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TRUST BOARD PAPER – COVER SHEET
Meeting Date: Thursday, 28 February 2008
Agenda Item:
6
Title:
Operational Performance (Month 10) and Executive Reports:
Purpose:
Chief Executive/Executive Directors to draw attention to key areas under
review by Executive Team
Summary:
Section 1: Finance
• Overall Risk Rating 4 (Green) with forecast outturn rating of 3
(Green).
Section 2: Service Performance
• Service Performance Scorecard Rating 1.0 (Amber) with forecast
outturn rating of 1 (Amber).
• Other Targets and Forecast Healthcare Commission Quality
Rating ‘Excellent’.
Section 3: Clinical Indicators
• Mortality (In-hospital) relative risk rating of 93.7 at Quarter 3
2007.
• MRSA 2 cases in January against a target of 1, with year to date
13 cases against an annual target of 12 cases.
• C.Diff 17 hospital cases in January against a target of 19.
Section 4: Workforce
• Sickness absence at 3.68% marginally above Trust target of
3.5%
• Increased usage of overtime and agency compared to 2006/07
levels.
Section 5: Risk Management
• Internal Audit Report: Risk Management – Substantial
Assurance – Action Plan in place
• Internal Audit Report: Clinical Governance – Full Assurance –
No Action Plan required
• NHSLA Assessment: Following inspection in January 2008,
Trust retained Level 2 compliance
• Risk Management Strategy and Policy No: 118 (V.4):
Recommendation to postpone formal review for four month
period to allow alignment with Board’s integrated governance
development plan.
• Clinical Governance Strategy No: 229 (V.2): Recommendation to
postpone formal review for four month period to allow alignment
with Board’s integrated governance development plan.
• Risk Register (Month 11):
- No extreme risks (Red)
- High Risks (Amber): 3 new Amber risks recorded in month 11
: 12 risks remain Amber from month 10
: 3 risks downgraded to Moderate
(Yellow) in month 11
Recommendation: To receive and note the Operational Performance Report and
approve extension on review of Risk Management and Clinical
Governance Strategies and Policies.
Prepared by:
Head of Performance
in conjuction with
Executive Directors
and Director of
Infection, Prevention
and Control
Presented by:
P Murphy,
Chief Executive/
Executive Directors/
DIPC
This report covers: (Please tick relevant box)
Assurance Framework
9
External Standards: NHSLA/KLOE/HCC
Please specify Standard & Reference No:
KLOE 4.1
NHSLA 2.1.5 and 2.1.6
Local Delivery Plan
Performance Management
9
9
Strategic Development
Business Planning
Complaints
Finance
Foundation Trust Compliance
Other (Please specify)
Financial Implications:
YES / NO
Legal Implications: POTENTIAL
Risk Implications: YES / NO
9
9
9
NO
9
YES
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 1: FINANCE REPORT
For Period Ending January 2008
When Essex Rivers Healthcare becomes a NHS Foundation Trust, the Trust will be monitored in
accordance with Monitor’s Compliance Framework. A key component of this is the compliance with a
set of financial risk ratings to determine an over financial risk score. The self-assessed risk rating
score for January is summarised in Table 1a below.
Table 1a: Risk Ratings using Monitor’s Assessment Criteria
Plan
Year to
Date
Forecast
Outurn
EBITDA Achieved (% of plan)
5
5
5
EBITDA Margin %
3
3
3
Return on assets excluding dividend (%)
5
5
5
I&E Surplus Margin Net of Dividend (%)
2
4
3
Liquidity Ratio (Days)
1
2
2
Overall Risk Rating
3
4
3
As a NHS Trust, Essex Rivers Healthcare also has to operate within a national financial performance
framework set by the Department of Health. Its key performance metrics are also summarised in
Table 1b below.
Table 1b: Summary of Performance
Year to
Date
Forecast
Outurn
I&E Breakeven Duty (against control total)
1
1
Achievement of EFL Duty
1
1
Achievement of CCAR Duty
1
1
Compliance with the Prompt Payment Code
3
3
ESSEX RIVERS HEALTHCARE NHS TRUST
KEY FINANCIAL INFORMATION
The Trust’s Key Financial Information at the end of January is summarised as follows:
* Year to date position – a surplus of £4,787k compared with the year to date budget of
£6,016k, an adverse variance of £1,229k.
* Forecast outturn is a net surplus of £2,937k after the final debt repayment of £6,518k.
* EBITDA margin year to date is 9.69%. The forecast outturn EBITDA margin is 7.52%,
which is slightly above plan of 7.39%.
* Short-term investments and cash deposits totalled £22,727k at the end of the month of
which £5,8432k relates to the year to date accrual of the final repayment of the outstanding
debt due in March (£6,518k).
* The Trust is forecasting it will meet its EFL duty within the tolerance allowed.
* The Trust is forecasting it will meet its CCAR duty within the tolerance allowed.
* Prompt payment performance:
- 40% by volume, 27% by value for the month
- 72% by volume, 68% by value for the year to date
* The Service and Cost Improvement Programme (SCIP) has currently achieved £4,210k
year to date compared with its budgeted trajectory of £3,346k. The year to date position
has therefore achieved the full year SCIP target.
* The Capital Programme is currently forecast to under spend by £200k although this is
expected to further reduce following the implementation of management action to address
slippage in schemes.
ESSEX RIVERS HEALTHCARE NHS TRUST
Income & Expenditure
January 2007
Income
NHS clinical income (note 1.1)
Elective income
Tariff income
Non-tariff income
Non-Elective income
Tariff income
Non-tariff income
Outpatient
Tariff income
Non-tariff income
A&E
Tariff income
Non-tariff income
Other
Tariff income
Non-tariff income
Sub-total
PbR (clawback)/relief and MFF
Total
Financial Year 2007/08
Budget
Full Year
£000
Forecast
Outturn
£000
Budget
Year to Date
£000
Actual
Year to Date
£000
33,051
2,198
33,994
2,143
27,543
1,832
26,926
1,811
58,335
952
57,155
610
48,613
793
47,639
508
30,633
1,762
28,199
2,438
25,527
1,468
24,016
2,086
5,344
-
5,335
-
4,453
-
4,446
-
36,739
169,014
7,553
176,567
36,987
166,861
7,359
174,220
29,909
140,138
6,294
146,432
29,893
137,325
6,055
143,380
1,264
1,105
2,369
1,039
1,271
2,310
1,051
928
1,979
812
1,031
1,843
146
5,848
5,017
11,011
163
5,848
4,459
10,470
121
4,876
4,255
9,252
136
4,877
3,930
8,943
-
-
-
-
189,947
187,000
157,663
154,166
108,114
11,154
18,997
31,090
105,595
12,333
16,626
32,397
88,486
8,434
13,481
26,548
86,785
8,836
14,830
24,697
169,355
166,951
136,949
135,148
EBITDA
Profit/loss on asset disposals
Exceptional income/costs
Total depreciation
Total interest receivable/(payable)
Total interest payable on loans and leases
PDC dividend
Taxation payable
20,592
6,518
6,381
- 130
4,886
-
20,049
13
6,518
6,358
- 663
4,886
-
20,714
5,432
5,302
- 108
4,072
-
19,018
13
5,432
5,280
- 566
4,072
-
Net Surplus/(deficit)
2,937
2,937
6,016
4,787
7.39%
120.34%
9.79%
1.55%
13
7.52%
120.54%
9.82%
1.57%
13
9.44%
171.78%
10.43%
3.82%
26
9.69%
154.40%
10.48%
3.11%
21
Non NHS clinical income (note 1.2)
Private patient income
Other non-protected clinical income
Total
Other Income (note 1.3)
Research & development
Education and training
Other income*
Total
PFI specific income
Total income
Expenses
Pay costs (note 1.4)
Drugs costs (note 1.5)
Clinical supplies & services (note 1.5)
Other costs (excl. depreciation) (note 1.5)
PFI specific costs
Unitary payment
Other costs
Total costs
Risk rating metrics
EBITDA margin
EBITDA % achieved
ROA
I&E surplus margin
Liquid ratio
ESSEX RIVERS HEALTHCARE NHS TRUST
Balance Sheet
January 2007
Fixed assets
Fixed assets
PFI residual interest
PFI deferred assets
Total fixed assets
Financial Year 2007/08
Budget
Full Year
£000
Forecast
Outturn
£000
Budget
Year to Date
£000
Actual
Year to Date
£000
148,081
148,081
147,708
147,708
146,812
146,812
146,554
146,554
3,519
5,976
1,043
2,124
440
13,102
3,263
9,380
2,267
114
1,632
440
17,096
3,430
7,197
3,206
9,393
23,226
3,354
3,050
3,534
697
1,029
22,727
32,997
3,836
3,233
837
1,078
8,984
5,622
3,470
906
3,424
13,422
6,295
2,464
1,629
460
4
3,658
14,510
6,351
4,308
1,629
580
4
13,274
26,146
Total current assets/(liabilities)
Long term debtors (note 2.4)
2,378
2,378
2,391
2,391
Total assets less current liabilities
Creditors: amounts falling due > one year
Finance leases
Provisions for liabilities and charges (note 2.7)
4,118
2,750
3,674
2,130
8,716
2,774
6,851
2,154
151,827
151,630
155,145
153,642
-
-
-
-
74,662
12,294
61,640
2,477
754
151,827
74,662
12,302
61,418
2,494
754
151,630
74,055
15,373
62,461
2,502
754
155,145
74,055
14,152
62,180
2,501
754
153,642
151,827
151,630
155,145
153,642
41.2
26.2
33.5
41.2
26.2
33.5
47.9
20.2
39.7
43.4
13.7
40.2
Current assets
Stocks & Work in Progress
NHS trade debtors (note 2.1 - 2.3)
Non NHS trade debtors (note 2.1 - 2.3)
Other debtors
Accrued income
Prepayments
Cash at bank and in hand (note 3.1)
Total current assets
Current liabilities (amounts due in less than one year)
Bank overdraft
Drawdown in committed facility
Trade creditors (note 2.5)
Other creditors (note 2.5)
PDC dividend creditor
Capital creditors
Interest payable creditor
Payments on account
Accruals (note 2.5)
Deferred income
Total current liabilities
Total assets employed
-
Loans
Total loans
Total loans
Taxpayers equity
Public dividend capital
Income and expenditure reserve
Revaluation reserve
Donated asset reserve
Other reserves (government grant reserve etc.)
