Clinical Operations Performance Report Northern Dev on ... · Report to Trust Board Date Wednesday 16 January 2008 Agenda Item 17 Title Clinical Operations Performance Report Sponsor

Report to Trust Board

Date Wednesday 16 January 2008

Agenda Item 17

Title Clinical Operations Performance Report

Sponsor Joanne Gibbs, Director of Operations

Prepared by Michael Lock, Planning & Performance Manager Presented by Joanne Gibbs, Director of Operations 1 Purpose and Key Issues

To present a summary of Trust achievement against key performance indicators and to brief the Trust Board on operational performance issues from the Clinical Directorates.

2 Equality and Diversity Implications

The Trust collects appropriate patient data and this report includes a high level analysis of service utilisation by type, ethnicity, gender and age.

There are no direct adverse or positive impacts arising from this report.

3 Legal Implications

The legal implications have been considered and none have been identified.

4 Patient, Public and Staff Involvement

In line with Section 11 of the Health and Social Care Act 2001, patients and the public have been involved in planning, design and decision making of clinical services, primarily through the Health Cabinet and local service planning groups. The PPI Forum receives regular performance reports within Trust Board papers.

5 Controls and Assurances

This report is normally presented to the Finance & Performance Committee for approval prior to Trust Board. On this occasion the timing of the Board meeting has precluded advance review by F&PC. The items within this report are the subject of scrutiny through internal performance management and governance systems. Most items are also subject to external reporting to the Department of Health, South West Health Authority, or commissioning Primary Care Trusts.

6 Cost Implications

There are no direct cost implications arising from this report.

7 Potential risk to the organisation

This report aims to reduce the risk of non-achievement against key performance targets by accurately reflecting the current performance position and highlighting any areas of specific concern.

8 Recommendations

The Trust Board is asked to APPROVE the Clinical Operations Performance Report.

Clinical Operations Performance Report Northern Devon Healthcare NHS Trust Trust Board January 2008

Performance Team 2

Strategic Objectives Ten strategic objectives were agreed by the Trust Board in May 2007 to support the Trust�s mission statement �Best Care, Highest Standards, Right Place�. The strategic objectives have been developed to ensure there is a shared understanding and common purpose throughout the organisation about the Trust�s strategic direction and what needs to be delivered.

Patient Safety x High Quality Services

x Efficient & Effective Strategic Partnerships

Listening and responding to the needs of patients Modern and Effective Infrastructure

Deliver Care in the most appropriate setting Public Health

Integrate Health and Social Care Robust and Sustainable

Standards for Better Health The Core and Developmental Standards for Better Health have been developed by the Healthcare Commission. Compliance with the Standards throughout the year form a part of the Trust�s Annual Health Check.

C1a Incident Reporting C7e Equality & Diversity C16 Patient Information

C1b Safety Alerts C8a Whistle blowing C17 Patient & Public Involvement

C2 Child Protection C8b Personal Development Programmes x C18 Access to Services �

Equality & Choice

C3 NICE � Interventional procedures C9 Records Management x C19 Access to Services �

Emergency care

C4a Infection Control C10a Employment Checks C20a Security and Health & Safety

C4b Medical Devices C10b Professional Codes of Conduct C20b Patient Privacy &

Confidentiality

C4c Decontamination C11a Recruitment C21 Hospital Cleanliness

C4d Medicine Management C11b Mandatory Training C22a Public Health � Health inequalities

C4e Waste Management C11c Professional Development C22b Public Health � D of

PH report

C5a NICE � Technology appraisals C12 Research &

Development C22c Public Health - Working with partners

C5b Clinical Supervision & Leadership C13a Dignity & Respect C23 Public Health �

Health promotion

C5c Clinical Professional Development C13b Consent to treatment C24 Major Incident

Planning

C5d Clinical Audit C13c Use of Confidential Information D1 Patient Safety � Risk

reduction

C6 Healthcare bodies co-operating together C14a Complaints -

Information D2a Clinical Effectiveness � Best practice

C7a Corporate Governance C14b Complaints � Non-discrimination D13a Public Health �

Health inequalities

C7b Finance & Probity C14c Complaints � Service improvements D13b Public Health �

National guidance C7c Clinical Governance C15a Patient Food Standards

x C7d Performance C15b Patient dietary requirements


Performance Team 3

Clinical Operations

Monthly Performance Report

As at end December 2007

Prepared: 8 January 2008 Updated:


Performance Team 4

CONTENTS

PAGE NO

1 Key Performance Indicator Summary 6 2 Healthcare Commission National Targets 7 3 18 Week Referral to Treatment 8 4 MRSA & Clostridium Difficile 10 5 Standards for Better Health 12 6 Unscheduled Care 15 7 Access 16 Referrals Outpatients Diagnostic Waits (including Endoscopy) Elective Patients Activity Suspended Waiting List Planned Waiting List Cancelled Operations 8 Delayed Transfer of Care 26 9 GUM Access 26 10 Coronary Heart Disease 28 11 Cancer Services 29 12 Workforce Data 31 13 Equality and Diversity � Access to Services 37 14 Handling of Complaints 41 15 Community Services 42 16 Glossary of Terms 44


Performance Team 5

The purpose of this paper is to present a summary of Trust Performance against key indicators and to highlight any significant issues and actions being undertaken to improve performance.

Unless otherwise stated this report is based on data at the end of December 2007.

Key to Performance Traffic Lights

Traffic Light Key Performance Red !!!! Worse than plan

Amber !!!! Almost on plan

Green #### As plan or better

Key to Directions of Travel

Key

↑ Variation between actual performance and planned performance indicates an improvement since last month

→ Variation between actual performance and planned performance has remained constant since last month

↓ Variation between actual performance and planned performance indicates a deterioration since last month


Performance Team 6

SECTION 1 KEY PERFORMANCE INDICATOR SUMMARY Target Actual Variance %

Variance Traffic Light

Mar 08 Target

Direction of Travel

Key Performance Indicators � DECEMBER DATA MRSA (Cum.) 9 12 3 - !!!! 12 ↑ C.Diff (Cum.) 117 78 -39 - #### 174 →

18wk Admitted 61% 52% - -9% !!!! 90% ↓ 18wk Non-Ad. 79% 98% - 19% #### 95% → OP wait >11wks 0 0 0 - #### 0 → OP WL Size 2078 2715 +637 +30.7% !!!! 1528 ↓ IP wait >20 wks 0 0 0 - #### 0 ↑ IP WL Size 1375 1686 +311 +22.6% !!!! 930 ↓ Diag. wait >13 wks (NOV) 0 0 0 - #### 0 → Q1 A&E 4 Hr waits (Inc. MIU) 98% 98.93% - 0.93% #### 98% → Cancer 2 week 100% 100% 223/223 - #### 100% → Cancer 31 days 98% 100% 28/28 - #### 98% → Cancer 62 days 95% 86.7% 13/15 - !!!! 95% ↓ Cancelled Ops rebook <28day 100% 100% 0 - #### 100% → Cumulative Activity - DECEMBER DATA (Early View) GP Referrals (November) 17694 18457 +763 +4.0% #### 26075 → Other Referrals (November) 9517 8784 -733 -8.0% !!!! 14025 → Day Case Activity 11682 11434 -248 -2.1% !!!! 15603 ↑ Ordinary IP Activity 4024 3785 -239 -5.9% !!!! 5364 → Total Elective Activity 15706 15219 -487 -3.1% !!!! 20880 → Non-elective Activity (All) (November)

12357 11189 -1168 -9.5% !!!! 18534 ↓

Non-elective Activity (G&A) (November)

9305 8823 -482 -5.2% !!!! 13958 ↓


Performance Team 7

SECTION 2 HEALTHCARE COMMISSION NATIONAL TARGETS Existing National Targets 2006/07 2007/08 Performance Indicator Threshold Result Actual Current Forecast

6 Month Elective Wait <0.03% Not Met !!!! 0.034% Met #### 3 Months Outpatient Wait <0.03% Met #### 0.000% Met #### Cancer 2wk Wait >98% Met #### 100.0% Met #### Cancer 31 Days >97% Met #### 99.7% Met #### Cancer 62 Days >94% Met #### 97.2% Met #### Thrombolysis >68% Met #### 60.0% Under Achieve !!!!

