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FRONT Sheet

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									 ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST

           INTEGRATED PERFORMANCE REPORT

                          DECEMBER 2008


APPENDICES:

       - 18 Week Programme Managers Report           Appendix 1

       - Finance Tables                              Appendix 2

           Key financial performance indicators
           Foundation Trust Risk Metrics
           Income & Expenditure Summary
           Balance sheet – actual year to date and forecast
           Cash flow statement – actual year to date and forecast

       -   IM & T Committee Update                   Appendix 3

       -   Workforce Partnership Update              Appendix 4
Performance Report                                                                                   1 April 2008 - 30 November 2008
 Overall   Year to   Current
                               No.                                            Title                                               Lead        Due Date   Report Updated?
 Status     Date      Month


 p          p         p        1a Quality target - Zero MRSA bacteraemia cases contracted within RNOH
                                                                                                                                Charlie
                                                                                                                                Sheldon
                                                                                                                                             31 Mar 09        
 q          q         q        1b Quality target - Zero pressure ulcers acquired within the RNOH
                                                                                                                                Charlie
                                                                                                                                Sheldon
                                                                                                                                             31 Mar 09        
 p          p         p        1c Quality target - National tolerance on clostridium difficile not exceeded (9 cases 08/09)
                                                                                                                                Charlie
                                                                                                                                Sheldon
                                                                                                                                             31 Mar 09        
 p          p         p        1d Quality target - No increase in surgical site infection rates
                                                                                                                                Charlie
                                                                                                                                Sheldon
                                                                                                                                             31 Mar 09        
 q          q         q        2a
                                  Access target - 18 week target - referral to treatment 90% for admitted patients and
                                  95% for non-admitted - trajectory to December 2008
                                                                                                                                Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Dec 08        
 q          q         p        2b
                                  Access target - 18 weeks target - maintain data completeness in line with national
                                  target of 90% - 120%
                                                                                                                                Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Dec 08        
 q          q         q        2c Access target - No breaches of current inpatient & outpatient access targets
                                                                                                                                Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Mar 09        
 q          q         q        3 Activity target – 10,249 NHS inpatients discharged (7% above 2007/08 income)
                                                                                                                                Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Mar 09        
 q          q         q        4 Strategic target - Hit all milestones in Foundation Trust timetable                          Ahmet Koray    31 Mar 09        
 q          q         q        5 Strategic target - Gain approval from SHA for hospital rebuild                               Mark Masters   31 Mar 09        
 p          p         p        6a Financial target - £985k revenue surplus for 2008/09                                        Ahmet Koray    31 Mar 09        
 p          p         p        6b Financial target - Paybill budget not exceeded                                              Ahmet Koray    31 Mar 09        
 q          q         q        7a
                                     Management & leadership target - achieve trajectory to improve staff appraisal
                                     average over a 15 month period – 70% by October 2008; 90% by March 2009
                                                                                                                                 Mark
                                                                                                                                Vaughan
                                                                                                                                             31 Mar 09        
 q          q         q        7b
                                     Management & leadership target - Achieve trajectory to reduce sickness rates to
                                     3.5% by March 2009
                                                                                                                                 Mark
                                                                                                                                Vaughan
                                                                                                                                             31 Mar 09        
 q          q         p        8a
                                     Performance target - No breaches of 28 day guarantee for operations cancelled on
                                     day of admission
                                                                                                                                 Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Mar 09        
 q          q         q        8b
                                     Productivity target - No increase in cancellations before admission on day of
                                     admission compared to 2007/08
                                                                                                                                 Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Mar 09        
 q          q         q        8c
                                     Productivity target - No increase in cancellations after admission (HRG S22)
                                     compared to 2007/08
                                                                                                                                 Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Mar 09        
 p          p         p        8d
                                     Productivity target - no increase in out-patient new to follow-up ratio compared to
                                     2007/08
                                                                                                                                 Sheila
                                                                                                                                Puckett
                                                                                                                                             31 Mar 09        
Performance Report (Commentary)                                                                                                  1 April 2008 - 30 November 2008
                Responsible Director          Charlie Sheldon                Due Date Tuesday, March 31, 2009          Report Status     Overall    Perf. Ind.    Plan   Current Month

       Top 10                1a        Quality target - Zero MRSA bacteraemia cases contracted within RNOH               Updated          p           p           p          p

                                                                                         Projected Variance at                          Current
        Month              Target          Actual         Variance       Variance %                              Plan Status                            Completed by:        Date
                                                                                              Completion                                 Month

##################           0               0                0                         On target                Plan in place          On Target      Lesley Macleod       9/12/08


Key achievements since last update
No cases recorded for the month of November.




