1. society
2. welfare
3. healthcare

TRUST BOARD PAPER – COVER SHEET
Meeting Date: Thursday, 27th March 2008
Agenda Item:
8
Title:
Operational Performance (Month 11) 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’ based on 2007/08 thresholds.
Section 3: Clinical Indicators
• MRSA NIL cases in February against a target of 1, with year to
date 13 cases against an annual target of 12 cases.
• C.Diff 13 hospital cases in February against a target of 19.
• Hand Hygiene compliance improvement to 90% in February.
Section 4: Workforce
• Variance between staff in post and budget has reduced to
6.28%.
• Sickness absence at 3.68% marginally above Trust target of
3.5%.
• Overtime levels reduced compared to the previous month.
Section 5: Risk Management
• Risk Register (Month 11):
- No extreme risks (Red)
- High Risks (Amber): 2 new Amber risks recorded in Month 11
: 12 risks remain Amber from Month 10
: 2 risks downgraded to Moderate
(Yellow) in Month 11
: 1 risk eliminated and archived 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
Business Planning
Complaints
Finance
Foundation Trust Compliance
Other (Please specify)
9
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
Financial Implications:
YES / NO
Legal Implications: POTENTIAL
Risk Implications: YES / NO
NO
9
YES
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 1: FINANCE REPORT
For Period Ending February 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 Trust’s self-assessed risk rating score for February 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
5
4
Return on assets excluding dividend (%)
5
5
5
I&E Surplus Margin Net of Dividend (%)
2
4
3
Liquidity Ratio (Days)
1
3
2
Overall Risk Rating
3
4
3
As a NHS Trust, Essex Rivers Healthcare also has to operate within the national financial
performance framework set by the Department of Health. The metrics are performance managed by
the DH through the SHA and are 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
1
ESSEX RIVERS HEALTHCARE NHS TRUST
KEY FINANCIAL INFORMATION
The Trust’s Key Financial Information at the end of February is summarised as follows:
* Year to date position – a surplus of £4,998k compared with the year to date budget of
£6,530k; an adverse variance of £1,532k.
* The forecast outturn is a net surplus of £2,937k (after the final debt repayment of
£6,518k).
* EBITDA margin year to date is 12.13%. The forecast outturn EBITDA margin is 10.74%,
which is slightly below plan of 10.82%.
* The Service and Cost Improvement Programme (SCIP) has currently achieved £4,554k
and has therefore the full year SCIP target of £4,195k has been delivered.
* The Capital Programme is currently forecast to underspend by £65k following
management action to address slippage in schemes.
* Short-term investments and cash deposits totalled £16,192k, a reduction on Month 10
following the repayment of the outstanding debt.
* 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:
- 24% by volume, 33% by value for the month
- 67% by volume, 65% by value for the year to date
The backlog in processing pharmacy invoices continues to have a detrimental impact
although the backlog of aged invoices has been reduced.
2
ESSEX RIVERS HEALTHCARE NHS TRUST
Income & Expenditure
February 2008
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
33,074
2,247
32,358
2,138
30,317
2,059
29,651
2,006
58,335
955
56,888
651
53,474
875
52,213
677
30,633
1,938
28,956
2,529
28,080
1,776
26,534
2,479
5,344
-
5,339
-
4,898
-
4,894
-
36,656
169,180
7,553
176,733
37,046
165,906
7,258
173,164
32,813
154,293
6,924
161,217
32,807
151,262
6,652
157,914
1,262
1,107
2,369
1,142
1,241
2,383
1,157
1,017
2,174
941
1,143
2,084
234
5,852
5,041
11,127
246
5,848
4,575
10,669
215
5,366
4,655
10,236
226
5,367
4,303
9,896
-
-
-
-
190,229
186,216
173,627
169,894
108,169
10,980
19,044
31,448
105,431
12,216
16,472
32,090
97,421
9,016
17,055
27,431
95,847
9,840
16,409
27,189
169,641
166,209
150,923
149,285
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
20,588
6,518
6,377
- 130
4,886
-
20,007
23
6,518
6,356
- 713
4,886
-
22,704
5,975
5,839
- 119
4,479
-
20,609
23
5,975
5,813
- 681
4,481
-
Net Surplus/(deficit)
2,937
2,937
6,530
4,998
10.82%
176.58%
9.79%
1.58%
14
10.74%
171.60%
9.82%
1.54%
13
13.08%
100.00%
15.89%
3.76%
26
12.13%
192.57%
14.43%
2.94%
22
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
3
ESSEX RIVERS HEALTHCARE NHS TRUST
Balance Sheet
February 2008
Financial Year 2007/08
Budget
Full Year
£000
Fixed assets
Fixed assets
PFI residual interest
PFI deferred assets
Total fixed assets
Forecast
Outturn
£000
Budget
Year to Date
£000
Actual
Year to Date
£000
148,085
148,085
147,818
147,818
147,203
147,203
146,940
146,940
3,397
5,981
1,065
2,124
440
13,007
3,233
3,707
3,239
114
4,232
440
14,965
3,436
6,031
3,234
11,513
24,214
3,489
5,493
3,724
497
878
16,192
29,279
3,612
3,185
1,018
1,078
8,893
7,280
361
466
3,326
11,433
6,901
2,460
2,036
334
4
3,658
15,393
7,290
3,876
2,038
760
4
8,661
22,629
Total current assets/(liabilities)
Long term debtors (note 2.4)
2,378
2,378
2,384
2,385
Total assets less current liabilities
Creditors: amounts falling due > one year
Finance leases
Provisions for liabilities and charges (note 2.7)
4,114
2,750
3,532
2,123
8,821
2,774
6,650
2,147
151,827
151,605
155,634
153,828
-
-
-
-
74,662
12,294
61,640
2,477
754
151,827
74,662
12,302
61,418
2,469
754
151,605
74,055
15,887
62,461
2,477
754
155,634
74,055
14,363
62,181
2,475
754
153,828
151,827
151,605
155,634
153,828
47.7
17.6
21.5
41.2
22.2
43.8
44.6
17.9
