nuh 1333 (a)

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Trust Board Integrated Performance Report

6th May 2010

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NUH at a Glance

Legend / key

Forecasts

Shows whether next month’s position will meet the standard

R GA

Data Quality indicator

Timeliness

Source

Completeness

Granularity

Validation

Audit

Judgment of Executive DirectorNot sufficient

Sufficient

Exemplary

Not yet assessed

A&E 4 hour wait target 98% March 99.0% 97% Patients recommend NUH (%) N/A to come

Access to'GUM' within 48 hours 98% March 100.0% N/A Complaint resp. times (Dec, %) 90% Dec 09 89%

2 week referral to appointment RACP 96% March 100.0% 99.8% Patient complaints 0.06% March 0.1%Succesful Choose and Book 96% March 91% 91% Same sex compliance Complete Complete

18 weeks referral to treatment - admitted 90% March 92.8% N/A STAFF EXPERIENCE

18 weeks referral to treatment - non-admitted 95% March 98.4% N/A Appraisal rate 70% March 89% N/A

# clinical specialties not achieving 18 week target 0 March 3 N/A Sickness rate 3% March 4.09% N/A

% spending >90% of their stay on a stroke unit 60% Q4 70% 77% WTE (actual versus plan) tbc March

Delayed transfers as a % of admissions 3.5% March 1.1% 0.9% Vacancy rate na March 4.81% N/APrimary Angioplasty within 150 mins 75% March 63% N/A Attendance at compulsory training 75%

Thrombolysis within 60 mins 68% March 71% N/A VALUE FOR MONEY

28 days readmission breaches 5% March 9.4% 7.8% Monitor Risk Rating 4

Last minute non-clinical cancelled ops(elective) 0.80% March 1.5% 1.60% EBITDA margin 5%

2 week GP referral to 1st outpatient appointment 93% Feb 97.3% 94.6% EBITDA achieved 85% of plan

31 day diagnosis to treatment 96% Feb 98.5% 98.0% Return on Assets (%) 5%

31 day second or subsequent treatment (drug) 98% Feb 100.0% 98.3% I&E Surplus margin 1%

31 day second or subsequent treatment (surgery) 94% Feb 100.0% 96.4% Liquidity ratio (days) 15 days

62 days urgent referral to treatment 85% Feb 86.7% 80.5% Total income (actual versus plan)within 0.5% of

plan

62 day referral to treatment from screening 85% Feb 93.5% 94.1% Pay Expenditure (actual versus plan) At or below plan

62 day referral to treatment from hospital specialist 85% Feb 100.0% 86.2% Non pay Expenditure (actual versus plan)At or below plan

Urgent referals for breast symptoms 93% Feb 99.2% 97.9% CIP (actual versus plan) At or above plan

Hospital standardised mortality ratio (all diagnoses) 100 Jan 97.1 91.7 Capex (actual versus plan)within 0.5% of

plan

HSMR - basket of 56 diagnosis groups tbc Jan 98.2 92.0 Theatre usage (%) 80% March 72% 71%

Number of patient slips, trips, falls and incidents tbc Jan 0.65% N/A Bed occupancy tbc March 90.1%

Clostridium difficile (NUH acquired) tbc March 24 191 ALOS (Elective) tbc March 3.46

MRSA (Number of cases NUH acquired) 1 March 2 21 ALOS (Non elective) tbc March 4.74

Screening all elective in-patients for MRSA 90% Feb 94.0% N/A ALOS (Elective pre op bed nights) tbc to come

Number of SUI's 0 March 1 Agency spend (% of pay) 1%

Number of emergency readmissions within 28 days tbc to come

Diagnostic waiters, 6 weeks and over-QDIAG 0 March 2 422 NHS Performance Framework March Performing

Diagnostic waiters, 6 weeks and over-DM01 0 March 0 53 CQC Indicators Under Development% coding completeness within 5 days 90% March 95.0% N/A CQUIN Under DevelopmentEthnic coding of inpatients 85% March 92.0% N/A

Forecast next

monthStandard Month Actual

YTD (April-March)

