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BOARD OF DIRECTORS OPERATIONAL PERFORMANCE REPORT

Presented By:

26th May 2015

Board of Directors

Produced By:

Stephen Chinn

Senior Performance Analyst

Steven Davies

NHS Finance Director

(Produced on 20th May 2015)

Month 1 (April 2015)

Action for Board: For information

For consideration

For decision

Board of Directors Performance Report - April 2015

Exception Report - 3

Compliance Performance Summary Page 4

Access - Referral to Treatment Page 5 - 6

Access - A&E Page 7 - 8

Access - Cancer Waiting Times Page 9

Access - Other Page 10

Efficiency Page 11 -12

Effectiveness Page 13

Safety Page 13

Ward Staffing Levels Page 14

Patient Experience Page 15

Bank and Agency Staff Information Page 16

CONTENTS

For decision

Page 1


Exception Report - April 2015

RTT Performance:

RTT admitted performance is at 90.1%, the 5th successive month Moorfields has achieved above the 90% target. However this is drop from the 92% performance recorded in March 2015 (M12 2014/15).

The main reasons for the reduction in performance relate to theatre refurbishment work taking place at the City Road site, with a number of patients being transferred across to theatres at The Whittington Hospital.

Some patients transferring from City Road to The Whittington had a number of valid patient choice pauses removed due to the hospital initiated cancellation rule, therefore increasing the number waiting longer than 18 weeks. Also as clinicians adapted to the new theatre space and equipment, this temporarily reduced the throughput at The Whittington.

Moorfields at Croydon has also seen a major drop in performance due to the data now being entered more accurately and the move of one of their surgeons to support the Whittington theatres.

In addition, there were also a reduced number of additional theatre lists.

RTT Non-Admitted performance remains above target, increasing to 96.8% (M12 2014/15: 95.8%), the 7th successive month above the 95% target.

RTT Incomplete Pathway performance also achieved the 92% threshold at 94.5%, a slightly drop from the previous month (94.8% from M12 2014/15)

There were no 52 week breaches recorded in April 2015. Accident and Emergency:

Activity Following on from the trends seen last year, the A&E department has seen continuing increases in the number of attendances. While there was slight drop in the total number of attendances compared to the previous month, when taking into account the extra day in March and the additional bank holiday days (Easter period) which traditionally experience lower activity, this was Moorfields busiest monthly period. On an average 'working day' Moorfields had a month high of 332 A&E attendances. This is an increase on last month's previous highest figure of 320 attendances per working day (+3.5%) and is the equivalent of an extra 44 (+15%) attendances per day compared to April 2014. Activity on non-working days (Weekends and Bank Holidays) also saw the highest levels recorded at 207 attendances per day. The week 13th-19th April recorded the highest weekly attendances at 2139, with the following week recording a 2nd high of 2118 attendances.

Page 2


Exception Report - April 2015 (Continued)

Accident and Emergency (cont.): Performance Despite the activity increases, the A&E four hour performance target 95% was achieved however this has dropped to 97.8% (M12 2014/15: 99.3%). This is Moorfields' lowest four hour performance since May 2011. This combined with the high activity led to 172 four hour breaches, however there continues to be no breaches over six hours. Our local three hour performance has also seen a drop and is below the 80% target at 75.5% (M12 2014/15: 77.1%). Cancer Performance

In April there were four 'cancer 2 week waits' and three '31 day waits for subsequent treatment' cases, all which were achieved in their respective targets. Choose and Book Performance:

Choose and Book Performance saw a slight increase to 88.2% (M12 2014/15: 87.3%), however due to increasing demand and capacity constraints, remains below the 96% target. Outpatient and Admission Activity:

Activity The number of outpatient attendances at Moorfields continues to rise, particularly the proportion of 'First appointment' activity.

While the total number of attendances was lower than the previous month (at 43,461), when taking into account the fewer number of days in April plus the additional bank holiday periods, April 2015 was the busiest monthly period recorded. The number of attendances per 'working day' was 2,173 which is 67 attendances per day higher than the previous highest month in Nov 2014 (+3.5%) and 113 attendances per day (+5.5%) higher than April 2014.

