bchc quality and performance report final jun_jul 2012.pdf
TRANSCRIPT
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Birmingham Community Healthcare NHS
Trust
Quality and Performance Report
Reporting Period:
June 2012
Report Date:19th July 2012
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Contents
Section Page
Executive Summary: Quality Update 3
Executive Summary: Summary of Issues to Report 6
Trust Scorecard 7
Domain 1: Patient Safety 9
Domain 2: Use of Resources 14
Domain 3: Patient Experience 21
Domain 4: Clinical Effectiveness 25
Domain 5: Efficiency and Productivity 30
Appendix 1: Finance Report 34
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Executive Summary
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Executive Summary
Quality Update
4Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Overview
Birmingham Community Healthcare NHS Trust is committed to providing high quality care to the communities that it serves.
Ensuring the highest standards of patient care and patient safety is one of the fundamental responsibilities of the Boards of all
NHS organizations and we continue to strive to make improvements in the quality of the care that we provide, at the same time
as ensuring that it is clinically effective, person-focused and safe.
Essential to meeting this objective is strong clinical leadership and the monitoring of the strategies that are put in place, and
although the Board retains ultimately accountability, the work is driven and monitored through the C linical Governance
Committee and the Quality Governance and Risk Committee.
The integrated performance report, which is driven by the delivery of safe and effective care, has been developed to provide the
Trust Board with assurance that quality is being carefully monitored and that improvement measures are being identified and
implemented where necessary. It also enables the Trust to demonstrate its commitment to encouraging a culture of continuousimprovement and accountability to patients, the community that it serves, the commissioners of its services and other key
stakeholders.
Some of the targets that form the balanced scorecard are targets that the Trust is mandated to report on, but a number of
additional targets that provide evidence of the quality of the services that we provide have been identified by the Trust Board
and feature on the balanced scorecard.
Of particular note this month is the publication of the Patient Environment and Action Scores (PEAT) PEAT is an annual
assessment of inpatient healthcare sites in England that have more than 10 beds. It is a benchmarking tool to ensure
improvements are made in the non-clinical aspects of patient care including environment, food, privacy and dignity.
The assessment results help to highlight areas for improvement and share best practice across healthcare organisations in
England. PEAT provides a framework for inspecting standards to demonstrate how well individual healthcare organisations
believe they are performing in key areas including: food, cleanliness , infection control, patient environment (including bathroom
areas, lighting, floors and patient areas) .
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Commentary
Overall, the Trust has achieved the following performance for June 2012:
The breakdown of the indicators the Trust did not achieve is as follows:
Executive Summary
Summary of issues to report
6Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Trust wide underperformance refers to any indicator which
the Trust has not achieved. For June these are all in the Use of
Resources Domain:
Contractual KPI breaches (p.16)
Commissioner Contract Deadlines Missed (p.18)
Staff appraisals (p.19)
Local underperformance refers to any indicator which the
Trust has achieved but which has been breached by individual
divisions and is being managed locally and through PPMB.
Watching Briefs refers to any indicator which the Trust is
achieving but PPMB feels important to monitor more closely.
Recovery Mode refers to any indicator where the original
target has not been achieved in one of the previous month and
therefore a revised trajectory has been agreed.
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Trust Scorecard June 2012
7
As had been detailed in the May report, actual reported percentage of sickness absence for June of is invalidated, while the previous month outturn (May 2012) is
validated.
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Trust Scorecard June 2012
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Domain 1:
Patient Safety
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Domain Summary Patient Safety
Ref Indicators with no areas of concern
1.1 Attendance at Mandatory Training 71%
1.2 Medical appraisals 16%
1.3 MRSA new bacter ia 0
1.4 C. Diff new cases 7
1.5 MSSA new cases 0
1.6 E. Coli new cases 3
1.7 Elective MRSA screening 100%
1.8 VTE risk assessment on admission 98.8%
1.9 Falls resulting in serious injury or death 4
1.11 100% compliance with WHO surgical checklist 100%
1.12 No. of serious incidents reported in 48 hours 100%
1.13 No. of never events 0
1.14 Percentage of SI RCAs completed in timescale 100%
1.15 No. of serious incidents 29
1.16 Patient Safety Thermometer 100%
1.17 Spend on Temporary Staffing 6.1%
1.18 NHS Safety Thermometer 91.4%
Ref Indicators with no data and comment
1.10 Grade 3 or 4 pressure ulcers Available in August
10
Commentary
In this summary, we have outlined the overall performance for the Trust for all of the Patient Safety indicators. Where the Trust
has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve
the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the
subsequent pages.
Avoidable Grade 3 and 4 pressure ulcers are monitored and
reported on a monthly basis to determine whether the pressure
ulcer was avoidable or unavoidable. A root cause analysis is
completed. Further details on pressure ulcers have been
included on slides 12 and 13.
