Trust Board Meeting: Wednesday 13th January 2016
TB2016.09
Title
Integrated Performance Report – Month 8
Status
For report
History
The report provides a summary of the Trust’s performance
against a range of key performance indicators as agreed by the
Trust Board.
Board Lead(s)
Mr Paul Brennan, Director of Clinical Services
Key purpose
Strategy
TB2016.09_ Integrated Performance Report M8
Assurance
Policy
Performance
Page 1 of 34
Oxford University Hospitals NHS FT
TB2016.09
Integrated Performance Report Month 8
Executive Summary
1.
Key Highlights on performance
•
•
•
•
•
•
•
2.
Areas of exception on performance
•
•
•
•
•
•
•
•
3.
The percentage of adult inpatients that had a VTE risk assessment in November
was 97.64% against the standard of 95%.
Diagnostic waits over 6 weeks, 42 patients waited over 6 weeks at the end of
November, achieving 0.34% against the standard of no more than 1% waiting
over 6 weeks.
The 18 week RTT Incomplete standard was achieved in November at 92.41%
against the standard of 92%.
Seven of the eight cancer standards were achieved in October 2015.
MRSA bacteraemia; zero cases were reported in November.
Patients spending >=90% of time on stroke unit was 88.33% against a standard
of 80% in October.
C Difficile, six cases were reported in November.
Cancer 62 day screening performance was 88.24% in October against the
standard of 90%.
Performance against the 4 Hour standard was 88.82% in November.
Nine patients waited 52 weeks or more for treatment in November.
Delayed Transfers of Care as a percentage of occupied beds is at 12.12% for
November against the standard of 3.5%.
In November 18 week RTT Admitted performance was 83.98% and NonAdmitted performance was 92.96% against the standards of 90% and 95%
respectively.
Eight same sex accommodation breaches were reported at the end of November.
Staff turnover rate is 13.72%, which is 3.22% above the standard.
Staff sickness absence rate was 3.56%, 0.56% above the standard.
Key Standards
3.1. 18 Week RTT, A/E and Cancer
3.1.1. 4 Hour 95% standard: Performance in November was 88.82%.
3.1.2. 18 Week Referral to Treatment [RTT] performance: The RTT admitted
standard was subject to an agreed plan fail in November with performance at
83.98% against the 90% target. The incomplete standard was achieved at
92.41% against the 92% target but the non-admitted standard was not
achieved at 92.96% against the 95% target.
3.1.3. Seven of the eight Cancer Standards were achieved in October 2015. 62
day screening performance was 88.24% against the standard of 90%.
3.2. Activity
3.2.1. Delayed Transfers of Care continue to be a significant concern for the Trust
with performance for November at 12.12% against a target of 3.5%. The
monthly average within the OUH for November was 144 and 170 across the
system.
TB2016.09_ Integrated Performance Report M8
Page 2 of 34
Oxford University Hospitals NHS FT
4.
TB2016.09
Monitor Assessment
4.1. Whilst Monitor’s Access and Outcomes matrix operates on a quarterly basis (except
for RTT) the Trust monitors performance against this matrix on a monthly basis. The
Trust monthly score to date is set out below.
April
May
June
July
Aug
Sept
Oct
Nov
Score
2
1
0
0
1
2
2
1
Standards
Not
Achieved
62 day
cancer
4 hour
62 day
cancer
-
-
4 hour
4 hour
62 day
cancer
4 hour
4 hour
62 day
screening
Note: Target score is zero.
Note: November figures exclude Cancer as figures awaited from Open Exeter.
4.2. The Q2 actual performance was a score of 1 as across the Quarter the 62 day
cancer standard was achieved.
5.
Workforce
5.1. Turnover increased from 13.5% in October to 13.7% in November and is 3.2% above
the KPI target. Increasing substantive capacity remains a priority and initiatives to
assist staff in their ability to remain employed in Oxford are being pursued in tandem.
6.
Additional Appendices
6.1. There are two new reports attached in appendix 2 and 3 respectively, the Efficiency
and Utilisation report focusing on length of stay, patient flow and detail on the
delayed discharges. The Quarterly monitoring report has been added for
completeness.
7.
Recommendations
The Trust Board is asked to receive the Integrated Performance Report for Month 8.
Paul Brennan
Director of Clinical Services
January 2016
TB2016.09_ Integrated Performance Report M8
Page 3 of 34
ORBIT Reporting
Trust Board Integrated
Performance Report
November 2015
At A Glance report
Data Quality Indicator
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
Escalation report
Graph Legend
Underachieving
Standard
Plan/ Target
Current Year Performance
Previous Year 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.
Page 4 of 34
Efficiency and Utilisation Report 2015-16
APPENDIX A: Efficiency and Utilisation IPR report Dec-15
Patients staying greater than 21 days and discharged in month
OUH
2015-16
Average Number of ward transfers
Number of patients with more than 3 ward stays in one
spell
0.7
0.1
0.1
0.1
0.1
0.1
0.1
0.1
123
111
129
149
126
140
121
105
March
February
January
December
November
October
September
August
July
June
May
April
* Excluding EAU,Discharge lounge, SEU, ITU( Adult, Neuro, Cardiac & Paeds)
This indicator records the number of ward moves that are
less clinically appropriate. Wards where a definitive
clinical decision has been made to move the patient to,
such as ITUs, Transfer Lounge, Emergency Admissions
Units have been removed.
21084
11840
9524
8726
5922
March
21746
11934
10771
9009
5922
March
20784
11915
9636
9313
5792
February
17985
10122
8656
8479
5649
February
November
20394
11725
9689
9675
5896
January
October
20263
11536
9712
9221
5923
January
September
17556
9942
8384
8504
5873
December
August
18247
10362
9066
8172
5730
December
July
Total number of first outpatient attendances
1st outpatient attends following GP referral
Other refs for a first outpatient appointment
Admissions and Day Cases
Non-elective FFCEs
June
2015-16
May
OUH
April
Number of Elective FFCEs - Admissions and Day Cases
These figures are sourced from the statutory Monthly
Activity Return (MAR) submitted to Unify each month.
For the first 8 months of 15/16 elective inpatients (1%)
continue to grow, however, non-elective spells are only
slightly raised since last year (0.8%), and ED type 1
attendances are now level with the same period last year.
