Trust Board Date 26 May 2016 · 2016-05-24 · APSH Monitor Performance - A&E A&E A&E NHSI Performance was recorded at 87.8%, a 5.0% improvement on Mar16 Total attendances in April

Paper 5.1

Trust BoardDate 26th May 2016

Agenda item number

Title of paper Performance Report

Confidential

Suitable for public access

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Strategic objective(s):

Best outcomes

To achieve the highest possible quality of care and treatment for our patients, interms of outcome, safety and experience.

Excellent experience

Skilled & motivated teams

Top productivity

ASPH value(s):

Patients first Patient expectations in terms of access are reflected in NHS performance targets.

Personal responsibility

Passion for excellence

Pride in our team

Executive summary The Trust missed the 4 hour A&E NHSI standard in April with performance recordedat 87.8%, which was a 5.0% improvement on March’s performance.

Total attendances in April (at 7,898) were lower than March's attendances (8,848)although 3.5% higher than April 2015 (7,630). Admissions during April (at 1,902) weresimilar to the very high daily average admissions we have seen from Decemberthrough all of Q4, with on average over 63-65 admissions every day.

We have in place an Urgent Care Improvement Programme which includes changesto our governance and clinical engagement in order to provide an improvementtrajectory delivering compliance from October 2016 onwards.

The Trust remained compliant for 18 weeks Incomplete Pathway Performance at94.0% for April although General Surgery, Urology, and Trauma and Orthopeadicswere non-compliant at specialty level.

The Trust is carrying a risk of non-compliance of the RTT aggregate IncompletePathway performance during Q1 due to the exceptional loss of elective capacity duringMarch (although also pre-affected due to winter pressures during Dec to Feb).

The Trust is scheduling additional elective activity during Q1 (& beyond) to regainsustainable compliance at specialty level.

The Trust reported compliance for all 7 Cancer standards for April.

Paper 5.1

Recommendation: Review the paper and discuss the contents seeking additional assurance asnecessary.

Specific issues checklist:

Quality and safety issues

Patient impact issues?

Employee issues?

Other stakeholder issues?

Equality & diversity issues?

Finance issues?

Legal issues?

Risk issues? Link to

relevant BAF item numberif so

Author name/role J Ruse, Associate Director of Performance

Presented by directorname/role

Lorraine Knight, Interim Chief Operating Officer

Date 12th

May 2016

Board action For Assurance

APSH Monitor Performance

April 2016

Lorraine Knight – Interim Chief Operating Officer

APSH Monitor Performance - April 2016

A&E

DomainQ1

15/16

Q2

15/16

Q3

15/16

Q4

15/16

Monthly

SparklineApr

Radiotherapy n/a n/a n/a n/a n/a n/a

86.7%

100%

100%

100%

95.8%

96.9%

100%

83.6%

100%

CANCER

All cancers: 62-day

wait for first

treatment

Urgent GP referral

for suspected

cancer

97.1%

96.4%

CANCER

All cancers: 31-day

wait for second or

subsequent

treatment

88.5%

81.3%

85.6%

NHS Cancer

Screening Service

referral

90.0%

CANCER

Cancer: two week

wait from referral to

date first seen

All urgent

referrals

91.3%

100%

Drug Treatment100%

97.9%

Surgery100%

100%

CANCERAll cancers: 31-day wait from diagnosis

to first treatment

97.3%

98.9%

97.0%

96.1%

93.9%

93.8%

95.4%

96.0%

95.8%

94.0%

95.1%

95.5%

97.0%

95.6%

Symptomatic

breast patients

94.7%

94.6%

94.5%

97.2%

RTT

Maximum time of 18 weeks from point

of referral to treatment in aggregate

(INCOMPLETE PATHWAYS)

96.4%

NHSI - APRIL 2016 PERFORMANCE UPDATE

Standard

A&E

Maximum waiting time of four hours

from arrival to

admission/transfer/discharge

93.3%

85.4%

87.8%

92.2%

90.4%

APSH Monitor Performance - A&E

A&E

A&E NHSI Performance was recorded at 87.8%, a 5.0% improvement on Mar16

Total attendances in April (at 7,898) were lower than March's attendances (8,848)

although 3.5% higher than April 2015 (7,630)

Admissions during April (at 1,902) were similar to the very high daily average

admissions we have seen from December through all of Q4, with on average over 63-

65 admissions every day (compared to FY2014/15=62 & FY2013/14=58)

