Balanced Score CardReview of October 2015 Data

Balanced Scorecard

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

CUH Debtor days –YTD 2015

Mallow Budget v Actual YTD October 2015

Budget € Actual € Variance € % VariancePay 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 ReportWeek ending 13th November 2015

Ambulance Turnaround Times - October

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

R

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

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

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

Inpatient – Day case Waiting Lists

Inpatient & Daycase Breaches – 31st December 2015

Outpatient Waiting Lists

OPD Potential Breaches – 21st December 2105Date Speciality planned in house Insourcing number remaining Balance To be Outsourced breaching Column1

21/12/2015 Cardiology 4 0Diabetes Mellitus 0 155 155Endocrinology 0 38 38Gastro-Enterology 0 0General Medicine 0 0General Surgery 0 89 50 39Gynaecology 0 850 850 ?Bon Secours Limerick 850Neurosurgery 3 2 0Ophthalmology 0 286 286Paediatric Neurology 0 22 22 ? 0Paediatrics 8 23 23 ? 0Plastic Surgery 2 136 90 46Respiratory Medicine 8 0Rheumatology 7 5Urology 0 0 11Vascular 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

Reasons for Treatment Delay - October

New Patients Treated within Target2014 Vs 2015

Brachytherapy ActivityJanuary 2015 – October 2015

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 Triageadministration supportpooling of investigative resourcesdata capture on processrecommendations 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 NovemberRisk Assessment –Grade 3 Pressure UlcerRisk Assessment –Grade 4 Pressure UlcerRisk Assessment – Sexual Assault

HIQA Announced VisitAntimicrobial Stewardship Programme

Site visit on Tuesday 20th October 2015Acknowledged good progress with Antimicrobial Stewardship Programme that ties in with the National Stewardship programme 

ChallengesMedication Safety officerInfection Control Nurse staffing levels Clinical Pharmacist resourcesLack 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 ProjectsProject Status

MRI Unit Completed  and operational 

Paediatric Unit Phase 1  - build programme commenced in JulyPhase 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