BOARD OF DIRECTORS PART 1 PAPER – COVER SHEET Meeting … Mar 11 E Finance and... ·...

BOARD OF DIRECTORS PART 1 PAPER – COVER SHEET

Meeting Date: 30 March 2011

Agenda Item: 12 Paper No: E Title:

Finance and Performance Report

Purpose:

To provide an analysis of the financial performance of the organisation for the 11 months to February 2011 including an analysis of contract performance and workforce.

Summary:

The financial results for the 11 months to February continue to demonstrate delivery of the revised forecast agreed with the Board and Monitor at 30th September 2010. The Trust has incurred a deficit of £0.6m for the month of February bringing the total deficit for the 11 months year to date to £4.3m. The Trust forecast surplus for the year to March at £4.7m remains in line with the agreed re-forecast.

Recommendation:

The Board of Directors is requested to review the attached report on financial performance.

Prepared by:

PAUL D TURNER / ANDREW GOODWIN Directory / Deputy Director of Finance KATE THOMAS Performance Manager

Presented by:

PAUL D TURNER Director of Finance MARY SHERRY Chief Operating Officer

Assurance Framework Y Risk Register I/D No. Y Healthcare Standards: Please specify which standard

Financial implications YES

Monitor compliance Y Human Resources implications NO Internal monitoring Y Legal implications NO

FINANCE AND PERFORMANCE REPORT Eleven Months to 28th February 2011

Key Issue Executive Summary Key

Performance Indicator

RAG Sch. Action Required

Financial Overview and Year End Forecast

The financial results for the 11 months to February continue to demonstrate delivery of the revised forecast agreed with the Board and Monitor at 30th September 2010. The Trust has incurred a deficit of £0.6m for the month of February bringing the total deficit for the 11 months year to date to £4.3m.

The Trust forecast surplus for the year to March at £4.7m remains in line with the agreed re-forecast.

£3.9m of the forecast deficit is caused by the impact of non-recurring expenditure relating to last year or to costs supporting the Trust's financial recovery. These are analysed in schedule A1. It has been agreed with the auditors and with the Audit & Governance Committee that £0.7m of these costs should be treated as prior year adjustments when preparing the annual accounts. This will reduce the deficit for 2010/11 from £4.7m to £4m and increase the deficit for 2009/10 by £0.7m. Monitor have been notified of this proposed prior year adjustment.

The underlying financial position of the Trust as it closes the year is therefore a deficit of approximately £1m. The Trust has recurring income of £15.6m and recurrent expenditure of approximately £15.7m. For this reason the RAG rating remains as RED.

Prior Period Adjustment – Asset Revaluation

In 2009/10 estate was revalued resulting in a technical charge to I&E of £3.6m with balance of impairment going to revaluation reserve. Because this was done later in the year the split between I & E was estimated on a reasonable basis and agreed with the auditors as at 31 March 2010. However it was recognised that further work was required on the accuracy of the accounting treatment. This work has

All financial variances with specific focus on: • Income • EBITDA • CIP • Cash • Capital

spend

ALL

The key action is to develop and agree detailed financial plans for 2011/12 which deliver a surplus of £2m and restore the Trust to a Financial Risk Rating of 3. This is the subject of a separate report to the Board

R

Key Issue Key

Executive Summary Performance RAG Sch. Action Required Indicator

now been completed and the external auditors and the Audit Committee have agreed a prior period adjustment of £1.9m. This adjustment has no impact on the underlying financial performance of the Trust. Monitor have been informed.

Non-Recurring Costs

Schedule A1 shows actual non-recurring costs for the month of February and 11 months YTD together with forecasts to year end. Year end forecast remains broadly in line with plan despite changes in individual elements:

o Reduced redundancy costs (£0.9m) offset by: o Increased turnaround support (£0.3m) o Reduced non-recurring income from charitable funds

and research funds (£0.6m) o Recognition of NHS Injury benefits charge (£0.3m) as

non-recurring o Increase in recognition of costs relating to last year

(£0.3m)

Non-recurring costs

A1

Complete work on research funds and agree accounting treatment Negotiate final settlement of all NHS debts relating to 9/10 Confirm expenditure plans for all major charitable funds and agree charge of revenue costs

Activity and Income

In January the Trust agreed a year end settlement with its two main commissioners in order to secure planned income levels for the year and to protect the Trust from any contract shortfalls. Actual contract performance would have delivered a similar (though slightly lower) level of income:

• shortfall on cost per case income increased to £0.8m, at full tariff (0.8% of contract).

• Above shortfall partly off-set by higher excluded drugs costs (£0.6m).

• The over-performance on Emergency Activity which was evident earlier in the year has continued to reduce month by month and is now only 1%

Schedule B provides detailed analysis of contract performance.

Agree contract for 2011/12

G

A

Key Issue Key

Executive Summary Performance RAG Sch. Indicator

Action Required

Financial Risk Rating

Financial Risk Rating FRR remains at 2. In order to return to FRR of 3 the Trust needs to achieve financial balance in 11/12.

5 key elements weighted to produce overall FRR: • EBITDA % • ROA • Surplus % • Liquidity

E

• Deliver monthly break-even

from April 2011 • Improve liquidity by

maintaining tight control over capital expenditure

Cost Improvement Programme (CIP)

For year to date the Trust has achieved savings of £5.7m, broadly in line with target and is on target to achieve targeted £6.5m for year.

CIP tracker Savings against target

E

Develop detailed plans for further £10m saving in 2011/12

Working Capital

The total overdue debt at the end of January 2011 amounts to £2.5m. However the debt overdue by more than 90 days has improved by £0.9m from £1.4m to £0.5m.

There are a number of disputed invoices relating to prior years. However there has been significant progress in February in resolving these and work is ongoing to resolve the remainder by the year end.

Creditors are broadly in line with plan.

Aged Debt Analysis Balance Sheet

F & G

Clear back-log of outstanding purchase invoices Implement e-procurement to improve financial control and efficiencies of creditor payment processes

Capital Expenditure

Capital expenditure has increased to £3.0m for the year to date including orders raised not yet delivered of £1.1m. The forecast for the year has now been reduced to £3.5m compared to an initial plan of £4.9m and a revised plan of £4.1m.

The Trust deliberately reduced capital expenditure in the first half of the year (only £0.6m was committed in the first 7 months of the year). The slippage in planned expenditure does not represent any risk to the Trust (indeed the opportunity has been taken to bring forward certain items of high priority replacement equipment from the 2011/12 capital programme.).

Expenditure against plan for individual schemes

H

Agree capital programme for 2011/12 including any priorities carried from 2010/11

A

A

A

R




Cash Flow

The Trust has established tighter control over cash management including a rolling 13 week forecast, daily monitoring and a weekly cash committee to monitor working capital and cash management. This has had a positive impact on cash balances which reached a low of £3.7m in February 2010. The cash balance at the end of February is £7.9m against an original plan of £8.2m and a revised plan of £6.4m. The positive variance of £1.5m is caused by negotiated recurring agreement with PCT for payment of W.I.P -£0.7m) and under-spend on capital (£0.9m).

• Average daily cash balance year to date = £13.5m -all Cash invested at 0.8% (Barclays Business Premium)

• Year end forecast increased from £4.5m to £8m reflecting agreement with PCT for payment of WIP (£0.7m) and lower levels of capital expenditure and other improvements in cash management

• Cash Balance projected to increase in 2011/12 to £10.5m as a result of planned surplus of £2.0m and continued prudent management of capital expenditure (Capex at least £2m below depreciation of £8m)

Aged Debt Cash balance Capital Expenditure against plan Operating Deficit

F

Workforce

• Workforce pay costs reduced from £10.8m in January 2010 to £10.5m in February 2011 despite AfC, consultant increments and winter pressures

• Staffing costs are £0.4m below re-forecast for the month and £1.3m below for year to date.

• Agency costs remain under control at 0.68% of pay • Sickness rates at 3.54% ytd remain very low • Staff numbers reduced by 151 wte from 3,237 at start of year to

3,076 in February (including bank wte) • Temporary wte represent 3.7% of staff (last month 3.9%)

Declining total pay costs Agency and locum costs Sickness rates Staff Turnover

K

Agree detailed workforce plan for 11/12 in line with agreed savings target

A

G

Actual FRP Variance Last Year Actual FRP Variance Last Year Forecast FRP Orig. Plan Last Year£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Contract Income - B&P PCT 9,200 8,950 250 9,439 104,645 103,781 864 105,060 113,900 113,456 114,032 114,193Contract Income - Dorset PCT 3,690 3,637 53 3,650 41,919 42,209 (290) 40,945 45,950 46,171 45,608 44,595Contract Income - Specialist Commissioning 243 258 (15) 237 2,824 2,838 (14) 2,607 3,080 3,096 3,083 2,862Contract Income - Other 273 346 (73) 366 3,754 4,002 (248) 4,179 4,020 4,383 4,111 4,430Other Operating Income 1,795 1,878 (83) 1,688 19,114 19,025 89 21,659 20,890 20,952 22,013 22,641

Total Operating Income 15,201 15,069 132 15,380 172,256 171,855 401 174,450 187,840 188,058 188,847 188,721

