Papworth Integrated Performance Report (PIPR) May 2018

Care | Valued | Excellence | Innovation

DRAFT Papworth Integrated Performance Report (PIPR) May 2018

June 2018


DRAFT Content Context:

Reading Guide Page 2

Trust Performance Summary Page 3

‘At a glance’ Page 4

- Balanced scorecard Page 4

- Externally reported/Regulatory standards Page 5

- Board Assurance Framework (BAF) risk summary Page 6

Performance Summaries Page 7

- Safe Page 7

- Effective Page 10

- Caring Page 13

- Responsive Page 16

- People Management and Culture Page 19

- Transformation Page 22

- Finance

Page 25

1

The activity table and RTT waiting time curve below sets out the context for the operational performance of the Trust and should be used to support constructive challenge from the committee.

Inpatient Episodes Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Trend

Cardiac Surgery 209 202 173 212 203 186

Cardiology 751 851 754 776 727 781

ECMO 6 6 6 10 6 2

PTE operations 16 17 16 16 16 16

RSSC 463 541 473 546 516 568

Thoracic Medicine 356 388 357 405 388 388

Thoracic surgery (exc PTE) 65 75 53 67 55 66

Transplant/VAD 43 47 54 48 41 54

Total Inpatients 1,909 2,127 1,886 2,080 1,952 2,061

Outpatient Attendances Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Trend

Cardiac Surgery 404 393 278 342 288 290

Cardiology 2,680 3,885 3,297 3,413 3,449 3,359

ECMO 0 0 0 0 0 0

PTE 0 0 0 0 0 0

RSSC 1,749 2,150 1,945 2,090 2,071 1,946

Thoracic Medicine 1,518 2,120 1,903 1,991 1,790 2,100

Thoracic surgery (exc PTE) 83 136 169 104 90 133

Transplant/VAD 283 347 321 364 340 357

Total Outpatients 6,717 9,031 7,913 8,304 8,028 8,185

Note - activi ty figures include Private patients and exclude unbundled radiology scan activi ty.


DRAFT Reading guide

2

The Papworth Integrated Performance Report (PIPR) is designed to provide the Board with a balanced summary of the Trust’s performance within all key areas of operation on a monthly basis. To achieve this, the Trust has identified the Board level Key Performance Indicators (“KPIs”) within each category, which are considered to drive the overall performance of the Trust, which are contained within this report with performance assessed over time. 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 to accompany the PIPR where requested by the Board or Executive Management, or where there is a significant performance challenge or concern.

• ‘At a glance’ section – this includes a ‘balanced scorecard’ showing performance against those KPIs considered the most important measures of the Trust’s performance as agreed by the Board. The second dashboard includes performance against those indicators set by the Trust’s regulators and reported externally.

• Performance Summaries – these provides a more detailed summary of key areas of performance improvement or concern for each of the categories included within the balanced score card (Transformation; Finance; Safe; Effective; Caring; Responsive; People, Management and Culture)

Rating Description

5

High level of confidence in the quality of reported data. Data captured electronically in a reliable and auditable system and reported with limited manual manipulation with a full audit trail retained. Sufficient monitoring mechanisms in place to provide management insight over accuracy of reported data, supported by recent internal or external audits.

4 High level of confidence in the quality or reported data, but limited formal mechanisms to provide assurance of completeness and accuracy of reported information.

3

Moderate level of confidence in the quality of reported data, for example due to challenges within the processes to input or extract data such as considerable need for manual manipulation of information. These could effect the assurance of the reported figures but no significant known issues exist.

2

Lower level of confidence in the quality of reported data due to known or suspected issues, including the results of assurance activity including internal and external audits. These issues are likely to impact the completeness and accuracy of the reported data and therefore performance should be triangulated with other sources before being used to make decisions.

1 Low level of confidence in the reported data due to known issues within the input, processing or reporting of that data. The issues are likely to have resulted in significant misstatement of the reported performance and therefore should not be used to make decisions.

Assessment rating

Description

Green Performance meets or exceeds the set target with little risk of missing the target in future periods

Amber Current performance is within 1% of the set target (above or below target) or performance trend analysis indicates that the Trust is at risk of missing the target in future periods

Red The Trust is missing the target by more than 1%

KPI ‘RAG’ Ratings The ‘RAG’ ratings for each of the individual KPIs included within this report are defined as follows:

Data Quality Indicator

The data quality ratings for each of the KPIs included within the ‘at a glance’ section of this report are defined as follows. It should be noted that the assessment for each of the reported KPI’s is based on the views and judgement of the business owner for that KPI, and has not been subject to formal risk assessment, testing or validation. The Trust will consider development of a data quality assurance framework to provide greater clarity around quality of underlying data.

Overall Scoring within a Category Each category within the Balanced scorecard is given an overall RAG rating based on the rating of the KPIs within the category that appear on the balance scorecard (page 4). • Red (10 points) = 2 or more red KPIs within the category • Amber (5 points) = 1 red KPI rating within the category • Green (1) = No reds and 1 amber or less within the category

Overall Report Scoring • Red = 4 or more red KPI categories • Amber = Up to 3 red categories • Green = No reds and 3 or less amber

5

5

1

1

5

5

10

Key

Trend graphs

Within the balanced scorecard, each KPI has a trend graph which summarises performance against target from April 2016 (where data is available)


DRAFT Trust performance summary

Favourable performance Safe – 1) There were no SI’s or incidents with moderate harm reported in May. 2) Registered nurse vacancies continue to improve with the Trust continuing to be a net recruiter. It must be noted that the nurses recruited require specialist training and many require to complete language courses prior to applying for NMC registration. This has an impact on the ward skills mix and level of support required from the existing trained staff. Effective - In spite of two bank holidays in May, admitted activity was the highest delivered in the past six months. Overall flow of patients through the hospital improved following the introduction of ring fenced CRU beds in Critical Care and restrictions on the number of transplants undertaken. People, Management & Culture – 1) Total turnover reduced to 12.9%. Nursing turnover was 9.7% a significant reduction from 32% in April. There were 5.1 wte nurse leavers in May compared to 16.3 wte in April. Healthcare Support Worker turnover was 19.1% a decrease from April at 23.7%. 2) We were a net gainer in the non-medical workforce by 7 WTE. We continued as a net recruiter to the nursing workforce for the tenth month in a row; 9.3 WTE (this includes pre-registration nurses). We were a net gainer of the HSCW workforce by 2.7 wte. Transformation – SIP: Of the £1.2m outstanding CIP £542k has been identified (Procurement plan £500k,Pensions £42k) leaving £658K still to be identified. CIP planning meetings commenced in June with a number of schemes across directorates being worked up . The programme remains amber at present. Finance - In month the Trust has reported a surplus of £674k, which is £93k ahead of the planned surplus of £581k. This results in the Trust’s year to date financial position being favourable to plan by £8k, with an actual deficit of £509k against a planned deficit of £517k.

Adverse performance Safe – 1) There was 1 sanctioned C Diff case in May. Learning has been identified and shared at ward level and across the Trust. 2) Safer staffing was red for May. Safer staffing is calculated on Registered Nurse numbers and doesn’t take into account the contribution of the pre registered nurses undergoing training and language tests. Effective - a series of infrastructure failures in theatres, cath labs and Pathology, resulted in high numbers of cancellations. This resulted in the in-month activity target not being met, a reduction in bed occupancy and Cath Lab 6 utilisation falling below target for the first time in the nine months. Responsive – 1) RTT recovery remains the key operational focus and although the Trust remains below the 92% standard, Cardiology recovery exceeded the revised trajectory approved at last month’s Trust Board. 2) IHU performance continues to be a concern. The actions taken have improved patient flow but have not had the intended impact due to the reduction in theatre capacity. Finance - Actual year to date CIP achievement of £1,032k is £478k adverse to plan of £1,510k, due to £94k planning gap and an operational delivery gap of £384k from overspends in Pay compared to the Gateway 2 rosters, partially offset by non-recurrent underspends.

3

Looking ahead NPH Design, Construction & Enabling Works: Construction is progressing towards the Phase 2 completion scheduled for July 2018, with an emphasis upon the checks necessary to ensure completion compliance. Site activity is focused on technical commissioning of whole building systems and the reduction of snags within rooms scheduled for handover. General construction progress as a whole has behind programme, but utilising extended day and weekend working to recover time. The proactive remedial activities to ensure fire compliance of external cladding materials are also underway for the top 3 levels of the building; the works have proved more arduous than anticipated ,with further access to the north of the site having to be negotiated with the developer. Progress in both areas is being monitored via the Independent Tester, the Design and Construction meeting and the Liaison Committee. In addition, the Trust’s technical adviser is undertaking fortnightly site visits and reporting on progress. Installation of major medical equipment is progressing broadly to plan, with the majority of equipment now on site and undergoing testing and commissioning. The delivery of one item will have to be accommodated post building handover due to delivery dates being missed by the supplier. The remainder of the equipping programme is now fully into a procurement phase, which it is recognised will face extreme time pressure.

