SUMMARY REPORT TRUST BOARD 1 March 218 Agenda Number: 7 Title of Report Accountable Officer Author(s) Purpose of Report Recommendation Consultation Undertaken to Date Signed off by Executive Owner 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 Claire Florey, Access and Performance Manager Judith Laity Strategy Programme Manager The objective of this report is to provide the Board with the Trust s performance against key targets and draw attention to those areas under review 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 HR & OD, Director of 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 (where applicable) Date(s) at which previously discussed by Trust Board / Committee Next Steps The Trust Board receive the IPR at every meeting Nil. January 218 Monthly 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;
Our People; Partnerships. The Executive Summary on page 2 of the report provides a summary of the data for January 217 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
SUMMARY INTEGRATED PERFORMANCE REPORT January 218
EXECUTIVE SUMMARY 2 Quality & Safety: There was one case of Clostridium difficile reported in January, above tolerance for the year to date. There were no non clinically justified single sex breaches reported in month. Nine Serious Incidents breach the national timescale for investigations. FFT response rates remain below target for the month and quarter. The nationally benchmarked mortality indicators of HSMR and SHMI are stable and (positively) below the national average. The primary PCI call to balloon standard was met for the first time since September. Operational Performance : The whole system emergency care access standard was 85.% in January, against the local trajectory of 9%. ED performance was 69.3% attendances were.% up on last year. Delayed transfers of care improved as a percentage of days lost to 6.5% and the daily average to 37.8/days however a correction to the recording of a cohort of these patients will means this figure will slightly increase from February. Patient flow pressure was on going resulting in 27 out of the 31 days in the month having black bed status which impacted on a number of other indicators. Stroke performance reduced below the standards for admission to and time on the stroke unit as a result of challenging patient flow. The number of patients whose cancelled on the day operations were not rebooked within 28 days increased by 6 to 36. 93 electives were cancelled on the day compared to 82 in the previous month, however the day case and day of surgery admission rates both improved in response. Neither the diagnostic nor the RTT standards were met in month and both will not be met in February; 13 patients have waited 52 weeks or more. The proportion of follow up outpatients more than 1 month past their To Be Seen date improved month on month. The Trust continues to meet all of the quarterly cancer standards. The number of fractured neck of femur patients operated on within 36 hours was above the 8% standard (85.7%). Net emergency readmissions within 28 days were.7%, falling (positively) below the threshold for the first time. Finance: Trust level I&E is a 5m deficit which is 3.m below plan. The forecast outturn is a 9.3m deficit with a total of 3.7m of lost STF income within this. The remainder relates to nondelivery of savings, lost elective income and overspends. The forecast deficit means that c 8.5m of additional cash support will be required from the Department of Health. Agency spend increased to 1.3m in month and total agency spend is expected to be 12.3m for the year. Our People: Total staffing deployed in January reduced by 1 FTE of which substantive staff increased by 21 FTE and temporary staff decreased by 35 FTE. Sickness absence increased by.5% to.6% which is.89% above the Trust standard. Appraisal compliance in January decreased by.6% to 7.7% reflecting the seventh month where compliance reduced and is 5% below the same point last year. Vacancies remain high at 39 FTE posts actively in the recruitment process. Focus continues on recruiting to substantive posts to reduce agency use. Mandatory training compliance reduced by 1.6% to 86.%. This is 8.6% below standard, however, compliance remains 1.8% higher than the same time last year. Partnership: Progress with the new model of care and the development of the ACS is being made, however this is not yet impacting on our key deliverables of ED attendances and DTOCs. The new Planned Care Board met for the first time in January 218 complementing the role of the existing A & E Delivery Board informing the governance of the developing new model of care. The new 111 service went live on 3th November 217 and has performed well in January 218
CONTENTS 3 Section Name Accountable Officer/s Page Section Summaries Quality & Safety: Patient Safety/Experience Quality & Safety: Patient Safety/Outcomes/Effectiveness Chief Nurse 11 Medical Director 21 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 2 7 Key Unless noted on each graph, all data shown is for the period up to, and including January 218. Directorate/Group Abbreviation Glossary CEO FUW NIHSS DOSA SI SHMI YTD RTT DTOC HSCIC HSMR FTE SRO ECIP Measure shows a decline in performance over the previous 3 month period. In Annual Plan 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
QUALITY PATIENT SAFETY SROs Medical Director and Chief Nurse Section Summary Areas of Concern: One C.Difficile infection was reported for January which is within the tolerance for the month although above the tolerance for the year to date. Nine Serious Incidents breached the national timescale for investigation. Trends: The rate of new harm free care (RCHT acquired harm) remains above target (98.5%). The trend for patient falls (as rated per 1 bed days) is increasing. Improvements: The incidence of MSSA continues to be stable and within revised tolerance for the year (following a high incidence at the beginning of 217/18). Actions: A comprehensive improvement plan is in place to remedy the issues with Serious Incidents both backlog and process.
QUALITY PATIENT EXPERIENCE Accountable Officer : Chief Nurse 5 Section Summary Areas of concern: FFT response rates remain below target for the month and quarter. New actions are being explored to make the FFT form more available to staff at the point of discharge. A rise is anticipated in complaints in January/February due to elective surgery postponements. Trends: Friends and Family Birth response (and recommended) rates are under target for the quarter. Improvements: This months total is in line with previous months and shows that wards and departments continue to use QUANTA to record compliments. The number of dissatisfied complainants (complainants who are not satisfied that the first response has fully answered their concerns) remains low. Actions: Procurement of new data collection and reporting system for FFT going ahead with a view to implementation in time for the new financial year.
