SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST CHIEF EXECUTIVE S REPORT. BOARD OF DIRECTORS 21 st March 2012

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1 SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST I CHIEF EXECUTIVE S REPORT BOARD OF DIRECTORS 21 st PERFORMANCE In overall terms, the Trust continues to perform well against both regulatory and contractual requirements and internal performance measures. The detailed position at Month 1 is attached at Appendix 1. As in previous months I would highlight the following points: Emergency services maintaining performance in 212 was particularly challenging. The current position for quarter 4 to date is 94.4%. Performance has improved over the past two weeks with performance in week commencing at 96.3%. In particular, the early analysis of the difficulties faced by the Trust has highlighted the following key facts: There were increased attendances at the Northern General Hospital A&E department between 12 and The number of attendances represented at 12% increase on the average weekly attendance from to date. In terms of patients coming to the department by ambulance, in the same period there was a 1% increase compared to the average number of ambulance patients from Sheffield was particularly affected by flu during these weeks in and in particular for the week commencing There were 57 confirmed cases of flu on the Northern General site. This was an increase from the 23 cases which had been confirmed the previous week. There were also a significant number of cases of Norovirus during this same week. The 3 confirmed cases during this week were, however, similar in terms of the impact on bed availability, to the same period in 211. Clostridium Difficile the position continues to improve with 5 cases in 212. The year to date position at the end of was 164 cases thus giving confidence that the improvement target for the year as a whole of 183 cases will be met and that the 212/13 target of 134 cases can be achieved if current levels of performance can be maintained. 18 weeks whilst it was not possible to achieve 18 weeks across every individual specialty within the Trust, the national standards for both admitted and non-admitted patients across the Trust as a whole were met in 212. Cancer services - in overall terms, the current preview of performance for quarter 4 is good. Performance against the GP referred 62 day cancer target is challenging given the emergency patient activity pressures since the New Year. In terms of patient activity, new outpatient activity was 1.2% above target for the year to date and follow ups 2.1% below target compared to.7% above and 2.8% below at the end of month 9. Although the majority of the overperformance on new attendances is due to accounting change in Obstetrics which continues to be corrected, the position is now that the performance is above target. New attendances are higher and follow up attendances lower than in the same period last year. The level of elected inpatient activity is 4% above target for the year to date, compared to 3.6% at the end of 211 and higher than the same period last year. Non-elective Page 1 of 7

2 activity is.4% below expected levels at the end of 212 compared to.8% below at the end of 211 and is lower than in the same period last year. In terms of the Trust s financial position, the month 11 position showed that the Trust had a modest surplus of 17k (.2% of turnover) which included an overperformance on activity of 1.9m This represented an improvement in the position at the end of month 9 of.84m and provides confidence that the Trust will meet its financial obligations for the year as a whole. In terms of the position regarding staffing, the establishment has increased by wte from 211 with an increase of wte in staff in post. The Primary and Community Care directorate accounts for an increase of wte in establishment and wte in staff in post. In other directorates, the year to date establishment reduced by 32.6 wte and staff in post reduced by wte (with an in-month reduction in the establishment of 2. wte and 29.8 wte in staff in post). This reduction in establishment is largely due to posts removed in pursuance of productivity and efficiency savings. 2. INFECTION PREVENTION AND CONTROL MRSA Target for 211/212 Bacteraemia are either classified as Trust attributable or community acquired. Community acquired cases are bacteraemia that are identified on either day or day 1 of the patient s stay. Any bacteraemia identified after that are considered to be Trust attributable. The target for Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) attributable bacteraemia for 211/212 is 1 cases. The target for the health community is 13 which will include any Sheffield resident cases at STHFT and any bacteraemia identified in a Sheffield resident, irrespective of where they were receiving treatment at that time. MRSA Performance for 212 cases of MRSA bacteraemia were recorded during the month of. The Trust year to date performance is 2 cases of MRSA against a year to date target of April May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar STH Target (cumulative) STH Target (monthly) STH Performance (cumulative) STH Performance (monthly) The target for 211/212 is 1 cases so the Trust remains 7 cases ahead of trajectory and on course to achieve this target. MRSA Screening MRSA screening figures are not available at this point in the time. MRSA screening figures were 127%. Page 2 of 7

3 211/212 C.DIFF PERFORMANCE In, STHFT recorded 6 positive samples. The full year to date performance is 164 cases of C.diff against a national target of 134. The Trust had previously breached its year end target in 211. The health community performance is always one month in arrears to allow for the allocation of cases in Sheffield residents treated in other hospitals. The position in was year to date performance of 3 cases against a year to date target of 143. As the Trust has now exceeded its performance target, an improvement target has been set to ensure the Trust continues to focus on C.diff performance and can judge if there is deterioration in current performance, to which Monitor should be alerted. The improvement target has been set at 183; the Trust is under the trajectory for the improvement target, with a year to date performance of 164 against a year to date target of 174. C.diff year to date performance STH Target STH Performance Improvement Target (cumulative) April May C.diff Monthly Performance 3 2 Monthly target STH monthly performance April May Page 3 of 7

4 C.diff Performance versus Improvement Target Improvement Target (cumulative) Improvement Target (monthly) STH Performance (cumulative) STH Performance (monthly) Surveillance There are currently no wards under surveillance. Action Plan The C.diff Action Plan continues to be implemented. In addition, an action plan has been developed to support the continued reduction of cases of C.diff during 212/213. MSSA The Trust continues to return data on the number of cases of MSSA bacteraemia to the Health Protection Agency. Cases are labelled as either Trust attributable or community acquired. For, 5 Trust attributable cases of MSSA bacteraemia were recorded. It is not now thought that the Trust will be set a reduction target for MSSA bacteraemia from April 212. At 14 months, the total Trust attributable cases of MSSA stood at 94, a mean average of 7 cases per month. Trust Attributable MSSA Data No. of cases April May Page 4 of 7

