Month 1 Integrated Performance Report

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0. Reference Information

Author: Claire Jones, Senior

Information Analyst Paper date: 24

th

May 2017 Executive Sponsor: Craig Macbeth, Director of

Finance Paper Category: Performance

Paper Reviewed by: Executive Team Paper Ref: Paper 3

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

1. Purpose of Paper

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

This Board are asked to discuss and note the Month 1 (April) Integrated Performance

Report.

2. Executive Summary

2.1. Context

The paper incorporates the monthly integrated performance report with associated narrative

and descriptions of key actions.

2.2. Summary

Overall performance for April was positive with no never events or cases of MRSA or C.

Difficile and serious incidents and VTEs acquired at the Trust were lower than March levels.

The Trust had another strong month with regards to waiting time performance and the

financial control for the month was achieved.

There are some red rated performance indicators, mainly across the patient and finance

domains, and these require continuing focus.

2.3. Conclusion

The Board are asked to discuss and note the report.

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Caring for Patients

Serious Incidents 0 1 ↑ RJAH Acquired MRSA

Bacteraemia 0 0 ↔

Patients Waiting Over 52 Weeks

- Welsh 0 1 ↑

Never Events 0 0 ↔ Unexpected Deaths 0 1 ↔ Patients Waiting Over 52 Weeks -

Welsh (BCU Transfers) 4

Total Patients Falls 2 11 ↓ RJAH Acquired VTE (DVT or PE) 4 0 ↑ Total Open Pathways 10061 9431 ↑

RJAH Acquired Pressure Ulcers -

Grade 2 1 0 ↑ VTE Assessments Undertaken 95% 100% ↑

6 Week Wait for Diagnostics -

English Patients 99% 99.93% ↓

Grades 3 or 4 0 0 ↔

28 days Emergency

Readmissions* 1% 0.4% ↑

Welsh Patients 100% 100% ↑

Pressure Ulcer Assessments 99% 100% ↑ % Reportable Cancellations 0.7% 0.91% ↓ New to Follow Up Ratio 2.5 2.41 ↑

Safety Thermometer - % with no

new harms 95% 100% ↑ % Non-Reportable Cancellations 2% 1.92% ↓

Safety Thermometer - % with

harm free care 95% 93.86% ↓

Cancellations Not Rebooked

Within 28 Days* 0 0 ↔

Medication Errors and those with

harm 2 0 ↑ Cancer Two Week Wait* 93% 100% ↔

Patient Friends & Family - %

Would Recommend 90% 99.08% ↓

31 Days First Treatment

(Tumour)* 96% 100% ↔

Would Not Recommend 0% 0.26% ↑

31 Days Subsequent Treatment

(Tumour)* 94% 100% ↔

Number of Complaints 9 10 ↑ Cancer Plan 62 Days Standard

(Tumour)* 85% 100% ↔

Safe Staffing 90% 95.2% ↓ Cancer 62 Day Consultant

Upgrade 85% 100% ↔

% Delayed Discharge Rate 2.5% 3.88% ↓ 18 Weeks RTT Open Pathways 92% 91.2% ↓

RJAH Acquired C.Difficile 0 0 ↔ Patients Waiting Over 52 Weeks 0 0 ↔

Plan Curr en t Mo n th Me asurem en t Mo n th o n Mo n th Tre n d Plan Curr en t Mo n th Me asurem en t Mo n th o n Mo n th Tre n d Plan Curr en t Mo n th Me asurem en t Mo n th o n Mo n th Tre n d

Caring for Patients

Improved:

- Serious Incidents

- RJAH Acquired VTE

- New to Follow Up Ratio

Decreased:

- Total Patient Falls - Safe Staffing

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Caring for Finances

Referrals Received for Consultant

Led Services* 2908 3113 ↑

Financial Control Total

(£ '000) -852 -842 ↓

Activity - Inpatient Activity 1004 1001 ↓ Clinical Income (£ '000) 5992 5879 ↓

Activity - Outpatient Contract -

New 1573 1380 ↓

Private Patients Income

(£ '000) 318 376 ↓

Follow Up 5678 5305 ↓ Other Income (£ '000) 540 476 ↑

Overall Daycase Rate 53% 47% ↓ Pay (£ '000) 4637 4599 ↑

% of Inpatients Admitted on Day

of Surgery 95% 94.29% ↓ Non Pay (£ '000) 2746 2656 ↑

% Theatre Lists Utilised 88 89 Financing (£ '000) 368 362 ↓

Theatre Cases per Session 2.15 2.1 ↓ CIP Delivery (£ '000) 403 385 ↓

Average Length of Stay 3.5 3.88 ↑ Agency Control Total (£ '000) 135 116 ↑

Bed Occupancy – Adult

Orthopaedic Wards – 2pm 87% 84.91% ↑ Cash Balance (£ '000) 3107 4366 ↓

Bed Occupancy – All Wards – 2pm 87% 80.21% ↓ Capital Expenditure (£ '000) 358 50 ↑

Outpatient DNA Rate 5% 5.65% ↓ Use of Resources (UOR) 3 3 ↑

Mo n th o n Mo n th Tre n d Plan Curr en t Mo n th Me asurem en t Mo n th o n Mo n th Tre n d Plan Curr en t Mo n th Me asurem en t

Caring for Finances

Improved:

- Referrals Received for

Consultant Led Services

- Average Length of Stay

Decreased:

- Theatre Cases Per Session

- Use of Resources

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Caring for Staff

Sickness Absence 3% 3.04% ↓

Staff Stability Index 91% 92.73% ↑

Voluntary Staff Turnover 8% 8.92% ↓

Voluntary Nurse Turnover Rate 12% 11.78% ↑

Staff Appraisal 90% 91.55% ↑

Mandatory Training 92% 94.9% ↓

Apprenticeship Starts 0

Apprenticeship Funding Accessed 0

Total WTE 1205.7

Pulse Check Q1 - Treat everyone

consistently 3 2.6

Pulse Check Q2 - Best placed person

to make Decisions 3 2.37

Pulse Check Q3 - Look for Ways to get

things Done 3 2.72

Pulse Check Q4 - Impact of our

behaviour is positive 3 2.62 Pulse Check Q5 - Cost Effective Ways

to do Things 3 2.62

Pulse Check Q6 - Constructively

3 2.4 Plan Curr en t Mo n th Me asurem en t Mo n th o n Mo n th Tre n d Requires Improvement

CQC Rating

Single Oversight Framework Segment

External Perception

Current Month Measurement

3 Caring for Staff

Improved:

- Staff Stability Index

Decreased:

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3 Serious Incidents - A Description Comment Target Executive Lead

4

Never Events - G Description Comments Target Executive Lead Number of Serious Incidents reported in month

Number of Never Events Reported in Month 0 serious incidents in month

Director of Nursing

There was one serious incident reported in April where a patient who was ready for discharge fell in a bathroom when they became unconscious and the fall resulted in a peri-prosthetic fracture.

