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Integrated Performance Report
June 2020
1
Agenda item:
Date: June2020
Title:
Interim Integrated Performance Report – incorporating COVID 19 related performance
Prepared by:
Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director / Deputy Chief Executive Darryn Allcorn, Chief Nurse Angela Hibbard, Director of Finance, Performance and Facilities
Presented by:
Responsible Executive:
Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director / Deputy Chief Executive Darryn Allcorn, Chief Nurse Angela Hibbard, Director of Finance, Performance and Facilities
Summary:
To advise the Board of the Trust’s performance against key performance standards and targets; and progress on the implementation of the Trust Strategy and key supporting projects.
Actions required:
In the absence of a public Board of Directors’ meeting, this paper is circulated for information only
Status (*): Decision Approval Discussion Information
X
History:
This is a standing agenda item at each meeting of the Board of Directors.
Link to strategy/ Assurance framework:
This paper details the Trust’s performance in respect of key performance standards and targets. Achievement of these performance standards and targets is a key objective within the Trust’s Strategy.
Monitoring Information Please specify CQC standard numbers and tick other boxes as appropriate
Care Quality Commission Standards Outcomes NHS Improvement / England Finance Service Development Strategy Performance Management Local Delivery Plan Business Planning Assurance Framework Complaints Equality, diversity, human rights implications assessed Other (please specify)
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Integrated Performance Report
June 2020
Integrated Performance Report – May 2020 Position
Contents
Section Page
Executive Summary 3
COVID-19 Related - Activity & Flow 5 - 6
COVID-19 Related – Operational Performance 7
COVID-19 Related – Safety & Quality 8 - 10
COVID-19 Related – Our People 11 - 12
COVID-19 Related – Finance 13
Activity & Flow 15 – 16 & 23
Operational Performance 17 - 22
Quality & Safety 24 - 28
Our People, including Communications & Engagement 29 – 30
Finance 31 – 44
2
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3
Executive Summary
Integrated Performance Report
June 2020
Quality and safety: • Low numbers of COVID-19 patients during May
• PPE supplies are adequate for the demands
• No Serious Incidents as a result of COVID-19
COVID-19 related Non COVID-19 related
Operational performance: • COVID activity was in line with the trajectories produced for good compliance
with national guidelines – self-isolating, travel restrictions etc.
• The Trust was able to reduce the number of areas managing COVID patients
and cohort all positive patients, including ICU into a single area.
Our people: • COVID staff absence & self-isolation numbers have remained steady. Good
availability of staff and family testing has enabled people to return to work more
quickly.
• Strong H&WB support for staff and line managers remains a key focus. Staff
lounge/decompression area continues in Fern centre and has been superbly
supported by Project Wingman volunteers.
• As we move through new phases in the national response to COVID 19 guidance
and support has been produced to facilitate the safe return of staff to on site
working where working from home cannot be maintained.
Finance: Still delays in national sign off process for COVID capital. March approved now
waiting for April tobe reviewed by national team.
Some small items have been ordered at risk against BAU capital programme due to
lead times on deliver and need to support life savings/sight saving activity restarting
All revenue costs recovered through national ‘true-up’ scheme to achieve break even
Financial regime changing from month 5 and COVID response allocations will be
passed through to STPs rather than at Trust level.
Quality and safety: • The Trust HSMR has reduced from 118 to 112.55
• Detailed reviews of pressure ulcer data continues
• Healthcare Associated Infection rates all remain below the agreed targets set
• In comparison to March 2020 there has been an 8% increase in substantive
registered nurses
Operational performance:
• Operational performance was affected by COVID during May 2020.
COVID had a positive impact in reducing the numbers attending ED and
on the number of outpatient referrals received, however, capacity was
significantly reduced with a resulting negative impact on some
constitutional standards.
Our people: • Although turnover has increased slightly it remains at an historic low
• The gap between funded positions and staff in post continues to narrow, resulting in
an overall vacancy rate of 5.2% (161.1 FTE)
• Non-COVID employee relations activity is beginning to return to BAU levels and we
are continuing to review how we undertake this in a safe way and move to a “just and
learning culture” approach.
Finance: Month 2 overall break even position under national ‘true-up’ scheme with £1.6m of true
up income being received year to date
Adverse impact on variable income due to COVID impact on activity - sexual health
contract with Local Authority (not part of national block income)
Overspend on substantive pay being validated. Includes COVID costs on over time and
offset against reduced agency but needs further examination.
Capital programme being reprioritised to ensure coverage of COVID at risk items and to
ensure some flexibility if COVID estates reconfiguration capital not received.
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4 Integrated Performance Report
June 2020
Part 1 COVID 19 related
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Inpatient beds
May saw a continued reduction in the number of COVID positive
inpatients. There were less than 5 inpatients at any time, towards the end
of May this reduced to 2 patients.
Bed Occupancy
During May general and acute (G&A) bed occupancy started to increase
from that seen in April. G&A bed occupancy was 63.2%, on average.
The percentage of G&A beds occupied by COVID-19 patients in May
reduced to 1.2% from 6% in April, in line with the decreasing number of
COVID positive inpatients.
Trajectory
The Trust is working with Exeter University, NHS Improvement/England
(NHSI/E) and Devon STP to produce COVID-19 related demand
projections.
The Trusts surge capacity plan can accommodate the projected bed
requirement, this will be kept under review as events unfold with the
projections being updated as more data becomes available.
Actual COVID-19 activity has largely been in line with the NHSI projection
for good compliance (with government guidelines).
COVID-19 Inpatient Activity – Overview of inpatient activity in relation to caring for patients with COVID-19
5 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
14
0
5
10
15
20
25
30
35
40
Inp
atie
nt
be
ds
occ
up
ied
Number of confirmed COVID 19 patients occupying inpatient beds
Actual NHSI Projection (Good compliance)
Exeter Uni Devon Projection NHSI Projection (Poor compliance)
0
50
100
150
200
250
01
/04
/20
20
08
/04
/20
20
15
/04
/20
20
22
/04
/20
20
29
/04
/20
20
06
/05
/20
20
13
/05
/20
20
20
/05
/20
20
27
/05
/20
20
Be
ds
occ
up
ied
COVID / Non-COVID Bed occupancy
Occupied by Covid 19 patients Occupied by Non Covid 19 patients Unoccupied
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COVID patients in Critical care beds
The number of COVID-19 patients in critical care beds has been fairly
static throughout the month at 2.
Critical care surge capacity plans
The Trust has a detailed critical care surge capacity plan, which is
summarised in the left hand table.
The Trust cohorted all COVID positive patients in Tarka Ward during May,
with part of the ward being designated as COVID positive ICU. This
enabled the Trust to consolidate staffing resources into a single COVID
positive area and return the main ICU to caring for non-COVID patients.
Trajectory
The Exeter University projections remain relatively static and low which is
in line with actual activity.
Critical Care – Overview of critical care activity in relation to caring for patients with COVID-19
6 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
2
3
0
1
2
3
4
5
6
01
/04
/20
20
08
/04
/20
20
15
/04
/20
20
22
/04
/20
20
29
/04
/20
20
06
/05
/20
20
13
/05
/20
20
20
/05
/20
20
27
/05
/20
20
HD
U/I
TU b
ed
s o
ccu
pe
d
Number of confirmed COVID 19 patients occupying HDU/ITU beds
Actual Exeter Uni Devon projection
0
5
10
15
20
25
01
/04
/20
20
08
/04
/20
20
15
/04
/20
20
22
/04
/20
20
29
/04
/20
20
06
/05
/20
20
13
/05
/20
20
20
/05
/20
20
27
/05
/20
20
Critical care surge capacity plans vs current use
1. ICU & HDU 2. Recovery room 3. Anaesthetic room 4. Theatre Room Critical care beds in use
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Executive Lead: Pete Adey & Jill Canning
Swab testing capacity
The NDHT microbiology department has a testing capacity of 88 tests per
day and manage all inpatient testing. Fast track testing is available at NDHT
with a 45 minute turnaround as required. Additional test capacity at RD&E is
utilised as required.
