NHS GRAMPIAN

PERFORMANCE REPORT –February 2011

This Performance Report is to provide Board members with assurance on key performance topics as discussed at the Performance Governance Committee (PGC) meeting on21st January 2011.

The first part of the meeting, termed Healthstat, reviewed the documentation and outcomes from the cross system performance reviewheld on 11th January 2011 (postponed from 17th December 2010) and sought assurance from the Chief Executive, Medical Director and Chief Operating Officer about performance improvement.

HealthStat / Discussion/Assurance
National Benchmarking Whole System Scorecard / PGC received an update on Grampian’s performance as assessed by the national benchmarking scorecard. This comprised 81 measures and related to the year 2008/09, Comparisons were made with the Scottish/English mean. The analysis showed that overall NHS Grampian’s performance had remained the same or improved since the previous year. It was however known that there had been significant improvements to performance against some of the measures e.g. length of stay, day case rates and bed occupancy since 2008/09. PGC was assured that whilst the benchmarking information was used to identify areas for improvement and monitor trends, more recent data was used to guide action. Work was underway to look at qualitative data on patient experience and quality which gave a more complete picture when combined with quantative measures such as those in the scorecard.
Pre-operative Length of Stay / Pauline Strachan reported on the outcome of recent audits at ARI which had identified reasons for patients being admitted the day before their surgery. NHS Grampian was known to have the longest pre-operative stay in Scotland, although it had been reducing. The audits covered 78 patients in 6 specialties and showed that 10% were being admitted because of doctor preference, 40% were patients from the Islands and the remaining 50% had been assessed as unsuitable medically for same day admission. The doctor preference admissions were being addressed by discussions with the individuals and specialties concerned and continued emphasis on pre-admission assessment. The position of patients travelling from a distance was more problematic as the audits showed that these patients were generally receiving some attention the day prior to surgery as pre assessment visits from the Islands was not practical. The patient hotel already had an occupancy level in excess of 90% so did not provide a solution. Pauline confirmed that pre-operative stay would continue to receive attention but in terms of delivering improved efficiency she advised that there was more to be gained by reducing length of stay generally and this was currently the focus of a number of pieces of work..
Access to specialist Stroke care /

A new measure had been introduced to the 2011/12 Local Delivery Plan- 90% of all patients admitted with a stroke to a stroke unit on the day of admission or day following presentation by March 2013. 80% was required to be achieved by March 2012. Analysis showed that in 2009, 65.3% was delivered against this target in Grampian which was the second highest rate in Scotland. It was not considered that delivery of this target would be problematic although improvement required a cross system approach to ensure patients received the right care in the right place. Effective discharge was key to ensuring beds were available for new admissions. Roelf Dijkhuizen advised that work was in hand around end of life arrangements as part of the response to Living and Dying Well. Stroke care in Grampian was of a high standard with an effective Managed Clinical Network in place. PGC was assured that the new target would be delivered on an equitable basis across Grampian.

The second part of the meeting considered Assurance Reports submitted to PGC by other Board Governance Committees and the Community Health Partnership Committees. These reports consist of a template which documents the business discussed at the committees relating to performance issues which might impact on delivery of one or more of NHS Grampian Strategic Objectives or Themes and the actions put in place to mitigate these risks. At the September meeting 6 reports were presented covering a wide range of topics including:-

  • Continued oversight of Safe and Affordable Workforce process (Staff Governance Committee)
  • Approval of Health and Safety work plan (Staff Governance Committee)
  • Consideration of a report on progress with actions following QIS anaesthetic review (Clinical Governance Committee)
  • Update on interim arrangements for named doctor for child protection in Moray (Clinical Governance Committee)
  • Implications of reduced capital spending (Aberdeenshire CHP)
  • Approval of CHP Action Plan (Aberdeenshire CHP)
  • Continued implementation of the CHP Delivery Plan(Aberdeen City CHP)
  • Approval of the extended local partnership agreement for older people (Aberdeen City CHP)

The thirdpart of the meeting considered progress against the Strategic Themes and Objectives aligned to the Balanced Performance Framework. The overall performance position according to the Corporate Scorecard was presented followed by more in depth consideration of key topics. These included:-

Strategic Theme

/

Topic

/

Discussion

/ Performance Rating /

Risk Rating

Improving the Public’s Health and Reducing Inequalities / Health improvement/
Inequalities Measures / PGC received an update on performance against the range of health improvement/inequalities measures which had been proving difficult to deliver in full. There had been significant improvement in recent months and the Child Healthy weight target had now been met. Similarly alcohol brief interventions had increased towards target and full delivery was expected. The smoking cessation target was still under trajectory and more people were required to take advantage of the services on offer for the target to be met. It was noted that amendments made from April would reduce the risk of non delivery for Grampian. More accurate data on breastfeeding was now available from the Child Health Surveillance system and showed that more required to be done, however improvements were expected. Dental registration for 3-5 year olds continued to fall short of the target although it was noted that all children had access to a dentist even if not registered with one. PGC was assured that action plans were in place and were being closely performance managed / Amber / High/
Medium
Delivering Safe, Effective and Timely care in the Right Place / Access Times / Pauline Strachan advised that Grampian continued to meet the current access time targets for outpatients, inpatients and diagnostic tests and progress was being made towards delivery of the 90% within 18 week referral to treatment target by March 2011. This was without the use of waiting list initiatives. There were however some areas where theatre capacity continued to be a limiting factor. Work was ongoing to ensure maximum theatre efficiency and elimination of waste. Orthopaedic outpatient referrals were a particular challenge as these continued to grow. A number of actions were being taken to address this.
Pauline also reported that she expected a dip in performance this quarter against the 31 day and 62 day cancer targets. This was due to theatre and staff availability within colorectal and breast services. She confirmed that action plans had been agreed and shared with Scottish Government Health Directorate. It was agreed that PGC would receive full progress reports at their March meeting. / Amber / High
Quality Strategy and Dashboard / Helen Robbins reported to PGC on the actions being taken locally to embed the Quality Strategy throughout the organisation. A Quality Framework had been developed and a work plan agreed. The work was linked closely to the emerging Health and Care Framework. Helen presented the quality dashboard which had been produced and which was still developmental. This pulled together measures of quality to share with relevant individuals and staff groups to encourage discussion and further analysis and action. /
Green
/ Low
Improving Efficiency, Productivity and Sustainability / Financial Position / Clark Paterson presented the Financial Report for the period to the end of December 2010. This showed an overall revenue deficit of £1.5m which was an improvement of £0.872m on the previous month. Pay remained above budget at £5m over but for the first time the pay budget had been underspent in December, generally as a result of reduced medical locum and nursing costs. Non pay budgets continued to be underspent at £3.8m to December, a large proportion attributable to secondary care drug costs. Capital remained underspent, however expenditure plans for the final quarter remained on track. It was therefore confirmed that it was expected that the Board would meet its financial targets at the end of March. PGC noted that this had been achieved only through a lot of hard work across the system. / Amber / Medium
Developing the Workforce and Empowering Staff / Safe and Affordable Workforce / Claire Ruxton provided an update on the Safe and Affordable Workforce process. Mid year reviews were continuing with Sectors and Directorates throughout January. Much progress had been made through natural turnover and vacancy management. Organisational change proposals were currently out for consultation and would be concluded in February. The recently announced Voluntary Severance scheme would further facilitate progress. / Green / Medium

Anne Ross

Head of Performance and Quality Improvement

January 2011

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