board of directors meeting · a recovery planning group was established in order to mitigate...

Integrated Performance Report Wednesday 29 February 2012 of 35

Board of Directors Meeting

Date: Wednesday 29 February 2012

Agenda item: 8.1, Open

Title: Integrated Performance Report incorporating:

Quality / Performance / Finance and Activity / HR

Prepared by: Warwick Heale, Associate Director of Planning & Performance Ann Goodridge, Corporate Performance Manager

Presented by: Em Wilkinson-Brice, Director of Nursing & Patient Care

Action required: The Board is asked to receive the Performance Report and note the progress that has been made together with any actions that are planned.

Monitoring Information Please specify CQC standard numbers

and tick other boxes as appropriate

Care Quality Commission Standards Outcomes

Monitor Finance

Service Development Strategy Performance Management

Local Delivery Plan Business Planning

Assurance Framework Complaints

Equality, diversity, human rights implications assessed

Other (please specify)


1. PURPOSE

1.1 To advise the Board of the Trust’s performance against the key performance standards and targets.

2. BACKGROUND

2.1

The Trust’s Annual Plan sets out the programme of work to be undertaken to ensure compliance with the Monitor Compliance Framework and local and national standards and targets included in PCT commissioning contracts. Detailed results of achievement as at 31 January 2012 are presented in Data Appendices - Performance (Dashboards and Data Tables).

3. KEY ISSUES

3.1 The rise in non-elective activity was sustained over the month of January particularly in the over 80 years old cohort. The impact of a 7.8% increase in general non-elective admissions over the first week in January when combined with a 31% increase in over 80 years old cohort admissions, culminated on the 6th January when the Trust took the unprecedented decision to request a divert for emergency patients. This divert remained in place for a period of 24 hours and resulted in 12 patients being diverted to other local providers; however ED remained open throughout and continued to receive self-referral. In total 55 emergency patients were admitted despite the divert arrangements. In response to Trust capacity pressures the daily Cluster Capacity Pressures Strategy Group conference calls were re-established with all health partners represented. The response of the wider health community was effective in creating the conditions from which recovery could be planned. The community response included additional resources being provided by Care Direct Plus to facilitate the discharge process. Devon Doctors extended provision of services, particularly over the weekend periods and GPs provided additional surgeries. Reablement services were bolstered in the community to support admission avoidance programmes and a community-wide communications plan was implemented. The continued capacity pressures resulted in 232 elective cancellations in the month of January with the Trust reducing elective activity to clinically urgent cases. Orthopaedics as the largest surgical specialty was most significantly impacted by this restriction as a very low proportion of its patients fall within this category. The reduction in elective activity was marginally less than had been experienced in the previous month despite greater pressure in the system. This is attributable to the planned reduction in elective activity for the month of January and the ability to plan staffing to sustain additional escalation areas. The Trust has been required to maintain 28 escalation beds over and above the planned escalation capacity of 30 beds for the majority of the reporting period. A recovery planning group was established in order to mitigate against disruption to RTT performance and the immediate action plan was agreed by the Trust Executive on the 16th January.


The Trust, NHS Devon, Devon Partnership Trust and the South of England SHA have developed a joint action plan to improve Accident and Emergency whole system performance against the A&E target through a shared responsibility of demand management, capacity planning, patient flow and public communication regarding choice of healthcare provision.

3.2 Performance Targets Two of the Monitor targets assessed on a quarterly basis are currently not being met for Quarter 4. MON01 - Clostridium Difficile target. The Trust achieved the target for January with 7 cases (1 toxin positive) against a trajectory of 7 but has now exceeded the trajectory for the year with 77 cases (31 toxin positive) against a full year target of 74. Monitor’s Executive Committee met on the 13 February 2012 and decided that they would not escalate the Trust at this time but would review the situation after the end of quarter 4. The risk rating for the Trust was amended from red to amber-red accordingly. Draft guidance has been circulated by the South of England SHA that clarifies the reporting of Clostridium Difficile cases prior to implementation from 1 April 2012. Trusts will then be required to use a two test protocol consisting of a Glutamate Dehydrogenase (GDH) Enzyme Immunoassay (EIA) or Nucleic Acid Amplification Test (NAAT) followed by a sensitive toxin EIA test. Tests that are GDH EIA positive and toxin positive will be reportable. The Trust is expecting to have to change the toxin tests currently used which may have an impact on the numbers of toxin positives reported but overall the number will still be lower than those reported currently.

MON08.I - Cancer 14 Day GP Urgent target. The position for January was 92.1% against a target of 93%. The 39 of the 60 breaches related to haematuria clinic capacity issues during the month resulting from a change in booking rules. Plans have now been put in place to resolve the temporary increase in demand and to prevent a recurrence of the situation further details of which can be found in Appendix B. The Trust position is expected to return to achieving before the quarter end as the current underperformance of 0.9% equates to 7 breaches. Targets Currently being Met but at Risk for this Quarter The Referral to Treatment target for admitted pathways remains at risk for Q4. The Trust will flag to Monitor expected failure of the target in Q1 and Q2 in 2012/13 because of the impact of treating the backlog of patients whose routine elective procedures were deferred as a result of operational pressures during the winter period details of which are given in the Key issues section above MON09 – ED performance returned to above 95% during January but is sensitive to the impact of increased emergency admissions. A community wide action plan has been agreed to ensure continued compliance with this standard but there remains a risk of non compliance during the quarter.

3.3 Finance The key areas of financial performance are as follows:

At month 10 a year to date surplus of £3.5m has been generated compared to a budgeted surplus of £2.5m. A year end surplus of £2.8m is forecast compared to the budgeted £3.5m.

£15.6m CIP has been achieved for the current year and £11.1m on a recurrent basis against a requirement of £17.1m.


A year to date Monitor Risk rating of 4 has been achieved but is forecast to be 3 at year end.

Clinical income is £0.1m under recovered year to date and is expected to be £0.8m adverse at year end.

Pay is under-spent by £316k year to date and is forecast to be £103k over-spent by year end. Non-pay is £884k over-spent at month 10 and forecast to be £1.1m over-spent by year end.

The Capital programme is £1.6m under-spent at month 10 and is expected to be £1.0m under-spent at year end.

3.4 Quality Key issues are:

The trustwide pressure sore assessment rate has improved in January and is above the 95% threshold.

There has been a small improvement in the compliance with initial assessment of nutritional screening (MUST). A further step increase has been observed in the early part of February following the Nutrition Matters campaign and active nurse leadership. Further improvement is necessary in the remainder of the quarter, in order to secure achievement of this CQUIN target in Q4.

Monthly spot audits of recording of VTE Risk Assessments are being undertaken to provide supplementary evidence to electronic recording of risk assessments. The Trustwide performance as measured by the electronic recording methodology was 80.12% in January, whereas the latest snapshot audit or practice demonstrates that the Trust is achieving 90.6%. Work is in progress through the VTE group, reporting to the Clinical Effectiveness Committee, to improve reporting of this target.

3.5 Human Resources Key issues are:

A reduction in the sickness absence rate. The sickness absence rate for the Trust for the twelve month period ending 31st December 2011 was 3.65%.

A decrease of 31.54 full time equivalents (FTE) in the Trust’s workforce to 4965.93 FTE; beneath the current funded establishment of 5154.65. Analysis of the volume of staff leaving the Trust indicates an elevated number of Band 5 registered nurses in December. Work is ongoing to collate the staff members’ stated reasons for leaving and their destination on leaving to enable the Trust to gauge the extent of any issues.

The rate of turnover for the twelve month period ending 30th November 2011 was 9.65%, a slight decrease on the position reported last month.

PDR compliance rates have improved, with the Trust target rate of 80% being achieved for the second consecutive month. A review of essential training compliance rates is being undertaken by Internal Audit. A position statement and Trustwide action plan will be submitted to the Governance Committee in March 2012.

4. FINANCIAL/OTHER IMPLICATIONS Achieving NHS plan targets and milestones is an important feature of the Trust’s


overall performance and demonstrates our commitment to delivering good quality care to patients. Commissioners have the discretion to apply financial penalties in respect of underperformance for the following targets:

Non-achievement of the Clostridium difficile target (depending on the degree of target underperformance, between 0.1% and 2% of the total contract year revenue), the standard contract allows for penalties to be applied where the current year outturn exceeds the number of cases identified in the previous contract year, by more than 2 cases. In order that the Trust is not disadvantaged by the introduction of the new testing methodology, it has been agreed to exclude the impact of the cases identified using the new testing methodology from both last year's baseline and this year's figures, for the purposes of financial and contract penalties. Based on current performance, the risk of penalties in 2011/12 is assessed as low.

Non-achievement of the referral to treatment time standard (depending on the degree of target underperformance between 0.5% and 5% of monthly elective care revenue). The risk of penalties, based on current performance is assessed as low, but there may be risks in Q4 as a result of cancellations in Q3. Depending on the degree of underperformance against the referral to treatment waiting time standard, this could equate to a maximum penalty of c£400k per month in relation to admitted patient care, or c£130k per month in relation to non-admitted patient care, but totalling no more than c£450k per month in aggregate.

each of the following cancer waiting times standards (2% of the actual outturn value of the service line revenue)

o 14 day urgent GP referral

o 14 day symptomatic breast

o 62 days first definitive treatment for GP urgent referral, NHS Cancer Screening Services and Consultant Upgrades

o 31 day first definitive treatment

o 31 day second or subsequent treatment (surgery)

o 31 day second or subsequent treatment (drug treatments)

o 31 day second or subsequent treatment (radiotherapy)

There may be a failure in any one month due to low volumes of cases. However as the penalties are viewed as relating to full year performance, the risk of financial penalties for 2011/12 is assessed as low.

breaches of the Eliminating Mixed Sex Accommodation Plan (£250 per breach per day). There have been no clinically unjustified breaches for first ten months of the financial year. The risk of penalties for 2011/12 above a very low financial value is assessed as low.

5. RECOMMENDATIONS The Board is asked to receive the Performance Report and note the progress that has been made together with any actions that are planned.


