1. Stewart Messer, Chief Operating Officer
Report to Board
INTEGRATED PERFORMANCE REPORT
July 2014
Stewart Messer, Chief Operating Officer

2. Trust Balance Scorecard

3. Quality & Outcomes - Overview
HSMR – June data is currently un-validated therefore this period should be viewed with caution.
Complaints – Response rates remain challenging although a reduction in comebacks suggests an increasing amount are being settled to the satisfaction of the complainant
Actions to address adverse areas of performance are outlined in the CMO/CNO Quality report.

4. Effectiveness – HSMR / SHMI
Quality & Outcomes
Effectiveness – HSMR / SHMI
The Trust’s HSMR is within expected limits for the year. June 2014 must be viewed with a degree of caution as HSCIC have had issues with the HES data release.
The Trust’s SHMI is within expected limits for the year.

5. Quality & Outcomes Safety - Falls
Overall numbers of falls are reducing as well as falls with harm. A renewed innovative approach is being undertaken to keep this momentum.

6. Experience – Friends & Family
Quality & Outcomes
Experience – Friends & Family
Overall score for the Friends and Family Test (FFT) within the Trust in July was 78.3% with a response rate of 23.1%.
The overall ward and A&E score is 85.5% and response rate is 34.8 %( the CQUIN response rate target for wards 2014/15 is 25%).

7. Performance & Efficiency 4 Hour Emergency Access Standard (EAS)
The Trust achieved an Emergency Access Standard (EAS) of 96.15% for July 2014 with continued levels of emergency demand and delays in discharging patients.
A broader selection of A&E quality standards have been produced (below) which give a better overall view of performance than simply measuring the 4 hour standard. It can be seen that the Trust achieved 4 out of 5 standards in June.

8. Performance & Efficiency Factors Affecting 4 Hour EAS
The first chart shows the overall trends in total emergency admissions over the last 3 years. Whilst the summer months of last year saw a reduction on the previous year, this trend has now reversed. As can be seen from the chart, the Trust is still experiencing high levels of demand in emergency admissions compared to the same period previously. This unplanned increased has left the Trust in a position where it has had to cancel elective work in order to prioritise patient safety. The second chart indicates that the Trust regularly has between patients that are medically fit for discharge, equating to between 3 and 4 wards.
The acuity of patients presenting as emergency is still higher than expected for the summer period with the majority presenting in the early and late evening.

9. Performance & Efficiency
A&E Attendances
A&E attendances continue to increase compared to the previous year.
Weeks have been normalised to allow comparison of full weeks across years
This year 31 Mar 2013 to 29 March 2015
Last Year 1 Apr 2013 to 30 Mar 2014

10. Performance & Efficiency
Referral to Treatment
There are three standard KPIs for 18 rtt. For the Non-admitted and admitted pathways both achieved compliance however the admitted pathway remains in a challenging situation. The Trust has submitted a recovery plan. The actions to deliver by the end of October include: Increased numbers of waiting list initiatives; Increased activity through the consortia; Validation of the waiting list and outsourcing to the independent sector. Whilst activity has risen the number of referrals continue to rise leaving a hiatus in the delivery on the reduction of the backlog. The total activity for the month of July is comparable to June’s activity with 922 inpatient cases being treated. It is also worth while noting that outpatient referrals and GP referrals continue to increase making any impact upon the backlog more difficult to reduce. Discussion continue with Commissioners to reduce this activity in line with the submitted plans to reduce the backlog. Further work outside this continues in line with Access and booking, education and training of staff re : OASIS and RTT rules, and outsourcing of activity to the Independent sector.

11. Performance & Efficiency
Cancer Standards
The updated July figures show the Trust in amber for the 2ww symptomatic breast patients (89.71% for the month and 88.52% year to date), amber for the 31 day target for first treatments (93.88% for the month and 95.02% year to date), red for the 62 day target with 134 treatments recorded and 31 breaches (76.87%  for the month and 82.05% year to date), and red for the 62 day screening target (70.59% for the month and 86.36% year to date).
The Trust is working with the IST team on a breach reporting tool to enable the Trust to view where the delays are in the pathway to enable improved pathway processes.
Please note: July figures will be final on 06th September.

