Item: 5.1. REPORT TO THE PUBLIC TRUST BOARD MEETING 30 th May Executive Summary. Title

Transcription

1 REPORT TO THE PUBLIC TRUST BOARD MEETING 30 th May 2013 Item: 5.1 Title Lead Director Author(s) Purpose Previously considered by Executive Summary Integrated Performance Report Mary Leadbeater - Interim Director of Finance & Performance Lynne Wigens Director of Nursing & Quality Julie Fryatt Director of HR Margaret Blackett Interim Chief Operating Officer Chief Information Officer Mike Meers Deputy Director of Nursing Catherine Morgan Dave Mountford Interim Director of Finance To receive for information e.g.: Draft version to Finance and Performance and Committee (22 April 2013) The board is being asked to note the contents of the integrated performance report (Appendix A) on: Quality Finance National & Contractual Standards Organisational Development Organisational Efficiency Trust summary performance management framework scorecard. The report also includes performance against the SHA Single Operating Model (SOM) for selfcertification (Appendix B). Related Trust Objectives Insert/delete as appropriate: 1. To provide safe, reliable, personal & responsive emergency care, planned care, maternity & children s care; 2. To provide nationally recognised care for older people in the hospital; 3. To provide a number of more specialised services where they meet defined accreditation standards. Risk and Assurance. Related Board Assurance Framework Entries Legal Implications/Regulatory Requirements Action Required by the Board The Trust Board is asked to receive the report. Sub-objectives Underlying Strategy: Effective Financial Management None Noted 1

2 BACKGROUND 1. This report has been revised to provide a new quality section and narrative with Appendix A. 2. The Trust SOM self-certification is Appendix B and shows. KEY ISSUES Governance Risk Rating Finance Contractual Amber/Red 2.0 for governance risk rating, with the trust scoring 1.0 for failing the 18 Week Trust Admitted Target being below the national threshold at 90% at 87.6%. The Trust has in place a remedial action plan for recovery of performance within Trauma & Orthopaedics and General Surgery. The trust failed the Accident & Emergency in March with 93.78% and scored 1.0%. Month 1 Financial Risk rating is 1. (The financial risk rating is scored from 1 to 5 (1 indicates High risk, 5 indicates Low risk). Quality The Trust VTE data achievement fell to 97.24% in April The Trust had 10 new SIRI s in April however its rate per 1000 bed days fell to The Trust had one read area on its Maternity dashboard Breast Feeding initiation 75.5% against contractual target of 78% (77.6% ). Despite 5 avoidable grade 3 and 4 pressure ulcers the rate per 1000 bed days of avoidable PU's remains at / The Contractual Risk Rating remained the same with a contractual notice open around Emergency department timeliness indicators. 2

3 Trust Quality & Performance Report April 2013 Appendix A 1

4 Contents Description Page Quality 4 Finance 22 National and Contractual Targets 39 Organisational Development 48 Operational Efficiency 51 2

5 Introduction This Corporate Trust Dashboard provides narrative for performance in five key areas: Quality, Finance, National and Contractual Standards Local Priorities, Organisational Development & Operational Efficiency. 3

6 Quality 4

7 Quality - Harm Free Care The National Acute Trust Dashboard shows an improving trend in harm free care with the Trust achieving its highest compliance in March 2013 at 97.24%. In April the Trust will report 95.57% compliance. (Proportion of all patients surveyed not experiencing any of the following 4 harms - pressure ulcer, VTE, UTI in patients with a catheter and falls ) 04/ / / / / / / / / / / /2013 Value Mean Upper Control Limit (+3SD) Lower Control Limit (-3SD) Patients not experiencing a harm All patients surveyed

8 Quality Priority Patient Safety - Infection Control MRSA 1 case attributed to IHT in April. The Trust will now be above its threshold of 0 for the 2013/14 contract year. C.difficile April 2 cases attributed to IHT. The Trust 2013/14 trajectory is for no more than 21 cases. Currently 2 against a trajectory of 2 for end of April

9 Quality Priority Patient Safety - Falls The contract target for falls during is to have no more than 6 serious harm/ death from falls causing an extended LOS. The trust has 2 serious harm falls in April A penalty of 3,000 per case in excess of the threshold applies. 7

10 Quality Patient Safety - Pressure Ulcers The contract target for pressure ulcers during is to reduce avoidable grade 2 pressure ulcers nil, however a penalty 250 only applies beyond 11 incidents in any month. 8

11 Quality Patient Safety VTE Risk Assessment April 2013 data shows a small reduction to below the 98% contractual standard to 97.24%. The audit team continue to provide patient level data to ward teams to sustain this improvement in compliance rates. Serious Incident Requiring Investigation 10 new SIRI s (0.62 per 1000 bed days)were reported April, 6 of which were avoidable grade 3 or 4 pressure ulcers, 3 falls and 1 baby born in a poor condition. The Trust is currently has a negative alert on the National Acute Quality Dashboard due to its increase in SIRI reporting in Q per 1000 bed days. 9

12 Quality Priority - Patient Experience Better Patient Experience - Net Promoter 18 Weeks Non Admitted YTD Last QTR Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Trust Inpatient Net Promoter Division Medicine & Therapies Division Surgery Division Cancer, Womens & Children, Pathology Trust Emergency Department Net Promoter Division Medicine & Therapies Trust Outpatient Department Net Promoter Division Medicine & Therapies Division Surgery Division Cancer, Womens & Children, Pathology Main Outpatients Inpatients score against 17.95%of patients surveyed.an over-arching patient and carer experience action plan has been developed and is monitored via the Patient Experience Group. Outpatients score The transformation work stream has actions in place to support improved patient satisfaction. The number of patients surveyed was 7.5% which was above the 2.5%. Emergency score The ED transformation work, and the delivery of an action plan in response to the national ED survey, should improve this further. The number of patients surveyed was 3.4%. ED are endeavouring to increase this to the 2013/14 national requirement of at least 15%. 10

