Item 8 8...Board of Directors Performance Report - May 2015 18 Weeks Referral to Treatment Forecast...

Item 8

BOARD OF DIRECTORS OPERATIONAL PERFORMANCE REPORT

Presented By:

25th June 2015

Board of Directors

Produced By:

Stephen Chinn

Senior Performance Analyst

Steven Davies

NHS Finance Director

(Produced on 18th June 2015)

Month 2 (May 2015)

Action for Board: For information

For consideration

For decision

Board of Directors Performance Report - May 2015

Exception Report - 4

Compliance Performance Summary Page 5

Access - Referral to Treatment Page 6 - 7

Access - A&E Page 8 - 9

Access - Cancer Waiting Times Page 10

Access - Other Page 11

Efficiency Page 12 -13

Effectiveness Page 14

Safety Page 14

Ward Staffing Levels Page 15

Patient Experience Page 16

Bank and Agency Staff Information Page 17

CONTENTS

For decision

Page 1


Exception Report - May 2015

RTT Performance:

For May 2015, Moorfields achieved all three RTT 18 week performance targets.

• RTT Admitted Performance for May was 91.3% (M1: (April 2015) 90.1%), with the current YTD position at 90.7%. This is the 6th successive month Moorfields has achieved this target.

• RTT Non Admitted Performance for May was 96.7% (M1: 96.8%), with the current YTD position at 96.8% This is the 8th successive month Moorfields has achieved this target.

• RTT Incomplete Pathway for May was 93.8% (M1: 94.5%), with the current YTD position at 94.1%. However we recorded one incomplete pathway 52 week breach for May 2015. The reasons established for the breach were that is was a complex medical pathway, but there were also a number of delays transferring the patient between subspecialty clinics. This incident was reviewed at the Serious Incident panel, where it was established no harm was caused as a result of delay.The patient's next appointment is scheduled in June to discuss any surgery required, which if agreed an early TCI will be offered. Accident and Emergency:

Following a review of our A&E Performance figures (4 hr and 3 hr performance), the May meeting of the Information Management Group approved an adjustment to the calculation of these measures to bring it in line with national guidance. Following this decision, our Weekly A&E figures were re-submitted via UNIFY backdated to the start of April 2015 and accepted by the DoH. The April figures within this report (shown as previous month) have been corrected to reflect this change. This has had the following effect on the below figures:

• An adjustment has been made to our ‘Four Hour Performance’ for April 2015 from 97.8% to 98.0% • An adjustment has been made to our ‘Three Hour Performance’ for April 2015 from 75.5% to 75.6%

No other figures have been affected by change; however for clarification the following A&E metrics have been renamed:

• ‘Total number of Attendances’ & ‘Total number of Expected Attendances’ have been renamed to ‘Total number of Arrivals in A&E’ & ‘Total number of Expected Arrivals in A&E’ respectively, to represent that this figure is the total number of arrivals at A&E (based on the patient’s arrival date)

• ‘A&E Maximum waiting time – 4 Hours’ and ‘A&E Maximum waiting time – 3 Hours’ have been renamed ‘A&E Four Hour Performance’ and ‘A&E Three Hour Performance’ respectively to avoid any confusion what this percentage represents.

Page 2


Exception Report - May 2015 (Continued)

Accident and Emergency:

Activity Moorfields recorded it's highest activity ever in A&E during May 2015, continuing the recent trend of higher activity over the last few months. There were 9,161 arrivals into A&E recorded, this is compared to 8,802 arrivals in March 2015 and 8,704 in April 2015, our 2nd and 3rd highest months respectively. On an average working day Moorfields would see a high of 343 arrivals which is a 10.6% increase compared to May 2014 and a 3% increase compared to last month. For non-working days Moorfields on average see a high of 220 arrivals, an increase of 12.8% on May 2014 and 6.2% on last month. Performance Despite the increasing activity, four hour performance has remained above the 95% target at 97.6%, but this is drop compared to last month which was at 98%. Our year to date performance is currently at 97.8%.

This combined with the high activity led to 218 four hour breaches, however there continues to be no breaches over six hours.

The high activity and some staffing capacity issues has meant our local three hour performance has continued to drop further below the 80% target , and is now at 74.8% (M1: 75.6%). Cancer Performance

In May 2015 there was only one cancer case to report, this was a 'two week wait' case which was treated within target. Year to date position therefore remains at 100%.

