Month 6 Integrated Performance Report

Month 6 Integrated Performance Report

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0. Reference Information

Author: Claire Jones, Principal Analyst and Data Quality Lead

Paper date: 29/10/2020

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 6 (September) 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 three of the response to covid-19 which covers the period August to March which is the period of recovering service levels. Although in phase 3, planning submissions for this phase are due for submission end of September, following which trajectories will be updated within the Trust IPR.

The standard targets within the IPR are either regulatory standards that stood pre-covid or where not regulatory standards are the draft 20/21 plan. 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. Trauma repatriated on the 24th August, from which time RJAH is restoring its services in line with the phase three planning submission which can be observed in a number of the KPI’s. Following the phase 3 submission the IPR is now being updated to reflect such through the use of trajectories on individual measures to enable the national regulatory target to remain as the standard but the trajectory be the submitted phase 3 plan. As a significant reporting change not all KPI’s have yet been updated to reflect the above, but will have for October reporting.

Month 6 Integrated Performance Report

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2.2. Summary 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 below the 3.60% target at 2.79%. Voluntary staff turnover remains above the 8% target for a third consecutive month; reported

at 8.34%.

Caring for Patients;

No serious incidents reported in September. Three falls reported throughout September; all low harm. Decrease reported for delayed discharges in September with 68 delayed days equating to a

rate of 1.80%; one of the lowest rates reported in the last 24 months. One RJAH acquired infection reported this month where a patient acquired E.Coli

Bacteraemia. Complaints remain within tolerance with four received in September and response rate

meeting the 100% target. All six cancer waits standards met in August (reported in arrears). Our English RTT open pathways performance is reported at 49.13% a c.6% increase on the

prior month following the restoration of elective activity. It should be noted that the September month end figure is reported at 10,567 the highest figure reported in the last two years.

Patients waiting 52 weeks continues to grow with 306 English patients and 301 Welsh patients, our Welsh transfer of care after 52 weeks patients has begun to reduce, with no further transfers accepted and patients being treated.

Both diagnostics standards (English and Welsh) did not achieve their respective targets but showing vast improvement of between 30-40% on the prior month reporting levels.

Our overdue follow up patient backlog remains above target, however a reduction of 1,423 patients between August and September gave an improving position.

Caring for Finances; As part of the Trust’s restoration activity levels increased throughout September in line with

current capacity. 503 theatre cases carried out throughout September, more than the submitted phase 3 plan. 9,068 attendances were seen throughout the month with 36% delivered by telephone/virtual

clinics. All financial measures green rated, with exception of Income.

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.

Integrated Performance ReportSeptember 2020 – Month 6

ContentsSummary 3

HeatmapsCaring for Staff 4

Caring for Patients 5

Caring for Finances 7

NarrativeCaring for Staff 8

Caring for Patients 10

Caring for Finances 34

Reading guide End

Integrated Performance Report 2

Integrated Performance ReportSeptember – Month 6



Caring for Staff

Sep

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Oct

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Sickness Absence 4.52% 5.19% 5.12% 4.87% 4.75% 4.83% 4.37% 4.06% 3.98% 2.82% 2.77% 2.61% 2.79% 3.6% 3.6% 3.16% G Feb-20

Voluntary Staff Turnover - Headcount 6.78% 7.17% 7.38% 6.73% 7.46% 7.51% 7.32% 8.41% 7.96% 7.99% 8.14% 8.24% 8.34% 8% 8% 8.34% G Sep-19

Thirteen-month heatmap view



Caring for Patients

Sep

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Serious Incidents 0 1 0 0 1 0 0 0 1 0 2 0 0 0 0 3 R Apr-18

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

Total Patient Falls 12 17 5 18 19 9 9 3 7 6 13 6 3 10 60 38 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) 99% 99.07% 98.63% 98.4% 98.48% 98.55% 98.23% 99.22% 97.85% 97.44% 97% 97.79% 97.26% 95% G Apr-18

Number of Complaints 15 19 11 5 7 13 7 2 7 5 3 2 4 8 48 23 G May-18

% Delayed Discharge Rate 5.61% 5.98% 6.67% 6.78% 4.76% 4.01% 7.7% 7.23% 2.16% 2.31% 1.39% 4.24% 1.8% 2.5% 2.5% 3.08% G 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 1 1 1 1 1 0 0 0 0 0 1 2 1 0 0 4 R 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 0 0 0 0 0 0 0 0 0 1 0 0 1 R Apr-18

