agenda item: 9.1, public board meeting date · this is a standing agenda item at each meeting of...

Integrated Performance Report of 38 28 October 2015

Agenda item:

9.1, Public Board meeting

Date: 28 October 2015

Title:

Integrated Performance Report

Prepared by:

Pete Adey, Operations Director Tracey Cottam, Director of Transformation & Organisational Development Adrian Harris, Medical Director Suzanne Tracey, Deputy Chief Executive / Chief Financial Officer Em Wilkinson-Brice, Deputy Chief Executive / Chief Nurse

Presented by:

Tracey Reeves, Deputy Chief Nurse / Midwife

Responsible Executive:

Pete Adey, Operations Director Tracey Cottam, Director of Transformation & Organisational Development Adrian Harris, Medical Director Suzanne Tracey, Deputy Chief Executive / Chief Financial Officer Em Wilkinson-Brice, Deputy Chief Executive / Chief Nurse

Summary:

To advise the Board of the Trust’s performance against key performance standards and targets; and progress on the implementation of the Trust Strategy and key supporting projects.

Actions required:

The Board is asked to receive the Performance Report and note the current risks and the proposed action plans to mitigate the risks against performance delivery.

Status (*): Decision Approval Discussion Information

Yes

History:

This is a standing agenda item at each meeting of the Board of Directors.

Link to strategy/ Assurance framework:

This paper details the Trust’s performance in respect of key performance standards and targets. Achievement of these performance standards and targets is a key objective within the Trust’s Strategy.

Monitoring Information Please specify CQC standard numbers and tick other boxes as appropriate

Care Quality Commission Standards Outcomes

Monitor Finance

Service Development Strategy Performance Management

Local Delivery Plan Business Planning

Assurance Framework Complaints

Equality, diversity, human rights implications assessed

Other (please specify)


1. PURPOSE

1.1 To advise the Board of the Trust’s performance against the key performance standards and targets. Following a Board sub-group review of the IPR, some changes have been made to the format and structure of this report. The implementation of the recommendations is work in progress and further changes will be made in November. The data tables continue to be circulated to Board members separately to this report.

2. BACKGROUND

2.1

September saw no significant change in bed capacity and patient flow, with the Trust declaring an Amber escalation level against the Capacity Escalation Framework for the majority of the month. The Emergency Department (ED) had a challenging month, with an average of 300 patients attending ED each day, the highest daily average since July 2014. This resulted in a slight deterioration in performance against the 4-hour wait standard, with performance in September (94.54%) failing to achieve the contractual target for the month, but the Monitor target was achieved. The number of patients waiting for onward care in September remains a concern. During the month there was a median number of 75 patients on the ‘medically fit to be discharged’ list, which was unchanged from August. The Trust continues to work closely with the Northern, Eastern & Western Devon Clinical Commissioning Group (CCG) and providers of onward care services in order to expedite the discharge of patients. An update will be provided to the Board of Directors on the development of the Delayed Transfers of Care remedial action plan as part of the Board meeting. The Integrated Care for Exeter (ICE) Project will be launched on 1st November and will improve the delivery of community services for adults with complex needs with a focus on helping more people to be able to be cared for in their own homes rather than in hospital, and to streamline the discharge pathways so that people only stay in hospital as long as is necessary. The RD&E Operational Capacity Planning for Winter 2015/16 has been completed and is being presented to the Trust’s Board of Directors at the Board meeting. The System Resilience Group (SRG) led by NEW Devon CCG is responsible for reviewing all health and social care partners’ Winter Capacity plans. The SRG is continuing to review priority areas for system improvement and to agree implementation plans as part of the preparation process for the winter. The Trust continues to perform well across the majority of indicators in terms of Patient Experience, Safety, Clinical Effectiveness, Operational Effectiveness and Workforce. Performance in relation to five cancer waiting time targets was below target in September. This only affects a small number of patients and clinical review processes are in place to ensure that there is no harm caused by these delays. Diagnostic waits are also not being achieved and a plan is in place to address this. The financial position has deteriorated by £1.9m compared to Month 5 due to income under-recovery, but the forecast outturn remains at a £20.1m deficit.


3. ANALYSIS & KEY ISSUES

3.1

Patient Experience

Scale

120 ⁻

50 ₋

105% ⁻

70% ₋

| Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |

2013 - 2014 | 2014 - 2015 | 2015 - 2016 Latest

month

68

97.1% Low

Medium

Risk for next

3 monthsIndicator

Complaints & Concerns

acknowledged within 3

days

100%

Number of Complaints and

Concerns

Target

line

<70

Complaints & Concerns There has been no change in the number of complaints and concerns received during September (68) compared to August. The main theme relates to communication. The discussion of weight management continues to result in complaints. Consideration is being given to the language used. This will be discussed with the CCG for communication to primary care as weight management needs to be discussed prior to hospital referral. The Trust is continuing to ensure that complaints lead to service improvements. Examples of changes recently put in place are displaying waiting times in the emergency department and improved information for patients undergoing chemotherapy day case treatment. Cases referred to the Parliamentary Health Service Ombudsman (PHSO) The PHSO has not requested any cases for review during September. One final report was received which has been partially upheld. A patient had a gynaecological problem, a particular treatment should have been offered, on the recommendation of the PHSO; this will be considered by the clinical team for future patients. CQAT

One of the Trust’s main measurement tools for quality is the Care Quality Assessment Tool (CQAT). During September 4 wards were audited. 2 of the wards achieved Silver with 2 obtaining Bronze. At the end of September there were no wards ungraded. OQAT

During September 2 outpatient areas were audited both of which obtained Bronze. Mixed Sex Accommodation

There were no clinically unjustified single sex accommodation breaches recorded in September.


3.2 Safety & Safe Staffing

Specialing requirements across the 3 Divisions totalled 61.84 WTE for the following reasons. (All requests were endorsed by the relevant Assistant Director of Nursing.)

1 CAHMS patients

1 Mental Health patient where Liaison Psychiatry had reviewed and requested 1:1 care

1 patient with Learning Difficulties requiring 1:1 care

7 patients with a challenging behaviour plan

5 wards had increased cohort bay requirements to support enhanced observation due to patients at a high risk of falls

7 surgical post-operative patients requiring enhanced observation

6 patients at risk of falls that could not be cohorted due to Infection Control risk. Twenty four ward areas this month are showing that they have not met their planned hours at some stage during the month. On all wards the Ward Matron and Senior Nurses reviewed the acuity and dependency of patients and were satisfied having exercised professional judgement that the wards were safely staffed. There have been no NICE ‘Nursing Red Flags’ this month. The Trust and Divisional Safe Staffing Thermometer tool is attached as Appendix 3. The report details patient and ward dependency over time to support the six monthly establishment review.


Safety

35 ⁻

0 ₋

13 ⁻

6 ₋

175 ⁻

75 ₋

3 ⁻

0 ₋

0.7 ⁻

-0.1 ₋

12 ⁻

0 ₋

115 ⁻

85 ₋

130 ⁻

70 ₋

135 ⁻

75 ₋

Scale

100% ⁻

84%₋

98% ⁻

86% ₋

6 ⁻

0 ₋

1 ⁻

0 ₋

5.8 ⁻

-0.2 ₋

Summary Hospital-level

Mortality Indicator (SHMI)

Rolling 3 months - Medical

Services

As

expect

ed or

lower

Low



Rolling 3 months - Surgical

Services

As

expect

ed or

lower

Low



Rolling 3 months -

Specialist Services

As

expect

ed or

lower

Low

67.77

89.92

135 ⁻

75 ₋

170 ⁻

50 ₋

180 ⁻

45 ₋



Rolling 3 months

As

expect

ed or

lower

Low



Rolling 3 months -

Weekday Admissions

As

expect

ed or

lower

Low



Rolling 3 months -

Weekend Admissions

As

expect

ed or

lower

Low

140 ⁻

70 ₋

Low

As

expect

ed or

lower

Latest

month

Low

≤0.2 Low

Low

Low

Low

Low

Low

Low

≥90%

Trajec

tory

2013 - 2014 | 2014 - 2015 | 2015 - 2016 Risk for next

3 months | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |

Low

Low

LowSafety Thermometer –

Absence of New Harm

Clostridium difficile cases

(Trust apportioned)

Trajec

tory

E-coli Bacteraemias (Trust

apportioned)

MRSA Bacteraemias (Trust

apportioned)

≤5

IndicatorTarget

line

National Summary

Hospital-level Mortality

Indicator (SHMI) - Rolling

12 months

≤2

Rate of Grade 3- 4 pressure

Sores /1000 bed days

NRLS moderate, major or

catastrophic incident

count

MSSA Bacteraemias (Trust

apportioned)

Rate of Grade 1- 4 pressure

Sores /1000 bed days≤2

NRLS incidents /100

admissions

Inpatient Slips, Trips and

Falls≤160

Safety Thermometer – Harm

Free Care≥90%

≤10

≤30 11

9.0

125

0.57

0.00

1

0

2

4

91.81

98.18

98.27

97.86

104.36

98.3%

95.8%


Infection Control Clostridium Difficile The rate of C.difficile cases per 100,000 bed days remains below the regional and national rate throughout Q1 and 2. As reported previously, the improvement in C.difficile rate has coincided with the in-patient ward deep clean programme which is now complete and will have contributed to the reduction in cases. Methicillin resistant Staphylococcus aureus (MRSA) It has now been 4 years since the last hospital attributable MRSA bacteraemia was reported. When compared to medium, large and acute teaching hospitals, the Trust has achieved the longest period without an MRSA bacteraemia. Achieving this sustained level of excellent performance has been down to the implementation of a wide range of measures and the continued hard work and engagement of our staff. E.coli bacteraemia In September, we have reported 16 E.coli bacteraemias as part of the mandatory surveillance to PHE, however, 12 of these were identified within 2 days of admission and therefore were deemed to be community acquired. Of the 4 that were identified more than 48 hours after admission, all are subject to enhanced surveillance and no obvious lapses in care were identified. Falls Risk Assessments As indicated in the Ward to Board Dashboard included in Appendix 4, in April 2015 there was a change introduced in the recording of falls risk assessments. Whereas previously compliance was assessed on a monthly spot check basis as part of the Safety Thermometer day, recording of falls risk assessments is now done for all patients. Performance for September is 89.6%. The Medical and Specialist Services Divisions have improvement plans in place which continue to focus on the admission areas. Serious Incidents & Coroner Reports There were no Never Events in September. General Medical Council Concerns There has been one concern raised from the General Medical Council (GMC) in August which has been closed in September with no further action required.


