PowerPoint Presentation › wp-content › uploads › ...2020/07/02 · Integrated Performance...

Integrated Performance Report

June 2020

1

Agenda item:

Date: June2020

Title:

Interim Integrated Performance Report – incorporating COVID 19 related performance

Prepared by:

Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director / Deputy Chief Executive Darryn Allcorn, Chief Nurse Angela Hibbard, Director of Finance, Performance and Facilities

Presented by:

Responsible Executive:

Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director / Deputy Chief Executive Darryn Allcorn, Chief Nurse Angela Hibbard, Director of Finance, Performance and Facilities

Summary:

To advise the Board of the Trust’s performance against key performance standards and targets; and progress on the implementation of the Trust Strategy and key supporting projects.

Actions required:

In the absence of a public Board of Directors’ meeting, this paper is circulated for information only

Status (*): Decision Approval Discussion Information

X

History:

This is a standing agenda item at each meeting of the Board of Directors.

Link to strategy/ Assurance framework:

This paper details the Trust’s performance in respect of key performance standards and targets. Achievement of these performance standards and targets is a key objective within the Trust’s Strategy.

Monitoring Information Please specify CQC standard numbers and tick other boxes as appropriate

Care Quality Commission Standards Outcomes NHS Improvement / England Finance Service Development Strategy Performance Management Local Delivery Plan Business Planning Assurance Framework Complaints Equality, diversity, human rights implications assessed Other (please specify)


June 2020

Integrated Performance Report – May 2020 Position

Contents

Section Page

Executive Summary 3

COVID-19 Related - Activity & Flow 5 - 6

COVID-19 Related – Operational Performance 7

COVID-19 Related – Safety & Quality 8 - 10

COVID-19 Related – Our People 11 - 12

COVID-19 Related – Finance 13

Activity & Flow 15 – 16 & 23

Operational Performance 17 - 22

Quality & Safety 24 - 28

Our People, including Communications & Engagement 29 – 30

Finance 31 – 44

2

3

Executive Summary


June 2020

Quality and safety: • Low numbers of COVID-19 patients during May

• PPE supplies are adequate for the demands

• No Serious Incidents as a result of COVID-19

COVID-19 related Non COVID-19 related

Operational performance: • COVID activity was in line with the trajectories produced for good compliance

with national guidelines – self-isolating, travel restrictions etc.

• The Trust was able to reduce the number of areas managing COVID patients

and cohort all positive patients, including ICU into a single area.

Our people: • COVID staff absence & self-isolation numbers have remained steady. Good

availability of staff and family testing has enabled people to return to work more

quickly.

• Strong H&WB support for staff and line managers remains a key focus. Staff

lounge/decompression area continues in Fern centre and has been superbly

supported by Project Wingman volunteers.

• As we move through new phases in the national response to COVID 19 guidance

and support has been produced to facilitate the safe return of staff to on site

working where working from home cannot be maintained.

Finance: Still delays in national sign off process for COVID capital. March approved now

waiting for April tobe reviewed by national team.

Some small items have been ordered at risk against BAU capital programme due to

lead times on deliver and need to support life savings/sight saving activity restarting

All revenue costs recovered through national ‘true-up’ scheme to achieve break even

Financial regime changing from month 5 and COVID response allocations will be

passed through to STPs rather than at Trust level.

Quality and safety: • The Trust HSMR has reduced from 118 to 112.55

• Detailed reviews of pressure ulcer data continues

• Healthcare Associated Infection rates all remain below the agreed targets set

• In comparison to March 2020 there has been an 8% increase in substantive

registered nurses

Operational performance:

• Operational performance was affected by COVID during May 2020.

COVID had a positive impact in reducing the numbers attending ED and

on the number of outpatient referrals received, however, capacity was

significantly reduced with a resulting negative impact on some

constitutional standards.

Our people: • Although turnover has increased slightly it remains at an historic low

• The gap between funded positions and staff in post continues to narrow, resulting in

an overall vacancy rate of 5.2% (161.1 FTE)

• Non-COVID employee relations activity is beginning to return to BAU levels and we

are continuing to review how we undertake this in a safe way and move to a “just and

learning culture” approach.

Finance: Month 2 overall break even position under national ‘true-up’ scheme with £1.6m of true

up income being received year to date

Adverse impact on variable income due to COVID impact on activity - sexual health

contract with Local Authority (not part of national block income)

Overspend on substantive pay being validated. Includes COVID costs on over time and

offset against reduced agency but needs further examination.

Capital programme being reprioritised to ensure coverage of COVID at risk items and to

ensure some flexibility if COVID estates reconfiguration capital not received.

4 Integrated Performance Report

June 2020

Part 1 COVID 19 related

Inpatient beds

May saw a continued reduction in the number of COVID positive

inpatients. There were less than 5 inpatients at any time, towards the end

of May this reduced to 2 patients.

Bed Occupancy

During May general and acute (G&A) bed occupancy started to increase

from that seen in April. G&A bed occupancy was 63.2%, on average.

The percentage of G&A beds occupied by COVID-19 patients in May

reduced to 1.2% from 6% in April, in line with the decreasing number of

COVID positive inpatients.

Trajectory

The Trust is working with Exeter University, NHS Improvement/England

(NHSI/E) and Devon STP to produce COVID-19 related demand

projections.

The Trusts surge capacity plan can accommodate the projected bed

requirement, this will be kept under review as events unfold with the

projections being updated as more data becomes available.

Actual COVID-19 activity has largely been in line with the NHSI projection

for good compliance (with government guidelines).

COVID-19 Inpatient Activity – Overview of inpatient activity in relation to caring for patients with COVID-19


June 2020 Executive Lead: Pete Adey & Jill Canning

14

0

5

10

15

20

25

30

35

40

Inp

atie

nt

be

ds

occ

up

ied

Number of confirmed COVID 19 patients occupying inpatient beds

Actual NHSI Projection (Good compliance)

Exeter Uni Devon Projection NHSI Projection (Poor compliance)

0

50

100

150

200

250

01

/04

/20

20

08

/04

/20

20

15

/04

/20

20

22

/04

/20

20

29

/04

/20

20

06

/05

/20

20

13

/05

/20

20

20

/05

/20

20

27

/05

/20

20

Be

ds

occ

up

ied

COVID / Non-COVID Bed occupancy

Occupied by Covid 19 patients Occupied by Non Covid 19 patients Unoccupied

COVID patients in Critical care beds

The number of COVID-19 patients in critical care beds has been fairly

static throughout the month at 2.

Critical care surge capacity plans

The Trust has a detailed critical care surge capacity plan, which is

summarised in the left hand table.

The Trust cohorted all COVID positive patients in Tarka Ward during May,

with part of the ward being designated as COVID positive ICU. This

enabled the Trust to consolidate staffing resources into a single COVID

positive area and return the main ICU to caring for non-COVID patients.

Trajectory

The Exeter University projections remain relatively static and low which is

in line with actual activity.

Critical Care – Overview of critical care activity in relation to caring for patients with COVID-19



2

3

0

1

2

3

4

5

6

01

/04

/20

20

08

/04

/20

20

15

/04

/20

20

22

/04

/20

20

29

/04

/20

20

06

/05

/20

20

13

/05

/20

20

20

/05

/20

20

27

/05

/20

20

HD

U/I

TU b

ed

s o

ccu

pe

d

Number of confirmed COVID 19 patients occupying HDU/ITU beds

Actual Exeter Uni Devon projection

0

5

10

15

20

25

01

/04

/20

20

08

/04

/20

20

15

/04

/20

20

22

/04

/20

20

29

/04

/20

20

06

/05

/20

20

13

/05

/20

20

20

/05

/20

20

27

/05

/20

20

Critical care surge capacity plans vs current use

1. ICU & HDU 2. Recovery room 3. Anaesthetic room 4. Theatre Room Critical care beds in use

Executive Lead: Pete Adey & Jill Canning

Swab testing capacity

The NDHT microbiology department has a testing capacity of 88 tests per

day and manage all inpatient testing. Fast track testing is available at NDHT

with a 45 minute turnaround as required. Additional test capacity at RD&E is

utilised as required.

