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Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
Report to Trust Board
Date 3 November 2009
Agenda Number O2
Agenda Item Clinical Operations Performance Report – September 2009
Sponsor Joanne Gibbs, Director of Operations
Prepared by Performance Team
Presented by Michael Lock, Head of Performance
EXECUTIVE SUMMARY
1 Purpose and key issues
The purpose of this paper is to present a summary of Trust achievement against key
performance indicators and to brief the Trust Board on operational performance issues from
the Clinical Directorates.
Key issues include:
2008/09 Annual Healthcheck results
Elective referral growth continues above plan with significant growth in some key specialties
Non-elective activity growth is high compared to previous seasonal trends
Outpatient follow up activity is still above plan but expecting to reduce further
2 Supporting Information
Is attached
3 Controls and assurances
The full Clinical Operations Performance Report is presented to the Finance & Performance
Committee prior to Trust Board. A summary report is also presented to Clinical Services
Executive Committee. The items within this report are the subject of scrutiny through internal
performance management and governance systems. Most items are also subject to external
reporting to the Department of Health, South West Strategic Health Authority, or
commissioning Primary Care Trusts.
4 Legal Implications
The legal implications have been considered and none have been identified.
5 Equality and Diversity Implications
The Trust aims to design and implement services, policies and measures that meet the diverse
needs of our service, population and workforce, ensuring that none are placed at a
disadvantage over others. No adverse or positive impacts have been identified from this report.
Performance Team Page 1 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
6 Patient, Public and Staff Involvement
The Trust ensures that patients, the public and staff are involved in the decision-making
process when appropriate.
7 Cost implications
There are no direct cost implications.
8 Potential risk to the organisation
This report aims to reduce the risk of non-achievement against key performance standards by
clearly showing the current performance position and highlighting any areas of specific
concern.
9 Board prompts
Is the Board confident that there are effective systems for identifying potential issues early
and for keeping THE Board informed.
10 Recommendations
The Trust Board is asked to APPROVE this report.
11 References
None
12 Strategic Objectives
The Trust’s Strategic Objectives were reviewed by the Board in July 2009.
X Effective care Exceptional workforce
X Financial health Integrated care
Modern environments X Sustainable services
13 Principal Risks
The Principal Risks have been identified through the Trust’s risk management processes. They
are updated as and when required.
Financial planning & management Clinical records management
Strategic & business planning Leadership & management
Workforce numbers Unsafe behaviour
Workforce skills External demands
Procedural management Partnership arrangements
Equipment & facilities arrangements
Performance Team Page 2 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
14 Standards for Better Health
The core Standards for Better Health have been developed by the Healthcare Commission.
Compliance with the Standards throughout the year forms a part of the Trust’s Annual Health
Check.
Complaints – Service
C1a Incident Reporting C7c Clinical Governance C14c
improvements
Equality & Diversity
C1b Safety Alerts X C7e C15a Patient Food Standards
Whistle blowing
C2 Child Protection C8a C16 Patient Information
NICE – Interventional Personal Development Patient & Public
C3 C8b C17
procedures Programmes Involvement
Access to Services –
C4a Infection Control C9 Records Management X C18
Equality & Choice
Access to Services –
C4b Medical Devices C10a Employment Checks X C19
Emergency care
Professional Codes of Security and Health &
C4c Decontamination C10b C20a
Conduct Safety
Patient Privacy &
C4d Medicine Management C11a Recruitment C20b
Confidentiality
Mandatory Training
C4e Waste Management C11b C21 Hospital Cleanliness
NICE – Technology Professional Public Health – Health
C5a C11c C22a
appraisals Development inequalities
Clinical Supervision Research & Public Health – D of PH
C5b C12 C22b
& Leadership Development report
Clinical Professional Public Health - Working
C5c C13a Dignity & Respect C22c
Development with partners
Public Health – Health
C5d Clinical Audit C13b Consent to treatment C23
promotion
Healthcare bodies co- Use of Confidential
C6 C13c C24 Major Incident Planning
operating together Information
Complaints –
C7a Corporate Governance C14a Information
Complaints – Non-
C7b Finance & Probity C14b
discrimination
Performance Team Page 3 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
Clinical Operations
Monthly
Performance
Summary Report
Month 6
September 2009
Prepared: 28 October 2009
Updated:
Performance Team Page 4 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
CONTENTS PAGE
NO
1 Key Performance Indicator Summary 7
2 Care Quality Commission National Standards 9
3 MRSA & Clostridium Difficile 11
4 Standards for Better Health 13
5 Hospital Standardised Mortality Rate 14
6 Glossary of Terms 15
Performance Team Page 5 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
Unless otherwise stated this report is based on data at the end of September 2009.
