Integrated Quality & Performance Report 4 March 2019 Safe & Effective Kind & Caring Exceeding Expectation Agenda Item No: 9.2
Meeting Date: 4 th March 2019 Trust Board Report Title: Executive Summary: Integrated Quality & Performance Report The report provides the Board with an update of performance against National and Local quality and performance indicators for January 2019. Action Requested: Receive and note: Current Progress For the attention of the Board Assure This report provides an integrate focus on key performance indicators that are monitored through the National contract and those metrics that the organisation measure for operational efficiency and patient safety. All data reported with thorough validation checks and relevant departments are aware of any underperformance. Advise None in this report Alert None in this report Author + Contact Details: Links to Trust Strategic Objectives Resource Implications: Report Data Caveats Performance Manager ext 6746 Email: Lesley.burrows2@nhs.net Deputy Chief Nurse ext 5968 Email: Vanessa.whatley@nhs.net Deputy Directory Strategic Planning and Performance ext 4366 Email: simon.evans8@nhs.net 1. Create a culture of compassion, safety and quality 3. To have an effective and well integrated local health and care system that operates efficiently 4. Attract, retain and develop our staff, and improve employee engagement 6. Be in the top 25% of all key performance indicators None All data reported with thorough validation checks and relevant departments are aware of underperformance.
CQC Domains Equality and Diversity Impact Risks: BAF/ TRR Public or Private: Other formal bodies involved: NHS Constitution: Safe: patients, staff and the public are protected from abuse and avoidable harm. Effective: care, treatment and support achieves good outcomes, helping people maintain quality of life and is based on the best available evidence. Caring: staff involve and treat everyone with compassion, kindness, dignity and respect. Responsive: services are organised so that they meet people s needs. Well-led: the leadership, management and governance of the organisation make sure it's providing high-quality care that's based around individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture. None Not applicable Public Session Trust Management Committee, Finance & Performance Committee and QGAC In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny Page 2 of 2
Integrated Quality & Performance Report January 2019 Exceeding Expectation Page 1 of 26
Contents Indicator Page Indicator Page Executive Summary - Quality 3 Performance Dashboard 15 Quality Dashboard 4 Referral to Treatment - Incomplete 16 Mortality 5-7 Diagnostic Test - 6 week wait 16 Late patient moves 8 Urgent care 17 Maternity - emergency C-section rates 8 Ambulance handover breaches 17 Complaints 9 Ambulance conveyances 18 HCAI 9 Emergency Admissions via ED 19 VTE risk assessment 10 Cancer waiting times 20 FFT response and recommendation rates 11 Theatre utilisation 21-22 Safety Thermometer 12 Executive Summary - Integrated Care 23 Safer staffing & Care Hours per Patient Day 13 Integrated Care Dashboard 24 Executive Summary - Performance 14 Primary Care 25-26 Page 2 of 26
QUALITY - EXECUTIVE SUMMARY VTE Risk Assessment Performance has been maintained in month, additional resource will help support performance. Complaints The number of complaints increased for the first time since August 2018, particular increase in Elderly Medicine and Obstetric & Gynaecology Directorate. Page 3 of 26
Quality Dashboard Patient Experience Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Number of cancelled operations on the day of surgery for non-medical reasons Surveillance 52 56 51 13 20 27 22 24 23 35 36 22 35 Cancelled operations as a % of elective admissions <0.8% 0.94% 1.11% 1.00% 0.26% 0.38% 0.51% 0.41% 0.47% 0.47% 0.62% 0.64% 0.44% 0.59% Cancelled operations as a % of elective admissions (cumulative) <0.8% 0.45% 0.50% 0.53% 0.26% 0.32% 0.39% 0.39% 0.41% 0.42% 0.42% 0.47% 0.47% 0.48% Number of cancelled operations not re-admitted within 28 days 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number of urgent cancelled operations cancelled for a 2nd time 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number of complaints as a % of admissions 0.44% 0.44% 0.40% 0.32% 0.38% 0.33% 0.36% 0.45% 0.34% 0.33% 0.34% 0.31% 0.43% Complaints response rate against Policy 90% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% 90% 100% FFT response rates (Trust Wide - excluding ED & Maternity) 20.7% 19.6% 20.2% 19.4% 19.2% 17.9% 20.5% 21.5% 22.9% 22.0% 22.2% 21.6% 21.6% FFT recommendation rates (Trust Wide - excluding ED & Maternity) 93.8% 93.4% 92.9% 93.3% 92.8% 93.9% 94.1% 93.9% 94.6% 94.7% 94.7% 94.7% 94.2% FFT response rates (Emergency Department) 13.9% 13.0% 15.8% 14.8% 14.4% 16.5% 16.5% 16.3% 16.6% 16.8% 15.5% 15.4% 15.9% FFT recommendation rates (Emergency Department) 82.3% 81.6% 82.5% 83.1% 86.8% 86.4% 86.3% 87.0% 86.0% 87.9% 86.7% 87.1% 85.8% Late observations (Trust Wide) 5% 6.90% 6.24% 6.14% 4.15% 