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

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

2 Contents Section Page Trust Scorecard 3 Trust Heatmap 5 Scorecard matrix 6 Areas of underperformance 7 Key achievements 9 Flash report 9 Finance overview position summary 10 Finance overview statement of comprehensive income 11 Finance overview statement of financial position 12 Finance overview - CIP 13 Appendix 1 Ward Staffing Levels 14 Integrated Quality, Performance and Finance Reporting Framework 2

3 Trust Scorecard Reporting Month December 2014 Compliance KPI: NHS TDA Accountability Framework, National Standard, local contract standard. Strategic KPI: Reflective of UHCW strategic objectives. N.B. Compliance KPIs are mapped to relevant UHCW strategic objective. Integrated Quality, Performance and Finance Reporting Framework 3

4 Trust Scorecard Reporting Month December 2014 Compliance KPI: NHS TDA Accountability Framework, National Standard, local contract standard. Strategic KPI: Reflective of UHCW strategic objectives. N.B. Compliance KPIs are mapped to relevant UHCW strategic objective. Integrated Quality, Performance and Finance Reporting Framework 4

5 Trust Heatmap Integrated Quality, Performance and Finance Reporting Framework 5

6 Scorecard matrix December 2014 Behind plan On plan Ahead of plan Improving Serious Incidents (Overdue) Theatre efficiency Rugby Theatre utilisation Day Surgery Choose and book appointment slot issues Delayed transfers as a percentage of admissions Liquidity days Personal Development Review Non-Medical Attendance at mandatory training Temporary costs and overtime as a % of total pay bill Performance in initiating trials (quarterly) Peer reviewed publications calendar year cumulative Pressure ulcers 3 and 4 (Trust associated) Capital Services capacity Harm free care C-UTI Number of complaints registered No of pts recruited into NIHR portfolio cumulative Submitted research grant applications cumulative Not Changing MRSA bacteremia (Trust acquired) cumulative Serious Incident (Number) Number of never events reported cumulative SHMI (quarterly) (6 months in arrears) Staff turnover rate Vacancy rate No of specialties at HEWM Level 3 and 4 Medication errors causing serious harm CAS Alerts (Overdue) Same sex accommodation breaches Number of maternal deaths Surgical Safety Checklist (WHO) Urgent ops cancelled for the second time RTT - 52 week waits 12 hour trolley waits in A&E Combined risk rating Forecast I&E compared to plan (,000) Clostridium difficile (Trust acquired) cumulative Eligible patients having VTE risk assessment 18 week RTT Non-admitted 31 day diagnosis to treatment cancer target 30 day emergency readmissions Job evaluation survey tool (JEST) score Doctor trainers provisionally accredited Deteriorating Reported harmful patient safety incidents Friends & Family Test A&E & IP Coverage Maternity FFT No of touchpoints achieving 15% response rate Theatre efficiency Main & Rugby Theatre utilisation Main, Rugby & Day Surgery Last minute non-clinical cancelled ops (elective) Breaches of the 28 day readmission guarantee 18 week RTT -admitted 18 week RTT - Incomplete Diagnostic waiters, 6 weeks and over 62 days urgent referral to treatment cancer target A&E 4 hour wait target Forecast recurrent and non recurrent efficiency compared to plan (,000) Personal Development Review Medical Sickness rate Performance in delivery of trials (quarterly) Research critical findings and serious incidents Commercial income invoiced 000 cumulative Falls per 1000 occupied bed days resulting in serious harm Friends and Family Test IP & A&E Recommenders Two week cancer wait (GP referral to OP appointment) Integrated Quality, Performance and Finance Reporting Framework 6

Areas of underperformance Headlines Scorecard Summary 42 KPIs underperformed; 31 of which are classified as compliance measures and 11 as strategic KPIs.

7 Areas of underperformance Headlines Scorecard Summary 42 KPIs underperformed; 31 of which are classified as compliance measures and 11 as strategic KPIs. Domain Indicators achieved Indicators in exception Indicators in watching status Total indicators 62 Day urgent referral to treatment cancer standard The Trust has failed to meet the 85% target for November Excellence in patient care and experience Deliver value for money Employer of choice Leading research based health care organisation Leading training and education centre The Trusts overall performance has deteriorated this month with indicators moving from watching status to being in exception. Aspects of the emergency pathway (A&E waiting times and delayed transfers of care) and the elective pathway (18 week referral time), RTT incomplete pathways and last minute cancelled operations) continue to have poor performance. Both the diagnostic waiters and the 62 day cancer KPIs have underperformed this month, further detail is described in this report. All of the indicators continue to be in exception or in watching status for the Employer of Choice domain despite the improvement of the mandatory training compliance and non medical PDR rates. Theatre KPIs for both efficiency and utilisation are still performing below target for main, Rugby and day theatres. The HSMR indicator cannot be reported this month due to delays in publication of data on the Dr Foster system. Following reassessment of previous mitigations, the Trust forecast position has deteriorated significantly this month. The Trust achieved 81.6% in November There has been an increase in breaches of the standard resulting from late referrals after 62 days from other Trusts. These are categorised as shared breaches. There has also been an increase in UHCW breaches of the standard in colorectal surgery, urology, gynaecology and radiotherapy. Actions include the following: Revisions to the colorectal pathways. Additional support for tracking urology patients on an urgent suspected cancer pathway. Re allocation of workload due to the enforced absence of a member of the gynaecology/oncology team. Additional support for tracking of patients on a gynaecology urgent suspected cancer pathway. Review of all radiotherapy breaches in the month. Integrated Quality, Performance and Finance Reporting Framework 7