May
June
July
August
September
October
November
Number of patients
April
Average LOS on Discharged Spells
0 to 2 Days
12429
13034
13727
14121
12674
13710
13451
13139
2 to 5 Days
1523
1604
1602
1571
1538
1505
1565
1545
5 to 7 Days
468
513
526
508
524
482
468
519
7 to 14 Days
741
731
687
681
652
683
729
652
14+ Days
Total number of patients
OUH
Number of bed days
Average LOS
626
611
602
640
603
634
664
591
15787
16493
17144
17521
15991
17014
16877
16446
0 to 2 Days
4870
4947
5084
5209
4848
4983
5025
4986
2 to 5 Days
5754
6043
6016
5970
5821
5697
5851
5833
5 to 7 Days
3024
3315
3390
3270
3390
3090
3055
3333
7 to 14 Days
7635
7501
7162
6975
6810
7130
7465
6737
14+ Days
18672
18345
19014
19248
19288
20083
19978
18547
Total number of Bed days
39955
40151
40666
40672
40157
40983
41374
39436
3.95
Average LOS Elective
3.93
4.30
4.30
4.12
4.11
4.70
4.15
Average LOS Non-elective
4.73
4.33
4.45
4.48
4.71
4.53
4.57
4.38
Average LOS Non-elective non- emergency
3.22
3.34
3.29
3.18
3.29
3.37
3.33
3.66
Day case
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Average LOS (excluding daycases)
4.25
4.10
4.17
4.13
4.28
4.32
4.22
4.14
1
The table shows the profile of stays for all admitted
patients to all sites of the hospitals across the OUH.
It is quite stark that in October, just under 4% of the
patients admitted to the hospitals accounts for over
48% of all bed days* consumed. Conversely, almost
80% of admitted patients account for 12% of all bed
days consumed.The trend on length of stay is
generally down. All PODs are showing a reduced
length of stay for the first few months of 15/16
compared with the same period for 14/15.
* bed days are counted for each midnight stay.
Page 5 of 34
Efficiency and Utilisation Report 2015-16
OUH
Average Number of
patients
486
423
586
589
493
565
570
577
594
626
613
623
625
608
615
638
Wednesday
623
642
665
627
603
659
584
626
Thursday
502
657
625
612
636
627
612
632
Friday
527
683
667
669
629
658
619
673
Saturday
329
338
357
331
333
363
355
344
Total number of Patients
234
229
234
222
218
237
237
223
14300
15644
16187
16595
15184
16132
15950
15650
The table and chart show the profile of
discharges by day of the week by month. It is
clear from the information, that the drop off in
discharges over the weekends, and through
Monday, will be a contributory factor in there
often being a capacity and patient flow
problem at the start of the working week.
Average Discharges by day of the week
November
673
638
626
March
February
January
December
November
October
September
August
July
Monday
Tuesday
Sunday
Total
June
Day of the week
May
April
Discharge Profile
Average number of Discharges in Month by Day of Discharge
632
577
Current Month as Chart
344
223
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
2
Sunday
Page 6 of 34
Efficiency and Utilisation Report 2015-16
OUH
Average Number of
patients
15
17
19
21
18
17
18
20
103
108
119
121
106
116
119
116
13:00 to 16:59 Hours
194
203
214
214
199
213
210
218
17:00 to 20:59 Hours
146
155
167
159
147
169
147
146
Total number of Patients
18
21
21
21
20
21
21
22
14300
15644
16187
16595
15184
16132
15950
15650
March
February
January
December
November
October
September
August
July
00:00 to 08:59 Hours
09:00 to 12:59 Hours
21:00 to 23:59 Hours
Total
June
Hour
May
April
Average number of Discharges in Month by Hour of Discharge
Level: Trust
The chart and table show the profile of discharges
within the month by grouped hour of day. The days
have been split into grouped hours of day giving 5
broader categories, which generally represent
overnight, morning (working hours), afternoon
(working hours), early evening and late evening.
Nearly 70% of discharges during November fell into
the afternoon and early evening brackets. The
Transformation Team are currently leading a
project to ensure that discharges happen generally
much earlier in the day.
Average Discharges by Hour
November
218
146
116
22
20
00:00 to 08:59 Hours
09:00 to 12:59 Hours
13:00 to 16:59 Hours
17:00 to 20:59 Hours
3
21:00 to 23:59 Hours
Page 7 of 34
Efficiency and Utilisation Report 2015-16
Delayed Discharges and Bed Utilisation
November
4164
4090
4939
4367
4634
4683
4447
35554
Number of patients Medically fit and not discharged at
month end
134
135
159
160
137
184
157
159
Total number of Bed days used by patients Medically fit
and not discharged at month end
1484
1316
1834
1680
1701
1901
1865
1818
4%
4%
5%
5%
5%
5%
5%
5%
Bed Utilisation - General & Acute
90%
91%
90%
89%
86%
89%
90%
90%
Bed Utilisation - Critical Care
75%
71%
76%
82%
79%
79%
74%
75%
30/04/2015
31/05/2015
30/06/2015
31/07/2015
31/08/2015
30/09/2015
31/10/2015
Delayed patients waiting for ongoing care continue
to be a major issue for the Trust and the wider
health economy. There was a very similar level of
DtoCs remaining within the hospital at the end of
November as there was at the end of October and
September. This is expected to drop significantly
during December as the DToC project begins to
have an effect.
