location: education centre time: 1730 –1830hrs...2016/05/19 · location: education centre time:...

Bolton NHS Foundation Trust – Council of Governor Meeting May 19th 2015

Location: Education Centre Time: 1730 –1830hrs

Time Topic Lead Process Expected Outcome

1730 Welcome Chairman

1. Apologies

2. Declarations of Interest

3. Minutes of meeting held on 12/03/15 Chairman Minutes For approval

3.1 Matters arising

1740 4 Chairman’s update Chairman Verbal update Governors to receive an update on key current issues - including Devo Manchester and car parking

1750 Performance update NED Presentation

Governors to receive an update on current performance from one of the NEDs in order to receive assurance with regard to performance of the Trust.

1810 Quality Account Trust Secretary/Acting Director of Nursing

Presentation Governors to respond to the Quality Account

1850 Feedback from Governor sub committees • Patient, Staff and Visitor experience • More than a Hospital • Membership and Member

Communications

Subcommittee chairs

Verbal Governors to note the work of the subcommittees

1900 Proposed resolution : that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted

1905 Governor and NED involvement/interaction

Update on NED appointment

1920 Any Other Business

1930 Close Date and Time of next meeting - Tuesday 2nd July 2015

1

Meeting Council of Governors

Time 5.30 p.m.

Date 12th March 2015

Venue Lecture Theatre, Education Centre

Present

David Wakefield Chairman Anne Bain Public Elected Governor Barbara Ronson Public Elected Governor Bob Airey Public Elected Governor Carol McBride Public elected Governor Champak Mistry Public Elected Governor Dan Hindley Staff Governor Derek Burrows Public Elected Governor Eric Hyde Public Elected Governor Jack Ramsay Public Elected Governor Janet Roberts Staff Governor Janet Whitehouse Public Elected Governor Jeffrey Mangnall Public Elected Governor Kate Cowpe Public Elected Governor Ken Hahlo Public Elected Governor Leigh Vallance Appointed Governor Michael Connolly Public Elected Governor Sarah Rutherford Staff Governor Sorie Sesay Public Elected Governor Tracey Holliday Staff Governor

In Attendance Andrew Thornton Non-Executive Director Andy Ennis Chief Operating Officer Bev Tabernacle Acting Director of Nursing Carol Davies Non-Executive Director Esther Steel Trust Secretary Jackie Bene Chief Executive Mark Harrison Non-Executive Director Mark Wilkinson Director of Strategic and Organisational Development Simon Worthington Director of Finance Simon Worthington Director of Finance Steve Hodgson Medical Director

Apologies

Jim Sherrington Jim Sherrington Allan Duckworth Pauline Lee Jack Firth Geoffrey Minshull Trish Armstrong-Child

Bolton NHS Foundation Trust Council of Governors’ Meeting – March 12th 2015 Page 1 of 5

2. Declarations of Interest

None

3. Minutes of the Council of Governors’ Meeting

The minutes of the meeting held on 15th January 2015 were approved as an accurate record.

3.1 Matters Arising

A question was raised as to whether steps could be taken to reduce the number of patients brought into A&E by accident - Governors were advised that ambulances go to the nearest A&E department irrespective of how busy they are unless an agreement has been reached to deflect or divert. Diverts and deflections have both been used over winter, a deflection applies to patients picked up in areas that could be classed as bordering the catchment area for other trusts. A divert which must be formally agreed applies irrespective of where the patient is picked up from.

4. Chairman and Chief Executive Update

With two weeks to go before the end of the financial year, the Chairman provided an update on the following:

Monitor - although the enforcement undertakings have been addressed, the Trust are not yet out of breach and are still red for governance. Monitor have indicated that the Trust will be handed back to the regional team in the very near future. An application has been made for a £30m loan from the DoH but this is not guaranteed, the FT sector as a whole is facing previously unseen challenges.

Finance - The Trust are forecasting a year end breakeven position

Quality - Quality over the year has been good, but could be better, in addition to the challenges in A&E, there are issues with consistency, the Board were concerned about issues raised in the latest patient story and are looking for assurance that the issues raised have been addressed. There is confidence that although A&E performance is challenged the focus of the operational team will bring the target back on track.

Devolution - There is still a lack of clarity and detail with regard to the potential impact of the recently announced devolution of healthcare to the Greater Manchester authorities “Devo Manc”. A Broad memorandum of understanding has been agreed between the Council and Commissioners but there is no real idea of the regulatory impact on Foundation Trusts.

5. Performance update

The Executive team presented an update on key indicators within the integrated performance report. The full report having previously been circulated to Governors.

Quality - having previously reported on issues with regard to meeting the standard for a timely response to complaints, the team had achieved 100% in January and February 2015.

The Trust have continued to perform well with regard to infection control and prevention - having gone 366 days without any cases of MRSA one bacteraemia was recorded in January, the reduction of C. difficile has continued with an anticipated year end result of approx. 20 cases which is well under the


agreed trajectory.

Two SUIs were reported in January 1 being the A&E major incident and the other a fall which is being investigated.

Operational - The challenges in meeting the A&E target have continued but performance is improving with Monday 9th March being the first Monday on which the target has been achieved since November 3rd. The aim is to achieve 93% in March and 95% from April onwards. Credit must go to the staff who have worked extremely hard to achieve this performance.

The Trust is planning a week long “perfect week” exercise in May 2015. This is a national improvement initiative to restart the system and reset good practice. Trusts that have undertaken this exercise have seen significant and sustained improvements.

The performance against the diagnostics target was challenged in part due to recent cancer awareness campaigns and an increased demand for colonoscopy - it is expected that performance will be back on target in March 2015.

Readmissions is a concern to the Trust and the CCG, approximately 20% of patients are readmitted - although this is similar to other Trusts in the area, there is more that could be done to address this - the Trust are working with the CCG to review data and identify potential for improvement.

The 18 week target continues to be achieved despite pressure from cancellations in January and February. Performance against the cancer targets has also been achieved with strong performance maintaining the Trusts position as one of the best in the country for timely treatment.

Governors discussed the indicators on quality and operational performance requesting further information about activity in A&E and the implications of the changing demographics and the reduction in the provision of social care.

Workforce - sickness absence remains a challenge, the initiatives introduced are starting to have an impact and some progress has been made in reducing the number of staff on long term sickness in particular but there is still a way to go.

The heat map included in the integrated performance report provides detailed information with regard to the hot spots and allows targeted intervention. The Health and well-being team provide support to staff. In response to a question regarding the nurses recruited from Spain and Portugal in 2014, the CEO advised that they have settled well and are still all with the Trust one nurse did leave but returned within a short time.

Finance - The Trust is on track for financial break even at the end of the year, this is fantastic progress and compares very favourably with other Trusts both locally and nationally.

Governors asked that their congratulations to the finance team and the wider team on the achievement of significant financial improvement be noted.

6. Quality Account priorities

The Trust Secretary provided an update on the development of the 2014/15 Quality report. Governors were reminded that this report is produced annually and includes a review of performance in the previous year and a look forward and affirmation of priorities for the coming year.

Governors, FT members and staff members have been responding to a survey to select the five priority indicators for 2015/16 - the survey will remain open for a further week with the Board scheduled to approve the selected indicators at their meeting at the end of March.

The top five as at March 11th 2015 are:

• Infection control


• Reducing mortality

• reduction in medication incidents

• reduction in falls with severe harm

• reduction in staff sickness rates

The Quality report is subject to audit by the Trust’s external auditor, this audit includes a review of three indicators included in the report - two are mandated and the third should be selected by the FT Governors.

The mandated indicators for 2014/15 are:

• percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the reporting period

• emergency re-admissions within 28 days of discharge from hospital.

Governors were asked to spend time discussing the full list of priorities included in the 2013/14 report to reach agreement on the third indicator for external review.

Following discussion in groups feedback was collated on the selected indictor.

Resolved: Governors agreed that the third indicator for external audit should be compliance with the dementia care bundle.

7. Feedback from Governor sub committees

7.1 Patient, Staff and Visitor experience

The group received and discussed a presentation on end of life care.

Other issues discussed included specific experiences with treatment provided in the Trust, the introduction of Better Listening Friday to replace 100 voices and concern with regard to a perceived lack of catering at weekends.

7.2 Strategy

The strategy group considered the annual plan and the implications of the five year forward view and the Dalton review.

7.3 Membership Group

Discussed engagement with members and recruitment of new members. Confirmed that a budget has been allocated for three newsletters a year and monthly e-bulletins to members.

A recent Medicine for Members event included an excellent presentation on diabetes but was poorly attended.

Resolved: that representatives of the press and other members of the public be excluded from the remainder of the is meeting having regard to the confidential nature of the business to be transacted.


Governor Meeting - Part Two

1. North West Sector Update

The Director of Strategic and Organisational Development and the Chairman provided an update on the work within the North West Sector and the exploration of a single service partnership.

The Chairman assured Governors that any proposal approved by the Board must be affordable and must not destabilise quality or affordability and must not have an adverse impact on patients.

2. Nomination and Remuneration.

The Chairman updated Governors on the outcome of recent discussions at the Governor Nomination and Remuneration Committee (the committee) where the focus of discussions had been on succession planning to ensure the long term stability of the Board.

Mark Harrison - Mark Harrison’s first term of office comes to an end at the end of March. The Committee discussed his appointment and performance and agreed to recommend to the Council of Governors that he be reappointed to serve for a further three year period until 31st March 2018.

Resolved: The Governors approved the appointment of Mark Harrison as NED and SID for a three year period to end 31st March 2018.

Andrew Thornton - Andrew’s appointment had previously been agreed until March 31st 2015, in view of Gina’s continued ill health the Committee were recommending this term be extended to the end of June 2015.

Resolved: the Governors approved the extension of Andrew Thornton’s interim contract to 30th June 2015.

Future NED appointments - Both Gina’s and Alan’s term of office will come to an end at the end of December 2015; at their next meeting, the Committee will consider the process to reappoint or advertise. Consideration will also be given to succession planning in readiness for August 2016 when Carol Davies’s second term of office ends.

The Committee also considered a proposal to appoint an additional NED, this proposal was based on the increased challenges facing NEDs and the requirement for increased involvement particularly post Francis report.

Resolved: The Council of Governors approved the appointment of an additional NED and delegated the oversight of the appointment process to the Governor Nomination and Remuneration Sub Committee.

3. NED appraisals

The Chairman advised that he had shared the outcomes from recent NED appraisals with the Committee, all NEDs were deemed to be performing well and meeting their objectives. It was however recognised that there needs to be more opportunity for Governors to input into reflections on individual NED performance.


Safe, High Quality Care, Fit for the Future

Quality and Safety

Valued Provider

Financially viable and sustainable

Great place to work

Fit for the future

Well Governed

Subject Integrated Performance Report – March 2015

Prepared By Performance and Information Team

Approved By Executive Management Team

Presented By Chief Executive – Bolton NHS Foundation Trust

Executive Summary

Please see the High level Executive Summary section at the beginning of the report

Key Recommendations

The Board are asked to receive the report and give approval.

