UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST. Capacity Plan Update

Transcription

1 UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST Capacity Plan Update Report to: Trust Board 29 th November, 2011 Report from: Sponsoring Executive: Sponsoring Divisional Director: Aim of Report/ Principle Topic: Mike Murphy, Deputy Director of Strategy Benjamin Hendy, Trust Capacity Planner Steve McManus, Chief Operating Officer N/A Monthly update and review of the Trust capacity position. This paper serves as an early warning indicator should significant risks to that plan arise. Review History to date: Monthly to TEC and Trust Board March 2011 to date. Recommendation(s): Trust Board to note: The Trust is moving towards the Risk 2 scenario presented in the original capacity plan; 3.5% annual growth and a failure to achieve full activity management The revised forecast of bed day demand shows that the Trust will potentially end the year with an occupancy rate of 97.3% unless further actions are taken to support capacity in Divisions A, B and D Opportunities to commission currently uncommissioned beds coupled with initiatives to create further capacity will ensure a year end occupancy of 93.7% at currently projected demand, the cost of which is expected to be c. 1m. This cost has been identified within the revised financial forecast and mitigates a potential greater spend of 300k if capacity is used in a reactive way 1

2 1. Introduction October Trust Board received an occupancy forecast of 95.2% (2011/12 average) compared to a planned position of 92%. This forecast could increase to a year end occupancy of 97.3% based on the latest (end September) activity profile, if current mitigating actions are not maintained and further actions taken in terms of available capacity identified. This forecast reflected: A 9% increase in bed days against plan from 308,776 to 336,776 The inclusion of 23 additional beds (annual average equivalent) against the existing capacity at that time. Trust Board requested details of further opportunities to mitigate the occupancy forecast and bring it back towards the target of 92%. It was recognised that the current ad-hoc use of uncommissioned capacity has a negative impact on the financial forecast. This paper identifies where the financial forecast can be improved by the planned use of uncommissioned beds which should reduce the use of agency spend and ensure staff are available as demand peaks. 2

3 2. Capacity Performance To the end of August Trust Summary By Month 2011/12 Actual Discharges Bed Days LoS R-12 Open Discharges Bed Days LoS R-12 Projection* Open Discharges Bed Days LoS R-12 Open April 6,456 26, % ,446 27, % ,390 27, % May 6,636 27, % ,531 27, % ,481 28, % June 6,569 26, % ,532 25, % ,500 26, % July 6,863 26, % ,445 25, % ,463 26, % August 6,625 26, % ,257 25, % ,282 26, % September 6,627 25, % ,264 24, % ,327 26, % Target** 2010/11 Actual YTD (September) 39, , % , , % , , % * LoS R-12 Projection is not a target but a trend-based projection made in March 2011 ** Activity Management is included in Targeted Year End Bed Days Forecast but not in Targeted Year End Discharges Forecast Discharge figures are for all spells, including non-chargeable and those charged as IPPDDs In the month of September, discharges were up by 4.7% while bed days were down by 0.6% compared to September 2010 Rolling length of stay (LoS) reduced further to 4.91, 0.10 lower than at the same time in 2010/11. Based on trends in 2010/11, LoS was projected to rise in 2011/12, but instead it has consistently fallen To the end of September 2011 (YTD), Trust-wide discharges were up 3.5%, but bed days were up by only 0.1%. The increase in occupancy is reflected in the decrease in open beds YTD by the end of September was 92.7%. While this is only marginally over the Trust target, it is 2.8% above the same point in 2010/11. Final occupancy in 2010/11 was 91.3%. A similar rise of 1.4% would give a 2011/12 year end position of 94.1% Conclusion: Year to date occupancy is currently running at higher than anticipated levels driven by a 3.7% increase in discharge activity year on year and reduced bed capacity. Analysis of available data suggests an October occupancy of 95.5%, which increases the overall year to date occupancy from 92.7% to 93.2%. 3

