Patient First Board Report – May 2018 Family and Friends Score Budget Management Staff Engagement HSMR Patient Safety Thermometer Referral to Treatment Time A&E 4 Hours Reduce the numbers of Falls Reduce MFFD Delays Reduce the amount of Premium rate spend Staff are able to make Improvements Patient First Improvement Programme Sustainability & Transformation Plan Workforce Transformation WS Eye Care @ Southlands CWS MSK Integrated Services Junior Doctor Contract Clinical Document Management Portal True North Breakthrough Objectives Strategic Initiatives Corporate Projects Outpatient Transformation Acute Surgical Review Pathology LIMS Arrows indicate: Metrics improving Metrics stable Metrics worsening Achieving target/project on track Not achieving target/not on track
What are we trying to achieve? Ensure that all staff are fully engaged in the work of the Trust. Three key elements: 1. Able to make improvements 2. Healthy culture 3. Motivation at work
What is it important to know? • Overall Staff engagement increased to
Highest (best) 20% of Acute Trusts • Ranked in the highest (best) 20% of
remains the same from 2016 at 3.88 • Best Trust scores to date - positive results
overall inc. recommend place to work/receive treatment, H&WB, team working
What are we doing about them? • Promoting results across the Trust • Compare National results • A3 refresh on breakthrough objective • Corporate V&A project proposed
What’s gone well? • Response to staff survey 2017 increased
by 7% to 66% • Communications strategy for staff survey • Leadership Academy within facilities and
estates – 3 sessions now completed
What are the current challenges? • Medical engagement remains low • Violence, Harassment & Bullying
remains a concern
What are the Organisational Risks? • Operational pressures and
available capacity impact on staff availability to engage
• Dissonance in organisational values and staff experience
How are we managing them? • Divisional SDR focus on improving
engagement • Violence & Aggression A3 completed
and submitted. Proposed corporate project being considered.
Status is GREEN and STABLE
Peop
le
Staff Engagement
Score
Board Assurance Risk Score
Target 12
M1 9
M2
M3
M4
M5
M6
M7
M8
M9
M10
M11
M12
HSMR
True North
Owner : George Findlay
What are we trying to achieve? • Reduce the mortality rate for non-
elective patients, we want to reduce the number of potentially avoidable deaths.
• To be in top 20% of trusts as measured by Dr Foster
• To learn from all deaths occurring at WSHFT and improve end of life care
What is it important to know? • HSMR is 89 (12mths to January
2018) with observed 1858 vs 2087 expected deaths
• WSHFT HMSR is on the 16th percentile
• HSMR by site 83.4 SRH/94.1 WH • April’s crude mortality rate was
3.1%, higher than last year 2.82% and ytd 3.10% (limit set at 3.13%)
What’s gone well? • First report to public board took
place in January 17 • Consultant screening reviews have
reviewed 85% of deaths since inception
• Five mortality reviewers have been trained and started work in January 2018.
What are the current challenges? • Continuing to achieve the sepsis
bundle & antibiotic administration < 1 h over the winter
• Full implementation of the the Structured Judgement Mortality Case Note review (SMR) tool for targeted cases.
• Responding to the learning points emerging from the reviews e.g. earlier recognition of end of life care needs.
What are we doing about them? • Refreshing the business case that
supports mortality reviews • Increasing the workload of SJR’s
and starting panel reviews • Including End of Life Business case
in core division service priorities for 2018/19
What are the Organisational Risks? • Mortality reviews highlight
patients with delays in recognition and issues meeting end of life care needs.
• Achieving the required volume of SJ reviews
How are we managing them? • Detailed Dr Foster monthly reports
shared with divisions and oversight via Quality Board
• Mortality Steering Group implementing process for review of all deaths and additional oversight
Status is GREEN and STABLE
Board Assurance Risk Score
Target 9
M1 9
M2 9
M3 9
M4 9
M5 9
M6 9
M7 9
M8 9
M9 9
M10 9
M11 9
M12 9
M1 9
Qua
lity
Impr
ovem
ent
80
85
90
95Hospital Standardised Mortality Ratio
source: Dr Foster
True North April 2018
Owner : Nicola Ranger
What are we trying to achieve? • Reduce the number of patients coming
to harm during their stay in WSHFT, this can impact on wellbeing, length of stay and recommendation.
• Harm is measured monthly using the National Safety Thermometer.
What are the Organisational Risks? • Safety Thermometer is a once a month
prevalence measure and only measures 4 harms on that day.
What are we trying to achieve? • Reduce the number of patients in
our hospitals that are medically fit for discharge.
• MFFD patients in hospital beds can compromise patient flow, and impact on A&E wait and LOS.
• Metric is to reduce average patient days delayed by 50% .
What is it important to know? • MFFD average patient days
reduced to 981 in April(compared with 1301 March)
• Numbers of delayed pts varied between 101 on 6th April to 64 on 17th April.
What’s gone well? • DTOC patients reduced to 2.54%
from 2.99% Mar and 3.12% April 2017
• Reduction in MFFD per day to 136 average Trust wide Apr-18 compared with 159 March
• Trust occupancy 94.1% on average midnight Apr-17 (94.5% Worthing, 94.0% SRH)
What are the current challenges? • Average A&E demand greater than
same period 2017 (+1.7%)
What are we doing about them? • Agreed National Funding to support
increased resilience schemes for CWS including 25 additional community beds
• Senior Management ward buddies implemented to support Board Rounds and discharge flow including launch of ‘Early Bird’ patient discharges to lounge before 9am
What are the Organisational Risks? • Failure to reduce MFFD patients
occupying acute hospital beds adversely impacts delivery of A&E and elective targets.
• Patients own health and wellbeing can be compromised by staying in hospital longer than required.
How are we managing them? • Weekly MFFD multi agency
meetings on both acute sites as per national recommendations.
• Daily Board Round collection of delays and next step information by Discharge Team Daily SITREP reporting of formal DTOC patient numbers and reasons.
What are we trying to achieve? • Reduce the amount spent on
premium rate workforce solutions • Remain within the agency ceiling
of £14.9m set by NHS Improvement.
What is it important to know? • Premium pay expenditure is £0.4m
below target at the end of M1.
What’s gone well? • Maintained agency expenditure
reductions for 2017/18 with in month expenditure of £0.9m
What are the current challenges? • Improving cap compliance
particularly within medical placements.
• Delivery of elective waiting times without increasing reliance on WLI payments.
What are we doing about them? • Bilateral meetings to review key
areas of spend and exit plans for medical agency.
• Regular reporting and review, including approval of high cost and long-term placements.
• Establishment of Medical Workforce Action Group.
What are the Organisational Risks? • Premium rate pay expenditure is
unsustainable and Trust is unable to deliver I&E control total and therefore not able to access Sustainability and Transformation fund.
How are we managing them? • Weekly reporting of agency spend. • Targeted divisional focus through
strategy deployment. • Weekly scrutiny of agency spend
against overall ceiling trajectory plan.
Status is GREEN and STABLE
Board Assurance Risk Score
Target 9
M1 8
Sust
aina
bilit
y
(5,000)
(3,000)
(1,000)
1,000
3,000
5,000
Apr-17 Jun-17 Aug-17 Oct-17 Dec-17 Feb-18 Apr-18
Agency Spend (£000s)
A&E 4 Hours
Breakthrough Objectives
Owner : Denise Farmer
What are we trying to achieve? • Enable staff to have the
opportunities, tools and support to identify and make improvements in their area of work
What is it important to know? • Staff survey 2017 results show
improvement in Q4d up by 2% to 57%. Average for acute trusts 56%
• Results by Key Finding 1, 4 & 7 now available at divisional. Department, team and cost centre level
What’s gone well? • SDR process in divisions with
engagement as a driver metric • Roll out of improvement huddles in
non-clinical areas
What are the current challenges? • Understanding what’s
underpinning variation in monthly results
What are we doing about them? • Communicating staff survey results
through posters of top 5, bottom 5 findings
• Divisions analysing Q4d by cost centre – target under performing
• Refresh A3 supporting staff able to make improvements
What are the Organisational Risks? • Roll out of PFIS to clinical areas
risks disengaging some groups of staff
How are we managing them? • Continuing roll out of PFIS inc. women and
children’s division • Extending improvement huddles in non-clinical
areas – estates and facilities at St Richards
Status is GREEN and IMPROVING
Board Assurance Risk Score
Target 12
M1 9
M2
M3
M4
M5
M6
M7
M8
M9
M10
M11
M12
Peop
le
Staff are able to make
improvements
Capacity and
Capability
Insert project
Patient First Pa
tient
Q
ualit
y Im
prov
emen
t
Strategic Initiatives
Lean Projects
PFIS
Peop
le
What are we trying to achieve? How are we doing? What is important to know?
• Development of continuous improvement (Kaizen) Strategy that supports True North and Patient First objectives within the Trust to empower staff to solve problems and make improvements.
• Western Sussex ‘Patient First’ approach praised at the external NHS-I (Lean Conference) including John Toussant, Elaine Mead (NHS Highlands) in terms of approach and adoption of lean management system
• Lean management systems (PFIS) implemented across the whole organisation with full support and engagement from all teams, operationalised to the required standard to enable staff to make improvements
• PFIS Wave 8 at SRH has started for GDU, PreOp, Delivery, Tangmere, Ashling, Ford, Day Surgery, Goodwood Lounge
• Coaching and Mentoring continues in line with implementation plan & schedules with agreed Driver & Watch Metrics in place to align with SDR / Divisions
• Wave 7 Lunch & Learn – 14 June (Worthing)
• To ensure all staff have knowledge, skills to participate in Lean based improvement activities in helping to build a culture of continuous improvement in supporting True North and objectives of Patient First
• This months Yellow Belt training at SRH (day 2) has finished - with positive feedback from all our staff.