Action

This is a decrease in month. The Serious Incidents process and policy is under review. The new policy and framework will be presented to the June Quality and Safety Committee.

There were no Never Events reported in April.

0 never events in month

Director of Nursing 0 1 2 3 4 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Serious Incidents - A Never Events - G 0 1 2 Target Actual

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7

Total Patients Falls - R

Description Comments

Target

Executive Lead

8

RJAH Acquired Pressure Ulcers - Grade 2 - G

Target

Executive Lead Director of Nursing

There were no hospital acquired pressure ulcers in April.

1 in month

Director of Nursing Total number of category 2 pressure ulcers acquired at RJAH Total number of patient falls, and those with harm

There were 14 inpatients falls in April that equates to 2.23% of inpatient activity. There were 3 further outpatient falls. There were ten falls that resulted in low level harm of bump to head (1), shock (1), skin graze (3), ooze to operated knee (1) and 4 further patients who had no obvious injuries but due to the falls being unwitnessed, are classed as low level harm, reported in this way since March 2017. 1 further patient sustained a fracture from their fall and this has been reported as a serious incident. Action

There continue to be streams of work in this area that include improved documentation specific to patient cohorts, frailty screening at Pre-Op, improved communication with Diagnostics for when patients leave the ward and a review with Estates to audit bathrooms and look at the prevention of falls in these areas. The next falls collaborative is due to meet again in July.

2 or fewer falls with harm Total Patients Falls - R 0 5 10 15 20 25

Target (Harms) Actual Harms Total Falls

RJAH Acquired Pressure Ulcers - Grade 2 - G 0 1 2 3 4 5 6 Target Actual

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9 RJAH Acquired Pressure Ulcers - Grades 3 or 4 - G

Target

Executive Lead

13

Pressure Ulcer Assessments - G

Target

Executive Lead

% of adult admissions in the month who have been risk assessed for pressure ulcers

The percentage of admissions risk assessed remains above target and is reported at 100% in April.

99% in month

Director of Nursing

There were no hospital acquired pressure ulcers in April.

0 in month

Director of Nursing Total number of category 3 & 4 pressure ulcers acquired at RJAH

0 1 2 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual RJAH Acquired Pressure Ulcers - Grades 3 or 4 - G Pressure Ulcer Assessments - G 98.4 98.6 98.8 99 99.2 99.4 99.6 99.8 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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10 Safety Thermometer - % with no new harms - G

Target

Executive Lead

11

Safety Thermometer - % with harm free care - R

Target

Executive Lead % of patients with no new harms at point of survey

At the time of the survey, there were no patients with new harms recorded. Therefore, this measure is reported at 100% in April.

95% in month

Director of Nursing

95% in month

Director of Nursing

At the point of the survey 93.86% of patients were 'harm free' and this falls below the 95% tolerance. There were seven harms recorded that were all spinal injuries patients who had been admitted for pressure sore management. Although the number of harms recorded remains at similar levels to those seen previously, the patient sample was lower on the survey day and this has impacted on the percentage reported.

Action

No action required as not controllable by RJAH. % of patients with harm

free care at point of survey 91 92 93 94 95 96 97 98 99 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17

Target Mean Actual

LCL (3 SD) UCL (3 SD) Safety Thermometer - % with no new harms - G Safety Thermometer - % with harm free care - R ₇₅ 80 85 90 95 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17

Target Mean Actual

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12 Medication Errors and those with harm - G

Target

Executive Lead

16

Patient Friends & Family - % Would Recommend - G

Target

Executive Lead 90% in month

Director of Nursing

The feedback collated in April indicates that 99.08% of patients would recommend the Trust. The performance continues to exceed the national average published results for February where the score for inpatients was 96% and 93% for outpatients.

There were 321 compliments received throughout the month with comments left that referred to the service and care provided by staff.

Total number of medication errors, and those with harm

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

There was a reduction in the number of medication errors this month, falling from 23 in March to 9 in April. These were categorised as prescribing (1), administration (5), dispensing (1) and storage (2). No patients came to harm as a result of the incidents.

2 or fewer errors with harm Director of Nursing 0 5 10 15 20 25 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17

Target (Harms) Actual Harms Total Errors

Medication Errors and those with harm - G Patient Friends & Family - % Would Recommend - G 84 86 88 90 92 94 96 98 100 Target Actual

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17

Patient Friends & Family - % Would Not Recommend - A Description Comments Target Executive Lead

18

Number of Complaints - A Description Comments Target Executive Lead % of patients who would not recommend the trust (inpatients and outpatients)

Number of complaints received in month 0% in month

Director of Nursing

The results collated in April indicated that 0.26% would not recommend the Trust. This equates to three patients, two on MCSI where one referred to staff being rushed off their feet and a third from theatres who had their operation cancelled seven hours after arrival.

10 complaints were received in April. 3 related to the quality of care associated with attitude of staff (1),

anaesthetic block given to patient in wrong arm (1) and the outcome of a pain injection (1). There were 7 further operational complaints with reasons relating to outcome of treatment (1), waiting times (2), the outcome of a

disciplinary process for a member of staff (1) and issues regarding a user of the hydrotherapy pool (3).

Action

All complaints are dealt with in line with NHS Complaints procedures. The Patient Experience Annual Report was presented to Quality and Safety Committee in April 2017. 9 or fewer in month Director of Nursing Patient Friends & Family - % Would Not Recommend - A 0 0.2 0.4 0.6 0.8 1 1.2 Target Actual Number of Complaints - A 0 5 10 15 20 Target LCL (3 SD) UCL (3 SD) Mean Actual

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34 Safe Staffing - G

Target

Executive Lead

21

% Delayed Discharge Rate - A

Target

Executive Lead % Shift Fill Rate

The total number of delayed days against the total available bed days for the month in % 90% in month

Director of Nursing

The overall shift rate for April was 95.20% against the 90% target. There were some times during the month where average fill rates fell below target on some wards, however they remained safely staffed and supporting data is collated to monitor this.

2.5% in month

Director of Nursing

The number of delayed days rose slightly this month, from 159 in March to 171 in April. This equates to 16 patients, of which 15 are rehabilitation patients who are awaiting appropriate placements or care packages and totalling 167 days. There was 1 further surgical patient who was delayed for 4 days. The patients fall under the responsibility of Shropshire (8), Walsall (2), Wales (2), Birmingham (2), Surrey (1) and Staffordshire (1). Action

There are steps being taken to improve this measure. Daily reports are now distributed to increase regular monitoring and there continues to be regular discussion with social services and Commissioners on this issue.