March
February
January
30/11/2015 31/12/2015 31/01/2016 29/02/2016 31/03/2016
November
August
October
36780
September
35554
July
36780
June
36780
March
October
4140
February
September
138
January
August
142
December
July
146
35554
POD / Admission Meth
2015-16
115
35970
Admissions
OUH
147
34771
% Bed days used by patients Medically fit and not
discharge at month end
2014-15
149
May
2015-16
123
April
OUH
129
December
Total number of bed days available
*exclude:daycase wards, maty,well babies etc using
OPS team bedstock
June
Total Delayed bed days in month
May
Number of Delayed patients at month end
April
*for bed days:exclude:daycase wards, maty,well babies etc using OPS team bedstock
Elective
1904
1874
2102
2095
1824
2046
2124
2025
1706
1925
1828
2110
Non- Elective
5284
5536
5460
5761
5451
5342
5625
5512
5652
5216
4727
5303
Non- Elective non-emergency
2077
2144
2053
2086
1991
2022
2193
1942
2022
2109
1802
2112
6977
7692
7351
8175
Day case
7123
7137
7559
8205
7405
7719
7890
7481
Elective
1995
1843
2107
2176
1926
2038
1980
1995
Non- Elective
5283
5673
5654
5601
5395
5479
5602
5464
Non- Elective non-emergency
1997
2167
2059
2072
2008
2046
2101
1948
Day case
6460
6724
7425
7680
6693
7608
7088
6923
4
Daycase activity looks to have reduced, but this is
artificial and as a result of chemotherapy now being
booked as regular attendances from April 15
onwards.
Page 8 of 34
Efficiency and Utilisation Report 2015-16
4 Hour standard by Month
November
December
January
February
March
30/11/2014 31/12/2014 31/01/2015 28/02/2015 31/03/2015
30/11/2015 31/12/2015 31/01/2016 29/02/2016 31/03/2016
October
31/10/2014
31/10/2015
September
30/09/2014
30/09/2015
August
31/08/2014
31/08/2015
July
2015-16
31/07/2014
31/07/2015
June
OUH Type
1&2
# of Attendances
Performance
# of Attendances
Performance
# of weeks in which 95% was achieved
# Of weeks in Month
30/06/2014
30/06/2015
May
2014-15
31/05/2014
31/05/2015
April
30/04/2014
30/04/2015
*OUH Type 1 & OUH Type 2
10434
90.8%
13517
91.1%
1
5
13482
91.9%
10673
96.4%
3
4
11291
92.4%
12010
96.2%
NA
NA
13908
94.3%
12282
96.5%
NA
NA
10211
95.1%
11542
93.8%
NA
NA
10978
93.8%
11823
90.6%
NA
NA
13520
91.4%
12519
88.0%
NA
NA
10651
86.2%
12067
88.8%
NA
NA
10409
83.8%
11840
83.5%
10191
88.3%
10968
84.9%
NA
NA
NA
NA
NA
NA
Performance stabilised in November at a similar level to
that in October. Total attendances are now 2% higher
than they were last year for the same period.
Attendances during November, September and August all
showed significantly higher numbers attending thaan in
the corresponding months of 2014.
*The statutory sitrep reporting has changed from weeks to calendar
months during June, therefore the number of weeks during the month
performing above 95% will no longer be reported.
NA
NA
October
November
905
1759
989
2105
1014
1935
1103
1972
1168
1892
1123
1859
Total number of incompletes
2727
2686
2664
3094
2949
3075
3060
2982
5
March
September
245
2441
February
August
226
2501
January
July
On Admitted Pathway
Not on Admitted Pathway
December
June
2015-16
May
OUH
April
18 week incompletes over 18 weeks
There are still a large number of over 18 week wait
incomplete pathways, which is growing. In light of the
plans to remove the financial penalties for the admitted
and non-admitted pathway targets, and for the
incomplete target to remain as the only sanctionable RTT
target, the Trust will need to address this figure of long
waiting incomplete pathways.
Page 9 of 34
ORBIT
Reporting
OUH - Quarterly Monitoring Report 2015-16
Operational
Standards RTT - admitted % within 18 weeks
RTT - non-admitted % within 18 weeks
RTT - incomplete % within 18 weeks
% <=4 hours A&E from arrival/trans/discharge
%patients cancer treatment <62-days urg GP ref
%patients cancer treatment <62-days - Screen
%patients 1st treatment <1 mth of cancer diag
%patients subs cancer treatment <31days - Surg
%patients subs cancer treatment <31-days - Drugs
%patients subs treatment <31days - Radio
%2WW of an urg GP ref for suspected cancer
%2WW urgent ref - breast symp
HCAI - Cdiff
Standard
Q1
Q2
Q3
90%
95%
92%
95%
85%
90%
96%
94%
98%
94%
93%
93%
69
87.13%
95.07%
93.17%
94.35%
81.35%
91.07%
97.73%
95.98%
100%
98.83%
94.86%
98.17%
15
87.33%
95.07%
92.22%
93.67%
85.22%
96.88%
97.49%
96.03%
99.46%
97.87%
94.64%
93.63%
15
84.95%
93.22%
92.26%
88.41%
86.43%
88.24%
98.53%
95.45%
100%
98.18%
95.38%
93.48%
13
Q4
YTD
86.6%
94.6%
92.6%
92.6%
83.7%
93.4%
97.7%
95.9%
99.8%
98.3%
94.8%
95.4%
43
Year: 2015-16
Division: Division of Children's & Women's,Division of Clinical Support Services,Division of Corporate Services,Division of Education and Training,Division of
Estates,Division of Medicine, Rehabilitation & Cardiac,Division of Neuroscience, Orthopaedics, Trauma & Specialist Surgery,Division of Operations & Service
Directorate: Acute Medicine & Rehabilitation ,Ambulatory Medicine ,Assurance,Biomedical Research,Cardiology, Cardiac & Thoracic Surgery ,Central Trust Services,Chief
Nurse Patient Services & Education,Children's ,Children’s,Critical Care, Pre-operative Assessment, Pain Relief and Resuscitation,CRS Implementation,Directorate of
Page 10 of 34
OUH -At A Glance 2015-16
ORBIT Reporting
Operational
Standards
Standard
Current
Data Period Period Actual
YTD
Data
Quality
RTT - admitted % within 18 weeks
90%
Nov-15
83.98%
86.6%
3
RTT - non-admitted % within 18 weeks
95%
92%
1%
Nov-15
Nov-15
Nov-15
92.96%
92.41%
0.34%
94.6%
92.6%
0.2%
Number of attendances at A/E depts in a month
0
0
0
NA
Nov-15
Nov-15
Nov-15
Nov-15
4
4
0
12067
% <=4 hours A&E from arrival/trans/discharge
95%
Nov-15
Last min cancellations - % of all EL admissions
0.5%
Quality
Outcomes
Standard
Current
Data Period Period Actual
YTD
Data
Quality