43.2
44.7
18.9
45.7
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)
4
ESSEX RIVERS HEALTHCARE NHS TRUST
Cash Flow
February 2008
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
20,588
20,007
22,704
20,609
3
454
59
80
- 2,893
- 96
167
2,728
- 1,737
80
- 2,600
- 255
- 98
- 723
- 36
404
14
74
1,571
- 72
- 89
942
- 857
73
- 200
151
8,854
- 699
CF from operations
18,195
17,569
24,659
28,784
Capital expenditure (note 3.2)
Maintenance capex
Non maintenance capex
- 4,785
- 2,531
- 5,140
- 2,111
- 3,037
- 2,063
- 3,248
- 1,844
- 291
-
- 313
-
- 266
-
- 282
-
10,588
10,005
19,293
23,410
130
713
119
681
- 6,518
- 6,518
- 5,975
- 5,975
607
- 4,886
607
- 4,886
225
- 2,443
- 2,443
Net cash outflow/inflow
- 79
- 79
11,219
15,673
Opening cash balance
New cash outflow/inflow
Closing cash balance
519
- 79
440
519
- 79
440
519
11,219
11,738
519
15,673
16,192
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
5
ESSEX RIVERS HEALTHCARE NHS TRUST
NOTES TO THE ACCOUNTS
1. INCOME & EXPENDITURE
1.1. NHS Clinical Income
NHS clinical income is currently £3,303k 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
January
2008
February 2008
Budget
Actual
Variance
Budget
Actual
Variance
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
14,429
17,903
54,269
29,695
116,296
4,898
5,402
6,049
132,645
13,617
17,995
52,811
28,852
113,275
4,894
5,143
5,769
129,081
-812
92
-1,458
-843
-3,021
-4
-259
-280
-3,564
1,312
1,646
4,863
2,700
10,521
445
491
550
12,007
1,278
1,547
4,664
2,750
10,239
448
494
249
11,430
-34
-99
-199
50
-282
3
3
-301
-577
-291
-203
-57
-548
-1,099
3
-152
0
-1,248
28,572
28,833
261
2,778
3,104
326
-242
161,217
157,914
-3,303
14,785
14,534
-251
-1,490
An update of the contributing factors to the cumulative under recovery is as follows:
• The Trust’s performance against its planned activity has contributed to this shortfall. There
were a net 89 less day cases/regular day attendances, 415 more elective inpatients but 996
less non-elective admissions year to date to Month 11 compared with the plan to date.
There were also 1,158 less outpatient attendances (first and follow-ups) compared with the
plan for the year. These have all contributed to the year to date position.
• The shortfall in income from activity also has an adverse impact on the Market Forces
Factor (MFF) calculated by the Department of Health. While the outturn position will be
notified to the Trust in due course, the estimated impact has been included.
Ongoing Action:
Performance review meetings are led by the Chief Executive. The anticipated activity to achieve
the 18 week wait has now been matched against planned available capacity. The Trust has
provided additional sessions within the resources available, and for some specialities, has
outsourced to achieve the required target.
There were only 2 penalties notified by the PCT at month 10 around increased growth of the HRG
S22 above last year’s outturn 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. Since Month 10 it has been agreed with the PCTs
that so long as the Trust can evidence improvement in its practices then these penalties will be
waived. The required actions are being implemented by the Chief Operating Officer
All issues of incorrect coding are referred to relevant directorates for action.
The position continues to be carefully monitored.
6
ESSEX RIVERS HEALTHCARE NHS TRUST
1.2. Non-NHS Clinical Income
Non-NHS income has under recovered by £90k for the year to date.
Private patient income continues to account for the majority of the shortfall. The deficit of £216k for
the year to date represents a further small improvement on Month 10. As previously reported, 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 nonprotected clinical income includes income from RTAs, which is £91k ahead of budget and
reimbursement income from the County Council relating to patients in receipt of social care
packages, which is also ahead of budget by £36k.
Ongoing Action:
A review and reassessment of private patient income has been 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. By its very nature, income from RTAs is not easy estimated and therefore it should be
expected to fluctuate.
1.3. Other Income
Other (non-patient related) income also continues to under recover (£340k year to date). The two
main causes of this are:
• Income from drug sales continues to under recover by £197k although there are associated
underspends in the cost of drugs. The decline in the number of private patients referred to in
1.2 above has also had an impact on the income from prescribed drugs.
• The income from the plastic surgery SLA continues to under recover (£168k).
Ongoing Action:
Income targets are being revised through the 2008/09 budget setting process and this will result in a
cost pressure to the Trust as income targets are realigned to more realistic levels.
1.4. Pay
Pay expenditure is £1,574k 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
January
2008
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
13,333
28,374
37,825
17,466
349
97,348
73
97,421
12,946
28,326
37,410
16,544
337
95,563
284
95,847
Year to Date
Staff Group
Management/Admin
Medical
Nursing
Scientific, Technical & Therapeutic
Other
Total
Reserves
Total Pay Expenditure
February 2008
387
49
415
921
13
1,784
(210)
1,574
1,235
2,590
3,523
1,641
101
9,090
(155)
8,935
1,220
2,645
3,580
1,607
95
9,146
(84)
9,062
15
(55)
(57)
34
6
(56 )
(71)
(127)
Vacant posts are making a significant contribution to the Trust’s overall SCIP target.
