BOARD OF DIRECTORS
MEETING IN PUBLIC
31 July 2014
PAPERS
Board of Directors’ Meeting
In Public
31 July 2014
The Education Centre, Birmingham Children’s Hospital
AGENDA
Item
Outcome
Time
Item
No.
14.176
Apologies for absence
Note
14.177
Declarations of interest
Note
Verbal
14.178
Minutes of public Board meeting 26 June 2014
Approve
Enclosure 01
14.179
Matters arising from public Board meeting 26 June 2014
Note
Verbal
14.180
Chairman’s Report
Note
10:55
10 mins
Verbal
14.181
Chief Executive’s Report
Note
11.05
10 mins
Verbal
Note
11.15
15 mins
Presentation
Note
11.30
15 mins
Presentation
Quality Report - Vin Diwakar, Chief Medical Officer and Note
Michelle McLoughlin, Chief Nursing Officer
*Performance Report - David Melbourne, Deputy Chief Note
Executive & Chief Finance Officer
*Resources Report - David Melbourne Deputy Chief Note
Executive & Chief Finance Officer and Theresa Nelson, Chief
Officer for Workforce Development.
AOB
11.45
15 mins
Enclosure 02
Questions from members of the public
12:00
10:50
Allocated
time
05 mins
Report type
Verbal
Strategy
14.182
14.183
Critical Care Summit Feedback, Vin Diwakar, Chief Medical
Officer
Aspire @ BCH, Theresa Nelson, Director of Workforce
Quality & Resources
14.184
14.185
14.186
14.187
Enclosure 03
Enclosure 04
05 mins
LUNCH 12.05 - 12.30
*For note, unless item becomes unstarred at the commencement of the meeting
Next meeting of the Board of Directors: 30 September 2014, Education Centre
None
UNCONFIRMED
Item 14.141, Enc 1
BOARD OF DIRECTORS MEETING
Minutes of the meeting held in public on 26 June 2014 at 09.00
in the Education Centre, Birmingham Children’s Hospital
Present
Attending
Ref.
14.139
14.140
14.141
14.142
Christine Braddock
Sarah-Jane Marsh
Vin Diwakar
Jon Glasby
Colin Horwath
Keith Lester
Michelle McLoughlin
David Melbourne
Theresa Nelson
Roger Peace
Elaine Simpson
Judith Smith
CB
SJM
VD
JG
CH
KL
MM
DM
TN
RP
ES
JS
Chairman
Chief Executive Officer
Chief Medical Officer
Non-Executive Director
Non-Executive Director
Non-Executive Director
Chief Nursing Officer
Deputy CEO and Chief Finance Officer
Chief Officer for Workforce Development
Non-Executive Director
Non-Executive Director
Non-Executive Director
Deborah Bannister
Claire Burden
Simon Crooks
DB
CBN
SC
Interim Company Secretary
Deputy Chief Operating Officer
Executive Office Manager (minutes)
Item
Action
Apologies for absence
Apologies for absence were received from Tim Atack and Matthew Boazman.
Declarations of interest
There were no declarations of interest.
Minutes of the Board meeting held in public on 26 June 2014
The minutes of the meeting held in public on 29 May 2014 were agreed as an accurate record.
Matters arising from the Board meeting held in public on 30 April 2014
CB referred to minute 14.118 and the action on her behalf to meet with YPAG. She had meet
with Iona Clayton and agreed to attend the upcoming YPAG conference. She would report back CB
to the next meeting.
14.143
Chairman’s Report
CB reported verbally as follows:
•
She had attended a series of meetings with Elisabeth Buggins and Jackie Smith to
discuss and progress the new hospital development. The intent to pursue the
development remained positive. In the future, she would be attending monthly chairs
Page 1 of 5
UNCONFIRMED
Item 14.141, Enc 1
Ref.
Item
meetings with the chairs of the Birmingham Women’s Hospital and University Hospital
Birmingham and will keep the board apprised of developments.
•
An invite from Aston University to discuss their new medical school had been received.
However, it was felt that this needed to be considered carefully and that a dialogue
should be opened first with Birmingham University to talk about the development in
light of our existing connections.
•
Since taking her the role of Chair, CB reported that she had received countless
invitations to attend a variety of hospital and other events. CB confirmed she was
having to think carefully about which to accept. Whilst it would be lovely to attend
everything, this would impact on the time she had available to concentrate on core
issues. As a result, she would be seeking assistance from other Non-Executive Directors
to attend these events on her behalf.
•
We are due to start our Monitor Well Led Board Self Assessment process. Further
detail will be provided at the session around objectives, work planning and timescales.
•
CB stated that going forward she would like to utilise the whole day that is allocated for
board, for board business from the Autumn. Where the board agenda results in the
meeting finishing at lunchtime, it will be important to use the afternoon for board
development. It may also be sensible for the NEDs to schedule in regular NED meetings
that day. CB will consider how the time can be best utilised over the summer, and
report back at September board.
The Board noted the verbal report
14.144
Chief Executive’s Report
SJM reported verbally as follows:
•
The care provided to critically ill children has been subject to an intense two day
external review. A number of areas were visited including theatres, ED, wards, PICU
and the operations centre. The result was very positive. The assessors were very
impressed. Of note, they stated that since their last visit in 2006, they felt there had
been a massive cultural change resulting in a big improvement in the service provided.
•
A review of the Trust’s Safeguarding processes had been carried out by the CCG. The
feedback was very positive. The assessors had specifically commented on the passion
that staff had for keeping children safe.
•
A new, exciting partnership bid for the CAMHS tender was announced last week. The
Trust had created a core partnership with Worcestershire Health and Care NHS Trust
and the Priory Group. Other partners involved include Beacon UK, the Children’s
Society and Birmingham Metropolitan College. CB felt this was a strong, stimulating bid
and would probably be different to any other bids that the commissioners received.
Page 2 of 5
Action
CB
UNCONFIRMED
Item 14.141, Enc 1
Ref.
Item
JG emphasised the values and cultures of the partnership were just as important as the
technical design and development. It would be important to show how the cultures of
the organisation would be brought together for the benefit of the patients.
Action
A strong marketing and communication campaign was behind the bid.
DM advised that the PQQ had been submitted and, assuming we were successful, the
tender had to be submitted by the second week of September.
•
Matthew Boazman and Dr Bruce Morland are currently in the USA with representatives
from Marketing Birmingham, University Hospital Birmingham and Birmingham
University promoting Birmingham Health Partners, with the aim of attracting
commercial investment and developing new partners / networks.
•
The Trust AGM will be held on 16th July 2014, during the Next Generation week. A new
interactive format was planned for this year with Chief Officers providing short video
presentations, together with a Governors stand. CB and SJM will discuss the invitation
of external stakeholders to the AGM.
CB/SJM
•
The Urgent Care Service across Birmingham was being reviewed by local
commissioners, with a view to redesigning it. The trust would be involved in the
planning, particularly the impact on children and young children.
•
SJM, JS and JG had attended the NHS Confederation Conference earlier in the month
where Simon Stevens, the new CEO of NHS England, had given his first major speech to
NHS leaders. This had been full of content and intellectual thought. Initial points were
the transfer of some specialised services to CCG commissioning. He felt too many
services were categorised as specialist services. Genomics Medicine Centres would be
going out to tender in the autumn.
JS felt the speech was directed to try and encourage local providers to plan and work
out solutions for services. In addition, Simon Stevens appeared very thoughtful on the
issues of primary care, community care and smaller hospitals.
JG agreed about the intellectual aspect of the speech, but feedback he had picked up
mentioned the lack of emotional engagement.
The Board noted the verbal report.
STRATEGY
14.145
Patient Safety Strategy
VD introduced the Trust’s Patient Safety Strategy. Clinical risk and quality assurance remained
important within each directorate. The issues relating to the capacity of the hospital and
workload pressures on staff were the main risks to providing safer high quality care. The
purpose of the strategy was to recognise this and to build the ability of staff to recognise when
a safety issue was potentially apparent.
Page 3 of 5
UNCONFIRMED
Item 14.141, Enc 1
Ref.
Item
Five key principles would therefore oversee the strategy;
•
•
•
•
•
A proactive approach to safety including a redesign of incident investigation to
encourage staff and patient career engagement
Building workforce capability in quality improvement and patient safety awareness
Design human factors into our clinical systems, i.e. what went wrong and how can we
learn from it. Improvements included the implementation of a sepsis 6 programme to
ensure 75% of patients received antibiotics within three hours of diagnosis, and the
introduction of the medication safety audit to counter drug errors.
Continual learning to include better use of patient safety and quality information,
including mortality review process and redesigning the mortally recording form.
Transparency of patient safety and quality information; the Trust App was very
proactive, provided a real time review and was seen as a clear leader in its field.
NHS England had devised and was promoting a ‘Sign up to Safety’ campaign encouraging
organisations and individuals to support five pledges to strengthen patient safety. We will be
signing up.
KL expressed concern over the timings WI in the strategy, and the expected timeframe to
achieve specific targets. A lack of an action plan to meet target dates could lead observers to
assume this was an unsafe hospital. CB agreed. The strategy lacked a stepping stone approach
saying what had to be achieved and by when. Furthermore CB was concerned as to where this
development sat within the overall development of hospital plans. The presentation needed to
show how this strand and its cost fit into the new development plans. CB commented that the
intention and strategy is absolutely right, however there are “missing chunks” in the way it is
presented.
TN mentioned that aligning this with other strategies is critical, in order to develop the right
culture for staff to feel confident about raising safety concerns.
CBN reassured the Board that the clinical panel are using the safety case strategy as an integral
part of the redesign programme, so each time we redesign a service the safety case principles
are used.
ES asked how progress in implementing the strategy would be monitored. She questioned
what processes would be utilised and would it come up to the Board at any point going
forward. VD explained that there would be a progress report four times a year, though the
Clinical Risk and Quality Assurance Committee.
After discussion, it was agreed that the Quality Committee should take the lead in this.
The Board received the report.
Page 4 of 5
Action
UNCONFIRMED
Item 14.141, Enc 1
Ref.
14.146
Item
QUALITY & RESOURCES
Action
Quality Report
JG raised a proposal from the Committee to organise a refresher training session on how to
analyse mortality data, in order to understand the information and to ask the right questions.
It was agreed that a time would be found on a scheduled Board meeting date to hold the
VD
training session.
The Board noted the report.
14.147
Performance Report
RP raised two items, namely diagnostic waiting times and cancelled operations.
Diagnostic waiting times were now coming to the attention of commissioners. Our original
target of bringing the MRI waiting list down to zero by the end of June was no longer possible.
This had been due in large part to over reliance on a mobile scanner which, due to the patient
mix, had not been possible to utilise as intended. CB asked if we could focus on capacity issues
in relation to cancelled operations – can we look at mobile theatres?
KL expressed his concern that whilst the position relating to both diagnostic waiting lists and
cancelled operations had not got any worse, we seemed unable to resolve the problem. What
assurance could the executive team give the Board that positive action was in hand. DM
advised that an independent diagnostic review had been conducted by the Royal College of
Radiologists, and their report was expected on 10th July. We are also assessed by the clinical
team that no patients are put at risk by waiting an extra one to two weeks. In addition there
were clear guidelines that prevented certain children being scanned via a mobile scanner due
to clinical imaging issues.
DM assured the Board that all steps were being undertaken to manage and resolve this issue,
and we are sighted on the clinical risk and safety of all patients.
The Board noted the report
14.148
Resources Report
The Resources Report was received and noted.
OTHER
14.149
Questions from the Public
There were no questions from members of the public.
Next Board Meeting: 31 July 2014, The Education Centre, BCH
Page 5 of 5
CRAQA
Item 14.184 Enc 02
Report Title
Sponsoring Directors
Contributors
Previously considered by
23rd July 2014
Quality Report
Dr Vin Diwakar, Chief Medical Officer & Michelle McLoughlin,
Chief Nursing Officer
Governance Services, Corporate Nursing, Education, Infection
Prevention and Control, PICU & Cardiac Services
Clinical Risk & Quality Assurance Committee, SLT
Situation
The enclosed report provides an update on key clinical safety and quality topics. A new
development this month has been to concentrate on an identified key existing or emergent
theme. This month the focus is on:
The risk to patient safety and quality of care resulting from cancelled operations.
Background
The report is collated from a number of information sources and provides assurance that key
risks are being escalated and monitored until sufficient action has been taken to address the
concerns.
The report includes information on key risks, serious incidents, mortality data, cardiac arrest,
respiratory arrest, other acute life threatening events, infection control data, Safety
Thermometer data, Net Promoter Question results, and data from the PED database.
Information on Never Events and other safety information is included by exception.
The report now aligns information against Trust priorities and measures.
Assessment
Achievements
Information suggests that BCH continues to provide high quality, safe healthcare with a good
experience for our patients:
•
546 positive comments
•
Zero new Never Events for 15 months
•
Over 78% of Patient Experience Feedback is positive
•
Net promoter scores:
Parent /carer 89
Children & Young People 87
•
Successful bid for funding from the Health Foundation’s Safer Clinical Systems
programme. Demonstrating the safety of the surgical system and the application of the
safety case
Opportunities for Improvement
•
4 new SIRIs
•
20 new complaints
•
153 new Need to Improve comments
Theme for discussion: Cancelled Operations
Concerns about high levels of cancelled operations led the Clinical Risk and Quality
Committee to examine this issue in detail.
•
•
•
There are 9 ongoing or recently concluded formal complaints related to cancelled
operations
There were 20 PALS Contacts during Quarter 1 related to Cancelled Operations
The number of cancelled operations flagged as nationally reportable in June 2014 is 54
and is above average. Total hospital cancellations at 261 are high compared to May
(169) and we remain above our strategic goal of a reduction on 12/13 levels. There
were seven breaches of the 28 day standard in June.
In March 2014, Clinical Risk & Quality Assurance Committee received a detailed risk
assessment considering the impact of cancelled operations on patient safety. The risk
assessment also considered the global service delivery risk to the organisation. The risk
assessment used central cancelled operations data but also specifically drew on relevant
reported incident data, formal complaints and PALS contacts.
Due to the control strategies we have in place the risk to patient safety was considered to be
low. The vast majority of cancellations resulted in no harm with a low level of minor
temporary harm also recorded.
However, the poor experience of patients is an ongoing concern. One the main causes of
cancellation is the lack of availability of a Paediatric Intensive Care bed due to more urgent
or long term patients. A Critical Care Summit took place in July, attended by over 40
clinicians, senior nurses, parents, and commissioners. The meeting examined the root causes
of problems with PICU availability and suggested 50 possible actions which the trust could
take. The recommendations will be assessed and worked up from September 2014.
Recommendations
•
Review the enclosed report and confirm that risks to quality, safety and patient
experience are being well managed in the trust
Risk Description
Failure to correctly identify the
greatest risks to the quality of care
and safety of our patients.
Key Risks
Controls
• Directorate Governance
systems
• Board Assurance
Framework
• Risk Register
• Safety Strategy
• Safety Dashboard
Key Impacts
Strategic Objective
Strategic Priorities
CQC Registration
NHS Constitution
Other Compliance
Equality, diversity & human
rights
Assurances
•
•
•
•
Monthly Board Safety Report
Mortality Review
Monitoring of incident trends
Monitoring of complaints
trends
Every child and young person cared for by Birmingham Children’s
Hospital will be provided with safe, high quality care, and a
fantastic patient and family experience
3. Further develop our approaches to gaining feedback from staff,
children, young people and families to ensure that their voice is
heard at every level of the organisation.
4. Further innovate our systems to promote and enhance patient
safety and reduce avoidable harm.
Standard 16 - Assessing & monitoring the quality of service
provision could be affected by a failure to manage risks
highlighted by the report. Risks to compliance with other
standards may be highlighted by the reports.
Patient Rights
• Quality of Care and Environment
•
Treatments, Drugs
•
Respect
•
Consent and Confidentiality
•
Informed Choices
•
Complaint and Redress
The report supports compliance with NHSLA and Monitor
requirements
Right to life
Quality Report:
Safety & Patient Experience
July 2014
Vin Diwakar, Chief Medical Officer
Michelle McLoughlin, Chief Nurse
Theme for discussion: Cancelled Operations
1
Cancelled Operations
Formal Complaints Waiting, delays & cancellations
30
25
There were 20 PALS Contacts during
Quarter 1 related to Cancelled Operations
20
15
10
5
0
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
1011 1112 1112 1112 1112 1213 1213 1213 1213 1314 1314 1314 1314 1415
There are 9 ongoing or recently concluded formal
complaints related to cancelled operations
Delays to theatre list. Eventually cancelled
as the surgeon ran out of time.
Planned fundoplication and
gastrostomy. Only the latter
went ahead, which Mum feels
was to save time.
