1. Lancashire Teaching Hospitals
Stroke Performance Update
Presented to Stroke Board
Lisa Hulme, Divisional Director
4th July 2017

2. Local SSNAP Update
Screen shot of performance tracker here showing our improvement across the 10 domains.

3. Local SSNAP Update

4. Local SSNAP Update

5. Local SSNAP Update

6. The latest news on our Stroke Service Developments
Good News Stories – 2017/18
The latest news on our Stroke Service Developments
Stroke Service Good News
2 substantive consultants in stroke now in post.
Since the formal launch of the ring-fenced Stroke Assessment Unit in February 2017 we have seen a significant improvement in getting patients onto the stroke unit within 4 hours – RIGHT CARE RIGHT PLACE RIGHT TIME.
Supporting ED and patient Flow
Trial started of having Specialist Nurses based in ED over 7 days moving to 8:00- 8:00pm.
Education to upskill nurses in CT ordering and interpretation.
Stroke Group established to assure progression of our ambition to achieve a consistent ‘A’ rating for SSNAP and meet requirements for HASU.
In Month
Adverse variance to budget in month 7 (October) of (£2.3m) excluding underachievement of PET target.
Comprises (£1.0m) overspend versus budget and (£1.9m) underperformance versus income plan.
Year to Date (YTD)
Adverse variance to budget cumulative to month 7 of (£6.8m) excluding underachievement of PET target.
Comprises (£1.5m) overspend versus budget and (£6.7m) underperformance versus our income plan.
Pay
Nurses / PAMS – £1.7m underspend, driven by current vacancy levels across various specialities.
Medical – (£0.6m) overspent, driven by the utilisation of agency staff.
PET – (£1.0m) underperformance YTD against the Pay related PET target.
Non-Pay
Independent Sector (£0.7m), which we obviously don’t budget for as is it is a genuine cost pressure & is where we don’t have the capacity to see patients ourselves within the ‘target’ timescales (i.e. 18 weeks). The adverse variance will have a corresponding offset generated by additional income but with no profit (assuming tariff is just passed to private provider). We would (hopefully) make a margin if we were able to undertake the associated work within the Trust, though are unable to do so due to capacity issues.
Vascular (£0.5m); accruing based on expected charges for hosting of LTHTR Vascular surgical activity at Blackpool & Morecambe. Underlying discrepancy is due to the initial estimate of demand in the SLA being too high. SLA is still under negotiation with Blackpool & Morecambe. The position has worsened significantly in the current month as 6 months of invoices have been provided (for Q1 and Q2 2016/17) from Blackpool, which are unsupported and are significantly higher than our expectation (by £29kp/m, and therefore accounting for c£200k of the overall adverse variance). A request for support has been escalated with Blackpool’s senior finance team but as yet no response has been obtained.
There may be an interventional radiology element included within the invoiced amounts, which shouldn’t sit with Surgery but with Diagnostics & Clinical Support. This still needs to be clarified, but any transfers to DCS would improve the overall position within Surgery.
PET (£0.3m) underperformance YTD against the Non-Pay related PET target.
Divisional Income
CDF income £0.1m favourable; Overseas & Private patients £01.m favourable.
CDF and Drugs fluctuate quite a bit, particularly if they have a couple of patients on the very high cost drugs (£10k+ per treatment).
Overseas patient income sees some fluctuation within demand & the timing of associated income being received.
Clinical Income
A(£6.7m) below our income plan driven largely by adverse variances within Orthopaedics A(£2.4m) – plan remains at pre SOTW level which is not being achieved, plus consultant vacancy until start of 2017 following recruitment.
Neurosurgery A(£1.5m) – driven largely by cancelled operations due to the lack of critical care beds.
General Surgery A(£0.7m) (comprises General Surgery, Upper GI/Colorectal, Urology & Breast) – work is required to split the plans for this specialities accurately as ‘General Surgery’ no longer exists.
Opthalmology A(£0.6m) – lack of throughput in outpatients due to poor patient flow.
Obstetrics (& midwifery) A(£0.5m) – seasonal variation, spiking in Sept - Nov generally versus a flat phased income plan.
29% reduction in total breaches for February and 54% reduction in March