7
33
(21)
70
82
(3 )
161
497
658
ESSEX RIVERS HEALTHCARE NHS TRUST
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. Additional
costs from outsourcing, additional agency and similar 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 £515k (5.6%) in February, continuing the steady increase seen
over the last few months. Expenditure has increased compared to this time last year 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
600
500
£'000
400
326
300
343
200
162
100
-
Non-NHS
162
115
191
182
186
224
276
234
285
130
15
31
39
69
Feb
Mar
Apr
May
60
Jun
64
86
85
86
104
78
Jul
Aug
Sep
Oct
Nov
Dec
189
125
Jan
Feb
NHS
Table 4 analyses year to date expenditure on temporary staffing expenditure by staff group:
Table 4: Year to date expenditure on temporary staffing
Staff Group
Management/Admin
Medical
Nursing
Scientific, Technical & Therapeutic
Other
Total Temporary Pay Expenditure
Agency
Bank
Locum
Total
January
2008
£'000
£'000
£'000
£'000
£'000
371
390
12
210
0
984
0
0
1,083
0
0
1,083
8
0
1,454
0
0
0
1,454
371
1,845
1,095
210
0
3,521
280
1,632
920
174
0
3,006
ESSEX RIVERS HEALTHCARE NHS TRUST
1.5. Non-Pay
Non-pay expenditure was £64k 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
January
2008
February 2008
Budget
Actual
Variance
Budget
Actual
Variance
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
9,016
16,787
5,481
3,344
7,587
9,246
51,461
2,041
53,502
9,840
16,279
5,316
3,169
7,413
10,487
52,504
934
53,438
-824
508
165
175
174
-1,241
-1,043
1,107
64
582
1,629
507
310
795
1,030
4,853
186
5,039
1,004
1,449
348
310
122
1,701
4,934
141
5,075
-422
180
159
0
673
-671
-81
45
-36
211
-964
10
33
458
248
-4
-314
-318
Of particular note is the variance of £1,241k relating to ‘Other’, which largely relates to the costs of
outsourcing activity although these costs are covered by slippage in reserves. 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.
1.6. Service and Cost Improvement Programme (SCIP)
The SCIP has achieved £4,554k year to date and so has now achieved the total target of £4,195k
for the year. Of the £4,554k achieved to date, £2,145k has been found recurrently (£2,849k full-year
effect). In achieving the full year target recurrently, unutilised reserves (incremental drift, NICE) will
be released to ensure there will be no overhang into 2008/09.
A summary of the Service and Cost Improvement Programme is shown in table 6.
Table 6: Service and Cost Improvement Programme
Projects
Infrastructure
Procurement
Workforce and Payroll
Service Improvements
Income
Prescribing and Medicines
Total
Full Year
Plan
Plan
£'000
£'000
109
619
2,246
264
820
137
4,195
Year to Date
Actual Variance
£'000
97
530
2,048
242
749
126
3,792
9
135
1,375
1,940
369
690
45
4,554
£'000
38
845
-108
127
-59
-81
762
Plan
February 2008
Actual Variance
£'000
17
40
288
22
67
12
446
£'000
12
126
102
26
70
8
344
£'000
-5
86
-186
4
3
-4
-102
ESSEX RIVERS HEALTHCARE NHS TRUST
Ongoing Action:
A significant proportion of the savings identified are of a non-recurrent nature although the release
of reserves has enabled the SCIP target to be achieved. Next year’s SCIP target has been included
as part of the FT application and the recommendations from RRC has ensured there has been no
overhang from 2007/08. SCIP savings are 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 February compared
with January.
Table 7: Total Debtors
NHS
Period Outstanding
£'000
February 2008
Non NHS
Prepay
£'000
£'000
Total
NHS
£'000
£'000
January 2008
Non NHS
Prepay
£'000
£'000
Total
£'000
30 days or less
31 - 60 days
61 - 90 days
In excess of 90 days
Total AR Debtors
939
-117
146
280
1,248
221
196
12
85
514
0
0
0
0
0
1,160
79
158
365
1,762
138
262
158
272
830
373
62
27
80
542
0
0
0
0
0
511
324
185
352
1,372
Other (Non AR) Debtors
4,245
3,591
2,385
10,221
2,220
3,324
2,391
7,935
Total Debtors
5,493
4,105
2,385
11,983
3,050
3,866
2,391
9,307
Budget
6,031
3,234
2,384
11,649
7,197
3,206
2,391
12,794
-538
871
1
334
-4,147
660
0
-3,487
Variance
Overall debtor balances have increased by £2,676k since January with NHS Debtors increasing by
£2,443k. This is mainly due to the under performance credit notes now being reported within current
liabilities.
2.2. Accounts Receivable Debtors
The amount due for invoices outstanding in excess of 31 days is £602k at the end of February
(£861k in January).
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.
10
ESSEX RIVERS HEALTHCARE NHS TRUST
2.4. Debtors Due more than One Year
The Trust is carrying a large prepayment in relation to the staff accommodation PFI scheme
(£1,544k 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
February 2008
Non NHS
POA
£'000
£'000
Total
NHS
£'000
£'000
January 2008
Non NHS
POA
£'000
Total
£'000
£'000
690
20
17
80
807
2,172
388
114
396
3,070
0
0
0
0
0
2,862
408
131
476
3,877
749
24
11
91
875
1,536
674
290
615
3,115
0
0
0
0
0
2,285
698
301
706
3,990
Other (Non AP) Creditors
3,036
15,716
0
18,752
10,599
11,557
0
22,156
Total Creditors
3,843
18,786
0
22,629
11,474
14,672
0
26,146
Budget
2,314
13,079
0
15,393
2,201
12,309
0
14,510
Variance
1,529
5,707
0
7,236
9,273
2,363
0
11,636
Creditor balances include all accruals, including the underperformance on activity of £3,307k that
will be refunded to PCTs. PCTs are asking that the repayment of the underperformance be
deferred to 2008/09 rather than 2007/08, which will result in a higher than planned creditor balance
at year end.
