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SUMMARY REPORT
TRUST BOARD 27 July 2017 Agenda Number: 05
Title of Report Integrated Performance Report
Accountable Officer Executive Directors
Author(s) Jo Davis, Associate Director Commissioning & Performance Richard Johnson, Head of Quality & Safety Compliance Graeme Booth, Financial Planning Manager Ruth Bardell, Deputy Director of HR & OD
Claire Florey, Access and Performance Manager
Judith Laity Strategy Programme Manager
Purpose of Report The objective of this report is to provide the Board with the Trust’s performance against key targets and draw attention to those areas under review by the Executive Team. The IPR includes performance against key national and local quality, operational, finance and workforce targets.
Recommendation The Board is recommended to:
Receive the report
Consultation Undertaken to Date
Nil.
Date(s) at which previously discussed by Trust Board / Committee
Nil.
Next Steps The Board will continue to be updated on Trust performance via the monthly Integrated Performance Report.
Executive Summary
The Integrated Performance Report highlights the key performance issues related to:
Quality;
Key Operational Standards;
Finance;
Our People;
Partnerships.
The Executive Summary on page 2 of the report provides a summary of the data for June 2017 and commentary on the wider aspects of our performance for the year thus far.
Financial Risks The report summarises the financial risks for the Trust.
Key Risks The Integrated Performance Report sets out mitigating actions in respect of most principal risks in the Board Assurance Framework
2
Disclosure Statement Performance data is held by the Trust and is used to produce the Integrated Performance Report. Audits have not identified data quality issues.
Equality and
Diversity Statement
There are no performance metrics relating specifically to Equality and Diversity in this report.
SUMMARY INTEGRATED PERFORMANCE REPORTJune 2017
EXECUTIVE SUMMARY
Quality & Safety:‐ There were three cases of Clostridium difficile reported in June, above tolerance for the year to date. MSSA incidence has continued with two in June, and due to the high
number in April this remains above tolerance.‐ The number of falls remains below the national average.‐ Eleven Serious Incidents (SIs) were declared in June, one of which met the classification of a Never Event.‐ The nationally benchmarked mortality indicators of HSMR and SHMI have reduced (positively) for the Trust. The new age and sex adjusted mortality rate shows a progressive
decline over the past 12 months. ‐ Friend and Family Test (FFT) response rates are improving.
Operational Performance : ‐ The Trust met the revised local ED 4‐hour standard performance trajectory for June (85.5% vs. 81.1%). The trajectory rises to 82.9% in July.‐ Delayed transfers of care were at 9.8%, equating to 61 per day, whilst average length of stay increased to 3.3 days.‐ Improved ambulance handover performance was sustained.‐ The diagnostic standard was not met in June for the 4th month in a row, July’s achievement is also at risk.‐ The Trust failed to achieve the RTT incomplete standard for the third month in a row – a standard that has been achieved consistently since October 2011– 90.7% (however the
local trajectory of 91.0% for Q1 was met). July’s achievement is also at risk.‐ Same day elective cancellations increased compared to the previous month as did 28 day rebooking breaches.
Finance: ‐ Trust level I&E is £0.2.m better than plan with a £3.5m deficit for the year to date. The deficit will increase each month until it reaches c£5m in M6 and then improves to a
£1.3m surplus. ‐ Agency spend has increased to £762k in month which is an improvement from £787k in May and is still below the £840k per month target.‐ The main risk relates to savings. CIP delivery is £0.5m below plan for the year to date and there is a shortfall of £5.7m against the £17.3m plan for the full year.
Our People: ‐ Total staffing utilised in June increased by 22 FTE of which substantive staff increased by 3 FTE and temporary staff increased by 19 FTE. ‐ Sickness absence at 3.52% improved to be the lowest absence rate reported by the Trust and within the Trust standard of 3.75%. ‐ Appraisal compliance in June increased by 1.9% to 83.8%. ‐ Vacancies remain high with 373 FTE posts actively in the recruitment process. Focus continues on recruiting to substantive posts, particularly in clinical roles.‐ Mandatory training compliance improved by 1% to 86.0% which is the highest compliance delivered in the last 5 years, albeit 9% below standard.
Partnership: ‐ SOF –The pre‐consultation business case is advancing, with co—production workshops planned with stakeholders across localities in early July. Contractual arrangements for
the delivery of the 111 and out of hours project are progressing. ‐ ED attendances and DTOCs are significantly ahead of the planned growth for the year to date.‐ Recruitment into clinical trial is on trajectory.
2
Key
CONTENTS
Section Name Accountable Officer/s Page
Section Summaries 4
Quality & Safety:Patient Safety/Experience Chief Nurse 11
Quality & Safety:Patient Safety/Outcomes/Effectiveness Medical Director 21
Key Operational Standards Chief Operating Officer 27
Finance Director of Finance 39
Our People Director of Human Resources & Organisational Development 42
Partnership Director of Strategy and Business Development 47
Unless noted on each graph, all data shown is for the period up to, and including June 2017.
Directorate/Group Abbreviation Glossary
– In Annual PlanCEO – Chief ExecutiveFUW – Follow up waitingNIHSS – NIH Stroke ScaleDOSA – Day of surgery admissionSI – Serious IncidentSHMI – Summary Hospital Level Mortality IndicatorYTD – Year to dateRTT – referral to treatmentDTOC – delayed transfer of careHSCIC – Health and Social Care Information CentreHSMR – Hospital Standardised Mortality RatioFTE – Full time equivalentSRO – Senior Responsible Officer
3
QUALITYPATIENT SAFETYSROs Medical Director and Chief Nurse
Section Summary
Areas of Concern:Three C.difficile infections reported for June which is above the monthly tolerance and above tolerance to date. There was one Never Event in Theatres in June.
Trends:The rate of “new” harm free care (RCHT hospital acquired harm) is just above target (97.52%). Catheter prevalence (19.29%) remains below the national average of 20%.
Improvements: The number of inpatient falls is below the national average.MSSA bacteraemia in June has significantly reduced from that seen in April.
Actions:1) Actions defined in the revised Trust Wide Falls Prevention Action Plan include a 12 month review
of the enhanced care process with further ward based training.2) Work continues to support the VTE exemplar status revalidation due August 2017, which
includes re‐introducing the VTE link nurses.
4
Section Summary
Areas of Concern:FFT feedback about the post natal ward has given some cause for concern with a significant increase in the ‘not recommended’ score. There was a common theme about the environment and lack of natural light, and there was also a theme about the lack of air conditioning and ventilation during the heatwave period. Actions taken are explained by charts 17 and 18.