Summary Hospital-level Mortality Indicator**
NA
Mar-15
0.98
2
2
2
Total # of deliveries
NA
62%
23%
Nov-15
Nov-15
Nov-15
663
61.69%
20.97%
5724
63.8%
21%
3
3
5
15
25
4
96433
4
4
4
2
Proportion of Assisted deliveries
15%
NA
0%
80%
Nov-15
Nov-15
Nov-15
Nov-15
17.35%
0
3.15%
72.56%
15.6%
0
3.6%
66.3%
5
4
5
4
88.82%
92.6%
5
0
Nov-15
0
0
5
Nov-15
0.34%
0.5%
2
NA
Nov-15
8
71
5
0%
Nov-15
16.67%
3.2%
2
Number of CAS Alerts received by Trust during
the month
Number of CAS alerts that were closed having
breached during the month
0
Nov-15
0
5
zero Urgent cancellations - 2nd time
0
Nov-15
0
0
0%
Oct-15
48.32%
Urgent cancellations
74
Dementia CQUIN patients admitted who have
had a dementia screen
Dementia diagnostic assessment and
investigation
Dementia :Referral for specialist diagnosis
1
MDA/20
15/027
64.5%
0%
Oct-15
79.94%
87.7%
0%
Oct-15
100%
100%
0%
Nov-15
16.69%
11.7%
2
NA
Nov-15
14.14%
22.3%
2
0%
Nov-15
24.63%
18.3%
2
NA
Nov-15
9.97%
8.4%
NA
Nov-15
1.51%
1.1%
NA
Nov-15
2.19%
1%
NA
Nov-15
83.25%
85%
NA
Nov-15
95.84%
96.3%
NA
Nov-15
95.07%
95.3%
NA
Nov-15
16
111
5
0%
Nov-15
93.33%
93.4%
3
NA
Nov-15
0
7
5
NA
Nov-15
46.43%
31%
5
0%
Nov-15
52.9%
RTT - incomplete % within 18 weeks
% Diagnostic waits waiting 6 weeks or more
Zero tolerance RTT waits AP
Zero tolerance RTT waits IP
Zero tolerance RTT waits NP
% patients not rebooked within 28 days
0
Nov-15
40
Contract Variations Open
NA
Nov-15
12
Contract Notices Open
NA
Nov-15
2
0
Nov-15
138
1089
3
Delayed transfers of care as % of occupied
beds*
Theatre Utilisation - Elective
3.5%
Nov-15
12.12%
12%
5
80%
Nov-15
75.59%
75.8%
3
Theatre Utilisation - Emergency
70%
Nov-15
58%
59.4%
2
Theatre Utilisation - Total
75%
Nov-15
71.47%
71.8%
2
Results Endorsed within 7 days
NA
Nov-15
61.78%
53.8%
%patients cancer treatment <62-days urg GP ref
85%
Oct-15
86.43%
83.7%
5
%patients cancer treatment <62-days - Screen
90%
Oct-15
88.24%
93.4%
5
%patients 1st treatment <1 mth of cancer diag
96%
Oct-15
98.53%
97.7%
5
%patients subs cancer treatment <31days - Surg
94%
Oct-15
95.45%
95.9%
5
%patients subs cancer treatment <31-days Drugs
%patients subs treatment <31days - Radio
98%
Oct-15
100%
99.8%
5
94%
Oct-15
98.18%
98.3%
5
%2WW of an urg GP ref for suspected cancer
93%
Oct-15
95.38%
94.8%
5
Delayed transfers of care: number (snapshot)*
Proportion of normal deliveries
Proportion of C-Section deliveries
Maternal Deaths
30 day emergency readmission
Medication reconciliation completed within 24
hours of admission
Medication errors causing serious harm
Patient
Experience
Safety
Patient Satisfaction -Response rate (friends &
family -Inpatients)
Patient Satisfaction- Response rate (friends &
family -Maternity)
Patient Satisfaction- Response rate (friends &
family -ED)
Friends & Family test % not likely to
recommend - ED
Friends & Family test % not likely to
recommend - IP
Friends & Family test % not likely to
recommend - Mat
Friends & Family test % likely to recommend ED
Friends & Family test % likely to recommend - IP
Friends & Family test % likely to recommend Mat
Number SIRIs
% of Patients receiving Harm Free Care
(Pressure sores, falls, C-UTI and VTE)
Never Events
Cleaning Scores- % of inpatient areas with initial
score >92%
Flu vaccine uptake
5
4
3
Page 11 of 34
Operational
Standards
Standard
Current
Data Period Period Actual
YTD
Data
Quality
93%
Oct-15
93.48%
95.4%
5
0
Nov-15
8
8
3
# patients spend >=90% of time on stroke unit
80%
Nov-15
88.33%
89.9%
5
Time to Surgery (% patients having their
operation within the time specified according to
their clinical categorisation)
0%
Nov-15
83.85%
83.3%
3
0
Nov-15
0
2
5
%2WW urgent ref - breast symp
Same sex accommodation breaches
HCAI - MRSA bacteraemia
HCAI - Cdiff
% adult inpatients have had a VTE risk assess
6
Nov-15
6
43
5
95%
Oct-15
97.75%
97%
5
Quality
Safety
Finance
Capital
Financial
Risk
I&E
Standard
Falls with moderate harm or greater as a
percentage of total harms
% of incidents associated with moderate harm
or greater
# newly acquired pressure ulcers (category 2,3
and 4)
Standard
Vacancy rate
Sickness absence**
Turnover rate
Substantive staff in post against budget
5%
3%
10.5%
11012.16
5%
Current
Data Period Period Actual
Nov-15
Nov-15
Nov-15
Nov-15
Nov-15
Temporary Workforce expenditure as a total of
Workforce expenditure
* The figures include acute hospital transfers which are not reported at a National Level
** This measure is collected for a 12 month period preceding the latest period shown 4.26%
3.56%
13.72%
10543.35
6.86%
YTD
Data
Quality
YTD
NA
May-15
0.93%
1.1%
NA
Nov-15
1.19%
2%
NA
Oct-15
77
474
Standard
Current
Data Period Period Actual
YTD
Data
Quality
Data
Quality
Monitor Risk Rating
90%
3
Nov-15
Nov-15
76.39%
2
5
5
Total CIP Performance Compared to Plan
90%
Nov-15
86.3%
5
I&E Surplus Margin (%)
1%
90%
Nov-15
Nov-15
-0.81%
89.81%
5
Capital Programme Compared to Plan
Recurrent CIP Performance Compared to Plan
Workforce
Workforce
Performance
Current
Data Period Period Actual
3
5
3
Year: 2015-16
Division: Division of Children's & Women's,Division of Clinical Support Services,Division of Corporate Services,Division of Education and Training,Division of Estates,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,Legacy
Division of Cardiac, Vascular & Thoracic,Legacy Division of Musculoskeletal and Rehabilitation,Medicine, Rehabilitation & Cardiac,TRUST,Trust-wide only,Unknown
Directorate: Acute Medicine & Rehabilitation ,Ambulatory Medicine ,Assurance,Biomedical Research,Cardiology, Cardiac & Thoracic Surgery ,Central Trust Services,Chief Nurse Patient Services & Education,Children's ,Children’s,Critical Care, Pre-operative Assessment, Pain Relief and Resuscitation,CRS Implementation,Directorate of Medical Staff Training,Directorate of MPET,Division of Clinical Support