3.3 Clinical Effectiveness

100% ⁻

65% ₋

101% ⁻

54% ₋

100% ⁻

84% ₋

100% ⁻

80% ₋

100% ⁻

75% ₋

100% ⁻

60% ₋

100% ⁻

87.5% ₋

100% ⁻

80% ₋

Scale

100% ⁻

69% ₋

100% ⁻

65% ₋

100% ⁻

60% ₋

Low

Low

Low

Low≥90%

95.3%

90.2%

| Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |

Risk for next

3 months

High

High

Low

Medium

High

High

Medium

≥90%

≥90%

2013 - 2014 | 2014 - 2015 | 2015 - 2016

Antimicrobial prescribing -

Indication specified on the

drug chart


Empirical therapy as per

guidelines

Trajec

tory

≥90%

VTE Thromboprophylaxis -

% of surveyed patients with

appropriate prophylaxis

≥90%

MUST General - % of

patients screened for

Malnutrition on weekly

review

MUST Triggers actioned

(High Energy Menu)


Duration specified on the

prescription

IndicatorTarget

line

Trajec

tory

≥95%

Surgery within 36hrs for

Patients with a Fractured

Neck of Femur (excluding

medically unfit)

≥90%

Trajec

tory

MUST Initial - % of

patients screened for

Malnutrition within 48hrs

of admission

% of Stroke Patients

spending ≥90% of their

time on a Stroke Unit

≥80%

VTE risk assessment - % of

eligible admissions

assessed for risk of VTE on

admission

MUST Triggers actioned

(Food Record Chart)

Latest

month

90.0%

75.0%

80.8%

89.7%

89.7%

97.2%

95.9%

99.2%

92.2%

Stroke

Performance for the proportion of patients spending ≥ 90% of their time on a stroke unit using the SSNAP tool is 83.9% for July, 81.4% for August and 75.0% for September against a target of 80%. These figures are provisional and it is anticipated will improve as in previous months as data from community hospital stroke patients is verified.

Antimicrobial prescribing – compliance with duration and indication on the drug chart, and compliance with guidelines Trust wide figures for compliance in September were: 80.8% (219/271) for inclusion of a duration on the drug chart; 89.7% (243/271) for inclusion of an indication on the drug chart; and 89.7% (156/174) for guideline compliance. A new Consultant Microbiologist has recently taken up post in the Trust and has also taken on the role of Lead Clinician for Antimicrobial Stewardship. He is currently re-evaluating our antimicrobial stewardship delivery strategy. Actions taken thus far involve a review and revision of our antimicrobial guidelines and the development of a new suite of metrics. Concomitant work on behalf of the Medical Director around a junior doctor’s forum and improved


methods of communication with junior doctors will facilitate this process. The work will continue to be driven through Divisional Performance Review Framework and the Antimicrobial Stewardship Group.

VTE Risk Assessment

The proportion of adult inpatients in September who were either risk assessed for the likelihood of VTE, or within one of the agreed low risk patient cohorts, was 95.33% against a target of 95%. Due to the small number of patients over target, the risk for the next three months is assessed as medium.


3.4 Operational Effectiveness

100% ⁻

85% ₋

101% ⁻

81% ₋

100% ⁻

86% ₋

101% ⁻

79% ₋

101% ⁻

91.5% ₋

101% ⁻

96% ₋

Scale

98% ⁻

91% ₋

99% ⁻

92% ₋

60 ⁻

0 ₋

97% ⁻

83% ₋

100% ⁻

92% ₋

98% ⁻

86% ₋

1.8% ⁻

0% ₋

30 ⁻

-2 ₋

Ambulance Handovers

Delayed >30 mins

Trajec

toryMedium

Risk for next

3 months

High

Low

High

Low

High

≥95%

A&E: maximum waiting

time of 4hrs from arrival to

admission/ transfer/

discharge (including WIC)

≥95%

Maximum time of 18 weeks

from point of referral to

treatment in aggregate -

Non-admitted

≥95% Not Set

Medium

Medium

Medium

Low

Low≥94%

Medium

Not Set

0




Incomplete Pathways

≥92%




Admitted

≥96%

≤0.8%

Patients not treated within

28 Days of same day

cancellation due to non-

clinical reason

31 Day Wait for Second or

Subsequent Treatment (All

Cancers) - Anti-cancer drug

treatments

14 Day Wait from referral

to date first seen (Cancer) -

Symptomatic Breast

Patients

≥93%



Cancers) - Radiotherapy

Same Day Cancellations

for non-clinical reasons as

a proportion of elective

admissions

92.94%

84.62%

93.13%

2013 - 2014 | 2014 - 2015 | 2015 - 2016

≥94%

Target

line | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |

A&E: maximum waiting

time of 4hrs from arrival to

admission/ transfer/

discharge (excluding WIC)

14 Day Wait from referral

to date first seen (Cancer) -

All Urgent Referrals

≥93%

31 Day Wait from

Diagnosis to First

Treatment (All Cancers)

Indicator

≥90%

≥98%



Cancers) - Surgery

Latest

month

94.54%

95.33%

31

88.78%

97.24%

93.15%

0.81%

0

81.73%

99.29%

100.00%


45% ⁻

0% ₋

101% ⁻

92% ₋

80 ⁻

0 ₋

9% ⁻

0% ₋

5.8 ⁻

4 ₋

99% ⁻

85.5% ₋

100% ⁻

75% ₋

100% ⁻

75% ₋

101% ⁻

70% ₋

101% ⁻

80% ₋

100% ⁻

70% ₋

High

High

Medium

Medium

Not Set

Not Set

Low

High

High

High

≥90%

Outpatient Appointment

Unavailability (ASIs)

62 Day Wait for First

Treatment (All Cancers) -

Consultant Upgrade

≥85%

≤10% High

≤95%

≤95%



Urgent GP Referral

≥85%



key diagnostic test

≥99%

Median average number of

patients 'Green to Go' on

Community Waiting List

≤30

30 Day Emergency

ReadmissionsN/A

Adult Inpatient Average

Length of Stay (excluding

Maternities)

N/A

Medical Bed Occupancy

Surgery Bed Occupancy

Trauma & Orthopaedics

Bed Occupancy

≤90%



Screening Service Referral

85.57%

94.44%

81.22%

7.3%

97.5%

75

5.5%

5.4

95.3%

87.9%

81.8%

A&E Maximum Waiting Time of Four Hours from Arrival to Admission, Transfer or Discharge (excluding Walk In Centre activity), and Ambulance Handover Delays

The position for A&E for the month of September including the WIC was 95.33% compared to 96.07% in August. Performance for the quarter including the WIC was 96.09%. The position for A&E for the month of September excluding the WIC was 94.54%. Although there was a slight deterioration in performance from August (95.28%) this is consistent with the seasonal profile and is better than the performance in September 2014. The Trust continues to work closely with the Liaison Psychiatry Team, part of the Devon Partnership NHS Trust. The team provide an on-site service for the RD&E to support swift assessment and treatment of patients with mental health concerns both presenting at the Emergency Department (ED), and those who subsequently require an admission to the hospital with physical health needs. Alongside a 50% increase in referrals across the last twelve months, the team have continued to develop new ways of working to ensure patients in mental health crisis or in mental health need are assessed and treated in a timely way. In September 2015, 94% of the referrals to the Liaison Psychiatry Team in ED were seen within 1 hour of referral, thereby helping to support delivery of the A&E waiting time target. The Liaison Psychiatry team continue to improve their staffing ratio and it is expected that there will be 24/7 cover for this service within the Emergency Department from January 2016, which will reduce delays for mental health patients who attend overnight. In September there were 31 ambulance handover delays greater than 30 minutes duration and no ambulance handover delays greater than 60 minutes duration. The team will review the


ambulance handover escalation plan to ensure that all potential issues that may result in delay are proactively managed. Ambulance handover delays will be reported daily at the performance meeting to ensure that improvements in performance are delivered and to reduce the risk of increased delays over the winter period. Cancer Waiting Times Performance

Performance against the Cancer standards at the end of September remains largely unchanged, based on non-validated figures. The Trust has failed to achieve 5 of the cancer waiting times standards for the month of September. Two Week Wait from Referral to Date First Seen

Standard Required Performance (%)

Actual Performance (%)

Number of Patients in Excess of the Threshold

Two week wait from Referral to Date First Seen (All Cancers)

93 92.94 1

Two Week Wait from GP Referral for Symptomatic Breast

93 84.62 3

The improvements noted in the August board report for 2 week waits have continued, although the target is likely to not be met this month, this is currently only by 0.06% - equivalent to one patient. It is likely that the Trust will be compliant with this target for the quarter. The Trust has again failed to achieve the symptomatic breast target for the month, which will result in failure of the quarter, as with last month all of the patients seen beyond 14 days were due to patient choice. 31 Day Wait from Diagnosis to First Treatment, to Second or Subsequent Surgical Treatment, and 62 Day Wait from Urgent GP Referral to Treatment

Standard Required Performance

(%)

Actual Performance

(%)

Number of Patients in Excess of the Threshold

31 Day Wait from Diagnosis to First Treatment (All Cancers)

96 93.13 10

31 Day Wait for Subsequent Treatment (Surgical Treatments)

94 81.73 13

62 Day Wait from Urgent GP Referral to First Treatment

85 81.22 7.5

Performance remains challenged within 31 day first treatments, 31 day subsequent surgical treatments and the 62 day urgent GP referral targets. As a consequence the Trust will fail in each of these areas for the quarter. Based upon current performance information, the Trust will have breached the 62 day GP target by 7.5 patients. The 0.5 patient reflects where a patient has been referred from another hospital where in the event of the patient breaching the 62 day waiting time standard, breaches are shared between hospitals.


