Board of Directors Meeting - Royal Devon and Exeter Hospital · Appendix A (on page 32) within this report. 3.4 Finance The key areas of financial performance are as follows: •

Title of Paper: Integrated Performance Report Board Date: Wednesday 25 th May 2011 Page 1 of 36

Board of Directors Meeting

Date: Wednesday 25 th May 2011

Agenda item: 8.1, Part 1

Title: Integrated Performance Report incorporating: Quality / Performance / Finance and Activity / HR

Prepared by: Warwick Heale, Associate Director of Planning & Performance Ann Goodridge, Corporate Performance Manager

Presented by: Lynn Lane, Director of Human Resources

Action required: The Board is asked to receive the Performance Report and note the progress that has been made together with any actions that are planned.

Monitoring Information Please specify CQC standard numbers and tick üother boxes as appropriate

Care Quality Commission Standards Outcomes

Monitor Finance

Service Development Strategy Performance Management ü

Local Delivery Plan Business Planning

Assurance Framework Complaints

Equality, diversity, human rights implications assessed

Other (please specify)


1. PURPOSE 1.1 To advise the Board of the Trust’s performance against the key performance

standards and targets.

2. BACKGROUND 2.1 The Trust’s Annual Plan sets out the programme of work to be undertaken to

ensure compliance with the Monitor Compliance Framework and local and national standards and targets included in PCT commissioning contracts.

Detailed results of achievement as at 30 th April 2011 are presented in The Data Appendices (Performance) section of this report.

3. KEY ISSUES 3.1 In April there was an unusual configuration of events resulting from a very late

Easter holiday followed by the Royal Wedding celebrations and the public holiday for May Day. We focussed our operational planning teams for some time on contingency planning as we prepared for the prolonged reduction in capacity across the health and social care system combined with the usual influx of visitors to the county as the weather improved. Our winter capacity arrangements had included the opening of additional bed capacity for medical admissions which we successfully closed through April. This gave us ward space to start our deep clean programme for this year. Essential to our ability to manage within reduced bed stock was our working closely with our community based colleagues to ensure that patients who were ready to be transferred out of hospital were not delayed and it was a key achievement for the whole community that throughput was maintained. A complexity in that achievement was the transfer of our local community based services to Northern Devon Healthcare Trust as from 1 st April 2100 they took over the responsibility for community facilities and staffing as part of Transforming Community Services from NHS Devon. The impact of the Easter and May holidays will influence achieving referral to treatment times for all elective patients and it required a sustained effort to maintain care pathways to treat people in a timely way. We particularly concentrated on patients who are included in the 62 days cancer target as being the most likely to be affected by the lost capacity and we achieved improved performance from March where we failed to achieve the target. We also looked forward to correct any issues that might arise from the end of April into May holiday period by creating additional clinics and moving outpatient and operating sessions which have been rescheduled over the month. This work has required significant input from clinical and managerial teams in achieving a major reorganisation of work. Non elective admissions performance monitored through the Emergency Department 95% of patients waiting less than 4hrs continues to be a challenge. We continue to evaluate the impact that eliminating mixed sex breaches have on performance but the number of breaches has fallen dramatically since the segregation of sexes at ward level. Although Norovirus continued sporadically through April the position is much improved from the winter months resulting in fewer beds closures. Some confirmation on thresholds and methodology for the 2011/12 performance


targets became available and gave the operational teams an indication of critical areas to focus attention on.

The suite of performance indicators depicted within the graphs under the “Respond, Deliver and Enable” framework within this report has been reviewed in light of the confirmed Compliance Framework. The following targets, which carry a risk rating of 1.0 within the Compliance Framework, are now contained within the main body of this report

• Clostridium Difficile

• MRSA (due to the very low target figure, this will be brought forward on an exceptions only basis)

• 31 Day Wait for Second or Subsequent Treatment, comprising o Surgery o Radiotherapy o Anti cancer drug treatments (this will be brought forward on an

exceptions only basis) • 62 day wait for first treatment, comprising

o Urgent GP referral to treatment o Consultant screening service referral (this will be brought forward

on an exceptions only basis) • Referral to Treatment Waiting Times – Admitted (95 th centile) • Referral to Treatment Waiting Times – Non Admitted (95 th centile) • A&E: Total Time in A&E (95 th centile) – this will be reviewed prior to Q2,

at which time the wider suite of A&E indicators become effective

3.2 Performance Targets There is one Monitor target that is not currently being achieved for Quarter 1.

MON01 Clostridium Difficile – The Trust is reporting 9 cases in the month, 7 of these infections were detected as a consequence of using the more sensitive test. It has been agreed with NHS Devon that for contract monitoring purposes cases identified using the new test will be excluded.

Discussion with Monitor has indicated that in Quarter 4 2010/11 organisations whose failure of this target could be demonstrated to be attributable to the introduction of the new PCR test were not the subject of regulatory intervention. It is the Trust’s understanding that the same approach will be used in the current financial year.

3.3 In response to the Board’s request for further analysis of the 2010/11 cancer 62 day target performance the information and proposed actions are included in Appendix A (on page 32) within this report.

3.4 Finance The key areas of financial performance are as follows: • A year to date deficit of £909k has been generated. This is lower than the

planned level of deficit. A year end surplus of £3.5m is planned and it is currently forecasted that this will be achieved.

• CIP requirement for the year is £17.1m. £63k has been achieved in month 1 against this month’s target of £282k.

• Figures for clinical income are not available as these are due to be processed a month in arrears.


• Pay is underspent by £154k and non pay by £527k with both areas expected to be in line with budget by year end.

• A year end Monitor Risk rating of 3 is planned and is currently forecasted to be achieved.

3.5 Quality This report now includes an additional set of graphs which summarise for the Board the key indicators under the new ‘Ward to Board’ safety and quality reporting process. The graphs include sets of matched process and outcome indicators. Of these indicators, the following are now incorporated within the main body of the Integrated Performance Report:

• Pressure Sore Assessment • Pressure Sore Screening • MUST Scoring Hand Hygiene Compliance • New MRSA Isolates Identified more than 72 hours after Admission

The key issues from this suite of graphs are included in the commentary below. It is intended to supplement these four indicators further, by the routine inclusion of data relating to Falls Risk Assessments and Inpatient Slips, Trips & Falls from June 2011.

3.6 Key issues are: • The ongoing work to improve the rate of compliance with pressure ulcer

assessment is resulting in sustained achievement of this indicator.

• Continued improvement in the rate of initial assessment of nutritional screening (MUST). Ward level action plans have been produced in those areas where MUST scoring is rated red. Work is ongoing to refine the assessment tool to ensure it enables timely and accurate data.

• The process for ensuring timely submission of the hand hygiene compliance audit results is being reviewed.

• There were no MRSA Isolates identified more than 72 Hours after admission in April.

• Monthly spot audits of recording of VTE Risk Assessments are being undertaken to provide supplementary evidence to electronic recording of risk assessments. These audits are consistently indicating a much higher rate of compliance. Work is ongoing to improve the electronic data collection.

• Datix web is being introduced Trustwide during May, June and July. It is anticipated that this will greatly improve the timeliness of incident reporting and the quality of the data submitted.

3.7 Human Resources Key issues are: • An ongoing reduction in the sickness absence rate. The sickness absence rate for the twelve month period ending 31 March 2011, was 4.11% compared to 4.19% for the period ending 28 February 2011, and 4.64% for the equivalent period last year. The sickness absence rate for the month of February 2011 was 3.76% compared to a rate of 4.51% in February 2010.

• A reduction of 99.62 full time equivalent (FTE) in the Trust’s Workforce arising from the transfer of Paediatric Respite Services to a Social Enterprise


organisation (33.32FTE), those leaving the organisation through the MARS scheme (25.47FTE) and natural turnover. The rate of turnover for the twelve month period ending 31 March 2011 was 9.50% compared to 10.36% for the equivalent period last year.

• Maintenance of the proportion of staff with a Personal Development Review (PDR) completed within the last 12 months. As at the end of March 2011, 80.07% of staff had a valid PDR.

4. FINANCIAL/OTHER IMPLICATIONS Achieving NHS plan targets and milestones is an important feature of the Trust’s overall performance and demonstrates our commitment to delivering good quality care to patients. There are three specific areas within the contract where Commissioners have the discretion to apply financial penalties in respect of underperformance

• Nonachievement of the Clostridium difficile target (up to 2% of the total contract year revenue), the standard contract allows for penalties to be applied where the current year outturn exceeds the number of cases identified in the previous contract year, by more than 2 cases. In order that the Trust is not disadvantaged by the introduction of the new testing methodology, it has been agreed to exclude the impact of the cases identified using the new testing methodology from both last year's baseline and this year's figures, for the purposes of financial and contract penalties only.

• nonachievement of the referral to treatment time standard (up to 5% of monthly elective care revenue),

• each of the following cancer waiting times standards (2% of the actual outturn value of the service line revenue)

o 14 day urgent GP referral o 14 day symptomatic breast o 62 days first definitive treatment for GP urgent referral, NHS

Cancer Screening Services and Consultant Upgrades o 31 day first definitive treatment o 31 day second or subsequent treatment (surgery) o 31 day second or subsequent treatment (drug treatments) o 31 day second or subsequent treatment (radiotherapy)

5. RECOMMENDATIONS The Board is asked to receive the Performance Report, including the changes arising from the revised Compliance Framework, and inclusion of the Ward to Board dashboard, and note the progress that has been made together with any actions that are planned.