The Testing SOP was approved at the end of April, this covers testing for

staff, key workers and patients including those in the community. This will be

updated as further national guidance is published.

The Trust has operated swab testing at a number of community sites and

provided a home testing service to elective inpatients who are shielding or

unable to attend a central location. Capacity within these services has

exceeded demand for swabbing.

Patient swab testing

Patient testing continued into May, during this time the Trust implemented

further testing after an inpatient stay of 7 days.

Staff swab testing

Staff testing has been available throughout April and May.

There was an increase in the volume of staff tested – on 23/24 April - as a

staff member, who was COVID positive with no visible symptoms, had been

working on an inpatient ward. Outside of this contact testing the volume of

staff tested has been at a steady level in April and reduced further in May.

Staff serology (antibody) testing

On the 25th May the Trust received a letter requiring it to commence a

serology (antibody) testing programme as soon as laboratory capacity was

available. The Trust developed an implementation plan to commence

serology testing during the first week of June.

COVID-19 Testing – Outline of COVID-19 patient testing activity and outcomes


June 2020

0

5

10

15

20

25

01

/04

/20

20

08

/04

/20

20

15

/04

/20

20

22

/04

/20

20

29

/04

/20

20

06

/05

/20

20

13

/05

/20

20

20

/05

/20

20

27

/05

/20

20

NDHT daily patients tested vs positive

NDHT Patients tested NDHT Number of +ve inpatients (COVID Confirmed)

0

5

10

15

20

25

30

35

40

45

50

01

/04

/20

20

08

/04

/20

20

15

/04

/20

20

22

/04

/20

20

29

/04

/20

20

06

/05

/20

20

13

/05

/20

20

20

/05

/20

20

27

/05

/20

20

NDHT daily staff tested

NDHT Staff tested NDHT Staff tested positive

Executive Lead: Darryn Allcorn

Quality and safety


June 2020

Patient deaths

The number of deaths reported has reduced in line with the number of inpatients

being treated for COVID in the Trust.

Patients recovered and discharged

This chart has reduced in line with the number of inpatients being treated for

COVID in the Trust.

Fit testing

The chart below shows the current running total of Fit testing across the Trust

there is a high testing rate compliance with our high risk areas where staff will

be exposed to aerosol generating procedures. As PPE stocks of masks are

now stable FIT testing is only being undertaken as required, as we have

adequate staff in priority and key areas tested.

Incidents and concerns raised

Although overall the number of incidents raised has reduced significantly, this

correlates with the reduced bed occupancy and the overall number of incidents

reported per a 1000 bed days, remains constant, the Safety huddle reviews

themes of COVID related incidents and there has been no increase in reported

harm. There have been no COVID related incidents that have met SI criteria.

0

1

2

3

4

01

/04

/20

20

05

/04

/20

20

09

/04

/20

20

13

/04

/20

20

17

/04

/20

20

21

/04

/20

20

25

/04

/20

20

29

/04

/20

20

03

/05

/20

20

07

/05

/20

20

11

/05

/20

20

15

/05

/20

20

19

/05

/20

20

23

/05

/20

20

27

/05

/20

20

31

/05

/20

20

Daily COVID 19 Patient deaths (past 24 hours)

Patient Deaths

0

1

2

3

4

5

6

7

8

Patients recovered and discharged (daily)

Patients recovered and discharged (daily)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

01

/04

/20

20

08

/04

/20

20

15

/04

/20

20

22

/04

/20

20

29

/04

/20

20

06

/05

/20

20

13

/05

/20

20

20

/05

/20

20

27

/05

/20

20

Fit Testing

Fit Testing % of Staff Fit Testing % of Priority Staff


Indirect impact of Covid 19


June 2020

NDDH patient deaths

This chart demonstrates that total hospital deaths are lower than average for

the past three years despite the number of covid deaths

Northern and Eastern population deaths

The chart shows an increased in the number of patient deaths in Devon from

20th March.

Regional death growth rates

The chart shows an increased in the number of patient deaths in the south

west region from 27th March. The green line demonstrates the increase in

deaths not attributed to covid.

Admission/attendance reductions

Dept/Specialty % change from this year to last year

A&E -28%

MIU -97%

Cancer 2ww referrals -79%

Stroke admissions -54%

Cardiology admissions -44%

Paediatric admissions 13%

-15-10

-505

1015202530

NDDH Death Tracker, 7-Day Running Totals

Average last 3 yrs 2020 Total

Excess (2020 vs baseline) 2020 COVID

-400

-200

0

200

400

600

800

1,000

03-Jan-20 03-Feb-20 03-Mar-20 03-Apr-20 03-May-20 03-Jun-20

No

. of

regi

ste

red

de

ath

s in

we

ek

Week

ONS Registered total Regional deaths growth 2019-2020

Movement TotalRegionalDeaths

Variancedue toCovid

Movement due tononCovidfactors

0

10

20

30

40

50

60

70

80

90

03/01/2020 03/02/2020 03/03/2020 03/04/2020 03/05/2020 03/06/2020

ONS All-Cause Population Deaths (Early View by Registration)

Northern Eastern

Northern (Non-COVID) Eastern (non-COVID)

PPE

The Trust monitors a Dashboard to ensure adequate supplies of all PPE. The number of days of stock is however subject to change dependent upon fluctuations in

usage. This can be impact by the number of patients and or the number of staff working, along with any changes in PPE guidance. Daily usage rates are monitored

and adjusted as required through the daily PPE/Logistics sub-group.

The Trust has adequate stock of all PPE items and assurance of supply. There are nuances to the stock holding at individual product level. For example, there may be

14 days of surgical gloves at aggregate level but a lower level of stock for one particular size. This is monitored on a daily basis with mitigating actions being

implemented.

The Trust is working closely in collaboration with other local acute Trusts to make best use of the PPE supplies available locally and will support the system in mutual

aid.

The Trust issued a Safety Alert recalls 4 batches of masks across the Trust due to concerns raised nationally that these had not be certified as latex free. There have

been no incidents reported within the Trust. The impact of this recall on stocks will be explored the week commencing 22 June.

Oxygen / ventilators

The Trust has adequate ventilators and supplies to support our surge plan if required, Surge plus will require support from the national stocks. Oxygen supply is a

issue that requires close monitoring there is daily oxygen usage tool managed monitored and a Standard operating procedure is in place to monitor and manage

oxygen supplies to all wards and clinical areas.

