Corporate Annual Plan 2012-13 - Walsall NHS -...

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EXECUTIVE SUMMARY

This Annual Plan outlines the progress the Trust has made in its first year as an integrated care

organisation. It reflects the plans we have to take the organisation forward successfully to

Foundation Trust status, through the delivery of the highest levels of quality and safety by

empowered professional staff resulting in a good patient experience.

Our plan shows how our progress over the last 12 months has been good, delivering the majority

of our stated objectives and achieving improvements and / or attainment in the vast majority of

the key standards and performance targets.

We have shown a real drive to address those issues that are more challenging, engaging clinical

leadership effectively to deliver best practice and innovative approaches to improvement and

providing a Board led focus on delivery of performance.

In particular, our focus on the improvement in patient experience has taken the whole

organisation through a journey, listening to the stories of people who use our services and

hearing feedback from our colleagues. This has enabled us to develop a set of Promises and

Standards which provide the backdrop to our approach to what we do everyday throughout the

organisation.

In addition our pilot scheme ‘Kissing it Better’, which works with local voluntary group and

colleagues to introduce activities and beauty therapies to wards and outpatients, has been very

successful and well received by patients and carers.

We have also focussed on key quality indicators, seeing improvements across the board through

the concerted effects of our clinical teams to address issues such as VTE assessment, pressure

ulcers and falls. We have achieved over 365 days without MRSA at the Manor Hospital site.

Where we require more focus the organisation has taken the required action to support change

learning from audit and assessment to prioritise investment for example in emergency care,

control of infection, and nursing establishment on wards.

We have successfully developed new services, for example the Midwifery Led Unit, the new Swift

Discharge Suite and the provision of cardiac devices as well as reconfiguring services to improve

effectiveness and efficiency in podiatry, elective surgery and community nursing. Our particular

focus on increasing the number of integrated care pathways has progressed well and our Pioneer

Pathways have successfully engaged clinical staff and delivered change.

We successfully achieved our full Cost Improvement Plans for 2011/12, achieving a surplus in

line with the planned £4m. This is in line with our Long Term Financial Model within the integrated

Business Plan.

We have significant ambitions for 2012/13 which will help us move forward effectively towards

Foundation Trust.

We will increase our drive to improve patient experience through the cascade of our ‘For One and

All’ programme, delivering changes and improvements at all levels of the organisation through

teams, divisions and corporately, together with emphasising the role individuals play in the

improvements to a patient experience and sharing our learning.

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We will be accelerating our delivery of integrated care, supporting additional pathways

development and reconfiguring our structure to support the integration of teams aimed at

delivering services in a seamless way.

We will be continuing and enhancing our focus on improving quality and safety as outlined in our

quality and strategy delivering continuing improvements in the numbers of pressure ulcers, falls

and infection that occur.

We are investing in a range of services aimed at improving the quality and access to our local

community including:

• Additional ward nursing

• Additional consultant posts in radiology and A&E

• bringing senior clinical decision making forward in pathways and extending cover

• repatriating cardiac and renal activity from Wolverhampton

• engaging effectively in the implementation of reconfiguration discussions, for example

pathology, vascular services and trauma

• development of integrated stroke services and reconfigured stroke rehabilitation services

• we will be investing in palliative care and improving our response to end of life needs

through an integrated approach.

In particular we will be developing approaches to improve the care of older people, those at the

end of their life and people with dementia to improve experience and care, deliver choice where

appropriate and support the highest quality care in the right place at the right time.

We will be developing new leadership approaches to support our workforce to lead change and

improvement and identifying innovation and new models of care. This will support rapid

improvement through empowered staff.

We will be delivering the agreed Cost Improvement Programme (CIP) for 2012/13 and developing

schemes for 2013/14 and 2014/15, working with a partner to support a range of schemes which

improve quality and safety as well as delivering cost improvement.

Our focus for 2012/13 is on making real changes to how the people that use and deliver our

services experience quality and we hope that the plans that we have put in place will support this

objective and demonstrate success over the coming 12 months.

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1. TRUST PROFILE Overview

Walsall Healthcare NHS Trust was created on 1st April 2011. The Trust brought together the

services of Walsall Hospitals NHS Trust and a large part of the services from NHS Walsall

Community Health which had previously been the provider arm of NHS Walsall, the PCT. The

creation of this integrated care organisation offers opportunities to address improvements in

patient experience and in the quality and efficiency of services across pathways which span the

community and the hospital. We will also build better and stronger partnerships with primary care

providers and with the Local Authority.

We have developed a clear vision for the organisation: To ‘provide first class integrated care

in the right place at the right time’. To support the delivery of this vision we have agreed six

strategic objectives:

1. Fist Class patient experience

2. Safe, high quality services

3. Integrated care

4. An engaged and empowered workforce

5. Good use of resources

6. An effective NHS Foundation Trust

1.1 Local Population

The catchment area covers the population of Walsall and parts of surrounding areas in South

Staffordshire and the Black Country, totalling approximately 260,000 people. The population is

among the 20% of areas in England with the poorest health and deprivation indicator scores.

There are wide variations in health inequality within the borough with an eight year difference in

life expectancy between the eastern and western parts of the area.

The population is expected to grow by 3% over the next 10 years and the number of very elderly

people (over 85) is set to double. High profile issues in the local health economy include: frailty in

the elderly; long term conditions; unhealthy lifestyles; high levels of teenage pregnancy and infant

mortality.

The minority ethnic population has increased in Walsall in recent years. The 2001 Census

showed a doubling of the Black and Minority Ethnic (BME) population compared with 1991,

bringing it to around 14% of the total population. Current estimates suggest that this has now

increased to approximately 20% which is higher than both West Midlands and national levels.

There are higher levels of school age children from BME groups and among these groups the

largest proportions are Indian, Pakistani and Bangladesh. In recent years there has been an

increase in the numbers of asylum seekers and immigrant workers from Eastern Europe,

particularly Poland.

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1.2 Service Portfolio

We provide services both in the local general hospital and in the community, through integrated

care pathways and services. The services we provide include the following:

• Community-based multidisciplinary services to support people to remain at home,

including rapid response and home based care

• Intermediate care services in people’s own homes and in nursing homes

• Full 24-hour consultant led Accident and Emergency service

• Neonatal level 2 services with outreach services in the community

• Full 24-hour consultant led provision of outpatient and inpatient services for children

• Full 24-hour consultant led obstetric service

• Community support for children with disabilities at home and in community settings

• Universal children’s health services providing support to the families in Walsall i.e. health

visiting and school nursing

• Broad range of specialties for both emergency and elective care

• Lifestyle management services.

1.3 Workforce Profile

We employ approximately 3,300 full time equivalent staff including doctors, nurses, allied health

professionals, facilities teams and administration and management staff.

Table 2.1 - Workforce profile as at September 2011

Staff Group Head Count FTE

Healthcare Scientists 104 91

Medical & Dental 330 317

Nursing & Midwifery Registered 1,134 998

Additional Clinical Services 624 535

Administrative & Clerical 972 807

Professional & Scientific 105 88

Allied Health Professionals 258 216

Estates & Ancillary 461 300

Total 3,988 3,351

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Working with Volunteers

• 24 people who provide the Expert Patient Programme across a number of different

chronic conditions.

• Approximately 272 hours provided by 68 volunteers at the Palliative Care Centre across a

range of activities including administration, reception and driving.

• The chaplaincy has in excess of 150 volunteers who provide support across a range of

faiths including Church of England, Muslim, and Hindu etc. They visit at the bedside,

collect for services and provide support at the time of death.

• The hospital has about 200 volunteers who help with a wide variety of activities including

feeding, collecting notes and driving the patient buggy around the hospital.

• Recently we have been recruiting younger volunteers and have piloted Duke of Edinburgh

candidates. Both have been successful and we are planning to continue with this.

The Trust has been working with a scheme to support improvements in patient experience

through a wide range of more ‘social’ activities whilst in hospital. The ‘Kissing it Better’

programme has been well received and is supported by volunteers and students from Walsall

College and it is planned that a small group of volunteers will continue to take this work forward in

the future.

1.4 Location of Services

Services are provided from a total of 60 sites including: the Manor Hospital, Walsall Palliative

Care Centre, community locations including nursing homes, health centres and clinics, General

Practice and Sure Start Centres. Services are provided in peoples’ homes and wider community

locations including schools, community centre and leisure facilities.

For services that need to be provided in hospital, the majority of our inpatient beds are at the

Manor Hospital. The site has 490 beds.

There are a further 41 beds provided within local nursing homes where we deliver our

intermediate care services. The following page shows a map of the service locations including the

main community based locations.

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Figure 1.0 Main Service Locations

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1.5 Income and expenditure

We had a forecast level of income of £224m in 2011/12 which will generate a surplus of £4.0m.

Both of the previous organisations that came together to form Walsall Healthcare have proven

track records in delivering challenging Cost Improvement Plans (CIPs).

Walsall Healthcare NHS Trust

Financial Performance - Period ended 29 February 2012

Year to Date

Budget

Year to Date

ActualVariance

Previous

Month

Year To

Date

Variance

Original

Annual

Budget

Annual

Budget

Budget

Movement In

Year

Recurrent

Budget

Non

Recurrent

Effect

Forecast

Outturn

Current

Forecast

Outturn

Variance

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

Income

Income from Main activities

Primary Care Trusts- patient related 181,056 184,846 3,791 2,949 189,887 198,866 8,979 193,307 5,560 199,903 1,037

Primary Care Trusts- non patient related 8,067 5,435 (2,632) (2,122) 3,800 8,800 5,000 8,800 8,800

Sub Total PCT Related activities 189,123 190,281 1,159 826 193,687 207,666 13,979 193,307 14,360 208,703 1,037

Flexing net of Performance adjustmensts 414 (207) (621) (416) - 414 414 414 (223) (637)

Net Total PCT Related activities 189,536 190,074 538 411 193,687 208,080 14,393 193,307 14,774 208,480 400

Other Patient Related 1,109 1,057 (52) (27) 1,174 1,210 36 1,210 - 1,210

Other operating income

Income from Other NHS Bodies 8,983 9,403 420 338 5,666 9,487 3,821 7,465 2,022 9,887 400

Other Income 4,186 4,608 422 372 3,400 4,533 1,133 3,521 1,012 4,866 333

Total Income 203,814 205,142 1,328 1,094 203,927 223,310 19,383 205,502 17,808 224,443 1,133

Expenditure

Divisional Directorates (141,463) (142,513) (1,051) (1,019) (139,717) (153,579) (13,861) (143,727) (9,852) (154,616) (1,037)

Estates & Facilities (20,377) (20,904) (527) (661) (20,637) (22,007) (1,370) (21,075) (933) (22,383) (376)

Corporate Services (22,423) (22,043) 381 327 (19,855) (23,996) (4,141) (21,081) (2,915) (23,651) 345

Reserves , Provisions & efficiency savings (1,898) - 1,898 2,000 (7,593) (6,732) 861 (5,274) (1,458) (5,328) 1,404

Total Expenditure (excl. Depn) (186,161) (185,460) 701 647 (187,802) (206,314) (18,512) (191,157) (15,157) (205,978) 336

Earnings before Interest & Depreciation 17,653 19,682 2,029 1,742 16,125 16,996 871 14,346 2,650 18,465 1,469

Profit/Loss on Disposal of Assets - 19 19 8 - - 0 (0) 19 19

Depreciation (6,521) (6,506) 15 13 (6,932) (7,082) (150) (6,932) (150) (7,067) 15 -

CRES Adjustment - - - -

Interest Receivable 33 33 0 (1) 36 36 - 36 - 36

Unitary Payment Interest (6,829) (6,829) (0) (0) (6,729) (7,450) (721) (7,450) - (7,450)

PDC payable - - - - - - - - -

Operating Surplus / Deficit (Pre Impairments) 4,336 6,399 2,064 1,761 2,500 2,500 0 0 2,500 4,003 1,503

PFI Technical Adjustment - -

Impairments - New Hospital (3) (3) (3) (3) (3)

Impairments - Estates Strategy - -

Surplus / Deficit for the year 4,336 6,396 2,060 1,758 2,500 2,500 0 0 2,500 4,000 1,500

Note: + equals a favourable variance, ( ) unfavourable variance

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2. REVIEW OF 2011/12

2.1. Annual Plan Objectives

Overall, progress against our Annual Plan for 2011/12 has been good, with the Trust anticipating

achieving a significant number of the key deliverables proposed, which has resulted in the

delivery of a number of key improvements under the strategic objectives in place at that time.

This is summarised under each strategic objective.

To deliver a high quality service

Overall, good progress has been made on the development of systems and processes to

measure quality and patient experience within the Trust

• A small improvement in our inpatient survey results has been achieved alongside an

Improvement in the number of people recommending us on NHS Choices website

• The introduction of monthly ward based surveys of patient experience

• Revision of the ward assurance tool

• Delivery of all CQUIN schemes including patient experience, VTE, medicine management

and blood cultures

• Establishment of our organisational development programme ‘For One and All’ including

‘In Your Shoes’ engagement sessions listening to patients, which has provided the basis

for our work on improving the patients’ experience

• Development of the Swift Discharge Suite, a community-based reablement unit

commissioned jointly by the Local Authority and NHS Walsall and based on an integrated

team model alined to the integrated discharge team.