Graph YTD Indicator Current Source Report

R1 Green ↑ Accident and Emergency Maximum 4 Hour Wait Green Performance

R2 Green ↑ Clostridium Difficile Infections Amber Performance

R3 Green → Cancer 31 Day Wait: Subsequent Treatment Green Performance

R4 Amber ↑ Cancer 62 Day Wait Green Performance

R5 Amber → Hand Hygiene Amber Qual ity

R6 Amber ↑ New MRSA Isolates Green Qual ity

R7 Green → Referral to Treatment for Admitted Pathways Green Performance

R8 Green ↑ Referral to Treatment for Non‐Admitted Pathways Green Performance


D1 Amber → Outpatient New Attendances Amber Finance

D2 Amber → Elective Daycase Admissions Amber Finance

D3 Amber → Elective Inpatient Admissions Amber Finance

D4 Green → Non‐Elective Inpatient Admissions Green Finance

D5 Green ↑ Pressure Sores Assessment Green Qual ity

D6 Amber ↑ Pressure Sores Incidence Green Qual ity

D7 Red ↑ MUST Scoring Red Qual ity

D8 Green Capital Expenditure Green Finance


E1 Amber ↓ Bank and Agency Spend All Staff Amber Human Resources

E2 Green ↑ Cash Green Finance

E3 Amber Cost Improvement Programmes Amber Finance

E4 Green Income and Expenditure Green Finance

E5 Amber → PDR/PDPs Completed Amber Human Resources

E6 Green → Risk Ratings Green Finance

E7 Amber ↑ Sickness Absence Rate Amber Human Resources

E8 Green ↑ Staff Employed Green Human Resources

E9 Green ↓ Staff Percentage Turnover Rate Amber Human Resources

E10 Green ↓ Starters and Leavers Amber Human Resources

Red Off target or significant concerns re. achievement. Board to review exception report.

Amber Slightly off target or minor concerns re. achievement. Board to be aware, but no action required. Green On target, no significant concerns re. achievement. No Board attention required.

→ Direction indicators point up for improvement, down for worsening and horizontal for no material change.

Respond

Integrated Performance Report ‐ Summary Table

Be the provider of choice, delivering care in the most convenient and appropriate location, with no delay. Eliminate all avoidable hospital infections. Deliver services in a comfortable, friendly environment in which staff can care for patients effectively. Recognise our wider responsibility to the environment and local community by using resources wisely.

Future and sustained success through good financial management.

Deliver

A high standard of care delivered by experts, which meets the needs and aspirations of patients, staff, carers and the A full range of cost‐effective accessible local hospital services. A range of excellent specialist services.

Staff to have a good work/life balance, and achieve their full potential.

Staff to do their jobs to the best of their ability, by valuing them, ensuring they have the right skills and giving them the opportunity to focus on meeting the needs of patients, so making the RD&E the employer of choice.

Enable

Additional Reported Indicators (by Exception)


Be the provider of choice, delivering care in the most convenient and appropriate location, with no delay. Eliminate all avoidable hospital infections. Deliver services in a comfortable, friendly environment in which staff can care for patients effectively. Recognise our wider responsibility to the environment and local community by using resources wisely.

YTD Indicator Current YTD Indicator Current

G R1 ‐ Accident and Emergency Maximum 4 Hour Wait G G R2 ‐ Clostridium Difficile Infections A

G R3 ‐ Cancer 31 Day Wait: Subsequent Treatment G A R4 ‐ Cancer 62 Day Wait G

A R5 ‐ Hand Hygiene A A R6 ‐ New MRSA Isolates Identified > 72 Hours After

Admission G

A number of wards ha ve not submi tted thei r a udi t da ta i n time for th is report whi ch i s re fl e cted in the ambe r ra ti ng. The proces s for ensuring timel y s ubmis s i on of th is pape r a udi t wi l l be re vi ewed.

Quality Quality

Respond

Performance Performance

Performance Performance

0

10

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80

90

100

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Feb10

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0

1

2

3

4

5

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Feb11

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RDE Average +1 sd

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

Apr‐09

Jun‐09

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‐09

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‐10

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% Treated

Within 4 Hou

rs

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10

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25

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‐08

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‐09

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‐10

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New PCR Test Introduced in October 2011

Toxin Positive Tests

75%

80%

85%

90%

95%

100%

Apr‐09

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Oct‐09

Dec

‐09

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‐10

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Apr‐11

% Treated

Within 31

Day

s

Subsequent Surgery Subsequent Radiotherapy

Radiotherapy Target introduced Jan‐11

70%

75%

80%

85%

90%

95%

100%

Apr‐09

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‐09

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‐10

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% Treated

Within 62

Days



G R7 ‐ Referral to Treatment for Admitted Pathways G G R8 ‐ Referral to Treatment for Non Admitted Pathways G

Performance Quality

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5

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15

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25 Ap

r‐10

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‐10

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95th Percentile (w

eeks)

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95th Percentile (w

eeks)



A D1 ‐ Outpatient New Attendances A A D2 ‐ Elective Daycase Admissions A

A D3 ‐ Elective Inpatient Admissions A G D4 ‐ Non‐Elective Inpatient Admissions G

G D5 ‐ Pressure Sores Assessment G A D6 ‐ Pressure Sores Incidence G

Current month vs plan: Planned figures not currently available 26% lower than the same month last year 25% lower than previous month Year to date: 26% lower than the same period in 2010‐11 Year to date vs plan: Planned figures not currently avai lable

Current month vs plan: Planned figures not currently available 2% higher than the same month last year 5% lower than previous month Year to date: 2% higher than the same period in 2010‐11 Year to date vs plan: Planned figures not currently avai lable

The ongoing work to improve pressure ulcer assessment compl iance i s resul ting in sustained achievment of thi s indicator

Grade 3 and 4 pressures ulcers are subject to investigation and immediate reporting to the Dierctor of Nursing & Patient Care. The best practice 'Skin Bundle' i s being used and wi l l be launched in June as part of the 'You Matter' campaign.

Deliver

Finance Finance

Finance Finance

A high standard of care delivered by experts, which meets the needs and aspirations of patients, staff, carers and the public. A full range of cost‐effective accessible local hospital services. A range of excellent specialist services.

Current month vs plan: Planned figures not currently available 12% lower than the same month last year 20% lower than previous month Year to date: 11% lower than the same period in 2010‐11 Year to date: planned figures not currently available

Current month vs plan: planned figures not currently available 2% higher than the same month last year 21% lower than the previous month Year to date: 2% higher than the same period in 2010‐11 Year to date vs plan: planned figures not currently avai lable

Quality Quality

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Feb10

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0%

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May…

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Feb11

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Apr11

Plan Actual

1500

1900

2300

2700

3100

3500

3900

4300

4700

5100

5500

5900

Apr08

May08

Jun08

Jul08

Aug

08

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Apr10

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Plan Actual

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1100

1300

1500

1700

1900

2100

Apr08

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Apr08

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Plan Actual


R D7‐ MUST Scoring R G D8 ‐ Capital Expenditure G

Spend YTD: £0.6m Planned Spend YTD: £0.6m Forecast Y/E Spend: £16.7m Planned Y/E Spend: £16.7m

Initial assement continues to improve each month. Red rated areas have an action plan to achieve compl iance. Refining the asses sment tool i s ongoing to ensure i t enables timely and accurate data.

Finance Quality

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Initial compliance with MUST Screening on Admission

General compliance with MUST Screening at Weekly Review

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£M

Month

Capital Spend

Capital Plan 10/11

Actual Capital Spend

Forecast Capital Spend



A E1 ‐ Bank and Agency Spend All Staff A G E2 ‐ Cash G

A E3 ‐ Cost Improvement Programmes A G E4 ‐ Income and Expenditure G

A E5 ‐ PDR/PDPs Completed A G E6 ‐ Risk Ratings G

ESR is us ed for the purpose of record ing a nd reporti ng PDR activi ty for non Medical a nd Dental staff.

Actual Surplus YTD: ‐£0.9m Plan Surplus YTD: ‐£1.9m Forecast Surplus Y/E: £3.5m Plan Surplus : £3.5m Actual Efficiency: 1.04% Planned Efficiency: 1.03%

Finance

Finance Human Resources

Finance

Enable

Human Resources Finance

Staff to do their jobs to the best of their ability, by valuing them, ensuring they have the right skills and giving them the opportunity to focus on meeting the needs of patients, so making the RD&E the employer of choice. Staff to have a good work/life balance, and achieve their full potential.

Future and sustained success through good financial management.

Cash in hand and at bank: £73.6m Working Capital Facil ity: £18m Cash Invested @ Month End: £ni l

The above chart indicates the amount of spend relating to staff registered on the bank and staff supplied by agencies.

Research and innovation.

100,000

200,000

300,000

400,000

500,000

600,000

Mar10

Apr10

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Other Ratios Plan YTD Actual YTD Plan Y/E Actual Y/E

Trade Creditor Days 5.7 6.0 6.4 6.4 NHS Trade Debtor Days 8.2 2.9 8.9 9.0 Debt to Asset Ratio 7.0% 6.6% 6.3% 6.3% Other items £ £ £ £ Revenue available for debt service 0.2m 0.8m 23.9m 23.9m Debt 21.5m 21.5m 20.2m 20.2m Total Assets 306.8m 326.6m 321.9m 321.9m

0

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CIP Actual

CIP Forecast

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Comparison of actual cumulative net surplus/deficit compared to plan

Actual Plan

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0 .5

1

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2 .5

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3 .5

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5 EBITDA Margin

EBITDA % Ach ieved

ROA

I&E Surplus Margin

Liquidity

Overall Rating

Risk Ratings

Plan YTD Actual YTD Plan Y/E Forecast Y/E

20

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£M

Month

12 Month forecast cashflow v plan

Plan Actual Forecast Commited Facility


A E7 ‐ Sickness Absence Rate A G E8 ‐ Staff Employed G

G E9 ‐ Staff Percentage Turnover Rate A G E10 ‐ Starters and Leavers A

The turnover rate of 9.50% for the combined 12 month period to end of March 2011 is lower than the 10.36% for the equivalent period last year.