Total taxpayers equity
Total funds employed
Key Balance Sheet metrics
Stock days
Trade debtor days
Trade creditor days (excl. Accruals)
ESSEX RIVERS HEALTHCARE NHS TRUST
Cash Flow
January 2007
Financial Year 2007/08
Budget
Full Year
£000
Forecast
Outturn
£000
Budget
Year to Date
£000
Actual
Year to Date
£000
EBITDA
Excluding non cash operational I&E items
20,592
20,049
20,714
19,018
- 119
459
81
80
- 2,802
- 96
137
- 2,945
- 765
80
1,636
- 716
- 30
- 762
42
67
1,095
- 72
46
3,385
- 618
67
12,731
- 692
CF from operations
18,195
17,476
21,054
33,937
Capital expenditure (note 3.2)
Maintenance capex
Non maintenance capex
- 4,785
- 2,531
- 4,972
- 2,136
- 2,401
- 1,771
- 2,392
- 1,772
- 291
-
- 313
-
- 241
-
- 256
-
10,588
10,055
16,641
29,517
130
663
108
566
- 6,518
- 6,518
- 5,432
- 5,432
607
- 4,886
607
- 4,886
- 2,443
- 2,443
Net cash outflow/inflow
- 79
- 79
8,874
22,208
Opening cash balance
New cash outflow/inflow
Closing cash balance
519
- 79
440
519
- 79
440
519
8,874
9,393
519
22,208
22,727
Movement in work ing capital
Stocks and work in progress
NHS trade debtors
Non NHS trade debtors
Other debtors
Accrued income
Prepayments
Trade creditors
Payment on account
Accruals
Deferred income
Provisions and liabilities
Other
Cash exceptional items
Cash receipt from asset sales
Transfer from reserves
Taxation paid
Cash at bank and in hand
CF before financing
Interest
Interest (paid) on loans and leases
Interest (paid)/received on cash balance/WC facility
Loans
Drawdown of loans and leases
Repayment of loans and leases
Other
Public dividend capital received/(repaid)
Capital dividends repaid
ESSEX RIVERS HEALTHCARE NHS TRUST
NOTES TO THE ACCOUNTS
1. INCOME & EXPENDITURE
1.1. NHS Clinical Income
NHS clinical income is currently £3,052k under recovered year to date as summarised in table 2.
Table 2: Analysis of NHS Clinical Income
Year to Date
Clinical Income
Elective Day Cases
Elective Inpatients
Non Elective Inpatients
Outpatients
Sub-total
Accident & Emergency
Pathology Open Access
Critical Care Services
Total Cost & Volume Income
Other NHS Clinical Income (incl. MFF)
Total NHS Clinical Income
December
2007
January 2008
Budget
Actual
Variance
Budget
Actual
Variance
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
13,117
16,257
49,406
26,995
105,775
4,453
4,911
5,499
120,638
12,339
16,448
48,147
26,102
103,036
4,446
4,649
5,520
117,651
-778
191
-1,259
-893
-2,739
-7
-262
21
-2,987
1,311
1,709
4,961
2,699
10,680
445
491
550
12,166
1,349
1,925
4,486
3,217
10,977
441
527
550
12,495
38
216
-475
518
297
-4
36
0
329
-291
-203
-57
-548
-1,099
3
-152
0
-1,248
25,794
25,729
-65
2,617
2,481
-136
-242
146,432
143,380
-3,052
14,783
14,976
193
-1,490
An update of the contributing factors to the current under recovery is as follows:
•
•
There were a net 26 more day cases, 91 more elective inpatients but 247 less non-elective
admissions in month 10 compared with the plan for the month. There were also 3,994 less
outpatient attendances (first and follow-ups) compared with the plan for the month. These
have all contributed to the year to date position.
The overall shortfall in income will also have an adverse impact on the Market Forces Factor
(MFF), which is calculated by the Department of Health. Whilst this has not yet been notified
to the Trust the estimated impact has been included.
Ongoing Action:
Performance meetings are led by the Chief Executive. The anticipated activity to achieve the 18
week wait has now been matched against planned available capacity. This has shown that the
Trust will need to plan for additional sessions and, for some specialities, outsourcing to enable the
Trust to achieve the required target.
The PCT has verbally notified the Trust that only 2 penalties will be imposed this year. This is
around any increased growth of the HRG S22 above last year solution position and the issuing of
sick certificates to patients on discharge following a procedure. The estimated impact of these
penalties is unlikely to be more than £50k and has been allowed for in the forecast outturn.
All issues of incorrect coding are referred to relevant directorates for action.
The position continues to be carefully monitored.
ESSEX RIVERS HEALTHCARE NHS TRUST
1.2. Non-NHS Clinical Income
Non-NHS income has under recovered by £136k for the year to date.
Private patient income continues to account for the majority of the shortfall, reporting a deficit of
£239k for the year to date, a small improvement on Month 9. The private patient market appears to
have shrunk, which is not surprising given that NHS waiting times have fallen. The private sector
has replaced available capacity by purchasing NHS work. Other non-protected clinical income
includes income from RTAs, which is ahead of budget by £78k and reimbursement income from the
county council relating to patients in receipt of social care packages, which is also ahead of budget
by £75k.
Ongoing Action:
A review and reassessment of private patient income is being carried out as part of the budget
setting process for 2008/09. It is likely this will result in a cost pressure to the Trust to reduce the
budget.
1.3. Other Income
Other (non-patient related) income also continues to under recover by £309k year to date. The two
main causes of this are:
• Income from drug sales continues to under recover by £190k although there are associated
underspends in the cost of drugs. The decline in the number of private patients has also had
an impact on the income from prescribed drugs.
• The income from the plastic surgery SLA continues to under recover (£153k).
Ongoing Action:
Both will be reviewed and income targets are being revised through the 2008/09 budget setting
process.
1.4. Pay
Pay expenditure was £1,701k under spent year to date, net of the Service and Cost Improvement
Programme (SCIP) and after release of reserves. Table 3 analyses pay expenditure by staff group.
Table 3: Pay by staff group
Budget
Actual
Variance
Budget
Actual
Variance
December
2007
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
12,098
25,784
34,302
15,825
248
88,258
228
88,486
11,727
25,681
33,830
14,938
242
86,417
368
86,785
Year to Date
Staff Group
Management/Admin
Medical
Nursing
Scientific, Technical & Therapeutic
Other
Total
Reserves
Total Pay Expenditure
January 2008
372
103
472
887
7
1,841
(140)
1,701
1,234
2,647
3,555
1,657
(36)
9,057
(106)
8,951
1,210
2,785
3,577
1,555
(34)
9,092
(77)
9,015
24
(138)
(21)
102
(3 )
(36 )
(28)
(64)
33
(21)
70
82
(3 )
161
497
658
ESSEX RIVERS HEALTHCARE NHS TRUST
Vacant posts are making a significant contribution to the Trust’s overall SCIP target. It is currently
forecast that by year end pay will be some £2.5m underspent.
Costs to achieve the 18 week target are currently being reported under non-pay. It is likely that as
additional sessions are identified between now and the end of March there will be a cost shift from
non-pay to pay, reducing the reported underspend for this category.
Ongoing Action:
The Trust continues to exercise strong control over its establishment control procedures. All vacant
posts are scrutinised and where appropriate a contribution made to the SCIP target. It is expected
that additional costs will continue to be incurred in order that the Trust can hit is activity targets.
It is strongly advised that the internal control processes operate as usual to contain the additional
costs to meet the activity targets.
Total temporary staffing costs were £468k in January, a further increase when compared with
December. Expenditure has increased compared to this time last year with expenditure on medical
locums increasing due to vacancies and the need to meet the 18 week wait and other targets. The
rolling 12 months analysis of temporary staffing expenditure is set out in graph 1.