Planned surgery
using Bone
Morphogenic
Protein was
cancelled with
inadequate
explanation.
10
9
8
7
6
5
4
3
2
1
0
Cardiac surgery had been
Cancelled and rearranged 3 times.
Planned removal of K-wires did not go ahead as the bed
had not been booked.
Concern that
surgical bed
had been
cancelled, due
to bed
availability
Parents unhappy that they were told that the procedure had
been cancelled 5 minuets prior to their allocated time slot.
Patient arrived at hospital for surgery under the Plastics Team. 3
hours later family were informed that the surgery had been
cancelled several weeks ago and attempts to contact the family by
telephone were unsuccessful.
Given a date for surgery in May, but it was cancelled due to lack of beds. Reassured that
child would be prioritised and not cancelled again. Given a date in June cancelled the
evening before due to lack of beds.
2
Cancelled Operations On The Day - National Definition
2012/13
80
2013/14
2014/15
Avge
66
70
54
60
50
40
28
30
20
10
Apr
May
Jun
Jul
Cancellation by Specialty April – June 14
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Reason for cancellation April – June 14
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
3
A patient’s story
I’m a single mum with 3 children. I am separated from my children’s father so live
on my own in Hampshire with XX and my other two children, aged 12 and 9.
This is our cancelled operation story……
1st operation planned for 18th with
TCI on 17th. Chosen because of
the school holidays.
15th : Mum was called at home by Consultant’s
secretary to cancel the operation due to no PICU
bed. No alternative date was given and mum was
told she was on call and likely to be asked to come in
next week. Mum not given a named person to
contact
Mum had not heard anything so called the
secretary back approximately a week later and
was told there may be a bed this or next week.
Mum was told she would get a call by Monday.
On Thursday, mum was called at 11am and was
asked if she could come to hospital before 6pm
that same day for surgery on Friday. Mum
arranged childcare and XX came to hospital
where he was prepared for theatre, a cannula
was inserted, IV fluids were started and he was
starved. Told XX would be going to theatre 1011am in the morning.
I found the situation stressful but fully
understood why XX was cancelled and that there
were other children that needed surgery sooner
On Wednesday XX was prepared for theatres again
(starved etc). The nurse looking after M told mum
that PICU was full again so the operation was
cancelled.
The ward manager spoke to mum about the
cancellations and the liaison team was informed.
Monday came and mum was told the operation
would not take place today, but perhaps on
Tuesday or Wednesday.
Mum and XX went to Ronald McDonald house. He
still had his cannula in and was asked to come
back twice a day to have the cannula flushed and
checked.
“I wish they had taken the cannula out and we felt
isolated in RM house with no TV in the bedroom
and no Wi Fi”
In the morning, mum was told the operation was
cancelled due to no PICU beds. Mum was told that
surgery would definitely not happen over the
weekend, possibly on Monday.
This has caused a financial burden on us, especially driving back and forth
between hospital and home. Although I get some money back for petrol, it
does not cover the full cost and the financial worries of living at BCH
including food and expenses. The Liaison nurses are helping me with this.
On Thursday Consultant
apologised to mum and said
that the operation would not
be until next Wednesday or
Thursday, but could not
guarantee this.
Mum was given the choice to
go home or stay. She chose to
go home because of child care
arrangements.
On Sunday, mum was called at
home by the ward nurse and told
XX was 1st on the list in the
morning and was asked to come
back to BCH by 6pm for surgery on
Monday morning.
Child care was arranged.
XX went to surgery
on Monday morning.
What are the causes of cancellations and
where in the process do they occur?
Hospital Cancellations
Operation not necessary
14%
Patient not suitable for OP 11%
Unfit with acute illness
6%
Lack of theatre time
6%
Surgeon Unavailable
4%
Anaesthetist unavailable 2%
Bed Shortage 26%
No ITU bed 8%
Emergency
Admission 16%
Admin error 2%
A third of cancellations due to
patient-specific factors.
A third due to bed
shortage.
An third in response to emergencies. and
problems on the day
(none assigned to transplant in this quarter)
Risk Controls
Risk that reduced bed availability leads
to increased cancellations
Day prior to admission review of bed
situation to identify whether cancellations
could be made the day before, this is then
reviewed with the Consultants to identify
clinical priority.
Daily 8.30 Ward Manager Bed Meeting –
this has been in place for the past 6 months
and is where TCIs for the day and discharges
are discussed.
Any patients that need to be cancelled on
the day are discussed with the Clinician
regarding clinical priority or to understand
any co-morbidities, eg learning difficulties or
pre-op preparations.
Any on the day cancellations are prioritised
to be re-admitted within 28 days. This is
monitored on a daily basis and a report
shared weekly with COO.
Risk that reduced PIC bed availability leads
to increased cancellations of cardiac
patients
Consultant surgeon of the week has clinical
oversight of all patients waiting for operations.
They review and prioritise taking into account
any new tertiary referrals received which are
predominantly new born/neonates
The surgical team use the PICU electronic bed
booking system and adjust the booking
sequencing according to clinical prioritisation.
The consultant surgeon will also discuss cases on
a daily basis with the PIC Consultant of the day.
The PICU team advise on likely patient
movement weekly and there is a daily
assessment of likely discharges at 4pm. The team
review what is on the electronic bed booking
system and discuss with the booking in clinician if
there is any capacity mismatch.
Parents are advised about the reliance on a PIC
bed. Theatre capacity is available every day to
ensure access to elective and emergency demand
and to ensure emergency demand does not
displace elective demand.
During times of high demand or low PIC we discuss with the wider PIC community, deploy
additional retrieval teams to support transfers to non specialist centres and back transfers and
finally to other specialist centres and will refer cardiac cases Out of Region. In this situation it's
escalated to Executive level and Commissioners are notified.
Risk that inefficient use of Theatre time
leads to increased cancellations
Reviews of all lists to ensure they are not over
booked. Queries are checked with the clinical
team and then operation booked may be
readjusted on ORMIS. The list is locked down 2
weeks prior to the operation.
Pre operation checklist to check surgeon
anaesthetist staffing and kit required. Any
queries checked with the management team
and set out in the weekly scheduling action log
sent to all service managers with a responsible
officer identified to complete required tasks.
On the day of operation the theatre
coordinator reallocates staff if required. Lists
are staggered if any issues present on the day.
The WHO checklist may identify last minute
issues and no operation will proceed if any
aspect is deemed as not being safe such as
missing or damaged instrumentation where no
other replacement can be secured quickly.
We report lost, missing and damaged items
sent to BBraun as per the pan Birmingham non
conformity SOP. Items that are missing
identified at team brief are fast tracked over
from BBraun as they are able.
6
Harm Caused
There were 607 cancellations affecting 528 patients

•

•

•
•


1 cardiac patient was cancelled 6 times, 5 times due to lack of PIC beds,
once due to emergency/trauma.
They were the subject of one incident during this time; this was unrelated
to the cancellation and caused no harm .
1 cardiac patient was cancelled 4 times due to lack of PIC beds,
They were not subject to an incident or PALS/Complaints contact.
8 patients were cancelled 3 times,
1 haematology patient was cancelled 3 times, due to their unsuitability for
treatment.
Of these ‘cancelled 3 times’ patients 5 were cancelled due to unsuitability
for treatment
53 patients had a procedure cancelled twice.
464 patients had a procedure cancelled once.
•
12 of these had an associated PALS contact,
•
3 had an associated complaint,
•
18 were subject of an incident report relevant to the cancellation,
•
2 were subject of an incident and families complained
•
1 incident had an impact of 3 (moderate, temporary harm)
•
5 incidents had an impact of 2 (Minor harm)
Risk Scores
Patient Safety risk score = 8, Moderate
Likelihood = 2: 5% of cancellations led to an incident
report being completed.
Severity = 4: The median harm score associated
with those reports was 2. However, since this risk
potentially affects patients across the Trust a
consequence modifier of +2 is added to the score.
Service Delivery risk score = 20; High
Likelihood = 5: In Q1 2014/15 there were 368
surgical cancellations. Each day saw a cancellation.
Severity = 4: Within the risk matrix Service/ Business
Interruption descriptors, ‘Loss/ interruption > 8
hours‘ is scored at 2.
However, since this is a service critical to the Trust a
consequence modifier (+2 is added to the score)
New Events & Concerns
There have been no new Never Events since 15/4/13
There have been 4 new SIRIs
14/15:22 Failure to identify NAI before discharge resulting in a patient being put at risk of further injury.
14/15:21 Severe tissue injury to buttock. This is believed to be a chemical burn caused by the patient’s faeces. The patient is a very complex
cardiac patient and had been suffering with gut motility problems. Documentation records that the patient was promptly cleaned after each
episode of diarrhoea.
14/15:19 Loss of power in the feet following spinal surgery. There may have been a delay identifying the loss of function and therefore
instigating treatment. The patient is currently expected to recover full functionality.
14/15:15 Unexpected death of a patient with Epidermolysis Bullosa. The patient had been admitted with possible sepsis and was treated for
this. They had clinically improved and were due to be discharged the following day, but unexpectedly passed away during the night.
There have been 20 new Formal Complaints
Need to Improve Comments Complaints Q1
waiting delays and cancellation
June 2014
staff attitude
Quality of Treatment
Communication
2
29
26
28
20
PALS Q1 2014/15
9
84
67
14 17
50
45
40
35
30
25
20
15
10
5
0
Waiting, delays & cancellations
Quality of Treatment
Other
Staff Attitude
Communication
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
1011 1112 1112 1112 1112 1213 1213 1213 1213 1314 1314 1314 1314 1415
New Formal Complaints
25
20
15
10
5
Jun-14
Apr-14
May-14
Feb-14
Mar-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
May-13
Apr-13
Feb-13
Mar-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
0
Mother raised several
Mother has raised concerns
concerns in relation to the
stating that Consultant
co-ordination of her son's
Paediatric Urologist failed to
care between specialties,
diagnose undescended testis
including cancellation of
on two occasions.
surgery due to bed
availability
Dad raised concerns following the letter sent to
his family in relation to the confidentiality
breach, where a handover sheet had been
found outside the Trust.
Mother is unhappy with the treatment and diagnosis that their child received. Following PM results, the family were told their child had a rhabdoid
tumour. A follow up letter mentioned that if the Consultant knew it was a rhabdoid tumour, they would have chosen a different treatment. The family
have numerous questions.
Mother states that an Orthoptist continued described her child as uncooperative during an assessment, and she disagrees.
Parents have raised concerns about the delay in being consulted by a member of the Paediatric Surgeon team on admission.
Mother has raised concerns regarding the quality of care received from a Consultant Nephrologist. Mother feels that the
Consultant has not listened to her, disagrees with the diagnoses given and wishes for it to be removed from her child's records.
Mother of patient unhappy with repeated cancellations of operation and delays to treatment.
Mum had visited her GP, as her son had painful, swollen testicles, and was told he had a trapped nerve and needed surgery immediately. Surgery took place
the next day. The Consultant surgeon subsequently informed the family that their son's ‘testicles had disappeared’, and if the operation had been
performed immediately this could have been prevented.
Foster carer states that as staff had failed to read the patient‘s medical records, they were
Patient arrived at hospital for surgery under the Plastics
unprepared for the admission and the procedure was cancelled.
Team. 3 hours later family were informed that the surgery
Following incidents reported to the Accommodation Manager involving the communal kitchen and
had been cancelled several weeks ago and attempts to
bathroom areas a family have been asked to leave hospital accommodation. he family believe that
contact the family by telephone were unsuccessful.
they have not been listened to, misunderstood and the situation not dealt with appropriately.
Family are concerned that the operation for their child's undescended testicle was not performed correctly.
Dad wrote in to complain that his son should not have been sectioned under the Mental Health Act.
Parents have raised concerns surrounding the quality of nursing care received on MDC.
Concerns that the management during admittance to
Surgical Day Care was poor resulting in the proposed
morning slot being rescheduled to an afternoon slot.
Mother felt that her daughter's rights were not respected. Other patients were seen before her and that no-one explained what was happening. She also felt
that her daughter's privacy was not respected.
Dad has raise concerns about his daughter's Cardiac surgery has been cancelled and rescheduled on 3 occasions.
Family state that they informed that they had been referred to the wrong specialty after a wait of several months. The child
was internally referred but that referral was subsequently refused and the child referred back with further delays.
Mother states that she was spoken to
9
rudely by Consultant Anaesthetist.
Closed SIRIs
There were 3 closed SIRIs in June
Summary
14/05:02 Delays processing referrals from other
organisations have resulted in delays in outpatient
appointments. One of the patients involved had symptoms
which indicated a brain tumour. That patient was reviewed
urgently and does not have a brain tumour. None of the
patients involved have suffered from harm.
Key Actions
The root cause of this incident was described as variation across the
specialties with how referral letters are handled.
•The Call centre processes will undergo redesign.
•The General paediatrics workflow will undergo redesign.
•A key component of the Call Centre redesign will be to identify more
effective ways of monitoring workflow.
13/14:87 A patient was transferred to BCH from a DGH for
line insertion. The patient was known to BCH because of his
underlying skin condition. The patient unexpectedly
suffered a cardiac arrest and passed away.
The patient’s death was considered unavoidable and solely due to the severity
of his condition. However, some recommendations were made to improve
processes, including:
•We will raise awareness at BCH about the significance of very high lactate
levels even when the rest of a patient’s blood markers are normal.
13/14:83 A PICU handover sheet was found off-site in a
public location by a member of BCH staff. This sheet
contained patient confidential information.
There have been 2 subsequent incidents with very similar
circumstances.
While we continue to work towards an electronic handover solution we will
develop the handover sheet to include a watermark and so that it is printed
on a specific colour which will act as visual cues to prompt staff about the
importance of keeping these documents safe. Posters have been displayed
across the Trust reminding staff about the importance of document security.
Specific guidance has been added to the Information Governance Policy in
relation to the practice of taking handover sheets off site. This guidance has
been publicised across the entire organisation via a joint letter from the Chief
Nurse and Chief Medical Officer.
10
There were 12 Closed Complaints in June
Summary
Key Actions
Father wants to know why child was not referred to Respiratory care earlier. •Explanations provided at a follow up meeting with father.
Requested pressure cubicle for child and wants transferred to PAU and
accommodation.
Mother is unhappy that cardiac surgery is now to be conducted at the QEH • Consultant to work closely with the relevant service manager on complex cases to ensure
and would like to know why the surgery was cancelled.
communications are clear and delivered in a timely fashion.
•Tracking of correspondence to be used on Heartsuite for out of region patients.
•Review of transitional care arrangements.
Mother unhappy with change of medications and no follow up.
•Apology given and case discussed with the epilepsy team.
inconsistent advice from Doctors. Epilepsy nurse not returning phone call.
Father has requested a written response as to why his child suffered blood
loss resulting in a further urgent procedure taking place.
Concerns with the quality of medical and nursing care received within the
Emergency Department and GP Referral Unit.
Mother has raised concerns surrounding a communication she has found
within her son's medical records. Referring to her as ‘difficult’.
Parents raised concerns in relation to care given on Ward 2. In particular,
infection control and barrier nursing.
Father has raised concerns regarding a lack of communication from a
Consultant Neurologist.
Mother has raised concerns about the quality of medical care received
from a Consultant Gastroenterologist.
•No recommendations were made as the post operative bleed is a recognised complication
of a tonsillectomy.
•Review the option to have a system of "Open Access" for patients that may need to return
to the hospital on successive days.
•Further training in relation to he Trust Infection Control Policy.
•Case to be used as part of our ongoing training for all medical secretaries within BCH
•The revised nursing assessment chart now has infection control status box.
•The storage of oxygen mask on Ward 2 has been discussed with the ward manager and
these are now stored in a more accessible place.
•Addressed via a letter from the Consultant.
None.
Concerns that notes were not available prior to a clinic appointment.
Apology given.
Father questioned why a full skeletal x ray and head scan were performed
after being admitted with a wheezy chest. Claims to not have been
informed of Hospital staff meeting with Social Services.
Mother was unhappy with treatment and transition of care for her child.
•The importance of clear communication has been shared with those concerned
None
11
Patient Experience Database
(PED)
The top 5 positive comments continue to reflect satisfaction with
Jun-14
Directorate
Total
Total
Positive
Need to
Improve
%+ve
CAMHS
92
46
46
50
Clincial Support Services
109
67
42
61.47
Medical
118
87
31
73.73
Specialised Services
279
257
22
92.11
Surgery
100
88
12
88
Trust
699
546
153
78.11
Adult
416
86
82.87
Young Person
130
67
65.99
nursing care, the overall experience of children, young people and
families, care by Allied health Professionals and overall quality of
care. This is consistent with the feedback from the Friends & Family
questionnaire and the patient experience APP
The need to improve comments are relatively small in number with
the highest concerns again relating to waiting and delays - the
comments relate to a number of areas but predominantly were
about ED and OPD waiting times, and waiting to go to theatre.