• SRH – Final YB Presentations set for 25 May 2018 at Kaizen Space for YB Project review & “Certification” process
• The Lean Improvement Projects are assigned to the Kaizen Team who provide coaching and mentoring, A3 approach and Problem Solving working within a collaborative team environment
• Kaizen Team currently providing coaching and support for the new “Putting Patients First for earlier discharges home” – with full Exec support and buy-in to the approach – with Weekly Project Huddles taking place (Exec, Medicine, Pharm, PFKO) as part of Leader Standard Work
Owner: Anil Mathew
Qua
lity
Impr
ovem
ent
443
37 W5 (4)
29
Sustainability and
Transformation Plan
Coastal Care
Patie
nt
Sust
aina
bilit
y Q
ualit
y Im
prov
emen
t
Strategic Initiatives
What are we trying to achieve? • Ensure the provision of high quality stroke
services meeting the National Stroke Strategy 2007 clinical standards
• Sussex-wide review of Stroke Services supported by the Sussex Collaborative Delivery Team and funded by the seven Sussex Clinical Commissioning Groups
How are we doing? • CWS CCG and WSHFT have
collaborated to implement the activity, bed capacity and financial analysis re-work recommended by Clinical Senate
What is important to know? • CCG & WSHFT are in process of
agreeing a joint recommendation which will to take into account the STP planning process
What are we trying to achieve? • Deliver a system wide plan to deliver
the 5 year forward view and close gaps in health and wellbeing, care and quality and finance across Sussex and East Surrey.
How are we doing? • The Trust continues to engage with
range of STP forum • Trust continues to support CCG in
developing Local Community Networks as outlined within ‘Inspiring Healthier Communities’
What is important to know? • New STP Chair appointed. Initial
meeting held with Chief Executive.
What are we trying to achieve? • A population based approach for Coastal
West Sussex delivered through increasing integration in order to improve standards, manage demand and make the system financially sustainable.
• Strategy includes Health and Social Care.
How are we doing? • Development of Local Community
Networks being led by CCG and receiving good engagement.
What is important to know? • CCG Considering future options and
models. Commitment to Place Based Plan remains.
Stroke Reconfiguration
Owner: Andy Gray
Outpatient Transformation
Time taken to process referrals
Patie
nt
Sust
aina
bilit
y Q
ualit
y Im
prov
emen
t
Strategic Initiatives
Demand and Capacity
Patient on-site waiting
times
What are we trying to achieve? • To improve every outpatient
appointment interaction • To improve patient experience
and simultaneously make the best use of Trust resources
What is important to know? • Programme priorities being delivered
predominantly to plan. Text reminder pilot demonstrated to be successful, implementation pending business case to demonstrate cost neutral.
• Docman well received by specialties; implementation of final specialties delayed pending system issues resolution
What is important to know? • 86.1% of referrals registered within 2 working
days year to date – target 80%. • Docman referral management system
implementation delayed due to unforeseen system issues. Plan to resolve
• Development work with NHS Digital ongoing to prepare for ‘Paper Switch Off’ by 1.10.18
What is important to know? • April 2018 recommend rate 96.7% - 0.3% below
compliance. • April 2018 response rate compliant at 7.5% and
compliant. • Analysis of patient feedback continuous to inform
future actions
What are we trying to achieve? • When patients come to our
Outpatients, they are waiting too long to be seen. Our objective is to reduce these waiting times - prioritising specialties with longer waits
Syst
ems a
nd
Part
ners
hips
What are we trying to achieve? • Once a referral is received,
manual processes are needed. Achieving best practice could reduce the time taken to manage and grade referrals by an average of 8 days
What are we trying to achieve? • This transformational programme
will support specialties to review clinic capacity . We anticipate this will reduce on-day delays and improve overall capacity to see more patients with the same resource.
What is important to know • April 2018 DNA rate 5.97% from 5.59% low in
November 2017 • DNA target 5.4% to achieve top 10% nationally. • SMS pilot demonstrated effectiveness to support
business case development. • Expected SMS go-live Q1 2018/19, pending
approval
Owner: George Findlay
Workforce Transformation
Strategic Initiatives
Peop
le
Owner: Denise Farmer
What are we trying to achieve? • To develop and maintain a robust
medical workforce, including creation of new and/or alternate roles to mitigate recruitment challenges and reduce reliance on agency
• Market manage agencies to ensure consistency and quality of supply at cost-effective rates, and to work towards full cap compliance
• To maximise opportunities from substantive workforce, including improved recruitment, retention and staff management
What is important to know? • Staff vacancies remain around 9%,
with a slightly improved turnover as we move into Q4
• Challenges from higher rates offered by neighbouring Trusts continues to impact on our ability to fill temporary shifts
• Continued roll-out of HR IT systems will provide increased visibility on job planning, junior doctor rostering and annual leave,
• Full Safe Care compliance is now forecast for 1st April 2018
How are we doing? • Nursing spend continues to decrease,
with agency reliance now at lowest levels for the past year. Cap compliance fluctuates around 50% as we balance fill of escalation shifts during winter pressure with notice offered to above-cap agencies
• Medical workforce spend remains against run-rate in 2017, with continued difficulties in recruitment into medical workforce vacancies; part mitigation achieved through development of alternate roles
Patie
nt
Corporate Projects
Owner: Karen Geoghegan
What are we trying to achieve? • Relocate Worthing
Ophthalmology to Southlands • Provide capacity to achieve 18
week RTT and meet anticipated future demand
• Improve patient experience by redesigning patient pathways
• Evidence benefit realisation/lessons learnt from Post Project Evaluation Delivery
What is important to know? • Go live – Tuesday 27th June. • Car parking phased plan agreed. • Theatres achieved IC approval. • Clinics and lists now booked. • OOH emergency pathways need to
be formally agreed. • Potential for OOH emergencies to go
to Susssex Eye in Brighton long term – under discussion
• Southlands Ophthalmology now in ‘business as usual’ status.
• PPE Launch completed. Data gathering progressing.
• Ophthalmology in scope for Theatre Productivity Corporate Projects.. Baselines agreed. Clinical workshops scheduled for 21.6.
• Improvement Plan for Trust Wide/Specialty specific progressing.
Key Risks: • Car parking solution insufficient for
staff needs at present. • OOH emergency pathways –
significant increase in walk in activity and OOH emergencies still not in place with weekend theatre access – discussions ongoing with BSUH
Mitigations: • Operational programme team in place to
oversee service changes and manage risk. • Equipment costs being tightly managed. • Joint work with Estates to identify number
of car parking spaces required –potentially 60-70 spaces needed – now identified as part of 17/18 capital plan – to be completed by Dec 17.
Target Date Workstream Progress
Spring 2017 Building programme
Complete
Dec 16 Staff consultation Complete
Upon opening Job Planning On track
Upon opening Recruitment & training plan ongoing
Feb 17 Development of new patient pathways - to be tested
Complete
Q4 16/17 Service Transition Plan Complete
ongoing Equipment plan & training Complete
Q1 17/18 Operational Policy complete
27.03/17 Evolve go live complete
Sept 17 OOH emergency theatre on call in place
On track
May/June PPE Launch & Reporting On Track
Q2/Q3 Theatre Productivity Optimisation On Track
Owner: Pete Landstrom
Target 9
M1 9
M2 2
M3 2
M4 2
M5 6
M6 6
M7 6
M8 6
M9 6
M10 6
West Sussex Eye Care @ Southlands
Corporate Projects
CWS MSK Integrated
Service
What are we trying to achieve? Improved patient outcomes, shorten waiting times & control health economy costs by: • Redesigning MSK Pathways for
elective and outpatient care • Lead on delivering an integrated
service collaboratively with SCFT & 3rd parties.
Syst
ems a
nd
Part
ners
hips
Owner: Marianne Griffiths
What is important to know? • Discussions relating to integrated
models of care, collaboration and progressing MSK are ongoing. These will continue in the context of the Aligned Incentive Contract.
• The upgrade of the Physiotherapy Department in Worthing Hospital to support the MSK redesign plan is complete.
Key Risks: • Significant loss of staff engagement
and momentum due to ongoing delays in start of the full MSK redesign programme
• The central MSK programme team within WSHFT has no staff in post following the promotion of the Project Manager within SCFT.
Mitigations: • Dialogue between SCFT and WSHT at
operational and executive level to Integrate care on several programmes of work and ensure priorities are aligned.
Junior Doctor Contract Junior Doctor Contract
Target 8
M1 20
M2 20
M3 20
M4 20
M5 20
M6 20
M7 20
M8 20
M9 20
M10 20
M11 20
M12 20
Target Date Action CompletenessJul-16 Develop detailed plans for triage and treatment service 100%Jul-16 Present work to date to CCG 100%
Aug-16 Develop Early Implementation and Change Control process 100%Aug-16 Develop Locality Plan and Iitemise Service Changes 100%Aug-16 Response from CCG to contract negotiation Still awaitingDec-16 Partnership MOU and NDA in place 100%Feb-17 Introduce GP Pilot and Triage and Treatment Service 100%Feb-17 Clinical Information System implementation commenced Investment TBDApr-17 Colocated MDT hubs in place at Worthing and Pulborough Investment TBDMay-17 Develop detailed plans for specialist MDT pathways not startedJun-17 Self management service commences (subject to contract) not startedOct-17 Bognor and Southlands Hubs and all MDTs fully operational not started
MSK Programme High level Milestones - Updated Sept 2017
Corporate Projects
Patie
nt
Clinical Portal
Patie
nt
Clinical Document
Management Portal
Key Risks: • Project is under resourced across all teams,
with a lack of the necessary skill mix to achieve results in a timely manner to meet project timescales.
• Operational Pressures and in some areas a resistance to change, may mean that agreed project timescales will not be met.
Mitigations: • Work is prioritised and completed
within the team’s capacity. In addition, BAU teams are being upskilled to meet requirements.
• Investigate areas with less operational pressures. Liaison with services to minimise the resistance. Where reluctance persists, to be escalated to the Project Board.
What are we trying to achieve? • All patient records to be
paperlight at WSHFT by 2020
Owner: Ian Arbuthnot
Target 9
M1 9
M2 9
M3 9
M4 9
M5 9
M6 9
M7 9
M8 9
M9 9
M10 9
M11 9
M12 9
What is important to know? 1. Owing to additional requirements
being, the planned date for the pilot roll-out to Paediatric IP wards was not met. Items are being worked through with the project team and a new date will be identified. Other services have been slotted into the space to keep the project on track.
