1. 1 EXECUTIVE RESPONSIBLE Adam Cairns Chief Executive AUTHOR (if different from above) Paul Hodson Head of Contracts & Performance Pete Gordon Head of Continuous Improvement William Wraith Head of Human Resources Tony Brown Assistant Director Financial Performance CORPORATE OBJECTIVE Enhancing Patient Experience, Safety and Effectiveness, Achieving NHS Foundation Trust Status BUSINESS PLAN OBJECTIVE NO(S) 6.1 - Establish a new Quality Framework for the Trust. 6.1.1 - Develop an integrated performance management framework that includes a balanced set of quality metrics across the domains of safety, effectiveness and patient experience. EXECUTIVE SUMMARY This paper reports current performance against a number of KPIs for the period up to the end of October 2010. As detailed in previous papers this reports only includes slides for those KPIs identified as suitable for monthly reporting. The summary sheet will continue to show a RAG for all KPIs with quarterly KPIs showing their RAG status at the end of the last full quarter. KEY FACTS Daycase rate decreased in October. Elective length of stay decreased at RSH and increased at PRH. Non elective length of stay decreased at RSH and increased at PRH. The number of staff employed was 4,231 WTE at the end of October. Validated sickness absence rate for July was 4.5%. RECOMMENDATIONS The Board is asked to NOTE: performance against a range of Key Performance Indicators covering Quality, Delivery and Foundations. INTEGRATED PERFORMANCE REPORT for period ending 31 st October 2010 Trust Board – 3 December 2010 Enclosure 5

2. 2 Integrated Performance Report:Delivery (CO2, CO3 & CO4) Foundations (CO5 & CO6) Target (2010/1 1) Executive Lead Monthly Performance Direction of Travel Year to DateForecastCommentaryFrequency Increasing productivity and encouraging innovation Theatre Utilisation % Utilisation of funded theatre sessionsDoS AMBER= GREEN Overall theatre performance remains constant but revised action plan should improve performance M Length of Stay (LOS) Elective - To achieve upper 20th percentile performance within five years from 2009 DoS GREEN  AMBERGREEN Increase at PRH of 0.2 days and a decrease at RSH of 0.4 days M Reduce total number of surgical pre-operative bed days per monthDoS GREEN= Decrease of 28 bed days at PRH and a decrease of 20 bed days at RSH M Non Elective - To achieve upper 20th percentile performance within five years from 2009 DoS AMBER= Increased by 0.3 days at PRH and decreased by 0.1 days at RSH M Daycases Maintain a daycase rate above 78%DoS AMBER  GREEN Decreased to 76.5% during October M Outpatient Utilisation % of patients booked in the capacity available (CO2.4)FD AMBER= Overall DNA rate in October was 6.3% Ophthalmology and T&O remain higher than the Trust average M Supporting and developing our workforce in a learning organisation Workforce Numbers All staff Whole Time Equivalent (WTE) employed on permanent & fixed contracts DCA RED= GREEN Recruitment of Junior Medical Staff far more successful this year which should reduce Locum costs M Sickness % Sickness Absence and WTE Days LostDCA GREEN= Validated absence level 0.2% lower than this month last year M Ensuring a clinically viable & financially sustainable organisation Financial Risk Rating Maintain Monitor Governance Risk Rating at Amber or aboveFD RED = Risk Score below target M Governance Risk Rating Assess performance against Monitor Governance RiskDSD RED  AMBERGREEN Monitor Governance Risk Rating of Red Q Achieving NHS Foundation Trust status Foundation Trust Status To achieve NHS Foundation Trust status in 2011DoS RED= AMBER Details for organisational transition continue to emerge in November. A revised trajectory for the Trust’s FT application must be agreed with the SHA and informed to the DH during November 2010 M

3. 3 Theatre Utilisation Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Theatre Utilisation % Utilisation of funded theatre sessions. DoS AMBER = GREEN Overall theatre performance remains constant but revised action plan should improve performance Theatre Utilisation:  Theatre Utilisation for PRH in October is 81% and RSH 75% which is a 2% increase at PRH and a reduction of 4% at RSH compared to the previous month.  The key reasons for under utilisation resulting in lost activity at RSH are: - Fixed emergency/trauma sessions 5% - Closed sessions 8% - Unused Theatre time 12% - Total RSH under-utilisation 25% - RSH lost a total of 100 theatre sessions in October. Performance Management:  Data is available for each Centre split by speciality.  Speciality data can be split by Consultant.  Percentage data can be converted into number of theatre sessions lost.  Data can be broken down into cancelled operations and the reasons why.  Data can be broken down into late starts and the reasons why.  Data is available for unfunded sessions, majority funded by WLT. Actions: Report findings to Clinical Leads and Divisional General Managers. A fortnightly meeting has now commenced and following actions have been agreed: - Start times for theatre sessions. - The removal of fixed emergency trauma sessions from theatre utilisation. - Continue with implementation of Theatre Briefing and roll out pilot in December as part of Productive Theatre. - Paper for Management Executive in January regarding Productive Theatre.

