BCHC Quality and Performance Report Final Jun - Jul 2012 PDF

Birmingham Community Healthcare NHS Trust
Quality and Performance Report

Reporting Period: June 2012
Report Date: 19th July 2012
Contents
Section Executive Summary: Quality Update Executive Summary: Summary of Issues to Report Trust Scorecard Domain 1: Patient Safety Domain 2: Use of Resources Domain 3: Patient Experience Domain 4: Clinical Effectiveness Domain 5: Efficiency and Productivity Appendix 1: Finance Report Page 3 6 7 9 14 21 25 30 34
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012
Executive Summary
Executive Summary
Quality Update
Overview Birmingham Community Healthcare NHS Trust is committed to providing high quality care to the communities that it serves. Ensuring the highest standards of patient care and patient safety is one of the fundamental responsibilities of the Boards of all NHS organizations and we continue to strive to make improvements in the quality of the care that we provide, at the same time as ensuring that it is clinically effective, person-focused and safe. Essential to meeting this objective is strong clinical leadership and the monitoring of the strategies that are put in place, and although the Board retains ultimately accountability, the work is driven and monitored through the Clinical Governance Committee and the Quality Governance and Risk Committee. The integrated performance report, which is driven by the delivery of safe and effective care, has been developed to provide the Trust Board with assurance that quality is being carefully monitored and that improvement measures are being identified and implemented where necessary. It also enables the Trust to demonstrate its commitment to encouraging a culture of continuous improvement and accountability to patients, the community that it serves, the commissioners of its services and other key stakeholders. Some of the targets that form the balanced scorecard are targets that the Trust is mandated to report on, but a number of additional targets that provide evidence of the quality of the services that we provide have been identified by the Trust Board and feature on the balanced scorecard. Of particular note this month is the publication of the Patient Environment and Action Scores (PEAT) PEAT is an annual assessment of inpatient healthcare sites in England that have more than 10 beds. It is a benchmarking tool to ensure improvements are made in the non-clinical aspects of patient care including environment, food, privacy and dignity. The assessment results help to highlight areas for improvement and share best practice across healthcare organisations in England. PEAT provides a framework for inspecting standards to demonstrate how well individual healthcare organisations believe they are performing in key areas including: food, cleanliness , infection control, patient environment (including bathroom areas, lighting, floors and patient areas) .
Quality and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012 4
Executive Summary
Quality Update
Overview continued Following the inspection, a programme of mealtime audits has been commenced to provide regular assurance on nutrition and hydration as well as the patient experience at mealtimes. This is consistent with our high level quality goals. Details of BCHC scores can be found on page 23. Pressure ulcer ambition Assertive work continues on the delivery of the pressure ulcer ambition and further details are now being provided to the Board on incidence and prevalence of pressure ulcers. VTE Pleasingly and of note, Ward 9, Inpatient Neuro Rehabilitation have achieved 100% in the VTE assessment scores and assurances have been provided from the Clinical Director and clinical team of sustainability going forward. Winterbourne review Publication on the 25th June 2012 of the Department of Health Review: Winterbourne View Hospital, interim report, currently the Safeguarding adult team are reviewing the findings and preparing a report for Quality Governance and Risk Committee Patient surveys A slight drop has been noted in the completion of patient experience surveys. The Learning Disability service have revised their questionnaires based on the work they have done to consult with service users. Having taken feedback, the team wanted to make sure service user feedback was used to redesign the questions, slippage will now be rectified.
Executive Summary
Summary of issues to report
Commentary Overall, the Trust has achieved the following performance for June 2012:
The breakdown of the indicators the Trust did not achieve is as follows:
Trust wide underperformance refers to any indicator which the Trust has not achieved. For June these are all in the Use of Resources Domain: Contractual KPI breaches (p.16) Commissioner Contract Deadlines Missed (p.18) Staff appraisals (p.19) Local underperformance refers to any indicator which the Trust has achieved but which has been breached by individual divisions and is being managed locally and through PPMB. Watching Briefs refers to any indicator which the Trust is achieving but PPMB feels important to monitor more closely. Recovery Mode refers to any indicator where the original target has not been achieved in one of the previous month and therefore a revised trajectory has been agreed.
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Trust Scorecard June 2012
As had been detailed in the May report, actual reported percentage of sickness absence for June of is invalidated, while the previous month outturn (May 2012) is validated.
Trust Scorecard June 2012
Domain 1: Patient Safety
Domain Summary Patient Safety