Pay Costs (10,500) (10,865) 365 (10,705) (116,355) (117,612) 1,257 (119,905) (126,970) (128,694) (129,638) (130,367)Non-Pay Costs (4,427) (4,227) (200) (4,239) (49,791) (48,695) (1,096) (46,936) (54,290) (52,870) (47,365) (51,437)

Total Operating Expenditure (14,927) (15,092) 165 (14,944) (166,146) (166,307) 161 (166,841) (181,260) (181,564) (177,003) (181,804)

Profit/(Loss) on disposal of fixed assets 0 0 0 0 0 0 0 (2) 0 0 0 (2)

EBITDA 274 (23) 297 436 6,110 5,548 562 7,607 6,580 6,494 11,844 6,915

Depreciation (665) (666) 1 (635) (7,530) (7,393) (137) (6,987) (8,200) (8,057) (8,057) (11,424)Interest Receivable/(Payable) 4 (2) 6 (2) (6) (28) 22 24 (30) 12 0Dividend (258) (263) 5 (304) (2,842) (2,891) 49 (3,346) (3,100) (3,150) (3,650) (3,625)

Month - February Year to Date Full Year

Trust I&E

Schedule A

Surplus/(Deficit) (645) (954) 309 (505) (4,268) (4,764) 496 (2,702) (4,720) (4,743) 149 (8,134)Non-recurring costs included above 87 182 (95) 0 3,818 3,477 341 0 3,882 3,812 0 3,650Normalised Surplus/(Deficit) (558) (772) 214 (505) (450) (1,287) 837 (2,702) (838) (931) 149 (4,484)

Key Observations Key ActionsForecast

The Trust has incurred a deficit of £0.6m for February bringing the total deficit for the 11 months year to date to £4.3m. For the year to date the Trust is slightly ahead of forecast . The reported deficit is almost entirely caused by non-recurring expenditure relating to last year or to costs supporting the Trust's financial recovery.Pay expenditure is £0.4m below the revised forecast for the month as a result of proactive management of vacancies and removal of posts associated with 13 week activity.Non-pay expenditure is £0.2m ahead of re-forecast because of increases in costs in February, particularly CNST and consultancy, and because of full reporting of overspend on excluded drugs costs

Review non-pay expenditure and bring back in line with re-forecast

Review underspends on pay and take recurrent savings where appropriate

Deliver FRP including savings in year of £6.5m with a full year effect of £12.2m

The Trust forecast deficit for the year has been left unchanged at £4.7m as per revised forecast agreed with Monitor at end September.

Schedule ASchedule A

NON‐RECURRING EXPENDITURE 2010/11

Mth of Jan10 mths to

JanMth of Feb Mar

Total 2010/11 Per FRP Sept 2010

Act Act F'cst F'cst£'000 £'000 £'000 £'000 £'000 £'000

Consultancy SupportKPMG Turnaround Consultanct Support 930 58 58 1,046 990KPMG Business Planning Support 527 527 527E & Y Turnaround Consultant Support 46 46 45Finnamores Acute Services Review 48 48 40Newtons Theatres improvement project 272 272 294Newtons Outpatients improvement Project 70 412 100 13 525 489Housden Turnaround Consultanct Support 32 32Other Turnaround Support 17 17 17 10 44

Recovery Director Full time from October 26 178 22 26 226 183Interim HR Director 19 51 19 15 85Redundancy Provision 50 148 20 168 1,090

Sub‐Total Recovery Costs 182 2,661 236 122 3,019 3,658

Costs Relating to Last YearReconciliation of RBH debtor / creditor position 150 150 150Credit raised for invoices to non-Dorset PCTS 81 162 81 82 325 0Increase in Bad Debt provision 100 100 300Review and assessment of Y/E debtor / creditor balances 70 70 68Consultancy Charge Relating to Last Year (Newtons) 200 200 200Back-Pay on various individual medical contracts 287 45 332 338SAS Contract 45 45 20 85 150 106Removal Expenses 60 60 88PCT top-slice central funds relating to 2009/10 204 204 204PCT top slice central funds relating to 2009/10 204 204 204Redundancy declared March 2010 not charged until 10/11 115 115 115Assumed recovery of pay overpayments relating to LY ‐28 ‐80 ‐108 ‐172 AfC Back pay 0 60 60

Sub Total Costs Relating to Last Year 126 1,365 101 192 1,658 1,397

Other Non‐Recurring Costs / Income Reconciliation of RBH debtor / creditor position 37SAS Contract 107Medical Records relocation 37Maternity Pay 26NHS Injury Benefit Charge 25 250 25 25 300Other / Contingency 200Non Recurring income ‐150 ‐545 ‐275 ‐275 ‐1,095 ‐1,650

Sub‐TotalOther Non‐Recurring Costs / Income ‐125 ‐295 ‐250 ‐250 ‐795 ‐1,243

Total 183 3,731 87 64 3,882 3,812

Schedule A1

Poole Hospital NHS Foundation Trust

2010/11 Income & ExpenditureActual Actual Cum Act Act Act Act Act Forecast Forecast FRP FRP Avg

£m 2008/09 2009/10 September October November December January February March Year Mth

Contract Income 161.4 166.1 84.1 14.0 13.9 14.4 13.7 13.7 13.7 167.5 167.1 166.0 13.8non-recurring contract income -0.2 -0.1 -0.1 0.5 0.4 0.5Other Operating Income 22.1 22.6 10.3 1.5 1.7 1.5 1.7 1.5 1.2 19.4 19.7 19.3 1.6Non-Recurring Income 0.0 0.1 0.1 0.2 0.2 -0.4 0.2 1.3Operating income 183.5 188.7 94.2 15.6 15.7 16.0 15.5 15.3 15.3 187.6 188.1 185.3 15.4ExpenditurePay costs -121.9 -130.4 -63.4 -10.5 -10.4 -10.5 -10.5 -10.6 -10.5 -126.4 -127.1 -121.8 -10.2 Non-pay costs -47.7 -51.4 -25.0 -4.1 -4.2 -4.4 -4.1 -4.2 -4.4 -50.4 -49.4 -49.3 -4.1 ‐4.2 10.5Non-recurring pay -0.4 -0.1 -0.1 -0.6 -1.6 4.2Non-recurring non-pay -2.2 -0.6 -0.3 -0.2 -0.3 -0.2 -0.1 -3.9 -3.5 -1.0 -0.1 1Total operating expenditure -169.6 -181.8 -91.0 -15.3 -14.9 -15.1 -14.9 -15.0 -15.1 -181.3 -181.6 -172.1 -14.3 EBITDA 13.9 6.9 3.2 0.3 0.8 0.9 0.6 0.3 0.2 6.3 6.5 13.2 1.1Depreciation, Interest & PDC -10.5 -15.0 -5.7 -1.0 -0.9 -1.0 -0.9 -0.9 -0.9 -11.3 -11.2 -11.2 -0.9 Actual surplus/(deficit) 3.4 -8.1 -2.5 -0.7 -0.1 -0.1 -0.3 -0.6 -0.7 -5.0 -4.7 2.0 0.2

Normalised Surplus / (deficit) 3.4 -4.5 0.1 -0.1 0.1 -0.1 -0.2 0.0 -0.5 -0.7 -0.9 3.0 0.3

2010/11 2011/12

2010/11

Schedule A2

1 Five Contracted PCT's - Actual v Plan 2010/11 YTD Eleven months to February 2011 The shortfall on cost per case income has increased to £800k (0.8%) at full income.

High day case activity increases elective overperformance to 3.5% above planand 2% above in income terms.

activity £ activity £ activity £ activity £ activity £ activity £

Elective 22,082 £22,224,295 20,141 £20,270,577 20,846 £20,673,354 705 £402,777 3.5% 2.0% £202,429 £221,978 Emergency (over)activity reduced to 1% above plan, but 1.3% below income target.Inpatients 5,120 £10,249,173 4,670 £9,348,178 3,761 £8,130,622 909‐ ‐£1,217,556 ‐19.5% ‐13.0% - B&P PCT activity volumes on target, but 2.3% below income target.Day Case 16,962 £11,975,122 15,471 £10,922,400 17,085 £12,542,732 1,614 £1,620,332 10.4% 14.8% - Dorset PCT 3.6% above plan, but only 0.6% in income terms.