The last few months we have seen a reduction in the overall number
of comments entered on to the PED. This is primarily due to a move
in emphasis from the yellow feedback cards – where the majority of
comments were previously received to the friends and family
questionnaires.
You said…
We did.…
We could improve
on waiting times in
out-patients
We have started a project into the flow of
patients through the out-patient
department and also addressing the booking
of patients into clinics. This project aims to
review the times at which appointments are
made in clinics that don't run well and reschedule them, to fit a more realistic pattern
which will hopefully result in much improved
waiting times
“The wait time is ridiculous.”
“The appt was 10.00am and still
not seen at 12.15. Just make one
appt at a time instead of booking 4
at a time.”
Friends and family questionnaire
Jun-14
Directorate
Target (20%)
Total
Total
Positive
Need to
Improve
Medical
77
56
48
8
85.71
Specialised Services
29
26
23
2
88.46
Surgery
94
275
235
34
85.45
Trust
88
357
306
44
85.71
Adult
88
357
281
39
78.71
Young Person
42
30
25
5
7
Target responses
achieved across
parent/ carer inpatient areas
Net promoter scores:
Parent /carer 89
Children & Young People 87
%+ve
ED
Directorate
Target
(15%)
Total
Total
Positive
Need to
Improve
Medical
313
38
33
3
86.84
Trust
313
38
33
3
86.84
Adult
313
38
28
3
73.68
Young Person
129
5
5
0
13.16
All detractor comments
have been discussed with
the relevant individual
ward managers for
response and action.
Positive
Jun-14
Needs to Improve
%+ve
Room for improvement in both
young people and ED
responses
In order to improve children
and young people responses
in ED we have introduced
more child-friendly forms
The issue of noise at night has
been raised with ward
managers and we will monitor
the issue as it continues to be
raised through all feedback
methods.
Feedback App & Social Media
During June we received 35 app comments
Responding to feedback
Finalist
“The fire alarm was terrible, too loud, went on way too long, and if it wasn't in that part of
the building, why did it go off in the first place. When we were seen the service was brilliant,
but the fire alarm was a huge let down.”
A new piece of work with the estates and fire team means that the fire alarm will very
soon be 'zoned'. this will result in the alarm only sounding in the areas nearest to the
trigger location. This will result in less disruption to our patients and their families,
hopefully allowing our service users to have a better experience when with us.
Social Media
The past year has seen an increase of the use of social media by staff. Social media and the app can
support our ambition to be open and transparent and encourage frank conversations as well as a great
opportunity to interact directly with children, young people and parents. The app and social media
provide an opportunity for parents, children and young people to let us know about their experience,
both positive and not so good, in real time and for staff to respond directly in real time too.
Facebook and Twitter:
In June 2014 we received almost 140 comments via the BCH facebook page and
twitter account @Bham_Childrens
All were positive except 1 twitter comment. The issue was addressed the same day
by the Lead Nurse.
14
The Application of
Safety Cases
BCH have been successful in a bid for funding from the Health
Foundation’s Safer Clinical Systems programme. The project
involves Demonstrating the safety of the surgical system and
the application of the safety case
A Safety Case is a structured argument, supported by evidence,
intended to justify that a system is acceptably safe. Safety cases
are often used in highly regulated industries such as the nuclear
industry to demonstrate that systems and processes are safe,
prior to their implementation. Until recently their use in
healthcare has been limited to the use of medical devices.
The overall aim of the project is to provide hazard and risk
analysis and sense checking around the level of safety of the
complex surgical clinical care pathway at BCH. We intend to use
a safety case approach to achieve this aim and explore the
feasibility of using the safety case methodology across a complex
clinical pathway.
We see safety cases as a potentially powerful tool underpinning
and aligning themes, helping us to consider safety as the ability
to succeed under varying conditions, rather than the absence of
harm. In theory, this will allow us to engineer resilience into our
systems by identifying those aspects of the system requiring redesign.
Patient Safety Study
The Collaboration for Leadership in Applied Health Research
and Care - West Midlands (CLAHRC- WM) have agreed to work
with BCH on a research project designed with the intention to
produce insights for developing the capacity needed to
translate evidence into practice for quality improvement,
specifically in the domain of patient safety.
The research will study the use and flow of patient safety
evidence at BCH and will consider the challenge in assimilating
evidence derived from the frontline of clinical service delivery
through the clinical governance infrastructure.
The initial focus of research will develop insight across about
the corporate management and governance of risk evidence.
This research will be undertaken through non-participatory
observation and interviews.
Tracer studies will be used to follow the processes and practices
associated with evidence ‘flows’ at middle levels of the
hospital. Specific studies will be identified through insights
developed in phase one.
The safety case method is still new and relatively untested in a
health context, particularly in its application to an existing
system.
15
Monitoring Infection control
June 2014
Infection
No.
MRSA Bloodstream Infections (BSI)
0
MSSA BSI (pre 48 hour)
2
MSSA BSI (post 48 hour)
2
E. Coli bacteraemia (pre 48 hour)
4
E. Coli bacteraemia (post 48 hour)
1
Glycopeptide-resistant enterococci
0
C. Difficile
0
MSSA pre 48 Hours 2011/12
MSSA pre 48 Hours 2013/14
MSSA pre 48 Hours 2012/13
MSSA pre 48 Hours 2014/15
5
4
3
2
1
0
MSSA post 48 hours 2011/12
MSSA post 48 hours 2013/14
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
April May June
5
4
3
2
1
0
E-Coli - pre 48 hours 2011/12
E-Coli - pre 48 hours 2013/14
E-Coli - pre 48 hours 2012/13
E-Coli - pre 48 hours 2014/15
July
Aug
Sept
MSSA post 48 hours 2012/13
MSSA post 48 hours 2014/15
Oct
Nov
Dec
Jan
Feb March
E-Coli - post 48 hours 2011/12
E-Coli - post 48 hours 2012/13
E-Coli - post 48 hours 2013/14
E-Coli - post 48 hours 2014/15
5
4
3
2
1
0
16
Respiratory Arrests, ALTEs and
Unplanned Admissions to PICU
Explanation of Data
Unplanned admissions to PICU
are a measure of how well we are
monitoring patients on the
wards. Good monitoring on the
wards means that we will pick up
deteriorating patients more
quickly, allowing us to admit
them to PICU when required. A
combination of high levels of
unplanned admissions and low
levels of cardiac arrests,
respiratory arrests and acute life
threatening events (ALTEs) means
that we are monitoring and
escalating clinical deterioration in
a timely manner.
Details of Cardiac Arrests
In June there were 4 cardiac
arrests outside PICU. 2 out of
hospital ED and 2 on the wards.
None have been classified as
predictable or preventable.
Number of Emergency Events
No of Cardiac Arrests (ex PIC)
No of Respiratory Arrests
No of Cardiac Arrests (PICU)
No of ALTEs
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
17
Safeguarding
Key Figures
Child Protection Training
Level 1
99.1%
Level 2
87.4.%
Level 3
86.1.%
There has been 0 Safeguarding SIRI
There has been 0 new Safeguarding Complaint
There has been 1 “Position of Trust’ case
There have been no new recommendations from Serious Case Reviews
100% of BSCB Meetings attended by BCH Executive lead or representative
90% of cases which require peer review /clinical supervision have had this
There has been 0 child deaths related to suspected physical abuse/neglect
Safeguarding CQUINS:
We have had discussions with our Commissioners and agreed some
Safeguarding CQUINS for 2014. An agreed Qualitative Audit Proforma will
be used to capture key aspects of a child’s journey through the
safeguarding process.
This will be done via the following groups:
•Burns Child Protection Peer Review
•General Paediatric Child Protection Peer Review
•Emergency Department Child Protection Clinical Supervision Sessions
•Safeguarding Operations Group.
A Child’s Journey through the Safeguarding Process:
A 15 month old baby was admitted following an unexplained
fracture to her left arm. There were some issues of delayed
presentation. The baby was in a shared care arrangement
between parents.
The Child Protection process was commenced in ED:
•A timely referral was made to Social Care.
•A Child Protection medical examination was completed and
the child was admitted to PAU.
•The Child Protection Nurse met with the family to explain
the process.
•The Health Visitor and GP were informed and Police
involved.
•A Strategy Meeting was held at BCH under CP procedures.
•A Section 47 Enquiry opened.
•A Social Worker met the family to agree a safe discharge
plan before the baby was discharged to the care of
grandmother.
Mother’s Feedback:
The process was stressful, however, good explanations,
support and information were received from all professionals
involved. Mother was happy with the process and clearly
understood the need for the investigation. She stated that
there was nothing in the process that could have been better.
All professionals involved recognised the need to safeguard
and promote the baby’s welfare and safety.
Mortality
Past Harm
Mortality data is presented in a number of ways, and
an overall picture can only be gained by using a
number of indicators. These are:
•Absolute number of deaths per time period.
•Number of deaths per time period per 1000
admissions.
•Standardised mortality ratio (See next slide)
•Cumulative sum (CUSUM) charts.
•Review of individual deaths.
Inpatient deaths per 1000 admissions
This is a simple calculation to overcome any
variations in admission numbers over time (e.g.
the hospital may have more admissions in the
winter months) or between hospitals of different
sizes.
Data can be compared between
organisations by this method as it allows for
different admission numbers but it is limited as a
tool for comparison as there is no modification
for case mix. The graph on the right shows the
number of inpatient deaths per 1000 inpatient
admissions at BCH since June 2012. Please note
that the data does not include deaths which
occurred in the Emergency Department.
Absolute Number of Deaths
The simplest way to represent mortality is as an
absolute number of deaths in a particular time period;
however it does not take into consideration either the
number of admissions to the hospital or the case mix of
patients. It is useful only as a sense guide to other data
as it has not been modified in any way. Data cannot be
compared between organisations in this format.
16
Deaths
Deaths per 1000 Admissions
14
12
10
8
6
4
2
0
19
Standardised Mortality Ratio (SMR)
In order to account for differences in case mix for different organisations the idea of standardised
mortality ratios has been developed. This attempts to account for differences in patients, such as
diagnosis, age and pre-existing medical problems, and allows for comparisons between hospitals.
A standardised mortality ratio (SMR) is the ratio of the actual number of deaths in a hospital within a
given time period, to the number that might be expected if the hospital had the same death rates as a
larger reference population (e.g. all English Hospitals). The SMR scores can be presented in a number of
ways.
Run Chart
This shows how the standardised
mortality rate of a hospital changes
over time. If there are a small
number of deaths in each time
period then the month to month
variation can be quite wide (as is the
case with BCH where there are on
average 4-12 deaths a month).
20
Bar chart presenting data comparing a number
of hospitals:
This shows the position of an individual hospital in comparison
with its peer group. It is easy to understand but does not give
much information about whether our outcomes are unusual. The
graph presented below shows 6 months’ worth of data rather
than 12 as previously presented.
Our SMR has fallen from 161.77 to 152.83
Movement in last month
Funnel plot
This shows the standardised mortality ratio on the Y axis, and the
number of expected deaths on the X axis. Control limits can be
applied, so that it is possible to see how likely that the variation
from a score of 100 is by chance only. In the example below an
amber dot occurs if there is between a 0.3% (1 in 330) and 5% (1 in
20) likelihood that the score is different from 100 by chance and a
red dot if there is less than a 0.3% likelihood that the score is
different from 100 by chance. Such warnings should be investigated
as to cause. The funnel plot below is presented using 6 months’
worth of data.
We are in the red section of the funnel plot.
21
Deaths in the Paediatric Intensive Care Unit
(PICU)
CUSUM Charts
Another way of representing outcome
data is by cumulative sum charts.
These can be used where there is a
score available to give a risk of
mortality for each individual patient.
Currently this method is in use at BCH
for intensive care.
The charts use data from all patients,
not just deaths, so are more powerful
than SMR in detecting problems.
For BCH, the PICU CUSUM is a good
reflection of overall hospital mortality
as over 70% of deaths at the hospital
occur on PICU. There is no evidence of
systemic care failures which could have
contributed to deaths on PICU.
22
Deaths in Cardiac Services
CUSUM Chart
One of the Trust’s highest risk specialties is Cardiac Services. The nature of the activity means that proportionally
more of our mortality is related to that specialty than others. The team carefully monitors clinical outcomes to
ensure that that we are providing high quality care.
The CUSUM chart is a graphical representation of the outcome data
for the specific procedures which are nationally monitored (70-80% of
our patients fall into this group).
In addition, the team also monitors overall mortality for all surgical
patients. In 2000-2005, the overall mortality rates (30 days postoperatively) was 4.8%. In the period October 2010 – September 2012
this had dropped to 3.3%.
An upward movement in
the chart means that the
outcome for a specific
patient was better than
expected. A large increase
means that the outcome
was significantly better
A downward movement
means that the outcome for a
specific patient was worse
than expected, again the size
of the decrease is a measure
of how much worse the
outcome was than expected
Overall our outcomes are better than
expected. However, please note that
the baseline will be reset on a regular
basis, so we do not expect to move
further and further from the x-axis
23
Item .
Board of Directors
Public Meeting
Thursday 31st July 2014
Enc 03
Strategic Objective/ Enabler
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Performance – June 2014 Performance Report
Sponsoring Director
Deputy Chief Executive
Author(s)
Head of Health Informatics, Performance Manager
Previously considered by
Finance and Resource Committee
Situation
This report provides the June update on this month’s Trust Performance supporting
improving our patient experience. The report highlights where performance is not being met
and any concerns or improvements.
The attachments provide:
•
Further details on our current and comparative performance
Background
There are five areas to highlight:
Access to services
1. Diagnostic waits including MRI
The trajectory for zero MRI breaches by August as reported last month now looks
unachievable with latest forecasts being 32 breaches in July and 30 in August. Breaches
amount to 7% of the total MRI waiting list. All of these are for non-GA.
Additional MRI capacity via a mobile scanner was put in place for June, and whilst this has
helped it has not had as significant an impact as was first envisaged as a number of the
patients booked for it were not suitable for the mobile scanner. It became apparent that the
quality of images was not acceptable eg in some complex cases to meet the clinical need,
hence reducing the number of patients who could use the facility. This impacted upon the
June figures in particular. This and an increased demand have meant we still are forecasting
breaches. Regarding demand, additions to the MRI Waiting List were very high in the last
week of June, at 171 the count was the highest in the last 18 months, and above the upper
confidence interval (see the SPC chart on slide 8)
The mobile scanner is booked again for July. The waiting list has been assessed to make
sure the capacity can be filled with suitable patients. A further booking for September is
planned. In order to further increase capacity, negotiations are currently being undertaken
with Aston University to make use of their 3T Scanner. Of the 32 predicted breaches for July,
16 could potentially use the scanner at Aston. The aim is to get this capacity in place for the
last week in July.
The size of the MRI waiting list has remained steady in June, despite the increased capacity
provided by the mobile scanner. This is due to the increased demand referred to above (15 20% increase in additions.)
Looking at all diagnostic wait breaches, there were 27 patients at the end of June who had
been waiting over 6 weeks for a diagnostic test, (23 for MRI and 4 for CT). The total
breaches amount to 3.1% of all diagnostic waits and this is above the 1% NHS standard.
Regarding MRI breaches alone, the 23 breaches equate to 7% of the waiting list.
Forward look
Recruitment for additional radiographers and radiologists has been successful and a number
of experienced staff have been appointed. This will provide more sustainable capacity from
October 2014, with increased utilisation of the scanner.
The independent review commissioned with a specialist from the Royal College of
Radiologists transformation team is complete and initial findings are as expected. A final
report is due soon which will provide some guidance on how the team works and what
actions can be taken to improve the performance.
As reported above, negotiations are on-going with Aston University, to use their top-of-therange 3T MRI scanner, which will increase routine capacity.
The second CT scanner is now fully operational.
2. 18 weeks waiting time
The 18-week standard was met in June with performance for admitted patients at 90.6%
against the 90% standard. 90 admitted patients and 46 non-admitted patients were not
treated within 18 weeks due to insufficient capacity (136 patients compared to 91 last month
– an increase of 49%).
The performance for incomplete pathways increased slightly to 92.9% against the 92%
standard. The chart on page 6 shows than increasing numbers are waiting over 14 weeks,
and will receive a TCI late in their pathway. This makes it difficult to meet the target and so
this trend is a concern as more breaches are likely.
The number of patients waiting over 30 weeks is 116 (a decrease from 140 last month), 9 of
these had their clock stopped.
There were three patients waiting over 52 weeks, all of whom had patient related pauses
which reduces the wait to below 52 weeks, (with 2 of these below 18 weeks.)
The overall waiting list size showed a small increase which was as expected due to the high
levels of cancellations in June.
