Integrated Performance Report · 2017-12-04 · Harm Free Care - Mortality Quality of Care Page 5...

Integrated Performance Report

October 2017

Mid Essex, Southend and Basildon Hospitals

Joint Working Board - 6th December 17

Contents



Section Content Page

Performance Overview Introduction by CEO 3

Domain Scorecards Quality of Care 4

Operational Performance 7

Workforce, Leadership and Improvement Capability 16

Finance and Use of Resources 23



The Single Oversight Framework (https://improvement.nhs.uk/resources/single-oversight-framework/) places Providers into “Segments” based on NHS Improvement’s judgement of the seriousness and complexity of issues faced by each Provider.

Introduction by CEOOctober 2017

The NHS Improvement (NHSI) single oversight framework was implemented from October 2016, with an update provided in November 2017. The framework helps identify NHS providers' support needs across five themes:• quality of care• finance and use of resources• operational performance• strategic change• leadership and improvement capability

NHSI monitor providers’ performance under each of these themes and consider whether they require support to meet the standards required in each area. NHSI segment individual trusts into four categories according to the level of support each trust needs. Where improvements in performance are required, NHSI develop a package of support with the provider to help them achieve this. All three Trusts are currently within segment 3.

https://improvement.nhs.uk/resources/single-oversight-framework/

Quality of CareCelia Skinner & Diane Sarkar

(CQC – Safe, Caring, Excellent, Well Led)

October 2017



Harm Free Care - Mortality

Quality of Care

Performance

The latest SHMI publication forthe 12 months up to Mar 17shows SUHFT as above expected(1.19) and MEHT (1.08) and BTUH(1.06) within expected limits, asreported at the last Board. Crudemortality rates are followingusual seasonal trends.

Critical actions in the next period are:• Further training for structured judgment reviews, initial training attended in

October 2017.• Acadiant on track to begin implementation of electronic mortality review tool in

December at SUFT• Initial output from cross site palliative care review has shown opportunity to

harmonize palliative care coding.• Respiratory pathway meeting occurring in November.• Unified reporting structure developing across the three sites.

Mortality SUHFT BTUH MEHT

SHMI to

Mar 171.19 1.06 1.08

Higher than

expected

As

Expected

As

Expected

Commentary Actions / Mitigations

Aug-17 Sep-17 Oct-17

Crude Mortality Rate 1.41% 1.65% 1.52%

Crude Mortality Rate

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

2016/17 Rate Threshold

Number of

deaths

Number of mortality

reviews conducted

% Structured Judgement

Review Completed

Number of deaths with an

element of avoidability

Basildon 380 172 45.3% 3

Mid-Essex 346 92 26.6% 1

Southend 378 327 86.5% 2

Basildon 368 61 16.6% 0

Mid-Essex 333 84 25.2% 2

Southend

Q1

Q2

To follow

Harm Free Care – Infection Control and Never Events / Other Quality Updates

Quality of Care

Issues There was one never event in October.

Themes and trends are now being reviewed across thethree sites and a group risk and compliance group hasbeen established where clinical risks are reviewed andappropriately escalated.

The “Harm Free” process and documentation is currentlyunder review for the three sites to ensure a consistent,standardised approach.

Work is underway with the CCG’s to establish a group wideClinical Quality Group. Final version of consistent qualityKPIs are now in progress.

An agreed approach for quality visits to each of the sites isbeing agreed.

Infection Control• The action plan for SUHFT NHSI has been

comprehensively reviewed and resubmitted to NHSI.

CQC• SUHFT had a 2 day inspection on 21 and 22nd

November, reviewing 6 core services• BTUH has undergone an internal CQC compliance peer

review

Performance Commentary Actions / Mitigations

Operational PerformanceYvonne Blucher

Lisa Hunt Clare Culpin

(CQC – Responsive)

October 2017



The three trusts have agreed their recovery trajectories with NHSI against:

– A&E 4 hour performance

– 62 day cancer performance

– RTT 92% incomplete performance

The expectation is to have all three trusts delivering 85% for 62 day cancer performance. For RTT there is an expectation to treat the current 52 week breachesand eliminate risk of further 52 week breaches jumping on to the PTL over the next couple of months although Mid Essex DIEP trajectory for recovery is March2018.

The 92% RTT performance should be delivering by March 2018.

In month key issues for SeptemberA&E 4 hour performance

Significant improvements in performance have been seen in recent months, with a group performance of 90% in September and October.

Cancer

The recent quarterly review meeting with NHSI stressed the 85% target for 62 days must be met in September. An elective taskforce covering RTT and cancer hasnow commenced and a plan has been produced highlighting target treatments and breaches that will be booked over the next few days.

