Executive Directors. Author(s) Manager. performance. against key. Nil. Date. Owner. Officer. Committee. applicable) meeting Nil. Next Steps.

Transcription

1 SUMMARY REPORT TRUST BOARD Title of Report Accountable Officer Author(s) Purpose of Report Recommendation Consultation Undertaken to Date Signed off by Executive Owner 5 July 28 Agenda Number: 8 Integrated Performance Report Executive Directors Jo Davis, Associate Director Commissioning & Performance Richard Johnson, Head of Quality & Safety Compliance Graeme Booth, Financial Planning Manager Ruth Bardell, Deputy Director of HR & OD O Claire Florey, Access and Performance Manager Judith Laity Strategy Programme Manager The objectivee of this report is to provide the Board with the Trust s performance against key targets andd draw attention to those areas under revieww by the Executive Team. The IPR includes performance against key national and local quality, operational, finance and workforce targets. The Board is recommended to: Receive the report Nil. Director of HRR & OD, Director of May 28 Strategy & Business Development, Medical Director, Chief Operating Officer, Chief Nurse, Joint Chief Financial Officer Reviewed by Executive Team Reviewed by Board Committee (where applicable) Reviewed by Trust Board The Trust Board receive the IPR at every (where applicable) meeting Monthlyy Date(s) at which previously Nil. discussed by Trust Board / Committee Next Steps The Board will continue to be updated on Trust performance via the monthly Integrated Performance Report. Executive Summary The Integrated Performance Report highlights the key performance issues related to: Quality; Key Operational s; Finance;

2 Our People; Partnerships. The Executive Summary on page 2 of the report provides a summary of the data for May 27 and commentary on the wider aspects of our performance for the year thus far. Financial Risks Key Risks Disclosure Statement Equality and Diversity Statement The report summarises the financial risks for the Trust. The Integrated Performance Report sets out mitigating actions in respect of most principal risks in the Board Assurance Framework Performance data is held by the Trust and is used to produce the Integrated Performance Report. Audits have not identified data quality issues. There are no performance metrics relating specifically to Equality and Diversity in this report. 2

3 SUMMARY INTEGRATED PERFORMANCE REPORT May 28

4 EXECUTIVE SUMMARY 2 Quality & Safety: There were 4 cases of Clostridium difficile reported in May, above the monthly tolerance. Although 5 Serious Incidents breached the national timescale for investigations, other markers of incident management are improving FFT response rate target for inpatient/daycase has achieved 25% target for the first time, meeting the Q target. Emergency and Birth responses still underperforming. No dissatisfied complainants were received in May but only 28% complaints closed in May within expected timeframe, deteriorating from 38% in previous month. Regarding Sepsis, admission of IV antibiotics being given within the hour for inpatients has improved for the second consecutive month Benchmarked data for mortality are rising but remain below national average; this is in the context of a stable crude mortality rate Operational Performance: The success of Gold Command Control led to major improvement across the range of patient flow indicators. The whole system emergency care access standard remained above both the 92% local trajectory and the national 95% standard at 96.6%. Delayed transfers of care as a snapshot percentage of days lost reduced to 4.9%, largely due to increased care home bed provision purchased by Cornwall Council this is the lowest in 2 years. Patient flow pressure improved significantly in month due to Gold Command the escalation status was OPEL or 2 throughout the month for all but 2 days. All stroke access indicators were achieved as a result of the improved patient flow. The number of cancelled on the day operations not treated within 28 days fell as anticipated to 9, the lowest since September 26. cancellations on the day were fewer than May last year. Neither the diagnostic nor the RTT standards were met in month and both will not be met in June; however for the st time in 2 months incomplete performance improved albeit slightly and whilst the RTT 52 week wait trajectory was not met, the number (23) reduced for the st time in 4 months. The Trust continues to meet all of the quarterly cancer standards, all standards were met in month and quarter although April is likely to see non achievement of the 62d standard. 57% of fractured neck of femur patients were operated on within 36 hours, not meeting the 8% standard this was due to an increase in paediatric demand over the Bank and halfterm holidays. Finance: Reported deficit of 4m year to date, which is.m worse than plan. Key risks are: The design and delivery of savings schemes to achieve the 2m cost improvement programme target. Containing expenditure on service developments within planned sum of 5m within the year. Agency spend totalled.5m in month which is an increase of.4m from the previous month. Our People: Total staffing deployed during May increased by 58 FTE of which substantive staff increased by 2 FTE and temporary staff increased by 46 FTE. Sickness absence reduced by.% to 3.35% which is within the Trust standard. Appraisal compliance during May improved by 4.% to 77.3% and reflects the second month of improvement following a period of sustained decline in compliance. Vacancies remain high at 572 FTE posts actively in the recruitment process. Focus continues on recruiting to substantive clinical posts. Mandatory training compliance decreased by.6% to 84.%. This is % below standard and % below the level at this time last year. Partnership: Progress continues towards an ICP through new system leadership posts, Ethna McCarthy will be Director of Planned Care working alongside the existing Director of Urgent Care, Director for Model of Care Development, Finance Director and others in the core team. Combined ED and MIU attendances were 5.5% higher (6 attendances) in May 8 than May 7, the majority of the increase is in the MIUs. Cornwall continues to meet all financially linked KPIs.

5 CONTENTS 3 Section Name Accountable Officer/s Page Section Summaries 4 Quality & Safety: Patient Safety/Experience Chief Nurse Key Unless noted on each graph, all data shown is for the period up to, and including May 28. Directorate/Group Abbreviation Glossary Measure shows a decline in performance over the previous 3 month period. Quality & Safety: Patient Safety/Outcomes/Effectiveness Medical Director 2 Key Operational s Chief Operating Officer 27 Finance Director of Finance 39 Our People Partnership Director of Human Resources & Organisational Development Director of Strategy and Business Development CEO FUW NIHSS DOSA SI SHMI YTD RTT DTOC HSCIC HSMR FTE SRO ECIP Chief Executive Follow up waiting NIH Stroke Scale Day of surgery admission Serious Incident Summary Hospital Level Mortality Indicator Year to date referral to treatment delayed transfer of care Health and Social Care Information Centre Hospital ised Mortality Ratio Full time equivalent Senior Responsible Officer Emergency Care Improvement Programme

