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THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

Board Paper - Cover Sheet

Date November 2016

Report Title

Business Delivery & Performance Report

Agenda Item:A5 (ii)

Lead Director

Report Author

Louise Robson

Jo McCallumClassification NHS Unclassified / NHS Protect / NHS Confidential

Purpose (Tick one only)

Approval Discussion For Information

Links to Strategic Objectives

To put patients and carers at the centre of all we do and to provide care of the highest standard in terms of both safety and quality

To continue to be recognised as a first class teaching hospital, counted amongst the top 10 in the country, which promotes a culture of excellence, in all that we do.

Links to CQC Domains/Fundamental Standard(s)

The BD&P Report is relevant to all the CQC domains but particularly the “good governance”, “person centred care” and “display of ratings” domains.

Identified Risk? (If yes, risk reference)

2745 - Failure of Trust-wide Performance StandardsAdditional risks on service-specific Risk Registers

Resource Implications

A number of resource implications within Directorates to meet both planned activity levels and key operational standards

Legal implications and equality and diversity assessment

E&D implications in relation to a number of issues included in the paper

Benefit to patients and the public

To ensure patients receive an excellent standard of care and promote a cycle of continuous improvement

Report History Routine BD&P report to Board

Next steps To closely monitor and promptly escalate any risks/issues

Healthcare at its very best - with a personal touch

Service Quality & Performance Report

April - November 2016

Healthcare at its very best - with a personal touch

Service Quality & Performance Report December 2016

1. EXECUTIVE SUMMARY

1.1. This report outlines a level of detail regarding the Trust’s performance for the period April 2016 to November 2016. This summary pulls out the key issues and implications.

1.2. It is hoped that Directors find the report useful, informative and straightforward to follow. Feedback is always most welcome

2. INTRODUCTION

2.1. This Business Delivery & Performance Report is reporting the period April 2016 to November 2016. The format and content of the report will continue to evolve, but it is hoped that Directors find the style of reporting useful, informative and straightforward to follow.

2.2. The remainder of the report sets out the activity and key targets the Trust has to deliver in 2016/17. The report will also specify financial penalties where they apply.

2.3. NHS England’s Final Standard Contract 2017/18-2018/19 sees little change to the content of national performance indicators. However, the arrangements in respect of financial sanctions will vary depending on whether a provider is granted funding from the general element of the Sustainability and Transformation Fund (STF) and agrees an annual financial control total.

2.4. The Appendices give a more detailed breakdown of some of the performance, for example, performance by Directorate and/or site level and additional activity such as critical care, maternity and chemo/radiotherapy. However the report itself will include key figures and graphics to demonstrate the Trust’s position and where possible, how it compares to other providers. As always, feedback is most welcome.

3. TRUST WAITING TIMES

3.1. Directors’ Summary

3.2. This section details the Trust’s performance against 18 Weeks, Cancer and Diagnostics standards. As the issues with compliance are increasingly complex, the position is summarised below:

The Incomplete (92%) 18 Weeks target was achieved Trust-wide during November 2016.

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The Admitted (90%) 18 Weeks metrics were achieved Trust-wide during November 2016.

Whilst the Non-Admitted (95%) performance has yet to be finalised, the Trust is expecting to achieve the standard at a Trust level.

The Trust met all of the Cancer standards with the exception of the 31 day subsequent treatment for drugs in October 2016;

Whilst the Trust achieved the 6 week diagnostic standard in November 2016, sustaining compliance remains very challenging.

3.3. 18 Weeks Referral to Treatment (RTT)

3.4. Table 1 shows the Trust performance by specialty for the 18 weeks targets in November 2016:

92% of incomplete pathways are under 18 weeks 95% of non-admitted patients are treated within 18 weeks Local 90% of admitted patients are treated within 18 weeks Monitoring

Table 1: 18 Weeks Compliance by Speciality - November 2016

RTT Specialty (C)Non-

Admitted (>95%)

Admitted (>90%)

Incompletes (>92%)

100 - GENERAL SURGERY

To be updated

94.6% 95.7%101 - UROLOGY 96.9% 97.9%110 - TRAUMA & ORTHOPAEDICS 78.5% 81.2%120 - EAR NOSE & THROAT 88.9% 95.2%130 - OPHTHALMOLOGY 95.2% 98.3%140 - ORAL SURGERY 73.7% 94.8%150 - NEUROSURGERY 88.5% 97.4%160 - PLASTIC SURGERY 91.4% 92.1%170 - CARDIOTHORACIC SURGERY 100.0% 97.5%300 - GENERAL MEDICINE 100.0% 93.8%301 - GASTROENTEROLOGY 100.0% 96.3%320 - CARDIOLOGY 90.0% 94.0%330 - DERMATOLOGY 85.9% 94.6%340 - RESPIRATORY MEDICINE 100.0% 96.0%400 - NEUROLOGY 100.0% 95.3%410 - RHEUMATOLOGY 100.0% 96.2%430 - CARE OF THE ELDERLY 100.0% 99.6%502 - GYNAECOLOGY 88.3% 93.8%X01 TOTAL 89.7% 93.1%TOTAL 90.2% 94.1%

3.5. Directors will note that the Trust met the overall Incomplete and Admitted targets in November 2016. From a national perspective, the RTT Incomplete target has not been achieved for some time, with October performance at 90.4%. Chart 1 shows the position across England; the dark blue line shows

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how rapidly waiting times have grown over the last 12 months whilst the pale blue lines show that Trusts are responding by treating the longest waiting patients.