Graph YTD Indicator Current Source Report

R1 Red ↑ Accident and Emergency Maximum 4 Hour Wait Green Performance

R2 Amber → Clostridium Difficile Infections Green Performance

R3 Green → Cancer 31 Day Wait: Subsequent Treatment Green Performance

R4 Green → Cancer 62 Day Wait Green Performance

R5 Green ↓ Hand Hygiene Green Quality

R6 Amber ↓ New MRSA Isolates Red Quality

R7 Green → Referral to Treatment for Admitted Pathways Green Performance

R8 Green ↓ Referral to Treatment for Non-Admitted Pathways Green Performance


D1 Amber ↑ Outpatient New Attendances Amber Finance

D2 Green ↑ Elective Daycase Admissions Green Finance

D3 Amber ↓ Elective Inpatient Admissions Amber Finance

D4 Green ↓ Non-Elective Inpatient Admissions Green Finance

D5 Green ↑ Pressure Sores Assessment Green Quality

D6 Amber ↓ Pressure Sores Incidence Green Quality

D7 Red ↑ MUST Scoring Red Quality

D8 Amber → Capital Expenditure Amber Finance


E1 Amber ↓ Bank and Agency Spend All Staff Amber Human Resources

E2 Green → Cash Green Finance

E3 Green ↓ Cost Improvement Programmes Green Finance

E4 Green ↑ Income and Expenditure Green Finance

E5 Amber ↑ PDR/PDPs Completed & Essential Training Compliance Amber Human Resources

E6 Green → Risk Ratings Green Finance

E7 Green ↑ Sickness Absence Rate Green Human Resources

E8 Green ↑ Staff Employed Green Human Resources

E9 Amber → Staff Percentage Turnover Rate Amber Human Resources

E10 Amber ↓ Reason for Leaving Amber Human Resources

Red Off target or significant concerns re. achievement. Board to review exception report.

Amber Slightly off target or minor concerns re. achievement. Board to be aware, but no action required.

Green On target, no significant concerns re. achievement. No Board attention required.

→ Direction indicators point up for improvement, down for worsening and horizontal for no material change.

Deliver services in a comfortable, friendly environment in which staff can care for patients effectively.

Recognise our wider responsibility to the environment and local community by using resources wisely.

Respond

Integrated Performance Report - Summary Table

Be the provider of choice, delivering care in the most convenient and appropriate location, with no delay.

Eliminate all avoidable hospital infections.

Future and sustained success through good financial management.

Deliver

A high standard of care delivered by experts, which meets the needs and aspirations of patients, staff, carers and the

A full range of cost-effective accessible local hospital services.

A range of excellent specialist services.

Staff to have a good work/life balance, and achieve their full potential.

Staff to do their jobs to the best of their ability, by valuing them, ensuring they have the right skills and giving them the

opportunity to focus on meeting the needs of patients, so making the RD&E the employer of choice.

Enable

Additional Reported Indicators (by Exception)


Be the provider of choice, delivering care in the most convenient and appropriate location, with no delay.

Eliminate all avoidable hospital infections.

Deliver services in a comfortable, friendly environment in which staff can care for patients effectively.

Recognise our wider responsibility to the environment and local community by using resources wisely.

YTD Indicator Current YTD Indicator Current

R R1 - Accident and Emergency Maximum 4 Hour Wait G A R2 - Clostridium Difficile Infections G

G R3 - Cancer 31 Day Wait: Subsequent Treatment G G R4 - Cancer 62 Day Wait G

G R5 - Hand Hygiene G A

R6 - New MRSA Isolates Identified > 72 Hours After

Admission R

Quality Quality

Respond

Performance Performance

PerformancePerformance

0

1

2

3

4

5

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Average SPC +1sd

0

10

20

30

40

50

60

70

80

90

100

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v-1

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Jan

-12

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

Ap

r-1

0

May

-10

Jun

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Jul-

10

Au

g-1

0

Sep

-10

Oct

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No

v-1

0

Dec

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Jan

-11

Feb

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r-1

1

May

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-11

Jul-

11

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g-1

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v-1

1

Dec

-11

Jan

-12

% T

reat

ed

Wit

hin

4 H

ou

rs

Wonford WIC Attendance figures are

added to A&E position replacing

community MIU data from July 2011.

75%

80%

85%

90%

95%

100%

Ap

r-0

9

Jun

-09

Au

g-0

9

Oct

-09

Dec

-09

Feb

-10

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r-1

0

Jun

-10

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g-1

0

Oct

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-11

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r-1

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-11

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g-1

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Oct

-11

Dec

-11

% T

reat

ed

Wit

hin

31

Day

s

Subsequent Surgery Subsequent Radiotherapy

Radiotherapy Target introduced Jan-

11

95%

96%

97%

98%

99%

100%

Ap

r-0

9

Jun

-09

Au

g-0

9

Oct

-09

Dec

-09

Feb

-10

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r-1

0

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g-1

0

Oct

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-11

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r-1

1

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g-1

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Oct

-11

Dec

-11

% T

reat

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Wit

hin

31

Day

s

0

5

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15

20

25

Ap

r-0

9

Jun

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Au

g-0

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Oct

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r-1

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Jun

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Au

g-1

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Oct

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Dec

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Feb

-11

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r-1

1

Jun

-11

Au

g-1

1

Oct

-11

Dec

-11

Trust Attributed Infections Toxin Positive Tests Trajectory

New PCR Test

Introduced in

October 2010



G R7 - Referral to Treatment for Admitted Pathways G G R8 - Referral to Treatment for Non Admitted Pathways G

PerformancePerformance

0

5

10

15

20

25

Ap

r-1

0

May

-10

Jun

-10

Jul-

10

Au

g-1

0

Sep

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Oct

-10

No

v-1

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Dec

-10

Jan

-11

Feb

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-11

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r-1

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May

-11

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g-1

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-12

95

th P

erc

en

tile

(w

ee

ks)

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18

20

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r-1

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-10

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-10

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-10

No

v-1

0

Dec

-10

Jan

-11

Feb

-11

Mar

-11

Ap

r-1

1

May

-11

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-11

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g-1

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Sep

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-11

No

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Dec

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-12

95

th P

erc

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tile

(w

ee

ks)



A D1 - Outpatient New Attendances A G D2 - Elective Daycase Admissions G

A D3 - Elective Inpatient Admissions A G D4 - Non-Elective Inpatient Admissions G

G D5 - Pressure Sores Assessment G A D6 - Pressure Sores Incidence G

Current month vs plan: 17% below plan

17% lower than the same month last year

1% lower than the previous month

Year to date:17% lower than the same period in 2010-11

Year to date vs plan:12% below plan


4% lower the same month last year

5% lower than the previous month

Year to date: 2% lower than the same period in 2010-11

Year to date vs plan: 1% below plan

Deliver

Finance Finance

FinanceFinance

A high standard of care delivered by experts, which meets the needs and aspirations of patients, staff, carers and the

public.A full range of cost-effective accessible local hospital services.

A range of excellent specialist services.


4% higher than the same month last year

16% higher than the previous month

Year to date: same as the same period in 2010-11

Year to date: 9% below plan

Current month vs plan:11% higher than plan

11% higher than the same month last year

21% higher than the previous month

Year to date: 4% higher than the same period in 2010-11

Year to date vs plan: 4% above plan

Quality Quality

0

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20

30

40

50

60

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80

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100

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0%

5%

10%

15%

20%

25%

30%

Jan

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No

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6000

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8000

8500

9000

9500

10000

10500

11000

Jan

-09

Mar

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Jul-

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v-0

9

Jan

-10

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-10

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-10

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10

Sep

-10

No

v-1

0

Jan

-11

Mar

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11

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No

v-1

1

Jan

-12

Plan Actual

2000

2500

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3500

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4500

5000

5500

6000

Jan

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09

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v-0

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Jan

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Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

-11

Mar

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May

-11

Jul-

11

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-11

No

v-1

1

Jan

-12

Plan Actual

500

700

900

1100

1300

1500

1700

1900

2100

Jan

-09

Mar

-09

May

-09

Jul-

09

Sep

-09

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v-0

9

Jan

-10

Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Plan Actual

1500

1750

2000

2250

2500

2750

3000

3250

Jan

-09

Mar

-09

May

-09

Jul-

09

Sep

-09

No

v-0

9

Jan

-10

Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

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Mar

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May

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Jul-

11

Sep

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No

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1

Jan

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Plan Actual



R D7- MUST Scoring R A D8 - Capital Expenditure A

Spend YTD: £10.7m Planned Spend YTD: £12.3m

Forecast Y/E Spend: £15.6m Planned Y/E Spend: £16.7m

FinanceQuality

0

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20

30

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60

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100

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-12

Initial compliance with MUST Screening onAdmission

General compliance with MUST Screening atWeekly Review

0

2

4

6

8

10

12

14

16

18

£M

Month

Capital Spend

Capital Plan 11/12

Actual Capital Spend

Forecast Capital Spend

Elective inpatient activity is 12% below plan, but day case activity is 11% above plan (year to date). As day cases account for the majority of elective activity, the combined position is 0.7% below plan. Day cases are a more efficient way to deliver surgery and, in most cases, attract the same tariff income as inpatients. However, the cancellations of elective cases experienced through the winter has led to pressure on the admitted waiting time targets and additional elective activity will be required in Q4 2011/12 and the first half of 2012/13 to sustainably achieve these targets in every specialty.



A E1 - Bank, Agency & Overtime Spend All Staff A G E2 - Cash G

G E3 - Cost Improvement Programmes G G E4 - Income and Expenditure G

A E5 - PDR/PDPs Completed & Essential Training Compliance A G E6 - Risk Ratings G

ESR is used for the purpose of recording and reporting PDR activity excluding Medical and Dental staff.

Actual Surplus YTD: £3.5m Plan Surplus YTD: £2.9m

Forecast Surplus Y/E: £2.8m Plan Surplus Y/E: £3.5m

Actual Efficiency: 0.80% Planned Efficiency: 1.03%

FinanceFinance

The above chart indicates the amount of spend relating to staff registered on the bank, staff

supplied by agencies and overtime worked by substantive staff.

Research and innovation.

FinanceHuman Resources

Enable

Human Resources Finance

Staff to do their jobs to the best of their ability, by valuing them, ensuring they have the right skills and giving them the

opportunity to focus on meeting the needs of patients, so making the RD&E the employer of choice.

Staff to have a good work/life balance, and achieve their full potential.

Future and sustained success through good financial management.