6 QUALITY PATIENT SAFETY SROs Medical Director and Chief Nurse 4 Section Summary Areas of Concern: Four cases of C.difficile have been reported in May which is above the monthly tolerance of 2 cases and brings the total to date to 9 which is a concern. 3 (39%) Serious Incidents breached the national timescale for investigation ( 56%) 5 Serious Incidents were declared during May. Trends: The rate of new harm free care (RCHT acquired harm) currently sits at 97.79%; a slight decrease on previous month however remains above target (98.8%). Improvements: As part of the Cornwall Safety Collaborative, current service improvement activity is focusing on evaluating the paperwork and process of a post fall safety huddle on one ward. Zero cases of MRSA Bacteraemia were reported in May. Actions: A comprehensive improvement plan is in place to remedy the issues with Serious Incidents both backlog and process. A thematic review is being carried out and the NHSI Infection Control Lead will carry out a Fresh Eyes review to identify any further areas for improvement.

7 QUALITY PATIENT EXPERIENCE Accountable Officer : Chief Nurse 5 Section Summary Trends: Rates of dissatisfied complainants has remained consistently low for six months. FFT showing an upward trend in response rates. Areas of concern: The rate of complaints breaching response timescales continues to worsen with only 28% of complaints closed during May being closed by agreed date. FFT response rates for Emergency and Birth remain below target for the month and quarter. Improvements: The inpatient / day case response has achieved the highest response rate ever, exceeding the end of Q target of 25% by.8% in May (26.8% ) Actions: Associate Directors of Nursing continue to drive improvements in FFT within their respective divisions. Care Opinion roll out will be part of the Patient Experience Project within the Strong Governance work stream of the Trust Quality Improvement Programme Issuing weekly complaints reports with central team assistance to recover complaints response time.

8 QUALITY PATIENT OUTCOMES/EFFECTIVENESS SRO Medical Director 6 Section Summary Areas of Concern: The number of cardiac peri arrest calls has increased from previous months, but this is subject to monthly variation and is not an established trend Trends: Mortality rates for weekday and weekends continue to (slightly) deteriorate though remain positively under the national average. Re setting against national averages is expected in coming months Improvements: The crude mortality rate for the RCHT slightly improved in April. The level of screening upon admission for Sepsis remains at an excellent (compliant) position. Actions RCHT continues to show only one sustained red flag HSMR diagnosis (acute cerebrovascular disease) and the formal report from the external peer review has now been received. The introduction of the Sepsis screening tool on NerveCentre remains on target for September. Work has commenced on the introduction of NEWS2, due to be fully in place by April 29.

9 KEY OPERATIONAL STANDARDS SRO Chief Operating Officer 7 Section Summary Areas of concern: RTT incompletes and 52 week waits, 6 week diagnostics, non bed related elective cancellations on the day, follow up outpatients past their to be seen date, fractured neck of femur patients operated on within 72 hours and short notice outpatient clinic cancellations. Trends: Failure to achieve both the RTT and diagnostic standards continued, whilst 52 week waits and the number of overdue outpatient follow ups remain significantly high. Quarterly cancer standards performance continues to be sustained though pressures on the 62 day pathways is on going. Measures deteriorating for 3 or more consecutive months were ED unplanned re attendances, diagnostics and the day case rate. Cornwall continues to meet all financially linked KPIs. Improvements: Improvements to flow related metrics including ED 4 hour performance, ambulance delays, stroke unit admission as well as time spent on the stroke unit and DTOCs associated with Gold Command were sustained. RTT incomplete performance improved for the st time in 2 months and the number of 52 week waits reduced (albeit slightly) for the st time after 4 months of deterioration. Actions:. Focus continues at an Executive level to continue to realise benefits from the Gold Command control in a sustainable way. 2. The RTT specialty level recovery plans are being closely managed to ensure actions are delivering at the required scale and pace to improve RTT, 52 week and diagnostic waits.

10 FINANCE SRO Director of Finance 8 Section Summary Areas of Concern: Reported deficit is marginally worse than plan. Shortfall in savings schemes identified to date. Savings schemes of.5m have been identified against the 2m cost improvement target. A proportion of the identified schemes are assessed as high risk for delivery. The delivered savings are lower than plan. Income levels improved in May although are still below plan for the year to date. Agency spend was.5m in May and this is.4m higher than in the previous month. Trends: Surgical Services overspent again in month. There is high medical agency spend in the Division. This brings a risk to the overall financial plan. Improvements: Income levels improved month on month. Actions:. Identify the.5m shortfall in the savings target and reduce the risk in relation to the schemes identified. 2. Ensure that additional costs for Service Developments are limited to 5m in the year.

11 OUR PEOPLE SRO Director of HR and OD 9 Section Summary Areas of Concern: Recruitment continues to be a focus. Active vacancies in the recruitment process total 572 FTE of which 88 FTE are for registered nurses. Agency use increased by 56 FTE compared to April and at 77 FTE is at an unsustainable level and cost. This contributed to increased pay costs in month by.57m. Trends: Mandatory training compliance continued a downward trend, reducing by.6% to 84.%. This represents % below the level at this time last year and is % below standard. Improvements: Attendance improved for the third consecutive month as sickness reduced by.33% to 3.46%. Appraisal compliance improved during May by 4.% to 77.3%. However, there remains work to do as this is 7.7% below standard and 4.6% lower than at this time last year. Actions: Work continues to recruit substantively to vacancies to reduce agency use.

12 PARTNERSHIPS SRO Director of Strategy and Business Development Section Summary Areas of Concern: Prompt discharge Delayed transfers of care remain higher than plan, however they remained under 5% and marginally reduced from the April position (standard 3.5%). ED/MIU attendances A 5% increase in MIU and 2.2% in ED attendances compared to May 7. New Model of Care Delays in the implementation of the new Hip and Knee pathway remain a significant risk to the timely achievement of objectives. The focus now is on expediting delivery, which will be led by CFT, including implementation of smaller scale process changes, whilst the digital systems are developed. Trends: The position on DTOCs remains unchanged, the year to date trend is a reduction compared to previous years. Improvements: Delayed transfers of care remain at lowest point since May 6 following interventions of Gold control. Actions: Operational Plan 8/9 The Trust s plan has been adopted by the Trust Board and reflects shared system priorities, a short /visual plan on a page will now be distributed across the Trust. System Planning A workshop has been held with practitioners across health and social care to identify opportunities for increased prevention and improvement to Falls services. This will be developed into a programme of interventions over the forthcoming weeks, as part of the next priority Pathway.

