BOARD PERFORMANCE REPORT MEETING 18 th October 2006

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1 BOARD PERFORMANCE REPORT MEETING 18 th October 2006 Title of Document Performance Report Report Authors Lead Director Contact details: Hazel Soin-Stanley,Shafqat Sultan, Rizwan Malik and Simon Harris David Avis Director of Finance, Contracting and Connecting for Health Hazel Soin-Stanley - hazel.soin-stanley@swlondon.nhs.uk Shafqat Sultan - shafqat.sultan@swlondon.nhs.uk Rizwan Malik - rizwan.malik@swlondon.nhs.uk Simon Harris - simon.harris@swlondon.nhs.uk Aims This report provides the Board with updates on performance against national and local targets. Performance monitoring and reporting on these areas is aimed at ensuring that WPCT is an organisation fit to support in a Patient-Led NHS. Summary 1. The results of the 2005/06 Annual Health Check were published on 12 th October Wandsworth PCT received a score of weak for use of resources and fair for Quality of Services. A breakdown of the scoring and plans for the Annual Health Check 2006/07 are detailed in paragraphs The report also details the PCTs performance in the first set of national productivity indicators for the period of April to June The areas assessed are Financial Productivity and Clinical Productivity. A summary of performance against the indicators is detailed in paragraphs Performance against national and local targets is also reported as usual. Changes in performance status for the DH top seven performance indicators 2006/07 are; the MRSA target has moved to Red, the extension of Choice/Choose and Book target has moved to Amber, the 62 days cancer wait target has moved to Green. All other targets remain unchanged. These are detailed in paragraph and Appendix 1. Financial Balance Amber Health Inequality Targets Smoking Cessation Red Cancer 31 and 62 Day Cancer Wait Target Green The 18 week total wait target for 2008 Amber Halving MRSA Rates by March 2008 Red Extension of Choice to all F. Trusts April 06 Amber The Sexual Health 48 Hour Target Green Recommendations To note the performance of the PCT at month 6. Equality & Diversity Impact Assessment Monitoring of performance indicators relating to equality and patient experience are included in the corporate objectives report that is included quarterly in this report. Other Implications (including patient and public involvement/legal/governance/diversity/staffing) The report monitors the performance of target relating to patient experience. Financial Implications To be read in conjunction with the Finance Report October 2006 Performance Report 20 th October 2006 Page 1 of 27

2 INTRODUCTION 1. This report highlights the national targets against which the PCT is monitored and assessed. It also advises on remedial action, which is being taken to improve performance. This is reported in the first part of the report in the section describing External Monitoring. External monitoring relates to the PCT as a whole ( Corporate PCT ) and indicators span all parts of the PCT s business. 2. External monitoring also focuses on external reviews of our organisation. This month it reports the results of the 2005/06 Annual Health Check. It also provides the results of the first set of national productivity indicators for the period of April to June The second part of the report looks at the PCT s targets that are of key importance and warrant internal monitoring by the Board. For October this concentrates on progress with the Demand Management strategy and acute activity. 4. The finance report gives details of how well the PCT is doing against its control total for 2006/07, which is in-year financial balance plus a 3.3m surplus to be generated from the profit from land sales. The current position is assessed as amber but anticipated to move to green as the year progresses. EXTERNAL MONITORING (Corporate PCT) - ANNUAL HEALTH CHECK 5. The Board will be aware that on the 12th October 2006, the Healthcare Commission published its new annual performance rating for all NHS organisations in England. In previous years this took the form of a star rating ranging from 0 3 stars. However, this year the rating has changed format and is now a four point scale consisting of the ratings weak, fair, good or excellent. 6. The Healthcare Commission have also broken down the assessment of Trusts into two main areas, these are: a. Use of Resources - based on how well an organisation in the NHS manages its finances. b. Quality of Services reflects the range of areas within a healthcare organisation that can affect the care and treatment a patient receives 7. Wandsworth PCT received a score of weak for use of resources and fair for Quality of Services. All organisations that had a financial deficit in 2005/06 were automatically rated as weak, irrespective of in year financial recovery. 8. A full list of Annual Health Check scores for London is detailed in Appendix 2. Use of Resources 9. The score for use of resources is based on how well an organisation in the NHS manages its finances. This could include how it plans and reports on its financial performance, how it monitors the money it spends, and how it makes sure that the services it offers to patients represent good value for money. 10. Wandsworth Primary Care Trust was scored weak for use of resources as it did not meet its financial targets for 2005/2006. Performance Report 20 th October 2006 Page 2 of 27