• Increasing the choice of delivery location through the opening of the Midwifery Led Unit at

the end of March 2012.

• No incidences of MRSA bacteraemia for a 12 month period as at 14th March 2012.

Areas requiring attention:

• Our HSMR, where our performance has remained above 100 for the majority of the year.

A significant programme of work is underway to address the issue, including the

development of care bundles and auditing of notes to develop learning

• Performance against the annual target of 51 (based on the old method of testing) was not

achieved when measured against the improved method of testing. However we are very

encouraged that our work is achieving major improvement against the old testing method

where we saw a significant reduction in cases

• We saw an increase in the number of pressure ulcers and falls and have instigated a wide

range of additional measures and training to address the issues arising.

To improve the provision of our clinical services, maximising the benefits of integration

• Good progress has been made within the Pioneer Pathways during the year. An

increased focus on this area has been developed through the new Integration and

Improvement Group which is driving the acceleration of this work across a wider area of

delivery. Quarterly update reports are made to Board.

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• The work on improving services for older people has progressed well and has identified a

number of key areas of development including care for people with dementia, improved

patients’ experience through the ‘Kissing it Better’ project on appropriate wards as well as

a focus on impact of other quality measures, particularly on the elderly. Our next step is to

deliver the key changes that achieve improvement. The Working Group is chaired by an

Associate Non-executive Director who reports quarterly to the Board on progress.

Areas requiring attention:

• We have delivered 50% of QIPP schemes planned

• Measurable change in numbers of people on End of Life Care pathways dying in their

place of choice slipped because of the development of the baseline based on the

Department of Health modeling tool. This remains a target for the Pioneer Pathways.

Develop an effective and fit for purpose organisation

• Achievement of Level 2 Maternity NHSLA achieved

• Good progress with key requirements within our Foundation Trust Programme including

Tripartite Formal Agreement timescales, production of the Integrated Business Plan,

Board development and formal consultation commenced

• Implementation of improved integrated Governance teams and systems across the

organisation

• Introduction of a more systematic business planning process

• Divisional Health and Wellbeing Plans in place for staff

• Sickness absence rate of 3.9% achieved

• Planning has progressed well with regard to estate development of ITU/HDU

reconfiguration and A&E/ Emergency Acute Care redesign

• A Carbon Reduction and Sustainability Strategy has been developed and approved and

related groups established

• Maintenance of PEAT scores

• Effective progress towards PAS system replacement achieved

• Order Communications project commenced

• Maternity Information System implemented

• There have been improvements in the 2011 Staff Survey results overall, with the

exception of staff views on the quality of care

• Planned reduction in agency spend of 3% achieved – year to date January 2012 2.66%

• Information Technology support for Pioneers Pathways developed.

Areas requiring further attention:

• Appraisal rate of 80% achieved by January against a target of 95%

• Implementation of Business Intelligence System has been delayed

• The plan for 100% attainment for mandatory training was revised to 75% following in-year

consideration of the methodology of measurement. However, it is not anticipated that this

figure will be achieved in-year with performance of 66% at January 2011

• The working group undertaking a review of HSDU has been reestablished to report by the

end of Q1 2012/13.

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Achieve a sustainable financial position

• Successful delivery of the 2011/12 Cost Improvement Programme of £10m

• Delivery of £4m surplus achieved

• Service Line Reporting implemented across the Trust and supported by training for users

• Introduction of Quarterly Divisional Review developed.

Work in partnership with stakeholders (including patients and users) to improve patient

and user experience

• The Trust has developed close working relationships with the Black Country Cluster and

the developing Walsall Clinical Commissioning Group through increasing contact with key

groups and individuals

• Increasing partnership and alliances with a wider body of stakeholders is developing

through membership and attendance of Borough wide meetings.

Areas requiring further attention:

• Consideration and approval of the Patient and Public Engagement Strategy has slipped

into early 2012/13.

2.2. Clinical Quality Improvements

a. Delivery of commitments in the 2011/12 Trust Quality Account Commitments Commitment 1 - To improve the patients’ experience

• During 2011/12 we launched our major organisational development programme aimed at improving the patient’s experience. The ‘For One and All’ Programme commenced with a series of engagement events entitled ‘In Your Shoes’ which facilitated one to one feedback and listening to people who had used our services about their experience. This work has formed the basis of our values and the development of Promises to patients and staff

• We undertook routine ward based and doctor based patient surveys and fed the results back to staff, resulting in real improvements in some of the more resistant areas of improvement i.e. hand-washing and providing explanations of care. This work has been continued and developed using the I Want Great Care methodology

• We have introduced the Kissing it Better pilot which provides simple but high impact activities to enhance patient experience. Provided by volunteers and students from Walsall College, activities include beauty treatments in outpatients, singing (on the Stroke Unit) and the use of personal memorabilia to put patients at ease

• Improvements in environmental conditions in non PFI accommodation as well as the new buildings.

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Commitment 2 – To further reduce Healthcare Acquired Infections

• We succeeded in achieving 365 days without MRSA bacteraemia infection in the hospital. During that period we had two community acquired MRSA infections

• We have invested in increased clinical staff to prevent the spread of infection. The new team have revised the guidance and practice in the organisation improving Root Cause Analysis processes and ensuring learning is cascaded throughout the organisation

• We have developed and are delivering a rapid response to infections and outbreaks reducing the impact across the organisation

• Clostridium Difficile infections have breached the agreed target (based on old testing methodology) following the increased identification of infection arising from the new techniques introducing increased sensitivity. However, we have seen a significant improvement in the number of cases when the old testing method is used

• We have introduced a wide range of new techniques to prevent infection including hydrogen peroxide misting, a revision of antibiotic formulary supported by improved management from antimicrobial stewardship from a dedicated pharmacist

• The Chief Executive chairs the Control of Infection Committee to provide the highest level of governance available.

Commitment 3 - Reducing harm with a focus on reducing the number of Medication Errors

• We have created a Medications Safety Group which is a sub group of the Medicines Quality Board

• We have enhanced incident reporting and analysis of incidents

• We have deployed a process of issuing alerts in respect of changes to practice and risks identified from incidents

• We have undertaken a series of audits in respect of administration and prescribing

• We have developed prescribing dashboard containing information on antibiotic dosage etc

• We are now producing a monthly report on medicines errors. Commitment 4 - To maintain our HSMR rate below the national average

• Mortality rates have been a challenge this year. After starting the year at 94.6 we saw an increase from May (111) through to October 2011 (128), which has now reduced to 96 for December 2011. Although, after rebasing we can see an improved position as a result of a significant number of actions, our year to date mortality rate is estimated to be above the national average at 117.

• Some of the actions taken by the Trust include: o Establishment of a Mortality/Quality of Care Group chaired by the Medical Director.

Oversees a number of actions based on optimised clinical care, enhanced senior medical cover out of hours and accuracy of medical records and coding. Monthly report to TAQ and Board

o Case by case review of deaths in hospital by senior clinicians o Undertaken a detailed review of mortality in respiratory cases highlighted by the CQC

alert system. Although this review found no direct omissions in care, incidents when care could be optimizsd were found and included an action plan

o We have sought input from an external expert to help us assure the Board that all possible actions are being taken, with initial feedback recognising that the Trust has issues to address in respiratory care but supports the action taken to date.

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Commitment 5 – End of Life Care

• We have undertaken a range of audits that have identified issues requiring our attention including the increased potential use of the Liverpool Care Pathway and extending the services of the palliative care team beyond cancer and into Long Term Conditions

• Developed a plan to integrate hospital and community services and pathways

• We have developed the Pioneer Pathway project to increase the number of patients who can choose their preferred place of care.

In particular our performance in relation to the following areas continues to be a challenge. Some of these areas have been identified and highlighted within our Quality Account for 2010/11 and identified as priorities for action. Pressure Ulcers After a concerted effort, the numbers of pressure ulcers are now beginning to fall. Improved training and increased awareness of the existence of pressure damage has resulted in a significant increase in the number of pressure ulcers being reported. A specialist team is now training, working and advising staff across the wards and in the community. The Director of Nursing has established a Steering Group to address any additional issues as they arise and Root Cause Analysis is undertaken on Grade 3 and above ulcers if they should occur, with the learning actively shared across the services. In addition she is visiting all wards to discuss their pressure care and any concerns from staff regarding performance. The introduction of two hourly comfort rounds is also aimed at ensuring that appropriate nutritional, hydration and turning is observed. Falls A variety of preventative measures are being piloted including alarmed pads and low rise beds. The impact is monitored and evaluated through the Falls Steering Group chaired by the Director of Nursing.

b. Management of Serious Incidents and any Never Events during 2011/12 During the year (April 2011 to end January 2012) the Trust has reported a total of 239 serious

incidents to its commissioners and the Trust Board. The most common relate to pressure ulcers.

The next most common trend relates to slips, trips and falls resulting in fractured neck of femur.

Learning from every serious incident is important to us. Detailed below are some of the

improvements made as a result of Serious Incidents:

• Review of maternal death policy and requirements for post mortem

• Review of policies pertaining to the care of patients with learning difficulties

• Increased consultant cover out of hours

• Additional investment in Nursing staff and clinical support workers.

During the year, we have also improved the rigour around Root Cause Analysis review and

testing lessons learnt from Serious Incidents through the development of a Serious Incident

Group chaired by the Chief Executive.

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In addition to the above, there were two National Never Events reported during 2011/12. One

related to a retained instrument post surgery, with the second relating to a retained guidewire

following cardiac intervention. As a result of these Never Events, the Trust has made a number

of improvement changes to local policy including:

• Extension of the WHO checklist to the ward environment

• Revised and improved ‘counting in and counting out’ mechanisms in theatres

• Monthly audit of WHO checklist.

2.3 Service Developments in 2011/12 A number of service changes occurred during 2011/12 including:

• Opening of the Swift Discharge Suite in October 2011; a 34 bed reablement facility commissioned jointly by the Primary Care Trust and the Local Authority. This enables the closure of an acute ward

• Reconfiguration of the elective surgical beds to support the increase in day surgery and reductions in length of stay and enabling a reduction in beds of 27 and concentration on the Outpatients and Day Case Centre

• Development and opening of the offsite Midwifery Led Unit in March 2012

• Reconfiguration of the emergency care beds during the winter period to support faster turnaround of patients and reduced length of stay

• Redesign of Community Nursing services to support the key service requirements including support of primary care, long term conditions and end of life care

• Transfer of staff into the Borough wide New Operating Model for children from targeted families in Walsall which provides integrated multidisciplinary team support

• Medical Staffing Review supporting the provision of senior physicians 7 days a week and increased access to specialty rounds

• Provision of on-site Urgent Care Centre (previously provided by local GP provision) awarded to third party with extended specification. Commenced in November 2011.

• Commencement of Pioneer Pathways including COPD, diabetes, heart failure, Frail Elderly Pathway (Phase 2) and TOMS Pathway pilot

• Redesigned Fractured Neck of Femur Pathways to deliver best practice tariff

• Trust has been accredited as Trauma Unit status with the Major Trauma Network

• Establishment of service for implantable cardiac devices. Slippage on planned schemes and impact on 2012/13

• Work has progressed on the integration of end of life services and a clear action plan is in place for implementation in 2012/13

• The proposed reconfiguration of Pathology services into effective network arrangements has progressed orchestrated across the Black Country Cluster thereby resulting in a rescheduling of the timescales for change. This work has progressed effectively and the Trust’s medium term strategic direction has been agreed for implementation in 2012/13

• The complexity of the Joint Venture proposal to provide an outpatient based dispensary had not been foreseen. Competitive dialogue is underway with a currently anticipated completion date of quarter 4 2012/13.

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2.4 Financial Plan and Performance 2011/12

This section identifies the Annual Financial Plan for the Trust, the year to date financial plan,

performance in year and forecast outturn for the 2011/12 financial year

Description Initial Plan

£m’s

Forecast actual

2011/12 £m’s

Variance

£m’s

Narrative

Income 203.927 224.443 20.516 The Trust received additional income allocations in year above planned levels for the following:

• Strategic change reserve

• Best Practice Tariff

• Winter pressures funding

• DOH 18 week /4 hour initiative

• Contractual over performance.

Expenditure (201.427) (220.443) (19.016) The Trust has increased expenditure above plan for the following reasons:

• Balance to full year effect of recurrent savings

• costs to deliver additional activity

• provision to compensate for loss of office.

• one off costs such as Foundation Trust project.

• Costs for winter pressures and DOH 18 week/4 hr initiative.

Surplus

2.500

4.000

1.500

Initial position revised following a review of financial position relating to increased activity and income to reflect service transformation.

CIP Recurrent

10,124

7,184

2,940

This shortfall reflects the balance to full year effect of schemes taken forward into 12/13 recurrent CIP targets. The Trust has plans already in place to achieve the 2012/13 target fully. The in year shortfall has been mitigated with non recurrent transitional support from NHS Walsall as agreed at the beginning of the year.

CIP Non Recurrent

0 2,945 Transitional support as above.

