Performance Report For Quarter 1 2013/14 B oard Meeting 8 August 2013

Colchester Hospital University NHS Foundation Trust

Performance ReportFor Quarter 1 2013/14

Board Meeting8 August 2013

Page

Overview 2

Quality (Including Risk) 3

Workforce 11

Performance 16

Finance 19

Appendices

Performance Framework 30

FRR Glossary 36

Colchester Hospital University NHS Foundation Trust Quarter 1

Overview

QualityThe HSMR position for April was 84.49. SHMI (which measures inpatient mortality and deaths up to 30 days after discharge) identifies CHUFT as having a 'higher than expected' mortality ratio.

Clostridium Difficile in Q1 was 7 against a ceiling of 5 (ceiling for 2013/14 is 18).

The overall score for the Net Promoter for Q1 was 77%.

Risk: At the end of Quarter 1 there were a total of 70 live risks held within the Trust section of the Risk Register. There are no outstanding Extreme or High risks to be reviewed on the Risk Register.

WorkforceMonthly turnover was 0.86% contributing to an annual turnover of 9.91% (which is over the 9.5% target).

The monthly figure for sickness absence is 3.22% and the rolling 12 month figure is 3.86%.

Vacancy rates are higher than the Trust 4% target for all staff groups, 6.5% for the Trust.

PerformanceThe Trust will be reporting a governance rating of Green for Quarter 1.

Although the Trust is above its plan on Clostridium Difficile for the year to date, it does not score adversely because Monitor applies a de-minimus of 12 cases for this indicator. The Trust had 7 cases against a plan of 5 for Q1.

Activity: Elective and day case activity is below plan due to the under delivery of planned developments. For day cases this is driven by Urology and T&O. For elective it is largely General surgery and Gastroenterology.

Outpatients are over delivering against the revised plan, mainly in Cardiology.

Non Elective activity is delivering to plan

FinanceThe Trust’s EBITDA and overall position were both worse than plan. EBITDA was £1.56m (2.5% margin) and the Trust delivered a deficit of £1.54m against a planned deficit of £1.17m. The Financial Risk Rating (FRR) of 2 meets plan. Liquidity scores a strong 4.

The spend on the capital programme for the year to date is £2.4m against a planned spend of £2.9m for the same period.

2


Quality

3

Quality Exception Report : Q1

Variance in Performance In Q1 there were 7 Clostridium difficile cases against a ceiling of 5. The ceiling for the year is 18. This over-performance is driven by 5 Cases in May, which was particularly high. Outside of May the Trust has been on trajectory. Evidence shows there is no correlation or link between the incidents to date.

The Trusts SHMI identifies CHUFT as having a 'higher than expected' mortality ratio. For the period October 2011 to September 2012, the SHMI for Trust was 117.22.

Actions To continue to monitor compliance of antibiotic prescribing, hand hygiene, environmental cleanliness. Review deep cleaning programme.

An on-going investigation of health records is underway to determine if the cause of the Trust’s SHMI is related to data quality, coding or pathway. CUSUM alerts are being monitored closely, and cases are reviewed as a CUSUM alert is identified.

Performance Recovery It is recognised that the target of 18 for the year I very challenging. It is essential that the actions identified are rigorously applied and performance is closely monitored if the required target is to be achieved.


Quality – Patient Safety

Summary

There were 258 falls recorded for Q1. Therefore, there have been 39 (13%) fewer falls recorded compared to the same quarter in 2012/13. There were 3 serious harm falls in Q1. There has not been a serious harm fall since 13th April 2013. The average number of reported hospital acquired grade 2 pressure ulcers each quarter during 2012/13 was 21; for Q1 2013/14 there were 13. Compared to Q1 2012/13, there has been a reduction of 53.6% in the number of grade 2 pressure ulcers and 53.3% fewer grade 3/4 pressure ulcers.

Rounding compliance for Q1 has been 93-96%. Significant improvements in audit performance has coincided with a re-launch programme that commenced late last year.

The NHS Safety Thermometer audit for Q1 was successfully conducted across the hospital and uploaded to the NHS information Centre in line with CQUIN requirements.

4


Quality – Patient Experience

Summary

‘At Our Best Everyone Everywhere’ ‘In Your Shoes’ workshop sessions took place during April 2013. This enabled the Trust to feedback the good work which has taken place over the past year but more importantly, to talk to patients to find out where further improvement is required. The information gathered has been correlated with the ‘In Our Shoes’ session which took place in February.

There will be key engagement with staff around ‘At Our Best’ over the next few months. Following the Keogh review, there's an opportunity to be more supportive towards each other and a chance to extend ‘At Our Best’ so that it's about how we are with each other as well as patients. The average Meridian score for Q1 was 89%.

The Net Promoter or Friends and Family score during Q1 was 77.1. That places the Trust in the upper quartile of Trusts for this indicator. Compliance with response returns was 23% against a target of 15%.

5


Quality – Infection Control

Summary

The MRSA bacteraemia trajectory remains at 0. MRSA screening compliance is improving (currently 86.9%). The Infection Control Team are visiting inpatient areas to understand why we are failing to regularly screen all patients.

Clostridium difficile in Q1 ; CHUFT 7 against a ceiling of 5 (ceiling for 2013/14 is 18). As of 30/6/2013, CHUFT were therefore 2 cases above trajectory. We have seen an improvement in nurse-led cleaning, but work needs to continue on antibiotic prescribing.

All cases are recorded as incidents on Datix, a root cause analysis is completed by ward staff, and panel reviews are organised.

Monthly meetings are held with the CCG and the Infection Control Team to review each case. An action log exists for these meetings.

Feedback from the panel review process identifies the cases appear unrelated. Work continues to ensure robust compliance with:

• Hand hygiene• Antibiotic prescribing• Environmental cleanliness

A number of new proposals are currently under review; these would increase capacity relating to equipment decontamination and the deep clean programme.

6

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar0 0 0 0 0 0 0 0 0 0 0 0

Augmented care specimens0 0 0 0 0 0 0 0 0 0 0 0

Actual (total)

Trajectory

MRSA bacteraemia reports (Time Series vs. trajectory) 2013/14 (HPA HCAI Data capture system)

0

1

2

3

4

5

6

April May June July August September October November December January February March

2013 2014MR

SA

bact

erae

mia

repo

rts

Cumulative MRSA envelope ceiling for Trust lab Cumulative MRSA reports from Trust lab


Quality – Mortality

Summary

The HSMR for April 2013 was 84.49. The indicative rebased HSMR position for 2012/13 is approximately 105. Crude relative risk for April was 84.59.

SHMI (which measures inpatient mortality and deaths up to 30 days after discharge) identifies CHUFT as having a 'higher than expected' mortality ratio. For the period October 2011 to September 2012, the SHMI for Trust was 117.22.

The Patient Safety Committee will be monitoring the negative CUSUM alerts in Dr Foster (diagnosis groups/procedures where Trust performance is significantly worse than the benchmark) and facilitating the investigation of health records to determine if the cause was down to data quality, coding or pathway.

Mortality rates followed historic trends for the end of 12/13. April to June figures are lower than previous years and continue the trend from the end of 12/13.

7

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD(Apr) Annual

2010/11 122.7 108.9 107.3 116.2 112.4 84 101 108.4 99.7 113.7 98.7 114.3 122.7 107.22011/12 120 103.4 109.5 103.6 95 79.2 90.5 81.9 104.6 110.4 103.9 113.1 120.0 101.72012/13 104.94 109.62 94.47 90.77 111.65 101.05 100.17 91.35 116.24 91.9 97.25 90.4 103 99.762013/14 84.49 84.49 84.49RR 100 100 100 100 100 100 100 100 100 100 100 100

70

80

90

100

110

120

130HSMR Trend Year on Year

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarYTD

(Apr-June)

Annual

2011/12 148 126 138 132 109 104 111 101 159 141 130 146 412 15452012/13 127 140 113 107 125 115 124 110 157 138 144 143 380 15432013/14 126 121 104 351 351

Varience12/13 - 13/14 1 19 29 1192

80

100

120

140

160

180

200CHUFT Crude Mortality


Quality - Risks Summary

Summary Currently, there are 70 active risks on the Trust Risk Register. There are currently 6 High risks that have been reviewed this month.

8

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June0

102030405060708090

100

Number of Trust Risks by current grading

Operations Finance Medical Director Estates & Facil-ities

Nursing & Pa-tient Experience

Workforce0

1

2

3

Number of Trust High Risks by Director


Quality – Risk Register

9

Datix Risk No

Initial Risk Grading

Current Risk Grading

Risk Previous Risk Grading

Service Area Responsible Officer

Date Reviewed

Date Opened

Action Plan in place

Update Summary

888 SHMI for CHUFT is higher than expected.

Whole Trust Medical Director

24.07.13 31.05.13 Yes

25.07.13 - Risk remains unchanged. Keogh investigation team have visited the trust and produced an action plan. The team will revisit the trust in November 2013.