PPE, Oxygen, Ventilators – Exception reporting on issues and proposed mitigations


June 2020 Executive Lead: Darryn Allcorn

0

20

40

60

80

100

120

140

160

23

/03

/20

20

25

/03

/20

20

27

/03

/20

20

29

/03

/20

20

31

/03

/20

20

02

/04

/20

20

04

/04

/20

20

06

/04

/20

20

08

/04

/20

20

10

/04

/20

20

12

/04

/20

20

14

/04

/20

20

16

/04

/20

20

18

/04

/20

20

20

/04

/20

20

22

/04

/20

20

24

/04

/20

20

26

/04

/20

20

28

/04

/20

20

30

/04

/20

20

02

/05

/20

20

04

/05

/20

20

06

/05

/20

20

08

/05

/20

20

10

/05

/20

20

12

/05

/20

20

14

/05

/20

20

16

/05

/20

20

18

/05

/20

20

20

/05

/20

20

22

/05

/20

20

24

/05

/20

20

26

/05

/20

20

28

/05

/20

20

30

/05

/20

20

Day

s Su

pp

ly

PPE Days Supply

FFP3 Surgical Mask Gloves (standard) Gowns / Suits Glasses

Executive Lead: Hannah Foster

Staff absence and self isolation

• Covid 19 related sickness also contains self isolating figures until

07/04/2020 when they were split out.

Staff absence and self isolation

• Numbers are relatively stable with only small fluctuations. Availability and

access to staff and family testing has been significantly increased and has

contributed to effective management.

• Absence hub still dealing with large volume of calls, both Covid & non-

Covid being supported

• People Inform cell continues to perform call-back welfare calls.

• Risk assessments for self-isolating and social distancing/shielding

continue to be performed by Medical staff.

Staff wellbeing

• H&WB support for staff and line managers now at a mature state. Staff

lounge/decompression area continues in Fern centre. Shortly to be

supported by Project Wingman volunteers.

• Regular communication of key messages and sources of support

available.

• We have continued to work with DPT colleagues to support psychological

welfare.

Staff Equality, Diversity & Inclusion

• NHSE and FOM Risk Reduction programme recommendations reviewed

to ensure that staff considered to be most at risk are fully supported.

Open letter sent to BAME staff by Chief Exec.

Workforce – Incorporate description of the slide here


June 2020

0

50

100

150

200

250

300

350

400

450

23

/03

/20

20

30

/03

/20

20

06

/04

/20

20

13

/04

/20

20

20

/04

/20

20

27

/04

/20

20

04

/05

/20

20

11

/05

/20

20

18

/05

/20

20

25

/05

/20

20

Staff sickness and self isolating

General Sickness Covid 19 related sickness Self Isolating (not able to work)

0

50

100

150

200

250

300

Nu

mb

er

of

staf

f

COVID 19 related sickness and self isolating (not able to work) by staff category

Clinical Services PRF Scientific tech Admin and clerical

Allied Health Professionals Estates and ancillary Healthcare scientists

Medical and dental Nursing and midwifery Students

0

50

100

150

200

250

23

/03

/20

20

30

/03

/20

20

06

/04

/20

20

13

/04

/20

20

20

/04

/20

20

27

/04

/20

20

04

/05

/20

20

11

/05

/20

20

18

/05

/20

20

25

/05

/20

20

Covid 19 related sickness

Covid 19 related sickness

Executive Lead: Hannah Foster

Workforce – Incorporate description of the slide here


June 2020

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NDDH South Molton

May 2020 - RN Nursing Fill Rate %

RNDay

RNNight

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NDDH South Molton

May 2020 - HCA Nursing Fill Rate %

HCADay

HCANight

Executive Lead: Angela Hibbard

COVID 19 related costs


June 2020

Revenue and Income

The Trust incurred £2,297k of revenue costs (£1,314k prior month) responding to

the Covid-19 pandemic.

In a change to reporting in 2020/21 lost income from private patients, overseas

visitors and car parking etc. are recoverable through a retrospective adjustment

against the baseline national top up rather than through direct claims against the

national Covid-19 funding.

Returns and supporting information has been provided through the monthly

reporting process to NHSEI and is reflected as additional income in the year to

date breakeven position above.

2020/21 Revenue costs include all committed non-pay costs and pay costs to the

31st May 2020 with ‘live capture’ of information throughout the current month.

2020/21 approvals continue to be updated monthly as advised by NHSEI.

NHSEI have approved in full the month 1 expenditure through the true-up

process.

Capital

£545k of capital has been incurred (£391k prior month) through Covid command

decisions in accordance with the Scheme of Delegation with a further £790k of

commitments recorded at 15 June 2020.

NHSEI have confirmed approval in full of £123k claimed in March 2020 and PDC

is being issued.

The Revenue, Income and Capital positions are being reported to the Director of

Finance with regular submissions being made to NHSEI.

Total costs Incurred to

31 May 2020

Confirmed

as approved

YTD

20/21

Committed

£000 £000 £000

Revenue costs 2,297 1,314

Capital costs 545 123 1,712

Total 2,842 1,712

Further analysis of revenue costs

incurred to May 2020

Revenue

costs

incurred to

31 May 2020

£000

Infection prevention and control training 2

Internal and external communication costs 5

Expanding NHS workforce -

medical/nursing/other workforce 96

Sick pay at full pay (all staff) 671

COVID-19 virus testing (NHS laboratories) 174

Remote management of patients 21

Direct Provision of Isolation Pod 5

Plans to release bed capacity 187

Increase ITU capacity (incl. Increase

hospital assisted respiratory support

capacity, particularly mechanical

68

Segregation of patient pathways 26

Existing workforce additional shifts 169

Decontamination 73

Backfil l for higher sickness absence 395

Remote working for non-patient activities 115

National procurement areas 162

Other actual 128

Total 2,297


June 2020

Part 2 Non COVID 19 related

Referrals: Referrals in May continued to be significantly lower than in previous months including April and over 75% lower than May 2019.

Outpatient attendances: New and follow up outpatient attendances increased slightly in May as clinical teams moved forward with non-face to face appointments.

Outpatient waiting list: The follow up outpatient waiting list reduced by 723 patients in May and the new outpatient waiting list by 168 as clinical teams introduced

non-face to face appointments and referrals continued to reduce..

Outpatient attendance by type: Both telephone and video appointments increased in May with in excess of 7700 telephone appointments and 300 video

consultations – considerable increases over the non-face to face activity in April. The Trust continues to promote the use of this provision within the recovery and

redesign plans and specialities continue to engage with the delivery method. The Trust is actively engaged in the restoration and long term redesign CCG Devon wide

meetings where this issue is being considered.

Elective activity- Referrals and Outpatients



0

2000

4000

6000

8000

10000

Fa

ce to F

ace

Te

lephone

Vid

eo

Fa

ce to F

ace

Te

lephone

Vid

eo

April May

Outpatient Attendances by Type and Media

New Follow Up

0

50

100

150

200

250

300

350

April May

Video data expanded

New Follow Up

0

2000

4000

6000

8000

10000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Referrals from All Sources

2018/19 2019/20 2020/21

0

2000

4000

6000

8000

10000

12000

14000

16000New and Follow Up Outpatient Attendances

New Attendances Follow up Attendances

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000New and Follow Up Outpatient Waiting List

New Outpatient Waiting List Follow Up Outpatient Waiting List

Elective activity : In May overall elective activity increased from the previous

month but remains significantly lower than the same period last year. Despite

activity increasing the incomplete waiting list increased in month, whilst above the

19/20 figure the list size remains lower than 18/19.

RTT performance : RTT performance further deteriorated in May 56.7% which is

below the target of 79%. The trajectory for incomplete pathways was met at

11438 against the trajectory of 12156.

Longer waiting patients, including approach to managing harm : The number

of patients waiting over 40 weeks increased further in May as a result of standing

down non-urgent elective surgery. Clinical teams continue to undertake risk

stratification of individual patients to ensure that cancer and time critical

procedures can continue to be offered to patients.