Overall Trust rating - AMBER


DRAFT At a glance – Balanced scorecard

4

Month

reported

on

Data

QualityPlan

Current

month scoreYTD Actual

Forecast

YETrend

Month

reported

on

Data

QualityPlan

Current

month scoreYTD Actual

Forecast

YETrend

Safety Thermometer harm free care May-18 4 97% 98.33% 99.17% FFT score- Inpatients May-18 4 95% 96.00% 96.50%

Number of serious incidents reported to

commissioners in monthMay-18 3 0 0 2 FFT score - Outpatients May-18 2 95% 99.00% 99.00%

Never Events May-18 3 0 0 0 n/a No of complaints (12 month moving average) May-18 4 5

Moderate harm incidents and above as % of total

PSIs reported May-18 3 4% 0.00% 0.80%

% of complaints responded to within agreed

timescaleMay-18 4 100% 100.00% 100.00%

Safer staffing – registered staff day (night) May-18 3 95%84.5%

(83.3%)

84.85%

(87.25%)Voluntary Turnover % May-18 3 15% 12.91% 19.31%

Number of C.Diff cases (sanctioned) May-18 5 5 1 2 Vacancy rate as % of budget May-18 4 6%

Bed Occupancy (excluding CCA) May-18 4 85% 76.36% 79.10% % of staff with a current IPR May-18 3 90%

CCA bed occupancy May-18 3 85% 86.80% 88.17% % sickness absence May-18 3 3.5% 2.75% 2.67%

Admitted Patient Care (elective and non-elective) May-18 4 4361 2120 4027 Year to date EBITDA surplus/(deficit) £k May-18 4 £36k

Cardiac surgery mortality EuroSCORE May-18 3 3% 2.47% 2.59% Year to date surplus/(deficit) £k May-18 4 £(516)k

Theatre Utilisation May-18 3 85% 88.0% 87.6% Cash Position at month end £k May-18 4 £33,327k

% diagnostics waiting 6 weeks and over May-18 tbc 99% 99.14% 99.37% Use of Resources rating (UOR) May-18 5 3 3 3

18 weeks RTT May-18 3 92% 83.62% 83.62% Capital Expenditure YTD £k May-18 4 £8,371k

62 days cancer waits May-18 3 85% 100.00% 100.00% In month Clinical Income £k May-18 4 £12,461k £12,160k £24,227k

31 days cancer waits May-18 3 96% 100.00% 100.00% CIP – Identified £000s May-18 4 £1,510k £1,032k £1,032k

Theatre cancellations in month May-18 3 30 53 106 CIP – FY Target £000s May-18 4 £9,522k £8,851k £8,851k

% of IHU surgery performed < 7 days of acceptance

for treatment or transferMay-18 3 95% 15.55% 21.88% Agency spend as % of salary bill May-18 4 3% 4.88% 3.54%

ORAC programme delivery on track May-18 4 →

SIP – project delivery May-18 4 →

Digital programme delivery on track May-18 3 →Tra

ns

form

ati

on

6.00

Sa

feE

ffe

ctiv

e

10.75%

Ca

rin

g

89.71%

£(509)k

Re

spo

nsi

ve

£43,097k

£(25)k

£3,292k

Pe

op

le M

an

ag

em

en

t &

Cu

ltu

reF

ina

nc

e


DRAFT At a glance – Externally reported / regulatory standards 1. NHS Improvement Compliance Framework

2. 2017/18 CQUIN 99% of the total 2017/18 CQUIN value was achieved and confirmed by commissioners as shown in the table below. The Trust is in discussion with NHSE regarding new schemes for 2018/19 including 1) NSTEACS 2) NSTEMI pathway and 3) Cardiac Network. The schemes will replace Complex Device Optimisation, Adult Critical Care Discharge and Angio to CABG waiting times. In addition CF Patient Adherence which is a scheme that is part of a larger National project will roll forward into 2018/19.

5

Total available Final (Q4)

Achievement

Final (Q4)

Achievement

Comments

£'000s £'000s %

GE3: Medicines Optimisation £251.80 £251.80 100%

IM2: CF Patient Adherence £220.56 £220.56 100%

IM4: Complex Device Optimisation £147.04 £147.04 100%

Adult Critical Care Discharge £110.28 £110.28 100% Year end assessment

Angio to CABG reduction in waiting times £110.28 £88.02 80%

New Papworth Hospital £1,000.00 £1,000.00 100%

NHSE total £1,839.96 £1,817.70 99%

1a Improvement of health and wellbeing of NHS staff £29.17 £29.17 100%

1b Healthy food for NHS staff, visitors and patients £29.17 £29.17 100%

1c Improving the uptake of flu vaccinations for frontline clinical staff within Providers £29.17 £29.17 100% Year end measure

2a Timely identification of sepsis in acute inpatient settings £21.88 £18.60 85%

2b Timely treatment of sepsis in acute inpatient settings £21.88 £21.88 100%

2c Antibiotic Review £21.88 £21.88 100%

2d Reduction in antibiotic consumption £21.88 £21.88 100%

6 Offering advice and guidance £87.51 £87.51 100%

7 NHS E Referrals £87.51 £87.51 100%

9a Tobacco screening £21.88 £21.88 100%

9b Tobacco brief advice £21.88 £21.88 100%

9d Alcohol screening £21.88 £21.88 100%

9e Alcohol brief advice or referral £21.88 £21.88 100%

Engagement in STP process £145.85 £145.85 100%

Risk reserve linked to achievement of the Trust’s prior year control total £145.85 £145.85 100%

CCGs total £729.27 £725.99 100%

Grand Total £2,569.23 £2,543.69 99%

Measure

NHSE

C&P CCG & Associates

NHSI Targets Measure Data

Quality

NHSI Target Month YTD Previous

quarter

Forecast Comments

C. Difficile Meeting the C.Diff Objective 5 5 1 2 3

RTT Waiting Times % Within 18wks - Incomplete Pathways 4 92% 83.88% Monthly measure

31 Day Wait for 1st Treatment 3 96% 98.3% Current month provisional as going through verification process.

31 Day Wait for 2nd or Subsequent Treatment - surgery 3 94% 100% Current month provisional as going through verification process.

62 Day Wait for 1st Treatment 3 85% 96% Current month provisional as going through verification process. Data is after reallocations

VTE Number of patients assessed for VTE on admission 3 95% 94.00%

Finance Use of resources rating 5 3 3 3 4 3

94.00%

83.62%

Cancer 100%

100%

100.00%


DRAFT Board Assurance Framework risks (above risk appetite)

6

PIPR Category Title Mgmt

Contact

Risk

Appetite

BAF with

Datix action

plan

Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Status

since last

month

Safe Failure to stay within ceiling trajectories for all HCAI's JR 6 Yes - 20 20 20 20 8 8

Safe Ageing Estate RC 6 Yes 12 16 16 16 16 16 16

Safe Safer staffing and Monitor's Agency Price cap JR 6 Yes 20 20 20 20 20 20 20

Safe Risk of insufficient workforce levels to meet the staffing requirements of the new Papworth Hospital (Ref closed risks ID

683 & 1695)

JS 12 Yes 20 20 16 16 16 16 16

Safe Optimisation of the EPR systems JR 6 Yes - 16 16 16 16 16 16

Safe Turnover in excess of our target level and that it will further increase as a result of the move of location OM 9 Yes - - - - - 16 16

Safe The Trust is unable to recruit the required number of staff at the required level of skills and experience. OM 12 Yes - - - - - 16 16

Effective Delivery of Efficiency Challenges - SIP Board approved EM 12 Yes 20 20 20 20 20 20 20

Effective Delivery of Efficiency Challenges - SIP targets EM 12 Yes 25 20 20 20 20 20 20

Responsive R&D strategic recognition RH 8 Yes 12 12 12 12 12 12 12

Responsive Capacity assumptions - length of stay EM 10 Yes 20 20 20 20 20 12 12

Responsive Capacity assumptions - activity EM 10 Yes 20 20 20 20 20 20 20

Responsive Capacity assumptions - higher occupancy EM 10 Yes 20 20 20 20 20 16 16

Responsive Utilisation of capacity to add financial gains to the overall SIP EM 6 Yes 12 12 12 12 12 12 12

People Manag. & Cult. Failure to release staff to undertake educational activity due to workload constraints and capacity pressure leading to

inadequately trained staff and revalidation issues affecting service developments and patient care.