4.04% 4.42% 4.74% 4.68% 4.66% 4.68% 4.83% 4.70% 5.22% Late patient moves (after 10pm) 235 257 310 230 214 253 276 238 228 319 303 248 376 Duty of Candour - Element 1: notifying patients and families of the incident and investigation taking place. Due 10 working days after incident is reported 0 0 0 0 0 0 0 0 0 0 0 0 0 0 to STEIS Duty of Candour - Element 2: sharing outcome of investigation with patients/relatives. Due 10 working days after final RCA report is submitted to 0 0 0 0 0 0 0 0 0 0 0 0 1 0 CCG Patient Outcomes Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Safety Thermometer - Harm Free Care 95% 96.13% 96.63% 96.23% 96.83% 96.80% 95.15% 95.83% 97.02% 95.18% 96.68% 96.48% 97.19% 96.73% Pressure Injuries - all cases 49 17 25 29 23 32 23 23 19 20 31 25 35 Pressure Injuries - STEIS reportable cases 16 5 7 4 3 5 3 1 1 3 2 2 2 Patient falls - rate per 1,000 occupied bed days <5.6 3.31 3.22 3.69 3.71 3.30 3.01 3.19 3.61 4.86 3.31 3.11 3.60 3.09 Crude mortality rate 4.24% 3.69% 3.53% 3.20% 2.67% 2.52% 2.54% 2.84% 2.49% 2.95% 3.27% 3.13% 3.44% RWT SHMI Number of deaths 242 1.22 189 199 170 1.21 154 144 147 1.22 160 143 179 198 186 209 Patient Safety Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 VTE % risk assessment data 95% 96.10% 95.75% 95.76% 92.65% 92.03% 91.50% 91.31% 92.83% 93.19% 93.87% 94.30% 93.03% 93.05% Clostridium Difficile 3 3 0 0 3 5 1 1 5 2 2 3 1 2 MRSA Bacteraemia 0 0 0 0 0 1 0 1 0 0 0 0 0 0 E.Coli Surveillance 38 28 21 40 27 39 27 31 24 39 23 24 27 % Rate of medication error 0.73% 0.89% 1.01% 1.34% 1.39% 1.25% 1.69% 1.68% 1.51% 1.88% 1.90% 1.73% 1.52% Serious incident reporting - report incidences within 48 hours 0 0 0 1 1 1 0 0 0 0 0 0 0 0 Serious incident reporting - update on immediate actions within 72 hours 0 0 0 1 0 0 0 0 0 0 0 0 0 0 Serious incident reporting - share investigations report/action plan (60 days) 0 4 7 5 2 4 1 4 6 2 5 1 1 0 Never Events 0 0 0 0 2 0 2 0 0 0 0 0 0 0 Radiation incident rate - radiotherapy 0.56 0.28 0.22 1.6 1.6 0.5 0.7 0.3 1.5 0.68 0.0 1.5 1.7 Radiation incident rate - radiology 0.5 0.45 0.6 1.09 0.58 0.46 0.51 0.57 0.61 0.65 0.47 0.67 0.52 Care hours per patient - total nursing & midwifery staff actual 7.6 7.3 7.0 7.1 7.3 7.3 7.4 6.9 7.1 6.9 7.6 7.7 7.5 Care hours per patient - registered nursing & midwifery staff actual 4.5 4.5 4.3 4.4 4.8 4.7 4.7 4.3 4.9 4.9 4.8 4.9 4.7 Care hours per patient - healthcare workers actual 3.0 2.8 2.7 2.6 2.5 2.6 2.7 2.6 2.7 2.7 2.8 2.8 2.8 The % of patients who met the criteria of the local protocol for sepsis screening and were screened for sepsis and for whom sepsis is appropriate - 90% 95.2% 95.6% Not yet available Emergency Department (reported 1 month in arrears) The % of patients who met the criteria of the local protocol for sepsis screening and were screened for sepsis and for whom sepsis is appropriate - 90% 75.8% 74.7% Not yet available Acute Inpatient Departments (reported 1 month in arrears) The % of patients who present with suspected sepsis to emergency departments and other units that directly admit emergencies, and were administered intravenous antibiotics within 1 hour - Emergency Department 90% 45.9% 52.0% Not yet available (reported 1 month in arrears) The % of patients who present with suspected sepsis to emergency departments and other units that directly admit emergencies, and were administered intravenous antibiotics within 1 hour - Acute Inpatient Departments (reported 1 month in arrears) 90% 83.1% 80.0% Not yet available Maternity Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 C-Section rates - elective <12% 11.4% 12.6% 12.2% 10.9% 10.7% 7.9% 10.7% 11.2% 12.2% 12.7% 12.3% 12.8% 11.1% C-Section rates - emergency <14% 17.0% 20.6% 17.1% 16.8% 17.7% 18.4% 14.7% 20.9% 16.4% 19.5% 16.8% 20.0% 18.5% Midwife to birth ratio </=30 31.0 31.0 30.0 30.0 30.0 29.0 29.0 29.0 29.0 29.0 28.0 28.0 28.0 FFT response rates (Maternity only) 6.7% 9.4% 7.2% 3.0% 4.6% 3.6% 5.4% 4.5% 3.3% 3.2% 7.5% 16.1% 10.9% FFT recommendation rates (Maternity only) 92.6% 98.0% 94.3% 100.0% 97.8% 93.9% 96.7% 98.5% 96.1% 96.8% 99.0% 99.0% 97.9% Page 4 of 26
Mortality Mortality The graph below (on the left - Jan 18 to Aug 18) provide the SJR allocation and reviewed figures when all deaths were being reviewed. The graph on the right is post the new criteria introduction in Sep 18. 300 250 200 150 100 50 0 SJR Divisional Allocation v Reviewed Jan 18 - Aug 18 Div 1 Allocated Div 1 reviewed Div 2 Allocated Div 2 Reviewed 25 20 15 10 5 0 SJR Divisional Allocation v Reviewed Sep 18 - Jan 19 Div 1 Allocated Div 1 reviewed Div 2 Allocated Div 2 Reviewed The identified allocations for the period Sep 18 to Jan 19 were 151 cases (up to 14th February 2019). Total completed reviews between Sep 18 and Jan 19 is 101. January data shows no completed SJR1 reviews returned the follow up process is to be revisited. Cases subject to SJR1 review are identified and will expect to be completed within 4 weeks of death if anyone of the criteria is satisfied: 1. LD deaths (identified on allocation) 2. Deaths in people with mental illness (identified on allocation) 3. Elective admissions (identified at times of allocation) 4. DATIX incident or complaints (identified at time of allocation) 5. 10% random selection of all other deaths (identified by Directorate) 6. Deaths directorate consider should be reviewed e.g. Unexpected deaths (identified by Directorate) The figures identify those cases that meet the criteria of points 1-4 for each specialty and where those specific cases have been reviewed or are outstanding. These are the minimum requirements for each speciality to complete. The position has improved in terms of numbers complete and will continue to improve once the ME role is embedded across the Trust to allow focus to move to learning and quality improvement. Page 5 of 26