13 QUALITY & SAFETY PATIENT SAFETY Summary Dashboard

14 QUALITY Patient Safety Safety Thermometer Accountable Officer: Chief Nurse 2 % 99% 98% 97% 96% 95% 94% 93% 92% () Safety Thermometer: % New harm free care Mean UCL LCL % New harm free 3.% 2.5% 2.%.5%.%.5%.% (2) Safety Thermometer: Catheters and UTIs Mean UCL LCL Catheters & UTIs () The new harm free care (RCHT hospital acquired harm) decreased slightly in May to 97.79% (from a high of 98.5% in April). Eleven new harms were recorded across 5 patients. This is in line with the national average (97.8%). (2) Zero new Catheter Associated Urinary Tract Infections were reported this month in the point prevalence audit. RCHT Catheter prevalence in May was much lower than previous months highs to 6.8%. Thenationalprevalencerateforacute Trusts is 8.9%..2%.%.8%.6%.4%.2%.% (3) Safety Thermometer: New VTEs Mean UCL LCL New VTEs 3% 2% % % (4) Safety Thermometer: Pressure Ulcers Mean UCL LCL % of new pressure ulcers (3) May s audit identified six new VTE harms (.%). Nationally the rate of harm is.5% for Acute Trusts. Further work on assuring accuracy of submitted data following switchover to the online submission system since April is underway to understand this high rate. (4) The Trust reported four new pressure ulcer harms in May s survey. All Category 2, the lowest level of harm reported and the same as the previous month. This is a point prevalence percentage of pressure related harms of.7%. The national average is currently.9%.

15 QUALITY Patient Safety Safety Thermometer and Falls Accountable Officer: Chief Nurse 3.4%.2%.%.8%.6%.4%.2%.%.4%.35% (5) Safety Thermometer: Falls with Harm (7) Moderate/Severe Harm Falls Mean UCL LCL (6) Falls per bed days Mean UCL LCL (5) On the Safety Thermometer data collection day in May, nine slips, trips and falls were reported (two higher that April). Seven falls were categorised as no harm and two low harms. Low Harm indicates a cut to an arm or the face for example. The Trust s overall falls rate was.7% compared to a national average this month of.5%. The Trust s falls with harm rate was.4% compared to the national average of.5%. (6) This month saw a further fall in Datix incident reported inpatient slips, trips and falls per overall bed days. May s data was 4.5 compared to 5.3 in April. This is the lowest rate for over twelve months. This downward trajectory mirrors previous years, so focus on sustaining this rate is required..3%.25%.2%.5%.%.5%.% Mean UCL LCL (7) Zero severe harm incident related to a fall was reported on Datix in May. As part of the Cornwall Safety Collaborative, current service improvement activity is focusing on evaluating both the documentation and the process as regards a post fall safety huddle on Karensa Ward.

16 QUALITY Patient Safety Infection Control Accountable Officer: Chief Nurse (8) MRSA 2 Tolerance (9) MSSA Cases Mean UCL LCL (8) cases of MRSA reported during May. 4 (9) 2 cases of MSSA bacteraemia were reported in May. One is related to an infected blister which occurred whist in hospital however we have not been able to identify the root cause and the other is still under review. (,) 4 cases of C.difficile have been reported in May which is above the monthly tolerance of 2 cases and brings the total to date to 9; which is a concern. Intensive practice facilitation processes are being implemented in the 2 wards with the most cases. A thematic review is being carried out and the NHSI Infection Control Lead will carry out a Fresh Eyes review to identify any further areas for improvement. () C Difficile Cases Mean UCL LCL Tolerance () C Difficile Tolerance 7/8 8/9 Tolerance 8/9 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

17 QUALITY Patient Safety Infection Control 5 5 Accountable Officer: Chief Nurse (2) Gram Negative Bacteraemia Total Mean UCL LCL Organism Total (3) Gram Negative Bacteraemia E. Coli Klebsiella Psuedonomas All Organism Total Total (2,3) Gram negative bacteraemia 3 cases of E.coli were reported in May. One is thought to be related to a UTI which was present on admission, one is thought to be biliary sepsis and the other is still under review. No lapses in care have been identified. One Klebsiella bacteraemia has been reported. This related to an abscess which was present on admission to hospital. No pseudomonas bacteraemia have been reported.

18 QUALITY & SAFETY PATIENT EXPERIENCE Summary Dashboard 6

19 QUALITY Friends & Family Test Response rates Accountable Officer: Chief Nurse Inpatients and Daycases Maternity (Antenatal Care) 9% % 27% 96% % Maternity (Postnatal Community) % % Maternity (Birth) 6% 97% % Outpatients 95% % Emergency Departments % 94% % Maternity (Postnatal Ward) 9% 3% Response Rates Recommended Not Recommended 7 In May 3,845 responses to the Friends and Family Test were received. Response rate targets Q Q2 Inpatient/daycase 25% 26% Emergency 5% 5% Maternity Birth 25% 26% The inpatient / day case response rate of 26.8% is the highest ever achieved exceeding the Q target. Emergency response rate of 9.86% remains well below the 5% target but is the best result so far in 28 Recommended Q Q2 targets Inpatient/daycase 98% 98% Emergency 95% 95% Maternity Birth % % Not Recommended threshold When Not Recommended scores hit 5% this can indicate issues in service. The Postnatal Ward Not Recommend score has reduced from 6% last month to 3% this month. Wheal Prosper has a high score of 7% which is due to extremely unlikely response in 3 responses overall. No comment on survey to cross reference the response

20 QUALITY Patient Experience Complaints Accountable Officer: Chief Nurse % 95% 9% 85% 8% 75% 7% 65% 6% (4) Total number of formal complaints (6) % complaints acknowledged in 3 working days Mean UCL LCL Total in Month (5) Total number of informal complaints % 8% 6% 4% 2% % (7) % Complaints responded to within agreed timescale Mean UCL LCL Total % responded to within timescale (4, 5) 34 formal and 75 informal complaints were received in May. (6) Complaints Regulations require that complaints are acknowledged within 3 working days of receipt. 94% of complaints achieved this in May with 2 breaches. Investment in the corporate Complaints Team, with new team members joining in July, will include a full time administrator to support the team and ensure that all complaints are acknowledged within 3 working days. (7) The Trust aims to respond to complaints within 3 working days unless agreed otherwise with the complainant. Of all complaints closed In May, only 28% were responded to within 3 working days, down from 38% in April and 55% in March. This decline is directly attributable to the very strong focus on reducing the backlog of incidents and serious incidents in the Divisions which are currently being prioritised. To assist the Divisions in recovering performance around complaints, the Complaints Team are issuing weekly status reports and will reinstate central case management of complaints after new team members join in July.