JS 8 Yes 9 9 9 9 9 9 9

People Manag. & Cult. Inability to retain or recruit staff affecting quality care delivery and capacity to treat JR 6 Yes 20 20 20 20 20 15 15

Transformation Pathology IM&T systems AR 12 Yes 16 16 16 16 16 16 16

Transformation Whole Hospital Equipping Plan purchases vs loan value RC 12 Yes 25 25 25 25 25 25 25

Transformation Expenditure Growth - New ways of working RC 12 Yes 15 15 15 15 15 15 15

Transformation The STP work includes Cardiology EM 8 Yes 9 9 9 9 9 9 9

Finance Failure to meet cardiac and cancer waiting targets EM 12 Yes 16 16 16 16 16 16 16

Finance Current Trading Income performance RC 10 Yes 15 15 15 15 15 15 15

Finance Current Trading Expenditure RC 10 Yes 25 25 25 25 25 25 25

Finance Income Growth - targets EM 12 Yes 25 25 25 25 25 25 25

Finance Income Growth - case mix EM 12 Yes 20 20 20 20 20 20 20

Finance Income Growth - activity transfers EM 12 Yes 20 20 20 20 20 20 20

Finance Master Development and control plans - sale value RC 10 Yes 20 20 20 25 25 25 25

Finance Master Development and control plans - sales dates RC 10 Yes 15 15 15 15 15 15 15

Finance Whole hospital equipping plan - deficit position RC 12 Yes 25 25 25 25 25 25 25

Finance Failure to deliver the operational financial plan 2016/17 RC 12 Yes 16 16 16 16 16 16 16


DRAFT Safe Performance summary Accountable Executive: Director of Nursing Report Author: Deputy Director of Nursing / Assistant Director of Quality and Risk 6 month performance trends

Summary of Performance and Key Messages:

There were no SI’s or incidents with moderate harm reported in May.

There was 1 sanctioned C Diff case in May. Learning identified and shared at ward level and across the Trust.

There were a total of 17 patient falls this month. All falls were categorised as no or low harm. See key performance challenges for further detail.

Safer staffing was red for May. Safer staffing is calculated on Registered Nurse numbers and doesn’t take into account the contribution of the pre registered nurses undergoing training and language tests.

Registered nurse vacancies continue to improve with the Trust continuing to be a net recruiter. It must be noted that many of the nurses recruited from overseas and Europe require specialist training and many require to complete language courses prior to applying for NMC registration. This has an impact on the ward skills mix and level of support required from the existing trained staff.

Unregistered nurse vacancies remain red following new base line being set with posts approved at Gateway 2.

*Note : Registered nurse vacancies - This figure reflects the registered nurse staffing used for safer staffing, areas where there are inpatients, and does not include any specialist nurses. The overall vacancy rate is reflected on the Workforce pages.

7

Data

Quality

Target Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18

Safety Thermometer harm free care 4 >97% 99.49% 99.43% 100.00% 98.16% 100.00% 98.33%

Number of serious incidents reported to

commiss ioners in month3 0 2 0 2 1 2 0

Never Events 3 0.00% 0 0 0 0 0 0

Moderate harm incidents and above as % of tota l PSIs

reported 3 <4% 0.60% 0.56% 1.70% 2.50% 1.60% 0.00%

87.9% 87.6% 87.6% 82.6% 85.2% 84.5%

93.6% 96.8% 92.3% 90.9% 91.2% 83.3%

Number of C.Di ff cases (sanctioned) year to date 4 5 in year 0 0 0 3 1 1

84.41 79.12 78.17 65.93 63.84 52.19

15.25% 14.29% 14.12% 11.91% 9.55% 7.81%

Number of Papworth acquired Pressure Ulcers (grade 2

and above)4 <4 1 1 1 1 3 1

Fal ls per 1000 bed days 3 <2.2 3.3 1.7 1.6 2.9 1.6 3

MRSA bacteremia 3 0.00% 1 0 0 1 0 0

20.29 22.7 18.84 21.27 49.21 45.52

11.62% 11.96% 9.93% 12.18% 24.46% 22.63%

E col i bacteraemia 3 M onitor only 2 1 0 0 1 0

Klebs iel la bacteraemia 3 M onitor only 1 0 0 0 1 0

Pseudomonas bacteraemia 3 M onitor only 1 0 0 0 0 2

High impact interventions 3 M onitor only 96.5% 98.5% 97.0% 96.3% 99.4% 99.6%

Moderate harm and above incidents reported in

month (including SIs )3 M onitor only 3 1 3 5 6 0

** Note - HCSW WTE and vacancy % figures in Safe section compiled from data collected from matrons.

Safer s taffing – regis tered s taff day

Safer s taffing – regis tered s taff night3 90-100%

3 10.00%

Das

hb

oar

d K

PIs

HCSW vacancies (WTE) **

HCSW vacancies (% total establ ishment) **

Regis tered nurse vacancies (WTE)*

Regis tered nurse vacancies (% total establ ishment)

Ad

dit

ion

al K

PIs

3 5.00%


DRAFT Safe Key performance challenges Escalated performance challenges Falls The number of patient falls was 17 this month. Whilst this is an increase from previous months the general trend in patient falls sees a decline since April 2016. All falls in month were categorised as no or low harm. The aging estate and cleanliness There continues to be interruptions to activity and impact on patient safety and experience due to aging equipment and aging estate. In May this included ceiling/roof leaks in clinical areas affecting bed capacity whilst repairs were carried out. There was also equipment failure in sleep labs, theatres, cath labs and monitoring equipment in ward areas. There are ongoing concerns relating to consistency of the cleanliness of the clinical areas due to ISS staffing and state of repairs of ward areas.

Key risks

Risk to patient safety Poor patient experience Risk to patient safety Risk to activity performance Poor patient experience Reputational damage to the Trust

Key Actions

All falls are investigated with learning identified for ward area and shared Trust wide.

Patient and carer leaflet introduced with advise on falls prevention and 1:1 patient education provided for patients.

High risk patients receive intentional rounding and falls mats if appropriate.

Falls prevention coordinator continuing to raise awareness and provide education to staff.

Qrtly MDT review of all falls identifying trends and actions.

Patient safety remains paramount with activity cancelled to allow for repair works to be carried out. Estate and engineering staff responsive 24/7 to attend to make urgent repairs. ED led environmental rounds continue addressing cleanliness and estate issues as appropriate. The impact of the Trust aging estate and aging equipment is recorded on the Trust risk register.

8

0

5

10

15

20

25

30

No

of

falls

Patient Falls (inc. near miss) Apr 16 to May 18


DRAFT Safe Spotlight on: Pressure Ulcers

9

Pressure Ulcers - Pressure ulcers are caused by unrelieved pressure to an area of the body. Pressure ulcers commonly occur over bony prominences (where bones are close to the skin) for example bottom, heels, hips, elbows, ankles, shoulders, back, ears and the back of the head.

The Trust has a low incidence of reported avoidable pressure ulcers as a result of being proactive in their prevention, dedicated Nurse Consultant and link nurses for tissue viability and learning from incidents.

Sometimes ulcers can occur from the use of mechanical devices eg nasogastric tubes, urinary catheters and drive lines. Whilst these are not recorded as part of our monthly reporting each of these incidents are investigated and practice changed and education put in place as appropriate.

Suspected deep tissue injury sometime occurs in patients where tissue perfusion is severely compromised eg ECMO referrals and prolonged theatre time.

Despite the increased acuity of patients referred to the Trust the incidence of pressure ulcers developed at Papworth remains low.

Prevention and learning actions A quarterly Pressure Ulcer scrutiny panel chaired by Consultant Nurse for tissue viability. All Grade 2 and above pressure ulcers are discussed with the ward representative to understand if the pressure ulcer was avoidable or unavoidable. Lessons learnt from avoidable pressure ulcers are shared with all ward areas through link nurses, lessons learnt and sisters forums. Link nurses for tissue viability meet regularly with Nurse Consultant for tissue viability. Rolling programme of tissue viability study days in place for all ward staff. Patients receive advise and guidance on the prevention of pressure ulcers on admission and throughout their stay. Alongside Datix reporting of incidents relating to pressure ulcers the TV team perform biannual point of prevalence monitoring. All at risk patients have a comprehensive care plan – SSKIN bundle commenced – and are assessed in terms of need for specialised mattress to help with prevention of pressure ulcers. There is close liaison between TV team at Papworth and other organisations including the community to ensure continuity of care and communication is optimal for patients being referred to and from Papworth with pressure ulcers.


DRAFT Caring Performance summary

Accountable Executive: Director of Nursing Report Author: Deputy Director of Nursing / Assistant Director of Quality and Risk 6 month performance trends


The number of formal complaints received in May was 4. All complaints have been acknowledged and are under investigation. The themes of the complaints are related to cancellations, poor communication, and inappropriate discharge.

All complaints were responded to within agreed timescales.

The inpatient friends and family score for May was 96% which is a slight decrease from previous months. This score however is comparable to the national average.

The out patient friends and family score remains excellent at 99% though the response rate was low.

The number of recorded compliments is higher than previous months. This does not capture all compliments received in the Trust.

The National inpatient survey results for 2017 have been published which describes patients responding positively to their experience at Papworth (see spot light on).

10

Data

Quality


FFT score- Inpatients 4 95% 98.0% 97.5% 98.0% 97.0% 97.0% 96.0%

FFT score - Outpatients 2 95% 96.3% 97.5% 98.0% 98.2% 99.0% 99.0%

Number of compla ints (12 month

moving average)4

5 and

below4.9 5.1 5.5 5.9 5.9 6.0

% of compla ints responded to

within agreed timescales4 100% 100% 100% 100% 96% 100% 100%

Number of compla ints upheld 43 (60% of

complaints

received)

2 7 6 7 1 N/A

Direct Care Time - Activi ty fol lows

completed in quarter 3 100% - - - 87.5% - -

Direct care time 3 40% - - - 38.6% - -

Direct Care Time - Number of

wards > 40% 3 100% - - - 13 - -

Number of compla ints 45 and

below2 7 9 11 3 4

Number of recorded compl iments 4 10 46 140 67 68 101 147

D

ash

bo

ard

KP

IsA

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KP

Is


DRAFT Caring Key performance challenges Escalated performance challenges: Whilst the number of formal complaints received was 4 in May, ward department and PALS staff are dealing with a number of informal complaints and enquiries on a daily basis. The themes are in relation to cancellations, poor communication delayed discharges and some in relation to care provided. The number of junior and inexperienced nurses on the wards affects the nursing skill mix and can impact on care delivery .

