Month 2 Integrated Performance Report - RJAH

Month 2 Integrated Performance Report

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0. Reference Information

Author:Claire Jones, Principal Analyst and Data Quality Lead

Paper date: 25/06/2020

Executive Sponsor:Kerry Robinson, Director of Performance, Improvement and OD

Paper Category: Performance

Paper Reviewed by: Executive Team Paper Ref: N/A

Forum submitted to: Board of Directors Paper FOIA Status: Full

1. Purpose of Paper

1.1. Why is this paper going to Trust Board and what input is required?

The committee is required to assure itself that the Trust is providing high quality, caring and safe health care services in accordance with national regulatory standards.

The purpose of the Integrated Performance Report (IPR) is to provide the committee with the evidence of achievement against the national regulatory standards, identification of emerging risks and the assurance that an improvement plan is in place and is effective.

This paper is for information summarising the key performance indicators, highlighting areas of high or low performance for operational and financial metrics.

The committee is asked to note the overall performance as presented in the month 2 (May) Integrated Performance Report, against all areas and actions being taken to meet targets.

2. Executive Summary

2.1. Context

The paper incorporates the monthly integrated performance report with associated narrative and descriptions of key actions.

It should be noted that the NHS is currently in phase two of the response to covid-19 which covers the period May to July which is the period of restoring safe service levels for critical services and signalling restart of some routine services. There are a number of regulatory standards data collection have been suspended, further guidance is awaited on access standards.

The targets within the IPR are either regulatory standards that stood pre-covid or where not regulatory standards are the draft 20/21 plan. These will be updated to align with national guidance and/or restoration plans as the year progresses to enable performance monitoring these will be approved the committees of the Board.

Changes to our services commenced week beginning 16th March 2020 and therefore due to this special cause variation there may have been impact on some of our standard KPI’s. From that time, and throughout April, the Trust has only seen or operated on urgent electives and has assisted the local system with trauma services.

2.2. Summary

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Month 2 Integrated Performance Report

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I In line with the Trust’s Performance Management Strategy and Accountability Framework, Board-level Key Performance Indicators (KPIs) which are considered to drive the overall performance of the Trust.

The 20/21 IPR has been adapted in line with our recently agreed 20/21 performance framework to now include a section of action, both action for improvement and actions for sustainability. As would be anticipated it is expected that this will strengthen over the period as the organisational structure embeds.

The Trust remains in segment 2 of the NHS Improvement Single Oversight Framework.

Areas of performance to highlight this month are as follows;

Caring for Staff;

Sickness remains above target at 3.98%, with slight reduction from previous month.

Voluntary staff turnover has reduced and back below the 8% target at 7.96%

Caring for Patients;

Total patient falls remains within tolerance level with seven reported in month; no falls resulting in moderate or severe, however inpatients ward fall per 1,00 bed days was outside of target.

Delayed Discharge rate green rated at 2.16% against the 2.5% target; lowest rate in 24 months reported.

No RJAH acquired infections reported this month.

Complaints remain within tolerance with seven received in May. Response rate red rated at 50% with one complaint not responded to within 25 days.

All previous cancer standards were met for April (reported a month in arrears), the newly introduced 28 day faster diagnosis standard did not meet the 75% target and reported at 72.22%

Our English RTT open pathways performance is reported at 67.30%, with our English list size increasing by 216 (3%) from that reported last month. The May month end figure is reported at 7,758 the highest for the last 13 months, 15% higher than our lowest point in the last 12 months.

33 English patients and 40 Welsh patients waiting over 52 weeks, along with continual reporting of Welsh transfer of care after 52 weeks at 203 patients.

Both diagnostics standards (English and Welsh) did not achieve their respective targets.

Caring for Finances;

Covid-19 continued to impact the level of theatre activity delivered in April. All non-urgent elective activity and inpatient dental work ceased from Friday 20th March.

194 theatre cases carried out for urgent electives and trauma services.

In response to covid-19, non-essential outpatient activity was cancelled from the 16th March. Throughout May, 4237 attendances were seen where 416 were classed as fracture clinics.

All financial measures green rated, with exception of Income.

The following targets will be reviewed in the next period;

Touchtime utilisation – to align with PPE requirements and implications for remainder of the year.

Bed occupancy – to align with national modelling assumptions for restoration.

% sessions used against plan – to align with restoration plans

Day case rate – to align with restoration plans

New to follow up ratio – to align with restoration plans.

2.3. Conclusion

The Trust Board is asked to note the report and where insufficient assurance is received via the responsible sub-committee of the Board, the Board will seek additional assurance.

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Integrated Performance Report

May 2020 – Month 2

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Contents

Summary 3

Heatmaps

Caring for Staff 4

Caring for Patients 5

Caring for Finances 7

Narrative

Caring for Staff 8

Caring for Patients 10

Caring for Finances 34

Reading guide End

Integrated Performance Report 2


May – Month 2

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May – Month 2

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Caring for Staff

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Sickness Absence 4.19% 4.45% 4.43% 4.86% 4.52% 5.19% 5.12% 4.87% 4.75% 4.83% 4.37% 4.06% 3.98% 3.6% 3.6% 3.98% G Feb-20

Voluntary Staff Turnover - Headcount 6.91% 6.42% 6.66% 6.13% 6.78% 7.17% 7.38% 6.73% 7.46% 7.51% 7.32% 8.41% 7.96% 8% 8% 7.96% G Sep-19

Thirteen-month heatmap view



May – Month 2

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Caring for Patients

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Serious Incidents 1 0 0 0 0 1 0 0 1 0 0 0 1 0 0 1 R Apr-18

