Integrated Performance Report June 2020 1 Agenda item: Date: 24 June 2020 Title: Integrated Performance Report – incorporating COVID-19 related performance Prepared by: Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director / Deputy Chief Executive Dave Thomas, Interim Chief Nurse Chris Tidman, Chief Financial Officer / Deputy Chief Executive Presented by: Dave Thomas, Interim Chief Nurse Responsible Executive: Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director/Deputy Chief Executive Dave Thomas, Interim Chief Nurse Chris Tidman, Chief Financial Officer/Deputy Chief Executive Summary: To advise the Board of the Trust’s performance against key performance standards and targets; and progress on the implementation of the Trust Strategy and key supporting projects. Actions required: The Board is asked to receive the Performance Report and note the current risks and the proposed action plans to mitigate the risks against performance delivery. Status (*): Decision Approval Discussion Information X History: This is a standing agenda item at each meeting of the Board of Directors. Link to strategy/ Assurance framework: This paper details the Trust’s performance in respect of key performance standards and targets. Achievement of these performance standards and targets is a key objective within the Trust’s Strategy. Monitoring Information Please specify CQC standard numbers and tick other boxes as appropriate Care Quality Commission Standards Outcomes NHS Improvement / England Finance Service Development Strategy Performance Management Local Delivery Plan Business Planning Assurance Framework Complaints Equality, diversity, human rights implications assessed Other (please specify) 8.1
Transcript
Integrated Performance Report
June 2020
1
Agenda item: Date: 24 June 2020
Title: Integrated Performance Report – incorporating COVID-19 related performance
Prepared by:
Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director / Deputy Chief Executive Dave Thomas, Interim Chief Nurse Chris Tidman, Chief Financial Officer / Deputy Chief Executive
Presented by: Dave Thomas, Interim Chief Nurse
Responsible Executive:
Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director/Deputy Chief Executive Dave Thomas, Interim Chief Nurse Chris Tidman, Chief Financial Officer/Deputy Chief Executive
Summary: To advise the Board of the Trust’s performance against key performance standards and targets; and progress on the implementation of the Trust Strategy and key supporting projects.
Actions required: The Board is asked to receive the Performance Report and note the current risks and the proposed action plans to mitigate the risks against performance delivery.
Status (*): Decision Approval Discussion Information
X
History: This is a standing agenda item at each meeting of the Board of Directors.
Link to strategy/ Assurance framework:
This paper details the Trust’s performance in respect of key performance standards and targets. Achievement of these performance standards and targets is a key objective within the Trust’s Strategy.
Monitoring Information Please specify CQC standard numbers and tick other boxes as appropriate
Care Quality Commission Standards Outcomes NHS Improvement / England Finance
Service Development Strategy Performance Management
Local Delivery Plan Business Planning Assurance Framework Complaints Equality, diversity, human rights implications assessed Other (please specify)
8.1
Integrated Performance Report
June 2020
Integrated Performance Report – May 2020 Position
Contents
Section Page
Executive Summary 3 – 4
COVID-19 Related - Activity & Flow 6 – 7
COVID-19 Related – Operational Performance 8
COVID-19 Related – Safety & Quality 9 – 10
COVID-19 Related – Our People, including Communications & Engagement
11 – 12
COVID-19 Related – Finance 13
Activity & Flow 15 – 16
Operational Performance 17 – 24
Quality & Safety 25 – 26
Our People 27
Finance 28 – 35
2
3
Executive Summary
Integrated Performance Report
June 2020
Quality and Safety: • There were 52 incidents of treatment delay due to COVID-19, of which 13
were reported as causing minor harm.
• The main factor in in delay is patients opting to decline treatment.
• The main concern reported to PALS relates to poor social distancing practice
by staff in communal areas.
• The new Family Liaison Service has had over 700 contacts in its first month,
and has extended to a seven-day working model, its aim is to support patients
and those closest to them to remain in touch.
COVID-19 Related Non COVID-19 Related
Operational Performance: • COVID-19 occupied inpatient and critical care beds have continued to reduce,
with current volumes well within the Trust’s capacity. The forecast shows a
predicted continuation of this trend to the end of June. This trend is in line with
other Devon trusts but there is some variation in the volume of COVID-19
occupied beds across the wider South West. Overall bed occupancy remains
comparatively low at 58% of total capacity.
• The Trust has recently started to undertake antibody testing in relation to
COVID-19. The results to date for RDE show a cumulative position of 7.6% of
staff and 8.5% of patients as having COVID-19 antibodies.
• The Trust has maintained a greater than 14 days’ supply for all core items of
PPE.
Our People: • Volumes of staff sickness and those self-isolating who are not able to work
continue to reduce over the period from a peak in early April.
• Confirmed COVID-19 staff sickness has reduced significantly during May and
maintained low levels.
Quality and Safety: • A sustained improvement in both SHMI and HSMR rates has been seen
between November 2019 and February 2020 due a correction in the
classification of some AMU activity.
Operational Performance: • Elective activity has increased on April’s volumes, which has resulted in a
stabilised overall waiting list position (May compared to April) for outpatients and
inpatients / day cases.
• However, long waiters have continued to increase as restricted capacity has
resulted in the need for the Trust to prioritise urgent elective procedures over
routine cases. More capacity has come on line in recent weeks with the re-
designation of more theatres at Wonford and the continued maximum use of the
Nuffield theatres.
• Daily attendances to ED in April were lower than the previous year but showing a
week on week increase, with May activity continuing this trend.
• May has seen a slight recovery in the volume of suspected cancer referrals with
the month seeing referral volumes at 56% of 2019 levels. The majority of
services (excluding Colorectal) are compliant with the two-week wait standard
and the Trust is expected to pass this standard for May.
• Diagnostics performance has deteriorated further into May due to significant
capacity restrictions associated with COVID-19.
