The Royal Wolverhampton NHS Trust

Transcription

1 The Royal Wolverhampton NHS Trust Meeting Date: 3 th June 214 Trust Board Report Title: Executive Summary: Action Requested: Report of: Author: Contact Details: Resource Implications: Public or Private: (with reasons if private) Integrated Quality & Performance Report This report provides the Board with an update of performance against national and local quality and performance indicators for May 214. It also provides assurances to the Board of the actions taken for any indicator that is underperforming. To note: current progress To approve: any corrective actions identified. To sign off: Single Operating Model self-certification Chief Operating Officer Head of Performance & Compliance Tel: simon.evans8@nhs.net None Public Session References: (e.g. from/to other committees) Appendices/ References/ Background Reading NHS Constitution: (How it impacts on any decision-making) 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 Page 1 of 1

2 Integrated Quality & Performance Report May 214 1/25

3 Contents Executive Summary Quality Patient Experience Patient Outcomes Patient Safety Maternity Mortality National & Contractual Standards Workforce Waiting Times Urgent Care Cancer Stroke Organisational Efficiency 2/25

4 QUALITY EXECUTIVE SUMMARY Safety: The rate of falls remains the same, however, the number of falls causing harm has fallen below trajectory for the first time in 18 months. The number of pressure ulcers continues to reduce, however, the Trust has reported 3 avoidable ulcers for the first time since December due to errors in documentation and gaps in nursing care on the following wards; Stroke, A5 (T&O) and Deanesly. There were 3 amber medication incidents reported. The percentage of harm free care as measured through the Safety Thermometer remains high at 93.79%. The number of C.Diff cases was one so below trajectory. There were no safeguarding referrals received in May. Experience: The FFT score continues to remain within acceptable levels and mid range for the region. The response rate is improving in ED through the use of the texting system and is being implemented across the Trust. The patient's voice which asks specific questions about aspects of care will change in August to reflect questions from last year's CQC Inpatient Survey around medication and side effects. PERFORMANCE RTT: The overall targets for Referral to Treatment were compliant for the month, however, we did not achieve compliance for 2 specialities (General Surgery and Trauma & Orthopaedics) against the 92% incomplete target, the fine for this is likely to be around 44,3. There is a further fine in May, across the same two specialties, of around 22,8 for failing the admitted target. We failed to achieve diagnostic test compliance during May, this is largely due to a significant increase in referrals to Dexa scans and the subsequent backlog caused by this. A detailed action plan has been agreed, highlighting a number of actions to help to deal with this backlog and recover our position moving forwards:- Recruitment has been successful to a.8 wte post in Bone Densitometry and this individual on commencement in post will be trained to scan, therefore with two trained staff in post maximum utilisation of scan slots can be maintained. Bank staff; work has begun to identify DEXA operators employed by other Trusts who may be willing to carry out bank work for New Cross DEXA service. The fine for not achieving this target is likely to be around 38,4. Emergency Department: A&E continues to see increasing numbers with attendances in May 8.4% higher than the same period last year this equates to an additional 8 attendances. The Trust did not achieve Type 1 for the month, however, the overall target was achieved. Ambulance handover saw an improvement in month for 3-6 minutes, and we continue to see no patients >6 minute target. We saw an increase in ambulance conveyances of 12.82% compared with the same period last year. The fine for Ambulances during May is 8,2. This is based on 41 patients between per patient and patients >6 1, per patient. There were no patients who breached the 12 hour target during the month. 3/25