Table 9 also provides a supplementary analysis of the number of invoices outstanding. The number
of invoices outstanding for more than 30 days has been reduced by 367.
Table 9: Number of Invoices
NHS
Period Outstanding
30 days or less
31 - 60 days
61 - 90 days
In excess of 90 days
Total AP Creditors
£'000
76
33
4
22
135
February 2008
Non NHS
POA
£'000
1,999
358
103
400
2,860
£'000
0
0
0
0
0
Total
NHS
£'000
£'000
2,075
391
107
422
2,995
75
18
5
23
121
January 2008
Non NHS
POA
£'000
1,963
407
175
659
3,204
Total
£'000
£'000
0
0
0
0
0
2,038
425
180
682
3,325
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.
11
ESSEX RIVERS HEALTHCARE NHS TRUST
Graph 2: Public Sector Payment Performance
100%
Percent
80%
60%
40%
20%
0%
Jan
Feb Mar
Apr May June July Aug Sep Oct
Volume %
Value %
Target
Cumulative Volume %
Nov Jan
Feb
Cumulative Value %
As can be seen from the graph, the Trust continues to fall short of the internal PSPP target of 80%
year to date, both on volume and value. The significant deterioration in performance for February
continues as a result of the new Trust Pharmacy system .Full data failed to transfer to the payments
system in month 9 resulting in a period of a catch-up in month 10 and the subsequent late payment
of a significant number of invoices in months 10 and 11. Staff sickness and vacancies have
acerbated the problem.
The finance department has also been undertaking a significant work plan to reduce the backlog of
other outstanding invoices that had been held due to outstanding queries (as shown in table 9).
This is also impacted on current performance but will enable performance to improve in the new
financial year.
In summary, PSPP performance is:
- 24% by volume, 33% by value for the month
- 67% by volume, 65% 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 unacceptable and solutions are being discussed by Finance and
Pharmacy to urgently address the situation.
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.
12
ESSEX RIVERS HEALTHCARE NHS TRUST
3.
CASH FLOW
3.1
Cash Balances
Graph 3 shows the rolling 12 month position for budgeted and actual/forecast cash balances to the
year end. The forecast for 2008/09 as included in the Trust’s financial model for its Foundation Trust
application, is included for comparative purposes
Graph 3: Cash Balances
25,000
£'000
20,000
15,000
10,000
5,000
Budget
S
ep
O
ct
N
ov
D
ec
Ja
n
Fe
M b
ar
-0
9
Ju
l
A
ug
Ju
l
A
ug
S
ep
O
ct
N
ov
D
ec
Ja
n
Fe
M b
ar
-0
8
A
pr
M
ay
Ju
n
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 February cash balance is £4,679k higher than budgeted, as analysed in table 10. The Trust’s
debt repayment of £6,518k was also credited to the PCT in February.
Table 10: Cash flow variance analysis
February 2008
£'000
£'000
Cash Balances per Budget
11,513
EBITDA
-2,095
Debtors
Debt Repayment
Other Working Capital
Capital Expenditure
Donated Depreciation
Interest Received
-6,852
5,975
7,097
8
-16
562
Net cash inflow/(outflow) variance
Actual Cash Balances
3.2
Comments
Outstanding debtors
Accrued to month (refunded to PCT in February)
Other working capital also includes an estimated
repayment of £3,307k to PCTs/DH relating to the
under performance on clinical income contracts.
Credit notes for Quarter 2 have now been raised.
4,679
16,192
Capital Expenditure
At the end of February the Trust had incurred £5,092k expenditure on this year’s capital
programme. Table 11 provides details of the programme, both year to date and forecast outturn.
13
ESSEX RIVERS HEALTHCARE NHS TRUST
Table 11: Capital programme expenditure
Capital Programme
Year to Date
Actual
Variance
£'000
Major Schemes
Health Records Service Im provem ent
TV Car Park
Modular Training Building
TV Staff Car Park L
Linking of Car Parks B&C
Maternity Expans ion
Relocation of Paediatric Facilities in A&E
Steam Boiler Replacem ent
EAU Expans ion
£'000
Forecast Outturn
Actual
Variance
£'000
£'000
1,673.9
193.5
7.1
449.6
104.7
143.0
138.0
56.8
172.9
-207
-37
-0
0
0
-2
-2
-150
53
1,781
194
359
491
140
304
160
100
173
Other
Other Schem es under £100k
Medical Equipm ent
Es tates
IM&T
259.1
957.0
183.6
753.0
22
326
1
-2
305
1,820
350
1,076
-23
546
8
59
Total Capital Expenditure
5,092
3
7,251
-65
Capital Resource Limit (CRL)
Progress
To
Date
Status
-378
Complete
Unders pent
-37
Complete
Unders pent
-51 In Progress
On Plan
0
Complete
On Plan
0
Complete
On Plan
-41 In Progress £500k slippage
0
Complete
On Plan
-200 In Progress £200k slippage
53 Design Stage
On Plan
Estimated
Completion
Date
Oct 07
May 07
Apr 08
Mar 08
Mar 08
June 08
Jan 08
2008
2010
7,316
Under/(Over)shoot
65
The Trust’s Capital Resource Limit is forecast to underspend by £65k (0.9%).
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 be reviewed by Finance with project managers to ensure there is no unexpected yearend slippage in implementation. It is important that all goods/works are completed by 31st March in
order that the capital programme’s contribution to hitting the EFL target is achieved. 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.
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.
