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Title of Paper: Integrated Performance Report Board Date: Monday 04 April 2011 of 36

Board of Directors Meeting

Date: Monday 04 April 2011

Agenda item: 8.1, Part 1

Title: Integrated Performance Report incorporating: Quality / Performance / Finance and Activity / HR

Prepared by: Warwick Heale, Associate Director of Planning & Performance Ann Goodridge, Corporate Performance Manager

Presented by: Martin Cooper, Joint Medical Director

Action required: The Board is asked to receive the Performance Report and note the progress that has been made together with any actions that are planned.

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.

2. BACKGROUND 2.1

The Trust’s Annual Plan sets out the programme of work to be undertaken to ensure compliance with the Monitor Compliance Framework and local and national standards and targets included in the PCTs’ patient services contract. The Care Quality Commission annually reviews the performance of all NHS organisations against the milestones and targets set out in the NHS Plan and annual operating framework. The outcome of this assessment is the publication of the Annual Health Check in October each year but following the revision of the Operating Framework the CQC have announced that they will not be publishing a rating for Trusts this year.

3. KEY ISSUES 3.1 February was busy and challenging month with the Trust and the community

recovering from deferred elective activity across the specialities. The Trust planned the return to normal elective activity and managing non elective demand. Critical to this was expediting community wide plans to increase the effectiveness of discharge planning. The winter reduction of elective activity was set to return to normal after January. The impact of the severe weather and lost capacity continued to be an issue for achieving referral to treatment times for all patients and specific priority was given to those patients on cancer pathways. The deferral of patients unfortunately continued through February including some same day cancellations. In order to avoid this and improve patient flow, beds opened for the medical directorate to contain its outliers continued to be required with around 30 additional patients continuing to out lie in surgical beds. In addition, a temporary discharge lounge was created on a closed ward to create capacity at pinch points throughout the day. Non elective admissions performance monitored through the Emergency Department 4hr wait target deteriorated, affected by a number of capacity factors including the changes required to achieve compliance with Eliminating Same Sex accommodation requirements. These changes are now completed. Although Norovirus continued to be a problem in February the position improved significantly compared to December/January, resulting in fewer beds closures. Levels of flu rapidly fell during the month and ceased to be an issue in managing capacity. NHS Devon continued to host daily conference calls and funded additional capacity (a total of 16 beds) in community hospitals. These beds remained open due to continued high numbers of patients waiting for a community transfer. Throughout this time the community waiting list has had a median of 70 patients waiting for a transfer to be arranged. The arrangement for additional capacity is now at an end and further additional beds may be closed as they are scheduled for deep cleaning.


NHS Devon is leading the planning arrangements for the community for the lengthy Easter holiday period. An Eastern Devon debrief of the winter experience took place on 16 February 2011 to inform planning for next year.

3.2 Performance Targets There are currently two Monitor targets that are currently not being achieved for Quarter 4.

MON03.II Cancer 31 Day Subsequent Drug – The Trust’s position is currently 97.2% against a target of 98% however it should be noted that this equates to 3 patients breaching the target over January and February.

MON04.I Cancer 62 Day GP Urgent – The Trust’s position is currently 80.2% against a target of 85%.

There are currently 4 CQC targets that are not being achieved year to date

CQC14.III Maternity Breast Feeding – The position for the year to date is currently 74.2% against an expected target of 76%, the position for February was 71.5%.

CQC18.I Cancelled Operations – The position for the year to date is currently 0.96% against an expected target of 0.8%, the Trust is not expected to achieve this target by year end.

CQC18.II Cancelled Operations 28 Day Rebooking – The position for the year to date is currently 7.8% against an expected target of 5%, the Trust is not expected to achieve this target by year end, this is primarily due to the high number of cancellations in December.

CQC19 Delayed Transfers of Care – The position for the year to date is currently 4.1% against an expected target of 3.5%. The Trust is not expected to achieve this target by year end.

Following publication by Monitor of the consultation on amendments to the Compliance Framework, a draft dashboard for 2011/12 has been developed and for reference is included within the data appendices at the back of this report.

3.3 Finance The key areas of financial performance are as follows: • At month 11 a surplus of £4.3m has been generated and a forecast year

end surplus of £4.9m which is £1.3m above plan. • CIP plans year to date are broadly in line with plan. The CIP requirement

for the year is forecast to be £501k under achieved and the recurrent plan is forecasted to be £577k under achieved.

• A year to date Monitor Risk rating of a 3 is being achieved however the forecast rating is 4 due to impairments not being included within the FRR calculation.

• Clinical income is over recovered year to date by £2.2m with the forecasted position to be an over recovery by £1.5m at year end when compared to the budget. NHS Devon are currently £2m over contract year to date and forecasted to be £2.2m at year end.

• Pay under-spend year to date has deteriorated with the year end forecast reflecting that this is expected to reduce further. Non pay is over-spent year to date by £0.7m and is expected to increase for the remainder of the year.

• The Capital programme for 10/11 is expected to incur slippage of £5.7m


3.4 Quality

This report includes an additional set of graphs which summarise for the Board the key indicators under the new ‘Ward to Board’ safety and quality reporting process. The graphs include sets of matched process and outcome indicators. The key issues from these graphs are included in the commentary below as well as the key issues from the set of safety and quality indicators that are usually included in the Integrated Performance Report. Key issues are: • The number of cases of Clostridium difficile being identified since the

introduction of the new more sensitive testing methodology is starting to increase. Of the six cases of Clostridium difficile identified in February, only two cases were identified by the element of the testing methodology which is similar to the previous testing methodology used. The remaining four cases involved identification of the toxin gene which is only detected with the new test.

• No MRSA Bacteraemia were identified in February. • A High Impact Action project is being undertaken to facilitate rapid

improvement in respect of MUST (nutritional screening) scoring. In addition ward level improvement targets are to be set.

• Monthly spot audits of recording of VTE Risk Assessments are being undertaken to provide supplementary evidence to electronic recording of risk assessments.

Following agreement reached previously, in April the Board will receive a detailed Quarterly Update outlining ward level performance. At that time, a discussion on the presentation of the Ward to Board performance, including its place within the Integrated Performance Report, will take place.

3.5 Human Resources Key issues are: • A continuing reduction in the sickness absence rate. The sickness absence rate for the twelve month period ending 31 January 2011, was 4.25% compared to 4.30% for the period ending 31 December 2010, and 4.60% for the equivalent period last year. • A continued reduction in turnover. The rate of turnover for the twelve month period ending 31 January 2011 was 8.60% compared to 10.26% for the equivalent period last year. • A continued increase in the proportion of staff with a Personal Development Review (PDR) completed within the last 12 months. As at the end of January 2011, 81.23% of staff had a valid PDR.

4. FINANCIAL/OTHER IMPLICATIONS

Achieving NHS plan targets and milestones is an important feature of the Trust’s overall performance and demonstrates our commitment to delivering good quality care to patients. There are two specific performance indicators within the contract where Commissioners have the discretion to apply financial penalties in respect of underperformance: non-achievement of the Clostridium difficile target (up to 2% of the contract revenue) and non-achievement of the referral to treatment time target (up to 5% of monthly elective care revenue) both of these targets are being achieved and there is no risk associated with either to date.

5. RECOMMENDATIONS The Board is asked to receive the Performance Report and note the progress that has been made together with any actions that are planned.


Graph YTD Indicator Current Source Report

R1 Green → Accident and Emergency Maximum 4 Hour Wait Amber Performance

R2 Amber ↑ Cancelled Operations Green Performance

R3 Amber → Cancer 31 Day Wait Green Performance

R4 Amber ↓ Cancer 62 Day Wait Red Performance

R5 Green → Clostridium Difficile Infections Green Quality

R6 Green → MRSA Bloodstream Infections Green Quality

R7 Green → Patient Experience Green Quality

R8 Green ↓ Referral to Treatment for Admitted Pathways Green Performance

R9 Green → Referral to Treatment for Non-Admitted Pathways Green Performance


D1 Green ↓ Outpatient New Attendances Amber Finance

D2 Green → Elective Daycase Admissions Green Finance

D3 Amber ↑ Elective Inpatient Admissions Amber Finance

D4 Green ↑ Non-Elective Inpatient Admissions Amber Finance

D5 Green → Hospital Standardised Mortality Rate Green Quality

D6 Green ↓ Adverse Events Amber Quality

D7 Green → All Incidents Reported Green Quality

D8 Amber → Capital Expenditure Amber Finance

D9 Red ↑ Discharge Summaries Red Performance


E1 Amber ↑ Bank and Agency Spend All Staff Amber Human Resources

E2 Green ↑ Cash Green Finance

E3 Green → Cost Improvement Programmes Green Finance

E4 Green ↑ Income and Expenditure Green Finance

E5 Amber → PDR/PDPs Completed Amber Human Resources

E6 Green ↑ Risk Ratings Green Finance

E7 Amber → Sickness Absence Rate Amber Human Resources

E8 Green → Staff Employed Amber Human Resources

E9 Green → Staff Percentage Turnover Rate Green Human Resources

E10 Green → Starters and Leavers Green Human Resources

Red Off target or significant concerns re. achievement. Board to review exception report.Amber Slightly off target or minor concerns re. achievement. Board to be aware, but no action required.Green On target, no significant concerns re. achievement. No Board attention required.

→ Direction indicators point up for improvement, down for worsening and horizontal for no material change.

Deliver services in a comfortable, friendly environment in which staff can care for patients effectively.Recognise our wider responsibility to the environment and local community by using resources wisely.

Enable

Additional Reported Indicators (by Exception)

Respond

Integrated Performance Report - Summary Table

Be the provider of choice, delivering care in the most convenient and appropriate location, with no delay.Eliminate all avoidable hospital infections.

Future and sustained success through good financial management.

Deliver

A high standard of care delivered by experts, which meets the needs and aspirations of patients, staff, carers and the A full range of cost-effective accessible local hospital services.A range of excellent specialist services.

Staff to have a good work/life balance, and achieve their full potential.

Staff to do their jobs to the best of their ability, by valuing them, ensuring they have the right skills and giving them the opportunity to focus on meeting the needs of patients, so making the RD&E the employer of choice.


Be the provider of choice, delivering care in the most convenient and appropriate location, with no delay.Eliminate all avoidable hospital infections.Deliver services in a comfortable, friendly environment in which staff can care for patients effectively.Recognise our wider responsibility to the environment and local community by using resources wisely.

YTD Indicator Current YTD Indicator Current

G R1 - Accident and Emergency Maximum 4 Hour Wait A A R2 - Cancelled Operations G

A R3 - Cancer 31 Day Wait G A R4 - Cancer 62 Day Wait R

G R5 - Clostridium Difficile Infections G G R6 - MRSA Bloodstream Infections G

As reported previous ly a new test method was introduced in October 2010. In Feb, a tota l of 6 cases were identi fied, which i s the lowest s ince the new test was introduced. The new method cons is ts of two parts - the fi rs t part, s imi lar to the previous used, identi fies toxins produced by the C.di ffici le organism. Only 2 of the 6 cases were toxin +ve . The additional 4, were identi fied us ing the second part of the test which uses PCR to identi fy the gene that regulates toxin production. Despi te the use of PCR the cumulative number of cases remains below national tra jectory, a tra jectory based on toxin tests only. If PCR resul ts are excluded, a reduction in cases has been achieved over the las t 4 months .