Further detail outlining performance at Tumour site level is included in Appendices 6 and 7 on pages 37 & 38. This incorporates patient volumes and breaches as well as the volume of patients for each specific tumour site. It should be noted that for some performance measures the patient volumes involved are small, and this impacts significantly on the % performance. The Trust is currently on track with all actions agreed as part of the cancer improvement plan. The national Intensive Support Team (IST) has spent two days in the Trust during September reviewing the performance improvement plan and tumour site clinical pathways. It has been positive to note that the IST’s initial feedback was that the teams were well led, had a clear understanding of their issues and the actions needed to resolve them. The IST commented that a number of areas of good practice are evident within the teams and that both management and clinical teams are working together to improve system performance. The recommendations made by the IST are mostly focussed on embedding further elements of best practice to ensure the good work the Trust is undertaking to resolve the capacity deficits are sustained for patients. In a number of cases these recommendations echo the team’s plans and ideas that are yet to be implemented. In summary it is felt by the IST that the Trust has developed achievable pathways that will result in improved timeliness of care for patients when implemented as planned. Maximum Time of 6 Weeks from Point of Referral to Key Diagnostic test

At the end of September there were 122 patients (2.48%) waiting longer than 6 weeks for a key diagnostic test, against a target of no more than 1%. Diagnostic performance is challenged in three main modalities, Endoscopy (33 patients), Echocardiography (21 patients) and Cardiac MRI (62 patients).

Endoscopy:

In order to prioritise capacity in accordance with patient need and improve cancer waiting times performance, routine diagnostic waits have been extended. There is a clear plan that will deliver additional endoscopy capacity on 17th December 2015 and a trajectory linked to this additional capacity that demonstrates that this target will be achieved by March 2016.

Echocardiography

Breaches of the 6 week diagnostic target for echocardiography relate to GP direct access referrals. A significant amount of work has been undertaken to ensure that there is sufficient capacity to manage demand of GP direct access referrals. The Cardiology team have worked collaboratively with the CCG to improve demand management of this service and there is now a triage process within the Devon Referral Support Service (DRSS). Capacity has been reviewed and additional slots arranged to reduce backlog. An action plan and trajectory for improvement has been developed, which forecasts that this target will come back to plan by November 2015.

Cardiac MRI:

There are capacity issues related to Stress MRI tests. A review of capacity and demand has been undertaken and a full action plan is in place, which includes increasing short term capacity to reduce the backlog, clarifying the arrangements for out of area patients and a request to the Cardiac Network, via the CCG to review MRI capacity and demand across the South West. The action plan is supported by an improvement trajectory which demonstrates the performance returning to plan by January 2016.

Overall diagnostic breaches at aggregate level are forecast to return to performance by March 2016.


18 Weeks Referral to Treatment

In September the Trust met the Referral to Treatment Waiting Times standard in aggregate for incomplete pathways with performance of 93.15% against the target of 92%. There were specialty failures in General Surgery, Orthopaedics and Urology. Whilst performance is no longer nationally monitored against the admitted and non-admitted standards, for information 88.78% of admitted patients were treated in September within 18 weeks of GP referral. This is in line with the modelled trajectory for planned backlog clearance. Performance against the Referral to Treatment standard for non-admitted pathways was 97.24%. At the end of September one patient had been waiting longer than 52 weeks to commence their treatment in General Surgery. This patient has chosen to defer their procedure until December.


3.5 Workforce

85.4%

86.8%

3.6%

Latest

month

11.6%% 12 Month Turnover 7-10%

% PDR completed ≥80%

Average % statutory

training compliance75%

Sickness absence – Overall <3.5%

| Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |

Low

Low

Medium

Medium

IndicatorTarget

line

2013 - 2014 | 2014 - 2015 | 2015 - 2016 Risk for next

3 monthsScale

90% ⁻

70% ₋

100% ⁻

50% ₋

5% ⁻

2.5% ₋

12% ⁻

6.5% ₋

NB: the Statutory Training Compliance graph reflects the confirmed decision of the Governance Committee that whilst 100% compliance is the aspiration, 75% is the minimum acceptable threshold for statutory training compliance

Sickness Absence Sickness levels for the month reduced from 3.66% to 3.56% (the lowest since May 2013) with the 12 month rolling average also reducing slightly from 4.04% to 4.02%. All areas of the Trust with sickness absence over the target of 3.5% continue to implement action plans to manage attendance performance. The improvement plans will be reviewed at the October Divisional Performance meetings.

Bank, Overtime and Agency Usage

Overall the number of hours covered by both bank & agency nursing resource across the Trust continues to decrease with a reduction of 13% reported this month with the associated costs reflected in page 19 within the Finance section. This performance reflects the proactive nursing workforce plan delivered over the last 12 months also resulting in a decrease in nursing vacancies.

Staffing Numbers and Turnover: Good progress is being maintained and the registered nurse vacancy rate continues to reduce.


Finance

YTD M6 YTD M6

Actual Budget Forecast

£m £m

EBITDA % -0.05% 0.29% -0.02% -0.05%

Misc other operating expenses

variance £'m-18.9 -18.9 -37.3 -37.3

Non clinical supplies variance

£'m-2.7 -2.7 -5.4 -5.3

Clinical supplies variance £'m -22.0 -23.1 -43.2 -44.4

Drug costs variance £'m -22.9 -23.2 -46.7 -46.8

Pay costs variance £'m -122.9 -122.7 -243.2 -242.2

Commercial income variance £'m 25.3 25.3 49.8 49.8

HEADLINE Key Performance

Indicators

Month by Month Variance

FY Forecast

£m

FY

Budget

£m

Patient Income variance £'m 163.5 166.5 334.0 336.3

Income and Expenditure - Actual

v Budget-9.7 -9.1 -20.1 -20.2

3 6 9

Actual


Financial Sustainability Risk

Rating (FSRR)2.0 2.0 2 2

I&E Margin Rating 1.0 1.0 1.0 1.0

Liquidity (days) 4.0 4.0 2.0 2.0

Capital servicing capacity (x) 1.0 1.0 1.0 1.0

Cash - Actual v Budget 14.5 11.1 6.6 5.2

Trade and Other Payables YTD -

Actual v Budget-11.5 -12.7 -13.9 -13.9

Trade and Other Receivables YTD -

Actual v Budget21.1 23.8 19.1 19.1

Inventories YTD - Actual v Budget 7.9 7.5 7.5 7.5

1.5 6.9

Capital spend - Actual v Budget 3.5 6.4

CIP - Actual v

Budget

CY 3.9 6.9

6.9 6.9

Recurrent

13.8 15.9


YTD M6 YTD M6

Actual Budget

vol vol

Combined Elective Care Activity 37,641 38,234

GP Referrals 37,412

Elective Inpatient Activity 6,765 6,928

Non-Elective Inpatient Activity 17,899 17,588

Day-case Activity 30,876 31,306

Detailed Income Statement

VariancesMonth by Month Variance

Outpatient Activity 60,054 66,390


3.6

Overview

At the end of September a deficit of £9.7m has been incurred compared to a budgeted deficit of £9.1m, a deterioration of £1.9m compared to last month’s report. The year to date position has deteriorated by £253k compared to the planned deficit movement during September. This is due to a worsening on clinical income of £1.8m which has been offset with a reduced expenditure on non-pay items (£316k) and a review of Trust reserves releasing £1.1m. The forecast position at year end is a deficit of £20.1m which is similar to last month’s report. The forecast income position has deteriorated by £1.4m and forecast expenditure has improved by £278k. The deterioration in the income and expenditure forecast has been offset by releasing reserves that are likely to be unspent at year-end (£2.2m) Under the Monitor Financial Sustainability Risk Rating (FSRR) the Trust has achieved a level of 2 in September and expected to be maintained at a level 2 through to year end. The Trust is mindful of the overall NHS financial position and is making every effort to improve upon its financial position and maintain a healthy cash balance into the future. Income Clinical income at the end of month 6 has under-recovered by £2.8m, an adverse movement on last month’s report of £1.7m. This is mainly due to a deterioration in Surgical Services (£1.2m) and Medical Services (£600k) with several specialties in both Divisions under-performing. An under-recovery of £2.1m at year end is forecast which is an adverse movement of £1.4m from the Month 5 report. This movement is summarised as follows:

Surgical Services has underperformed by £2.1m, a deterioration of £1.2m in month 6. The movement mostly relates to adverse positions for Trauma and Orthopaedics (£526k, mainly due to case mix variance and emergency activity under-performance), General Surgery (£181k) and Intensive Care Unit (£105k). The Division is forecasting an under-recovery of income of £2.4m at year end.

