Agenda and supporting papers - Plymouth Hospitals NHS Trust

More documents

Recommendations

Info

Item 9 Diagnostics & surveillance (Section C6 of Performance Dashboard) 3.5 Diagnostic wait performance has deteriorated in May with 2.8% of the total waiting list (173 patients) waiting longer than 6 weeks for a diagnostic test at the end of May. Of the 173 breach patients, the majority (79) were waiting for an Echocardiogram. A number of options are being considered to address the capacity issues identified by a review of this modality. These options include employing external cardiology technicians to carry out tests using our facilities although this additional support would not be available until August. In the meantime, the department are putting on additional lists to provide extra capacity. 31 patients were waiting for an Endoscopy due to a complex mix of issues ranging from patient choice to staff availability for specialist paediatric and general anaesthetic cases. 52 patients were waiting for Imaging - 12 MRI scans and 14 CT scans were delayed due to staff availability for specialist cases and breakdown of the Alliance scanner whilst 26 ultrasound delays were due to unusual levels of staff unavailability. A more detailed report on diagnostic delays is being developed with the service line and will be made available to the Board when complete. 4 Finance & Efficiency – 4.1 A separate report on the Trust’s financial position is being presented to the Trust Board by the Director of Finance. 4.2 This section of the report will provide the Board with an update on key contract issues including activity variances as well as full details on contract penalties and CQUIN achievement. 4.3 Contract Position 4.4 If the Trust was on a fully variable contract it would, at Month 2 owe commissioners £1.4m. Key issues to highlight from this high level analysis are the continuing significant underperformance on elective care, and the level of contractual penalties incurred. 4.5 Elective activity is underperforming at Month 2 by 126 spells (1.2%) under plan and £1m under on income. This income underperformance is significant being 8% below plan. Key specialties with underperformance are cardiac surgery (£189k) where they are still suffering cancellations. In April, 43 theatre slots were lost, and in May 25 slots were lost. ITU capacity was a key issue, but staffing levels have now been addressed so performance should improve back to contract level in future. However, if the lost capacity from the first few months is not recovered through future over-performance the Trust will continue to under-perform for the year. In Neurosurgery the activity is only slightly under plan but the income variance is £275k under plan due to case mix. Neurosurgery has capacity gaps that are being addressed through extended days and more formalised weekend working. Plastic Surgery is continuing to underperform (£221k) with reduced theatre capacity and under-utilisation of the plastics trauma theatre. Waiting lists are beginning to rise slightly. Further work is being done to understand the picture more fully. 7
Item 9 4.6 Non Elective Activity is overall 455 spells under plan and £181k under the income plan. Within this, Obstetric activity is underperforming (120 spells under for birth HRGs year to date) as is Neonatology. This underperformance masks the fact that emergency activity is over performing by 228 (3%) spells and £641k income. This over-performance on emergency activity continues to impact on the Trust’s elective capacity. The Trust therefore needs to continue to work with commissioners on reducing emergency demand, otherwise it will continue to impact upon elective work. 4.7 A&E remains fairly close to plan, though there is a continuing shift towards a more complex case mix. 4.8 Outpatients are over performing on first outpatients, but this is offset by an underperformance on outpatient procedures. Further effort is required to work down the follow up backlog. Wherever possible, this needs to be done by alternatives to face to face contacts, with minimal resource required. An active discussion with the CCG is on-going. 4.9 There are further contractual financial penalties in 2013-14 compared with 2012/13. The Trust has incurred £427k of contractual penalties to Month 2. The key figures within this are for RTT £260k, Diagnostic Waits £47k and Cancelled Operations £52k. RTT is being intentionally breached over the first part of this year, to ensure backlogs are cleared and to put the Trust in a sustainable RTT position moving forward. Under the Managed PbR arrangements, penalties are returned to the Trust to invest in corrective action. 4.10 As the Board will be aware the Trust’s contract will operate on a managed payment by results (PbR) basis. For month 2 this means that the variance to date of £1.4m is significantly mitigated as only the variable and semi variable elements of the contract have an impact on the Trust’s financial position in 2013-14. The variance after return of fines and the managed PbR adjustment is £0.136m with the significant adverse variance being cardiac surgery offset by stem cell transplant activity. 