Looking forward, based on current assumptions and forecasts meeting the standard in July
will be a challenge and the 18 week waiting time continues to be a risk for the organisation.
Demand for elective services is increasing, with referrals growing including from outside of
the main Birmingham catchment area. The outpatient list size has increased significantly; by
36% from start of April due in part to this rising demand. There have also been some
administrative delays in creating appointments and adding referrals to the list which have
had an impact here. If the additional outpatients also need inpatient treatment it will put
further pressure on the RTT targets.
Regarding the outpatient referrals from outside Birmingham, there has been a 16% increase
in these in Q1 2014/15 when compared with 13/14 average. The Contracting Team at BCH
are intending therefore to raise this with our lead CCG in order to further emphasise the
issue of demand management across associate commissioners.
Nationally there is increased scrutiny on RTT and weekly reporting is now required to
Monitor and Commissioners on our backlog of RTT patients who are awaiting a clock stop.
It has been announced that funding will be made available to support organisations to meet
the targets, although It is not necessarily the case that this amounts to additional moneys
above tariff. Specialities are putting recovery plans in place, and these plans will be
submitted to commissioners.
CAMHS achieved 98.9% for 18 weeks. However the average wait time has increased to 5
weeks due to data catch up.
3. Emergency
The Trust continues to perform well against the 4 hour standard and met the target in June.
The 95th percentile performance was 3.93 hours. This was despite continued high levels of
demand.
The following Emergency Department (ED) standards were not met:
•
The local ED triage objective (all within 15 minutes), the 95 percentile performance
•
being 33 minutes (previous month was 32).
Median time to be seen was 64 minutes (target is 60 minutes).
This report does not normally report patients deflected from ED as we don’t normally have
any of these. However this month 4 patients were transferred. This is as a result of a series
of measures to create capacity in ED on the morning of 11th June, to ensure we could
provide a safe emergency service. The other measures included additional consultant
support in ED and the wards, cancellation of operations, delays in tertiary admissions and
diverting ambulances (except trauma & life threatening cases) to HEFT. The parents of the
transferred children agreed to the transfer and this was to the most appropriate DGH for
them (based on where they lived). The KIDS team supported the transfers.
Utilisation of resources
4. Cancelled operations
In June there were 54 patients or 2.58% of all operations were cancelled on the day due to
hospital reasons. This is more than previous months (at 28) and June 2013. In addition
there were a further 207 patients that had their operation cancelled by the hospital before the
day of the operation. Similar to last month, the total number is above the upper confidence
level and any previous months.
There were seven breaches of the 28 day standard in June. The target is zero except that it
is recognised that there may be breaches due to no PICU capacity. 2 of the breaches were
due to no ward beds, 3 due to no ICU beds and 2 due to emergency cases. Directorates
continue to review how they are managing this target given the relatively small numbers in
the context of the total activity each month.
Of the total of 607 cancellations year to date 158 (26%) were due to no ward bed being
available, 100 (16.5%) were due to emergencies and only 50 (8.2%) were due to no PICU
bed. This compares to 24% of all cancellations being due to no PICU beds for 2013/14 and
14% being due to ward beds.
The Surgical Directorate had 393 (65%) of the cancellations with plastics having 88 (14%),
Paediatric surgery having 73 (12%) and ENT having 69 (11.4%).
33 patients had an operation cancelled more than once by the hospital, with total
cancellations for these patients totalling 80 operations.
Work continues to understand the drivers for the cancellations and bed capacity issues, to
minimise the level of cancellations. One factor is that the classification of cancellations that
are the responsibility of the hospital changed in April 2014 so that more are being counted
as such. For example ‘patient not suitable for op’ now maps to hospital cancelled. In total
this has added 30% to the total number.
5. Long stayers and delayed discharges
Our ability to deliver elective activity has been impacted by the high level of emergencies.
Another factor is the increase in the length of stay. The charts on page 17 of the report
show the profile of those in inpatient beds. The overall number of children staying more than
seven days is increasing, in particular since the last quarter of 2013/14. There is also an
increase in those staying over 30 and 90 days. Some of these will link to the delayed
discharges referred to below whilst others still need treatment in hospital reflecting the
complexity.
Paediatrics is the specialty which has experienced the biggest growth in these longer staying
patients. Prior to Winter 2013 there were on average 15 Paediatrics patients who had been
in the hospital more than 7 days at any one time. During Winter this increased to 30, but
rather than come down since then the number increase so that for May 14 and first half of
June it was closer to 35. The second half of June has at last shown some reduction in the
numbers of long stayers for Paediatrics however, with numbers in the low to mid 20s.
In June there were 4 children (compared to 7 last month and 9 the month before), who were
fit for discharge but waiting for other reasons. One has waited for over a year. This is the
lowest number for some months. The reasons are for housing and social care reasons. The
total number of bed days relating to these delays is 916 days.
In addition there were seven CAMHS patients with delayed discharges (of 817 days). Six
were waiting for placements and/or funding whilst the seventh was waiting on agreement of
funding.
These delayed discharges have been escalated to commissioners.
Update on other areas of performance
Tertiary referrals and Home Referrals
There were seven West Midlands and one out of region patient who couldn’t get a bed in
June. In the longer term, there has been a significant drop in refusals since December 2010
with the numbers fluctuating between 0 and 6 each month, although for June the number of
refusals was 8, higher than normal due to the high demand within the emergency
department.
Twenty nine, of which twenty five were West Midlands patients that were admitted had to
wait over 24 hours before a BCH bed was provided. This was despite continued high levels
referrals and demand for beds.
When a referral is received the specialty consultant is asked to identify the time period in
which the child should be admitted. This is under 12 hours, 12 – 24 hours or 48 hours.
When comparing actual time to admission against recommended time for admission, 81% of
requests were met compared to 87% last month. The decrease is due to demand for beds
from the high Emergency Department attendances.
92% of patients who were assessed as needing a bed within 12 hours were admitted within
the timeframe, again lower than last month’s 99%.
Internal Audit completed their review of this indicator for data quality and have provided
significant assurance. Recommendations and an action plan for their implementation have
been agreed.
PICU (Paediatric Intensive Care Unit) referrals
The West Midlands (WM) PICU service is provided by BCH, University Hospitals of North
Staffordshire NHS (UHNS) Trust and the KIDS (Kids Intensive care Decision Support)
service run by BCH.
Twelve West Midlands (WM) patients and ten non WM patients could not be supported due
to hospital reasons. This is higher than last month due to the increased ED demand already
mentioned.
CAMHS referrals
The CAMHS Tier-4 (Child & Adolescent Mental Health Service) West Midlands service is
provided by BCH and other providers (some private) with BCH providing the assessment of
all requests. Due to capacity and urgency, Twelve patients could not be supported by BCH
CAMHS in June; lower than last month (at 17).
There continues to be significant capacity pressures across the West Midlands and
nationally for Tier 4 beds.
Internally the ERA service has now extended to 7 days a week and this has had a positive
impact providing a more rapid response where needed and ensuring young people receive
support whilst waiting.
Assessment
Continued increases in elective demand have led to an increase in inpatient and outpatient
waiting lists and the waiting times for MRI. The demand is not just from Birmingham, there is
growth from across the West Midlands. Reductions in beds and limited access to services in
other parts of the local NHS are playing a part. The additional demand is putting us at risk of
not meeting our access targets.
Emergency demand is up in ED, and although short stay emergency admissions are down,
longer stay patients for example in paediatrics have been creating pressures on beds. There
has been a resultant impact on cancelled operations.
Plans to reduce delays are noted below.
PICU Capacity:
•
•
We expect a delay to increase beds from 28 to 31 beds. This is predominantly due to
staffing issues in nursing. Therefore there will continue to be an impact on performance.
Commissioners have been informed that a 31 beds position is unlikely until quarter four
of 2014/15.
Recent interruptions in the supply of medical trainees are having a short term impact on
capacity but a range of actions have been put in place to mitigate this risk.
Theatre Capacity:
•
•
•
Weekend working, including lists on Sundays and additional capacity at the Birmingham
Treatment Centre have been in place for some months now.
A Theatre Working Group is in place with a focus on improving staffing levels to maintain
and increase theatre capacity.
A project is underway to look at how we ensure all elective patients undergo pre-
•
•
•
•
admission which will help to reduce the risk of cancellation.
Business case for extending capacity through use of the Plaster room approved, and is
expected to become operational in October 2014.
Newton currently reviewing the flow management through theatres. Their scheduling tool
is planned to go live in early August
In August, there is an intention to expand the use of the laser theatre to support more
emergency lists to stop them overrunning into elective lists.
Are considering the use of a mobile theatre and ward to increase capacity, alongside
other proposals stemming from the work being done with commissioners around
Operational Resilience
Diagnostic waits - MRI capacity:
•
•
•
•
•
•
•
A medium term capacity plan for Imaging is being produced which includes new ways of
working.
New consultants are now in place and more expected to start in September 2014.
Additional lists for GA were agreed both in week and on Saturdays for January and May,
with discussion over this continuing in future months.
Mobile scanner was used in May and June and has been booked for July
Extended working hours agreed with radiographer workforce.
New roster agreed with radiologists.
Investigating use of Aston University Scanner, (which will provide more routine additional
capacity).
The Medium Term Clinical Estates Strategy is being developed to identify future demand
and solutions to meet demand.
Recommendations
The Board is asked to note the performance and plans for further improvement.
Key Risks
Risk Description
Controls
Assurances
Escalating demand for our Discussions
with Maintaining
scrutiny
on
services, potential risk of commissioners to be held performance against various
failing access targets
about demand management RTT targets
Bids against operational
resilience moneys
Insufficient capacity in place Appropriate
escalation
to meet service demands
systems in place
Validation of waiting lists
stepped up
Daily, weekly and monthly
reporting in place.
Specialty recovery plans and Revised capacity plans being
plans for additional capacity produced.
being put in place as part of
response to ‘Operational
Resilience’
Capacity
plans
being
renewed and developed.
This
includes
modelling
capacity/demand
between
now and 2020 (new hospital)
Key Impacts
Strategic Objectives
CQC Registration
outcome)
NHS Constitution
This reports covers progress against meeting the strategic
objectives linked to supporting improving our patient
experience.
(state 4: Care and welfare
Yes – treatment within 18-weeks is a requirement within the
NHS Constitution.
Other Compliance (e.g. Many of the indicators are local or national standards
NHSLA,
Information monitored by the Department of Health, Monitor and our
Commissioners.
Governance, Monitor)
Equality, diversity & human The report considers any particular impact on patients with
learning disabilities, and on different ethnic groups.
rights
Trust contracts
Non-delivery of NHS standards can result in financial
penalties
Other
Meeting the strategic objectives raises the profile of Trust
locally, regionally and nationally
Operational Performance Report
Month 3 2014/15
Performance for June 2014
David Melbourne
Paul Franklin
Pragati Raithatha
Deputy Chief Executive Officer and Chief Finance Officer
Head of Health Informatics
Performance Manager
1
Operational Performance Indicators
How our patients access care
ED - time in ED
18 weeks performance (incomplete)
PICU – non WM patients supported
ED – time to seen
18 weeks performance (admitted)
PICU – non WM patients not supported
ED – Time to triage (all)
18 weeks performance - CAMHS
PICU – WM patients not supported
ED – time to triage (ambulance)
Long waiters - patients not treated within 18 weeks
due to insufficient capacity
MRI waits over 6 weeks
ED – Left without being seen
Long waiters - patients not treated within 30 weeks
In region Tertiary referrals sent elsewhere
ED – Unplanned readmissions
Long Waiters - patients waiting over 52 weeks
Tertiary patients waiting over 24 hours for a BCH
bed
Patient Deflectors
18 weeks performance (non admitted)
CAMHS Patients that requested a T4 bed and were
not admitted
Utilisation of our facilities
Cancelled operations – national definitions
Cancelled operations – breaches of 28 day standard
Cancelled operations – all hospital
cancellations
Cancelled operations - equipment failures or admin
errors
Long stay patients and patients with delays after
being declared fit for discharge
Cancelled operations - patients cancelled
more than twice
2
Operational Performance Report
Month 3 2014/15
Performance for June 2014
How our patients access care
3
Emergency Department
95th % time
in A&E:
3.93hrs
95th % time to
triage (all):
33 minutes
Median time to
be seen: 64
minutes
95th % time to
triage (ambulance):
13 minutes
4 Patients
Deflected
Left without being
seen:
2.17%
ED re-attenders
for related
condition 2.44%
ED overall position: June has been extremely busy for ED. Despite this, we continue to see ambulance patients within target and have met the four hour wait
target for 15 consecutive months and only small numbers of our patients are leaving the Dept. without being seen. It is also pleasing that re-attenders have
reduced compared to the previous month. However three targets have not been met. The target of all patients (not just ambulance patients) having an initial
assessment within 15 minutes is routinely not met, but the target on seeing patients within 60 minutes of arrival was also not met this month by one minute.
This report does not normally report on the final missed target (patients deflected from ED) as there are none. However this month 4 patients were
transferred. This is reported by the relevant Operational colleagues as being part of a series of measures to create capacity in ED on the morning of 11th June,
to ensure we could provide a safe emergency service. The other measures included additional consultant support in ED and the wards, cancellation of
operations, delays in tertiary admissions and diverting ambulances (except trauma & life threatening cases) to HEFT. The parents of the transferred children
agreed to the transfer and this was to the most appropriate DGH for them (based on where they lived). The KIDS team supported the transfers.
Total Time Spent in A&E
Standard ≤ 4 hours (95th Percentile)
% Patients Who Left ED Without Being Seen
Standard < 5%
Time to be Seen
Standard ≤60 minutes (Median)
90
4.70
7.0
6.0
4.50
5.0
4.30
4.0
80
70
60
50
4.10
3.0
2.0
3.90
1.0
3.70
0.0
A M
J
J
A
S
O N
D
2012-13
2013-14
2014-15
Target
J
F M
40
30
20
10
3.50
0
A M
J
J
A
S
O
N
D
J
F
M
A M J
J
A
S
O N D
J
2012-13
2013-14
2012-13
2013-14
2014-15
Target
2014-15
Target
F M
4
18 week waits
Admitted
Non admitted
Incomplete
• 90.6%
• 95.6%
• 92.9%
18 weeks overall position: all targets were met in June 2014. The admitted performance level has decreased compared last
month’s figure of 91.3%. The incomplete pathways remain just above target. 116 patients were waiting over 30 weeks and also the
number of patients receiving TCIs late in their pathway remain relatively high, so the pressure on waiting times is likely to continue
going forward. It is anticipated that meeting the targets in July 2014 will be challenging.
136 patients were not treated within 18 weeks due to insufficient capacity.
Increase in non admitted clock stops from 4 to 46 is mainly due to additional
cardiology clinics to clear waiting patients.
18 weeks admitted performance
94.0%
93.0%
Patients not treated within 18 weeks due to insufficient
capacity
14
10
11
3 patients were waiting over 52 weeks
(All 3 patients had patient related pauses which
reduces their wait to below 52 weeks)
Admitted
Non admitted
112
90 87 90
Jun-14
M
97
May-14
F
Target
118
Jan-14
J
Nov-13
D
4
1
75
Oct-13
N
2014/15
61 56 62
128 118
73
Sep-13
O
105
Aug-13
S
2
8
Jul-13
A
2013/14
Apr-13
J
Mar-13
J
2012/13
4
54
41
25 29
Feb-13
M
42
Jan-13
A
83
Dec-12
86.0%
3
Nov-12
8
0
Jun-13
2
14
87.0%
3
May-13
88.0%
46
4
Mar-14
7
89.0%
12
8
Dec-13
90.0%
Apr-14
14
91.0%
Feb-14
92.0%
The 3 patients waiting over 52 weeks had patient related pauses, which reduces the
wait to below 52 weeks, (with 2 of these below 18 weeks).
5
18 week waits
Fig 1 - % still waiting for clock stop (incomplete)
under 18 weeks
Fig 2 - 18 Weeks: Current problem, future problem
600
100.0%
500
98.0%
400
96.0%
94.0%
300
92.0%
200
90.0%
100
88.0%
M
2012/13
J
J
A
2013/14
S
O
N
D
2014/15
J
F
M
Target
0
02.06.13
16.06.13
30.06.13
14.07.13
28.07.13
25.08.13
08.09.13
22.09.13
06.10.13
20.10.13
03.11.13
17.11.13
01.12.13
15.12.13
05.01.14
19.01.14
02.02.14
16.02.14
01.03.14
16.03.14
30.03.14
13.04.14
27.04.14
11.05.14
01.06.14
22.06.14
A
Performance for patients still waiting for their initial treatment (either admitted or non admitted pathway) has increased slightly since last month to
92.9% being within 18 weeks (Fig 1.)