Services,Division of Corporate Services,Division of Estates,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,Education and Training,Estates and Facilities,Finance and Procurement,Gastroenterology, Endoscopy and Theatres
(CH),Generic Directorate of Clinical Excellence Awards,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,Legacy- Anaesthetics, Critical Care & Theatres,MARS -Research & Development,Medical
Director,Medicine, Rehabilitation & Cardiac 2,Networks,Neurosciences ,OHIS Telecoms & Med Records,Oncology & Haematology ,Oncology & Haematology ,Orthopaedics,Pathology & Laboratories,Pharmacy,Planning & Communications,Private Patients,Radiology & Imaging,Renal, Transplant & Urology,Specialist Surgery ,Strategic Change,Surgery ,Teaching Training and Research,Theatres, Anaesthetics
and Sterile Services,Trauma ,Trust wide R&D,Trust-wide only,Unknown,Women's
Page 12 of 34
Capital Programme Compared to Plan
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Expenditure on some of the
Trust’s new capital projects for
2015/16 has started later than
originally anticipated.
The capital programme is reviewed regularly by
the Business Planning Group (BPG). The largest
areas of slippage have been on the Swindon
Radiotherapy satellite unit, the Horton CT
scheme and on the EPR re-procurement. This
slippage will impact on 2016/17. Some of the
slippage has been managed by bringing
additional schemes into this year’s programme.
In November the BPG agreed to advance
expenditure in the current year on the Clinical
Genetics unit, as well as increasing the
expenditure on IT infrastructure and on
replacing medical equipment.
Expected date to meet standard
Lead Director
Standard
Current Data Period
Period Actual
90%
Nov-15
76.39%
YTD
The Trust is forecasting to
Director of Finance & Procurement
underspend the funds set aside
for its capital programme by £4m
by the end of the year (excluding
technical capital expenditure on
CEF). This is due to slippage on
some schemes and will be
managed into 2016/17.
Page 13 of 34
RTT - admitted % within 18 weeks
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
90%
Nov-15
83.98%
86.6%
Admitted performance continues Regular meetings are being held with Divisional
to be a challenge in November
Teams and the Director of Clinical Services.
due to workforce and capacity
constraints.
Specialties with significant challenges continue
to be:
• Orthopaedics
• Cardiology
• Urology
• Ophthalmology
• Ear Nose & Throat
• Neurosurgery
• Gynaecology
Additional theatres lists are being undertaken
and external providers are being used to support
some surgical activity.
Expected date to meet standard Lead Director
Quarter 4 for Trust level standard Director of Clinical Services
with risk limited to Orthopaedics,
Neurosurgery and Spinal.
Page 14 of 34
Zero tolerance RTT waits IP
What is driving the reported
underperformance?
What actions have we taken to improve
performance
52 week breaches of incomplete
pathways have increased from 2
in October to 4 in November.
Four patients waited over 52 weeks or more
for treatment in November; two have been
admitted and treated in November; one patient
has a date for January and the other for
February 2016.
Expected date to meet standard
Lead Director
Quarter 4 2015/16
Director of Clinical Services
Standard
Current Data Period
Period Actual
YTD
0
Nov-15
4
25
Page 15 of 34
% <=4 hours A&E from arrival/trans/discharge
What is driving the reported
underperformance?
November performance has
remained below the 95%
standard. There have been some
staffing issues with late absences
due to sickness. High levels of
patients who are delayed
transfers of care remain a
significant concern for the Trust.
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
95%
Nov-15
88.82%
92.6%
The System Resilience Group continues to meet
weekly, with OCCG, OH, OCC and OUH
colleagues to improve patient flow across the
system.
Escalation is in place with significant focus
across all clinical teams to minimize the number
of patients waiting over four hours.
An Integrated Urgent care Improvement Plan is
being implemented.
Expected date to meet standard
Lead Director
Quarter 4 2015/16
Director of Clinical Services
Page 16 of 34
% patients not rebooked within 28 days
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
0%
Nov-15
16.67%
3.2%
The number of 28 days rebooking Clinical teams are focused on forward booking.
breaches has deteriorated again
in November.
Recruitment of key critical theatre staff is ongoing.
Expected date to meet standard
Lead Director
Quarter 4 2015/16
Director of Clinical Services
Page 17 of 34
Delayed transfers of care as % of occupied beds*
What is driving the reported
underperformance?
A slight improvement in
performance in November at
12.12% compared to 12.41% in
October.
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
3.5%
Nov-15
12.12%
12%
Daily whole system teleconference calls remain
in place, with escalation to Oxfordshire
colleagues when system is on RED.
Weekly meeting with OCCG, OH and OCC
colleagues to manage Oxfordshire system
issues.
Further work is progressing internally to
improve the patient flow and discharge process
for all patients.
Expected date to meet standard
Lead Director
This system has not agreed a date Director of Clinical Services
to achieve this standard.
Page 18 of 34
Theatre Utilisation - Emergency
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
70%
Nov-15
58%
59.4%
A 0.19% deterioration on October Work is progressing internally to review and
utilisation performance during
improve theatre utilization, developing a
November.
standardized approach across the Trust to
manage emergency lists.