Graph 1: Temporary staffing expenditure by month
£'000
500
450
400
350
300
250
200
150
100
50
-
Non-NHS
343
153
162
224
186
276
234285
104125
78
162
182
191
69
60
64
86
85
86
May
Jun
Jul
Aug
Sep
Oct
130
115
39
15
31
39
Jan
Feb
Mar
Apr
Nov
Dec
Jan
NHS
Table 4 also analyses the current month’s temporary staffing spend by staff group:
Table 4: Temporary staffing analysis for the month
Staff Group
Management/Admin
Medical
Nursing
Scientific, Technical & Therapeutic
Other
Total Temporary Pay Expenditure
Agency
Bank
Locum
Total
December
2007
£'000
£'000
£'000
£'000
£'000
39
59
2
25
0
125
0
0
146
0
0
146
0
197
0
0
0
197
39
256
148
25
0
468
38
191
114
20
0
363
ESSEX RIVERS HEALTHCARE NHS TRUST
1.5. Non-Pay
Non-pay expenditure was £100k under spent year to date, net of the Service and Cost Improvement
Programme and after release of reserves. An analysis of non-pay by expenditure type is presented
in table 5.
Table 5: Non-pay by Expenditure Type
Year to Date
Non Pay
Drugs
Clinical supplies
General supplies
Establishment expenses
Premises expenses
Other
Total
Reserves
Total Non-Pay Expenditure
December
2007
January 2008
Budget
Actual
Variance
Budget
Actual
Variance
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
8,434
15,158
4,974
3,034
6,792
8,216
46,608
1,855
48,463
8,836
14,830
4,968
2,859
7,291
8,786
47,570
793
48,363
-402
328
6
175
-499
-570
-962
1,062
100
807
1,726
500
305
726
709
4,773
157
4,930
1,133
1,490
631
305
453
1,146
5,158
(137)
5,021
-326
236
-131
0
273
-437
-385
294
-91
211
-964
10
33
458
248
-4
-314
-318
The year to date overspend on non-pay of £962k has increased by £389k compared with
December. This is not totally unexpected as budgets tend to be phased in twelfths. In January,
activity generally climbs back up after Christmas and the New Year and so costs have begun to
return to the normal weekly amount and include costs to achieve the 18 week target. The reserves
position includes slippage against developments.
The position includes costs to deliver the additional activity to deliver the 18 week wait as advised
by the Chief Operating Officer.
Ongoing Action:
Various budgets, such as drugs and medical consumables, can be volatile in nature and vary in
relation to the level and complexity of activity. Service areas continue to review and report their year
to date variations and forecasts for the year-end. Where adverse variations are identified, mitigating
actions to offset overspends will be identified with help from the finance team. Reserves are
reviewed on a monthly basis and forecasts updated as required.
1.6. Service and Cost Improvement Programme
The SCIP has achieved £4,210k year to date (100.4%) and so has now achieved the target for the
year. Of the £4,210k achieved to date, £2,339k (56%) is non-recurrent and of that, £1,501k relates
to frozen or vacant posts.
A summary of the Service and Cost Improvement Programme is shown in table 6.
ESSEX RIVERS HEALTHCARE NHS TRUST
Table 6: Service and Cost Improvement Programme
Full Year
Plan
Plan
£'000
£'000
Projects
Infrastructure
Procurement
Workforce and Payroll
Service Improvements
Income
Prescribing and Medicines
Total
109
619
2,246
264
820
137
4,195
Year to Date
Actual Variance
£'000
80
490
1,760
220
682
114
3,346
123
1,249
1,838
343
620
37
4,210
£'000
Plan
January 2008
Actual Variance
£'000
43
759
78
123
-62
-77
864
11
40
288
22
67
11
439
£'000
£'000
22
131
94
26
62
8
343
11
91
-194
4
-5
-3
-96
Ongoing Action:
An over reliance on non-recurrent schemes to deliver the SCIP target this year means the savings
will still need to be achieved next year, thereby adding to next year’s target. Divisions continue to
review which of the non-recurrent schemes, particularly the vacant posts, can become recurrent
and so make the saving permanent.
These will be subject to the sign-off process by the Project Assurance Team.
2. BALANCE SHEET
2.1. Debt Management
The Trust actively pursues both NHS and Non-NHS debts in accordance with its debt management
procedures. Table 7 summarises the ages of debts outstanding at the end of January compared
with December.
Table 7: Total Debtors
NHS
Period Outstanding
30 days or less
31 - 60 days
61 - 90 days
In excess of 90 days
Total AR Debtors
£'000
January 2008
Non NHS
Prepay
£'000
£'000
Total
NHS
£'000
£'000
December 2007
Non NHS
Prepay
£'000
£'000
Total
£'000
138
262
158
272
830
373
62
27
80
542
0
0
0
0
0
511
324
185
352
1,372
1,144
401
54
1,056
2,655
168
126
79
77
450
0
0
0
0
0
1,312
527
133
1,133
3,105
Other (Non AR) Debtors
2,220
3,324
2,391
7,935
829
4,095
2,397
7,321
Total Debtors
3,050
3,866
2,391
9,307
3,484
4,545
2,397
10,426
Budget
7,197
3,206
2,391
12,794
5,944
3,181
2,398
11,523
-4,147
660
0
-3,487
-2,460
1,364
-1
-1,097
Variance
Overall debtor balances have decreased by £1,119k (11%) since December to £9,307k. NHS
Debtors of £3,050k have decreased by £434k (11%) since December.
ESSEX RIVERS HEALTHCARE NHS TRUST
2.2. Accounts Receivable Debtors
The amount due for invoices outstanding in excess of 31 days is £861k at the end of January
(£1,793k in December).
Ongoing Action:
The Trust continues to pursue all debts in accordance with its debt management policies.
2.3. Other (Non-AR) Debtors
These include income accrued at the end of the month. It also includes a large proportion of the
balance related to RTA income that is paid to the Trust by the Central Recovery Unit (CRU) once
claims have been settled.
2.4. Debtors Due more than One Year
The Trust is currently carrying a large prepayment in relation to the staff accommodation PFI
scheme (£1,550k year to date). This balance reduces over the life of the scheme (25 years).
2.5. Creditors Due Within One Year
Table 8 analyses creditors due within one year.
Table 8: Creditors due within one year
NHS
Period Outstanding
30 days or less
31 - 60 days
61 - 90 days
In excess of 90 days
Total AP Creditors
£'000
January 2008
Non NHS
POA
£'000
749
24
11
91
875
1,536
674
290
615
3,115
Other (Non AP) Creditors
10,599
Total Creditors
£'000
Total
NHS
£'000
£'000
December 2007
Non NHS
POA
£'000
Total
£'000
£'000
0
2,285
698
301
706
3,990
245
4
3
26
278
2,180
986
554
619
4,339
0
0
0
0
0
2,425
990
557
645
4,617
11,557
0
22,156
10,655
11,149
0
21,804
11,474
14,672
0
26,146
10,933
15,488
0
26,421
Budget
2,201
12,309
0
14,510
2,057
11,091
0
13,148
Variance
9,273
2,363
0
11,636
8,876
4,397
0
13,273
Creditor balances include all accruals, including that for the planned debt repayment, which year to
date stands at £5,423k. This is being accrued during the year to the total owed of £6,518k and will
now be paid in March. NHS creditors also assume that the year to date shortfall in clinical income
of £3,055k will be repaid to PCTs. Credit notes have now been raised.
Table 9 also provides a supplementary analysis of the number of invoices outstanding.
ESSEX RIVERS HEALTHCARE NHS TRUST
Table 9: Number of Invoices
January 2008
Non NHS
POA
NHS
Period Outstanding
£'000
30 days or less
31 - 60 days
61 - 90 days
In excess of 90 days
Total AP Creditors
£'000
75
18
5
23
121
1,963
407
175
659
3,204
£'000
0
0
0
0
0
Total
NHS
£'000
£'000
2,038
425
180
682
3,325
245
4
3
26
278
December 2007
Non NHS
POA
£'000
Total
£'000
2,180
986
554
619
4,339
£'000
0
0
0
0
0
2,425
990
557
645
4,617
2.6. Public Sector Payment Policy (Prompt Payment Code)
Under the prompt payment code, invoices received from non-NHS trade creditors should be paid
within 30 days of the receipt of goods or date of invoice (whichever is the later) unless other
payment terms have been agreed. The target is to pay 95% of invoices within this period. Trust
performance against this target is shown in graph 2.
Graph 2: Public Sector Payment Performance
100%
Percent
80%
60%
40%
20%
0%
Dec
Jan
Feb Mar
Apr May June July Aug Sep Oct
Volume %
Value %
Target
Cumulative Volume %
Nov Jan
Cumulative Value %
The Trust continues to fall short of the internal PSPP target of 80% year to date, both on volume
and value. There has been a significant deterioration in performance for January due to a one-off
event. The new Trust Pharmacy system was implemented in November. However, full data failed to
transfer to the payments system in month 9. This resulted in a period of a catch-up in month 10 and
the subsequent late payment of a significant number of invoices in month 10.
In summary, PSPP performance is:
- 40% by volume, 27% by value for the month
- 72% by volume, 68% by value for the year to date
Ongoing Action:
The Trust has set an internal target to achieve a PSPP of 80% by the year end. The deterioration in
the pharmacy performance is being closely monitored and solutions are being discussed by
Finance and Pharmacy to urgently address the situation.