80 82 84 86 88 90 92 94 96 98 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Safe Staffing - G % Delayed Discharge Rate - A 0 1 2 3 4 5 6 7 8 9 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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2 RJAH Acquired C.Difficile - G

Target

Executive Lead

1

RJAH Acquired MRSA Bacteraemia - G

Target

Executive Lead 0 cases in Month

Medical Director

No comments this month. Number of cases of

C.Difficile in Month

Number of cases of MRSA bacteraemia in month

No comments this month.

0 cases in Month Director of Nursing 0 1 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17

Target (Harms) Actual

RJAH Acquired C.Difficile - G RJAH Acquired MRSA Bacteraemia - G 0 1 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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5 Unexpected Deaths - R

Target

Executive Lead

6

RJAH Acquired VTE (DVT or PE) - G

Description Comments Target Executive Lead Number of Unexpected Deaths in Month Number of RJAH acquired DVT or PE within 90 days of surgery 0 Unexpected deaths in month Medical Director

There were 2 deaths within the Trust in April, both on the care of the elderly ward where one was not unexpected. The second death, unexpected, was a patient who had been transferred for rehabilitation but suffered a cardiac arrest. Action

This will be investigated through a root cause analysis and be considered by the Quality and Safety Committee. It will be further reviewed by the clinical lead for "Learning From Deaths" in case there is any learning for the Trust.

3 or fewer in month

Medical Director

There were no patients with hospital acquired VTE in April who had undergone surgery within 90 days.

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 O ct -16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17

Target LCL (3 SD) UCL (3 SD) Actual Unexpected Deaths - R RJAH Acquired VTE (DVT or PE) - G 0 1 2 3 4 5 6 7 8 Target Mean LCL (3 SD) UCL (3 SD) Actual

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15

VTE Assessments Undertaken - G

Target

Executive Lead

14

28 days Emergency Readmissions - G

Target

Executive Lead less than 1% in month

Medical Director

Three patients were readmitted as an emergency within 28 days of initial discharge in March 2017 giving a readmission rate of 0.40% against the 1% tolerance. The reasons for readmission were washout of wound (1), haematoma (1) and a query haematoma (1).

% of adult admissions in the month who have been risk assessed for VTE % of patients readmitted to RJAH as an emergency following an overnight stay 95% in month Medical Director

The percentage of admissions risk assessed remains above target and is reported at 100% in April.

VTE Assessments Undertaken - G 92 93 94 95 96 97 98 99 100 % Target Actual 28 days Emergency Readmissions - G 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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19 % Reportable Cancellations - R Description Comments Target Executive Lead

75

% Non-Reportable Cancellations - G Description Comments Target Executive Lead % of procedures which were reportable cancellations i.e. within Trust's Control % of procedures which were non-reportable cancellations 0.7% in month Director of Operations

There were 9 operations cancelled in April with reasons associated with lack of equipment (1), lack of time (3), wrong loan kit (1) and no HDU bed available (4).

Action

There were 2 instances whereby equipment was not available for surgery. 1 was due to breakdown of equipment and the other was due to the supplier placing incorrect order for equipment. The company is reviewing their internal processes. There were 3 patients cancelled due to the previous case being more complex. Scheduling of lists forms part of the Theatre Utilisation project. The patients cancelled due to insufficient HDU beds were as a result of patients being unsuitable for step down to accomomodate new admissions.

2% in month

Director of Operations

There were 19 non-reportable operations cancelled in April with reasons associated with medically unfit (13), DNA (4), patient declined surgery (1) and patient was going on holiday (1).

Action

A review of cancellations on the day has been undertaken to identify key themes to address in 2017/18 as part of the Theatre Utilisation project. Further benchmarking is being undertaken with other providers as part of NHSI Theatre Productivity programme. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 % C an ce llation s Target % Cancellations % Reportable Cancellations - R % Non-Reportable Cancellations - G 0 0.5 1 1.5 2 2.5 3 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 % C an ce llation s % Cancellations

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20 Cancellations Not Rebooked Within 28 Days - G

Target

Executive Lead

22

Cancer Two Week Wait - G

Target

Executive Lead Director of Operations

The Cancer 2 week wait standard was achieved in March and indicative data for April shows achievement of the standard will continue.

All reportable cancellations were rebooked within 28 days of cancellation. Number of theatre cancellations (reportable) not rebooked within 28 days % of urgent cancer referrals seen within 2 weeks 0 in month Director of Operations 93% in month 0 0.5 1 1.5 2 2.5 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Cancellations Not Rebooked Within 28 Days - G Cancer Two Week Wait - G 88 90 92 94 96 98 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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23 31 Days First Treatment (Tumour) - G

Target

Executive Lead

24

31 Days Subsequent Treatment (Tumour) - G

Target

Executive Lead % of cancer patients treated within 31 days of decision to treat % of cancer patients subsequent treatment within 31 days of decision to treat 96% in month Director of Operations

The Cancer 31 day first treatment standard was achieved in March and indicative data for April shows achievement of the standard will continue.

94% in month

The Cancer 31 day subsequent treatment standard was achieved in March and indicative data for April shows achievement of the standard will continue.

90 91 92 93 94 95 96 97 98 99 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual 31 Days First Treatment (Tumour) - G 31 Days Subsequent Treatment (Tumour) - G 91 92 93 94 95 96 97 98 99 100 Target Actual

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25

Cancer Plan 62 Days Standard (Tumour) - G

Target

Executive Lead

26

Cancer 62 Day Consultant Upgrade - G

Target

Executive Lead 85% in month

The Cancer 62 day consultant upgrade standard was achieved in March and indicative data for April shows achievement of the standard will continue.

% of cancer patients treated within 62 days of referral

% of cancer patients treated within 62 days of date of upgrade 85% in month

The Cancer 62 day standard was achieved in March and indicative data for April shows achievement of the standard will continue. Cancer Plan 62 Days Standard (Tumour) - G 0 10 20 30 40 50 60 70 80 90 100 Target Actual Cancer 62 Day Consultant Upgrade - G 80 82 84 86 88 90 92 94 96 98 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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27 18 Weeks RTT Open Pathways - A

Target

Executive Lead

29

Patients Waiting Over 52 Weeks - English - G

Target

Executive Lead

% of English patients on waiting list waiting 18 weeks or less Number of English RTT patients currently waiting 52 weeks or more 92% at month end Director of Operations

Our April performance was 91.20% against the 92% open pathway performance for patients waiting 18 weeks or less to start their treatment. The total number of breaches has reduced from 673 in March to 551 in April.