Capital Spend

4,819 2,815 2,004 Capital expenditure is behind planned levels due to the slippage in schemes including:

• PACs system 0.8m

• PMS replacement 0.262m

• Business Intelligence System 0.360m

• Digital Dictation 0.130m

• Maternity Information System 0.119m

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Contract Performance The table below shows the analysis of the income performance against plan by Commissioner to the end of February: PCT Performance to February 2012

Annual

Plan Plan Actual Variance

£'000 £'000 £'000 £'000 %

Walsall 131,874 120,502 123,134 2,632 2.2%

Wolverhampton 2,242 2,045 2,231 186 9.1%

Sandwell 6,000 5,477 6,792 1,315 24.0%

South Staffs 9,654 8,814 9,424 610 6.9%

Heart of Birmingham 530 486 639 153 31.4%

South Birmingham 241 220 368 148 67.2%

Birmingham East and North 1,638 1,500 1,285 (215) (14.3)%

Dudley 446 411 493 82 20.0%

North Staffs 191 174 210 36 20.8%

Stoke on Trent 246 223 185 (38) (17.0)%

Solihull 60 55 60 5 9.2%

Telford and Wrekin 169 154 115 (39) (25.5)%

Other PCTs (Includes Pan Bham Network - Drugs) 5,361 4,971 4,432 (539) (10.8)%

Other NHS Walsall - Transisitional Support 5,000 4,583 3,764 (819) (17.9)%

Other NHS Walsall - PFI Support 3,800 3,483 3,483 0 0.0%

Other non-patient related from WPCT - Frail Elderly 255 255 255 0 0.0%

PCT prior year end of year activity adjustment (264) (264) (264) 0 0.0%

Repatriation of Specialist Cardiac Services 480 440 0 (440) (100.0)%

Community recharge 34,937 32,055 31,950 (104) (0.3)%

CQUIN/Penalities performance adjustment (207) (207) (207) 0 0.0%

Winter Pressures 3,408 2,840 2,840 0 0.0%

18 Week Funding 1,400 700 700 0 0.0%

NET QIPP Adjustment Income Loss 0 0 (1,813) (1,813) (100.0)%

TOTAL 208,080 189,536 190,074 538 0.3%

SLA Income

Year to Date

The NHS Walsall contract is over performing by £2.6 million year to date (February) against the acute part of its contract and is against all patient types excluding A&E.

The other main over performance is with NHS Sandwell (£1.3m), across outpatients, ward

attenders and non electives (mainly connected with births coming to Walsall from Sandwell

following the closure of the Consultant Led Birthing unit at Sandwell). NHS South Staffordshire

has also over performed which may be related to patient choice.

We have also been subject to a number of penalties imposed by the Commissioner in relation to non-achievement of key performance indicators. This has resulted in a cost of £207,000. We have also had performance notices for long waits in bariatric surgery and non-compliance to IVF pathways. The Trust is working with NHS Walsall on implementing action plans to address these.

• Lifecycle spend 0.365m

17

The activity performance by the largest specialities is highlighted in the table below: Analysis of Variances £ of the Largest Specialities - Month11

Emergencies Gross - Prior

to Emerg Thres CAPEmergencies Net Electives Non Elective Outpatient A&E Other Grand Total

Specialty 000's 000's 000's 000's 000's 000's 000's 000's

Genera l Medicine (2,723) (1,585) 532 19 (314) - (56) (1 ,404)

Genera l Surgery (881) (595) 230 31 79 - 156 (98)

Trauma & Orthopaedics (156) (40) 97 (4) 203 - 84 339

Obstetric 236 125 - 840 130 - 333 1 ,428

Accident & Emergency (10) (5) - - (53) (160) - (218)

Geriatric Medicine 1,812 584 16 (27) 76 - 0 650

Gynaecology (23) 100 (55) 6 (43) - 91 99

Direct Access - - - - - - 177 177

Paediatrics (147) (112) 7 (13) 490 - 16 389

Cardiology 1,475 721 153 14 39 - 60 988

QIPP Adj Income Loss - - - - - - (1,813) (1 ,813)

OTHER 1,088 533 (229) 163 983 - (1,450) 0

TOTAL 671 (275) 751 1,031 1,592 (160) (2,401) 538

The combined General Medicine and Geriatric Medicine specialties underperformed year to

date by £754,000 with General Surgery reporting an underperformance of £98,000. Obstetrics

and Cardiology have the greatest level of over performance year to date.

Alignment with Commissioner Priorities

We have been working closely to deliver a number of QIPP and demand management schemes

that deliver the key activity changes for NHS Walsall. The table below shows how the Trust is

performing against schemes in relation to NHS Walsall commissioned activity only.

There were a number of QIPP schemes that the Trust agreed to reduce its activity (and income)

levels by 2011/12 and these include reduction in follow up outpatients and in emergency

admissions due to the frail elderly pathway, etc. This income (gross £4.844m prior to emergency

cap) was stripped from the 2011/12 contracts and part of the £5 million transitional support is a

recognition that the Trust will not be able to reduce its expenditure base from day 1 following the

reduction in income.

NHS Walsall QIPP Performance as at February 2012

QIPP Plan

£'000

QIPP

Plan

YTD

£'000

QIPP

Actual

YTD

£'000

QIPP

Varianc

e YTD

£'000

QIPP In

Month

Movement

£'000

QIPP

Forecast

Outturn

£'000

QIPP

Forecast

Outturn

Variance

£'000

(4,844) (4,440) (2,627) 1,813 276 (2,866) 1,977

The Trust has delivered £2.6 million year to date against the QUIPP agenda to the end of

February. At Month 11, part of the over performance against income relates to underachievement

against the QIPP programme. The QIPP schemes include the following:

• Palliative Care / End of Life

• Frail Elderly Pathway

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• COPD

• Procedures of Limited Clinical Value

• Outpatient Review Ratios

• Maternity

• Community Matrons

• Sexual Health Integration

• MSK Pathway Re-design 2.6 Performance against national and contractual standards for 2011/12

Walsall Healthcare has performed well against the following indicators in 2011/12:

A&E Total Time in Department (4 hour Overall) – Performance against this indicator has

improved compared to last year and although the target was not achieved during the months of

October 2011 and January 2012, the year to date achievement has always achieved 95% or

above.

MRSA (Number of cases) - The Trust has not had a case of MRSA bacteraemia within the

hospital for over 12 months.

18 weeks – We have delivered against all of the 18 week targets during 2011/12.

Cancer 31 Days (Diagnosis to Treatment, Second or Subsequent Treatment (Surgery) and

Second or Subsequent Treatment (drug) – Strong performance has been delivered against

these three indicators: 31 Days (Diagnosis to Treatment) and Second or Subsequent Treatment

(drug) have exceeded target every month with current year to date performance at 99.8% and

100% respectively against a target of 98%. Subsequent Treatment (Surgery) has also achieved

100% each month against a target of 94% with the exception of just one month making year to

date achievement 99.3%.

Immunisation rate human papilloma virus full course of vaccine for girls aged 12-13 years

(i.e. three doses of HPV) – The organisation achieved 88.1% for the cohort due to receive this

vaccination during the academic year 2011/12, against a target of 80%.

Number of Health Visitors – The target of 38 Health Visitors to be in post at year end has been

exceeded as we currently have 41.54 staff in post.

We are reporting a challenge to delivery at year end for the following performance indicators:

Indicator Y TD (Feb) Target

• A&E Re-attenders 5.74% <5%

• A&E Admitted Pathway 85.73% 95%

• Ambulance Turnaround Times 76.18% >80%

• Clostridium Difficile 83 51

• MRSA Screening

• Elective 98.59% 100%

• Non-elective 95.46% 100%

• Stroke door to needle time 50% 80%

• Stroke – Thrombolysed >10%

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• Choose & Book 92.50% 95%

• Smoking at time of delivery 18.00% 14%

CQUINS 2011/12

• Patient Experience Acute

• Patient Experience Community

• Blood Cultures

• VTE Prevention

• Enhanced Recovery Programme

• Tissue Viability

• Health Care Associated Infections (Urinary Catheters)

• Medicines Management

• Specialised Services CQUIN

The organisation has participated in all of the CQUIN Schemes detailed above in 2011/12 and

has delivered strong performance and evidenced qualitative outcomes. NHS Walsall has

approved and confirmed release of all monies attributable to the schemes as at the end of

Quarter 3.

We are currently forecasting a total financial achievement between 94% and 99% for the year

ending 31st March 2012.

Monitor Compliance Framework

The organisation undertakes an in-month assessment against the Monitor Compliance

framework. An estimated forecast using February and March information available indicates a

rating of 2 for Quarter 4. Clostridium Difficile will report an underachievement and Cancer 62

Days is a risk across the year after Quarter 1 and 3 reporting underperformance. January

performance for screening of 62 Day Cancers was below target and although the Trust is

currently reporting a provisional achievement for February, based on previous submissions a

cautious forecast of 2 with an amber/red rating at year end is predicted.

2.7 Board Development

During the year April 2011 to end March 2012, the following movements took place at Board

level:

• Departure of interim Chief Executive Mr. Michael Scott (May 2011)

• Appointment of Substantive Chief Executive Mr. Richard Kirby (May 2011)

• Appointment of Director of Strategy Mrs. Anne Baines (August 2011)

• Departure of interim Director of Operations, Mr. Philip Walmsley (June 2011)

• Appointment of Chief Operating Officer Mrs. Jayne Tunstall (June 2011)

• Appointment of Medical Director Mr. Amir Khan (October 2011)

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May 2011 saw the integration of the risk assurance and quality agenda via the establishment of a

Risk Assurance and Quality Committee as a delegated sub-committee to the Trust Board. A

review of all Terms of Reference and Business Cycles for Board sub committees also took place

following recommendations from a State of Readiness review for Foundation Trust status

conducted by Chantrey Vellacott.

In response to the growing quality agenda, a number of improvements at Board level have taken

place including the presentation of patient stories at each Board meeting, a detailed review of

mortality levels on a monthly basis and presentation of a quarterly quality stock-take to further

assist in identifying trends and mitigating actions.

A Board Development Programme specification was tendered in December 2011, leading to the

appointment of Deloitte as the partner for the Trust. This partnership commenced in March 2012

and a detailed programme of activities is planned. In addition to this, the Board Governance

Assurance Framework review is assisting in identifying any developmental modules required.

Prior to implementation of the Deloitte Board Development programme, a schedule of local

activities commenced during the summer of 2011 which particularly focussed on preparations for

the Foundation Trust application. This programme has seen the Board debate in detail

governance and constitutional aspects of the organisation, quality and safety, risk identification,

analysis and management and financial sustainability. In addition, the Board has taken part in two

State of Readiness reviews as part of the Foundation Trust application process (September 2011

and January 2012 via Chantrey Vellacott) which saw significant improvements being reported in

terms of governance, business focus and financial management.

2.8 Progress with the Foundation Trust Application

The Board has continued to lead the Foundation Trust application throughout the year and has

successfully achieved all milestones contained in the Tripartite Formal Agreement. Such

milestones have included:

• Establishment of a Foundation Trust Project Management Office

• Development of the ‘first cut’ of the Integrated Business Plan and Long Term

Financial Model

• Completion of independent State of Readiness Reviews

• Commissioning of a Board Development Programme

• Approval to formally consult following a Board to Board meeting with the Midlands

and East Strategic Health Authority

• Opening of the formal 90 day consultation process.

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3. STRATEGY AND SERVICE DEVELOPMENT

We have developed a clear Vision for the organisation: To ‘provide first class integrated care for the people we service in the right place at the right time’ To ensure that we deliver our Vision in line with our values we have set six strategic objectives.

Figure 1.2 Strategic Objectives

These strategic objectives set the framework for all our planning and service development work

for the next 3-5 years.

1. First-class patient experience – although we receive many compliments from patients

about our services, we know from national patient survey scores that we do not

consistently provide all of our patients with a first class experience. Based on listening to

around 100 individual patient stories, our innovative “For One & All” programme is

designed to ensure we will be able to provide a consistently first class experience in the

future.

2. Safe, high quality services – alongside a continued focus on high standards of care in

both hospital and community (including good management of infection control, pressures

sores, falls and nutrition and dignity) and reducing hospital mortality rates, we have

prioritised improving care for older people and improving end of life care.

3 Integrated care – our Pioneer Pathways have delivered some good examples of the

potential of integrated care to improve services. We are building on this and have

prioritised working with hospital and community teams, social care and GP colleagues to

ensure that we are able to wrap services around the patient.

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4 An engaged and empowered workforce – the scale of the change that we are setting

out to undertake will require an engaged workforce who feel supported in successful

delivery. The new operational management structure and the “For One & All” programme

is designed to support this objective.

5 Good use of resources – we are responding to the pressures which the NHS is under by

seeking to deliver a £33m cost improvement programme over the next three years. This

includes the impact on the Trust of the local QIPP programme.

6 An effective NHS Foundation Trust – ensuring that we continue to meet our obligations

to the Care Quality Commission and securing authorisation as an NHS Foundation Trust

are both essential in remaining a well organised and effective provider of care.

