EXECUTIVE SUMMARY REPORT TO THE BOARD OF DIRECTORS

EXECUTIVE SUMMARY REPORT TO THE BOARD OF DIRECTORS

Subject:

Integrated Performance Report

Supporting Directors:

Kirsten Major, Director of Strategy & Operations; Neil Priestley, Director of Finance; Hilary Chapman, Chief Nurse; Mark Gwilliam, Director of Human Resources & OD; David Throssell, Medical Director.

Author(s):

Paul Buckley, Deputy Director of Strategy & Planning; Annette Peck, Head of Information.

Status (see footnote): D & A

PURPOSE OF THE REPORT

To provide the Board with a detailed assessment of the performance against the agreed indicators and describe the specific actions that are under way to deliver the required standards. Supplementary to this report is the Integrated Performance Report for August, which is included because no Board meeting was held in that month.

RECOMMENDATIONS

The Board is asked to:

a) Receive the Integrated Performance Reports for August and September. b) Debate the current performance against the agreed indicators. c) Review the detailed actions described within the exception reports and be assured that improvements are being made where performance is not at the required level. c) Note the deep dive topic for the October Board meeting will be Cancellations (covering operations and out-patients appointments - whether initiated by patients or the Trust).

IMPLICATIONS STH Strategic Aims

1 Deliver the best clinical outcomes 2 Provide patient centred services 3 Employ caring and cared for staff 4 Spend public money wisely 5 Deliver excellent research, education & innovation

Tick as appropriate

APPROVAL PROCESS

Meeting

Trust Executive Group

Approved Y/N

Y

Date

9 September 2015

Finance, Performance & Workforce Committee

Y

7 September 2015

Board of Directors 16 September 2015

A = Approval; A* = Approval & Requiring Board Approval; D = Debate; N = Note.

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BOARD OF DIRECTORS 16 SEPTEMBER 2015

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Contents

Section

Executive Summary

Trust Performance Overview

Trust Performance Report by Exception

MSSA bacteraemia - Actual numbers Serious Untoward Incidents - Approved SUI report submitted within timescales Incidents - Incidents not approved after 35 days Average Length of Stay by Discharges - Average LOS Non Elective Sickness Absence - All days lost as a percentage of those available Appraisals - Completed appraisals last year Efficiency - Variance from plan A&E 4 hour wait - Patients seen within 4 hours Ambulance Turnaround - Time taken for ambulance handover of patient 15 & 30 minutes 52 week waits - Actual numbers Cancelled Operations - Number of operations cancelled on the day for non clinical reasons Cancelled Operations - Number of patients cancelled on the day and not readmitted within 28 days Cancelled Outpatients - Percentage of out-patient appointments cancelled by hospital Cancelled Outpatients - Percentage of out-patient appointments cancelled by patient Cancer Waits - Patients seen within 2 weeks Cancer Waits - 62 days from referral to treatment (GP referral) Cancer Waits - 31 day subsequent treatment (Surgery) Choose & Book Utilisation - Percentage appointments booked through C&B Elective inpatient activity - Variance from contract schedules New outpatient attendances - Variance from contract schedules Follow up op attendances - Variance from contract schedules FFT Response Rates - Increased response rates for A&E

Directorate Dashboard

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Executive Summary

Deliver The Best Clinical Outcomes

There have been 0 cases of Trust assigned MRSA bacteraemia recorded for the month of July. The year to date total remains nil. There were 5 Trust attributable cases of MSSA bacteraemia recorded in June, which is worse than the monthly trajectory that the Trust has set itself. The

year to date performance is 17 cases of MSSA against an internal threshold of 14 cases. The Trust recorded 5 cases of C.diff for July. This is better than the monthly target of 7.25 cases. The year to date performance is 20 cases of C.diff against

an internal threshold of 26 cases and a Monitor threshold of 29. Safer staffing ? overall, the actual fill rate for day shifts for Registered Nurses was 91.7% and for other care staff against t he planned levels was 101.4%. At

night these fill rates were 90.2% for registered nurses and 111.0% for other care staff. On a number of individual wards the fill rate fell below 85%. The main reasons for this are vacant posts, sickness and parenting leave above the planned level. The fill rates for Registered Nurses at night continue to be carefully monitored. The Trust, in partnership with NHS Professionals, has offered 11 Spanish nurses posts for a year on a bank only c ontract. 4 new SUIs had been reported during the period 9th June to 13th July 2015 with 9 currently being investigated. Saving Lives, Improving Mothers' Care: the enquiry identified key topic-specific messages for care, namely: Think Sepsis; Prevention and treatment of haemorrhage; Caring for women with Amniotic Fluid Embolism; Learning from neurological complications; Lessons for Anaesthesia ; and Caring for women with other medical and surgical complications The report contained a gap analysis of the current position within the Trust's Maternity Services. An action plan with named responsible officers and timescales for completion of the actions has been developed. This would be monitored through the Directorate Healthcare Gove rnance Group. The Trust was notified on 8th July 2015 of concerns regarding staffing and the impact on patient care and safety at A&E over the weekend of 4th/5th July 2015. The CQC had asked that concerns were reviewed and that they were informed of the outcome of the Trust investigation. N o patient safety concerns have been identified at this stage of the investigation. The Health and Safety Annual Report highlighted that no enforcement actions were served on the Trust for 2014/15 and that the Health and Safety Executive (HSE) had not investigated any RIDDOR incidents reported to them. The Sharps Incident Group continued to review incidents an d ongoing improvement work continues to reduce these incidents. Two RIDDOR incidents were being investigated following a patient falls and one had been escalated as a Serious Untoward Incident (SUI). A review of the process for RIDDOR reporting was currently underway.