The Trust has recorded 7 cases of C. Diffto date. This is slightly
over the YTD plan of 6 cases by the end of June so we have
reviewed this area in more detail.
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
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Patient Safety watching brief
1.4 C. Diff new casesOverall Trust position
Breakdown by Division
11
Indicator Goal: Place
This indicator reports the total number of incidences of ClostridiumDifficile for the month indicating if the Organisation is managing its
overall target of equal to or less than 24 cases per annum. This is a
target set out in the Operating Framework for 2012/13.
As with MRSA, this demonstrates our standard of practice in relation
to Control of Infection, links to quality of patient care and to
managing our reputation as a healthcare provider and can affect our
registration with the Care Quality Commission.
The Director of Infection Prevention and Control has reported that
there appears to be no link between the cases and that there is the
usual proactive approach from the clinical team in order to monitor
any potential causal factors.
Patient safety visits:
The number of visits between April 2012 and June 2012 was 5:
Rapid response team
Perry Tree Centre
Physiotherapy (Musculo-skeletal), Walmley Health Centre
Combined Community Dental Services, Stockland Green PrimaryCare Centre
Speech & Language Therapy, Stockland Green PCC
The quarterly report will be submitted to QGRC in August.
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Patient Safety service update
1.10 Grade 3 or 4 pressure ulcers
12
Commentary
The final data for avoidable pressure ulcers for April has now been
confirmed as 12 and the table opposite has been amendedaccordingly. Of the 21 grade 3 and 4 Pressure Ulcers originally
reported in April, 2 were re-classified as the root cause analysis
identified that the wound was not due to pressure damage, and 7
were classified as unavoidable using the SHA definitions.
There were 27 grade 3 and 4 pressure ulcers attributable to BCHC
reported in June. These are currently undergoing a root cause
analysis investigation to determine factors of causation and whether
any were unavoidable. It is noted that overall the numbers of
Pressure ulcers occurring in our care increased in June. Detailedanalysis has been undertaken to examine the rise in overall numbers
and this has been escalated to the Adults and Communities Division
for action. Three Community teams were identified as potential
hotspots in June.
Detailed analysis shows that all 3 teams have had an increase in
training and the prevention of pressure ulcers emphasised. In
addition the demographics of the geographical area covered by one
of the teams shows a high percentage of older adults with a number
of retirement communities located in the area. This team also have alarger number of grade 2 pressure ulcers reported, showing that skin
damage is being identified and managed at an earlier stage.
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Source: Serious Incident Data
Location June
Inpatients Grade 3 1
Inpatients Grade 4 0
Community Grade 3 13
Community Grade 4 13
Total 27
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Patient Safety service update
1.10 Grade 3 or 4 pressure ulcers
13
Commentary
The prevalence graphs are based on the percentages identified
through the monthly NHS Safety Thermometer data collection. Junescollection was based on a total of 2,302 patients (April n=2,168, May
n = 2,146). This data is providing an excellent baseline to show
improvement in reducing pressure ulcer prevalence.
Midlands & East SHA data forAllPressure ulcers showed 7% (April)
6.9% (May) prevalence data. BCHC prevalence in June is 6.6% for
Allpressure ulcers. For new pressure ulcers (acquired in our care)
Safety Thermometer showed 10 (0.44%) grade 3 and 4 pressure
ulcers in June (April 15 (0.69%), May 14 (0.66%)). There is a
programme of work being monitored by the Pressure UlcerReference Group that is reviewing staff competency, accessibility of
equipment and actions arising from all root cause analyses
investigations
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Source: Serious Incident Data
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Domain 2:
Use of Resources
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Domain Summary Use of Resources
15
Commentary
In this summary, we have outlined the overall performance for the Trust for all of the Use of Resources indicators. Where the Trust
has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the
required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent
pages.
The Monitor Governance Rating for June is expected to be 0, the
same as in April and May. Since the indicator is based on a number
of individual elements, one of which might only be available by the
27th July, the rating will either be reported verbally to the Trust
Board or included as the previous months data on the scorecard for
July.
The YTD target was not met for the delivery of contractual KPI (KPIbreaches). An analysis into this is carried out overleaf.
In June, the Trust did not meet the revised trajectory for Percentage
of staff appraised. Children and Families and Specialist Services
both showed red ratings against their recovery trajectories which
have been further analysed overleaf.
One commissioner contract deadline was missed for June which
turned the indicator to show as red due to the zero tolerance target.
Further details regarding this missed contract deadline have been
provided overleaf.