4 2.2. Year To Date Summary By Division 2011/12 Actual Discharges Bed Days LoS R-12 Open Discharges Bed Days LoS R-12 Projection** Open Discharges Bed Days LoS R-12 Open Division A 7,375 32, % ,177 31, % ,218 32, % Division B 16,467 59, % ,014 55, % ,389 57, % Division C 7,480 15, % ,605 16, % ,765 16, % Division D 8,454 51, % ,681 49, % ,071 49, % Trust* 39, , % , , % , , % Target*** 2010/11 Actual Divisions A/B/D 32, , % , , % N/A , , % * NB Bed Days figures for Trust also include bed days spent on Therapies ward, not included in Divisional totals ** LoS R-12 Projection is not a target but a trend-based projection made in March 2011 *** Activity Management is included in Targeted Year End Bed Days Forecast but not in Targeted Year End Discharges Forecast Discharge figures are for all spells, including non-chargeable and those charged as IPPDDs R Division A Discharges and bed days have now risen above the targeted levels for the year, while length of stay is 3.2% down, but occupancy is significantly up on both 2010/11 and target as capacity has fallen by almost 16 beds on average. R Division B Discharges are 3.2% below target while bed days are 7.8% over target. Length of stay has increased by 1.1% on 2010/11. Total open beds have stayed approximately the same and so occupancy has risen. G Division C Discharges are up 10.6% on 2010/11 and 13.2% on target but bed days are 4.9% below target and 8.3% below 2010/11. Rolling 12-month LoS is the same as in 2010/11. Then it was on an upward trend, peaking at 2.92 in Feb 2011, now it is coming down. R Division D Discharges are 10.1% above target while bed days are 3.8% above target. Divisional occupancy is 1.4% below target. A R Trust Discharges are 3.4% above target, while bed days are 2.5% over. Rolling 12-month length of stay is significantly lower than the original projected level reducing from 5.09 to is up due to year on year reduction in bed numbers Conclusions: Year to date aggregate Trust occupancy rates are above both the target and the previous year, with the September 2011 (92.7%) figure significantly higher than September 2010 (89.9%). Overall Trust bed days are up, year on year, by only 0.1%, but for Divisions A, B & D collectively they are up by 2.7%. These are the divisions that can share capacity and so this rise in activity is more keenly felt. Capacity is down by 2.9% while discharges are up by 3.8% which means we are running hotter with fewer beds. 4

5 3. The 2011/12 Year End Forecast Bed Days 2011/12 Target 2010/11 Activity 2011/12 Activity 152, , , /12 Risk 2 Activity 179,245 92% further beds released by mitigation plans 939 September 2011 Capacity beds after mitigation 2011/12 Bed /12 Risk Mitigation beds + 95% occupancy = Trust covering Risk beds after mitigation The above chart shows the bed requirements for the remainder for 2011/12 (October 2011 March 2012). The revised projections show that the Trust will need 1041 beds on average for the remainder of the year in order to meet 92.0% occupancy for this period. In the previous paper, the projected year end bed day activity was 336,776, against a Risk 2 position of 347,186. The updated year end projection is for a total annual demand of 335,389. However, due to the lower level of beds implemented in September, the average beds required for the remainder of the year to meet 92% increases. With current capacity, average occupancy for the year is forecast to be 97.3% (Appendix A). Early indications suggest that October 2011 bed day activity is above target and has grown year-on-year, although not at a rate to match Risk 2. However, due to occupancy being above 92%, the number of beds required in the remaining 5 months of the year to reduce annual occupancy to 92% overall is liable to increase further. Section 4 details 65 beds that have been identified as potential available capacity mitigation to enable the Trust to meet demand, along with a further 35 beds with a limited impact. The chart shows what impact these beds would have on the Trust s capacity requirements in the remainder of the year working at 92% and at 95%. This is explored in greater detail in Appendix A. 5

