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TRANSCRIPT
Integrated Performance Report
May 2020
1
Agenda item: 7.2, Confidential Board meeting
Date: 20 May 2020
Title:
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 Dave Thomas, Interim Chief Nurse Chris Tidman, Chief Financial Officer / Deputy Chief Executive
Presented by:
Adrian Harris, Executive Medical Director / Deputy Chief Executive
Responsible Executive:
Pete Adey, Chief Operating Officer Hannah Foster, Director of People Adrian Harris, Executive Medical Director/Deputy Chief Executive Dave Thomas, Interim Chief Nurse Chris Tidman, Chief Financial Officer/Deputy Chief Executive
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:
The Board is asked to receive the Performance Report and note the current risks and the proposed action plans to mitigate the risks against performance delivery.
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)
Integrated Performance Report
May 2020
Integrated Performance Report – April 2020 Position
Contents
Section Page
Executive Summary 3 – 4
COVID-19 Related - Activity & Flow 6 – 7
COVID-19 Related – Operational Performance 8
COVID-19 Related – Safety & Quality 9 – 10
COVID-19 Related – Our People 11 – 12
COVID-19 Related – Finance 13
Activity & Flow 15 – 16
Operational Performance 17 – 24
Quality & Safety 25 – 26
Our People, including Communications & Engagement 27
Finance 28 – 35
2
3
Executive Summary
Integrated Performance Report
May 2020
Quality and Safety: • The Executive Safety Huddle is reviewing all incidents of treatment delay due
to COVID-19.
• A Harm Reduction Framework has been developed which will increase
consistency and assurance related to these harms.
• Pressure ulcers have not exceeded normal variation, but the presentation of
pressure ulcers in COVID-19+ patients appears to differ.
• Complaints raised related to COVID-19 all relate to concerns over social
distancing at our sites.
COVID-19 Related Non COVID-19 Related
Operational Performance: • The volume of COVID-19 patients occupying Inpatient and critical care beds
has reduced further into May, with current numbers are well below the
capacity identified by the Trust’s surge capacity plans. Bed occupancy
remains relatively low but is increasing as non COVID-19 activity is stepped
up.
• Testing activity has increased into May as the Trust has increased staff
testing and increased the volume of tests performed for partners, now
including care homes. Overall testing capacity has reduced since last month
due to central allocations, but overall capacity remains adequate for current
testing need.
• Daily usage of PPE is being monitored and the Trust is working to a 14 day
stock holding. The Trust is working in close collaboration with other local
providers to make the best use of PPE supplies available.
Our People: • In the past month there has been a considerable reduction in the number of
staff absent from work due to COVID-19. At the beginning of April c1,100 staff
were absent related to COVID-19, but this has now fallen to c.520, a reduction
of 47%.
• The proportion of staff absence due to COVID-19 at the end of April as a
percentage of Trust workforce was c5%.
Quality and Safety: • A Family Liaison Service has been established via the PALs team to improve
patient experience and compassionate care whilst visitor restrictions are in
place.
Operational Performance: • Restricted elective activity has continued to increase elective waiting lists and
increase the length of time patients are waiting for treatment. Recovery plans are
being developed to step up urgent elective care.
• New outpatient and follow up outpatient attendances in April were 49% and 56%
respectively of April 2019 volumes.
• There has been a marked increase in the proportion of virtual outpatient
attendances, with April reporting more virtual appointments than face to face
appointments for the first time.
• Daily attendances to ED in April were lower than the previous year but showing a
week on week increase, with May activity continuing this trend.
Our People: • Overall Trust wide sickness absence (excluding COVID-19) as a percentage of
Trust workforce decreased from 4.0% in March to 3.8% in April.
4
Executive Summary
Integrated Performance Report
May 2020
COVID-19 Related Non COVID-19 Related
Finance:
• The Trust is reporting a break even financial position for month 1 in line with national guidance.
• The Trust's financial position will continue to be break-even for the first four months of the year after NHSE/I have notified a block value for patient income and a top-up
payment. A retrospective top up or claw back will be made each month to achieve a break even position. It is expected that this process will continue until the end of
October with updated block and top up payments and more rules regarding the retrospective payment past July.
• A direct claim for the Trust’s COVID costs of £2.6m for reimbursement from NHSE/I COVID fund in April. The Trust will also receive a top-up for any underlying increase
in its net run rate (£2.0m in April including a loss of commercial income of £582k).
• Expenditure and commercial income budgets have been rolled over from the previous financial year and inflation added relating to pay.
• In month 1 pay has overspent by £529k and non pay of £211k.
• The Trust savings programme is currently on hold, however will form part of the recovery phase.
• The Trust has incurred £33k as a result of setup costs for the Nightingale Hospital during April. These costs will be recovered as part of the retrospective top-up payment.
• Cash as at the end of April is £104.1m, an increase of £46.0m on the value held at the year end.
• Expenditure budgets have not been adjusted for any budget setting requests at Month 1. The Trust is reviewing budget setting requests in light of COVID 19 and new
ways of working.
5 Integrated Performance Report
May 2020
Part 1 COVID-19 Related
COVID-19 Occupied Inpatient Beds
COVID-19 occupied inpatient beds have continued to reduce, with current
volumes well within the Trust’s capacity. The forecast shows a predicted
continuation of this trend to the end of May. This trend is in line with other
STP trusts and wider regional position.
Trajectories
The primary source of projections being used by the Trust is in
collaboration with Exeter University (displayed in Blue). A secondary
source of projections, which is used and recognised by NHSI/E and the
Devon system, is also displayed in the chart above. This has been
displayed for context and shows a range between good and poor
compliance (with social distancing by the public), with the Trust position
clearly more closely aligned to the ‘good compliance’ trajectory.
Overall bed occupancy
Overall bed occupancy remains comparatively low at 55% of total
capacity but has been increasing since April. COVID-19 inpatients have
decreased over this period but non COVID-19 occupied beds have
increased as non COVID-19 activity is stepped up. As a result, overall
bed occupancy is expected to continue to rise over the next month.
COVID-19 Inpatient Activity – Overview of inpatient activity in relation to caring for patients with COVID-19
6 Integrated Performance Report
May 2020 Executive Lead: Pete Adey & Chris Tidman
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Bed
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COVID / Non-COVID Bed Occupancy
Occupied by Non Covid 19 patients Occupied by Covid 19 patients Unoccupied
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Inp
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COVID Acute Inpatient Beds (Non Critical Care) Capacity Plans vs Current Use
4. Capener & Knapp
3. Kenn, Bovey, Yealm
2. Culm East and West
1. Ashburn
Actual Non Critical CareCovid IP Beds in use
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Number of Confirmed COVID-19 Patients Occupying Acute Inpatient Beds (up to 12 May 2020)
Actual Exeter Uni Devon projection
NHSI projection (Good compliance) NHSI projection (Poor compliance)
COVID-19 Patients in Critical Care Beds
The number of COVID-19 patients in critical care beds has reduced from
mid-April and then stabilised at an average position of 5-6 patients.
Volumes are expected to reduce even further towards the end of May.
The volumes experienced are well within the Trust’s surge capacity.
Critical Care – Overview of critical care activity in relation to caring for patients with COVID-19
7 Integrated Performance Report
May 2020 Executive Lead: Pete Adey & Chris Tidman
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Number of Confirmed COVID 19 Patients Occupying HDU / ITU Beds
Actual
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Critical care surge capacity plans vs current use
1. ITU with Second Area 2. Main Theatre Recovery3. Theatre & Anaesthetic Rooms 4. PEOC Theatres and RecoveryCritical Care Beds in Use
Executive Lead: Pete Adey
Testing Capacity
Testing volumes have increased in May both due to a combination of an
increase in Trust staff testing, including participation in a Public Health England
study on 06 May, and testing being provided to system partners.