The Testing SOP was approved at the end of April, this covers testing for
staff, key workers and patients including those in the community. This will be
updated as further national guidance is published.
The Trust has operated swab testing at a number of community sites and
provided a home testing service to elective inpatients who are shielding or
unable to attend a central location. Capacity within these services has
exceeded demand for swabbing.
Patient swab testing
Patient testing continued into May, during this time the Trust implemented
further testing after an inpatient stay of 7 days.
Staff swab testing
Staff testing has been available throughout April and May.
There was an increase in the volume of staff tested – on 23/24 April - as a
staff member, who was COVID positive with no visible symptoms, had been
working on an inpatient ward. Outside of this contact testing the volume of
staff tested has been at a steady level in April and reduced further in May.
Staff serology (antibody) testing
On the 25th May the Trust received a letter requiring it to commence a
serology (antibody) testing programme as soon as laboratory capacity was
available. The Trust developed an implementation plan to commence
serology testing during the first week of June.
COVID-19 Testing – Outline of COVID-19 patient testing activity and outcomes
7 Integrated Performance Report
June 2020
0
5
10
15
20
25
01
/04
/20
20
08
/04
/20
20
15
/04
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20
22
/04
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29
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20
06
/05
/20
20
13
/05
/20
20
20
/05
/20
20
27
/05
/20
20
NDHT daily patients tested vs positive
NDHT Patients tested NDHT Number of +ve inpatients (COVID Confirmed)
0
5
10
15
20
25
30
35
40
45
50
01
/04
/20
20
08
/04
/20
20
15
/04
/20
20
22
/04
/20
20
29
/04
/20
20
06
/05
/20
20
13
/05
/20
20
20
/05
/20
20
27
/05
/20
20
NDHT daily staff tested
NDHT Staff tested NDHT Staff tested positive
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Executive Lead: Darryn Allcorn
Quality and safety
8 Integrated Performance Report
June 2020
Patient deaths
The number of deaths reported has reduced in line with the number of inpatients
being treated for COVID in the Trust.
Patients recovered and discharged
This chart has reduced in line with the number of inpatients being treated for
COVID in the Trust.
Fit testing
The chart below shows the current running total of Fit testing across the Trust
there is a high testing rate compliance with our high risk areas where staff will
be exposed to aerosol generating procedures. As PPE stocks of masks are
now stable FIT testing is only being undertaken as required, as we have
adequate staff in priority and key areas tested.
Incidents and concerns raised
Although overall the number of incidents raised has reduced significantly, this
correlates with the reduced bed occupancy and the overall number of incidents
reported per a 1000 bed days, remains constant, the Safety huddle reviews
themes of COVID related incidents and there has been no increase in reported
harm. There have been no COVID related incidents that have met SI criteria.
0
1
2
3
4
01
/04
/20
20
05
/04
/20
20
09
/04
/20
20
13
/04
/20
20
17
/04
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/04
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25
/04
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29
/04
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03
/05
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07
/05
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20
11
/05
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15
/05
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20
19
/05
/20
20
23
/05
/20
20
27
/05
/20
20
31
/05
/20
20
Daily COVID 19 Patient deaths (past 24 hours)
Patient Deaths
0
1
2
3
4
5
6
7
8
Patients recovered and discharged (daily)
Patients recovered and discharged (daily)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
01
/04
/20
20
08
/04
/20
20
15
/04
/20
20
22
/04
/20
20
29
/04
/20
20
06
/05
/20
20
13
/05
/20
20
20
/05
/20
20
27
/05
/20
20
Fit Testing
Fit Testing % of Staff Fit Testing % of Priority Staff
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Executive Lead: Darryn Allcorn
Indirect impact of Covid 19
9 Integrated Performance Report
June 2020
NDDH patient deaths
This chart demonstrates that total hospital deaths are lower than average for
the past three years despite the number of covid deaths
Northern and Eastern population deaths
The chart shows an increased in the number of patient deaths in Devon from
20th March.
Regional death growth rates
The chart shows an increased in the number of patient deaths in the south
west region from 27th March. The green line demonstrates the increase in
deaths not attributed to covid.
Admission/attendance reductions
Dept/Specialty % change from this year to last year
A&E -28%
MIU -97%
Cancer 2ww referrals -79%
Stroke admissions -54%
Cardiology admissions -44%
Paediatric admissions 13%
-15-10
-505
1015202530
NDDH Death Tracker, 7-Day Running Totals
Average last 3 yrs 2020 Total
Excess (2020 vs baseline) 2020 COVID
-400
-200
0
200
400
600
800
1,000
03-Jan-20 03-Feb-20 03-Mar-20 03-Apr-20 03-May-20 03-Jun-20
No
. of
regi
ste
red
de
ath
s in
we
ek
Week
ONS Registered total Regional deaths growth 2019-2020
Movement TotalRegionalDeaths
Variancedue toCovid
Movement due tononCovidfactors
0
10
20
30
40
50
60
70
80
90
03/01/2020 03/02/2020 03/03/2020 03/04/2020 03/05/2020 03/06/2020
ONS All-Cause Population Deaths (Early View by Registration)
Northern Eastern
Northern (Non-COVID) Eastern (non-COVID)
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PPE
The Trust monitors a Dashboard to ensure adequate supplies of all PPE. The number of days of stock is however subject to change dependent upon fluctuations in
usage. This can be impact by the number of patients and or the number of staff working, along with any changes in PPE guidance. Daily usage rates are monitored
and adjusted as required through the daily PPE/Logistics sub-group.
The Trust has adequate stock of all PPE items and assurance of supply. There are nuances to the stock holding at individual product level. For example, there may be
14 days of surgical gloves at aggregate level but a lower level of stock for one particular size. This is monitored on a daily basis with mitigating actions being
implemented.
The Trust is working closely in collaboration with other local acute Trusts to make best use of the PPE supplies available locally and will support the system in mutual
aid.
The Trust issued a Safety Alert recalls 4 batches of masks across the Trust due to concerns raised nationally that these had not be certified as latex free. There have
been no incidents reported within the Trust. The impact of this recall on stocks will be explored the week commencing 22 June.
Oxygen / ventilators
The Trust has adequate ventilators and supplies to support our surge plan if required, Surge plus will require support from the national stocks. Oxygen supply is a
issue that requires close monitoring there is daily oxygen usage tool managed monitored and a Standard operating procedure is in place to monitor and manage
oxygen supplies to all wards and clinical areas.
PPE, Oxygen, Ventilators – Exception reporting on issues and proposed mitigations
10 Integrated Performance Report
June 2020 Executive Lead: Darryn Allcorn
0
20
40
60
80
100
120
140
160
23
/03
/20
20
25
/03
/20
20
27
/03
/20
20
29
/03
/20
20
31
/03
/20
20
02
/04
/20
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/04
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/04
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/04
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02
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16
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24
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26
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20
28
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30
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20
Day
s Su
pp
ly
PPE Days Supply
FFP3 Surgical Mask Gloves (standard) Gowns / Suits Glasses
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Executive Lead: Hannah Foster
Staff absence and self isolation
• Covid 19 related sickness also contains self isolating figures until
07/04/2020 when they were split out.
Staff absence and self isolation
• Numbers are relatively stable with only small fluctuations. Availability and
access to staff and family testing has been significantly increased and has
contributed to effective management.
• Absence hub still dealing with large volume of calls, both Covid & non-
Covid being supported
• People Inform cell continues to perform call-back welfare calls.