VTE Assessments Undertaken 99.76% 99.85% 99.85% 100% 100% 100% 99.88% 100% 100% 100% 100% 99.75% 99.72% 95% 95% 99.88% G Apr-18

Cancer Two Week Wait* 100% 100% 100% 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)* 80% 100% 0% 100% 100% 100% 100% 85.71% 50% 100% 100% 100% 85% 84.21% G



Sep

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Oct

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Cancer 62 Days Consultant Upgrade* 100% 80% 100% 100% 25% 100% 100% 100% 66.67% 100% 71.43% 100% 85% 76.92% G Feb-20

28 Day Faster Diagnosis Standard* 70% 85% 91.2% 94.1% 82.4% 91.3% 91.3% 68.75% 90.91% 91.67% 89.47% 91.67% 75% 86.59% G

18 Weeks RTT Open Pathways 88.54% 88.01% 88.1% 88.3% 88.15% 87.08% 85.27% 78.77% 67.3% 50.6% 40.82% 42.93% 49.13% 92% 92% 53.67% R

Patients Waiting Over 52 Weeks – English 0 0 0 0 0 0 0 12 33 68 123 198 306 0 R Nov-19

Patients Waiting Over 52 Weeks – Welsh 0 0 0 0 0 1 3 15 40 77 135 199 301 0 R Nov-19

Patients Waiting Over 52 Weeks – Welsh (BCU Transfers) 164 172 167 126 81 106 137 169 203 226 243 243 234 R Nov-19

6 Week Wait for Diagnostics - English Patients 98.99% 99.87% 99.87% 98.09% 98.8% 98.6% 90.2% 22.38% 20.24% 26.36% 28.66% 39.56% 72.35% 99% 99% 33.97% R

8 Week Wait for Diagnostics - Welsh Patients 98.87% 100% 99.78% 99.32% 99.75% 99.52% 90.57% 41.65% 21.04% 21.2% 20.66% 36.73% 74.93% 100% 100% 33.07% R



Caring for Finances

Sep

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Total Theatre Activity 1,044 1,078 1,064 827 1,042 940 639 134 194 255 351 293 503 1,044 634 5,607 1,730 R Sep-19

Bed Occupancy – All Wards – 2pm 85.43% 85.06% 86.26% 88.31% 85.88% 89.53% 80.53% 74.31% 70.96% 71.57% 74.43% 72.33% 72.86% 87% 87% 72.75% R Sep-19

Outpatients Activity Attendances 14,144 13,062 12,129 10,253 13,249 11,850 9,576 5,340 4,696 6,475 7,432 6,556 9,068 15,249 89,150 39,567 R Sep-19

Financial Control Total 357 611 379 -457 794 560 1,107 0 0 0 0 0 0 0 0 0 G

Income 9,583 10,256 10,064 8,595 10,415 9,792 10,633 8,783 8,756 8,776 8,962 8,656 9,361 9,585 57,507 53,294 G

Expenditure 9,270 9,688 9,731 9,095 9,670 9,275 9,564 8,783 8,756 8,776 8,962 8,656 9,361 9,585 57,507 53,294 G

Efficiencies Delivery 302 270 321 301 230 356 303 46 57 61 155 152 200 0 0 671 G

Agency Core 93 125 107 94 103 133 119 50 27 23 29 27 30 132.25 793.5 186 G

Agency Non-Core 252 314 334 229 291 370 208 9 0 0 0 0 0 167 1,002 9 G

Cash Balance 4,387 5,450 5,708 5,822 5,467 6,781 8,250 15,380 17,150 17,270 18,140 18,880 18,850 6,170 6,170 18,850 G

Capital Expenditure 119 179 546 158 836 234 2,451 72 167 267 308 183 770 1,005 2,921 1,768 G

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

Proportion of Temporary Staff 6.14% 7.68% 7.58% 5.72% 6.85% 9.01% 5.8% 1.06% 0.46% 0.41% 0.51% 0.5% 0.54% 5.34% 5.34% 0.54% G



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

2.79% against 3.6% targetWithin target green rated

Exec Lead:Director of People

Integrated Performance Report

NarrativeSickness absence rate is reported at 2.79%. The total absence rate has increased, but remains below tolerance. All units experienced increases in short term absences, but this did not cause rates to exceed the tolerance.

