Performance report Page · June 2018 Page 2 Introduction This month’s performance report provides separate detail of the June performance for both Colchester Hospital University

Performance report

Month 3 (June)

Consolidated report for Colchester Hospital University NHS Foundation Trust and the Ipswich Hospital NHS Trust Board of Directors 2nd August 2018

Introduction 2 - 3

Single Oversight Framework 4 - 5

Accountability Framework 6 - 7

Spotlight Reports 8 - 17

Performance Report 18 - 31

Finance and use of resources 32 - 35

Well-led 36 - 43

Page

June 2018

Page 2

Introduction

This month’s performance report provides separate detail of the June performance for both Colchester Hospital University NHS Trust (Colchester) and the Ipswich Hospital NHS Trust (Ipswich) but in a single consolidated report. This was their final month as individual statutory bodies; before their merger and the formation of East Suffolk and North Essex NHS Foundation Trust (ESNEFT) from 1st July 2018. The report includes two overarching sections related to each Trust’s performance:

❶NHSI Single Oversight Framework

NHS Improvement (NHSI) implemented the Single Oversight Framework (SOF) in October 2016. The framework has 35 metrics across the domains of:

1. Quality: Safe, Effective and Caring

2. Operational performance

3. Organisational health

4. Finance and use of resources

NHSI uses a series of “triggers” to identify potential concerns and inform provider segmentation. There are four segments ranging from maximum provider autonomy (segment 1) to

special measures (segment 4).

The NHSI single oversight framework includes five constitutional standards:

1. A&E

2. RTT 18-weeks

3. All cancer 62 day waits

4. 62 day waits from screening service referral

5. Diagnostic six week waits

In November 2017 a small number of changes were made to the information and metrics NHSI use to assess providers’ performance under each theme, and the indicators that trigger

consideration of a potential support need. The updated metrics are to be reviewed and will be incorporated in the performance report at the earliest opportunity.

This report shows the June performance for each of the SOF metrics for each Trust (where available). No trend information is provided, but this will be reinstated in future

reports for ESNEFT as single reporting develops.

❷Performance against the Accountability Framework

The Accountability Framework (AF) is the mechanism implemented in both Trusts to hold to account both Clinical and Corporate Divisions for their performance. The AF has been

developed to be the primary performance management regime for each Trust to cover all aspects of Division’s business plans. As a result, its purpose is to ensure each Trust delivers

its promises to patients and stakeholders.

Work is being progressed to ensure that these arrangements and benefits exist for ESNEFT as well, and to move from two AFs to a single overarching framework for the new

organisation. Because of this transitional period, it is not possible to report the June AF for CHUFT and IHT as separate Trusts. Instead more detail is provided on how the AF is being

developed.

June 2018

Page 3

Introduction

Performance against the Trust’s Clinical Strategy

The performance report also needs to reflect the key elements of the organisational clinical strategy.

The post transaction integration plan (PTIP) for ESNEFT sets a delivery date for the development and finalisation of its strategy by January 2019.

Development of the Trust strategy is a formative process for the new organisation; and will contribute to the creation of the culture of ESNEFT. Extensive engagement of staff in the

Trust and external stakeholders is needed. Framing the strategy is required to give a clear focus to this engagement.

A facilitated event is being run at the end of August where the board will be asked and to frame the strategy. As the details of the strategy begin to emerge then this will need to be

reflected in the focus of the performance report.

The Performance Report also includes spotlight reports to provide more detail on performance and recovery actions being implemented

June 2018

Page 4

Single Oversight Framework NHS Improvement

Indicator Domain FrequencyTarget /

Standard

CHUFT

Jun-18

IHT

Jun-18Comments

Number of written complaints Well -led Q 0 52 63 Clinical divisions; Low, medium, high

Staff Friends and Family Test % recommended - care Caring Q 30% 49.6% 42.9% Monthly FFT test reported

Occurrence of any Never Event Safe M 0 0 1

IHT: Wrong implant. Intrauterine device

different from that identified in the procedure

plan.

Mixed sex accommodation breaches Caring M 0 0 0

Inpatient scores from Friends and Family Test − % positive Caring M 90% 97.3% 97.1%

A&E scores from Friends and Family Test − % positive Caring M 90% 89.1% 82.4%

Number of emergency c-sections Safe M tbc 46 43

Maternity scores from Friends and Family Test − % positive :

- % Recommending - birth Caring M 90% 99.0% 99.2%

- % Recommending - postnatal Caring M 90% 97.0% 98.8%

VTE Risk Assessment Safe M 95% 96.1% 47.0%IHT: audit and process issues in collecting

information compromise monthly score.

Incidences of Clostridium Difficile infection Safe M 2 3 5

Both Trusts awaiting panel review for

determination of lapses in care. Target is per

Trust.

MRSA bacteraemias Safe M 0 0 0

HSMR (DFI Published - By Month Data Available) Effective Q 100 108.5 107.7

HSMR Weekend (By Month Data Available) Effective Q 100

Summary Hospital Mortality Indicator Effective Q 100 109.2 104.4

Emergency re-admissions within 30 days following an elective or emergency spell at

the provider Effective M tbc 6.7% 8.7%


Standard

CHUFT

Jun-18

IHT

Jun-18Comments

A&E maximum waiting time of 4 hours from arrival to admission/transfer/discharge Respons ive M 95.0% 97.8% 90.5%

Maximum time of 18 weeks from point of referral to treatment (RTT) in aggregate −

patients on an incomplete pathway Respons ive M 92.0% 85.0% 92.8%

All cancers – maximum 62-day wait for first treatment from:

- urgent GP referral for suspected cancer Respons ive M 85.0% 82.7% 77.6%

- NHS cancer screening service referral Respons ive M 90.0% 85.7% 94.1%

Maximum 6-week wait for diagnostic procedures Respons ive M 1.0% 0.9% 1.7%

Not available

Quality : Safe, Effective & Caring

Operational Performance

AE waiting time performance based on

economy (previously reported Trust only until

Jan 18 report).

June 2018

Page 5

Single Oversight Framework NHS Improvement


Standard

CHUFT

Jun-18

IHT

Jun-18Comments

Staff sickness Well -led M 3.5% 3.4% 3.5%

Staff turnover Well -led M tbc 10.9% 8.3% Rolling 12 mths voluntary turnover

Executive team turnover Well -led M tbc 1 0

NHS Staff Survey - recommend as place to work** Well -led Q tbc 3.64Not

available

**Annual results across 3 years - most recent

2016

Proportion of temporary staff Well -led Q tbc 9.7% 5.3%Agency staff costs as a proportion of total

staff costs.

Aggressive cost reduction plans : Favourable/(adverse) variance to YTD CIP plan £k Well -led M 0 (931) (194)

Both Trusts reporting a YTD shortfall on CIP,

but CHUFT reporting FY delivery, IHT stil l

trying to close gap.


Standard

CHUFT

Jun-18

IHT

Jun-18Comments

CAPITAL SERVICE COVER : Does income cover financing obligations? Finance M 4 4 4

LIQUIDITY : Days of operating costs held in cash (or equivalent) Finance M 4 2 4

I&E MARGIN : Degree to which Trust is operating at a surplus/deficit Finance M 4 4 4

I&E MARGIN : Variance from Plan Finance M 1 1 2

Agency Spend : Remain within agency ceiling Finance M 1 1 3

Overall: Use of Resources Rating Finance M 3 3 3


Standard

CHUFT

Jun-18

IHT

Jun-18Comments

Segmentation Overal l 3 2

CHUFT has now been removed from special

measures and is now categorised as segment

3: mandated support.

Overall : Segment Score

Quality : Organisational Health

Finance and Use of Resources

Trigger:

Poor levels of overall financial performance

(score 3 or 4); very poor performance (score 4)

in any individual metric. Potential value for

money concerns for both Trusts. Improved

liquidity for CHUFT following receipt of STF

monies.

June 2018 ② Summary Performance - Accountability Framework

The Accountability Framework is the mechanism which both Trusts have developed to hold to account both Clinical and Corporate Divisions for their performance. To align to, and support, the new organisational structure of ESNEFT, the Accountability Framework (AF) is currently in ‘transition’ and being reconfigured. Transitioning to a single framework is challenging.

Page 6

Background

To align to, and support, the new organisational structure of ESNEFT, the Accountability Framework (AF) is currently in ‘transition’ and being reconfigured. This means that performance for June for Colchester and Ipswich hospitals is not available in a form that would allow comparison with previous reporting. The AF has been established as the primary performance management regime for both Trusts for some time now. It is the mechanism used to hold both Clinical and Corporate Divisions to account for their performance, and for ensuring that Trust resources are converted into the best possible outcomes, for both the quality of services and treatment, as well as the value for money of the work performed. The AF therefore encapsulates the Trust’s vision and more detailed objectives, resourcing, delivery, monitoring performance, course correction and evaluation.

Developing the AF for ESNEFT

Given the success and importance of the AF there is a commitment to continue to develop the AF for ESNEFT so that these benefits continue and enhanced. Transitioning to a single framework is not without its challenges, some of which are significant: - Whilst the principles are the same and the performance management actions are aligned, AF metrics at each hospital do vary due to the

operational nuances of the former organisations. - The reputation and trust in the use of this tool (both internally and externally) would be tarnished if the transition did not carefully manage

the understanding and expectation of the users. - The AF is complex, and collecting the supporting information is a massive undertaking. The AF pulls together a wide range of measures

including NHS Constitution, regional and local indicators. Every indicator has a data owner and whilst a significant proportion of indicators are pulled using technology (c60%), there remain a significant number of manually reported indicators, including from operational teams across the two sites.

- The platform for facilitating the reporting of this information is being developed using the existing infrastructure with a view to moving this

to cloud technology in the future. This approach is essential to allow the volume of data and flexibility of reporting to support ESNEFT across the vast geography of users (which includes the Trust’s commissioners)

- The new organisation will be performance managing according to service level and not site specific, with the exception of the ward heat

maps. For the reporting to have integrity, measures need to be reflective of the whole service and not parts of the service and recorded and reported consistently, to avoid misrepresentation of true performance.