Current concerns
No significant concerns at present. Awareness of importance of infection control to be improved.




Remedial actions
Not applicable
Performance Report (Commentary)                                                                                                     1 April 2008 - 30 November 2008
                Responsible Director           Charlie Sheldon                Due Date Tuesday, March 31, 2009            Report Status           Overall     Perf. Ind.      Plan       Current Month

       Top 10                1b        Quality target - Zero pressure ulcers acquired within the RNOH                        Updated               q             q             p              q

                                                                                           Projected Variance at                                 Current
        Month              Target          Actual          Variance       Variance %                                Plan Status                                   Completed by:               Date
                                                                                                Completion                                        Month
                                                                                                                                                  Behind
##################            0              39               39                         Behind target              Plan in place                                 Lesley Macleod            9/12/08
                                                                                                                                                   target

Key achievements since last update
7sores, a decrease in month of 2 sores and an improvement in severity of sores. Further work is in progress to prevent sores in patients leaving wards on trolleys for tests and investigations. Alan
Bray unit 2 x grade 1 ulcer,1 x grade 2 ulcer. Duke of Gloucester patient went to x-ray on trolley, for 3 hours skin was unmarked, but on return there was a grade 1 ulcer. Jackson Burrows, 1 blister
formed to crease of buttocks and 1 natal cleft split detected. Margaret Harte had 1 sacrum shearing.




Current concerns




Remedial actions
Director of Nursing will now meet with each Ward Manager each time a pressure sore occurs.
Performance Report (Commentary)                                                                                                       1 April 2008 - 30 November 2008
                Responsible Director           Charlie Sheldon                  Due Date Tuesday, March 31, 2009            Report Status     Overall    Perf. Ind.    Plan   Current Month

       Top 10               1c
                                       Quality target - National tolerance on clostridium difficile not exceeded (9
                                       cases 08/09)
                                                                                                                              Updated          p           p           p          p

                                                                                            Projected Variance at                            Current
       Month              Target           Actual          Variance        Variance %                                 Plan Status                            Completed by:        Date
                                                                                                 Completion                                   Month

#################           6                 4                -2              -33%        On Target                  Plan in place          On Target      Lesley Macleod       9/12/08


Key achievements since last update
0 cases reported for November




Current concerns
There are no current concerns.




Remedial actions
Performance Report (Commentary)                                                                                                      1 April 2007 - 30 November 2008
                Responsible Director           Charlie Sheldon                  Due Date Tuesday, March 31, 2009           Report Status     Overall    Perf. Ind.    Plan   Current Month

       Top 10               1d         Quality target - No increase in surgical site infection rates                         Updated          p           p           p          p

                                                                                             Projected Variance at                          Current
       Month              Target            Actual          Variance        Variance %                               Plan Status                            Completed by:        Date
                                                                                                  Completion                                 Month

#################            8                1                -7              -88%        On Target                 Plan in place          On Target      Lesley Macleod       9/12/08


Key achievements since last update
No further cases for November. The next quarterly report for hips, knees and spines is due in January.




Current concerns
No significant concerns at present.




Remedial actions
Performance Report (Commentary)                                                                                                    1 April 2008 - 30 November 2008
                Responsible Director              Sheila Puckett              Due Date ####################              Report Status         Overall      Perf. Ind.      Plan      Current Month


                                                                                                                                                 q
                                       Access target - 18 week target - referral to treatment 90% for admitted
       Top 10               2a
                                       patients and 95% for non-admitted - trajectory to December 2008
                                                                                                                           Updated                            q             p              q

                                                                                           Projected Variance at                               Current
       Month              Target           Actual           Variance      Variance %                               Plan Status                                  Completed by:              Date
                                                                                                Completion                                      Month
                                                                                                                                               Behind
#################            8                8                    0          0%         Behind target             Plan in place                               Lesley Macleod            11/12/08
                                                                                                                                                target