Stress/anxiety/depression and other psychiatric illnesses were the highest individual reason for sickness absence in September, accounting for 0.82% of the overall absence rate and continued to predominantly occur as episodes of long term absence. 0.39% of absence due to stress/anxiety/depression occurred within our additional clinical services staff group (the grouping that includes our healthcare assistants and clinical support staff). It is also notable that the additional clinical services staff group had the highest % of absence, accounting for counted for 0.92% of the total absence %).

Performance over 24 months – SPCSPC Alert - 7 or more consecutive points above or below the mean indciates a step change.

Trajectory ActionsAction to Sustain: Implementation of the People Plan Actions agreed by People Committee to safeguard the wellbeing of our people.

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD3.95% 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% 2.82% 2.77% 2.61% 2.79% 3.16%

Heatmap performance over 24 months



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

8.34% against 8% targetBreaching target red rated

Exec Lead:Director of People


NarrativeThe voluntary staff turnover rate is reported above tolerance at 8.34%, which is a further increase. 14 voluntary leavers during September; 3 retirement and 11 voluntary resignations. Turnover above tolerance within MSK, CSU delivery units and A&S. Nursing turnover 11.82%, AHP turnover at 9.2%.


Trajectory ActionsAction to Improve: Operationalising local actions in accordance with are "We are the NHS": People Plan":- Design roles which make the greatest use of each person's skill and experience and fits with their needs and preferences;- Ensure that staff who are mid-career have a conversation with their line manager, HR, OH.

Active focus on learning and actions from exit process for nursing and AHPs

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD8.14% 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% 7.99% 8.14% 8.24% 8.34% 8.34%




Serious IncidentsNumber of Serious Incidents reported in month

0 against 0 targetOn target green rated

Exec Lead:Director of Nursing


NarrativeThere were no serious incidents reported in September.

Performance over 24 months –

Trajectory Actions

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD1 1 0 0 0 0 1 0 0 1 0 0 0 1 0 2 0 0 3




Never EventsNumber of Never Events Reported in Month




NarrativeThere were no never events reported in September.


Trajectory Actions





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

3 against 10 targetWithin target green rated



NarrativeThe Total Patient Falls KPI is green rated in September as there were three falls, two relating to inpatients and one relating to outpatients. The falls are broken down as follows:- Low harm (3) 100%, made up of - unwitnessed but with no obvious injury (1), unwitnessed with graze (1) and unwitnessed with pain (1)

The falls occurred within the following wards/areas: - Inpatient falls: Powys (1) and Clwyd (1) & Outpatient falls: Outpatients (1)

Performance over 24 months – SPC

Trajectory ActionsAction to Sustain: Falls was identified as one of our clinical priorities for further focus this financial year. Although this month sees a reduction in falls we are still mindful of incidents in recent months due to a change in casemix within the Trust.





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




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


Trajectory Actions





Patient Friends & Family - % Would Recommend (Inpatients & Outpatients)% of patients who would recommend the trust (inpatients and outpatients)

97.26% against 95% targetAbove target green rated



NarrativeThere were 840 responses collected with a breakdown as follows: - 817 positive - giving a rate of 97.26% would recommend the Trust to friends and family - 10 negative - giving a rate of 1.19% would not recommend the Trust to friends and family - 13 neutral responses

Some of the comments left by those giving a negative or neutral response related to poor communication, appointments running late and patients not feeling listened to.

The number of compliments received in September was 594.

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

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

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% 97.44% 97% 97.79% 97.26%




Number of ComplaintsNumber of complaints received in month




NarrativeThere were four complaints received in September. One complaint related to quality of care with issues surrounding change to medication. There were three complaints relating to operational issues with reasons related to unable to provide a surgery date after surgery cancelled (1), delay with appointment (1) and appointment cancelled (1).


Trajectory Actions





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




NarrativeThe Delayed Discharge rate is green rated this month at 1.80%. The total delayed days for September is 68 days with a breakdown as follows:- 4 spinal injuries patients amounting to 46 days - attributed to 2 patients from each organisation; Worcestershire, Wales- 2 care of the elderly patients with 15 delayed days - attributed to Shropshire - 2 T&O patients delayed 7 days - attributed to Shropshire There were 18 less patients delayed in September than in August, equating to 92 fewer days delayed. Following the cessation of SaTH trauma activity in August, only 2 of these delays were T&O patients.