Cash in hand and at bank: £55.3m

Working Capital Facility: £0m

Cash Invested @ Month End: £43.0m

£0

£50,000

£100,000

£150,000

£200,000

£250,000

£300,000

£350,000

£400,000

Dec-1

0

Jan-1

1

Feb-1

1

Mar-

11

Apr-

11

May-1

1

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Agency Bank Overtime

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Jan-1

1

Feb-1

1

Mar-

11

Apr-

11

May-1

1

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Jan-1

2

PDR Equality & DiversityFire Infection ControlManual Handling

-3,000

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

April

May

June

July

August

Septe

mber

Octo

ber

Novem

ber

Decem

ber

January

Febru

ary

Marc

h

Month

£

Actual

Plan

Risk Ratings

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

EBITDA Margin

EBITDA % Achieved

ROA

I&E Surplus Margin

Liquidity

Overall Rating

Plan YTD

Actual YTD

Plan Y/E

Forecast Y/E

Other Ratios Plan YTD Actual YTD Plan Y/E Forecast Y/E

Trade Creditor Days 6.3 8.7 6.4 6.2

NHS Trade Debtor Days 9.7 9.6 8.9 9.4

Debt to Asset Ratio 6.5% 6.6% 6.3% 6.5%

Other items £ £ £ £

Revenue available for debt service 19.8m 20.6m 23.9m 23.1mDebt 20.8m 20.8m 20.2m 20.2m

Total Assets 319.8m 318.1m 321.9m 309.3m

0

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mber

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ber

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h

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£m

CIP Plan

CIP Actual

CIP Forecast

12 Month forecast cashflow v plan

(20)

(10)

-

10

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Ap

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y-1

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p-1

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Oc

t-1

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No

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Dec

-11

Ja

n-1

2

Feb

-12

Ma

r-12

Month

£M

Plan

Actual

Forecast

Commited Facility



G E7 - Sickness Absence Rate G G E8 - Staff Employed G

A E9 - Staff Percentage Turnover Rate A A E10 - Reason for Leaving A

The total FTE has decreased by 31.54 to 4965.93. This is below the funded FTE establishment of

5154.65. Headcount has decreased by 32 to 5746.The cumulative rate for 12 months to 31st December 2011 is 3.65%.

Human Resources Human Resources

Human ResourcesHuman Resources

The turnover rate of 9.63% for the combined 12 month period to end of December 2011 is

higher than the 8.70% for the equivalent period last year. Based on FTE for all staff groups (excludes Bank workers)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Dec-1

0

Jan-1

1

Feb-1

1

Mar-

11

Apr-

11

May-1

1

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Long Term Medium Term Short Term

0%

2%

4%

6%

8%

10%

12%

Dec-1

0

Jan-1

1

Feb-1

1

Mar-

11

Apr-

11

May-1

1

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Substantive Staff

Substantive less retirements

Predicted Substantive less retirements

0

20

40

60

80

100

120

140

160

180

Dec-1

0

Jan-1

1

Feb-1

1

Mar-

11

Apr-

11

May-1

1

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Dismissal End of Fixed Term Contract

Retirement Voluntary Resignation

4,800

4,900

5,000

5,100

5,200

5,300

5,400

Dec-1

0

Jan-1

1

Feb-1

1

Mar-

11

Apr-

11

May-1

1

Jun-1

1

Jul-11

Aug-1

1

Sep-1

1

Oct-

11

Nov-1

1

Dec-1

1

Contracted FTE Funded FTE

Worked FTE


Finance FINANCIAL REPORT FOR THE TRUST COVERING THE PERIOD

ENDING 31ST JANUARY 2012

Executive Summary

The Trust has generated a year to date surplus at month 10 of £3.5m compared to a budgeted surplus of £2.5m and a planned surplus of £2.9m. At year end the Trust is forecasting a surplus of £2.8m compared to the budgeted and planned surplus of £3.5m. The year to date surplus is an improvement on last month’s report by £900k, the surplus was budgeted to improve during January by £836k. Further improvement has been seen mainly due to an over recovery on income and a reduction in expected pay spend. The year end forecast has improved by £941k compared to last months report due to similar improvements seen in the year to date position. This position gives the Trust a Monitor Financial Risk Rating of 4 year to date and forecast to drop to 3 at year end in line with plan. Please note all variances given below are compared to budget.

INCOME Clinical income at month 10 is £111k under recovered which is a £356k improvement on last month’s report. The forecast is £785k adverse and is also an improvement on that reported at month by £293k. Both year to date and forecast improvements have been seen mainly within Critical Care (due to increased ICU activity) and Women & Childs’ Health (partly in Gynaecology but mainly due to an increase in non-elective events in Maternity). At month 10 (based on 9 months actual activity) the contract with NHS Devon is £1.6m over recovered. It is expected all areas of over performance will be settled by the relevant commissioner (please see Receivables section below for further details). Winter pressures and the cancellation of elective work have started to reduce along with the risk of not meeting the Refer to Treat (RTT) target for quarter 4. At present plans are being formulated in conjunction with NHS Devon on ensuring all elective patients can be treated within the RTT target by specialty. The majority of these plans are expected to start next financial year. The main Divisional over/under performances year to date (for all Commissioners) are;

Women & Childs’ Health continues to be the main area to over recover (£1.5m). Gynaecology planned activity is the main specialty to over-perform by £944k. This is

YTD Month 10 YTD Month 9 Change

£’000 £’000 £’000

I&E year to date 3,537 2,652 885

I&E Forecast 2,790 1,849 941

I&E year end forecast variance to budget/Plan

-710 -1,651 941

Total Income variance to date 413 -79 492

CIP variance to date -525 117 -642

Pay expenditure variance to date 316 -7 324

Non pay (excl. R&D) expenditure variance to date

-884 -779 -105

Cash at month end 55,256 49,228 6,028


due to day-cases activity treating 29% more patients than budgeted. Midwife activity is another area to over recover £844k due to approximately 536 more non elective patients being treated than budgeted.

The Surgery Division continues to be the main area to under-perform by £1.2m. General Surgery (£664k) is one of the main areas due to elective activity being 23% down on budget. Thoracic Surgery (£523k) is the other main area to under recover also treating less elective activity than budgeted (46%).

Trauma & Orthopaedics Directorate is another area to under-perform compared to budget (£1.1m). Orthopaedic elective is 16% down compared to budget which is mainly due to cancelling work as a result of winter pressures.

EXPENDITURE At month 10 pay is £316k underspent which is an improvement by £324k on the position reported at month 9. The forecast position on pay has also improved by £102k to a forecast overspend of £103k. The deterioration between the year to date and forecast is due to additional spend forecast on nursing due to the increased emergency activity experienced during December and is forecast to continue. Admin & Clerical (A&C) staff is the main area to under-spend year to date by £804k, this is partially offset by spend on agency staff (£315k). Following the A&C review it is likely that a significant portion of underspend will transfer to CIP. Further under-spends are occurring within technical/Estates officers (£266k) and domestics (£282k) budgets. This is being offset by an over-spend on Non NHS staff (£311k, excluding A&C mentioned above), medical staffing (£260k) and nursing/bank/agency nurses (£452k). Non-pay expenditure at month 10 is over-spent by £884k year to date which is a deterioration on last month’s report by £105k. The forecast year end position on non pay is £1.1m adverse which is comparable to the month 9 report. The main areas to under/over-spend year to date are as follows:

Spend on drugs (not those rechargeable back to the Commissioners) continues to be below budgeted levels, £347k favourable. This is mainly due to blood usage across the Trust being lower than planned.

Clinical supplies is an area over-spending by £307k with activity related spend in Medicine, Radiology and Women and Childs’ Health the main reason.

Maintenance contractor costs are over-spent by £437k with spend across the Trust but mainly within the Trust’s Estates Departments (£285k RD&E Estates, £70k Community Estates which is recoverable).

Electricity expenditure at month 10 is £210k over budget, this is partially offset with underspends on gas and oil (£160k).

COST IMPROVEMENT PROGRAMME (CIP)

Current Year Savings of £15.6m have been achieved at month 10 for the year so far. £7.0m has been generated via the 10 work streams and a further £8.6m has been generated centrally. The remaining requirement of £1.6m to meet the £17.1m target is expected to be generated by year-end. Recurrently On a recurrent basis £11.1m of savings have been achieved, £8.4m via the 10 work streams and £2.7m centrally. A further £6m of savings is forecast to be achieved by year end. Of the £2.6m currently shown as unidentified in appendix 7, £1.5m is expected to be achieved by service lines, with a further £400k generated through MARS. The remaining shortfall of £700k is expected to be identified and delivered by year end. The level of unidentified


schemes reflects in part a decision taken earlier this year to reduce the savings from the number of beds given the operational pressure on the hospital. In addition to the £700k shortfall there remains £250k which is categorised as high risk in relation to medical staffing. Please refer to appendix 7 for more detail on the 10 CIP work streams.

CAPITAL

Actual capital expenditure for the first ten months of the year was £10.7m in comparison to £12.3m in the plan. Capital expenditure is therefore £1.6m lower than planned, representing 13% of planned capital expenditure (excluding the University’s RILD capital additions, capital expenditure would be £2.9m lower than planned representing a 24% capital slippage). Capital expenditure for the year is now forecast to be £15.6m, which is £1m less than plan. The forecast capital additions represent a 6% capital plan reduction (excluding the University’s RILD capital additions, capital expenditure is forecast to be £2.8m lower than planned representing a 17% capital slippage). Guidance has been received from the Trust’s external auditors on the accounting treatment of the RILD building. The University’s element of the building should be classed in the Trust’s assets under construction additions until the asset is brought into use. When brought into use the University’s element will be disposed of and their contribution towards the building costs will be treated as the sale proceeds, therefore no loss on disposal is expected. Appendix 6 provides details of expenditure variances for capital schemes in excess of £1 million. There is a risk that capital expenditure could slip further as several large capital schemes are forecast to incur expenditure in March 2012. The annual plan included an estimated 5% increase in the value of land and buildings as at 31 March 2012. The District Valuer has advised that there will be a small fall in value for land and buildings. The change in value is not considered sufficiently material to require the Trust to revalue its land and buildings and the forecast position therefore no longer includes a change in valuation. The Trust’s external auditors have been advised.

RECEIVABLES

Receivables are £2.4m higher than budget and £2.0m higher than plan. Receivables include £2.4m of income due from NHS Devon relating to the variance for additional activity between periods 1 to 8, this amount is now overdue. NHS Devon have been requested to settle this debtor.

CASH

The cash balance at the end of January is £55.3m, which is very similar to the budget and plan (£55.8m).

INVESTMENTS The above cash includes £43m of investments placed with permitted financial institutions in accordance with the Treasury Management Policy approved by the Board. See below table for further details.


Investor £m Interest rate Period Return date

Barclays Bank £10m 0.72% 54 days 23/3/2012 NatWest Bank £3m 1.18% 90 days 90 days notice National Loans Funds £15m 0.48% 89 days 5/3/2012 National Loans Funds £5m 0.42% 18 days 16/2/2012

Nationwide B/Soc £10m 0.57% 26 days 24/2/2012

Total £43m

As at 3 February 2012, a total of £63m of investments had been placed. An additional £13m was invested with National Loans Funds and £7m with the Nat West Bank.