June 2018 ② Summary Performance - Accountability Framework

AF indicators and scoring methodology are being reviewed and will be updated in time. The ambition is to have a fully functioning core AF indicator by October 2018 which will be shared with external partners. The comprehensively updated AF (new scores and indicators) should be ready for the new financial year.

Page 7

Developments to the AF

Being able to report true performance is absolutely paramount; and this has meant that it has been necessary to review every indicator previously reported at Ipswich and Colchester to ensure that they are perfectly aligned. If any inconsistencies have been identified for a metric, then this metric will not be reported for ESNEFT until these can be resolved. Therefore, relative to what might have been reported previously, the first few months of AF reporting for ESNEFT will only include indicators that are consistent. At the same time, to make the AF even better, the opportunity has been taken to review indicators in conjunction with operational and clinical staff to determine what should or should not be included, appropriate targets and the relative indicator importance. Similarly, the AF’s scoring methodology is being assessed with a view to aligning to the CQC approach (the use of resources domain simply being assessed as ‘another’ domain rather than an overarching domain along with quality).

The transitional period A great deal of work is being progressed to make the AF as accurate and useful as it possibly can be for the new organisation. However, while this is ongoing it does mean that the AF domain scores in particular will be in transition: not all present indicators will be included as alignment issues are tackled; existing indicators may soon be revised or new indicators added following the workshops, and the scoring approach is likely to change too. A lot of very powerful and informative performance information will still be available during the transition phase in the AF, and this will be used and discussed in the monthly Divisional accountability meetings, but domain scores and segmentation will be transitional. The ambition is to have a fully functioning core indicator AF by October 2018 which will be shared with external partners, with the full updated version ready for the new financial year.

June 2018

Commentary Risks & Mitigating Actions

Falls There were 91 inpatient falls reported in June which is an increase on May (66). The cumulative number of falls for this financial year stands at 225.The Trust does however continue to demonstrate a reduction in falls every month in comparison to 2017-18 (currently -7% overall) and the focus needs to remain on trends. There were 2 falls with serious harm at the point of falling. Pressure Ulcers There were 7 grade 2–4 hospital acquired pressure ulcers reported in June 2018. There were an additional 5 Deep Tissue Injuries of which 2 resolved and x 3 are under review. The Trust reported 0.40 pressure ulcers per 1,000 bed days. Improvement work continues with the support of the NHSI collaborative. In Hospital Cardiac Arrests There have been 3 arrests in the last 12 months where there was a failure to escalate the deteriorating patient. Other arrests were in the categories ‘sudden and unforeseen’ events (54) or where there should have been a DNACPR order (25). (2 are awaiting review). All cardiac arrests are reviewed for ensuring learning is captured and actioned

ESNEFT are now part of the NHS Improvement Falls Prevention Collaborative which commenced in June. The initial focus will predominantly be in two ward areas on the Colchester site and will roll out on the Ipswich site in the near future. The newly formed Harm Free Care Team following the Trust merger will be working collaboratively across the two sites to identify those areas requiring support and to implement best practice to reduce falls. Clinical demand in June has been higher than expected with a rise in complex wound referrals and assessment for Topical Negative Pressure therapy on wards which currently has to be managed by the TVNs owing to training issues. The TNP company representative is currently rolling out a programme of training across the Trust. NHSI has issued new recommendations on definition & measurement of PUs throughout England to ensure consistency. Amendments will be required to Datix categories/coding and wording of PU reporting frameworks i.e. removal of avoidable/unavoidable as an outcome. The timeframe for categorization of “hospital acquired” will also change from 72 hours after admission to after admission. This will result in higher numbers reported by the Trust. The TV action plan for 2018/2019 is in development with colleagues in Ipswich and the new Harm Free Care Team structure.

Spotlight Report

Page 8

Patient Safety – Falls and Pressure Ulcers (Colchester)

5.54

0

1

2

3

4

5

6

7

8

9

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Fe

b

Ma

r

Falls Per 1000 Bed Days

2016/2017 2017/2018 2018/2019 Local Benchmark

The falls per 1000 bed days figure April to June was 5, against a ceiling of 5.

0

2

4

6

8

10

12

14

16

18

Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18

Hospital Acquired Pressure Ulcers Grades 2-4 - Trend

All Grade 2 Grade 3 Grade 4 Linear (All)

3

0

5

10

15

20

25

Avoidable Cardiac Arrests - Failure to Escalate Rolling 12 mths

June 2018 June 2018 June 2018


Falls June performance saw a decrease in the number of actual falls from 132 to 124. Repeat Falls – IHT There were 16 patients in total who fell more than once in June, representing 46 falls (1 patient with 5 falls on Stradbroke and 1 with 6 falls on Haughley). 1 x Severe Harm Fall – 2nd fall for patient on Claydon Ward. Repeat Falls – Community There were 2 patients in total who fell more than once in June representing 4 falls (all at Felixstowe).

Pressure Ulcers May 2018 Verified PU Data: 15 reported developed pressure ulcers for May. 11 considered avoidable and 4 unavoidable. (3 of these were incomplete investigations). Themes are recurring issues of staff not documenting when equipment is ordered, delivered and put into place. Also not following escalation chart if there are compliance issues. Staff not following policy with assessing on change of ward and under scoring of risk with Waterlow. Future reports will only show total numbers of hospital acquired pressure ulcers rather than classification by avoidable only.

Falls per 1000 bed days are high and going forward the QI methodology to achieve improvement at the Colchester site will be adopted. ESNEFT are now part of the NHS Improvement Falls Prevention Collaborative which commenced in June. This will support shared learning. The newly formed Harm Free Care Team following the Trust merger will be working collaboratively across the two sites to identify those areas requiring support and to implement best practice to reduce falls.

1) Documentation will now be reviewed post merger to consider best documentation process and ease of use for staff. 2) Current risk assessment (Waterlow) to be considered for removal in favour of newly developed evidenced based less subjective risk assessment (Purpose-T) 3) Review of current yearly updates and removal of mandatory PU training. To consider Harm Free Training within Induction and mandatory with face to face and/or e-learning rather than handbook.

Spotlight Report

Page 9

Patient Safety – Falls and Pressure Ulcers (Ipswich)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Total Falls 2018/19 per 1000bed days

7.21 6.89 6.79

Total Falls 2017/18 per 1000bed days

5.17 4.88 5.82 4.81 6.84 5.97 6.73 6.08 6.01 6.92 7.02 8.01

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

Falls

pe

r 1

00

0 B

ed

Day

s Total Ward based Falls per 1000 Bed Days 2018/19

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Trust 2018/19 7 7 11

Trust 2017/18 7 7 10 11 1 8 11 7 7 19 7 11

02468

101214161820

Nu

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of

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pre

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Avoidable Pressure Ulcers 2018/19

June 2018 Spotlight Report

Page 10


The Divisions are expected to maintain 100% compliance with Duty of Candour as a statutory requirement. Compliance for Duty of Candour (pre investigation) increased slightly to 84.61% (83.3%) during June. The Trust also monitors post Duty of Candour compliance following the conclusion of the SI investigation. Compliance was maintained at 100.0% in June. . 8 (10 in the previous month) incidents were considered to meet the criteria of being a serious incident. This equates to 1.17% of all incidents reportable to the NRLS in the month. There were: - 1 incident reported as Slips/Trips/Falls meeting SI Criteria -4 Diagnostic Incidents meeting SI Criteria, -1Maternity/obstetric incident meeting Si Criteria -1 Sub-optimal care of deteriorating patient meeting SI Criteria Overdue incidents have decreased from last month 580 (613). The Divisions have been asked to continue to focus on reducing the amount of overdue incidents. There are currently 62 (68) overdue action plans for serious incidents still waiting for evidence. Serious Incidents will not be fully closed until evidence for each action has been received. The number of outstanding LEAPS has reduced greatly in past months due to an increased focus from the Divisions

There are now 213 staff members in the Trust who have completed a full day’s RCA training. Divisions are informed of those who have undertaken the training. Divisions must nominate an RCA trained staff member to complete SI investigations. Face to Face training on Duty of Candour supports the E-Learning package in place. 90.53% (89.12%) of staff have completed the Incident Reporting & Risk Assessment E-learning package. The Trust target of compliance is 95%. Serious Incident compliance and overdue actions are monitored through SI Panel and the Accountability Framework. The Divisions are being supported to return to 100% compliance with 60 day reports. There was an increased focus in closing overdue action plans during June prior to the merger.

Patient Safety – Duty of Candour, Serious Incidents and Never Events (Colchester)

Target Standard YTD Apr-18 May-18 Jun-18

100% 89% 100% 83% 85%

0 21 3 10 8

0 0 0 0 0

Duty of candour

Serious Incidents

Never Events

0

5

10

15

20Serious Incidents

Standard (= zero) Actual

0%

50%

100%

150%Duty of candour

Standard Actual

0

1

2

3

4Never Events

Actual Standard (= zero)

June 2018 June 2018 June 2018 Spotlight Report

Page 11


Never events There was one never event reported in June. This involved the wrong implant being given to a patient. The patient waiting list theatre schedule was correctly completed, but the individual patient sheet, was incorrectly completed during the pre-assessment appointment. WHO checklist was completed correctly.

Serious incidents At the end of the reporting period (30 June 2018) the Trust had 75 serious incident cases open – (45 Trust, 30 Community). Of these 75 open cases, 41 were pressure ulcers (12 Trust, 29 Community) which are under investigation or for final review by the Clinical Commissioning Group (CCG). Within the June reporting period 20 cases were reported to StEIS (12 pressure ulcers) and 24 cases were closed by the CCG.

