Corporate Performance Report December 2012 By Chris Tidman Director of Resources/Deputy Chief Executive

Key Indicators Emergency Access – The 4 hour standard has not been achieved in November for the first time in 5 months, due mainly to the impact of Norovirus on bed availability. Pressure has continued into December. 18 Weeks waiting time performance has been sustained. Cancer targets have been mostly achieved – some pressure on subsidiary targets due to low numbers / patient choice Both the Stroke and TIA targets have been achieved 9 C-Diff cases , taking the year to date total to 60 cases against the annual cap of 52 cases.

4 Hour Emergency Access 11.7% increase on previous year Month Trust WRH/KTC ALX 2011/12 92.15% 91.66% 92.94% Apr-12 88.43% 87.92% 89.20% May-12 89.70% 89.57% 89.91% Jun-12 94.21% 95.29% 92.50% Jul-12 95.58% 96.16% 94.65% Aug-12 96.13% 96.99% 94.75% Sep-12 96.15% 96.60% 95.43% Oct-12 95.21% 95.15% 95.30% Nov-12 94.34% 94.38% 94.28% Dec-12 (as at 16th Dec) 91.69% 91.53% 91.93% 2012/13 YTD (as at 16th Dec) 93.67% 93.9% 93.1% 4 hour standard was not achieved in November as a result of Norovirus outbreak on both main sites which restricted the availability of beds. Emergency admissions have continued at a high level albeit appear to be plateauing. It is forecast that admission avoidance schemes will begin to have further impact over the winter period. Norovirus has continued into early December impacting on performance. Commissioners have stated their intention to issue a contract penalty 11.7% increase on previous year

PCT Cluster Analysis -Growth in All Emergencies – 0 Day LOS YTD Apr-Aug 2012/13 over previous year All HRGs 0 LOS 6% Commissioners have expressed concerns that the growth in emergency admissions at Worcs Acute has been disproportionately in the zero length of stay category. UHNS/MS 2% Bur 18% GE 1% SaTH 26% RW 6% In order to give assurance that the Trust has not changed its admission threshold for short stay admissions, this has been analysed in more detail. Wals 5% DG 2% HoE 0% Sand 16% UHCW 12% UHB/BC -15% SWHT 12% WAHT18% WV 6%

Emergency Admissions -Zero Length of Stay (Un-Normalised) This shows that the growth in zero length of stay admissions peaked in August at 18% before reducing to 14.3%. However, it can be seen that the July-August period in 2011 was unusually low which related to the 7 week closure of the Observation Unit to allow for single sex compliance work to be completed.

Emergency Admissions -Zero Length of Stay (Normalised) Once normalised for the closure of the Observation unit, the increase in the zero length of stay admissions are in line with the overall increase seen. Also, the % of admissions that have a zero length of stay is lower than seen in 2010/11.

Emergency Admissions by HRG Chapter The pie chart shows that the growth in admissions is spread across a number of HRG chapters. It has been agreed that these areas will be analysed further by clinicians to gain a better understanding as to what is driving the increased emergency admissions. P – Paediatrics – up by 24.31% - across all LOS bandings E – Cardiac – up by 15.46% mainly in 0-1 day LOS bandings D – Respiratory – up by 17.6% – main increase in >2 day LOS W – Immunology , Infectious Diseases –up 10.28% across all LOS bandings F – Digestive – up by 13.2% - across all LOS bandings

Stroke Direct Admissions Trust achieved 77.5% against the standard of 70% 90% LOS on Stroke Ward Trust achieved 80.4% against the standard of 80% TIA Trust achieved 62.1 %, against the standard of 60%.  

C difficile Toxin Detections 2012/13 C-Diff cases continue to be above trajectory and there remains the potential for the Trust to be issued with a contract penalty. However, it should be noted that the Trust continues to test for C-Diff at significantly higher levels than its peer group and has an overall detection rate that is within the average range. Based on this fact and the Trust’s clear intent to bring C-Diff levels back within the trajectory, it is anticipated that any penalty imposed will be re-invested. A detailed action plan is in place which includes regularising the prescribing of antibiotics in both hospital and primary care settings and accelerating testing within the first 48 hours of admission.

Cancer Standards The Trust missed the Symptomatic Breast target in November due to patient choice delays to first appointment. GPs have been asked to counsel patients on the need to accept an appointment within the 2 week timeframe. Year to date performance is ahead of target. The Trust achieved the 31 day wait for first treatment in November. The Trust failed to achieve the 31 day subsequent treatment (surgery) target. This amounted to 3 breaches in total, with underachievement driven by a very low denominator. Year to date performance is ahead of target.

Cancer Standards 31 Days Wait for Second or Subsequent Treatment-Anti Cancer Drug was achieved in November. All the 62 Day Cancer targets were achieved in November.

18 Weeks Referral to Treatment The 18 week target has been consistently achieved despite some specialty level risks. In particular, Orthopaedics is currently reliant on running additional waiting list initiative lists in order to manage the excess demand. Whilst every effort will be made to ensure this continues, this may not be a sustainable position for the Trust unless there is an agreed change in pathways / referral patterns. The importance of receiving timely outpatient referrals from the ICAT triage service has been stressed to commissioners.