The Board of Directors approved, in November 2011, permitted financial institutions that the Trust may place investments with subject to them meeting credit rating requirements. Lloyds Bank no longer complies with the agreed short and long term Standard and Poors credit rating criteria, as set by the Board of Directors, as it has been down graded to short term A-2 (minimum requirement per the Treasury policy A-1) and long term A- (minimum requirement per the Treasury policy A). This has reduced the approved investment options available to the Trust

ACTIVITY Outpatient and day-case activity for January is higher than that delivered in December (16% and 21% respectively) with elective and non-elective inpatient activity lower (1% and 5% respectively). Compared to January 2011 this January has seen a similar trend with higher activity for outpatients and day-cases (4% and 11% respectively) and lower activity for elective and non-elective inpatients (17% and 4% respectively). So far for the year compared to the first 10 months of last year outpatient activity has been virtually the same. For day-cases 4% more patients have been treated and for both elective and non-elective inpatients fewer patients have been treated (17% and 2% respectively) Compared to plan, for the year to date with the exception of day-cases (4% above plan), outpatient, elective and non elective inpatient activity are below plan (9%, 12% and 1% respectively). This trend is the same for January activity with day-cases 11% above plan, outpatients 6% below, elective inpatients 17% below and non-elective 1% below plan. Referrals for January are 4.72% (448 referrals) higher than January 2011, however referrals for the first 10 months of the year are 2.12% lower than the first 10 months of last year. This trend compares to last months report of 2.84%.

OTHER ISSUES Service Line Reporting Appendix 8 shows a surplus/deficit analysis by Directorate and is based on a Service Line Reporting perspective. It should be noted the figures relate to the Month 9 position. As the year unfolds SLR reporting reflects how profitability across Directorates shifts during the year, for example as a result of winter pressures where elective surgery is cancelled and income reduced. Of greatest interest is the deficit shown for Medicine with the Care of the Elderly Service Line being of greatest concern. The Finance department in conjunction with the Service line have undertaken rigorous investigation to refine and understand the position and some valuable lessons have been learned which will be used to improve accuracy of the SLR financial reporting in future months. However, the SLR financial reporting for Care of the Elderly will continue to show significant deficit which will now be examined further as part of


Fit for the Future in 2012/13. More work is needed to understand the loss making nature of the activity and what can be done to improve the position. Other services which have reported deficit positions will also be required to achieve improvements in financial performance going forward. An action plan of work around the next phase of the SLR/SLM agenda has now been agreed by the SLM Project Board. Planned developments include extending the scope of SLR to include the Diagnostics Directorate in order to drive financial improvement in this area through a focus on demand management and financial performance. Improving performance management information and systems is a key part of the action plan and will require considerable focus and effort if the move towards SLM is to be successful. The plan sets out a timetable of work to draft an SLM Framework and task and finish groups are being established to progress this work urgently so that consultation and pilots can follow later in the year.

Month 9 Foundation Trust Consolidation Schedules (FTCS)

The Trust was required to prepare FTCS for the nine month period ending 31 December 2011. The FTCS are equivalent in content to preparing full statutory accounts and also include additional information relating to inter NHS balances and transactions and further information requested by Monitor to assist with their accounts consolidation. The FTCS were submitted to Monitor in January and February in accordance with Monitor’s timetable.

CONCLUSION

The key areas of financial performance are as follows:

At month 10 a year to date surplus of £3.5m has been generated compared to a budgeted surplus of £2.5m. A year end surplus of £2.8m is forecast compared to the budgeted £3.5m.

£15.6m CIP has been achieved for the current year and £11.1m on a recurrent basis against a requirement of £17.1m.

A year to date Monitor Risk rating of 4 has been achieved but is forecast to be 3 at year end.

Clinical income is £0.1m under recovered year to date and is expected to be £0.8m adverse at year end.

Pay is under-spent by £316k year to date and is forecast to be £103k over-spent by year end. Non-pay is £884k over-spent at month 10 and forecast to be £1.1m over-spent by year end.

The Capital programme is £1.6m under-spent at month 10 and is expected to be £1.0m under-spent at year end.


Performance

BOARD EXCEPTION REPORT

CORPORATE TARGET NUMBER & DESCRIPTION:

Cancer Waiting Times

CURRENT CORPORATE RATING:

RESPONSIBLE DIRECTOR: Chief Operating Officer

Brief description of how the rating was derived – All Cancer Two week wait

Maximum two week wait from urgent GP referral for suspected cancer to first hospital assessment.

Background & Contributing factors

Prior to December 2011, haematuria referrals could either be referred under the 2WW system or as a routine new referral if the consultant and GP agreed the risk of cancer was minimal. In December 2011 the Urology team amended their booking rules to be in line with NICE guidance which advised that all patients presenting with haematuria should be referred under the 2WW rules.

The overall demand did not rise but the 2WW demand saw a sharp rise in December 2011 & January 2012. Urology have got past this one-off increase it is not anticipated that there should be any further problems meeting this demand.

Details of actions necessary to return performance back to either good or excellent

Action Dept responsible

Timescale Progress

Increased Endoscopy Capacity for Urology 1 stop haematuria clinic

Endoscopy 24/02/2012 An additional endoscopy clinic was held on the 3rd February and a further additional clinic has been arranged on the 24th February to accommodate the increased one-off demand following the reclassification of urgent patients to 2 week wait patients. The Clinical Service Manager (CSM) for Urology will monitor the demand for the haematuria clinic and in the event of any capacity issues will work with endoscopy to create an additional clinic within 1 week to accommodate the demand.

Increased ultrasound capacity for Urology1 stop haematuria clinic

Radiology 24/02/2012 Support for the additional clinics above has been arranged. The CSM for Urology will arrange for additional ultrasound support for any haematuria clinic created to accommodate increased demand.

Extra outpatient clinic and Surgery / 06/02/2012 In order to mitigate any risk


corresponding ultrasound support for a 2 stop haematuria service. This is an interim measure and only necessary for a small number of patients to get past the temporary increase in 2 week wait demand.

Radiology Completed

where endoscopy capacity and ultrasound capacity cannot be implemented at the same time extra slots have created during February by implementing a 2 stop service where patient with ultrasound is seen by consultant first and then referred for cystoscopy if clinically indicated. This is not a long term solution and will only be implemented if all other actions fail.


Quality MUST Scoring There has been some improvement in this measure from last month to 78% but the Trust is currently falling short of the Q4 CQUIN target in this area. The target for Q4 (90%) is significantly higher than that for Q3 (78%). There has been an increase in performance in the early part of February to 88% following the Nutrition Matters campaign and active nurse leadership. Extra support has been provided to ensure the Matron on AMU gives dedicated time to securing improvement for patients on admission to AMU. Whilst challenging, nursing staff are striving to sustainably achieve this target, accepting the clinical importance for patients of robust nutritional assessment on admission. MRSA Isolates There has been an increase in the number of MRSA isolates identified on patients who have been in hospital for more than 72 hours. These have been examined and have been cross-correlated with other ward level infection control indicators. There are no significant patient safety risks currently associated with the increase in this indicator as it does not relate to MRSA bacteraemia but any MRSA identified from a specimen greater than 72 hours after admission. This does not necessarily indicate infection or that it is hospital acquired. Electronic VTE Risk Assessment The target for this is 90% and currently the electronic reporting against this indicator is showing the Trust is achieving 80%. However, the latest snapshot audit of practice demonstrates that the Trust is achieving 90.6%. Work is in progress through the VTE group (accountable to the Clinical Effectiveness Committee) to improve electronic reporting of this target. Pressure Sores Assessment Pressure Ulcer Risk Assessment has improved in January and is back above the 95% threshold following a three month dip in performance.


Human Resources

Sickness Absence It is pleasing to report the sickness absence rate has dropped to 3.65% from the 3.79% reported last month. As a result of the measures introduced to manage sickness absence this shows a significant reduction on the January 2011 rate of 4.25%. This reduction represents an estimated saving of £500,000.

Turnover The annual rate of turnover for December 2011 of 9.63% shows a small drop in the rate reported last month and continues the trend over the last six months. The rate of turnover for substantive staff leaving the organisation for reasons other than retirement is 5.26% and this compares favourably with the anticipated rate of 5%.

Staff Numbers After the increase in contracted staffing numbers reported last month the December 2011 figure has decreased by 31.54 FTE’s to 4965.93. This is still less than the funded FTE of 5154.65. Total headcount is now 5746, a decrease of 32 from last month. During the month of December 65 staff, 16 of which were Band 5 Registered Nurses, left the Trust and this contributed to the reduction in staffing numbers. Based on the six months prior to December the average number of Band 5 Registered Nurses leaving the Trust was 7 a month. Given the increase reported this month, work is ongoing to ensure data collected around reason for leaving and destination on leaving is complete and accurate to enable the Trust to gauge the extent of this problem. The number of staff employed on fixed term contracts ending in the next twelve months has continued to rise with 345 staff (284.67 FTE) recorded at the end of December 2011.

Bank, Agency & Overtime Spend The December 2011 agency spend is almost double the amount recorded last month with the Medical Directorate accounting for the majority of the increase. This is due to the staffing by substantive employees of the escalation wards set up to alleviate winter bed pressures. These staff are ‘back filled’ by agency nurses. In contrast, both bank and overtime spend show a small reduction on the last months reported amounts.

Personal Development Reviews (PDRs) and Essential Training Compliance After last month’s success in reaching the Trust PDR target rate of 80% the December 2011 rate shows a further small increase. The compliance rate for Manual Handling however has reduced, with a reported rate for December of less than 60%, subject to a data validation project to check the accuracy of this figure. This project is due to be completed by the end of March. All other Trustwide essential training rates have remained fairly static this month, although Fire and Infection Prevention and Control continue to have rates below the Trust target rate of 80%. In order to improve the Trust’s compliance rates, Internal Audit have been instructed to identify any variances between central ESR records and those held locally at directorate level. This will establish whether training has taken place but not recorded on ESR. Where there are areas of low compliance, those directorates will be asked to submit an action plan. A position statement and Trustwide action plan will be submitted to the Governance Committee in March.


Data Appendices – Performance

IndicatorPosition for

QuarterTarget

Monitor

Weighting

Risk for

Period

Risk for

YearIndicator

Position for

Quarter

Target for

Period

Monitor

Weighting

Risk for

Period

Risk for

Year

Indicates that the target has been achieved for the quarter Indicates that the target has been achieved for that month but the quarter has not yet finished

Indicates that the target has not been achieved for the quarter Indicates that the target has not been achieved for that month but the quarter has not yet finished

Indicates that the target is not yet enforced

1 MON01 - Clostridium Difficile - The Department of Health are currently reviewing the impact of increased testing. This target may be subject to change.

