Mid Essex, Southend and Basildon Hospitals Joint Working Board 05/04/2017, 2pm Integrated Performance Report February 2017
Mid Essex, Southend and Basildon Hospitals Introduction by CEO February 2017 The Single Oversight Framework (http://bit.ly/2eq8sne) places Providers into Segments based on NHS Improvement s judgement of the seriousness and complexity of issues faced by each Provider. Joint Working Board 05/04/2017, 2pm
Introduction by CEO - Operation Performance Overview Approach to performance recovery The three Trusts have recently formed a joint performance oversight committee resulting in : - Shared ownership of performance trajectories - A single PTL management approach - Focus on improving current delivery against site specific trajectories - Demand and capacity modelling across the three sites to address Cancer, Diagnostic and RTT backlogs A&E 4 hour performance All sites are currently underperforming against trajectory and are working to site specific recovery plans.some improvements have been made across the patch during February and each site is expected to deliver at or above 90% from April 2017 following delivery of the actions detailed in the following slides and to achieve 95% by year end 2018 Cancer 62 days All three sites have breached their trajectory of improvement for the 62 day standard. Backlogs are now reducing across all sites and are on track to deliver the standard from July 2017. 18 week RTT All sites failed the 92% incomplete standard in February. Mid Essex is expected to deliver and sustain 92% from March 2017. Basildon and Southend have agreed trajectories of recover the 92% standard by March 2018. The specialty backlogs driving this poor performance are highlighted within the report although orthopaedics is a key delivery area impacting on performance across Basildon and Southend sites. Having moved to a collaborative approach to PTL management we anticipate further improvements on these delivery timescales. Orthopaedics as our priority area with Mid Essex developing capacity plans to treat >400 cases from the other sites to support a stepped improvement in performance. Task and finish groups have been initiated to address issues within other specialities including benchmarking and efficiency programmes to improve theatre throughput and outpatients clinic utilisation 52 week breaches 52 week breaches have remained a concern across the three sites. Southend has now cleared their longest waits and forecast 0 > 52 weeks from February onwards. Basildon reported 6 > 52 weeks in February and forecast 4 in March and are currently working on a plan to deliver zero. Mid Essex has a single speciality issue impacting on > 52 week breaches and has reported 4 in February, predicting 3 in March. Risks for Mid Essex link to transfer from planned lists to PTL and could impact until June 2017. All patients are currently being dated and all breaches have had a harm review applied. Social Care Fund. The CCG Chief Officer of the CCG has formally written to the CEOs of the three councils to clarify how the additional social care fund will be utilised. The implied benefits for our bed base are expected to release 6 for Southend, 6 for Basildon and 8 for Mid Essex. Introduction Page 3
Mid Essex, Southend and Basildon Hospitals Joint Working Board 05/04/2017, 2pm Quality of Care Celia Skinner & Diane Sarkar (CQC Safe, Caring, Excellent, Well Led) February 2017
Harm Free Care (1) Apr-16 May-16 Jun-16 Mid & South Essex Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 C.Diff Confirmed cases attributed to Trust 4 4 3 7 9 12 10 11 6 7 8 Never Events Total 1 0 2 0 0 0 0 1 0 3 0 Mortality SUHFT MEHT BTUH SHMI to June-16 1.14 1.06 0.99 HSMR to Nov-16 tbc 120 99 NRLS Patient Safety Report October 2015 - March 2016 No Harm Low Harm Moderate Harm Severe Harm Death Trust No of incidents no. % no. % no % no % no % BTUH 5,477 4,549 83.1 864 15.8 53 1 7 0.1 4 0.1 MEHT 2,372 2,011 84.8 326 13.7 26 1.1 6 0.3 3 0.1 SUHFT 4,667 4,139 88.7 441 9.4 54 1.2 27 0.6 6 0.1 MSB Total 12,516 10,699 85.4 1,631 13 133 1.06 40 0.32 13 0.1 All acute 655,193 494,509 75.5 141,806 21.6 16,236 2.5 1862 0.3 780 0.1 Quality of Care Page 5