773

The governance arrangements for the

clinical portal are insufficiently clear and

robust to ensure effective delivery of the de

Whole Trust Director of Finance

24.07.13 23.01.13 Yes

25.07.13 - Risk 774 has been amalgamated with Risk 773 as requested by the Director of Operations as the Risks were very similar. A gateway meeting is scheduled for 9th August to assess progress against the critical activities identified to the Executive Team on the 24/07/13. By this stage the Trust should be able to determine whether key Data Migration and BI issues have been resolved and whether the project is viable to continue.

743Failure to capture the

benefits that the Clinical portal makes possible

Whole TrustDirector of

Finance24.07.13 24.09.12 Yes

25.07.13 - 'Go live' date is anticipated to be Mid October subject to Board approval.

This year the trust has a CIP target of £9.6m Q1 delivery of £1.6m for the current year.Divisions are under continuous review by PMO to monitor delivery and to identify new schemes.PMO CIP report reviewed at Finance Committee monthly.Robust challenge to divisional CIP plans by Executive provided at Monthly Divisional Performance Reviews.CEO and Chair to visit Monitor to review progress on 1 August.

633 Significant outbreak of MRSA or CDiff cases

Whole Trust

Director of Nursing &

Patient Experience

15.07.13 18.08.11 Yes25.07.13 -C-Diff cases are currently off trajectory (8 cases against a target of 7). The Trust envelop for 2013/14 is 18.

Whole Trust Director of Finance

10.07.13 05.09.11 Yes648 Failure to deliver the Cost Improvement Programme


10

Quality – Risk Register

Datix Risk No

Initial Risk Grading

Current Risk Grading

Risk Previous Risk Grading

Service Area Responsible Officer

Date Reviewed

Date Opened

Action Plan in place

Update Summary

630Not Achieving Workplace

PlanWhole Trust

Director of Workforce

24.05.13 18.08.11 Yes

25.07.13 - The Director of HR has completed a revew of the nurse template and has instigated processes to manage risk of maintaining vacancy levels within 2% by October. A plan for the recruitment of medical roles will be prepared by the end of July.

474 Safeguarding childrenNursing &

Quality

Director of Nursing &

Patient Experience

02.07.13 20.11.09 Yes

25.07.13 - Decision made to close recommendation for social worker to be based at the hospital as closed by the Essex safeguarding Children Board. The Acting Director of Nursing to discuss further with her counterpart at the CCG.

396Infrastructure Resilience -

Telecoms Switch Single Point Of Failure

Whole TrustDirector of

Finance11.07.13 16.03.09 Yes

11.07.13 -The installation will go ahead during the weekend of the 27th/28th July.


Workforce

11

Workforce Exception Report : Q1

Variance in Performance At the end Q1, the Trust had a vacancy rate of 6.43% against a target of 4%.

Mandatory Training was at 55.6% against a target of 100%.

Staff Engagement/advocacy scores put the Trust at or below average for Acute Trusts. (Scores: Engagement 3.61 (UQ 3.9), Advocacy 3.53 (UQ 4))

Actions An international recruitment campaign for nursing and medical staff.

Changes to medical rotas and creation of revised resourcing model to deliver OOH care, with a plan for contingency/winter pressure by End September

Review of mandatory training offering/simplification and clarity on training for fitness to practice and time allocation

Engagement plan prepared for Board and a range of actions underway across leadership, communication, alleviating work pressure and managing performance. We will undertake trust wide survey end Sept to measure progress.

Performance Recovery

The aim is to have a vacancy level for nurses of 2% by end October and to have offers by October for ‘difficult to fill roles’.

To have revised medical rotas and resourcing plan by the end of December

By the end of Q3 to have 90% of the revised proposal for mandatory training met

By end of Q4 aim for 3rd quartile re Staff Engagement/advocacy subject to full accountability and leadership


12

Workforce – Staff in Post & Turnover

The Turnover % excludes all Locums & Junior Doctors (Foundation Year 1, 2 and Speciality Registrars)

Summary The information provided shows the Establishment and Staff in Post figures at the end of Quarter 1 – 2013-2014.

Vacancies – The Trust now employees 63 more employees in Jun-13 than it did in Mar-13. A successful overseas recruitment campaign has resulted in 40 additional Band 5 Nurses being recruited in Quarter 1. An additional 30 will be placed in Quarter 2. The trust has also reviewed its acuity staffing levels on the Wards, reviewed the need for maternity backfill to be covered and to replace sisters to enable them to remain super numery. A further international campaign will be undertaken in August and by 1 October, vacancy levels for nursing will be reduced to below 2%.

Risks continue around stability of the scientific community due to uncertainty of future roles in TPP.

Annual turnover to 30-Jun-2013 was of 9.91% (still below the 10% target rate for 13-14).


13

Workforce – Vacancies

Summary

The information provided shows the Establishment and Staff in Post figures at the end of Quarter 1 – 2013-2014.

By Staff Group - Vacancy % is above Trust target for all Staff Groups. Nursing & Midwifery has reduced from 8% to just over 4% following the Recruitment of Spanish Nurses. Plans are in place to reduce the Nursing target to under 2% by the end of Quarter 2.

By Division – Women’s & Children’s and Corporate are both below the Trust target of 4%

Medical vacancies remain above target with challenges in filling emergency department roles and at middle grade. An international campaign has begun to seek to fill these roles by September.


14

Workforce – Sickness Absence

Summary

Although the rolling sickness absence for this period remains over the Trust target of 3.5% (at 3.86%), the quarter-on-quarter figure does show a downward trend.

Sickness absence is being actively managed by HR Business Partners and also by line managers, using the Health & Wellbeing Staff Off Sick support mechanism.


15

Workforce – Summary

Organisations Funded FTE In Post FTE Vacancies Vacancy % Sickness % (12 Months)

Turnover (12 Months)

Colchester Hospital University FT 3876.13 3626.71 249.42 6.43% 3.86% 9.91%CORP Director of Operations 11.47 6.00 5.47 47.69% 1.03% 38.43%CORP Finance 208.72 199.75 8.97 4.30% 2.70% 8.31%CORP Iceni Centre 2.30 1.70 0.60 26.09% 0.00% 0.00%CORP Medical Director 7.77 9.50 -1.73 -22.27% 1.00% 41.40%CORP Nursing & Patient Experience 54.43 56.43 -2.00 -3.68% 2.15% 15.05%CORP Trust Board 4.23 4.00 0.23 5.44% 2.40% 0.00%CORP Workforce 58.56 57.83 0.73 1.24% 3.76% 23.16%CS&C Breast Services 52.81 47.56 5.25 9.94% 4.69% 7.12%CS&C Cancer Services 204.76 205.27 -0.51 -0.25% 3.88% 6.33%CS&C Pathology 153.16 140.74 12.42 8.11% 2.64% 10.53%CS&C Pharmacy 101.68 101.62 0.06 0.06% 3.88% 7.44%CS&C Radiology 136.67 112.82 23.85 17.45% 3.93% 8.79%CS&C Therapies 156.32 149.27 7.05 4.51% 1.72% 14.96%FM Car Parking 2.50 1.00 1.50 60.00% 0.00% 0.00%FM Catering 90.12 85.13 4.99 5.54% 5.27% 4.88%FM Ests & Capital Projects 34.00 33.77 0.23 0.68% 1.07% 6.04%FM Facilities Mgt & Admin 13.19 11.00 2.19 16.60% 8.28% 13.66%FM Grounds & Gardens 1.00 1.00 0.00 0.00% 20.82% 0.00%FM Helpdesk 10.39 9.39 1.00 9.66% 3.03% 20.65%FM Housekeeping 182.82 156.00 26.82 14.67% 6.83% 8.09%FM Portering 75.09 71.07 4.02 5.36% 6.12% 1.40%FM Security 14.00 14.00 0.00 0.00% 3.44% 7.14%FM Transport 14.43 13.07 1.36 9.45% 13.73% 0.00%MED Emergency Medicine 204.71 188.81 15.90 7.77% 6.12% 12.31%MED General Medicine 228.88 218.16 10.72 4.68% 4.20% 9.48%MED Site Operations 23.70 22.17 1.53 6.44% 2.02% 12.51%MED Specialist Medicine 377.62 357.28 20.34 5.39% 3.85% 11.37%SURG Anaesthetics & Technical Services 394.20 359.77 34.43 8.73% 4.51% 8.04%


Performance

16

Performance Exception Report : Q1

Variance in Performance Currently the Trust is delivering on its performance plans.

The Trust has reported governance rating of Green for Quarter 1 and has seen marginal variations on planned activity. Clinical Income is on plan.