• Risk assessments for self-isolating and social distancing/shielding
continue to be performed by Medical staff.
Staff wellbeing
• H&WB support for staff and line managers now at a mature state. Staff
lounge/decompression area continues in Fern centre. Shortly to be
supported by Project Wingman volunteers.
• Regular communication of key messages and sources of support
available.
• We have continued to work with DPT colleagues to support psychological
welfare.
Staff Equality, Diversity & Inclusion
• NHSE and FOM Risk Reduction programme recommendations reviewed
to ensure that staff considered to be most at risk are fully supported.
Open letter sent to BAME staff by Chief Exec.
Workforce – Incorporate description of the slide here
11 Integrated Performance Report
June 2020
0
50
100
150
200
250
300
350
400
450
23
/03
/20
20
30
/03
/20
20
06
/04
/20
20
13
/04
/20
20
20
/04
/20
20
27
/04
/20
20
04
/05
/20
20
11
/05
/20
20
18
/05
/20
20
25
/05
/20
20
Staff sickness and self isolating
General Sickness Covid 19 related sickness Self Isolating (not able to work)
0
50
100
150
200
250
300
Nu
mb
er
of
staf
f
COVID 19 related sickness and self isolating (not able to work) by staff category
Clinical Services PRF Scientific tech Admin and clerical
Allied Health Professionals Estates and ancillary Healthcare scientists
Medical and dental Nursing and midwifery Students
0
50
100
150
200
250
23
/03
/20
20
30
/03
/20
20
06
/04
/20
20
13
/04
/20
20
20
/04
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27
/04
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20
04
/05
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11
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25
/05
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20
Covid 19 related sickness
Covid 19 related sickness
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Executive Lead: Hannah Foster
Workforce – Incorporate description of the slide here
12 Integrated Performance Report
June 2020
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NDDH South Molton
May 2020 - RN Nursing Fill Rate %
RNDay
RNNight
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NDDH South Molton
May 2020 - HCA Nursing Fill Rate %
HCADay
HCANight
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Executive Lead: Angela Hibbard
COVID 19 related costs
13 Integrated Performance Report
June 2020
Revenue and Income
The Trust incurred £2,297k of revenue costs (£1,314k prior month) responding to
the Covid-19 pandemic.
In a change to reporting in 2020/21 lost income from private patients, overseas
visitors and car parking etc. are recoverable through a retrospective adjustment
against the baseline national top up rather than through direct claims against the
national Covid-19 funding.
Returns and supporting information has been provided through the monthly
reporting process to NHSEI and is reflected as additional income in the year to
date breakeven position above.
2020/21 Revenue costs include all committed non-pay costs and pay costs to the
31st May 2020 with ‘live capture’ of information throughout the current month.
2020/21 approvals continue to be updated monthly as advised by NHSEI.
NHSEI have approved in full the month 1 expenditure through the true-up
process.
Capital
£545k of capital has been incurred (£391k prior month) through Covid command
decisions in accordance with the Scheme of Delegation with a further £790k of
commitments recorded at 15 June 2020.
NHSEI have confirmed approval in full of £123k claimed in March 2020 and PDC
is being issued.
The Revenue, Income and Capital positions are being reported to the Director of
Finance with regular submissions being made to NHSEI.
Total costs Incurred to
31 May 2020
Confirmed
as approved
YTD
20/21
Committed
£000 £000 £000
Revenue costs 2,297 1,314
Capital costs 545 123 1,712
Total 2,842 1,712
Further analysis of revenue costs
incurred to May 2020
Revenue
costs
incurred to
31 May 2020
£000
Infection prevention and control training 2
Internal and external communication costs 5
Expanding NHS workforce -
medical/nursing/other workforce 96
Sick pay at full pay (all staff) 671
COVID-19 virus testing (NHS laboratories) 174
Remote management of patients 21
Direct Provision of Isolation Pod 5
Plans to release bed capacity 187
Increase ITU capacity (incl. Increase
hospital assisted respiratory support
capacity, particularly mechanical
68
Segregation of patient pathways 26
Existing workforce additional shifts 169
Decontamination 73
Backfil l for higher sickness absence 395
Remote working for non-patient activities 115
National procurement areas 162
Other actual 128
Total 2,297
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14 Integrated Performance Report
June 2020
Part 2 Non COVID 19 related
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Referrals: Referrals in May continued to be significantly lower than in previous months including April and over 75% lower than May 2019.
Outpatient attendances: New and follow up outpatient attendances increased slightly in May as clinical teams moved forward with non-face to face appointments.
Outpatient waiting list: The follow up outpatient waiting list reduced by 723 patients in May and the new outpatient waiting list by 168 as clinical teams introduced
non-face to face appointments and referrals continued to reduce..
Outpatient attendance by type: Both telephone and video appointments increased in May with in excess of 7700 telephone appointments and 300 video
consultations – considerable increases over the non-face to face activity in April. The Trust continues to promote the use of this provision within the recovery and
redesign plans and specialities continue to engage with the delivery method. The Trust is actively engaged in the restoration and long term redesign CCG Devon wide
meetings where this issue is being considered.
Elective activity- Referrals and Outpatients
15 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
0
2000
4000
6000
8000
10000
Fa
ce to F
ace
Te
lephone
Vid
eo
Fa
ce to F
ace
Te
lephone
Vid
eo
April May
Outpatient Attendances by Type and Media
New Follow Up
0
50
100
150
200
250
300
350
April May
Video data expanded
New Follow Up
0
2000
4000
6000
8000
10000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Referrals from All Sources
2018/19 2019/20 2020/21
0
2000
4000
6000
8000
10000
12000
14000
16000New and Follow Up Outpatient Attendances
New Attendances Follow up Attendances
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
55,000New and Follow Up Outpatient Waiting List
New Outpatient Waiting List Follow Up Outpatient Waiting List
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Elective activity : In May overall elective activity increased from the previous
month but remains significantly lower than the same period last year. Despite
activity increasing the incomplete waiting list increased in month, whilst above the
19/20 figure the list size remains lower than 18/19.
RTT performance : RTT performance further deteriorated in May 56.7% which is
below the target of 79%. The trajectory for incomplete pathways was met at
11438 against the trajectory of 12156.
Longer waiting patients, including approach to managing harm : The number
of patients waiting over 40 weeks increased further in May as a result of standing
down non-urgent elective surgery. Clinical teams continue to undertake risk
stratification of individual patients to ensure that cancer and time critical
procedures can continue to be offered to patients.
Elective activity- Inpatient and Daycase
16 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Elective Inpatient and Daycase Activity
2019/20 Daycase 2019/20 Inpatient 2020/21 Daycase 2020/21 Inpatient
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Incomplete Waiting List (Inpatient and Daycase Combined)
18/19 Actual 19/20 Actual 20/21 Actual
0%
20%
40%
60%
80%
100%
RTT 18 Week Performance
18 Week Performance (%) Target
020040060080010001200
0
3000
6000
9000
12000
15000
Vo
lum
e o
f P
ati
en
ts W
ait
ing
> 4
0
Weeks
Vo
lum
e o
f In
co
mp
lete
Path
ways
Incomplete Pathways and Longer Waiting Patients
Volume of Incomplete Pathways
Incomplete Pathway Trajectory
Volume of Patients Waiting >40 Weeks
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Integrated Performance Report
June 2020
17
Elective activity- Long Waiting Patients
Executive Lead: Pete Adey & Jill Canning
COVID-19 has had a significant, detrimental, impact on the number of long
waiting patients.
There were a total of 131 patients waiting over 52 weeks in May as a direct
result of the reduction in elective activity.