Elective activity- Inpatient and Daycase



0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000


Elective Inpatient and Daycase Activity

2019/20 Daycase 2019/20 Inpatient 2020/21 Daycase 2020/21 Inpatient

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Incomplete Waiting List (Inpatient and Daycase Combined)

18/19 Actual 19/20 Actual 20/21 Actual

0%

20%

40%

60%

80%

100%

RTT 18 Week Performance

18 Week Performance (%) Target

020040060080010001200

0

3000

6000

9000

12000

15000

Vo

lum

e o

f P

ati

en

ts W

ait

ing

> 4

0

Weeks

Vo

lum

e o

f In

co

mp

lete

Path

ways

Incomplete Pathways and Longer Waiting Patients

Volume of Incomplete Pathways

Incomplete Pathway Trajectory

Volume of Patients Waiting >40 Weeks


June 2020

17

Elective activity- Long Waiting Patients


COVID-19 has had a significant, detrimental, impact on the number of long

waiting patients.

There were a total of 131 patients waiting over 52 weeks in May as a direct

result of the reduction in elective activity.

The waiting list for patients waiting over 40 weeks rose to 977 in May. The

specialities with the greatest number of patients waiting over 40 weeks are

Elective Orthopaedics, Ophthalmology and Urology. The Trust has submitted an

application for the purchase of an additional Ophthalmic microscope which is

progressing through the national capital funding route. Plans for the other

specialities are currently in development.

The Trust is actively involved in the on-going STP discussions as to how best to

increase capacity within Elective Orthopaedics and Urology and ensuring equity

of access for all patients.

0

10

20

30

40

50

60

70

80

90

100

Dec

-18

Jan

-19

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

52+ Weeks Waited Trajectory vs. Actual

Actual Trajectory

Specialty Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20

> 4

0 w

eeks

T & O 58 71 68 65 68 76 51 53 74 74 83 127 215 315

General Surgery 10 4 4 6 7 2 3 6 2 1 5 5 16 23

Dermatology 1 1 4 3 4 2 3 9 16

Gynaecology 5 5 11 9 5 7 7 7 5 5 2 8 24 38

Neurology 16 7 4 6 7 5 4 2 2 4 7 16 22

Colorectal 3 3 3 2 1 2 2 1 2 8

Cardiology 17 11 8 12 8 8 10 9 10 11 12 15 24 32

Ophthalmology 2 5 10 25 37 55 35 45 49 39 38 88 228 381

Other 8 25 42 68

Upper GI 5 4 9 12

Urology 8 7 7 13 13 12 11 12 16 15 12 22 40 62

Grand Total 120 113 112 137 148 167 121 139 159 153 173 305 625 977

> 5

2 w

eeks

T & O 3 4 6 5 4 2 3 7 5 9 3 3 10 56

Neurology 1 1 2

Cardiology 1 6 9

Ophthalmology 1 11 34

Other 11 23

Urology 2 2 1 2 7

Grand Total 3 4 6 5 4 4 3 7 5 9 5 7 41 131


June 2020

18

Non-elective activity


Emergency activity :

The number of emergency admissions, whilst still considerably lower than in

previous financial years, increased during May 2020 by some 300 admissions

from April back to a similar level of activity to that seen in March.

The Trust met the target for surgery within 48 hours post fractured neck of

femur.

0

200

400

600

800

1000

1200

1400

1600

1800

2000


Emergency Inpatient Activity based on Date of Admission

2018/19

2019/20

2020/21

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

De

c-1

9

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Elective and Emergency Activity Combined based on date of admission - excludes Maternity

Emergency

Elective

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Ap

rM

ay Jun

Jul

Au

gSe

pO

ctN

ov

De

cJa

nFe

bM

arA

pr

May Jun

Jul

Au

gSe

pO

ctN

ov

De

cJa

nFe

bM

ar

2019/20 2020/21

Surgery within 36hrs - Fractured Neck of Femur

36hrs 48hrs Target


Overall emergency admissions increased from the previous month, this was particularly visible in emergency admissions when on a different speciality waiting list –

with the numbers exceeding those seen in the previous 3 months. There was a slight increase in the emergency admissions when on the same speciality waiting list,

however this has not yet reached previous levels.

Analysis of those emergency patients admitted whilst on a waiting list for a different speciality shows that the biggest cohort of patients are admitted under general

medicine which would infer that these patients have multiple health problems.

Further analysis shows that the speciality with the greatest number of patients being admitted as an emergency whilst on the same speciality waiting list is

gynaecology – in May this was 21 of the 36 patients. Further analysis is being undertaken by the gynaecology team. Historically general surgery has always had a

number of patients admitted as emergencies whilst on a general surgical waiting list however, the numbers have reduced considerably since January 2020.

Emergency Department – key metrics relating to activity & performance in urgent & emergency care services


June 2020

550 557 543

525

568

600

555 566

478

415

352

489

0

100

200

300

400

500

600

700

Emergency Admissions - Different Specialty to RTT WL Specialty

43

62 60

65 68

85

56

62

57

53

29

36

0

10

20

30

40

50

60

70

80

90

Emergency Admissions - Same Specialty to RTT WL Specialty


• There were a total of 3030 all type ED attendances during May an increase of

601 from that seen in April 2020, back to a level seen in February pre-

COVID.

• Type 3 activity ceased as a direct impact of MIU services at Bideford and

Ilfracombe closing in March to allow for staff redeployment to the main ED.

• The Trust achieved 93.0% 4 hour flow performance in May.

• Ambulance handovers in excess of 30 minutes continued to be below the

10% target in May.

• There were 0 reportable handovers in excess of 60 minutes.

The ED department continues to refine its processes, and layout, to support the

separation of COVID and non-COVID patients, funding has been requested from

the national capital allocation to provide additional space to enable long term

solutions to be reached.

The Trust is engaged in system wide meetings regarding the future configuration

of urgent and emergency care provision in the North Devon locality.

Emergency Department – key metrics relating to activity & performance in urgent & emergency care services


June 2020

0

1

2

3

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

12 H

ou

r Tro

lley B

reaches

(Vo

lum

e)

Att

en

dan

ces (

Vo

lum

e)

May - Trust Daily Attendance Profile

Type 1 Type 3 12hr Trolley Breaches

75%

80%

85%

90%

95%

100%

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

4 Hour Wait Performance

Trust Trust Trajectory Target

0

2

4

6

8

10

12

14

16

0

20

40

60

80

100

120

140

160

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

60 M

in+

Han

do

vers

(Vo

lum

e)

Am

bu

lan

ce H

an

do

vers

(V

olu

me)

Ambulance Handovers Delayed >30 mins

>30 Min Handover Target >60 Min Handover

Cancer 62 Day – Proportion of patients treated within 62 days following referral by a GP for suspected cancer



• In May 2020 2ww referrals continued to be significantly lower in comparison

to May 2019 at 48%.

• The Trust saw 95.22% of 2ww referrals in May within the 14 day target,

exceeding the national standard of 95%.

• May 62 day performance was below the trajectory of 86% at 79.7% with

validation on-going. Impacted by COVID, although where possible cancer

treatment was initiated.