Never Events 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 G Apr-18

Total Patient Falls 11 16 10 8 12 17 5 18 19 9 9 3 7 10 20 10 G Mar-19

RJAH Acquired Pressure Ulcers -

Grades 3 or 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 G Apr-18

Patient Friends & Family - % Would

Recommend (Inpatients & Outpatients) 98.52% 99.28% 98.9% 99.21% 99% 99.07% 98.63% 98.4% 98.48% 98.55% 98.23% 99.22% 97.85% 95% G Apr-18

Number of Complaints 8 7 9 7 15 19 11 5 7 13 7 2 7 8 16 9 G May-18

% Delayed Discharge Rate 3.6% 4.63% 6.82% 4.75% 5.61% 5.98% 6.67% 6.78% 4.76% 4.01% 7.7% 7.23% 2.16% 2.5% 2.5% 4.73% R Nov-19

Mixed Sex Accommodation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 G Jun-19

RJAH Acquired E. Coli Bacteraemia 2 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 G Jun-19

RJAH Acquired C.Difficile 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 G Apr-18

RJAH Acquired MRSA Bacteraemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 G Apr-18

Unexpected Deaths 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 G Apr-18

VTE Assessments Undertaken 99.83% 99.73% 99.92% 100% 99.76% 99.85% 99.85% 100% 100% 100% 99.88% 100% 100% 95% 95% 100% G Apr-18

Cancer Two Week Wait* 100% 100% 96.77% 100% 100% 100% 100% 100% 100% 100% 100% 100% 93% 100% G Feb-20

31 Days First Treatment (Tumour)* 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 96% 100% G Nov-19

31 Days Subsequent Treatment

(Tumour)* 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 100% G Nov-19

Cancer Plan 62 Days Standard

(Tumour)* 100% 100% 100% 100% 80% 100% 0% 100% 100% 100% 100% 85.71% 85% 85.71% G



May – Month 2

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Cancer 62 Days Consultant Upgrade* 100% 100% 100% 100% 100% 80% 100% 100% 25% 100% 100% 100% 85% 100% G Feb-20

28 Day Faster Diagnosis Standard* 81.8% 93.8% 83.9% 92.3% 70% 85% 91.2% 94.1% 82.4% 91.3% 91.3% 72.22% 75% 72.22% G

18 Weeks RTT Open Pathways 91.4% 90.61% 89.9% 88.69% 88.54% 88.01% 88.1% 88.3% 88.15% 87.08% 85.27% 78.77% 67.3% 92% 92% 72.94% R

Patients Waiting Over 52 Weeks – English 0 0 0 0 0 0 0 0 0 0 0 12 33 0 R Nov-19

Patients Waiting Over 52 Weeks – Welsh 0 1 0 0 0 0 0 0 0 1 3 15 40 0 R Nov-19

Patients Waiting Over 52 Weeks – Welsh (BCU Transfers) 6 18 86 128 164 172 167 126 81 106 137 169 203 G Nov-19

6 Week Wait for Diagnostics - English

Patients 97.21% 98.35% 98.55% 98.85% 98.99% 99.87% 99.87% 98.09% 98.8% 98.6% 90.2% 22.38% 20.24% 99% 99% 21.24% R

8 Week Wait for Diagnostics - Welsh

Patients 99.72% 100% 100% 100% 98.87% 100% 99.78% 99.32% 99.75% 99.52% 90.57% 41.65% 21.04% 100% 100% 30.95% R



May – Month 2

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Caring for Finances

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Total Theatre Activity 970 886 930 921 1,044 1,078 1,064 827 1,042 940 639 134 194 905 1,801 328 R Sep-19

Bed Occupancy – All Wards – 2pm 81.46% 82.49% 83.07% 81.03% 85.43% 85.06% 86.26% 88.31% 85.88% 89.53% 80.53% 74.31% 71.13% 87% 87% 72.66% R Sep-19

Outpatients Activity Attendances 13,734 12,972 14,238 12,848 14,144 13,062 12,129 10,253 13,249 11,850 9,576 5,297 4,237 13,879 27,758 9,534 R Sep-19

Financial Control Total 31 -207 73 -288 357 611 379 -457 794 560 1,107 0 0 0 0 0 G

Income 9,508 8,842 9,486 8,837 9,583 10,256 10,064 8,595 10,415 9,792 10,633 8,690 8,848 9,492 18,983 17,538 G

Expenditure 9,521 9,092 9,457 9,168 9,270 9,688 9,731 9,095 9,670 9,275 9,564 8,827 8,799 9,585 19,169 17,626 G

Efficiencies Delivery 193 241 246 303 302 270 321 301 230 356 303 44 59 0 0 103 G

Agency Core 68 44 65 77 93 125 107 94 103 133 119 50 27 132 264 77 G

Agency Non-Core 239 221 231 254 252 314 334 229 291 370 208 9 0 167 334 9 G

Cash Balance 4,861 5,013 9,051 5,457 4,387 5,450 5,708 5,822 5,467 6,781 8,250 15,380 17,150 6,000 6,000 17,150 G

Capital Expenditure 336 162 458 588 119 179 546 158 836 234 2,451 72 167 83 136 239 G

Use of Resources (UOR) 3 3 3 3 3 3 3 2 2 2 1 1 1 1 1 1 G

Proportion of Temporary Staff 5.48% 4.81% 5.3% 5.94% 6.14% 7.68% 7.58% 5.72% 6.85% 9.01% 5.8% 1.06% 0% 0.05% 5.34% 0.76% G



May – Month 2

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Sickness AbsenceFTE days lost as a percentage of FTE days available in month

3.98% against 3.6% target

Breaching target red rated

Exec Lead:

Director of People


NarrativeSickness absence rated is reported at 3.98% in May and remains above tolerance. Short term absence was below tolerance at

1.03% following a reduction in short term absences. Long term absence increased in month and remained above tolerance at

2.95%

Anxiety/stress/depression was the highest individual reason for absence again in May, accounting for 1.2% of the absence rate.