Non Elective 42,792 £67,317,384 39,084 £61,465,351 39,676 £61,328,734 592 ‐£136,617 1.5% ‐0.2% £87,187 £94,616

Emergency 29,174 £53,360,761 26,623 £48,694,085 26,895 £48,055,715 272 ‐£638,370 1.0% ‐1.3% Overperformance in other non-electives (maternity) increased in February.Other 13,618 £13,956,623 12,461 £12,771,266 12,781 £13,273,019 320 £501,753 2.6% 3.9%

Outpatients 168,584 £21,342,305 153,764 £19,466,122 148,096 £18,380,407 5,668‐ ‐£1,085,715 ‐3.7% ‐5.6% ‐£542,019 ‐£594,235 Outpatient performance remains stable with first outpatients 11-12% below and First 64,200 £11,498,679 58,556 £10,487,841 51,725 £9,305,537 6,831‐ ‐£1,182,304 ‐11.7% ‐11.3% followups 1% above activity and income targets.Followup 104,384 £9,843,626 95,208 £8,978,282 96,371 £9,074,870 1,163 £96,588 1.2% 1.1%

Overperformance on A&E attendances further reduced 1% above plan.A&E Attds 55,068 £4,701,346 50,391 £4,302,054 50,874 £4,279,650 483 ‐£22,404 1.0% ‐0.5% ‐£11,201 ‐£12,257

Other activity £99,315 £90,300 £132,878 £42,578 47.2% £21,290 £23,265 Income underperformance at full tariff reduced 70% by application of marginalCost per Case Contract Total £115,684,645 £105,594,405 £104,795,023 ‐£799,382 ‐0.8% ‐£242,314 ‐£266,633 tariff.Excluded Drugs £12,122,502 £11,112,294 £11,469,794 £357,500 3.2%

Block Contract £33,445,567 £30,757,789 £30,757,789 £0 0.0%

Market Forces Factor (MFF) £5,392,814 £4,943,413 £4,943,413 £0 0.0% £3,596 £4,282

Contract Total £166,645,528 £152,407,900 £151,966,019 ‐£441,882 ‐0.3% ‐238,718 ‐262,351

Non Contract £460,472 £422,099 £422,099 £0

Total £167,106,000 £152,830,000 £152,388,118 ‐£441,882 ‐0.3% ‐238,718 ‐£262,351

activity/marginal tariff

Key Actions

Contract Performance Key Observations

2010/11 Contract Year to Date Over/Under Performance Year end Projection

Contract Actual diff % diff

Total Elective Spells

1,500

1,750

2,000

2,250

2,500

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

2009/10 Actual 2010/11 Contracted 2010/11 Actual/Forecast

Total Nonelective Spells

3,200

3,400

3,600

3,800

4,000

4,200


2009/10 Actual 2010/11 Contracted 2010/11 Actual/Forecast 2008/09 Actual

Schedule B

Complete financial negotiations around 11/12 contract with Dorset-based PCT's.

Baseline activity/values now to be adjusted to reflect finacial settlement, current. and planned casemix.

Review and respond on detailed contract documentation.

Review PCT plans for QIPP and CQUIN.

Establish and value commissioning plans of Non-Dorset PCT's.

2 Cost per Case Income Summary by main commissioner (£000) Projecting small underperformance in total contract income following application of marginal tariff.

Contract £ Actuals £ Under/Over Under/Over Under/Over

PCT Totals 2010/11 YTD YTD @Full Tariff @Marginal Est Yr end

Bournemouth& Poole 82,261 75,090 73,656 ‐1,434 ‐533 ‐585

Dorset 29,940 27,325 27,737 412 187 205

Others 3,484 3,179 3,401 222 103 113

Cost per Case Contract Total 115,685 105,594 104,794 ‐800 ‐243 ‐267

Year End Projection

Total Elective Spells

1,500

1,750

2,000

2,250

2,500


2009/10 Actual 2010/11 Contracted 2010/11 Actual/Forecast

Total Nonelective Spells

3,200

3,400

3,600

3,800

4,000

4,200


2009/10 Actual 2010/11 Contracted 2010/11 Actual/Forecast 2008/09 Actual

Schedule BSchedule B

Actual FRP Variance Last Year Actual FRP Variance Last Year Forecast FRP Orig. Plan Last Year£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

2,878 2,924 46 2,852 31,920 32,489 569 32,692 34,820 35,645 35,716 36,8683,786 3,896 110 3,975 42,569 43,175 606 43,554 46,430 46,935 49,243 48,507

802 839 37 797 8,729 8,766 37 8,813 9,530 9,579 10,552 9,74991 90 (1) 94 994 974 (20) 964 1,085 1,062 1,214 1,052

950 917 (33) 909 10,120 9,941 (179) 9,842 11,070 10,836 11,542 11,12838 40 2 37 420 430 10 404 460 465 488 440

383 673 290 380 4,415 4,742 327 4,261 4,810 4,403 4,783 4,7051,076 1,055 (21) 1,108 11,968 11,996 28 12,519 13,050 13,261 14,571 13,694

330 339 9 338 3,568 3,675 107 3,470 3,900 4,001 3,754 3,78876 85 9 77 848 900 52 867 925 984 1,022 92790 7 (83) 134 804 434 (370) 2,712 890 433 166 (491)

0 0 0 4 0 90 90 (193) 0 1,090 0 00 0 0 0 (3,413) 0

10,500 10,865 365 10,705 116,355 117,612 1,257 119,905 126,970 128,694 129,638 130,367

67 126 897 1,360 1,49390 7 134 806 427 2,712 433 433 166 2,912

271 364 3,454 4,332 4,681

Professions allied to Medicine

Pay Expenditure

Month - February Year to Date Full Year

Pay ExpenditureMedical staff incl. medical locumsNursing staff

Total Pay Costs

Scientific & Professional staffProfessional & Technical staffOther Scientific, Therapeutic & Technical staffSenior Managers and Board MembersAdministrative & Clerical staffHealth Care Assistants and Other Support staffMaintenance & Works staffNon NHS staff excl. medical locumsOther Non-Directorate costsFRP schemes

Of which Medical Locums Agency staff Bank staff

11.2Actual

Schedule C

Key Observations Key Actions Forecast

10.0

10.2

10.4

10.6

10.8

11.0

11.2

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

£m

Actual

Forecast

Original Plan

Pay is underspent by £365k in the month compared to reforecast

The variance against senior managers arises as a result of the actual redundancy provision being less than forecast

Ensure savings projects delivered in line with FRP

Re-assess pay forecast

Forecast is in line with financial recovery plan agreed by Board and submitted to monitor

Schedule CSchedule C

Actual FRP Variance Last Year Actual FRP Variance Last Year Forecast FRP Budget Last Year£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Drugs 1,343 1,328 (15) 1,320 15,163 14,563 (600) 15,152 16,500 15,870 16,103 17,083 Other Clinical Supplies 1,279 1,169 (110) 1,147 13,063 12,806 (257) 12,632 14,250 13,996 12,711 13,617 General Supplies & Services 332 342 10 359 3,799 3,815 16 3,941 4,140 4,154 4,198 4,292 Establishment 204 208 4 240 2,542 2,514 (28) 2,797 2,750 2,729 2,782 3,027 Premises & Fixed Plant 417 377 (40) 407 4,101 4,061 (40) 3,949 4,480 4,480 4,357 4,466 Purchase of healthcare from non-NHS bodies 2 4 2 7 30 37 7 53 32 40 29 50 Services from other NHS bodies 208 208 0 266 2,471 2,567 96 2,777 2,700 2,777 2,782 3,120 External Contract Staffing & Consultancy 249 60 (189) 4 3,038 2,603 (435) 55 3,300 2,648 62 65 Auditors Remuneration 5 5 0 4 96 95 (1) 89 100 105 56 80 Miscellaneous 583 526 (57) 428 5,650 5,634 (16) 4,969 6,200 5,580 5,583 5,345 Other Non-Directorate costs (195) 195 57 (162) 0 162 522 (162) 491 559 292 FRP schemes (1,857)

Total Non-Pay Costs 4,427 4,227 (200) 4,239 49,791 48,695 (1,096) 46,936 54,290 52,870 47,365 51,437

Non-Pay Expenditure

Month - February Year to Date

4 04.24.44.64.85.0

Actual

Forecast

Original Plan

Schedule D

Key Observations Key Actions Forecast

3.03.23.43.63.84.04.24.44.64.85.0

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

£m

Actual

Forecast

Original Plan

Non-Pay is overspent by £200k

Drugs overspend (£15k) primarily relates to full cost of Chemotherapy drugs being included. The slippage on the procurement FRP is having an impact on non-pay costs. In the month, an adverse variance arose on consultancy due to additional consultant time and budget phasing. The clinical supplies overspend primarily relates to a downward valuation of stock levels following the stocktake. Other Non-Directorate primarily relates to VAT refunds.Total drugs cost in 10/11 are forecast to be £0.6m lower than 2010/11despite inflation and Nice guidance.Potential dispute with RBH who have raised £0.5m charges for non-cyto drugs which should not be recharged to Poole but have been in previous years and have been paid. PCT agrees with our interpretaion of contract

Review miscellaneous expenditure. Forecast is in line with financial recovery plan agreed by Board and submitted to monitor

Forecast includes non-recurring costs of £3.4m

Schedule DSchedule D

WeightingM11

YTDForecast

CIPs Key Observations

2 2 2 1 3 2

2

2 2 2

Financial Risk Ratings

2 2 1 1 3

1 3 2

25% 10% 20% 20% 25%

Key Observations

Ratings (5: Excellent - 1: Weak)

EBIDTA Margin EBIDTA Achieved Return On Assets I&E Surplus Margin Liquidity Overall

700

800

900

1,000

5,000

6,000

7,000 CIPsActual CIPs on plan in M11, and ahead YTD by £32k

- Shortfall on the following in month:Private Patients 15k

FRROverall target of FRR for year.