Key achievements since last update
Figures submitted for November show 92% compliance for non-admitted patients and 69% compliance for admitted patients. For admitted patients the backlog has reduced significantly and non
spinal is now approximately 150 patients, or 1.5 weeks work. For non admitted patients, the backlog is reducing and more effort is being applied to ensuring that the backlog reduces further. Non
spinal backlog is approximately 50% in total.
Completion of clinic outcome forms has improved to 85%; 95% is the necessary rate. Clinic processes were externally reviewed during a DH intensive support team visit and were found to be
robust and embedded. Some excellent practice was reinforced, suggestions for improvment paricularly to the Clinic Outcome Forms, are being acted on.
The new 18 week waiting list tool has been finalised and will be implemented in December, training has been put in place for new methodology for all relevant staff.
Additional resource has been targeted at chasing unknown clock starts to enable effective 18 week management of patients during December and next quarter with good results. and the steady

Current concerns
As we apporoach Christmas we are noting that some patients in the backlog have declined surgery before Christmas. Patients are therefore still being dated appropriately in the future.
The performance remains flat and below trajectory for admitted in particular but we continue to push through backlog patients in an effort to ensure improved compliance after the end of December.
This will also impact on our overall performance for December.
The plan for admitted backlog is vulnerable to any problem arising in theatre - 2 days were lost in November - these risks have been added to the risk register.




Remedial actions
Implementation of the 18 week PTL over the next 2 weeks will enable greater focus on non admitted performance for patients past first outpatient appointment and in the diagnostic stage.
Booking current known backlog patients through out December as much as possible and identifying potential backlog coming through the outpatient waiting list.
Further cleansing of data continues to ensure effective use of the PTL and a model established to asses proportion of 18 week patients booked for January, February and March by unit and
consultant in order to inform future assessment of performance..
Performance Report (Commentary)                                                                                                     1 April 2008 - 30 November 2008
                Responsible Director           Sheila Puckett                 Due Date ####################               Report Status           Overall   Perf. Ind.    Plan   Current Month

       Top 10                2b
                                       Access target - 18 weeks target - maintain data completeness in line with
                                       national target of 90% - 120%
                                                                                                                            Updated                q          q           p          p

                                                                                          Projected Variance at                                  Current
        Month             Target           Actual         Variance        Variance %                                Plan Status                                 Completed by:        Date
                                                                                               Completion                                         Month

#################            1                                                          On target                   Plan in place               On Target      Lesley Macleod      11/12/08


Key achievements since last update
Provisional Data completeness figures for November are 88% for admitted and 90% for non-admitted.
For the last week in November unknown clock starts were reported as 10% of non-admitted patients, and 16.2% of admitted.
Improvement of clinic outcome forms to 85% is improving data quality.




Current concerns
Data completeness is still being hampered by unknown clock start dates.
The impact of correct clock starts upon data completeness has to be considered before January to ensure any additional adjustments are secured. This is in hand.
The IST visit raised some issues with the COFs, primarily that too many clocks could be started and stopped which could be affecting data quality.




Remedial actions
Additional resource and effort is being applied to obtain clock start for referrals and we are targeting the reduction to zero by 15th December 2008.
Review of impact of establishing correct clock starts.
Some points from IST visit have been adopted and COF undergoing redesign.
Performance Report (Commentary)                                                                                                    1 April 2008 - 30 November 2008
                Responsible Director              Sheila Puckett              Due Date Tuesday, March 31, 2009           Report Status           Overall     Perf. Ind.      Plan       Current Month

       Top 10               2c
                                       Access target - No breaches of current inpatient & outpatient access
                                       targets
                                                                                                                            Updated               q             q             p              q

                                                                                          Projected Variance at
        Month             Target           Actual           Variance      Variance %                               Plan Status                Overall Risk       Completed by:               Date
                                                                                               Completion
                                                                                                                                                 Behind
#################            0                2                    2                    Behind target              Plan in place                                 Lesley Macleod            11/12/08
                                                                                                                                                  target

Key achievements since last update
1 breach in November, 2 cumulative to date. The operation was due to take place at the end of November, but the surgeon was taken ill in theatre on the day the operation was due to take place
and therefore there was no time to rebook the patient before the end of the month. A new date has now been given. Despite significant problems in managing spinal patients all were dated
appropriately.
 We are still within the tolerance forachieving the standard against our activity for the year to date.