Action

The Trust open pathway peformance was above planned trajectory for April 2017. The delivery trajectory for 2017/18 anticipated a reduction in planned activity this month with Clinical Audit, annual leave and working days all contributing. The Trust will continue to work to planned trajectory for delivery of 92% in Quarter 3.

0 at month end

At the end of April there were no English patients waiting over 52 weeks. 80 82 84 86 88 90 92 94 96 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17

Internal Trajectory National Target Actual 18 Weeks RTT Open Pathways - A Patients Waiting Over 52 Weeks - English - G 0 2 4 6 8 10 12 14 16 18 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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30 Patients Waiting Over 52 Weeks - Welsh - R

Target

Executive Lead

81

Patients Waiting Over 52 Weeks - Welsh (BCU Transfers)

Target

Executive Lead No target

At the end of April there were 4 Welsh patients waiting over 52 weeks who were all transfers of care from BCU. They were receieved by RJAH in January and had already waited at least 52 weeks at that time.

Number of RJAH Welsh RTT patients currently waiting 52 weeks or more

Number of BCU transfer Welsh RTT patients currently waiting 52 weeks or more 0 at month end

At the end of April there was 1 Welsh patient waiting over 52 weeks. This was due to delays in completing diagnostics at an alternative provider.

Action

Spinal Disorders remains a pressure area for service delivery. An action plan is in place for Spinal Disorders services to manage the capacity constraints.

0 5 10 15 20 25 30 35 40 Target RJAH Patients Waiting Over 52 Weeks - Welsh - R Patients Waiting Over 52 Weeks - Welsh (BCU Transfers) 0 2 4 6 8 10 12 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Actual

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35 Total Open Pathways - R

Target

Executive Lead

28

6 Week Wait for Diagnostics - English Patients - G

Target

Executive Lead Director of Operations

The total number of open pathways has increased from 9019 in March to 9431 in April.

Action

A transfer of Paediatric Orthopaedic services and Spinal Disorders has seen an increase in our total open pathways. The target has been increased for 2017/18 to take into account this change in service delivery. The Trust also saw an increase in referrals for some services this month as compared to previous months. This is being monitored by the Trust and CCG via the Planned Care Working Group.

The 6 week standard for diagnostics was achieved this month. Total number of open

RTT pathways

% of English patients currently waiting less than 6 weeks for diagnostics 10061 in month Director of Operations 99% at month end 8000 8500 9000 9500 10000 10500 11000 11500 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Total Open Pathways - R 6 Week Wait for Diagnostics - English Patients - G 98 98.2 98.4 98.6 98.8 99 99.2 99.4 99.6 99.8 100 Target Actual

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76

8 Week Wait for Diagnostics - Welsh Patients - G

Target

Executive Lead

50

New to Follow Up Ratio - G

Target

Executive Lead % of Welsh patients currently waiting less than 8 weeks for diagnostics

The 8 week standard for diagnostics was achieved this month.

Outpatient new to follow up ratio

(Consultant Led Activity)

The new to follow up ratio is green rated in April at 2.41. 100% at month end

2.5 follow up for each new in April Director of Operations 8 Week Wait for Diagnostics - Welsh Patients - G 98 98.5 99 99.5 100 Target Actual New to Follow Up Ratio - G 0 0.5 1 1.5 2 2.5 3 3.5 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

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36 Referrals Received for Consultant Led Services - G

Target

Executive Lead

37

Activity - Inpatient Activity - G

Description Comments Target Executive Lead Total number of referrals received in month

Contracted Inpatient & Daycase activity 2908 in March

Referrals received for consultant led services increased in March and were 205 above plan at 3113. There were particular increases seen from Shropshire and Telford. Referrals received will continue to be an item for discussion with Commissioners in each contract meeting.

1004 in April

The inpatient activity performance is just 3 cases behind plan in April.

Action

It was anticipated that a reduction in planned activity would be seen in April due to Clinical audit, annual leave and working days as contributing factors. The Trust will continue to monitor this closely and ensure delivered activity meets planned levels. 2000 2200 2400 2600 2800 3000 3200 3400 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Referrals Received for Consultant Led Services - G Activity - Inpatient Activity - G 500 600 700 800 900 1000 1100 1200 1300 1400 1500 Target Actual

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68

Activity - Outpatient Contract - New - A

Target

Executive Lead

69

Activity - Outpatient Contract - Follow Up - A

Target

Executive Lead 5678 in April

Performance was behind plan for the number of follow up outpatient attendances seen in April.

Action

It was anticipated that a reduction in planned activity would be seen in April due to annual leave and working days as contributing factors. The medicine division in particular has also been impacted in the Rheumatology and Metabolic Medicine sub-specialties due to a consultant vacancy and the loss of one agency consultant. The Trust will continue to monitor this closely and ensure delivered activity meets planned levels. Contracted new outpatient activity Contracted follow up outpatient activity 1573 in April Director of Operations

Performance fell behind plan for the number of new outpatient attendances seen in April.

Action

It was anticipated that a reduction in planned activity would be seen in April due to annual leave and working days as contributing factors. The medicine division in particular has also been impacted in the Rheumatology and Metabolic Medicine sub-specialties due to a consultant vacancy and the loss of one agency consultant. The Trust will continue to monitor this closely and ensure delivered activity meets planned levels. Activity - Outpatient Contract - New - A 0 500 1000 1500 2000 2500 3000 Target Actual Activity - Outpatient Contract - Follow Up - A 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

(25)

42 Overall Daycase Rate - R Description Comments Target Executive Lead % of procedures performed as a daycase 53% in April Director of Operations

The daycase rate remains static in April at 47% against the 53% target. This equates to 56 cases below target. Action

The Theatre Utilisation programme associated with this target is reviewing the patient pathway for dedicated theatre lists to improve patient flow and improve theatre utilisation. 30 35 40 45 50 55 60 65 70 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Overall Daycase Rate - R

(26)

43 % of Inpatients Admitted on Day of Surgery - A

Target

Executive Lead

44

% Theatre Lists Utilised - G

Description Comments Target Executive Lead % of elective NHS inpatients admitted on day of surgery % of theatre lists utilised 95% in April Director of Operations

The percentage of patients admitted on the day of surgery remains consistent with previous months at 94.29% and is amber rated against the 95% target.

Action

A casenote review is undertaken for all patients that are admitted prior to day of surgery. Booking arrangements for patients admitted prior to date of surgery due to travelling distances is being reviewed as part of our programme for staggered admissions.