Forecast next

month

Current data

monthMonth Actual

Data QualityCLINICAL OUTCOMES

Access

PATIENT EXPERIENCE

Last Period Actual

YTD (April-March)Standard

Efficiency and Utilisation

Perspectives

Data Quality

Other

FinanceCancelled Ops

Cancer targets

Patient Safety

Overall

Workforce

A

G

G

G

G

G

G

G

G

G

G

A

AA

G

1

VALUE FOR MONEY

Monitor Risk Rating 4 3 3EBITDA margin 5% 5.2% 6.5%

EBITDA achieved 85% of plan 84.2% 86.5%

Return on Assets (%) 5% 5.0% 5.0%

I&E Surplus margin 1% 1.3% 1.0%

Liquidity ratio (days) 15 days 1 1

Total income (actual versus plan)within 0.5% of

plan 6.2% 1.8%

Pay Expenditure (actual versus plan) At or below plan 2.7% 0.1%

Non pay Expenditure (actual versus plan) At or below plan 17.80% 9.10%CIP (actual versus plan) At or above plan 16.3% 0.0%Capex (actual versus plan)

within 0.5% of plan 37.1% (6.7%)

Theatre usage (%) 80.0% March 72.0% 71.0%

Bed occupancy tbc March 90.1%

ALOS (Elective) tbc March 3.46

ALOS (Non elective) tbc March 4.74

ALOS (Elective pre op bed nights) tbc to come

Agency spend (% of pay) 1% 3.6% 3.4%

Finance

Efficiency and Utilisation

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Escalation pages (1/4)

Michelle Rhodes

Successful Choose and Book appointments

▪ General reduction across services of slots availability over the Easter bank holiday period.

▪ Ophthalmology – impact of significant increase in referrals following the change in Royal College referral guidance.

▪ Ophthalmology - A referral refinement pathway for NHS Nottingham City went live on 4th Jan and NHS Notts County referral pathway will live by 30th April 2010. A triage service went live from March for Nottingham City PCT – limited success made date.

▪ ENT: Shortage of specialised staff. New staff due to commence in post over period of the next 2 months.

▪ Work continues with PCTs to redirect appropriate referrals into the appropriate community based service. Referral criteria are agreed and the pathways for the Nottingham Back Care Team, Pain Management and Spinal Service have now also been agreed. Michelle Rhodes

What actions have we taken to improve performance?What is driving the reported underperformance?

96% 91% 91%

• Bed and theatre capacity

Standard YTD Forecast

5% 9.4% 7.8%

▪ Weekly reviews of reasons for cancelled operations is highlighting any emerging trends. This is enabling appropriate actions to be taken, for example reviews of theatre scheduling

Indicator level 1

Lead Director

Expected date to meet standard

% of successful Choose and Book referrals to appointments booked via the Telephone Appointment Line, over number of TAL slots A


% patients whose operation was cancelled, by the hospital, for non-clinical reasons, on the day of or after admission, treated within 28 days

Standard March YTD Forecast

Lead Director


Breaches of the 28 day readmissions guarantee Indicator level 1 March

September 2010

July 2010

A

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Escalation pages (2/4) Screening all day case patients for MRSA

▪ Certain areas continue to develop systems and practices to allow screening of all day cases

▪ Due to screening and clinical coding data there is a two month gap which may not reflect improvement made until later data is released

▪ Underperforming areas identified and being performance managed via the Infection Control Operational Group

▪ Clinical Leads have developed Action plans to ensure greater compliance in future months

Stephen Fowlie


90% 75% N/A

▪ This does not become a reportable national target until 31st December 2010

▪ Currently NUH screens all emergency patients admitted to surgical wards. At present there is not the lab capacity to process the increased swabs to extend to other clinical inpatient areas


90% 58% N/A

▪ Work is being undertaken to ensure that the lab capacity is in place. Once completed clinical areas will be asked to commence screening all emergency admissions

Indicator level 2

Lead Director Stephen Fowlie


Screening of all day case patients for MRSA; exclusions currently includes Children, Radiology, ophthalmic, Routine Obstetrics, Termination of Pregnancies, Pain management, Endoscopy, Minor Dermatology


