BOARD OF DIRECTORS OPERATIONAL … 5a(ii... · attendances per day, ... A&E 4 hour waiting time ... A&E Patients treated by ENP Pathway increased compared to September however …

BOARD OF DIRECTORS OPERATIONAL PERFORMANCE REPORT

Month 7 - October 2014

Presented By:

20th November 2014

Board of Directors

Rob Elek

Director of Strategy and Business Development

Produced By:

Stephen Chinn

Senior Performance AnalystAction for Board: For information

For consideration

For decision

Exception Report Page 1

Compliance Performance Summary Page 2

Access - Referral to Treatment Page 3 - 4

Access - A&E Page 5 - 6

Access - Cancer Waiting Times Page 7

Access - Other Page 8

Efficiency Page 9 -10

Effectiveness Page 11

Safety Page 11

Page 12

Page 13Patient Experience

Ward Staffing Levels

CONTENTS

Board of Directors Performance Report - October 2014

Page 1

Exception Report - October 2014

18 Week RTT Performance: Month 7 has seen further improvement in our admitted performance towards the 90% target, with 87.2% of patients seen within 18 weeks (M6 84.6%). Non-admitted performance achieved the 95% target for the first time since May 2014, reaching 95.5% (M6 94.1%). We maintain our incomplete pathway achievement with performance continuing to improve at 94.9% for October (M6 93.0%) compared to the 92% target.

The above performance is provisional pending final validation and submission on 19th November The return to compliance for the remaining indicator remains a high, and we continue to progress actions with the goal of achieving the revised national requirement of compliance by the end of December. As at 11th November, our projected admitted performance for December is very close to the target with the key risks to achieving the target now centring on:

Early booking of new, non-breaching, patients for surgery to ensure that the denominator remains high as we bring in the remainder of the backlog of breaching patients.

The impact of the breaching patients already booked into the system over the coming months as these patients would predominately not be willing to move the date of their surgery.

Maximising the available capacity in the early part of the month to mitigate the effect of the holiday season.

The conversion rate to surgery for outpatients already in the system.

Control of annual leave over December. A further update will be provided at the Board. A&E October 2014 saw the highest number of A&E attendances on record at 8,386, surpassing the previous record of 8,373 set in June 2014 (although based on attendances per day, the figure for June 2014 remains higher as October has an extra day). The highest attendance day in October was Monday 20th with 351, which was just below the record set in May of 360. Despite the additional activity our performance remains strong.


COMPLIANCE PERFORMANCE SUMMARY

ThresholdCurrent

Month

YTD

14/15

Monthly

TrendSource Threshold

Current

Month

YTD

14/15

Monthly

TrendSource

≥ 90% 87.2% 83.0% CQC,

Monitor,TDA0 0 3 CQC, TDA

≥ 95% 95.5% 94.7% CQC,

Monitor,TDAn/a 2.9% 3.6% Monitor

≥ 92% 94.9% 92.5% CQC,

Monitor,TDAn/a 2.9% 3.8%

CQC, TDA,

Outcomes

Framework

≥ 95% 99.4% 99.2% CQC,

Monitor,TDAn/a 57.6% 53.2% Local

≥ 80% 80.9% 81.7% Local 0 0 0 CQC, Monitor,TDA

≥ 5% 0.9% 1.1% CQC, TDA 0 0 0 CQC, Monitor,TDA

≥ 30% 25.1% 24.7% Local ≥ 95% 98.1% 98.4% CQC, TDA

≥ 5% 0.4% 0.7% CQC, TDA 0 0 0 CQC, TDA

≥ 93% 100% 90.9% CQC,

Monitor,TDAn/a 101% 99% CQC, TDA

≥ 96% n/a 100% CQC,

Monitor,TDA20% 62.1% 69.4%

CQC,TDA, Outcomes

Framework

≥ 94% n/a 100% CQC,

Monitor,TDA30% 27.0% 27.3%

CQC,TDA, Outcomes

Framework

≥ 85% n/a n/a CQC,

Monitor,TDACompliant? n/a n/a CQC, Monitor, TDA

≥ 99% 100% 100% CQC, TDA

n/a 84.7% 85.9% Local Compliant?

≥ 96% 85.7% 85.3% Local 4?