13 Quality Patient Experience The Trust received 61 complaints in April 2013 which equates to 0.12 % compared to the number of 38,232 individual patients who attended for Inpatient, Emergency of Outpatient care. 1 high level complaint has been received in April, 11

14 Quality - Maternity Breast Feeding Fell below contractual target for the sixth month in a row in March at 75.5%. The Trust has been informed by the CCG that a Contract Query is to be raised seeking a action plan to achieve compliance. The contractual requirement is 78% Quarter 1 3 rising to 80% in Q4. 12

15 MONTH: April 2013 Performance measure Patient experience 1-1 care in labour: 100% Comments 75.5% mothers initiated breastfeeding We have put on additional UNICEF breast feeding training for the Midwives in May. We are about to recruit a BF coordinator to support breast feeding initiation and continuation. Booking by 12 weeks 6 days: % Consistently high compliance with this quality target. Clinical Midwife Led Births: 17% YTD the MLC births average 17% against a locally set target of 25%. Home births are 3% against the local target of 4%. Home Births: 3% The changes to NICE guidance are having a sustained impact on the eligible women considered clinically suitable for MLC and home birth. For 2013/14 the locally set targets will need to reflect this. Caesarean Section rate: 24.6% Clinical activity 270 mothers delivered in April with 8 sets of twins Bookings for birth at Ipswich in 2013/14 do not currently appear significantly reduced, but it has been noticed that there is an increase in women booking for delivery at West Suffolk since the opening of their new birthing unit. Deben ward s modernisation is now complete and Brook ward will be the next area to be modernised. A leaflet promoting Consultant services is now being used. Work is currently being undertaken on the booking process for women in the Stowmarket area, and once the refurbishment of Brook has taken place marketing and publicising IHT Midwife Led birthing choices will be launched. 2 stillbirths 1Neonatal death Normal birth rate 65% All stillbirths are examined using existing robust Risk Management and processes. For this cluster a separate report has been published. Consistently above the locally set target of 65% this demonstrates that normal birth is achieved both on the low and high risk clinical pathways. Staffing Midwife to mother ratio: 1:30 There are still 10 wte MW on maternity leave and these continue to be counted when ratio is calculated. 13

16 Quality - Maternity Quality Year to date Quarter Current Month Target Actual Target Actual Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Penalty Booking by 12 Weeks 6 days >=90% 96.5% >=90% 96.5% >=90% 96.5% 0 Number of Births Combined LSCS rates against all deliveries 24.6% 24.6% 24.6% 0 Elective LSCS rates against all deliveries 10.4% 10.4% 10.4% 0 Emergency LSCS rates against all deliveries 14.3% 14.3% 14.3% Care in labour (Patient Survey) 100% 100.0% 100% 100.0% 100% 100.0% 0 Breast Feeding Initiation 78% 75.5% 78% 75.5% 78% 75.5% 0 Midwife, Mother to includes band 4 1:30 Green, 1:31-34 Amber,1:35 Red 1:30 1:30 1:30 1:30 14

17 Quality - Mortality HSMR Please note the improved HSMR between April and January HSMR for the 12 months ending: HSMR YTD HSMR Mar 2010 Mar 2011 Mar 2012 Jun 2012 Sep 2012 Dec 2012 Apr 2012-Jan 2013 Ipswich Hospital NHS Trust HSMR Low High /13 rebased Low High vs 2009/10 benchmarks National HSMR /13 rebased vs 2009/10 benchmarks England HSMR /13 rebased vs 2009/10 benchmarks

18 Quality SHMI 16

19 Quality - Amenable Mortality Amenable Mortality A new measure observed alongside the SHMI Mortality indicator within the new National Quality Dashboard. Quality Statement Reduce Avoidable Mortality Quality Measure Metric: Number of deaths from causes amenable to healthcare Metric: Rate of actual deaths from cause amenable to healthcare against all admissions Rationale Deaths from causes considered "amenable" to health care are premature deaths that should not occur in the presence of timely and effective health care 17

20 All Quality Amenable Mortality ENG - England > Q42 - Midlands & East > L42D - East Anglia > RGQ - IPSWICH HOSPITAL NHS TRUST Trend Data 02/ / / / / / / / / / / /2013 Value Mean Upper Control Limit (+3SD) Lower Control Limit (-3SD) Deaths Admission Distribution of Acute Trusts Amenable Mortality 18

21 Quality Ward Performance Staffing: A Trust wide review of in-patient area nursing establishments is now implemented in budgets, senior nurses are working with HR colleagues to reduce the use of temporary staffing through recruitment to substantive vacancies in line with these revised establishments. The Board staffing report for April 2013 data presented in June will reflect the agreed revised establishments and progress on recruitment into these. Open day recruitment events have been held for RN s and HCA s earlier in April. The Trust is showing a positive alert on the National Acute Quality Dashboard based on January 2013 data with an improved Nurse to Bed Ratio from 1.47 to 1.63 over the past 12 months, this is mainly due to a reduction in the Trust Bed base with FTE nurses reported rising from 864 to 876. Quality Metrics: All quality metrics and associated actions are discussed by the Director of Nursing /Heads of Nursing, Matrons and Ward Sisters on a monthly basis, as well as actions that have been identified through self and peer audit of CQC essential standards. 19