Screening of all relevant emergency admissions for MRSA 'Relevant emergency admissions' is currently defined as excluding all children


Lead Director


Screening all emergency patients for MRSA Indicator level 2 March

June 2010

December 2010

A

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Escalation pages (3/4) Diagnostic waiters (number waiting 6 weeks and over) - as reported in QDIAG

▪ Visual electo diagnostic - Ophthalmic Science - Delayed referral due to Admin error

▪ Nerve conduction test - Neurophysiology. Delayed referral received from Kings Mill

▪ Admin and process procedures reviewed and amended to avoid any recurrence

▪ Issue has been taken forward with Kings Mill for them to ensure systems are reviewed and revised

Michelle Rhodes


0 2 N/A


Indicator level 1

# patients waiting over 6 weeks for diagnostic procedures in endoscopy, imaging, pathology and physiological measurement


Lead Director


Primary Angioplasty within 150 mins Indicator level 1 March

April 2010

Lead Director Michelle Rhodes


September 2010

▪ This is a jointly owned target with EMAS and the long delays for March have been experienced in the call to door times not door to perfusion

▪ We will be operating a 24 hour service in September before which we are planning to work with colleagues at a 'productive cath lab‘

▪ A project manager has been appointed to start in May. ▪ We will instigate regular performance meetings with our

colleagues from EMAS as we plan to move towards full operational 24/7.

▪ We also need to ensure that the data capture is accurate and in line with MINAP guidelines, we have put in an audit officer for PPCI within the business case to ensure the accuracy of data being used for this indicator


75% 63% N/APatients receiving Primary Angioplasty within 150 mins A

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Escalation pages (4/4) Patient complaints responded to within agreed time

▪ Matrons and Clinical Leads have been supporting the increased operational activity during the winter months, which has led to challenges in delivering timely responses

▪ During this period the Complaints Lead has provided addition support by reviewing and editing response letters for those directorates where timelines have been more difficult to achieve

Jenny Leggott


90% 89%

Indicator level 1

% patient complaints responded to within agreed timescale


Lead Director


June 2010

% theatre usage over past month

▪ Session utilisation (due to cancelled list)

▪ In session utilisation ▪ Theatre closure

▪ Productive elective specialty (Better for you)▪ Performance management framework▪ Cancellation fees

Michelle Rhodes


80% 72%

Indicator level 1

Specialty Usage of Session Time


Lead Director


Incremental as Better for You rolls out

71% A

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The In-Depth Review: Cancelled ops

SOURCE: ORMIS, PAS, HISS, Information team

Cancelled ops

1

2

2

3

3

5

7

11

12

18

63

1

3

10

4

6

3

4

7

10

14

59

Signed off by: Expected date to meet standard:

Plan for next Board report:

Reasons for Cancellations Number

Cancellations TrendNumber per month

128

174

141122

98119124

94102 121

1218

55974410141280

50

100

150

200

MarMay NovJul JanMar Sep

102

65

Number of cancellations

Number of 28 Day breaches

38

Cancellations by Directorate % per directorate in Mar 10

% of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or on the day of operation

Agreed corrective actions (planned and commenced)Issues causing underperformance

▪ Revised processes and procedures to be followed have been finalised with directorates

▪ Weekly PLT meeting set up to look at reasons for cancellations

▪ Directorate level trajectories have been set up

▪ Performance management framework in place

▪ Cancellations in March were due largely due to lack of ward beds available due to D&V virus City Campus (Lister ward) and at QMC (D8), in addition to Operating list over runs. Scheduling of Operating lists being reviewed to ensure effective utilisation of lists by Directorates