5 Executive Summary cont.. Cancer: We are currently predicting possible failure of the 31 Day Sub Surgery, 2ww Breast Symptomatic and the 62 Day Screening targets for May, validation is on-going and we continue to explore the possibility of re-allocation of late tertiary referrals back to the referring organisations. Final cancer data is uploaded nationally 6 weeks after month end. 62 day to first treatment - there were 11 patient breaches during the month of May - 3 x tertiary referrals, 2 x capacity issues (Urology), 1 x Patient Initiated and 5 x Complex Pathways. 31 Day Sub Surgery - failure to achieve this target is largely due to on-going capacity issues for Urological Surgery. 2ww Breast Symptomatic - we have continued to see extremely high numbers of referrals to the breast symptomatic clinics, this coupled with the mammogram machine failure in April and the subsequent re-allocation of patients has made this target unachievable in May. 62 Day Screening - This target is always very fragile due to very low numbers - we had 2 breaches during May 1 x Complex Pathway and 1 x Radiological investigation delayed by patient. WORKFORCE Staff turnover - remains below the national NHS average. Staff sickness - saw an improvement in month, and is reported at.36% above the Trust target of 3.24%. Absence during May, was.5% higher than the same period last year. All of the four Divisions achieved absence rates of below 4% in May 214. Sickness absence workshops continue in a majority of areas as does the targeted advice and support from Human Resources. esams has now been rolled our across the Trust. A programme of audits to monitor compliance with policy in hot spot areas is continuing. Training is also being provided where required. 4/25

6 QUALITY Patient Experience Cancelled Operations - Non-medical Reasons Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Surveillance Number of Cancelled Operations only Cancelled Ops as a % of Elective Admissions <.8%.63%.96%.83%.75%.79% Cancelled Ops as a % of Elective Admissions (Cumulative) <.8%.84%.85%.85%.75%.77% Comments: 52 operations were cancelled during May. A root cause analysis continues to be undertaken for every cancelled operation for non-medical reasons and is reviewed weekly at the Divisional Managers meeting. This is a 28.8% improvement on the same period last year (73 cancellations). The cancelled operations that fall into the 'other' category consist of 8 - Cardiac (1 x Consultant ill and 1 x Air Flow problem in theatre), Cardiology (2 x Consultant ill), General Surgery (1 x Communication error, 2 x Consultant unwell), Ophthalmology (1 x injection not available). Breakdown of Monthly Cancellations for Non-medical Reasons May-14 Ran out of More Urgent Air Con 8 Theatre No Beds Other Total Case(s) Broken 7 Time Cardiac Surgery Cardiology General Surgery Gynaecology Head & Neck Ophthalmology Orthopaedics Urology Total Cancelled Operations not Re-admitted within 28 days Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Number of patients not re-admitted within 28 days Number of Urgent Operations cancelled for 2nd time /25

7 Patient Experience cont. Complaints Number of Complaints Received Number of Complaints Re-opened The Trust received 36 complaints during May 214 in comparison to 38 received in the previous year. 1 complaints were re-opened during May 214 compared to 8 in the previous year. Division 1 saw 4 complaints re-opened (Trauma/Orthopaedics x 2, Cardiology x 1, Obs/Gynae x 1). Division 2 saw 6 complaints re-opened (Renal x 2, Paediatrics x 1, Cancer Services x 1, Sexual Health x 1 and Gastroenterology x1). 4 of the re-opened complaints have received a further response with the remaining 4 still under further investigation. Response Time of Complaints 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % 26 complaints were closed in May 214. Of these 26 complaints 12 complaints were responded to within 25 days. 7 complaints took between 25 to 35 working days to investigate and respond (1 with consent to breach, 6 without consent to breach). 7 complaints took longer than 36 working days to investigate and respond (3 with consent to breach, 4 without consent to breach). Overall the Trust response rate for May is 62% (a decrease on last months 79%). -25 Days Days Over 35 Days 6/25

8 Patient Experience cont. Mixed Sex Accommodation Breaches Comments: There were no single sex breaches reported during May. 2 1 Number of Breaches Number of Patients Impacted Friends & Family 85 Net Promoter Score The FFT remains at or above the national average at 75 with a slight reduction in ED FFT to RWT FFT Score RWT ED FFT Score Nat Avg FFT Nat Avg ED FFT 7/25