Ref Indicators whichdid not meet YTD target
2.1 Delivery of contractual KPI (KPI breaches) 4 X
2.2 Commissioner contract deadlinesmissed for
month
1 X
2.3 Percentage of staff appraised (within 18 months) 69% X
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Ref Indicators with no areas of concern
2.4 Monitor GovernanceRating 0
2.5 Totalworkforce (WTE) 4,410
2.6 Turnover rolling total 13.9%
2.7 Total pay costs 14.8M
2.8 Percentage of vacancies 6.61%
2.9 Percentage of sickness absence for month 5.04%
2.10 Monitor Financial Rating 3
2.11 Del ivery of QIPP 95.96%
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Patient Safety area of underperformance
2.1 Delivery of Contractual KPI (KPI breaches)
Overall Trust position
Breakdown by Division
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Indicator Goal: Partnership
This is the number of Key Performance Indicators agreedwith commissioners for 2012/13 which were in breach of
contract in the month. This measure encourages proactive
management of areas of risk across the organisation and
identifies areas where the trust may be financially
penalised.
The annual target is to have no breaches. This was achieved
by all divisions in month 1 but was breached in months 2
and 3.
The Contractual KPI breach position has improved this
month from a Trust total of 6 breaches last month to 4 this
month. The improvement relates to breaches of the MLA
contract requiring levels of staff training in a range of topics.
Discussions between the Contracting team and the
Commissioners have clarified that whilst there are a
number of failing areas, these are grouped contractually
into Infection Control, Universal Mandatory Training and
Essential to Role Training. As a result of this clarification the
number of KPIs at risk has been adjusted accordingly.
The three breaches in Adults and Communities and the
three breaches in Children and Families relate to the same
contract (MLA). The Specialist breach relates to the Dental
contract. Hence, the Trust has breached 4 contractual KPIs
overall.
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Patient Safety area of underperformance
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Commentary
MLA Contract - 3x Training KPI breaches
Three breaches for Adults and Communities and Children and
Families:
Infection Control Training KPI
Mandatory Training KPI
Essential to Role Training KPI
Both Divisions continue to work with Learning and Development
to improve performance.
In addition, The Nursing Director proposed a recovery trajectory
to the Commissioner against the indicators within the contract.
2.1 Delivery of Contractual KPI (KPI breaches)
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Dental Contract - Percentage of Elective Care operations
cancelled for non-clinical reason.
Performance against this indicator was 0.95% against a threshold
of 0.5% for May.
The BMI Edgbaston Daystay session for the 7th June was
cancelled as both of the dentists that usually provide cover for
the session were unavailable.
However subsequently two patients were booked on the session,and as a result both bookings required cancelling. In line with
policy, both patients were rebooked within five days for
appointments within 28 days of the cancellation (one within 7
days, the other within 14 days).
To prevent further occurrence, clinical and support staff
availability has been rechecked, a rota compiled and forwarded
to all involved, and a monthly review of the service
administration will be undertaken at which the cover rota will be
confirmed and circulated.
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Patient Safety area of underperformance
2.2 Commissioner Contract Deadlines Missed
Overall Trust position
18
Indicator Goal: Partnership
This measure reports the number of contractual reportingdeadlines missed in the month. This measure encourages
proactive management of areas of risk across the
organisation, gives the Board assurance on the Trusts
ability to be timely and responsive to commissioners and
identifies areas where the trust may be financially
penalised.
The monthly reports to the commissioner on the financial
impact of activity are provided by a reporting system called
SLAM.
Reports covering April, May and June activity were due on
the 3rd July 2012, and were provided on the 4th July 2012.
The delay was due to a late resolution of a query around
phasing of activity. The issue has been resolved, and we do
not expect a recurrence in future months.
This will result in no financial penalty for the Trust as
remedial action was applied immediately.
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Patient Safety area of underperformance
2.3 Percentage of staff appraised (within 18 months)
Overall Trust position
Breakdown by Division
19
Indicator Goal: People
This measures the percentage of staff recorded as receiving anappraisal within the past 18 months. This indicator demonstrates
a commitment to developing staff and is linked to evidence
required for Investors in People/Improving Working Lives and the
Organisational Development Strategy.
If the majority of staff have had a personal development review
in the past eighteen months it shows that the organisation takes
the personal development of its workforce very seriously and is
endeavouring to develop staff and deal with any performance
issues in a timely manner.
In addition it demonstrates that we ensure staff are competent
to deliver their role by equipping them with the skills needed to
perform their job and builds the foundations for succession
planning. It should also improve the outcomes of the annual
Staff Survey.
This indicator follows a recovery trajectory Trust wide and in all
Divisions apart from Corporate and Rehab Services within
Specialist.