Areas of underperformance Headlines Diagnostic waiters 6 weeks and over The Trust has breached the 1% tolerance for this indicator for the first time since July 2013 Reported low and moderate harmful

47% against the national target of 1% for diagnostic waits six weeks and over, for December 2014 this is a failure against the standard.

8 Areas of underperformance Headlines Diagnostic waiters 6 weeks and over The Trust has breached the 1% tolerance for this indicator for the first time since July 2013 Reported low and moderate harmful patient safety incidents Rise in harm incidents (low, moderate and severe) as reporting rate goes up The Trust has posted 1.47% against the national target of 1% for diagnostic waits six weeks and over, for December 2014 this is a failure against the standard. Some of the issue was as a result of operational pressures necessitating the diversion of resource away from routine work, alongside increased demand, equipment failure and industrial action. Imaging is developing a plan with a trajectory to recover this important target by the end of January. Internal audit will review the governance arrangements relating to diagnostic waiting list management and report back at a later date. The monthly target is based on Trust figures against the national average for overall incident reporting, which is provided every six months by the National Reporting & Learning System (NRLS) (the latest report refers to incidents Oct 2013 March 2014). Therefore, this rise could be in line with the national picture but this cannot be verified until April Of the 27.85% of reported patient safety incidents which were harmful incidents, 94.57% are classified as minor or moderate harm. 72% of all reported incidents result in no harm to patients. A high level of reporting is a good indicator of an open, learning culture and the Trust continues to encourage reporting of all incidents and nearmisses so that trends can be identified and concerns addressed. Integrated Quality, Performance and Finance Reporting Framework 8

9 Key Achievements December 2014 Flash Report December 2014 The Trust has completed its data submission, as requested by the Care Quality Commission (CQC) prior to their visit which is due to take place in March. Staff throughout the Trust have been involved in providing a substantial amount of information across a range of core services identified by the CQC. Pressure Ulcer performance is back on target with no Trust acquired Grade 3 or 4 Ulcers reported for December. A comprehensive programme of education is in place for staff on all wards, and national pressure ulcer week was extended to a month in the Trust, focussing on specific elements of pressure ulcer prevention. Friends and Family Test (FFT) response rates decrease and nationally UHCW drop below the average for percentage recommenders FFT response rates dropped again in December across Inpatients, A&E and Maternity. Achievement of the 14/15 CQUIN is now a risk to the Trust and has been placed on the corporate Risk Register. National average percentage recommenders for A&E is 87%, UHCW reports 85%. National average percentage recommenders for Inpatients is 95%, UHCW reports 91%. Emergency pathways are resulting in pressures on RTT targets The Trust position is such that the size of the elective backlog will now require a prolonged period of recovery to reduce the backlog to an acceptable level ahead of next winter. Dr Foster delays mortality reporting Delays in publication of data on the Dr Foster system means that HSMR data will not be available this month. The next publication date has been announced as being February. Integrated Quality, Performance and Finance Reporting Framework 9

Finance overview position summary Nine finance performance indicators are in escalation this month. Debtors and total income have moved out of escalation this month.

10 Finance overview position summary Nine finance performance indicators are in escalation this month. Debtors and total income have moved out of escalation this month. All other indicators remain in breach. The EBITDA margin achieved indicator has moved into a red rated position due to the Trust reporting a year to date IFRS operating deficit of 14.4m deficit, which is 12m adverse to plan. This is aligned to the overall deterioration in the forecast financial position discussed on page 11. The deteriorating year to date financial position is reflected in the decline in performance against all of the income and expenditure linked indicators. Integrated Quality, Performance and Finance Reporting Framework 10