Delayed Transfers <3.5% Met #### 3.6% Under Achieve !!!!

Convenience & Choice Compliance Met #### Compliance Met #### Cancelled Operations <0.8% Met #### 0.38% Met #### Rapid Access Chest Pain >98% Met #### 100.0% Met #### A&E 4hr Wait >98% Met #### 98.96% Met #### Revascularisation N/A N/A N/A N/A

New National Targets

2006/07 2007/08 Performance Indicator Threshold Result Actual Current Forecast

Access to GUM Clinics = standard Met #### On Plan Met ####

Data Quality on Ethnic Group >80.0% Under Achieved !!!! 75.0% Under

Achieve? !!!!

Drug Misuse Information >60.0% Met #### 80.0% Met #### Emergency Beddays <3.0% Met #### -7.0% Met #### Patient Experience - Met #### - Met #### Clostridium Difficile New New New On Plan Met #### Smoking/Breastfeeding Rates Imp on LY Met #### Imp on LY Met #### 20wk Elective Waits Changing Met #### TBC TBC #### 11wk Outpatient Waits Changing Met #### TBC TBC #### 13wk Diagnostic Waits Changing Met #### TBC TBC #### MRSA >Plan Under Achieved !!!! >Plan Under Achieve !!!!

Participation in Audits Complied Under Achieved !!!! Complying Met #### Self Harm NICE Guidance >80.0% Met #### 80.0% Met #### Obesity NICE Guidance New New New TBC TBC !!!! Key Met #### Under Achieved !!!! Not Met !!!! Not Applicable Note that Thresholds for National Targets are not always defined prior to results publication. Details will be updated as/when further guidance is released.


Performance Team 8

SECTION 3 18 Weeks Referral to Treatment (RTT) NOVEMBER DATA

Target Actual Variance Traffic Light Target

Mar 2008 Direction of Travel

Admitted Patients 61% 52% -9% !!!! 90% ↓

2007/08 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Plan Pathways 887 887 981 1027 1099 1099 1001 1149 1099 952 1076 1027 929

Actual Pathways 770 532 622 602 698 992 977 1023 1019

Plan <18 Weeks 246 246 314 383 431 484 491 621 665 629 812 849 845

Actual <18 Weeks 280 217 289 263 321 538 494 543 529

Plan % < 18 Weeks 28% 28% 32% 37% 39% 44% 49% 54% 61% 66% 76% 83% 91%

Actual % < 18 Weeks 36% 41% 46% 44% 46% 54% 51% 53% 52% Issues to Highlight The Trust position overall is 9% below the planned position. Significant at specialty level are: Over Performance Under Performance General Surgery 12% above plan Ophthalmology 33% (51 pathways) below plan Medical Specialties All above plan ENT 25% (19 pathways) below plan

Oral Surgery 17% (15 pathways) below plan Orthopaedics 14% (40 pathways) below plan

Gynaecology 5% (6 pathways) below plan Urology 4% (2 pathways) below plan Total (133 pathways)

0%10%20%30%40%50%

60%70%80%90%

100%

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

Plan % Actual %

Latest national guidance indicates that the total number of admitted pathways identified is within acceptable limits.


Performance Team 9

Target Actual Variance Traffic

Light Target Mar 2008

Direction of Travel

Non-admitted Patients 79% 98% 19% #### 95% →

2007/08 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Plan Pathways 1698 1698 1877 1966 1966 1966 1787 2056 1966 1698 1966 1877 1698

Actual Pathways 1087 1112 1295 1303 1223 1195 1223 1354 1340

Plan <18 Weeks 1091 1091 1209 1270 1351 1371 1249 1539 1553 1424 1652 1669 1513

Actual <18 Weeks 1027 1054 1240 1261 1182 1160 1187 1319 1313

Plan % < 18 Weeks 64% 64% 64% 65% 69% 70% 70% 75% 79% 84% 84% 89% 90%

Actual % < 18 Weeks 94% 95% 96% 97% 97% 97% 97% 97% 98% Issues to Highlight The Department of Health has recently issued new guidance on the expected number of non-admitted pathways. The objective is to make a direct link to the number of new outpatient attendances and to the expected number of admitted pathways each month. This will ensure that the overall number of 18 week reported pathways is within nationally acceptable levels. In accordance with this guidance the Trust will reassess and validate data completeness with publication of the December 18 week performance. Actions to Improve Performance The 18wk Steering Group reviewed progress during December and agreed further specific action to increase the number of admitted pathways completed within 18 weeks. This will include additional capacity to further support waiting time reduction and implementation of new booking processes that will fully transfer priority from stage of treatment measurement to18 week measurement by March 2008. Further detailed work will identify generic service improvements that will help to achieve and sustain 18 week targets.


Performance Team 10

SECTION 4 MRSA & CLOSTRIDIUM DIFFICILE DECEMBER DATA

MRSA Cumulative Target

Actual Cases

Variance from plan

Traffic Light

2007/08 Target

Direction of Travel

Number of infections 9 12 +3 !!!! 12 ↑ 2006/07 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot Taken in A&E 1 0 0 0 0 1 0 0 0 0 0 0 2 Taken at DC Admission 0 0 0 0 0 0 0 0 0 0 0 0 0 < 2 days of Admission 0 0 0 1 0 1 1 2 1 1 0 0 7 2+days after Admission 3 2 0 0 2 1 0 0 1 0 2 2 13 Total 4 2 0 1 2 3 1 2 2 1 2 2 22 LDP Target 2 2 2 1 1 1 1 1 1 1 1 1 15 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot Taken in A&E 1 1 0 1 1 0 0 0 0 4 Taken at DC Admission 0 0 0 0 0 0 0 0 0 0 < 2 days of Admission 1 0 0 2 0 0 1 0 0 4 2+days after Admission 1 1 0 0 0 0 1 1 0 4 Total 3 2 0 3 1 0 2 1 0 12 LDP Target 1 1 1 1 1 1 1 1 1 1 1 1 12 Issues to Highlight There were no cases of MRSA in December. Actions to Improve Performance Following the Department of Health Infection Control Improvement Review visit a number of improvement steps have been identified, including:

• To commence the process of embedding ownership and responsibility down to Directorate and ward level.