14
ESSEX RIVERS HEALTHCARE NHS TRUST
Appendix A
Rolling 12 Month Income & Expenditure
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
Feb-09
£m
NHS clinical income
Non NHS clinical income
Other Income
Total income
15.3
0.3
0.8
16.3
15.2
0.2
1.1
16.5
14.9
0.2
1.1
16.2
15.0
0.2
1.1
16.3
15.0
0.2
1.1
16.3
14.5
0.2
1.1
15.8
15.3
0.2
1.1
16.6
15.6
0.2
1.1
16.9
14.8
0.2
1.1
16.1
14.8
0.2
1.1
16.1
14.9
0.2
1.1
16.3
13.7
0.2
1.1
15.0
Pay costs
Drug costs
Clinical supplies and services
Other costs
Total costs
9.6
2.4
0.1
5.4
17.5
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
9.2
0.9
1.6
2.7
14.4
EBITDA
-1.1
2.1
1.8
1.7
1.9
1.4
2.0
2.5
1.7
1.5
1.8
0.6
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
0.6
0.0
0.4
-2.1
1.1
0.8
0.8
0.9
0.4
1.0
1.5
0.7
0.5
0.8
-0.4
Total Depreciation & Amortisation
Total interest receivable/ (payable)
PDC Dividend
Net Surplus/(Deficit)
15
ESSEX RIVERS HEALTHCARE NHS TRUST
Appendix B
Rolling 12 Month Balance Sheet
Mar-08
£m
FIXED ASSETS
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
Feb-09
£m
147.8
153.0
153.0
152.8
152.6
152.3
152.6
152.8
152.9
153.8
154.2
154.7
CURRENT ASSETS
Stocks & Work in Progress
Debtors
Accrued Income
Prepayments
Cash at bank and in hand
Total Current Assets
3.2
6.9
0.1
4.2
0.4
15.0
3.4
7.3
0.3
1.5
6.5
19.0
3.4
6.9
0.5
0.6
9.0
20.4
3.4
6.9
0.7
0.6
9.8
21.3
3.4
6.9
0.3
0.5
11.1
22.1
3.4
6.9
0.5
0.4
12.1
23.2
3.4
6.9
0.7
0.4
11.0
22.4
3.4
6.9
0.3
0.3
13.0
24.0
3.4
6.9
0.5
0.2
13.6
24.7
3.4
6.9
0.7
0.2
14.2
25.4
3.4
6.9
0.3
0.1
14.9
25.6
3.4
6.8
0.5
0.1
14.6
25.3
CURRENT LIABILITIES (amounts due < one year)
Creditors
Accruals
Total Current Liabilities
8.1
3.3
11.4
11.6
2.8
14.4
12.3
2.8
15.1
13.1
2.8
15.9
12.7
2.8
15.5
13.2
2.8
16.0
11.7
2.8
14.5
12.0
2.8
14.8
12.1
2.8
14.9
13.2
2.8
16.0
13.0
2.8
15.8
13.5
2.8
16.3
2.4
2.4
2.4
2.4
2.4
2.3
2.3
2.3
2.3
2.3
2.3
2.3
153.7
160.0
160.8
160.6
161.5
161.9
162.8
164.3
164.9
165.5
166.3
165.9
2.1
2.1
2.1
1.8
1.8
1.8
1.6
1.6
1.6
1.6
1.5
1.5
151.6
157.9
158.7
158.8
159.7
160.1
161.2
162.7
163.4
164.0
164.8
164.4
-
-
-
-
-
-
-
-
-
-
-
-
TAXPAYERS' EQUITY
Public dividend capital
Income and expenditure reserve
Revaluation reserve
Donated asset reserve
Other Reserves (Government grant reserve etc)
TOTAL TAXPAYERS EQUITY
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
16.0
66.4
2.5
0.8
159.7
74.1
16.4
66.4
2.5
0.8
160.1
74.1
17.5
66.4
2.5
0.8
161.2
74.1
19.0
66.4
2.5
0.8
162.7
74.1
19.8
66.4
2.4
0.8
163.4
74.1
20.3
66.4
2.4
0.8
164.0
74.1
21.2
66.3
2.4
0.8
164.8
74.1
20.9
66.3
2.4
0.8
164.4
TOTAL FUNDS EMPLOYED
151.6
157.9
158.7
158.8
159.7
160.1
161.2
162.7
163.4
164.0
164.8
164.4
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
16
ESSEX RIVERS HEALTHCARE NHS TRUST
Appendix C
Rolling 12 Month Cash Flow
Mar-08
£m
EBITDA
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
Feb-09
£m
-1.1
2.1
1.8
1.7
1.9
1.4
2.0
2.5
1.7
1.5
1.8
0.6
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
-0.9
2.2
0.0
-2.5
-2.9
0.0
-0.3
-0.2
0.1
5.5
0.0
0.4
-0.2
0.9
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
0.3
0.1
-0.2
0.1
0.0
0.0
0.0
0.0
-5.2
0.0
-0.6
0.0
0.0
6.6
0.0
0.0
0.0
0.0
3.1
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
0.0
0.0
0.0
0.0
0.8
Capex spend
PFI residual interest
Cash receipt from asset sales
-2.2
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
-0.9
0.0
0.0
CF before Financing
Other movement in financing
Dividends paid
-7.4
0.0
-2.4
6.1
0.0
0.0
2.5
0.0
0.0
0.8
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
0.6
0.0
0.0
0.7
0.0
0.0
-0.2
0.0
0.0
Net cash outflow/inflow
-9.8
6.1
2.5
0.8
1.3
1.0
-1.1
2.0
0.6
0.6
0.7
-0.1
Excluding Non cash I&E items
Movement in working capital:
Stocks & Work in Progress
Debtors
Accrued Income
Prepayments
Creditors
Payments on Account
Accruals
Deferred Income
Provisions & Liabilities
CF from Operations
Capital Expenditure
Maintenance capex
17
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 2: SERVICE PERFORMANCE
Service Performance Scorecard - 2007/08
Score & Threshold
Actuals - YTD
Weighting
Score
Threshold
Jan-08
Feb-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)
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*
Forecast Outturn (FOT)
Trend
Monitor
Score
Mar-08
Monitor
Score
99.9%
BETTER
0.0
99.9%
0.0
99.3%
99.3%
BETTER
0.0
99.3%
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
SAME
1.0
13
1.0
0.0
1.0
12
13
13
18 week maximum wait - Admitted Patients
18 week maximum wait - Non - Admitted Patients
1.0
85%
90%
66.1%
93.8%
72.7%
92.9%
BETTER
0.0
85.0%
90.0%
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%
98.9%
98.9%
BETTER
0.0
98.8%
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%
71.2%
71.2%
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
99.9%
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%
1.6%
1.7%
WORSE
0.0
1.5%
0.0
Each national core standard
0.4
0
0
0
SAME
0.0
0
0.0