The number of admissions also saw a reduction compared to the previous month, but taking into account the reduced days in April, has seen a slight increase on a 'per working day' basis by 2.8%. However this is a reduction compared to April 2014, where activity 'per working' day has reduced by 5.2% Safety

Mixed Sex Accommodation Breaches: This month we experienced 3 mixed sex accommodation (MSA) breaches, these occurred because of the unavailability of side rooms. It is usual practice for staff to transfer patients from side rooms to accommodate either all male or female patients in the 4 bedded bay. On these occasions however, the staff were not able to remove the patients from the side rooms due to clinical reasons, therefore the remaining patients (surgical and emergency patients) were mixed. The patients did not stay overnight but were undressed. The staff will always try to manage this to avoid breaches but on this occasion the ward had a number of emergency admissions plus theatre cases.

Page 3


COMPLIANCE PERFORMANCE SUMMARY

Threshold Apr-15Monthly

TrendSource Threshold Apr-15

Monthly

TrendSource

≥ 90% 90.1% CQC, Monitor,TDA ≥ 99% 100% CQC, TDA

≥ 95% 96.8% CQC, Monitor,TDA n/a 85.6% Local

≥ 92% 94.5% CQC, Monitor,TDA ≥ 96% 88.2% Local

0 0 CQC, Monitor,TDA 0 0 CQC, TDA

0 0 CQC, Monitor,TDA n/a 2.5% Monitor

0 0 CQC, Monitor,TDA n/a 3.0% CQC, TDA, Outcomes

Framework

≥ 95% 97.8% CQC, Monitor,TDA n/a 59.6% Local

≥ 80% 75.5% Local 0 0 CQC, Monitor,TDA

≤ 5% 2.2% CQC, TDA 0 0 CQC, Monitor,TDA

≥ 30% 23.7% Local ≥ 95% 98.9% CQC, TDA

≤ 5% 0.3% CQC, TDA 0 3 CQC, TDA

≥ 93% 100% CQC, Monitor,TDA n/a 98% CQC, TDA

≥ 96% n/a CQC, Monitor,TDA ≥ 20% 28.5% CQC,TDA, Outcomes

Framework

≥ 94% 100% CQC, Monitor,TDA ≥ 30% 59.6%Updated

Measure

CQC,TDA, Outcomes

Framework

≥ 85% n/a CQC, Monitor,TDA ≥ 15% 13.0%New

MeasureLocal

Key Reference:

Performance 2015/16Performance 2015/16

Percentage 18 weeks Non Admitted

Pathways

Emergency Readmissions within 28

days of discharge

Percentage 18 weeks Incomplete

Pathways

Emergency Readmissions within 30

days of discharge

Indicator Indicator

Percentage 18 weeks Admitted

Pathways

Cancelled Operations - 28 Days Re-

Book

18 weeks Admitted Pathways

52 Week Breaches

18 weeks Non Admitted Pathways

52 Week Breaches

18 weeks Incomplete Pathways

52 Week Breaches

Choose & Book Appointment

Availability

Diagnostics 6 week waiting time

A&E 3 hour waiting times Number of MRSA cases

Outpatient appointment - Over 6

week waiters

Cancer 31 day wait - subsequent

treatment - surgery

Cancer 62 day from urgent GP

referral to first definitive treatment

A&E Unplanned re-attendance

Cancer 2 week wait - first

appointment urgent GP referral

% Cancer 31 day wait - diagnosis to

first appointment

Friends & Family Test - Inpatients

(Response Rate)

A&E 4 hour waiting timeGP referrals first outpatient using

Choose & Book

VTE Screening - all admissions

Number of Mixed Sex

Accommodation Breaches

Friends & Family Test - A&E

(Response Rate)

A&E ENP Pathways

A&E Left Before Treatment Number of C.Diff cases

Ward Staffing Levels

(Inpatient Wards Only)

Within tolerance and drop in figures

No target or N/A

On or above target

Stable on/above target

On target and drop in figures

Within tolerance and stable

Within tolerance and rise in figures

Friends & Family Test - Outpatients

(Response Rate)