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 ActionsAction to Sustain: There is a risk that the delayed discharge rate will increase in future months. The continuing health care assessments began to be used again from the 1st September. The Trust will ensure we are engaged with relevant local authorities to drive the process and escalate to commissioners where appropriate. A member of the senior nursing team will be preparing an action plan to support reduction of delays.

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD5.57% 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% 2.31% 1.39% 4.24% 1.8% 3.08%




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




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



Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD0 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




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

1 against 0 targetBreaching target red rated



NarrativeThere was one case of hospital acquired E.Coli Bacteraemia during September. A post infection review was undertaken and the source of the bloodstream infection was unknown. The patient was treated with intravenous antibiotics and made a full recovery.


Trajectory ActionsAction to Improve: A post-infection review meeting has taken place with the ward manager and microbiologist. One action was to ensure that antibiotics are reviewed once urine test results are received.





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




NarrativeThere were no incidents reported in September.


Trajectory Actions





RJAH Acquired MRSA BacteraemiaNumber of cases of MRSA bacteraemia in month




NarrativeThere were no incidents reported in September.


Trajectory Actions





Unexpected DeathsNumber of Unexpected Deaths in Month


Exec Lead:Medical Director


NarrativeThere was one unexpected death within the Trust in September. Unfortunately, a patient had a myocardial infarction immediately after surgery whilst still being attended to by the anaesthetic team. Despite resuscitation attempts the patient died. There had been a previous history of ischaemic heart disease.


Trajectory ActionsAction to Improve: It is unlikely that there will be a post mortem but the patient's care is being reviewed by the learning from deaths lead.





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

99.72% against 95% targetAbove target green rated

Exec Lead:Medical Director


NarrativeThe percentage of admissions risk assessed is reported at 99.72% in September and remains above the 95% target.



Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD99.92% 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% 100% 99.75% 99.72% 99.88%




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

100% against 93% target green rated

Exec Lead:Clinical Services Unit


NarrativeThe Cancer 2 week wait standard was achieved in August and indicative data for September shows achievement of the standard will continue.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD100% 100% 100% 100% 100% 92.86% 100% 100% 100% 100% 96.77% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%




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




NarrativeThe Cancer 31 day first treatment standard was achieved in August and indicative data for September shows achievement of the standard will continue.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%




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




NarrativeThe Cancer 31 day subsequent treatment standard was achieved in August and indicative data for September shows achievement of the standard will continue.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%




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




NarrativeThe Cancer 62 day standard was achieved in August and indicative data for September shows achievement of the standard will continue.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD0% 50% 100% 66.67% 50% 100% 100% 100% 100% 100% 100% 100% 80% 100% 0% 100% 100% 100% 100% 85.71% 50% 100% 100% 100% 84.21%




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




NarrativeThe Cancer 62 day consultant upgrade standard was achieved in August and indicative data for September shows achievement of the standard will continue.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 25% 100% 100% 100% 66.67% 100% 71.43% 100% 76.92%




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

91.67% against 75% target green rated



NarrativeThe 28 Day faster diagnosis standard was achieved in August and indicative data for September shows achievement of the standard will continue.


Trajectory Actions

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD90.5% 81.8% 93.8% 83.9% 92.3% 70% 85% 91.2% 94.1% 82.4% 91.3% 91.3% 68.75% 90.91% 91.67% 89.47% 91.67% 86.59%




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

49.13% against 92% targetBelow target red rated

Exec Lead:MSK Unit


NarrativeOur September performance was 49.13% against the 92% open pathway performance for patients waiting 18 weeks or less to start their treatment. The total number of breaches has decreased by 290, reducing from 5665 at the end of August to 5375 at the end of September. The performance breakdown by milestone is as follows: MS1 - 6880 patients waiting of which 2650 are breaches, MS2 - 1031 patients are waiting of which 696 are breaches, MS3 - 2656 patients are waiting of which 2029 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: In line with national guidance our restoration and recovery will need to take into consideration the balance of clinical prioritisation as well as the waiting times for our patients. Work is continuing to clinically assess the volume of patients needing treatment alongside available capacity. A working group has been set up to look at harms and use of PROMS data to assist with the prioritisation of patients.

The phase three plans we recently submitted required plans for English 52+ weeks and English list size that indicates this is where the national focus will be as opposed to open pathway performance.