Acronyms/Terms used in Report

TRUST BOARD

Trust Objectives

Purpose

This report sets out the Trust’s integrated performance against leading national and local targets and draws attention to key areas for specific review by the Trust Board. Driven by the Trust’s strategic objectives this report is underpinned by a strong platform of integrated governance and assured data quality controls allowing the Trust Board to make effective decisions and demonstrate its commitment to delivering high quality healthcare for the people of Bolton.

Report

Appendix A

Appendix B

Report change log

1 All available data correct as of Tuesday 21st April 2015.


Executive Apex Reports High Level Executive Summary High Level Executive Dashboard High Level Executive Report • Monitor Risk Assessment Framework • District Nursing

Section 1 Improving the Quality of Care and Safety of our patients • Quality and Governance Scorecard • Quality and Governance Charts • Quality and Governance Report • Acquired Infection • Falls • Pressure Damage

Section 2 Valued provider of Integrated Services • Operations Scorecard

• Operations Charts • Operations Report

Contents



Section 3 Financially viable and sustainable • Finance Scorecard • Finance Report Section 4 A great place to work • Workforce Scorecard • Workforce Charts • Workforce Report Section 5 Ward to Board Heat Map District Nursing Heat Map Section 6 Fit for the Future

Section 7 Well Governed

Appendix A Acronyms/Terms used in Report

Appendix B Dashboard Change log - in month


93.7% of Complaints were responded to within timescale, slightly below the target of 95%

Pressure ulcers have decreased to previous levels. There were 2 in hospital, one of which was avoidable. There were 4 in the community with two of these are at grade 3.

There were three C. Diff infections in March but no cases of Trust apportioned MRSA infections

A&E performance improved to 91.7% in March from 88%.

Sickness absence has decreased to 4.92% (rolling 12 month average). The rate in-month for March 2015 stood at 4.79%.

The quarterly Staff Friends & Family Test survey in March 2015 shows largely unchanged levels of staff advocating the Trust, compared to Quarter 2 where staff were surveyed. 74% of staff recommend the Trust as a place to receive treatment and 58% of staff recommend the Trust as a place to work.

Mandatory training compliance has continued the sustained improvement seen through 2014/15 and now stands at above 90% for the first time.

Appraisal rates are close to the target at 79.9%. Divisions are prioritising those staff who have not had an appraisal for 18 months.

Five Year Strategic Plan - there is no requirement to submit a revised strategic plan. A one year operational plan for 2015/16 is needed.

There were two breaches of same sex accommodation

North West Sector work on emergency and high risk surgery and urgent emergency and acute medicine.

Diagnostic waits longer than 6 weeks reduced from 1.1% to 0.4%. The is the best performance since July 2014.

Readmissions within 30 days of discharge were at 14.4% in March. This was an increase on the previous month and stands at 13.8% YTD

Better Care Fund - comes into full effect on 1 April when performance reporting will become more meaningful, although some indicators will only be updated annually.

ICIP delivery for the year is £21.2m, which is £1.0m under plan.

ICIP delivery is £2.3m in month, which is £0.1m over plan.

The full year position is a surplus of £0.6m and is off track by £1.0m

March's in month surplus is £0.7m and is over plan by £0.1m

RTT achieved in month

Executive Summary

This executive summary provides an integrated overview of the Trust Board Performance Report. Supporting the Trust's Strategic Objectives it orientates executives quickly to the areas that have been escalated, are of particular note or political significance. The accompanying High-Level Dashboard and narrative gives further analyses. Compliance levels with the Monitor Risk Assessment Framework and CQC (Care Quality Commission) are also shown.

Improving the Quality of Care and Safety of our patients A great place to work

Valued provider of Integrated Services Fit for the future

Financially viable and sustainable Well GovernedOur Patients

The Trust has received a certificate of compliance with the enforcement undertakings

agreed with Monitor.

Monitor Risk Assessment Framework

CQC

Governance Finance ‐ Level 2

All available data correct as of Tuesday 21st April 2015.

The Trust has been awarded a band 3 weighting by the CQC


Improving the Quality of Care and Safety of our patients

FFTThe recommended rate Likely/Extremely Likely FFT in Community is 91.52% based on February 2015 responses. No target has yet been set. Due to the submission deadlines on UNIFY, this is currently a month behind. Special School Nursing is excluded at request from the Division.

Complaints 1 complaint was received in Community for March 2015 in Elective Care. 28 complaints were received during 2014/15.

Pressure Ulcers4 Pressure Ulcers were reported in March 2015, 2 were reported as grade 3. 75 pressure ulcers have been reported during 2014/15.

Patient Falls 15 falls were reported in March 2015. 126 falls have been reported during 2014/15.

Hand HygieneThe Self Assessed Hand Hygiene score for March 2015 is 97.9% against a plan of 100%. The need to monitor this indicator has been highlighted in Community to ensure complete reporting across services. We will monitor and encourage response rates going forward with our Infection Control Team.

Incidents A total of 188 incidents were reported in March 2015. 2 were graded as severe and 23 are yet to be graded. 1821 incidents have been reported during 2014/15. Targets to be worked on.

Valued provider of Integrated Services

AttendancesA total of 70823 attendances recorded for March 2015 against 72130 attendances this time last year. The total attendances for 2014/15 is 850259. This is subject to change as further inputting takes place.

DNA RatesMarch 2015 DNA rate is 3.4% same as this time last year. The DNA rate for 2014/15 is 3.6%. This is subject to change as further inputting takes place.

Total ReferralsA total of 8045 referrals were received during March 2015 compared to 7766 in March 2014. The total referrals for 2014/15 is 97256 compared to 91856 during 2013/15. The 2014/15 figure is subject to change following further inputting.

Waiting TimesWe are currently working with divisions on reporting new and follow-up waiting times. Figures reported are currently manually collected.

A great place to work

Staff Turnover Staff turn-over during March 2015 is at 10.6% against a plan of 10%.

Appraisals Staff appraisals were reported at 87.8% during March 2015, compared to a plan of 80%.

Sickness staff sickness fell slightly in March 2015 to 5.4% against a plan of 3.75%.

Community Dashboard 2014_15 Executive SummaryExecutive Summary

Workforce figures on the Dashboards have been reviewed and revised across some Services. Relevant changes are in this months Dashboards. Any missing activity is due to on-going discussions with the Services.


Indicator (All measured/reported Quarterly) Threshold WeightingQuarter 1 Actual

Quarter 2 Actual Oct-14 Nov-14 Dec-14

Quarter 3 Actual Jan-15 Feb-15 Mar-15

Quarter 4 Actual

Referral to treatment time, 18 weeks in aggregate, admitted patients 90% 1.0 94.9% 93.7% 93.4% 93.1% 93.1% 93.2% 91.1% 90.3% 92.1% 91.2%Referral to treatment time, 18 weeks in aggregate, non-admitted patients 95% 1.0 97.5% 97.0% 96.8% 96.8% 97.2% 96.9% 97.0% 96.8% 97.1% 97.0%Referral to treatment time, 18 weeks in aggregate, incomplete pathways 92% 1.0 96.6% 96.1% 95.8% 95.5% 95.5% 95.6% 95.1% 96.0% 96.4% 95.8%A&E Clinical Quality- Total Time in A&E under 4 hours 95% 1.0 95.5% 95.6% 92.6% 90.3% 86.30% 89.7% 85.80% 88.0% 91.8% 88.5%All cancers: 62-day wait for first treatment from:

(from urgent GP referral) - post local breach re-allocation (Amended) 85% 90.7% 90.4% 88.5% 94.3% 93.7% 92.2% 93.2% 86.5% 89.9%(from NHS Cancer Screening Service referral) - post local breach re-allocation (Amended) 90% 100% 99% 92% 81% 100% 90.9% 95% 100.0% 97.5%

(from urgent GP referral) - pre local breach re-allocation (New) 93% 92% 89% 94% 96% 93.1% 90.8% 88.9% 91.9%(from NHS Cancer Screening Service referral) - pre local breach re-allocation (New) 100% 99% 92% 84% 100% 92.2% 92.7% 100.0% 96.4%

All cancers: 31-day wait for second or subsequent treatment Surgery 94% 1.0 100% 100% 100% 100% 100% 100.0% 100% 100.0% 100%

Drug treatments 98% 1.0 100% 100% 100% 100% 100% 100.0% 100% 100.0% 100%From diagnosis to first treatment 96% 1.0 99% 98% 99% 99% 98% 98.6% 97% 98.7% 97.7%

Cancer: two week wait from referral to date first seen, comprising:Cancer 2 week (all cancers) 93% 97.5% 97.5% 98.4% 97.2% 98.4% 98.0% 96.2% 97.6% 96.9%

Cancer 2 week (breast symptoms) 93% 95.6% 97.6% 93.4% 95.0% 95.8% 94.7% 93.4% 88% 90.9%C.Diff due to lapses in care (Amended) 12 1.0 8 2 0 1 3 4 3 0 3 6

Total C.Diff YTD (including: cases deemed not to be due to lapse in care and cases under review) (New) 8 10 10 11 14 14 17 17 20 20C.Diff cases under review (New) 0 0 0 0 0 0 0 0 0 0Certification against compliance with requirements regarding access to health care for people with a learning disability 1.0 100% 100% 100% 100% 100% 100% 100% 100% 100%Community care:

Referral to treatment information completeness 50% 99.4% 99.4% 99.4% 99.4% 99.3% 99.4% 99.1% 99.1% 99.2% 99.1%Referral information completeness 50% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100%Activity information completeness 50% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100%

Risk of, or actual, failure to deliver Commissioner Requested Services No No No No No No No No No NoCQC compliance action outstanding (as at time of submission) No No No No No No No No No NoCQC enforcement action within last 12 months (as at time of submission) No No No No No No No No No NoCQC enforcement action (including notices) currently in effect (as at time of submission) No No No No No No No No No NoModerate CQC concerns or impacts regarding the safety of healthcare provision (as at time of submission) No No No No No No No No No NoMajor CQC concerns or impacts regarding the safety of healthcare provision (as at time of submission) No No No No No No No No No NoTrust unable to declare ongoing compliance with minimum standards of CQC registration No No No No No No No No No No

Monitor Risk Report 2014-15

1.0

1.0

1.0


Improving The Quality Of Care And Safety Of Our Patients Plan 14/15 Plan YTD

Actual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Financially Viable And Sustainable

Plan 14/15

Plan YTD

Plan Actual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Well Governed Status

Total number of new SUIs received within the month 0 0 9 1 Forecast year end deficit - FYE 1.6 1.6 0.6 0.0 0.6 -1.0

Monitor Risk Assessment Framework On Plan

Total Incidents reported on Safeguard 10786 10786 10934 1079 Forecast year end income and cost improvement - FYE 22.2 22.2 21.2 0.0 0.6 -1.0 CQC Intelligent Monitoring Report On Plan

Never Event 0 0 3 0 Actual position against plan - YTD 1.6 1.6 0.6 0.7 0.9 -1.0CQC Essential Healthcare Standards (5) On Plan

All Patient Falls (Safeguard) 982 984 0 104 Actual Income and Cost Improvement -YTD 22.2 22.2 21.2 2.3 0.1 -1.0CQUINS: National Clinical Quality Indicators On Plan

Acute Inpatients acquiring pressure damage (grades 2+) 27 27 50 2 Capital Expenditure YTD 7.8 7.8 6.5 3.5 3.2 -1.3 Report to prevent future deaths On Plan