Headroom to FRR of 1 is £4.0m YTD based on over riding rules

To return to FRR of 3 the Trust needs to achieve financial balance in 11/12

Schedule E

£'000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 TotalMonth Target 110 129 243 197 688 492 640 675 750 805 899 910 6,538Month Actual 110 129 243 197 688 509 686 704 704 806 882 5,660Mth Variance 0 0 0 0 0 17 46 29 (46) 1 (17) -

YTD Target 110 239 482 679 1,367 1,859 2,499 3,174 3,924 4,729 5,628 6,538YTD Actual 110 239 482 679 1,367 1,876 2,564 3,268 3,972 4,778 5,660YTD Variance 0 0 0 0 0 17 65 94 48 49 32 -

0

100

200

300

400

500

600

700

800

900

1,000

1 2 3 4 5 6 7 8 9 10 11 12

£m

Month Target Month Actual

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1 2 3 4 5 6 7 8 9 10 11 12

£m

YTD Target YTD Actual

CIPsActual CIPs on plan in M11, and ahead YTD by £32k

- Shortfall on the following in month:Private Patients 15kMedical Staffing 67k Mgmt Structure 6k

These shortfalls have been offset by overachievements on other schemes.

Stricter cost controls have been introduced for pay and non-pay costs

See detailed Recovery Plan Update

PMO is fully established

Establish detailed CIP plans to achieve savings of £17m in 2 years to March 2012 in line with Financial Recovery Plan were presented to the Board in September and further work is ongoing

FRROverall target of FRR for year.

Headroom to FRR of 1 is £4.0m YTD based on over riding rules

To return to FRR of 3 the Trust needs to achieve financial balance in 11/12

Schedule ESchedule E

£'000Non-current assetsCurrent assets- Inventories- Trade & other receivables- Cash and equivalentsTotal current assetsCurrent liabilities- Trade & other payables- OtherTotal current liabilities

Non current liabilitiesAssets employed

£000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12Actual - Inventories 2.2 2.2 2.2 2.2 2.2 2.2 2.2 2.1 2.1 2.1 2.0Actual - Debtors 7.9 8.7 10.9 11.4 10.0 9.1 9.5 9.5 10.4 11.0 7.8

1.3

Balance Sheet Key Observations

M11: Actual v Budget M12Actual Forecast Variance Forecast Original Plan Variance97.2 98.3 1.1 98.1 99.4

0.72.0 2.2 0.1 2.2 1.8 (0.4)7.8 7.0 (0.8) 7.3 8.0

3.97.9 6.4 (1.4) 4.5 8.1 3.617.7 15.6 (2.1) 14.0 17.9

0.0(14.3) (14.2) 0.1 (12.3) (12.8) (0.5)(3.3) (3.4) (0.1) (3.4) (3.4)

0.1

(17.6) (17.6) 0.0 (15.7) (16.2) (0.5)

(1.0) (0.9) 0.1 (1.0) (0.9)

Working Capital Key Observations

96.3 95.4 (0.9) 95.4 100.2 4.8

Trade and other receivables variance of £0.8m - this is mainly due to higher than planned accrued income.

Cash is higher than plan, as detailed on Schedule G

Working capital is reviewed on a weekly basis at the Cash Management Meeting. Detailed analysis of creditors and debtors over 60 days is now subject to a separate action plan

Schedule F

Actual - Cash 6.0 4.8 5.1 5.8 10.1 7.8 9.2 9.7 10.6 9.3 7.9Actual - Creditors (16.5) (15.9) (18.0) (18.9) (22.1) (18.9) (20.8) (21.3) (22.7) (21.9) (17.6)Actual - Net current Assets (0.4) (0.2) 0.2 0.5 0.2 0.2 0.1 0.1 0.5 0.4 0.1Forecast - Inventories 2.2 2.2 2.2 2.2 2.2 2.2Forecast - Debtors 8.2 7.9 7.6 7.2 7.0 7.3Forecast - Cash 5.0 5.6 6.5 6.8 6.4 4.5Forecast - Creditors (16.6) (16.8) (17.1) (17.4) (17.6) (15.7)Forecast - Net current Assets (1.2) (1.1) (0.8) (1.2) (2.0) (1.7)

Trade and other receivables variance of £0.8m - this is mainly due to higher than planned accrued income.

Cash is higher than plan, as detailed on Schedule G

Working capital is reviewed on a weekly basis at the Cash Management Meeting. Detailed analysis of creditors and debtors over 60 days is now subject to a separate action plan

(25.0)

(20.0)

(15.0)

(10.0)

(5.0)

0.0

5.0

10.0

15.0

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

Actual ‐ Inventories

Actual ‐ Debtors

Actual ‐ Cash

Actual ‐ Creditors

Schedule FSchedule F

£000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12YTD Actual 5,986 4,806 5,066 5,753 10,147 7,828 9,245 9,745 10,641 9,292 7,866YTD Forecast 4,975 5,563 6,488 6,796 6,437 4,543YTD Orig Plan 5,939 4,001 4,494 5,195 5,659 4,973 5,614 6,502 7,376 8,462 8,214 8,153

Key Observations

2010/11

Cash

3,500

4,500

5,500

6,500

7,500

8,500

9,500

10,500

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

£'00

0

YTD Actual

YTD Forecast

YTD Orig Plan

Average Daily Cash Balance for February is £16.6m.Cumulative Cash Balance as at 28th February is £7.9m.

Cash balances as at end of month 11 are ahead of plan by £1.4m due to the advance payment of partially completed spells by B&P PCT of £0.8m and managed delays in capital expenditure and creditors

Net cashflow from operations in the month is (£1.1m).

Cash balances will reduce in March mainly due to the payment of the PDC dividend. However it is anticipated that the yearend cash position will be approximately £1.0m ahead of plan.

Schedule G

£'000

NHSNon NHS

Total - Current Month 516 544 309

134 411

33 276

127 389

Aged Debt Key Observations

Current Over 30 days Over 60 days Over 90 daysTotal

1,176

511

2,546

2,035 217 960

3,500

4,500

5,500

6,500

7,500

8,500

9,500

10,500

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

£'00

0

YTD Actual

YTD Forecast

YTD Orig Plan

Average Daily Cash Balance for February is £16.6m.Cumulative Cash Balance as at 28th February is £7.9m.

Cash balances as at end of month 11 are ahead of plan by £1.4m due to the advance payment of partially completed spells by B&P PCT of £0.8m and managed delays in capital expenditure and creditors

Net cashflow from operations in the month is (£1.1m).

Cash balances will reduce in March mainly due to the payment of the PDC dividend. However it is anticipated that the yearend cash position will be approximately £1.0m ahead of plan.

An experienced credit controller has been appointed to review and chase all aged debt.

There are a number of disputed invoices relating to the prior year. However there has been significant progress resolving these in February and work is ongoing to resolve the remainder by the end of March

The non-NHS over 90 day debt relates primarily to private patients, salary overpayments and other miscellaneous debtors.

‐200 400 600 800

1,000 1,200 1,400 1,600

Current Over 30 days Over 60 days Over 90 days

Total ‐ Current month

Total ‐ Previous month

£'00

0

Schedule GSchedule G

YTD C it l E dit (i l di it t )

Capital Expenditure

0

1,000

2,000

3,000

4,000

5,000

6,000

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

£m

YTD Actual

YTD Forecast

YTD Orig Plan

Schedule H

£000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12YTD Actual 88 130 272 373 402 528 611 1,578 1,816 1,996 2,965YTD Forecast 1,000 1,500 2,100 2,800 3,400 4,100YTD Orig Plan 132 441 750 1,100 1,450 1,850 2,350 2,850 3,350 3,850 4,350 4,850

Month YTD Full Year Plan£'000 £'000 £'000

Medical Equipment 573 1521 1600IT replacment/upgrade 207 420 800Estates 114 583 1100Other priorities/developments 75 441 600Totals 969 2965 4100

The total capital commitment at the end of the month included in the above is £1126k

Capital Expenditure in the month was £969k (of which actual spend was £311k and commitments were £658k) as analysed below:

Key Observations Key Actions

YTD Capital Expenditure (including commitments)

Forecast

0

1,000

2,000

3,000

4,000

5,000

6,000

M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

£m

YTD Actual

YTD Forecast

YTD Orig Plan

Agree detailed expenditure profiles for remaining projects

Establish effective processes for development and approval of business cases

Assess medical equipment requirements for next 3 years

Ensure £3m charitable funds are invested in accordance with donors wishes and to support strategic objectives of organisation

The capital programme has been re-phased to ensure that the Trust's cash position is protected with no overall change in the programme but with higher expenditure in the second half of the year

Schedule HSchedule H

Medicine£'000

Actual Forecast Var Actual Forecast VarPay 3,357 3,475 118 37,574 38,136 562Non-pay 1,385 1,234 (152) 14,774 14,213 (562)Total Costs 4,743 4,709 (34) 52,348 52,349 1

Surgery

Directorate Position Key Observations

M11: Actual v Budget YTD: Actual v Budget

0 100 200 300 400YTD Position

YTD Variance by Department (£000)

Medicine

Surgery

MC-POD

Corporates

The overall directorate position for the year to date shows a favourable variance against budget of £787k.

Key overspends in the month include:

The Medical division is £34k overspent in the month. The oncology drugs budget shows an overspend of £83k, which is mainly due to procument FRP savings being removed from the budget.

