– COVER SHEET Meeting Date: 28 November 2012

Transcription

INTEGRATED PERFORMANCE REPORT – COVER SHEET
Meeting Date: 28 November 2012
Agenda Item: 1.12
Paper No: G
Title:
Integrated Performance Report
Purpose:
To report on performance against key indicators for the Trust in October 2012.
Summary:
Financial Performance
The Trust remains broadly in line with plan for the 7 months to October 2012 although there is a
shortfall for the month because of additional cost pressures and shortfalls on original CIP
programme:
•
surplus of £160k for month of October against planned surplus of £285k;
•
surplus of £836k for seven months ytd against planned surplus of £958k
However the reported surplus includes £847k of non-recurring income/costs meaning that the
underlying financial position of the Trust is broadly break-even.
Financial Risk Rating remains at 3 and cash continues ahead of plan: £13.8m against plan of
£12.5m.
Clinical Performance & Quality
All Monitor Targets were met for October 2012 (Quarter 2 for cancer)
All Monitor cancer standards were achieved in Quarter 2, the most recent period available, despite
the 62 day referral target being missed in September.
At aggregate level all three RTT18 targets were achieved. Gynaecology sub speciality issues are
likely to continue, and gynaecology will remain challenging during Quarter 3.
Endoscopy waiters over 6 weeks have shown some improvement, but waiters over 6 weeks in
diagnostics remain more than 1% of the overall list.
No further MRSA cases have occurred since September, the year to date total remains 2.
The continued improvement in Trauma and Orthopaedics, resulting in all targets being achieved in
October is noted.
The stroke target was failed in October. The disappointing drop in performance was directly linked
to the bed reconfiguration coinciding with an increase in stroke presentations which proved
challenging for a period of days.
Recommend
ation:
Prepared
by:
For discussion and noting.
PAUL TURNER
Director of Finance
/ KATE THOMAS
Performance Manager
Presented by:
PAUL TURNER Director of Finance
MARY SHERRY Chief Operation Officer
MARTIN SMITS Director of Nursing
SARAH-JANE TAYLOR HR Director
This report is relevant to: (Please tick relevant box)
Assurance Framework

Risk Register I/D No.
Healthcare Standards:
Please specify which standard
Monitor compliance

Financial implications

Human Resources implications
Internal monitoring

Legal implications
YES
YES
NO
INTEGRATED PERFORMANCE REPORT
TRUST PERFORMANCE SUMMARY
October 2012
Target /
Limit
2012-13
Mar-12 Aug-12 Sep-12 Oct-12
Direction #
2011-12
Year To Date
YTD/
current
Actual
YTD
Target /
Limit
17.4
-
Year End
Forecast
Monitor
targets &
weightings
Ja 00
ACCESS AND TARGETS
Referral to waiting time (weeks) for admitted (95th centile)
23.0
21.3
17.0
16.9
17.4
RTT
Referral to waiting time (weeks) for non-admitted (95th centile)
18.3
17.0
16.7
16.4
16.7
Referral to treatment (18 weeks) for admitted
90%
92.5%
97.3%
97.6%
97.1%
Referral to treatment (18 weeks) for non-admitted
Referral to waiting time (18 weeks) for incomplete pathways
Maximum 62 day wait from referral to treatment for all cancers
62 day wait for 1st treatment - consultant screening service (all)
95%
92%
85%
90%
cancer
31 day wait for 2nd or sub treatment : Anti cancer drug treat
98%
31 day wait for 2nd or sub treatment : Surgery
94%
31 day wait for 2nd or sub treatment : Radiotherapy
94%
31 days wait diagnosis to start of 1st treatment: All cancers
96%
96.6%
93.5%
90.1%
qtr 92.2%
100%
qtr 98.2%
98.3%
96.3%
95.2%
98.1%
97.4%
96.9%
97.5%
97.4%
81.7%
qtr 97.7%
94.4%
qtr 97.9%
100%
100%
qtr 100% 100.0% qtr 100%
97.9%
100%
qtr 98.8% 100.0% qtr 98.9%
99.3%
97.7%
qtr 99.6% 98.9% qtr 98.4%
100%
98.5%
qtr 98.8% 99.4% qtr 99.3%
87.1%
95%
96.1%
97.2%
97.5%
96.9%
Total time in A+E (95th centile) from Q1
=< 4 hours
3hrs 59
3hrs 58
3hrs 57
3hrs 58
Time to initial asessement (95th centile) from Q2
=< 15 mins
12
15
16
15
Time to treatment decision (median) from Q2
=< 60 mins
67
51
59
42
=< 5%
2.83%
3.00%
3.00%
NR
=< 5%
3.35%
2.80%
2.70%
2.50%
68%
100.0%
83.0%
-
2 week maximum wait for Rapid Access Chest Pain Clinic appt
0
0
1
0
0
No waits more than 6 weeks for diagnostic investigations
0
27
37
41
26
Elective Access - rebooking
0
1
1
0
1
80%
68%
80.0%
91.0%
76%
A&E
cardiac
access
Patients who spend at least 90% of their time on a stroke unit
↑
↑
95%
1.0
97.4%
92%
1.0
↑
81.7%
qtr 97.7%
94.4%
qtr 97.9%
↓
93%
Heart attack patients to receive thrombolysis within 60 mins of call
1.0
97.5%
↓
percentage of patients within the 4 hour target
Unplanned reattendance rate from Q2
Left without being seen from Q2
90%
↑
2 week wait for Symptomatic Breast Patients
95.2%
-
97.1%
↔
93.5%
qtr 94.8%
97.7%
qtr 94.8%
93%
16.7
↓
95.8%
qtr 96.3%
100%
qtr 96.1%
2 week wait from urgent GP referral to 1st appt (susp cancer)
↓
↓
↓
↓
↓
breast screen
Outpatient Access : ASIs at =< 4%
4%
8%
12%
11%
21%
Screening to normal results within 14 days
90%
96.8%
96.0%
98.0%
96.0%
Screening to assessment in 21 days - screening to 1st appt offer
90%
94.8%
99.0%
96.0%
99.0%
Screening to assessment in 21 days - screening to attended appt
90% of eligible woman screened within 36 months
90%
92.2%
96.0%
92.0%
98.0%
90%
99.2%
99.1%
99.1%
95.4%
↓
↓
↑
↑
↑
↑
↔
↑
↓
↓
↓
↓
↑
↑
↓
100%
qtr 100%
100%
qtr 98.9%
97.7%
qtr 98.4%
98.5%
qtr 99.3%
93.5%
qtr 94.8%
97.7%
qtr 94.8%
96.9%
85%
1.0
90%
98%
94%
1.0
94%
96%
93%
0.5
0.5
93%
95%
3hrs 58
=< 4 hours
15
=< 15 mins
42
=< 60 mins
NR
=< 5%
2.50%
=< 5%
-
68%
0
0
26
0
1
0
76%
80%
21%
4%
96.0%
90%
99.0%
90%
98.0%
90%
95.4%
90%
1.0
Target /
Limit
2012-13
Mar-12 Aug-12 Sep-12 Oct-12
Delayed transfers of care to be maintained at a minimal level
3.5%
6.2%
3.5%
3.0%
3.8%
Trauma inpatients (fit for surgery) receive treatment within 48 hrs
Hip fractures (fit for surgery) receive treatment within 48 hrs
95%
96%
95%
94%
97%
95%
96%
84%
92%
100%
Direction #
2011-12
↓
↑
↑
Year To Date
YTD/
current
Actual
YTD
Target /
Limit
3.8%
3.5%
97%
95%
100%
95%
Year End
Forecast
Monitor
targets &
weightings
CLINICAL QUALITY
Dr Foster Mortality relative risk rating (3 month rolling)
100%
78
91.3
All deaths - actual as % of expected (Dr Foster)
100%
89%
112%
HSMR deaths - actual as % of expected (Dr Foster)
100%
94%
115%
all
1
2
2
1
0
1
2
2
1
Theatre Utilisation - Main
85%
87.0%
93.0%
87.2%
87.0%
Theatre Utilisation - Day
85%
74.0%
75.0%
70.8%
77.0%
Day Case Rates (basket of 25)
Bed Occupancy
75%
84%
74%
95%
96%
95%
97%
99%
meeting the C-Diff objective (ytd)
=<24
24
11
13
14
meeting the MRSA objective (ytd)
=<1
1
1
2
2
Number of SUIs reported within appropriate timeframe
Number of Serious Untoward Incidents (SUIs)
↓
↓
↓
↑
↑
91.3
100%
112%
100%
115%
100%
1
all
1
0
87%
85%
77%
85%
74%
75%
99%
95%
14
=<24
1.0
2
=<1
1.0
OPERATIONAL EFFICIENCY
↓
↑
↓
↓
PATIENT EXPERIENCE
↑
↔
STAFF EXPERIENCE
Staff Turnover (Overall)
Staff Turnover (Auxiliaries and HCAs)
Absence
<=11%
0.92%
0.90%
0.72%
0.62%
<= 13.5%
1.54%
1.95%
2.37%
1.50%
<=3.5%
3.85%
3.37%
3.43%
3.44%
↑
↑
↓
0.62%
<=11%
1.50%
<= 13.5%
3.44%
<=3.5%
FINANCE & ACTIVITY
Cash balance
15.4
16.5
13.6
13.8
13.80
12.51
13.40
Income
21.20
16.62
16.17
16.56
113.83
112.77
197.63
Operating Expenditure
20.30
15.38
15.04
15.41
106.09
104.87
184.23
EBITDA
0.70
1.07
0.93
0.95
6.34
6.51
11.00
EBITDA %
3.3%
6.4%
5.7%
5.7%
5.6%
5.6%
5.6%
Surplus/Deficit
-0.30
0.26
0.14
0.16
0.84
0.96
1.50
SLA over / (under) performance
0.1
0.1
-
-
0.03
0.00
0.03
CIP
0.8
0.6
0.6
0.6
4.17
4.24
7.79
3
3
3
3
3.0
3.0
3.0
Financial Risk rating
# : Arrow direction indicates improvement ↑, deterioration ↓, or no change ↔ in performance since the previous month
INTEGRATED FINANCE AND PERFORMANCE REPORT
Month Seven - October 2012
Key Issue
Trust
Performance
– Monitor
Targets
Executive Summary
KPI
Cancer
RTT
The Trust achieved the targets for admitted clock stops (97.1% against 90% target) and non-admitted
(97.5% against 95% target) clock stops, at aggregate level in October. The incomplete pathways target of
92% was achieved, with 97.4% of incomplete pathways waiting less than 18 weeks at the end of October.
Performance Report appended.
MRSA
CDiff
Monitor scorecard
ED
The Monitor A&E metric (95% within 4 hours) was achieved in October (96.9%).
Performance Report appended
No further MRSA cases have occurred since September. The Trust total for the year to date therefore
remains at 2 cases.
Only 1 C-Diff case was identified in October, brining the year to date total to 14, meeting the planned
trajectory of 14 (based on 2 per month).
Sch
G
The 2012-13 monitor scorecard is comprised of 14 key indicators, all standards have been met as at
October and Quarter 2.
All Monitor cancer standards were achieved in Quarter 2.
The 62 day target was however failed in September.
The Quarter 2 cancer report and charts, are appended
RAG
Key Issue
Trust
Performance
– Finance &
Activity
Executive Summary
However the reported surplus includes £847k of non-recurring income/costs meaning that the
underlying financial position of the Trust is broadly break-even.