Therefore there are no material exceptions to report.


Performance - Monitor Compliance Framework

17

Priority Indicator ScoringThreshold/

agreed target YTD

June 2013 Performance

Target or Indicator (per 2013-14 Compliance Framework)

1 * Clostridium Difficile - meeting the objective (YTD) 1 18 0

1 MRSA - meeting the objective (YTD) 1 1 01 Cancer 31 day wait second or subsequent - failure of any threshold represents failure against the overall target Drugs 98% 100.00%

1 Cancer 31 day wait second or subsequent - failure of any threshold represents failure against the overall target, Radiotherapy 94% 98.29%1 Cancer 31 day wait second or subsequent - failure of any threshold represents failure against the overall target Surgery 94% 95.65%

1 ** All Cancers 62-day wait for the first treatment - failure of any thresold represents failure against the overall target. from national screening service referral

90% 90.70%

1 All Cancers 62-day wait for the first treatment - failure of any thresold represents failure against the overall target. from urgent GP referral to treatment

85% 86.52%

1 Percentage of patients treated under 18 weeks - Admitted 1 90% 95.35%

1 Percentage of patients treated under 18 weeks - Non Admitted 1 95% 98.85%1 Percentage of patients on an incomplete pathway with a maximum of 18 weeks waiting time 1 92% 98.96%

1 A&E Total time in A&E - 4 Hr Standard 1 95% 97.35%2 All Cancers 31-day wait from diagnosis to first treatment 0.5 96% 97.47%

2 Cancer two week wait from referral to date first seen - failure of any threshold represents failure against overall target. Comprising either: all cancers

93% 96.90%

2 Cancer two week wait from referral to date first seen - failure of any threshold represents failure against overall target. Comprising either: for symptomatic breast patients

93% 93.21%

NB Cancer Snapshot data at 30/7/2013 * As De Minimis (12) is not exceeded, Q1 performance for this indicator is reported as 'Achieved'** June data unvalidated - 0.5 (shared) breach manually removed due to complications in recording. Discussions ongoing with regards to showing this on Open Exeter

CQC Standards

Failure to comply with requirements regarding access to healthcare for people with a learning disability 0.5 No NoRisk of, or actual, failure to deliver mandatory services 4 No NoCQC compliance action outstanding (as at 30 June 2013) special No NoCQC enforcement action within last 12 months (up to 30 June 2013) special No NoCQC enforcement notice currently in effect (as at 30 June 2013) 4 No NoMinor CQC concerns or impacts regarding the safety of healthcare provision (as at 30 June 2013) special No YesModerate CQC concerns or impacts regarding the safety of healthcare provision (as at 30 June 2013) special No Yes 0.0Major CQC concerns or impacts regarding the safety of healthcare provision (as at 30 June 2013) 2 No NoUnable to maintain, or certify, a minimum published CNST level of 1.0 or have in place appropriate alternative arrangements 2 No NoTrust unable to declare ongoing compliance with minimum standards of CQC registration special No NoHas the Trust has been inspected by CQC (in the quarter ending 30 June 2013) special No NoIf so, did the CQC inspection find non compliance with 1 or more essential standards special No No

OverideRating

0.0

0 00 0

No

0 00 0

0.5 0

1

0

1 11

0

0 00 0

0 0

0 0

0 00 0

0 0

001

Monitor Governance score – Green

Jun-13 Q1

0 0

0 0

01 0

00 00 0


Performance - Activity

Summary The activity plan shown is revised to take in to account the outcome of contractual negotiations with the CCG which concluded in month 1.

Elective and day case activity is below plan due to the under delivery of planned developments. For day cases this is driven by Urology and T&O. For elective it is largely General surgery and Gastroenterology.

Outpatients are over delivering against the revised plan, mainly in Cardiology.

Variances between RDA and day case from last year is caused by a planned and agreed change in recording methodology.

AprMay Jun Jul

AugSep Oct

NovDec Jan Feb Mar YTD

Full Y

ear-

1,000

2,000

3,000

4,000

5,000

6,000Elective Spells (Incl

RDAs)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Full Year

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Non Elective Spells

RevisedPY Fav / (Adv) %>PY Plan Actual Fav / (Adv) %>Plan

Day cases 6,427 4,184 65.1% 10,874 10,611 (263) -2.4%Inpatients 1,889 (67) -3.5% 2,124 1,822 (302) -14.2%RDAs 3,388 (3,009) -88.8% 356 379 23 6.5%Non Electives 10,445 (271) -2.6% 10,171 10,174 3 0.0%First Outpatient 27,826 5,660 20.3% 31,556 33,486 1,930 6.1%Follow Up Outpatients 63,656 8,448 13.3% 71,017 72,104 1,087 1.5%Outpatient Procedures 10,489 1,484 14.1% 11,729 11,973 244 2.1%Non Face to Face 3,981 1,666 41.8% 6,540 5,647 (893) -13.7%A&E Attendances 19,320 349 1.8% 19,522 19,669 147 0.8%

18


Finance

19

Finance Exception Report : Q1

Variance in Performance For Q1 the Trust reported a deficit of £1.5m, £ 0.4m down against plan. This resulted in an FRR of 2 which is consistent with plan. Increased costs of £1.2m were partially offset by £0.8m of additional income. Of the £1.2m increased costs, £0.8m was in relation to pay, the remainder was mainly in relation to under-delivery of Cost Improvement Programme (CIP). The pay variance was driven by a £1.5m overspend on consultant and doctors budgets. Against a CIP plan of £1.4m for the year to date, £0.5m was delivered. Actions Divisions have been tasked to produce detailed revised plans to return to target. These are well underway and are due to be delivered at their August performance meetings with Execs. These plans aim to fully identify CIPs. HR are leading on plans to address doctors pay. A Project Management Office (PMO) assurance process has been implemented to review and test all projects, but especially CIP plans. Further efficiency projects have been identified and scoped with Birch (Portering, ED, Housekeeping) Performance Recovery By the end of Q2 we expect to report a positive ‘in quarter’ surplus and to be delivering an FRR of 3. We expect to be achieving a cumulative surplus and on track to deliver the trust plan by Q3.


Financial Overview

Cost Improvement ProgrammeThe Trust CIP target for 2013/14 is £9.65m. CIP Schemes have delivered £1.4m of recurring savings for the year.

EBITDA and SurplusThe Trust’s EBITDA and Surplus were both worse than plan at the end of Quarter 1. EBITDA was £1.56m (2.5% margin) while the deficit was £1.54m against a planned deficit of £1.17m.

CashThe Trust held cash of £26.4m at the end of Quarter 1 which was lower than planned (£31.0m) because the drawdown of the agreed FTFF loan for the Radiotherapy development (£4.5m) was delayed from June into July.

Financial Risk RatingThe Financial Risk Rating (FRR) at the end of Quarter 1 was a 2 as planned.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-5

101520253035

Cash : Plan v Actual (£m)

Plan Actual

Actual RatingEBITDA Margin 2.5% 2

EBITDA % of plan achieved 80.0% 3Return on assets -3.5% 2IS Surplus margin -2.4% 1

Liquidity 45 4Weighted Average Rating 2.4

Financial Risk Rating 2

Financial Risk Rating Qtr 1

Summary I&EAll in £m Plan Actual Fav / (Adv)

Income 62.32 63.15 0.83Expenditure (60.37) (61.58) (1.22)

EBITDA 1.95 1.56 (0.39)Non Operating Costs (3.12) (3.11) 0.01

Surplus / (Deficit) (1.17) (1.54) (0.38)EBITDA Margin % 3.1% 2.5%Surplus Margin % -1.9% -2.4%

YTD Qtr 1

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total0.00.20.40.60.81.01.21.41.6

CIP: Monthly Plan vs Actual (£m)

Plan Actual

20


21

Summary The Financial Risk Rating (FRR) at the end of Quarter 1 was as planned at 2.

Weighted Average Risk Rating Definition5 : Lowest risk - no regulatory concerns.4 : No regulatory concerns.3 : Regulatory concerns in one or more components. Significant breach of Terms of Authorisation is unlikely.2 : Risk of significant breach in Terms of Authorisation in the medium term, e.g. 9 to 18 months in the absence of remedial action.1 : Highest risk - high probability of significant breach of Terms of Authorisation in the short-term, e.g. less than 9 months, unless remedial action is taken.

Monitor Risk Rating

Additional Risk Indicators In addition to the FRR, Monitor reviews ten risk indicators that give an indication of whether there are financial risks within the Trust. They do not have a bearing on the formal risk rating. At Quarter 1, the Trust was compliant with all of these except Creditors and Debtors over 90 days. Details of the reasons for this are provided in this report under Debtors and Payments (page 13).