Commentary In this summary, we have outlined the overall performance for the Trust for all of the Patient Safety indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Indicators with no areas of concern Attendance at Mandatory Training Medical appraisals MRSA new bacteria C. Diff new cases MSSA new cases E. Coli new cases Elective MRSA screening VTE risk assessment on admission Falls resulting in serious injury or death 100% compliance with WHO surgical checklist No. of serious incidents reported in 48 hours No. of never events Percentage of SI RCAs completed in timescale No. of serious incidents Patient Safety Thermometer Spend on Temporary Staffing NHS Safety Thermometer 71% 16% 0 7 0 3 100% 98.8% 4 100% 100% 0 100% 29 100% 6.1% 91.4%
Ref
1.10
Indicators with no data and comment Grade 3 or 4 pressure ulcers Available in August
Avoidable Grade 3 and 4 pressure ulcers are monitored and reported on a monthly basis to determine whether the pressure ulcer was avoidable or unavoidable. A root cause analysis is completed. Further details on pressure ulcers have been included on slides 12 and 13. The Trust has recorded 7 cases of C. Diff to date. This is slightly over the YTD plan of 6 cases by the end of June so we have reviewed this area in more detail.
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Patient Safety watching brief

1.4 C. Diff new cases
Indicator Goal: Place This indicator reports the total number of incidences of Clostridium Difficile for the month indicating if the Organisation is managing its overall target of equal to or less than 24 cases per annum. This is a target set out in the Operating Framework for 2012/13. As with MRSA, this demonstrates our standard of practice in relation to Control of Infection, links to quality of patient care and to managing our reputation as a healthcare provider and can affect our registration with the Care Quality Commission. The Director of Infection Prevention and Control has reported that there appears to be no link between the cases and that there is the usual proactive approach from the clinical team in order to monitor any potential causal factors. Patient safety visits: The number of visits between April 2012 and June 2012 was 5: Rapid response team Perry Tree Centre Physiotherapy (Musculo-skeletal), Walmley Health Centre Combined Community Dental Services, Stockland Green Primary Care Centre Speech & Language Therapy, Stockland Green PCC The quarterly report will be submitted to QGRC in August. Overall Trust position
Breakdown by Division
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Patient Safety service update

1.10 Grade 3 or 4 pressure ulcers
Commentary The final data for avoidable pressure ulcers for April has now been confirmed as 12 and the table opposite has been amended accordingly. Of the 21 grade 3 and 4 Pressure Ulcers originally reported in April, 2 were re-classified as the root cause analysis identified that the wound was not due to pressure damage, and 7 were classified as unavoidable using the SHA definitions. There were 27 grade 3 and 4 pressure ulcers attributable to BCHC reported in June. These are currently undergoing a root cause analysis investigation to determine factors of causation and whether any were unavoidable. It is noted that overall the numbers of Pressure ulcers occurring in our care increased in June. Detailed analysis has been undertaken to examine the rise in overall numbers and this has been escalated to the Adults and Communities Division for action. Three Community teams were identified as potential hotspots in June. Detailed analysis shows that all 3 teams have had an increase in training and the prevention of pressure ulcers emphasised. In addition the demographics of the geographical area covered by one of the teams shows a high percentage of older adults with a number of retirement communities located in the area. This team also have a larger number of grade 2 pressure ulcers reported, showing that skin damage is being identified and managed at an earlier stage.
Source: Serious Incident Data
Location Inpatients Grade 3 Inpatients Grade 4 Community Grade 3 Community Grade 4 Total
June 1 0 13 13 27
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Patient Safety service update

1.10 Grade 3 or 4 pressure ulcers
Commentary The prevalence graphs are based on the percentages identified through the monthly NHS Safety Thermometer data collection. Junes collection was based on a total of 2,302 patients (April n=2,168, May n = 2,146). This data is providing an excellent baseline to show improvement in reducing pressure ulcer prevalence. Midlands & East SHA data for All Pressure ulcers showed 7% (April) 6.9% (May) prevalence data. BCHC prevalence in June is 6.6% for All pressure ulcers. For new pressure ulcers (acquired in our care) Safety Thermometer showed 10 (0.44%) grade 3 and 4 pressure ulcers in June (April 15 (0.69%), May 14 (0.66%)). There is a programme of work being monitored by the Pressure Ulcer Reference Group that is reviewing staff competency, accessibility of equipment and actions arising from all root cause analyses investigations
Source: Serious Incident Data

Domain 2: Use of Resources
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Domain Summary Use of Resources