The waiting list for patients waiting over 40 weeks rose to 977 in May. The
specialities with the greatest number of patients waiting over 40 weeks are
Elective Orthopaedics, Ophthalmology and Urology. The Trust has submitted an
application for the purchase of an additional Ophthalmic microscope which is
progressing through the national capital funding route. Plans for the other
specialities are currently in development.
The Trust is actively involved in the on-going STP discussions as to how best to
increase capacity within Elective Orthopaedics and Urology and ensuring equity
of access for all patients.
0
10
20
30
40
50
60
70
80
90
100
Dec
-18
Jan
-19
Feb
-19
Mar
-19
Ap
r-1
9
May
-19
Jun
-19
Jul-
19
Au
g-1
9
Sep
-19
Oct
-19
No
v-1
9
Dec
-19
Jan
-20
Feb
-20
Mar
-20
Ap
r-2
0
May
-20
52+ Weeks Waited Trajectory vs. Actual
Actual Trajectory
Specialty Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20
> 4
0 w
eeks
T & O 58 71 68 65 68 76 51 53 74 74 83 127 215 315
General Surgery 10 4 4 6 7 2 3 6 2 1 5 5 16 23
Dermatology 1 1 4 3 4 2 3 9 16
Gynaecology 5 5 11 9 5 7 7 7 5 5 2 8 24 38
Neurology 16 7 4 6 7 5 4 2 2 4 7 16 22
Colorectal 3 3 3 2 1 2 2 1 2 8
Cardiology 17 11 8 12 8 8 10 9 10 11 12 15 24 32
Ophthalmology 2 5 10 25 37 55 35 45 49 39 38 88 228 381
Other 8 25 42 68
Upper GI 5 4 9 12
Urology 8 7 7 13 13 12 11 12 16 15 12 22 40 62
Grand Total 120 113 112 137 148 167 121 139 159 153 173 305 625 977
> 5
2 w
eeks
T & O 3 4 6 5 4 2 3 7 5 9 3 3 10 56
Neurology 1 1 2
Cardiology 1 6 9
Ophthalmology 1 11 34
Other 11 23
Urology 2 2 1 2 7
Grand Total 3 4 6 5 4 4 3 7 5 9 5 7 41 131
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Integrated Performance Report
June 2020
18
Non-elective activity
Executive Lead: Pete Adey & Jill Canning
Emergency activity :
The number of emergency admissions, whilst still considerably lower than in
previous financial years, increased during May 2020 by some 300 admissions
from April back to a similar level of activity to that seen in March.
The Trust met the target for surgery within 48 hours post fractured neck of
femur.
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Emergency Inpatient Activity based on Date of Admission
2018/19
2019/20
2020/21
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Jun
-19
Jul-
19
Au
g-1
9
Sep
-19
Oct
-19
No
v-1
9
De
c-1
9
Jan
-20
Feb
-20
Mar
-20
Ap
r-2
0
May
-20
Elective and Emergency Activity Combined based on date of admission - excludes Maternity
Emergency
Elective
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Ap
rM
ay Jun
Jul
Au
gSe
pO
ctN
ov
De
cJa
nFe
bM
arA
pr
May Jun
Jul
Au
gSe
pO
ctN
ov
De
cJa
nFe
bM
ar
2019/20 2020/21
Surgery within 36hrs - Fractured Neck of Femur
36hrs 48hrs Target
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Executive Lead: Pete Adey & Jill Canning
Overall emergency admissions increased from the previous month, this was particularly visible in emergency admissions when on a different speciality waiting list –
with the numbers exceeding those seen in the previous 3 months. There was a slight increase in the emergency admissions when on the same speciality waiting list,
however this has not yet reached previous levels.
Analysis of those emergency patients admitted whilst on a waiting list for a different speciality shows that the biggest cohort of patients are admitted under general
medicine which would infer that these patients have multiple health problems.
Further analysis shows that the speciality with the greatest number of patients being admitted as an emergency whilst on the same speciality waiting list is
gynaecology – in May this was 21 of the 36 patients. Further analysis is being undertaken by the gynaecology team. Historically general surgery has always had a
number of patients admitted as emergencies whilst on a general surgical waiting list however, the numbers have reduced considerably since January 2020.
Emergency Department – key metrics relating to activity & performance in urgent & emergency care services
19 Integrated Performance Report
June 2020
550 557 543
525
568
600
555 566
478
415
352
489
0
100
200
300
400
500
600
700
Emergency Admissions - Different Specialty to RTT WL Specialty
43
62 60
65 68
85
56
62
57
53
29
36
0
10
20
30
40
50
60
70
80
90
Emergency Admissions - Same Specialty to RTT WL Specialty
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Executive Lead: Pete Adey & Jill Canning
• There were a total of 3030 all type ED attendances during May an increase of
601 from that seen in April 2020, back to a level seen in February pre-
COVID.
• Type 3 activity ceased as a direct impact of MIU services at Bideford and
Ilfracombe closing in March to allow for staff redeployment to the main ED.
• The Trust achieved 93.0% 4 hour flow performance in May.
• Ambulance handovers in excess of 30 minutes continued to be below the
10% target in May.
• There were 0 reportable handovers in excess of 60 minutes.
The ED department continues to refine its processes, and layout, to support the
separation of COVID and non-COVID patients, funding has been requested from
the national capital allocation to provide additional space to enable long term
solutions to be reached.
The Trust is engaged in system wide meetings regarding the future configuration
of urgent and emergency care provision in the North Devon locality.
Emergency Department – key metrics relating to activity & performance in urgent & emergency care services
20 Integrated Performance Report
June 2020
0
1
2
3
0
20
40
60
80
100
120
140
160
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
12 H
ou
r Tro
lley B
reaches
(Vo
lum
e)
Att
en
dan
ces (
Vo
lum
e)
May - Trust Daily Attendance Profile
Type 1 Type 3 12hr Trolley Breaches
75%
80%
85%
90%
95%
100%
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
4 Hour Wait Performance
Trust Trust Trajectory Target
0
2
4
6
8
10
12
14
16
0
20
40
60
80
100
120
140
160
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
60 M
in+
Han
do
vers
(Vo
lum
e)
Am
bu
lan
ce H
an
do
vers
(V
olu
me)
Ambulance Handovers Delayed >30 mins
>30 Min Handover Target >60 Min Handover
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Cancer 62 Day – Proportion of patients treated within 62 days following referral by a GP for suspected cancer
21 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
• In May 2020 2ww referrals continued to be significantly lower in comparison
to May 2019 at 48%.
• The Trust saw 95.22% of 2ww referrals in May within the 14 day target,
exceeding the national standard of 95%.
• May 62 day performance was below the trajectory of 86% at 79.7% with
validation on-going. Impacted by COVID, although where possible cancer
treatment was initiated.