The Surgical division is £79k overspent in the month. Year end stock take adjustments of £86k were the main cause of the overspend, due to reduced stock levels. This was partially offset by recharges for audiology and stomacare being less than anticipated. The £31k overspend against pay budgets related to backpay for medical staff contracts and additional claims.

MCPOD division is £103k underspent in the month. This is primarily due to underspends against the pay budgets, particularly within maternity, paediatrics and radiology. There was an underspend of £55k against paediatric non pay budgets due to reduced drugs expenditure partially offset by increased pathology non pay costs.

The finance and IT directorate underspent by £46k in the month, due to capitalisation of expenditure and a £30k credit relating to medical gases.

Schedule I

Surgery£'000

Actual Forecast Var Actual Forecast VarPay 2,439 2,409 (30) 27,142 27,278 136Non-pay 568 519 (49) 5,862 5,824 (39)Total Costs 3,007 2,928 (79) 33,004 33,102 98

MC-POD£'000

Actual Forecast Var Actual Forecast VarPay 3,308 3,400 92 36,408 36,872 463Non-pay 517 528 11 6,052 5,910 (142)Total Costs 3,825 3,928 103 42,460 42,781 321

Corporates£'000

Actual Forecast Var Actual Forecast VarPay 1,395 1,713 318 15,231 15,969 738Non-pay 1,464 1,179 (284) 14,901 14,530 (371)Total Costs 2,859 2,892 34 30,132 30,499 367




0 100 200 300 400YTD Position

YTD Variance by Department (£000)

Medicine

Surgery

MC-POD

Corporates

The overall directorate position for the year to date shows a favourable variance against budget of £787k.

Key overspends in the month include:

The Medical division is £34k overspent in the month. The oncology drugs budget shows an overspend of £83k, which is mainly due to procument FRP savings being removed from the budget.

The Surgical division is £79k overspent in the month. Year end stock take adjustments of £86k were the main cause of the overspend, due to reduced stock levels. This was partially offset by recharges for audiology and stomacare being less than anticipated. The £31k overspend against pay budgets related to backpay for medical staff contracts and additional claims.

MCPOD division is £103k underspent in the month. This is primarily due to underspends against the pay budgets, particularly within maternity, paediatrics and radiology. There was an underspend of £55k against paediatric non pay budgets due to reduced drugs expenditure partially offset by increased pathology non pay costs.

The finance and IT directorate underspent by £46k in the month, due to capitalisation of expenditure and a £30k credit relating to medical gases.

Schedule ISchedule I

1. Summary Staff Costs 3. Sickness Absence

Total Staff Cost (including Agency) £116,354,206 Staff Group 2009‐10 2009‐10 YTD YTDAgency Staff Cost £805,677 WTE % WTE %Employed Staff Cost YTD £115,548,529 Additional Clinical Services 37.78 5.76% 31.99 5.12%Total WTE Employed Staff 3076.06 Administrative and Clerical 24.32 4.07% 20.58 3.64% There was a favourable staffing cost variance of £1,900,354 at month 11. ThisUnit WTE Cost (Employed Staff): £40,978.70 Allied Health Professionals 6.56 2.78% 5.02 2.22% equates to 1.61% of the year to date budget, compared to 1.31% at month 10

Estates and Ancillary 7.19 4.01% 6.07 3.46%Healthcare Scientists 3.18 3.18% 2.35 2.45% Agency spend remained at 0.68% of the year to date staffing budget; the same

2. WTE Staffing (paid) at Month 11 Medical and Dental 3.61 0.96% 3.96 1.01% level as months 9 and 10.Nursing and Midwifery Registered 38.41 4.21% 34.75 3.85%

STAFF GROUPSubstantive

WTEBank WTE Total

WTEProfessional Scientific and Technical 5.50 3.41% 6.52 3.96% Unit WTE employed staff costs were £40,979 at month 11 ‐ marginally higher

Ancillary (and other support staff) 171.08 12.65 183.73 Trust Total 121.05 3.93% 111.24 3.54% than month 10.% of wte 93.11 6.89 100.00

Maintenance & Works 29.46 0.00 29.46 Long Term / Short Term Sickness Absence% of wte 100.00 0.00 100.00

Admin & Clerical 509.16 23.40 532.56% of wte 95.61 4.39 100.00 Jan ‐ Dec 2010 23668 18749 55.8 44.2 Substantive staff numbers were 277 wte below the rebased establishment.

Medical & Dental 366.09 0.00 366.09 Feb 2010 ‐ Jan 2011 23572 18380 56.19 43.81 Allowing for bank usage, total staffing was 157.58 wte below the rebased% of wte 100.00 0.00 100.00 Change Between Reporting Periods ‐96 ‐369 0.39 ‐0.39 establishment.

Registered Nurses & Midwives 814.13 28.89 843.02

% of wte 96.57 3.43 100.00 Bank staffing fell slightly in M11 to 119.25 wte compared to 120.62 wte in M10.

Unregistered Nurses & HCAs 405.54 51.15 456.69 There is a continuing need for bank staff in several areas: Registered and% of wte 88.80 11.20 100.00 Unregistered Nursing staff, Admin & Clerical and Ancillary. There is also

AHPs 255.37 0.11 255.48 a small on‐going requirement in specific areas of Technical and AHP staff% of wte 99.96 0.04 100.00

Scientific & Professional 42.75 0.00 42.75

Workforce Overview for period ending 28th February 2011

L/T Days Lost

S/T Days Lost

L/T % S/T %

Key Observations

Staffing costs

Staffing Levels

3.63% 3.80% 4.02% 4.28%3.93%

3.43% 3.17%

3.80%

4.04%

0 0150.02

0.0250.03

0.0350.04

0.045

% Overall Sickness Absence

Schedule J

% of wte 100.00 0.00 100.00Technical 294.29 3.05 297.34% of wte 98.97 1.03 100.00 The year to date rate (April‐January) stands at 3.54%, a slight increase over

Senior Managers & Managers 68.94 0.00 68.94 the previous month's rate. This is in line with seasonal expectations, and the% of wte 100.00 0.00 100.00 rate for January of 4.04% is the lowest recorded in the Trust since 2007.

Trust Total 2956.81 119.25 3076.06 It is the lowest year to January rate recorded for at least 4 years.% of wte 96.12 3.88 100.00 4. Turnover

Budgeted Establishment 3233.64 Additional Clinical Services (healthcare support staff) has the highest rate atVariance SiP vs Establishment 157.58 Staff Group 2009‐10 2010‐11 Year End 5.12%. An increase on the 5.05% reported in M10 and 4.99% in M9.

YTD ProjectionAdditional Clinical Services 15.37 11.93 13.01 A comparison with 12 local Trusts in the South and Southwest as at OctoberAdmin and Clerical 7.14 6.82 7.44 showed the Trust continuing to have the third lowest sickness rate within theAllied Health Professionals 9.87 10.00 10.91 comparator group, and the lowest rate amongst the Dorset Trusts.Estates and Ancillary 4.18 6.07 6.62Healthcare Scientists 5.73 0.98 1.07 At the end of January salary costs associated with sickness absence stoodMedical and Dental 6.75 3.04 3.32 at £2.70m. A year end reduction of some £94,000 can be anticipatedNursing and Midwifery Qualified 8.35 7.12 7.77 compared with last year if cumulative sickness absence rates remain at theirProfessional Scientific and Technical 6.69 9.41 10.27 current level. Trust Total 9.14 7.64 8.33

Staff turnover in the year to February stands at 7.64%, projecting to a yearend rate of 8.33%. This compares with 8.51% (9.28% projected) at the samestage in 2009‐10.

Turnover for Auxiliaries (part of the Additional Clinical Services group) remainscomparatively high at 13.13% ytd, projecting to 14.32% at year end. However, this is the lowest turnover rate recorded for this staff group for many years

Turnover

Sickness Absence

3070 3015 2993 2957

153

115 116 119

33933280 3230 3234

2500

2600

2700

2800

2900

3000

3100

3200

3300

3400

Q1 Q2 Q3 Q4 YTD

WTE Paid Staffing Levels at 28.02.2011 vs Budgeted Establishment

Bank

Substantive

Establishment

3.63% 3.80% 4.02% 4.28%3.93%

3.43% 3.17%

3.80%

4.04%

00.0050.01

0.0150.02

0.0250.03

0.0350.04

0.045

Q1 2009-10

Q2 2009-10

Q3 2009-10

Q4 2009-10

Year End 2009-10

Q1 2010-11

Q2 2010-11

Q3 2010-11

Q4 2010-11

to date

% Overall Sickness Absence

2.12

2.67 2.57 1.78

1.90

2.58

2.03

0

0.5

1

1.5

2

2.5

3

Q1 2009-10 Q2 2009-10 Q3 2009-10 Q4 2009-10 Q1 2010-11 Q2 2010-11 Q3 2010-11

% T

urno

ver

% Overall Turnover

Schedule J

INTEGRATED FINANCE AND PERFORMANCE REPORT

Eleven Months to 28th February 2011




Trust Performance – Monitor Targets

The monitor scorecard is comprised of 14 key indicators. For the most recent year to date position (Jan/Feb 2011) there are 4 red rated indicators:

MRSA • There have been no cases of MRSA in February, which is a

maintained improvement on the 1st Quarter, however the year to date position remains rated red as at 2010. There have been 4 MRSA cases for the year to date, which is the annual target set by Monitor C-Diff

• There have been no cases of C-Diff in February, resulting in the year to date total remaining at 37 C-Diff cases so far this year. When compared with a calculated annual Monitor target of 38 (using Monitor calculation of 15% reduction on outturn) this is red rated. It should, however, be noted that the Trust’s contract with local providers is set at 72 cases per year as delegated by the SHA. MRSA Screening

• MRSA screening in February attained 97%. The 3 month rolling average is 99% and the year to date average currently at 103%. Thrombolysis call to needle within 60 minutes

• The Thrombolysis (call to needle) target was not met in January, this relates to two patients not thrombolysed within the 60 minute target.

