Item Reference documents that are not attached (e.g. previous reports or appendices) List of attached appendices (if applicable) State impact on corporate priorities The report uses a number of mechanisms to put performance in context, showing achievement against target, in comparison to previous periods and as a trend. The first section of the document also contains an exception report which explains the current position with those indicators which fall short of target and outlines the corrective action being taken to improve that position. Action Required/Recommendation (for information), (for decision) The report is primarily for information purposes but will inform discussion regarding how the Trust is performing against its Operational measures. This may in turn generate subsequent action. State impact on CQC domain (if applicable) Prepared by This report will reflect, in performance terms, progress in meeting a range of the corporate priorities. Not Applicable Not Applicable Brief Summary of Report This report highlights a series of metrics regarded as the Key Indicators of Operational Performance. They cover a variety of activities covering including the management of Referral to Treatment waiting times, Accident & Emergency accessibility, cancer treatment, access to services, efficiency (including activity levels, attendance and cancellation rates and journey times), effectiveness and safety measures, patient feedback and information relating to staffing levels. Report to Trust Board – 21/07/2016 Operational Performance Report - June 2016 and Quarter 1 2016/17 John Quinn, Director of Operations Stephen Chinn, Senior Performance Analyst (Produced on 14/07/2016) This report will encompass all five key CQC domains/questions. Report from Report Title
Transcript
Item
Reference documents that are not attached
(e.g. previous reports or appendices)
List of attached appendices (if applicable)
State impact on corporate priorities
The report uses a number of mechanisms to put performance in context, showing achievement against target, in comparison to previous
periods and as a trend. The first section of the document also contains an exception report which explains the current position with those
indicators which fall short of target and outlines the corrective action being taken to improve that position.
The report is primarily for information purposes but will inform discussion regarding how the Trust is performing against its Operational
measures. This may in turn generate subsequent action.
State impact on CQC domain (if applicable)
Prepared by
This report will reflect, in performance terms, progress in meeting a range of the corporate
priorities.
Not Applicable
Not Applicable
Brief Summary of Report
This report highlights a series of metrics regarded as the Key Indicators of Operational Performance. They cover a variety of activities
covering including the management of Referral to Treatment waiting times, Accident & Emergency accessibility, cancer treatment, access
to services, efficiency (including activity levels, attendance and cancellation rates and journey times), effectiveness and safety measures,
patient feedback and information relating to staffing levels.
Report to Trust Board – 21/07/2016
Operational Performance Report - June 2016 and Quarter 1 2016/17
John Quinn, Director of Operations
Stephen Chinn, Senior Performance Analyst (Produced on 14/07/2016)
This report will encompass all five key CQC domains/questions.
Report from
Report Title
Board of Directors Operational Performance Report - June 2016 and Quarter 1 2016/17
Exception Report Pages 2 - 4
Compliance Performance Summary Page 5
Access - Referral to Treatment Pages 6 - 7
Access - A&E Pages 8 - 9
Access - Cancer Waiting Times Page 10
Access - Other Page 11
Efficiency Pages 12 -13
Effectiveness Page 14
Safety Page 14
Ward Staffing Levels Page 15
Patient Experience Page 16
Bank and Agency Staff Information Page 17
CONTENTS
Page 1
Board of Directors Operational Performance Report - May 2016
Exception Report - June 2016 and Quarter 1 2016/17
RTT Performance
Please note June’s and Quarter 1’s RTT figures are provisional and subject to further validation, with the final figures to be submitted on 19th July
18 weeks Referral to Treatment - Incomplete Performance (All Pathways) was at 97.8% for June (M2 (May 2016): 98.1%) and 97.9% for the Quarter (Q4 2015/16: 96.4%). The 92% target has not been breached since August 2014. From this month onward we will also be monitoring this indicator against the trajectory figure agreed as part of Sustainability and Transformation Fund, namely 96.5%. This figure has been achieved for June.
18 weeks Referral to Treatment -Incomplete (Pathways with DTA) recorded a new highest performance level of 94.6%, up from 93.9% in May. For the Quarter, performance was at 93.7%, up from 90.6% in Q4 2015/16.
18 weeks Referral to Treatment - Admitted Performance saw an increase to 90.7%, the first time the original 90% target has been achieved since July 2015, following the increased scrutiny on closing the pathways of longer waiting patients. Non-Admitted Performance was at 96.7%.
For the quarter, there was one 52 week non-admitted breaches, the details of which were reported in the May 2016 Operational Performance Report.
