Agenda Item: 5.1 REPORT TO THE TRUST BOARD 31 TO THE TRUST BOARD 31 March 2016 ... A patient’s poor…

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    Agenda Item: 5.1


    31 March 2016

    Title Integrated Performance Report

    Lead Director

    Paul Scott - Director of Finance & Performance Lisa Nobes Director of Nursing & Quality Clare Edmondson Director of HR Neill Moloney - Chief Operating Officer


    Chief Information Officer Mike Meers Acting Deputy Director of Nursing Karen Kemp Simon Rudkins Deputy Director of Finance Jennifer Canham Deputy Director of Human Resources

    Purpose To receive for information

    Previously considered by Finance and Performance Committee

    Executive Summary

    Related Trust Objectives Sub-objectives

    Consistently deliver great healthcare to every patient every day

    Maintain our focus on safe care

    Improve the effectiveness of our care

    Ensure we always have caring staff for our patients

    Improve the way our services are responsive to the needs of patients.

    Ensure care is well-led by # team Ipswich

    Improve the healthcare we provide to patients where and when you need it.

    Improve our efficiency to ensure our patients receive better care

    Ensure all our clinical staff undertake thoughtful practice

    Develop our infrastructure to improve patient access to care and information

    Flexible and responsive to future demands

    Demonstrate leadership in addressing the needs of Suffolk

    Understand future needs

    Supporting our workforce to meet future demands

    A hospital without walls

    Risk and Assurance N/A

    Related Board Assurance Framework Entries

    Risk to financial sustainability of the Trust (935)

    Financial Implications N/A

    Legal Implications/Regulatory Requirements


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    Action Required by the Trust Board The Trust Board is asked to receive for Information.


    Harm free care


    The total number of inpatient falls in February was 104 which equates to 6.1 falls per 1000

    bed days. 47% of the total falls occurred between the hours of 2100 and 0700.

    Of the 104 falls, 26 can be attributed to 11 patients who fell more than once. This represents

    25% of the total.

    There were no falls resulting in serious harm in February. There have been 12 patients YTD who have experienced a fractured neck of femur and 2 who experienced a serious head injury. Grundisburgh have met their stretch target for 7 months running and demonstrates an upward trend. Brantham has only met their target twice YTD. Pressure ulcers

    There were no avoidable pressure ulcers reported in February.

    Woodbridge Ward have actively undertaken some intensive work with staff to improve the

    documentation and use of the rounding tool following Januarys RCAs which has shown a

    significant improvement in their documentation of care this month and is an example of

    excellent learning and good practice.

    There have been 4 incidents in last 4 months with inaccurate pressure ulcer risk

    assessments which were completed initially on Brantham and not on transfer to ward areas.

    There is a trend emerging from root cause analyses in the last 6 months that identify staff on

    Brantham completing the risk assessment inaccurately. A plan to address this with

    Brantham staff is being developed.

    Infection Prevention and Control

    C Difficile

    There were 5 cases of C. Diff reported in February, one occurring on Somersham,

    Debenham, Stradbroke and 2 cases on Washbrook. The ribotyping on the Washbrook cases

    were different which demonstrates no transmission between patients.

    Patient Experience

    Complaints and PALS

    42 complaints were raised in February, this compares with 48 in January, 37 in December,

    45 in November and 54 in October.

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    Of the 42 complaints, one was graded as high level. This case relates to a patient

    exacerbating an ankle fracture having fallen in the toilet. 28 cases were graded as medium

    level and 13 were graded as low.

    Occasionally the Trust receives a complaint that covers a number of health care providers, in

    which case a coordinated response is required. There were no co-ordinated complaints

    received in February.

    Issues raised in February include:-

    3 complaints relating to the standard of care provided on Sproughton ward.

    Problems with cardiology referrals to Papworth hospital.

    Failure to recognise a deteriorating patient on Haughley ward.

    Delay in having a biopsy and diagnosis of cancer in an oral surgery patient.

    Delay in a dermatology patient receiving treatment due to lost samples.

    Poor communication and a delay in receiving a colorectal outpatient appointment.

    Medication issues on Lavenham and Stowupland wards.

    A patients poor care following 2 ectopic pregnancies.

    2 complaints relating to poor obstetric care on Deben ward.

    Overdue Complaints:

    There were no overdue complaints in February.