6 4. Capacity Mitigation Trust Board requested further actions to be identified to improve the forecast outturn occupancy as well as to mitigate the financial costs of ad hoc capacity being used. The below table details currently identified actions planned as part of the COO reserve and in the forecast. If continued these actions will lead to a year end position of 95.2% occupancy. Action Bed Numbers Impact Status RAG Paediatric Capacity 8 Increase capability to address paediatric Funded - Opened orthopaedic/surgical capacity 10 October G Additional Medical on COO winter reserve planned as part of winter 12 E5 contingency November G Orthopaedic outsourcing to Not able to 14 Separates elective and non-elective facilities Nuffield progress R Increase ESD Releases funded bed capacity already accounted for 17 (Healthcare@Home) in revised projections In progress G Critical Care length of stay Increased Critical Care bed day availability minimal 2 reduction (level 2/3 beds) impact on level 1 bed capacity/demand In progress G Surgical outsourcing for Separates elective and non-elective facilities, provides 10 January 2012 SGH non-elective beds impact for one month only January A Disinvest from Neuro Movement of Victoria House facility to community Rehabilitation service 6 setting Victoria House facility not viable capacity for general medical patients January R Sub-Total 69 Green Complete/On-Track Amber In Progress/Minor Risk Red At Risk 6

7 In addition, currently uncommissioned capacity is occasionally being used to alleviate pressures on an ad hoc basis. If this capacity were commissioned it would further reduce annual occupancy to 93.7% Action Bed Numbers Impact Status RAG Utilising E2 Day Case Not in capacity forecast previously unfunded cost 12 Capacity 24 hours pressure already impacting on financial forecast Uncommissioned N/A E7 2 Uncommissioned N/A F3d 24hr use of Day Case Not in capacity forecast previously unfunded cost 12 Capacity pressure already impacting on financial forecast Uncommissioned N/A C6 1 Uncommissioned N/A F Level Orthopaedics 4 Unfunded elective capacity in use Uncommissioned N/A Sub-Total 31 Grand Total 100 7

8 5. Financial Implications As part of the winter resilience plan for quarters 3 & 4 of this financial year the trust has been reviewing bed & non-bed related proposals to increase capacity and also to ensure our clinical teams can cope with the predicted demand. The plan is to spend up to 1m to provide this resilience during this time and whilst this is a challenge to the Trust s financial position it does allow for planned expenditure rather than ad hoc which usually comes at a premium. The capacity identified within the revised forecast to use in a planned way is identified within the above tables. In addition a number of outsourcing opportunities are also being reviewed and considered in light of the Trust s financial position. Fixing the use of this capacity within the financial assumptions does allow the Trust to mitigate the potential financial impact of the capacity requirement based on avoiding costs of approx 300k through not reactively opening this capacity Risks The risks to the Trust from the implementation or otherwise of the various mitigation schemes are: Higher occupancy rates will have an impact on performance and quality measures (see section 5.2) Costs are associated with all capacity, but differ for planned and unplanned usage It is unlikely that commercial sector capacity will be available for outsourcing activity No further bed capacity within our control that would allow us to navigate back down to 92% occupancy based on current forecast 5.2. Quality The table below gives an indication of the kind of effects on clinical quality that can be expected due to operating at a higher level of occupancy. 87% Ave Annual 90% Ave Annual 92% Ave Annual 94% Ave Annual Red/Black Alerts 6 Alerts per Month 9 Alerts per Month 12 Alerts per Month 15+ Alerts per Month Patient Moves 80 patients with >2 non-clinical 100 patients with >2 nonclinical moves per month clinical moves per month moves per month 112 patients with >2 non- 124 patients with >2 non-clinical moves per month Elective Cancellations due to Bed Availability Rare at 88% or below <10 per month per month approx 20+ per month ED Breaches Approximately 60 per week Approximately 75 per week Approximately 87 per week Approx. 100 per week, substantial variability regarding outcomes Red Incidents Rare at 88% or below Fewer than 2 per week Approx. 2 per week on average 3+ per week, rising rapidly 8

9 6. Conclusion & Recommendations The Trust is currently over-trading in Divisions A&B with significant levels of non-elective activity and in Divisions C&D on referred activity we would want to attract. Due to this overperformance the Trust is moving towards the worst case scenario outlined in the original Capacity Plan presented in March 2011 and our ability to deal with winter pressure is already threatened. Divisions A, B and D combined are already running at over 95% occupancy for the year to date. The Trust has to consider do we: Step back from activity generation that we can control in Divisions C & D? o In mitigation to this, Division C is in line to meet occupancy targets and beds are effectively ring-fenced, or Recognise the requirement to access and fund further capacity in order to return towards an occupancy level of 92% in this financial year, and Recognise the consequences and impact of over-trading on the Trust s financial position 9

