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Performance Report to 30th April 2014 St George’s Healthcare NHS TrustPerformance ReportTrust BoardPeriod ending 30th April 2014 St George’s Healthcare NHS Trust
Section 1: Executive Summary • The Performance Management FrameworkThe Trust is realigning its Performance Framework with the requirements of the NHS Trust Development Authority (TDA) and Monitor. The performance report is being updated to cover the new requirements of the TDA Accountability Framework for Trusts and to include greater visibility of performance at Divisional level, alongside Trust wide aggregate performance. • The TDA Accountability FrameworkThe accountability framework covers three domains – Quality, Finance and Delivering Sustainability. A set of indicators has been identified in each domain and delivery will be evaluated against a threshold and aggregated for each domain. Performance against these indicators will determine a score for each domain. These domain scores in turn contribute towards an overall Escalation score for the Trust. The Trusts will be rated using escalation levels 1 to 5 with Level 1 being the highest and 5 the lowest. The measurement and monitoring process will continue to place each trust in one of five Oversight categories, based on their scoring against the various oversight domains, relevant views of third parties such as the CQC, and the judgement of the TDA . Those categories will be: • Standard Oversight with reduced frequency– The organisation has developed a sound FT application and received a ‘Good or Outstanding’ rating from CIH • Standard Oversight with standard frequency: Limited or no delivery issues • Supporting Intervention: The organisation has some delivery issues including clinical and/or financial challenges • Strategic Intervention: The organisation has significant delivery issues clinical and/or financial challenges • Special Measures: The organisation has significant delivery issues, including serious clinical and/or financial challenges or concerns. • The Trust is also required to sign a self certifications on a monthly basis at Board level covering compliance with Monitor’s license requirements and a set of Board Statements . • The Monitor Compliance FrameworkThe Trust is reporting an AMBER/ GREEN Governance rating and a forecasted position on Continuity of Service Risks Rating of 3. The trust is forecasting that the Governance rating be Amber / Green or Green from Q1 once ED performance and remedial plans take full effect. • Exceptions • The reportable areas of underperformance at month 1 are as follows : • A&E <4hrs:- • In April performance for ED (Type 1) was 94% and ED & MIU (Type 1 & 3) was 94.7%. St George’s Healthcare NHS Trust
Section 2: Performance Management Framework of the Trust The Performance Management Framework of the TrustThe Trust continues to operate the Performance Framework presented to the Board and Finance and Performance Committee in April 2012. This is being refreshed to ensure the indicators included within the TDA Accountability Framework for NHS Trusts are reported against and to ensure that Divisional contributions to the Trusts aggregate reported performance are more visible.The diagrams illustrate the components of the Trust’s Performance Management Framework. The Trust operates escalation processes with Divisions that reflect the national escalation processes and the recommendations in Monitor’s toolkits for implementing Service Line Management. Quarterly Performance Reviews at Divisional Level, regular meetings with our commissioners, weekly Executive management Team meetings to address potential risks are all part of the Trusts Performance Management strategy. - Escalation actions following Divisional reviews have focused on the action plan for recovering A&E 4 hour waits, financial performance within SNT and MedCard Divisions and Cancer performance to look at how delivery of the 62 day target can be improved and sustained.. St George’s Healthcare NHS Trust
Section 2: Performance Management Framework of the Trust The Performance Management Framework of the Trust The performance management arrangements includes quarterly reviews for each Division which review and challenge Divisional progress, with an opportunity for Divisions to share with the Executive team issues of concern. The Trust has extended this process by reporting divisional performance against the metrics within the TDA Accountability Framework, to the Finance and Performance committee on a monthly basis. The Trust reports on the vast majority of these metrics within the existing quarterly review process. The Trust is also currently in the process of reviewing the indicators and thresholds in the scorecard in view of the most recently published TDA Accountability framework technical guidance , updated Monitor Compliance Framework and local Trust objectives. This work is being undertaken in conjunction with the current Performance Framework review. A draft updated performance framework is being sent to the Executive Management Team Meeting on the 27th May after which a full suite of targets, thresholds and scoring methodology for the trust and divisional scorecards will be agreed and routinely reported on going forward. Divisional Reports Divisional rag ratings will be reported in the performance reports on a quarterly basis, however actions and escalation areas will be monitored and reported on a monthly basis and an overview provided. Any adjustments in rag rating will also be reported..