Successfully delivering our Estates and Information Management & Technology strategies

are fundamental elements of this.

The Development of our ‘Promises’

From the outcome of our recent work with patients and colleagues where we have received their

feedback about what could be done to improve the patient and staff experience within the Trust,

we have developed a set of values. These in turn have been turned into a set of Promises to

patients and colleagues which will form the basis of delivery of our vision in the future and will

provide the backdrop to how we monitor services from now on. The Promises were publicly

launched in April with a high profile communications campaign.

The Promises are shown below together with the standards by which we will measure their

impact.

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24

25

WALSALL HEALTHCARE NHS TRUST

CORPORATE OBJECTIVES 2012/13

1. First Class Patient Experience

Annual Objective Measure of Success and Timescale Lead Director

1.1 Improve patient experience

through the delivery of the For

One & All Programme

• Improvement in national inpatient survey results

• Improvement in A&E survey results

• Continued improvement in outpatient survey results

• Roll out of real time measurement of patient experience across all services including Patient Experience Score (net promoter score)

• Delivery of patient experience CQUIN

Chief Executive (Director of

Nursing)

1.2 Develop effective public and

patient engagement mechanisms

• Create a formal systematic approach to consultation based on the Trust’s strategy (Q2)

• Complete FT consultation and provide feedback(Q1/2)

• Evidence effective patient and public engagement in service development and redesign through an annual report to the Trust Board (Q4)

Director of Nursing

1.3 Improve the information we

provide to patients and their GPs

about their care.

• Review of quality and standards of patient information (clinical)(Quarter 2)

• Implementation of recommendations from review (Quarter 3 to 4 )

• Improve the information we provide to patients on discharge from the hospital

• Written information on 80% of outpatient procedures to be given to patients in outpatients (AK)Q2 commence trajectory to target over Q3/Q4

• Improve uptake and quality of Electronic Discharge Summaries (deliver contract targets)

• Improve timeliness of outpatient letters to GPs.

Director of Nursing

Director of Nursing

Medical Director

1.4 Improve our systems for

outpatient appointment scheduling

• Review of key issues (Quarter 2 )

• Implementation of recommendations from review (Quarter 3 to 4)

Chief Operating Officer

1.5 Continue to deliver national

Access targets

• A&E

• 18 weeks

• Cancer targets

• (full details to be included)


26

2. Safe, High Quality Services


2.1 Reduce hospital mortality as

measured by the Hospital

Standardised Mortality Rate

(HSMR) and Standardised

Hospital Mortality Index (SHMI)

• Reduction in HSMR (specific target to be agreed)

• SHMI remains “as expected” nationally

Medical Director

2.2 Deliver effective control of

infection across hospital and

community services

• MRSA target delivered

• Deliver National C. diff target of 51 cases

Medical Director

2.3 Ensure delivery of CQUINs • Pressure Ulcers

• Falls

• Every Contact Counts

• NHS Safety Thermometer

• Dementia Screening

• Antimicrobial Prescribing Stewardship

• Discharge Summaries

• Medicines Management

• Implementer of net promoter score (Patient Care revolution)

• VTE

• Responsiveness to patient need

Director of Nursing

/Medical Director

2.4 Introduce the Trust’s new “quality

system” as set out in the Quality

and Safety Strategy

• Implement consultant dashboard – agree Q3, Implement Q4

• Divisional and Directorate Quality Teams in place Q1

Medical Director

2.5 Continue to develop the Trust’s

stroke services

• Deliver improvements in performance against standards and targets

• Review plans for community stroke rehabilitation facility

Director of Transformation

& Integrated Pathways

2.6 Continue to develop the Trust’s

A&E services

• Agree and deliver an A&E Improvement Plan

• Ensure achievement of the five A&E national clinical indicators

• Increase “shop floor” consultant cover through new appointments


2.7 Retain unconditional CQC

registration

• CQC registration in place

• Effective response to ‘moderate concerns’ identified

Director of Corporate

Affairs

2.8 Implement key service

reconfigurations effectively:

• Vascular surgery

• Repatriation of PCI’s and renal activity

• Pathology Network

• Successful transfer of activity and operation of network model for Vascular Surgery (Phase I) – Quarter 1 2012

• Negotiate repatriation of PCI and renal activity with Commissioners, providers and Network (Q1) and implement the transfers once agreed

• Successful development of pathology network with neighbours



Director of Strategy

27

2.9 Deliver effective and high quality

Medical Education and Training

• Deliver recommendations of Deanery Review to be held in February

• Establish a system for ensuring the Trust continues to develop medical education and training

Medical Director

3. Integrated Care


3.1 Accelerate the delivery of

integrated care through delivery of

the Integration and Improvement

Programme

• Agree and deliver the next stage of development of the Trust’s seven pioneer pathways: COPD, Diabetes, End of Life Services, Trauma and Orthopaedic Skeletal services, Heart Failure, Children’s Asthma Pathway.

• New operational management structure agreed and implemented

• Deliver new GP-practice-based approach to developing care closer to home with at least two practices

• Develop and deliver an action plan to improve support for those patients attending A&E / being admitted to hospital most frequently.

• Implement “new operating model” for children’s services in Walsall

• Developed planned approach to 24 hour / 7 day cover proposals.

Director of Transformation

and Integrated Pathways


3.2 Improve the care provided in

hospital and community to older

people including people with

dementia and people needing end

of life care

• Deliver Stage 2 of the Trust’s pathway for Frail Elderly patients increasing the number who can be supported at home

• Deliver the Trust’s Dementia strategy including achievement of national CQUIN targets for dementia screening for over 65s.

• Integrate End of Life service provision

• Deliver End of Life Care Action Plan

• Deliver an increase in the number of people receiving a choice of preferred place of care for people at the end of their lives through integrating services and routinely audit use of recognised national frameworks and tools (baseline for measure out turn 2011/12).

Director of Transformation &

Integrated Pathways

Director of Nursing

Director of Nursing

3.3 Deliver QIPP plans in partnership

with primary care

Potential schemes include

o Telehealth

o Regular reattenders

o Admission avoidance model with social

Director Transformation and

Integrated Pathways

28

care (older adults / vulnerable)

o Enhanced Recovery

o End of Life Care

o Dementia

o PLCV

o New to Follow-up outpatients

(Details will become clear through contract negotiation)

4. Engaged and Empowered Workforce


4.1 Develop leadership style which

supports engagement of staff,

delivery of effective services and

change and delivers the outcomes

within the For One and All Action

Plan

• Develop Leadership Strategy addressing clinical and organisational leadership needs (Q2)

• Review processes to enable front line staff to take responsibility for service improvement and undertake problem solving (Q2)

• Programme of regular staff feedback/graffiti boards and Values into Action Sessions developed and linked to organisation planning cycle (Q2)

Director of Human

Resources

4.2 Improve staff health, wellbeing and experience

• Introduce local staff survey to provide routine information on staff opinion

• Improvement in Staff Survey results across the organisation (Q4)

• Increase in numbers of staff recommending Trust to friends and relatives – under review

• Increase % staff seeing quality as a core priority for the organisation – under review

• % increase in staff saying we are a good employer

• % reduction in staff subject to violence and harassment – under review

• Appraisal rates (maintained at 95% or above)

• Sickness absenteeism (3.3%)

• Completion of mandatory training (at least 90% by end of year)

Director of Human Resources

4.3 Ensure effective staff engagement in Foundation Trust Consultation process

• Completion of consultation for FT for staff (Q1)

• Feedback on outcome (Q2)


5. Good Use of resources


5.1 Deliver financial plans as outlined in

the Integrated Business Plan and

• Deliver a surplus of £4.7m

Director of Finance

29

Long Term Financial Model

5.2 Deliver 2012/13 Cost Improvement

Programme (CIP) and develop CIP

for 2013/14 and 2014/15

• Deliver 12/13 CIP of £12.9m

• Plans approved for 2013/14 and 2014/15

• CIP development partner appointed and working effectively with the Trust.

Chief Executive

Director of Finance

5.3 Develop further the business

planning process and supporting

financial information

• Implement SLR and SLM across organisation (Q2)

• Agree specialty specific contribution levels (Q2)

• Effective implementation of any Qualified Provider regime

Director of Finance

Director Strategy

5.4 Successfully delivery our 2012/13

Capital Programme including

progressing plans for ITU and A&E

redevelopment

• Confirm funding package for ITU/A&E capital schemes (Q1)

• Business Cases for A&E and HDU/ITU developed (Q2)

• Procurement commenced (Q3)

Chief Operating Officer /

Director of Finance

5.5 Successfully implement year 1 of

Trust’s Sustainability Strategy

• Develop a five year investment programme with identified savings and benefits

• Complete formal risk assessment including appropriate climate change risks onto corporate risk register and associated financial risks

• Become a carbon literate and numerate organisation


5.6 Achieve required improvements

within HSDU provision

• Develop Business Case (Q1)

• Implement agreed way forward as appropriate (Q2)


6. An Effective NHS Foundation Trust


6.1 Deliver high level of performance as

outlined in required regulatory

systems

• National Operating Framework

• Monitor Compliance Framework

• SHA Provider Monitoring Regime

• Contracts standards and specifications This section will be expanded to identify the key requirements when agreed/notified by Monitor/DOH/SHA/Commissioners

Exec Team

6.2 Progress our Foundation Trust

application in line with the agreed

Programme Plan

• Deliver TFA requirements in 2012/13 o Complete formal public consultation (Q1) o Submission of Final IBP (Q2) o Due Diligence(Q2) o Quality Assessment Process (Q2) o Approval to proceed to DH (Oct)

Develop Shadow Foundation Trust Council of Governors



Director of Corporate Affairs

6.3 Improve quality of medical records • To be agreed Medical Director

30

6.4 Achieve agreed CNST standards in

general services and maternity

• Maintain Level 1 CNST for general standards

• Work towards Level 2 accreditation for general standards in early 13/14

• Achieve Level 3 in Maternity Standards

Director of Corporate Affairs

6.5 Deliver projects as outlined in IM&T

Strategy

• Procurement of PACs/RIS system commenced (Q2) deployed (Q4)

• Procurement of Replacement PAS commenced Q (Q)

• Implementation of Business Intelligence System (TBC)

• Electronic Patients Record Business Case to be developed (TBC) for procurement commencement (TBC)

• Develop Business case for E- prescribe (Q1) to deliver commencement in Q4 (with Head of Pharmacy)

• Further enhancement of Fusion clinical functionality (progress based on clinical work stream)

Director of IM&T

3.1 Service developments in 2012/13

The Trust has identified a number of areas where investment and service development is required. The priorities for investment have been based on discussion with the senior clinical and management team. For 2012/13 the majority of investments will be aimed at delivering improvements in quality and safety, i.e. ward nursing establishments, additional senior medical staff and radiology. However, a number of the schemes are reflective of changes in activity in terms of 1) shifts based on choice or 2) the repatriation of activity:

• Investment in maternity services including the Midwifery Led Unit supports the increasing number of deliveries arising from closure in services in Sandwell and patient choice from South East Staffordshire. This scheme is supported by commissioners

• Repatriation of Cardiac PCIs from Wolverhampton. This scheme is supported by Walsall Commissioners; however neither the Black Country Network or Specialised services Commissioners are currently supporting the shift. A revised Business Case is in production for discussion in May 2012

• Repatriation of Renal services from Wolverhampton. This is supported by local Commissioners.

• The reconfiguration of stroke services to consolidate local provision, particularly to support dedicated stroke rehabilitation is supported by local Commissioners. It involves the re-commissioning of current bed based services in the community

• The increase in health visiting establishment is in line with national policy and supported by the commissioners

• The recurrent investment in the Swift Discharge Suite, a community style reablement facility in the Manor Hospital site is commissioned jointly from NHS Walsall and the Local Authority. This scheme has supported the closure of a 27 bedded acute ward.

The list below lists the key service developments for 2012/13. A number are in the process of developing business cases for consideration.

31

1. First Class Patient experience 2. Safe High Quality services 3. Integrated care 4. Engaged and Empowered workforce 5. Good Use of resources 6. An Effective NHS Foundation Trust

Service development Link to Strategic

objective Investment Timescale

(start) Swift Discharge Suite – sustain service 1,2, 3 470k Q1 Health Visitors numbers expansion 1,2 350k Q2 Increase in A&E consultant staff 1,2,3 300k Q1 Expansion of Radiology Staff 1,2 150k Q1 Ward Nursing Funding 1,2 400k Q1 Midwifery Led Unit 1,2 787k Q1 Repatriation of renal and PCI services 1,2 678k Q2 Emergency Care Improvement Plan 1,2,3 375(Capital

initially) Q3

Pioneer pathways/QIPP Transformation/Community services

1,2,3 1,000k (NR) Ongoing

Redesign and reconfiguration of stroke services

1,2,3 TBC Q2

Implementation of the Business intelligence System

4,5 250k Q1

Trauma Unit 2 200k Q1 Seven day working 150k Q1 End of Life Care 200k Alignment to Commissioner Plans This plan reflects the key areas of development planned by the main commissioners over the next 12-18 months. In particular, the QIPP schemes reflect the key priorities for the commissioner where the Trust has a significant role in terms of delivery. Senior Trust clinical and management representation attends the QIPP Programme Boards to ensure effective alignment and delivery. We have been working to develop closer working relationships with our Clinical Commissioning Group and can see considerable alignment with their commissioning ambitions which include demand management and the development of integrated services, clinical decision making and intermediate care redesign. Black Country System Plan Development of the System Plan has been predominantly undertaken by the Cluster based on intelligence through the draft Integrated Business Plan and general QIPP commissioning and contract discussions. In addition, The Trust has been engaged in strategic development discussions through the Quality and Sustainability Review. In addition, opportunities to comment on a draft Plan were given and requests for specific updates regarding Foundation Trust timescales, innovation and developments were made.