Current concerns
Increased referral rates which were first noted from July onwards will result in increasing pressure on the 26 week wait target. There are at least 7 potential breaches in February for degenerative
spinal operations.




Remedial actions
Additional capacity is being sourced in both the independent sector and the NHS. The surgeon concerned has also formally agreed to local rates for out of job plan working, and the general
manager is working with the consultant to avoid the breaches. From February on, the new consultant for the degenerative spinal work should relieve the pressure on this type of work.
Performance Report (Commentary)                                                                                                  1 April 2008 - 30 November 2008
                Responsible Director           Sheila Puckett               Due Date Tuesday, March 31, 2009           Report Status           Overall     Perf. Ind.      Plan      Current Month

       Top 10                3
                                       Activity target – 10,249 NHS inpatients discharged (7% above 2007/08
                                       income)
                                                                                                                          Updated               q             q            p              q

                                                                                        Projected Variance at
       Month              Target           Actual         Variance      Variance %                               Plan Status                Overall Risk       Completed by:              Date
                                                                                             Completion
                                                                                                                                               Behind
#################          6995             6735            -260            -4%        On Target                 Plan in place                                 Lesley Macleod            9/12/08
                                                                                                                                                target

Key achievements since last update
849 patient discharges compared to 935 planned discharges in November. Activity is 10% above equivalent period last year.




Current concerns
Joint reconstruction, foot and ankle and shoulder surgery are the units behind target.
The target for JRU was set at the beginning of the year anticipating 50 discharges from SPIRE during this month. In fact, only 14 took place as the backlog of routine work proved smaller than
anticipated and was dealt with more quickly earlier in the year.
Two JRU lists were lost due to equipment breakdown in theatre, and a further 12 operations did not take place due to unfit patient or DNA.
Both Foot and Ankle surgeons were absent for a week in November, but the unit is ahead of target year to date.
Shoulder unit was not able to pick up any extra lists during the month.


Remedial actions
Less complex patients continue to be sent to SPIRE Bushey in order to release capacity and additional lists are being undertaken at the weekends.
Performance Report (Commentary)                                                                                                     1 April 2008 - 30 November 2008
                Responsible Director              Ahmet Koray                  Due Date Tuesday, March 31, 2009           Report Status          Overall      Perf. Ind.      Plan        Current Month

       Top 10                4         Strategic target - Hit all milestones in Foundation Trust timetable                  Updated               q             q             p               q

                                                                                            Projected Variance at                                Current
        Month             Target           Actual          Variance        Variance %                               Plan Status                                   Completed by:               Date
                                                                                                 Completion                                       Month
                                                                                                                                                 Behind
#################            8                7                 -1            -13%        Behind target             Plan in place                                Lesley Macleod              9/12/08
                                                                                                                                                  target

Key achievements since last update
A revised timetable has been presented to the Trust Board for consideration to reflect the unlikely support of NHS London to allow the Trust to proceed with a full application in June 2008. This is a
result of the potential performance target issues the Trust currently faces, delivery of improved Audit Commission ALE scores, developing an affordable procurement option for the redevelopment
and mitigating the financial impact of HRG version 4 when introduced. These 4 factors are considered significant enough to warrant a delay in the application until the end of 2009, by which time,
performance targets including the ALE scores are expected to improve and clarity on the redevelopment and HRG version 4 obtained.




Current concerns
1. Uncertainty as to quantification of impact of national tariff changes impact from 2009/10 onwards (reference costs remain 2nd highest in the country under the new tariff structure)
2. Delivery of 18 weeks access target
3. Redevelopment PFI/Financing uncertainty and affordability risks
4. Private Patient income cap - statutory requirement to restrict income to 2002/3 levels (a reduction of £1.7m net contribution);
5. Membership numbers - 2000 non-staff members need to be increased to c3000;
6. Trust Board development to ensure readiness for FT status.


