Integrated Quality & Performance Report 30 July 2018

Transcription

1 Integrated Quality & Performance Report 30 July 2018 Safe & Effective Kind & Caring Exceeding Expectation Agenda Item No: 9.2

2 Meeting Date: 30 th July 2018 Trust Board Report Title: Report of: Action Requested: For the attention of the Board Assure Author + Contact Details: Links to Trust Strategic Objectives Resource Implications: CQC Domains Equality and Diversity Impact Risks: BAF/ TRR Public or Private: Other formal bodies involved: NHS Constitution: Integrated Quality & Performance Report The report provides the Board with an update of performance against National and Local quality and performance indicators for June and Quarter Receive and note: Current Progress This report provides an integrated focus on key performance indicators that are monitored through the national contract and those metrics that the organisation measure for operational efficiency and patient safety. All data reported with thorough validation checks and relevant departments are aware of any underperformance. Performance Manager ext lesley.burrows2@nhs.net Deputy Chief Nurse ext debrahickman@nhs.net Deputy Director Strategic Planning and Performance Tel simon.evans8@nhs.net 1. Create a culture of compassion, safety and quality 3. To have an effective and well integrated local health and care system that operates efficiently 4. Attract, retain and develop our staff, and improve employee engagement 6. Be in the top 25% of all key performance indicators None Safe: patients, staff and the public are protected from abuse and avoidable harm. Effective: care, treatment and support achieves good outcomes, helping people maintain quality of life and is based on the best available evidence. Caring: staff involve and treat everyone with compassion, kindness, dignity and respect. Responsive: services are organised so that they meet people s needs. Well-led: the leadership, management and governance of the organisation make sure it's providing high-quality care that's based around individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture. None Not Applicable Public Session TMC, F&PC and QGAC In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny

3 Integrated Quality & Performance Report June 2018 Page 1 of 38

4 Contents Executive Summary Quality Patient Experience Patient Outcomes Patient Safety Maternity Mortality National & Contractual Standards Waiting Times Urgent Care Cancer Stroke Organisational Efficiency Workforce Page 2 of 38

5 EXECUTIVE SUMMARY - PERFORMANCE Referral to Treatment RTT Incomplete - Performance saw further improvement during June remaining above trajectory for the month. We are continuing to focus on reducing the backlog where possible and work closely with Directorates. Diagnostics This indicator saw further improvement in month and remains within target. We continue to monitor this closely through the weekly performance meeting. Emergency Department The Trust failed to achieve both Type 1 and the All Types target for the month. RWT ranking for June was 45th out of 137 Trusts. There were no breaches of the 12 hour decision to admit target during the month. Ambulance handover saw a deterioration during June 18 for both minutes and >60 minute handover times, however, we saw a significant rise of 123 (3.06%) ambulance conveyance numbers in month compared with the same period last year. The fine for Ambulance handovers during the month was 21,000. This is based on 90 patients between per patient and 3 patients >60 1,000 per patient. Cancer We are currently predicting possible failure of the 2 week wait, 2 week wait Breast Symptomatic, 31 Day First Treatment, 31 Day Sub Radiotherapy, 31 Day Sub Surgery, 62 Day Screening and 62 Day wait for first treatment for June, validation is on-going. Final cancer data is uploaded nationally 6 weeks after month end. Specific actions are:- Revised PTL meetings - all patients on backlog discussed weekly to ensure pathway is correct Monthly cancer recovery meetings Monitor the potential impact of SWBH/UHB transition to ensure capacity is available to meet demand Page 3 of 38

6 EXECUTIVE SUMMARY - WORKFORCE Head Count as at 30/06/2018 WTE as at 30/06/2018 Vacancy Rate % SIP vs NHSi Plan June Month Turnover % 12 Month Turnover % Normalised Annual Appraisal Rates Mandatory Generic Compliance Rates Mandatory Specific Compliance Rates Sickness % May 2018 Sickness % May 18 (12 month rolling) 8,532 7, % 0.57% 10.68% 9.69% 83.7% 91.0% 92.4% 3.67% 4.31% Workforce turnover: The current turnover of 10.68% (11.01% last month) the Trust target of 10.5%, there has been a decrease compared to the figures this time last year 11.87%. Please note this calculation excludes Rotational Doctors. By removing Rotational Doctors, Students and TUPE Transfers to produce a Normalised Workforce Turnover Rate, this reduces to 9.69%. Staff sickness absence: The sickness rate for May 2018 is 3.67%. This month's sickness rate is 0.18% below the Trust s target of 3.85%. Vacancy Rate (9.15%): This is based on the WTE in post on the 30th June 2018 compared against Finance's budgeted FTE for June Once Establishment Control is introduced and embedded this well the method used to calculate vacancy figures. RWT employee's average days lost compared to: - Public Services = 8.7 days (increased from 7.9 days in 2015 CIPD report) - note that under this category Health sector is reported as an average of 10 days lost per employee and an average 4.4%. - Private Sector = 5.8 days (No change since 2015) - Manufacturing & Production = 5.9 days (decreased from 6.2 days in 2015 CIPD report) - Not for Profit Sector = 7.8 days (increased from 5.4 days reported in 2015 CIPD report) (data sourced from the annual CIPD (Chartered Institute of Personnel and Development) survey report on Absence Management (2015) Mandatory Training - Overall mandatory training rates are compliant with the Trust's target. Action plans to address low compliant areas are monitored through IMTG and Governance meetings. Appraisal - The Trust wide total is compliant with the target. Those specific departments below target are reported locally to Divisions and Directorates. Page 4 of 38