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Patient Safety area of underperformance
2.3 Percentage of staff appraised (within 18 months)
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Commentary
Due to the indicator being based on an 18 month rolling total,the Divisions had been asked to review their trajectories with the
Head of Learning and Development in order to achieve a better
understanding of the numbers of PDRs necessary each month to
achieve the target.
Based on this review, Adults and Communities adjusted their
trajectory accordingly and are achieving their recovery plan
target.
Children and Families and Specialist Division (Dental and
Learning Disabilities) did not achieve their recovery plan targets
in June due to a deterioration in performance in May.
Children and Families :
The Division is using data detailing the performance against the
indicator at service level to enforce performance against the
target.
Learning and Development provide monthly reports which helps
to inform service managers monitor the 18 months rolling target.
PDRs are being cascaded from Divisional Director to ADs andHeads of Service.
Specialist Services:
Services are meeting with the Head of Learning and
Development over the next 2 weeks to identify further actionsthat need to be adopted in order to improve the compliance in
the future.
LD services have a significant programme of PDRs in June and
July and Rehabilitation over the summer through to September,
it is aimed that this will improve the Divisions overall
performance against this indicator.
Adults and Communities:
Although achieving their current recovery plan target, the
Division has taken further measures to improve performance
throughout all service areas which should have a positive impact
on Trust performance over the next months:
In Patient Services - all staff have dates for PDRs, including both
General Managers.
Community Services- Sets of core objectives have been
produced to support line managers undertake PDRs. All line
managers will have specific objectives regarding PDR
achievement in their areas/ team responsibilities.
Specialist services are in excess of target and all PDRs have been
scheduled for 2012/13.
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Domain 3:
Patient Experience
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Domain Summary Patient Experience
Ref Indicators with no areas of concern
3.1 Number of Complaints 13
3.2 Number of Complaints acknowledged
within 3 days
100%
3.3 Percentage of complaints responded to
within 6 months or as agreed100%
3.4 18 week pathway (admitted patients) 96.7%
3.5 18 week pathway (non-admitted patients) 97.5%
3.6 18 week pathway (incomplete pathway) 98.6%
3.7 Cancer Referrals (Urgent 2WW) 100%
3.8 Customer experience patient surveys
completed in all areas in past 12 months96%
3.9 Net Promoter Score (in patient only) 45
22
Commentary
In this summary, we have outlined the overall performance for the Trust for all of the Patient Experience indicators. Where the Trust
has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the
required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequentpages.
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Net promoter: This Indicator is being reported for the first time
this month and its implementation is driven by a regionally
mandated CQUIN target. More commentary follows overleaf.
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Patient Experience service update
23Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Net Promoter Overview
The Net Promoter Score (NPS) is also known as the Friends and
Family Test / question
Introduced by Midlands and East SHA as regional CQUIN
Implemented in Acute settings to gain feedback from 10%
of footfall
Part of the CQUIN requires that scores are discussed at Board
Our target is to show an improvement on Q1 baseline scores
by the end of the year
Scoring System
Patient asked a specific question how likely is it on a scale
of 1 to 10 that you would recommend this service to friends
and family?
Promoter: Scores of 10 or 9
Passive: Scores of 8 or 7
Detractor: Scores of 6 and below
To establish the NPS, the percentage of detractors (i.e.
patients scoring 6 or below) is subtracted from the
percentage of promoters (i.e. scoring 9 or 10). Passive
scoresare not considered.
Next Steps
In Q1 we achieved a NPS of 45 for in patient discharges and a score of 49.2 for all patients in BCHC who were surveyed
Nationally scores are reported to vary from 20 to 89
Concerns have been expressed nationally about the use of the question, and there may well be amendments before roll out
next year
We are part of a group of community trusts who have agreed to benchmark (anonomysed data) to assess the scoring in
community settings
We feel there are challenges around when, who and how the question is asked, which may influence scores
Our target is to show an improvement on Q1 baseline scores by the end of the year
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PEAT SCORES
Site Name
Environment Score Food Score Privacy & Dignity Score
Community Unit 3 Good Hope
Hospital
3 Acceptable 3 Acceptable 4 Good
Community Unit 29 at Heartlands
Hospital
4 Good 5 Excellent 5 Excellent
Intermediate Care Rehabilitation
Unit Ann Marie
4 Good 5 Excellent 5 Excellent
Perry Trees Care Centre 5 Excellent 5 Excellent 5 Excellent
Riverside Lodge 5 Excellent 5 Excellent 5 Excellent
Sheldon Nursing Home 4 Good 5 Excellent 5 Excellent
Moseley Hall Hospital 4 Good 5 Excellent 4 Good
West Heath Hospital 4 Good 5 Excellent 4 Good
Norman Power Centre 5 Excellent 5 Excellent 5 Excellent
Patient Experience service update
PEAT Scores
Commentary
The annual Patient Environment Action Team (PEAT) scores have been added to this months reports as they have now beennationally published. There is a positive performance in all areas, noting that CU3 have now moved to much improved ward (CU 27).