Trends: Complaints acknowledgement is 100% for the second month running. Complaints numbers are at a higher level for the last 2 months.
Improvements: FFT response rates continue to improve. Inpatient/daycase FFT at 16.79%, is higher than it has been for over a year. Emergency FFT has exceeded its Q1 target even though it has dropped slightly this month. Compliments reporting has increased and responding to feedback on public website Care Opinion has increased.
Actions: to improve FFT response rates continue to meet more challenging targets in Q2. This involves communicating with staff in areas of high activity, and encouraging staff by publishing results on the new Patient Experience newsletter.
QUALITYPATIENT EXPERIENCEAccountable Officer : Chief Nurse
5
Section Summary
Areas of Concern:Sepsis: Although the rate of screening for sepsis in all admitting areas is satisfactory and although the rate of administration of antibiotics within 1 hour has improved significantly, performance has not reached the level we would like to see. Trends:All three adjusted mortality rates continue to evidence reduction and all are firmly within the expected rage.
Improvements:The gap between week day and weekend mortality is now showing a sustained reduction
Actions:1. The positive impact on the reduction of mortality continues to be progressed through the work of the clinical mortality subgroups and the Mortality Oversight Committee.2. The addition of the application for sepsis screening onto NerveCentre will mean that all patients, where eObs are used, will be consistently screened. 3. Work continues towards embedding the 4 priority standards and identified in the NHSE Seven Day Clinical Standards and will help to redress the disparity between weekend and weekend mortality rates.
QUALITY ‐ PATIENT OUTCOMES/EFFECTIVENESSSRO Medical Director
6
KEY OPERATIONAL STANDARDSSRO Chief Operating Officer
Section Summary
Areas of concern:DTOCs remain high at an average of 61 per day. The Trust did not meet the diagnostic or the RTT incomplete national standard (although the Q1 local trajectory was achieved). The number of patients cancelled on the day increased. ED 4‐hour performance was 85.5%, below the latest national average but meeting the local trajectory of 81.1% for Q1.
Trends:
Improvements:Stoke CT scanning, swallow screening and the percentage of patients more than 1 month past their to be seen date all improved on May.
Actions:
The improved trend in ambulance handover delays was sustained. Stroke performance continues strongly – all indicators were met. High levels of DTOCs continue. Both the RTT waiting list and backlog are increasing putting Q2 at risk. The Trust continues to meet all reported Cancer standards.
1. Key focus remains recovering diagnostic performance and managing risk of waiting list backlogs.2. The Trust continues to work with system wide key partners to mitigate and address the step
changes experienced since the changes to NHS 111 and out of hours services implemented in October 2015. CQC system wide DTOC assessment visit end of April.
7
Section Summary
Areas of Concern: • Savings of £2.3m delivered to date which is £0.5m below plan. However, the full year forecast stands
at £11.6m compared to a plan of £17.3m meaning that there is a risk of a £5.7m shortfall at present.• The shortfall is entirely in relation to schemes designed to reduce pay costs.
Trends:• Agency spend is below budgeted levels.• Two of the four clinical Divisions, plus Corporate departments, are operating below budget.• Surgical Services Division continues to overspend due to unidentified savings.
Improvements:• Income is £0.1m better than plan and is now £0.5m better than plan for the year to date.
Actions:1. Focus on reduction in substantive pay costs through service redesign. Minimise investment to
safeguard contingency and reserves.
FINANCESRO Director of Finance
8
Section Summary
Areas of Concern:• Recruitment continues to be challenging. As part of the countywide Shaping Our Future health and
social care programme, joint working across organisations in Cornwall will focus recruitment campaigns for clinical staff.
• Agency use increased by 2 FTE to 77 FTE with the associated pay costs totalling £762k in June.
Trends:• Appraisal compliance has resumed an upwards trend and at 83.8% is the highest recorded at RCHT.• Turnover remained relatively static at 10.6%, 3% of which relates to junior doctor rotations.
Improvements:• Sickness absence at 3.52% in June is the lowest monthly rate reported by the Trust.• Mandatory training compliance improved by 1% to 86.0% and is at the highest rate achieved in the
past five years.
Actions:• Work continues to recruit to vacancies.• The Trust’s new Pay Progression Policy will further drive focus and improvement in training and
appraisal compliance.
OUR PEOPLESRO Director of HR and OD
9
Section Summary
Areas of Concern:
Trends:
Improvements:Recruitment into clinical trials is now on trajectory for the year to date.
Actions:
PARTNERSHIPSSRO Director of Strategy and Business Development
Sustainability and Transformation Plan – Size and scale of the challenges within the ‘Shaping Our Future’ programme remain ambitious, and scope has expanded to include Cancer, Mental Heath, Maternity and Children's services Some key roles remain vacant within the programme. Prompt appropriate discharge – Delayed transfers of care remain high, significantly above the level experienced in 2016. Reduce the growth in the number of ED attendances – Growth in ED attendance increased in June and remains significantly ahead of the plan which allows only for demographic growth.
DTOC remain significantly over profile; ED attendances are over profile.
SOF – Recruitment into key roles including the SOF Clinical Director and the Pre‐Consultation Business Case Manager has commenced. Development of the activity model to support the SOF is on going. Co‐production work shops to be held during July forthe pre‐consultation business casePathways of Care – The business case for investment to implement the Hip and Knee Pathway work is on going and planned to be presented to the New Models of Care Meeting at the end of July. Divisional analysis of the outpatient savings calculated using the Carter methodology will be presented at the July meeting for the top 4 specialties.
10
QUALITY & SAFETYPATIENT SAFETYSummary Dashboard
11
QUALITYPatient SafetySafety ThermometerAccountable Officer: Chief Nurse
(1) In June the rate of “new” harm free care (RCHT hospital acquired harm) is just above target (97.52%). 15 patients received a new harm compared to 21 in June.
(2) Catheter prevalence (19.29%) remains below the national average of 20%. Two new UTI was reported for June.
(3) Work continues to support the VTE exemplar status revalidation due August 2017, which includes re‐introducing the VTE link nurses.
4) There is a downward trend this month for pressure ulcers and this is also reflected in the incidence data for June: lowest rate to date this year. Work continues to promote preventative care with the Tissue Viability team being proactive at ward level to promote on‐going and consistent use of risk and skin assessments.