22 Ward Establishment Metrics Bed Numbers Current Funded Establishment (includes Housekeeping) Total Funded RN Establishement Total Funded HCA Establishement Total RN Vacancies Total HCA Vacancies Total vacancies Vacancy rate against current funded establishment (%) Bank shift requests made Bank shifts successfully filled Bank Fill Rates Nursing and Midwifery % Additional Clinicl Services (HCA)% Notes* Monthly recruitment to vacancies rep Vacancy Rate Bank fill rate Sickness absence Comments Paediatrics Paediatrics Bergholt % % RN vacancy filled but yet to start. HCA vacancy out to advert 15/5/13 Emergency Assessment Unit Emergency Assessment Unit Brantham % % Emergency Emergency Capel % % Critical Care Critical Care CCU % % Cardiology Cardiology Claydon % % M edicine M edicine Debenham % % Emergency Emergency ED % % Older people Older people Grundisburgh % % Older People Older People Haughley % % M edicine M edicine Kirton ARCU % % Surgery Surgery Lavenham % % Orthopaedics Orthopaedics Martlesham % % Orthopaedics Orthopaedics Needham % % Neonates Neonates NNU % % HCA vacancy filled but yet to start Paediatric Assessment Unit Paediatric Assessment Unit PAU % % Trauma Trauma Saxmundham % % Stroke Stroke Shotley % % Oncology & Haematology Oncology & Haematology Somersham % % Stroke & M edicine Stroke & M edicine Sproughton % % Gynaecology Gynaecology Stour % % Surgery Surgery Stowupland % % Surgery Surgery Stradbroke % % M edicine M edicine Woodbridge % % % 20

23 % harm free care Falls PU Developed VTE % Complaints Call bell answered in timely manner % Patients supported with eating & drinking in a timely manner % Told who to contact if worried about condition % Net Promoter % How likely are you to recommend our ward/a&e department to friends and Did you think the hospital staff did everything they could to control your pain % Told about medication side effects % Staff to talk to about worries or concerns % Notes* WARD QUALITY METRICS Quality Metrics Paediatrics Bergholt n/a 0 0 n/a n/a 59 n/a n/a n/a Emergency Assessment Unit Brantham n/a 100 n/a n/a n/a Emergency Capel Critical Care CCU Cardiology Claydon M edicine Debenham Emergency ED n/a 0 0 n/a n/a n/a 66 n/a n/a n/a Older people Grundisburgh Older People Haughley n/a M edicine Kirton ARCU Surgery Lavenham Orthopaedics Martlesham Orthopaedics Needham Neonates NNU n/a 0 0 n/a 0 n/a n/a n/a n/a n/a n/a n/a Paediatric Assessment Unit PAU n/a 0 0 n/a 0 n/a n/a n/a n/a n/a n/a n/a Trauma Saxmundham n/a 100 n/a n/a n/a Stroke Shotley Oncology & Haematology Somersham n/a Stroke & M edicine Sproughton n/a 100 Gynaecology Stour Surgery Stowupland Surgery Stradbroke M edicine Woodbridge * Kesgrave & Washbrook Wards also received 1 Low Level Complaint each *Kesgrave Ward had 2 Grade Two developed pressure ulcers 21

24 Finance 22

25 Report to the Board of Directors for the period ending 30 April 2013 Subject Purpose Responsible Executive Author of attached report Risk Evaluation Finance Report Report to Board of Directors on key financial indicators for April 2013 Interim Director of Finance and Performance Dave Mountford Interim Deputy Director of Finance Month 1 Final Financial Risk rating is 1 Month 1 I&E deficit of 1.7m is behind planned deficit of 0.2m by 1.5m Month 1 Income of 18.4m is 1.5m behind plan of 19.9m by 1.4m Month 1 Operating expenditure of 18.9m is 0.1m more than plan. Month 1 EBITDA is a deficit of 0.5m which is 1.4m worse than plan surplus of 0.9m Month 1 Activity profiles have been phased on calendar days and working days in line with the 2nd Annual Plan submission of 30 April. Further refinement of phasing at a Trust level is being developed. The Trust Cash position is 8.8m which is equal to liquidity risk rating of 4 The key risks to the planned full year surplus of 257k are identification and delivery of the Trust CIP programme and management of cost pressures, and delivery of contracted activity within budget Management Actions Mitigating actions to manage CIP and cost pressure risks are being planned through a series of review and challenge meetings led by the executive team. Activity planning to deliver annual contract income targets is being pursued with divisions. Paper Seen By Mary Leadbeater 23

26 Run rate 000's Income and Expenditure Account 1 month ending 30 April 2013 April Year to Date Key Messages (full details on page 3 of finance report) Figures 000's Actual Budget Var Actual Budget Var NHS Clinical Income 15,285 16,322-1,037 15,285 16,321-1,036 NHS High Cost Drugs (HCD) 1,459 1, ,459 1, Non NHS Clinical Income Research & Training Other Operating Income NHS Clinical Income Overall clinical income from contract performance was significantly below plan for April. 0.5 m relates to High cost drugs and is likely to recover when activity rises. The remainder is under assessment, being partly related to budget profiling, with the full year risk being assessed in partnership with divisions to mitigate and recover this shortfall as the year progresses Total income 18,418 19,913-1,495 18,418 19,912-1,494 Pay -12,604-12, ,605-12, Drugs Drugs HCD -1,459-1, ,459-1,459 0 Clinical Supplies -2,102-2, ,102-2, Other Non Pay -2,391-2, ,391-2, CIP Under delivery Central Held Budgets Total expenses -18,881-19, ,882-19, EBITDA , ,358 EBITDA % (2.5) 4.5 (2.5) 4.5 Loss on Disposal Depreciation PDC Dividend Interest receivable Interest payable Retained surplus/(deficit) -1, ,480-1, ,480 Less Government Grant /Donated Asset Net Income Trading Surplus/(Deficit) for 2012/13 (1,704) (228) -1,470 Run Rate against current IHT Budget (profiling to be reviewed with Divisions ) CQUIN Performance is estimated at 74% of plan pending individual scheme review Pay - Overspent by 0.4 with Nursing and HCA cost being the highest component. Divisional reports provide details Clinical Supplies & Other Non Pay 0.5m under spend relating to 1. surgical consumable s in operating budgets mainly D2-193k. This is unlikely to be maintained when activity performance improves 2 130k budget that will move to interest payable offsetting the overspend in that area Centrally Held Budgets The favourable variance of 0.4m reflects the saving against budget expenditure for High Costs Drugs CIP Under delivery This variance reflects an estimate of Divisions Unidentified CIP schemes that requires review and clarification 2,000 Plan 1,000 Actual/Forec ast 0-1,000-2,000 Apr 13 May June July Aug Sept Oct Nov Dec Jan Feb March 24