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Domain 4:
Clinical Effectiveness
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Domain Summary Clinical Effectiveness
Ref Indicators with no areas of concern
4.1 CQC conditions or compliance concerns 0
4.2 Percentage of compliance with CQC standards 100%
4.3 Essential Care Indicators (aggregated
measure)93.6%
4.4 Acute admission avoidance (adults only) 14%
4.5 Percentage of compliance with CQUINs 100%
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Commentary
In this summary, we have outlined the overall performance for the Trust for all of the Clinical Effectiveness indicators. Where the
Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not
achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the
subsequent pages.
While the Trust was only slightly below its target for the Essential
Care Indicators (ECI) in June, achieving an Amber rating, we have
provided further analysis for each of the ECIs overleaf.
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Clinical Effectiveness watching brief
4.3 Essential Care Indicators
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Indicator Goal: Product
Essential Care Indicators are a set of metrics recordingquality of care. This indicator records the compliance with
assessment and care planning for Essential Care in bedded
areas. Reporting is based on an audit of 10 sets of care
plans per ward per month against an agreed set of care
standards.
The compliance scores are aggregated into an overall Trust
compliance. The expectation is for 95% compliance with
the standards. This demonstrates that appropriate care
standards are followed.
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4.3 Essential Care Indicators
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Commentary
Patient Observations ECI Criteria
Wards at MHH and WHH are maintaining good compliance with
Wards 11, 12, 14, 4, 5 and 6 achieving 100% compliance. CU 29
has also achieved 100% compliance. The remaining intermediate
care units have improved compliance. Perry trees unit are
awaiting training and not yet using Modified Early Warning Signs
and this is reflected in their poor compliance score.
Falls Assessment ECI Criteria
A number of Units achieved 100% compliance Wards 11, 12, 14
and 4. Most of the remaining units showed good compliance
apart from reassessment of risk. Norman Power unit also needs
to improve compliance with care plans. Units CU 29 and CU 27
both need to improve compliance across a number of falls
standards and both have remedial plans in place.
Tissue Viability ECI Criteria
Ward 5 has achieved 100% compliance across all the Tissue
Viability standards. The majority of the remaining Wards at MHH
and WHH need to improve compliance in reassessment of risk.
Ward 6, Anne Marie Howes, Perry trees and CU 29 Units all needto improve compliance with care planning. Ward 8, Norman
Power unit and CU 27 showed poor compliance overall for Tissue
Viability. Action plans are already in place for Norman Power and
CU 27. The results from Ward 8 are being escalated for action and
will be closely monitored in month.
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Clinical Effectiveness watching brief
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4.3 Essential Care Indicators
29
Commentary
Nutritional ECI Criteria
The majority of units are showing good compliance with Nutritional standards, with Wards 14 and 4 and Norman Power and Anne
Marie Howes Units having 100% compliance. Wards 6,11,12, 8, and C29 need to improve compliance in re-screening and CU27 unit
is showing poor compliance across the majority of Nutritional standards which has been escalated for action.
Medicines Management ECI Criteria
The Intermediate Care Units and Wards 5 and 6 at MHH are all showing reduced compliance in some elements of Medicines
management documentation, particularly the use of full patient Identification, the signing of discontinued prescriptions and the use
of Capital letters for medicine names.
Environmental ECI Criteria
All units continue to perform well against these criteria apart from a number of the Intermediate Care Units which were not found
to be displaying Estimated Date of Discharge.
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Domain 5:
Efficiency and Productivity
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Domain Summary Efficiency and Productivity
Ref Indicators with no areas of concern
5.1 Agency as a percentage of temporary staff
spend
36.7%
5.2 Average length of time to recruit (Date
Advertised to Offer)
89.7
5.3 CRES achievement - % YTD actual compared
to YTD Plan
84.38%
5.5 NHS DTOC SHA target snapshot percentage
of patients
2.11%
5.7 Percentage of patient ethnicity codes
recorded on PAS/Child Health System
89.4%
5.8 Availability of agreed services on Choose and
Book
100%
5.10 YTD % CRES milestones achievement position 95.15%
Ref Indicators with no data and comment
5.4 DNA rates Not available as at
report date
5.6 SUS data with a valid NHS number Not available as at
report date
5.9 Increase in funded health visitor WTE
establishment
Availabilityto be
confirmed
31
Commentary
In this summary, we have outlined the overall performance for the Trust for all of the Efficiency and Productivity indicators. Where
the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not
achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the
subsequent pages.