Chart 1: 18 Weeks Compliance by Speciality - November 2016

3.6. Although the Incompletes target was achieved overall, there was a specialty level breach in Trauma and Orthopaedics (689). In total, the penalty will amount to a fine of £206.7k for November 2016 (Table 2). Whilst Newcastle Gateshead CCG committed to reinvesting the spinal penalties in this year’s contract agreement (based on the recommendations of the Spinal Task & Finish Group), they recently confirmed they do not have the funds to reinvest the Quarter 2 penalty at this moment in time.

3.7. As previously reported, the Trust submitted a mitigation paper for the true ‘T&O’ element of the penalty asking for reinvestment of £322.8k. The Trust is currently awaiting formal feedback from the CCG Executive Team.

Table 2: 18 Weeks Compliance within T&O - November 2016

RTT Specialty (C)Total PTL

Backlog % Excess Breache

s

Penalty

110 - TRAUMA & ORTHOPAEDICS 3797 597 84.28% 294 £88,200108 - SPINAL SURGERY ORTHOPAEDICS 1763 479 72.83% 338 £101,40010801 - SPINAL SURGERY NEUROSURGERY 823 123 85.05% 58 £17,400Combined 6383 1199 81.22% 689 £206,700

3.8. Whilst the Admitted target was achieved overall, there were 7 areas where the standard was breached at a specialty level (this is the highest number of specialities breaching in over 20 months); Trauma & Orthopaedics, Dermatology, ENT, Oral Surgery, Neurosurgery, Dermatology and

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Gyneacology totaling 123 excess breaching patients (a reduction of 4 since last month which is attributable to Dermatology).

3.9. Appendix shows the geographical spread of breaches for November to further clarify for Directors where issues lie. In almost all cases, services experiencing breaches have developed action plans to achieve compliance and in most cases, they are providing additional capacity to treat patients. Table 3 demonstrates the RTT penalties incurred April to November 2016.

Table 3: RTT Penalties

Indicator

Pena

lty

per

brea

ch

Jul-1

6

Aug

-16

Sept

-16

Oct

-16

Nov

-16

Incomplete Penalty£300

£184.8k £185.1k £247.5k £256.5k £206.7kAgreed Reinvestment 0 0 0 TBC TBCPenalty Total £ £184.8k £185.1k £247.5k TBC TBC

3.10. Following the significant increase in the RTT backlog as reported in September 2016, the backlog has continued to decrease with a reduction of 293 in November 2016 (Table 4). Further analysis will be undertaken to better understand the significant shifts in backlog.

Table 4: 18 Weeks Backlog by Directorate – November 2016

Directorate BacklogChange from

previous month

Backlog Direction

Cancer Services 0 -2 Cardiothoracic Services 215 -21 Children’s Services 73 -8 Clinical Genetics 8 2 Dental Hospital & School 167 -25 ENT 295 -19 Internal Medicine 281 -16 Musculoskeletal Services 1147 -215 Neurosciences 294 -24 P.O.D. 449 62 Peri-op and Critical Care 94 30 Renal Services 41 7 Surgical Services 298 -32 Therapy Services 21 -13 Women’s Services 156 -19 Trust Total 3539 -293

3.11. The contract specifies a zero tolerance on over 52 week waiters and the Trust maintained this target in November 2016. The legally binding contracts also

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require a quarterly reduction in over 36 week waiters by specialty. There is no penalty stipulated in the contract but it is good practice to achieve this standard.

3.12. Chart 2 shows that the over 36 week waiters in November reduced by 21 from October. This is largely due to an increased focus on this within the Trust and new patient-specific actions to reduce the number of long-waiters.

Chart 2: Over 36 week waits (All Specialties) Trend

0

1000

2000

3000

4000

5000

6000

0

50

100

150

200

250

300

350

Apr-

14

Jun-

14

Aug-

14

Oct

-14

Dec-

14

Feb-

15

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15

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15

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-15

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15

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Jun-

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Aug-

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-16

Tota

l bac

klog

Back

log

>18w

ks

Backlog (>36 weeks) Total backlog

Milestone Month

3.13. As shown in Table 5, Newcastle was ranked first in the Shelford Group for RTT Incomplete performance in October 2016 and is comfortably above the England average of 90.4%.

Table 5: RTT Performance NuTH vs Shelford & England

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3.14. Table 6 shows the number of patients waiting to be seen for a first appointment by length of wait (all current patients regardless of appointment status). The accompanying Chart 3 shows that the total number of patients waiting for a first appointment has decreased and is 2,855 patients below last months position which is the largest drop this fiscal year.

Table 6: Weeks from Referral to First Seen – 2016/17

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-160 to 5 weeks 11,206 11,197 12,227 12,557 11,874 12,086 12,829 11,924 06 to 11 weeks 17,225 17,568 17,391 18,022 19,850 18,811 18,381 17,352 12 to 15 weeks 4,599 4,799 4,836 5,542 5,997 5,524 5,140 4,675 16 to 18 weeks 1,375 1,736 1,781 1,786 2,070 2,348 2,121 1,771 Greater than 18 weeks 3,365 3,343 3,131 3,218 3,385 3,424 3,628 3,522 Grand Total 37,770 38,643 39,366 41,125 43,176 42,193 42,099 39,244 Percent over 12wks 24.73% 25.56% 24.76% 25.64% 26.52% 26.77% 25.87% 25.40%Percent over 18wks 8.91% 8.65% 7.95% 7.82% 7.84% 8.12% 8.62% 8.97%

Chart 3: Outpatient Waiters (All Specialties) Trend

3.15. Table 7 shows the top 5 Directorates/Specialties (based on volume of patients waiting for a first outpatient appointment). Most of the specialties are showing an decrease in total outpatient waiters since last month.

