856.9 3908 IPF Red Escalation Report FY 2013‐14
Break Even Surplus Compared to Plan What is driving the reported underperformance?
Although the Trust was slightly behind plan in the achievement of its break even target in Month 8, its year‐to‐date “bottom line” position is on plan and “green”. This is due to “technical” reasons and it is believed that these technical reasons will remain for most of the rest of the year. What actions have we taken to improve performance
Divisions have been challenged at performance meetings to control their costs. In addition, the Director of Clinical Services and Director of Finance & Procurement have written to each Division setting them an expenditure target, based on their Month 7 forecasts, which they should not plan to exceed. Divisions will be monitored against this target for the remainder of the year and they are expected to take further action to control their costs should it appear that they will spend more than their limit. Expected date to meet standard Lead Director Q4 2013/14 Director for Finance & Procurement Standard
Current Data Period
Period Actual
YTD Forecast next period
1772 Nov‐13
1251.9 8994.5 ‐1313 IPF Red Escalation Report FY 2013‐14
EBITDA Achieved (Score)
What is driving the reported underperformance?
What actions have we taken to improve performance
Although the Trust was slightly behind plan in the achievement of its EBITDA target, its year‐to‐date break even position is on plan and “green”. This is due to “technical” reasons and it is believed that these technical reasons will remain for most of the rest of the year. The Trust currently believes it will meet its key financial targets for the year but that there are key risks which, if they materialise, could change this assessment. It will be important for the Trust to maintain a tight grip on its expenditure over the remainder of the year and Divisions have been set expenditure targets against which their performance will be monitored. Expected date to meet standard
Lead Director
Q4 2013
Director for Finance & Procurement
Standard
Current Data Period
Period Actual
YTD Forecast next period
5 Nov‐13
4 4 IPF Red Escalation Report FY 2013‐14
RTT 95th centile for admitted pathways
What is driving the reported underperformance?
The growing trend in the 95th percentile of admitted waits is a clear indication that, despite the high levels of elective activity, the numbers of long waiters is growing in a number of services. This has been confirmed by the results of the recent service level IMAS capacity and demand modelling showing that there are a significant number of services with growing elective backlogs. What actions have we taken to improve performance
Plans are being progressed to implementation to ensure the numbers of long waiters are reduced over the coming months. In addition, daily validation of waiting lists remains critical to managing patient pathways. Support and additional training are been given to Elective Access Teams where appropriate. Additional theatres lists are being undertaken to ensure patients are treated within 18 weeks. External providers are been used to support some surgical activity and this is likely to increase in the final quarter. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
23 Nov‐13
26.61 23.35 25.14 IPF Red Escalation Report FY 2013‐14
Ambulance Handovers within 15 minutes
What is driving the reported underperformance?
What actions have we taken to improve performance
The data is provided by South Ambulance handover continues to improve Central Ambulance Service (SCAS). since September. The Trust is unable to validate A system is being reviewed to in real time the ‘clock start’ time but continues ensure that the Trust can validate to double verify the ‘clock stop’ time. The OUH this information and ensure what and SCAS have produced a handover document. is being reported is accurate. The OUH will randomly audit the ‘clock start’ time and ratify against SCAS data, both organisations are agreeing the audit process. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
95% Nov‐13
89.84% 81.9% 83.66% IPF Red Escalation Report FY 2013‐14
1st outpatient attends following GP referral What is driving the reported underperformance?
What actions have we taken to improve performance
The number of first attendances is The Trust is working with CCG colleagues to look still tracking above plan, (though at ways of reducing demand to outpatient at a reduced level above the plan services. than in previous months) in line As part of the Outpatient Reprofiling Project with the increased (above plan) new clinic profiles have now started to be levels of GP referrals being implemented, starting with Specialist Surgery. received. However, the last 2 months have seen sustained growth in first attendances seen, and this is a reflection of the large amount of work being undertaken within outpatients looking at the clinic profiles and booking practices. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
8539 Nov‐13
9406 78142 10521 IPF Red Escalation Report FY 2013‐14
Total number of first outpatient attendances What is driving the reported underperformance?
What actions have we taken to improve performance
The total number of first The Trust is working closely with commissioner attendances is still showing a very colleagues in looking at ways of reducing GP similar pattern to other referrals. outpatient activity metrics, tracking at a sustained level above the plan. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
15083 Nov‐13
16367 135803 17888 IPF Red Escalation Report FY 2013‐14
Number of Elective FFCEs ‐ daycases
What is driving the reported underperformance?