Expected date to meet standard
Lead Director
Quarter 3 2015/16
Director of Clinical Services
Page 19 of 34
Same sex accommodation breaches
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
0
Nov-15
8
8
There was one same sex breach This will be investigated further to establish any
incident reported by the
lessons learned and any required changes in
Emergency Assessment Unit
practice.
(EAU) at the JR which was found
not to be clinically justified. This
involved eight patients. This is the
first reported breach in 10
months. The breach was due to
issues with capacity during a very
busy clinical time for EAU and the
JR.
Expected date to meet standard
Lead Director
December 2015
Chief Nurse
Page 20 of 34
Medication reconciliation completed within 24 hours of admission
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
80%
Nov-15
72.56%
66.3%
1. With the withdrawal of winter pressure 1. Recurrent funding has been approved to
funding in April 2015 and the
support seven day ward based pharmacy
subsequent removal of all ward based
clinical services to a number of MRC clinical
clinical pharmacy support on weekends
areas across the Horton and JR sites from
this has had a drastic effect on stage 2
October 2015. Furthermore reconfiguration of
medicines reconciliation figures.
weekend working at the CH site has released
Medicines reconciliation is now
pharmacists on weekends to support a number
completed 5/7 days a week in most
of clinical areas. Since this change a month-onclinical areas.
month improvement can be seen. Areas that
have 7/7 ward based services are almost
2. Stage 2 medicines reconciliation relies
meeting the standard despite also completing
heavily on the completion of stage 1
stage 1 medicines reconciliation.
medicines reconciliation completed on
admission by the clerking doctor on
2. EPMA training for medical staff to highlight
ePMA. Currently 87% of stage 1
importance of completion of reconciling
medicines reconciliations are being
medication on admission for all admitted
completed by ward based clinical
patients. Dr. Sudhir Singh leading on
pharmacy staff and not medical staff.
improving.
This has placed a significant new burden
on pharmacy staff that was not there
3. Dr Sudhir Singh to identify a medical team to
prior to ePMA introduction and
champion identified medication admission
significantly reduced the time available
reconciliation.
to complete stage 2 medicines
reconciliation.
Expected date to meet standard
Lead Director
April 2016
Medical Director
Page 21 of 34
Sickness absence**
What is driving the reported
underperformance?
What actions have we taken to improve performance
The Trust’s Centre for Occupational Health and Wellbeing
continues to see a high number of mental health referrals and
FirstCare records confirm that a principal reason provided by
staff for their absence is stress, anxiety, depression, or other
psychological illnesses. Whilst, in the majority of cases, these
symptoms are not directly linked to work issues, they have a
Within the clinical Divisions, the
direct impact on the workplace. In response, a number of
highest levels of sickness absence interventions and initiatives are being pursued, which aim to
are recorded within CSS (4.0%) and provide direct support to staff and managers, and to promote
CHWO (3.8%). Illness relating to awareness regarding the recognition and management of
mental health is the most
mental health-related issues.
frequently recorded reason for
A key priority has been to offer managers new training
staff absence, accounting for the
opportunities to explore how they can influence the Trust’s
highest number of days lost for the
culture and manage their own mental wellbeing, thus helping
rolling year to date (i.e. 13.7% of
to create and sustain a ‘mentally healthy workplace’.
all days lost). The clinical support
Associated training, sponsored by NHS Employers, continues to
staff group (which comprises
be delivered. To date, a total of 92 managers have benefitted
health care assistants and other
by this important and well-evaluated initiative, and the target
support staff) has the highest rate
of ensuring at least 100 managers receive training by January
of absence (6.0%).
2016 will be exceeded. Requests for team ‘building resilience’
workshops have increased and the Health and Wellbeing
Promotion Specialist continues to provide a range of shorter
interventions to suit the particular needs of staff and
departments.
Standard
Current Data Period
Period Actual
3%
Nov-15
3.56%
YTD
Whilst still above the key
performance indicator (KPI) of 3%,
sickness absence is now lower than
in the same reporting period in the
previous year.
Expected date to meet standard
Lead Director
Q2 2016/17
Director Of Organisational Development and Workforce
The Trust’s Employee Assistance Programme (EAP), introduced in July 2015, is
available for all staff on a 24/7 basis. The EAP facility can be accessed via
telephone and online and provides a wealth of information and advice on a
number of topics and issues that may be a cause of anxiety. A confidential
counselling service is also available. The first quarterly performance report will
be received in Q3.
Page 22 of 34
Turnover rate
What is driving the reported
underperformance?
Overall staff turnover remains relatively
stable at 13.7%. Within the clinical
Divisions, MRC has the highest turnover
level (14.6%), whilst CHWO has the lowest
(11.1%). The two areas which most
influence the higher level of turnover in the
MRC Division are ambulatory medicine,
and acute medicine and rehabilitation,
where attrition is greatest amongst clinical
support staff and registered nursing staff.
What actions have we taken to improve performance
Standard
Current Data Period
Period Actual
10.5%
Nov-15
13.72%
YTD
The work being undertaken to reduce staff turnover levels is
strongly linked to the continued recruitment activity aimed at
increasing substantive staff capacity. This has a significant and
positive impact upon staff motivation and wellbeing, team
working, and influences people’s intentions to stay or leave.
Whilst increasing substantive capacity remains a priority, other
initiatives are being pursued, which aim to assist staff in their
ability (from a financial perspective) to remain employed within
Oxford where, for example, house and rental prices, in
comparison to average salary levels, are the highest in the
country. Nationally imposed pay systems and the absence of any
form of local salary weighting, combined with multiple years of
The highest level of ‘churn’ continues to be pay restraint, present significant challenges. However, within a
number of areas (for example radiography) targeted recruitment
associated with band 5 employees in
and retention premia are being applied. A wider incentive
clinical staff groups.
scheme, to be applied to band 5 and band 6 clinical staff, has
been scoped, with the aim of implementing in the early part of
2016. Furthermore, the efficacy of continuing to apply local spot
salaries to certain posts has been assessed, and realignment with
national pay scales is planned, again for early next year.