21 QUALITY Patient Experience Complaints Accountable Officer: Chief Nurse (8) Complaints per bed days (2) Mixed Sex Accommodation breaches Mean UCL LCL Value Mean (9) Dissatisfied Complainants Mean UCL LCL Total (8) The number of complaints received per, bed days has steadily decreased over the past 3 months. This can be attributed to staff being encouraged to try and resolve concerns there and then which results in a better experience for the patient. (9) There were no dissatisfied complainants (complainants who are not satisfied that the first response has fully answered their concerns) in the month of May. There is a robust quality assurance checking process which is completed prior to Chief Nurse approval ensuring that responses are scrutinised for accuracy prior to being sent to the complainant. However, the number of complaints closed this month has decreased and it is expected that this figure will rise next month as more responses are sent to complainants. 3 2 UCL LCL Total (2) There were no non clinically justified single sex breaches reported in May.

22 QUALITY Patient Experience Compliments & Ratings Accountable Officer: Chief Nurse (2) Total compliments Mean UCL LCL Total Current NHS Choices Rating Based on 49 Ratings for the Hospital (RCH Treliske) Source: (2) Total compliments received during May was 74. Online feedback continues to be mostly positive. The Trust aims to respond to all feedback left on Care Opinion and this is measured as the % of the last stories responded to. This fluctuates during the month but at end of May was 89%. Three stories have now led to change. In May, feedback about being unable to contact audiology has resulted in improved and additional contact details being made available on public websites such as NHS Choices. Care Opinion Response rates (Treliske) The roll out of Care Opinion promotional material, and licences to enable managers to respond to feedback directly, now sits within the Strong Governance work stream of the Trust s Quality Improvement Programme. Access and guidance for responding in the public domain, will be rolled out across the Trust during Q and Q2 and should be in place in every service by the end of Q3. Source: Twitter Followers: 595

23 4 3 2 SAFETY Patient Safety Never Events & Serious Incidents Accountable Officer: Medical Director (22) Never Events (24) SI Investigations SIs breached SIs not breached (23) Serious Incidents (25) Serious Incident Types: Apr 27 May 28 VTE Information Governance Medication incident Abuse / alleged abuse of adult patient by staff Disruptive / aggressive / violent behaviour Healthcare Acquired Infection Other Abuse / alleged abuse of child patient by third party Pressure Ulcer Major incident Maternity / Obstetric: baby only Sub optimal care of the deteriorating patient Surgical / invasive procedure incident Diagnostic incident delay / failure to act on test results Treatment delay Slips. Trip, falls Date incident declared /8 28/9 (22 & 23) There were 5 Serious Incidents reported in May: 2 28/22: Treatment delay (GS) 28/59: Patient fall (Gastroenterology and Liver Unit) 28/75: Treatment delay (TU) 28/94: Child safeguarding (ED) 28/42: Unexpected admission to NNU (Truro Birth Centre) 28/6: Treatment delay (GS) 28/474: Treatment delay (Kedhlow Building) 28/559: Treatment delay (Cardiac Investigation Unit) 28/578: Treatment delay (SAL) 28/228: Treatment delay (ED) 28/2245: Treatment delay (Truro Birth Centre) 28/2692: Treatment delay (Ophthalmology) 28/36: Sub optimal care of the deteriorating patient (ED) 28/3224: Treatment delay (Dermatology) 28/34: Sub optimal care of the deteriorating patient (ED) (24) Of the 75 SIs underway in May, 34 were due with KCCG in month. The current overdue backlog KPI stands at 3. (25) Treatment delays are the most common reason for Serious Incidents.

24 SAFETY Patient Safety Medicines Management Medicine Reconciliation Accountable Officer: Medical Director 22 9% 85% 8% 75% 7% 65% 6% 55% 5% 45% 4% (26) Medicine Reconciliation (26) The accurate prescribing of medicines at the transfer of care is a high risk area and medicines reconciliation is a key control measure undertaken by the clinical pharmacy team. Pharmacy undertakes >2, meds recs a month for >8% of patients (excluding <24hrs, paeds, Obs and SMH). NICE guidance is to achieve % of patients within 24hrs. RCHT achieves approximately 65% within 24hrs and 86% overall. Options to improve medicine reconciliation are being explored within divisions Current improvements in this metric are due to the implementation of a team huddle each morning which ensures the team are very aware of current operational pressures and performance.

25 QUALITY & SAFETY PATIENT OUTCOMES/EFFECTIVENESS Summary Dashboard 23

26 QUALITY Patient Outcomes/Effectiveness Mortality Accountable Officer: Medical Director 24 SHMI / HSMR / SMR (27) Rolling HSMR by Non weekend/weekend (28) SHMI, HSMR, SMR and Crude Mortality Crude Mortality SHMI Rolling 2 month HSMR Nonweekend HSMR SMR Weekend Crude Mortality (27) The SHMI is the ratio of observed deaths to expected deaths. It includes those patients who die within 3 days of discharge. The HSMR is the ratio of observed deaths to expected deaths for a basket of 56 (clinical classification system) diagnosis groups which represent approximately 8% of in hospital deaths. The overall HSMR is at 97.8 and remains positively below the national benchmark of and continues to sit within the expected range. The crude mortality rate remains stable. (28) The improvement in weekend mortality compared with weekday has been sustained (HSMR for patients admitted at the weekend remains below that for patients admitted during the week (95.36 compared to 97.8). RCHT continues to show only one sustained red flag HSMR diagnosis (acute cerebrovascular disease) and the formal report from the external peer review has now been received and a range of actions have been developed.