QUALITY PATIENT OUTCOMES/EFFECTIVENESS SRO Medical Director 6 Section Summary Areas of Concern: Regarding Sepsis, the CQUIN results in December showed a decrease to 65% in December from 82% in November for antibiotics being given within the hour. Trends: Mortality rates for weekday and weekends are stable. Improvements: The mortality rate for the Trust (HSMR) remains stable and is below the average for England. The level of screen for Sepsis remains at an excellent (compliant) position. The primary PCI call to balloon standard was achieved for the first time since September. Actions: 1. The Sepsis screening tool on Nervecentre will commence in February 218 resulting in all patients being screened for sepsis and staff alerted to make a decision on a possible diagnosis. 2. Root cause analysis has been carried out on all ppcis which did not meet the standard.
KEY OPERATIONAL STANDARDS SRO Chief Operating Officer 7 Section Summary Areas of concern: Key concerns remain the emergency access hour standard, RTT incompletes and 52 week waits, 6 week diagnostics, elective cancellations on the day and 28 day re booking standard, DTOCs and patients on the follow up pending list past their to be seen date. Stroke performance was also an emerging concern in January. Trends: Patient flow pressure continues to impact on a number of measures. Failure to achieve both the RTT and diagnostic standards continued, whilst the number of incomplete pathways over 52 weeks is growing. Cancer standards performance continue to be sustained. Improvements: Fractured neck of femur patients operated on within 36 hours, daycase and DOSA rates and net emergency readmissions within 28 days all improved. In addition a number of ED indicators improved, particularly the number of ambulance delays over 3 minutes. Actions: 1. For patient flow the successful series of Multi Agency Discharge Events (MADE) continue. 2. A number of activities are underway to improve ED performance against the A&E quality indicators as part of the Tackling Patient Delays workstream of the Quality Improvement Delivery Programme, this includes changes implemented to the medical model which move the medical take out of ED.
FINANCE SRO Director of Finance 8 Section Summary Areas of Concern: Savings of 9.7m delivered to date which is 3.m below plan. The full year forecast stands at 1.1m compared to a plan of 17.3m. The shortfall is entirely in relation to schemes designed to reduce pay costs and the improvement in month is due to non recurrent savings expected in M12. Agency spend increased to 1.3 in month. Elective income was.8m below plan in month and is expected to be lower than plan due to operational pressures in February and March. Significant investment is likely to be required in response to CQC findings / Quality Improvement. Trends: Two of the four clinical Divisions, plus Corporate departments, are operating below budget. Surgical Services and Medical Services Divisions continue to overspend due to unidentified savings. Improvements: Corporate departments continue to underspend to help improve the financial position. Actions: 1. Focus on reduction in substantive pay costs through service redesign. Re prioritise funds to achieve Quality Improvement priorities. Increase bank usage to reduce agency spend.
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 39 FTE of which 165 FTE are for registered nurses. Agency use increased further during January by 1 FTE to 125 FTE and remains at an unsustainable level and cost. Trends: Appraisal compliance continued a seventh consecutive month in decline and at 7.7% is 2.3% below standard and 5% below this same point last year. Sickness absence increased for the sixth month and at.6% is.89% above standard. Improvements: Success is being seen in recruitment. January reports a net increase of 21 FTE substantive staff and an additional Saturday recruitment event saw offers made to 15 nurses and 22 healthcare assistants Actions: Work continues to recruit substantively to vacancies and to reduce agency use. Business planning activity continues for 218/19 with focus on improved recruitment, retention and attendance to achieve more substantive staff in work and reduce temporary use.
PARTNERSHIPS SRO Director of Strategy and Business Development 1 Section Summary Areas of Concern: Prompt discharge Delayed transfers of care remain high, significantly above the level experienced in 216. ED attendances Activity remains ahead of plan. New Model of Care Investments required for the implementation of the new MSK pathway, were considered at the first meeting of the Planned Care Board (23/1/18), and arrangements are in place to pump prime early costs pending formal go live April 218. However any ongoing delay, will defer the realisation of patient and financial benefits. System working needs to be accelerated to achieve the scale of change required to meet quality and financial targets. Trends: The recent improvements in DTOCs has been maintained and the year to date trend is a reduction compared to previous years; ED attendances are over profile. Improvements: The new 111 service remains on plan, with further improvement in key metrics of interest eg % of calls resulting in ED disposition Actions: Discharges and ED refer to Operational report Integrated Care system Following the publication of NHSE Planning guidance, the system is working toward the production of a system wide plan for 218/19, and is developing the structure to do this as an Integrated Care System. This now replaces the previous term of Accountable Care System.
QUALITY & SAFETY PATIENT SAFETY Summary Dashboard 11
QUALITY Patient Safety Safety Thermometer Accountable Officer: Chief Nurse 12 1% 98% 96% 9% 92% 9% 88% 86% (1) % New harm free care vs all harms % New harm free All harm free % 1.8% 1.6% 1.% 1.2% 1.%.8%.6%.%.2%.% (2) Catheters and UTIs Catheters & UTIs (1) January s rate of new harm free care (RCHT hospital acquired harm) improved from a three month static performance from around 97.75% to 98.5%. New harms reported were down to eight harms across 526 inpatients. This equally the Trust s highest previous performance score (July 217). (2) For the second month in a row, zero Catheter Associated Urinary Tract Infections. RCHT Catheter prevalence in January was 15%. The current national prevalence for Acute Trusts is 19.1%. 1.2% 1.%.8%.6%.%.2%.% (3) New VTEs New VTEs 7% 6% 5% % 3% 2% 1% % () Pressure Ulcers % of old pressure ulcers % of new pressure ulcers (3) January s audit identified four new VTE harms (.7%) slightly up on Decembers two. Nationally the rate of harm is.% for Acute Trusts. The overall rate of Hospital Associated Thrombosis is on trajectory to meet the 2% reduction target this year. () The Trust reported a significant reduction in new pressure ulcer harms in January, just two. Both Category 2 (lowest level of harm reported) this is a point prevalence percentage of.%. The national average is currently.9%.