Community patients acquiring pressure damage 76 76 73 4 Cash Position YTD 1.1 1.1 5.3 5.3 -1.3 4.2 Litigation On Plan

VTE Assessment Compliance 95.0% 95.0% 96.8% 97.2% Continuity of services rating 2.0 2.0 2.0 2.0 0.0 0.0 Formal Contract Notices On Plan

Total number of medication incidents 636 636 1149 90 Formal Performance Notices On Plan

Same sex accommodation 0 0 11 2 Contract Fines/Penalties Off Plan

C Diff Hospital acquired 48 48 20 3

CHKS RAMI (Rolling 12 months) 100 100 86 90 Staff friends and family test - Recommend treatment (Quarterly) 74.0%

SHMI 1.000 1.000 1.066 1.069Staff friends and family test - Recommend place to work (Quarterly) 58.0%

Surgical WHO Checklist compliance (Elective) 100% 100.0% 98.1% 99.0% Appraisals completed % 80% 80% 79.1% 79.9% Five Year Strategic Plan Off Plan

Surgical WHO Checklist compliance (Emergency) 100.0% 100.0% 99.2% 99.0% Sickness days % of days lost 3.75% 3.75% 4.89% 4.79% Healthier Together On Plan

Formal complaints from patients 240 240 494 33 Mandatory Training Compliance % 100% 100% 87.1% 90.8% IT and Estates Strategy On PlanComplaints responded to within the time period % 95.0% 95.0% 91.6% 93.7% Better Care Fund On Plan

Cancer Treatment Targets (7) reported 1 month retrospectivelyPlan 14/15

Plan YTD Actual YTD

Monthly Actual

Monthly Change

On Plan Off Plan

Valued Provider Of Integrated Services Plan 14/15 Plan YTDActual YTD

Monthly Actual

Monthly Change

On Plan Off Plan Patients 2 week wait (all cancers) % 93.0% 93.0% 97.5% 97.6%

A&E 4 hour target 95.0% 95.0% 92.4% 91.8% Patients 2 week wait (breast symptomatic) % 93.0% 93.0% 95.0% 88.4%

RTT Admitted Clock Stops % 90.0% 90.0% 93.3% 92.1% 31 days to first treatment % 96.0% 96.0% 98.3% 98.7%

RTT Non-Admitted Clock Stops % 95.0% 95.0% 97.1% 97.1% 31 days subsequent treatment (surgery) % 94.0% 94.0% 100.0% 100.0%

RTT: Incomplete pathways within 18 weeks % 92.0% 92.0% 93.3% 96.4% 31 days subsequent treatment (anti cancer drugs) % 98.0% 98.0% 100.0% 100.0%

Diagnostic waits >6 weeks % 1.0% 1.0% 0.7% 0.4% 62 day standard % 85.0% 85.0% 90.9% 86.5%% of patients who spend 90% of their stay on the stroke unit 80.0% 80.0% 81.7% 82.7% 62 day screening % 90.0% 90.0% 96.7% 100.0%

% Readmissions within 30 days of discharge 12.6% 12.6% 13.8% 14.4%

High Level Executive Dashboard

Fit for the Future

Performance improved but off target in month

Performance deteriorated and off target in month

Monthly/ Quarterly Change

On Plan Off PlanDeveloping Our Staff

Plan 14/15

Plan YTD Actual YTD

Monthly/ Quarterly

Actual

Status

The On Plan / Off Plan Columns represent a projected Year End position. The status columns represents the current status of the initiative detailed

Performance improved and on target in month

Performance deteriorated but on target in month


High level Executive Report March 2015

Complaints

• There were 2 breaches of the 25 day response time in March 2015. Both complainants have now received a final response to their concerns. The delays related to a QA process, which highlighted issues around the quality of the investigation and the final draft letter.

Pressure Damage

• March 2015 has seen an improvement in the number of pressure ulcers across the hospital and community. A final summary report will be presented at the May QA committee followed by a presentation to the CCG. Although it is disappointing that we have not achieved our target of zero tolerance of category 3 and 4 pressure ulcers, we have seen a marked improvement throughout the year against performance in 2013/14. In 2014/15 there were 123 pressure ulcers compared to 228 in 13/14, a reduction of 46%. The tables below show the reductions for Acute and Community services. We continue to drive the Pressure Ulcer Prevention Strategy and Harm Free Care.

Acute

2013-14 Total 2014-15 Total Variance

94 50 -44 -46.81% % Decrease

Community

2013-14 Total

2014-15 Total Variance

134 73 -61 -45.52% % Decrease


Category Performance Indicator Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

Patients acquiring pressure damage (grade 2) 4 3 9 2 0 3 1 3 0 1 4 2Patients acquiring pressure damage (grade 3) 1 5 0 2 1 0 0 0 1 3 4 0Patients acquiring pressure damage (grade 4) 0 0 0 0 0 0 0 0 0 0 1 0Patients acquiring pressure damage (Total) 5 8 9 4 1 3 1 3 1 4 9 2Patients acquiring pressure damage (grade 2) 3 8 5 3 1 5 2 4 2 6 8 2Patients acquiring pressure damage (grade 3) 0 3 1 1 3 0 1 0 0 1 4 2Patients acquiring pressure damage (grade 4) 0 0 1 1 0 0 0 0 2 2 2 0Patients acquiring pressure damage (Total) 3 11 7 5 4 5 3 4 4 9 14 4

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Acquired Infection

• CDT: There were three Trust apportioned CDT cases in February. There were a number of lapses, including failure to isolate and inconsistent documentation on stool charts. To the end of March and the end of the financial year, there were 20 Trust apportioned cases against an external target of 48 cases. We also have an internal stretch target of 28 cases for the year. The target for 15/16 is no more than 19 cases

• MRSA: There have been no further Trust apportioned MRSA with the total for the financial year standing at one case.

• MRSA: There have been no new non-Trust apportioned MRSA bloodstream infections; the total being five for the financial year

• CPE: CPE admission screening and weekly screening has commenced on HDU; screening for high-risk patients is being rolled out across the Trust during February and March. There will be a meeting in May between the IPC team and the senior teams (Professional Leads, Heads of Division and Divisional Directors of Operations) for the inpatient divisions to discuss the potential impact


Valued provider of Integrated Services National Targets

• There was an improvement in performance against the 4 hour access target in March compared to the previous 4 months. However, some patients

experienced very long waits for beds including two patients who breached 12 hours. Root Cause Analyses are underway on these cases and will be reported in May. Improvement work has concentrated on ward round standards and TTO standard work in March.

• Ambulance handover performance remained challenging in March due to the impact in ED of limited bed availability and consequential over-crowding

in ED. Another attributory factor was related to the reliability of the Hospital Ambulance Screen IT; this has now been resolved with new screens in place. Performance improvements are anticipated for April due to new schemes coming into effect.

• Ambulance handover: Some patients experienced waits over 60 minutes. A new escalation process and supporting flow chart has been developed and circulated to staff to manage potential long waits.

• The non-elective average length of stay has been maintained at 4.1 days for the third month running. It is anticipated that this will reduce again once we move out of winter months.

• Stroke performance for 90% stay on the stroke unit has been above 80% for the first time since December 2014. Improved oversight by the matron of potential stroke patients admitted to other wards has contributed to this improvement. The centralisation of stroke services in Greater Manchester in April 2015 will see changes to the pathway for stroke patients in Bolton. Performance within the new model is being closely monitored in April.

• All cancer targets were met in February with the exception of patient 2 week wait for breast symptomatic. This was slightly below target at 88.4%. There have been challenges with breast symptomatic performance due to volume and some operational challenges. The breaches have been reviewed and action taken, which has resulted in improvement in performance week on week and this is being monitored on a daily basis.


1. Executive Dashboard & Commentary


‐1

‐0.5

0

0.5

1

1.5

2

Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

Surplus / (deficit) £m

Cumulative Actual Cumulative Plan

0

0.5

1

1.5

2

2.5


In month ICIP delivery £m

Acute Adult Elective Care

Family Care Trust wide contingency

Non recurrent flexibility release Plan

0

1

2

3

4

5

6

7

8


Month end cash balance £m

Actual Plan Revised Cash forecast

024681012141618


Cumulative Capital expenditure £m

Cumulative Actual Cumulative Plan Financed Capital Plan


1. Executive Dashboard & Commentary


Income & ExpenditureThe Trust position in month is a surplus of £719k which brings the full year surplus of £601k, £1m below plan. This is an interim/unaudited position and may change during the finalising of the accounts.

Income is up on the previous month by £2.7m and is over the in-month plan by £2.2m. This is largely contract income. Costs are up by £1.7m on February and are £2.2m over plan in month.

Annually we have earned £287.5m of income, which has over performed the plan by £6.3m. This is offset by £286.9m of costs, which have over spent by £7.3m.

The Trust has released, non-recurrently, £4.6m into the annual position.

ICIPs delivered in March total £2.3m. The year to date delivery is £21.2m.

The Trust has an estimated impairment of £25.3m reducing the surplus to a deficit of £24.7m. This is a non cash item and is normalised out for reporting

Cash & Capital• There was a cash balance of £5.3m at the end of the month. This is higher than the £1.1m plan. This is partly due to an increase in capital creditors.

• The Capital budget for the year was £6.1m plus £1.7m of financed developments. The remaining £9.7m of these proposed developments slipped into 2015/16.

• At the end of March, £6.5m was spent on the Capital programme (this includes £0.5m for radiology MFS and £0.2m received as donated assets).

• The Trust Continuity of Service rating remains 2 as planned for Q4.


2.1.1 Trust Income & Expenditure position

Trust SummaryAnnual budget £m Budget £m Actual £m Var £m Budget £m Actual £m Var £m

Contract income 254.3 21.5 23.5 2.0 254.3 259.6 5.3Education and Training Income 8.8 0.7 1.0 0.3 8.8 9.5 0.7Other income 18.1 1.6 1.6 0.0 18.1 18.4 0.3

Total Income 281.2 23.8 26.1 2.2 281.2 287.5 6.3Direct - Pay (189.8) (15.8) (17.6) (1.8) (189.8) (202.4) (12.6)Direct - Non Pay (74.5) (6.2) (7.4) (1.2) (74.5) (79.4) (4.9)Risk reserve (5.9) (0.4) 0.4 0.8 (5.9) 4.0 9.9

Total Operational Costs (270.2) (22.4) (24.6) (2.2) (270.2) (277.9) (7.7)

EBITDA 11.0 1.4 1.4 0.0 11.0 9.6 (1.4)Capital charges (9.4) (0.8) (0.7) 0.1 (9.4) (9.0) 0.4

Total Costs (279.6) (23.2) (25.3) (2.2) (279.6) (286.9) (7.3)

Surplus / (Deficit) 1.6 0.6 0.7 0.1 1.6 0.6 (1.0)Impairment of Fixed Assets 0.0 0.0 (25.3) (25.3) 0.0 (25.3) (25.3)

In Month Year to Date



2.3.1 Income Summary position

Areas of DeliveryActivity Plan

Activity Actual

Activity Var

Income Plan £m

Income Actual £m

Income Var £m

Activity Plan

Activity Actual

Activity Var

Income Plan £m

Income Actual £m

Income Var £m

Unscheduled Care 15,047 15,793 746 7.2 8.1 0.9 178,994 180,413 1,419 83.6 86.8 3.2Scheduled Care 2,725 3,065 340 2.9 3.3 0.4 33,600 32,830 (770) 33.9 32.4 (1.4)Outpatient Care 24,487 27,330 2,843 3.2 3.6 0.4 299,973 306,835 6,862 38.9 40.2 1.3Clinical Support Services 701 774 73 0.6 0.5 (0.0) 9,832 8,824 (1,008) 7.0 6.9 (0.0)Other & Block 10.1 10.6 0.5 117.8 121.1 3.3

Total £m 23.8 26.1 2.2 281.2 287.5 6.3

In Month Movement Year to Date


0

10000

20000

30000

40000


Activity Actual (number) Activity Plan (number)

0

5

10

15

20

25

30


Income Actual £m Income Plan £m

Trust Income year to date• Unscheduled Care - Activity is above plan both in month and year to date, income is also

above plan in month and year to date. A&E activity has increased significantly in month by over 1,000 attendances. Non-elective activity has also increased.