All three trusts have seen a continued reduction in 104 day waits – all have been through a harm review process and the majority of these patients have beendated. However, across the MSB, September delivery remains an amber risk.

RTT

92% is the agreed trajectory and all three sites expect to achieve trajectory by end March 2018.

52 weeks

52 week breaches are stabilising and reducing however there is a residual risk around DIEP breaches at MEHT as the tariff for treatment in the private sector is yetto be agreed. This has been escalated to NHSE who are supporting.

Winter resilience

Each Trust has worked within its own local health community and submitted a system-wide plan to NHSI on 25th August. Any gaps in assurance or opportunities fora collective MSB approach to facilitate the sustainability of performance has been addressed through the Performance Oversight Committee and is highlighted in aseparate report.

Operational Performance Overview

Operational Performance

Accident and Emergency 4 Hour Standard - MEHT



• The emergency 4 Hour Performance standardincreased from 90.5% in September to 92.9% inOctober, reaching the trust’s internal trajectoryobjective

• 265 extra admissions via ED compared to Octoberlast year (8 extra admissions per day).

• 93% bed occupancy for October remaining stablefrom last month

• 627 breaches with full breach analysis available anddisplayed weekly in control room

• 5% increase in attendance for October against thesame period last year (averaging 13 extraattendances per day)

• Ambulance attendances remain as expected

• Red 2 Green data now being captured and reportedon daily basis.

• Different ways of working (workforce innovation etc)are being implemented eg ACPs appointed andawaiting start dates.

• Flow and Discharge steering group chaired by ADOwith Foureyes support. Focusing on related workstreams and monitoring continues.

• Flow and discharge group showing benefits indischarge lounge use, r2g tracking, Stranded patientimprovement and trust data quality.

• Non-elective task force now in place to identifyimprovements daily reporting into ADO.

• Daily mobile stranded patients meetings are now in place and monitoring all patients with a LOS of 7day+.

• Daily reviews of DTOCs and deep dive against national guidance - ongoing

• GP Streaming – on target for delivering nationalrequirements.


Target 95% 95% 95%

Performance 83.6% 90.5% 92.9%

Attendances 7,944 8,412 8,782

Waits over 4-hours 1,299 796 627

MEHT

Accident and Emergency 4 Hour Standard - BTUH



Improving care for emergency patients continues to be aTrust priority, has seen recent improvement but remainsfragile.

Performance for September is 91.3% and October 90.2%of patients being seen and treated/admitted within 4hours.

Issues• Staffing – Remains a risk for Trust• Breach analysis confirms that most breaches are due

to lack of capacity and flow• The high numbers of Medically Fit patients continues

to be high and DTOCs fluctuate week on week• Health and social care provision and capacity within

the community

Actions and Mitigations• Increased capacity in Ambulatory care from 8 to 13

beds, although capacity demands use 4 bedsovernight, this service continues to pull patientsthrough from the A&E including GP referrals andsupported improvement in A&E performance

• Protection of 2 beds on AMU West for FrailtyAmbulatory unfortunately failed due to capacitydemand, 4 beds on Frailty unit protected forambulatory until building work completed on AMUWest mid December.

• Daily Breach analysis and weekly meetings to discussissues and promote learning and solutions

• Bed modelling for medicine and surgery completedby Four Eyes Insight

• Dedicated manager of day in all specialities• Revising bed management model including roles and

responsibilities of all divisions to supportperformance

• Red2Green(R2G), SAFER bundle and ClinicalUtilisation Reviews (CUR) are now live and beingutilised by staff on 18 wards on daily Board Rounds

• Continue to promote and embed use of Red2Greenand SAFER bundle

• Daily monitoring of MFFD and DTOC data to escalatedelays to external partners

• Weekly LOS meetings for all patients over 7 and 14days

• Elective activity continues and steady improvementof theatre utilisation

• Robust weekend planning• Consultants/therapies, social care/pharmacy in place

at weekends which is now improving weekenddischarge numbers

• Planning with community and social care partners viaA&E Board and Stepping Up Board.

• Winter plans both local and system wide tested bytabletop exercise.

• Winter Sitreps commenced


Performance 92.4% 91.3% 90.2%

Attendances 11,384 11,470 12,367

Waits over 4-hours 862 995 1,216

BTUH

Accident and Emergency 4 Hour Standard - SUHFT



IssuesPerformance improved slightly in October.