No MRSA bacteraemias were ideni fied in February mainta ining a tota l of 2 for 2011-12 aga inst a target of 4.

Quality Quality

Respond

Performance Performance

PerformancePerformance

0

5

10

15

20

25

30

Apr

-07

Jul-0

7

Oct

-07

Jan-

08

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8

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Jul-0

9

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Jan-

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Infections Trajectory

0

1

2

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Jun-

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Feb-

11

96.0%

96.5%

97.0%

97.5%

98.0%

98.5%

99.0%

99.5%

100.0%

Apr

-07

Jun-

07

Aug

-07

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-07

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Feb-

08

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11

% T

reat

ed W

ithi

n 4

Hou

rs

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

Apr

-07

Jun-

07

Aug

-07

Oct

-07

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Feb-

08

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Jun-

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% T

reat

ed W

ithi

n 31

Day

s

70%

75%

80%

85%

90%

95%

100%

Apr

-07

Jun-

07

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08

Apr

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Feb-

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% T

reat

ed W

ithi

n 62

Day

s

Change in the constructionof the indicator issuedby Department of Health

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Apr

-07

Jun-

07

Aug

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Oct

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Jun-

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Oct

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% C

ance

lled

on o

r aft

er a

dmis

sion



G R7 - Patient Experience G G R8 - Referral to Treatment for Admitted Pathways G

G R9 - Referral to Treatment for Non-Admitted Pathways G

Performance

PerformanceQuality

90%

92%

94%

96%

98%

100%

Jun-

09

Jul-0

9

Aug

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Sep

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Oct

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Nov

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Jan-

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0

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Jan-

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Feb-

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Ans

wer

ed 'Y

es d

efin

itely

'

Have you felt safe throughout your stay?Have you felt cared for throughout your stay?Would you recommend this hospital to your f riends and family

2009/10 Q1 10/11 Q2 10/11 Q3 10/11 Jan-11 Feb-11 Total

Patients 376 127 141 68 45 30 787Wards 68 23 24 12 8 6 141

6 Patients = 1 Nursing Quality Assessment on 1 ward.

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

Apr

-08

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% T

reat

ed W

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n 18

Wee

ks

90%

91%

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93%

94%

95%

96%

97%

98%

99%

100%

Apr

-08

Jun-

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Aug

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Oct

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% T

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18

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ks



G D1 - Outpatient New Attendances A G D2 - Elective Daycase Admissions G

A D3 - Elective Inpatient Admissions A G D4 - Non-Elective Inpatient Admissions A

G D5 - Hospital Standardised Mortality Rate G G D6 - Adverse Events A

Current month vs plan: 15% below plan8% lower than the same month last year13% higher than previous monthYear to date: 10% lower than the same period in 2009-10Year to date vs plan: 13% below plan

Current month vs plan: 9% above plan 6% higher than the same month last year 8% lower than previous monthYear to date: 5% higher than the same period in 2009-10 Year to date vs plan: 3% above plan

The HSMR based on Dr Foster information using the Diagnosis HSMR Groups continues to remain below the lower control l imit and is therefore 'better than expected'. Data is from Apr-96 to Dec-10.

The Oct-10 adverse event rate currently l ies outside of the control l imits. The length of stay for the 12 sets of notes reviewed totalled 31 days which is significantly lower than the average of 89 days whilst the number of adverse events is 3 compared to an average of 2.9, this wil l mean that the adverse event rate will change when the additional notes are reviewed. Once the final figure is known additional investigation may be carried out if the rate sti l l remains high.

Deliver

Finance Finance

FinanceFinance

A high standard of care delivered by experts, which meets the needs and aspirations of patients, staff, carers and the public.A full range of cost-effective accessible local hospital services.A range of excellent specialist services.

Current month vs plan: 6% below plan6% higher than the same month last year 6% lower than previous monthYear to date: 7% higher than the same period in 2009-10Year to date: 2% lower than plan

Current month vs plan: 7% above plan12% higher than the same month last year2% lower than the previous month Year to date: 19% higher than the same period in 2009-10Year to date vs plan: 4% above plan

Quality Quality

70

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HSM

R

Rolling 12 Months Ending

RR Low High 100 mark

020406080

100120140160180

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Adv

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Adverse Events/1000 Bed Days CL-1σ +1σ+2σ +3σ

Currently only 12 notes reviewed for Oct-10 and Dec-10.

0

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Plan Actual

20002200240026002800300032003400360038004000420044004600480050005200

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Plan Actual


G D7 - All Incidents Reported G A D8 - Capital Expenditure A

R D9 - Discharge Summaries R

Spend YTD: £12.0m Planned Spend YTD: £17.2mForecast Y/E Spend: £14.3m Planned Y/E Spend: £20.0m

There were 6446 patient incidents between the 1st February 10 and the 31st January 11. This is a decrease from the same time period last year of 281 (4.1%) incidents. For employee incidents there were 2135 between 1st February 10 and the 31st January 11. This was a decrease of 7 (0.3%) incidents from the same period last year. Catastrophic and major incidents have consistently dropped year on year.

Performance

FinanceQuality

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Employee Patient Anywhere

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Proportion of Discharge Summaries Transmitted within 48 Hours

Target

Proportion of Discharge Summaries Transmitted within 24 Hours

Capital Spend

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£M

Capital Plan 10/11

Actual CapitalSpendForecast CapitalSpend

Exception report in respect of discharge summaries covered by specific report to Board of Directors on 25 June 2010.



A E1 - Bank and Agency Spend All Staff A G E2 - Cash G

G E3 - Cost Improvement Programmes G G E4 - Income and Expenditure G

A E5 - PDR/PDPs Completed A G E6 - Risk Ratings G

FinanceHuman ResourcesESR is used for the purpose of recording and reporting PDR activi ty for non Medica l and Denta l s taff.

Actual Surplus YTD: £4.3m Planned Surplus YTD: £2.2mForecast Surplus Y/E: £4.9m Planned Surplus Y/E: £3.6mActual Efficiency: 1.41% Planned Efficiency: 1.18%

Finance

Research and innovation.

Finance

Enable

Human Resources Finance

Staff to do their jobs to the best of their ability, by valuing them, ensuring they have the right skills and giving them the opportunity to focus on meeting the needs of patients, so making the RD&E the employer of choice.Staff to have a good work/life balance, and achieve their full potential.

Future and sustained success through good financial management.

Cash in hand and at bank: £61.5mWorking Capital Facil ity: £18mCash Invested @ Month End: £3m

The above chart indicates the amount of spend relating to staff registered on the bank and staff supplied by agencies.

-

100,000

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Jan-

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11

Bank Staf f Agency Staf f

0.00%

10.00%

20.00%

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90.00%

100.00%

Mar

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-2,000

-1,000

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il

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r

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r

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ch

£

Month

Comparison of actual cumulative net surplus/deficit compared to plan

Actual

Plan

00.5

11.5

22.5

33.5

44.5

5EBITDA Margin

EBITDA % Achieved

ROA

I&E Surplus Margin

Liquidity

Overall Rating

Risk Ratings

Plan YTDActual YTDPlan Y/EActual Y/E

Other Ratios Plan YTD Actual YTD Plan Y/E Actual Y/E

Trade Creditor Days 5.7 9.5 5.5 5.6NHS Trade Debtor Days 9.5 9.2 9.5 11.0Debt to Asset Ratio 7.2% 7.1% 6.8% 6.9%Other items £ £ £ £Revenue available for debt service 21.5m 23.6m 25.1m 26.5mDebt 22.1m 22.1m 21.5m 21.5mTotal Assets 306.5m 313.5m 314.8m 313.6m

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

0

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

£m

Month

CIP Plan v Actual

CIP PlanCIP ActualCIP Forecast

12 Month forecast cashflow v plan

-20

-10

-

10

20

30

40

50

60

70

80

Apr-1

0

May

-10

Jun-

10

Jul-1

0

Aug-

10

Sep-

10

Oct

-10

Nov-

10

Dec-

10

Jan-

11

Feb-

11

Mar

-11

Month£M

PlanActualForecastCommited Facility


A E7 - Sickness Absence Rate A G E8 - Staff Employed A

G E9 - Staff Percentage Turnover Rate G G E10 - Starters and Leavers G

The turnover rate of 8.6% for the combined 12 month period to end of January 2011 is lower than the 10.26% for the equivalent period last year.

Figures include staff on fixed term contracts and rotational training schemes but exclude those registered on the Staff Bank.

The sickness absence rate is calculated by expressing the amount of days lost as a percentage of the total contracted time. The cumulative rate for 12 months to 31st January 2011 is 4.25%.

The total FTE has increased by 12.29 to 5146.68. This is below the funded FTE establishment of 5249.72. Headcount has increased by 15 to 5962.

Human Resources Human Resources

Human ResourcesHuman Resources

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Short Term Medium Term Long Term

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Leavers > 12 LoS

Leavers Between 6 & 12 LoS

Leavers < 6 LoS

0

20

40

60

80

100

120

140

160

180

200

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Sta

rters

and

Lea

vers

Starters Leavers

4,500

4,700

4,900

5,100

5,300

5,500

5,700

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Contracted FTE Funded FTE


Performance CORPORATE TARGET NUMBER & DESCRIPTION:

Cancer Waiting Times

CURRENT CORPORATE RATING: Medium RESPONSIBLE DIRECTOR: Chief Operating Officer

Brief description of how the rating was derived 31 day subsequent treatments. The indicator is derived from a maximum of 31 days from decision to treat/earliest clinically appropriate date to start of second or subsequent treatment(s) for all cancer patients including those diagnosed with a recurrence where the sequent treatment is surgery or drug. 62 day referral to treatment – The indicator is derived from a maximum of 62 days from urgent referral for suspected cancer to first treatment

Details of actions necessary to return performance back to either good or excellent

Action Dept responsible

Timescale Progress

31 day subsequent treatments (Drug)

Small denominator numbers. Ensure all data is being recorded.

Cancer Services

Immediate Completed but ongoing monitoring required

Action Dept responsible

Timescale Progress

62 day urgent referral to treatment

Weekly Cancer Waiting Times (CWT) predictors to be sent out to Directorates in addition to standard weekly breach reports until the end of March to ensure a compliant March position.

IMT March 2011 Completed

Bowel Cancer Awareness Increased numbers of patients being referred for endoscopy as a result of cancer screening campaign with additional referrals for surgery and oncology. Specialties teams preparing to increase capacity to manage demand

Surgical and Cancer Services Directorates

March 2011 Referral rates being monitored and plans developed. Understanding lessons learnt for further Public Awareness campaigns

Bank Holidays Clinical Service teams to ensure capacity for cancer pathways OP, theatre sessions and MDT meetings particularly mitigating the loss of two consecutive Mondays

All Directorates April 2011 Directorates addressing capacity issues. Meeting to discuss plans w/c 21 March.


Finance FINANCIAL REPORT FOR THE TRUST COVERING THE PERIOD ENDING 28th

FEBRUARY 2011

The year to date surplus at month 11 is comparable to last month’s report at £4.3m which is £2.4m above the budgeted position and £2m above the planned position. The forecast surplus position is £4.9m which is £1.3m above the planned £3.6m. The I&E year to date and forecast variances have improved compared to month 10’s report (improvement by £599k year to date and £939k forecast). The main reason for this is due to increased clinical income and a decrease in expenditure. This position gives the Trust a Monitor risk rating of 3 year to date (in line with plan) and a forecast of 4 against a plan of 3 (see capital impairment section).