Below target and rise in figures

Below target and stable

Below target and fall in figures

Page 4


18 Weeks Referral to Treatment

Forecast

Year End YTD

Current

Month

Previous

Month Qtr1 Qtr2 Qtr3 Qtr4 YTD Qtr1

≥ 90% 86.2% 79.1% 90.1% 92.0% 90.1% 90.1% Monitor, CQC,

TDA

≥ 95% 95.1% 94.6% 96.8% 95.8% 96.8% 96.8% Monitor, CQC,

TDA

≥ 92% 93.7% 92.4% 94.5% 94.8% 94.5% 94.5% Monitor, CQC,

TDA

Forecast

Year End YTD

Current

Month

Previous


0 3 0 0 1 0 0

N/A 250 538 247 220 247 247

N/A 2 -281 3 53 3 3

0 2 0 0 0 0 0

N/A 284 331 214 293 214 214

N/A 54 -23 124 58 124 124

0 7 1 0 1 0 0

N/A 1,333 1,587 1,333 1,199 1,333 1,333

N/A 603 79 603 657 603 603

Compliance

Source

52 Week RTT Breaches

18w(95%) Shortfall/Surplus

Monthly

Trend

Monthly

TrendIndicator Threshold

Performance 2015/16

Threshold

Performance 2015/16

18 weeks Referral to Treatment - Admitted

Admitted



Non Admitted

Incomplete

Trust Total

18 weeks Referral to Treatment -Non

Admitted

18 weeks Referral to Treatment -Incomplete

Indicator

Patients Waiting >18 weeks



Performance 2014/15

Performance 2014/15

Compliance

Source



Page 5


18 Weeks Referral to Treatment (Cont.)

Trust Total

Page 6


Forecast

Year End YTD

Current

Month

Previous


N/A95,950 7,641 8,704 8,802 8,704 8,704

N/A92811 7,799 8,217 8,292 8,217 8,217

≥ 95% 99.2% 99.6% 97.8% 99.3% 97.8% 97.8% CQC, Monitor,

TDA

≥ 80% 81.8% 84.7% 75.5% 77.1% 75.5% 75.5% Local

N/A 605 29 172 48 172 172

N/A 30 7 0 0 0 0

≤ 5% 1.2% 1.2% 2.2% 2.3% 2.2% 2.2% CQC, Monitor,

TDA

≤ 60 mins 25 mins 21 mins 30 mins 31 mins 30 mins 30 mins CQC, TDA



≥ 30% 24.0% 21.5% 23.7% 23.1% 23.7% 23.7% Local

≤ 5% 0.6% 1.5% 0.3% 0.2% 0.3% 0.3% CQC, TDA

Monthly

Trend

A&E Maximum waiting times - 4 hours

Threshold

Performance 2015/16

Total number of attendances

Total number of expected attendances

Accident & Emergency

Indicator

Left without being seen

Total time spent in A&E -Admitted 95th

Percentile

Total time spent in A&E - Non Admitted 95th

Percentile

A&E Unplanned Re-attendance

A&E ENP Pathway

Performance 2014/15

Compliance

Source

A&E Maximum waiting times - 3 hours

Time to Treatment in Department - median

Total number of 4 hour breaches

Total number of 6 hour breaches

Page 7


Accident & Emergency (Cont.)

In addition to the comments within exception report:

Unplanned re-attendances and patients who left A&E before treatment remain below the 5% targets. There has been a slight increase by 1% of patients who left scene before treatment in recent months,

this is due to a process change to improve the data quality of this metric.

A&E ENP Pathway performance remains below our local target of 30% at 23.7%

Page 8


Forecast

Year End YTD

Current

Month

Previous


Cases 29 3 4 0 4 4

≥ 93% 93.1% 100.0% 100% n/a 100% 100.0%

Cases 15 1 0 0 0 0

≥ 96% 100% 100% n/a n/a n/a n/a

Cases 3 0 3 0 3 3

≥ 94% 100% n/a 100% n/a 100% 100%

Cases 0 0 0 0 0 0

≥ 85% n/a n/a n/a n/a n/a n/a

Cancer 31 day waits - subsequent treatment

Cancer 62 days from urgent GP referral to first

definitive treatment

In April there were four 'cancer 2 week waits' and three '31 day waits for subsequent treatment' cases, all which were achieved in their respective targets.