Regarding patients waiting for an admission (Fig. 2), the green line, (which is the total of the red and blue lines) illustrates the overall potential
problems we have in managing our 18 weeks admitted demand; this showed a large increase in December 13 and has steadily decreased until
March, but is now higher than December 2013 levels.
The blue line illustrates patients with a date to come in who are already over 18 weeks or whose TCI date is over 18. The red line illustrates patients
who are waiting 14 plus weeks and do not have a TCI date yet. Both these are increasing and therefore the challenge of meeting 18 weeks for our
admitted patients continues to grow.
6
Whole Inpatient waiting list and long waits
Whole Waiting List Size (not just RTT
patients)
116 RTT patients either still waiting or
whose clock stopped after 30 weeks
8000
7000
All Patients Still Waiting or Whose Clock Stopped
Over 30 Weeks
160
6000
Specialty break down of the 107
patients still waiting over 30 weeks
140
5000
120
4000
100
3000
80
2000
60
40
20
Inpatients
Surg/Cardiac Inpatient
Outpatients
The overall waiting list for surgical and cardiac stands
at 2111, with the total inpatient list standing at 3554.
The Cardiac/Surgical list was reducing since the new
calendar year but has increased slightly in the last 3
months. The outpatient list size has increased
significantly (36%) from start of April due to a mix of
rising demand, short term reduction in capacity and
admin errors. Specialities are putting recovery plans
in place.
73
94
109
116
99 107
At end of June, there are still 116 patients
waiting over 30 weeks (either still waiting or
who had their clock stopped in the month).
Of the 116 patients 9 had their clock stopped
over 30 weeks and 107 are still waiting.
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
0
Jul-13
03/06/2014
03/05/2014
03/04/2014
03/03/2014
03/02/2014
03/01/2014
03/12/2013
03/11/2013
03/10/2013
03/09/2013
03/08/2013
03/07/2013
03/06/2013
0
54 49 54 57 61
Jun-13
1000
140 140
Cleft Lip & Palate
Surgery
Paediatric Burns
Care
Paediatric Cardiac
Surgery
Paediatric
Cardiology
Paediatric
Dermatology
Paediatric Ear
Nose and Throat
Paediatric
Neurosurgery
Paediatric
Ophthalmology
Paediatric Plastic
Surgery
Paediatric Surgery
Paediatric
Thoracic Surgery
Paediatric Trauma
and Orthopaedics
Paediatric Urology
Paediatrics
Grand Total
1
2
2
16
1
24
4
1
25
10
1
15
4
1
107
7
Diagnostic waiting lists
Diagnostic waits overall position: we continue to fail to
meet our key target for MRI. However June breaches are
much lower than previous months. Demand continues to be
high.
The charts below illustrate that demand for diagnostic test continues to be high and
the waiting list is showing a slight decrease. There is a switch in the make up of the
list towards non GA.
MRI Waiting list
Number of patients waiting over 6 weeks for MRI (actual
and forecast)
123
107 101 106
88
101
500
Aug-14
32 30
Jul-14
Jun-14
May-…
Apr-14
Mar-…
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
May-…
23
NON GA WL
1000
0
71
45 51
GA WL
2012-03-…
2012-04-…
2012-05-…
2012-07-…
2012-08-…
2012-09-…
2012-10-…
2012-11-…
2012-12-…
2013-01-…
2013-03-…
2013-04-…
2013-05-…
2013-06-…
2013-07-…
2013-08-…
2013-09-…
2013-11-…
2013-12-…
2014-01-…
2014-02-…
2014-03-…
28/04/20…
29/05/20…
2014-06-…
97
Patients
139
133
115
Total WL
1500
The MRI service continues to be under significant pressure, but
actions to manage the position are starting to show results, with 27
patients breaching the 6 week target in June 2014 (23 for MRI and 4
for CT scan.) The forecast position for July is 32 breaches. A nil
breach position is now expected to be reached in September, as
whilst the capacity is there, it cannot all be utilised as some patients
are not suitable for treatment on the mobile facility. However other
options such as the use of a scanner at Aston University are being
investigated which should reduce the predicted breach position.
The SPC chart (right) on total waiting list additions shows that levels
of additions remain high. The most recent complete week is well
above the upper confidence interval of the SPC chart. Demand is a
continuing factor in the achievement of this target.
8
Access to CAMHS
Community CAMHS
Breakdown of Waiting Time to Assessment
CAMHS 18 Weeks Performance
A:- 0-4 wks
105
100%
100
95
90
80%
364
708
60%
952
40%
85
20%
80
B:- 4-8 wks
C:- 8-13 wks
D:- >13 wks
382
361
36
237
1059
755
852
870
766
1465
1117
873
2010/2011
2011/2012
2012/2013
1210
0
76
50
390
0%
75
Apr
May
Jun
Jul
2012/13
Aug
Sep
Oct
2013/14
Nov
Dec
Jan
2014/15
Feb
Mar
2014/2015
CAMHS are now assessing more of their patients within four weeks
(76% so far in 2014/15 compared with 52% in 2013/14.) Data catch-up
exercise in the department shows that the average wait is now 5 weeks
from 4 weeks in 2013/14, and 8 in 2012/13. The overall level of
assessments has reduced over time following the introduction of
improved protocols for the management and assessment of referrals.
Target
CAMHS continue to achieve their 18 week target with 98.9% of patients
seen within target in June.
CAMHS Patients that requested a T4 bed and were not admitted
(month trend)
18
2013/2014
CAMHS Tier 4 Gateway Referrals
The no has reduced to 12
16
Total No Referrals
14
GA Completed
Referred to SCT
40
12
30
10
20
8
6
10
4
0
2
0
Apr
May
Jun
Jul
Aug
2012/13
Sep
Oct
2013/14
Nov
Dec
2014/15
Jan
Feb
Mar
Tier 4 referrals (in blue) and gateway assessments (the red line) are
decreasing since the start of this year and patients not able to access a
bed and are referred to the Specialised Commissioning Team has 9
decreased in June to 12 (from 17 in May).
Urgent Tertiary and Home Referrals
179 referrals for
specialist beds,
150 admitted
7 in region
patients unable to
get a bed
1 out of region
patients unable to
get a bed
21 patients no
longer required a
BCH bed
25 in region patients
waited over 24 hours
to get a BCH bed
4 out of region waited over
24 hours to get a BCH bed
Overall position: Tertiary and home urgent referrals in June at 179 is lower than past three months. 8 patients were unable to get a bed and
29 patients waited over 24 hours (further detail for these 2 indictors about in and out of region is provided above). 81.3% of requests were
met within the required clinical timescale.
Activity levels
The level of urgent
referrals is lower this
month than for the past
three months.
Urgent Tertiary and Home Referrals
250
200
150
100
50
0
175
186
199
175
170
188
191
172
182
Home
Waiting time vs. clinical target
time
Clinicians can request the patient to be
admitted in up to 48 hours, dependent on
their assessment. The graph shows the
timescales requested for admittance and
time of decision to admit.
Overall 81.3% of requests were met in June
(compared to 87.5% in May). This
percentage has reduced since May due to
the high admissions during this month via
the Emergency department, resulting in less
beds and delaying of tertiary patients
197
177
188
Tertiary
181
225
173
163
169
209
217
Total
Performance vs clinical target time for patients provided a bed - home and tertiary referrals - June 14
80
70
60
50
40
30
20
10
0
100%
92%
81%
80%
57%
60%
40%
20%
0%
within 12 hours
Met
12-24 hours
Up to 48 hours
Target Time
Not met
% patients meeting tgt time
10
Urgent Tertiary and Home Referrals
Referrals Sent Elsewhere
Referrals Waiting over 24 Hours
8 referrals were sent elsewhere in June 14. Referrals sent
elsewhere for 14/15 is now 50% of the entire 13/14 financial year
total, indicating that the management of these urgent referrals has
been challenging.
The number of children waiting over 24 hours for a bed
after a tertiary referral is close to the average. Referrals
were lower this month. 81.3% of referrals were managed
within the clinical target time, which is lower than last
month (87.5%), due to high Emergency Department
demand.
Tertiary and Home Urgent Referrals Sent Elsewhere
Paediatrics
Trend - Tertiary and Home Referrals Waiting Over 24
Hours for a Bed
T&O
50
Plastic
45
Surgery
40
35
Resp Med
30
Neurology
25
Nephrology
20
Medical Oncology
15
ENT
10
5
Clin Haem
0
Jun-14
lower ci
Apr-14
Avge
Feb-14
Over 24 Hr Waits
Dec-13
20
Oct-13
15
Aug-13
YTD 14/15
10
Jun-13
5
Apr-13
0
Feb-13
Hepatology
Dec-12
Oct-12
Cardiology
upper ci
Tot 13/14
11
PICU Demand and KIDS Service
10 non West Midlands
patients could not be
supported
12 West Midlands patients
could not be supported
4 additional non West Midlands
patients were supported
PICU demand overall: Referrals
are higher than previous month. 22 patients could not be supported within the local network and
had to be taken out of region, due to the exceptionally high demand for beds.
Year on Year Comparison of Total Referrals to KIDS
300
There were 128 referrals to KIDS in June 2014. 22% of referrals
were avoided , 37% were admitted to BCH, 24% were referred to
other WM hospitals and 17% went out of the region.
200
100
Referrals to KIDS Service Taken Out of Region
0
(Leics or Other Non WM Provider)
Apr
May
Jun
Jul
Aug
2012/13
Sep
Oct
2013/14
Nov
Dec
Jan
2014/15
Outcome of Referrals to KIDS - Trend
Feb
Mar
30
25
20
70%
15
60%
10
50%
5
40%
0
Total
Avge
Jun-14
Apr-14
Feb-14
Dec-13
Oct-13
BCH
Out of Region
The red line shows that BCH took
fewer referrals in the first part of
Winter 2013, but is now able to
return to a more normal level,
albeit with a relatively low level in
June 14. With avoided admissions
also low in June 14, out of Region
admissions ended up being the
highest in recent months
Aug-13
Avoided Admission
UHNS and Other WM
Jun-13
0%
Apr-13
10%
Feb-13
20%
Dec-12
Oct-12
30%
For the winter periods patients
are more likely to be taken out of
Region. However in recent months
due to high demand for beds,
more patients have been taken
out of region.
12
Operational Performance Report
Month 3 2014/15
Performance for June 2014
Utilisation of our facilities
13
Cancelled operations trends
Cancelled operations overall position: the number of cancelled operations flagged as nationally reportable in June 2014 is 54
and is above average. Total hospital cancellations at 261 are high compared to previous month (169) and we remain above our strategic
goal of a reduction on 12/13 levels. There were seven breaches of the 28 day standard in June.
There were 54 nationally reportable* cancelled operations in June 14,
which is above the average.
* Cancelled by hospital for non medical reasons on the day of admission or after admission
Nationally Reportable
Cancellations by Reason
Total Hospital
Cancelled
Operations at
261 are well
above the upper
confidence
interval in June
14.
Total
ICU/HDU beds unavailable
11
Bed shortage
30
Emergency/Trauma
7
Staff unavailable
1
Lack of theatre time
5
Total
54
There were 7 breaches of
the 28 day standard in
June 2014. 3 T&O, 2
Surgery, 1 Cardiac Surgery
and 1 Plastics. Reasons
are the same as last
month - bed shortages,
accommodating more
urgent patients and
general high levels of
demand.
14
All Hospital cancelled operations year to date by specialty
All Hospital cancelled operations year to date by reason
The hospital has cancelled 607 operations so far in 2014/15. The Surgical Directorate have the most cancellations (393 – 65%) with Paediatric
Surgery and Plastics being the largest single specialties. The biggest reason for the cancellations is due to bed shortages. This month 65
cancellations were due to bed shortages.
15
Multiple cancellations
In June 2014 33 patients had an operation cancelled who had
previously had an operation cancelled at least once in the same
specialty in the previous 12 months. These 33 patients had 80
cancellations between them in total in the previous 12 months
in the relevant specialty.
Strategic objective: Year to date hospital cancelled
operations are running 351% higher than the equivalent
year to date figure for 2013/14. (Target 10% reduction)
Classification changes account for this in part.
Strategic Objective – patients cancelled more than twice
(Hospital Cancellations Only)
Eight patients had an operation cancelled in June 2014 for the
third or more time (NB cancellations have to be in the same
specialty and in the previous 12 months to be counted)
Strategic objective: In June 2015, 10 operations were cancelled
due to admin error, and 7 due to equipment failure or
unavailability (Target is zero)
16
Fit For Discharge Days
Long Stay Patients
CAMHS - Long Stay Patients at end of June - Fit for Discharge Days
Figure 1 illustrates the trend in various cohorts of long stay patients. There is
an increasing number of these patients in the hospital, as can be seen by the
trend lines illustrating the numbers over 7, 30 and 90 days at any particular
point in time.
As we have more of these patients and they stay for longer, there is an
impact on the number of beds available to manage the hospital’s elective
flow for example.
Patient 7
Patient 6
Patient 5
Patient 4
Patient 3
Patient 2
Patient 1
0
100
200
300
400
500
The area with a particular increase is Paediatrics emergency patients
Before fit for discharge
Trend in Long Stay Patients
After fit for discharge
7 CAMHS patients were fit for discharge at end of June. 2 were waiting for adult
placements and funding to be available, 4 were waiting placements and one was
waiting for agreement of funding. In total these seven cases have been fit for
discharge for 817 days.
140
120
Long Stay patients at end of June - days fit for discharge
100
80
Patient 3
60
Patient 1
0
100
200
300
400
500
600
40
Before fit for discharge
20
04/07/2013
17/07/2013
30/07/2013
12/08/2013
25/08/2013
07/09/2013
20/09/2013
03/10/2013
16/10/2013
29/10/2013
11/11/2013
24/11/2013
07/12/2013
20/12/2013
02/01/2014
15/01/2014
28/01/2014
10/02/2014
23/02/2014
08/03/2014
21/03/2014
03/04/2014
16/04/2014
29/04/2014
12/05/2014
25/05/2014
07/06/2014
20/06/2014
0
Sum of GT7
Sum of GT30
Sum of GT90
After fit for discharge
4 patients were waiting for discharge at end of June, the lowest number for
some months. Three patients were waiting for a care package (with one of
these also waiting for housing and one having social issues). The fourth patient
is waiting for housing (which won’t be available until September 2014). In total
these 4 patients have been fit for discharge for 916 days. Assuming an
average length of stay (excluding day cases) of 4 days, another 229 patients
could have been seen at the hospital if these patients had been discharged, as
they became fit .
17
Board of Directors
Public Meeting
Thursday 31 July 2014
Enc 04
Strategic Objective/ Enabler
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Resources report period 1st April 2014 – 30th June 2014
Sponsoring Director
Chief Finance Officer
Author(s)
Director of Finance and Procurement, Chief Officer for
Workforce, Head of Informatics
Previously considered by
Finance and Resource Committee
Situation
This report is to communicate the various aspects of Trust performance in the financial
year to date, period ending 30 June 2014, and to identify any key risks that are evident
within the organisation.
The contents of this report will form the basis of the Trust’s Quarter 1 (Q1) Return to
Monitor.
The Trust is also required to report its predicted status for Governance and Mandatory
Services.
Background
The Trust is required to comply with the finance related legal issues contained within our
Terms of Authorisation as well as other key financial targets. This includes:
•
•
Not breaching the Private Patient Cap (a legal requirement);
Performing at plan for Monitor’s Continuity of Service Risk Rating leading to an overall
CoSRR of 4;
•
Minimising triggering the additional financial indicators; and the
•
Risk Assessment Framework, which may result in formal discussions with Monitor.
Delivery against these targets is driven by:
•
•
The volume and mix of demand experienced by the Trust; and
How the Trust uses its most valuable resource, its staff, in responding to that
demand.
The report explores each of these areas in turn and the impact on the financial position
and performance.
Assessment
Monitor Declarations
The key ongoing governance issue which impacts upon the Trust’s Monitor Governance
rating is the performance against the 18 week target for admitted patients. Performance
in month was 90.6% ie just above the 90% threshold. This and the continuing level of
performance of the other metrics enable the Trust to forecast a Green Governance rating.
From a financial perspective the ratings will be a 4 under the Continuity of Service Risk
Rating. Under the old Compliance Framework a FRR of 4 would also have been
reported. These remain strong performances.
The Trust will soon be undertaking its Q1 and 2014/15 5 Year Plan Conference Call with
Monitor and this will help formulate feedback on both these submissions.
Activity
Activity performance in the year to date against plan and compared to 2013/14 is as
follows:
Activity Type
Against Plan
Against 2013/14
Emergency Department
+6.9%
+6.9%
Emergency/Non-Elective
-5.3%
-11.7%
Planned Care
+1.1%
+2.6%
Outpatients
+1.8%
+2.8%
From a financial perspective income has underperformed by a further £0.8m in the
month. The level of cancelled operations and the causes of these cancellations as
reported in the Performance Report are instrumental in this.