QUALITY Patient Safety Safety Thermometer Accountable Officer: Chief Nurse 13 8. 7. 6. 5.. 3. 2. 1.. 7 6 5 3 2 1 (5) Falls per 1 bed days (7) Falls SIs 1.% 1.2% 1.%.8%.6%.%.2%.%.35%.3%.25%.2%.15%.1%.5%.% (6) Falls with harm Safety Thermometer (8) Moderate/Severe Harm Falls (5) This month saw a slight increase again in Datix incident reported inpatient slips, trips and falls per 1 overall bed days again. January s data was 6.2 compared to December s 6.1. The trend has been creeping slowly upwards over the last few months, despite no reciprocal increase in harms during this time. (6) On the Safety Thermometer data collection day in January, nine slips, trips and falls were reported (one less that December). This was 1.7% compared to the national average of 1.6%. Two harms were reported. These were graded Low Harm, indicating the harm related to cut to an arm or face for example. (7) One moderate and one severe harm incident related falls were reported on Datix in January, two down on the previous month. These harms occurred on Kerensa Ward and Lowen Ward. (8) One severe harm from a falls incident was reported in January. This fall was on Kerensa Ward and is being investigated as a serious incident.
QUALITY Patient Safety Infection Control 1 Accountable Officer: Chief Nurse (9) MRSA (1) MSSA Cases (9) MRSA bacteraemia no cases reported in January 2 1 Tolerance 3 25 2 15 1 5 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 16/17 17/18 Tolerance 17/18 (1) MSSA bacteraemia 2 cases reported in January which is above the monthly tolerance but remains within the re set annual tolerance of 25. One case is thought to be a contaminant and the other the cause is unknown. (1,11) C. difficile 1 case reported in January which is within the monthly tolerance. The total to date however is 2 which is above the annual tolerance. The recovery plan continues to be delivered. 6 (11) C Difficile Cases 3 (12) C Difficile Tolerance E.Coli bacteraemia one case was reported in January. The total number of cases reported to date is 27 against the tolerance to date of 32. 5 25 3 2 1 Tolerance 2 15 1 5 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 16/17 17/18 Tolerance 17/18
QUALITY & SAFETY PATIENT EXPERIENCE Summary Dashboard 15
QUALITY Friends & Family Test Response rates Accountable Officer: Chief Nurse Inpatients and Daycases Maternity (Antenatal Care) 95% 5% 2% 96% 1% Maternity (Postnatal Community) 1% % Maternity (Birth) 6% 1% % Outpatients 98% % Emergency Departments 1% 95% 1% Maternity (Postnatal Ward) 9% 5% Response Rates Recommended Not Recommended 16 In January 2,67 responses to the Friends and Family Test were received. Response rate targets Q Q1 Inpatient/daycase 23% 25% Emergency 13% 15% Maternity Birth 25% 25% Low response rates discussed at Operational Executive Group (OEG). Associate Directors asked to report back corrective actions to OEG next month. New system (Meridian) being implemented from 1 April which will offer SMS option for Emergency Maternity and Paediatrics Recommended targets Q Q1 Inpatient/daycase 98% 98% Emergency 95% 95% Maternity Birth 1% 1% Not Recommended threshold When Not Recommended scores hit 5% this can indicate issues in service. Comments for postnatal ward suggest that stopping partners from staying has led to dissatisfaction. Antenatal 3 negative responses but numbers returned were very low.
QUALITY Patient Experience Complaints Accountable Officer: Chief Nurse 17 6 5 3 2 1 (13) Total number of formal complaints Mean UCL LCL Total in Month 1 12 1 8 6 2 (1) Total number of informal complaints Mean UCL LCL Total (13, 1) The Trust received an average number of complaints in January. (15) Complaints Regulations require that complaints are acknowledged within 3 working days of receipt. The new process of acknowledging complaints immediately when they are received by email or in person/by telephone is working well and to further improve performance the team will now acknowledge complaints received by letter as soon as the DATIX record is created (normally on date of receipt). 1% 95% 9% 85% 8% 75% 7% 65% 6% (15) % complaints acknowledged in 3 working days 1% 8% 6% % 2% % (16) % Complaints responded to within agreed timescale % responded to within timescale (16) In January, of all complaints closed, 2% were closed within the agreed target response time of either 25 or 5 working days. This target is now changing and from the start of Q, the target response time will be 3 working days for all complaints unless agreed otherwise with the complainant. The Team are currently trialling a function on DATIX which will automatically alert the IO when a complaint response is due to breach and this will hopefully show improvement in this area.