2. Statistics since go live to end April 2018:
• 4,065 staff trained to date • 1,992 active system users • 52,862 completed e-Forms to
date.
Roll-Out
Timeframes Action Progress
Completed
Apr 18 Roll-out to Upper GI / General Surgery – all sites
May 18
Roll-out to Colorectal OP – all sites
Completed
May - June Roll-out to Gastro / Endoscopy Op – all
sites
In progress - On track
Corporate Projects
Patie
nt
Target 6
M1 6
M2 6
M3 6
M4 6
M5 8
M6 8
M7 6
M8 6
M9 6
M10 6
How are we doing? • Review is complete – 16 recommendations • Report presented to Trust Board, TEC, joint
surgical governance meetings and physicians meeting.
• Colorectal team now meeting weekly. • Joint polyp MDT commenced January 2018. • RMOs started in August to help under pin
junior doctor shortages at WG. Full review of jnr dr workforce to take place Q4 17/18.
• 2 emergency consultant surgeons now appointed at WG.
• Improved data quality and project level KPI dashboards progressing as part of the 1819 Surgery Improvement Strategy
• Project Resource Plan progressing to resource a the increase in scope for surgery delivery in 1819
What are we trying to achieve? • Service review to ensure we are
operating emergency and urgent surgery across the St Richard’s and Worthing sites in the most effective way.
What is important to know? • No major reconfiguration required at this
time – not evidenced via the review. • Very clear view articulated via the listening
exercise – all of these viewed represented in the recommendations.
• Some recommendations already implemented and others merging to reduce recommendations and manage project more effectively.
• 2 outstanding recommendations relating to centralisation agenda for Breast and Urology part of the 1819 Surgery Improvement Strategy Corporate Project
Owner: George Findlay
Key Risks: • Risk of lack of engagement by staff. • Data analysis must be robust – tight
timeframe to complete this work. • Risk outcome may not be accepted by
surgeons who feel the review has take too long and not addressed key issues.
• Some concerns around overnight workload for RMOs and Jnr Drs. Subject to full review by DDO/CoS.
Mitigations: • Communication and engagement
plans in place to communicate outcome – complete.
• Project governance further supported by PMO.
• Key recommendations to try and address concerns of clinicians – some like cross site working may not be popular but deemed necessary for cross collegiate working to improve .
Acute Surgical Review
Owner: Pete Landstrom
What are we trying to achieve? • Install a new laboratory information
management system (Winpath) and order comms system (Cyberlab) as part of the Abbott pathology managed equipment service which will support full service integration and delivery of the process and workforce efficiencies associated with the planned automated hot and cold site lab configuration for WSHFT.
How are we doing? • Programme went fully live on Monday
14th May 2018. • There have been some infrastructure
related issues which caused a 24 hour outage. We are awaiting RCA before passing from project to BAU.
What is important to know? • The go-live was achieved on minimal spend
when compared to similar LIMS implementations. (£200K cf £12M (Viapath))
Key Risks: • There is a risk that until the RCA of
the system outage is identified a similar outage might occur.
Pathology LIMS
Corporate Projects
Patie
nt
Mitigations: • Ongoing investigations by the supplier
utilising the manufacturers of the various software elements of the solution are underway.
Title Month 01 (April), 2018/19 Monthly Quality Report
Responsible Executive Director Dr George Findlay (Chief Medical Officer) and Nicola Ranger (Chief Nurse)
Prepared by Jo Habben (Head of Clinical Governance and Patient Safety)
Status Disclosable
Summary of Proposal Not applicable
Implications for Quality of Care Describes performance against quality outcome KPIs, including safety, infection control, experience, effectiveness and mortality.
Link to Strategic Objectives/Board Assurance Framework This report pulls together key national, regional and local quality indicators relating to quality and safety providing assurance for the Board and (if necessary) highlighting issues.
Financial Implications Describes KPIs that have potential financial impact (e.g. CQUIN.)
Human Resource Implications Describes KPIs linked to workforce.
Recommendation The Board is asked to: Note the contents of this report.
To: Trust Executive Board/Quality Board Date of Meeting: May 2018
Agenda Item: 5.1
1 Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Jo Habben Head of Clinical Governance and Patient Safety
1 INTRODUCTION
1.1 This report brings together key national, regional and local indicators relating to quality, performance
and safety. The purpose of the report is to bring to the attention of the Trust Board quality
performance within Western Sussex Hospitals Foundation Trust (WSHFT).
1.2 The paper describes performance on an exceptional basis determined by RAG (red/amber/green)
ratings based on national, regional or local targets.
2 2018/19 REFRESH
2.1 There has been a refresh of the Monthly Quality Report for 2018/19 to reflect the key quality
objectives for the next year aligned to Patient First and our True North objective1. The report follows
the same format as previously using the same suite of metrics, with revised targets using similar logic
in the interim to that applied for 2017/18:-
• If 2017/18 performance exceeded target, then 2017/18 actuals used as 2018/19 target
• If 2017/18 performance did not meet target then 2017/18 target remains the same for 2018/19
• If there is a national or set target then that will continue as the measure
• Any metrics with no target set continue as before
2.1.2 The Quality Scorecard for 2018/19 incorporates the following changes:
• Site view
New indicators:
a) E59-Rate of discharges by Midday under section ‘Increase discharge effectiveness’ b) E55-Normal delivery rate under section ‘To improve maternity care by encouraging natural
childbirth’ c) E58-Induction of labour under same as b)
• Removal of some indicators as advised
• Some minor re-arranging of metrics and changes to metric definitions
3 KEY QUALITY OBJECTIVES
3.1 Scorecard Definitions
3.1.1 The full Clinical Quality Scorecard is presented as Appendix 1. Figures are in-month figures (e.g. the
number of falls reported in April) unless otherwise stated. The scorecard shows 13 months to allow
trends to be identified, although some data items are reported retrospectively. Year to date
1 Patient First is our long term approach to transforming services. ‘True North’ is the one constant towards which the four strategic themes for the organisation – sustainability, people, quality improvement and Systems & partnerships – should lead.
2 Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Jo Habben Head of Clinical Governance and Patient Safety
actuals/targets are based on financial years unless otherwise stated (standardised mortality ratios are
recorded as 12 month positions for example). A subset of the key measures from the report is
presented at 3.3. These currently remain the same sub-set as last year and will be refreshed when
the new scorecard is established.
3.1.2 Exception reports are included under the relevant section of this report (Effectiveness, Safety and
Patient Experience).
3.1.3 Although the scorecard reflects 13 months of data, only the current financial year and year to date
values are RAG rated - with the exception of those metrics reported in arrears where the most recent
data-point of last year is RAG rated.
3.2 Domain scores
3.2.1 The score is an overall indication of the performance in relation to each of the domains -
Effectiveness, Safety and Patient Experience. The score is calculated as follows: Each RAG rated
indicator for a month is scored: red scores 1, amber scores 2, green scores 3. These scores are then
totalled and divided by the total number of indicators with RAG ratings to give a score for the domain
as a whole between 1 and 3. This final score can then itself be RAG rated with >2.5 giving an overall
green, 1.5 to 2.5 amber and <1.5 an overall red score for the domain as a whole. For example if a
domain had two greens and a red the calculation would be as follows:
3 (green) + 3 (green) + 1 (red) = 7
7 / 3 (i.e. the total number of metrics) = 2.33 i.e. amber overall.
3.2.2 Domain scores are calculated based on the year to date RAG ratings for each metric. Previous
months are retrospectively updated to take account of any measures reported in arrears, and should
additional metrics be added within the domain. As with any aggregate indicator, it remains essential
that the Board retains sight of the individual elements as well as the domain score as a whole.
3 Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Jo Habben Head of Clinical Governance and Patient Safety
3.3 Overview of Key Quality Objectives
3.3.1 The following table shows performance against key quality objectives.
S28 Numbers of hospital C. diff where a lapse in the quality of care was noted
2 2 0 0 16
X38 The Friends and Family Test: Percentage Recommending Inpatients
97.0% 96.3% 97.2% 97.2% 97%
X39 The Friends and Family Test: Percentage Recommending A&E
85.5% 87.4% 91.7% 91.7% 93%
X13 Mixed Sex Accommodation breaches (number of breaches)
0 0 0 0 0
X18 Number of complaints 28 38 26 26 456
4 Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Jo Habben Head of Clinical Governance and Patient Safety
4 EFFECTIVENESS
4. 1 Crude Trust Mortality
4.1.1 Due to the low level of mortality experienced in elective care, the Trust measures mortality in relation
to non-elective activity using the previous year as a benchmark.
4.1.2 Crude non-elective mortality decreased from 3.52% in March to 3.10% in April, this is higher than the
equivalent month in 2018 (2.82%). However provisional data from the Office for National Statistics
shows that weekly death rates for England and Wales have been higher throughout quarter 4 when
compared with the weekly averages for the preceding 5 years. Further analysis of the national picture
is awaited. Screening data from the ‘Learning from Deaths’ process will also be examined carefully to
check there has been no increase in reported problems.
4.1.3 The number of non-elective patients (Crude) who died in April was 184 (3.10%) from 5939
discharges. Worthing and Southlands reported 91 deaths of 3070 discharges (2.96%) and St
Richards Hospital reported 93 deaths of 2869 discharges (3.24%). The year to date mortality rate is
3.10% and the rolling 12 month mortality rate is 3.13%.
4.2 Hospital Standardised Mortality Ratio (HSMR)
4.2.1 There is a delay in data being available in Dr Foster tools to allow for coding and processing by the
Health and Social Care Information Centre and Dr Foster. The most recent data available is January
2018.
4.2.2 The Trust’s HSMR for the twelve months to January 2018 is 89.0 (1858 deaths against expected
2087) 100 is the level predicted by the Dr Foster model using the September 2017 benchmark.
4.2.3 The twelve month HSMR to January 2018 split by site continues to be lower for St Richard’s 83.4 (832
deaths against expected 998) than for Worthing and Southlands 94.1 (1027 deaths against expected
1091). The difference is marginally lower for SRH than the previous month and remains well within
acceptable variation limits, with both sites remaining below 100.