Executive Summary

At month 11 clinical income is over recovered by £2.2m (for all Commissioners) and forecasted to be £1.5m at year end. This is an improvement on month 10 by £0.7m year to date and an increase of £0.5m forecasted when compared to last month’s report. The main areas to improve are General Medicine, Plastic Surgery and General Surgery. The main areas of over/under performance year to date (for all Commissioners) are;

INCOME

• Cancer Services is over recovered by £1.1m, in line with last months report. Virtually all specialties within the Directorate are over-performing. The main area to over perform is Radiotherapy Treatments (£399k) due to treating 13% more outpatients than expected. Clinical Haematology is another area over performing (£311k), mainly due to an additional 886 excess bed days.

• Critical Care is over recovered by £882k a slight decrease on last month’s report by £65k. All specialties within the Directorate are performing above plan with Prep for Surgery activity (£320k) the main area over performing due to 74% more follow-up outpatients being seen than planned.

• Trauma & Orthopaedics is one of the main areas now under-performing with a year to date position of £666k adverse. This is due to both Orthopaedics and Trauma specialties (£757k & £166k respectively); this is partially offset by an over-recovery on income relating to High Cost Drugs & Devices (£265k).

• Women and Childs’ Health is an area that continues to over-perform but has decreased by £263k on last month’s report to a favourable £652k. This decrease is due to a correction in Maternity scan clinic income. The over performance is mainly due to Maternity activity exceeding expectations.

YTD Month 11 YTD Month 10 Change £’000 £’000 £’000

I&E year to date 4,252 4,290 -38 I&E Forecast 4,928 3,989 939 I&E year end forecast variance to budget/Plan

1,328 389 939

Total Income variance to date 2,446 1,794 652 CIP variance to date -88 17 -105 Pay expenditure variance to date 850 1,069 -219 Non pay (excl. R&D) expenditure variance to date

-668 -871 201

Cash at month end 61,507 65,950 -4,443


At present NHS Devon is over recovered by £2m year to date (to month 10), an increase on month 9 by £0.8m. The year end forecast is currently £2.2m over budget at year end.

Pay is under-spent year to date by £850k and forecast to be £797k favourable at year end. The forecast position has improved by £105k compared to last month’s report with a number of Directorates improving their position. The main reason Directorates have improved is due to contingencies being retained for winter pressures now being released. If the year to date under-spend was to continue at the same rate the year-end position could improve by a further £130k. The main areas under-spending are Nursing £240k, A&C staffing £512k, Ancillary staff £345k and MTO’s/Technical staff £331k. These under-spends are being partially offset by an over-spend on Snr/Jnr/Agency Medical Staff of £656k. The year to date position on non pay expenditure is £668k adverse which is £203k improvement on month 10’s report. The improvement has been seen across a number of areas within the Directorates. The forecast position is £1.4m adverse, an improvement of £137k. The main areas of overspending within the year to date position are as follows:

EXPENDITURE

• Drugs £677k of which approximately £500k relates to drugs recharged to the PCT. The balance is due to activity seen mainly within Medicine.

• Medical and Surgical Items are £1.1m adverse, a marginal improvement on last month’s report. This continues to be due to Medicine (£506k adverse in Cardiology and Haemodialysis) and within Diagnostics (£292k in Radiology).

• Chemicals and Reagent spend is £239k adverse which is similar to month 10’s report. This spend is seen across the majority of departments within Diagnostics due to the volume of testing being performed for RD&E patients.

• Spend on Services Received has improved by £28k on month 10 to £215k adverse. This spend is across several Directorates but is mainly on send away tests within Diagnostics (£112k), Community theatre recharges in Critical Care (£82k) and patient transport services in Operations (£69k).

• Admin Expenditure is £149k adverse and this is mainly due to spend on IT equipment and software within IM&T that has been recharged back to the PCT.

The year to date position on CIP achievement at month 11 is under-achieved by £88k which is a deterioration by £105k compared to last month’s report. The forecast achievement for this current year is £17.8m, £0.5m under achievement compared to plan. However there is a high risk associated with approximately £900k of workforce savings in relation to reduction in sickness levels. The recurrent achievement of CIP has improved by £491k to £14.1m with a further £3.6m forecast to be achieved by year end. This will leave a shortfall of £577k to be carried forward to 2011/12 The savings made by the Directorates is the highest level of achievement on CIP seen in any financial year previously by the Trust. Please see appendix 9 for a Highlight Report detailing progress on the 10 CIP projects.

COST IMPROVEMENT PROGRAMME (CIP)

The current and forecast capital position continues to reflect the previous capitalisation threshold of £5k. Work continues to be carried out relating to the increase in the capitalisation threshold to £15k. From the work carried out to date it is likely that the

CAPITAL Appendix 6 provides details of actual, forecast and planned capital expenditure.


reduction in the depreciation charge will be higher than the value of additions that will be treated as a revenue expense, this will result with an estimated small increase to the Trust’s forecast surplus at year end. Actual capital expenditure for the first eleven months of the year was £12m in comparison to £18.6m on the plan. Capital expenditure is therefore £6.6m lower than planned. The slippage represents 35% of planned expenditure and is due to a number of capital schemes. The larger schemes are included on appendix 6.

Slippage to date has exceeded 25% of the capital plan. Monitor has previously been informed of the capital slippage. A revised capital plan based upon the month 10 forecast was provided to Monitor.

Capital expenditure for the year is now forecast to be £14.3m, which is £5.7m less than plan. The forecast capital additions represent capital slippage of 28%. The schemes that represent the majority of the slippage are the CIVAS unit and equipment, laboratory information management system, order comms and e-prescribing system and an element of the contingency allocated to 2011/12. The slippage on these schemes has been reported on previous monthly Board reports.

CAPITAL FORECAST - REVALUATION The forecast value of property and land has not yet been adjusted for the latest draft valuation received from the District Valuer. The valuation is still being checked, but it is likely that the increase in buildings will be lower than the 7% included in the current forecast. The final valuation will be included in the month 12 report and the year end draft accounts.

CAPITAL - IMPAIRMENT It is likely that a total impairment charge of around £2m will arise on two of the Trust’s buildings in addition to the £443k already provided in the plan. These likely impairments will be accounted for as a revenue expense. They are not reflected within the forecast included within the Income Statement and the Statement of Financial Position, but will be offset by central reserves slippage. As impairments are not included when calculating the risk rating it is likely that this will lead to a reported FRR of 4 at year end.

BALANCE SHEET - DEBTORS The value of trade and other receivables at month 11 is £13.4m, which is £0.3m lower than plan (plan is £13.7m). The percentage of trade debtors that exceed their due date by 90 days is 6.0%. The largest invoice that has exceeded this due date relates to a debt due from NHS West Sussex for £128.9k. The invoice has been queried/disputed, but we have now received confirmation from this organisation that the invoice has now been passed for payment. Adjusting for this debtor the percentage of debtors that would have exceeded their due date would reduce to 4.5%.

Surplus higher than plan

CASH The cash balance at the end of February is £61.5m, which is £14.4m higher than plan (plan is £47.1m). The following provides a summary of the main reasons for the increase:

£2.1m Capital expenditure lower than plan

£6.6m See appendix 6 for details

Non-current assets held for sale £0.5m Proceeds for Occ Health Building received sooner than plan

Trade and other payables higher than plan

£3.4m Capital creditors £0.7m and trade creditors £1.6m. Also £1.18m of VAT received on sale of Heavitree site payable to HMRC.

Deferred income higher than plan £(2.8)m Income previously planned to be received


by the Trust has been paid directly to another organisation.

Other financial liabilities higher than plan

£4.4m Deferred expenditure higher than plan

Other changes £0.2m Total £14.4m

ACTIVITY Elective inpatient and outpatient activity is lower patients than planned (15% and 6% respectively) during February whereas day-case and non-elective inpatient activity is above plan (7% and 9% respectively). With the exception of elective inpatients all patient types have seen lower activity in February than in January; this will be partially due to fewer operational days in February. Compared to the same month last year all patient types have treated on average 7% more activity this February. With the exception of elective inpatients all patient types have received more patient activity for the year to date than the same period last year (Outpatients 7%, day-cases 19%, non-elective 5%). Elective inpatient activity is 10% lower for the year to date when compared to last year. This is probably due to treating more patients as day-cases instead as an elective inpatient.

The Director of Finance wishes to delegate responsibility for signing contracts valued at less than £100k to the Head of Procurement to improve operational efficiency. This is an amendment to Standing Financial Instruction and Standing Orders and subject to approval by the Board of Directors, will take effect immediately and will be incorporated into the update of SFIs and SOs in November 2011.

OTHER ISSUES

Regarding the impact of working capital facilities on the calculation of PDC the DH has written to Finance Directors. The guidance note essentially states that where an FT has drawn a short term working capital facility, this cannot be used to reduce the PDC dividend payable. The guidance is effective for the calculation of the 2010/11 PDC Dividends.

The key areas of financial performance are as follows: CONCLUSION

• At month 11 a surplus of £4.3m has been generated and a forecast year end surplus of £4.9m which is £1.3m above plan.

• CIP plans year to date are broadly in line with plan. The CIP requirement for the year is forecast to be £501k under achieved and the recurrent plan is forecasted to be £577k under achieved.

• A year to date Monitor Risk rating of a 3 is being achieved however the forecast rating is 4 due to impairments not being included within the FRR calculation.

• Clinical income is over recovered year to date by £2.2m with the forecasted position to be an over recovery by £1.5m at year end when compared to the budget. NHS Devon are currently £2m over contract year to date and forecasted to be £2.2m at year end.

• Pay under-spend year to date has deteriorated with the year end forecast reflecting that this is expected to reduce further. Non pay is over-spent year to date by £0.7m and is expected to increase for the remainder of the year.