RedLatest performance

YTD ForecastIndicator level

Amber Green

Ward Bed Unavailable

Emergencies/Trauma

Surgeon Unavailable

Other

Equipment Failure/Unavailable

Medical/Anaesthetist/Theatre staff unavailable

Replaced By Urgent Case

Theatre Time Unavailable

No ICU/HDU Beds

List Overrun

Complications Previous Patient

14%

6%

1%

6%

10%

12%

51%

Michelle Rhodes 0.8% in month for Dec 10 – Mar 11

July 2010>1.5% 1.53% 1.6% Amber10.8% - 1.5%

<0.8%

Cancer and associated specialities

Musculo-skeletaland neuro-sciences

Diagnostics and clinical support

Thoracic and digestive diseases

Family health

Diabetic, infection, renal and cardiovascular

Head and neck

20102009

Feb 10

Mar 10

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0 20 40 60 80

Spines

Trauma and Ortho

Neurosurgery

Maxillo Facial

Neurosurgery

Maxillo Facial

Spines

Trauma and Ortho

Ad

mitt

edN

on

adm

itted

Capacity

Patient choice

Hospital cancellation

Diagnostic delay

Complex case

Non in patients best interest

Medically unfit

Process delays

late tertiary referral

Patient non cooperation

Admin error

Other

The In-Depth Review: 18 week

Number of treatment functions which are failing the 18 week admitted or non-admitted targets



The number specialties with <85% of eligible admitted patients whose adjusted RTT clock stopped in 18 weeks or less (<127 days) or <90% of eligible non-admitted patients whose RTT clock stopped in 18 weeks or less (<127 days)

Michelle Rhodes September 2010 July 2010



Amber Green

1 3 N/A Red1 N/A 0

Bed and theatre capacity Funding approved to open 6 bedsAdditional spinal theatre capacity

Imminent appointment of locum neurosurgeon. Use of private sectorAdditional capacity

Reduction in day case proceduresCancer surgery has been extremely active in the first quarter

All daycase beds now open Additional consultant capacity

Ward closure due to D&V virus Consultant sickness leave

Patients moved out to the private sectorBeds opened on a temporary basis to allow more electives admissionsReview of administration services within the specialty


Spines

Neuro-surgery

Maxillo Facial

Trauma and Ortho

Admitted: Spines

Admitted: Trauma and OrthoAdmitted: Neurosurgery

Admitted Maxillo Facial

Non admitted: Neurosurgery

StandardMonthActual # Treated Breaches

90% 74.9% 203 51

90% 84.0% 463 74

90% 79.2% 48 10

90% 81.0% 84 16

95% 82.6% 69 12

Bed and theatre capacity

Non admitted: Spines 95% 91% 267 24

Non admitted: Trauma and Ortho

95% 94.1% 236 14

Non admitted: Maxillo Facial

95% 92.6% 444 33

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The In-Depth Review: Sickness Rate

Sickness Rate



Danny Mortimer March 2011 Monthly



Amber Green

3.5% 4.09% N/A Red1 3-3.5% 3.0%

•The Trust has made significant progress with reducing sickness absence, with an underlying downward trend.

•Directorates continue to work towards the challenging Trust target of 3% sickness by March 2011

•Robust sickness management policy in place

•Closer scrutiny on 2 areas reporting highest sickness

•Ongoing monitoring of all sickness absence Trust-wide

•Further escalation methods being considered


Sickness Rate per Directorate % Mar-10Sickness Rate %

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62 days urgent referral to treatment of all cancers

▪ Specialties produce a Root Cause Analysis report to understand the cause of their breaches. This is presented at the weekly Cancer PTL meeting.

▪ There is Directorate Management representation at the Cancer PTL, with Directorates feeding back on patients. This has improved the lines of communication and accountability.

▪ A red alert system for cancer diagnostic referral requests has been implemented both at NUH and Treatment Centre with a maximum 5 days turnaround time for tests.

▪ The majority of Patient Navigators are now working within the specialty areas, which has improved clinical engagement as well as identifying where potential problems exist with the patient’s pathway.

▪ Patient pathways for each tumour site have been reviewed and bottle necks identified. The new pathway are currently being agreed and signed off by the Clinical Leads.

▪ A daily PTL has been developed with all 62 day patients from day 1 of entering the pathway. Specialties have received training on how to use and access this report.