Mortality Mortality Cont. *Estimates; to be replaced with published data once available Actions: The Patient Experience lead is in discussions regards a family liaison role as per the learning from deaths guidance around engaging families. A third audit of deceased patient records following death from sepsis or pneumonia has been undertaken and fed back to MRG. A system of quality audits of wards is in the final stages of development aimed at identifying risks for deterioration. Page 6 of 26
Mortality Mortality Cont. 30 SJR2 - Phases Judgements - Summary 25 20 15 10 5 0 Phase 1 Admission Phase 2 Ongoing Care Phase 3 Care during Procedure Phase 4 Perioperative Care Phase 5 EoL Care Phase 6 Overall Care 1 - Very Poor 2 - Poor Care 3 - Adequate Care 4 - Good Care 5 - Excellent Care Of the 101 reviews undertaken in the period (Sep 18 to Jan 19), 10 identified as poor/very poor care. These will receive an independent review via the SJR2 process. The following overall themes have been identified following all SJR2 reviews:- End of life care - earlier intervention with specialist palliative care team to improve the care provided. Recognition of the deteriorating patient - initiation of Sepsis 6 could be improved along with identification of deteriorating patient. Safeguarding - improved knowledge of MCA/DoLs to improve care. Documentation - primary diagnosis unclear in patient record. All of the above themes are being managed via the Quality Improvement Programme for Mortality which is reported against separately. The above summary indicates at this stage that more detailed analysis of patient care through admission and on-going care should be considered to identify any further themes. All directorate packs have been circulated for each mortality lead to provide a summary of learning. The responses to these are awaited. Page 7 of 26
Maternity - Emergency C-Section Rate Late Patient Moves after 10pm Quality 12,000 Late Patient Moves after 10pm 400 Of the 376 patients moved after 10pm; 297 (79%) were moved from AMU onto a ward as part of normal process, and 79 (21%) patients were moved between wards. The themes identified are: Capacity Outlying patients to create capacity Clinical need 10,000 8,000 6,000 4,000 2,000 0 235 257 310 230 214 253 276 238 228 319 303 248 376 350 300 250 200 150 100 50 0 Actions: Action plan currently in development. After 10pm ED Admissions All Admissions ED >4 hour Breaches 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Maternity - Emergency C-Section Rates Themes: Restrictions on booking numbers have been successful thus far with end of calendar year birth rate figures slightly over for commissioned births of 5,000 - end of year total was 5,025. An audit into emergency C-section rates has been completed and has indicated that RWT is not an outlier in terms of national total rates. Actions: Monitoring of booking numbers continues with a review on booking restrictions in the spring. The maternity dashboard has been reviewed and following the latest national data from NHS digital HES data 2017/18 the maternity service will be altering tolerance indicators s to reflect the national levels for Caesarean section rate. Total C/S rates 29%, new tolerances will be; Emergency rates = 16.0%, Elective rates 13.0%. These changes will occur in April 2019. Actual Target Page 8 of 26
HCAI Complaints Quality cont Complaints 50 45 40 35 30 25 20 15 10 5 0 Number of complaints as a % of admissions 0.50% 0.45% 0.40% 0.35% 0.30% 0.25% 0.20% 0.15% 0.10% 0.05% 0.00% Themes: General care of patient (17.28%) Communication (16.05%) Delay in receiving outpatient appointment (14.81%) - The category of delay in receiving an outpatient appointment has seen further improvement (January x 12, December x 14 and November x 20), this could be attributed to effective communication between staff and patients. In particular Elderly Medicine and Obstetric & Gynaecology wards saw an increase in the number of complaints this month for both services. The main themes were general care of patient, attitude or communication. Actions: The Patient Experience Team to include outpatients in their outreach schedule to gain real time feedback from service users around appointments. Elderly Medicine and Obstetric & Gynaecology Directorates to review individual action plans and monitor for trends. Number of complaints received Themes: E.coli bacteraemia numbers are within the improvement trajectory. Actions: The Community Continence Service has commenced the reviewing of patients from the VI practices who were discharged with a urinary catheter (regarding Gram negative bacteraemia reduction). The multi agency action plan continues. 50 40 30 20 10 0 E.coli Page 9 of 26