Harm Free Care (2) - MRSA Mid & South Essex Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 MRSA Confirmed cases attributed to Trust 0 0 0 1 1 1 0 1 0 0 1 MEHT Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 MRSA Confirmed cases attributed to Trust 0 0 0 1 0 0 0 0 0 0 1 BTUH Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 MRSA Confirmed cases attributed to Trust 0 0 0 0 1 1 0 1 0 0 0 SUHFT Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 MRSA Confirmed cases attributed to Trust 0 0 0 0 0 0 0 0 0 0 0 Quality of Care Page 6
Quality Priorities 2017/18 Approach to Quality 2017/18 onwards Establish QI Institute with basic competencies in QI and identification of QI experts Use Learning from Deaths Framework to standardise approach to mortality and engage carers/relatives Use Quaser framework with JWB to establish consistent priorities which are in alignment with clinical re-design and approach Clinical Re-design programme, measurement and improvement integral to all pathways Ward Accreditation process to be fully implemented and rolled out Strategic risk management approach agreed by JWB Joint BAF developed, principle risks identified across the group: Failure to meet ED target, RTT and cancer Failure to maintain financial stability Failure to recruit and retain appropriate workforce Failure to ensure compliance of fundamental standard 15 Premises and Equipment Failure to develop and embed a robust clinical It strategy Risk that ESR may fail to deliver Failure to resolve the ongoing issues of IPP Quality of Care Page 7
Quality Indicators Areas of Good Practice Outstanding services for Maternity and Burns and Plastics Key challenges Regulatory compliance Inconsistent mortality performance Differing governance models Inconsistency of measurement and reporting of data Deterioration in pressure ulcer performance Quality of Care Page 8
CQC Inspection Quality Regulatory compliance Trust Regulation Core Services MEHT 9 Person-centred care End of Life Care 12 Safe care & treatment (medicines management) 17 Good governance (heath records management) 18 - Staffing (mandatory training) SUHFT 12 Safe care & treatment Surgery & ED 15 Premises & Equipment End of Life Care 17 Good governance Trust wide, ED & EoLC 18 - Staffing Medicine, Critical Care, EoLC 20 Duty of Candour Trust wide Trust Requirement Notices MUST take Actions BTUH Nil 0 MEHT 4 6 SUHFT 5 31 Key Questions BTUH MEHT SHUFT Safe Good Requires Improvement Requires Improvement Caring Good Good Good Responsive Good Good Requires Improvement Effective Good Good Good Well Led Good Good Requires Improvement Overall rating Good Good Requires Improvement Current CQC compliance status and actions reviewed by JWB JWB sited on draft key lines of enquiry from CQC, preparations for compliance visits and governance structures being defined utilising Well Led component Quality of Care Page 9
Mid Essex, Southend and Basildon Hospitals Joint Working Board 05/04/2017, 2pm Operational Performance Yvonne Blucher Lisa Hunt Clare Culpin (CQC Responsive) February 2017
Accident and Emergency 4 Hour Standard - MEHT MEHT KPI Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Operational performance Performance 95% 88.8% 79.7% 73.1% 73.4% 79.1% 79.4% 76.4% 77.2% 80.7% 84.1% 80.8% 83.7% 81.2% 77.2% 88.2% A&E 4-hour Attendances 7,548 7,616 7,535 8,630 7,683 8,590 8,063 8,593 8,031 8,326 8,386 7,827 7,927 7,816 7,244 Waits over 4-hours 842 1,546 2,024 2,296 1,602 1,768 1,906 1,961 1,546 1,327 1,614 1,277 1,490 1,781 853 Issues Performance below trajectory during 2016 / 2017 : Q1-78.3% Q2-80.63% Q3 81.85% January performance 77.2% recovering to 88.22% in February following implementation of recovery plan Non elective activity remains high - resulting in capacity pressures on Medical beds Medically fit for discharge