7 QUALITY Surveillance only Quality Dashboard Patient Experience Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Number of cancelled operations on the day of surgery for nonmedical reasons Cancelled operations as a % of elective admissions <0.8% 0.45% 0.21% 0.21% 0.62% 0.43% 0.58% 0.92% 0.94% 1.11% 1.00% 0.26% 0.38% 0.51% Cancelled operations as a % of elective admissions (cumulative) <0.8% 0.34% 0.30% 0.28% 0.32% 0.34% 0.36% 0.40% 0.45% 0.50% 0.53% 0.26% 0.32% 0.39% Number of cancelled operations not re-admitted within 28 days Number of urgent cancelled operations cancelled for a 2nd time Number of complaints as a % of admissions 0.33% 0.45% 0.33% 0.34% 0.44% 0.37% 0.30% 0.44% 0.44% 0.40% 0.32% 0.38% 0.33% Complaints response rate against Policy 90% 100% 100% 98% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% FFT response rates (Trust Wide - excluding ED & Maternity) 18.5% 20.1% 21.0% 18.3% 20.1% 16.9% 20.0% 20.7% 19.6% 20.2% 19.4% 19.2% 17.9% FFT recommendation rates (Trust Wide - excluding ED & Maternity) 93.7% 93.5% 92.9% 93.3% 93.2% 92.8% 93.9% 93.8% 93.4% 92.9% 93.3% 92.8% 93.9% FFT response rates (Emergency Department) 13.6% 13.4% 14.2% 12.7% 12.9% 11.1% 11.6% 13.9% 13.0% 15.8% 14.8% 14.4% 16.5% FFT recommendation rates (Emergency Department) 82.3% 83.1% 84.8% 84.0% 83.1% 80.5% 82.0% 82.3% 81.6% 82.5% 83.1% 86.8% 86.4% Late observations (Trust Wide) 5% 6.51% 6.58% 6.53% 5.96% 5.69% 6.07% 6.64% 6.90% 6.24% 6.14% 4.15% 4.04% 4.42% Late patient moves (after 10pm) Duty of Candour - Element 1: notifying patients and families of the incident and investigation taking place. Due 10 working days after incident is reported to STEIS Duty of Candour - Element 2: sharing outcome of investigation with patients/relatives. Due 10 working days after final RCA report is submitted to CCG Patient Outcomes Safety Thermometer - Harm Free Care 95% 94.99% 95.35% 94.98% 96.47% 95.59% 96.87% 96.95% 96.13% 96.63% 96.23% 96.83% 96.80% 95.15% Pressure Injuries - all cases Patient falls - rate per 1,000 occupied bed days < Patient Safety VTE % risk assessment data 95% 95.73% 95.50% 95.51% 95.00% 95.04% 96.41% 95.70% 96.10% 95.75% 95.76% 92.65% 92.03% 91.50% Clostridium Difficile MRSA Bacteraemia Surveillance E.Coli only % Rate of medication error 0.52% 0.86% 0.73% 0.86% 1.06% 0.82% 0.83% 0.73% 0.89% 1.01% 1.34% 1.39% 1.25% Serious incident reporting - report incidences within 48 hours Serious incident reporting - update on immediate actions within 72 hours Serious incident reporting - share investigations report/action plan (60 days) Radiation incident rate - radiotherapy Radiation incident rate - radiology Care hours per patient - total nursing & midwifery staff actual Care hours per patient - registered nursing & midwifery staff actual Care hours per patient - healthcare workers actual Maternity C-Section rates - elective <12% 12.2% 12.2% 11.5% 10.0% 13.4% 11.0% 9.9% 11.4% 12.6% 12.2% 10.9% 10.7% 7.9% C-Section rates - emergency <14% 13.9% 12.7% 19.4% 16.1% 12.9% 17.4% 16.1% 17.0% 20.6% 17.1% 16.8% 17.7% 18.4% Midwife to birth ratio </= FFT response rates (Maternity only) 3.5% 10.1% 7.3% 1.9% 11.7% 4.2% 6.6% 6.7% 9.4% 7.2% 3.0% 4.6% 3.6% FFT recommendation rates (Maternity only) 98.5% 88.7% 94.2% 86.1% 93.6% 96.3% 96.5% 92.6% 98.0% 94.3% 100.0% 97.8% 93.9% Page 5 of 38

8 Quality cont Late Moves after 10pm Themes: Capacity Portering Delays Actions: For discussion at CD's meeting in July. Reviewing Huddles, MDT engagement and consistency of process. Review portering arrangements 12,000 10,000 8,000 6,000 4,000 2, Late Moves after 10pm After 10pm All Admissions ED Admissions ED >4 hour Breaches Serious Incident Reporting (60 days) Themes: Table top exercises frequently hard to schedule with appropriate representation. 8 6 Serious Incident Reporting Actions: SUI identified additional executive support to lead table tops. ed executive time to be allocated to allow for timely table top reviews and avoid future backlog build up. Weekly SUI meeting to commence from 30th July Maternity - Emergency C-Section Rate Themes: Following birth rate plus it is recognised that we have been booking RWT higher acuity (categories 4 & 5) following monitoring activity from Walsall it is also recognised women booking at RWT are also of high acuity with complex co-morbidities. Actions: Audit programmes need to be discussed and implemented Birth rate plus paper to be presented at Board. 25% 20% 15% 10% 5% 0% Maternity - Emergency C-Section Rates Upper Limit Page 6 of 38