88% in April

The % theatre lists utilised is green rated this month at 89% against the 88% plan. As this measure is being reported differently from April, the graph only reflects the latest month. 70 75 80 85 90 95 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 M ar-17 Ap r-17 Target Actual % of Inpatients Admitted on Day of Surgery - A % Theatre Lists Utilised - G 70 75 80 85 90 95 100 Target Actual

(27)

45

Theatre Cases per Session - R

Target

Executive Lead

46

Average Length of Stay - R

Target

Executive Lead 3.5 in month

The average length of stay remains red rated in April, although there is an improvement from March. The average length of stay has reduced from 4.26 days to 3.88 days.

Action

The average length of stay continues to be impacted by a number of patients who require a longer period of rehabilitation. To give some context, there were 9 patients discharged in April who had an inpatient stay in excess of 20 days, excluding these patients would give an average length of stay of 3.24 days.

Average number of cases per theatre session

Elective patients length of stay (excluding daycase)

2.15 in April

Performance of this measure remains behind planned levels at 2.1 cases per sessions against a plan of 2.15 cases per session. Action

This will be taken forward in 2017/18 as part of the Theatre Utilisation project. Further Benchmarking is being undertaken with other providers as part of NHSI Theatre Productivity programme. Theatre Cases per Session - R 2 2.05 2.1 2.15 2.2 2.25 2.3 2.35 Target Actual Average Length of Stay - R 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Aug-16 Se p-16 Oct -16 N o v-16 De c-1 6 Jan -17 Fe b-17 Ma r-17 Ap r-17 Target Actual

(28)

48 Bed Occupancy – Adult Orthopaedic Wards – 2pm - G

Target

Executive Lead

77

Bed Occupancy – All Wards – 2pm - G

Description Comments Target Executive Lead % bed occupancy at 2pm % bed occupancy at 2pm

The occupancy rate for all wards is green rated in April at 80.21%

87% in month

The occupancy rate for adult orthopaedic beds is green rated in April at 84.91%. 87% in month Director of Operations 60 65 70 75 80 85 90 95 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct -16 N o v-16 De c-1 6 Jan -17 Fe b -17 M ar-17 Ap r-17

BottomTarget Target Actual

Bed Occupancy – Adult Orthopaedic Wards – 2pm - G Bed Occupancy – All Wards – 2pm - G 60 65 70 75 80 85 90 95 100 Ap r-16 M ay -1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

(29)

49 Outpatient DNA Rate - R Description Comments Target Executive Lead % of outpatient appointments not attended

The DNA rate has deteriorated further in April and remains red rated at 5.65% against the 5% target. This equates to 48 missed appointments above target.

Action

The Trust continues to actively target areas with high DNA rates and ensures text reminders and letters to patients requesting notification if they are unable to attend a scheduled appointment. 5% in month Director of Operations 0 1 2 3 4 5 6 7 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct -16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Outpatient DNA Rate - R

(30)

1 Financial Control Total - G Description Comments Target £0.513m Exec Lead

2

Clinical Income - A Description Comments Target Actions £84.7m Exec Lead Surplus/deficit adjusted for donations and excluding STF funding

- Overall in month deficit of £842k - £10k ahead of plan in month

Director of Finance

Income associated with clinical activities (excludes pass through drugs)

- £113k behind plan overall in month - Theatre activity behind plan.

- Surgery and Medicine outpatient activity was behind plan in month

Improve theatre utilisation / take up of allocations Director of Finance -1000 -800 -600 -400 -200 0 200 400 600 800 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Financial Control Total - G Clinical Income - A 4000 4500 5000 5500 6000 6500 7000 7500 8000 Target Actual

(31)

3

Private Patients Income - G Description Comments Target £4.8m Exec Lead

4

Other Income - A Description Comments Target Actions £6.6m Exec Lead

Non-clinical income e.g. research, education and NHS Injury Cost

Recovery (ICR)

- £64k behind plan in month - Variance due to a shortfall in car parking, catering,

research and donations income in mth

Review key drivers for under performance in month.

Director of Finance Income generated by private patient activity

- £58k ahead of plan in month

Director of Finance Private Patients Income - G 0 100 200 300 400 500 600 Target Actual Other Income - A 0 100 200 300 400 500 600 700 800 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

(32)

5 Pay - G Description Comments Target £56.6m Exec Lead

6

Non Pay - G Description Comments Target Action £36.9m Exec Lead

Controls on private sector bookings Expenditure on

workforce

- Pay costs £38k underspent overall driven by vacancies in

funded posts - Premium pay pressures of £53k (OJP, bank and agency)

-

Director of Finance

Non-workforce expenditure e.g. consumables, implants and drugs (excludes pass through drugs)

- £90k under spent in month due to activity volumes below

plan, utilities and corporate costs. - Private Sector usage was the main pressure in month

Director of Finance 4200 4300 4400 4500 4600 4700 4800 4900 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Pay - G Non Pay - G 0 500 1000 1500 2000 2500 3000 3500 Target Actual

(33)

7

Financing - G Description Comments Target £4.4m Exec Lead

8

CIP Delivery - A Description Comments Target Actions £3.6m Exec Lead

Controls on private sector bookings and continue to work up mitigation schemes to offset any potential slippage.

Director of Finance Costs associated with financing the Trust i.e. depreciation, PDC and interest charges

- £6k under plan in month

Director of Finance

Cost Improvement Programme requirement

- CIPs underachieved by £18k in month (private sector repatriation) Financing - G 200 220 240 260 280 300 320 340 360 380 400 Target Actual CIP Delivery - A 0 50 100 150 200 250 300 350 400 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

(34)

9 Agency Control Total - G Description Comments Target £1.6m Exec Lead

10

Cash Balance - G Description Comments Target Exec Lead

Annual ceiling for total agency spend

introduced by NHS Improvement

- Overall agency spend £116k in month (£187k last month) - Remained within control total of £135k

Director of Finance

Cash in bank - Cash balances increased by £0.2m to £4.6m

- 2016/17 under performance (c£1m) still to be recovered by Commissioners £3.5m (at March 2018) Director of Finance 0 20 40 60 80 100 120 140 160 180 200 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Actual Agency Control Total - G Cash Balance - G 1000 2000 3000 4000 5000 6000 Target Actual

(35)

11

Capital Expenditure - G

Target

Exec Lead

12

Use of Resources (UOR) - G

Target

Exec Lead Overall Use of Resources indicator

- UOR Rating of 3 on plan in month

2 (at March 18)

Director of Finance Expenditure against Trust capital programme

- Capital spend of £50k in month was behind phased plan by £308k £5m Director of Finance Capital Expenditure - G 0 100 200 300 400 500 600 700 800 900 1000 Target Actual Target Actual Use of Resources (UOR) - G 0 0.5 1 1.5 2 2.5 3 3.5 Target Actual

(36)

31 Sickness Absence - A

Target

Executive Lead

32

Staff Stability Index - G

Target

Executive Lead WTE lost due to Staff Absence

Total staff with more than 12 months service as a percentage of the total 12 months ago. 3% in month

Director of Human Resources

Sickness rates increased slightly in April following an increase in short term absences. Estates and Facilities, Physical Medicine and Surgical Divisions all failed to meet the target. Most common reasons for short term absence were Gastrointestinal illness. Stress and Anxiety was the most common reason for long term absence.