Inpatient Friends and family scores for May though 96% is a decline of 1% from the previous month and 2% from March. This could be reflective of the continued high rate of cancellations and postponement of procedures and other themes as identified through formal and informal complaints.

Key risks: Poor patient experience Negative reputational impact on the Trust Negative effect on staff morale Poor patient experience Negative reputational damage for Trust

Key Actions: There is a high presence of clinical education and CPD staff on ward areas to support the junior staff to build up competencies and skills. Ward Sisters and Matrons ensure that concerns are heard and that an apology is given but also that a plan is put in place to improve the experience for patient and carer going forward. Where possible patients who have their procedure cancelled or postponed are provided with a new date as soon as possible.

Proactively responding and addressing concerns through daily Matron rounds. Ensuring cancellations and postponements are dealt with in a timely way keeping the patient informed throughout.

11


DRAFT Caring Spotlight on: National inpatient survey 2017

Summary of performance: Royal Papworth Hospital is leading the way when it comes to inpatient care, according to a new report

released today (Wednesday 13 June).

Patients were asked about their experience at the hospital, and whether they had been treated with

dignity and respect, as part of the Care Quality Commission’s (CQC) 2017 Adult Inpatient Survey - with

79% of responses chosen the 'most positive' available. The trust average across the country was 69%.

Royal Papworth Hospital was one of eight acute specialist trusts to have been categorised within the

highest bands after performing ‘much better than expected’ compared with other trusts in the survey.

This is because a higher proportion of patients responded positively about the inpatient care they had

received than in most other trusts.

Josie Rudman, Director of Nursing at Royal Papworth Hospital, said: “Staff at Royal Papworth Hospital are

committed to providing the best care possible to all our patients, and ensuring they are treated as

individuals throughout their time here.

“The Trust’s excellent results in the CQC’s 2017 Adult Inpatient Survey are a reflection of the ethos of

dedication, professionalism and compassion which is at the heart of everything we do.”

The experiences of 72,778 inpatients across 148 NHS acute and NHS foundation trusts were recorded for

the survey in July 2017. Each trust has been assigned one of five bands: ‘much worse than expected’,

‘worse than expected’, ‘about the same, ‘better than expected’ or ‘much better than expected’.

The questions identified in the table are those where there was a % decrease change from 2016 . An action plan will be formulated and will be monitored by the patient experience group.

12

0

10

20

30

Same Better Worse New

Royal Papworth Performance 2017 compared to 2016

Number Question % change

6 Length of time waiting for hospital admission 1%

14 Noise at night 3%

16 Hospital Cleanliness 3%

18 Brought in own medications and able to take when

required

1%

26 Nurses able to answer important questions 2%

27 Confidence and Trust in Nurses 1%

30 Identity of nurse in charge of care 4%

38 Enough emotional support 1%

41 Were you in pain 1%

50 Discharge delays 3%

55 When you left hospital did you know the plan for the

next steps

2%

56 Given printed information on discharge 1%


DRAFT Summary of Performance and Key Messages • Operational site status this month was Amber / Red overall

due to a number of operational challenges caused by failing infrastructure.

• In spite of two bank holidays in May, admitted activity was

the highest delivered in the past six months. Overall flow of patients through the hospital improved following the introduction of ring fenced CRU beds in Critical Care and restrictions on the number of transplants undertaken at the same time. However, a series of infrastructure failures in theatres, cath labs and Pathology, resulted in high numbers of cancellations which meant that the in month activity target was not met (See Key Challenges).

• Bed usage reduced as a consequence of these cancellations, although utilisation of theatres as a whole was maintained as staff were re-deployed from theatre 5 to extend the list in the remaining four theatres into the evening.

• Cath Lab 6 utilisation fell below target for the first time in the

nine months that it has been in operation following a series of power related issues which resulted in 13 patient cancellations and extended into June. No patient harm was caused and the issues are now resolved.

• There has been a deterioration in Length of stay (LOS) for

elective CABG and valves which correlates with the high acuity of cases treated in month. LOS for these procedures does fluctuate and the trend for both is till showing a downward trend.

Effective Performance summary Accountable Executive: Chief Operating Officer Report Author: Deputy Directors of Operations

6 month performance trends

13

Data

Quality


Bed Occupancy (excluding CCA) 4 85% 75.7% 73.9% 72.1% 73.6% 81.8% 76.4%

CCA bed occupancy 3 85% 85.5% 89.2% 86.0% 85.4% 89.5% 86.8%

Admitted Patient Care (elective and non-elective) 42217 (current

month) 1909 2117 1934 2077 1907 2120

Cardiac surgery mortality EuroSCORE 3 <3% 2.65% 2.71% 2.61% 2.81% 2.70% 2.47%

Theatre Utilisation 3 80% 82.82% 77.65% 84.05% 79.36% 87.12% 88.04%

Same Day Admissions – Cardiac (eligible) 4 40% 18.81% 18.52% 27.78% 24.47% 31.87% 25.36%

Same Day Admissions – Thoracic (eligible) 4 40% 52.94% 32.56% 35.90% 44.19% 40.00% 51.11%

Length of stay – Cardiac Elective – CABG (days) 3 8.22 9.39 7.50 7.81 8.38 7.93 9.06

Length of stay – Cardiac Elective – valves (days) 3 9.65 10.39 9.59 10.09 9.80 8.84 10.49

Cath Lab Utilisation 1-5 (including 15 min Turn Around Times) 4 90% 88% 87% 89% 87% 89% 90%

Cath Lab Utilisation 6 (including 15 min Turn Around Times) 4 70% 76% 73% 75% 81% 75% 69%

CCA length of stay (LOS) (hours) - Mean 3Monitor

only100 115 107 103 98 105

CCA LOS (hours) - median 3Monitor

only45 36 45 45 40 36

Length of Stay – combined (excl. Day cases) days 3Monitor

only5.11 4.84 4.78 4.54 4.75 5.12

% Day cases 3Monitor

only53.10% 55.40% 55.48% 53.51% 55.83% 55.78%

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DRAFT Effective Key performance challenges

Failing Infrastructure: A number of significant infrastucture and equipment challenges were experienced within theatres, cath lab 6 and the pathology building in May. This had an impact on both the number of cases scheduled and cancellations.

Theatre 5 air handling unit 15th – 25th May Within theatres the air handling unit in theatre 5 failed on the 16th May and following a review chained by the Medical Director with the wider multidisciplinary team it was deemed unusable for major surgery The potential Impact was minimised by extending theatre time to run additional late case – three late theatres plus emergency rather than two. Additional late cases were facilitated by staff altering working hours or working additional/overtime hours The estates team sourced a replacement unit from Italy and this was fitted over the following weekend allowing theatre 5 to reopen on 26th May. As a result of the air handling unit failure 9 fewer patients were scheduled for cardiac surgery in this time period and 5 patients were cancelled . Cath lab 6 generator and door failure 29thMay – 1st June The generator in cath lab 6 failed on 29th May, this resulted in 4 patient cancellations. A replacement generator was sourced and fitted on May 31st In health experienced problems with the door control mechanism in cath lab 6 on 01st June As a result 5 patients were cancelled due to this failure. The door fault was resolved on the evening of the failure A further generator failure occurred in the morning and afternoon of 8th June. A second back up generator was sourced and fitted on the 11th June. 4 patients were cancelled on this date. No patient harm was associated with the generator failures and door failure. Power failure Pathology building 30Th May On May 29th a power failure to the pathology building occurred Power to blood transfusion was maintained by temporary electricity feeds One major thoracic case was cancelled due to this power failure Power was fully restored and tested to all areas of the pathology building that evening

.

14

Cancellation code Apr-18 May-18

1a Patient DNA 1 0

1b Patient refused surgery 0 0

1c Patient unfit 6 3

1d Sub optimal work up 0 0

2a All CCA beds full with CCA patients 6 8

2b No ward bed available to accept transfer from CCA 11 0

2c Delay in repatriation of patient from CCA 0 0

2d No ward bed available 0 0

3a Critical Care 6 0

3b Theatre Staff 0 0

3c Consultant Surgeon 0 0

3d Consultant Anaesthetist 0 0

3e Other 0 0

4a Emergency took time 4 10

4b Transplant took time 6 9

4c ECMO/VAD took time 0 0

4d Additional urgent case added and took slot 7 4

4e Equipment/estate unavailable 0 5

5a Planned case overran 5 12

5b Additional urgent case added and took slot 0 0

5c Overruns delayed start 0 0

6a Scheduling issue 1 2

Total 53 53


DRAFT ERS – Current Performance

Currently we receive on average 20 referrals through ERS, per day, we will be monitoring this on a weekly basis against total number of GP referrals.