The over performance in outpatient activity is likely to be a significant driver in the continued over performance in elective admissions, as well as the drive to improve the 18 week performance at a specialty level for patients on an admitted pathway. Oversized waiting lists are being experienced in a significant proportion of the clinical services, and this is likely to mean that the over performance may well become more pronounced. What actions have we taken to improve performance
Significant demand analysis work is been undertaken using the IMAS model across surgical specialties to understand both current waiting list size, backlogs and additional theatre capacity requirements. Additional theatres lists are being undertaken to ensure patients are treated within 18 weeks. External providers are been used to support some surgical activity and this is likely to increase in the final quarter. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
6305 Nov‐13
7232 54750 7004 IPF Red Escalation Report FY 2013‐14
Delayed transfers of care as % of occupied beds
What is driving the reported underperformance?
What actions have we taken to improve performance
Total number of delays have Supportive Hospital Discharge Scheme is open to remained constantly high through 50 patients reviewing the establishment of team November, though at a slightly to increase patient capacity over the coming lower level than the overall Q2 months. position. Daily whole system teleconference calls remain in place. Twice weekly discussions with COO s Oxfordshire Urgent care Working group to The most recent figures for manage the winter plans and funding and December (19th December snapshot) show a deterioration reprioritise where necessary. Escalation to on the number of delayed Oxfordshire colleagues when system is on RED. transfers, which have increased Further work is progressing internally to improve from 103 at the end of November the discharge process for all patients, review of policy, standardized documentation, to 126 on 19th December. improving training and competency skills at all levels. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
3.5% Q3 13‐14
10.34% 10.7% 10.69% IPF Red Escalation Report FY 2013‐14
%patients cancer treatment <62‐days urgt GP ref
What is driving the reported underperformance?
The main reasons for the under performance in 62 day pathway treatments are late receiving of referrals, patient choice to delay appointments and complex treatments and the scheduling. What actions have we taken to improve performance
The MDT co‐ordination team has been strengthened, four cancer trackers are now in post to ensure the cancer PTL is kept up‐to‐date.
Working closely with other Trust to improve late referrals and continued working with CCG and GPs to ensure patients and colleagues understand the national standards and referral pathways. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
85% Oct‐13
73.99% 82.5% 80.95% IPF Red Escalation Report FY 2013‐14
%patients subs treatment <31days ‐ Radio
What is driving the reported underperformance?
Upgrades to the Radiotherapy equipment has resulted in delays to planning and treatment of patients, and this has had a knock‐
on effect. Additionally, staff recruitment and therefore available resource remains an issue, however, this is not a unique problem being experienced by the OUH as there is a national shortage of therapeutic radiographers. What actions have we taken to improve performance
Additional treatment sessions have been released, in order to ensure patients continue to be treated. Expected date to meet standard Lead Director December Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
94% Oct‐13
88.26% 95.4% 92.8% IPF Red Escalation Report FY 2013‐14
Dementia CQUIN patients admitted who have had a dementia screen
What is driving the reported underperformance?
What actions have we taken to improve performance
1. Cognitive screening is not a 1.
mandatory completion field on EPR / CaseNotes so continues to be low 2. Cognitive screen in embedded 2.
within medical admission proforma + Trauma #NOF proforma leading to increased levels of completion 3.
3. No universal senior clinical oversight on completion in many areas
4.
Specialty reporting has been trialed in the Trauma, Neurosurgery & Specialist Surgery Division, with new ward level breakdowns being rolled out within Medicine. There is varied compliance with the completion of cognitive screening on different ward and these trends are beginning to be explored to refine systems. The changes to data collection has enabled more sensitive reporting with high 95%+ of physical casenotes being reviewed November figures of 59% show the improvement reported in October has been sustained
Expected date to meet standard
Lead Director
Ongoing
Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
90% Oct‐13
60.81% 51.2% 52.32% IPF Red Escalation Report FY 2013‐14
Same sex accommodation breaches What is driving the reported underperformance?