    Nine requests for an extension were made in February; five were Division 1 cases, three

    were Division 2 cases and one was a Division 3 case. This compares with nine extension

    requests being made in January, ten in December, five in November and eight in October.

    Re-opened Complaints:

    Three complaints were re-opened in February; this compares with 6 cases being re-opened

    in January and four being re-opened in December. November and October also saw four

    complaints being re-opened.

    Of the three complaints that were re-opened, two relate to Division 2 and one relates to

    Division 1. One Division 2 case was easily resolved by offering the patient a Trauma and

    Orthopaedic clinic appointment, the other re-opened Division 2 complaint is currently being

    re-investigated by the Rheumatology team. The Division 1 case relates to a stroke patient

    and is currently being re-investigated within the Division.

    24 Hour Courtesy Calls:

    There were 3 failures to make the 24 hour courtesy calls in February; this is a higher level of

    failure than recorded in previous months. One failure was in relation to a Renal Unit

    complaint, one was in relation to a Trauma and Orthopaedic complaint and the other related

    to an Estates and Facilities complaint.

    Parliamentary and Health Service Ombudsman (PHSO):

    One new case was referred to the PHSO in February; this complaint relates to a Division 2

    Oral Surgery complaint.

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    In February the Trust received the Ombudsmans final report for a complaint regarding the

    Emergency department. The complaint also refers to the patients GP and Mental Health

    service provider. The final report indicates that the Ombudsman is upholding the complaint

    and making recommendations including that each organisation involved should pay financial

    recompense to the patient and her mother for the injustice they have suffered as a result of

    the failings identified. The Trust has now written a letter of apology to the complainant and

    paid recompense in line with the PHSO recommendations. The Trust must also provide the

    complainant and the PHSO with a copy of the action plan in relation to this case by May


    The number of Ipswich Hospital complaints that the Ombudsman upholds or partially

    upholds is low when compared with the national average. To date, in 2015/16 25% of

    complaints referred to the PHSO have been upheld or partially upheld, compared with the

    national average of 45%.

    There are currently seven Ipswich Hospital cases under investigation by the PHSO.

    94% of the Division 2 courtesy calls were made in February, the one failure relates to a

    Trauma and Orthopaedic case.

    Patient Advice and Liaison Service:

    PALS handled 210 contacts in February, following a higher than average number of contacts

    being made in January (241). The usual range of contacts for PALS each month is between

    180 and 220. Approximately 50% of the calls to PALS are graded as PALS 1 contacts as

    they relate to straightforward matters such as signposting other service providers, lost

    property, Access to Health Record requests, car park enquires and families trying to contact


    Other matters, requiring some element of liaising or investigation, are graded as PALS 2.

    Issues raised include:-

    Cardiology patients being unable to contact the Cardiology department.

    Urology patients chasing surgery or procedures dates.

    Neurology patients chasing appointments

    Colorectal patients chasing appointments and results.

    Patients chasing Dermatology appointments.

    Patients chasing Eye Clinic appointments

    Patients chasing Trauma and Orthopaedic appointments.

    Care and communication issues occurring on wards.

    The PALS team handled 17 ward related concerns in February. This compares with 13 in

    January, 20 in December and 24 in November. No particular ward stands out as having

    more concerns raised through PALS but in general the matters raised by inpatients and their

    families relate to discharge arrangements and families not knowing who to speak to on the


    In each case where PALS have liaised with families and ward staff the issues raised have

    been resolved without the need to raise a formal complaint.

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    Family Carers of People with Dementia CQUIN

    Dementia family carer CQUIN to provide family carers of patients with dementia the

    opportunity to provide feedback on support given to them by the hospital:

    58 dementia carer packs were distributed this was 100% of the carers identified who met

    the CQUIN criteria.

    10 follow up feedback calls were undertaken with all agreeing to take part. 90% felt confident

    to leave their relative in our care; 100% felt supported some or all of the time. 90% reported

    receiving a carers pack.



    Forecast outturn in 2015/16 of 22.1m

    YTD at Month 11, Trust is 5.9m adrift of plan, deficit of 22.8m; actions in M12 will

    adjust to FOT projection (including TPP)

    Agreement with Lead Commissioner re 15/16 contract position reduces financial

    risk and improved cash flow in-year

    Focus on Workforce initiatives to reduce Agency spend

    Received loan to support working capital 18.5m deficit plan


    The schedule of risks presented shows how the deficit of 22.8m at Month 11 (an adverse

    variance to plan of 5.9m) reflects the increased risks facing the organisation against the

    initial assessment at budget approval. The Risk & Opportunities schedule builds on the

    Board-approved financial plan for 2015/16 of a deficit of 19.8m.