Financial Risk Rating remains at 3 and cash continues ahead of plan: £13.8m against plan of
£12.5m.
All
financial
variances
with
specific
focus on:
•Income
•EBITDA
•CIP
•Cash
•Capital
spend
RAG
Sch
A
Trust I&E table
The Trust remains broadly in line with plan for the 7 months to October 2012 although there is a
shortfall for the month because of additional cost pressures and shortfalls on original CIP
programme:
•
surplus of £160k for month of October against planned surplus of £285k;
•
surplus of £836k for seven months ytd against planned surplus of £958k
KPI
Key Issue
Trust
Performance
– Access and
Targets
Executive Summary
KPI
RAG
Sch
The Access and Targets scorecard is comprised of 22 key indicators, of which 5 are red rated.
•
•
•
•
•
RTT
The Trust achieved the targets for admitted clock stops (97.1% against 90% target) and non-admitted
(97.5% against 95% target) clock stops, at both aggregate and Unify specialty level in October. The
incomplete pathways target was achieved (97.4% against 92% target) at both aggregate and specialty
level.
Diagnostic Access
There were 26 Endoscopy patients waiting in excess of the 6 week diagnostic target at the end of
October. The percentage of diagnostic waiters over 6 weeks at the month end has reduced but is still in
excess of the 1% PCT contract target for the 7th consecutive month (1.14% - 29 including
endoscopy). Thi s is potentially subject to a financial penalty under the 12/13 contract arrangements.
Action: The Trust will continue to work with the PCT to address capacity issues and reduce referrals
where possible. Capacity will be increased before the next bowel screening campaign commences.
The department will be running additional Saturday lists throughout November.
Cancer
A-G
RTT
Diagnostic
Access
Delayed Transfers of Care
The percentage of patients formally delayed on the last Thursday of October (DH reporting
methodology) was 3.75%.
Action : Targeted actions continue to be pursued to reduce delays further.
Delayed
Transfers
of Care
48 hours standard for #NoF and Trauma
The 48 hour operating target (95%) was achieved in October for general trauma patients (94%). Local
and National targets for fractured NoFs were also achieved.
Performance in Trauma shows a significant improvement in performance compared to recent months.
48 hours
standard
for #NoF &
Trauma
•
Emergency Department : 4 hour target (95%) :
The 4 hour wait target of 95% was achieved in October, despite a difficult start to the month.
ED 4 hr
target 95%
•
Stroke
Stroke performance failed to achieve the 80% target in October (76%)
Performance Report Appended
Stroke
Access and Targets Scorecard
•
Cancer
All Monitor cancer standards were achieved in Quarter 2.
Achievement of the 62 day standard was challenging given the target was missed in September.
Review of pathways is going on to determine how to ensure performance is more robust in this area.
The Quarter 2 cancer report and charts, are appended
•
ASI
ASIs in October increased substantially to 21%, this was due mainly to Dermatology.
Actions are underway to reduce the level of ASIs.
ASIs
•
Elective cancellations rebooked within 28 days
1 pelvic floor patient due to treated in October was cancelled but could not be rebooked within 28 days.
28 day
rebooks
Key Issue
The Clinical Quality scorecard is comprised of 5 key indicators, none of which are part of the Monitor
scorecard. For the most recent year to date position (August/October 2012) there are red rated indicators
relating to Mortality and SUIs
•
•
•
A
Mortality performance for August (the most recent period reported by Dr Foster) has been red rated
since both the HSMR subset and the overall number of deaths were more than the expected level
calculated by Dr Foster for August.
3 positive alerts were reported by Dr Foster in the three month period to August 2012. One negative
alert was also reported.
Action : The Mortality group will commence reviewing those cases with a zero or very low co-morbidity
rating in order to determine the underlying causes for the reduction in performance and devise an
appropriate action plan.
Mortality
There was one SUI identified in October, this was reported within the prescribed timeframe.
SUI
The Efficiency scorecard is comprised of 4 key indicators; none of these are part of the Monitor scorecard.
For the most recent year to date position (October 2012) there are two red rated indicators:
•
Theatre Utilisation
Day theatre utilisation in October was 77%.
•
Bed Occupancy
Average bed occupancy in October was 99%, and did not achieve the target of 95% or less.
RAG
A-G
Theatre
Utilisation
Bed
occupancy
Sch
Efficiency Scorecard
Trust
Performance
– Efficiency
KPI
Clinical Quality Scorecard
Trust
Performance
– Clinical
Quality
Executive Summary
The Patient Experience scorecard is comprised of 6 key indicators, 3 of these are part of the Monitor
scorecard. For the most recent year to date position (October 2012) there are no red rated indicators:
•
C-Diff
There have been 14 cases of C-Diff during the period 1 April to 31 October 2012. The Trust is currently
meeting its trajectory of 2 per month (14 ytd).
Action: DoN to review
A
C Diff
objective
MRSA
objective
•
MRSA
The MRSA year to date total for 2012-13 remains two, the cases occurred in June and September.
Action : Infection Control issues remain under continued scrutiny DoN/Infection Control.
•
MSA
There have been no breaches of mixed sex accommodation (MSA) in October.
Mixed Sex
Accommo
dation
•
VTE
VTE performance was 89.1% for October narrowly missing the pct target of 90%.
VTE
Patient Experience Scorecard
Trust
Performance
– Patient
Experience
Trust I&E
Month - October
Year to Date
Full Year
Actual
Plan
Variance
Last Year
Actual
Plan
Variance
Last Year
Forecast
Plan
Last Year
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
9,515
3,673
1,045
386
1,738
16,357
200
16,557
9,077
3,645
990
386
1,889
15,987
200
16,187
438
28
55
0
(151)
370
0
370
9,462
3,798
315
356
1,793
15,724
58
15,782
64,001
25,609
7,138
2,593
13,089
112,430
1,400
113,830
63,516
25,559
6,957
2,591
12,749
111,372
1,400
112,772
485
50
181
2
340
1,058
0
1,058
66,236
26,586
2,205
2,534
12,104
109,665
386
110,051
155,669
12,280
4,400
22,877
195,226
2,400
197,626
109,039
43,917
11,654
4,400
22,068
191,078
2,813
193,891
118,639
45,914
4,855
4,203
21,140
194,751
301
195,052
Pay Costs
Non-Pay Costs
(10,705)
(4,704)
(10,608)
(4,301)
(97)
(403)
(10,482)
(4,253)
(74,454)
(31,634)
(74,093)
(30,772)
(361)
(862)
(73,163)
(29,966)
(129,829)
(54,396)
(127,711)
(52,172)
(127,940)
(54,247)
Total Operating Expenditure
(15,409)
(14,909)
(500)
(14,735)
(106,088)
(104,865)
(1,223)
(103,129)
(184,225)
(179,883)
(182,187)
0
0
0
0
0
0
0
0
0
0
(218)
948
(747)
5
(246)
1,078
(749)
6
(250)
(130)
2
(1)
4
989
(744)
11
(250)
6,342
(5,227)
42
(1,721)
6,507
(5,242)
43
(1,750)
(165)
15
(1)
29
6,536
(5,120)
61
(1,750)
11,001
(8,986)
85
(3,000)
11,195
(8,986)
78
(3,000)
12,346
(8,859)
95
(2,928)
160
0
160
40
120
285
0
285
40
245
(125)
0
(125)
0
(125)
64
0
64
88
(24)
836
0
836
847
(11)
958
0
958
280
678
(122)
0
(122)
567
(689)
113
0
113
626
(513)
1,500
0
1,500
1,377
123
2,100
0
2,100
400
1,700
955
(839)
116
(2,175)
3,130
Contract Income - B&P PCT
Contract Income - Dorset PCT
Contract Income - Specialist Commissioning
Contract Income - Other
Other Operating Income
Total Operating Income
Charitable Income
Total Income
Profit/(Loss) on disposal of fixed assets
EBITDA
Depreciation
Interest Receivable/(Payable)
Dividend
Surplus/(Deficit)
Impairment
Surplus/(Deficit) after Impariment
Non-recurring costs included above
Normalised Surplus/(Deficit)
Key Observations
Forecast
Key Actions
Cancer Waiting Times Q2 2012/13: Poole Hospital NHS Foundation Trust
– Summary report
The following convention is used for indicating compliance with the performance standards.
Standard achieved or
exceeded
Performance within 10% of
standard
Performance more than
10% below standard
Data are taken from the Open Exeter national database for Cancer Waiting Times.
Scorecard
Target
PHT
14 days: referral to date first seen (93%)
▼
14 days: all breast symptom referrals (93%)
▼
31 days: first treatment (96%)
▼
31 days: subsequent treatment (surgery) (94%)
▼
31 days: subsequent treatment (drug) (98%)
◄
31 days: subsequent treatment (radiotherapy) (94%)
▼
62 days: referral to first treatment (85%)
▼
62 days: referral from screening programmes (90%)
▼
The arrows on the performance measures in the scorecard indicate whether performance has increased
decreased or stayed the same, relative to the previous quarter. Data for the Dorset Cancer Network and other
acute Trusts was not available at the time of writing
14 days: Urgent GP referral to Date First Seen
Maximum 2 week wait from urgent GP referral for suspected cancer to first hospital assessment by 2000
Measure
Everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they
need to be seen urgently and requesting an appointment by 2000
Target
93% or more
Source
National Cancer Waiting Times Database (Open Exeter)
Time Period
Q2 2012/13
Tumour Type
Total
% meeting Median
referrals standard
wait
seen
in Poole
during the
period
93.3
National
%
meeting
standard
Suspected brain/central nervous system tumours
30
8
97.2
Suspected breast cancer
305
96.1
8
97.4
Suspected children's cancer
16
93.8
9
93.9
Suspected gynaecological cancer
111
96.4
9
95.8
Suspected haematological malignancies (excluding acute leukaemia)
13
92.3
6
96.7
Suspected head & neck cancer
196
96.9
9
95.9
Suspected lower gastrointestinal cancer
179
91.1
11
94.5
Suspected lung cancer
53
100
9
97.2
Suspected other cancer
1
100
7
94.9
Suspected sarcoma
6
100
9
96.2
Suspected skin cancer
285
94.4
9
94.5
Suspected upper gastrointestinal cancer
Suspected urological malignancies (excluding testicular)
Totals
110
1
1306
90.9
100
94.8
12
14
93.6
95.3
95.4
Breach reasons
No. of patients
Breach reasons
62
Patient cancelled/declined 1st. OPA/investigation within target
2
Endoscopy capacity issues
1
Referral form not completed appropriately
1
Patient was an inpatient for a different problem from 28/8 - 5/9
1
The patient needed to be off warfarin for a certain length of time prior to
gastroscopy. However there was insufficient information on the referral form
to allow appropriate triage of the patient. As a result there was a clinical delay
to date first seen
1
Hospital cancelled appointment because a different procedure was needed.
Trends in ‘Urgent referrals for suspected cancer’ are given in the chart below:
The number of referrals
first seen each quarter
continues to increase.
In Q2 12/13, 1306
patients were first seen
- the highest number
reported to date. This
represents a 22%
increase compared with
the number seen in the
same quarter 2 years
ago and a 9.5%
increase compared with Q2 11/12.
14 days: All breast symptom referrals
Measure
Maximum 2 week wait from referral of any patient with breast symptoms to first hospital assessment by
December 2009
Target
93% or more
Source
Time Period
Q2 2012/13
Totals
Total referrals
seen during the
period
% meeting
standard at
Poole
115
94.8
Median National
wait
% meeting
standard
8
95.7
Breach reasons
No. of patients
Breach reasons
3
Patient cancelled/declined 1st. OPA/investigation within target
1
Difficulty in contacting patient
1
Admin error
1
Patient was originally referred as choose and book.