Key Reference:

On or above target

Stable on/above target

Page 2On target and drop in figures

Percentage 18 weeks Non Admitted

Pathways

Emergency Readmissions within 28

days of discharge

Percentage 18 weeks Incomplete

Pathways

Emergency Readmissions within 30

days of discharge

A&E 4 hour waiting timeGP referrals first outpatient using

Choose & Book

Below target and rise in figures

Below target and stable

Below target and fall in figures

Governance

VTE Screening - all admissions

Number of Mixed Sex Accommodation

Breaches

Friends & Family Test - Inpatients

(Response Rate)

Learning Disability Compliance

Indicator Indicator

Percentage 18 weeks Admitted

Pathways

Cancelled Operations - 28 Days Re-

Book

Performance 2014/15Performance 2014/15

Monitor Risk Rating

Number of C.Diff cases

No target or N/A

Friends & Family Test - A&E (Response

Rate)


Within tolerance and drop in figures

Monitor Finance RatingChoose & Book Appointment Availability

A&E 3 hour waiting times Number of MRSA cases

Within tolerance and rise in figures

Within tolerance and stable

Outpatient appointment - Over 6 week

waiters

Cancer 31 day wait - subsequent

treatment - surgery

Cancer 62 day from urgent GP referral

to first definitive treatment

Diagnostics 6 week waiting time

A&E Unplanned re-attendance

Cancer 2 week wait - first appointment

urgent GP referral

Cancer 31 day wait - diagnosis to first

appointment

A&E ENP Pathways

A&E Left Before Treatment


Performance

2013/14

YTD

Current

Month

Previous

Month Qtr1 Qtr2 Qtr3 Qtr4 YTD Qtr3 Qtr4

90% N/A 87.2% 84.6% 80.9% 83.4% 87.2% 83.0% Monitor, CQC,

TDA

95% N/A 95.5% 94.1% 95.0% 94.1% 95.5% 94.7% Monitor, CQC,

TDA

92% N/A 94.9% 93.0% 92.2% 92.1% 94.9% 92.5% Monitor, CQC,

TDA

Performance

2013/14

YTD

Current

Month

Previous


90% N/A 97.3% 90.6% 86.3% 85.3% 97.3% 87.4% Monitor, CQC,

TDA

95% N/A 99.4% 94.8% 97.3% 95.1% 99.4% 96.6% Monitor, CQC,

TDA

92% N/A 95.3% 89.3% 94.3% 85.9% 95.3% 91.0% Monitor, CQC,

TDA

Performance

2013/14

YTD

Current

Month

Previous


90% 91.30% 86.7% 84.2% 80.8% 83.3% 86.7% 82.7% Monitor, CQC,

TDA

95% 95.60% 94.9% 94.0% 94.6% 93.9% 94.9% 94.4% Monitor, CQC,

TDA

92% 92.50% 94.9% 93.3% 92.0% 92.6% 94.9% 92.7% Monitor, CQC,

TDA

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7

538 433 471 512 431 420 350 281 191 215 230 166 147 76

331 268 335 393 311 393 310 23 -34 20 66 49 61 -33

Page 3

Patients Waiting >18 weeks

18 weeks Referral to Treatment - Admitted

Threshold

Moorfields (excluding Croydon)

Threshold

Monthly

Trend

Performance 2014/15

Performance 2014/15 Monthly

Trend

18 weeks Referral to Treatment -Non

Admitted

18 weeks Referral to Treatment -Incomplete

Indicator Threshold

Performance 2014/15


18 Weeks Referral to Treatment

Trust Total

Croydon

Indicator

Indicator



Admitted


Non Admitted Pathway

Admitted Pathway


Admitted


Compliance

Source

Compliance

Source

Monthly

Trend

Compliance

Source

Patients to be seen to achieve standard

Forecast

Forecast

Forecast


18 Weeks Referral to Treatment (Cont.)

Page 4

Trust Total

Moorfields at Croydon achieved all three RTT target in October while the remainder of Moorfields only achieved the Incomplete Pathway Performance, although Non-Admitted Pathway

Performance achieved 94.9% and Admitted Pathway Performance has seen an improvement compared to previous months.