Cancer - 14,31 & 62 Day Wait
Performance(%) and Number of Breaches Target
2018/19 2019/20 2020/21
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
14
Da
y
All Urgent (%) 93%
74.50% 68.40% 65.30% 68.60% 66.80% 72.40% 86.40% 89.90% 95.6% 94.17% 96.06% 93.76% 94.62% 94.60% 96.66% 95.37% 90.02% 87.90% 90.21% 93.30% 94.80% 95.60% 95.22%
All Urgent (N) 162 137 189 181 221 171 77 59 25 30 24 33 36 34 19 32 55 67 52 46 28 8 14
Symptomatic Breast (%) 93%
89.30% 94.10% 90% 93.10% 61.50% 59.30% 71.40% 93.10% 96.3% 88.90% 96.30% 82.05% 94.74% 94.44% 95.45% 94.21% 80% 50% 71.10% 93.50% 96.15% 75.00% 100.00
%
Symptomatic Breast (N) 3 2 1 2 10 11 4 2 1 4 1 7 2 1 1 2 7 7 11 2 1 2 0
31
Da
y
All Decision To Treat (%) 96%
98.30% 97.40% 95% 96.60% 96.60% 97.60% 93.30% 96.10% 97.3% 94.40% 95.60% 96.40% 96.80% 95.23% 94.48% 95.40% 98.90% 98% 98% 100% 100% 100.00% 100.00
%
All Decision To Treat (N) 2 2 4 3 4 2 7 3 2 6 4 3 4 5 7 5 1 1 1 0 0 0 0
Subsequent - Surgery (%) 94%
100% 100% 87.50% 100% 100% 75% 92.30% 100% 93.9% 84.60% 94.40% 90.90% 88.20% 88.66% 96.01% 88.88% 92.30% 100% 93.30% 100% 92.30% 100.00% 100.00
%
Subsequent – Surgery (N) 0 0 0 0 0 2 1 0 1 2 1 1 2 3 2 3 1 0 1 0 1 0 0
Subsequent - Anti-Cancer Drug %
98%
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Subsequent - Anti-Cancer Drug 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62
Da
y
All Screening Service (%) 90%
100% 71% 50% 100% 80% 100% 100% N/A 100% 100% 60% N/A% 100% N/A N/A N/A 100% 100% 100% 80% 0% N/A N/A
All Screening Service (N) 0 1 1 0 0.5 0 0 N/A 0 0 1.5 N/A 0 N/A N/A N/A 0 0 0 0.5 0.5 N/A N/A
Consultant upgrade (%) 90%
92.20% 83.10% 84.20% 69.60% 87.70% 80.20% 83.30% 82% 88.4% 79.40% 68.30% 85.70% 94.11% 87.10% 74.15% 78.02% 73.20% 65.60% 89.50% 91% 87.30% 93.30% 81.60%
Consultant upgrade (N) 3 5.5 4.5 12 7 9 7 4.5 4 7.5 9.5 4 2.5 5 11.5 9 8.5 11.5 4.5 3 5.5 5.5 4.5
28
da
y 28 Ref to diagnosis (%)
N/A 75.10 63.20 64.30 66.50 70.40 71.80 66.40 75.1 72.00 70.20 70.00 77.00 71.00 77.00 74.00 78.00 75.00 75.00 73.00 82.00 74.00 65.00 74.00
28 day Ref to diagnosis (N) N/A N/A N/A N/A N/A N/A N/A N/A 157.00 168.00 157.00 126.00 172.00 117.00 130.00 142.00 132.00 86.00 163.00 88.00 135.00 78.00 71.00
60%
65%
70%
75%
80%
85%
90%
95%
100%
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
2019/20 2020/21
Urgent GP Referral Cancer 62 Day Wait - All Cancers
62 Day Wait - All Cancer Performance (%) Target Trust Trajectory
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• Diagnostic performance has been significantly affected by COVID-19, as a
result of this only 42.4% of patients waited less than 6 weeks for a
diagnostic test in May, this was a slight improvement on the April position of
41.4%.
• Capacity within diagnostic areas is impacted by the need to maintain social
distancing (waiting & recovery areas) and the level of cleaning required
between patients. The Trust is working hard to make additional waiting &
recovery space available, including repurposing other areas and the use of
temporary facilities.
• In May the Trust had staffed mobile CT and MRI scanners on site to provide
additional capacity.
• Diagnostic services have continued to be provided for all 2ww and urgent
referrals since the outbreak of COVID in line with guidance.
• Patient COVID testing is in place for those procedures that require it to be
undertaken pre-procedure.
• Additional capacity within CT, ECHO and endoscopy provided via the
independent sector, weekend working and visiting teams was stood down
from April due to COVID, the teams are working with the providers to make
this available as soon as travel & accommodation restrictions are lifted.
• Audiology ceased assessment due to COVID, activity is planned to
recommence towards the end of June.
• The Trust is actively involved in STP work streams that are considering the
opportunities available to increase diagnostic and screening capacity.
Diagnostics - volumes of patients waiting longer than 6 weeks for one of fifteen key diagnostics tests
22 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
0%
20%
40%
60%
80%
100%
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
6 Week Wait Referral to Key Diagnostic Test
6 Week Diagnostic Performance (%) Target
Performance inc. Non-Obstetric Ultrasound % Trust Trajectory
0
500
1000
1500
2000
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
6 Week Diagnostic Breaches by Specialty Group
Endoscopy Imaging Physiological Measurement
Area Diagnostics by Specialty Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20
Imaging
Magnetic Resonance Imaging 91.7% 74.1% 76.3% 83.9% 90.1% 96.2% 98.6% 99.8% 98.9% 96.7% 99.7% 97.0% 78.4% 68.6%
Computed Tomography 64.3% 66.1% 79.3% 80.8% 79.1% 69.3% 65.7% 71.1% 64.1% 71.7% 90.8% 73.4% 50.6% 52.4%
Non-obstetric ultrasound 97.0% 99.1% 97.1% 98.9% 99.6% 99.5% 99.0% 99.6% 100.0% 99.7% 99.9% 89.1% 27.8% 38.0%
Barium Enema - -
DEXA Scan 96.3% 96.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.1% 35.1% 42.4%
Physiological Measurement
Audiology - Audiology Assessments 90.6% 93.7% 97.7% 100.0% 99.6% 99.5% 99.2% 100.0% 99.5% 100.0% 99.6% 98.2% 27.9% 1.0%
Cardiology - echocardiography 81.5% 53.5% 73.1% 75.1% 79.8% 92.0% 83.1% 75.4% 86.9% 90.9% 95.3% 94.8% 67.5% 49.2%
Cardiology - electrophysiology - -
Neurophysiology - peripheral
neurophysiology 94.6% 89.2% 91.5% 90.5% 100.0% 93.1% 97.2% 92.6% 95.5% 97.5% 98.4% 96.7% 24.7% 3.4%
Respiratory physiology - sleep studies 83.3% 75.0% 67.9% 93.8% 96.7% 90.0% 83.3% 100.0% 90.9% 95.5% 94.4% 97.5% 26.1% 88.9%
Urodynamics - pressures & flows 53.5% 56.9% 35.3% 48.1% 33.3% 31.8% 44.3% 45.8% 41.9% 39.7% 48.1% 48.1% 18.3% 83.3%
Endoscopy
Colonoscopy 80.2% 87.6% 88.2% 97.5% 100.0% 98.4% 97.4% 100.0% 96.8% 98.1% 98.9% 98.9% 55.3% 39.7%
Flexi sigmoidoscopy 75.4% 81.2% 81.4% 95.8% 97.3% 95.6% 97.0% 98.2% 100.0% 95.3% 100.0% 100.0% 57.4% 40.4%
Cystoscopy 74.6% 72.1% 70.5% 75.0% 80.9% 74.7% 90.2% 94.6% 94.5% 100.0% 94.3% 94.3% 49.1% 54.9%
Gastroscopy 83.1% 83.8% 79.0% 95.7% 97.1% 97.3% 97.8% 100.0% 100.0% 100.0% 99.2% 98.3% 47.9% 38.4%
Total 84.1% 80.7% 83.7% 88.2% 90.4% 91.2% 90.4% 89.8% 90.3% 92.4% 96.7% 91.6% 41.4% 42.4%
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The Trust continues to perform well against the DTOC standards – with a
further reduction in the number of acute delayed transfers of care during May
at 0.7%. There were no delayed days within the Community in April or May.
The Health & Social Care Team continue to be engaged in the daily forum
meetings, actively managing discharges and supporting patients to return to
their main residence, access care packages and placements.