3 11. This score was based on information received from the Audit Commission on financial reporting, financial management, financial standing, internal control and value for money. The Healthcare Commission gets its financial information from the local auditor s evaluation. The outcome of the Auditor s Local Evaluation (ALE) is given in Appendix 2a. 12. For use of resources, none of the 303 PCT s country wide scored excellent and only 24 were good. 155 were rated fair and 124 were weak. 13. Of the 31 London PCT s 9 were scored weak, 16 were scored fair and only 6 were scored good for the use of resources. 14. The finance report gives details of the plan to achieve in-year financial balance plus a 3.3m surplus to be generated from the profit from land sales. Quality of Service 15. The score for quality of services covers a range of areas within a healthcare organisation that can affect the care and treatment a patient receives, including access to services, safety and the way an organisation is run. 16. In particular, it reflects whether an organisation provides the basic standard of care required by the government and whether it strives to improve the care and treatment it provides for patients of the 31 London PCTs were scored fair for quality of service, 6 were scored good and 2 were scored weak. 18. Wandsworth Primary Care Trust was given a score of fair for the Substance Misuse review, good for the tobacco control review and weak for the review of Adult community mental health services. 19. WPCT could not achieve an overall score of good for quality of services because it received a score of partly met in existing national targets and fair in new national targets. 20. The table below shows the elements that make up the Quality of Services rating. Performance in core standards, existing targets and new national targets is reviewed in detail in this report. Performance in the reviews of substance misuse and tobacco control were reviewed in July Board report. The results of the Wandsworth PCT and LB Wandsworth Joint Adult Mental Health Commissioning Strategy are being developed into an action plan that will include addressing areas of weak performance reviewed in the Annual Health Check. This action plan will be detailed in the November Board report. Components Assessment of compliance with core standards Existing national targets New national targets Review of substance misuse Review of tobacco control Review of adult community mental health services Results Almost Met Partly Met Fair Fair Good Weak Performance Report 20 th October 2006 Page 3 of 27

4 Core Standards 21. Wandsworth PCT achieved a rating of almost met for compliance with core standards. 38% of all PCTs were awarded the same rating. 22. In May 2006 the Board declared that based on the evidence it had been provided with, it was able to declare that the organisation was meeting 21of the 24 core standards. For the remaining 3, it declared that there was insufficient assurance to make a clear decision on these. 23. For the 3 standards that were declared as not being met, action plans have been developed and are monitored on a regular basis. 24. The Clinical Governance Department, in conjunction with Clinical staff have developed a new concept called the Team Tool. This is designed to help clinicians monitor the "must-dos" when providing care via completing specific audits, (one per month) which are based on the core standards. It also provides a structured audit plan for the year for staff. 25. The first tool on Respect, Privacy and Dignity launched at the start of October and results are being returned to the Clinical Governance Department during this month. At the end of each month, all clinical teams will receive a report informing them of their score. The Board will receive bi-monthly reports on how all services within the provider arm are scoring in the audits so that they can identify good practice and areas of concern. 26. The core standards also relate to the PCT s commissioning functions and Independent Contractors and work is underway to combine current methods of assessment with core standard requirements. This will also be reported to the Board shortly. Existing National Targets 27. Existing national targets focus on patient access to health care services and waiting times. 28. Wandsworth Primary Care Trust was assessed against 19 of the 21 existing national target indicators. The organisation achieved 13 indicators, underachieved 3 indicators and failed to meet 3 indicators. 29. Progress against target for the 6 indicators that the PCT failed to meet in 2005/06 will be reported monthly to the Board. Indicators Plan Director (To be Advised) Achievement of plan for increasing the number of people who have quit smoking after four weeks PCT action plan agreed with SHA. Public Health is setting monthly targets to achieve year end target based on Salman Rawaf The percentage of category B calls receiving a response within 14 minutes in urban areas or 19 minutes in rural action plan. Agree action plan with London Ambulance Service and other commissioners in the sector David Avis Performance Report 20 th October 2006 Page 4 of 27