• The Capital programme for 10/11 is expected to incur slippage of £5.7m


Quality Hospital Standardised Mortality Ratio The HSMR based on Dr Foster information using the Diagnosis HSMR Groups continues to remain below the lower control limit and is therefore 'better than expected'. Data is from Apr-96 to Dec-10. Adverse Events The Oct-10 adverse event rate currently lies outside of the control limits. The length of stay for the 12 sets of notes reviewed totalled 31 days which is significantly lower than the average of 89 days whilst the number of adverse events is 3 compared to an average of 2.9, this will mean that the adverse event rate will change when the additional notes are reviewed. Once the final figure is known additional investigation may be carried out if the rate still remains high. All Incidents Reported There were 6446 patient incidents between the 1st February 10 and the 31st January 11. This is a decrease from the same time period last yearof 281 (4.1%) incidents. For employee incidents there were 2135 between 1st February 10 and the 31st January 11. This was a decrease of 7 (0.3%) incidents from the same period last year. Catastrophic and major incidents have consistently dropped year on year. Clostridium Difficile Infections As reported previously a new test method was introduced in October 2010. In Feb, a total of 6 cases were identified, which is the lowest since the new test was introduced. The new method consists of two parts - the first part, similar to the previous used, identifies toxins produced by the C.difficile organism. Only 2 of the 6 cases were toxin +ve. The additional 4 were identified using the second part of the test which uses PCR to identify the gene that regulates toxin production. Despite the use of PCR the cumulative number of cases remains below national trajectory, a trajectory based on toxin tests only. If PCR results are excluded, a reduction in cases has been achieved over the last 4 months. MRSA Bloodstream Infections No MRSA bacteraemias were idenified in February maintaining a total of 2 for 2011-12 against a target of 4. Patient Experience

2009/10 Q1 10/11 Q2 10/11 Q3 10/11 Jan-11 Feb-11 Total

Patients 376 127 141 68 45 30 787Wards 68 23 24 12 8 6 141

6 Patients = 1 Nursing Quality Assessment on 1 ward.


Human Resources Sickness Absence For the twelve month period ended 31st January 2011 the sickness rate of 4.25% shows a very small decrease on the 4.30% reported for December rate. This is an improvement on the rate of 4.60% reported for the same period last year. The rate of 4.21% for the individual month of January 2011 is significantly lower than the 5.23% reported last month and is also a significant reduction on the January 2010 rate of 4.97%. A complete review of all December sickness absence episodes during January led to a higher rate of recovery from winter pressures than was reported last year. The number of recorded long term sick cases continues to reduce month on month reflecting the ongoing management by line managers with the support of Occupational Health and Human Resources. In addition, as a result of implementing the new Sickness Absence Policy and managing cases earlier on a formal basis the number of short term sick cases is also reducing. Turnover The turnover rate of 8.6% for the year ended January 2011 continues the overall trend of small decreases each month and is a significant decrease on the rate of 10.26% reported the same time last year. Staff Numbers The total full time equivalent (FTE) as at January 2011 has increased across the general workforce by 12.29 to 5146.68 when compared with the December 2010 report although this is still 103.04 FTE’s below the current funded establishment of 5249.72. Headcount has also increased this month by 15 to 5962. The funded establishment has reduced by 71.65 FTE’s since September 2010 reflecting the emphasis on controlling pay expenditure. The number of staff with fixed term contracts continues to rise with a further increase of 5 (8.31 FTE) this month making a total of 195 (165.41 FTE) staff with contracts ending within the next twelve months. This is in line with the strategy to maintain a flexible workforce into 2011/12 and beyond. The establishment of a Trustwide vacancy panel which meets weekly will provide additional rigour and scrutiny of all requests to recruit to vacancies, in a drive to resource prudently whilst ensuring that risks to quality and safety are fully mitigated. Personal Development Review’s (PDR) The rate of PDRs recorded on ESR continues to rise with an increase of 0.32% shown in the compliance rate this month to 81.23%. This reflects the continued focus on ensuring PDR’s are completed, recognised in the staff survey as crucial to staff engagement. Training Delivery In response to recommendations from the recent Learning and Development Service review, a range of training modules is available to suit different learning styles and through flexible modes of delivery. Currently available are a number of courses aimed at assisting managers during periods of change with a new offer of twenty Personal Effectiveness learning opportunities planned which are deliverable via audio files downloaded from the Trust’s intranet. These can either be listened to at the computer or stored on MP3 player/ ipod for later use.


Data Appendices – Performance

Indicator PositionTarget for

PeriodRisk for Period

Risk for Year



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 yet enforced

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.

Medium Medium

Trend graphs run from April 2009 to current month

MON09.IIMRSA Screening

Emergency103.1% 100%

MON12Learning Disability

Compliance

Compliant Very LowCompliant Very Low

MON05.IIIRTT Admitted

Data Completeness

Not applicable

Not SetMON11

ThrombolysisCall to Needle

n/a 68% Very LowNot applicable Very Low

96.4% 95% LowLow

Trend

Monitor Dashboard - February 2011

Medium

Medium

Not Set

Not Set

n/a n/a Not Set

n/a

Not Set

MON09.IMRSA Screening

Elective

MON10A&E 4 Hr Wait

Low

149.6% 100% Low

Low

Low

96.6% 93%

97.5% 96% Low

96.8% 93% Very Low

Low

Very Low

n/a Not Set

n/a n/a Not SetNot Set

Medium

Medium

Medium

Medium

Medium

Medium

Trend

24Q = 30

0Q = 1

94%

94%

85%

90%

n/a

Medium

n/a

Not Set

Not Set

n/a

n/a

95.4%

97.2% 98% Medium

MON06.IIRTT Non-AdmittedSpecialty

MON06.IRTT Non-AdmittedPosition

n/a

n/a

Not Set

Not Set

Medium

Medium

Medium

Medium

MON01Clostridium

Difficile

MON02MRSA

MON03.ICancer 31 Day

Subsequent Surgery

MON03.IICancer 31 Day

Subsequent Drug

MON05.IIRTT Admitted

SpecialtyFailures


GP Urgent

MON08.IICancer 14 DaySymptomatic

Breast

99.5%

80.2%


Screening

MON05.IRTT Admitted

Position

MON03.IIICancer 31 Day

Subsequent Radiotherapy


GP Urgent

96.2%

Target removed

Target removed

Target removed

Target removed

Target removed

Target removed

MON06.IIIRTT Non-

Admitted Data Completeness

MON07Cancer 31 Day

First Treatment

17

1

\






Indicates that the target has been achieved for the month Indicates that the target is not yet enforcedIndicates that the target has not been achieved for the month

Targets have yet to be published but where possible current performance has been assessed against 2009/10 targets, where these targets have yet to be published for the 2009/10 assessment targets have be applied from previous years and are indicated by enclosure in brackets.

Care Quality Commission Dashboard - February 2011

Trend Trend

n/a Very LowP94.4% (94.0%) Low

3Y = 4

Low

100.0% (100.0%) Low

2

n/a Very Low

3.7% 15% Very Low

P

(90.0%) Low

88156

Y = 162Low

93.8%

Low

96.6% (90.0%) Low

85.5%

(98.0%) Low


(93.0%) Low

98.5% (93.0%) Low

97.9%

(85.0%)

Very Low

97.4% (96.0%) Low

Low

2 (2) Low

90.6% (90.0%)CQC01.I

RTT Admitted

CQC01.IIRTT Admitted

SpecialtyFailures

CQC01.IIIRTT Admitted Data

Completeness

CQC04.IIICancer 31 Day

Subsequent Drug

CQC02.IRTT Non-Admitted

CQC04.IICancer 31 Day

Subsequent Surgery

CQC02.IIRTT Non-Admitted

SpecialtyFailures

CQC02.IIIRTT Non-Admitted

CQC03Learning Disability

Compliance

CQC04.ICancer 31 Day

First Treatment


Symptomatic Breast


Urgent GP


Screening

CQC06.IIICancer 62 Day

Consultant Upgrade

CQC07Clostridium Difficile

82.6%>= 80%

and<= 120%

Low

97.6%

0 (2)

(95.0%) Low

108.9%


Urgent GP

CQC11.IHeart Disease AuditData Completeness

CQC11.IIHeart Disease Audit

Participation

>= 80%and

<= 120%Low

Low

CQC08Clinical Audit

CQC09Maternity Data

Quality

n/a

CQC10MRSA


Compliance with recommendations set out in ‘Healthcare for all' (2008) - the Independent Inquiry into Access to Healthcare for People with Learning Disabilities.

Compliance with key points set out in 'Principles for Best Practice in Clinical Audit' (NICE, 2002)

Participation in the following audits; adult cardiac surgery, cardiac rhythm management, congenital heart disease audit and heart failure audit. The Trust participates in 2 of the 4 audits listed and does not undertake any activity that would be covered by the other two

audits.

CQC04.IVCancer 31 Day


P

96.8% (94.0%) Low

99.6%






Indicates that the target has been achieved for the month Indicates that the target is not yet enforcedIndicates that the target has not been achieved for the month

Target removed


Not Known

Not Known

Low

CQC24.IReperfusion

Call to NeedleNot applicable to this Trust as Primary Angioplasty is the preferred method.

n/a n/a Not Set

0.96% (0.80%)

tbc Low

CQC19Delayed Transfers of

Care

CQC20Ethnic Coding

CQC2126 Week Stage of Treatment Wait

Target removed

tbc Low

0.00% 0.10% Low

76.2%

Very Lown/a tbc

n/a n/a Not Set

100.0% 98% Very Low

Very Low

n/a n/a Not Set

93.7% 85%

Medium

4.1% (3.5%) Medium

7.8% 5%

Medium

Care Quality Commission Dashboard - February 2011

Not Known

Not Known

LowCQC12Patient

Experience

CQC18.ICancelled

OperationsDependant on national survey results

Trend Trend

65.7% tbc Low

7.0% (10.2%) Low

CQC25Revascularisation

CQC15Staff Satisfaction

CQC23Rapid Access Chest

Pain Clinic

CQC16A&E 4 Hr Wait

CQC17GUM Access

98.0% 98% Very Low

CQC24.IIReperfusion

Call to BalloonNot applicable to this Trust

CQC2213 Week Stage of Treatment Wait

CQC14.IIIMaternity Breast

Feeding

CQC14.IVMaternity Breast

Feeding Data Quality

1.1%

74.6%

5% Low

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.Targets have yet to be published but where possible current performance has been assessed against 2009/10 targets, where these targets have yet to be published for the 2009/10 assessment targets have be applied from previous years and are indicated by enclosure in brackets.

CQC18.IICancelled

Operations 28 Day Rebooking

CQC13Stroke Care

CQC14.IMaternity Smoking

CQC14.IIMaternity

Smoking Data Quality

0.3% 5% Low

Dependant on national survey results


Code Target Jan-11 Feb-11 Q1 Q2 Q3 Q4 Weighting PositionRisk for Quarter

Risk for Year

MON01 162 11 (13) 6 (11) 23 (43) 23 (41) 25 (48) 17 (30) 1.0 Achieving Medium MediumMON02 4 1 (0) 0 (0) 0 (1) 1 (1) 0 (1) 1 (1) 1.0 Achieving Medium Medium

surgeryMON03.I 94%

96.8%(2 of 63)

93.5%(3 of 46)

95.9%(5 of 122)

97.7%(4 of 172)

97.4%(4 of 153)

95.4%(5 of 109)

Medium Medium

anti cancer drug treatments

MON03.II 98%97.1%

(2 of 69)97.4%

(1 of 38)100.0%

(0 of 171)100.0%

(0 of 218)99.5%

(1 of 197)97.2%

(3 of 107)Medium Medium

radiotherapy(from 1 Jan 2011)

MON03.III 94%99.0%

(1 of 101)100.0%

(0 of 121)84.2%

(49 of 310)97.1%

(9 of 309)98.9%

(3 of 264)99.5%

(1 of 222)Medium Medium

from urgent GP referral to treatment

MON04.I 85%85.0%

(10.5 of 70)

76.3%(20.5 of

86.5)

83.2%(37.5 of

223)

86.7%(38 of 285)

89.0%(31.5 of 286.5)

80.2%(31 of 156.5)

Medium Medium

from consultant screening service referral

MON04.II 90%100.0%

(0 of 15.5)90.9%

(1 of 11)97.6%

(1 of 41)98.0%

(1 of 51)93.9%

(2.5 of 41)96.2%

(1 of 26.5)Medium Medium

aggregate MON05.I Not Known Not Set Not Setby speciality MON05.II Not Known Not Set Not Setdata completeness MON05.III Not Known Not Set Not Setaggregate MON06.I Not Known Not Set Not Setby speciality MON06.II Not Known Not Set Not Setdata completeness MON06.III Not Known Not Set Not Set