Remedial actions
1. Continue road testing of tariff changes achieved by the Specialist Orthopaedic Alliance agreement with DH - Autumn - December/January;
2. Maximise financial surplus by March 2008 and 2008/09 financial plan through continuing the Turnaround project;
3. Deliver 18 week access action plan
4. Consult with legal advice and other Foundation Trusts on options to address Private Patient Income cap;
5. Expand membership campaign;
6. Implement Board Development plan agreed at Foundation Trust Project Steering Group - Board to Board practice days to review business units; further development support available from SHA;

7. Report produced for NHS London outlining Redevelopment procurement options
Performance Report (Commentary)                                                                                                     1 April 2008 - 30 November 2008
                Responsible Director              Mark Masters                 Due Date Tuesday, March 31, 2009            Report Status           Overall     Perf. Ind.      Plan       Current Month

       Top 10                5         Strategic target - Gain approval from SHA for hospital rebuild                        Updated                q             q             p              q

                                                                                           Projected Variance at                                  Current
        Month              Target          Actual          Variance       Variance %                                Plan Status                                    Completed by:               Date
                                                                                                Completion                                         Month
                                                                                                                                                  Behind
#################            8                8                  0             0%        Behind target              Plan in place                                  Lesley Macleod            9/12/08
                                                                                                                                                   target

Key achievements since last update
OBC has now been approved by the SHA and Department of Health OBC checklist has been submitted in preparation for meeting to discuss financing options and procurement route. An
Executive report setting out the implications of IFRS on the affordability of a PFI scheme, impact of breaching the Trust's future Prudential Borrowing Limit (PBL) as well as looking at other potential
financing solutions, has been prepared and submitted to NHS London. The report outlines the difficulties the Trust faces in securing finance for the redevelopment and has sought a response from
NHS London on a way forward. The Trust's preferred option is to secure public funding through Public Dividend Capital (PDC) for the balance (£96million) after land sales and a contribution from
Special Trustees.




Current concerns
Financing including land sales & fund raising strategies, action plan and timetable yet to be agreed by Trust Board.




Remedial actions
Post report - continued dialogue with NHS London and Department of Health to discuss financing options (Public Dividend Capital or alternative innovative solutions).
Performance Report (Commentary)                                                                                                   1 April 2008 - 30 November 2008
                Responsible Director            Ahmet Koray                   Due Date Tuesday, March 31, 2009          Report Status       Overall     Perf. Ind.      Plan      Current Month

       Top 10                6a        Financial target - £985k revenue surplus for 2008/09                               Updated            p             p            p              p

                                                                                          Projected Variance at                             Current
        Month              Target          Actual          Variance       Variance %                              Plan Status                               Completed by:             Date
                                                                                               Completion                                    Month
                                                                                                                                           Ahead of
#################            59             436                  377        637%        Ahead of target           Plan in place                             Lesley Macleod          12/12/08
                                                                                                                                            target

Key achievements since last update
£148k surplus achieved in November - generating a £436k year to date surplus which is £377k ahead of plan.

Foundation Trust overall risk ratings metrics are as follows:-
- Year to date performance - 3/5
- Forecast full-year outturn - 4/5
- Planned full-year outturn - 4/5


Current concerns
Key Risks to delivery of forecast
• Maintaining NHS activity levels and casemix to support delivery of 18 week access
• Private Patient risks – demand currently below plan and risk of reduced paediatric private capacity
• 18 week fines
• Redevelopment project costs not funded
• Back-dated Agenda for Change Assimilation - Medirest staff


Remedial actions
The Finance Director's Report to Performance Committee recommends that the Finance Director leads on the following:-
o Maintaining regular monthly review of the financial forecast and forecast risks through the Trust’s performance review framework (i.e. Directorate Performance Review, Performance Committee
and Trust Board).
o Reporting projected variances from plan and mitigating corrective measures back to the performance committee following review at Directorate performance review meetings.
o Lead directors and managers to continue to work to deliver the mitigating actions described in the risk table reviewed in performance committee.
Performance Report (Commentary)                                                                 1 April 2008 - 30 November 2008
           Responsible Director       Ahmet Koray              Due Date ############## Report Status            Overall     Perf. Ind.    Plan      Current Month
      Top 10              6b      Financial target - Paybill budget not exceeded                 Updated         p             p           p             p

                                                                             Projected
                                                                                                                Current
       Month            Target      Actual    Variance     Variance %       Variance at       Plan Status                      Completed by:             Date
                                                                                                                 Month
                                                                             Completion
################        30193       29662       -531           -2%        On Target           Plan in place    On Target       Lesley Macleod          11/12/08

Key achievements since last update
The year-to-date position remains favourable against plan with an advantageous variance of £531k.