Key to Performance Traffic Lights
Traffic Light Key Performance
Red Worse than plan
Amber Almost on plan
Green As plan or better
Key to Direction of Travel
Key
Variation between actual performance
and planned performance indicates an
improvement since last month
Variation between actual performance
and planned performance has
remained constant since last month
Variation between actual performance
and planned performance indicates a
deterioration since last month
Performance Team Page 6 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
SECTION 1 KEY PERFORMANCE INDICATOR - SUMMARY
% Traffic Mar 10 Direction
Plan Actual Variance Variance Light Plan of Travel
Key Performance Indicators – SEPTEMBER DATA
MRSA (Cum.)
4 2 -2 n/a 8
C.Diff (Cum.)
Acute >3 Days
20 14 -6 n/a 39
18wk RTT
Admitted
90% 97.1% n/a +7.1% 90%
18wk RTT
Non-Ad.
95% 99.6% n/a +4.6% 95%
Outpatients
Waiting >11 wks
0 1 +1 n/a 0
Elective patients
Waiting >20 wks
0 0 0 n/a 0
Diagnostics
Waiting >6 wks
0 0 n/a n/a 0
A&E 4 HR waits
Q2 (Inc. MIU)
98% 98.09% n/a +0.09% 98%
Cancer 14 Day
Urgent Referral
93% 95.6% 260/272 +2.6% 93%
Symptomatic
25/36
Breast 14 Day 93% 69.4%
(Aug)
-23.6% 93%
(August)
Cancer 31Day
Diag. to Treat
96% 100% 73/73 +4.0% 96%
Cancer 31Day
Subs Surgery
94% 100% 13/13 +6.0% 94%
Cancer 31Day
Subs Drug
98% 100% 32/32 +2.0% 98%
Cancer 62 Day
Urg Ref to Treat
85% 78.6% 33/42 -6.4% 85%
Cancer 62 Day
Screening
90% 100% 6/6 +10.0% 90%
Cancer 62 Day
Cons Upgrde
85% 0% 0/1 - 85%
Cancelled Ops.
<28 day (Cum)
100% 100% 90/90 n/a 98%
Cancelled Ops.
As % of <0.80% 0.78% 90 -0.02% 0.8%
Electives
GU Offer <48Hrs
100% 100% 257/257 n/a 100%
Issues to Highlight
To note that the national 14 day standard for Symptomatic Breast clinic referrals applies from
January 2010. Data collection for this indicator is currently being developed. Results are included
in this schedule to ensure visibility of progress.
Performance Team Page 7 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
% Traffic Mar 10 Direction of
Plan Actual Variance Variance Light Plan Travel
Cumulative Activity Consultant Led Services – SEPTEMBER DATA
GP Referrals
15284 15765 +481 +3.1% 30689
Other Referrals
7545 8005 +460 +6.1% 15150
Total Referrals
22829 23770 +941 +4.1% 45839
Outpatient FST
Attends
21552 22061 +509 +2.4% 43275
Outpatient FUP
Attends
38397 41314 +2917 +7.6% 77103
Outpatient
Waiting List
2011 3024 +1013 +50.4% 1680
Elective DC
Activity
8720 8987 +261 +3.1% 17510
Elective IP
Activity
2402 2348 -54 -2.2% 4829
Elective Total
Activity
11124 11349 +225 +2.0% 22339
Elective Waiting
List
1254 1344 +90 +7.2% 1170
Non-elective
(All)
8715 9260 +545 +6.2% 17381
Non-elective
(G&A)
6724 7137 +413 +6.1% 13409
A&E Attendance 18851 20081 +1230 +6.5% 33777
Issues to Highlight
To note that the overall increase in non-elective/emergency admissions has been influenced by
higher than expected demand from non-resident patients through the summer period.