Low Lowmin. 96%

MON11

Learning Disability

Compliance

The position for Cancer targets is subject to change when the data is uploaded to the National Cancer Waiting Times Database 6 weeks after month end.

Trend graphs run from April 2010 to current month

96.9%

(6 of 195)0.5 Compliant

Monitor Dashboard - January 2012

Trend Trend

MON01

Clostridium

Difficile1

7 (19)max. 74

annualHigh Very Low

Not Set

MON07

Cancer 31 Day

First Treatment

1.0

max. 3

annual0 (0)

MON03.I

Cancer 31 Day

Subsequent

Surgery

100.0%

(0 of 17)min. 94% Low

min. 98%

1.0

Medium

Medium

MON03.III

Cancer 31 Day

Subsequent

Radiotherapy

min. 94% Low

MON03.II

Cancer 31 Day

Subsequent Drug

100.0%

(0 of 88)

96.5%

(5 of 143)

MON02

MRSAMedium

High

MON08.I

Cancer 14 Day

GP Urgent

92.1%

(60 of 763)

Medium

Medium

MON08.II

Cancer 14 Day

Symptomatic Breast

96.1%

(2 of 51)Very Low

0.5

min. 93%

Not Set

Not Set Not Set

min. 93% Low

Very Low

95th Percentile

max.

4 hours

Not Set4.0MON09.I

A&E - Total Time2

MON05

RTT Admitted

95th Percentile

Medium

High 1.7%1.0

MON09.IV

A&E - Unplanned

Reattendance Rate2

MON09.III

A&E - Time to

Treatment Decision2

18.9

min. 85%

MON09.II

A&E - Time to Initial

Assessment2

Medium

1.0 Low

MON06

RTT Non-Admitted

95th Percentile

MON04.II

Cancer 62 Day

Screening

94.4%

(1 of 18)

Medium

1.0

min. 90% Medium

MON04.I

Cancer 62 Day

GP Urgent

85.0%

(15.5 of

103.5)

95th Percentile

max.

23 weeksmax. 5%

37.0

18.0

Median

max.

60 minutes

7.2% max. 5%

95th Percentile

max.

15 minutes

MON10

Stroke IndicatorLow15.1

95th Percentile

max.

18.3 weeks

Low

MON09.V

A&E - Left Without

Being Seen2

Medium

Very LowVery Low

n/a Not known

0.5

Not Set

Compliant

Not Set

Not applicable

1.0

0.5 for each

indicator

failure

capped at a

maximum of

1.0

0.5

Not Set

Not Set

Not Yet Defined Not Set

2 MON09.I to MON09.V - Following amendments to the 2011/12 Operating Framework Monitor sent a letter to Foundation Trusts on the 2nd August 2011 with the subject Changes to A&E indicator in the 2011/12 Compliance Framework which stated that the A&E performance will be assessed on the number

of patients treated within 4 hours but unlike the previous A&E target this would become site specific. The 5 Clinical Indicators for A&E will still need to be monitored but are now no longer part of the Compliance Framework.

Not Set Not Set

MediumMON09

A&E - 4 Hour Target96.0% min. 95% 1.0 Medium


Code Target Jan-12 Q1 Q2 Q3 Q4 Weighting PositionRisk for

Quarter

Risk for

Year

MON01 74 7 (7) 27 (18) 26 (18) 17 (19) 7 (19) 1.0 Achieving High High

MON02 3 0 (0) 0 (1) 1 (1) 0 (1) 0 (0) 1.0 Achieving Medium Medium

surgeryMON03.I 94%

100.0%

(0 of 17)

97.4%

(4 of 153)

98.8%

(2 of 162)

96.8%

(4 of 125)

100.0%

(0 of 17)Low Medium

anti cancer drug

treatmentsMON03.II 98%

100.0%

(0 of 88)

99.5%

(1 of 203)

99.6%

(1 of 225)

100.0%

(0 of 200)

100.0%

(0 of 88)Low Medium

radiotherapyMON03.III 94%

96.5%

(5 of 143)

99.0%

(3 of 314)

98.8%

(4 of 320)

99.4%

(2 of 344)

96.5%

(5 of 143)Low Medium

from urgent GP referral to

treatment MON04.I 85%

85.0%

(15.5 of

103.5)

86.1%

(41 of

294.5)

85.9%

(38.5 of

273.5)

85.9%

(40 of 283)

85.0%

(15.5 of

103.5)

Medium Medium

from consultant screening

service referralMON04.II 90%

94.4%

(1 of 18)

94.9%

(2 of 39.5)

92.9%

(3 of 42)

91.7%

(4 of 48)

94.4%

(1 of 18)Medium Medium

admitted pathways MON05 23 weeks 18.9 19.3 18.0 18.1 18.9 1.0 Achieving High Medium

non-admitted pathways MON06 18.3 weeks 15.1 14.0 14.3 14.9 15.1 1.0 Achieving Low Low

MON07 96%96.9%

(6 of 195)

98.1%

(12 of 639)

98.0%

(12 of 598)

98.5%

(8 of 545)

96.9%

(6 of 195)0.5 Achieving Low Low

all cancers

MON08.I 93%92.1%

(60 of 763)

96.3%

(93 of 2484)

94.7%

(124 of

2357)

95.0%

(121 of

2435)

92.1%

(60 of 763)Low Very Low

for symptomatic breast

patients (cancer not

initially suspected)

MON08.II 93%96.1%

(2 of 51)

100.0%

(0 of 136)

99.2%

(1 of 123)

98.3%

(2 of 116)

96.1%

(2 of 51)Very Low Very Low

MON09 95% 96.0% 96.5% 95.8% 93.7% 96.0% 1.0 Achieving Medium Medium

A&E Clinical Quality Indicators 2 Total time in A&E (95th

percentile)MON09.I ≤4 hrs 4.0 4.8 4.3 5.0 4.0

Not Yet

ImplementedNot Set Not Set

Time to initial assessment

(95th percentile)MON09.II ≤15 mins 18.0 29.0 22.0 19.0 18.0

Not Yet


Time to treatment decision

(median)MON09.III ≤60 mins 37.0 45.0 41.0 40.0 37.0

Not Yet


Unplanned reattendance

rateMON09.IV ≤5% 7.2% 8.2% 7.3% 7.5% 7.2%

Not Yet


Left without being seenMON09.V ≤5% 1.7% 2.8% 2.6% 2.7% 1.7%

Not Yet


MON10 tbc 0.5 Not Known Not Set Not Set

Patient

experienceMON11 n/a 0.5 Achieving Very Low Very Low

Quality

Monitor Targets Detail - January 2012

Indicator

Clostridium Difficile – meeting the Clostridium Difficile objective1

MRSA – meeting the MRSA objective

Not yet defined

Safety

Quality

Referral to treatment waiting times – (95th

percentile)

Patient

experience

All cancers: 62-day wait for first treatment

Stroke Indicator

Achieving

Achieving

Currently Not

Achieving

1.0

1.0

All cancers: 31-day wait for second or subsequent

treatment

2 MON09.I to MON09.V - Following amendments to the 2011/12 Operating Framework Monitor sent a letter to Foundation Trusts on the 2nd August 2011 with the subject Changes to A&E indicator in the

2011/12 Compliance Framework which stated that the A&E performance will be assessed on the number of patients treated within 4 hours but unlike the previous A&E target this would become site

specific. The 5 Clinical Indicators for A&E will still need to be monitored but are now no longer part of the Compliance Framework.

The position for Cancer targets is subject to change when the data is uploaded to the National Cancer Waiting Times Database 6 weeks after month end.1MON01 - Clostridium Difficile - The Department of Health are currently reviewing the impact of increased testing. This target may be subject to change.

All cancers: 31-day wait from diagnosis to first treatment

Cancer: two week wait from referral to date first

seen

0.5

Certification against compliance with requirements regarding access to

healthcare for people with a learning disabilityCompliant

0.5 for each indicator

failure capped at a

maximum of 1.0

4 Hour Target A&E


Data Appendices – Finance

Actual Surplus YTD Plan Surplus YTD Spend YTD Planned Spend YTD

£3.5m £2.9m £10.7m £12.3m

Forecast Surplus Y/E Plan Surplus Y/E Forecast Y/E Spend Planned Y/E Spend

£2.8m £3.5m £15.6m £16.7m

Actual Efficiency* Planned Efficiency*

0.80% 1.03%

Other Ratios Plan YTD Actual YTD Plan Y/E Forecast Y/E

Trade Creditor Days 6.3 8.7 6.4 6.2

NHS Trade Debtor Days 9.7 9.6 8.9 9.4

Debt to Asset Ratio 6.5% 6.6% 6.3% 6.5%

Other items £ £ £ £

Revenue available for debt service 19.8m 20.6m 23.9m 23.1mDebt 20.8m 20.8m 20.2m 20.2m

Total Assets 319.8m 318.1m 321.9m 309.3m

Cash in hand and at bank £55.3m

Working Capital Facility £0m

Cash invested @ Month End £43.0m

*(planned surplus / planned operating income *100)

*(forecast surplus / forecast operating income *100)

4. Cash 6. WTE

RD&E Financial Overview as at 31st january (YTD - Month 10)1. I&E 3. Capital 5. Ratios/Risk Rating

Graph – Capital Plan Vs Actual and forecast spend

2. CIP

Graph – Actual, Forecast & Plan

AP

PE

ND

IX 1

CIP Plan v Actual

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Apr

ilM

ayJu

neJu

ly

Aug

ust

Septe

mbe

r

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febru

ary

Mar

ch

Month

£m

CIP Plan

CIP Actual

CIP Forecast

Contracted WTE, Worked WTE & Funded WTE

4700

4800

4900

5000

5100

5200

5300

5400

M7-

10/1

1

M8-

10/1

1

M9-

10/1

1

M10

-10/

11

M11

-10/

11

M12

-10/

11 M1

M2

M3

M4

M5

M6

M7

M8

M9

M10

M11

M12

Month

WT

E

Worked WTE

Contract WTE

Funded WTE

Annual Plan

WTE

Risk Ratings

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

EBITDA Margin

EBITDA % Achieved

ROA

I&E Surplus Margin

Liquidity

Overall Rating

Plan YTD Actual YTD Plan Y/E Forecast Y/E

Comparison of actual cumulative net surplus/deficit compared to plan

-3,000

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

Apr

ilM

ay

June Ju

ly

Aug

ust

Sep

tem

ber

Octob

er

Nov

embe

r

Dec

embe

r

Janu

ary

Febru

ary

Mar

ch

Month

£

Actual

Plan0

2

4

6

8

10

12

14

16

18

£M

Month

Capital Spend

Capital Plan 11/12

Actual Capital Spend

Forecast Capital Spend

(20)

(10)

-

10

20

30

40

50

60

70

80

Ap

r-1

1

Ma

y-1

1

Ju

n-1

1

Ju

l-11

Au

g-1

1

Sep

-11

Oc

t-11

No

v-11

Dec-11

Ja

n-1

2

Fe

b-1

2

Ma

r-1

2

£M

Month

12 Month forecast cashflow v plan

Plan

Actual

Forecast

Commited Facility


Overall : Year to Date 1% down compared to similar period in 1011

OP 1st Attendances ● Current Month 6% below plan. Daycase 1st FCEs ● Current Month 11% above plan

●4% higher than the same month last year ●11% higher than the same month last year

● 16% higher than previous month ●21% higher than the previous month

● Year to Date same as same period in 1011

● Year to Date 4% above than same period in

1011.