5 areas Indicators Plan Director Are crises resolution/home treatment services provided to all who need them? Action plan to be formulated with Mental Health Trust. Delayed transfers of care Convenience and choice: PCT facilities in place to support patients in choosing their hospitals Convenience and choice: booking of appointments, mapped to the PCT New National Targets No longer an AHC indicator to be monitored as a part of long term conditions strategy Choice of hospital booklets circulated to all GPs. Links to web sites available through Trust web pages. Well defined services on DoS. PALS given as contact for further information/telephone queries. Action plan agreed with SHA on the roll out of Directly Booked Services at QMH with completion by year end Ghazwa Alwani- Starr Ghazwa Alwani- Starr David Avis David Avis 30. The new national targets focus on the ways in which healthcare organisation can help to improve the health of the population. 31. Wandsworth Primary Care Trust was assessed against all of the 28 new national target indicators. The organisation achieved 21 indicators, underachieved 3 indicators and failed to meet 4 indicators. 32. Progress against target for the 7 indicators that the PCT failed to meet in 2005/06 will be reported monthly to the Board. Indicators Plan Directors Blood sugar and blood pressure levels of patients with diabetes Proportion of women aged 50 to 70 years screened for breast cancer Rate of smoking during pregnancy Community Matrons against plans Number of very high intensity user against plan Practices with validated registers of patients at risk of coronary heart disease Percentage of working age users of adult metal health services on the enhanced level of the care programmed approach (CPA) followed up within seven days of discharge from an inpatient setting Directorate of Strategy and Service Improvement primary care to action plan in the November Board Report Public Health to action plan in the November Board Report Public Health to action plan in the November Board Report Provider services to action plan in the November Board Report Provider services to action plan in the November Board Report Primary Care to action plan in the November Board Report Director of strategy and improvement to action plan in the November Board Report Ghazwa Alwani- Starr Salman Rawaf Salman Rawaf Di Caulfeild-Stoker Di Caulfeild-Stoker Ghazwa Alwani- Starr Ghazwa Alwani- Starr Performance Report 20 th October 2006 Page 5 of 27

6 EXTERNAL MONITORING (Corporate PCT) PRODUCTIVITY METRICS 33. In a letter to Chief Executives on 22 September, Duncan Selbie announced the first set of national productivity indicators for the period April to June These indicators provide a national set of information that can be used to benchmark current performance and to identify areas for further improvement. 35. Wandsworth PCT was ranked 3rd nationally and 1st in London for financial balance. A full report is provided in Appendix Wandsworth PCT is better than the national average in two of the clinical indicators (surgery rates and emergency admission rates) and worse in one (level of outpatient appointments); Wandsworth is 21st best nationally for surgery rates. 37. Wandsworth PCT was ranked 215th for outpatient appointments. All PCT's in the sector were below the national average. This presents Wandsworth with a productivity opportunity of 2.6 m. 38. If WPCT were to move into the top quartile nationally for each of its clinical / prescribing indicators (none of which it features in at the moment), it is estimated that 3.7m of savings could be made. 39. Wandsworth was ranked 167 th nationally for prescribing low-cost statins and was below the national average. All other PCTs in the sector were in the top quartile; therefore the pharmacy team will provide an action plan to improve performance in the November Board. EXTERNAL MONITORING (Corporate PCT) 40. The PCT is monitored on a range of external targets. The 6 key national targets, sometimes referred to as the Selbie s 6 were detailed in the Operating Framework for 2006/07. These are monitored and reported monthly. THE FOLLOWING TARGETS HAVE BEEN RATED AS RED Health Inequality Targets - Smoking Cessation 41. Health inequalities are a national priority and the key area of focus for 2006/07 is smoking cessation. The 2006/07 target of 2250 four week quitters is challenging. 42. Last month the Board were requested to note that the most accurate return is the quarterly data submitted to the SHA two months after the end of relevant quarter. Therefore the most accurate performance for Quarter 2 will be reported to the Board in December. 43. Again, the management team have requested that Public Health set internal monthly targets for meeting the end of year target. To date, this has not been done. 44. The PCT target for 2006/07 is to achieve 2250 four-week smoking quitters. The total number of quitters between April to September 2006 is 334 (15% against the target of 100%). Therefore performance remains consistently below what is required in order to achieve this target for 2006/07. Performance Report 20 th October 2006 Page 6 of 27