Our People: • Overall Trust wide sickness absence (excluding COVID-19) as a percentage of
Trust workforce decreased from 3.77% in April to 3.67% in May.
4
Executive Summary
Integrated Performance Report
June 2020
COVID-19 Related Non COVID-19 Related
Finance:
• The Trust is reporting a break even financial year to date position in line with national guidance.
• The Trust's financial position will continue to be break-even for the first four months of the year after NHSE/I have notified a block value for patient income and a top-up
payment process. A retrospective top up or claw back will be made each month to ensure a break even position is achieved. It is expected that this process will continue
until the end of October with updated block and top up payments and more rules regarding the retrospective payment/claw back from July onwards.
• A direct claim from NHSE/I for the Trust's COVID expenditure of £3.6m was incurred during May (year to date £6.3m). The Trust will also receive a top-up/claw back for
any underlying increase/decrease in its net run rate (£2.0m in May and a total of £4.0m year to date).
• The Trust has incurred £6.7m as a result of the setup costs for the Nightingale Hospital during May. These costs will be recovered as part of the retrospective top-up
payment.
• Expenditure and commercial income budgets have been rolled over from the previous financial year and inflation added relating to pay.
• In month 2 pay has overspent by £182k, non pay has underspent by £571k and planned developments (reserves) not spent of £955k.
• NHSI/E has requested the Trust to provide a forecast to month 4. The forecast assumes a similar rate of expenditure as month 1 and 2, with an increase in non-pay
expenditure in month 3 and 4 aligned with the expected increase in patient activity.
• The Trust savings programme is currently on hold, and will form part of the recovery and restoration phase.
• Cash as at the end of April is £91.8m, an increase of £33.7m on the value held at the year end due to a pre-payment of June block income.
• Divisional budgets have not been adjusted for any budget setting requests or COVID 'top ups' at Month 2. The Trust is reviewing budget setting requests in light of
COVID 19 and new ways of working and will be conducting a mid year review in the Autumn.
5 Integrated Performance Report
June 2020
Part 1 COVID-19 Related
COVID-19 Occupied Inpatient Beds
COVID-19 occupied inpatient beds have continued to reduce, with current
volumes well within the Trust’s capacity. The forecast shows a predicted
continuation of this trend to the end of June. This trend is in line with other
Devon trusts but there is some variation in the volume of COVID-19
occupied beds across the wider South West.
Trajectories
The primary source of projections being used by the Trust is in
collaboration with Exeter University, based on a reproduction rate of 1.06.
In previous reports a secondary source of projections issued by NHSI/E
have been included for reference, but these have now been removed as
they have not been updated.
Overall Bed Occupancy
Overall bed occupancy remains comparatively low at 58% of total
capacity but has been increasing since April. COVID-19 inpatients have
decreased over this period but non COVID-19 occupied beds have
increased as non COVID-19 activity is stepped up.
COVID-19 Inpatient Activity – Overview of inpatient activity in relation to caring for patients with COVID-19
6 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Chris Tidman
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Inp
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COVID Acute Inpatient Beds (Non Critical Care) Capacity Plans vs Current Use
4. Capener & Knapp
3. Kenn, Bovey, Yealm
2. Culm East and West
1. Ashburn
Actual Non Critical CareCovid IP Beds in use
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Bed
s o
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COVID / Non-COVID Bed Occupancy
Occupied by Non Covid 19 patients Occupied by Covid 19 patients Unoccupied
Phase 2 bed numbers from 26th May
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Inp
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Number of Confirmed COVID-19 Patients Occupying Acute Inpatient Beds
Actual Projection
COVID-19 Patients in Critical Care Beds
The number of COVID-19 patients in critical care beds has reduced since
mid-April.
The volumes experienced are well within the Trust’s surge capacity.
Critical Care – Overview of critical care activity in relation to caring for patients with COVID-19
7 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Chris Tidman
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HD
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Number of Confirmed COVID-19 Patients Occupying HDU / ITU Beds
Actual
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Critical Care Surge Capacity Plans vs Current Use
1. ITU with Second Area 2. Main Theatre Recovery
3. Theatre & Anaesthetic Rooms 4. PEOC Theatres and Recovery
Critical Care Beds in Use
Executive Lead: Pete Adey
Testing Capacity
Testing volumes in April have continued into May with the Trust continuing to
test its own staff as well as neighbouring organisations.
The Trust has recently started to undertake antibody testing in relation to
COVID-19. The results to date for RDE show a cumulative position of 7.6% of
staff and 8.5% of patients as having COVID-19 antibodies.
COVID-19 Testing – Outline of COVID-19 patient testing activity and outcomes
Cumulative position from 29th May 2020 - 8th June 2020
Tests Positive % Positive
2254 172 7.63%
353 30 8.50%Patients Tested
RDE Staff Tested
Fully FIT Tested 50%
Attended and successful FIT tested
39%
Attended but failed testing 11%
FIT Testing (Number of Staff)
Executive Lead: Adrian Harris & Dave Thomas
Quality and Safety
9 Integrated Performance Report
June 2020
Patient Deaths and Harm
There were 104 incidents reported which referenced COVID-19.
• 52 were incidents of treatment being delayed or declined. These
incidents are reviewed each week on a case by case basis by the
Executive Safety Huddle. 58% of these incidents were patients declining
treatment due to concerns. 25% (n=13) were reported as resulting in
minor harm for the patient. No incidents resulted in a greater degree of
reported harm.
COVID-19 Related Pressure Ulcers
• There were no disease specific pressure ulcers reported.
Patient Experience
• The Trust received 7 items of feedback relating to COVID-19. 2 Formal
complaints related to communication regarding appointments where it
wasn’t clear that the appointment would be telephone based, resulting in
unnecessary journeys. The remaining concerns (1) and comments (4) all
related to poor social distancing practices by staff or staff not wearing
PPE.