% VTE Risk Assessment Quality cont 97.00% 96.00% 95.00% 94.00% 93.00% 92.00% 91.00% 90.00% 89.00% VTE Risk Assessments Actual % VTE Assessment Target % VTE Assessment Themes: During January elective activity returned to normal, however, the Trust experienced an increase in emergency admissions and obstetric admissions. Actions: Increased ward visits from mid-january (additional support from anticoagulation services). Medical Director to send a Trust wide email regarding a focus on VTE risk assessment. Paediatric increased ward visits has commenced. This has identified some patients who are under the care of general surgery, urology or Maxillo Facial teams whilst in paediatric areas. A reminder has been sent to all surgical/theatre teams regarding paper risk assessments for under 16 year olds in paediatric areas. Paper assessments have also been supplied to ED as some patients within this group are admitted from ED to theatre before going onto the ward. Page 10 of 26
Friends and Family Test - Recommendation and Response Rates Quality cont FFT Response Rates (Trust Wide - Excluding ED) 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% FFT Recommendation Rates (Trust Wide - Excluding ED) RWT England RWT England 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% FFT Response Rates (Emergency Department) 90.0% 88.0% 86.0% 84.0% 82.0% 80.0% 78.0% FFT Recommendation Rates (Emergency Department) RWT Target England RWT England The Trust remains above the national average for ED, Outpatients and Births in terms of recommendation rates. Response rates are consistent with the previous two months (response rate 20% and recommendation rate 93%). Actions: Review of Matrons/Ward Managers access to Envoy to be undertaken. Matrons/Ward Managers to log onto Envoy to view comments from patients to enable proactive action to be taken in order to increase recommendation rates. Page 11 of 26
Safety Thermometer Quality cont 30 25 20 15 10 5 0 Pressure Injury Prevalence New Old 6 5 4 3 2 1 0 Falls Causing Harm 0.50% 0.40% 0.30% 0.20% 0.10% 0.00% Catheters & UTI's 0.40% 0.30% 0.20% 0.10% New VTE's 0.00% Catheters UTI's Catheters New UTI's 97.50% 97.00% 96.50% 96.00% 95.50% 95.00% 94.50% 94.00% 93.50% Safety Thermometer - Harm Free Care Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Actual Target Page 12 of 26
Safer Staffing Quality cont Safer Staffing 82% of wards achieved 80% or higher fill rate for registered nurses on days which is an 11% improvement from the previous month. Night fill rates for registered nurses remains a challenge with 62% of wards achieving 80% or higher fill rate, this is a 3% improvement on the previous month. The shortfall on nights particularly has been mitigated by providing additional Healthcare Assistants to support the registered nurses and meet the needs of the patients. High percentage fill rates for HCA's reflect cover where registered nurses cannot be recruited or there is high acuity of patients. Actions: Recruitment events are planned for February and March 2019, including attending the RCN career event on 12th March in Birmingham. Interviews for International and UK Clinical Nursing Fellowship programme continue. Finalisation of procurement contract for overseas recruitment will occur February. Care hours per patient day (CHPPD) Care hours per patient day is monitored via the nursing quality dashboard, alongside other nurse sensitive indicators on a monthly basis. Adult inpatient wards range between 4.5-8.9 Critical care/neonatal units range between 18.5-25.2 There is currently no nationally agreed CHPPD score for specialities. Page 13 of 26
PERFORMANCE - EXECUTIVE SUMMARY Referral to Treatment - Incomplete - Performance saw deterioration during January. This is a knock on effect from reduced activity over the bank holiday period and patients choosing to prolong their waits until the new year. We continue to focus on reducing the backlog where possible and work closely with Directorates to use all available capacity effectively. Diagnostics - This target has shown slight improvement during January 2019, however, we have seen an increase of cardiac referrals into Radiology for CT and MRI Heart. The radiology department is working closely with the Cardiac Directorate to utilise scan capacity and in addition to this extra capacity has been made available during February and March 2019 to help reduce the backlog. Emergency Department - The Trust failed to achieve both Type 1 and the All Types target for the month. There was one patient who breached the 12 hour decision to admit target during the month of January. This was a child waiting for a PICU bed. Ambulance handover saw a deterioration