Annual Members Meeting Looking Back at 2014/15 Karen Jackson Chief Executive 30 September 2015 1
Performance Headlines – Part 1: In 2014/15, the Trust continued the process of quality improvement begun following the Keogh Review process in the summer of 2013. Though there is still plenty of work for us to do, we have made demonstrable progress, and improved services for our patients. • Following a CQC inspection in the spring of 2014, the Trust was removed from “Special Measures” status in July 2014. This vindicated much of the work that we had done as a Trust over the previous 18 months • Though the Trust was rated by the CQC inspection in the “Requires Improvement” category, the Trust’s staff were rated highly on the “caring” element of the assessment, a vote of confidence in our staff. • The CQC did find issues in the coordination of our critical care services, and suggested further improvements in structure and service provision. The Trust created a forward plan for this area, and has already implemented the immediate action phase of this plan.
Performance Headlines – Part 2: The year has seen further progress in bringing clinicians further into decision making, across organisations as well as within the Trust. • The Trust has continued to develop its clinical leadership structure, with a major development programme for clinical leads in each service area, and the appointment of a new Medical Director and Deputy Medical Directors. The Trust Remains committed to further developing engagement with clinical staff at all levels. • The Trust has continued to work hard on improving its mortality performance position, and the SHMI weighted mortality index has remained within the expected range through 2014/15 on the official measures published to date. • The work of the wider health community to improve mortality performance and service quality has taken significant steps forward, recognising that clinicians can (and must) work together across organisations to improve services for patients. • The Trust continues to develop and implement a rolling programme of improvement via its Quality Development Plan, to improve quality of care and patient experience.
Performance Metrics Overall Performance During 2014/15: • The Trust achieved all the performance standards set out in Monitor’s Risk Assessment Framework in the final quarter except for the A&E standard – though the Trust’s performance still compared well to many other Trusts. • The Trust achieved all targets with the exception of A&E throughout the whole of the year, aside from the 18 week admitted wait measure – though for the period of non compliance this measure had been officially suspended, to support a programme of waiting list action • The Trust remained a strong performer in cancer services and in infection control. • This performance would, in normal circumstances result in the Trust being rated GREEN at quarter four, although the rating continues to be subject to a RED override due to continued conditions on licence • The trends evident here have been continued through the first part of 2015/16, though we have seen an increase in c difficile infections, which is the subject of specific action plans.
2014/15 2014/15 2014/15 QTR 1 QTR 1 THRESHOLD ACTUAL TO Q4 POSITION QTR 1 QTR 2 QTR 3 TO DATE DATE Infection Control Clostridium Difficile G G G 33 20 G Referral to Treatment Waiting Times Admitted - Maximum waiting time of 18 weeks G R R 90.0% 91.0% G Non-admitted - Maximum waiting time of 18 weeks G G G 95.0% 95.3% G Incomplete - Maximum waiting time of 18 weeks G G G 92.0% 96.2% G Cancer Waiting Times 31 day wait diagnosis to treatment G G G 96.0% 99.0% G 31 day wait for subsequent treatments - Surgery G G G 94.0% 100.0% G 31 day wait for subsequent treatments - Anti cancer drugs G G G 98.0% 100.0% G 62 day wait GP referral to treatment G G G 85.0% 86.4% G 62 day wait Consultant screening service referrals G G G 90.0% 94.7% G 2 week wait referral to consultation G G G 93.0% 98.4% G 2 week wait breast symptom referrals G G G 93.0% 95.8% G A&E Waiting Times A&E 4 Hour Wait Compliance G G R 95.0% 90.4% R Data Completeness Community Services Referral to treatment information G G G 50.0% 91.0% G Referral Information G G G 50.0% 91.0% G Treatment Activity Information G G G 50.0% 93.0% G Access Access to healthcare for people with learning disability G G G Y/N Y G Total Monitor Compliance Score 1.0 Monitor Compliance Rating Green Monitor Over ride Rating Red 5
Comparative Performance Overall national A&E performance issues: • 66 out of 109 Foundation Trusts failed A&E in Q4 • Overall performance fell to 91.6% (NLAG reported 90.4%) • Many non FTs also struggled with the A&E target – NLAG were generally viewed as delivering in line with expectations given the pressure nationally. Other overall national performance issues: • The 18 week “incomplete pathway” average for FTs was 92.7% (NLAG was 96.2%) • Performance on cancer waits remained within threshold all year – whilst 66 other FTs failed the 62 week wait targets • NLAG continued to reduce C Diff infections, while the national position saw a small increase • NLAG performance remains reasonably robust compared to the wider NHS
Summary of Financial Position 2014/15 2013/14 £m £m Income 330.82 319.27 Expenditure (339.22) (313.20) EBITDA (8.41) 6.07 Accounting Surplus/(Deficit) (21.07) (5.49) Cash balances held 21.16 26.50
In Year Liquidity Changes The Trust’s cash position fell by £5.3mil during the year. This was a positive outcome, given the significant underlying I&E defict seen through the year. The Trust saw a significant underlying I&E deficit, but was able to counter this in year by improving cash flow from CCGs, reflecting improved working between organisations. The underlying cash position (excluding loans held but committed for future spending) shows that the Trust has reached a perilously low cash base position – a result of successive year of underlying 8 financial imbalance.
Patients Treated During 2014/15: 2013/14 2014/15 Variance % variance Activity Actual against last against last year year Non Elective Spells 47,391 47,841 450 1.0% Elective/Daycase Spells 57,930 60,475 2,545 4.4% Outpatient Attendances 388,498 386,375 (2,123) (0.6%) Critical Care Days 19,323 19,731 408 2.1% A&E Attendances 137,017 144,992 7,975 5.8% • The Trust undertook more activity than the previous year in order to meet increased demand. • In addition to the volume of activity the Trust did see a noticeable increase in the average acuity of the patients seen, as evidenced by the increase in the number of patients requiring critical care. • Income growth did not match activity growth – but expenditure was 9 driven up sharply in many areas.
National Financial Position • 54 out of 84 Acute Foundation Trusts reported a deficit in 2014/15. • Cash balances fell by £0.24bil across the FT sector in the year despite a £0.63bil capital underspend and £0.63bil of cash support. • 2015/16 is set out to become a crunch year for NHS finances, with the crisis focused on the acute sector. • NLAG will require, and has reached the point of securing up to £20m of cash support for 2015/16 • Though local cooperation is significantly improved, national action is still required to provide both short term and long term solutions. • The local health economy can use Healthy Lives Healthy Futures to deliver more sustainable local service delivery – but this won’t close the longer term financial gap, no matter how efficient our services become . • r10
Workforce Pressures • In the face of increased activity, and the need to maintain patient safety, the Trust has sought to increase staff numbers on the clinical front line. • Supply of key clinical staff remains restricted – particularly for doctors in medical specialties, registered nurses, and specific skill sets within the AHP groups • This has driven up costs through increasing use of agency staff – but we have been taking action to respond to this: – We are looking closely at local pay frameworks to incentivise key staff groups; – We are developing plans for enhanced development programmes for staff and new recruits; – We are looking to enhance healthcare skills education locally; – We are developing innovative job roles to maximise the effectiveness of staff in delivery of patient care • We have a bright future if we can build the proper frameworks for developing local people into the healthcare professionals of tomorrow. 11
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