Choose and Book Performance:

Choose and Book Performance has seen a drop in performance to 81.8% (M1: 88.2%). There have been two reason given for this: • Capacity Issues Performance was high at 16.3% (M1: 11.2%) due to capacity issues across all sites which are impacting on CAB slot

availability, caused by a mixture of summer annual leave and the changeover of fellows. • System Issue Percentage was high at 3.3% (M1: 0.6%) due the issuing of a new BT end point registration following the installation of a

new Choose & Book message handler on 28/04/2015 where slots freed up by appointment cancellations were not available for use in C&B until the next sequential slot poll.

Page 3


Exception Report - May 2015 (Continued)

Outpatient and Admission Activity:

Outpatient Activity remains high although total activity saw a drop compared to the previous month. First Appointment Attendances dropped from 9,360 to 8,698 (reduction of 7.1%), although taking into account the fewer working days in May compared to April (19 vs 20) the reduction in first appointment activity was 2.2%. Taking into account working days, this represents a 10% increase on May 2014 and was the second busiest month on record. Year to date, First appointments are up 11% compared to the same period last year.

Follow Up Appointment Attendances also dropped from 34,101 to 31,859 (reduction of 6.6%), although taking into account the fewer working days in May compared to April, the reduction was 2%. Taking into account working days, this represents a 5% increase on May 2014. Year to date, Follow Up appointments are up 5% compared to the same period last year.

The number of Admissions also dropped from 3,116 to 2,886 (reduction of 7.4%), although taking into account the fewer working days in May compared to April, there was a 4% increase in activity. Taking into account working days, there was also a 3% increase on May 2014. Year to date, Admission are down by 1% compared to the same period last year.