People suffering heart attack to receive thrombolysis within 60 minutes of call
YTD - Year To Date
* - Cancer reporting previous month
TOTAL SCORE
Figures in italics are forecast
18
1.0
1.0
ESSEX RIVERS HEALTHCARE NHS TRUST
Other HCC Targets Performance Scorecard - 2007/08
Actuals - YTD
FOT
Target
Jan-08
Feb-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
80.6%
79.9%
WORSE
81.0%
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
-1.5%
-1.4%
WORSE
-1.5%
Secure sustained national improvements in NHS patient experience by
2008
Not Known
Not Known
SAME
Not Known
Smoking during pregnancy and Breastfeeding initiation
77%
78%
BETTER
80%
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
3.1%
2.9%
BETTER
3.0%
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
EXCELLENT
HCC Quality rating*
* HCC Quality rating prediction based on estimated outturn position for 2007/08
Figures in italics are forecast
19
ESSEX RIVERS HEALTHCARE NHS TRUST
2.1.
18 Weeks RTT Performance – All Specialties
In February the Trust’s performance for the 18 Weeks referral to treatment was 72.7% for
Admitted Patients (last month 66.1%) and 92.9% for Non-Admitted Patients (last month
93.8%). The targets for March 2008 are 85% for Admitted Patients and 90% for NonAdmitted Patients. 18 week RTT performance continues to be 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
All Specialties
2.2.
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
Target
All Specialties
Target
A&E 4 Hour Standard of 98%
For the period to February 2008 the Trust had 73,932 attendances (last month 67,798
attendances) and the average performance of patients seen, treated or discharged against
the 4 Hour standard was 98.22% (last month 98.17%). Performance against the Healthcare
Commission target for ‘mapped’ A& E services for February 2008 was 98.90% (last month
98.86%). 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
20
October
November
07/08 Cumulative
December
07/08 Mapped
January
February
March
ESSEX RIVERS HEALTHCARE NHS TRUST
2.3.
Delayed Transfers of Care
Delayed Transfer of Care performance deteriorated slightly again in February 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.
2.4.
Data Quality on Ethnic Monitoring
Data Quality on Ethnic monitoring performance deteriorated slightly again in February 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.
2.5.
Emergency Bed Days
Emergency bed day performance deteriorated slightly again in February 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.
21
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 3: CLINICAL INDICATORS
3.1.
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
13
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
Oct
Nov
Dec
Jan
Feb
Mar
Jan
Feb
Mar
Trajectory
Actual
2007/2008 Cumulative MRSA Bacteraemia
30
25
20
15
10
5
0
Apr
May June July Aug Sept Oct
Cum' Actual
Cum' Trajectory
Nov Dec
2006/07 Cum' Actual
2005/06 Cum' Actual
The Trust remains on target for the revised SHA target of 6 cases October through March.
22
ESSEX RIVERS HEALTHCARE NHS TRUST
3.2.
C.Difficile
Clostridium difficile infections Information 2007-2008 (Patients aged 65 and over)
RDE
Apr
Acute trust specimens taken after day 1 of admission*
Acute trust specimens: No admission date recorded
Acute trust specimens taken before day 2 of admission*
Not acute trust specimens
Monthly envelope ceiling
Data signed off by month deadline?
Oct
Nov
Dec
Jan
0
0
0
0
0
0
2
12
10
14
9
0
39
May
32
June
21
July
19
Aug
18
Sept
16
17
0
0
2
0
0
0
0
0
0
0
0
0
3
2
0
0
0
9
6
9
8
8
3
5
7
_______
Feb
Mar
0
7
9
0
12
12
12
Signed-off o Signed-off laSigned-off o Signed-off o Signed-off o 0
Sign-off status key
Signed-off on time
Signed-off late
Not signed-off
Clostridium difficile reports by specimen date month (HCAI Data Capture System data)
45
40
No. Specimens
35
30
25
20
15
10
5
0
Apr
May
June
July
Aug
Acute trust specimens taken after day 1 of admission*
Acute trust specimens taken before day 2 of admission*
Monthly envelope ceiling
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Acute trust specimens: No admission date recorded
Not acute trust specimens
The number of C diff cases continues to follow a downward trend. The Trust is on trajectory
to meet its challenging target of 36 cases, for inpatients >64 years of age, in the last quarter
of the financial year.
23
ESSEX RIVERS HEALTHCARE NHS TRUST
3.3.
Saving Lives Audit
These audits are of High Impact interventions and are intended to improve performance as a consequence of audit and feedback. Overall results
are encouraging.
Saving Lives Results Jan/Feb 2008. Scores represent compliance with all elements performed for each high impact intervention.
Area
Month
HI2c Renal
HI2c Renal
HI4 VENT REG HI4 VENT CONT. HI5 URINARY
HI2b PVC Cont.
dialysis catheter dialysis catheter HI3 SSI PRE OP HI3 SSI PERI OP
OBS
CARE
CATH. INS
Care
INSERT
CONT. CARE
HI2 CVC CONT.