during January 2019 for both the 30-60 minutes and the >60 minute target compared with the previous month. We continue to see a rise of ambulance conveyances into the Trust, receiving an additional 524 (11.17%) during January 2019 compared with the same period last year. This equates to an additional 17 ambulances per day or the equivalent of 3.5 days extra activity. Cancer - We are currently predicting possible failure of the 2 week wait, 2 week wait Breast Symptomatic, 31 Day First Treatment, 31 Day Sub Surgery, 31 Day Sub Radiotherapy, 62 Day wait for First Treatment, 62 Day Screening and 62 Day Consultant Upgrade for January, validation is ongoing. Final cancer data is uploaded nationally 6 weeks after month end. Specific actions are:- Model impact on RWT on the interactions of Gynae oncology service following transition from SWBH/UHB. Improve quality and timeframe of tertiary referrals. CCG to support GP's to improve referrals into the Trust. Continued support from the Intensive Support Team. Page 14 of 26
Performance Dashboard Waiting Times Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 RTT - % of patients on an incomplete pathway 92% 90.25% 90.37% 90.13% 90.40% 90.62% 90.94% 90.94% 90.98% 90.84% 90.89% 90.80% 90.76% 90.05% RTT - number of patients waiting over 52 weeks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Diagnostic Test - % of patients waiting 6 weeks or more <1% 0.76% 0.84% 0.80% 0.83% 0.82% 0.74% 0.95% 0.97% 2.38% 3.75% 2.71% 1.86% 1.74% Urgent Care Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Total time spent in ED (4 hours) - New Cross Hospital 95% 73.80% 76.08% 74.57% 84.09% 90.27% 85.55% 86.06% 89.33% 86.83% 86.91% 82.73% 87.85% 80.69% Total time spent in ED (4 hours) - Phoenix Walk in Centre 95% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% Total time spent in ED (4 hours) - Cannock Minor Injuries Unit 95% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.92% 99.92% 100.00% Total time spent in ED (4 hours) - Vocare 95% 93.90% 96.29% 96.02% 98.56% 98.42% 98.48% 98.73% 98.61% 98.62% 97.47% 95.68% 96.46% 96.33% Total time spent in ED (4 hours) - Combined 95% 84.73% 86.27% 85.08% 90.81% 94.16% 91.29% 91.58% 93.51% 91.82% 91.80% 89.15% 92.44% 88.23% Trolley waits in ED longer than 12 hours 0 0 2 0 0 1 0 1 2 0 1 0 0 1 Ambulance handover breaches - 30-60 minutes 0 199 102 131 122 10 90 68 38 56 71 103 42 240 Ambulance handover breaches - >60 minutes 0 66 28 22 11 0 3 18 1 1 3 21 1 24 % of emergency admissions via Emergency Department Surveillance 19.51% 17.86% 18.82% 18.75% 18.01% 18.70% 18.63% 18.91% 18.38% 19.09% 18.68% 19.65% 18.07% Cancer Waiting Times Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 2 Week Wait - Cancer Referrals 93% 90.78% 93.97% 91.52% 79.03% 80.68% 84.07% 89.01% 86.64% 84.76% 87.63% 85.98% 82.38% 80.77% 2 Week Wait - Breast Symptomatic Referrals 93% 93.33% 94.50% 88.33% 42.02% 48.03% 69.61% 73.91% 74.77% 66.67% 85.22% 64.42% 59.65% 66.67% 31 Day to First Treatment 96% 96.36% 97.22% 96.36% 91.79% 92.21% 93.28% 94.04% 90.37% 86.96% 92.92% 85.08% 90.82% 84.04% 31 Day Sub Treatment - Anti Cancer Drug 98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.00% 31 Day Sub Treatment - Surgery 94% 71.70% 84.38% 84.21% 89.47% 88.00% 82.14% 80.56% 75.76% 78.79% 72.55% 71.43% 59.26% 57.14% 31 Day Sub Treatment - Radiotherapy 94% 98.06% 100.00% 94.63% 96.15% 93.86% 88.64% 69.29% 82.58% 89.08% 93.15% 85.83% 95.28% 80.62% 62 Day Wait for First Treatment 85% 70.18% 67.88% 74.76% 69.89% 62.38% 65.17% 60.81% 58.57% 56.88% 75.36% 60.43% 67.02% 59.02% 62 Day Wait - Screening 90% 60.00% 91.67% 72.41% 73.68% 87.50% 75.00% 86.67% 88.57% 66.67% 71.88% 81.48% 88.89% 73.91% 62 Day Wait - Consultant Upgrade (local target) 88% 90.82% 88.41% 90.21% 92.25% 88.24% 90.20% 81.01% 74.47% 80.79% 86.13% 78.34% 82.58% 71.43% Stroke Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Patients admitted with primary diagnosis of stroke should spend greater than 90% of their hospital stay on a dedicated stroke unit 80% 80.00% 86.80% 95.10% 94.00% 93.00% 89.00% 95.00% 87.00% 82.00% 88.50% 96.00% 96.00% 99.00% High risk patients will be assessed and treated within 24 hours 60% 71.40% 69.10% 69.00% 78.00% 81.00% 77.00% 81.00% 92.00% 83.00% 80.80% 96.00% 87.00% 97.00% Organisational Efficiency Target Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Theatre Utilisation (Trust Wide) 90% 86.00% 102.00% 89.00% 84.00% 94.00% 80.00% 84.00% 95.00% 91.18% 91.00% 90.30% 90.73% 88.99% NHS E-referral - Sufficient appointment slots <10% 17.22% 20.35% 18.62% 21.72% 27.05% 36.22% 23.27% 19.61% 20.03% 28.27% 21.58% 20.90% Delayed Transfers of Care - All <4% 2.56% 3.09% 3.48% 3.38% 2.36% 2.68% 2.98% 3.63% 4.24% 2.91% 3.17% 2.79% 2.90% Delayed Transfers of Care - Excluding social care delays <2% 1.02% 1.30% 1.48% 0.92% 0.77% 0.82% 0.97% 1.26% 1.75% 0.85% 0.84% 1.10% 1.06% Page 15 of 26