11 Finance overview statement of comprehensive income The Trust is forecasting 1.8m surplus against a breakeven position, in line with the TDA plan, but would require 22m of additional funding to achieve this. The Trust is in close consultation with the TDA and has taken advice on how to present this month s position and will continue to work closely with regulatory colleagues to ensure appropriate disclosure at the right time. Statement of Comprehensive Income Income 2014/15 Year To Date Month Revised Forecast Plan TDA Plan Outturn Variance Plan Actual Variance Plan Actual Variance Contract income from activities 449, , ,172 (5,085) 352, ,068 (4,160) 41,265 38,182 (3,083) Contract Income (Additional Income) ,233 22, Other income from activities 25,031 12,742 12,552 (190) 9,291 9,225 (66) 1,318 1,037 (281) Other Operating Income 64,702 64,967 66,465 1,498 47,053 49,901 2,848 5,292 5, Total Income 538, , ,422 18, , ,194 (1,378) 47,875 44,809 (3,065) Operating Expenses Pay (300,296) (315,137) (326,405) (11,269) (235,974) (241,740) (5,766) (26,205) (28,316) (2,111) Non Pay (177,506) (184,308) (191,940) (7,631) (138,909) (143,758) (4,849) (15,194) (16,455) (1,261) Reserves (11,723) (106) (148) (42) (195) (114) (132) Contract income is forecast at 5.0m adverse to plan, reflecting performance, risks and penalties. Group expenditure forecasts include cost pressures of 18.6m: ( 4.5m) nursing costs, driven by agency usage, including 2.1m for specialing of patients. ( 3.7m) adverse variance due to timing differences in education & research. ( 3.5m) RTT and capacity. ( 2.6m) emergency pathway costs. ( 2.2m) cover for medical staff vacancies. ( 1.7m) net effect of other favourable variances and cost pressures in groups. ( 0.5m) Pathology network. in education & research. Total Operating Expenses (489,525) (499,551) (518,494) (18,943) (375,078) (385,436) (10,359) (41,381) (44,885) (3,504) EBITDA 49,415 49,415 48,929 (486) 33,494 21,758 (11,737) 6,494 (76) (6,569) EBITDA Margin % 9.2% 9.0% 8.6% 8.2% 5.3% 13.6% -0.2% Non Operating Items Profit / loss on asset disposals Fixed Asset Impairments Depreciation (17,795) (17,795) (18,310) (515) (13,346) (13,732) (386) (1,483) (1,526) (43) Interest Receivable (9) (10) 8 4 (4) Interest Charges (228) (228) (257) (29) (171) (174) (3) (19) (22) (3) Financing Costs (26,665) (26,665) (26,665) 0 (20,090) (20,071) 19 (2,264) (2,313) (49) Unwinding Discount (49) (49) (49) 0 (49) (49) PDC Dividend (3,078) (3,078) (2,961) 117 (2,309) (2,221) 88 (257) (247) 10 Total Non Operating Items (47,715) (47,715) (48,149) (434) (35,890) (36,180) (291) (4,014) (4,103) (89) Net Surplus/(Deficit) 1,700 1, (920) (2,396) (14,423) (12,027) 2,480 (4,179) (6,659) Net Surplus Margin % 0.3% 0.3% 0.1% -0.6% -3.5% 5.2% -9.3% Donated/Government grant assets adjustment (66) (44) Residual interest IFRIC Integrated Quality, Performance and Finance Reporting Framework Break-even in-year position 1,817 1,817 1,817 0 (2,172) (13,432) (11,260) 2,480 (4,179) (6,659) 11