27 Income and Expenditure Account 1 month ending 30 April 2013 Figures 000's April NHS Clinical Income Overall clinical income from contract performance was significantly below plan for April. Non elective threshold costs were 51% ( 220k) above planned levels partly associated with non elective activity being above plan. Elective inpatients ( 268k) and day cases ( 123k)are also below planned levels. Further detailed work will be rolled out to review capacity planning assumptions with divisions to assess and mitigate full year contract performance issues NHS HCD & Income Central Budgets High cost drugs income is below plan by 0.5m with a matching reduction in expenditure (ie no bottom line impact) Research & Training R&D Income over recovered by 0.1m continuing the trend seen last year Other Operating Income Other operating income is line plan Pay Clinical Supplies & Other Non Pay CIP - Delivery EBITDA Pay is overspent against plan by 0.4m. D 1 was 163k of this, High nursing costs ( 49k overspend in in HCA and 49k on RN nursing ), action is underway to contain this in line with the new nursing budgets. Division 4 was 112k of the total relating to pool costs. Clinical supplies are under spent by 257k. This is predominantly in D 2 and initially appears to be related to low levels of activity and may not be maintained when income recovers. Other non pay under spends mainly relate to budget that will be moved to the financing section, the remainder, at this early stage are broadly in line with initial plan CIP delivery is estimated as being behind plan. April performance for identified schemes is on track with a small (33k) Adverse variance (see CIP page). However a number of schemes remain unidentified - with profiles to be clarified when detailed phasing of schemes is worked up. The The Trust planned for an EBITDA of 2.5 % in month, actual delivery was a negative (deficit ) of - 4.5% 25

28 Financial Ratios 1 month ending 30 April 2013 Financial Risk Rating (per SHA Compliance Framework) Unit cost ratios 's Year to date Forecast Year to date % Rating U/L % Rating U/L Actual Budget Var % EBITDA margin % -2.5% 1 5.0% 6.3% 3 9.0% Total cost per spell <1% 5.0% EBITDA achieved % Net Return After Financing % I&E surplus margin % Liquid ratio days -51.9% -13.5% -9.4% <50.0% 100.0% >100% -5.0% 0.4% 3 2.0% <-5.0% -1.0% <-2% 0.2% 2 1.0% % Medical cost per spell Nursing cost per bed day Drug cost per spell Clinical supplies cost per spell % % -0.03% % % Key Messages Risk Rating: Risk rating is 1 for April with a full year 2013/14 forecast of 3 Unit Costs: Costs per activity remain significantly higher than plan across all areas in medical staff and clinical supplies. Overall rating 1 3 Balance sheet ratios Income per activity 's Year to date Forecast Year to date Actual Budget Var Actual Budget Var Actual Budget Var % Stock days (0.5) (4.5) Day Case per spell % Debtor days (2.9) Elective per spell 2,874 2, % Creditor days (0.4) (7.9) Non-elective per spell 1,597 1, % Liquid ratio (actual) (3.8) (17.7) Outpatients per attendance % Unit Income/Case Mix: Income per spell is on plan for Elective and day case activity. Non elective and outpatient unit prices remain below plan as in previous months. 26

29 Financial Risks & Opportunities 1 month ending 30 April 2013 Figures 000's Category Area Lead Risks to the Annual Plan Full year potential impact (notional ) Risks m % Risk Adjusted Commentary 18 Week Fines MB % 0.4 Risks in Ophthalmology, Gastro T&O, Low Priority Procedures RM To be assessed Service Level Agreement Breach of C.Diff target LW 0 0% 0 To be assessed % 0.2 Based on m1 fines Ambulance handovers RM Sub Total NHS Clinical Income Expenditure Elective Activity MB % 1.8 Elective activity is not delivered as per the weekly operational plans.estimated on m1 Performance NHSS QIPP Plans NHSS QIPP Plans begin to impact and income reduces % 0.4 MB assumed budget benefit of 2.3m CQUIN LW % 0.5 Budget assumes 100% achievment. Non elective threshold % k variance in m1 Sub Total 7 4 CIP Under delivery ALL % 0.8 Failure to deliver target. Risk mitigation action underway recharges -other hospitals ML % 0.2 Assumes other providers succesful re invoice disputes Direct cost Escalation ward MB 100% TBA Outsourcing Costs MB % 0.0 No current plan to outsource above those already within budget Unbudgeted Pay Overspend continu ALL % 5.0 if overspending continpay overspending continues Sub Total Total Risks to Surplus Category Area Lead CCGS fail to remove any QIPP activity Opportunities to Year end Surplus Current Month Opps to Risk Adjusted Forecast % % 0.5 Sub Total Total Opportunities Surplus Target Worst Case 9.73 Best Case