9 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Quality cont Complaints Themes: Delay (25%) and General Care of Patient (19%). Actions: Regarding delays in receiving appointments - information to be shared with respective Directorates. Matrons with responsibility for Ophthalmology and Urology to ensure that the timeliness of appointments to be communicated to patients in order to manage their expectations and give clarity. Regarding general lack of care - information to be shared with Directorates. A maternity services local survey is being developed and will be undertaken to gain feedback from service users post discharge Complaints Complaints as a % of Admissions Number of Complaints 0.50% 0.40% 0.30% 0.20% 0.10% 0.00% VTE Risk Assessment Themes: Whilst a drop in compliance was anticipated due to the planned changes in reporting, other factors have also had a negative impact on compliance:- Introduction of Badgernet to maternity services with dated and timed information on VTE risk assessments. Changes to coding of patients on CDU introducing C55 A & C55 F as inpatient activity. Actions: Daily consultant and ward manager s for patients not risk assessed. Weekly RAG status for all inpatient areas circulated Trust Wide. Inclusion of VTE assessment data from ward audits on IGR report. Discussion and quality improvement projects with poor performing areas. Commence circulation of monthly VTE performance from July % 96.00% 95.00% 94.00% 93.00% 92.00% 91.00% 90.00% 89.00% % VTE Risk Assessment % VTE Assessment % VTE Assessment Page 7 of 38

10 Quality cont Clostridium Difficile One case was positive by toxin test and was attributable to RWT using the external definition of attribution. The Trust is exactly on the monthly trajectory for A combination of antibiotic diversity, attendance at ward huddles and strong environmental controls is thought to have contributed. An improving picture for C. difficile infection this month Clostridium Difficile RWT Monthly MRSA Bacteraemia No cases in June. The Trust remains at 1 for Actions: Increased screening for MRSA on wards with higher than expected levels of acquisition to reduce the risk of further MRSA bacteraemia. Further education and support directed at key areas of concern from the IP Team. Devices must be clinically indicated and reviewed on a regular basis to ensure prompt removal when appropriate, along with monitoring of urinary catheters and PVC via IP03 and MRSA screening must be adhered to, ensuring all sites are screened within 24 hours of admission, compliance data will be presented at IPCG. If a patient requires MRSA decolonisation treatment it must be prescribed and administered promptly through IP visits to wards and reviewing EMPA. IP01 Hand Hygiene has been reviewed and ratified, mandatory training reports and Hand Hygiene compliance is monitored at IPCG Monthly. Dermatological conditions are a consistent theme in MRSA bacteraemia investigations, meetings are to be arranged with the Directorate to seek further guidance MRSA Bacteraemia Page 8 of 38

11 Quality cont FFT Response Rates (Trust Wide - Excluding ED) 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 95.0% 94.5% 94.0% 93.5% 93.0% 92.5% 92.0% 91.5% FFT Recommendation Rates (Trust Wide - Excluding ED) RWT England RWT England 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% FFT Response Rates (Emergency Department) 90.0% 88.0% 86.0% 84.0% 82.0% 80.0% 78.0% 76.0% FFT Recommendation Rates (Emergency Department) RWT England RWT England Actions: Ward A21 (Paediatrics) - separate FFT reports are produced which will allow the Directorate to focus on individual areas. Installation of FFT on ward 'computers on wheels' to proactively complete on discharge. Raising the profile and importance of completing survey's across the nursing workforce Page 9 of 38

12 Quality cont 98% 97% 97% 96% 96% 95% 95% 94% 94% Safety Thermometer - Harm Free Care Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 1,260 1,240 1,220 1,200 1,180 1,160 1,140 1,120 1,100 1,080 1,060 1,040 Number of sample patients % Performance Patient Falls 0.45% 0.40% 0.35% 0.30% 0.25% 0.20% 0.15% 0.10% 0.05% % Acquired PI Incidents % per OBD Falls with Serious Harm Total Falls Unavoidable Avoidable Unavoidable RWT / Avoidable Other Page 10 of 38

13 Quality cont 60 Datix Reported Medication Incidents Apr-18 May-18 Jun-18 0 Administration Delivery Dispensing Patient Monitoring Pharmacy Recommendations Preparation Prescribing Procurement Storage Medication Incidents by Harm No Harm Low Moderate Severe Apr-18 May-18 Jun-18 Medication Incidents: Themes: There has been a peak in dispensing incidents during June, the most common type being errors with labelling of medicines. Prescribing incidents also increased during June. Eleven incidents have been reported raising issues with the electronic prescribing system. The incidents have been raised with the epma project team, and communication issued to highlight and embed processes into practice. Actions: Incidents associated with harm are discussed at Medicine Safety Group. Imminent roll out of datix dashboard will assist with trend analysis, and comparisons between similar wards. The dashboard will also aid identification of areas which are not reporting any medication incidents. Page 11 of 38

14 Quality cont % % % % % 90.00% 80.00% Trust Average Fill Rate (%) DAY Nurse/ Midwives Fill Rate Upper Control Limit DAY Care Staff Fill Rate Lower Control Limit NIGHT Nurse/ Midwives Fill Rate NIGHT Care Staff Fill Rate 70.00% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Lower Control Limit The care hours per patient day (CHPPD) calculation, measures the combined number of hours of care provided to a patient over a 24 hour period by both nurses and healthcare support workers. It was designed to measure and compare the standard of patient care in hospitals around the United Kingdom. This measurement does not take into account different non-nursing specialists who contribute to the patients care in the 24 hour period. CHPPD is benchmarked within the Model Hospital dashboard. The latest reported period is April 2018 which shows:- RWT Rostering compliance work is being undertaken with proactive recruitment proving successful. Acuity and dependency monitoring occurred in June. Peer Median National Median CHPPD Total Nursing & Midwifery staff actual CHPPD Registered Nursing & Midwifery staff actual CHPPD Healthcare Support Workers actual Page 12 of 38