• After a brief trial at the end of April the Family Liaison Service has
launched. The service includes:
• Relaying personal messages to inpatients from family.
• Arranging virtual visiting with a video call to family.
• Receive essential items for patients.
• Arranging essential visits for End of Life Care patients.
• This has been widely used and feedback from staff and families has been
overwhelmingly positive. We have received over 300 messages from
loved ones and had over 400 relative contacts dropping off property. The
service has also extended from five-days to seven.
0
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Daily COVID-19 Patient Deaths (Past 24 Hours)
Patient deaths
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2
4
6
8
10
03
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09
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Patients Recovered and Discharged (Daily)
Patients recovered and discharged (daily)
Oxygen
As highlighted in past months’ IPR as part of the national programme in response to COVID-19, the Trust has been allocated a second vacuum
insulated evaporator (VIE) oxygen store. The expected date of delivery for the VIE was the 22nd June, this has however been delayed owing to the
process for sign off of the funding associated with the ground works business case with the national team. At this time a new date for assignment has
not yet been agreed.
The Trust has installed oxygen flow meters in a number of high use oxygen areas across the hospital, including an overarching flow meter on the
current VIE. A process is underway to automate the readings from these flow meters, which will be linked to an alarm system to flag any significant
changes in use. This will enable an early response to any future potential issues with oxygen flow in a specific clinical area to minimise the risk of
critical supply issues.
PPE
The Trust has maintained a greater than 14 days’ supply for all core items of PPE. The Trust has continued to source type IIR surgical facemasks to
maintain supply levels in line with the nationally agreed local procurement guidance. Overall stock of FFP3 masks remains above 14 days, but specific
mask availability is becoming more of a challenge. As a consequence large numbers of staff are being re-fit tested in order to ensure that they have an
alternate suitable FFP3 mask available to them.
The announcement from the Health and Social Care Secretary, on the 5th June in relation to the implementation of surgical mask use for all staff
working in hospitals from the 15th June will have a significant impact upon PPE supply going forward. The Trust has a comprehensive action plan to
support the implementation of this guidance. Where possible the Trust will procure type 1 or type 2 surgical masks for use by non-clinical staff in order
that stocks of type IIR masks are maintained for staff working in direct patient facing roles who are at the greatest risk.
The PPE hub have worked with a local manufacturer to develop a re-useable fluid resistant cloth mask. Work is underway with Exeter University to
determine the feasibility of assessing the filtration rate of this material in order that consideration can be given as to whether this could be used as a
safe alternative to a type 1 mask.
PPE, Oxygen, Ventilators – Exception reporting on issues and proposed mitigations
10 Integrated Performance Report
June 2020 Executive Lead: Adrian Harris & Dave Thomas
Executive Lead: Hannah Foster
• Volumes of staff sickness and those self-isolating who are not able to work
continue to reduce over the period from a peak in early April.
• Confirmed COVID-19 staff sickness has reduced significantly during May
and maintained low levels.
Workforce
11 Integrated Performance Report
June 2020
Note : Sickness and Staff Isolating – General sickness figures for 3, 23 and 24th May 2020 are low due to data only being available from Healthroster.
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Staff Sickness and Self Isolating
General sickness Covid 19 related sickness Self Isolating (not able to work)
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5
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COVID-19 (Staff Confirmed Cases) Related Sickness
Covid 19 related sickness
The communications and engagement team maintained support to Gold Command and the reset and recovery work.
within 24 hours where possible (unless waiting for
national / local guidance)
• Daily comms all staff COVID update has been issued daily though the last month – although now
reverted to 5 days instead of 7 days – plus ad-hoc Manager updates
• The daily comms bulletin has been changed to an all staff bulletin issued 5 days a week covering
COVID, Reset/recovery, and MY CARE.
Responsive communications supports the
organisation by gathering feedback to enable us to
respond quickly to the issues most important to staff
• A staff survey to receive staff feedback on comms, engagement, wellbeing and fundraising efforts
has received over 2,000 responses. Analysis of the results due shortly.
• Response to government announcements - facemasks, COVID-secure workplaces etc
• Proposed adoption of staff pulse over coming month.
• Letter on BAME COVID study issued to all staff by CEO
Proactive communications supports Gold
Command by proactively identifying areas of
interest to staff to anticipate/avoid high call volumes
to the incident cells.
1. Exec webcast: Execs undertake a monthly COVID-related webcast across RDE and NDHT
2. Travel to work: ongoing support to changes to car parking and promotion of alternatives
3. Serology testing: Promotion of antibody testing to staff
4. Nightingale: Continued support to the Nightingale - integrated into existing team
5. Donations and giving: coordinated donations and engaged in a process on how to best utilise
money raised through the RD&E appeal as well as national donations
6. Open for business: Continued public comms on promoting use of hospital services
Impact/outcome • Media coverage/ socials: We had 156 stories covered by the media in April. There were 156
positive stories and 0 Negative. There were also an additional 593 neutral stories which only
included an incidental factual mention of the RD&E. Twitter followers: 351 (↑4.2%) Facebook
followers :514 (↑10.6%)
Team Resilience • Established an equitable team rota to ensure all key meetings are covered
• Business continuity plan enacted: remote working enabled./Social distancing/ sickness cover
• Supported the development of a core set of communications skills to support Gold: swift and
accurate communications, consideration of audience, alignment to messaging, responsiveness
• Key messages from executive director meetings fed back to team instantly
Strategic • Developed strategic messaging management
• Development of influencing and advocacy work with key stakeholders
• Development of forward plan based on modelling
• Strategic communications and engagement advice to Executive Directors and Gold Command
• Liaison with NHS England ref national messaging
Executive Lead: Chris Tidman
COVID-19 Related Costs
13 Integrated Performance Report
June 2020
COVID Expenditure and Financial Commitment Summary
Revenue
£7.4m of revenue expenditure has been incurred on COVID-19 with expenditure in May of £3.6m. The major areas of spend include £896k on personal protective
equipment - locally procured, £660k on COVID-19 virus testing (NHS laboratories), £514k on Increased ITU capacity (including hospital assisted respiratory support
capacity, particularly mechanical ventilation) which includes building up stocks of consumables, £445k on existing workforce additional shifts to meet increased
demand and £431k backfill for higher sickness absence.