12
0.0%0.2%0.4%0.6%0.8%1.0%1.2%1.4%1.6%1.8%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(2) Catheters and UTIs
Catheters& UTIsTrend
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(3) New VTEs
NewVTEsTrend
0%
1%
2%
3%
4%
5%
6%
7%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(4) Pressure Ulcers
% of oldpressure ulcers
% of newpressure ulcers
Trend
86%
88%
90%
92%
94%
96%
98%
100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(1) % New harm free care vs all harms
% Newharmfree
Allharmfree %
QUALITYPatient SafetySafety ThermometerAccountable Officer: Chief Nurse
(5) For June the number of inpatient falls is 6.2 per 1000 OBD; so the number of falls are fewer than the national average of 6.63.
RCHT has also supported the use and ownership of local data to drive improvement by reintroducing the safety crosses for recording number of falls. This information is visible to patients, visitors and staff on the ‘Know How We Are Doing Boards’ in all inpatient areas.
Actions defined in the revised Trust Wide Falls Prevention Action Plan include a 12 month review of the enhanced care process with further ward based training; review of temporary staff induction around key risk; roll out of post falls huddles, bay watch and bay working; improving multidisciplinary discussions regarding incidents and risks. These will be driven by using quality improvement methodology. . (6) 6 falls with harm were reported on Safety Thermometer in June with one of these occurring in the community. (7 & 8) 2 serious incidents have been declared relating to a patient fall. Falls resulting in moderate to severe harm per 1000 bed days were 0.
13
0
1
2
3
4
5
6
7
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(7) Falls SIs
Actual
Trend
0.00%
0.05%
0.10%
0.15%
0.20%
0.25%
0.30%
0.35%Ap
r‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(8) Moderate/Severe Harm Falls
Actual
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(6) Falls with harm Safety Thermometer
Actual
Trend
0.01.02.03.04.05.06.07.08.0
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(5) Falls per 1000 bed days
Actual
QUALITYPatient SafetyInfection ControlAccountable Officer: Chief Nurse
(9) No MRSA bacteraemia were reported during June. The last case was reported in September 2016.
(11, 12) Three cases of C.difficle were reported in June which is above the monthly tolerance of 2 and above the tolerance to date. Two of the cases have been reviewed through the RCA process and one is currently under review. Lapses in care contributing to the acquisition of C. difficile were not identified in one of the cases however in the second case probiotics were not prescribed as per policy.
(10) Two cases of MSSA bacteraemia were reported in June above the monthly tolerance of 1. Review of one of the cases was unable to clearly identify the source and the second case is under review. We will continue to focus on line care via the Quanta data as this has been a recurring theme to date.
14
0
1
2
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(9) MRSA
Actual
Tolerance
0
5
10
15
20
25
30
Apr‐17
May‐17
Jun‐17
Jul‐1
7Au
g‐17
Sep‐17
Oct‐17
Nov
‐17
Dec‐17
Jan‐18
Feb‐18
Mar‐18
(10) MSSA Cases
16/17 Actual
17/18 Actual
0
1
2
3
4
5
6
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(11) C‐Difficile Cases
Actual
Tolerance
0
5
10
15
20
25
30
Apr‐17
May‐17
Jun‐17
Jul‐1
7Au
g‐17
Sep‐17
Oct‐17
Nov
‐17
Dec‐17
Jan‐18
Feb‐18
Mar‐18
(12) C‐Difficile Tolerance
Actual 16/17
Actual 17/18
Tolerance 17/18
QUALITY & SAFETYPATIENT EXPERIENCESummary Dashboard
15
QUALITY – Patient ExperienceFriends & Family TestResponse ratesAccountable Officer: Chief Nurse
(13, 15) The Medical Day Case Unit and Wheal Prosper Ward have seen a considerable increase in their response rates this month which has assisted the inpatient/daycase areas to move closer to their 20% target for the end of Q1. June saw a 3% increase in response rates from last month resulting in an overall total of 17%. Paediatrics are working with the Patient Experience Team to trial new posters and leaflets encouraging their patients/service users to complete the survey online, using their SMART phones.
(14, 16) Emergency services response rates have seen a slight decrease from last month, but remain in‐line with the NHS England average. AECU continue to achieve response rates >70% which is commendablele and Paediatric Assessment Unit, St Mawes, and MAU are all achieving response rates >20%. ED, CDU, and WCH Urgent Care Centre are low performing and it is hoped that the more successful areas can share their learning and ideas to achieve better results in these areas going forward into Q2.
16
0.00%5.00%10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(13) Inpatient/Daycase Response Rates
Series1
Series2
Trend
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(14) Emergency Services Response Rates
Series1
Series2
Trend
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(15) Inpatients/Daycases Comparators Response Rates
RCHT
PHT
RD&E
SW
England 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%Ap
r‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(16) Emergency Services Comparators Response Rates
RCHT
PHT
RD&E
SW
England
QUALITY – Patient ExperienceFriends & Family TestAccountable Officer: Chief Nurse
(17) (18) Both Maternity (Antenatal Care) and (Birth) saw improvements in their recommended scores (circa +4%) and both achieved nil scores for their ‘not recommended’ returns.
Maternity (Care on Postnatal Ward) has seen a considerable increase in their ‘not recommended’ score at 14.13%. This was down to 13 people of the 92 who returned questionnaires stating that they were either ‘unlikely’ (4) or ‘extremely unlikely’ (9) to recommend Wheal Fortune. Whilst generally there is praise for the midwives on the ward, the common theme is about environment and lack of natural light. In June, Cornwall experienced a heat‐wave and many of the comments from women stated that there was a lack of air conditioning and ventilation. Staff tried to rectify this with immediate action and fans were sourced to try and cool the area. An action plan is now in place with Estates to ensure that contractors finish the roof with a reflective coating and that an opaque privacy film is applied to windows to allow blinds and curtains to be open and encourage full air circulation.
17
0%10%20%30%40%50%60%70%80%90%
100%
(17) Friends & Family ‐‐ Recommended Rates
Standard (17/18)
Mar‐17
Apr‐17
May‐17
Jun‐17
0%2%4%6%8%10%12%14%16%
Inpatient/Daycase Emergency Outpatients MaternityAntenatal
Maternity Birth MaternityPostnatal Ward
MaternityPostnatalCommunity
(18) Friends & Family ‐ Not Recommended Rates
Mar‐17 Apr‐17 May‐17 Jun‐17
QUALITYPatient ExperienceComplaintsAccountable Officer: Chief Nurse
(19) 41 complaints were received in June, which is slightly less than May but still higher than at any other time since May 2016.
(20) This higher than usual number is due to a peak in number of complaints being received in Medicine (22). Other Divisions have received complaints within their usual range: Surgery 9, WCSH 5, CSCS 4 and 1 was received for Corporate Services.
(21) PALS recorded 97 concerns which lies within an average range.