ERS - Background

From October 1st 2018 all GP referrals must be sent electronically through the ERS portal. Any referral outside this process which is not returned to the GP will result in providers not being paid for this activity. The change is to ensure that referrals are sent in a safe, efficient and auditable way, patients can book an appointment which is acceptable to them and as providers we should be able to see what is coming through our doors which will enable us to plan more effectively.

There are some exclusions from this which would follow a slightly different process, these exclusion will be determined and agreed with commissioners.

At Papworth we already receive some referrals through the Electronic Referral Service (ERS). Previously this has been used for patients to book a telephone slot where we will call to discuss a date with them after reviewing the referral and agreeing which clinic type they should be booked into.

We are changing this so that the patient and their GP can book directly into the clinic. We have therefore been working to ensure our directory of services is correct so that GPs know which clinics to book into.

Our launch for this change took place on Monday June 11th. For those teams receiving direct GP referrals the process now involves reviewing the referral and that the patient is booked into the correct clinic. Between now and July 30th we will be reminding GPs when they send paper referrals to use ERS, we will continue to proceed with the referral at this stage

From July 30th we have agreed with our commissioners that from we will not take any GP paper referrals, at this stage referrals will be sent back to GPs and not accepted.

The clinical responsibility at this stage sits with the GP.

The main areas of the hospital who will be involved in this change are RSSC and Cardiology.

15

Effective – Spotlight on Electronic Referral Service (ERS)

ERS – Summary

From October 1st all GP referrals will need to be made through ERS. This will lead to:

• an improved patient experience,

• A safe and auditable service

• An increased ability to understand demand

Start Paper referral

received

Referral sent

to Booking

team

Booking team

contact GP

practice to

notify and

request e-RS

re-referral

Booking team

process

referral

Booking team contact GP

practice again and

request e-RS re-referral

CCG to liaise with the

GP practice and ensure

action is taken to

provide appropriate care

to the patient

Paper referral rejected

Weekly paper referral

data to be shared with

CCG by specialty GP

practice code.

Close

GP refers via

e-RS

GP no

response

within 48

hours

GP practice

receive and

acknowledge

receipt

GP no response

within 5 days

Within 24 hours


DRAFT Summary of Performance and Key Messages:

RTT Recovery

• RTT recovery remains the key operational focus and although the Trust remains below the 92% standard, Cardiology recovery exceeded the revised trajectory approved at last month’s Trust Board.

• Cardiac surgery recovery remains above trajectory but the planned switch of operating capacity from elective to In-House Urgent cases has reduced the margin above which over-performance has been tracking.

• The infrastructure failings that effected both Theatre 5 and Cath lab 6, resulted in the loss of 13 theatre and 13 Cath lab slots, following mitigation by the actions of the teams. This constrained recovery in both areas in month.

28 day re-booked patients

• The re-booking of patients within 28 days also was impacted by the theatre 5 failure with one patient being re-booked beyond 28 days.

In-House Urgents

• IHU performance continues to be a concern. The actions taken have improved patient flow but have not had the intended impact due to the reduction in theatre capacity.

• Referrals have increased significantly – 219 in 16/17 increasing to 474 in 17/18 and 85 in April 18. There is currently insufficient capacity to meet this demand and to also service our elective waiting list. A business case to open the sixth theatre at New Papworth shortly after the move is being developed.

Accountable Executive: Chief Operating Officer Report Author: Associate Director of Operations 6 month performance trends

Responsive Performance summary

16

Data

Quality


% diagnostics waiting less than 6 weeks tbc >99% 99.53% 99.33% 99.11% 99.04% 99.59% 99.14%

18 weeks RTT (combined) 3 92% 83.51% 84.27% 84.17% 83.21% 83.38% 83.62%

62 days cancer waits post re-allocation* 3 85% 100.0% 100.0% 100.0% 87.5% 100.0% 100.0%

31 days cancer waits * 3 96% 100.0% 95.0% 100.0% 100.0% 100.0% 100.0%

Theatre cancellations in month 3 30 56 79 57 61 53 53

% of IHU surgery performed < 7 days of

acceptance for treatment or transfer3 95% 39.58% 44.18% 25.58% 31.11% 28.20% 15.55%

18 weeks RTT (cardiology) 3 92% 81.38% 83.78% 82.58% 81.17% 79.24% 79.45%

18 weeks RTT (Cardiac surgery) 3 92% 67.33% 69.25% 69.15% 67.29% 67.05% 67.16%

18 weeks RTT (Respiratory) 3 92% 94.04% 93.87% 95.34% 95.80% 97.10% 96.64%

Acute Coronary Syndrome 3 day transfer % 3 90% 100.00% 100.00% 100.00% 100.00% 99.25% 100.00%

Other urgent Cardiology transfer within 5

days %3 90% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

% patients rebooked within 28 days of last

minute cancellation3 100% 100.00% 94.74% 98.28% 100.00% 100.00% 98.00%

Outpatient DNA rate 4Monitor

only9.75% 10.50% 9.46% 9.55% 10.18% 9.40%

* Note - latest month of 62 day and 31 cancer wait metric is still being validated and is not RAG rated

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DRAFT Responsive Key performance challenge – Capacity to deliver Performance

QuickTime™ and a decompressor

are needed to see this picture.

Escalated performance challenges RTT Recovery:

• Cardiology recovery exceeded the revised recovery trajectory through the deployment of additional Out-patient lists and temporary re-allocation of Cath lab capacity for Korner wait patients to long waiting elective patients.

• Cardiac Surgery continues to perform above trajectory but this over performance has dropped to <6% as capacity has been re-directed to support IHU activity.

IHU Performance

• Ring-fencing of Critical care capacity for patients with a LOS <48 hours complete.

• Restriction of Transplant activity in place.

• IHU referrals have doubled in twelve months with a marked step change since October 2017.

Delivery against Recovery Trajectory

Key Actions

• Cryo ablation anticipated to go live in Cath Lab 6 week commencing 25th June. This was delayed due to the power supply issues.

• Continued migration of the majority of

Private Patient Cardiology activity to Cath lab 6 weekend sessions. GA cases will still be undertaken in labs 1-5 in the interests of patient safety.

• Maintain additional Out-patient lists at recovery trajectory level.

• Monitor closely the split of IHU and

Elective capacity and flex as required. • Pilot IHU patient advocate role from July

2018 to support decisions regarding treatment.

• Re-launch enhanced recovery

programme. June 2018. • Maintain Estate and equipment failure

response times and mitigate impact on capacity where possible.

17


DRAFT

NSTEACS – The Future • ECG sent ahead of the patient arrival for triage. • Discussion of ECG to ensure criteria is reached

before the pathway is activated. • Modified score is captured for future criteria

driven independent decision making.

NSTEACS – Current Performance A prospective audit was undertaken in 2017 to look at length of stay (at the referring hospital) before the patient was declared fit to transfer. The audit looked at 112 patients and the average length of stay was determined to be 2.4 days. The audit revealed the potential 3652 bed days at local DGH could be saved.

NSTEACS - Background

At present, our patients with non-ST elevation MIs (or Acute Coronary Syndromes) are admitted via the EAAST, GPs or Emergency Departments to our referring DGHs. They may then be seen on a Medical Assessment Unit, admitted after tests to the Cardiology ward and subsequently referred on the PRIS system for coronary catheterisation at Papworth.

Papworth are seeking to establish an improved NSTEACS Pathway driven by ESC 2015 guidance, and as per the STP Planned Care Cardiology Strategy to improve the patient pathway, experience and outcomes even further. This would have no impact on absolute patient numbers, but the implementation will follow a phased approach with the final patient pathway delivering one of the most forward thinking ACS pathways in the country.

Responsive – Spotlight on NSTEACS

NSTEACS – Key Risks

• Poor adherence to criteria, will result in the admission of in-house urgent patients, without a date would generate red bed days in Papworth.

• Ability to ring fence beds to protect flow into the lab.

• Ability to ring fence lab scheduled time to ensure throughput without delay.

• No cost to Papworth to implement, however there is a possible cost implication to the ambulance service with the future development of on-board blood testing.

• Patient admission out of normal working hours and the implication to the out of hours team

NSTEACS – Summary

A redesign of the NSTEACS pathway in Papworth is predicted to provide

• an improved patient experience,

• improved clinical outcomes,

• substantial cost savings though the region (DGH and commissioners), and

• has the potential to further improve co-operation between all the acute Trusts within the region.

NSTEACS – Recent development To support the new access route for this patient group the email of ECG and discussion pathway has gone live effective 11th June 2018.

18


DRAFT Summary of Performance and Key Messages Key highlights in May are: • Total turnover reduced to 12.9%. Nursing turnover was 9.7% a

significant reduction from 32% in April. There were 5.1 wte nurse leavers in May compared to 16.3 wte in April. Healthcare Support Worker turnover was 19.1% a decrease from April at 23.7%.