31 days: Decision to Treat to First Treatment
Measure
Maximum 31 day wait from decision to treat to first treatment for all cancers by 2005
Target
96% or more
Source
Time Period
Q2 2012/13
a) By tumour site
Patients
treated
following an
urgent
referral for
suspected
cancer
Total
treated
Brain/Central Nervous System
0
3
3
0
100
0
98.7
Breast
36
92
90
2
97.8
19
99.2
Gynaecological
23
40
40
0
100
8
99
Haematological
17
35
35
0
100
0
99.8
Head & Neck
28
43
42
1
97.7
15
96.9
Lower Gastrointestinal
15
56
56
0
100
9
98.7
Lung
24
49
49
0
100
4
98.8
Other
1
8
8
0
100
0
98.8
Sarcoma
0
1
1
0
100
26
97.8
Skin
24
74
74
0
100
6
98.6
Upper Gastrointestinal
15
30
30
0
100
3
99.2
Urological
5
14
14
0
100
17
96.5
188
445
442
3
99.3
Tumour Type
All Cancers
%
Median
Treated on Treated
or within after 31 meeting Waiting
days
standard
Time
31 days
National
%
meeting
standard
98.4
b) By treatment type
Treatment Group
Patients
treated
following an
urgent
referral for
suspected
cancer
Drug Treatments
Other Treatments
Palliative Treatments
Radiotherapy Treatments
Surgery
All Treatments
44
1
26
31
86
188
Patients
Patients Patients
Total
treated
treated
treated treated
following following following
an urgent an urgent a referral
referral
referral
from
for breast from an
another
symptoms
NHS
source or
Cancer
urgency
Screening
Service
0
2
32
78
0
0
0
1
0
0
39
65
0
1
34
66
4
51
94
235
4
54
199
445
Treated Treated
%
Median National
on or
after 31 meeting Waiting
%
standard
within 31
days
Time
meeting
at Poole
days
standard
78
1
65
66
232
442
0
0
0
0
3
3
100
100
100
100
98.7
99.3
Breach reasons
Tumour
Type
Breast
Wait
Days
37
Breast
37
Head &
Neck
35
Report
Need time for Haematology consultant to assess patient and do any further investigations as
required.
Patient admitted for surgery within target but ran out of theatre time so was discharged without
treatment.
No capacity to bring surgery forward & surgeon on annual leave 23/7/12 - 3/8/12.
31 days: Second and Subsequent Treatments
Measure
Maximum 1 month wait from ready to treat to treatment for all second and subsequent treatments
3
0
0
14
13
99.9
96.8
100
97.9
97.5
98.4
(chemotherapy and surgery by December 2008, all other treatments December 2009)
Target
98% - Anti Cancer drug treatments ; 94% - Surgery treatments ; 94% - Radiotherapy treatments
Source
Time Period
Q2 2012/13
a) By tumour site
Tumour Type
Total
treated
Treated
on or
within 31
days
17
17
0
100
11
99.3
Breast
290
287
3
99
13
98.5
Gynaecological
48
47
1
97.9
7
98.7
Haematological
64
64
0
100
4
99.7
Head & Neck
38
36
2
94.7
14
97.4
49
49
0
100
8
98.8
Lung
74
74
0
100
6
99.5
Other
11
11
0
100
5
99.1
8
7
1
87.5
2
98.2
Skin
63
61
2
96.8
19
98.2
44
44
0
100
2
98.6
Urological
All Cancers
146
852
145
842
1
10
99.3
98.8
6
97.8
98.5
Total
treated
Treated
on or
within 31
days
198
7
118
434
95
852
198
6
117
427
94
842
Sarcoma
Treated
%
Median
days
standard
Time
National
%
meeting
standard
Treatment Group
Drug Treatments
Other Treatments
Surgery
All Treatments
Treated Poole % Median
days
standard
Time
0
1
1
7
1
10
100
85.7
99.2
98.4
98.9
98.8
0
14
0
14
19
National
%
meeting
standard
99.8
97
100
97.9
97.5
98.5
Breach reasons
Tumour Type
Skin
Treatment
type
Surgery
Wait
Days
47
Head & Neck
Other
36
Urological
Radiotherapy
146
Breast
Radiotherapy
51
Report
Unable to bring TCI date forward - spoke to management &
discussed at breach meeting (Consultant on leave 29 June & 2529June).
Insufficient capacity - treatment room not available.
Patient requested treatment start after a holiday at the end of July
2012.
Patient requested start date at the beginning of August because
of son’s wedding.
Skin
Radiotherapy
44
Patient not due to start RT until 27/09/12 as going on holiday
17/09 - 20/09 and wanted to defer treatment until after holiday.
Head & Neck
Radiotherapy
36
Breast
Radiotherapy
36
Technical difficulties during RT planning. A new Zentec+ CT Scan
was required as the quality Imaging tolerance was unacceptable
with the original orfit
Patient was on holiday so treatment was delayed
Gynaecological
Radiotherapy
35
Breast
Radiotherapy
34
Sarcoma
Radiotherapy
34
Patient referred to community palliative care first contact delayed
by episodes in hospital
Required replanning
Patient was not ready to start treatment until 6/8 due to
extractions of his teeth.
62 days: Urgent GP referral to First Treatment
Measure
Maximum 62 day wait from urgent GP referral to first treatment for all cancers by 2005
Target
85% or more
Source
Time Period
Q2 2012/13
a) By tumour site
Breast
Gynaecological
Haematological (Excluding Acute Leukaemia)
Head & Neck
Lung
Other
Skin
Urological
Total
Actual no.
treated
Accountable
no. treated
36
23
17
28
16
28
1
25
16
5
195
36
16
15.5
21.5
13
22
1
23.5
14.5
3
166
Accountable Poole % National
no. over
meeting
%
target
standard meeting
standard
3
91.7
97.8
2
87.5
85.2
1
93.5
83.5
4.5
79.1
75.8
3
76.9
79
4
81.8
80.4
0
100
81.3
0.5
97.9
97.9
1
93.1
81
1.5
50
83
20.5
87.7
87.2
Treatment Group
Accountable Accountable
no. treated
no. over
target
Drug Treatments
Other Treatments
Surgery
Totals
39
1
25
20
81
166
4
0
3
6
7.5
20.5
Poole %
meeting
standard
89.7
100
88
70
90.7
87.7
National
%
meeting
standard
84.1
83
92.4
64.9
89.9
87.2
Breach reasons
Tumour Type
First
Treatment
Trust
RD3
Wait
Days
Report
Breast
First
Seen
Trust
RD3
111
Breast
RD3
RD3
64
Breast
RD3
RD3
70
Gynaecological
RBD
RD3
69
Haematological
(Excluding
Acute
Leukaemia)
Head & Neck
RBD
RD3
147
Patient has known CLL and required lots of biopsies and diagnostic
tests.
Patient originally given a TCI date of 22/6/12 but at pre-assessment
required various cardiac investigations to determine if fit for surgery.
Patient admitted for surgery within target but ran out of theatre time so
was discharged without treatment.
Late referral from other trust - required staging before treatment could
be considered.
Complex case with many tests required
RBD
RD3
95
Head & Neck
Head & Neck
RD3
RD3
RD3
RD3
69
85
Head & Neck
RD3
RD3
73
Complex pathway patient needed several diagnostic tests (trying to find
primary cancer). Patient refused to travel to Southampton for a PET
scan.
ENT Admissions unable to book patient within target date.
Complex pathway - originally referred via Haematology and then lack of
capacity to book surgery within target date due to consultant being on
annual leave.
Patient needed numerous diagnostic tests to try and find primary
cancer and also was not very compliant (would not wait in clinic to
discuss treatment plan)
Patient was booked to start treatment 05/09/12 but when they arrived
they did not have PICC line inserted.
Provisional date for surgery 17/07/12 delayed as patient needed to stop
aspirin and have CPEX test before operation.
Complex diagnostic pathway - referred via an Upper GI fast track
patient non-compliant with investigations.
Patient initially thought to be fit for RFA but was considered unfit and
referred for surgery. Borderline fitness for surgery, requested
anaesthetic assessment.
Referral from other Trust received day 66 of pathway. Complex
diagnostic pathway
complex pathway
Patient referred from another site - had investigations for UGI and H&N
cancer
CARP received day 237 of pathway. Patient non-compliant at referring
trust during diagnostic investigations.
Lower
Gastrointestinal
Lower
Gastrointestinal
Lung
RBD
RD3
66
RD3
RD3
78
RD3
RD3
75
Lung
RD3
RHM
108
Lung
RDZ
RD3
83
Skin
Upper
Gastrointestinal
Urological
(Excluding
Testicular)
Urological
(Excluding
Testicular)
Urological
(Excluding
Testicular)
Gynaecological
RD3
RD3
RDZ
RD3
126
68
RDZ
RD3
306
RDZ
RD3
196
Cross Trust Referral received day 135 of pathway.
RDZ
RD3
161
Clinical referral and CARP recd day 86 of pathway from other trust - no
breach reason given by referring trust
RD3
RD3
80
Gynaecological
RDZ
RD3
83
Haematological
(Excl Acute
Leukaemia)
Head & Neck
Head & Neck
RDZ
RD3
114
patient was unsure whether or not she wanted to have treatment - she
is an elderly lady and was persuaded to have treatment by her family.
Was due to start treatment - PET scan revealed uptake in Bone
marrow - had bone marrow trephine and had to be re-planned for
radiotherapy.
Patient declined systemic chemotherapy.
RDZ
RDZ
RD3
RD3
72
132
Lower
Gastrointestinal
RD3
RD3
154
Lower
Gastrointestinal
RD3
RDZ
86
Lung
RD3
RD3
88
Lung
RD3
RD3
195
Non compliance for various investigations by patient.
Patient was removed from tracking by referring trust in error following
1st diagnostic test. which was reported as inadequate sample.
Patients extensive co-morbidities caused many investigations to be
delayed or were cancelled by the patient both for diagnosis and to
determine fitness for treatment
Patient away on holiday at beginning of pathway. Patient then DNA'd
OPA on 22.5.12. Many diagnostic tests USS, CT, EUS/Biopsy, PET,
MRI
29 day delay for PET scan (soonest available appointment and patient
didn’t wish to travel to other site for scan). Patient initially booked to
start treatment on breach date but was eligible for trial so needed
longer planning.
