Integrated Board Performance Report

INTEGRATED BOARD PERFORMANCE REPORT

SAFETY, QUALITY, PERFORMANCE,

WORKFORCE AND FINANCE

February2012

INTEGRATED BOARD PERFORMANCE REPORT

1. ABOUT THIS REPORT

This report is split into five sections, reflecting the integrated approach to performance within Hertfordshire Community NHS Trust (HCT).

Safety Standards
Quality Standards
Performance Standards
Workforce Standards
Finance Standards

Each section provides a table of the key indicators, with detailed commentary within each section on those indicators that have been RAG rated Red, or where there has been a significant change in performance in month. Also included in the commentary is any change in practice or guidance that has been issued in relation to the indicator in month. Trajectories against relevant indicators are highlighted in blue, starting with the letter T.

The format of this report has been reviewed and the summary section has been amended to include an overall dashboard summary, trends on the top KPIs and a greater emphasis on analysis and actions being taken to address the issues for Board review. The top KPIs are derived from the monthly Governance Risk Register submission to the SHA which is in turn based on Monitor’s key indicators.

Appendix 1 details the triggers by contract type (e.g. national indicator, CQC, NHS Hertfordshire Contract, External contracts etc).

1.SUMMARY OF PERFORMANCE

The table below summarises the indicators performance for February2012.

Areas of Progress

Healthcare associated infections (S2 and S5) – There were no MRSA cases reported for the fourth consecutive month andno C.diffcases reported for the last two months. The indicators remainunder the ceiling for the year.

Safeguarding Vulnerable Adults SOVA(S26)

SOVA training achieved the 80% target in February and is on trajectory.

National Indicators – HCT achieved the target for the following National Indicators in February - 18 weeks (P1), GUM (P2, P3) and MIU (P7). HCT are ahead of both year to date and rolling 12 month targets for Retinal Screening.

Pledge 2 (P9) –The performance target was met with 100% for the third consecutive month in February. There were 7,536 patients that were seen in February with no avoidable breaches and 16 legitimate breaches.

VTE (Venous Thromboembolism) Assessments - Performance for Februarywas 100% with all 236 patients having had their VTE assessments.

District Nursing response times (P11, P12) –Response times for 24hr urgent responses and 48hr non-urgent responses are 100% compliant.

Community Hospitals DTC (P14) -HCT reported 3.6% NHS delays in February a decrease of 1% from January. Year to date performance is 4.7%, (against a target of 6%) and the indicator is marked green. The total delays were at 7.5% including 3.9% social delays. Social delays also decreased by 1.3% from last month.

Community matrons (P20) –Caseload numbers are achieving the target figure of an average of 50 patients per WTE matron.

New birth visits (P25) –Following validation the target was achieved with 91% of face to face new birth visits completed within 14 days in January.

Human Papilloma Virus (P31) –HCT are above the Trajectory for February with 87% receiving dose 1 and 85% receiving dose 2 immunisations.

Community information data-set (CIDS) – HCT are able to report on 17 of the 19 data items identified by Monitor for data completeness monitoring and have achieved a completion rate of 95% against the target of 50% (95% of patient records had these data items recorded in the relevant field).

Finance –Financial Risk Rating (FRR) continues to be 3 (green) overall. Financial position to month 11 (February 2012) is on plan. Forecast is marginally (£30k) below planned £1m surplus. Performance against the Better Payment Policy code to have paid invoices within 30 days is performing well at 94% against a target of 95%.

Areas for Board Review.

Number of Serious Incidents (SIs) reported in month (S9) – Seven serious incidents were reported to the PCT in February; three incidents of category 3 or 4 pressure ulcers, two incidents concerning breaches of confidentiality and two incidents reporting an outbreak of infection.

Analysis/Action

The outbreaks during this period were influenza A at Herts and Essex hospital and Norovirus (diarrhoea and vomiting) at Langley House. The outbreak of influenza A was complex and contributed to the death of three patients; a debriefing meeting is planned for March to consider learning. All outbreaks were managed effectively and safely; HCT were commended by both the PCT and the Health Protection Agency for high standards of outbreak management.

Prevention of pressure ulcers was further promoted through new arrangements to enable clinical staff to access essential pressure relieving equipment. Locally held stocks will ensure patients at high risk receive equipment outside normal hours, the assessment tool used by Hertfordshire Equipment Service (HES) is being revised to strengthen the provision of equipment at the preventative stage of care, and a clinical liaison post in HES to improve partnership working has been agreed.

One breach of confidentiality occurred within the MSK service and one within Children’s Specialist services. There have now been six serious incidents within Children’s Specialist services since August 2011. The recommendations and an action plan identified through the review of all six incidents are being implemented and an internal audit has been commissioned to provide additional assurance of progress. Learning from these incidents is being discussed in team meetings in each of the services.

Patient incidents (S14) – The number of patient-related incidents reported in January was 422, significantly above the target range of 211 to 335.