Workforce
Demand remains high and this has brought into sharp focus the short to medium term
capacity issues faced by the Trust. Sickness levels decreased in the month and stood at
3.3%. The cumulative rate remained static at 3.6% meaning both measures remain
above the Trust’s 3% target.
The combined substantive and bank staff level decreased in June by 16wte. Bank use
dropped by 15wte whilst substantive staffing reduced by 1wte. Compared to June 2013
substantive wte have increased by 5% whilst Bank Staff has decreased by 13%.
Engaging with staff, especially during periods of pressure, is important and appraisals are
one indication of how well this is working in the Trust. The reported appraisal rate has
dropped below 77% in the last month and remains short of the 90% target.
Finance
The end of the first quarter sees the Trust continuing to perform slightly below plan. An
in-year surplus of £1.8m sounds strong. However, it falls short of the plan submitted to
Monitor, is well below the levels reported in the final 6 months of 2013/14 and we have to
be mindful that the plan we set was at the lower-end of expectations.
Controlling the costs of care that we provide remains central to our financial success as
downward pressure continues on the tariffs we are paid. Our savings levels are below
target in June although we have started the year more strongly than in 2013/14. The key
areas of shortfall are within trust-wide schemes (contract penalties and drugs) and it is
vital that all trust-wide schemes are delivered given that these constitute 50% of the plan
this year. We have to secure the level of savings that we anticipate this financial year to
ensure affordability of the Next Generation project and having plans exceeding 100% of
our target is a positive move to achieving this. A detailed review of CIP performance will
be undertaken at the July Performance Board.
The key issue financially in Quarter One has been the impact of cancelled operations on
clinical income, which is £1.9m under target. This is clearly unsustainable.
Our cash balances have once again dropped below plan. The June plan was the highest
ever cash balance planned for the Trust and due to a delay in receiving payment for
some 2013/14 year-end invoices we have fallen short of this.
The Capital Programme was ratified by the Finance and Resource Committee in July.
Quarter Two will now see higher levels of expenditure being incurred.
Recommendations
The Board review, discuss and approve the Resources Report.
The Board of Directors is asked to approve a forecast Governance (Green) and
Continuity of Service Risk Rating (“4”) for inclusion in the Monitor Q1 Return, which must
be submitted by July 31.
Key Impacts
Strategic Objectives
Staff and finance are key enablers to meeting the Trust’s strategic
objectives.
CQC Registration (state
outcome)
N/A
NHS Constitution
NHS Constitution has a pledge regarding 18-week waits.
Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Monitor metrics are considered in the report.
Equality, diversity & human
rights
N/A
Trust contracts
N/A
Other
N/A
Resources Report
July 2014
Phil Foster
Theresa Nelson
Paul Franklin
Director of Finance and Procurement
Chief Officer for Workforce
Head of Informatics
1
Reporting on resources use
1. Summary
2. Monitor Assessments and Declarations
3. Volume and mix of activity
4. The impact on our workforce
5. Financial Performance Summary
2
Summary.
June 2014
The end of the first quarter sees the Trust continuing to perform slightly below plan. The year to date surplus of
£1.8m is a strong position but it does fall short of the plan submitted to Monitor and is also below the run rate
reported in the second half of 2013/14.
Achievement of the Trust’s planned £4.4m surplus is expected. However, the plan was widely accepted as being
a downside case which makes the continued underperformance a worrying scenario.
The operational difficulties at the Trust with regards to PICU and acute bed capacity, with increasing numbers
of long stay patients, are leading to high levels of total cancelled operations. This is having a direct impact on
clinical income, which is 3.4% below plan. Should this continue it will become financially unsustainable for the
Trust.
Controlling the costs of care that we provide remains central to our financial success as downward pressure
continues on the tariffs we are paid. Our savings levels are below target in June although we have started the
year more strongly than in 2013/14. It is crucial that the trust-wide schemes are delivered but these too are
being impacted by the operational difficulties being experienced. We have to secure the level of savings that
we anticipate this financial year to ensure affordability of the Next Generation project and having plans
exceeding 100% of our target is a positive move to achieving this.
Bank usage in June was 13% lower than the equivalent period last year although substantive staffing levels are
4.8% higher. Appraisal rates have reduced further and are now under 78%. In-month sickness reduced by 0.45%
to 3.33%. This is its lowest level since September 2013. Year to date sickness has remained static at 3.56%.
Our cash balances although remaining strong have dropped below plan. Cash received during June has not
included significant year-end contracting debts, the largest of which is £1.25m with NHS England.
The Capital Programme has been formally ratified by the Finance and Resource Committee with prioritised
schemes now identified.
3
2. Monitor Assessments and Declarations
4
Our month 2 regulatory position remains strong.
Quarter 4 - 2013/14
The predicted ratings for Quarter 4 reported
to the Board in April 2014 have now been
confirmed by Monitor.
Monitor Quarter 4 2013/14 (Confirmed)
Finance risk rating - Continuity of Service Risk Rating
Governance risk rating
Finance risk rating - Compliance Framework
Plan
Actual
G (4)
G (4)
G
G
G(4)
G(4)
Month 3
Monitor Quarter 1 2014/15 (Predicted)
Based on this performance the predicted
measureable Month 3 performance is Green.
The Continuity of Service Risk Rating for June
is a 4 (the highest level).
Finance risk rating - Continuity of Service Risk Rating
Governance risk rating
Finance risk rating - Compliance Framework
Plan
Actual
G (4)
G (4)
G
G
G(4)
G(4)
For information under the old Compliance
Framework regime a FRR of 4 would have
been reported in Month 3.
The above will result in the Trust achieving its
planned Risk Ratings for 2014/15.
5
3. Volume and Mix of Activity
6
Emergency activity profile
ED attendances
Emergency
Department
(ED)
attendances are slightly lower
than the previous month but have
increased by 6.9% YTD compared
with last year. There was a 7.9%
increase on the June 2013 figure.
Activity is also 6.9% above plan in
14/15 so far.
6000
5000
4000
3000
2000
1000
0
A M
J
2011/12
J
A
S
2012/13
O
N
D
J
F M
2013/14
2014/15
2014/15 Emergency department
activity against plan
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
J
J
A
S
2014/15 actual
O N
D
J
F M
2014/15 plan
2000
1500
1000
500
0
A M
Despite the additional ED demand,
emergency FCE activity in month
has decreased by 5.0% compared
with June 2013 and shows a
decrease of 11.7% in YTD figures
compared to the same period last
year.
Emergency FCE activity is 5.3%
behind plan YTD, with June activity
levels being 6.8% lower than
planned.
A M
Emergency /Non Elective FCEs
The main reason for this change is
the large reduction in the number
of zero day length of stay patients
being admitted from the ED
Department and assigned to the
A&E specialty as an admission –
these are 20% down on plan. ENT,
Trauma and Oncology show 10% +
increases versus plan.
J
2011/12
J
A
S
O N
2012/13
D
J
F M
2013/14
2014/15
2014/15 Emergency/non elective FCEs
activity against plan
1800
1600
1400
1200
1000
800
600
400
200
0
A M
J
J
A
2014/15 actual
S
O
N
D
J
F M
2014/15 plan
7
Planned activity profile
All elective FCEs
2014/15 All Elective FCE activity against plan (incl Reg
Day Admissions)
3000
3000
2500
2500
2000
2000
1500
1500
1000
1000
500
500
0
0
A
M
J
2011/12
J
A
2012/13
S
O
N
2013/14
D
J
F
2014/15
M
A
M
J
J
A
2014/15 actual
S
O
N
D
J
F
M
2014/15 plan
Elective activity in June was 2.6% higher than in June 2013 and YTD activity also shows a 2.6% increase over 2013/14.
Elective activity is now 1.1% above plan YTD, however activity was 1.7% below plan in June 2014.
Although the overall variation against plan is quite small at this stage of the higher volume specialties Paediatric Surgery is
showing an 11% increase, and Medical Oncology a 17% increase
8
Outpatient activity profile
New OP attendance
Outpatient Procedures
4000
3500
3000
2500
2000
1500
1000
500
0
June 2014 saw a 5.2% increase for
new attendances and 5.0% increase
for follow up patients when
compared with June 2013.
YTD activity shows that new
attendances have decreased by
1.0% and follow ups YTD have
increased by 4.2% when compared
to 2013/14.
A
M
J
J
2011/12
A
S
2012/13
O
N
D
J
2013/14
F
M
2014/15
Follow up OP attendance
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
Outpatient procedures performed
in June are 46.7% higher than for
June 13 and 38.1% higher than for
same period in 2013/14. There has
been in increase in the level of
diagnostic coding in outpatients
which may be impacting here.
Against plan, all outpatient activity
was 0.7% below plan in June 2014
and overall 1.8% ahead of plan YTD.
A
M
2011/12
J
J
A
2012/13
S
O
N
2013/14
D
J
F
M
2014/15
For new attendances against plan
the largest areas of growth are
Orthopaedics (10%), and Cardiology
(26%). For follow ups the biggest
areas of growth are Paediatric
Surgery (28%) and Oncology (23%).
For procedures Cardiology and ENT
are both over plan significantly for
both activity and income.
1200
1000
800
600
400
200
0
A
M
2011/12
J
J
A
2012/13
S
O
N
D
2013/14
J
F M
2014/15
2014/15 outpatient activity against
plan (excl AHP CNS and Phone)
16000
14000
12000
10000
8000
6000
4000
2000
0 excludes AHP, CNS and phone attendances
Activity
A M J J A S O N D J F M
2014/15 actual
2014/15 plan
9
4. Workforce
10
Workforce Report Summary June 2014
Sickness Summary – In month sickness has decreased to 3.33%, which is higher than this time last year. Long term sickness (%) has
decreased slightly to 2.21%, these staff are being supported through our processes. Short term sickness has decreased slightly to 1.09%
during May 2014.
The top 3 reasons for sickness during May are Anxiety/Stress (760.58 WTE days lost), Musculoskeletal (656.55 WTE days lost) and
Gastrointestinal (282.85 WTE days lost). There is some evidence to suggest that gastrointestinal absences are linked to stress related
absences (e.g. IBS exacerbated by stress).
The majority of stress sickness absence episodes are due to personal circumstances, for example bereavements, change in family
circumstances, financial pressures and carer responsibilities. However where work related factors are identified, these are addressed by
way of individual stress risk assessments, OH referrals, signposting to the Trust’s support mechanisms and regular 1:1s with managers as
appropriate.
Bank/Agency Usage – There has been a slight decrease of 14.82WTE during June 2014 to 160.91 WTE, compared to May. Admin usage has
decreased slightly by 0.36 WTE, however it continues to be high in the Medical Secretary profession (17.22 WTE) and also in Health Records
(12.61 WTE).
Top 3 Clinical departments using bank are:
• PICU (20.75 WTE) to cover vacancies and maternity leave. Advertised vacancies June 14 (30.4WTE). 6 WTE awaiting clearances
• Theatres (12.86 WTE) to cover vacancies. No jobs advertised in June. 1WTE awaiting clearance.
• PAU (6.98 WTE) – Increased usage due to sickness, covering maternity and specialist skills required.
PDR Summary - PDR % remains below 80%. This has been highlighted as a priority and Directorates are identifying hotspot areas, sending
out email reminders to managers and supplying their DMT’s with monthly figures.
Turnover Summary -12 month Turnover % for the Trust has decreased for the 12 month period ending June 2014 but remains above the
Trust KPI (9%) at 10.89%. All Directorates with the exception of Surgery have a 12 month turnover % above the Trust 9% KPI target.
11
Workforce Dashboard
Trust
Target
CSS
Medical
Specialised
Surgical
CAMHS
Corporate
Trust (Previous
Month)
Trust (Current
Month)
<3.00%
3.58%
4.65%
3.63%
3.02%
2.98%
2.84%
3.56%
3.56%
▬
<3.00%
3.47%
4.48%
2.36%
3.21%
3.48%
3.00%
3.78%
3.33%
▼
85
111
88
70
38
59
449
451
▲
LT Sickness %
2.23%
3.16%
1.45%
2.02%
1.94%
2.42%
2.39%
2.21%
▼
ST Sickness %
1.24%
1.33%
0.92%
1.19%
1.54%
0.58%
1.39%
1.09%
▼
£44,909.07
£75,483.39
£38,451.87
£29,108.14
£27,917.18
£31,479.14
£275,233.77
£247,348.79
£102,453.57
£154,056.12
£86,667.23
£58,839.97
£51,196.88
£69,368.79
£275,233.77
£522,582.56
546.29
901.37
558.82
439.66
312.07
502.40
3580.90
3260.61
▼
81.25%
84.11%
80.04%
79.57%
68.40%
66.43%
78.75%
77.44%
▼
Starters FTE
4.00
5.40
7.00
4.80
1.40
9.49
44.83
32.09
▼
Leavers FTE
3.40
6.20
12.60
0.80
3.00
4.67
35.85
30.67
▼
9.20%
10.63%
12.31%
8.42%
12.45%
12.07%
11.10%
10.89%
▼
▬
Indicator
Sickness % (YTD)
Sickness %
(Month)
Episodes
Cost of sickness
Cost of sickness
YTD
FTE days lost
sickness
PDR's %
Rolling Turnover %
90%
<9%
Trend
In Month Turnover
%
Headcount
WTE in post
0.71%
0.90%
0.96%
0.21%
0.81%
0.36%
0.69%
0.69%
579
511.28
715
652.26
830
761.97
469
431.95
316
283.87
575
532.46
3483
3174.96
3484
3173.79
Active Recruitment
3
18
12
11
12
21
58
77
▲
5.73
38.33
40.35
23.53
9.10
43.87
175.73
160.91
▼
3.63%
4.68%
3.64%
4.42%
4.25%
1.77%
3.57%
3.70%
▲
5
17
14
9
5
4
61
54
▼
2
n/a
Bank Usage
Maternity Leave %
Staff in Difficulty
Org Change
Please note that sickness is still one month behind so we are currently reporting on Mays data
Current months WTE may be slightly lower due to new starters from the 2nd induction still being inputted onto ESR.
Employee Relations - On going or started during reporting month
Consultant Appraisals % is now a rolling 12 month figure
Turnover % is based on permanent staff leavers only
0
0
1
0
0
1
2
12
Sickness Absence
BCH Monthly Sickness %
Long and Short Term Sickness %
4.00%
3.50%
3.00%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2.50%
2.00%
13/14
1.50%
14/15
1.00%
Trust Target
0.50%
0.00%
2.21%
2.23%
1.09%
1.24%
3.16%
1.45%
2.02%
1.94%
1.19%
1.54%
2.42%
Long Term Sickness
BCH Trust
Sickness
1.33%
0.92%
284 Dir 1 284 Dir 2 284 Dir 3 284 Dir 4 284 Dir 5
Clinical
Medical Specialised Surgical
CAMHS
Support Directorate Services Directorate Services
Services
Short Term Sickness
0.58%
284 Dir 6
Corporate
BCH Sickness Comparison
13/14
April
May
June
2.85%
3.13%
3.78%
3.33%
July
3.39%
August
3.58%
3.22%
September
October
November
December
January February
March
3.36%
3.74%
3.65%
3.43%
3.73%
3.76%
3.77%
14/15
BCH Sickness Absence - May 2014
BCH Total
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHS Services
Corporate
Number of
Episodes
Monthly
Sickness %
Cumulative 12
Month Sickness
%
451
3.33%
3.56%
85
3.47%
3.58%
111
4.48%
4.55%
88
2.36%
3.63%
70
3.21%
3.02%
38
3.48%
2.98%
59
3.00%
2.84%
With the exception of CAMHS all other Directorates have seen a decrease in their sickness %
between April and May which has helped the Trust sickness % decrease from 3.78% to 3.33%
The Medical Directorate continues to have LTS cases, 4 due to employee relations cases and the
remaining due to MSK and long term health conditions. Sickness Management interventions
continue to be managed tightly.
• Sickness continues to be high on Ward 2, Complex Care and Haem/Onc .
• Review meetings with all dept/ward managers scheduled for July and each quarter thereafter.
.
PICU has seen a reduction in their sickness absence figures. In March 2014, the absence was 4.7%,
April 14 was 3.2% and May 14 has reduced further to 2.8% (Trust target is 3%). In February 2014,
there were 11 long term sick cases which has reduced to 3 in May 2014.
CAMHS – There has been an increase in sickness from 2.77% in April to 3.52% in May. This is due to
an increase in LTS cases due to work related injury and employee relations cases.
13
Sickness Absence/Stress Audits
A management of stress audit process has been developed in order to assess compliance with the requirements set out in the management of stress
policy and reduce stress related sickness. There were 10 hotspot areas identified based on workforce KPI areas and have piloted a sickness
absence/stress audit. PICU was identified as the pilot area by triangulating high sickness absence, high numbers of staff reporting stress, PDR rates and
number of leavers etc.