Figures include staff on fixed term contracts and rotational training schemes but exclude those regi stered on the Staff Bank.

The sickness absence rate i s calculated by expressing the amount of days lost as a percentage of the total contracted time. The cumulative rate for 12 months to 31st March 2011 i s 4.11%.

The total FTE has decreased by 99.62 to 5056.36. This is below the funded FTE establi shment of 5221.85. Headcount has decreased by 98 to 5873.

Human Resources Human Resources

Human Resources Human Resources

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Mar10

Apr10

May10

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Jul1

0

Aug

10

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10

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Nov

10

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Short Term Med ium Term Long Term

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Mar10

Apr10

May10

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Jul1

0

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Leavers > 12 LoS Leavers Between 6 & 12 LoS Leavers < 6 LoS

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Starters and Le

avers

Starters Leavers

4,500

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Contracted FTE Funded FTE


Finance FINANCIAL REPORT FOR THE TRUST COVERING THE PERIOD ENDING 30 th April

2011

Executive Summary

The year to date position is a deficit of £909k compared to a budgeted deficit of £1.4m and planned deficit of £1.9m. The forecast surplus at year end is in line with plan £3.5m and is achieving a Monitor Risk Rating of 3.

INCOME

Unfortunately clinical income figures are not available due to it being processed a month in arrears. The values shown in appendix 3 are matched to budget with the exception of Road Traffic Accident (RTA) income which is currently £17k underrecovered.

Contracted patient activity schedules in relation to clinical income with NHS Devon for the current financial year is currently in the process of being finalised.

Other income is £195k underrecovered at this point of the year, this is due to a variety of areas underperforming including Childcare services, Pharmacy and Community Estates. It is expected these areas will be in line with budget by year end.

EXPENDITURE

Expenditure on Pay is underspent at month 1 by £154k and forecast to be breakeven at year end. If the current underperformance was to continue at the current rate an under spend of £1.8m at yearend would occur. The main areas underspending currently are within nursing staff (£78k) and ancillary staff (Porters, Catering, Domestics and Laundry £38k).

Non pay expenditure at month 1 is underspent by £527k, mainly within budgets for clinical supplies and miscellaneous other operating expense. The main reason for this level of spend is considered to be due to the low number of operational days within April because of bank holidays and elective activity being low (please refer to the activity section below for more detail).

The main budget areas currently underspending include prostheses spend across the Trust which is £104k under budget, this primarily in Orthopaedics and will be due to the activity levels delivered during April. Exeter Mobility Centre spend on consumables is £112k

YTD Month 1

10/11

£’000 £’000 I&E year to date 909 4,061 I&E Forecast 3,500 4,061 I&E year end forecast variance to budget/Plan

0 461

Total Income variance to date 195 1,797 CIP variance to date 220 261 Pay expenditure variance to date

154 369

Non pay (excl. R&D) expenditure variance to date

527 1,902

Cash at month end 73,618 53,580


favourable, if this continues it will be reflected in the recharge to the PCT. An underspend on blood products (IVGs and clotting factors) is £106k lower than expected, this will also be reflected in the recharge to the PCT. Underspends on maintenance costs within the Community Estates which is in line with the underrecovery on income mentioned above.

COST IMPROVEMENT PROGRAMME (CIP)

The CIP target for this year is £17.1m plus £2.3m requirement brought forward from last year. It is anticipated that the £2.3m will be resolved within the next couple of months therefore the report will focus on the requirement for this year.

For month 1 £63k savings have been generated against a target of £282k. Overall for the year £579k savings have been delivered against the £17.1m target. It is currently forecasted that full requirement of CIP for this year will be met by year end.

Focus on the 10 CIP work streams remains one of the key priorities of the Trust. Recently a number of the vacant project managers for each scheme have been appointed on an interim basis to strengthen the infrastructure delivering work stream plans. Please see appendix 7 for more detail on the 10 CIP work streams.

CAPITAL

Actual expenditure for the first month of the year was £0.6m. This is in line with the plan.

Trust’s capital expenditure forecast is £16.7m. Forecast expenditure is in line with the plan.

DEBTORS

Debtors are £5.1m lower than plan. The value is lower mainly due to the monthly block instalment received from NHS Devon being higher than the actual income due and also recoverability on other debtors being better than expected.

CASH

The cash balance at the end of April is £73.6m, which is £24.5m higher than plan (plan is £49.1m). The following provides a summary of the main reasons for the increase:

Deficit lower than plan £1.0m Trade and other receivables lower than plan

£5.1m NHS Trade receivables lower than plan, NHS Trusts paid sooner than planned at year end.

Deferred income higher than plan £18.5m NHS Devon paid the majority of the month 2 contract payment early

Other £0.1m Total £24.5m

ACTIVITY

April activity for all patient type areas is lower than March’s activity and this is due to the number of bank holidays occurring within April. March had 23 operational days for activity to be delivered whereas April only had 18 when bank holidays are excluded. Outpatient and elective inpatient activity is lower for April 2011 than the same month last year (12% and 26% respectively). Daycase and non elective inpatient activity is higher than last year (both 2% higher than April 2010).


OTHER ISSUES

In previous reports an appendix giving the Directorate position was included (previously appendix 7). This report will be replaced in the June Board report by a Service Level Report.

As part of the International Financial Reporting Standards (IFRS) requirement Charitable Fund financial activity has been integrated within the main Financial Reports

CONCLUSION

The key areas of financial performance are as follows: • A year to date deficit of £909k has been generated. This is lower than the planned level

of deficit. A year end surplus of £3.5m is planned and it is currently forecasted that this will be achieved.

• CIP requirement for the year is £17.1m. £63k has been achieved in month 1 against this month’s target of £282k. £579k savings have been achieved for the year so far.

• A year end Monitor Risk rating of 3 is planned and is currently forecasted to be achieved.

• Figures for clinical income are not available due to be processed a month in arrears. • Pay is underspent by £154k and non pay by £527k with both areas expected to be in

line with budget by year end. • The Capital programme for 2011/12 is currently in line with plan.


Quality

Pressure Sores Assessment & Incidence The ongoing work to improve pressure ulcer assessment compliance is resulting in sustained achievement of this indicator.

Grade 3 and 4 pressure ulcers are subject to investigation and immediate reporting to the Director of Nursing & Patient Care. The best practice “Skin Bundle” is being used and will be launched in June as part of the “You Matter” campaign.

MUST Scoring Initial assessment continues to improve each month. Red rated areas have an action plan to achieve compliance. Refining the assessment tool is ongoing to ensure itenables timely and accurate data.

An electronic link from the assessment tool to the dietetics service will ensure automatic and early referral to dietetics service once a critical score is reached. This link and the process to be followed is currently being finalised.

Hand Hygiene, and New MRSA Isolates more than 72 hours after Admission A number of wards have not submitted their audit data in time for this report which is reflected in the amber rating. The process for ensuring timely submission of this paper audit will be reviewed.

Housekeeping & Equipment Cleaning Compliance with this standard is consistently met. The housekeeper role review is underway and links to the ward redesign work being undertaken as part of the Strategic Redesign Programme.

Patient Falls Risks Assessment, and Inpatient Slips, Trips & Falls The IT infrastructure is currently being finalised to enable real time monitoring of this indicator on the Trust whiteboard system.

The severity of injury associated with inpatient falls reduced in 2010/11. The focus this year is a reduction in the total number of falls.

Early Warning Scores, and Cardiac Arrest Calls Each cardiac arrest is subject to a review to investigate the precipitating factors. Data is collated for trend analysis by the Resuscitation Committee.

Electronic VTE Risk Assessment, and Thromboprophylaxis Audit Work is ongoing to improve the electronic data collection. At present a paper audit is undertaken monthly and shows a much higher compliance rate.

Bank & Agency Staff Usage, Incidents & Complaints / Concerns Bank and agency staff usage is monitored monthly and has been mapped to total sickness and absence, holidays, and activity. To date, analysis has shown no clear correlation. Work is undertaken to review Bank Office function and productivity.

Datix web is being introduced Trustwide throughout May, June and July. This will greatly improve timeliness of reporting and the quality of the data.


Human Resources

Sickness Absence The sickness absence rate for the individual month of March 2011 of 3.62% is an improvement on the 3.76% recorded for February 2011 and a significant reduction on the March 2010 rate of 4.75%.

The sustained reduction in monthly rates is contributing to the decrease in overall annual rates which has fallen again for the 12 month period ending 31 st March 2011 to 4.11%. This is a further decrease on the rate of 4.19% reported for February and very favourable when compared to the rate of 4.64% reported for the same period last year.

Turnover In March 2011 the annual turnover rate has increased as described above, but remains a decrease on the rate of 10.36% reported the same time last year.