* not including loss of commercial Income in April of £528k and for May £1.2m; excluded as required by NHSE/I guidance.
Capital
£587k of capital expenditure has been incurred to date with expenditure in May of £377k which related to the Exeter Renal Unit Covid Expansion Plan (£227k), 3x
Blood gas analysers (£50k), a Chemagic 360 RNA extraction machine (£50k) and a Ultrasound Machine £50k).
• "Remote management of patients" includes IT provision for medical staff to enable remote consultations.
• "Increased ITU capacity (including hospital assisted respiratory support capacity, particularly mechanical ventilation)" is the equipment and consumables used in relation to assisted
breathing on COVID wards (mainly ICU)
• "Segregation of patient pathways" includes Provision of estates recharges specifically for segregation of all patients with respiratory problems.
• "Remote working for non-patient activities" includes provision to support staff working form home including additional IT support and costs.
• "Other" includes Provision of Estates recharges for various works not relating to the segregation of all patients with respiratory problems and provision for free TV to patients.
Expand NHS Workforce – Medical / Nursing / Other (including AHPs and Healthcare Scientists) 3 53 239 295
Backfil l for higher sickness absence 8 239 431 677
Remote working for non-patient activities 207 5 27 239
NHS Staff Accommodation - if bought outside of national process 0 0 0 0
PPE - locally procured 42 531 896 1,470
Other 6 158 207 371
Loss of commercial income * 230 * * 230
Total 1,161 2,645 3,606 7,412
Revenue
costs
incurred to
March
(£000's)
Revenue
Costs
incurred in
April
(£000's)
Revenue
Costs
incurred in
May
(£000's)
Total
Revenue
cost
incurred
(£000's)
14 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Chris Tidman
Part 2 Non COVID-19 related
Elective activity- Referrals and Outpatients
15 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Chris Tidman
0
2000
4000
6000
8000
10000
12000
14000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Referrals - Excluding Community
2019/20 2020/21
0
10000
20000
30000
40000
50000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
New and Follow-up Outpatient Attendances
New 20/21 Follow-up 20/21 New 19/20 Follow-up 19/20
0
20000
40000
60000
80000
100000
120000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2019/20 2020/21
New and Follow-up Outpatient Waiting List
New OP WL Follow-up Waiting List
0
10000
20000
30000
40000
50000
60000
70000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2019/20 2020/21
Outpatient Attendances (New and Follow-up) by Appointment Type
Not Specified Face to Face Telemedicine Telephone
Referrals: have increased from April 2020 but are still only at a level equivalent to 40% of May 2019 referral volumes. This continued reduction is attributed to COVID-
19, and mainly due to a reduction in GP referrals as presentations to primary care have reduced significantly. If COVID-19 levels remain low it is anticipated that the
rise in referrals will continue.
Outpatient Attendances: New outpatient attendances increased between April and May but still only equate to 50% of May 2019 attendance volumes. Fol low up
outpatient attendances show a similar pattern with attendances in April 56% of May 2019 volumes, but with a weekly increase. The increase in proportion of virtual and
telephone appointment compared to face to face has continued, with more than 50% of attendances being virtual.
Outpatient Waiting List: The new outpatient waiting list has slightly reduced in May as attendances are higher than referrals . The follow up outpatient waiting list
appears to be stabilising as the number of follow up attendances increase.
Elective activity- Inpatient and Daycase
16 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Chris Tidman
Elective Waiting List (Inpatient and Daycase Combined)
IPDC Waiting List
0.0
500.0
1000.0
1500.0
2000.0
2500.0
20,000
25,000
30,000
35,000
40,000
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
2019/20 2020/21
Vo
lum
e o
f Pa
tien
ts W
aitin
g >
40
we
ek
s
Vo
lum
e o
f In
co
mp
lete
Pa
thw
ays
Incomplete Pathways and Longer Waiting Patients
Incomplete pathways >40 Weeks
Elective Activity and Waiting List: Elective inpatient and daycase activity has increased by 36% from April, but is still only 36% of May 2019 levels. However, activity
is increasing on a week by week basis, a trend which is continuing into June. The elective waiting list has increased from April but only marginally, which indicates a
move to a more stable position. The Trust continues to use the Nuffield Exeter Hospital for outpatient attendances, daycase and inpatient procedures. The extent to
which the Trust will be able to continue to fully utilise the Nuffield’s capacity is unclear at the present time, but activity will continue for non-complex elective activity
until notified otherwise.
RTT Performance and longer waiting patients: RTT performance deteriorated further in April at 58%, which is attributed to a shift in the waiting list due to lower
reduced capacity during the 1st phase of COVID-19 and therefore patients waiting longer for treatment. The number of patients waiting longer than 40 weeks for
treatment continued to increase significantly at the end of May to 2,137 patients from 1,513 in April.
Lower activity during the COVID-19 1st phase has created a large backlog and recovery plans are predicated on clinical prioritisation, with patients being seen and
treated in priority order. Physical capacity in the form of theatres is returning to pre-COVID-19 levels, with an additional 3 theatres planning to come back online in
early July and plans for community theatre use being developed. There is now enough capacity to treat all urgent surgical cases, and with additional capacity in
coming weeks this will soon extend to elective priority 2 “soon” patients. Specialties with specific designated capacity outs ide of main theatres (Orthodontics,
Ophthalmology) are developing plans to treat lower priority patients if capacity allows.
