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BOARD OF DIRECTORS PAPER – COVER SHEET
Meeting Date:
30 July 2008
Agenda Item: 9
Paper No: E/7/08
Title:
TRUST PERFORMANCE REPORT
Purpose:
To report on Trust performance against key indicators for the Trust in
June 2008.
Summary:
All targets related to the Monitor compliance framework for June and
quarter 1, where information is currently available, have been
achieved.
The Trust has already achieved the 15 week referral to treatment
target for non admitted patients, nine months ahead of the required
date, and the high percentage of patients treated within 18 weeks has
continued to be maintained.
Sustained delivery of the 4 hour maximum waiting in Accident and
Emergency is a cause for concern and an action plan is in place to
address the issues identified.
The improvement work to ensure stroke patients are treated on a
dedicated stroke ward is underway.
Work is continuing with Social Services and Primary Care to improve
delayed transfers of care
Recommendation: For discussion and noting
Prepared
by:
HEATHER HAUSCHILD
Director of Operations
Presented
by:
HEATHER HAUSCHILD
Director of Operations
This report covers: (Please tick relevant box)
Assurance Framework
Business Planning
Healthcare Standards:
Please specify which standard
Local Delivery Plan
9
9
Complaints
9
Performance Management
Finance
9
Strategic Development
Foundation Trust Compliance
Financial implications
Other (Please specify)
Legal implications
YES / NO
Indirectly
YES / NO
POOLE HOSPITAL NHS FOUNDATION TRUST
Report to the Board of Directors – 30 July 2008
TRUST PERFORMANCE REPORT
1.
INTRODUCTION
1.1
The Trust performance report for June 2008 is outlined in this report and is
specifically focussed on Compliance with Monitor terms of authorisation and the
contract agreed with the Bournemouth and Poole Primary Care Trust for 2008/09 as
lead commissioners.
1.2
The report includes a balanced scorecard and a separate scorecard for each
domain.
2.
MONITOR PERFORMANCE (Appendix 1)
2.1
All Monitor access targets were achieved where information is currently available,
during June and quarter 1 2008.
2.2
For Cancer Services, performance shown against the current targets relates to May
2008, the latest information available.
2.3
The Emergency Department have continued to deliver the 4 hour maximum waiting
time, and the target was achieved at the end of June and for quarter 1. The position
remains fragile, and a particularly difficult weekend (12 and 13 July) where 82
breaches were incurred have jeopardised achievement of the month end and looking
forward to quarter 2 presents a significant risk. A comprehensive exception report
and action plan has been submitted to the Director of Operations and is attached in
Appendix 8.
2.4
An exception will be submitted to Monitor at the end of July in order to highlight the
risk and notify the actions being undertaken to restore the position.
3.
FINANCE (Appendix 2)
3.1
A separate report has been produced by the Director of Finance.
4.
ACCESS AND TARGETS (Appendix 3)
Transfers of Care
4.1
Delayed transfers of care reduced from 4.9% in May to 4.8% in June against a target
of 3.5% and early indications for July are that delays are continuing to fall. Bed days
lost for patients transferring to community hospitals were 559 for the period 2nd
June to the 29th June of which 246 were for Christchurch.
4.2
Social Service delays reduced to 193 in June compared to 225 in May, of which 120
were attributable to Poole Social Services, and of these 29 were waiting a funding
decision, and 25 waiting for a package of care in their own home.
1
4.3
An extensive work programme is underway with Primary Care and Social Service
partners to address delayed transfers of care, in particular reviewing the process for
Continuing Healthcare Assessment and ensuring every patient has a discharge plan.
A more detailed report is provided by the Director of Operations on the current
position by sector at Appendix 9.
4.4
The Trust has continued to maintain a high percentage of patients treated within 18
weeks and has already achieved the 15 week referral to treatment target for non
admitted patients, nine months ahead of the required date, and is ahead of schedule
to deliver the target for admitted patients, a significant achievement.
4.5
Negotiations are currently taking place with the Primary Care Trust on the level of
funding required to achieve a 13 week wait by 31st March 2009 and an 8 week wait
by March 2010. Details of costs and activity levels have been provided and the Trust
is currently waiting for their response.
4.6
In April (the latest information available), the Trust did not achieve the target that
65% of patients admitted with a stroke spend 90% of their admission on a specialist
stroke unit. An exception report has been submitted to the Director of Operations
and a number of actions are taking place. In particular improving the information
issued daily to the stroke co-ordinator to help facilitate more admissions to the stroke
unit, and undertaking a review with the clinical management team of all patients with
a stroke who are not admitted directly to the stroke ward to identify remedial action
required.
5.
CLINICAL QUALITY (Appendix 4)
5.1
The scorecard remains incomplete due either to time lags in data availability or
where targets have yet to be agreed with the Primary Care Trust. Other than targets
where publication of national guidance is awaited, all targets will be agreed with the
Primary Care Trust before the end of Quarter 2.
6.
EFFICIENCY (Appendix 5)
6.1
The four week rolling average percentage for Fractured Neck of Femurs treated
within 48 hours was 48% and for all traumas was 74% as at week commencing 30th
June. Case mix continues to compromise performance and six total hip replacement
revisions were undertaken in June, each requiring a minimum of one theatre session
to complete reducing available capacity for immediate trauma. Steps continue to be
taken to implement the trauma expansion plan which will provide an additional two
lists per week. These will commence in September, eventually the plan will lead to a
total of six extra sessions per week.
6.2
The Trust is actively engaged in recruiting additional clinicians to improve preoperative waiting times and recruitment of additional theatre staff and an
Anaesthetist is currently in progress.
6.3
A detailed and comprehensive review of trauma pathways involving both managers
and clinicians is planned for October. The review will include identifying optimum
pathways, comparing Trust processes with best practice elsewhere in the NHS, and
will explore the idea of establishing a Trauma rehabilitation unit as an alternative to
transferring patients to Christchurch Community Hospital.
Theatres and Day Surgery
2
6.4
Day Theatre’s utilisation rate increased slightly to 71% although continues to remain
below the target of 85%. The Service Redesign and Improvement Programme
focussing on Day Theatres and utilisation rates have been rescheduled. A staff
conversations event involving both clinician and managers will “kickstart” the work
and will take place in September. The event will be chaired by the Director of
Operations
6.5
Additional capacity is being commissioned from Community hospitals, although start
dates have been deferred from those originally intended. As well as additional
theatre sessions at Swanage, previously indicated, it is intended to provide an
additional theatre list each week at Blandford Community Hospital for oral surgery
day cases with effect from the 1st September. Start dates at Swanage have yet to
be confirmed. Discussions are also taking place with Wimborne Community
Hospital although there is limited additional capacity available to the Trust.
7
PATIENT EXPERIENCE (Appendix 6)
7.1
Clostridium Difficile performance is within contract levels and is notable as one of the
best performances in NHS South West.