4.2.4 E10. 30 day mortality rate following hip fracture – remains relatively static and in January 2018 was
reported at 7.4% against target of 5.70% (YTD actual 7.39%).
4.2.6 A further report is available to clinical leaders in the Trust showing the clinical diagnostic areas with
high actual versus expected mortality and any mortality CuSum alerts.
4.2.7 The Trust has set the goal of achieving a position within the top 20% of Trusts as measured by
HSMR. For the twelve months to January 2018 performance using this measure continues to place
us just within the top 20% of Trusts on the 19th centile.
5 Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Jo Habben Head of Clinical Governance and Patient Safety
4.3 Summary Hospital-Level Mortality Indicator (SHMI) 4.3.1 The latest data made available by the Health and Social Care Information Centre is for the period to
August 2017. The Trust value remains at 0.95 (where 1.00 is the national average), with the Trust
banded as “as expected”.
4.4 Exception Reports Relating to Effectiveness
4.4.1 E13. C-Section rate- the Trust Caesarean Section rate from March to April shows an improving
trajectory decrease to 26.4% against a target of 27.8%. Each case where a woman has a caesarean
delivery undergoes a review process to look for learning opportunities. No systemic causes or trends
have been identified and practice is very much in line with national recommendations for safe practice
and NICE guidance. Increasing normal birth continues to be an area of focus for the division and
rates are closely monitored via monthly divisional performance reviews.
4.4.2 E58. Induction of labour (new indicator). April’s data reports 37.9% against a target of 29.4%.
4.4.3 E59. Rate of discharges by midday (new indicator). April’s data reports 12.8% against a target of
45%. Summary report to be provided in M2.
4.4.4 E47. % of patients with sepsis receiving antibiotic therapy within one hour (new indicator). April’s data
reports 74.55% against a target of 90%.
4.4.3 E42. Night time moves in patients with a diagnosis of dementia. In April, 45 patients with a diagnosis
of dementia were moved at night (between 23:00-07:00hrs), this is a decrease (improvement) from
March when a total of 59 patients were moved at night.
4.4.4 The dementia team continues to monitor and record/audit the moves and the Kaizen work stream is
not only focused on patients with a diagnosis of dementia but also any patient that is moved at night.
Ongoing improvement work continues with representation from the Kaizen team, matrons, dementia
matron, the site team and the clinical lead for the emergency floors.
5 SAFETY
5.1 Central Alert System (CAS) Safety Alerts
5.1.1 There are no outstanding alerts for the Trust up to April 2018.
6 Western Sussex Hospitals Foundation NHS Trust – Quality Report for Trust Board
Jo Habben Head of Clinical Governance and Patient Safety
Staff engagement (indicators/targets not yet agreed) *NEW*
X47 Local staff engagement score: I am able to make improvements happen in my area of work 60.4% 63.6% 59.3% 65.1% 64.5% 60.8% 57.6% 66.1% 60.3% 56.5% 59.6% 67.6% 67.6% 68% 68%
Keith Ashall, Senior Health Intelligence Analystt: 01903 205111 (ext 84478)
5.1(a) Copy of Quality scorecard 1819_M01_Trust.Quality Scorecard - Worthing Page 5 of 12 Printed 24/05/2018 20:35
WORT APRIL 2018MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR YTD Actual YTD Target Target Trend
Giles Frost, Interim Director – Performance & Information
Status
Disclosable
Summary of Proposal The paper sets out organisational compliance against national and local key performance metrics. The report summarises both in year and projected year end performance for Western Sussex Hospitals NHS Foundation Trust, as detailed in dedicated performance scorecards relating to Quality Board indicators aligned to the Quality Strategy, the NHSI Single Oversight Framework and, when relevant, other indicators. This paper describes performance on an exceptional basis determined by RAG rating, key national/regulatory significance, or in year trend analysis.
Implications for Quality of Care
Describes Quality Outcome KPIs
Link to Strategic Objectives/Board Assurance Framework
Trust Strategic Theme B - Provide the highest possible quality of care to our patients. This we will do through focusing on a range of measures to improve clinical effectiveness. Trust Strategic Theme G - Ensure the sustainability of our organisation by exceeding our national targets and financial performance and investing in appropriate infrastructure and capacity. Trust Strategic Theme F - Improve our performance against a range of quality, access and productivity measures through the introduction and spread of best practice throughout the organisation.
Financial Implications
Describes KPIs linked to financial performance
Human Resource Implications
Describes KPIs linked to workforce
Recommendation
The Board is asked to: NOTE the Trust position against the NHS Single Oversight Framework and STF Performance Monitoring targets.
Actions:1. Enhanced discharge planning arrangements 2. Augmented patient flow arrangements in conjunction with external partners3. Dedicated operational delivery review cycle under the leadership of the Chief Operating Officer
Description / Comments / Actions
Month YTD Projected O/T
95.33% 95.33% >93%
Actions:1. Management/tracking oversight through DDO led Cancer Delivery Group2. Dedicated weekly review led by Chief Operating Officer
Description / Comments / Actions
Month YTD Projected O/T
93.57% 93.57% >93%
Actions:1. Management/tracking oversight through DDO led Cancer Delivery Group2. Dedicated weekly review led by Chief Operating Officer
Cancer - 62 days from referral to treatment following screening contact Description / Comments / Actions
Month YTD Projected O/T
90.70% 90.70% >90%
Actions:1. Management/tracking oversight through DDO led Cancer Delivery Group2. Dedicated weekly review led by Chief Operating Officer
Patients with cancer can expect to commence treatment within 62 days following referral after a positive screening test.
Target
90%
Delays in receipt of onward referral from screening which reduces the time to secure capacity to treat patients.
Cancer - Two weeks from urgent GP referral to first appt - Breast symptoms
Significant and sustained increases in demand level.
Cancer - Two weeks from urgent GP referral to first appointment
Target
Target Patients with breast symptoms can expect to be seen within 2 weeks following an urgent GP referral.
93%
Significant and sustained increases in demand level.
Key Performance Deliverables ReportA&E 4-hour waiting time target
Target
95%
Patients can expect to be admitted, transferred or discharged in 4 hours from arrival in A&E
Sustained increases in underlying demand and acuity. Increased demand challenging ability to maintain hospital/system flow essential to delivery of A&E waiting time.
93.0%
Patients can expect to be seen within 2 weeks following an urgent GP referral for suspected cancer.
50%55%60%65%70%75%80%85%90%95%
100%
Apr
May Jun Jul
Aug
Sep
Oct
Nov De
c
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Feb
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r
50%55%60%65%70%75%80%85%90%95%
100%
Apr
May Jun Jul
Aug
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Nov De
c
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Feb
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r
50%55%60%65%70%75%80%85%90%95%
100%
Apr
May Jun Jul
Aug
Sep
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Nov De
c
Jan
Feb
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r
50%55%60%65%70%75%80%85%90%95%
100%
Apr
May Jun Jul
Aug
Sep
Oct
Nov De
c
Jan
Feb
Mar Ap
r
Mark Dennis, Head of Information Servicest: 01903 285273 (ext 85273)
APRIL 2018Key Performance Deliverables ReportDescription / Comments / Actions
Month YTD Projected O/T
86.21% 86.21% >85%
Actions:1. Management/tracking oversight through DDO led Cancer Delivery Group2. Dedicated weekly review led by Chief Operating Officer
Description / Comments / Actions
Month YTD Projected O/T
84.34% 84.34% >90%
Actions:1. Increase in internal capacity as per Monitor/NHSE agreed Joint Recovery Plan developed with support from IMAS2. CCWSCCG commitment to reduced demand levels as supporting component of Joint Recovery Plan.3. Dedicated weekly Divisional review meeting, with overarching assurance review by Chief Operating Officer (also weekly)4. System Summit meetings with Monitor/NHSE to ensure partner deliver of agree Joint Recovery Plan actions.
Description / Comments / Actions
Month YTD Projected O/T
70.10% 70.10% >90%
Actions: 1. Improved tracking and escalation processes in place to manage fluctuations in demand on a daily basis2. Revised protocol introduced based on four key demand based triggers to ensure early escalation/intervention in periods of abnormal demand.
% Medically fit hip fracture patients going to theatre within 36 hours
Target
Increased volume of demand and variation of demand have impacted sustained compliance.
To ensure the best possible outcomes, hip fracture patients who are medically fit should be operated on within 36 hours of admission. This standard is part of the 'Best Practice Tariff' payment process under PbR.90%
Non-compliance an expected outcome of planned RTT recovery programme.
85%
Demand pressure exposing pathway efficiencies. Reduces the time to secure capacity to treat patients.
92.0%
Cancer - 62 days from referral to treatment following urgent referral by a GP.
Target
Referral to treatment - Incomplete Pathways
Target All patients can expect to commence treatment within 18 weeks of a referral to consultant.
Patients with cancer can expect to commence treatment within 62 days following urgent referral by a GP.
80%82%84%86%88%90%92%94%96%98%
100%
Apr
May Jun Jul
Aug
Sep
Oct
Nov De
c
Jan
Feb
Mar Ap
r
0%10%20%30%40%50%60%70%80%90%
100%
Apr
May Jun Jul
Aug
Sep
Oct
Nov De
c
Jan
Feb
Mar Ap
r
50%55%60%65%70%75%80%85%90%95%
100%
Apr
May Jun Jul
Aug
Sep
Oct
Nov De
c
Jan
Feb
Mar Ap
r
Mark Dennis, Head of Information Servicest: 01903 285273 (ext 85273)
1 National reporting for these performance measures is on a quarterly basis. Data are subject to change up to the final submission deadline due to ongoing data validation and verification.
2 Data are provisional best estimates and will be amended to reflect the position signed-off in the relevant statutory returns in due course.
3 Staff sickness is reported one month in arrears.
4 A&E counting kept consistent with 2017/18 LHE reporting January 2018, following NHSE revised guidance to remove non co-terminous MIU activity and EF type 3 attendances from monthly Trust reporting from January (which is then subsequently reallocated back to the LHE)
Notes
Mark Dennis, Head of Information Servicest: 01903 285273 (ext 85273)
This report can be made available in other formats and in other languages. To discuss your requirements please contact Andy Gray, Company Secretary, on [email protected] or 01903 285288.