Commentary In this summary, we have outlined the overall performance for the Trust for all of the Use of Resources indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref
2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 Indicators with no areas of concern Monitor Governance Rating Total workforce (WTE) Turnover rolling total Total pay costs Percentage of vacancies Percentage of sickness absence for month Monitor Financial Rating Delivery of QIPP 0 4,410 13.9% 14.8M 6.61% 5.04% 3 95.96%
The Monitor Governance Rating for June is expected to be 0, the same as in April and May. Since the indicator is based on a number of individual elements, one of which might only be available by the 27th July, the rating will either be reported verbally to the Trust Board or included as the previous months data on the scorecard for July. The YTD target was not met for the delivery of contractual KPI (KPI breaches). An analysis into this is carried out overleaf. In June, the Trust did not meet the revised trajectory for Percentage of staff appraised. Children and Families and Specialist Services both showed red ratings against their recovery trajectories which have been further analysed overleaf. One commissioner contract deadline was missed for June which turned the indicator to show as red due to the zero tolerance target. Further details regarding this missed contract deadline have been provided overleaf.
Ref
2.1 2.2 2.3
Indicators which did not meet YTD target Delivery of contractual KPI (KPI breaches) Commissioner contract deadlines missed for month Percentage of staff appraised (within 18 months) 4 1 69% X X X
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Patient Safety area of underperformance

2.1 Delivery of Contractual KPI (KPI breaches)
Overall Trust position Indicator Goal: Partnership This is the number of Key Performance Indicators agreed with commissioners for 2012/13 which were in breach of contract in the month. This measure encourages proactive management of areas of risk across the organisation and identifies areas where the trust may be financially penalised. The annual target is to have no breaches. This was achieved by all divisions in month 1 but was breached in months 2 and 3. The Contractual KPI breach position has improved this month from a Trust total of 6 breaches last month to 4 this month. The improvement relates to breaches of the MLA contract requiring levels of staff training in a range of topics. Discussions between the Contracting team and the Commissioners have clarified that whilst there are a number of failing areas, these are grouped contractually into Infection Control, Universal Mandatory Training and Essential to Role Training. As a result of this clarification the number of KPIs at risk has been adjusted accordingly. The three breaches in Adults and Communities and the three breaches in Children and Families relate to the same contract (MLA). The Specialist breach relates to the Dental contract. Hence, the Trust has breached 4 contractual KPIs overall.

2.1 Delivery of Contractual KPI (KPI breaches)
Commentary MLA Contract - 3x Training KPI breaches Three breaches for Adults and Communities and Children and Families: Infection Control Training KPI Mandatory Training KPI Essential to Role Training KPI Both Divisions continue to work with Learning and Development to improve performance. In addition, The Nursing Director proposed a recovery trajectory to the Commissioner against the indicators within the contract. Dental Contract - Percentage of Elective Care operations cancelled for non-clinical reason. Performance against this indicator was 0.95% against a threshold of 0.5% for May. The BMI Edgbaston Daystay session for the 7th June was cancelled as both of the dentists that usually provide cover for the session were unavailable. However subsequently two patients were booked on the session, and as a result both bookings required cancelling. In line with policy, both patients were rebooked within five days for appointments within 28 days of the cancellation (one within 7 days, the other within 14 days). To prevent further occurrence, clinical and support staff availability has been rechecked, a rota compiled and forwarded to all involved, and a monthly review of the service administration will be undertaken at which the cover rota will be confirmed and circulated.
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2.2 Commissioner Contract Deadlines Missed
Overall Trust position Indicator Goal: Partnership This measure reports the number of contractual reporting deadlines missed in the month. This measure encourages proactive management of areas of risk across the organisation, gives the Board assurance on the Trust s ability to be timely and responsive to commissioners and identifies areas where the trust may be financially penalised. The monthly reports to the commissioner on the financial impact of activity are provided by a reporting system called SLAM. Reports covering April, May and June activity were due on the 3rd July 2012, and were provided on the 4th July 2012. The delay was due to a late resolution of a query around phasing of activity. The issue has been resolved, and we do not expect a recurrence in future months. This will result in no financial penalty for the Trust as remedial action was applied immediately.
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2.3 Percentage of staff appraised (within 18 months)
Overall Trust position Indicator Goal: People This measures the percentage of staff recorded as receiving an appraisal within the past 18 months. This indicator demonstrates a commitment to developing staff and is linked to evidence required for Investors in People/Improving Working Lives and the Organisational Development Strategy. If the majority of staff have had a personal development review in the past eighteen months it shows that the organisation takes the personal development of its workforce very seriously and is endeavouring to develop staff and deal with any performance issues in a timely manner. In addition it demonstrates that we ensure staff are competent to deliver their role by equipping them with the skills needed to perform their job and builds the foundations for succession planning. It should also improve the outcomes of the annual Staff Survey. This indicator follows a recovery trajectory Trust wide and in all Divisions apart from Corporate and Rehab Services within Specialist.
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2.3 Percentage of staff appraised (within 18 months)
Commentary Due to the indicator being based on an 18 month rolling total, the Divisions had been asked to review their trajectories with the Head of Learning and Development in order to achieve a better understanding of the numbers of PDRs necessary each month to achieve the target. Based on this review, Adults and Communities adjusted their trajectory accordingly and are achieving their recovery plan target. Children and Families and Specialist Division (Dental and Learning Disabilities) did not achieve their recovery plan targets in June due to a deterioration in performance in May. Children and Families : The Division is using data detailing the performance against the indicator at service level to enforce performance against the target. Learning and Development provide monthly reports which helps to inform service managers monitor the 18 months rolling target. PDRs are being cascaded from Divisional Director to ADs and Heads of Service. Specialist Services: Services are meeting with the Head of Learning and Development over the next 2 weeks to identify further actions that need to be adopted in order to improve the compliance in the future. LD services have a significant programme of PDRs in June and July and Rehabilitation over the summer through to September, it is aimed that this will improve the Divisions overall performance against this indicator. Adults and Communities: Although achieving their current recovery plan target, the Division has taken further measures to improve performance throughout all service areas which should have a positive impact on Trust performance over the next months: In Patient Services - all staff have dates for PDRs, including both General Managers. Community Services- Sets of core objectives have been produced to support line managers undertake PDRs. All line managers will have specific objectives regarding PDR achievement in their areas/ team responsibilities. Specialist services are in excess of target and all PDRs have been scheduled for 2012/13.
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Domain 3: Patient Experience
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Domain Summary Patient Experience