27 QUALITY Patient Outcomes/Effectiveness Sepsis Accountable Officer: Medical Director % 9% 8% 7% 6% 5% 4% 3% % 8% 6% 4% 2% % (29) Patients who met the criteria and were screened for sepsis ED & other admitting areas (3) Patients who met the criteria and were screened for sepsis Inpatients % 8% 6% 4% 2% % % 8% 6% 4% 2% % (3) IV antibiotics within hour (severe sepsis) ED & other admitting areas (32) IV antibiotics within hour (severe sepsis) Inpatients *When looking at the results on these graphs it should be noted that the information is derived from the CQUIN audit, which only requires 5 emergency admissions and 5 inpatients notes to be used as a data source, where available. (29) 98% screening was achieved in admitting areas. This is based on non screen out of 5 sets of notes reviewed (3) There has been another increase in the giving of antibiotics within the hour. (3) There was an increase in screening for inpatients again. This is based on 2 patients out of 5 reviewed. Neither of the 2that were not screened had sepsis. 25 (32) There was an increase in antibiotics being given within the hour for inpatients. This was based on 3 patients all of which had had their antibiotics within the hour. The plan is for the Sepsis screening tool to be implemented in September within the Enerve centre which should improving screening and intervention in sepsis.

28 QUALITY Patient Outcomes/Effectiveness Cardiac and Peri Arrests Accountable Officer: Medical Director (33) Cardiac Arrests per bed days (34) Cardiac Arrests (33,34) The number of cardiac arrests in May () less than previous 2 months (). (35) The number of peri arrest calls has reduced from previous months in 28 May (5) April (9) March (7) Feb (7) Jan (8). There is a reduction from the previous years May 27 periarrest calls (6) May 26 (). It was hoped with continued use of Nervecentre, expansion of the outreach service along with more appropriate use of Treatment Escalation Plans the Trust would see a sustained reduction in the number of cardiac arrests. This info has been highlighted to the Resuscitation Committee and D&E group. 26 (36) 3 out of patients (who were eligible for the Call to Balloon audit) received reperfusion within 5 minutes of calling for help in May. This equated to 8.3%, meeting the 75% standard. (35) Peri Arrests (36) Primary PCI 'call to balloon' of 75% within 5 minutes.% 8.% 6.% 4.% 2.%.%

29 Key Operational s Summary Dashboard Accountable Officer: Chief Operating Officer 27

30 Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 28 Emergency Department Heat Map & Patient Flow Alert Status HOUR OF THE DAY DATE /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ /5/ Alert Status The heat map shows the number of patients in the Treliske Emergency Department at the start of each hour. This includes both majors and minors, as well as all adults and paediatric patients. The alert status shows the status provided on the daily bedstate at the start of each day. The improved OPEL status achieved in April was sustained for most of May, with only 2 out of the 3 days on level 3 (red) escalation the remaining days were all either green or amber (alert status and 2). The movement of the medical take to the Acute Medical Unit continued to have a significant positive impact on ED crowding.

31 Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 29 Winter Pressures Dashboard May 28 Category Indicator STANDARD TREND ED ED 4hr Emergency (RCH + WCH) 95% 8.% 79.7% 77.7% 8.7% 84.5% 85.5% 84.5% 8.3% 74.2% 8.9% 73.7% 66.% 69.3% 65.2% 78.7% 95.2% 92.6% ED ED 4hr Emergency (Type RCH) 95% 75.5% 75.% 72.5% 76.7% 8.6% 8.5% 8.3% 74.7% 67.6% 77.6% 68.% 57.8% 6.8% 56.6% 73.% 94.% 9.% ED ED Departures left unseen ѱ 5%.4%.5% 2.% 2.8% 2.9% 2.5% 3.3% 4.% 3.6% 2.4% 2.7% 2.9%.9% 2.2% 2.%.4%.4% ED ED Unplanned reattenders ѱ 5% 7.9% 7.2% 8.% 7.6% 7.2% 7.6% 7.8% 7.5% 7.8% 7.9% 7.8% 8.% 7.2% 7.% 7.3% 7.8% 7.9% ED ED Time to triage (95th Percentile) ѱ ED ED Time to treatment (Median) ѱ ED ED Decision to admit (Mean) ѱ ED ED 2 hour trolley waits ѱ 7 ED ED Avg patients in department ѱ ED ED Hours with >5 patients in department ѱ ED ED Medically Expected patients in department at 8am ѱ ED ED Medically Expected patients in department at 4pm ѱ ED ED Average Medically Expected patients in department at 4pm ѱ Inpatient Medical Outliers Inpatient Surgical Outliers 3 3 Inpatient Bed occupancy (Base Wards only) 88% 89.3% 89.2% 89.9% 89.2% 87.% 9.9% 9.2% 9.% 89.9% 9.3% 92.% 87.4% 85.8% 87.6% Inpatient Stranded patients (LOS>7) Trust average Inpatient Super Stranded patients (LOS>2) Trust average Inpatient DTOCs Acute All Inpatient DTOCS Community All DTOCS All All Inpatient DTOCs Acute Social Inpatient DTOCS Social (Acute & Community) Ambulance Ambulance delays > 3 mins Ambulance Ambulance delays > 6 mins Sepsis Emergency Sepsis Antibiotics within 6mins 9% 68.% 56.% 79.% 6.% 7.% 65.% 73.% 6.% 7.% 67.% 77.% 67.% 36.% 43.% 5.% 54.% 48.% Staffing Safe Staffing Fill Rates 96% 94.7% 96.6% 97.7% 97.8% 96.4% 95.7% 94.% 96.% 97.6% 94.9% 95.3% 9.4% 94.% 96.5% 97.3% 99.6% 98.6% ED audits Care Rounds 9% 96.% 9.% 9.% 87.% 94.% 97.% 9.% 88.% 9.% 93.% 92.% 84.% 82.% 9.% 82.% 95.% 89.% ED audits Pain 9% 88.% 95.% 8.% 9.% 87.% 9.% 95.% 89.% 89.% 86.% 9.% 86.% 86.% 94.% 75.% 8.% 88.% ED audits Documentation 9% 89.% 94.% 9.% 88.% 96.% 94.%.% 94.% 96.% 87.% 87.% 83.% 88.% 83.% 87.5% 92.5% 78.% ED audits NEWS 9% 94.% 9.% 89.% 7.% 93.% 8.% 9.% 9.% 9.%.%.% 9.% 9.% 9.%.% 9.%.% ѱ = Type RCH Only Worse than last year AND not meeting standard Better than last year but not meeting standard/ worse than last year but meeting standard Meeting standard, or improved on last year where no standard exists

