Balanced Score Card Review of October 2015 Data

Balanced Scorecard

Finance Patient Access

Quality

&

Safety

Human Resource

Management

Finance

Finance Report – October 2015

Actual outturn YTD - October 2015

• Group budget €235.2m (2014 €228.3m)

• Group actual expenditure €236.5m (2014 €235.8m)

• Group actual deficit €1.3m ( 2014 : €7.5m) • Less: Additional bad debts provision re MOU €1.1m

• Loss of earnings –Radiation therapists €150k

• Waiting list penalties €170K

• Adjusted group surplus –YTD Oct €0m

• CUH Budget €220.8m (2014:€212.5m)

• CUH /SMOH actual expenditure €222.6m (2014 €219.6m)

• CUH /SMOH actual deficit €1.8m (2014 €7.1m)

• Adjusted deficit (excl bad debt/LOE)–ytd Oct €0.4m

• Mallow Budget €14.4m (2014:€13.9m)

• Mallow actual expenditure €13.9m (2014 €14.3m) • Mallow actual surplus €460k ( 2014 deficit €372k)

CUH Group –Surplus / (Deficit) percentage %

(October)

CUH Group Summary – Budget v Actual Expenditure YTD - October 2015

Pay €k Non-Pay €k Income €k Total

CUH -2,816 -7,615 8,579 -1,852

SMOH 0 -24 73 49

CUH-SMOH -2,816 -7,639 8,652 -1,805

Mallow -4 -504 968 460

Total -2,820 -8,143 9,620 -1,343

CUH Budget v Actual Pay YTD – October 2015

2015 Budget €k

2015 Actual €k

Variance €k

% Variance

2014 Actual €k

v 2014 Variance €k

Medical/Dental 53,447 54,344 -(897) -1.7% 52,797 -(1,547) Nursing/Midwifery 72,386 73,002 -(616) -.9% 72,862 -(140)

Paramedical 26,739 27,016 -(277) 1% 26,918 -(98)

Housekeeping 5,479 5,652 -(173) -3% 5,324 - (327)

Care Assistants 5,053 5,567 -(514) -10% 5,324 -(243)