QUALITY Patient Experience Complaints Accountable Officer: Chief Nurse 18 3.5 3. 2.5 2. 1.5 1..5. (17) Complaints per 1 bed days Mean UCL LCL Value 1 12 1 8 6 2 (18) Dissatisfied Complainants Mean UCL LCL Total (17) In line with other exemplar Trust s and to provide more meaningful data the Patient and Family Experience Team will now start to monitor the number of complaints received per 1 bed days. (18) The number of dissatisfied complainants (complainants who are not satisfied that the first response has fully answered their concerns) remains low and the quality assurance checking process which is completed prior to Chief Nurse approval ensures that responses are scrutinized for accuracy prior to being sent to the complainant. 5 (19) Mixed Sex Accommodation breaches Mean (19) There were no non clinically justified single sex breaches reported in January. 3 UCL 2 1 LCL Total
QUALITY Patient Experience Compliments & Ratings Accountable Officer: Chief Nurse 19 9 8 7 6 5 3 2 1 (2) Total compliments Mean UCL LCL Total Current NHS Choices Rating Based on 393 Ratings for the Hospital (RCH Treliske) (2) This months total is in line with previous months and shows that wards and departments continue to use QUANTA to record compliments. The Patient and Family Experience Team are now working with the Application Development Team Leader to see how QUANTA can be used to record compliments received via other sources, for example, Wonderwall. Source: www.nhs.uk/services/hospitals/reviewsandratings Care Opinion Response rates (Treliske) Source: www.careopinion.org.uk/services/ref12 Twitter Followers: 31
3 2 1 SAFETY Patient Safety Never Events & Serious Incidents Accountable Officer: Medical Director 9 8 7 6 5 3 2 1 (21) Never Events (23) SI Investigations Feb 18 Mar 18 SIs breached SIs not breached 35 3 25 2 15 1 5 (22) Serious Incidents (2) Serious Incident Types: Apr 216 Jan218 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 1 2 3 216/17 217/18 (21 & 22) There were 12 Serious Incidents reported. There were no never events reported. The SIs for January are as follows: 218/11: Medication (MAU1) 218/132: Treatment Delay (Clinical Imaging) 218/25: Treatment Delay (Ophthalmology) 218/616: Adult Safeguarding (Emergency Department) 218/726: Pressure Ulcer (Gastroenterology and Liver Unit) 218/77: Information Governance Breach 218/119: Sub optimal Care of the Deteriorating Patient (Endocrine) 218/253: VTE (St Mawes Unit) 218/2522: Maternity (Truro Birth Centre) 218/273: Medication (Phoenix) 218/273: Maternity (Delivery Suite) 218/278: Surgical / Invasive Procedure (Medical Day Unit) (23) Of the 53 SI investigations underway in January, 2 were due with KCCG during the month. 9 of these breached their deadline. The current overdue backlog KPI stands at 9. (2) Treatment delays are the most common reason for Serious Incidents. 2
SAFETY Patient Safety Medicines Management Medicine Reconciliation Accountable Officer: Medical Director 21 9% 85% 8% 75% 7% 65% 6% 55% 5% 5% % (25) Medicine Reconciliation (25) 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 <2hrs, paeds, Obs and SMH). NICE guidance is to achieve 1% of patients within 2hrs. RCHT achieves approximately 65% within 2hrs and 86% overall. Investment in a 7 day clinical ED service would be required to significantly improve our performance. This was discussed at TMG and will be taken forward within the division. 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.
QUALITY & SAFETY PATIENT OUTCOMES/EFFECTIVENESS Summary Dashboard 22
QUALITY Patient Outcomes/Effectiveness Mortality Accountable Officer: Medical Director 23 SHMI / HSMR / SMR 125 12 115 11 15 1 95 9 115 11 15 1 95 9 85 8 (26) Rolling HSMR by Non weekend/weekend (27) SHMI, HSMR, SMR and Crude Mortality 12 1 8 6 2 Crude Mortality Rolling 12 month HSMR Non weekend Weekend SHMI HSMR Crude Mortality SMR (26) The SHMI is the ratio of observed deaths to expected deaths. It includes those patients who die within 3 days of discharge. The SHMI is stable, being 93.5 for October 217; data lags behind the HSMR data. 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 stable at 9.75 and is within the expected range. The crude mortality rate for January 218 (11.5) has very slightly increased. (27) This month weekend mortality (91.71) has been reported as lower than weekday (95.8) mortality. Both the HED data and the national SSNAP audit have alerted that the Trust is an outlier for stroke mortality. A deep dive into stroke mortality revealed that overall care was good, although timely access to the dedicated stroke unit remains a challenge. A national peer review visit is scheduled for 9/3/18 and all stroke deaths are now subject to in depth review. HED data has also alerted for still births and the Obstetrics team have been asked to perform a deep dive into stillbirth with the Trust mortality lead; a report is currently being collated.
QUALITY Patient Outcomes/Effectiveness Sepsis Accountable Officer: Medical Director 2 1% 9% 8% 7% 6% 5% % 3% (28) Patients who met the criteria and were screened for sepsis ED & other admitting areas 1% 8% 6% % 2% % (29) IV antibiotics within 1 hour (severe sepsis) ED & other admitting areas *When looking at the results on these graphs it should be noted that the information is derived from the CQUIN audit. This audit requires only 5 emergency admissions and 5 inpatients notes to be used as a data source. (28) Sepsis screening continues to be at an excellent level (29) The CQUIN results in December showed a decrease to 65% in December from 82% in November for antibiotics being given within the hour. 1% 8% 6% % 2% % (3) Patients who met the criteria and were screened for sepsis Inpatients 1% 8% 6% % 2% % (31) IV antibiotics within 1 hour (severe sepsis) Inpatients (3) 1% of inpatients were screened. (31) 1% of patients diagnosed with sepsis as an inpatient were given antibiotics within an hour. The plan was for the Sepsis screening tool on Nervecentre to commence in April 218. When introduced, all patients will be screened for sepsis and staff alerted to make a decision on a possible diagnosis. For this to succeed all staff will need to ensure they are logged in throughout their working shift, or delays will occur.
QUALITY Patient Outcomes/Effectiveness Cardiac and Peri Arrests Accountable Officer: Medical Director 25.8.7.6.5..3.2.1. 2 18 16 1 12 1 8 6 2 (32) Cardiac Arrests per 1 bed days (3) Peri Arrests 1 12 1 8 6 2 (33) Cardiac Arrests 1.% 8.% 6.%.% 2.%.% (35) Primary PCI 'call to balloon' of 75% within 15 minutes (32) The number of cardiac arrests in January (11) increased from the previous month December (1). This number is more than Jan 217 (8) but less than Jan 215 (13). Whilst 216 showed a reduction in arrest numbers by 2% (RCHT target was 1%), 217 saw a slight increase in number of arrests; 15 arrests compared with 12 total in 216 (135 arrests in 215); an increase of 3%. (3) The number of peri arrest calls has increased from Dec (9 to 1). In 217 these reduced overall with 12 peri arrest events compared to 13 in 216. It was hoped with continued use of Nervecentre, expansion of the outreach service along with more appropriate use of Treatment Escalation Plans we would see a sustained reduction in the number of cardiac arrests. This info. has been highlighted to the Resuscitation Committee & CAOG. (35) 17 out of 22 patients (who were eligible for the Call to Balloon audit) met the target in January 77.3% rising above the 75% standard for the first time since September.
