1. business and industrial

BOARD OF DIRECTORS PAPER – COVER SHEET
Meeting date: 28th February 2007
Agenda item: 8.2
Title:
Performance Targets 2006-07
Purpose:
To advise the Board of the current performance against targets
Summary: (to include confirmation that any legal, equality, diversity, human rights and PPI implications have been considered where relevant)
This report provides a summary identifying key targets and
performance results.The Trust’s current performance is being managed
as stated within the Annual Plan.
Recommendation: For information
Prepared by: Debi Carpanini
Performance Manager
Presented by: Elaine Hobson
Director of Operations
This report covers: (Please tick relevant box below)
Healthcare Standards (CORE –
Monitor
√
please specify which standard)
Healthcare Standards (DEV’T –
Finance
please specify which standard)
√
Service Development Strategy
Performance Management
Local Delivery Plan
Business Planning
Assurance Framework
Complaints
Other (Please specify)
Note: This paper/policy has been assessed for any equality, diversity or human rights implications.
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Performance Targets 2006-07
National Target number 12 Emergency Care Target
98% of patients to have a maximum 4-hour wait in A & E from arrival to admission, transfer
or discharge. This includes attendances at all types of A&E department run by the trust or
“minor injury attendances” in partner PCT.
RD&E
Devon PCT
– MIU’s
Total
Attend’s
Breaches
%
achieved
Target
%
Q1
17,588
26,567
44,155
271
99.4
98
Q2
17,289
29,519
46,808
260
99.4
98
Q3
16,839
21,471
38,310
324
99.2
98
5,511
6,268
11,779
190
98.4
98
57,227
83,825
141,052
1045
99.3
98
Jan 07
Cumulative
This indicator is measured annually (Financial Year 2006/07)
The individual RD&E performance for the month of January 2006 was 96.5% , however
when combined with the minor injury unit performance the community wide performance of
98.4% exceeded the required target performance.
The RD&E cumulative performance for the period (April 2006– January 2007) is 98.2%
rising to 99.3% when the minor injury unit activity is included.
There has been significant rise in A%E attendances and emergency admissions since early
December 2006. The senior management team from Devon PCT and the RD&E are meeting
regularly to discuss the Community wide implications of these increases.
National Target number 2 & 3 Cancer Waiting Times
The Trust achieved the following results in the period April- December 2006
31 day target
Total Treated
Breaches
% achieved
Target %
Q1
528
8
99
98
Q2
528
11
98
98
Q3
553
6
99
98
1609
25
99
98
Breaches
% achieved
Target %
Cumulative
62 day target
Total Treated
Q1
171
11.5
93
95
Q2
184
13.5
93
95
Q3
184
8
96
95
Cumulative
539
33
94
95
This indicator is measured annually (Financial Year 2006/07)
2
The 62 day target was achieved for the first time in quarter 3. Directorate level tracking
arrangements to monitor patients scheduling to eliminate avoidable delays have been
introduced. The report from the Department of Health Cancer waiting times - Intensive
Support Team is awaited and an action plan will be developed following its receipt.
Exception Report attached.
National Target number 8 Inpatient/Daycase – maximum 20 weeks wait by March 2007
The inpatient/daycase target of no patients waiting over 20 weeks by 31 March 2007 is still a
challenging target, however action plans have been implemented within each directorate and
the total number of patients waiting more than 20weeks has reduced by 73 in Jan 07.
By 31 March 2007, the milestone requires that at least 97% of patients should be seen within
20 weeks, in January 07 the trust achieved an overall performance of 95%. (NT No 27)
National Target number 4 % of patients whose operation was cancelled for non-clinical
reasons
Cancelled operations are defined as those patients who have their operations cancelled by
the Trust for non-clinical reasons on the day of admission or later.
The Healthcare Commission has set a 0.8% tolerance level to measure performance in
2005/06. For monitoring purposes the Trust is assuming this tolerance level will be
maintained for 2006/07.
The percentage of cancelled operations in comparison to total elective operations performed
for the period April-January 2007 has remained steady at 0.9 % of total elective activity.
However, the trust will not achieve the Healthcare Commission tolerance level of 0.80% for
this element of the indicator by the year end. Performance is monitored on a daily basis but
due to increasing pressures to deliver maximum waiting times, demand on the A&E
department and the pressure on available beds to support the increased emergency
workload maintaining current performance will be challenging.
This indicator will feature in the Annual Health Check assessment and the Trust’s current
performance will be benchmarked against national performance. It is possible therefore the
RD&E may be assessed as being underachieved on this indicator.
National Target number 6 Convenience & Choice Delivery of Booking Targets
The target is 100% of inpatient and outpatient appointments are booked in advance at the
convenience and choice of the patient. This target continues to be achieved.
The roll out to Directly Bookable Services continues with all specialties expected to achieve
DBS by the end of February. 50% of specialties are now DBS.
National Target number 25,27 & 28 18 Week Referral to Treatment (RTT)
By 2008 no-one will wait longer than 18 weeks from GP referral to hospital treatment.