• Refocus our Annual Infection Control Action Plan to a smaller number of actions and initiatives that can make a real impact.

• Each Directorate will be required to develop their own local action plan consistent with the Trust wide plan.

• Clarify roles and responsibilities and communicate these throughout the organisation.

• Major overhaul of relevant comparative performance management information for the Board Directorates and wards.

• Review the membership and Terms of Reference of the Infection Control Committee to ensure the Directorates are fully played into the drive for improvement.

• Review the root cause analysis of all MRSA cases in 2007, with support from the Clinical

Governance Team.


Performance Team 11

DECEMBER DATA

Clostridium Difficile

Cumulative Target

ActualCases

Variance from plan

Traffic Light

2007/08 Cumulative Plan

Direction of Travel

Number of infections age 65+ (cumulative) 117 78 -39 #### 174 → 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot LDP Target 65+ 12 12 10 10 10 12 15 17 19 19 19 19 174Cumulative Target 12 24 34 44 54 66 81 98 117 136 155 174 Source (65+) From NDDH 5 7 3 9 4 7 5 5 5 50 From NDHT CHs 2 1 3 0 2 2 0 2 1 13 From DPT 0 0 0 1 0 0 0 0 0 1 From Stratton Hosp. 0 1 0 0 0 0 0 0 0 1 From GP 0 1 1 1 2 1 2 0 5 13 Total Age 65+ 7 10 7 11 8 10 7 7 11 78 Age Under 65 0 2 1 0 0 3 1 3 1 11 Overall Trust Total 7 12 8 11 8 13 8 10 12 89 Issues to Highlight The LDP Target profile for 2007/08 was developed in agreement with Devon PCT and reflects a commitment to achieve a minimum 20% reduction in Clostridium Difficile cases. The baseline used was the actual number of cases recorded during Q1-Q3 2006/07. Further work is underway to enhance monthly reporting and presentation of both MRSA and C.Difficile data and this will be included here when completed.


Performance Team 12

SECTION 5 STANDARDS FOR BETTER HEALTH - DECEMBER END POSITION Issues to highlight As part of the sign-off process operational leads have been asked to provide formal assurance statements to Executive Leads in January. The Governance team has made an appointment with each operational lead to review the current position. New Lines of Enquiry have now been agreed. These are much simpler and have less references than previously. Copies of each of these will be supplied to each operational lead as a guide to an evidence check. Appointments have been made for meetings with executive leads to nominate new operational leads where the position is currently vacant or they are on long-term leave. Review work is continuing in readiness for formal assurance statements to be available in January.

Core Std

Declared status 06/07

Projected year end 2007/08

and progress

Title Comment

(based on the evidence presented to/viewed by the Support Team)

Exec & Op Lead

C1a By Year End MET Incident

Reporting NED - S Jones Exec- A Robinson Op- J Cross

C1b MET MET Safety Alerts NED - S Jones Exec- I Roy Op- B Lowe

C2 MET MET Child Protection NED - S Jones Exec- C Mills Op- A Allen

C3 By Year End MET

NICE - Interventional Procedures

NED - S Jones Exec- A Diamond Op- D Lowe

C4a MET MET Infection Control 4.12.07 Evidence Folders have been supplied to Internal Audit upon request.

NED - S Jones Exec- M Roberts & C Mills Op- D Richards

C4b MET MET Medical Devices NED - S Jones Exec- I Roy Op- M Ambridge

C4c MET MET Decontami-nation

NED - S Jones Exec- I Roy Op- J Squire

C4d MET MET Medicines NED - S Jones Exec- I Roy Op- P Cooper

C4e MET MET Clinical Waste NED - S Jones Exec- I Roy Op- T Hawson

C5a MET MET

NICE � Technology Appraisals

NED � T Gatland Exec- A Diamond Op- D Lowe


Performance Team 13

Core Std



and progress

Title Comment


Exec & Op Lead

C5b MET MET

Clinical Supervision &

Leadership New Op Lead to be appointed (CM)

NED � T Gatland Exec- M Roberts Op-

C5c By Year End MET

Clinical Professional Development

New Op Lead to be appointed (CM) NED � T Gatland Exec- M Roberts Op-

C5d MET MET Clinical Audit NED � T Gatland Exec- M Roberts Op- D Lowe

C6 MET MET Healthcare

Organisations Co-operating

together

NED � T Gatland Exec- N Kennelly Op- C Raby

C7a&c By Year End MET Corporate

Governance

NED � B Sherwin Exec- A Robinson Op- J Cross

C7a&c By Year End MET Clinical

Governance NED � B Sherwin Exec- A Diamond Op- M Kilby

C7b By Year End MET

Efficient & Effective use of

resources Exec- A Robinson

Op- J Begley

C7e NOT MET By Year End

HR - Equality Diversity

4.12.07 Equality &Diversity Level 1 training started.

NED � B Sherwin Exec- M Bignell Op- T Howse

C8a MET MET HR � Whistle

blowing Programmes

NED � B Sherwin Exec- C Oliver Op- M Bignell

C8b By Year End MET

Personal Development Programmes

NED � B Sherwin Exec- M Bignell Op- L Sanders

C9 NOT MET By Year End

Records Management

4.12.07 Electronic tracking system for Clinical records now in place. New Op Lead to be appointed

Exec- J Gibbs Op- J Hillman &

C10a By Year End MET Employment

Checks NED � B Sherwin Exec- C Oliver Op- M Bignell

C10b MET MET Professional

Codes of Conduct


C11a By Year End MET Recruitment

4.12.07 Evidence Folders have been supplied to Internal Audit upon request


C11b MET MET Mandatory Training

NED � B Sherwin Exec- M Bignell Op- L Sanders

C11c By Year End MET

Professional Occupational Development

NED � B Sherwin Exec- M Bignell Op- Lin Sanders

C12 By Year End MET Research

NED � B Sherwin Exec- A Diamond Op- J Craib

C13a NOT MET By Year End

Dignity & Respect .

NED � J Lake Exec- C Mills Op- J Williamson

C13b MET MET Consent NED � J Lake Exec- A Diamond Op- M Kilby

C13c MET MET Patient Confidentiality NED � J Lake

Exec- A Diamond


Performance Team 14

Core Std



and progress

Title Comment


Exec & Op Lead

Op- D Lawrence

C14a NOT MET By Year End

Complaints (Accessibility)

4.12.07 New Customer Relations Manager appointed to start in January. Support person interviews 19.12.07

NED � J Lake Exec- A Diamond Op- M Kilby

C14b NOT MET By Year End

Complaints (Non-

Discriminatory)

4.12.07 Complaints training starting wk / comm 10.12.07


C14c NOT MET By Year End

Complaints (Action-

Planning)


C15a MET MET Patient Food NED � J Lake Exec- I Roy Op- T Hawson

C15b MET MET Help with Eating & Drinking

NED � J Lake Exec- I Roy Op- T Hawson

C16 MET MET Patient Information

NED � J Lake Exec- C Mills Op- G Everton

C17 MET MET Patient & Public Involvement

4.12.07 Evidence Folders have been supplied to Internal Audit upon request

NED � J Lake Exec- C Mills Op- L Stapleton

C18 By Year End MET

Access to Services

Equality & Choice

NED � J Lake Exec- M Bignell Op- T Howse

C20a MET MET Safety & Security

NED � J Lake Exec- I Roy Op- B Lowe

C20b MET MET Privacy & Confidentiality

NED � J Lake Exec- I Roy Op- B Lowe

C21 MET MET Hospital Cleanliness

NED � J Lake Exec- I Roy Op- T Hawson

C22a&c By Year End MET Working with

Partners New Op Lead appointed

NED � A Tucker-Jones Exec- K Maynard Op- Emma Spouse

C22b By Year End MET

Director of Public Health

Report

THIS STANDARD IS NO LONGER ASSESSED FOR ACUTE TRUSTS.