MON07 96%97.4%

(5 of 193)97.6%

(5 of 205)95.5%

(25 of 551)97.7%

(14 of 611)98.7%

(8 of 620)97.5%

(10 of 398)0.5 Achieving Low Low

all cancersMON08.I 93%

95.4%(31 of 673)

98.0%(15 of 768)

98.7%(26 of 2010)

98.1%(47 of 2469)

97.6%(56 of 2340)

96.8%(46 of 1441)

Very Low Very Low

for symptomatic breast patients (cancer not initially suspected)

MON08.II 93%96.4%

(2 of 55)96.9%

(2 of 64)97.6%

(6 of 255)100.0%

(0 of 150)100.0%

(0 of 130)96.6%

(4 of 119)Low Low

elective MON09.I 100% 160.4% 139.7% 172.5% 149.6% 0.5 Achieving Low Lowemergency MON09.II 100% 79.7% 130.0% 76.8% 103.1% 0.5 Achieving Medium Medium

MON10 95% 96.5% 96.4% 98.8% 98.4% 97.6% 96.4% 0.5 Achieving Low LowMON11 68% 0.5 Achieving Very Low Very Low

All MON12 n/a 0.5 Achieving Very Low Very Low

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.Risk assessment of targets may differ between Monitor and CQC as the consequence of a single indicator failure for a CQC target is less than that of a Monitor target due to the scoring methodology used by the regulator

Acu

te ta

rget

s –

min

imum

sta

ndar

ds

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

Cancer: two week wait from referral to date first seen

Maximum waiting time of four hours in A&E from arrival to admission,People suffering heart attack to receive thrombolysis within 60 minutes of call

0.5

Self-certification against compliance with requirements regarding access to Not applicable

Achieving

1.0

1.0

Targets removed

Monitor Targets Detail

IndicatorA

cute

targ

ets

– na

tiona

l req

uire

men

tsClostridium difficileMRSA

Maximum time of 18 weeks from point of referral to treatment for non-admitted pathways Targets removed

All cancers: 31-day wait for second or subsequent treatment

Currently Not

Achieving

Currently Not

Achieving

All cancers: 62-day wait for first treatment

Maximum time of 18 weeks from point of referral to treatment for admitted pathways

Compliant

Screening all in-patients for MRSA


Code Target Feb-11 YTD PositionRisk for

YearAggregate

CQC01.I tbc90.6%

(247 of 2619)n/a Not Known Low

By Specialty CQC01.II tbc 2 n/a Not Known LowData completeness

CQC01.III>=80% and

<=120%82.6%

(2619 of 3170)n/a Achieving Low

AggregateCQC02.I tbc

97.6%(92 of 3880)

n/a Not Known Low

By Specialty CQC02.II tbc 0 n/a Not Known LowData completeness

CQC02.III>=80% and

<=120%108.9%

(3880 of 3563)n/a Achieving Low

CQC03 tbc Compliant Not Known Very Low

First Definitive TreatmentCQC04.I tbc

97.6%(5 of 205)

97.4%(57 of 2180)

Not Known Low

Subsequent SurgeryCQC04.II tbc

93.5%(3 of 46)

96.8%(18 of 556)

Not Known Low

Subsequent DrugCQC04.III tbc

97.4%(1 of 38)

99.6%(3 of 693)

Not Known Low

Subsequent RadiotherapyCQC04.IV tbc

100.0%(0 of 121)

94.4%(62 of 1105)

Not Known Low

Urgent GP ReferralCQC05.I tbc

98.0%(15 of 768)

97.9%(175 of 8260)

Not Known Low

Symptomatic Breast ReferralCQC05.II tbc

96.9%(2 of 64)

98.5%(10 of 654)

Not Known Low

Urgent GP ReferralCQC06.I tbc

76.3%(20.5 of 86.5)

85.5%(138 of 951)

Not Known Low

Screening Service ReferralCQC06.II tbc

90.9%(1 of 11)

96.6%(5.5 of 159.5)

Not Known Low

Consultant UpgradeCQC06.III tbc

77.1%(4 of 17.5)

93.8%(8.5 of 137)

Not Known Low

Clostridium difficile infections CQC07 162 6 (11) 88 (162) Achieving LowEngagement in clinical audits

CQC08

Yes to Question 1 and

Y to 4/5 of other questions

Achieving Very Low

Maternity data qualityCQC09 <=15%

4.1%(1333 of 32826)

3.7%(13998 of 375864)

Achieving Very Low

MRSA Bacteraemias CQC10 4 0 (0) 2 (4) Achieving Low

Data completenessCQC11.I =100% Achieving Low

Participation CQC11.II >=66% 100.0% 100.0% Achieving Very LowPatient experience

CQC12Dependant on all

responsesNot Known Low

Quality of stroke careCQC13 tbc

77.3%(34 of 44)

65.7%(364 of 554)

Not Known Low

SmokingCQC14.I tbc

9.6%(30 of 314)

7.0%(256 of 3638)

Not Known Low

CQC14.II <=5%1.3%

(4 of 314)0.3%

(11 of 3638)Achieving Low

CQC14.III tbc75.2%

(236 of 314)

74.6%(2714 of

3638)Not Known Low

Breastfeeding - Data QualityCQC14.IV <=5%

1.9%(6 of 314)

1.1%(40 of 3638)

Achieving Low

Staff satisfactionCQC15

Dependant on all responses

Not Known Low

A&E waiting times CQC16 >=98% 96.4% 98.0% Achieving Very LowAccess to genito-urinary medicine (GUM) clinics CQC17 n/a Not Known Not Set

Cancelled OperationsCQC18.I <=0.8%

0.7%(41 of 5757)

0.96%(625 of 64911)

Currently Not Achieving

Medium

28 Day RebookingCQC18.II <=5.0%

9.8%(4 of 41)

7.84%(49 of 625)

Currently Not Achieving

Medium

Delayed transfers of careCQC19 tbc

6.3%(39 of 620)

4.1%(915 of 22138)

Not Known Medium

Ethnic coding data qualityCQC20 >=85%

94.3%(13114 of 13900)

93.7%(148580 of

158523)Achieving Very Low

Inpatients waiting longer than the 26 week standard CQC21 Not Known Not SetOutpatients waiting longer than the 13 week standard CQC22 Not Known Not SetRapid access chest pain clinic waiting times

CQC23 >=98%100.0%(0 of 57)

100.0%(0 of 589)

Achieving Very Low

Call to needleCQC24.I tbc

(0 of 0)0.0%

(6 of 6)Not Known Very Low

Call to balloonCQC24.II tbc

62.5%(6 of 16)

76.2%(30 of 126)

Not Known Low

Revascularisation waiting timesCQC25 <=0.1%

0.0%(0 of 63)

0.00%(0 of 662)

Achieving Low

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

Not applicable

Compliant

Compliant

Not yet known

Not yet known

Exis

ting

Com

mitm

ents

Target removedTarget removed

100%

18 week referral to treatment waiting times

Access to healthcare for people with a learning disability

Smoking during pregnancy and breastfeeding initiation rates

Non-Admitted Pathways

Cancer urgent referral to treatment waiting times

Participation in heart disease audits

Cancer diagnosis to treatment waiting times

Risk assessment of targets may differ between Monitor and CQC as the consequence of a single indicator failure for a CQC target is less than that of a Monitor target due to the scoring methodology used by the regulator

Care Quality Commission Targets Detail

Cancer urgent referral to first outpatient appointment waiting times

Nat

iona

l Pri

oriti

es

Indicator

Admitted Pathways

Smoking - Data Quality

Breastfeeding

Cancelled operations

Reperfusion waiting times


Draft Monitor Dashboard 2011/12

IndicatorPosition 2010/11

YTDTarget

Monitor Weighting

Risk for Period

Risk for Year


PeriodMonitor

WeightingRisk 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 yet enforced

DRAFT Monitor Dashboard 2011/12

Trend Trend

MON01Clostridium

Diffici le

max. 74 annual

Not Set Not Set 0.5min. 96%1.0

1.0

MON07Cancer 31 DayFirst Treatment

1.0MON03.I

Cancer 31 Day Subsequent

Surgery

min. 94% Not Set Not Set

Not SetMON02

MRSAmax. 3 annual

Not Set

Not Set

MON10Stroke Indicator

Not Yet Defined

MON09.IA&E - Total Time

Awaiting Data

Awaiting Data

Not Set Not Set

Not Set Not Set

Not Set Not Set

min. 93%

MON03.IIICancer 31 Day


min. 94% Not Set

95th Percentile max.

4 hoursmin. 98% Not Set

Not Set


GP Urgentmin. 85% Not Set

Not Set


GP Urgent

MON09.IIIA&E - Time to

Treatment Decision

Not Set

MON08.IICancer 14 DaySymptomatic

Breast

min. 93%

Awaiting Data

Awaiting Data

Awaiting Data

Not SetMON03.II

Cancer 31 Day Subsequent Drug


Screeningmin. 90% Not Set

1.0

1.0

MON04.IIICancer 62

Consultant Upgrade

0.5

MON06RTT Non-Admitted

95th Percentile


18.3 weeksNot Set

Not Setmin. 85% Not Set

Not Set

Not Set

MON09.IVA&E - Unplanned

Reattendance Rate

Not Set Not Set

MON11Learning

Disabil ity Compliance

0.5Not known Not Set

Not Set

Not Set

MON05RTT Admitted

95th Percentile


max. 5% Not Set Not Set


23 weeksNot Set

MON09.VA&E - Left

Without Being Seen


max. 5% Not Set Not Set

Compliant

1.0

1.0 Not applicable

Not Set

MON09.IIA&E - Time to

Initial Assessment


15 minutesNot Set Not Set

0.5 for each indicator

failure capped at a maximum of

1.0

Median max.

60 minutesNot Set


Data Appendices – Finance

Actual Surplus YTD Plan Surplus YTD Spend YTD Planned Spend YTD£4.3m £2.2m £12.0m £17.2m

Forecast Surplus Y/E Plan Surplus Y/E Forecast Y/E Spend Planned Y/E Spend£4.9m £3.6m £14.3m £20.0m

Actual Efficiency* Planned Efficiency* 1.41% 1.18%

Other Ratios Plan YTD Actual YTD Plan Y/E Actual Y/E

Trade Creditor Days 5.7 9.5 5.5 5.6NHS Trade Debtor Days 9.5 9.2 9.5 11.0Debt to Asset Ratio 7.2% 7.1% 6.8% 6.9%Other items £ £ £ £Revenue available for debt service 21.5m 23.6m 25.1m 26.5mDebt 22.1m 22.1m 21.5m 21.5mTotal Assets 306.5m 313.5m 314.8m 313.6m

Cash in hand and at bank £61.5mWorking Capital Facility £18mCash invested @ Month End £3m

*(planned surplus / planned operating income *100)*(forecast surplus / forecast operating income *100)

RD&E Financial Overview as at 28th February (YTD - Month 11)1. I&E 3. Capital 5. Ratios/Risk Rating

Graph – Capital Plan Vs Actual and forecast spend

2. CIP 4. Cash 6. WTEGraph – Actual, Forecast & Plan

APPEN

DIX 1

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

£m

Month

CIP Plan v Actual

CIP Plan

CIP Actual

CIP Forecast

4700

4800

4900

5000

5100

5200

5300

5400

WT

EMonth

Contracted WTE, Worked WTE & Funded WTE

Worked WTE

Contract WTE

Funded WTE

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Margin

EBITDA % Achieved

ROA

I&E Surplus

Liquidity

Overall Rating

Risk Ratings

Plan YTD

Actual YTD

Plan Y/E

Actual Y/E

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

6,000

£

Month

Comparison of actual cumulative net surplus/deficit compared to plan

Actual

Plan

Capital Spend

0

5

10

15

20

25

Apr-

10

May-1

0

Jun

-10

Jul-

10

Aug

-10

Sep

-10

Oct-

10

Nov-1

0

Dec-1

0

Jan

-11

Feb

-11

Mar-

11

Month£

M

Capital Plan 10/11

Actual CapitalSpendForecast CapitalSpend

12 Month forecast cashflow v plan

-20

-10

-

10

20

30

40

50

60

70

80

Ap

r-10

May-1

0

Ju

n-1

0

Ju

l-10

Au

g-1

0

Sep

-10

Oct-

10

No

v-1

0

Dec-1

0

Jan

-11

Feb

-11

Mar-

11

Month

£M Plan

ActualForecastCommited Facility


Overall : Year to Date 8% up compared to similar period in 0910

OP 1st Attendances ● Current Month v plan. 6% below plan. Daycase 1st FCEs ● Current Month v plan. 7% above plan.