Duty of candour 100% compliance was not achieved in June. 20 incidents reported on to StEIS in June 2018 (12 IHT and 8 Community) There is a record of DoC verbal on Datix for 13 incidents and records of stage 1 DoC letters which were sent within 10 days. 24 investigations closed in June 2018, 23 had completed second stage letter within 10 days.

The incorrect implant was removed and the correct implant fitted. The patient was visited by the Consultant post-op ; Duty of Candour was fully explained and apologies again offered. There is no harm to the patient. Serious incidents investigated; and summarised in a detailed report produced by governance team. This enables the early identification of any themes of poor standards of care to be made that would benefit from a wider review in the context of proactive clinical risk management when considered in triangulation and against previous reporting periods The National SI reporting framework does not required all pressure ulcers to be reported as an SI, only cases where there is new learning or exceptions e.g. cluster should be reported as an SI. This has been discussed and agreed with the CCG and commenced in July. All PUs will continue to have completion of an RCA.

Trends in % compliance will be reported in future

Patient Safety – Duty of Candour, Serious Incidents and Never Events (Ipswich)

0

2

4

6

8

10

12

14

SIRIs reported by category – 13 month reporting history

Sub Optimal care

Screening Issues

#REF!

Potential for serious harm

Potential for media interest

Surgical /Invasive procedure

Obstetrics issue or Paediatric Death

Never Events

Medication

Infection Control

Delay in Diagnosis/treatment

Data Protection

Alleged abuse

Adult Death (due to incident or unexpected)


Page 12


52 complaints were received in June, this is slightly lower when compared with 63 in May and slightly lower than the average number of complaints received over the past 7 months. There were no high level complaints received in June The statutory three working day log and acknowledgement target of 100% was met this month. Responding to the complainant within the agreed timeframe decreased to 95% in June, compared with 96% in May and 97% in April. The poorer response rate is due to 3 complaints being overdue when closed in June, the Specialties in question were: -Site Operations and Discharge -COTE -Trauma and Orthopaedics 24 Hour courtesy calls 81% of courtesy calls were made in June. The 10 calls that were not made relate to:- Emergency Medicine x 3 Trauma & Orthopaedics x 2 COTE x 1 Specialist Medicine x 4

Staff attitude has typically been the most commonly raised subject of complaint, but for the second month running poor explanation or clinical communications and concerns relating to treatment plans, was the most commonly cited issued in June. Indeed, it is encouraging to see complaints related to the attitude of staff decreased by 27% when compared with April 2018. The implementation group continues to manage the establishment of new patient feedback (including FFT) solution awarded to Healthcare Comms. Patient experience collaborative work - IHT and CHUFT teams continue to focus on noise at night and medicines information based on the baseline and Jan/Feb data. The team will present to PSEG on progress so far: date TBC

FFT scores for June 18 (Colchester) and national ranking (May 18) were:

Patient Experience (Colchester)

Returns compliance not available owing to change of processing methodology using external agency.


90% 97.3% 97.3% 96.8% 97.3%

90.0% 89.1% 88.6% 89.4% 89.1%

90.0% 97.6% 96.7% 100.0% 97.6%

TBC 174 59 63 52

95% 97.0% 97.0% 96.0% 95.0%

FFT - Recommending- Inpatients

FFT - Recommending - A&E

FFT - Recommending - Maternity

Complaints & whistleblowing - Number

of wri tten complaints

Complaints - Respons iveness

June 2018 June 2018 June 2018 Spotlight Report

Page 13


63 complaints were raised in June, this compares with 56 in May, 51 in April, 53 in March, 64 in February and 59 in January. There were 6 complaints deemed to be high level in June. 47 complaints were graded as medium level and 10 were graded low. There were no community services related complaints were raised in June. The top subjects of complaints in June were:- Treatment - 24% (14% in May), Attitude – 16% ( 14% in May), Care – 16% (30% in May) Poor Communication – 13% (21% in May) 24 hour courtesy calls: 97% of Courtesy Calls were made or attempted in June. The two failures relate to: Neurology Paediatrics

Examples of lessons learned and/or actions taken from complaints closed in June: Due to a new version of Datix being launched this will be completed and updated in due course.

Patient Experience (Ipswich)

Returns compliance not available owing to change of processing methodology using external agency.


90% 97.1% 97.9% 96.9% 97.1%

90.0% 82.4% 80.2% 83.0% 82.4%

TBC 170 51 56 63

FFT - Recommending- Inpatients

FFT - Recommending - A&E

Complaints & whistleblowing - Number

of wri tten complaints

Maternity FFT commentary Maternity Antenatal responder score 33.3% - down from 44.1% with a recommender score of 95.9% compared to national average of 95.0% for May. Maternity Birth responder score 43.8% - down from 57.9%. National responder score for May is 22.0%. Recommender score of 99.2% up from 96.1% last month. National recommender score is 96.8% for May. Maternity Postnatal Community responder score 32.3% – up from 29.9% (no national comparison available) with a recommender score of 98.8% - which is down slightly from last month’s score of 98.9%. National recommender score for May is 97.9%. Maternity Postnatal Ward responder score 48.4% - down from 56.3% (no national comparison available) with a recommender score of 97.1% - up from 96.0%. National recommender score for May is 95.1%.



Dr Foster Summary

The Trusts are 2 of 6 out of 16 local trusts listed as

statistical outliers. SHMI – 12 months to September 2017 IHT – 104.4 (‘as expected’) 89/134 CHUFT - 109.2 (‘as expected’) 116/134). CHUFT Mortality Mortality rates returned to normal in June with 133 in-hospital deaths (average for the last 5 years 132). Actions requested by Medical Director Additional perinatal mortality reviews following

recent press reports. Review of controlled drug prescribing in light of

National Gosport report. Analysis of mortality rates by age compared to

national

CUSUM Alerts Approximately 1,300 CHUFT records (17%) missed the first coding deadline owing to staffing shortages. HSMR should come down when records are included. The CUSUM data cannot therefore be relied upon owing to missing and partial coding. CHUFT Patient Safety Indicators Dr Foster confirms that there are zero mortality outliers, including ‘deaths in low risk groups’. The relative risk in this category will invariably be higher than 100 for the majority of trusts because deaths are not expected. Concern is only raised when the lower confidence interval goes above 100. Business Informatics is looking into this indicator on the Accountability Framework so that it only flags when the result is statistically significant. The death rates in age bands 65-74 and 85+ are statistically significant and require further investigation.

Mortality – Colchester and Ipswich

0

1

2

3

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7

8

9

10

0-17 18-29 30-49 50-64 65-74 75-84 85+

Cru

de

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Ra

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Death Rates by Age Group - All DiagnosesApr 17 to Mar 18

CHUFT

National Acute Non-Spec

IHT

70

80

90

100

110

120

130

140

Ma

r-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep-

15

Oct

-15

No

v-1

5

De

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Jan

-16

Feb-

16

Ma

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Apr

-16

Ma

y-1

6

Jun-

16

Jul-

16

Aug

-16

Sep

-16

Oct

-16

No

v-1

6

De

c-16

Jan

-17

Feb

-17

Ma

r-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep-

17

Oct

-17

Nov

-17

De

c-17

Jan

-18

Feb

-18

Ma

r-18

IHT HSMR - In-month & Rolling 12 Months

12 month HSMR

Benchmark

In-month HSMR

70

80

90

100

110

120

130

140

Ma

r-15

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-15

Jan

-16

Feb

-16

Ma

r-16

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

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6

Sep

-16

Oct

-16

No

v-1

6

De

c-16

Jan

-17

Feb

-17

Ma

r-17

Ap

r-1

7

Ma

y-1

7

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

De

c-17

Jan

-18

Feb

-18

Ma

r-18

CHUFT HSMR - In-month & Rolling 12 Months

12 month HSMR

Benchmark

In-month HSMR

1

1.5

2

2.5

3

All Diagnosis Groups - Crude Mortality Rates

CHUFT

IHT

All Acute Non-spec

Dr Foster metrics as at

March 2018 discharges

In-month HSMR 134.2 102.1 115.6 104.5

12 month HSMR 109.9 107.4 108.5 107.7

Death rate HSMR (nat.

3.8%)4.2% 3.4% 4.2% 3.5%

Lower confidence limit

(HSMR)104.4 101.5 103.2 101.8

Statistical outlier for

HSMR?Y Y Y Y

All diagnosis groups 12

months110.3 105.8 110.0 107.1

Lower confidence limit

(all)105.2 107.1 105.0 101.6

IHTCHUFT

Refreshed

CHUFT IHT

Original

Page 14


Mortality – Learning from deaths (example of dashboard to load to Trust website)

Page 15

June 2018

Mortality – Learning from Deaths – Numerical Data and Breakdown by Division (Colchester)

ID Metric Dec Jan Feb Mar Apr May Jun

S60 Still birth rate 0.0% 0.9% 0.4% 0.0% 0.7% 0.3% 0%

S61 No. Stillbirths 0 3 1 0 2 1 0

The Royal College of

Physicians states: “Most

people who die in hospital

have had good care, but

research shows that between

10% and 15% have some sort

of problem in their care, and

around 3% of deaths might

have been avoided.”

Non-compliance with the

return of mandatory review

forms is being addressed by

clinical leads.