As well as neighbouring NHS trusts, testing is also now being performed to
support local care homes.
Total testing capacity reduced during May due to a notified central allocation
reduction for one of the platforms. However, the revised capacity is still well
within the Trust’s current daily requirements.
COVID-19 Testing – Outline of COVID-19 patient testing activity and outcomes
8 Integrated Performance Report
May 2020
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RDE Daily Patients Tested vs Positive
RDE Patients tested RDE Patients tested positive
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RDE Daily Staff Tested vs Positive
RDE Staff tested RDE Staff tested positive
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Testing performed vs planned capacity
Elitech capacity Perkin Elmer capacityCepheid capacity Roche Cobas 6800 capacityRDE Staff tested RDE Patients testedNon RDE testing
Executive Lead: Adrian Harris & Dave Thomas
Quality and Safety
9 Integrated Performance Report
May 2020
Patients Recovered and Discharged
A total of 153 patients have recovered and been discharged from the acute
Trust since the beginning of the pandemic.
Fit Testing
A total of 3,039 staff have been FIT tested across the trust.
Patient Deaths and Harm
In April there were 34 submissions to Datix in relation to recorded incidents of
treatment being either delayed or declined as a result of COVID-19. These
incidents are reviewed on a case by case basis for the weekly Executive
Safety Huddle. A Harm Review process is being established which will
provide consistent reporting of any harms realised secondary to COVID-19.
COVID-19 Related Tissue Damage
Eight incidents of tissue damage / pressure ulcers were reported as directly
attributable to COVID-19, 4 of which were community nursing cases and the
majority relating to tissue damage associated with proning.
An increase in pressure ulcers had been expected as a result of COVID-19,
however they remain within normal variation when adjusted per 1,000 bed
days. There is an emergent theme that the presentation of pressure ulcers in
COVID-19 positive patients appears to differ. A system to track this has been
established and changes made to capture these “Disease Specific” class of
ulcers via Datix. Two pressure ulcers met this criteria:
Four community caseload ulcers were identified but were all known to be at
risk patients who have requested reduced contact from services due to
COVID-19.
Patient experience
There were two complaints (Wonford) and one comment (Heavitree)
reported. All related to concerns from shielded patients who had attended
appointments and found a lack of social distancing within the hospitals. These
issues have been responded to and continued efforts have been made to
reinforce the importance of social distancing across all Trust sites.
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Daily COVID-19 Patient Deaths (Past 24 Hours)
Patient deaths
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Patients Recovered and Discharged (Daily)
Patients recovered and discharged (daily)
Fully FIT Tested 50%
Attended and successful FIT
tested 41%
Attended but failed testing
9%
FIT testing (number of staff)
Oxygen
As part of the national programme in response to COVID-19, the Trust has been allocated a second vacuum insulated evaporator (VIE) oxygen store. Ground works
need to take place in order to house the VIE. A business case is currently being prepared for approval. The VIE will increase the total oxygen supply to the Trust from
3,000l / minute to 8,000l / minute. The expected date for delivery of the VIE is the 22nd June.
PPE
The Trust has maintained a greater than 14 days supply for all core items of PPE.
From the 1st May greater central control of PPE supply was established via guidance received from the Department of Health and Social Care. In summary, the
guidance stated that the UK Government would procure more items nationally, rather than individual NHS organisations competing for the same supplies. The
guidance does not cover all PPE, with some local procurement continuing.
The RD&E PPE and Logistics group has aligned its operations in line with revised guidance. Escalation procedures are in place through mutual support arrangements
with the STP and (items of less than 5 days stock and the national team (less than 3 days stock).
The PPE stock holding for the Trust will start to reduce as a consequence of this change in process. There remain nationally shortages for fluid resistant surgical face
masks and gowns.
PPE, Oxygen, Ventilators – Exception reporting on issues and proposed mitigations
10 Integrated Performance Report
May 2020 Executive Lead: Adrian Harris & Dave Thomas
Executive Lead: Hannah Foster
• In the past month, there has been a considerable reduction in the number of
staff absent from work due to COVID-19. At the beginning of April c1,100
staff were absent due to COVID-19 (either symptomatic or self-isolating as
in a vulnerable group). This number has fallen to c520 total staff absence
due to COVID-19, a reduction of 47%.
• There has been a vast improvement in the number of staff self-isolating due
to either themselves or a household contact being symptomatic. In March
c60% of COVID-19 absence (c780 staff) was due to being symptomatic, this
has fallen to c17% of COVID-19 absence (c85 staff).
• There are currently c315 staff that are self-isolating due to them or a
household contact being classified in a vulnerable group. This represents
c3.5% of the Trust's workforce. A further c120 staff classified as vulnerable
are working from home.
• The proportion of staff absence due to COVID-19 at the end of April as a
percentage of Trust workforce was c5%.
Workforce
11 Integrated Performance Report
May 2020
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Staff Sickness and Self Isolating
General sickness Covid 19 related sickness Self Isolating (not able to work)
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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
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COVID-19 (Staff Confirmed Cases) Related Sickness
Covid 19 related sickness
Note : Sickness and Staff Isolating – General sickness figure for 3 May 2020 is low due to data only being available from Healthroster.
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.
Communications and Engagement
12 Integrated Performance Report
May 2020 Lead: Tracey Cottam
Objectives Actions, outcomes, achievements & risks
Timely decisions and updates are communicated
within 24 hours where possible (unless waiting for
national / local guidance)
• Daily comms all staff COVID update has been issued daily though the last month – although now
reverted to 5 days instead of 7 days.
• Manager updates issued as necessary
Responsive communications supports the
organisation by gathering feedback to enable us to
respond quickly to the issues most important to staff
• A staff survey has been issued to receive feedback on comms, engagement, wellbeing and fundraising
efforts over the last 8 weeks
• Regular update of FAQs
• Proposed adoption of staff pulse over coming month.
Proactive communications supports Gold Command
by proactively identifying areas of interest to staff to
anticipate/avoid high call volumes to the incident cells.
1. Weekly webcast: Execs leading a weekly COVID-related webcast across RDE and NDHT
2. Using the NHS: work ongoing on encouraging people to use NHS services
3. Lobbying: LRF/MPs on protecting against future spikes in the region
4. Nightingale: supported the CG-led comms on the Nightingale set up
5. Donations and giving: coordinated donations and set up appeal for staff
6. Media coverage: Panorama, Spotlight, Devon live
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 managing 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 materials leave comms team
• Consistency of language to align to overarching messaging from execs
• Supported an in-month messaging change from management to reset
• Increasing coordination and alignment 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 enabled./Social distancing/ sickness cover
• Supported the development of a core set of communications skills to support Gold: swift and accurate
communications, consideration of audience, alignment to messaging, responsiveness
• Key messages from executive director meetings fed back to team instantly
Strategic • Developed strategic messaging management
• Development of influencing and advocacy work with key stakeholders
• Development of forward plan based on modelling
• 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
Executive Lead: Chris Tidman
COVID-19 Related Costs
13 Integrated Performance Report
May 2020
COVID Expenditure and Financial Commitment Summary
Revenue
£931k of revenue expenditure was incurred in 19/20 along with lost commercial
income of £230k, with expenditure in April of £2.6m. The major areas of spend
during April include £836k on diagnostic testing, £452k on increased admin
cover (additional staff hours and acting up of staff during the COVID-19
pandemic) and £358k on personal protective equipment.
* not including loss of commercial Income in April (£528k) as required by NHSE/I
guidance
• "Hospital assisted respiratory support capacity" is equipment and
consumables used in relation to assisted breathing on COVID wards (mainly
ICU).