Delayed Transfer of Care
23 Integrated Performance Report
June 2020 Executive Lead: Pete Adey & Jill Canning
0
25
50
75
100
125
150
175
200
225
250
Ap
r
May Jun
Jul
Au
g
Sep
Oct
No
v
Dec Jan
Feb
Mar
Ap
r
May Jun
Jul
Au
g
Sep
Oct
No
v
Dec Jan
Feb
Mar
2019/20 2020/21
DTOC Total Delayed Days Acute
NHS Social Services Both
0
25
50
75
100
125
150
175
Ap
r
May Jun
Jul
Au
g
Sep
Oct
No
v
Dec Jan
Feb
Mar
Ap
r
May Jun
Jul
Au
g
Sep
Oct
No
v
Dec Jan
Feb
Mar
2019/20 2020/21
DTOC Total Delayed Days Community
NHS Social Services Both
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
5.0%
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
2019/20 2020/21
Percentage DTOC to Available Beds
% DTOC to Available Beds Target
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Executive Lead: Darryn Allcorn
Mortality Rates – SHMI & HSMR – Rate of mortality adjusted for case mix and patient demographics
24 Integrated Performance Report
June 2020
The Mortality Review Group met virtually on the 16 June 2020 to review the
current position.
The HSMR is no longer affected by un-coded spells and the coding team are
now reviewing real-time discharges/death. The HSMR has fallen from 118 a few
months ago to 112.55 (100 is average/good).
As previously escalated to the Safety and Risk Committee there remains
concerns regarding Palliative Care Coding. Lower palliative care input to our
patients compared to other trusts appears to be a significant factor in our higher
HSMR (If we removed this cohort our HSMR would drop to 98.19). There are a
number of reasons which contribute to this all of which are continuing to be
explored in more detail.
60708090
100110120130140
Ap
r
Jun
Au
g
Oct
De
c
Feb
Ap
r
Jun
Au
g
Oct
De
c
Feb
Ap
r
Jun
Au
g
Oct
De
c
Feb
2017/18 2018/19 2019/20
Hospital-level Mortality Indicator (SHMI) - Rolling 12 months
Position Lower Limit Upper Limit
60708090
100110120130140
Ap
r
Jun
Au
g
Oct
De
c
Feb
Ap
r
Jun
Au
g
Oct
De
c
Feb
Ap
r
Jun
Au
g
Oct
De
c
Feb
2017/18 2018/19 2019/20
Hospital-level Mortality Indicator (SHMI) Rolling 3 months
SHMI Lower Limit Upper Limit
60708090
100110120130140
Ap
r-1
7
Jun
-17
Au
g-1
7
Oct
-17
De
c-1
7
Feb
-18
Ap
r-1
8
Jun
-18
Au
g-1
8
Oct
-18
De
c-1
8
Feb
-19
Ap
r-1
9
Jun
-19
Au
g-1
9
Oct
-19
De
c-1
9
Feb
-20
2017/18 2018/19 2019/20
Mortality Indicator (SHMI) Rolling 3 months - Weekday Admissions
SHMI Lower Limit Upper Limit
6080
100120140160180200220240
Ap
r
Jun
Au
g
Oct
De
c
Feb
Ap
r
Jun
Au
g
Oct
De
c
Feb
Ap
r
Jun
Au
g
Oct
De
c
Feb
2017/18 2018/19 2019/20
Mortality Indicator (SHMI) Rolling 3 months - Weekend Admissions
SHMI Upper Limit
60
80
100
120
140
160
Ap
r-1
7
Jun
-17
Au
g-1
7
Oct
-17
De
c-1
7
Feb
-18
Ap
r-1
8
Jun
-18
Au
g-1
8
Oct
-18
De
c-1
8
Feb
-19
Ap
r-1
9
Jun
-19
Au
g-1
9
Oct
-19
De
c-1
9
Feb
-20
2017/18 2018/19 2019/20
HSMR (12 Month Rolling)
HSMR Lower Limit Upper Limit
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ACUTE – • The number of category one pressure ulcers reported in May 2020 has remained static and continues to remain lower than the category 2 ulcers reported. • There has been an increase in the number of category 2 pressure ulcers reported in May 2020. • Three medical device related pressure ulcers category 2 have been reported. • There have been a cluster of three pressure damage incidents DTI on a Medical Ward, these have being reviewed and Tissue Viability are undertaking some rapid insitu support
for the team to ensure rapid learning. • There have been two category 3 pressure ulcers reported, neither of which have required a concise investigation as initial reviews by the tissue viability teams indicated
appropriate care plans and care were in place. • Reported zero category 4 pressure ulcers. • COMMUNITY – • There were no category four pressure ulcers reported. • The number of category three pressure ulcers reported during May decreased Of the 7 reported none have been escalated for concise investigation. Four of the patients who
developed category 3 have passed away. All had appropriate care plans in place and/or concordance was a significant factor and so have not been escalated for investigation. • There was one category 4 pressure ulcer reported. This developed in a patient who was also developing suspected deep tissue injuries who was on an end of life pathway. All
care was appropriate. A review of community pressure ulcers has taken place to explore the perceived increase, the Trust wide pressure Ulcer Action Plan was reviewed alongside this. The action plan remains appropriate however it was agreed to add a ‘Back to Basics’ approach to refocus the holistic approach to management following minor changes to ways of working due to COVID-19.
Pressure Ulcers – Rate of pressure ulceration experienced whilst in Trust care
Integrated Performance Report
June 2020 25 Executive Lead: Darryn Allcorn
0
2
4
6
8
10
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Rate of Grade 1- 4 pressure Sores /1000 bed days
Position Target
0
0.2
0.4
0.6
0.8
1
1.2
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Rate of Grade 3- 4 pressure Sores /1000 bed days
Position Target
0
0.10.2
0.3
0.4
0.5
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Community Nursing and Population: Newly Identified Pressure Ulcers - Grade 1 - 4
Position
0
0.020.04
0.06
0.08
0.1
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Community Nursing and population: Newly Identified Pressure Ulcers - Grade 3 - 4
Position
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There has been one case of Clostridium Difficile identified in the Trust in May 2020, this under investigation in order identify any contributory factors and learning to be
shared.
There have been no MRSA or MSSA cases identified during May.
E-coli bacteraemia cases have remained within normal variation for the past 12 months, with only once case noted for May, which is under review.
Healthcare Associated Infection –Volume of patients with Trust apportioned laboratory confirmed infection
26 Integrated Performance Report
June 2020 Executive Lead: Darryn Allcorn
0
1
2
3
4
5
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
2019/20 2020/21
Clostridium Difficile Cases
Hospital Onset Community Onset Target
0
1
2
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
2019/20 2020/21
MRSA Cases
Actual Target
0
1
2
3
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
2019/20 2020/21
MSSA Cases
Actual Target
0
1
2
3
4
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
2019/20 2020/21
E-coli Bacteraemias Cases
Actual Target
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Patients being admitted directly to the Stroke Unit within four hours; performance against this standard remains well below the target of 90%.
Stroke Performance – Quality of care metrics for patients admitted following a stroke
27 Integrated Performance Report
June 2020 Executive Lead: Darryn Allcorn
30%
40%
50%
60%
70%
80%
90%
100%
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Proportion of patients admitted following a Stroke spending 90% or more of their stay on the Stroke unit
Validated Position Target
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Discharge Destination to Home (%)
Discharge Destination to Home % National Position
0
20
40
60
80
100
120
140
160
180
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20 2020/21
Average Thrombolysis Times (minutes) - Awaiting NDHT Data
Trust Door to Needle Trust Call to Needle
National Door to Needle National Call to Needle
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The reports demonstrates a positive trajectory with improvements being seen in substantive appointments/reduction in vacancies and reduction in Temporary/agency
staff over the last 3 months.
In comparison to March 2020 there has been an 8% increase in substantive registered nurses (associated with overseas recruitment) and a 6% increase in
substantive HCA’s. Over all there has been a 10% reduction in temporary staffing in comparison to March 2020.