32

The Cluster has identified priorities to improve the quality of healthcare whilst ensuring high levels of patient safety, address issues of health inequality, prevent ill health and deliver more care in community settings, while increasing quality and productivity. The Cluster Plan identified areas of alignment in relation to service priorities particularly in relation to dementia and care of older people, health visitors, pressure ulcers, making every contact count, quality and safety improvement and patient experience improvement and engagement. Our plans to focus of the improvement of patient experience and the quality and safety of patients, development of increasing levels of integrated care into the community as well as developing effective organisations all align well with the Cluster priorities. The Cluster have supported our Foundation trust application based on our Integrated Business Plan for which this Plan forms Year 1. Agreement of the 2012/13 contract has been progressing well. It is anticipated that the contract will be signed with our host commissioner by 30th March 2012 in line with required performance.

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4. KEY RISKS 2012/13

The organisations’ strategic risks were identified by the Board in October 2011 and are:

o Failure to demonstrate sustainable financial viability/strategy o Viability of service configuration and provision o Failure to improve the patient experience impacting on loss of activity and regulatory

requirements/standards o Failure to ‘take staff along the journey’ o Failure to deliver the integration agenda o External turbulence impact on local instability

Risks for 2012/13

The Trust has an Assurance Framework that identifies strategic and operational objectives and

the risks and key controls in place to manage these and positive assurances. It also identifies

gaps in controls and assurances and actions to be taken to mitigate these. The risks are

prioritised and assessed using the Trust’s Risk Grading Matrix detailed in the Risk Management

Strategy.

The Trust Board has considered the key risks in delivering the organisation’s vision and strategic

priorities and has linked these to the risk and downside content in the Integrated Business Plan

and downside financial model. These can be summarised as:

Strategic Priority: Safe, High Quality Services; A First Class Patient Experience

Risk 1 That the Trust fails to continue to improve patient experience and service

quality resulting in a loss of business to competitors and/or a failure to meet

the requirements of regulators (CQC, Monitor).

Potential Impact • Poor service provided to the people we serve.

• Significant damage to the reputation of the Trust.

• Loss of income due to loss of work.

• Failure to meet standards required for licensing (CQC) or authorisation (Monitor)

Possible

Mitigation

• Successful delivery of For One and All programme to improve patient experience

• Replica patient experience surveys and I Want Great Care

• Successful delivery of the Quality and Safety Strategy priorities for 12/13.

• Implementation of promises to patients

• Continued delivery of action plans to reduce hospital infections, pressure ulcers and falls.

• Renewed focus on hospital mortality and HSMR.

• Development and delivery of plans to improve care for older people.

34

Strategic Priority: Integrated Care

Risk 2 That the Trust is not able to deliver the 2012/13 integration programme

priorities.

Potential Impact • Patients do not get the benefit of integrated care.

• The Trust’s reputation suffers as we do not deliver what we have set out to as an integrated organisation.

• Increased expenditure as a result of continued reliance on acute hospital at expense of community provision

• Limited improvement in services to patient

• No reduction in demand on acute services capacity, placing a range of CIP schemes at risk

Possible

Mitigation

• Close project management of delivery of plans for Pioneer Pathways.

• Monthly performance management by Integration and Improvement Programme Group

• Development of plans for further integration of services.

• Work with clinical teams to ensure vision of integrated services is widely shared.

• Review of management capacity to deliver change across organisation.

Strategic Priority: An Engaged and Empowered Workforce

Risk 3 That the Trust is not able to “take staff with us” to deliver the changes

required to remain financially and clinically viable.

Potential Impact • Staff morale falls leading to further difficulty in delivering change and a failure to improve the patient experience.

• Change programmes are not successful due to lack of staff engagement.

• Sickness absence and use of temporary staff (bank and agency) increases affecting quality of care.

• Best staff leave to work for other Trusts / difficulties in recruiting good new staff.

• Poor national Staff Satisfaction Survey results

Possible

Mitigation

• For One and All programme seeking to increase staff engagement through team and divisional cascade and team commitments

• Implementation of promises to colleagues and promises to patients.

• Programmes to develop first-line managers.

• Delivery of action plans in response to staff survey

• Implementation of quarterly local staff surveys

• Development and implementation of local leadership programme

• Investment in clinical and nursing infrastructure

35

Strategic Priority: Effective Use of Resources

Risk 4 That the Trust cannot develop a sustainable financial strategy in the light of pressures on public finances.

Potential Impact • Without a sustainable financial strategy and viable LTFM the Trust will not be authorised as an NHS Foundation Trust

Possible Mitigation

• Ensure LTFM robust for both base-case and downside scenarios.

• Ensure CIPs for at least two years are identified and agreed

• Outline identification of CIPs for subsequent years of IBP

Risk 5 That the Trust does not deliver year 1 of the financial strategy as outlined in the Annual Plan 12/13.

Potential Impact • Achievement of a financial risk rating that is incompatible with a successful NHS FT application

Possible Mitigation

• Delivery of the CIP for 2012/13

• Effective budgetary management

• Delivery of the QUIPP agenda and CQUIN schemes

• Successful conclusion to service change proposals i.e. cardiac PCI and Renal

• Effective working with Clinical Commissioning Groups and Cluster

• Ensure continued alignment between service transformation and clinical commissioning intentions

• Delivery of the 2012/13 contract

• Successful implementation of Any Qualified Provider

Strategic Priority: An Effective NHS Foundation Trust

Risk 6 Strategic reconfiguration of services across the Black Country and Wider West Midlands impacts negatively on our local hospital and community based portfolio

Potential Impact • Reconfiguration of service(s) leading to inability to sustain acute/community service model, for 12/13

• Change in access to services for the people we serve.

• Increased difficulty in recruiting / retaining high quality clinical staff.

• Loss of income.

Possible Mitigation

• Clear plans to support service interdependencies.

• Close working with GP commissioning colleagues on plan for Walsall

• Increase visibility, presence and contribution across clinical networks and strategic debate

• Continued investment in key areas (e.g. A&E consultants)

• Ensure understanding of strengths / weaknesses and what action needed to maintain / address these.

• Collaboration with partners to ensure maximum local access and minimise impact on recruitment / retention (e.g. vascular)

• Delivery of the Clinical Services Strategy

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Strategic Priority: An Effective NHS Foundation Trust; Effective Use of Resources

Risk 7 That the external changes to the NHS structure and policy generate local instability which affects the delivery of the Trust’s financial or clinical strategy priorities during 12/13

Potential Impact • Change in local commissioning intentions.

• Black Country Cluster takes more assertive approach to service configuration leading to loss of key services.

• Loss of services and income to other Trusts as result of competitive commissioning processes

• Any Qualified Provider regime could result in loss of income and activity

Possible Mitigation

• Ensure strong relationships with local Clinical Commissioning Group(s).

• Maintain strong relationships with local GPs.

• Ensure close relationships with Black Country Cluster and Clinical Senate leadership.

5. IMPROVING SAFETY AND QUALITY

Our corporate objectives are shown in Section 3. There are key deliverables outlined for a number of Patient Experience and Quality areas. Patient Experience We have in recent years failed to significantly improve our inpatient experience survey scores and although there has been some improvement in the 2011 survey, we still consider this area to be one of the Trust’s major risk areas. We have therefore developed an organisational development programme which has begun by listening to the people that use our services. These In Your Shoes events gave over 100 patients the opportunity to tell a member of our staff their experience of the journey through our services on a one to one basis. We also asked our colleagues across the organisation to identify how they wanted to provide services and what were the key areas where they could support the best services. These two sources of information have helped us develop a set of Promises and standards by which we will provide our services. These are outlined in Section 3 and use the words which patients and colleagues used in their feedback. These will form the basis of how the improvements to services will occur and provide a drive for a change in culture. The next stage is to take these promises forward at every team level to develop a new approach to how we provide care based on the agreed action plans of teams through the organisation. Through this process we intend that the changes will become embedded at all levels of the organisation. A series of quick wins have been developed for implementation by May 2012 which we hope will address many of the small but often key issues that impact on experience. In addition we have introduced other initiatives to address improvements including:

37

• Routine survey of inpatients’ views of ward and doctors

• Introduced the net promoter scoring techniques

• Participation of staff and volunteers in the ‘Kissing it Better’ pilot where a wide range of recreational activities are undertaken in both outpatients and inpatient areas which are aimed at improving the overall experience. Activities include singing, beauty therapies, reading sessions.

• Introduction of two hourly comfort rounds on wards

• Investment in additional nursing staff on wards

• A refreshed focus on priorities such as control of infection, reduction in falls and pressure ulcers.

Mortality Ratios We have had a challenging year with regard to mortality rates with performance for the year being above the national average at estimated 117. We have seen a variation in the month by month rates with a peak from May to October and then a much improved performance for November and December. This pattern is also evident in the SHMI indicator. We continue to work to understand and reduce the rates with the introduction of a case by case review by senior clinicians, development of a monthly Mortality Group chaired by the Medical Director and producing reports to the Risk Assurance and Quality Committee and Board. We have reviewed our process for response to CQC triggers which has resulted in additional action with regard to respiratory medicine including the development of Trust wide care bundles. The work has highlighted a service gap with regard to effective palliative care capacity and we intend to invest in 2012/13 to address this need. We have also engaged the input of a senior colleague from a neighbouring Trust to act as a critical friend in relation to assessing if the actions we are taking can be improved and whether new activities should be begun. Healthcare Acquired Infections We have been successful in achieving over 365 days MRSA bacteraemia free in the hospital. We have had two cases which were community acquired and these have been addressed through systematic Root Cause Analysis with learning being shared across the organisation. We have increased the size of the Control of Infection Team and have therefore increased the guidance, audit and support of services to ensure infection free activities. Our performance with Clostridium difficile infections has been less positive and the annual target of 51 cases has been breached, with current performance at 83 (February 2012). We have retained our target of 51 cases for 2012/13. Pressure Ulcers We have seen an improvement in our pressure ulcer numbers in the hospital, particularly grade 3 and 4. There has been a decline in numbers in recent months but we still remain below target. In the community the number of overall has been fluctuating without any discernable trend. We have identified this as a key corporate objective within the Trust and have instigated further action to achieve a reduction in the numbers of ulcers. These include assessment of nurse competencies and supporting training being provided, visits to clinical areas by the Director of Nursing to consider directly with staff the key issues, link nurses working with the Tissue Viability team, introduction of new equipment and techniques. We have also introduced two hourly

38

‘comfort’ rounds to assess patient condition in terms of hydration, nutrition, skin condition and pressure points when patient turning will occur, if appropriate. We anticipate that this continued drive to improve the care planning of patents at risk will reduce our current incidence and help with an overall reduction of approximately 50% of grade 2, 3 and 4 ulcers in line with the agreed CQUIN measures. We will be aiming to eradicate grade 3 and 4. Single Sex Accommodation The Trust intends to continue its high level of performance on this area. We have had no breaches since June 2011 following a poor performance at the beginning of the year. Our year end position is expected to be a total of 59 breaches. We do not expect any in 2012/13. VTE Risk Assessment Our performance against the target of 90% has been consistent in recent months. We have agreed a target supported by CQUIN for 2012/13 that retains the current target level for completion of assessment and introduces target for the prescribing of prophylaxsis. Although a harder target to achieve, this has a greater impact on the patients’ outcome and experience and therefore was prioritised and recommended by the clinical leadership. CQC Registration and Compliance The Trust continues to hold unconditional registration with the Care Quality Commission. In April

2011, the Care Quality Commission undertook an unannounced inspection relating to outcomes 1

and 5 of the essential standards of quality and safety. Overall a positive report was received

although minor concerns were noted which resulted in the development of improvement actions

which have now been implemented. In November 2011, the Care Quality Commission undertook

a further unannounced inspection which focussed on a much wider range of outcomes. This

inspection again highlighted many areas of good practice, but did identify some areas where

improvements were required, with minor concerns being applied to outcomes 4, 7 and 14, with a

moderate concern being applied to outcome 8 Infection Prevention and Cleanliness. This

moderate concern resulted from the Trust’s failure to achieve its trajectory for Clostridium Difficile

during 2011/12 following the introduction of a more sensitive dual testing model. An improvement

plan relating to all areas of concern has been approved by the Trust Board and submitted to the

Care Quality Commission and we continue to closely monitor implementation and improvement.

Our aim for 2012/13 is to maintain unconditional registration with the CQC and to address all

concerns ensuring improved compliance with all essential standards.