10 APPENDIX A YTD Performance Actual Bed Days Division A Division B Division C Division D Trust Actual Ave Actual Actual Bed Actual Ave Actual Actual Bed Actual Ave Actual Actual Bed Actual Ave Actual Actual Bed Actual Ave Days Days Days Days Apr-Sep 32, % 59, % 15, % 51, % 160, % Targetted Sep 2011 Targetted Sep 2011 Targetted Sep 2011 Targetted Sep 2011 Targetted Sep 2011 Actual With With With With With 92.0% % % % % Forecast Current Current Current Current Current Bed Days Bed Reqs Bed Days Bed Reqs Bed Days Bed Reqs Bed Days Bed Reqs Bed Days Bed Reqs Oct-Mar 33, % 68, % 18, % 55, % 175, % Full Year Impact Actual Bed Days Actual Ave Actual Actual Bed Days Actual Ave Actual Actual Bed Days Actual Ave Actual Actual Bed Days Actual Ave Actual Actual Bed Days Actual Ave Actual FYE - No Extra 65, % 127, % 33, % 107, % 335, % Forecast Year End including additional beds found through mitigation (see section 3) for December 2011 to March 2012 Original Plan - Forecast Year End Original Plan - Risk 2 Forecast Year End 335, % 308, % 347, % The above table is in 3 parts. The first part shows actual performance by Division for the period of April 2011 to September The second part illustrates the forecast for the period October 2011 to March 2012 and highlights the occupancy for that period that the current bedstock will deliver. The third part of the table reflects the full year position of actual and forecast combined. The table shows that with the current bedstock the Trust will post a 97.4% occupancy for the year based on current trends. The benefit of the capacity mitigations to release up to 103 beds between July 2011 and March 2012 in the Trust (see Section 3) can be seen in the projected year end occupancy of 95.0%*. Based on these projections, in order for the Trust to reduce occupancy from 92.7% at the end of September to 92.0% at the end of the year, the Trust would need to provide beds on average per month from October to March, an increase of 97 beds on the number of open beds in September *This assumes the beds are opened for December 2011 to March 2012 this approximation is in place due to the staggered timings and durations of the bed mitigation plans and should be considered indicative. 10

11 APPENDIX B November 2011 March 2012 Requirements in Detail Section 2 demonstrated how an average of 1041 beds would be required for October 2011 to March 2012 in order to reach 92% occupancy this financial year. However, due to the seasonal variability in bed demand, 1041 would still lead to issues with capacity in Q4. Trust Average Max Min Currently Open Weekly Ave with Current Capacity November % December % January % February % March % Average % As the above table shows, with 1041 open level 1 beds, some days in January would still be operating at over 100% occupancy, while December appears to require considerably fewer beds than any other month. A close look at December reveals that this isn t quite the case either. Trust Average Max Min Currently Open Weekly Ave with Current Capacity Dec % Dec % Dec % Dec % As of 1 November, 2011, the Trust has 974 beds open on a weekday and 930 at the weekend, giving a weekly average of 961 open beds. 11

12 APPENDIX C Future Projections: and Beyond The revised projections of activity for shows how the current trends in growth for both spells and bed days manifests itself in the next financial year. These are preliminary figures, not taking into account SAVOs and service shifts and excluding any future successful Activity Management of CIP schemes. 100% 92% Open 2010/ / / / / / / /12 Q Q Q Q Q Q Q Q Q Q Q Q Ave Ave Ave Data presented is latest projected data Data presented is actual historic data Data is a mixture of actuals and projections Simple projections for 2013/14 and 2014/15 have also been produced. These figures demonstrate the challenge facing the Trust is current growth trends continue, with bed demand at 92% rising by over 100 beds in the next 3 years. @85% 2011/12 335, , , , /13 343, , , , , /14 357, , , , , /15 369,295 1, , , , ,