FRR Thresholds See Appendix 1 for a table of FRR Thresholds

Financial Risk RatingFinancial Criteria Weight Metric Score Rating Score Rating Score Rating

Underlying performance 10% EBITDA Margin rating 5.0% 6.4% 3 3.1% 2 2.5% 2

Achievement of plan 25% EBITDA % of plan achieved rating 70.0% 136.6% 5 136.6% 5 80.0% 3

Financial Efficiency 20% Net return after financing rating -0.5% 1.6% 3 -2.7% 2 -3.5% 220% IS Surplus margin rating 1.0% 1.2% 3 -1.9% 2 -2.4% 140% 3 5 2

Liquidity 25% Liquidity days rating 15 45 4 51 4 45 4

Overall Risk Rating 100% 3.5 2.8 2.4

Quarter 1 Plan Quarter 1 ActualThreshold for FRR 3

Full Year Plan


22

Income & Expenditure : Summary

Summary At Quarter 1 the Trust delivered a deficit of £1.54m which is £0.38m worse than plan.

The major drivers of this adverse variance are the overspend on pay and the under delivery of CIP.

Other (non clinical) income shows a significant variance which is caused by a number of non-recurring items. These include staff recharges (£0.3m), income received for community dental services in relation to last year (£0.2m), lease car income (£0.1m), and a rate rebate (£0.1m).

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar(2)

(1)

1

2

3

4

Surplus Plan v Actual (£m)

Plan Actual

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

5

10

15

20

EBITDA Plan v Actual (£m)

Plan Actual

Income & Expenditure

All in £000 Plan Budget Actual Fav / (Adv) to Plan

NHS Clinical Income 57,952 58,386 58,010 57Non NHS Clinical Income 604 579 438 (166)Research & Training 1,819 1,738 1,754 (65)Other 1,947 2,639 2,945 999Total Income 62,322 63,342 63,147 825Pay (40,951) (41,177) (41,791) (840)Drugs (5,245) (5,206) (5,354) (109)Clinical Services (6,368) (6,348) (5,592) 777Other Non Pay (7,804) (8,077) (8,849) (1,044)Total Expenditure (60,368) (60,808) (61,585) (1,217)EBITDA 1,954 2,534 1,563 (391)Non Operating (3,122) (3,115) (3,107) 15Surplus / (Deficit) (1,168) (581) (1,545) (376)EBITDA % 3.1% 4.0% 2.5%

Quarter 1


23

Income

Summary At Quarter 1 income was higher than planned with a positive variance of £0.8m (1.3%). This positive variance is driven by other non clinical income.NHS Clinical Income There have been shortfalls in elective income caused by delays in developments but this has been mitigated by additional income for non-elective activity. Although non-elective activity is on plan, the richer case-mix seen in quarter 1 is generating increased income.

An additional £1.8m of income has been agreed with the CCG in post plan negotiations. This has now been added into Trust budgets. Part of this has been used to create a budget for C.Difficile penalties (£0.4m) which is profiled into month 12.Other Non NHS Clinical Income A fall in private patient income accounts for the majority of the adverse variance (£0.09m). There has also been lower income than planned from the NHS Injury Scheme (£0.04m).

Other Operating Income The additional income comes from a number of non-recurring items. These include staff recharges (£0.3m), income received for community dental services in relation to last year (£0.2m), lease car income (£0.1m), and a rate rebate (£0.1m).

Income

All in £000 Plan Budget Actual Fav / (Adv) To Plan

Elective 11,817 12,088 11,189 (628)Non Elective 16,123 16,543 16,923 800Outpatients 12,969 12,680 12,924 (46)Accident & Emergency 2,118 2,118 2,130 13Other 14,926 14,958 14,844 (81)Total 57,952 58,386 58,010 57Non NHS 604 579 438 (166)Other Operating 3,766 4,377 4,700 934Total 62,322 63,342 63,147 825

Contract PenaltiesAll in £000 Plan Budget Actual Fav / (Adv)18wk Penalty - Admitted - - 7 (7)18wk Penalty - Non Admitted - - - -C. Difficile - - - -Daycase - PPNCO 42 42 49 (7)Elective - PPNCO 20 20 18 2Elective - Readmissions 74 74 78 (4)Non Elective - Readmissions 248 248 257 (9)OP 1st to FUP 56 56 22 34Total 440 440 431 9

PPNCO - Planned procedures not carried out

Quarter 1

Quarter 1

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Full Year05

1015202530

Income Trends: Comparing Last Year v Plan v Actual (£m)

Last Year

Plan

Actual


24

Pay

Summary In Quarter 1 pay overspent by £0.8m (2%).

Temporary Staff Temporary pay spend is now at £1.6m a month compared to £1m a month at this time last year. Temporary pay costs made up 11% of all spend on pay. Although the majority of this is in medical staffing, recent months have seen an increase in nursing agency/bank as a result of the drive to increase nursing numbers.

Medical Staff Consultant and junior doctor pay continues to significantly overspend, particularly in Surgery and A&E/EAU. This is largely caused by the use of agency and locum staff to cover vacancies and other unplanned absences. HR have met with the Divisions concerned and are continuing to look at solutions to deal with the issues involved.

Nursing Staff The nursing staff plan has been increased to reflect the outcomes of the Trust’s AUKUH Report which requires an increase in nursing numbers. Recruitment is underway and starting to fill these newly created vacancies.

Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr - 13 May - 13 Jun - 130.000.200.400.600.801.001.201.401.601.802.00

Temporary Pay Rolling Trend (£m)

NHS - Bank

Non NHS

Pay Expenditure


YTD Temp % Temp

Consultants 6,425 6,392 6,920 (495) 1,138 16.4%Junior Doctors 4,444 4,694 5,494 (1,049) 1,275 23.2%Nursing, Midwifery & HV 15,080 14,853 14,440 641 1,183 8.2%S, T & T 6,197 6,279 6,205 (9) 348 5.6%Non Clinical Staff 8,805 8,960 8,732 72 646 7.4%Total 40,951 41,177 41,791 (840) 4,589 11.0%

Quarter 1 Total vs Temp

89

10111213141516

Pay Trends : Comparing Last Year v Plan v Actual (£m)

Actual

Plan

Last Year


25

Non Pay

Summary The Trust overspent on non pay by £0.4m (2%). This mainly relates to shortfalls in the delivery of CIPs.

Drugs Overspends against plan are caused by greater than expected use of high cost drugs in Cancer. These drugs are directly chargeable to the PCT and are met by additional income.

Clinical Supplies These costs are primarily driven by activity and are a reflection of the under delivery of income. The main underspends are in prosthesis (£0.4m) and medical and surgical consumables (£0.2m).

Establishment Under spends are mainly related to printing and stationary costs which are £0.09m under budget.

Premises & Fixed Plant & Other Over spends are caused by non delivery of CIP. Unidentified CIP is recorded as ‘Other’ non pay.

Non Pay Expenditure


Drugs 5,245 5,206 5,354 (109)Clinical Suppl ies 6,368 6,348 5,592 777Non Clinical Supplies 905 941 981 (76)Secondary Commissioning 1,585 1,843 1,714 (129)Research and Training 256 152 161 95Establ ishment & Transport 752 933 881 (129)Premises & Fixed Plant 2,324 2,221 2,452 (128)Other 1,982 1,986 2,660 (678)Total 19,417 19,631 19,794 (376)

Quarter 1

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Full Year

4

5

6

7

8

9

10Non Pay Trends : Comparing Last Year v Plan v Actual (£m)

Actual

Plan

Last Year


CIP

Summary CIP is significantly off trajectory, with only 32% delivery of the year-to-date plan (£0.5m of £1.4m).

For the full year, £1.6m of savings have been delivered against the plan of £9.6m. Only half of the CIP plan is supported by identified plans.