New Emergency Standards of Care We have undertaken a review of both our capability to produce the required information and our performance against the standards and a number of amendments to the A&E reporting system are in progress. In terms of performance, in the main we are on track to achieve these standards. Key areas of concern are, high risk patients being reviewed by a consultant and specific reporting requirements for

MRSA bacteraemia acquired C Diff infection acquired. Screening of all elective inpatients for MRSA Cardiac Access Call to Needle

Monitor scorecard

Infection Control issues under continued scrutiny by Performance and Director of Nursing/Infection Control. Issues indentified and being acted upon with partners such as SWAST

A

patients with DVT and Cellulitis. The standard of establishing the patient experience metric is not yet clarified. Work continues on all aspects of meeting the new standards. Attached as Appendix 1 is the internal review document being used by the Emergency Department to review current position and project manage the required actions. Outlook for Quarter 4 The Monitor targets indentified as potentially most at risk for Q4 are : • MRSA Screening (0.5 weighting); • Thrombolysis call to needle (0.5 weighting); • Cancer 62-day screening target (1.0 weighting).

Trust, Performance – Access and Targets

The Access and Targets scorecard is comprised of 22 key indicators. For the most recent year to date position ( Jan/Feb 2011) there are 6 red rated indicators:

Diagnostic Access • The Trust had 64 patients waiting longer than 6 weeks for a

diagnostic test at the end of February in Endoscopy. The department continues to operate above planned capacity levels and the number of waiters in excess of 6 months has been decreasing. Improvements in efficiency within the department are also being implemented, these will include increased use of Nurse Endoscopists and triaging of fast track gastroscopy referrals to ensure their appropriateness Breast Screening

• Breast Screening performance has achieved the 90% target for 3 of the 4 indicators in February. Despite the DBSU achieving 92% against the “screening to 1st offered appointment” target, they did not meet the “screening to attendance”. This target is always vulnerable to patient choice and in February the flexibility in the system, which would normally accommodate this, was compromised by extended staff sickness ad exacerbated by periods of network failure. Delayed Transfers of Care

• Delayed discharges remain an area for concern. The delays percentage has risen slightly since last month to 10.27%. Bed days lost as a result of delays resulting from community hospitals has risen sharply in February at both Christchurch and Alderney and Kimmeridge. In addition we continue to suffer high levels of delays for Social Services assessments and placements and

Diagnostic Access Breast Screening Delayed Transfers of Care

A

ccess and Targets Scorecard Weekly monitoring of waiting list. Analysis of demand required to feedback to PCT. The DBSU have devised and implemented an action plan which includes redistribution of resources more evenly across the screening types as some areas are performing well within target. Audit and review arrangements for newly qualified film readers have also been streamlined. The Operations Manger has continued to work with relevant partners on agreed scheme to reduce delays The Trust continues to flex polling ranges in line with national

A

Continuing Healthcare assessments and funding decisions. • Formal discussions have now in progress with all Borough

Councils and PCTs and a new project will commence in April to establish actions that that can be taken on these issues.

• An action plan will be set out for this work and progress reported to the Board on a quarterly basis. Outpatient Access

• The ASIs (previously TALs) as a percentage for January is 5%, the latest data available, the Trust continues to flex polling ranges in line with national guidance. Thrombolysis (call to needle)

• The Thrombolysis (call to needle) target was not met in January, this relates to two patients,

Time spent on the stroke unit

• Time spent on the stroke unit is also currently below the phased target agreed.

Outpatient Access Call to Needle Time spent on a stroke unit

guidance, and monitor RTT performance. Patient acuity and delays prior to arrival at the Trust have been identified as issues. This will be pursued with SWAST before the end of March

Trust Performance – Clinical Quality

The Clinical Quality scorecard is comprised of 5 key indicators, none of these are part of the Monitor scorecard. For the most recent year to date position (Jan/Feb 2011) all indicators are green. • During the 3 month period ended December, (the latest

information available from the Dr Foster information system) the hospital standardised mortality rate (HSMR) for the Trust was 91.1, within the target of 100.

• The overall number of deaths as well as the HSMR basket of 56 Diagnoses for December was below the expected level calculated as expected by Dr Foster.

• The Mortality group met twice in February to review data with Dr Foster and to agree an action plan.

• There were no serious untoward incidents declared in February.

Mortality Serious Untoward Incidents

Clinical Q

uality Scorecard

Mortality group established in December to continue to review rates with input from Dr Foster and report back to Board.

Trust Performance – Efficiency

The Efficiency scorecard is comprised of 6 key indicators, none of these are part of the Monitor scorecard. For the most recent year to date position ( Jan/Feb 2011) there are 2 red rated indicators: % Trauma and NOFS Operated within 48hrs • During February Overall Trauma performance for patients

operated on within 48 hours was 94% for the month , which is just

% Trauma and NOFS

Efficiency Scorecard

A

G

below the target of 95%. The percentage of patients with a fractured neck of femur operated on within 48 hours of being fit was 97%, against a target of 95%.

Theatre Utilisation • Day theatre utilisation (72%) did not attain the 85% target in

February.

Operated within 48hrs Theatre Utilisation

Trust Performance – Patient Experience

The Patient Experience scorecard is comprised of 6 key indicators, 3 of these are part of the Monitor scorecard. For the most recent year to date position (Jan/Feb 2011) there are 3 red rated indicators:

MRSA

• There have been no cases of MRSA in February, the seventh clear month in succession. The year to date position remains rated red as at 2010 as there have been 4 MRSA cases for the year to date, which is the annual target set by Monitor.

C-Diff

• There have been no cases of C-Diff in February, resulting in the year to date total remaining at 37 C-Diff cases so far this year. When compared with a calculated annual Monitor target of 38 (using Monitor calculation of 15% reduction on outturn) this is red rated. It should, however, be noted that the Trust’s contract with local providers is set at 72 cases per year as delegated by the SHA.

MRSA Screening

• MRSA screening in February attained 97%. The 3 month rolling average is 99% and the year to date average currently at 103%

MRSA bacteraemias acquired C Diff infection acquired. Screening of all elective inpatients for MRSA

Patient Experience Scorecard

Infection Control issues under continued scrutiny by Performance and Director of Nursing/Infection Control.

R

External Assessments Monitor Governance Risk Rating Red

Patient ExperienceReferral to Treatment (Admitted) 18 weeks G Mortality G MRSA Bactaraemias R

Referral to Treatment (Non-Admitted) 18 weeks G Serious Untow ard Incidents (reporting) G MRSA Bactaraemias Root Cause Analysis G

Cancer Access (31 days) G Serious Untow ard Incidents (occurrence) G Clostridium Difficile Infections R

Cancer Access (62 days) G Promoting healthy lifestyles 0 Screening of all elective inpatients for MRSA R

Cancer Access (31 days drugs) G Patient Report Outcome Measures 0

Cancer Access (31 days surgery) G Efficiency Patient Experience 0

Cancer Access (14 days breast symptomatic) G % Trauma operated w ithin 48 hrs R Public Confidence 0

Cancer Access (14 day first outpatient) G % NOFS operated w ithin 48 hrs G

A&E Access (4 hours) G Theatre Utilisation - Main G

Cardiac Access (call to needle) R Theatre Utilisation - Day RCardiac Access (RACPC) G Day Case Rates (basket of 25) GDiagnostic Access (6 w eeks) R Bed Occupancy GElective Access - rebooking GStroke Service (Time on Unit) RStroke Service (TIA treatment w ithin 24 hrs) G (note - all cancer targets as at January 2011)Outpatient Access (Choose and Book) RBreast Screening (Screening to normal) G KeyBreast Screening (Screening to Assessment offered) G Target not achieved action required RBreast Screening (Screening to Assessment attended) R Area Of Concern ABreast Screening (Round Length) G On Target GDelayed Transfers of Care R New target or data not available for current

reporting month

Reporting for Month of February 2011Access and Targets Clinical Quality

Standard Description Target Monitoring period

Weighting Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Comment

Quarterly 1

7 2 3 6 1 3 3 5 4 3 0

7 9 12 18 19 22 25 30 34 37 37Quarterly 1 1 1 1 1 0 0 0 0 0 0 0

1 2 3 4 4 4 4 4 4 4 4Maximum 62 day wait from GP referral to treatment for all cancers

85% Quarterly 1 80.9% 90.8% 92.9% 92.9% 89.7% 96.8% 90.0% 94.2% 95.4% 88.1% 0.0%

Maximum 62 day wait for first treatment from consultant screening service referral:all cancers