(22) 648 compliments have been logged in the Trust in June demonstrating the success of utilising QUANTA for compliments reporting.
PHSO – One new enquiry and two final reports were received in June, one relating to a complaint first received in CSCS in July 2015, and one relating to a complaint received in WCSH in August 2016.Neither final report were upheld by the PHSO.
18
0
20
40
60
80
100
120
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(19) Total number of complaints
Total inMonth
Open atMonth End
Trend
0
5
10
15
20
25
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(20) Number new complaints by Service
Medicine
Surgery
WC&SH
CSCS
Corporate
0
20
40
60
80
100
120
140
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(21) Total PALS concerns
Actual
Trend
0
100
200
300
400
500
600
700
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(22) Total compliments
Actual
Trend
QUALITYPatient ExperienceComplaintsAccountable Officer: Chief Nurse
(23) The top four subjects of new complaints in May were:• Clinical Treatment (10)• Communication (8)• Patient Care (5)• Values and Behaviours (5)These are now under investigation.
(24) 100% of complaints were acknowledged within 3 working days as required by complaints regulation.
(25) Of complaints closed in June, only 1 had breached the agreed 25 day timescale (Medicine).
(26) ‘Follow‐ups’ are further letters received from complainants who are not satisfied with the Trust’s first response to their complaint; 1 was received in June.
Care Opinion/ NHS ChoicesMonitoring and responding in the public domain to online feedback was taken over by the Patient and Family Experience Team from 1 April. At end of June, 61% of feedback has been responded to (based on the last 100 comments) compared with 35% at the end of May and 12% at the end of April. In June, 31 comments were left: 25 positive, 6 negative and one mixed. One change in response to this feedback: post natal ward have devised a ward information sheet explaining the routine of the ward.
19
0 5 10 15
Apr‐16May‐16Jun‐16Jul‐16Aug‐16Sep‐16Oct‐16Nov‐16Dec‐16Jan‐17Feb‐17Mar‐17Apr‐17May‐17Jun‐17
(23) Top subjects of complaintOther
Privacy Dignity and Well Being
Staff Numbers
Appointments
Patient Care
Prescribing
Facilities
Admissions and Discharges
Values and Behaviour of staff
Clincal treatment
Access to Treatment or Drugs
Communications
0123456789
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(25) Number of complaints responses which breached 25 days
Medicine
Surgery
WC&SH
CSCS
Corporate 0
1
2
3
4
5
6
7
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(26) Number of complaints 'follow ups' by Service
Medicine
Surgery
WC&SH
CSCS
Corporate
60%65%70%75%80%85%90%95%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(24) % complaints acknowledged in 3 working days
Actual
QUALITY Patient ExperienceMixed Sex Accommodation BreachesAccountable Officer: Chief Nurse
(27) 2 non‐clinically justified single sex breaches were reported in June. One occurred on Critical Care due to delay in transferring out of the unit as a result of organisational pressures (opal level 4) and one on Wellington ward with the patient being transferred to the respiratory higher care despite not requiring respiratory higher care needs. This was deemed the safest place for the patient at the time during a period of increased organisational pressures (opal level 4).
20
0
1
2
3
4
5
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(27) Mixed Sex Accommodation breaches
Actual
Trend
QUALITYPatient SafetyNever Events & Serious IncidentsAccountable Officer: Medical Director
(28 & 29) There were 11 Serious Incidents reported, one of which was a Never Event. The SIs for June are as follows:2017/14082 – Treatment Delay (Ophthalmology)2017/14131 – Maternity/Obstetrics (Delivery Suite)2017/14136 – Patient Fall (Wheal Coates)2017/14572 – Maternity/Obstetrics (Delivery Suite)2017/14736 – Alleged Abuse (Kerensa)2017/15124 – Patient Fall (Wheal Prosper)2017/15137 – Failure to Monitor (MAU1)2017/15311 – Failure to Monitor (Carnkie)2017/15856 – Treatment Delay (Eye Unit)2017/15885 – Information Governance (CITS)2017/16109 – Never Event – Wrong Implant (Endoscopy)
(30) Of the 65 SI investigations underway in June, 14 have breached the deadline for completion. Additional KPI’s will be added to this slide
(31) Patient falls continue to be the most common reason for Serious Incidents. The Quality Assurance Committee review the improvement actions at each meeting.
21
0
1
2
3
4
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(28) Never Events
Actual
0246810121416
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(29) Serious Incidents
Dateincidentdeclared
0 5 10 15 20 25 30
Slips. Trip, fallsTreatment delay
Diagnostic incident‐ delay / failure to act on test resultsSurgical / invasive procedure incident
Sub‐optimal care of the deteriorating patientMaternity / Obstetric: baby only
Major incidentPressure Ulcer
Abuse / alleged abuse of child patient by third partyOther
Healthcare Acquired InfectionDisruptive / aggressive / violent behaviour
Abuse / alleged abuse of adult patient by staffMedication incident
Information GovernanceVTE
(31) Serious Incident Types: April 2016‐ June 2017
2016/17 2017/18
0
10
20
30
40
50
60
70
Jun‐17
Jul‐1
7Au
g‐17
Sep‐17
Oct‐17
Nov
‐17
Dec‐17
Jan‐18
Feb‐18
Mar‐18
(30) SI Investigations
SIs breached
SIs not breached
QUALITY – Patient SafetyMedicines ManagementMedicine Reconciliation Accountable Officer: Medical Director
(32) The accurate prescribing of medicines at the transfer of care is a high risk area and medicines reconciliation is a key control measure undertaken by the clinical pharmacy team.
Pharmacy undertakes >2,000 meds recs a month for >80% of patients (excluding <24hrs, paeds, Obs and SMH).
NICE guidance is to achieve 100% of patients within 24hrs. RCHT achieves approximately 65% within 24hrs and 86% overall.
Investment in a 7 day clinical ED service would be required to significantly improve our performance.
There is currently no clinical pharmacy service provided to ICDU and thus no medicines reconciliation for patients directly admitted to this ward.
22
40%45%50%55%60%65%70%75%80%85%90%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(32) Medicine Reconciliation
Actual
Trend
QUALITYPATIENT OUTCOMES/EFFECTIVENESSSummary Dashboard
23
QUALITY Patient Outcomes/EffectivenessMortalityAccountable Officer: Medical Director
(33) The SHMI is the ratio of observed deaths to expected deaths. It includes those patients who die within 30 days of discharge. The SHMI has shown a slight decrease, being 98.44 for February 2017; data lags behind the HSMR data.