7.2
Targets remain to be agreed with the Primary Care Trust for complaints, the patient
advice and liaison service, and patient surveys.
8.
STAFF EXPERIENCE (Appendix 7)
8.1
A separate quarterly workforce report has been produced by the Director of Human
Resources
9.
CONCLUSION
9.1
While Monitor targets have been achieved for the end of Quarter 1 performance
remains unsatisfactory in trauma and looking ahead to quarter 2 delivery of the 4
hour maximum waiting time target for Accident and Emergency remains fragile .A
comprehensive action plan has been developed to ensure sustained achievement of
the target.
9.2
Further improvement work is also required on stroke admissions to achieve the
required target and this is underway
9.3
Work is progressing to reduce delayed transfers of care. The early implementation of
the No Delays Scheme by August 2008 and the positive engagement from Royal
Bournemouth and Christchurch hospitals Foundation Trust on orthopaedic
rehabilitation is encouraging.
HEATHER HAUSCHILD
Director of Operations
July 2008
ANDREW SPARKS
Head of Performance and Redesign
3
Ratings
External
Assessments
Current
Predicted
Annual Health Check
Use of Resources
Quality of Service
Good
Good
Monitor Governance
Risk Rating
Red (Q4 2007-8)
Green
Reporting for Month of June 2008
Access and Targets
Clinical Quality
Finance
Referral to Treatment (Admitted) 18 weeks
Adverse Incidents - SUI
Income and Expenditure
Referral to Treatment (Non-Admitted) 18 weeks
Adverse Incidents
Income and Expenditure (Surplus / Deficit)
Referral to Treatment (Non-Admitted) 15 weeks
Cancer IOG compliance
Cash
Referral to Treatment (Admitted) 15 weeks
Cancer Data Compliance
Capital
Cancer Access (62 days) - All
Mental Health Capacity Act - May 2008
Financial Risk Rating
Cancer Access (31 days) - All
Mortality
Elective Activity / Contract
Cancer Access (31 days) - May 2008
NICE / Clinical Audit - May 2008
Non-Elective Activity / Contract
Cancer Access (14 day first outpatient) - May 2008
NHSLA Standard
A&E Attendances / Contract
A&E Access (4 hours)
Stop Smoking Services
Day Cases activity / Contract
A&E Access (2 hours)
Maternity Standards
Outpatient Activity / Contract
Cardiac Access (call to needle)
Breast Feeding
Cardiac Access (RACPC)
Smoking at Birth
Patient Experience
Elective Revascularisation
MRSA Infections
Outpatient Access (11 weeks)
MRSA Root Cause Analysis
Efficiency
Elective Access (20 weeks)
Elective Cancellations
Clostridium Difficile Infections
Diagnostic Access (6 weeks) - May 2008
% Trauma operated within 48 hrs
Hygiene Code
Diagnostic Access and Reports (4 weeks)
% NOFS operated within 48 hrs
Complaints
Bowel Screening
Patient Reported Outcome Measures
Patient Advice and Liaison Service
Breast Screening (Screening to normal) - May 2008
Theatre Utilisation - Main
Patient Survey
Breast Screening (Screening to Assessment) - May 2008
Theatre Utilisation - Day
Breast Screening (Round Length) - May 2008
Day Case Rates (basket of 25)
Cervical Screening
Length of Stay
Staff Turnover
Stroke Service (Time on Unit) - April 2008
Pre-operative Bed Days
Unplanned Vacancies
Stroke Service (TIA treatment within 24 hrs)
Excess Bed Days
Absence
Delayed Transfers of Care
Bed Occupancy
Staff Survey
Staff Experience
Agency
Key
Target not achieved action required
Area Of Concern
On Target
New target under development or data not available for current reporting month
4
MONITOR COMPLIANCE - APPENDIX 1
Reporting for Month of June 2008
Standard
Description
Clostridium Difficile
Contractual Target is 4.0 cases per 1,000
ordinary admissions. This equates to 176
cases per annum based on 44,000
ordinary admissions undertaken in the last
financial year.
Clostridium Difficile
Contractual Target is 4.0 cases per 1,000
ordinary admissions. This equates to 176
cases per annum based on 44,000
ordinary admissions undertaken in the last
financial year.
MRSA
MRSA PHFT acquired– (20 cases will be
considered a breach)
Target
Qtr 1 - 44
Qtr 2 - 44
Qtr 3 - 44
Qtr 4 - 44
cases
cases
cases
cases
Source
Weighting
Quarter
Monitor
1
Qtr
Qtr
Qtr
Qtr
1234-
6 cases
6 cases
4 cases
4 cases
Year to date
cumulative
TBC
Referral to Treatment Non-admitted patients: maximum time of
18 weeks from point of referral to
treatment
Quarter
Monitor
Monitor
1
Monitor
1
Monitor
1
95%
To be achieved from end December
2008 and monitored monthly
thereafter
Monitor
1
Maximum waiting time of four hours in
A&E from arrival to admission, transfer or
discharge
Maximum waiting time of 31 days from
diagnosis to treat to start of treatment
98%
Quarter
Monitor
0.5
98%
Quarter (Target applies up to
December 2008)
Monitor
0.5
Cancer Access
Maximum waiting time of two weeks from
urgent GP referral to first outpatient
appointment for all urgent suspect cancer
referrals
98%
Quarter (Target applies up to
December 2008)
Monitor
0.5
Cardiac Access
People suffering heart attack to receive
thrombolysis within 60 minutes of call
(where this is the preferred local treatment
for heart attack)
68%
Month
Monitor
0.5
Hygiene Code
Compliance with Hygiene Code
Compliance
Annual
Monitor
Ad Hoc
Monitor
Quarter
Monitor
Cancer Access
Each National Core
Standard
Monitor Governance Monitor Service performance score
Rating
Trust performance report for Trust Board 30th July 2008
May-08
Jun-08
Qtr 1
End of Year
Forecast
Comment
15
3
3
21
15
18
21
21
1
0
0
1
1
1
1
1
91.8%
94.9%
94.5%
93.7%
95.3%
96.6%
96.9%
96.3%
98.2%
98.5%
98.0%
98.2%
100%
100%
100%
1 month data lag
100%
100%
100%
1 month data lag
100%
100%
0
0
1
To be achieved from end December
2008 and monitored quarterly
thereafter
To be achieved from end December
2008 and monitored quarterly
thereafter
To be achieved from end December
2008 and monitored monthly
thereafter
A&E Access
Apr-08
Year to date
cumulative
MRSA PHFT acquired– (20 cases will be
considered a breach)
Maximum waiting time of 31 days from
Cancer Access
decision to treat to start of treatment
extended to cover all cancer
Maximum waiting time of 62 days from all
Cancer Access
referrals
to treatment
Referral to Treatment Admitted patients: maximum time of 18
weeks from point of referral to treatment