Performance

2013/14

YTD

Current

Month

Previous


N/A 52,863 8,386 7,978 24,338 24,268 8,386 56,992

N/A N/A 8,055 7,811 23,766 23,755 8,055 55,576

95% 99.6% 99.4% 99.0% 99.3% 99.1% 99.4% 99.2% CQC, Monitor,

TDA

80% 82.2% 80.9% 79.4% 82.0% 81.7% 80.9% 81.7% Local

N/A 176 33 63 139 190 33 362

N/A 2 0 0 20 10 0 30

5% 0.9% 0.9% 0.9% 1.2% 1.0% 0.9% 1.1% CQC, Monitor,

TDA

60 mins 10 mins 24 mins 24 mins 23 mins 24 mins 24 mins 23 mins CQC, TDA



30% 21.6% 25.1% 23.5% 22.8% 26.5% 25.1% 24.7% Local

5% 1.4% 0.4% 0.3% 1.1% 0.3% 0.4% 0.7% CQC, TDA

Page 5

A&E Maximum waiting times - 4 hours

Threshold

Performance 2014/15

Total number of attendances

Total number of expected attendances

Accident & Emergency

Indicator

Total number of 4 hour breaches

Total number of 6 hour breaches

Left without being seen

Total time spent in A&E -Admitted 95th

Percentile

Total time spent in A&E - Non Admitted 95th

Percentile

A&E Unplanned Re-attendance

A&E ENP Pathway

Forecast Compliance

Source

Monthly

Trend

A&E Maximum waiting times - 3 hours

Time to Treatment in Department - median


Page 6

A&E 4 Hour Performance remains above the 95% target at 99.2%, with the number of 4 hour breaches halved compared to September 2014. Overall time in A&E also saw an increase compared

to previous months. However compared to the previous year the number of 4 and 6 hour breaches remains high compared to the same period during the previous year.

A&E Activity compared to the previous year remains high, with activity on working days around 300 per day (compared to 270-280 the previous year).

A&E Patients treated by ENP Pathway increased compared to September however remains below our local target of 30%

Accident & Emergency (Cont.)


Performance

2013/14

YTD

Current

Month

Previous


Cases 19 1 2 8 13 1 22

93% 100.0% 100% 100% 100% 84.6% 100% 90.9%

Cases 7 0 2 2 7 0 9

96% 100% n/a 100% 100% 100% n/a 100%

Cases 1 0 0 0 1 0 1

94% 100% n/a n/a n/a 100% n/a 100%

Cases 0 0 0 0 0 0 0

85% N/A n/a n/a n/a n/a n/a n/a

Performance

2013/14

YTD

Current

Month

Previous


99% 100% 100% 100% 100% 100% 100% 100% CQC, TDA

TBA 78.7% 84.7% 87.5% 84.5% 87.7% 84.7% 85.9% Local

TBA 57.4% 27.2% 34.2% 46.6% 37.6% 27.2% 40.9% Local

96% 94.6% 85.7% 86.9% 86.1% 84.4% 85.7% 85.3% Local

N/A 4.8% 12.6% 12.8% 13.4% 15.0% 12.6% 13.9% Local

N/A 0.5% 1.7% 0.3% 0.6% 0.6% 1.7% 0.7% Local

Page 7

Choose and Book Capacity Issue Rate

Monthly

Trend

Cancer 31 day waits - subsequent treatment

Choose and Book System Issue Rate

Indicator Threshold

Performance 2014/15

First Outpatient Appointment Waiting more

than 6 weeks

Patients Waiting more than 13 weeks for

Admission

Diagnostic waiting times - 6 weeks

Choose and Book appointment availability

Cancer 62 days from urgent GP referral to

first definitive treatment

There was one suspected cancer referral received in October which was seen within the two week target. The YTD for this measure remains below the 93% target due to 2 two week breaches

during in Quarter 2.

The quarter 2 'Cancer 2 Week Waits' percentage has been amended to 84.1% (11 out of 13 cases achieving the two week target). This was previously reported at 88% in error, which was an

average of the three months of the quarter.

Forecast

Access - Other

CQC, Monitor,

TDA

CQC, Monitor,

TDA

CQC, Monitor,

TDA

CQC, Monitor,

TDA

Compliance

Source

Cancer Waiting Times

Indicator

Cancer 2 week waits - first appointment

urgent GP referral

Threshold

Performance 2014/15 Monthly

Trend

Forecast

Compliance

Source

Cancer 31 day waits - diagnosis to first

appointment


Access - Other (Cont.)

Page 8

Choose and Book Performance continues to be below the 96% target however this month saw a slight increase in the number of Choose and Book slots available due to the Choose and Book

System being unavailable.