9 Patient Experience cont. Friends and Family Test Results by Division and Ward The Friends and Family Test by Division and Ward bar charts show quarterly results. Division 1 - FFT Score results by ward Quarter 3 Quarter 4 Apr-14 May Division 2 - FFT Score results by ward Quarter 3 Quarter 4 Apr-14 May-14 Friends and Family Response Rates 3.% 25.% 2.% 15.% 1.% 5.%.% Accident & Emergency Response Rates RWT England 4.% 35.% 3.% 25.% 2.% 15.% 1.% 5.%.% Inpatient Response Rates RWT England 8/25

10 Patient Experience cont. Patient and Carer Voice The Patient and Carer voice asks specific questions where we know, from the inpatient survey, that we can improve on. Question Did you feel cared for? Responses to patient buzzers Pain control Discussing worries and fears Patient involvement in decisions about discharge RWT Score National Survey - RWT Baseline Score (n=415) Not Applicable 6% 79% 54% 64.5% March 214 Score (n = av 957 ) 95.% 82.6% 95.4% 88.6% April 214 Score (n = av 944 ) 95% 76.9% 96% 9.1% 89.5% May 214 Score (n = av 867 ) 95.5% 77.2% 95.4% 89.8% 65% 87.7% 89.3% 86.1% 89.9% 88.8% The overall percentage for the Patient's Voice remains around 9%. The responses to buzzers has increased and patients continue to feel well cared for in the main. Duty of Candour Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Duty of Candour Incident Breaches 9/25

11 Patient Outcomes: Safety Thermometer: Harm Free Care The Safety Thermometer is a national initiative that records the presence of four harms on all patients on one day every month. The rationale for focusing on the four harms is because they are common and because clinical consensus is that they are largely preventable through appropriate patient care The Proportion of patients with any harm from a fall Pressure Ulcer Prevalence There has been just under 2% of patients recorded as having a fall with no harm throughout the Trust. In May from incident data we know that there were 2 falls causing harm in A12 and C18. New The number of pressure ulcers has fallen again in May. Old 1.2% 1.%.8%.6%.4%.2%.% Catheters & UTIs 1.%.9%.8%.7%.6%.5%.4%.3%.2%.1%.% New VTEs 96% 95% 95% 94% 94% 93% 93% 92% 92% 91% Safety Thermometer UTI's New UTI's Linear (New UTI's) There were 12 catheters and UTIs recorded in May with 5 of these being new in comparison to 3 in April. Only 3 New VTEs were recorded which is less than.3% harm to patients overall. Average Harm Free Care for 213/14 was 92.41%. Harm free care for May was 93.79%, we remain just below the Trust target of 95%. 1/25

12 Patient Safety Clostridium Difficile MRSA Comments: 18 positive by PCR. Of these 7 were attributed to RWT according to the internal definition of attribution, against a target of 9 for the month. 9 were positive by toxin test; 1 of these is potentially attributable to RWT using the external definition of attribution, against a target of 3 for the month. We can negotiate with the commissioners over this case, however, as only 'avoidable' cases actually count against our target E Coli Comments: The target for the year is no avoidable cases. We are still awaiting the decision of the commissioners over whether the April case is considered to have been avoidable or not MSSA Comments: 19 in total: 5 attributable to RWT using our internal definition of attribution, 3 attributable to RWT using the DH s definition of attribution. None were device related hospital acquired bacteraemia. No internal or external targets set. Comments: 7 in total: 3 attributable to RWT using our internal definition of attribution, 3 attributable to RWT using the DH's definition. No external target set, but internal target is 18 for the year, so 3 cases is over the target for the month but puts us one over for the year to date. Serious Incident Reporting Report Incidences within 48 hours Update on immediate actions of incident within 72 hours Share investigations report grade 1 (45 days) Share investigation report grade 2 (6 days) May-14 24/ % 28/28 1.% Comments: 28 incidents were reported to STEIS in May. The fine for not achieving 1% in the 48 hour standard is 1, for the month ( 25 per breach). 11/25