Medicine has under-performed by £1.5m to Month 6, which is a deterioration of £588k compared to the Month 5 report. The under-recovery mostly relates to fewer emergency inpatients and lower case mix than expected in General Medicine (£325k), capacity issues

YTD Month 6 YTD Month 5 Change

£’000 £’000 £’000

I&E year to date -9,667 -7,788 -1,879

I&E forecast -20,123 -20,127 4

I&E year-end forecast variance to budget/plan

109 105 4

Total income variance to date -2,979 -1,044 -1,935

CIP variance to date 34 -132 166

Pay expenditure variance to date -229 -209 -20

Non pay (excl. R&D) expenditure variance to date

1,387 1,071 316

Cash at month end 14,548 20,910 -6,362


and planned closure of the Catheter lab in September affecting Cardiology income (£157k) and a reduction in Dermatology outpatients (£138k). The Division is forecasting an under-recovery of income of £1.0m at year end.

Specialist Services are under-recovering by £168k at the end of September, a similar position to last month. The Division is forecasting an under-recovery of income of £0.6m at year end.

A number of challenges have been raised by the commissioners in relation to contract income. Where there is a risk to the income position mitigating actions are being taken. Expenditure Pay at the end of September is £229k overspent which is comparable to last month’s report. This overspend is forecast to increase to £977k by year end, a similar position when compared to last month’s report. Medical Staff have overspent by £366k year to date and forecast to overspend by £770k by year end, similar positions to last month. This mostly relates to Senior Medical Staff long term sickness in Medicine and Specialist Services Divisions. Nursing pay is underspent by £49k to the end of September, and forecast to be break even by year end which is comparable to last month’s report. The forecast spend on total agency nursing for this year is £3.5m compared to £7.6m in 2014/15, which is well within the tolerances of the guidance recently released by Monitor. Non-pay expenditure at the end of September is £1.4m underspent, a favourable movement of £316k compared to last month’s report. This mostly relates to underspends in clinical supplies in line with activity reductions particularly within the Surgery division. Non-pay is forecast to be under spent by £1.2m at year end. Monthly performance meetings with the Divisions are in place at which expenditure overspends are discussed and action plans agreed to control and reduce expenditure. Discretionary expenditure and overspent budget reports are also produced and discussed at these meetings. Additional expenditure control measures proposed by Divisional Directors were discussed at the September Hospital Operations Board, and will be developed further. Cost Improvement Programme (CIP) The total target for 2015/16 is £6.9m which consists of the 2015/16 target of £6.0m in addition to CIP schemes that were planned to be achieved in 2014/15 of £0.9m brought forward. £3.9m of savings have been achieved on a current year basis against the target of £6.9m, an improvement of £1.2m during September. Year to date CIP is over recovered by £34k and £6.9m is forecast to be achieved by year end, but plans remain unidentified for £674k. The Hospital Operations Board has introduced a number of control measures to deliver the remaining unidentified CIP. A 1.8% additional target across the Trust has been applied and it is currently assumed that Divisions will meet the current year target at a Trust level while the Divisions are finalising plans. £1.5m of savings have been achieved on a recurrent basis against the target of £6.9m. Schemes totalling a further £4.6m have been identified on a recurrent basis, but £767k remains unidentified.


It is anticipated that remaining unidentified will be achieved via the Acute Pathway Transformation (APT) project. Property, Plant and Equipment Actual capital expenditure for the six month period ended 30 September 2015 was £3.5m in comparison to the plan of £6.4m. Capital expenditure is therefore £2.9m (45%) lower than the budget. The larger variances contributing to this underspend are reported in the capital appendix. Forecast capital expenditure for the year is £13.8m, compared to a budget of £15.9m, a decrease of £2.1m. A review of forecast capital expenditure is being undertaken by Divisions and Support Directorates to identify capital schemes that can be deferred to future years. The value of capital expenditure may therefore further reduce. Receivables Trade and other receivables are £2.7m lower than plan and mainly relates to NHS trade receivables. This reduction is primarily because block invoices that have been paid are higher than the value of activity/income receivable (due to income underperformance). Cash The cash balance at the end of September 2015 is £14.5m which is £3.4m higher than the budget. The increase in cash is due to capital expenditure being lower than plan (as explained above) and changes in working capital balances, in particular trade and other receivables being lower than plan (see above explanation), net current liabilities being lower than planned and the deficit being higher than budget.

3.7 Leadership and Governance

CQC

The Trust has continued to perform well in the quarterly CQC Intelligent Monitoring Report, maintaining a score of 6 which is the highest score awarded, indicating low risk. The Trust has been advised by the Care Quality Commission (CQC) that it will undergo a routine, planned inspection between the 3rd and 6th November 2015. Duty of Candour There were 17 incidents involving patients graded with an actual impact of moderate, major or catastrophic closed between 1st July March 2015 and the 30th September 2015 which fulfilled the criteria. 16 out of the 17 incidents have met the requirements. In 1 case the investigation report has yet to be shared with the patient with a due date of the 15th October 2015. This is being followed through to completion by the Surgical Services Division.


3.8

Regulatory and Contractual Position As a result of the performance reported in Section 3, the following is anticipated: Monitor The trust is currently failing the 62 day cancer target for a seventh successive quarter, the 31 day wait for first definitive treatment target for a fifth successive quarter, the 31 day wait for second or subsequent surgery for a fourth successive quarter, and the two week wait (symptomatic breast patients) for the first quarter. As part of its quarterly monitoring process Monitor will consider if any regulatory action is required. On the basis of performance across Quarter 2, four Monitor targets are currently not being achieved for the quarter. In aggregate, these four targets carry a weighting of four points.

Two Week Wait from Referral to Date of First Appointment for Symptomatic Breast Patients. Performance of 86.67% compared to a target of 93%.

31 Day Wait from Cancer Diagnosis to First Treatment. Performance of 91.69% compared to a target of 96%.

31 Day Wait for Surgery for Second or Subsequent Cancers. Performance of 85.47% compared to a target of 94%.

62 day wait from Urgent GP Referral to Treatment. Performance of 76.88% against a target of 85%.

Within Monitor’s Risk Assessment Framework these four targets carry an aggregate weighting of 4.0 points. Under the Monitor Financial Sustainability Risk Rating (FSRR) the Trust has achieved a level of 2 has been achieved in September and expected to be maintained at a level 2 through to year end.

3.9 Contract As a result of the performance reported in Section 3 and other data included in Appendix 1 (page 23), the contractual implications are as follows: The total penalty risk for month 6 is £171k, primarily relating to quarterly penalties for cancer targets (£105k) and RTT incomplete pathways (£39k). In addition to those penalties incurred in months 1-5 and reported previously, this brings the year to date position to £826k. NEW Devon CCG has issued a number of contractual notices to the Trust. These are being progressed in line with the contract requirements.

3.10 Future risks

The financial position is likely to continue to be challenging throughout the year. Whilst plans are in place to improve performance against key targets (particularly cancer, RTT and diagnostics), emergency winter pressures across the healthcare system (including delayed transfers of care) are the key risks to delivery of those plans.

3.11

Appendices

1. Monitor Targets

2. Safer Staffing Return (Ward Level data )


3. Safer Staffing Thermometer Dependency Tool

4. Ward to Board Report

5. Additional Financial Tables

6. Cancer Waiting Times Standards Performance by Tumour Site

7. Cancer Waiting Times Performance (62 day wait targets) by Tumour Site (Count of Patients)

8. Data Tables (circulated as a separate appendix)


1. Monitor Targets

IndicatorPosition for

QuarterTarget

Monitor

Weighting

Risk for

Period

Risk for

YearIndicator

Position for

Quarter

Target for

Period

Monitor

Weighting

Risk for

Period

Risk for

Year

Indicates that the target has been achieved for the quarter Indicates that the target has been achieved for that month but the quarter has not yet finishedIndicates that the target has not been achieved for the quarter Indicates that the target has not been achieved for that month but the quarter has not yet finished

Indicates that the target is not enforced

Cancer 62 Day

Screening (pre

breach re-

allocation)

95.37%

(2.5 of 54)

Area 19

Learning

Disability

Compliance

Not applicable Compliant Compliant 1.0

86.67%

(12 of 90)min. 93% Low Low

93.08%

(304 of

4391)

min. 93%

1.0

High High

Area 3

RTT Incomplete

Area 4

A&E - 4 Hour

Target

Area 8.II

Cancer 14 Day

Symptomatic

Breast

Area 6.III

Cancer 31 Day

Subsequent

Radiotherapy

93.29% min. 92%

Cancer 62 Day GP

Urgent (pre

breach re-

allocation)

76.88%

(112.5 of

486.5)

n/a

n/a

n/a

Area 8.I

Cancer 14 Day

GP Urgent

Area 6.I

Cancer 31 Day

Subsequent

Surgery

85.47%

(42 of 289)min. 94%

High

Area 6.II

Cancer 31 Day

Subsequent Drug

99.64%

(1 of 278)min. 98%

99.72%

(1 of 362)min. 94%

Area 7

Cancer 31 Day

First Treatment

91.69%

(75 of 903)min. 96%

97.71% n/a n/a

1.0 Medium

96.1% min. 95% 1.0 Low Low High

1.0

High High

Low

Low Low

Low

1.0 High

Monitor Dashboard - September 2015

Trend Trend

Area 14

C. difficile

due to lapses

in care

0 (8)max. 30

annual1.0 Low Low

Area 1

RTT Admitted88.76% n/a n/a

Area 2

RTT Non-Admitted

C.Diff cases due to lapses in care has only been calculated since April 2014. The dotted line represents the total cases as reported historically.

High

Area 5.II Cancer

62 Day Screening

(post breach re-

allocation)

95.37%

(2.5 of 54)min. 90% Medium Low

Area 5.I Cancer

62 Day GP Urgent

(post breach re-

allocation)

79.24%

(101 of

486.5)

min. 85%

1.0

High

Trend graphs run from April 2013 to current month

The position for Cancer targets is subject to change when the data is uploaded to the National Cancer Waiting Times Database 6 weeks after month end.