30 NHS Clinical Income - Contract Performance 1 month ending 30 April 2013 Finance Figures 000's Actual Budget Var Actual Budget Var % Contract Standards Incurred 18 Weeks 73 NHS Suffolk CCGs 13,949 14,993-1,044 13,949 14,993-1, % New to Follow Up 0 NHS Gt Yarmouth & Waveney CCG % Low Priority Procedures 0 NHS North East Essex CCG % 73 NHS Mid Essex CCG % A&E NHS Norfolk CCGs % A&E 4 hour 95% 0 NHS England 2,417 2, ,417 2, % A&E Initial assessment 1 NCAs % A&E Single longest time 2 QR Fines % A&E Ambulance handover 28 NHS Suffolk Non-Contract % 31 Total 16,744 18,277-1,533 16,744 18,277-1, % Stroke Admitted to unit within 4 hours 1 % high TIA treated within 24 hours 0 Figures 000's Anti-coagulation 0 24 hours brain scan access 0 YTD Price/Volume Variance Analysis Actual Unit Price Plan Unit Price Unit price Var Price Variance Volume Variance Total Variance Thrombolysis <3 hours 0 Elective Day Cases Urgent brain scan <60 minutes 0 Elective Inpatients 2,874 2, Non Elective 1,597 1, Maternity 991 2,028-1, Discharge Summaries Outpatients A&E 0 Price/Volume Analysis April Year to Date Income Penalties Year to date The above table shows whether the income under performance in each POD is made up as a result of lower activity (volume variance) or casemix (price variance). Inpatients 10 Outpatients 8 18 Total Penalties/Fines 123 Example: The previous page shows that NEL activity is 6.6% above plan, however a reduction in case mix has resulted in lower average unit price of 1685 per spell which has an adverse price variance impact of 87k. k. The impact of this means that we have done more NEL activity than plan but at a lower price than planned. Year End Standards Provided for New to Follow Up Consultant to Consultant Ref Cancer Standards Total

31 NHS Clinical Income - Contract Performance 1 month ending 30 April 2013 Finance Figures 000's Actual Budget Var Actual Budget Var % Elective Day Cases DC 2,114 2, ,114 2, % Elective Inpatients EL 1,587 1, ,587 1, % Outpatients OP 3,168 3, ,168 3, % Non Elective NEL 4,829 4, ,829 4, % Non Elective Threshold THRES % Readmissions RA % Maternity MAT % OP Diagnostic Imaging OPUI % OP Care Package OPCP % Accident & Emergency A&E % Renal Renal % Direct Access DA % Critical Care CC % Excluded Drugs & Devices EXDD 1,459 1, ,459 1, % Other C&V C&V % Block BL % Fines and commissioning adjustments Fine % CQUIN CQ % QIPP Slippage QP % Total exc High Cost Drugs 15,285 16,320-1,035 15,285 16,320-1, % Total High Cost Drugs 1,459 1, ,459 1, % Total Income 16,744 18,277-1,533 16,744 18,277-1, % April Year to Date Income Analysis of Income Position Elective - Inpatients in M1 continues to underperform (14.5%) Outpatients- Finance in M1 was 4.3% higher than plan in particularly in Ophthalmology and Dermatology. Non Elective - Finance for the month was 5.3% higher than plan. Non Elective Threshold - is significantly (51.9%) higher than plan reflecting the Non elective activity performance that is above plan CQUIN - Delivery has been assumed at 74% for the YTD pending a full assessment. Contract challenges have been estimated at 230k for the Month across all contract currancies pending CCG challenge on receipt of Trust data Activity April Year to Date Actual Budget Var Actual Budget Var % Elective Day Cases 3,113 3, ,113 3, % Elective Inpatients % Outpatients 35,249 29,137 6,112 35,249 29,137 6, % Non Elective 2,544 2, ,544 2, % Maternity % Accident & Emergency 6,405 6, ,405 6, % Total 48,344 42,382 5,962 48,344 42,382 5, % 29

32 Activity - Contract Performance 1 month ending 30 April Plan (Current Year) Actuals (Current Year) Actuals (Last Year) Elective & Day Case (spells) Non-Elective (spells) 3,600 4,600 4,400 4,200 4,000 3,800 3,600 3,400 3,200 3,000 2,800 2,600 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 3,400 3,200 3,000 2,800 2,600 2,400 2,200 2,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Outpatients (attendances) A&E (attendances) 7,500 38,000 7,000 35,000 6,500 32,000 6,000 29,000 5,500 26,000 5,000 23,000 4,500 20,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 4,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 30

33 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar' 13 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Pay Expenditure 1 month ending 30 April 2013 Pay Expenditure - Actuals Total Pay ( 000's) April Year to Date 12,500 12,000 11,500 11,000 10,500 10, Forecast Actual Budget Var Actual Budget Var % Directors % Senior Managers % Mgt, Admin & Estates 1,369 1, ,369 1, % Consultants 2,300 2, ,300 2, % Other Medical 1,491 1, ,491 1, % Nursing Staff 3,971 3, ,974 3, % Pharmacists % Healthcare Scientists % Allied Health Prof % Other Qualified STT Staff % HCAS & Support Staff 1,260 1, ,259 1, % Total 12,603 12, ,605 12, % Notes Temporary Staff Usage - Rolling 12 Months Nursing and HCA costs are the largest elements of the overspend with mitigating action underway to contain these pressures Locum Add'n Sessions Bank Agency Temporary Staff ( 000's) April Year to Date Agency Bnk/Lcm Ad Sess Agency Bnk/Lcm Ad Sess Total TBA TBA Consultants Other Medical Staff Nursing ST&T Healthcare Assistants Support Staff Total ,369 31

34 Apr May June Jul Aug Sep Oct Nov Dec Jan Feb Mar 446 Apr 398 May 373 Jun 394 Jul 267 Aug Sep Oct Nov 413 Dec Jan Feb Mar Non Pay Expenditure 1 month ending 30 April 2013 Non-Pay Expenditure - Actuals Locum /14 Total Non Pay ( 000's) April Year to Date Actual Budget Var Actual Budget Var % Staff Expenses % Drugs 1,784 1, ,784 1, % Medical & Surgical Cons 1,100 1, ,100 1, % Patient Appliances % Diagnostic Costs % Medical Equipment % Healthcare Services % Hotel & Support Costs % IM&CT % Establishment Costs % Estate Costs % Clinical Negligence % Total 6,277 6, ,277 6, % Outsourcing - Rolling 12 Months Expenditure Clinical Supplies are underspent by 257k. This is predominantly in D2 and relates to low levels of activity and may not be maintained when income recovers. Other non pay underspends relate to budget that will be moved to the financing section and relate to the GAC financing costs of 195k