Diagnostic Waiting Times within 6 week remains at 100%

There has also been a decrease in patient waiting times for both first appointments and admissions. In both cases, this reduction is due to increased clinic and theatre capacity provided as part of

the RTT recovery programme, which has helped to remove long waiters (backlog patients). This has been further supported by patients being booked in a more efficient manner. While waits for

admission continues to improve, the waiting times for first outpatient appointments remains challenging.


Performance

2013/14

YTD

Current

MonthPrevious


N/A 21,540 2,995 3,203 8,787 8,931 2,995 20,713 Local

N/A 17,965 2,991 2,963 8,297 8,821 2,991 20,109 Local

N/A 52,089 8,540 8,121 22,017 22,559 8,540 53,116 Local

N/A 216,541 34,781 33,650 92,666 95,094 34,781 222,541 Local

TBA 8.5% 10.3% 10.2% 8.5% 9.5% 10.3% 9.2% Local

TBA 10.6% 11.7% 11.5% 11.0% 11.6% 11.7% 11.3% Local

TBA 12.3% 11.9% 12.0% 12.4% 12.4% 11.9% 12.3% Local

TBA 63.1% 57.3% 54.1% 55.6% 54.9% 57.3% 55.5% Local

TBA 76.1% 69.5% 69.7% 69.9% 70.5% 69.5% 70.1% Local

TBA 6.6% 6.6% 5.8% 6.1% 5.8% 6.6% 6.0% Local

TBA 38.8% 25.4% 27.2% 27.1% 26.4% 25.4% 26.5% Local

0 1 0 1 1 2 0 3 CQC, TDA

Page 9

Threshold

Outpatient Attendance - new

Outpatient Attendance - follow-up

Number of patients not treated within 28 days of

last cancellation due to non clinical reasons

Efficiency

Indicator

Outpatient DNA rates - first appointment

Theatre Sessions Starting Late

Clinic Journey Times New Appointment less than

2 hours

Clinic Journey Times Follow-up Appointment less

than 2 hours

Outpatient DNA rates - follow-up appointment

Theatre Cancellation Rate

Admission Demand - Decision to Admit (DTA)

Admission Activity

Outpatient cancellations

Compliance

SourcePerformance 2014/15 Monthly

TrendForecast


Key:

Page 10

Efficiency (Cont.)

:Monthly Trend :4 Month Average

The number of DTA and Admissions for October are very similar

indicating the Admitted waiting list is no longer increasing.

Outpatient Appointment (New and Follow Up) and Admissions

continue to remain high compared to the previous year.

There has been slight increase in the number of Theatre

cancellations compared to previous months, the increase due to

medical reasons and patient cancellations.

There were zero Non-Medical Cancellations which were

untreated within 28 days of the cancellation.


Effectiveness

Performance

2013/14

YTD

Current

MonthPrevious


N/A 3.90% 2.90% 5.80% 3.50% 4.00% 2.90% 3.60% Monitor

Cases 63 7 14 23 28 7 58 -

N/A 4.00% 2.90% 6.30% 3.60% 4.10% 2.90% 3.80% CQC, TDA

Cases 65 7 15 24 29 7 60 -

N/A 61% 57.6% 57.8% 51.8% 53.0% 57.60% 53.2% Local

Safety

Performance

2013/14

YTD

Current

MonthPrevious


0 0 0 0 0 0 0 0 CQC, TDA,

Monitor

0 0 0 0 0 0 0 0 CQC, Monitor,

TDA

95% 97.5% 98.1% 98.3% 98.5% 98.5% 98.1% 98.4% CQC, TDA

0 0 0 0 0 0 0 0 CQC, TDA

Page 11

VTE Screening

Mixed Sex Accommodation

Emergency Re-admission within 28 days of

discharge

Emergency Re-admission with 30 days for elective

and emergency cases

Proportion of GP referrals for first outpatient

appointments booked using Choose & Book

Monthly

Trend

Indicator Threshold

Compliance

Source

ForecastPerformance 2014/15

Compliance

Source

Threshold

Monthly

Trend

Number of C.Diff cases

Indicator

Performance 2014/15

Number of MRSA cases

Forecast

There continues to be no breaches for MRSA cases, C.Diff Case and Mixed Sex Accommodation, and VTE Screening performance remains well within the 95% target.