32 Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 3 % 95% 9% 85% 8% 75% 7% 65% 6% 7% 6% 5% 4% 3% 2% % % (37) ED & MIU (from July7) attenders 4 hours arrival to discharge, admission or transfer (39) Ambulance Delays % waiting over 5 minutes Local trajectory % Waiting over 5 mins 9% 8% 7% 6% 5% 4% 3% 2% % % (38) Unplanned reattendance at ED (% of total attenders) (4) Ambulance Handover Delays 3 & 6 Minutes Threshold min Over 3 Mins Over 6 Mins (37) Performance against the emergency 4 hour access standard continued above both the local trajectory of 92% and the national 95% standard at 96.6% due to the ongoing impact of Gold Command. (38) Unplanned re attendances (patients returning to ED within 7 days of their original attendance) increased for the fourth consecutive month, rising to 7.2%. This remains under the most recently available national figure of 7.9% (March 8). (39, 4) Both ambulance measures remained low as crowding remained eliminated from the department due to the significant improvements in patient flow. The percentage of ambulances waiting over 5 minutes to handover reduced to 2% this compares to 58% in May last year. None waited over 6 minutes. The median time to triage patients arriving by ambulance was 9 minutes this is the same as the latest national average (March).

33 6% 5% 4% 3% 2% % % Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer (4) % of ED Attenders who left without being seen (42) 95th percentile, Time to Initial Assessment (mins) 3 (4) The percentage of ED attenders who left without being seen was.4%; remaining well within the 5% standard. (42) 95 th percentile time to initial assessment improved significantly as anticipated due to the removal of crowding from ED achieved through Gold Command actions improving patient flow. The 95 th centile wait was 25 minutes, 3 minutes less than May last year. (43) Median time from arrival to treatment increased to 59 minutes, just below the 6 minute standard. Improvements in this quality indicator are expected with the improvements in patient flow. (44) There were no 2 hour trolley wait breaches in May (43) Median Time from Arrival to Treatment (mins) (44) 2 hour trolley waits

34 Key Operational s Length of Stay Accountable Officer: Chief Operating Officer 4% 35% 3% 25% 2% 5% % 5% % (46) Length of Stay over days 32 (45) Specialty outliers reduced slightly again to 28, 4 more than May 27. (46, 48) The additional care home beds purchased by Cornwall Council during Gold Command continue to have a positive effect on long lengths of stay LOS over days reduced again to 29.9% compared to 3.6% in May last year. Average LOS was 3. days a further improvement and.3 days better than the same month last year. (47) Morning discharge performance increased to 2.9%. (45) Total specialty outliers (47) % Discharges Between 6am and am 4.% 3.5% 3.% 2.5% 2.%.5%.%.5%.% % Patients discharged before am (48) Average LOS (monthly average over 3 years)

35 Key Operational s Cancer Accountable Officer: Chief Operating Officer 33 99% 98% 97% 96% 95% 94% 93% 92% 9% 9% 9% 89% 88% 87% 86% 85% 84% 83% 82% 8% 8% (49) Cancer 2 week wait (5) Cancer treated within 62 Days Target % 99% 98% 97% 96% 95% 94% % 95% 9% 85% 8% 75% 7% 65% 6% (5) Cancer treated within 3 Days Target (52) Percentage receiving first definitive treatment within 62 days of urgent referral from national screening service (49 52) The 62 day referral to treatment and 62 day screening standards were not met in April with the majority of the breaches occurring on the colorectal pathway. The 62 day standard is expected to remain challenging in quarter, given continued difficulties with aspects of the diagnostic pathway. A number of recovery plans are in place in diagnostic specialties to deliver increased capacity. There were 4.5 breaches of the 4 day backstop target: colorectal, 5 day breach due to diagnostic and surgical outpatient capacity; 2.5 Lung breaches. 6 days due to complex pathway, 3 days due to complex diagnostics and one at 32 days due to complex diagnostics and tertiary delays;.5 Urology at 57 days due to delayed diagnostic pathway, referred to Tertiary centre on day 98. The Trust retains its record of quarterly achievement on all standards since Q2 2.

36 Key Operational s Referral to treatment Accountable Officer: Chief Operating Officer (53) RTT Incomplete % within 8 weeks 95.% 9.% 85.% 8.% 75.% 7.% Local Trajectory (53) For the first time in 2 months the percentage of incomplete referral to treatment (RTT) pathways over 8 weeks improved, rising from 78.4% to 79.3%, fractionally below the local trajectory of 79.4%. (54) The overall RTT waiting list reduced to 2558, remaining stable after several months of growth. (55) The number of specialties not meeting the RTT standard improved by 3 to 24. The specialties with the biggest backlogs remain Surgical specialties and Cardiology. (56) Diagnostic performance deteriorated again for the 3 rd consecutive month, falling to 93.8%. Pressure areas in particular remain non obstetric ultrasound, endoscopy (colonoscopy) and Urology. Whilst recovery plans are in place in the relevant specialties, the standard will not be met in June. 34 (55) Total Backlog for Specialties Not Achieving Non Admitted Breaches Admitted Breaches (54) Incomplete pathways Trajectory 5 (56) Proportion of patients receiving one of the 5 Key Diagnostic Tests within 6 weeks.% 98.% 96.% 94.% 92.% 9.% Paediatric Nephrology Colorectal surgery Upper Gastrointestinal Paediatric Surgery Cardiology Paediatric Urology Trauma and Vascular surgery Respiratory Medicine Urology Paediatric Diabetic Dermatology General surgery Gynaecology Oral surgery ENT Hepatology Paediatric Ophthalmology Rehabilitation Gastroenterology Rheumatology Clinical Neurophysiology Paediatric Cardiology Jun 8 Aug 8 Oct 8 Dec 8 Feb 9