CIP plans are under continuous review with Divisions to identify further schemes and to support delivery.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar0

2

4

6

8

10

12

CIP: Cumulative Plan v Actual (£m)

Target Achieved FY

CIP by DivisionAll in £000 Plan Actual Fav / (Adv)Surgery 334 68 (266)Medicine 128 53 (75)Women & Chi ldrens 404 132 (272)Corporate 275 97 (178)Total 1,400 453 (947)

32%

Year to Date

CIP by DivisionAll in £000 Plan Identified Ach (CY) Ach (FY)Surgery 1,389 211 329 348Medicine 1,086 905 240 (0)Cancer & Support Services 1,071 382 232 246Women & Childrens 1,852 795 535 536Corporate 4,257 2,456 274 276Total 9,654 4,749 1,610 1,405

49% 17% 15%

Full Yr

26


27

Balance Sheet

Summary At the end of Quarter 1, the Trust held cash of £26.4m. This was lower than planned because the drawdown of the agreed FTFF loan for the Radiotherapy development was delayed from June into July. This also meant that non-current liabilities were lower by a corresponding amount. Other key balance sheet indicators areKey BS Metrics Q1Stock Days 41Trade Debtor Days 10Trade Creditor Days 60

All in £m Plan Actual Fav / (Adv)AssetsAssets, Non CurrentTangible & Intangible 152.4 150.3 (2.0)PFI 5.6 5.6 - Receivables and Prepayments - - - Total Assets, Non Current 158.0 156.0 (2.0)Assets, CurrentInventories 5.2 5.7 0.5 Trade Receivables 2.0 7.3 5.3 Cash 31.0 26.4 (4.6)Other current Assets 7.4 6.7 (0.7)Total Assets, Current 45.5 46.1 0.6 ASSETS, TOTAL 203.6 202.1 (1.5)

LiabilitiesLiabilities, CurrentTrade and Other Payables (14.3) (14.6) (0.3)Other Financial Liabi lities (8.5) (11.5) (3.1)Total Liabilities, Current (22.8) (26.2) (3.4)

NET CURRENT ASSETS (LIABILITIES) 22.8 19.9 (2.8)

Liabilities, Non Current (16.9) (12.4) 4.5

TOTAL ASSETS EMPLOYED 163.9 163.5 (0.4)

Taxpayers EquityPublic dividend capital 76.2 76.2 - Retained Earnings 44.9 45.0 0.0 In Year Surplus/Deficit (1.2) (1.5) (0.4)Revaluation Reserve 43.2 43.2 (0.0)Miscel laneous Other Reserves 0.8 0.8 - TOTAL TAXPAYERS EQUITY 163.9 163.5 (0.4)

Summary : Statement of Financial Balances June 2013

Debtors Processes are in place to ensure outstanding debts are under continuous review at all ages of debt. Total debtors have increased since Q4, particularly in the range of debtors under 30 days old. In the under 30 day range, 82% of invoices are NHS. In particular, there was a an SLA invoice to Mid Essex CCG (£1.8m) which has not been paid in the normal 14 days for SLA invoices. It was paid on 2 July.

Payments PSPP performance is strong at 93%. 74% of invoices outstanding are under 30 days old and therefore within current payment terms. Creditors over 90 days relate to on going disputes where products have not been delivered or services have not been satisfactorily performed.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar70%

75%

80%

85%

90%

95%

100%

PSPP - Non NHS Cumulative Volumes

Target Last Year This Year In Month


Capital Programme

Capital Programme StatusAll in £000 Budget Actual Fav / (Adv) CompletionRadiotherapy Centre 1,900 1,716 184 In ProgressClinical Portal - (66) 66 In ProgressE-prescribing and Medicines administration - 18 (18) In ProgressA&E Minor Extension/Refurbishment - 15 (15) PlanElectrical Infrastructure Upgrade 100 176 (76) In ProgressPathology - - - PlanPSU Automation - - - In ProgressRefurbishment of Special Delivery Room - - - In ProgressCondensing Flu Economiser (externally funded) - - - PlanCar of the Elderly Alterations 80 76 4 In ProgressLaparoscopic Theatre Upgrade - - - PlanRefurbishment of Bereavement Suite - 66 (66) In ProgressStroke and Easthorpe Upgrade - 6 (6) PlanReprovision of Chemotherapy Services - 2 (2) In ProgressCondensing Flu Economiser (externally funded) Plan4th Linear Accelerator for Radiotherapy Centre In ProgressRelocation of Services from ECH PlanCatheterisation Laboratory PlanContingency - - -

Infrastructure and Other - - Medical Equipment 360 279 81 Estates 110 193 (83)IM&T 385 13 372 Total 2,935 2,494 441

Year to date SummaryThis month, year-to-date capital spend on the programme is £2.5m against a budget of £2.9m.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-

5,00010,00015,00020,00025,00030,00035,00040,000

Cumulative Capex: Plan v Actual (£000)

Plan Actual/Forecast

28


Appendices

Page

Performance Framework 30

FRR Glossary 36

29


Performance Framework

30

Current Year End Target

Target Actual Target May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13

INFECTION CONTROL ** Rag rating based on Monitor Profiled Threshold

Incidence of MRSA Infection post 48 hrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0

Screening of a l l El igible EL Inpati ents for MRSA 95% 95% 105.26% 95% 114.77% 121.82% 119.97% 120.14% 119.09% 127.63% 115.71% 112.85% 110.28% 110.46% 104.20% 102.70% 103.29% 109.69%

Screening of a l l El igible NEL Inpati ents for MRSA 95% 95% 84.92% 95% 81.85% 82.06% 82.52% 82.25% 82.57% 82.01% 80.38% 82.14% 83.38% 79.51% 82.50% 83.97% 83.97% 86.91%

Incidence of Clostridium Diffi ci le Infection** 18 5 7 1 1 3 1 2 2 1 5 5 2 1 2 2 5 0

Compl ia nce with Ha nd Hygiene Code 95% 95% 96.64% 95% 96.76% 96.85% 95.55% 94.65% 98.09% 98.49% 98.54% 98.17% 98.99% 97.67% 97.62% 96.94% 94.30% 98.44%

NPSA Envi ronmenta l Audi t Target 90% 90% 93.35% 90% 93.80% 92.54% 91.68% 92.16% 90.76% 90.73% 89.41% 90.97% 88.47% 92.48% 92.83% 91.89% 94.15% 93.85%

PATIENT EXPERIENCE

Meridian Tracker (Pati ent Experience) TBA TBA - TBA 86.4% 86.3% 85.85% 85.00% 85.00% 88.00% 89.0% 89.0% 82.0% 82% 82% 88.1% 88.1% 89.4%In patient survey -a nnual in house survey to be underta ken s ix

months after Nati onal in pa tient surveyAudi t Audi t - Audi t - - -

Mixed Sex Accommodati on : No. of Brea ches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mixed Sex Accommodati on : Brea ches as % of BDs 0% 0% 0.00% 0% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

PROMS score (% Offered) 100% 100% 100.0% 100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Dela yed tra nsfers of ca re 3.50% 3.50% 0.19% 3.50% 0.44% 0.48% 0.41% 0.28% 0.53% 0.22% 0.23% 0.35% 0.08% 0.10% 0.13% 0.17% 0.14% 0.28%

PATIENT SAFETY **Please note that Never events for March and April are shown as grey as they haven't been confirmed

VTE Risk As sessment 95% 95% 93.69% 95% 92.81% 92.41% 93.58% 94.79% 89.62% 89.58% 91.41% ** 90.39% 93.02% 92.68% 92.94% 93.46% 94.71%

Pati ent at Ri sk (PAR) compl ia nce 90% 90% 98.54% 90% 98.25% 95.68% 94.36% 95.35% 96.97% 97.41% 96.82% 97.96% 97.17% 99.25% 93.81% 98.43% 97.86% 99.38%

MUST Nutriti on As sessment 85% 85% 96.3% 85% 91.9% 88.7% 92.9% 92.6% 95.9% 87.9% 94.2% 92.6% 94.7% 93.7% 88.9% 93.5% 97.9% 97.7%

Intenti onal Rounding 80% 80% 94.4% 80% 87.5% 50.0% 75.0% 62.5% 25.0% 87.5% 100.0% 100.0% 100.0% 100.0% 100.0% 94.2% 93.0% 96.0%

Never Events** 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0

NHS Safety Thermometer Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Reducti on in inpati ent fa l l s res ulting in serious harm 40 10 3 3 2 1 2 3 1 2 1 3 2 3 4 3 0 0Duty of Candour - Fa i lure to notify of suspected pati ent safety

incident that resul ted in severe ha rm or death0 0 0 0 - - - - - - - - - - 0 0

Percenta ge of patients ri sk as sessed for VTE who receive the appropriate prophylaxi s (Audi t)

TBC TBC - TBC 99.0% 99.0% 98.0% 100.0% 98.0% 97.0% 99.0% 95.0% 96.0% 96.0% 97.0% 99.0% 99.0% 97.0%

Think Glucose Pa tient Assessment Tool completed 95% 95% 96.7% 95% 96.8% 96.0% 96.0% 98.0% 96.0% 98.0% 96.0% 96.0% 98.0% 96.0% 96.0% 96.0% 96.0% 98.0%

Grade 3 & 4 Hospita l Acqui red Pressure Ulcers 0 0 TBC 0 - - - - - - - - - 3 TBC 1

Grade 2, Hospi ta l Acquired Pres sure Ulcers 0 in Q4 0 in Q4 TBC 0 in Q4 - - - - - - - - - 3 TBC TBC

Pressure Ulcers awa iting panel review - - - - - - - - - - - - - 1 3 6

Emergency Ca re – Consul tant review 35.0% 35.0% - 35.0% - - - - - - - - - - - - - -

