UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST. Activity Management Monitoring

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Estella Morris
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1 UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST Activity Management Monitoring Report to: Trust Board - 29 th November 2011 Report from: Sponsoring Executive: Aim of Report/ Principle Topic: Review History to date: Assurance Framework Strategic Objective Ref: Sue Leamore, Head of Corporate Strategy, Kim Perry, Assistant Director of Finance Michael Marsh, Medical Director (Activity Management Executive Lead) Progress of Activity Management Programme Monthly Report SO2 Delivering for Taxpayers Recommendation(s): To note the latest (M6) activity position Divisions to identify further cost reduction schemes to mitigate the Activity Management budget reductions Divisions to take specific actions identified within this paper To note a review is being undertaken of the Top 10 activity reductions by specialty to assess sustainability and the release of capacity 1. Strategic Context Nationally the QIPP (Quality, Innovation, Productivity & Prevention) Agenda sets the framework to deliver system reform through Activity Management and Cost Improvement Programmes. For the Trust the Cost Improvement Programme is delivered, monitored and reported separately. The Trust faces a significant challenge to support the Activity Management set by PCTs, to deliver an affordable local health system over the coming 4 years: Income Reductions 2011/ / / /15 Total '000 '000 '000 '000 '000 NHS Southampton 10,700 9,000 3,000 4,000 26,700 NHS Hampshire 9,200 3,900 3,200 3,300 19,600 Total 19,900 12,900 6,200 7,300 46, Staff, Patient & Public Involvement: South West Hampshire System Reform Board (SWHSRB) will identify need and engagement will be undertaken as appropriate. 3. SUHT Progress To Date a) Key Performance Headlines Please see appendix 1 for a Trust summary of M6 activity and income performance (NHS Southampton and NHS Hampshire only). This shows the Gross position (excluding activity 1

2 management targets) therefore a perspective of outturn to which budgets are aligned to. It also shows the Net position (including activity management) so what we are contractually committed to. Current Trends: Referrals: at M6 overall Trust referrals for NHS Southampton have increased 3.3% and NHS Hampshire 1% compared to the same period last year. : first attendances continue to be 2% above Gross Plan / 8% above Net Plan, follow-ups remain at M5 position of 7% below Gross Plan / 7% above Net Plan. This represents approximately 50% delivery of QIPP so internal schemes beginning to impact but not to the target required. Action: i) Divisions to continue reporting new schemes and actions/schemes taken to account for the current 50% delivery. Admissions: continue to reduce from M5 position from 1% reduction to 5% against Gross Plan and 5% to 2% above Net Plan at M6, so activity is reducing. This position will include 18 week backlog so once cleared should release further reductions in activity. Action: Division schemes to reduce admissions to be reported to Sue Leamore. Non-elective Admissions: remain at M5 position at M6 of 4% above Gross Plan / 10% above Net Plan. Action: PCTs to share assumptions for Q3/4 Remedial Action Plans requested. Divisions to report new schemes to improve position. Excess Bed Days (XBDs): 18% below gross plan for elective (mainly Divisions A and D) and 5% below gross plan for non elective (all except Division D). This position has improved since M5. Action: Review specialties with reductions to assess capacity impact (KP) Overall the cost reduction target currently removed from budgets for Activity Management is 1,883k. However there continues to be only a small number of schemes to reduce cost and therefore this is causing run-rate pressures within the Divisions. There are some schemes included within the CIP Programme which also have an impact on the Excess Bed Day Schemes within the Activity Management Programme. It is difficult to identify the component relating to activity and therefore these schemes remain to be included in CIPs. The activity as at month 6 is being analysed at specialty level to identify potential areas where capacity and cost can be released. This is being raised at the Executive reviews with Divisions. Action: Divisions to identify cost reductions to mitigate the Activity Management budget reductions. b) Update on SUHT Internal Scheme Progress Advice & Guidance Pilot: meeting to validate pilot data and outcomes with PCTs planned to inform benefits and next steps. NHS Southampton recruiting pilot practices to join pilot. Virtual Clinics: Patient Triggered Follow-up pilot due to commence end Oct/Nov, service specification being finalised to present to CCGs. GP Event on 19 October 2011 was well received. Clinical Variation/Follow-up Ratios: Divisions to continue reviewing for opportunities for new schemes. Benchmarking analysis against BCBV and current Trust activity suggests opportunity for improvement in Gastroenterology (adult and paediatrics), Respiratory Medicine, Diabetic Medicine this needs to be validated by Divisions and response made to Sue Leamore (analysis will be circulated). This informs a report requested by the SWH System Reform Board for December. XBDs Schemes: The PCTs have asked the Trust to provide a progress report for the SWH System Reform Board in December. The benchmarking data shows that last year we were the worst of our peer group for elective XBDs and average for non elective. However there has been some significant reductions this year which has improved our position to average for elective XBDs and this is supported by 117k (16%) delivery as at month 6. Our peer group position for non elective XBDs has remained unchanged this year but there is 304k (7%) delivery as at month 6. However the analysis by PCT shows the delivery is all within NHS Southampton and no delivery for NHS Hampshire. Action: Kim Perry working with Divisions to understand the reasons where 2