To: Board
Date of Meeting: 31st May 2018 Agenda Item: 5.3
Title:
Report on Organisational Development and Workforce performance
Responsible Executive Director
Denise Farmer, Director of OD and Leadership
Prepared by:
Jennie Shore, Human Resources Director
Status:
Disclosable
Summary of Proposal: This report details the Trust’s performance in relation to the supply, development and engagement of its workforce and the organisations culture. Implications for Quality of Care: Provision of high quality, engaged staff has a direct impact on the quality of care. Financial Implications:
Supports good financial performance
Human Resource Implications:
As described
Recommendation The Board is asked to NOTE the report Consultation:
From: Denise Farmer, Chief Workforce and OD Officer
Agenda Item: 5.3
FOR INFORMATION WORKFORCE AND ORGANISATIONAL DEVELOPMENT REPORT 1.00 Introduction 1.01 This sets out the key headlines relating to the Trust’s workforce at 30 April 2018.
2.00 Workforce Capacity 2.01 Budget setting changes are reflected in the workforce scorecard for month 1 resulting in an
overall increase in the budgeted establishment of 103 wte. This includes additional staffing for Apuldram Ward at St Richards Hospital, from April to mid May and then from December to February and the conversion of radiography agency wte to substantive staff. Within paediatrics, there was a small reduction in the establishment following the switch from the winter staffing model to the summer staffing model.
Whilst Balcombe Ward opened as a new medical ward at Worthing Hospital, it did not impact of budgeted establishment because there was a transfer of staff and budget from Burlington Ward.
Adjustments were also made to take account of the transfer of the Orthoptists from the Core to
the Surgery Division. 2.02 The number of substantive staff employed in April fell by 18 wte and is at a broadly similar
position to the same period last year. Conversely investment in our budgeted position has grown by 157 wte, resulting in an increased vacancy factor of 10.5% compared to 8.4% in April 2017.
2.03 Despite the budget increase of £900k in month 1, there was an adverse pay spend of £486.5k.
Medical pay accounted for £334k, representing 5% over budget, and Nursing pay accounted for £183k, representing 2% over budget. Other staff pay was favourable at £30.5k.
2.04 The number of temporary staff used during April increased by circa 34 wte to 731 wte, with
bank staff accounting for this rise. 2.05 Total spend on agency staff in month was £543k. This is an overall reduction of £49k from last
month, with a reduction in medical agency of £106k. 3.00 Workforce Efficiency 3.01 Sickness absence increased during March to 3.7%. This ended 2017/18 with a 12 month
rolling sickness rate of 3.6%. This is a marginal improvement on last year’s absence rate of 3.7% although sickness absence in month in March 2017 was 3.2%.
Page 2 of 7
3.02 With the exception of the Surgery Division, short term absence fell in month to 2.2%. Long term absence continues to vary across divisions ranging from 0.6% in the Corporate division to 2.2% in the Medicine division. Sickness rates within Estates and Facilities are no longer an outlier within the Trust, reflecting the interventions being made to address this in the division.
3.03 At 7.5%, staff turnover remains static for a further month. This compares to 8.2% at the same
time last year. Whilst there is variation across the Trust from 4.3% in the Women and Children’s division to 10.2% in the Core division, retention remains good.
4.00 Equality, Diversity and Human Rights Week 4.01 More than 150 staff and visitors participated in events held across the Trust to celebrate
Equality, Diversity and Human Rights Week between 14-18 May 2018. This included information stands, food tasters and interactive quizzes. 4.02 The new equality and diversity training materials, delivered on the Trust’s Your Health and
Safety days also successfully launched on 14 May. 5.00 NHS Terms and Conditions of Service: Contract Refresh 2018 5.01 A steering group, with representation from divisions and trade unions, has been established to
oversee the implementation of the new contract refresh. This group will meet monthly and has now met to approve the terms of reference, project plan, risk register and agree the content of the staff briefings.
5.02 Over 12 briefings, timed to include night and weekend staff, have been held across the Trust
for staff to understand the proposed changes to the NHS Terms and Conditions of Service. These briefings have been jointly led by HR and trade union colleagues and attendance has been mixed. To date 80 staff have attended.
5.03 It is anticipated that the trade unions will accept the three-year pay deal in early June after
which the NHS Staffs Council will approve the deal and issue pay circulars during July. The 2018/19 element of the pay deal will be backdated to 1 April 2018.
5.04 Further staff briefings are being scheduled during July and August in readiness for
implementation. 6.00 Appraisals 6.01 With the exception of the Medicine division, currently at 80.5% compliance, all divisions have
seen an improvement in the number of staff of have had an appraisal in the last 12 months. Appraisal rates in the Core, Estates and Facilities and Women and Children’s divisions exceed 90%, and the Corporate and Surgery divisions are close at 88.5% and 89.2% respectively.
6.02 94% of medical staff have had an appraisal, with the Women and Children’s division achieving
96%. 7.00 General Data Protection Regulations (GDPR) 7.01 The HR policies and processes have been reviewed to ensure compliance with the new
legislation, which comes into effect from 25 May 2018. This includes staff being advised of the privacy notice. All staff are receiving a personally addressed letter, distributed through their line manager, that explains what data the Trust holds about them and how that data is used.
Page 3 of 7
8.00 Statutory and Mandatory Training 8.01 This month the board report data includes data on all nine statutory and mandatory modules.
This will provide greater visibility on all training in future. Attendance on eight out of nine of the modules remains above the Trust’s target of 90%. Attendance on resuscitation is currently below the Trust’s target at 82.7%. This is mainly due to lower attendance rates for Medical staff (65.8%) and certain patient facing staff in Facilities and Estates (e.g. porters). The Learning and Development team is working with the Medical Director and Director of Estates and Facilities to develop an action plan to redress this.
8.02 The DNA rate has slightly decreased from last month and is currently 6.92 (7.27% in March)
but still remains a concern. The DNA rate is due to operational pressures which result in some nursing staff being withdrawn from training at the last minute. This has also impacted on our overall capacity and led to an increase in demand for training places. Additional courses have been organised but this places a cost pressure on the Learning and Development team and the staff who deliver the training.
8.03 The number of staff who have never completed any training is 10, an decrease of 1 since last
month. The majority of those on the list (8) are medical staff who have joined the Trust in the last 6 months and have not completed their mandatory on-line Induction training. This has been escalated to Chiefs/ DDOs and we will continue to work with Divisions to ensure that these individuals complete their training as soon as possible.
9.00 Funding for CPD 9.01 Funding for external CPD training for all staff (except medical staff) is provided by HEE KSS
via the CPD Direct and CPD Indirect (Universities contract) budgets. There has been a delay in HEE KSS confirming CPD budgets for 2018-19. It is hoped that the budgets will be confirmed in June.
However, the delays in funding will result in staff having to delay some professional training, which will impact on their engagement and the smooth running of our Services.
10.0 Widening Participation 10.01 The Levy
The Trust Levy contribution for April 2018 was £95k, with an additional 10% government contribution the total amount entering the Apprentice Service (TAS) Account in April was £1.02M. Payments for apprenticeship qualifications are deducted monthly from the Apprentice Account.
The total spends out of the Levy account for April 2018 was £12.2k.
Our Digital Account balance at 17 May stands at £1,162,401.
Page 4 of 7
10.02 Apprentice starts
Since the 1 April, three new apprentices have started posts in the Trust, with a further five waiting to start pending employment checks. There are currently 14 vacancies at advert or waiting for interview stage.
10.03 Procurement
We are currently in the process of procurement for health care support workers (level 2) and senior health care worker (level 3). These are the qualifications that the clinical support workers will complete. Nine tenders have been received and they are currently being scored.
Health Education Kent Surrey and Sussex are funding an apprentice who will work in procurement and support the provision of apprentice qualifications; this post is currently being advertised.
10.04 Apprentice induction day
On 16 May, the first apprentice induction day took place. Feedback at the end of the day was very positive; the apprentices had no negative comments to make. After a successful day this session will be running for all new starter apprentices once a month every other month at each site.
10.05 Learning at work week
Drop in sessions took place w/c 14th May for both clinical and non-clinical members of staff to give them information on what is available in the Trust to support them with progression. National Numeracy has been released in the Trust; a global email has been requested for the first series of emails to be sent out.
10.06 Health Education Kent, Surrey and Sussex Awards
It was a successful day for the Trust at the Health Education Kent Surrey and Sussex awards held on 3 May and we received the following awards: Runners up: Support workers care awards Emelia Dlugaszek- Compassion and Care Dave Akenhurst- Compassion and Care Paul Berry – Compassion and Care Kirsten Duff – Working above and beyond the call of duty Apprenticeships Lily Morris – L2 Clinical apprentice Charlotte Robinson- L2 Non Clinical apprentice Alice Jalley – L3 Non Clinical Apprentice Employer of the year award- WSHT Winners: Niamh Mulhall – L3 non Clinical Kam Hull – L2 Clinical
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10.07 Work Experience
In April, 22 Year 10 students took part in the ‘Introduction to the NHS’ programme at St Richard’s and Worthing Hospitals. The schools who took part were Bishop Luffa, Bourne community college, Chichester High School, The Angmering School, Durrington High School and Sir Woodard Academy This is aimed at students who are interested in a career in the NHS. Each group spent 3 days in the hospital taking part in interactive sessions led by internal staff. The feedback from students included ‘It was a really good/interesting 3 days’, ‘staff were lovely’ and a parent emailed mentioning that her son ‘could not wait to come back and work for the NHS when he is old enough’. On 16 May, two Occupational Therapist’s and two Radiographers volunteered to take part in the ‘Whats my Line’ Activity at Durrington High School. In this activity, the students guess what their job role is by asking a series of questions. The Trust also helped support the Mock interviews for this day.