● Year to date 9% below plan. ● Year to date 4% above plan.

Elective IP 1st

FCEs ● Current Month 17% below plan.

Non Elective IP 1st

FCEs ● Current Month 5% below plan.

●17% lower than the same month last year ● 4% lower than same month last year

● 1% lower than previous month ● 5% lower than previous month

● Year to Date 17% lower than the same

period in 1011.

● Year to Date 2% lower than same period in

1011.

● Year to date 12% below plan. ● Year to date 1% below plan.

RD&E Activity Overview as at 31 January 2012 (YTD - Month 10)

Day Case 1st FCEs

2000

2500

3000

3500

4000

4500

5000

5500

6000

Jan

-09

Mar

-09

May

-09

Jul-

09

Sep

-09

No

v-0

9

Jan

-10

Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Plan Actual

Non-Elective IP 1st FCEs

1500

1750

2000

2250

2500

2750

3000

3250

Jan

-09

Mar

-09

May

-09

Jul-

09

Sep

-09

No

v-0

9

Jan

-10

Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Plan Actual

Elective IP 1st FCEs

500

700

900

1100

1300

1500

1700

1900

2100

Jan

-09

Mar

-09

May

-09

Jul-

09

Sep

-09

No

v-0

9

Jan

-10

Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Plan Actual

OP 1st Attendances

6000

6500

7000

7500

8000

8500

9000

9500

10000

10500

11000

Jan

-09

Mar

-09

May

-09

Jul-

09

Sep

-09

No

v-0

9

Jan

-10

Mar

-10

May

-10

Jul-

10

Sep

-10

No

v-1

0

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Plan Actual


Royal Devon & Exeter NHS Foundation Trust Prior Yr

Actual Budget Actual Annual Actual Actual Budget Actual Annual Actual Mar-11

Income Statement Variance Plan Variance Variance Plan Variance Actual

Period ending 31/01/2012 to Budget to Plan to Budget to Plan

Month 10 Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Income

NHS Clinical Income 237,703 237,814 (111) 1 232,691 5,012 284,674 285,459 (785) 1 278,936 5,738 1 287,191

Private patient income 826 952 (126) 954 (128) 1,025 1,151 (126) 1,150 (125) 1,142

Research and Development 10,901 10,607 294 10,541 360 12,720 12,720 0 12,649 71 13,071

Education and Training 11,543 11,536 7 10,874 669 13,842 13,834 8 12,982 860 14,231

Other income 29,650 29,301 349 28,998 652 35,193 35,096 97 34,806 386 35,035

Total income 290,623 290,210 413 284,057 6,566 347,454 348,260 (806) 340,524 6,930 350,670

Expense

Employee Benefits Expenses (Pay) (167,798) (168,114) 316 2 (165,834) (1,964) (202,103) (202,001) (103) 2 (198,588) (3,516) (203,420)

Drug Costs (24,604) (24,887) 283 (24,187) (417) (29,537) (29,718) 181 (29,120) (417) 2 (27,777)

Clinical Supplies (29,893) (29,586) (307) 3 (32,368) 2,476 (35,731) (35,420) (311) (38,858) 3,127 2 (40,253)

Non Clinical Supplies (4,362) (4,114) (248) (3,694) (668) (5,155) (4,845) (310) (4,364) (791) (4,432)

Research & Development Expenses (10,171) (9,942) (229) (10,718) 547 (11,948) (11,948) 0 (12,861) 913 (13,009)

Misc. Other Operating Expenses (32,411) (31,799) (612) 4 (27,586) (4,825) (38,128) (37,488) (640) 3 (33,016) (5,112) 3 (36,505)

Reserves (1,000) (2,453) 1,453 0 (1,000) (2,028) (3,123) 1,095 0 (2,028) 0

Total Costs (270,239) (270,894) 655 (264,386) (5,853) (324,630) (324,542) (88) (316,806) (7,824) 7 (325,396)

EBITDA 20,384 19,316 1,068 19,672 712 22,824 23,718 (894) 23,718 (894) 25,274

Profit / loss on asset disposals (103) 0 (103) 0 (103) (140) 0 (140) 0 (140) (2,841)

Exceptional Income/ Costs & Impairments **

Total Depreciation (9,935) (9,951) 16 (9,949) 14 (11,955) (11,995) 40 (11,994) 39 (10,499)

Total operating surplus (deficit) 10,346 9,365 981 9,723 623 10,729 11,723 (994) 11,723 (994) 11,934

227 162 65 163 64 260 195 65 195 65 247

Total interest payable on Loans and leases (860) (843) (17) (843) (17) (1,007) (1,007) 0 (1,007) 0 (1,072)

PDC Dividend (6,176) (6,176) 0 (6,176) (0) (7,192) (7,411) 219 (7,411) 219 (7,048)

Net Surplus/(deficit) 3,537 2,508 1,029 2,867 670 2,790 3,500 (710) 3,500 (710) 4,061

YTD KEY MOVEMENTS FORECAST KEY MOVEMENTS

1 Year to date income has improved by £0.4m compared to last months report, mainly due to non-elective work in ICU and Maternity. 1

2 Pay expense has improved by £324k but additional spend on Nursing continues

3 2

4

3

Year to Date Outturn

Total interest receivable/ (payable) - inc

committed WC facilities

AP

PE

ND

IX 3

Overperformances within W&C Health, Medicine and Critical Care and

underperformances on Cancer, Trauma & Orthopaedics and Surgery

Clinical supplies spend mainly within Radiology, W&C Health and Medicine due to activity. Pay is forecasted to deteriorate due to additional nursing spend expected in the

remaining part of the year.Miscellaneous expense overspend on electricity and maintenance contractors.

Misc. expense is overspending mainly on electricity, maintenance contractors and

other services received.




Statement of Financial Position Variance Plan Variance Variance Plan Variance



£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Assets, Non-Current

Intangible Assets, Net 1,289 362 927 362 927 326 326 0 326 0 544

Property, Plant and Equipment, Net 238,695 241,355 (2,660) 241,355 (2,660) 241,388 254,072 (12,684) 254,072 (12,684) 238,779

Non NHS Trade Receivables, Non-Current 1,014 838 176 838 176 1,000 838 162 838 162 966

Assets, Non-Current, Total 240,998 242,555 (1,557) 1 242,555 (1,557) 242,714 255,236 (12,522) 255,236 (12,522) 240,289

Assets, Current

Inventories 4,588 4,502 86 4,502 86 4,624 4,624 0 4,624 0 4,592

Trade and Other Receivables, Net, Current 17,229 14,840 2,389 2 15,199 2,030 13,280 12,642 638 12,642 638 11,009

Non Current Assets held for sale 0 0 0 0 0 0 0 0 0 0 0

Cash 55,256 55,759 (503) 55,759 (503) 48,657 47,644 1,013 47,644 1,013 53,583

Other Assets - Current Assets Held by Charitable Funds 0 0 0 1,800 (1,800) 0 0 0 1,800 (1,800) 0

Assets, Current, Total 77,073 75,101 1,972 77,260 (187) 66,561 64,911 1,651 66,711 (150) 69,184

Liabilities, Current

Loans, non-commercial, Current (DH, FTFF, NLF, etc) (1,270) (1,270) 0 (1,270) 0 (1,270) (1,270) 0 (1,270) 0 (1,270)

Trade and Other Payables, Current (11,763) (9,627) (2,137) 3 (9,627) (2,138) (10,007) (10,007) 0 (10,007) 0 (10,262)

Deferred Income, Current (2,052) (3,853) 1,801 (3,853) 1,801 (1,575) (1,620) 45 (1,620) 45 (1,520)

Provisions, Current (1,368) (193) (1,175) 4 (193) (1,175) (193) (193) 0 (193) 0 (1,368)

Current Tax Payables (4,272) (4,275) 3 (4,275) 3 (4,276) (4,276) 0 (4,276) 0 (5,083)

Other Financial Liabilities, Current (15,251) (17,698) 2,448 5 (17,698) 2,448 (11,315) (11,315) 0 (11,315) 0 (10,893)

Liabilities, Current, Total (35,976) (36,917) 941 (36,917) 941 (28,636) (28,681) 45 (28,681) 45 (30,396)

NET CURRENT ASSETS (LIABILITIES) 41,097 38,185 2,913 40,343 754 37,925 36,230 1,696 38,030 (105) 38,788

TOTAL ASSETS LESS CURRENT LIABILITIES 282,095 280,740 1,355 282,899 (803) 280,639 291,466 (10,827) 293,266 (12,627) 279,077

Liabilities, Non-Current

Loans, Non-Current, non-commercial (DH, FTFF, NLF, etc) (19,578) (19,577) (1) (19,577) (1) (18,942) (18,942) 0 (18,942) 0 (20,213)

Other Creditors, Non-Current 0 (84) 84 (84) 84 0 (78) 78 (78) 78 (123)

Provisions, Non-Current (418) (346) (72) (346) (72) (346) (346) 0 (346) 0 (346)

TOTAL ASSETS EMPLOYED 262,099 260,733 1,366 262,892 (792) 261,351 272,100 (10,749) 273,900 (12,549) 258,395

TAX PAYERS' EQUITY

Public dividend capital 149,715 149,715 0 149,715 0 149,715 149,715 0 149,715 0 149,715

Retained Earnings (Accumulated Losses) 53,031 47,729 5,302 6 48,088 4,943 52,561 49,145 3,416 49,145 3,415 43,949

Charitable Funds 0 0 0 1,800 (1,800) 0 0 0 1,800 (1,800) 0

Revaluation Reserve 59,353 59,928 (575) 6 59,928 (575) 59,076 69,924 (10,848) 69,924 (10,848) 61,200

Donated Asset Reserve 0 3,361 (3,361) 6 3,361 (3,361) (0) 3,316 (3,316) 3,316 (3,316) 3,531

TOTAL TAX PAYERS' EQUITY 262,099 260,733 1,366 262,892 (792) 261,351 272,100 (10,749) 273,900 (12,549) 258,395

OUTTURN KEY MOVEMENTS

1

2

3

4

5

6


AP

PE

ND

IX 4

Capital spend is £1.6m lower than plan, see appendix 6 for further details.