Commentary In this summary, we have outlined the overall performance for the Trust for all of the Patient Experience indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref
3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Indicators with no areas of concern Number of Complaints Number of Complaints acknowledged within 3 days Percentage of complaints responded to within 6 months or as agreed 18 week pathway (admitted patients) 18 week pathway (non-admitted patients) 18 week pathway (incomplete pathway) Cancer Referrals (Urgent 2WW) Customer experience patient surveys completed in all areas in past 12 months Net Promoter Score (in patient only) 13 100% 100% 96.7% 97.5% 98.6% 100% 96% 45
Net promoter: This Indicator is being reported for the first time this month and its implementation is driven by a regionally mandated CQUIN target. More commentary follows overleaf.
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Patient Experience service update

Net Promoter Overview The Net Promoter Score (NPS) is also known as the Friends and Family Test / question Introduced by Midlands and East SHA as regional CQUIN Implemented in Acute settings to gain feedback from 10% of footfall Part of the CQUIN requires that scores are discussed at Board Our target is to show an improvement on Q1 baseline scores by the end of the year Next Steps In Q1 we achieved a NPS of 45 for in patient discharges and a score of 49.2 for all patients in BCHC who were surveyed Nationally scores are reported to vary from 20 to 89 Concerns have been expressed nationally about the use of the question, and there may well be amendments before roll out next year We are part of a group of community trusts who have agreed to benchmark (anonomysed data) to assess the scoring in community settings We feel there are challenges around when, who and how the question is asked, which may influence scores Our target is to show an improvement on Q1 baseline scores by the end of the year Promoter: Passive: Detractor: Scores of 10 or 9 Scores of 8 or 7 Scores of 6 and below Scoring System Patient asked a specific question how likely is it on a scale of 1 to 10 that you would recommend this service to friends and family?
To establish the NPS, the percentage of detractors (i.e. patients scoring 6 or below) is subtracted from the percentage of promoters (i.e. scoring 9 or 10). Passive scores are not considered.
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Patient Experience service update

PEAT Scores
Commentary The annual Patient Environment Action Team (PEAT) scores have been added to this months reports as they have now been nationally published. There is a positive performance in all areas, noting that CU3 have now moved to much improved ward (CU 27).
PEAT SCORES Site Name Environment Score Food Score Privacy & Dignity Score
Community Unit 3 Good Hope Hospital Community Unit 29 at Heartlands Hospital Intermediate Care Rehabilitation Unit Ann Marie
3 Acceptable
3 Acceptable
4 Good
4 Good
5 Excellent
5 Excellent
4 Good
5 Excellent
5 Excellent
Perry Trees Care Centre Riverside Lodge Sheldon Nursing Home Moseley Hall Hospital West Heath Hospital Norman Power Centre
5 Excellent 5 Excellent 4 Good 4 Good 4 Good 5 Excellent
5 Excellent 5 Excellent 5 Excellent 5 Excellent 5 Excellent 5 Excellent
5 Excellent 5 Excellent 5 Excellent 4 Good 4 Good 5 Excellent
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Domain 4: Clinical Effectiveness
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Domain Summary Clinical Effectiveness