HI1RED ANTI
HI2 CVC INSERT
CARE
MICRO
HI2b PVC
INSERT
100%(3/3)
95%(18/19)
no data
93%(53/57)
no data 100%(30/30) 95% (37/39)
82% (23/28) 71% (22/31)
Medicine
Jan
Feb
86% (19/22)
NA
NA
NA
NA
NA
NA
93%(14/15)
100%(1/1)
Surgery
Jan
Feb
93%(56/60)
no data 100%(15/15) 74% (29/39)
NA
NA
NA 100% (19/19)
NA
NA
NA
NA
NA 100%(10/10) 100%(48/48)
100%(5/5)
Care of the Elderly
Jan
Feb
91%(39/43)
86%(38/44)
no data
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA 100%(17/17) 97%(37/38) 100%(10/10)
NA 81% (17/21) 39% (12/31) 92% (11/12)
Critical Care
Jan
Feb
no data
no data
100%(7/7)
100% (10/10)
no data
100% (7/7)
100% (10/10)
NA
NA
NA
NA
no data
NA
NA
100%(6/6)
100% (6/6)
100%(6/6)
100% (6/6)
ECH
Jan
Feb
100%(5/5)
100% (10/10)
no data
no data
100% (1/1)
40% (4/10)
73% (8/11)
80%(8/10)
82% (9/11)
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
100%(2/2)
100% (3/3)
100%(2/2)
100% (4/4)
no data
Womens Services
Jan
Feb
100%(10/10)
no data
no data
100% (15/15) 100% (10/10) 100% (10/10)
100%(6/6)
90%(9/10)
100% (9/9)
NA
NA
no data
100% (10/10)
NA
NA
NA
NA
NA
NA
no data 100%(10/10)
100% (3/3) 100% (20/20)
no data
Childrens Services
Jan
Feb
no data
no data
NA
NA
NA
NA
no data
NA
NA
NA
NA
NA
NA
OVERALL TOTAL
Jan
Feb
92%(129/140) 100%(1/1) 100%(23/23) 82%(72/88) 93%(132/142)
91% (63/69) 100% (10/10) 100% (21/21) 83% (40/48) 82% (51/62)
no data
no data 100%(19/19)
100% (10/10)
no data
100%(6/6)
100% (6/6)
no data
100%(1/1)
no data
Based on files received in the ICT office (as of 3rd March 2008).
no data
No data received from Surgery, Medicine or Children's services as of 3.3.08.
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.
24
100%(3/3)
HI6 CDIFF
NA
NA
no data
100%(1/1)
HI5 URINARY
CATH CONT.
CARE
no data 100% (10/10)
100% (10/10)
no data
no data
no data
no data
100%(6/6) 100%(32/32) 98%(121/123) 100%(16/16)
100% (6/6) 85% (23/27) 71% (46/65) 92% (11/12)
ESSEX RIVERS HEALTHCARE NHS TRUST
3.4.
Hand Hygiene compliance results - February 2008
Area/Division
Nurse
Dr
HCA
Others
Medical
(35/38) 92%
(7/13) 54%
(17/21) 81%
(2/2) 100%
(61/74) 82%
Care of the Elderly
(27/29) 93%
(1/5) 20%
(28/28) 100%
(3/3) 100%
(59/65) 91%
Surgical
(55/58) 95%
(3/8) 38%
(42/46) 91%
(8/12) 67%
(108/124) 87%
Critical Care
(6/6) 100%
(1/1) 100%
(7/7) 100%
Womens
(4/4) 100%
(4/4) 100%
(8/8) 100%
Childrens
No data
No data
No data
No data
No data
ECH
(45/45) 100%
(13/16) 81%
(15/15) 100%
(4/4) 100%
(77/80) 96%
Copford Ward
(24/25) 96%
(0/1) 0%
(25/26) 96%
(4/4) 100%
(53/56) 95%
Overall
(196/205) 97%
(24/43) 56%
(132/141) 95% (21/25) 84%
Key:
Red <70%
Amber 70%-84%
Green >85%
Please note: These results are based on audits received in the ICT office as of 11.00 on 4.3.08.
Any gaps mean that there were no observations of these members of staff during the audit.
25
Overall
(373/414) 90%
ESSEX RIVERS HEALTHCARE NHS TRUST
Area/Division
Medium Risk
Medical
Care of the Elderly
Surgical
Critical Care
Womens
Childrens
ECH
Copford Ward
(40/49) 82%
(48/52) 92%
(77/90) 86%
(7/7) 100%
(7/7) 100%
No data
(61/64) 95%
(38/41) 93%
Overall
(278/310) 90%
High
Risk
(21/25) 60%
(11/13) 85%
(31/34) 91%
(1/1) 100%
No data
(16/16) 100%
(15/15) 100%
(95/104) 83%
See Key and notes above.
These results are an overall improvement from the previous month. A “warning card” system is being modified for introduction
locally. The purpose is to identify any persistent offenders.
26
ESSEX RIVERS HEALTHCARE NHS TRUST
Section 4: WORKFORCE
All data in this report is for the month of February 2008 with the exception of Bank, Agency & Locum
usage which is for January 2008.
•
Staff in Post
Variance between staff in post compared to budgeted establishment has decreased from
6.99% in January to 6.28% as staff are recruited to posts previously frozen under SACIP.
•
Sickness Absence
This month it has been possible to include sickness absence data for February. Sickness
absence levels have remained stable at 3.68% for the year to date this is marginally
above the Trust target of 3.5%.
•
Turnover
Turnover shows a marginal reduction when compared to the figure for February 2008
and year to date figures show a 7.77% reduction on the year to February 2007.
•
Overtime
Overtime shows a reduction when compared to the previous month.