It has been reported that visitor numbers have been higher than in recent years.
The impact of this summer increase is expected to become less significant as we move into the
winter period.
Performance Team Page 8 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
SECTION 2 2008/09 NATIONAL COMMITMENTS & PRIORITY INDICATORS
Care Quality Commission Annual Health Check 2008/09
Existing National Targets Outturn Position Score Comment
Access to Genito-Urinary Medicine (GUM) clinics Achieved 3
Data quality on ethnic group Failed 3>0 Data Transmission
Time to reperfusion for heart attack patients Achieved 3
Delayed transfers of care Failed 2>0 Data Transmission
Total time in A&E Achieved 3
Inpatients waiting longer than the 26 week standard Achieved 3
Outpatients waiting longer than the 13 week standard Achieved 3
Patients waiting for revascularisation Not Applicable -
Waiting times for rapid access chest pain clinic Achieved 3
Cancelled operations and 28 day readmissions Achieved 3
Achieved scores 3 =>25 Fully Met
Max Score = =>22 Almost Met
Under Achieved 2 21 =>19 Fair
Failed scores 00 27 <19 Weak
National Priorities
Smoking during pregnancy and breastfeeding initiation Achieved 3
Participation in heart disease audits Achieved 3
Engagement in clinical audits Achieved 3
Stroke care Under Achieved 2 Sentinel Audit
Maternity HES Data quality indicator Failed 3 >0 Data Transmission
Incidence of MRSA Bacteraemia Achieved 3
Incidence of Clostridium difficile Achieved 3
18 week referral to treatment times (RTT) Achieved 3
All cancers: two week wait Achieved 3
All cancers 31 Day (including new commitment) Achieved 3
All cancers 62 Day (including new commitment) Achieved 3
Experience of Patients – combined into one Indicator Achieved 3
NHS staff satisfaction Achieved 3
Achieved scores 3 =>37 Excellent
Max Score = =>33 Good
Under Achieved 2 35 =>29 Fair
Failed scores 000 39 <29 Weak
Issues to Highlight
The Trust submitted 4 Extenuating Circumstances requests in mid July. Audiology RTT data
completeness was supported by the CQC. However Maternity HES, Ethnicity Data and Delayed
Transfers of Care were not accepted as having extenuating circumstances. As a consequence,
by a margin of one point (21/22), the Trust could not achieve better than Fair for overall Quality
of Services.
Care Quality Commission 2009/10 - Periodic Review Indicators
Performance Team Page 9 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
31 Mar 2010 Forecast Current position
Existing Commitments Forecast position Score Vs Plan
Access to Genito-urinary medicine (GUM) clinics Achieved Equal
Data quality on ethnic group Achieved Better
Time to reperfusion for heart attack patients Achieved Worse
Delayed transfers of care Under Achieved Worse (4.0%)
Total time in A&E Achieved Higher Risk
Inpatients waiting longer than the 26 week standard Achieved Equal
Outpatients waiting longer than the 13 week standard Achieved Equal
Patients waiting for revascularisation Not Applicable
Waiting times for rapid access chest pain clinic Achieved Equal
Cancelled operations and 28 day readmissions Achieved Higher Risk
National Priorities
Access to healthcare for people with learning disability Achieved New Indicator
Smoking during pregnancy and breastfeeding initiation Achieved Worse (smoking)
Participation in heart disease audits Achieved TBC
Engagement in clinical audits Achieved TBC
Stroke care Achieved TBC
Maternity HES Data quality indicator Achieved Equal
Incidence of MRSA Bacteraemia Achieved Better
Incidence of Clostridium difficile Achieved Better
18 week referral to treatment times (RTT) Achieved Better
All cancers: two week wait Achieved Better
All cancers 31 Day (including new commitment) Achieved Better
All cancers 62 Day (including new commitment) Achieved Worse
Experience of Patients - combined into one Indicator Achieved TBC
NHS staff satisfaction Achieved TBC
Issues to Highlight
This is an early forecast pending CQC publication of further details and achievement thresholds.