Very Low Very Low


Area Target Jul-15 Aug-15 Sep-15 Q1 Q2 Weighting PositionRisk for

Quarter

Risk for

Year

admitted pathways Area 1 n/a 88.79% 88.72% 88.78% 89.26% 88.76% n/a High High

non-admitted pathways Area 2 n/a 97.83% 98.11% 97.24% 97.53% 97.71% n/a Low Low

incomplete pathways Area 3 92% 93.46% 93.25% 93.15% 92.19% 93.29% 1.0 Achieving Medium High

Area 4 95% 96.85% 96.07% 95.33% 95.97% 96.09% 1.0 Achieving Low Low

urgent GP referral for

suspected cancer (pre

breach re-allocation)

n/a n/a74.43%

(39 of

152.5)

73.79%

(38 of 145)

81.22%

(35.5 of

189)

73.22%

(115 of

429.5)

76.88%

(112.5 of

486.5)NHS Cancer Screening

Service referral (pre


n/a n/a92.50%

(1.5 of 20)

100.00%

(0 of 16)

94.44%

(1 of 18)

86.13%

(9.5 of

68.5)

95.37%

(2.5 of 54)

urgent GP referral for

suspected cancer (post


Area 5.I 85%77.70%

(34 of

152.5)

76.21%

(34.5 of

145)

82.80%

(32.5 of

189)

76.14%

(102.5 of

429.5)

79.24%

(101 of

486.5)

High High

NHS Cancer Screening

Service referral (post


Area 5.II 90%92.50%

(1.5 of 20)

100.00%

(0 of 16)

94.44%

(1 of 18)

86.13%

(9.5 of

68.5)

95.37%

(2.5 of 54)Medium Low

surgeryArea 6.I 94%

87.50%

(13 of 104)

87.65%

(10 of 81)

81.73%

(19 of 104)

87.60%

(32 of 258)

85.47%

(42 of 289)High High

anti-cancer drug

treatmentsArea 6.II 98%

100.00%

(0 of 97)

98.81%

(1 of 84)

100.00%

(0 of 97)

100.00%

(0 of 284)

99.64%

(1 of 278)Low Low

radiotherapyArea 6.III 94%

100.00%

(0 of 127)

100.00%

(0 of 95)

99.29%

(1 of 140)

98.89%

(4 of 361)

99.72%

(1 of 362)Low Low

Area 7 96%90.42%

(30 of 313)

91.48%

(23 of 270)

92.48%

(22 of 320)

89.89%

(83 of 821)

91.69%

(75 of 903)1.0 Not Achieving High High

all urgent referrals

(cancer suspected) Area 8.I 93%

92.25%

(118 of

1523)

94.11%

(83 of

1410)

92.94%

(103 of

1458)

87.94%

(459 of

3806)

93.08%

(304 of

4391)

High High

for symptomatic breast

patients (cancer not

initially suspected)

Area 8.II 93%93.75%

(2 of 32)

81.25%

(6 of 32)

84.62%

(4 of 26)

96.61%

(4 of 118)

86.67%

(12 of 90)Low Low

total incl. cases deemed

not to be due to lapse in

care & cases under review

n/a n/a 2 0 1 7 3 n/a

cases under reviewn/a n/a 0 0 1 0 1 n/a

due to lapses in careArea 14 30 0 (2) 0 (3) 0 (3) 1 (7) 0 (8) 1.0 Achieving Low Low

Area 19 n/a 1.0 Achieving Very Low Very Low

Not Achieving

Outcomes

Clostridium (C.) difficile – meeting the C. difficile

objective

Certification against compliance with requirements regarding access to health

care for people with a learning disabilityCompliant

The position for Cancer targets is subject to change when the data is uploaded to the National Cancer Waiting Times Database 6 weeks after month end.

Please note that the sum of C.Diff cases under review and those attributed to lapses in care will not equal the total

Monitor Targets Detail - September 2015

Indicator

Access

Maximum time of 18 weeks from point of referral

to treatment in aggregate

A&E: maximum waiting time of four hours from arrival to admission/ transfer/

discharge

All cancers: 62-day wait for first treatment from:

n/a

1.0 Not Achieving

All cancers: 31-day wait for second or subsequent

treatment, comprising:

1.0 Not Achieving

All cancers: 31-day wait from diagnosis to first treatment

Cancer: two week wait from referral to date first

seen, comprising:

1.0


2. Safer Staffing Return (Ward Level data )

290 ⁻

200 ₋

320 ⁻

220 ₋

80 ⁻

40 ₋

Scale

125% ⁻

95%₋

125% ⁻

95% ₋

125% ⁻

95% ₋

130% ⁻

95% ₋

40 ⁻

0 ₋

N/A Not Set

Latest

month

99.7%

| Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |

Risk for next

3 months

Not Set

Not Set

Not Set

Not Set

Not Set

Not Set

Not Set

2013 - 2014 | 2014 - 2015 | 2015 - 2016

Average fi l l rate (Day) -

registered

nurses/midwives

Average fi l l rate (Day) -

care staff

Average fi l l rate (Night) -

registered

nurses/midwives

Average fi l l rate (Night) -

care staff

Safer Staffing Thermometer

Dependency Tool - Volume

of Patients with a Level 3

Dependency




Dependency




Dependency




Dependency

N/A

N/A

N/A

10

0%

of

bas

elin

e es

tab

lish

men

t

i.e. a

ctu

al h

ou

rs =

pla

nn

ed h

ou

rs

IndicatorTarget

line

99.2%

101.1%

105.9%

6

260

293

54

Key to Safer Staffing Thermometer Indicators:

Dependence Acuity 1 – Independent

Dependence Acuity 2 – Independent with some additional input

Dependence Acuity 3 – Two to four hourly

Dependence Acuity 4 – Constant supervision with up to one-to-one nursing


The top four Safe Staffing indicators relate to the comparison of the volume of planned nursing hours to actual nursing hours worked. The four indicators represent this comparison separately for registered and for non-registered staff, across the day and the night time periods. Individual ward level data for all in-patient wards relating to each of these four indicators is included within Appendix 2. An additional 83.57 whole time equivalents [WTE] of nursing time has been rostered this month, including 17.96 WTE additional registered and unregistered staff hours to staff escalation beds.

Division Ward Name Planned Worked Planned Worked Planned Worked Planned Worked

Medical Service AMU East 3103.0 3240.0 3563.0 3483.5 2154.8 2211.8 2399.0 2406.5 104.4% 97.8% 102.6% 100.31%

Medical Service Ashburn 1543.0 1537.5 1642.5 1549.0 701.5 724.5 1391.5 1403.0 99.6% 94.3% 103.3% 100.83%

Medical Service Avon 1266.0 1301.0 752.5 787.0 632.5 667.0 346.0 362.0 102.8% 104.6% 105.5% 104.62%

Medical Service Bolham 1144.0 1144.5 2328.5 2370.3 655.5 655.5 1380.0 1609.5 100.0% 101.8% 100.0% 116.63%

Medical Service Bovey 2297.5 2220.8 4560.5 4438.5 1690.5 1518.0 3198.0 3220.0 96.7% 97.3% 89.8% 100.69%

Medical Service CCU 962.0 943.6 690.0 714.0 98.1% #DIV/0! 103.5% #DIV/0!

Medical Service Clyst 1601.0 1527.3 1994.8 1843.8 931.5 944.0 1115.5 1104.0 95.4% 92.4% 101.3% 98.97%

Medical Service Creedy 1906.0 1947.2 1913.5 2043.8 989.0 1000.5 667.0 815.5 102.2% 106.8% 101.2% 122.26%

Medical Service Culm 3225.3 3106.3 2673.0 2754.5 2438.0 2415.0 1771.0 1885.5 96.3% 103.0% 99.1% 106.47%

Medical Service Lowman 1339.0 1321.0 1708.0 1752.0 713.0 736.0 1012.0 989.0 98.7% 102.6% 103.2% 97.73%

Medical Service Mardon Hou 861.5 785.0 1689.0 1621.3 336.0 346.0 649.0 969.4 91.1% 96.0% 103.0% 149.37%

Medical Service Okement 1577.0 1551.0 1465.5 1367.5 828.0 793.5 908.0 869.8 98.4% 93.3% 95.8% 95.79%

Medical Service Taw 1249.0 1141.5 797.0 727.2 644.0 655.5 80.5 92.0 91.4% 91.2% 101.8% 114.29%

Medical Service Torridge 979.5 987.5 931.5 1171.5 632.5 667.0 608.0 1023.0 100.8% 125.8% 105.5% 168.26%

Medical Service Yealm 1306.5 1327.5 1485.2 1540.2 668.0 691.0 402.5 448.5 101.6% 103.7% 103.4% 111.43%

Medical Service Total 24360.3 24081.5 27504.5 27449.9 14704.8 14739.3 15928.0 17197.7 98.9% 99.8% 100.2% 107.97%

Specialist Services Bramble 4143.5 4194.4 1012.0 1046.5 2275.7 2364.2 69.0 80.5 101.2% 103.4% 103.9% 116.67%

Specialist Services Maternity 4487.0 4508.3 2016.0 1869.8 2613.5 2630.3 572.0 583.0 100.5% 92.7% 100.6% 101.92%

Specialist Services NNU 2969.0 2999.8 720.0 718.0 1805.5 1886.5 563.5 563.5 101.0% 99.7% 104.5% 100.00%

Specialist Services Wynard 1592.0 1685.0 1993.0 1989.0 862.5 943.0 897.0 968.5 105.8% 99.8% 109.3% 107.97%