12. Workforce & Training - Overview
Sickness
The Trust sets itself a stretch target of 3.5% for sickness. The cumulative sickness rate for current year to date is slightly above target at 3.63% against 3.83% at the same time last year. Both short term and long term sickness absence have been on target for all three months of the first quarter. There are some staff groups where sickness continues to need close management; Health Care Assistants, Estates and Ancillary staff. Healthcare Scientists sickness has risen in the last two months and this is under review.
Mandatory Training
Mandatory performance training reports continue to be sent to Divisional Directors of Operations, Nurse Directors and Medical Directors to cascade with managers within their Division so that mangers know who needs to attend training. Resuscitation saw a small decline in performance due to the resuscitation team rolling out the new DE fib training programme , focus is now back onto provision of mandatory training.
Trust is involved in NHS Mandatory and Statutory Streamlining Project and this project is expected to increase performance in mandatory training compliance due to transferred learning from other NHS organisations and development and sharing of e-learning programmes.
Those topics that have not achieving the 70% target the topic lead has been asked to provide an action plan to the next Mandatory training meeting on the 4th September 2014 so that actions can be agreed to meet compliance.
Staff Turnover
Overall staff turnover was 10.32% in July which is consistent with the previous four months and in line with normal range. There has been a slight increase of 0.06% in Qualified Nursing Staff turnover in July to 11.41%. Turnover of unqualified Nursing Staff has also increased by 0.32% to 12.06%. We have reviewed Exit Interview processes to gain more information about the reasons for this.
Non Medical Staff Appraisals 
The Trusts non medical appraisals rate has improved by 2.6% since June but remains low at 69.7% . The Divisions have been asked to review this and ensure appraisals are completed for the relevant staff. There has been a slight increase in performance in the last month, this can be attributed to staff who were due an increment in July and August receiving a letter informing them unless they had an up to date PDR recorded they will not receive their incremental progression, this action prompted some activity in the completion of PDR's and this monitoring is continuing. Monthly reports continue to be sent out to managers highlighting staff who have not received a PDR. Medical appraisal rates have improved by 4.2% but remain low at 38.9% . There has been a significant improvement in consultant compliance from 56% to 65.1%

13. Workforce & Training Sickness and Absence
The Trust’s sickness rate as reported in July 2014 was 3.94% which has increased from 3.59% in June. The 12 month cumulative year to date figure for the Trust at the end of July 2014 is 3.93%. The year to date figure April 2014 – July 2014, is 3.63%.
Rates of absence had been falling since January 14 when a peak figure of 4.43% for the year was reached. However the retrospective June figure showed a slight upward trend to 3.59% and this trend has continued in July 2014 which is 0.56% higher than the same month last year. This is being kept under close review.
Benchmarking the Trust against other Trusts in the West Midlands, we are in 8th Position against other Trusts. Of the 17 Acute Trusts we remain in the top 50%. Divisional reports are produced to enable Divisions to manage both their long and short term sickness cases proactively.
The number of episodes of sickness peaked in January 2014 which correlates with an increase in short term sickness through the winter periods due to coughs/colds/gastrointestinal problems. This is a common seasonal trend which is closely monitored within divisions. All staff have return to work interviews and those who have higher episodes will trigger a meeting under the Trust’s Sickness Absence, Health and Wellbeing Policy.

14. Statutory and Mandatory Training
Workforce & Training
Statutory and Mandatory Training
Hand Hygiene continues to be above target. Vulnerable Adults training is above target.
Other areas remain below target and the Head of Learning and Development working with topic leads on action plans to improve performance.
Work continues with West Midlands Streamlining project.
The overall level of training is above target at 71.8%.

15. Workforce & Training Turnover NEED TO UPDATE CHARTS
Nursing Turnover is showing a steady increase in both qualified and unqualified staff and this is above the 10% target that we set ourselves. However, this needs to be taken in the context that turnover rates for nurses within the West Midlands has increased. Our rates of turnover have been benchmarked against other Trusts in the LETC and is lower than other Trusts within the LETC for both qualified and unqualified staff (source: Productive Workforce Metrics Data April 2014)

16. Finance & Contractual - Overview
Based on a set of assumptions regarding activity levels and QIPP delivery, the Trust has planned on a £9.8m deficit in 2014/15. Once adjusted for the impact of non recurrent funding rebates, the Trust’s underlying deficit stands at £3.8m (circa 1% of turnover).
The run rate has been maintained at the similar levels as in Quarter 1 giving a YTD adverse variance of £0.8m. The Key Drivers of the variance to plan are:
30% Marginal Rate triggered for additional Emergency Admissions (£0.25m)
Premium costs of temporary medical staff related to vacancies and additional demand (£0.4m)
Unfunded Governance Reviews (£0.15m)
Income for July has continued above Trust plan, with day case and critical care income driving most of the positive variance. In addition, A & E activity continues to be 9% over plan, which is also translating into a 1.6% growth in emergency demand. Therefore, at present, it can be seen that the CCG QIPPs to reduce emergency demand have yet to embed. As set out above, the Trust is currently only paid at 30% for any growth in emergency admissions, with the reinvestment of the 70% balance subject to mutual agreement.
Pay overspends are being driven by two factors – firstly, the need to cover medical vacancies at middle grade and consultant level. Secondly, the current demand for both elective and emergency care has led to the Trust having to put in place additional premium cost medical capacity through agency staff and additional waiting list sessions, which are not allowed for within the standard tariff.
Scenario forecasts show both potential upside and downside forecasts. The potential of the downside forecast remains a higher value with the risks identified later in the paper. Confirm and Challenge meetings are being held with all overspent divisions to bring the trajectory back to plan by the end of the year.
QIPP actuals remain broadly in line with the planned profile.
The Trust has had a temporary cash payment of £9.25m and has now submitted its application for a permanent PDC injection to ensure liquidity is not affected by the current deficits.

17. Income & Expenditure Position
Finance & Contractual
Income & Expenditure Position

18. Finance & Contractual
CIP Delivery

19. Finance & Contractual
Activity