MSK delivery unit continues to be above tolerance for both long and short term absences, reporting an overall absence rate of

6.31% in month, noting an increase in long term absences. The highest individual reason for short term absence in the MSK unit

was confirmed Covid-19 cases. The highest individual reason for long term absence was anxiety/stress/depression. Absence

within Theatre scrub accounting for 20% of all absences in MSK Delivery Unit in May.

The rate includes any staff who were absent following a positive Covid-19 test result. It does not include any staff who were

absent due to self-isolation, as this is reported separately as Special Leave. Covid-19 absence was 0.38% in month.

Performance over 24 months – SPC

SPC Alert - 7 or more consecutive points above or below the mean indciates a step change.

Trajectory ActionsAction to Improve: People Business Partners reviewing long-term sickness absence to ensure ongoing communication and

appropriate support.

May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May YTD

3.41% 3.4% 4.11% 3.57% 3.95% 4.39% 4.07% 4.29% 4.43% 4.58% 4.33% 4.59% 4.19% 4.45% 4.43% 4.86% 4.52% 5.19% 5.12% 4.87% 4.75% 4.83% 4.37% 4.06% 3.98% 3.98%

Heatmap performance over 24 months



May – Month 2

29

Voluntary Staff Turnover - HeadcountTotal numbers of voluntary leavers in the last 12 months as a percentage of the total employed

7.96% against 8% target

Within target green rated

Exec Lead:

Director of People


NarrativeThe voluntary staff turnover has reduced and is reported within tolerance at 7.96%. Top 3 reasons for voluntary turnover were

age retirement, work-life balance and other/not known. MSK Delivery Unit saw a further increase in voluntary turnover and is

reported at 10.07%.



Trajectory Actions


9.56% 8.71% 8.78% 8.07% 8.14% 8.02% 8% 8.18% 7.94% 7.95% 7.37% 7.05% 6.91% 6.42% 6.66% 6.13% 6.78% 7.17% 7.38% 6.73% 7.46% 7.51% 7.32% 8.41% 7.96% 7.96%




May – Month 2

30

Serious IncidentsNumber of Serious Incidents reported in month

1 against 0 target


Exec Lead:

Director of Nursing


NarrativeThere was one serious incident reporting in May relating to transmission of covid-19 on one of the wards where a mini outbreak

occurred. The incident was managed in accordance with outbreak policies and all correct procedures were followed.

Performance over 24 months –

Trajectory ActionsAction to Improve: A full investigation is underway to review this incident.


2 0 0 1 1 1 1 1 0 0 2 1 1 0 0 0 0 1 0 0 1 0 0 0 1 1




May – Month 2

31

Never EventsNumber of Never Events Reported in Month

0 against 0 target

On target green rated

Exec Lead:

Director of Nursing


NarrativeThere were no never events reported in May.


Trajectory Actions


0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0




May – Month 2

32

Total Patient FallsTotal number of falls - excludes slips, trips and assisted slides

7 against 10 target


Exec Lead:

Director of Nursing


NarrativeThe Total Patient Falls KPI is green rated in May as there were seven falls, all relating to inpatients. The falls are broken down as

follows:

- No harm (1) 14.29%

- Low harm (6) 85.71%, made up of - all unwitnessed but with no obvious injury

The falls occurred within the following wards/areas:

- Inpatient falls: Sheldon (2), Powys (2), Kenyon (2), Theatres (1).


Trajectory ActionsAction to Sustain: The Quality Priorities for 2020/2021 have been set, of which Falls is one of them.


9 10 13 10 15 20 13 16 11 10 8 5 11 16 10 8 12 17 5 18 19 9 9 3 7 10




May – Month 2

33

RJAH Acquired Pressure Ulcers - Grades 3 or 4Total number of category 3 & 4 pressure ulcers acquired at RJAH

0 against 0 target


Exec Lead:

Director of Nursing


NarrativeThere were no category three or four pressure ulcers in May.


Trajectory ActionsAction to Sustain: The Quality Priorities for 2020/2021 have been set, of which Pressure Ulcers is one of them.


0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




May – Month 2

34

Patient Friends & Family - % Would Recommend

(Inpatients & Outpatients)% of patients who would recommend the trust (inpatients and outpatients)


Above target green rated

Exec Lead:

Director of Nursing


NarrativeThere were 93 responses collected with a breakdown as follows:

- 91 positive - giving a rate of 97.85% would recommend the Trust to friends and family

- 2 negative - giving a rate of 2.15% would not recommend the Trust to friends and family

The number of compliments received in May was 68.

Although national reporting for this measure is currently suspended we have taken the decision to continue reporting internally,

this will support the safe and efficient care of our patients.


Trajectory Actions

May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

99.08% 99.49% 99.23% 100% 99.45% 99.01% 99.29% 99.06% 99.18% 98.84% 98.84% 98.44% 98.52% 99.28% 98.9% 99.21% 99% 99.07% 98.63% 98.4% 98.48% 98.55% 98.23% 99.22% 97.85%




May – Month 2

35

Number of ComplaintsNumber of complaints received in month

7 against 8 target


Exec Lead:

Director of Nursing


NarrativeThere were seven complaints received in May. Five complaints related to quality with reasons associated with care received (2),

scans performed (1), consultant attitude (1) and outcome of appointment (1). There were operational complaints relating to

issues surrounding CCG fading forms (1) and current delays to elective surgery (1).