The HSMR is the ratio of observed deaths to expected deaths for a basket of 56 (clinical classification system) diagnosis groups which represent approximately 80% of in‐hospital deaths. The overall HSMR has shown a further reduction to 97.3 remaining within the expected range. SMR is mortality adjusted for age and gender alone, this too is firmly in the expected range.
The crude mortality rate for March (11.3) is also stable although there is a slight upward trend.
(34) There is a gap between weekend and weekday mortality, however this continues to narrow and the Trust is not alerting for weekend mortality. Increased weekend mortality is a national phenomenon that is not well understood. RCHT benchmarks in mid position within the SW. RCHT has conducted a gap analysis into the National Guidance for Learning from Deaths (03/17) and is producing an action plan to address these.
24
90
95
100
105
110
115
120
125
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
(34) Rolling HSMR by Non‐weekend/Weekend
Rolling 12monthHSMRNon‐weekend
Weekend
0
20
40
60
80
100
120
80
85
90
95
100
105
110
115
Apr‐16
May‐16
Jun‐16
Jul‐1
6
Aug‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(33) SHMI, HSMR and Crude Mortality
SHMI
HSMR
Crude Mortality
SMR
Trend (SHMI)
Trend (HSMR)
Trend (Crude Mortality)
QUALITY Patient Outcomes/EffectivenessSepsisAccountable Officer: Medical Director
When looking at the results on these graphs it needs to be noted that the information is derived from the CQUIN audit. This audit only requires 50 emergency admissions and 50 inpatients notes to used as a data source.
(35)There was 94% screening for sepsisas patients were admitted in May. This was reduced as other admitting areas have been included in the audit.
(36) There has been a further 10% increase in the administration of antibiotics within the hour for patients with severe sepsis. Deep dive audits are now in progress in ED to try to find what the factors are influencing the timely administration. Figures from the ED retrospective audit for April are awaited.
(37) There has been an increase in the number of inpatients screened of 6%.
Scoping for the screening tool on Nervecentre starts on the 7th of August with a projected start date of October 2017. This will coincide with the introduction of the NICE guidelines.Training is on going with the start of the use of a sepsis training trolley. This will be taken out to areas around the hospital to ease the pressure of releasing staff.
25
30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(35) Patients who met the criteria and were screened for sepsis ‐ ED & other admitting areas
Actual
Standard
Trend
0%
20%
40%
60%
80%
100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(36) IV antibiotics within 1 hour (severe sepsis) ‐ED & other admitting areas
Actual
Standard
Trend
0%
20%
40%
60%
80%
100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(37) Patients who met the criteria and were screened for sepsis ‐ Inpatients
Actual
Standard
Trend
0%
20%
40%
60%
80%
100%Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(38) IV antibiotics within 1 hour (severe sepsis) ‐Inpatients
Actual
Standard
Trend
QUALITY Patient Outcomes/EffectivenessCardiac and Peri ArrestsAccountable Officer: Medical Director
26
(40) The number of cardiac arrests in June is the same as the previous month (7). This was a reduction on the number of arrests for the same month last year (9). The overall trend for 2016 showed a reduction in arrest numbers by 32% (RCHT target was 10%). 2017 seemed to be following suit with a reduction every month until April when there was an increase and now a constant in both May & June.
(41) The number of peri‐arrest calls increased slightly from 6 to 7 (May/June). There were 12 peri‐arrest calls for same month in 2016. 2016 saw an overall increase in peri‐arrest calls by 9%.
The continuing use of Nervecentreacross the Trust and more appropriate use of Treatment Escalation Plans should further reduce the number of cardiac arrests.
(42) 84.6% of Primary PCI call to balloon times were within 150 minutes, above the standard of 75%.
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%Ap
r‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(42) Primary PCI 'call to balloon' of 75% within 150 minutes
Actual
Standard
Trend
0
2
4
6
8
10
12
14
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(40) Cardiac Arrests
Actual
Trend
02468101214161820
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(41) Peri Arrests
Actual
Trend
0.000.100.200.300.400.500.600.700.80
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(39) Cardiac Arrests per 1000 bed days
Actual
Trend
Key Operational Standards Summary DashboardAccountable Officer: Chief Operating Officer
27
Key Operational StandardsEmergency & Urgent CareAccountable Officer: Chief Operating Officer
28
(43) Performance against the 4 hour standard in June was 85.5%, remaining above the new local trajectory of 81.1%.The local trajectory rises to 82.9% In July. Nationally, the most recent benchmark is May’s performance which was 89.7% ‐ only 17 out of 138 Trusts achieved the national standard.
ED attendances were 6.6% above the same month last year – all this growth was within Cornish residents as opposed to visitors to the county.
(44) Unplanned re‐attendances reduced very slightly to 7.6%, remaining above best practice of 5% but remaining in line with national performance (7.8% March 17).
(45, 46) The improving ambulance handover delay performance was sustained across both metrics (% waiting over 15 minutes and number of ambulances waiting over 30 minutes) with both slightly reducing.
0%10%20%30%40%50%60%70%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(45) Ambulance Delays ‐% waiting over 15 minutes
Actual
Standard
Trend
0
100
200
300
400
500
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(46) Ambulance Delays ‐ Numbers waiting over 30 minutes
Actual
Trend
60%65%70%75%80%85%90%95%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(43) ED attenders 4 hours arrival to discharge, admission or transfer
Actual
Standard
Localtrajectory
0%1%2%3%4%5%6%7%8%9%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(44) Unplanned reattendance at ED (% of total attenders)
Actual
Threshold min
Standard
Trend
Key Operational StandardsEmergency & Urgent CareAccountable Officer: Chief Operating Officer
29
(47) The percentage of ED attenders who left without being seen reduced from 2.6% to 2.3%, within the national standard. It remains below the most recent national figure (Feb 17) of 2.9%.
(48, 49) Of the other ED quality indicators, the 95th percentile time to initial assessment (triage) remained 28 minutes (remaining well above the 15 minute standard but sustaining the recent improving trend). Median time for arrival to treatment also stayed the same as the previous month – 59 minutes which is the highest since March last year.
(50) There were no 12 hour trolley waits.
0
1
2
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(50) 12 hour trolley waits
Actual
0%
1%
2%
3%
4%
5%
6%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(47) % of ED Attenders who left without being seen
Actual
Standard
Trend
0510152025303540
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(48) 95th percentile, Time to Initial Assessment (mins)
Actual
Standard
Trend
010203040506070
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(49) Median Time from Arrival to Treatment (mins)
Actual
Standard
Trend
Key Operational StandardsLength of StayAccountable Officer: Chief Operating Officer
30
(51) Although the number of specialty outliers increased by 1, this indicator remains at its lowest since October 2015.
