TAUNTON AND SOMERSET NHS FOUNDATION TRUST Performance Report Report to: Trust Board on 25 September 2013 Purpose of the Report: To update the Trust Board on the Trust s performance to August 2013. The report provides a summary of performance in key areas, and highlights the main risks and issues. Sponsor: David Allwright, Director of Corporate Planning & Performance Author: Contact Details: Kelvin Grabham, Associate Director of Performance & Information Russell Nightingale, Corporate Performance Manager Kelvin.Grabham@tst.nhs.uk Russell.Nightingale@tst.nhs.uk Indicative Timings (Minutes) 15 Financial/Resource Implications: Risk Implications Link to Assurance Framework or Corporate Risk Register: Legal Implications: Link to CQC Essential Standards Freedom of Information Status: Previous Considerations: Action Required: Potential contractual penalties and investment in additional capacity IC001 Infection Control (MRSA) 15 (15) IC002 Infection Control (C.Diff) 20 (15) F1003 Operating Framework & Contract 20 (15) PC004 Orthopaedic RTT 15 (15) CS009 Cancer Targets 16 (16) EU003 Delivery of Financial Plan 16 (12) TB001 HOT Site 15 (15) IN001 Cerner Contract 15 (0) AM001 Poor Patient Experience 15 (9) RTT 18 weeks is a legal right for patients from 1 April 2010 and part of the national contractual requirement. Outcome 16 - Assessing & monitoring the quality of service provision. Tick if one of the following apply: Data protection staff or patient detail Commercially sensitive Stakeholder management Early stage of discussion Potentially prejudicial to staff morale or partnership working Monthly For information and discussion Performance Report Page 1 of 5 TSTA/09.13
1. INTRODUCTION This report presents a summary of high level performance for the Trust as at the end of August 2013 highlighting key risks and issues. 2. PERFORMANCE AGAINST KEY TARGETS Summary Headlines The Trust continues to achieve national referral to treatment (RTT) targets at an aggregate level for admitted and non-admitted pathways; The Trust achieved the national A&E target of 95% of patients seen within 4 hours in August (95.2%); All eight Monitor cancer targets were met in August. 2.1 Referral to Treatment (RTT) 2.1.1 RTT Admitted (90%) In August the Trust achieved the 90% admitted pathway target at an aggregate and specialty level excluding Orthopaedics (87.5%), ENT (80.7%), Ophthalmology (88.9%) and General Surgery (87.0%). As part of the Trust s backlog reduction plan extra breaches are being seen for these specialties, which have the largest backlog of long waiters ( of the backlog is in these four specialties). ENT, Ophthalmology and General Surgery are being targeted again in September although this will not affect the Trust s aggregate RTT position, provisionally at 90.5% for the month. The Trust s aggregate performance against the admitted RTT target since July 2012 is presented below: Chart 1: RTT admitted pathway performance 93% 91% 90% 89% 88% * Includes provisional September performance Performance Report Page 2 of 5 TSTA/09.13
2.1.2 RTT Non Admitted (95%) In August the Trust achieved the 95% non-admitted pathway target at an aggregate level (95.3%) and specialty level excluding Oral Surgery (79.5%), Orthopaedics (90.2%), Neurology (92.3%) and General Surgery (93.9%). September provisional performance is 95.3%. The Trust s performance since July 2012 is presented below: Chart 3: RTT non-admitted pathway performance 98% 97% 96% 95% 93% * Includes provisional September performance 2.1.3 Long waits The Trust has continued its focus on reducing long waits for outpatient appointments. Over 35 week waits have fallen from 41 in June to 8 in August and there are now only 10 patients without an appointment date waiting over 28 weeks. For admitted patients the number of long waiters has remained relatively static between July and August, with 208 patients waiting over 28 weeks and 66 patients waiting over 35 weeks. Of the patients waiting over 35 weeks the majority are waiting for ENT (26), General Surgery (23) and Ophthalmology (12). The Trust is committed to tackling long waits and as such is planning to prioritise treatment of the longest wait admitted pathway patients in quarter three. The focus will be on significantly reducing the longest waits for ENT, General Surgery and Ophthalmology in particular but there will also be an opportunity for reducing long waits in other specialties. The focus on bringing the longest waiting times down will result in performance falling below the 90% admitted target in quarter three, but this will return above 90% in January. During quarter three measures will also be taken to continue the reduction of non-admitted long waits and to ensure lower waiting times are maintained in future months. Performance Report Page 3 of 5 TSTA/09.13