37 Key Operational s Cancelled Operations Accountable Officer: Chief Operating Officer (57) RTT waits over 52 weeks for incomplete pathways Jun 8 Aug 8 Oct 8 Dec 8 Feb 9 3.5% 3.% 2.5% 2.%.5%.%.5%.% (58) Percentage Cancellations on same day (57) At the end of May there were 23 referral to treatment pathways over 52 weeks. Whilst this was above the local trajectory of 23, this was 3 fewer than the previous month the first time this has reduced in 4 months. (58) Reportable cancellations on the day increased slightly from April s record low of.6% to.%. There were 59 cancellations on the day, 24 fewer than May last year. Of the 59, only 4 were bed related the top reason for cancellations was insufficient time. The most affected specialties were Orthopaedics, Cardiology and Vascular (59) 28 day re booking breaches & urgent operations cancelled more than once Breaches Urgent More than Once 7% 6% 5% 4% 3% 2% % (6) Short notice OP Clinic cancellations (59) The number of 28 day rebooking breaches reduced significantly as anticipated, this time to 9 the lowest since September 26. (6) 4.9% of clinics were cancelled with less than 6 weeks notice within the range of normal variation. 52% (63) of those cancelled with less than the required notice (as stated in the Trust s Access Policy) were cancelled for avoidable reasons (mostly planned absence and rota issues). This is static. % Trajectory

38 Key Operational s Specialised Pathways Fractured Neck of Femur & Stroke Indicators Accountable Officer: Chief Operating Officer % 9% 8% 7% 6% 5% 4% 3% 2% % % % 9% 8% 7% 6% 5% 4% 3% 2% % % (6) NOF patients operated on within 36 hours (63) Stroke unit within 4 hours % 9% 8% 7% 6% 5% 4% 3% 2% % % % 9% 8% 7% 6% 5% 4% 3% 2% % % (62) % Patients spending 9% of their time on stroke unit (64) Stroke patients receiving CT scan within 2 hours (6) The percentage of patients with fractured neck of femur (NOF) operated on within 36 hours was 56.8%, below the 8% standard. 36 Exceptions continue to be reviewed in detail at the bi monthly NOF meeting. (62, 63) The stroke metrics related to flow remained above their respective standards 76.8% of patients were admitted to the Stroke Unit within 4 hours, whilst 89.% of patients spent 9% or more of their time on the unit (the standard is now 83.8%). Again, this is fundamentally due to the increased patient flow seen as a result of Gold Command interventions. (64) The percentage of stroke patients receiving at CT scan within 2 hours fell slightly to 92.9%, fractionally below the increased standard of 93.5% (based on the most recently available national average).

39 Key Operational s Specialised Pathways Stroke Indicators Accountable Officer: Chief Operating Officer (65) Scanning CT Urgent within hour % 9% 8% 7% 6% 5% 4% 3% 2% % % % 9% 8% 7% 6% 5% 4% 3% 2% % % (66) Swallow screening within 4 hours (65 68) Performance against the remaining stroke indicators continues above the respective standards other than swallow assessment which dipped very slightly below the increased standard of 87.%. 37 *Please note that all standards for stroke are based on the most recent national averages. These have all been reviewed and updated for the new financial year, hence the changes in some of the standards. (67) NIHSS Compliance % 9% 8% 7% 6% 5% 4% 3% 2% % % % 9% 8% 7% 6% 5% 4% 3% 2% % % (68) Swallow Assessment 72 hours

40 Key Operational s Productivity and efficiency measures Accountable Officer: Chief Operating Officer 38 4% 2% % 8% 6% 4% 2% % (69) Delayed transfers of care (days lost %) (7) Delayed transfers of care by reason Public Funding Residential Home Patient or Family Choice Nursing Home Further non acute NHS care Domiciliary Package Completion of assessment Community Equipment (69) Delayed Transfers of Care (DTOC) percentage of days lost (from the validated national snapshot data) reduced to 4.9%, the best achieved since May 26. This remains due to the significantly reduced number of long stay patients achieved during Gold Command, which is likely to be fundamentally due to the additional care home capacity commissioned by Cornwall Council as part of Gold Command. (7) The top categories for delay are further non acute NHS care and domiciliary packages, however both categories remain the 2 with the greatest improvement. 88% 87% 86% 85% 84% 83% 82% 8% 8% (7) Daycase rate % 98% 96% 94% 92% 9% 88% 86% 84% (72) DOSA Rate (7, 72) The daycase rate reduced for the 3 rd consecutive month to 83.2% compared to 86.4% in May last year. This is likely due to RTT recovery plans targeting long waiting theatre cases and is reflected in the improved day of surgery admission rate.

41 Key Operational s Productivity and efficiency measures Accountable Officer: Chief Operating Officer 39 7% 6% 5% 4% 3% 2% % (73) Net Emergency Readmissions within 28 days 7.5% 7.% 6.5% 6.% 5.5% 5.% 4.5% (74) All OP DNA Rate National UQ (73) Net emergency readmissions within 28 days was 6.% the upper limit of normal variation it was 5.5% in May last year. (74) The outpatient DNA rate increased to 6.% after April s low 5.8%. (75) The proportion of follow up outpatients waiting more than month past their to be seen by date reduced to 5.3% but remains high. % 9% 8% 7% 6% 5% 4% 3% 2% % % (75) Patients on the FUWL Month Past Their To Be Seen Date 4.% (76) Average Points per Clinic The biggest backlogs remain in Ophthalmology, Urology, Hepatology and Cardiology. The Trust s Clinical Harm Review Panel is developing a process with support for the Transformation Team to standardise harm review processes and reviews are underway. The co efficient tool continues to be used to inform risk assessment and booking prioritisation. (76) Average points are used as a measure of productivity within outpatient clinics, with attended new patients equating to 2 points and follow ups to. The average points per clinic reduced to. remaining on an overall downward trend.