Analysis/Action

The increase is due to increased reporting of pressure ulcers, patient accidents, and incidents related to issues with patient transport. 62% (16 of 26) transport incidents impacted on patients attending for podiatry. HCT is providing information on incidents related to patient transport to support the PCT in their contract management of the transport provider and to understand the impact on patients.

Safeguarding Children (S21, S22) – Staff accessing safeguarding training at level one and staff working directly with children level two training, remained below the monthly target for the third consecutive month in February with 89% and 84% respectively against targets of 90%.

Analysis/Action

Whilst uptake of level 1 Safeguarding children training in month is below the 90% threshold at 89%, the average uptake across the year is 91%. Uptake of level 2 safeguarding children training has increased by 4% (80% to 84%) representing an average uptake of 87%. There have been no incidents which would indicate staff who work with children have not received training appropriate to their role. The following actions are in place:-

Manual reconciliation of uptake and staff to ensure staff are recorded in the correct cohort; this will ensure the information reported is valid.
A training programme is in place, including both single and multi-agency training, which is delivered across Hertfordshire using a flexible model.
Staff are monitored through supervision to ensure they have met their required training needs.

Community Matrons -In East & North Herts Community Matrons recorded 7 patients on their caseload with a non-elective (NEL) hospital admission for a related condition from a total caseload of 625 (1.1%). In the West Community Matrons recorded one patient on their caseload with a NEL hospital admission for a related condition from a total caseload of 530 (0.2%). Personal health plans are being offered to every patient on Matron Caseloads,although there is not currently a reporting method on SystmOne to record completion of personal health plans. There are plans for next year to record these on SystmOne when Read coding is available.

Analysis/Action

Work to determine a baseline level of expected NEL admissions for patients on a Community Matrons caseload and comparison to reported levels is planned for the next few months.

Community Hospitals (P16a, P16b) – HCT are achieving the average length of stay stroke target (42 Days) with an average of 40.1 days, an increase of two days from the previous month. The non-stroke length of stay has increased by 2.7 days from last month and is still not achieving the target of 21 days with performance at 27 days. HCT is achieving the ALOS for all patients on the rehabilitation pathway; however some patients remain outside this pathway for a period of their care e.g. when medically unwell, non-weight bearing and delayed transfers of care. Overall the length of stay is 31 days for February.

Integrated community services - Number of patients transferred from acute hospital/AAU in West Herts (P18)

The number of patients admitted to the integrated community services caseload in the West from an acute hospital/ AAU is below the cumulative performance for last year.

Analysis/Action

Performance levels continueto increase and 43 patients were transferred in from acute hospitals inFebruary, which is above themonthly average levels of 2010/11.

Health Visiting (P26) - In February 86% of children who transferred from out of area had a face to face contact with a health visitor within five days,(37 of 43 Children). The target of 98% has not been achieved for February.

Analysis/Action

The percentage of children with a face to face contact increased to 86% in February. Of the six children seen over five working days, two of the visits were delayed due to the Health Visitor being unable to make contact with the family through any form of correspondence despite numerous attempts. The target is being reinforced at team meetings and managers are scrutinising the return closely. The clinical pathway has been changed with a letter inviting the client to make contact with the Health Visiting team sent first which has been found successful with those where English is not their first language; this is then followed up with phone contact to make an appointment within five days.

Vacancy rates Health Visitor caseload (P27, P28)– The Health Visitorvacancy rate decreased to 5.5% for February and remains within the 8% vacancy threshold. The average caseload is 635 against a target of 500(November Figures).

Analysis/Action

The recruitment of trainee Health Visitors will not have an effect upon caseload numbers until later in their training when caseloads start to be assigned to them. An action plan has been enacted for further recruitment and tofocusposts in the highest caseload affected areas. Three ‘Return to Practice’ Health Visitors started the University module to refresh their practice and will apply for posts in June 2012 following their course. Recruitment to vacancies is underway with interviews taking place in March.

Chlamydia Screening (P30) – HCT completed 95 family planning clinic screens in February. HCT are currently 17 screens below trajectory and marked amber.

Analysis/Action

Additional screens held at young person’s clinics have yet to be verified by the HPA and upon inclusion in the year-end total are expected to bring us back on target.

Workforce W4, W6, W9 and W10

Mandatory fire training remains below target levels at 67%. The Appraisal rate hasincreased slightly to 81%, however is still below the target of 90%. The turnover rate hasincreased for the first time in five monthsto 12.8% and is still above the threshold of 12%. Absence rates continue to decrease to a new low of 3.9% against a threshold of 3.5%.

Analysis/Action

Both the turnover and absence rates have shown a steady improvement over the last year. Recruitment activity is now reducing as vacancies are being filled and the improved staffing levels are contributing towards the downward trends. Work is underway to gain more information into the reasons why staff choose to leave the organisation, to help us manage our retention rates. Absence particularly in the inpatient units continues to be closely monitored.