Cancer - 14,31 & 62 Day Wait

Performance(%) and Number of Breaches Target

2018/19 2019/20 2020/21

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

14

Da

y

All Urgent (%) 93%

74.50% 68.40% 65.30% 68.60% 66.80% 72.40% 86.40% 89.90% 95.6% 94.17% 96.06% 93.76% 94.62% 94.60% 96.66% 95.37% 90.02% 87.90% 90.21% 93.30% 94.80% 95.60% 95.22%

All Urgent (N) 162 137 189 181 221 171 77 59 25 30 24 33 36 34 19 32 55 67 52 46 28 8 14

Symptomatic Breast (%) 93%

89.30% 94.10% 90% 93.10% 61.50% 59.30% 71.40% 93.10% 96.3% 88.90% 96.30% 82.05% 94.74% 94.44% 95.45% 94.21% 80% 50% 71.10% 93.50% 96.15% 75.00% 100.00

%

Symptomatic Breast (N) 3 2 1 2 10 11 4 2 1 4 1 7 2 1 1 2 7 7 11 2 1 2 0

31

Da

y

All Decision To Treat (%) 96%

98.30% 97.40% 95% 96.60% 96.60% 97.60% 93.30% 96.10% 97.3% 94.40% 95.60% 96.40% 96.80% 95.23% 94.48% 95.40% 98.90% 98% 98% 100% 100% 100.00% 100.00

%

All Decision To Treat (N) 2 2 4 3 4 2 7 3 2 6 4 3 4 5 7 5 1 1 1 0 0 0 0

Subsequent - Surgery (%) 94%

100% 100% 87.50% 100% 100% 75% 92.30% 100% 93.9% 84.60% 94.40% 90.90% 88.20% 88.66% 96.01% 88.88% 92.30% 100% 93.30% 100% 92.30% 100.00% 100.00

%

Subsequent – Surgery (N) 0 0 0 0 0 2 1 0 1 2 1 1 2 3 2 3 1 0 1 0 1 0 0

Subsequent - Anti-Cancer Drug %

98%

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Subsequent - Anti-Cancer Drug 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

62

Da

y

All Screening Service (%) 90%

100% 71% 50% 100% 80% 100% 100% N/A 100% 100% 60% N/A% 100% N/A N/A N/A 100% 100% 100% 80% 0% N/A N/A

All Screening Service (N) 0 1 1 0 0.5 0 0 N/A 0 0 1.5 N/A 0 N/A N/A N/A 0 0 0 0.5 0.5 N/A N/A

Consultant upgrade (%) 90%

92.20% 83.10% 84.20% 69.60% 87.70% 80.20% 83.30% 82% 88.4% 79.40% 68.30% 85.70% 94.11% 87.10% 74.15% 78.02% 73.20% 65.60% 89.50% 91% 87.30% 93.30% 81.60%

Consultant upgrade (N) 3 5.5 4.5 12 7 9 7 4.5 4 7.5 9.5 4 2.5 5 11.5 9 8.5 11.5 4.5 3 5.5 5.5 4.5

28

da

y 28 Ref to diagnosis (%)

N/A 75.10 63.20 64.30 66.50 70.40 71.80 66.40 75.1 72.00 70.20 70.00 77.00 71.00 77.00 74.00 78.00 75.00 75.00 73.00 82.00 74.00 65.00 74.00

28 day Ref to diagnosis (N) N/A N/A N/A N/A N/A N/A N/A N/A 157.00 168.00 157.00 126.00 172.00 117.00 130.00 142.00 132.00 86.00 163.00 88.00 135.00 78.00 71.00

60%

65%

70%

75%

80%

85%

90%

95%

100%

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

2019/20 2020/21

Urgent GP Referral Cancer 62 Day Wait - All Cancers

62 Day Wait - All Cancer Performance (%) Target Trust Trajectory

• Diagnostic performance has been significantly affected by COVID-19, as a

result of this only 42.4% of patients waited less than 6 weeks for a

diagnostic test in May, this was a slight improvement on the April position of

41.4%.

• Capacity within diagnostic areas is impacted by the need to maintain social

distancing (waiting & recovery areas) and the level of cleaning required

between patients. The Trust is working hard to make additional waiting &

recovery space available, including repurposing other areas and the use of

temporary facilities.

• In May the Trust had staffed mobile CT and MRI scanners on site to provide

additional capacity.

• Diagnostic services have continued to be provided for all 2ww and urgent

referrals since the outbreak of COVID in line with guidance.

• Patient COVID testing is in place for those procedures that require it to be

undertaken pre-procedure.

• Additional capacity within CT, ECHO and endoscopy provided via the

independent sector, weekend working and visiting teams was stood down

from April due to COVID, the teams are working with the providers to make

this available as soon as travel & accommodation restrictions are lifted.

• Audiology ceased assessment due to COVID, activity is planned to

recommence towards the end of June.

• The Trust is actively involved in STP work streams that are considering the

opportunities available to increase diagnostic and screening capacity.

Diagnostics - volumes of patients waiting longer than 6 weeks for one of fifteen key diagnostics tests



0%

20%

40%

60%

80%

100%

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

6 Week Wait Referral to Key Diagnostic Test

6 Week Diagnostic Performance (%) Target

Performance inc. Non-Obstetric Ultrasound % Trust Trajectory

0

500

1000

1500

2000

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

6 Week Diagnostic Breaches by Specialty Group

Endoscopy Imaging Physiological Measurement

Area Diagnostics by Specialty Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20

Imaging

Magnetic Resonance Imaging 91.7% 74.1% 76.3% 83.9% 90.1% 96.2% 98.6% 99.8% 98.9% 96.7% 99.7% 97.0% 78.4% 68.6%

Computed Tomography 64.3% 66.1% 79.3% 80.8% 79.1% 69.3% 65.7% 71.1% 64.1% 71.7% 90.8% 73.4% 50.6% 52.4%

Non-obstetric ultrasound 97.0% 99.1% 97.1% 98.9% 99.6% 99.5% 99.0% 99.6% 100.0% 99.7% 99.9% 89.1% 27.8% 38.0%

Barium Enema - -

DEXA Scan 96.3% 96.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.1% 35.1% 42.4%

Physiological Measurement

Audiology - Audiology Assessments 90.6% 93.7% 97.7% 100.0% 99.6% 99.5% 99.2% 100.0% 99.5% 100.0% 99.6% 98.2% 27.9% 1.0%

Cardiology - echocardiography 81.5% 53.5% 73.1% 75.1% 79.8% 92.0% 83.1% 75.4% 86.9% 90.9% 95.3% 94.8% 67.5% 49.2%

Cardiology - electrophysiology - -

Neurophysiology - peripheral

neurophysiology 94.6% 89.2% 91.5% 90.5% 100.0% 93.1% 97.2% 92.6% 95.5% 97.5% 98.4% 96.7% 24.7% 3.4%

Respiratory physiology - sleep studies 83.3% 75.0% 67.9% 93.8% 96.7% 90.0% 83.3% 100.0% 90.9% 95.5% 94.4% 97.5% 26.1% 88.9%

Urodynamics - pressures & flows 53.5% 56.9% 35.3% 48.1% 33.3% 31.8% 44.3% 45.8% 41.9% 39.7% 48.1% 48.1% 18.3% 83.3%

Endoscopy

Colonoscopy 80.2% 87.6% 88.2% 97.5% 100.0% 98.4% 97.4% 100.0% 96.8% 98.1% 98.9% 98.9% 55.3% 39.7%

Flexi sigmoidoscopy 75.4% 81.2% 81.4% 95.8% 97.3% 95.6% 97.0% 98.2% 100.0% 95.3% 100.0% 100.0% 57.4% 40.4%

Cystoscopy 74.6% 72.1% 70.5% 75.0% 80.9% 74.7% 90.2% 94.6% 94.5% 100.0% 94.3% 94.3% 49.1% 54.9%

Gastroscopy 83.1% 83.8% 79.0% 95.7% 97.1% 97.3% 97.8% 100.0% 100.0% 100.0% 99.2% 98.3% 47.9% 38.4%

Total 84.1% 80.7% 83.7% 88.2% 90.4% 91.2% 90.4% 89.8% 90.3% 92.4% 96.7% 91.6% 41.4% 42.4%

The Trust continues to perform well against the DTOC standards – with a

further reduction in the number of acute delayed transfers of care during May

at 0.7%. There were no delayed days within the Community in April or May.

