BOARD OF DIRECTORS
This is to advise that there will be a meeting of the Board of Directors on
Wednesday 22 January 2014 at 9:00am
in the Boardroom, Level 1, Yeovil District Hospital NHS Foundation Trust
AGENDA - PART 1
Presenter
1
APOLOGIES
2
DECLARATIONS OF INTEREST
Members of the Board are required to make known any
interests relating to items on the current agenda
3
MINUTES OF THE PREVIOUS MEETING HELD ON
20 NOVEMBER 2013
PW
Appendix
To APPROVE the Minutes of the Board of Directors’ meeting
held on 18 December 2013
4
ACTION SHEET
PW
Appendix
5
MATTERS ARISING
PW
Oral
6
PATIENT STORY
HR
Presentation
PM
Appendix
JH
Oral
HR
Oral/Present
ation
TN
Appendix
JHi/TN
Appendix
To DISCUSS a patient story and to DISCUSS the current
approach to patient stories
7
CHIEF EXECUTIVE’S REPORT
To DISCUSS the key current issues affecting the Trust
8
MEDICAL DIRECTOR’S REPORT
To DISCUS key current issues within the Medical Director’s
remit
9
DIRECTOR OF NURSING’S REPORT
To DISCUSS key current issues within the Director of Nursing’s
remit
10
CHIEF FINANCE AND COMMERCIAL OFFICER’S REPORT
To DISCUSS key current issues within the Chief Finance and
Commercial Officer’s remit
11
MRI BUSINESS CASE
To APPROVE the MRI business case
12
HR DIRECTOR’S REPORT – ANNUAL STAFF SURVEY
MP
Appendix
JHIG/SD/TN
/MP
Appendix
To DISCUSS key current issues within the HR Director’s remit
PERFORMANCE REPORT
13
OPERATING & FINANCIAL PERFORMANCE OVERVIEW
To DISCUSS the overall performance of the Trust
14
ASSURANCE COMMITTEE MINUTES / REPORTS
PW
To NOTE the minutes of the following meeting:
CGAC – 10 January 2014
15
RISK AND ASSURANCE REPORT
JH
To follow
HR
Appendix
PW
To follow
PW
Oral
To NOTE the report and the updated Corporate Risk Register
16
BOARD APPROVAL OF MONITOR Q3 RETURN
To APPROVE the Monitor Quarter 3 return
ITEMS TO NOTE
17
ANY OTHER BUSINESS
18
EXCLUSION OF THE PUBLIC
To RESOLVE to exclude the public from the rest of the meeting by passing the following
resolution:
The Board of Directors resolves to exclude the public from the rest of the meeting because
publicity would be prejudicial to the public interest by reason of the confidential nature of the
business to be transacted or for other reasons arising from the nature of the business and
the proceedings.
19
DATES AND TIMES OF FUTURE MEETINGS AND EVENTS
There will be a meeting of the Board of Directors on
Wednesday 19 February 2014 at 9.00am in the Boardroom,
Level 1, Yeovil District Hospital
APPENDIX
Board of Directors
BOARD OF DIRECTORS
Minutes of the meeting of the Board of Directors held on Wednesday 18 December 2013 at
Yeovil District Hospital
Present:
Peter Wyman [PW]
Paul Mears [PM]
Maurice Dunster [MD]
Julian Grazebrook [JG]
Jane Henderson [JH]
Paul von der Heyde [PH]
Mark Saxton [MS]
Jonathan Howes [JHo]
Tim Newman [TN]
Helen Ryan [HR]
In Attendance:
Susan Davies [SD]
Jonathan Higman [JHig]
Mark Power [MP]
Simon Blackburn [SB]
Simon Chase [SC]
Nicola Webber
Jane Johnston
Chairman
Chief Executive
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Medical Director & Deputy Chief Executive
Chief Finance & Commercial Officer
Interim Director of Nursing & Clinical
Governance
Director of Elective Care
Director of Urgent Care & Long Term
Conditions
Director of Workforce and HR
Head of Communications and Marketing
Company Secretary
Minutes
Staff Governor
Apologies:
Action
202/13
DECLARATIONS OF INTEREST
The Chairman declared that he is Treasurer and a member of the
Council of the University of Bath.
Mark Power declared that he is Director of Workforce & HR for Dorset
County Hospital NHS Foundation Trust.
203/13
APOLOGIES AND WELCOME
There were no apologies.
The Chairman welcomed a member of staff and a member of the
public. He also welcomed Jane Johnston, Staff Governor, and asked
her to participate freely but to respect the confidentiality of the topics
discussed in part two.
204/13
MINUTES OF THE PREVIOUS MEETING
The minutes of the meeting held on 20 November 2013 were AGREED
with one amendment. It was agreed that minute 190/13, paragraph
three should read “Mr Higman reassured the Board…”
205/13
ACTION SHEET
The Board NOTED the action sheet.
1
206/13
MATTERS ARISING
There were no matters arising
207/13
PATIENT STORY
Prior to the meeting, the Chairman and Non-Executive Directors,
together with the Chief Finance and Commercial Officer had visited the
Theatres and witnessed staff practise emergency scenarios. It was
agreed that this was a very valuable insight into the processes
Theatres used. Attendees were very impressed by the standard of
teamwork. The Board discussed what had been seen and the practical
implications.
PW
It was agreed that the Chairman would send a note of thanks.
208/13
CHIEF EXECUTIVE’S REPORT
Mr Mears thanked Simon Chase, who was attending his last Board
meeting, for his service to YDH as Company Secretary and in his
previous roles. Jade Renville has been appointed to the position of
Company Secretary and will join the Trust from Somerset CCG in mid
February 2014. The Company Secretary from DCH will provide interim
advice and support.
The Board noted the developments connected with the Somerset Case
for Change agenda. The importance of that programme was noted, but
the Board also agreed on the fundamental importance of the
Symphony project and the significant strategic potential this approach
offers for the whole health and social care community.
The Board also noted the arrangements for the Head of Midwifery role
after Neil Tomlin’s departure. The new role will be a shared position
with Dorset County Hospital NHS Foundation Trust. Some concerns
had been expressed by midwifery staff, but these have been
recognised and there will be a trial of the new arrangements for the
first six months of 2014.
Mr Mears also reported on a meeting with AgustaWestland, who
presented him with a cheque for £147K. This had been raised by their
staff who have been very supportive of the Flying Colours Appeal. The
Board expressed its very great appreciation to those involved at
AgustaWestland.
The Board was informed of the arrangements for recruiting Mark
Power’s successor. This will be a joint process, for a joint appointment
with Dorset County Hospital NHS Foundation Trust. Mark Appleby and
Ali Morris will manage the HR function in the interim period. Mark
Saxton and Maurice Dunster offered their support if required.
209/13
CHIEF FINANCE AND COMMERCIAL OFFICER’S REPORT
The Board noted the report and Mr Newman reported that November
is £100k ahead of budget. The Trust is £500k ahead of budget on a
year-to-date basis. It is anticipated that staff costs will increase given
the expected emergency demand after Christmas.
210/13
DIRECTOR OF NURSING’S REPORT
Helen Ryan provided an oral report.
Page 2
Two members of staff had recently visited Portugal to recruit nursing
staff and had made 14 job offers. There are measures in place to
integrate them with YDH staff. Those recruited will be very capable,
but also have with the right personal qualities and will rapidly attain
fluency in the English language. The Board briefly discussed the
reasons for the lack of success in an earlier visit to Ireland and the
lessons that had been learned.
The Trust has also been in discussions with NHS Professionals
regarding their temporary clinical staff service. The Project
Management Office team is working with Helen Ryan on this
opportunity to establish a clear business case. An arrangement could
provide some clear advantages for the Trust.
Helen Ryan reported on a good CNO conference.
The new Matron for Elective Care is now in post.
The Board was informed of a never event regarding a surgically
retained swab. Monitor and the CQC have been notified and early key
actions have been taken to avoid a recurrence. Further information will
be provided when the investigation has been completed.
211/13
MEDICAL DIRECTOR’S REPORT
The Medical Director provided an oral report.
He drew the Board’s attention to the Dr Foster Good Hospital Guide
which did not highlight the Trust in any way.
Dr Howes then reported on a recent Coroner’s court case. The
narrative verdict will result in the issuing of a Coroner’s Report to
Prevent Future Deaths. The patient’s family was content with the
Trust’s openness in the matter. Monitor has been informed of this case
and steps are being taken to strengthen measures to minimise the
human error which lay at the root of this case.
The Board also considered Sir Bruce Keogh’s proposals for
implementing seven day working. It was noted that the Trust is already
taking steps to build on its present arrangements. This topic will be the
subject of further work in the New Year and some proposals will be
brought to the Board in the spring. The focus on acute provision is
seen as only part of the issue, with a need for the whole health and
social care community to be functioning in a mutually-supporting way.
The Board discussed both the opportunities and obstacles to achieving
this.
JHo
The Board welcomed news of the appointment of David Maritz as an
Emergency Department consultant.
212/13
OPERATING AND FINANCIAL PERFORMANCE OVERVIEW
The Board NOTED the report and discussed a number of points.
The Board discussed mortality data and queried the accuracy of the
overall number of deaths. It was established that the figure reported
Page 3
related to far more than a 12 month period. The Board was satisfied
that the data demonstrated no weekend mortality phenomenon.
The Board noted that service delivery performance was stable and the
risks are known and being managed. The Board discussed aspects of
bed occupancy and how this will be influenced by the pathway
redesign work.
The Board was very pleased to hear how well the hospital was
managing the high volume of emergency patients and maintaining both
the elective programme and the best ambulance handover standard in
the region.
The Board discussed stroke performance, noting the need to improve
the percentage of admissions to the stroke unit within 4 hours. All
trusts are struggling with this target but it was acknowledged that
process targets are important as well as outcome targets.
The Board discussed the lower level of discharges at the weekend. It
noted that was in no small part due to problem of a lack of provision in
the community during this time.
The Board appreciated the new presentation of complaints data, but
also asked for them to be presented by theme. Helen Ryan confirmed
this would be addressed as part of the ongoing improvement of how
this information is reported.
The Board considered that the presentation of information in the report
is far better, and the format is still developing. Further amendments
can be made and suggestions should be made outside the meeting.
Mr Newman underlined that feedback is welcome but data is manually
produced and represents considerable work at present.
The financial position was noted and Mr Mears reported on a very
good meeting with Monitor, who were generally satisfied with the
Trust’s performance.
The Board was pleased to see workforce information integrated into
the overall report and Mark Power confirmed there would be further
refinements.
213/13
CLINICAL QUALITY
This was covered in the preceding discussion.
214/13
SERVICE DELIVERY
This was covered in the preceding discussion.
215/13
WORKFORCE
This was covered in the preceding discussion.
216/13
ASSURANCE COMMITTEE MINUTES / REPORTS
1. Audit Committee
The Audit Committee minutes of the meeting held on 3 December
2013 were noted.
Page 4
The Board discussed the arrangements for the Annual Report, Quality
Accounts, given the transition in the Company Secretary position.
2. Non-Clinical Risk Assurance Committee
The NCRAC minutes of the meeting held on 3 December 2013 were
noted.
217/13
INTERNAL AUDIT GOVERNANCE REVIEW
The Board agreed to defer discussion of the Board and Board
committees until the outcome of the Board effectiveness review, being
conducted by EY, is presented. The Executive directors have agreed
to set up a new governance and risk committee.
218/13
RISK AND ASSURANCE REPORT
Helen Ryan reported that the work on making the Risk Register a
‘living document’ as the draft internal audit report recommended is just
being implemented. The register would be accessible by departments
and subject to regular review by the Strategic Business Units and by
the Board.
The Board reviewed the content of the Assurance Framework and Risk
Register, which have been significantly re-engineered and revised.
The Board was also alerted to the updated version of the ‘Foundations
of Good Governance’, published by the Foundation Trust Network.
219/13
CONSTITUTIONAL AMENDMENTS
The Board APPROVED the additional changes as set out in the paper
and welcomed the contribution of the governors to the process of
reviewing the constitution.
The Board agreed to retain the wording “and local authorities” in Annex
4 section 1.3.4 to safeguard future potential arrangements.
220/13
FEEDBACK FROM THE COUNCIL OF GOVERNORS
The Board noted a very positive Council of Governors meeting on 6
December 2013.
221/13
ANY OTHER BUSINESS
There was no other business.
222/13
EXCLUSION OF THE PUBLIC
The Board RESOLVED to exclude the public from the rest of the
meeting.
223/13
DATE OF NEXT MEETING
The next meeting will be held on Wednesday 22 January 2014.
Page 5
APPENDIX
BOARD OF DIRECTORS
22 JANUARY 2014
BOARD OF DIRECTORS – ACTION SHEET
22 January 2014
Minute
75/13
Action
South West Patient Safety
Programme – RUH Bath
consultants to be invited to Board
seminar
142/13
Resourcing of Complaints &
PALS – Provide an update
143/13
Assurance Framework – Present
a populated, updated version
185/13
187/13
189/13
190/13
207/13
211/13
South West Patient Safety
Programme – Invite Jo Howarth,
Rachel Johns and Zubair Khan to a
future Board meeting
Patient Story – Report back on the
implementation of the
recommendations arising from
patient stories
Francis Report – Report on the
gap analysis following the
publication of guidance on safe
staffing levels
Performance Report – Consider
holding a seminar session on the
pathway administration project
Patient Story
Send a thank you letter from Board
attendees of Theatre Simulation
Medical Director’s Report
Sir B Keogh proposals for seven
day working.
Outcome
Due
By
Not yet due
Early 2014
PM
Not yet due
22 January
2014
HR
This has been
deferred pending the
internal audit report
20
November
2013
PM
Not yet due
Spring 2014
HR
To be incorporated in
the Patient Story item
From now
HR
In progress
December
13 or
January 14
meeting
HR
In progress
Early 2014
JHig
Completed
18
December
2013
PW
In progress
Early 2014
JHo
1
Appendix
Board of Directors
22 January 2014
Report to:
Board of Directors
Report from:
Chief Executive
Paper for Approval:
Chief Executive’s Report
Date:
22 January 2014
Director of Nursing
Board members will be aware that Sue Jones was appointed substantively to the Director of
Nursing post at North Bristol NHS Trust. I would like to congratulate Sue on her
appointment and wish her well in her exciting new role.
I am pleased that the Remuneration Committee has confirmed the substantive appointment
of Helen Ryan in the post of Director of Nursing here at YDH. Helen has done a great job
over the past eighteen months leading the nursing and midwifery staff and I am delighted
that she has now been made permanent in the post.
Director of Organisational Development and Workforce
We have begun the recruitment process for replacing Mark Power and are in the process of
agreeing the selection process jointly with Dorset County Hospital. We anticipate that the
recruitment process will happen in late February.
Following Mark Power’s departure in mid February, Mark Appleby will providing cover for the
Director role in the interim.
BBC Somerset coverage
BBC Somerset recently spent the morning at YDH with their mobile studio broadcasting from
the hospital live. This included segments on our dementia work, Flying Colours, maternity,
emergency department, ITU as well as a phone-in with the Chief Executive. The broadcast
was a great success and we received very positive feedback from the BBC team as well as
staff and members of the community. It was a great opportunity to showcase the work of the
hospital and I would like to thank Simon Blackburn for his hard work in getting the
programme of interviews together as well as organising the logistics of the day.
Last Friday we also had very positive publicity of the Symphony project on the BBC
Somerset breakfast programme with interviews with me, Jeremy Martin and Dr Matthew
Dolman. The BBC also interviewed the CEO of Torbay Care Trust which is a leading
example of integrated care and a live interview with Norman Lamb MP and Chris Ham, Chief
Executive of the Kings Fund. Both the Minister and Chris Ham were very positive about the
Symphony project and provided a helpful national context on why integrated care is critical to
the future of the NHS.
Winter Funds
We received notification before Christmas that the Department of Health had allocated
further funding to health communities that had not received funding in the first allocation of
winter monies. For the health community around YDH this was £762k and we have worked
closely with partner organisations to understand how best to allocate this resource to support
the usual pattern of increased activity in winter months.
Somerset Transformation Programme
We continue to work closely with colleagues in the CCG, Somerset County Council and
other NHS providers to develop thoughts on how the health and social care community in
the county needs to develop and adapt to the significant challenges ahead.
Somerset Stroke Review
Somerset CCG has recently communicated the process to develop a business case for a
single hyper acute stroke service in Somerset. We will be working closely with the CCG on
this to ensure that the good clinical service we provide is understood and that the financial