Staff Numbers The total full time equivalent (FTE) decreased by 99.62 to 5056.36 in March 2011 which is 165.49 FTE’s below the current funded establishment of 5221.85. Headcount has also decreased by 98 to 5873 this month reflecting the 28 staff (25.47 FTE) who have left the organisation through the MARS scheme and a further 45 staff (33.32) in Children’s Services transferring from the Trust to a Social Enterprise organisation. The number of staff with fixed term contracts continues to increase with a total of 220 (176.64 FTE) staff with contracts ending within the next twelve months.

Personal Development Review’s (PDR) Although the rate of PDRs recorded on ESR has reduced slightly by 1.89% this month to 80.07%, it is still above the Trust’s target rate of 80%.

Learning & Development The RDE has led a panDevon community initiative to develop the educational infrastructure for Clinical Health Apprenticeships. This is a key development which will enable the Trust to recruit and train from the locality in a number of clinical pathways to grow the cadre of Assistant Practitioners in line with workforce strategy.

Professional Registration and Revalidation ESR (the Trust's payroll system) has an automatic link to the GMC and NMC to update annual renewal of professional registration. Monthly reports are produced to audit this and ensure accuracy. Any errors or anomalies ie name spelt differently on ESR/GMC/NMC is automatically highlighted by the system via a notification to HR Administrator, if not actioned within 4 days is escalated to appropriate HR Line Manager. Reports are processed by HR Administrator, with copy to HR Line Manager to ensure all actions are taken. Doctors are given 56 days after expiry, by the GMC to renew their licence each year. Doctors are currently required to complete an annual appraisal, and the Medical Director completes the final sign off of the appraisal process.

Line Managers / professional leads are responsible for ensuring that, when a members of their staff’s registration has been highlighted as expiring, action is taken to renew the registration and that the ESR system is updated with new expiry dates. Line Managers are able to update expiry dates on ESR but are not able to update registration numbers as the ESR system prevents this. Updating the registration number must be completed by Human Resources and is only completed if the number has been evidenced by checking directly with the professional body.


The automatic interface between ESR and the GMC / NMC ensures renewal data is uploaded as quickly as possible into ESR. The ESR system automatically notifies members of the Resourcing Team of the details of nurses, midwives, allied health professionals and medical staff who’s registration is due to expire during the coming month. The appropriate website of the professional body is then checked by them and ESR updated with the revised renewal date if it is shown. If the new date cannot be obtained via the website the Line Manager / Professional Lead will be notified to take the necessary action to ensure that registration is renewed as quickly as possible. Escalation procedures in HR are in place to facilitate this. Failure to renew registration and in the absence of any satisfactory explanation will put an employee in breach of contract and result in the Trust invoking disciplinary proceedings in line with the Disciplinary and Appeals Policy and Procedure which will include suspension without pay.

Revalidation of doctors GMC registration is expected to be launched late 2012 following a test of readiness in summer 2012. Revalidation will occur on a 5 yearly basis. Part of the revalidation process will be the expectation that the doctor will have had an annual appraisal, with 5 appraisals having occurred in a revalidation cycle. Nationally, the Medical Appraisal Framework (MAF) is being prepared and it is expected that testing will commence late 2011. Royal Colleges are also working with the GMC to help identify core components and streamline the appraisal documentation. The appraisal will focus on 4 domains (knowledge, skills and performance; safety and quality; communication, partnerships and teamwork; and maintaining trust). The 4 domains are subdivided into 12 key attributes. The doctor will be expected to provide evidence that they meet these requirements.

It is expected that revalidation will be an extension of the existing requirements on doctors to annually renew their GMC professional registration. Mr Martin Cooper – Medical Director/Board member has been appointed as Responsible Officer in advance of the revalidation start date and will be required to sign off the doctors to the GMC every 5 years. Dr Vaughan Pearce is currently conducting a review of our current appraisal process and how this can be strengthened to ensure we meet revalidation requirements.


Data Appendices – Performance

Indicator Position Target Monitor Weighting

Risk for Period

Risk for Year

Indicator Position Target for Period

Monitor Weighting

Risk for Period

Risk for Year

Indicates that the target has been achieved for the quarter Indicates that the target has been achieved for that month but the quarter has not yet finished Indicates that the target has not been achieved for the quarter Indicates that the target has not been achieved for that month but the quarter has not yet finished

Indicates that the target is not yet enforced

Not Set Not Set

Medium MON09

A&E ‐ 4 Hour Target

97.0% min. 95% 1.0 Medium

95 th Percentile max.

15 minutes

Not Set

Not applicable

1.0

0.5 for each indicator failure

capped at a maximum of 1.0

0.5

Not Set

Not Set

Not Yet Defined

1.0

Not Set Not known

0.5

Not Set

Compliant Compliant 0.5 99.0%

n/a MON10

Stroke Indicator Low 12.3


18.3 weeks Low

MON09.V A&E ‐ Left

Without Being Seen

Medium


23 weeks Medium 2.9% max. 5%

46.0

30.0

Median max.

60 minutes

9.2% max. 5%

min. 85% Medium

1.0

min. 90% Medium

MON04.I Cancer 62 Day GP Urgent

92.6%

20.7 MON05

RTT Admitted

95 th Percentile

Medium

MON06 RTT Non‐ Admitted

95 th Percentile

MON04.II Cancer 62 Day Screening

100.0%

MON09.I A&E ‐ Total Time

Medium

Medium

Medium

MON09.IV A&E ‐ Unplanned Reattendance

Rate

4.4

min. 93%

MON08.II Cancer 14 Day Symptomatic

Breast

100.0%


4 hours

MON09.III A&E ‐ Time to Treatment Decision

MON09.II A&E ‐ Time to

Initial Assessment

min. 93% Very Low

Very Low Medium

Medium

Very Low

min. 98%

Not Set

Not Set Not Set

Not Set Not Set

Medium

0.5

Medium

1.0

MON03.III Cancer 31 Day Subsequent Radiotherapy

min. 94% Medium

MON03.II Cancer 31 Day

Subsequent Drug 100.0%

100.0%

min. 94% Medium

Monitor Dashboard ‐ April 2011

Trend Trend

MON01 Clostridium Difficile*

9 (6) max. 74 annual

Medium Very Low MON08.I

Cancer 14 Day GP Urgent

97.2%

MON02 MRSA

0 (0)

MON03.I Cancer 31 Day Subsequent Surgery

95.9%

1.0

max. 3 annual

Medium 1.0

*MON01 ‐ Clostridium Difficile ‐ The Department of Health are currently reviewing the impact of increased testing. This target may be subject to change.

Low Low min. 96%

MON11 Learning Disability

Compliance

The position for Cancer targets is subject to change when the data is uploaded to the National Cancer Waiting Times Database 6 weeks after month end.

Very Low

Trend graphs run from April 2010 to current month

MON07 Cancer 31 Day First Treatment

Very Low


Code Target Apr‐11 Q1 Weighting Position Risk for Quarter

Risk for Year

MON01 74 9 (6) 9 (18) 1.0 Currently Not Medium Medium MON02 3 0 (0) 0 (1) 1.0 Achieving Medium Medium

surgery MON03.I 94%

95.9% (2 of 49)

95.9% (2 of 49)

Medium Medium

anti cancer drug treatments

MON03.II 98% 100.0% (0 of 55)

100.0% (0 of 55)

Medium Medium

radiotherapy

MON03.III 94% 100.0% (0 of 72)

100.0% (0 of 72)

Medium Medium

from urgent GP referral to treatment MON04.I 85%

92.6% (6.5 of 88)

92.6% (6.5 of 88)

Medium Medium

from consultant screening service referral

MON04.II 90% 100.0% (0 of 11)

100.0% (0 of 11)

Medium Medium

admitted pathways MON05 23 weeks 20.7 20.7 1.0 Achieving Medium Medium non‐admitted pathways MON06 18.3 weeks 12.3 12.3 1.0 Achieving Low Low

MON07 96% 99.0%

(2 of 210) 99.0%

(2 of 210) 0.5 Achieving Low Low

all cancers MON08.I 93%

97.2% (25 of 885)

97.2% (25 of 885)

Very Low Very Low

for symptomatic breast patients (cancer not initially suspected)

MON08.II 93% 100.0% (0 of 47)

100.0% (0 of 47)

Very Low Very Low

MON09 95% 97.0% 97.0% 1.0 Achieving Medium Medium A&E Clinical Quality Indicators Total time in A&E (95th

percentile) MON09.I ≤4 hrs 4.4 4.4 Not Yet Implemented Not Set Not Set

Time to initial assessment (95th percentile)

MON09.II ≤15 mins 30.0 30.0 Not Yet Implemented Not Set Not Set

Time to treatment decision (median)

MON09.III ≤60 mins 46.0 46.0 Not Yet Implemented Not Set Not Set

Unplanned reattendance rate

MON09.IV ≤5% 9.2% 9.2% Not Yet Implemented Not Set Not Set

Left without being seen MON09.V ≤5% 2.9% 2.9% Not Yet Implemented Not Set Not Set MON10 tbc 0.5 Achieving Not Set Not Set

Patient experience

MON11 n/a 0.5 Achieving Very Low Very Low

The position for Cancer targets is subject to change when the data is uploaded to the National Cancer Waiting Times Database 6 weeks after month end. *MON01 ‐ Clostridium Difficile ‐ The Department of Health are currently reviewing the impact of increased testing. This target may be subject to change.