We are now part of the National E-Review Programme with emphasis on a clinically validated waiting list.

We continue to work within the system to understand population demand across providers.





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


Exec Lead:Specialist Services Unit


NarrativeAt the end of September there were 306 English patients waiting over 52 weeks. This is below our trajectory figure of 343.

The patients are under the care of the following sub-specialities; Arthroplasty (111), Spinal Disorders (103), Knee & Sports Injuries (39), Upper Limb (21), Foot & Ankle (17), Paediatric Orthopaedics (10), Neurology (2), Tumour (1), Rheumatology (1) and Orthotics (1).

The number of patients waiting, by weeks brackets is: - 52 to 60 weeks - 190 patients - 61 to 70 weeks - 87 patients - 71 weeks to 80 weeks - 29 patients


Trajectory ActionsAction to Improve: As our restoration develops our capacity increases to treat these patients. We continue to book in accordance with clinical priority and responding to any patients identified with potential harm. Beyond that, patients are booked according to chronological order.

It must be noted that whilst the Trust does not currently plan to restore to 100% activity levels we are not in a position to do backlog clearance. Our submitted phase three plans show an increasing position for this measure and this can be viewed on the trajectory graph. The phase three planning only required a plan for English 52+ weeks but it must be acknowledged that we must treat Welsh patients as well.

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

0 2 2 4 2 4 0 0 0 0 0 0 0 0 0 0 0 0 0 12 33 68 123 198 306




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




NarrativeAt the end of September there were 301 Welsh patients waiting over 52 weeks.

The patients are under the care of the following sub specialties; Spinal Disorders (119), Arthroplasty (85), Knee & Sports Injuries (39), Foot & Ankle (35), Upper Limb (14), Paediatric Orthopaedics (5), Tumour (2), Neurology (1) and Spinal Injuries (1). The patients are under the care of the following commissioners; BCU (176), Powys (119), Hywel Dda (5) and Swansea (1).

The number of patients waiting, by weeks brackets is: - 52 to 60 weeks - 184 patients - 61 to 70 weeks - 95 patients - 71 to 80 weeks - 19 patients - 80+ weeks - 3 patients


Trajectory ActionsAction to Improve: As our restoration develops our capacity increases to treat these patients. We continue to book in accordance with clinical priority and responding to any patients identified with potential harm. Beyond that, patients are booked according to chronological order.

It must be noted that whilst the Trust does not currently plan to restore to 100% activity levels we are not in a position to do backlog clearance. Our submitted phase three plans show an increasing position for this measure. The phase three planning only required a plan for English 52+ weeks but it must be acknowledged that we must treat Welsh patients as well.


6 3 6 7 3 6 1 0 0 1 0 0 0 0 0 0 0 1 3 15 40 77 135 199 301




Patients Waiting Over 52 Weeks – Welsh (BCU Transfers)Number of BCU transfer Welsh RTT patients currently waiting 52 weeks or more.

234 against N/A target

Exec Lead:MSK Unit


NarrativeAt the end of September there were 234 Welsh patients waiting over 52 weeks who were transfers of care from BCU.

The patient are under the care of the following sub-specialities; Upper Limb (97), Knee & Sports Injuries (91), Arthroplasty (23), Foot & Ankle (22) and Tumour (1).


Trajectory Actions


87 54 72 66 52 26 0 1 6 18 86 128 164 172 167 126 81 106 137 169 203 226 243 243 234




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




NarrativeThe 6 week standard for diagnostics was not achieved this month and is reported at 72.35%. This equates to 222 patients who waited beyond 6 weeks, a 302 reduction on the figure reported at the end of August.The breaches occurred in the following modalities; - MRI (160 - with 93 dated)- Ultrasound (23 - with 22 dated) - CT (12 - with 7 dated)- DEXA (27 - with 10 dated)


Trajectory ActionsAction to Improve: • Following a deep dive into the efficiency of CT, extended working hours and weekend working remain in place.• The second MRI scanner has become operational in July. Additional training has been provided for the new scanner to ensure there is sufficient use of the 2nd scanner. Efficient use of the scanner will continue as radiographers become more familiar with the new equipment.• Recruitment of additional radiographers, to include agency radiographers. Options of recruiting internationally are also being explored.• Ongoing review of workforce/skill mix, recruitment of support positions to release radiographer capacity that will improve activity levels delivered.• Ultrasound capacity was lost due to IPC requirements but estates work is in progress to utilise space in Menzies that will provide two further rooms.





