The total efficiency programme was 161,272 behind target in Month 4.

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Charlotte Owens
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1 Royal National Orthopaedic Hospital Trust Trust Board Meeting - Executive Summary Report/Paper: Update on Service Transformation Programme Date: Aug 2013 Purpose of Paper: To give the Board assurance and provide a progress update on the delivery of the Service Transformation Programme Context/Summar y: The service transformation programme in 13/14 seeks to drive quality and safety, while delivering efficiency and economy, by coordinating delivery of the following: 1. A combined cost reduction programme and transformation programme across divisions that will deliver 5.4m of savings in 2013/14 through efficiencies and redesign; and 2. Throughput efficiency also a feature of the transformation plan (to meet demand increases and improve care quality at no extra cost). The total efficiency programme was 161,272 behind target in. The dashboard (herein) provides a view of throughput efficiency alongside quality & access measures. Throughput efficiency should translate into higher margin. Scheme Area WTE Pay Non-Pay Income Total Identifed CIP Target at CIP Achieved at (Under) / Over Achievment at Clinical Support ,800 18, ,600 17,644 5,709 (11,935) Direct Care 1 112,600 6,600 1,058,700 1,177, , ,618 (124,282) Procurement 0 42,000 1,153, ,195, , ,005 9,835 Therapies 0 666, ,600 16,527 31,218 14,691 Transformation (IP) 0 233, , ,907 30,240 0 (30,240) Transformation (OP) 0 126, , ,844 53, ,839 84,055 Transformation (workforce) , ,904 42,256 0 (42,256) CEO 0 36,207 33, ,450 7,717 3,333 (4,383) Operations 0 21,850 58, ,000 8,889 20,000 11,111 Finance 0 57,344 67, ,082 17,231 0 (17,231) Corporate Nursing 0 28,497 26, ,650 6,072 0 (6,072) WACA 0 66,842 61, ,250 14,250 11,080 (3,170) IT 0 68,509 62, ,450 14,606 0 (14,606) Estates 0 191, ,093 15, ,730 45,859 5,000 (40,859) Modernisation 0 25,459 23, ,869 5,430 0 (5,430) Research 0 0 8,200 45,300 53,500 17,833 50,785 32,952 Unallocated , ,064 13,452 0 (13,452) 25 2,177,400 1,889,999 1,332,600 5,400, , ,588 (161,272) Risk Assessment: Action Required by the Board: Recommendation from Legal Advisors (if applicable): Author and position of Report/Paper Lead Director Does this paper require a decision to be made by the board? Yes* / No (Please delete as applicable) *A risk assessment form only needs to be completed and attached if the decision required by the Board pertains to strategic policy decisions and/or project initiation documents. Adam Thwaites, Head of Transformation Lynn Hill, Deputy CEO and COO

2 Links to Assurance Framework and Local Key Performance Indicator (KPI) Targets: (please tick as appropriate): Principal Objectives to support strategic aims (Linked to Strategic Aims and key performance indicator targets (KPIs) categories: Quality, Access, Finance, Management and Productivity) as appropriate 1. Maintain clinical excellence high quality outcomes for our patients: Improve patient care by reducing avoidable infections and providing a clean, safe environment (KPI Targets 1 8): Supports Strategic Aims 1 & 2 Provide safe and effective care, improving patient experience and clinical productivity (KPI Targets 1 20): Supports Strategic Aims 1 & 2 Provide timely access to our services. Consistently achieve patient access national standards (KPI Targets 10 17): Supports Strategic Aims 2. Deliver our transformation programme to ensure clinical activity targets and financial targets are met and supported by high quality patient care that is also at the most efficient and effective level attainable (KPI Targets 18, 20): Supports Strategic Aims 1 & 2 and supported by Transformation Programme 3. Improve the quality of our buildings and facilities to ensure patients receive clinical care in an appropriate environment and staff work in facilities that are fit for purpose (Linked to the Redevelopment Programme, including Redevelopment Business Case: Supports Strategic Aims 1,2,3 & 4) 4. Provide timely, accurate and comprehensive clinical management information to a high standard of data quality (Linked to the IM&T Strategy Implementation Plan): Supports Strategic Aims 2,3 & 4 5. Improve workforce effectiveness and engagement to ensure that it is fit for purpose (KPI Target 19); Supported by Organisational Development Programme and Supports Strategic Aims 1 & Deliver planned in-year service developments (Linked to the Integrated Business Plan, Annual Clinically Led Business Plan and Annual Operating Plan): Supports Strategic Aims 1, 2,3 & 4 7. Maintain and update the RNOH Integrated Business Plan and continue to improve the planning process including 10 year clinical service, finance and estates plan securing the redevelopment of the Stanmore site (Linked to the Integrated Business Plan): Supports Strategic Aims 1,2,3 & 4 8. Further develop academic track record by delivering research and education developments in line with the Joint Academic Plan agreed with UCL (Linked to the Joint Academic Plan): Supports Strategic Aim 3 9. Further develop relationships and partnerships including insourcing, outsourcing and establishing RNOH@ other NHS provider sites (Linked to: the Specialist Orthopaedic Alliance and UCL): Supports Strategic Aims 1,3 & Meet Foundation Trust milestones for the year: Supports Strategic Aims 1,2,3 & 4