• October saw our highest ever attendance figure of363

• Medical workforce shortage continues to be achallenge

• Discharges still occur too late in the day• ED Nursing vacancy position has improved but recent

Long and short term sickness remains a challenge• Overnight remains a challenge with high acuity

particularly through Resus• Conflicting priorities between planned and

unplanned work

Performance for October is 89.4%, but remains above91% for the year to date.

Actions and Mitigations• Surges/spikes continue to be a theme in ED between

18.00 – 02.00 and remained a constant pressure in resus. The nursing rota changes have been implemented but are not consistently filled due to short term sickness and vacancies. This is improving but remains fragile

• Although the medical rota has been aligned with the surges in activity, due to the medical workforce vacancies, consistently delivering the new rota remains a challenge particularly in respiratory and DME.

• Medical workforce recruitment – 8 new starters joined the team in Sept, 36 vacancies remain with 16 out to offer. Dedicated recruitment officer remains in place

• We have seen a increase in DTOC figures this month. Conference calls reinstated to provide additional escalation opportunities

• Plans to change the AMU consultant rota to increase consultant cover in the afternoon/evening this remains inconsistent due to vacancies . This will provide in-reach to ED and allow the development of hot clinic pathways – recruitment remains an issue

• Estates work and recruitment continues in line with winter planning. The first of the planned escalation beds are on target to open in November

• CDU continues to work well. Currently accepting c50 patients a week resulting in 50 less referrals to Medicine

• Initial system wide winter plan submitted to NHSiand internal plan finalised, some of the actions already completed

• Primary care streaming on target – Estate ready• Continue to embed use of Red2Green and SAFER

bundle• New acute medicine general manager started and

providing additional support to the pathway • Senior management cover in ED continues till 21.00

every weekday• Foureyes team supporting patient flow


Performance 91.1% 87.5% 89.4%

Attendances 8,355 8,205 8,770

Waits over 4-hours 743 1,022 931

SUHFT

Cancer 62 day Standard



• The number of patients waiting over 62 and 104 days continues to reduce.

• Backlog reduction has been driven by both increased treatment numbers and changes to shorten pathways overall.

Key issues across the group:

• Significant diagnostic capacity challenge across the group in both endoscopy and cross sectional imaging (CT & MRI)

• MEHT challenges are Skin (plastics), Urology, Lower GI, Upper GI

• SUHT challenge in Lung• BTUH challenges in Urology, Lower GI, Lung

Actions and Mitigations

Group actions:

• STP-wide events were held in October to review four of the most challenged areas in Urology, Lung, Lower GI and Skin. These were focussed on moving towards best practice with short, medium and long term actions identified.

• Working to roll out the Southend straight to test Prostate pathway across the group.

• Focus on endoscopy capacity and demand on each site with support from FourEyesconsulting. Solutions include outsourcing and insourcing.

• Expectations set for diagnostics within 7 days for all cancer pathways. Escalation lists are now in place on each site for Radiology and Pathology to ensure senior oversight of waiting times and daily updates of progress.

• A number of issues across the skin plastics pathway have been identified with MEHT and these are being worked through.

• The MEHT cancer taskforce is embedded and driving the recovery with increased pace with Plastic surgery as one of their priority areas for support.

• NHSI Improvement Coach continues to support in high priority areas including LGI, UGI and Lung pathways. This has included analytical review of current pathways to inform improvements including a focus on early diagnostics through straight to test and one stop models.

• Cancer Alliance colleagues are also supporting with a number of areas including attempt to introduce the Southend Prostate referral guidance across the group.

Jul-17 Aug-17 Sep-17 Jul-17 Aug-17 Sep-17 Jul-17 Aug-17 Sep-17 Jul-17 Aug-17 Sep-17

62- day performance 76.6% 70.7% 79.5% 70.4% 81.0% 74.6% 68.0% 72.4% 75.7% 71.3% 75.4% 76.3%

Treatment Points 70.5 73.5 78.0 101.5 113.0 132.0 89.0 96.0 70.0 261.0 282.5 280.0

Treatment Points over 62 days 16.5 21.5 16.0 30.0 21.5 33.5 28.5 26.5 17.0 75.0 69.5 66.5

Treatment Points over 104 days 4.5 4.0 3.0 5.5 5.0 3.5 11.5 7.5 4.0 21.5 16.5 10.5

SUHFT MSB HospitalsBTUHMEHT

Jul-17 Aug-17 Sep-17 Jul-17 Aug-17 Sep-17 Jul-17 Aug-17 Sep-17 Jul-17 Aug-17 Sep-17

2ww performance 95.2% 94.2% 96.4% 91.2% 90.2% 93.0% 84.6% 87.9% 90.8% 89.2% 90.2% 92.8%

Referrals 787 845 686 1,294 1,292 1,139 1,560 1,589 1,372 3,641 3,726 3,197

Referrals seen after more than 2 weeks 38 49 25 114 126 80 240 192 126 392 367 231

SUHFT MSB HospitalsBTUHMEHT

Cancer 62 day Standard


Breach Re-allocation

Background• Published cancer waiting times (CWT) performance is collated from data that each provider submits to the openexeter system. These are the

published figures that are referenced in this performance report on slide 12.• Where a patient has breached the 62 day standard and was treated by a different Trust than received the original referral, the openexeter

system shares the breach with 0.5 points allocated to those 2 Trusts (ie the Trusts where the pathway started and ended). Similarly thetreatment is also split between the 2 Trusts.