• We were a net gainer in the non-medical workforce by 7 WTE. We continued as a net recruiter to the nursing workforce for the tenth month in a row; 9.3 WTE (this includes pre-registration nurses). We were a net gainer of the HSCW workforce by 2.7 wte.

• Trust total vacancy rates decreased to 10.8%. • Nurse vacancy rate decreased to 7.8% (52.19 wte). We have a large

cohort of PRP staff (53 wte) who are working towards gaining registration. HCSW vacancy rate decreased to 22.4% ( 45.5 wte) from 24.5% (49.2 wte).

• Non-medical IPR compliance decreased to 89.7% and medical to 87.5%. The Spotlight section looks at the delivery of the improvement plan on IPR.

• The Friends and Family Staff Recommender questions are now being asked as part of the monthly pulse survey. Previously they had been asked on a quarterly basis and response rates were low. The KPI is the national average score. Our recommender score as a place to receive treatment was better than the national average at 91% but recommender as a place to work remains below the national average reflecting the impact of the pending relocation and organisational change on staff.

People, Management & Culture Performance summary Accountable Executive: Director of Workforce and Operational Development Report Author: HR Manager Workforce 6 month performance trends

19

Data

Quality


Voluntary Turnover % 3 15.0% 16.44% 19.17% 13.06% 21.54% 25.78% 12.91%

Vacancy rate as % of budget 4 5.50% 9.98% 9.92% 9.48% 8.87% 11.30% 10.75%

% of s taff with a current IPR 3 90% 91.09% 90.75% 89.23% 88.38% 90.81% 89.71%

% s ickness absence 3 3.50% 3.72% 3.66% 3.32% 2.92% 2.58% 2.75%

% Medica l Appraisa ls 3 90% 91.18% 90.20% 92.16% 92.31% 90.29% 87.50%

FFT – rec as place to work 3 63% - - - - 40.00% 42.00%

FFT – rec as place for treatment 3 80% - - - - 80.00% 91.00%

Mandatory tra ining % 3 90.00% 89.50% 90.31% 90.38% 90.71% 90.54% 91.15%

Regis tered nurs ing vacancy rate 3 5.0% 11.79% 10.94% 10.20% 9.10% 9.55% 7.81%

Unregis tered nurs ing vacancy rate 3 8.00% 11.62% 11.10% 11.50% 12.18% 24.46% 22.36%

Long term s ickness absence % 3 0.80% 0.99% 0.47% 0.00% 0.62% 0.70% 0.75%

Short term s ickness absence 3 2.70% 2.73% 3.19% 3.32% 3.32% 1.88% 2.00%

Agency Usage (wte) Monitor only 3 M onitor only 36.2 42.6 43.2 44.6 43.7 51.1

Bank Usage (wte) monitor only 3 M onitor only 49.5 57.1 47.1 54.1 50.1 54.5

Overtime usage (wte) monitor only 3 M onitor only 45.6 60.3 55.1 63.9 52.8 53.0

WTE Totals : Non Medica l Starters 3 M onitor only 23.8 28.1 29.0 26.5 42.0 23.5

WTE Totals : Non Medica l Leavers 3 M onitor only 23.1 25.1 22.4 28.8 35.7 16.5

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DRAFT People, Management & Culture Key performance challenges

20

Key Actions:

• There are 53 wte PRP staff working towards registration. 14 staff took the Occupational English Test (OET) in May. 3 of these passed (we are still awaiting the results of 2 members of staff). 10 staff sat the OET exam on 16 June and we await their results.

• The Trust provides the following for overseas staff requiring OET/IELTs:

• Paid study time • Paid programme of study • Cost of one attempt at the exam

• We received poor feedback from staff about the education provider and following swift review by the Nurse Recruitment and Retention team the provider has taken action. However this leaves a problem for the July programme as the education provider is not able to provide an alternative arrangement we are happy with. We are therefore planning to provide staff with a combination of access to high quality online teaching and directly engaging teaching support for staff.

• A new OSCE programme for 5 members of staff commenced on 15 June.

• PRP staff undertake a Band 4 role whilst they are studying for the OET and/or OSCE programmes. This partially mitigates the vacancy rate for HCSW.

• The Nurse Recruitment and Retention Nurses are working with line managers of OET/IELTS nurses where they are within 3 months of expiration of contract, or have failed one or more exams, or have not booked an exam/made adequate progress to support fair and transparent decisions regarding contract renewal or change.

• Careful consideration is given to the numbers of PRP staff that are started each month to ensure that their language skills are evidenced to be at a high level and that the clinical areas can provide appropriate support.

• We are reviewing the attraction and recruitment approach for HCSW roles. We are liaising with CUH to learn from their approach in the Cambridge labour market and it is hoped that the pay deal will help recruitment.

Escalated performance challenges:

• Turnover remains above target and is likely to remain so ahead of the move to the new facilities.

• Vacancy rates are improving but we have a high number of Pre-Registration Nursing and newly qualified staff who require support and supervision and makes ensuring the appropriate skill mix on wards difficult.

• Recruitment remains difficult across a number of non-medical staff groups. In particular recruitment to HCSW roles is becoming more difficult as we get closer to the move date and vacancy rates have increased as a result of increased establishment arising from Gateway 2.

• Organisational change processes will require significant management time and is negatively impacting staff recommender score as a place to work.

Key Risks:

• Turnover increases as we get closer to the move date as staff decide not to move location.

• Trust’s ability to recruit substantial numbers of clinical and non-clinical staff to match turnover and increases in establishments in some areas as a result of new operating models post-move.

• Impact of increased demand on current staff to deliver activity may adversely affect staff morale, sickness absence, and turnover.

• The capacity to provide hospital accommodation for overseas recruitment pre the hospital re-location is challenging and needs to be carefully managed to ensure that this does not inhibit recruitment.

• Significant organisational change as a consequence of the move and new operating models. This requires effective partnership working with staff side organisations and good change processes to be implemented in order to not detrimentally impact on staff engagement .

• Leaders having the skills and capacity to effectively lead staff through the organisational change processes.

• Length of time required for overseas nursing starters to successfully complete OET/OSCE and become registered staff.

• Trade Union capacity to work in partnership and provide support for employees through organisational change.


DRAFT People, Management & Culture Spotlight on: IPR Compliance

21

Summary of performance:

IPR Purpose

• IPR forms an important role in promoting good staff engagement, communication of key messages and ensuring appropriate training and development takes place for staff. This is particularly important during

periods of substantial organisational change.

Appraisal Improvement Plan

• In May 2017 the Trust’s appraisal performance was highlighted by the CCG as inadequate and the Trust launched an IPR Remedial Action Plan.

• A number of actions were taken including an IPR calendar for managers accessible on the shared drive, regular updates on performance from HR Partners and Executive Team championing of the importance of appraisals.

Performance and Challenges

• IPR performance has improved substantially over the last 12 months with the Trust achieving the 90% target for non-medical staff on three out of the last six months and five our of the last six months for medical staff.

• Achieving and maintaining performance requires regular monitoring and communication to emphasise the importance of IPRs and ensuring their completion is accurately recorded.

• Ensuring sufficient time can be dedicated to IPRs remains a challenge given vacancy levels and the time demands of the move. This will be particularly keenly felt during the move and its immediate build up.

• Feedback from 2017 Staff Survey indicates that the quality of appraisals is also improving.

Actions

• Focus on areas with persistent compliance below 90% and the very small number of individuals who have not had an IPR recorded for more than two years.

• Strengthen skills training for managers on IPR s.


DRAFT Transformation Performance summary Accountable Executive: Chief Operating Officer / Director of Finance Report Author: Project Director/Deputy Project Director/SIP Programme Manager