90% Quarterly 1100.0% 96.9% 100.0% 91.7% 84.4% 87.2% 90.5% 100.0% 100.0% 95.0% 0.0%

Maximum waiting time of 31 days for second or subsequent treatment : Anti cancer drug t t t

98% Quarterly 1100.0% 100.0% 100.0% 100.0% 100.0% 99.6% 99.6% 100.0% 100.0% 100.0% 0.0%

Maximum waiting time of 31 days for second or subsequent treatment :Surgery

94% Quarterly 1 100.0% 100.0% 100.0% 95.8% 95.5% 100.0% 100.0% 96.4% 100.0% 100.0% 0.0%

Admitted patients: maximum time of 18 weeks from point of referral to treatment

90% none 97.6% 98.0% 97.1% 98.0% 97.4% 97.0% 96.7% 96.3% 96.7% 96.2% 95.5%

Non-admitted patients: maximum time of 18 weeks from point of referral to treatment

95% none 98.7% 99.2% 98.7% 98.4% 98.9% 98.7% 98.3% 98.5% 98.9% 97.4% 97.8%

A&E Access Maximum waiting time of four hours in A&E from arrival to admission, transfer or discharge

95% Quarterly 0.598.4% 99.0% 99.4% 99.1% 98.2% 98.2% 98.8% 98.5% 96.6% 97.8% 98.8%

Maximum waiting time of 31 days from diagnosis to treat to start of first treatment: All cancers

96% Quarterly 0.597.7% 100.0% 100.0% 98.2% 100.0% 100.0% 100.0% 100.0% 99.2% 98.6% 0.0%

Maximum waiting time of two weeks from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals

93% Quarterly 0.595.1% 95.0% 95.2% 93.0% 93.5% 96.9% 93.9% 95.9% 93.6% 96.3% 0.0%

Maximum waiting time of two weeks for symptomatic breast patients (cancer not initially suspected)

93% Quarterly 0.5100.0% 91.2% 87.2% 92.3% 96.9% 98.2% 94.9% 93.2% 96.7% 93.8% 0.0%

Cardiac Access People suffering heart attack to receive thrombolysis within 60 minutes of call (where this is the preferred local treatment for heart attack)

68% Quarterly 0.5

100.0% 33.3% 66.7% 100.0% 80.0% 100.0% 100.0% 66.7% 83.0% 0.0% 0.0%1 month Data

Lag

Screening of all elective inpatients

for MRSA

Percentage of eligible patients screened for MRSA prior to an elective admission (3 month rolling %)

100% Quarterly 0.5100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96% 97% 96% 99%

1 month data lag

Referral to Treatment

38 annually based on Monitor

reduction of 15% on previous year

MONITOR COMPLIANCEReporting for Month of February 2011

1 month data lag

1 month data lag

4 per year - Monitor target

acute target - national requirement

acute target - minim

um standards

The number of Clostridium Difficile infections PHFT acquired for normal admissions

Clostridium Difficile

MRSA Bactaraemias

MRSA PHFT acquired– (12 cases will be considered a breach)

Cancer Access

Cancer Access

Standard Description Target Monitoring period Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Comment

Referral to TreatmentAdmitted patients: maximum time of 18 weeks from point of referral to treatment 90% Monthly 97.6% 98.0% 97.1% 98.0% 97.4% 97.0% 96.7% 96.3% 96.7% 96.2% 95.5%

Referral to TreatmentNon-admitted patients: maximum time of 18 weeks from point of referral totreatment

95% Monthly 98.7% 99.2% 98.7% 98.4% 98.9% 98.7% 98.3% 98.5% 98.9% 97.4% 97.8%

Cancer AccessMaximum 62 day wait from referral to treatment for all cancers 85% Quarterly 80.9% 90.8% 92.9% 92.9% 89.7% 96.8% 90.0% 94.2% 95.4% 88.1% 1 month Data Lag

Cancer AccessMaximum 62 day wait for first treatment from consultant screening service referral:all cancers

90% Quarterly 100% 96.9% 100% 91.7% 84.4% 87.2% 90.5% 100.0% 100.0% 95.0% 1 month Data Lag

Cancer Access Maximum waiting time of 31 days for second or subsequent treatment : Anti cancer drug treatments

98% Quarterly 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 1 month Data Lag

Cancer Access Maximum waiting time of 31 days for second or subsequent treatment :Surgery

94% Quarterly 100% 100% 100% 95.8% 95.5% 100% 100% 96% 100% 100.0% 1 month Data Lag

Cancer AccessMaximum waiting time of 31 days from diagnosis to treat to start of first treatment: All cancers

96% Quarterly 97.7% 100% 100% 98.2% 100.0% 100% 100% 100% 99% 98.6% 1 month Data Lag

Cancer AccessMaximum waiting time of two weeks from urgent GP referral to first outpatient appointment for all urgent suspected

93% Quarterly 95.1% 95% 95.2% 93.0% 93.5% 96.9% 93.9% 95.9% 93.6% 96.3% 1 month Data Lag

Cancer AccessTwo week wait for Symptomatic Breast Patients ( cancer not initially suspected) 93% Quarterly 100% 91.2% 87.2% 92.3% 96.9% 98.2% 94.9% 93.2% 96.7% 93.8% 1 month Data Lag

A&E AccessMaximum waiting time of four hours in A&E from arrival to admission, transfer or discharge

95% Quarterly 98.4% 99.0% 99.4% 99.1% 98.2% 98.2% 98.8% 98.5% 96.6% 97.8% 98.8%

Cardiac AccessPeople suffering heart attack to receive thrombolysis within 60 minutes of call (where this is the preferred local

68% Quarterly 100% 33% 67% 100% 80% 100% 100.0% 67% 83% 0% 1 month Data Lag

Cardiac AccessMaximum wait of 2 weeks for an appointment for the Rapid Access Chest Pain Clinic

0 greater than 14 days

Quarterly 0 0 0 0 0 0 0 0 0 0 0

ACCESS AND TARGETS (1)Reporting for Month of February 2011


Diagnostic AccessNo waits more than 6 weeks for diagnostic investigations 0 Monthly 40 58 119 106 118 96 90 113 134 76 64 Care Quality Commission Rating

1 month data lag

Elective Access - rebooking

All patients who have operations cancelled for non-clinical reasons to be

100% given binding date Quarterly 0 0 0 0 0 0 0 0 0 0 Care Quality Commission Rating

Stroke Service

Patients who spend at least 90% of their time on a stroke unit

Q1 70.0%Q2 71.4%Q3 72.9%Q4 80.0%

60% by 31 Mar 2010

Monthly 68.3% 65.4% 74.2% 72.7% 62.9% 48.6% 60.5% 75.7% 54.9% 60.0% 69.0% 1 month data lag, numbers are small and data can be revised

Stroke Service Higher risk TIA cases who are treated within 24 hours

Monthly 62.2% 73.8% 70.5% 82.0% 81.8% 68.0% 56.0% 86.4% 84.0% 82.0% 84.0%

Outpatient Access

Provider will ensure that “sufficient appointment slots” are made available on the Choose and Book system

TALS to be kept to less than 4% of total

appointmentsMonthly 9.0% 7.0% 10.0% 13.7% 11.1% 9.6% 11.0% 13.3% 4.0% 5.0% monitoring to change to ASI's

Consequence clause 33 (PCT contract)

Breast Screening (screening to normal)

Screening to normal results within 14 days 90% Monthly 91.0% 95.0% 96.0% 97.0% 96.0% 98.0% 93.0% 94.2% 93.2% 96.2% 94.8%

Screening to assessment within 21 days - screening to 1st offered appt 90% Monthly 97.0% 99.0% 99.0% 96.0% 98.0% 99.0% 93.0% 92.8% 95.0% 96.9% 92.9%

Screening to assessment within 21 days - screening to attended appt 90% Monthly 91.0% 84.0% 90.0% 82.0% 94.0% 93.0% 91.0% 86.2% 90.0% 90.1% 85.1%

Breast Screening (round length)

National Minimum Standard is 90% of eligible woman screened within 36 months

90% Monthly 99.0% 99.0% 99.0% 98.0% 98.0% 99.0% 98.0% 99.5% 99.1% 97.7% 99.1%

Delayed Transfers of Care

Delayed transfers of care to be maintained at a minimal level

3.5% Monthly 6.2% 4.4% 6.4% 5.3% 4.8% 3.6% 5.1% 5.2% 6.4% 10.0% 10.3% Care Quality Commission Rating

Breast Screening (screening to assessment)

up to 1 month data lagnow reported in line w ith

national timetable

ACCESS AND TARGETS (2)


Mortality

The benchmark is the average mortality rate for England and is standardised for diagnosis/procedure group, subgroup, admission type, age, sex, deprivation, month of admission (for some respiratory diagnoses) and financial year

Less than 100 (relative risk

rating)Monthly 82.1 89.8 84 96.3 103.8 93.6 93.3 90.5 91.1

up to 3 month data lag

Dr Foster Data3 month period used w ef Aug

2010

All deaths - actual 119 112 105 116 106 87 118 115 126All deaths - expected (calculated by Dr Foster)