• There are many types of cancer treatment that are not provided in every hospital (including specialist surgery, Radiotherapy andchemotherapy). In order to understand overall CWT and identify where there may be delays in treatment, a more refined approach to breachsharing is required.

Regional guidance• In 2012 the East of England Cancer Network published regional guidance on breach re-allocation. This was a voluntary process and did not

replace the formal openexeter method. This was intended as a tool for Trusts and sub-regions to better understand their pathways.• Southend and Basildon adopted the EoE method and used this information for internal analysis.• Mid Essex recently adopted the EoE method.• Under this approach breach re-allocation takes account of how long each Trust took in completing their respective elements of the patients’

pathway. The breach is then allocated based on where the delays occurred.

National guidance• In 2016 NHS Improvement published national guidance on breach re-allocation. This was similar in format to the EoE guidance but with specific

differences.• From April 2018 the openexeter CWT data submissions will be changed and at that time the formal published CWT performance data will

reflect the NHSI national breach re-allocation rules.• Southend and Basildon have adopted the national rules for breach re-allocation whilst Mid Essex have not yet transitioned and continue to use

the regional rules.

Performance• Southend performance in August improved by 1.9% overall after re-allocation with a net change of -2.0 breaches. Southend picked up 1.0

additional breaches due to late referrals out. However, Southend also lost 3.0 breaches due to late referrals received from other Trusts.• Basildon performance in August reduced by 0.8% overall after re-allocation with a net change of +0.5 breaches. Basildon picked up 1.5 additional

breaches due to late referrals to Southend. However, Basildon also lost 1.0 breaches due to treatment delays at Mid Essex.• Mid Essex started using breach re-allocation analysis in September so do not have data for August.• Regulators advise that the re-allocated performance position be reported to Board for a more nuanced understanding of CWT performance.

18 weeks Referral to Treatment Incomplete Standard



IssuesIncomplete 52 week breach at monthendMEHT –124- Biggest risk area - PlasticSurgery (Complex Breast)BTUH -11 - Biggest Risk areas - Neurologyand Respiratory SleepSUHFT – 3.

Backlog PositionsMEHT – Please see actions/mitigationscomment regarding the growth of the PTLfollowing the implementation of LorenzoBTUH – 4,044 - Neurology,Dexa/Osteoporosis, T&O,GastroenterologySUHFT – 4,397 - Key areas ; Hot spots -admitted Orthopaedics , ENT and GeneralSurgery, non admitted - Ophthalmology,Chest Medicine, Cardiology andCommunity Paediatrics

Actions and Mitigations• RTT x-group being formed with initial focus on the development of cross-

site PTLs (and PTL discussions) for long waiting patients to identifyopportunities to transfer patients across site to aid earlier booking andprevent excessive waits for patients.

• Examine areas of capacity which could aid backlogs on other site.• Network wide approach to neurology backlog to be discussed. SUHFT is

reviewing their neurology activity in preparation for potentialrepatriation.

• MEHT - The Plastics team have developed a recovery plan to treat theircomplex and DIEP patients in 2017/18. The DIEP recovery plan ismonitored in weekly meeting between ADO Plastics and Burns andDirector of Commissioning at MEH CCG. However there is significant riskto delivery of the plan due to a) outsourcing tariff and b) theatre staffingbeing increased to support the ramping up of activity.

• MEHT – There has been a significant increase in the overall waiting list sizesince the implementation of Lorenzo. This is being monitored dailythrough the control room.

• MEHT – IST visited the trust to support with our data quality and theoutput report is expected shortly. It is not expected that our PTL size willreturn to 24000 and is likely to end up around 35000. An action plan isbeing developed for Board on the back of the IT report.

• MEHT - A large number of the duplicate entries are due to a systemsissues which was raised with DXC. They have identified the solution andwill be applying a fix in their next update. Unfortunately the recent updatedid not include this fix and this is being investigated with DXC.

• BTUH – Theatre and Outpatient utilisation and productivity programmecontinues , now integrated as business as usual .