7 Halving MRSA rates by March The national target is to halve MRSA rates by March As there has been consistent overperformance against plan since April the MRSA target is now scored as Red. An update on progress with the action plan will be provided in the next Board report. 47. In the last Board report the figures at month 3 suggested that we were significantly overperforming against plan (26 cummulative actual cases against a cummulative target of 13). Figures for the period of September 2006 for St Georges show that the cummulative actual remain significantly above plan (38 against YTD plan of which giving a variance of 79%). St Georges are implementing their action plan and are anticipating improvement over next few months. THE FOLLOWING TARGETS HAVE BEEN RATED AS AMBER 18 Week Target - 20 Week Inpatient Waiting Time Target 48. The national target is that by April 2007 no patient waits more than 20 weeks. 49. In the last Board report it was reported that in July, the number of inpatients waiting 20 weeks or more was 22% greater than the LDP plans. In August performance against target is 9% greater. This would suggest that there may have been a data quality issue in August. 50. WPCT is meeting the target for 13 week wait for MRI and CT scan. Extension of Choice and Choose & Book 51. The target for choose and book is to achieve 90% implementation by March Between April and July actual outpatient s bookings via Choose and Book exceeded the monthly trajectories. However in September performance was 30% against the target of 31%. If this underperformance continues the reasons for this will be identified and detailed in the next report. THE FOLLOWING KEY TARGETS HAVE BEEN RATED AS GREEN Sexual Health 48 Hour Target 53. The target is for 100% Access to GUM Services within 48 hours by March The LDP trajectory for March 2007 is 71%. 54. In July 2006 performance against target was 85% at SGH and 82%at QMHR. Performance against this target has been consistently good this year. 31 and 62 Day Cancer Wait Targets 55. The national target is that 95% of patients are waiting less than 62 days from referral to treatment and that 98% of patients are waiting less than 31 days from diagnosis to treatment. 56. In the previous report underperformance against the 62 days targets was Performance Report 20 th October 2006 Page 7 of 27

8 reported. Both the 31 and 62 days cancer targets were achieved in August. EXTERNAL MONITORING (Corporate PCT) - MANPOWER PLANS 57. The summary of workforce, pay bill and agency spend is detailed in Appendix 4. INTERNAL MONITORING (Commissioning PCT) Acute Activity 58. The activity for Month 4 at our four main providers and all other providers is detailed in Appendix 5. The activity compares Month 4 performance in 2006/07 with the previous year. The data shows that: a. Outpatient appointments across all providers have reduced by 13%. This results from demand management action being taken by GPs and also a reduced number of consultant to consultant referrals. b. Total inpatient activity that includes all elective, non-elective, day cases and maternity have reduced by 2% in Month 4. c. Emergency admissions have decreased by 5.8%. Demand Management 59. The proposed saving at St.Georges through Demand Management initiatives is 2.7m. 60. The demand management plan is aimed at making financial savings by reducing; A&E attendances at SGH, unplanned emergency admissions, outpatient referrals and by reduction in excessive hospital length of stay and delayed patient discharge. 61. Monitoring of the Demand Management Plan has shown a significant improvement in outpatient attendances, length of stay and delayed patient discharge. 62. A&E attendances and non elective admissions are overperforming to plan. A& E attendance is up by against plan (5.5%) Q2 2006/07 when compared to Q2 2005/06. Pressures are also being experienced in obstetrics, drugs and devices and day cases. 63. Progress against the demand management work areas is summarised in Appendix 6. INTERNAL MONITORING (Primary Care PCT) 64. A balanced scorecard is attached for the provision of primary care. Key indicators have been agreed and baselines and performance is reported where data is available (Appendix 7). INTERNAL MONITORING (Provider PCT) 65. A balanced scorecard is attached for other provider services (community and QMH). Key indicators that have been agreed and performance where data available is included. At present there is very limited data available and the Board Performance Report 20 th October 2006 Page 8 of 27