109.9 101.3 117.5 108.5 112.7 102.5 119.8 129 149.2

HSMR diagnosis - actual 95 89 92 94 86 75 97 90 108HSMR diagnosis - expected (calculated by Dr Foster)

84.5 77.7 96.1 84.4 87.7 81.6 93.7 103.6 122

Serious Untoward Incidents

The Provider will reports SUIs to the Commissioner via STEISS within 24 hrs (if relates to a Commissioners patient or services) and within 24 business hrs for all other SUIs

100% compliance Monthly 1 2 2 0 0 0 2 1 0 1 0

Serious Untoward Incidents

Number of Serious Untoward Incidents0 Monthly 1 2 2 0 2 0 2 1 0 1 0 No contractual

consequence

CLINICAL QUALITYReporting for Month of February 2011

actual and expected deaths from Dr Foster for

information

MonthlyDr foster datalines addedDec 2010


% Trauma operated

within 48 hrs

Trauma inpatients who are medically fit for surgery receive treatment within 48 hours

95% Month 94.0% 88.0% 89.0% 90.0% 93.0% 93.0% 89.0% 99.0% 92.0% 98.0% 97.0% No contractual consequence

% NOFS operated

within 48 hrs

Hip fractures who are medically fit for surgery receive treatment within 48 hours

95% Month 97.0% 95.0% 76.0% 82.0% 88.0% 95.0% 73.0% 97.0% 95.0% 98.0% 94.0% No contractual consequence

Theatre Utilisation -

Main

Needle to skin to end of operating85% Month 86.3% 84.0% 87.0% 83.0% 83.0% 85.0% 85.0% 82.9% 84.0% 84.5% 87.9%

Theatre Utilisation -

Day

Needle to skin to end of operating85% Month 72.3% 74.0% 74.0% 71.0% 72.0% 74.0% 76.5% 76.5% 68.0% 69.7% 72.3%

Day Case Rates (basket

of 25)

Day case (Healthcare Commission Basket of 25) percentage of elective discharges

75%Month (Dr.

Foster)75.7% 72.7% 83.9% 76.2% 77.8% 80.2% 77.9% 75.2% 79.2%

2 month data lagConsequence - No

contractualBed

OccupancyBed Occupancy as per Thursday midnight snapshot 95% Month 92.4% 92.2% 87.0% 92.0% 92.0% 90.0% 93.0% 95.0% 94.0% 94.0%

EFFICIENCYReporting for Month of February 2011


MRSA Bactaraemias MRSA PHFT acquired Quarterly 1 1 1 1 0 0 0 0 0 0 0MRSA Bactaraemias

(Cumlative)MRSA PHFT acquired

1 2 3 4 4 4 4 4 4 4 4

Clostridium DifficileThe number of Clostridium Difficile infections PHFT acquired for normal admissions

Quarterly 7 2 3 6 1 3 3 5 4 3 0

Clostridium Difficile

The number of Clostridium Difficile infections PHFT acquired for normal admissions

7 9 12 18 19 22 25 30 34 37 37

Percentage of eligible patients screened for MRSA prior to an elective admission (3 month rolling %)

100% Quarterly 100% 100% 100% 100% 100% 100% 100% 96% 97% 96% 99%up to 1 mth time lagcalculated using a 3 month rolling period

Percentage of eligible patients screened for MRSA prior to an elective admission (monthly)

100% 121% 126% 108% 104% 96% 103% 90% 100% 99% 97%NB: screening can legitimately exceed

100%

Patient Report Outcome Measures

Provider to implement routine collection of PROMS using the national standards for PROMs instruments for elective NHS patients

In line with DOH response rates for

each tool (65% average)

Monthly 73% 72% 22% 61% 1-2 month lag

Patient ExperienceSelf reported experience of patients/users

Inpatients 79.0Outpatients 81.0

A&E 77.0Annually

Public ConfidenceMeasure of public confidence in local NHS

Person 53.0Dignity 40.0

Organisation 83.0Annually

38 annually based on Monitor

reduction of 15% on previous year

4 per year - Monitor target

PATIENT EXPERIENCEReporting for Month of February 2011

Screening of all elective inpatients for

MRSA

APPENDIX 1

Short Title Long Title Issue Action Date RAG Current Performance Target Action Date RA

G

1 Number of Attendances

Number of attendances to Emergency Department

None - Data matches SUS data / CDS extract None None G n/a n/a none Ongoing G

CDS extract does not exclude patients moved to CDU within 4

hours

MB to request Ascribe to make change to CDS

extract

1st March 11 R

RISK: Ascribe do not amend extract in time for 1st April 11

MM to create enquiry / report to identify patients admitted to CDU within 4 hours to extract manually

from data return

15th March 11 R

SHA are reporting breaches as patients waiting in excess of 240 mins 59 secs. Symphony reports a breach after 239 mins 59secs causing disparity between the

front end reports and SUS data

PCT to confirm to Trust what timings the SHA are

working to

15th March 11 A

3 Unplanned re-attendance rate

Unplanned re-attendance at A&E within 7 days of original attendance (including if

referred back by another health professional)

Symphony report shows absolute number

CS confirms unable to add % due to report structure CLOSED G Performance 3.12%

To be between 1% - 5%. Below 1%

may indicate undue risk

aversion. Above 5% may trigger

intervention

Ongoing monitoring as part of professional standard framework

for ED

Ongoing G

4Total time spent

in the A&E department

The median, 95th percentile and longest total time spent by patients in the A&E

department, for admitted and non-admitted patients

See section 2CS to add in ward to report to help identify root causes

Also see section 2

See section 2 R

Median - 154 mins Max time 17pts> 6hr

98.53% < 4 hrs

tbc (mins) 0 pts > 6hrs 95%


for ED

A

5 Left without being seen

The percentage of people who leave the A&E department without being seen

SHA report performance to 1 decimal place

The CDS extract adds the number of patients who DNW'd

and those who left prior to tx. All instances in both categories will

be reported as DNW's.

CS to amend Symphony report to report % to 1

decimal place CS to split performance by

'patients who DNW and those who leave prior to

tx.'

11th March 11 A 3.72% 5%


for ED

G

6 Service experience

Qualitative description of what has been done to assess the experience of patients using A&E services, what the results were,

and what has been done to improve services in light of the results

not applicable under data section not applicable under data section n/a G

Service improvement plan in place, based upon professional

standards. Currently does not capture patient feedback

Evidence of service

improvement plan that addresses

and considers pt feedback

MM & AC to formalise a mechanism to

capture all feedback within performance

management framework which

underpins action plan

1st April 2011 A

7 Time to initial assessment

Time from arrival to full initial assessment, which includes a pain score and early warning score, for all major patients

SUS data highlighted too many unknowns / blank fields. The data returned indicated good

performance

CS to create performance report using 'time of

arrival,' to 'nurse assessment time.'

MB to identify what field is being reported to SUS

MM to make Nurse Handover DEP mandatory

to ensure good rate of data capture

1st March 2011 R

Undertaking nurse assessment as part of ambulance handover

means good compliance when measured against

standard

Assessment within 20mins of arrival

(inc pain assessment)

MM to agree with ED definition of assessment

1st March 2011

G

8 Time to Treatment Time from arrival to start of treatment

Symphony reporting from treatment time field, SUS data

reporting from clinician seen field

CS to amend Symphony to report time 'seen by clinician' in accordance

with data description

A

Median - 145 mins (Symphony currently

shows poor performance: SUS /

SHA shows good performance)

Amending reporting field will resolve issue

Median wait < 60 mins G

9Senior

Consultant Sign-off

The percentage of patients in high-risk patient groups who are reviewed by a senior

consultant before being discharged from A&E

n/a as data will be collected from an Audit by the College of

Medicine

For the purposes of this standard a re-attendance

is defined as a linked episode within 72 hours.

CS to amend the definition of re-attender within report CS to add in ST4 doctor as able to senior review

G 44%100% of pts in

specified 3 high risk groups

MR to ensure all senior Dr's &

Consultants record 'senior review'

R

10 Ambulatory care

Ambulatory care sensitive conditions: the number of admissions for cellulitis and deep vein thrombosis (DVT) per head of weighted population. Ambulatory care for emergency conditions: the percentage of A&E attendances for cellulitis and deep vein thrombosis (DVT) that end in admission.

Method of data collection not confirmed by SHA. Symphony is reporting any ambulatory care patients admitted however standard is 'any admission of an ambulatory care condition,

MB to confirm method of data collection

1st March 2011 A

All DVT and Cellulitis patients attending the clinic are categorised

as admissions

tbc

As agreed with Paul Stebbings, MM to Change current categorisation from 'admission and ward attender' to 'outpatient, new & FU'

15th March 2011

R

MMCSMB

threshold ACMRtbc

Amanda Coleman - PALSMike Reichl - Clinical Director & Emergency Consultant, EDto be confirmed

Mark Major - Directorate ManagerNo data issues / performance above thresholdMinor data issue / performance close to threshold (+/- 1%)Major data issues / performance significantly below

Christine Stewart - Information DepartmentMatt Braithwaite - Information Department

2Continue to monitor local performance

against 98%98%None

Data / Information

Number of pts > 4 hours

Number of patients breaching the 4 - hour waiting time target

Performance

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