Key Operational s Summary Dashboard Accountable Officer: Chief Operating Officer 26
Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 27 Emergency Department Heat Map & Patient Flow Alert Status HOUR OF THE DAY DATE 1 2 3 5 6 7 8 9 1 11 12 13 1 15 16 17 18 19 2 21 22 23 1/1/218 2 38 33 38 5 5 55 5 53 55 56 55 6 7 71 7 67 63 62 6 61 59 58 2/1/218 5 53 8 7 5 9 8 6 5 6 51 51 52 58 59 5 55 61 61 69 6 65 63 6 3/1/218 59 5 6 1 37 38 37 3 37 2 38 5 8 53 55 5 8 5 7 5 /1/218 37 33 3 29 28 23 23 22 25 26 29 31 37 8 7 51 57 5 58 58 63 56 5 58 5/1/218 6 55 7 7 1 3 3 2 3 5 7 5 5 5 9 57 51 9 5 9 5 5 8 8 6/1/218 3 39 39 39 33 29 27 25 25 2 32 3 9 3 6 6 5 39 6 3 1 37 3 7/1/218 3 36 32 36 32 35 36 3 36 3 25 33 37 37 3 7 56 62 5 52 2 51 52 8/1/218 52 5 3 2 1 37 33 3 3 23 27 33 36 38 6 6 7 6 55 57 57 6 59 5 9/1/218 33 33 3 3 28 31 32 31 38 6 5 8 52 53 55 51 5 8 6 33 1/1/218 3 28 31 25 28 25 16 19 19 19 3 35 35 29 6 6 53 55 6 62 6 59 55 6 11/1/218 37 3 27 2 25 23 23 22 23 23 29 33 38 7 5 5 2 37 39 7 12/1/218 35 22 18 13 9 9 7 8 7 11 15 21 2 27 39 38 3 1 3 33 37 1 13/1/218 26 17 9 6 8 9 9 9 12 15 17 26 32 31 29 33 38 31 35 35 2 3 1 2 1/1/218 37 35 32 3 28 27 22 2 21 33 1 7 56 57 57 6 2 39 35 38 33 29 32 15/1/218 27 2 25 18 23 19 2 18 19 2 3 32 3 51 6 56 51 9 55 65 66 62 62 16/1/218 56 8 39 36 33 3 31 31 33 1 9 53 9 52 3 38 5 5 65 55 58 55 5 17/1/218 51 8 2 1 1 36 35 37 8 5 8 53 9 8 3 5 7 55 6 9 55 55 18/1/218 5 9 37 3 35 38 32 32 3 27 33 28 3 6 51 8 52 6 62 6 63 68 66 19/1/218 51 5 2 2 37 37 31 28 27 2 3 2 2 1 33 39 37 2 3 2 3 2 6 2/1/218 7 53 7 1 39 37 39 39 3 55 53 58 52 58 58 61 59 6 63 57 57 55 21/1/218 58 56 51 5 51 5 39 5 2 39 39 7 51 5 59 53 8 53 55 51 56 5 53 55 22/1/218 52 52 9 2 38 36 3 3 31 31 31 5 5 5 9 51 52 65 63 7 66 61 6 23/1/218 6 6 3 8 38 36 33 38 2 3 51 53 56 58 58 6 77 77 59 58 59 2/1/218 56 53 9 36 3 32 3 31 33 35 33 1 8 8 7 52 53 61 66 63 5 5 59 53 25/1/218 3 3 37 32 3 25 26 26 22 27 37 5 8 9 52 59 59 61 58 59 58 65 69 26/1/218 62 57 7 2 36 31 36 33 29 33 33 33 35 1 2 7 52 57 63 63 68 67 7 62 27/1/218 61 51 5 5 3 1 36 35 36 35 6 58 6 61 61 57 56 53 51 5 3 28/1/218 2 29 28 27 23 28 21 2 26 3 6 5 8 56 53 55 62 5 6 52 52 53 52 29/1/218 5 5 38 33 33 32 29 29 3 35 1 7 2 1 3 7 52 59 59 62 62 63 55 3/1/218 5 53 5 6 39 37 36 35 39 39 1 36 2 5 9 6 7 52 51 51 52 53 31/1/218 3 33 26 23 2 27 25 25 22 2 25 28 36 1 35 35 2 31 36 3 5 51 8 Alert Status 3 3 3 3 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. In January, 27 out of the 31 days were at a black alert status.
Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 28 Winter Pressures Dashboard
Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 29 1% 95% 9% 85% 8% 75% 7% 65% 6% (36) ED & MIU (from July17) attenders hours arrival to discharge, admission or transfer Local trajectory 9% 8% 7% 6% 5% % 3% 2% 1% % (37) Unplanned reattendance at ED (% of total attenders) Threshold min (36) Performance against the emergency hour access standard in January across the system was 85.% against the 9% local trajectory. RCHT hour performance was 69.3% in January compared to 66.% in December. ED attendances were up.% on the same month last year. (37) Unplanned re attendances (patients returning to ED within 7 days of their original attendance) were 7.3% compared to 8.1% in January 17 and below the latest national figure (8.1% Dec 17). 7% 6% 5% % 3% 2% 1% (38) Ambulance Delays % waiting over 15 minutes 3 25 2 15 1 5 (39) Ambulance Delays Numbers waiting over 3 minutes (38, 39) The percentage of ambulance delays over 15 minutes improved slightly (59.6%, just above the 57.6% standard), whilst the number waiting over 3 minutes improved significantly month on month despite the increase in days on black alert, reducing by more than half to 123. The ED team continue to work closely with SWAST to reduce handover delays. %
Key Operational s Emergency & Urgent Care Accountable Officer: Chief Operating Officer 3 6% 5% % 3% 2% 1% % 9 8 7 6 5 3 2 1 () % of ED Attenders who left without being seen (2) Median Time from Arrival to Treatment (mins) 5 35 3 25 2 15 1 5 2 1 (1) 95th percentile, Time to Initial Assessment (mins) (3) 12 hour trolley waits () The percentage of ED attenders who left without being seen improved to 1.7%, significantly below the most recent national performance (December 17) of 2.8%. (1) 95 th percentile time to initial assessment remains a concern and therefore focus for the ED team, but improved by 7 minutes to 3 minutes it was 28 minutes in the same month last year. (2) Median time from arrival to treatment also improved, falling 16 minutes to 61 minutes compared with December. This was just under the median national performance (December 17), which was was 62 minutes. Both clinical quality indicators remain a key focus of the ED team and are being reviewed with support from the Transformation Team as well as ECIP. (3) There were no 12 hour trolley waits reported in January.
Key Operational s Length of Stay Accountable Officer: Chief Operating Officer 31 () Total specialty outliers (5) Length of Stay over 1 days () Specialty outliers were, 9 fewer than last year. 6 5 3 2 1.% 3.5% 3.% 2.5% 2.% 1.5% 1.%.5%.% (6) % Discharges Between 6am and 1am % Patients discharged before 1am % 35% 3% 25% 2% 15% 1% 5% % 3.8 3.6 3. 3.2 3 2.8 2.6 2. 2.2 2 (7) Average LOS (5, 7) Length of stay over 1 days increased from 27.8% to 32.8%. Average length of stay was 3.5 days, increasing slightly on December, but slightly less than January last year. (The standard shown is the average for each month over the last 3 years.) (6) The KPI for measuring morning discharges has been redefined to discharges between 6am and 1am (previously discharges before 1am) to ensure that night time discharges are not included, and re based for the purpose of the chart. The percentage of patients discharged between 6am and 1am was 2.6%, which was slightly higher than the same month last year (2.%). The standard is under review as part of the Tackling Patient Delay workstream of the Quality Improvement Delivery Programme.
Key Operational s Cancer Accountable Officer: Chief Operating Officer 32 (8) Cancer 2 week wait (9) Cancer treated within 31 Days Target (8 51) All standards in December were met. 99% 98% 97% 96% 95% 9% 93% 92% 91% 9% 1% 99% 98% 97% 96% 95% 9% The 62 day standard remains the biggest challenge with pressures on diagnostic and treatment services as well as capacity issues in some areas of Oncology. An unexpected rate of breast referrals in December led to not being able to schedule 17 breast symptomatic within 1 days and is expected to impact on January s reported performance (this standards is reported in arrears). 9% 89% 88% 87% 86% 85% 8% 83% 82% 81% (5) Cancer treated within 62 Days Target 1% 95% 9% 85% 8% 75% 7% 65% 6% (51) Percentage receiving first definitive treatment within 62 days of urgent referral from national screening service There were 6.5 reported breaches of the 1 backstop policy: 2 Colorectal breaches past 1 days due to multiple diagnostics, need of HDU bed and medical delays; 1.5 Lung breaches (2 patients) due to delayed diagnostics and the other was a late referral from another Trust; 1 Upper GI breach past 1 days due to delay confirming primary site and 2 Urology breaches (3 patients) past 1 days due to diagnostic waits and treatment times at tertiary centres. The Trust retains its record of quarterly achievement on all standards since Q2 21 11.
Key Operational s Referral to treatment Accountable Officer: Chief Operating Officer 33 Backlog (breaches) 9.% 92.% 9.% 88.% 86.% 8.% 82.% 8.% 78.% 76.% 9 8 7 6 5 3 2 1.% (52) RTT Incomplete % within 18 weeks (5) Specialties not achieving RTT standard ADMITTED NON ADMITTED INCOMPLETE % 86.75% 88.2% 89.57% 9.8% 9.91% 79.78% 82.61% 71.9% 71.88% 86.96% 89.55% 9.17% 9.91% 65.35% 78.85% 8.87% 83.33% 71.19% 71.8% 51.91% 58.72% Paeds Urology Colorectal surgery Upper GI Surgery Paeds Surgery Dermatology T & O Cardiology Vascular surgery Urology Gynaecology General surgery Oral surgery Paeds Gastro ENT Paeds neurology Rehabilitation Ophthalmology Orthodontics Neurology Resp Medicine Paeds Clinical Paeds Diabetic Local Trajectory 1% 8% 6% % 2% % Incomplete % 3 25 2 15 1 5 1.% 98.% 96.% 9.% 92.% 9.% (53) Incomplete pathways (55) Proportion of patients receiving one of the 15 Key Diagnostic Tests within 6 weeks (52) The decline in Referral to Treatment performance continued in January the number of incomplete pathways under 18 weeks reduced from 83. to 82.5% at the time of writing. This is the 1th consecutive month that the Trust failed to meet the national 92% standard which was previously consistently achieved. 92% of patients are treated within 25 weeks, compared to 21 weeks nationally (December data for both). (53) The overall RTT waiting list remains static. (5) Of those, 98 were waiting at least 18 weeks, an increase of 88 on December. 5 more specialties than the previous month did not meet the standard. (55) Diagnostic performance was 92.% (99.% in January last year), as a result the diagnostic target was not achieved for the 11th consecutive month. Key specialties not meeting the standard remain Clinical Imaging (CT and non obstetric ultrasound), Cardiology and Urology. It is not expected that either standards will be met in February, particularly due to CT equipment breakdowns in month.