Current concerns
Recruitment and retention of key staff remains a concern in theatres and on some wards. An overseas recruitment drive has been undertaken in November
2008 for theatre nurses from Europe.




Remedial actions
Plans to increase staffing to meet the 18 week activity target are very clearly set out and agreed before this expenditure is committed. A clear process is set up
to ensure that agreed increased pay costs relating to additional NHS activity are reflected in devolved budgets so that budgetary control is not undermined.
Performance Report (Commentary)                                                                                      1 April 2008 - 30 November 2008
            Responsible Director           Mark Vaughan                  Due Date Tuesday, March 31, 2009 Report Status            Overall      Perf. Ind.   Plan    Current Month

                                                                                                                                    q              q         p           q
                                   Management & leadership target - achieve trajectory to improve staff
       Top 10             7a                                                                                Updated
                                   appraisal average over a 15 month period – 70% by October 2008; 90%


                                                                                      Projected Variance at
       Month            Target         Actual         Variance        Variance %                                Plan Status     Current Month     Completed by:          Date
                                                                                           Completion
#################        75%           58.6%              0              -22%        Behind target              Plan in place   Behind target     Lesley Macleod        9/12/08

Key achievements since last update
The number of appraisals undertaken has increased in the last month, with some areas making a marked improvement. Managers are starting to submit their schedule for appraisals
and the Director of HR/HRD Manager are meeting managers to provide support and advice where take up has remained low.




Current concerns
Managers have chosen to postpone appraisals whilst focussing on activity but it is anticipated that an increase in appraisals will take place in December/January.




Remedial actions
Appraisals are discussed at every senior managers' meeting. The Director of HR and the HRD Manager are meeting with managers with low take-up to ensure that adequate support
is provided.
Performance Report (Commentary)                                                                                                     1 April 2008 - 30 November 2008
                Responsible Director           Mark Vaughan                   Due Date Tuesday, March 31, 2009            Report Status           Overall      Perf. Ind.      Plan       Current Month

       Top 10                7b
                                       Management & leadership target - Achieve trajectory to reduce sickness
                                       rates to 3.5% by March 2009
                                                                                                                             Updated               q              q            p               q

                                                                                          Projected Variance at                                   Current
        Month             Target           Actual         Variance        Variance %                                Plan Status                                    Completed by:               Date
                                                                                               Completion                                          Month
                                                                                                                                                  Behind
#################           3.70            3.79              0               2%         Behind target              Plan in place                                 Lesley Macleod             11/12/08
                                                                                                                                                   target

Key achievements since last update
The HR Department continues to work with managers to reduce long term sickness in the Trust. Out if 25 staff members identified as having 100 days sickness in the latest months report 7 were
still off sick in November 2008.




Current concerns
The overall monthly rate for November has decreased to 2.41. 13 staff members were on long term sick (28 days continuous) as at 31October 2008 an increase of one from last month. A report for
the period between December 2007 and November 2008 shows 25 members of staff had more than 100 days sickness.




Remedial actions
The HR department continues to work with managers on return to work or dismissal/ill health retirement. HR are running monthly reports to identify staff who are on long term sick to help them
back to work. More in depth investigations are underway to identify where the increase in sickness is occurring. In addition to the departmental sickness rates, the highest 'Bradford' scores for staff
are sent to General Managers on a monthly basis.
Performance Report (Commentary)                                                            1 April 2008 - 30 November 2008
           Responsible Director       Sheila Puckett      Due Date ################## Report Status         Overall   Perf. Ind.   Plan      Current Month

                                                                                                             q          q           p                p
                                  Performance target - No breaches of 28 day guarantee
       Top 10             8a                                                            Updated
                                  for operations cancelled on day of admission


                                                        Variance Projected Variance at                     Current
       Month           Target      Actual    Variance                                  Plan Status                       Completed by:               Date
                                                           %          Completion                            Month
#################         0          11         11               Behind target         Plan in place      On Target     Lesley Macleod          11/12/08

Key achievements since last update
No breaches of 28 day guarantee for November. Within tolerance for year to date, but threat to achievement of standard is from volume of cancelled
operations.