Catering 3,303 3,382 -79 -2.4% 3,482 100

Portering 4,814 4,827 -13 -.3% 4,981 154

Administration 14,865 15,075 -210 -1.4% 14,757 -319

Other Staff 2,908 2,945 -37 -1.3% 2,978 33

Total 188,994 191,810 -2,816 -1.5% 189,424 -2,386

CUH Actual Non-pay Expenditure €k YTD 2015

CUH AGENCY COSTS €k 2013 – YTD 2015

CUH AGENCY WTE – YTD 2015

CUH Average Nursing & HCA Agency WTE’s per Week 2013-15

CUH Average Specials /Other Nursing & HCA Agency WTE’s per Week 2014-15

Patient Income 2013 – YTD 2015

Consultant Claims

Consultant claims at 30th October 2015

Consultants at 12th Nov

No of claims Value €k

HARTY, JAMES 121 573,471

MCSWEENEY, NIAMH 61 208,003

GILLIGAN, OONAGH 77 180,309

KEARNEY, PETER 69 177,116

O'BROIN, EOIN 56 168,571

O'SHEA, DERVILLE 49 167,750

TAYLOR, COLM 92 159,486

FULTON, GREG 34 158,960

O'HALLORAN, D. J. 34 142,658

MCFADDEN, EUGENE 36 138,026

HINCHION, JOHN 12 116,032

REIDY, DECLAN 35 110,067

MANNING, BRIAN 17 106,815

GUERIN, SHANE 12 105,999

POWER, DEREK 99 103,178

CARROLL, JENNIFER 31 98,292

HARNEDY, NORMA 8 96,991

SWEENEY, BRIAN 92 96,754

ANDREWS, EMMET J. 37 94,488

KELLY, LOUISE 30 92,118

PLANT ,BARRY 10 90,798

TOTAL 3,185,882

Directorate Value €k Prev

Value €k Current

Diagnostics 45 38

Medicine 3,411 3,020

Surgery 2,266 2,109

Women and Children CUH 477 488

Total-CUH Primary 6,200 5,655

Women & Children CUMH est

950 1,000

Total-CUH /CUMH Primary

7,150 6,655

CUH Debtor days –YTD 2015

Mallow Budget v Actual YTD October 2015

Budget € Actual € Variance € % Variance

Pay 12,631 12,635 -4 0.0%

Non Pay 3,604 4,108 -504 -14.0%

16,235 16,744 -509 -3.1%

Income -1,869 2,837 968 51.8%

Total 14,366 13,907 459 3.2%

Forecast

• Group Budget €283.0m (2014 €284.9m)

• Group projected expenditure €286.4m (€284.2m)

• Collection of EU Charges €0.7m

• Group Projected Deficit €2.6m ( surplus 0.7m)

• Less: Additional bad debts provision re MOU €2.2m

• Loss of earnings –Radiation therapists €0.4m

• Waiting list penalties €170k

• Add National service contracts €210k

• Adjusted group projected surplus €0.4m

• CUH Budget €265.8m (2014:€265.1m)

• CUH projected actual €268.7m (€265.3m)

• CUH projected Deficit €2.9m (€0.2m)

• Mallow Budget €17.2m (2014:€17.5m)

• Mallow Projected Actual €16.9m (€16.8m)

• Mallow Projected Surplus €0.3m (€0.7m)

Patient Access

CUH Weekly INMO Trolley Report

Week ending 13th November 2015

Ambulance Turnaround Times - October

ED – 6hr & 9hr Target – All Patients (January – October )

R

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

9hr PET

6hr Pet

Expon. (9hr PET)

Expon. (6hr Pet)

ED – 6hr & 9hr Target – Non Admitted Patients (January – October )

ED – 6hr & 9hr Target –Admitted Patients (January – October )

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15

9hr PET

6hr PET

Expon. (9hr PET)

Expon. (6hr PET)

Delayed Discharges - 2015 January - October (10th November)

Inpatient – Day case Waiting Lists

Inpatient & Daycase Breaches – 31st December 2015

Outpatient Waiting Lists

OPD Potential Breaches – 21st December 2105

Date Speciality planned in house Insourcing number remaining Balance To be Outsourced breaching Column1

21/12/2015 Cardiology 4 0

Diabetes Mellitus 0 155 155

Endocrinology 0 38 38

Gastro-Enterology 0 0

General Medicine 0 0

General Surgery 0 89 50 39

Gynaecology 0 850 850 ?Bon Secours Limerick 850

Neurosurgery 3 2 0

Ophthalmology 0 286 286

Paediatric Neurology 0 22 22 ? 0

Paediatrics 8 23 23 ? 0

Plastic Surgery 2 136 90 46

Respiratory Medicine 8 0

Rheumatology 7 5

Urology 0 0 11

Vascular Surgery 0 0

28/12/2015 Rheumatology 4 1 0

Scope Waiting List

Scopes Urgent – September G

Scopes Routine - September R

Medical ALOS (September Dashboard)

A

New Patients Treated with Radiation Oncology in Target - October

89%

11%

In Target Out of Target

Reasons for Treatment Delay - October

Personal Choice, 2, 33%

Medical Reasons, 2, 33%

Capacity, 1, 17%

Data Missing, 1, 17%

Other, 0, 0%

New Patients Treated within Target

2014 Vs 2015

January February March April May June July August September October November December

2014 89% 88% 91% 88% 90% 91% 86% 95% 93% 89% 81% 86%

2015 79% 84% 82% 82% 80% 95% 90% 88% 89%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Brachytherapy Activity January 2015 – October 2015