Clinically unjustified mixed sex accommodation breach on Ward 5B (Stroke Unit) on 3 October 2013 between 04:45 and 09:00. This resulted in four patients being accommodated in a mixed sex bay. What actions have we taken to improve performance
RCA being reviewed by Chief Nurse. Pathway agreed with Ops Managers and Stroke Unit. High Dependency bay is being created to avoid both non‐clinically and clinically justified same sex breaches. Expected date to meet standard Lead Director On‐going Chief Nurse Standard
Current Data Period
Period Actual
YTD Forecast next period
0 Q3 13‐14
4 4 1 IPF Red Escalation Report FY 2013‐14
Total costs of staff (000s)
What is driving the reported underperformance?
What actions have we taken to improve performance
Pay costs are being driven by the continuing high use of bank & agency staff, and additional payments made to medical staff to work weekend sessions that is required to meet waiting list and activity targets. It is estimated that the Trust has paid £6.5m in additional premium payments on bank & agency staff in the first seven months of the year, whilst sessional payments and overtime have cost £4.9m to date. The Trust has introduced a number of workforce measures to reduce the usage and cost of agency staff, and has also initiated recruitment drives to replace temporary staff with permanent employees. In addition, the Director of Clinical Services and Director of Finance & Procurement have written to each Division setting them an expenditure target, based on their Month 7 forecasts, which they should not plan to exceed. Divisions will be monitored against this target for the remainder of the year and they are expected to take further action to control their costs should it appear that they will spend more than their limit. Expected date to meet standard
Lead Director
Director for Finance & Procurement
Pay is likely to continue to overspend while activity remains above plan, with the funding from over‐performance being used to cover the additional cost incurred.
Standard
Current Data Period
Period Actual
YTD Forecast next period
£ ‐38366 Nov‐13
£ ‐40261 £ ‐321132 £ 38391 IPF Red Escalation Report FY 2013‐14
Sickness absence***
What is driving the reported underperformance?
What actions have we taken to improve performance
Sickness absence for the financial The First Care initiative will “go live” in March year to date is 3.24%. In 2014. A project manager will commence in November 2012 absence was January 2014. First Care is an absence 3.03%. September to November management system that will assist managers has seen increases in the with improving attendance. Training for monthly rate of absence. managers will commence in January and will be combined with training in the new absence 72,000 wte have been lost to policy. sickness absence compared to The Occupational Health Department and the 66,000 for the same point last ward based vaccinators have immunised 65% of year. staff so far against flu, an increase on last year’s uptake. This will have a beneficial impact on Stress/anxiety has the highest wte lost of absence reasons and improving resilience during the winter months. represents circa 7% of episodes The target for vaccination is 75%. HR, line managers and Occupational Health in the financial year to date. continue to work closely. Other initiatives, Cold/flu account for 8k of wte lost, but circa 24% of episodes. previously noted, such as Go Active Campaign, Healthy Eating continue. A proposal for an The Children’s and Women’s Employee Assistance Programme is also being Division has the highest rate of developed. absence at 3.82%.
Action to reduce vacancies and improve permanent staffing will have a beneficial impact in reducing work pressure. Expected date to meet standard Lead Director
Fourth quarter
Director of Workforce and Organizational Development
Standard
Current Data Period
Period Actual
YTD Forecast next period
2.9% Nov‐13
3.24% 3.18% IPF Red Escalation Report FY 2013‐14
Turnover rate
What is driving the reported underperformance?