Commentary In this summary, we have outlined the overall performance for the Trust for all of the Clinical Effectiveness indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref
4.1 4.2 4.3 4.4 4.5 Indicators with no areas of concern CQC conditions or compliance concerns Percentage of compliance with CQC standards Essential Care Indicators (aggregated measure) Acute admission avoidance (adults only) Percentage of compliance with CQUINs 0 100% 93.6% 14% 100%
While the Trust was only slightly below its target for the Essential Care Indicators (ECI) in June, achieving an Amber rating, we have provided further analysis for each of the ECIs overleaf.
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Clinical Effectiveness watching brief

4.3 Essential Care Indicators
Indicator Goal: Product Essential Care Indicators are a set of metrics recording quality of care. This indicator records the compliance with assessment and care planning for Essential Care in bedded areas. Reporting is based on an audit of 10 sets of care plans per ward per month against an agreed set of care standards. The compliance scores are aggregated into an overall Trust compliance. The expectation is for 95% compliance with the standards. This demonstrates that appropriate care standards are followed.
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Commentary Patient Observations ECI Criteria Wards at MHH and WHH are maintaining good compliance with Wards 11, 12, 14, 4, 5 and 6 achieving 100% compliance. CU 29 has also achieved 100% compliance. The remaining intermediate care units have improved compliance. Perry trees unit are awaiting training and not yet using Modified Early Warning Signs and this is reflected in their poor compliance score. Falls Assessment ECI Criteria A number of Units achieved 100% compliance Wards 11, 12, 14 and 4. Most of the remaining units showed good compliance apart from reassessment of risk. Norman Power unit also needs to improve compliance with care plans. Units CU 29 and CU 27 both need to improve compliance across a number of falls standards and both have remedial plans in place. Tissue Viability ECI Criteria Ward 5 has achieved 100% compliance across all the Tissue Viability standards. The majority of the remaining Wards at MHH and WHH need to improve compliance in reassessment of risk. Ward 6, Anne Marie Howes, Perry trees and CU 29 Units all need to improve compliance with care planning. Ward 8, Norman Power unit and CU 27 showed poor compliance overall for Tissue Viability. Action plans are already in place for Norman Power and CU 27. The results from Ward 8 are being escalated for action and will be closely monitored in month.

Commentary Nutritional ECI Criteria The majority of units are showing good compliance with Nutritional standards, with Wards 14 and 4 and Norman Power and Anne Marie Howes Units having 100% compliance. Wards 6,11,12, 8, and C29 need to improve compliance in re-screening and CU27 unit is showing poor compliance across the majority of Nutritional standards which has been escalated for action. Medicines Management ECI Criteria The Intermediate Care Units and Wards 5 and 6 at MHH are all showing reduced compliance in some elements of Medicines management documentation, particularly the use of full patient Identification, the signing of discontinued prescriptions and the use of Capital letters for medicine names. Environmental ECI Criteria All units continue to perform well against these criteria apart from a number of the Intermediate Care Units which were not found to be displaying Estimated Date of Discharge.
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Domain 5: Efficiency and Productivity
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Domain Summary Efficiency and Productivity

Commentary In this summary, we have outlined the overall performance for the Trust for all of the Efficiency and Productivity indicators. Where the Trust has achieved the required target for the year to date, there are no areas of concern. However, where the Trust did not achieve the required to date (or a specific Division is significantly under-performing), we have provided supporting analysis on the subsequent pages. Ref
5.1 5.2 5.3 5.5 5.7 5.8 5.10 Indicators with no areas of concern Agency as a percentage of temporary staff spend Average length of time to recruit (Date Advertised to Offer) CRES achievement - % YTD actual compared to YTD Plan NHS DTOC SHA target snapshot percentage of patients Percentage of patient ethnicity codes recorded on PAS/Child Health System Availability of agreed services on Choose and Book YTD % CRES milestones achievement position 36.7% 89.7 84.38% 2.11% 89.4% 100% 95.15%
Ref
5.4 5.6 5.9
Indicators with no data and comment DNA rates SUS data with a valid NHS number Increase in funded health visitor WTE establishment Not available as at report date Not available as at report date Availability to be confirmed
The DNA rates and SUS data with a valid NHS number outturn are not made available until the 20th and 25th July so the Trust Board will be verbally updated on this area of performance at the Board meeting. While the recovery plan for CRES achievement - % YTD actual compared to plan was met by the Trust, we have provided the Trust Board with a financial update to reflect current CRES savings overleaf.
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Efficiency and Productivity watching brief

5.3 CRES achievement - % YTD actual compared to YTD plan
Indicator Goal: Price The Trust is required to make financial efficiency savings and this indicator will show the Board the progress being made throughout the year to deliver these savings. This is a new calculation. Previously the Trust reported cumulative CRES savings against the total target. The new indicator assesses CRES savings each month against the cumulative Year to Date (YTD) planned savings. The target is to achieve 100% of the YTD plan. Overall Trust position
Following month one outturns, the forecast has been revised to achieve 82% overall compliance by June 2012. While the Trust exceeded its June recovery target, Dental Hospital fell behind their YTD plan for the first time. This does not affect the overall target which is to achieve 100% compliance.
Efficiency and Productivity watching brief