• BTUH – Weekly PTL and Access Board meetings continue .• Meeting held with NHSI, NHSE, BBCCG ON 11 October 2017 to assure

delivery of standard by March 2018. A further meeting is scheduled for 30November.

• BTUH – Planned move of cystoscopy from endoscopy unit to provide extraspace for endoscopy.

• BTUH – Cystoscopy outsourcing to Mayflower commenced in September.Volumes below those anticipated, working with CCG to rectify .

• SUHFT – Monitoring outpatient slot utilisation and short noticecancellation to maximise capacity

• SUHFT - Maximising theatre productivity through the 6 4 2 process –increase in productivity already experienced

• SUHFT – RTT trajectory has been updated against capacity plan and winterpressures. Scoping capacity plan for Ophthalmology capacity with CCG

Aug-17 Sep-17 Oct-17 Aug-17 Sep-17 Oct-17 Aug-17 Sep-17 Oct-17 Aug-17 Sep-17 Oct-17

Performance 82.7% 82.6% 84.2% 80.1% 80.8% 75.8% 82.3% 82.6% 83.2% 81.4% 81.8% 80.2%

Waiting List Size 28,739 29,178 27,890 43,469 46,516 41,745 23,928 23,694 24,117 96,136 99,388 93,752

Waits over 18 weeks 4,963 5,067 4,397 8,652 8,931 10,123 4,233 4,125 4,044 17,848 18,123 18,564

Waits over 52 weeks 5 7 3 99 118 124 4 9 11 108 134 138

SUHFT BTUHMEHT MSB Hospitals

6 week Diagnostic Standard



Issues

Southend• Consultant vacancies covered by locums during

recruitment phase• Implementing new service improvement plan

and business case for safe staffing in nursingbeing written

• Environment – architect commissioned todevelop a reconfiguration of the unit

Mid Essex• DM01 total list for October 2017: 4,833• Over 6 weeks: 457• Due to changes in process following CRIS

implementation (e.g. switching from paper to electronic) the waiting list size has increased. This is more accurately capturing data than the previous method.

• The area with the most 6+ week waits is non-obstetric ultrasound. Other areas remain largely in line with pre Lorenzo/CRIS implementation

• The waits for non-obstetric ultrasound have been impacted by the ongoing sonographer staffing shortages

BTUH• Endoscopy working to full capacity

Actions and Mitigations

Southend• Substantive nurse recruitment has now commenced for

Endoscopy• Endoscopy unit flow streamlined to increase productivity• Average points per list has increased from 7.4 to 10.5 due to

reduction in DNA and same day cancellation rate as a result ofpre-assessment process

• Triage by pre-assessment is removing inappropriate referrals• Aiming to achieve 99% in November as the backlog has

reduced significantly• The business case going to tender to enable the department to

have contingency equipment

Mid Essex• Validation in CRIS (new reporting system) has been completed• A internal system has been put in place to allow CRIS, Lorenzo

and Tomcat data to merge to produce a DM01 return.• Site visit from HSS (provider of CRIS) took place in October• Further training with HSS being arranged on CRIS statistics for

Radiology data team and Information Services• DM01 Task Force set up with weekly meetings continuing,

now focussing on improved performance• Ongoing recruitment for sonographers• Planned weekend backlog clearance for non obstetric

ultrasound in November• CT: Running additional weekend sessions and continue

outsourcing to InHealth• Exploring further CT outsourcing options• Recruitment drive for radiographers to support further

extended day and weekend working to increase capacity• Introduced contingency appointments to increase capacity

BTUH• Weekend and evening working in endoscopy• Session utilisation improved• Business plan agreed for cystoscopy move from Endoscopy by

December 2017• Additional CT and MRI sessions continue• Cystoscopy capacity has improved through outsourcing at

Mayflower , although volumes need to be higher.

Aug-17 Sep-17 Oct-17 Aug-17 Sep-17 Oct-17 Aug-17 Sep-17 Oct-17 Aug-17 Sep-17 Oct-17

Performance 98.2% 97.2% 98.4% 91.1% 90.5% 98.7% 97.7% 99.6% 95.4% 96.4%

Waiting List Size 4,581 4,482 4,849 5,301 4,833 5,830 6,301 5,785 16,084 15,467

Waits over 6 weeks 81 126 78 473 457 77 142 26 741 561

SUHFT BTUHMEHT MSB Hospitals

Workforce, Leadership and Improvement Capability

Mary Foulkes(CQC - Well Led)

October 2017



Workforce KPIs – Agency Spend


PerformanceSUHFT MEHT BTUH

Mid & South Essex

KPI Oct-16 Oct-17 KPI Oct-16 Oct-17 KPI Oct-16 Oct-17 KPI Oct-16 Oct-17

Agency Spend (as a % of the pay bill) 5.7% 9.92% 10.71% 8.3% 9.96% 11.95% 5.5% 9.12% 6.50% 6.5% 9.65% 9.66%

Medical Locum Target (actual) spend £000) 465 561 954 567 698 1,037 1,421 562 528 2,453 1,821 2,519

SUHFT MEHT BTUH

• October has seen an increase in agency spend to 10.71% of pay bill.