To reduce missed doses in Antibiotic therapy & Pa rkinson's Drugs 5.6% 5.6% - 5.6% - - - - - - - - - - - - - -

Indicators - Monitor, DoH, Contract or Internal

Current Year to Date Month



31



CLINICAL QUALITY : Mortality * HSMR Data two months behind, latest available April 2013 ** SHMI Data Captured Quarterly, Q3 2012/13 published on 24/07/2013

Hospi ta l Standardised Morta l i ty Rati o (HSMR)* 100 100 84.5 100 111.5 94.2 90.1 113.1 100.5 96.2 92.1 116.5 92.7 98.3 93.3 84.5 ** **

Summa ry Hospita l -Level Morta l i ty Indica tor (SHMI)*** 100 100 - 100

CLINICAL QUALITY : Other

Discharge summaries wi thin 24 hours 98% 98% 88.88% 98% 93.52% 91.70% 91.81% 91.00% 91.34% 89.82% 90.01% 90.03% 89.58% 89.66% 90.54% 92.49% 91.50% 83.05%

Referra ls to Stop Smoking Service 600 150 25 50 25 3 9 1 6 13 4 7 5 4 1 2 11 12

Stroke (Snapshot Data as at 13/7/2013)Proportion of patients and carers with joint care plans on

discharge from hospital85% 85% 97.44% 85% 100.00% 95.45% 96.15% 88.00% 90.48% 100.00% 85.71% 100.00% 88.24% 87.50% 100.00% 92.31% 100.00% 100.00%

Proporti on of pa tients with Psychologica l s upport 6 months post s troke

40% 40% 23.3% 40% 7.7% 5.4% 0.0% 12.1% 15.8% 30.6% 34.9% 29.7% 35.7% 16.7% 35.7% 18.8% 44.0% 15.2%

Proportion of Stroke pa tients reviewed a fter 6 months 95% 95% 6.1% 95% 6.5% 2.8% 16.7% 2.6% 7.1% 3.3% 5.0% 6.9% 0.0% 0.0% 7.3% 7.9% 0.0% 8.8%Proportion of pa tients wi th known AF presenti ng wi th s troke a nd

TIA receiving a nti-coagulati on60% 60% 71.74% 60% 68.42% 42.86% 70.59% 58.33% 28.57% 50.00% 14.29% 66.67% 71.43% 78.57% 100.00% 60.00% 84.62% 76.92%

Proporti on of pa tients admitted directly to the s troke uni t wi thin 4 hours of hospi ta l arriva l

90% 90% 85.16% 90% 72.41% 76.32% 82.98% 78.72% 87.10% 82.50% 79.49% 81.82% 79.55% 68.90% 79.30% 88.89% 84.21% 82.22%

Proporti on of pa tients who sca nned within one hour of hos pi ta l arriva l

50% 50% 73.02% 50% 42.11% 51.43% 64.44% 67.44% 90.00% 69.23% 76.32% 71.43% 68.90% 68.20% 72.40% 75.61% 65.79% 76.60%

Proportion of s troke patients sca nned within 24 hours of hospi ta l arriva l

100% 100% 98.47% 100% 94.74% 91.43% 100.00% 97.67% 100.00% 94.87% 94.74% 100.00% 93.50% 93.60% 90.00% 100.00% 100.00% 95.74%

Number of high ri sk TIAs seen a nd as sess ed wi thin 24 hours - - - - - - - - - - - - - - -Proportion of non-a dmitted high ri sk TIA pa tients treated wi thin

24 hours 60% 60% 70.83% 60% 52.94% 53.33% 73.68% 73.33% 85.71% 78.57% 75.00% 77.78% 82.40% 77.78% 61.10% 78.95% 50.00% 90.91%

Proporti on requi ring access to ca rotid enderartectomy to receive acces s wi thin 14 days of referra l

95% 95% - 95% - - - - - - - - - - - -

Pati ents spending => 90% of thei r s tay on a s troke unit 80% 80% 94.53% 80% 84.48% 81.08% 89.36% 93.62% 93.33% 85.37% 85.00% 93.02% 89.13% 82.60% 86.70% 100.00% 97.44% 86.96%

CT Sca n wi thin 60 mins of s troke 60% 60% 93.65% 60% 77.78% 85.71% 94.44% 86.96% 94.74% 94.44% 90.91% 86.67% 81.25% 76.50% 79.20% 90.91% 100.00% 91.67%


**117


116.2 ** ** ** **



32



ACCESS : A&E (Snapshot Data as at 13/7/2013)

% of pati ents waiti ng less than 4 hours in A&E: Tota l 95% 95% 96.81% 95% 97.68% 97.71% 96.83% 95.69% 96.46% 95.88% 97.19% 96.12% 95.50% 92.08% 96.10% 95.90% 97.18% 97.35%

% of pa tients wa iting less than 4 hours in A&E: Admitted 95% 95% 92.70% 94.44% 95.65% 93.41% 90.21% 91.56% 89.21% 94.02% 91.92% 88.91% 82.92% 91.23% 91.64% 93.13% 93.41%

% of pati ents waiti ng less than 4 hours in A&E: Non-Admitted 95% 95% 98.20% 98.90% 98.39% 98.01% 97.62% 98.20% 98.10% 98.35% 97.87% 98.04% 95.91% 98.14% 97.39% 98.58% 98.71%

Tota l time s pent in A & E : 95th percenti le 4 hours 4 hours 3.98 4 hours 3.98 3.98 4.00 4.00 4.00 4.00 3.98 4.00 4.00 5.23 4.00 4.00 3.98 3.98

Tota l time spent in A & E (Admitted) : 95th percenti le 4 hours 4 hours 5.07 4 hours 4.85 4.00 5.03 5.79 5.41 5.82 4.89 5.50 6.05 6.41 5.63 5.28 5.07 4.82

Tota l ti me spent in A & E (Non Admitted) : 95th percentile 4 hours 4 hours 3.93 4 hours 3.92 3.92 3.93 3.97 3.93 3.93 3.92 3.93 3.93 3.98 3.95 3.95 3.90 3.92

Time to initia l a ssess ment (Ambulance Arriva l s ) : 95th percenti le 15 Mins 15 Mins 10 15 Mins 14 13 13 12 13 12 12 11 10 13 12 10 11 10

Time to trea tment in depa rtment (median) 60 mins 60 mins 54 60 mins 52 50 51 60 52 54 48 47 54 55 54 59 53 49

Trol ley Wai ts in A&E over 12 hours 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Unpla nned Rea ttendance Rate 5.00% 5.00% 4.25% 5.00% 4.34% 4.92% 4.86% 4.45% 4.36% 4.35% 4.11% 4.30% 4.59% 4.54% 4.80% 4.49% 4.00% 4.25%

Left department wi thout being seen 5.00% 5.00% 2.09% 5.00% 2.24% 2.39% 2.46% 3.07% 1.89% 2.80% 1.99% 2.10% 1.78% 2.38% 1.80% 2.56% 1.93% 1.78%

Admis s ions for DVT per head of weighted pop N/A N/A 0.008% N/A 0.001% 0.002% 0.002% 0.002% 0.004% 0.001% 0.001% 0.002% 0.001% 0.000% 0.001% 0.002% 0.003% 0.003%

Admiss ions for cel lul itis per hea d weighted pop N/A N/A 0.036% N/A 0.014% 0.011% 0.012% 0.013% 0.009% 0.013% 0.011% 0.010% 0.010% 0.009% 0.009% 0.012% 0.013% 0.011%

DQ - % Completed Attendance Category 95% 95% 100.0% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

DQ - % Completed Arriva l Mode 95% 95% 100.0% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

DQ - % Completed Dispos al Method 95% 95% 100.0% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

DQ - % Completed Depa rture Time 95% 95% 99.9% 95% 99.89% 99.83% 99.78% 99.94% 99.87% 99.80% 99.70% 99.70% 99.84% 99.73% 99.80% 99.95% 99.89% 99.89%

DQ - % Completed Initia l Asses sment Time 95% 95% 99.7% 95% 98.08% 97.49% 97.20% 98.01% 98.64% 99.60% 99.60% 99.30% 99.78% 99.27% 99.80% 99.64% 99.74% 99.68%

DQ - % Completed Time Seen for Treatment 95% 95% 98.4% 95% 97.99% 98.09% 97.64% 97.20% 98.63% 97.50% 98.40% 97.70% 98.28% 96.95% 99.70% 97.75% 98.60% 98.70%

Admiss ions via A&E : Convers ion rate (Type 1) TBC TBC 24.49% TBC 26.9% 23.3% 24.42% 24.73% 25.54% 24.22% 25.43% 24.59% 26.85% 28.12% 26.62% 24.93% 24.39% 24.14%