This data has been reviewed at SWC and will continue to be monitored
through this group
Stress Risk Assessments (SRA)
(staff members off sick with stress related issues –
Jan to May 14)
Compliant – Manager completed a stress risk
assessment within required timeframe
Non Compliant - Manager didn't complete a stress
risk assessment or within the required timeframe
Total Stress Risk Assessments requested
This Audit did not include the 19 staff members
with less than 5 days off work with Stress
Total number of staff off sick with stress
Stress Risk Assessments
(staff members who are have not taken time off
sick with stress related issues)
Number of SRA completed for staff who have said
they are stressed but have not gone off sick
Figures
52
40
92
19
111
Figures
30
•68 of the 92 cases audited were due to work-related
stress.
• 27 of the 52 individual stress risk assessments also had
completed action plans to manage/minimise stress which
is an improvement on the previous audit Jan – Dec 2013.
•There were 30 stress risk assessments completed for staff
who said they are stressed but who have not gone off sick.
This figure indicates that managers are now identifying
staff members stress at an early stage, which means that
proactive signposting or support interventions can be put
in place.
Case Study: PICU
There has been significant engagement from the PICU Senior team for the audit
and the majority of the actions identified are now in place. The department has
already begun to see a reduction in their sickness absence figures. In March 2014,
the absence was 4.7%, April 14 was 3.2% and May 14 has reduced further to 2.8%
(Trust target is 3%). In February 2014, there were 11 long term sick cases which
has reduced to 3 in May 2014.
Actions to improve management of stress
•Currently reviewing the Management of Stress Policy
•Feedback results of the audit to Directorates
•Improve the information available on the management of stress via the
Intranet.
•Include an additional section within ESR training which explains the
importance of, and how to record stress.
•Promote the importance of undertaking individual stress risk
assessments.
•For the next audit undertake a review of persistent non-compliance
with the Management of Stress Policy and target/support those areas.
•Use local survey data to help determine where issues may exist
•Use national survey to identify hotspot areas and targeted support
•Development of e-resilience training and also training for managers
•Listening sessions to help understand specific group issues
•Commissioned the Big White Wall as additional staff support
•Re tendered for staff psychological support contract for improved
provision
•Developing clinical supervision and professional support frameworks
14
Bank/Agency Usage
Feb 14
Mar 14
Apr 14
May 14
June 14
CSS
8.29
8.20
8.88
4.66
6.01
5.73
Medical
41.03
39.80
57.04
39.14
42.61
38.33
Specialised
47.33
48.30
57.12
44.95
47.57
40.35
Surgical
17.62
19.60
27.99
26.57
26.80
23.53
CAMHS
9.27
7.80
9.01
9.07
8.65
9.10
Corporate
40.46
35.54
43.91
46.05
44.09
43.87
Total
163.99
159.24
204.00
170.44
175.73
160.91
* The latest month is an indicative figure and about 95% accurate. The previous month figure will be updated
each month
Trust Bank/Agency Usage (WTE) Yearly Comparison
250
200
WTE
Jan 14
150
100
50
0
Top 3 reasons for Bank/Agency usage
1. Vacancy – 115.68 WTE
2. Sickness – 17.39 WTE
3. Specialist Skills Required – 10.22 WTE
2013/14
2014/15
Admin bank and agency usage = 76.61 WTE. This is a decrease of 0.36 WTE (May ’s
usage was 76.97 WTE).
Bank/Agency Usage - June
14
Top 3 reasons for Admin usage are Vacancy, Backlog and Sickness.
Directorate Admin bank and agency is as follows:
Priority
7
13.01
CSS - 2.90 WTE - Labs, Radiology and Surgical Day Care
Medical - 8.88 WTE - Primarily Medical Secretary Areas (6.01WTE)
47.67
Specialised - 4.46 WTE – Cardiac Service, PICU and Theatres
39.32
Surgical - 18.63 WTE - Primarily Medical Secretary Areas (11.21 WTE)
CAMHS – 4.49 WTE - Primarily East Locality (3.72 WTE)
A&C
Reg
Non Reg
Corporate – 38.28 WTE – Primarily in Health Records (12.61 WTE)
15
BCH Nursing Staffing:
•
•
•
•
NHS choices reported 1st submission with 100% score for
BCH
A new separate web section on our Web page for Safer
Staffing reports: http://www.bch.nhs.uk/story/safe-staffing
First Month of Patient/Staffing acuity data collected
Revised methodology for calculating trust-wide total used.
Nursing Workforce Summary
Monthly
Ave:
Annual
Mat Leave Sickness
Leave
Bank
6.0%
12.4%
5.8%
4.6%
2.3%
81.1%
4.5%
15.2%
5.9%
3.5%
4.0%
79.9%
2.9%
14.15
6.55
3.0%
6.4%
Act vs.
Plan
Acuity
Apr-14*
95.9%
TBC
81.5%
May-14**
99.7%
TBC
Jun-14**
98.2%
92.4%
*April data collected prior to DH guidance
** May & June data presented using new agreed format
Skill Mix Vacancy
Nursing Workforce Jun 2014
Nursing
Workforce
Dashboard:
Ward
Patient/Staffing Acuity
Level
Nursing Staffing Actual vs Planned
Registered
Care Staff
Registered
Care Staff
Day
Day
Night
Night
Actual vs
Planned %
Actual vs
Planned %
Actual vs
Planned %
Actual vs
Planned %
Ward 11
120.6%
96.0%
96.8%
98.1%
97.8%
92.4%
93.5%
91.9%
95.4%
92.4%
102.7%
90.0%
115.3%
97.9%
88.9%
100.1%
106.1%
99.1%
135.2%
91.7%
107.7%
85.2%
108.4%
N/A
89.8%
177.4%
90.8%
105.4%
98.3%
92.9%
101.7%
93.4%
102.2%
130.3%
100.9%
100.0%
98.0%
97.5%
100.0%
95.3%
116.7%
93.7%
N/A
97.5%
90.2%
156.6%
110.6%
N/A
143.3%
93.3%
100.0%
96.7%
93.3%
N/A
126.7%
N/A
125.0%
N/A
100.0%
100.0%
Ward 12
101.1%
93.5%
94.2%
N/A
98.5%
PICU
MDC*
92.0%
122.1%
95.6%
85.6%
92.4%
N/A
121.6%
N/A
92.8%
116.1%
SDC*
120.6%
187.9%
N/A
N/A
132.2%
Ashfield
107.7%
92.1%
125.9%
91.5%
98.0%
112.9%
118.2%
90.2%
103.5%
95.6%
104.7%
98.4%
May-14
Burns
Neonatal Surgical
Ward 1
Ward 5
Ward 9
Ward 10
ED
PAU
MHDU
Ward 2
Ward 7
Ward 15
ODC*
Ward 8
Heathlands
Irwin
Overall trust Average:
National Submission
reported Average
96.17%
95.59%
* Excluded from National Upload
102.83%
102.59%
97.54%
97.54%
114.29%
114.29%
Unplanned: Actual &
Response
Planned Resources
Total
Registerd
Unfilled Vacancy
Mat Leave
Skill
Leave%
Roster% WTE
%
Mix%
No of Green
shifts
No of
Amber
shifts
No of Red
shifts
3
1
2
9
7
4
9
5
9
22
0
13
TBC
5
4
9
11
0
2
TBC
TBC
TBC
0
0
0
0
0
0
0
0
0
0
0
1
TBC
0
0
0
3
0
0
TBC
TBC
TBC
77
83
82.7
71
81.4
80.3
81.6
80.7
85.3
82
100
88
64.6
88.5
86.5
9.6
4
3.5
8.2
10.1
3.7
5.4
6.6
9.1
7.6
1.9
18.2
26.5
15.8
4.6
0.8
-0.91
0.8
-0.2
-2
-0.3
8.7
-2
0.4
-2.4
-3
6.1
2.58
4.2
-0.3
12.7
11.9
9.2
12.5
14.4
18.1
15.3
12.8
15.7
12.7
19.2
16.6
10.3
9.8
17.2
88.6
89.2
88.8
8.2
21.1
32.9
1.2
22.41
-0.3
105.4%
95.3%
111.7%
87
89
88
81
83
86
81
85
81
68
90
76
TBC
85
86
81
76
60
58
TBC
TBC
TBC
72.7
73.8
53.7
58
40.1
19.8
19.2
15.7
98.2%
1441
115
4
79.9
13.3
Actual vs
Planned %
112.2%
97.7%
99.2%
115.5%
97.7%
97.2%
94.1%
95.5%
97.5%
95.5%
130.1%
91.8%
112.0%
97.9%
90.0%
98.0%
No of
Times
Raised to
HoN
Sickness
Bank Fill
%
Bank
Used
3.8
6.7
10.6
4.2
7.8
10.1
7.3
10
12.5
6.7
0
7
11.7
13.4
0
1.4
6.7
0.3
2.2
2.8
3
3.6
2.3
5.9
0.7
0.7
2.3
1.3
4.1
3.4
26.1
88.6
57.9
35.5
57.1
64.7
71.3
39.7
62.2
54.8
0.25
27.1
82.4
60
51.4
2.6%
3.8%
2.2%
3.8%
5.2%
2.6%
9.3%
5.7%
20.2%
22.4%
1.6%
4.5%
6.7%
5.9%
2.2%
9.7
15.5
19.1
1.8
4.9
5.1
8
1.9
4.6
49.1
43
100
4.8%
11.8%
1.9%
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
TBC
-5.7
-0.6
-5.2
1.1
10.3
21.2
10.5
14.6
7.2
6
0
7
6
0.4
2.7
1.7
76.9
74.6
40
82.9
7.4%
8.9%
0.4%
7.7%
TBC
TBC
TBC
TBC
1.2
14.1
6.5
3
56.6
6.4%
Nursing, Midwifery and Care Staff Staffing
June 2014 Submission to NHS England
Hospital Site Details
Main 2 Specialties on each ward
Registered midwives/nurses
Care Staff
Registered midwives/nurses
Care Staff
Ward name
Site code *The Site
code is automatically
populated when a Site
name is selected
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
RQ301
Hospital Site name
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
BIRMINGHAM CHILDREN'S
HOSPITAL
Specialty 1
171 - PAEDIATRIC
SURGERY
171 - PAEDIATRIC
Neonatal Surgical SURGERY
171 - PAEDIATRIC
Ward 1
SURGERY
171 - PAEDIATRIC
Ward 5
SURGERY
171 - PAEDIATRIC
Ward 9
SURGERY
171 - PAEDIATRIC
Ward 10
SURGERY
Burns
ED
420 - PAEDIATRICS
PAU
420 - PAEDIATRICS
MHDU
420 - PAEDIATRICS
Ward 2
420 - PAEDIATRICS
Ward 7
420 - PAEDIATRICS
Ward 15
420 - PAEDIATRICS
Ward 8
420 - PAEDIATRICS
Ward 11
Ward 12
PICU
RQ301
BIRMINGHAM CHILDREN'S
HOSPITAL
Ashfield
RQ301
BIRMINGHAM CHILDREN'S
HOSPITAL
Heathlands
RQ301
BIRMINGHAM CHILDREN'S
HOSPITAL
Irwin
321 - PAEDIATRIC
CARDIOLOGY
321 - PAEDIATRIC
CARDIOLOGY
420 - PAEDIATRICS
711- CHILD and
ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
Specialty 2
160 - PLASTIC SURGERY
171 - PAEDIATRIC
SURGERY
361 - NEPHROLOGY
100 - GENERAL SURGERY
100 - GENERAL SURGERY
150 - NEUROSURGERY
180 - ACCIDENT &
EMERGENCY
300 - GENERAL
MEDICINE
300 - GENERAL
MEDICINE
300 - GENERAL
MEDICINE
192 - CRITICAL CARE
MEDICINE
303 - CLINICAL
HAEMATOLOGY
171 - PAEDIATRIC
SURGERY
170 - CARDIOTHORACIC
SURGERY
170 - CARDIOTHORACIC
SURGERY
192 - CRITICAL CARE
MEDICINE
711- CHILD and
ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
Total monthly
planned staff
hours
Total monthly
actual staff
hours
Total monthly
planned staff
hours
Total monthly
actual staff
hours
Total monthly
planned staff
hours
Total monthly
actual staff
hours
Total monthly
planned staff
hours
Total monthly
actual staff
hours
Average fill rate Average fill rate registered
registered
Average fill rate Average fill rate care staff (%)
care staff (%)
nurses/midwives
nurses/midwives
(%)
(%)
1170 1414
1950 1872
1170 1132
1924 1888
2022 1977
1833 1701
2730 2553
1950 1792
1170 1116
2145 1982
1365 1402
3673 3307
1898 1859
2360 2127
2022 2039
12285 11300
410
376
273
637
501
442
890
390
0
582
397
722
299
390
390
585
410
891
410 1463
271
990
861
990
459 1320
476 1221
810 2228
370 1320
0
990
526 1650
704
990
655 2915
294 1320
363 1683
365 1320
560 10153
906
1366
1012
1290
1343
1221
2184
1298
990
1573
1155
2731
1265
1518
1243
9381
99
517
0
231
330
286
330
330
0
330
0
44
187
132
0
407
155 120.8%100.1%101.7%156.6%
572 96.0% 109.2% 93.4% 110.6%
0 96.8% 99.1% 102.2% #DIV/0!
331 98.1% 135.2%130.3%143.3%
308 97.8% 91.7% 101.7% 93.3%
286 92.8% 107.7%100.0%100.0%
319 93.5% 91.0% 98.0% 96.7%
308 91.9% 94.8% 98.3% 93.3%
0 95.4% #DIV/0! 100.0% #DIV/0!
418 92.4% 90.3% 95.3% 126.7%
319 102.7%177.4%116.7% #DIV/0!
55 90.0% 90.8% 93.7% 125.0%
187 97.9% 98.3% 95.8% 100.0%
132 90.1% 92.9% 90.2% 100.0%
22 100.9% 93.5% 94.2% #DIV/0!
495 92.0% 95.6% 92.4% 121.6%
1348 1429
819
749
935
1106
385
368
1006
916
923
894
792
721
528
534
897 1130
806
910
847
877
517
509
106.0% 91.5% 118.2% 95.6%
91.0% 96.8% 91.0% 101.2%
125.9%112.9%103.5% 98.4%
PDR - AFC Staff
Staff Group - Table 1
Jan-14
Feb-14
Mar-14
Apr-14
May-14 Jun-14
Add Prof Scientific &
Technical
86.43%
83.50% 87.25%
87.11%
84.10% 79.59%
88.89%
89.49% 87.54%
85.67%
77.42% 80.46%
Admin & Clerical
77.96%
77.22% 77.38%
77.36%
74.18% 72.21%
AHP's
87.76%
87.96% 89.09%
87.39%
78.76% 77.31%
Estates & Anciliary
89.92%
90.40% 88.19%
85.39%
72.30% 70.00%
Specialised Services
Healthcare Scientists
83.78%
83.04% 76.00%
75.61%
76.42% 80.49%
Surgical Directorate
Nursing
87.50%
85.76% 85.47%
82.73%
81.80% 79.61%
CAMHS Services
Additional Clinical Services
Table 1 shows via staff group the Appraisal compliance. Compared to last months
report Additional Clinical Services and Healthcare Scientists are the only staff groups
to see an increase in their PDR rate.
Corporate PDR % (Hot spot areas)
The below departments are showing red on the workforce dashboard and
have a PDR rate less than 75%
Bereavement Services – 33.3%
Chaplaincy – 50%
Child Protection – 33.3%
Clinical Coding – 42.86%
Contracting – 50%
Corporate Nursing – 55.86%
Domestics – 50%
Executive Team (Including Exec Assistants) – 25%
ICT Projects – 50%
Facilities – 60%
Finance – 54.55%
Governance – 66.67%
Human Resources – 61.11%
Operations Management – 33.3%
Porters – 66.67%
Procurement – 25%
Research & Development – 50%
Trust Bank Management – 30%
Table 2
BCH
Clinical Support Services
Medical Directorate
Corporate
Jan
Feb
Mar
Apr
May
June
85.23%
84.68%
83.66% 82.22% 78.75% 77.44%
87.23%
88.21%
87.47% 86.68% 80.36% 81.25%
87.34%
88.49%
86.36% 83.55% 82.35% 84.11%
81.79%
81.47%
82.15% 81.87% 80.72% 80.04%
91.09%
87.13%
87.88% 85.91% 83.86% 79.58%
92.86%
90.25%
84.62% 86.40% 80.09% 68.40%
76.80%
76.17%
75.29% 72.15% 66.35% 66.43%
This table shows the PDR %. Each months totals is for PDR’s that have taken place and
recorded on ESR during the last 12 months, so for June the PDR period is July 13 to June
14.
