BOARD OF DIRECTORS OPERATIONAL PERFORMANCE REPORT. Month 9 (December 2014) and Quarter 3 (Oct-Dec 14)

Transcription

1 BOARD OF DIRECTORS OPERATIONAL PERFORMANCE REPORT 9 (December 2014) and Quarter 3 (Oct-Dec 14) Presented By: Rob Elek Director of Strategy and Business Development Produced By: Action for Board: For information For consideration For decision Stephen Chinn Senior Analyst Board of Directors 22nd January 2015

2 CONTENTS Exception Report Page 2-3 Summary Page 4 Access - Referral to Treatment Page 5-6 Access - A&E Page 7-8 Access - Cancer Waiting Times Page 9 Access - Other Page 10 Efficiency Page Effectiveness Page 13 Safety Page 13 Ward Staffing Levels Patient Experience Page 14 Page 15

3 Exception Report - December 2014 and Quarter 3 18 Week RTT : The Trust achieved referral to treatment (RTT) compliance in December for all three RTT measures. Admitted performance achieved the 90% target for the first time this financial year, with 92.1% of patients seen within 18 weeks (M8 88.9%). The Q3 position of 89.2% (Q2 83.4%) remained below target, as anticipated, following M7 and M8 performance. RTT Non Admitted continued to achieve at 96.1% (M8 95.7%). The target was also achieved for Q3 with performance of 95.8% (Q2 94.1%). RTT Incomplete Pathways continues to achieve the target with performance of 95.1% (M8 95.6%), well above the 92% target. Q3 performance of 95.3% (Q2 92.1%) has resulted in compliance in our position at 93.2%. The above is provisional pending final validation and submission on 20 th January. Accident and Emergency: A&E 4 Hour performance continues to meet the national target of 95%, achieving 99.3% in December and 99.1% for Q3. A&E 3 hour performance continues to achieve the internal target of 80%, achieving 81.2% in December and 81.2% in Q3. Activity continues to increase, especially compared to the previous year where it has increased 10% compared to last December and 8.4% for the year to date. This represents an average increase of 20 A&E attendances every day. Percentage of A&E patients seen, treated and discharged by an Emergency Nurse Practitioner (ENP) remains below our local target of 30%, with 22.8% of patients treated in December and 23.8% of patients treated in Q3. Cancer For December and Q3 all cancer waiting time targets were achieved with no breaches, however year to date the two week wait for first appointment remains just below the 93% target at 92% due to two missed cases in Q2. Page 2

4 Exception Report - December 2014 and Quarter 3 (Continued.) Choose and Book for Choose and Book (first appointment slot availability) has increased in December to 87.2% (M8: 82.3%), Q3 performance was 85.1% (Q2 84.4%). Efficiency Following the successful migration of data from Croydon s to Moorfields information systems in December, all measures now include our activity prior months currently exclude activity at Croydon University Hospital and Purley War Memorial Hospital. Compared to November total activity remains at a similar level for First Outpatient Attendances, there is an increase in admissions, and is lower for Follow up attendances, even with the inclusion of the Croydon data. However this is due to December containing less working days and an expected lower than normal activity level between the Christmas and New Year period. For Q3 compared to the previous year, excluding the additional Croydon data (for a like-for-like comparision), first appointment activity increased by 8%, follow up activity increased by 4% and admissions increased by 10%. First Attendances continues to increase with Q3 at 24,561, against 22,017 and 22,559 in Q1 and Q2 respectively. Follow up Attendances remain at a similar level to Q2. Did not attend (DNA) rates remain stable at around 11% for both first and follow up appointments compared to previous months. For December Outpatient Cancellations are at 13.7%, an increase of 3% from 10.9% in the previous month. For quarter 3 this has increased from 9.5% in quarter 2 to 11.6%. There were no reported 28 days breaches for inpatient cancellations in December 2014 or Quarter 3. VTE The migration of data from Croydon, has (at present) resulted in the unavailability of the flag confirming whether a Venous thromboembolism (VTE) assessment had been completed prior to an admission. Therefore, these Croydon admissions are marked as not compliant. This has had a negative effect on the overall VTE performance, taking it below the 95% target to 89.9%, compared to 99.0% the previous month. For Q3, the trust remains above target at 95.8%. Page 3