Mandatory Review Compliance – by Division

Div Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18

D1 70% 86% 85% 100% 40% 43%

D2 96% 89% 68% 67% 42% 45%

D3 67% - 100% - 0% 0%

Total 86% 88% 76% 74% 40% 41%

Quarterly Mandatory Review Hogan Score – by Division, Q4

1. Death due

to problems

2. Strong

evidence due to problems

3. Probably due to problems

4. Possibly due to

problems

5. Slight evidence

of problems

6. Death not due to problems

D1 0% 0% 0% 0% 18% 82% D2 0% 0% 0% 0% 9% 91% D3 0% 0% 20% (SI 1 pt) 0% 20% 60%

0% 0% 2% 0% 13% 86%

Total % of Inpatient/ED Cases Reviewed

Div Nov 2017

Dec 2017

Jan 2018

Feb 2018

Mar 2018

Apr 2018

D1 60% 61% 70% 65% 30% 38%

D2 60% 73% 48% 52% 32% 34%

D3 67% - 100% - 0% 0%

Total 60% 70% 54% 54% 31% 35%

Quarterly Mandatory Review NCEPOD Grading, Q4

Division Good Practice Room for

Improvement Less than

satisfactory

D1 76% 24% 0%

D2 74% 26% 0%

D3 75% 25% 0%

Total 75% 25% 0%

Spotlight Report

Page 16


Learning Learning/Actions

Learning from Deaths Actions and Themes by Division – April 2018

Summary of Findings Of the 46 April cases reviewed thus far, 4 cases were deemed to be deaths where the

reviewer felt the death was not expected or they were not sure. Of the 43 reviews where the question was answered: 3 had slight evidence where the

reviewer felt that the death might be due to problems in healthcare and 1 had strong evidence that death was due to problems in healthcare

Learning Points Non-compliant patient underwent an emergency procedure late at night. Skill mix and

staffing levels on the return to ward did not allow RN 1:1 nursing for this patient which might have been anticipated. This is an SI.

Acute kidney injury not identified, with delay in insertion of a percutaneous nephrostomy – under investigation

Examples of good practice – Reviewer Prompt assessment and consultant review. Early interdisciplinary decision re: ceiling of

care, early commencement of DNACPR order and ICR LDL/EOL pathway. Patient's husband involved in all decisions.

2 hourly symptom check Input from SALT and dietetics. Recognition that patient is approaching end of life and therefore OGD not indicated

despite dysphagia.

Learning Disabilities No feedback from LeDeR reviews but the Learning Disability Nurse Specialist has devised an action plan based on feedback from the National Report.

Examples of good practice – Family - There were 3 plaudits received, all for Birch. Summaries…We would particularly like to thank Tracey and Gloria for their humour, care and sensitivity.. .thank you for all your kindness, compassion, patience…the final days of his eventful and much-loved life were played out with dignity and respect. My husband had a very simple wish. This was to make his final days pain free and dignified. All the staff on Birch ward allowed this to happen….Everyone from the cleaning staff who were relentless in their quest to clean every nook and cranny, to the catering team who took the time and effort to learn each patient’s likes and dislikes…

Dashboard Learning - for publication

Mortality – Learning from Deaths (Colchester)

Issue - failure to escalate for hypotension Action - staff have been reminded that observations and their subsequent National Early Warning Score (NEWS) should not be used in isolation to patient history and that if, for example, the blood pressure sits within 'normal' ranges but is atypical for the patient , this should still be escalated if there are concerns. Issue – fall with head injury Action - ED staff have been advised that any CT head should automatically mandate an accompanying CT neck and vice-versa where the description of the fall suggests that dissection of the carotid/vertebral artery could be a possibility Issue – risk-feeding for patients with poor swallow Action – this will be part of a larger piece of work involving multidisciplinary teams - staff will examine striking a balance between nutritional support and patient wishes in the last weeks/days of life so that patients are supported in eating an appetizing diet whilst minimizing risk and discomfort.

Issue - failure to document P-POSSUM - a pre-operative risk score Action - Colchester Hospital participates in the NELA audit which tracks pre/peri/post operative care. It can be seen that patient assessment has improved since December 2017 when the concern was raised.

Page 17

June 2018 Performance : Overview (Colchester)

Page 18

70%75%80%85%90%95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

ED 4 Hr Standard - Trajectory vs Actual

Actual ED Plan National standard

80%

85%

90%

95%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

RTT Incompletes - Trajectory vs Actual

Actual Performance incl schemes National standard

50%60%70%80%90%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Cancer 62 Day Waits Standard - Trajectory vs Actual

Actual Cancer Plan National standard

0%

2%

4%

6%

8%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Diagnostic Standard - Trajectory vs Actual

Actual Diagnostics Plan National standard

TOP FIVE ISSUES

A&E Economy Performance

Cancer Performance

RTT Performance

Ambulance Handover Diagnostics Performance

97.77% 82.70%* 84.97%* 1 excess of 60 mins 0.90%*

* Unvalidated (RTT & Diagnostics require Oaks data update)

URGENT CARE Performance in line with Trajectory RTT Exception Report Needed

70%

75%

80%

85%

90%

95%

100%

ED Economy 4 Hr Standard -Trajectory vs Actual

Actual ED Economy Plan National Standard

12,000

15,000

18,000

21,000

24,000

27,000

70%

75%

80%

85%

90%

95%


Pathways Actual Performance inc Schemes National Standard

2,000

2,500

3,000

3,500

4,000

4,500

0%

1%

2%

3%

4%

5%

Diagnostic Standard

Total Diagnostic Patients Actual National Standard

40

60

80

100

120

140

50%

60%

70%

80%

90%

100%

Cancer 62 Waits Standard - Trajectory vs Actual

Cancer Patients National Standard Cancer Plan Actual

DIAGNOSTICS Performance in line with Trajectory CANCER Exception Report Needed

June 2018 Performance : Overview (Ipswich)

Page 19

70%75%80%85%90%95%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17


Actual ED Plan National standard

80%

85%

90%

95%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17


Actual Performance incl schemes National standard

50%60%70%80%90%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Cancer 62 Day Waits Standard - Trajectory vs Actual

Actual Cancer Plan National standard

0%

2%

4%

6%

8%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Diagnostic Standard - Trajectory vs Actual

Actual Diagnostics Plan National standard

TOP FIVE ISSUES

A&E Economy Performance

Cancer Performance

RTT Performance

Ambulance Handover Diagnostics Performance

90.51% 77.59%* 92.79%* 10 excess of 60 mins 1.69%*

40

60

80

100

120

140

50%

60%

70%

80%

90%

100%



75%

80%

85%

90%

95%

100%



3,500

4,000

4,500

5,000

5,500

6,000

0%

1%

2%

3%

4%

5%

Diagnostic Standard

Total Diagnostic Patients Actual National Standard

URGENT CARE Exception Report Needed RTT Performance in line with Trajectory

DIAGNOSTICS Exception Report Needed CANCER Exception Report Needed

12,000

14,500

17,000

19,500

22,000

24,500

85%

88%

90%

93%

95%



* Unvalidated

June 2018

Monthly Trend

Performance : Urgent Care (Colchester)

Page 20

Performance against the 4 hr standard for June 2018 was 95.52% (COL only), which is above the June trajectory of 92% and above the 95% National Standard. ED Economy performance for June 2018 was 97.77% which is above the trajectory and National Standard for June both of which are 95%.

Performance against the 15 minute time to initial assessment remained within standard at 10 minutes for the month Performance against 60 minute time to treatment for June remained within target at 56 minutes.

Service Commentary

• Performance has been maintained above the national standard

• A 28 day trial of a Registrar streaming minor attendances commenced in July which has initially shown to be effective in reducing patient waiting times further and will be fed back next month

• Focus now remains on winter capacity to ensure sustainability in the future months

6,000

6,500

7,000

7,500

8,000

8,500

50%

60%

70%

80%

90%

100%


ED Attendances Actual ED Plan National Standard

70%

75%

80%

85%

90%

95%

100%



June 2018

Monthly Trend

Performance : Urgent Care (Ipswich)

Page 21

Performance against the 4 hr standard for June 2018 was 89.2% (Type 1 only), which is below the 95% National Standard. ED Economy performance for June 2018 was 90.5% which is below the National Standard for June (which is 95%). Performance against the 15 minute time to initial assessment for June was above standard at 24 minutes for the month. Performance against 60 minute time to treatment for June remained above target at 94 minutes.

Service Commentary

• Incoming management have undertaken initial 2 week observation period

• Recovery plan strengthened and to be rolled out through nursing, medical and operational task and finish groups feeding into an overarching steering board

• Operational improvements implemented from week 3 of ESNEFT including daily morning telephone review process, and senior support rota for ED floor co-ordination which has seen performance meeting the type 3 standard for 5 consecutive days (the first time since February 18)

75%

80%

85%

90%

95%

100%



5,500

6,000

6,500

7,000

7,500

8,000

50%

60%

70%

80%

90%

100%


ED Attendances Actual ED Plan National Standard

June 2018

Monthly Trend

Performance : Ambulance (Colchester)

Page 22

Ambulance metrics have largely maintained the previous month’s strong performance. 60 minute handover breaches have increased from 0 in May to 1 in June. Handovers over 30 minutes have decreased from 14 in May to 12 in June. Total ambulance handover time has decreased from 872 hours in May to 803 in June. Handover breach penalties are no longer paid by the Trust due to the move to block contract.

Service Commentary

- Consistent delivery of both 30 and 60 minute handovers in view of increased arrivals

0

200

400

600

Number of ambulance handovers over 30 minutes


0

100

200

300

400



0

200

400

600

800

1000

1200

1400

1600

1800

Total ambulance handover time (hours)

Total ambulance handover time (hours)

June 2018

Monthly Trend

Performance : Ambulance (Ipswich)

Page 23

60 minute ambulance handover breaches have decreased from 13 in May to 10 in June. Handovers over 30 minutes have increased from 111 in May to 116 in June. Handover breach penalties are no longer paid by the Trust due to the move to block contract.

Service Commentary

• Colchester processes to be adopted to provide focus including development and timely implementation of a SOP

• HALO being interviewed next week which when appointed will play a key role in supporting the process

0

200

400

600



0

50

100

150



June 2018 Performance : Cancer (Colchester)

Page 24

62 Day Cancer Waits for 1st Treatment remain below Target and trajectory. Performance was 82.7% for June 2018– this was below the trajectory of 86.9% Gap to compliance for June 2018: currently we are 4.2% below Trajectory of 86.9% and 2.3% below the 85% target. 2WW wait from referral to first seen is below target, at 89.2% against 93% 31 day wait from decision to treat to treatment is above target at 97.5% this month against target of 96% The number of patients currently waiting (snapshot) 104+ days on a 62 day first Cancer pathway currently stands at 7. * From Apr 17 only reporting 62 day first patients waiting 104+ days *Unvalidated figures as at 16/07/2018. Final figures for June will be available in Aug after submission

Monthly Trend

Service Commentary:

2WW standard not achieved for 3rd consecutive month although month on month improvement can be seen as Breast services recover their position. We are on track to deliver 2ww standard in July.