3 there are increases and to also evaluate the impact of pipeline initiatives. This work will help inform the targets being set for next year. Top 5 Division Schemes: work is progressing with palliative care schemes, patient triggered follow-ups and Heart Failure proposal. SWH are in the process of recruiting GP PAs to work in ED as part of the Integrated ED Model (first step). A meet and greet session has been arranged with DCDs and CCG Leads to develop relationships and understanding of key service and clinical issues. c) Update on External Schemes PCT Current Status of the Activity Management Plans GP Referrals (only): At M6 NHS Southampton continues to increase 4.5% compared to last year whilst NHS Hampshire has continued to reduce to 0.5% against the same period last year. NEL Admissions: Division B are developing a Frail & Elderly (Dementia) Scheme following this being a hotspot area from the Interqual Audit, as well as Falls Scheme. Action: Unscheduled Care Board leading with stakeholders. A&E Attendances: A proposal for Joint System Co-ordinators has been approved at the November Unscheduled Care Board to use dedicated time to improve patient flows and discharge. Resource time from each key stakeholder including UHS has been committed. GPs in ED: 3 GPs have volunteered for advert to i) do an ED audit ii) work in ED during some of the pressure point time *Job Plans tbc OPOST Expansion (NHSSC) has been implemented with 2 additional posts that will focus on majors with aim to turn patients almost at the door and/or process sooner than currently. COAST (Paeds): PCT reporting this is now working well with referrals increasing from UHS Single Point of Access (111): Tender process has been initiated with scoping event 8 November PCTs consider this a priority scheme to deliver non-elective admission and A&E attendance avoidance by sign-posting and triaging patients through appropriate system capacity. Virtual Ward Expansion for elderly care: Solent increased capacity utilisation from 40 to 70 beds as at 4 November 2011 against a plan of 100. PCTs now receive daily reports, Solent are auditing which patients are avoiding admissions as well as % of case managed patients (what and why) to further improve efficiency and inform future plans. High Cost Drug Schemes: Biologics baseline being established and savings reviewed for January implementation date. Some non tariff drug schemes already in place and delivering with 146k (UHSFT share 102k) savings as at month 6, awaiting sign off from the PCTs. Further potential schemes being evaluated. No further progress to report at this time on Avastin. The Trust is linking with the SHA and Oxford Radcliffe to share schemes and explore further opportunities. Action Divisions to identify further non tariff drugs savings to maximise the savings opportunities for the local health economy with UHSFT benefitting from a 70% share of the savings in year 1, 50% year 2 and 35% in year RAG Status and Forecast Outturn The latest RAG rating has remained unchanged from last month: 54% of schemes are rated as RED and 44% as AMBER as per appendix 3. The latest forecast as per the PCTs Remedial Action Plan (RAP) is 7.7m against their original plan of 19.9m. This represents 39% of the programme. However the PCTs have indicated that the exit run-rate for the QIPP Programme is forecast to only have a shortfall of 2m. 3