5 COMPLIANCE PERFORMANCE SUMMARY Percentage 18 weeks Admitted Pathways Percentage 18 weeks Non Admitted Pathways Percentage 18 weeks Incomplete Pathways A&E 4 hour waiting time A&E 3 hour waiting times A&E Left Before Treatment A&E ENP Pathways A&E Unplanned re-attendance Cancer 2 week wait - first appointment urgent GP referral % Cancer 31 day wait - diagnosis to first appointment Cancer 31 day wait - subsequent treatment - surgery Cancer 62 day from urgent GP referral to first definitive treatment Diagnostics 6 week waiting time 2014/15 Dec-14 Q3 14/15 14/15 Dec-14 Q3 14/15 14/15 90% 92.1% 89.2% 84.5% CQC, Monitor, Cancelled Operations - 28 Days Re- Book % 96.1% 95.8% 94.9% CQC, Monitor, n/a 5.0% 3.3% 3.6% Monitor 92% 95.1% 95.3% 93.2% CQC, Monitor, Emergency Readmissions within 30 days of discharge n/a 5.0% 3.6% 3.8% CQC, CQC,, Outcomes Framework 95% 99.3% 99.1% 99.2% CQC, Monitor, n/a 50.4% 54.7% 53.2% Local 80% 82.9% 81.2% 81.6% Local Number of MRSA cases % 0.6% 0.9% 1.1% CQC, Number of C.Diff cases % 22.8% 23.8% 24.4% Local VTE Screening - all admissions 95% 89.9% 95.8% 97.5% 5% 0.5% 0.6% 0.7% CQC, Number of Mixed Sex Accommodation Breaches % 100% 100% 92.0% CQC, Monitor, Ward Staffing Levels (Inpatient Wards Only) n/a 100% 100% 101% 96% 100% 100% 100% CQC, Monitor, Friends & Family Test - Inpatients (Response Rate) 20% 74.7% 72.4% 70.3% 94% 100% 100% 100% CQC, Monitor, Friends & Family Test - A&E (Response Rate) 30% 23.6% 25.9% 26.9% 85% n/a n/a n/a 99% 100% 100% 100% CQC, Monitor, CQC, Emergency Readmissions within 28 days of discharge GP referrals first outpatient using Choose & Book 2014/15 CQC, Monitor, CQC, Monitor, CQC, CQC, CQC, CQC,, Outcomes Framework CQC,, Outcomes Framework Outpatient appointment - Over 6 week waiters Choose & Book Appointment Availability n/a 87.4% 85.6% 85.9% Local 96% 87.0% 85.1% 86.5% Local Key Reference: On or above target Below target and rise in figures Stable on/above target Below target and stable On target and drop in figures Below target and fall in figures Within tolerance and rise in figures Within tolerance and stable Within tolerance and drop in figures No target or N/A Page 4

6 18 Weeks Referral to Treatment (Provisional) Trust Total Admitted Incomplete Croydon 18 weeks Referral to Treatment - Admitted 18 weeks Referral to Treatment -Non Admitted 18 weeks Referral to Treatment -Incomplete Non Admitted Patients Waiting >18 weeks 90% Shortfall / Surplus Patients Waiting >18 weeks 95% Shortfall / Surplus Patients Waiting >18 weeks 92% Shortfall / Surplus 18 weeks Referral to Treatment - Admitted 18 weeks Referral to Treatment -Non Admitted 18 weeks Referral to Treatment -Incomplete Moorfields (excluding Croydon) 18 weeks Referral to Treatment - Admitted 18 weeks Referral to Treatment -Non Admitted 18 weeks Referral to Treatment -Incomplete 2013/14 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 90% N/A 92.1% 88.9% 80.9% 83.4% 89.2% 84.5% 95% N/A 96.1% 95.7% 94.95% 94.1% 95.8% 94.9% 92% N/A 95.1% 95.6% 92.2% 92.1% 95.3% 93.2% 2013/14 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 N/A N/A ,442 1, ,604 N/A N/A ,284 N/A N/A , ,840 N/A N/A N/A N/A 1, ,035 5,066 2,964 13,065 N/A N/A ,305 6, /14 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 90% N/A 100.0% 97.8% 86.3% 85.3% 98.5% 89.3% 95% N/A 99.0% 98.0% 97.3% 95.1% 98.9% 97.0% 92% N/A 95.0% 96.4% 94.3% 85.9% 96.7% 92.1% 2013/ / / / /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 ly ly ly ly 90% 91.2% 91.9% 88.4% 80.8% 83.3% 88.8% 84.2% 95% 95.5% 95.8% 95.4% 94.6% 93.9% 95.4% 94.6% 92% 92.4% 95.1% 95.5% 91.96% 92.6% 95.2% 93.3% Page 5