All cancers: 31‐day wait from diagnosis to first treatment

Cancer: two week wait from referral to date first seen

0.5

Certification against compliance with requirements regarding access to healthcare for people with a learning disability

Compliant

0.5 for each indicator failure capped at a maximum of 1.0

Total time in A&E (95th percentile)

Stroke Indicator

Achieving

Achieving

Achieving

1.0

1.0

Monitor Targets Detail ‐ April 2011

Indicator

Clostridium Difficile – meeting the Clostridium Difficile objective* MRSA – meeting the MRSA objective

Not yet defined

Safety

Quality

Referral to treatment waiting times – (95th percentile)

Patient experience

All cancers: 62‐day wait for first treatment

All cancers: 31‐day wait for second or subsequent treatment

Quality


Data Appendices – Finance

Actual Surplus YTD Plan Surplus YTD Spend YTD Planned Spend YTD £0.9m £1.9m £0.6m £0.6m

Forecast Surplus Y/E Plan Surplus Y/E Forecast Y/E Spend Planned Y/E Spend £3.5m £3.5m £16.7m £16.7m

Actual Efficiency* Planned Efficiency* 1.04% 1.03%

Other Ratios Plan YTD Actual YTD Plan Y/E Forecast Y/E

Trade Creditor Days 5.7 6.0 6.4 6.4 NHS Trade Debtor Days 8.2 2.9 8.9 9.0 Debt to Asset Ratio 7.0% 6.6% 6.3% 6.3% Other items £ £ £ £ Revenue available for debt service 0.2m 0.8m 23.9m 23.9m Debt 21.5m 21.5m 20.2m 20.2m Total Assets 306.8m 326.6m 321.9m 321.9m

Cash in hand and at bank £73.6m Working Capital Facility £18m Cash invested @ Month End £nil

*(planned surplus / planned operating income *100) *(forecast surplus / forecast operating income *100)

RD&E Financial Overview as at 30th April (YTD Month 01) 1. I&E 3. Capital 5. Ratios/Risk Rating

Graph – Capital Plan Vs Actual and forecast spend

2. CIP 4. Cash 6. WTE Graph – Actual, Forecast & Plan

APPEN

DIX 1

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

££k

Month

CIP Plan v Actual

CIP Plan

CIP Actual

CIP Forecast

4700

4800

4900

5000

5100

5200

5300

5400

WTE

Month

Contracted WTE, Worked WTE & Funded WTE

Worked WTE

Contract WTE

Funded WTE

0

0 .5

1

1 .5

2

2 .5

3

3 .5

4

4 .5

5

Margin

EBITDA % Achieved

ROA

I&E Surplus

Liquidity

Overa ll Ra ting

Risk Ratings

Plan YTD

Actual YTD

Plan Y/E

Forecast Y/E

3,000

2,000

1,000

0

1,000

2,000

3,000

4,000

£k

Month

Comparison of actual cumulative net surplus/deficit compared to plan

Actual

Plan

Capital Spend

0

2

4

6

8

10

12

14

16

18

Apr

11

Ma y

11

J un

1 1

J ul 1

1

Au g

11

Se p

11

Oc t

11

No v

11

De c

11

J an

1 2

F eb

1 2

Ma r

12

Month

£M

Capital Plan 10/11

Actual Capital Spend Forecast Capital Spend

20

10

10

20

30

40

50

60

70

80

Apr11

May11

Jun11

Jul11

Aug11

Sep11

Oct11

Nov11

Dec11

Jan12

Feb12

Mar12

£M

Month

12 Month forecast cashflow v plan

Plan Actual Forecast Commited Facility


Overall : Year to Date 7% down compared to similar period in 1011

OP 1st Attendances Current Month v plan. Planned figures not currently available. Daycase 1st FCEs

Current Month v plan. Planned figures not currently available.

12% lower than the same month last year 2% higher than the same month last year

20% lower than previous month 21% lower than the previous month

Year to Date 11% lower than same period in 1011

Year to Date 2% above than same period in 1011.

Year to date v plan. Planned figures not currently available.


Elective IP 1st FCEs


Non Elective IP 1st FCEs


26% lower than the same month last year 2% higher than the same month last year

25% lower than previous month 5% lower than previous month

Year to Date 26% lower than the same period in 1011.

Year to Date 2% higher than same period in 1011.



RD&E Activity Overview as at 30 April 2011 (YTD Month 1)

0

2000

4000

6000

8000

10000

12000 Apr08

May08

Jun08

Jul0

8 Aug08

Sep08

Oct08

Nov08

Dec08

Jan09

Feb09

Mar09

Apr09

May09

Jun09

Jul0

9 Aug09

Sep09

Oct09

Nov09

Dec09

Jan10

Feb10

Mar10

Apr10

May10

Jun10

Jul1

0 Aug10

Sep10

Oct10

Nov10

Dec10

Jan11

Feb11

Mar11

Apr11

OP 1st Attendances

Plan Actual

1500

1700

1900

2100

2300

2500

2700

2900

3100

3300

3500

3700 3900

4100

4300

4500

4700

4900

5100

5300

5500

5700

Apr08

May08

Jun08

Jul08

Aug08

Sep08

Oct08

Nov08

Dec08

Jan09

Feb09

Mar09

Apr09

May09

Jun09

Jul09

Aug09

Sep09

Oct09

Nov09

Dec09

Jan10

Feb10

Mar10

Apr10

May10

Jun10

Jul10

Aug10

Sep10

Oct10

Nov10

Dec10

Jan11

Feb11

Mar11

Apr11

Day Case 1st FCEs

Plan Actual

500

700

900

1100

1300

1500

1700

1900

2100

Apr08

May08

Jun08

Jul08

Aug08

Sep08

Oct08

Nov08

Dec08

Jan09

Feb09

Mar09

Apr09

May09

Jun09

Jul09

Aug09

Sep09

Oct09

Nov09

Dec09

Jan10

Feb10

Mar10

Apr10

May10

Jun10

Jul10

Aug10

Sep10

Oct10

Nov10

Dec10

Jan11

Feb11

Mar11

Apr11

Elective IP 1st FCEs

Plan Actual

0

500

1000

1500

2000

2500

3000

3500

Apr08

May08

Jun08

Jul08

Aug08

Sep08

Oct08

Nov08

Dec08

Jan09

Feb09

Mar09

Apr09

May09

Jun09

Jul09

Aug09

Sep09

Oct09

Nov09

Dec09

Jan10

Feb10

Mar10

Apr10

May10

Jun10

Jul10

Aug10

Sep10

Oct10

Nov10

Dec10

Jan11

Feb11

Mar11

Apr11

Apr11

NonElective IP 1st FCEs

Plan Actual


Royal Devon & Exeter NHS Foundation Trust Prior Yr Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar10

Income Statement Variance Plan Variance Variance Plan Variance Actual Period ending 30/04/2011 to Budget to Plan to Budget to Plan Month 01 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 Income

NHS Clinical Income 21,354 21,371 (17) 1 21,371 (17) 279,153 279,153 0 1 278,936 217 1 287,191

Private patient income 23 82 (59) 82 (59) 1,150 1,150 0 1,150 0 1,142

Research and Development 904 832 72 1,054 (150) 9,984 9,984 0 12,649 (2,665) 13,071

Education and Training 1,173 1,173 0 1,165 8 14,100 14,100 0 12,982 1,118 14,231

Other income 2,784 2,975 (191) 2 2,889 (105) 33,533 33,533 0 34,806 (1,273) 35,035

Total income 26,238 26,433 (195) 26,562 (324) 337,920 337,920 0 340,524 (2,604) 350,670 Expense

Employee Benefits Expenses (Pay) (16,511) (16,665) 154 3 (17,094) 583 (198,799) (198,799) 0 (198,588) (211) (203,420)

Drug Costs (2,174) (2,225) 51 (2,398) 224 (27,073) (27,073) 0 (29,120) 2,047 2 (27,777)

Clinical Supplies (2,676) (2,931) 255 4 (3,082) 406 (36,247) (36,247) 0 (38,858) 2,611 2 (40,253)

Non Clinical Supplies (372) (370) (2) (369) (3) (4,420) (4,420) 0 (4,364) (56) (4,432)

Research & Development Expenses (856) (905) 49 (1,072) 216 (10,849) (10,849) 0 (12,861) 2,012 (13,009)

Misc. Other Operating Expenses (2,539) (2,762) 223 5 (2,757) 218 (31,431) (31,431) 0 (33,016) 1,585 3 (36,505)

Reserves (361) (361) 0 0 (361) (5,383) (5,383) 0 0 (5,383) 0

Total Costs (25,489) (26,219) 730 (26,772) 1,283 (314,202) (314,202) 0 (316,806) 2,604 (325,396)

EBITDA 749 214 535 (210) 959 23,718 23,718 0 23,718 0 25,274

Profit / loss on asset disposals 0 0 0 0 0 0 0 0 0 0 (2,841) Exceptional Income/ Costs & Impairments **

Total Depreciation (973) (973) 0 (973) (0) (11,995) (11,995) 0 (11,994) (1) (10,499)

Total operating surplus (deficit) (224) (759) 535 (1,183) 959 11,723 11,723 0 11,723 (0) 11,934

11 16 (5) 12 (1) 195 195 0 195 0 247

Total interest payable on Loans and leases (84) (84) 0 (85) 1 (1,007) (1,007) 0 (1,007) 0 (1,072)

PDC Dividend (612) (612) 0 (618) 6 (7,411) (7,411) 0 (7,411) 0 (7,048)

Net Surplus/(deficit) (909) (1,439) 530 (1,874) 965 3,500 3,500 0 3,500 (0) 4,061

YTD KEY MOVEMENTS FORECAST KEY MOVEMENTS

1 1

2 3 4 5 Main underspends have occurred within Community Estates, in line with Other Income under recovery Underspends within clinical supplies expenditure is prodominantly due to the low number of operational days within April

Year to Date Outturn

Total interest receivable/ (payable) inc committed WC facilities

APPE

NDIX 3

Due to clinical income being processed a month in arrears Month 1 actual income is in line with the budget. This is with the exception of Road Traffic Accident (RTA) income which is £17k under budget.

