Council of Governors Performance Report – Quarter 1 and July 2015

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Monitor Risk Assessment Framework 2015/16 This report provides a high level summary of performance for Quarter 1 and for the month of July 2015 against the access and outcome indicators for the Monitor Risk Assessment Framework. The narrative on the slides that follow covers the key issues and risks to delivery , together with the actions in place to sustain and improve performance. The table below highlights the compliance and patient numbers.

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Q1 Q2Performance Indicator Performing Weighting Compliant

Not Compliant Percentage July Score

Four-hour maximum wait in A&E (All types from April 2014) 95.0% 1.0 94.4% 94.3% 90.6% 85.9% 7024 900 87.2% 1 92.4% 1

C diff >72 hours post admission (target for year= 37) Cum 22 1.0 3 9 16 27 6 1 10 1

RTT - admitted - 90% in 18 weeks in all specialties 90.0% 1.0 90.5% 90.5% 82.9% 79.0% 1004 338 61.4% 1 62.6% 1

RTT - non- admitted - 95% in 18 weeks in all specialties 95.0% 1.0 95.7% 95.5% 92.4% 93.0% 5354 344 93.6% 1 94.2% 1

RTT - open pathways in 18 weeks 92.0% 1.0 93.1% 92.4% 92.3% 91.2% 19608 1480 92.5% 0 92.8% 0

31 day diagnosis to first treatment for all cancers 96.0% 0.5 98.1% 98.2% 98.2% 99.4% 174 2 98.9% 0 99.2% 0

31 day second or subsequent treatment for all cancers - surgery 94.0% 95.4% 97.8% 99.3% 100.0% 35 0 100.0% 100.0%

31 day second or subsequent treatment - drug treatments 98.0% 100.0% 100.0% 100.0% 100.0% 29 0 100.0% 100.0%

31 day second or subsequent cancer treatment for all cancers - radiotherapy treatment

94.0% 98.8% 99.0% 97.7% 100.0% 58 0 100.0% 99.3%

2 week GP GP referral to 1st outpatient 93.0% 94.6% 93.6% 93.5% 93.1% 1085 99 90.9% 93.6%

2 week GP GP referral to 1st outpatient - breast symptoms 93.0% 95.4% 95.6% 94.8% 94.6% 274 19 93.1% 93.0%

62 day to treatment from screening 90.0% 98.3% 96.1% 93.8% 100.0% 4.0 0.0 100.0% 88.2%

62 days urgent referral to treatment of all cancers 85.0% 98.7% 91.5% 88.6% 90.0% 95 4 95.8% 90.4%

Access to healthcare for people with learning disabilities - Trust compliance

N/A 0.5 Yes Yes Yes Yes Yes 0 Yes 0

Governance Risk Rating 1 1 3 3 4 2

Jul-15Prediction

Q1 Q2 Q3 Q4 Q1 Percentage

Q1 Score

2014/15 2015/16

0

0

1

Red

4.5 5

1.0

0.5

1.0

0

0.5

0

Red

4 Hour Maximum Wait in A&E and 18 weeks

Key Performance Issues for Quarter 1 (15/16) 4 hour Performance During quarter 1 performance against the 4 hour indicator was rated red with quarterly performance of 92.4%. Reduced patient flow was compromised by activity levels, reduced capacity and a deterioration in the average length of stay across all non elective specialties. RTT Performance was rated red as forecast and planned against the admitted and non admitted pathway indicators. Admitted Pathways 62.6% against the 90% indicator (red) as agreed at Board of Directors Non admitted Pathways 94.2% against the 95% indicator (red) Open pathways 92.8% against the 92% ( green) Key performance Issues for July 2015 4 hour Performance: During July performance against the 4 hour indicator was rated red with performance of 87.2%. RTT Performance: Rated red as forecast and planned across the admitted and non admitted indicators Admitted Pathways 61.4% against the indicator (red) Non admitted Pathways 93.6% against the indicator (red) Open pathways achieved 92.5% against the indicator ( green)

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Activity Levels Activity levels Activity levels for Quarter 1 were 3.7% above contracted plan In July non-elective admissions were 4.7% above plan (excluding Maternity). Table 3

July Bed Pressures as a result of activity Total Escalation Beds peaked at 39 with an average of 33. Medical Outliers peaked at 57 with an average of 41 and a median of 39.

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M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

Spel

ls

Financial Year Month

Non Elective Activity Against Contract - Excludes Maternity

15/16 Contract 15/16 Activity 14/15 Activity

C – Difficile Infection > 72 hours post admission

C – Difficile At the end of quarter 1 the full year position for C- Difficile was 10 cases against threshold of 22 cases. The Trust continues to appeal cases with commissioners when it is felt that the C Diff is community acquired. The year end ceiling of cases for 2015/16 is set at 22. During July there were 6 cases of C diff. with 3 cases pending. A C Diff working group has been set up to oversee improvements alongside the performance reviews. Norovirus During July there were no wards closed due to Norovirus.

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18 Weeks Referral to Treatment

July RTT performance: Trust level performance was rated red overall with one RTT indicator (open pathways) achieving green as shown in the table below. Performance at specialty level is shown in table 5 below.

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RTT Performance: for Quarter 1 the performance was rated red across the admitted and non admitted indicators this was in line with the agreed planned failure supported by Monitor and the Board of Directors. A detailed action plan is in place and this has been approved through Management Board. The indicator performance is outlined below:

Admitted Pathways 62.6% against the indicator (red) Non admitted Pathways 94.2% against the indicator (red) Open pathways achieved 92.8% against the indicator ( green)

Cancer Access Green performance was seen across seven indicators for quarter 1 and for the month of July. July Performance Green performance was seen across seven of the eight indicators in the month of July. 2 week GP referral to 1st outpatient performance was red rated in month with performance of 91.1% against the 93% target. In July there was a 30% increase in 2 w w referrals. The performance deteriorated due to a number of patient choice (94%) and capacity breaches particularly in colorectal and dermatology. The July position failure has highlighted potential risk for Q2 performance. To address this there have been actions identified for specialty managers to ensure that it is clear by specialty what needs to be done to achieve green performance in August and September. All specialties have also been tasked with providing additional 2ww capacity. Performance will be monitored daily and adjustments made to the plan as required. 2ww breast symptomatic target has been very challenged in recent months although green performance is sustained. The Breast Unit have implemented immediate text message confirmations following an appointment being booked to try and reduce cancellations/DNAs. They have also established additional weekend clinic lists for non cancer patients to free up capacity in the week for 2ww patients. They have also redeveloped their 2ww referral proforma, highlighting the importance of patients being made aware to be available within 14 days for their appointment. The 62 day screening denominator is increasing now that the Breast Screening van has returned to the Bath area.

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The Council of Governors Integrated Balanced Scorecard summary outlines the position with regards to quarter 1. (appendix 1) .

Caring Responsive Effective Safe Well Led

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