CQC Quality Risk Profile (QRP)

Our CQC Quality Risk Profile is considered monthly at the Risk Assurance and Quality Committee and quarterly at the Trust Board. During 2011/12 there has been moderate movement within the QRP. The majority of standards are considered amber/neutral. Two outcomes have been identified as red, namely outcomes 8 and 9 (Infection Control and Cleanliness and Medicines Management). Detailed analysis of the QRP has identified areas where further assurances have been required such as Local Security Management Specialist arrangements. Many of the amber/neutral outcomes have been driven by responses to questions contained in the National Patient and Staff Surveys conducted in 2010. Improving the patient and staff experience are two key priorities for the Trust and we hope to see improvements in our 2011 survey responses which will drive a lower risk rating in many of the essential standards during 2012.

39

NHS Litigation Authority

The Trust attained General NHSLA level 1 accreditation in January 2011 and has continued to

sustain this throughout 2011/12. We are currently working towards attaining level 2 accreditation

in 2013.

With regard to Maternity Services, the Trust attained level 2 accreditation in November 2011. We

are working towards attaining level 3 accreditation during 2012.

Complaints

The Trust reviewed its complaints management process during 2011/12 through the

establishment of a Patient Relations Function and development of a complaints management

toolkit for the organisation. During the year, we have increased complaints management

awareness and training, established investigating officer roles within divisions and addressed a

historic backlog of complaints. Main themes arising from complaints relate to attitude and

communication between our staff and our patients/their relatives and carers. Whilst we are

addressing these concerns on an individual basis, we have also used the experience of our

complainants to inform our organisational development programme ‘For One and All’. A total of

266 complaints were received during the year (as at end January 2012), of which 241 related to

hospital based care and 25 to community care provision.

The Trust has a strong appetite for improvement and is keen to learn from complaints. Some of

the improvements we have made as a result of complaints received during 2011/12 are identified

below:

• A complete review of End of Life Care resulting in the approval of an End of Life Care

Strategy

• Review of waiting room facilities for male bariatric patients

• Review of patient fasting procedures in Arrivals Lounge

• Implementation of staggered arrival times for surgery

• Escalation procedure for when patients require earlier outpatient appointment due to deterioration in condition.

6. DELIVERING CONTRACTUAL AND NATIONAL TARGETS

Contractual Requirements 2012/13

The following indicators are currently being proposed for inclusion in the contract for 2012/13.

These include all of the key national and contractual deliverables required by the National

operating Framework and the Strategic health Authority Framework (Ambitions).

Delivery of the following areas may prove challenging for the organisation and mitigating plans

are currently being discussed to ensure that whilst Q1 may return an underperformance, plans

are in place to improve the position for the following quarter.

40

Discharge Summaries – currently the organisation is delivering an in month performance of

93.74%. It has been acknowledged that delivery of a 100% target leaves no margin for error and

therefore penalties are instigated when performance falls below 95%.

Outpatient Letters – This is measured through an audit cycle. Whilst performance was

favourable in January for Unplanned Care, there remains a risk to delivery against this indicator

across the wider organisation. This is monitored closely through a joint working group consisting

of Primary Care Clinicians and Healthcare Trust senior clinic representatives. Financial penalties

for 2012/13 have been increased as this along with Discharge Summaries remains an area of

concern for General Practitioner colleagues.

Clostridium Difficile – The target in 2012/13 has been agreed at 51 for the healthcare

organisation. An allowance of six cases for true community (identified through a robust Route

Cause Analysis) has been agreed. Since the implementation of new testing this particular

indicator remains a risk. It is pertinent to note that whilst the organisation was above trajectory

towards the end of 2012/13 for new testing, against the old testing regime the number of cases

reported consistently reduced across the year. The organisation is confident that with the

introduction of guidance to enable the measurement of significant cases, an improved outcome at

the end of 2012/13 is achievable.

A&E – Admitted – Whilst we are confident of delivery against the overall 4 hour wait target, the

Trust is able to forecast a challenge to delivery of this indicator during the early part of Q1.

Performance in month during February was 84.58% with a year to date performance of 85.73%.

A&E – Reattenders – Measurement of this indicator is across all re-attenders including those not

linked to original diagnosis. With the methodology including all reattenders the organisation was

forecast to underperform at the end of 2012/13. Cases linked to the original diagnosis

contributed to 6.08% in month for February. An Emergency Care Improvement Programme is

underway and will focus on improving the key clinical quality indicators in Q1 of 2012/13.

Choose & Book – The introduction of the Strategic Health Authority Contractual Framework

includes newly revised penalties that pose a financial risk to the organisation. There is a risk to

delivery of this indicator in Q1 based on achievement across the whole of 2011/12.

Ambulance Turnaround Times - Contractual penalties for this indicator are in relation to 30

minutes handover time; however the SHA Contractual Framework carried new penalties that

relate to the first 15 minutes of handover. These carry heavy financial penalties. Delivery of both

of these indicators remains a challenge and the organisation awaits further confirmation on how

this will be measured. The in month performance during February 2012 for 30 minute handover

was 74.01%, year to date reporting 76.18% against a target of 80%.

Details of the CQUIN schemes are included in the Finance Section 7 below.

Risks to delivery of these schemes can be attributed to delivery of Patient Experience, Dementia

Screening as a result of recording capabilities which are not currently in place. Q1 will be a

significant challenge. Patient Revolution is closely linked to patient experience and therefore the

component in relation to the 10 point improvement could be challenging. Falls and Pressure

Ulcers presents as requirements for this scheme have increased significantly. Plans are in place

to focus efforts in this area.

41

Performance Management Regime 2012//13

The Provider Management Regime is reported monthly to the Strategic Health Authority. The

return presents new challenges for the Trust. Within this there are additional indicators that are

not routinely reported in the contract. These will be included in the 2012/13 and challenges relate

to data completeness and quality that will be resolved in Q1. Areas of underperformance are:

• New birth visits

• Urgent district nurse response within 24 hours

• Non-urgent district nurse response within 48 hours

Areas of underperformance triangulate to those areas listed as risks in the current year and

moving forward in the early part of Q1 during 2012/13:

• Clostridium difficile

• A&E reattenders

• MRSA screening

• HMSR potentially during the new financial year.

• WHO checklist

The governance section of the report demonstrated during 2011/12 moderate concerns regarding

the safety of healthcare provision.

42

7. FINANCIAL PLANS 2012/13

INCOME AND EXPENDITURE PLAN FOR 2012/13

The 2012/13 budget reflects the contractual agreements with NHS Walsall, Walsall Metropolitan

Borough Council and contractual offers relating to other NHS Commissioners. It also reflects the

budgetary exercises carried out to inform the expenditure budgets for 2012/13, including service

developments and cost pressures.

The Trust will be measured against the operating surplus position. The recurrent and non

recurrent financial position is discussed on the following page.

The table below highlights that the surplus position consists of £4.6 million. This includes the non-

recurrent income from NHS Walsall of £6.8 million to support the transitional arrangements

relating to the QIPP schemes and A&E reconfigurations, then a reduction of £0.5 million relating

to the Emergency Threshold from other NHS Commissioners. It is imperative that the Trust

43

delivers the recurrent savings in order to secure future recurrent

surpluses.

2012/13 Budget

£,000

Income

NHS Activity Revenue (205,132)

Non NHS Clinical Revenue (RTA etc) (1,378)

Education and Training Income (3,707)

Other Operating Income (5,756)

Total Income (215,973)

Expenditure

Employee Benefits Expense 139,819

Drug Expense 11,673

Clinical Supplies 15,983

Non Clinical Supplies 6,095

PFI Operating Expenses 4,637

Other Operating Expense 26,774

In Year CIP (8,500)

Sub - Total Operating Expenses 196,481

Interest Expense on Loans/Working Capital 7,734

Depreciation and Amortisation 7,082

PDC Dividend 0

Sub-Total Non Operating Expenses 14,816

Total Expenses 211,297

SURPLUS (4,676)

INCOME BUDGET

PCT Income Plan

The Trust’s income plan for PCTs reflects the following:

• The 2012/13 Operating Framework

• Technical changes in the national tariff.

• Changes in activity levels (growth and demand management)

• A gross inflation deflator of 1.8% (or 1.5% locally agreed).

• A CQUIN payment (Commissioning for Quality and Innovation) of 2.5%

44

NHS Walsall Contract

The Trust has negotiated a risk sharing agreement with NHS Walsall that has secured additional

income negating reductions due to tariff deflation and QIPP. The 2012/13 NHS Walsall recurrent

contract is identified as follows:

The following summarises the main changes compared to 2011/12:

The 2012/13 contract has been based on forecast out turn as at January 2012 and is subject to

1.5% tariff deflation with further reductions in contract for the national QIPP agenda of £4.95

million. This has been offset with the national increase in CQUIN by a further 1%, further

community developments and additional growth of £4 million that has been negotiated for

2012/13.

There has also been non recurrent income of £6.8 million secured as transitional support for

QIPP and for the A&E transformation.

The following summarises the total 2012/13 NHS Walsall agreement:

11/12 Contract

11/12 Forecast

Outturn 12/13 Contract

Variance to

Forecast Outturn 2012/13 LTFM Variance to LTFM

£'000 £'000 £'000 £'000 £'000 £'000

Recurrent (164,195) (166,741) (165,955) 786 (162,887) (3,068)

Non Recurrent (5,171) (6,033) (6,800) (767) (5,800) (1,000)

Grand Total (169,366) (172,774) (172,755) 19 (168,687) (4,068)

The table above shows that the Trust is planning to secure a contract with NHS Walsall that is in

line with the 2011/12 forecast out turn despite major reductions due to tariff deflation and QIPP.

This is also £4 million more than the previously agreed figures included in the Long Term

£'000

2011/12 Forecast Out Turn (166,741) Net Tariff Deflator and Other Activity Changes 1,877 2012/13 QIPP Reduction 4,950 CQUIN Uplift (1,309) Community Developments (636) Additional Growth (4,096)

2012/13 Baseline Contract (165,955)

NHS WALSALL

2011/12 Recurrent

Contract

Forecast Out Turn

(based on mth 10) Variance

2012/13 Contract Based

on Activity Changes

and Tariff Deflator

2012/13 Growth and

QIPP

2012/13 Recurrent

Contract £'000 £'000 £'000 £'000 £'000 £'000

Baseline Contract A&E (6,344)

(6,008)

337

(5,999)

(5,999)

CQUIN (1,947)

(1,947)

-

(1,947)

(1,309)

(3,256) Critical Care (5,113)

(5,253)

(140)

(5,266)

(5,266)

Direct Access (4,437)

(4,628)

(191)

(4,626)

(4,626) Electives (24,608)

(25,065)

(457)

(24,088)

(24,088)

Emergency (37,536)

(37,947)

(411)

(38,052)

(38,052) Non Elective (7,185)

(7,654)

(469)

(8,355)

(8,355)

Other (18,597)

(19,091)

(495)

(15,445)

(15,445) Outpatients (23,241)

(24,296)

(1,055)

(26,094)

(26,094)

Rehab (2,744)

(2,409)

335

(2,576)

(2,576) Community (32,443)

(32,443)

-

(32,416)

(636)

(33,052)

QUIPP 4,950

4,950 2012/13 Growth (2,596)

(2,596)

Additional Growth & Best Practice Tariff (1,500)

(1,500)

Grand Total (164,195)

(166,741)

(2,546)

(164,864)

(1,091)

(165,955)

45

Financial Model (LTFM). £814,000 of this is subject to agreement of the business case in relation

to re-ablement funding, however for planning purposes has been included in the 2012/13

financial plan.

The reconciliation between the 2012/13 contract and the LTFM is as follows:

Recurrent Non Recurrent Total

NHS Walsall £'000 £'000 £'000

Modelled In LTFM (162,887) (5,800) (168,687)

A&E adjustments (800) (800)

Additional Growth (1,500) (1,500)

Community Developments (636) (636)

Other (132) (1,000) (1,132)

Total Agreement (165,955) (6,800) (172,755)

The additional monies of £4million compared to the LTFM agreed figures are subject to a risk

sharing agreement with NHS Walsall. The current proposal being discussed notes that the first

1% over performance in 2012/13 over and above the acute part of the contract of £133 million will

be offset by an equal sum reduction in non recurrent support. Any acute over performance

beyond this will be paid at a marginal rate still to be agreed.

Other Commissioners

The Trust is currently agreeing contracts with other PCT Commissioners and these will be

finalised by 31st March. £198 million contracted income has been modelled into the 2012/13

budget and is not expected to materially change. Further details are shown in Appendix 1.

The Trust has also agreed recurrent funding of £814,000 from Walsall Council for providing

re-ablement services, including the Swift Discharge Suite. This is subject to a business case

however it has been included in the financial plan. The Trust is pursuing further funded re-

ablement solutions in partnership with Walsall Council and NHS Walsall during 2012/13.

Activity Projections

The activity figures that have been incorporated into contracts/service level agreements for

20012/13 have been based on the first 10 months of activity for the financial year 2011/12 (up to

end of 31st January 2012). The reduction in QUIPP activity and the additional growth is currently

being modelled.