Integrated Performance Report
June 2020
17
Elective activity- Long Waiting Patients
Executive Lead: Pete Adey
Specialty 2019/20 2020/21
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
There were 754 patients waiting longer than 6 weeks for MRI at the end of May, of whom 487 were non cardiac MRI. Capacity was severely restricted due to the
COVID pandemic and recovery will be protracted. Additional capacity is being delivered through use of scanners at the Nuffield, MG Neurological Centre (University of
Exeter), and full-time staffed mobile MRI scanner.
Cardiac and non-cardiac CT
Of the 472 patients waiting longer than 6 weeks for CT at the end of May, 254 were for Cardiac CT (an increase from 118 in April), and a further 218 patients for non-
cardiac CT in May (an increase from 5 at the end of April). As is the case with MRI, a combination of social distancing, shielding staff and new infection control
protocols has meant that capacity has been reduced by up to 70% from pre-pandemic levels. Actions to increase capacity include the provision of additional locum
agency radiographic staff and access to additional scanners e.g. MG Neurological Centre, mobile scanners.
DXA
Four hundred and sixty patients waited longer than 6 weeks in May, up from 127 in April. The provision of DXA imaging to routinely referred patients is currently
suspended with only clinically urgent examinations being performed. Some routine recovery lists are planned to restart over the coming months where this does not
impact on other clinically urgent service provision.
Non-obstetric Ultrasound
One thousand one hundred and sixteen patients waited longer than 6 weeks for ultrasound in May – an increase from 108 at the end of April. Actions to improve
include the provision of locum agency sonographic staff. Lists are being delivered at the Nuffield, and imaging within community sites is being extended through use of
overtime.
Endoscopy
The volume of patients waiting longer than 6 weeks for an endoscopy increased from 320 at the end of April to 398 at the end of May. Endoscopy has been running at
approximately 50% capacity as a result of implementation of social distancing in waiting areas, PPE for clinical staff, enhanced infection control procedures between
cases and shielding staff. From the 15th June 10 additional lists a week will recommence at Tiverton which will increase capacity up to approximately 65%, with any
further increase reliant on changes to national guidance.
Echocardiography
The volume of patients waiting longer than 6 weeks for echocardiography increased to 379 patients at the end of May. All patients on the waiting list have been
reviewed by a Consultant to ensure that all clinically urgent cases are prioritised. Diagnostic activity remains at a lower level than pre-pandemic as a result of the need
to space out lists to accommodate new cleaning protocols and social distancing. As with Endoscopy, any immediate further increase in activity is reliant on changes to
national guidance.
Recovery and redesign
Diagnostics remains a key focus for the Trust and in addition to plans to increase capacity as outlined above, others measures include continued use of the
independent sector including the Nuffield, and work across Devon STP to make best use of system diagnostic capacity.
Diagnostics - volumes of patients waiting longer than 6 weeks for one of fifteen key diagnostics tests
23 Integrated Performance Report
June 2020 Executive Lead: Pete Adey
The Delayed Transfers of Care (DToC) performance from April to May worsened marginally from 11 people per day experiencing a delay to 13.5. This is in the
context of an increase in the number of patients requiring additional support to facilitate a discharge from the Acute hospital by 13% from 297 to 338 for the same
period. Prior to the outbreak of COVID-19, the monthly average was 425 patients.
Referrals into the Urgent Community Response (UCR) teams increased from 676 to 713 reflecting the increasing number of patients requiring support for discharge
and also admission avoidance work they are performing. Despite increasing referrals, the UCR teams have managed to reduce their average length of stay for each
patient from 10 to 8 days.
Patients awaiting personal care hours, also managed by our UCR teams, decreased from 770 hours per week to 564 hours allowing the UCR team to focus on
expediting discharges & prevention work.
Maintaining the new discharge pathways in line with COVID-19 national discharge guidance is important to further reducing the DToC position. This is planned to be
facilitated through the development of the Integrated Discharge Hub at the acute site.
Delayed Transfers of Care – Volumes of patients identified as clinically ready for discharge
24 Integrated Performance Report
June 2020 Executive Lead: Pete Adey
0
10
20
30
40
50
60
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2019/20 2020/21
Acute DTOC - Average Volume vs. Trajectory
Volume
58
5
59
4
63
2
54
2
56
8
65
1
64
1
59
8
71
9
59
5
57
4
67
6
71
3
-
2.00
4.00
6.00
8.00
10.00
12.00
14.00
-
100
200
300
400
500
600
700
800
May
-19
Jun
-19
Jul-
19
Au
g-19
Sep
-19
Oct
-19
No
v-19
Dec
-19
Jan
-20
Feb
-20
Mar
-20
Ap
r-20
May
-20
Tota
l Re
ferr
als
UCR Referrals & Length of stay on Caseload
Total referrals LOS on Caseload Linear (Total referrals)
Average Weekly hours requiring Personal Care backfill
Zone 3 & 8 (Mid Devon) Zone 4 (Exeter) Zone 5 (East Devon)
106 124 118 109 137 140 134 146 110 97 86 97
153 146 140 141 145 142 131
159 125 128
98 94
132 161 159 133
159 166 162 186
163 155
113 147
0
100
200
300
400
500
Ju
n-1
9
Ju
l-19
Aug
-19
Sep
-19
Oct-
19
No
v-1
9
De
c-1
9
Ja
n-2
0
Feb
-20
Mar-
20
Apr-
20
May-2
0
Acute Patients Requiring additional Support for Discharge
Mid Devon Exeter East Devon
Executive Lead: Professor Adrian Harris
Mortality Rates – SHMI & HSMR – Rate of mortality adjusted for case mix and patient demographics
25 Integrated Performance Report
June 2020
• Both the SHMI and HSMR positions demonstrate a sustained improvement
between November 2019 and February 2020. This is due to a correction in
the way some AMU activity was being coded, previously as ‘elective’ activity
as opposed to ‘non-elective’ activity. A resubmission of historical data with
this correction in classification applied from April 2019 to November 2019 will
be made in July 2020 and it is anticipated to have a significant effect on
bringing these indices back to well within expected levels.