There were no '31 day wait for subsequent treatment' or '62 days from urgent GP referral to first definitive treatment' cases recorded.

CQC, Monitor,

TDA

CQC, Monitor,

TDA

CQC, Monitor,

TDA

Compliance

Source

Cancer Waiting Times

Indicator

Cancer 2 week waits - first appointment

urgent GP referral

Threshold

Performance 2015/16

Monthly

Trend

CQC, Monitor,

TDA

Performance 2014/15

Cancer 31 day waits - diagnosis to first

appointment

Page 9


Forecast

Year End YTD

Current

Month

Previous


≥ 99% 100% 100% 100% 100% 100% 100% CQC, TDA

TBA 85.5% 84.4% 85.6% 84.1% 85.6% 85.6% Local

TBA 33.8% 38.5% 18.8% 19.8% 18.8% 18.8% Local

≥ 96% 87.3% 94.2% 88.2% 87.3% 88.2% 88.2% Local

N/A 12.0% 5.1% 11.2% 12.4% 11.2% 11.2% Local

N/A 0.7% 0.7% 0.6% 0.2% 0.6% 0.6% Local

Access - Other (Cont.)

Choose and Book Capacity Issue Rate

Choose and Book System Issue Rate

Indicator Threshold

Performance 2015/16

First Outpatient Appointment Waiting more

than 6 weeks

Patients Waiting more than 13 weeks for

Admission

Diagnostic waiting times - 6 weeks

Choose and Book appointment availability

Access - Other

Monthly

Trend

Diagnostic waiting times Performance remains at 100%.

The wait time of first appointments within 6 weeks and wait for admission within 13 weeks has remained stable compared to previous months.

Performance 2014/15

Compliance

Source

Page 10


Forecast

Year End YTD

Current

MonthPrevious


N/A 104,890 8,242 9,360 9,682 9,360 9,360 Local

N/A 403,657 33,817 34,101 36,050 34,101 34,101 Local

N/A 10.4% 7.9% 11.5% 11.2% 11.5% 11.5% Local

N/A 11.6% 11.0% 11.6% 12.3% 11.6% 11.6% Local

N/A 12.4% 12.7% 11.8% 13.5% 11.8% 11.8% Local

N/A 56.7% 55.0% 56.6% 57.5% 56.6% 56.6% Local

N/A 70.5% 68.4% 70.6% 70.0% 70.6% 70.6% Local

N/A 36,500 2,998 3,116 3,446 3,116 3,116 Local

N/A 37,232 3,108 2,924 3,131 2,924 2,924 Local

N/A 6.2% 7.8% 6.4% 6.0% 6.4% 6.4% Local

N/A 28.8% 27.1% 36.2% 33.4% 36.2% 36.2% Local

0 3 1 0 0 0 0 CQC, TDA

Efficiency

Trust Total

Outpatient DNA rate

- First Appointment

Theatre Sessions Starting Late

Clinic Journey Times Less Than 2 Hours

- Outpatient First Appointment

Clinic Journey Times Less Than 2 Hours

- Outpatient Follow Up Appointment

Outpatient DNA rate

- Follow Up Appointment

Theatre Cancellation Rate

Admission Demand

- Decision to Admit (DTA)

Admission Activity

Outpatient Cancellations

Outpatient Total Attendances

- First Appointment

Monthly

Trend

Compliance

Source


Outpatient Total Attendances

- Follow Up Appointment

Threshold

Cancelled Operations - 28 Days Re-Book

Page 11


Key:

Efficiency (Cont.)

In addition to the comments within exception report:

DNA rates have seen a drop for both First and Follow Up

appointment. 'First Appointment' have dropped from 12.3%

(M12 2014/15) to 11.6% while 'Follow Up' Appointments

have dropped from 13.5% to 11.8%.