• "Other" includes Provision of Estates recharges for various works as a result
of COVID-19, Anaesthetic machines and additional security / agency works.
• "Increased Admin capacity" includes staff released from other projects (e.g.
My Care) to assist in the COVID response as well as increased staff costs
(e.g. Acting up or additional hours).
• "Sickness / isolation cover" includes bank / agency staffing to cover staff
either sick or self isolating as a result of COVID-19.
Capital
£66k of capital expenditure was incurred in 19/20. Spend in April was £145k
which related to a Janus DNA expraction machine (£88k), Ultrasound machines
(£40k) and a Blood Gas analyser (£17k).
Decontamination 0 45 45
Diagnostic sampling in community 271 368 639
Diagnostic sampling in hospital 254 468 722
Isolation Pod 48 0 48
Hospital assisted respiratory support capacity 6 452 458
Other 37 220 257
PPE 73 358 431
ITU capacity 24 7 31
Segregation of patient pathways 0 6 6
Support stay at home model 210 28 238
Increased admin capacity 8 458 466
Sickness / isolation cover 0 235 235
Loss of commercial income * 230 * 230
Total 1,161 2,645 3,806
Revenue
costs
incurred to
March
(£000's)
Revenue
Costs
incurred in
April
(£000's)
Total
Revenue
cost
incurred
(£000's)
14 Integrated Performance Report
May 2020 Executive Lead: Pete Adey & Chris Tidman
Part 2 Non COVID-19 related
Referrals: were 50% lower than March 2020 volumes and 62% lower than the April 2019 position. This continued reduction is attributed to COVID-19, and mainly due
to a reduction in GP referrals as presentations to primary care have reduced significantly.
Outpatient Attendances: New outpatient and follow up outpatient attendances in April were 49% and 56% respectively of April 2019 volumes, but the May position to
date shows a week by week increase in both categories of attendance volumes. The current situation has resulted in a significant increase in the proportion of
appointments taking place virtually, with 14, 872 virtual appointments (taking place compared to 11,748 on a face to face basis in April.
Outpatient Waiting List: The size of the new outpatient waiting list has slightly reduced in April as a result of an increasing proportion of outpatient attendance taking
place, and reductions in new referral volumes. The follow up outpatient waiting list has increased significantly by 42% (30,000 patients) since February, due to lower
attendances attributed to COVID-19. Plans are in development to increase the number of outpatient appointments through virtual appointments where possible, and
use of facilities at the Nuffield Exeter Hospital.
Elective activity- Referrals and Outpatients
15 Integrated Performance Report
May 2020 Executive Lead: Pete Adey & Chris Tidman
0
2000
4000
6000
8000
10000
12000
14000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Referrals - Excluding Community
2019/20 2020/21
0
20000
40000
60000
80000
100000
120000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
New and Follow-up Outpatient Waiting List
New OP WL
0
10000
20000
30000
40000
50000
60000
70000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Outpatient Attendances (New and Follow-up) by Appointment Type
Not Specified Face to Face Telemedicine Telephone
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
New and Follow-up Outpatient Attendances
New 20/21 Follow-up 20/21 New 19/20 Follow-up 19/20
Elective Activity and Waiting List: In line with previous years’ reporting at month 1, elective inpatient and daycase activity was not available at the time of writing this
report, and so the elective activity chart above depicts the month 12 position shared previously. A detailed overview of the aggregate month 1 and 2 position will be
included in the month 2 report. The inpatient / daycase combined waiting list increased in April to the highest position in 12 months. This is attributed to lower activity
related to COVID-19.
The Trust continues to use the Nuffield Exeter Hospital for outpatient attendances, daycase and inpatient procedures. At the time of writing the Trust is now fully
utilising the Nuffield’s theatre capacity, and expecting to continue to use this facility for non-complex urgent elective activity.
RTT Performance and longer waiting patients: RTT performance deteriorated further in April to 65%, which is attributed to lower than usual activity levels and
patients waiting longer for treatment attributed to COVID-19. The number of patients waiting longer than 40 weeks for treatment increased significantly at the end of
April to 1,532 patients from 751 in February.
Elective activity- Inpatient and Daycase
16 Integrated Performance Report
May 2020 Executive Lead: Pete Adey & Chris Tidman
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
RTT 18 Week Performance
2019/20 2020/21 Target
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
1400.0
1600.0
1800.0
20,000
25,000
30,000
35,000
40,000
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
2019/20 2020/21
Vo
lum
e o
f Pa
tien
ts W
aitin
g >
40
we
ek
s
Vo
lum
e o
f In
co
mp
lete
Pa
thw
ays
Incomplete Pathways and Longer Waiting Patients
Incomplete pathways >40 Weeks
2020/21
7000
7500
8000
8500
9000
9500
10000
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Apr
2019/20 2020/21
Elective Waiting List (Inpatient and Daycase Combined)
IPDC Waiting List
-
1,000
2,000
3,000
4,000
5,000
6,000
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Elective Inpatient and Daycase Activity
2018/19 Daycase 2018/19 Inpatient 2019/20 Daycase 2019/20 Inpatient
Integrated Performance Report
May 2020
17
Elective activity- Long Waiting Patients
Executive Lead: Pete Adey
The continued heightened COVID escalation status and consequential impact on
elective activity prevented continued improvements to long wait positions. No
trajectory for improvement has been agreed with regulators yet due to the
uncertainty of the position going forward.
Divisional teams have been asked to recommence as much elective activity,
including diagnostics as current circumstances, such as staffing constraints and
social distancing, allow. As a Trust, the intention is to address all backlogs for
urgent and cancer work before any routine activity is restarted, with the
exception of some specialist areas, such as Fertility Services, where delaying
the start of routine activity would not provide capacity for urgent patients in other
areas.
In order to ensure consistency and pace to this work, a Trust-wide working group
named “Redesign and long Term Recovery” has been established. This will
utilise elements of the Gold Command infrastructure and will consist of clinical
and managerial leaders from across the Trust.
0
50
100
150
200
250
300
Apr-
19
May-1
9
Ju
n-1
9
Ju
l-19
Aug
-19
Sep
-19
Oct-
19
No
v-1
9
De
c-1
9
Ja
n-2
0
Feb
-20
Mar-
20
Apr-
20
52+ Weeks Waited Trajectory vs. Actual
Actual Trajectory
Specialty
2019/20 2020/21
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
40
+ w
ee
ks
Orthopaedics 233 234 217 214 277 257 243 266 311 336 298 353 602
Cardiology 184 208 165 192 218 218 188 196 162 164 148 211 290
General surgery 94 108 103 122 144 129 116 118 108 103 107 141 205
Other 108 94 169 148 214 200 155 138 185 191 198 238 435
52
+ w
ee
ks
Orthopaedics 13 18 19 18 26 27 33 26 22 30 26 38 97
Cardiology 19 29 30 40 52 55 57 58 28 17 12 19 59
General surgery 26 19 16 16 36 37 41 42 30 27 22 29 58
Other 9 5 9 16 32 28 28 17 12 8 7 17 51
Integrated Performance Report
May 2020
18
Non-elective activity
Executive Lead: Pete Adey
Non Elective Activity: In line with previous years reporting at month 1, non-
elective inpatient activity was not available at the time of writing this report, and
so the non-elective activity chart above depicts the month 12 position shared
previously. A detailed overview of the aggregate month 1 and 2 position will be
included in the month 2 report.
Time to Surgery for Patients with a Fractured Neck of Femur
In April, 94.6% of patients with a fractured neck of femur were operated on
within 36 hours, where this was clinically appropriate - the first occasion since
January 2019 that the Trust target of 90% has been achieved. One hundred
per cent of patients with a fractured neck of femur for whom it was clinically
appropriate received surgery within 48 hours in April.