(52, 54) Length of stay over 10 days was 30.0% (26.9% in June 2016) whilst average length of stay was 3.3 days –0.2 days longer than the same month last year.
(53) The percentage of patients discharged before 10am reduced slightly month on month; at 6.2% it was just under June 2016’s performance which was 6.3%.
0
10
20
30
40
50
60
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(51) Total specialty outliers
Actual
Standard
Trend
0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(53) % Discharges Before 10am
% Patientsdischargedbefore 10am
Target (%)
22.22.42.62.83
3.23.43.63.8
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(54) Average LOS
Actual
Standard
Trend
0%5%10%15%20%25%30%35%40%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(52) Length of Stay over 10 days
Actual
Standard
Trend
Key Operational StandardsCancerAccountable Officer: Chief Operating Officer
31
(55‐58) Although neither the 62 day referral to treatment or the 31 day subsequent surgery standards were met in May, the Trust remains on track to meet all the standards for Q1.
There 1.5 breaches recorded past the 104 day backstop target in April. All were in Urology and due to delays for prostate biopsies.
There remains a number of challenges across the cancer pathways currently – the specialty teams are progressing plans to ensure performance is recovered.
The Trust retains its record of quarterly achievement on all standards since Q2 2010‐11.
90%91%92%93%94%95%96%97%98%99%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(55) Cancer 2 week wait
Actual
Standard
Trend
94%
95%
96%
97%
98%
99%
100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(56) Cancer treated within 31 Days Target
Actual
Standard
Trend
81%82%83%84%85%86%87%88%89%90%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(57) Cancer treated within 62 Days Target
Actual
Standard
Trend
60%65%70%75%80%85%90%95%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
(58) Percentage receiving first definitive treatment within 62 days of urgent referral from
national screening service
Actual
Standard
Trend
Key Operational StandardsReferral to treatmentAccountable Officer: Chief Operating Officer
32
(59, 60) Referral to Treatment target performance continued to worsen in June – 90.7% of incomplete pathways were under 18 weeks. This is the 3rdmonth in the row that the Trust failed to meet the national standard. The overall size of the RTT waiting list continues to grow – 19% bigger than June last year. The backlog of patients exceeded 2000 for the first time, rising to 2238. However, the local trajectory of 91% was met for Q1.
National performance was 90.4% in May, median wait of 7.1 weeks –RCHT’s median wait (June) was 7.7 weeks, worse than national average.
It is highly unlikely that the standard of 92% will be met in July.
(61) The incomplete backlogs of the 4 most challenged specialties are shown – the backlog increased in all 4.
(62) The proportion of patients receiving key diagnostics within 6 weeks was 97.2%, meaning the Trust failed the diagnostic target for the 4th month in a row. This was due to capacity issues within Urology and Cardiology and equipment breakdowns within Clinical Imaging. In May national performance was 98.1% ‐ the Trust is now in the lowest quartile of all diagnostic providers.
89.5%90.0%90.5%91.0%91.5%92.0%92.5%93.0%93.5%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(59) RTT Incomplete‐ % within 18 weeks
Actual
Standard
LocalTrajectory
0
5000
10000
15000
20000
25000
30000
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(60) Incomplete pathways
Actual
Trend
0
100
200
300
400
500
600
700
Apr‐16
Jun‐16
Aug‐16
Oct‐16
Dec‐16
Feb‐17
Apr‐17
Jun‐17
Trauma andOrthopaedics
GeneralSurgery
Cardiology
Gynaecology
(61) Specialties not achieving RTT standard
97.00%
97.50%
98.00%
98.50%
99.00%
99.50%
100.00%Ap
r‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(62) Proportion of patients receiving one of the 15 Key Diagnostic Tests within 6 weeks
Actual
Standard
Trend
Key Operational StandardsCancelled OperationsAccountable Officer: Chief Operating Officer
33
(63) The number of patients cancelled on the day and not re‐booked to return within 28 days increased by 6 to 22 – there were 8 in June last year.
(64) The number of patients cancelled on the day increased again from 84 to 123 (2.0%). 39.8% were due to lack of routine beds.
(65) There were no urgent patients cancelled more than once.
(66) This relates to cancelled outpatient clinics with less than 6 weeks’ notice. This increased to 4.2% compared to 3.1% In June last year. Of the 200 clinics cancelled with less than 6 weeks’ notice, 69.0% were for avoidable reasons.
0%
1%
2%
3%
4%
5%
6%
7%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(66) Short notice OP Clinic cancellations
Actual
Trend
00.10.20.30.40.50.60.70.80.91
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(65) Urgent operations cancelled more than once
Actual
051015202530354045
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(63) 28 day re‐booking breaches
Actual
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(64) Percentage Cancellations on same day
Actual
Standard
Trend
Key Operational Standards Specialised PathwaysFractured Neck of Femur & Stroke IndicatorsAccountable Officer: Chief Operating Officer
34
(67) The percentage of patients with fractured neck of femur operated on within 36 was 80.0%, meeting the local standard (and national upper quartile) of 80% (increased from 75% last year). The team are working with the Associate Medical Director for Quality Improvement using a variety of continuous quality improvement methods to ensure achievement of this standard is sustained.
(68, 69) Performance remains above standard for all stroke metrics. 70.0% of patients were admitted to the stroke unit within 4 hours, whilst 87.8% of patients spent at least 90% of their inpatient stay on the stroke unit.
(70, 71) The stroke scanning KPIs continued above standard as expected.
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(68) % Patients spending 90% of their time on stroke unit
Actual
Standard
Trend
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(69) Stroke unit within 4 hours
Actual
Standard
Trend
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(70) Stroke patients receiving CT scan within 12 hours
Actual
Standard
Trend
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(67) NOF patients operated on within 36 hours
Actual
Standard
Trend
Key Operational Standards Specialised PathwaysStroke IndicatorsAccountable Officer: Chief Operating Officer
35
(72) Swallow screening continues to be delivered above standard, increasing to 86.5%.
(73) More timely data collection is now being achieved following the establishment of the new team of stroke nurses. The NIHSS Compliance indicator was 96.3% against the standard of 75.0%.
(74) Swallow assessment within 72 hours was 91.7%.
*Please note that all standards for stroke are based on the most recent national averages.
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(71) Scanning CT Urgent within 1 hour
Actual
Standard
Trend
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(72) Swallow screening within 4 hours
Actual
Standard
Trend
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(73) NIHSS Compliance
Actual
Standard
Trend
0%10%20%30%40%50%60%70%80%90%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(74) Swallow Assessment 72 hours
Actual
Standard
Trend
Key Operational StandardsProductivity and efficiency measuresAccountable Officer: Chief Operating Officer
36
(75) Delayed Transfers of Care (DTOC) days lost remained at 9.8%, significantly above the 3.5% standard and last June’s days lost (6.2%). This equated to 61 per day – 6 more than June last year.