13 Patient Safety cont. Medication Incidents This report details the number of medication incidents reported through Datix. The data encompasses incidents involving nurses, pharmacists and doctors. Medication Incidents Division 1 Division 2 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 No Incidents causing serious harm (as classified by RPS) Comments: Division 1: There were 8 reported medication incidents in May of which 1 one rated Amber: A5, Warfarin was prescribed and administered alongside Acenocoumarol which is also an anticoagulant. Medical supervisor informed and nurse counselled. Division 2: There were 15 medication incidents in May of which 2 were rated Amber: Patient in community services has been under dosed insulin and blood glucose was found to be elevated at 14.4 mmols. CHU ward chemotherapy drug set up to be administered through an IV pump and wrong amount entered into the pump resulting in patient receiving 4 hours of chemotherapy over 1.5 hours Safeguarding Adults Division 2 Division 1 Comments: No Safeguarding Adult referrals were received during May. Division 1 - referrals received in May Division 2 - referrals received in May Safeguarding Children Community Hospital Site Comments: 32 Referrals were made to Social Care during May - 25 Child Protection referrals were submitted from the Hospital site and 7 from Community sites. 12/25

14 Patient Safety cont.. Radiation Incidents Comments: Radiology reported 3 radiation incidents during May against 2,753 examinations, therefore rate per 1, is.14. The number of radiation reported in Radiotherapy in May was 4 at a rate of 1.31 per 1, fractions. May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Radiotherapy Incident Rate per 1 Fractions Diagnostic Radiology Incident Rate per 1 Procedures WHO Surgical Checklist Compliance 1.1% 1.% 99.9% 99.8% 99.7% 99.6% 99.5% VTE 1.% 98.% 96.% 94.% 92.% WHO Surgical safety checklists are carried out in all operating theatres. 743 theatre sessions took place during May (2 were non-compliant), compliance for the surgical safety checklist is reported at 99.73% for the month. One debrief session was conducted in Eye-Infirmary Theatres without a surgeon present and no 'sign out' was conducted in Cardiac Theatres as the surgeon had left the theatre and staff were unsuccessful trying to contact him by mobile. VTE assessment remains high at 97.35%, remaining above target. The number of VTEs was 28 of which 16 were community acquired and 12 hospital acquired. % VTE Assessment % VTE Assessment Hospital Acquired VTE Community Acquired VTE 13/25

15 Maternity Unexpected Term Babies to Neo Natal Unit (level 3 care) 34.% 32.% 3.% 28.% 26.% 24.% 22.% 2.% C Section Rates There were two unexpected term admissions to NNU (needing level 3 care) during May. This indicator and target has changed for 14/15 reporting - this now only includes babies that require level 3 care on NNU May saw 344 births. C/S births saw a very slight deterioration. The directorate continues to review its induction processes as initial audit data findings identifies Primigravida inductions as a key factor in rising C/S rates. 7.% 6.% 5.% 4.% 3.% 2.% 1.%.% Percentage of 3rd & 4th Degree Tears 3rd & 4th degree tears are classed as significant perineal trauma at birth. The directorate grades the perineal tears as 3A - C and grade 4 and incidence is scrutinised locally to determine cause. Performance for May was 4.1% this is a deterioration in month and we remain above target by 1.2%. The table on the right delineates between grade 3 and 4 tears Number of 3rd & 4th Degree Tears 3A Degree 3B Degree 3C Degree 4th Degree 14/25

16 Maternity cont Midwife to Birth Ratio 22% 2% 18% 16% 14% 12% Smoking at Delivery Improvement in month. The directorate continues to liaise closely with HR with regards to recruitment. Smoking at time of delivery saw a very slight improvement of.4% from the previous month, we remain above target by 4.3% Adms of Full Term Babies to Neo Natal Unit*** C-Section Rates 3rd & 4th Degree Tears Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 < <26% 28.% 27.5% 27.1% <26% 27.% 27.5% <3% 4.3% 5.9% 2.1% <3% 3.2% 4.1% *** This indicator and target has changed for 14/15 reporting - this now only includes babies that require level 3 care on NNU Maternal Deaths Midwife to Birth ratio < < Smoking at Delivery <15% 17.9% 17.7% 19.8% <15% 19.7% 19.3% Breast Feeding Initiated >64% 65.% 66.4% 65.9% >64% 6.5% 62.4% Early Neonatal Death (Born Here) /25