• An increase of £16k on previous month however £27k was a rollover from the previous months finances –therefore would have been a reduction in agency spend

• Medical spend increased in October by £30k• Nursing spend increased in October by £9k• High Medical spend in Medicine & Emergency Services. • High Nursing spend in Medicine wards and Women &

Children wards

• October has seen an increase in agency spend to 11.95% (10.87% in September)

• The increased cost of £2,237k in October was £683kadverse to the ceiling.

• Medical spend increased in October by £84k• Nursing spend increased in October by £110k• High Medical spend in A&E, Dermatology, ENT, Gen

Surgery , Oncology & Orthopaedics• High Nursing spend in all Emer Care Areas, Plastics &

Medical Wards, Surgical Wards and MSK Wards

• October has seen an increase in agency spend to 6.5% (5.2% in September)

• Agency spend increased to over the target of £1m a month

• Medical spend increased in October by £128,000. • Nursing spend decreased in October by £51,000.• Administrative and Clerical has increased in October to

£181,000 from the September position of £80,000 which needs to be investigated to reduce

• Vacancies continue to be the main reason for spendacross all clinical staff groups

• Increase of bank rates to encourage bank bookings rather than using agency

• Review of Doctors bank rates across 3 Trusts• Review with Overseas Doctors agencies with new

agencies being included in the cascade• Doctors Agency supply meeting held on 4th Nov with

approx 100 agencies in attendance• Group agency spend reduction discussion scheduled for

26.10.17

• Agency controls in place include – strict prior authorisation by senior managers,

• Weekly financial control meetings, • Weekly Agency Rule Breaches approval meeting, non-

Clinical shifts reviewed weekly at SDM.• Project linking areas of high nursing agency spend to

vacancies and specific recruitment plans.• Medical Agency is measured and reported monthly in

the Trust Board Report.

• Recruitment open days will be held in the Trust in November and December for nursing

• The Trust will attend the medicine conference in November to market the Trust to potential nursing and medical candidates

• The increase spend in non-clinical needs a deep dive to determine reason, though for senior managers it is vacancy cover and backfill

• As vacancies remain the main reason for spend a retention project has been agreed

• Targeted Group work on reducing agency spend in (A & E middle grades, Radiographers and Ophthalmology) • Proposal for Group wide audit of Locum rates in order to introduce a reduced common rate Q4/17 • Consolidate bank and agency team across the three trusts Q1/18

Group Actions

Site Actions taken to mitigate

Workforce KPIs – Recruitment

Performance

SUHFT MEHT BTUHMid & South

Essex


Vacancy Vacancy Rate 7% 7.10% 10.95% 7% 14.01% 15.31% 7% 9.50% 10.27% 7% 10.36% 12.21%

Nurses 7% 10.55% 11.69% 7% 15.83% 18.41% 7% 13.18% 14.98% 7% 13.35% 15.23%

Consultants 7% 4.16% 12.32% 7% 13.02% 10.58% 7% 3.96% 2.88% 7% 7.46% 8.64%

• October has seen a reduction in registered nurses vacancies (from 14.07% in Sept -17 to 11.69% in October-17)

• 33 pre-registered nurses have now received registration and added to the nursing figures

• Consultant Vacancies has increased to 12.32% in October from 11.69%

• 138 Medical offers (excluding Deanery doctors) have been made since January

• 20 Medical offers due to start in the next 3 months

• October has seen a small decrease in registered nurses vacancies (from 293 in September to 282 in October)

• October has seen no change in consultant vacancies (28 in September and October)

• Investigating possibility of ‘Golden Hello’ payments to new nurses in certain areas.

• Recent Consultant appointments include Breast Surgery, Palliative Medicine and Obs & Gynae.

• October has seen a decrease in registered nurse vacancies (from 267.81 in September to 233.65 in October).

• October has seen a decrease in consultant vacancies (from 7.9WTE in September to 6.53WTE in October )

• Newly qualified nursing candidates conversion to starters improved significantly since last year due to the keep in touch scheme

• We have 1 Locum Consultant commencing in November in Surgery and a consultant neurologist commencing in December.