MRSA
Monitoring period
TBC
90%
Less than 1.0
5
100%
100%
0.4
0
FINANCE - APPENDIX 2
Reporting for Month of June 2008
Standard
Description
Target
Monitoring period
Source
Income and Expenditure
(EBITDA)
Earnings before interest, taxes, depreciation and
amortization (EBITDA) (£'s , 000's)
13600
Month
PHFT
Income and Expenditure
Surplus / (Deficit)
(£'s, 000's)
3371
Month
PHFT
Cash
£'s , 000's
13470
Month
PHFT
Capital
£'s , 000's
4450
Month
PHFT
4
Month
PHFT
Financial Risk Rating
Elective Activity / Contract
Elective activity verses contracted levels
100%
Month
PHFT
Non-Elective Activity /
Contract
Non-Elective activity verses contracted levels
100%
Month
PHFT
A&E Attendances / Contract A&E Attendances verses contracted levels
100%
Month
PHFT
Day Cases activity /
Contract
Day Case activity verses contracted levels
100%
Month
PHFT
Outpatient Activity /
Contract
Outpatient activity verses contracted levels
100%
Month
PHFT
Trust performance report for Trust Board 30th July 2008
6
Weighting
Apr-08
May-08
Jun-08
Qtr 1
End of Year
Forecast
1,215
1,448
1281
3,945
13,600
360
591
431
1381
3371
10,200
11,484
11936
11,936
14,471
262
258
432
952
5,650
4
4
4
4
4
102.1%
95.0%
91.0%
96.2%
96.0%
109.2%
115.0%
107.3%
108.7%
109.0%
98.3%
104.4%
104.6%
102.4%
102.0%
120.1%
110.0%
118.6%
118.0%
118.0%
105.1%
104.3%
105.3%
104.9%
105.0%
Comment
ACCESS AND TARGETS - APPENDIX 3
Reporting for Month of June 2008
Standard
Description
Target
Monitoring period
Source
Weighting
Referral to Treatment Admitted patients: maximum time of
18 weeks from point of referral to
treatment
Referral to Treatment Non-admitted patients: maximum
time of 18 weeks from point of
referral to
treatment
90%
Month
Monitor /
PCT
1
Monitor /
PCT
1
Referral to Treatment Admitted patients: maximum time of
15 weeks from point of referral to
treatment
Referral to Treatment Non-admitted patients: maximum
time of 15 weeks from point of
referral to treatment
Maximum waiting time of 31 days
Cancer Access
from decision to treat to start of
treatment extended to cover all
cancer
90%
To be achieved by March
2009
PCT
1
To be achieved by March
2009
PCT
TBD
To be achieved from
end December 2008
and monitored
quarterly thereafter
Monitor /
PCT
1
95%
95%
Month
1
Cancer Access
Maximum waiting time of 62 days
from all referrals
to treatment
TBD
To be achieved from
end December 2008
and monitored
quarterly thereafter
Monitor /
PCT
1
Cancer Access
Maximum waiting time of 31 days
from diagnosis
to treat to start of treatment
Maximum waiting time of two weeks
from urgent GP
referral to first outpatient
appointment for all urgent
suspect cancer referrals
98%
Quarter (Target applies up
to December 2008)
Monitor /
PCT
0.5
Quarter (Target applies up
to December 2008)
Monitor /
PCT
0.5
Cancer Access
A&E Access
A&E Access
Cardiac Access
Cardiac Access
Elective
Revascularisation
100%
Maximum waiting time of four hours
in A&E from arrival
to admission, transfer or discharge
98%
Stretch target 50% of minor and
intermediate attenders are seen
within 2 hours
People suffering heart attack to
receive thrombolysis within 60
minutes of call (where this is the
preferred local treatment for heart
attack)
50%
Maximum wait of 2 weeks for an
appointment for the Rapid Access
Chest Pain Clinic
Maximum wait of 11 weeks
68%
0 greater than 14 days
0
Month
Monitor /
PCT
Month
Apr-08
May-08
Jun-08
Qtr 1
End of Year
forecast or
Forecast
actual
Comment
91.8%
94.9%
94.5%
93.7%
95.3%
96.6%
96.9%
96.3%
83%
(79%)
87.4%
(80%)
86.22%
(81%)
85.5%
92.1%
(90%)
93.4%
(90%)
95.45%
(90%)
93.7%
100
100
Not
available
yet
100
1 month Data Lag
100
100
Not
available
yet
100
1 month Data Lag
98.2
98.5
98.0
98.2
60
61
58
60
100
100
100
100
0
1
0
1
0
0
0
0
Performance
against trajectory
in brackets
Performance
against trajectory
in brackets
0.5
PCT
Month
Monitor
Month
0.5
PCT
Month
PCT
Trust performance report for Trust Board 30th July 2008
7
Risk
ACCESS AND TARGETS - APPENDIX 3
Reporting for Month of June 2008
Standard
Description
Outpatient Access
No outpatient waits more than 11
weeks for a new appointment
No elective waits more than 20
weeks inpatient appointment
A maximum wait of 6 weeks for
diagnostic investigations
By 31 March 2009 all non-radiology
diagnostics including reports are
provided within 4 weeks and
radiology diagnostics within 3 weeks,
with 90% reported within 3 working
days
Elective Access
Diagnostic Access
Diagnostic Access
and Reports
Bowel Screening
Proportion of men and women aged
60-74 taking part in bowel screening
programme
Target
Monitoring period
Source
0
Month
PCT
0
Month
PCT
6 weeks
Month (Diagnostic Return)
PCT
4 weeks
Month
PCT
Data system to be
developed for end
Q2
100% of 60-74 year old
eligible adults are offered
screening for bowel cancer
in the previous two years
Month
PCT
Target deferred by
PCT until
screening
programme
commences
90%
Month
PCT
Screening to normal results within 14
Breast Screening
(screening to normal) days
Breast Screening
(screening to
assessment)
Breast Screening
(round length)
Cervical Screening
Stroke Service
Screening to assessment within 21
days
90%
National Minimum Standard is 90%
of eligible woman screened within 36
months
Meet the cancer plan target of a 2
week turnaround for reporting
cervical screening
90%
Patients are treated on dedicated
stroke unit
Stroke Service
Time to treatment for high risk TIA
Delayed Transfers of
Care
Delayed transfers of care will be
maintained at a minimal level subject
to the development and
implementation of a jointly agreed
action plan executed by the PCT
Month
Weighting
Apr-08
May-08
Jun-08
Qtr 1
End of Year
forecast or Forecast
actual
0
0
0
0
0
0
0
0
0
0
0
0
1 month data lag
91%
92%
90%
90%
90%
90%
98.4%
99.4%
90%
PCT
Month
Comment
1 month data lag
PCT
1 month data lag
100%
Month
PCT
Target deferred by
PCT until
screening
programme
commences
65% of people admitted with
a stroke patients spend 90%
of their admission on a
specialist acute stroke unit
Month
PCT
2 month data lag
25% treated within 24 hours
Month
PCT
Q1 - 3.5%
Q2 - 3.5%
Q3 - 3.5%
Q4 - 2%
Month
PCT
43%
34.2%
28.5%
28.6%
30.4%
6.2%
4.9%