22

Summary of Performance and Key Messages: Operational Readiness: Weekly Exec-led ‘Our Big Move’ briefings continue as a regular feature with consistently high attendance. The Relocation Leads workshops are on-going with good level of attendance and engagement. A solution for library services continues to be developed . Medical records scanning project has commenced for completion by end May 2018. Final preparations for move to RP House are in train , including expediting ICT infrastructure installation, with a Go No Go decision being made at June PMG. A clinical familiarisation training programme has been developed to ensure that we remain clinically safe when we become operational in the new hospital. The staff consultation for Royal Papworth Hospital commenced 11th June 2018. The Travel Plan has been updated and new car parking policies have been developed for staff and patients to support the move to the new hospital. NPH Design, Construction & Enabling Works: Construction is progressing towards the Phase 2 completion scheduled for July 2018, with an emphasis upon the checks necessary to ensure completion compliance. Site activity is focused on technical commissioning of whole building systems and the reduction of snags within rooms scheduled for handover. General construction progress as a whole has behind programme, but utilising extended day and weekend working to recover time. The proactive remedial activities to ensure fire compliance of external cladding materials are also underway for the top 3 levels of the building; the works have proved more arduous than anticipated ,with further access to the north of the site having to be negotiated with the developer. Progress in both areas is being monitored via the Independent Tester, the Design and Construction meeting and the Liaison Committee. In addition, the Trust’s technical adviser is undertaking fortnightly site visits and reporting on progress. Installation of major medical equipment is progressing broadly to plan, with the majority of equipment now on site and undergoing testing and commissioning. The delivery of one item will have to be accommodated post building handover due to delivery dates being missed by the supplier. The remainder of the equipping programme is now fully into a procurement phase, which it is recognised will face extreme time pressure. CTP: The agreements with CUH to support all but one pathology services have been finalised with the remaining item to be agreed this month. The procurement for the off site histopathology provider is progressing positively and site visits are underway to the laboratories that have submitted a tender return and will conclude in June. The lease with University of Cambridge for access for Tissue Bank services is near completion. Patient transfers policy between CUH and RPH has been amended following further feedback from CUH nursing executive and is for final committee approvals during June 2018. Application for discharge of the car parking planning condition has been made with determination due during June 2018. Service Improvement (SIP/CIP): Of the £1.2m outstanding CIP £542k has been identified (Procurement plan £500k,Pensions £42k) leaving £658K still to be identified. CIP planning meetings commenced in June with a number of schemes across directorates being worked up . The programme remains amber at present.. 2019/20 CIP planning will be commencing October/November 2018 when we have moved to the RP Hospital. Lorenzo benefits: NHS Digital have provide d feedback to the trust as we have reported the first benefits. The next submission will be in Mid July. They raised an issue with the trust that the benefits realised so far whilst they are positive and they have confidence in our approach to benefits, we are down on our planned benefits. This has been escalated to the Nursing and ICT directors and are noted in the key performance challenges.. New Papworth Hospital benefits: No further activity, await data mapping and collation of base line data by NPH team. Agreed benefits will have to owned by Operational and Executive leads and will be tracked in a similar style to Lorenzo benefits . Note – Amber/Green and Red/Amber on the New Papworth ORAC progress report are both mapped to Amber for the performance summary table on this page.

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SIP – project delivery 3 Red Red Red Red Amber Amber

Digital programme delivery on track 3 Amber Amber Amber Amber Amber Amber

New Papworth ORAC - overall progress 3 Amber Amber Amber Amber Amber Amber

PFI, Equipping & Estates - Design &

Construction3 Amber Amber Amber Amber Amber Amber

PFI, Equipping & Estates - Equipping 3 Amber Amber Amber Amber Amber Amber

PFI, Equipping & Estates - Enablement of

New Papworth3 Green Green Green Green Green Green

PFI, Equipping & Estates - Retained Estate

Enablement3 Green Green Green Green Green Green

PFI, Equipping & Estates - Site Sale and &

De-commissioning3 Amber Amber Amber Amber Amber Amber

Operational readiness - CTP Clinical

Services3 Green Green Green Green Amber Amber

Operational readiness - CTP Pathology 3 Amber Red Red Amber Amber Amber

Operational readiness - DORACS Clinical

Delivery3 Amber Green Green Green Green Green

Operational readiness - DORACS Clinical

Support3 Green Green Green Green Green Green

Operational readiness - DORACS Office

Policy3 Green Green Green Green Green Amber

Operational readiness - Move and

Migration3 Green Green Green Green Green Green

Workforce & Communications -

Communications3 Green Green Green Green Green Green

Workforce & Communications - Training

& Education3 Amber Amber Amber Amber Amber Amber

Workforce & Communications -

Workforce Planning3 Amber Amber Amber Amber Amber Amber

ICT - ICT & Telecoms 3 Amber Amber Amber Amber Amber Amber

Hospital Cutover - Move Control 3 Green Green Green Green Green Green

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DRAFT Transformation Key performance challenges Escalated challenges CTP: 1. Determining the initial solution for

Histopathology NPH Construction/Operational Readiness 1. NPH Delivery/Discharge of Planning

Condition (Car Parking) 2. Workforce – recruitment 3. Releasing staff to undertake NPH

delivery 4. Installation of ICT Equipment in a

Construction Environment 5. Effective pathology IT connectivity

between RPH and CUH

Service Improvement (SIP/CIP): 1. Two year operational plan

2. Lorenzo Benefits

3. Lorenzo Benefit - realisation

Key Risks CTP: 1. The risk that the LMB solution will not be available in time for the

hospital has been confirmed and therefore crystallised into an issue. NPH Construction/Operational Readiness: 1. If the planning condition regarding parking spaces is not discharged

then a certificate of occupation cannot be obtained 2. If the move to New Papworth Hospital leads to a worsening of retention

rates and staff leaving the Trust then the ability to deliver service could be compromised

3. If it is not possible to release staff to undertake NPH delivery preparation and training due to high turnover and vacancy levels then the operational readiness for the move will be affected .

4. If there are environmental issues with the rooms supporting the network infrastructure during construction the integrity of the new ICT infrastructure could be damaged.

5. If there is no IT connectivity there will be no facility for electronic pathology results reporting.

Service Improvement (SIP/CIP):

1. If the trust does not identify sufficient schemes to close the gap , then

the trusts planned deficit will increase by £658k for 2018/19.

2. If the trust cannot increase activity over the agreed plan then the planned cashable benefits will not be available to the trust. This may impact the agreement between the trust and NHS digital.

3. If the baseline for the Private Patient benefits is not valid then the trust will not accrue cashable benefits. This may impact the agreement between the trust and NHS digital.

Key Actions CTP: 1. Operational finalisation of elements of service that can be provided by CUH or by using space

within CUH/UofC buildings e.g. Frozen sections, urgent biopsies and tissue cut-up, is underway with the Pathology team at CUH. The commercial arrangements to support this have been agreed.

2. The procurement of a third party provider for the processing element of the service is underway and a decision is expected end of June 2018.

NPH Construction/Operational Readiness: 1. An application to discharge the condition has been made to the local planning authority with a June

deadline for determination. This is operating in parallel with applications by CUH to re-open the Forum car park

2. Agreed Recruitment Strategy in operation. Regular recruitment events scheduled and long-run vacancy levels reducing. Recruitment is in accordance with the agreed workforce models from Gateway 2. Staff consultations for move to Royal Papworth House are complete and those for the move to Royal Papworth Hospital now underway. Recruitment to new posts has commenced following conclusion of Gateway 2 and agreement of workforce models.

3. NPH familiarisation training plan developed and bookings well advanced, with agreement to supported additional hours working by staff and transportation arrangements via funding from the transitional budget.

4. The server and network rooms are on a regular cleaning regime and subject to review for other environmental conditions, pending full implementation of the building management system.

5. Linked to delivery of Requests and Results project.

Service Improvement (SIP/CIP): 1. Additional schemes from the CIP workshops have identified some opportunities and these are

currently being quantified. Gateway 2 style meetings are planned with operational directorates from June onwards to identify more schemes.

2. To report LOS bed day savings only at this stage and escalate to the Nursing and ICT directors. To investigate how the trust could use the LOS opportunities going forward.

3. To re audit the baseline and review the results in June 2018 . Issue escalated to the Nursing and ICT directors.

23


DRAFT Summary of Performance and Key Messages: Overall project confidence delivery has remained at red amber based upon the need to mobilise a revised solution for Histopathology. Work is advancing in this regard as solutions have been identified and once the procurement process for this element of work has more fully advanced, it is anticipated that the overall rating for the project will return to amber status.

Transformation Spotlight on : New Papworth ORAC progress report Summary of performance in figures:

Monthly RAG rating

24

Workstream Lead FEB MAR APR MAY Trend

PFI, Equipping & Estates RC

Design and Construction NH =

Equipping JMc =

Enablement of New Papworth AS 5 5 5 5 =

Retained Estate Enablement AS 5 5 5 5 =

Site Sale & Decommissioning AS 4 4 4 4 =

Operational Readiness EM

CTP - Clinical Services LC 5 5 4 4 =

CTP - Pathology JP 1 2 2 2 =

DORACs - Clinical Delivery AG 5 5 5 5 =

DORACs - Clinical Support MM 5 5 5 5 =

DORACs - Office Policy AG 5 5 5

Move and Migration LB 5 5 5 5 =

Workforce & Communications OM

Communications KW 5 5 5 5 =

Training & Familiarisation SHB 3 3 3 4

Workforce Planning JS 2 3 3 3 =

ICT AR

ICT and Telecoms MJ 3 3 3 3 =

Hospital Cutover RH/JR

Move Control JR 5 5 5 5 =

Overall Project Delivery Rating PMT 2 2 2 2 =

Workstream Delivery Assessment


DRAFT Finance Performance summary Accountable Executive: Director of Finance Report Author: Deputy Director of Finance 6 month performance trends