2.2 Urgent Care Performance 2.2.1 A&E 4-Hour Target (95%) The 95% target was achieved in August (95.2%), although performance was affected by relatively high attendance rates particularly towards the end of the month. This pressure continued into early September but the Trust currently remains above 95% for this month. The Trust s performance since August 2012 is shown in the chart below: Chart 4: A&E 4-hour performance 98% 96% 90% 2.2.2 Ambulance Turnaround Times 137 breaches of the 30-minute target were seen in August, around the same level as was seen in July. Building work in the A&E department will be completed towards the end of 2013 and will help improve flow and reduce the level of handover breaches. All over 30 minute delays are reviewed through multidisciplinary team meetings which include a South West Ambulance Trust representative present so data can be validated from both organisations. 2.3 Diagnostic 6-Week Breaches (99%) In August the Trust fell below the national target of 99% of patients seen within 6 weeks, with performance at 95%. The majority of breaches (52 out of 78) were within neurophysiology and relate to a temporary lack of clinical capacity. This has now been resolved and it is expected there will be a reduced number of breaches in September and then minimal breaches in October. In August there were also 26 breaches in sleep studies due to equipment failure but this will also be resolved in September. It is expected that overall performance will return above 99% in October. 2.4 Cancer Performance The Trust achieved all eight Monitor cancer targets in August (based on provisional data). Quarterly performance is above target for all measures apart from the 62 day wait following a screening service referral indicator which is at 89.5% against the 90% target. However, it is expected that the improvement in performance against this target seen in August will continue in September and the quarterly target will be achieved. The table below shows performance against cancer targets since March 2013. Performance Report Page 4 of 5 TSTA/09.13
Standard Target Mar April May June July August All Cancer Two week wait 93% 95.7% 95.9% 95.1% 95.2% 93.4% 93.7% 31 days decision to treat to treatment 96% 98.6% 97.5% 98.7% 97.0% 99.5% 100.0% 62 day urgent GP referral to treatment 85% 89.2% 87.5% 89.0%. 90.8% 89.5% 88.0% subsequent treatment drugs subsequent treatment-surgery subsequent treatmentradiotherapy 62 day wait for first treatment from Consultant screening service referral Two week wait (symptomatic breast) 2.5 Other Performance Targets 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 94.7% 95.5% 95.8% 96.8% 97.7% 100.0% 100.0% 97.9% 100.0% 100.0% 100.0% 97.7% 90% 97.0% 95.5% 100.0% 100.0% 73.3% 100.0% 93% 97.6% 93.8% 98.1% 99.0% 93.1% 96.2% Performance remains strong against the range of national and local performance targets. Any underperformance will be included in this report on an exception basis. 3. CHANGE TO MONITOR ASSURANCE FRAMEWORK 3.1 From October 1 st Monitor will make changes to its assurance framework - the regulatory framework under which it will ensure NHS foundation trusts are well run and can continue to deliver good quality services for patients in the future. The Risk Assessment Framework, replacing the Compliance Framework, sets out a revised rating system where an organisation will be rated for governance as follows: Green if there are no evident concerns; Where Monitor identifies cause for concern the green will be replaced by a description of the issues and the steps being taken to address them; Red if Monitor take formal regulatory action. 3.2 Part of this governance rating is linked to performance against selected national access and outcome standards. For acute trusts these are similar to the standards previously used, focusing on waiting times for A&E, outpatient appointments and inpatient treatment (including cancer treatment), plus reductions in preventable infections. Each measure is weighted and where trusts breach targets Monitor will use the sum of the weightings to calculate a service performance score. Where the score is 4.0 or greater this will represent a governance concern and require the trust to share plans for improvement. Taunton and Somerset NHS Foundation Trust has performed very well against Monitor targets in the past and would expect to continue this high level of performance within the new framework. Performance Report Page 5 of 5 TSTA/09.13