Performance Team Page 10 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
SECTION 3 MRSA & CLOSTRIDIUM DIFFICILE
SEPTEMBER DATA
Cumulative Actual Variance Traffic 2009/10 Direction
MRSA Plan Cases from Plan Light Plan of Travel
Number of infections 4 2 -2 8
2009/10 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot
Taken in A&E 0 0 0 0 0 0 0
Taken at DC Admission 0 0 0 0 0 0 0
< 2 days of Admission 0 0 0 0 1 0 1
2+days after Admission 0 0 0 0 0 1 1
Total Cases 0 0 0 0 1 1 2
Plan Trajectory 1 1 0 1 1 0 1 1 0 1 1 0 8
Issues to Highlight
One case of MRSA during September taken more than 2 days after admission to NDDH.
Actions to Improve Performance
Continuation of plans developed in conjunction with the DH Improvement Review Team.
MRSA Hospital Acquired Infection 2008-09
2009-10
4
3
2
1
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
MRSA Community Acquired Infection 2008-09
2009-10
5
4
3
2
1
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2008-09
MRSA Infection Trust Total 2009-10
2009-10 Plan
10
8
6
4
2
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
SEPTEMBER DATA
Performance Team Page 11 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
Clostridium Difficile Cumulative Actual Variance Traffic 2009/10 Direction of
Plan Cases from Plan Light Plan Travel
Number of infections
(NDDH >3 Days Cum.)
20 14 -6 39
Acute Hosp Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot
NDDH >3 Days 2 3 2 3 1 3 14
Monthly Plan 4 3 3 4 3 3 4 3 3 4 3 2 39
Cumulative Total 2 5 7 10 11 14
Cumulative Plan 4 7 10 14 17 20 24 27 30 34 37 39
Comm. Hospital Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot
NDHT CHs >3 Days 1 0 2 0 1 0 4
Cumulative Total 1 1 3 3 4 4
ND ‘Community’ Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Tot
NDDH <3 Days 3 1 1 0 1 0 6
CHs <3 Days 0 0 0 0 0 0 0
From DPT 0 0 0 0 0 0 0
Stratton Hosp. 0 0 0 0 0 0 0
From GP 2 0 1 3 0 0 6
Monthly Total 5 1 2 3 1 0 12
Cumulative Total 5 6 8 11 12 12
Cum Plan
Acute Hospital Clostridium Difficile Cumulative
Cum 2009/10
Cum 2008/09
80
60
40
20
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Acute Hospital Clostridium Difficile Monthly Mth Plan
Mth 2009/10
Mth 2008/09
10
8
6
4
2
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Issues to Highlight
There were 3 cases of C.Difficile taken within the Acute Hospital three or more days after
admission during September.
Performance Team Page 12 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
SECTION 4 STANDARDS FOR BETTER HEALTH - SEPTEMBER END POSITION
At the end of March 2009 the Trust self assessment showed that all core standards had
been fully met throughout the previous year.
Ongoing monitoring during 2009/10 indicates continuing compliance with all 44 core
standards.