0
1000
2000
3000
4000
5000
6000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Non Elective and Elective Inpatient Activity
Non Elective 19/20 Elective 19/20 Non Elective Elective
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Surgery within 36hrs - Fractured Neck of Femur
Target 36hrs Performance 48hrs Performance
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Non Elective Inpatient Activity
2018/19 2019/20
Executive Lead: Pete Adey
Overall performance:
Attendances to the Trust’s ED and local WICs and MIU decreased
significantly in April, which is attributed to COVID-19. A significant reduction
in activity was seen with total system attends reducing from 318 in March to
171 per day in April.
Including all local WICs and MIUs, performance against the 4-hour target for
April was 94.90%. This represents an improved position from March when
performance was 86.52%. Nationally 90.4% of patients were treated,
admitted or discharged within 4 hours in April.
The breakdown of ED performance within the Trust for different categories of
patients is shown in the table below.
No patients waited longer than 12 hours from decision to admit to transfer.
As a result of significant pathway redesign in response to COVID-19, patients
with mental health needs are now being seen by Devon Partnership Trust in
their own premises. This has significantly improved the pathway for mental
health patients and the ED will continue to work with DPT to consider how
this model can be sustained in the longer term.
COVID-19
The COVID-19 surge plan for ED is now well developed and continues to be
refined to ensure that the ED is responsive to demand from both COVID-19
and non COVID-19 patients. The ED continues to run ‘hot’ and ‘cold’ facilities,
which has be achieved through the extension of the ED footprint into an
adjacent template. Work continues to ensure adequate provision of staff,
estates and equipment for current service provision and future surge..
Ambulance Handover Delays
An average of 67 ambulances arrived per day in April, which is a reduction
from March, when there were 80 arrivals per day. Out of 2055 ambulance
arrivals in April, there was one delay greater than 60 minutes in duration and
3 delays greater than 30 minutes. This is compared to no delays greater than
60 minutes in duration and 29 delays greater than 30 minutes in duration in
March.
Emergency Department – key metrics relating to activity & performance in urgent & emergency care services
19 Integrated Performance Report
May 2020
0
1
2
3
0
50
100
150
200
250
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
12 H
ou
r Tro
lley B
reaches (V
olu
me)
Att
en
dan
ces (
Vo
lum
e)
Report Month - Trust Daily Attendance Profile
Wonford ED & Honiton MIU Wonford and Sidwell St.WICs 12hr Trolley Breaches
2020/21
0
2
4
6
8
10
0
10
20
30
40
50
60
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
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
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
r2019/20 2020/21
4 Hour Wait Performance
Trust Eastern Devon Area Target Trust Trajectory
Integrated Performance Report
May 2020 20
Cancer 14 and 28 Day
0
500
1000
1500
2000
2500
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
Volume of 2 Week Wait Referrals
2019/20 2020/21
At the end of March 2 week wait referral numbers had decreased by 70%. The
Trust has now seen a modest rebound with referral levels now at 55%
compared to last year. Referral levels have a high degree of variation between
tumour type with Lung referrals remaining 80% down whereas Breast cancer
referrals nearly comparable to 2019 levels.
In order to ensure that cancer patients are effectively reviewed, prioritised and
treated in order, a cancer surgery Hub was established as part of the COVID-
19 Incident Management Framework. This clinically led process uses a tool to
score patients according to their clinical indicators and match up patient need
with the available infrastructure.
The Nuffield Hospital has been procured for NHS use at a national
level. Locally this has provided capacity to treat cancer patients and has been
well utilised by the surgical teams.
Services able to offer virtual clinic appointments are performing well against the
2week wait standard but this has been counteracted by limited endoscopy
capacity leading to delays for GI services. The Trust overall performance was
77.3% against a 93% standard.
From April 2020, the 28-day Faster Diagnosis Standard (FDS) was introduced
nationally. All patients referred on a Suspected Cancer pathway are expected
to be given a diagnosis, or ruling out, of cancer within the first 4 weeks of their
pathway.
Current forecasts indicate that April performance is 51.2%. Achievement of this
standard has been impacted patient and hospital deferrals during the
‘lockdown’ period. In March Trust performance against the FDS was 74.7%.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Apr-
20
May-2
0
Ju
n-2
0
Ju
l-20
Aug
-20
Sep
-20
Oct-
20
No
v-2
0
De
c-2
0
Ja
n-2
1
Feb
-21
Mar-
21
28 Day Faster Diagnosis Standard
28 Day Faster Diagnosis Standard Performance Target
Executive Lead: Pete Adey
Cancer 62 Day – Proportion of patients treated within 62 days following referral by a GP for suspected cancer
21 Integrated Performance Report
May 2020 Executive Lead: Pete Adey
For April, current performance against the 62-day standard is 70.2%, against the
national standard of 85%.
Waiting times for diagnostic biopsies, histopathology and imaging within the Urology
pathway has led to the majority of the breaches in April, with many patients being
treated with hormones or being actively monitored until appropriate surgery is available.
Cancer surgical activity levels have dropped to a third but utilisation of the Nuffield has
allowed key operations to continue. Alternative treatments and the safe triage of
deferment of patients is being used to manage other patients. Chemotherapy and
Radiotherapy activity levels have seen minimal reduction and are maintaining Cancer
Waiting Time standards.
The Trust has put in place additional cancer patient tracking processes in order to
support the safe and effective monitoring of patients who have had treatment plans
deferred or modified.
As of the 30th April there were 59 patients on an open pathway over 104 days. Of
these patients, 32 were on a urological pathway, 9 were lower gastrointestinal patients
and 5 were lung. The remaining 13 patients were spread across haematology (4),
sarcoma (3), gynaecology (2), with 1 in each of upper gastrointestinal, brain, breast,
and head & neck pathways.
Cancer - 14, 31 & 62 Day Wait
Performance(%) and
Number of Breaches TARGET
2019/20 2020/21
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
14 D
ay
All Urgent (%) 93%
80.7% 82.2% 81.8% 80.3% 70.1% 79.1% 82.9% 72.0% 71.8% 68.8% 77.0% 77.7% 77.3%
All Urgent 390 359 330 385 605 353 371 514 520 540 404 393 196
Symptomatic Breast (%) 93%
72.5% 91.8% 92.1% 75.5% 7.1% 64.6% 95.5% 23.8% 9.7% 28.8% 41.7% 94.1% 50.0%
Symptomatic Breast 19 5 5 12 52 17 2 16 28 37 21 2 3
31 D
ay
All Decision To Treat (%) 96%
90.3% 92.6% 93.7% 95.0% 94.3% 93.6% 94.9% 94.3% 95.2% 96.5% 94.9% 95.0% 96.3%
All Decision To Treat 31 25 18 17 18 19 19 17 14 11 12 17 10
Subsequent - Surgery (%) 94%
85.4% 85.9% 93.1% 94.3% 97.6% 83.5% 93.1% 94.7% 95.5% 89.3% 94.9% 92.6% 98.1%
Subsequent - Surgery 14 14 6 6 2 14 7 5 4 9 4 7 1
Subsequent - Radiotherapy (%) 94%
98.1% 97.8% 95.8% 95.9% 96.9% 93.9% 97.4% 99.4% 99.3% 97.5% 96.3% 99.3% 98.2%
Subsequent - Radiotherapy 3 3 6 6 4 8 4 1 1 4 4 1 2
Subsequent - Anti-Cancer Drug (%) 98%
99.3% 99.4% 98.5% 100.0% 99.2% 100.0% 100.0% 100.0% 99.1% 100.0% 100.0% 99.2% 98.8%
Subsequent - Anti-Cancer Drug 1 1 2 0 1 0 0 0 1 0 0 1 1
62 D
ay
All Screening Service (%) 90%
94.4% 100.0% 90.0% 92.6% 83.8% 89.7% 81.0% 88.0% 94.3% 100.0% 90.9% 80.9% 64.0%
All Screening Service 1 0 2 2 3 3.5 4 3 1 0 0.5 4.5 4.5
104
days
Volume of Patients Waiting Longer than 104
Days at Month End 56 61 69 59 54 50 58 44 62 52 53 72 59
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
2019/20 2020/21
Urgent GP Referral Cancer 62 Day Wait - All Cancers
62 Day Wait - All Cancer Performance (%) Target Trust Trajectory
In accordance with the national directive issued on 17 March 2020, non urgent
diagnostics activity at the Trust has been stood down. This has had a
significant impact upon both the volumes of diagnostic activity undertaken and
the associated waiting list position
Performance against the diagnostic waiting times standard deteriorated by
10.3% to 69.9% at the end of April. The volume of patients waiting longer than
6 weeks for one of the specified key diagnostic tests increased from 869 at the
end of March to 1,412 at the end of April. This increase was underpinned by
the following key changes at modality level:
• Echocardiography (an increase of 222 breaches from 136 breaches at the
end of March to 358 breaches at the end of April )
• Endoscopy (an increase of 155 to 320 breaches)
• Non obstetric ultrasound (an increase of 87 to 108 breaches).