What actions have we taken to improve performance
Standard
Current Data Period
Period Actual
YTD Forecast next period
11% Nov‐13
11.35% 11.44% Whilst employee turnover has fallen on the previous month and is currently running at 11.35%, this is still higher than the same point last year when turnover was 10.98%. There are circa 60 wte more leavers at this point than a year ago. A workshop with senior clinical managers from the divisions was held in November where lean methodology was applied to expedite the recruitment process. A review of high retention impact initiatives was undertaken which will inform a Recruitment & Retention Strategy. The staff group with the highest rate of turnover is Allied Health Professionals at The staff survey results will also provide 14.72%. The division with the highest important information when targeting turnover rate is Medicine, Rehabilitation initiatives. This will be published in the new and Cardiac at 12.52%. year. Nursing & Midwifery turnover rate is The Trust will continue to try and Improve 11.96%. This staff group accounts for 39% the staff experience via employee of leavers. engagement, and the Health and Wellbeing Strategy. Expected date to meet standard
Lead Director
Fourth quarter
Director of Organizational Development & Workforce Year: 2013‐14
Directorate: Acute Medicine & Rehabilitaion ,Ambulatory Medicine ,Anaesthetics, Critical Care & Theatres,Assurance,Biomedical Research,Cardiology, Cardiac & Thoracic Surgery ,Central Trust Services,Chief Nurse Patient Services & Education,Children's ,CRS Implementation,Division of Clinical Support Services,Division of Corporate Service
Cardiac,Division of Neuroscience, Orthopaedics, Trauma & Specialist Surgery,Division of Operations & Service Improvement,Division of Research & Development,Division of Surgery & Oncology,Estates and Facilities,Finance and Procurement,Gastroenterology, Endoscopy and Churchill Theatres ,Gastroenterology, Endoscopy and Theatres (C
Resources and Admin,Legacy Cardiac, Vascular & Thoracic Surgery,Legacy Cardiology,Legacy Division of Cardiac, Vascular & Thoracic,Legacy Division of Musculoskeletal and Rehabilitation,Legacy Rehabilitation & Rheumatology,MARS ‐Research & Development,Medical Director,Networks,Neurosciences ,OHIS Telecoms & Med Records,Onco
,Orthopaedics,Pathology & Laboratories,Pharmacy,Planning & Communications,Private Patients,Radiology & Imaging,Renal, Transplant & Urology,Specialist Surgery ,Strategic Change,Surgery ,Teaching Training and Research,Trauma ,Trust wide R&D,Trust‐wide only,Uknown,Unknown,Women's Division: Division of Children's & Women's,Division of Clinical Support Services,Division of Corporate Services,Division of Medicine, Rehabilitation & Cardiac,Division of Neuroscience, Orthopaedics, Trauma & Specialist Surgery,Division of Operations & Service Improvement,Division of Research & Development,Division of Surgery & Oncolog
Vascular & Thoracic,Legacy Division of Musculoskeletal and Rehabilitation,Trust‐wide only,Unknown
IPF Amber Escalation Report FY 2013‐14
RTT ‐ admitted % within 18 weeks
What is driving the reported underperformance?
What actions have we taken to improve performance
November’s admitted RTT Plans are being progressed to implementation to position for the Trust has ensure the numbers of long waiters are reduced continued to decline, now at 88%. over the coming months. This reflects the significant In addition, daily validation of waiting lists numbers of oversized service remains critical to managing patient pathways. Support and additional training are been given waiting lists (backlogs) being apparent across the Trust. Some to Elective Access Teams where appropriate. services are endeavouring to clear Additional theatres lists are being undertaken to these backlogs by undertaking ensure patients are treated within 18 weeks. extra activity. External providers are been used to support some surgical activity and this is likely to However, the situation is likely to increase in the final quarter. worsen over the winter period as elective capacity becomes more constricted. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
90% Nov‐13
88.06% 91.1% 89.44% IPF Amber Escalation Report FY 2013‐14
RTT ‐ # specialties not delivering the admitted standard
What is driving the reported underperformance?
ENT (69.74%), Ophthalmology (57.57%), Neurosurgery (83.87%), Plastic Surgery (83.13%) and Gynaecology (83.9%). All of these services performance has significantly worsened compared with October’s position. What actions have we taken to improve performance
Weekly meetings are been held with the Specialist surgery and recovery plans are in place. High level of demand, workforce and capacity constraints have been the three defining factors to achieving the standard. Gynaecology also has recovery plans and is starting to improve their position in December. Expected date to meet standard Lead Director Q4 Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
0 Nov‐13
6 6 IPF Amber Escalation Report FY 2013‐14
RTT ‐ # specialties not delivering the non‐admitted standard
What is driving the reported underperformance?
Trauma & Orthopaedics (87.71%), ENT (80.21%) and Ophthalmology (94.18%) were the 3 services that failed the RTT non‐admitted standard of 95%. Plastic Surgery recovered for November and was above 95% compared with the October position. What actions have we taken to improve performance
Detailed analysis of the back log on the incomplete pathways and implementation of the recovery plans to improve the position has resulted in a number of pathways being closed. This has in turn had a direct impact on the non admitted pathway. Work is progressing to move orthopaedics and rheumatology on to the 18 week strategic solution in Cerner Millennium. Expected date to meet standard Lead Director Q4 Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
0 Nov‐13
3 2 IPF Amber Escalation Report FY 2013‐14
RTT ‐ incomplete % within 18 weeks
What is driving the reported underperformance?