35 Cost Improvement Programme 1 months ending 30th April 2013 Figures 000's In April Forecast to 31st March 2014 Recurrent WTE Scheme Actual Target Var Identified Target Var Total D1 Medicine and Therapies ,788 3, , D2 Surgery ,363 3, , D3 Cancer, Women and Children ,212 2, , D4 Executive Support ,226 4, , Grand total all schemes ,589 12,826-1,237 7, Headlines: In April 341K of savings (1) were delivered against a target of 374km. The Divisions have plans for 11.5m of CIPS and a shortfall of 1.2m still to Identify, this has improved significantly from the 3,3m gap previously. Work to continue to close this GAP in the divisions is ongoing The Financial RAG rating of identified programmes in divisions is shown below Risk of Delivery Red Amber Green CIPS Total QIPP Grand Total D1 Medicine and Therapies 446 1,057 1,285 2, ,997 D2 Surgery 368 1, , ,971 D3 Cancer, Women and Children 225 1, , ,295 D4 Executive Support 441 1,788 1,997 4,226 4,226 Grand total all schemes 1,480 6,119 3,990 11, ,489 RAG KEY Green Amber Red Actions in Place &a timeline to deliver Actions in Place &clear to deliver No evidence of actions 33

36 Balance Sheet 1 month ending 30 April 2013 Figures 000's Opening Year to Date Actual Budget Var Fixed assets 151, , , Stock 3,772 3,661 3, Debtors 10,059 11,755 10, Cash 6,726 8,774 11,230-2,456 Current liabilities -19,021-24,740-25, Net Current Assets 1, ,246 DH loan Creditors > 1 yr -27,506-27,438-27, Provisions -1,312-1,353-1, Net Assets 124, , ,072-1,587 Public Dividend Capital 85,185 85,186 85,185 1 Revaluation Reserve 52,861 52,861 52,861 0 Donation Reserve Govt Grant Reserve I&E reserve -13,841-15,562-13,974-1,588 Taxpayers Equity 124, , ,072-1,587 Fixed Assets Notes See capital expenditure page for detailed commentary. Debtors See working capital page for detailed commentary on debtors. Cash A number of year end actions including prompt supplier payment have been implemented. See rolling cash flow forecast for further detail. I&E reserve The year-to-date variance relates to the deficit on the Income and Expenditure account and the transfer from the revaluation reserve

37 Capital Expenditure month ending 30th April 2013 Figures 000's April 2013 Year to Date Forecast Scheme Actual Budget Var % Actual Budget Var % Actual Budget Var % Strategic Schemes Cardiology Scheme % % % Decontamination Unit % % % Chemo Day Unit % % % Maternity Fireworks % % 1,457 1, % Maternity Refurbishment % % % Lorenzo Regional Care % % 7,000 7, % Sub Total Strategic Schemes % % 9,467 9, % Equipment % % 1,596 1, % IT Schemes % % 1,105 1, % Other Estate Schemes % % 1,500 1, % Sub Total Other Schemes % % 4,201 4, % Total Capital Programme % % 13,668 13, % Capital Expenditure by Month Actual Budget Notes Capital expenditure in April is underspent against plan by 299k overall. The Maternity project started last financial year but the detailed scheme design highlighted service continuity issues that required an extended timetable. It is now expected to complete in this financial year. The Chemo Day Unit business case was approved by the Trust Board in March The design and feasibility aspect of the project will start this year with significant amount of work to be done in the next financial year

38 Cashflow Forecast 1 month ending 30th April 2013 Actual Forecast Rolling 13 weeks Cashflow Forecast Apr-13 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Income Clinical NHS Income 14, , , , Non-Clinical NHS Income Clinical Non-NHS Income Education & Training Income Research & Development Income PDC Funding Transformation Funding Other Operating Income 3, Grand Total Income 18, , , , Expenditure Employee Benefits 8, , , ,965 6, ,965 0 Drugs Operating Expenses ,015 1,015 1,015 1, Cost of Capital Payments Repayment of Loans PDC/Grant Funded Capital Projects 1, Other Capital Projects Other Expenses 4, Grand Total Expenses 16,219 1,410 1,404 6,479 1,483 7,624 1,769 1,763 6,726 7,971 1,558 1,552 6,627 1,630 Net Inflow/Outflow 2,058-1, ,775-1,301-7, ,242-7,047-1,303-1,097 10,678-1,398 Previous month's cash balance 6,716 8,774 7,569 6,569 17,345 16,044 8,602 7,728 6,867 18,110 11,063 9,760 8,663 19,341 Closing month cash balance 8,774 7,569 6,569 17,345 16,044 8,602 7,728 6,867 18,110 11,063 9,760 8,663 19,341 17,942 36

39 Cashflow Forecast 1 month ending 30 April 2013 Actual Forecast Rolling 12 month Cashflow Forecast Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 Income Clinical NHS Income 14,515 17,155 17,155 17,155 17,155 17,155 17,155 17,155 17,155 17,155 17,155 17,155 17,155 Non-Clinical NHS Income Clinical Non-NHS Income Education & Training Income 0 0 1, , , ,976 0 Research & Development Income PDC Funding Transformation Funding Other Operating Income 3, Grand Total Income 18,278 18,229 20,690 18,479 18,676 20,840 18,685 18,685 21,051 19,075 19,075 21,051 19,075 Expenditure Employee Benefits 8,793 11,186 11,186 11,186 11,186 11,186 11,186 11,186 11,189 11,189 11,189 11,189 11,189 Drugs 840 1,000 1,200 1,000 1, , ,000 1, Operating Expenses 0 4,403 4,060 4,979 5,092 5,198 5,455 4,624 5,745 4,745 4,745 3,745 3,745 Cost of Capital Payments 0 2,083 Repayment of Loans 0 2,118 1,804 PDC/Grant Funded Capital Projects 1, Other Capital Projects 746 1, ,037 1,059 1,213 1,044 1,132 1,132 1,132 1,132 1,132 Other Expenses 4, Grand Total Expenses 16,219 18,400 18,229 19,138 19,715 23,394 20,054 18,904 19,966 19,266 19,466 19,770 17,966 Net Inflow/Outflow 2, , ,039-2,554-1, , ,281 1,109 Previous month's cash balance 6,716 8,774 8,603 11,064 10,406 9,367 6,813 5,444 5,226 6,311 6,119 5,728 7,009 Closing month cash balance 8,774 8,603 11,064 10,406 9,367 6,813 5,444 5,226 6,311 6,119 5,728 7,009 8,117 37