A dedicated Nurse Recruitment Advisor post was established in
September 2015. The purpose of this role is to provide dedicated
support in the recruitment and retention of nursing and
midwifery staff. In particular, the post holder is undertaking work
to increase the applicant-to-interview rate, review all
unsuccessful candidates to determine whether the offer of
alternative roles might be appropriate, and (in support of
Divisional teams) provide additional direct assistance to the
Trust’s recruits from EU countries outside of the UK. The role is
directly supporting Divisional nursing teams in the identification
of particular interventions to assist staff retention.
Expected date to meet standard
Lead Director
Q4 2016/17
Director Of Organisational Development and Workforce
A further initiative aimed at improving retention is the introduction of ‘link
grades’. Where applicants excel at interview by demonstrating a high level of
motivation, strong work ethic and alignment with Trust values, but lack certain
competencies and experience, recruiting managers are able to appoint into a
lower grade post called a link grade position. Whilst occupying such a position,
individuals are provided with further agreed training and, when considered
appropriate, promoted into the higher-banded post. This initiative has already
been successful in cardiac physiology and is being applied in radiotherapy. The
IM&T department is also adopting link grades as a means by which to compete
with private sector competitors.
Page 23 of 34
Temporary Workforce expenditure as a total of Workforce expenditure
What is driving the reported
underperformance?
What actions have we taken to improve performance
Standard
Current Data Period
Period Actual
5%
Nov-15
6.86%
YTD
The percentage of pay spent on temporary The Trust continues to focus on recruiting substantively to vacant
posts. Current strategies, including the recruitment of qualified nursing
staffing has remained above target,
staff from EU countries outside of the UK re meeting with success.
although the overall trend is downwards.
Expenditure on bank and agency capacity
in November reflects an improved position
compared with the previous month.
Nurse agency expenditure remains below
the imposed 8% ceiling.
The use of bank and agency staff is driven
by the need to cover essential staffing
requirements where capacity is impacted
by gaps in establishment levels, unplanned
absence and the requirement to provide
intensive “specialing” care to certain
categories of patients.
Under a new rule introduced in October 2015, all trusts are mandated
to reduce nurse agency expenditure to a prescribed ceiling in Q3, Q4
and beyond. The imposed ceiling for OUH is 8% (i.e. expenditure on
nurse agency capacity must not exceed 8% of the total nurse pay bill)
for the remainder of this financial year. The ceiling further reduces to
6% in 2016/17 and 3% in 2018/19.
A second rule dictates that, from October 2015, trusts must secure
agency staff via four government approved frameworks, only. This rule
is designed to bring: greater transparency on nurse agency
expenditure; greater assurance on quality of nursing agency supply,
and control on the cost of nursing agency use. Throughout 2015/16,
OUH has achieved a marked decrease in non-framework nursing
agency spend (i.e. from 19% of total agency expenditure in Month 1 to
almost zero, year to date). This reduction has been achieved by
working closely with ward managers and service leads to recruit into
substantive posts, transfer agency to the bank and removing nonframework suppliers from the NHS Professionals platform as soon as is
practicable. Where the procurement of agency staff from a nonframework supplier is deemed to be essential, then approval can only
be granted by the Chief Nurse. Notwithstanding the particular focus on
In late November 2015 nationally mandated maximum hourly rate caps for all agency staff
nursing agency expenditure, these same controls are being applied to
were implemented.
all categories of staff and demonstrable progress is being made.
This initiative is intended to support trusts when they procure workers from agencies and to
Strict adherence to the framework will achieve further reductions in
encourage staff to return to permanent and bank working. The price caps set are the
the charge rates associated with the two main providers (i.e. Crown
maximum total hourly rate that trusts may pay for any agency worker. Subject to monitoring,
Commercial Services and the National Collaborative Framework).
the maximum rates will be further reduced in February and April 2016, such that by April
Additional benefits have already been achieved by aggregating the
2016 no agency worker should be rewarded more than an equivalent substantive member of
collective purchasing influence of the Shelford Group to obtain a higher
staff. This initiative is expected to have a significant impact in reducing the Trust’s
volume-based discount, which will deliver in-year and recurrent
expenditure on agency staff and in eliminating any agencies which refuse to comply with the
savings. These improvements will assist in the achievement of the
rate caps.
annual ceiling requirement.
Expected date to meet standard
Lead Director
Q2 2016/17
Director Of Organisational Development and Workforce
Page 24 of 34
Monitor Risk Rating
What is driving the reported
underperformance?
The Trust’s current liquidity and
surplus from operating activities is
lower than required to generate a
score of “3”.
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
3
Nov-15
2
YTD
Divisions and Corporate Departments have
action plans in place which will improve their
financial performance. These actions together
with central mitigations will result in a year end
surplus of £5m and improve the Trusts monitor
risk rating.
However, whilst the achievement of a £5m
surplus will strengthen the financial risk rating
the forecast for 2015/16 would remain at a 2
without the cash benefit from the sale of an
asset which improves the financial risk rating to
a 3.
It should be noted that Monitor has now
changed the methodology they use to measure
their risk rating.
Expected date to meet standard
Lead Director
Q4 2015/16
Director of Finance & Procurement
Page 25 of 34
Total CIP Performance Compared to Plan
What is driving the reported
underperformance?
There has been slippage in
relation to the planned starts of
some Divisional and crossDivisional savings schemes.
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
90%
Nov-15
86.3%
YTD
Clinical Divisions are aware they have to make
up any slippage in the remainder of the year and
their performance is being monitored monthly.
Performance against all schemes is monitored at
monthly meetings of the Transformation & CIP
Steering Group, and Divisions and project
managers are required to identify alternative
savings when current projects are not forecast
to deliver the full level of savings in the year.
Mitigating actions have been identified and are
expected to improve CIP performance.
A CIP workshop has been set up in January to
review the current 2016/17 schemes, which will
inform the Trusts annual plan for 2016/17.
Expected date to meet standard
Lead Director
The end of year forecast is 89%, Director of Finance & Procurement
therefore this standard will not be
achieved in Q4.
Page 26 of 34
I&E Surplus Margin (%)
What is driving the reported
underperformance?
What actions have we taken to improve
performance
The Trust is behind plan in the
achievement of it’s I&E target
surplus, mainly due to
expenditure within the Divisions
being higher than planned.