Key Operational s Cancelled Operations Accountable Officer: Chief Operating Officer 3 16 1 12 1 8 6 2 5 35 3 25 2 15 1 5 (56) RTT waits over 52 weeks for incomplete pathways (58) 28 day re booking breaches & urgent operations cancelled more than once Trajectory Breaches Urgent More than Once 3.% 2.5% 2.% 1.5% 1.%.5%.% 7% 6% 5% % 3% 2% 1% % (57) Percentage Cancellations on same day (59) Short notice OP Clinic cancellations (56) The Trust reported 13 patients waiting in excess of 52 weeks at month end a revised trajectory is in place from February onwards and the capacity at independent sector providers in Cornwall and Devon is being explored. The highest number are within Orthopaedics, Urology and Cardiology. (57) As expected reportable cancellations remained high at 1.5% 93 were cancelled on the day in January, 12 more than the same month last year. Highest volume specialties were Gynaecology (17%), followed by Vascular (13%), Cardiology (13%) and Ophthalmology (13%). (58) There were 36 breaches of the 28 day rebooking standard 7 Vascular, 6 Upper GI, 6 Orthopaedic, 6 Cardiology, Ophthalmology, 3 Urology, 2 ENT, 1 Oral Surgery and 1 Colorectal. (59).9% of clinics were cancelled with less than 6 weeks notice, compared with 3.9% last January. Of those short notice cancellations, 52% (161 clinics) were cancelled for avoidable reasons.
Key Operational s Specialised Pathways Fractured Neck of Femur & Stroke Indicators Accountable Officer: Chief Operating Officer 35 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (6) NOF patients operated on within 36 hours 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (61) % Patients spending 9% of their time on stroke unit (6) The percentage of patients with fractured neck of femur operated on within 36 hours increased from 68.5% to 85.7%, above the 8% standard, in part due to improved an escalation process. (61, 62) The percentage of patients spending 9% of their time on the stroke unit was 69.9% compared to 92.9% because of patient flow pressure. Similarly the percentage of patients admitted to the stroke unit within hours also reduced to 53.7%, the lowest performance against this metric since June 216. 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (62) Stroke unit within hours 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (63) Stroke patients receiving CT scan within 12 hours (63) The percentage of stroke patients receiving at CT scan within 12 hours reduced for the 3 rd consecutive month, reflecting pressure on CT capacity, but remained above the standard at 9.%.
Key Operational s Specialised Pathways Stroke Indicators Accountable Officer: Chief Operating Officer (6) Scanning CT Urgent within 1 hour 1% 9% 8% 7% 6% 5% % 3% 2% 1% % 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (65) Swallow screening within hours 36 (66) NIHSS Compliance 1% 9% 8% 7% 6% 5% % 3% 2% 1% % 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (67) Swallow Assessment 72 hours (6 67) Performance against the remaining stroke indicators continues above the respective standards other than swallow assessment. Swallow assessment within 72 hours was 78.1%, falling below the standard of 83% for the first time since December 216. *Please note that all standards for stroke are based on the most recent national averages.
Key Operational s Productivity and efficiency measures Accountable Officer: Chief Operating Officer 37 1% 12% 1% 8% 6% % 2% % 88% 87% 86% 85% 8% 83% 82% 81% 8% (68) Delayed transfers of care (days lost %) (7) Daycase rate 35 3 25 2 15 1 5 9% 93% 92% 91% 9% 89% 88% 87% 86% 85% (69) Delayed transfers of care by reason (71) DOSA Rate Public Funding Residential Home Patient or Family Choice Nursing Home Further non acute NHS care Domiciliary Package Completion of assessment Community Equipment (68) Delayed Transfers of Care (DTOC) percentage of days lost (from the validated national snapshot data) improved to 6.5%, equating to an average of 37.8/day. However an issue has been identified regarding the recording of a cohort of patients previously included in this metric this has been corrected from mid February and will mean that this figure will increase slightly. (69) The top categories for delay are further non acute NHS care and nursing home. (7, 71) The daycase rate increased after 3 months of deterioration to 85.5%, whilst the day of surgery admission rate mirrored that improvement, rising to 91.3% from 87.9%. This was also reflected in an increase in day case activity on both last month and last year.
Key Operational s Productivity and efficiency measures Accountable Officer: Chief Operating Officer 38 7% 6% 5% (72) Net Emergency Readmissions within 28 days 7.5% 7.% 6.5% (73) All OP DNA Rate (72) Net emergency readmissions within 28 days were.7%, dipping below the standard for the first time. (73) The outpatient DNA rate was 6.5%, the same as last year. % 3% 2% 1% % 6.% 5.5% 5.%.5%.% (7) The proportion of follow up outpatients waiting more than 1 month past their to be seen by date was 5.2%. At the end of January there were 797 patients more than 1 month past their to be seen date, a further month on month improvement. The specialties with the biggest backlogs are Ophthalmology, Respiratory, Urology, Cardiology and General Surgery. 9% 8% 7% 6% 5% % 3% 2% 1% % (7) Patients on the FUWL 1 Month Past Their To Be Seen Date 11.2 11. 1.8 1.6 1. 1.2 1. 9.8 (75) Average Points per Clinic (75) Average points are used as a measure of productivity within outpatient clinics, with attended new patients equating to 2 points and follow ups to 1. The average points per clinic remained static at 1.2.