ESSEX RIVERS HEALTHCARE NHS TRUST
2.7.
Provisions for Liabilities and Charges
The Trust provides for legal or constructive obligations that are of uncertain timing or amount.
These are based on the best estimate of the expenditure required to settle the obligation. Provisions
for Agenda for Change relate to arrears of pay for staff still to be assimilated and are expected to be
cleared by the year end. Actual pension provisions will also be determined at year end.
3.
CASH FLOW
3.1
Cash Balances
Graph 3 shows the rolling 12 month position for budgeted and actual/forecast cash balances and a
forecast for 2008/09 as included in the Trust’s financial model for its Foundation Trust application.
Graph 3: Cash Balances
25,000
£'000
20,000
15,000
10,000
5,000
Budget
Ja
n
F
eb
M
ar
-0
9
O
ct
N
o
v
D
e
c
Ju
l
A
ug
S
ep
Ju
n
A
pr
M
ay
Ja
n
F
eb
M
ar
-0
8
O
ct
N
o
v
D
e
c
S
ep
Ju
l
A
ug
Ju
n
A
pr
-0
7
M
ay
-
Actual / Forecast
The build up of cash from 2008/09 onwards is required to fund the Trust’s Strategic Capital
Programme. The Trust’s FT Application expects cash balances to continue to increase until the end
of 2009/10 before reducing thereafter as the investment in the strategic developments come on line.
The January cash balance is £13,334k higher than budgeted, as analysed in table 10.
Table 10: Cash flow variance analysis
January 2008
£'000
£'000
Cash Balances per Budget
EBITDA
Debtors
Debt Repayment
Other Working Capital
Capital Expenditure
Donated Depreciation
Interest Received
Net cash inflow/(outflow) variance
Actual Cash Balances
Comments
9,393
-1,696
3,487
5,432
5,660
8
-15
458
Outstanding debtors
Accrued to month - to be repaid at month 12
Other working capital also includes an estimated
repayment of £3,055k to PCTs/DH relating to the under
performance on clinical income contracts. Credit notes for
Quarter 2 have now been raised.
13,334
22,727
ESSEX RIVERS HEALTHCARE NHS TRUST
3.2
Capital Expenditure
At the end of January the Trust had incurred £4,164k expenditure on this year’s capital programme.
Table 11 provides details of the programme, both year to date and forecast outturn.
Table 11: Capital programme expenditure
Capital Programme
Year to Date
Actual
Variance
£'000
£'000
Forecast Outturn
Actual
Variance
£'000
Progress
To
Date
£'000
Status
Estimated
Completion
Date
Major Schemes
Health Records Service Improvement
TV Car Park
Modular Training Building
TV Staff Car Park L
Linking of Car Parks B&C
Maternity Expansion
Relocation of Paediatric Facilities in A&E
Steam Boiler Replacement
EAU Expansion
1,673.7
193.5
7.1
267.7
8.3
71.1
137.2
30.8
172.9
0
-37
-0
0
0
0
-2
-0
53
1,805
194
279
491
140
305
157
76
173
-354
-37
-131
0
0
-41
-3
-224
53
Other Schemes under £100k
Medical Equipment
Estates
IM&T
230.6
555.6
169.5
646.1
22
-17
-13
-15
308
1,661
397
1,124
-20
387
54
107
Total Capital Expenditure
4,164
-8
7,108
-208
On Plan
Complete
Complete
Underspent
In Progress
On Plan
In Progress
On Plan
On Plan
In Progress
On Plan
In Progress
On Plan
Complete
In Progress £224k slippage
Design Stage
On Plan
Oct 07
May 07
Apr 08
Mar 08
Mar 08
June 08
Jan 08
2008
2010
Other
Capital Resource Limit (CRL)
Under/(Over)shoot
7,316
208
The Trust’s Capital Resource Limit is currently forecast to underspend by £208k (2.8%). A review
has been carried out to bring those schemes that had been slipping as far back on track as possible
and to bring forward capital schemes from 2008/09 to reduce to a minimum any capital underspend.
Projects that have been identified to bring forward are:
• Bowel Screening Scopes and IT system
• Minor Estates projects
.Actions Arising:
Whilst the forecast is for the majority of the Trust’s CRL to be used by the year end, capital projects
continue to being reviewed with project managers to ensure there is no further slippage in
implementation. These reviews include checking that all tenders are out and ensuring all orders
have been raised and goods/works are expected to be complete by 31st March. Where appropriate,
schemes have been brought forward from the 2008/09 capital programme to offset any residual
slippage in 2007/08.
It is anticipated that this forecast underspend will be further reduced.
ESSEX RIVERS HEALTHCARE NHS TRUST
3.3
Capital Cost Absorption Rate (CCAR)
The Trust has a statutory duty for to achieve a 3.5% return on net relevant assets. The Trust is
forecasting it will achieve a CCAR of 3.4% - and a tolerance +/–0.5% is allowed.
3.4
External Financing Limit (EFL)
The External Financing Limit is a statutory duty for the Trust and is set by the Department of Health.
Trust will manage its cash position to achieve its currently notified EFL of £686k.
ESSEX RIVERS HEALTHCARE NHS TRUST
Appendix A
Rolling 12 Month Income & Expenditure
Feb-08
£m
Mar-08
£m
Apr-08
£m
May-08
£m
Jun-08
£m
Jul-08
£m
Aug-08
£m
Sep-08
£m
Oct-08
£m
Nov-08
£m
Dec-08
£m
Jan-09
£m
NHS clinical income
Non NHS clinical income
Other Income
Total income
15.4
0.2
0.7
16.3
15.4
0.2
0.8
16.5
15.1
0.2
1.2
16.5
14.8
0.2
1.2
16.2
14.9
0.2
1.2
16.3
14.9
0.2
1.2
16.3
14.4
0.2
1.2
15.8
15.2
0.2
1.2
16.6
15.5
0.2
1.2
16.9
14.7
0.2
1.2
16.1
14.7
0.2
1.2
16.1
14.9
0.2
1.2
16.3
Pay costs
Drug costs
Clinical supplies and services
Other costs
Total costs
9.4
1.6
0.8
4.0
15.7
9.4
1.9
1.0
4.8
17.2
9.2
0.9
1.6
2.7
14.4
9.2
0.9
1.6
2.7
14.4
9.3
0.9
1.6
2.8
14.6
9.2
0.9
1.6
2.7
14.4
9.2
0.9
1.6
2.7
14.4
9.3
0.9
1.6
2.8
14.6
9.2
0.9
1.6
2.7
14.4
9.2
0.9
1.6
2.7
14.4
9.3
0.9
1.6
2.8
14.6
9.2
0.9
1.6
2.7
14.4
EBITDA
0.6
-0.7
2.0
1.8
1.7
1.9
1.4
2.0
2.5
1.7
1.5
1.8
Total Depreciation & Amortisation
Total interest receivable/ (payable)
PDC Dividend
0.5
0.1
0.4
0.5
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
0.6
0.0
0.4
-0.2
-1.6
1.1
0.8
0.8
0.9
0.4
1.0
1.5
0.7
0.5
0.8
Net Surplus/(Deficit)
ESSEX RIVERS HEALTHCARE NHS TRUST
Appendix B
Rolling 12 Month Balance Sheet
Feb-08
£m
FIXED ASSETS
Mar-08
£m
Apr-08
£m
May-08
£m
Jun-08
£m
Jul-08
£m
Aug-08
£m
Sep-08
£m
Oct-08
£m
Nov-08
£m
Dec-08
£m
Jan-09
£m
147.0
147.7
153.0
153.0
152.8
152.6
152.3
152.6
152.8
152.9
153.8
154.2
CURRENT ASSETS
Stocks & Work in Progress
Debtors
Accrued Income
Prepayments
Cash at bank and in hand
Total Current Assets
3.3
4.9
0.1
1.5
11.9
21.8
3.3
11.6
0.1
1.6
0.4
17.1
3.4
7.2
0.3
0.7
6.5
18.1
3.4
6.8
0.5
0.6
8.3
19.5
3.4
6.8
0.7
0.6
9.0
20.4
3.4
6.8
0.3
0.5
10.3
21.2
3.4
6.7
0.5
0.4
11.3
22.3
3.4
6.8
0.7
0.4
10.2
21.5
3.4
6.8
0.3
0.3
12.2
23.1
3.4
6.8
0.5
0.3
12.8
23.7
3.4
6.8
0.7
0.2
13.4
24.5
3.4
6.8
0.3
0.1
14.2
24.7
CURRENT LIABILITIES (amounts due < one year)
Creditors
Accruals
Total Current Liabilities
12.1
3.6
15.7
10.0
3.4