9 is provided with a template that shows the key areas the PCT will be monitoring and reporting (Appendix 8). INTERNAL MONITORING (Corporate PCT) 66. Information will be provided to enable the PCT to judge its organisational health. The corporate objectives will be reported to the Board quarterly. RECOMMENDATIONS 67. The performance in the 2005/06 Annual Health Check, the Q1 2006/07 Productivity Metrics and against PCT targets should be noted. 68. The Board is asked to note the actions being taken to improve those indicators rated as red or amber. 69. The Board is asked to note that there is alot of new contents in the report and therefore there are gaps whilst in the process of setting up systems for monitoring and collecting data. Most data will be available for the December Board. David Avis Interim Director of Finance 18 th October 2006 Performance Report 20 th October 2006 Page 9 of 27

10 APPENDIX 1 Balance Score Card Performance Report 20 th October 2006 Page 10 of 27

11 APPENDIX 2 Annual Health Check Annual Health Check London PCTs Results PCTs Use of resources Quality of Services Barking & Dagenham FAIR FAIR Barnet FAIR WEAK Bexley WEAK GOOD Brent FAIR FAIR Bromley GOOD GOOD Camden FAIR FAIR City & Hackney FAIR FAIR Croydon GOOD FAIR Ealing FAIR FAIR Enfield FAIR FAIR Greenwich GOOD FAIR Hammersmith & Fulham FAIR FAIR Haringey FAIR FAIR Harrow WEAK FAIR Havering FAIR WEAK Hillingdon WEAK FAIR Hounslow WEAK FAIR Islington FAIR GOOD Kensington & Chelsea WEAK GOOD Kingston WEAK FAIR Lambeth GOOD GOOD Lewisham FAIR FAIR Newham FAIR GOOD Redbridge FAIR FAIR Richmond & Twickenham GOOD FAIR Southwark FAIR FAIR Sutton & Merton WEAK FAIR Tower Hamlets FAIR FAIR Waltham Forest WEAK FAIR Wandsworth WEAK FAIR Westminster FAIR FAIR Source: SHA London Performance Report 20 th October 2006 Page 11 of 27

12 APPENDIX 2a Auditors Local Evaluation Results of the 05/06 Healthcare Commision Annual Health Check & Audit Commission Auditor's Local Evaluation, released 12/10/06 Health Care Commision Rating Overall Score for Managing Resources Financial Financial Financial Internal Codes Organisation Org type Reporting Management Standing Control 5C2 Barking & Dagenham PCT PCT Fair A9 Barnet PCT PCT Fair TAK Bexley Care Trust Care Trust Weak K5 Brent Teaching PCT PCT Fair A7 Bromley PCT PCT Good K7 Camden PCT PCT Fair C3 City and Hackney PCT PCT Fair K9 Croydon PCT PCT Good HX Ealing PCT PCT Fair C1 Enfield PCT PCT Fair A8 Greenwich Teaching PCT PCT Good H1 Hammersmith and Fulham PCT PCT Fair C9 Haringey Teaching PCT PCT Fair K6 Harrow PCT PCT Weak A4 Havering PCT PCT Fair AT Hillingdon PCT PCT Weak HY Hounslow PCT PCT Weak K8 Islington PCT PCT Fair LA Kensington and Chelsea PCT PCT Weak A5 Kingston PCT PCT Weak LD Lambeth PCT PCT Good LF Lewisham PCT PCT Fair C5 Newham PCT PCT Fair NA Redbridge PCT PCT Fair M6 Richmond and Twickenham PCT PCT Good LE Southwark PCT PCT Fair M7 Sutton and Merton PCT PCT Weak C4 Tower Hamlets PCT PCT Fair NC Waltham Forest PCT PCT Weak LG Wandsworth PCT PCT Weak LC Westminster PCT PCT Fair Value for money Performance Report 20 th October 2006 Page 12 of 27