Trajectory Actions


9 11 2 7 12 13 6 7 6 17 8 5 8 7 9 7 15 19 11 5 7 13 7 2 7 9




May – Month 2

36

% Delayed Discharge RateThe total number of delayed days against the total available bed days for the month in %

2.16% against 2.5% target


Exec Lead:

Director of Nursing


NarrativeThe Delayed Discharge rate is green rated this month at 2.16%. The total delayed days for May is 75 days with a breakdown as

follows:

- 4 spinal injuries patients amounting to 53 days - attributed to 1 patient from each organisation; Coventry, Solihull,

Warwickshire, Wales

- 2 care of the elderly patients with 22 delayed days - both attributed to Shropshire

In response to covid there was a requirement for timely discharge processes. Effective system working has enabled the

discharge of our patients and reduced delays. There has been a change to funding with the aim of discharging patients out of

an acute setting. This has contributed to the reduction in delays for spinal injuries patients as they have been able to be

discharged to step-down beds.




Trajectory ActionsAction to Sustain: The Quality Priorities for 2020/2021 have been set, of which Delayed Transfers of Care is one of them. As

part of the action plan we will assess where improvements have been made during the covid pandemic to assess if these

processes can be sustained.


4.12% 4.99% 4.42% 3.27% 5.57% 6.1% 7.53% 8.17% 4.02% 6.05% 6.72% 7% 3.6% 4.63% 6.82% 4.75% 5.61% 5.98% 6.67% 6.78% 4.76% 4.01% 7.7% 7.23% 2.16% 4.73%




May – Month 2

37

Mixed Sex AccommodationNumber of breaches to the mixed sex accommodation standard for non clinical reasons

0 against 0 target


Exec Lead:

Director of Nursing


NarrativeThere were no breaches of the mixed sex accommodation standard in May.




Trajectory Actions


0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




May – Month 2

38

RJAH Acquired E. Coli BacteraemiaNumber of cases of E. Coli Bacteraemia in Month.

0 against 0 target


Exec Lead:

Director of Nursing


NarrativeThere were no incidents reported in May.


Trajectory Actions


1 0 1 0 1 0 1 0 0 0 0 0 2 0 1 0 1 1 1 1 1 0 0 0 0 0




May – Month 2

39

RJAH Acquired C.DifficileNumber of cases of C.Difficile in Month

0 against 0 target


Exec Lead:

Director of Nursing




Trajectory Actions


0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




May – Month 2

40

RJAH Acquired MRSA BacteraemiaNumber of cases of MRSA bacteraemia in month

0 against 0 target


Exec Lead:

Director of Nursing




Trajectory Actions


0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0




May – Month 2

41

Unexpected DeathsNumber of Unexpected Deaths in Month

0 against 0 target


Exec Lead:

Medical Director


NarrativeThis indicator relates to unexpected deaths, of which there were none to report in May. There was one covid related death that

occurred in May.


Trajectory Actions


0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0




May – Month 2

42

VTE Assessments Undertaken% of adult admissions in the month who have been risk assessed for VTE

100% against 95% target


Exec Lead:

Medical Director


NarrativeThe percentage of admissions risk assessed is reported at 100% in May and remains above the 95% target.




Trajectory Actions


100% 99.92% 99.7% 100% 99.92% 99.71% 99.86% 99.91% 100% 99.84% 99.92% 99.91% 99.83% 99.73% 99.92% 100% 99.76% 99.85% 99.85% 100% 100% 100% 99.88% 100% 100% 100%




May – Month 2

43

Cancer Two Week Wait*% of urgent cancer referrals seen within 2 weeks (*Reported one month in arrears)


green rated

Exec Lead:

Clinical Services Unit


NarrativeThe Cancer 2 week wait standard was achieved in April and indicative data for May shows achievement of the standard will

continue.



Trajectory Actions


100% 100% 96.88% 100% 100% 100% 100% 100% 100% 92.86% 100% 100% 100% 100% 96.77% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%




May – Month 2

44

31 Days First Treatment (Tumour)*% of cancer patients treated within 31 days of decision to treat (*Reported one month in arrears)


green rated

Exec Lead:



NarrativeThe Cancer 31 day first treatment standard was achieved in April and indicative data for May shows achievement of the standard

will continue.


Trajectory Actions


100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%




May – Month 2

45

31 Days Subsequent Treatment (Tumour)*% of cancer patients subsequent treatment within 31 days of decision to treat (*Reported one month in arrears)


green rated

Exec Lead:



NarrativeThe Cancer 31 day subsequent treatment standard was achieved in April and indicative data for May shows achievement of the

standard will continue.


Trajectory Actions


100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%




May – Month 2

46

Cancer Plan 62 Days Standard (Tumour)*% of cancer patients treated within 62 days of referral (*Reported one month in arrears)


green rated

Exec Lead:



NarrativeThe Cancer 62 day standard was achieved in April and indicative data for May shows achievement of the standard will not be

met.



Trajectory Actions


100% 66.67% 50% 0% 0% 50% 100% 66.67% 50% 100% 100% 100% 100% 100% 100% 100% 80% 100% 0% 100% 100% 100% 100% 85.71% 85.71%




May – Month 2

47

Cancer 62 Days Consultant Upgrade*% of cancer patients treated within 62 days of date of upgrade (*Reported one month in arrears)


green rated

Exec Lead:



NarrativeThe Cancer 62 day consultant upgrade standard was achieved in April and indicative data for May shows achievement of the

standard will continue.


Trajectory Actions


100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 25% 100% 100% 100% 100%




May – Month 2

48

28 Day Faster Diagnosis Standard*% of patients informed of a diagnosis or ruling out of cancer within 28 days’


red rated

Exec Lead:



NarrativeThe 28 Day faster diagnosis standard is a new metric added last month whereby it reports the percentage of patients that have

been informed of either their diagnosis or ruling out of cancer within 28 days. Like the other cancer waiting times standards, this

one will be reported a month in arrears.