Action

Divisions outside of the target to ensure all short term absence is managed in accordance with triggers. There will be a review of trends for Stress and Anxiety absence.

There is a slight increase in staff stability and within Trust target. 91% in April Director of Human Resources 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Sickness Absence - A Staff Stability Index - G 86 88 90 92 94 96 98 100 Target Actual

(37)

72

Voluntary Staff Turnover - A

Target

Executive Lead

66

Voluntary Nurse Turnover Rate - G

Target

Executive Lead Total numbers of voluntary leavers in the last 12 months as a percentage of the total employed

Total numbers of voluntary nurse leavers in the last 12 months as a percentage of the total nurses employed

The voluntary nurse turnover is within target this month. 8% in month

Voluntary staff turnover increased by 0.04% and remains above target.

Action

Identification of reasons for absence for both Theatres and Diagnostics Divisions. 12% in month Director of Human Resources Voluntary Staff Turnover - A 4 5 6 7 8 9 10 Target Actual Voluntary Nurse Turnover Rate - G 8 9 10 11 12 13 14 15 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Actual

(38)

33 Staff Appraisal - G Description Comments Target Executive Lead

62

Mandatory Training - G Description Comments Target Executive Lead

% of staff who have had an appraisal

Appraisal levels continue to achieve the Trust target.

% of staff completed mandatory training in latest 12 month period

The percentage of staff that are compliant with their mandatory training is above target in April.

90% at month end Director of Human Resources 92% in month Director of Human Resources 75 80 85 90 95 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual Staff Appraisal - G Mandatory Training - G 75 80 85 90 95 100 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Target Actual

(39)

73 Apprenticeship Starts

Target

Executive Lead

74

Apprenticeship Funding Accessed -

Target

Executive Lead

Number of apprentices commencing with the Trust in month.

No apprentices started within month.

No target

Financial contribution accessed through level in month.

Not able to access Levy until 1st May.

No target Director of Human Resources 0 1 2 3 4 5 6 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Actual Apprenticeship Starts Apprenticeship Funding Accessed - 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Target Actual

(40)

63

Total WTE

Target

Executive Lead

100

Pulse Check - All Questions - A

Target

Executive Lead 3 in each question

Director of Strategy and Planning

- Response rate of 26%

- 48% response rate from Admin & Clerical making up 51% of respondents

- 60% see evidence that we look for ways to get things done - 54% see evidence that we look for better, more cost effective ways of doing things

Action

-Actions to increase response rate and focus on particular professional groups

- Further work required to understand the response rate by department

The number of whole time equivalent employees on the last day of the month

There is a slight reduction in WTE in month.

No target

Pulse check question response scores Total WTE 1080 1100 1120 1140 1160 1180 1200 1220 Ap r-16 Ma y-1 6 Ju n -16 Ju l-16 Au g-16 Se p -16 Oct-16 N o v-16 De c-1 6 Jan -17 Fe b -17 Ma r-17 Ap r-17 Actual Pulse Check - All Questions - A 2.6 2.37 2.72 _2.62 _2.62 2.4 0 0.5 1 1.5 2 2.5 3 3.5 Q1 Q2 Q3 Q4 Q5 Q6 Target Actual

(41)

No v-16 De c-16 Jan-17 Apr-17 Target/ Ceiling Fe b-17 Mar-17 Apr-17 Se p-16 Oct-16 Jul-16 Au g-16 Apr-16 Ma y-16 Ju n-16

Caring for Patients

Serious Incidents 0 0 2 1 1 2 0 0 3 3 3 3 1 0

Never Events 0 0 0 0 1 0 0 0 0 1 1 0 0 0

Total Patients Falls 5 2 1 6 6 7 4 9 5 8 6 5 11 2

Grade 2 0 1 0 0 0 0 1 3 0 5 0 1 0 1

Grades 3 or 4 0 1 0 1 0 0 0 0 0 0 0 0 0 0

Pressure Ulcer Assessments 100% 99.9% 100% 100% 99.78% 100% 100% 100% 100% 100% 100% 99.67% 100% 99%

Safety Thermometer - % with no

new harms 99.17% 97.73% 98.78% 98.19% 97.76% 96.15% 95.8% 96.32% 97.96% 99.41% 99.35% 98.73% 100% 95%

Safety Thermometer - % with

harm free care 92.56% 92.42% 95.73% 96.99% 91.79% 91.54% 91.61% 88.97% 94.56% 97.65% 96.75% 95.57% 93.86% 95%

Medication Errors and those with

harm 1 3 0 0 1 1 1 0 1 2 0 2 0 2

Would Recommend 98.71% 98.76% 98.72% 99.13% 98.39% 99.17% 99.41% 99.51% 99.52% 98.56% 98.86% 99.6% 99.08% 90%

Would Not Recommend 0.16% 1.06% 0.92% 0.7% 0.36% 0% 0.15% 0.37% 0% 0.39% 0.38% 0.3% 0.26% 0%

Number of Complaints 10 9 7 2 14 8 11 11 6 8 7 11 10 9

Safe Staffing 94.2% 95.7% 95.5% 97.8% 98.5% 98.6% 98.7% 99.2% 98.3% 98.6% 97.5% 99.4% 95.2% 90%

% Delayed Discharge Rate 7.04% 6.25% 5.63% 5.04% 3.18% 3.46% 5.08% 7.44% 8.04% 5.76% 4.58% 3.22% 3.88% 2.5%

RJAH Acquired C.Difficile 0 0 0 0 0 0 0 0 0 0 0 0 0 0

No v-16 De c-16 Jan-17 Apr-17 Target/ Ceiling Fe b-17 Mar-17 Apr-17 Se p-16 Oct-16 Jul-16 Au g-16 Apr-16 Ma y-16 Ju n-16

(42)

Se p-16 Apr-16 Ma y-16 Ju n-16 Jul-16 Au g-16 Apr-17 Apr-17 Target/ Ceiling Oct-16 No v-16 De c-16 Jan-17 Fe b-17 Mar-17

Caring for Patients

RJAH Acquired MRSA

Bacteraemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Unexpected Deaths 0 0 0 0 0 0 0 0 1 0 1 1 1 0