4. 4 Actions : Continued bi-weekly meetings of the Elective Length of Stay Project Group. Increase usage of Surgical Admission Suite at RSH. Capital work to expand the area commences 15th November with a planned completion date - 17th Dec 2010. Covert inpatients to daycase where possible using BADS (British Association Day Surgery) criteria. Continued implementation of the Enhanced Recovery Programme. Elective Length of Stay (LOS) Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Length of Stay (LOS) – Elective To achieve upper 20th percentile performance within five years from 2009 DoS GREEN  AMBERGREEN Increase at PRH of 0.2 days and a decrease at RSH of 0.4 days PRH Elective LOS Increased by 0.2 days between September and October. The median elective length of stay remained at 1 day during October. RSH Elective LOS Decreased by 0.4 days between September and October. The median length of stay reduced to 1 day during September.

5. 5 Elective Surgical Pre Operative Bed Days per Month Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Elective Surgical Pre Operative Length of Stay (LOS) Reduce total number of surgical pre- operative bed days per month DoS GREEN = Decrease of 28 bed days at PRH and a decrease of 20 bed days at RSH The number of elective surgical pre operative bed days decreased at PRH by 28 from September and decreased by 20 at RSH. The median number of pre operative bed days per month over the last 12 months at PRH is 105 and 129 at RSH. The Surgical Admission Suite (SAS) at RSH is currently open 4 days a week. 124 patients were admitted via the SAS in October 2010 (the highest to date). Capital work to expand the SAS & pre-operative assessment area commences 15 th November with a planned completion date 17 th December 2010. This will enable more elective surgical patients at RSH to be admitted on the day of surgery. Actions: Increase the number of patients being admitted via the Surgical Admission Suite. Provision of monthly Elective Surgical Pre-operative Length of Stay information for clinical and managerial staff. Increase day of surgery admission for elective Orthopaedic inpatients at PRH.

6. 6 Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Length of Stay (LOS) – Non Elective To achieve upper 20th percentile performance within five years from 2009 DoS AMBER = Increased by 0.3 days at PRH and decreased by 0.1 days at RSH PRH Non Elective LOS Increased by 0.3 days between September and October. The median length of stay remained constant at 2 days. RSH Non Elective LOS Decreased by 0.1 days between September and October. The median length of stay remained constant at 2 days. Non Elective Length of Stay (LOS) Actions : Continue monthly ‘Joint Discharge Transformation Team’ meetings focussing upon significant areas of delay for patients with continuing healthcare needs. New model of Consultant Working to commence December 2010 at RSH. Live ‘visual’ SQL reporting for admissions, discharges and discharge lounge utilisation available via intranet to all SATH staff. A number of QIPP schemes focussed upon improving patient flow are being introduced to ensure closer partnership working between primary & secondary care. These include 7 day working within DAART, GPs within the emergency departments and a ‘virtual ward’. Confirm clinical lead for unscheduled care to enable improved flow management within the local health economy. Implement patient status at a glance technology Trust wide.

7. 7 Daycases Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Daycases Maintain a daycase rate above 78%DoS AMBER  GREEN Decreased to 76.5% during October This key performance indicator measures the percentage of Daycase procedures as a total of all elective procedures. Daycase rate for October decreased by 2.8% to 76.5%. Actions: Convert inpatients to daycase where possible. Create BADS (British Association of Day Surgery) report within MedeAnalytics for Consultants.

8. 8 Outpatient Utilisation Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Outpatient Utilisation % of patients booked in the capacity available (CO2.4) FD AMBER = Overall DNA rate in October was 6.3% Ophthalmology and T&O remain higher than the Trust average In October, the total OP attendances were 52,005 (19,064 new and 32,941 follow- up). The Scheduling Team booked an additional 33 OP clinics in October, arranged within 3 weeks notice to meet national standards (21 at RSH and 12 at PRH). Other additional clinics booked by the SDUs are not recorded in these numbers. Recorded total DNA rate in October was 3,641 (6.3%), an improvement of 0.3% compared with September 2010. DNA rate in Ophthalmology was 9.7% for new appointments and 7.8% for follow- up and DNA rate in T&O was 6.5% for new appointments and 11.4 % for follow-up. Ophthalmology OP appointment letters were amended in October following feedback from patients and GPs, offering the date of appointment directly, but giving the choice to change if the appointment offered is not convenient. Appointment letters are sent 30 days prior to the appointment date. Actions: DNA rate for Ophthalmology will be monitored following the change to the appointment letter. Investigation underway to add a further text reminder via SEMA.