The standard is reported at 72.22% in April with a target of 75% operational from April. Indicative data for May shows

achievement of the standard will be met.


Trajectory ActionsAction to Improve: The pathways of those patients that were not diagnosed within 28 days are being reviewed to understand

the reasons why and if appropriate, derive appropriate actions.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May YTD

90.5% 81.8% 93.8% 83.9% 92.3% 70% 85% 91.2% 94.1% 82.4% 91.3% 91.3% 72.22% 72.22%




May – Month 2

49

18 Weeks RTT Open Pathways% of English patients on waiting list waiting 18 weeks or less


Below target red rated

Exec Lead:

MSK Unit


NarrativeOur May performance was 67.30% against the 92% open pathway performance for patients waiting 18 weeks or less to start

their treatment. The total number of breaches has increased by 934, rising from 1603 in April to 2537 at the end of May. The

performance breakdown by milestone is as follows: MS1 - 4622 patients waiting of which 705 are breaches, MS2 - 828 patients

are waiting of which 459 are breaches, MS3 - 2308 patients are waiting of which 1373 are breaches.

Our response to COVID-19 meant cancelling and deferring normal clinical activity, whilst continuing with critical and urgent

clinical cases.


Trajectory ActionsAction to Improve: The Trust is reviewing national guidance as this is published in how we manage patient pathways. As a

local system we have agreed to commence inpatient demand categorised as priority 2. This is a small volume of our current

waiting lists. The Trust is working with the system to assess capacity to commence further activity.


89.49% 89.98% 89.96% 89.6% 90.29% 90.66% 90.28% 90.04% 90.02% 90.47% 92.14% 92.01% 91.4% 90.61% 89.9% 88.69% 88.54% 88.01% 88.1% 88.3% 88.15% 87.08% 85.27% 78.77% 67.3% 72.94%




May – Month 2

50

Patients Waiting Over 52 Weeks – EnglishNumber of English RTT patients currently waiting 52 weeks or more

33 against 0 target


Exec Lead:

Specialist Services Unit


NarrativeAt the end of May there were 33 English patients waiting over 52 weeks. The patients are under the care of the following sub-

specialities; Arthroplasty (14), Spinal Disorders (13), Knee & Sports Injuries (2). Foot & Ankle (2) and Upper Limb (2).






1 0 1 1 0 2 2 4 2 4 0 0 0 0 0 0 0 0 0 0 0 0 0 12 33




May – Month 2

51

Patients Waiting Over 52 Weeks – WelshNumber of RJAH Welsh RTT patients currently waiting 52 weeks or more

40 against 0 target


Exec Lead:



NarrativeAt the end of May there were 40 Welsh patients waiting over 52 weeks. The patients are under the care of the following sub

specialties; Spinal Disorders (15), Arthroplasty (13), Foot & Ankle (5), Knee & Sports Injuries (5) and Upper Limb (2). The patients

are under the care of the following commissioners; BCU (33) and Powys (7).






2 2 9 8 6 3 6 7 3 6 1 0 0 1 0 0 0 0 0 0 0 1 3 15 40




May – Month 2

52

Patients Waiting Over 52 Weeks – Welsh (BCU

Transfers)Number of BCU transfer Welsh RTT patients currently waiting 52 weeks or more.

203 against N/A target

Exec Lead:

MSK Unit


NarrativeAt the end of May there were 203 Welsh patients waiting over 52 weeks who were transfers of care from BCU. No patients have

been transferred throughout May.


Trajectory Actions


126 128 121 124 87 54 72 66 52 26 0 1 6 18 86 128 164 172 167 126 81 106 137 169 203




May – Month 2

53

6 Week Wait for Diagnostics - English Patients% of English patients currently waiting less than 6 weeks for diagnostics



Exec Lead:



NarrativeThe 6 week standard for diagnostics was not achieved this month and is reported at 20.24%. This equates to 717 patients who

waited beyond 6 weeks.

The breaches occurred in the following modalities; MRI (419), ultrasound (167), CT (113) and DEXA (18) . MRI capacity is planned

to be increased during June 2020 with known capacity issues within this area.

From week commencing 16th March the Trust has seen the impact of COVID-19 and had to adjust the services delivered. All

requests for investigations are being triaged by a radiologist with non-urgent requests being postponed. Referrers are sent lists

of all postponed investigations. Postponements are being held on the waiting list and as predicted, the majority of patients

waiting for diagnostics continue to breach at the end of May.

Following the postponement of non-urgent requests the Trust has continued to review its waiting list impacts. This has meant a

resubmission of our March 2020 DM01 as part of ensuring all cancellations were correctly represented.


Trajectory Actions


99.53% 99.37% 98.59% 99.15% 99.16% 99.07% 98.7% 99.1% 98.91% 98.88% 97.64% 97.53% 97.21% 98.35% 98.55% 98.85% 98.99% 99.87% 99.87% 98.09% 98.8% 98.6% 90.2% 22.38% 20.24% 21.24%




May – Month 2

54

8 Week Wait for Diagnostics - Welsh Patients% of Welsh patients currently waiting less than 8 weeks for diagnostics



Exec Lead:



NarrativeThe 8 week standard for diagnostics was not achieved this month and is reported at 21.04%. This equates to 424 patients who

waited beyond 8 weeks. The breaches occurred in the following modalities MRI (327), CT (46), ultrasound (46) and DEXA (5).

MRI capacity is planned to be increased during June 2020 with known capacity issues within this area.

From week commencing 16th March the Trust has seen the impact of COVID-19 and had to adjust the services delivered. All

requests for investigations are being triaged by a radiologist with non-urgent requests being postponed. Referrers are sent lists

of all postponed investigations. Postponements are being held on the waiting list and as predicted, the majority of patients

waiting for diagnostics continue to breach at the end of May.