11.00 Communications and Engagement 11.01 Campaigns
The communications team has continued to work with colleagues from across the trust to provide support for a number of strategic campaigns and initiatives. This includes plans for the 70th anniversary of the NHS this year; go-live of new Pathology laboratory information management system; support for recruitment campaigns; launch and promotion for this year’s Patient First STAR Awards; planning and support of Where Better Never Stops staff conference; and support of staff engagement initiatives, including staff health and wellbeing and the ongoing monthly Wellbeing Wednesdays campaign. The team also organised a royal visit to Southlands Hospital on 8 May for the official opening of the new ophthalmology service at the hospital called Western Sussex Eye Care | Southlands. See below.
11.02 News and social media
The Trust welcomed HRH Countess of Wessex to officially open Western Sussex Eye Care | Southlands on Tuesday 8 May. The event, which was arranged and organised by the communications team, was shared through the Trust’s social media channels (Facebook 5,200 views + 250 reactions, comments and shares | Flicker 1,200 views of online downloadable picture slideshow | Twitter 2,735 impressions) and publicised by local media via a Trust press release. In the same week, the communications team worked with the BBC One Show and facilitated a full day’s filming on 9 May which culminated in chief biomedical scientist Malcolm Robinson being surprised with a BBC One Show Young People’s Care Award for his work founding the charity Harvey’s Gang at Worthing Hospital which now helps unwell youngsters better understand their treatment in more than NHS 40 hospitals nationwide. The communications team used the Trust’s social media channels to help further promote the BBC One Report among our followers (Facebook 3,500 views + 184 reactions, comments and shares). On 21 May, the communications team announced the trust’s CHKS Top Hospital 2018 award by issuing a press release and publishing on the trust’s website, further promoted by social
Page 6 of 7
media. Initial reaction has been very positive, with immediate publication on local newspaper websites and sharing via social media, but at this time evaluation of this good news story is still being monitored. Other recent press releases include the announcement of the chairman’s decision to retire; and the launch announcement and appeal for public nominations for the trust’s annual staff recognition awards. To date, with two weeks left to nominate, nearly 200 nominations have been received for this year’s Patient First STAR Awards. The Trust’s social media audiences continue to grow as the communications team shares more trust news, staff achievements and team successes directly with the public via Facebook, Twitter, Instagram and YouTube. Highlights from the previous month include; A&E holiday weekend advice (Facebook 10,000 views); Bank Holiday public health advice (5,500 views); and the Trust penguin sculptures being ready for Royal Wedding (Facebook 4,800).
12.00 Fundraising
12.01 Corporate and Community
The new Mayor of Worthing has selected Love Your Hospital as one of his three chosen charities for his forthcoming year starting from 18 May. Chosen charities typically receive approx. £6,000 each from various fundraising activities. Funds raised will go to benefit children’s services at Worthing Hospital. The newly rebranded Love Your Hospital collection boxes are now being rolled out across our catchment area.
12.02 Direct Marketing
As part of the requisite General Data Protection Regulations compliance, the charity has mailed all of its existing supporters requesting information on contact preferences. The response rate has been in line with expectation and has returned an unexpected income of £1,600. The outcome of this will influence the direct marketing strategy which will be reviewed towards the end of June.
12.03 Marketing
Love Your Hospital participated in the official opening of Western Sussex Eye Care | Southlands by HRH the Countess of Wessex on 8 May. The charity arranged a celebratory cake and presented charity ambassador councillor Jamie Fitzjohn from the £70k Our Vision, Your Sight campaign to HRH. Migration of the Love Your Hospital’s website onto the WordPress platform has been successfully completed. Work on functionality will continue into June with ongoing testing of the new Love Your Hospital lottery sign-up page. Lift wraps (poster designs on lift doors) are due to be installed at both St Richard’s and Worthing Hospitals by the end of May boosting the presence of the charity internally alongside the new collection tins in various locations across all sites.
12.04 Lottery Target
Investment into the lottery is starting to show shoots of growth with the development of lottery
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collateral and promotional strategy enabling the introduction of a new recruitment programme throughout 2018/19. Plays to date have risen to 660 each week and we envisage this increasing once lottery online sign-up has been launched publically at the end of May. During 2018/19, sales will be used to benchmark the lottery strategy moving forward.
13.00 RECOMMENDATION The Board is asked to NOTE the report.
WSHFT WORKFORCE SCORECARD April 2018
Key performance Indicators Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr2018/19
Number of Staff with no mandatory training 6 6 6 8 5 4 5 5 3 3 3 11 8 N/A
Number of Staff > 12 months since any mandatory training 0 0 0 0 0 0 0 0 0 0 0 0 0 N/A
4) REAL-TIME STAFF FEEDBACK NB
Total Respondents To Survey 246 274 386 258 212 300 257 276 239 170 204 288 309 309 N/A N/A
% Respondents who would recommend this trust as a place to work 84.7% 84.3% 84.9% 83.1% 82.5% 84.3% 86.4% 89.8% 85.3% 84.0% 87.7% 85.9% 87.4% 87.4% N/A N/A
% Respondents happy with standard of care if a friend/relative needed treatment 92.9% 90.8% 91.5% 91.6% 92.7% 91.2% 90.8% 94.7% 91.5% 91.1% 93.1% 95.4% 93.9% 93.9% N/A N/A
Notes:1 Absence data is available one month in arrears.3 Overall indicator for staff engagement is a composite score using 3 key finding questions, friend and family recommendation, motivation and making improvements.3 WSHT Total Respondents To Survey is greater than the sum of the divisional Total Respondents To Survey as some staff did not select a division when completing the survey.3 Baseline Data from 2016 Staff Survey, Overall Staff Engagement Score - 3.88
This report can be made available in other formats and in other languages. To discuss your requirements please contact Company Secretary, on 01903 285288.
To: Trust Board
Date of Meeting: 31st May 2018 Agenda Item: 5.4
Title Financial Performance - April 2018
Presented by
Karen Geoghegan, Chief Financial Officer
Prepared by
Alison Ingoe, Finance Director; Karen Seabridge, Assistant Director of Finance
Status
Confidential
Summary of Proposal
The Trust reported a deficit of £1.4m, excluding STF at the end of April against a planned deficit of £1.15m. The Trust needs to a deliver a deficit of no more than £0.88m at the end of quarter 1. The Trust is forecasting delivery of the Q1 control total and waiting time trajectories and has accrued STF income on this basis. The Trust is reporting an FSRR rating of '3' in month. This due to the phasing of the financial plan and the small adverse variance on in-month performance. This is forecast to be recovered in Q1. The Financial Performance paper provides further detail on the Trust’s financial position.
Implications for Quality of Care
Financial planning principles have been established to ensure that expenditure budgets reflect anticipated activity levels and that agreed staffing levels are maintained.
Support for/integration with Corporate Objectives and Strategies
G1. Maintain an acceptable financial risk rating
Financial Implications
These are noted within the Financial Performance Report
Human Resource Implications
N/A
Recommendation The Board is asked to NOTE the Financial Performance Report for April 2018.
Consultation
N/A
Appendices
Financial Performance Report
Finance Report M1 2018/19
Summary
SOF Finance Rating A Control Total (exc STF) Surplus £k A Premium Pay Spend £k G
Plan Actual / Forecast Plan Actual / Forecast Plan Actual
Year to Date 2 3 Year to Date £k (1,147) (1,398) Agency Ceiling (YTD) £k 1,357 925
Year End Forecast 1 1 Year End Forecast £k 1,185 1,185 WLI Payments (YTD) £k 147 173
Total Premium Pay (YTD) £k 1,503 1,098
Income £k A Operating Costs £k A Agency Ceiling £k G
Plan Actual / Forecast Plan Actual / Forecast Plan Actual/Forecast
Year to Date £k 35,519 34,884 Year to Date £k (34,697) (34,493) Year to Date £k 1,357 925
Year End Forecast 434,620 434,620 Year End Forecast £k (409,805) (409,805) Year End Forecast £k 14,969 12,720
Cash £k A Capital £k G Efficiency and Transformation Programme £k G
Plan Actual Plan Actual / Forecast Plan Actual / Forecast
Year to Date £k 6,174 7,271 Year to Date £k 709 283 Year to Date £k 929 955
Year End Forecast £k 16,974 16,974 Year End Forecast £k 17,145 17,145 Year End Forecast £k 18,235 18,235
Key Risks:
1. The Trust has agreed 2018/19 activity and income on an aligned incentives (AIC) basis with its main commissioner, Coastal West Sussex CCG. Although the AIC approach has improved joint working between the Trust and CWS CCG, this is still in its early
stages and governance arrangements are not yet fully embedded. The ability to progress and resolve issues remains a risk.
2. Reducing premium staffing costs remains a significant challenge. Although the Trust has seen some successes in reducing agency expenditure within nursing, in other areas costs have increased, predominantly within medical staff. A medical workforce action
group with Director leadership has been established to provide oversight and focus in this area.
3. The financial plan for 2018/19 and reported performance are based on an assumed 1% pay uplift. A national pay award, which proposes increases in excess of this, is currently being consulted upon. Any increased pay award is expected to fully funded centrally
and therefore should not impact on the Trust's financial performance. The Trust has established a working group to oversee the implementation of contract changes and to monitor and manage any financial impact.
4. Alignment of capacity to non-elective and elective activity levels and responsiveness to changes in levels of demand. Close management of capacity and flow will be required.
The Trust reported a deficit of £1.4m, excluding STF at the end of April against a planned deficit of £1.15m. The Trust needs to a deliver a deficit of no more than £0.88m at the end of quarter 1. The Trust is forecasting delivery of the Q1 control total and waiting
time trajectories and has accrued STF income on this basis. The Trust is reporting an FSRR rating of '3' in month. This due to the phasing of the financial plan and the small adverse variance on in-month performance. This is forecast to be recovered in Q1.
The Trust is reporting an FSRR rating of '3' in month. This due to the phasing of the
financial plan and the small adverse variance on in-month performance. This is
forecast to be recovered in Q1.
At the end of April, the Trust is reporting a deficit of £1.4m excluding STF which was
£0.25m adverse to the planned positions. Elective activity was below plan in month but
was partially offset by higher non-elective activity levels. Operational pressures in April
led to additional capacity being opened which resulting in high premium pay costs.