implications of any change on both YDH and the wider health community are factored into
the final decision which is planned for the Spring.
Quarter 3 Quality Report: additional
details for Trust Board
January 2014
Sectio
n
Title
Page
CONTENTS
1
Clinical Effectiveness
2
Patient Safety
3
Patient Experience
2
CLINICAL EFFECTIVENESS NICE COMPLIANCE
NICE Guidance published October to December 2013
NICE Guidance
Number Published
Compliance
Clinical Guideline
3
3 = Under review – compliance assessment in progress
Technology Appraisal
6
1 = Compliant
1 = Terminated – Guidance withdrawn
4 = Under review – compliance assessment in progress
Interventional Procedure
7
4 = Compliant
3 = Under review – compliance assessment in progress
Public Health
2
2 = Under review – compliance assessment in progress
Medical Technology Guidance
1
1 = Compliant
Diagnostics Guidance
1
1 = Under review – compliance assessment in progress
•
•
Current position: Partial compliance declared for 12 Clinical Guidelines. None reported as
presenting significant clinical risk. Actions in place to improve compliance identified by SBUs
One partial compliance for use of Rivaroxaban closed in October 2013 with full compliance
declared
3
CLINICAL EFFECTIVENESS NATIONAL AUDITS
National Audits completed October – December 2013
Audit Title
National Pregnancy in Diabetes Audit (NPID)
UK IBD Audit – Round 4 Ulcerative Colitis (UC)
UK Anti TNF Withdrawal Audit
National Care of the Dying Audit
Report due date
August 2014
June 2014
Spring 2014
Spring 2014
Reports received on:
• Individualised Paediatrics Diabetes Unit - Patient and Parent
experience measures
• National Audit on Dementia
4
PATIENT SAFETY- INCIDENT
REPORTING
•
•
•
Increase in severity of harm currently being validated by CG team.
1 incident of major harm as a result of delay in decision making by tertiary centre
(Neurosurgery)
1 incident of major harm resulting in failure to recognise deterioration and sepsis
5
PATIENT SAFETY - RCA
THEMES AND TRENDS
•
•
•
•
•
6 Serious Incident Requiring Investigation:
1 C.diff related death (requesting reattribution to other provider)
2 falls resulting in fractured neck of femur
2 Grade 3 pressure ulcers
1 Never Event
6
PATIENT SAFETY –
MEDICATION INCIDENTS
Incident Category:
69 insignificant
10 minor
1 moderate
10 significant medication incidents for the year to date, compared with 13
for the same period in 12/13.
7
PATIENT SAFETY – ERROR TYPE
Increase in medication administration errors in Quarter 3, consistent with overall
increase in incident reporting. Increased dispensing errors were noted during a time of
locum use. This has been addressed.
The reporting of administration errors continues at the same rate across the quarter and
is attributed to increased scrutiny by the supervisory ward sister
8
PATIENT EXPERIENCE – FRIENDS AND
FAMILY
•
•
•
Patients surveyed: October = 631, November 470, December 451
Reducing numbers of surveys completed
Significant decrease in FFT score in December (5 wards decrease >10)
9
PATIENT EXPERIENCE
COMPLAINTS AND PALS
ACTIVITY
Complaints and PALs
Apr 12 - Mar 14
120
120.00
100
100.00
Number of PALs
received
80.00
80
84
60
64
71
67
72
60
42
48
40.00
37
22
15
23 22
28
Rate of complaints
per 1000 bed days
34 36
27
20.00
22
13
Mar-14
Feb-14
Jan-14
Dec-13
Jul-13
Jun-13
May-13
Apr-13
Mar-13
Feb-13
Nov-12
0.00
Oct-12
Sep-12
Jul-12
Jun-12
May-12
0
Aug-12
12 13
24
20 22
Jan-13
16
Apr-12
28
24 25
Dec-12
27
20
60.00
Number of
complaints received
78
53
Nov-13
46
55 52
78
Oct-13
46
61
72 85
Sep-13
48
40
64
Aug-13
86
Increase in PALS and decrease in formal complaints noted and in
line with agreed approach.
10
PATIENT EXPERIENCE –
THEMES AND TRENDS
• Reduction in PALS and Complaints from 9A, 9B and
Radiology
• Communication remains the most commonly reported
concern
• Clinical Treatment and Information to Patients continue
to feature highly in concerns raised
11
EXCEPTION REPORT
• January 2014 - 1 case of avoidable C.diff under
investigation
• Never Event Investigation completed. Actions identified
and in place.
• Launch of Patient Experience/Front of House Team
12
Board of Directors
22 January 2014
Report to:
Board of Directors
Report from:
Chief Finance and Commercial Officer
Subject:
Monthly update
Date:
13th January 2014
Estates update
Consultation work regarding the master plan continues with council planners, with
wider public and staff engagement planned to take place in February once we have
worked through in more detail the impact and design of the multi-storey car park
concept.
The precise timetable for Cheverton demolition will be agreed shortly. We are
obtaining planning permission for the revised proposal which has been amended to
enable preliminary works for construction of a multi-storey car park.
The combined heat & power (boiler) project continues and is on schedule.
The upgrade of Ward 6A is due to be completed at the end of January with the bays
being handed over week commencing 20th January. The frail elderly person’s
assessment unit in the day hospital on the site of the former cardio gym is also
virtually complete and will open at the same time.
Works to the ground floor of the Women’s hospital are nearing completion. Just
before Xmas the Dept of Health announced a £10m maternity capex fund and we
have submitted an application for £244k to refurbish parts of the maternity (Freya)
ward to improve ante and post natal facilities. The focus is on providing better
facilities for fathers, improving the ward environment and providing 2 additional single
rooms.
Work continues on reviewing the configuration of the main entrance of the hospital.
Plans and costing will be shared in due course. The aim is to provide a much
stronger sense of arrival for patients and visitors, as well as grouping retail, catering
and patient service facilities together to promote both efficiency of operation and
revenue generation.
Finally there is a focus on fixing visible routine maintenance issues and a programme
of urgent repairs and decoration is being undertaken.
Cost Improvement Programme
Currently the PMO team continues to forecast a £1.3m shortfall of cost savings
programmes vs. £3.5m plan. An update will be given at the Board meeting. The
forecast assumes delays on some material programmes however whilst the saving in
the current year will be lower than planned the expectation is that the full year effect
next year will be substantial.
Financial position
At the time of writing December results have been finalised and shows a deficit of
£135k in month, and a surplus of £666k YTD which is £405k above budget.
Staff
Consultation regarding a new structure for the information team is underway (to bring
them into line with the business unit structure and strengthen the capability of the
team) and we are also consulting on changes to the senior team within the estates
department.
Strategic estates partner
Workshops have been arranged at Bevan Brittan’s offices on 20th January and 6th
February to draft the OJEU notice and associated evaluation criteria seeking a
strategic estates partner. Assuming we follow the traditional timetable the partnership
would be operational by October.
Smartcare
The Collaboration Exec / SRO steering group continue to discuss and assess what
collaboration may look like post procurement. The evaluation of the bidder’s
proposals is underway.
Tim Newman
Radiology Department
Business case for the upgrade of the current
Magnetic Resonance Imaging (MRI) Scanner
January 2014
Authors:
• Mr Simon Jones – Deputy Superintendent Radiographer CT/MRI
• Mrs Fiona Rooke – Radiology Services Manager.
• Sheena Morrow/Dean Stevens/Andrea Price – Finance team
Background:
The Radiology department at Yeovil District Hospital (YDH) performs approximately 6000 MRI
examinations per annum. The current scanner was commissioned in November 2003 and was
funded by the New Opportunity fund supported by the National Lottery. The scanner was installed
as part of a major refurbishment of the radiology department and involved significant building work.
The Trust installed a Siemens 1.5T Symphony MRI scanner replacing a smaller open MRI scanner.
The Trust has offered MRI scanning for the last 17 years and the requirement for such imaging
continues to rise as further clinical applications and benefits are realised. The demand for MRI
scanning has grown by 300% in the last decade. The Department of Health expects increases in
the demand for MRI scans to continue, driven by technological improvements and clinical decisions.
(National Audit Office 2011)
The MRI scanner plays a pivotal role in the cancer, orthopaedic and stroke / TIA pathways as well
as a developing role in breast imaging. It also provides a significant revenue stream related to
private and MSK interface imaging and the department has developed a good relationship with
Yeovil Town FC who use the scanner privately for their players.
As the current scanner is ten years old there has been a significant technical improvement in
current scanners, so we are no longer producing images of the highest quality. There has been
some degradation to the image quality produced by the scanner due to its age. The current scanner
is likely to become unsupported technically within the next 24 months which would leave the service
at risk, unless we either replace the scanner or upgrade the present scanner.
The options are listed below. Note that the costs below assume the addition of a toilet in the CT/MRI
waiting area which is currently without such a facility. At present, patients who have had laxatives
and other examinations have to use a public toilet following their examination which has led to
several complaints from patients.
Option 1 – buy a new scanner.
Benefits:
•
•
•
•
•
•
•
•
•
•
Large (70cm) bore magnet which can accommodate more patients (less claustrophobic and
wider to allow larger body habitus)
Advanced neurological package for diffusion, perfusion and functional imaging
Advanced orthopaedic imaging with dedicated coils and susceptibility artifact reduction
functionality to enable scanning around metallic joint replacements
Fast 3D measurements for superfast orthopedic scanning
Cardiac suite enabling a range of cardiac applications from morphology and ventricular function
to tissue characterization.
High channel body imaging including Ultra-fast high resolution 2D and 3D protocols for
abdomen, pelvis, MR Colonography, MRCP, dynamic kidney, and MR Urography applications.
Oncological examinations can be acquired with whole body coverage for metastasis staging in a
single, continuous move.
High resolution coils providing multiparametric imaging of the prostate in terms of morphology,
physiology and function.
Zero Helium boil-off technology meaning helium refills would not be required.
Scan sequences will be 30% quicker than the TIM (Total imaging matrix) upgrade
Risks:
•
•
Significant cost
Significant down time of existing service, with only real option of service continuity being location
of temporary scanner within hospital ground, incurring significant cost and loss of parking
revenue for the hospital.
Cost:
•
The estimated capital cost for replacing the existing scanner is £1,408k with average on-going
revenue costs of £228k per annum based on a life of 10 years for the new scanner.
Option 2 – upgrade the current scanner
Benefits:
The TIM upgrade technology is becoming the standard in MRI around the world. The upgrade will
provide new hardware:
• New RF system with 18/32 independent channels for faster imaging and better signal-to-noiseratio (SNR) to improve the quality of images
• New quantum gradient coil
• New integrated body coil
• New patient table for easier patient handling
• Audio comfort improvements for quieter more relaxed examinations
• New standard integrated head neck and spine coils allowing faster throughput
• New dedicated coils for high resolution orthopaedic imaging
• New host computer and image processor for faster reconstructions
• Scan sequences will be 30% quicker than the current scanner
The upgrade will have a superior image quality with:
• Less distortions
• Less blurring
• Higher B1 homogeneity due to zooming
• Better fat saturation
• Less motion and flow artefacts
• Increased spatial resolution in region of interest
• Head-to-toe imaging without patient repositioning
• Seamlessly scan up to 205 cm with excellent image quality
• Shorter examination times allow increased throughput
Significantly less cost than a replacement scanner
Costs:
The estimated capital cost for upgrading the existing scanner is £476k with average on-going
revenue costs of £145k per annum. This is assumes that the upgraded scanner will operate for 7
years.
Option 3 - do nothing
Benefits:
•
•
No additional cost
No scanner down time/service continuity plan.
Risks:
•
•
•
•
YDH will be unable to provide whole body imaging and diffusion weighted imaging which are
becoming standards in oncological imaging.
YDH will become less competitive when seeking to continue to provide MSK imaging for private
sources due to a lack of specific coils and sequences provided by our competitors. Taunton &
Somerset NHS FT currently have two scanners both of which are less than 5 years old.
The current scanner is outside of the DoH guidelines for equipment replacement targets and is
likely to reduce levels of reliability and increased “down-time”.
Loss of income
Siting of mobile scanner unit
To facilitate any of the three options for replacement / upgrade there is a need for the current
service to be taken down for a period of time. The upgrade option has a shorter downtime
requirement than the replacement option. To ensure continuity of service a mobile unit will need to
be rented and the unit could be sited at South Petherton Hospital or on the hospital site if a suitable
place is identified.
The preferred option is for the mobile unit to be sited on the YDH site as this will provide an
improved patient experience and better patient flow as there will be no requirement for patients to
be transported to South Petherton for their scans. A suitable location outside of the Womens
Hospital has been identified and the cost for the construction of the Pad to support the temporary
unit is £7k. The Pad will also provide a facility for any future temporary requirements and enable
the Trust to host mobile units for other initiatives eg Mobile Mammography Unit.
Recommendation:
The Trust should upgrade the current scanner. This offers a balance between maintaining and
improving clinical applications and their associated revenue streams at lower cost thus preserving
capital. The trust has recently started a cardiac CT service and an upgrade or replacement MRI
scanner would be capable of offering a complimentary service. The current MRI scanner is not
capable of diffusion weighted scanning in the abdomen and pelvis which is considered to be
important in oncological staging and would be possible following an upgrade/replacement.
The upgrade has been installed in a number of Trusts in England. The Yeovil Hospital Radiology
Department went on a site visit to Swindon (where they have already installed the upgrade) to view
the upgraded system and discuss the implementation process. The feedback from Swindon was
very positive and they recommended this option.
The current scanner can be supported until 2020 at which point it will be 17 years old. An interim
upgrade offers almost all of the benefits of a new scanner, with additional clinical applications,
greater scanning speed and increased image quality all at significantly lower cost than a new
scanner. The additional longevity an interim upgrade could offer would allow the service to grow
until the scanner reaches end of support in 2020 at which time the Trust would need to replace.
The preferred option for the siting of the temporary unit is on the YDH site and therefore the
construction of the Pad is recommended.
Funding options
There are two options available to fund the upgrade of the scanner, either outright purchase or
utilising a finance lease over a period of seven years. The purchase and finance lease options have
been compared using the discounted cash flow technique at a 3.5% discount rate.
The annual depreciation costs for the upgrade option of £68.0k compares to the current
depreciation of £76.5k resulting in a reduction of £8.5k per annum; the maintenance costs for the
upgraded option remain the same as the current costs.
•
Trust Capital
Funding of £500k was identified in the 2013/14 Capital budget for an upgrade to the MRI
scanner based on the project being undertaken in quarter 4 of the 2013/14 financial year.
Capital Cost
£476k
•
Average Revenue costs pa
£144k
Net Present Value
-£961k
Finance Lease
Utilising a finance lease will release the Trust capital for use on other projects. There are some
estates related costs which will be funded via Trust capital.
Capital Cost Average Revenue costs pa Net Present Value
£83k
£147k
-£928k
It should be noted that the lease option would require the Trust to ‘sell’ the current scanner to
the lease company for £100 and then lease back the upgraded option, however as the current
scanner will be fully depreciated in quarter 4 of this financial year the sale will not have a
material financial impact.
The Board of Directors are requested to approve the recommendation to upgrade the current
scanner, and to delegate the final decision on which funding option to utilise to the Executive
Directors.
BOARD OF DIRECTORS PAPER
TITLE:
2013 National Staff Opinion Survey - Initial Analysis
DATE:
22 January 2014
PRESENTED BY:
Director of Workforce and Human Resources
What is this item about?
The report provides a summary of the initial analysis of feedback received from staff who
participated in the 2013 NHS Staff Survey.
Why is this item necessary?
The annual NHS Staff Survey seeks the views of staff regarding their working environment
and experience within the workplace. The feedback covers five key themes, namely:





your personal development
your job
your managers
your organisation
your health, wellbeing and safety at work
The information provided by the Survey outcomes indicates where improvements need to be
made in areas such as staff engagement; communications; leadership, and training and
development. Specific questions ask for individuals’ perception of the standard of care
provided by the organisation, whether patient care is recognised as the top priority and how
likely staff would be to recommend the Trust as a place to receive treatment and/or as a
place to work.
What is the Board asked to do?
To note the report.
1. How does this paper improve patient care?
There is a direct correlation between the degree of engagement, motivation, competence
and attitude of staff and the quality of care they provide to patients.
2. How does this paper advance the Annual Plan?
The maintenance of a workforce which is adequately resourced, appropriately skilled,
trained and developed, effectively managed, and engaged, underpins many of the key
objectives associated with the delivery of the Annual Plan.
3. How does this advance our strategic objectives?
The overall performance of the workforce, at all levels of the organisation, impacts
significantly on the achievement of Trust strategic objectives. There needs to be continued
focus on improving the working environment and becoming an employer of choice.
4. Is further information available?
Yes, upon request.
Are there implications for the Trust?
•
Legally? Yes
•
Financially? Yes
•
Regarding Workforce? Yes
Is this paper clear for release under Freedom of Information? Yes
2
1.
Purpose
1.1
The purpose of this paper is to provide a summary of the initial analysis of the
feedback received from staff who participated in the 2013 national NHS Staff Survey. The
summary is based upon a report received from the Trust’s Survey provider, Capita. Full
details of the Staff Survey results associated with all NHS employing organisations will be
published by the Department of Health in March 2013.
1.2
This first report provides an overview of the Survey outcomes at Trust-level: A further
report will follow, which will provide more detailed information relating to particular staff
groups and departments.
2.
Introduction and Background
2.1
The Staff Survey was facilitated by Capita between October and December 2013. In
previous years, only a ‘core’ sample of 750 employees have been surveyed (i.e. the
minimum sample set for a trust of this size). For 2013, a full census of all staff was
undertaken.
2.2
The Survey covers five key themes relating to the working environment and
individuals’ experience within the workplace, namely:





your personal development
your job
your managers
your organisation
your health, wellbeing and safety at work
The questions associated with each of these themes are determined nationally.
2.3
Questionnaires were batch-delivered to YDH and then distributed to staff at their
work location. Staff responded by using a pre-paid response envelope provided by the
contractor. Two reminders were sent; a first reminder letter, and a further mailing which
included a repeat questionnaire.
3.
Response Rates and Staff Profile
3.1
For this Survey year, a total of 899 staff returned a completed questionnaire, which
equated to an overall response rate of 49.6%, i.e. 2.4% lower than the previous year. The
national ‘mean’ response rate for all acute trusts using Capita as their Survey provider was
50% (lowest 20%; highest 78%).
3.2
A total of 80% of YDH respondents were female and the majority of all respondents
were aged 41 or over, with 39% in the pre-retirement age group of 51-65 (compared with
36% nationally). One third of respondents claimed to have worked in the Trust for between
one and five years, and two thirds for more than six years (one fifth of whom claimed more
than 15 years’ local service). One third of respondents declared that they work part-time
(i.e. less than 30 hours per week), compared to one fifth nationally.
3.3
Respondents by staff and ethnic groups (as a percentage of all respondents) were
as follows:
3
Staff Group
Nursing (Registered)
Health Care Assistant
Midwifery
Allied Health Professional
Support to Allied Health Professionals
Medical and Dental (Consultant)
Medical and Dental (Other)
General Management
Central Functions/Corporate Services
Scientific and Technical
Support to Healthcare Scientists
Admin and Clerical
Maintenance/Ancillary
Other
Respondents
Percentage (rounded)
Number
26%
229
8%
71
3%
25
11%
100
1%
13
6%
49
4%
34
1%
13
7%
64
1%
11
1%
10
21%
187
7%
65
3%
9
Ethnic Group
British
Other White background
White and Black Caribbean, White and Black African, White and
Asian, any other mixed background
Indian
Pakistani
Bangladeshi
Other Asian background
Caribbean, African, any other Black background, Chinese, and any
other ethnic background
Not declared
4.
Percentage
Respondents
89%
4%
1%
2%
0%
0%
3%
1%
0%
Analysis of Survey Feedback
4.1
The following section provides an overview of the staff feedback received via the
Survey questionnaires. Summary analysis is provided for the key questions associated with
each Survey theme. Comparison is also made against the responses received via the 2012
Survey (i.e. in-year movement). The in-year trends are shown as follows:
Positive trend
Negative trend
Neutral/No
Change
4.2
A ‘Neutral’ indicator means there are roughly equal numbers of positive and negative
differences for the particular question, or no significant change overall. Irrespective of
whether the question is negatively or positively worded, red always indicates a negative
outcome and green a positive outcome. The final column shows the figures for all trusts
surveyed by Capita, which provides an initial comparison between YDH and national
responses. Since the Survey is anonymous, it is not possible to compare actual responses
by individuals, year on year, and no account has been taken of staff turnover during this
same period.
4
Key Themes - 2013 Results and In-Year Movement
YOUR PERSONAL DEVELOPMENT
2012
2013
2013
NATIONAL
In the last 12 months, have you taken part in any of the following, paid for and
provided by your Trust:
Health and safety (e.g. fire training, manual
67%
+7
73%
74%
handling).
Equality and diversity training.
35%
51%
+16
57%
How to prevent or handle
violence/aggression (e.g. conflict resolution
training).
27%
34%
+7
38%
Infection control.
75%
80%
+5
77%
How to handle confidential information.
58%
64%
+6
73%
How to deliver a good patient/service user
experience.
43%
51%
+9
53%
Any other job-relevant training, learning or
development.
72%
74%
+2
77%
My training, learning and development has helped me:
Do my job more effectively.
64%
62%
-2
67%
Stay up to date with professional
requirements.
68%
70%
+2
72%
Helped me to deliver a better patient/service
user experience.
58%
58%
-
62%
82%
79%
-3
82%
Did the appraisal/review help you to
improve how you do your job?
54%
48%
-6
53%
Did the appraisal/review help you agree
clear objectives for your work?
75%
72%
-3
77%
Did the appraisal/review leave you feeling
that your work is valued by your Trust?
65%
64%
-1
63%
Were any training, learning or development
needs identified?
65%
76%
+11
78%
Did your manager support you in receiving
this training, learning or development?
78%
80%
+2
82%
Appraisal
In the last 12 months, have you had an
appraisal or Knowledge and Skills
Framework (KSF) development review?
5
YOUR JOB
2012
2013
Team members have a set of shared
objectives.
80%
78%
-2
2013
NATIONAL
77%
Team members often meet to discuss the
team’s effectiveness.
64%
59%
-5
59%
Team members have to communicate
closely with each other to achieve the
team’s objectives.
83%
80%
-3
79%
I look forward to going to work.
56%
56%
-
52%
I am enthusiastic about my job.
72%
70%
-2
68%
Time passes quickly when I am working.
76%
74%
-2
74%
I have clear, planned goals and objectives
for my job.
75%
73%
-2
74%
I always know what my work responsibilities
are.
84%
85%
+1
86%
I am trusted to do my job.
90%
90%
-
91%
I am able to do my job to a standard I am
personally pleased with.
78%
79%
+1
79%
There are frequent opportunities for me to
show initiative in my role.
70%
68%
-2
69%
I am able to make suggestions to improve
the work of my team/department.
73%
70%
-3
74%
I am involved in deciding on changes
introduced that affect my work
area/team/department.
53%
48%
-5
52%
I am able to make improvements happen in
my area of work.
56%
51%
-5
55%
I am unable to meet all the conflicting
demands on my time at work.
45%
40%
-5
42%
I have adequate materials, supplies and
equipment to do my work.
53%
54%
+1
57%
There are enough staff at this organisation
for me to do my job properly.
36%
32%
-4
32%
6
How satisfied are you with:

the recognition you get for good work;
48%
48%
-
50%

the support you get from your manager;
64%
66%
+2
65%

the freedom you have to choose your
own method of working;
65%
66%
+1
66%

the support you get from your
colleagues;
79%
78%
-1
78%

the amount of responsibility you are
given;
74%
74%
-
75%

the opportunities you have to use your
skills;
74%
69%
-5
71%

the extent to which the Trust values
your work;
42%
40%
-2
42%

your level of pay;
39%
38%
-1
38%

the quality of care you give to
patients/service users.
84%
85%
+1
83%
How satisfied are you that:

your role makes a difference to
patients/service users;
92%
89%
-3
83%

you are able to deliver the patient care
you aspire to.
69%
68%
-1
68%
2012
2013
YOUR MANAGERS
2013
NATIONAL
My manager:

encourages us to work as a team;
69%
69%
-
70%

can be counted on to help me with a
difficult task at work;
66%
68%
+2
69%

gives me clear feedback about how well
I am doing my job;
57%
53%
-4
56%

asks for my opinion before making
decisions that affect my work;
53%
49%
-4
51%

is supportive in a personal crisis.
75%
73%
-2
72%
I know who the senior managers at the
Trust are.
83%
78%
-5
83%
7
Communication between senior
management and staff is effective.
37%
33%
-4
37%
Senior managers try to involve staff in
important decisions.
31%
27%
-4
30%
Senior managers act on staff feedback.
27%
27%
-
29%
Senior managers are committed to patient
care.
57%
50%
-7
53%
YOUR ORGANISATION
2012
2013
Care of patients/service users is my
organisation’s top priority.
74%
70%
-4
2013
NATIONAL
69%
My Trust acts on concerns raised by
patients/service users.
81%
74%
-7
71%
64%
58%
-6
61%
69%
66%
-3
69%
I would recommend my Trust as a place to
work.
If a friend or relative needed treatment, I
would be happy with the standard of care
provided by this Trust.
Hot water, soap and paper towels, or
alcohol rubs, are always available when
they are needed by:

staff;
95%
94%
-1
92%

patients/service users.
88%
88%
-
81%
HEALTH, WELLBEING AND SAFETY AT
WORK
In general, my job is good for my health.
2012
2013
44%
41%
-3
2013
NATIONAL
42%
My immediate manager takes a positive
interest in my health and wellbeing.
60%
55%
-5
55%
My Trust takes positive action on health and
wellbeing.
50%
43%
-7
45%
In the last three months have you ever
come to work despite not feeling well
enough to perform your duties?
64%
59%
-5
62%
Have you felt pressure from your manager
to come to work?
31%
35%
+4
34%
8
Have you felt pressure from your
colleagues to come to work?
24%
23%
-1
24%
Have you put yourself under pressure to
come to work?
92%
93%
+1
93%
During the last 12 months have you felt
unwell as a result of work related stress?
40%
37%
-3
37%
In the last month have you seen any errors,
near misses, or incidents that could have
hurt:

staff?
19%
18%
-1
18%

patients/service users?
29%
29%
-
27%
58%
51%
-7
52%
My Trust treats staff who are involved in an
error, near miss or incident fairly.
50%
47%
-3
48%
My Trust encourages us to report errors,
near misses or incidents.
85%
86%
+1
85%
My Trust treats reports of errors, near
misses or incidents confidentially.
66%
62%
-4
62%
My Trust blames or punishes people who
are involved in errors, near misses or
incidents.
10%
13%
+3
13%
When errors, near misses or incidents are
reported, my Trust takes action to ensure
that they do not happen again.
63%
61%
-2
63%
We are informed about errors, near misses
and incidents that happen in the Trust.
42%
39%
-3
44%
We are given feedback about changes
made in response to reported errors, near
misses and incidents.
40%
34%
-6
43%
If I was concerned about fraud, malpractice
or wrongdoing, I would know how to report
it.
92%
92%
-
87%
I would feel safe raising my concerns.
74%
82%
+8
81%
I would feel confident that the Trust would
address my concerns.
60%
67%
+7
67%
In the last month if you witnessed an error
or near miss that could have hurt staff or
patients/service users, did you or a
colleague report it?
9
In the last 12 months, have you
experienced physical violence at work from:

patients/service users, their relatives or
other members of the public?
15%
15%
-
14%

managers/team leaders or other
colleagues?
2%
1%
-1
2%
The last time you experienced physical
violence at work, did you or a colleague
report it?
60%
60%
-
59%
In the last 12 months have you personally
experienced harassment, bullying or abuse
at work from:

patients/service users, their relatives or
other members of the public?
32%
29%
-3
28%

managers/team leaders or other
colleagues?
22%
23%
+1
22%
The last time you experienced harassment,
bullying or abuse at work, did you or a
colleague report it?
49%
51%
+2
50%
My Trust acts fairly with regard to career
progression/promotion, regardless of ethnic
background, gender, religion, sexual
orientation, disability or age. The Trust acts
fairly with regard to career progression.
56%
55%
-1
60%
In the last 12 months, have you personally
experienced discrimination at work from:

patients/service users, their relatives or
other members of the public;
5%
3%
-2
5%

your manager/team leader or other
colleagues.
9%
8%
-1
7%
5.
Summary
5.1
In comparison with the 2012 outcomes, the 2013 results show a downward trend in
three of the five themes (i.e. Your Job, Your Managers, and Your Organisation) and positive
movement in one theme (i.e. Your Personal Development). With respect to the one
remaining theme (i.e. Health, Wellbeing and Safety at Work), overall there is no discernible
movement between the two Survey years:
10
Survey Theme
Estimated Overall Movement
in Year
Your Personal Development
Your Job
Your Managers
Your Organisation
Health, Wellbeing and Safety at Work
5.2
There is particular deterioration (i.e. 5%+ movement) in response to the following
questions:













Did the appraisal/review help you to improve how you do your job?
Team members often meet to discuss the team’s effectiveness.
I am involved in deciding on changes introduced that affect my work area/team/
department.
I am able to make improvements happen in my area of work.
I am satisfied with the opportunities I have to use my skills.
I know who the senior managers at the Trust are.
Senior managers are committed to patient care.
My Trust acts on concerns raised by patients/service users.
I would recommend my Trust as a place to work.
My immediate manager takes a positive interest in my health and wellbeing.
My Trust takes positive action on health and wellbeing.
In the last month if you witnessed an error or near miss that could have hurt staff or
patients/service users, did you or a colleague report it?
We are given feedback about changes made in response to reported errors, near
misses and incidents.
5.3
There is particular improvement (i.e. 5%+ movement) in response to the following
questions:











6.
Health and safety training (e.g. fire training, manual handling).
Equality and diversity training.
How to prevent or handle violence/aggression (e.g. conflict resolution training).
Infection control.
How to handle confidential information.
How to deliver a good patient/service user experience.
Were any training, learning or development needs identified?
I am unable to meet all the conflicting demands on my time at work.
In the last three months have you ever come to work despite not feeling well enough to
perform your duties?
I would feel safe raising my concerns.
I would feel confident that the Trust would address my concerns.
Next Steps
6.1
The analysis of more detailed information from Capita will provide additional
feedback by main staff group. This will further inform the development and implementation
of a response plan that prioritises those key areas in which improvements need to be made
11
and which establishes appropriate actions and interventions. As part of the overall
response, the Survey results will need to be appropriately communicated to all Trust staff
and, as part of this process, it is planned to convene a number of ‘workshop’ style briefing
sessions during February.
6.2
Noting the frequency of the Staff Survey (i.e. annual) and the limited timeframe in
which to communicate the results, develop and implement a response plan, and effectively
communicate with the workforce, it is proposed to concentrate on several key themes, only,
rather than attempt to cover all issues. This way, there is an increased likelihood that
reasonable progress will be evident, prior to the issue of the 2014 Survey in October.
6.3
The Board will receive details of the response plan and will be informed of progress
with its implementation.
7.
Recommendation
7.1
The Board is asked to note the initial analysis of the feedback received from staff in
the 2013 national NHS Staff Survey.
Paper Submitted by:
Mark Power, Director of Workforce and HR
Contributor:
Mark Appleby, Head of Workforce Performance and Development
(as Annual Staff Survey Lead)
January 2014
12
Operating & Financial
Performance Overview
December 2013 – Month 9
Section
Title
Page
CONTENTS
1
Operational Performance
2
Financial Performance Summary
3
Appendix - Financial Detail
2
Mortality
HSMR in September 13 was 86.2 (5.0 lower than September 12), reducing steadily over the last 12 months
Actual number of deaths in December 13 was 48, (Dec 12 51)
Hospital Standardised Mortality Ratio (HSMR)
Actual number of deaths
6 month moving average
6 month moving average
Oct-13
Dec-13
Jun-13
Aug-13
Apr-13
Feb-13
Oct-12
Dec-12
Aug-12
Jun-12
Apr-12
Feb-12
Oct-11
Dec-11
Jun-11
Oct-13
Jun-13
Aug-13
Apr-13
Feb-13
Oct-12
Dec-12
Aug-12
Jun-12
Apr-12
Feb-12
Dec-11
Oct-11
Jun-11
Aug-11
Apr-11
Feb-11
Oct-10
Dec-10
Aug-10
Jun-10
Apr-10
0.0
Aug-11
20.0
Apr-11
40.0
Feb-11
60.0
Dec-10
80.0
Oct-10
100.0
Jun-10
120.0
Aug-10
90
80
70
60
50
40
30
20
10
0
Apr-10
140.0
3
RTT [1/2]
In November 2013 95.6% (target 90%) of admitted patients and 97.5% (target 95%) of non-admitted patients started
consultant-led treatment within 18 weeks of referral.
RTT completed pathways - 18 week - admitted
Oct-13
Oct-13
Apr-13
Jan-13
Oct-12
Jul-12
Jan-12
Oct-11
Jul-11
Apr-11
Jul-13
6 month moving average
RTT target
Jul-13
RTT incompleted pathways - 18 week - admitted
Jan-11
Apr-10
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
75%
Apr-12
75.0%
Jan-12
80%
Oct-11
80.0%
Jul-11
85%
Apr-11
85.0%
Jan-11
90%
Oct-10
90.0%
Jul-10
95%
Apr-10
95.0%
Oct-10
6 month moving average
100%
Apr-12
RTT target
100.0%
Jul-10
6 month moving average
RTT completed pathways - 18 week - non admitted
RTT incompleted pathways - 18 week - non admitted
RTT target
6 month moving average
110.0%
RTT target
100%
100.0%
95%
90.0%
80.0%
90%
70.0%
85%
60.0%
80%
50.0%
40.0%
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
Jul-10
Apr-10
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
Jul-10
Apr-10
75%
4
RTT [2/2]
There are 129 admitted patients and 131 non-admitted patients were waiting longer than 18 weeks as at the end of
December 2013, 92 of these patients were waiting over 26 weeks. The only two specialities where RTT incomplete
% waiting less than 18 weeks is less than the 93% target are General Surgery (92.9%) and Neurology (83.3%).
RTT incomplete pathways
RTT incomplete pathways
Dec-13
Oct-13
Nov-13
Sep-13
Jul-13
Aug-13
Jun-13
Apr-13
May-13
Mar-13
Jan-13
Feb-13
Dec-12
Oct-12
Nov-12
Sep-12
Jul-12
Aug-12
Jun-12
Apr-12
Dec-13
Oct-13
Nov-13
Sep-13
Jul-13
Aug-13
Jun-13
Apr-13
May-13
Mar-13
Jan-13
Feb-13
Dec-12
Oct-12
0
Nov-12
50
0
Sep-12
100
1,000
Jul-12
150
2,000
Aug-12
200
3,000
Jun-12
250
4,000
Apr-12
300
5,000
May-12
350
6,000
May-12
RTT incomplete pathways > 18 weeks
7,000
RTT incomplete pathways > 18 weeks
RTT Incomplete pathways - Aging
Non Admitted
26+ weeks
25 weeks
24 weeks
23 weeks
22 weeks
21 weeks
20 weeks
19 weeks
140
120
100
80
60
40
20
0
Admitted
Patients that delay treatment through choice are counted as an incomplete pathways until they receive their treatment, or it is decided that they
don’t need treatment. Patient choice only changes things once they have received an admitted treatment (non-admitted stops aren’t adjusted for
patient choice)
5
Waiting lists
In December 13, both the daycase and inpatient waiting lists continue to get smaller, while the outpatient waiting
list has grown across most specialties.
Waiting Lists
OP Waiting List Size
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jun-12
Apr-12
Feb-12
Dec-11
Oct-11
Aug-11
Jun-11
Apr-11
Feb-11
Dec-10
Oct-10
Aug-10
Jun-10
Apr-10
4000
3500
3000
2500
2000
1500
1000
500
0
IP/DC Waiting List Size
Numbers above are live waiting list patients, they include patients that have chosen to delay their treatment.
Currently it is difficult to identify these patients due to the booking methods i.e. this information is only in the form of a
“comment”. Previously we used a separate waiting list code, which enabled us to exclude these patients from our
reports. This was stopped in order to increase visibility of all patients.
The above numbers do not include planned or suspended patients i.e. medically unfit or regular future bookings i.e.
five year endoscopies.
Outpatients waiting list - patients that have been referred but not yet seen.
Inpatients/Day cases – patients that have been referred for elective admissions but not yet treated.
6
Day Case Admissions
Day case admissions (1,274) were 82% of total elective admissions in December 2013. This mix has remained stable
between 80% and 86% since April 2010.
60% of all day cases this financial year to date were in 4 specialities –Gastroenterology (18.0%), General Surgery
(17.6%), Oncology (15.7%) and Ophthalmology (8.0%).
YTD day cases
Day Case admissions
2500
2,500
2000
2,000
1500
1,500
1000
1,000
500
500
Thoracic Medicine
Paediatrics
Cardiology
ENT
Care of the Elderly
Neurology
Rheumatology
Urology
Oral Surgery
Plastic Surgery
General Medicine
Dermatology
Gynaecology
Haematology
Orthopaedics
Ophthalmology
General Surgery
Oct-13
Dec-13
Aug-13
Jun-13
Medical Oncology
Day Case admissions
Apr-13
Feb-13
Oct-12
Dec-12
Jun-12
Aug-12
Apr-12
Feb-12
Dec-11
Oct-11
Jun-11
Aug-11
Apr-11
Feb-11
Oct-10
Jun-10
Aug-10
Apr-10
Dec-10
Total Elective admissions
Gastroenterology
0
0
7
A&E [1/2]
In December 95.3% (target 95%) of patients were seen and discharged within 4 hours from A&E. The 6 months
rolling average trend has decreased due to an increase in 4 hour breaches.
Average A&E overall attendances have increased slightly since November. Ambulance arrivals averaging 42 YTD.
A&E 4 hour performance - All Attendances
Average attendances per day
Day
Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Monday
142
132
145 146
125
145
129
128
135
Tuesday
122
124
121 132
127
119
113
117
114
Wednesday
119
118
127 129
120
128
120
115
125
Thursday
125
119
121 135
123
121
117
115
123
Friday
116
120
117 121
126
111
115
116
119
Saturday
125
127
131 136
127
123
123
121
127
Sunday
143
126
136 138
146
134
128
135
133
TOTAL
128
123
128 134
128
127
120
121
125
6 month moving average
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
88.0%
Avg A&E ambulance arrivals per day
Avg A&E attendance per day
60
135
130
40
125
120
20
115
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jun-12
0
Apr-12
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jun-12
Apr-12
110
8
3200
-5.0%
3000
-10.0%
6 month moving average
9
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jun-12
Apr-12
Feb-12
Dec-11
Oct-11
3400
Aug-11
3600
Jun-11
A&E Activity
Apr-11
3800
Feb-11
4000
Oct-10
4200
Dec-10
4400
Aug-10
80
26/12/2013
19/12/2013
12/12/2013
05/12/2013
28/11/2013
21/11/2013
14/11/2013
07/11/2013
31/10/2013
24/10/2013
17/10/2013
10/10/2013
03/10/2013
26/09/2013
19/09/2013
12/09/2013
05/09/2013
29/08/2013
22/08/2013
15/08/2013
08/08/2013
YTD, activity is down on last year by 0.2%.
Jun-10
December 13 activity is up compared to November by 7.1%
(3,877 vs. 3,619) but lower than previous year by 1.1%.
01/08/2013
A&E activity increased by 5% in 12/13 vs 11/12, mainly due
to spikes in June (+7.2%), August (8.8%), September (7.3%)
and December (+13.1%).
Apr-10
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jun-12
Apr-12
Feb-12
Dec-11
Oct-11
Aug-11
Jun-11
Apr-11
Feb-11
Dec-10
Oct-10
Aug-10
Jun-10
Apr-10
A&E [2/2]
A&E Attendances by day
170
160
150
140
130
120
110
100
90
% increase/decrease vs LY
15.0%
10.0%
5.0%
0.0%
Ambulance targets
We have achieved the 30 minute handover target (98%) for the last 8 months running.
YTD fines total £29,000 , mainly due to spike in April of £16,800, the same period last year fines were £27,330.
£18,000
£16,000
£14,000
£12,000
£10,000
£8,000
£6,000
£4,000
£2,000
£0
102.0%
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
Ambulance handovers - Fines
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jun-12
Apr-12
88.0%
Ambulance Handover <30mins
NOTES:
Ambulance fines for over 30mins only began in April 2011
Imposed Fines have changed each year but have always been based on breaching 30 mins or more
10
Cancer 2 week waits
Since October 2011, we have achieved the 2 week wait target (93%) of seeing patients within 2 weeks of a suspected
cancer referral. The 2 week wait target for breast referrals not suspected of cancer fell to 85% in November 2013 due
to patient choice.
Number of referrals
2 wk wait suspected cancer
2 wk wait Breast
11
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Jul-11
Oct-11
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
0
75.0%
Apr-11
100
80.0%
Jan-11
200
85.0%
Oct-10
300
90.0%
Jul-10
400
95.0%
Apr-10
500
100.0%
no. referrals - breast symptons
80
70
60
50
40
30
20
10
0
Jul-10
105.0%
2 week wait exhibited breast symptoms
600
Apr-10
no. referrals - suspected cancer
2 week wait suspected cancer
2 week cancer targets
Cancer 31 day and 62 day targets
31 day treatment first
Oct-13
Jan-13
Apr-13
Oct-12
Jan-12
Apr-12
Oct-11
Apr-11
Jan-11
Oct-10
Apr-10
31 day treatment first subsequent drugs
31 day treatment subsequent surgery
Achievement %
Target %
6 month rolling %
Monthly data
Target %
6 month rolling %
Target %
Oct-13
Jul-13
Jan-13
Apr-13
Jul-12
Oct-12
Apr-12
Jan-12
Jul-11
Monthly data
Oct-11
Jan-11
Oct-10
Jul-10
Apr-10
Jul-13
Oct-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Jul-10
Oct-10
103.0%
101.0%
99.0%
97.0%
95.0%
93.0%
91.0%
89.0%
87.0%
85.0%
83.0%
81.0%
79.0%
77.0%
75.0%
Apr-10
Jul-13
Oct-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jul-10
Apr-10
Jan-11
101.0%
99.0%
97.0%
95.0%
93.0%
91.0%
89.0%
87.0%
85.0%
Oct-10
101.0%
99.0%
97.0%
95.0%
93.0%
91.0%
89.0%
87.0%
85.0%
Apr-11
Oct-13
Jan-13
Apr-13
Oct-12
Jan-12
Apr-12
Oct-11
Apr-11
Jan-11
Apr-10
Oct-10
We continue to achieve the target of delivering treatment within 31 days of the decision to treat.
6 month rolling %
We are currently achieving all 62 day targets.
62 day treatment standard
Achievement %
Target %
120.0%
60
100.0%
Achievement %
Target %
Number of referrals
60.0%
10
40.0%
Achievement %
Target %
Jul-13
Oct-13
Jan-13
Apr-13
Oct-12
Jul-12
Jan-12
0
Apr-12
0.0%
Jul-11
0
5
Oct-11
20.0%
Apr-11
10
Jan-11
Jul-13
Oct-13
Apr-13
Jan-13
Jul-12
Oct-12
Apr-12
Jan-12
Oct-11
20
15
80.0%
Oct-10
30
20
Jul-10
40
Jul-11
Jul-13
Number of referrals
Oct-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Jul-11
0
Oct-11
0.0%
Apr-11
1
Jan-11
20.0%
Oct-10
2
Jul-10
3
40.0%
Apr-10
60.0%
70
50
Apr-11
4
Jan-11
80.0%
Oct-10
5
Jul-10
100.0%
62 day treatment upgrades
102.0%
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
88.0%
86.0%
84.0%
Apr-10
6
Apr-10
62 day treatment screening
120.0%
Number of referrals
12
DNA - Outpatients
DNA rate
November 13 DNA ratio 7.2%, decrease of
0.9% compared to October 13.
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
In December 176 patients did not attend their
first appointment, 629 did not attend their
follow up appointment
£120,000
£100,000
£80,000
£60,000
£40,000
£20,000
£0
Overall DNA rate
First DNA rate
Follow up DNA rate
DNA Cost
YTD DNAs by speciality
1200
20.0%
18.0%
1000
16.0%
14.0%
800
12.0%
600
10.0%
8.0%
400
6.0%
4.0%
200
2.0%
DNAs
Cardiology
Anaes/Pain
Haematology
General Surgery
Medical Oncology
Urology
Plastic Surgery
Orthopaedics
Ophthalmology
Dermatology
Rheumatology
Thoracic Medicine
Neurology
Gynaecology
Gastroenterology
Oral Surgery
General Medicine
Orthodontics
Obstetrics/Mat Midwife
ENT
Paediatrics
0.0%
Rehabilitation
0
Rate %
13
First to follow up
1st to follow up ratio in November 2013 remains steady at 1:1.2, 6 month moving average has stabilised at
1:1.98
Orthopaedics and Ophthalmology have the highest first to follow up ratio
2500
2.3
2000
1st
Follow Up
Anaes/Pain
Plastic Surgery
Oral Surgery
Orthodontics
6 month moving average
0
Urology
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
1.5
500
ENT
1.7
1000
General Surgery
1.9
1500
Ophthalmology
2.1
Orthopaedics
attendances
2.5
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
-
rate
YTD 1st to follow up ratio by speciality
New:Follow ratio
Rate
14
Stroke
In November we achieved the 80% target for the third month in a row for stroke patients spending >90% of their
time on the stroke ward.
62% of patients were admitted directly to the stroke ward within 4 hours, this is below target of 90%.
Stroke Unit Stay >90%
4Hr Direct Admission
120%
100%
100%
80%
80%
60%
60%
40%
40%
20%
0%
0%
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
20%
Stroke Unit Stay >90%
Target
4Hr Direct Admission
Target
100% of high risk Transient Ischaemic Attack (TIA) patients were treated within 24 hours.
52% of patients that were subsequently diagnosed with a stroke had a CT scan within 1 hour of arrival. Please note
that the underlying data includes all patients, whether a CT scan is needed within 1 hour or not, therefore our
achievement maybe understated
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Jul-13
Oct-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
0%
Jan-12
0%
Oct-11
10%
Jul-11
20%
Jan-11
20%
Apr-11
30%
40%
Jul-10
40%
60%
Oct-10
50%
80%
Apr-10
100%
Jun-12
Achievement 1HrCTScan
60%
Apr-12
High Risk TIA <24Hrs
120%
15
Discharges
39.1% of inpatients had an EDD (estimated discharge date) recorded, of these only 37.8% were actually discharged
by the estimated due date.
Top 4 largest specialities (% discharged by EDD) - General medicine 29%, Paediatrics 41%, General Surgery 49%,
Orthopaedics 43%
YTD IP Discharges with EDD Recorded by Specialty - Top 7 Specialties (excluding EAU)
Apr - Dec 2013
YTD Discharges by Day of the Week Apr - Dec 2013
3500
3500
3000
3000
2500
2500
2000
2000
1500
1500
1000
1000
500
500
0
0
Monday
Tuesday
Wednesday
Elective
Thursday
Emergency
Friday
Saturday
Sunday
General
Medicine
General Surgery
Paediatrics
disch on EDD
Orthopaedics
Gynaecology
no EDD recorded
Care of the
Elderly
Urology
Anaes/Pain
not disch on EDD
16
Cancelled operations
For any elective operation cancelled by the trust on the day of the operation/admission, an offer of a new date
must be made within 5 calendar days, and the newly offered date must be within 28 days of the cancelled operation
date.
YTD to Dec 13, 100 operations have been cancelled by the trust on the day for non-clinical reasons, 98 were
contacted within 5 days to be offered a new date and 97 were rebooked within 28 days.
Most common reason of cancelling
operation is “patient cancellation”
Top 10 Reasons for Cancellation of Elective Operations
For Hospital Cancellations – 30% are
cancelled on the day, while 51% give at least
8 days notice
PATIENT CANCELLED - TCI / APPOINTMENT INCONVENIENT
PATIENT FAILED TO ARRIVE / DNA
TCI / APPOINTMENT RESCHEDULED - DATE BROUGHT
FORWARD
Patient Cancellations – 62% on the day, 24%
give at least 8 days notice.
PATIENT CANCELLED - UNFIT FOR TREATMENT