4.8%
5.3%
1 month data lag
Risk
Trust performance report for Trust Board 30th July 2008
8
CLINICAL QUALITY - APPENDIX 4
Reporting for Month of June 2008
Standard
Description
Target
Monitoring
period
Source
Adverse Incidents
Adverse Incidents
The Provider will have a robust process for reporting adverse
incidents
Number of Adverse Incident Reports
100% SUI reports to PCT
within 60 days
TBD
Quarter
PCT
Month
PHFT
Cancer IOG compliance
Providers will be compliant with IOGs within national timescales
100%
Quarter
PCT
Cancer Data Compliance
Providers will ensure that they meet new national recording
standards as per national Cancer Strategy
100%
Quarter
PCT
Action plan to be
reviewed after new
guidance released in
2008 and shared with
PCT on a quarterly basis
Quarter
PCT
Mental Health Capacity Act Providers will meet the requirements of the Mental Health
Capacity Act 2005 and develop a joint action plan across the
local health community in line with new national guidance
Weighting
Apr-08
May-08
Jun-08
929
840
962
Qtr 1
End of Year
Forecast
Comment
2 month lag
Data System to
be developed by
end of Q2
Data System to
be developed by
end of Q2
Mortality
The benchmark is the average mortality rate for England and is
standardised for diagnosis/procedure group, subgroup,
admission type, age, sex, deprivation, month of admission (for
some respiratory diagnoses) and financial year
% Deaths against %
Expected Deaths (Dr
Foster)
Month
PHFT
NICE / Clinical Audit
The Provider will have robust processes for:
Clinical audit
NICE Technology Appraisals
NICE Guidance and Interventional Procedures (as appropriate)
Implementation of
agreed actions following
clinical audits
Quarter
PCT
NHSLA Standard
Achievement of NHSLA risk management standards
Level 2 achievement Q4
Quarter
PCT
Stop Smoking Services
Providers will ensure smoking status is recorded for all
outpatients and inpatients and there is a record of signposting to
‘Quitter’ programmes
The Provider will comply with all Health Care Commission
maternity standards and vital signs
Breast Feeding Initiation rates within 48 hours of birth (This
figure is from questionnaires returned based on 90%
completion)
Percentage of women still smoking at birth
TBD
Annual
PCT
Audit to be
planned
As HCC standards and
Vital Signs targets
68%
Quarter
PCT
3 month data lag
Quarter
PHFT
Maternity Standards
Breast Feeding
Smoking at Birth
Quarter
Maximum 15% (stretch
12% for Bournemouth
LAA)
Trust performance report for Trust Board 30th July 2008
9
3 month data lag
74.7%
71.7%
71.4%
72.6%
7.8%
9.4%
9..3%
8.6%
PCT
EFFICIENCY - APPENDIX 5
Reporting for Month of June 2008
Standard
Description
Target
Monitoring
period
Source
Elective Cancellations
100% of patients who have operations
cancelled for non-clinical reasons to be offered
another binding date within 28 days, or the
patient's treatment to be funded at the time
and hospital of the patient's choice
100%
Month
PCT
% Trauma operated within 48 hrs
Trauma inpatients who are medically fit for
surgery receive treatment within 48 hours
95%
Month
PHFT
% NOFS operated within 48 hrs
95%
Month
PCT
Patient Reported Outcome
Measures
Hip fractures who are medically fit for surgery
receive treatment within 48 hours
Providers will implement patient reported
outcome measures, As a minimum this will
cover nationally agreed areas hip and knee
replacements, varicose vein ligations and
inguinal hernia repair.
TBD
TBD
PCT
Theatre Utilisation - Main
Needle to skin to end of operating
85%
Month
PHFT
Theatre Utilisation - Day
Needle to skin to end of operating
85%
Month
PHFT
Day Case Rates (basket of 25)
Day case (Healthcare Commission Basket of
25) percentage of elective discharges
75%
Month (Dr.
Foster)
PHFT
Length of Stay (Trust)
The number of days between the date of
admission and the date of discharge in a spell
3.5 days
Month
PHFT
Pre-operative Bed Days
The number of days between the date of
admission and the date of operation
The number of days above the long trimpoint
TBD
PHFT
3 month data lag
PHFT
3 month data lag
Bed Occupancy as per Thursday midnight
snapshot
95%
Month (Dr.
Foster)
Month (Dr.
Foster)
Month
Excess Bed Days
Bed Occupancy
TBD
Weighting
Apr-08 May-08 Jun-08
Qtr 1
100%
100%
100%
100%
86%
84%
74%
81%
Risk
75%
79%
48%
67%
Risk
Data System to
be developed in
line with national
programme
89%
88%
91%
89%
75%
70%
71%
72%
2.9
2.7
2.8
2.8
PHFT
94.3
Trust performance report for Trust Board 30th July 2008
10
94.2
93.4
94.0
End of
Year
Forecast
Comment
Risk
3 month data lag
PATIENT EXPERIENCE - APPENDIX 6
Reporting for Month of June 2008
Standard
Description
MRSA Infections
MRSA PHFT acquired– (20 cases will be considered a
breach of Contract). The stretch target is 15.
MRSA Infections
MRSA Root Cause
Analysis
MRSA PHFT acquired– (20 cases will be considered a
breach of Contract). The stretch target is 15.
100% of diagnosed MRSA bactaraemias will have a root
cause analysis within 28 days and this will be shared
with the PCT
Clostridium Difficile The Contractual Target is 4.0 cases per 1,000 ordinary
admissions. This equates to 176 cases per annum
Infections
based on 44,000 ordinary admissions undertaken in the
last financial year. The stretch target is yet to be
confirmed with the PCT.
Clostridium Difficile The Contractual Target is 4.0 cases per 1,000 ordinary
admissions. This equates to 176 cases per annum
Infections
based on 44,000 ordinary admissions undertaken in the
last financial year. The stretch target is yet to be
confirmed with the PCT.
Target
Monitoring period
Source
Weighting
Qtr 1 - 4 cases
Qtr 2 - 4 cases
Qtr 3 - 4 cases
Qtr 4 - 3 cases
Quarter
Monitor / PCT
1
Year to date
cumulative
100%
Qtr 1 - 44
Qtr 2 - 44
Qtr 3 - 44
Qtr 4 - 44
cases
cases
cases
cases
Month
Quarter
Monitor / PCT
Jun-08
Qtr 1
1
0
0
1
1
1
1
1
100
100
100
1
15
3
3
21
15
18
21
21
23
29
30
93
88
119
Year to date
cumulative
Compliance with Hygiene Code
Compliance
Annual
Monitor
Complaints
Number of complaints received
TBD
Month
PHFT
Patient Survey
May-08
The Provider will have in place a Patient Advice and
Liaison Service (PALS) function that is easily accessible.
