Shaun Stacey, Chief Operating Officer. Richard Peasgood, Executive Assistant

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NLG(21)111

DATE OF MEETING

1

June 2021

REPORT FOR

Trust Board of Directors (Public)

REPORT FROM

Shaun Stacey, Chief Operating Officer

CONTACT OFFICER

Richard Peasgood, Executive Assistant

SUBJECT

Executive Update - Performance

BACKGROUND DOCUMENT

(if any)

N/A

OTHER GROUPS WHO

HAVE CONSIDERED PAPER

(where applicable) AND

OUTCOME

N/A

EXECUTIVE SUMMARY

The Operational Update details the current position with ED

and ambulance waits, as well as the Discharge to Assess

program and Elective and Cancer position.

LINK TO STRATEGIC OBJECTIVES - which does this link to? (please tick )

1. To give

great care

2. To be a good

employer

3. To live

within our

means

4. To work more

collaboratively

5. To provide

strong leadership

TRUST PRIORITIES - which Trust Priority does this link to? (please tick )

Pandemic Response

Workforce and Leadership

Quality and Safety

Strategic Service Development and

Improvement

Estates, Equipment and

Capital Investment

Digital

Finance

The NHS Green Agenda

Partnership & System

Working

BOARD ASSURANCE

FRAMEWORK (explain

which risks this relates

to within the BAF or

state not applicable

(N/A)

Risk 1: Risk of non-delivery of constitutional performance targets,

specifically: (a) Cancer 62 day, (b) A&E, (c) RTT - 18 weeks, (d)

Diagnostics - DMO1

BOARD / COMMITTEE

ACTION REQUIRED

(please tick )

Highlights

Lowlights

Risks

• Zero 12 hour DTA breaches during April 2021

• Reduction in number of ambulance 60min+ handover

breaches during April 2021 compared to March 2021

• New patient pathway – EMAS direct streaming to SDEC

services at both sites now in place

• New patient pathway – Ambulance protocol for patient

self-handover now in place at both sites

• The new ED builds are progressing well with

construction ongoing at DPOWH and the final decanting and enabling works ongoing at SGH. Detailed room specifications and digital strategy being developed

• NLAG are early adopters for the region to go live with

direct bookable arrival slots in ED at DPOWH for the SPA using the new Any2Any interfacing as part of the NHS111 First initiative programme

• Good progress is being made on recruitment due to the

launch of a new ED medical staffing recruitment strategy and nurse training and development plans

• Additional medical staff have been injected into ED to

improve patient safety throughout the department

• 78% increase in ED attendances in April and May 2021

compared to April 2020. Average daily attendances during May 2021 is 429 per day, up from 419 per day during April 2021. Maximum number of arrivals of 509 experienced.

• Trust performance against the 4hr target for April 2021

was 72.35% (DPOWH 69.9%, SGH 74.3%)

• In conjunction with the system partners, two audits at the

front door are being undertaken, outcome of which will help focus on areas of improvement; retrospective missed opportunities audit and real time point prevalence audit.

• The Trust has included a 3 tier oversight arrangement in

the both EDs to address fragility due to an increasing number of attendances.

• The impacts of covid-19 on ED are still providing

additional challenge for waiting room capacity due to social distancing, delays in diagnostics due to increased cleaning regimes, additional PPE requirements, and delays to admission

• Staffing numbers remain a challenge as covid-19 heavily

impacted the appointed recruitment pipeline

• Ambulance handovers have been a targeted focus

throughout 2020/21, with a direct correlation between high bed occupancy levels and 60 min+ ambulance handovers

• Staffing experience, skill mix and reliance on agency staff

is continuing to be a challenge in ED especially on overnight shifts

• Risk of overcrowding in

and fragility in both EDs due to increase in attendances and reduced capacity from both physical and workforce perspectives.

• High bed occupancy

levels leading to a lack of patient flow and exit block in ED will result in delays for patients in ED and drop in 4hr performance and delays in off loading patients from

ambulances and risk 60min+ handover breaches

• Reliance on locum bank

and agency specialty doctors in ED due to delayed recruitment pipeline

Highlights

Lowlights

Risks

• In May 2021 the SDEC activity improved to 37.65% compared to 33.08%

in April 2021. This is compared to 30% good national average. The 3+ days LoS in May 2021 improved to 41.02% from 44.8% in April 2021.