Patient non compliant with appointments and DNAd surgery disease
then progressed so no longer fit for any active treatment
62 days: Suspected cancer patients detected through national screening programmes
Measure
Maximum 2 month wait from referral from NHS Cancer Screening Programme to treatment by December 2008
Target
90% or more
Source
Time Period
Q2 2012/13
Breast
First
Seen
Provider
First
Treatment
Provider
Actual
no.
treated
RD3
RD3
RD3
Total
RBD
RD3
RDZ
15
39
18
72
Accountable Accountable Poole % Median
no. treated
no. over
meeting Waiting
target
standard
Time
7.5
39
9
55.5
0
0
0
0
100
100
100
100
33
48
35
National
%
meeting
standard
97.6
97.6
97.6
97.6
a) Gynaecological
First
Seen
Provider
First
Treatment
Provider
Actual
no.
treated
RD3
RD3
1
2
3
RBD
RD3
Total
b)
First
Seen
Provider
no. treated
no. over
meeting Waiting
target
standard
Time
0.5
2
2.5
0
0
0
100
100
100
37
31
National
%
meeting
standard
95.2
95.2
95.2
Lower GI
First
Treatment
Provider
Actual
no.
treated
RD3
RHM
12
1
13
RD3
RD3
Total
meeting Waiting
no. treated
no. over
standard
Time
target
12
0.5
12.5
1
0.5
1.5
91.7
0
88
53
79
National
%
meeting
standard
81.3
81.3
81.3
c) ALL SCREENING PROGRAMMES
First
Seen
Provider
First
Treatment
Provider
Actual
no.
treated
RD3
RBD
RD3
RDZ
RHM
1
15
53
18
1
88
RBD
RD3
RD3
RD3
RD3
Total
Accountable Accountable Poole % National
no. treated
no. over
meeting
%
target
standard meeting
standard
0.5
0
100
94.9
7.5
0
100
94.9
53
1
98.1
94.9
9
0
100
94.9
0.5
0.5
0
94.9
70.5
1.5
97.9
94.9
Breach reasons
Tumour Type
Lower
Gastrointestinal
Lower
Gastrointestinal
First
Seen
Trust
RD3
First
Treatment
Trust
RD3
Wait
Days
Report
88
RD3
RHM
79
There was a long wait for the patients scans to be booked and then
reported despite repeated attempts to expedite
Complex pathway
62 days: Suspected cancer patients not referred urgently and upgraded by Consultants
Measure
Maximum 2 month wait from consultant upgrade of urgency of a referral to first treatment by December 2008
Target
Not yet defined
Source
Time Period
Q2 2012/13
Accountable Accountable Poole % National
no. treated
no. over
meeting
%
target
standard meeting
standard
2
0
100
100
Breast
1
0
100
98.1
Haematological
2
0
100
95.3
17
1
94.1
94.3
Lung
2.5
0
100
89.1
Skin
4
0
100
98.8
Urological
0.5
0.5
0
91
All Cancers
29
1.5
94.8
93.2
Breach reasons
Tumour Type
Lower
Gastrointestinal
Urological
(Excluding
Testicular)
Consultant
Upgrade
Trust
RD3
First
Treatment
Trust
RD3
Wait
Days
Report
90
Several diagnostic tests required and complex investigations
RDZ
RD3
167
CARP and referral received after upgrade breach date from
referring trust - complex diagnostic pathway at referring trust.
62 days: Breast symptomatic referral (non cancer) to first treatment
Measure
Maximum 2 month wait from breast symptomatic referral (non cancer) to first treatment
Target
No standard set
Source
Time Period
Q2 2012/13
First
First
Seen
Treatment
Provider Provider
RD3
Total
RD3
Actual
Total
treated
Accountable
no. treated
4
4
4
4
Accountable Poole % National
meeting
no. over
%
standard meeting
target
standard
0
100
95.6
0
100
95.6
Key of Trust Codes:
RBD
DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST
RD3
POOLE HOSPITAL NHS FOUNDATION TRUST
RDZ
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION
TRUST
RHM
SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST
RAN
ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST
RNZ
SALISBURY NHS FOUNDATION TRUST
RA4
YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST
RPY
THE ROYAL MARSDEN NHS FOUNDATION TRUST
RBA
TAUNTON AND SOMERSET NHS FOUNDATION TRUST
RM1
NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
RH8
ROYAL DEVON AND EXETER NHS FOUNDATION TRUST
RJZ
KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST
RWA
HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
Prepared by
Anne Foulkes
Performance Manager
Medical Division
November 2012
CWT Trends in performance
Anne Foulkes
Business & Performance Manager,
Medical Division
November 2012
PERFORMANCE REPORT October 2012
Emergency Department Professional Standards
The Risk:
The first week of October presented a challenge to the performance against the 4 hour target.
However, there was a rapid recovery and the performance against the 4 hour target for the
remainder of the month was strong, resulting in the month-end position being 96.89%.
All of the key performance indicators were met in October. Progress has been made to improve
data quality for the nurse assessment times, and this has resulted in the target being met for
October.
Clinician seen time for October was 42 minutes (against the target of 60 minutes). This represents
the best performance against the target this year. The total time spent in the department was 238
minutes (95th percentile target), which has remained steady since April 2012.
The time spent in the department for admitted patients was 264, which is a worsening position from
the previous month’s improvement. The position was severely affected by the first week of October
when bed pressures caused a number of breaches. Whilst this is not a monitor standard, the aim is
to reduce this to within 240 minutes.
To date, the Quarter position shows a continuation of recent performance with all targets on track to
be achieved.
Current Position and Actions:
The Emergency Department delivered the 4 hour target for October 2012. The first four days of
October presented a significant decline in performance with a large number of breaches. Actions to
identify and address the issues causing the decline were taken swiftly and the performance
improved towards the end of the week and has been sustained throughout October.
The full Business case for staffing remains unresolved. The medical staffing shortages continue to
be managed according to plan – two SpR vacancies are filled pending visa applications, one of
whom has now started in post. Until both SpRs are in post, ad-hoc locums and consultants are
being used to fill the week end shifts uncovered by the gaps in the rota. ST4 or above level trained
staff continue to be available 24 hours a day 7 days per week, which is the standard expected. The
locum consultant has started, and the substantive replacement post, as well as the 6th consultant
post, has been advertised. To date, there has not been the level of interest required to fill both
posts. Some contingency plans for consultant cover may be required for 2013.
The chart below demonstrates the weekly performance trend against the 95% target for 4 hours:-
Poole Hospital NHS Foundation Trust
Weekly Progress Chart - A&E 4 hour 95% target
Weekly and Quarterly Position
100.00%
98.00%
96.00%
94.00%
92.00%
90.00%
88.00%
86.00%
84.00%
82.00%
04-Nov-12
28-Oct-12
21-Oct-12
14-Oct-12
07-Oct-12
30-Sep-12
23-Sep-12
16-Sep-12
09-Sep-12
02-Sep-12
26-Aug-12
19-Aug-12
12-Aug-12
05-Aug-12
29-Jul-12
22-Jul-12
15-Jul-12
08-Jul-12
01-Jul-12
24-Jun-12
17-Jun-12
10-Jun-12
03-Jun-12
27-May-12
20-May-12
13-May-12
06-May-12
29-Apr-12
22-Apr-12
15-Apr-12
08-Apr-12
01-Apr-12
25-Mar-12
18-Mar-12
11-Mar-12
04-Mar-12
26-Feb-12
19-Feb-12
12-Feb-12
05-Feb-12
29-Jan-12
22-Jan-12
15-Jan-12
08-Jan-12
01-Jan-12
25-Dec-11
18-Dec-11
11-Dec-11
04-Dec-11
27-Nov-11
20-Nov-11
13-Nov-11
06-Nov-11
30-Oct-11
23-Oct-11
16-Oct-11
09-Oct-11
02-Oct-11
week ended
weekly % within 4 hours
qtr to date % seen within 4 hours
95% target
98% target
Action:
There is an action plan in place which is monitored weekly. It covers a range of areas for
improvement (leadership on shop floor, specialty response to ED and flow through the hospital
including some specific pathway development, links with outside agencies, improving staffing
resources and addressing the future medical cover gaps). The plan is adjusted regularly to also
take into account seasonal / local pressures, and as such will address measures required to support
continued performance through the winter period.
Plans to develop space in minors have been developed with the architects, this work will also
include some office space and a seminar room to facilitate training of nursing and medical staff
within the department. The staff are being consulted with to ensure the plans are a “best fit” for the
department, as there are a number of outstanding estates issues to be addressed which cannot all
be achieved within the constraints of the current space.
Further analysis of frequent attenders and re-attendance rates is due to take place. A steering
group has been established, which is due to meet for the first time in November, in order to develop
actions to address these issues.
Prepared by:
Sarah Knight
Directorate Manager, Emergency Services
12.11.12
Referral to Treatment (RTT) - Admitted: Trust performance for October is 97.2%
Summary:
The Trust achieved the 90% RTT Target, and Gynaecology achieved the specialty target of 90%,
achieving 92.9% for October. This is a fourth month of achieving the target.
Current Position:
At 13th November 2012, the most recent (12th November 2012) predicted performance in October
for Gynaecology is 95.7%.
Whilst the target continues to be achieved, fundamental capacity challenges exist within the
specialty.
Actions for November and December 2012:
•
Work with the booking team and consultant body to accommodate the one potential
November breach patient currently without a TCI.
•
Plan in place re- lost Gynaecology theatre capacity over Christmas – Consultant body have
agreed to changes in their programme resulting in a reduced loss of theatre capacity without
additional cost .
•
21st November meeting with Chief Operating Officer, Gynaecology CD, MCDD - DD & DM to
review capacity and demand tool re-implementation of a sustainable capacity solution for
Gynaecology.
•
13th November meeting with RBH information Team and PHT information team re- exploring
implementation of RBH live Gynaecology capacity and demand tool. .
•
Working with booking team to review RJH patients with January TCI’s to identify patients
‘colleague able to do’ pooling patients re- potential capacity issues due potential for RJH to
accommodate ‘urgents’ re- lost oncology capacity over Christmas.
•
Review of theatre utilisation has identified the potential for additional patients to be added to
Gynaecology Associate Specialist theatre lists from November onwards in agreement with
TCH.