17 Mortality Mortality ALL Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 HSMR Observed Death Rate 3.7% 4.1% 3.5% 4.2% 3.2% 3.3% 3.5% 3.4% 3.2% 4.% 3.6% 3.7% Expected Death Rate 3.8% 4.1% 3.7% 3.9% 3.4% 3.8% 3.4% 3.4% 3.7% 4.2% 4.% 3.7% No of in Hospital Deaths 1, Expected Deaths 1, Excess Deaths There is no update since the last report for HSMR as the data for this has not yet been published. RWT SHMI: April January 214 Trust Name SHMI SHMI 95% CI Lower SHMI 95% CI Upper Total Discharges Obs. Deaths Exp. Deaths In Hospital Deaths % In Hospital Deaths Crude Mortality Rate The Royal Wolverhampton NHS Trust ,89 1,725 1,829 1, % 3.39% The SHMI position for the Trust has consistently improved for this financial year, being the lowest in 4 years and significantly better than the benchmark. 3 Day Emergency Readmission Rate 6.% 5.5% 5.% Comments: This is a deterioration in month and we are currently.96% above target. 4.5% 4.% 3.5% 3.% 16/25

18 Waiting Times Referral to Treatment 18 Weeks - Admitted 18 Weeks - Non-admitted 18 Weeks - Incomplete Community - Referral to treatment information Community - Referral information Community - Treatment Activity information % of patients waiting >6 weeks or more for a diagnostic test Number of patients waiting >52 weeks 92% 91% 91% 9% 9% 89% NATIONAL & CONTRACTUAL STANDARDS Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 9% 9.2% 9.47% 9.35% 9.81% 9.82% 95% 96.16% 97.28% 97.28% 97.59% 97.91% 92% 92.2% 93.63% 94.7% 92.97% 93.48% 5% 75.6% 75.5% 75.99% 74.42% 75.47% 5% 98.2% 96.6% 97.6% 99.96% 99.98% 5% 99.7% 99.7% 99.7% 99.5% 99.5% <1%.%.%.% 7.79% 7.47% RTT Admitted 99% 98% 97% 96% 95% 94% Comments: Non-admitted continues to be achieved both by specialty and bottom line. Admitted and Incomplete pathways was achieved at bottom line level and with the exception of General Surgery and Orthopaedics this was also achieved by every other specialty. We failed to achieve diagnostic test compliance again during May, this is largely due to the significant rise in referrals to Dexa scan and subsequent backlog. A detailed action plan is in place with a number of actions identified to help recover this position. RTT Non-Admitted 96% 95% 94% 93% 92% 91% RTT Incomplete Fine: The fine for not achieving incompletes by specialty is likely to be around 23,9 for General Surgery & 2,4 for Orthopaedics. Admitted fine is likely to be around 12,4 for General Surgery & 1,4 for Orthopaedics. Diagnostic fine is likely to be around 38,4. 17/25

19 Urgent Care Total Time Spent in Emergency Department (4 hours) Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 New Cross 95% 92.88% 92.29% 96.32% 93.31% 93.76% Walk in Centre 95% 1.% 1.% 1.% 1.% 1.% Combined 95% 94.58% 94.3% 97.26% 95.2% 95.27% 13% 98% 93% 88% May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 New Cross Walk in Centre Combined Ambulance Handover Number between 3-6 minutes Number over 6 minutes Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar Trolley Waits in Emergency Department over 12 Hours Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Number of patients waiting over 12 hours in A&E Comments: The fine for Ambulances during May was 8,2. This is based on 41 patients between per patient and patients >6 1, per patient. There were patients who breached the 12 hour target during May. 18/25