7 18 Weeks Referral to Treatment (Cont.) Trust Total All RTT Targets were achieved for the Trust in December Croydon continues to remain high across all performance targets at 100%, 99% and 95% for Admitted, Non-Admitted and Incomplete performance respectively Moorfields excluding Croydon also achieved all three targets at 91.9%, 95.8% and 95.1% for Admitted, Non-Admitted and Incomplete performance respectively Page 6

8 Accident & Emergency A&E Maximum waiting times - 3 hours Total number of 4 hour breaches Total number of 6 hour breaches Left without being seen Time to Treatment in Department - median Total time spent in A&E -Admitted 95th Percentile Total time spent in A&E - Non Admitted 95th Percentile A&E ENP Pathway Total number of attendances Total number of expected attendances A&E Maximum waiting times - 4 hours A&E Unplanned Re-attendance 2013/ /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 ly 66,400 N/A 7,147 7,869 24,338 24,268 23,402 72,008 N/A N/A 6,767 7,346 23,766 23,755 22,168 69,689 95% 99.6% 99.3% 98.5% 99.3% 99.1% 99.1% 99.2% CQC, Monitor, 80% 83.1% 82.9% 79.8% 82.0% 81.7% 81.2% 81.6% Local N/A N/A % 0.9% 0.6% 1.2% 1.2% 1.0% 0.9% 1.1% 60 mins 10 mins 25 mins 23 mins 23 mins 24 mins 24 mins 20 mins 240 mins 216 mins 222 mins 262 mins 224 mins 191 mins 234 mins 226 mins 240 mins 215 mins 217 mins 223 mins 220 mins 221 mins 220 mins 221 mins CQC, Monitor, CQC, CQC, CQC, 30% 21.7% 22.8% 23.4% 22.8% 26.5% 23.8% 24.4% Local 5% 1.3% 0.5% 0.7% 1.1% 0.3% 0.6% 0.7% CQC, Page 7

9 Accident & Emergency (Cont.) A&E 4 Hour performance continues to meet the national target of 95%, achieving 99.3% in December and 99.1% for Quarter 3. A&E 3 hour performance continues to our target of 80%, achieving 81.2% in December and 81.2% in quarter 3. Activity continues to increase, especially compared to the previous year where it has increased 10% compared to last December and 8.4% for the year to date. This represents an average increase of 20 A&E attendances every day. The increase was seen for both working and non-working days activity compared to December Percentage of A&E patients treated by an Emergency Nurse Practitioner (ENP) remains below our local target of 30%, with 22.8% of patients treated in December and 23.8% of patients treated in quarter 3. Percentage of Unplanned Re-Attendances and Left A&E before treatment remain well below their 5% targets. Page 8

10 Cancer Waiting Times Cancer 2 week waits - first appointment urgent GP referral Cancer 31 day waits - diagnosis to first appointment Cancer 31 day waits - subsequent treatment Cancer 62 days from urgent GP referral to first definitive treatment 2013/ /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 Cases % 95.8% 100% n/a 100% 84.6% 100% 92.0% Cases % 100% 100% 100% 100% 100% 100% 100% Cases % 100% 100% 100% n/a 100% 100% 100% Cases % n/a n/a n/a n/a n/a n/a n/a ly CQC, Monitor, CQC, Monitor, CQC, Monitor, CQC, Monitor, For December and quarter 3 all cancer waiting time targets were achieved with no breaches, however year to date the two week wait for first appointment remains just below the 93% target at 92% due to two missed cases in Quarter 2. To achieve the 93% target for the financial year MEH will need 5 or more two week waits in quarter 4 and no further breaches. Access - Other Diagnostic waiting times - 6 weeks First Outpatient Appointment Waiting more than 6 weeks Patients Waiting more than 13 weeks for Admission Choose and Book appointment availability Choose and Book Capacity Issue Rate Choose and Book System Issue Rate 2013/ /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 ly 99% 100% 100% 100% 100% 100% 100% 100% TBA 79.4% 87.4% 83.9% 84.5% 87.7% 85.6% 85.9% Local TBA 58.0% 18.7% 22.0% 46.6% 37.6% 23.6% 37.6% Local 96% 94.8% 87.0% 82.3% 86.1% 84.4% 85.1% 86.5% Local N/A 4.6% 11.6% 16.4% 13.4% 15.0% 13.4% 12.7% Local N/A 0.6% 1.2% 1.3% 0.6% 0.6% 1.4% 0.8% Local CQC, Page 9