Table 7: Top 5 – all patients awaiting a 1st Outpatient Appointment

Directorate Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16Ophthalmology 4047 4154 4391 4397 4532 4343 4415 4296ENT 3982 4276 4442 4388 4367 4306 4377 4157Maxillofacial/Oral Surgery 3067 3124 3227 3671 4225 4095 4172 3947Cardiothoracic 3274 3370 3243 3341 3400 3532 3854 3714Medicine and COE 3812 3624 3697 3702 3919 3961 3948 3473

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3.16. Diagnostic Waits

3.17. The Trust met the 99% diagnostic target in November 2016 for the first time since March 2016, achieving 99.01% (Table 8). Although the Trust was compliant, there are still significant pressures within key diagnostic tests and routine meetings and action plans continue.

Table 8: Diagnostic Breaches (15 Key Diagnostic Tests)

Jul-16 Aug-16 Sept-16 Oct-16 Nov-16

Number of Breaches 110 163 139 118 90Number of ‘Excess’ Breaches 13 72 53 29 0Penalty £2.6k £14.4k £10.6k £5.8k -Number of Patients Waiting 9,637 9,039 8,552 8,802 9,108Compliance 98.9% 98.2% 98.4% 98.7% 99.01%

3.18. The Trust-wide action plan (Table 9) is being routinely monitored and meetings are continuing with Directorate Managers to agree medium and long term trajectories. Furthermore, the diagnostic action plans, 7 day services audit and diagnostic service improvement plan are being reviewed in tandem to ensure a joined up approach.

Table 9: Diagnostic Action Plan

Issue Progress 01.12.16

1) MRI New RVI scanner has been successfully commissioned and is operational (still recruiting to posts)

New Neuro scanner due for install and handover in December (estimated), already reduced GA capacity

Equipment at FH ageing - risk Continued outsourcing Providing additional waiting list initiatives in-house. Additional Radiographers recruited but would require additional 2 years training

to operate MRI scanners Agreeing short, medium and long term solutions with Cardiothoracic Directorate

2) Cardiac ECHO – Locum Physiologist in post. WLI continuing. Outsourcing to Spire. Demand Capacity work ongoing

3) Paediatric Sleep Study

New equipment operational Capacity identified on acute paediatric ward Alternative home sleep study provided in a small number of cases Risk of bed availability due to Winter pressures Bank staff use Locum Physiologist in post required for backlog and to maintain service Business case for sustainability

4) Urodynamics - WLI sessions Consultant commenced in August.

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Locum Consultant in post to cover short term Consultant returned from sickness. Nurse consultant appointed start date in January 2016. Nurse practitioner working independently.

4. Cancer Waits

4.1. Due to the timing of submissions, cancer data runs one month behind the majority of performance data, this paper therefore reports the October 2016 position. Appendix 1 shows the Directorate cancer compliance. All breaching services are flagged to ensure that Directors have full view of the high risk areas.

4.2. The Breast Symptomatic Two Week Wait target and the 2WW Suspected Cancer target continue to be achieved. Most tumour groups in the 2ww suspected cancer standard experienced fewer referrals with the biggest decrease in Skin referrals; breaches equated to 5.8% of the total referrals. There were no reported capacity issues and all breaches were reported as patient choice. There was no change in the numbers in the Breast Symptomatic Target. The projected outturn for 2WW Suspected Cancer referrals 2016/17 shows an overall increase of 4% in comparison to 2015/16.

4.3. The 62 day target for October was achieved at 87.2% against the 85% standard. Whilst performance is nationally reported at Trust level, internal reporting by tumour group showed those falling considerably below the 85% standard were Lung (69.7%), HPB (66.6%) and Head & Neck (62.5%). Sarcoma also featured with 1 patient treated in the standard who breached, giving them a 0% compliance. These and a number of other tumour groups remain a cause for concern.

4.4. Across NESCN, 3 of the 9 Trusts, Sunderland (84.3%), South Tees (75.1%), and Durham & Darlington (82.9%), failed the 62 day standard for October. The national average was reported at 80.9%.

4.5. The Trust achieved the 90% screening standard for October, reporting performance at 96.3%.

4.6. The Trust achieved the 31 day standard to first treatment for October at 99.3% against the 96% standard. Treatment numbers were at their lowest since April 2016. The projected outturn for 2016/17 shows no increase in the patient numbers in this standard.

4.7. The Subsequent treatment target for Radiotherapy and Surgery were achieved. However, the Subsequent Drug Treatment failed the standard reporting

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performance at 96.6% against the 98% standard. There were 5 breaches of this standard, 3 recorded as patient choice and 2 due to patient fitness. This standard is repeatedly challenging and efforts are being made to ensure that administering of drugs is captured in a robust and timely way.

4.8. Looking forward to November 2016, data is currently being validated but reports show all cancer standards are on target to achieve. The position for 62 day standard is currently 88% against the 85% standard. Root Cause Analyses are underway to better understand the reasons for breaches which are predominantly in Lung, HPB and OG.

4.9. The Corporate Cancer Team continues to work with all tumour groups to establish robust processes to support the new breach re-allocation guidance. The national IT system will not be available until April 2017 so in the interim providers must work together to implement local solutions for reporting. A breach re-allocation policy has been drafted by the Cancer Alliance with input from all stakeholders.

4.10. As reported previously, the “Backstop” policy requires review and weekly reporting to the CCG of any long waiters (patients classified as waiting 104 days or more). Table 10 shows the most recent position. Patients are often delayed because of medical fitness or diagnostic uncertainty. In all cases, the patients are being actively tracked and clinical teams are aware of their pathway status. The pathway of any patient who has waited more than 104 days to be treated is reviewed by the Trust Cancer Clinician and assessed for harm. Since implementation in October 2015, none of the long wait patients have been identified as ‘coming to harm’.