20 Urgent Care cont Emergency Department Attendances Diff Apr-14 8,969 9, May-14 9,149 9, Diff 1-Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun The table on the left and the graph above show the current number of attendances for June 214 compared with the same period last year. In the first 18 days of the month we have seen an additional 854 attendances this is a current increase of 14.1% compared with the same period last year CAD Compliance Minimum Standard Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 CAD Compliance 8% 93.72% 94.81% Non A&E Clinical Handover Delays Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 1 Hour delay 3 Minute delay 2%.%.55% 25% 16.52% 2.78% 19/25

21 Cancer Waiting Times 2 Week Wait Cancer s 2WW Cancer 2WW Breast Symptomatic Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 93% 94.89% 96.69% 96.61% 94.99% 95.13% 93% 98.14% 94.12% 94.85% 85.39% 86.56% 31 Day Cancer s 31 Day First Treatment 31 Day Sub Treatment - Anti Cancer Drug 31 Day Sub Treatment - Surgery 31 Day Sub Treatment - Radiotherapy Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 96% 98.89% 98.33% 98.79% 97.6% 96.72% 98% 1.% 1.% 1.% 1.% 1.% 94% 94.74% 88.% 95.83% 8.49% 92.86% 94% 98.24% 1.% 1.% 99.45% 1.% 62 Day Cancer s 62 Day Wait for First Treatment 62 Day Wait - Screening 62 day Wait - Consultant Upgrade (local target) Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 85% 73.29% 79.26% 7.43% 85.11% 86.72% 9% 92.31% 91.67% 85.19% 95.% 81.82% 88% 91.59% 91.36% 93.64% 93.18% 94.17% Comments: 62 day to first treatment - there were 11 patient breaches during the month of May - 3 x tertiary referrals, 2 x capacity issues (Urology), 1 x Patient Initiated and 5 x Complex Pathways. 31 Day Sub Surgery - failure to achieve this target is largely due to on-going capacity issues for Urological Surgery. 2ww Breast Symptomatic - we have continued to see extremely high numbers of referrals to the breast symptomatic clinics, this coupled with the mammogram machine failure in April and the subsequent re-allocation of patients has made this target unachievable in May. 62 Day Screening - This target is always very fragile due to very low numbers - we had 2 breaches during May 1 x Complex Pathway and 1 x Radiological investigation delayed by patient. 2/25

22 Stroke Patients admitted with primary diagnosis of stroke should spend greater than 9% of their hospital stay on a dedicated stroke unit High risk patients will be assessed and treated within 24 hours 9% 88% 86% 84% 82% 8% 78% 76% 74% 72% 7% 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Comments: This is a significant improvement in month, we remain above target by 8%. Comments: This is a slight improvement in month, we remain above target by 24%. 21/25

23 Organisational Efficiency Choose and Book - Sufficient Appointment Slots This indicator measures RWT ability to offer appointment slots via Choose and Book. The target is to achieve less than 1% failure rate for all directly bookable appointments. 15% Comments: Although we have seen a slight deterioration in month, we remain below the upper limit by 2%. 1% The areas facing the biggest challenge are Ear, Nose & Throat, Orthopaedics, Urology and GI & Liver. 5% These issues continue to be escalated daily and are discussed weekly at the Divisional Managers meeting. % Upper Limit Delayed Transfers of Care Delayed transfers of care is based on the number of occupied bed days versus the number of delayed bed days during the month. The target is no more than 5%. 6% Delayed Transfers of Care 5% 4% 3% 2% May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Delay awaiting assessment Delay awaiting public funding Delay awaiting further NHS care Delay awaiting residential/nursing home Delay awaiting domiciliary package Delay awaiting equipment Delay awaiting family choice May 31.3% 3.1% 15.6%.% 12.5% 1.9% 26.6% 22/25