The measure shows the number of PALs enquiries per
month. The Provider will supply to the PCT a quarterly
PALS report by trend by directorate.
TBD
Patient Satisfaction / feedback measures
TBD
End of Year
Forecast
Comment
One April
Bacteraemia was
removed from the
contract figures as
it was community
acquired.
PCT
Hygiene Code
Patient Advice and
Liaison Service
Apr-08
Quarter
Quarter
Trust performance report for Trust Board 30th July 2008
11
PCT
PHFT
The target will
change with over
or under contract
numbers. The
current position
has been clarified
with the PCT by
the Director of
Finance.
STAFF EXPERIENCE - APPENDIX 7
Reporting for Month of June 2008
Standard
Description
Staff Turnover
Overall avoidable staff turnover under 11% and
Auxiliaries/ HCAs under 13.5%. (To be reviewed in light of
2007/08 outturn)
Unplanned Vacancies
Target
Monitoring
period
Source
11%
Month
Unplanned vacancies under 5%.
5%
Absence
Sickness absence rate below 4%. (By 31st March 2009).
Monthly trajectories to achieve a 4% absence rate by 31st
March 2009 based on 2007/8 cumulative absences are
shown in brackets. First figure is rate for the month,
second is cumulative rate for year to date, bracketed
figure is trajectory based on 2007-08 results.
4%
Staff Survey
Staff Satisfaction / feedback measures
Agency
% Temporary staff used against % of total employed staff
Weighting
Apr-08
May-08
PCT
0.69 % (see
comment)
0.74%
(see
comment)
Month
PCT
3.76%
3.96%
4.79%
Month
PHFT
4.08%
4.08%
(4.38%)
3.88%
3.98%
(4.11%)
TBD
Quarter
PHFT
TBD
Month
5.62%
5.87%
PCT
Trust performance report for Trust Board 30th July 2008
12
Jun-08
Qtr 1
End of Year Comment
Forecast
9.41%
The cumulative Q1 turnover figure of 2.4% is
consistent with achieving the target of <11%.
4.17%
average
< 5%
Vacancies being actively recruited to at the end
of June 2008. The quarter 1 figure is an
average for the three months.
3.85%
3.93%
(3.91%)
4.00%
(3.91%)
<4%
The rate recorded for June 2007 (3.48%) was
particularly good and set the cumulative
trajectory for Q1 at a low level. This has been
exceeded by this June's rate of 3.85%.
However, with the summer months and the
continued absence management programme,
lower sickness levels can be anticipated making
this rate of trajectory compatible with a year end
outturn of below 4%
5.72%
5.74%
0.97% (see 2.40% (see
comment) comment)
The Q1 figure is an average over the three
months.
Appendix 8
Directorate of Medicine
FOUR HOUR WAITING TIME TARGET – EMERGENCY DEPARTMENT
1
INTRODUCTION
1.1
Since April 2008 the Emergency Department’s performance against the 4-hour wait
has been variable with more recent performance showing a steady decline, indicating
that immediate attention is required.
1.2
This report provides a briefing for the Board of Directors on the current position and
actions being taken to restore performance to the level expected of the Emergency
Department.
1.3
Chart 1 below shows the Emergency Department performance against the 4-hour
waiting time target.
Chart 1
Emergency Department Performance
100.0
99.5
99.0
98.5
98.0
97.5
97.0
96.5
96.0
95.5
95.0
April
May
June
% For Month 08/09
98.2
98.5
98.0
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
March
% For Month 07/08
97.0
99.1
99.3
% Cumulative for Quarter 08/09
98.2
98.4
98.2
98.6
98.3
97.8
98.0
98.9
98.6
98.3
98.4
98.4
% Cumulative for Quarter 07/08
97.3
98.2
Target
98.0
98.0
98.5
98.6
98.5
98.2
98.0
98.5
98.5
98.1
98.3
98.3
98.0
98.0
98.0
98.0
98.0
98.0
98.0
98.0
98.0
98.0
2
CURRENT POSITION
2.1
The target of 98% of patients being discharged, transferred or admitted within 4
hours has been achieved each month since September 2007. However 82 patients
breached the 4-hour target during the week ending 13th July 2008 which will prevent
the trust meeting the target for July and, potentially, Quarter 2 2008/09.
2.2
A number of factors have been identified as adversely impacting the department’s
performance against the four-hour waiting time target including:
•
Junior doctors are more reliant on senior supervision than ever before;
•
Inability to recruit to middle grade posts has meant the department has been
short of 3 registrars since May 2008;
13
•
We know that the department will experience two peaks of activity, or patients
attending, each day. The first occurs at approximately 0900 Monday –
Friday, and 1220 Saturday and Sunday. The second peak in patient
presentation occurs around 1830 Monday – Friday; and 1700 Saturday and
Sunday. Over the last 8 weeks the second peak that has occurred has gone
on later, with up to 33% of daily attendances presenting between 1800 and
2200. This is at a time when the department is most vulnerable due to a
decline in the number of senior medical decision makers supervising the
Department.
Unless this backlog can be cleared within 2 hours, then
breaches will start to occur.
•
Considering the pattern of presentation to the department, consultant cover to
the department needs to extend beyond 1800. This is currently difficult to
achieve given that there are only three consultants;
•
More generally, medical / nursing capacity is not currently effectively aligned
to demand;
•
Some of the processes supporting patient throughout within ED need to be
reviewed as working practises and staffing levels have changed;
•
Nurse practitioners have left the department creating gaps in the rota;
•
The physical environment is inadequate during busy periods; specifically
resuscitation rooms and paediatric areas;
•
Co-ordination of patients attending department is not robust enough during
busy periods.
2.3
Much work has already been undertaken to strengthen the department’s position
against the target; including, capacity and demand modelling, including reviewing
rotas; developing nursing staff to assist medical staff; process mapping event to
define and outline a more efficient process for managing patients attending as
‘minors,’ the acquisition of a new Emergency Department system, Symphony.
2.4
However it has been recognised that the recent performance demands that
immediate and additional action be taken to ensure that, with the exception of clinical
cases, no patient waits in excess of four – hours for discharge, admittance, or
transfer.
2.5
A detailed action plan is provided as Appendix 8a that highlights the work already
being undertaken, as well as the action taken immediately to strengthen the current
position.
2.6
The Board of Directors are asked to consider the details of this exception report to
assure itself that robust processes are in place to address the current difficulties.
HEATHER HAUSCHILD
Director of Operations
July 2008
MARK MAJOR
Business Manager, MCCG
14
Annexe A
Exception Report - Four Hour Waiting Time Target – Emergency Department
Medical Staffing Update
• Middle grade starting 9th August 2008 providing support for 3 weeks.