Table 10: Cancer Patients waiting >104 days

Tumour Group Number of Patients Waiting with

Decision to Treat

Number of patients Waiting Without Decision to Treat

Breast 0 0Gynae 0 2Head & Neck 0 0HPB 0 1Lower GI 1 1Lung 1 1Sarcoma 0 2Skin 0 1Upper GI 2 2Urology 1 1Total 5 11

4.11. The Corporate Cancer Team continues to review and discuss cancer pathways with each Directorate to ensure that cancer remains a high priority. Areas that

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continue to be a cause for concern are endoscopy, radiology (particularly breast radiology) and elements of the pathology service.

Table 11: Cancer Targets as at October 2016

Cancer

Qua

rter

116

/17

Jul-1

6

Aug-

16

Sep-

16

Qua

rter

2

16/1

7

Oct

-16

All cancers: 2 week wait (C,M)(Target 93.0%)

95.9% 95.7% 96.5% 94.6% 95.6% 94.2%

2 Week Wait for Symptomatic Breast Patients (Cancer Not initially Suspected) (C,M)(Target 93.0%)

96.4% 95.2% 96.4% 94.1% 95.1% 97.0%

All cancers: 1 month diagnosis to first treatment (C,M)(Target 96.0%)

97.9% 98.7% 98.2% 98.2% 98.4% 99.3%

All cancers: 1 month diagnosis to subsequent treatment – surgery (C,M)(Target 94.0%)

96.8% 96.8% 97.5% 93.5% 95.8% 96.5%

All cancers: 1 month diagnosis to subsequent treatment – drug (SS,M)(Target 98.0%)

100% 100% 100% 98.5% 99.2% 96.6%

All cancers: 1 month diagnosis to subsequent treatment – radiotherapy (SS,M)(Target 94.0%)

98.7% 98.7% 98.4% 98.0% 98.6% 98.5%

All cancers: 2 month urgent referral to treatment (C,M)(Target 85.0%)

85.1% 91.1% 88.4% 85.0% 87.9% 87.2%

Percentage patients referred from cancer screening service treated within 62 days (C,M)(Target 90.0%)

95.2% 95.6% 96.0% 95.5% 95.7% 96.3%

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5. EMERGENCY CARE (INCLUDING A&E INDICATORS)

5.1. Directors will note that the Trust failed to meet the A&E 4hr target in November 2016 at 92.95% (Table 12). Unfortunately, the A&E performance for Type 1 (main RVI ED) missed meeting the standard at 89.16% for the fourth month in a row. Looking forward, December is currently below target at 88% (to 11 th

December 2016), with the Quarter 3 performance at 93.3%. Whilst there has been no real change to the volume of Main ED attendances, the department have reported multiple issues; a higher level of acuity in patients attending ED, staffing pressures, implementation of ‘paper lite’ and bed pressures.

5.2. The ‘A&E Improvement Programme’ continues to progress at pace with a number of new initiatives being developed and piloted. Whilst it is difficult to currently predict the impact on the A&E 4hr performance, the programme is tackling the hospital wide issues, such as timely Consultant review, diagnostic pressures and delayed discharges. There is also a stream to review Paediatrics.

5.3. Recent guidance reported that NHS Trusts will have to report how quickly they are treating patients experiencing mental health crisis in A&E or hospital wards from April 2017 as part of new NHS England standards. Liaison psychiatry is one of nine priority areas as set out in the 2 year planning guidance for 2017-19 and NHS England recently announced a £30m fund which A&E delivery boards could bid against to extend liaison psychiatry services.

Table 12: Emergency (A&E) Indicators

Emergency Indicators

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sept

-16

Oct

-16

Nov

-16

Percentage of A & E attendances where the patient was admitted, transferred or discharged within 4 hours of their arrival at an A&E department (CCG,M)(Target: 95.0%)

94.7%P’lty

£6.8k96.4% 97.4% 96.8% 96.5% 95.5%

92.9%P’lty

£41.6k

Trolley waits in A&E >12 hours (CCG)(Target: Nil)

0 0 0 0 0 0 0

All handovers between ambulance and A & E must take place within 15 minutes – Handovers >30 minutes (CCG) (Target: Nil)

10P’lty£2k

5P’lty£1k

4P’lty£800

5P’lty£1k

3P’lty£600

7P’lty

£1,400

5P’lty£1k

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Handover breaches >60 minutes (CCG) (Target: Nil)

0 0 0 0 0 0 0

5.4. The Trust reported 5 ambulance handover delays in November 2016 (still being validated). These breaches will incur a penalty of £1,000 for the Trust.

5.5. The contract also contains a number of local indicators around A&E, with associated figures for items 1-4 located in Appendix 2.

1) Unplanned re-attendance rate - 7 days <5%2) Left department without being seen rate <5%3) Time to initial triage/assessment (95th percentile <15 minutes)4) Time to treatment in department (median <60 minutes)5) % of patients presenting at type 1 and 2 (major) A & E sites in certain high

risk categories who are reviewed by an emergency medicine consultant before being discharged (95% at site level)

6) A & E service experience - qualitative description of what has been done to assess the experience of patients using A&E services, their carers and staff.

5.6. Table 13 shows that the Trust achieved both the ‘unplanned re-attendance’ and ‘left department without being seen’ targets in November 2016. Further detail about these indicators, as well as a site breakdown of A&E performance is given in Appendix 2.