●6% higher than the same month last year ●12% higher than the same month last year

● 6% lower than previous month ● 2% lower than the previous month

● Year to Date 7% higher than same period in 0910

● Year to Date 19% above than same period in 0910.

● Year to date v plan. 2% lower than plan. ● Year to date v plan. 4% above plan.

Elective IP 1stFCEs ● Current Month v plan. 15% below plan.

Non Elective IP1st FCEs

● Current Month v plan. 9% higher than plan.

●8% lower than the same month last year ● 6% higher than the same month last year

● 13% higher than previous month ● 8% lower than previous month

● Year to Date 10% lower than the same period in 0910.

● Year to Date 5% higher than same period in 0910.

● Year to date v plan. 13% below plan. ● Year to date v plan is 3% above plan.

RD&E Activity Overview as at 28 February 2011 (YTD - Month 11)

1500

1700

1900

2100

2300

2500

2700

2900

3100

3300

3500

3700

3900

4100

4300

4500

4700

4900

5100

Apr

-08

Jun-

08

Aug

-08

Oct

-08

Dec

-08

Feb-

09

Apr

-09

Jun-

09

Aug

-09

Oct

-09

Dec

-09

Feb-

10

Apr

-10

Jun-

10

Aug

-10

Oct

-10

Dec

-10

Feb-

11

Day Case 1st FCEs

Plan Actual

0

500

1000

1500

2000

2500

3000

3500

Apr

-08

Jun-

08

Aug

-08

Oct

-08

Dec

-08

Feb-

09

Apr

-09

Jun-

09

Aug

-09

Oct

-09

Dec

-09

Feb-

10

Apr

-10

Jun-

10

Aug

-10

Oct

-10

Dec

-10

Feb-

11

Non-Elective IP 1st FCEs

Plan Actual

500

700

900

1100

1300

1500

1700

1900

2100

Apr

-08

Jun-

08

Aug

-08

Oct

-08

Dec

-08

Feb-

09

Apr

-09

Jun-

09

Aug

-09

Oct

-09

Dec

-09

Feb-

10

Apr

-10

Jun-

10

Aug

-10

Oct

-10

Dec

-10

Feb-

11

Elective IP 1st FCEs

Plan Actual

0

2000

4000

6000

8000

10000

12000

Apr

-08

Jun-

08

Aug

-08

Oct

-08

Dec

-08

Feb-

09

Apr

-09

Jun-

09

Aug

-09

Oct

-09

Dec

-09

Feb-

10

Apr

-10

Jun-

10

Aug

-10

Oct

-10

Dec

-10

Feb-

11

OP 1st Attendances

Plan Actual


Royal Devon & Exeter NHS Foundation Trust Prior YrActual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar-10

Income Statement Variance Plan Variance Variance Plan Variance ActualPeriod ending 28/02/2011 to Budget to Plan to Budget to PlanMonth 11 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000Income

NHS Clinical Income 262,537 260,319 2,218 1 260,235 2,301 287,331 285,819 1,512 1 285,812 1,519 1 271,558

Private patient income 955 1,083 (128) 1,059 (104) 1,061 1,189 (128) 1,164 (103) 1,205

Research and Development 11,947 11,690 257 11,451 496 13,188 12,763 425 12,492 696 12,319

Education and Training 12,898 12,898 0 17,539 (4,641) 14,095 14,180 (85) 19,103 (5,008) 19,443

Other income 31,446 31,347 99 32,429 (983) 34,411 34,163 248 35,429 (1,018) 31,083

Total income 319,783 317,337 2,446 322,713 (2,931) 350,086 348,114 1,972 354,000 (3,914) 335,608Expense

Employee Benefits Expenses (Pay) (185,298) (186,148) 850 2 (190,110) 4,812 (201,957) (202,754) 797 (207,348) 5,390 (189,132)

Drug Costs (25,235) (24,547) (688) 3 (24,576) (659) (27,775) (26,949) (826) 2 (26,954) (821) 2 (26,651)

Clinical Supplies (33,729) (33,426) (303) 4 (32,509) (1,220) (37,290) (36,834) (456) 3 (35,639) (1,651) 2 (35,650)

Non Clinical Supplies (3,985) (4,138) 153 (4,790) 805 (4,429) (4,547) 118 (5,225) 796 (4,477)

Research & Development Expenses (11,892) (11,722) (170) (11,644) (248) (12,931) (12,763) (168) (12,702) (229) (11,657)

Misc. Other Operating Expenses (29,951) (30,121) 170 (37,701) 7,750 (32,650) (32,453) (197) (41,123) 8,473 3 (38,822)

Reserves (6,340) (6,340) 0 0 (6,340) (6,775) (6,881) 106 0 (6,775) 0

Total Costs (296,430) (296,442) 12 (301,331) 4,901 (323,806) (323,181) (625) (328,990) 5,184 (306,389)

EBITDA 23,353 20,895 2,458 21,383 1,970 26,280 24,933 1,347 25,010 1,270 29,219

Profit / loss on asset disposals (111) 0 (111) 5 0 (111) (562) (443) (119) (443) (119) (114)Exceptional Income/ Costs & Impairments **

Total Depreciation (11,503) (11,626) 123 (11,626) 123 (12,645) (12,745) 100 (12,745) 100 (13,706)

Total operating surplus (deficit) 11,739 9,269 2,470 9,756 1,982 13,073 11,745 1,328 11,823 1,250 15,399

223 201 22 123 100 212 212 0 135 77 144

Total interest payable on Loans and leases (995) (976) (19) (981) (14) (1,064) (1,064) 0 (1,064) 0 (1,131)

PDC Dividend (6,715) (6,685) (30) (6,685) (30) (7,293) (7,293) 0 (7,293) 0 (7,577)

Net Surplus/(deficit) 4,252 1,809 2,443 2,214 2,038 4,928 3,600 1,328 3,600 1,327 6,835

YTD KEY MOVEMENTS FORECAST KEY MOVEMENTS

1 1

23 24 35 Loss on pre capitalisation expenditure relating mainly to the Emergency Hub

Main overspend relates to Medical and Surgical Items within Cardiology, Haemodialysis and Radiology Over spend is being seen mainly on activity related Medical and Surgical items witin Cardiology, Haemodialysis and Radiology

Year to Date Outturn

Total interest receivable/ (payable) - inc committed WC facilities

APPEN

DIX 3

Over-recovery is still being seen within Cancer Services, Critical Care and W&C Health. Under recovered areas include Medicine, Trauma & Orthopaedics and Surgery 1

Over-recovery is being seen within Cancer Services, Critical Care, W&C Health and Specialist Surgery. Under recovered areas include Medicine, Trauma & Orthopaedics and Surgery 1Underspent within nursing, technical staff, A&C and anciliary staff, overspending on Agency and Snr Med Staff

Aproximately £500k of this overspend relates to Drugs and Device items that are recharged on to the PCT Drug spend is predominatly due to items we can reclaim from the PCT.


Royal Devon & Exeter NHS Foundation Trust Prior YrActual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar-10

Statement of Financial Position Variance Plan Variance Variance Plan VariancePeriod ending 28/02/2011 to Budget to Plan to Budget to PlanMonth 11 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000Assets, Non-Current

Intangible Assets, Net 651 562 89 1 562 89 543 543 0 543 0 789

Property, Plant and Equipment, Net 232,269 238,932 (6,663) 1 238,932 (6,663) 245,780 251,483 (5,703) 251,483 (5,703) 231,737

Non NHS Trade Receivables, Non-Current 1,018 838 180 838 180 838 838 0 838 0 838

Assets, Non-Current, Total 233,938 240,332 (6,394) 240,332 (6,394) 247,161 252,864 (5,703) 252,864 (5,703) 233,364

Assets, Current Inventories 4,791 4,850 (59) 4,850 (59) 4,871 4,871 0 4,871 0 4,607

Trade and Other Receivables, Net, Current 13,300 13,310 (10) 2 13,714 (415) 14,503 13,156 1,347 13,156 1,347 13,116

Non Current Assets held for sale 0 500 (500) 3 500 (500) 0 500 (500) 500 (500) 6,000

Cash 61,507 47,139 14,368 4 47,139 14,368 47,025 43,365 3,660 43,365 3,660 41,498

Assets, Current, Total 79,598 65,799 13,798 66,204 13,393 66,399 61,892 4,507 61,892 4,507 65,221

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 (1,271)

Trade and Other Payables, Current (12,965) (9,582) (3,383) 5 (9,582) (3,384) (9,045) (10,069) 1,024 (10,069) 1,024 (10,555)

Deferred Income, Current (1,870) (4,667) 2,797 (4,667) 2,797 (1,500) (3,000) 1,500 (3,000) 1,500 (2,250)

Provisions, Current (115) (115) 0 (115) 0 (113) (113) 0 (113) 0 (130)

Current Tax Payables (4,373) (4,586) 213 (4,586) 213 (4,583) (4,583) 0 (4,583) 0 (4,048)

Other Financial Liabilities, Current (20,952) (16,563) (4,389) 5 (16,563) (4,389) (11,927) (11,927) 0 (11,927) 0 (11,668)

Liabilities, Current, Total (41,545) (36,783) (4,762) (36,783) (4,762) (28,439) (30,963) 2,524 (30,963) 2,524 (29,922)

NET CURRENT ASSETS (LIABILITIES) 38,053 29,017 9,036 29,421 8,632 37,960 30,929 7,031 30,929 7,031 35,299

TOTAL ASSETS LESS CURRENT LIABILITIES 271,991 269,348 2,643 269,753 2,238 285,121 283,793 1,328 283,793 1,328 268,663

Liabilities, Non-Current Loans, Non-Current, non-commercial (DH, FTFF, NLF, etc) (20,848) (20,847) (1) (20,847) (1) (20,212) (20,212) 0 (20,212) 0 (21,483)

Other Creditors, Non-Current (73) (23) (50) (23) (50) (13) (13) 0 (13) 0 (153)

Provisions, Non-Current (366) (296) (70) (296) (70) (296) (296) 0 (296) 0 (296)

TOTAL ASSETS EMPLOYED 250,704 248,182 2,522 248,586 2,117 264,599 263,272 1,328 263,272 1,328 246,731

TAX PAYERS' EQUITY

Public dividend capital 149,715 149,715 0 149,715 0 149,715 149,715 0 149,715 0 149,715

Retained Earnings (Accumulated Losses) 49,973 46,401 3,572 46,806 3,167 50,289 48,961 1,328 48,961 1,328 42,401

Revaluation Reserve 47,463 48,593 (1,130) 48,593 (1,130) 61,154 61,154 0 61,154 0 50,784

Donated Asset Reserve 3,553 3,473 80 3,473 80 3,441 3,441 0 3,441 0 3,831

TOTAL TAX PAYERS' EQUITY 250,704 248,182 2,522 248,586 2,117 264,599 263,272 1,328 263,272 1,328 246,731

OUTTURN KEY MOVEMENTS

1 Capital spend is £6.6m lower than plan, see appendix 6 for further details.2345


APPEN

DIX 4

Receivables are £0.3m lower than plan, percentage of trade debtors that exceed their due date by 90 days is 5.96%.Lower than plan due to proceeds received for Occ Health Building sale received earlier than plan.Cash is £14.4m higher than plan. Further information included within the Integrated Performance Report.The value is higher mainly due to deferred expenditure and capital creditors being higher than plan.