Prepared by:
Ian Sprigmore
Directorate Manager
Obstetrics and Gynaecology
13.11.12
Admitted Performance
RTT Performance - Admitted Patients
100
%
75
50
25
0
Oct-11
94.4
% Within 18 Wks
Target 90%
95th Centile Wait (wks)
95th Centile Target
Admitted Patients
Total patients admitted
Greater than 18 weeks
Unknown Clock Starts
% Within 18 Wks
Nov-11
93.0
Dec-11
90.8
Jan-12
92.2
Feb-12
88.7
Mar-12
92.5
Apr-12
94.5
May-12
95.4
Jun-12
96.0
Jul-12
97.2
Aug-12
97.3
Sep-12
97.6
Oct-12
97.1
90
90
90
90
90
90
90
90
90
90
90
90
90
19.2
20.3
22.3
19.7
24.1
21.3
18.9
17.7
17.7
17.0
17.0
16.9
17.4
23
23
23
23
23
23
23
23
23
23
23
23
23
Oct-11
947
53
0
94.4
19.2
Nov-11
1114
78
0
93.0
20.3
Dec-11
818
75
0
90.8
22.3
Jan-12
978
76
0
92.2
19.7
Feb-12
962
109
0
88.7
24.1
Mar-12
1073
81
0
92.5
21.3
Apr-12
923
51
0
94.5
18.9
May-12
1132
52
0
95.4
17.7
Jun-12
866
35
0
96.0
17.7
Jul-12
1070
30
0
97.2
17.0
Aug-12
1041
28
0
97.3
17.0
Sep-12
983
24
0
97.6
16.9
Oct-12
1186
34
0
97.1
17.4
Admitted Performance Tables
Code
100
110
120
140
300
320
330
400
410
430
502
**X01
% Within 18 Wks By Specialty
General Surgery
Trauma & Orthopaedics
Ear, Nose & Throat
Oral Surgery
General Medicine
Cardiology
Dermatology
Neurology
Rheumatology
Eld Care
Gynaecology
**Other
TRUST TOTAL
**Breakdown of X01 (Other)
107 Vascular Surgery
141 Restorative Dentistry
191 Pain Management
301 Gastroenterology
303 Haematology
311 Genetics
314 ABI & Neurorehab
321 Paediatric Cardiology
370 Med Onc
420 Paeds
800 Clin Onc
Oct-11
90.7
95.9
94.0
98.1
87.5
92.3
97.7
100.0
98.0
100.0
86.5
100.0
94.4
Nov-11
85.5
94.7
91.0
96.9
100.0
90.0
97.3
100.0
97.2
N/A
N/A
88.6
92.1
93.0
Oct-11
100.0
100.0
100.0
100.0
100.0
100.0
Dec-11
73.8
96.2
91.7
97.8
100.0
100.0
98.1
Feb-12
68.2
86.0
85.0
96.7
92.9
100.0
97.2
100.0
98.9
100.0
82.6
93.1
88.7
Mar-12
81.4
95.2
89.9
96.8
100.0
95.7
99.5
100.0
100.0
100.0
85.6
100.0
92.5
Apr-12
88.9
96.7
96.6
99.1
100.0
100.0
97.3
100.0
100.0
100.0
87.2
97.1
94.5
May-12
91.0
100.0
94.6
97.6
100.0
100.0
100.0
100.0
100.0
100.0
87.9
100.0
95.4
Jun-12
94.7
96.8
97.6
98.2
100.0
100.0
99.5
100.0
98.1
82.4
97.1
90.8
Jan-12
91.2
98.2
82.0
95.1
100.0
87.5
95.6
100.0
97.5
100.0
87.2
94.4
92.2
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
100.0
100.0
100.0
92.3
100.0
84.6
100.0
88.2
100.0
96.2
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
N/A
97.0
100.0
100.0
100.0
100.0
85.7
100.0
100.0
97.6
Jul-12
96.7
98.8
95.6
98.4
100.0
100.0
99.5
Aug-12
95.6
98.9
97.2
97.1
100.0
100.0
99.0
Sep-12
94.0
100.0
96.5
98.2
100.0
100.0
99.1
Oct-12
94.4
100.0
97.5
99.3
93.3
100.0
98.9
N/A
N/A
100.0
100.0
100.0
100.0
100.0
N/A
100.0
100.0
86.2
96.7
96.0
98.4
100.0
94.0
97.4
97.2
94.5
100.0
97.3
96.4
100.0
97.6
92.9
95.7
97.1
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
100.0
100.0
92.9
N/A
93.3
95.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
Non-Admitted Performance
RTT Performance - Non-Admitted Patients
100
75
%
50
25
0
% Within 18 Wks
Target 95%
Oct-11
98.4
Nov-11
97.9
Dec-11
97.4
Jan-12
97.6
Feb-12
97.0
Mar-12
96.6
Apr-12
96.1
May-12
97.0
Jun-12
97.5
Jul-12
98.1
Aug-12
98.3
Sep-12
97.4
95
95
95
95
95
95
95
95
95
95
95
95
15.4
15.7
16.0
15.7
17.0
17.0
17.4
16.9
16.0
16.0
16.7
16.4
95th Centile Target
18.3
18.3
18.3
18.3
18.3
18.3
18.3
18.3
18.3
18.3
18.3
18.3
Jun-12
1808
43
0
97.5
16.0
Jul-12
2343
44
0
98.1
16.0
Aug-12
2199
37
0
98.3
16.7
Sep-12
2385
63
0
97.4
16.4
Month
Non-Admitted Patients
Total patients treated
Greater than 18 weeks
Unknown Clock Starts
% Within 18 Wks
Oct-11
2150
34
0
98.4
15.4
Nov-11
2304
48
0
97.9
15.7
Dec-11
2001
52
0
97.4
16.0
Jan-12
2178
52
0
97.6
15.7
Feb-12
2038
62
0
97.0
17.0
Mar-12
2236
77
0
96.6
17.0
Apr-12
2117
82
0
96.1
17.4
May-12
2455
76
0
97.0
16.9
Oct-12
2753
68
0
97.5
16.7
Non-Admitted Performance Tables
Code
100
101
110
120
130
140
150
170
300
320
330
400
410
430
502
**X01
% Within 18 Wks By Spec
Gen Surg
Urology
T&O
ENT
Ophthalmology
OMF
Neurosurgery
Cardiothoracic Surgery
Gen Med
Cardiology
Dermatology
Neurology
Rheumatology
Eld Care
Gynae
**Other
TRUST TOTAL
**Breakdown of X01 (Other)
107 Vascular Surgery
141 Restorative Dentistry
171 Paed Surg
191 Pain Management
303 Haematology
311 Genetics
314 ABI & Neurorehab
315 Palliative Medicine
321 Paediatric Cardiology
324 Anticoagulation
370 Med Onc
420 Paeds
421 Paed Neurology
800 Clin Onc
Oct-11
99.0
80.0
97.1
97.4
100.0
98.4
100.0
N/A
97.2
100.0
100.0
98.5
99.2
96.6
98.5
97.8
98.4
Oct-11
100.0
N/A
100.0
94.7
100.0
100.0
100.0
Nov-11
97.9
75.0
98.0
96.7
96.8
97.1
100.0
100.0
98.8
99.2
99.5
96.8
98.8
97.8
98.5
97.5
97.9
Dec-11
99.4
100.0
97.4
99.3
94.6
96.9
100.0
Feb-12
97.1
100.0
97.0
97.8
90.6
99.3
94.8
99.0
99.5
92.4
96.5
98.1
98.4
96.6
97.4
Jan-12
97.3
100.0
97.3
96.3
96.2
98.4
100.0
100.0
98.7
99.3
97.8
96.3
99.2
100.0
97.4
95.9
97.6
Nov-11
100.0
100.0
100.0
92.2
100.0
100.0
100.0
Dec-11
94.1
100.0
100.0
93.9
100.0
100.0
100.0
Jan-12
100.0
100.0
100.0
90.9
100.0
100.0
100.0
Feb-12
92.3
100.0
N/A
N/A
100.0
94.2
99.0
97.1
94.7
99.4
100.0
97.9
95.8
97.0
N/A
96.5
100.0
100.0
100.0
Mar-12
99.5
100.0
96.6
96.6
90.2
98.8
100.0
100.0
96.7
97.1
98.0
92.9
97.7
100.0
96.0
94.0
96.6
Apr-12
95.9
94.4
98.2
96.2
95.8
95.1
Jun-12
97.4
100.0
98.9
99.3
100.0
97.6
98.1
96.7
99.1
90.5
99.0
100.0
97.8
92.9
96.1
May-12
97.7
100.0
99.5
98.2
100.0
98.5
100.0
100.0
97.3
98.3
98.3
93.0
97.3
100.0
95.5
94.4
97.0
Mar-12
100.0
100.0
100.0
88.0
100.0
100.0
100.0
Apr-12
100.0
100.0
100.0
76.6
100.0
100.0
100.0
May-12
100.0
100.0
100.0
87.0
100.0
93.3
100.0
N/A
N/A
100.0
97.1
100.0
98.8
95.9
98.3
100.0
97.2
95.2
97.5
Jul-12
96.1
100.0
99.3
99.5
100.0
99.4
100.0
100.0
97.6
96.9
99.5
98.2
98.3
100.0
97.1
97.4
98.1
Aug-12
98.4
100.0
100.0
98.3
100.0
97.8
100.0
100.0
99.4
98.1
99.5
96.0
97.4
96.7
96.4
99.1
98.3
Sep-12
97.8
97.3
95.5
97.8
96.8
97.7
100.0
100.0
96.1
98.5
99.1
95.0
97.9
100.0
99.5
95.7
97.4
Oct-12
97.3
100.0
99.2
96.6
99.1
97.0
N/A
100.0
96.0
97.7
99.6
97.1
97.3
97.5
98.2
96.9
97.5
Jun-12
100.0
100.0
100.0
85.7
100.0
100.0
100.0
Jul-12
100.0
100.0
100.0
94.7
100.0
100.0
100.0
Aug-12
100.0
100.0
100.0
98.2
100.0
100.0
100.0
Sep-12
100.0
100.0
100.0
96.5
100.0
100.0
100.0
Oct-12
100.0
100.0
100.0
92.9
100.0
100.0
100.0
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
87.5
100.0
100.0
97.9
75.0
100.0
100.0
100.0
100.0
97.6
100.0
96.8
88.2
100.0
100.0
95.8
100.0
100.0
90.0
100.0
96.3
95.7
90.0
100.0
89.5
96.0
100.0
95.0
80.0
100.0
88.9
100.0
100.0
93.9
50.0
100.0
93.1
100.0
100.0
95.1
100.0
100.0
87.0
100.0
96.0
95.8
100.0
100.0
85.7
100.0
100.0
95.7
100.0
100.0
84.0
100.0
100.0
97.9
100.0
100.0
95.8
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
92.0
100.0
98.5
93.3
100.0
100.0
95.8
100.0
100.0
Diagnostic Access Times: Patients waiting in excess of 6 weeks
The Risk: Endoscopy continues to see patients waiting past the six week target time, primarily due to the
number of referrals the service receives compared to the capacity the service is able to provide. The
number of patients on the surveillance waiting list continues to reduce however an influx of fast rack
patients has impacted on available capacity this month.
Current Position: The number of patients waiting 6 weeks and above at the end of October is 26 (36 at
the end of September) as shown in the graph below. Of the total number of patients waiting, 91% are
waiting less than 6 weeks. The total number of patients on the waiting list has decreased to 422 (449 at the
end of September). The reduction in the number of patients waiting, despite referrals remaining high, is a
result of additional activity run by the department. This has been achieved by additional weekend lists
which need to be continued until sustained additional capacity is in place.
In terms of the surveillance backlog, this continues to reduce as planned due to additional lists dedicated to
surveillance patients and close monitoring. Currently, there are 7 surveillance patients who are breaching
the 6 week target – 37 surveillance patients due to be seen in total.
Endoscopy Breaches against the 6 week target
90
80
Number of Patients
70
60
50
40
30
Target
20
10
0
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Following discussions with the PCT, funding has been granted for additional lists. It is anticipated that this
will support additional equipment to fully utilise the third endoscopy procedure room, allowing for maximum
utilisation and increase capacity in the department. This is currently with the Purchasing department for
finalisation.
Following on from the JAG visit in September, the draft report has been received to be signed off. The
report states various actions which need to be met by the department, mainly privacy and dignity and
timeliness. Work has already begun on these.
Action: The department will be running additional Saturday lists throughout November in order to keep up
with demand. If increased capacity can be sustained in the long term, it is anticipated that this will ensure
patients are seen within 6 weeks.
Prepared by :
Rebecca Gouveia
Endoscopy Admissions Manager/Assistant Business Manager Surgical Division
November 2012
Bowel Cancer Screening Programme: Non-achievement of diagnostic screening target – 98.82%
Target:
100% of patients are offered a diagnostic screening appointment within 14 days.
1.
Summary
1.1
During October 2012, all patients who were fit for screening colonoscopy were offered a diagnostic
test within 14 days.
1.2
One patient, due to a history of major abdominal trauma, was not fit for colonoscopy and was
referred for a diagnostic CT colonography.
1.3
It was not possible to arrange a diagnostic CT colonography for this patient within 14 days. The first
available date was 28 days after their SSP appointment.
2.
Reasons for referral by the BCSP to CT colonography
2.1
Patients are referred for a diagnostic CT colonography for one of two reasons:
• The screening colonoscopy could not be completed (e.g. due to looping bowel or pain) and a CT
colonography is requested to complete the diagnostic test.
• Following review at nurse clinic, a screening colonography is deemed not clinically suitable.
2.2
It is the patients who are deemed not clinically suitable for a colonography who have to be seen
within 14 days to prevent a breach being reported.