• A frailty service pilot at DPOWH commenced on 12 May 2021 for 4 weeks

providing improved patient experience for frail patients on SDEC instead of ED. Pathways for EMAS to access advice and guidance through SPA to avoid acute attendances where possible

• Additional investment into the medical staffing for IAAU has been made

during the year, allowing an increase in the service provision out of hours to support SDEC services

• New EMAS pathways went live during March 2021 that enables EMAS

crews to speak directly with a Consultant Acute Care Physician for clinical advice and a decision on whether to directly stream patients to SDEC services

• Advice and guidance services for Medicine Acute SDEC is now in place

that allows primary care to speak directly with a Consultant Acute Care Physician for clinical advice and guidance

• The final phase of the IAAU will be the move into the newly refurbished

units located next to the new ED builds and the additional workforce required to increase the service hours

• Although significant recruitment has

taken place, demands on the workforce remain high and work is ongoing to fill all posts required to deliver the service

• The Acute Medicine team has taken on

significant increases in workload during the year, with an increased number of beds coming under their remit and the introduction of covid/non-covid acute assessment wards

• Continued embedding to improve

specialty input times and remove traditional barriers from quick access to SDEC services

• Reliance on sufficient

daily discharges to enable flow out of IAAU is required

• Turnaround times for

covid-19 swab results impacts on ability to move patients on from IAAU into green/red wards

• Workforce and skillmix

ED Streaming, Integrated Acute Assessment Unit

and Same Day Emergency Care

Highlights

Lowlights

Risks

• The Trust’s performance for 21 day+ currently reported at 7.27% (as at

23rd_{May) remains under the national average of 12% and is the second}

lowest within the North east and Yorkshire region.

• Improvement work at rapid pace has taken place to enable the whole

northern Lincolnshire system implement and embed the Hospital Discharge Service: Policy & Operating Model.

• All wards now have senior consultant presence at board rounds before

10am

• All wards are now able to report if and when a patient no longer has a

criteria to reside in an acute hospital bed by completing web v

• A vast amount of work has been carried out on the Web V System to

enable wards to record which patients no longer meet the criteria to reside this enables national daily reporting

• Working with our system partners daily to ensure patients who require

care when leaving the acute trust receive this within 24 hours of identification with a full escalation plan for delays in place

• Reduction in long length of stay continues to be recognised at a national

level with further recognition by the beneficial change programme

• The trust are carrying out a frailty pilot on the Grimsby site this has already

seen significant improvements in the patient pathway with over 85% of patients assessed by the frailty team discharged on the same day

• The trust have been accepted onto the ward/board round collaborative

with NHS E/I a medical ward from the Scunthorpe & Grimsby site have been nominated

• Medical and Nurse staffing numbers

remain a challenge and this impacts on the overall flow on all sites

• Although there have been significant

improvements for senior presence on all wards before 10am there is a vast amount of work that now needs to take place to improve the effectiveness of board rounds to ensure every patient has a plan

• Work needs to be carried out on

ensuring the identification of patients being placed on an end of life pathway is carried out in a timely manner to ensure the appropriate ongoing care can be put in place dependant on the patient and relative needs and wishes

• Turnaround times for

covid-19 swab results impacts on ability to move patients to community beds and placements

• Continued pressures on

the acute workforce resulting in delay in decision making and timely discharge

• Continued IT system &

reporting improvements required to ensure all data is captured and reported accurately

Highlights

Lowlights

Risks

• Volume of patients waiting longer than 104 days in Cancer is improving

since July 2020.

• The number of RTT 52 week plus waiters continues to decrease

• Delivery of 101% of the agreed 2020/21 phase 3 recovery plan for

out-patient attendances, with both Surgery and Family Services exceeding the plan and Medicine delivering 87%

• The out-patient follow up backlog position continues to reduce with

significant improvements in Medical specialties with the support of the Independent Sector

• The Independent Sector continues to support the Trust with additional

capacity within CT, MRI, Gynaecology, Orthopaedics and General Surgery. This capacity is targeted to support long waiter backlog patients.

• Processes in place to record, track and monitor risk stratification for all

patients at all points in the pathway

• Inpatients Live Risk Stratification at 99.8%

• Volume of patients waiting longer than

104 days in Cancer is 30 (trust wide – all tumour sites except Breast &

Gynaecology (25th_{May 2021))}

• RTT Performance continues to be low

• Due to reduced theatre capacity,

particularly during the peak of Covid waves, this has resulted in delivering below plan for elective recovery. The Trust has delivered 83% of the plan for elective and 71% of the plan for daycases within the agreed 2020/21 phase 3 recovery plan.

• Plans are being put in place to risk

stratify all open Outpatient episodes

• Risk stratification in ophthalmology at

SGH.

• Workforce risk around

significant vacancy gap

• Workforce risk around

carried over annual leave

• Potential wave 3 of

COVID-19

• Capacity to deliver risk

stratification for Outpatients

• Challenges to delivery

of the elective recovery plan