31 day first – Compliant. Also compliant for the Quarter. On track to deliver standard in July

62 Day first. Below trajectory but improvement on May position however overall treatment numbers are low compared to previous month/year.. Breast have 3 breaches mainly due to knock on effect of delay to first appointment, H&N had 1.5 breaches and no treatments within target. This is the lowest number of treatments in H&N for over a year. Delays with access to diagnostics resulting in ate referrals to MEHT for surgery. Recovery plan for Colchester and Ipswich in place. Gynae has had delays with tracking which has been addressed. New staff in post and new process in place for referrals to Ipswich. Joint pathway recovery plan in place. Lower GI 3 breaches due to delays with patients moving from other tumour sites and 1 complex pathway

104 day position (snapshot) – Remains steady for June. Reported breaches are unavoidable. Breach report completed and sent to NHSI weekly

0%

20%

40%

60%

80%

100%

62 day wait for 1st treatment: GP referral to treatment

62 day wait for 1st treatment: GP referral to treatment Target

40

60

80

100

120

140

50%

60%

70%

80%

90%

100%



June 2018 Performance : Cancer (Ipswich)

Page 25

62 Day Cancer Waits for 1st Treatment remain below Target and trajectory. Performance was 77.6% for June 2018 – this was below the national standard of 85%. Gap to compliance for June 2018: currently we are 7.4% below the 85% target. 2WW wait from referral to first seen is above target at 93.6% against 93%. 31 day wait from decision to treat to treatment is above target at 97.3% this month against target of 96%. The number of patients currently waiting (snapshot) 104+ days on a 62 day first Cancer pathway currently stands at 14.

*Unvalidated figures as at 19/07/2018. Final figures for June will be available in Aug after submission

Monthly Trend

Service Commentary

• 62 day standard not met for 6th consecutive month. Treatment numbers in line with previous months.. Although Breast, LGI, Lung and Skin were compliant the high number of breaches in UGI, Gynae, H&N and Urology significantly reduced the overall percentage against target. There is now a detailed recovery plan in place for each tumour site which will be reviewed weekly to ensure progress against actions. There is a joint pathway plan for Gynae which should allow us to recover quickly in this specialty. A weekly joint PTL meeting will be in place from 23/7

• An overarching risk and actions log is to be added to address the wider issues behind pathway delays across both sites.

• These include reducing waiting times to access diagnostics, faster turnaround in reporting times and a review of cross-site cover in those areas where service is provided by a just one clinician.

• Recovery plans and the recovery trajectory have been shared and discussed with NHSI, NHSE and the Cancer Alliance. There is more work to be done on the trajectory once the PTL has been cleansed (Patients awaiting remove from pathway letters etc.) but trust recovery overall unlikely to be before October 2018. 104 day breaches: There is a focused piece of work being undertaken by Cancer Performance Manager to understand the issues behind the delays.

0%

20%

40%

60%

80%

100%

62 day wait for 1st treatment: GP referral to treatment

62 day wait for 1st treatment: GP referral to treatment Target

40

60

80

100

120

140

50%

60%

70%

80%

90%

100%



June 2018 Performance : Diagnostics (Colchester)

Page 26

Diagnostic performance currently at 0.90% against target of 1%. This has increased since May’s figure of 0.28% Please note a revised position for Cystoscopies was submitted in Nov 17 for July and Aug 17 – the information shown within this report reflects this updated submission. *Unvalidated figures as at 16/07/2018. Oaks data required to be added. Final figures for June will be available in Aug after submission

Monthly Trend

Service Commentary

Increase was due to breaches in MRI, Ultrasound and Urology. Higher breaches in MRI and U/S were mainly down to admin errors, lessons learnt have been embed to ensure that these do not occur again

0.87%

3.92%

3.36%

2.72%

2.00%

1.08%

0.67% 0.64% 0.46% 0.49%

0.60%

0.28%

0.90%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%


% patients waiting over 6 weeks for a diagnostic test

% patients waiting over 6 weeks for a diagnostic test Threshold

June 2018 Performance : Diagnostics (Ipswich)

Page 27

Diagnostic performance currently at 1.69% against target of 1%. This has increased since May’s figure of 1.18%.

Monthly Trend

Service Commentary

1.49%

2.58%

1.17%

2.75%

0.73%

0.21%

1.36%

1.18%

0.29%

2.48%

0.24%

1.18%

1.69%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%


% patients waiting over 6 weeks for a diagnostic test

% patients waiting over 6 weeks for a diagnostic test Threshold

• The key issue is ultrasound performance across both sites, but particularly Ipswich. there are 2 radiologist vacancies and one on maternity leave being covered by a locum. Cases are more specialist/complex referrals that are requiring consultant input. Additional lists are being undertaken and further locums are being sourced.

• Expected Recovery is end of September assuming we can increase sessions and/or recruit a locum.

June 2018 Performance : Stroke (Colchester)

Page 28

Monthly Trend – Colchester Site

For Stroke metrics, Published SSNAP Values have been added for Apr 17 – March 18, indicative monthly values from April 18 have been provided for internal reporting only. Agreed SSNAP values will be updated quarterly with SSNAP published figures.

Service Commentary

The June data is incomplete as at 23 July 2018. SSNAP data is based on admissions and we have 9 patients admitted in June 2018 that are still inpatients which need to be uploaded. June 2018 has been a particularly challenging month with a high number of high acuity patients requiring admission to the Stroke Unit. The higher demand and acuity has led to pressures on beds resulting in a number of low acuity patients being transferred off the Stroke Unit to accommodate new patients.

The Stroke Consultant responsible for managing the targets conducts a root cause analysis on all admissions at 3 hours and above to the Stroke Unit. A MDT performance meeting is held twice a month to review the findings and discuss mitigations to prevent further breaches and improve performance.

SSNAP Values for Dec 17 – March 18 have been published. For Dec 17 – March 18, the Standard for Patients being admitted directly to a stoke unit within 4 hours of arrival has seen an improved performance of 76.4% this standard continues to be below the 90% standard. Published SSNAP values for Dec 17 – March 18 for Scans within one hour of hospital arrival continue to be above target at 62%. The Target (80%) for Patients spending => 90% of their stay on a stroke unit was met for the reporting period Dec 17 – March 18 – early view for June 18 is slightly under target at 79.41%. It should be noted that all data for April 18 – June 18 is subject to change.

Stroke - Team centred results

Standard

Targ

et

April 17 -

July 17

Aug 17 -

Nov 17

Dec 17 -

March 18Apr-18 May-18 Jun-18

% patients admitted directly to stroke unit

within 4 hours of hospital arrival90% 69.2% 69.3% 76.4% 86.5% 85.5% 76.5%

patients admitted directly to stroke unit

within 4 hours of hospital arrival / total

number of applicable admissions

Numerator/

Denomiator.137/198 .149/215 .172/225 .32/37 .47/55 .26/34

% patients who scanned within one hour of

hospital arrival50% 50.2% 58.0% 61.6% 63.2% 63.6% 67.7%

Patients spending => 90% of their stay on a

stroke unit80% 82.6% 88.3% 89.2% 89.2% 91.7% 79..41%

June 2018 Performance : Stroke (Ipswich)

Page 29

Monthly Trend

SSNAP values for Scans within one hour of hospital arrival continue to be above the 50% target. The Target (80%) for patients spending => 90% of their stay on a stroke unit for April and May 18 remains below the Target but is subject to change. *It should be noted that all data for April and May 18 is subject to change.

Service Commentary

• All breaches of 4 hour to the Stroke Unit are root cause analysed by the Stroke Consultant and the findings are shared with the team weekly. The primary causes for delay have been that the Stroke Unit has not been the first admission ward due to challenging diagnoses and delayed referrals from the Emergency Department. Education sessions regarding signs and symptoms have taken place with Emergency Department staff to drive improvement with a 10% improvement noted between April 2018 and May 2018. The service continues to monitor this on a weekly basis.

• In terms of the 90% stay on the Stroke Unit, the primary cause for non-compliance is the high number of patents requiring a prolonged period of inpatient stay; predominantly delayed transfers of care, such as awaiting a placement or a package of care. When demand for a stroke bed is high, this cohort of patients need to be moved to accommodate the new admissions.

• Further improvement is indicated in respect of June 2018 with 82.9% of patients being admitted within 4 hours of hospital arrival, 60.6% scanned within 1 hour of hospital and 77.1% spending 90% or more of their stay on a Stroke Unit.

Stroke - Team Centred Results

Standard TargetApr17 -

Jul17

Aug17 -

Nov17

Dec17 -

Mar18Apr18 May18 Jun18

% patients admitted directly to Stroke Unit within 4 hours of

hospital arrival.90% 69.4% 79.6%

Patients admitted directly to Stroke Unit within 4 hours of

hospital arrival / total number of applicable admissions.

% patients who were scanned within 1 hour of hospital

arrival.50% 54.3% 57.5%

Patients spending >= 90% of their stay on a Sroke Unit. 80% 61.1% 71.4%

June 2018

Monthly Trend

Performance : RTT (Colchester)

Page 30

June’s current RTT position is 84.97%. This is below trajectory, and has decreased from May 2018. Gap to compliance for June 2018 as at 16/07/2018 is 1391 to achieve 92% T&O, Urology, Respiratory, Neurology and ENT are the top 5 specialties with the largest gap to compliance. There are currently 14 52+ Week breaches for June 2018 *Unvalidated figures as at 16/07/2018. Oaks data required to be added. Final figures for June will be available in Aug after submission

Service Commentary

• Final overall achievement for June was 86.67%. • A combined trajectory has now been established with overall compliance for ESNEFT

forecasted for November 2018. • The numbers of over 52 weeks has reduced in July, and forecasting to have zero by

the end of September. A Joint weekly PTL is now in place for all specialities and focussing on changing the shape of the waiting list to reduce those patients over 40 weeks.