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




NarrativeThe 8 week standard for diagnostics was not achieved this month and is reported at 74.93%. This equates to 90 patients who waited beyond 8 weeks; a reduction of 189 from volume reported at the end of August. The breaches occurred in the following modalities; - MRI (80 - with 57 dated)- CT (3 - with 1 dated)- DEXA (7 - with 5 undated)


Trajectory ActionsAction to Improve: • Following a deep dive into the efficiency of CT, extended working hours and weekend working remain in place.• The second MRI scanner has become operational in July. Additional training has been provided for the new scanner to ensure there is sufficient use of the 2nd scanner. Efficient use of the scanner will continue as radiographers become more familiar with the new equipment.• Recruitment of additional radiographers, to include agency radiographers. Options of recruiting internationally are also being explored.• Ongoing review of workforce/skill mix, recruitment of support positions to release radiographer capacity that will improve activity levels delivered.• Ultrasound capacity was lost due to IPC requirements but estates work is in progress to utilise space in Menzies that will provide two further rooms.

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD100% 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% 21.2% 20.66% 36.73% 74.93% 33.07%




Total Theatre ActivityActivity in theatres in month

503 against 1,044 targetBelow target red rated

Exec Lead:MSK Unit


NarrativeNationally, Trusts are being monitored against activity levels delivered in 19/20, therefore the 20/21 plans have been updated to monitor against these figures. The Trust has recently submitted phase 3 planning figures that included the volume of cases that would be delivered by month throughout the remainder of the financial year. These figures are represented as a trajectory in the trajectory graph. COVID-19 continued to impact the delivered activity throughout September 2020 with a slow and steady restore to elective activity.

For all areas the Trust delivered 503 (48.18%) of the 19/20 actual, broken down as follows: - T&O - 424 - Hand Trauma - 35 - Tumour - 16 - MCSI - 18 - Private - 10 (Clinical Priority)September theatre activity was 47 cases ahead of the trajectory of 456. The Trust has achieved sustained levels of activity based on current capacity available, monitoring is built in for this measurement to ensure learning is embedded to get better performance in future.


Trajectory ActionsAction to Improve: A forecasting and scheduling team has been set up in response to this to ensure capacity is well utilised. They will be working with the re-established 6-4-2 process.

Taking into account the latest PPE guidance the Trust plans to work to 2.0 cases per session in October and for the remainder of the financial year.

Other available capacity is being assessed to understand how the Trust can support the system in providing an equitable orthopaedic service for the local population.

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD1,017 1,115 1,157 883 1,094 1,024 1,082 856 970 886 930 921 1,044 1,078 1,064 827 1,042 940 639 134 194 255 351 293 503 1,730




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

72.86% against 87% targetWithin target red rated



NarrativeThe occupancy rate for all wards is red rated this month at 72.86%. The breakdown below gives the September occupancy per ward along with details on bed base and it's current use. Beds have been reduced in line with social distancing guidance:MSK Unit:- Clwyd - 63.41% - usually 28 beds; closed for majority of the month, on days open varied between 12-20 beds- Powys - 55.43% - usually 28 beds; open to 20 beds for majority of the month- Kenyon - 55.88% - open to usual 16 beds at until closure from 18th September- Ludlow - 55.08% - usually 16 beds; when open varied between 12-16 beds - used for suspected/confirmed covid patientsSpecialist Unit:- Alice - 71.43% - usually 16 beds; the number of open beds varied between 1-10- Oswald - 71.48% - open to usual 10 beds for majority of the month- Gladstone - 90.80% - open to usual 29 beds for majority of the month- Wrekin - 96.15% - open to usual 15 beds- Sheldon - 68.86% - usually 23 beds: the number of open beds varied between 8-15Following the trauma work transferring back Powys & Clwyd wards were closed at the end of August for a deep clean and were closed at the start of September. Clwyd remained closed longer until elective activity levels required the need to reopen.


Trajectory ActionsAction to Improve: This was our transition month for restoration so occupancy was at anticipated levels. We expect to see occupancy levels increase in line with activity levels planned and will review alongside casemix.

The Trust continues to review any updates to guidance but at the moment we are still working to same target.