5 E.COLI The Trust commenced returning data on the number of cases of E.Coli bacteraemia to the Health Protection Agency in 211. Cases are labelled as either Trust attributable or community acquired. For, 21 Trust attributable cases of E.Coli bacteraemia were recorded. Currently it is not expected that the Trust will be set a reduction target for E.Coli bacteraemia as E.Coli bacteraemia is often not directly associated with healthcare. After 9 months, the total Trust attributable cases of E.Coli stands at 17. Trust Attributable E.Coli Data INFECTION PREVENTION AND CONTROL NHS Sheffield - MRSA and C.diff Reporting The Trust continues to report cases of C.diff weekly to NHS Sheffield. Norovirus The Trust has experienced significant levels of norovirus during which has had a considerable impact on service delivery with up to 2 wards affected at a time. The impact has been mitigated by trying to ensure that the smallest possible area is closed such as bays rather than whole wards; this had kept the number of beds closed to less than 2 for most of. 3. MONITOR ASSESSMENT QUARTER 3 The Trust has now received its assessment at Q3. Both the Financial Risk Rating and the governance rating are in line with the Trust s plan as set out at the beginning of the year. The covering letter and executive summary are attached as Appendix COMMUNICATIONS During 212 there was mainly positive media coverage in both the local, national and online media including a new device developed at STH to predict premature births, the announcement that 3m funding had been awarded to the Clinical Research Facility and a new treatment for Motor Neurone Disease. There was also extensive national coverage of the new Page 5 of 7

6 Institute for Biomedical Imaging and Modeling (INSIGNEO), a new research institute set up by the Trust and the University of Sheffield. Researchers at the Institute are developing models of different parts of the human body, which will ultimately build into a complete digital replica of a patient. A press conference to launch INSIGNEO was held as part of National Science Week. Consultation continued with staff, partners and the public on the new draft corporate strategy. The Deputy Prime Minister, Right Honourable Nick Clegg MP, officially unveiled a new Centre of Excellence in Rheumatology. The prestigious title was awarded by leading health organisation the European League Against Rheumatism (EULAR), based on the city s outstanding record in rheumatology clinical research. The Lord Mayor of Sheffield along with guests attended the official launch of the Sheffield Cancer Research Centre. 5. SHEFFIELD S PUBLIC HEALTH BEYOND 212 The Director of Public Health for Sheffield has written to the Trust asking if the Trust would join the City Council and the Clinical Commissioning Group in signing up to the vision as set out below: The transfer of public health leadership from the NHS to the City Council is once in a generation change and opportunity for Public Health. Public Health being led from the City Council will broaden the scope of public health activity, and enable us to have an impact on a much wider range of factors that determine health and ill health for the people of Sheffield. We will build on this change so as to make the biggest possible impact on the health of the citizens of Sheffield. Our aims are both simple and ambitious: to promote good health; to prevent and tackle illhealth; to enable all of us as citizens to make healthier lifestyle choices; and to develop public health capacity and know-how across organisations and communities so as to make a real difference. Although health in Sheffield has improved dramatically in recent years, there are still populations within the City who suffer unacceptably poor health, and wide inequalities in health persist. Health inequalities are among the starkest manifestation of unfairness within our society, and we are committed to reduce them as much as possible. We seek to prevent avoidable ill health wherever it occurs, and to ensure that where ill health does exist, any barriers faced by disadvantaged individuals and communities to necessary treatment and care are removed. We will work with people to ensure they have maximum choice and control in designing their own solutions to things which adversely affect their own, their families and community s health. To do this we will work with local people and organisations to address the root causes of ill health. We will seek to ensure that the circumstances in which people live and work do not cause them to become unwell. However we are aware that lifestyle choices are heavily influenced by the circumstances in which people live, so that helping people to lead healthier lifestyles means in many cases changing those circumstances. We will seek to address not only the causes of ill health, but also the causes of the causes. Sheffield City Council will lead Public Health in the City beyond 211. We will turn the Council into a public health organisation, so that every contact the Council has with the people of Sheffield is designed to have a positive impact on their health. Furthermore, from within the Council we will organise the efforts of the whole of Sheffield society to promote health, prevent disease and prolong life. Wherever possible, we will prioritise improving the health of those whose health is currently poorest, so as to reduce Page 6 of 7

7 inequalities. Although Public Health will be led by the Council, Public Health capacity will not be restricted to it. Public Health expertise will also be active and visible in local communities, amongst GPs, in the NHS, in wider public services, in the voluntary, community and faith sector, and in local businesses. Our vision is that by doing all this, we will improve health and wellbeing for all. As you will be aware, subject to the passage of the Health and Social care bill, responsibility for public health at local level will transfer from the NHS to the City Council. This represents a new start for public health and so a timely point at which to articulate a new vision for public health in the city. I propose that the Board APPROVES the vision. 6. NATIONAL INSTITUTE FOR HEALTH RESEARCH FUNDING FOR CLINICAL RESEARCH FACILITIES I am pleased to report that the Trust has received 3.1m to support research into experimental new treatments through its clinical research facilities which are situated on both sides of the city. Sheffield is 1 of 19 centres across the UK to receive such funding which will cover a 5 year period from 212 to 217. Experimental medicine research within the Trust covers a wide range of specialities with particular strength in neuroscience / bone research / rheumatology / respiratory medicine / communicable diseases and diabetes and endocrinology. The research includes exploring new treatments in areas such as motor neurone disease and Parkinson s disease, looking at new ways to prevent stroke and researching new vaccines for meningitis. Sir Andrew Cash Chief Executive Page 7 of 7