• SHO starting 18th August 2008 for 3 weeks and will provide additional cover to current establishment in the department.
• The department has recruited 11 SHO’s to start 6th August with the 12th taking up post on the 25th August. The department is trying to identify a doctor
who could work the rota until the 25th August.
• Several additional doctors with ED experience have confirmed that they are able to provide additional sessions in August.
• Agency middle grade starting 28th July – 10th August & 17th August – 25th August.
• A clinical fellow has been identified that could work in the department. The doctor is scheduled to visit the department within the next few days.
• A locum consultant has been arranged from 1st September 2008. An initial 3 month contract has been offered.
• A second locum consultant is able to work for a three month period starting in August. This is to be discussed with Mr Reichl to ensure maximum return
on the investment.
Actions
Short Term – 0 – 28 days
Medium Term 1 – 6 months
Long Term >6 months
Status
Action Complete
Partially Complete
Not Yet Complete
G
A
R
15
Immediate / Short Term
1.
Issue Identified
Remedial Action
Lead
Due to the number of breaches that
occurred 11th – 14th July, the position for the
quarter is fragile.
Doctor cover to be arranged for
vulnerable times or shifts where
there are gaps.
DC
By When
Immediate
Progress / Impact
•
•
The principle area of concern is medical
staffing
MM
Immediate
Arrange for additional
consultant sessions.
GC
Notify RBCH consultants that
available sessions are available
at Poole.
GP’s working the front of
house.
Immediate
Additional doctor
arranged for Sat /
Sun (19th & 20th)
1100 – 2300
Additional doctor
arranged for Wed
16th Jul
Gary Cumberbatch /
Simon Bell to provide 3
hours consultant cover on
Sat 19th Jul and Sun 20th
Jul.
SF
Consultant at RBCH
expressed an interest in
additional sessions.
GP’s agreed to work in
minors out of hours. Fee
agreed. Steve Frost is
targeting several GP’s,
including
One GP already working
as clinical assistant in ED
will confirm availability
once back from annual
leave, w/c 28th July.
16
Progress
Amber
2.
The co-ordination of the department by the
Nurse Co-ordinator is compromised when
department is busy.
Introduce a ‘Progress Chaser,’
role providing monitoring
support to the nurse coordinator.
SF
Immediate
Progress Chaser to escalate
where patients reach 2 hours
and no treatment plan is in
place.
Progress Chaser to
commence Wed 16th July.
Initially focussing on 1400
– 2200, the most
vulnerable shift.
Progress chaser will
escalate those patients
without treatment plan
after 2 hours.
Additional receptionists to
support the back and the
progress chaser.
MM
Additional receptionists
being arranged for Sun &
Mon to assist coordinator.
3.
Breach / tracking board is slow to re-fresh
and frequently crashes making patient
tracking difficult.
IT to investigate.
MM
24th July
4.
Insufficient numbers of nurse practitioners
to provide an extended service to the front
needed to support medical staff.
Nurse practitioners from Out of
Hours to undertake extra shifts
in ED.
MM
1st August
IT to lock down the PC
driving this hardware to
prevent people from
using it and altering the
set up.
Amber
All NP’s offered double
time to provide additional
cover to ED. To date noone has come forward.
Red
Efforts to encourage
additional NP’s will
continue
17
Green
5.
Department short of middle grade support
as unable to recruit suitable candidates into
vacancies.
Medical staffing to continue to
provide department with CV’s of
suitable candidates.
Med
Staffing
1st August
The remainder of July is
now up to establishment.
Green
Several SHO’s / Middle
grades with ED
experience have
confirmed availability for
August.
Medical staffing / department
continue to cover gaps in rotas.
Two middle grades
arranged to support the
department from 28th July
2008 through to the end
of August.
Registrar recruited with
start date 29th July.
6.
Non – clinically urgent children breaching 4
hour waiting target due to lack of medical
staffing, a busy department and clinically
urgent attendances.
Agree and implement a process
with the Paediatric department
for getting children straight to
the children’s ward throughout
July whilst medical staffing an
issue.
MM
15th July
15th Aug
18
Process implemented
Tuesday 15th July 2008
until end of July, where a
certain cohort of medical
children can be fast
tracked to a ward and
treated / discharged.
Several patients have
avoided delay as a result
of this process. Full
analysis will be
undertaken at the
beginning of Aug.
Green
7.
Insufficient details regarding breaches for
analysis and learining.
Co-ordinator to complete
breach pro-forma for every
breach.
MM
1st June
Pro-formas being
completed for each
patient breach allowing
for more effective breach
analysis.
Green
8.
Medical staff not recording time correctly
Robust breach validation
MM
1st June
Time stamp provided to
record time of discharge.
Green
Policy in place states that
where there is evidence that
demonstrate a time recorded is
incorrect a change can be
signed off by the ADO.
9.
Disparity in clinical practice between nurse
practitioners.
Clarify expectations of role and
communicate to all nurse
practitioners.
Minor head injuries are not being dealt with
by all NP’s. Some are happy to see and
treat otherwise require supervision.
Consultants to provide additional training.
Validation of all breaches
takes place each week,
each month and
quarterly.
SF
1st August
Clear expectations of
nurse practitioner role
conveyed to those in
post.
Identify any training
issues and resolve.
Future NP’s will be
recruited on a band 6 and
will be promoted to band
7 having demonstrated
clinical competence &
confidence to a required
level.
2 additional NP’s being
recruited Oct 2008.
19
Green
Medium Term
Issue Identified
Remedial Action
Lead
By
When
10.
Nurses are leaving the department to
replace and repair plasters for patients
residing elsewhere within the trust; for
example, ortho & trauma wards.
Quantify issue and feedback to
Trauma Department. Data
could underpin business case
for extending plaster service.
HR
1st Sept
AIRs forms to be
completed where nurses
have to leave
department. Numbers,
times, details etc to be
feedback to orthopaedics.
Amber
11.
Lodgers are spending > 4 hours in ED,
slowing patient through put and preventing
other patients from being admitted often
resulting in 4 hour breaches.
Quantify issue
MM
15th Aug
Report detailing all
lodgers, time of
attendance, waiting time
has been generated for a
one year period.
Amber
Performanc
e Team
28th Sep
Orthopaedic process redesign work to be
undertaken in Sept 2008.
Lodgers will be flagged
as an issue impacting on
four hour performance.
1st Jul
Where an assessment
has determined that a
patient will be admitted to
hospital, the patient is to
go straight to the ward
and not wait for an ortho
SHO to assess.
Data to underpin re-design.
Heather
Ramsden /
Mandy
Khan
20
Impact / Progress
12.
13.
Nurses unable to suture causing delays to
patients.
Process for managing minors needs
revising
Provide suturing courses.
Process mapping event to
identify most effective way of
managing minors
Heather
Ramsden /
Mandy
Khan
28th Sep
Mike
Reichl
1st Sept
Two suturing courses
already run.