Whilst COVID has been a contributory factor towards the reduction in temporary staffing, the Trust has also held a number of successful recruitment events with the
appointment of a further 22 registered nurses due to start in the Trust between July and September 2020 and therefore anticipate to see a continual positive trajectory.
Temporary vs Substantive Staff
28 Integrated Performance Report
June 2020 Executive Lead: Darryn Allcorn
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• Absence – Sickness levels remain above those seen last year. The ‘Anxiety/stress/depression/other psychiatric illnesses’ category continues to top the
absence reasons charts, accounting for more than a quarter (27.2%) of all sickness absence recorded. The ongoing impact of Covid is also evident, with
‘Chest & Respiratory Problems’ increasing to take up 21.4% of the latest month’s total.
• Turnover – Substantive staff turnover shows a very slight increase to 10.2% but remains historically low.
• Establishment – The gap between funded positions and staff in post continues to narrow, resulting in an overall vacancy rate of 5.2% (161.1 FTE).
• Staff Group Vacancies – The Registered Nursing & Midwifery staff group with 76.6 FTE posts vacant accounts for almost half of the Trust total vacancies, but
only 27% of the funded posts. Allied Health Professionals show some improvement but also remains a disproportionately high group, with 17.3% of the Trust
vacancies (27.9 FTE), compared to 8.0% of the overall posts funded.
Other workforce indicators
29 Integrated Performance Report
June 2020 Executive Lead: Hannah Foster
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Ap
r
Jun
Au
g
Oct
Dec
Fe
b
Ap
r
Jun
Au
g
Oct
Dec
Fe
b2019/20 2020/21
Sickness Absence by Top 6 Reasons (inc. Other)
Chest and RespiratoryProblems
Unknown causes / Notspecified
Cold, Cough, Flu -Influenza
Other musculoskeletalproblems
Other known causes -not elsewhere classified
Anxiety/stress/depression/other psychiatricillnesses
9.5%
10.0%
10.5%
11.0%
11.5%
12.0%
Ap
r
Ma
y
Jun
Jul
Au
g
Se
p
Oct
Nov
Dec
Jan
Fe
b
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
p
Oct
Nov
Dec
Jan
Fe
b
Ma
r
2019/20 2020/21
12 Monthly Turnover
Position Target
-10%
-8%
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
Au
g-1
8
Se
p-1
8
Oct-
18
Nov-1
8
Dec-1
8
Jan
-19
Fe
b-1
9
Ma
r-19
Ap
r-19
Ma
y-1
9
Jun
-19
Jul-1
9
Au
g-1
9
Se
p-1
9
Oct-
19
Nov-1
9
Dec-1
9
Jan
-20
Fe
b-2
0
Ma
r-20
Ap
r-20
Ma
y-2
0
PLAN
Established FTE vs. Plan
Variance to Plan Target High Target low
0%
20%
40%
60%
80%
100%
Ap
rM
ay Jun
Jul
Au
gSe
pO
ct
No
vD
ec
Jan
Feb
Mar
Ap
rM
ay Jun
Jul
Au
gSe
pO
ct
No
vD
ec
Jan
Feb
Mar
2019/20 2020/21
Vacancies by staff group
Add Prof Scientific and Technic Additional Clinical ServicesAdministrative and Clerical Allied Health ProfessionalsEstates and Ancillary Healthcare ScientistsMedical and Dental Nursing and Midwifery RegisteredStudents
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The communications team increased their support to Gold Command to seven days a week and OOH. The role of communications is to support the mission-critical
cascade of business continuity and preparedness information to all staff , patients and stakeholders who are supporting the NHS response to Covid-19. Additionally,
dealing with a significant increase in media enquiries. A summary of the actions, outcomes achievements and risks against each of the agreed objectives follows in
the table below:
Comms and engagement
30 Integrated Performance Report
February 2020 Executive Lead: Hannah Foster
Objectives Actions, outcomes, achievements & risks
Strategic communications and engagement advice • Strategic communications and engagement advice to Executive Directors and Gold Command • Advice and guidance to Incident Cells to handle sensitive staff communications • Liaison with NHS England ref national messaging
Timely decisions/updates are communicated within
24 hours where possible
• Daily comms all staff Covid update has been achieved every day since 13 March 2020 • Twice / weekly line manager update has been achieved every week since 20 March 2020
Responsive communications supports the
organisation by gathering feedback to enable us to respond quickly to the issues most important to staff and patients
• We anticipated fatigue in daily messaging and introduced diverse comms tactics to maintain interest. Included more audio-visual, use of facebook closed group, more graphic design, webcasts
• Responded to feedback from staff for more positive news, more light-hearted and social communications and more community based stories.
• Highlighted themes of common public enquiries so that processes could be established, reducing enquiries to Trust teams and responding in a timely manner to members of the public
Proactive communications supports Gold
Command by proactively identifying areas of interest to staff to anticipate/avoid high call volumes to the incident cells.
1. PPE information campaign: Messaging of protect staff, protect patients, ensure preserve stocks 2. Social distancing campaign: posters, banners and incorporating feedback from staff and public 3. Launch of staff survey to assess effectiveness of communications (end of April) 4. Testing: introduction of more testing capacity 5. Social media and comments in press statements to give the public clear guidance on how they can
support us 6. New ways of working: supporting remote working and new patient care approaches, recruitment and
remote inductions / video-interviews etc
Operational communications supports
operational cascades far more than usual to reflect manager’s reduced capacity to communicate effectively
• 100% completion of all Gold command actions • Consistent, reliable and daily output achieved across whole team • Established a regular feed of health and wellbeing comms and tips on how to manage remote working
staff
Consistency and quality tone of voice and
style of communications to be consistent high quality comms across all channels
• Quality control check before leaves comms team for sign off • Consistency of language to align to overarching messaging from execs • Supported an in-month messaging change from preparedness to management • Increasing volume of shared and joint communications across RD&E and NDHT
Team resilience • Established an equitable team rota to ensure all key meetings are covered 7 days per week. • Business continuity plan enacted: remote working, social distancing at work and resilient rota. • Supported the development of a core set of communications skills to support Gold: swift and accurate
communications, consideration of audience, alignment to messaging, responsiveness
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Executive Lead: Angela Hibbard
Run Rate, PSF & Use of Resources
31 Integrated Performance Report
June 2020
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Run Rate, PSF & Use of Resources continued
32 Integrated Performance Report
Junel 2020 Executive Lead: Angela Hibbard
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Activity & Income
33 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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Expenditure & CIP
34 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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Expenditure & CIP Continued
35 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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Divisional Positions
36 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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Cash & Capital Expenditure
37 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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Cash & Capital Expenditure