(76) The top categories for delay were further non acute NHS care, domiciliary package and completion of assessment.
(77, 78) The daycase rate was 86.1% whilst the day of surgery admission (DOSA) rate increased from 90.1% to 92.7%.
0%
2%
4%
6%
8%
10%
12%
14%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(75) Delayed transfers of care (days lost %)
Actual
Standard
Trend
0
50
100
150
200
250
300
350
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(76) Delayed transfers of care by reason
Public Funding
Residential Home
Patient or Family Choice
Nursing Home
Further non acute NHS care
Domiciliary Package
Completion of assessement
Community Equipment
80%81%82%83%84%85%86%87%88%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(77) Daycase rate
Actual
Standard
Trend
88%89%89%90%90%91%91%92%92%93%93%94%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(78) DOSA Rate
Actual
Standard
Trend
Key Operational StandardsProductivity and efficiency measuresAccountable Officer: Chief Operating Officer
37
(79) Net emergency readmissions within 28 days was 5.3% and thus stayed above the target of 4.8%.
(80) The outpatient DNA rate was static at 6.5% (6.6% last year) as the recent improvement trend – achieved through implementation of the Netcalltext and phone reminder service – has now levelled out. This remains above national upper quartile performance which is now 5.7%.
(81) The number of follow‐up patients waiting more 1 month past their to be seen by date reduced to 3.9% however there was no significant change in the tail of the waiting list backlog or length of time waited beyond due date.
(82) Average points are used as a measure of productivity within outpatient clinics, with attended new patients equating to 2 points and follow‐ups to 1. The average points per clinic was 10.5, the same as June 2016.
0%1%2%3%4%5%6%7%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(81) Patients on the FUWL 1 Month Past Their To Be Seen Date
Actual
Trend
4.0%
4.5%
5.0%
5.5%
6.0%
6.5%
7.0%
7.5%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(80) All OP DNA Rate
Actual
Standard
Trend
9.8
10.0
10.2
10.4
10.6
10.8
11.0
11.2Ap
r‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(82) Average Points per Clinic
Actual
Target
0%
1%
2%
3%
4%
5%
6%
7%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(79) Net Emergency Readmissions within 28 days
Actual
Standard
Trend
FINANCESummary Dashboard
38
FINANCEIncome, Expenditure and SavingsAccountable Officer: Director of Finance
(83) I& E ‐ Trust level I&E is £0.2m better than plan for the year to date with a £3.5m deficit. The deficit will increase each month until it reaches c£5m in M6 and then improves to a £1.3m surplus.
Income – Income is £0.5m over plan for the year to date. Income from Kernow CCG is £0.1m over plan before contract penalties. CCG elective income was £0.1m below. NHSE income being £1m over for the YTD plan due to the non‐delivery of QIPP schemes by NHSE.
Expenditure ‐ Pay totalled £19.1m in M3. This is £0.3m below budget. For the year to date, pay costs are £0.7m below budget although the profiling of pay savings means that the budget will drop significantly by the year end.
(84) CIP ‐ Savings of £2,158k delivered to date which is £506k below plan. The full year forecast stands at £11.6m compared to a plan of £17.3m meaning that there is a risk of a £5.7m shortfall.
39
(6.0)
(5.0)
(4.0)
(3.0)
(2.0)
(1.0)
0.0
1.0
2.0
£ms
(83) I&E Surplus / (deficit) ‐ actual / forecast v plan
Actual Forecast Plan
0.02.04.06.08.0
10.012.014.016.018.020.0
£ms
(84) CIP ‐ actual / forecast v plan
Actual / Forecast Forecast Plan
FINANCECash and CapitalAccountable Officer: Director of Finance
(85) Agency spend – Monthly agency‐spend totalled £762k in June, an improvement from £787k in May and still below the £840k per month target.
In May there were 66 agency workers that have worked for the Trust for more than 2 months, up from 58 in April. The 20 most expensive agency staff cost the Trust £345k in M3, down from £352k in M2.
(86) Cash ‐ £6.4m actual cash balance due to timing of creditor payments and the under‐spend against the capital programme. This balance will decrease as the year continues.
(87) Capital ‐ £2.9m of expenditure to date which is £3.6m below plan. The main delays against spend planned for the month relate to the Neonatal project (£1m), HI schemes including E‐notes and PAS and the Cath Lab (£0.3m). However, all schemes are still expected to be delivered in year and their delay is not a cause for concern. If any are delayed, the spend planned for 2018‐19 can be brought forward.
40
0.02.04.06.08.0
10.012.014.016.018.020.0
£ms
(87) Capital spend ‐ actual / forecast v plan
Actual Plan
0.01.02.03.04.05.06.07.08.09.0
10.0
£ms
(86) Cash ‐ actual / forecast v plan
Actual / Forecast Forecast Plan
0.0
2.0
4.0
6.0
8.0
10.0
12.0
£ms
(85) Agency and Locum spend ‐ actual / forecast v plan
Actual / Forecast Plan Forecast
OUR PEOPLESummary Dashboard
41
OUR PEOPLEKey Workforce IndicatorsAccountable Officer: Director of HR & OD
(88) Sickness absence in June decreased by 0.29% to 3.52%. This is the lowest sickness rate reported by the Trust. Long‐term absence at 2.52% is much higher than short‐term at 1.62% p.a. predominantly due to stress and MSK problems.
(89) Turnover reduced by 0.2% to 10.6% which is well within the planned range. Circa 3% of turnover is due to annual training rotations for junior doctors.
(90) Pay spend decreased in June. As shown in the ‘Total Staffing’ chart, both substantive and temporary staffing use increased marginally. However, the pay cost apportioned by skill mix deployed is reflected in the movement of pay costs.
(91) Active vacancies represent those in the recruitment process; between the approval to recruit to the starter joining us. Greater focus on partnership working between divisions and the recruitment team continues. As anticipated the spike in activity seen in May reduced during June as vacancies reduced.