• Seven new Structured Judgement Reviewers have been appointed (3 from
AMU, 2 renal, 1 ED, 1 Cardiology) This should significantly increase the
number of reviews undertaken and enrich the narrative around learning.
• There has been a strong response to the advert for Medical Examiner
Officers with some excellent candidates. It is anticipated to have these posts
in place within the next six weeks.
80
90
100
110
120
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Hospital-level Mortality Indicator (SHMI) - Rolling 12 months
Position Upper Limit Lower Limit
60
80
100
120
140
160
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Mortality Indicator (SHMI) Rolling 3 months - Weekday Admissions
SHMI Lower Limit Upper Limit
60
80
100
120
140
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Hospital-level Mortality Indicator (SHMI) Rolling 3 months
SHMI Lower Limit Upper Limit
60
80
100
120
140
160
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Mortality Indicator (SHMI) Rolling 3 months - Weekend Admissions
SHMI Lower Limit Upper Limit
80
90
100
110
120
130
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
HSMR (12 Month Rolling)
HSMR
• The indicators for stroke are showing an improvement between April and May, which demonstrates a recovery post COVID-19 phase one.
• The stroke pathway since COVID has had to adapt and has faced some challenges with changes in ward allocation impacting on the stroke hyper acute, acute,
post-acute and rehabilitation pathways; however the Stroke Team has worked tirelessly during this initial COVID surge, having had to plan rapidly, make changes
and adapt quickly to different working practices to keep stroke patients and staff safe.
Stroke Performance – Quality of care metrics for patients admitted following a stroke
26 Integrated Performance Report
June 2020 Executive Lead: Professor Adrian Harris
0
20
40
60
80
100
120
140
160
180
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Average Thrombolysis Times (minutes)
Trust Door to Needle Trust Call to Needle
National Door to Needle National Call to Needle
65%
70%
75%
80%
85%
90%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2019/20 2020/21
Proportion of patients admitted following a Stroke spending 90% or more of their stay on the Stroke unit
Unvalidated Position Validated Position Target
0%
10%
20%
30%
40%
50%
60%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2019/20 2020/21
Discharge Destination to Home (%)
Discharge Destination to Home % National Position
Sickness and Absence
• In May the monthly sickness absence rate decreased marginally to 3.67% from the April rate of 3.77%.
• There were 35 sickness absence recorded in May attributed to COVID-19. It is important to note the 3.67% rate quoted does not take account of significant staff absence
in May due to COVID-19 related self isolating to prevent the further spread of the virus. National guidance advised such absences be recorded as ‘other leave’ and not
sickness.
• The rate of absence related to COVID-19 in May was 5.8%.
• At 31.26% the percentage of days lost to Anxiety / stress / depression / other mental illnesses in May is the highest rate for 9 months.
Recruitment
• The Trust is responsible for the recruitment of staff for the Exeter Nightingale which is due to open late June/early July. To date, 71 staff (contracted and bank) have been
recruited by the Trust to staff this new regional facility.
• The COVID-19 alert and the task of adapting recruitment activity in response has resulted in some notable outcomes and challenges. The additional on boarding to the
Central Bank has enabled 160 new bank workers to be hired, including over 130 HCAs. Nursing students have been taken on early, totalling 97 RGN (Registered General
Nurses) and 16 midwives. And for medics, 30 medical students beginning their FY1 placements early. The Bring Back scheme proved more challenging however (eight
taken on and nine in progress out of 59 put forward) due to candidates mainly seeking non-patient or remote working roles. Plus, supporting the Volunteers Department to
manage the overwhelming interest in voluntary roles. These additional workstreams on top of the ongoing training programmes for midwives, Trainee Nurse Associates
and Clinical Apprentices.
Other Workforce Indicators
27 Integrated Performance Report
June 2020 Executive Lead: Hannah Foster
0
100
200
300
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
2019/20 2020/21
Volume of Newly Recruited Members of Staff
Add Prof Scientific and Technic Additional Clinical Services Administrative and Clerical
Allied Health Professionals Estates and Ancillary Healthcare Scientists
Medical and Dental Nursing and Midwifery Registered
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
2019/20 2020/21
12 Monthly Turnover
Position Target
Executive Lead: Chris Tidman
Income & Expenditure
28 Integrated Performance Report
June 2020
I & E
Surplus/(Deficit)
Income Variance
to Budget
Fav/(-Adv.)
(£'000)
Patient Income / top-up
NHSE/I have notified a block value for patient income and a top-up payment to the Trust for the first four months of the year. The value covers income expected from all the main commissioners of the Trust. Patient income is therefore in line with budget.
Other/Private Patient Income
Private patient income is £56k in the first two months, £215k lower than budget.
Commercial Income
Commercial income has under-recovered by £1.7m year to date, mostly relating to under recovery of commercial income as a result of COVID 19 including Genomics (£417k (due to NHSI/E COVID recharging policy), Car Parking (£344k), Catering / restaurant (£235k), FORCE (£166k) Fertility (£127k), Childcare (£126k) and Laundry (£108k).
0-213
-1,657
00
Year to Date
NHS
Other/PrivatePatients
Commercial
Total
-1,869
Month 2 Summary Finance position
• The Trust is reporting a break even financial year to date position in line with national guidance. • The Trust's financial position will continue to be break-even for the first four months of the year after NHSE/I have notified a block value for patient income and a top-
up payment process. A retrospective top up or claw back will be made each month to ensure a break even position is achieved. It is expected that this process will continue until the end of October with updated block and top up payments and more rules regarding the retrospective payment/c law back from July onwards.