The Health & Social Care Team continue to be engaged in the daily forum

meetings, actively managing discharges and supporting patients to return to

their main residence, access care packages and placements.

Delayed Transfer of Care



0

25

50

75

100

125

150

175

200

225

250

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

2019/20 2020/21

DTOC Total Delayed Days Acute

NHS Social Services Both

0

25

50

75

100

125

150

175

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

2019/20 2020/21

DTOC Total Delayed Days Community

NHS Social Services Both

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

2019/20 2020/21

Percentage DTOC to Available Beds

% DTOC to Available Beds Target


Mortality Rates – SHMI & HSMR – Rate of mortality adjusted for case mix and patient demographics


June 2020

The Mortality Review Group met virtually on the 16 June 2020 to review the

current position.

The HSMR is no longer affected by un-coded spells and the coding team are

now reviewing real-time discharges/death. The HSMR has fallen from 118 a few

months ago to 112.55 (100 is average/good).

As previously escalated to the Safety and Risk Committee there remains

concerns regarding Palliative Care Coding. Lower palliative care input to our

patients compared to other trusts appears to be a significant factor in our higher

HSMR (If we removed this cohort our HSMR would drop to 98.19). There are a

number of reasons which contribute to this all of which are continuing to be

explored in more detail.

60708090

100110120130140

Ap

r

Jun

Au

g

Oct

De

c

Feb

Ap

r

Jun

Au

g

Oct

De

c

Feb

Ap

r

Jun

Au

g

Oct

De

c

Feb

2017/18 2018/19 2019/20

Hospital-level Mortality Indicator (SHMI) - Rolling 12 months

Position Lower Limit Upper Limit

60708090

100110120130140

Ap

r

Jun

Au

g

Oct

De

c

Feb

Ap

r

Jun

Au

g

Oct

De

c

Feb

Ap

r

Jun

Au

g

Oct

De

c

Feb

2017/18 2018/19 2019/20

Hospital-level Mortality Indicator (SHMI) Rolling 3 months

SHMI Lower Limit Upper Limit

60708090

100110120130140

Ap

r-1

7

Jun

-17

Au

g-1

7

Oct

-17

De

c-1

7

Feb

-18

Ap

r-1

8

Jun

-18

Au

g-1

8

Oct

-18

De

c-1

8

Feb

-19

Ap

r-1

9

Jun

-19

Au

g-1

9

Oct

-19

De

c-1

9

Feb

-20

2017/18 2018/19 2019/20

Mortality Indicator (SHMI) Rolling 3 months - Weekday Admissions

SHMI Lower Limit Upper Limit

6080

100120140160180200220240

Ap

r

Jun

Au

g

Oct

De

c

Feb

Ap

r

Jun

Au

g

Oct

De

c

Feb

Ap

r

Jun

Au

g

Oct

De

c

Feb

2017/18 2018/19 2019/20

Mortality Indicator (SHMI) Rolling 3 months - Weekend Admissions

SHMI Upper Limit

60

80

100

120

140

160

Ap

r-1

7

Jun

-17

Au

g-1

7

Oct

-17

De

c-1

7

Feb

-18

Ap

r-1

8

Jun

-18

Au

g-1

8

Oct

-18

De

c-1

8

Feb

-19

Ap

r-1

9

Jun

-19

Au

g-1

9

Oct

-19

De

c-1

9

Feb

-20

2017/18 2018/19 2019/20

HSMR (12 Month Rolling)

HSMR Lower Limit Upper Limit

ACUTE – • The number of category one pressure ulcers reported in May 2020 has remained static and continues to remain lower than the category 2 ulcers reported. • There has been an increase in the number of category 2 pressure ulcers reported in May 2020. • Three medical device related pressure ulcers category 2 have been reported. • There have been a cluster of three pressure damage incidents DTI on a Medical Ward, these have being reviewed and Tissue Viability are undertaking some rapid insitu support

for the team to ensure rapid learning. • There have been two category 3 pressure ulcers reported, neither of which have required a concise investigation as initial reviews by the tissue viability teams indicated

appropriate care plans and care were in place. • Reported zero category 4 pressure ulcers. • COMMUNITY – • There were no category four pressure ulcers reported. • The number of category three pressure ulcers reported during May decreased Of the 7 reported none have been escalated for concise investigation. Four of the patients who

developed category 3 have passed away. All had appropriate care plans in place and/or concordance was a significant factor and so have not been escalated for investigation. • There was one category 4 pressure ulcer reported. This developed in a patient who was also developing suspected deep tissue injuries who was on an end of life pathway. All

care was appropriate. A review of community pressure ulcers has taken place to explore the perceived increase, the Trust wide pressure Ulcer Action Plan was reviewed alongside this. The action plan remains appropriate however it was agreed to add a ‘Back to Basics’ approach to refocus the holistic approach to management following minor changes to ways of working due to COVID-19.

Pressure Ulcers – Rate of pressure ulceration experienced whilst in Trust care


June 2020 25 Executive Lead: Darryn Allcorn

0

2

4

6

8

10

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Rate of Grade 1- 4 pressure Sores /1000 bed days

Position Target

0

0.2

0.4

0.6

0.8

1

1.2

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Rate of Grade 3- 4 pressure Sores /1000 bed days

Position Target

0

0.10.2

0.3

0.4

0.5

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Community Nursing and Population: Newly Identified Pressure Ulcers - Grade 1 - 4

Position

0

0.020.04

0.06

0.08

0.1

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Community Nursing and population: Newly Identified Pressure Ulcers - Grade 3 - 4

Position

There has been one case of Clostridium Difficile identified in the Trust in May 2020, this under investigation in order identify any contributory factors and learning to be

shared.

There have been no MRSA or MSSA cases identified during May.

E-coli bacteraemia cases have remained within normal variation for the past 12 months, with only once case noted for May, which is under review.

Healthcare Associated Infection –Volume of patients with Trust apportioned laboratory confirmed infection



0

1

2

3

4

5

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

2019/20 2020/21

Clostridium Difficile Cases

Hospital Onset Community Onset Target

0

1

2

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

2019/20 2020/21

MRSA Cases

Actual Target

0

1

2

3

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

2019/20 2020/21

MSSA Cases

Actual Target

0

1

2

3

4

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Mar

2019/20 2020/21

E-coli Bacteraemias Cases

Actual Target

Patients being admitted directly to the Stroke Unit within four hours; performance against this standard remains well below the target of 90%.

Stroke Performance – Quality of care metrics for patients admitted following a stroke



30%

40%

50%

60%

70%

80%

90%

100%

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Proportion of patients admitted following a Stroke spending 90% or more of their stay on the Stroke unit

Validated Position Target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Discharge Destination to Home (%)

Discharge Destination to Home % National Position

0

20

40

60

80

100

120

140

160

180

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

2019/20 2020/21

Average Thrombolysis Times (minutes) - Awaiting NDHT Data

Trust Door to Needle Trust Call to Needle

National Door to Needle National Call to Needle

The reports demonstrates a positive trajectory with improvements being seen in substantive appointments/reduction in vacancies and reduction in Temporary/agency

staff over the last 3 months.

In comparison to March 2020 there has been an 8% increase in substantive registered nurses (associated with overseas recruitment) and a 6% increase in

substantive HCA’s. Over all there has been a 10% reduction in temporary staffing in comparison to March 2020.