9. 9 Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Workforce Numbers All staff Whole Time Equivalent (WTE) employed on permanent & fixed contracts DCA RED = GREEN Recruitment of Junior Medical Staff far more successful this year which should reduce Locum costs Thresholds Descriptions: Green: WTE > 95.9% of establishment AND total workforce cost < budget Amber: WTE = 93.0-95.9% of establishment AND total workforce cost < budget Red: WTE budget 4,231 WTE substantive staff, end of October 2010; increase of 1 since end September (ESR). 91.7% of monthly budgeted establishment; 93.1% YTD average of monthly budgeted establishment; YTD rating amber except for cost. The contracted figure is 4,245 WTE. The budgeted establishment for October was 4,615 WTE (£14.421M). The chart illustrates total workforce for October from all sources was 4,521 WTE (£15.138M) - met through the use of permanent staff, overtime, bank and agency staff. Areas of highest use of agency (by cost): Medical Staff Anaesthetics – RSH (£95,302), Medical Staff General Medicine – RSH (£45,552), Medical Staff General Medicine – PRH (£34,097), Medical Staff Ophthalmology – RSH (£29,837). Total Agency spend: £0.552M. Agency use by WTE: Workforce Numbers Actions : Recruitment is being closely monitored by the Executive Team. The use of bank and agency staff is continuously reviewed on a weekly basis by the Line-Managers and the Executive Team. MedicsNursingOther Aug.37217 Sep.41311 Oct.381311

10. 10 Sickness Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Sickness % Sickness Absence and WTE Days Lost DCA GREEN = Validated absence level 0.2% lower than this month last year Overall validated absence level is 0.2% lower than for same month last year. Year to date validated level is less than last year’s average. Benchmarking data provided by the West Midlands for July 2010 showed SaTH to be 15th lowest of all 44 Trusts in the West Midlands. SaTH's sickness absence for 2009/10 was 4.3% (0.1% lower than 2008/9). A target of 4.2% has been set for 2010/11. It should be noted that the DoH have set a target of 3.39% for the West Midlands, to be achieved by 31st March 2013. Validated sickness average for April to June 2010 is 4.0%, mirroring 2009. Divisions continue to manage sickness absence in line with Trust policy and with support from HR, which includes using HR generated trigger lists to ensure early intervention in management of sickness absence, and completion of return to work interviews. Actions : There is a proposed new draft Management Sickness Absence policy, which is currently subject to consultation with staff-side representatives.

11. 11 Finance Target (2010/11) 3 Monthly Status Direction of Travel Year to Date Commentary Monitor Risk RatingRisk Score = 2 RED ═ Risk Score below target Month 7 EBITDA £1.409m (Plan £1.498m) : shortfall to plan £0.089m Cumulative EBITDA £7.041m (Plan £9.786m) : shortfall to plan £2.745m Month 7 I&E Surplus £0.275m (Plan Surplus £0.370m) shortfall to plan £0.095m Cumulative Deficit £0.820m (Plan Surplus £.1.868m) : shortfall to plan £2.688m Unfavourable Emergency Threshold adjustment £0.262m in Month 7 (£1.465m cumulative) Pay overspend £0.717m (£4.323m cumulative) Pay spend Month 7 £15.138m (Months 1 to 6 average £15.238m) Agency spend Month 7 £0.552m (Months 1 to 6 average £0.617m) Working capital and cash management pressure continues. Trust plan £2.6m surplus for year, at Month 7 the forecast position is a £0.225m surplus. Actions : Pay run rate reduction schemes identified, control totals issued to Divisions. All non pay spend for non-clinical items continues to be reviewed by senior finance officers prior to approval. Financial Performance reviews at SDU level.

12. 12 Target (2010/11) Executive Lead Monthly Status Direction of Travel Year to Date ForecastCommentary Foundation Trust Status To achieve NHS Foundation Trust status in 2011 DoS RED = AMBER Details for organisational transition continue to emerge in November. A revised trajectory for the Trust’s FT application must be agreed with the SHA and informed to the DH during November 2010 Monitor Compliance Framework Foundation Trust steering groups Current Position The current assessment of performance against Monitor’s Compliance framework shows: a financial risk rating remains of 2 (RED) a governance risk rating which has moved to 3 (RED) during Q2. Maintaining essential standards of safety and quality through the appropriate governance mechanisms is the primary focus of the Board at this time. Establishing our NHS Foundation Trust (FT) trajectory The Trust will shortly be assessed by the SHA Regional Director of Provider Development on our ‘state of readiness’, where assurances are expected by the Department of Health that the organisation has a robust plan to achieve FT within the expected timescale. The assessment; an evidence based preparatory phase, will assure the DH of our fitness for purpose and will inform the SHA’s view in support of our FT application. This process, consisting of a Quality Review, and assessment of the capacity and capability of Board, will be undertaken between January and March 2011. Foundation Trust Status Actions: Board assessment of trajectory for FT authorisation to be outlined in November 2010 for agreement with SHA. Chairman asked to inform the Secretary of State of the proposed FT timetable by 30 November. SHA assessment of organisational state of FT readiness during Q4. Governance, Membership and Constitution Steering Group Partnership Forum Finance and Performance Steering Group GovernanceFinance