numbers remain high > 100 against a target of 50 Clinical vacancies continues to impact on delivery Actions & Mitigation Actions embedded in system wide recovery plan yet to be completed Bed reconfiguration planned to address shortfall in medical bed base. Due for completion 3 rd April Surgical Assessment Go Live 3 rd April Reduce MFFD by 50%. Delayed by CCG - but now on track to increase capacity by Mid April. Clinical gaps covered by locums Two newly recruited ED consultants due to start May 2018 Once residual issues have been addressed we anticipate performance can be sustained above 90% from April, delivering 95% by year end 2017/18. Operational Performance Page 11
Accident and Emergency 4 Hour Standard - BTUH BTUH KPI Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Operational performance Performance 95% 88.4% 86.5% 81.0% 79.3% 77.7% 82.3% 80.6% 84.4% 88.1% 90.3% 88.5% 93.0% 89.0% 87.6% 91.7% A&E 4-hour Attendances 10,926 10,873 10,922 11,853 10,967 11,812 11,187 11,719 10,678 11,182 11,582 11,284 11,910 11,165 10,152 Waits over 4-hours 1,268 1,464 2,074 2,450 2,450 2,089 2,169 1,832 1,272 1,080 1,334 789 1,316 1,385 847 Emergency Care Improving care for emergency patients continues to be a Trust priority, steadily improving but remains fragile. Performance in February was 91.7% of patients being seen and treated/admitted within 4 hours. Issues Staffing Remains a risk for Trust Increasing numbers of Medically Fit patients including DTOC which affect patient flow Attendances remain high despite primary and community care remodelling Health and social care provision and capacity within the community 1 12 hour breach in March. Actions & Mitigation Streaming in place with senior decision maker and senior clinical support 24/7 in ED Ambulatory care model now embedded well. Operate a PULL system in medicine and surgery. Plan to extend to urology and orthopaedics Regular board rounds in place 7 days a week Additional consultants/therapies, social care/pharmacy in place at weekends to improve discharge process Discharge and Choice policy revamped Red2Green(R2G) and CUR are now live and being utilised by staff on 3 wards, with plans to roll out across medicine Creating a single point of referral for complex discharges Daily Breach analysis Revised operating procedures including roles and responsibilities of all divisions to support performance Weekly LOS meetings including daily monitoring of all medically fit patients including DTOC Dedicated manager of day in ED AAR undertaken of 12 hour breach, actions implemented, including introduction of nightly telecom with OCM/Site and NIC in ED OOH relocating to OPD so agreed pathways being developed for deflection The Trust forecasts that it is on track to deliver 90% for March and the Q4 2016/17 position overall. Operational Performance Page 12
Accident and Emergency 4 Hour Standard - SUHFT SUHFT Issues Medical workforce shortage Lack of acute assessment capacity Red to Green not fully embedded KPI Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Operational performance Performance 95% 86.3% 83.8% 81.9% 80.8% 87.5% 88.3% 87.1% 85.7% 86.4% 80.4% 76.7% 77.0% 73.1% 81.4% 85.3% A&E 4-hour Attendances 8,020 7,877 7,814 8,673 8,234 8,838 8,523 9,008 8,525 8,485 8,472 8,083 8,375 7,989 7,328 Waits over 4-hours 1,098 1,278 1,413 1,668 1,031 1,036 1,102 1,286 1,162 1,661 1,977 1,862 2,252 1,484 1,079 Actions and Mitigations Medical workforce recruitment 26 job offers in place. Dedicated recruitment officer for Medical Directorate in place and will continue for the next 6 months. Acute assessment capacity increase in ambulatory care capacity, refresh of the ambulatory care model (new model June), refresh of ED process with ambulance offload with ECIP support (April). Red to Green/SAFER rolled out in February as planned. Work continues to fully embed Red to Green within the organisation. Exec sponsor for each ward and board round challenge. Easter plan plans in place to reduce occupancy to 85% and cover in place for on call and weekend discharges. Bed modelling presentation to Execs planned for 29 th March. Forecast 90% achievement from March 2017, 95% from June 2017. Operational Performance Page 13