Table 13: Local A&E Indicators

Local A&E Indicators

Apr-

16

May

-16

Jun-

16

Jul-1

6

Aug-

16

Sept

-16

Oct

-16

Nov

-16

Unplanned re-attendance rate (CCG)

RVI Main ED

1.8% 2.3% 3.0% 3.8% 4.5% 3.7% 3.2% 3.6%Eye Casualty

1.4% 0.6% 2.8% 4.1% 2.1% 2.9% 0.6% 0.7%Left department without being seen rate (CCG) (Target:

RVI Main ED

3.6% 4.6% 2.9% 3.4% 3.9% 4.2% 3.6% 4.2%Eye Casualty

0.3% 0.5% 0.1% 0.5% 0.6% 0.3% 0.5% 0.3%

5.7. The time to initial triage/assessment in ED (Table 14) has consistently failed to achieve the 15 minute target throughout 2015/16. However, the ED staff predominantly use FirstNet as a Tracking system, not a clinical recording system so at this point, it is difficult to identify if this is a genuine patient flow issue or linked to data recording. Whilst it is hoped that the A&E paperlite system (implemented on 9th November) will improve real-time data capture, it is too early to report progress at this time.

Table 14: Time to Initial Triage/Assessment in Department

A&E Key Performance Indicators Target May-

16Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Time to Initial Triage/Assessment in department – 95th percentile

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RVI - Main Emergency Department <15 mins 00:48 01:02 01:19 00:42 00:48 00:42 01:19

5.8. Whilst the median arrival to treatment time in main ED is showing a minimal deterioration (Table 15), as per above, there are concerns about the quality of data. The Walk-in-Centres have historically achieved a median time to treatment well below the 60 minute target.

Table 15: Time to Treatment in Department - median

A&E Key Performance Indicators

Target 15/16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sept-16

Oct-16

Nov-16

RVI - Main <60 00:40 00:40 00:37 00:36 00:54 00:56 00:58 01:17Eye Casualty <60 00:53 00:50 00:56 00:57 01:11 01:01 01:09 00:56Walk-in Centre <60 00:11 00:12 00:15 00:11 00:10 00:20 00:10 00:12Molineux Street <60 00:20 00:24 00:20 00:18 00:17 00:24 00:31 00:33

5.9. Whilst the Trust reported a reduction in delayed bed days to 838 (Chart 4), the national trend is one of continued growth. A meeting is to be held imminently with the urgent care lead from NECS, the Trust and South Tees to discuss how to address repatriation delays. They are hoping to agree some guiding principles (aligned to the concordat agreement), although how this will be implemented with other Trusts is unknown at this point. Furthermore, the Executive Director of Business & Development recently escalated concerns to the Chief Executive of Northumbria NHS Trust about the significant repatriation delays currently being experienced by the Trust.

Chart 4: Trust reported Delayed Bed Days

0

200

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1,000

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Apr-

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-16

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-16

No. of Days Delayed (NHS)

Non-acute NHS Care Care packageCommunity equipment Patient choiceAssessment Series2

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5.10. Directors will note that the Divert indicator remains within contracts in 2016/17. The Trust accepted 125 diverts in 2015/16, equating to an incentive payment of £187.5k. Table 16 shows the ambulance diverts for 2016/17 and whilst this equates to a financial incentive for the Trust of £145.5k, the pressure this creates within A&E and the wider Trust is a significant concern.

Table 16: A&E Ambulance Diverts

A&E Patient Diverts Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 2016/17NHS South Tyneside CCG 2 2 4 4 12

NHS Sunderland CCG 2 1 1Northumberland CCG 10 5 4 2 3 11 7 42

North Durham CCG 5 5NHS Durham Dales 2 2

North Tyneside CCG 7 5 1 3 8 2 26Newcastle Gateshead Alliance 1 1 4 6

Total 23 17 12 6 11 19 9 97£'000s £34.5 £25.5 £18.0 £9.0 £16.5 £28.5 £13.5 £145.5

5.11. OTHER EXTERNAL PERFORMANCE REQUIREMENTS

5.12. Appendix 3 reports the other contractual and Monitor targets that have not yet been discussed.

5.13. There were no reported cases of MRSA in November, meaning a year to date total of 5 (post successful appeals).

5.14. In November 2016, the Trust reported 7 cases of C-Difficile infections against a trajectory of 6. The infections were reported in Cardio (1), Childrens (1), Medicine (3), Surgical (2). Taking into account 10 successful appeals, the year to date total is 45, 6 below the cumulative trajectory of 51.

5.15. There were no reportable breaches of the urgent cancelled operation or the 28 day standard in November 2016.

Table 17: Reportable Cancelled Operations

Reportable Cancelled Operations Jun-16 Jul-16 Aug-16 Sept-16 Oct-16 Nov-16

Total number of cancelled operations

31 38 48 48 38 48

Number of 28 day breaches

1 1 0 0 0 0

Urgent operations cancelled for a 2nd or

0 0 0 0 0 0

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subsequent time

Penalty Amount £6,343 £12,350 0 0 0 0

5.16. Whilst NHS England has removed the national financial sanctions relating to VTE risk assessment and formulary publication from the Contract for 2016/17, it remains essential that providers continue to meet these (particularly as this indicator is included as a quality/safety measure in the Single Oversight Framework). Due to significant pressures in coding, it is becoming increasingly difficult to evidence compliance with the target by the submission deadlines. However, the Trust was compliant in October 2016, achieving 95.7% against the 95% standard.