• Neurophysiology (an increase of 92 to 98 breaches)
Continued changes in the patterns of non urgent referrals for diagnostic tests
saw an increase in the overall waiting list of 1,144 patients between the end of
March and the end of April, (subject to the outcome of validation).
A more detailed explanation at individual modality level is contained overleaf.
Diagnostics - volumes of patients waiting longer than 6 weeks for one of fifteen key diagnostics tests
22 Integrated Performance Report
May 2020 Executive Lead: Pete Adey
Area Diagnostics By Specialty May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20
Endoscopy
Colonoscopy 79.7% 72.0% 77.9% 70.1% 82.2% 66.1% 58.7% 67.7% 60.7% 67.7% 58.5% 50.0%
Cystoscopy 63.6% 66.7% 60.9% 51.7% 65.7% 60.9% 64.5% 65.0% 60.5% 65.6% 48.4% 23.7%
Flexi Sigmoidoscopy 77.4% 84.6% 80.6% 63.1% 72.0% 71.4% 64.6% 74.4% 69.8% 79.3% 60.3% 34.6%
Gastroscopy 71.9% 80.7% 85.8% 71.3% 69.5% 75.7% 76.9% 71.9% 76.6% 83.9% 73.2% 33.7%
Imaging
Barium Enema 82.0% 92.9% 80.0% 76.5% - - - - - - - -
Computed Tomography 67.8% 71.1% 72.5% 79.8% 78.4% 72.8% 75.8% 76.4% 76.7% 69.4% 79.3% 80.3%
DEXA Scan 87.2% 89.0% 86.3% 77.8% 80.5% 90.3% 100.0% 100.0% 86.9% 98.9% 69.5% 69.8%
Magnetic Resonance Imaging 71.9% 75.5% 80.6% 79.8% 89.5% 85.7% 87.2% 82.1% 85.7% 89.4% 74.7% 75.3%
Non-obstetric Ultrasound 100.0% 100.0% 100.0% 68.9% 73.9% 84.5% 84.3% 83.1% 89.1% 99.3% 98.3% 91.7%
Physiological
Measurement
Cardiology - Echocardiography 63.4% 67.5% 61.3% 47.3% 40.6% 34.0% 35.7% 36.1% 34.8% 6.4% 71.3% 39.6%
Cardiology - Electrophysiology - - - - - - - - - - - -
Neurophysiology - peripheral neurophysiology 97.7% 97.5% 100.0% 96.0% 97.0% 97.1% 98.8% 100.0% 95.7% 95.8% 91.8% 30.9%
Respiratory physiology - sleep studies 94.1% 95.2% 92.7% 69.7% 85.7% 86.5% 94.1% 76.3% 95.9% 93.9% 41.2% -
Urodynamics - pressures & flows 85.6% 90.1% 88.3% 89.8% 77.8% 100.0% 98.6% 95.1% 94.1% 98.7% 82.4% -
Total 80.4% 83.1% 83.9% 72.6% 75.6% 77.2% 78.3% 76.6% 80.7% 86.0% 80.2% 69.9%
50%55%60%65%70%75%80%85%90%95%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
6 Week Wait Referral to Key Diagnostic Test
6 Week Diagnostic Performance (%) Target Trust Trajectory
0
500
1000
1500
2000
2500
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
2019/20 2020/21
6 Week Diagnostic Breaches by Specialty Group
Endoscopy Imaging Physiological Measurement
Cardiac and Non Cardiac MRI
There were 278 patients waiting longer than 6 weeks for MRI at the end of April, of whom 108 were non cardiac MRI. Capacity was severely restricted due to the
COVID pandemic and recovery will be protracted.
Cardiac and non-cardiac CT
One hundred and eighteen patients waited longer than 6 weeks for Cardiac CT in April - a reduction from 171 in February. Five patients waited longer than 6 weeks
for non-cardiac CT in April - an increase of 5 from the end of February. This position was maintained due to good recovery prior to the COVID outbreak.
DXA
One hundred and twenty seven patients waited longer than 6 weeks in February, an increase of 122 from the end of February. The provision of DXA imaging to
routinely referred patients is currently suspended under the service prioritisation model with only clinically urgent examinations being performed.
Non-obstetric Ultrasound
One hundred and eight patients waited longer than 6 weeks for ultrasound up from 11 in February. Capacity was severely restricted due to the COVID pandemic and
recovery will be protracted.
Endoscopy
The volume of patients waiting longer than 6 weeks for an endoscopy increased from 165 at the end of March to 320 at the end of April. Implementation of the
aforementioned nationally issued guidance resulted in all Endoscopy referrals being reviewed and triaged by a consultant. Patients deemed clinically urgent were
offered a date for their test to be undertaken. Other options for treatment and review have been discussed with patients.
Echocardiography
The volume of patients waiting longer than 6 weeks for echocardiography increased by 222 to 358 patients at the end of April. All patients on the waiting list have
been individually reviewed by a Consultant, and reprioritised according to acuity. Echos identified as clinically urgent have been undertaken across the last six weeks.
Diagnostic activity is beginning to increase, albeit at a lower level than previously as a result of the need to space out lists to accommodate new cleaning protocols and
social distancing.
Diagnostics - volumes of patients waiting longer than 6 weeks for one of fifteen key diagnostics tests
23 Integrated Performance Report
May 2020 Executive Lead: Pete Adey
There was a significant improvement in the delayed transfers of Care (DToC) performance in April, with an average of only 11 patients each day experiencing delay
in their discharge from the acute hospital, compared to 44 in March Despite challenging circumstances, including an increase in Urgent Community Response (UCR)
Team referrals by 22% from 575 in March to 705 in April, the introduction of streamlined discharge pathways which ensure that social care assessments are
completed outside of the hospital setting and align with national COVID discharge guidance, helped enable the trajectory of no more than 15 patients to be met for the
first time.
The number of hours of personal care backfill have also decreased in April as a result of a reduction in demand (clients declining the provision of care) combined with
a temporary increase in capacity (with care staff electing not to take annual leave).
As part of the Trust’s redesign and long term recovery plan, there will be a strong emphasis upon maintaining reduced volumes of delayed transfers of care and
“green to go” patients, and sustaining the good practice which has supported this position.