Accident and Emergency 4 Hour Standard Recovery Trajectories Mid & South Essex KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 95% 88.3% 91.5% 91.8% 92.0% 92.3% 92.7% 93.4% 93.4% 93.4% 93.1% 92.8% 93.2% 93.9% Attendances 29,048 27,683 29,325 28,289 29,589 27,779 27,987 28,998 28,088 28,527 28,251 26,406 29,882 Waits over 4-hours 3,413 2,352 2,417 2,257 2,265 2,023 1,846 1,920 1,861 1,973 2,042 1,797 1,811 MEHT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 95% 82.0% 90.0% 90.0% 90.0% 91.0% 92.0% 93.0% 93.0% 93.0% 92.0% 91.0% 92.5% 95.0% Attendances 8,242 8,159 9,122 8,562 9,125 8,528 8,842 8,905 8,312 8,418 8,300 7,693 8,752 Waits over 4-hours 1,480 815 912 856 821 682 618 623 581 673 747 576 437 BTUH KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 95% 89.8% 91.5% 91.5% 91.4% 91.5% 91.5% 92.5% 92.5% 92.5% 92.5% 92.4% 92.4% 92.5% Attendances 12,268 11,272 11,675 11,500 11,988 10,819 10,993 11,698 11,658 11,717 11,558 11,101 12,679 Waits over 4-hours 1,250 959 993 990 1,020 919 820 877 874 880 875 840 951 SUHFT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 A&E 4-hour Performance Trajectory 95% 92.0% 93.0% 94.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% Attendances 8,538 8,252 8,528 8,227 8,476 8,432 8,152 8,395 8,118 8,392 8,393 7,612 8,451 Waits over 4-hours 683 578 512 411 424 422 408 420 406 420 420 381 423 Operational Performance Page 14
Cancer 62 day Standard Mid & South Essex KPI Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 62-day Cancer (urgent GP referral) Issues: Performance 85% 71.1% 67.2% 71.5% 70.7% 68.1% 71.5% 70.8% 73.0% 71.7% 71.2% 72.6% 73.1% 70.6% Treatment Points 230 230 246 227 259 272 257 281 265 260 271 227 248 Treatment Points over 62 days 0 67 76 70 67 83 78 75 76 75 75 74 61 73 Treatment Points over 104 days 0 17 19 27 21 15 23 21 23 19 20 19 14 19 Late referrals (post day 38) between Trusts Capacity issues Key tumour sites requiring joint action for rapid improvement: o Urology o Skin o Head and Neck o Colorectal o Upper GI Key Actions and Mitigations from joint plan: Group wide cancer group being established to initially create a whole group PTL, focused on shared ownership with an ambition of creating a compliant position by July 2017 Robust escalation policy across sites to ensure early resolution of missed pathway milestones Impro ved theatre planning and utilisation across all three sites Urology: timely access to JOC 52 weeks per year, pathway mapping and diagnostic timelines at BTUH. Skin: single point of referral for all plastics referrals, plastics demand and capacity, accommodation to expand one stop capacity for south Essex Head and Neck: One stop clinics within ENT Colorectal: straight to test for GPs to reduc e diagnostic delays UGI: Additional EUS sessions at MEHT following completion of EUS training Confirmation of 2 week wait future compliance agreed Operational Performance Page 15
Cancer 62 day Standard Recovery Trajectories Mid & South Essex KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 74.9% 76.5% 80.2% 83.4% 84.9% 85.1% 85.5% 85.6% 85.2% 85.4% 85.2% 85.2% 85.3% Treatment Points 268 277 251 286 271 285 254 275 271 245 277 262 275 Treatment Points over 62 days 0 67 65 50 48 41 42 37 40 40 36 41 39 40 Treatment Points over 104 days 0 21 21 19 17 16 5 5 5 2 0 0 0 0 Waits over 104 days 0 83 68 53 36 19 8 5 2 0 0 0 0 0 Adjustment for double reporting 19 10 8 6 5 2 2 1 - - - - - Group Trajectory 0 64 58 45 30 14 6 3 1 - - - - - MEHT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 73.5% 77.2% 79.3% 81.2% 85.3% 85.2% 85.0% 85.1% 85.2% 85.4% 85.2% 85.2% 85.2% Treatment Points 106 119 107 117 109 125 100 111 118 96 122.0 115 115 Treatment Points over 62 days 0 28 27 22 22 16 19 15 17 18 14 18.0 17 17 Treatment Points over 104 days 0 5 5 5 5 5 5 5 5 2 - - - - Waits over 104 days 0 23 20 17 14 11 8 5 2 0 0 0 0 0 BTUH KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 70.3% 70.3% 79.3% 84.5% 85.1% 85.1% 86.4% 86.9% 85.4% 85.9% 85.2% 85.4% 85.7% Treatment Points 82.5 77.5 84.5 87.0 84.0 84.0 84.5 84.0 85.5 78.0 84.5 82 84 Treatment Points over 62 days 0 24.5 23.0 17.5 13.5 12.5 12.5 11.5 11.0 12.5 11.0 12.5 12 12 Treatment Points over 104 days 0 10.0 10.0 10.0 10.0 10.