Following the postponement of non-urgent requests the Trust has continued to review its waiting list impacts. This has meant a

resubmission of our March 2020 DM01 as part of ensuring all cancellations were correctly represented.


Trajectory Actions


100% 99.76% 99.77% 99.67% 100% 99.24% 99.65% 99.64% 99.66% 98.72% 100% 98.76% 99.72% 100% 100% 100% 98.87% 100% 99.78% 99.32% 99.75% 99.52% 90.57% 41.65% 21.04% 30.95%




May – Month 2

55

Total Theatre ActivityActivity in theatres in month

194 against 905 target


Exec Lead:

MSK Unit


NarrativeCOVID-19 continued to impact the delivered activity throughout May 2020. All non-urgent elective activity and all inpatient

dental work at RJAH ceased from Friday 20th March. Tumour and emergency spinal surgery continues as an exception, and a

judgement on all other urgent surgery is made on a case-by-case basis.

For all areas the Trust delivered 194 (21%) of the 905 plan, broken down as follows:

- T&O - 16

- Trauma - 170

- Tumour - 8

- MCSI - 0


Trajectory ActionsAction to Improve: For May 2020 restoration and recovery discussions were ongoing within the System. Agreement was made

for the Trust to commence priority 2 activity was made within the system. This was to commence week beginning the 8th

June. These are small volumes of elective activity.

The Trust is working with the system following agreement that Trauma would return to SaTH August/September 2020. These

discussions are ongoing and impacts to activity are being modelled. This would enable the Trust to commence further elective

activity.


1,004 1,023 1,053 929 1,017 1,115 1,157 883 1,094 1,024 1,082 856 970 886 930 921 1,044 1,078 1,064 827 1,042 940 639 134 194 328




May – Month 2

56

Bed Occupancy – All Wards – 2pm% Bed occupancy at 2pm


Within target red rated

Exec Lead:



NarrativeThe occupancy rate for all wards is red rated this month at 71.13%. The breakdown below gives the May occupancy per ward

along with details on bed base and it's current use:

Trauma/Urgent Elective Work:

- Clwyd - 84.89% - usually 28 beds; open to 14/16 beds at start of May, increased to 20 beds by end of May

- Powys - 83.74% - usually 28 beds; open to 14 beds for majority of the month

- Kenyon - 66.80% - open to usual 16 beds throughout May

- Alice 44.83% - open to low numbers of patients in late May but primarily closed - 16 beds

- Ludlow 21.79% - usually 16 beds; start of May open to 14 beds, second half of month reduced to 8 beds open - ward used for

suspected/confirmed covid patients

- Oswald - ward of 10 beds fully closed throughout May

MCSI/Sheldon

- Gladstone 65.25% - open to 25 of usual 29 beds with 4 beds used as an isolation area

- Wrekin 70.19% - open to usual 15 beds

- Sheldon 90.04% - open to 15 of usual 23 beds


Trajectory Actions


82.52% 85.73% 83.78% 86.61% 89.08% 85.94% 84.03% 84.83% 86.78% 87.62% 85.32% 81.44% 81.46% 82.49% 83.07% 81.03% 85.43% 85.06% 86.26% 88.31% 85.88% 89.53% 80.53% 74.31% 71.13% 72.66%




May – Month 2

57

Outpatients Activity AttendancesNumber of attendances seen in Outpatients clinic – excludes SOOS, MCSI and NCG as they are block contracts

4,237 against 13,879 target


Exec Lead:

Support Services Unit


NarrativeThe number of attendances was behind plan in month 2 with 4237 attendances seen against a plan of 13879. 416 of the

attendances were classed as fracture clinics which is part of the Trauma work that has transferred to the Trust during this period.



Trajectory ActionsAction to Improve: The Trust capacity for delivering outpatient activity has been reduced following application of infection,

prevention and control measures e.g. social distancing. The Trust is reviewing the estate capacity available to see patients

requiring face-to-face activity. Wherever possible the Trust is reviewing patients virtually.

System discussions are ongoing to review the fracture and trauma outpatient activity currently being undertaken at RJAH.


13,662 13,609 13,631 12,885 13,792 15,939 15,298 11,440 14,995 13,616 13,718 13,677 13,734 12,972 14,238 12,848 14,144 13,062 12,129 10,253 13,249 11,850 9,576 5,297 4,237 9,534




May – Month 2

58

Financial Control TotalSurplus/deficit adjusted for donations and excluding STF funding

0 against 0 target


Exec Lead:

Director of Finance


NarrativeBreakeven requires retrospective top up of £93k. Covid expenditure amounted to £237k - £138k decrease from M1.


Trajectory Actions


7 235 279 -190 152 676 621 -833 359 59 535 -775 31 -207 73 -288 357 611 379 -457 794 560 1,107 0 0 0




May – Month 2

59

IncomeAll Trust Income, Clinical and non clinical



Exec Lead:

Director of Finance


NarrativeIncome £829k adverse, predominantly driven by commercial shortfalls


Trajectory Actions


8,958 9,378 9,559 9,080 9,194 10,357 10,004 8,048 9,583 9,049 10,278 8,677 9,508 8,842 9,486 8,837 9,583 10,256 10,064 8,595 10,415 9,792 10,633 8,690 8,848 17,538




May – Month 2

60

ExpenditureAll Trust expenditure including Finance Costs



Exec Lead:

Director of Finance


Narrative

Plan budgetary variances:

Pay £220k adverse (driven by Covid)

Non pay £1,050k favourable (driven by activity volumes)

Underlying cost base reduced by £973k compared to winter 2019 (basis for plan).