5.17. Whilst the Psychological Therapies line in the community contract rolled over into 2016/17, the joint clinical model with NuTH and NTT commenced in April 2016. Table 18 shows current performance for the new joint service ‘Talking Helps Newcastle’ (THN). The ‘moving to recovery’ standard has decreased to 43.6% and is below the 50% target, a robust recovery plan is in place which is discussed with commissioners on a bi-weekly basis.

Table 18: IAPT Progress towards targets

5.18. There is a data quality penalty for NHS number completeness within inpatient/ outpatient and A&E submitted commissioning datasets. The standard needs to be maintained on an individual monthly basis to avoid a £10 penalty per excess missing number. For 16/17, this target has been consistently achieved.

Table 19: SUS Data Quality

SUS Data Quality Target Apr-16 May-

16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

Completion of a valid NHS Number field in

99% 99.1% 99.1% 99.2% 99.2% 99.1% 99.2% 99.1%

Page 15 of 24


acute (Admitted/Non-Admitted Care) (C)Completion of a valid NHS Number field in acute (A&E) (CCG)

95% 97.7% 97.8% 97.8% 97.8% 97.1% 97.7% 96.9%

5.19. The national Electronic Referral System (ERS) went live in June 2015 as a direct successor to the ‘Choose and Book’ system launched back in 2005. As Directors will be aware, the Trust historically reported performance against the national Choose & Book ‘slot issues’ indicator (less than 4% of its Choose and Book (C&B) bookings to result in a slot issue). However, following the launch of e-Referral, the Trust’s commissioning position was that these targets could no longer be applicable as the Choose and Book System had been decommissioned. Furthermore, given the e-Referral reporting difficulties, the C&B indicator was subsequently removed from the contract requirements in 2016/17.

5.20. More recently, however, ERS seems to have become a national and local priority. Newcastle Gateshead CCG has ERS as one of their Quality Premium measures and they will be financially incentivised if they achieve 80% ERS utilisation by March 2017 (to the tune of circa £500k). To this effect, they are keen to work with their local Trusts to increase electronic referrals.

5.21. Chart 5 shows the e-Referral utilisation rate for local and Shelford Trusts in August 2016. Whilst the Trust has the 4th highest utilisation rate in Shelford, the utilisation is lower when compared to local Trusts where it sits 2nd from bottom. However, it is worth noting that NuTH consistently features in the ‘top 10’ Trusts for number of ERS bookings along with the highest number of published services.

Page 16 of 24


Chart 5: e-Referral Utilisation Rate August 2016

5.22. The CCG CQUIN consultation document for 2017/18 proposes e-Referral as a nationally mandated indicator. This would require providers to publish ALL of their applicable services and make ALL of their applicable First Outpatient Appointment slots available on ERS by 31st March 2018. Furthermore, the schedule proposes a reduction in ‘Appointment Slot Issues’ to a rate of 4% or less. Whilst the Trust has deliberately excluded certain services from ERS for operational reasons (which will need to be worked through on a case by case basis), factors such as referral demand influence slot issues and are largely outside of the Trust’s control.

5.23. The national contract consultation goes one step further and is proposing that from October 2018, acute providers will be able to return any non eRS referrals to GPs. However, providers will only be paid for the resulting activity where the GP referral was made through the Electronic Referral System (ERS). Future versions of this paper will report in more detail on ERS, and the actions being undertaken to improve coverage and utilisation.

5.24. Table 20 shows the e-Referral utilisation for each Directorate (using the number of e-Referrals v paper referrals). This will form the basis of the Trust-wide action plan and each service line will be interrogated to clarify the ERS availability and/or exclusion rationale. This work will feed into the commissioner action plan as they need to ensure that GPs are referring via e-Referral where available.

Page 17 of 24


Table 20: Directorate e-Referral Utilisation Rates

Sum of Ereferral Utilisation rate Original Referral FY YearOriginal Referral Month Name2016/17 Grand Total

Directorte Code Directorate April May June July August September100 Surgical Services 65.0% 59.6% 59.0% 57.2% 56.4% 57.3% 59.2%101 Renal Services 57.5% 61.6% 61.8% 59.6% 59.0% 60.7% 60.0%110 Musculoskeletal Services 27.4% 25.4% 20.3% 16.2% 13.2% 23.6% 21.0%120 ENT 64.3% 66.2% 60.5% 63.5% 65.4% 67.7% 64.6%130 Plastic Surgery, Ophthalmology and Dermatology 85.2% 85.3% 86.3% 85.8% 85.0% 85.4% 85.5%140 Dental Hospital And Oral Surgery 61.0% 67.3% 56.2% 70.5% 77.2% 65.0% 67.1%150 Neurosciences 40.8% 33.4% 43.4% 43.9% 52.5% 52.2% 44.2%170 Cardiothoracic Services 18.8% 21.3% 24.0% 31.4% 25.2% 31.6% 25.4%191 Periop and Critical Care 72.0% 74.7% 75.6% 74.8% 64.0% 60.2% 70.0%300 Internal Medicine 38.8% 40.0% 39.7% 37.0% 38.8% 36.7% 38.5%420 Childrens Services 43.4% 47.5% 44.0% 51.6% 52.9% 48.7% 47.5%501 Womens Services 60.3% 56.6% 58.7% 56.2% 54.2% 60.8% 58.0%800 Cancer Services 51.4% 44.4% 45.9% 67.0% 55.0% 57.0% 53.8%

Grand Total 57.6% 58.0% 57.2% 57.7% 57.2% 60.0% 58.0%

6. RECOMMENDATIONS

6.1. Directors are asked to:

1) receive this report;

2) note the areas of compliance and non-compliance, particularly the risk this poses to high quality patient care and the Trust, both financially and reputationally and;

3) note the actions ongoing to address areas of underperformance and any key risks for 2017/18.