• Scheduled Care - is above plan in month due to an increase in the level of daycases. Both activity and income are above plan in month for daycases, with the elective point of delivery being slightly below plan in month. Year to date schedule care remains under plan due to the level of cancellations of elective work during the year.

• Outpatient Care - is above plan in the month for activity due to an increase in outpatient new attendances and is also above plan in the month for income due to increases in outpatient procedures that generate higher levels of income. Year to date both activity and income are above plan.

• Clinical Support Services - Clinical support service are on plan in the month, and slightly behind plan year to date. Over the year the number of ECGs has reduced inline with a CCG QIPP scheme for these to provide in other settings.

• Block & Other - is above plan in the month, and remains above plan year to date. The main movements in the month is due to an increase in the level of national clinical excellence awards, which are funded by the Department of Health.

• Penalties & CQUINS - there have been more penalties in the month due to not achieving the A&E 4 hour target and 18 week targets, but we still remain lower than last year and significantly better than plan.

• (more detailed information on income is available at appendix 10.03 to 10.05)


2.4.1 Pay costs position

Pay category

Annual budget £m

Budget £m

Actual £m Var £m

Budget £m

Actual £m Var £m

Senior Managers (5.2) (0.4) (0.5) (0.0) (5.2) (5.3) (0.1)Medical and Dental (48.1) (4.0) (4.0) (0.0) (48.1) (46.5) 1.7Nursing, Midwifery And Health Visiting (71.4) (6.0) (6.1) (0.2) (71.4) (72.8) (1.3)Scientific, Therapeutic and Technical (23.6) (2.0) (1.9) 0.1 (23.6) (22.5) 1.2Professional and Technical (4.9) (0.4) (0.4) 0.0 (4.9) (4.6) 0.2Administrative and Clerical (21.9) (1.9) (1.8) 0.1 (21.9) (20.8) 1.1Healthcare Assistants and Other Support Staff (19.5) (1.6) (1.7) (0.0) (19.5) (18.6) 0.9Agency Staff (2.2) (0.2) (1.0) (0.8) (2.2) (9.9) (7.7)Other Pay Budgets 7.2 0.6 (0.3) (0.9) 7.2 (1.5) (8.6)

Total (189.8) (15.8) (17.6) (1.8) (189.8) (202.4) (12.6)



PayIn total £17.6m has been spent on pay in March compared to a budget of £15.8m, an over spend of £1.8m. This is £0.5m worse than February. The in-month overspend is mainly on nursing (including agency; £459k) and medical (including agency; £277k).

The main areas of overspend in March is the use of agency - £1.0m of spend against a budget of £0.2m. This is £0.05m more than February. Of the agency spend £158k relates to Winter Resilience compared to £159k in February.

• Medical £374k – Complex Care (£86k), General Surgery (£34k), Cardiology (£62k), Clinical Haem (£15k), Respiratory (£23k) Radiology (£12k) and Intermediate care (£12k).

• Nursing £326k – Complex Care (£66k), Theatres (£63k), Acute Medicine (£46k), Endoscopy (£25k), A&E (£29k) and General Surgery (£35k).

• Admin £86k – a increase of £55k in month.

• Other £170k –Blood sciences (£60k), Pharmacy (£23k), Intermediate care (£18k), SALT (£12k) and Stroke/ESD (£11k).

The Other Pay Budgets includes the cost reductions (ICIPs) monies that have all been removed from specific specialty budgets, but not yet allocated 15 All available data correct as of Tuesday 21st April 2015.

2.5.1 Non Pay costs position

Non Pay category

Annual budget £m

Budget £m

Actual £m Var £m

Budget £m

Actual £m Var £m

Drugs (17.6) (1.5) (1.5) (0.1) (17.6) (19.3) (1.7)Medical & Surgical (10.1) (0.8) (0.5) 0.3 (10.1) (9.7) 0.4Clinical Supplies (9.1) (0.8) (0.9) (0.2) (9.1) (10.1) (0.9)

Activity Dependent (36.8) (3.1) (3.0) 0.1 (36.8) (39.0) (2.2)Establishment (11.3) (0.9) (0.9) 0.0 (11.3) (11.5) (0.1)Estates & Premises (11.5) (1.0) (1.1) (0.1) (11.5) (10.3) 1.2Services from other NHS bodies (3.1) (0.3) (0.3) (0.0) (3.1) (3.5) (0.4)Other Non Pay (11.7) (1.0) (2.2) (1.2) (11.7) (15.1) (3.3)

Other Non Pay (37.7) (3.1) (4.4) (1.3) (37.7) (40.4) (2.7)

Total Non Pay (74.5) (6.2) (7.4) (1.2) (74.5) (79.4) (4.9)

Total Risk Reserve (5.9) (0.4) 0.4 0.8 (5.9) 4.0 9.9



Non Pay

The total non-pay spend at £7.4m is £1.2m worse than plan.

Non pay expenditure against activity dependant items is better than plan by £0.1m in month mainly on medical and surgical £0.3m (£269k on year end stock adjustment benefits on wards, theatres and pharmacy) offset with £0.2m on clinical supplies and £0.1m on drugs.

Other non-pay is worse than plan by £1.3m, mainly on Other (re-setting provisions and year-end accounting adjustments).

Again, there has been the release of £0.43m of non-recurrent year end flexibilities into the position.

The Trust has utilised £0.4m of the Risk reserve, which takes it to the maximum available year to date


2.6.1 Capital Charges

Trust Position

Annual budget £m

Budget £m

Actual £m Var £m

Budget £m

Actual £m Var £m

Dividends (3.2) (0.3) 0.4 0.6 (3.2) (2.5) 0.7Interest Paid (0.9) (0.1) (0.3) (0.2) (0.9) (1.0) (0.0)Interest Received 0.0 0.0 0.0 0.0 0.0 0.0 0.0Depreciation (5.2) (0.4) (0.8) (0.4) (5.2) (5.5) (0.3)Profit / Loss on disposal 0.0 0.0 (0.0) (0.0) 0.0 (0.0) (0.0)

Total (9.4) (0.8) (0.7) 0.1 (9.4) (9.0) 0.4

Impairment

Impairment of Fixed Assets 0.0 0.0 (25.3) (25.3) 0.0 (25.3) (25.3)Total 0.0 0.0 (25.3) (25.3) 0.0 (25.3) (25.3)

£m Values Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar YTD

0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Impairment of Fixed Assets 0.0 0.0 0.0 (25.3) (25.3) 0.0 0.0 (25.3) (25.3) 0.0 0.0 0.0 0.0Total 0.0 0.0 0.0 (25.3) (25.3) 0.0 0.0 (25.3) (25.3) 0.0 0.0 0.0 0.00 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0£m Values Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar YTD

Dividends (0.3) (0.3) (0.3) (0.2) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) (0.3) 0.4 (2.5)

Interest Received 0.0 0.0 (0.0) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Depreciation (0.5) (0.5) (0.5) (0.5) (0.5) (0.5) (0.4) (0.3) (0.4) (0.4) (0.4) (0.8) (5.5)



Capital charges :As a result of the revaluation the Trusts estate has decreased in value by £27.0m. Comprised of an increase of £8.8m had the estate not been valued using an alternate site and a decrease of £35.8m due to the alternate site valuation.The nett impact for 2014/15 is PDC decreased by £0.5m and £0.0m for depreciation.


4.1 Statement of Financial Position year to date

£m Values Mar-14MarPlan £m

MarActual

Var to plan £m

Year end Plan £m

Non-current assetsIntangible assets 0.5 0.3 0.3 (0.0) 0.3Property, plant & equipment 131.4 137.1 105.4 (31.7) 137.1Trade & other receivables >1 year 0.7 0.9 0.6 (0.3) 0.9

132.6 138.4 106.3 (32.1) 138.4Current assets

Inventories 1.6 1.6 2.6 1.0 1.6Trade receivables 5.4 2.8 5.6 2.8 2.8Other receivables 0.8 0.8 0.8 (0.0) 0.8Accrued income 1.8 2.8 1.3 (1.5) 2.8Prepayment 1.3 1.5 1.8 0.3 1.5Cash & cash equivalents 0.4 1.0 5.3 4.3 1.0

11.3 10.5 17.4 6.9 10.5Total assets 143.9 148.9 123.7 (25.2) 148.9

Current liabilitiesLoans due < 1 year (1.4) (2.8) (1.4) 1.4 (2.8)Trade payables (7.3) (8.8) (9.6) (0.8) (8.8)Accruals (4.6) (4.6) (5.2) (0.6) (4.6)Payments on Account (0.4) (0.6) (0.2) 0.4 (0.6)Leases due < 1 year (0.1) (0.1) 0.0 0.1 (0.1)Other current liabilities (8.1) (7.7) (11.4) (3.7) (7.7)

(21.9) (24.6) (27.8) (3.2) (24.6)Net Current assets / (liabilities) (10.6) (14.1) (10.4) 3.7 (14.1)Non-current liabilities

Loans due > 1 year (18.5) (25.5) (18.9) 6.6 (25.5)Provisions (0.3) (0.3) (0.3) 0.0 (0.3)Leases due > 1 year (0.1) (0.7) 0.0 0.7 (0.7)

(18.9) (26.5) (19.2) 7.3 (26.5)

Total assets employed 103.1 97.7 76.7 (21.0) 97.7

Taxpayers Equity:Public dividend capital 102.0 102.0 102.0 0.0 102.0Retained earnings (35.3) (35.7) (36.1) (0.4) (33.3)Revaluation reserve 36.4 29.0 36.4 7.4 29.0

103.1 95.4 102.3 6.9 97.7


Summary

• As at month 12 the Trust had net current liabilities of £10.4m better than plan by £3.7m.

• The Trust's current assets are £6.9m above plan. This variance includes cash & cash equivalents of £4.3m and trade receivables of £2.8m.

• The Trust's current liabilities of £27.8m compare with a plan of £24.6m. The variance of £3.2m relates to:-

• Provisions (1.3)• Other payables (2.2)• Accruals (0.7)• Loans* 1.4• Other liabilities (0.4)

• * Loans current liability variance is offset by the non-current liabilities variance (1.5m). This is due to a change in repayable term since the plan was submitted.