13.4
10.7
2.8
13.5
11.4
2.8
14.2
12.2
2.8
15.0
11.9
2.8
14.7
12.3
2.8
15.1
10.8
2.8
13.6
11.1
2.8
13.9
11.2
2.8
14.0
12.3
2.8
15.1
12.1
2.8
14.9
2.4
2.4
2.4
2.4
2.4
2.4
2.3
2.3
2.3
2.3
2.3
2.3
155.4
153.8
159.9
160.7
160.6
161.5
161.9
162.7
164.2
164.9
165.5
166.3
2.2
2.1
2.1
2.1
1.8
1.8
1.8
1.6
1.6
1.6
1.6
1.5
153.2
151.6
157.9
158.7
158.8
159.7
160.1
161.1
162.7
163.4
163.9
164.7
-
-
-
-
-
-
-
-
-
-
-
-
TAXPAYERS' EQUITY
Public dividend capital
Income and expenditure reserve
Revaluation reserve
Donated asset reserve
Other Reserves (Government grant reserve etc)
TOTAL TAXPAYERS EQUITY
74.1
13.9
62.0
2.5
0.8
153.2
74.7
12.3
61.4
2.5
0.8
151.6
74.1
13.4
67.1
2.6
0.8
157.9
74.1
14.2
67.1
2.5
0.8
158.7
74.1
15.0
66.4
2.5
0.8
158.8
74.1
15.9
66.4
2.5
0.8
159.7
74.1
16.4
66.4
2.5
0.8
160.1
74.1
17.4
66.4
2.5
0.8
161.1
74.1
19.0
66.4
2.5
0.8
162.7
74.1
19.7
66.4
2.4
0.8
163.4
74.1
20.3
66.4
2.4
0.8
163.9
74.1
21.2
66.3
2.4
0.8
164.7
TOTAL FUNDS EMPLOYED
153.2
151.6
157.9
158.7
158.8
159.7
160.1
161.1
162.7
163.4
163.9
164.7
NET CURRENT ASSETS (LIABILITIES)
Long term Debtors
TOTAL ASSETS LESS CURRENT LIABILITIES
Provisions for liabilities and charges
TOTAL ASSETS EMPLOYED
LOANS
Total Loans
TOTAL LOANS
ESSEX RIVERS HEALTHCARE NHS TRUST
Appendix C
Rolling 12 Month Cash Flow
Feb-08
£m
Mar-08
£m
Apr-08
£m
May-08
£m
Jun-08
£m
Jul-08
£m
Aug-08
£m
Sep-08
£m
Oct-08
£m
Nov-08
£m
Dec-08
£m
Jan-09
£m
EBITDA
0.7
-0.7
2.0
1.8
1.7
1.9
1.4
2.0
2.5
1.7
1.5
1.8
Excluding Non cash I&E items
Movement in working capital:
Stocks & Work in Progress
Debtors
Accrued Income
Prepayments
Creditors
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.1
0.4
0.0
0.0
-10.8
0.0
-6.8
0.0
0.0
-0.3
0.0
-0.3
-0.2
1.0
4.7
0.0
0.5
-0.2
0.1
0.3
0.0
0.0
-0.2
0.1
0.1
0.0
0.0
0.4
0.1
-0.1
0.0
0.0
-0.2
0.1
0.0
0.0
-0.1
-0.2
0.1
0.1
0.0
0.0
0.4
0.1
-0.1
0.0
0.0
-0.2
0.1
-0.3
0.0
0.0
-0.2
0.1
0.0
0.0
0.0
0.4
0.1
-0.1
0.0
0.0
0.0
0.0
-9.7
0.0
0.0
-7.8
0.0
-0.6
0.0
0.0
6.6
0.0
0.0
0.0
0.0
2.3
0.0
0.0
0.0
-0.2
1.4
0.0
0.0
0.0
0.0
2.2
0.0
0.0
0.0
0.0
1.3
0.0
0.0
0.0
-0.2
1.6
0.0
0.0
0.0
0.0
2.8
0.0
0.0
0.0
0.0
1.3
0.0
0.0
0.0
0.0
1.3
0.0
0.0
0.0
0.0
2.2
-1.1
0.0
0.0
-1.9
0.0
0.0
-0.5
0.0
0.0
-0.6
0.0
0.0
-0.6
0.0
0.0
-1.0
0.0
0.0
-0.3
0.0
0.0
-0.3
0.0
0.0
-0.8
0.0
0.0
-0.7
0.0
0.0
-0.8
0.0
0.0
-1.5
0.0
0.0
CF before Financing
Other movement in financing
Dividends paid
-10.8
0.0
0.0
-9.7
0.0
-2.4
6.1
0.0
0.0
1.7
0.0
0.0
0.7
0.0
0.0
1.3
0.0
0.0
1.0
0.0
0.0
1.3
0.0
-2.4
2.0
0.0
0.0
0.6
0.0
0.0
0.5
0.0
0.0
0.7
0.0
0.0
Net cash outflow/inflow
-10.8
-12.1
6.1
1.7
0.8
1.3
1.0
-1.1
2.0
0.6
0.6
0.7
Payments on Account
Accruals
Deferred Income
Provisions & Liabilities
CF from Operations
Capital Expenditure
Maintenance capex
Capex spend
PFI residual interest
Cash receipt from asset sales
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 2: SERVICE PERFORMANCE
Service Performance Scorecard - 2007/08
Score & Threshold
Actuals - YTD
Weighting
Score
Threshold
Dec-07
Jan-08
1.0
98%
99.9%
1.0
95%
Maximum waiting time of 26 weeks for inpatients
1.0
Maximum waiting time of 13 weeks for outpatients
1.0
MRSA year-on-year reduction (year-end target) (Annual Figure)
Forecast Outturn (FOT)
Trend
Monitor
Score
Mar-08
Monitor
Score
99.9%
SAME
0.0
99.9%
0.0
99.6%
99.5%
WORSE
0.0
99.0%
0.0
99.97%
100.00%
100.00%
SAME
0.0
100.00%
0.0
99.97%
100.00%
100.00%
SAME
0.0
100.00%
0.0
1.0
12
11
13
WORSE
1.0
13
1.0
18 week maximum wait - Admitted Patients
18 week maximum wait - Non - Admitted Patients
1.0
85%
90%
57.7%
95.8%
66.1%
93.8%
BETTER
0.0
85.0%
90.0%
0.0
Sexual health - 48 hour access to GUM clinics by 2008
1.0
100%
100.0%
100.0%
SAME
0.0
100.0%
0.0
Implementation of choice and book - convenience and choice - elective (ip and dc)
and outpatient booking
1.0
100%
100.0%
100.0%
SAME
0.0
100.0%
0.0
Maximum waiting time of 4 hours in A&E from arrival to admission, transfer or
discharge
0.4
98%
98.8%
98.9%
BETTER
0.0
98.5%
0.0
All patients who have ops cancelled for non-clinical reasons to be offered another
binding date within 28 days
0.4
95%
100.0%
100.0%
SAME
0.0
100.0%
0.0
0.4
68%
71.0%
71.0%
SAME
0.0
75.0%
0.0
Maximum waiting time of 3 months for revascularisation
0.4
99%
N/A
N/A
SAME
0.0
N/A
0.0
Maximum waiting time of 2 weeks from urgent GP referral to 1st outpatient
appointment for all urgent suspect cancer referrals*
0.4
98%
99.9%
99.9%
SAME
0.0
100.0%
0.0
Maximum waiting time of 2 weeks for rapid access chain pain clinics
0.4
98%
98.0%
98.0%
SAME
0.0
99.0%
0.0
Minimising delayed transfers of care by 2008
0.4
<=3.5%
1.5%
1.6%
WORSE
0.0
1.5%
0.0
Each national core standard
0.4
0
0
0
SAME
0.0
0
0.0
Targets and National Core Standards 2007-08
Maximum waiting time of 31 days from diagnosis to treatment for all cancers*
Maximum waiting time of 62 days from urgent referral to treatment for all cancers*
People suffering heart attack to receive thrombolysis within 60 minutes of call
YTD - Year To Date
* - Cancer reporting previous month
Figures in italics are forecast
TOTAL SCORE
1.0
1.0
ESSEX RIVERS HEALTHCARE NHS TRUST
Other HCC Targets Performance Scorecard - 2007/08
Actuals - YTD
FOT
Target
Dec-07
Jan-08
Trend
Mar-08
Data submission for all quarters, completeness and NHS number
100%
100%
SAME
100%
Data quality on ethnic group
>=80% FCEs with ethnic coding completeness
84.6%
80.6%
WORSE
85.0%
Drug misusers: information, screening and referral
Compliance with 'Models of Care' requirements
100%
100%
SAME
100%
Emergency bed days
Reduce Emergency Bed Days by 5% by 2008
-1.7%
-1.5%
WORSE
-2.0%
Secure sustained national improvements in NHS patient experience by
2008
Not Known
Not Known
SAME
Not Known
Smoking during pregnancy and Breastfeeding initiation
77%
77%
SAME
85%
Halting the year on year rise in obesity in under 11 by 2010
100%
100%
SAME
100%
Greater than or equal to 90% completion for the key fields recorded by
MINAP
100%
100%
SAME
100%
Processes in place to ensure compliance with NICE guidelines in
emergency departments
100%
100%
SAME
100%
By March 2008 patients should be seen within 6 weeks
3.9%
3.1%
BETTER
0.0%
Patient safety & Clinical and cost effectiveness
Yes
Yes
SAME
Yes
Other HCC Target Indicators 2007-08
Clostridium Difficile data quality
Experience of patients
Infant health and inequalities
Obesity: compliance with NICE guidance 43
Participation in audits
Self harm: compliance with NICE guidelines
Waiting times for Diagnostic Tests
Development Standards
HCC Quality rating*
* HCC Quality rating prediction based on estimated outturn position for 2007/08
Figures in italics are forecast
EXCELLENT
ESSEX RIVERS HEALTHCARE NHS TRUST
2.1.