Royal Devon & Exeter NHS Foundation Trust Prior Yr

Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar-10

Cash Flow Statement Variance Plan Variance Variance Plan Variance

Period ending 28/02/2011 to Budget to Plan to Budget to Plan

Month 11 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 4,252 1,809 2,443 2,214 2,038 4,928 3,600 1,328 3,600 1,327 6,835

Non-cash flows in operating surplus/(deficit)Finance (income)/charges 772 775 (3) 858 (86) 852 852 0 929 (77) 987

Depreciation and amortisation 11,503 11,626 (123) 11,626 (123) 12,645 12,745 (100) 12,745 (100) 13,706

Impairment 0 0 0 0 0 443 443 0 443 0 0

PDC dividend expense 6,715 6,685 30 6,685 30 7,293 7,293 0 7,293 0 7,577

Other increases/(decreases) to reconcile to profit/(loss) from operations (170) (358) 188 (358) 188 (271) (390) 119 (390) 119 (155)

Non-cash flows in operating surplus/(deficit), Total 18,820 18,728 92 18,811 9 20,962 20,943 19 21,019 (57) 22,115

Increase/(Decrease) in working capital(Increase)/decrease in inventories (184) (243) 59 (243) 59 (264) (264) 0 (264) 0 84

(Increase)/decrease in NHS Trade Receivables (458) (386) (71) (791) 333 (2,159) (813) (1,347) (813) (1,347) 592

(Increase)/decrease in Non NHS Trade Receivables 756 203 553 203 553 318 318 0 318 0 188

(Increase)/decrease in other receivables 1,764 209 1,555 209 1,555 271 271 0 271 0 (44)

(Increase)/decrease in accrued income (599) (136) (463) (136) (463) (36) (36) 0 (36) 0 159

(Increase)/decrease in prepayments (1,647) (84) (1,563) (84) (1,563) 219 219 0 219 0 (152)

Increase/(decrease) in Deferred Income (excl. Donated Assets) (380) 2,417 (2,797) 2,417 (2,797) (750) 750 (1,500) 750 (1,500) 613

Increase/(decrease) in provisions 55 (15) 70 (15) 70 (17) (17) 0 (17) 0 9

Increase/(decrease) in Trade Creditors 2,558 (747) 3,305 (747) 3,305 (955) (955) 0 (955) 0 (1,062)

Increase/(decrease) in tax payable 325 538 (213) 538 (213) 535 535 0 535 0 348

Increase/(decrease) in Other Creditors 173 798 (625) 798 (625) 470 470 0 470 0 151

Increase/(decrease) in accruals 5,780 1,419 4,361 1,419 4,361 259 259 0 259 0 2,813

Increase/(Decrease) in workling capital, Total 8,144 3,972 4,171 3,568 4,576 (2,109) 737 (2,847) 737 (2,847) 3,699

Net cash inflow/(outflow() from investing activitiesProperty, plant and equipment - replacement (3,430) (7,594) 4,164 (7,594) 4,164 (7,768) (8,278) 510 (8,278) 510 (5,441)

Property, plant and equipment - new build & enhancement (8,585) (11,000) 2,415 (11,000) 2,415 (6,548) (11,722) 5,174 (11,722) 5,174 (12,682)

Proceeds on disposal of property, plant and equipment 6,008 5,500 508 5,500 508 6,642 6,142 500 6,142 500 86

Increase/(decrease) in Capital Creditors (321) (1,024) 703 (1,024) 703 (1,024) 0 (1,024) 0 (1,024) (1,556)

Net cash inflow/(outflow() from investing activities, Total (6,328) (14,119) 7,791 (14,119) 7,791 (8,698) (13,858) 5,160 (13,858) 5,160 (19,593)

Net cash inflow/(outflow) from financing activitiesPDC Dividends paid (3,655) (3,646) (9) (3,647) (9) (7,293) (7,293) 0 (7,293) 0 (7,861)

PDC Dividend Received 0 0 0 0 0 0 0 0 0 0 396

Interest (paid) on commercial loans (551) (539) (12) (544) (7) (1,064) (1,064) 0 (1,064) 0 (1,131)

Interest received on cash and cash equivalents 223 201 22 123 100 212 212 0 135 77 144

Repayment of non-commercial loans (635) (636) 1 (636) 1 (1,271) (1,271) 0 (1,271) 0 (1,270)

(Increase)/decrease in non-current receivables (180) 0 (180) 0 (180) 0 0 0 0 0 (28)

Increase/(decrease) in non-current payables (80) (130) 50 (130) 50 (140) (140) 0 (140) 0 (167)

Net cash inflow/(outflow) from financing activities, Total (4,878) (4,749) (129) (4,832) (46) (9,555) (9,555) 0 (9,633) 77 (9,917)

Net increase/(decrease) in cash and cash equivalents 20,009 5,641 14,368 5,641 14,368 5,527 1,867 3,660 1,867 3,660 3,139

Opening cash and cash equivalents 41,498 41,498 0 41,498 0 41,498 41,498 0 41,498 0 38,359

Closing cash and cash equivalents 61,507 47,139 14,368 47,139 14,368 47,025 43,365 3,660 43,365 3,660 41,498


APPEN

DIX 5


Royal Devon and Exeter NHS Foundation Trust

Capital expenditure

Period ending 28/02/11

Month 11 Column B Column C Column D Column E Column F Column G Column H

YTD planned expenditure per

annual planYTD actual

expenditure

YTD variance slippage /

(overspend)

Forecast future capital

expenditure for the year

Forecast total capital

expenditure for the year

Full year expenditure per

annual plan

10/11 forecast slippage /

(overspend)

Expenditure approved by the

Exec Group

Total expenditure

forecast for the scheme

Scheme variance under

spend / (overspend)

( B - C) (C + E) (G - F)£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

1,240 172 1,068 63 235 1,500 1,265 8,700 8,700 - 31-Aug-13

240 36 204 - 36 300 264 5,300 5,300 - 31-Mar-13

1,372 838 534 224 1,062 1,536 474 6,200 6,045 155 31-Mar-13

75 27 48 48 75 100 25 3,900 3,900 - 31-Mar-13

1,026 909 117 - 909 1,026 117 3,370 2,426 944 Occupied

1,001 1,427 ( 425) 15 1,441 1,001 ( 440) 2,803 3,180 ( 377) 31-Mar-11

182 96 86 44 140 182 42 2,370 1,923 447 Occupied

1,771 971 799 361 1,332 2,012 680 2,207 2,193 14 31-Jan-12

137 95 42 - 95 137 42 1,805 1,603 202 31-Mar-11

1,333 1,036 297 80 1,116 1,333 217 1,366 1,219 147 30-Apr-11

43 ( 12) 55 10 ( 2) 43 45 1,357 1,212 145 31-Mar-11

800 - 800 - - 961 961 1,267 1,267 - 31-Oct-11

441 479 ( 38) 4 483 441 ( 42) 1,248 1,290 ( 42) Occupied

139 58 81 32 89 139 49 1,165 983 182 Occupied

50 39 12 - 39 50 12 756 635 121 Complete

34 18 16 - 18 34 16 727 708 20 Complete

620 620 - - 620 620 - 620 620 - Complete

375 60 315 715 775 500 ( 275) 925 925 - 31-Mar-11

7,714 5,148 2,566 674 5,822 8,083 2,261

18,595 12,016 6,579 2,269 14,285 20,000 5,715

Planned capital schemes included within other schemes that have slipped Approved capital expenditure is subject to approval of FBC for the following schemes: to date by > £25k - Fracture clinic and rationalisation of PEOC and J0

- Research, Innovation and Learning Development2x Phaco machines 001347 & 001437 + Handpieces 194 Dicker House conversion 186 REPLACEMENT OF CCTV SYSTEM (Wonford site) 150 OBC approved for the following schemes:Laundry Asbestos And Tumble Dryer Gantry Work 129 - Rebuild CIVAS unit and equip - up to a value of £8.7 million2010/11 Technology Refresh 123 Decommissioning & disposal of part of H/Tree Hospital 118 Data Support (Mobile Devices) 97 Residential accommodation - review CWS tank 80 IT support for right patient, right blood 75 CARD EP Workmate replacement 60 3 non invasive ventilators 60 Washer Disinfector HAMO 2 53 Washer Disinfector HAMO 3 53 Washer Disinfector HAMO 4 53 Washer Disinfector HAMO 1 52 Other schemes >25k slippage 502

1,984

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.

Schemes over £500K in progress or planned

Scheme

Rebuild CIVAS unit and equip.

Fracture clinic and rationalisation of PEOC and J0

Increasing Radiotherapy Capacity(3rd LINACC)

Research, Innovation and Learning development

South Devon Satellite Kidney Unit

Pain Management (Inc. Physio)

Renal Heavitree

Order Comms and e-prescribing IT systems

Refurb 2 Heavitree Inpatient Theatres

Procurement of Third CT Scanner

Specialist Procedure' X-Ray equipment

Lab. Info. Management Sys.