The DNA rates and SUS data with a valid NHS number outturn are
not made available until the 20th and 25th July so the Trust Board will
be verbally updated on this area of performance at the Board
meeting.
While the recovery plan for CRES achievement - % YTD actual
compared to plan was met by the Trust, we have provided the Trust
Board with a financial update to reflect current CRES savings
overleaf.
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Efficiency and Productivity watching brief
5.3 CRES achievement - % YTD actual compared to YTD plan
Breakdown by DivisionOverall Trust position
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Indicator Goal: Price
The Trust is required to make financial efficiency savings and this indicator will show the Board the progress being made throughoutthe year to deliver these savings.
This is a new calculation. Previously the Trust reported cumulative CRES savings against the total target. The new indicator assesses
CRES savings each month against the cumulative Year to Date (YTD) planned savings. The target is to achieve 100% of the YTD plan.
Following month one outturns, the forecast has been revised to
achieve 82% overall compliance by June 2012. While the Trustexceeded its June recovery target, Dental Hospital fell behind their
YTD plan for the first time.
This does not affect the overall target which is to achieve 100%
compliance.
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
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Appendix 1:
Finance Report
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Finance Performance Report
Month 3
2012/13
353
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Finance Board Report Index
Page
Executive Summary 37
In Year Income & Expenditure Plan & Year End Performance 38
Corporate Financial Risks 39
CRES Delivery 40
Capital Plan 41
Working Capital Statement of Financial Position 42
Working Capital Cash Flow/Debtors/Creditors/PSPP 43
Working Capital Summary 44
Figure Explanations 45
Glossary 46
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Summary & Key Performance Indicators Executive Summary
Fig.1
Fig. 3
Fig. 2
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In Year Income & Expenditure Plan & Year End Performance
Fig.4
Rehabilitation Mth3 (73k), Mth2 (30k), Mth1 (102k)
YTD overspend of (73k) with continuing pressures in RTS which is consideredto be a non recurrent issue, special seating (67k), Rehab Engineers (55k) andFES (28k), offset by vacancies. The division has been asked to complete a fullreview of service line profitability.
CRES 5k adverse to recovery plan
Dental/PDS Mth3 62k, Mth 2 54k, Mth1 69k
As reported in previous months the favourable variance relates to continuing
vacancies, and slippage on non pay contracts .CRES 9k adverse to plan.
Corporate Mth3 15k, Mth 2 10k, Mth1 6k
Month 3 favourable variance is primarily due to slippage on vacancies, offset bynon pay cost pressures.
CRES 40k adverse to original plan
The net I & E position as at month 3 is a YTD surplus of 869k and is against an inyear planned surplus of 965k, demonstrating a 96k unfavourable variance
from target.
Through the newly created PPMB (Programmes & Performance Management
Board) the YTD and forecast outturn positions are reported and discussed
along with future planned recurrent positions and projections. Where divisions
continue to underperform recovery plans will also be closely monitored through
the Business and Finance Technical Committee.
Figure 4 shows the summary of the divisional YTD position currently reporting a
YTD unfavourable variance of 220k including income;
At Month 3 the forecast outturn position for the Trust remains at 2,948k.The main factors and risks influencing the divisions month 3 position including
income are:
Children's and Families Mth 3 165k, Mth2 72k, Mth1 (3k)
The YTD favourable variance relates to continuing slippage on vacancies
offset by pressures in drugs (66k)
Achievement of YTD CRES.
Adults and Communities Mth3 (252k),Mth2 (42k), Mth1 (24k)
The month 3 position relates mainly to the delay in Inpatient Service Redesign
(225k), now expected to complete in July, medical staffing locum cover (58k)
and underperformance (250k) relating to the phas ing of activity. The issue
has been resolved, and is expected to result in no financial penalty to the
Trust by year end.
Offset by continuing slippage on vacancies in the main within central services
and medical staffing.
Achievement of YTD CRES against recovery plan
Specialist
LD Mth3 (122k), Mth2 52k, Mth1 (15k)
The unfavourable movement in month relates to short t erm breaks (88k). Inaddition the YTD position as previously reported includes additional income,offset by continuing bank and agency spend and non pay cost pressures.
Achievement of YTD CRES against plan.
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Corporate Financial Risks
Financial Risk RegisterAll risks to the organisation are managed through the risk management committee, with all those attaining a score of 15 or above being escalated to
the corporate risk register, and presented to the Governance and Risk Management Committee and the Board. All financial risks with a score of 15
or above are presented below.
There are no Financial Risks with a score of 15 or above for this month.
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CRES Delivery
Fig 6 Fig 7.