Average non-elective length of stay & delayed discharges remain low

We have in place an Urgent Care Improvement Programme which includes

changes to our governance and clinical engagement in order to provide an

improvement trajectory delivering compliance from October onwards. In addition we

opened an Urgent Care Centre on 7th March 2016

DomainQ1

15/16

Q2

15/16

Q3

15/16

Q4

15/16

Monthly

SparklineApr

NHSI - APRIL 2016 PERFORMANCE UPDATE

Standard

A&E

Maximum waiting time of four hours

from arrival to

admission/transfer/discharge

93.3%

85.4%

87.8%

92.2%

90.4%

Urgent Care Programme - Objectives

Establishing the Urgent Care Centre (UCC)

Objectives:

Establish the UCC processes and staffing model

Launch the UCC and implement UCC pathways

Implementing Ambulatory Care in the medical assessment area

Objectives:

Implement ambulatory pathway in order that all patients presenting with a GP letter attend the AMU & not ED

Complete analysis of 0 to 1-day LoS patients to establish additional pathways/services required in ambulatory

care

Convert one bay on AMU to an ambulatory area, closing at night

Improving the medical model and input to Cherry Annex and the medical inpatient wards

Objectives:

Agree and implement a medical model for Cherry Annex ward

Review and improve the acute medical continuity model as required

Work with the medical specialty teams to agree and implement consultant-continuity models for the inpatient

wards

Establishing & implementing the core clinical standards for acute & emergency care at ASPH

Objectives:

Engage with clinical teams to identify and agree the core clinical standards

Agree standards with leadership and Divisional Directors

Cascade sign-up to the standards through the clinical teams and communicate through the organisation

A&E - ASPH and National Performance vs Target

Urgent Care Programme - Objective 1 Update

Establishing the Urgent Care Centre (UCC)

Objectives:

Establish the UCC processes and staffing model

Launch the UCC and implement UCC pathways

.REF PROJECT RAG

1.0 Establishing an Urgent Care Centre

2.0 Implementing Ambulatory Care In AMU

3.0 Improving the Medical Model

4.0 Establishing and Implementing Core Clinical Standards


ESTABLISHING AN URGENT CARE CENTRE

REF: 1.0 CLINICAL LEAD: JACOB ADDO MANAGEMENT LEAD: RICK STRANG

Overall

Milestones

Risks

Benefits

Patients walking into ED or arriving with a minor illness/ injury or a less urgent problem will be directed to the UCC during the hours of 0800-2000 hrs. The unit will be staffed by a combination of Emergency Department doctors, GPs and Emergency Nurse Practitioners. Patients will receive an improved patient experience and the initiative will support delivery of the ED 4 hour target by reducing overcrowding in ED and consequently time to assessment, treatment, discharge or transfer

The UCC is in place and milestones are on track. ASPH are working with the CCG to recruit GPs to further enhance the service. Building works to enlarge the reception area and CDU are awaiting planning approval and are on track to deliver in June 2016 The UCC is in place and seeing 40% of ED attendances between 0800-2000 hrs. ASPH are working with the CCG and external agencies to recruit GPs which will enhance service delivery

Ability to recruit GPs jeopardises the ability to deliver the benefits of the UCC long term.

The benefits of the UCC are to improve patient experience and support delivery of the ED 4 hours target by reducing overcrowding in ED.




Implementing Ambulatory Care in the medical assessment area

Objectives:

Implement ambulatory pathway in order that all patients presenting with a GP letter attend the AMU & not ED

Complete analysis of 0 to 1-day LoS patients to establish additional pathways/services required in ambulatory

care

Convert one bay on AMU to an ambulatory area, closing at night

.REF PROJECT RAG






IMPLEMENTING AMBULATORY CARE IN AMU

REF: 2.0 CLINICAL LEAD: NAZIA RASHID MANAGEMENT LEAD: RICK STRANG

Overall

Milestones

Risks

Benefits

All patients will be treated as ambulatory unless proven otherwise. Patients referred by a GP practice or walking into ED/UCC with an ambulatory condition will go directly to the AECU to be assessed, diagnosed, treated, discharged or transferred.

Ambulatory pathways are in place however requires review, communication and compliance across the organisation. Milestones for implementation have slipped however a project plan is in development.

The risk impacts the ability to achieve the benefits of the project which are to improve patient experience and support delivery of the 4 hour target.

Ambulatory pathways are in place however requires review, communication and compliance – these milestones have slipped by a couple of weeks

There is a risk to delivery due to the lack of workforce to deliver the AECU due to recruitment and investment.