70%

75%

80%

85%

90%

95%

% of incomplete pathways within 18 weeks

% of incomplete pathways within 18 weeks Target

12,000

15,000

18,000

21,000

24,000

27,000

70%

75%

80%

85%

90%

95%


Pathways Actual

Performance inc Schemes National Standard

TOP 5 SPECIALTIES W/E 16/07/2018

Specialty Gap to Compliance

TRAUMA & ORTHOPAEDICS 345

UROLOGY 278

RESPIRATORY 270

NEUROLOGY 218

ENT 97

June 2018

Monthly Trend

Performance : RTT (Ipswich)

Page 31

June’s current RTT position is 92.79%. This is above the National Standard and has increased from May 2018. Surg Combined, Urology, T&O, Ophthalmology and Neurology are the top 5 specialties with the largest gap to compliance. There are not currently any 52+ week breaches for June 2018.

Service Commentary

• Good improvement in the 5 specialities in Ipswich during June with an overall Trust performance of 92.8%. Despite the good improvement in overall performance,

• Gynaecology for the first time in June fell below 92% with achieving 91.2%. A recovery plan has been put in place.

• A combined PTL has now been developed and being worked through for ESNEFT and the detail of the top 5 specialities gap numbers now include both sites.

TOP 5 SPECIALTIES W/E 19/07/2018

Specialty Gap to Compliance

Surg Combined -77

Urology -467

T&O -411

Ophthalmology -73

Neurology -240

85%

87%

89%

91%

93%

95%

% of incomplete pathways within 18 weeks

% of incomplete pathways within 18 weeks Target

12,000

14,500

17,000

19,500

22,000

24,500

85%

88%

90%

93%

95%



June 2018 June 2018 Finance and Use of Resources (Colchester)

Page 32

Headlines Commentary on key items Forecast / Trends

In June the Trust incurred a deficit of £1.9m; this was worse than planned by £0.3m. The year to date deficit is now £4.2m; a favourable variance to plan of £0.1m Total income exceeded plan by approximately £0.5m in June. NHS clinical income over recovered by approximately £0.2m, which was primarily due to additional income for pass through drugs and devices. Other income exceeded plan by £0.3m In contrast, pay was overspent by £0.3m mainly due to the cost of medical staffing, and non-pay was overspent by £0.6m. The Trust scored a Use of Resources Rating (UoR) of 3 for Month 3. The Trust is forecasting that it will meet its control total for the first quarter.

Clinical Income: The NHS clinical income benefit at month 3 is mainly driven by the income associated with pass through drugs and devices. The benefit from an improved contract position agreed with the CCG after original plans were submitted (total gain £2.1m), was offset in the month by underperformance on the NHS England Specialised Commissioning contract. Other income: Assorted additional income received in June. This includes NEESPS, STP infrastructure/central pool, FBC funding, and pharmacy sales. Pay: The overspend was attributable to medical staffing costs, largely in Medicine and Surgery Divisions. The main areas of overspend were Gastroenterology, Rheumatology, Anaesthetics and Urology. Non-pay:. The main reasons for the overspend in the month were additional transformation costs (£0.4m) pass through costs (excluded drugs £0.2m) which are funded by additional income, and clinical supplies which resulted from overspends within NEEEPS (£0.1m). These were in part offset by underspends on secondary commissioning (Gastroenterology and Dermatology £0.2m). Cost improvement plans: For June there was a shortfall in CIP delivery of £0.5m. During the first quarter £3.3m of CIP has been banked and £9.3m confirmed for the year. A further £5m of CIP has been forecast, largely through the release of reserves following a review of their future requirement. This means that £17.6m of CIP has been identified against the annual plan of £17.3m. Capital programme: The capital programme was underspent by £0.8m for the year to date due to delays in progressing schemes. It is expected that by year-end the Trust will undershoot the annual plan b £0.3m. Temporary pay. For 2018/19 NHSI have set a limit on agency and medical locum expenditure of £22.85m. For month 3 agency costs were at ceiling (£1.7m v £1.7m).

Pay Award: Funding for the nationally agreed 3% pay rise has yet to be confirmed. However more information is becoming available and a risk is emerging that only substantive staff, actually in post, will be funded. Conversely, costs June not be so high as anticipated as it would seem that some pay growth will in part be covered by incremental change. Cost improvement plans: The delivery of the full £17.3m CIP required for the year is recognised as being very challenging. The delivery of the £17.3m CIP required for the year is recognised as being very challenging. Whilst the full value has been identified for the year, a proportion of this was linked with the release of reserves and some of this delivery is non recurrent. Temporary pay spend: For the year to date the Trust is under ceiling (£5.1m v £5.3m) but the ceiling is planned to reduce as the year progresses. The Trust must therefore continue to reduce spending on agency staff to more affordable levels for the benefit of the overall financial position.

Commentary/Actions

At M3 the divisional budgets show an adverse variance of £1.5m. The Surgery Division is the largest contributor to this position (though June represented an improvement in its run rate) with a cumulative adverse variance of £1.3m. This is attributed to pay overspends (£0.9m) (medical staffing costs) and non-pay cost pressures (CIP delivery remains worryingly low, with a shortfall at Q1 of £0.5m and a forecast delivery of only 59% of the annual target). The Medicine Division has also reported a significant adverse position relative to plan in June which was mainly continued medical staffing overspends (high medical agency costs / additional sessions – particularly at consultant level). Women’s and Children’s and Corporate essentially broke even in month.

Divisional Performance

Division Budget Actual Variance Budget Actual Variance RAG

SURGERY & CANCER 1,416 1,542 (126) 3,788 5,046 (1,258) -

MEDICINE & EMERGENCY 697 1,001 (304) 1,086 2,256 (1,170) -

WOMEN & CHILDREN & CSS 171 208 (37) 261 (235) 496 1.0

CORPORATE SERVICES 629 650 (21) 1,583 1,175 408 1.0

NESSPS (10) (10) 0 101 101 0 1.0

Total Divisions 2,904 3,392 (488) 6,819 8,342 (1,524) -

Other Budgets (994) (1,493) 499 (2,516) (4,108) 1,592 1.0

Total Trust 1,910 1,898 12 4,302 4,234 68 1.0

In Month Full Year

June 2018 June 2018 Finance and Use of Resources (Colchester)

Page 33

Commentary / Actions

The Trust delivered £0.9m of CIP in June. This represented a £500k shortfall relative to plan. Although the year to date position shows an under-delivery against the CIP plan, the overall I&E performance suggests that other costs are under control. The total delivered for the year (against the plan of £17.3m) stands at £12.6m. During the first quarter £3.3m of CIP has been banked; and £9.3m confirmed for the remaining months of the year. An additional £5m of CIP has been forecast, largely through the release of reserves following a review of their future requirement. This means that £17.6m of CIP has been identified against the annual plan of £17.3m.

Cost Improvement Plan (CIP)

Agency Price Cap and Frameworks Compliance


For month 3 agency costs were at ceiling (£1.7m v £1.7m). For the year to date the Trust is under ceiling (£5.1m v £5.3m) but the ceiling is planned to reduce as the year progresses. The Trust must therefore continue to reduce spending on agency staff to more affordable levels for the benefit of the overall financial position.

0

200

400

600

800

1,000

1,200

1,400

1,600

A M J J A S O N D J F M

£0

00

Delivered Rec Delivered NR Undelivered

-200400600800

1,0001,2001,4001,6001,8002,000


Agency and Locum Ceiling (£000) Actual Ceiling

June 2018 June 2018 June 2018 Finance and Use of Resources (Ipswich)

Page 34

Headlines Commentary on key items Forecast / Trends

In June the Trust incurred a deficit of £1.8m; this was worse than planned by £0.2m. The year to date deficit is now £6.5m; an adverse variance to plan of £0.3m Total income fell short of plan by approximately £1.0m in June. NHS clinical income under recovered by approximately £0.6m. Other income also fell short of plan by £0.5m Pay was overspent by £0.1m, but by contrast non-pay was underspent by £1.0m.

At month 3, the Trust is £0.3m off plan, after accounting for a shortfall in Provider Sustainability Funding (PSF) to plan of £337k in Q1. The underlying position is actually £49k ahead of plan excluding the PSF impact. PSF monies are dependent of the achievement of the required financial performance, with 70% of monies then received for financial performance and 30% linked to A&E 4 hour access performance. A&E performance in Q1 whilst above 90%, was lower than the equivalent performance in the prior year. Month 3 YTD I&E position is £0.29m adverse against plan (4.6% adverse variance to plan) Underlying (excluding PSF) position is £0.05m ahead of plan; shortfall of (£0.34m) on PSF Clinical Income of £73.2m is £0.8m adverse to plan. YTD Pay expenditure of £49.6m is £0.7m adverse to plan YTD EBITDA adjusted is (£3.2m), which is £0.2m adverse of plan CIP is slightly off-track at M3, with 94.9% delivered in Q1; the full-year CIP targets remains the highest risk.

Cost improvement plans: The delivery of the full £23m CIP required for the year is recognised as extremely challenging. There is presently a shortfall of identified efficiencies of approximately £12m. PSF funding: The non-receipt of these monies has the potenital to cause cashflow pressures. It is not clear how the performance of each site will impact on PSF funding when reported as ESNEFT. Improvement of the A&E position must therefore be considered a priority.