TME agreed a number of control measures and
other mitigations which are in place to rectify
the current financial performance and to
achieve a year end surplus of £5m.
Expected date to meet standard
Lead Director
Standard
Current Data Period
Period Actual
1%
Nov-15
-0.81%
YTD
The Trust will meet its key financial targets for
the year, however it should be noted that this
has been achieved as a result of non-recurrent
benefits such as the sale of an asset. As the
Trust moves forward into 2016/17 it will be
important for the Trust to maintain a tight grip
on its expenditure.
The Trust is not planning to make Director of Finance & Procurement
a 1% I&E surplus in 2015/16.
Page 27 of 34
Recurrent CIP Performance Compared to Plan
What is driving the reported
underperformance?
There has been slippage in
relation to the planned starts of
some Divisional and crossDivisional savings schemes.
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
90%
Nov-15
89.81%
YTD
Divisions are aware that they have to make good
any slippage in the remainder of the year and
their performance is being monitored monthly.
They are also aware that, if any schemes put in
place for 2015/16 are non-recurrent, they have
to identify additional recurrent savings for
2016/17.
Performance against all schemes is monitored at
monthly meetings of the Transformation & CIP
Steering Group, and Divisions and project
managers are required to identify alternative
savings when current projects are not expected
to deliver the full level of savings.
Mitigating actions have been identified and are
expected to improve CIP performance although
some will only deliver a non-recurrent benefit.
Expected date to meet standard
Lead Director
The end of year forecast is 89%, Director of Finance & Procurement
therefore this standard will not be
achieved in Q4.
Page 28 of 34
RTT - non-admitted % within 18 weeks
What is driving the reported
underperformance?
Non-admitted performance has
deteriorated in November and is
below the 95% standard. This is
due to workforce and an increase
in referrals in some specialties.
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
95%
Nov-15
92.96%
94.6%
Specialties with significant challenges are:
• Orthopaedics
• Ear Nose & Throat
• Cardiology
• Urology
• Neurosurgery
Additional outpatient clinics are being
undertaken.
Expected date to meet standard
Lead Director
Quarter 4
Director of Clinical Services
Page 29 of 34
Theatre Utilisation - Elective
What is driving the reported
underperformance?
What actions have we taken to improve
performance
November has seen a slight
improvement in elective theatre
utilisation compared to October.
Clinical teams are focused on improving booking
procedures and maximizing productivity.
Improvement Plans are being drawn up
following the “perfect theatre week” initiative.
Expected date to meet standard
Lead Director
Quarter 4 2015/16
Director of Clinical Services
Standard
Current Data Period
Period Actual
YTD
80%
Nov-15
75.59%
75.8%
Page 30 of 34
Theatre Utilisation - Total
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
75%
Nov-15
71.47%
71.8%
November has seen a slight
Focus continues on productivity for all clinical
increase in total theatre utilisation teams both on the day and forward booking.
compared with October.
Recruitment of key critical theatre staff is ongoing.
Actions plans are being drawn up following the
“perfect theatre week” initiative.
Expected date to meet standard
Lead Director
Quarter 4 2015/16
Director of Clinical Services
Page 31 of 34
%patients cancer treatment <62-days - Screen
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
90%
Oct-15
88.24%
93.4%
The numbers of 62 day screening Cancer Plan is in place with daily monitoring of
are very small.
patient numbers to avoid breaches.
Two patients breached.
Expected date to meet standard
Lead Director
November 2015
Director of Clinical Services
Page 32 of 34
Proportion of normal deliveries
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
62%
Nov-15
61.69%
63.8%
The rate of normal births is linked Continue to monitor.
to LSCS and assisted delivery
rates. Changes in monthly rates
can be related to a number of
factors including the clinical
requirements of the women.
Expected date to meet standard
Lead Director
December 2015
Director of Clinical Services
Page 33 of 34
Proportion of Assisted deliveries
What is driving the reported
underperformance?
What actions have we taken to improve
performance
Standard
Current Data Period
Period Actual
YTD
15%
Nov-15
17.35%
15.6%
There are variations in the
Continue to monitor.
proportion of assisted births each
month because this relates to the
LSCS rate and the clinical
condition of the mother and baby.
The LSCS rate in OUHFT continues
to be lower than most units in
Thames Valley.
Expected date to meet standard
Lead Director
December 2015
Director of Clinical Services
* The figures include acute hospital transfers which are not reported at a National Level
** This measure is collected for a 12 month period preceding the latest period shown
Year: 2015-16
Directorate: Acute Medicine & Rehabilitation ,Ambulatory Medicine ,Assurance,Biomedical Research,Cardiology, Cardiac & Thoracic Surgery ,Central Trust Services,Chief Nurse Patient Services &
Education,Children's ,Children’s,Critical Care, Pre-operative Assessment, Pain Relief and Resuscitation,CRS Implementation,Directorate of Medical Staff Training,Directorate of MPET,Division of Clinical Support
Services,Division of Corporate Services,Division of Estates,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,Education and Training,Estates and Facilities,Finance and Procurement,Gastroenterology, Endoscopy and Theatres
(CH),Generic Directorate of Clinical Excellence Awards,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,Legacy- Anaesthetics, Critical Care & Theatres,MARS -Research & Development,Medical Director,Medicine,
Rehabilitation & Cardiac 2,Networks,Neurosciences ,OHIS Telecoms & Med Records,Oncology & Haematology ,Oncology & Haematology ,Orthopaedics,Pathology & Laboratories,Pharmacy,Planning &
Communications,Private Patients,Radiology & Imaging,Renal, Transplant & Urology,Specialist Surgery ,Strategic Change,Surgery ,Teaching Training and Research,Theatres, Anaesthetics and Sterile
Services,Trauma ,Trust wide R&D,Trust-wide only,Unknown,Women's
Division: Division of Children's & Women's,Division of Clinical Support Services,Division of Corporate Services,Division of Education and Training,Division of Estates,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,Legacy Division
of Cardiac, Vascular & Thoracic,Legacy Division of Musculoskeletal and Rehabilitation,Medicine, Rehabilitation & Cardiac,TRUST,Trust-wide only,Unknown
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