1. Integrated Performance Report – June 2016 Executive Summary
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Integrated Performance Report – June 2016 Executive Summary

2. Contents Page Section 3 4 6 8 9 10 1 Performance Outcomes 2
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Contents
 Section
Page  1
Performance Outcomes 3 2
Quality Performance 4
Operational Performance 6
Financial Performance 8 5
Contract Performance 9
Workforce Performance 10

3. Integrated Performance Outcomes – June 2016
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Integrated Performance Outcomes – June 2016
The quality position remains stable, with a significant improvement being seen in the response rates and positive response for the Friends and Family Test and the a reduction in number of times patients are moved between 0001 and There has, however, been one Never Event reported in June. This concerned insulin administration using the incorrect device. The incident has been thoroughly investigated and there was no harm to the patient.
A&E performance improved during June and the Trust achieved more than 85% performance against the 4 hr standard on 10 days and achieved 85.12% in the week ending 19th June. Overall performance for the month was 81.98% against an improvement trajectory of 76.7%. This was achieved despite continued high demand with an average of 303 type 1 attendances per day (comparable with June last year) despite the direct admission of GP heralded patients and an average of 194 medically fit for discharge patients occupying beds on a daily basis. Average occupancy was 96.3% and there were an average of 28 escalation beds open and a maximum of 46. The key area for further improvement is delivery of the ward standards and discharge targets set by CSCs in their ‘Safer’ bundles. This will require an improvement in the number of ‘simple’ discharges achieved by clinical teams at PHT and an increase in the number of complex discharges health and social care organisations are able to support, particularly at week-ends.
Continued capacity constraints and the cancellation of some weekend lists impacted on the Trusts ability to deliver the 18 week standard and the trust achieved 91.9% despite treating 535 (8%) more elective patients than in June last year, and the number of patients waiting more than 35 wks for treatment has continued to improve There were 70 on the day cancellations but no breaches of the 28 day guarantee. The diagnostic 6 wk standard was achieved as per improvement and sustainability trajectory.
The Trust is forecasting achievement of 5 of the 8 national cancer standards, provisionally, 62 day and 31 day first definitive treatment, and 2 wk. breast symptomatic have not been achieved. All are expected to improve once validation and capture of all treatments is completed. Provisionally 11 patients were treated outside the 104 day maximum wait standard.
Overall Sentinel Stroke National Audit Programme (SSNAP) performance has improved from level D to level C due to improvement in therapy responsiveness, multidisciplinary working and discharge planning.
The Income and Expenditure annual plan delivers a £1.2m surplus. The Trust's I&E position at the end of Month 3 was an actual deficit of £4.8m, this is in line with plan at this time. The month 3 income position has been reported at planned levels for most points of delivery where activity information was not readily available. Cost Improvement Savings of £3.2m have been recorded for the year to date against a plan level of £2.4m. The Trust has spent £1.9m of capital against a programme for the year of £18.5m. The Trust had a cash balance of £2.5m at the end of June which was aligned to the minimum level of cash holding expected of 2 days. Currently the Trust has drawn down £31.2m of its working capital facility.
The temporary workforce capacity increased by 45 FTE and total workforce capacity increased by 52 FTE in June. The sickness absence rate in month has improved and decreased to 3.6%. There is a big drive towards improving the trusts appraisal compliance to bring it back up to 85%. Appraisal compliance decreased in month and currently records at 73.4%. 1 referral received in June for whistleblowing in June.
Enablers – Performance Outcomes

4. Quality of Care Key Exceptions
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Quality of Care Key Exceptions
June performance
Exceptions to note in performance
Indicator
April
May
June
Comment
Safe
Falls
(Moderate or severe harm – confirmed)
Monthly numbers subject to change as incidents are confirmed 2
(2x severe harm)
Reduction in total falls incidents reported of 198 compared to 229 in May.
Current year-to-date position of 4 confirmed falls incidents, all severe harm. 4x moderate harm incidents are yet to be confirmed.
Medication 3
(1x severe, 2x moderate harm)
(2x moderate harm)
Never Event reported concerning insulin administration with the incorrect device. The incident has been thoroughly investigated and there was no harm to the patient.
Current year-to-date position of 5 confirmed medication incidents; 1x severe harm and 4x moderate harm. 4x moderate harm incidents to be confirmed.
SIRIs 32 40 9
Reduction in the number of SIRIs reported in June. The decrease is explained by the reduction in 12 hour DTA breaches reported.
One Never Event reported; as noted above.
Effective
HSMR
99.46
(Feb.-Jan ‘16)
98.77
(Mar.-Feb. ’16)
100.64
(April-March ’16)
Increase in the HSMR for the 12 months to March 2016, however; the rate remains within the confidence interval and is therefore, ‘within expected range’.
SHMI
107.32
(Oct.-Sept.’15)
107.11
(Jan.-Dec. ‘15)
Slight decrease in the SHMI for January to December 2015 ; the rate remains within the official control limits, although slightly above the National Average of 100. 
Caring
CQC – Integrated Care of Older People
Not applicable
The CQC have published the results of their thematic review into how well health and social care and support work services work together to meet the needs of older people, and how this affects people’s experiences of care.
The Trust participated in the fieldwork for this review between October and December 2015.
The MOPRS CSC have reviewed the findings and are working to ensure there is further joined up working across the local health economy.
National Cancer Patient Experience Survey
Survey published by Quality Health on 5th July 2016.
On a scale of zero (very poor) to 10 (very good) patients rated their care within the Trust as 8.6, compared to 8.7 nationally.
Responsive
Patient moves
(non-clinical) after midnight
155
123 82
The number of non-clinical moves after midnight decreased from 123 in May (average 4.0 per day) to 82 in June (average 2.8 per day).
A decrease has also been seen in the number of reported non-clinical moves between 2100 and midnight, from 183 (average 5.9 per day) in May to 153 (average 5.1 per day) in June.
Well-led
Friends and Family Test
In-patient response rate
23.7%
23.4%
32.8%
An overall improvement has been seen in response rate and positive responses.
ED response rate
16.9%
14.7%
27.9%
Quality of Care – Executive Summary