Page 12

The fill rate during July for the Cumberlege Wing was of 54% and based on a small denominator - a total of 3 WTE care staff. During this time a member of staff was absent

which resulted in the reduction of the fill rate. This was mitigated by cover being provided by a registered nurse, giving adequate cover in the skill mix. It is not uncommon

that whenever necessary, the absence of a care worker can be substituted with a registered nurse to ensure safe standards are maintained on the wards.


Ward/Department Name Planned Actual Planned Actual Planned Actual Planned Actual

CR - Observation Unit CR 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

CR - Observation Unit CR 727.5 729.0 267.5 262.0 440.0 430.0 180.0 180.0 100% 98% 98% 100% 100% 98% 98% 100%






SG - St George's Duke Elder Ward 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

SG - St George's Duke Elder Ward 1004.0 1055.8 105.0 133.0 310.0 310.0 310.0 310.0 105% 127% 100% 100% 94% 120% 100% 3%

SG - St George's Duke Elder Ward 1144.5 1167.0 0.0 0.0 310.0 310.0 290.0 290.0 102% 100% 100% 102% 100% 0%





CR - Cumberlege Wing (NHS) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

CR - Cumberlege Wing (NHS) 1324.0 1320.1 441.5 429.3 400.0 421.0 0.0 10.0 100% 97% 105% 89% 59% 80%

CR - Cumberlege Wing (NHS) 1490.0 1441.8 413.5 407.8 440.0 420.8 0.0 10.0 97% 99% 96% 92% 58% 87%

CR - Cumberlege Wing (NHS) 1509.5 1651.5 439.0 237.0 440.0 492.5 10.0 10.3 109% 54% 112% 103% 103% 3% 93% 0%




Trust Total 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Trust Total 3055.5 3104.8 814.0 824.3 1150.0 1161.0 490.0 500.0 102% 101% 101% 102% 93% 80% 92% 39%

Trust Total 3301.0 3288.3 671.0 654.8 1200.0 1170.8 440.0 440.0 100% 98% 98% 100% 98% 72% 94% 32%

Trust Total 3537.0 3703.5 716.5 506.5 1240.0 1302.5 440.0 440.3 105% 71% 105% 100% 102% 40% 98% 27%

Trust Total 3345.0 3245.8 434.5 405.3 1100.0 1058.5 540.0 541.0 97% 93% 96% 100% 94% 56% 90% 39%

Trust Total 3943.5 3872.5 537.5 472.1 1180.0 1158.5 430.0 430.3 98% 88% 98% 100% 94% 79% 96% 26%

Trust Total 3767.0 3763.3 683.0 706.7 1260.0 1307.5 450.0 460.5 100% 103% 104% 102% 95% 96% 93% 29%

Average

fill rate -

registered

nurse

/midwifes

(%)

Excluding

Temporary

Staff

Average

fill rate -

care staff

(%)

Excluding

Temporary

Staff

Average

fill rate -

registered

nurse

/midwifes

(%)

Excluding

Temporary

Staff

Average

fill rate -

care staff

(%)

Excluding

Temporary

Staff

Day Night

Registered

nurses/midwife Care Staff

Registered

nurses/midwife Care Staff

Average

fill rate -

registered

nurse

/midwifes

(%)

Average

fill rate -

care staff

(%)

Average

fill rate -

registered

nurse

/midwifes

(%)

Average

fill rate -

care staff

(%)

Day Night Day Night


Page 13

Patient Experience

Q1 Q2 Q3 Q4Yearly

AverageQ1 2014 Q2 2014 Oct-14 Q1 Q2 Q3 Q4

Yearly

AverageQ1 2014 Q2 2014 Oct-14

A&E City Road 12% 17% 23% 23% 19% 27% 28% 27% 76 73 79 76 76 72 74 76

Observation Bay 61% 31% 40% 100% 58% 70% 70% 66% 88 93 96 86 90 95 92 97

Cumberledge (NHS) 61% 52% 56% 63% 58% 65% 67% 71% 91 85 92 85 88 95 88 100

Duke Elder 29% 41% 85% 70% 58% 71% 63% 100% 62 90 85 95 83 84 88 100

Response Rate Scores

2013/14 Performance 2014/15 2013/14 Performance 2014/15

Documents

BOARD OF DIRECTORS OPERATIONAL … 5a(ii... · attendances per day, ... A&E 4 hour waiting time ... A&E Patients treated by ENP Pathway increased compared to September however …