Whilst COVID has been a contributory factor towards the reduction in temporary staffing, the Trust has also held a number of successful recruitment events with the

appointment of a further 22 registered nurses due to start in the Trust between July and September 2020 and therefore anticipate to see a continual positive trajectory.

Temporary vs Substantive Staff



• Absence – Sickness levels remain above those seen last year. The ‘Anxiety/stress/depression/other psychiatric illnesses’ category continues to top the

absence reasons charts, accounting for more than a quarter (27.2%) of all sickness absence recorded. The ongoing impact of Covid is also evident, with

‘Chest & Respiratory Problems’ increasing to take up 21.4% of the latest month’s total.

• Turnover – Substantive staff turnover shows a very slight increase to 10.2% but remains historically low.

• Establishment – The gap between funded positions and staff in post continues to narrow, resulting in an overall vacancy rate of 5.2% (161.1 FTE).

• Staff Group Vacancies – The Registered Nursing & Midwifery staff group with 76.6 FTE posts vacant accounts for almost half of the Trust total vacancies, but

only 27% of the funded posts. Allied Health Professionals show some improvement but also remains a disproportionately high group, with 17.3% of the Trust

vacancies (27.9 FTE), compared to 8.0% of the overall posts funded.

Other workforce indicators


June 2020 Executive Lead: Hannah Foster

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Ap

r

Jun

Au

g

Oct

Dec

Fe

b

Ap

r

Jun

Au

g

Oct

Dec

Fe

b2019/20 2020/21

Sickness Absence by Top 6 Reasons (inc. Other)

Chest and RespiratoryProblems

Unknown causes / Notspecified

Cold, Cough, Flu -Influenza

Other musculoskeletalproblems

Other known causes -not elsewhere classified

Anxiety/stress/depression/other psychiatricillnesses

9.5%

10.0%

10.5%

11.0%

11.5%

12.0%

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

2019/20 2020/21

12 Monthly Turnover

Position Target

-10%

-8%

-6%

-4%

-2%

0%

2%

4%

6%

8%

10%

Au

g-1

8

Se

p-1

8

Oct-

18

Nov-1

8

Dec-1

8

Jan

-19

Fe

b-1

9

Ma

r-19

Ap

r-19

Ma

y-1

9

Jun

-19

Jul-1

9

Au

g-1

9

Se

p-1

9

Oct-

19

Nov-1

9

Dec-1

9

Jan

-20

Fe

b-2

0

Ma

r-20

Ap

r-20

Ma

y-2

0

PLAN

Established FTE vs. Plan

Variance to Plan Target High Target low

0%

20%

40%

60%

80%

100%

Ap

rM

ay Jun

Jul

Au

gSe

pO

ct

No

vD

ec

Jan

Feb

Mar

Ap

rM

ay Jun

Jul

Au

gSe

pO

ct

No

vD

ec

Jan

Feb

Mar

2019/20 2020/21

Vacancies by staff group

Add Prof Scientific and Technic Additional Clinical ServicesAdministrative and Clerical Allied Health ProfessionalsEstates and Ancillary Healthcare ScientistsMedical and Dental Nursing and Midwifery RegisteredStudents

The communications team increased their support to Gold Command to seven days a week and OOH. The role of communications is to support the mission-critical

cascade of business continuity and preparedness information to all staff , patients and stakeholders who are supporting the NHS response to Covid-19. Additionally,

dealing with a significant increase in media enquiries. A summary of the actions, outcomes achievements and risks against each of the agreed objectives follows in

the table below:

Comms and engagement


February 2020 Executive Lead: Hannah Foster

Objectives Actions, outcomes, achievements & risks

Strategic communications and engagement advice • Strategic communications and engagement advice to Executive Directors and Gold Command • Advice and guidance to Incident Cells to handle sensitive staff communications • Liaison with NHS England ref national messaging

Timely decisions/updates are communicated within

24 hours where possible

• Daily comms all staff Covid update has been achieved every day since 13 March 2020 • Twice / weekly line manager update has been achieved every week since 20 March 2020

Responsive communications supports the

organisation by gathering feedback to enable us to respond quickly to the issues most important to staff and patients

• We anticipated fatigue in daily messaging and introduced diverse comms tactics to maintain interest. Included more audio-visual, use of facebook closed group, more graphic design, webcasts

• Responded to feedback from staff for more positive news, more light-hearted and social communications and more community based stories.

• Highlighted themes of common public enquiries so that processes could be established, reducing enquiries to Trust teams and responding in a timely manner to members of the public

Proactive communications supports Gold

Command by proactively identifying areas of interest to staff to anticipate/avoid high call volumes to the incident cells.

1. PPE information campaign: Messaging of protect staff, protect patients, ensure preserve stocks 2. Social distancing campaign: posters, banners and incorporating feedback from staff and public 3. Launch of staff survey to assess effectiveness of communications (end of April) 4. Testing: introduction of more testing capacity 5. Social media and comments in press statements to give the public clear guidance on how they can

support us 6. New ways of working: supporting remote working and new patient care approaches, recruitment and

remote inductions / video-interviews etc

Operational communications supports

operational cascades far more than usual to reflect manager’s reduced capacity to communicate effectively

• 100% completion of all Gold command actions • Consistent, reliable and daily output achieved across whole team • Established a regular feed of health and wellbeing comms and tips on how to manage remote working

staff

Consistency and quality tone of voice and

style of communications to be consistent high quality comms across all channels

• Quality control check before leaves comms team for sign off • Consistency of language to align to overarching messaging from execs • Supported an in-month messaging change from preparedness to management • Increasing volume of shared and joint communications across RD&E and NDHT

Team resilience • Established an equitable team rota to ensure all key meetings are covered 7 days per week. • Business continuity plan enacted: remote working, social distancing at work and resilient rota. • Supported the development of a core set of communications skills to support Gold: swift and accurate

communications, consideration of audience, alignment to messaging, responsiveness

Executive Lead: Angela Hibbard

Run Rate, PSF & Use of Resources


June 2020

Run Rate, PSF & Use of Resources continued


Junel 2020 Executive Lead: Angela Hibbard

Activity & Income


June 2020 Executive Lead: Angela Hibbard

Expenditure & CIP



Expenditure & CIP Continued



Divisional Positions



Cash & Capital Expenditure



2020/21 Plan & Key Assumptions



Financial Tables



NHSEI

COVID

Plan

Actual Variance

NHSEI

COVID

Plan

Actual Variance

31/05/2020 31/05/2020 31/05/2020 30/04/2020 30/04/2020 30/04/2020

YTD YTD YTD YTD YTD YTD

£'000 £'000 £'000 £'000 £'000 £'000

Income

Patient Income - NHS 30,936 30,899 (37) 15,468 15,446 (22)

Patient Income - Local Authority 3,568 2,352 (1,216) 1,784 1,137 (647)

Other Patient Income 208 15 (193) 104 (9) (113)

Operating Income 5,480 6,109 629 2,739 3,244 505

Income 40,192 39,375 (817) 20,095 19,818 (277)

Pay

Substantive (21,706) (22,477) (771) (10,853) (11,066) (213)

Bank (1,562) (1,652) (90) (781) (824) (43)

Agency (1,088) (600) 488 (544) (277) 267

Pay (24,356) (24,729) (373) (12,178) (12,167) 11

Non Pay

Drugs (2,898) (2,692) 206 (1,449) (1,306) 143

Clinical Supplies (3,118) (2,136) 982 (1,559) (1,182) 377

Purchase of Social Care (1,852) (2,031) (179) (926) (964) (38)

Other Non-Pay (7,648) (7,452) 196 (3,824) (4,026) (202)