3.
Actions for November 2012
3.1
A review of all patients who have been referred directly for a diagnostic CT colonography (2012) as
part of the BCSP is being undertaken to identify if any changes in practice need to take place to
prevent further breaches. This review is being undertaken by the Programme Manager and Lead
Nurse, in conjunction with the Clinical Director.
Prepared by:
Suzie Scaddan
Bowel Cancer Screening Programme Manager
08.11.12
OPERATIONS SUMMARY OCTOBER 2012
st
th
(For the period of 1 September 2012 to 30 September 2012)
This report summarises various operational aspects year to date and provides an update regarding
the reconfiguration of beds.
1
ACTIVITY
1.1
The number of non elective admissions year to date is 1.6% more compared to the
same period last year.
1.2
Attendances at the Emergency Department have increased negligibly by 0.03% year to date,
although at times the Department is experiencing extremely high levels of attendances. There have
also been a number of specialties which have seen larger than average increases in their
emergency admissions as shown below;
Specialty
General Surgery
Trauma and Orthopaedics
ENT
Paediatrics
2011/12
2012/13
% Increase
1365
1757
330
2423
1674
1959
406
2997
22.6%
11.5%
23.0%
23.7%
1.3
The number of Emergency admissions to the Trust has increased by 4.2% year to date, which also
includes an 8.3% rise in admissions directly requested by General Practitioners and 4.7% increase
from admissions directly from ED.
1.4
Elective activity has increased year to date, with 5.6% more elective admissions and 31% more day
case admissions.
1.5
The number of Maternity admissions year to date has decreased by 11.9% compared to the same
period last year.
1.6
The variance in Trust activity (YTD) is summarised below:
Activity Year to Date
Adult Emergency Admissions
Adult Non Elective Admissions
(Inc emergency & transfers excl maternity)
Child Non Elective Admissions
(Excl maternity)
Maternity Admissions
Emergency Dept Attendances
Inpatient Electives (all ages)
Day Cases (all ages)
Year to
date
12/13
15,284
11,906
Previous year
to date 11/12
Variance
14,655
11,714
+4.2%
+ 1.6%
3,772
3,151
+ 19.7%
5,717
30,920
2,031
13,866
6,486
30,835
1,992
10,560
- 11.9%
+ 0.03%
+ 5.6%
+ 31%
2
LENGTH OF STAY
2.1
Adult Non Elective average Length of Stay (LOS) for September 2012 has reduced from 5.68 bed
days in September 2011 to 5.16 bed days in September 2012. This is an improvement of 9.2%.
The graph below shows the average adult non elective LOS from April 10 to date
LOS - Adult
8.00
LOS Adult
12/13
7.00
LOS Adult
11/12
6.00
LOS Adult
10/11
5.00
4.00
Apr
2.2
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
The table below shows LOS by Directorate from April 2011 to date. The majority of areas have seen
a reduction in LoS, however there are still a number of outlying services. The Medical statistics
include the Emergency Assessment Unit.
2011
2012
Directorate
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Elderly Medicine
7.9
9.7
9.1
8.5
8.1
7.1
7.1
7.8
6.1
7.2
7.6
7.8
7.0
7.0
7.3
7.6
7.4
7.5
Gynaecology
1.9
1.8
1.8
1.8
1.7
1.5
1.8
2.0
1.5
1.6
1.9
1.9
1.6
1.9
1.9
1.8
1.7
1.6
Medical
2.1
2.6
2.7
2.1
2.4
2.3
2.4
2.4
2.9
2.9
3.2
2.8
3.2
2.7
2.7
2.9
3.1
2.8
Obstetrics and Well Babies
1.1
1.1
1.2
1.2
1.1
1.1
1.2
1.2
1.2
1.1
1.2
1.2
1.1
1.2
1.2
1.2
1.4
1.4
Oncology
5.5
6.3
6.7
6.4
7.0
7.0
5.6
6.6
6.2
5.8
5.6
5.6
7.0
7.4
6.0
7.0
7.4
4.2
Paediatric
1.9
2.2
2.1
2.1
2.1
2.0
1.4
1.7
1.7
1.7
1.9
1.8
2.4
1.8
2.0
2.0
2.0
2.1
Specialist Medical Services
23.3
9.3
18.0
6.6
17.8
9.4
15.0
10.3
8.6
16.7
14.2
16.8
19.1
19.2
9.3
14.1
9.6
9.7
Surgery
2.7
2.5
2.5
2.2
2.8
2.6
2.5
2.6
2.6
2.4
2.5
2.4
2.6
2.7
2.7
2.3
2.6
2.5
7.0
6.0
6.9
6.0
5.8
5.6
6.4
6.5
6.4
7.0
6.1
6.3
6.6
5.5
5.9
6.1
6.1
6.2
2.3
The 4 Directorates showing the most variation in average LoS and have the highest recorded
figures are Elderly Medicine, Oncology, Trauma & Orthopaedics and Specialist Medical Services.
The graph below shows the variation experienced by the 4 Directorates.
25.0
20.0
15.0
Elderly Medicine
Oncology
10.0
Specialist Medical Services
5.0
0.0
2.4
The percentage of time the Trust is in a Green/Amber bed state position is a clear indication of how
pressurised the whole system is. The Hospital was in a red bed state for 63% of the time during
September 2012, it was recorded as 43% the previous year. The graph below shows the
Amber/Green bed state since April 2010.
Monthly Comparison Bed State: Green & Amber Amalgamated
125%
100%
75%
50%
25%
0%
Apr
May
June
July
Aug
Sept
Bed State 12/13
30%
29%
30%
32%
35%
37%
Oct
Nov
Dec
Jan
Feb
Mar
Bed State 11/12
30%
19%
40%
84%
87%
57%
29%
77%
52%
48%
24%
48%
Bed State 10/11
90%
97%
100%
100%
90%
90%
97%
73%
45%
48%
68%
52%
3
DELAYS
3.1
The percentage of Delayed Transfers of Care has significantly reduced this year compared to last,
with decreases in the number of waits reported for Social Services and Community Hospitals and
Intermediate Care. Continuing Healthcare and Community Hospitals represent the majority of all
waits.
3.2
The table below shows the variance in bed delays lost due to formal delays as a comparison with
the same period in 2011. The largest improvements are seen in Intermediate Care (-85%) and
Social Service delays (-57%). Further work needs to be undertaken with our Housing and
Continuing Healthcare colleagues.
Bed Days Lost
YTD 12/13
Previous YTD
11/12
Variance
Overall Bed Days Lost
4059
5900
-31%
Community Hospitals
1077
1765
-39%
Social Services
487
1123
-57%
Continuing Healthcare
753
662
+14%
Housing
103
58
+77%
Self Funding
597
805
-26%
Intermediate Care
105
685
-85%
3.3
The graph below demonstrates the total number of bed days lost due to formal delays since April
2010. September 2012 and May 2012 had the lowest number of delays recorded since April 2010
at 3%.
Total Bed Days Lost
1750
1500
1250
TOTAL Delays 12/13
1000
TOTAL Delays 11/12
750
TOTAL Delays 10/11
500
250
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
4
CANCELLATIONS
4.1
All waiting list cancellations
4.1.1
Elective admissions cancelled have reduced compared to the same period last year with 24.3%
cancellations recorded in September 2011 and 15.5% in September 2012. This continues to be the
trend this financial year.
4.1.2
The graph below shows the % of elective admissions cancelled as a % of all elective admissions
Elective Admissions Cancelled as % of All Elective Admissions
40%
30%
% Elective Cancellations 12/13
20%
10%
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
4.2
Waiting list cancellations within 1 day of the TCI (to come in) date
4.2.1
Elective admissions cancelled within a day of their TCI date (a subset of the total in the previous
paragraph) have reduced over the financial year but is still in higher than the same period last year.
When compared to the same period last year with 4.0% cancellations recorded in September 2011
and 3.2% in September 2012.
4.2.2
The graph below shows the % of elective admissions cancelled within a day of their TCI date as a %
of all elective admissions.
Elective Admissions Cancelled within 1 day of TCI date as % of All Elective Admissions
6%
% Elective
cancellations
<= 1 day
12/13
5%
4%
% Elective
cancellations
<= 1 day
11/12
3%
2%
% Elective
cancellations
<= 1 day
10/11
1%
0%
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
4.3
Cancelled operations
4.3.1
Operations cancelled either on the day of admission or the planned day of operating fluctuates
month by month but on a cumulative basis has increased slightly when compared with last year and.
The year to date position for September 2012 was 133 cancellations, compared with 130 for
September 2011, and 128 for September 2010.
4.3.2
The graph below shows the cumulative position for cancelled operations on the day of admission or
operation.
Monthly cumulative position for cancelled operations
300
250
200
cancelled ops 2012/13
150
100
50
0
Apr
4.3.3
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
The graph below shows monthly numbers of cancelled operations on the day of admission or
operation, split by cause.
Cancelled operations per month split by cause
40
35
30
25
other
no bed
20
staff sickness
15
no theatre time
list cancelled
10
5
Sep-12
Jul-12
Aug-12
Jun-12
Apr-12
May-12
Mar-12
Jan-12
Feb-12
Dec-11
Oct-11
Nov-11
Sep-11
Jul-11
Aug-11
Jun-11
Apr-11
May-11
Mar-11
Jan-11
Feb-11
Dec-10
Oct-10
Nov-10
Sep-10
Jul-10
Aug-10
Jun-10
Apr-10
May-10
0
5
READMISSIONS
5.1
The readmission rate is calculated by dividing the number of discharges that were followed by an
emergency readmission within 30 days by total number of discharges (excluding deaths).
5.2
The table below shows the readmission rates by specialty from April 2012 to date.
Month of Dis c har ge of O r iginal Admis s ion
Dis c har ging s pec ialty of or iginal
admis s ion
Apr
May
Jun
Jul
Aug
Sep
ACCIDENT AND EMERGENCY
10.4%
2.6%
5.6%
11.7%
8.3%
6.8%
ACUTE INTERNAL MEDICINE
13.8%
9.6%
9.1%
8.2%
8.4%
7.1%
CARDIOLOGY
6.8%
6.1%
7.5%
14.7%
7.7%
13.1%
CLINICAL ONCOLOGY
0.3%
0.3%
0.0%
1.4%
0.3%
1.5%
DERMATOLOGY
1.0%
0.6%
0.5%
0.0%
0.9%
0.9%
EAR, NOSE AND THROAT
4.7%
6.5%
3.0%
3.5%
1.2%
1.8%
GASTROENTEROLOGY
0.0%
2.1%
1.3%
3.0%
1.5%
2.1%
GENERAL MEDICINE
8.2%
8.7%
9.9%
9.9%
9.9%
7.1%
GENERAL SURGERY
7.3%
6.5%
5.1%
7.4%
5.0%
7.9%
15.1%
GERIATRIC MEDICINE
14.2%
17.0%
15.5%
14.7%
13.8%
GYNAECOLOGY
5.7%
5.2%
4.3%
9.0%
4.1%
3.3%
HAEMATOLOGY (CLINICAL)
2.0%
0.0%
0.9%
0.8%
0.5%
1.3%
Max Fax & Oral Surgery
5.4%
0.6%
0.6%
0.5%
0.6%
3.4%
MEDICAL ONCOLOGY
0.0%
0.0%
0.5%
0.0%
0.0%
0.0%
NEUROLOGY
0.0%
3.2%
2.2%
4.0%
0.0%
0.0%
OBSTETRICS
0.0%
0.1%
0.0%
0.0%
0.0%
0.0%
PAEDIATRICS
5.2%
5.9%
5.4%
3.2%
3.4%
3.9%
PAIN MANAGEMENT
4.5%
0.0%
5.4%
0.0%
7.1%
3.3%
REHABILITATION
0.0%
0.0%
0.0%
0.0%
12.5%
0.0%
RHEUMATOLOGY
0.0%
3.5%
2.0%
0.8%
1.6%
2.3%
TRAUMA AND ORTHOPAEDICS
6.1%
3.4%
5.9%
5.3%
6.5%
4.3%
Grand Total
4.8%
4.5%
4.3%
4.6%
4.1%
4.1%
Oct
Nov
Dec
Jan
Feb
Mar
5.3
There are significant readmission rates in September (>10%) within Cardiology (13.1%) and
Geriatric Medicine (15.1%).