• The plan was submitted prior to a revaluation of the Trust's assets therefore the property, plant and equipment variance is due to the impact of the revaluation..


5.1 Cash flow Source and Application year to date

£m Values Mar-14MarPlan £m

MarActual £m

Var to plan £m

Year end Plan £m

Income 24.4 23.5 25.2 1.7 283.0

PaymentsSalaries / Wages (10.3) (9.4) (9.1) 0.2 (110.2)Tax, NI & Superannuation (4.4) (6.2) (6.0) 0.2 (71.2)Capital (3.3) (2.3) (1.0) 1.3 (15.5)Non Pay (12.2) (6.7) (8.9) (2.2) (90.1)Loan repayment (0.1) (0.1) (0.1) 0.0 (1.4)Loan interest (0.0) 0.0 (0.0) (0.0) (0.7)PDC Dividend (1.6) (1.6) (1.4) 0.2 (3.2)PDC cash support 7.5 1.6 0.1 (1.5) 9.8Decrease in provision 0.0 0.0 0.0 0.0 0.0

Total payments (24.4) (24.7) (26.5) (1.8) (282.4)

Cashflow (0.0) (1.1) (1.3) (0.1) 0.6Opening balance 0.5 2.2 6.6 4.4 0.4

Closing balance 0.4 1.1 5.3 4.3 1.1


Summary

• In month 12 there is a cash outflow of £1.3m with a closing cash balance of £5.3m.

• Cash is above plan by £4.3m at month 12.

• All of the standard block payments relating to activity in month 12 were received in month 12.

• The Trusts plan showed a cash inflow of £0.6m for the year with a balance of £1.1m at 31st March 2015 this was based on the approved Budget / Annual plan.

• The Trust achieved a cash position of £5.3m. This is due to £1.3m Capital underspend, £2m increase in Capital creditors and £0.9m of other working capital movements.


6. Capital Expenditure position

Capital schemes

Annual budget £'000

Budget £'000

Actual £'000

Var £'000

Budget £'000

Actual £'000

Var £'000

Plant and Equipment 2,037 88 513 426 2,037 1,885 (152)Property - Maintenance 3,350 550 1,430 880 3,350 2,247 (1,103)Plant and Equipment - Information Technology 713 15 205 190 713 886 173Sub Total 6,100 653 2,148 1,496 6,100 5,019 (1,081)Funded Developments 1,743 0 633 633 1,743 1,455 (288)

Schemes plus funded development 7,843 653 2,782 2,129 7,843 6,473 (1,370)

Other Developments 9,693 1,639 0 (1,639) 9,693 0 (9,693)GROSS CAPITAL EXPENDITURE 17,536 2,292 2,782 490 17,536 6,473 (11,063)



Capital Expenditure• The Trust Capital plan for the year was £6.1m plus £1.7m of financed developments. The further developments of £9.7m relate to Estates and IT strategy

and are dependent on additional finance being agreed. These strategies have slipped into 15/16.• At the end of month 12 Capital Expenditure was £11.1m underspent (£1.4m excluding Estates and IT strategy).• The main areas of underspend are ventilation plant, Defibs, refurbishment of B4 and community IT with a total of £2.1m underspend against plan to month

12. Plus £9.7m on IT and Estates strategy "other developments" as above.• The Trust has spent 37% of the year to date Capital plan, this is below the 85% Monitor threshold.• Both Radiology MFS (£0.5m) and donated assets (£0.2m) have been included in these figures at M12. This results in a difference in the monthly trend

from previously reported as all of this took effect prior to month 12.

• (more detailed information on planned capital spend is available at appendix 10.09)


6. Capital Expenditure run rate

Capital schemes Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar YTD

Plant and Equipment 245 (10) 55 23 16 11 23 29 284 622 74 513 1,885Property - Maintenance 7 31 60 155 125 14 147 16 186 15 62 1,430 2,247Plant and Equipment - Information Technology 0 0 23 0 0 0 7 255 22 242 132 205 886

Sub Total 252 21 138 178 141 24 177 300 492 879 267 2,148 5,018Funded Developments 0 0 0 180 0 0 328 157 49 36 71 633 1,455

Schemes plus funded development 252 21 138 358 141 24 505 457 541 915 338 2,782 6,473

Other Developments 0 0 0 0 0 0 0 0 0 0 0 0 0GROSS CAPITAL EXPENDITURE 252 21 138 358 141 24 505 457 541 915 338 2,782 6,473

Plan 176 568 1,259 805 714 684 2,208 2,138 2,258 2,142 2,292 2,292 17,536Variance to Plan 76 (547) (1,121) (446) (573) (659) (1,704) (1,681) (1,717) (1,227) (1,954) 490 (11,063)



7. Income & Cost Improvement Programme

Division Savings typeFull year target £'000

Forecast £'000

Actual £'000 Var £'000

Forecast £'000

Actual £'000 Var £'000

Adult Acute Pay 3,646 363 135 (228) 3,646 1,404 (2,242)Non Pay 700 67 481 414 700 130 (570)Income 2,822 221 109 (112) 2,822 1,154 (1,668)Corporate share 1,394 116 116 0 1,394 1,394 (0)Contingency (1,184) 0 0 0 (1,184) 0 1,184Benefit of Risk reserve usage 0 0 139 139 0 2,216 2,216

Total Adult Acute 7,378 767 980 213 7,378 6,298 (1,080)

Elective Pay 1,815 149 106 (43) 1,815 1,066 (749)Non Pay 1,017 85 (327) (412) 1,017 (3,512) (4,529)Income 4,720 393 313 (80) 4,720 3,074 (1,646)Corporate share 1,277 106 106 0 1,277 1,285 8Contingency (1,104) 0 0 0 (1,104) 0 1,104Benefit of Risk reserve usage 0 0 128 128 0 2,033 2,033

Total Elective 7,725 733 326 (407) 7,725 3,945 (3,780)

Families Pay 3,468 289 48 (241) 3,467 2,168 (1,299)Non Pay 618 52 559 507 618 578 (40)Income 2,968 247 121 (126) 2,968 1,313 (1,655)Corporate share 955 80 80 (0) 955 955 0Contingency (912) 0 0 0 (911) 0 911Benefit of Risk reserve usage 0 0 105 105 0 1,659 1,659

Total Families 7,097 668 912 244 7,097 6,673 (424)

Trust wide Contingency 0 0 (400) (400) 0 (383) (383)Trust wide Non Recurrent 0 0 436 436 0 4,667 4,667

Total ICIP Delivery 22,200 2,168 2,254 86 22,200 21,201 (999)



Cost Improvement Programme• The Trust has released £4.7m non recurrently in the year, and with the divisions' releasing of risk reserves the overall delivery against ICIP plan is

£1.0m adverse for the year.


8. Forecast outturn for year


Forecast outturn for year• As its Month 12 there is no forecast for the year end outturn.


9. Continuity of Service Risk Rating (CSRR)


Capital Service Cover rating 1 1 1 2 2 2 2 2 2 2 2 3Liquidity rating 1 1 1 1 1 1 1 1 1 1 1 1

Continuity of Service Risk Rating - Actual 1 1 1 2 2 2 2 2 2 2 2 2

Continuity of Service Risk Rating - Plan 1 2 2 2


Continuity of Service Risk Rating

• The Capital Service Cover rating is a 3 and the Liquidity rating 1, giving an overall Continuity of Service Risk Rating of 2.

• This is as per plan for quarter 4.


Workforce Sickness Absence

• Sickness Absence – there has been a slight reduction in both short and long term absence. During March 2015 the most significant reduction in long term absence has been in the Integrated Community Services Division (4.91% compared to 6.37% in February 2015)

Division

Rolling 12 month average in February 2014

Rolling 12 month average February 2015

February 2015 only

Acute Adult Care Division 5.22% 5.13% 5.31% Business Unit 4 - Community Services 7.84% 7.00% 4.91% Elective Care Division 5.21% 4.84% 4.10% Estates & Facilities Division 4.20% 5.48% 6.42% Family Division 4.85% 4.68% 5.70% Corporate 2.32% 2.74% 2.43% Bolton FT Total 5.06% 4.92% 4.79%

• The rolling 12 month trend shows a slight reduction over 2014/15 in sickness absence, the reduction has been in the clinical divisions with an increase in the Corporate areas and Estates & Facilities.


• The rolling 12 month trend for each Division and the Trust overall is shown below.

• The top four departments with under 2.5% sickness absence during the last 12 months (and over 15 whole time equivalent people) in each Division are shown below. Some are also achieving very good levels of appraisal and mandatory training compliance.

Division Department

Sickness Absence

Mandatory Training Appraisal

Acute Adult Care Dietetics 2.50% 96.60% 88.20% Integrated Community Services

Single Point of Access 1.60% 98.80% 81.30%

Elective Care Clinical Chemistry 2.00% 95.80% 100%

Family Care

Paediatric Speech Therapy 2.30% 98.90% 97.20%


Better Care Fund

Integrated Neighbourhood Teams

• Workshop held on the 9th march to confirm plans for roll out of the Integrated Neighbourhood Teams across the borough. The team based in Great

Lever is now fully resourced and the case load of the team is building. The ATTP project around patient experience is in progress and the new team manager is now in place.

• Although the number of patients known to the team is growing there is still a need to increase these numbers much more. The work completed on capacity planning and trajectories will clarify the expectations on the team, which should help to resolve this.

• New roll out plan to be presented to Integration Board on the 10th April – thereafter an intensive programme of communications and engagement is to be implemented from mid- April to end of June.


Complex Lifestyles

• The complex lifestyles evaluation and recommendations paper went to the JTG where it was decided that the programme should not be continued. A

new model of delivery to be fully developed. A paper will be developed for the JTG in April providing details of how the new model will operate. Intermediate Tier Services

• The integrated health and social care teams are working well together-staff development sessions are continually taking place with learning and

development support and Culture Club. Positive patient feedback has been received together with a number of positive patient stories.

• The Admission Avoidance Team (referral & assessment) is significantly robust to respond within an hour to avoid hospital admissions from within the community; the team are also proactively supporting A/E to deflect admissions from the front end of the hospital.

• The home based pathway is performing well and above target in terms of referrals with a peak in referrals of 351 in January 2015 against a target of

216 for the month, this did put a significant amount of pressure on the team in the month and was a result of winter pressures.

Care Coordination Centre

It has been agreed that the Care Coordination Centre work-stream will not be taken forward as first planned. Instead there will be three routes of entry into health services:

• The reactive Admission Avoidance route-via the Referral and Assessment Team. • The SPA at Waters Meeting Health Centre for routine clinic appointments for community services. • Proactive service provided by the Integrated Neighbourhood Teams, via the keyworker at the Hub administrative centre.

Staying Well

At the last work-stream meeting it was agreed that a workshop will be held to process map the customer journey across health and social care. This will ensure that the inter-dependencies between Staying Well, INT’s and Complex Lifestyles are identified and streamline the customer journey.