Accident and Emergency
Monthly A&E performance in June saw an increase to 98.9% treated within four hours as per national guidance. This is an increase from the 97.3% position in May 2016 and remains above the 95% four hour target. As per RTT, A&E four-hour performance is also one of the Trust's Sustainability and Transformation Fund trajectory targets, the agreed target being 97.6%. This has been achieved for June.
Out of the 30 days in June we only failed to achieve the 95% target on 2 occasions which were 94.6% and 94.2%. There were 16 days where we had no four hour breaches. There were zero 12 hour breaches reported and just one six hour breach. For the quarter, A&E Performance was at 97.5% with a total of 41 six hour breaches.
Three hour performance also saw an improvement to 79.5% and 77.1% for the month and quarter (M2: 74.9%, Q4: 79.5%), just below the 80% target.
Overall A&E monthly Activity was at 8,829 which is a decrease compared to the previous two months and June 2015. The most significant decrease was during Monday to Friday period where the average number of attendances dropped to 309 per day compared to 345 in June 2015 and 321 last month.
The calculation changes reported last month regarding the percentage of patients re-attending A&E within 7 days and the percentage of patients seen via A&E ENP (Emergency Nurse Practitioner) Pathway continue to be applied.
Page 2
Board of Directors Operational Performance Report - May 2016
Exception Report - June 2016 and Quarter 1 2016/17 (Cont.)
Cancer Performance
There were 19 ‘2 week waits - first appointment urgent GP referral’ cases in Quarter 1 with 1 breach in April due to patient choice. Performance for the quarter was at 94.7%, above the 92% target.
There were 57 'Cancer 31 day wait - diagnosis to first appointment’ cases with 1 breach in April due to the cancellation of the patient's original treatment due to them being unwell. Performance for the quarter was at 98.2%, above the 96% target.
There were 11 'Cancer 31 day wait - subsequent treatment’ case also with 1 breach in June, this was due to the correct medical equipment not being available for procedure. This breach meant performance for June was at 80% while for the quarter it was at 90.9%, below the 94% target.
There were two 62 day cases reported in quarter 1 (both in April), with both achieved so the YTD also remains at 100%.
NHS England requires that all referrals of suspected cancers from whatever source will be seen by a senior doctor within 14 days, with a target of 93%. This continued to be below the 93% at 86.1% for the quarter with 29 breaches from 244 cases.
Diagnostic Waiting Times
An indicator of diagnostic waiting time performance has also been included in the Sustainability and Transformation Fund trajectories for this financial year. The agreed target, of 100% within 6 weeks, has been achieved this month.
ASI Performance for E-Referral (Previously Choose and Book)
We have recently received Monthly ASI data from the E-Referral system for the previous financial year. For the financial year 2015/16 performance (percentage of successful electronic bookings) was at 78.2% against a 96% target. Of these, 21.1% of bookings failed due to slot unavailability (no capacity) while a further 0.8% failed due to system unavailability. At this time for this financial year we are only able to report on April 2016 due to ongoing reporting functionality development by the national E-Referral development team. For April performance was at 79.8% with 20.2% of bookings failing due to no capacity.
Page 3
Board of Directors Operational Performance Report - May 2016
Exception Report - June 2016 and Quarter 1 2016/17 (Cont.)
Outpatient and Admission Activity
Following on from the last financial year, overall outpatient activity continues to be higher than the previous quarter and same period last year, with an average of 2,193 attendances seen per day (up 2% on Q4 2015/16 and 2.2% to Q1 2015/16). Compared to Quarter 4 2015/16, first appointment activity was down by 1.1% however follow up activity was up 2.9%.
Admission activity saw a slightly drop compared to Quarter to an average of 149 admissions every working day, which is down on quarter 4 which was at 153 (a 3.9% decrease)
Outpatient DNA rates
First appointment DNA rates for the Quarter remain high at 13.5% (Q4: 13.7%), while follow up DNA rates are at 11.7% (Q4: 12.1%). For the month First DNAs were at 13.8% and Follow ups at 12.1% (M2: 13.4% and 11.7% respectively). Cost improvement programmes are being implemented to address this across a number of sites.
Theatre Cancellations Performance
The theatre cancellation rate has reduced for both the quarter and month to 7.9% and 7.5% respectively, against 8.8% and 8.0% recorded in Quarter 4 and May. As previously reported the Trust has now recruited a member of staff to telephone all pre-admissions one week prior to admission and this indicator should therefore continue to improve.
Theatre Sessions Starting Late
Performance for Quarter 1 has deteriorated to 42.5% from 38.8% recorded in Quarter 4; however there was an improvement to 41.3% in June from 44.3% in May. These previously identified issues will be addressed as part of the Theatre Improvement Programme.