Nursery expansion

Main Entrance/Concourse Area

DR Mammography

APPEN

DIX 6

Dermatology/Lymphodema - Heavitree

Integrated Minimal Access Theatre Wonford

Energy Centre - Replace main air conditioning

Other schemes < £500K and contingency


Royal Devon & Exeter NHS Foundation Trust

Forecast Surplus / (Deficit) by Directorate28/02/201111

Actual Income/Expense

Cancer Services

Critical Care Diagnostics Medicine

Orthopaedics

Prof Serv

Spec Surgery

Surgery 1

Women & CH Facilities Non Dir Depreciation Interest

Trust Totals

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Trust Income OT3can CRCare DIAgcd MEDicd ORThcd PROfsu SPEscd SUR1cd WOChcd OT1FACPatient Income 24,868 9,462 9,761 89,268 35,783 11,215 28,650 31,141 44,158 - 3,070 0 0 287,375RTA Income - - - - - 39 15 - - - 963 1,017Education Income 449 1,036 650 3,856 620 230 895 1,089 1,505 52 3,713 14,095R&D Income - - - - - - - - - - 12,157 12,157Commercial Income 1,731 463 3,613 2,241 472 2,589 685 478 2,464 6,703 14,004 0 0 35,442

Total Operating Income 27,047 10,961 14,024 95,365 36,875 14,072 30,246 32,708 48,127 6,755 33,907 0 0 350,086

Pay 8,720 20,705 16,384 46,226 12,385 12,001 11,916 11,170 26,466 12,928 26,905 205,804Drugs 7,544 940 3,043 7,154 2,489 2,356 2,445 695 1,044 - 71 27,781Clinical Supplies 607 5,203 6,640 7,921 5,751 7,792 1,214 594 1,362 143 175 37,400Non-clinical supplies 36 448 34 385 190 44 118 54 166 2,606 350 4,432Other Non-Pay 205 1,232 996 1,639 238 889 443 150 2,746 1,716 31,363 41,615Reserves 134 20 3 1 22 2 0- 44- 111 - 6,527 6,776Depreciation 12645 12,645

Recharges to Other Dir 977- 21,566- 14,561- 2,790- 1,849- 12,012- 913- 1,368- 1,002- 10,842- 39,093- 13,144- 8,324- -128,441Recharges from Other Dir 11,653 2,391 3,341 36,325 17,584 4,477 15,100 19,856 17,714 - 1- 0 0 128,440

Total Operating Expenditure 27,921 9,374 15,880 96,860 36,809 15,549 30,321 31,106 48,607 6,550 26,297 -499 -8,324 336,451

Total Operating Surplus -873 1,587 -1,857 -1,495 66 -1,477 -76 1,602 -480 205 7,610 499 8,324 13,635

Net Gain / (loss) on disposal of asset 0Impairment -562 -562Interest receivable 212 212Interest payable 1,064- -1,064Dividends on PDC 7,293- -7,293

Retained Surplus / (Deficit) for period -873 1,587 -1,857 -1,495 66 -1,477 -76 1,602 -480 205 7,610 -63 179 4,928

APPEN

DIX 7

Period endingMonth


Royal Devon & Exeter NHSFoundation Trust Actual Plan Variance Actual Plan Variance Actual Plan Variance Forecast

to Budget (target) to Budget to BudgetCost Improvement Programme Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

Period ending 28/02/2011Month 11 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Directorate

OT3Cancer Services 452 679 (227) 496 760 (264) 504 (256) 528 760 (232) 708CRCCritical Care 557 577 (20) 594 650 (56) 594 (56) 492 650 (158) 491DIAGDiagnostics 735 730 5 797 797 0 797 0 752 797 (45) 797OT1Facilities 277 211 66 295 231 64 295 64 190 231 (41) 231MEDMedicine 2,039 3,799 (1,760) 2,204 4,252 (2,048) 2,204 (2,048) 1,762 4,252 (2,490) 1,762OT1Non Dir 955 1,503 (548) 1,039 882 157 1,037 155 886 882 4 898ORTOrthopaedics 1,205 1,476 (271) 1,334 1,648 (314) 1,334 (314) 1,599 1,648 (49) 1,650PROProfessional Services 256 255 1 280 278 2 278 0 278 278 0 278SPESpecialist Surgery 661 1,245 (584) 754 1,375 (621) 754 (621) 747 1,375 (628) 781SURSurgery 1 498 1,102 (604) 622 1,271 (649) 666 (605) 854 1,271 (417) 930WOWomen & Childs' Health 964 1,600 (636) 1,047 1,800 (753) 1,044 (756) 1,189 1,800 (611) 1,160

Trustwide Schemes 7,405 2,915 4,490 8,296 4,315 3,981 8,329 4,014 4,780 4,315 465 7,996

16,004 16,092 (88) 17,758 18,259 (501) 17,836 (423) 14,057 18,259 (4,202) 17,682

APPEN

DIX 8

Year to Date - Achieved Current Year - Achieved Current Year - Forecast Full Year - AchievedForecast CY Forecast

Variance Fav / (Adv)

264

560

(64)

2,048

(4,138)

314(2)

621 649 753

(32)

102

45

105

442

3,669

(265)2

70

(142)

528

492 752 190

1,762

5,666 1,599 278

747854

1,189

-40%

-20%

0%

20%

40%

60%

80%

100%

Cancer Services Critical Care Diagnostics Facilities Medicine Non Dir Orthopaedics Professional Services

Specialist Surgery Surgery 1 Women & Childs' Health

Ach

ieve

men

t

Directorate

CIP Achievement Current Year

Recurrent

Non-Recurrent

To be Achieved


MONITOR PROPOSED FURTHER INDICATORS FOR FRR - COMPLIANCE FRAMEWORK CONSULTATION

Proposed indicator Potential financial weakness Criteria to measure against 31/03/2010

Unplanned decrease in EBITDA margin in two consecutive quarters Deteriorating trend in operating performance and cashflow generation Variance to planned EBITDA margin 98.09% NO 141.84% NO 108.25% N0 106.97% N0 106.75% N0 109.21%

Quarterly self-certification by trust that FRR may be less than 3 in the next 12 months

Identified risk of potential financial breach within the next year

Forecast financial risk rating for the next 12 months NO 3+ NO 3+ NO 3+ NO 3+ NO 3+

FRR 2 for any one quarter In year deterioration in financial performance Current period Financial Risk Rating NO 4 NO 4 NO 4 NO 3 NO 3

Debtors more than 90 days past due account for more than 5% of total debtor balances

Potential for payment / debtor collection concerns

% of Debtors more than 90 days past due account NO 4.77% NO 3.44% YES 7.77% NO 4.62% YES 5.96%

Creditors more than 90 days past due account for more than 5% of total creditor balances

Potential for build up in creditors, resulting in future liquidity concerns

% of Creditors more than 90 days past due account NO 0.08% NO 0.00% NO 0.00% NO 0.03% NO 0.00%

2Capital expenditure is less than 75% of plan for the year to date Capital expenditure plans are

delayed to conserve cash Capital expenditure variance to plan NO 75.27% NO 77.73% YES 67.09% YES 65.35% YES 64.62%Quarter end cash balance less than 10 days of operating expenses Potential liquidity concerns and

ability to meet liabilities as they fall due Liquidity days at period end NO 42.54 NO 39.40 NO 58.67 NO 74.52 NO 69.42

1

Working capital facility (WCF) agreement includes default clause. This will require all trusts to review their WCF agreements.

Risk that WCF, whilst included in calculation of liquidity days for the purpose of FRR, may not be available if and when required (eg: FRR 1 or 2). Review of WCF YES Yes NO NO NO No NO NO NO No

Interim Finance Director in place over more than one quarter end Absence of permanent / substantive appointment to key position NO NO NO NO NO NO NO NO NO NO

Two or more changes in Finance Director in a twelve month period Multiple changes in a short period of lead financial officer NO NO NO NO NO NO NO NO NO NO

Notes / Explanations

1

2

APPEN

DIX 9

30/06/2010 30/09/2010 31/12/2010 31/01/2011 28/02/2011

Included with the Q2 Monitor return is additional guidance on this indicator. Monitor has produced a schedule of typical clauses that do not require disclosure. Foundation Trusts only need to disclose a default clause if they do not consider it to be included in the schedule. We have reviewed our Working capital default clauses and consider that they are all included, and therefore no longer need to make any disclosure against this indicator.

If Capital expenditure is less than 75% of plan at a Quarter end it is likely that Monitor will require an explaination, and a potential reforecast of capital


Data Appendices – Quality

Green

Outcome - Pressure Sores Outcome - MUST Score

RDE

Process - Pressure Sores Assessment Process - MUST Score Process - Hand HygieneGeneral (Red) Amber

GreenAmber

Initial (Red)

Outcome - New MRSA Isolates Identified > 72 Hours After Admission

Compliance data collated from electronic whiteboard assessment. Target of 90% has been consistently achieved.

Compliance data collated from electronic whiteboard assessment . Target set at 80%. Current compliance may reflect recent introduction of electronic monitoring process.

Compliance measured via monthly audit. Target of 85% achieved. This year we will focus on audit of medical staff compliance with hand hygiene.

Target = < 0.8% incidence of grade 2 and above pressure sores. Target consistently met. Currently refining the monitoring and reporting of incidents to ensure prompt referral and management

MUST score derived from height and weight data plus risk factors. We are currently working to identify the most accurate indicator of patient nutrition status at discharge which could be weight static, gained or lost.

Monitoring MRSA isolates in addition to bacteraemia enables tracking of carriage and colonisation. Incidence of new MRSA isolates is consitently low.

0

10

20

30

40

50

60

70

80

90

100

Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11

0

10

20

30

40

50

60

70

80

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-10 Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Initial compliance with MUST Screening on Admission

General compliance with MUST Screening at Weekly Review

0

10

20

30

40

50

60

70

80

90

100


0%

10%


0

1

2

3

4

5


RDE Average +1 sd

Indicator to be developed


No threashold

No threshold No threshold

Housekeeping (Green) Equipment (Green)

RDE

Process - Housekeeping & Equipment Cleaning Process - Falls Risk Assessment Process - EWS Calls

Compliance data derived from monthly audit. Target of 95% compliance consistently achieved.

Currently establishing electronic process for monitoring falls risk assessment. Monthly spot check of falls risk assessment compliance will be undertaken.

Expectation for the number of early warning score calls to increase as the medical emergency team rapid response process is implemented Trust wide

Implementation of the 'Intentional Rounding' project should result in a reduction in the total number of falls.

Expectation is that the number of cardiac arrest calls reduce as EWS calls increase. However, factors such as periodic activity surges, increased patient complexity and dependence will influence the number of arrest calls.

Outcome - C.Difficile Infections Identified > 72 Hours After Admission Outcome - Inpatient Slips, Trips & Falls Outcome - Cardiac Arrest CallsGreen

0

2

4

6

8

10

12

14


RDE Average +1 sd

80

82

84

86

88

90

92

94

96

98

100


Housekeeping Equipment

Percentage Compliance with Falls Risk Assessment by month to follow when

data becomes available

0

5

10

15

20

25

30


0

20

40

60

80

100

120

140

160

180


RDE Average +1 sd

0

5

10

15

20

25

30

35

40



RDE

Process - Electronic VTE Risk Assessment Process - Estimated Date of Discharge Process - Bank & Agency Staff UsageNo thresholdRed Green

Outcome - Thromboprophylaxis Audit Outcome - Estimated Date of Discharge met Outcome - Incidents & Complaints/Concerns

Target = 90%. Compliance rate reflects the recent introduction of the electronic whiteboard monitoring system. An agreement with the PCT is that monthly spot audits will be undertaken whilst the data capture issues are addressed. Nov and Dec spot audit data = 68.5% and 71% respectively.

Compliance data collated from electronic whiteboard assessment. Target of 75% has been consistently achieved.

Monitored via monthly Rosterpro report.

No Threshold

With the introduction of EPS we will be able to undertake real time audit of Thromboprophlaxis prescriptions.

An improvement trajectory will be considered alongside exception reporting.

Monitored through complaints and incident reporting process.

No Threshold

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Jul-10 Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11 71

72

73

74

75

76

77

78

79

80


0

20

40

60

80

100

120


Bank Assigned Agency Assigned

Indicator to be developed

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


0

50

100

150

200

250

300


Complaints/Concerns Incidents

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