15 Mortality Structured Judgement reviews of mortality cases The structure judgement review process as part of National Guidance was implemented in Oct 2017, this has been evolving and the graph below is the outcome data from the process at RWT to date. The SJR process continues to be modified as the Trust looks to appoint a Medical Examiner role early Autumn The learning identified from the reviews is fed back to the directorate governance meetings by the lead reviewer, the directorate then undertakes an action plan to address the key points. 300 Graph 1 - SJR: Divisional Allocation (No) - v - Completed - Period April 17 to June Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Div 1 Allocated Div 1 Completed Div 2 Allocated Div 2 Completed Div 3 Allocated Div 3 Completed NB: SJR process implemented October 2017 Graph 1: All mortality cases are currently subjected to an SJR 1 s review, allocated via Governance to the mortality leads. Actions: To clear the backlog of cases since implementing this process in October 2017, of which there are: 846 SJR 1 s and 50 SJR 2 s. Page 13 of 38

16 Mortality Cont. Graph 2 - SJR - Trust - Phase 6 Overall Care Assessment score (by judgement) 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 0.08% 3.00% 49.70% 1 - very poor 2 - poor care 3 - adequate care 38.72% NB: SJR process Oct-June 2018 (as at 17th July 2018) i.e. 1 Medic/1 Nurse (as at 25th June 2018) Graph 2 (SJR 1 overall care): Completed SJR 1 s of which are deemed to be of very poor or poor care are then subject to a SJR 2 review, which is external to the Directorate and completed by a Medic and Non-Medic independently. Graph 3 (SJR level 2 outcome): SJR 2 s comprise of the SJR 1 s which were graded as 1 very poor care and 2 - poor care, cases whereby the deceased was known to have Mental Health issues, Learning Disabilities, concerns raised by a third party via the complaints process or reported as a STEIS incident. There are currently 85 cases requiring a SJR 2, 35 cases have been allocated and 21 completed reviews as per table 2. Actions: The Mortality Review Group are in the process of agreeing actions, which is currently out for the groups confirmation. 8.50% 4 - good care 5 - excellent care Graph 3 - SJR 2 level 2 - Outcome Judgement following reviews by strong evidence of avoidability 3 - probably avoidable (more than 50:50) 4 - possibly avoidable (less than 50:50) 5 - slight evidence of avoidability definitely not avoidable Div 1 Div 2 Page 14 of 38

17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Waiting Times 18 Weeks - Incomplete Number of patients waiting >52 weeks % of patients waiting >6 weeks or more for a diagnostic test NATIONAL AND CONTRACTUAL STANDARDS Quarter /18 Quarter /19 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 92% 90.26% 90.38% 90.11% 90.38% 90.61% 90.94% <1% 0.76% 0.84% 0.80% 0.83% 0.82% 0.74% 93% RTT - Incomplete 2% Diagnostic 92% 91% Recovery Trajectory 1% Upper Limit 90% 89% 0% Comments: RTT - performance saw further improvement during June and exceeded the recovery trajectory figure of 90.7% for the month. Each directorate continues to be monitored against their individual trajectories for both activity numbers and backlog reduction for each month. This continues to be reviewed weekly to ensure attainment of the recovery trajectory. Diagnostic waiting times - saw further improvement during June, remaining within tolerance. The pressure points continue in Cardiac diagnostic testing and additional sessions are utilised to keep up with demand. This continues to be monitored weekly at the performance meeting. Actions: * Monthly prediction reports continue to be circulated, highlighting priority patients and expected activity numbers for each month. * Patient pathway validation is on-going - where error trends are identified one to one/team training is undertaken. * Weekly reports continue to be circulated to directorates highlighting long waiting patients. Page 15 of 38

18 Urgent Care Total Time Spent in Emergency Department (4 hours) Quarter /18 Quarter /19 Q1 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun /19 New Cross 73.80% 76.08% 74.57% 84.09% 90.27% 85.55% 86.71% Walk in Centre % % % % % % % Cannock MIU 95% % % % % % % % Vocare 94.76% 96.29% 96.03% 98.56% 98.42% 98.48% 98.49% Combined 84.73% 86.27% 85.08% 90.81% 94.16% 91.29% 92.13% % 95.00% ED <4 Hour Performance 90.00% 85.00% 80.00% 75.00% Ambulance Handover Number between minutes Number over 60 minutes Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Quarter /18 Quarter /19 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun Comments: The fine for Ambulances during June was 21,000. This is based on 90 patients between per patient and 3 patients >60 1,000 per patient. There were no patients who breached the 12 hour decision to admit target during June Minutes Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 >60 Minutes Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Page 16 of 38

19 Urgent Care cont The graph and table below show the increase in the number of ambulance conveyances into Royal Wolverhampton NHS Trust and the fine comparisons compared with the previous 2 years. Monthly Fines Comparison Ambulance Numbers Comparison 2016/ / / / / /19 Apr 10,600 7,600 35,400 Apr 3,735 3,782 3,837 May 17,000 15,800 2,000 May 3,960 4,039 4,007 June 13,600 15,800 21,000 June 3,723 3,893 4,016 July 22,400 5,600 July 3,768 3,939 Aug 16,000 14,600 Aug 3,591 3,655 Sept 10,000 16,000 Sept 3,657 3,726 Oct 61,800 10,200 Oct 3,835 3,951 Nov 10,000 28,800 Nov 3,729 3,920 Dec 38,000 45,400 Dec 4,082 4,297 Jan 85, ,800 Jan 4,142 4,166 Feb 66,200 48,400 Feb 3,624 3,595 Mar 24,200 48,200 Mar 3,885 3,955 Page 17 of 38