40 Apr-13 Working Capital 1 month ending 30 April 2013 Figures 000's Trade Debtors by Age Figures 000's <30 days days days >90 days Total Current Month (Apr 13) 3,754 (164) ,520 Last month (Mar 13) 1, ,012 Movement in Month 1, ,508 78% Figures 000's <30 days days days >90 days Total Pharmacy EoE SHA NHS Suffolk Gt. Ormond Street NCAs N&S NHS FT Other NHS 3,323 (480) ,299 7% 12% -3% <30 days days days >90 days Total NHS 3,498 (341) ,835 Other Non NHS Total Debtors 3,754 (164) , <30 days increase of 1.8m: The current month balance of 3.7m is mainly due to five outstanding invoices to a total value of 3m for one debtor and one for 177k. The balance is made up of 321k small NHS invoices and 256k Non-NHS invoices days decrease of 877k: This is due to two NHS credit notes totalling 1.2m. The other items include five NHS invoices totalling 708k. The steps are taken to recover these days increase 420K: This is mainly due to one NHS invoice to Colchester Hospital for 435k. >90 days increase of 84k: This is mainly due to outstanding invoices from NHS Suffolk totalling 109k, also see detail of Non-NHS debts below. Debts> 90 Days Key Points: NHS : The various managers are aware of the debts and steps are in place to address it. Other non-nhs: This has increased to 196k from 169k last month. This relates to 85k overseas patients and is mainly covered in one in voice for 58k which is in the process of being recovered with support from senior staff. The private patients proportion is 12k, payroll overpayments of 64k, a sum of 3 3k being repaid in instalments. There is a further 35k miscellaneous small debt made up of various transactions. Bad debt provision: The current provision for bad debts is 422k which includes all debt on spectrum system, payroll overpayments and in year RTA (Road Traffic Accidents) debts. There is a further provision of 91k for RTA debts in previous financial years. Better Payments Practice Code Rolling 13 Months Performance Volume Value Apr 13 Total Within % % All Creditors 3,402 2, % 87.6% NHS % 90.1% Target 95.0% 10 day local and small suppliers payment Volume Value Total Within % % NHS All Creditor s Cumulative to Apr % 63.3% 38

41 National and Contractual Standards 39

42 National and Contractual Standards 18 Weeks The Trust failed the Trust level admitted performance at 87.6% due problems at a speciality level within Trauma & Orthopaedics 84.8%,General Surgery 74.3% and Oral Surgery 81.8%. The Trust achieved the Non Admitted target at a Trust level 97.9% but failed at a speciality level in General Surgery 88.7%, Oral Surgery 90.4% and Gastroenterology 94.4%. The Trust is currently alerting on the National Acute Quality Dashboard due to its 18 Week admitted performance in Q4 2012/13. 40

43 Better Patient Experience - Hospital of Choice 18 Weeks Non Admitted 18 Weeks Admitted Current Year to date Quarter Month Month Target Actual Target Actual Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Penalty Trust 90% 87.6% 90% 87.6% 90% 87.6% 73,000 General Medicine 90% 100.0% 90% 100.0% 90% 100.0% Cardiology 90% 100.0% 90% 100.0% 90% 100.0% 0 Thoracic Medicine 90% 100.0% 90% 100.0% 90% 100.0% Nephrology 90% 100.0% 90% 100.0% 90% 100.0% Geriatric Medicine 90% 100.0% 90% 100.0% 90% 100.0% Surgical Specialities Combined 90% 74.3% 90% 74.3% 90% 74.3% 33,000 Urology 90% 91.1% 90% 91.1% 90% 91.1% Breast Surgery 90% 100.0% 90% 100.0% 90% 100.0% Gastroenterology 90% 94.6% 90% 94.6% 90% 94.6% ENT 90% 92.9% 90% 92.9% 90% 92.9% Oral Surgery 90% 81.8% 90% 81.8% 90% 81.8% 3,000 Plastic Surgery 90% 90.8% 90% 90.8% 90% 90.8% Ophthalmology 90% 95.0% 90% 95.0% 90% 95.0% Pain Management 90% 95.7% 90% 95.7% 90% 95.7% Trauma & Othopaedics 90% 84.8% 90% 84.8% 90% 84.8% 37,000 Rheumatology 90% 100.0% 90% 100.0% 90% 100.0% Clinical Oncology 90% 100.0% 90% 100.0% 90% 100.0% Clinical Haematology 90% 100.0% 90% 100.0% 90% 100.0% Gynaecology 90% 93.1% 90% 93.1% 90% 93.1% Gynaecology Oncology 90% 100.0% 90% 100.0% 90% 100.0% Paediatrics 90% 100.0% 90% 100.0% 90% 100.0% 41