Diagnostic Tests - 6 week wait Referral to Treatment - Incomplete Performance Themes: Patient choice extending pathways. Capacity issues at sub-specialty level. Actions: Monthly prediction reports circulated to Managers and Waiting list detailing expected activity numbers and priority patients Continue to monitor specialties against individual trajectories. On-going validation of all patients >18 weeks and training issues/errors picked up Additional sessions being undertaken in some specialties during quarter 4 to help to reduce the overall backlog. 93.00% 92.00% 91.00% 90.00% 89.00% 88.00% 87.00% 86.00% 85.00% RTT - Incomplete Actual Target 4.00% 3.00% Diagnostic - 6 week wait Themes: Gastroscopy, Colonoscopy and Flexi Sigmoidoscopy are now booking back within standard. However, we have seen an increase of cardiac referrals into radiology for CT and MRI Heart. 2.00% 1.00% 0.00% Actual Target Actions: The radiology department is working closely with the Cardiac Directorate to utilise scan capacity and in addition to this extra capacity has been made available during February and March 2019 to help reduce the backlog. Endoscopy - Daily monitoring of lists continues to ensure capacity is fully utilised. Flexing of lists to ensure specific demand is continually being met. Page 16 of 26
Ambulance Handover Emergency Department Performance cont Themes: Continued increase of attendances through ED in month (9.14%) compared with same period last year, this continues to be linked to the on-going rise in ambulance conveyances that we experienced in January 2019. Actions: WMAS are in discussion about the implementation of 'Intelligent Conveyances' between hospitals. 98.00% 93.00% 88.00% 83.00% 78.00% Total Time Spent in ED (4 hours) Actual Target 300 250 200 150 100 50 0 Ambulance Handover Breaches (30-60 minutes) 240 ambulances breached the 30-60 minute ambulance handover target during January compared with 199 for the same period last year. 24 ambulances breached the >60 minutes handover target during the month compared with 66 for the same period last year. 70 60 50 40 30 20 10 0 Ambulance Handover Breaches (over 60 minutes) The longest waiting ambulance during the month was recorded at 2 hours and 52 minutes. This was on 18th of the month when we had 162 ambulance conveyances and a total of 395 attendances on the day. The average daily number over the rest of the month were 151 ambulances and 397 attendances. Page 17 of 26
Ambulance Conveyances Performance cont 250 Stroke (Ambulances into NX) 5,000 Ambulance Conveyance Numbers 230 210 190 170 150 130 4,000 3,000 2,000 1,000 0 2017/18 2018/19 RWT Dudley City & Sandwell Walsall Q1 Q2 Q3 2018/19 2018/19 2018/19 Jan 2017/18 11,714 11,320 12,168 4,166 2018/19 11,860 12,081 13,236 4,690 Diff 146 761 1,068 524 % Var 1.23% 6.30% 8.07% 11.17% 2017/18 9,874 9,874 10,711 3,692 2018/19 10,253 10,386 11,162 4,015 Diff 379 512 451 323 % Var 3.70% 4.93% 4.04% 8.04% 2017/18 13,335 13,467 14,271 4,745 2018/19 13,687 14,020 14,603 5,062 Diff 352 553 332 317 % Var 2.57% 3.94% 2.27% 6.26% 2017/18 8,067 7,819 8,732 2,928 2018/19 8,115 8,146 8,949 3,094 Diff 48 327 217 166 % Var 0.59% 4.01% 2.42% 5.37% In the graph above it is noted that January saw a continuation in the upward trend in the number of ambulance conveyances into the Trust with an additional 524 (11.17%) during the month. Year to date there has been an overall rise in numbers of 2,499 (5.97%). The tables to the left show the number of ambulance conveyances into RWT and surrounding Trusts and the variance compared with the same period last year. Page 18 of 26
Attendances Admissions Emergency Admissions via ED Performance cont 20.50% 20.00% 19.50% 19.00% 18.50% 18.00% 17.50% 17.00% 16.50% 16.00% 15.50% % of Emergency Admissions via ED Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2018/19 2017/18 2,500 2,000 1,500 1,000 500 0 Number of Emergency Admissions via ED Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2018/19 2017/18 Emergency Admissions via ED vs. ED Attendances 13,800 2,500 11,800 9,800 7,800 5,800 3,800 1,800 2,000 1,500 1,000 500 0 These graphs show the admission rates and numbers of patients who are admitted via the Emergency Department compared with the same period last year. At the end of month ten we have seen and additional 2,877 attendances in ED compared with last year, and an increase of 590 emergency admissions (2.74%) in the same period. ED Attendances Admissions via ED Page 19 of 26
Cancer Waiting Times Performance cont Themes: The breaches in month were as follows:- 67.06% due to internal issues (capacity) 17.88% due to patient choice. 9.41% due to complexity of case 5.65% were tertiary referrals received between days 32 and 221 of the patient pathway. Of the tertiary referrals received 6 (25%) were received before day 40 of the pathway, and 9 (38%) were received on or after day 62 of the patient pathway. Actions: Continued support from the Intensive Support Team. Patients over 104 days - Following December 2018 month end final upload, 15 patients were treated at 104+ days on a cancer pathway during the month, all of these patients had a harm review and no harm was identified. Tumour Site Breast Colorectal Gynaecology Haematology Head & Neck Lung Skin Upper GI Urology Total Total Pts Breaches % 17 4 76.47% 5 4 20.00% 8 3.5 56.25% 5.5 2 63.64% 5.5 5 9.09% 4.5 1.5 66.67% 12.5 1 92.00% 5 4 20.00% 28.5 12.5 56.14% 91.5 37.5 59.02% Average Cancer Waiting Times by tumour site The following table shows the average wait time of all patients who were treated on a 62 day pathway within the month they are treated - this is shown by cancer tumour site and shows; of the patients who were treated in month the average waiting time in days. Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Breast 48 43 35 47 59 43 49 74 46 50 52 52 Colorectal 81 70 64 61 80 72 81 74 72 56 67 72 Gynae 62 59 80 64 68 68 61 90 86 57 69 70 Haem 64 63 53 57 53 49 47 50 42 45 66 60 H&N 83 77 95 103 77 97 81 115 79 67 77 79 Lung 36 82 60 37 46 54 51 46 54 68 74 37 Skin 38 42 39 36 39 26 33 31 34 33 25 37 Upper GI 57 66 68 55 43 56 44 66 49 58 73 75 Urology 82 69 80 97 81 78 79 83 102 78 90 83 Page 20 of 26
Theatre Utilisation Performance cont Total Specialty Available Sessions 110.0% 90.0% 70.0% 50.0% Cancelled Sessions % of Utilisation - Jan 2019 Cardiothoracic - New Cross Theatre Utilisation Trend from Previous Cardiothoracic 112 0 100.00% ENT 58 0 100.00% Maxillo Facial 50 0 100.00% Urology 83 0 100.00% Orthopaedics Nx 53 2 96.23% Ophthalmology 87 4 95.40% General Surgery 162 15 90.74% Gynaecology 98 12 87.76% Orthopaedics CCH 238 34 85.71% The table to the left shows what percentage of available theatre sessions were actually used during the month of January and the trend compared with the previous month. The top 3 reasons for cancelled sessions during the month were:- 1) Consultant Leave 2) Consultant on call 3) Consultant in clinic In addition to this the individual graphs below demonstrate, of the theatre sessions that were used how much theatre time was utilised during the same period. 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Ear, Nose & Throat - New Cross Theatre Utilisation Actual Target Actual Target 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% General Surgery - New Cross Theatre Utilisation 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Gynaecology - New Cross Theatre Utilisation Actual Target Actual Target Page 21 of 26
Theatre Utilisation Performance cont 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Maxillo Facial - New Cross Theatre Utilisation 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Ophthalmology - New Cross Theatre Utilisation Actual Target Actual Target 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Orthopaedic - New Cross Theatre Utilisation 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Urology - New Cross Theatre Utilisation Actual Target Actual Target 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Orthopaedic - Cannock Chase Theatre Utilisation Actual Target Utilisation is below target in a number of specialties due to reduction in elective operating during the first week of January due to Human Factors training and Consultant vacancies. OTEG work plan for the forthcoming year is in the final stages of development following recent workshops and will include an assessment/action against opportunities identified in the recent NHSI publication in February 2019. Continued over performance against stretched plan of 618k (day case/elective only) in month. Page 22 of 26
INTEGRATED CARE - EXECUTIVE SUMMARY Sexual Health: Recruitment is underway for a Clinical Nurse Specialist in Sexual Health/HIV. This role will support the delivery of HIV targets as well as the wider sexual health targets. The percentage of tests being offered to the appropriate cohort of patients has increased whilst the percentage of test uptake has seen a slight drop. Emergency Admissions: The Community Transformation Team are now in post, scoping is underway to form a baseline of the current services. The first Community Transformation Workshop has taken place with key stakeholders present, which formed part of the launch of the Community Transformation Programme. 0-19 Health Visitors: The percentage of mothers who received a first face- to- face antenatal contact with a Health Visitor was on plan in December. In addition the percentage of infants who receive a face to face New Birth Visit (NBV) within 14 days from birth, by a Health Visitor was also on plan as well as the percentage of infants who receive a face to face New Birth Visit (NBV) within 14 days from birth, by a Health Visitor. GP Appointments: Across the service there are on average 49 appointments being offered per 1,000 patients in comparison to the Royal College of General Practitioners suggested target of 45 per 1,000 patients. In addition there are 37 other (includes nursing and other health professionals) appointments being delivered compared to the RCGP target of 27. A Demand and Capacity review alongside a review of all job plans is underway to identify potential additional capacity within the service. Page 23 of 26