The Trust has dipped below the 92% standard for the first time this financial year. This is a reflection of the large backlogs both in outpatient and inpatient PTLs. The incomplete position is likely to worsen in the short term.
What actions have we taken to improve performance
Detailed analysis of the back log on the incomplete pathways, validation of patient waiting and implementation of the recovery plans to improve the position has resulted in the incomplete pathways becoming transparent. Expected date to meet standard Lead Director Q4 Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
92% Nov‐13
91.34% 92.9% 91.82% IPF Amber Escalation Report FY 2013‐14
% Diagnostic waits waiting 6 weeks or more
What is driving the reported underperformance?
The remaining number of longer waiting patients has stabilized in November, leaving the Trust slightly short of achieving the target. The majority of these longer waiters still remain within MRI, with small numbers spread across the other 14 reported diagnostic tests. What actions have we taken to improve performance
The total diagnostic waiting list has reduced from 8273 in September to 7788 in November. 110 patients are waiting over 6 weeks , 79 are waiting for an MRI. Work is on‐going to reduce the final cohort of patients. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
1% Nov‐13
1.41% 8.1% 1.73% IPF Amber Escalation Report FY 2013‐14
% <=4 hours A&E from arrival/trans/discharge
What is driving the reported underperformance?
What actions have we taken to improve performance
Q3 performance deteriorated The Trust has an urgent care group meeting every through November. The 4 hour 2 weeks to ensure the ED action plan continues to standard has been very be implemented. Key focus areas have been: challenging since the end of October, November’s • Admission avoidance performance was 93.38%, with • Implementing rapid nurse assessment only one week being reported as • Increase medical workforce & senior over 95%. December had a decision making similar performance profile, • Improving access to diagnostics & 92.56% with only one week pharmacy 24/7 achieving the standard, which • Expanding EAU was the Christmas week where • Improving patient flow demand significantly reduced • Timely escalation (~15%). • Delays to patient being discharged. In addition November saw high volumes of The start to the new year has paediatirc ED attendances ‐ national picture. continued to be challenging, Opened additional paediatric beds with a CDU performance for the 2 weeks opening 24/1/14. ending since the New Year have Weekly meetings with OCCG, OH and OCC both been below 90%. colleagues to improve patient flow across the system Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD 95% Q3 13‐14
94.7% 94.2% Forecast next period
IPF Amber Escalation Report FY 2013‐14
Last min cancellations ‐ % of all elec admissions
What is driving the reported underperformance?
Validation of the last minute cancellations is still not happening in a timely manner. Unfortunately it is still not possible for this data to be validated in Millennium. What actions have we taken to improve performance
The data is validated on a quarterly basis, although clinical teams validate on daily basis. Work is progressing to have a monthly validated position from the end of December. The position is improving. November did have high gynecology and paediatric cancellations due to high volume from non‐elective admissions. Expected date to meet standard Lead Director On‐going. Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
0.8% Nov‐13
1.93% 0.8% 1.48% IPF Amber Escalation Report FY 2013‐14
No of GP written referrals
What is driving the reported underperformance?
GP referrals are tracking around 1,000 above the plan routinely. November’s received referrals were slightly lower than previous months elevated levels at approximately 400 above the plan. What actions have we taken to improve performance
Joint work with the OCCG is ongoing to identify where and why these elevated levels are occurring. The Trust is working with CCG colleagues to look at ways of reducing demand to outpatient services Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
11691 Nov‐13
12050 101901 12768 IPF Amber Escalation Report FY 2013‐14
Number of Elective FFCEs ‐ admissions
What is driving the reported underperformance?
What actions have we taken to improve performance
Over performance on inpatient Significant demand analysis work is been electives is not as pronounced as undertaken using the IMAS model across day cases, but the correction of surgical specialties to understand both current the oversizing of waiting lists in a waiting list size, backlogs and additional theatre significant proportion of the capacity requirements. clinical services, is likely to mean Additional theatres lists are being undertaken to that the activity over performance ensure patients are treated within 18 weeks. may well become more External providers are been used to support some surgical activity and this is likely to pronounced. This however, is likely to be counterbalanced by increase in the final quarter. the increasing bed pressures throughout the final quarter of the year. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
1967 Nov‐13
2019 16172 2021 IPF Amber Escalation Report FY 2013‐14
Theatre Utilisation ‐ Elective
What is driving the reported underperformance?