5.3 CRES achievement - % YTD actual compared to YTD plan
Commentary The chart below highlights the YTD performance for the Trust and each Division compared to the YTD plan. The Trust achieved 2,030,989 savings against a YTD plan of 1,968,089 which equates to 103% CRES savings achieved compared to plan. This represents an improvement from May 2012, where the Trust achieved 83.61% of its CRES YTD savings target. Childrens (100%), Specialist LD (100%) and Adults and Communities (121%) achieved their revised YTD plan. Specialist Dental Community (95%), Specialist Rehab (95%) and Corporate (93%) are the only marginally underperforming services against the revised plans.
Specialist Rehab Services and Corporate Services Rehab Services, Adults and Communities and Corporate CRES savings have been re-profiled with a percentage of the schemes due to be phased in from Quarter two (no anticipated impact on the original outturn). Against the reprofiled plan, two of the three Divisions are now delivering 100% or more of their YTD savings.
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Appendix 1: Finance Report
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Finance Performance Report Month 3 2012/13
353 35
Finance Board Report Index
Page Executive Summary In Year Income & Expenditure Plan & Year End Performance Corporate Financial Risks CRES Delivery Capital Plan Working Capital Statement of Financial Position Working Capital Cash Flow/Debtors/Creditors/PSPP Working Capital Summary Figure Explanations Glossary 37 38 39 40 41 42 43 44 45 46
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Summary & Key Performance Indicators Executive Summary
Fig.1
Fig. 3
Fig. 2and Performance Report Birmingham Community Healthcare NHS Trust Report period June 2012 Quality
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In Year Income & Expenditure Plan & Year End Performance
The net I & E position as at month 3 is a YTD surplus of 869k and is against an in year planned surplus of 965k, demonstrating a 96k unfavourable variance from target. Through the newly created PPMB (Programmes & Performance Management Board) the YTD and forecast outturn positions are reported and discussed along with future planned recurrent positions and projections. Where divisions continue to underperform recovery plans will also be closely monitored through the Business and Finance Technical Committee. Figure 4 shows the summary of the divisional YTD position currently reporting a YTD unfavourable variance of 220k including income; At Month 3 the forecast outturn position for the Trust remains at 2,948k. The main factors and risks influencing the divisions month 3 position including income are: Children's and Families Mth 3 165k, Mth2 72k, Mth1 (3k) The YTD favourable variance relates to continuing slippage on vacancies offset by pressures in drugs (66k) Achievement of YTD CRES. Adults and Communities Mth3 (252k),Mth2 (42k), Mth1 (24k) The month 3 position relates mainly to the delay in Inpatient Service Redesign (225k), now expected to complete in July, medical staffing locum cover (58k) and underperformance (250k) relating to the phasing of activity. The issue has been resolved, and is expected to result in no financial penalty to the Trust by year end. Offset by continuing slippage on vacancies in the main within central services and medical staffing. Achievement of YTD CRES against recovery plan Specialist LD Mth3 (122k), Mth2 52k, Mth1 (15k) The unfavourable movement in month relates to short term breaks (88k). In addition the YTD position as previously reported includes additional income, offset by continuing bank and agency spend and non pay cost pressures. Achievement of YTD CRES against plan.
Fig.4
Rehabilitation Mth3 (73k), Mth2 (30k), Mth1 (102k) YTD overspend of (73k) with continuing pressures in RTS which is considered to be a non recurrent issue, special seating (67k), Rehab Engineers (55k) and FES (28k), offset by vacancies. The division has been asked to complete a full review of service line profitability. CRES 5k adverse to recovery plan Dental/PDS Mth3 62k, Mth 2 54k, Mth1 69k As reported in previous months the favourable variance relates to continuing vacancies, and slippage on non pay contracts . CRES 9k adverse to plan. Corporate Mth3 15k, Mth 2 10k, Mth1 6k Month 3 favourable variance is primarily due to slippage on vacancies, offset by non pay cost pressures. CRES 40k adverse to original plan
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Corporate Financial Risks
Financial Risk Register All risks to the organisation are managed through the risk management committee, with all those attaining a score of 15 or above being escalated to the corporate risk register, and presented to the Governance and Risk Management Committee and the Board. All financial risks with a score of 15 or above are presented below.
There are no Financial Risks with a score of 15 or above for this month.
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CRES Delivery
Fig 6
Fig 7.
CRES Delivery Our CRES requirement for 2012/13 is (12.1m) and projects have been identified and developed through PIDs (Project Initiation Document). These plans have been developed with Divisions and have been corporately overseen and clinically driven; each project is owned by an individual within the relevant division, and they are held responsible for achievement of the savings requirements. We have developed a rigid gateway acceptance that ensures all PIDs accepted are monitored through PPMO (Performance Management Office). Regular monitoring of progress against CRES schemes will be reported to the PPMB (Programmes and Performance Management Board). Figure 6 above details the planned YTD savings and the identified YTD savings by division. It shows that currently there is an minor under achievement of savings, in year relating to Corporate, Rehab and Dental and small overachievement of revised plan by Adults & Communities Division. Divisions are confident that savings will be achieved, and the Business, Finance and Technical Committee and PPMO will continue to monitor progress .
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Capital Plan
Fig.8
Capital Update 2012/13 Sources of funds - The forecast outturn has been revised in Month 3 to reflect that currently the expected transfer of Estates has not taken place. The Trust expects this to be updated later in the year, when the transfer is certain. It can be noted, that in order to maintain the Trusts capital plans more funds will need to be found from surplus / PDC Loan if the transfer does not take place. As at the end of June 2012 capital expenditure totalled 149k. New scheme codes have been issued to managers relating to the 2012/13 capital plan and are now in use following the migration of shared services to SBS. The Trust continue to manage the building schemes for all buildings that will transfer during the financial year and the placing of orders commenced during May 2012. A detailed plan for the expenditure is almost complete with managers and will provide accurate capital profiling for the remainder of the year.
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Working Capital Statement of Financial Position