3 EFFICIENCY PROGRESS MONITORING PACK DATE 21/08/2013 ATTACHMENT D As at month 4 (end Jul13), with exception of Imaging KPIs which are always one month behind due to data capture delay: Quality & satisfaction Margin (& new build affordability) M4 YTD 13/14 YTD 13/14 YTD 12/13 MRSA 0 Target: 0 % of income % of income Clostridium difficile 3 Target: <=3 in FY Surplus/(-deficit)* 1.92% 1.36% CQUIN achievement Target met Direct care cost 39.21% 39.74% Staff engagement 3.84/5 Peer group = 3.77 Clinical support cost 31.68% 32.95% Friends & family score* (for current month) 72 Target: >=80 Corporate support cost* 23.31% 21.45% Total number of responses was 320 (61%) Capacity usage & access Jul-13 YTD Cost control Bed fill - open beds (8am) 75% 72% Pay (WTE usage) Jul-12 Jun-13 Jul-13 Mar-14 Plan Gap Theatre capacity unused/unavailable 16%/3% 19%/8% Medical Cancelled operations: on the day 0.7% 1.4% Nurses/HCA Clinic capacity unused/unavailable 3%/13% 3%/18% AHP/Scientific Admin & Estate week (admitted) 93.3% 92.7% 1,298 1,362 1,377 1, week (non-admitted) 95.1% 95.5% 18week (incomplete) 97.1% 96.4% Imaging: on-time exam 77% 80% Imaging: on-time report 42% 67% Imaging: reports reperformed 8% 9% EXECUTIVE SUMMARY *Normalised after stripping out one-off redevelopment costs *The Trust s Workforce Plan has been updated to include current CIPs, service developments and in line with the Trust s current Long Term Financial Model (LTFM). The end of year March 2014 position of this updated plan is outlined above and is compared to the July 2013 wte usage including bank and agency. It is important to note that the LTFM and workforce plan remain under development as part of the Integrated Business Plan process. A further updated workforce plan will be available in December The favourable movement in the Trust s surplus margin would suggest that the Trust is more efficiently managing its cost base. The high level analysis shows that year on year cumulatively direct care and clinical support costs have reduced as a percentage of Trust income. This is aligned with the fact that within the reporting period there were three additional working days, from which the Trust would have anticipated a marginal benefit due to the relatively stable nature of a high proportion of the cost base. The relative increase in corporate costs could be in part explained by the additional investment in support functions to ensure areas are 'fit for purpose', though further analysis of this movement is required. 3

4 SAVINGS DETAIL TRANSFORMATION AND CIP PROGRAMME IN TOTALITY Scheme Area WTE Pay Non-Pay Income Total Identifed CIP Target at Month 4 CIP Achieved at (Under) / Over Achievment at Clinical Support ,800 18, ,600 17,644 5,709 (11,935) Direct Care 1 112,600 6,600 1,058,700 1,177, , ,618 (124,282) Procurement 0 42,000 1,153, ,195, , ,005 9,835 Therapies 0 666, ,600 16,527 31,218 14,691 Transformation (IP) 0 233, , ,907 30,240 0 (30,240) Transformation (OP) 0 126, , ,844 53, ,839 84,055 Transformation (workforce) , ,904 42,256 0 (42,256) CEO 0 36,207 33, ,450 7,717 3,333 (4,383) Operations 0 21,850 58, ,000 8,889 20,000 11,111 Finance 0 57,344 67, ,082 17,231 0 (17,231) Corporate Nursing 0 28,497 26, ,650 6,072 0 (6,072) WACA 0 66,842 61, ,250 14,250 11,080 (3,170) IT 0 68,509 62, ,450 14,606 0 (14,606) Estates 0 191, ,093 15, ,730 45,859 5,000 (40,859) Modernisation 0 25,459 23, ,869 5,430 0 (5,430) Research 0 0 8,200 45,300 53,500 17,833 50,785 32,952 Unallocated , ,064 13,452 0 (13,452) 25 2,177,400 1,889,999 1,332,600 5,400, , ,588 (161,272) HIGHLIGHTS: The overall programme is currently under-achieving by 161,000; this represents a fall on last month s 42,750 adverse position. There are three key areas of under-achievement in ; Procurement: Partial under-achievement (within Direct Care division), due to delays in issuing OJEU notices for prostheses procurement programmes. Contingency schemes based upon price capping of high-cost prostheses that will be introduced in the short term 4

5 Corporate Functions: Progress has been made in identifying savings from corporate functions. However, there remain a number of areas that have not yet identified savings. Work is underway to identify where these savings will come from, and how they can be safely delivered this year. Scoliosis in-sourcing: The delivery of this activity has been delayed, but procedures are booked and this position will be fully recovered in-year. 14 th AUGUST 2013 SERVICE TRANSFORMATION PROGRAMME BOARD UPDATE Inpatients Bed Realignment The Programme Board agreed that the optimum time for this to take place would be during December 2013 Workforce Planning The workforce plan has been revised upwards to 1,345 from 1,270 WTEs reflect the Trust s ongoing growth figures Clinical Impact & Risks no new risks were added to the register for the programme 5

Integrated Quality, Performance and Finance Reporting Framework. Reporting period: Month 9 December 2014

Integrated Quality, Performance and Finance Reporting Framework Reporting period: Month 9 December 2014 Contents Section Page Trust Scorecard 3 Trust Heatmap 5 Scorecard matrix 6 Areas of underperformance