Better Care Fund Indicators Proportion of over 65 still at home >=91 days after discharge Permanent admissions to care homes per 100,000 pop Non elective emergency admissions all providers

52.3%

79.7%85.9%

78.5%83.2% 81.1% 82.1% 86.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010/11 2011/12 2012/13 2013/14 2014/15Q1

2014/15Q2

2014/15 BCF

ambition

2015/16 BCF

ambition

Admissions per 100,000 population

Proportion of older people (65 and over) who were still at home 91 days after discharge to reablement/rehabilitation services (effectiveness of the service)

Ful l year Quarterly posi tion BCF ambition

805.4 809.9793.1

856.2 852813 805.7

752.6

500

550

600

650

700

750

800

850

900

2010/11 2011/12 2012/13 2013/14 2014/15Q1

2014/15Q2

2014/15 BCF

ambition

2015/16 BCF

ambition

Admissions per 100,000 population

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes in Bolton, per 100,000 population

Ful l year Quarterly pos ition BCF ambition

1,500

1,700

1,900

2,100

2,300

2,500

2,700

2,900

3,100

3,300

3,500

Apr‐2012

May‐2012

Jun‐2012

Jul‐2012

Aug‐2012

Sep‐2012

Oct‐2012

Nov‐2012

Dec‐2012

Jan‐2013

Feb‐2013

Mar‐2013

Apr‐2013

May‐2013

Jun‐2013

Jul‐2013

Aug‐2013

Sep‐2013

Oct‐2013

Nov‐2013

Dec‐2013

Jan‐2014

Feb‐2014

Mar‐2014

Apr‐2014

May‐2014

Jun‐2014

Jul‐2014

Aug‐2014

Sep‐2014

Oct‐2014

Nov‐2014

Dec‐2014

Jan‐2015

Feb‐2015

Number of admissions

Month

Non‐elective emergency admissions to all acute providers ‐ all Bolton CCG patientsIncludes BCU admissions between April 2012 ‐ December 2013

Target Actual number of admissions Average UCL LCL

Proportion of deaths in usual place of residence Delayed Transfers of Care

37.1%37.7% 37.9%

38.7% 38.8%

39.8%40.6% 40.5% 40.7%

42.3% 42.4%

43.9% 44.0%

32%

34%

36%

38%

40%

42%

44%

46%

Apr '10 to

Mar '11

Jul '10 to

Jun '11

Oct '10 to

Sep '11

Jan '11 to

Dec '11

Apr '11 to

Mar '12

Jul '11 to

Jun '12

Oct '11 to

Sep '12

Jan '12 to

Dec '12

Apr '12 to

Mar '13

Jul '12 to

Jun '13

Oct '12 to

Sep '13

Jan '13 to

Dec '13

Apr '13 to

Mar '14

Proportion of deaths in usual place of residence

Period

Proportion of deaths in usual place of residence (%) ‐ Bolton CCG

Proportion of deaths in usual place of residence Trend

0

100

200

300

400

500

600

700

800

900

Apr‐2012

May‐2012

Jun‐2012

Jul‐2012

Aug‐2012

Sep‐2012

Oct‐2012

Nov‐2012

Dec‐2012

Jan‐2013

Feb‐2013

Mar‐2013

Apr‐2013

May‐2013

Jun‐2013

Jul‐2013

Aug‐2013

Sep‐2013

Oct‐2013

Nov‐2013

Dec‐2013

Jan‐2014

Feb‐2014

Mar‐2014

Apr‐2014

May‐2014

Jun‐2014

Jul‐2014

Aug‐2014

Sep‐2014

Oct‐2014

Nov‐2014

Dec‐2014

Jan‐2015

Feb‐2015

Total delayed days

Month

Delayed transfers of care ‐ total delayed days for Bolton patients

Target Actual total delayed days Average UCL LCL


Well Governed

Penalties

Plan Actual £'000 £'000 Penalties (1,771) (709) C-Diff 0 0 TOTAL (1,771) (709)

• At month 11 we reported penalties for A&E 4 hours, 18 weeks and 6 week diagnostics waits all of which were validated in the month.

• In month 12 reporting we are predicting the following penalties changes:

• There is a new penalty for A&E deflection; this has been applied due to not following the deflection pathway in A&E.

• Re-admission penalty is a set amount based on an audit; this value may change once we've completed a new audit of all emergency re-admissions within 30 days of original discharge. The audit looks at a sample of patients and determines how many of them could have been avoided if better primary/social care services existed, the audit will be taking place and there is a risk of significant increase to this penalty.

• The 18 weeks referral to treatment penalties are estimated to continue for several specialities as above.

• The A&E four wait penalty has been applied in month due to the non-achievement of the 95% threshold. The penalty is £200 per patient below the threshold of 95% and we have received the maximum penalty in month.

• CQUINS, at month 12 we are reporting a significant level achievement of the available CQUINs. But we have recognised a £135k reduction to the year end position with a couple schemes being at risk of not achieving in quarter 3 & 4.

• Improvement on the validation penalty as we have improved on clearing these.


INDICATORS Acute Frailty Unit B2 B3 B4 C1 C2 C3 C4 CCU CDU D1

(MAU1)D2

(MAU2) D3 D4 Darley Court

H3 (Stroke Unit) HDU ICU DCU

(Daycare)EU

(Daycare) E3 E4 F3F4/F6

(Combined wards)

G3/G3TSU G4 G5 H2 (daycare)

UU (Daycare)

E5 (Paed HDU and

Obs)

F5 (Short Stay Paed Ass Unit)

M1 and Assessme

ntEPU M2 CDS M3 (Birth

Suite) M4/M5 NICU Total

Number of Beds 26 26 25 26 26 27 10 14 27 22 27 35 24 10 8 15 15 25 25 24 24 23 25 14 10 4 38 16 6 26 18 5 44 38 728Exception indicator Closed 0

Friends and Family Net Promoter Score 65.3 81.8 NA 100.0 83.6 100.0 73.1 66.7 86.1 58.6 46.2 58.3 77.3 87.1 NA 81.8 100.0 100.0 NA NA 84.6 75.0 78.3 82.1 92.9 100.0 88.2 NA NA NA NA 88.7 NA NA NA NA NA NA 82.1

Safety Express Programme Harm Free Care (%) 95.45% 92.31% NA 88.46% 100.00% 73.08% 100.00% 92.59% 100.00% NA 100.00% 100.00% 100.00% 88.89% 92.31% 100.00% 85.71% 100.00% NA NA 100.00% 91.67% 100.00% 100.00% 100.00% 96.00% 90.00% NA NA 100.00% NA 87.50% 100.00% 100.00% 100.00% NA 95.83% 100.00% 96.75%

Weekly KPI Audit % 99.10% 91.20% 98.50% 99.00% 98.70% 92.50% 85.00% 94.80% 95.70% 92.60% 94.70% 97.70% 98.80% 98.40% 83.50% 80.90% 100.00% 100.00% 100.00% 98.60% 96.70% 99.00% 100.00% 97.90% 96.50% 99.30% 100.00% 100.00% 100.00% 94.90% 100.00% 71.80% 100.00% 98.20% 93.60% 95.65%

Hand Washing Compliance % (Self Assessed) 92.00% 98.33% 100.00% 90.00% 100.00% 100.00% 98.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.00% 100.00% 100.00% 97.33% 96.33% 98.00% 95.00% 100.00% 94.00% 85.00% 100.00% 100.00% 96.25% 92.00% 100.00% 100.00% 83.67% 100.00% 100.00% 99.00% NA 92.08% 100.00% 100.00% 96.25% 100.00% 97.33%

1.60 - Monthly New pressure Ulcers (Grade 2+) 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2

1.01 - All Patient Falls (Safeguard) 6 1 0 1 2 8 7 5 1 3 8 3 14 1 10 4 0 0 0 0 5 3 4 1 1 2 2 0 0 1 0 1 0 0 0 0 1 0 95

1.13 - Infection Control (C. Diff) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3

1.39 - MRSA HA acquisitions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1.20 - VTE Assessment Compliance (February) 95.83% 100.00% 20.00% 0.00% 100.00% 85.71% 94.59% 66.67% 69.89% 96.40% 95.26% 96.77% 100.00% 100.00% NA 88.24% 100.00% 100.00% 99.75% 99.22% 100.00% 100.00% 99.48% 98.87% 100.00% 98.00% 100.00% 100.00% 96.36% 99.58% 100.00% 96.21% 100.00% 94.53% 94.12% 97.24%

ESSA Assessment *** ** ** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** * * *** *** *** *** *** *** *** *** *** *** *** ** ***1.27 - Number of complaints received 0 0 1 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 8

Budgeted Nurse: Bed Ratio (WTE) #DIV/0! 1.16 #DIV/0! 1.16 1.21 1.16 1.16 1.22 2.72 1.43 1.47 1.59 1.12 #DIV/0! 0.94 1.37 4.00 6.57 1.65 1.96 1.21 1.21 1.66 1.19 1.78 1.36 1.49 2.87 4.02 1.73 1.48

Actual/Current Nurse: Bed Ratio (WTE) #DIV/0! 1.01 #DIV/0! 1.11 1.10 1.17 1.14 1.16 2.18 1.28 1.30 1.44 1.13 #DIV/0! 1.18 1.23 3.99 6.41 1.47 2.09 1.08 1.06 1.53 1.02 1.70 1.35 1.41 2.49 3.72 1.63 1.42

% Qualified Staff (Night) 98.4% 95.6% 87.8% 83.7% 101.3% 91.5% 92.7% 96.7% 95.3% 89.2% 91.0% 90.1% 93.2% 87.1% 92.3% 91.6% 97.5% 97.2% 92.3% 91.6% 105.4% 115.9% 104.5% 85.5% 93.1% 109.5% 100.0% 100.0% 103.1% 103.8% 95.9%

% un-Qualified Staff (Night) 134.4% 130.7% 131.8% 111.4% 108.9% 114.3% 103.3% 97.1% 111.6% 99.4% 101.5% 112.1% 114.5% 114.2% 94.3% 77.9% 97.5% 113.0% 87.2% 86.7% 92.7% 96.9% 81.4% 82.3% 132.0% 86.3% 100.0% 100.0% 90.4% 136.0% 104.7%

% Qualified Staff (Day) 95.2% 95.7% 101.6% 99.9% 100.5% 98.4% 90.3% 100.0% 96.8% 93.5% 93.8% 99.3% 111.3% 93.5% 94.8% 100.0% 100.7% 99.3% 90.1% 143.5% 101.1% 100.0% 87.3% 87.6% 96.0% 100.0% 100.0% 100.0% 100.0% 102.9% 99.1%

% un-Qualified Staff (Day) 163.7% 158.3% 146.5% 153.2% 117.5% 129.9% 176.6% 96.6% 100.0% 117.7% 140.2% 123.2% 125.8% 177.4% 100.0% 100.0% 116.1% 175.6% 131.1% 95.2% 140.9% 119.4% 86.4% 87.1% 104.5% 99.6% 100.0% 100.0% 95.6% 100.0% 122.6%

AUKUH Acuity/Dependency (WTE) (This will not change until the nex A&D audit) 36.63 47.16 48.69 36.10 43.15 26.31 51.39 11.12 44.35 45.88 26.81 49.22 49.16 32.17 23.98 22.58 32.63 19.72 32.60 44.82 11.60 12.41

1.07 - Total Incidents reported on Safeguard 13 5 1 12 10 24 18 15 1 24 42 20 24 10 41 9 5 13 15 6 12 10 12 16 7 8 8 1 5 18 1 4 4 7 73 7 22 37 560