Specialist Services Yarty 1160.5 1158.5 452.5 469.5 690.0 689.5 379.5 322.0 99.8% 103.8% 99.9% 84.85%

Specialist Services Yeo 1644.0 1581.0 1046.0 1035.0 701.5 690.0 575.0 529.0 96.2% 98.9% 98.4% 92.00%

Specialist Services Total 15996.0 16126.9 7239.5 7127.8 8948.7 9203.4 3056.0 3046.5 100.8% 98.5% 102.8% 99.69%

Surgical Services Abbey 1082.0 1085.3 1227.5 1228.5 690.0 671.0 665.5 673.5 100.3% 100.1% 97.2% 101.20%

Surgical Services Dart 1359.5 1442.3 1746.0 1641.3 896.5 898.0 677.0 676.5 106.1% 94.0% 100.2% 99.93%

Surgical Services Durbin 1422.5 1475.0 1820.0 1893.5 989.0 1000.5 1357.0 1345.5 103.7% 104.0% 101.2% 99.15%

Surgical Services Dyball 1230.5 1218.5 1496.3 1324.2 724.5 714.0 690.0 644.0 99.0% 88.5% 98.6% 93.33%

Surgical Services Exe 1059.8 1079.8 1134.0 1291.8 690.0 690.0 356.5 585.0 101.9% 113.9% 100.0% 164.10%

Surgical Services Lyme 1652.0 1401.4 1331.5 1260.3 1012.0 1015.0 690.0 694.5 84.8% 94.6% 100.3% 100.65%

Surgical Services Mere 1379.0 1431.0 1066.0 1073.5 712.5 689.5 575.0 644.0 103.8% 100.7% 96.8% 112.00%

Surgical Services Otter 1416.5 1418.0 1346.0 1327.5 712.0 906.0 667.0 701.5 100.1% 98.6% 127.2% 105.17%

Surgical Services Tavy 994.5 975.5 1641.5 1558.0 700.3 677.3 828.0 845.5 98.1% 94.9% 96.7% 102.11%

Surgical Services Teign 4508.5 4548.5 605.5 607.0 3852.5 3806.5 425.5 402.5 100.9% 100.2% 98.8% 94.59%

Surgical Services Total 16104.8 16075.3 13414.3 13205.4 10979.3 11067.8 6931.5 7212.5 99.8% 98.4% 100.8% 104.05%

Grand Total 56461.1 56283.7 48158.3 47783.1 34632.8 35010.5 25915.5 27456.7 99.7% 99.2% 101.1% 105.95%

Day Night Day Night

Registered Nurses/Midwives Care Staff Registered Nurses/Midwives Care Staff

Average fill

rate -

registered

Average fill

rate - care staff

(%)

Average fill rate -

registered

nurses/

Average fill rate -

care staff (%)


3. Safer Staffing Thermometer Dependency Tool

Note:

Dependence Acuity 1 – Independent

Dependence Acuity 2 – Independent with some additional input

Dependence Acuity 3 – Two to four hourly

Dependence Acuity 4 – Constant supervision with one-to-one nursing


4. Ward to Board Report


5. Additional Financial Tables

Royal Devon & Exeter NHS Foundation Trust Prior Yr

Actual Budget Actual Actual Budget Actual Actual Budget Actual Annual Mar-15

Income Statement Variance Variance Variance Plan Actual

Period ending 30/09/2015 to Budget to Budget to Budget

Month 06 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Income

NHS Clinical Income 25,905 27,604 (1,699) 162,892 165,685 (2,793) 1 332,577 334,725 (2,148) 1 334,587 329,412

Private patient Income 39 141 (102) 581 811 (230) 1,388 1,618 (230) 1,618 1,453

Research and Development 1,589 1,589 0 9,537 9,536 1 18,812 18,812 0 17,729 19,301

Education and Training 1,192 1,192 0 6,717 6,717 0 13,332 13,332 0 12,182 13,492

Other Income 2,904 3,038 (134) 18,617 18,573 44 36,504 36,418 86 38,201 35,466

Total income 31,629 33,564 (1,935) 198,343 201,322 (2,979) 402,613 404,905 (2,292) 404,317 399,124

Expense

Employee Benefits Expenses (Pay) (20,516) (20,496) (20) (122,912) (122,683) (229) 2 (243,206) (242,229) (977) 2 (246,857) (238,310)

Drug Costs (3,526) (3,419) (107) (22,893) (23,181) 288 (46,724) (46,778) 54 (48,440) (46,690)

Clinical Supplies (3,014) (3,513) 500 (21,985) (23,064) 1,079 3 (43,219) (44,436) 1,217 3 (47,115) (46,187)

Non Clinical Supplies (487) (377) (110) (2,720) (2,684) (36) (5,393) (5,256) (137) (5,213) (5,283)

Research & Development Expenses (1,542) (1,542) (0) (9,086) (9,086) (0) (17,996) (17,996) 0 (17,526) (18,107)

Misc. Other Operating Expenses (2,927) (2,961) 34 (18,851) (18,906) 56 (37,293) (37,336) 42 (39,357) (37,422)

Cost Improvement Programme 0 (166) 166 0 (34) 34 0 (0) 0 0 0

Reserves 0 (1,100) 1,100 0 (1,100) 1,100 4 (8,864) (11,065) 2,200 4 0 0

Total Costs (32,012) (33,574) 1,562 (198,447) (200,738) 2,291 (402,694) (405,096) 2,401 (404,509) (391,999)

EBITDA (383) (10) (373) (104) 584 (688) (81) (191) 109 (191) 7,125

Profit / loss on asset disposals 0 0 0 0 0 0 0 0 0 0 (31)

Exceptional Income/ Costs & Impairments ** 0 0 0

Total Depreciation (931) (999) 68 (5,900) (5,974) 74 (12,645) (12,645) 0 (12,645) (11,712)

Total operating surplus (deficit) (1,314) (1,009) (305) (6,004) (5,390) (614) (12,726) (12,836) 109 (12,836) (4,618)

8 10 (2) 50 53 (3) 104 104 0 104 114

Total interest payable on Loans and leases (58) (65) 7 (393) (391) (2) (768) (768) 0 (767) (830)

PDC Dividend (515) (562) 47 (3,320) (3,367) 47 (6,733) (6,733) 0 (6,733) (5,884)

Net Surplus/(deficit) (1,879) (1,626) (253) (9,667) (9,095) (572) (20,123) (20,233) 109 (20,232) (11,218)

KEY MOVEMENTS

1 Clinical income is under-performing particularly within Geriatric & General Medicine, General Surgery,Opthalmology, Trauma and Orthopaedics.

2 Pay - overspends on Medical Staff (£366k) are offset with underspends on Nursing (£49k) other staff (£88k).

The forecast estimates overspends on medical staff pay (£770k) and other staff (£229k).

3 Clinical supplies expenditure is underspent mainly due to medical and surgical items and prothesis related to the Surgical division's reduced activity.

4 Income and Expenditure Reserves have been restricted and are therefore under utilised both year to date and at year end.

Current Month Year to Date Outturn

Total interest receivable/ (payable) - inc

committed WC facilities



Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar-15

Statement of Financial Position Variance Plan Variance Variance Plan Variance

Period ending 30/09/2015 to Budget to Plan to Budget to Plan

Month 06 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Assets, Non-Current

Intangible Assets, Net 1,182 1,121 61 1,121 61 1,121 1,121 0 1,121 0 1,121

Property, Plant and Equipment, Net 203,859 206,754 (2,895) 1 206,754 (2,895) 224,829 226,964 (2,135) 226,964 (2,135) 206,340

Non NHS Trade Receivables, Non-Current 1,111 839 272 839 272 839 839 0 839 0 839

Assets, Non-Current, Total 206,152 208,714 (2,562) 208,714 (2,562) 226,789 228,924 (2,135) 228,924 (2,135) 208,300

Assets, Current

Inventories 7,943 7,525 418 7,525 418 7,525 7,525 0 7,525 0 8,025

Trade and Other Receivables, Net, Current 21,070 23,815 (2,744) 2 23,815 (2,745) 19,085 19,085 0 19,085 0 19,015

Non Current Assets held for sale 0 0 0 0 0 0 0 0 0 0 0

Cash 14,548 11,132 3,416 3 9,296 5,252 6,582 5,211 1,371 5,211 1,371 27,366

Other Assets - Current Assets Held by Charitable Funds 0 0 0 0 0 0 0 0 0 0 0

Assets, Current, Total 43,561 42,471 1,090 40,636 2,926 33,192 31,821 1,371 31,821 1,371 54,406

Liabilities, Current

Loans, non-commercial, Current (DH, FTFF, NLF, etc) (1,270) (1,270) 0 (1,270) 0 (1,270) (1,270) 0 (1,270) 0 (1,270)

Trade and Other Payables, Current (11,466) (12,663) 1,197 4 (12,663) 1,197 (13,897) (13,897) 0 (13,897) 0 (14,043)

Deferred Income, Current (2,093) (1,900) (193) (1,900) (193) (2,400) (2,400) 0 (2,400) 0 (2,377)

Provisions, Current (284) (284) 0 (284) 0 (284) (284) 0 (284) 0 (284)

Current Tax Payables (4,643) (4,821) 178 (4,821) 178 (4,800) (4,800) 0 (4,800) 0 (4,556)

Other Financial Liabilities, Current (12,346) (11,797) (549) 4 (11,797) (549) (12,198) (12,198) 0 (12,198) 0 (12,247)

Liabilities, Current, Total (32,102) (32,735) 633 (32,735) 633 (34,849) (34,849) 0 (34,849) 0 (34,777)