FINANCE Summary Dashboard 39
FINANCE Income, Expenditure and Savings Accountable Officer: Director of Finance ms 2. 1.. (1.) (2.) (3.) (.) (5.) (6.) (76) I&E Surplus / (deficit) actual / forecast v plan Forecast Plan ms 2. 18. 16. 1. 12. 1. 8. 6.. 2.. (77) CIP actual / forecast v plan / Forecast Forecast Plan (76) I& E The Trust has a 5m year to date deficit. This is 3.m off plan due to failure to identify and deliver CIP plans and the loss of STF funding. The forecast outturn is a 9.3m deficit. Income Income is.2m below plan for the year to date. Income from Kernow CCG is 1.6m over plan before contract penalties. Within this, Elective income for KCCG is 1.m behind plan for the YTD and Non Elective income is 2.1m above plan. Non PbR income is.2m behind plan for the YTD. Expenditure Pay totalled 19.8m in M1. This is 1.2m over plan in month. For the year to date, pay costs are 2.m above budget and the profiling of pay savings means that the variance is expected to increase. (77) CIP Savings of 9.7m delivered to date which is 3.m below plan. The full year forecast is 1.1m compared to a plan of 17.3m meaning that there is a likely 3.2m shortfall.
FINANCE Cash and Capital Accountable Officer: Director of Finance 1 ms 1. 12. 1. 8. 6.. 2.. (78) Agency and Locum spend actual / forecast v plan / Forecast Plan Forecast ms 12. 1. 8. 6.. 2.. (79) Cash actual / forecast v plan / Forecast Forecast Plan (78) Agency spend Monthly agencyspend totalled 1.25m in January which is 128k more than M9 and 1k more than budget. At current rates, agency spend will total 12.3m for the year against a budget of 1.1m. However, agency spend is 2.8m lower for the year than at the same time in 216 17. The 2 most expensive agency staff cost the Trust 33k in month 1 compared to 1k in month 9. In month 1, there were 68 agency workers that have worked for the Trust for more than two months, down from 92 in month 9. ms 2. 18. 16. 1. 12. 1. 8. 6.. 2.. (8) Capital spend actual / forecast v plan Plan (79) Cash In M1 the Trust has received loan funding of.2m linked to its deficit plan. This has increased the cash balance to 1.8m although this balance will reduce by the year end. (8) Capital 1.6m of expenditure to date which is 6.1m below plan. The delays against planned spend include Health Informatics schemes and replacement of high value medical capital equipment. Work is underway to ensure that there is no capital underspend by the year end.
OUR PEOPLE Summary Dashboard 2
OUR PEOPLE Key Workforce Indicators Accountable Officer: Director of HR & OD 3 5.%.5%.% 3.5% 3.% 2.5% 21 2 19 18 17 16 (81) Sickness rate (Month) (83) Pay Expenditure ( m's) Sickness % Pay Spend 12% 11% 1% 9% 8% 1% 12% 1% 8% 6% % 2% % (82) Turnover rate (8) Active Vacancies % Turnover % Total Active Vacancies Active Registered Nurses Active Medical Staff (81) Sickness absence in January increased by.5% to.6%. The current rate is.89% above standard. Long term absence at 2.7% is much higher than short term at 1.57% p.a. predominantly due to stress and MSK problems. (82) Turnover remained stable at 1.2% for the year to 31 January. Circa 3% of turnover is due to annual training rotations for junior doctors. (83) Pay spend increased in January by.12m compared to December. As shown in the Total Staffing chart, net temporary use reduced by 35 FTE but this included an increase of 1 FTE in agency. Substantive staff increased by 21 FTE in January. The increased substantive staff therefore did deliver a reduction in temporary staffing but not sufficiently to stem agency demand for clinical cover. (8) Active vacancies represent those in the recruitment process; between the approval to recruit to the starter joining the Trust. During January active vacancies increased following a comprehensive analysis of demand and projected future turnover. Medical staff vacancies reduced following 8 new staff joining the Trust.
OUR PEOPLE Key Workforce Indicators Accountable Officer: Director of HR & OD 18% 16% 1% 12% 1% 8% 6% % (85) Vacancy Gap % Total Vacancies Total Registered Nurses Total Medical Staff 1% 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. The total vacancy gap increased slightly in January. (86) Appraisal compliance in January reduced by.6% to 7.7%. This is the seventh consecutive month in decline and is 5% below the same point last year. Compliance is currently 2.3% below the 95% of eligible staff standard. (87) Mandatory training compliance in January decreased by 1.6% to 86.%. Although currently 8.6% below standard this is 1.8% higher than at the same point last year. 1% 95% 9% 85% 8% 75% (87) Mandatory Training Rate Training Compliance 52 5 8 6 2 (88) Total Staffing FTE Substantive Bank Agency (88) Total staffing deployed in January decreased by 1 FTE of which substantive staff increased by 21 FTE and temporary staff decreased by 35 FTE. Across temporary staffing, bank usage reduced by 5 FTE and agency increased by 1 FTE.
OUR PEOPLE Key Workforce Indicators Accountable Officer: Director of HR & OD 5 1% 9% 8% 7% 6% 5% % 3% 2% 1% % (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 January remained high with medical and AHP staff at 1% compliant. 86.7% of agency nursing shifts were framework compliant and 13% were cap compliant during January.
3 25 2 15 1 5 OUR PEOPLE H&S Reporting Accountable Officer: Chief Operating Officer (9) Sharps Incidents reported Trend (91) Sharps training compliance with safer sharps 11.% 1.% 9.% 8.% 7.% 6.% 5.%.% Trend (9) The number of sharps incidents is showing an overall downward trend. There was a decrease in the number of incidents relating to dirty sharps with only 7 reported. There is continued work to improve based on learning outcomes from investigations. (91) Compliance in sharps device training increased by.2% during January to 92.3% and remains within target. (92) RIDDOR reports decreased to 3 this month, moving towards a downward trend. (93) There were no reported case of occupational dermatitis. This still remains low and is the second month in a row with no reports. 6 12 1 8 6 2 (92) Number of RIDDOR reports Trend (93) Confirmed cases of occupational dermatitis 6 5 Trend 3 2 1