4.11 Although the financial variance is significantly mitigated due to the contract agreed the early signs are of concern and the overall contract position to date will need further review and close monitoring to ensure that we have a full understanding of the issues as well as having mitigating actions in place. 4.12 In respect of CQUIN (Quality payments) measures for the year these are at the final stages of agreement and we expect to be able to start reporting these at the end of quarter 1. 5 Workforce Month 2 has seen a small increase in establishment with a similarly small rise in staff in post. There have also been sharp reductions in discretionary pay and sickness absence. Key variances are: Staff in post (Section E1 of Performance Dashboard) 5.1 The budgeted establishment has increased in Month 2 by 7 WTE to 5,754, WTE and staff in post has increased in Month 2 by 6 WTE to 5,398. 8
Page 1 and 2:
Trust Board Friday 5 July 2013, 9.0
Page 3 and 4: Members of Plymouth Hospitals NHS T
Page 5 and 6: Item 3 observer. The Chairman requi
Page 7 and 8: Item 3 Board oversight of contribut
Page 9 and 10: Item 3 the Board next month. • Th
Page 11 and 12: Item 3 been involved and there was
Page 13 and 14: Item 3 continuing to build. Mr Babe
Page 15 and 16: Item 3 to Norovirus, Professor Lewi
Page 17 and 18: Item 3 • Careful communication of
Page 19 and 20: Item 3 • Approved the writing off
Page 21 and 22: Updated: prior to July Board Item 4
Page 23 and 24: Updated: prior to July Board Item 4
Page 25 and 26: Item 8 Quality Impact Assessment Pa
Page 27 and 28: Item 8 3.2 Quarterly Summary Hospit
Page 29 and 30: Item 8 4.4 Monthly Proportion of Pa
Page 31 and 32: Item 8 Inpatient falls are currentl
Page 33 and 34: Item 8 REI signage PALS were contac
Page 35 and 36: Item 8 Complaints received listed b
Page 37 and 38: Item 8 The graphs below illustrate
Page 39 and 40: Item 8 5.5 Friends and Family Test
Page 41 and 42: Item 8 1. Pressure Ulcers (EoC) 2.
Page 43 and 44: Item 8 Observations The essence of
Page 45 and 46: Item 8a SUMMARY REPORT Trust Board
Page 47 and 48: Annex 2 Item 8a Summary of Serious
Page 49 and 50: Item 9 Key Recommendations The Trus
Page 51 and 52: Item 9 Effective Care (Section B2 o
Page 53: Item 9 Description 31 days from 'de
Page 57 and 58: Item 9 Summary of performance excep
Page 59 and 60: Item 9 Ensure that all patients adm
Page 61 and 62: Item 9 Forecast Significant progres
Page 63 and 64: Item 9 Update on previous actions C
Page 65 and 66: Contents EXECUTIVE SUMMARY D FINANC
Page 67 and 68: B1 Safe care Description Hospital S
Page 69 and 70: Response Rate Recommender Score B3
Page 71 and 72: B5 Other safety & quality metrics D
Page 73 and 74: C2 Non-Elective Activity Descriptio
Page 75 and 76: C4 Referral To Treatment (RTT) Desc
Page 77 and 78: C6 Other access & activity metrics
Page 79 and 80: D2 Cost improvement programme (CIP)
Page 81 and 82: D4 Cash Management Description Revi
Page 83 and 84: E1 Staffing numbers Description Est
Page 85 and 86: E3 Sickness absence PERFORMANCE IND
Page 87 and 88: Risk Rating F2 Monitor's Financial
Page 89 and 90: Item 10 DETAILED REPORT Trust Board
Page 91 and 92: Item 10 4. Key Issues for the Board
Page 93 and 94: Item 11 SUMMARY REPORT Trust Board
Page 95 and 96: Item 11 DETAILED REPORT Trust Board
Page 97 and 98: Item 11 • Challenge in respect of
Page 99 and 100: Item 11 Over the past two years, me
Page 101 and 102: Item 11 Getting it Right Charter An
Page 103 and 104: Item 11 Outcome of review with exte
Page 105 and 106:
Item 11 Learning Disabilities Natio
Page 107 and 108:
Item 11 Peer Review 2.5 Peer Review
Page 109 and 110:
Item 12 Next Steps 1. Conversation
Page 111 and 112:
Item 12 2. Board Inclusion Developm
Page 113 and 114:
Item 12 EDS Grades and E & D Object
Page 115 and 116:
Item 12 Plymouth Hospitals Trust -
Page 117 and 118:
Item 12 3.6 The workforce is suppor
Page 119 and 120:
Item 13 Key Recommendations The Tru
Page 121 and 122:
Item 13 Telephone conversations.
Page 123 and 124:
Item 13 19. The Medical Director ha
Page 125 and 126:
Item 14 SUMMARY REPORT Trust Board
Page 127 and 128:
Item 15 incident investigations to
Page 129 and 130:
Item 15, Annex 1 3. Review of Actio
Page 131 and 132:
Item 15, Annex 1 • Top three issu
Page 133 and 134:
Item 15, Annex 1 The Chair asked SS
Page 135 and 136:
Item 16 COMMITTEE MINUTES Finance,
Page 137 and 138:
Item 16 pay and staffing, highlight
Page 139 and 140:
Item 16 • PACS contract - likely
Page 141 and 142:
Item 17 Terms and Conditions of Emp
Page 143 and 144:
Item 17, Annex 1 29/2013 Minutes an
Page 145 and 146:
Item 17, Annex 1 31/2013 Francis Re
Page 147 and 148:
Item 18 SUMMARY REPORT Trust Board
Page 149 and 150:
Item 18 Next Steps The Audit Commit
Page 151 and 152:
Item 18, Annex 1 Matters arising 4/
Page 153 and 154:
Item 18, Annex 1 time to embed and
Page 155 and 156:
Item 18, Annex 1 Payroll & Expenses
Page 157 and 158:
Item 18, Annex 1 The Committee note
Page 159 and 160:
Item 18, Annex 1 Going Concern Revi
Page 161:
Item 18, Annex 1 if Internal Audit
show all

Agenda and supporting papers - Plymouth Hospitals NHS Trust

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?