The designated milestones/ targets for the programme are:
• 85% of pathways where patients are admitted by March 2008
• 90% of pathways where patients are not admitted by March 2008
• 100% achievement for all patients by December 2008
The 18 week Project Board has established a trust wide muti-professional team who will
meet regularly to agree the pln to achieve the delivery of 18weeks maximum waiting.
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Measurement for RTT waiting across all specialties will be complete by end of February 07.
Further developments to the Patient Administration System to support pathway
measurement will be piloted in March 07.
The National team have produced 10 “ Good Practice Pathways” a further 27 will be
delivered in the future. These will help us to look critically at our patient pathways to identify
ways to improve through put.
National Target number 20 MRSA Infections
The target for 2006-07 is a maximum number of 25 cases of MRSA. This is still a joint
community and hospital acquired infection target.
In January five cases have been reported bringing the total for 2006/07 to 33.
The number of reported cases has breached the overall planned target for 2006/07 of 25.
As a consequence, this may have an effect on the service performance element of Monitor’s
governance risk ratings.
MRSA – Number of Reported Cases
Month/Year
Community
Acquired
RD&E
Acquired
TOTALS
Quarter 1
3
4
7
Quarter 2
3
5
8
Quarter 3
7
6
13
January 07
4
1
5
Cumulative
17
16
33
MRSA Bacteraemias
8
Community Acquired
7
RD&E Acquired
6
5
4
3
2
1
0
Apr04
May04
Jun04
Jul04
Aug04
Sep04
Oct04
Nov04
Dec04
Jan05
Feb05
Mar05
Apr05
May05
Jun05
4
Jul05
Aug05
Sep05
Oct05
Nov05
Dec05
Jan06
Feb06
Mar06
Apr06
May06
Jun06
Jul06
Aug06
Sep06
Oct06
Nov06
Dec06
Jan07
National Target number 11 Thrombolysis 60-minute Call to Needle Time Performance
The cumulative performance position for the 60minute call to needle indicator has
deteriorated from 47% to 41% in Jan 07 against a target of 38% for 2006/07. This was due
to three of the four patients eligible for thrombolysis arriving at the RD&E later than 60
minutes from the initial call.
Primary Angioplasties: 95 primary angioplasties have been performed in the period April to
January 2007 and the combined thrombolysis/primary angioplasty performance is 91%.
National Target number 7 Delayed Transfers of Care
This indicator measures the impact of community-based care in ensuring timely discharge
from hospital. People should receive the right care in the right place at the right time and
primary care trusts must ensure, with acute trusts and social services partners, that people
move on from the acute environment once they are medically safe to transfer.
The Healthcare Commission has set a tolerance level for a score of “achieved” at 3.5%
Delayed transfers of care as % of occupied acute beds
F
A
Special Cause Flag
7.00%
Individual Value
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
1/8/2007
12/11/2006
11/13/2006
10/16/2006
9/18/2006
8/21/2006
7/24/2006
6/26/2006
5/29/2006
5/1/2006
4/3/2006
3/6/2006
2/6/2006
1/9/2006
12/12/2005
11/14/2005
10/17/2005
9/19/2005
8/22/2005
7/25/2005
6/27/2005
5/30/2005
5/2/2005
4/4/2005
-1.00%
Period
In recent months the percentage of patients occupying an acute hospital bed whose transfer
of care was delayed has seen an upward trend as indicated in the above graph.
The performance position for the month of January 2007 for the RD&E was 4.68% with a
cumulative position for the period (April 2006– January 2007) of 2.51%. The Trust therefore
remains on target for meeting this target
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National Target number 25 Total number of patients waiting more than 13 weeks
for a diagnostic test by March 2007
(a) Imaging
th
CT, MRI & Non-Obs Ultrasound Patients - Waiting >13 Weeks since 8 Jan 2007
500
Number Waiting >13 Weeks
450
400
350
300
CT
MRI
US
250
200
150
100
50
02-Apr
26-Mar
19-Mar
12-Mar
05-Mar
26-Feb
19-Feb
12-Feb
05-Feb
29-Jan
22-Jan
15-Jan
08-Jan
0
Action plans have been implemented to achieve a maximum 13 week wait by Mar 07. CT &
Ultrasound scans have seen significant reduction in the number of patients waiting greater
than 13 weeks and the level of risk has been amended to “low” risk of the target not being
met.
MRI continues to be monitored closely and an exception report is attached, however we are
confident that the team will achieve the year end target.
(b) Physiological Measurements
Diagnostic & Therapeutic - Sleep Studies
120
Sleep
CPAP >=13
weeks
100
80
60
Sleep
>=13
weeks
40
20
See Exception Report attached.