Jo McCallumSenior Business Development Manager (Performance)

Helen ByworthAssistant Director of Contracting & Performance

Louise RobsonExecutive Director of Business and Development

14th November 2016

Page 18 of 24


Appendix 1: Directorate Level Performance

DirectorateDa

y of

Sur

gery

Ar

rival

Refe

rral

Gro

wth

Adm

itted

W

aitin

g

OP

Wai

ting

Non

-Adm

itted

Cl

ock

Stop

s (>

95%

)Ad

mitt

ed C

lock

St

ops (

>90%

)

Inco

mpl

etes

(>

92%

)

Back

log

Back

log

dire

ction

Rela

tive

Risk

Le

ngth

of S

tay

Out

patie

nt D

NA

Rate

s aga

inst

Pe

erO

utpa

tient

N:R

ra

tio -

agai

nst

peer

Canc

elle

d O

pera

tions

28 d

ay B

reac

hes

Canc

elle

d O

pera

tions

Canc

er

Cancer Services 75% -2.2% 10 458 100.0%

100.0%

0 1.21 3.2% 18.54 0 0Cardiothoracic Services

71% 10.5% 1,150 2,981 91.6% 95.1% 215 0.74 10.1% 1.44 16 0 2mChildren’s Services 92% 57.6% 1,187 2,024 97.2% 96.7% 73 1.39 10.8% 1.85 1 0 2wClinical Genetics 99.3% 8 0.0% 4.00Dental Hospital &School

100% 2.6% 827 4,312 77.4% 96.6% 167 1.01 10.5% 2.05 1 0ENT 93% -3.2% 1,015 4,229 88.9% 95.9% 295 1.17 10.1% 1.41 0 0 2mInternal Medicine 80% 1.4% 1,124 3,680 100.0

%93.8% 281 1.17 12.5% 2.26 2 0

Musculoskeletal 89% -0.6% 4,282 3,199 82.3% 84.2% 1147 1.20 9.8% 3.14 2 0 2mNeurosciences 92% -1.3% 1,360 2,964 92.4% 92.9% 294 1.41 11.1% 2.48 14 0P.O.D. 92% -4.0% 4,378 8,310 92.6% 96.4% 449 1.42 10.2% 3.11 1 0Peri-op and Critical Care

22.4% 194 896 55.6% 86.8% 94 1.53 7.6% 6.14 0 0Renal Services 92% -7.8% 971 1,552 97.0% 98.2% 41 1.12 10.0% 2.61 3 0Surgical Services 91% 2.0% 1,675 1,881 86.2% 92.8% 298 1.30 8.3% 1.27 8 0 2w, 2m,

ScrTherapy Services -1.2% 600 96.3% 21 Women’s Services 100% 1.5% 556 2,393 88.3% 93.9% 156 1.02 6.1% 2.71 0 0

Indicator Tolerance Data periodDay of Surgery Arrival - November 2016Referral Growth - All referrals <0% Red, Amber 0-5%, Green >5% November 2016 compared to

November 2015Admitted Waiting (includes planned and suspended patients)

- November 2016

New Outpatients Waiting List - November 2016Risk Adjusted Length of Stay - Source HED Green = Performance is below (better) than

Shelford, RED = Performance is above (worse) than Shelford

October 2015 – September 2016Outpatient DNA Rates against Shelford - Source HED

Outpatient New to Review Ratio - against Shelford -

Page 19 of 24


Source HEDCancelled Operations - Source Patient Services Red >0.8% FFCEs November 2016Cancelled Operations Breaches 28 days - Source Patient Services Red >=1 November 2016

Cancer tbc September 2016

Page 20 of 24


Appendix 2: A&E Performance

A&E Key Performance Indicators Threshold Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16

Unplanned re-attendance rate - 7 days RVI - Main Emergency Department 5% 2.1% 3.2% 3.0% 2.8% 1.8% 2.3% 3.0% 3.8% 4.5% 3.7% 3.2% 3.6%

Eye Casualty 5% 0.9% 0.5% 0.8% 1.6% 1.4% 0.6% 2.8% 4.1% 2.1% 2.9% 0.6% 0.7%

Walk-in Centre 5% 0.1% 0.1% 0.0% 0.0% 0.2% 0.2% 0.3% 0.4% 0.0% 0.6% 0.3% 0.2%

Molineux Street 5% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.0%

95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%All Emergency Departments (Combined

performance)95% 92.7% 92.2% 92.0% 90.5% 94.2% 94.7% 96.4% 97.4% 96.8% 96.5% 95.5% 92.9%

RVI - Main Emergency Department 95% 89.0% 88.1% 87.9% 85.6% 91.3% 92.0% 94.5% 96.0% 94.7% 94.7% 93.4% 89.2%

Eye Casualty 95% 99.5% 99.0% 97.5% 96.8% 97.9% 97.5% 98.5% 99.0% 98.1% 99.0% 96.2% 98.0%

Walk-in Centre 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Molineux Street 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Left department without being seen rate

RVI - Main Emergency Department 5% 4.0% 3.7% 4.1% 4.3% 3.6% 4.6% 2.9% 3% 3.9% 4.2% 3.6% 4.2%

Eye Casualty 5% 0.2% 0.2% 0.2% 0.6% 0.3% 0.5% 0.1% 0.5% 0.6% 0.3% 0.5% 0.3%

Walk-in Centre 5% 2.6% 1.1% 2.9% 2.2% 1.3% 0.9% 1.8% 0.8% 0.0% 1.1% 1.1% 1.2%

Molineux Street 5% 1.3% 1.4% 1.4% 2.1% 1.2% 1.6% 1.4% 1% 0.0% 1.0% 1.5% 1.9%Time to initial assessment - 95th percentile (Emergency Ambulance arrivals only)