Current concerns




Remedial actions
Action Plan being monitored as part of Healthcare Commission Annual Health check monitoring. Communication of operations cancelled in theatre now
circulated on a daily basis to General Managers.
Performance Report (Commentary)                                                                 1 April 2008 - 30 November 2008
           Responsible Director      Sheila Puckett         Due Date ###################       Report Status     Overall    Perf. Ind.    Plan   Current Month

                                                                                                                  q            q          p          q
                                  Productivity target - No increase in cancellations before
       Top 10             8b                                                                      Updated
                                  admission on day of admission compared to 2007/08


                                                         Variance    Projected Variance at                       Current
       Month            Target      Actual    Variance                                        Plan Status                      Completed by:         Date
                                                             %            Completion                              Month
                                                                                                                 Behind
################          13         19           6         46%     Behind target             Plan in place                   Lesley Macleod       11/12/08
                                                                                                                  target

Key achievements since last update
Cumulatively, the number of cancellations are 121 against a performance measure of 101 (1.5% of activity), which translates into a percentage variance of 20%.
The high number is partially explained by the cancellation of 6 patients due to theatre failure.
The number has been validated carefully throughout the month to ensure data is captured correctly, new systems of recording the information have been
implemented which have become embedded and awareness of the importance of the issue has improved considerably. Senior staff in theatre are actively
engaged in the processes.




Current concerns
The pressure to put through volume is pressurising the capacity and reducing the flexibility to cope with operational problems as they arise.
Lists are reportedly ambitious and not achievably by junior medical staff.




Remedial actions
Performance Report (Commentary)                                                                1 April 2008 - 30 November 2008
           Responsible Director      Sheila Puckett         Due Date #################        Report Status   Overall   Perf. Ind.   Plan   Current Month

                                                                                                               q          q          p           q
                                  Productivity target - No increase in cancellations after
      Top 10             8c                                                                      Updated
                                  admission (HRG S22) compared to 2007/08


                                                         Variance    Projected Variance                       Current
       Month           Target       Actual    Variance                                       Plan Status                   Completed by:         Date
                                                            %           at Completion                          Month
                                                                                                              Behind
################        5.6%        5.8%          0         4%      Behind target            Plan in place                Lesley Macleod       11/12/08
                                                                                                               target

Key achievements since last update
These levels continue to be below 2007/08. However, there has been an increase in November.




Current concerns




Remedial actions
Pre-operative admission expansion is being undertaken which will have a beneficial impact on numbers. In addition there is a new Access and Booking Policy
in place.
Performance Report (Commentary)                                                                        1 April 2008 - 30 November 2008
           Responsible Director       Sheila Puckett        Due Date Tuesday, March 31, 2009         Report Status    Overall   Perf. Ind.   Plan   Current Month

                                                                                                                       p          p          p          p
                                  Productivity target - no increase in out-patient new to follow-
       Top 10             8d                                                                            Updated
                                  up ratio compared to 2007/08


                                                          Variance      Projected Variance at                         Current
       Month            Target      Actual    Variance                                              Plan Status                    Completed by:        Date
                                                              %              Completion                                Month
                                                                                                                     Ahead of
################         4.0         3.9          0          -3%     Ahead of target                Plan in place                 Lesley Macleod      11/12/08
                                                                                                                       target

Key achievements since last update
The levels continue to be below 2007/08 and at present the Trust remains on target to deliver this.




Current concerns
No current concerns




Remedial actions
Medical and clinical directors continue to be required to influence changing practice.
                                                                  Admitted and Non-Admitted Pathways: RTT Performance and Completeness Score
                                                         Completeness indicator for admitted pathways (%)                   Completeness indicator for non-admitted pathways (%)
                                                         Revised trajectories: Admitted                                     Revised trajectories: Non-Admitted
                                                         Actual 18 Week Performance (%)                                     Actual 18 Week Performance (%)
                                                         Estimated 18 week performance (%)                                  Estimated 18 week performance (%)
                                     1.2                                                                                                                                           1.2




                                      1                                                                                                                                            1
RTT Performance/Completeness Score




                                     0.8                                                                                                                                           0.8




                                     0.6                                                                                                                                           0.6




                                     0.4                                                                                                                                           0.4




                                     0.2                                                                                                                                           0.2




                                      0                                                                                                                                            0
                                           Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Dec-
                                            07   07   07   07   07   07   08   08   08   08   08   08   08   08   08   08   08   08   08

								
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