18 Weeks RTT Performance – All Specialties
In January the Trust’s performance for the 18 Weeks referral to treatment was 66.1% for
Admitted Patients (last month 57.7%) and 93.8% for Non-Admitted Patients (last month
95.8%). The targets for March 2008 are 85% for Admitted Patients and 90% for NonAdmitted Patients. 18 week RTT performance is the subject of significant work to ensure
sufficient capacity to deliver the March targets and thereby enabling admitted patients to be
dated within 18 weeks.
18 Weeks RTT - Admitted Patients
18 Weeks RTT - Non-Admitted Patients
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
88.0%
86.0%
84.0%
82.0%
80.0%
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
45.0%
40.0%
35.0%
30.0%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Target
All Specialties
2.2.
Apr May Jun
Jul
Aug Sep Oct Nov Dec Jan Feb Mar
All Specialties
Target
A&E 4 Hour Standard of 98%
For the period to January 2008 the Trust had 67,798 attendances (last month 60,573
attendances) and the average performance of patients seen, treated or discharged against
the 4 Hour standard was 98.17% (last month 98.11%). Performance against the Healthcare
Commission target for ‘mapped’ A& E services for January 2008 was 98.86% (last month
98.83%). A recovery plan has been actioned to improve Type 1 performance in the final
quarter to ensure continued delivery of the 98% standard.
100.00%
99.00%
98.00%
97.00%
96.00%
95.00%
April
May
June
July
August
07/08 Monthly
September
06/07 Monthly
October
November December
07/08 Cumulative
07/08 Mapped
January
February
March
ESSEX RIVERS HEALTHCARE NHS TRUST
2.3.
Cancer 62 Day
There was 1 patient breach in the 62 Day Cancer pathway in December 2007, resulting from
a complex diagnostic pathway and referral to another provider for treatment. The breach will
be a shared breach with the other provider unit. The year to date number of breaches is
therefore 3.5. Performance is above the threshold for this indicator.
2.4.
Delayed Transfers of Care
Delayed Transfer of Care performance deteriorated slightly in January 2008 compared to the
previous months position, however, the overall levels are within the threshold levels used by
the Healthcare Commission in the 2007 ratings.
2.5.
Data Quality on Ethnic Monitoring
Data Quality on Ethnic monitoring performance deteriorated slightly in January 2008
compared to the previous months position. This has been raised with the Data Quality
Manager and actions put in place to ensure that data recording and capture is improved to
return performance to previous levels. The current and forecast levels are above the
threshold levels used by the Healthcare Commission in the 2007 ratings.
2.6.
Emergency Bed Days
Emergency bed day performance deteriorated slightly in January 2008 compared to the
previous months position, however, the overall levels are within the threshold reduction
levels used by the Healthcare Commission in the 2007 ratings.
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 3: CLINICAL INDICATORS
3.1.
Mortality
Basket: Diagnoses - HSMR | Outcome: Mortality (in-hospital) | Benchmarks: Data year
Chapter: All | Diagnosis: All | Department: All | Team: All
First / Last: Apr-05 / Sep-07 | Admission type: All | Sex: All | Deprivation: All | Age Range:
All
Spells: 52343 | Superspells: 51962 (40883/11079) | Deaths: 3956 (7.6%) | Expected: 3785
(7.3%) | Relative Risk: 104.5 (101.3—107.8) | C-Statistic: 0.82 (High) | LoS: 8.8/11
Trend
Spells Superspells %
(Quarter)
Deaths %
2005-Q2
9.7%
424
8.4% 365.2
7.2% 116.1 105.3 127.7
5068
5046
Expected %
RR
Low
96.9
High
2005-Q3
4957
4924
9.5%
387
7.9% 360.7
7.3% 107.3
2005-Q4
5491
5444
10.5% 471
8.7% 396.8
7.3% 118.7 108.2 129.9
118.5
2006-Q1
5468
5426
10.4% 505
9.3% 415.5
7.7% 121.5 111.2 132.6
2006-Q2
4915
4879
9.4%
376
7.7% 355.3
7.3% 105.8
95.4
117.1
2006-Q3
5141
5090
9.8%
346
6.8% 347.3
6.8% 99.6
89.4
110.7
2006-Q4
5638
5594
10.8% 377
6.7% 408.5
7.3% 92.3
83.2
102.1
2007-Q1
5287
5255
10.1% 379
7.2% 399.6
7.6% 94.9
85.5
104.9
2007-Q2
5254
5221
10%
355
6.8% 377.6
7.2% 94
84.5
104.3
2007-Q3
5124
5083
9.8%
336
6.6% 358.6
7.1% 93.7
84
104.3
The chart shows the HSMR trend for the period April 2005 to October 2007. The overall
HSMR for this period is 104.5, however there has been a downward trend since January
2006 and the HSMR for the most recent twelve month period shown is ~93.7.
This improvement is attributed to multiple interventions including the implementation of focus
charts, “care bundles”, “ALERT” training for frontline nursing & medical staff, as well as “drill
ESSEX RIVERS HEALTHCARE NHS TRUST
downs” into specific diagnostic groups where a coding issue was suspected. These latter
identified issues that have subsequently been addressed with the coding department.
The mortality audit group continues to meet regularly to review individual cases and the Dr
Foster data is reviewed by divisional governance groups. There are currently no negative
“alerts” for mortality in any of the underlying diagnostic groups.
3.2.
MRSA
MRSA Information 2007-2008
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Actual
2
1
2
2
1
1
1
0
1
2
0
0
Of which in Augmented care after 48 hours
0
0
0
0
0
1
0
0
0
1
0
0
Trajectory
1
1
1
1
1
1
1
1
1
1
1
1
Cum Actual
2
3
5
7
8
9
10
10
11
13
Cum Trajectory
1
2
3
4
5
6
7
8
9
10
11
12
2006/07 Cum Actual
2
5
7
10
12
16
17
17
18
20
22
24
2005/06 Cum Actual
4
7
8
8
12
13
14
16
17
17
18
19
2007/2008 Actual MRSA Bacteraemia by month
3
2
1
0
Apr
May
June
July
Aug
Sept
Actual
Oct
Nov
Dec
Jan
Feb
Mar
Trajectory
2007/2008 Cumulative MRSA Bacteraemia
30
25
20
15
10
5
0
Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar
Cum' Actual
Cum' Trajectory
2006/07 Cum' Actual
2005/06 Cum' Actual
ESSEX RIVERS HEALTHCARE NHS TRUST
3.3.
C.Difficile
Clostridium difficile infections Information 2007-2008 (All ages)
"Hospital Inpatient" specimens
"Not Hospital Inpatient" specimens
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
45
35
30
27
24
23
23
17
17
18
2
2
6
7
10
20
19
19
19
19
19
19
19
19
19
19
19
"Hospital inpatient" specimens 2006/07
28
28
23
32
27
10
13
17
30
38
35
42
Cum "Hospital Inpatient" specimens
45
80
110
137
161
184
207
224
241
259
92
127
47
5
11
9
165
198
7
Mar
Local Trajectory
Cum Specimens (all)
10
Feb
228
253
276
300
328
Cum Trajectory
20
39
58
77
96
115
134
153
172
191
210
229
Cum "Hospital inpatient" specimens 2006/07
28
56
79
111
138
148
161
178
208
246
281
323
2007/2008 Actual Clostridium difficile infections by month
50
45
40
35
30
25
20
15
10
5
0
Apr
May
June
July
"Hospital Inpatient" specimens
Aug
Sept
Oct
"Not Hospital Inpatient" specimens
Nov
Dec
Jan
Feb
Mar
Jan
Feb
Mar
Local Trajectory
2007/2008 Cumulative Clostridium difficile infections
350
300
250
200
150
100
50
0
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Cum Trajectory
Cum Specimens (all)
Cum "Hospital Inpatient" specimens
Cum "Hospital inpatient" specimens 2006/07
ESSEX RIVERS HEALTHCARE NHS TRUST
3.4.
Saving Lives Audit
Saving Lives Results Jan 2008. Scores represent compliance with all elements performed for each high impact intervention.
Area
Month
HI1RED ANTI
MICRO
HI2b PVC Cont.
Care
HI2c Renal
dialysis catheter
INSERT
100%(3/3)
95%(18/19)
no data
74% (29/39)
93%(53/57)
no data 100%(30/30)
HI2 CVC INSERT
HI2 CVC CONT.