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
250.60
499.95
198.07
313.58
272.35
170.39
355.28
166.32
130.81
102.61
14.87
150.97
90.40
3.87
9.34
71.80
50.06
32.29
41.26
6.00
20.81
2,951.63
WTE
244.97
481.40
183.41
265.59
269.13
148.12
336.19
139.70
132.54
99.46
8.98
143.83
85.41
3.81
7.60
65.39
51.99
38.73
32.33
6.00
21.66
2,766.29
27
Heads
338
568
233
318
300
183
369
191
171
111
14
174
103
10
9
71
60
44
40
6
24
3,337
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
21.44
543.14
541.11
179.58
3.00
144.95
388.08
934.19
10.80
2,766.29
Heads
27
672
681
225
3
167
427
1,124
11
3,337
ESSEX RIVERS HEALTHCARE NHS TRUST
TRUST TOTAL
CURRENT YEAR
February
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
4.36%
3.69%
0.75%
0.63%
5.12%
2.84%
£469
£3,007
0.57%
10.21%
2766.24 (WTE)
Var 06/07 (YTD)
February
0.27%
(141.27)%
(90.84)%
7.77%
3337 (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
244.97
481.40
183.41
265.59
269.13
148.12
336.19
139.70
132.54
99.46
8.18
143.83
85.41
3.81
7.60
65.39
51.99
38.73
32.33
6.80
21.66
2,766.24
Sickness Absence
YTD
February
6.51%
4.91%
4.45%
3.54%
4.40%
4.25%
3.01%
3.72%
2.89%
3.16%
6.81%
3.81%
4.27%
4.13%
6.97%
5.90%
2.91%
2.93%
5.90%
2.70%
12.21%
5.22%
3.15%
1.79%
3.70%
2.29%
2.45%
0.58%
0.00%
4.53%
2.35%
1.93%
2.42%
4.34%
7.88%
5.70%
2.35%
1.66%
0.00%
1.43%
1.11%
3.13%
4.36%
3.69%
Overtime
February
0.22%
0.72%
0.58%
0.62%
0.58%
1.13%
1.87%
1.14%
0.31%
0.61%
0.00%
0.19%
0.68%
0.00%
0.00%
0.41%
1.07%
2.31%
0.22%
0.00%
0.00%
0.75%
YTD
0.10%
0.34%
0.42%
0.29%
0.49%
0.39%
2.21%
1.04%
0.58%
0.32%
0.00%
0.15%
0.10%
2.44%
1.81%
0.41%
1.71%
0.29%
0.17%
0.00%
0.94%
0.63%
January figures shown as information on Bank, Agency & Locum spend is not yet available for February
28
YTD
1.68%
3.70%
0.19%
0.26%
0.19%
1.49%
Bank
No comparison figures available
0.60%
11.07%
2778.66 (WTE)
3408 (Heads)
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
Extreme Risk Register
There are no extreme (red) risks reported as of 13th March 2008.
5.2
Top Risks Reported
The highest risks reported are therefore amber and 15 such risks were reported to the Board on 17th February 2008. The Trust’s ‘all risk
register’ is a live document and risks are identified and reduced or eliminated on a continual basis.
Since 17th February the activities of the amber risk register have been monitored as follows:
5.2.1
New Amber Risk Identified Since 17th February 2008
Source of
Risk/Service Area
COR 18
Description of Risk
Patient Falls in Care of the Elderly Wards
Summary of Action
Pilot falls care pathway on Birch Ward. Strengthening the role of Link
Nurses. To roll out Pathway across Care of the Elderly Wards.
To ensure there is an action plan on each ward for falls prevention.
MS 11
Difficulty maintaining staff template due to
high level of midwifery vacancies (11 w. t. e.)
across the district.
Shift by shift monitoring in place. Rigorous action plan in place, utilising
NHSP where appropriate according to workload. Active recruitment in
progress.
29
ESSEX RIVERS HEALTHCARE NHS TRUST
5.2.2
Update of previous Amber Risks Reported 17th February 2008
Source of
Risk/Service
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.
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
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.
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.
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
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
30
ESSEX RIVERS HEALTHCARE NHS TRUST
Source of
Risk/Service
Area
Description of Risk
Summary of Action plan
management or Clinical management.
supply such resources.
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.
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.
GI system currently being migrated to a new system.
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.
Introduction of electronic requesting will eliminate the problem of inadequate
requesting – target date September 2008.
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.
2 seconded Band 6 nurses assigned to ward to negate risk.
31
ESSEX RIVERS HEALTHCARE NHS TRUST
Source of
Risk/Service
Area
Description of Risk
Specialist
Medicine 01
Difficulties in staffing of contingency beds
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.
Specialist
Medicine 07
Risk of lack of capacity for chronic
Haemodialysis
Summary of Action plan
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.
Appropriate action plan in place. New substantive post agreed to support
workload.
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.
PCT have raised issue with Specialist commissioning. Meeting arranged for short
term and long term plan.
5.2.3
Amber (High) Risks reduced to Yellow (Moderate)
Source of
Risk/Service
Area
ICT 32
Description of Risk
Summary of Action
Software installed and ITC department testing interfaces.
ICNET infection control system about to be
implemented without proper system
administration cover, high risk that a technical Integration work completed, scenario and user acceptance testing in progress.
problem with the database would leave the
infection control team unable to enter or
report on data for national targets.
32
ESSEX RIVERS HEALTHCARE NHS TRUST
Source of
Risk/Service
Area
Specialist
Medicine 05
5.2.4
Description of Risk
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
Summary of Action
Departmental action plan in place. Backlog of follow-up patients being seen. The
situation continues to be monitored.
Amber (High) Risks eliminated and archived
Source of
Risk/Service
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
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.
Equipment now in place – risk eliminated and archived
33