20 Apr May Jun Quarter 1 Total Apr May Jun Quarter 1 Total Apr May Jun Quarter 1 Total Apr May Jun Quarter 1 Total Urgent Care cont The tables below show the number of ambulances conveyances into RWT and surrounding Trusts and the increase or decrease compared with the same period last year. Wolverhampton 2017/ /19 % Diff 3,782 4,039 3,893 11,714 3,837 4,007 4,016 11, % -0.80% 3.06% 1.23% Dudley 2017/ /19 % Diff 3,229 3,365 3,280 9,874 3,352 3,535 3,366 10, % 4.81% 2.55% 3.70% City & Sandwell 2017/ /19 % Diff 4,317 4,578 4,440 13,335 4,471 4,745 4,471 13, % 3.52% 0.69% 2.57% Walsall 2017/ /19 % Diff 2,642 2,744 2,681 8,067 2,640 2,783 2,692 8, % 1.40% 0.41% 0.59% Page 18 of 38

21 Urgent Care cont Emergency Admissions via ED The graphs above show the admission rates and numbers of patients who are admitted via ED compared with the same period last year. In the first three month's of the year we have seen 565 less attendances compared with last year, we have also seen a decrease in admissions (-37). Page 19 of 38

22 Cancer Waiting Times Cancer Compliance Quarter /18 Quarter /19 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 2 Week Wait Cancer 2WW Breast Symptomatic 31 Day to First Treatment 31 Day Sub Treatment - Anti Cancer Drug 31 Day Sub Treatment - Surgery 31 Day Sub Treatment - Radiotherapy 62 Day Wait for First Treatment 62 Day Wait - Screening 62 Day Wait - Consultant Upgrade (local target) 93% 90.78% 93.91% 91.52% 79.03% 80.70% 84.05% 93% 93.33% 95.28% 88.33% 42.02% 48.03% 71.00% 96% 96.36% 97.06% 96.36% 91.87% 92.21% 92.95% 98% % % % % % % 94% 71.70% 84.85% 84.21% 89.47% 88.00% 81.48% 94% 98.06% % 94.63% 96.15% 93.86% 88.00% 85% 70.66% 66.85% 74.51% 69.89% 62.38% 63.14% 90% 60.00% 92.31% 72.41% 73.68% 87.50% 75.00% 88% 90.82% 86.00% 90.21% 91.10% 88.24% 89.93% Comments: 2 Week Wait: the breaches in month were as follows; 69.3% were due to internal issues (capacity) and 30.7% were patient choice. 2WW Breast Symptomatic: the breaches in month were as follows; 62.1% were due to capacity issues and 37.9% were patient choice. 31 Day to Treatment: 17 patient breaches in month, 15 were due to capacity issues and 2 complex cases. 31 Day Sub Surgery: 5 patient breaches in month; all due to capacity issues. 62 Day to Treatment: 51 patient breaches in month; 8 x Tertiary referrals received between days 42 and 77 of the patients pathway, 37 x Capacity Issues, 2 x Patient Initiated and 4 x Complex Pathways. Of the tertiary referrals received 0 (0%) were received before day 40 of the pathway, and 3 (37.5%) were received after day 62 of the patient pathway. 62 Day Screening: 3 patient breaches in month; 2 were due to capacity issues and 1 complex pathway. Patients over 104 days - Following May 2018 month end final upload - 14 patients were treated at 104+ days on a cancer pathway during the month, all of these patients had a harm review and no harm was identified. Page 20 of 38

23 Cancer Waiting Times cont 62 Day by Cancer Site Tumour Site Breast Colorectal Gynaecology Haematology Head & Neck Lung Other Sarcoma Skin Upper GI Urology Total Total Patients Breaches % % % % % % % % % % % Average Cancer Waiting Times by tumour site The following table shows the average of all patients who were treated on a 62 day pathway within the month they are treated - this is shown by cancer tumour site and shows; of the patients who were treated in month the average waiting time in days. Breast Colorectal Gynaecology Haematology Head & Neck Lung Skin Upper GI Urology Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May Page 21 of 38

24 Stroke Patients admitted with primary diagnosis of stroke should spend greater than 90% of their hospital stay on a dedicated stroke unit % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 90% of stay on Stroke Unit This indicator remains on target and was reported at 89% in June. High risk patients will be assessed and treated within 24 hours High Risk Patients This indicator remains above target by 17% % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Page 22 of 38

25 Organisational Efficiency Theatre Utilisation Specialty Total Available Sessions Cancelled Sessions % of Utilisation - June 2018 Trend from Previous Cardiothoracic % Urology % ENT % Ophthalmology % Maxillo Facial % General Surgery % Orthopaedics CCH % Orthopaedics Nx % Gynaecology % The table to the left shows what percentage of available theatre sessions were actually used during the month of June and the trend compared with the previous month. The top 3 reasons for cancelled sessions during the month were:- 1) Consultant Leave 2) Unplanned theatre maintenance 3) Consultant on call In addition to this the individual graphs below demonstrate, of the theatre sessions that were used how much theatre time was utilised during the same period % Cardiothoracic - New Cross Theatre Utilisation 95.0% Ear, Nose & Throat - New Cross Theatre Utilisation 100.0% 95.0% 90.0% 90.0% 85.0% 85.0% 80.0% 75.0% 80.0% 75.0% 70.0% 70.0% Page 23 of 38

26 Organisational Efficiency cont 95.0% General Surgery - New Cross Theatre Utilisation 95.0% Gynaecology - New Cross Theatre Utilisation 90.0% 85.0% 80.0% 90.0% 85.0% 75.0% 70.0% 65.0% 60.0% 80.0% 75.0% 70.0% 110.0% Maxillo Facial - New Cross Theatre Utilisation 100.0% Ophthalmology - New Cross Theatre Utilisation 100.0% 90.0% 80.0% 70.0% 95.0% 90.0% 85.0% 60.0% 80.0% 50.0% 75.0% Page 24 of 38