12 Finance overview statement of financial position The statement of financial position shows the assets, liabilities and equity held by the Trust and is used to assess the financial soundness of an entity in terms of liquidity risk, financial risk, credit risk and business risk. Cash and cash equivalents have reduced by 21m, as a result of the cash associated additional funding that is required in month 12 to break even, being assumed to be accrued rather than cash backed at 31st March 2015.The Trust is currently in the process of putting an application into the Independent Financing Facility (ITFF) for revenue PDC support. The receipt of this PDC is not factored into the cash forecast therefore it assumes an overdrawn cash balance of 20.1m. Trade and other payables have increased by 21.5m, to compensate for the cash impact of the increase in income accruals and additional funding. The forecast already includes a capital investment loan of 8.9m which was approved in December m was drawn down in December and the balance of 0.4m will be drawn down in March. Statement of Financial Position 2014/15 Year To Date Month Forecast Planned Actual Plan Variance Plan Actual Variance Variance Outturn Change Change Non-current assets Property, plant and equipment 393, ,366 (16,959) 365, ,159 (14,348) 3,905 (108) (4,013) Intangible assets 1,143 1, ,143 1, Investment Property 5,007 5, ,007 5, Trade and other receivables 15,173 23,419 8,246 23,798 31,480 7,682 (3,773) (1,738) 2,035 Total non-current assets 414, ,935 (8,713) 395, ,789 (6,666) 132 (1,846) (1,978) Current assets Inventories 10,293 10, ,293 11, Trade and other receivables 21,365 45,585 24,220 22,752 40,792 18,040 (7,468) (385) 7,083 Cash and cash equivalents 893 (20,107) (21,000) 948 4,177 3,229 (138) 2,168 2,306 32,551 35,771 3,220 33,993 56,208 22,215 (7,606) 1,828 9,434 Non-current assets held for sale Total current assets 32,551 35,771 3,220 33,993 56,208 22,215 (7,606) 1,828 9,434 Total assets 447, ,706 (5,493) 429, ,997 15,549 (7,474) (18) 7,456 Current liabilities Trade and other payables (43,062) (44,644) (1,582) (48,225) (69,712) (21,487) 10,699 3,520 (7,179) Borrowings (6,470) (6,357) 113 (7,030) (6,868) DH Working Capital Loan DH Capital loan (1,500) (2,390) (890) (1,500) (2,350) (850) 0 (850) (850) Provisions (196) (194) 2 (196) (1,323) (1,127) Net current assets/(liabilities) (18,677) (17,814) 863 (22,958) (24,045) (1,087) 3,093 4,498 1,405 Total assets less current liabilities 395, ,121 (7,850) 372, ,744 (7,753) 3,225 2,652 (573) Non-current liabilities: Trade and other payables Borrowings (267,367) (266,757) 610 (266,147) (267,301) (1,154) DH Working Capital Loan DH Capital loan (5,250) (13,260) (8,010) (6,000) (13,650) (7,650) 0 (7,650) (7,650) Provisions (2,422) (2,692) (270) (2,520) (2,653) (133) 0 (133) (133) Total assets employed 120, ,412 (15,520) 97,830 81,140 (16,690) 3,369 (4,179) (7,548) Financed by taxpayers' equity: Public dividend capital 48,470 33,870 (14,600) 38,536 33,870 (4,666) (891) Retained earnings 23,638 22,718 (920) 18,644 6,620 (12,024) 2,478 (4,179) (6,657) Revaluation reserve 48,824 48, ,650 40, Integrated Quality, Performance and Finance Reporting Framework Total Taxpayers' Equity 120, ,412 (15,520) 97,830 81,140 (16,690) 3,369 (4,179) (7,548) 12

13 Finance overview CIP The Trust has fully identified its annual CIP target Headlines Delivery in December matched the plan of 3.2m. 24.3m delivered year to date against a cumulative plan of 23.8m. Forecast delivery of 33.3m against the Trust target of 33.5m, giving a forecast shortfall of 0.2m. Risks The Trust has now fully identified its CIP target but is forecasting a shortfall in delivery. Therefore, there still remains significant risk around delivering the full year plan. A number of schemes are dependent on maintaining patient flow through the hospital during the winter months to deliver in full. In an effort to fully deliver their targets, Groups have identified a number of non recurrent measures. The value of identified non recurrent CIP currently stands at 4.8m which whilst delivering the in year target, creates a pressure for 2015/16 and will need to be factored into financial planning. The value of PbR income schemes is a significant element of the programme and the value continues to rise ( 17.4m of 34m opportunities). There is a risk that the schemes are delivered but our overall performance and commissioner affordability might affect the overall amount paid to us. As part of the validation of income schemes, the corporate team have identified a potential 2m of risk against the forecast position. These risks are not reflected in the CIP position reported here or the Trust income position. The contracting team have reviewed all of these schemes and confirmed that they in line with counting and charging rules. These risks are being managed by the corporate team with Groups to mitigate against any potential loss of income against these schemes and ensure that forecasts are realistic and achievable. Key Actions Groups who have not fully identified schemes against their target to continue identifying schemes. Groups with slippage need to identify routes to covering the shortfall. All Groups to focus on ensuring delivery of identified schemes. Corporate support functions (HR, Governance and ICT ) still need to identify savings for inclusion in Group positions. CIP Steering Group to continue scrutiny of Group positions, including provision of support to unblock obstacles where necessary. 13

These figures show the previous months Trust wide nurse staffing, along with exceptions and actions

14 The figures reported above are submitted to the DoH via Unify on a monthly basis to support NHS England Safer Staffing along with the ten expectations from the NQB. These figures show the previous months Trust wide nurse staffing, along with exceptions and actions being taken. Patients are able to view this information on the Trust s Internet Site. Integrated Quality, Performance and Finance Reporting Framework 14

Operational Performance. SaTH Overall Performance

Operational Performance. SaTH Overall Performance Balanced Scorecard Summary Operational Performance Previous This Year to Date Previous This Year to Date Number Number Number Number Number Green 17 17 15 Green 7 7 0 Amber 3 2 2 Amber 1 0 0 Red 2 4 5