What actions have we taken to improve performance
Steady improvements in planned Clinical Teams are focused on real time list theatre utilization have emphasis on booking procedures and start and continued throughout the year, finish times ensuring maximum productivity. continuing through November this has increased again slightly to 79.3% across the Trust. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
80% Nov‐13
79.3% 78.6% 79.19% IPF Amber Escalation Report FY 2013‐14
Theatre Utilisation ‐ Emergency
What is driving the reported underperformance?
Emergency theatre utilization figures continue to be volatile. What actions have we taken to improve performance
Clinical Teams are focused on real time emphasis on booking procedures and start and finish times ensuring maximum productivity. Daily monitoring of emergency lists is on‐going. The last three months of 2013/14 will be the greatest challenge due to reduced inpatient capacity as increased pressures on A/E. Expected date to meet standard Lead Director On‐going Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
70% Nov‐13
66.35% 66.3% 66.2% IPF Amber Escalation Report FY 2013‐14
%patients 1st treatment <1 mnth of cancer diag
What is driving the reported underperformance?
What actions have we taken to improve performance
The radiotherapy equipment and staffing issues highlighted in the red exception report for the subsequent radiotherapy treatment, also apply to this metric. Additionally there are capacity constraints within the Oncology outpatient department that has been delaying the decisions for treatment for some patients Expected date to meet standard Lead Director Director of Clinical Services Standard
Current Data Period
Period Actual
YTD Forecast next period
96% Oct‐13
95.97% 97.5% 97.54% IPF Amber Escalation Report FY 2013‐14
Proportion of Assisted deliveries
What is driving the reported underperformance?
What actions have we taken to improve performance
A number of factors affect the performance of the maternity service and the resulting types of birth. These factors include the activity, the Induction of Labour rate, the risk of the woman and the proportion of first time and subsequent mothers. The maternity service reviews activity , acuity and staffing regularly throughout the day to ensure the intrapartum service is responsive, clinically safe, well managed and provides evidence based individualised care. The Directorate produces a monthly dashboard which is monitored and reviewed by the Directorate and Division. Any areas of performance outside the agreed performance target are subject to scrutiny and audit. The service has been auditing the assisted delivery rate to ensure themes are identified and learning occurs. Expected date to meet standard Lead Director Director of Clinical Services Standard
Current Data Period
Period Actual
YTD 15% Nov‐13
16.04% 15.2% Forecast next p
14.59% Year: 2013‐14
Directorate: Acute Medicine & Rehabilitaion ,Ambulatory Medicine ,Anaesthetics, Critical Care & Theatres,Assurance,Biomedical Research,Cardiology, Cardiac & Thoracic Surgery ,Central Trust Services,Chief Nurse Patient Services & Education,Children's ,CRS Implementation,Division of Clinical Support Services,Division of Corporate Services,Division of Medicine, Rehabilitation & Cardiac,Division of Neuroscience, Orthopaedics, Trauma & Specialist Surgery,Division of Operations & Service Improvement,Division of Research & Development,Division of Surgery & Oncology,Estates and Facilities,Finance and Procurement,Gastroenterology, Endoscopy and Churchill Theatre
,Gastroenterology, Endoscopy and Theatres (CH),Horton Management,Human Resources and Admin,Legacy Cardiac, Vascular & Thoracic Surgery,Legacy Cardiology,Legacy Division of Cardiac, Vascular & Thoracic,Legacy Division of Musculoskeletal and Rehabilitation,Legacy Rehabilitation & Rheumatology,MARS ‐Research & Development,M
Director,Networks,Neurosciences ,OHIS Telecoms & Med Records,Oncology,Oncology & Haematology ,Orthopaedics,Pathology & Laboratories,Pharmacy,Planning & Communications,Private Patients,Radiology & Imaging,Renal, Transplant & Urology,Specialist Surgery ,Strategic Change,Surgery ,Teaching Training and Research,Trauma ,Trus
R&D,Trust‐wide only,Uknown,Unknown,Women's Division: Division of Children's & Women's,Division of Clinical Support Services,Division of Corporate Services,Division of Medicine, Rehabilitation & Cardiac,Division of Neuroscience, Orthopaedics, Trauma & Specialist Surgery,Division of Operations & Service Improvement,Division of Research & Development,Division of Surgery & Oncology,Le
Division of Cardiac, Vascular & Thoracic,Legacy Division of Musculoskeletal and Rehabilitation,Trust‐wide only,Unknown