6
BED RECONFIGURATION
6.1
There are a number of bed reconfigurations planned from January 2013 which have been
developed to support the Trust cost improvement programme, with a net loss of 15 beds within
DME. The impact on patient quality and hospital flow has been carefully considered and a number
of initiatives introduced to support the changes.
6.2
Cranborne Ward will close on 2nd January 2013 resulting in the loss of 15 General Medical bed.
There will be a transfer of DME beds on Avonbourne Ward to General Medicine which will balance
the bed stock for the Directorate.
6.3
Lychett Ward (Furzey) will open in January 2013 as a DME ward. There will be a loss of 15 beds
across DME due to a clinical improvement plan to introduce more cubicles to improve infection
control within the Directorate and the loss of beds on Avonbourne.
6.4
A number of actions are in place to improve Trust resilience due to the bed reductions. They are as
follows;
•
•
•
•
•
An integrated discharge facility (Discharge Lounge) will allow for proactive discharge with an
additional 5 cubicles and a trained nurse.
Stroke ESD team in place
Nurse Practitioner for Older People present in Emergency Department to reduce admissions.
Additional community service (Intermediate Care) at weekends to facilitate discharge
Wards will where possible absorb escalation areas/beds into their bed compliment with
appropriate staffing, improving the flow of patients
•
•
•
•
•
MIU will increase the range of tests undertaken on the unit to support early discharge and
reduce admissions.
Ansty Ward will look to increase capacity over winter months to support the surgical
admissions pathway.
Review of top 10 frequent flyers for multiple admissions
Increase in the number of board rounds on General Medical wards, resulting in speedier
access to senior decision making
Introduction of Red Cross Assisted Discharge service for DME patients (in place)
7
SUMMARY
7.1
Despite a 4.2% increase in non elective admissions to the Trust, the length of stay is 9.2% lower
than the previous year. There has been a drive across all Directorates to manage patient flow with a
reduced bed capacity which has been supported by a number of innovative initiatives across teams.
The next challenge will present itself in January 2013 as the bed stock is reduced by a further 15
DME beds.
7.2
Discharge delays continue to decrease however the focus must remain on working with partner
agencies to provide robust services out of hours and to improve internal processes to reduce
avoidable ‘informal’ delays.
7.3
The bed state position year to date has significantly declined compared to previous years with the
Trust remaining in a Red bed state for 63% of the time in September 2012 compared to 43% in
September 2011. This is a consistent trend with performance ranging between 63% and 71% red
state recorded throughout the financial year. This will become unsustainable during winter
pressures and will be the main focus of operational and Directorate teams over coming months.
Prepared by
Sophie Jordan
Operations and Performance Manager
November 2012
PERFORMANCE EXCEPTION REPORT
Department: Delayed Transfers of Care
The Risk:
Delayed Transfers of Care have an adverse effect on patient length of stay and hospital capacity
Current Position:
Using DH reporting methodology, the percentage of patients formally delayed on the last Thursday of
October was 3.75%, 0.25% over the Trust target. This is an increase of 0.75% on the September figure.
The total number of bed days remains low in month with 590 days compared to August (798) and
September (533).
The method for measuring delayed transfers of care has been altered to replicate methods undertaken by
local acute trusts and to follow DH guidance to ensure consistency.
The majority of delays during October were as follows:
Community hospitals (41%)
CHC assessment process (13%)
Social service delays (9%)
Self-funding patients (6%)
Angio waits (29%)
Actions:
The following actions continue to be progressed to achieve a continuous reduction in bed days:
•
•
•
•
•
•
•
•
•
•
•
•
•
The implementation of an integrated approach between the hospital, social services, CHC staff,
community services, including community hospitals has commenced, confirmation of additional
accommodation to complete full integration of teams has been agreed. The aim is to reduce
administrative duplication and improve communication in support of discharge.
Dorset County Council are reviewing funding a Social Worker to support the RACE Unit for a further
year, this has a major impact on discharging patients within 48hours and keeping packages of care open
in order to reduce future delays in the patient pathway.
Teams from Local Authorities (LA) and Poole Hospital, are liaising to enable better IT access for both
organisations
Daily review of delays whiteboard between all partner services.
Twice weekly discharge surgeries are taking place with the aim of reviewing complex cases and new
referrals leading to improved communication and a reduction in unnecessary delays
Successful recruitment for a senior nurse to a 6 month trial of a dedicated CHC discharge support worker,
working in partnership with the PCT in order to give greater focus on reducing unnecessary delays in
gathering evidence and completion of the assessment process started on 15th October 2012.
The screening service pilot led by the PCT, continues to be reviewed on a monthly basis.
Lead the development of a pan Dorset set of reporting principles to ensure consistent and transparent
application of DH guidance.
NHS Bournemouth & Poole and Dorset have allocated a member of staff to each acute hospital as a link
nurse to support the DST process and improve communication. Added to an improved Funding out of
Hospital funding agreement, looks set to reduce delays for patients referred to CHC for consideration.
Trust discharge staff have adapted their role, to improve support given to ward staff, visiting each ward
most days.
Discharge, Therapy, Nursing and IT development staff are using EPR to refer to single point of access to
improve referral and communication, plan in place to roll out across Trust.
Help & Care or social services are also utilising this system via EPR on a selection of wards, replacing
several forms including social services section 2s and 5s.
Weekly validation communication with Dorset Community Hospital lead, to review all patients on formal
delay list awaiting a community bed.
Transfers of Care (ToC) Update October 2012
The percentage of patients formally delayed on the last Thursday of October (DH reporting methodology)
was 3.75%, 0.25% over the Trust target.
Delays during October were due to: Community Hospitals (41%), the CHC assessment process (13%),
Social Services (9%), Self-Funding patients (6%), and transfer of patients for Angiography/Angioplasty at
RBCHFT (29%). Actions continue to be progressed on a continuous basis to improve delays overall and
tackle the main causes of delays
Total Bed Days Lost
1750
1500
1250
TOTAL Delays
12/13
1000
TOTAL Delays
11/12
750
TOTAL Delays
10/11
500
250
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
The total number of bed days lost during October (590) an increase compared to September (533),
however this continues to remain low compared to recent years.
Number of Bed Days lost due to awaiting Self-Funding (data started Aug-09)
350
300
250
Self-Funding
12/13
Self-Funding
11/12
Self-Funding
10/11
200
150
100
50
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
The number of bed days lost due to self funding patients decreased in October to 36 bed days compared
to 74 in August and 59 in September. This appears to show a downward trend since July 2012. The new
screening service implemented from June has assisted in the early identification of self funding patients and
consequently a further reduction in delays, this will be closely monitored on a monthly basis but appears to
have some impact on the improvement.
Number of Bed Days lost due to awaiting transfer to Community Hospitals
1250
1000
Community
Hospitals
12/13
Community
Hospitals
11/12
750
500
250
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
The number of patients delayed waiting for a community hospital has increased to an average of 8
patients per day, compared to 5 last month. The Discharge Team are undertaking weekly validation of
delays with the Community Hospital Matron, however demand for community hospital beds has been high
across all 3 local acute trusts. Community beds delays in October (244 bed days) have been the highest
so far this year.
Number of Bed Days lost due to awaiting CHC (data started Aug-09)
500
400
CHC: Bed
Days
12/13
CHC: Bed
Days
11/12
300
200
100
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
The number of patients delayed as a result of the Continuing Health Care (CHC) assessment process
has increased in month to an average of 3 per day, compared to an average of 2 per day during
September. Joint work with the PCT continues and a trial of a dedicated CHC discharge support worker
from mid October will help to support ward staff and reduce delays as they gather evidence and assist in
completing the assessment paperwork.
Number of Bed Days lost due to awaiting Intermediate Care (data started Mar11)
350
300
250
Intermediat
e Care 12/13
200
Intermediat
e Care 11/12
150
100
Intermediat
e Care 10/11
50
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Delays for intermediate care have reduced significantly, with 1 bed day lost in October.
Number of Bed Days lost due to awaiting Social Services (Section5)
400
300
Social
Services
12/13
200
Social
Services
11/12
100
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
On average 2 patients were delayed each day during October due to social services, which remains
consistent with September figures. Key focus areas are: increased social services support within the RACE
unit and the further support from Bournemouth social services. Poole local authority is planning to
commence a weekend service in the near future further supporting weekend discharge and also 7 day
discharge planning.
Number of Bed Days lost due to awaiting Angio
300
200
Angio Waits:
Bed Days
12/13
Angio Waits:
Bed Days
11/12
100
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Delays for patients awaiting transfer for cardiac intervention/imaging (Angio wait) has decreased in month
to 29% of all delays being attributable to this issue, a reduction of 6% compared to September. There are a
number of internal issues that impact on a timely discharge of this patient cohort and the Operational team
will be focusing on reducing this delay. The delay in transferring patients once medically fit continues to be
raised at executive level with the Royal Bournemouth Hospital.
Sophie Jordan
Operations and Performance Manager
Trauma Directorate:
Waiting Times for Surgery:
Fractured Neck of Femur within 36 hours of admission (Best Practice Tariff Criteria)
Fractured Neck of Femur within 36 hours of being clinically appropriate for surgery (PCT)
Trauma Patients within 48 hours of being deemed fit for surgery
The Risk:
Fractured neck of femur patients
99% within 36 hours of being clinically appropriate for surgery (PCT target: 85% by September 2012 and
95% by March 2013)
93% within 36 hours of admission (Best Practice Tariff: Internal target 90%)
All trauma patients
97% within 48 hours of being fit for surgery (target 95%)
Further improvement against fractured neck of femur targets for October 2012. The risk remains in
consistently achieving and improving compliance, balanced against maintaining the Trauma target of 95%,
particularly at times of peak demand.
Current Position:
The graph below shows that the overall number of trauma admissions was slightly higher than in
September at 427. This month included 67 patients admitted with a fractured neck of femur, which as can
be seen on the graph below, was the lowest number since November 2011. Unusually, the preceding nine
months had not seen the usual levels of variation in fractured neck of femur numbers experienced in
previous years.
Combined with the continued drive from all staff within the MDT to manage individual patients through their
pathway to avoid breaching access times, the lower number of admissions contributed to the Directorate
achieving its best performance against the neck of femur and trauma targets to date.
Of the fractured neck of femur patients, 5 patients did not meet the NHFD target of theatre within 36 hours;
4 patients because they were unfit upon admission and one who required a surgeon with specific
experience due to their associated co-morbidities. There were 9 general trauma patients who failed the 48
hour (from fit) target; 4 that awaited a specialist surgeon and five due to lack of capacity, in 3 cases due to
prioritisation of fractured neck of femur patients.