Section 3: The NHS Trust Development Authority Accountability Framework for NHS Trusts
Section 3: TDA Accountability Framework The Accountability FrameworkThe TDA will assess delivery across three domains as shown in the diagram :- Quality - Finance- SustainabilityAgainst each domain Trusts will report against a series of metrics. These are listed in detail in Section 6 : definitions and metricsFor 2014/15 trusts will be scored using escalation levels 1 to 5 with 1 being the highest risk rating and 5 the lowest. This is being done to ensure consistency with the CQC’s approach to assessing risk. The measurement and monitoring process will continue to place eachNHS trust in one of five oversight categories, based on their scoring against the various oversight domains, relevant views of third parties such as the CQC, and the judgement of the TDA . Those categories are:-The Trust is also required to sign off self certifications on a monthly basis at Board level covering progress against FT milestones, and compliance with Monitor’s license requirements Key Elements of the Oversight Model Overall Escalation score (1 to 5) Moderation including CQC Rating warning notices and third party report Quality Score (1 to 5) Sustainability Score (1-5) Finance RAG Assessment Caring Score (1-5) Effective Score (1 to 5)report Responsive Score (1 to 5) Safe Score (1 to 5) Well-led (1to 5) St George’s Healthcare NHS Trust
Section 3: TDA Accountability Framework : Access metrics This section headed ‘Access’ indicates how effective the trust is at providing patients with the appointments and treatment they need and require in accordance with the national standards and the NHS Constitution. The ED target is that 95% or more of patients should be seen and discharged within 4 hours of attending the Emergency Department. In April the Trust failed to meet this target with performance for ED (Type 1) at 94% and ED & MIU (Type 1 +3) at 94.7%. However for Qtr1, the trust is on track for Type 1+3 with performance as at the 22nd May at 95.2%.In April 1.3% of patients had their operation cancelled for non-clinical reasons against a target of 0.8% and 3.9% were not offered another binding date within 28 days against a target of 5%. The number of operations cancelled for non clinical reasons and rebooked within 28 days has fluctuated over the year due to bed pressures and an increase in the acuity of patients. In April, 36.5% of LAS arrivals to patient handover times were within 15 minutes against the target of 100%. and 88.5% were within 60 minutes. St George's Hospital is not unusual in this regard as all trusts within the sector are underperforming. The trust will continue to monitor performance closely as fines will be applied where patient handovers exceed 30 and 60 minutes. Not yet available St George’s Healthcare NHS Trust
Section 3: TDA Accountability Framework : Outcome metrics These indicators measure the outcomes resulting from treatment activity for which the Trust is responsible. The TDA framework includes monitoring Healthcare associated Infections and mortality. The Trust has a target of no more than 40 Cdiff incidents in 2014/15 and the zero tolerance against MRSA continues. In April, the trust met both the CDiff and MRSA target. There were 3 Cdiff incidents against a trajectory of 5 and no MRSA blood stream infections. The trust will continue its programme of close monitoring and vigilance to ensure it remains complaint in 2014/15. Prevention and education has been the focus throughout 2013/2014, with the trust aiming for zero tolerance of avoidable pressure ulcers. In April there were 15 reported Grade 3 Pressure Ulcers and no Grade 4’s. All grade 3 and 4 pressure ulcers acquired in our care are investigated as serious incidents, and a. full investigation and Root Cause Analysis is produced for each and reviewed at the Pressure Ulcer Strategy group, chaired by the Deputy Chief Nurse. The PU CQUIN for 14/15 has yet to be agreed.The trust is reporting 1 Never Event. The incident took place in March, but was not reported on Datix until April when It was promptly declared as a SI . The incident was reported, following the retrieval of a throat swab in recovery following a dental procedure. The patient made a full recovery and did not come to any harm. The WHO Surgical Checklist is a surgery safety checklist used prior to all surgical procedures. Compliance is just below target at 99%. Care group leads will continue to raise the profile through meetings and working with non compliant areas. St George’s Healthcare NHS Trust
Section 3: TDA Accountability Framework : Quality governance The Trust is required to respond to 85% of all complaints within 25 days and if this cannot be met, then an extension must be agreed with the complainant. The target then becomes 100% of all of those complaints should be responded to within 25 days or the agreed time In March 70% of all complaints were responded to within 25 working days and 87% were responded to when an agreed extensions was included. The trust has seen an increase in the number of complaints received with 116 complaints in March compared to 103 in February. Complaints remains a key focus and priority for the Chief Nurse & DOO and is being monitored and focused on at divisional, governance and clinical leads meetings. There were 4 EMSA breaches in April. A root cause analysis has been undertaken and reported to the CCG. system.The trust is reporting research activity from the Research leadership with the aim of increasing its research activity. St George’s Healthcare NHS Trust
The Trust Rating as at 30th April 2014 Section 4 : Monitor Compliance Framework • The Trust Overall Rating is AMBER/GREEN for Performance and our forecasted position for 2014/15 for CoSRR is 3 at the end of April. • The 62 Day target was met in Qtr 4 and for the month of March. In March performance was 85.5%, and for the quarter January to March performance was 85.2% • For Qtr 1 to date, the trust is currently non-compliant against the ED target. ED (Type 1) is 94% and ED & MIU (Type 1 & 3) is 94.7%. Current monthly performance for Type 1 & 3 as at the 22nd May is 95.2% Performance Rating Forecasted CoSRR 3 St George’s Healthcare NHS Trust
Section 5 : Exceptions and Actions Exceptions and ActionsThe following pages provide a summary of performance for the areas where the Trust is not meeting the required standards and the actions being taken to address the performance issues St George’s Healthcare NHS Trust
A&E performance Section 5: Exceptions and Actions Where MIU data are not yet available average daily figures have been used and 100% performance assumed.
Section 5: Exceptions and Actions 18 week Referral to Treatment (RTT) performance : Admitted pathway
Section 5: Exceptions and Actions 18 week Referral to Treatment (RTT) performance : 52 Week Waits
Section 5: Exceptions and Actions Cancer Performance- 62 Day
Section 6: Definitions and metrics TDA Accountability FrameworkThe following pages provide details of the metrics included in the TDA performance framework applicable to Acute Trusts.
Section 6: Definitions and metrics TDA Accountability FrameworkThe following pages provide details of the metrics included in the TDA performance framework applicable to Acute Trusts
Accident & Emergency: Week Ending 30th March 2014 All type A&E: 94.88%, up from 94.69% last week Type 1: 91.71%, up from 91.42% last week For week ending: 11/5/2014 London is ranked 2nd for All Types and 3rd for Type 1 performance. For QTD performance, London is ranked 2nd for All Types, and 4th for Type 1 (National ranking is based on the 4 commissioning regions)
MRSA Dashboard 2014-15 NB. Trajectories for 2014/15 are Zero for MRSA.
C.Difficile Dashboard 2014-15 Note – The 2014/15 weekly C.diff numbers are aggregated at provider level but not attributed to the Trusts, therefore to avoid giving an inaccurate position we have omitted any comparison to plan and associated RAG rating. * Data in the body of the report may not reflect more recent updates