Red
Skill assessment
currently being
undertaken for all nursing
staff. Individuals unable
to suture will attend an
additional course.
Two processes outlined
and presented to group.
Amber
Group agreed, subject to
numbers, to trial ‘see &
treat.’
Meeting with Mike Reichl
and Steve Frost to take
place 22nd July 2008.
14.
When department busy the co-ordinator is
drawn into clinical practise thus not being
able to effectively monitor department.
Ring fence an individual from
clinical practise to focus solely
on co-ordinating patients
through the department. Role
could be clinical or non –
clinical.
21
Steve
Frost
1st Aug
Progress chaser role
commenced 16th July
2008 with senior HCA.
4 HCA’s have now been
recruited to this role
allowing a rota to be put
into place for August
2008
Amber
15.
Nursing Staff within Emergency Services
are finding it increasingly difficult to cover
shifts and staff shortages.
Review method of payment to
individuals working under a
bank arrangement.
HR
1st Jul
Increase recruitment of bank
nurses with experience of ED.
Staff providing cover
under a bank
arrangement that have a
permanent contract with
the trust, will now be paid
weekly.
Green
Dept to continue to
arrange for rotation /
Ansty nurses in addition
to Thornberry / agency,
nurses to provide cover to
ED.
16.
The department is vulnerable between 1800
and 2100 to activity peaks. Surges in
attendances between these times leads to
back-log and risks breaches. The number
of senior decision (NP’s and Medical staff)
makers within the department reduces
during this period.
Increase medical staffing and
nurse practitioners during
vulnerable times to reflect work
loads.
Mike
Reichl /
Gill
Christian
Steve
Frost
22
tbc
1st Oct
4th and 5th consultant jobs
agreed. Initial round of
interviews abandoned
due to a lack of applicant.
Post due to be advertised
in Nov with interviews
scheduled for Jan / Feb
2009.
Increasing Nurse
Practitioner establishment
in Oct by 2 and then an
additional 2 NP’s every 6
months. Additional NP’s
will enable the current
service to be extended,
more appropriately
aligning staffing to
demand.
Amber
1st Aug
Existing NP rota being
reviewed and revised,
where possible, to
provide more ‘shop floor,’
cover between 1800 –
2200.
1st Sept
Locum consultant takes
up post from 1st Sept
2008.
1st Dec
Workforce planning
underway.
Additional medical
staffing arranged on an
ad-hoc basis where cover
required.
Consultants to provide
additional sessions at
weekend when available
and at agreed times.
17.
Strengthen current process of escalation
Implement reviewed escalation
policy.
Mark
Major
1st Oct
Inaugural meeting took
place. Follow up meeting
arranged and foundations
of a policy drafted.
1st draft sent for
consultation.
23
Amber
18.
Patients waiting in CDU overnight for
transport as ambulance service unable to
provide transport service after 2000.
Establish use of private
ambulances.
Steve
Frost /
Nick
Caplin
Dec
2008
Process designed and
disseminated to nursing
staff and reception staff
for arranging for transport
depending on their
needs.
Separate budget set up
for the use of private taxis
for patients who were
clinically well.
Spec document drafted to
underpin a tender for a
private ambulance firm.
This will take place within
8 weeks.
As an interim measure
HUXSTEP will be used
on an ad-hoc basis until a
more formal arrangement
is made.
19.
Ward transfers delayed as ED staff cannot
contact co-ordinators on wards. Nursing
staff leave department to take patients to
wards thus reducing nursing presence in
ED.
Patient transfer policy to be reiterated to all wards.
Heather
Hauschild
Steve
Frost
tbc
August Ansty ward and
ED will liaise directly to
arrange for patient
admissions.
Ward co-ordinators /
board holders will wear
earpieces so as to remain
contactable at all times.
24
Amber
20.
Issue Identified
Remedial Action
Lead
By
When
Skill mix does not always reflect the
demands of the department.
Full review of nursing staff to
take place to determine the
number of nurses required to
meet demand for all shifts.
Steve
Frost
15th July
Review of nursing staff
and skill mix required to
run the current service
through to 2010, has
been carried out. This
will be the blue print for
moving towards ‘see &
treat,’ model of managing
minors.
Green
Mark
Major
1st Nov
ED environment
reviewed.
Amber
Skill mix also to be defined for
each shift.
21.
The current method of monitoring / tracking
patients through the department is not
robust enough or accurate. It crashes and
reports patients who have left the
department.
Until the new ED system is in place, this will
continue to be an issue and a risk to the
department performing against access
targets such as the 4 hour wait.
New ED system will track
patient’s real time, flagging
those nearing a deadline. It will
allow for individual patient
escalation to take place; for
example, no management plan
in place after 2 hours will be
escalated to senior doctor.
The dept, including CDU and
the waiting area, can be
monitored real time & remotely
from any PC.
Ansty and CMT will be able to
pro-actively monitor patients
with MAU identifying and
transferring appropriate patients
from ED.
25
Impact / Progress
Project initiated.
Project group assembled.
Software delivered.
Config process underway
Training schedule being
drafted.
Long Term
Issue Identified
22.
Remedial Action
Lead
Nursing staff difficult to recruit.
HR
By When
31st Dec
Impact / Progress
Recruitment fair
Red
Review of recruitment
process taking place
23.
Current footprint does not support
patient throughput.
Capital development – Phase 1
Mike
Reichl
Dec 2008
Phase 1 of the capital redevelopment includes
expanding CDI within
current footprint
2011
Phase 2 will create 2
more resus rooms
Red
CDU inadequate
Resus area inadequate
Capital development – Phase 2
24.
CDU cannot accommodate certain
patients when no trained nurse in the
facility.
Review of CDU
- function
- environment
- capacity
Mike
Reichl
31st Nov
25.
Psychiatric Assessment team do not
attend the department with the urgency
needed to avoid breaching the four –
hour waiting time target. If CDU is full
patients requiring assessment will
breach
Time from referral to attendance by
psychiatric assessment unit being
audited.
Mark
Major
1st Aug
On-site parking provided
for Psychiatric team
tbc
PCT written proposal
document outlining an
Acute Psychiatric
Assessment service for
PCT
26
Red
Amber
acute wards. This will
replace existing service.
Document out for
consultation and
comment.
26.
NICE guidelines regarding head injuries
has resulted in more patients requiring
CT scan. As patients are accompanied
by ED nurses, additional demands are
placed on nurses remaining in dept.
CT scanner adjacent to Emergency
Department. Capital development
plans submitted to address this.
Mike
Reichl
2013
Red
27.
Treatment nurse has to leave
department
to fetch medication for patients.
•
•
•
Additional dedicated porter
Pharmacy in department
Vending Machine
Heathe
r
Ramsd
en /
Mandy
Khan
Q1 09/10
Red
28.