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Waits over 104 days 0 36.0 28.0 20.0 12.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 SUHFT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 62-day Cancer (urgent GP referral) Performance Trajectory 85% 81.6% 81.5% 83.0% 85.3% 84.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% Treatment Points 80.0 81.0 60.0 82.0 78.0 76.0 69.0 80.0 67.0 71.0 70.0 65.0 76.0 Treatment Points over 62 days 0 14.7 15.0 10.2 12.1 12.5 11.4 10.4 12.0 10.1 10.7 10.5 9.8 11.4 Treatment Points over 104 days 0 5.5 5.5 3.5 1.5 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Waits over 104 days 0 24.0 20.0 16.0 10.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Operational Performance Page 16
18 weeks Referral to Treatment Incomplete Standard Mid & South Essex KPI Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 18wRTT (Incomplete Pathways) Performance 92% 92.1% 91.1% 91.2% 91.4% 91.4% 91.2% 90.4% 88.8% 88.6% 89.3% 87.8% 87.4% 87.1% Waiting List Size 65,816 67,485 70,097 69,439 70,241 72,277 73,603 74,837 72,540 73,751 74,271 73,636 74,093 Waits over 18 weeks 5,221 6,008 6,163 5,989 6,056 6,366 7,047 8,357 8,254 7,904 9,032 9,295 9,560 Waits over 52 weeks 0 5 2 1 6 9 12 15 17 16 18 22 20 12 Issues 52 week breach MEHT February = 4, 2016/17 YTD = 57, March Forecast = 3 - Biggest risk area - Plastic Surgery (Complex Breast) BHUT - Current 52 week breaches - February = 12, 2016/17 YTD = 59, March Forecast = 10 - Biggest Risk areas - Neurology and Respiratory Sleep SUHFT Current 52 week breaches February = 2, 2016/17 YTD - 27, March forecast = 6 Risk areas Urology and Paediatrics Backlog Positions MEHT 2053 Hot spots in Plastics, T&O, Rheumatology, Neurology, Oral Surgery, General Surgery BHUT 4408 - Neurology, Dexa/Osteoperosis, T&O, Gastroenterology SUHFT 3716 - Orthopaedics, General Surgery, Urology Actions and Mitigation RTT x-group being formed with initial focus on the development of cross-site PTLs (and PTL discussions) for long waiting patients to identify opportunities to transfer patients across site to aid earlier booking and prevent excessive waits for patients. Examine areas of capacity which could aid backlogs on other site. For example backlog of DC T&O at BHUT and SUHFT could potentially be supported by MEHT as although they have a T&O backlog this is predominately IP. Network wide approach to neurology backlog to be discussed MEHT specific recovery plan for complex breast patients in discussion with CCG, Rheumatology locum appointed, longer term plans for T&O service in development BHUT for neurology choose and book closure agreed with CCG for 6 months, locum commences in post next week, working with community/primary care on demand management such as headache pathway, community management of Parkinson's and epilepsy. Dexa/Osteoporosis- task and finish group underway, Respiratory / Sleep - discussions commenced with CCG re potential decommissioning of PSG service. SUHFT - Comprehensive activity modelling - IST support confirmed (exec delivery planning, capacity and demand modelling), Foureyes review to support theatre utilisation, BAYER review of ophthalmology and recovery plan currently in progress to identify opportunities to improve productivity, Optimise day stay activity to 220 cases per week. Seasonal front load elective in-patient activity protecting Dec, Jan and Feb for urgent / cancer care. All site implementing robust PTL meetings and management and RTT leads from each site to ensure consistency of approach in relation to RTT Guidance application and Access Policies. Harm reviews routinely in place for all long waiting patients. Operational Performance Page 17