For month 1 it is forecasted that all areas will be in line with budget at year end.

Various areas currently underrecovered against budget, including Childcare, Pharmacy and Community Estates. Pay underspends have occurred within Nursing and ancilary staff


Royal Devon & Exeter NHS Foundation Trust Prior Yr Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar10

Statement of Financial Position Variance Plan Variance Variance Plan Variance Period ending 30/04/2011 to Budget to Plan to Budget to Plan Month 01 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 Assets, NonCurrent

Intangible Assets, Net 527 526 1 526 1 326 326 0 326 0 544

Property, Plant and Equipment, Net 238,403 238,401 2 238,401 2 254,072 254,072 0 254,072 0 238,779

Non NHS Trade Receivables, NonCurrent 1,047 1,047 0 1,047 0 838 838 0 838 0 966

Assets, NonCurrent, Total 239,977 239,974 3 239,974 3 255,236 255,236 0 255,236 0 240,289

Assets, Current Inventories 4,613 4,613 0 4,613 0 4,624 4,624 0 4,624 0 4,592

Trade and Other Receivables, Net, Current 6,633 11,777 (5,144) 1 11,348 (4,715) 12,642 12,642 0 12,642 0 11,009

Non Current Assets held for sale 0 0 0 0 0 0 0 0 0 0 0

Cash 73,618 49,093 24,525 2 49,093 24,525 47,644 47,644 0 47,644 0 53,583

Other Assets Current Assets Held by Charitable Funds 1,800 1,800 0 4 1,800 0 1,800 1,800 0 1,800 0 0

Assets, Current, Total 86,664 67,282 19,382 66,854 19,810 66,711 66,711 0 66,711 0 69,184

Liabilities, Current Loans, noncommercial, Current (DH, FTFF, NLF, etc) (1,270) (1,270) 0 (1,270) 0 (1,270) (1,270) 0 (1,270) 0 (1,270)

Trade and Other Payables, Current (8,874) (8,874) 0 (8,874) (1) (10,007) (10,007) 0 (10,007) 0 (10,262)

Deferred Income, Current (19,786) (1,286) (18,500) 3 (1,286) (18,500) (1,620) (1,620) 0 (1,620) 0 (1,520)

Provisions, Current (1,368) (1,368) 0 (1,368) 0 (193) (193) 0 (193) 0 (1,368)

Current Tax Payables (4,324) (4,324) 0 (4,324) 0 (4,276) (4,276) 0 (4,276) 0 (5,083)

Other Financial Liabilities, Current (11,084) (10,724) (360) (10,730) (354) (11,315) (11,315) 0 (11,315) 0 (10,893)

Liabilities, Current, Total (46,706) (27,846) (18,860) (27,852) (18,854) (28,681) (28,681) 0 (28,681) 0 (30,396)

NET CURRENT ASSETS (LIABILITIES) 39,958 39,436 522 39,001 957 38,030 38,030 0 38,030 0 38,788

TOTAL ASSETS LESS CURRENT LIABILITIES 279,935 279,410 525 278,975 960 293,266 293,266 0 293,266 0 279,077

Liabilities, NonCurrent Loans, NonCurrent, noncommercial (DH, FTFF, NLF, etc) (20,213) (20,213) (0) (20,213) (0) (18,942) (18,942) 0 (18,942) 0 (20,213)

Other Creditors, NonCurrent (119) (118) (1) (118) (1) (78) (78) 0 (78) 0 (123)

Provisions, NonCurrent (340) (346) 6 (346) 6 (346) (346) 0 (346) 0 (346)

TOTAL ASSETS EMPLOYED 259,263 258,733 530 258,298 965 273,900 273,900 0 273,900 0 258,395

TAX PAYERS' EQUITY

Public dividend capital 149,715 149,715 0 149,715 0 149,715 149,715 0 149,715 0 149,715

Retained Earnings (Accumulated Losses) 43,040 42,510 530 42,075 965 49,145 49,145 0 49,145 0 43,949

Charitable Funds 1,800 1,800 0 4 1,800 0 1,800 1,800 0 1,800 0 0

Revaluation Reserve 61,200 61,200 0 61,200 0 69,924 69,924 0 69,924 0 61,200

Donated Asset Reserve 3,508 3,508 (0) 3,508 (0) 3,316 3,316 0 3,316 0 3,531

TOTAL TAX PAYERS' EQUITY 259,263 258,733 530 258,298 965 273,900 273,900 0 273,900 0 258,395

OUTTURN KEY MOVEMENTS

1 Debtors are £5.1m lower than plan. The value is lower mainly due to the monthly block instalment received being higher than the actual income due and also recoverability on other debtors being better than expected. 2 3 4


APPEN

DIX 4

The cash balance is higher mainly due to receiving income in advance. See the below deferred income explanation and also the integrated performance report for further details. The majority of the month 2 block income due from NHS Devon was received in month 1. It is likely that the Royal Devon and Exeter NHS Foundation Trust General Charity will have to be consolidated within the Trust's accounts. Actual figures at month 1 are based upon the annual plan figures.


Royal Devon & Exeter NHS Foundation Trust Prior Yr

Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar10

Cash Flow Statement Variance Plan Variance Variance Plan Variance

Period ending 30/04/2011 to Budget to Plan to Budget to Plan

Month 01 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES

Surplus/(deficit) after tax (909) (1,439) 530 (1,874) 965 3,500 3,500 0 3,500 (0) 4,061

Noncash flows in operating surplus/(deficit)

Finance (income)/charges 73 68 5 73 (0) 812 812 0 812 0 825

Depreciation and amortisation 973 973 0 973 0 11,995 11,995 0 11,994 1 10,499

Impairment 0 0 0 0 0 0 0 0 0 0 2,806

PDC dividend expense 612 612 0 618 (6) 7,411 7,411 0 7,411 0 7,048

Other increases/(decreases) to reconcile to profit/(loss) from operations (26) (19) (7) (23) (3) (278) (278) (0) (278) (0) (238)

Noncash flows in operating surplus/(deficit), Total 1,632 1,634 (2) 1,640 (8) 19,940 19,940 (0) 19,940 0 20,940

Increase/(Decrease) in working capital

(Increase)/decrease in inventories (21) (21) 0 (21) 0 (32) (32) 0 (32) 0 15

(Increase)/decrease in NHS Trade Receivables 4,733 (411) 5,144 18 4,715 (1,204) (1,204) 0 (1,204) 0 974

(Increase)/decrease in Non NHS Trade Receivables 386 386 0 386 0 71 71 0 71 0 163

(Increase)/decrease in other receivables (169) (169) 0 (169) 0 (276) (276) 0 (276) 0 749

(Increase)/decrease in accrued income (327) (327) 0 (327) 0 (208) (208) 0 (208) 0 187

(Increase)/decrease in prepayments (247) (247) 0 (247) 0 (16) (16) 0 (16) 0 (250)

Increase/(decrease) in Deferred Income (excl. Donated Assets) 18,266 (234) 18,500 (234) 18,500 100 100 0 100 0 (730)

Increase/(decrease) in provisions (6) 0 (6) 0 (6) (1,175) (1,175) 0 (1,175) 0 1,288

Increase/(decrease) in Trade Creditors (695) (695) 0 (695) 0 (200) (200) 0 (200) 0 (139)

Increase/(decrease) in tax payable (759) (759) 0 (759) 0 (807) (807) 0 (807) 0 1,035

Increase/(decrease) in Other Creditors 89 89 0 89 0 (55) (55) 0 (55) 0 88

Increase/(decrease) in accruals (505) (866) 361 (866) 361 684 684 0 684 0 (1,037)

Increase/(Decrease) in workling capital, Total 20,745 (3,253) 23,998 (2,825) 23,570 (3,119) (3,119) 0 (3,119) 0 2,343

Net cash inflow/(outflow) from investing activities

Property new land, buildings or dwellings see below (446) (446) 0 (446) 0 (4,434) (4,434) 0 (4,434) 0 (3,555)

Property maintenance expenditure see below (30) (30) 0 (30) 0 (3,042) (3,042) 0 (3,042) 0 (8,851)

Plant and equipment Information Technology see below (27) (27) 0 (27) 0 (1,451) (1,451) 0 (1,451) 0 0

Plant and equipment Other see below (74) (74) 0 (74) 0 (7,723) (7,723) 0 (7,723) 0 0

Proceeds on disposal of property, plant and equipment 0 0 0 0 0 0 0 0 0 0 6,081

Increase/(decrease) in Capital Creditors (782) (782) 0 (782) 0 0 0 0 0 0 (242)

Other cash flows from financing activities 0 0 0 0 0 63 63 0 63 0 0

Net cash inflow/(outflow() from investing activities, Total (1,359) (1,359) 0 (1,359) 0 (16,587) (16,587) 0 (16,587) 0 (6,568)