In month the Trust has reported a surplus of £674k, which is £93k ahead of the planned surplus of £581k. This is driven by Clinical income being below plan by £301k/-2.4% (£12,160k actual compared to £12,461k plan), Pay expenditure above plan by £161k/-1.0% (£15,262k actual against a plan of £15,101k), offset by favourable combined Non Pay expenditure which was below plan by £529k/+7.9%, with net variances of £26k in Other income and Donated assets making the balance. This results in the Trust’s year to date financial position being favourable to plan by £8k, with an actual deficit of £509k against a planned deficit of £517k.Total Clinical Income year to date position is adverse by £339k/-1.4%, however, £497k of this variance relates to reduced high cost device & drugs income (which offsets lower expenditure, as procured on a pass through basis), resulting in a net favourable year to date income position of £158k. This income position is predominately driven by lower Inpatient/Day case activity which is below plan (£195k), in Cardiac Surgery and Thoracic Medicine, with Transplant and ECMO showing higher activity; lower Outpatient activity (£110k); offset by increased Private patient activity (£170k) resulting from higher Cardiac Surgery and PTE activity. In addition, the Guaranteed Income Contract (GIC) agreed with NHSC&PCCG reflects an over performance of £77k, which is within the £100k contracted cap. The year to date Pay is £161k/-1.1% adverse to plan due to the level of temporary staffing, offset by favourable non pay expenditure totaling £605k/+4.6%,on clinical supplies, other non pay consumables and timing of the new hospital project expenditure. Actual year to date CIP achievement of £1,032k is £478k adverse to plan of £1,510k, due to £94k planning gap and an operational delivery gap of £384k from overspends in Pay compared to the Gateway 2 rosters, partially offset by non-recurrent underspends. Capital expenditure year to date is £6,727k which is underspent by £1,644, due to delays in timing of IT and Medical equipment purchases. The cash balance of £43,097k is favourable to plan by £9,770k, predominantly due to the receipt of the full £6.9m of Transitional funding in month (plan assumed monthly receipts throughout the year) together with the timing of the NPH capital equipping programme.

25

Data

Quality


Year to date EBITDA

surplus/(defici t) 4 £36k £(1,097)k £(879)k £(1,858)k £(2,470)k £(271)k £(25)k

Year to date

surplus/(defici t) £000s4 £(516)k £(5,542)k £(5,658)k £(48,544)k £(53,102)k £(1,183)k £(509)k

Cash Pos i tion at month

end £000s4 £33,327k £16,718k £15,127k £13,927k £50,224k £48,883k £43,097k

Use of resources rating 5 3 3 3 3 4 3 3

Capita l Expenditure YTD

£000s4

£35,724k

pa£3,052k £3,773k £4,244k £12,952k £3,435k £3,292k

In month Cl inica l Income

£000s4

£12461k

(current

month)

£11,362k £11,655k £10,759k £12,248k £12,067k £12,160k

CIP – Identi fied - YTD £000s 4 £1,510k £1,930k £2,338k £2,515k £3,021k £545k £1,032k

CIP – FY Target £000s 4£6,023k

pa£3,290k £3,446k £3,446k £3,446k £8,309k £8,851k

Agency spend as % of

sa lary bi l l4 2.89% 2.88% 3.45% 3.62% 4.71% 3.54% 4.88%

Ad

dit

ion

al

KP

Is

Debtors > 90 days overdue 4 10% 32.5% 36.8% 30.3% 22.8% 24.1% 32.0%

Das

hb

oar

d K

PIs


DRAFT May 2018 risk score changes:

Risk Increases: Master development and control plan: an increase in the risk has resulted from a reduced offer from Homes England for the existing site, resulting in a new risk score of 20 (previously 15). The Trust is continuing negotiations to ensure best value for money is achieved. Risk decreases: Current Trading – Income: this risk has reduced from 25 to 20 following the underlying year to date achievement of the Income plan (when adjusting for High Cost Drugs and Devices). Current Trading – Expenditure: this risk has also reduced as the net year to date expenditure is below planned levels. Delivery of efficiency challenges: an decrease in the likelihood of the Trust not delivering the levels of efficiency required to meet its plan, resulting in a new risk score of 20 (previously 25). This assessment has been made following the identification and sign off of a further £542k of CIP in month, which reduced the CIP planning gap to £670k. Transitional Relief: the Trust has received full payment of the first years tranche of transitional relief amounting to £6.9m in May, this has therefore reduced this risk from a score of 9 to 6.

Finance Key performance challenges

26

Progress against 2018/19 Annual Plan Submission YTD

Net deficit - The Trust‘s performance for the month of May was a surplus of £0.67m, which was favourable by £0.09m to the planned surplus of £0.58m.

Total Income - Clinical income in the month of £12.16m was behind the plan of £12.46m. This was due to a reduced pass through income for high costs drugs & devices, as a result of reduced activity levels and the EP devices which are now purchased directly by NHSE. This is offset with the reduction in expenditure. Actual Clinical activity in the month was adverse to plan in Cardiac Surgery, Thoracic Medicine and Outpatients, offset by increased performance in Transplant & ECMO activity. There was also a £0.01m under performance in the C&P CCG GIC contract . Non-clinical Income is close to plan this month, with an adverse variance of £0.04m, due to reduced charitable donated income for the New Hospital equipping programme, from that planned.

Pay costs - Total pay costs were adverse in the month against original plan, by £0.10m. There is an underlying favourable substantive pay position due to the number of vacancies that exist across the Trust, offset by the continued high levels of temporary staffing expenditure, specifically within the Operational Directorates. In addition, Hosted pay costs are £0.06m higher than plan, which is offset by other income.

Non-pay costs – Total Non-pay costs in the month were below plan, by £0.47m. There are a number of overspend and offsetting underspends across Directorates and expenditure categories, however it is the underspend in device costs, due to reduced activity that drives the overall favourable position, offset with other income reduction. There is also a favourable Depreciation variance of £0.06m, which in turn is due to the delay in the purchasing and commissioning of RPH medical equipment against the original equipment roll out plan.

Risk

appetite

FSRA

May 18

FSRA

June 18

A 7.1.1 Income 10 25 20

B 7.1.1 Expenditure 10 25 20

C 7.1.2 Income 12 20 20

D 7.1.2 Expenditure 12 15 15

Capacity Assumption E 7.2.1 Capacity Assumptions 10 25 25

F 7.3.1 Efficiency Assumptions 12 8 8

G 7.3.2 Delivery of Efficiency Challenge 12 25 20

Master Development & Control Plan H 7.4.1 Master Development & Control Plan 10 15 20

I 7.5.1 CBC Land and Link Tunnel 9 3 3

J 7.5.2 Unitary Payment 9 9 9

K 7.5.3 Capital Contribution Funding 10 10 10

L 7.5.4 Variations on the New Hospital 10 10 10

Whole Hospital Equipping M 7.6.1 Whole Hospital Equipping Plan 12 16 16

N 7.7.1 Transitional Relief 9 9 6

O 7.7.2 Additional Costs 10 12 12

Electronic Patient Record P 7.8.1 Electronic Patient Record System 12 10 10

Operational Transition

Financial Strategic Risks

Current Trading Impact

Future Growth

Efficiency

PFI


DRAFT Finance Spotlight on Cost Improvement Programme

27

May 2018 Cost Improvement Programme (CIP) Performance: The operational plan for 2018/19 contained a total CIP target of £9,951k which consisted of £2,757k unachieved CIP gap carried forward from 2017/18 and a £6,764k CIP target for 2018/19; Identified projects at the start of the year which had received full sign off as part of the 2018/19 Operational Plan were £8,309k as set out in the table below. In May an additional £542k CIP has been identified leaving a remaining unidentified gap of £671k. Of the £8,851k identified projects the operational CIP variance is adverse to plan by £383k at the end of May 2018. The actual year to date achievement was £1,032k to May 2018 against the identified plan of £1,416k. The total variance against the CIP target including the unidentified CIP to M02 is adverse by £478k against the plan of £1,510k. Key CIP Project Year to Date progress: The adverse CIP operational variance to May of £383k is detailed in Appendix 1 and is related to pay overspends in the following Directorates where a Gateway 2 pay CIP has been removed in 2018/19 but the budget is currently overspending. − Clinical Support Services £208k adverse; − Cardiology £64k adverse − Surgery £57k adverse; − Thoracic £43k adverse This is partially mitigated by non recurrent favourable pay variances in other directorates at M02 of £223k.

2018/19 CIP actual vs Target

CIP Summary – May 2018

2018/19

2018/19 TOTAL CIP TARGET £9,521k

Full year effect of 17/18 schemes:

Pathology Office Reconfiguration £12k

Finance Directorate Budget Review £1,458k

New Schemes in 2018/19:

Redundancy payment review (non-recurrent) £2,101k

Gateway 2 identified £4,738k

TOTAL IDENTIFIED 2018/19 CIP in Operational Plan £8,309k

Procurement Work Plan – Expenditure Reduction £500k

Pension cost reduction scheme £42k

TOTAL IDENTIFIED 2018/19 CIP including new schemes £8,851k

CIP balance to be allocated (planning variance) £671k

2018/19 full year

Target Actual Variance Target

Expense Type Identified Gap Total Actual Identified Gap Total Identified Gap Total

£'k £'k £'k £'k £'k £'k £'k £'k £'k £'k

CIP - Pay 732 0 732 349 (383) 0 (383) 4,803 0 4,803

CIP- Non Pay 684 94 778 684 0 (94) (94) 4,048 671 4,719

CIP - Total 1,416 94 1,510 1,032 (383) (94) (478) 8,851 671 9,521

Year to Date

Documents

Papworth Integrated Performance Report (PIPR) May 2018