42
8%
9%
10%
11%
12%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(89) Turnover rate
Turnover %
Trend
16
17
18
19
20
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(90) Pay Expenditure (£m's)
Pay Spend
Trend
0%
2%
4%
6%
8%
10%
12%
14%Au
g‐16
Sep‐16
Oct‐16
Nov‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(91) Active Vacancies %
TotalActiveVacancies
ActiveRegisteredNurses
ActiveMedicalStaff
2.5%
3.0%
3.5%
4.0%
4.5%
5.0%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(88) Sickness rate (Month)
Sickness %
Standard
Trend
OUR PEOPLEKey Workforce IndicatorsAccountable Officer: Director of HR & OD
(92) The vacancy gap reflects funded establishment less substantive staff in post. The total vacancy gap reduced marginally during June. However, both registered nurse and medical staff vacancies increased slightly. Work continues to align recruitment campaigns across providers in Cornwall with campaigns to attract holiday makers to relocate to Cornwall.
(93) Appraisal compliance in June increased by 1.9% to 83.8%. This is 13.7% higher than the same point last year. Compliance is currently 11.2% below the 95% of eligible staff standard.
(94) Mandatory training compliance improved by 1% to 86.0% in June (9% below standard).
(95) Total staffing utilised in June increased by 22 FTE of which substantive staff increased by 3 FTE and temporary staff increased by 19 FTE. Across temporary staffing, bank usage increased by 17 FTE and agency increased by 2 FTE.
43
0%2%4%6%8%10%12%14%16%
Aug‐16
Sep‐16
Oct‐16
Nov‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(92) Vacancy Gap %
TotalVacancies
TotalRegisteredNurses
TotalMedicalStaff 50%
55%60%65%70%75%80%85%90%95%100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(93) Appraisal Rate
Appraisal %
Standard
Trend
75%
80%
85%
90%
95%
100%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(94) Mandatory Training Rate
TrainingCompliance
Standard
Trend 4200
4400
4600
4800
5000
5200
Apr‐16
May‐16
Jun‐16
Jul‐1
6
Aug‐16
Sep‐16
Oct‐16
Nov‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(95) Total Staffing FTE
Substantive Bank Agency
OUR PEOPLEKey Workforce IndicatorsAccountable Officer: Director of HR & OD
(96) Quarterly staff surveys are conducted in addition to the annual national staff survey. During Q1 2017/18 the percentage of staff responding positively to recommending the Trust as a place to work increased by 2% to 55% compared to the previous quarter. The response in the 2015 annual staff survey was 42% and although the Trust has much work to do to improve how it feels to work at RCHT, progress is being made. The national median for all acute Trust’s nationally in 2016 was 62%.
(97) Staff Friends & Family Survey results for those responding positively to RCHT being a Trust where they recommend receiving care decreased by 2% to 69% compared to the previous quarter.
(98) Challenges remain to find cap compliant agencies. However, excellent progress has been achieved for AHPs during June as previous month’s reported no shifts were cap compliant. Agency framework compliance is almost 100% across each staff group.
44
0%10%20%30%40%50%60%70%80%90%100%
Agency Framework Cap Compliance
(98) Agency Framework / Cap Compliance
All Nursing
Medical
AHP
30%
40%
50%
60%
70%
80%
90%
(96) Staff Friends & Family Survey Recommend the Trust as a Place to Work
% StaffRecommendTrust as a Placeto WorkStandard
Trend30%
40%
50%
60%
70%
80%
90%
(97) Staff Friends & Family SurveyRecommend the Trust as a Place to Receive Care
% StaffRecommendTrust as a Placeto Receive CareStandard
Trend
OUR PEOPLEH&S ReportingAccountable Officer: Chief Operating Officer
(98) Decrease in June, overall trend shows a decrease in the last 12 months for the number of reported sharps incidents. Review of 12 months shows Butterfly needles have caused the most injuries.
(99) Compliance in sharps device training continues to improve. At 87.8% compliance is currently 2.2% below the standard set by the Trust of 90%.
(100) RIDDOR reports reduced to 5 this month, and the trend shows an average of 7 to 8 a month.
(101) There were no reported cases of occupational dermatitis. This still remains low.
45
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(99) Sharps ‐ training compliance with safer sharps
Actual
Trend
0
5
10
15
20
25
30
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(98) Sharps ‐ Incidents reported
Actual
Trend
0
2
4
6
8
10
12
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(100) Number of RIDDOR reports
Actual
Trend
0
1
2
3
4
5
6
Apr‐16
May‐16
Jun‐16
Jul‐1
6Au
g‐16
Sep‐16
Oct‐16
Nov
‐16
Dec‐16
Jan‐17
Feb‐17
Mar‐17
Apr‐17
May‐17
Jun‐17
(101) Confirmed cases of occupational dermatitis
Actual
Trend
Partnership – Offer, integrated care, as close to home as possibleSummary DashboardAccountable Officer: Director of Strategy and Business Development
3.1i Develop Shaping Our Future (SOF) with our partner organisations. • Recruitment has commenced for key roles within SOF
including the Clinical Director and the Pre‐Consultation Business Case Manager.
• Scrutiny Committee has been briefed on the case for change.
• Arrangements to strengthen the linkages between the Devon and Cornwall STPs with a meeting planned in early July.
• Co‐production workshops based in each of the localities are planned for early July to develop the pre‐consultation business case.
• Development of the master model by the AHSN continues.
3.1ii Progress the development of an Accountable Care System• The STP Programme Director will attend the Programme
Director Network for the South of England on 29th June 2017. A presentation from Health Education England about the support they can offer to STPs, along with an update on the work taking place to support the first wave ACSs which we can draw on as we take forward ACS developments locally.
• Options for recruitment into the key post of ACS Business Change Lead are being considered.
46
Partnership3.3 Offer prompt appropriate dischargeAccountable Officer: Chief Operating Officer3.4 Research, Development and InnovationAccountable Officer: Director of Strategy and Business Development
(102) Reduce Growth in ED AttendancesChanges in the delivery of NHS 111 and Out of Hours service are anticipated to deliver a reduction in ED growth. The consortium bid was successful and will commence delivery in December 2017. A focus will need to be on interim arrangements via the A & E delivery board to ensure that there is no further deterioration.
ED attendances remain ahead of profile with growth of 6.5% in June compared with June 2016.
(103) RD&I Recruitment to trials is on profile for the year to date.
DTOCs – please refer to chart 75 on slide 36.
47
010002000300040005000600070008000900010000
Apr
May Jun Jul
Aug
Sep
Oct
Nov Dec
Jan
Feb
Mar
(102) ED Attendances
2016‐17
2017‐18
0
500
1000
1500
2000
2500
3000
Apr‐17
May‐17
Jun‐17
Jul‐1
7Au
g‐17
Sep‐17
Oct‐17
Nov
‐17
Dec‐17
Jan‐18
Feb‐18
Mar‐18
(103) R,D & I ‐ Patients recruited into clinical trials
Actual
Trajectory