27 Organisational Efficiency cont 95.0% Orthopaedic - New Cross Theatre Utilisation 100.0% Urology - New Cross Theatre Utilisation 90.0% 95.0% 85.0% 80.0% 90.0% 85.0% 80.0% 75.0% 75.0% 70.0% 70.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% Orthopaedic - Cannock Chase Theatre Utilisation Continued reduction in demand has initiated a review of Gynaecology theatre capacity with a clear expectation that there will be a release of theatre time to accommodate Gynae Oncology activity likely transferring from SWBH and/or to other specialties. High numbers of cancelled operations on the day for clinical and non clinical reasons and DNAs driving focus on meetings and pre-op processes. Text reminders to commence. If all such cases had proceeded circa 600 more operations in Q1 and income generation of circa 2m. Page 25 of 38

28 Organisational Efficiency cont British Association of Day Surgery Patients want treatment that is safe, efficient and effective, and which provides the least possible disruption to their lives. Day case surgery gives this patientfocused care. Repeated patient surveys have demonstrated that the great majority of patients prefer to recover in their own homes rather than staying overnight in hospital. The following table shows the Trust performance by specialty for Day Case Surgery. Breast Surgery Ear, Nose and Throat General Surgery Gynaecology Head & Neck Surgery Ophthalmology Orthopaedic Surgery Urology Vascular Medical Paediatric Surgery Trust Total Q1 2018/19 65% 68.83% 82% 91.67% 75% 87.90% 78% 97.06% 66% 91.07% 96% 99.74% 82% 98.59% 81% 97.28% 88% 96.25% 91% 95.10% 93% 95.99% 82% 96.49% Providing surgery as a day case is beneficial to several groups:- Patients: Know when your operation will be, with little risk of cancellation and minimal time away from home Surgeons: Less risk of cancellation permits better scheduling of operating lists with greater turnover of cases and release of in-patient beds Trust: Cost-effective treatment, still attaining clinical goals. Facilitates less demand for in-patient beds Page 26 of 38

29 Organisational Efficiency cont NHS e-referral - Sufficient Appointment Slots This indicator measures RWT ability to offer appointment slots via NHS e-referral. The target is to achieve less than 4% failure rate for all directly bookable appointments % Comments: June 2018 saw an increase, this is largely due to the paper switch off of referrals and the move towards ERS for all first GP appointments. This 30.00% indicator continues to be monitored against RWT's contractual target rather 20.00% than the CQUIN target. Actions: 10.00% Upper ASI reports distributed to directorates. Limit 0.00% Weekly reports to directorates monitoring current % of services/ clinics that are published on ERS. Delayed Transfers of Care Delayed transfers of care is split into 2 indicators, the graph on the left shows all delayed transfers where as the graph on the right shows the measure against our contractual obligations (excluding social care delays). 6.00% Delayed Transfers of Care 3.00% Delayed Transfers of Care - Excluding Social Care Delays 5.00% 4.00% 3.00% 2.00% 1.00% 2.00% 0.00% Delay awaiting assessment Delay awaiting public funding Delay awaiting further NHS care Delay awaiting Residential/Nursing Home Delay awaiting domiciliary package Delay awaiting equipment/ adaptations Delay awaiting family choice 18.7% 0.0% 6.7% 21.3% 32.0% 10.7% 10.7% Comments: The total performance for June 2018 is reported as 2.68%, excluding social care delays is 0.82%. Page 27 of 38

30 Organisational Efficiency cont Discharge Summary within 24 hours of Patient Discharge In the 2018/19 contract Discharge Summary continues to be reported as two indicators:- 1) Electronic discharge summary - for all wards including assessment units - 95% 1) Electronic discharge summary - for all assessment units - 95% % 90.00% 80.00% 70.00% 60.00% Discharge Summary - All Wards (excluding assessment) 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00% 60.00% Discharge Summary - Assessment Units only The tables below show the monthly breakdown of compliance by ward for the Assessment Areas for Quarter /19. Ward Disch's Comp Incomp Apr-18 Ward Disch's Comp Incomp May-18 Ward Disch's Comp Incomp Jun-18 MATY % AMU % AMU % AMU % PAU % PAU % PAU % GAU % GAU % GAU % SEU % SEU % SEU % MATY % MATY % Comments: Total 1,339 1, % Total 1,461 1, % Total 1,400 1, % The Maternity Ward saw a significant decrease in compliance, this was due to the implementation of the Badgernet system within the Maternity Department and subsequent problems with the functionality between this new software and PAS. Fine: The fine for not achieving the assessment ward targets during Quarter 1 is 15,000 ( 5,000 per month). Page 28 of 38

31 Organisational Efficiency cont VI Appointments Pre and Post VI Integration comparison - May 18 snapshot The Royal College of GP's have set recommended targets for GP practice appointments per 1,000 patients / per week for both GP and non GP appointments. The analysis below measures VI practices against these targets for both post VI and pre VI integration Fig 1 - GP Average Weekly Appointments per 1,000 patients GP Average Weekly Appointments per 1,000 patients Variance National Pre VI Post VI Post vs Pre VI GP Average Weekly Appointments per 1,000 patients Pre VI Post VI National Fig 2 - Other Average Weekly Appointments per 1,000 patients Other Average Weekly Appointments per 1,000 patients Pre VI Post VI National The additional 4.96 GP appointments per 1,000 patients equates to an additional circa 24,000 GP appointments when we compare average weekly GP appointments 12 months prior to VI to the weekly average Post VI - see Fig Fig 3 - Total Average Weekly Appointments per 1,000 patients Total Average Weekly Appointments per 1,000 patients Pre VI Post VI National Other Average Weekly Appointments per 1,000 patients Variance National Pre VI Post VI Post vs Pre VI The additional 2.1 Non GP appointments per 1,000 patients equates to an additional circa 13,000 Non GP appointments when we compare average weekly GP appointments 12 months prior to VI to the weekly average Post VI - see Fig Overall for all VI appointments, there has been an additional 8.11 appointments per 1,000 patients equates to an additional circa 37,000 appointments when we compare average weekly appointments 12 months prior to VI to the weekly average Post VI - see Fig 3 Page 29 of 38