RVI - Main Emergency Department <15 mins 00:57 0:38 01:06 01:08 01:21 00:48 01:02 01:19 00:42 00:48 00:42 01:29

Eye Casualty <15 mins # # # # # # # # # # # #Time to treatment in department - Median

RVI - Main Emergency Department <60 mins 00:49 00:51 00:45 00:41 00:40 00:40 00:37 00:36 00:24 00:56 00:58 01:17

Eye Casualty <60 mins 00:46 00:50 00:57 01:04 00:53 00:50 00:56 00:57 01:27 01:01 01:09 00:56

Walk-in Centre <60 mins 00:18 00:14 00:21 00:19 00:11 00:12 00:15 00:11 00:10 00:20 00:10 00:12

Molineux Street <60 mins 00:28 00:30 00:30 00:25 00:20 00:24 00:20 00:18 00:17 00:24 00:31 00:33

2015/16

Total time spent in A&E department (All Attendances)

Note: # Not provided as minimal data available

2016/17

Page 21 of 24


Appendix 3: Additional Targets (not covered above)

Key Performance Indicators

Actu

al

15/1

6

Targ

et

Mon

thly

Ta

rget

Qua

rter

1

July

Augu

st

Sept

Oct

Nov

Mixed Sex Accommodation Breaches (c)Sleeping Accommodation Breach 0 0 0 0 0 0 0 0 0

Cancelled Operations (c)Those not admitted within 28 days 21 0 1 1 0 0 0 0

No urgent operation should be cancelled for a second time 0 0 0 0 0 0 0 0

Delayed Transfers of CareDelayed Discharges 1,088 Minimal n/a 366 115 72 91 101

HCAI (c)Zero tolerance MRSA 5 0 0 2 0 0 0 3 0Rates of Clostridium difficile (cumulative & appeals removed)

67 77 <6-7 13 6 10 10 9 7

Duty of Candour (c)Failures to notify the Relevant Person of a suspected or actual Reportable Patient Safety Incident

0 0 0 0 0 0 0 0 0

VTE Assessments

Proportion of Patients who have had a VTE Risk Assessment on Admission

96.1% 95% 95% 96.9% 95.2% 96.0% 96.3% 95.7%

Page 22 of 24


Appendix 4: RTT Compliance by Specialty and Commissioner, November 2016

The Newcastle upon Tyne HospitalsNHS NEWCASTLE GATESHEAD CCGNHS NORTH TYNESIDE CCGNHS NORTHUMBERLAND CCGNHS SUNDERLAND CCGNHS SOUTH TYNESIDE CCGNHS NORTH DURHAM CCGNHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCGNHS DARLINGTON CCGNHS HARTLEPOOL AND STOCKTON-ON-TEES CCGNHS SOUTH TEES CCGNHS CUMBRIA CCGSpecialisedThe Newcastle upon Tyne Hospitals 0 0 63 5 0 34 1 0 n/a 0 n/a 0 14 n/a 0 0 n/a 6 0NHS NEWCASTLE GATESHEAD CCG 0 0 41 0 0 n/a n/a 0 n/a n/a n/a 1 11 n/a n/a 0 n/a 1 13NHS NORTH TYNESIDE CCG n/a 0 13 1 0 n/a n/a 1 n/a n/a n/a 1 2 n/a n/a n/a n/a 3 0NHS NORTHUMBERLAND CCG n/a 0 4 11 0 n/a n/a 0 n/a n/a n/a 0 0 n/a n/a n/a n/a 2 0NHS SUNDERLAND CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0NHS SOUTH TYNESIDE CCG n/a n/a 3 n/a n/a n/a n/a n/a n/a n/a n/a 0 1 n/a n/a n/a n/a n/a 0NHS NORTH DURHAM CCG n/a n/a 2 2 0 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0NHS DARLINGTON CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS HARTLEPOOL AND STOCKTON-ON-TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0NHS SOUTH TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0NHS CUMBRIA CCG n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0Specialised n/a n/a 5 n/a n/a 34 1 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a 0

Gene

ral M

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Non

-Adm

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Adm

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Card

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Page 23 of 24


The Newcastle upon Tyne Hospitals 0 0 689 0 0 0 0 0 n/a 0 0 0 0 0 0 0 n/a 0NHS NEWCASTLE GATESHEAD CCG n/a 0 361 0 0 n/a n/a 0 n/a 0 n/a 0 0 n/a n/a 0 n/a 0NHS NORTH TYNESIDE CCG n/a n/a 96 0 n/a n/a n/a n/a n/a n/a n/a 0 0 n/a n/a n/a n/a n/aNHS NORTHUMBERLAND CCG n/a n/a 65 0 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/aNHS SUNDERLAND CCG n/a n/a 17 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS SOUTH TYNESIDE CCG n/a n/a 36 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS NORTH DURHAM CCG n/a n/a 23 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG n/a n/a 14 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS DARLINGTON CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS HARTLEPOOL AND STOCKTON-ON-TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS SOUTH TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aNHS CUMBRIA CCG n/a n/a 23 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/aSpecialised n/a n/a 57 n/a n/a 0 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a

Inco

mpl

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Neur

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Gene

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Commissioner

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Target does not apply/Trust level targetn/a Target does not apply, < 20 cases in month

Target applies and was metx Target breached and number of 'excess' breaches

Underline Patients subject to a penalty

Page 24 of 24

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