NED � A Tucker-Jones Exec- K Maynard Op- R Hooper

C23 By Year End MET Information for

Public Health

NED � A Tucker-Jones Exec- K Maynard Op- R Hooper

C24 MET MET Major Incident Planning

NED � A Tucker-Jones Exec- J Gibbs Op- R Green


Performance Team 15

SECTION 6 UNSCHEDULED CARE ACCIDENT AND EMERGENCY - Q3 END DECEMBER DATA Target

Actual Q3

% Var.

Traffic Light

Actual 2007/08

Direction of Travel

% patients seen within 4 hours (inc MIU) 98% 98.93% 0.93% #### 98.96% →

% patients seen within 4 hours (Type 1 A&E only) 98% 98.47% 0.47% #### 98.46% → EMERGENCY ATTENDANCES & TURNROUND Issues to Highlight During Q3 the Trust achieved 98.93% overall against the 98.0% target.

A&E Breach Reasons for Q3 2007/08 (inc MIU)

27

2423

8

25

4

6

1 1 1 12

0

5

10

15

20

25

30

FirstAssessment

Unknown OngoingTreatment

Other OngoingAssessment

AwaitingTransport

Awaiting Bed SpecialistOpinion(MentalHealth)

SpecialistOpinion(Medic)

SpecialstOpinion(Ortho)

Diagnostic -Awaiting

Xray

Diagnostic -Awaiting CT

Scan

Primary Breach Reason

Num

ber o

f Bre

ache

s

Actions to improve performance Continuing daily monitoring. Breach reasons are investigated daily unless numbers are below an acceptable level. Significant issues are highlighted and escalated to the Duty Manager and/or Director of Operations as appropriate.


Performance Team 16

SECTION 7 PATIENT ACCESS 7.1 OP REFERRALS - NOVEMBER DATA Target

YTD Actual YTD

Variance % Variance

Traffic Light

Mar 07 target

Direction of Travel

GP Referrals 17694 18457 +763 +4.0% #### 26075 → Other Referrals 9517 8784 -733 -8.0% !!!! 14025 → Total Referrals 27211 27241 +30 +0.1% #### 40100 →

Outpatients - GP referrals received

0500

10001500

2000250030003500

Apr M ay Jun Jul Aug Sep Oct Nov Dec Jan Feb M ar

GP refs 07/08 GP refs 06/07 GP refs pln

Outpatients - other referrals received

0250500750

100012501500


Other refs 07/08 Other refs 06/07 Other refs pln

Outpatients - total referrals received

0

1000

2000

3000

4000


Total refs 07/08 Total refs 06/07 Total refs pln

Issues to highlight It is a commissioning intention to reduce consultant-consultant referrals between specialties where no defined referral pathways exist, and to then involve GPs in subsequent referral decisions. This is expected to contribute to a reduction in Other referrals and potentially to an increase in GP referrals.


Performance Team 17

7.2 OUTPATIENT WAITERS FOLLOWING GP REFERRAL � DECEMBER DATA Patients Waiting

Target Mth End

Actual Mth End

Variance % Variance

Traffic Light

March 08 Target

Direction of Travel

>13 wks 0 0 0 - #### 0 → >11 wks 0 0 0 #### 0 → Total OP List Size 2078 2715 +637 +30.7% !!!! 1528 ↓

Outpatient waiting list

1000

2000

3000

4000

M ar07/Total

M ay Jul Sep Nov Jan M ar

Outpatient wl Outpat ient wl pln

Issues to Highlight

Significantly above plan are:

Specialty Patients % Orthopaedics 154 61.1% Ophthalmology 76 22.5% Cardiology 96 86.5% Oral Surgery 113 99.1%

The Trust consultant led outpatient waiting list by wait band is:

Waiting time % 4 weeks or less 69.1% 5 weeks or less 81.1% 6 weeks or less 88.9% 7 weeks or less 92.7%

Actions to improve performance Clinic templates and utilisation are being assessed critically to determine readiness for the much shorter waiting times required to achieve and sustain the 18wk national target. Additional clinic capacity is needed for the specialties listed above and this is being incorporated into Directorate plans.


Performance Team 18

7.3 OUTPATIENT FOLLOW UP RATIO (CONSULTANT LED) � NOVEMBER DATA 2007/08 Cumulative

Target Ratio

Actual Ratio

Traffic Light

Mar 08 Target

Direction of Travel

Overall (all specialties)

1.90:1 1.96:1 #### 1.90:1 ↑

Issues to Highlight . Actions to improve 7.4 OUTPATIENT FOLLOW UP OVERDUE APPOINTMENTS � NOVEMBER DATA Number Overdue

Cal. Year

Actual Traffic Light

Mar 08 Target

Direction of Travel

Consultant 2006 7 !!!! 0 → Non-Cons 2006 0 #### 0 → Consultant 2007 1027 !!!! 0 ↓ Non-Cons 2007 1761 !!!! 0 ↓ Issues to Highlight There are 7 Consultant led overdue appointments from 2006. Over due appointments in 2007 are showing a further increase. Actions to improve The backlog was reviewed at the 11th December Planning, Contracting & Performance Management meeting. Directorates have been requested to investigate clinic utilisation and to augment capacity where necessary to reduce the backlog of follow up appointments. Clinical and Support Services Directorate have been asked to undertake a more detailed review of outpatient demand and capacity requirements for both new and follow up appointments.


Performance Team 19

7.5 DIAGNOSTIC WAITERS � NOVEMBER DATA Diagnostics Target Actual Variance Traffic

Light Mar 08 Target

Direction of Travel

Top 15 Monthly Reported Tests 0 0 0 #### 0 → Issues to Highlight

Actions to improve performance 7.6 ENDOSCOPY LENGTH OF WAIT � NOVEMBER DATA Target

(weeks) Actual (weeks)

Traffic Light

March 08 Target

Direction of Travel

Urgent 4 4 #### 2 → Routine 13 6 #### 4 → Issues to Highlight There were no patients waiting over 6 weeks for a routine Endoscopy appointment. Actions to improve performance Ongoing monitoring.


Performance Team 20

7.7 ELECTIVE WAITERS � DECEMBER DATA Patients Waiting Target Actual Variance %

VarianceTraffic Light

Mar 08 Target

Direction of Travel

Max Local Wait 15Wks 20Wks - - #### 11wks → >20 wks 0 0 0 - #### 0 ↑ >11 wks 318 193 -125 - #### 0 →

Total IP List Size 1375 1686 +311 +22.6% !!!! 930 →

Total waiting list

1000

1500

2000

2500

Mar07/Total

May Jul Sep Nov Jan Mar

Total waiters Total pln waiters

Issues to Highlight At the end of the Month the Trust:

• Was 311 patients (22.6%) above plan for Total Elective Waiting list size.