Fig. 10
Non Current Assets Non current assets have increased by 77k due to expenditure in month being in excess of depreciation. Current assets Overall current assets - excluding cash and cash equivalents have increased by 1,662m due to an increase in accrued income and prepayments during the month. Financial assets - accrued income There is an increase in accruals and prepayments in month of 1,706k. The increase in accruals is mainly due to invoices not raised on time Trade and other receivables (invoiced debtors) There is a decrease in outstanding debtors in month of 44k Cash and Other Financial Assets Cash has decreased in month (5,558k). The decrease is mostly due to the continued effort in reducing aged creditors migrated from the old payment systems and some correction by SBS to the ledger relating to the cashbook Current Liabilities Current liabilities have decreased by 3,780k in month Trade and other payables / other financial liabilities accruals There has been a decrease of 3,907k in outstanding trade and other payables during the month as a result of continued work to clear aged creditors. Non Current Liabilities The Trust has no non current liabilities. Liquidity Position The Trust has cash totalling 30,758k which represents the Trusts cash requirement for more than one month.
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Working Capital
Fig 11.
Cash Flow Analysis 2011/12 - 2012/13 Plan vs Actual

m m m m m m m m m m m m m m m m
Plan balance Actual balance

Fig.13
Dec-11 27.4 29.6
Jan-12 28.0 31.2
Feb-12 28.4 30.3
Mar-12 26.3 28.7
Apr-12 May-12 27.1 27.9 29.3 36.3
Jun-12 28.7 30.7
Jul-12 29.5
Aug-12 30.2
Fig.15
Sep-12 31.0
Oct-12 31.8
Nov-12 32.6
Dec-12 33.3
Jan-13 34.1
Feb-13 34.9
Mar-13 35.7
Aged Debt
Current '000 2,044
31-60 Days 61-90 Days 91-120 Days > 120 Days > 180 Days '000 536 '000 74 '000 1,222 '000 289 '000 232
Month 3 Total '000 4,397
Month 2 Total '000 4,439
Variance (42)
Total
Fig.12
Fig.14
Aged Creditors
Current '000
31-60 Days 61-90 Days 91-120 Days > 120 Days > 180 Days '000 3,543 772 4,315 '000 247 463 710 '000 308 337 645 '000 -35 176 141 '000 509 118 627
Month 3 Total '000 7,565 2,777 10,342
Month 2 Total '000 6,799 5,233 12,032
Variance '000 766 (2,456) (1,690)