Receivables are £2.4m higher than budget and £2m higher than plan, see narrative in performance report for further information.

Actual payables are higher than the estimate on the annual plan, this is off-set with other financial liabilities being lower than plan.

Plan assumed a provision would be settled by the end of September 2011, settlement negotiations continue.

Actual accruals are lower than the estimate on the annual plan.

Prior year adjustments due to change in accounting treatment to comply with Government's alignment project. I&E reserve increased by £4.1m, Donated asset reserve removed £3.5m, Revaluation reserve reduced by £0.4m and

deferred income liabilities reduced by £0.2m.




Cash Flow Statement Variance Plan Variance Variance Plan Variance



£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES

Surplus/(deficit) after tax 3,537 2,508 1,029 2,867 670 2,790 3,500 (711) 3,500 (710) 4,061

Non-cash flows in operating surplus/(deficit)

Finance (income)/charges 633 681 (48) 680 (47) 747 812 (65) 812 (65) 825

Depreciation and amortisation 9,935 9,951 (16) 9,949 (14) 11,955 11,995 (40) 11,994 (39) 10,499

Impairment 0 0 0 0 0 0 0 0 0 0 2,806

PDC dividend expense 6,176 6,176 0 6,176 0 7,192 7,411 (219) 7,411 (219) 7,048

Other increases/(decreases) to reconcile to profit/(loss) from operations 103 (234) 337 (232) 335 139 (278) 417 (278) 417 (238)

Non-cash flows in operating surplus/(deficit), Total 16,847 16,574 273 16,573 274 20,033 19,940 93 19,940 93 20,940

Increase/(Decrease) in working capital

(Increase)/decrease in inventories 4 90 (86) 90 (86) (32) (32) 0 (32) 0 15

(Increase)/decrease in NHS Trade Receivables (2,030) (1,624) (406) (1,982) (48) (1,842) (1,204) (638) (1,204) (638) 974

(Increase)/decrease in Non NHS Trade Receivables (888) 71 (959) 71 (959) 71 71 0 71 0 163

(Increase)/decrease in other receivables (295) (276) (19) (276) (19) (276) (276) 0 (276) 0 749

(Increase)/decrease in accrued income (745) (758) 13 (758) 13 (208) (208) 0 (208) 0 187

(Increase)/decrease in prepayments (2,262) (1,245) (1,017) (1,245) (1,017) (16) (16) 0 (16) 0 (250)

Increase/(decrease) in Deferred Income (excl. Donated Assets) 577 2,333 (1,756) 2,333 (1,756) 100 100 0 100 0 (730)

Increase/(decrease) in provisions 72 (1,175) 1,247 (1,175) 1,247 (1,175) (1,175) 0 (1,175) 0 1,288

Increase/(decrease) in Trade Creditors 2,035 (280) 2,315 (280) 2,315 (200) (200) 0 (200) 0 (139)

Increase/(decrease) in tax payable (811) (808) (3) (808) (3) (807) (807) 0 (807) 0 1,035

Increase/(decrease) in Other Creditors (75) (55) (19) (55) (19) (55) (55) 0 (55) 0 88

Increase/(decrease) in accruals 1,814 4,267 (2,453) 4,267 (2,453) 684 684 0 684 0 (1,037)

Increase/(Decrease) in workling capital, Total (2,604) 541 (3,145) 182 (2,786) (3,757) (3,119) (638) (3,119) (638) 2,343

Net cash inflow/(outflow) from investing activities

Property - new land, buildings or dwellings (6,173) (3,549) (2,624) (3,549) (2,624) (4,434) (4,434) 0 (4,434) 0 (3,555)

Property - maintenance expenditure (997) (2,622) 1,625 (2,622) 1,625 (3,042) (3,042) 0 (3,042) 0 (8,851)

Plant and equipment - Information Technology (1,691) (1,201) (490) (1,201) (490) 712 (1,451) 2,163 (1,451) 2,163 0

Plant and equipment - Other (1,848) (4,971) 3,123 (4,971) 3,123 (7,723) (7,723) 0 (7,723) 0 0

Proceeds on disposal of property, plant and equipment 14 0 14 0 14 0 0 0 0 0 6,081

Increase/(decrease) in Capital Creditors (459) (300) (159) (300) (159) 0 0 0 0 0 (242)

Other cash flows from financing activities 0 63 (63) 63 (63) 0 63 (63) 63 (63) 0

Net cash inflow/(outflow() from investing activities, Total (11,154) (12,581) 1,426 (12,581) 1,426 (14,487) (16,587) 2,101 (16,587) 2,101 (6,568)

Net cash inflow/(outflow) from financing activities

PDC Dividends paid (3,968) (3,968) (0) (3,968) (0) (7,454) (7,673) 219 (7,673) 219 (6,502)

PDC Dividend Received 0 0 0 0 0 0 0 0 0 0 0

Interest (paid) on commercial loans (524) (513) (11) (514) (11) (1,007) (1,007) 0 (1,007) 0 (1,072)

Interest received on cash and cash equivalents 227 162 65 163 64 260 195 65 195 65 247

Repayment of non-commercial loans (635) (636) 1 (636) 1 (1,271) (1,271) 0 (1,271) 0 (1,271)

(Increase)/decrease in non-current receivables (48) 128 (176) 128 (176) (34) 128 (162) 128 (162) (128)

Increase/(decrease) in non-current payables 0 (39) 39 (39) 39 (0) (45) 45 (45) 45 34

Net cash inflow/(outflow) from financing activities, Total (4,948) (4,866) (83) (4,865) (83) (9,506) (9,673) 167 (9,673) 167 (8,692)

Net increase/(decrease) in cash and cash equivalents 1,678 2,177 (499) 2,177 (499) (4,927) (5,939) 1,012 (5,939) 1,013 12,085

Opening cash and cash equivalents 53,583 53,583 0 53,583 0 53,583 53,583 0 53,583 0 41,498

Closing cash and cash equivalents 55,261 55,760 (499) 55,760 (499) 48,656 47,644 1,012 47,644 1,013 53,583


AP

PE

ND

IX 5


Royal Devon and Exeter NHS Foundation Trust

Capital expenditure

Period ending 31/01/2012

Month 10 Column B Column C Column D Column E Column F Column G Column H

YTD planned

expenditure per

annual plan

YTD actual

expenditure

YTD variance

slippage /

(overspend)

Forecast future

capital

expenditure for

the year

Forecast total

capital

expenditure for

the year

Full year

expenditure per

annual plan

11/12 forecast

slippage /

(overspend)

Expenditure

approved by the

Exec Group

Total expenditure

forecast for the

scheme

Scheme variance

under spend /

(overspend)

( B - C) (C + E) (G - F)

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

FBC 1,443 2,091 ( 648) 525 2,616 2,251 ( 365) 8,344 8,344 - 31-Mar-15

OBC 301 844 ( 544) 237 1,081 378 ( 703) 7,900 7,900 - 31-Mar-15

FBC 2,261 2,016 245 412 2,428 2,261 ( 167) 6,200 5,897 303 30-Jun-12

Approved 100 91 9 347 438 165 ( 273) 5,000 5,000 - 31-Mar-14

FBC - 9 ( 9) 8 16 - ( 16) 3,126 3,126 - Occupied

FBC ( 22) ( 19) ( 3) - ( 19) ( 22) ( 3) 2,370 1,924 446 Complete

FBC 515 254 262 24 278 527 249 2,207 2,193 14 31-Mar-14

FBC 47 29 18 - 29 77 48 1,366 1,104 262 Complete

FBC - 60 ( 60) - 60 - ( 60) 1,248 1,346 ( 98) Occupied

Note 1 (CAP1 rec'd) 188 - 188 - - 267 267 1,175 1,175 - 31-Mar-15

Approved 6,126 2,822 3,304 2,342 5,164 8,613 3,449

10,959 8,196 2,763 3,895 12,091 14,516 2,425

FBC 1,036 1,264 ( 228) 418 1,683 1,484 ( 198) 4,014 4,014 - 31-Mar-15

Note 1 134 - 134 50 50 250 200 2,787 2,787 - 31-Mar-14

Note 1 214 - 214 - - 400 400 1,440 1,440 - On hold

1,384 1,264 120 468 1,733 2,134 402

12,343 9,460 2,883 4,363 13,824 16,650 2,826

Note 2 - 1,249 ( 1,249) 508 1,757 - ( 1,757) 13,848 13,848 - 31-Mar-15

12,343 10,710 1,634 4,872 15,581 16,650 1,069

Approval Level Key

OBC Outline business case

FBC Full business case

SOC Strategic outline case

Note 1 Subject to Board approval of full business cases (SOC, OBC, FBC)

Note 2 Full cost of RILD scheme capitalised during the construction period. When asset is brought into use the cost of the university's element will be offset against their contribution received. There is no loss anticipated.

Annual plan schemes <£1 million includes some schemes that have bow been classed as revenue expenditure schemes. The to date figures includes £450k and the forecast for the year includes £585k.

Research, Innovation, Learning and Development (RILD)

Increasing radiotherapy capacity(3rd LINACC)

Expected completion

date

Actual expenditure to date compared to budget on

annual plan

Total expenditure forecast for the year compared to the budget on the

annual plan

Total expected expenditure compared to the value

approved by the Exec Group.

Schemes over £1 million in progress or planned

Scheme Approval level

Priority 1

Rebuild CIVAS unit and equip.

Priority 2 schemes - £2,768k allocated below plus £184k

allocated to priority 1 Durbin Ward refurbishment

Electronic document management

Estates infrastructure (for capital schemes moved to revenue

please see below)

Pain management (inc. physio)

Renal Heavitree

Order comms and e-prescribing IT systems

Procurement of third CT scanner

Nursery expansion

Core network upgrade

Other schemes < £1m and contingency

Priority 1 total

Priority 2

Replacement PAS,CDM & ward whiteboard

North Devon expansion and central water processing plant

Priority 2 total

AP

PE

ND

IX 6

Total Priority 1 and Priority 2

RILD - University of Exeter element

(The University's RILD capital additions were not included on the Annual Plan, these

additions are suppressing the Trust's actual capital slippage, excluding them the Trust's

capital slippage would be £2.9 million to date)

Grand total


Royal Devon & Exeter NHS Monitor YTD Target CY Target

Foundation Trust Actual Plan Variance Actual Plan Variance Actual Plan Variance Forecast

to Budget (target) to Budget to Plan

Cost Improvement Programme Fav./(Adv.) Fav./(Adv.) Fav./(Adv.)