RJAH Acquired VTE (DVT or PE) 0 0 4 1 2 5 0 1 0 3 1 4 0 4

VTE Assessments Undertaken 100% 99.91% 100% 99.91% 99.81% 100% 100% 100% 100% 99.92% 99.92% 99.79% 100% 95%

28 days Emergency Readmissions 1.36% 0.97% 1.15% 0.16% 0.56% 0.95% 0.15% 0.61% 0.65% 0% 0.63% 0.4% N/A 1%

% Reportable Cancellations 0.26% 0.27% 0.51% 0.65% 0.63% 0.67% 0.73% 0.83% 0.82% 0.83% 0.8% 0.76% 0.91% 0.7%

% Non-Reportable Cancellations 1.83% 2.37% 2.44% 0.5% 0.74% 0.97% 0.31% 0.5% 0.7% 0.19% 0.43% 0.55% 1.92% 2%

Cancellations Not Rebooked

Within 28 Days 0 1 0 0 2 0 0 0 0 0 0 0 0 0

Cancer Two Week Wait 100% 95.24% 100% 93.94% 100% 100% 100% 100% 100% 94.44% 100% 100% N/A 93%

31 Days First Treatment (Tumour) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% N/A 96%

31 Days Subsequent Treatment

(Tumour) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% N/A 94%

Cancer Plan 62 Days Standard

(Tumour) 100% 100% 66.67% 100% 100% 100% 100% 100% 50% 100% 100% 100% N/A 85%

Cancer 62 Day Consultant

Upgrade 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% N/A 85%

18 Weeks RTT Open Pathways 88.57% 88.9% 89.21% 88.75% 87.38% 87.14% 87.68% 88.07% 87.68% 88.47% 89.22% 91.37% 91.2% 92%

(43)

Caring for Patients

Patients Waiting Over 52 Weeks -

English 4 4 9 10 16 10 4 3 2 1 1 0 0 0

Welsh 35 24 20 10 15 10 8 2 5 7 4 5 1 0

Welsh (BCU Transfers) 0 0 0 0 0 0 0 0 0 11 5 2 4 N/A

Total Open Pathways 10061 10354 10461 10805 10923 10461 10213 9879 9785 9521 9010 9019 9431 10061

English Patients 99.94% 99.77% 99.73% 99.84% 99.84% 99.79% 99.89% 99.82% 99.93% 99.86% 99.8% 99.94% 99.93% 99%

Welsh Patients 99.92% 99.93% 100% 99.93% 100% 99.93% 100% 99.76% 100% 99.9% 100% 99.9% 100% 100%

New to Follow Up Ratio 2.34 2.23 2.37 2.22 2.21 2.14 2.29 2.26 2.18 2.32 2.39 2.66 2.41 2.5

(44)

Caring for Finances

Referrals Received for Consultant

Led Services 2856 3046 3134 2953 3048 2869 2888 2921 2394 2810 2578 3113 N/A 2443

Activity - Inpatient Activity 1254 1140 1218 1115 1026 1248 1223 1251 1078 1209 1244 1386 1001 1004

New 1761 2037 2136 1837 1959 2306 2088 1895 1627 1998 1679 1837 1380 1573

Follow Up 6307 6419 7174 5918 6256 7203 7175 6961 5779 7068 6485 7675 5305 5678

Overall Daycase Rate 51.46% 46.51% 47.67% 46.49% 48.5% 50.31% 47.36% 48.77% 45.44% 51.84% 48.59% 47.22% 47% 53%

% of Inpatients Admitted on Day

of Surgery 95.53% 94.61% 92.58% 95.92% 94.43% 94.84% 94.56% 94.83% 94.2% 95.05% 94.14% 94.57% 94.29% 95%

% Theatre Lists Utilised 89 88

Theatre Cases per Session 2.23 2.18 2.1 2.25 2.15 2.25 2.13 2.15 2.13 2.13 2.18 2.2 2.1 2.15

Average Length of Stay 3.65 3.76 3.84 3.85 4.29 3.9 3.84 3.35 3.87 3.48 3.66 4.26 3.88 3.5

Bed Occupancy – Adult

Orthopaedic Wards – 2pm 77.56% 82.5% 89.63% 82.97% 86.09% 94.63% 89.88% 89.61% 87.34% 87.07% 92.15% 90.05% 84.91% 87%

Bed Occupancy – All Wards – 2pm 78.25% 78.18% 83.49% 82.58% 84.49% 87.62% 85.49% 85.68% 81.11% 83.02% 82.19% 82.69% 80.21% 87%

Outpatient DNA Rate 5.84% 5.66% 6.54% 5.71% 5.69% 5.42% 5.54% 5.29% 5.49% 5.76% 5% 5.55% 5.65% 5%

(45)

Apr-17 Apr-17 Target/ Ceiling Oct-16 No v-16 De c-16 Jan-17 Fe b-17 Mar-17 Se p-16 Apr-16 Ma y-16 Ju n-16 Jul-16 Au g-16

Caring for Finances

Financial Control Total (£

'000) 184 -173 414 82 -291 379 88 477 -644 313 202 623 -842 -852

Clinical Income (£ '000) 6861 6541 6932 6823 6443 7226 7076 7363 6136 7322 7190 8521 5879 5992

Private Patients Income (£

'000) 235 251 393 269 383 401 466 393 324 466 342 388 376 318 Other Income (£ '000) 499 574 582 480 444 594 548 504 571 566 479 431 476 540 Pay (£ '000) 4556 4523 4475 4513 4483 4595 4718 4817 4667 4774 4712 4852 4599 4637 Non Pay (£ '000) 2562 2767 2749 2705 2789 2948 3002 2683 2824 3005 2773 3144 2656 2746 Financing (£ '000) 331 289 310 312 343 342 327 327 234 315 377 377 362 368 CIP Delivery (£ '000) 107 190 200 201 294 297 359 386 372 376 350 390 385 403

Agency Control Total (£ '000) N/A N/A N/A N/A N/A 182 109 122 92 87 105 187 116 135

Cash Balance (£ '000) 4808 4678 4895 4601 4565 3929 3957 4054 4530 3776 3144 4623 4366 3107

Capital Expenditure (£ '000) 518 853 874 824 205 174 182 354 412 390 88 682 50 358

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

Apr-17 Apr-17 Target/ Ceiling Oct-16 No v-16 De c-16 Jan-17 Fe b-17 Mar-17 Se p-16 Apr-16 Ma y-16 Ju n-16 Jul-16 Au g-16

(46)

Caring for Staff

Sickness Absence 3.48% 3.19% 3.41% 3.35% 2.9% 2.83% 2.82% 4% 3.56% 4.18% 3.6% 2.96% 3.04% 3%

Staff Stability Index 92.58% 92.19% 91.52% 92.17% 91.51% 91.17% 92.19% 92.06% 91.75% 92.09% 92.37% 92.1% 92.73% 91%