18 weeks Referral to Treatment Incomplete Standard Recovery Trajectories Mid & South Essex KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 87.2% 87.4% 88.0% 88.6% 89.1% 89.4% 89.8% 90.2% 90.6% 91.0% 91.3% 91.7% 92.2% Waiting List Size 74,979 75,011 74,571 74,138 73,865 73,783 73,464 73,125 72,743 73,090 73,336 73,584 73,823 Waits over 18 weeks 0 9,569 9,446 8,943 8,464 8,059 7,790 7,489 7,146 6,840 6,613 6,366 6,127 5,730 SUHFT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 86.0% 86.0% 86.5% 87.0% 87.5% 88.0% 88.5% 89.0% 89.5% 90.0% 90.5% 91.0% 92.0% Waiting List Size 27,509 27,650 27,788 27,923 28,056 28,187 28,317 28,445 28,572 28,698 28,823 28,948 29,071 Waits over 18 weeks 0 3,851 3,871 3,751 3,630 3,507 3,382 3,256 3,129 3,000 2,870 2,738 2,605 2,326 BTUH KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 84.0% 84.5% 85.9% 87.2% 88.3% 88.8% 89.4% 90.1% 90.7% 91.2% 91.7% 92.2% 92.8% Waiting List Size 24,055 23,966 23,856 23,747 23,678 23,686 23,675 23,637 23,549 23,461 23,373 23,285 23,188 Waits over 18 weeks 0 3,845 3,704 3,358 3,037 2,782 2,656 2,516 2,334 2,191 2,069 1,937 1,814 1,679 MEHT KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 18wRTT (Incomplete Pathways) Performance Trajectory 92% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% Waiting List Size 23,415 23,395 22,927 22,468 22,131 21,910 21,472 21,043 20,622 20,931 21,140 21,351 21,564 Waits over 18 weeks 0 1,873 1,871 1,834 1,797 1,770 1,752 1,717 1,683 1,649 1,674 1,691 1,708 1,725 Operational Performance Page 18
6 week Diagnostic Standard Mid & South Essex KPI Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 6w diagnostic waits Performance Waiting List Size Waits over 6 weeks 99% 99.2% 98.9% 99.1% 99.1% 99.4% 99.4% 98.7% 93.2% 94.9% 99.2% 98.4% 97.0% 97.2% 14,907 14,560 14,735 14,362 14,502 13,985 13,322 15,361 15,258 15,121 13,501 13,614 13,433 121 156 127 135 94 78 172 1,040 783 125 217 410 374 The main ongoing concern relates to diagnostic service at Southend which the group are supporting to resolve. Issues Increase in demand Lack of physical space within Endoscopy and Cardiology Long term sickness within Endoscopy team Changes in NICE guidance has impacted on Cardiac Echo and CT Coronary Angiogram (36% increase in demand). Actions and Mitigations Whole group escalation policy and process in development to identify potential risks and to secure mutual support. Weekly review of capacity across ESR for Cardio Echo and CT Angio. Developing CNS role to provide non medical prescribing Additional sessions in place for Echo and Endoscopy Additional Endoscopy room planned pending capital investment CCG to review referral guidelines and pathways to aim to decrease demand A proposed trajectory for Southend services is here: KPI Mar-17 Apr-17 May-17 Jun-17 Jul-17 6w diagnostic waits Performance Trajectory 99% 92.5% 94.2% 96.3% 97.6% 99.0% Waiting List Size 4,572 4,366 4,505 4,365 4,457 Waits over 6 weeks 345 255 167 106 45 Operational Performance Page 19
Appendix Recent Site and Group Level Performance SUHFT MEHT BTUH Mid & South Essex KPI Dec-16 Jan-17 Feb-17 KPI Dec-16 Jan-17 Feb-17 KPI Dec-16 Jan-17 Feb-17 KPI Dec-16 Jan-17 Feb-17 Operational performance Performance 95% 73.1% 81.4% 85.3% 95% 81.2% 77.2% 88.2% 95% 89.0% 87.6% 91.7% 95% 82.1% 82.8% 88.8% A&E 4-hour Attendances 8,375 7,989 7,328 7,927 7,816 7,244 11,910 11,165 10,152 28,212 26,970 24,724 Waits over 4-hours 2,252 1,484 1,079 1,490 1,781 853 1,316 1,385 847 5,058 4,650 2,779 Performance 85% 69.4% 76.8% 85% 74.7% 70.6% 85% 74.2% 64.2% 85% 73.1% 70.6% 62-day Cancer Treatment Points 60.5 69.0 87 110.5 79.5 68.5 227 248 (urgent GP referral) Treatment Points over 62 days 0 18.5 16.0 0 22 32.5 0 20.5 24.5 0 61 73 Treatment Points over 104 days 0 5.0 4.5 0 1.5 6.5 0 7.5 7.5 0 14 19 18wRTT (Incomplete Pathways) Performance 92% 86.3% 86.5% 