Core Standards for Better Health Not Met Met by Year end Fully Met
50
44 44
37
24
22
19
14
6 6
3
0 0 0 0 0
0
2005/06 Outturn 2006/07 Outturn 2007/08 Outturn 2008/09 Declared 2009/10 Forecast
Performance Team Page 13 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
SECTION 5 HOSPITAL STANDARDISED MORTALITY RATE
All Specialties January 2006 – June 2009 by Quarter (Source Dr Foster)
Trend (Quarter) Spells Superspells % Deaths % Expected % RR Low High
2006-Q1 8970 8914 5.40% 186 2.10% 216 2.40% 86.1 74.2 99.4
2006-Q2 8930 8881 5.40% 148 1.70% 173.3 2.00% 85.4 72.2 100.3
2006-Q3 9257 9177 5.60% 143 1.60% 182 2.00% 78.6 66.2 92.6
2006-Q4 9331 9170 5.60% 165 1.80% 209.1 2.30% 78.9 67.3 91.9
2007-Q1 9128 8810 5.40% 187 2.10% 201.5 2.30% 92.8 80 107.1
2007-Q2 9754 9421 5.70% 193 2.00% 205.2 2.20% 94 81.2 108.3
2007-Q3 10326 9998 6.10% 183 1.80% 182.4 1.80% 100.3 86.3 115.9
2007-Q4 10415 10078 6.10% 200 2.00% 198.9 2.00% 100.5 87.1 115.5
2008-Q1 10496 10123 6.20% 206 2.00% 218.5 2.20% 94.3 81.8 108.1
2008-Q2 10657 10381 6.30% 222 2.10% 214.5 2.10% 103.5 90.3 118
2008-Q3 10657 10333 6.30% 181 1.80% 181.4 1.80% 99.8 85.8 115.4
2008-Q4 10862 10497 6.40% 247 2.40% 229 2.20% 107.9 94.8 122.2
2009-Q1 11042 10705 6.50% 230 2.10% 230 2.10% 100 87.5 113.8
2009-Q2 10835 10478 6.40% 182 1.70% 203 1.90% 89.7 77.1 103.7
Trend (Quarter) Spells Superspells % Deaths % Expected % RR Low High
Issues to Highlight
The Trust overall HSMR is generally close to the expected level.
To note that the ‘expected’ HSMR has recently been recalculated nationally. Lowering of the
expected level has resulted in a slight increase of the Trust HSMR position. This change will also
have affected other Trusts.
The case mix standardised expected national average is a score of 100 where lower is better.
Where the confidence interval crosses the 100 line then the variation is not statistically
significant. If the complete confidence interval is above or below 100 then the Trust position is
considered to be statistically better or worse than the expected position.
Performance Team Page 14 of 15
Clinical Operations Performance Report - September 2009 Northern Devon Healthcare NHS Trust
Trust Board Meeting 3 November 2009
SECTION 6 GLOSSARY OF TERMS
A&E Accident and Emergency Department
C/D Core Standard/Developmental Standard
CHD Coronary Heart Disease
CONS Consultant
CT Computer Tomography
CTN Call To Needle time
CQC Care Quality Commission (previously Healthcare Commission)
CUM Cumulative
DC Day Case
DGH District General Hospital
DIR Direction
DTN Door To Needle time
EM Emergency
ENT Ear, Nose and Throat
FFCE First Finished Consultant Episode
FTE Full Time Equivalent (number of staff)
FUP Follow Up (Outpatient Attendances)
G&A General and Acute specialties only (excludes Obstetrics & Midwifery)
GP General Practioner
HCC Healthcare Commission
HSMR Hospital Standardised Mortality Ratio
IP In Patient
IT Information Technology
LDP Local Delivery Plan
MIU Minor Injuries Unit (in Community Hospitals)
MRI Magnetic Resonance Imaging
MRSA Methicillin Resistant Staphylococcus Aureus
NDHT Northern Devon Healthcare NHS Trust
NICE National Institute for Clinical Excellence
NON CONS Non-Consultant
NSF National Service Framework
OP Out Patient
OPS Operations
OT Occupational Therapy
Q1 Quarter 1 (IE April – June)
RACP Rapid Access Chest Pain
RD&E Royal Devon & Exeter NHS Foundation Trust
SALT Speech and Language Therapy
SWAST South West Ambulance Services Trust
TBC To Be Confirmed
TYPE 1 A&E department located at main hospital
VI Vertical Integration (of staff transferred from ND PCT in Oct 2006)
WL Waiting List
WTE Whole Time Equivalent (number of staff)
YTD Year To Date
Performance Team Page 15 of 15
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