• A direct claim from NHSE/I for the Trust's COVID expenditure of £3.6m was incurred during May (year to date £6.3m). The Trust will also receive a top-up/claw back for any underlying increase/decrease in its net run rate (£2.0m in May and a total of £4.0m year to date).
• The Trust has incurred £6.7m as a result of the setup costs for the Nightingale Hospital during May. These costs will be recovered as part of the retrospective top-up payment.
• Expenditure and commercial income budgets have been rolled over from the previous financial year and inflation added relating to pay. • In month 2 pay has overspent by £182k, non pay has underspent by £571k and planned developments (reserves) not spent of £955k.• NHSI/E has requested the Trust to provide a forecast to month 4. The forecast assumes a similar rate of expenditure as month 1 and 2, with an increase in non-pay
expenditure in month 3 and 4 aligned with the expected increase in patient activity. • The Trust savings programme is currently on hold, and will form part of the recovery and restoration phase. • Cash as at the end of April is £91.8m, an increase of £33.7m on the value held at the year end due to a pre-payment of June block income.• Divisional budgets have not been adjusted for any budget setting requests or COVID 'top ups' at Month 2. The Trust is reviewing budget setting requests in light of
COVID 19 and new ways of working and will be conducting a mid year review in the Autumn.
Pay Expenditure
29 Integrated Performance Report
June 2020 Executive Lead: Chris Tidman
Pay
Fav/(-Adv.)
(£'000)
Agency Staffing
(exc COVID
costs)
£000
Pay has overspent by £710k year to date - overspends on medical staff (£90k), nursing (£479k), other staff (£195k) are offset with underspends within Admin and Managers (£54k).
An overspend in May of £182k relates to: • Nursing staff expenditure has overspent by £330k in May, mostly relating to self
isolation/sickness cover in response to COVID 19. As shown by the charts below, bank fill rates have significantly improved and nursing teams are reviewing the use of bank and agency requests, to ensure nurse redeployment is being fully optimised.
• An overspend on "other" staff of £195k in May mostly relates to Domestic Services £81k, Radiology £80k and Genomic Lab £52k.
• Medical staff expenditure has underspent by £131k in May. This mostly relates to consultant vacancies in Histology and Radiology and a reduction in WLI's across the Trust as illustrated in the chart below:
Consultant enhanced PA's are currently being reviewed as part of the recovery andredesign phase.
• Admin and Managers have underspent by £69k in May.
• Pay budgets have not been adjusted for any budget setting requests this financial year. The Trust is reviewing requests made as part of budget setting in light of COVID 19 and new ways of working.
• The Trust awaits national guidance for Senior Medical Staff pay inflation, however 2% has been provided for and included in this position. There is a risk that when the national guidance is announced ring-fenced funding might not be sufficient to cover the actual increase.
• Pay is forecast to month 4 to continue at a similar rate as the first two months.
-90
-47954
-195
Year to Date
Med Staff
Nursing
Admin & Mgrs
Others
Tota l
Variance
-710
• Agency expenditure for May was £450k (£667k in April) with expenditure of £165k on "other staff", £154k Admin and managers, £92k for Medical staff and £38k for Nursing.
• As seen in the chart below Nursing has seen a large reduction in Agency usage partially offset with an increase in use of Bank nursing. An increased fill rate for bank shifts has meant less agency requirement and improved staff morale and patient safety. Vacancies also have reduced after a student nurse intake.
NB. March 2020 excludes the Children and Young People Alliance adjustment of £4.5m and NHSI employers' contribution of £15m; COVID and Nightingale expenditure
Non Pay & Divisional Position
30 Integrated Performance Report
June 2020 Executive Lead: Chris Tidman
Non Pay
and Reserves
Fav/(-Adv.)
(£'000)
Divisional
Position
Fav/(-Adv.)
(£'000)
Divisional Positions
Surgery (£1.6m underspent) The year to date underspend mostly relates to lower expenditure within clinical supplies (£1.6m)
relating to reduced activity levels, due to COVID 19. Pay is overspent (£25k) mainly within Nursing (£185k) partially offset with Medical staffing (£104k) due to low WLI spend and vacancies.
Medicine (£1.2m overspent) The year to date overspend includes a pay overspend of £501k (£280k Medical Staff and £199k Nursing). Non pay is overspent by £667k, overspends of £1.1m on pass through Drugs and £120k on
activity carried out by the independent sector are partly offset by favourable variances on pass through devices (£305k), Med & Surgical Items (£60k) and in-tariff drugs (£93k).
Specialist (£1.1m overspent) In April and May commercial income has under recovered by £846k, relating to reduced activity in
Fertility, Blood Sciences and Pharmacy due to COVID (£272k), loss of income from UK NHS trusts for
Genetics tests (£416k) and a loss of external income for staff recharges (£155k). Non-pay has overspent by £314k, mainly driven by clinical supplies (£285k) due to spending on testing, genetics
consumables previously covered by commercial income, and chemo consumables due to growth.
Community (£64k underspent) Non pay expenditure is underspent by £99k year to date, which mostly relates to reduced staff travel and medical sundries (dressings), due to a reduction in activity. This is partially offset by a £43k
overspend on pay due to increased agency for high dependency on inpatient wards (£30k) and day sitting (£25k).
1,647
-1,227
-1,153
64
670
Year to Date
Surgery
Medicine
Specialist
Community
Other
0
Total
Variance
Non-pay expenditure (excluding R&D, COVID and Nightingale expenditure) is £360k underspent year to date, with an underspend of £571k in May.