NET CURRENT ASSETS (LIABILITIES) 11,459 9,736 1,723 7,900 3,559 (1,657) (3,028) 1,371 (3,028) 1,371 19,629

TOTAL ASSETS LESS CURRENT LIABILITIES 217,611 218,450 (839) 216,614 997 225132 225896 (764) 225,896 (764) 227,929

Liabilities, Non-Current

Loans, Non-Current, non-commercial (DH, FTFF, NLF, etc) (14,496) (14,748) 252 (14,748) 252 (14,433) (15,957) 1,524 (15,957) 1,524 (15,131)

Other Creditors, Non-Current 0 0 0 0 0 0 0 0 0 0 0

Provisions, Non-Current (363) (376) 13 (376) 13 (376) (376) 0 (376) 0 (376)

TOTAL ASSETS EMPLOYED 202,752 203,326 (574) 201,490 1,262 210,323 209,563 760 209,563 760 212,422

TAX PAYERS' EQUITY

Public dividend capital 151,792 151,792 0 151,792 0 152,443 151,792 651 151,792 651 151,792

Retained Earnings (Accumulated Losses) 25,473 25,863 (390) 24,027 1,446 14,913 14,805 109 14,805 109 34,877

Charitable Funds 0 0 0 0 0 0 0 0 0 0 0

Revaluation Reserve 25,487 25,673 (186) 25,673 (186) 42,969 42,969 0 42,969 0 25,753

Donated Asset Reserve 0 0 0 0 0 0 0 0 0 0 0

TOTAL TAX PAYERS' EQUITY 202,752 203,328 (576) 201,492 1,260 210,325 209,565 760 209,565 760 212,422

KEY MOVEMENTS

1

2

3

4 The net total value of trade and other payables and other financial liabilities is £0.6m lower than the plan.

Year to Date Outturn

Actual capital expenditure to date is £3.5m in comparison to £6.4m per the plan submitted. Capital expenditure is therefore £2.9m (45%) lower than the budget. Forecast capital expenditure for the year is £13.7m, compared to a budget of £15.9m, a

decrease of £2.2m. A review of forecast capital expenditure is being undertaken to identify capital schemes that can be deferred to future years. The larger variances contributing to the current actiual and forecast underspend are reported in the

capital appendix.

Trade and other receivables are £2.7m lower than plan and mainly relates to NHS trade receivables, this reduction has arisen predominantly due to the value of block invoices which have been paid are higher than the value of activity/income receivable.

The cash balance is £14.5m and is £3.4m higher than the budget. The increase in cash is due to capital expenditure being lower than plan, changes in working capital balances and the deficit being higher than budget.



Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar-15

Cash Flow Statement Variance Plan Variance Variance Plan Variance

Period ending 30/09/2015 to Budget to Plan to Budget to Plan

Month 06 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES

Surplus/(deficit) after tax (9,667) (9,095) (572) (10,931) 1,264 (20,123) (20,233) 110 (20,232) 109 (11,218)

Non-cash flows in operating surplus/(deficit)

Finance (income)/charges 343 338 5 339 4 664 664 0 663 1 716

Depreciation and amortisation 5,900 5,974 (74) 5,974 (74) 12,645 12,645 0 12,645 (0) 11,712

Impairment 0 0 0 0 0 0 0 0 0 0 0

PDC dividend expense 3,320 3,367 (47) 3,367 (47) 6,733 6,733 0 6,733 0 5,884

Other increases/(decreases) to reconcile to profit/(loss) from operations 0 0 0 0 0 0 0 0 0 0 31

Non-cash flows in operating surplus/(deficit), Total 9,563 9,679 (116) 9,680 (117) 20,042 20,042 0 20,041 1 18,343

Increase/(Decrease) in working capital

(Increase)/decrease in inventories 82 500 (418) 500 (418) 500 500 0 500 0 (1,312)

(Increase)/decrease in NHS Trade Receivables 1,746 (1,999) 3,744 (1,999) 3,745 1 1 0 1 (0) (2,630)

(Increase)/decrease in Non NHS Trade Receivables 409 471 (62) 471 (62) (1) (1) 0 (1) 0 (604)

(Increase)/decrease in other receivables 426 444 (18) 444 (18) 1 1 0 1 0 (6)

(Increase)/decrease in accrued income (914) (446) (468) (446) (468) (1) (1) 0 (1) 0 4

(Increase)/decrease in prepayments (3,722) (3,270) (452) (3,270) (452) (70) (70) 0 (70) 0 (350)

Increase/(decrease) in Deferred Income (excl. Donated Assets) (284) (477) 193 (477) 193 23 23 0 23 0 860

Increase/(decrease) in provisions (13) 0 (13) 0 (13) 0 0 0 0 0 (73)

Increase/(decrease) in Trade Creditors (1,541) (95) (1,446) (95) (1,446) 155 155 0 155 0 2,309

Increase/(decrease) in tax payable 87 265 (178) 265 (178) 244 244 0 244 0 89

Increase/(decrease) in Other Creditors 22 173 (151) 173 (151) 157 157 0 157 0 196

Increase/(decrease) in accruals (56) (447) 391 (447) 391 (47) (47) 0 (47) 0 (707)

Increase/(Decrease) in working capital, Total (3,758) (4,881) 1,122 (4,881) 1,123 961 961 0 961 (0) (2,224)

Net cash inflow/(outflow) from investing activities

Property - new land, buildings or dwellings (53) (1,252) 1,198 (1,252) 1,198 (3,630) (3,630) 0 (3,630) 0 (457)

Property - maintenance expenditure (1,417) (2,585) 1,167 (2,585) 1,167 (1,545) (3,680) 2,135 (3,680) 2,135 (3,917)

Plant and equipment - Information Technology (991) (1,357) 366 (1,357) 366 (1,666) (1,666) 0 (1,666) 0 (1,691)

Plant and equipment - Other (1,018) (1,194) 176 (1,194) 176 (6,917) (6,917) 0 (6,917) 0 (2,940)

Proceeds on disposal of property, plant and equipment 0 0 0 0 0 0 0 0 0 0 0

Increase/(decrease) in Capital Creditors (1,058) (1,458) 400 (1,458) 400 (458) (458) 0 (458) 0 (116)

Other cash flows from financing activities 0 0 0 0 0 0 0 0 0 0 (105)

Net cash inflow/(outflow() from investing activities, Total (4,538) (7,846) 3,307 (7,846) 3,307 (14,217) (16,352) 2,135 (16,352) 2,135 (9,226)

Net cash inflow/(outflow) from financing activities

PDC Dividends paid (3,165) (3,367) 202 (3,367) 202 (6,733) (6,733) 0 (6,733) 0 (5,540)

PDC Dividend Received 0 0 0 0 0 651 0 651 0 651 862

Interest (paid) on commercial loans (393) (394) 1 (391) (2) (770) (770) 0 (767) (3) (830)

Interest received on cash and cash equivalents 50 53 (3) 52 (2) 104 104 0 104 0 114

Repayment of non-commercial loans (635) (633) (2) (633) (2) (1,268) (1,268) 0 (1,268) 0 (1,271)

Receipt of non-commercial loan 0 250 0 250 (250) 570 2,094 (1,524) 2,094 (1,524) (1,270)

(Increase)/decrease in non-current receivables (272) 0 (272) 0 (272) 0 0 0 0 0 (67)

Increase/(decrease) in non-current payables 0 0 0 0 0 0 0 0 0 0 0

Net cash inflow/(outflow) from financing activities, Total (4,415) (4,091) (74) (4,088) (327) (7,446) (6,573) (873) (6,570) (876) (6,732)

Net increase/(decrease) in cash and cash equivalents (12,815) (16,233) 3,418 (18,067) 5,251 (20,782) (22,154) 1,372 (22,151) 1,370 (11,058)

Opening cash and cash equivalents 27,366 27,366 0 27,366 0 27,366 27,366 0 27,366 0 38,420

Closing cash and cash equivalents 14,551 11,133 3,418 9,299 5,251 6,584 5,212 1,372 5,215 1,370 27,362

Year to Date Outturn


Royal Devon and Exeter NHS Foundation Trust

Capital expenditure

Period ending 30/9/2015

Month 6 Column B Column C Column D Column E Column F Column G Column H

Scheme

YTD actual

expenditure

YTD planned

expenditure per

annual plan

YTD variance

slippage /

(overspend)

Forecast future

capital

expenditure for

the year

Forecast total

capital

expenditure for

the year

Full year

expenditure per

annual plan

15/16 forecast

slippage /

(overspend)

Expenditure

approved by the

Exec Group /

SCG

Total

expenditure

forecast for the

scheme

Scheme

variance under

spend /

(overspend)

( C - B) (B + E) (G - F)

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

FBC 21 0 (21) 128 149 149 (0) 8,494 8,494 (0) May-16

CRIC 625 2,063 1,438 1,827 2,452 3,158 706 4,122 4,171 (49) Mar-16

CRIC 2 6 4 0 2 6 4 1,401 1,313 88 Jun-15

FBC 118 194 76 76 194 194 0 4,014 3,621 393 TBC

CRIC 7 60 53 53 60 60 (0) 744 744 (0) Mar-16

CRIC 0 9 8 8 9 9 (0) 1,628 1,805 (177) Dec-14

CRIC 105 100 (5) 33 138 100 (38) 800 380 420 Oct-15

CRIC 222 25 (197) 572 794 794 0 794 794 0 Oct-15

CRIC 426 0 (426) 85 511 511 (0) 511 511 (0) Dec-15

CRIC 8 0 (8) 0 8 0 (8) 581 573 8 Mar-15

CRIC 220 295 75 405 625 625 0 625 625 0 Jan-16

CRIC 0 0 0 0 0 804 804 804 804 0 Jul-16

Siemens Magnetron MRI 2 CRIC 0 0 0 1,069 1,069 1,069 0 1,069 1,069 0 Dec-15

Siemens Sensation 16 CT CRIC 0 0 0 635 635 635 0 635 635 0 Dec-15

Coffee Lounge Theatre 11 CRIC 0 90 90 100 100 674 574 2,500 2,500 0 TBC

Theatre 12 CRIC 0 80 80 250 250 765 515 3,500 3,500 0 TBC

Resus CRIC 0 80 80 220 220 655 435 2,800 2,800 0 TBC

100,000 Genomes CRIC 155 0 (155) 496 651 0 (651) 651 651 (0) Mar-16

Approved 1,571 3,386 1,815 4,322 5,893 5,686 (207)

3,481 6,388 2,907 10,279 13,759 15,894 2,135

6

FBC 0 0 0 0 0 0 0 0 894 (894) ?