32 Organisational Efficiency cont VI Practice DNA Appointment trend The graph below illustrates the DNA % of practice appointments per month. It can be seen that the average post VI integration DNA rate of 6.32% is slightly lower than the average pre VI DNA rate of 6.9%. In actual terms, there are on average 1,500 DNA appointments per month across all VI practices. The reduction in DNA rate post VI integration equates to approximately 60 appointments per month. However, it can be seen that there has been a noticeable increase in DNA rate from Nov 17 which will be investigated further % VI Practice DNA Appointment Rates 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 VI Practice DNA Rates Pre VI Average Post VI Average Page 30 of 38

33 Organisational Efficiency cont ED attendances per 1,000 patients The graph below illustrates the number of ED attendances per 1,000 VI patients per month. It can be seen that the average post VI integration figure of is lower than the average VI figures of This is a reduction of 1.5% in ED attendances since the practices have joined VI ED attendances per 1,000 patients Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 VI ED attendances per 1,000 patients Pre VI Average Post VI Average Linear (VI ED attendances per 1,000 patients) In actual terms, there are on average 1,200 ED attendances (over last 12 months) per month across all VI practices, the reduction in ED attendances post VI integration equates to approximately 27 attendances per month. The graph below compares VI practices to NON VI practices in terms of ED attendances per 1,000 patients and it can be seen that VI practices have consistently lower ED attendances ED Attendances per 1,000 patients - VI vs Non VI Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 VI ED attendances per 1,000 patients NON VI ED attendances per 1,000 patients Page 31 of 38

34 Organisational Efficiency cont Emergency admissions per 1,000 patients The graph below (left) illustrates the number of Emergency admissions per 1,000 VI patients per month. It can be seen that the average post VI integration figure of 7.38 is lower than the average pre VI figures of This is a reduction of 8% in emergency admissions since the practices have joined VI. In actual terms, there were on average 400 emergency admissions (over last 12 months) per month across all VI practices, the reduction in emergency admissions post VI integration equates to approximately 38 admissions per month. The graph below (right) compares VI practices to NON VI practices in terms of Emergency admissions per 1,000 patients and it can be seen that VI practices overall have lower emergency admissions Emergency admissions per 1,000 patients Emergency admissions per 1,000 patients - VI vs Non VI VI Emergency admissions per 1,000 patients Pre VI Average Post VI Average Notes: - Appointment data source is EMIS Enterprise GP systems - Above figures combines all VI individual practice data together - Pre VI figures are calculated from 12 months prior for each practice joining VI - Figures above do not include MGS Medical Practice who are no longer part of the VI Programme VI Emergency admissions per 1,000 patients NON VI Emergency admissions per 1,000 patients Page 32 of 38

35 Workforce 18.00% 13.00% 8.00% Turnover 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Vacancy Rate RWT RWT Average Large Acute West Midlands Trusts National NHS Current Turnover (excluding rotational doctors): The turnover rate reported in June 2018 is 10.68%. Last month the turnover was 11.01%. This is lower than June 2017 when it was 11.87%. Benchmarked Turnover (reported by NHS Digital): The most recent benchmarked data available is for April 2018, RWT was 11.32%. The average for all Trusts nationally was 8.95%, and 9.69% in the West Midlands (62 in total). The national average for large Acute trusts was 15.61%. Selected other local trusts (reported by NHS Digital): Non-Foundation Trusts : Birmingham Community Healthcare (14.79%), Walsall Healthcare (14.61%) and Shrewsbury and Telford Hospital (11.65%). Foundation Trusts : Birmingham University Hospitals (8.66%) and Burton Hospitals (13.04%). The Normalised Turnover (excluding Rotational & Fellow doctors, Students, TUPE Transfers and End of Fixed Term) for June 18 is 9.69%. This internal measure allows the Trust to identify areas where interventions may impact on leavers. Top 3 Highest normalised turnover rates for staff groups Allied Health Professionals 11.85% Nursing and Midwifery 11.32% Add Prof Scientific & Technical 9.60% Trust Trust Vacancy Rate We are currently only able to provide high-level information as the Trust does not have Establishment Control within ESR, however, the Workforce Planning & Business Intelligence Team will be working alongside Finance during final budget setting meetings to be held in Quarter 4 to align the budgets within Finance to ESR. The overall vacancy rate for the Trust is 9.15%; this is within the Trust target of 10.5%. High-level analysis provided to NHS Improvement is based on the following staff groups: Staff Group Vacancy Rate % Vacancy Rate NHS Infrastructure Support 13.48% Medical Staff 12.31% Registered Nursing, Midwifery & Health Visiting Staff 9.35% Qualified Allied Health Professionals 8.48% Support to Clinical Staff 7.67% Grand Total 9.15% Page 33 of 38