TCI / APPOINTMENT RESCHEDULED - REQUIRES
ALTERNATIVE SESSION / CLINIC
Timing of Cancelled Operation (By Hospital)
PATIENT UNFIT FOR SURGERY (PRE-EXISTING MEDICAL
CONDITION)
500
450
400
PATIENT UNFIT FOR SURGERY (ACUTE ILLNESS)
350
300
250
CONSULTANT / CLINICIAN UNAVAILABLE
200
150
MORE URGENT CASE TOOK PRIORITY - ELECTIVE ONLY E.G.
CANCER
100
50
0
SURGERY / APPOINTMENT NOT REQUIRED
1 day before
0
50
100
150
200
250
2-7 days before
8 or more days
before
On the day
300
17
Safety
Patient falls in October were 75 with spikes in Feb and Mar 13. The last reported case of MRSA was in Mar 13 with
only 4 cases in the last 3 years. Pressure ulcers are on a decreasing trend
Pressure ulcers +2
Patient falls
Monthly data
Monthly data
6 month moving average
140
30
120
25
100
20
80
6 month moving average
15
60
MRSA
Monthly data
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
Apr-10
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
0
Jul-10
5
0
Apr-10
20
Jul-10
10
40
C difficile cases
6 month moving average
Monthly data
6 month moving average
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-13
Jul-13
Apr-13
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
Oct-10
Jul-10
Apr-10
0
Oct-10
1
Jul-10
8
7
6
5
4
3
2
1
0
Apr-10
2
18
Friends and Family Test
YTD response rate 18.4%, low A&E response rate of 5.8%.
No of Respondants
A&E
30
50
133
85
81
144
166
98
121
908
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
TOTAL
IP
368
318
362
383
456
437
467
377
330
3,498
No of eligible Patients
TOTAL
398
368
495
468
537
581
633
475
451
4,406
A&E
1,815
1,642
1,631
1,894
1,828
1,705
1,815
1,700
1,657
15,687
IP
991
923
928
950
901
845
950
914
873
8,275
TOTAL
2,806
2,565
2,559
2,844
2,729
2,550
2,765
2,614
2,530
23,962
Friends and Family Test Inpatient and ED Response
to 'extremely likely' and 'likely' to recommend YDH
76%
69%
68%
72%
71%
73%
76%
76%
71%
60%
40%
20%
26%
23%
21%
23%
22%
20%
21%
23%
20%
0%
Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Extremely Likely
Likely
A&E
1.7%
3.0%
8.2%
4.5%
4.4%
8.4%
9.1%
5.8%
7.3%
5.8%
IP
37.1%
34.5%
39.0%
40.3%
50.6%
51.7%
49.2%
41.2%
37.8%
42.3%
TOTAL
14.2%
14.3%
19.3%
16.5%
19.7%
22.8%
22.9%
18.2%
17.8%
18.4%
Friends and Family Test % of Responses
100%
80%
% of Responses
4000
3500
3000
2500
2000
1500
1000
500
0
25%
20%
15%
2,765
2,806 2,565 2,559 2,844 2,729 2,550
2,614 2,530
10%
5%
398
368
495
Apr-13 May-13 Jun-13
No of Respondants
468
537
581
633
475
451
0%
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
No of eligible Patients
% of Responses
19
Patient complaints and compliments
April to December 2013
YTD there have been 1071 compliments to Clinical
Departments and Medical Staff and 648 complaints
1200
1000
800
There has been an increase in number of PALs
contacts, Sep (72), Oct (85) compared to average AprAug (57)
600
400
200
0
YTD complaints & PALS
Complaints - Highest 10 Departments Apr - Dec 2013
YTD compliments
Complaints - Rate Apr - Dec 2013
Orthopaedic Outpatients
Ward 6A - Charlton
Ward 8B - Montacute
Ward 9B - Merriott
Radiology
Kingston Wing
Ward 9A - Sparkford
Ward 6A - Charlton
Ward 9A - Sparkford
Ward 9B - Merriott
Ward 8B - Montacute
EAU - Emergency Admissions Uni
EAU - Emergency Admissions Uni
Kingston Wing
Emergency Department
Out-Patient Department
Orthopaedic Outpatients
Emergency Department
Out-Patient Department
0
10
20
30
40
50
60
0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50%
20
Admissions
Total elective admissions in December 2013 were 1,546 compared to non-elective 1,575. For the last 12 months the
mix has remained at a 50:50 equal split, compared to prior year which was 54% Elective to 46% Non Elective
admissions.
Average length of stay is 2.7 days for Elective Division and 5.1 days for UCLTC Division.
Admissions
Average Length of Stay (days)
3,500
3,000
2,500
2,000
1,500
1,000
500
0
7.0
6.0
5.0
4.0
3.0
Total admissions (6 mths avg)
LOS
Elective
Non Elective
Oct-10
3.5
5.2
LOS Elective
Oct-11
3.3
4.8
Oct-12
3.6
5.1
Oct-13
2.5
5.1
LOS Non Elective
In November we are carrying out further analysis to
determine relevant and accurate criteria for LOS vs accurate
targets
21
Dec-13
Oct-13
Jun-13
Aug-13
Apr-13
Feb-13
Dec-12
Oct-12
Jun-12
Aug-12
Apr-12
Feb-12
Dec-11
Oct-11
Jun-11
Aug-11
Apr-11
Feb-11
Dec-10
Oct-10
Non Elective admissions
Jun-10
0.0
Aug-10
Oct-13
Dec-13
Jun-13
Aug-13
Apr-13
Feb-13
Dec-12
Oct-12
Jun-12
Aug-12
Apr-12
Feb-12
1.0
Apr-10
Total Elective admissions
Dec-11
Oct-11
Jun-11
Aug-11
Apr-11
Feb-11
Dec-10
Oct-10
Jun-10
Aug-10
Apr-10
2.0
Length of stay – long stayers
WARD 9B
As of 10/01/14, the current longest staying inpatient is 96 days, but they are not medically fit for discharge. The
longest staying inpatient fit for discharge has been an inpatient for 88 days, and is yet to be discharged due to
patient or family choice.
Mental Health Delay
Social Service Delay
Not Medically Fit
WARD 9A
Community Hospitals Delay
(blank)
Social Service Delay
Patient or Family Choice
WA
RD
8B
Not Medically Fit
Social Service Delay
60-100
WARD 8A
Mental Health Delay
30-60
Social Service Delay
15-30
Patient or Family Choice
KIN
WA
GST WARD RD
ICU ON
6B
7A
Not Medically Fit
Not Medically Fit
Social Service Delay
Not Medically Fit
Not Medically Fit
Not Medically Fit
0
1
2
3
4
5
6
7
8
22
Re-admissions within 30 days
(YTD December 2013)
General Medicine has a high rate of readmissions post electively from other specialties, and post-emergency
generally, because General Medicine has a large portion of all emergency admissions.
General Surgery has a high rate of post-elective same-specialty readmissions due to the high rate of elective
admissions for general surgery (all endoscopies are managed as day cases, and therefore count as admissions)
Post Elective Readmissions by Specialty
Post Emergency Readmissions
by Specialty
General Medicine
General Medicine
General Surgery
General Surgery
A&E
Gynaecology
Geriatrics
Trauma & Orthopaedics
Trauma & Orthopaedics
A&E
Gynaecology
Paediatrics
Geriatrics
Obstetrics
Paediatrics
Urology
0
10
20
30
different speciality
40
50
60
same speciality
70
80
90
100
0
50
100
150
different speciality
200
250
300
350
400
450
same speciality
23
Theatre utilisation
(YTD December 2013)
ENT, Ophthalmology, Oral Surgery, Plastic Surgery,
and Urology are the areas most prone to theatre
lists ending at least 45 minutes earlier than
scheduled
Conversely, private endoscopy sessions have
overrun in 38% of cases, and never ended early.
24
Workforce
Performance
Month 8
25
Total Workforce Capacity
Total Workforce Capacity outturn for Month 8 was 1,752 full time equivalent (FTE).
Temporary Staff Capacity increased by the equivalent of 8 FTE. Temporary workforce capacity accounted
for 6% of the total workforce capacity (increase of 0.3% against the previous month).
FTEs Contracted vs Temp
FTE Actual vs PLan
1,680
1,780
140
1,670
1,660
1,740
1,650
1,720
1,700
1,680
120
100
1,640
80
1,630
1,620
60
1,610
40
1,600
1,590
1,660
Temp FTEs
Contracted FTEs
1,760
20
1,580
Total FTEs
Plan FTE
Administrative and Clerical
374
81
Estates and Ancillary
161
Healthcare Scientists
5
Medical and Dental
213
Nursing and Midwifery Registered
500
0
100
200
300
400
500
600
Nursing and Midwifery Registered
Administrative and Clerical
Additional Clinical Services
Medical and Dental
Estates and Ancillary
Allied Health Professionals
Add Prof Scientific and Technic
Healthcare Scientists
Total
Oct-13
Nov-13
Sep-13
Jul-13
Aug-13
Jun-13
Apr-13
May-13
Mar-13
Jan-13
Feb-13
Dec-12
Oct-12
Nov-12
Sep-12
Jul-12
Aug-12
Jun-12
Apr-12
May-12
Oct-13
Nov-13
FTEs
253
Allied Health Professionals
0
Contracted FTE
41
Additional Clinical Services
1,570
Rolling 6 mth avg FTE
YTD a vera ge FTE mix profile
Add Prof Scientific and Technic
Sep-13
Jul-13
Aug-13
Jun-13
Apr-13
May-13
Mar-13
Jan-13
Feb-13
Dec-12
Oct-12
Nov-12
Sep-12
Jul-12
Aug-12
Jun-12
Apr-12
May-12
1,640
Temp Worked FTE
YTD
avg
500
374
253
213
161
81
41
5
1,628
PY YTD
avg
508
381
262
218
162
75
38
10
1,654
var
-1.6%
-1.7%
-3.5%
-2.2%
-0.5%
7.4%
5.9%
-46.2%
-1.6%
26
Substantive Workforce Capacity Movement
The total number of substantive staff (i.e. directly employed staff) increased by 8 FTE.
FTEs - Variance to Prior Month by Staff Group
-50
-40
-30
-20
-10
0
10
20
30
40
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Professional Scientific and Technical
Additional Clinical Services
Administrative and Clerical
Allied Health Professionals
Estates and Ancillary
Healthcare Scientists
Medical and Dental
Nursing and Midwifery Registered
27
Mandatory Training
The percentage of staff remaining in date for all elements of their Mandatory Training remained at 81%, against a
target of 80%.
Mandatory Training Compliance vs Target
Mandatory Training by Staff Group - % of staff remaining in date
85.0%
Add Prof Scientific and Technic
80.0%
Additional Clinical Services
75.0%
Administrative and Clerical
70.0%
Allied Health Professionals
Estates and Ancillary
65.0%
Healthcare Scientists
Actual
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
Apr-13
May-13
Feb-13
Mar-13
Jan-13
Dec-12
Oct-12
Nov-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
60.0%
Medical and Dental
Nursing and Midwifery Registered
Target
0%
10%
20%
Nov-13
30%
Oct-13
40%
50%
60%
70%
80%
90% 100%
Sep-13
28
Mandatory Training
The percentage of staff remaining in date for all elements of their Mandatory Training remained at 81%, against a
target of 80%
Mandatory Training Compliance vs Target
Mandatory Training by Staff Group - % of staff remaining in date
85.0%
Add Prof Scientific and Technic
80.0%
Additional Clinical Services
75.0%
Administrative and Clerical
70.0%
Allied Health Professionals
Estates and Ancillary
65.0%
Healthcare Scientists
Actual
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
Apr-13
May-13
Feb-13
Mar-13
Jan-13
Dec-12
Oct-12
Nov-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
60.0%
Medical and Dental
Nursing and Midwifery Registered
Target
0%
10%
20%
Nov-13
30%
Oct-13
40%
50%
60%
70%
80%
90% 100%
Sep-13
29
Annual Appraisal
The percentage of staff remaining in date for their Annual Appraisal increased to 78%, against a target of 90%.
Appraisal Complaiance vs Target
Annual Appraisal by Staff Group - % of staff remaining in date
100.0%
Add Prof Scientific and Technic
90.0%
80.0%
Additional Clinical Services
70.0%
60.0%
Administrative and Clerical
50.0%
Allied Health Professionals
40.0%
Estates and Ancillary
30.0%
20.0%
Healthcare Scientists
10.0%
Medical and Dental
Actual
Target
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
Apr-13
May-13
Feb-13
Mar-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Jul-12
Aug-12
Jun-12
May-12
Apr-12
0.0%
Nursing and Midwifery Registered
0%
20%
Nov-13
40%
Oct-13
60%
80%
100%
120%
Sep-13
30
Staff Turnover
Between Month 7 and Month 8, Staff Turnover decreased by 0.1% to 13.0% (against a target upper limit of 15%).
The rolling twelve-month average is 12.8%.
Staff Turnover
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
Actual
Target Lower Limit
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
May-13
Apr-13
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
0.0%
Target Upper Limit
31
Sickness Absence
The overall Sickness Absence Rate for Month 7 was 3.5%, (0.4% higher than the Month 6 performance) representing
an adverse variance of 0.5% against target.
All areas with high levels of sickness absence have action plans in place to improve attendance.
Sickness Absence vs Target
Sickness Absence by Staff Group - Last 3 months
5.0%
Add Prof Scientific and Technic
4.5%
4.0%
Additional Clinical Services
3.5%
3.0%
Administrative and Clerical
2.5%
Allied Health Professionals
2.0%
Estates and Ancillary
1.5%
1.0%
Healthcare Scientists
0.5%
Medical and Dental
Target
Oct-13
Sep-13
Jul-13
Aug-13
Jun-13
May-13
Apr-13
Mar-13
Jan-13
Total for YDH
Feb-13
Dec-12
Nov-12
Oct-12
Sep-12
Jul-12
Aug-12
Jun-12
May-12
Apr-12
0.0%
Nursing and Midwifery Registered
0.0%
5.0%
Aug-13
10.0%
Sep-13
15.0%
20.0%
25.0%
Oct-13
32
Finance
YTD surplus £802k, £529k favourable against budget, Monitor risk rating of 4, YTD capital expenditure £1,717k,
Cash balance £7.3m
Financial Summary
Income
Pay
Non Pay
EBITDA
Other
Surplus
EBITDA Margin %
Surplus %
In Month
Actual
Variance
9,713
(6,151)
(2,998)
564
(415)
149
4.9%
1.5%
220
(113)
21
128
2
130
0.3%
1.3%
Year to Date
Actual
Variance
76,757
(48,826)
(23,717)
4,214
(3,412)
802
5.3%
1.0%
(179)
339
357
517
12
529
0.7%
0.7%
Variance: Favourable/(Adverse)
33
APPENDIX
Financial Detail
34
Summary (£’000)
YTD: £802k surplus, £529k favourable against budget
Financial Summary
Income
Clinical Income
Non NHS Clinical Income
Other Income
Total Income
Prior Months Actuals
September
October
In Month - November
Actual
Variance
Year to Date
Actual
Variance
8,295
232
1,073
9,600
8,741
270
1,132
10,143
8,338
220
1,155
9,713
121
(80)
179
220
66,338
1,914
8,505
76,757
(503)
(240)
564
(179)
Pay
Nursing
Medical Staff
Estates, Admin & Clerical
Scientific, Therapeutic & Technical
Ancillary
CIP
Total Pay Expenditure
(2,152)
(1,974)
(1,065)
(575)
(303)
0
(6,069)
(2,229)
(2,058)
(1,091)
(612)
(327)
0
(6,317)
(2,198)
(1,955)
(1,087)
(591)
(320)
0
(6,151)
12
65
(26)
(11)
(16)
(137)
(113)
(17,403)
(15,718)
(8,498)
(7,207)
0
(48,826)
444
351
216
(45)
(61)
(566)
339
Non Pay
Drugs
Consumable M&SE
High Cost M&SE
Other
Central Budgets
Total Non Pay Expenditure
EBITDA
Other
Surplus
EBITDA Margin %
Surplus %
(803)
(621)
(275)
(1,304)
0
(3,003)
528
(410)
118
5.4%
1.2%
(974)
(663)
(231)
(1,255)
0
(3,123)
703
(415)
288
6.8%
2.8%
(890)
(615)
(277)
(1,216)
0
(2,998)
564
(415)
149
4.9%
1.5%
(43)
7
0
(67)
124
21
128
2
130
0.3%
1.3%
(6,837)
(4,798)
(1,983)
(10,099)
0
(23,717)
4,214
(3,412)
802
5.3%
1.0%
(302)
(26)
125
23
537
357
517
12
529
0.7%
0.7%
Variance: Favourable/(Adverse)
35
Monitor Risk Ratings
The Trust is achieving a risk rating of 4
Month 8
Month 7
In Month
YTD
In Month
YTD
Debt Service Cover
Debt Service
131
1107
130
976
Revenue available for Debt Service
474
4,080
690
3,606
Debt Service Cover Matrix
3.6
3.7
5.3
3.7
Debt Service Cover Rating
4
4
4
4
4109
4109
4101
4101
-9,149
-72,543
-9,440
-63,394
13.5
15.3
13.0
13.6
Liquidty Rating
4
4
4
4
Continuity of Service Risk Rating
4
4
4
4
Liquidity
Cash for Continuity of Service
Operating Expenses
Liquidty Matrix *
* Calculation is based on Cash for Continuity of Service divded by Operating Expenses x 30 days per month
36
Income (£’000)
Income in month £9,713k; YTD £76,757k (£179k adverse to budget)
Clinical Income - There is a favourable variance of £121k in month. Of
this £118k is as a result of higher than planned Specialist Commissioning
income (for pass through drug payments) & £42k due to high NCA and
Overseas patients. This is offset by Cancer Drug Fund income being
lower than planned due to NICE approval of some high cost drugs,
meaning that these are now billed to Specialist Commissioning.
Non NHS Clinical Income - There is a adverse variance of £80k in month.
Patient Patients is £74k below budget & Injury Cost Recovery Scheme is
£6k below budget.
Other Income – There is a favourable variance of £179k in month. This
is due to a favourable variance on Education & Training of £23k. Other
Operating Income is £70k favourable in month and relates to Radiology,
Pathology, & Symphony income. Donated Asset Income is favourable by
£92k in month due to the receipt of the ultrasound scanner.
N.B. Main components of Other Income include Research &
Development, Education & Training funding and Donated Asset Income.
Other significant income streams include services provided to external
organisations for pharmacy & facilities contracts.
37
Summary of Clinical Activity Performance
Patient Type
Elective inpatients
Elective day case patients (Same day)
Emergency inpatients
Outpatient Attendances
Outpatient Procedures
A and E Attendances
Maternity
Direct Access
Other
TOTAL
Annual Plan
3,399
17,689
16,965
145,503
14,350
47,098
5,004
29,229
819,045
1,098,282
Year to Year to
date
date
%
plan
actuals Variance variance
2,288
2,037
(251) -11%
11,909
10,744
(1,165) -10%
11,341
11,168
(174)
-2%
97,956
97,602
(354)
0%
9,661
11,366
1,705
18%
31,484
30,857
(627)
-2%
3,345
3,186
(160)
-5%
19,539
19,276
(264)
-1%
547,526 566,850 19,324
4%
735,051 753,085 18,034 2.45%
• Underperformance in General Surgery is the main reason for both the Elective admissions and Elective
same-day activity.
• Our planned activity is not adjusted for seasonality, therefore the emergency work is likely to be overperforming in the winter months. This may address the year-to-date under-performance in these
areas.
• We have improved our data capture for procedures carried out in outpatient settings, particularly in
Trauma and Orthopaedics. This is seen in the Outpatient Procedure over-performance.