Number of ambula nce cl inica l handovers over 15 minutes 0 0 3212 0 - - - - - - - - - - - 985 1058 1169

Number of ambula nce cl inica l handovers over 60 minutes 0 0 50 0 - - - - - - - - - - - 29 7 14

Submit compl ia nce for Ambulance Ha ndovers 80% 80% - 80% - - - - - - - - - - - - - -





33



ACCESS : RTT

18 weeks RTT Admitted Performance : Cons Led 90% 90% 95.09% 90% 92.95% 90.22% 96.14% 95.62% 95.05% 94.59% 93.97% 92.87% 93.06% 93.84% 94.37% 94.59% 95.33% 95.35%

18 weeks RTT Admitted Median wa it 11.1 11.1 10.57 11.1 11.29 11.71 11.29 11.43 11.29 11.43 11.86 10.14 12.43 11.36 10.86 10.50 10.71 10.29

18 weeks RTT Admitted 95th percenti le 23 23 18.00 23 20.25 21.51 18.00 18.00 18.00 18.29 18.59 19.71 19.57 19.44 19.00 18.29 18.00 18.00

18 weeks RTT Admitted Data Completeness 80%-120% 80%-120% 92.53% 80%-120% 97.05% 91.21% 93.07% 94.92% 97.58% 97.56% 90.85% 85.35% 95.77% 102.18% 95.08% 99.62% 87.98% 90.55%

18 weeks RTT Non-Admitted Performa nce : Cons Led 95% 95% 98.90% 95% 98.02% 97.92% 98.31% 98.28% 98.15% 98.21% 98.51% 98.60% 98.25% 98.19% 98.68% 98.86% 98.99% 98.85%

18 weeks RTT Non-Admitted Media n wai t 6.6 6.6 7.29 6.6 7.00 7.29 7.43 8.00 8.14 7.86 7.00 6.86 7.86 7.43 6.71 7.14 7.29 7.57

18 weeks RTT Non-Admitted 95th percenti le 18.3 18.3 15.57 18.3 16.00 16.14 16.29 16.43 16.14 16.14 16.00 16.00 16.00 16.29 16.00 15.57 15.43 15.57

18 weeks RTT Non-Admitted Da ta Completeness 80%-120% 80%-120% 110.51% 80%-120% 97.84% 103.20% 95.09% 104.43% 100.82% 101.59% 100.26% 93.71% 104.78% 105.36% 108.99% 104.99% 105.01% 122.63%

% of incomplete pathways within 18 weeks 92% 92% 99.01% 92% 98.03% 98.53% 98.46% 98.09% 98.00% 98.30% 98.08% 98.40% 98.04% 98.38% 98.86% 98.95% 99.11% 98.96%

18 weeks RTT Incomplete Median wai t 7.2 7.2 5.29 7.2 5.00 5.43 5.57 5.57 5.71 5.00 5.14 6.00 6.00 4.86 5.29 5.14 5.14 5.43

18 weeks RTT Incomplete 95th percentile 28.0 28.0 14.29 28.0 14.43 14.71 15.07 15.29 15.43 15.14 15.14 14.86 15.43 14.57 14.57 13.71 14.43 14.57

Number of RTT Incomplete pathways >52 weeks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

ACCESS : Other ** Breast Screening data two months behind, latest available March 2013

18 weeks Di rect Access Audiology Performance 95% 95% 100% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

% pati ents waiti ng 13 weeks or more for OP appointment 0.03% 0.03% 0.02% 0.03% 0.00% 0.01% 0.26% 0.03% 0.01% 0.00% 0.00% 0.00% 0.07% 0.06% 0.03% 0.03% 0.00% 0.04%

% Pa tients wa iting 6 weeks or more for a key diagnosti c test 1.00% 1.00% 0.01% 1.00% 0.03% 0.00% 0.00% 0.07% 0.51% 0.03% 0.00% 0.00% 0.28% 0.14% 0.00% 0.03% 0.00% 0.00%

% pati ents waiti ng 26 weeks or more for Electi ve Admiss ion 0.03% 0.03% 0.08% 0.03% 0.03% 0.06% 0.14% 0.11% 0.42% 0.08% 0.16% 0.26% 0.32% 0.17% 0.27% 0.21% 0.00% 0.03%

2 week wai t for Rapid Access Chest Pain Cl inics 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Brea st Screening: % pati ents s creened wi thin 3 weeks ** 90.00% 90.00% 90.48% 90.00% 93.42% 100.00% 98.18% 95.65% 96.72% 97.41% 92.50% 88.89% 92.31% 95.71% 91.95% 90.48% ** **

Brea st Screening: 3 weeks or less from s creen to DOFOA ** 90.00% 90.00% 100.00% 90.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% ** **

8 day lab turnaround for Cervica l Cytology screening tests 99.00% 99.00% 99.08% 99.00% 99.91% 99.88% 99.37% 99.89% 99.50% 99.95% 99.69% 99.75% 99.77% 98.87% 98.20% 99.49% 98.11% 99.74%

Access to GUM : Appointments Offered wi thin 48 hours 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Access to GUM : Seen wi thin 48 hours 85% 85% 90.39% 85% 89.76% 93.04% 91.87% 93.16% 94.06% 90.24% 89.95% 92.10% 92.78% 92.33% 89.75% 90.30% 90.00% 90.88%

Choos e & Book ASIs 0.05 0.05 0.041 0.05 0.07 0.08 0.09 0.07 0.04 0.03 0.05 0.05 0.03 0.047 0.04 0.04 0.06 0.03

Choos e & Book as a Di rectly Bookable Service 95% 95% 100.0% 95% - - - - - - - - - - 100.00% 100.00% 100.00%

Choos e & Book for Diagnosti cs 75% 75% - 75% - - - - - - - - - - - - -





34



CANCER(Snapshot data as at 31/07/2013)

2 week wai t from referra l to da te fi rst seen : Al l 93.00% 93.00% 95.77% 93.00% 95.56% 97.60% 97.82% 97.04% 96.34% 96.07% 95.44% 97.75% 93.32% 93.70% 94.54% 94.21% 96.15% 96.89%

2 week wai t from referra l to da te fi rst seen : Symptoma tic Breast 93.00% 93.00% 96.14% 93.00% 98.40% 99.20% 98.51% 95.97% 97.39% 95.38% 98.68% 97.99% 97.04% 95.90% 98.27% 99.38% 95.91% 93.21%

31 day wai t from dia gnos is to 1st trea tment 96.00% 96.00% 98.54% 96.00% 97.14% 97.12% 98.87% 99.29% 98.70% 99.45% 97.45% 98.64% 98.24% 98.20% 98.75% 99.41% 99.32% 96.79%

31 day wai t 2nd or Subsequent Treatment : Drugs 98.00% 98.00% 100.00% 98.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.85% 100.00% 100.00% 100.00% 100.00% 98.46% 100.00% 100.00% 100.00%

31 da y wa it 2nd or Subsequent Trea tment : Ra diotherapy 94.00% 94.00% 98.41% 94.00% 98.40% 99.26% 98.47% 97.27% 94.87% 97.41% 100.00% 97.96% 96.90% 100.00% 99.17% 99.31% 97.41% 98.29%

31 da y wa it 2nd or Subsequent Treatment : Surgery 94.00% 94.00% 97.30% 94.00% 100.00% 97.50% 100.00% 96.67% 100.00% 97.14% 100.00% 95.83% 100.00% 100.00% 96.43% 100.00% 96.30% 95.65%

31 day Subsequent Treatment: Pa l l iati ve Ca re 94.00% 94.00% 100.00% 94.00% 100.00% 100.00% 100.00% - 100.00% 100.00% 100.00% - 100.00% 100.00% - 100.00% - 100.00%

62 da y wa it for 1st trea tment : Nationa l Screening Service Referra l 90.00% 90.00% 90.44% 90.00% 93.94% 88.89% 83.33% 88.89% 100.00% 100.00% 97.83% 100.00% 95.35% 90.30% 97.30% 91.23% 88.57% 90.48%

62 day wa it for 1st trea tment : GP referra l to trea tment* 85.00% 85.00% 89.86% 85.00% 73.48% 91.37% 92.93% 85.81% 85.37% 92.39% 85.21% 87.23% 90.70% 84.80% 90.54% 94.44% 88.19% 86.62%

62 da y wa it for 1st trea tment : Consul ta nt (CRS) Upgra de 85.00% 85.00% 66.67% 85.00% 100.00% 86.67% 100.00% 100.00% 75.00% 100.00% 81.82% 85.71% 80.00% 100.00% 100.00% 100.00% 100.00% 50.00%

ACTIVITY AND EFFICIENCY

Cancel led e lecti ve offered a binding da te within 28 Days 100% 100% 98% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 95% 100%