However the waiting list in both General Surgery and Gynaecology is significantly below plan, which tends to help correct the overall position. In other main surgical specialties the November end waiting list position is: Orthopaedics +196 above plan (53%) Ophthalmology +134 above plan (71%) Oral Surgery + 76 above plan (72%) ENT +65 above plan (52%) 471

The size of the elective waiting list is now compromising achievement of the 18 week planned profile for admitted patients. Actions to improve performance Additional theatre lists are being planned/implemented. Some theatre lists are being extended and additional cases added where appropriate.


Performance Team 21

7.8 CATARACT WAITERS � DECEMBER DATA Target Actual Variance Traffic

Light Target Direction

of Travel Maximum 13 week wait for Cataracts

0 0 0 #### 0 →

Issues to Highlight

• None 7.9 CUMULATIVE ACTIVITY SUMMARY � DECEMBER (Early View) Target

Activity Actual Activity

Variance % Variance

Traffic Light

Mar 07 Target

Direction of Travel

Day Case Activity 11682 11434 -248 -2.1% !!!! 15603 ↓ Ordinary IP Activity 4024 3785 -239 -5.9% !!!! 5364 ↓ Total Elective Activity 15706 15219 -487 -3.1% !!!! 20880 ↓ Day Case Rate (All specialties)

74.8% 75.1% - 0.3% #### 75.0% →

DC Rate (Surgical specialties)

TBC

TBC

NOVEMBER DATA Non-elective Activity (All) 12357 11189 -1168 -9.5% !!!! 18534 ↓ Non-elective Activity (G&A) 9305 8823 -482 -5.2% !!!! 13958 ↓ (G&A includes all General and Acute specialties, but excludes Obstetrics and Midwifery) In agreement with Devon PCT (lead Commissioner) the elective activity target was formally reprofiled in July 2007. This has reduced the activity target in the first 6 months (to compensate for reduced availability of theatre capacity) and increased the activity target in the second half of the year. Although the reprofiling exercise has not directly changed the overall elective activity that the Trust needs to deliver, Devon PCT has also asked the Trust to carryout an additional 87 elective cases in 2007/08 in order to reduce the maximum elective waiting time from 12 weeks to 11 weeks by March 2008. This additional requirement has been built into the elective activity target profiles.


Performance Team 22

Total elective FFCE activity (IP+DC)

1000

1500

2000

Mar07/Total

May Jul Sep Nov Jan Mar

Total elect FFCE Total elect pln FFCE

Issues to Highlight Activity throughput dropped significantly below plan in December. • Day Case activity is now 2.1% below plan • Ordinary elective activity is now 5.9% below plan • Overall elective activity is now 3.1% below plan.

(1.2% below plan excluding Urology - which is currently subject to a separate agreement with Devon PCT for handling that shortfall)

Of the total shortfall of 221 cases during December, Ophthalmology and Orthopaedics together accounted for 141 cases. Gynaecology contributed another 32, with the remainder spread across other specialties. Actions to improve performance Activity against plan for the main elective specialties is being monitored and reported to Directorates weekly. Further action is being taken to increase activity throughput in Orthopaedics, Ophthalmology and ENT. Progress is reviewed in detail at the monthly Planning, Contracting & Performance Management meetings.


Performance Team 23

Elective Activity by Specialty Vs Plan - DECEMBER DATA (Early view) 2007/08 Cumulative

Specialty Actual Plan +/- Dec % Last Mth Traffic Light Direction

ARTERIAL AND VASCULAR SURGERY 162 74 88 118.92% 119.40% #### → BREAST SURGERY 180 173 7 4.05% 5.81% #### → CARDIOLOGY 81 97 -16 -16.49% -19.32% #### ↑ CARE OF THE ELDERLY 264 230 34 14.78% 18.84% #### ↓ CLINICAL ONCOLOGY 1737 1755 -18 -1.03% -0.32% #### → COLORECTAL SURGERY 921 900 21 2.33% 2.61% #### → DISEASES OF CHEST AND RESP MED 4 0 4 ENT 613 732 -119 -16.26% -17.18% !!!! → GASTROENTEROLOGY 1398 1289 109 8.46% 10.61% #### → GENERAL MEDICINE 385 340 45 13.24% 13.07% #### → GENERAL SURGERY 1079 1118 -39 -3.49% -2.20% #### → GP MEDICINE 0 0 0 GYNAECOLOGY 1291 1395 -104 -7.46% -5.74% #### ↓ HAEMATOLOGY 748 771 -23 -2.98% -5.33% #### ↑ HEPATOBILIARY PANCREATIC SURG 197 112 85 75.89% 72.55% #### → MAXILLOFACIAL SURGERY 674 598 76 12.71% 15.61% #### ↓ MIDWIFERY 3 7 -4 -57.14% -66.67% #### → NEUROLOGY 5 44 -39 -88.64% -90.00% !!!! → OBSTETRICS 5 8 -3 -37.50% -28.57% #### → OPHTHALMOLOGY 1300 1477 -177 -11.98% -10.51% !!!! ↓ ORTHOPAEDICS AND TRAUMA 2123 2372 -249 -10.50% -7.25% !!!! ↓ PAEDIATRICS 107 90 17 18.89% 25.00% #### ↑ PAIN 302 276 26 9.42% 9.24% #### → PLASTIC SURGERY 153 93 60 64.52% 61.45% #### ↑ RHEUMATOLOGY 46 72 -26 -36.11% -40.00% !!!! ↑ SCBU 2 1 1 #### THORACIC MEDICINE 13 0 13 #### UPPER GASTROINTESTINAL SURG 161 94 67 71.28% 79.76% #### ↓ UROLOGY 1265 1588 -323 -20.34% -20.03% !!!! → TOTAL 15219 15706 -487 -3.10% -1.84% !!!! ↓ TOTAL (Excluding Urology) 13954 14118 -164 -1.16% 0.23% #### ↓


Performance Team 24

Issues to Highlight Underperformance in Urology arises primarily due to consultant and service delivery changes that have occurred since the original plan was prepared. Agreement has been reached with Devon PCT to offset Urology underperformance against another area of the contract that was not fully defined at the time of contract sign-off. Excluding the Urology underperformance from the above elective activity table indicates an overall 164 cases (1.16%) below plan. Under performance on surgical specialties Orthopaedics, Ophthalmology and ENT is having an adverse affect on waiting times reduction and is currently compromising achievement of the planned profile for 18 weeks Referral to Treatment on admitted pathways. Actions to Improve Performance Plans are in place to recover activity shortfalls at individual specialty level through to March 2008. 7.10 SUSPENDED WAITING LIST � DECEMBER DATA Target Actual % Variance Traffic Light Target Direction Suspended List 5% 11.6% 6.6% !!!! 5% ↑ Issues to Highlight

0.0%2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Apr

-06

May

-06

Jun-

06

Jul-0

6

Aug

-06

Sep

-06

Oct

-06

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

Apr

-07

May

-07

Jun-

07

Jul-0

7

Aug

-07

Sep

-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08

Feb-

08

Mar

-08

Actions to Improve Performance Local guidance on the use of the �suspended� status was revised and reissued in December to facilitate implementation of the 18 week standard. This will significantly reduce the numbers of new patients being suspended. As existing suspended patients are managed via the appropriate pathways, the overall level of suspended patients should reduce.