Theatre Sessions starting has seen an 11% increase over the

last 5 months.:4 Month Average:Monthly Trend

Page 12


Effectiveness

Forecast

Year End YTD

Current

MonthPrevious


N/A 3.8% 3.0% 2.5% 2.2% 2.5% 2.5% Monitor

Cases 102 6 6 5 6 6

N/A 4.1% 3.0% 3.0% 2.2% 3.0% 3.0% CQC, TDA

Cases 109 6 7 5 7 7

N/A 54% 48% 59.6% 57.0% 59.6% 59.6% Local

Safety

Forecast

Year End YTD

Current

MonthPrevious


0 0 0 0 0 0 0 CQC, TDA,

Monitor

0 0 0 0 0 0 0 CQC, Monitor,

TDA

≥ 95% 98.5% 98.5% 98.9% 98.6% 98.4% 98.5% CQC, TDA

0 0 0 3 0 3 3 CQC, TDA

Compliance

SourceThreshold

Monthly

Trend

Compliance

Source


Number of C.Diff cases

Performance 2015/16

Number of MRSA cases

Indicator Threshold

Emergency Re-admission within 28 days of

discharge

Emergency Re-admission with 30 days for

elective and emergency cases

GP referrals first outpatient using Choose &

Book

Indicator

VTE Screening

Mixed Sex Accommodation

There were no MRSA or C. Diff case recorded in April 2015, and VTE performance remain above the 95% target.

See Exception report for details for MSA Breaches

Monthly

Trend

Performance 2014/15

Page 13


Ward Staffing Levels (Only 'wards with inpatient beds' as per report requirement) - Provisional

Total

Shift Period Ward/Department Name Planned Actual Planned Actual Planned Actual Planned Actual

Oct 2014 CR - Observation Unit CR 697.5 707.0 236.0 244.0 500.0 490.0 120.0 130.0 101% 103% 98% 108% 101%

Nov 2014 CR - Observation Unit CR 502.0 486.0 352.0 302.0 600.0 570.0 0.0 20.5 97% 86% 95% n/a 95%

Dec 2014 CR - Observation Unit CR 569.5 538.0 274.5 297.5 620.0 600.0 0.0 30.0 94% 108% 97% n/a 100%

Jan 2015 CR - Observation Unit CR 588.0 568.0 323.5 322.0 660.0 660.0 0.0 0.0 97% 100% 100% n/a 99%

Feb 2015 CR - Observation Unit CR 459.0 411.5 261.0 285.0 560.0 570.0 0.0 0.0 90% 109% 102% n/a 99%

Mar 2015 CR - Observation Unit CR 547.0 523.0 320.0 321.5 640.0 630.0 0.0 10.0 96% 100% 98% n/a 99%

Apr 2015 CR - Observation Unit CR 581.5 518.5 329.0 321.0 660.0 605.0 0.0 44.0 89% 98% 92% n/a 95%

Oct 2014 SG - St George's Duke Elder Ward 1523.0 1506.0 0.0 0.0 310.0 310.0 310.0 310.0 99% n/a 100% 100% 99%

Nov 2014 SG - St George's Duke Elder Ward 1420.0 1417.5 0.0 0.0 300.0 300.0 300.0 300.0 100% n/a 100% 100% 100%

Dec 2014 SG - St George's Duke Elder Ward 1356.5 1393.5 84.0 84.0 310.0 310.0 310.0 310.0 103% 100% 100% 100% 102%

Jan 2015 SG - St George's Duke Elder Ward 1338.0 1381.5 28.0 28.0 310.0 260.0 310.0 310.0 103% 100% 84% 100% 100%

Feb 2015 SG - St George's Duke Elder Ward 1742.5 1705.0 347.5 347.5 310.0 310.0 280.0 280.0 98% 100% 100% 100% 99%

Mar 2015 SG - St George's Duke Elder Ward 1770.0 1770.0 375.0 367.5 450.0 440.0 190.0 190.0 100% 98% 98% 100% 99%