Actions taken and lessons learnt

% of patients receiving first definitive treatment within 62-days following referral from an NHS Cancer Screening Service during a given period

Projected Improvement Trackers

YTD 80.5%

Standard

Month escalated

Latest period

Performance when escalated

85%

May 09

86.7%

77.9%


YTD 97%

A&E 4 hour wait target

▪ Implemented actions from national emergency care intensive support review

▪ Additional senior mangers support to patient flow process

▪ Additional clinical start in ED and admission wards

▪ Development programme for advance nurse practitioners

▪ Additional winter beds

Actions taken and lessons learnt

Standard

Month escalated

Latest period

Performance when escalated

98%

Aug 09

99%

97%

% of patients spending four hours or less in all types of A&E department, until discharge/ admission/ transfer


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Appendix 1: NHS Performance Framework Indicators 2009/2010

Standards and targets:SOURCE: NHS Performance Framework Implementation Guidance (Annex 1: Operation Standards and targets indicators acute trusts - June 2009)

YTD - Year to Date, MA - Monthly Actual

Weight IndicatorCURRENT

DATA MONTH

Performance ScoreWeighted

scoreAchieve Fail

1.00 A&E Type 1 & 2 (Trust) waiting time (% within 4 hours from arrival to discharge/ admission/ transfer) Mar YTD 97% 2 2.0 98% 97%

1.00 Breaches of 28 days readmission guarantee as % of cancelled ops Mar YTD 7.8% 2 2.0 5% 15%

1.00 MRSA (Number of cases) Mar YTD 21 3 3.0 45.0 46.0

1.00 Clostridium difficile (number of cases - NUH Acquired) Mar YTD 191 3 3.0 240.0 241.0

1.00 18 weeks referral to treatment time - admitted Mar MA 92.8% 3 3.0 90% 85%

1.00 18 weeks referral to treatment time - non-admitted Mar MA 98.4% 3 3.0 95% 90%

0.50 18 weeks RTT - Number of specialties not achieving 18 week standards (excluding Orthopaedics/ including DA Audiology)*

Mar MA 3 3 1.5 5 9

0.50 Non-achievement of 18 week referral to treatment standards in Orthopaedics Mar MA 2 0 0.0 0 1

1.00 Breaches of 3 month wait target for revascularisation (as % of admissions for revascularisation) Mar YTD 0% 3 3.0 0.10% 0.20%

1.00 % of patients meeting 2 week target (referral to appointment): Rapid Access Chest Pain Clinic (RACP) Mar YTD 99.8% 3 3.0 98% 95%

1.00 Access to Genito-urinary medicine clinic 'GUM' (48 hour referral to appointment) Mar MA 100% 3 3.0 98% 95%

1.00 Delayed transfers as % of admissions Mar MA 0.9% 3 3.0 3.5% 5.0%

1.00 2 week GP referral to 1st outpatient, cancer Feb YTD 95% 3 3.0 93% 88%

0.33 31 day diagnosis to treatment for all cancers Feb YTD 98% 3 1.0 96% 91%

0.33 31 day second or subsequent treatment (drug) Feb YTD 98.3% 3 1.0 98% 93%

0.33 31 day second or subsequent treatment (surgery) Feb YTD 96.4% 3 1.0 94% 89%

0.33 62 days urgent referral to treatment of all cancers Feb YTD 81% 2 0.7 85% 80%

0.33 62 day referral to treatment from screening Feb YTD 94.1% 3 1.0 90% 85%

0.33 62 day referral to treatment from hospital specialist Feb YTD 86.2% 3 1.0 85% 80%

1.00 Patients that have spent more than 90% of their stay in hospital on a stroke unit Quarter 4 (2009-10)

70% 3 3.0 60% 30%

0.50 Outpatient breaches as % of first outpatient attendances Mar YTD 0% 3 1.5 0.03% 0.15%

0.50 Inpatient breaches as % of elective admissions Mar YTD 0% 3 1.5 0.03% 0.15%

44.1* awaiting full confirmation of calculation from Strategic Health Authority but expect full achievement currently.

Upper Lower 2.40 2.10

Current performance rating: Performing

Standards & Targets Thresholds

Current performance total:2.76

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nuh 1333 (a)

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