13 APPENDIX 3 Productivity Metrics PRODUCTIVITY METRICS Q REPORT Introduction The indicators used in Productivity metrics report provide a national set of information that WPCT can use to benchmark our current performance and identify areas for further improvement. The purpose of the indicators is to help us: Identify savings opportunities from improving performance in key areas Highlight the variation in performance across the NHS Inform local improvement planning and monitoring The construct of the indicators are detailed in Appendix 1. Section 1: Financial Productivity 1. Achieving financial balance This indicator shows whether or not an organisation is heading for financial balance at the end of the financial year, a fundamental requirement of the Department of Health. PCT National Ranking SW London Ranking Surplus (+) or deficit (-) ( 000s) Wandsworth ,300 Croydon Richmond & Twickenham Sutton & Merton , 500 Kingston , 200 Wandsworth PCT was ranked 3 rd nationally and 1 st in SHA: London. See appendix 2 2. Monitoring cash flow This indicator compares the year to date cash drawings from the Department of Health against those planned, giving a measure of current financial performance, shown as a percentage variance from plan. PCT National Ranking SW London Ranking % variance in cash from plan Sutton & Merton Wandsworth Richmond & Twickenham Croydon Kingston Wandsworth PCT was ranked 74 th nationally and 2 nd in South West London. See appendix 3 Performance Report 20 th October 2006 Page 13 of 27

14 3. Monitoring monthly run rate This measure compares recurrent income and expenditure for the last month of the quarter in question, giving a one-month indicator of financial balance. This is shown as a percentage variance from the planned position. PCT National SW London Variance from plan (%) Ranking Ranking Richmond & Twickenham 67 = 1 0 Croydon 67 = 1 0 Kingston 67 = 1 0 Wandsworth Sutton & Merton Wandsworth PCT was ranked 232 nd nationally and 4 th in South West London. See appendix 4 Section 2: Clinical Productivity 1. Managing variation in surgical thresholds Certain elective surgical procedures are carried out much more frequently in some PCT areas than others. In some cases the operation is performed in situations where it has little or no benefit for the patient. PCT National Ranking National Benchmarking Relative level of surgery Productivity opportunity Wandsworth 21 Top Quartile ,000 Richmond & Twickenham 112 National Average ,000 Sutton & Merton 156 National ,000 Average Croydon 166 Below National ,000 Average Kingston 198 Below National Average ,000 Top Quartile: Trust that performed in the top 25 % nationally National Average: PCTs that were in the top 100 PCTs nationally Below National Average: Poorer than average performance Wandsworth PCT was ranked 21 st Quartile See appendix 5 nationally and is in the national Top 2. Managing variation in emergency admissions Many patients present at A&E with problems which may have been avoidable if they had been managed better in the community. This is distressing for patients, but also wastes valuable A&E time and NHS money. Nineteen conditions have been identified where this is particularly likely. Performance Report 20 th October 2006 Page 14 of 27

15 PCT National Ranking National Benchmarking Relative level of emergency admissions Productivity opportunity Croydon 15 Top Quartile , 000 Richmond & 32 Top Quartile , 000 Twickenham Wandsworth 82 Above Average ,000 Sutton & Merton 93 Above Average ,082,000 Kingston 205 Below National Average , 000 Wandsworth PCT was ranked 82 nd nationally and are above the average national performance. See appendix 6 3. Managing variation in outpatient appointment Some outpatient appointments could be eliminated by handling them in other ways. Many patients could be treated effectively and more cheaply outside hospital altogether, and follow-up of some could be conducted over the telephone. PCT National Ranking National Benchmarking Relative level of outpatient appointments Productivity opportunity Croydon 171 Below Average ,174,000 Sutton & Merton 178 Below Average ,397,000 Wandsworth 215 Below Average ,656,000 Kingston 279 Below Average ,675,000 Richmond & Twickenham 282 Below Average ,955,000 Wandsworth PCT was ranked 215 th nationally. All PCTs within South West London were below the national average level of performance. See appendix 7 Achieving financial balance Indicator Construction This shows the forecast outturn operating costs for PCTs compared to the revenue resource limit for the full year, as forecast at the last month of the quarter in question. The figure is given as the absolute amount in thousands of pounds so there will be a tendency for larger PCTs to show larger variances between operating costs and resource limits. The operating cost is total forecast net operating cost minus non-discretionary expenditure for the full year. This is subtracted from the total forecast revenue resource limit for the full year. Monitoring cash flow This indicator shows actual cash drawings year to date compared to x/12ths of the current cash limit, where x is the number of months of the financial year elapsed to date. The variance is expressed as a percentage of x/12ths of the current cash Performance Report 20 th October 2006 Page 15 of 27