Delayed Transfers of Care – Volumes of patients identified as clinically ready for discharge
24 Integrated Performance Report
May 2020 Executive Lead: Pete Adey
0
10
20
30
40
50
60
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Acute DTOC - Average Volume vs. Trajectory
Volume Trajectory
585
617
585
594
632
542
568
651
641
598
719
595
575
705
-
2.00
4.00
6.00
8.00
10.00
12.00
14.00
-
100
200
300
400
500
600
700
800
Mar-
19
Apr-
19
May-1
9
Ju
n-1
9
Ju
l-19
Aug
-19
Sep
-19
Oct-
19
No
v-1
9
De
c-1
9
Ja
n-2
0
Feb
-20
Mar-
20
Apr-
20
To
tal
Refe
rrals
UCR Referrals & Length of stay on Caseload
Total referrals LOS on Caseload Linear (Total referrals)
121 99 98 112 143 260 197 203 205 229 294 243 322 275 337
241 201 244 273 259
316 284 318 286 288
366 257 278 280 377 323
171 136 156 182 171
156
227 216 235 235 217
130 100 157
210 110
68
0
200
400
600
800
1,000
Feb
-19
Mar-
19
Apr-
19
May-1
9
Ju
n-1
9
Ju
l-19
Aug
-19
Sep
-19
Oct-
19
No
v-1
9
De
c-1
9
Ja
n-2
0
Feb
-20
Mar-
20
Apr-
20
May-2
0
Average Weekly Hours Requiring Personal Care Backfill
Zone 3 & 8 (Mid Devon) Zone 4 (Exeter) Zone 5 (East Devon)
Executive Lead: Professor Adrian Harris
Mortality Rates – SHMI & HSMR – Rate of mortality adjusted for case mix and patient demographics
25 Integrated Performance Report
May 2020
In March 2020, two important measures were implemented to improve the
accuracy of the data submitted for mortality index calculation – an issue driving
elevated rates. A further three measures are planned for implementation.
The nature of hospital activity in the most recent data bears little resemblance to
activity since the start of the COVID response. It will be very difficult to
meaningfully interpret mortality rates during the COVID surge due to
fundamental changes activity & COVID prevalence variation across the country.
The Trust has appointed three new Medical Examiners. The service is due to
commence within two months enabling completion of training & appointment of
medical examiner officers.
A thematic review of 105 most recent SJRs has provided a detailed account of
opportunities for improvement highlighted by reviewers. Many of the themes
identified will inform the content of a series of Trust-wide education events
planned for later this year.
80
90
100
110
120
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
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Hospital-level Mortality Indicator (SHMI) - Rolling 12 months
Position Upper Limit Lower Limit
60
80
100
120
140
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
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Hospital-level Mortality Indicator (SHMI) Rolling 3 months
SHMI Lower Limit Upper Limit
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
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Mortality Indicator (SHMI) Rolling 3 months - Weekday Admissions
SHMI Lower Limit Upper Limit
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
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2017/18 2018/19 2019/20
Mortality Indicator (SHMI) Rolling 3 months - Weekend Admissions
SHMI Lower Limit Upper Limit
80
85
90
95
100
105
110
115
120
125
Apr
May
Ju
n
Ju
l
Aug
Sep
Oct
No
v
De
c
Ja
n
Feb
Mar
2019/20
HSMR (12 Month Rolling)
HSMR
The indicators for stroke are showing a decline from March to April representative of COVID surge planning and changes to the configuration of capacity.
The stroke pathway since COVID has had to adapt and has faced some challenges with changes in ward allocation impacting on the stroke hyper acute, acute, post-
acute and rehabilitation pathways; however the Stroke Team has worked tirelessly during this initial COVID surge, having had to plan rapidly, make changes and
adapt quickly to different working practices to keep stroke patients and staff safe.
All mandatory NHS England national audits including SSNAP have been suspended presently.
Stroke Performance – Quality of care metrics for patients admitted following a stroke
26 Integrated Performance Report
May 2020 Executive Lead: Professor Adrian Harris
65%
70%
75%
80%
85%
90%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Proportion of patients admitted following a Stroke spending 90% or more of their stay on the Stroke unit
Unvalidated Position Validated Position Target
0%
10%
20%
30%
40%
50%
60%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
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 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Average Thrombolysis Times (minutes)
Trust Door to Needle Trust Call to Needle
National Door to Needle National Call to Needle
Sickness and Absence
• In April the reported monthly sickness rate (excluding COVID-19) decreased to 3.8% from 4.0% in March.
• There were 96 sickness absence episodes recorded in April attributed to COVID-19. It is important to note the 3.8% rate quoted does not take account of significant staff
absence in April due to COVID-19 related self isolating to prevent the further spread of the virus. National guidance advised such absences be recorded as ‘other leave’ and
not sickness.
• The rate of absence related to COVID-19 in April was 7.6%. By the end of April this has reduced toc.5%.
Turnover
• The Trust wide turnover rate has decreased slightly this month from 10.7% to 10.5% for the past 12 months.
• The rate for Registered Nursing also showed a small decrease from 10.4% to 10.3%.
Recruitment 2019/20
• A total of 288 registered Nursing and Midwifery staff were recruited in the 12 months ending 30th April. Additionally in April 43 final year student nurses were recruited to supplement
the registered nurse workforce.
Other Workforce Indicators
27 Integrated Performance Report
May 2020 Executive Lead: Hannah Foster
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
Nov
Dec
Ja
n
Feb
Mar
Ap
r
2019/20 2020/21
Sickness Absence by Top 5 (inc. Other)
Other Injury, fracture Cold, Cough, Flu - InfluenzaGastrointestinal problems Musculoskeletal problems Stress (and related illness)Target Trust Position
9.0%
9.5%
10.0%
10.5%
11.0%
11.5%
12.0%
12.5%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
12 Monthly Turnover
Position Target
-6%
-4%
-2%
0%
2%
4%
6%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
2019/20 2020/21
Established FTE vs. Plan
Variance to Plan Target low Target High
PLA
N
0
50
100
150
200
250
Ap
r
May
Ju
n
Ju
l
Au
g
Se
p
Oct
No
v
De
c
Ja
n
Feb
Mar
Ap
r
2019/20 2020/21
Volume of Newly Recruited Members of Staff
Add Prof Scientific and Technic Additional Clinical ServicesAdministrative and Clerical Allied Health ProfessionalsEstates and Ancillary Healthcare ScientistsMedical and Dental Nursing and Midwifery Registered
Executive Lead: Chris Tidman
Finance - Income & Expenditure
28 Integrated Performance Report
May 2020
I & E
Surplus/(Deficit)
Income Variance
to Budget
Fav/(-Adv.)
(£'000)
Patient Income / top-up
NHSE/I have notified a block value for patient income and a top-up payment to the Trust for the first four months of the year. Patient income is therefore in line with budget.
Commercial Income
Commercial income has under-recovered by £511k year to date, mostly relating to under recovery of commercial income as a result of COVID 19 (£582k, including Car Parking (£207k), Catering / restaurant (£198k), Fertility (£69k), Blood sciences (£52k) and Nursery (£46k).
-90
-511
00
Year to Date
NHS
Private patients
Commercial
Education
R & D
Total
-520
Month 1 Summary Finance position
• The Trust is reporting a break even financial position for month 1 in line with national guidance. • The Trust's financial position will continue to be break-even for the first four months of the year of after NHSE/I have notified a block value for patient income and a
top-up payment. A retrospective top up or claw back will be made each month to achieve a break even position. It is expected that this process will continue until the end of October with updated block and top up payments and more rules regarding the retrospective payment past July
• A direct claim for the Trusts Covid costs of £2.6m for reimbursement from from NHSE/I COVID fund in April. The Trust will also receive a topup for any underlying increase in its net run rate (£2.0m in April including a loss of commercial income of £582k).