Trajectory Actions


8,959 9,129 9,165 9,264 9,038 9,734 9,416 8,648 9,189 9,031 9,464 9,495 9,521 9,092 9,457 9,168 9,270 9,688 9,731 9,095 9,670 9,275 9,564 8,827 8,799 17,626




May – Month 2

61

Efficiencies DeliveryCost Improvement Programme requirement

59 against 0 target


Exec Lead:

Director of Finance


NarrativeEfficiency requirement postponed nationally as part of funding arrangements for M1-4.

Internal performance of £59k - predominantly full year effect

Note: target efficiency subject to revised planning guidance


Trajectory Actions


288 356 249 310 298 327 311 329 284 307 358 166 193 241 246 303 302 270 321 301 230 356 303 44 59 103




May – Month 2

62

Agency CoreAnnual ceiling for total agency spend introduced by NHS Improvement - Core Agency only



Exec Lead:

Director of Finance


NarrativeCore Agency favourable £105k



Trajectory Actions


167 158.27 186.24 122.05 112.7 171.62 141.07 105.5 90.56 45.75 68.59 51 68 44 65 77 93 125 107 94 103 133 119 50 27 77




May – Month 2

63

Agency Non-CoreAnnual ceiling for total agency spend introduced by NHS Improvement - Non Core Agency



Exec Lead:

Director of Finance


NarrativeNo non core agency used in month


Trajectory Actions


207.73 248.74 246.63 296.21 243.2 302.08 233.41 234.72 243.13 243.43 317.48 229 239 221 231 254 252 314 334 229 291 370 208 9 0 9




May – Month 2

64

Cash BalanceCash in bank



Exec Lead:

Director of Finance


NarrativeCash balance of £17m, which includes the following payments in advance:

- £6.0m English block income

- £2.4m of Covid top up funding

Underlying cash balance £8.8m


Trajectory Actions


4,773 4,200 6,300 6,200 5,400 5,000 4,200 3,900 4,700 4,300 5,700 5,094 4,861 5,013 9,051 5,457 4,387 5,450 5,708 5,822 5,467 6,781 8,250 15,380 17,150 17,150




May – Month 2

65

Capital ExpenditureExpenditure against Trust capital programme


Breaching target green rated

Exec Lead:

Director of Finance


NarrativeMRI replacement scheme project ahead of plan


Trajectory Actions


264 346 205 164 297 160 377 400 304 165 1,327 260 336 162 458 588 119 179 546 158 836 234 2,451 72 167 239




May – Month 2

66

Use of Resources (UOR)Overall Use of Resources indicator

1 against 1 target


Exec Lead:

Director of Finance


Narrative Performance over 24 months –

Trajectory Actions


3 3 2 3 2 2 2 2 2 2 1 3 3 3 3 3 3 3 3 2 2 2 1 1 1 1




May – Month 2

67

Proportion of Temporary StaffAgency staff costs as a proportion of total staff costs.

0% against 0.05% target


Exec Lead:

Director of Finance


NarrativeReduction in flexible staffing requirements due to Covid



Trajectory Actions

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May YTD

4.88% 5.48% 4.81% 5.3% 5.94% 6.14% 7.68% 7.58% 5.72% 6.85% 9.01% 5.8% 1.06% 0% 0.76%




May – Month 2

68



May – Month 2

69

Reading guideThe Integrated Performance Report (IPR) is designed to provide the Board with a monthly balanced summary of the Trust ’s performance across the three areas of the Trust’s mission: caring for patients,

caring for staff and caring for finances. To achieve this, the Trust has identified the Board-level Key Performance Indicators (KPIs), which are considered to drive the overall performance of the Trust. The

report highlights key areas of improvement or concern enabling the Board to identify those areas that require the most consideration. As such, this report is not designed to replace the need for more

detailed reporting on key areas of performance, and therefore detailed reporting will be provided to the Board and its committees to accompany the IPR where requested by the Board, its committees

or the Executive Team. Contents of the report include:

HeatmapsIn month, year-to-date and forecast performance against target for each KPI and rolling 13-month performance information. A data quality indicator for each KPI is also included where available.

NarrativeSupporting narrative and trend graphs (with statistical process control where appropriate) are provided for each KPI including mitigating actions for red rated indicators.

Key

Key Performance Indicator RAG Ratings Trend graphs

Each KPI has a trend graph (or Statistical Process Control

(SPC) where appropriate), which summarises

performance over a rolling 24-month period.

Green

Red

Forecast: Little risk of missing target at year end

YTD: Performance meets or exceeds target

Forecast: High risk of missing target at year end

YTD: Performance behind target and outside tolerance

KPIs reported in arrears

KPIs reported in arrears, for which no current-month values are available, are marked with an

asterisk (*) next to their name. The latest values for these KPIs are from the previous reporting

month.

Data Quality Indicator

The data quality rating for each KPI is included within the 'heatmap' section of this report. The

indicator score is based on audits undertaken by the Data Quality Team and will be further

validated as part of the audit assurance programme.

No improvement required to comply with the dimensions of data qualityBlue

Green Satisfactory – minor issues only

Amber Requires improvement

Red Significant improvement required

Where available, three-month trajectory data is included

to indicate expected future performance. Historical

trajectory data will be kept to compare actual

performance with forecast performance.

Trajectories

Bullet graphs provide a clear visualisation to understand

how well a KPI is performing against its target.

Bullet graphs



May – Month 2

70

2228

*Pre covid plan - this will be superseded by new planning.