Net cash inflow/(outflow) from financing activities

PDC Dividends paid 0 (0) 0 0 0 (7,673) (7,673) 0 (7,673) 0 (6,502)

PDC Dividend Received 0 0 0 0 0 0 0 0 0 0 0

Interest (paid) on commercial loans 0 1 (1) 0 0 (1,007) (1,007) 0 (1,007) 0 (1,072)

Interest received on cash and cash equivalents 11 12 (1) 12 (1) 195 195 0 195 0 247

Repayment of noncommercial loans 0 (0) 0 0 0 (1,271) (1,271) 0 (1,271) 0 (1,271)

(Increase)/decrease in noncurrent receivables (81) (81) 0 (81) 0 128 128 0 128 0 (128)

Increase/(decrease) in noncurrent payables (4) (5) 1 (5) 1 (45) (45) 0 (45) 0 34

Net cash inflow/(outflow) from financing activities, Total (74) (74) (0) (74) (0) (9,673) (9,673) 0 (9,673) 0 (8,692)

Net increase/(decrease) in cash and cash equivalents 20,035 (4,491) 24,526 (4,491) 24,526 (5,939) (5,939) (0) (5,939) (0) 12,085

Opening cash and cash equivalents 53,583 53,583 0 53,583 0 53,583 53,583 0 53,583 0 41,498

Closing cash and cash equivalents 73,618 49,092 24,526 49,092 24,526 47,644 47,644 (0) 47,644 (0) 53,583


APPENDIX 5


Royal Devon and Exeter NHS Foundation Trust

Capital expenditure

Period ending 30/04/11

Month 1 Column B Column C Column D Column E Column F Column G Column H

Approval level YTD planned expenditure per annual plan

YTD actual expenditure

YTD variance slippage / (overspend)

Forecast future capital

expenditure for the year

Forecast total capital

expenditure for the year

Full year expenditure per annual plan

10/11 forecast slippage / (overspend)

Expenditure approved by the Exec Group

Total expenditure

forecast for the scheme

Scheme variance under

spend / (overspend)

( B C) (C + E) (G F) £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

OBC 88 88 2,162 2,251 2,251 8,700 8,700 31Mar15

FBC 365 365 1,896 2,261 2,261 6,200 5,339 861 31Jan12

SOC 10 10 368 378 378 5,600 5,600 31Mar15

SCG 750 750 750 3,250 3,250 31Mar14

FBC 2,803 3,104 ( 301) Complete

FBC ( 22) ( 22) ( 22) ( 22) 2,370 1,921 449 Occupied

FBC 9 9 517 527 527 2,207 2,207 31Mar14

FBC 37 37 36 74 74 1,366 1,149 217 31Aug11

FBC 1,248 1,286 ( 38) Complete

SCG 267 267 267 950 950 31Mar14

Approved 188 188 188 925 925 31Aug11

SCG 850 850 850 850 850 29Feb12

SCG 400 400 400 600 600 31Mar13

Approved / SCG 90 90 8,640 8,727 8,727

577 577 16,073 16,650 16,650

Approval Level Key OBC Outline business case FBC Full business case SOC Strategic outline case SCG Subject to Strategic Capital Group approval on 20th May 2011

Expected completion date

Actual expenditure to date compared to budget on annual plan

Total expenditure forecast for the year compared to the budget on the annual plan

Total expected expenditure compared to the value approved by the Exec Group.

Schemes over £500K in progress or planned

Scheme

Rebuild CIVAS unit and equip.

Increasing radiotherapy capacity (3rd LINACC)

Research, Innovation, Learning and Development

Estates infrastructure

Pain Management (Inc. Physio)

Heavitree replace B block windows

Durbin ward refurbishment

Other schemes < £500K and contingency

Renal Heavitree

Order comms and eprescribing IT systems

Procurement of third CT scanner

Nursery expansion

Core network upgrade

Energy Centre replace main air conditioning


Royal Devon & Exeter NHS Foundation Trust Actual Plan Variance Actual Plan Variance Actual Plan Variance Forecast

to Budget (target) to Budget to Budget Cost Improvement Programme Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

Period ending 30/04/2011 Month 01 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Work Stream Bed Utilisation 0 43 (43) 0 2,081 (2,081) 2,081 0 0 2,081 (2,081) 2,081 Theatre Utilisation 9 38 (29) 9 984 (975) 984 0 0 984 (984) 984 Outpatients 0 5 (5) 0 1,397 (1,397) 1,397 0 0 1,397 (1,397) 1,397 Workforce 7 31 (24) 88 1,748 (1,660) 1,748 0 88 1,748 (1,660) 1,748 Medical Staffing 0 5 (5) 0 3,716 (3,716) 3,716 0 0 3,716 (3,716) 3,716 Nursing & AHP Staff 0 24 (24) 0 1,824 (1,824) 1,824 0 0 1,824 (1,824) 1,824 Procurement 12 72 (60) 73 2,115 (2,042) 2,115 0 66 2,115 (2,049) 2,115 Diagnostics 7 0 7 88 1,179 (1,091) 1,179 0 88 1,179 (1,091) 1,179 Pharmacy 4 19 (15) 44 747 (703) 747 0 44 747 (703) 747 Back Office 23 45 (22) 276 1,269 (993) 1,269 0 276 1,269 (993) 1,269

62 282 (220) 578 17,060 (16,482) 17,060 0 562 17,060 (16,498) 17,060

APPEN

DIX 7

Year to Date Achieved Current Year Achieved Current Year Forecast Full Year Achieved Forecast CY Forecast

Variance Fav / (Adv)

2,081 975 1,397 1,660 3,716 1,824 2,042 1,091 703

993

0 9 0 0 0 0

7 0 0

0

0 0

0 88 0 0 66 88 44

276

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Bed Utilisa tion Thea tre Utilisation Outpatients Workforce Medical Sta ffing Nursing & AHP Staff

Procurement Diagnostics Pha rmacy Back Office

Achievement

Directorate

CIP Achievement Current Year

Recurrent

NonRecurrent

To be Achieved


MONITOR PROPOSED FURTHER INDICATORS FOR FRR COMPLIANCE FRAMEWORK CONSULTATION

Proposed indicator Potential financial weakness Criteria to measure against

Unplanned decrease in EBITDA margin in two consecutive quarters Deteriorating trend in operating performance and cashflow generation Variance to planned EBITDA margin NO 101.63% NO 109.21% NO 101.34% NO 356.67%

Quarterly selfcertification by trust that FRR may be less than 3 in the next 12 months

Identified risk of potential financial breach within the next year

Forecast financial risk rating for the next 12 months NO 3+ NO 3+ NO 3+ NO 3+

FRR 2 for any one quarter In year deterioration in financial performance Current period Financial Risk Rating NO 3 NO 3 NO 3 NO 3

Debtors more than 90 days past due account for more than 5% of total debtor balances

Potential for payment / debtor collection concerns

% of Debtors more than 90 days past due account NO 4.62% YES 5.96% NO 3.68% NO 1.75%

Creditors more than 90 days past due account for more than 5% of total creditor balances

Potential for build up in creditors, resulting in future liquidity concerns

% of Creditors more than 90 days past due account NO 0.03% NO 0.00% NO 0.00% NO 0.00%

Capital expenditure is less than 75% of plan for the year to date Capital expenditure plans are delayed to conserve cash Capital expenditure variance to plan YES 65.35% YES 64.62% YES 70.44% NO 100.00%

Quarter end cash balance less than 10 days of operating expenses Potential liquidity concerns and ability to meet liabilities as they fall due Liquidity days at period end NO 62.27 NO 69.42 NO 60.16 NO 85.52

Working capital facility (WCF) agreement includes default clause. This will require all trusts to review their WCF agreements.

Risk that WCF, whilst included in calculation of liquidity days for the purpose of FRR, may not be available if and when required (eg: FRR 1 or 2). Review of WCF

Interim Finance Director in place over more than one quarter end Absence of permanent / substantive appointment to key position

Two or more changes in Finance Director in a twelve month period Multiple changes in a short period of lead financial officer

Notes / Explanations APPEN

DIX 9

31/01/2011 28/02/2011 31/03/2011 30/04/2011

No No No No

No No

No No No No

No No


Data Appendices – Quality

Green

Outcome ‐ Pressure Sores Outcome ‐ MUST Score

RDE

Process ‐ Pressure Sores Assessment Process ‐ MUST Score Process ‐ Hand Hygiene General (Green) Amber

Green Green

Initial (Red)

Outcome ‐ New MRSA Isolates Identified > 72 Hours After Admission

The ongoing work to improve pressure ulcer assessment compliance i s resul ting in sustained achievement of this indicator.

Initia l assessment continues to improve each month. Red rated areas have an action plan to achieve compl iance. Refining the assessment tool i s ongoing to ensure itenables timely and accurate data.

A number of wards have not submitted their audi t data in time for this report which i s reflected in the amber rating. The process for ensuring timely submission of this paper audit wil l be reviewed.

Grade 3 and 4 pressure ulcers are subject to investigation and immediate reporting to the Director of Nursing & Patient Care. The best practice “Skin Bundle” i s being used and wi ll be launched in June as part of the “You Matter” campaign.

An electronic l ink from the assessment tool to the dietetics service wi ll ensure automatic and early referral to dietetics service once a critical score i s reached. This l ink and the process to be followed is currently being final ised.