86.6% 92% 92.3% 91.4% 91.3% 92% 85.1% 84.3% 83.5% 92% 87.8% 87.4% 87.1% Waiting List Size 27,419 26,846 27,663 23,840 23,698 23,415 23,012 23,092 23,015 74,271 73,636 74,093 Waits over 18 weeks 3,762 3,626 3,716 1,847 2,045 2,043 3,423 3,624 3,801 9,032 9,295 9,560 Waits over 52 weeks 0 5 2 2 0 11 11 4 0 6 7 6 0 22 20 12 Performance 6w diagnostic waits Waiting List Size Waits over 6 weeks 99% 97.6% 92.7% 92.0% 99% 99.7% 99.7% 99.8% 99% 98.1% 98.5% 99.4% 99% 98.4% 97.0% 97.2% 4,035 4,350 4,125 3,886 3,723 4,228 5,580 5,541 5,080 13,501 13,614 13,433 96 318 331 13 10 10 108 82 33 217 410 374 Operational Performance Page 20
Mid Essex, Southend and Basildon Hospitals Joint Working Board 05/04/2017, 2pm Workforce, Leadership and Improvement Capability Mary Foulkes (CQC - Well Lead) March 2017
Workforce Priorities Hotspots Agency The agency spend to date across the three trusts is over 50m. Vacancies 590 registered nursing vacancies Hard to fill specialists post (acute medicine, stroke, middle grades, ophthalmologists, radiographers etc.) Robust controls in place best practice shared Focus on recruitment and retention activities Identifying joint roles Consistent recruitment process One temporary staffing team across the Trusts Workforce, Leadership and improvement capability Page 22
Workforce Priorities Reducing Agency Spend (2) Agency Ceiling Performance Trust Ceiling Actual Variance Fav/(Adv) BTUH 11.9 17.4 ( 5.5) MEHT 17.5 17.1 0.4 SUHFT 11.4 16.3 ( 4.9) BTUH The Trust spend on agency is higher in 16/17 than for the same period in 15/16. The improvement seen in January spend on medical agency spend has not been maintained. MEHT The Trust is above plan year to. Given the spend in the last quarter has averaged 1.7m a month the Trust will probably exceed the agency cap for 16/17 by over 1m. SUHFT The has already exceeded its full year target. The actuals have decreased since the start of the year in line with the planned reduction, and whilst the Trust has as a YTD average Workforce, Leadership and improvement capability Page 23
Workforce Priorities Nursing Vacancies Priority 1 : reduce the band 5 nursing vacancies across the group. Task and finish groups with outcomes by September include: developing one recruitment and retention plan creating one consistent recruitment process (messages in adverts and JDs, competencies & values ) identifying and advertise joint posts Workforce, Leadership and improvement capability Page 24
Workforce Priorities Doctor Vacancies Priority 2: reduce the number of hard to fill doctor vacancies for 2017 across the group Consultants to align the priority medical policies advertise for joint post standardise the recruitment process new post developed and advertised standardise WLI and other additional payments Workforce, Leadership and improvement capability Page 25
Workforce Priorities Reducing Agency Spend (1) Business case will be completed to by the end of the month which will result in plan to introduce one bank service for the group. Engagement with agencies who specialise with recruiting overseas Doctors into substantive contracts. Working in partnership with the agencies to devise plans to reduce current break glass arrangements with agency staff Working together within the CPP framework for standardisation of agency rates Business Case in development to harmonisation the bank rates for Doctors Workforce, Leadership and improvement capability Page 26