Ward Staffing Levels
From May 2016, to provide a single consistent way of recording and reporting deployment of staff working on inpatient wards/units, a new measure has been adopted called Care Hours per Patient Day (CHPPD).
CHPPD is calculated by adding the hours of registered nurses to the hours of healthcare support workers and dividing the total by the count of patients at midnight.
CHPPD reports split out registered nurses and healthcare support workers to ensure skill mix and care needs are met.
Page 4
Board of Directors Operational Performance Report - June 2016 and Quarter 1 2016/17
* May 2016 and June 2016 Electronic Booking Figure unavailable (See notes below)
Electronic Booking System Issue Rate
Indicator Threshold
Monthly
Trend
2015/16 Performance 2016/17
Diagnostic waiting times Performance remains at 100%.
The percentage of patients both waiting more than 6 weeks for a first appointment and waiting for admission within 13 weeks have seen a slight decrease compared to the previous month.
For Electronic Bookings at this time we are unable to report on May and June's data due to ongoing reporting functionality development by the national E-Referral development team.
Electronic Booking Capacity Issue Rate
Quarterly
Trend
First Outpatient Appointment Waiting more than 6
weeks
Patients Waiting more than 13 weeks for
Admission
Diagnostic waiting times - 6 weeks
Electronic Booking appointment availability
Access - Other
Compliance Source
Page 11
Board of Directors Operational Performance Report - June 2016 and Quarter 1 2016/17
There were no MRSA or C.Diff Cases recorded at Moorfields this financial year.
VTE Screening Performance remains above the 95% target.
Following a review of the Mixed Sex Accommodation guidance and further confirmation from DoH, Moorfields are now exempt from submitting MSA breaches as the number of overnight beds at
our sites are less than the required standard to submit (10 beds per site), however any MSA breaches are still monitored locally.
Quarterly
Trend
Monthly
Trend
2015/16
Number of C.Diff cases
Performance 2016/17
Number of MRSA cases
Monthly
Trend
Compliance
Source
Performance 2016/17
Quarterly
Trend
2015/16
% GP referrals From Electronic Booking (Choose & Book
/E-referrals)
Indicator Threshold
Emergency Re-admission within 28 days of discharge
Emergency Re-admission with 30 days for elective and
emergency cases
Page 14
Board of Directors Operational Performance Report - June 2016 and Quarter 1 2016/17
Ward Staffing Levels (Only 'wards with inpatient beds' as per report requirement) - Provisional
From May 2016, to provide a single consistent way of recording and reporting deployment of staff working on inpatient wards/units, a new measure has been adopted called Care Hours per Patient
Day (CHPPD).
• CHPPD is calculated by adding the hours of registered nurses to the hours of healthcare support workers and dividing the total by every 24 hours of in-patient admissions (or approximating 24
patient hours by counts of patients at midnight)
• CHPPD reports split out registered nurses and healthcare support workers to ensure skill mix and care needs are met.
For June 2016, the overall staffing fill rate has increased across the main metrics – the nurse day staffing fill increased to 103% (from 99% in May), and the care day staffing fill rate increased to 96%
(from 92% in May).
Cumberlege continues to have a high (111%) day nurse staffing fill rate, which is most likely reflective of high demand. This is supported by the fact that the majority of the additional hours appear
to be worked by agency staff, similar to the pattern in May 2016.
Sick leave was minimal across all three wards – 1 member of staff is on maternity leave in Obs Bay, and 1 member of staff is on long term sick leave at St George’s.
Page 15
Board of Directors Operational Performance Report - June 2016 and Quarter 1 2016/17
Patient Experience - Friends and Family Test (FFT)
The scoring system is represented as a simple percentage method, where patients who are ‘Extremely likely’ or ‘Likely’ to recommend Moorfields to friends and family are listed as ‘Would
Recommend’ the hospital, and patients who are ‘Unlikely’ or ‘Extremely Unlikely’ to recommend Moorfields are listed to ‘Would Not Recommend’ the hospital.
The eligible patient population includes under-16’s in all categories.
The ‘Inpatient’ FFT responses include ‘day case’ patients as well as patients who stayed overnight, which has increased the number of results received in this category.
The ‘outpatient’ FFT scores and response rates are also included in this report, covering most patients who attended an outpatient clinic.
Accident and Emergency FFT response rate method remains unchanged from last year (aside from the aforementioned inclusion of under-16s).
Page 16
Board of Directors Operational Performance Report - June 2016 and Quarter 1 2016/17
Nursing Bank and Agency Staff Information (To May 2016, June 2016 data available at time of production)
Proportion of Nursing Bank and Agency Staff Hours filled, with total hours worked