January February March April May June July August September October

Gynaecological 0 7 10 24 12 9 23 20 6 17

Prostate 0 7 7 5 8 6 4 10 7 4

0

5

10

15

20

25

30

Quality & Safety

Day Surgery Admission Rate (September Dashboard)

G

Surgery – Length of Stay (September Dashboard)

A

ALOS – Excluding LOS over 30 days (September Dashboard) A

Cancer KPI – Breast-Lung-Prostate –January – October

OPAT

Outpatient Parenteral Antimicrobial Therapy

– IV antibiotics/antifungals/antivirals given at home

• Reduces patients length of stay in hospital

• Avoids Admission for long period

• Reduces healthcare associated infection risk

• Patients can return to work

Bed Days Saved

Quality and Safety

Appointment of Clinical Director for Women and Children Directorate

Appointment of Lead for Clinical Audit

External Expert for Radiology Review identified

Improvement Programme on Complaints Management

Housekeeping Services Project Group – Principals agreed

Pilot project on risk assessment , risk escalation and risk register using module on Q Pulse (medium term plan is an electronic system)

Quality Improvement programme for Outpatient services

Interviews for post of Risk Manager, Quality Assurance Manager and Quality Improvement Manager

Patient Experience Report Jan – June 2015

Complaints by Directorate

Compliance with Timeframes

Compliments

Complaint Management Review Group

Lean mapping project June 2015

Pilot project November 2015 on improvements in the

Triage

administration support

pooling of investigative resources

data capture on process

recommendations for improvements

monitoring of recommendations

Risk Register

Risk Register update submitted 22nd October

11 on-going investigations

Three new risks escalated to Group CEO in November

Risk Assessment –Grade 3 Pressure Ulcer

Risk Assessment –Grade 4 Pressure Ulcer

Risk Assessment – Sexual Assault

HIQA Announced Visit Antimicrobial Stewardship Programme

Site visit on Tuesday 20th October 2015

Acknowledged good progress with Antimicrobial Stewardship Programme that ties in with the National Stewardship programme

Challenges

Medication Safety officer

Infection Control Nurse staffing levels

Clinical Pharmacist resources

Lack of surgical site surveillance

Laboratory surveillance of multi-drug resistant organisms not performed

Reducing Healthcare Acquired Infection (MRSA)

(September Dashboard)

R

Reducing Healthcare Acquired Infection- C diff (August Dashboard)

R

Antibiotic Consumption Rate (September Dashboard)

G

Human Resource Management

Sick Leave – October 2015

Staffing & Costs October 2015

EWTD Compliance (Jan – October)

Nursing - Starters/Leavers 2015

Capital Projects

Project Status MRI Unit Completed and operational

Paediatric Unit Phase 1 - build programme commenced in July

Phase 2 – submitted for capital funding

Mental Health Unit Completed and operational

Acute Medical Assessment Unit – Phase 3 &

Endoscopy Unit

Completed and operational

Radiation Oncology Unit Planning permission granted Enabling works to commence in November 2015

Cystic Fibrosis/ Respiratory Ward Completed

Education and Training Centre Statement of Need being developed

Blood Sciences Project Design Team appointed – request for managed service approved

Oncology Service Expansion of Day Unit – plan signed off – submitted for Philanthropic funding (ACT)

Refurbishment of Ward 2D – capital funding in place Medical Oncology Centre – developing Statement of Need

Ophthalmology Transfer – phase 2 Project group in place

Helipad Interim helipad in place - final solution being assessed by CAA.

Transitional Care Unit Completed

Key Issues

• Reopening of 31 inpatient beds

• Recognition of Budgetary performance

• Dependency on patient income

• 2016 Estimates

• Undergraduate Training costs - €6.5m per annum

• Management of Unscheduled Care

Implementation of Change Programme Initiatives

• Scheduled Care

Implementation of plan to meet waiting list targets –Hospital

Group approach to maximise capacity