QIPP Schemes

The Trust has to deliver a further £5 million of QIPP schemes in 2012/13 that will reduce income. These are in conjunction with NHS Walsall and are as follows:

QUIPP Scheme Point of Delivery

Proposed Activity

Reduction

£'000

Reduction of rehabilitation activity Rehab Bed Days (1,535)

High cost drugs levy reduction Other (500)

COPD Emergency (165)

Consultant to Consultant - Outpatient Referrals Outpatient - New (38)

Procedures of Limited Clinical Value Electives (634)

46

Heart Failure Emergency (20)

Outpatients - New to Review Ratios Outpatient - Follow Up (825)

Maternity TBC (636)

Frail Elderly Pathway Emergency (250)

Diabetes Emergency (77)

End of Life / Palliative Care Emergency (99)

MSK Pathway Re-Design Electives (31)

A&E Attendances and A&E Outpatient Coding Changes Outpatient Follow Ups (155)

TOTAL QUIPP SCHEMES (4,965)

Incentives & Penalties

For the 2012/13 national contract there are a number of national priorities that will attract pre

identified financial consequences. Negotiations are underway with NHS Walsall as to the

possible financial penalties associated with breaching these priorities. At the time of writing

the penalties are summarised below:

• Ambulance Turnarounds – Regional Contractual Framework – application of fines based on SHA Contractual Framework – methodology still being defined by SHA

• Choose & Book – Regional Contractual Framework - 1% of the value of the Contract for non-achievement of 95%

• Discharge Summaries – local initiative - 100% target, but not applied unless Trust achieves below 95%

• Breastfeeding – £7k penalty quarterly for non-achievement of 60%

• National penalties apply for Cancer, based on performance this year screening could be a risk (2% of the service line for under achievement)

• C. diff – national contractual target will be based on the number of C Diff cases reported in 2011/12, with penalties based on nationally defined contractual fines as set out in contract

• Outpatient letters – local initiative - £7.5k for every monthly breach of 95%

• Postponement/Cancellation of Outpatient Clinics – £5k for every breach after three cumulative breaches

• A&E legible information – local initiative - £7.5k

• Early Access for Maternity – local initiative – nationally measured and monitored by SHA - £10,000 quarterly penalty, applied if Trust breaches target for the quarter as a whole.

The financial plan has built in a loss of £500,000 in relation to emergency readmissions relating to

non Walsall Commissioners and has assumed no loss of income against any other penalty. The

Trust needs to ensure that it minimises the risks relating to the penalties.

There are also local incentives included in the contract that include:

• Ensuring that the backlog does not worsen compared to 2011/12 levels

• Levels of C. diff

• Breastfeeding at 62%

• Breastfeeding check at 6-8 weeks post birth

• HPV vaccinations

47

• Ambulance Turnaround times over 30 minutes.

CQUIN Schemes

The CQUIN schemes relate to qualitative elements of the contract. The value of the schemes is

2.5% (£3.8million for Acute and £0.9 million for Community, giving a total of £4.7million) in

2012/13. The following highlights the proposed schemes. These will need to be approved by the

SHA.

Proposed CQUIN

Scheme 2012/13

Description of what scheme is about % £’000

VTE Risk Assessment

(national mandated)

90% of all adult inpatients to receive VTE risk

assessment tool plus prescribing if appropriate 10% 470

Dementia (national

mandated)

Screening for Dementia of all patients over the age of

65yrs

10% 470

NHS Safety Thermometer

(national mandated)

Improve collation of data in relation to pressure ulcers,

falls, UTIs and VTE for both Acute and Community

settings

5% 235

Patient Experience inc

community (national

mandated)

Improvement in scores for national patient surveys 10% 470

Net Promoter (regional

mandated)

Demonstrate improvements in patient experience

using a net promoter score

10% 470

Patient Falls Risk assessment and care planning of patients at risk

of falls and a 50% Reduction in number of falls

10% 470

Tissue Viability Risk assessment and care planning of patients at risk

of pressure ulceration in acute and community

10% 470

Pharmaceutical Risk

Assessment

An ongoing audit to highlight medication risks using an

agreed risk assessment tool, improved communication

with primary care and a reduction in medicines related

admissions

15% 705

Antimicrobial Stewardship Improvement in self assessment scores for

antimicrobials, audit of antibiotic prescribing and

snapshot analysis of prescribing

15% 705

Making Every Contact

Count

Train front line staff to deliver brief opportunistic advice

and make referrals to lifestyles services

5% 235

TOTAL 100% 4,700

Cost Pressures and Developments

48

A number of cost pressures and service developments are included in the 2012/13 budgets as

summarised below:

Cost Pressures and Developments

Recurrent

£’000

Non Recurrent

£’000

National Cost Pressures 2,318 0

Local Cost Pressures and service developments

12,101 2,474

TOTAL

14,419 2,474

The national cost pressures were identified using inflation modelling detailed within the below table:

Description 2012/13 %

Pay (Incremental drift and pay award) 2.0

Drugs (Historic average) 5.0

Clinical Supplies & Services (Historic average) 2.7

Unitary Charge (Estimate of RPI @ February 2012) 4.0

Other Costs (Balance to Operating Framework percentage)

4.9

Sub-total Pay and Non-pay impact 2.5

Funded by pay & prices -2.5

Tariff & Non-tariff inflation -1.5

Total -4.0

National and Local Cost Pressures

National and local cost pressures include the following:

Total

£'000

National

Incremental Drift 1,768

Pay Awards 350

Carbon Footprint 200

Sub Total 2,318

Local

Unitary Payment 528

Energy & Rates 948

49

Drugs 500

NHLSA etc 122

Sub Total 2,098

Total 4,416

Local Service Developments

The following divisional service developments and cost pressures have been agreed:

2012/13 Divisional

Bids Family Health

and

Diagnostics Planned Care

Unplanned

Care

Estates &

Facilities Corporate Total £ £ £ £ £ £

-

Non Pay Inflation 177,527 119,657 - 199,362 190,973 687,519

Volume/Activity - 468,000 1,518,908 - - 1,986,908

Quality / Standards 177,566 18,000 264,000 109,920 112,000 681,486

Local Developments (incl Swift/AMU) - 0 1,274,000 174,875 13,000 1,461,875

Non Recurrent 77,000 - - - 40,000 117,000

Sub Total 432,093 605,657 3,056,908 484,158 355,973 4,934,789

Incremental Drift 536,776 352,870 685,467 55,865 136,657 1,767,635

- - - - -

Total 968,869 958,527 3,742,375 540,023 492,630 6,702,424

Further service developments take account of those identified in the Integrated Business Plan

(IBP) and the Long Term Financial Model and include the following major themes:

Recurrent Non

Recurrent Total

£'000 £'000 £'000

Nursing Investment 400 400

CQUIN 56 181 237

Obstetrics/MLU 787 787

Health Visitors 350 350

7 Day Working 370 370

Imaging Consultant 150 150

Trauma Unit 200 200

Re-ablement 407 407

FT/OD strategy 76 815 891

Transformation 1,000 1,000

Growth 1,500 1,500

TOTAL 4,296 1,996 6,292

50

Other Operating Income and Interest Receivable

Other operating income mainly relates to the training element of junior doctors’ staffing costs,

services provided to other organisations e.g. catering services to NHS Walsall, car parking and

accommodation income etc. The recurring budget totals £10 million for these services.

The interest receivable budget has been increased from £36,000 to £51,000 to reflect the

continuing low rates of interest albeit on higher cash balances.

Overall recurrent 2012/13 CIP position

Against a recurrent target of £11.445m the Trust has plans in place totalling £11.566m, a positive

variance of £0.12m. All operational Divisions have plans to deliver their targets. All Divisions have

plans in place to achieve their targets. This equates to 5.4% of the Trust recurrent turnover.

CIP scheme values

New schemes have been identified and developed by the Divisions and Directorates to deliver an

in-year value of £8.697m. In addition the forecast full year effect of the schemes which

commenced during 2011/12 totals £2.734. A small number of Directorates are also forecast to

over-deliver against their 2011/12 in-year targets and this over recovery amounts to £0.134m

which is carried forward into 2012/13. The sum of these three elements provides the overall

planned delivery for 2012/13 totalling £11.566m.

At a high level the schemes fall into the following categories:

Division/Directorate

Sta

ffin

g s

kill

mix

and

restr

uctu

ring

Bed s

toc

k r

econfigura

tion

Pro

cure

ment

of

goods a

nd

serv

ices

Clin

ical &

Opera

tional

inte

gra

tion

Best

pra

ctice t

ariff

path

ways

Es

tate

rationalis

ation

New

/ addit

ional in

com

e

str

eam

s

Repatr

iation o

f patient

activity

Pharm

acy

rela

ted d

rug c

ost

reduc

tions

Budget

revie

w

Medic

al sta

ff job p

lannin

g

Path

olo

gy n

etw

ork

ing

CN

ST

pre

miu

m d

iscount

Serv

ice r

edes

ign -

Pro

cedure

s

of

Lim

ited C

linic

al V

alu

e

Patient

applia

nces

sta

ndard

isation

Tota

l

Unplanned Care 810 1,304 199 303 420 0 265 265 156 40 75 0 0 0 0 3,836

Planned Care 122 728 224 0 464 0 0 0 48 40 51 0 0 166 160 2,004

Family Health & Diagnostics 870 0 179 253 0 4 148 0 331 132 206 300 238 0 0 2,662

Estates and Facilities 351 22 637 0 0 597 29 0 0 75 0 0 0 0 0 1,712

Corporate Services 750 0 60 436 0 0 45 0 0 60 0 0 0 0 0 1,351

Grand Total £,000 2,904 2,054 1,300 992 884 601 487 265 535 347 333 300 238 166 160 11,566

Table 1: High level categorisation of 2012/13 CIP schemes

51

Development of CIPs for 2013/14 and 2014/15

Our Long Term Financial Model proposes CIP Plans for 13/14 of £8m and 14/15 of £8.5 m

Outline schemes have been developed for approximately 58% of the 13/14 figures (£4.8m)

including £2.0 from balance to full year effects of 12/13 schemes. Outline schemes for 13/14 will

be developed by the end of May 2012.

Our Integrated Business Plan and LTFM, forming part of the Foundation Trust application

requires an outline for schemes for both years delivering a two year rolling Cost Improvement

Plan. We have appointed an external partner to help us identify and deliver further schemes.

2012/13 Planned Surplus The Trust is forecasting attainment of break-even duty, with financial performance to include the projected SHA control total and retained surplus planned for the 2012/13 financial year detailed within this section of the report. I&E planned forecast attainment

Description

2012/13 £m’s

SHA control total performance

4.7

Retained surplus/(Deficit) for the financial year

4.7

Capital Expenditure The Trust is planning to spend £6.1m on capital for the 2012/13 financial year as identified below:

Scheme £000

Estates & Support Services 921

Medical Equipment Replacement 1,570

Capital incentives for Divisions/Non Medical 250

Information Management & Technology 3,409

Total 6,150

This will be funded through the internally generated means.

52

Balance Sheet The Trust impaired its new hospital in 2010/11 that resulted in a negative balance sheet, with the balance sheet forecast to move into a £1.5m positive balance at close of the 2012/13 financial year. The Trust has modelled attainment of a cash holding of £12.5m at close of the financial year 2012/13. Monitor Risk Ratings for 2012/13 The Trust has forecast performance against monitor risk ratings as denoted by the below table:

Monitor risk ratings (Score 1-5) 2012/13

EBITDA % Margin attained 3

EBITDA % Achieved to plan 5

Return on Assets Employed 5

I&E Surplus margin 4

Liquidity Ratio 3

OVERALL SCORE 4

Table 3; - Monitor Risk Ratings (MRR) 2012/13

The Trust is exceeding the minimum required score of 3 overall for application to Foundation Trust Status, only scoring 3 for EBITDA margin (attaining 8.9% that would have been a 4 if the Trust had scored 9%) and Liquidity (attaining 20.9 days liquidity owing to inclusion of short term PFI debt in current liabilities). Service Line Reporting The Trust has implemented service line reporting and produces these reports quarterly. This

information will be used, amongst others, for the following:

• To underpin the strategic direction of travel to Service Line Management (SLM), enabling the engagement and performance management of specialties and clinicians

• To inform and identify areas for potential savings

• To enable a drilldown for continuous service improvement, benchmarking, efficiency savings and reduction in variation and outliers in a particular specialty, point of delivery, or HRG

• An aid to ad hoc clinical audits e.g. anaesthetic time variation, day case rates across clinicians etc

• To flush out data quality issues and identify the source of inaccurate data, thus enabling improvements to be targeted and tracked.

53

8. WORKFORCE PLANNING/MODELLING

The Trust has ensured synergies exist between the activity modelling and workforce movements needed to ensure attainment of financial balance for the 2012/13 financial year. The Trust has modelled the impact of reduction in activity in relation to QIPP and increases for developments, growth and complexity to enable an analysis of workforce movements to be completed. The below table confirms the impact on workforce from savings delivery, case mix movements, QIPP and Health Economy investments and disinvestments.