• Expenditure and commercial income budgets have been rolled over from the previous financial year and inflation added relating to pay. • In month 1 pay has overspent by £529k and non pay of £211k.• The Trust savings programme is currently on hold, however will form part of the recovery phase.• The Trust has incurred £33k as a result of setup costs for the Nightingale Hospital during April. These costs will be recovered as part of the retrospective top-up
payment.• Cash as at the end of April is £104.1m, an increase of £46.0m on the value held at the year end.• Expenditure budgets have not been adjusted for any budget setting requests at Month 1. The Trust is reviewing budget setting requests in light of COVID 19 and new
ways of working.
Finance – Pay & Non-Pay
29 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Non Pay
and Reserves
Fav/(-Adv.)
(£'000)
Pay
Fav/(-Adv.)
(£'000)
Agency Staffing
(exc COVID
costs)
£000
Pay has overspent by £528k in April - overspends on medical staff (£221k), nursing (£149k), admin & managers (£15k) and other staff (£143k).
• Pay inflation for Agenda for Change (AfC) staff and Junior Medical Staff have been applied to budgets and paid from month 1 in line with national guidance. The Trust awaits guidance for Senior Medical Staff pay inflation, however 2.5% has been provided for and included in this position. There is a risk that when the national guidance is announced ring-fenced funding might not be sufficient to cover the actual increase.
• Medical staff expenditure has overspent by £221k in April. This mostly relates to Junior Doctors and additional sessions.Consultant job plans will need to be reviewed to ensure they continue to reflect current and future working patterns.
• Nursing staff expenditure is overspent by £149k in April, mostly relating to self isolation/sickness cover in response to COVID 19. In the light of the unusually low bed occupancy, nursing teams are now reviewing the use of bank and agency requests, to ensure nurse redeployment is being fully optimised.
• The overspend on "other" staff of £143k mostly relates to Domestic Services £53k, Radiology £44k and Genomic Lab £27k.
• Pay budget have not been adjusted for any budget setting requests at month 1, The Trust is reviewing requests budget setting in light of COVID 19 and new ways of working.
-221
-149
-15
-143
Year to Date
Med Staff
Nursing
Admin & Mgrs
Others
Total
Variance
-528
Non-pay expenditure (excluding R&D) at the end of April is £211k overspent.
An overspend on drugs of £710k (£980k overspend relates to PbR drugs which is refunded in the top-up income from NHSE/I) is offset with an underspend due to reduced patient activity due to COVID 19 - Clinical Supplies (£827k).
Miscellaneous Other Expenditure overspend in April (£326k) mostly relates to planned IT equipment expenditure (£202k) and smaller variances across the Trust) and Services received (£129k) relates to activity at other organisations and an increase in send away testing.
-710
827
127
0
-129
-326
Non Pay Year to Date
DrugsClinical SuppliesNon ClinicalR&D ExpenseServices ReceivedMisc. Other
Total Variance
-211
• Agency expenditure for April has amounted to £667k (£1.0m last month) with expenditure of £193k relating to Nursing, £159k for Medical staff and £315k for Other staff.
• Bank nursing has also increased due to an increased staffing requirement.
NB. March 2020 excludes the Children and Young People Alliance adjustment of £4.5m and NHSI employers' contribution of £15m; COVID and Nightingale expenditure
Finance - Cash & Capital Expenditure
30 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Capital
expenditure
Cash
Cash - Year to Date
Closing cash as at the end of April is £104.1m, an increase of £46.0m on the value held at the year end.
The increase is due to all NHS Trusts receiving May's monthly income in advance. This national NHSE&I decision was made to help support Trusts' liquidity during the Covid-19 crisis.
Capital - Year to Date
Capital additions of £2.7m were incurred in the first month of the financial year, with the majority relating to MyCare.
The capital regime has changed - STP’s are now responsible for co-ordinating the level of capital expenditure (CDEL) across their system. Each Trust will be given an annual CDEL limit by its STP. Whilst Foundation Trusts can still legally set its own capital spending, any over commitment has the potential to impact on other Trusts.
The capital programme for 2020/21 will be higher than originally forecast due to postponing the go-live date. The additional cost has been escalated to NHSE&I via the STP. Also due to COVID-19 there is a risk that it may lead to delay with implementing other capital schemes, i.e. equipment replacement schemes and some strategic schemes. Schemes will need to be reviewed to check that operationally they can be implemented, but also due to the uncertainty relating to the STP capital expenditure cap. The Board will be provided with a further update at the meeting.
The Trust is working with the Devon STP to progress with finalising its capital programme. The Trust has asked NHSE/I to increase the STP allocation by circa £30m relating to MyCare expenditure as the Trust has received loan funding for the programme. NHSE/I have currently not agreed to this increase. The capital programme for the Devon system is required to be agreed by the 29th May 2020.
Cash
Actual
£m
Opening cash balance 58.1
Cash inflow / (outflow) from operating activities 0.0
Depreciation charge - non cash expense 0.9
Working capital movements - inventories (1.2)
Working capital movements - receivables 7.0
Working capital movements - payables inc. deferred income 41.5
Capital expenditure (2.7)
Loan repayments 0.0
Loan drawn down 0.5
Closing cash balance 104.1
Capital
Year to date
£m
Capital expenditure 2.7
Finance – Divisional Position
31 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Divisional
Position
Fav/(-Adv.)
(£'000)
Divisional financial performance :
Surgery (£906k underspent) Most of the year to date underspend (£922k) relates to an underspend on clinical supplies (£970k related to a reduction in activity). This is offset with an overspend of £76k on pay.
Medicine(£198k overspent) The overspend of £198k mostly relates to pay (£230k , £198k being Medical Staff) this is offset with a £55k underspend on non pay due to reduced patientactivity (Drugs £66k and medical and surgical items £55k).
Specialist (£115k overspent) In April commercial income has under recovered by £104k relating to reduced activity in Fertility (£69k)and Blood sciences (£52k). Pay has overspent by £95k offset by non pay (£53k) and reserves (£31k).
Community (£60k underspent) Community non pay expenditure is underspent by £74k mostly relating to dressings,
906
-198-115
60
-653
Year to Date
Surgery
Medicine
Specialist
Community
Other
0
Total Variance
Financial Tables
32 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Royal Devon & Exeter NHS Foundation Trust
Actual Budget Actual
Income Statement Variance
Period ending 30/04/2020 to Budget
Month 01 Fav./(Adv.)
£000 £000 £000
Income
NHS Commissioner Block Income 37,978 37,978 0 1
NHS Clinical Income - Other and Private Patients 253 253 (0)
NHS Top up Income 2,022 2,031 (9) 1
Covid-19 related Income 2,645 2,645 0
Nightingale related Income 33 33 0
Research and Development 1,271 1,271 0
Education and Training 1,098 1,098 0
Other Income 3,470 3,981 (511)
Total income 48,770 49,289 (520)
Expense
Employee Benefits Expenses (Pay) (29,360) (28,832) (528) 2
Drug Costs (6,144) (5,435) (710) 3
Clinical Supplies (2,912) (3,739) 827
Non Clinical Supplies (344) (470) 126
Covid-19 related Costs (2,645) (2,645) 0
Nightingale related Costs (33) (33) 0
Research & Development Expenses (1,271) (1,271) 0
Misc. Other Operating Expenses (3,896) (3,569) (326)
Services Received (814) (686) (129)
Reserves / Mitigation and Cost Improvement Plan 0 (1,262) 1,262 4
Total Costs (47,420) (47,942) 523
EBITDA 1,350 1,347 3
Profit / loss on asset disposals 1 0 1
Total Depreciation (910) (910) 0
Total operating surplus (deficit) 441 437 4
20 19 1
Total interest payable on loans and leases (44) (39) (5)
PDC Dividend (417) (417) 0
Net Surplus/(deficit) (0) 0 (0)
Donated asset income & depreciation and AME impairment (17) (17) 0
Net Surplus/(deficit) after donated asset & PSF/MRET Income (17) (17) (0)
KEY MOVEMENTS
1 Block contract income and top-up income for first four months of the year.
2 Pay - overspends on Medical Staff (£221K), Nursing (£149k), Admin&Managers(£15k) and Other staffing(£143k).
3
4
Total interest receivable/ (payable) - inc committed WC facilities
Drugs and Devices overspend state pass through is over by £980k and is not recovered directly but mopped up in the top up. This being
offset with a £270K underspend on normal in tariff Drugs.