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

9,068 against 15,249 targetBelow target red rated

Exec Lead:Support Services Unit


NarrativeThe number of attendances was behind plan in month 6 with 9068 attendances seen against a plan of 15249. Face to face appointments amount to 64%, with the remaining 36% delivered by telephone/virtual clinics.

A breakdown by Unit is: - Specialist Unit - 1934 against a plan of 2898 (9022 YTD against YTD plan of 16944) - MSK Unit - 4741 against a plan of 7568 (16188 YTD against a YTD plan of 44245) - Clinical Support Unit - 2393 against a plan of 4783 (11219 YTD against a YTD plan of 27961)


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 and reductions in our diagnostics capacity. We have commenced the introduction of patient flow co-ordinators to ensure the efficient flow of attendances in main outpatients. A time and study motion is underway to monitor this with the aim of reducing the time a patient needs to spend in the outpatient department and so enable increased throughput. Wherever possible the Trust is reviewing patients virtually.

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD13,792 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 5,340 4,696 6,475 7,432 6,556 9,068 39,567




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


Exec Lead:Director of Finance


NarrativeBreakeven achieved after retrospective top up of £512k. Covid expenditure amounted to £203k.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD152 676 621 -833 359 59 535 -775 31 -207 73 -288 357 611 379 -457 794 560 1,107 0 0 0 0 0 0 0




IncomeAll Trust Income, Clinical and non clinical

9,361 against 9,585 targetBelow target red rated



NarrativeIncome £898k adverse driven predominantly by non NHS shortfalls.


Trajectory Actions





ExpenditureAll Trust expenditure including Finance Costs

9,361 against 9,585 targetWithin target green rated



NarrativePay £199k favourable

Non pay £85k favourable

Underlying cost base reduced by £483k compared to winter 2019 (basis for plan).


Trajectory Actions





Efficiencies DeliveryCost Improvement Programme requirement

200 against 0 targetAbove target green rated



NarrativeEfficiency requirement postponed nationally under new interim covid financial framework.

Efficiencies £200k delivered in month, £673k YTD. Predominantly FYE and procurement schemes.


Trajectory Actions





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

30 against 132.25 targetWithin target green rated



NarrativeCore agency favourable £102k


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD112.7 171.62 141.07 105.5 90.56 45.75 68.59 51 68 44 65 77 93 125 107 94 103 133 119 50 27 23 29 27 30 186




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




NarrativeNo non core agency used in month


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD243.2 302.08 233.41 234.72 243.13 243.43 317.48 229 239 221 231 254 252 314 334 229 291 370 208 9 0 0 0 0 0 9




Cash BalanceCash in bank

18,850 against 6,170 targetAbove target green rated



NarrativeCash balance of £18.9m, which includes the following payments in advance:- £6.0m English block income - £1.9m of Covid top up funding

Underlying cash balance £10.9m


Trajectory Actions





Capital ExpenditureExpenditure against Trust capital programme

770 against 1,005 targetWithin target green rated



NarrativeSlippage on schemes expected to be recovered by year end.


Trajectory Actions

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD297 160 377 400 304 165 1,327 260 336 162 458 588 119 179 546 158 836 234 2,451 72 167 267 308 183 770 1,768




Use of Resources (UOR)Overall Use of Resources indicator




NarrativeUOR on plan


Trajectory Actions





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




NarrativeReduction in flexible staffing requirements due to Covid


Trajectory Actions

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD4.88% 5.48% 4.81% 5.3% 5.94% 6.14% 7.68% 7.58% 5.72% 6.85% 9.01% 5.8% 1.06% 0.46% 0.41% 0.51% 0.5% 0.54% 0.54%






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 graphsEach 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 arrearsKPIs 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 IndicatorThe 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 qualityBlueGreen 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



2228

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

Finance Dashboard 30th September 2020Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Statement of Financial Position £'000s

Category Aug-20 Aug-20 Movement Drivers

Fixed Assets 75,478 75,942 464 Additions less depreciation

Non current receivables 1,043 998 (45) CRU/RTA Recievables

Total Non Current Assets 76,521 76,940 419

Inventories (Stocks) 1,288 1,302 14

Receivables (Debtors) 4,303 4,609 306

Cash at Bank and in hand 18,878 18,851 (27)

Total Current Assets 24,469 24,762 293

Payables (Creditors) (18,918) (18,954) (36)

Borrowings (1,180) (1,310) (130) Energy Improvements (Salix) Loan drawdown

Current Provisions (204) (204) 0

Total Current Liabilities (< 1 year) (20,302) (20,468) (166)