16 limit. A positive percentage indicates they have drawn more cash than expected, and a negative percentage indicates they have drawn less cash than expected. This is calculated as the actual year-to-date net discretionary draw down from the department of Health minus x/12ths of the current ash limit divided by x/12ths of the current cash limit expressed as a percentage. Monitoring monthly run rate This indicator is shows the variance between operating costs and revenue resource limit for the last month of the quarter, expressed as a percentage of the revenue resource limit for the month. Take actual net operating costs for the month and subtract any non discretionary expenditure. Subtract this from the revenue resource limit for the month. Then subtract any planned surplus or deficit for the month. The result is divided by the total actual revenue resource limit for the month and expressed as a percentage. A negative figure shows that the organisation has failed to achieve its financial plan for the month. The calculation excludes any nonrecurrent impact of RAB carry forward and the reversal of previous years financial support, in order to establish the true underlying recurrent position. Managing variation in surgical thresholds Rates of operations vary widely between different areas. Here we look at five procedures where there is evidence they are often overused and carried out on patients who derive little or no benefit as a result. An expected (average) rate of these five operations is calculated for each PCT based on the age, sex and social deprivation of the population. This expected rate is then compared to the actual rate and expressed as a ratio. A figure of 110 indicates a 10% higher level of activity than expected, whereas 90 indicate activity that is 10% lower than expected. The five procedures that are included in this indicator are tonsillectomy, dilatation and curettage, hysterectomy, lower back surgery and myringotomy (grommets). Managing variation in emergency admissions This is a ratio of actual emergency admissions to the expected level for these conditions, standardised by age, sex and population. Nineteen such 'Ambulatory Care Sensitive' conditions have been identified, and these include COPD, asthma, diabetes with complications and hypertension. Managing variation in outpatient appointment This indicator measures the rates of outpatient appointments within a PCT relative to the expected rates. The ratio shows the level of first attended outpatient appointments compared to the level that would be expected given national rates and adjusting for the age sex and need of your population. A figure of 110 indicates a 10% higher level of referrals than expected. In general, high or low figures may suggest poor management of thresholds for referral. Performance Report 20 th October 2006 Page 16 of 27

17 Achieving financial balance Performance Report 20 th October 2006 Page 17 of 27

18 Monitoring cash flow Performance Report 20 th October 2006 Page 18 of 27

19 Monitoring monthly run rate Performance Report 20 th October 2006 Page 19 of 27

20 Managing variation in surgical thresholds Performance Report 20 th October 2006 Page 20 of 27

21 Managing variation in emergency admission Performance Report 20 th October 2006 Page 21 of 27

22 Managing variation in outpatient appointment Performance Report 20 th October 2006 Page 22 of 27

23 APPENDIX 4 Summary of Workforce Wandsworth PCT Trust plan and actual Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Staff in Post (SIP) Plan Actual Paybill ( ) Plan Actual Medical Locum-Staff No's Plan Actual Agency-Staff No's Plan Actual Bank-Staff No's Actual Sickness-Staff No's Actual Leavers-Staff No's Actual Non cumulative and calculated monthly figures Paybill ( ) Medical Locum-Staff No's Agency-Staff No's Planned monthly total spend ( ) Actual monthly total spend ( ) Sickness-Staff No's Leavers-Staff No's Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar Average paybill per head Paybill Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar Performance Report 20 th October 2006 Page 23 of 27

24 APPENDIX 5 Quarter 1 Activity Performance Report 20 th October 2006 Page 24 of 27

25 Performance Report 20 th October 2006 Page 25 of 27 APPENDIX 6 Demand Management Project report

26 APPENDIX 7 Primary Care Scorecard Performance Report 20 th October 2006 Page 26 of 27

27 APPENDIX 8 Provider Arm Scorecard Performance Report 20 th October 2006 Page 27 of 27