Apr 2015 SG - St George's Duke Elder Ward 1717.5 1690.0 657.5 650.0 300.0 300.0 450.0 480.0 98% 99% 100% 107% 100%

Oct 2014 CR - Cumberlege Wing (NHS) 1546.5 1550.3 447.0 462.7 450.0 507.5 20.0 20.5 100% 104% 113% 103% 103%

Nov 2014 CR - Cumberlege Wing (NHS) 1499.5 1521.8 430.0 461.8 420.0 391.8 20.0 20.5 101% 107% 93% 103% 101%

Dec 2014 CR - Cumberlege Wing (NHS) 1354.5 1373.8 535.0 478.5 390.0 362.3 40.0 41.5 101% 89% 93% 104% 97%

Jan 2015 CR - Cumberlege Wing (NHS) 1559.5 1632.8 393.5 370.5 450.0 455.0 50.0 30.8 105% 94% 101% 62% 101%

Feb 2015 CR - Cumberlege Wing (NHS) 1372.5 1408.0 320.0 300.0 400.0 370.0 30.0 30.0 103% 94% 93% 100% 99%

Mar 2015 CR - Cumberlege Wing (NHS) 1528.0 1503.5 412.5 387.5 410.0 410.0 20.0 20.0 98% 94% 100% 100% 98%

Apr 2015 CR - Cumberlege Wing (NHS) 1310.0 1301.5 343.5 343.5 360.0 343.0 20.0 18.0 99% 100% 95% 90% 99%

Oct 2014 Trust Total 3767.0 3763.3 683.0 706.7 1260.0 1307.5 450.0 460.5 100% 103% 104% 102% 101%

Nov 2014 Trust Total 3421.5 3425.3 782.0 763.8 1320.0 1261.8 320.0 341.0 100% 98% 96% 107% 99%

Dec 2014 Trust Total 3280.5 3305.3 893.5 860.0 1320.0 1272.3 350.0 381.5 101% 96% 96% 109% 100%

Jan 2015 Trust Total 3485.5 3582.3 745.0 720.5 1420.0 1375.0 360.0 340.8 103% 97% 97% 95% 100%

Feb 2015 Trust Total 3574.0 3524.5 928.5 932.5 1270.0 1250.0 310.0 310.0 99% 100% 98% 100% 99%

Mar 2015 Trust Total 3845.0 3796.5 1107.5 1076.5 1500.0 1480.0 210.0 220.0 99% 97% 99% 105% 99%

Apr 2015 Trust Total 3609.0 3510.0 1330.0 1314.5 1320.0 1248.0 470.0 542.0 97% 99% 95% 115% 98%

Average fill

rate -

registered

nurse

/midwifes

(%)

Registered Care Staff Registered Care Staff Average fill

rate -

registered

nurse

/midwifes

(%)

Average fill

rate - care

staff (%)

Average fill

rate -

registered

nurse

/midwifes

(%)

Average fill

rate - care

staff (%)

Day Night Day Night

Page 14


Patient Experience (A&E and Inpatient Wards Only)

Friends and Family Test (FFT)

Please note there have been a number of changes to the Friends and Family Test (FFT) response rate and scoring.

The scoring system has been replaced with a simpler percentage method, where patients who are ‘Extremely likely’ or ‘Likely’ to recommend Moorfields to friends and family are listed as ‘Would Recommend’

the hospital, and patients who are ‘Unlikely’ or ‘Extremely Unlikely’ to recommend Moorfields are listed to ‘Would Not Recommend’ the hospital.

The eligible patient population now includes under-16’s in all categories.

The ‘Inpatient’ FFT responses now include ‘day case’ patients as well as patients who stayed overnight, which has increased the number of results received in this category.

The ‘outpatient’ FFT scores and response rates are now also included in this report, covering most patients who attended an outpatient clinic.

Accident and Emergency FFT response rate method remains unchanged from last year (aside from the aforementioned inclusion of under-16s).

Page 15


Nursing Bank and Agency Staff Information

Proportion of Nursing Bank and Agency Staff Hours filled, with total hours worked

Page 16

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