4 The forecast delivery of 7.8m as above, leads to 12.2m over performance on the contract (assuming all other activity being as per contract). At marginal rates this equates to approx. 8.4m payable which compares to 9m assumed in the PCT s forecast for contract over performance as at M6. It is difficult for us to evaluate the forecast as the programme is 80% of PCT led schemes. We have requested the detail underpinning their Remedial Action Plan i.e. activity assumptions, key performance indicators and trajectories. The current Trust forecast is shown in the table below and compared with the PCT forecast included in their Remedial Action Plan. k NHS SC NHS H TOTAL M6 Run Rate Delivery 1, ,703 M6 FoT 3, ,406 Q3/4 Additional Delivery of QIPP 1,000 1,000 2,000 UHS Forecast M12 OT QIPP Delivery 4,090 1,316 5,406 PCT RAP Forecasts: 3,726 4,070 7,796 Difference: 364-2,754-2, Next Steps to Improve Confidence of Delivery A RAP has been produced by both PCTs and the Trust (18 weeks) to provide clear plans and trajectories for the remainder of this financial year, these have been presented to the SHA and delivery is being monitored. The Trust has been given assurance by both PCTs that Winter Planning has been factored into their RAP and delivery of schemes as per their latest forecasts, Trust 18 week delivery is dependant upon both of these. We have asked to meet with the PCTs urgently to ensure we understand the detail including key performance indicators and trajectories for each of the schemes included with the PCTs RAP. 6. Conclusion The Trust is making progress in some areas (follow-ups, excess bed days), but is not achieving the activity management plan in a number of others and in some cases activity is above last years levels. Whilst the risk has been mitigated this year, for commissioners and providers alike, through the marginal rates, this puts a significant cost pressure into the health economy. Division Top 5 Schemes have been shared with SWH Executive Team and they have given an initial response, the Trust will feedback on this and agree next steps. The SWH Reform System acknowledges pace is not where it is needed to deliver the full Activity Management Programme for 2011/12 and faster delivery is required. 4

5 APPENDIX 1 ACTIVITY & INCOME PERFORMANCE ACTIVITY M6 Row Labels Firsts Follow-ups Procedures Inpatient Spells Inpatient Spells Non-elective Excess Bed Days Excess Bed Days Non-elective Total ActivityPlanGross Total Activity Management Total ActivityPlanNet Total ActivityActual Total activity gross Variance Total activity net variance Total Variance % Net Plan 8% 7% 2% 2% 10% 73% 6% Total Variance % gross plan 2% -7% -2% -5% 4% -18% -5% INCOME M6 Row Labels Firsts Followups Procedures Inpatient Spells Inpatient Spells Nonelective Excess Bed Days Excess Bed Days Nonelective Total ActivityPlanGross 9,326,484 10,728,569 3,832,727 35,822,042 51,976, ,242 4,196,922 Total Activity Management 505,499 1,458, ,391 2,294,224 2,281, , ,732 Total Plan total net 8,820,985 9,270,559 3,669,335 33,527,818 49,694, ,914 3,752,190 Total Activity Total 9,419,312 10,185,282 3,701,342 35,787,502 55,260, ,062 3,892,931 Total Actity Variance Gross 92, , ,384-34,539 3,283, , ,991 Total Activity Variance Net 598, ,723 32,007 2,259,685 5,565, , ,741 Total Variance % Net Plan 7% 10% 1% 7% 11% 76% 4% Total variance % gross plan 1% -5% -3% 0% 6% -16% -7% 5

6 APPENDIX /12 SUMMARY RAG RATING BY PCT RED AMBER GREEN Total '000 '000 '000 '000 % NHS Southampton PCT Led 5,483 3, ,479 89% SUHT Led 0 1, ,221 11% Total 5,483 5, ,700 NHS Hampshire PCT Led 4,297 1, ,355 69% SUHT Led 1,064 1, ,845 31% Total 5,361 3, ,200 Total PCT Led 9,780 5, ,834 80% Total SUHT Led 1,064 2, ,066 20% Total 10,844 8, ,900 54% 44% 1% 100% Total as per Oct ,844 8, ,900 54% 44% 1% 100% Total as per Sept ,582 8, ,900 58% 41% 1% 100% Total as per Aug ,022 8, % 43% 1% 100% 6

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Finance and QIPP (Quality, Innovation, Productivity & Prevention) Plan 2015/16 John Ingham, Chief Financial Officer

Agenda Item: 11.2 Subject: Presented by: Finance and QIPP (Quality, Innovation, Productivity & Prevention) Plan 2015/16 John Ingham, Chief Financial Officer Submitted to: NHS West Norfolk CCG Governing