38 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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2020/21 Plan & Key Assumptions
39 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
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Financial Tables
40 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
NHSEI
COVID
Plan
Actual Variance
NHSEI
COVID
Plan
Actual Variance
31/05/2020 31/05/2020 31/05/2020 30/04/2020 30/04/2020 30/04/2020
YTD YTD YTD YTD YTD YTD
£'000 £'000 £'000 £'000 £'000 £'000
Income
Patient Income - NHS 30,936 30,899 (37) 15,468 15,446 (22)
Patient Income - Local Authority 3,568 2,352 (1,216) 1,784 1,137 (647)
Other Patient Income 208 15 (193) 104 (9) (113)
Operating Income 5,480 6,109 629 2,739 3,244 505
Income 40,192 39,375 (817) 20,095 19,818 (277)
Pay
Substantive (21,706) (22,477) (771) (10,853) (11,066) (213)
Bank (1,562) (1,652) (90) (781) (824) (43)
Agency (1,088) (600) 488 (544) (277) 267
Pay (24,356) (24,729) (373) (12,178) (12,167) 11
Non Pay
Drugs (2,898) (2,692) 206 (1,449) (1,306) 143
Clinical Supplies (3,118) (2,136) 982 (1,559) (1,182) 377
Purchase of Social Care (1,852) (2,031) (179) (926) (964) (38)
Other Non-Pay (7,648) (7,452) 196 (3,824) (4,026) (202)
Non-Pay (15,516) (14,311) 1,205 (7,758) (7,478) 280
Total Non-Operating Costs (Pre IFRS) (320) (379) (59) (159) (187) (28)
OPERATING SURPLUS / (DEFICIT) 0 (44) (44) 0 (14) (14)
Add back SOCI impact of impairments included above 0 44 44 0 14 14
Remove SOCI impact of capital donations/grants 0 0 0 0 0 0
Adjusted Financial Performance surplus / (deficit) 0 0 0 0 0 0
Less PSF, FRF, MRET, National Top Up Funding (2,838) (4,427) (1,589) (1,418) (2,365) (947)
ADJUSTED SURPLUS/(DEFICIT) FOR THE PERIOD/YEAR
AFTER PSF, FRF and MRET(2,838) (4,427) (1,589) (1,418) (2,365) (947)
Detailed Income & Expenditure
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Financial Tables
41 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
NHSEI
COVID
Plan
Actual Variance
NHSEI
COVID
Plan
Actual Variance
31/05/2020 31/05/2020 31/05/2020 30/04/2020 30/04/2020 30/04/2020
YTD YTD YTD YTD YTD YTD
£'000 £'000 £'000 £'000 £'000 £'000
Registered Nursing - Substantive 5,716 5,934 (218) 2,858 2,933 (75)
Registered Nursing - Bank 410 532 (122) 205 248 (43)
Nursing Agency 380 9 371 190 12 178
Registered Nursing 6,506 6,475 31 3,253 3,193 60
Scientif ic, Ther & tech (Qual) - Substantive 3,110 3,236 (126) 1,555 1,601 (46)
Scientif ic Thera, Tech - Bank 86 78 8 43 33 10
Scientif ic, Thera, Tech - Agency 60 135 (75) 30 43 (13)
Scientific, Ther and Tech 3,256 3,449 (193) 1,628 1,677 (49)
Qualif ied Ambulance Staff - Substantive 70 81 (11) 35 43 (8)
Qualif ied Ambulance - Agency 0 0 0 0 0 0
Qualified Ambulance Staff 70 81 (11) 35 43 (8)
Support to Clinical - Substantive 3,832 4,067 (235) 1,916 2,004 (88)
Support to Clinical Bank 396 417 (21) 198 200 (2)
Support to Clinical Agency 50 50 0 25 24 1
Support to Clinical 4,278 4,534 (256) 2,139 2,228 (89)
Medical & Dental - Substantive 5,562 5,650 (88) 2,781 2,754 27
Medical & Dental bank 536 550 (14) 268 299 (31)
Medical & Dental Agency 528 326 202 264 156 108
Medical & Dental 6,626 6,526 100 3,313 3,209 104
NHS Infrastructure Support - Substantive 3,294 3,407 (113) 1,647 1,679 (32)
NHS Infrastructure - Bank 134 75 59 67 43 24
NHS Infrastucture - Agency 70 81 (11) 35 42 (7)
NHS Infrastructure Support 3,498 3,563 (65) 1,749 1,764 (15)
Others Substantive 122 101 21 61 52 9
Other Substantive 122 101 21 61 52 9
Total Staff Costs 24,356 24,729 (373) 12,178 12,166 12
Staff Group Costs
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Financial Tables
42 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
Audited PY Actual Variance
Statement of Financial Position 31/03/2020 31/05/2020 31/05/2020
Year ending YTD YTD
£'000 £'000 £'000
Non-current assets
Intangible assets 7,911 7,815 (96)
Property, plant and equipment: other 74,396 74,122 (274)
Right of use assets - leased assets for lessee (excluding PFI/LIFT) 0 0 0
Trade and other receivables: due from non-NHS/DHSC Group bodies 849 882 33
Total non-current assets 83,156 82,819 (337)
Current assets
Inventories 3,169 3,132 (37)
Trade and other receivables: due from NHS and DHSC group bodies 8,442 3,631 (4,811)
Trade and other receivables: due from non-NHS/DHSC Group bodies 7,330 5,476 (1,854)
Cash and cash equivalents: GBS/NLF 3,940 23,307 19,367 Income in advance - COVID-19 f inancial framew ork plus net improvement in w orking capital
Cash and cash equivalents: commercial / in hand / other 9 9 0
Total current assets 22,890 35,555 12,665
Current liabilities
Trade and other payables: capital (1,296) (688) 608
Trade and other payables: non-capital (20,324) (16,575) 3,749
Borrow ings (20,690) (20,335) 355 In-year deficit funding not required - COVID-19 f inancial framew ork
Provisions (20) (20) 0
Other liabilities: deferred income (1,102) (18,187) (17,085) Income in advance - COVID-19 f inancial framew ork
Total current liabilities (43,432) (55,805) (12,373)
Total assets less current liabilities 62,614 62,569 (45)
Non-current liabilities
Borrow ings 0 0 0
Provisions (64) (64) 0
Total non-current liabilities (64) (64) 0
Total net assets employed 62,550 62,505 (45)
Financed by
Public dividend capital 58,467 58,466 (1)
Revaluation reserve 9,635 9,631 (4)
Income and expenditure reserve (5,552) (5,592) (40)
Total taxpayers' and others' equity 62,550 62,505 (45)
Audited PY Actual Variance
Borrowings 31/03/2020 31/05/2020 31/05/2020
Year ending YTD YTD
£'000 £'000 £'000
Current
Borrow ings: DHSC w orking capital / revenue support loans 20,003 20,003 0
Accrued interest on DHSC loans 80 80 0
Borrow ings: other (non-DHSC) 607 252 (355) Salix loan repayment
Total current borrowings 20,690 20,335 (355)
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Financial Tables
43 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
Actual
Statement of Cash Flows 31/05/2020
YTD
£'000
Operating surplus/(deficit) 335
Non-cash income and expense:
Depreciation and amortisation 864
Impairments and reversals 0
Income recognised in respect of capital donations (cash and non-cash) (1)
(Increase)/decrease in trade and other receivables 6,665
(Increase)/decrease in inventories 37
Increase/(decrease) in trade and other payables (4,357)
Increase/(decrease) in other liabilities 17,085
Increase/(decrease) in provisions 0
Net cash generated from / (used in) operations 20,628
Cash flows from investing activities
Interest received 3
Purchase of intangible assets (98)
Purchase of property, plant and equipment and investment property (811)
Proceeds from sales of property, plant and equipment and investment property 0
Receipt of cash donations to purchase capital assets 0
Net cash generated from/(used in) investing activities (906)
Cash flows from financing activities
Public dividend capital received 0
Loans from Department of Health and Social Care- received 0
Loans from Department of Health and Social Care - repaid 0
Other loans repaid (355)
Interest paid 0
PDC dividend (paid)/refunded 0
Net cash generated from/(used in) financing activities (355)
Increase/(decrease) in cash and cash equivalents 19,367
Cash and cash equivalents at start of period 3,949
Cash and cash equivalents at end of period 23,316
Actual
DHSC loan facilities cash flows 31/05/2020
YTD
£'000
Revenue support loans
Interim revenue support loans - Received 0
Interim revenue support loans - Repaid 0
Net Interim revenue support loans Received/(Repaid) 0
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Version Control (Non COVID Section)
44 Integrated Performance Report
June 2020 Executive Lead: Angela Hibbard
Data Item Missing Data Owner Slide owner
Use of Resources Financial Risk Rating table not
currently reported by NHSEI
NHSEI Angela Hibbard