7. Key Pathway Risks & Actions
Highlight our key issues & Actions. Eg specialist nurse workforce
3 SN’s in now post
Recruitment started for 4th SN
Trial to start mid July of SN’s in ED 8 to 8 over 7 days
To review validation process to ensure that we are not penalised for short stay patients.
CT and scanning pathway review
4 hour
90% Stay
In Month
Adverse variance to budget in month 7 (October) of (£2.3m) excluding underachievement of PET target.
Comprises (£1.0m) overspend versus budget and (£1.9m) underperformance versus income plan.
Year to Date (YTD)
Adverse variance to budget cumulative to month 7 of (£6.8m) excluding underachievement of PET target.
Comprises (£1.5m) overspend versus budget and (£6.7m) underperformance versus our income plan.
Pay
Nurses / PAMS – £1.7m underspend, driven by current vacancy levels across various specialities.
Medical – (£0.6m) overspent, driven by the utilisation of agency staff.
PET – (£1.0m) underperformance YTD against the Pay related PET target.
Non-Pay
Independent Sector (£0.7m), which we obviously don’t budget for as is it is a genuine cost pressure & is where we don’t have the capacity to see patients ourselves within the ‘target’ timescales (i.e. 18 weeks). The adverse variance will have a corresponding offset generated by additional income but with no profit (assuming tariff is just passed to private provider). We would (hopefully) make a margin if we were able to undertake the associated work within the Trust, though are unable to do so due to capacity issues.
Vascular (£0.5m); accruing based on expected charges for hosting of LTHTR Vascular surgical activity at Blackpool & Morecambe. Underlying discrepancy is due to the initial estimate of demand in the SLA being too high. SLA is still under negotiation with Blackpool & Morecambe. The position has worsened significantly in the current month as 6 months of invoices have been provided (for Q1 and Q2 2016/17) from Blackpool, which are unsupported and are significantly higher than our expectation (by £29kp/m, and therefore accounting for c£200k of the overall adverse variance). A request for support has been escalated with Blackpool’s senior finance team but as yet no response has been obtained.
There may be an interventional radiology element included within the invoiced amounts, which shouldn’t sit with Surgery but with Diagnostics & Clinical Support. This still needs to be clarified, but any transfers to DCS would improve the overall position within Surgery.
PET (£0.3m) underperformance YTD against the Non-Pay related PET target.
Divisional Income
CDF income £0.1m favourable; Overseas & Private patients £01.m favourable.
CDF and Drugs fluctuate quite a bit, particularly if they have a couple of patients on the very high cost drugs (£10k+ per treatment).
Overseas patient income sees some fluctuation within demand & the timing of associated income being received.
Clinical Income
A(£6.7m) below our income plan driven largely by adverse variances within Orthopaedics A(£2.4m) – plan remains at pre SOTW level which is not being achieved, plus consultant vacancy until start of 2017 following recruitment.
Neurosurgery A(£1.5m) – driven largely by cancelled operations due to the lack of critical care beds.
General Surgery A(£0.7m) (comprises General Surgery, Upper GI/Colorectal, Urology & Breast) – work is required to split the plans for this specialities accurately as ‘General Surgery’ no longer exists.
Opthalmology A(£0.6m) – lack of throughput in outpatients due to poor patient flow.
Obstetrics (& midwifery) A(£0.5m) – seasonal variation, spiking in Sept - Nov generally versus a flat phased income plan.
Speech and Language
Out to recruit
Bleep system for referrals as no longer assigned to Ward
Further engagement with lead
ESD and Named person at discharge
ESD and rehab pathway redesign
Systems review