CRES Delivery
Our CRES requirement for 2012/13 is (12.1m) and projects have been identified and developed through PIDs (Project Initiation Document). These plans have been
developed with Divisions and have been corporately overseen and clinica lly driven; each project is owned by an individual within the relevant division, and they are held
responsible for achievement of the savings requirements.
We have developed a rigid gateway acceptance that ensures all PIDs accepted are monitored through PPMO (Performance Management Office). Regular monitoring ofprogress against CRES schemes will be reported to the PPMB (Programmes and Performance Management Board).
Figure 6 above details the planned YTD savings and the identified YTD savings by division. It shows that currently there is an m inor under achievement of savings, in yearrelating to Corporate, Rehab and Dental and small overachievement of revised plan by Adults & Communities Division. Divisions are confident that savings will be
achieved, and the Business, Finance and Technical Committee and PPMO will continue to monitor progress .
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Capital Plan
Fig.8
Capital Update 2012/13Sources of funds - The forecast outturn has been revised in Month 3 to reflect that currently the expected transfer of Estates has not taken place. The
Trust expects this to be updated later in the year, when the transfer is certain. It can be noted, that in order to maintain the Trust s capital plans morefunds will need to be found from surplus / PDC Loan if the t ransfer does not take place.
As at the end of June 2012 capital expenditure totalled 149k. New scheme codes have been issued to managers relating to the 2012/13 capital plan
and are now in use following the migration of shared services to SBS.
The Trust continue to manage the building schemes for all buildings that will transfer during the financial year and the placing of orders commenced
during May 2012. A detailed plan for the expenditure is almost complete with managers and will provide accurate capital profiling for the remainder of
the year.
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Working Capital Statement of Financial Position
Fig.
10Non Current Assets
Non current assets have increased by 77k due to expenditure in m onth being in
excess of depreciation.
Current assets
Overall current assets - excluding cash and cash equivalents have increased by
1,662m due to an increase in accrued income and prepayments during the month.
Financial assets - accrued income There is an increase in accruals and
prepayments in month of 1,706k. The increase in accruals is mainly due toinvoices not raised on time
Trade and other receivables (invoiced debtors) There is a decrease in
outstanding debtors in month of 44k
Cash and Other Financial Assets
Cash has decreased in month (5,558k). The decrease is mostl y due to thecontinued effort in reducing aged creditors migrated from the old payment systems
and some correction by SBS to the ledger relating to the cashbook
Current Liabilities
Current liabilities have decreased by 3,780k in month
Trade and other payables / other financial liabilities accruals
There has been a decrease of 3,907k in outstanding trade and other payablesduring the month as a result of continued work to clear aged creditors .
Non Current Liabilities
The Trust has no non current liabilit ies.
Liquidity Position
The Trust has cash totalling 30,758k which represents the Trust s cash
requirement for more than one month.
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Working Capital
Fig.13
Fig.12
Fig.15
Fig.14
Fig 11.
Aged Credi to rs Cur rent 31-60 Days 61-90 Days 91-120 Days > 120 Days > 180 Days
ont
Total
ont
Total Variance
'000 '000 '000 '000 '000 '000 '000 '000 '000
NHS 2,993 3,543 247 308 -35 509 7,565 6,799 766
Non NHS 911 772 463 337 176 118 2,777 5,233 (2,456)
Total 3,904 4,315 710 645 141 627 10,342 12,032 (1,690)
Aged Debt Current 31-60 Days 61-90 Days 91-120 Days > 120 Days > 180 Days
Month 3
Total
Month 2
Total Vari ance
'000 '000 '000 '000 '000 '000 '000 '000
Total 2,044 536 74 1,222 289 232 4,397 4,439 (42)
m m m m m m m m m m m m m m m m
Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
Plan balance 27.4 28.0 28.4 26.3 27.1 27.9 28.7 29.5 30.2 31.0 31.8 32.6 33.3 34.1 34.9 35.7
Actual balance 29.6 31.2 30.3 28.7 29.3 36.3 30.7
Cash Flow Analysis 2011/12 - 2012/13 Plan vs Actual
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Working Capital
CashCash in hand and in the bank totalled 30,758k as at the end of June 2012 which is a decrease of 5,558k in month. This was due to the continued effort in reducing aged
creditors migrated from the old payments systems and corrections to the ledger carried out by SBS.
Debtors
The total debts outstanding at the end of Month 3 is 4,397k, which is a reduction of 41k from Month 2, with debts exceeding 120 days totalling524k - an equivalent of 11.92% (refer table below) The total debts include both NHS and NON-NHS and are actively being chased for payment
A summary of debts over 120 days mainly relates to the following customers:
Birmingham East and North - 151k - 72k of the outstanding debt has been received in July, plus the requested credit note for 58k re: charges over the agreed
maximum 57k charge has been raised. This leaves a balance of 21k outstanding which will be paid on receipt of the credit note.