Plans to target PDR %
CAMHS
The CAMHS SLT will discuss and agree actions to address this issue and this
will be monitored on a monthly basis. In addition monthly reports are going
to be distributed to managers highlighting those that have expired and are
due in next 3 months. An administrator is now covering for a LTS sick case
and part of the role is to input PDR’s.
Corporate
HR will continue to email Corporate HODs and copying in chief officers
requesting that appraisals are undertaken and also
request a trajectory for them to be 100% compliant.
19
DBS Update
One of the pre-employment checks undertaken for new starters is a DBS (Disclosure and Barring Scheme) check. As good
practice the Trust re-checks all its staff who’s DBS check has expired after 3 years of employment with the Trust. The last
phase of re-checking DBS’s involved 202 members of staff which are 100% complete.
The next phase of re-checks is for approximately 2200 employees whose DBS’s are due to expire throughout 2014. This is
high as in 2011 there was a significant push on DBS checks. Due to the volume of staff involved re-checking will be phased
throughout the remainder of the year but prioritised with the safe guarding team.
Directorate
HC of staff required
to complete BDS
check
HC completed
% Completed
CSS
27
27
100%
Medical
49
49
100%
Specialised
53
52
98.10%
Surgical
24
24
100%
CAMHS
22
22
100%
Corporate
28
28
100%
Total
203
202
99.50%
20
Staff in Difficulty
Staff in Difficulty Cases (January 14 to June 14)
70
Number of Cases
60
61
53
54
50
40
37
35
38
30
20
10
0
January
February
The number of cases has decreased since last months
report due to cases being ended or employees
leaving the Trust, however a large proportion of the
staff in difficulty cases are due to conduct issues.
Managers are becoming more effective at dealing
with inappropriate behaviour and measuring against
the Trust values.
Managers are identifying and managing staff in
difficulty more effectively. This is supported by the
HR team through the roll out of the master classes.
March
April
May
June
Breakdown of Cases June 14
Total 54 cases
26%
Disciplinary
42%
Grievance
Harassment
15%
Performance
17%
21
Staff Friends and Family Test
Understanding how staff feel about working at BCH has a direct link to measuring quality of care. This is why NHS England have launched Staff
Friends and Family Test in April 2014 and all NHS Organisations must implement the test over 3 quarters with a break in Q3 for the national staff
survey to be undertaken. The SFFT results will be submitted via UNIFY 2 to NHS England once approval has been given by the Chief Officer for
Workforce Development.
There are two questions related to the SFFT:
•
How likely are you to recommend Birmingham Children’s Hospital to friends and family if they needed care or treatment?
How likely are you to recommend Birmingham Children’s Hospital to friends and family as a place to work?
•
Total number of staff responses: 477 approximately 14% of our workforce
I would recommend this organisation as a
place to work.
If a friend or relative needed treatment I would be happy
with the standard of care provided by this organisation.
Staff Response
Staff Response
80%
1%
Yearly Comparison
2%
2% 0%
70%
12%
70%
50%
74%
60%
40%
50%
30%
40%
30%
20%
20%
10%
96%
0%
Yes
Neither likely or unlikely
No
Don't know
90%
80%
60%
13%
Yearly Comparison
100%
2012
2013
10%
0%
2014
2012
2013
2014
‘Significant improvement in both measures’
22
Mandatory Training Update
Mandatory training compliance is currently 81.82%. This represents a 3.31% increase compared to the average for mandatory training taken at the end of Dec 2013
which is 13.1% below the Trust KPI of 95% . The table below identifies the compliance statistics for all mandatory topics between Jan 2014 and July 2014 (source:
Vesper 7/7/14). Notable improvements are in BLS, Blood Sampling, Blood Admin, Child Protection L2, Conflict Resolution, Healthcare Records and Manual Handling
Practical.
The pressure in the hospital is having and impact of releasing people to attend Mandatory Training. Education and Learning have seen lower engagement in face to
face training as reported in June 2014. A review of the last 3 mandatory updates suggests 41% attendance with a 15% DNA rate . Bookings numbers for the next
mandatory training date on 25th July are currently at 16% which supports suggestions that the release of staff to face to face training is still challenging for
departments. Moodle however has seen a big increase in engagement with activity for mandatory refreshers increasing from 737 completions in May 14 to 1007 in
June 14. This rise is partially due to the introduction of CP L2 online learning which has supported the big improvement in CP L2 compliance. As stated in the
previous report, Education and Learning are going to pilot the use of “Training Boards” in areas as another option for staff to access training which may help in the
challenge of releasing staff to face to face training and provide an alternative update method.
Issues and Risks
•
•
•
•
•
Completed Actions:
•
•
•
•
•
Exclusion rules (Bloods and CP completed)
Ongoing development of Ed Reporting systems – 21 day Education Reporting response working
well.
Review training plans and course content with Trainers – M&H currently planning changes using
Moodle for Induction and mandatory refresher training.
“Email Checker” – developed to correct email anomalies and gaps to ensure reminders reach staff
– to be made available (Comms/Ed Reporting to sort)
CP L2 – on induction D2 now and SfH online update in place
Staff engagement low on face to face
training
DNA rates result in underutilised training
places
Exclusions need reviewing for some topics
Top 3 staff groups with low compliance –
Nursing, Medical and Additional Clinical
Services
Email reminders – not received by some
due to incorrect email address or no email
address on ESR
Future Plans:
•
•
•
•
•
•
Continue exclusion rule amends across all
mandatory topics
Booking reminder service pilot – work in progress
Monthly Directorate reports to be introduced
eTechnologist Intern starting Sep 15th
Training Boards - pilot scheme to be planned
Explore Refresher training to be assessment
based avoiding repetition of training where
competency can be demonstrated with the
assessment
23
5. Financial Performance
24
Financial Performance Summary
FINANCIAL PERFORMANCE REPORT
Monitor Risk Assessment Framework
Criteria
Financial Performance
Plan
Actual
Status
Direction
of Travel
Capital Service Capacity
4
4
Liquidity
4
4


k seeks assurance regarding w hether the Trust is a going concern.
Issue
Plan
£'000
Actual
£'000
Variance
£'000
Income and Expenditure
1,933
1,769
-164
Cash Balance
50,734
48,403
-2,331
Capital Programme
1,568
1,965
397
CIP
1,645
1,345
-300
Status
Direction of
Travel




Incom e and Expenditure
(Monitor assesses financial risk on a scale from 1 (high risk) to 4 (no evident concerns)
The Trust is reporting a below plan position in Month 3. The key cause of this is a shortfall in clinical
Foundation Trust Requirements
income. Bed pressures and subsequent cancelled operations are the prime causes of this.
Issue
Measure
Plan
Actual
Private Patient Cap
Not to exceed 49%
0.4%
0.1%
Status
Direction
of Travel

Cash Balance
At the end of June the cash balance w as 4.6% below plan.
Capital Program m e
The Trust is performing ahead of plan in Month 3 due to levels of expenditure being incurred
on schemes carried forw ard from the previous financial year happening in a shorter timeframe.
CIP
Performance in June w as 18% below plan. This is a result of 2 trust-w ide schemes.
25
Income and Expenditure against Plan
The Trust’s I&E position has deteriorated
slightly in June with an overall deficit against
plan of £0.16m now being reported.
Headlines are:
• The Trust is reporting a significant deficit
against Clinical Income;
• The key issues are the continued financial
impact of cancelled operations, long stay
patients and the associated causes of these.
This has impacted upon the Trust’s elective
activity performance most notably within
Surgery and Cardiac Surgery;
• Pressures are being felt in Directorates due to
the impact of the clinical income
performance (this is being particularly felt in
Specialised Services and Surgery) and the
phasing of trust-wide CIP targets;
• At this stage of the year the Trust remains
confident that the planned surplus of
£4.377m will still be achieved.
2013/14 I&E to June 2014
Income from activities
Other Income
Operating Expenses
EBITDA
Interest Receivable
Depreciation
Profit/(Loss) on Asset Disposal
Impairment
PDC Dividend
Interest Paid
Net Surplus/(Deficit)
Brackets indicate adverse
variance
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHs
Corporate
Total Operational Budgets
Bad Debts
Donated Assets
Operating Leases
Teaching & Research
Reserves and Provisions
Total Other Budgets
Total Budgets
Annual
Revised
YTD Plan
Plan per Annual Plan per LTFM
LTFM
£'000
£'000
£'000
217,995
216,904
55,568
19,666
22,218
4,687
-225,841
-227,341
-56,460
11,820
11,782
3,794
243
247
61
-4,624
-4,559
-1,156
0
0
0
0
0
0
-2,762
-2,762
-690
-300
-326
-75
4,377
4,381
1,933
Revised
YTD Plan
£'000
55,617
5,517
-57,351
3,783
62
-1,140
0
0
-690
-82
1,933
June
Income
Variance
Pay
Variance
Non-Pay
Variance
Total
Variance
88
10
-57
7
-8
297
337
-76
-135
-138
-413
94
-78
-746
-42
-47
-904
-62
-18
-420
-1,494
0
-30
-172
-1,100
-468
68
-202
-1,903
0
-0
-22
285
3,295
3,558
1,655
-0
-22
285
284
621
0
0
-746
3,295
3,273
1,779
YTD Actual
£'000
53,766
6,138
-56,317
3,587
40
-1,157
0
0
-631
-70
1,769
Variance
£'000
-1,851
621
1,034
-196
-22
-17
0
0
59
11
-164
May
Variance
£000
In-month
Movement
£000
-60
-208
-653
-285
38
-333
-1,502
0
-0
-20
190
2,167
2,337
835
31
36
-447
-183
30
132
-401
0
-0
-2
95
1,129
1,221
820
26
Profitability against Target
The EBITDA (Earnings Before Interest, Taxation, Depreciation
and Amortisation) Margin remains below target
(6.0% compared with 6.3%), although this is
an improvement on the gap experienced in
Month 2 (6.9% actual compared with 7.4%
plan). In monetary terms EBITDA was also
below the YTD Monitor Plan, with little inmonth movement.
EBITDA Margin
8.0%
7.5%
6.8%
7.0%
6.5%
6.0%
Actual
6.0%
5.8%
5.5%
Plan for
Year
5.0%
4.5%
4.0%
Apr May Jun
The I&E Surplus Margin also continues below
plan (3.0% compared with 3.2%) which is
reflecting the EBITDA margin. This too is an
improved performance compared with
Month 2.
With the plan of both metrics due to reduce,
on average, through the remainder of the
year it is expected that the variance between
planned and actual %s will shorten over time.
Jul
Aug Sep Oct Nov Dec
Jan
Feb Mar
I&E Surplus Margin
5.0%
4.5%
4.0%
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
3.9%
2.7%
3.0%
Actual
Plan for
Year
Apr May Jun
Jul
Aug Sep
Oct Nov Dec
Jan
Feb Mar
27
CIP
This is the third CIP report for the new year. The overall target reflects the following:
• Directorate targets;
• Trust-wide scheme targets; and
• Residual balance of the underlying legacy position from 2013/14.
Headlines from Month 3 are as follows:
• Overall schemes identified exceed the annual target – this is an improved position compared to 2013/14;
• The majority of schemes have been risk assessed within Directorates;
• Quality Impact Assessment review process has commenced with a further progress undertaken at 30 June;
• Corporate is the area which is furthest from target for overall schemes. The gap has been reduced following work during June
although formalised PIDs await completion which is leading to a potential under-reporting of achievement;
• The June performance although under plan is potentially a prudent position as work continues on the evidencing of savings in
some key areas;
• The shortfall on the trust-wide schemes is within Contract Penalties (where pressures are evident for Diagnostics and 18 weeks)
and Drugs (where schemes have been developed but await implementation);
• Delivery against schemes in the year to date for Clinical Directorates is on target;
• Phasing throughout the year remains back-ended;
• A more detailed review of CIP performance will be presented at the July Performance Board.
Directorate
CAMHS
Corporate
CSS
Medicine
SSD
Surgery
Trustwide
Totals
Annual Target In Year Identified
£389,526
£723,251
£666,136
£1,324,237
£1,390,984
£725,583
£4,240,000
£9,459,716
£388,640
£532,571
£634,116
£1,649,825
£1,420,330
£740,282
£4,240,000
£9,605,764
YTD Plan
YTD Actual
YTD Variance
% Plan To Date
% Annual Target
£47,397
£116,666
£125,156
£389,869
£330,991
£109,208
£525,500
£1,644,787
£47,397
£67,315
£156,705
£355,320
£312,213
£148,318
£257,302
£1,344,571
-£0
-£49,351
£31,549
-£34,549
-£18,778
£39,110
-£268,198
-£300,217
100%
58%
125%
91%
94%
136%
49%
82%
12%
9%
24%
27%
22%
20%
6%
14%
28
Cash and Capital
2014/15 Plan
Mar-16
Jan-16
Feb-16
Dec-15
Oct-15
Nov-15
Sep-15
Jul-15
Aug-15
Jun-15
Apr-15
May-15
Mar-15
Jan-15
Feb-15
Dec-14
Oct-14
Actual
Nov-14
Sep-14
Jul-14
Aug-14
Jun-14
Apr-14
The Capital performance in June was £0.4m ahead
of plan. With the core 2014/15 Capital Programme
now agreed at July’s Finance and Resource
Committee expenditure will start to increase in line
with the plan. The spend to date relates to schemes
carried forward from 2013/14. The impact of these
at Month 3 is higher than anticipated although over
the course of the year this will have a neutral
impact upon cashflow.
May-14
Although cash is below target the Trust’s Liquidity
remains significantly above the Continuity of
Service threshold of 4.
2014/15 Cash Position and Rolling Forecast
55,000
50,000
45,000
40,000
35,000
30,000
£k 25,000
20,000
15,000
10,000
5,000
0
Mar-14
Cash is now 4.6% below plan at Month 3. This
equates to £2.3m and is primarily a result of
increasing debtor balances as some year-end
contracting invoices remain outstanding.
Rolling Forecast
2014/15 Cumulative Capital Expenditure against Plan and Monitor
Margins
16,000
14,000
12,000
10,000
£k
8,000
6,000
4,000
2,000
Apr
May
14/15 Actual
Jun
Jul
Aug
14/15 85%
Sep
Oct
14/15 115%
Nov
Dec
Jan
Feb
Mar
14/15 Plan - Original
29
Debtors and Creditors
Debtors over 90 days have increased in June in both
percentage and actual terms. The overall level of
debt is such that the top 5 debts reported below
account for over 20% of our overall debt.
Although major legacy debts have now all been
cleared a wide range of other medium-high value
debts remain.
The single highest-value aged debt, relating to
2013/14 year-end settlements with NHS England
was paid in early July with the other debts being
actively chased.
% Debtors and Creditors over 90 days
30%
25%
20%
15%
10%
5%
0%
Apr
May
Jun
Jul
Aug
Debtors>90 days %
The Creditors position over 90 days has improved in
the month with the payment of the largest single
outstanding creditor. Of the 17% over 90 days still
outstanding 7% relates to disputed charges
associated with CF Year of Care tariff. This is subject
to ongoing negotiations.
Top 5 Debts Over 90 Days Old
Customer
NHS England
NHS Sandwell and West Bham CCG
Sep
Oct
Nov
Dec
Creditors>90 days %
30th June 2014
Age
(Days)
107
Value
(£k)
1,284
93
285
Health and Social Care Board
NHS Bham South and Central CCG
101
Jan
Feb
Mar
Target
31st May 2014
Age
(Days)
Value
(£k)
102
171
106
145
170
University Hospitals Birmingham
Private Patient - MK
1063
139
1033
139
Slater & Gordon (UK) LLP
265
136
235
136
NHS Birmingham Cross City CCG
188
57
158
2,013
57
649
30
Financial summary.
June 2014
The Monitor Financial Risk rating is 4 per plan, with liquidity remaining strong. This 4 is per the Compliance
Framework and the Continuity of Service Risk Rating (CoSRR).
The I&E position is below the Monitor plan and the revised plan at £1.769m.
The EBITDA and Income Surplus margins are 0.3% and 0.2% below plan, respectively.
Clinical Income performance in June was below the Monitor plan and this was the key cause of the shortfall
against the I&E plan.
CIP at a Directorate level has started the year more strongly than previous years. This will remain the
primary focus throughout the year. However, trust-wide schemes have fallen behind schedule resulting in
82% of the YTD plan being achieved as at 30 June.
Cash balances are slightly below plan in June. The causes of the shortfall are known and being acted upon.
Capital in month 3 performed ahead of plan.
The Forecast position for the Trust remains to achieve the planned surplus of £4.377m, excluding any further
benefit of donated asset income.
31