Transcript Slide 1

Corporate Performance Report
December 2012
By
Chris Tidman
Director of Resources/Deputy Chief Executive
Key Indicators
•
Emergency Access – The 4 hour standard has not been achieved in
November for the first time in 5 months, due mainly to the impact of Norovirus
on bed availability. Pressure has continued into December.
•
18 Weeks waiting time performance has been sustained.
•
Cancer targets have been mostly achieved – some pressure on subsidiary
targets due to low numbers / patient choice
•
Both the Stroke and TIA targets have been achieved
•
9 C-Diff cases , taking the year to date total to 60 cases against the annual
cap of 52 cases.
4 Hour Emergency Access
Trust
WRH/K
TC
ALX
92.15%
91.66%
92.94%
Apr-12
88.43%
87.92%
89.20%
May-12
89.70%
89.57%
89.91%
Jun-12
94.21%
95.29%
92.50%
Jul-12
95.58%
96.16%
94.65%
Aug-12
96.13%
96.99%
94.75%
Sep-12
96.15%
96.60%
95.43%
Oct-12
95.21%
95.15%
95.30%
Nov-12
94.34%
94.38%
94.28%
Dec-12 (as at 16th Dec)
91.69%
91.53%
91.93%
93.67%
93.9%
93.1%
Month
2011/12
2012/13 YTD (as at 16th
Dec)
• 4 hour standard was not achieved in November as a result of
Norovirus outbreak on both main sites which restricted the availability
of beds.
• Emergency admissions have continued at a high level albeit appear to
be plateauing. It is forecast that admission avoidance schemes will
begin to have further impact over the winter period.
• Norovirus has continued into early December impacting on
performance.
• Commissioners have stated their intention to issue a contract penalty
11.7% increase on previous year
PCT Cluster Analysis -Growth in All Emergencies – 0 Day LOS
YTD Apr-Aug 2012/13 over previous year
All HRGs
0 LOS
6%
Commissioners have
expressed concerns
that the growth in
emergency admissions
at Worcs Acute has
been disproportionately
in the zero length of
stay category.
UHNS/MS 2%
Bur 18%
GE 1%
SaTH 26%
RW 6%
Wals 5%
DG 2%
Sand 16%
HoE 0%
UHCW 12%
UHB/BC -15%
WAHT18%
WV 6%
SWHT 12%
In order to give
assurance that
the Trust has
not changed its
admission
threshold for
short stay
admissions, this
has been
analysed in
more detail.
Emergency Admissions -Zero Length of Stay (Un-Normalised)
This shows that the growth in zero length of stay admissions peaked in August at 18% before reducing to 14.3%.
However, it can be seen that the July-August period in 2011 was unusually low which related to the 7 week closure
of the Observation Unit to allow for single sex compliance work to be completed.
Month
April
May
June
July
Aug
Sept
Oct
YTD
2010/11
811
1003
1004
985
911
941
940
6595
No. of Zero LOS Admissions
2011/12 10/11 vs 11/12 2012/13 11/12 vs 12/13
859
5.9%
933
8.6%
869
-4.7%
996
11.6%
841
-8.8%
922
11.0%
795
-11.5%
1069
16.5%
729
-13.2%
908
18.0%
861
-12.4%
885
15.3%
911
-11.1%
991
14.3%
5865
-11.1%
6704
14.3%
Total Admissions
2010/11
2011/12
2012/13
3119
3302
3554
3526
3310
3654
3466
3202
3573
3515
3144
3915
3380
3131
3561
3415
3316
3478
3485
3433
3744
23906
22838
25479
% Proportion Zero's
2010/11 2011/12 2012/13
26.0%
26.0%
26.3%
28.4%
26.3%
27.3%
29.0%
26.3%
25.8%
28.0%
25.3%
27.3%
27.0%
23.3%
25.5%
27.6%
26.0%
25.4%
27.0%
26.5%
26.5%
27.6%
25.7%
26.3%
Emergency Admissions -Zero Length of Stay (Normalised)
Once normalised for the closure of the Observation unit, the increase in the zero length of stay
admissions are in line with the overall increase seen. Also, the % of admissions that have a zero
length of stay is lower than seen in 2010/11.
Month
April
May
June
July
Aug
Sept
Oct
YTD
2010/11
811
1003
1004
985
911
941
940
6595
No. of Zero LOS Admissions
2011/12 10/11 vs 11/12 2012/13 11/12 vs 12/13
859
5.9%
933
8.6%
869
-4.7%
996
11.6%
841
-8.8%
922
11.0%
860
-9.8%
1069
14.3%
860
-9.0%
908
12.6%
861
-8.9%
885
10.9%
911
-8.1%
991
10.6%
6061
-8.1%
6704
10.6%
Total Admissions
2010/11
2011/12
2012/13
3119
3302
3554
3526
3310
3654
3466
3202
3573
3515
3209
3915
3380
3262
3561
3415
3316
3478
3485
3433
3744
23906
23034
25479
% Proportion Zero's
2010/11 2011/12 2012/13
26.0%
26.0%
26.3%
28.4%
26.3%
27.3%
29.0%
26.3%
25.8%
28.0%
26.8%
27.3%
27.0%
26.4%
25.5%
27.6%
26.0%
25.4%
27.0%
26.5%
26.5%
27.6%
26.3%
26.3%
Emergency Admissions by HRG Chapter
% Contribution Towards
Growth in Emergency
Admissions (12.31%)
P - Diseases of Childhood and Neonates
24.31%
E - Cardiac Surgery and Primary Cardiac Condition
15.46%
D - Respiratory System
13.22%
W - Immunology, Infectious Diseases
10.28%
F - Digestive System
8.98%
A - Nervous System
7.81%
Other HRGs Grouped
19.95%
100%
% Value Contributed
Towards 12.31%
Growth
2.99%
1.90%
1.63%
1.27%
1.11%
0.96%
2.46%
12.31%
The pie chart shows that the growth in
admissions is spread across a
number of HRG chapters. It has been
agreed that these areas will be
analysed further by clinicians to gain a
better understanding as to what is
driving the increased emergency
admissions.