Premium pay expenditure at the end of April is £0.4m below the target level, this is due
to agency spend reporting a £0.43m favorable variance to the ceiling level. Waiting List
Initiative payments remained at a similar level to March and were above plan by
£0.03m.
Cumulatively income is £0.6m behind plan. Non-elective admissions were above plan
but this was offset by lower than plan elective activity. Income from high cost drugs
and devices was £0.4m lower than plan. Private patient income remains behind plan
year to date.
Operating costs are below plan by £0.2m in M1, however, this includes reduced
expenditure on high cost drugs and devices which are £0.4m below plan. Pay is £0.3m
above plan with nursing and medical pay both above plan. Lower clinical supplies and
services costs were incurred in non pay linked to reduced Elective activity levels.
The agency ceiling has reduced to £14.9m in 2018/19. Agency expenditure has
maintained a similar run rate to 2017/18 and was £0.4m below the ceiling target.
At the end of April the cash position is ahead of plan by £1.1m. This is primarily due to
lower than plan capital expenditure in month and a favourable movement on working
capital.
Capital expenditure totalled £0.28m at the end of April which is £0.4m lower than plan.
The slippage is expected to be recovered as projects come on stream and forecast for
the year is in line with plan.
Year-to-date savings of £0.96m have been achieved against a plan of £0.93m. This
reflects the deferral of £30k of CNST related spend from M1 to M2.
Finance Report M1 2018/19 SOF Finance Rating A
Plan Plan Actual Actual
YTD Metric Rating Metric Rating
Capital Service Capacity 2.1 2 1.8 2
Liquidity (6.5) 2 (7.0) 3
I&E Margin (0.9)% 3 (1.6)% 4
Distance from Financial Plan 0.0% 1 (0.7)% 2
Agency Spend (9.8)% 1 (31.8)% 1
2018/19 Finance Rating 2 3
Area Weighting1
(best)
2 3 4
(worst)
Financial
Efficiency
Financial
Controls
20%
YTD Planned I&E Surplus/Deficit
Agency CeilingYTD Actual Agency Ceiling - YTD Planned Agency Ceiling
0% 25% 50% ≥50% 20%YTD Planned Agency Ceiling
Distance from Financial Plan YTD Actual I&E Surplus/Deficit - YTD Planned I&E Surplus/Deficit 0% (1)% (2)% ≤(2)%
(1)% ≤(1)% 20%0%
<1.25x 20%Annual debt service
Liquidity DaysWorking capital balance x 360
0.0 (7.0) (14.0) <(14.0) 20%
Total Operating and Non Op Income
Annual operating expenses
I&E MarginI&E Surplus or deficit
1%
At the end of April, the finance rating is a '3'. The deficit plan for April had caused the planned I&E margin metric to fall to a '3'. The small adverse variance in April has caused this metric to reduce to a '4' which
has limited the overall rating to a '3'. It is forecast that this will be recovered in Q1.
Metric Construction Rating
Financial
Sustainability
Capital Service Capacity Revenue available for capital service 2.5x 1.75x 1.25x
less Sustainability and Transformation Fund 813 813 - less Sustainability and Transformation Fund 16,252 16,252 -
Underlying Performance against Control Total excluding STF (335) (586) (251) Underlying Performance against Control Total excluding STF 17,437 17,437 (0)
Prev Yr Actual Plan Actual Variance Plan Actual Variance
£k £k £k £k £k £k £k
Income 33,630 35,519 34,884 (634) Income 434,621 434,620 (0)
Donated Asset Depreciation and Amortisation 77 77 77 0 Donated Asset Depreciation and Amortisation 923 923 -
less Profit/Loss on Disposal of Fixed Assets 0 - - - less Profit/Loss on Disposal of Fixed Assets - - -
Control Total excluding STF (1,759) (1,147) (1,398) (251) Control Total excluding STF 1,185 1,185 (0)
add Sustainability and Transformation Fund (578) 813 813 - add Sustainability and Transformation Fund 16,252 16,252 -
Control Total including STF (2,337) (335) (586) (251) Control Total including STF 17,437 17,437 (0)
* EBITDA Earnings before Interest Taxation Depreciation and Amortisation
At the end of April the Trust reported a deficit of £1.4m, excluding STF, this was against a planned deficit of £1.15m. Elective activity was below plan in month but was partially offset by higher non-elective activity levels. Operational pressures in April led to additional capacity being opened which
resulting in high premium pay costs.
Year To Date Year Forecast
In aggregate contract income in April was £0.4m behind plan although this includes under-performance of £0.4m in relation to PbR excluded items. Non Elective activity continued at levels seen in Q4 but Elective activity delivered below plan predominantly within Trauma & Orthopaedics.
Pay continued at the higher levels seen in Q4 and is £0.3m above plan driven predominantly by Medical and Nursing. Medical staff continue to use high levels of locum and agency staff to cover sickness, vacancy and emergency department pressures. Increased recruitment of substantive staff within
Nursing did not lead to reduced temporary staffing usage as additional bed capacity was opened in April due to higher than planned non-elective activity. Continued management of vacancies within corporate areas helped mitigate the pressures within the clinical divisions.
Non Pay expenditure decreased in comparison to March by £0.2m and was £0.5m favourable to plan, the majority of which related to PbR exclusions which are matched with income. Clinical supplies and services were favourable to plan as a result of reduced activity levels in Orthopaedics.
Year to Date Full Year
(2,000)
(1,500)
(1,000)
(500)
0
500
1,000
1,500
2,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar£0
00
s
Cumulative Control Total by Month
Budget
Actual
(2,000)
(1,500)
(1,000)
(500)
0
500
1,000
1,500
2,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar£0
00
s
Control Total by Month
Budget
Actual
Finance Report M1 2018/19 Sustainability and Transformation Fund A
Actual Actual Actual
Apr-17 May-17 Jun-17 Q1 Q2 Q3 Q4 2017/18
Plan £000s (1,147) (1,289) (884) (884) 177 549 1,185 1,185
Actual £000s (1,398) 0 0 0 0 0
Eligible for STF Funding
STF Income Available £000s 813 1,626 2,438 2,438 5,688 10,564 16,252 16,252
Achieved? No
Income 70.0% 0 1,707 3,982 7,395 11,376 11,376
Achieved? Yes
Income 30.0% 0 731 1,706 3,169 4,876 4,876
Achieved? No
Income 0.0% 0 0
Achieved? Yes
Income 0.0% 0 0
Total STF Income Achieved (£000s) 0 0 0 0 0 0 0
At the end of M1, the Trust is behind its financial control total trajectory by £251k. The Trust needs to deliver a deficit of more than £0.9m in order to be eligible to earn STF. The Trust is
forecasting delivery of the quarterly control total and have accrued STF income on this basis.
A&E waiting times in M1 were below the constitutional target but above the STF trajectory and STF income has been accrued on this basis.
Financial Control Total (exc STF)
Delivery of Financial Control Total
A&E Waiting Times
RTT
Cancer
Finance Report M1 2018/19 Income A
Year To Date Year End Forecast
Prev Yr. Actual Plan Actual Variance Plan Actual Variance
£k £k £k £k £k £k £k
Total Income 33,630 35,519 34,884 (634) Total Income 434,620 434,620 0
Prev Yr Actual Plan Actual Variance Plan Actual Variance
Income £k £k £k £k Income £k £k £k
Coastal West Sussex 23,237 25,269 25,269 0 Coastal West Sussex 315,981 315,981 0
Other Clinical Commissioning Groups 1,288 1,629 1,548 (81) Other Clinical Commissioning Groups 20,337 20,337 0
Specialist LAT 3,871 4,105 3,763 (342) Specialist LAT 47,048 47,048 0
WSCC - Sexual Health 398 452 425 (27) WSCC - Sexual Health 5,420 5,420 0
NCA 558 262 398 136 NCA 3,774 3,774 0
Other Trust Income 732 (4) (74) (69) Other Trust Income (54) (54) 0
Income From Activities 30,083 31,713 31,330 (383) Income From Activities 392,506 392,506 0
Education, Training and Research 1,254 1,229 1,229 0 Education, Training and Research 14,847 14,847 0
Donated Asset / Grant Income 50 78 0 (78) Donated Asset Income 937 937 0
Other Income 1,776 1,825 1,835 10 Other Income 19,248 19,248 0
Other Operating Income 3,547 3,806 3,554 (251) Other Operating Income 42,114 42,114 0
Total Income 33,630 35,519 34,884 (634) Total Income 434,620 434,620 0
Sustainability and Transformation Funding
(STF) 579 813 813 0
Sustainability and Transformation Funding
(STF) 16,252 16,252 0
Total Income including STF 34,209 36,331 35,697 (634) Total Income including STF 450,872 450,872 0
of which : PbR Drugs/Devices 2,694 2,928 2,508 (419)
Year to Date Full Year
Total income is £0.6m behind plan at the end of April of which £0.4m relates to income from activities. Private patient activity is behind due to lower activity levels in month which is partially due to the high volumes of non-elective
patients particularly in the early half of the month.
Elective activity and income were behibnd plan in M1 which was partially offset by increased non-elective admissions. There was a reduction in PbR excluded drugs spend and associated income this month.
Private patient income is behind plan in April. Donated asset income is behind plan, however this is excluded from the calculation of the control total.
33,500
34,000
34,500
35,000
35,500
36,000
36,500
37,000
37,500
38,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
£0
00
Monthly Income
Budget Actual
25,000
27,000
29,000
31,000
33,000
35,000
37,000
39,000
Ap
r
May Jun
Jul
Au
g
Sep
Oct
No
v
De
c
Jan
Feb
Mar
£0
00
Monthly Income Yearly Comparison
2017-18 2018-19
Finance Report M1 2018/19 Contract Performance A
Table 2. Activity and Income by Point of Delivery
Point of Delivery YTD Plan YTD Actual YTD Var YTD Plan YTD Actual YTD Var
FYE Plan YTD Plan YTD Actual YTD Var Daycases 4,705 4,599 (106) 2,870 2,841 (29)
Total Income from Activities 392,509 31,713 31,330 Subtotal CCG Acute Contracts 26,898 26,817 (81)
Strategic Transformation Fund 16,252 813 813 NHS England 4,105 3,763 (342)
Total 31,003 30,580 (423)
Total Income from Activities plus STF 408,761 32,526 32,142
£'000
Estimated Values YTD (inc CQUIN)
The Trust reports income based on the contract monitoring position for prior months and an estimate of income for the current month based on priced and coded activity in the month as available. An estimate is made for the value of uncoded spells and missing days and included within the reported income position.