Voluntary Staff Turnover 7.78% 8.31% 8.5% 8.45% 8.35% 8.91% 9.34% 8.85% 8.92% 8.58% 8.67% 8.88% 8.92% 8%

Voluntary Nurse Turnover Rate 13.62% 13.46% 14.62% 14.34% 13.41% 13.55% 13.47% 13.17% 13.96% 13.18% 12.54% 13.03% 11.78% 12%

Staff Appraisal 83.48% 83.6% 89.63% 93.3% 95% 93.79% 92.44% 93.64% 91.35% 89.88% 89.84% 91.32% 91.55% 90%

Mandatory Training 88.52% 88.43% 87.03% 89.13% 90.77% 95.97% 95.89% 95.66% 95.98% 92.46% 95.79% 95.41% 94.9% 92%

Apprenticeship Starts 0 1 5 2 1 1 1 1 0 1 1 1 0 0

Apprenticeship Funding Accessed 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total WTE 1143.8 1139.76 1136.14 1152.26 1160.94 1169.57 1182.9 1191.35 1188.82 1205.78 1206.73 1209.11 1205.7 TBC

Staff Friends & Family Test - Care N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Staff Friends & Family Test - Work N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Staff Friends & Family Test -

Response N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Pulse Check Q1 - Treat everyone

consistently 2.6 3

Pulse Check Q2 - Best placed

person to make Decisions 2.37 3

Pulse Check Q3 - Look for Ways to

get things Done 2.72 3

Pulse Check Q4 - Impact of our

(47)

Caring for Staff

Pulse Check Q5 - Cost Effective

Ways to do Things 2.62 3

Pulse Check Q6 - Constructively

Challenge when we Disagree 2.4 3

(48)

Commentary

Income - Dependant upon delivery of activity plan going forward and recovery of YTD

shortfall.

Non current receivables 635 699 64

Total Non Current Assets 67,690 67,572 (118)

Inventories (Stocks) 1,067 1,048 (19)

Receivables (Debtors) 5,936 6,774 838 Health Education England monies due in May and income over _performance Cash at Bank and in hand 4,623 4,367 (256)

Total Current Assets 11,626 12,189 563

Payables (Creditors) (9,444) (10,759) (1,314) Prepayments and contract invoicing adjustment from twelfths to _{Trust delivery plan.}

Borrowings (1,201) (1,201) 0

Current Provisions (187) (187) (0)

Total Current Liabilities (< 1 year) (10,833) (12,147) (1,314) Total Assets less Current Liabilities 68,483 67,613 (869)

Non Current Borrowings (8,236) (8,236) 0 Non Current Provisions (112) (99) 12

Non Current Liabilities (> 1 year) (8,348) (8,335) 12

Total Assets Employed 60,135 59,278 (857)

Public Dividend Capital (33,260) (33,260) 0

Revenue Position (3,008) 857 3,865 In month deficit and roll up ofr 16/17 surplus into retained earnings Retained Earnings (7,019) (10,027) (3,008)

Revaluation Reserve (16,848) (16,848) 0

Total Taxpayers Equity (60,135) (59,278) 857

Apr-17 YTD

Debtor Days 31 31

Creditor Days 42 42

Plan Actual Variance

Clinical Income from activity 89,900 6,427 6,271 (156) (156)

Private Patient income 4,763 318 376 58 58

Other income 6,566 540 476 (64) (64) Pay (56,639) (4,637) (4,599) 38 38 Non-pay (40,261) (3,181) (3,048) 133 133 EBITDA 4,921 (504) (494) 10 10 Finance Costs (4,417) (368) (362) 6 6 Capital Donations 200 13 0 (13) (13) Operational Surplus 705 (859) (857) 2 2

Remove Capital Donations (200) (13) 0 13 13

Add Back Donated Dep'n 600 50 45 (5) (5)

Remove STF Funding (592) (30) (30) 0 0 Control Total 513 (852) (842) 10 10 STF Earnt 592 30 30 0 0 Planned Surplus 1,105 (822) (812) 10 10 EBITDA margin 4.9% -6.9% -6.9% 0.0% Prior Month

Capital service 4 I&E Margin 4

Liquidity (days) 3 Variance in I&E Margin 1

Agency 1 3 Overall UOR 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 C a s h £ M

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Monitor Plan £M 3.0 3.3 3.5 4.0 3.5 3.0 3.0 3.2 3.4 3.8 3.4 3.5 Actual £M 4.4 Forecast £M 4.4 4.3 4.6 4.3 4.1 3.6 3.6 3.8 4.0 4.4 4.0 4.0 Cash Flow Risks (£1,000) (£800) (£600) (£400) (£200) £0 £200 £400 £600 £800

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

S u r p l i u s / ( D e f i c i t ) Period Monthly Surplus/Deficit Plan Actual £0 £100 V a Cumulative Variances £'000s

(49)

RAG of Total Schemes Being Tracked 1,432 40% g 2,037 57% a 132 4% r 3,600 100.0% C a pi ta l C o mm is sio n er P erf o rm a n ce

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

C IP by T h eme

Year To Date Commissioner Income against Plan £m

C IP by D iv is io n

Year to date capital programme £000's

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

0 50 100 150 200

Capacity Alignment Divisional Local Strategic (Transformation) National Strategic (Lord Carter) FYE 16/17

Apr Plan Apr Actual

0 50 100 150 200 250 300 350 400 450

YTD Plan YTD Actual

0 50 100 150 200

Capacity Alignment Divisional Local Strategic (Transformation) National Strategic (Lord Carter) FYE 16/17

YTD Plan YTD Actual

0 50 100 150 200 250

Surgery Medicine Diagnostics Estates & Facilities Corporate Theatres

Apr Plan Apr Actual

0 50 100 150 200 250

Surgery Medicine Diagnostics Estates & Facilities Corporate Theatres

YTD Plan YTD Actual

- 0.50 1.00 1.50 2.00 2.50

Shropshire BCU Specialist Other English Contracted Powys Telford Other Uncontracted

Position as at 1718-01

Project Annual Plan

£000s Year to date Plan £000s Year to date Completed £000s Year to date Variance £000s Forecast Outturn £000s Generator / Medical Gas Plant Upgrade 200 100 0 100 200

Outpatient Development 250 0 0 0 250 Office Reconfiguration 150 38 31 7 150 CT Scanner 300 0 0 0 300 IT Investment 300 0 2 -2 300 Backlog Maintenance 300 25 7 18 300 Equipment Replacement 400 0 1 -1 400 Project Management 100 8 9 -1 100 Menzies Equipment 200 50 0 50 200 Capital Programme 2017-18