Total Assets less Current Liabilities 80,688 81,234 546

Non Current Borrowings (4,523) (5,058) (535) Energy Improvements (Salix) Loan drawdown

Non Current Provisions (975) (975) 0

Non Current Liabilities (> 1 year) (5,498) (6,033) (535)

Total Assets Employed 75,190 75,201 11

Public Dividend Capital (35,486) (35,486) 0

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

Retained Earnings 162 151 (11) Operational deficit/(surplus) before control total adjustments

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

Total Taxpayers Equity (75,190) (75,201) (11)

YTD

Debtor Days 15

Creditor Days 36

Plan Actual Variance Plan Actual Variance

Clinical Income 103,617 8,414 8,439 25 50,484 49,248 (1,236)

Covid Top Up 558 93 605 512 558 1,925 1,367

Private Patient income 5,496 455 74 (381) 2,730 166 (2,564)

Other income 7,034 624 187 (436) 3,734 1,841 (1,894)

Pay (66,979) (5,558) (5,359) 199 (33,627) (33,555) 72

Non-pay (43,689) (3,600) (3,515) 85 (21,338) (17,037) 4,301

EBITDA 6,037 427 431 4 2,541 2,588 46

Finance Costs (5,498) (427) (475) (48) (2,541) (2,853) (312)

Capital Donations 3,050 0 55 55 0 115 115

Operational Surplus 3,589 0 11 11 0 (151) (151)

Remove Capital Donations (3,050) 0 (55) (55) 0 (115) (115)

Add Back Donated Dep'n 270 0 44 44 0 266 266

Control Total* 809 0 0 0 0 0 0

EBITDA margin 5.2% 4.5% 4.6% 0.2% 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

£0

£2

£4

£6

£8

£10

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 17.27 18.14 18.88 18.85

Forecast £M 18.85 17.01 16.31 15.49 14.92 13.87 5.84

Cash Flow

RAG of Total Schemes Being Tracked

0%

837 25%

831 25%

1,623 49%

3,291 100%

Year To Date Commissioner Income against Plan £m

Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustFinance Dashboard 30th September 2020

Efficiencies

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

ap

ita

l

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

0 20 40 60 80 100 120 140 160

Unit

FYE 19/20

Local Strategic

National Strategic

Sep Plan Sep Actual

0

100

200

300

400

500

600

700

800

YTD Plan YTD Actual

0 50 100 150 200 250 300

Unit

FYE 19/20

Local Strategic

National Strategic

YTD Plan YTD Actual

(50) 0 50 100 150 200

CSU

MSK

OOA

SPEC

SSU

Sep Plan Sep Actual

0 50 100 150 200 250 300 350 400

CSU

MSK

OOA

SPEC

SSU

YTD Plan YTD Actual

- 5.00 10.00 15.00 20.00

Shropshire

Telford

BCU

NHS England (Specialist)

Other English Contracted

Powys

Cheshire

Unsold Activity

Other

YTD actual YTD plan

Position as at 2021-06

Project

Annual

Plan

£000s

YTD

Plan

£000s

YTD

Completed

£000s

YTD

Variance

£000s

Forecast

Outturn

£000s

Diagnostic equipment replacement 1,545 945 856 89 1,545

EPR planning & implementation 200 20 0 20 200

Backlog maintenance (RJAH CIR) 500 220 152 68 500

I/T investment & replacement 295 100 -3 103 295

Equipment & service continuity 600 150 97 53 354

Project management 50 0 0 0 50

Scheme slippage from 19/20 135 135 83 52 90

Salix energy improvements 1,210 750 308 442 1,210

E-job planning 86 86 36 50 86

Covid-19 0 0 36 -36 36

Contingency 1,165 215 -5 220 895

Backlog maintenance (System CIR) 0 0 0 0 425

Restoration Schemes (System CIR) 0 0 0 0 1,900

NHS Capital Funding 5,786 2,621 1,559 1,062 7,586

Veteran's facility 3,000 250 93 157 1,000

Donated medical equipment 100 50 115 -65 170

Total Capital Funding (NHS & Donated) 8,886 2,921 1,768 1,154 8,756

Capital Programme 2020-21

Backlog maintenance expenditure to be analysed over the 2 allocations in future months

Documents

Month 6 Integrated Performance Report