24 Organisational Efficiency cont.. Discharge Summary within 24 hours of Patient Discharge 1% 95% 9% 85% Comments: Discharge summary saw a slight deterioration in month and is reported at 9.76%, this means that we failed to achieve the target for the month of May. 8% Fine: The fine for not achieving this target in May is 1,. Patients with Fractured Neck of Femur May-14 Apr-14 Mar-14 Feb-14 Jan-14 Dec-13 Nov-13 Oct-13 Sep-13 Aug-13 Jul-13 Jun-13 May % of patients admitted with a fractured neck of femur underwent surgery within two days of admission % 2% 4% 6% 8% 1% 23/25

25 14.% 13.% Turnover WORKFORCE Turnover: We continue to achieve a much better turnover rate than the National NHS rate of 13.2%. 12.% 11.% 1.% 9.% 5.% 4.5% 4.% 3.5% 3.% Sickness Absence Sickness Absence: Sickness absence for the Trust decreased by.29% from 3.89% in April 214 to 3.6% in May 214, reducing the Trust's percentage to.36% above its target of 3.24%. May 214 rate absence rate is.5% higher than May 213. All 4 Divisions achieved absence rates below 4% during the month. 3 out of the 4 top reasons for absence in May 214 remain unchanged from those reasons recorded in the preceding month of April 214. All 4 reasons for absence saw an increase in May 214. Reasons are as follows:- Other Musculoskeletal problems 17.98% (increase of 3.2% from last month), Anxiety/stress/depression/other psychiatric illness 17.68% (increase of.18%), Gastrointestinal problems 1.47% (increase of.74%), Back problems 9.29% (increase of 1.33%). Actions: Sickness absence workshops continue in a majority of areas as does the targeted advice and support from HR. esams has been rolled out across the Trust, work is on-going with IT to resolve continuing issues. A programme of audits to monitor compliance with policy in hot spot areas is continuing. Training is also being provided where required. 8.% 7.% 6.% 5.% 4.% 3.% 2.% 1.%.% Temporary Medical Staff - Agency Spend.6%.5%.4%.3%.2%.1%.% Temporary Nursing Staff - Agency Spend Comments: Medical agency costs saw a deterioration in month from 6.3% in April to 7.5% in May. Surgical Division: saw an increase in month from 21K in April to 57K in May. Radiology spend remains high due to use of locum's to cover Radiographer vacancies, recruitment is underway, however, we will continue to use locum cover until vacancies are filled, this is likely to be around September time Medical Division: also saw an increase in month from 314K in April to 346K in May. A&E continues to remain high due to on-going vacancies at Consultant and Middle Grade level, as does Oncology due to Locum Consultants covering a vacant post and maternity leave. Stroke remains high due to continued use of a Locum Consultant covering maternity leave. 24/25

26 Workforce cont. Annual Appraisal Rates Surgical Division Medical Division Estates & Facilities Corporate Services Trust Total Q4 Results 213/14 Q1 Results 214/15 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 8% 85.1% 86.3% 84.8% 87.1% 87.% 8% 85.6% 88.4% 89.6% 9.% 87.5% 8% 91.% 92.4% 91.3% 92.1% 91.3% 8% 85.4% 85.8% 85.9% 87.4% 86.8% 8% 86.1% 87.9% 87.7% 89.% 87.8% Comments: May's position saw a slight deterioration, however, we remain above the target set for 214/15. The following areas are showing RED for under compliance i.e. <7% overall compliance. Surgical Division - Currently showing no departments as Red. Medical Division - Dermatology (6%), Diabetes (65.4%), Endoscopy (64.5%) and Neurology (69.6%) Estates & Facilities - Engineering Services (39.3%) Corporate Services - Hospital Services Mgmt (6%), Human Resources (63.3%), IT Department (54.5%) and Medical Illustration (16.7%) 95% 9% 85% 8% Trust Wide Annual Appraisal Rates 75% May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 % of Nurses - Registered Nurses Trained Nurses Head Count 2,78 % 73.9% Comments: Out of a total number of 2,843 nursing staff 73.9% are Registered Nurses (band 5 and above) Untrained Nurses % Total Nursing Staff 2,843 1.% 25/25