Period ending 31/01/2012

Month 10 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 R/A/G R/A/G

Work Stream

Bed Utilisation (235) (235) 0 1,576 (280) (280) 0 (280) 0 (269) 821 (1,090) (269) G G

Theatre Utilisation 807 848 (41) 770 1,040 1,090 (50) 1,128 38 1,359 1,342 17 1,658 G G

Outpatients 679 437 241 1,064 840 575 265 868 293 911 923 (12) 923 G G

Workforce 670 724 (54) 1,248 812 979 (168) 862 (117) 861 2,204 (1,343) 1,997 A A

Medical Staffing 559 679 (120) 2,754 706 926 (220) 926 (0) 995 1,471 (476) 1,146 A G

Nursing & AHP Staff 514 601 (87) 1,358 640 846 (206) 703 (143) 755 1,409 (654) 1,135 A A

Procurement 649 734 (85) 1,630 827 1,287 (460) 1,296 9 995 1,673 (678) 1,401 A G

Diagnostics 603 546 57 861 780 764 16 764 (0) 948 1,179 (231) 1,179 G G

Pharmacy 474 490 (16) 581 581 636 (55) 636 0 642 747 (105) 747 G G

Back Office 903 772 131 995 1,056 966 90 1,090 124 1,253 1,357 (104) 1,733 G G

5,623 5,598 26 12,837 7,002 7,789 (787) 7,993 204 8,449 13,126 (4,677) 11,652

RESTOT Central Plans 6,761 6,056 705 8,553 9,337 (784) 9,133 (204) 2,687 2,687 0 2,887 G G

RESTOT Unidentified 0 1,256 (1,256) 1,314 (1,314) 2,587 G G

12,384 12,910 (525) 12,837 15,555 17,126 (1,571) 17,126 (0) 11,136 17,127 (5,991) 17,126

Key

580

Red > 20% variance to plan

Amber > 5 % variance to plan

Green < 5% variance to plan

YTD Plan Forecast CY Forecast

Variance Fav /

(Adv)

Year to Date - Achieved Current Year - Achieved Current Year - Forecast Full Year - Achieved

Confidence

Rating

Confidence

Rating

AP

PE

ND

IX 7

CIP Achievement Current Year

(0) 50

(265)

168 220 206460

(16)55

(90)(11)(319)

(70)

(49) (115) (168) (168)

(269)

911

861995

755995

948

(289) (61)(197)

1,359

642

1,253

-100%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

100%

Bed Utilisation Theatre Utilisation Outpatients Workforce Medical Staffing Nursing & AHP

Staff

Procurement Diagnostics Pharmacy Back Office

Work Streams

Ach

iev

emen

t

To be Achieved Non-Recurrent

Recurrent


Royal Devon & Exeter NHS Foundation Trust

Surplus / (Deficit) by Directorate based on SLR reporting

Medicine Critical Care

Orthopaedic

s Surgery I

Specialist

Surgery

Women &

Child Health

Cancer

Services Diagnostics

Professional

Services Other Trust

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Patient Income -PbR 48,252 1,081 23,985 23,446 18,478 20,701 5,085 58 1 0 141,086

Patient Income - Non PbR 20,550 5,651 1,591 866 3,050 11,185 12,785 7,432 7,961 602 71,673

Total Clinical Income 68,802 6,732 25,576 24,312 21,528 31,886 17,871 7,490 7,961 602 212,759

Admin Secretarial Support 2,105 59 757 833 747 1,189 260 0 0 0 5,951

Anaesthetics 166 0 1,517 1,602 1,402 862 14 0 0 0 5,563

Devices 3,510 453 2,968 229 356 92 0 0 0 0 7,608

Other Departments 3,554 15 732 642 1,011 4,111 892 330 615 289 12,192

Diabetes services 817 0 0 0 0 0 0 0 0 0 817

Dialysis 2,754 4 0 0 0 0 0 0 0 0 2,757

Medical Staffing 10,764 975 3,559 3,671 4,783 6,463 1,582 0 0 0 31,796

Mobility Centre 0 0 0 0 0 0 0 0 6,026 0 6,026

Nuclear Medicine 102 0 39 193 37 24 131 4 24 0 554

Oncology Centre 0 0 0 0 0 0 2,194 0 0 0 2,194

Professions Allied to Medicine 2,095 130 479 492 346 245 98 0 1,101 0 4,986

Pathology 2,334 198 314 1,265 384 1,406 1,290 5,085 24 0 12,300

Pharmacy 5,210 305 1,351 882 2,353 529 6,188 2 164 0 16,982

Radiology 3,357 58 736 1,243 577 417 1,098 386 167 0 8,039

Health Records 513 17 574 139 237 198 133 0 77 0 1,889

R.T. Physics 0 0 0 0 0 0 937 0 0 0 937

Theatres 4,314 326 6,726 5,977 5,329 2,300 141 0 0 0 25,114

Wards / Nursing 28,030 2,995 4,798 7,626 3,981 13,941 3,024 6 0 0 64,401

Total Expense 69,627 5,534 24,550 24,795 21,543 31,778 17,981 5,812 8,198 289 210,106

Surplus / Deficit -825 1,198 1,026 -483 -15 108 -111 1,678 -237 313 2,653Margin % -1.2% 17.8% 4.0% -2.0% -0.1% 0.3% -0.6% 22.4% -3.0% 52.0% 1.2%

AP

PE

ND

IX 8

Period ending 30 December 2011

Month 9


MONITOR PROPOSED FURTHER INDICATORS FOR FRR - COMPLIANCE FRAMEWORK CONSULTATION

Proposed indicator Potential financial weakness Criteria to measure against

Unplanned decrease in EBITDA margin in two consecutive quarters Deteriorating trend in operating

performance and cashflow

generation Variance to planned EBITDA margin NO 112.61% NO 105.95% NO 103.24% NO 107.96%

Quarterly self-certification by trust that FRR may be less than 3 in the next 12

months

Identified risk of potential

financial breach within the next

year

Forecast financial risk rating for the next 12

months NO 3+ NO 3+ NO 3+ NO 3+

FRR 2 for any one quarter In year deterioration in financial

performance Current period Financial Risk Rating NO 4 NO 4 NO 4 NO 3

Debtors more than 90 days past due account for more than 5% of total debtor

balances

Potential for payment / debtor

collection concerns

% of Debtors more than 90 days past due

account NO 1.46% NO 0.79% NO 1.04% NO 2.06%

Creditors more than 90 days past due account for more than 5% of total creditor

balances

Potential for build up in creditors,

resulting in future liquidity

concerns

% of Creditors more than 90 days past due

account NO 0.05% NO 0.00% NO 0.00% NO 0.00%

Capital expenditure is less than 75% of plan for the year to date Capital expenditure plans are

delayed to conserve cash Capital expenditure variance to plan YES 65.26% YES 73.39% NO 81.44% NO 88.36%

Quarter end cash balance less than 10 days of operating expenses Potential liquidity concerns and

ability to meet liabilities as they

fall due Liquidity days at period end NO 63.07 NO 62.36 NO 55.61 NO 62.39

Working capital facility (WCF) agreement includes default clause. This will

require all trusts to review their WCF agreements.

Risk that WCF, whilst included in

calculation of liquidity days for

the purpose of FRR, may not be

available if and when required

(eg: FRR 1 or 2). Review of WCF NO NO NO NO NO NO NO NO

Interim Finance Director in place over more than one quarter end Absence of permanent /

substantive appointment to key

position NO NO NO NO NO NO NO NO

Two or more changes in Finance Director in a twelve month period Multiple changes in a short

period of lead financial officer NO NO NO NO NO NO NO NO

Notes / Explanations

AP

PE

ND

IX 9

31/10/2011 30/11/2011 31/12/2011 31/01/2012


Data Appendices – Quality

Green

TrustProcess - Pressure Sores Assessment Process - MUST, MST, STAMP Score Process - Hand Hygiene

General (Green)

Outcome - MUST Score

Green

Red

Green

Outcome - Pressure Sores Outcome - New MRSA Isolates Identified > 72 Hours After Admission

Initial (Red)

Threshold - 95% Threshold - 85%

Threshold - 0.8% Threshold - 0 cases

0

10

20

30

40

50

60

70

80

90

100

Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12

0

10

20

30

40

50

60

70

80

90

100


Initial compliance with MUST Screening on Admission

General compliance with MUST Screening at Weekly Review

0

10

20

30

40

50

60

70

80

90

100


0%

5%

10%

15%

20%

25%

30%


0

1

2

3

4

5


Average SPC +1sd

Indicator to be developed


GreenOutcome - C.Difficile Infections Identified > 72 Hours After Admission Outcome - Inpatient Slips, Trips & Falls Outcome - Cardiac Arrest Calls

Process - Housekeeping & Equipment Cleaning Process - Falls Risk Assessment Process - EWS CallsHousekeeping (Green) Equipment (Green)

Trust

Threshold - Housekeeping 90% Equipment 90% No Threshold

Green

Threshold - 6 cases No Threshold No Threshold

0

5

10

15

20

25


Actual Cases Trust Theshold

80

82

84

86

88

90

92

94

96

98

100


Housekeeping Equipment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep-11 Oct-11 Nov-11 Dec-11 Jan-12

0

5

10

15

20

25

30

35

40

45

50


0

20

40

60

80

100

120

140

160

180

200


5

10

15

20

25



Outcome - Thromboprophylaxis Audit Outcome - Estimated Date of Discharge met Outcome - Incidents & Complaints/Concerns

Process - Bank & Agency WTE Staff Usage

Trust

No Threshold No Threshold

Green

Threshold - 100% Threshold - 40% No Threshold

Process - Electronic VTE Risk Assessment Process - Estimated Date of Discharge Red

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12

0

10

20

30

40

50

60

70

80

90

100


0

20

40

60

80

100

120


Bank Assigned Agency Assigned

Indicator to be developed

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


0

50

100

150

200

250

300

350

400

450

500


Complaints/Concerns Incidents

board of directors meeting · a recovery planning group was established in order to mitigate...

Documents