Page 4


COMPLIANCE PERFORMANCE SUMMARY

Threshold May-15 YTD 15/16Monthly

TrendSource Threshold May-15 YTD 15/16

Monthly

TrendSource

≥ 90% 91.3% 90.7% CQC, Monitor,TDA ≥ 99% 100% 100% CQC, TDA

≥ 95% 96.7% 96.8% CQC, Monitor,TDA n/a 86.3% 86.0% Local

≥ 92% 93.8% 94.1% CQC, Monitor,TDA ≥ 96% 81.8% 84.7% Local

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

0 0 0 CQC, Monitor,TDA n/a 7.4% 5.0% Monitor

0 1 1 CQC, Monitor,TDA n/a 7.8% 5.4% CQC, TDA, Outcomes

Framework

≥ 95% 97.6% 97.8% CQC, Monitor,TDA n/a 54.7% 57.2% Local

≥ 80% 74.8% 75.2% Local 0 0 0 CQC, Monitor,TDA

≤ 5% 2.9% 2.5% CQC, TDA 0 0 0 CQC, Monitor,TDA

≥ 30% 24.2% 23.9% Local ≥ 95% 98.4% 98.7% CQC, TDA

≤ 5% 0.3% 0.3% CQC, TDA 0 0 3 CQC, TDA

≥ 93% 100% 100.0% CQC, Monitor,TDA n/a 95% 97% CQC, TDA

≥ 96% n/a n/a CQC, Monitor,TDA ≥ 20% 22.5% 25.0% CQC,TDA, Outcomes

Framework

≥ 94% n/a 100% CQC, Monitor,TDA ≥ 30% 57.0% 58.3% CQC,TDA, Outcomes

Framework

≥ 85% n/a n/a CQC, Monitor,TDA ≥ 15% 12.2% 12.6% Local

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 5


18 Weeks Referral to Treatment

Forecast

Year End YTD

Current

Month

Previous

Month Qtr1 Qtr2 Qtr3 Qtr4 YTD Qtr1

≥ 90% 86.2% 80.6% 91.3% 90.1% 90.7% 90.7% Monitor, CQC,

TDA

≥ 95% 95.1% 95.1% 96.7% 96.8% 96.8% 96.8% Monitor, CQC,

TDA

≥ 92% 93.7% 92.3% 93.8% 94.5% 94.1% 94.1% Monitor, CQC,

TDA

Forecast

Year End YTD

Current

Month

Previous


0 3 1 0 0 0 0

N/A 250 971 216 247 463 463

N/A 2 4,027 33 3 36 36

0 2 0 0 0 0 0

N/A 284 599 207 214 421 421

N/A 54 11,605 106 124 230 230

0 7 1 1 0 1 1

N/A 1,333 3,237 1,541 1,333 2,874 2,874

N/A 603 39,036 444 603 1,048 1,048

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 6


18 Weeks Referral to Treatment (Cont.)

Trust Total

Page 7


Forecast

Year End YTD

Current

Month

Previous


N/A95,950 15,969 9,161 8,704 17,865 17,865

N/A92,811 15,766 8,524 8,217 16,741 16,741

≥ 95% 99.2% 99.5% 97.6% 98.0% 97.8% 97.8% CQC, Monitor,

TDA

≥ 80% 81.8% 82.8% 74.8% 75.6% 75.2% 75.2% Local

N/A 605 73 218 172 390 390

N/A 30 7 0 0 0 0

≤ 5% 1.2% 1.2% 2.9% 2.2% 2.5% 2.5% CQC, Monitor,

TDA

≤ 60 mins 25 mins 23 mins 30 mins 30 mins 30 mins 30 mins CQC, TDA



≥ 30% 24.0% 23.2% 24.2% 23.7% 23.9% 23.9% Local

≤ 5% 0.6% 1.3% 0.3% 0.3% 0.3% 0.3% CQC, TDA

Monthly

Trend

A&E Four Hour Performance

Threshold

Performance 2015/16

Total number of Arrivals in A&E

Total number of Expected Arrivals in A&E

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 Three Hour Performance

Time to Treatment in Department - median

Total number of 4 hour breaches

Total number of 6 hour breaches

Page 8


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. The percentage of patients who left scene before treatment has continued to rise, 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 24.2% (M1: 23.7%).

Page 9


Forecast

Year End YTD

Current

Month

Previous


Cases 29 6 1 4 5 5

≥ 93% 93.1% 100.0% 100.0% 100.0% 100.0% 100.0%

Cases 15 2 0 0 0 0

≥ 96% 100% 100% n/a n/a n/a n/a

Cases 3 0 0 3 3 3

≥ 94% 100% n/a n/a 100% 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 May 2015 there was only one cancer case to report, this was a 'two week wait' case which was treated within target. Year to date position therefore remains at 100%.

There were no '31 day waits (both for 'diagnosis to first appointment' or '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 10


Forecast

Year End YTD

Current

Month

Previous


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

TBA 85.5% 85.1% 86.3% 85.6% 86.0% 86.0% Local

TBA 33.8% 38.9% 19.4% 18.8% 19.1% 19.1% Local

≥ 96% 87.3% 92.0% 80.4% 88.2% 84.7% 84.7% Local

N/A 12.0% 8.0% 16.3% 11.2% 13.5% 13.5% Local

N/A 0.7% 0.5% 3.3% 0.6% 1.8% 1.8% 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 11


Forecast

Year End YTD

Current

MonthPrevious


N/A 104,890 16,643 8,698 9,360 18,058 18,058 Local

N/A 403,657 64,661 31,859 34,101 65,960 65,960 Local

N/A 10.4% 9.5% 10.3% 11.5% 10.9% 10.9% Local

N/A 11.6% 10.9% 11.9% 11.6% 11.8% 11.8% Local

N/A 12.4% 13.0% 12.1% 11.8% 11.9% 11.9% Local

N/A 56.7% 55.9% 56.2% 56.6% 56.4% 56.4% Local

N/A 70.5% 70.1% 70.4% 70.6% 70.5% 70.5% Local

N/A 36,500 5,919 2,886 3,116 6,002 6,002 Local

N/A 37,232 6,030 2,889 2,924 5,813 5,813 Local

N/A 6.2% 6.5% 6.9% 6.4% 6.7% 6.7% Local

N/A 28.8% 27.5% 32.6% 36.2% 34.5% 34.5% 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 12


Key:

Efficiency (Cont.)

In addition to the comments within exception report:

DNA rates have seen a slight increase for both First and

Follow Up appointment. 'First Appointment' have increased

from 11.6% (M1) to 11.9% while 'Follow Up' Appointments

have increased from 11.8% to 12.1%.

:4 Month Average:Monthly Trend

Page 13


Effectiveness

Forecast

Year End YTD

Current

MonthPrevious


N/A 3.8% 4.2% 7.4% 2.5% 5.0% 5.0% Monitor

Cases 102 18 18 6 24 24

N/A 4.1% 4.2% 7.8% 3.0% 5.4% 5.4% CQC, TDA

Cases 109 18 19 7 26 26

N/A 54% 53% 54.7% 59.6% 57.2% 57.2% 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% 98.8% 98.4% 98.9% 98.7% 98.7% CQC, TDA

0 0 0 0 3 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 cases recorded in May 2015, and VTE performance remain above the 95% target. There were also no Mixed Sex Accomdation Breaches.

Monthly

Trend

Performance 2014/15

Page 14


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

Page 15


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 16


Nursing Bank and Agency Staff Information

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

Page 17

Item 8 8...Board of Directors Performance Report - May 2015 18 Weeks Referral to Treatment Forecast...

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