36 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Workforce cont Sickness 12 month rolling period 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% 6.00% 4.00% 2.00% 0.00% Sickness Absence ESR Trust Total RWT The ESR rolling sickness rate for the 12 month period 1st June 2017 to 31st May 2018 was 4.31%. For the same rolling 12 month period 1st June 2016 to 31st May 2017 the sickness absence rate from ESR was 4.37%, therefore showing a decrease from the same period last year. This compares to:- - Public Services 3.8% (0.3% increase from 2014) - Private Sector 2.5% (0.1% increase from 2014) - Manufacturing & Production 2.6% (0.1% decrease from 2014) - Not for Profit Sector 3.5% (0.2% increase from 2014) (sourced from the annual CIPD (Chartered Institute of Personnel and Development) survey report on Absence Management 2015). The 3 most reported reasons for sickness absence at RWT:- Anxiety, Stress, Depression, Other Back Problems & Other musculo-skeletal problems Gastrointestinal problems The 2015 CIPD Survey report shows 4.4% for the Health Sector. RWT RWT Average Large Acute West Midlands Trusts National NHS The sickness rate for May 2018 was 3.67%; this indicates a decrease compared to 3.91% for April This takes the Trust 0.18% below the 3.85% target, and shows a decrease from the 4.08% calculated for May Division May-18 Division % Division % Division % Corporate Division 2.53% Estates & Facilities Division 3.84% Trust Total 3.67% Long Term/Short Term sickness rates: The long term (28+ days) rate for May 2018 was 2.42%. Short term rate for May 2018 was 1.25%. May-18 Division Short Term Long Term Division % 2.87% Division % 2.27% Division % 2.14% Corporate Division 0.74% 1.79% Estates & Facilities Division 1.32% 2.52% Page 34 of 38

37 Workforce cont Annual Appraisal Rates Surgical Division Medical Division Estates & Facilities Corporate Services Community Children's & Support Services Trust Total 90% Quarter /18 Quarter /19 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun % 85.4% 85.1% 82.0% 80.9% 81.6% 85.1% 84.9% 83.7% 81.8% 88.1% 80.8% 89.7% 90.4% 90.3% 91.9% 93.3% 92.2% 88.3% 88.0% 88.7% 89.7% 88.6% 89.0% 85.2% 82.8% 82.3% 86.1% 86.2% 85.6% 84.6% 83.7% 83.7% 92.0% 90.0% 88.0% 86.0% 84.0% 82.0% 80.0% 78.0% 76.0% 74.0% Trust Wide Annual Appraisal Rates The following areas are reported as the 5 lowest under compliance i.e. <=90%:- Surgical Division - Critical Care (76.7%), General Surgery Management (69.6%), Gynaecology (60.8%), Neonatal (53.6%)and Obs & Midwifery (79.1%). Medical Division - Community Stroke Co-Ordinators (50%), Disability Services (33.3%), Management Acute Medicine (50%), Management ED (0.0%), Outpatients West Park (60%), Walk-In Centres - ED (28.6%) and Wheelchair Services (33.3%). Community Children's & Support Division - Children's Management & Admin (57.6%), Looked After Children (50%), Pharmacy (59.3%), Primary Care Services (49.1%) and Speech and Language Therapy Services (66%). Estates & Facilities - Buildings & Grounds Services (86.4%), Commercial Services Sect (75.0%), Electrical Services (61.5%), Estates Services (83.3%), Maintenance Technical Services (75%) and Portering Services (87.6%). Corporate Services - Human Resources (73.2%), IT Department (73.5%), Nurse Training (83.3%), Patient Experience Team (50%) and Trust Management - Team (70.6%). Page 35 of 38

38 Workforce cont Mandatory Compliance Rates Mandatory Generic Quarter /18 Surgical Division Medical Division Estates & Facilities Corporate Services Community & Support Trust Total Quarter /19 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun % 96.3% 94.4% 96.1% 85.8% 90.8% 95.2% 95.1% 95.4% 95.6% 85.8% 90.5% 95% 94.8% 96.5% 95.7% 95.3% 84.5% 88.9% 94.9% 96.3% 97.3% 98.0% 88.5% 93.3% 93.1% 85.5% 91.8% 95.2% 95.9% 96.1% 95.5% 85.9% 91.0% Mandatory Specific Quarter /18 Surgical Division Medical Division Estates & Facilities Corporate Services Community & Support Trust Total Quarter /19 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun % 91.8% 92.9% 89.8% 91.1% 92.3% 92.5% 91.2% 92.1% 88.7% 90.2% 91.6% 95% 85.4% 89.2% 89.0% 91.7% 92.5% 92.5% 94.7% 95.1% 92.6% 96.3% 97.2% 98.1% 88.4% 89.8% 92.3% 92.4% 91.7% 92.3% 89.6% 90.9% 92.4% The Trust Mandatory training target is 95%. Overall for the generic topics we have decreased and have fallen below target. There is now the introduction of Health & Safety (All Staff and Managers). The overall compliance % with specific topics has decreased but has remained below 95%. There is a new Training Needs Analysis as of April 2018, some topics have been removed but there are new topics added. Primary Care and CRN are now included in the Monthly Compliance Reports. Refer to mandatory training reports for details of performance against each topic. Action plans to address low compliant areas are monitored through IMTG and Governance meetings. 99% 97% 95% 93% 91% 89% 87% 85% Mandatory Compliance Rates Mandatory Generic Mandatory Specific Page 36 of 38

39 Workforce cont Primary Care Directorate Since June 2016, as part of a Vertical Integration pilot The Royal Wolverhampton NHS Trust has been collaborating with the following GP Surgeries: Alfred Squire, Lea Road, MGS, West Park, Warstones, Thornley Street, Ettingshall, Penn Manor and Lakeside. WTE when transferred WTE as at 30/06/2018 Leavers since Transfer Starters since Transfer Internal Movement* Alfred Squire Ettingshall Practice Lea Road MGS Warstones West Park Surgery Thornley Street Penn Manor Medical Centre Lakeside Medical Centre Primary Care Directorate Team *Internal movements consist of transfer of staff in and out of department and changes to hours. Page 37 of 38

40 Workforce cont SIP vs NHSi Plan June 2018 Staff Group ESR SIP in Post (30th June WTE) NHSi Annual Plan SIP (June) WTE % Difference against Plan Total Non Medical - Clinical Staff 5, , % Non Clinical Staff 1, , % Total Medical and Dental Staff % Total 7, , % Page 38 of 38