Finance

Estates expenditure is a continuing pressure. The Income and Expenditure Margin within the finance risk rating has reduced to a 2 and has marginally dropped below the 1% trigger point for scoring a 3.

Analysis/Action

Expenditure to year end is being monitored closely. Individual service positions are reviewed at the monthly performance meetings with each Business Unit. Debtors with NHS Hertfordshire have been settled and Director of Finance is meeting with Barnet and Chase Farm Hospital Trust concerning its level of aged debt. Action taken in recent months to reduce estates expenditure is showing a reducing run rate per month

Income and Expenditure Surplus component of the Financial Risk Ratings has altered due to the Trust’s anticipated total income from the PCT increasing by £4m for depreciation and capital charges for the whole year. Income has increased whilst forecast surplus remains constant. I&E margin has consequently dropped to below the 1% trigger point.

Top KPIs

The top KPIs are derived from the monthly Governance Risk Register (GRR) submission to the SHA which is in turn based on Monitor’s key indicators. The chart below shows year to date performance against year to date targets. (This differs slightly from the GRR that measures a monthly snapshot of performance against monthly indicators)

The chart below shows the historical YTD performance of the top indicators.

Sean McKeever, Director of Finance

Andrew Chronias, Assistant Director, Performance and Information

20thMarch2012

Hertfordshire Community NHS Trust – Safety, Quality, Performance, Workforce & Finance Report –

February 2012Final

SAFETY STANDARDS

SAFETY STANDARDS SCORECARD (1 OF 2)

Healthcare Associated Infections(Indicator S1 and S2) – There were no MRSA cases reported for the fourth consecutive month and no C.diff cases reported for the last two months. The indicators remain under the ceiling for the year.

MRSA admission screening (S5)– All patients were screened when admitted directly toour communityhospitals in February.

Serious Incidents (S9) –Seven serious incidents were reported to the PCT in February; three incidents of category 3 or 4 pressure ulcers, two incidents concerning breaches of confidentiality and two incidents reporting an outbreak of infection. All seven day and 45 days reports were completed on time. There are 50 serious incidents that remain open.

Hertfordshire Community NHS Trust – Safety, Quality, Performance, Workforce & Finance Report –

February 2012Final

Patient related incidents reported in month (S14) - The number of patient-related incidents reported in January was 422, significantly above the target range of 211 to 335. The increase is due to increased reporting of pressure ulcers, patient accidents, and incidents related to issues with patient transport. 62% (16 of 26) transport incidents impacted on patients attending for podiatry; HCT is providing information on incidents related to patient transport to support the PCT in their contract management of the transport provider and to understand the impact on patients.

Hertfordshire Community NHS Trust – Safety, Quality, Performance, Workforce & Finance Report –

February 2012Final

Hertfordshire Community NHS Trust – Safety, Quality, Performance, Workforce & Finance Report –

February 2012Final

Falls analysis

In 2011/12 HCT aims to reduce falls in bed-based units by 20% compared to 2010/11. This reduction will be achieved if a total of 56 or less falls are reported per month, or if the rate of falls per 1000 occupied bed days per month is no higher than 8.1. The number of falls decreased in February to 53 falls (8.9 falls per 1000 occupied bed days) compared to 57 in January (following Datix validation), with no patients experiencing severe harm as a consequence of their fall.

This represents a reduction of 23.3% in patient falls compared to 2010/11.

Additional visual prompts on bedroom doors are being used to highlight to all staff those patients who are at risk of falling in bed-based units where the layout of the ward hinders patient observation. The benefit of more sensor mats on chairs in addition to the sensor mats in use on beds is to be determined following evaluation of a pilot in two bed-based units during March and April.

Pressure Ulcer Analysis – (reported a month in arrears)

Of the 186 pressure ulcers incident reported during January, 3 (1.6%) were identified as serious (category 3 or 4) and acquired in HCT care; these are being investigated through the Serious Incident process.

Hertfordshire Community NHS Trust – Safety, Quality, Performance, Workforce & Finance Report –

February 2012Final

SAFETY STANDARDS SCORECARD (2 OF 2)

Hertfordshire Community NHS Trust – Safety, Quality, Performance, Workforce & Finance Report –

February 2012Final

Medicines Management (S19) -Of the 22 medication incidents reported this month 14 (64%) relate to HCT provided care. The two most frequently reported medication incidents continue to relate to the administration of anticoagulants (23%, 5 of 22) and insulin (14%, 3 of 22). 7 (32%) incidents this month related to the handling, storage or administration of controlled drugs. No patient harm has been reported.

Safeguarding Children (S21, S22) - Whilst uptake of level 1 Safeguarding children training in month is below the 90% threshold at 89%, the average uptake across the year is 91%. Uptake of level 2 safeguarding children training has increased by 4% (80% to 84%) representing an average uptake of 87%. There have been no incidents which would indicate staff who work with children have not received training appropriate to their role. The following actions are in place:-