Patients are being referred back to ED
doctors for confirmation of no fractures
present on x-rays. This is delaying
•
Business case for the
installation of an x-ray
workstation in ED to be
submitted as part of
business planning process.
Mark
Major
•
Implement radiographer led
discharge.
2009
Trial demonstrated value
of radiographer led
discharge.
Key
HH
MM
Heather Hauschild
Mark Major
GC
SF
Gary Cumberbatch
Steve Frost
HR
MK
Heather Ramsden
Mandy Khan
27
MR
GC
Mike Reichl
Gill Christian
NC
DC
Nick Caplan
Debbie Cook
Red
Appendix 9
POOLE HOSPITAL NHS FOUNDATION TRUST
DELAYED TRANSFERS OF CARE
1.
INTRODUCTION
1.1
Delayed transfers of care have been problematic for the Trust for some time despite a
number of measures having been undertaken by Health and Social Care partners from
2004/5 onwards.
1.2
The Trust position for 2007/08 was 4.76%, with the target of a maximum of 3.5% only
having been achieved in Quarter 3.
1.3
The two main causes of delay remain waits for transfer to community hospitals (70% of
all delays) and waits for social care intervention and placement.
1.4
Specific problem areas are high numbers of delays waiting for orthopaedic rehabilitation
for Christchurch Hospital which is part of the Royal Bournemouth Hospitals NHS
Foundation Trust and waits for assessment and placement by Poole Social Services.
1.5
The Board of Directors have been briefed regularly on the position and actions being
taken to address delays generally and these two areas specifically.
1.6
For 2008/9 the position is as follows;
2008/9
April
May
June
%
6.2%
4.9%
4.8%
2.
PROPOSED ACTION
2.1
No Delays
2.1.1
The Bournemouth and Poole Primary Care Trust have worked actively with Poole
Hospital NHS Foundation Trust and with Social Care partners to develop a robust action
plan to address the issues identified.
2.1.2
In 2007/8 £680,000 was allocated for the development of the Poole Intermediate Care
Scheme (PICS) which integrates health and social care services to avoid admissions
wherever possible and to work with in the Trust on early supported discharge. Two
geriatricians employed by Poole Hospital work with this team rotating into the
community. The service commenced in December 2007 and has developed the scope
and range of interventions in subsequent months.
2.1.3
PICS will be supplemented by a more comprehensive ‘No Delays’ scheme which
includes the purchase by the Primary Care Trust of a number of nursing and rest home
beds. This will be in place by 3 August 2008. initially £1 million was allocated to the ‘No
Delays’ scheme, however, following our representation a further £500,000 was allocated
to support placement for the elderly mentally ill, for whom longer term care is very
problematic. Five orthopaedic rehabilitation beds have also been purchased as part of
the scheme.
28
2.2
Orthopaedic Rehabilitation
2.2.1
Meetings have taken place with senior managers of the Royal Bournemouth
Foundations Trust Hospitals and an action plan has been agreed as follows;
•
Patients to be identified strictly according to the protocol to ensure
appropriateness of referral for rehabilitation consistently.
•
Intermediate Care Teams to review patients jointly with our therapists on a daily
basis for three months to establish a common assessment and scope for
diversion from inpatient care.
•
Royal Bournemouth Foundation Trust Hospitals are currently reviewing capacity
and the feasibility of increasing inpatient facilities.
•
Poole Hospital has notified the Primary Care Trust and Royal Bournemouth that if
delays for orthopaedic rehabilitation continue at present levels (typically 10-15
patients delayed at any one time) despite actions agreed, we will provide a local
facility for rehabilitation. The feasibility and costings are currently being
undertaken. However, it is recognised that patients who need inpatient
rehabilitation are best served closer to their homes.
2.3
Poole Social Services
2.3.1
Delays for Poole Social Services have been running at around 180 bed days per
month, double the target set with them last November. 75% of these delays were
attributable to waits for elderly mentally ill patients (EMI), both for assessment and
placement. Patients with mental illness have traditionally been referred to the
community mental health team and working practices have not mirrored that of the
hospital social work team.
2.3.2
As part of the pooled budget arrangements agreed 2008/9 an allocation has been set
aside for social work assistants specifically to support EMI patients. It was also
agreed that the community social work teams would be managed in conjunction with
the Poole Intermediate Care Service and this has been implemented as of 1 July
2008.
2.3.3
Early indications are that a more robust response is being provided, and in early July
there have been several days where no delays have been reported.
2.3.4
The Pooled Budget arrangements will be withdrawn if sustained improvement is not
achieved.
2.4
Internal Arrangements
2.4.1
An extensive internal review has been undertaken to identify and address processes
within the Trust some deficiencies have arisen in part due to changes in external
processes that the Trust has struggled to assimilate. A range of actions have been
taken and others are in progress. These are summarised below;
•
Ward Sisters/Charge Nurses have agreed to adopt focussed targets on discharge
for their own ward areas.
•
An extensive training programme has been put in place for ward staff to include
support on Continuing Health Care and managing complex discharge.
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•
The Hospital Discharge Liaison Team, which is funded by the PCT but works
entirely within the Trust have been refocused and is being supported by the
newly appointed Clinical Manager with the responsibility for discharge. He
reports directly to the Director of Operations.
•
Therapists have agreed a single referral protocol with community partners.
•
Poole Hospital NHS Foundation Trust has agreed the relocation of a ward from
Alderney Hospital (Bournemouth and Poole Primary Care Trust rehabilitation
facility) for a three month period while the Unit is upgraded, in order to strengthen
relationships with community staff and to avoid loss of capacity.
•
Monthly Liaison Meetings with Social Services and Matrons have been
reinstated, chaired by the Director of Operations.
•
Documentation has been reviewed and a new adult inpatient record incorporating
a more robust discharge planning tool will be sent to print in the next month.
•
Work is underway to strengthen our response to the Single Assessment Process.
3.
NEXT STEPS
3.1
The principle objectives are to reduce bed occupancy and length of stay by
taking delays to below 3.5%, and to improve the patient experience.
3.2
The ‘No Delays’ programme and the continued development of PICS is expected to
have a significant positive impact in securing sustained improvement.
3.3
There is commitment from Poole Social Services to reshape their services to
secure improvement.
3.4
While delays for Dorset community hospitals and intermediate care are less
problematic they remain a factor and further work is required to ensure the
action plan agreed with them in June 2008 is implemented. The Director of
Operations has asked for confirmation of the current position.
3.5
Given the complexity associated with delayed discharge and the involvement of
several agencies the activity and performance will continue to be routinely reviewed
by the Board of Directors.
3.6
Risks remain around loss of capacity in the private care sector. Significant increases
in emergency admissions particularly in trauma, and elderly care may also adversely
affect the delayed discharge rate if the community is unable to generate sufficient
capacity to accommodate increased demand.
HEATHER HAUSCHILD
Director of Operations
July 2008
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