    Community budgets are included within the Trusts financial reporting; to date, there is

    minimal variance to plan YTD and forecast, although a risk remains regarding continence


    The table below presents a view by Division of both YTD at Month 11 and a run-rate

    projection to year-end.

    The primary reasons for the variance of 5.9m at Month 11 are:

    M11 YTD FOT

    Div 1 (2.1) (2.5) Adjusted M9 for Diag Imaging

    Div 2 (1.5) (2.1)

    Div 3 (1.1) (1.1) Adjusted M9 for Diag Imaging

    Div 4 0.2 0.0

    Reserves (1.3) 2.1 includes TPP adj M12

    Variance (5.9) (3.6)

    Plan (16.9) (18.5)

    FOT (22.8) (22.1)

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    Delayed Transfers of Care; these impact on the ability of the trust to discharge

    patients into community care once the appropriate level of hospital-based care has

    been concluded; this is a significant part of the Division 1 CIP plan

    Higher than plan Non-elective activity; this impacts on capacity within the hospital

    and also is a primary contributor to the level of agency staffing deployed within the


    The Trust is undertaking a number of initiatives aimed at reducing the level of agency

    expenditure across the organisation in line with the targets for agency reduction

    issued centrally. Agency expenditure has reduced in recent months, and the Trust

    achieved the 6% target in Month 11; Pay was higher than the previous month and is

    anticipated to stabilise for the remainder of Quarter 4 and achieve the 6% target even

    with increased activity.

    The extrapolated run-rate from the M11 position to year end remains 26m, after release of

    contingency and including estimate of financial pressures arising from additional activity over

    the winter period. However, recognition of the investment in TPP during 2015/16 and

    transfer of 0.75m from Capital to Revenue resource will result in the FOT 22.1m deficit

    being achieved.

    The table below shows a projected likely deficit of 22.1m (C).

    Opportunities have been identified; there are action plans to deliver these:

    Agency Expenditure: improvement has been delivered in Quarter 3 but the

    sustainability of the significant reduction in Month 9 remains under scrutiny

    Utilise an opportunity to move unused Capital Resource Limit non-recurrently in-year

    to Revenue via receipt of income for the CRL unutilised (0.75m has now been

    agreed and reflected in M11 position)

    Resolution of significant proportion of contractual challenges through the contract

    agreement with lead commissioner for 2015/16 (achieved and reflected in YTD run-


    Maximise CIP delivery (CIP is predicted to deliver target in-year and recurrent full-

    year effect financial impact already in YTD run-rate)

    The Pathology Partnership is being treated as an investment, following receipt of a

    revised business plan and agreement from the Partnership Board; this will not reduce

    the cash flow requirement in-year but enables partner organisations to agree a

    consistent accounting treatment (in Month 12, the Trust will reverse the revenue

    provision apportioned in-year and transfer to the balance sheet).

    The forecast, as shown in the Risk & Opportunities schedule, is to achieve a likely deficit of

    22.1m (C) in 2015/16 assuming delivery of the above mitigating actions.

    The summary of the three scenarios as presented in the Risk & Opportunities schedule is as


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    The Trust submitted an application for cash support to replace the interim working capital

    facility in October; this was approved by the Department of Health in December and has now

    been received by the Trust and has been used to repay the working capital facility; the sum

    in both counts was 17.3m. The Trust has received a further 1.3m cash support in Month

    11, reflecting the additional cash resource required against the 18.5m revised plan. There

    is a set of criteria to which the Trust must adhere as part of the loan agreement conditions;

    this is being reported to the executive via the Finance & Performance Committee.


    Monitoring of the performance of Divisions against Financial Recovery Plans agreed at the

    Divisional Board-to-Board meetings continues, with Executive reviews with Divisions as

    required where performance is more than 50k adrift from plans. At Month 11, Divisions are

    delivering (individually and collectively) the revised projections within their Financial

    Recovery Plans.


    Emergency Care

    The Trust failed to achieve the 4 Hour wait target in February with 92.79%, year to date

    performance fell just below 95% at 94.95% however the Trust remains the best performing

    Trust year to date with the Midlands and East.

    Activity continues to increase above 2014/15 levels 5.4 Year to D...


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