44 Better Patient Experience - Hospital of Choice 18 Weeks Non Admitted 18 Weeks Non Admitted Year to date Quarter Current Month Month Target Actual Target Actual Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Penalty Trust 95% 97.9% 95% 97.9% 95% 97.9% 7,000 General Medicine 95% 100.0% 95% 100.0% 95% 100.0% Cardiology 95% 95.6% 95% 95.6% 95% 95.6% 0 Thoracic Medicine 95% 98.3% 95% 98.3% 95% 98.3% Neurology 95% 100.0% 95% 100.0% 95% 100.0% Geriatric Medicine 95% 100.0% 95% 100.0% 95% 100.0% General Surgery 95% 88.7% 95% 88.7% 95% 88.7% 5,000 Urology 95% 98.1% 95% 98.1% 95% 98.1% Cardiothoracic Surgery 95% 100.0% 95% 100.0% 95% 100.0% Gastroenterology 95% 94.4% 95% 94.4% 95% 94.4% 1,000 ENT 95% 100.0% 95% 100.0% 95% 100.0% Oral Surgery 95% 90.4% 95% 90.4% 95% 90.4% 1,000 Plastic Surgery 95% 100.0% 95% 100.0% 95% 100.0% Dermatology 95% 99.2% 95% 99.2% 95% 99.2% 0 Ophthalmology 95% 99.7% 95% 99.7% 95% 99.7% Trauma & Othopaedics 95% 98.3% 95% 98.3% 95% 98.3% Rheumatology 95% 100.0% 95% 100.0% 95% 100.0% Gynaecology 95% 98.6% 95% 98.6% 95% 98.6% 42

45 National and Contractual Standards - Cancer The Trust achieved all Cancer Targets in April. 43

46 Better Patient Experience - Cancer Cancer Year to date Quarter Current Month Month Target Actual Target Actual Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target YTD Penalty 2 WW Cancer Trust 93% 96.22% 93% 96.15% 93% 95.92% 0 2 WW Symptomatic Breast Trust 93% 94.00% 93% 94.00% 93% 94.00% 31 Day First Treatments Trust 96% 99.4% 96% 99.4% 96% 99.4% 0 62 Day - 2WW Trust 85% 91.4% 85% 91.4% 85% 91.4% 62 Day - Screening Trust 90% 100.0% 90% 100.0% 90% 100.0% 0 62 Day - Upgrades Trust National Avg 100.0% National Avg 100.0% National Avg 100.0% 31 Day - Subsequent Surgery 94% 100.0% 94% 100.0% 94% 100.0% 0 31 Day - Subsequent Drug Therapy 98% 100.0% 98% 100.0% 98% 100.0% 31 Day - Subsequent Radiotherapy 94% 98.6% 94% 97.2% 94% 98.9% 0 NB - Validated Cancer Performance 1 month in arrears 44

47 National Standards Emergency Care The Trust failed with 93.78% in April against the four hour target however achieved across the 95.35% year 2012/13 and continues to achieve the Left Not Seen, ED Admission Threshold and Unplanned attendance targets across the year. The Trust continues to fail the contractual timeliness targets in relation single longest wait breaches and time to initial assessment. 45

48 Better Patient Experience - Emergency Department Emergency Year to date Quarter Current Month Month Target Actual Target Actual Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Penalty ED 4 Hour Wait 95% 93.78% 95% 93.78% 95% 93.78% ED Left without seen <=5% 3.15% <=5% 3.15% <=5% 3.15% 0 ED Unplanned Reattendance <=5% 1.98% <=5% 1.98% <=5% 1.98% ED Admission Threshold <=25.75% 24.66% <=25.75% 24.66% <=25.75% 24.66% 0 ED Median Time to Treatement (mins) 60 mins mins mins Ambulance Arrivals ED Median Time to Treatment > 60 mins for No breaches 937 No breaches 937 No breaches Ambulance Arrivals ED Single Longest Wait >6 hours (Penalty 25) No Breaches 102 No Breaches 102 No Breaches 102 2,550 ED Single Longest Time to initial assessement >25 Mins (Penalty 25) No Breaches 55 No Breaches 55 No Breaches 55 1,375 Ambulance Arrivals ED Ambulance Button Submit (penalties below >=90% >=90% 85%) Ambulance Handover exceeding 60 mins No Breaches 13 No Breaches 13 No Breaches 13 13,000 (Penalty 1000)** Ambulance Handover exceeding 30 mins No Breaches 75 No Breaches 75 No Breaches 75 15,000 (Penalty 200)** ** Ambulance Service Data validated one month in arrears 46

49 Better Patient Experience - Stroke Stroke Year to date Quarter Current Month Target Actual Target Actual Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Penalty % of people treated on stroke unit > 90% of time % of people admitted to stroke unit <4 hours % of high risk TIAs treated <24 hours % of patients with AF receiving anti-coagulation % of stroke patients with access <24 hour to brain scan 80% 92.3% 80% 92.3% 80% 92.3% 0 90% 96.3% 90% 96.3% 90% 96.3% % 63.0% 60% 63.0% 60% 63.0% 0 60% 100.0% 60% 100.0% 60% 100.0% 100% 97.3% 100% 97.3% 100% 97.3% 200 % Thrombolysed <3 hrs 100% 100.0% 100% 100.0% 100% 100.0% 65% of patients with low risk TIA have access to MRI or carotid scan within 7 65% 76.9% 65% 76.9% 65% 76.9% days % of suspected stroke patients access to urgent 100% 100.0% 100% 100.0% 100% 100.0% brain scan <60 mins % of stroke patients and carers offered a joint health and social care discharge plan 100% 100.0% 100% 100.0% 100% 100.0% NB - Validated Stroke figures are available 1 month in arrears 47

50 Organisational Development 48

51 Organisational Development The Trust sickness rate in month was 3.73 % compared to a Trust 2012/13 cumulative average of 4.5%. National Trust Quality Dashboard Sickness Rate Performance Numerator: Total number of FTE days taken sick ESR Denominator: Total number of FTE days available ESR 02/ / % against England average 4.77% Distribution of Trusts for staff sickness 49