Performance Team 25

7.11 PLANNED WAITING LIST MOVEMENT � DECEMBER DATA Number of Waiters Variation>10% and 10 pts Specialty Sep Oct Nov Dec Oct Nov Dec Risk Urology 256 247 254 267 → → → #### Colorectal Surgery 290 276 276 287 ↑ → → #### Upper Gastrointestinal Surgery 21 19 14 22 ↑ → → #### Vascular Surgery 0 0 0 0 → → → #### Orthopaedics 40 31 32 33 ↑ → → #### Ophthalmology 47 27 16 18 ↑ ↑ → #### Pain Management 19 19 23 15 → → → #### General Medicine 1 6 1 3 ↓ → → #### Gastroenterology 344 351 343 368 → → ↓ #### Cardiology 29 28 25 21 → → → #### Rheumatology 0 0 0 0 → → → #### Total List Size 1047 1004 984 1034 ↑ ↑ ↓ ####

Issues to Highlight Additional throughput of diagnostic endoscopy activity has contributed to the recent reduction in the planned waiting list size. Actions to Improve Performance Ongoing monitoring to detect any unexpected change in list size. 7.12 CANCELLED OPERATIONS � DECEMBER DATA Target Actual Num. Traffic

Light Mar 08 Target

Direction

Rebooked < 28 days 100% 100% 1/1 #### 100% → % Canc. last minute 0.6% 0.38% - #### 0.6% → Issues to Highlight The total number of last minute cancelled operations is below the Annual Health Check threshold level. Directorate Teams are aware of the need to minimise the number of last minute cancellations for non-clinical reasons. Actions to Improve Performance No specific action required.


Performance Team 26

SECTION 8 DELAYED TRANSFER OF CARE DECEMBER DATA Target Actual % Var Tfc Light Mar 08 Targ Direction Delays as a % of occupied beds (cumulative) 2.0% 3.6% +1.6% !!!! 2.0% → Issues to Highlight 3.6% Acute delayed transfers equates to an average of 9 acute beds occupied by delayed transfers. The local target was reset from 3.0% to 2.0% in June 2007 following confirmation from the HC that the England average position in 2006/07 had been 2.4%. This target is measured against the DGH acute beds only. The number of delayed transfers has reduced in recent weeks at both acute and community hospitals. Actions to improve performance Delayed transfers are monitored and reported weekly to the Executive Team meeting. SECTION 9 GU MEDICINE - 48 HOUR ACCESS DECEMBER DATA Actual Traffic Light Mar 08 Target Direction

% of patients seen within 48 hours 82.2% #### 95.0% ↑ % of patients offered appt within 48 hours 97.5% #### 100.0% ↑

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Sep

-06

Oct

-06

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

Apr

-07

May

-07

Jun-

07

Jul-0

7

Aug

-07

Sep

-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08

Feb-

08

Mar

-08

Offered <48Hrs

Target Offered Target Seen

Seen < 48Hrs


Performance Team 27

Issues to Highlight The Trust has been highlighted by the South West SHA for having a comparatively low % of patients seen within 48hrs of contacting the service. In particular the Trust variation between patients offered an appointment and those seen within 48hrs is currently 15%, whereas the SWSHA expectation is that this should be around 5%. Validation work has been carried out on the December data to confirm data quality and completeness. Within the month there were 197 attendances at GU Clinics that should have been offered an appointment within 48hrs. Of these 192 (97.5%) were correctly processed and recorded as having been offered a 48hr appointment. The remaining 5 attendances could not be fully validated and action has been taken to further improve the recording processes. In respect of patients seen within 48hrs there were 30 that were offered an appointment within 48hrs but exercised patient choice to be seen at a later date/time. Of these only 8 requested a later community clinic appointment, suggesting that, for December, community clinic availability was not the only significant factor influencing patient choice. The department is undertaking further work to collect and analyse the reasons why patients are exercising choice to attend a clinic that is later than that originally being offered. Actions to Improve Performance Targets for 2007/08 have been profiled to achieve the national requirement of 100% of patients offered an appointment within two days of referral, and the SHA LDP target of 95% of patients seen within 48Hrs of referral by March 2008. Data will now be validated each month to ensure that all eligible patients are captured within the recording systems.


Performance Team 28

SECTION 10 CORONARY HEART DISEASE NOVEMBER DATA %

Target %

Actual Number Treated

Traffic Light

March 08

Target

Direction of Travel

Cum. Position

% Cum.

Call to Needle 69% 29% 2 out of 7 !!!! 73% ↓ 15/25 60.0%

Door to Needle 75% 100% 8 out of 8 #### 75% ↑ 25/30 83.3%

2 week wait - RACPC

100% 100% 54/54 #### 100% → 322/322 100%

Issues to Highlight The Trust achieved:

• 29% of eligible patients receiving thrombolysis within 1 hr of calling for professional help. • 100% of eligible patients receiving thrombolysis within 30 minutes of arrival in hospital. • 100% of patients seen within 2 weeks in Rapid Access Chest Pain Clinics.

5 patients did not receive thrombolysis within 60mins of calling for professional help.

1 x attended by first responder, followed by ambulance crew without required training.

1 x not authorised by hospital doctor � the reason for this is being investigated. 1 x thrombolysis delayed because A&E had difficulty contacting a senior hospital doctor to give the necessary authorisation. A&E advise that this is a very unusual occurrence.

2 x thrombolysis administered pre-hospital but delayed beyond 60 mins. Of these 1 was treated in 62 mins. This delay was due to the ambulance crew traveling from Barnstaple to Ilfracombe because there was no Ilfracombe crew available. The other case is being investigated with SWAST.

Actions to Improve Performance

All cases of non-compliance are reviewed by A&E, CCU and SWAST on a monthly basis. Call To Needle time performance is closely linked to SWAST ability to deliver pre-hospital thrombolysis via ambulance paramedic services. A patient�s condition can prohibit this treatment prior to hospital attendance.