0

10

20

30

40

50

60

70

80

90

100

Jan10 Apr10 Jul10 Oct10 Jan11 Apr11

0

10

20

30

40

50

60

70

80

90


Initial compliance with MUST Screening on Admiss ion

General compliance with MUST Screening at Weekly Review

0

10

20

30

40

50

60

70

80

90

100


0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%


0

1

2

3

4

5


RDE Average +1 sd

Indicator to be developed


No threshold

No threshold No threshold

Housekeeping (Green) Equipment (Green)

RDE

Process ‐ Housekeeping & Equipment Cleaning Process ‐ Falls Risk Assessment Process ‐ EWS Calls

Compliance with this standard is consis tentl y met. The housekeeper rol e review i s underway and l inks to the ward redesign work being undertaken as part of the Strategic Redes ign Programme.

The IT infrastructure is currently being finalised to enable real time monitoring of this indi cator on the Trust whiteboard system.

The severity of injury associated with inpatient fal ls reduced in 2010/11. The focus this year is a reduction in the total number of falls .

Each cardiac arrest is subject to a review to investi gate the precipitating factors. Data is collated for trend analysi s by the Resuscitation Committee

Outcome ‐ C.Difficile Infections Identified > 72 Hours After Admission Outcome ‐ Inpatient Slips, Trips & Falls Outcome ‐ Cardiac Arrest Calls Green

0

2

4

6

8

10

12

14


RDE Average +1 s d

80

82

84

86

88

90

92

94

96

98

100


Housekeeping Equipment

Percentage Compliance with Falls Risk Assessment by month to follow when

data becomes available

0

5

10

15

20

25

30


0

20

40

60

80

100

120

140

160

180


RDE Average +1 sd

0

5

10

15

20

25

30

35

40



RDE

Process ‐ Electronic VTE Risk Assessment Process ‐ Estimated Date of Discharge Process ‐ Bank & Agency Staff Usage No threshold Red Green

Outcome ‐ Thromboprophylaxis Audit Outcome ‐ Estimated Date of Discharge met Outcome ‐ Incidents & Complaints/Concerns

Work is ongoing to improve the electronic data col lection. At present a paper audit is undertaken monthly and shows a much higher compl iance rate.

Bank and agency staff usage i s monitored monthly and has been mapped to total sickness and absence, hol idays, and activi ty. To date, analysis has shown no clear correlation. Work i s undertaken to review Bank Office function and productivity.

No Threshold

Datix web is being introduced Trustwide throughout May, June and July. This will greatly improve timeliness of reporting and the qual ity of the data.

No Threshold

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Aug10 Oct10 Dec10 Feb11 Apr11

71

72

73

74

75

76

77

78

79

80


0

20

40

60

80

100

120


Bank Assigned Agency Assigned

Indicator to be developed

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


0

50

100

150

200

250

300


Complaints /Concerns Incidents


Appendix A DIRECTORATE OF CANCER SERVICES

Cancer Waiting Times – additional report on failed 62 day referral to 1 st treatment for Quarter 1 and Quarter 4 2010/11

Introduction The report below outlines the issues relating to the failed 62 day referral to 1 st treatment target in Quarters 1 and 4 in 2010/11 and the actions put into place to reduce recurrences.

The national Cancer Waiting Times Target is that 85% of the total number of patients referred who are diagnosed with cancer must be treated within 62 days.

The report also outlines the current position for April 2011.

Background to Quarter 1 2010/11 Performance of the 62 day referral to 1 st treatment target in Quarter 1 2010/11 was a problem predominantly in May and June. The reasons for breaches were multifaceted which, following analysis showed no particular trends. However, actions were agreed at validation meetings, attended by senior members of the Directorate teams, to address specific issues are outlined in the action plan below.

Reasons for breaches

April 2010 (85% achievement – 9.5 breaches)

Breach reason Number Complex clinical pathways 5.5 Patient choice 1 Enabling treatment 0.5 Diagnostic delay 2 Late referral from referring Trust 0.5

May 2010 (83% achievement – 12 breaches)

Breach reason Number Complex clinical pathways 4 Patient choice 1 Diagnostic delay 3 Admin processes 1 Clinical Capacity 1 Late referral from referring Trust 1 Escalation issues 1

June 2010 (82% achievement – 14 breaches)

Breach reason Number Complex clinical pathway 10 Admin error 1 Patient choice 1 Clinical Capacity 1 Prediagnostic delays 1


Background to Quarter 4

January 2011

The reasons for breaches in January 2011 were mainly attributed to complex clinical pathways (see table below) There was also a lower than normal denominator due to the impact of reduced referrals over the extended Christmas and New Year period.

January 2010 (86% achievement 9.5 breaches)

Breach reason Number Complex pathway 4.5 Adverse weather 1.0 Theatre capacity 1.0 Patient choice 1.0 Diagnostic delays 2.0

February 2011

February 2011 saw the impact of the increased numbers of patients being referred for endoscopy as a result of the bowel cancer screening campaign with additional referrals to surgery and oncology.

Feb 2011 (73.9% achievement 19.5 breaches)

Breach reason Number Complex pathway 10 Patient choice 5 Patient not fit 1.5 Late referral from other provider 0.5 Not originally felt to be cancer 2 Enabling treatment required 0.5

March 2011

The majority of breaches in March were as a result of complex clinical pathways.

March 2011 (84.8% 17.5 breaches)

Breach Reason Number Complex clinical pathway 9 Patient thinking time 1 Late referral from referring Trust 1.5 Adverse weather 1 Clinical capacity 1 Admin 2 Not originally felt to be cancer 1 Patient issues 1


62 Day Referral to First Treatment Action Plan

The actions outlined below were implemented throughout 2010/11 involving clinicians and senior managers from clinical and support directorates and from IM&T and performance teams.

Issue Description Planned Actions Lead Date

Diagnosis

Slot availability and planning for radio frequency ablation for urology patients.

The Radiology Department were not aware that the patients were on a cancer pathway as it had not been flagged on the request form. This was addressed by adding a visual trigger orange sticker to all relevant requests the pathway of care to be timely.

Abbie Sowden/Sarah Hodder

Completed

Inter Trust Referrals

Referrals from other acute provider Trusts not being added to the Cancer Waiting Time (CWT) Tracker quickly enough whilst waiting for a formal referral in order for the patient to be tracked in a timely way.

Agreement was reached that these patients should be added to the CWT Tracker as soon as they were discussed at the Multi Disciplinary Team (MDT) meeting and before the intertrust referral had been received.

Gail Marsden Completed

Fit for Surgery

Patients added to or left on waiting lists when they were not clinically fit to undertake their treatment.

It was therefore agreed that any patient not fit for treatment should not be added to waiting lists.

Christian Hamilton Completed

Do Not Attends

Patients who Do Not Attend (DNA) their pre operative assessment which caused delay sin the patient treatment.

It was agreed that any instances of this should be escalated to clinical service managers to avoid patients missing

Christian Hamilton Completed


their To Come In (TCI) date. An alternative telephone preoperative assessment for patients who DNA’d/cannot attend on appointed date was introduced which has greatly improved this situation.

Escalation

Patients seen initially at neighbouring Acute Trusts are then referred to the RD&E for their treatment. There were issues around estimating the capacity for these patients.

This was resolved through a series of discussions with referring Trusts and the Peninsula Cancer Network and an agreed escalation process is now in place.

CSMs/ Cancer Services

Completed

Lost Activity due to Bank Holiday Weekends

Escalation meetings led by Divisional leads, MDT Chairs, and subspeciality teams took place to address lost activity due to two bank holiday weekends in April/May and to create additional capacity for two week wait, outpatient and surgical slots. MDT meetings were also rescheduled to avoid delays in case presentation and clinical decision making.

Clinical Directorate leads

Completed

Further detail relating to identification of potential breaches required.

Predictor reports which identified potential patients were issued to Directorates in addition to the standard weekly breach reports to endeavour to deliver a compliant position for March.

Steve Roffe Completed

Forthcoming lung awareness campaign

Work is underway to review specific clinical pathways of the high volume 62 day cancer subspecialties with the

Service Development/CSMs/ Cancer Services

June 2011


support of the Service Development Team. Further work to look at changing trends in specialties is also taking place supported by sub specialty performance run charts to enable earlier indication of changing referral trends.

Unexpected adverse weather conditions

In our plan for business continuity during or following adverse weather conditions, we will include the learning from our Easter planning and by planning capacity for outpatients and diagnostics during the winter months preempt any delays and accelerate the process earlier in the clinical pathway to avoid breaches.

Clinical Directorates Sept 2011

April 2011 (92.6% 6.5 breaches)

The actions outlined above have had a positive impact as the 62 day1 st treatment and the April position has improved giving an in month position of 92.6%.

Conclusion

Outlined through this report are the changes to clinical and administrative pathways to improve performance against the Cancer Waiting Times targets.

The Cancer Services Directorate Team continues to work actively with clinical and support Directorates and external teams to improve clinical pathways, data recording and cancer tracking. This includes the identification of additional capacity requirements around planned holidays and unexpected adverse weather conditions.

Currently it is not felt that additional theatre slots or clinic availability is required.

The increased engagement of the subspeciality teams in achieving this target has had a major impact on the delivery of the 62 day clinical pathway which is demonstrated in April 2011. Sustaining the performance against cancer targets is a key challenge for this year; however with the full implementation of the action plan outlined above we expect the current improvements to be sustained.

Peter Adey Divisional Manager Cancer Services and Child and Women’s Health

Documents

Board of Directors Meeting - Royal Devon and Exeter Hospital · Appendix A (on page 32) within this report. 3.4 Finance The key areas of financial performance are as follows: •