0 0 0 0 0 0 0

3,481 6,388 2,907 10,279 13,759 15,894 2,135

Approval Level Key Report for all schemes where planned expenditure is to exceed £0.5m in 2015/16 and the total scheme value is above £1m

CRIC Capital and Revenue Investment Case

SOC Strategic outline case

OBC Outline business case

FBC Full business case

CRIC Capital business case

EPR Removed from plan for 2015/16

The additional funding request for the Pacing room redesign, currently estimated at £177k, will be presented to the Exec Group, once the additional costs have been fully analysed.

Expected

completion date

Actual expenditure to date compared to budget on

annual plan Total expenditure forecast for the year compared to the budget on

the annual plan

Total expected expenditure compared to the value

approved by the Exec Group / Board of Directors

Schemes over £500k in progress or planned

Approval level

Rebuild CIVAS unit and equip

Estates Infrastructure (various schemes)

Core network upgrade

eNotes

Service Resilience (DR)

Pacing room redesign

Replacement of PEOC Chillers

Cardiology equipment Lab2

Automated Endoscopic Reprocessor

Value not known with certainty until the benefits realisation

exercise concluded

Electronic Patient Record (EPR)

Total RD&E Capital Schemes

Gamma Camera room

Heavitree Theatre Recovery Beds

Laundry Continuous Batch Washer & Garment

finishing

Other schemes < £500k and contingency

Total 2015/16 Capital Schemes excluding EPR


Royal Devon & Exeter NHS YTD Target CY Target

Foundation Trust Actual Plan Variance Actual Plan Variance Actual Plan Variance Forecast

to Budget (target) to Budget to Plan

Cost Improvement Programme Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

Period ending 30/09/2015

Month 06 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 R/A/G R/A/G

Business As Usual

Medical Services 185 668 (483) 568 1,519 (951) 1,159 (360) 57 539 (481) 412 R A

Specialist Services 492 727 (235) 656 1,559 (903) 1,054 (505) 186 523 (337) 523 R R

Surgical Services 602 1,080 (478) 1,153 2,241 (1,087) 1,753 (487) 922 1,153 (231) 2,361 R R

Operations Support Unit 268 116 152 466 232 234 466 234 15 15 0 15 G G

Corporate 347 292 55 657 522 135 699 177 212 433 (220) 552 A G

Central Plans 105 105 0 140 140 0 140 0 70 70 0 70 G G

0 0 0 0 G G

1,999 2,987 (988) 3,641 6,213 (2,572) 5,271 (942) 1,462 2,731 (1,269) 3,933

Trustwide Projects

Medical Agency Spend 0 0 0 0 0 0 0 0 0 15 (15) 15 G G

Health Cost Recovery 80 0 80 80 200 (120) 200 0 0 350 (350) 350 G G

Readmissions 0 0 0 0 65 (65) 65 0 0 260 (260) 260 G G

Outpatient Redesign 0 0 0 0 30 (30) 30 0 0 100 (100) 100 G G

KPMG VAT 35 17 17 35 35 0 35 0 0 0 0 0 G G

Removal Expenses 60 60 0 120 120 0 120 0 0 0 0 0

Trustwide Procurement 26 (51) 77 26 213 (187) 213 0 0 1,304 (1,304) 1,304 G R

201 26 174 261 663 (402) 663 0 0 2,029 (2,029) 2,029

Unidentified 0 (848) 848 0 (17) 17 925 942 0 2,099 (2,099) 1,350 G R

2,200 2,166 34 3,901 6,859 (2,957) 6,859 0 1,462 6,859 (5,397) 7,312

Summary by Planning Status

Achieved 3,901 3,901 0 1,462 1,462 0

Firm Plans 0 402 (402) 0 1,125 (1,125) Key

Plans being Scoped 0 1,882 (1,882) 0 3,505 (3,505) Red > 20% variance to plan

Unidentified 0 674 (674) 0 767 (767) Amber > 5 % variance to plan

3,901 6,859 (2,957) 1,462 6,859 (5,397) Green < 5% variance to plan

Year to Date - Achieved Current Year - Achieved Current Year - Forecast Full Year (recurring) - Achieved

Forecast CY Forecast

Variance Fav /

(Adv)

Confidence

Rating

Confidence

Rating


6. Cancer Waiting Times Standards Performance by Tumour Site

Month: 9 - 15/16 Inf services check: OK

Census date run: 19/10/2015

Target Position Worst CaseAcute

Leukaemia

Brain &

CNSBreast Gynae Haem

Head &

NeckLower GI Lung Sarcoma Skin Testicular

Thyroid/

Endocrine

Unknown

PrimaryUpper GI Urology Blank

Breaches 103 0 1 16 3 0 9 27 4 0 26 0 0 0 13 4

Total 1458 0 14 315 99 14 101 195 47 43 338 4 2 0 137 149

Position 92.94% 92.86% 94.92% 96.97% 100.00% 91.09% 86.15% 91.49% 100.00% 92.31% 100.00% 100.00% 90.51% 97.32%

Breaches 4

Total 26

Position 84.62%

Breaches 22 22 0 0 0 0 0 1 3 0 0 2 0 0 0 1 15

Total 320 281 3 1 51 13 20 11 25 23 2 77 1 1 7 21 64

Position 93.13% 92.17% 100.00% 100.00% 100.00% 100.00% 100.00% 90.91% 88.00% 100.00% 100.00% 97.40% 100.00% 100.00% 100.00% 95.24% 76.56%

Breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 97 91 0 1 40 1 15 1 10 8 1 3 3 0 0 2 12 0

Position 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Breaches 19 19 0 0 1 0 1 1 0 0 0 4 0 0 0 0 12 0

Total 104 102 0 0 21 3 1 2 2 0 2 51 0 0 0 0 22 0

Position 81.73% 81.37% 95.24% 100.00% 0.00% 50.00% 100.00% 100.00% 92.16% 45.45%

Breaches 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 140 134 0 3 48 8 3 3 1 9 0 9 0 1 2 0 53 0

Position 99.29% 99.25% 100.00% 97.92% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Breaches 35.5 35.5 0 1.5 0.5 1 0.5 5 4.5 0 2 0 2 3 15.5

Total 189.0 169.0 0 28 6.5 10 7.5 15 15.5 0 50 1 2 16.5 37

Position 81.22% 78.99% 94.64% 92.31% 90.00% 93.33% 66.67% 70.97% 96.00% 100.00% 0.00% 81.82% 58.11%

Breaches 1.0 1.0 0 0 0 0 0 1 0 0 0 0 0 0 0

Total 18.0 17.0 0 15 0 0 0 3 0 0 0 0 0 0 0

Position 94.44% 94.12% 100.00% 66.67%

Breaches 7.0 7.0 0 0 0 0 2 0 1 0 0 0 1 0 3

Total 48.5 44.0 0 1 3 5 3 7 4 0 3 0 3.5 4 15

Position 85.57% 84.09% 100.00% 100.00% 100.00% 33.33% 100.00% 75.00% 100.00% 71.43% 100.00% 80.00%

Tumour site break down

Current Position for Month and tumour site break down.

93%

93%

96%

98%

Symptomatic Breast Patients

First Treatment: All Cancers

Subsequent Treatment: Anti-Cancer Drug

Treatments

14

Day

All Cancer Two Week Wait

Subsequent Treatment: Surgical Treatments

Subsequent Treatment: Radiotherapy

Treatments

62

Day

First Treatment: Urgent GP to Treatment (n.b.

does not include symptomatic breast

referrals despite these being on 62 day

First Treatment: Consultant Screening Service

Referral

First Treatment: Consultant Upgrade Service

Referral 85%

94%

94%

85%

90%

31

Day


7. Cancer Waiting Times Performance (62 day wait targets) by Tumour Site (Count of Patients)

62d patient counts

Count of pts

Acute

Leukaemia

Brain &

CNSBreast Gynae Haem

Head &

NeckLower GI Lung Sarcoma Skin Testicular

Thyroid/

Endocrine

Unknown

PrimaryUpper GI Urology Blank

Breaches 45.0 0 2 1 1 1 6 6 0 3 0 2 4 19

Total 204.0 0 29 8 10 9 16 18 0 52 1 2 18 41

Breaches 1.0 0 0 0 0 0 1 0 0 0 0 0 0 0

Total 18.0 0 15 0 0 0 3 0 0 0 0 0 0 0

Breaches 7.0 0 0 0 0 2 0 1 0 0 0 1 0 3

Total 49.0 0 1 3 5 3 7 4 0 3 0 4 4 15

Tumour site break down

First Treatment: Urgent GP to Treatment (n.b. does not include

symptomatic breast referrals despite these being on 62 day pathways)

First Treatment: Consultant Screening Service Referral

First Treatment: Consultant Upgrade Service Referral

62

Day

agenda item: 9.1, public board meeting date · this is a standing agenda item at each meeting of...

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