Commentary/Actions

At M3 the divisional budgets show an adverse variance of £0.6m. Division 3, Cancer, Women & Children has an adverse variance in Quarter 1 of £0.5m. The gap is primarily driven by DI outsourcing additional costs £0.2m, and CIP under-delivery of £0.2m. Division 1, Medicine and Therapies has a £0.5m adverse variance YTD. Agency usage in ED has increased costs by £0.2m, other pay is adverse to plan by £0.2m, particularly in EAU and Respiratory. CIP has been under-delivered against Q1 target by £0.2m. Division 5, Community has an adverse variance in Quarter 1 of £0.3m The gap is primarily driven by a shortfall in CIP delivery. These overspends are in part offset by significant underspends against plan in both Division 4, Corporate where CIP is over-delivering and existing accruals have been reviewed and some identified as no longer needed, and Division 2, Surgery where again CIP is over-delivering and vacancies lead to pay benefits.

Divisional Performance Month 3 YTD

June 2018 June 2018 June 2018 Finance and Use of Resources (Ipswich )

Page 35


The Trust delivered £1.3m of CIP in June. This meant the plan for the month was achieved. However, the cumulative position shows an under-delivery against the CIP plan of approximately £0.2m. Moreover, there is currently a shortfall of over £12m relative to the overall CIP target for the year. Closing this gap is vital if financial performance is to not be significantly impacted.

Cost Improvement Plan (CIP)

Agency Price Cap and Frameworks Compliance


For month 3 agency costs were above ceiling (£0.9m v £0.7m). For the year to date the Trust is also beyond the ceiling (£2.6m v £1.9m). The total ceiling for the year is £7.3m and is planned to reduce as the year progresses. The Trust must therefore continue to reduce spending on agency staff to more affordable levels for the benefit of the overall financial position.

June 2018 June 2018 Well-Led (Colchester)

Page 36

Workforce Dashboard June 2018

Trust Level

Key Metrics Vacancy (Ex Agency) Pay (YTD) Sickness Mandatory Training Appraisal Voluntary Turnover Ceiling Ward Fill Rate

Performance 11.5% (£1.0m) 3.3% 94.0% 80.2% 10.9% £0.14m 88.5%Target Budget 4662wte Budget £53.9m 3.5% 95% 85% 12% (£5.26m) 95%

Achieved Contracted 4128wte Spend £52.9m 3.3% View portal for detail 3096 out of 3861 staff (£5.12m)

Vs Prior Month

Prior Month 11.8% £0.03m 3.4% 93.4% 85.7% 11.4% £0.17m 92.4%

HeadcountStarter - Leavers

(12Mth Rolling)

wte Headcount

Agency Ceiling £m

%

Significant Improvement Required

Agency Trends (ex Locum)

£m%

Workforce TrendsSickness

Appraisals & Mandatory Training Compliance

AF rating

2

Turnover by Staff

Group

0.00

0.20

0.40

0.60

0.80

1.00

1.20

J J A S O N D J F M A M J

Medical Nursing Other

-

1,000

2,000

3,000

4,000

5,000

A M J J A S O N D J F M A M J J A S O N D J F M

Substantive & Bank Locum&Agency Budget

-

0.500

1.000

1.500

2.000


Non Clinical S, T & TNursing Junior DrCons Ceiling

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


Appraisal % Mandatory Training %

26

67

345

175

212

12

22

256

154

195

Cons

Junior Dr

Nursing

S, T & T

Non Clinical

Starters Leavers

5.3%

13%

13%

16%

14%

4%

5%

11%

13%

11%

Cons

Junior Dr

Nursing

S, T & T

Non Clinical

Voluntary Turnover

3.4% 3.5% 3.6% 3.6%3.9% 3.8% 3.9% 4.1%

3.6% 3.6% 3.6% 3.4% 3.3%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%


In Mth 12 Mth Rolling


Page 37


In June, month 3, there were 4,127 WTE in post compared to 4,102 WTE in May. There were 20 leavers in the month compared with 73 new employees. 14 Band 5 RNs commenced in June. 10 Band 2 Healthcare Assistant s commenced in June. There are 15 vacant Consultant posts and 20 training post vacancies. During June, the rolling turnover reduced from 14.1% to 13.5% and the voluntary turnover also reduced to 10.9%. Building on the work of EPED, the total average time to hire (excluding medical posts) has been identified as a key indicator. Encouragingly, the timeframe for an advert to go live to the conditional offer has continued to decrease.

Sickness: The total recorded number of staff being managed through the sickness steps is 810 as at 30 June 2018 – this is 22 more than May.

Mandatory training: Month 3 showed an increase in compliance from 93.4% to 94.0% The overall increase was reflected in all divisions apart from Surgery.

Appraisals: Month 3 showed a decrease in compliance from 85.7% to 80.2%. This is now below the expected standard.

Within the Every Patient Every Day Workforce Workstream, the Nursing and Midwifery Workforce Group has focused on the recruitment and retention of the workforce in addition to ensuring that student nurses have a good training experience with the Trust. The Nursing workforce are a key group within the retention programme, and documentation is being piloted within one area of the nursing workforce for this programme in advance of discussions taking place across the wider workforce. The International Recruitment continues to be successful with a new cohort each month. The Trust is on track to double the amount of international nurses compared to 2017. 7 international nurses commenced in July, with a further 7 scheduled for August, Regular change over meetings continue for August 2018. Work schedules have been issued within the timeframe stipulated in the 2016 Junior Doctors Contract Medical workforce are to complete the required NHSI returns for August. Currently 39 WTE vacancies declared for August 2018 compared to 58 WTE vacancies in 2017 but expect this figure to reduce further. Sickness. The increase in individuals on the step process is due to the positive work being carried out by the Employee Relations team in regards to training managers on the policy and helping them to develop their skills in order to manage short term sickness efficiently. The figure of staff absent for 4 weeks to 3 months has increased significantly by ten new cases 39 to 49. A contributing factor is the proactive work with managers to ensure sickness absences are recorded correctly. This issue is also being addressed within the License to Lead Absence Management training Mandatory training: The AD for Education has been attending divisional performance meetings to discuss mandatory training and ways of increasing compliance. However, compliance is expected to reduce in month 1 of ESNEFT due to changes to mandatory training requirements. Appraisals: The reduction in compliance was mainly due to the appraisal cycle of NEESPS staff (noted last month). The division is fully sighted on the situation.

wteWorkforce Trends

-

1,000

2,000

3,000

4,000

5,000

A M J J A S O N D J F M A M J J A S O N D J F M

Substantive & Bank Locum&Agency Budget

Sickness Trend - All Staff %

3.4% 3.5% 3.6% 3.6%3.9% 3.8% 3.9%

4.1%

3.6% 3.6% 3.6%3.4% 3.3%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%


In Mth

12 Mth Rolling

Appraisal & Mandatory Training Compliance Trend %

84.5%89.1% 87.8% 87.6% 87.2% 86.3% 87.6% 89.2% 88.1% 86.1% 87.2% 85.7%

80.2%

92.1% 92.1% 91.7% 91.6% 91.6% 92.8% 93.1% 93.3% 93.5% 93.3% 93.9% 93.4% 94.0%

25.0%

35.0%

45.0%

55.0%

65.0%

75.0%

85.0%

95.0%


Appraisal Compliance % Training Compliance %

June 2018 June 2018 Well-Led (Colchester and Ipswich)

Page 38

Nursing Fill Rates


Each month data on staffing fill rates for nurses, midwives and care staff is published on the NHS Choices website. This enables patients and the public to see how hospitals are performing on meeting inpatient safe nursing levels in an easy and accessible way. As well as submitting the monthly staffing data via UNIFY, all Trusts are also required to publish their actual versus planned staff fill rates on a ward by ward basis on their Trust website*.

*http://www.colchesterhospital.nhs.uk/nursing_sta

ffing_levels.shtml The overall fill rates for Qualified (Registered) Nurses and Midwives has remained reasonably stable in both the Ipswich and Colchester sites. In terms of temporary backfill from bank and agency nurses this reduces during the summer months therefore each specialty is ensuring early mitigating plans are in place. There has been a reduction in unqualified day fill for both sites, Colchester site reporting is lowered by one clinical area reporting 27% fill (CCU) which is due to a delay in a template update on e roster. The actual fill in this area is nearer 90%. RAG rules Less than 80% : Red 80 - 95%: Yellow 95 - 101%: Green More than 101%: Amber

Nurse staffing is monitored on a shift by shift basis and is discussed at the bed meetings and risk assessed throughout the day by the Specialty Matrons and Site Matrons. Staff are moved between departments and wards to mitigate risk where appropriate An SOP for staffing escalation is in place. Offers to newly qualified nurses and midwives have been made and we are awaiting confirmation of current provisional numbers. Recruitment plans for ESNEFT are being reviewed and updated with a refresh of the retention plan. Details of which will be reported through the people and organisational development committee.