Performance Team 29

SECTION 11 CANCER SERVICES DECEMBER DATA This is an early view which may change as underlying data continues to be validated up to the end of the following month. %

Target %

Actual Number Treated Within Target

Traffic Light

Direction of Travel

2 Wk waits 100% 100% 223 out of 223 #### → 31 Days 98% 100% 28 out of 28 #### → 62 Days 95% 86.7% 13 out of 15 !!!! ↓ % of patients seen within 2 weeks of urgent GP Referral

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Apr-

05

Jun-

05

Aug-

05

Oct

-05

Dec

-05

Feb-

06

Apr-

06

Jun-

06

Aug-

06

Oct

-06

Dec

-06

Feb-

07

Apr-

07

Jun-

07

Aug-

07

Oct

-07

Dec

-07

Feb-

08

2 Week Actual

% within 31 days diagnosis to treatment

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr-

05

Jun-

05

Aug-

05

Oct

-05

Dec

-05

Feb-

06

Apr-

06

Jun-

06

Aug-

06

Oct

-06

Dec

-06

Feb-

07

Apr-

07

Jun-

07

Aug-

07

Oct

-07

Dec

-07

Feb-

08

31 Days Actual 31 Days Plan


Performance Team 30

% within 62 days urgent GP referral to treatment

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr-

05

Jun-

05

Aug-

05

Oct

-05

Dec

-05

Feb-

06

Apr-

06

Jun-

06

Aug-

06

Oct

-06

Dec

-06

Feb-

07

Apr-

07

Jun-

07

Aug-

07

Oct

-07

Dec

-07

Feb-

08

62 Days Actual 62 Days Plan

Issues to Highlight This is an early view of data. There were two breaches of the 62 day standard in December, one UGI and one Urology. Both involved complex diagnostic processes, subsequent changes of planned treatment regime and changes in planned treatment location. Actions to Improve Performance Continuation of systems and processes for tracking and management of cancer patients.


Performance Team 31

SECTION 12 WORKFORCE � NOVEMBER DATA Budgeted WTE Vs Staff in Post (contracted) 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budgeted 2150 2152 2149 2157 2170 2183 2178 2179 2178 2178 2177 2177 Contracted 1942.3 1938.0 1947.9 1947.7 1979.4 1998.1 2014.1 2032.9 Worked 2044.6 1998.4 2012.4 2014.1 2042.2 2060.4 2061.9 2096.7

Contracted A further increase of contractual staff takes the total up by 18.83 WTEs from October and stands 90.61higher than at the end of April 2007. Worked Overall the worked WTE�s are up by 34.75 when compared to last month�s figures. Additional Workforce Usage 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Med Locum 8.5 6.2 5.6 8.1 6.2 1.0 2.8 5.9 Bank Nurse 57.7 53.9 55.3 53.0 47.2 36.1 37.3 38.6 Other bank 16.2 15.4 20.3 24.5 23.0 21.4 18.6 18.1


Performance Team 32

Additional Workforce Costs 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total Med Locum 48.5 50.8 39.1 42.9 75.1 9.5 30.7 41.7 338.4 Bank Nurse 96.3 99.6 103.1 71.8 106.5 68.8 71.6 89.3 707.1 Other bank 20.0 23.2 29.9 25.6 38.3 26.9 29.9 36.5 230.1

Medical Locum WTEs Medical Locum usage has increased by 3.1 WTEs in November. Excluding the last 2 months when levels were particularly low, this has returned to the general level seen earlier in this financial year. Cost Although cost figures have further increased by £9,854 from last month, the total cost of £40,568 is still below the levels seen earlier in the financial year. Medical categories represented are as follows (costs in brackets) � Staff Group WTEs Cost Associate Specialist 0.00 (£ 0) Consultant 4.51 (£ 33,409) SHO 0.00 (£ 248) Specialist Registrar 0.00 (£ 27) Staff Grade 1.36 (£ 6,884) Bank Nurses WTEs Acute Bank Nurse use has increased & VI�d use reduced, the net effect being an overall increase of just 1.24 WTEs. Cost The Acute Bank Nurse costs reported shows an increase of £15,229. VI�d reported costs have also increased, the additional £2,447 contributing towards the total reported increase of £17,675. The staff groups represented are as follows (previous months figures in brackets) � Staff Group WTEs Cost Nursing & Midwifery Registered 20.4 (19.5) £60,119 (£46,751) Additional Clinical Services 18.2 (17.8) £29,157 (£24,848)


Performance Team 33

Other Bank WTEs Other Acute bank use has increased by 0.53, whilst VI figures have decreased by 0.97 WTEs. The combined figure shown of 18.1 is the lowest figure seen since May 2007. Cost Acute costs have increased by £7,082 but the VI�d figure is £477 lower. The combined figure of £36,480 is therefore £6,605 higher than last month and is the second highest seen this financial year. The staff groups represented are as follows (previous months figures in brackets) � Staff Group WTEs Cost Additional Clinical Services 3.1 (2.1) £ 4,645 (£ 2,347) Administrative & Clerical 6.2 (7.4) £10,630 (£ 10,599)

Allied Health Professionals 4.8 (4.5) £14,350 (£ 11,058) Estates & Ancillary 4.1 (4.5) £ 6,854 (£ 5,871)

Overtime 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total OT Hours Paid 5679 4456 4685 4731 4584 5053 4788 4765 38741.0

Cost Exc EOC 58529 47658 47595 48651 49365 54458 51034 53510 410800.

0 Overtime Hours Overtime hours are 23 lower this month. Cost The Trust total for November was £53,510, an increase of £2476.


Performance Team 34

Sickness Absence Summary � October Data 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total % Target 2.9 2.9 2.9 2.8 2.8 2.7 2.7 2.7 2.6 2.6 2.6 2.5 % Actual 3.6 4.2 3.8 4.2 4.2 4.3 5.3 Cost (£000) 130.0 152.3 136.3 143.2 146.8 161.2 193.3 1063.2 12mth Average 3.66 3.73 3.79 3.85 3.9 4.0 4.1

Sickness absence Sickness absence has increased dramatically from 4.3% in September to 5.3% in October; the highest figure seen this year. The 12 month rolling average measure shows a year-on-year increase for the seventh successive month, the figure now standing at 4.11%. Basic salary cost in relation to sickness absence at £193,265 is by far the highest figure seen.


Performance Team 35

Staff Turnover 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total % of Total 0.53 0.69 0.71 0.80 1.00 0.70 0.60 0.60 WTE 10.39 13.37 13.79 15.57 20.41 14.49 12.10 12.29 112.41

Turnover of staff The overall % turnover is unchanged with the total number of WTE�s (excluding medical rotations) leaving the Trust in November being 12.29. Enhanced Hours Paid 2007/08 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total En. Hours Paid 16982 20916 19510 18360 17959 20401 19654 18370 152152.0 Cost Exc EOC 163.7 206.5 192.7 180.7 178.4 200.3 192.0 182.7 1497.1


Performance Team 36

Enhanced Hours Hours As expected, there has been a reduction in enhanced hours paid this month due to there being one less weekend in the pay period. The number of hours paid reduced by a total of 1,283 to18,370. Cost The reported costs reflect the reduction in hours worked.


Performance Team 37

SECTION 13 EQUALITY AND DIVERSITY AUGUST DATA

Inpatient Admissions Cumulative Target

Actual Variance from plan

Traffic Light

2007/08 Target

Direction of Travel

With Valid Ethnic Code 85% 75% -10% !!!! 85% ↓ Issues to Highlight Data for age and gender is complete. In line with Annual Health Check guidance the Trust is required to collect ethnicity data for over 80% of IP admissions. Current achievement is estimated at 77%. It is believed that a data transfer problem within the information system data warehouse is distorting the ethnicity information for emergency admissions. This has been referred to the system supplier for more detailed investigation. (Dec 2007). Action has been taken to improve the collection and recording of ethnicity information. The following charts show recent access trends for new outpatients, elective and emergency admissions (emergency subject to concerns noted above). Actions to Improve Performance Action continues to be taken within the Trust to reinforce the need for Ward Clerks and Outpatient booking staff to request ethnicity details during admission or appointment booking.