Workforce Priorities Reducing Agency Spend (2) Southend Basildon Mid Essex Increased number of Recruitment Officers to deliver higher focus on Doctors recruitment 32 offer made in Feb and March Site Leadership Team scrutinises all agency request over the cap rate with a duration of over a week/frequent requests Auto enrolment of all nurses has increased the number of staff on the bank Dedicated resource appointed to target sickness cases filled by agency Board led speciality reviews to challenge high cost agency usage and develop plans to reduce reliance on long term agency. New bank rates for Nurses implemented Mid-February. At the start of the new rate bank fill rate was 30% and Agency 70%. Week ending 19 th March the fill rate for bank was 51% and Agency 41%. 12 Agency workers have moved across to bank and 4 have moved to permanent roles Nurse Assurance group which reviews and approves agency requests New marketing campaign launched Efforts have been made to phase annual leave to reduce agency spending during March when in previous years it was disproportionately high. Site leadership scrutiny of agency spend Workforce, Leadership and improvement capability Page 27
Sickness, Turnover and Board Vacancies SUHFT MEHT BTUH Mid & South Essex Dec-16 Jan-17 Feb-17 Dec-16 Jan-17 Feb-17 Dec-16 Jan-17 Feb-17 Dec-16 Jan-17 Feb-17 Staff sickness Performance 4.4% 4.5% 3.7% 4.6% 4.8% 4.8% 4.7% 4.7% 4.1% 4.5% 4.5% 3.9% Hours 887,604 887,207 796,537 124995 125077.7 125077.7 132423 132623 120072 1,145,022 1,144,908 1,041,687 Hours sickness 39,429 39,674 29,681 5,703 6,054 6,054 6,176 6,267 4,906 51,308 51,995 40,641 Staff turnover (last 12 months) Performance 17.1% 17.4% 17.6% 8.9% 8.7% 8.7% 16.0% 16.2% 16.5% 14.2% 14.3% 14.5% WTEs 3,749 3,770 3,752 3,552 3,592 3,617 4,407 4,415 4,429 11,708 11,777 11,798 Leavers (WTEs) in last 12 months 641 654 661 315 312 314 706 715 731 1,663 1,681 1,706 Board vacancies Performance 4.1% 4.1% 22.7% 0.0% 0.0% 0.0% 0.0% 14.3% 14.3% 1.1% 5.4% 10.0% Total members 6.60 6.60 5.60 10 10 10 8 7 7 24.6 23.6 22.6 Vacancies 0.27 0.27 1.27 - - - - 1 1 0.3 1.3 2.3 Commentary Staff turnover is relatively low in MEHT compared to the other two hospitals and staff staff engagement in the staff survey has significantly increased. The 18 month culture programme that the Trust implemented has made a significant impact. Staff turnover at Southend is relatively high and although the staff engagement in the NHS staff survey has increased, the hospital remains in the bottom 20% of Trusts. Staff turnover is relatively high in BTUH compared to the other two hospitals but staff engagement in the staff survey has increased. Sickness absence is reducing and targeted efforts are in place to ensure that return to work interviews are conducted. Workforce, Leadership and improvement capability Page 28
Mid Essex, Southend and Basildon Hospitals Joint Working Board 05/04/2017, 2pm Finance and use of Resources James O Sullivan (CQC Use of Resources) February 2017
Contents 2016/17: summary I&E FOT position 2017/18: summary I&E plan and Control Total BTUH bridge: 2016/17 FOT to 2017/18 plan BTUH risks to 2017/18 plan MEHT bridge: 2016/17 FOT to 2017/18 plan MEHT risks to 2017/18 plan Ensuring delivery of plan Finance and Use of Resources Page 30
2017/18 I&E FOT position Finance and Use of Resources Page 31
2017/18: Summary I&E plan and Control Total Finance and Use of Resources Page 32
MEHT: 2016/17 FOT to 2017/18 plan bridge Finance and Use of Resources Page 33
MEHT: 2017/18 Risks Income CCG QIPP delivery potential stranded costs Fines and Penalties given historic non performance CQUIN Trusts capacity to deliver against the terms of the CQUIN Costs Containment of agency bill Cost to deliver the Access targets CIP delivery Containment of cost pressures Finance and Use of Resources Page 34
BTUH: 2016/17 FOT to 2017/18 plan bridge Finance and Use of Resources Page 35
BTUH: 2017/18 Risks Costs Pay run rate Agency costs linked to vacancies Unfunded cost of change: Containment of cost pressures Finance and Use of Resources Page 36
Ensuring delivery of plans (1) Carter Reviewing Carter data to identify opportunities Opportunities in estates & facilities, back office, etc. Plan to centralise this for the three Trusts Maximise identified benefits Finance and Use of Resources Page 37
Ensuring delivery of plans (2) Cost control & CIPs Q1 programme across the 3 Trusts using Accelerus Implement a consistent approach Ensuring effective grip and control Ensuring CIP delivery Finance and Use of Resources Page 38