Apr-18 May-18 Jun-18 Apr-18 May-18 Jun-18

85.5% 87.8% 84.7% 91.8% 91.5% 88.8%

97.0% 106.0% 99.1% 91.6% 93.0% 89.1%

83.4% 93.5% 79.6% 98.0% 95.1% 94.8%

95.4% 101.1% 94.4% 99.6% 94.6% 94.0%

89.4% 95.8% 88.6% 94.1% 93.1% 90.9%

COL IHT

Unqual i fied day - Col

Unqual i fied night - Col

Overal l (average) fi l l - Col

Qual i fied day - Col

Qual i fied night - Col

70%

75%

80%

85%

90%

95%

100%

Apr-18 May-18 Jun-18

Day fill rates

Qualified day - Col Unqualified day - Col

Qualified day - IHT Unqualified day - IHT

70%

75%

80%

85%

90%

95%

100%

105%

110%

Apr-18 May-18 Jun-18

Night fill rates

Qualified night - Col Unqualified night - Col

Qualified night - IHT Unqualified night - IHT


Page 39

POD Profiles - Trust Level

All Staff

Headcount 4,606 4,586 4,614 4,627 4,687 4,708 4,689 4,711 4,717 4,722 4,712 4,729 4,770

Establishment (including agency) 4,681 4,567 4,628 4,596 4,600 4,614 4,684 4,641 4,641 4,692 4,687 4,701 4,716

In post 4,017 4,016 4,048 4,014 4,060 4,054 4,057 4,079 4,093 4,119 4,093 4,102 4,128

Vacancy 664 551 580 582 539 560 627 562 547 573 594 599 588

Vacancy % 14.2% 12.1% 12.5% 12.7% 11.7% 12.1% 13.4% 12.1% 11.8% 12.2% 12.7% 12.8% 12.5%

Establishment (excluding agency) 4,623 4,509 4,568 4,539 4,542 4,556 4,612 4,575 4,575 4,606 4,638 4,652 4,662

Vacancy (excluding agency) 606 493 520 525 481 502 555 496 482 488 545 550 534

Vacancy % (excluding agency) 13.1% 10.9% 11.4% 11.6% 10.6% 11.0% 12.0% 10.8% 10.5% 10.6% 11.7% 11.8% 11.5%

Turnover1

Turnover (12 Month) 15.0% 15.1% 15.0% 15.3% 15.1% 15.2% 15.1% 14.9% 14.8% 14.4% 14.4% 14.1% 13.5%

1Voluntary Turnover (12 Month) 11.5% 11.6% 11.5% 11.8% 11.7% 11.8% 11.8% 11.8% 11.7% 11.9% 11.8% 11.4% 10.9%

1Starters (to Trust) 367 44 76 74 110 72 46 78 56 63 66 67 73

1Leavers (from Trust) 43 65 63 73 47 59 47 44 46 90 48 37 20

Sickness

% In Mth 3.4% 3.5% 3.6% 3.6% 3.9% 3.8% 3.9% 4.1% 3.6% 3.6% 3.6% 3.4% 3.3%

WTE Days Absent In Mth 4,105 4,278 4,371 4,297 4,811 4,629 4,887 5,084 4,129 4,493 4,332 4,280 4,041

% of sickness Short-term 42.7% 40.5% 40.1% 43.8% 43.4% 41.3% 42.0% 56.2% 45.4% 42.8% 36.5% 38.7% 38.0%

% of sickness Long-term 57.3% 59.5% 59.9% 56.2% 56.6% 58.7% 58.0% 43.8% 54.6% 57.2% 63.5% 61.3% 62.0%

Mandatory Training & Appraisal Compliance

Mandatory Training 92.1% 92.1% 91.7% 91.6% 91.6% 92.8% 93.1% 93.3% 93.5% 93.3% 93.9% 93.4% 94.0%

Appraisal 84.5% 89.1% 87.8% 87.6% 87.2% 86.3% 87.6% 89.2% 88.1% 86.1% 87.2% 85.7% 80.2%

Temporary staffing as a % of spend

Substantive Pay Spend 14,255 14,566 14,445 14,601 14,686 14,627 14,818 14,952 15,102 14,926 15,096 15,232 15,079

Overtime Pay Spend 112 107 107 113 124 114 118 102 102 96 114 105 94

Bank Pay Spend 451 749 627 620 645 629 587 680 747 798 679 703 693

Agency Pay Spend 1,812 1,700 1,989 2,284 2,231 1,721 1,881 1,853 1,876 1,975 1,622 1,787 1,709

Total Pay Spend 16,630 17,122 17,168 17,618 17,687 17,090 17,404 17,588 17,826 17,795 17,512 17,827 17,575

Agency & Bank % 13.8% 14.7% 15.7% 17.0% 16.8% 14.3% 14.7% 14.9% 15.2% 16.2% 13.9% 14.7% 14.4%

Agency % 10.9% 9.9% 11.6% 13.0% 12.6% 10.1% 10.8% 10.5% 10.5% 11.1% 9.3% 10.0% 9.7%

Jan 18Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Feb 18 Mar 18 Apr 18 May 18 Jun 18


Page 40

Nursing (Qualified) - excluding Midwives

Establishment (including agency) 1,244 1,163 1,194 1,183 1,186 1,193 1,201 1,198 1,198 1,201 1,209 1,204 1,200

In post 987 983 983 986 999 1,009 1,015 1,009 1,004 1,002 1,000 1,011 1,022

Vacancy 257 180 211 197 187 184 186 190 194 198 209 192 178

Vacancy % 20.7% 15.5% 17.7% 16.7% 15.8% 15.5% 15.5% 15.8% 16.2% 16.5% 17.3% 16.0% 14.8%

Nursing (Band 5) - excluding Midwives

Establishment (including agency) 645 616 621 618 619 619 621 621 619 624 629 629 626

In post 473 473 469 470 485 491 496 492 485 483 476 487 492

Vacancy 172 144 152 148 135 129 125 128 134 142 153 142 134

Vacancy % 26.7% 23.4% 24.5% 23.9% 21.8% 20.8% 20.1% 20.7% 21.7% 22.7% 24.3% 22.6% 21.3%

Nursing (Band 4)

In post Band 4 33 32 31 31 35 35 38 37 36 37 39 40 49

In post Band 4 Pre Reg 16 16 16 20 36 25 23 32 39 41 43 37 26

Nursing (Apprentice, B2 & B3)


In post 468 465 458 463 457 460 464 465 464 465 458 457 440

Vacancy 78 46 72 66 71 74 70 59 62 60 59 71 70

Vacancy % 14.3% 9.1% 13.5% 12.6% 13.4% 13.9% 13.1% 11.3% 11.8% 11.4% 11.5% 13.4% 13.8%

Consultants


In post 193 195 194 196 197 193 192 195 194 196 197 199 198

Vacancy 28 21 23 22 20 27 30 25 27 38 26 24 25

Vacancy % 12.7% 9.7% 10.6% 10.2% 9.4% 12.4% 13.3% 11.3% 12.2% 16.2% 11.8% 10.9% 11.3%

Junior Medical


In post 272 269 302 265 275 265 268 267 271 275 278 272 275

Vacancy 44 47 15 52 41 52 56 51 49 46 40 45 43

Vacancy % 14.0% 14.9% 4.6% 16.5% 12.9% 16.3% 17.2% 16.0% 15.4% 14.3% 12.6% 14.1% 13.4%

Scientific, Technical and Therapeutic


In post 795 794 797 799 803 810 811 811 812 823 808 812 824

Vacancy 107 108 111 101 94 94 95 93 92 89 117 114 103

Vacancy % 11.8% 12.0% 12.2% 11.2% 10.5% 10.4% 10.5% 10.3% 10.2% 9.8% 12.6% 12.3% 11.1%

Apprentices

In post Nursing 4 4 4 8 8 5 5 5 4 4 3 - -

In post Non Clinical 4 4 3 3 3 2 2 8 9 11 6 5 5

Sep 17Jun 17 Jul 17 Aug 17 Apr 18 May 18 Jun 18Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18

June 2018 June 2018 June 2018 Well-Led (Ipswich)

Page 41


Since May 2018, staff in post has decreased by 10.0 WTE, and the establishment has decreased by 3.0 WTE due to merger related changes. In the financial year June 16/17 to June 2017/18 staff in post increased by 140 WTE. Turnover is in line with the Trust target of 10.00%. As part of the staff experience programme, work to understand why 5% of staff leave within the first 6 months (and 15% within the first year) of joining the trust will be undertaken. Sickness: The sickness rate has decreased from 3.8% during May to 3.5% in June which is line with the trust target of 3.5%. The data shows that there has been a increase across the Trust in short term absence and a decrease in long term absence. The top reason for sickness during June related to mental health issues Mandatory training: Mandatory Training Compliance is at 90.7%. The L&D team continue to offer support and guidance to staff accessing the e-assessment.

The work started by Colchester Hospital to learn from the NHSI national programme on retention across the NHS is being developed into a single ESNEFT work package. The national programme is set to run to 2020 and is focused on stabilising and reducing leaver rates. In terms of registered nurses, four international recruitment campaigns have been undertaken resulting in 309 offers being made for nurses in the Philippines. 60 have started with the trust year to date. Cohorts are expected to arrive each month until December 2018. A newly qualified RN open event took place in early April and 20 offers were made to students due to qualify in September. Sickness: The focus of the HR Services team remains on the top six CDGs reporting the highest % of short term sickness absence (colleagues with over 100 absence points) per headcount. The following actions are underway in these areas: -Monthly meetings continue to he held to review all cases which will result in an action plan with a particular focus on the Midwifery, Pharmacy and Community and theatres. -HRBPs are working with new managers to assist in the robust management of sickness. -Review of the health and wellbeing work programme, occupational health initiatives and better communication of support available to staff including counselling. Mandatory training: As of 5th June 2018, 2102 staff have completed the 2018/19 e-assessment. The HR Business Partners are working with their divisions to increase compliance on all aspects of mandatory training. There have been some issues with staff not being able to access to ESR. L&D and IT have been working closely to resolve these issues. One to one support for staff and guides has been made available.

Staff In Post – June 18


Page 42


Appraisal compliance for May remains above target for the Trust for the fifth month.

Agency spend in June was £0.2m beyond the cap set by NHSI and the forecast for the year produced by Divisions far exceeds the annual

target set of £7.4m.

Appraisals: Division 1 continues to implement improvement plans across all service areas that are not complaint following seeing PDR completion rates as a division continue to remain below 85%. Compliance for all divisions will continue to be monitored in AF Oversight meetings with a focus on improvement plans for non-compliant areas.

Agency: Medical spend continues to be high across the clinical Divisions due to cover required for hard to recruit posts. Division One’s increase in Medical spend is predominantly due to additional locum cover within the Emergency Department. Work is progressing with other Trusts to create a 2018/19 regional rate card for medical locums to

help reduce/manage the level of medical spend.

Agency Activity


Page 43

WTE year on year movement by staff group:

Documents

Performance report Page · June 2018 Page 2 Introduction This month’s performance report provides separate detail of the June performance for both Colchester Hospital University