Finance Dashboard 31st May 2020Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Statement of Financial Position £'000s

Category Apr-20 May-20 Movement Drivers

Fixed Assets 75,783 75,643 (140) Additions less depreciation

Non current receivables 1,266 1,259 (7)

Total Non Current Assets 77,049 76,902 (147)

Inventories (Stocks) 1,393 1,384 (9)

Receivables (Debtors) 5,708 4,312 (1,396)19/20 PSF & Covid reimbursement received,

reduction in commercial recievables due to no activity.

Cash at Bank and in hand 15,377 17,149 1,772 19/20 PSF & Covid reimbursement received.

Total Current Assets 22,478 22,845 367

Payables (Creditors) (17,232) (17,487) (255)

Borrowings (1,199) (1,208) (9)

Current Provisions (216) (216) 0

Total Current Liabilities (< 1 year) (18,647) (18,911) (264)

Total Assets less Current Liabilities 80,880 80,836 (44)

Non Current Borrowings (4,708) (4,708) 0

Non Current Provisions (883) (883) 0

Non Current Liabilities (> 1 year) (5,591) (5,591) 0

Total Assets Employed 75,289 75,245 (44)

Public Dividend Capital (35,467) (35,467) 0

Revenue Position (17,703) (17,703) 0

Retained Earnings 44 88 44 Operational deficit before control total adjustments

Revaluation Reserve (22,163) (22,163) 0

Total Taxpayers Equity (75,289) (75,245) 44

May-20 YTD

Debtor Days 26 25

Creditor Days 36 35

Plan Actual Variance Plan Actual Variance

Clinical Income 104,488 8,414 8,240 (174) 16,828 16,397 (431)

Covid Top Up 0 93 186 93 186 323 137

Private Patient income 5,510 455 0 (455) 910 0 (910)

Other income 6,892 622 330 (293) 1,244 819 (425)

Pay (66,899) (5,592) (5,818) (226) (11,185) (11,383) (198)

Non-pay (43,963) (3,572) (2,517) 1,055 (7,142) (5,316) 1,826

EBITDA 6,028 420 420 0 841 840 (1)

Finance Costs (5,618) (420) (464) (44) (841) (928) (87)

Capital Donations 3,825 0 0 0 0 0 0

Operational Surplus 4,235 (0) (44) (44) 0 (88) (88)

Remove Capital Donations (3,825) 0 0 0 0 0 0

Add Back Donated Dep'n 359 0 44 44 0 88 88

Control Total* 769 (0) 0 0 0 0 0

EBITDA margin 5.2% 4.4% 4.9% 0.5% 4.4% 4.9% 0.4%

Income and Expenditure £'000s

CategoryAnnual

Plan

In Month Position Year To Date Position

Capital service 1 I&E Margin 1

Liquidity (days) 1 Variance in I&E Margin 1

Agency 1

1Overall UOR

(£200)

£0

£200

£400

£600

£800

£1,000

£1,200

£1,400

Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

S

u

r

p

l

i

u

s

/

(

D

e

f

i

c

i

t)

Period

Monthly Surplus/Deficit

Plan

Actual

Note: Current assumption is English block contract payments in advance continue until the end of the 2021

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

20.00


C

a

s

h

£

M


Plan £M 6.25 6.00 6.38 6.84 6.30 6.17 6.69 7.04 6.84 7.12 5.92 5.81

Actual £M 15.38 17.15

Forecast £M 17.15 17.85 18.52 18.00 17.77 17.89 17.59 17.12 16.92 14.43 5.81

Cash Flow

71

RAG of Total Schemes Being Tracked

0%

575 17%

478 14%

2,328 69%

3,381 100%

Year To Date Commissioner Income against Plan £m

Ca

pit

al

Co

mm

issio

ne

r P

erf

orm

an

ce

In Month Efficiencies Achievement £000's Year To Date Efficiencies Achievement £000's

Eff

icie

ncie

s b

y T

he

me

Eff

icie

ncie

s b

y U

nit

Year to date capital programme £000's

Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustFinance Dashboard 31st May 2020

Efficiencies

In Month Efficiencies Achievement £000's Year To Date Efficiencies Achievement £000's Trust YTD Achievement Against YTD Plan £000's

0 5 10 15 20 25 30 35

Unit

FYE 19/20

Local Strategic

National Strategic

May Plan May Actual

0

20

40

60

80

100

120

YTD Plan YTD Actual

0 10 20 30 40 50 60

Unit

FYE 19/20

Local Strategic

National Strategic

YTD Plan YTD Actual

0 5 10 15 20 25

CSU

MSK

OOA

SPEC

SSU

May Plan May Actual

0 10 20 30 40 50

CSU

MSK

OOA

SPEC

SSU

YTD Plan YTD Actual

- 1.00 2.00 3.00 4.00 5.00 6.00

Shropshire

Telford

BCU

NHS England (Specialist)

Other English Contracted

Powys

Cheshire

Unsold Activity

Other

YTD actual YTD plan

Position as at 2021-02

Project

Annual

Plan

£000s

YTD Plan

£000s

YTD

Completed

£000s

YTD

Variance

£000s

Diagnostic equipment replacement 1,545 45 127 -82

EPR planning & implementation 200 0 0 0

Backlog maintenance 500 10 10 0

I/T investment & replacement 300 0 -4 4

Equipment & service continuity 600 0 -1 1

Project management 100 16 0 16

Invest-to-save schemes 200 0 0 0

Contingency 410 0 0 0

Scheme slippage from 19/20 135 60 57 3

Salix energy improvements 1,210 5 14 -9

E-job planning 86 0 0 0

Covid-19 0 0 36 -36

NHS Capital Funding 5,286 136 239 -103

Veteran's facility 3,000 0 0 0

Donated medical equipment 100 0 0 0

Total Capital Funding (NHS & Donated) 8,386 136 239 -103

Capital Programme 2020-

72

Documents

Month 2 Integrated Performance Report - RJAH