P – Paediatrics – up by 24.31% across all LOS bandings
E – Cardiac – up by 15.46% mainly in
0-1 day LOS bandings
D – Respiratory – up by 17.6% – main
increase in >2 day LOS
W – Immunology , Infectious Diseases
–up 10.28% across all LOS bandings
F – Digestive – up by 13.2% - across
all LOS bandings
Stroke
Direct Admissions to a Stroke Ward
90.00%
Direct Admission
(via A&E) to a
Stroke Ward
Target
80.00%
70.00%
60.00%
50.00%
Apr-12 May-12 Jun-12
Jul-12
Direct Admissions
Trust achieved 77.5%
against the standard of 70%
Aug-12 Sep-12 Oct-12 Nov-12
90% of LOS on Stroke Ward
100.00%
80% of Patients spend
90% of time on a
Stroke Ward (Final)
90.00%
80.00%
Target
70.00%
90% LOS on Stroke Ward
Trust achieved 80.4% against
the standard of 80%
60.00%
Apr-12 May-12 Jun-12
Jul-12
Aug-12 Sep-12
Oct-12 Nov-12
TIA
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
TIA
Target
Apr-12 May-12 Jun-12
Jul-12
Aug-12 Sep-12
Oct-12 Nov-12
TIA
Trust achieved 62.1 %,
against the standard of 60%.
C difficile Toxin Detections 2012/13
12
cases
10
C-Diff cases continue to be above trajectory and there
remains the potential for the Trust to be issued with a
contract penalty. However, it should be noted that the
Trust continues to test for C-Diff at significantly higher
levels than its peer group and has an overall detection
rate that is within the average range. Based on this fact
and the Trust’s clear intent to bring C-Diff levels back
within the trajectory, it is anticipated that any penalty
imposed will be re-invested.
trajectory
8
6
4
2
0
70
60
50
40
A detailed action plan is in place which includes
regularising the prescribing of antibiotics in both
hospital and primary care settings and accelerating
testing within the first 48 hours of admission.
30
cases
trajectory
20
10
0
Cancer Standards
2 Week Waits
100.00%
95.00%
All Cancer Two Week Wait
90.00%
Wait for Symptomatic Breast
Patients
Target
85.00%
80.00%
Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov '12
The Trust missed the
Symptomatic Breast target in
November due to patient choice
delays to first appointment. GPs
have been asked to counsel
patients on the need to accept
an appointment within the 2
week timeframe. Year to date
performance is ahead of target.
31 Days Wait for First Treatment
100.00%
98.00%
Wait For First Treatment:
96.00%
Target
The Trust achieved the 31 day
wait for first treatment in
November.
94.00%
Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov '12
31 Days Wait for Second or Subsequent Treatment
100.00%
95.00%
Wait For Second Or
Subsequent Treatment
90.00%
Target
85.00%
Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov '12
The Trust failed to achieve the
31 day subsequent treatment
(surgery) target. This amounted
to 3 breaches in total, with
underachievement driven by a
very low denominator. Year to
date performance is ahead of
target.
Cancer Standards
31 Days Wait for Second or Subsequent Treatment- Anti Cancer Drug Treatment
100.00%
Wait For Second Or
Subsequent Treatment Anti
Cancer Drug Treatments:
Target
99.00%
98.00%
97.00%
31 Days Wait for
Second or Subsequent
Treatment-Anti Cancer
Drug was achieved in
November.
Apr '12 May '12 Jun '12 Jul '12 Aug '12 Sep '12 Oct '12 Nov '12
62 Days Wait for First Treatment From Urgent GP Referrals
95.00%
90.00%
Wait For First Treatment from
Urgent GP Referral
85.00%
Target
80.00%
Apr '12 May '12 Jun '12
Jul '12
Aug '12 Sep '12 Oct '12 Nov '12
62 Days Wait for First Treatment From National Screening Service Referral
100.00%
Wait For First Treatment from
National Screening Service
Referral
Target
95.00%
90.00%
85.00%
80.00%
Apr '12 May '12 Jun '12
Jul '12
Aug '12
Sep '12 Oct '12 Nov '12
All the 62 Day Cancer
targets were achieved
in November.
18 Weeks Referral to Treatment
Admitted-All Specialties
97%
95%
93%
RTT - Admitted - 90%
in 18 Weeks
91%
Target
89%
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Non-Admitted-All specialties
100%
RTT - Non-Admitted 95% in 18 Weeks
98%
96%
Target
94%
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Incomplete
100%
98%
96%
94%
92%
90%
RTT - Incomplete 92%
in 18 Weeks
Target
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
The 18 week target has
been consistently achieved
despite some specialty
level risks.
In particular, Orthopaedics
is currently reliant on
running additional waiting
list initiative lists in order to
manage the excess
demand. Whilst every
effort will be made to
ensure this continues, this
may not be a sustainable
position for the Trust unless
there is an agreed change
in pathways / referral
patterns. The importance of
receiving timely outpatient
referrals from the ICAT
triage service has been
stressed to commissioners.