• The ‘Other’ category includes the Pathology activity, which includes a high volume of low-cost items.
38
Clinical Activity Performance against Plan by
Activity Type and Commissioner
The biggest Activity % variances are on the Specialist Commissioning baselines: however, these are relatively small in ‘real’ terms and have a
negligible financial value compared to the underperforming activity on the Somerset CCG baselines.
These graphs exclude ‘non PbR’ and ‘Other’ elements such as High Cost Drugs, Critical Care and SCBU. These are shown on the following slide.
Maternity underperformance is at least partly due to inconsistent capturing of data in the first half of the year, this has since improved.
‘Other’ commissioners include Local Authority, Out-of-Area work and Public Health and Military work (both commissioned by NHS England)
39
Non Tariff Performance against Plan by
Activity Type and Commissioner
Best Practice Tariffs – We are under-performing for both
our Stroke and Fragility of Hip Best Practice Tariffs.
Critical Care– Our under-performance on Somerset’s
planned activity is offset by over-performance in specialist
commissioning.
High Cost / Chemo Drugs– The SWSCG over-performance
is funded through a pass-through arrangement with NHS
England.
40
Activity Comparison, Year on Year
This graph shows the difference between this year to date activity
with the same period in 12-13. The bars are in % terms, with the
numbers of additional or lesser activity described on the chart.
Outpatients– The biggest over-performance is in outpatient
procedures, although it is fair to note that this is largely a data issue
as well as YDH performing more work in this setting.
The remaining under /over-performances are relatively consistent
with the overall contract performance.
Note: Maternity is now recorded on a different tariff currency
(being pathway -rather than activity- based) and so to allow for likefor-like comparison maternity work has been excluded from this
graph.
41
Substantive &Total Pay (£’000)
Pay in month £6,151k; YTD £48,826k (£339k favourable variance to budget)
Nursing – Total expenditure in month is £2,198k, resulting in a favourable variance of £12k. This is due to vacancies, approved timing & CIP variances.
The business units that are underspent are Somerset Academy, Theatres, Surgery & Critical Care, partially offset by overspends in Medicine and ED.
Medical Staffing – Total expenditure in month is £1,955k, resulting in a favourable variance of £65k. Of this £30k is in relation to Clinical Excellence
Awards underspend. The remainder is due to risk budget slippage and CIP achievement in ED
A&C & Estates – Total expenditure in month is £1,087k, resulting in an adverse variance of £26k. This is primarily due to delays in implementation of
pathway support project.
Other CIP – This is the CIP target for total employment costs and should be measured against the savings in other categories.
42
Pay Non Substantive (£’000)
Non substantive Pay in month £487k; YTD £3,503k (£534k greater YTD than 12/13)
In Month
Bank
Agency
Locum
Medical and Dental
Nursing and Midwifery
Other
Total
82
82
82
50
132
76
101
95
272
YTD
Total
158
184
145
487
Locum
432
432
Bank
759
346
1,105
Agency
652
511
804
1,966
Total
1,084
1,269
1,150
3,503
43
Drugs (£’000)
Drugs spend in month £890k; YTD £6,837k (£302k adverse variance to budget)
Drugs are reporting an overspend of £302k year to date. This is offset by increased income of £312k; £65k from the cancer drug
fund, £274k from Specialist Commissioning less £27k from other NHS Trusts. The net impact is a £10k favourable variance. In
addition Somerset and Dorset CCGs’ high cost drugs are overspent by £48k but this tends to fluctuate month to month.
Note: Any total under or over performance relating to drugs commissioned by NHS England will be paid through on a ‘pass through’
basis.
44
Non Pay (£’000)
Non Pay (excl drugs) spend in month £2,108k; YTD £16,880k (£180k favourable variance to budget)
In month:
–
Consumable M&SE – Favourable £7k.
–
High Cost M&SE – Breakeven.
-
Other Non Pay – Adverse £67k. Estates and Facilities are adverse in month by £34k due to void residences charges, underachievement of CIP,
increased parts costs for the maintenance contract and increased water consumption. Legal fees are £31k overspent in month due
to higher usage than planned.
45
Overhead costs include Facilities, Energy, Maintenance, Management, HR, Finance etc.
46
Use of Capital (£’000)
Total Capital spend in month is £397k, YTD spend is £1,717k
Site Capex
The cumulative favourable variance relates
mainly to Women’s Hospital and Fire Alarms
capital expenditure now scheduled later than
originally planned.
Medical Equipment
The £357k year to date favourable variance on
Medical Equipment largely represents a change
in the phasing of orders. The Medical Equipment
budget is forecast to underspend by £73k at year
end, plans in place to carry forward the purchase
of a Laparoscopic Ultrasound to 2014/15.
Car Park Phase 1 (Including Demolition)
The costs against this line include the cost of the
site master plan and associated works. The
favourable variance relates to the delayed start.
Donated Schemes
The adverse month 8 variance is due to the Aplio
Ultrasound scanner being delivered in month
rather than the planned date of September.
Other
The cumulative adverse variance includes the
dementia project of £43k which has central
funding and the Frail and Older Person Project of
£57k which is a new project to support the
ambulatory care model.
Capital Expenditure
Operational Capital
Site Capex
Medical Equipment
Radiology Equipment
Other
Major Developments
Energy Project
Car Park Phase 1
IT - E.H.R
Other
Donated schemes
Total Annual Budget
In Month
Year to Date
Actual
Variance
Actual
Variance
154
42
1
0
(58)
23
(1)
5
556
365
119
236
287
357
11
60
0
22
28
58
92
397
0
137
13
(58)
(92)
(31)
0
110
79
101
151
1,717
0
236
39
(101)
(8)
880
47
Cash (£’000)
Cash inflow in month is £726k, YTD Cash outflow is £2,530k
There is a cash inflow in month of £726k primarily due to a
an increase in invoiced income. This is a favourable
variance of £512k in month compared to plan.
The closing cash balance is £7.3m which is £166k
favourable against the plan.
The main variances in month are:
Trade Receivables:
NHS Debtors are higher than plan due to the delayed
payments on the NHS England invoices.
Trade Payables:
Creditors and Accruals are above plan in month
predominantly due to the late invoicing for the Pathology
contract , as well as an increase in general trade creditors
due to the timing of the payment run.
Stock is higher than planned by £19k, all of which can be
attributed to Pharmacy stocks.
Forecast.
The Cash flow forecast as at 31st March 2014 includes a
capital spend forecast of £6.4m for the year. The Trust is
currently expecting some additional winter pressure
funding , however as this has not yet been confirmed, it is
not reflected in this forecast.
Cashflow
In Month Variance Year to Date Variance
Trade Receivables
(147)
(2,195)
Trade Payables
536
971
Provisions
(12)
124
Capital
16
919
PDC
0
(145)
Stock
(19)
(146)
Other
138
638
Cash inflow/(outflow) Variance
512
166
48
Statement of Financial Position (£’000)
October 13
November 13
Mvt In Mth
Non Current Assets
50,914
51,021
107
Current Assets
Stock
NHS Trade Debtors
Non NHS Trade Debtors
Accrued Income
Prepaid Contracts
Non Current Assets Held for Sale
Cash in Hand and at Bank
Total Current assets
1,923
1,693
882
3,336
808
0
6,616
15,258
1,944
1,768
788
2,832
1,164
0
7,342
15,838
21
75
(94)
(504)
356
0
726
580
Current Liabilities
Trade Creditors
Other Creditors
PDC Dividend Creditor
Capital Creditor
Accruals
Borrowings <1yr
Deferred Income
Current Liabilities
(935)
(2,970)
(130)
(225)
(3,995)
(128)
(623)
(9,006)
(1,152)
(2,831)
(261)
(252)
(4,285)
(128)
(648)
(9,557)
(217)
139
(131)
(27)
(290)
0
(25)
(551)
6,252
6,281
29
Total Assets less Current Liabilities
Trade and other Payables >1yr
Loans > 1yr
Provisions >1yr
Net Assets employed
57,166
0
0
(1,143)
56,023
57,302
0
0
(1,130)
56,172
136
0
0
13
149
Financed by:
I&E Reserve Current year
Public Dividend Capital
I&E Reserve Previous year
Revaluation Reserve
Donation Reserve
Total Financed
652
41,030
6,238
8,103
0
56,023
801
41,030
6,238
8,103
0
56,172
149
0
0
0
0
149
Net Current Assets
Current Assets
Stock has increased by £21k in month.
This relates to Pharmacy stock.
Accrued Income has decreased by £504k.
This is due to Transitional Funding being
invoiced, and business rates being
reclassified.
Prepayments have increased by £334k this
is largely in relation to business rates being
prepaid for the next three months.
Current Liabilities
Creditors and accruals have increased by
£551k in month. This relates to the timing
of the payment run £232k and the
monthly pathology contract invoice being
received late and therefore accrued
£262k.
49
Trust Level Key Ratios
EBITDA margin 5.3% YTD, 4.9% in month
There are no material variations in month for Pay and Non Pay compared to last year.
Return on pay has slightly decreased compared to the previous month.
Return on non pay remained the same compared to the previous month.
EBITDA margin is 0.2% higher than achieved YTD in 12/13
Notes: Ratios are calculated under the current contract income value and not PbR
50
Service Line Reporting Summary (£’000)
Year to Date (as of Month 8)
Elective Care
Urgent Care
Revenue
Corporate
Total
33,884
32,789
1,271
67,943
Direct Costs
Indirect Costs
(15,510)
(11,655)
(21,451)
(6,088)
0
0
(36,961)
(17,743)
Gross Contribution
Central Costs
6,718
(6,510)
5,250
(5,928)
1,271
0
13,239
(12,438)
209
(678)
1,271
801
Net Contribution
The Corporate income figure of £1,271k includes other income streams such as car parking and Injury Cost Recovery Scheme
income.
The £12.4m of central costs are overheads, and include departments such as Facilities, Management services, HR, Finance, and also
depreciation costs.
51
Service line reporting – Elective Care contribution
Elective Care Strategic Business Unit Contribution
Actual
Budget
£000's
%
£000's
%
Month 8
694
17%
1,438
30%
YTD
6,718
20%
7,904
22%
Full Year Budget
11,566
22%
• Average full year budget margin for Elective Care is 22%
• ICU activity has over-performed in month, therefore catching up
with its expected contribution.
52
Service line reporting – Urgent Care contribution
Urgent Care Strategic Business Unit Contribution
Actual
Budget
£000's
%
£000's
Month 8
567
14%
194
YTD
5,250
16%
5,529
Full Year Budget
9,825
%
5%
17%
19%
• Average full year budget margin for Urgent Care is 19%
• The full year contribution of 19% is higher than the YTD plan of 17%
due to CIP savings a due to be made in the latter part of the year.
53
REPORT TO:
Board of Directors
PRESENTED BY:
Trust Risk Manager
TITLE:
Risk and Assurance Report Qtr 3 - 2013-14
DATE:
22 January 2014
____________________________________________________________________
PAPER
Yes
PRESENTATION
No
PAPER & PRESENTATION No
What is this item about?
The risk report aims to provide the Board of Directors with the key operational risks and
activity from Qtr 3 relevant to risks scoring Significant or Higher (12+) on the risk matrix.
Why is this item necessary?
The risk report provides the necessary information for the Board of Directors that is a
fundamental part of the Governance arrangements required by Monitor and the Care
Quality Commission.
What is the Clinical Governance Delivery Committee asked to do?
The Board of Directors is asked to NOTE the report and corporate risk register
1. How does this paper improve patient care?
This report and attachments highlight the key operational risks facing the Trust to
achieve its Strategic Objectives of Patient Safety and Quality
2. How does this paper advance the Annual Plan?
The report is an essential part of the work towards the Annual Report and the Annual
Governance Statement
3. How does this advance our strategic objectives?
The report identifies key areas of operational risks that are fundamentally part of the
Trust’s governance arrangements
4. Is further information available?
Risk registers and Risk Management Policy is on YCloud
Are there implications for the Trust?
•
•
•
Legally? No
Financially? Yes. Some of the issues discussed reflect the current position against
Trust performance
Regarding Workforce? No
Is this paper clear for release under Freedom of Information?
YES
1.
RISK AND ASSURANCE REPORT
1.1
This report presents to the Board of Directors the activity around the risks
scoring Significant or High risk (12+) on the risk registers over Qtr 3. The
Corporate risk register is attached with 13 risks identified under the business
unit areas.
2.
2.1
SIGNIFICANT MOVEMENT IN RISK ON THE RISK REGISTERS
Elective Care
Obs and Gynae risk OGV002 – Obstetric theatre assessed as unfit for purpose has
been reviewed with a work program in place to address issues. The risk has reduced
under 12+ and has been removed from the corporate risk register.
Strategic risk ST002 – Underperformance in Elective Care has been reduced in risk
score under 12+ with actions in place. The risk remains significant but has been
removed from the corporate risk register.
Strategic risk ST003 – risk around managing the delivery of Best Practice Tariff for
Fractured Neck of Femur has been reduced in risk score under 12+ as the contract is
being met. The risk remains as significant but has been removed from the corporate
risk register.
Strategic risk ST009 – Movement of wards due to the refurbishment of 6A has being
reviewed and reduced in risk score under 12+ due to the opening up of 6A with bed
reconfiguration taking place. Removed from the corporate risk register
Orthopaedics risk OTH009 – Inadequate levels of medical cover on the Orthopaedic
ward to support the long term condition of frail elderly patients has been reduced in risk
score under 12+ but remains significant. Actions in place through the Business Unit.
Removed from the corporate risk register.
2.2
Urgent Care and Long Term Conditions
Medicine and Paediatrics risk M018 –Medium term sickness within the respiratory
consultant body has been reduced in residual risk with a full time locum starting in Jan
14. This risk remains on corporate risk register.
Radiology risk RA002 – Carestream (Radiology System) images not available for staff
to review has reduced in risk with the on-going actions being taken through the project.
Removed from the corporate risk register
Radiology risk RA005 – Under resourcing of Radiology staff with lack of experienced
radiographers and technicians has reduced in risk under 12+. There is an action plan in
place, lower levels of incidents and complaints experienced. Removed from the
corporate risk register
Risk OP002 - New contract for patient transport leading to delays in the discharge of
patients and problems with patient flow. This risk has been reviewed and has been
reduced in risk score under 12+ but remains a significant risk. Staff at YDH are getting
used to a new service being delivered however there are differences cross county
which the respective CCG is reviewing.
2.3
Trustwide Clinical Risks
Risk TW008 – Failure to maintain a reduction in Cdiff rates has reduced in risk from
12+. In December there was an agreement through the CCG that the trust is reporting 2
attributable (avoidable) cases and 5 unavoidable cases to date. Removed from the
corporate risk register
2.4
Workforce and Human Resources
Risk HR010 – risk around planning for future workforce demand has reduced in score
from 16 (High Risk) after review through HR. This risk remains significant with annual
workforce plans in place. Removed from the corporate risk register
Risk HR001 – risk around relationships with unions has been reduced in risk score
under 12+. Improved relationships have been experienced over the last 12 months with
greater consultation happening. Removed from the corporate risk register
2.5
Estates and Facilities
Risk EFM002 - The condition of the Obstetric theatre is being reviewed in Qtr 4 with
actions being identified for improvement to meet quality standards. Risk remains on the
risk register.
Risk EFM031 – Identifies the risk around compliance with NHS Protect standards. This
risk should reduce in Qtr 4 with the action plan in place led by the Local Security
Management Specialist (LSMS), reviewed by the Security Committee. Risk remains on
the risk register.
Risk EFM032 added - New risks are emerging from the period of poor weather
experienced in December with the ingress of water through the South elevation of the
main building structure.
3.
RECOMMENDATION
The Board of Directors is asked to NOTE the report and corporate risk register

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