1) Context
The Trust signed two-year contracts with all of its major commissioners in 2017/18. The Trust has agreed contract envelopes for 2018/19 with its major commissioners that are in line with the anticipated values in the financial plan.
2) YTD Report
Trust internal monitoring information shows underperformance against the Trust's main CCG contract.
It is important to note that the performance indicated is compared to the Trust's plan and does not necessarily reflect the over-performance against commissioner contracts.
£'000
Activity Volumes £'000
Table 1. Total Financial Values by Contract
This table represents the Trusts assessment of the performance against commissioners only with whom a Contract SLA has been agreed. There are some differences between the Trust's income plan and the agreed contract values due to QIPP assumptions
Page 6
Finance Report M1 2018/19 Operating Costs A
Prev Yr Actual Plan Actual Variance Plan Actual Variance
Other Non-Pay (122) (94) (136) (41) Other Non-Pay (689) (814) (125)
Total Non-Pay (9,780) (10,538) (10,025) 513 Total Non-Pay (121,805) (122,069) (264)
Total Expenditure (33,650) (34,697) (34,493) 204 Total Expenditure (409,805) (409,805) (0)
Year To Date Year Forecast
Pay: In aggregate Medical pay decreased by £0.1m in comparison with March with reductions in both substantive and agency expenditure, however costs remained above plan for locum staff which were used to cover junior doctor sickness and vacancies in Emergency medical areas.
Nursing pay expenditure increased within substantive staff following increased recruitment without an offsetting reduction in agency expenditure due additional capacity that was open April. Estates staff increased in comparison to March following recruitment within a number of departments
but remained within plan. Other staff groups continued to hold a number of vacancies mitigating pressures in clinical areas.
Non Pay: High cost drug usage decreased in April compared to March and was significantly below plan as a result of reduced levels of elective activity undertaken in month, this decrease was offset by income. These low activity levels also impacting on reduced clinical supplies and
services expenditure in a number of surgical areas.
Operating costs are below plan by £0.2m in M1, however, this includes reduced expenditure on high cost drugs and devices which are £0.4m below plan. Income is received for these items and so there is no net gain to the Trust from the underspend. The underlying position on operating
costs is £0.2m adverse which comprises £0.3m overspend on pay offset by £0.1m favourable variance on non-pay.
Year to Date Full Year
23,000
23,500
24,000
24,500
25,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
£0
00
s
Monthly Pay
Budget Actual
32,500
33,000
33,500
34,000
34,500
35,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
£0
00
s
Monthly Operating Costs
Budget Actual
9,000
9,500
10,000
10,500
11,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
£0
00
s Monthly Non Pay
Budget Actual
21,000
22,000
23,000
24,000
25,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
£0
00
s
Monthly Pay Yearly Comparison
2017-18 2018-19
Finance Report M1 2018/19 A
Agency Waiting List Initiative Payments
2016/17 2017/18 Ceiling Actual Variance1) Context
£k £k £k £k £k Budget Actual Variance
Medical and Dental Staff (7,031) (6,936) (754) (538) 216 Division
The Trust Balance Sheet is produced on a monthly basis, and reflects changes in the asset values, as well as movement in liabilities.
Year to Date Full Year Forecast
1. The non current asset position includes the interim impact of the District Valuer's valuation. This will be updated when the 2017/18 accounts are approved.
2. Trade payables are higher than plan due to the Trust's cash position necessitating the restriction of supplier payments in 2017/18.
Statement of Financial Position
Finance Report M1 2018/19 Cash G
Plan Actual Variance Plan Actual Variance
£k £k £k £k £k £k
Cash Balance 6,174 7,271 1,097 16,974 16,974 -
Plan Actual Variance Plan Actual Variance
£k £k £k £k £k £k
EBITDA 1,565 1,209 (356) EBITDA 40,257 40,257 -
Movement in Working Capital (1,160) (129) 1,031 Movement in Working Capital (1,403) (1,403) -
Provisions - (30) (30) Provisions - - -
Cashflow from Operations 405 1,049 644 Cashflow from Operations 38,854 38,854 -
Capital Expenditure (712) (283) 429 Capital Expenditure (17,145) (17,145) -
Cash receipt from asset sales - - - Cash receipt from asset sales - - -
Cashflow before financing (307) 766 1,073 Cashflow before financing 21,709 21,709 -
PDC Received - 0 0 PDC Received - 0 0
PDC Repaid - - - PDC Repaid (8,425) (8,425) -
Dividends Paid - (0) (0) Dividends Paid - -
Interest on Loans and leases (57) - 57 Interest on Loans and leases (690) (690) -
Interest received - 4 4 Interest received - - -
Donations received in cash - - - Donations received in cash - - -
Drawdown on debt - - - Drawdown on debt - - -
Repayment of debt - (37) (37) Repayment of debt (2,158) (2,158) -
Cashflow from financing (57) (33) 24 Cashflow from financing (11,273) (11,273) 0
Net Cash Inflow / (Outflow) (364) 733 1,097 Net Cash Inflow / (Outflow) 10,436 10,436 0
At the end of April the cash position is ahead of plan by £1.1m. This is primarily due to lower than plan capital expenditure in month and a favourable movement on working capital. The movement in working capital is due to
lower levels of accrued income and prepayments.
Year to Date Full Year
Year To Date Full Year Forecast
Finance Report M1 2018/19 Aged Debtors
1-30 days31-60
days
61-90
days> 90 days
£k £k £k £k £k £k
CCG's (4,811) 621 138 82 10,420 6,450
NHS England (in Health
Education England)1,256 53 820 402 682 3,213
NHS Trusts 55 181 1,304 236 1,920 3,696
Foundation Trusts 40 425 489 84 2,356 3,394
Other NHS - 21 3 9 117 150
Non-NHS 32 649 289 56 1,192 2,219
Total (3,429) 1,951 3,043 869 16,688 19,122
-18% 10% 16% 5% 87%
Provision for Bad Debts (including RTA Provision) (779)
Accrued Income (including Work in Progress) 8,369
Prepayments 1,578
Other Debtors 4,974
Total Trade & Other Receivables 33,263
The Trust debtors are a mixture of invoiced debtors, accrued income and prepayments as set out in the table below. The Trust has outstanding debtors of 31 days or more of £20.6m, which is an increase of
£2.9m since March. The most significant debtors greater than 90 days relate to invoices for 2016/17 over-performance with the Trust's lead CCG and outstanding balances with three foundation trusts for
provider to provider agreements and specialist drugs/services. A credit has been issued to the CCG following the outcome of the expert determination and the balance cleared in full during May.
Other debtors includes £2.3m of RTA debtors, £1.2m of Private Patients, £0.7m relates to Charity funding (of which £0.1m relates to the League of Friends and £0.6m relates to LYH) and £0.8m relating to VAT
and other debtors.
Accrued income includes £3.5m STF income for 2017/18 and 0.8m relating to STF 18/19 income, £0.8m of provider to provider income, £0.2m private patient income, work-in-progress £3.0m and £0.1m of
other income.
OverdueWithin
TermsTotal
1,951k
3,043k
869k
16,688k
Debtors
1-30 days
31-60 days
61-90 days
> 90 days
Finance Report M1 2018/19 Capital G
Year To Date Year End Forecast
Plan Actual Variance Plan Actual Variance
£k £k £k £k £k £k
Total Capital 709 283 (426) Total Capital 17,145 17,145 -
Capital
Budget Actual Variance Plan Actual Variance
Source of Funds £k £k £k Source of Funds £k £k £k
Depreciation (net of IFRIC 12) 1,219 1,219 0 Depreciation (net of IFRIC 12) 14,630 14,630 -
Total Expenditure 709 283 (426) Total Expenditure 17,145 17,145 -
Year to Date
At the end of April, capital expenditure totalled £0.28m. The largest areas of expenditure £0.04m Clinical Document Management Portal, £0.05m Canopy replacement, £0.04m Infastructure, £0.03m hot and cold water replacement, £0.03m
Licensing, £0.02m Referral Management and £0.01m West Wing Calorifier. Expenditure is £0.4m lower than plan, this is a timing issue and the total expenditure in year is forecast to be on plan.
The remainder of the project budgets have been phased according to their business case dates plus the lead times required to commence the works and then the expected duration of those works.
Full Year
Finance Report M1 2018/19 Efficiency and Transformation Programme G
Workstream Plan Actual Variance Plan Forecast Variance
£k £k £k £k £k £k
FYE 17/18 470 472 2 2,692 2,692 (0)
Back Office & Corporate Support 69 79 10 1,118 1,118 0
Core 18 18 - 2,700 2,700 -
Estates & Facilities 39 38 (1) 831 831 -
Growth 146 146 - 1,746 1,746 -
Medical Workforce 18 18 - 2,350 2,350 -
Medicine 11 - (11) 930 930 (0)
Medicines Management 9 9 - 302 302 -
Nursing Workforce 26 24 (1) 725 725 0
Procurement 136 136 - 1,997 1,997 -
Surgery 13 10 (3) 1,476 1,476 -
Women and children (26) 4 30 1,102 1,102 -
Workforce - - - 160 160 -
Transformation - - - 107 107 -
Efficiency Plan Total 929 955 25 18,235 18,235 0
102.7%
Month 1 Plan vs Actual
Year-to-date savings of £0.96m have been achieved against a plan of £0.93m. This reflects the deferral of £30k of CNST related spend from M1 to M2. A delay in the agreement of the Porstmouth P2P Chemotherapy SLA has been offset by overseas
visitor income.
Year-to-Date Full Year
(100)
0
100
200
300
400
500
FYE 17/18 Back Office &Corporate Support
Core Estates & Facilities Growth Medical Workforce Medicine MedicinesManagement
Nursing Workforce Procurement Surgery Women and children Workforce Transformation