This reflects the reduced expenditure compared to the run rate derived by NHSE/I when calculating the Top-up payment. The expenditure run
rate is based on our expenditure at month 9 last financial year.
Year to Date
Financial Tables
33 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Royal Devon & Exeter NHS Foundation Trust Prior Yr
Actual March 2020
Statement of Financial Position
Period ending 30/04/2020
Month 01
£000 £000
Assets, Non-Current
Property, Plant and Equipment, Net (including intangibles) 251,186 249,390 1
Investment in joint venture 5 5
Non NHS Trade Receivables, Non-Current 2,574 2,455
Assets, Non-Current, Total 253,765 251,850
Assets, Current
Inventories 9,917 8,709
Trade and Other Receivables, Net, Current 28,125 35,133 2
Non Current Assets held for sale 0 0
Cash 104,148 58,081 3
Other Assets - Current Assets Held by Charitable Funds 0 0
Assets, Current, Total 142,190 101,923
Liabilities, Current
Loans, non-commercial, Current (DH, FTFF, NLF, etc) (3,215) (3,171)
Finance leases - Current 0 0
Trade and Other Payables, Current (57,705) (15,480) 4
Deferred Income, Current (7,407) (5,163) 5
Provisions, Current (352) (352)
Current Tax Payables (7,233) (7,131)
Other Financial Liabilities, Current (23,950) (26,867) 6
Liabilities, Current, Total (99,862) (58,164)
NET CURRENT ASSETS (LIABILITIES) 42,328 43,759
TOTAL ASSETS LESS CURRENT LIABILITIES 296,093 295,609
Liabilities, Non-Current
Loans, Non-Current, non-commercial (DH, FTFF, NLF, etc) (59,576) (59,075)
Deferred income - Non-current (2,048) (2,048)
Other Creditors, Non-Current 0 0
Provisions, Non-Current (1,437) (1,437)
TOTAL ASSETS EMPLOYED 233,032 233,049
TAX PAYERS' EQUITY
Public dividend capital 161,055 161,055
Retained Earnings (Accumulated Losses) 41,103 41,120
Charitable Funds 0 0
Revaluation Reserve 30,874 30,874
Donated Asset Reserve 0 0
TOTAL TAX PAYERS' EQUITY 233,032 233,049
KEY MOVEMENTS
1
2
3
4
5
6
Deferred income is £2.2m higher than at March-20, including HEE / SIFT income of £2.8m received in advance.
Other Financial Liabilities are £2.9m lower than at March-20 reflecting the invoices that were not approved at year end due
to operational pressures, now approved and awaiting payment in Trade Payables.
Year to Date
Property, Plant and Equipment is £1.8m higher than at March-20, with capital expenditure being £2.7m and depreciation of
£0.9m in April.
Trade and other receivables are £7m lower than at March-20 with NHS Trade receivables being £8.9m lower due to an
improvement in collecting NHS receivables due, particularly the receipt of £3.9m Devon CCG M12 Blocks and £6.3m from
NHS England, plus the receipt of £1.1m Covid19 funding from NHSE, accrued at March-20. Non NHS Trade Receivables
are £1.4m lower than March-20, reflecting the reduction in activity during April. Prepayments are £2.9m higher due to the
timing of payments made in April 2020, including rates prepayment of £1.7m.
Cash is £46.1m higher than at March, as this income includes block payments received in advance for May 2020 of
£37.9m. The cash flow statement provides greater analysis of the key variances.
Trade and other payables are £42.2m higher than at March-20, including NHS Trade Payables, which are £38.9m higher.
This is primarily due to the reciept of additional months block income meant to assist the organisations cash flow during
Covid 19. Non NHS Trade Payables are £3.4m higher that at March-20, due to a delay in approving invoices at the year
end, due to operational pressures caused by Covid 19.
Financial Tables
34 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Royal Devon & Exeter NHS Foundation Trust Prior Yr
Actual March 2020
Cash Flow Statement
Period ending 30/04/2020
Month 01
£000 £000
NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES
Surplus/(deficit) after tax (17) (32,394)
Non-cash flows in operating surplus/(deficit)
Finance (income)/charges 24 (142)
Depreciation and amortisation 927 9,706
Impairment 0 26,508
PDC dividend expense 417 4,410
Other increases/(decreases) to reconcile to profit/(loss) from operations (1) 5
Other recognised gains/losses straight to reserves
Non-cash flows in operating surplus/(deficit), Total 1,367 40,487
Increase/(Decrease) in working capital
(Increase)/decrease in inventories (1,208) (934)
(Increase)/decrease in NHS Trade Receivables 8,897 10,709
(Increase)/decrease in Non NHS Trade Receivables 1,373 134
(Increase)/decrease in other receivables (502) (33)
(Increase)/decrease in accrued income (250) (3,002)
(Increase)/decrease in prepayments (2,928) (677)
Increase/(decrease) in Deferred Income (excl. Donated Assets) 2,244 1,691
Increase/(decrease) in provisions 0 1,188
Increase/(decrease) in Trade Creditors 42,234 (2,437)
Increase/(decrease) in tax payable 102 463
Increase/(decrease) in Other Creditors 134 296
Increase/(decrease) in accruals (2,917) 5,783
Increase/(Decrease) in working capital, Total 47,180 13,181
Net cash inflow/(outflow) from investing activities
Property - new land, buildings or dwellings (2,721) (49,601)
Property - maintenance expenditure 0 0
Plant and equipment - Information Technology 0 0
Plant and equipment - Other 0 0
Proceeds on disposal of property, plant and equipment 0 0
Increase/(decrease) in Capital Creditors (143) (1,164)
Other cash flows from financing activities 0 0
Net cash inflow/(outflow) from investing activities, Total (2,864) (50,765)
Net cash inflow/(outflow) from financing activities
PDC Dividends paid 0 (5,110)
PDC Dividend Received 0 3,524
Interest (paid) on non-commercial loans 0 (542)
Interest received on cash and cash equivalents 20 684
Repayment of non-commercial loans (8) (1,270)
Receipt of finance leases and loans 509 9,150
(Increase)/decrease in non-current receivables (119) (1,302)
Increase/(decrease) in non-current payables 0 0
Net cash inflow/(outflow) from financing activities, Total 402 5,134
Net increase/(decrease) in cash and cash equivalents 46,068 (24,357)
Opening cash and cash equivalents 58,081 82,440
Closing cash and cash equivalents 104,149 58,083
Year to Date
Financial Tables
35 Integrated Performance Report
May 2020 Executive Lead: Chris Tidman
Royal Devon and Exeter NHS Foundation Trust
Capital Expenditure
Period ending 30/04/2020
Month 1
Scheme Approval level
YTD actual
expenditure
£'000
FBC 1,769
CRIC 218
CRIC 1
CRIC / Unapproved 734
2,721
Approval Level Key
CRIC Capital and Revenue Investment Case
SOC Strategic outline case
OBC Outline business case
FBC Full business case
Notes
Other schemes < £500k and contingency
Total 2020/21 Capital Schemes
My Care
Estates Infrastructure
Bowmoor House
Actual expenditure