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3 1 /0 3 /2 0 0 7
2 8 /0 2 /2 0 0 7
3 1 /0 1 /2 0 0 7
3 1 /1 2 /2 0 0 6
3 0 /1 1 /2 0 0 6
3 1 /1 0 /2 0 0 6
3 0 /0 9 /2 0 0 6
3 1 /0 8 /2 0 0 6
3 1 /0 7 /2 0 0 6
3 0 /0 6 /2 0 0 6
3 1 /0 5 /2 0 0 6
3 0 /0 4 /2 0 0 6
3 1 /0 3 /2 0 0 6
2 8 /0 2 /2 0 0 6
3 1 /0 1 /2 0 0 6
0
( c) Endoscopy
Endoscopy Waiting Times
1,800
1,600
Number Waiting
1,400
1,200
1,000
800
600
400
200
Under 13 weeks
13 weeks plus
Jan-07
Dec-06
Nov-06
Oct-06
Sep-06
Aug-06
Jul-06
Jun-06
May-06
Apr-06
Mar-06
Feb-06
Jan-06
0
Total waiting
Action plans have been implemented to achieve a maximum 13 week wait by Mar 07. All
patients who will be classified as waiting greater than 13 weeks by March 07 will receive
their procedure date by the end of February 07, therefore, the level of risk has been
amended to “low” risk. We will continue to monitor this target closely.
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BOARD EXCEPTION REPORT
CORPORATE TARGET NUMBER &
DESCRIPTION:
3. All cancers: two month GP urgent
CURRENT CORPORATE RATING:
High
RESPONSIBLE DIRECTOR:
Director of Operations
referral to treatment
Brief description of how the rating was derived
All efforts are made to ensure the target of 95% for the 62-day target is being met.
However there remains the risk that the number of clinically complex cases may be
above the 5% tolerance allowed and that a small number of patients will not be
treated within the target time due to delays in the pathway at the RD&E or referring
Trust.
Details of actions necessary to return performance back to either good or
excellent
Although the 62 day target was met for Quarter 3, the cumulative position for the
year to date remains at 94%. However strenuous efforts are being made to try and
ensure that performance against the 62 day target is improved, especially in the
higher risk, high volume cancer sites. Systems for day to day monitoring of waiting
times are also being strengthened with the aim of identifying and addressing
potential delays earlier in the treatment pathway.
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BOARD EXCEPTION REPORT
CORPORATE TARGET NUMBER &
DESCRIPTION:
25. Total number of patients waiting more than
13 weeks for a diagnostic test by March 2007
(a) Imaging - MRI
CURRENT CORPORATE RATING:
Medium
RESPONSIBLE DIRECTOR:
Director of Operations, Clinical Director
and Directorate Manager of Diagnostics
Brief description of how the rating was derived
An initial review was carried out and indicated insufficient capacity levels to achieve the
maximum 13 week target wait time for CT and MRI scans by March 2007.
Data quality has been an issue but has improved with full implementation of the new Radiology
Information System (RIS).
Successful implementation of PACS (Picture Archive Control System) and the new RIS in late
September through October has improved data capture and quality and enabled further waiting
list validation. The implementation of these systems did, however, reduce activity levels in
September and October with consequent adverse effects on the numbers of patients waiting.
Details of actions necessary to return performance back to either good or excellent
A detailed action plan has been implemented and is being monitored on a weekly basis to
ensure capacity levels are maintained to meet the maximum waiting time of 13 weeks by
March 2007. Some of the actions are:
y Additional scan sessions have commenced and are being reported by the RD&E Consultant
Radiologists.
y Review of Independent Sector provision continues and patients transferred where possible.
y Detailed work continues to asses and review referral patterns into the services.
y Capital planning for the replacement of the original MRI scanner (one of two)has been
approved. The work will begin in the Spring with attention to the potential impact on
throughput in the department being a major issue
Current projections indicate that circa 140 scans need performing above the existing capacity
in MRI. Additional internal capacity is currently being implemented to address this backlog by
March 07.
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BOARD EXCEPTION REPORT
CORPORATE TARGET NUMBER &
DESCRIPTION:
25. Total number of patients waiting more than 13
weeks for a diagnostic test by March 2007
(b) Physiological Measurements – Sleep Studies
CURRENT CORPORATE RATING:
Medium
RESPONSIBLE DIRECTOR:
Director of Operations
Brief description of how the rating was derived
Waiting times for Sleep Studies are reportable against a 13 week target from 1 April 2007.
Current review of numbers waiting and longest waits indicate this target will now be met within
the increased capacity in Clinical Measurements provided by working in new ways.
Details of actions necessary to return performance back to either good or excellent
Current waiting lists have been fully validated and Waiting List Policy applied.
Over the last 16 months capacity has been increased by the introduction of two additional
diagnostic sleep slots per week (up from 6 to 8), resulting in the diagnostic waiting list steadily
falling from 154 (31 Jan 06) to 66 (11 Feb 07).
Further actions taken since November 2006:
•
Commenced ‘pilot’ trial of home-based therapeutic sleep studies increasing potential
studies from only 2/week to between 4 and 8 / week depending on staff availability.
•
Commenced ‘pilot’ trials comparing two portable diagnostic kits that could be used in the
medium-term to transfer in-patient diagnostic sleep studies to the home environment.
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