Total in Recruitment Process (WTE)

Projected new starters WTE (Nov-Jan)

24 4

165 42

Recruitment Consultants

Nurses



11 0

117 42



5 5

65 65



40 9

347 149

Overseas Recruitment -Nurses

EU

Non - EU



27 6

33 3



3 3

39 8



3 3

16 16



33 10

88 27

Group Actions • EU Campaign – procurement includes all the Trusts. Currently at BTUHT Board level

and Procurement• Joint attendance at careers fairs• Nursing and Midwifery Recruitment and Retention Plan

Group Actions • Standardised JDs and selection process • Joint advert for PMO posts • Business case developed to consolidate the recruitment and bank & agency team

Workforce KPIs – Turnover

Performance


Essex


Voluntary Turnover (rolling over 12 months)

9.50% 12.46% 13.00% 9.50% 17.22% 18.01% 9.50% 15.35% 13.29% 9.50% 15.02% 14.72%

Voluntary Turnover Nurses 9.50% 12.14% 12.33% 9.50% 17.51% 18.45% 9.50% 15.41% 13.10% 9.50% 15.13% 14.68%

Consultants 9.50% 6.63% 10.76% 9.50% 5.02% 4.99% 9.50% 5.05% 8.00% 9.50% 5.54% 7.80%

IssuesSUHFT MEHT BTUH

The rolling 12 month turnover rate has reduced marginally from 13.01% in September to 13.00% in October 2017.

The rolling 12 month turnover rate at the end ofOctober 2017 was 18.01%, a slight increase from17.88% at the end of September 2017.

The rolling 12 month voluntary turnover rate at the end ofOctober 2017 was 13.29%, an increase from 12.9% at theend of September 2017.

Site Actions taken to mitigate

• SUHT has commenced the NHSI retention support programme and has 90 days to implement an action plan to stabilise and reduce turnover over a 12 month period.

• We are in the first phase of the 90 day programme, which is interrogating and understanding the turnover data and engaging with staff to understand reasons.

• A working party has been established, which will report the plan and progress through to the Finance and Resource Committee.

• The areas targeted will include new starters, career pathways and transfer opportunities, staff benefits and wellbeing, supporting flexible working Health and focus on the retention of the pre-retirement workforce.

• Exit meetings and questionnaire offered to all leavers Feedback and responses evaluated and fed back to relevant managers.

• HR Managers discuss with leads areas of concern, support managers in addressing issues and improving processes and culture

• Summary analysis will inform staff survey action plans.

• The Trust has been invited to participate in the 2nd

cohort of the NHSi Retention Support Programme for Nursing.

• Task and finish recovery plan identified actions to improve retention and increase recruitment activity to fill nursing posts

• The NHSI workshop on retention gave further ideas for actions to add to our local retention recovery plan

• The Trust will work on the development of an MSB wide retention plan

• The ward diagnostic work showed good communication, fair application of off-duty and annual leave, plus continuous recruitment to fill gaps had a positive impact on retention. This learning to be shared with other departments/wards


Group Actions• Joint staff survey action and bullying and harassment • Recruitment and retention plan for registered nurses • Group OD and workforce Strategy Q1 18 • Develop career pathway outlines for clinical staff• Development of core improvement skills/resilience training for all staff

Workforce KPIs – Training

Performance


Essex


Training Statutory and Mandatory Training 85.0% 80.17% 85.24% 85.0% 87.96% 85.29% 85.0% 77.23% 81.26% 85.0% 82.08% 84.41%

Issues

SUHFT MEHT BTUH

Statutory and mandatory training has increased from 84.67% in September 2017 to 85.24% in October 2017. This is 5.07% higher than the same month last year.

Overall compliance for end of October was 85.29%, an decrease of 0.9% on September (86.99%); 1.69% lower that the same month last year.

• Mandatory training compliance decreased slightly from 81.5% in September 2017 to 81% in October 2017.

Actions & Mitigation

• Performance has improved after being impacted by the holiday period, Doctor rotation, introduction of refresher training for safeguarding level 1 and inclusion of CPR Paediatric training.

• Analysis of teams and departments compliance continues to be highlighted to Directorates for action

• HR working with Directorates on junior doctors with outstanding training

• Trial to raise completion rates for bank staff due to start in Jan 2018

• Focus on increasing safeguarding compliance across the Trust across the Trust

• Targeted focus continues, and each element has as many modes of delivery as possible to support ease of access.

• Via supervisor self-service in ESR managers are able to access staff compliance at a time convenient to them

• Divisions monitor their performance monthly and have trajectories in place to increase rates in hot spot areas.