Performance Team 38

Service Utilisation by Ethnic Group

Ethnic Group - Unknown

0.00%10.00%20.00%30.00%40.00%50.00%60.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

OP New Elective Emergency

Ethnic Group - White

40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

OP New Elective Emergency % Population

Ethnic Group - Mixed

0.00%

0.20%

0.40%

0.60%

0.80%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Ethnic Group - Asian

0.00%0.10%0.20%0.30%0.40%0.50%0.60%0.70%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep



Performance Team 39

Ethnic Group - Black

0.00%

0.05%

0.10%

0.15%

0.20%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Ethnic Group - Other

0.00%

0.10%

0.20%

0.30%

0.40%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Service Utilisation by Gender

Gender - Male

35.00%

40.00%

45.00%

50.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Gender - Female

45.00%

50.00%

55.00%

60.00%

65.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Service Utilisation by Age Band


Performance Team 40

Age Band 0 - 15 years

0.00%

5.00%

10.00%

15.00%

20.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep



40.00%

45.00%

50.00%

55.00%

60.00%

65.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep



0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Age Band 75 years and over

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun

Jul

Aug

Sep


Data Volumes Typical monthly activity volumes represented in the above charts are: Outpatient New 3000 Elective 1600 Emergency 1500


Performance Team 41

SECTION 14 COMPLAINTS DECEMBER DATA Statutory NHS Complaints Procedure Performance Data New Complaints Received: 10 Complaints Acknowledged within 2 working days: 10/10 (100%)

Complaints closed during month within statutory timescales including extensions 16

Complaints closed subject to appropriate extension 2 x HCC

Closed complaints responded in Month - outside of timescale: (Number of working days delayed per case). Note: Even in the event of an extension being requested, if there is an impact on the extended time scales this will constitute a breach.

5 in total 2 between Complaints Dept and CEO sign off each 2 days and 3 due to Directorate causing

26 days

At Month End - total number of complaints at Stage One Local Resolution over three months.

0

Total number of reopened complaints at Stage One Local Resolution over three months. Complainant has received final response but feels further investigation should be undertaken. (as at month end).

0

Healthcare Commission cases with HCC for action 2

HCC cases with Trust for action 2

Total HCC cases

4

Total Ombudsman cases 1

New Complaint Themes

2 30 0 0 1

4

02468

1012

Treatmen

t & C

are

Staff Attit

ude

Communicati

on

Hotel Serv

ices

Delays/C

ance

llatio

ns

Aids &

Applia

nces

Other


Performance Team 42

SECTION 15 COMMUNITY SERVICES SUMMARY

November Data Target YTD

Actual YTD Var % Var

Mth Vs Plan

Mar 08 target

Direction of Travel

Target 2006/07

Actual 2006/07

CREADO (Resp Outreach) Referrals 138 152 13.8 10.0% ! 204 # 204 223 CREADO (Pulm Rehab) Referrals 41 65 24.4 60.0% ! 60 ! 60 49 CARDIAC REHAB Referrals 386 693 307 79.5% ! 570 # 570 478 COMMUNITY HEART FAILURE Referrals 234 198 -36 -15.5% # 346 ! 346 254 LYMPHOEDEMA Referrals 31 52 20.8 66.9% ! 46 ! 46 95 ORTHOPAEDIC INTERFACE Referrals 507 760 253 49.8% ! 749 ! 749 928 PALLIATIVE CARE Referrals 77 70 -6.5 -8.5% $ 113 ! 113 134 COMM. CHILDRENS NURSING Referrals 144 285 141 97.6% ! 213 ! - 213 CHRONIC PAIN Referrals 68 87 19.3 28.5% ! 100 ! 100 64 BIDEFORD MIU Referrals 6599 5306 -1293 -19.6% # 9743 $ 9743 8666 ILFRACOMBE MIU Referrals 2276 2562 286 12.5% ! 3361 # 3361 2270 LYNTON MIU Referrals 899 674 -225 -25.0% # 1327 # 1327 1174 HOLSWORTHY IP ADMIS. Total admissions 223 253 30.2 13.5% ! 329 # - 329 BIDEFORD IP ADMIS. Total admissions 360 323 -37 -10.2% # 531 ! - 531 TORRINGTON IP ADMIS. Total admissions 129 110 -19 -14.5% # 190 # - 190 ILFRACOMBE IP ADMIS. Total admissions 75 70 -4.5 -6.0% $ 110 ! - 110 SOUTH MOLTON IP ADMIS Total admissions 211 252 40.7 19.3% ! 312 # - 312 OT COMMUNITY REHAB Referrals 238 243 5.27 2.2% $ 351 # - 351 OT INTERMEDIATE CARE Referrals 227 239 12.1 5.3% $ 335 # - 335 OT INPATIENTS Referrals 0 0 0 #DIV/0! � - OT HOSPICE Referrals 30 27 -3.5 -11.4% # 45 ! - 45 OUT OF HOURS Referrals 482 369 -113 -23.5% # 712 $ - -

PHYSIO 0 0 0 #DIV/0! � - DISTRICT NURSING Referrals 0 0 0 #DIV/0! 10662 � - 10662 SALT 530 731 201 38.0%

!782

! - 825


Performance Team 43

Referrals

PODIATRY Referrals 948 1041 93 9.8% ! 1400 # 1400 1395 The Community Services summary shows the demand for individual services, as measured by the total number of new referrals received, compared to the planned levels of demand. This is the first year that information to this level of detail has been collected for many of these services and the underlying data collection systems will continue to be reviewed and improved during the remainder of this year.


Performance Team 44

SECTION 16 GLOSSARY OF TERMS A&E Accident and Emergency Department C/D Core Standard/Developmental Standard CHD Coronary Heart Disease CONS Consultant CT Computer Tomography CTN Call To Needle time CUM Cumulative DC Day Case DGH District General Hospital DIR Direction DTN Door To Needle time EM Emergency ENT Ear, Nose and Throat FFCE First Finished Consultant Episode FTE Full Time Equivalent (number of staff) G&A General and Acute specialties only (excludes Obstetrics & Midwifery) GP General Practioner HCC Healthcare Commission IP In Patient IT Information Technology LDP Local Delivery Plan MIU Minor Injuries Unit (in Community Hospitals) MRI Magnetic Resonance Imaging MRSA Methicillin Resistant Staphylococcus Aureus NDHT Northern Devon Healthcare NHS Trust NICE National Institute for Clinical Excellence NON CONS Non-Consultant NSF National Service Framework OP Out Patient OPS Operations OT Occupational Therapy Q1 Quarter 1 (IE April � June) RACP Rapid Access Chest Pain RD&E Royal Devon & Exeter NHS Foundation Trust SALT Speech and Language Therapy SWAST South West Ambulance Services Trust TBC To Be Confirmed TYPE 1 A&E department located at main hospital VI Vertical Integration (of staff transferred from ND PCT in Oct 2006) WL Waiting List WTE Whole Time Equivalent (number of staff) YTD Year To Date


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Documents

Clinical Operations Performance Report Northern Dev on ... · Report to Trust Board Date Wednesday 16 January 2008 Agenda Item 17 Title Clinical Operations Performance Report Sponsor