11 Access - Other (Cont.) for Choose and Book (first appointment slot availability) as increased in December to 87.2% (M8: 82.3%), for quarter 3 performance was 85.1%, an increase on quarter 2 performance (84.4%). This is due to a percentage reduction in 'capacity issues' compared to November. Patients waiting more than 6 weeks for a first appointment remains stable, while patient waiting more than 13 weeks for an admission continues to fall. Diagnostics Waiting Times less than 6 weeks remains compliant at 100% Page 10

12 Efficiency Outpatient Total Attendances - First Appointment Outpatient Total Attendances - Follow Up Appointment Outpatient Cancellations Outpatient DNA rate - First Appointment Outpatient DNA rate - Follow Up Appointment Clinic Journey Times Less Than 2 Hours - Outpatient First Appointment Clinic Journey Times Less Than 2 Hours - Outpatient Follow Up Appointment Admission Demand - Decision to Admit (DTA) Admission Activity Theatre Cancellation Rate Theatre Sessions Starting Late Cancelled Operations - 28 Days Re-Book 2013/ /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 ly N/A 65,833 8,048 7,973 22,017 22,559 24,561 69,137 Local N/A 273,355 29,906 30,906 92,666 95,094 95, ,353 Local TBA 8.5% 13.7% 10.9% 8.5% 9.5% 11.6% 9.9% Local TBA 10.6% 11.0% 11.7% 11.0% 11.6% 11.5% 11.4% Local TBA 12.3% 11.5% 11.3% 12.4% 12.4% 11.6% 12.1% Local TBA 62.2% 60.5% 57.1% 55.6% 54.9% 58.2% 56.2% Local TBA 75.7% 73.0% 71.0% 69.9% 70.5% 71.0% 70.4% Local N/A 27,148 2,921 3,180 8,787 8,931 9,096 26,814 Local N/A 22,615 2,650 2,724 8,297 8,821 8,365 25,483 Local TBA 6.7% 6.1% 6.3% 6.1% 5.8% 6.3% 6.0% Local TBA 36.9% 28.5% 28.3% 27.1% 26.4% 27.3% 26.9% Local CQC, Page 11

13 Efficiency (Cont.) Key: :ly :4 Average Page 12

14 Effectiveness 2013/ /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 ly Emergency Re-admission within 28 days of discharge Emergency Re-admission with 30 days for elective and emergency cases GP referrals first outpatient using Choose & Book N/A 3.70% 5.00% 2.10% 3.50% 4.00% 3.30% 3.60% Monitor Cases N/A 3.70% 5.00% 2.10% 3.60% 4.10% 3.60% 3.80% Cases N/A 61% 50.4% 56.2% 51.8% 53.0% 54.7% 53.2% Local CQC, Safety Number of MRSA cases Number of C.Diff cases VTE Screening Mixed Sex Accommodation 2013/ /15 Qtr1 Qtr2 Qtr3 Qtr4 Qtr4 ly % 97.2% 89.9% 99.0% 98.4% 98.3% 95.8% 97.5% CQC,, Monitor CQC, Monitor, CQC, CQC, There remain zero MRSA, C.Diff Cases or Mixed Sex Accommodation breaches reported this financial year. Page 13

15 Ward Staffing Levels (Only 'wards with inpatient beds' as per report requirement) The fill rate during July for the Cumberlege Wing was of 54% and based on a small denominator - a total of 3 WTE care staff. During this time a member of staff was absent which resulted in the reduction of the fill rate. This was mitigated by cover being provided by a registered nurse, giving adequate cover in the skill mix. It is not uncommon that whenever necessary, the absence of a care worker can be substituted with a registered nurse to ensure safe standards are maintained on the wards. Page 14

16 Patient Experience (A&E and Inpatient Wards Only) Friends and family score: December 2014 Site: Moorfield Extremely Likely Neither likely Likely or unlikely Unlikely Not at all likely Don't Know Total Number of people eligible to respond Total responses Response rate Ward Name: Duke Elder % Ward Name: Observation Bay % Cumbelege Wing (NHS Pts) % Overnight Admissions Average % Accident and Emergency (+2 Blk) 6, % Page 15