% Ca ncel led Ops a s a proportion of FFCEs 0.80% 0.80% 0.47% 0.80% 0.12% 0.21% 0.19% 0.17% 0.26% 0.24% 0.40% 0.44% 0.64% 0.32% 0.48% 0.39% 0.45% 0.59%

Appointment offered wi thin 5 ca lendar da ys of ca ncel la tion 85% 85% 98% 85% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 95% 100%

Planned procs not carried out for non cl inica l reas ons : EL 1.20% 1.20% 1.70% 1.20% 0.80% 1.95% 1.56% 1.43% 1.66% 2.57% 1.31% 2.65% 1.95% 2.15% 0.95% 1.94% 1.33% 1.03%

Planned procs not carried out for non cl inica l reasons : DC 2.40% 2.40% 1.00% 2.40% 1.50% 1.72% 2.08% 2.21% 1.82% 2.03% 1.75% 1.24% 2.15% 1.95% 1.82% 1.58% 1.33% 0.94%

WA14Zs for e lective inpa tients 1.20% 1.20% 4.01% 1.20% 2.56% 3.60% 2.97% 3.17% 2.87% 5.14% 3.94% 5.10% 4.19% 3.23% 2.06% 4.77% 3.56% 2.57%

WA14Zs for e lective dayca ses 2.40% 2.40% 2.93% 2.40% 3.22% 3.43% 3.90% 4.09% 4.82% 4.13% 3.53% 4.27% 4.90% 4.06% 2.98% 3.50% 3.91% 3.24%

Number of urgent operati ons ca ncel led for the s econd ti me 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Proportion of electi ve pati ents admitted as Day Cas e - Enhanced

Recovery Progra mme (TURBT)34.50% 34.50% 37.25% 34.50% 20.00% 27.78% 8.57% 21.05% 20.93% 35.85% 24.44% 43.59% 39.39% 58.82% 20.41% 52.78% 25.81% 31.43%

Maternity Figures taken from SUS Data as at 14/07/2013 Termina ti ons of Pregnancies to be ca rried out wi thin 21 da ys of

referra l98% 98% 99.5% 98% 100.0% 98.4% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 100% 100%

Proporti on materni ty a ppointments wi thin 12+6 weeks (VSB06) 90% 90% 98.46% 90% 97.32% 94.16% 96.96% 97.05% 96.69% 94.84% 95.25% 98.22% 92.68% 98.47% 97.12% 97.92% 97.58% 100.00%

Brea st feeding initi ati on ra te 75% 75% 79.14% 75% 76.37% 74.21% 78.49% 75.30% 77.29% 79.54% 76.44% 76.45% 78.09% 77.94% 78.53% 77.12% 81.79% 77.36%

Reduction of numbers of mothers smoking in pregnancy 15.88% 15.88% 13.33% 15.88% 12.09% 9.46% 11.02% 12.80% 11.04% 11.53% 12.08% 14.07% 15.43% 19.22% 13.19% 14.05% 10.80% 15.88%

Materni ty – Norma l i s ing Bi rth 76.01% 76.01% 73.76% 76.01% 72.25% 76.15% 74.73% 79.10% 76.73% 76.44% 72.51% 80.12% 79.81% 75.99% 71.29% 76.14% 70.43% 75.00%



* FEB 13 - 62 day wait for 1st treatment - NHS England have recognised CHUFT are not responsible for 0.5 of breach (as Patient referred to CHUFT at day 82) - performance excluding this would be 85.29% (green).

All unvalidated cancer performance figures are provided in grey until submitted to open Exeter on 2nd August 2013



35



PARTNER SATISFACTION ** Compliance with Mandator National Audits" included on Performance Framework from March 2013Compl iance with Mandatory Nati ona l Audits ** Yes Yes Yes Yes Yes Yes - - - - - - - - Yes Yes Yes Yes

Ethnic Group Data Qual i ty : Inpatients 85% 85% 94.83% 85% 96.37% 96.10% 95.91% 95.69% 95.90% 96.07% 95.56% 96.20% 95.47% 94.96% 94.81% 94.88% 94.80% 94.47%

Complia nce with Materni ty data Set : Bi rth type records 1.1 1.1 0.99 1.1 1.01 0.99 0.99 1.02 0.99 0.98 1.01 0.98 1.03 1.01 1.00 0.99 0.98 1.02

Complia nce with Ma terni ty data Set : Ma nda tory fi elds 15% 15% 8.41% 15% 7.92% 8.13% 8.35% 8.22% 8.36% 8.46% 8.34% 8.89% 8.21% 8.12% 9.03% 8.51% 8.64% 8.95%

EMPLOYEE SATISFACTION

Va cancy 3.0% 3.0% 6.68% 3.0% 5.11% 6.08% 5.09% 5.47% 6.03% 5.85% 6.18% 6.62% 6.72% 6.77% 6.58% 6.80% 6.81% 6.43%

% Bank/Agency s pend agains t total pay 6.5% 6.5% 12.00% 6.5% 7.25% 7.60% 7.96% 7.91% 8.62% 9.90% 10.65% 10.18% 11.47% 12.18% 12.53% 11.37% 11.60% 13.03%

Sicknes s Abs ence Rate 3.50% 3.50% 3.35% 3.50% 3.67% 3.56% 3.67% 3.64% 3.85% 4.21% 4.37% 3.96% 4.00% 4.17% 3.93% 3.78% 3.06% 3.22%

% Appra isa ls Completed 100% 100% 68.04% 100% 72.81% 72.12% 72.81% 76.04% 76.57% 76.17% 73.64% 73.25% 72.11% 68.35% 65.33% 69.18% 68.84% 66.16%

Monthly Turnover 1.5% 1.5% 0.71% 1.5% 0.57% 0.60% 0.82% 0.98% 0.89% 0.45% 0.69% 0.82% 0.71% 0.61% 1.00% 0.63% 0.64% 0.86%




FRR Glossary

36

Financial Criteria Weight % Metric Threshold Rating11% 59% 4

10 5% 31% 2

<1% 1100% 585% 4

25 70% 350% 2

<50% 13% 52% 4

20 -0.5% 3-5% 2

< -5% 13% 52% 4

20 1% 3-2% 2

< -2% 160 525 4

25 15 310 2

<10 1

Liquidity metric

EBITDA achieved (% of plan)

Net return after financing rating

IS surplus margin

Liquidity ratio (days)

Underlying performance

Achievement of plan

Financial Efficiency

EBITDA margin

Weighted Average Risk Rating DefinitionsRating 5 - Lowest risk - no regulatory concernsRating 4 - No regulatory concernsRating 3 - Regulatory concerns in one or more components. Significant breach of Terms of Authorisation is unlikelyRating 2 - Risk of significant breach in Terms of Authorisation in the medium term, e.g. 9 to 18 months in the absence of remedial actionRating 1 - Highest risk - high probability of significant breach of Terms of Authorisation in the short-term, e.g. less than 9 months, unless remedial action is taken

Over-riding Monitor Metric RulesThe overall risk rating is a weighted average of the five metrics, but there are four rules that override this average:1. If any one metric is ranked at 1 or 2 than the maximum Trust rating is 3 2. If any 2 metrics are ranked at 1 or 2 then the maximum Trust rating is 23. 3. If any 2 metrics are ranked at 1 then the maximum Trust rating is 1 4. If any metric is

ranked at 1 then the maximum Trust rating is 2

NB For the purpose of these over-riding rules, the Financial Efficiency metrics are averaged together, leaving a total of 4 metrics against which these rules are tested

Glossary of terms EBITDA is earnings before deducting interest, taxes, depreciation and amortisation. It also excludes exceptional items and dividends. It is a measure of the performance of the "underlying business" i.e. the surplus/deficit from day to day operations and is similar to the directorate financial statements.EBITDA Margin This is EBITDA as a percentage of total income.EBITDA % Achieved This is designed to measure the ability of the Trust to achieve its financial plans. The target is therefore 100% or more. Financial Efficiency Net return after financing rating measures how efficiently the Trust uses its assets. It is defined as (I&E Surplus less PDC dividend, interest, PFI financing and other financial lease costs) divided by (total debt + total balance sheet PFI and finance leases + taxpayers equity).I&E Surplus Margin This is the Net Surplus as a percentage of total income. Liquidity This ratio measures the Trust's ability to pay its bills from liquid assets (assets that are easily realisable), and is intended to show whether the Trust can continue to pay its bills in the short term. The metric shows for how many days the Trust could continue to pay its bills just using its net working capital. Net working capital (i.e. liquid assets) consists of cash in bank and debtors due in less than one year, less creditors /accrued costs due in less than one year.

Performance Report For Quarter 1 2013/14 B oard Meeting 8 August 2013

Documents

trust section

performancethe trust

clostridium difficile

day cases

trusts shmi

revised plan

elective activity

performance reportfor