The underspend in May mostly relates to lower expenditure due to reduced patient activity. Under-spends on Clinical Supplies (£990k) and Non Clinical Supplies (£190k) are offset with an overspend on Drug costs (£475k) largely related to pass through drugs which are refunded via the top-up income from NHSE/I.
The year to date overspend on drugs of £1.2m (£1.4m overspend relates to pass through drugs) is offset with an underspend due to reduced patient activity due to COVID 19 - Clinical Supplies (£1.8m).
Miscellaneous Other Expenditure overspend (£364k) mostly relates to planned IT equipment expenditure (£221k) and smaller variances across the Trust. Services received (£225k) relates to activity received from other organisations and an increase in send away testing.
The forecast for the end of July anticipates that non pass through drugs and devices, clinical and non clinical supplies will increase in months 3 and 4 by 20% to allow for an increase in patient activity.
-1,184
1,818
315
0
-225
-364
Non Pay Year to Date
DrugsClinical SuppliesNon ClinicalR&D ExpenseServices ReceivedMisc. Other
Total
Variance
360
Cash & Capital Expenditure
31 Integrated Performance Report
June 2020 Executive Lead: Chris Tidman
Capital
expenditure
Cash
Cash - Year to Date
Closing cash as at the end of May is £91.8m, an increase of £33.7m on the value held at the year end.
The increase is due to all NHS Trusts receiving June's monthly income in advance. This national NHSE&I decision was made to help support Trusts' liquidity during the COVID 19 crisis.
Capital - Year to DateCapital additions of £4.2m were incurred in the first two months of the financial year, with the majority relating to MyCare.
The capital regime has changed - STP’s are now responsible for co-ordinating the level of capital expenditure (CDEL) across their system. Each Trust will be given an annual CDEL limit by its STP. Whilst Foundation Trusts can still legally set its own capital spending, any over commitment has the potential to impact on other Trusts.
The capital programme for 2020/21 will be higher than originally forecast due largely to the impact of COVID-19 in deferring the go-live date of MyCare. The additional cost has been escalated to NHSE&I via the STP. Also due to COVID 19 there is a risk that it may lead to delay with implementing other capital schemes, i.e. equipment replacement schemes and some strategic schemes. Schemes will need to be reviewed to check that operationally they can be implemented, but also due to the uncertainty relating to the STP capital expenditure cap. Separately, £22m of national capital bids have also been submitted via the STP linked to phase 2 and phase 3 recovery, and a response is still awaited.
The Trust is working with the Devon STP to progress with finalising its capital programme. The Trust has asked NHSE/I to increase the STP allocation by circa £30m relating to MyCare expenditure as the Trust had received loan funding for the programme prior to the new capital regime being introduced. NHSE/I have currently not agreed to this increase, meaning that the Trust and STP will technically have a non compliant capital plan.
Cash
Actual
£m
Opening cash balance 58.1
Cash inflow / (outflow) from operating activities (0.0)
Depreciation charge - non cash expense 1.9
Working capital movements - inventories (0.2)
Working capital movements - receivables (7.9)
Working capital movements - payables inc. deferred income 43.4
Capital expenditure (4.2)Loan repayments (0.0)
Loan drawn down 0.8
Closing cash balance 91.8
Capital
Year to date
£m
Capital expenditure 4.2
Financial Tables
32 Integrated Performance Report
June 2020 Executive Lead: Chris Tidman
Royal Devon & Exeter NHS Foundation Trust Outturn to end July 2020 (4 months)
Actual Budget Actual Actual Budget Actual Actual Budget Actual
Income Statement Variance Variance Variance
Period ending 31/05/2020 to Budget to Budget to Budget
Donated asset income & depreciation and AME impairment (19) (19) 0 (36) (36) 0 (72) (72) 0
Net Surplus/(deficit) after donated asset & PSF/MRET Income (19) (19) 0 (36) (36) 0 (72) (72) 0
KEY MOVEMENTS
1 Block contract income and top-up income for the first four months of the year.
2 Pay - overspends on Medical Staff (£90K), Nursing (£479k) and Other staffing (£195k) are partially offset with an underspend on Admin & Managers (£54k) .
3 Drugs overspend- pass through is overspent by £1.4m and is not recovered directly but form part of the top up process. This being offset with a £200K underspend on normal in tariff Drugs.
4 This reflects unallocated development bids where expenditure has not yet been incurred.
Current Month Year to Date
Total interest receivable/ (payable) - inc committed WC facilities
Financial Tables
33 Integrated Performance Report
June 2020 Executive Lead: Chris Tidman
Royal Devon & Exeter NHS Foundation Trust Prior Yr
Actual March 2020
Statement of Financial Position
Period ending 31/05/2020
Month 02
£000 £000
Assets, Non-Current
Property, Plant and Equipment, Net (including intangibles) 251,691 249,390 1
Investment in joint venture 5 5
Non NHS Trade Receivables, Non-Current 2,599 2,455
Assets, Non-Current, Total 254,295 251,850
Assets, Current
Inventories 8,898 8,709
Trade and Other Receivables, Net, Current 43,040 35,133 2
Non Current Assets held for sale 0 0
Cash 91,793 58,081 3
Other Assets - Current Assets Held by Charitable Funds 0 0
Assets, Current, Total 143,731 101,923
Liabilities, Current
Loans, non-commercial, Current (DH, FTFF, NLF, etc) (3,249) (3,171)
Finance leases - Current 0 0
Trade and Other Payables, Current (54,623) (15,480) 4
Deferred Income, Current (6,418) (5,163) 5
Provisions, Current (352) (352)
Current Tax Payables (7,546) (7,131)
Other Financial Liabilities, Current (29,470) (26,867) 6
Liabilities, Current, Total (101,658) (58,164)
NET CURRENT ASSETS (LIABILITIES) 42,073 43,759
TOTAL ASSETS LESS CURRENT LIABILITIES 296,368 295,609