SUIs in Month 0

Current Budgeted WTE (From Ledger) 30.22 30.22 0.00 30.22 30.22 30.22 30.22 32.87 27.21 19.97 39.64 35.05 30.22 30.22 33.02 32.87 39.96 52.54 24.73 29.42 30.22 30.21 39.93 28.64 40.83 34.11 20.80 28.74 16.08 65.21 27.60 109.34 1,080.75

Actual WTE In-Post (From Ledger) 24.99 26.14 13.15 28.95 27.49 30.30 29.51 31.29 21.75 17.92 34.97 31.60 30.41 31.93 41.16 29.56 39.87 51.26 22.02 31.42 27.12 26.49 36.67 24.49 39.00 33.75 19.72 24.89 14.88 62.88 26.07 102.04 1033.69

Actual Worked (From Ledger) 28.85 29.19 26.14 37.99 29.17 35.88 32.23 31.33 22.91 17.91 36.17 30.12 29.55 32.15 48.67 31.44 38.75 51.41 24.42 33.04 28.64 31.38 39.47 26.78 41.05 35.18 19.84 26.22 14.89 61.87 26.60 95.95 1095.19

Pending Appointment 3.84 0.92 0.92 2.84 4.92 2.84 1 3.45 1 1.92 2.92 1.87 4.0 4.65 1 1 3 9.15 1 1 9.61 62.85

Current Budgeted Vacancies (WTE) 5.23 0.24 -14.07 0.35 -0.11 -0.08 -4.21 -1.26 5.46 1.05 1.22 2.45 -2.11 -4.63 -10.01 3.31 -3.91 -3.37 2.71 -2.00 2.10 2.72 3.26 4.15 1.83 0.36 1.08 0.85 1.20 -6.82 0.53 -2.31 -14.79

Sickness (%) 0.43 3.55 17.28 5.50 9.88 11.90 6.52 9.49 1.88 1.94 4.49 8.19 0.72 6.49 10.04 5.56 4.55 4.26 2.24 5.91 6.74 4.41 10.13 6.30 5.92 4.49 3.57 6.97 5.97 9.32 6.56 6.56 6.56 6.56 7.80 6.25

4.02 - Substantive Staff Turnover Headcount (rolling average 12 months) 10.34% 16.13% 14.29% 6.45% 2.63% 9.38% 18.75% 3.57% 33.33% 14.29% 9.09% 11.76% 12.50% 15.79% 5.88% 6.67% 8.62% 4.17% 15.79% 15.63% 16.13% 9.76% 15.15% 9.76% 12.12% 4.35% 6.45% 0.00% 8.45% 16.00% 8.18% 8.18% 8.18% 8.18% 10.16% 10.75%

12 month Appraisal 72.41% 7.69% 34.48% 86.67% 70.59% 93.10% 17.65% 82.14% 85.00% 66.67% 86.21% 87.88% 83.87% 76.60% 48.48% 79.49% 77.19% 88.46% 62.50% 75.86% 65.52% 42.86% 59.26% 81.40% 72.22% 95.83% 82.14% 69.23% 94.12% 84.62% 70.87% 70.87% 70.87% 70.87% 90.91% 71.56%

12 month Mandatory Training 88.27% 62.45% 63.39% 92.90% 96.60% 88.16% 77.17% 92.93% 83.16% 74.07% 91.16% 93.97% 87.90% 80.30% 95.14% 92.22% 96.11% 95.52% 75.29% 87.97% 91.47% 95.67% 89.62% 78.33% 83.07% 95.51% 82.25% 96.67% 94.06% 85.76% 93.89% 93.89% 93.89% 93.89% 94.95% 87.93%

Friends and Family (Staff) *

Board Assurance Heat Map - Hospital - March 2015

Friends and Family (Staff) - From Quarter 4 onwards (March 2015) Friends and Family will be available by ward.Monthly New pressure Ulcers (Grade 2+)


Families Narrative (March)

Safe

Fall on M4/5 relates to a baby falling from the bed after the mother left it unattended, no injury to baby on review by neonatologistFalls on M1 was a patient found on the floor no injury and on E5 child banged lip on window ledge but recorded as fall

Caring

Harm free care event on M1 relates to PE following emergency surgery. Reviewed by ward team. Fragmin prescribed after bleeding risk minimised as contraindicated initially. Flowtrons and TED stockings in situ initially. KPI's on CDS - this was caused by erronour data being entered due to a change to the form. From April KPI's for Maternity, neonates and paediatrics more in line with spoecialist areasVTE - compliance with this being investigated by ward team

Responsive

N/A

Effective

Areas continue to work against the action plans pi place in recent SSA assessments

Well Led

E5- Nurse:pt ratio 1:4.5, Monitoring supernumary nurse in charge on IPM dashboard, vacancy – mixture of all grades including full-time MatronCurrent staffing within maternity at 1:28.7, vacancy of 4 WTE band 2 going through vacancy vetting processSickness in maternity improving from last month, staff following policy for return to workMaternity - action plan in place to ensure appraisal rate increases


Acute Narrative (March)

Safe Pressure Ulcers 2 reported in March, B4 was deemed avoidable with D4 being unavoidableFalls- There has been an increase in falls on D3, Matron is working with falls coordinator and rolling out an improvement program

CaringH3 has seen a downward trend in weekly KPIs, Matron is monitoring weekly and reporting compliance to the Professional Lead until improvements have been seen

KPI percentage noted for C4 at 85% for March, it should be noted that this is on an upward trajectory from February which was reported as 80.7%. Compliance and improvements are being monitored weekly by the Matron.

Responsive

Complaints the Division has reported a slight reduction in complaints in March which were total of 5 compared with 8 in February.

Well led

B3 ward has now been closed

Ward manager vacancies on C2 and B4, this has impacted on appraisals which is being managed by the Matron

B2 appraisal rate has been confirmed as significantly higher than figure on the heatmap, this is being updated for April, C4 has a detailed plan to improve appraisal rates and is being monitored by the Matron


Elective Narrative (March)SafeTwo C.Diffs.Wards E3 and E4.Themes emerging form RCAs.RCAs mainly completed by nursing staff.Need to be completed in future by MDT and representatives from all the team to attend RCA meetings.Patients need to be isolated as soon as possible.All care documents to be completed.Strict recording of stool chart and daily review of Antibiotics. Messages and learning to be reinforced at Elective Care Divisional Board.Safety Thermometer - One harm reported for HDU, patient admitted with old pressure ulcer therefore outside of their control.

12 falls in general surgery. 1 fall resulting in serious harm, fractured neck of femur. Staff need to consider wider resources for managing patients at risk of falls such as use of low beds, at risk patients to be discussed at ward safety huddles. Pressure mats being purchased on all wards.

CaringLow percentage figues for hand hygiene on E3,E4 and G4.Matrons and Ward Managers to focus work in these areas. Infection control will be attending the monthly divisional Matron meeting to discuss any issues and developments.

The Matrons and Ward managers need to set dates for ESSA audits which at present are behind plan. Meeting with Matron planned to set dates for all outstanding ESSA assessments to be completed by end of May 15.

EffectiveN/A

ResponsiveComplaints complaince is 100% throughtout the Division.Ward area had 2 complaints this month.One for F3 which was dealt with at Ward level and one Medical complaint.

Well LedMajority of areas are not achieving the target for appraisals, continued focus by General Managers to address poor performance areas, to All wards are established for 1:6 nursing ratio on the day shift, some shortfalls on E3, E4 and F4 due to sickness and vacancies. Sickness High staff turnover on E3, F3, F4 and G4. Mixed reasons, staff promotion, retirement and movement to other specialities for personal Complaints - Developed process for tracking action logs.


INDICATORSAvondale Team 1

Avondale Team 2

Avondale Team 3

Breightmet Team 1

Breightmet Team 2

Crompton Team 1

Crompton Team 2

Crompton Team 3

Egerton & Dunscar Team 1

Egerton & Dunscar Team 2

Waters Meeting Team 1

Waters Meeting Team 2

Farnworth Team 1

Farnworth Team 2

Farnworth Team 3

Great Lever

Team 1

Great Lever

team 2 Horwich Team 1

Horwich Team 2

Horwich Team 3

Pikes Lane Team 1

Pikes Lane Team 2

Westhougton Team 1

Westhougton Team 2 Evening Service Total

Safety Express Programme Harm Free Care (%) *

100.00% 100.00% 100.00% 86.36% 100.00% 97.50% 90.00% 100.00% 100.00% 100.00% 97.22% 100.00% 92.86% 100.00% 96.88% 87.50% 100.00% 93.33% 100.00% 97.06% 100.00% 100.00% 97.21%

Monthly New pressure Ulcers (Grade 2+) **

0 3

Monthly New pressure Ulcers (Grade 2+) (outside our control) **

0 3

High Dependency Patients (40 Minutes >) 95 95 96 45 50 56 56 56 36 32 66 63 237 103.5 103.5 96 64 47 73.5 89.5 230 176 206.5 206.5 2379

Medium Dependency Patients (21 Mins >) 195 195 195 429 455 551 551 552 120 151 390.5 403.5 602 480.5 480.5 436 503 373 361 318 599 645 463 463 9912

Low Dependency Patients (< 20 mins) 234 235 235 432 463 338 338 339 564 405 427 433 619 331.5 331.5 468 412 155 177 113 191 272 199.5 199.5 7912

Number of Home Visits (from Lorenzo) *** 785 455 166 1268 353 1483 551 804 887 355 866 832 731 346 758 140 183 432 444 1536 755 1004 2459 19377

ESSA Assessment

Current Budgeted WTE*****19.98 136.61

Actual WTE In-Post*****18.55 139.63

Actual WTE Worked*****19.78 141.08

Pending Appointment (Please see total in final column)****

8.00

Current Budgeted Vacancies (WTE)1.43 -11.02

Sickness (%)13.87 6.27

Substantive Staff Turnover Headcount (rolling average 12 months)

5.4% 8.3%

12 month Appraisal100.00% 92.12%

12 month Mandatory Training91.25%

12 month Staff Survey/ Temp checks

Number of complaints received0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Incidents reported on Safeguard (see end total column)

49

* Harm Free Care is from the Monthly Safety Thermometer showing percentage of patients with no harm recorded within District Nursing Domiciliary. ** Pressure Ulcers are not broken down by team 1 or 2. For this reason, pressure ulcers have been recorded under the relevant Health Centre Name. *** Home visits on this report excludes Groups. 14 contacts were seen in a group environment during March. This brings the total activity for District Nursing Domiciliary to 19391. **** Pending Appointment. Please check the final column for the correct overall position. When District nurses are appointed they are only allocated to a Team during induction. The final figure includes future starters. This month there are an additional ??? WTE pending appointment into the relevant teams. **** Current Budgeted WTE/Actual WTE In-Post/Actual WTE Worked includes District Nurses - Domicillary in the final column.