Risk to delivering on time and achieving the project benefits due to milestone slippage

The benefits of the Ambulatory Emergency Care Unit will be to improve patient experience and support achievement of the ED 4 hour target



Improving the medical model and input to Cherry Annex and the medical inpatient wards

Objectives:

Agree and implement a medical model for Cherry Annex ward

Review and improve the acute medical continuity model as required

Work with the medical specialty teams to agree and implement consultant-continuity models for the inpatient

wards

.REF PROJECT RAG






IMPROVING THE MEDICAL MODEL

REF: 3.0 CLINICAL LEAD: PETER WILKINSON MANAGEMENT LEAD: TOM SMERDON

Overall

Milestones

Risks

Benefits

Plan to undertake ward moves to improve specialty bed base and ensure all patients are under the care of a specialty team

Agreed to develop plans to achieve consultant continuity of care on gastro, general medicine, and cardiology teams

A fifth respiratory consultant has been recruited.

New junior doctor continuity rota has been implemented Defining roles for the Junior Doctor team covering the weekend on AMU and Medicine

Plan to undertake ward moves to improve specialty bed base and ensure all patients are under the care of a specialty team

Agreed to develop plans to achieve consultant continuity of care on gastro, general medicine, and cardiology teams

A fifth respiratory consultant has been recruited.

New junior doctor continuity rota has been implemented but requires further work Defining roles for the Junior Doctor team covering the weekend on AMU and Medicine

Bed modelling shows that there are not enough beds to meet demand at 90 - 95% occupancy level causing elective cancellations, lack of bed capacity to admit pts from A&E/AMU causing breaches to the 4 hour target and increased outliers – develop plan Lack of OPAL/ Care of the elderly consultants, junior doctors, and therapy support to manage increased bed base on OPSSU – approval of investment required to increase resources Lack of investment to recruit locums as an interim solution during 6 month procurement process Lack of resources to fulfil clinical duties on Maple ward – review workforce structure and job plans

Continuity of care of all patients will lead to improved discharges and flow in the hospital supporting the delivery of the 4 hour target and Keogh Standards


IMPROVING THE MEDICAL MODEL

REF: 3.0 CLINICAL LEAD: PETER WILKINSON MANAGEMENT LEAD: TOM SMERDON

Overall

Milestones

Risks

Benefits

Deputy Divisional Directors have been appointed Overarching bed modelling work complete and identifies that there is insufficient bed base to meet demand working at an 90-95% occupancy level A number of risks to delivery including ability to recruit to consultant posts in CoE, respiratory and gastroenterology; and reaching agreement on a medical model of care for Maple ward.

Deputy Divisional Directors have been appointed Overarching bed modelling work complete and identifies that there is c. 33 beds too few in medicine and a further 10 beds too few in surgery

Impact of rheumatology consultant availability due to future MSK work – review workforce structure Unable to reach agreement on a medical model of care with consultants on Maple ward –discussion/consultation Deanery concern regarding sick patients on cherry annexe – respond with cherry annexe model and plan for ward moves



Establishing and implementing core clinical standards

Objectives:

Engage with clinical teams to identify and agree the core clinical standards

Agree standards with Exec and clinical leadership

Cascade sign-up to the standards through the clinical teams and communicate through the organisation

.REF PROJECT RAG






ESTABLISH AND IMPLEMENT CORE CLINICAL STANDARDS

REF: 4.0 CLINICAL LEAD: DAVID FLUCK MANAGEMENT LEAD: RICK STRANG

Overall

Milestones

Risks

Benefits

Actions in place to engage with clinicians from each Division to agree the philosophy of care, developing a set of ’10 golden rules’ for emergency care (core clinical standards) by which our team will operate. In addition, determining routes for escalation when non-compliant.

The standards will outline the guiding principles for the appropriate admission of emergency patients to the correct clinical team preventing delays in patient assessment, transfer or admission to a specialty, and improving patient experience

Engage with clinicians from each division to agree the philosophy of care, developing a set of core clinical standards and determining routes for escalation when non-compliant. Launch the philosophy of care and clinical standards at a Trust wide event led by the Chief Executive and Medical Director.

Lack of clinical engagement across the Trust to develop clinical standards and maintain compliance.

Improved management and transfer of patient care to the right person at the right time, in the right place will lead to early diagnosis, treatment, discharge, transfer or admission and will reduce overcrowding in ED thereby supporting delivery of the 4 hour target and achievement of the Keogh standards. Improved patient experience due to a reduction in delays to assess, transfer or admit a patient.

Documents

Trust Board Date 26 May 2016 · 2016-05-24 · APSH Monitor Performance - A&E A&E A&E NHSI Performance was recorded at 87.8%, a 5.0% improvement on Mar16 Total attendances in April