South Staffordshire PCT - 113k The Division is actively pursuing payment for the outstanding invoices, Copies of requested signed SLA documentation has being
forwarded to South Staffordshire, who has confirmed that payment will be forthcoming within the next 2 weeks.
Sandwell and West Birmingham Hospitals NHS Trust - 57k Credit notes are in the process of being raised to clear the disputes on these invoices. On receipt of the
credit notes, payment of the outstanding balance will be imminent.
Cape Hill Medical Centre - 32k The Division is actively liaising with Cape Hill to try resolve the disputes on the 2 outstanding invoices.
CreditorsAged Creditors at the end of month 3 is currently showing a balance of 10,342k, which is a decrease of 1,690k in month. Over 120 days past due date creditors
have increased to 768k in month 3 from 639k in month 2 which represents 7.43% of total creditors.
PSPP
The Public Sector Prompt Payment Policy target is 95% of bills to be paid within 30 days and will be reported in the annual accounts.The cumulative performance for the year is 73.48% (M2 75.61%) with 71.47% (M2 71.64%) of invoices within the month being paid within the PSPP target timescale.
Work is on-going to ensure that the cumulative performance is improved and it is being reported at PPMO.
Note : The SHA has asked organisations to provide turnaround plans where debtors and creditors exceed 90 days past due. The newly established monthly performance
management meeting (Performance and Programme Management Board, PPMB) will oversee local delivery of the 90 day and 30 day targets in the future.
Aged Debt Month 3 Current 31-60 Days 61-90 Days 91-120 Days >120 Days >180 Days Grand Total
'000 '000 '000 '000 '000 '000 '000
NHS 1,733 276 69 1,082 277 149 3,586
NON NHS 311 260 5 140 12 83 811
Non NHS - Excl L/Cars & Sal O/P 305 256 5 136 9 51 762
leaseCars 5 4 0 2 3 7 21
Salary Overpayment 1 0 0 2 0 25 28
Grand Total 2,044 536 74 1,222 289 232 4,397
Total number of Invoices 279 114 30 98 58 122 701
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Figure Explanation
Figure 10. The balance sheet shows prior month, current month,
movement in month. It also shows the balances as if we
were operating as an FT for comparison
Figure 11. Shows the cash balance on a rolling basis. A full cash
forecasting model supports this data.
Figure 12. Graph showing the Cash Flow Analysis of actual vs. plan
Figure 13. Provides an analysis of aged debt within the period.
Figure 14. Provides an analysis of aged creditor within the period.
Figure 15. Shows the in month and Cumulative PSPP compared to
the annual target
Figure 1. Demonstrates the current I&E position compared to both
the in year planned position and full year plan.
Figure 2. Assesses financial risk and looks at four criteria:
achievement of plan, underlying performance; financial
efficiency; and liquidity and is scored from 5 to 1. A
weighted average of these scores is then used to
determine the overall financial risk rating
Figure 3. Key performance indicators
Figure 4. Demonstrates the current I&E position
Figure 5. Corporate Financial Risks of rating 15 or over
Figure 6. CRES Performance illustrating Recurrent & Non
Recurrent, the forecast and the actual achieved.
Figure 7. Graph illustrating the CRES Performance YTD
Figure 8. Provides an analysis of Capital budget by directorate
Figure 9. Provides an analysis of capital sources and applications
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Glossary
ALE Auditors Local Evaluation MADEL Medical and Dental Education Levy
BCC Birmingham City Council MHH Moseley Hall Hospital
BDC Business Development Centre NPSA Named Patient Service Agreement
BFM Business Finance Manager OBC Outline Business Case
CDM Centre for Defence Medicine OOH Out of Hours
CRES Cost Releasing Efficiency Savings PBR Payment by Results
CRL Capital Resource Limit PFI Private Finance Initiative
EBITDA Earnings Before Interest, Tax, Depreciation and Amortization PL Project Lead
ESR Electronic Staff Record PLD People with Learning Disabilities
FDC Financial Delivery Committee PSC Public Sector Consulting
FBC Full Business Case PSPP Public Sector Payment Policy
FOT Forecast Outturn QTR Quarter
FPMG Finance & Performance Management Group R&D Research & Development
FT Foundation Trust RMHN Registered Mental Health Nurse
HoEFT Heart of England NHS Foundation Trust RPL Revenue Resource Limit
HOS Heads of Services SBCH South Birmingham Community Health
HR Human Resource SHA Strategic Health Authority
I&E Income & Expenditure SFIs Standing Financial Instructions
IT Information Technology YTD Year to Date
LDP Local Development Programme ZBB Zero Based Budgeting
LTFM Long Term Financial Model
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