Non-Pay (15,516) (14,311) 1,205 (7,758) (7,478) 280

Total Non-Operating Costs (Pre IFRS) (320) (379) (59) (159) (187) (28)

OPERATING SURPLUS / (DEFICIT) 0 (44) (44) 0 (14) (14)

Add back SOCI impact of impairments included above 0 44 44 0 14 14

Remove SOCI impact of capital donations/grants 0 0 0 0 0 0

Adjusted Financial Performance surplus / (deficit) 0 0 0 0 0 0

Less PSF, FRF, MRET, National Top Up Funding (2,838) (4,427) (1,589) (1,418) (2,365) (947)

ADJUSTED SURPLUS/(DEFICIT) FOR THE PERIOD/YEAR

AFTER PSF, FRF and MRET(2,838) (4,427) (1,589) (1,418) (2,365) (947)

Detailed Income & Expenditure

Financial Tables



NHSEI

COVID

Plan

Actual Variance

NHSEI

COVID

Plan

Actual Variance

31/05/2020 31/05/2020 31/05/2020 30/04/2020 30/04/2020 30/04/2020

YTD YTD YTD YTD YTD YTD

£'000 £'000 £'000 £'000 £'000 £'000

Registered Nursing - Substantive 5,716 5,934 (218) 2,858 2,933 (75)

Registered Nursing - Bank 410 532 (122) 205 248 (43)

Nursing Agency 380 9 371 190 12 178

Registered Nursing 6,506 6,475 31 3,253 3,193 60

Scientif ic, Ther & tech (Qual) - Substantive 3,110 3,236 (126) 1,555 1,601 (46)

Scientif ic Thera, Tech - Bank 86 78 8 43 33 10

Scientif ic, Thera, Tech - Agency 60 135 (75) 30 43 (13)

Scientific, Ther and Tech 3,256 3,449 (193) 1,628 1,677 (49)

Qualif ied Ambulance Staff - Substantive 70 81 (11) 35 43 (8)

Qualif ied Ambulance - Agency 0 0 0 0 0 0

Qualified Ambulance Staff 70 81 (11) 35 43 (8)

Support to Clinical - Substantive 3,832 4,067 (235) 1,916 2,004 (88)

Support to Clinical Bank 396 417 (21) 198 200 (2)

Support to Clinical Agency 50 50 0 25 24 1

Support to Clinical 4,278 4,534 (256) 2,139 2,228 (89)

Medical & Dental - Substantive 5,562 5,650 (88) 2,781 2,754 27

Medical & Dental bank 536 550 (14) 268 299 (31)

Medical & Dental Agency 528 326 202 264 156 108

Medical & Dental 6,626 6,526 100 3,313 3,209 104

NHS Infrastructure Support - Substantive 3,294 3,407 (113) 1,647 1,679 (32)

NHS Infrastructure - Bank 134 75 59 67 43 24

NHS Infrastucture - Agency 70 81 (11) 35 42 (7)

NHS Infrastructure Support 3,498 3,563 (65) 1,749 1,764 (15)

Others Substantive 122 101 21 61 52 9

Other Substantive 122 101 21 61 52 9

Total Staff Costs 24,356 24,729 (373) 12,178 12,166 12

Staff Group Costs

Financial Tables



Audited PY Actual Variance

Statement of Financial Position 31/03/2020 31/05/2020 31/05/2020

Year ending YTD YTD

£'000 £'000 £'000

Non-current assets

Intangible assets 7,911 7,815 (96)

Property, plant and equipment: other 74,396 74,122 (274)

Right of use assets - leased assets for lessee (excluding PFI/LIFT) 0 0 0

Trade and other receivables: due from non-NHS/DHSC Group bodies 849 882 33

Total non-current assets 83,156 82,819 (337)

Current assets

Inventories 3,169 3,132 (37)

Trade and other receivables: due from NHS and DHSC group bodies 8,442 3,631 (4,811)

Trade and other receivables: due from non-NHS/DHSC Group bodies 7,330 5,476 (1,854)

Cash and cash equivalents: GBS/NLF 3,940 23,307 19,367 Income in advance - COVID-19 f inancial framew ork plus net improvement in w orking capital

Cash and cash equivalents: commercial / in hand / other 9 9 0

Total current assets 22,890 35,555 12,665

Current liabilities

Trade and other payables: capital (1,296) (688) 608

Trade and other payables: non-capital (20,324) (16,575) 3,749

Borrow ings (20,690) (20,335) 355 In-year deficit funding not required - COVID-19 f inancial framew ork

Provisions (20) (20) 0

Other liabilities: deferred income (1,102) (18,187) (17,085) Income in advance - COVID-19 f inancial framew ork

Total current liabilities (43,432) (55,805) (12,373)

Total assets less current liabilities 62,614 62,569 (45)

Non-current liabilities

Borrow ings 0 0 0

Provisions (64) (64) 0

Total non-current liabilities (64) (64) 0

Total net assets employed 62,550 62,505 (45)

Financed by

Public dividend capital 58,467 58,466 (1)

Revaluation reserve 9,635 9,631 (4)

Income and expenditure reserve (5,552) (5,592) (40)

Total taxpayers' and others' equity 62,550 62,505 (45)

Audited PY Actual Variance

Borrowings 31/03/2020 31/05/2020 31/05/2020

Year ending YTD YTD

£'000 £'000 £'000

Current

Borrow ings: DHSC w orking capital / revenue support loans 20,003 20,003 0

Accrued interest on DHSC loans 80 80 0

Borrow ings: other (non-DHSC) 607 252 (355) Salix loan repayment

Total current borrowings 20,690 20,335 (355)

Financial Tables



Actual

Statement of Cash Flows 31/05/2020

YTD

£'000

Operating surplus/(deficit) 335

Non-cash income and expense:

Depreciation and amortisation 864

Impairments and reversals 0

Income recognised in respect of capital donations (cash and non-cash) (1)

(Increase)/decrease in trade and other receivables 6,665

(Increase)/decrease in inventories 37

Increase/(decrease) in trade and other payables (4,357)

Increase/(decrease) in other liabilities 17,085

Increase/(decrease) in provisions 0

Net cash generated from / (used in) operations 20,628

Cash flows from investing activities

Interest received 3

Purchase of intangible assets (98)

Purchase of property, plant and equipment and investment property (811)

Proceeds from sales of property, plant and equipment and investment property 0

Receipt of cash donations to purchase capital assets 0

Net cash generated from/(used in) investing activities (906)

Cash flows from financing activities

Public dividend capital received 0

Loans from Department of Health and Social Care- received 0

Loans from Department of Health and Social Care - repaid 0

Other loans repaid (355)

Interest paid 0

PDC dividend (paid)/refunded 0

Net cash generated from/(used in) financing activities (355)

Increase/(decrease) in cash and cash equivalents 19,367

Cash and cash equivalents at start of period 3,949

Cash and cash equivalents at end of period 23,316

Actual

DHSC loan facilities cash flows 31/05/2020

YTD

£'000

Revenue support loans

Interim revenue support loans - Received 0

Interim revenue support loans - Repaid 0

Net Interim revenue support loans Received/(Repaid) 0

Version Control (Non COVID Section)



Data Item Missing Data Owner Slide owner

Use of Resources Financial Risk Rating table not

currently reported by NHSEI

NHSEI Angela Hibbard

PowerPoint Presentation › wp-content › uploads › ...2020/07/02 · Integrated Performance...

Documents

Transcript of PowerPoint Presentation › wp-content › uploads › ...2020/07/02 · Integrated Performance...