Workforce Projections

Staff Group SIP at

01/04/2011 FTE

SIP at 31/03/2012

FTE

SIP Actual Movement

11/12

LTFM Planned Establishment

31/03/2013

LTFM Forecast Change

Workforce Plans

2012/13 Variance

Consultants 116.0 114.0 -2.0 129.4 15.4 118.1 11.3

Junior medical 196.0 201.4 5.4 191.5 -9.9 200.4 -8.9

Nursing, midwifery & health visitors

1015.3 1039.0 23.7 1057.6 18.6 1050.3 7.3

Dental 1.0 1.0 0.0 2.0 1.0 1.0 1.0

Scientific, therapeutic, & technical

538.0 549.8 11.8 475.5 -74.3 521.6 -46.1

Other clinical staff 403.9 434.9 31.0 781.4 346.5 461.1 320.3

Non clinical staff 1071.7 1090.5 18.8 718.2 -372.3 1020.7 -302.5

Total 3342.0 3430.6 88.6 3355.6 -75.0 3373.3 -17.6

We have seen an increase in the number of staff in post of 88.6 FTE between 2010/11 and

2011/12. The LTFM planned establishment was 3416.2 a difference of 14.4 FTE between the

actual staff in post as at 31/03/12. The net increase from plan was due to:

1) The implementation of Mutually Agreed Resignation Scheme to support the delivery of

CIP schemes

2) The reduction in vacancy rates throughout the Trust.

The LTFM workforce projection for 2012/13 is 3,355.6. 2012/13 local workforce plans, at

divisional and corporate directorate level throughout the Trust, have been developed to take

account of known and anticipated change at local and national level to inform the provision of

services and workforce reductions which align with the high level organisational workforce plan,

LTFM and CIPs. Further workforce reductions are anticipated as service strategies continue to

develop and be implemented.

The detailed plans will achieve a net workforce reduction of 57.3 FTE. This equates to a

reduction achieved through CIP of 150.1 FTE and an investment of 92.8 FTE. These changes

54

will be achieved by implementation of MARS, removal of vacant posts, service reconfiguration

and outsourcing.

Workforce Key Performance Indicators (KPIs)

Workforce KPIs are routinely reported and monitored on a monthly basis by the Trust Board

against the following targets.

Target

2011/12

Performance

to

February

2012

Target

2012/13

Turnover <10% 8.03% <10%

Vacancy Rates 7.2% 7.2%

Agency Usage <3% 2.75% 2.75%

Bank Usage 6.30%

Sickness 3.90% 3.95% 3.39%

Appraisals 90% 82% 90%

Mandatory Training 75% 70% 90%

Areas of difficulty in recruitment

Medical recruitment at specialty doctor grade has represented a challenge for the organisation. To address this the Trust has developed the Physician Assistant role in both Paediatrics and A&E. We have also set up a medical training scheme with Pakistan where we provide a two year training scheme for medics at staff grade level. We are presently recruiting candidates for anaesthetics and medicine to provide further resources within our medical workforce and assist in mitigating risk.

Actions to address the staff survey results

The 2011 NHS Staff Survey indicates an improved performance from 2010, the comparison with

other acute Trusts shows 31 of the Trust’s responses to the indicators are within the central 60%

of trust scores, 5 were in the best 20% and 2 were within the worst 20%.

Through the For One and All programme, a series of corporate actions are in place that respond

to the feedback from Staff Graffiti Boards and also from the health and wellbeing survey. This

action plan is monitored by the For One and All Steering Group. The team cascade process will

provide the opportunity for teams to discuss the Promises and develop action plans to enable

them to meet both patient and staff Promises and Standards.

As part of the corporate actions a staff survey will be conducted on a quarterly basis that will

provide real time feedback of staff experience and measure the impact of the programme.

55

Talent & Leadership Development

The role of leaders within the Trust requires them to translate the Trust’s vision into actions and

to set the direction for their team, effectively manage resources and transform services whilst

engaging and empowering their staff.

The Trust places a high importance on leadership and management development, and has had

success in implementing leadership and talent management strategies to support the

development of leaders through a competency framework, 360 degree leadership assessment,

leadership and talent rating and the development of interventions based on individual and

corporate needs. The organisational changes experienced in 2011/12 now require a refresh of

the Leadership Strategy and approach and this is contained within the objectives for 2012/13.

Promoting Staff Health and Wellbeing

The Trust has established a Health and Well Being Group to specifically integrate health and well

being initiatives and to carry forward existing best practice. The group commissioned a health

and wellbeing survey that has been used along with the staff graffiti board feedback to develop a

work programme that will impact on the staff experience during 2012.

Workforce Strategy

Our workforce strategy is being reviewed and updated to reflect our vision, values and priorities

as we move ahead as an integrated organisation and these will become the Workforce Strategy

2012 – 2017. The review has reflected the listening exercise that is part of the ‘For One & All’

programme as well as ensuring that it is fit for purpose as an overarching HR framework to

deliver the workforce vision of an NHS Foundation Trust (FT).

9. SUSTAINABILITY

We have continued to demonstrate our commitment to sustainability, with the production of our

Sustainability Policy and the aim to reduce our carbon emissions and minimise our impact on the

environment and climate change.

We aim to make Sustainability an integral part of the Trust’s core business, with the development

of a Carbon Reduction Strategy and further development of:

• Environmental Policy

• Environmental Management System

• Waste Management Policy

• Waste Management Strategy

• Purchasing Policies

The Chief Operating Officer is the Board delegated officer for sustainability and carbon reduction.

We will:

• Identify a sustainability and carbon management roadmap, highlighting milestones and targets

• Confirm a detailed action plan to underpin our commitment to become a Good Corporate Citizen

56

• Set interim targets and trajectories to meet the Climate Change Act • Disaggregate targets to the component sources of emissions • Monitor and report progress towards delivering the strategy and SDMP

We will consider encompassing sustainability opportunities within our new developments (A&E

Upgrade and Integrated Critical Care Unit) such as renewable energy via ground source heat

pumps and solar powered air circulation if these are appropriate. The renewable energy will not

only deliver financial savings but will also help towards the challenging targets facing all NHS

organisations.

Managing energy as a finite resource, minimising and mitigating energy wastage would have a

positive financial impact on the Trust.

Principles are continually practiced to promote awareness of the Trust’s responsibilities and to

engage staff, service users and visitors. Specifically with regard to the following, which form part

of the NHS Carbon Reduction Strategy for England.

• Raising awareness of the need to manage resources more effectively, reducing consumption, waste, emissions and expenditure.

• Investing in new buildings, plant, equipment and technology to improve efficiency, and

provide more with less.

• Adopting procurement practices which promote sustainable development. Consciously

specifying, procuring and re-cycling materials from sustainable sources.

• Promoting the need to embed sustainability in / as part of the day-day business of the

Trust.

Carbon Reduction Commitment (CRC) Energy Efficiency Scheme:

The Trust has made a declaration and information disclosure on the CRC as required. Our Trust

will also be trading on the CRC and have procured Carbon Credits (allowances).

The Trust will respond to and work within guidance being developed by Department for Energy

and Climate Change re revisions to the CRC qualification criteria and trading regulations.

Priorities

The Trust will continue to:

• Be innovative in the way it continues to drive down energy wastage. Continually develop a range of tools and materials to promote our commitment to sustainability, engaging with staff and patients as appropriate. With consideration for Energy roadshows to showcase achievements and interventions and to highlight areas where further improvements are necessary.

• Invest where business case exists in environmentally efficient and sustainable products and services.

• Work with our partners to drive down waste, increase recycling further and seek financial efficiencies.

• Ensure that the new projects encompass sustainable development principles and designs out wastage as a core component of its development.

57

• Lead in promoting sustainability in the wider community in collaboration with other organisations from the public, private and voluntary sectors.

• Develop a coordinated five year investment programme with defined identified capital and revenue investment and saving implications

• Become carbon literate, carbon numerate and ensure appropriate investment to become part of a low carbon NHS and in preparation for the carbon tax regime associated with the CRC

• Engage in partnership working to deliver appropriate incentives, economies and training to support this shift in culture

• Ensure all business cases consider carbon impact inform the final decision making process

• Consider green sustainable initiatives as part of the Annual Capital programme process

• Complete formal risk assessment and ensure climate change is included within the Trust’s risk register, highlighting both climate change mitigation and adaptation risks as well as the associated financial risks

The Trust recognises that “sustainability” is not a project, and has no end, rather that it is integral

to and impacts on all Trust activities, its day-day business and the quality and cost of services.

58

Measure Performance

2011/2012

Jan-12 Year to Date (January's position)

Target

Forecast for 2011/2012 outturn

Infection Control

C Diff - Acute old (new) 3 (6) 40 (73) 51

C Diff - Community old (wider health economy)

0 0 6

MRSA - Acute 0 0 2

MRSA - Community 1 2 4

Stroke Measures

Stroke - 90% stay * 76.70% 84.30% >80%

Stroke - CT Scan * 90.00% 93.13% >80%

Stroke -TIA * 63.00% 76.54% >60%

Stroke - % of patient thrombolysed *

8.50% 8.50% 10.00%

Stroke - Door to needle time * 50% 50.00% 80% regional 50% national

A&E Measures

A&E - 4 Hour Total Wait 92.01% 96.03% 95.00%

A&E - 4 Hour Total Wait (Admitted)

72.61% 85.91% 95%

A&E - 4 Hour Total Wait (Non-Admitted)

97.76% 98.39% 95%

A&E - Reattenders 5.83% 5.71% 5%

A&E - Left Without Being Seen 2.27% 2.56% < 5%

A&E - Time to Initial Assessment 15 15 mins < 15 mins

A&E - Time to Treatment 47 46 mins < 60 mins

Ambulance Turnaround 76.10% 76.41% > 80%

Cancer Measures

Cancer - 2 week wait 98.50% 96.00% 93.00%

Cancer - 2 week wait (Breast Symptomatic)

96.20% 94.30% 93.00%

VALIDATED PERFORMANCE POSITION AT JANUARY 2012

59

Cancer - 31 day Diagnosis to Treatment

100.00% 99.80% 96.00%

Cancer - 31 day 2nd or Subsequent Treatment (Surgery)

100.00% 99.30% 94.00%

Cancer - 31 day 2nd or Subsequent Treatment (Drug)

100.00% 100.00% 98.00%

Cancer - 62 day RTT All Cancers 88.50% 87.30% 85.00%

Cancer - 62 day RTT from Screening

75.00% 94.00% 90.00%

Cancer - 62 day RTT consultant upgrade

88.60% 93.30% 94%

18 Weeks Measures

18 Weeks - % Admitted within 18 weeks

94.31% (19

weeks) 94.31%

90% ( <23 wks)

18 Weeks - % Non-Admitted within 18 weeks

99.84% (12

weeks) 99.84%

95% (<18.3 wks)

18 Weeks - Incomplete Pathways (95th Percentile)

19 < 28 weeks

18 Weeks - Backlog (number of patients waiting over 18 weeks)

1043 patients in December 2011

<500 unofficially

GUM Measures

GUM - Offered 100.00% 100.00% 100.00%

GUM - Seen 98.48% 98.59% 96.00%

Access Measures

Choose and Book 93.13% 92.30% 95.00%

Inpatients waiting longer than 26 week standard

27 (Bariatric

s) 27 (Bariatrics) 0

Outpatient waiting longer than 13 week standard

0 0 0

Elective Cancellations (Last Minute)

0.33% 0.38% 0.75%

Outpatient Cancellations 3.20% 3.50% 5.00%

Maternity Measures

Smoking in Pregnancy 18.98% 18.10% <14%

Breast Feeding Initiation 61.31% 60.04% >60%

Maternity - 12 week 6 day Social Care Assessment

90.60% 91.70% >65%

Maternity - 2 Antenatal contacts before 13 weeks of Pregnancy

77.60% 77.60% 65.00%

Maternity - % of Antenatal visits with the same Maternity

79.00% 81.71% >75%

60

Healthcare Professional **

Maternity - Babies with FGR at birth who are diagnosed antenally

49.10% 39.00% >37.4%

Other Measures

Electronic Discharge Summaries 93.37% 92.44% 100.00%

Mixed Sex Accommodation Breaches

0 56 0

Delayed Transfers of Care 0.60% 0.97% 2.50%

VTE 90.2 6 90.40% 90.00%

Community Measures

Breastfeeding 6-8 weeks coverage 95.00% 96.00%

Breastfeeding 6-8 weeks rates 27.00% 32.60%

Immunisation rate HPV Full course of vaccine for girls aged 12-13 years (i.e. three doses of HPV) ***

N/A On target 80.00%

Immunisation rate for children aged 15 - 18 who have been immunised with a booster dose of tetanus, diptheria and polio

N/A On target 80.00%

Chlamydia Screening - % of 15-24 year olds

222 2794 3500

Cancellation / postponements by WCH for any consultant led service that uses the outpatient booking system

7.04% 4.94% 5.00%

Cancellation / postponements by WCH of clinical appointments for services which currently use IPM to record activity

3.50% 2.28% 5.00%

CQUIN Measures

CQUIN Measures - Acute On Track 100.00%

CQUIN Measures - Community On Track 100.00%

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