5. Quality of Care Overview – June 2016
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Page 5
Quality of Care Overview – June 2016
Safety - Overview

6. Performance Against TDA Accountability Framework – June
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Performance Against TDA Accountability Framework – June
Responsive – Operational Overview

7. NHS Constitution performance key Standards - June
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NHS Constitution performance key Standards - June
Referral to Treatment (RTT) Incomplete standard
This is all patients waiting for treatment (total waiting list) The Trust achieved 91.9% against the 92% standard for June, just behind the improvement trajectory of 92% at aggregate level with speciality fails due to continued capacity issues.
There were no breaches of the 0 tolerance 52 wk. maximum wait standard.
Diagnostic waits
The maximum 6 week waiting time standard for diagnostics was achieved, performance was 99.4% against the improvement trajectory of 99.1% (national standard 99%)
A&E service quality standards
Performance was 81.98% against the 95% standard and improvement trajectory of 76.7% Total attendances in June averaged 392 per day compared to 400 per day in June last year despite the direct admission of GP heralded patients.
There were 0 breaches of the 12 hr trolley wait standard
Cancer standards - Provisional
5 of the 8 national standards were achieved. 31 day and 62 day first definitive treatment, and 2 wk. breast symptomatic are currently not being achieved, validation and capture of all treatments is expected to improve performance but the standards are unlikely to be achieved.
Provisionally there were 11 patients who waited more than 104 days for treatment.
Cancelled operations
There were no breaches of the 0 tolerance 28 day guarantee.
3 urgent operations were cancelled but none of these for a second time.
Delayed Transfers of Care
5.1% of patients were officially delayed in their transfer of care which is compared to 0.9% 3.6 in June last year. Average number of medically fit for discharge patients in Trust beds was 194 per day (66 Portsmouth, 128 Hampshire, 6 out of area)
Responsive – Operational Overview

8. 12/11/2018
Finance: Overview
Enablers - Finance

9. 16/17 Contracts Executive Summary – key exceptions to note
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16/17 Contracts Executive Summary – key exceptions to note
16/17 Contracts - Contract information is dependent on validation processes so this report is regarding Month 2
CCG.
STF trajectory plans are under way in Unscheduled care and Elective care as Service Development & Improvement Plans (SDIP). Progress against SDIPs requires close monitoring with Commissioners, the outcome of which is discussed at Contract meetings.
A Contract Performance Notice (CPN) has been issued by CCGs for some incomplete actions in the CQC report which are not covered by current agreed plans. The Trust agreed additional actions have been added to existing plans (e.g. SDIP) by agreement, and therefore not to result in additional Remedial Action Plans.
The CCG have introduced a revised PLCV policy and the Trust have brought some clinical risks and other ambiguities arising from the amendments to the attention of the Commissioners. Whilst these issues are resolved, this policy was implemented on 22 June it is still expected for the additional authorisation processes to apply. Failure to apply for correct authorisation will result in non-payment.
Some proposed QIPP aspirations have yet to be agreed in practice, and the Indicative Activity Plan (IAP) therefore still remains higher than Commissioners can afford. In some cases, the Trust is unable to deliver the full likely activity requirements without further plans for alternatives, and discussions are under way with other local partners to assist.
The Trust continues to discuss some suggested changes in responsibility for mental health, learning difficulties, and other social needs services which were provided in the past by community partners during acute hospital stay.
Local CQUIN agreement
A collaborative transformation project (COBIC) CQUIN scheme is agreed with Commissioners in outline, and the Trust is currently meeting with main Community partners in MSK to agree a way forward and a milestone plan in order to earn the full CQUIN Value.
The Trust continue to discuss aspects of the Paediatric unscheduled care strategy that can be implemented this year as part of the local CQUIN programme.
The CCG have proposed that we make improvements in Admission, Discharge and Transfer (ADT) processes as an additional CQUIN. The Trust is discussing with CCGs how this might work in practice, and may agree further work streams.
NHS England contracts
The NHSE Contract is agreed and signed
A Contract Performance Notice has been received for delays in Pathology response times in Cervical Screening. A Remedial Action Plan is in place and agreed, expected to complete within 3 months without major concerns.
Enablers – Contract Performance Theme

10. Workforce Executive Summary – key exceptions to note
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Workforce Executive Summary – key exceptions to note
Performance Theme
The total workforce capacity increased by 52 FTE to 6,865 FTE in June and is 35 FTE over the new funded establishment.
The temporary workforce capacity increased to 445 FTE in June, this is an in month increase of 38 FTE and comprises 6.5% of the total workforce capacity.
Staffing levels (as per NQB Safe Staffing Levels) are reported as 102.5% in June, this is a increase compared to May 16.
Appraisal compliance has decreased from 75.2% to 73.4% in June and continues to be below the 85% target.
Total essential skills increased in May from 87.9% to 88.5% in June and continues to record above the 85% target.
Information Governance Training has increased to at 86.9% in June, however continues to be below the 95% target.
Fire Safety (face to face training) decreased to 69.5% in June.
Sickness Absence Rate (12 month rolling average) slightly increased in month to 3.6% in May and remains above the target. In-month sickness absence decreased by 0.3% to 3.6% in May and is above the target.
1 referrals received in June for whistleblowing and no referrals received for professional registrations or safeguarding.
Well Led – Workforce Performance Theme