Board Assurance Heat Map - District Nursing - March 2015

Nor

th D

N T

eam

s

Sout

h &

Wes

t DN

Tea

ms

0 1 0 0 0 2 0 0 0 0

0 1 0 0 0 2

8.64 11.27 16.88 9.23 10.99

0 0 0 0

1784

*** ** *** ** ***17.03 11.34 12.03 10.50 8.72

*** *** *** *** **

11.30 11.22 18.41 7.53 10.23

10.88 11.09 18.41 7.59 10.36

18.08 11.81 10.80 11.79 10.13

11.81 11.28 11.50 9.7218.44

2

-2.24 0.18 -1.53 1.64 0.63 -1.41 -2.47 0.75 -1.00 -1.00

1.11 0.92 7.68 0.00 14.30 10.01 8.11 1.37 0.60 0.00

9.1% 7.7% 0.0% 36.4% 23.1%

100.00%

90.68% 86.72% 61.95% 95.92% 92.05%

9.5% 0.0% 7.7% 7.1% 0.0%

90.91% 92.31% 85.71% 100.00% 77.78% 89.47% 85.71% 91.67% 92.86%

82.35% 76.56% 88.32% 71.03% 89.80%


COMMUNITY NARRATIVE (MARCH 2015) The community heat map relates to District Nursing Domiciliary Day, Night & Evening Services.PRESSURE ULCERSThe Harm Free Care Panels March incidents are : 6 Pressure Ulcers

SICKNESS ABSENCE

The overall sickness absence for the District Nursing (domiciliary day, evening & night services) is 5.27%

At the end of March 2015, the long term sickness absence rate is X with 6 members of staff off on long term sick, one of whom has a return towork date in April and another has a return to work date in May. The remaining 4 are not in a position to agree a return to work date.

All sickness absence is being proactively managed via the Trusts new attendance management policy.DEPENDENCYDependency is entered daily by the District Nursing Team Leaders based upon anticipated length of visit. This is used to plan and managecaseloads and staffing resources against capacity and demand. The Lorenzo contact is based on actual activity. This is currently showing asless than the prospective activity recorded in the dependency data. This is due to lag time in data entry on Lorenzo before the in‐monthreporting cut‐off date which was 5th April 2015 for March data. There is also a small difference in these figures due to the changes in dailyworkload once the situational report is populated.There is a rectification plan to retrospectively enter the March data for completeness and accuracy and to ensure data capture by cut off datesfor future months. There is a general improvement in timely data inputting and data accuracy with a difference of X contacts between plannedand actual activity in March compared to 802 contacts last month.

The future data quality will improve with the proposed plans to roll out Single Point of Access pan Bolton in Quarter 1 this financial year,however due to the nature of care delivery compared to data capture there will be a working tolerance of data quality that will be agreed.

ESSAOf the 10 Health Centre Domiciliary District Nursing Teams7 received an ESSA rating of ***3 received an ESSA rating of **All have action plans monitored at monthly community board.


TURNOVER AND VACANCY

APPRAISAL

MANDATORY TRAININGThe overall mandatory service compliance is 92.6%. All DN Teams have an action plan which is strengthened by the new career progressionpolicy and ESSA compliance. No further training is agreed without completion of mandatory training or a plan to do so. InformationGovernance and Equality & Diversity training is e‐learning and staff are booked on to complete this. However, many are reporting difficulty inaccessing the system due to poor IT connectivity (this has been reported to IT). We are again working closely with the workforce directorate toensure timely recording and reporting of training.COMPLAINTSThere have been no complaints against the service in March.INCIDENTSThere have been 49 incidents reported on Safeguard.

Turnover is at 8.3%. There are vacancies being held pending completion of the Community Specialist Practitioner students who are substantive District Nursing staff seconded to the course. All have been backfilled on a temporary basis. In addition the other vacancies are for newly qualified nurses who finish their course in March and have a start date late March but are not registered as qualified nurses until they have their PIN number on the NMC register, anticipated in April.

The service appraisal rate is reported as 92.12%. However, at team level the evidenced recorded percentage figure is 100%. We are however working closely with the workforce directorate to ensure timely recording and reporting of appraisals.


Date Indicator Code Indicator Description Requested by Change Authorised by

19/11/2013Monitor Compliance Governance 1013-14

Monitor Compliance Governance 1013-14 Report Esther Steel Remove from Report. No longer used. Esther Steel

27/11/2013

1.07 - Total number of incidents (Clinical and non-clinical)

This metric is everything reported, patient, staff, visitors, contractors, non person. “Clinical & non clinical” infers just patient incidents. Eric Porter

Change to 1.07 - Total Incidents reported on Safeguard Trish Armstrong-Child

04/12/2013

4.02 - Substantive Staff Turnover Headcount (rolling average 12 months)

Labour turnover of substantive contracted employees Kelly King

This metric previously included turnover relating to contrived reductions in workforce over the course of the year, relating to Turnaround schemes, redundancies (voluntary and compulsory) etc. The data for this metric should be based on “natural” turnover in order to demonstrate a representative picture of the workforce. Retrospective figures have replaced the previously reported figures for the current year (2013/14). The 2012/13 figures have not been adjusted. The target remains at 10%. The metric definition has also been changed. Louise Ludgrove

13/12/2013 1.39 ‐ MRSA HA acquisitions N/A Julie Dziobon This is a duplicate of metric number 1.38 - MRSA Bacteraemia post-48 Hours admission Trish Armstrong-Child

13/12/20131.37 - MRSA Bacteraemia pre-48 Hours admission

No of pts identified as having MRSA presenting complaint 48 hrs before admission Julie Dziobon

All pre cases are now the responsibility of the CCG, for both CDT & MRSA bacteraemia cases, so despite having 4 pre cases of MRSA bacteraemia for the current year– none of them have been attributed to the Foundation Trust. Action: To remove this metric . Trish Armstrong-Child

17/01/2014 1.50 Infection Control Level 1 National Qualification David Wakefield Not Reportable David Wakefield17/01/2014 1.51 Infection Control Level 2 National Qualification David Wakefield Not Reportable David Wakefield

14/02/20141.36 Surgical WHO Checklist compliance (Emergency)

Checklist to reduce surgical morbidity and mortality Mike Steele Metric added Jill Patterson

19/02/20141.10 - pt incidents that resulted in severe harm or death %

Number of incidents involving pts that resulted in severe harm or death Trish Armstrong-Child Target changed to 0% Trish Armstrong-Child

19/02/2014 1.27 - complaints receivedTotal number of complaints received into trust Trish Armstrong-Child

change target to 10% reduction on last years outturn Trish Armstrong-Child

11/03/2014

1.25 - NICE Guidelines Adoption of Technology Appraisals

% of Technology appraisals applicable to the Trust that are adopted or adopted with caveat Steve Hodgson

Use the percentages based on total adopted technology appraisals Steve Hodgson

03/04/20144.13 - Qualified Nurse to bed ratio

Compares the number of contracted WTE nurses against in the number of occupied beds in the most recent month Nigel Moloney

Remove from Report. Replaced by ‘Budgeted Nurse: Bed Ratio’ and ‘Actual Nurse: Bed Ratio’ in the Board Staffing Assurance Heat Map Suzanne Woolridge

03/04/20141.33 - Compliance of 6 access criteria for learning disability %

to ensure equality of access and equity for all people with learning disabilities Mike Steele

After reviewing the 13-14 and 12-13 data there were incorrect figures in (83%). We were 100% compliant in year 12-13 and also in 13-14. Data changed to reflect this Bev Tabernacle

07/05/20142.46 - Readmissions within 30 days of discharge % - National

scorecard to have a line to show the nationalrate of readmissions along with the Trust’s performance. Esther Steel

Added Line to scorecard and series into 2.40 - Readmissions within 30 days of discharge % Chart Simon Worthington

14/05/20141.01, 1.02, 1.03, 1.04, 1.52, 1.56 (All falls and pressure damage grade 2) Trish Armstrong-Child

a 5% reduction in year 2013/14 target applied to 2014/15 targets Jill Patterson

14/05/20142.40 - Readmissions within 30 days of discharge % Joanna Warburton

Readmission % for Feb14 reported last month has changed from 12.8% to 13.3% due to natural changes in data on LE2.2. The figure has still come within the ranges of previous month’s figures reported. Mike Steele

10/06/20141.13 - Infection Control (C. Diff) Mike Steele Metric duplicated by 1.45 Jill Patterson

Report Change log


Date Indicator Code Indicator Description Requested by Change Authorised by

Report Change log

13/06/20142.40 - Readmissions within 30 days of discharge % Simon Worthington

Target of 8% replaced by average of last years Readmission data = 12.6% Jill Patterson

02/07/2014

Total number of patient incidents (clinical and non-clinical) Total number of patient incidents

Mike Steele/Richard Sachs Number better represented by metric 1.07 Richard Sachs

15/07/2014

4.13 - Substantive Staff Turnover Headcount (Contrived) (rolling average 12 months)

This includes redundancies and MARS but still excludes junior doctors, flexi retirements and TUPE transfers Nigel Moloney New metric Suzanne Woolridge

17/07/20141.34 - No of CQUIN targets achieved in month

CQUINs are reported Quarterly to the CCG. This metric should reflect this position. Mike Steele Revise from monthly reporting to quarterly. Jill Patterson

01/08/2014 N/A Added new metrics into Monitor Risk Report Mike SteeleNew Metrics added to reflect new and amended metrics in the "Monitor Declaration of Risk" return Mike Steele

26/08/20141.07 - Total Incidents reported on Safeguard

Total number of all incidents, patient, staff, visitors, contractors etc Trish Armstrong-Child

The QA committee has agreed that we need to increase our incident reporting and to get us in the top 20% of reporting nationally. New annual target of 10,786 added inorder to double our incident reporting per 100 admissions ratio from 6.26 per 100 to 12.60 per 100. Trish Armstrong-Child

27/08/2014

1.09 - Total number of patient incidents reported per 100 admissions

Total number of patient incidents per 100 admissions within the month Richard Sachs as above Trish Armstrong-Child

11/09/2014

4.05 - Local Induction Attendance (starters in the last 12 months)

Number of local (department) induction packs divided by the number of new starters in the most recent 12 month period Mark Wilkinson

4.05 - Completion of local induction system (starters in the last 12 months) - More accurate metric description. Suzanne Woolridge

07/10/20144.29 - FFT Recommend treatment

Implementation of staff FFT as per guidance, according to the national timetable. Suzanne Woolridge

Added metric 4.29 and 4.30 to the Workforce scorecard, to measure the National CQUIN Friends and Family Test – Implementation of staff FFT Mark Wilkinson

07/10/20144.30 - FFT Recommend place to work

Implementation of staff FFT as per guidance, according to the national timetable. Suzanne Woolridge

Added metric 4.29 and 4.30 to the Workforce scorecard, to measure the National CQUIN Friends and Family Test – Implementation of staff FFT Mark Wilkinson

16/12/20144.12 - Total Bank Shifts requested (hours) N/A Nigel Moloney

Replaced with 4.12 - Total Agency Shifts filled %. Chart combined with 4.11 - Total Bank Shifts filled % Suzanne Woolridge

17/12/20141.23 - Catheter associated Urinary Tract Infection

No. of pts with UTI caused by catheter/Total pts that have a Catheter Fitted % Mike Steele

Corrected monthly figures to reflect in month data instead of a YTD cumulative figure. Gary Young

09/03/2015

4.04 - Substantive/temporary ratio %

Number of permanent contracts compared to the number of fixed term substantive contracts i.e. not bank/agency Mark Wilkinson

Remove from Report. Not a useful metric in the context of the Board Report. Mark Wilkinson


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