Integrated Care Dashboard Sexual Health (Quarterly) Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Total number of appointments against block contract 4,500 per Qtr 4,777 4,733 4,837 % appropriate patients offered HIV test (reported 1 month in arrears) 95% 58.20% 50.44% 73.12% Community Nursing (Rapid Intervention Team) Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Referrals received Surveillance 492 465 460 532 477 566 704 783 819 798 Patients accepted and seen (actuals) Surveillance 398 383 379 401 407 452 620 674 685 668 Number of patients sent to ED or admitted to hospital by RITs (Including accepted patients and patients who have been telephone triaged and an Surveillance 50 52 37 42 36 43 64 76 69 51 emergency ambulance advised) % of referred patients who are sent to ED/admitted Surveillance 10.1% 11.1% 8.0% 7.8% 7.5% 7.5% 9% 9% 8.4% 6.3% Number of referral from West Midlands Ambulance Service Surveillance 18 21 23 28 20 22 34 28 34 28 0-19 Health Visiting (reported 1 month in arrears) Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 % of infants who receive a face to face New Birth Visit (NBV) within 14 days from birth, by a Health Visitor 93% 92.00% 89.24% 89.93% 88.72% 88.85% 90.59% 94.12% 93.96% 92.73% % of children who receive a 6-8 week review 82.5% 73.14% 77.43% 69.06% 87.22% 74.52% 82.75% 82.70% 73.58% 85.82% 0-19 School Nursing (reported 1 month in arrears) Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 % of health assessment or carried out at school entry 95% 68.00% 73.00% 83.00% 92.00% 99.00% 0.00% 0.00% 0.00% 0.06% % of health assessment or carried out at year 6 95% 68.00% 73.00% 83.00% 98.00% 98.00% 2.00% 21.24% 35.41% 8.50% Primary Care (Appointments per 1,000 patients) Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Total appointments - all VI practices 288 333.98 348.40 354.55 377.41 354.05 334.04 438.49 412.65 308.88 381.33 GP appointments - all VI practices 180 181.09 196.04 200.17 211.27 195.65 190.20 221.99 212.58 176.55 209.72 Other appointments - all VI practices 108 152.89 152.36 154.38 166.14 158.40 143.84 216.50 200.07 132.33 171.61 Page 24 of 26
Primary Care Integrated Care 10.00 Emergency Admissions per 1,000 Patients The graph to the right illustrates the number of Emergency admissions per 1,000 Vertical Integration (VI) patients per month. It can be seen that the average post VI integration figure of 7.73 is lower than the average pre VI figures of 8.38. 8.00 6.00 4.00 2.00 0.00 VI Emergency Admissions per 1,000 patients Pre VI Average Post VI Average 10.00 9.50 9.00 8.50 8.00 7.50 7.00 6.50 6.00 5.50 5.00 Emergency Admissions per 1,000 patients - VI vs Non VI VI Emergency Admissions per 1,000 patients Non VI Emergency Admissions per 1,000 patients The graph to the left shows compares VI practices to Non VI practices in terms of ED attendances per 1,000 patients and it can be seen that VI practices overall have lower emergency admissions. In actual terms, there are on average 400 emergency admissions (over last 12 months) per month across all VI practices, the reduction in emergency admissions post VI integration equates to approximately 40 admissions per month. Page 25 of 26
Primary Care Integrated Care cont GP Appointments per 1,000 patients - by VI Practice GP Practice Alfred Squire Coalway Road Lea Road Penn Thornley West Park Warstones Ettingshall Lakeside VI Total Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 232.82 238.62 222.44 231.98 214.59 213.26 245.62 238.01 198.04 236.57 221.79 202.53 188.13 204.67 170.04 159.73 216.93 200.33 209.96 213.43 240.67 206.95 195.51 242.78 238.11 189.64 212.07 195.69 227.68 225.94 198.38 193.43 183.08 210.12 203.34 172.48 218.12 180 142.56 165.75 152.19 164.47 157.99 141.48 178.82 164.57 119.28 145.8 262.76 286.70 279.78 283.82 256.13 265.94 292.18 305.16 275.17 291.32 281.68 275.48 261.48 282.60 254.59 254.36 298.90 278.47 244.03 279.61 184.83 157.47 167.01 184.37 177.52 204.25 219.56 229.61 178.43 186.89 156.00 172.78 164.99 169.49 152.37 148.05 181.43 169.32 142.51 173.12 181.09 196.04 200.17 211.27 195.65 190.20 221.99 212.58 176.55 209.72 These 2 tables show the number of appointments offered to patients each month by the VI practices, split by GP and other. Targets are taken from Royal College of GP's recommended weekly targets and have been converted into monthly targets. Other Appointments per 1,000 patients - by VI Practice GP Practice Alfred Squire Coalway Road Lea Road Penn Thornley West Park Warstones Ettingshall Lakeside VI Total Target Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 240.55 210.96 225.58 258.66 235.36 224.37 389.93 334.74 228.84 281.85 68.48 70.43 64.79 140.66 127.63 55.84 71.21 146.90 159.99 192.96 197.02 159.09 135.31 221.70 166.77 117.85 186.03 182.82 172.82 138.14 172.13 172.56 163.52 191.69 223.25 143.01 188.30 108 72.90 65.44 60.13 68.38 82.24 61.41 104.74 75.16 71.72 79.58 141.04 144.51 138.74 130.37 140.18 134.99 144.79 129.51 79.61 100.37 134.76 141.64 156.80 144.63 140.73 132.69 194.90 198.12 114.33 141.18 140.74 158.10 156.96 164.04 148.96 96.41 167.92 101.44 82.25 109.21 281.39 296.26 285.20 284.33 262.54 264.10 371.67 401.94 247.32 327.91 152.89 152.36 154.38 166.14 158.40 143.84 216.50 200.07 132.33 171.61 Page 26 of 26