Employ Caring & Cared For Staff

The Trust was recently identified as one of the top 100 Best Places to Work in the NHS by the HSJ (and one of 40 Acute Trusts). Using data compiled from the recent NHS staff survey, independent research firm Best Companies Group identified 120 top performing NHS organisations. Data was categorised into seven core areas: leadership and planning; corporate culture and communication; role satisfaction; work environment; relationship with s upervisor; training, development and resources; employee engagement and satisfaction.

Phase 2 of Listening into Action has been launched with 26 schemes in place. The recent Pass it On event from Phase 1 was fel t to be successful and market stalls from that event will be showcased at the Annual members meeting in September.

Sickness absence in July 2015 continued to rise and was 4.37% as compared with 4.31% in June resulting in a year end position as at end July of 4.27% against a target of 4%. This figure was 0.35% worse than the same period in 2014/15. Long term sickness absence continues to be of conc ern at a monthly figure of 2.59% and a year to date position of 2.68%.

The number of appraisals which have been carried out in the preceding 12 month period continue to be around 84% with the rate at the end of July 2015 standing at 83.7%. At the recent summit directorates were encouraged to ensure that all outstanding appraisals are scheduled and plans in place over the coming months to ensure that performance levels can be maintained.

Compliance with mandatory training requirements continues to improve with a level of 72.7% compliance being reported as at th e end of July against a target of 70% for quarter 1. Directorates are working towards the next quarterly target of 90%. This training is taking place at the same t ime as training associated with T3 and good progress appears to be being made.

Bank and agency spend continues to rise. The development of a standard operating procedure for the approval of agency spend h as been agreed with TEG.

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Executive Summary

Spend Public Money Wisely

The Month 4 position shows a ?6.2m (2.0%) deficit against plan. This represents a significant deterioration on the month 3 position in both value and percentage terms.

There is a significant year to-date activity under-performance of ?3.6m, which is a deterioration of ?1.5m in July. The under-performance is largely in respect of elective activity, out-patients and a significantly larger than expected deduction for the MRET and emergency readmissions within 30 days. There is an over performance on non-elective activity.

There was a pay overspend of ?2.2m (1.1%) in the first 4 months of the year, largely due to medical staffing pressures, and a ?2.2m under delivery against efficiency plans.

Overall, Clinical Directorates reported positions ?6.4m worse than their plans. With regard to Patient Service contracts, the CCG and NHS England contracts are now signed. The contract with Sheffield City Council is not agreed given

that the council has now requested further savings from the Sexual Health Service. Discussions are on-going. The key risks for the year remain contract challenges, performance penalties, delivery of the Local Quality Incentive Schemes, delivery of

activity/efficiency/financial plans, service/cost pressures and consequences of the T3 Electronic Patient Record project. There are no issues of concern at this stage in respect of the working capital position, balance sheet or capital programme. The position at the end of Month 4 is of considerable concern and action is required to improve delivery of activity, efficiency and financial plans and to

mitigate risks and maximise contingencies. The Trust wide Action Plan is largely formulated. All Directorates have submitted Recovery Plans which, if delivered, will return the Trust to at least a balanced position against plan. However, there are clearly many risks to be overcome to achieve this position.

Provide Patient Centred Services

91% of complaints were responded to within 25 working days. This is the first time the Trust target of 85% has been met in a single month since September 2014. This issue is covered in more detail as part of a deep dive.

FFT response rates for inpatients in July was 35.8%. FFT response rates for A&E in July was 19.4%. New outpatient activity was 6.5% below target in July and is 2.6% below target for the year to date. Follow up activity was 7.3% below target in July and is 2.4% below for the year to date The level of elective inpatient activity was 5.3% below target in July and is 0.6% below for the year to date. Non elective activity was 3.1% above target in July and is 1.8% above for the year to date. Accident and Emergency activity was 2.0% above target in July and is 0.9% above for the year to date. At any one time in July there were, on average, 47 patients whose discharge from hospital was delayed for non clinical reasons compared to 60 during

June. There were 85 operations cancelled on the day in July compared to 76 in June. There were 2 patients who were cancelled on the day and not readmitted

within 28 days, both were in ENT. The percentage of A&E attendances seen within 4 hours was 92.84% in July compared to 95.33% in June. The targets for Cancer waiting times are not currently being met for 2 week wait and 62 day GP referrals and for the 31 day subsequent treatment

(surgery). The percentage of first outpatient appointments made through the e-Referral Service was 24.9%.

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