CARE
100%(1/1)
100%(1/1)
Medicine
Jan
Feb
86% (19/22)
Surgery
Jan
Feb
93%(56/60)
no data 100%(15/15)
Care of the Elderly
Jan
Feb
91%(39/43)
no data
Critical Care
Jan
Feb
no data
no data
100%(7/7)
ECH
Jan
Feb
100%(5/5)
no data
Womens Services
Jan
Feb
100%(10/10)
Childrens Services
Jan
Feb
no data
OVERALL TOTAL
Jan
Feb
92%(129/140)
HI2b PVC
INSERT
HI2c Renal
HI4 VENT REG HI4 VENT CONT.
dialysis catheter HI3 SSI PRE OP HI3 SSI PERI OP
OBS
CARE
CONT. CARE
HI6 CDIFF
NA
NA
NA
NA
NA
NA
93%(14/15)
100%(1/1)
NA
NA
NA 100% (19/19)
NA
NA
NA
NA
NA 100%(10/10) 100%(48/48)
100%(5/5)
95% (37/39)
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA 100%(17/17)
NA
no data
100% (7/7)
NA
NA
NA
NA
no data
NA
NA
100%(6/6)
100%(6/6)
no data
40% (4/10)
80%(8/10)
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
no data
no data
100%(6/6)
90%(9/10)
NA
NA
no data
NA
NA
NA
NA
no data
no data
no data
no data
NA
NA
NA
NA
no data
NA
NA
NA
NA
82%(72/88) 93%(132/142)
no data
no data 100%(19/19)
no data
100%(6/6)
Based on files received in the ICT office (as of 12th February 2008).
NB: no data means that these sections were not completed on the files returned to the ICT, I.e. there may have been no observations to document.
NA = Not applicable high impact intervention for that area.
100%(3/3)
HI5 URINARY
CATH CONT.
CARE
NA
NA
100%(1/1) 100%(23/23)
no data
HI5 URINARY
CATH. INS
97%(37/38) 100%(10/10)
no data 100% (10/10)
100%(2/2)
no data
100%(2/2)
no data
NA
NA
no data 100%(10/10)
no data
NA
NA
no data
no data
no data
100%(6/6) 100%(32/32) 98%(121/123) 100%(16/16)
ESSEX RIVERS HEALTHCARE NHS TRUST
SHA Healthcare Associated Infection Feedback Form
Name of PCT
North East Essex
Name of Trust
Essex Rivers Healthcare NHS Trust
Jan-08
Report for the month of
MRSA
Annual Target
No. Cases MRSA this month
12
2
Cumulative Actual Total for the
year
Against monthly target of
13
Status to annual target
1
Status to monthly target
0
No. Cases pre 48 hours this
month
1
No. Cases with previous
admissions in the past 6
months
2
MRSA Root Cause Analysis (RCA)
No. MRSA RCA this month
2
No. Cases in Augmented Care
this month
No. Avoidable Cases this month
No. Unavoidable Cases this
month
Main themes from RCAs
Care of Renal dialysis lines; responsibility in part with outsourced renal dialysis
provider
How was policy/practice changed as a
result
C diff
No. cases C diff (over 65s) this
month
No. cases C diff (all ages) this
month
13
4
C diff Root Cause Analysis (RCA)
No. C diff RCA this month
(RCAs should be carried out on
all cases of C diff related deaths
and colectomies)
Total No. deaths from C diff this
month
8
No. Colectomies for C diff this
month
0
No. admissions to ITU for C diff
this month
0
2
No. deaths this month
(C diff main cause of death)
0
No. deaths this month
(C diff contributory to death)
2
Main themes from RCAs
No clear theme emerged
How was policy/practice changed as a
result
Antibiotic prophylaxis regimens agreed with surgical team as an ongoing part of
action plan, not as a consequence of RCAs
Hand Hygiene
Trust-wide audited compliance percentage this month
83
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 4: WORKFORCE
All data in this report is for the month of January 2008.
•
Staff in Post
Variance between staff in post compared to budgeted establishment has risen to 6.99%
in January; this occurs at the time when posts frozen under SACIP have been released
and has translated into significant growth of recruitment activity in the last two months.
•
Sickness Absence
This month it has been possible to include sickness absence data for January. Sickness
absence has increased in both December and January and at 3.68% for the year to date
is marginally above the Trust target of 3.5%. This has occurred at a time of high
incidence of Noro-virus. This is however a reduction of 2.38% on the year to January
2007.
•
Turnover
Turnover shows a reduction, the figure for January 2008 is just over half that of
December 2007 and year to date figures show a 6.93% reduction on the year to January
2007.
•
Overtime & Agency
Both overtime and agency show a marked increase over the previous month and over
the comparable period in 2006/07. This has occurred in parallel to higher levels of
sickness absence, and delivery of the 18 week and emergency access target.
Directorate
Womens Services
General Medicine
Cancer Services
Specialist Medicine
General Surgery
Specialist Surgery
Theatres Anaes & Crit Care
Ambulatory Care
Therapy Services
Pharmacy
Site Operations
Pathology
Radiology
Chief Executive
Medical Director
Finance
PFI & Estates
Nursing
Human Resources
Operations
ICT
Total
Estab
257.23
491.90
198.31
312.31
270.30
170.52
358.72
166.56
134.19
105.33
12.86
150.73
89.43
3.87
9.14
72.02
50.00
32.22
41.26
6.00
20.81
2,953.71
WTE
245.91
474.91
183.55
267.28
264.33
149.55
335.54
138.54
131.60
99.86
9.00
140.95
83.41
3.81
7.60
65.67
48.96
37.73
31.33
6.00
21.66
2,747.19
Heads
342
562
234
320
295
183
368
191
171
111
14
171
101
10
9
71
56
43
39
6
24
3,323
Staff Group
Add Prof Scientific and T
Additional Clinical Servic
Administrative and Cleric
Allied Health Profession
Estates and Ancillary
Healthcare Scientists
Medical and Dental
Nursing and Midwifery R
Students
Total
WTE
20.44
538.06
533.33
179.70
3.00
143.06
385.08
933.73
10.80
2,747.19
Heads
26
668
673
226
3
165
426
1,125
11
3,324
ESSEX RIVERS HEALTHCARE NHS TRUST
TRUST TOTAL
CURRENT YEAR
January
Sickness Absence
Overtime (% of Estab)
Bank, Agency & Locum (% of Staff cost)
Bank, Agency & Locum cost (£000)
Turnover
Staff in post
2006/2007 FOR COMPARISON
YTD
5.05%
0.81%
5.12%
£469
0.59%
2747.19 (WTE)
3.68%
0.54%
2.84%
£3,007
9.67%
Var 06/07 (YTD)
January
2.38%
(143.81)%
(75.53)%
6.93%
3323 (Heads)
DIRECTORATES
Womens Services
General Medicine
Cancer Services
Specialist Medicine
General Surgery
Specialist Surgery
Anaes & Tech Serv
Ambulatory Care
Therapy Services
Pharmacy
Site Operations
Pathology
Radiology
Chief Executive
Medical Director
Finance
Estates & Facilities
Nursing
Human Resources
Operations
ICT
Trust Total
WTE in
Post
245.91
474.91
183.55
267.28
264.33
149.55
335.54
138.54
131.60
99.86
8.19
140.95
83.41
2.81
7.60
65.67
48.96
37.73
31.33
7.80
21.66
2,747.19
Sickness Absence
YTD
January
5.57%
4.75%
6.30%
3.61%
4.82%
4.24%
5.01%
3.76%
4.06%
3.22%
5.81%
3.58%
5.33%
4.14%
4.98%
5.68%
4.27%
2.93%
2.97%
2.35%
12.51%
4.52%
3.51%
1.86%
4.26%
2.24%
3.94%
0.39%
1.13%
5.04%
3.41%
1.91%
5.54%
4.98%
7.95%
5.46%
2.66%
1.59%
2.99%
1.55%
5.62%
3.89%
5.05%
3.68%
Overtime
January
0.10%
0.73%
1.29%
0.74%
0.54%
0.92%
1.97%
0.88%
0.45%
0.70%
0.00%
0.15%
0.19%
0.00%
0.00%
0.91%
1.39%
0.00%
0.09%
0.00%
1.05%
0.81%
YTD
2.83%
3.77%
0.17%
0.22%
0.47%
1.62%
No comparison figures available
0.87%
10.39%
2790.06 (WTE)
3423 (Heads)
YTD
0.08%
0.26%
0.35%
0.21%
0.39%
0.27%
1.93%
0.98%
0.56%
0.26%
0.00%
0.13%
0.46%
0.12%
1.84%
0.40%
1.70%
0.04%
0.16%
0.00%
1.83%
0.54%
Bank, Agency & Locum
YTD
January
7.46%
2.16%
11.74%
6.29%
6.48%
3.35%
6.35%
2.66%
2.95%
2.25%
0.00%
4.02%
2.11%
1.56%
-0.41%
1.52%
2.51%
1.82%
6.09%
0.53%
4.95%
0.39%
2.68%
1.13%
2.68%
1.08%
0.00%
0.00%
1.29%
0.60%
3.36%
0.90%
13.63%
3.86%
0.23%
0.36%
3.89%
3.35%
0.00%
0.00%
0.72%
1.38%
5.12%
2.84%
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 5: RISK REPORT
5.1.
Internal Audit Assessment by Deloitte & Touche Public Sector Internal Audit Limited
5.1.1. Risk Management Audit undertaken between 12-22 October 2007
Report received February 2008.
Summary of Findings
As a result of testing, one
priority 2 recommendation has
been raised and an audit
opinion of Substantial
Assurance given.