42 FINANCE Summary Dashboard 4

43 FINANCE Income, Expenditure and Savings Accountable Officer: Director of Finance 4 ms 2.. (2.) (4.) (6.) (8.) (.) (2.) (4.) (77) I&E Surplus / (deficit) actual v plan Plan ms (78) CIP actual v plan Plan (77) I& E For the year to date the Trust has a 4m deficit which is.3m worse than plan. The forecast for the full year remains the planned.9m deficit although there are risks to this related to the savings shortfall and high agency spend. Patient related income was largely on plan in M2 which is an improvement against M. The Trust s block contract with Kernow CCG secures income levels although it should be noted that there continues to be significant underperformance in relation to elective activity against plan. Surgical Services reported a cumulative adverse variance against plan of c.25m caused by the backfilling of vacant posts and the level of sickness. Expenditure In month, pay totalled 2.6m against a budget of 2.2m. Pay is.3m over budget for the year to date. Non pay spend for the year to date is as planned. (78) CIP Savings of.8m have been delivered against a plan of.2m. Half of the savings to date are nonrecurrent.

44 FINANCE Cash and Capital Accountable Officer: Director of Finance (79) Capital spend actual v plan 4. (8) Cash actual v plan (79) Agency spend Monthly spend totalled.5m in May compared to.m in April. ms Plan ms Minimum cash balance The 2 most expensive agency staff cost the Trust 259k in month 2 compared to 3k in month. In month 2, there were 72 agency workers that have worked for the Trust for more than two months, down from 8 in March. (8) Cash The cash balance at the end of the month was m. This will reduce during the year and the Trust will need cash support based on its.9m planned deficit (8) Agency and Locum spend actual v plan (8) Capital Capital spend is below plan although is expected to return to plan by the year end. The Trust expects to operate within its Capital Resource Limit. ms Plan

45 OUR PEOPLE Summary Dashboard 43

46 OUR PEOPLE Key Workforce Indicators Accountable Officer: Director of HR & OD (8) Sickness rate (Month) 5.% 4.5% 4.% Sickness % 3.5% 3.% 2.5% 2% % % 9% 8% (82) Turnover rate Turnover % (8) Sickness absence in May decreased by.% to 3.35%. The current rate is within standard. Longterm absence at 2.36% is much higher than short term at.58% p.a. predominantly due to stress and MSK problems. (82) Turnover decreased by.2% to 9.2% for the year to 3 May. Circa 3% of turnover is due to annual training rotations for junior doctors. (83) Pay spend increased in May by.57m compared to April. As shown in the Total Staffing chart, net temporary use increased by 46 FTE and substantive staff increased by 2 FTE in May. (84) Active vacancies represent those in the recruitment process; between the approval to recruit to the starter joining the Trust. During May the number of FTE vacancies being advertised increased by FTE to FTE. 44 (83) Pay Expenditure ( m's) Pay Spend 7 6 4% 2% % 8% 6% 4% 2% % (84) Active Vacancies % Total Active Vacancies Active Registered Nurses Active Medical Staff

47 OUR PEOPLE Key Workforce Indicators Accountable Officer: Director of HR & OD 45 8% 6% 4% 2% % 8% 6% 4% (85) Vacancy Gap % Total Vacancies Total Registered Nurses Total Medical Staff % 95% 9% 85% 8% 75% 7% 65% 6% 55% 5% (86) Appraisal Rate Appraisal % (85) The vacancy gap reflects funded establishment less substantive staff in post. Both the total and nursing vacancies reduced as recruits started work following the April peak of new investment funding. Medical vacancies continued to reduce during May following successful recruitment. (86) Appraisal compliance in May improved notably by 4.% to 77.3%. This is the second month of improvement following a sustained period of declining compliance. However, compliance is 4.6% below the same point last year and 7.7% below the 95% of eligible staff standard. % 95% 9% 85% 8% 75% (87) Mandatory Training Rate Training Compliance (88) Total Staffing FTE Substantive Bank Agency (87) Mandatory training compliance in May decreased by.6% to 84.%. Compliance is currently.% below standard and 7% lower than at this time last year. (88) Total staffing deployed in May increased by 58 FTE of which substantive staff increased by 2 FTE and temporary staff increased by 46 FTE. Across temporary staffing, bank usage reduced by FTE and agency increased by 56 FTE.

48 OUR PEOPLE Key Workforce Indicators Accountable Officer: Director of HR & OD 46 % 9% 8% 7% 6% 5% 4% 3% 2% % % (89) Agency Framework / Cap Compliance All Nursing Medical AHP Agency Framework Cap Compliance (89) Challenges remain to find cap compliant agencies. However, agency framework compliance during May remained very high with medical and AHP staff at % compliant. 99% of agency nursing shifts were framework compliant and 3.5% were cap compliant during May.

49 OUR PEOPLE H&S Reporting Accountable Officer: Chief Operating Officer (92) Sharps Incidents reported (93) Number of RIDDOR reports (92) The number of sharps incidents is showing an overall downward trend, but there has been an increase in the last 4 months. The number of incidents relating to dirty sharps has reduced to 5, but there has been an increase in the number of splash incidents (). (93) RIDDOR reports decreased again to 2 this month, both patient related falls. (94) There were no reported cases of occupational dermatitis. This still remains low. There is a potential change to the glove supplier possible, that may impact on the number of cases seen (94) Confirmed cases of occupational dermatitis

50 Partnership Offer, integrated care, as close to home as possible Summary Dashboard Accountable Officer: Director of Strategy and Business Development 48 3.i Develop Shaping Our Future (SOF) with our partner organisations. Progress continues towards an ICP through new system leadership posts, Ethna McCarthy will be Director of Planned Care wef st July 28, working alongside the existing Director of Urgent Care, Director for Model of Care Development, Finance Director and others in the core team. A new work stream within the Pathways Programme has been formally launched with a multi professional, multiorganisational workshop on Falls held in June. Data shows the Cornwall STP to benchmark poorly against peers on the number of falls. Priorities for improvement will be confirmed in July, focussing on falls prevention and reducing falls in community settings (out of hospital). Model of Care development is continuing with small tests of concept across localities including a frailty pilot at WCH in conjunction with Penwith locality, intended to impact ahead of winter. Implementation of the MSK pathway is now focussing on what can be achieved without IT developments to offset further delay.