• Hot spot areas continue to offer protected time for staff training in the form of study days to enable staff to complete their training.

• Changing local induction practices to provide protected time for mandatory training

• Changing the induction policy to support and encourage timely completion of mandatory training


Group Actions• Group People and OD team established • Plans to implement same learning platforms Q2 /18

Workforce KPIs – Appraisals

Performance


Essex


Appraisals 90.0% 71.14% 76.76% 90.0% 68.51% 73.15% 90.0% 91.79% 90.07% 90.0% 78.57% 80.93%

Issues

SUHFT MEHT BTUH

The Appraisal compliance rate increased from 76.57% in September 2017 to 76.76% in October 2017.

• The overall appraisal rate increased by 0.64% in Octoberto 73.15% from 72.51% in September.

• The appraisal compliance rate decreased from 91% inSeptember 2017 to 90.1% in October.


• HRBP’s continue to work with Directorates to improve compliance rates.

• HR are centrally tracking and monitoring appraisals to ensure all outstanding appraisals have been booked.

• Focus continues on ensuring outstanding appraisals of 18 months + are cleared by the end of 2017 – with central monitoring and tracking.

• Performance is being reviewed at Directorate Board and SLT Directorate performance review meetings.

• Appraisal data is being audited to ensure it is accurate and up to date.

• Appraisal compliance is now incorporated into the monthly mandatory training report at both directorate and department level

• Via ESR managers are able to pull their own reports at a time convenient to them

• On going support to utilise the supervisor self-service functionality in regards to uploading appraisal dates continues with drop in sessions, small group sessions and bespoke 1:1’s

• Appraisal rates are monitored continually in divisional performance reviews and smaller departmental meetings.

• The appraisal paperwork and process has been revamped to improve the appraisal process in line with the Trust values and the need to show compliance with mandatory training.

• HRBPs continue to work with divisional colleagues to increase compliance rates


Group Actions• Share best practice to increase compliance in Southend and Mid Essex

Workforce KPIs – Sickness

Operational Performance Report

Performance


Essex

KPI Sep-16 Sep-17 KPI Sep-16 Sep-17 KPI Sep-16 Sep-17 KPI Sep-16 Sep-17

Sickness Absence

Sickness Absence (1 month) 3.5% 3.94% 3.56% 3.5% 3.40% 4.21% 3.5% 4.42% 3.72% 3.5% 3.93% 3.83%

Sickness Absence (12 months) 3.5 % 4.10% 3.78% 3.5 % 3.87% 4.13% 3.5 % 3.98% 3.87% 3.5 % 3.98% 3.93%

Issues

SUHFT MEHT BTUH

• Sickness Absence has remained static this month from last month at 3.78% YTD. This is a reduction on last yearand has been reducing month on month since January 2017.

September’s Sickness figure of 4.21% is slightly higher than August’s figure of 4.14%. The 12 month figure is slightly higher at 4.13%.

• The sickness absence rate increased from 3.44% inAugust to 3.72% in September


• HR continue to work closely on targeted interventions to tackle short term and long term sickness.

• Hot spot areas and the measures in place are being further reviewed to ensure the reductions continue..

• The Health and wellbeing strategy has been reviewed and an action plan is in place to support this – current focus is on promoting the health and wellbeing Directorate Champion role. OH and the POD are further developing the stress management and resilience session offer to staff.

• Sickness is proactively managed by HR Operations teamwith senior managers.

• Trigger reports are analysed and actioned. • Hotspots targeted by managers and action plans are

developed in consultation with leads. • These plans are logged and progressed.HR Managers

advise and support.

We continue to manage sickness absence by : • Identifying hot spot areas and related causes to better

tackle absence issues in divisions. • Monthly case reviews with managers, HRBPs and

Occupational Health to address high profile cases in the first instance

• Ongoing training on managing sickness

Notes: Sickness data all three trusts are reported a month in arrears therefore data above is at September 2016 and September 2017 respectively.

Finance and use of ResourcesJames O’Sullivan

(CQC – Use of Resources)

October 2017



James Please update

Finance and Use of Resources

2017/2018 Financial Summary Year-to-date


2017/18 Financial Summary Forecast


2017/2018 Agency Ceiling Performance Year-to-Date

2017/2018 Cost Improvement Programme Year-to-Date


2017/2018 Capital Expenditure Year-to-Date


2017/2018 Cash and Borrowing Year-to-Date



2017/2018 Use of Resources Metric Year-to-Date

Integrated Performance Report · 2017-12-04 · Harm Free Care - Mortality Quality of Care Page 5...

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