Recommendation
Appropriate resources, in terms of
management and staff training and
development time, are devoted to the
implementation of the DatixWeb Risk
Register software system across all service
and corporate areas.
Action Taken
Datix software for the Risk Register
purchased in September 2007.
Software currently being aligned to suit
organisational reporting requirements.
Training commenced February 2008 to
all identified leads for risk within the
three Divisions of the Trust. Good work
in progress thus far.
5.1.2. Clinical Governance Audit undertaken between 12-22 October 2007
Report received February 2008.
Summary of Findings
Full Assurance audit opinion
has been given.
Recommendation
None
Action Taken
None
ESSEX RIVERS HEALTHCARE NHS TRUST
5.2.
NHSLA Assessment
The assessment was undertaken on 30th and 31st January 2008 by a designated NHSLA Assessor and observed (for day one) by the new
Chair of the NHSLA, Professor Dame Joan Higgins.
Standard
Score
1. Governance
10 out of 10
2. Competent and Capable Workforce
6 out of 10
3. Safe Environment
10 out of 10
4. Clinical Care
10 out of 10
5. Learning from Experience
10 out of 10
Total
46 out of 50
The Trust has retained compliance with Level 2 of the new NHSLA Risk Management Standards for Acute Trusts. A detailed report
regarding the areas of non-compliance is expected not later than the 28th February 2008.
5.3.
Risk Management Strategy and Policy No. 118 Version 4
The Risk Management Strategy and Policy was approved by the Board in February 2007 and is due for its annual review in February 2008.
In view of the Trust’s application for NHS Foundation Trust status it is requested that the Board consider continuance of this Policy for a
further 4 months, to allow alignment with Trust’s Integrated Governance Plan.
ESSEX RIVERS HEALTHCARE NHS TRUST
5.4.
Clinical Governance Strategy No. 229 Version 2
The Clinical Governance Strategy was approved by the Board in March 2007 and is due for its annual review in March 2008. In view of the
Trust’s application for NHS Foundation Trust status it is requested that the Board consider continuance of this Policy for a further 4 months,
to allow alignment with Trust’s Integrated Governance Plan.
5.5.
Risk Register
5.5.1. Extreme Risk Register
There are no extreme (red) risks reported as of 17th February 2008.
5.5.2. Top Risks Reported
The highest risks reported are therefore amber and 13 such risks were reported to the Board on 31st January 2008. The Trust’s ‘all risk
register’ is a live document and risks are identified and reduced or eliminated on a continual basis.
Since 31st January the activities of the amber risk register have been monitored as follows:
5.5.2.1.
New Amber Risk Identified Since 31s January 2008
Source of
Risk/Service Area
Description of Risk
Summary of Action
Clinical Audit 10
Health Records: Clinical Audit Department
experiencing problems in retrieving health
records for audits.
Clinical audit staff working with health care records staff to improve
processes
General Medicine 02
Expansion of Layer Marney Ward
Due to expansion of Layer Marney Ward, staffing compliment needs
review. Establishment Control Forms have been completed and
approved for nursing and clerical staffing.
Site Op 01
Resource issues regarding the opening of
contingency ward.
Equipment has been ordered and now in place. Staffing remains the
concern as reliant on NHS Professionals to fill large numbers of slots.
ESSEX RIVERS HEALTHCARE NHS TRUST
5.5.2.2.
Previous Amber Risks Reported 31st January 2008
Source of
Risk/Servic
e Area
Description of Risk
Summary of Action plan
Clinical Audit
01
Difficulty in meeting targets, accreditation
standards and supporting medical specialities
with clinical audit projects
Resource and workload review within the Audit Department is currently in
progress. Looking at ways in which the department can work differently.
Children’s
Services 02
Treatment room too small - Paeds
Risk is being managed within the Children’s Ward and continues to be monitored.
Delivery Suite
09
Insufficient Labour Ward Beds to meet
current demands. Women being delivered on
Antenatal Ward and Recovery area in
theatre.
Birth rate increasing, need for more labour rooms. Currently reviewing existing
facilities outside of Delivery Suite. Escalation plan procedure agreed and used
when required. Successful Business Case to Capital Development Group, tender
process completed. Work has commenced for the development of a new
Gynaecology OPD to enable expansion of the Labour Ward.
Continuous monitoring of activity with Delivery Suite. Birth rate has increased this
financial year.
ICT 09
Custom Built Databases containing Patient
Level Data. Databases have been developed
without involvement of ICT leading to
fragmented data of poor quality. Data is held
that may have serious clinical or income
consequences but is not available to Trust
management or Clinical management.
Databases in Access are unstable. The
Information Team who deal with databases
currently have no staff with Access
experience, ESSA do not support Access
databases.
Have identified databases, plan to migrate data either into PAS or a proper
commercial off the shelf system that can be integrated to PAS e.g. as per GI
reporting
Engaging departments with view to purchasing commercial system to replace the
databases. Any database that fails before this happens will require contract
resource to be hired to fix the problem. ICT is in contact with companies that can
supply such resources.
Assisting departments in procurement, plan work according to resource
availability, will speed up when new system administrators in post. Temporary
member of staff in ICT has Access capability, ICT is using that resource to carry
out remedial work on the databases to ensure they can continue to operate.
ESSEX RIVERS HEALTHCARE NHS TRUST
Source of
Risk/Servic
e Area
Description of Risk
Summary of Action plan
ICT 32
ICNET infection control system about to be
implemented without proper system
administration cover, high risk that a technical
problem with the database would leave the
infection control team unable to enter or
report on data for national targets.
Software installed and ITC department testing interfaces.
Maternity
Services 03
Antenatal Clinics- Poor state of medical
records.
Trust has detailed action plan for the management of Medical Records. Situation
continues to be monitored. Datix reporting forms completed as required.
Pathology 01
Handling of mislabelled specimens &
Incorrectly completed request forms
All patient details on specimens and forms are checked prior to the specimen
being processed. If any errors are found these are noted and appropriate action
taken depending on the nature of the error and the type of specimen received.
Agreed procedures in place for the rejection of specimens.
All new medical staff are given clear instruction on the requirement of completing
specimen requests.
There is a Trust policy on identification of patients that includes instructions on
completing request cards and labelling specimens.
Specialist
Medicine 01
Difficulties in staffing of contingency beds
Contingency beds have been spread across other wards to reduce risk in one
area. Skill mix review in progress to ensure safety and quality of care can be
maintained. Further bed configuration currently under discussion.
Specialist
Medicine 02
Increase in renal dialysis patients dialysing in
chronic renal unit. Numbers of patients likely
to be dialysing in Unit by end of July 2007 will
exceed predicted numbers that were to be
seen by year three of opening. This will lead
to medical manpower deficit.
Appropriate action plan in place. New substantive post agreed to support
workload.
ESSEX RIVERS HEALTHCARE NHS TRUST
Source of
Risk/Servic
e Area
Specialist
Medicine 04
Description of Risk
Increased failure in endoscopes. Scopes
have been sent for repair 44 times in last 6
month Period. Scopes are 7 years old.
Summary of Action plan
Risk that equipment cannot deliver the activity required to achieve the 13 week
maximum wait time for endoscopy. A bid is also pending for the colorectal
screening service and plan to achieving a six week wait will need to be delivered to
ensure that we would be considered. Impact also felt on efficiency of lists impacting on increased cancellation of patients. Bid for replacement equipment
submitted to the capital planning group and linked to the bowel screening bid.
Approval gained for purchase of three scopes in the interim and replacement for
the scoping equipment in rooms 1 and 2. Orders placed with anticipated
equipment delivery scheduled for mid to end February 2008
Specialist
Medicine 05
Inability to meet current neurology demand
with single handed neurologist. Governance
issues emerging with inability to follow up
patients due to new patient demand. Lack of
capacity in the speciality risks 13 week
breaches in waiting time standard
Departmental action plan in place. Backlog of follow-up patients being seen. The
situation continues to be monitored.
Specialist
Medicine 07
Risk of lack of capacity for chronic
Haemodialysis
Renal capacity within dialysis unit now at 100 patients. Unit has been open since
July 2006. Maximum capacity is 120 patients. This has been raised with specialist
commissioning but no direction has been given at this time. Surrounding hospitals
also have constraints and could not be considered as contingency.
ESSEX RIVERS HEALTHCARE NHS TRUST
5.5.2.3
Amber (High) Risks reduced to Yellow (Moderate)
Source of
Risk/Service
Area
COR 07
Description of Risk
Summary of Action
ISTC may open in Braintree in Sept 08 and
attract some patients away from the Trust.
Potential maximum gross loss of income
estimated to be £2.7m.
The Trust must defend its market share by delivering good local services that
patients continue to choose.
COR 16
Increase use by PBC of clinicians with
special interests in the community reduces
Trust activity. Potential gross loss of income
is estimated to be £2.3m.
Impact of PbC included in commissioning intentions so potential impact already
discounted to some degree.
FAC 07
Move into new Healthcare Records Centre,
the introduction of a new case note
management system and requests for
additional clinics has led to inefficiency in
availability of records for patient clinics.
Detailed recovery plan led by Head of Healthcare Records, action plans in
progress.
Decision expected Mar 08. PCTs may be required to fund ISTC regardless of
patient choice.