The challenge remains maintaining these performance levels going forward and a considerable amount of
work is required on individual days, particularly on the part of main theatres and the TAC Team, to ensure
that the patients do not breach. The fluctuation in daily admission numbers, the complexity of the case mix
and the management of competing access targets in theatres across all the specialties, which include
cancer waiting times, RTT times and CEPOD access times, all present significant challenges on a daily
basis.
The accompanying graphs show the treatment times for fractured neck of femur and general trauma
patients after they have breached their respective targets and it can be seen that the waiting times for
surgery for those as patients that breached their access times were considerably lower in October.
% operated within 36hrs of admission
% Patients Operated on within 36hrs
Number of NOF's admitted
500
100%
450
400
80%
350
300
60%
250
200
40%
150
20%
95
92
67
74 79 72 77 79 77 81 73 73 67
0%
100
50
0
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct11
11
11
12
12
12
12
12
12
12
12
12
12
% Patients Operated on within 36hrs
Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12
55%
77%
72%
77%
78%
73%
69%
80%
68%
52%
58%
75%
93%
Number of NOF's admitted
95
67
92
74
79
72
77
79
77
81
73
73
67
Number of Trauma Admissions
435
384
381
364
360
358
386
436
439
450
488
407
427
Patients not fit
pre-op & needed
optimising
Other trauma
cases taking
priority/ran out
of time
Insufficient
theatre capacity
Awaited
specialist
surgeon for THR
Patient refused
surgery on the
day
4
0
0
1
0
Actions:
The improvement programme continues and in October the focus remained on:
- Breach avoidance/breach management plans for individual patients in conjunction with reporting and
understanding by relevant staff of the position on a daily basis.
- Highlighting crucial patients and their breach times on the main theatre white board so that all staff can
see which patients require prioritisation, in particular where lists have to be reorganised.
- Prioritising of fractured neck of femur patients over other trauma (where appropriate) and on-going
involvement of consultant surgeons in the process and planning of lists, particularly at weekends.
- Clinical Director led training programme to increase the number of middle grade surgeons able to operate
on fractured neck of femur patients requiring a total hip replacement, with one additional surgeon signed off
so far.
- Completion of an in depth demand and capacity study, which will be reported on shortly...
- Implementation of a second all day Sunday theatre list from 14 October 2012, which has been fully utilised
on all but the first week and has contributed to a much improved situation at the start of each week.
- Full implementation and consolidation of the Trauma business case, phased in between April and
September. This has included not only the additional theatre capacity, but also DME weekend ward
rounds, an additional therapist and the introduction of the Older Persons’ Mental Health Nurse, which have
all contributed to an improved performance over against all the Best Practice Tariff criteria over the last two
months.
Prepared by
Yvonne Hunter
Directorate Manager
9 November 2012
NOFs - Treatment Times for Patients Breaching the 36 hour Target: October 2011 - October 2012
36-48 hours
2-3 days
3-4 days
> 4 days
30
Number of patients Breaching
25
20
15
10
5
0
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Month
Non NOFs: Treament times for Patients Breaching the 48 Hour Target: October 2011 - October 2012
2-3 days
3-4 days
4-5 days
>5 days
14
12
Number of Patients Breached
10
8
6
4
2
0
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
Month
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Stroke : Target: ≥80% of patients should spend > 90% of their LOS on the Stroke Unit
The Risk: The Trust met this target in Quarter 1 & Quarter 2 2012/13.
Current Position:
In October 76% (39) of patients spent > 90% of their LOS on the Stroke Unit (target ≥ 80%).
The following table indicates the number of stroke patients admitted and the % that achieved the target in the previous
3 months.
No. of stroke pts admitted
% of patients should spend
> 90% of their LOS on the
Stroke Unit
Jul
56
Aug
50
Sep
43
Oct
51
89
80
91
76
OCTOBER
39 (76%) patients had >90% of their stay on the Stroke Unit out of 43 patients discharged during October. The Trust
had achieved this target in Quarters 1& 2 2012/13.
This is a disappointing outcome after achieving this target for the last 2 quarters. The movement of beds to support the
reconfiguration plan impacted badly on the ability for ASU to manage a higher than usual number of Stroke
presentations and admissions over the weekend the initial moves took place. The remainder of the month was
managed very well, with reduced bed numbers on the new ASU location; however this has resulted in us breaching
this target for the month of October despite thorough validation of the data.
Direct access also dropped to 75% after a positive rise to 86% in October (66% in August). There remains a variety of
clinical reasons necessitating initial care elsewhere or inpatient Strokes with delayed diagnosis which will continue to
effect figures though these are reviewed upon validation and managed onwards and appropriately actioned.
CT scan access <24 hours was 78%, this figure being reduced due to delay in scan requests, this will be addressed
by the clinical teams.
TIA ‘First Professional to Clinic’ remained below target at 43% (target 60%), this has been discussed at PCT level and
recording of this target will be reviewed once the Capture TIA IT system is in place from December. The TIA referral
pathway is being currently reviewed and will be put into place to support the reporting of data from the new system.
Delays in clinical appointments are due to a number of factors, these mainly being a delay in the referral from being
sent from the GP after initial contact, this then causes delay in appointing into TIA clinics held daily at PHT.
We did not close the Stroke pathway or re-designated any other area as Stroke in the month of October.
There have been some delays in discharge due to care packages being arranged/agreed, these issues are picked up
weekly with ward discharge coordinators meetings with our secondary and council colleagues.
Actions:
th
1. Work on the DME bed reconfiguration plan is underway with initial staff consultation commenced on August 13 .
Building work has now commenced and the first of the ward moves have taken place.
2. Ward processes continually reviewed. Staffing and skill mix managed appropriately during times of sickness and
during high levels of leave during the month of July and August. Outcomes of the consultation and decisions for
staffing of the new ward based on the old Furzey footprint will be made available soon.
3. Winter plans are being drawn up and discussed at a ward and management level and will feed into capacity
meetings.
Prepared by :
Barry Duell
Directorate Manager
Medical Division (DME, Diabetes, Rheumatology, Neurology & Gastroenterology)
November 2012
Month 7 Contract Performance Position Statement
Elective
Elective activity was at planned levels in October and so reduces year to date over performance to 3% in
activity and 2.4% in income terms.
Elective over-performance is seen particularly in Chapters C (Mouth, Head, Neck and Ears), Chapter D
(Respiratory), E (Cardiology), F (Digestive) and G (Hepato-billiary & Pancreatic).
A contract variation for additional colonoscopy activity is not yet reflected in these figures and will reduce,
but not eliminate, the over performance under Chapter F.
At specialty level, over performance is seen under General Surgery in particular, but also Pain
Management, Cardiology, Neurology and Oncology.
Non-elective
Total non-elective activity remains 2.5% below target as over performance in emergency spells is
outweighed by the substantial reduction in short say antenatal admissions.
Emergency activity remains cumulatively 1.2% above plan but with a 3.9% shortfall against planned income
arising from the reduction in excess bed days.
The Trust is exceeding emergency spell targets in General Surgery, T&O, General and Elderly Medicine
and Paediatrics but of these, only General Surgery and Trauma and &Orthopaedics show a positive income
variance. Over-performance in these specialties largely compensates for fewer admissions being recorded
under A&E since the closure of CDU.
Obstetrics
Volumes of activity in Obstetrics have been substantially below contract all year, regardless of new
systems, with major reductions in the number of recorded short stay admissions at Poole for
investigation/observation. Conversely, income has increased as the additional clinical data recorded within
the new Medway system enables ‘augmented’ births to be identified and more fully reflected within our
casemix.
Outpatients
First outpatients continue to exceed the year to date activity target now by 8.5 % above contract targets,
income by 9.8%. Both percentages exceed those quoted for the year to date position last month.
Outpatient follow-ups remain under contract by 1.9% for activity and 1.3% in terms of value, this is
unchanged since lasts month.
1st to follow up ratios should not be cause for concern by commissioners in next year’s contract
negotiations.
A&E
A&E attendances were relatively high in October and are now 3.2% above the year to date target. This is
generating 7% more income which is believed to be due to improvements in recording of clinical data
which drives up the acuity of our HRG-based casemix.
The performance against contract for both activity and income is summarised in the following table.
Prepared by
Paul Stebbings
Head of Information
November 2012
Poole Hospital NHS Foundation Trust
Contract Performance 2012/13
All Contracted PCTs Summary : 2012/13 year to date (month 7)
Year to Date
2012/13 Contract
activity
£
Contract
activity
Over/Under Performance @ full tariff
diff
% diff
activity
£
activity
£
Actual
£
activity
£
Marginal tariff
YTD/Year end est
£
£
Elective
Inpatients
Day Case
24,908
3,818
21,090
£23,479,335
£8,356,892
£15,122,443
14,646
2,245
12,401
£13,805,849
£4,913,852
£8,891,996
15,083
2,267
12,816
£14,136,580
£4,938,556
£9,198,024
437
22
415
£330,731
£24,704
£306,028
3.0%
1.0%
3.3%
2.4%
0.5%
3.4%
£165,366
£12,352
£153,014
£281,234
£21,006
£260,227
Non Elective
Emergency
Other
41,375
28,145
13,230
£60,942,274
£48,365,841
£12,576,433
24,258
16,502
7,757
£35,730,539
£28,356,959
£7,373,580
23,659
16,701
6,958
£35,015,667 £27,251,204
£7,764,463 -
599
199
799
-£714,872
-£1,105,755
£390,883
-2.5%
1.2%
-10.3%
-2.0%
-3.9%
5.3%
-£915,641
-£1,111,083
£195,442
-£1,561,725
-£1,895,071
£333,347
Outpatients
First
Followup
Procedures
173,102
56,070
101,676
15,356
£21,073,988
£9,647,971
£9,353,764
£2,072,253
101,784
32,969
59,785
9,029
£12,391,505
£5,673,007
£5,500,013
£1,218,485
103,802
35,776
58,649
9,377
£12,944,681
£6,231,379
£5,426,130 £1,287,172
2,018
2,807
1,136
348
£553,176
£558,372
-£73,883
£68,687
2.0%
8.5%
-1.9%
3.9%
4.5%
9.8%
-1.3%
5.6%
£276,588
£279,186
-£36,941
£34,344
£470,388
£474,806
-£62,825
£58,408
55,558
£4,699,596
32,574
£2,755,380
33,605
£2,947,639
1,031
£192,259
3.2%
7.0%
£96,130
£163,960
-5.0%
-£8,298
-£14,154
A&E Attds
Direct Access
£562,669
£329,894
£313,297
-£16,596
Readmissions
-£2,229,432
-£1,300,502
-£1,300,502
£0
Best Practice
£1,457,175
£850,019
£850,019
£0
£107,509
£62,714
£53,384
-£9,330
-£4,665
-£7,997
£7,331,553
£4,276,739
£4,357,350
£80,611
£40,305
£69,095
£117,424,667
£68,902,135
£69,318,115
£415,980
-£350,216
-£599,199
£36,060,871
£21,035,508
£21,035,508
£0
-£40,232
-£68,968
-£390,447
-£668,167
Other Activity
MFF
@6.66%
Cost per Case Contract Sub Total
Non-PbR
CQUIN
Spec services
Contract Total
@2.5%
£4,010,235
£2,339,304
£2,258,841
-£80,463
£11,984,834
£6,991,153
£6,991,153
£0
£169,480,607
£99,268,100
£99,603,617
£335,516
1%
0.3%

– COVER SHEET Meeting Date: 28 November 2012

Transcription

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