43
NHS Non NHS Total
2,993 911 3,904
Working Capital
Cash Cash in hand and in the bank totalled 30,758k as at the end of June 2012 which is a decrease of 5,558k in month. This was due to the continued effort in reducing aged creditors migrated from the old payments systems and corrections to the ledger carried out by SBS. Debtors The total debts outstanding at the end of Month 3 is 4,397k, which is a reduction of 41k from Month 2, with debts exceeding 120 days totalling 524k - an equivalent of 11.92% (refer table below) The total debts include both NHS and NON-NHS and are actively being chased for payment
Aged Debt Month 3 Current '000 31-60 Days '000 61-90 Days '000 91-120 Days '000 >120 Days '000 >180 Days '000 Grand Total '000
NHS NON NHS Non NHS - Excl L/Cars & Sal O/P leaseCars Salary Overpayment Grand Total Total number of Invoices
1,733 311 305 5 1 2,044 279
276 260 256 4 0 536 114
69 5 5 0 0 74 30
1,082 140 136 2 2 1,222 98
277 12 9 3 0 289 58
149 83 51 7 25 232 122
3,586 811 762 21 28 4,397 701
A summary of debts over 120 days mainly relates to the following customers: Birmingham East and North - 151k - 72k of the outstanding debt has been received in July, plus the requested credit note for 58k re: charges over the agreed maximum 57k charge has been raised. This leaves a balance of 21k outstanding which will be paid on receipt of the credit note. South Staffordshire PCT - 113k The Division is actively pursuing payment for the outstanding invoices, Copies of requested signed SLA documentation has being forwarded to South Staffordshire, who has confirmed that payment will be forthcoming within the next 2 weeks. Sandwell and West Birmingham Hospitals NHS Trust - 57k Credit notes are in the process of being raised to clear the disputes on these invoices. On receipt of the credit notes, payment of the outstanding balance will be imminent. Cape Hill Medical Centre - 32k The Division is actively liaising with Cape Hill to try resolve the disputes on the 2 outstanding invoices. Creditors Aged Creditors at the end of month 3 is currently showing a balance of 10,342k, which is a decrease of 1,690k in month. Over 120 days past due date creditors have increased to 768k in month 3 from 639k in month 2 which represents 7.43% of total creditors. PSPP The Public Sector Prompt Payment Policy target is 95% of bills to be paid within 30 days and will be reported in the annual accounts. The cumulative performance for the year is 73.48% (M2 75.61%) with 71.47% (M2 71.64%) of invoices within the month being paid within the PSPP target timescale. Work is on-going to ensure that the cumulative performance is improved and it is being reported at PPMO. Note : The SHA has asked organisations to provide turnaround plans where debtors and creditors exceed 90 days past due. The newly established monthly performance management meeting (Performance and Programme Management Board, PPMB) will oversee local delivery of the 90 day and 30 day targets in the future.
44
Figure Explanation
Figure 1.
Demonstrates the current I&E position compared to both the in year planned position and full year plan. Assesses financial risk and looks at four criteria: achievement of plan, underlying performance; financial efficiency; and liquidity and is scored from 5 to 1. A weighted average of these scores is then used to determine the overall financial risk rating Key performance indicators
Figure 10.
The balance sheet shows prior month, current month, movement in month. It also shows the balances as if we were operating as an FT for comparison Shows the cash balance on a rolling basis. A full cash forecasting model supports this data. Graph showing the Cash Flow Analysis of actual vs. plan
Figure 2.
Figure 11.
Figure 12.
Figure 13. Figure 3.
Provides an analysis of aged debt within the period.
Figure 14. Figure 4.
Provides an analysis of aged creditor within the period.
Demonstrates the current I&E position

Figure 15.
Figure 5.
Corporate Financial Risks of rating 15 or over CRES Performance illustrating Recurrent & Non Recurrent, the forecast and the actual achieved. Graph illustrating the CRES Performance YTD
Shows the in month and Cumulative PSPP compared to the annual target
Figure 6.
Figure 7.
Figure 8.
Provides an analysis of Capital budget by directorate Provides an analysis of capital sources and applications
Figure 9.
45
Glossary
ALE BCC BDC BFM CDM CRES CRL EBITDA ESR FDC FBC FOT FPMG FT HoEFT HOS HR I&E IT LDP LTFM
Auditors Local Evaluation Birmingham City Council Business Development Centre Business Finance Manager Centre for Defence Medicine Cost Releasing Efficiency Savings Capital Resource Limit Earnings Before Interest, Tax, Depreciation and Amortization Electronic Staff Record Financial Delivery Committee Full Business Case Forecast Outturn Finance & Performance Management Group Foundation Trust Heart of England NHS Foundation Trust Heads of Services Human Resource Income & Expenditure Information Technology Local Development Programme Long Term Financial Model
MADEL MHH NPSA OBC OOH PBR PFI PL PLD PSC PSPP QTR R&D RMHN RPL SBCH SHA SFIs YTD ZBB
Medical and Dental Education Levy Moseley Hall Hospital Named Patient Service Agreement Outline Business Case Out of Hours Payment by Results Private Finance Initiative Project Lead People with Learning Disabilities Public Sector Consulting Public Sector Payment Policy Quarter Research & Development Registered Mental Health Nurse Revenue Resource Limit South Birmingham Community Health Strategic Health Authority Standing Financial Instructions Year to Date Zero Based Budgeting
46

BCHC Quality and Performance Report Final Jun - Jul 2012 PDF

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Birmingham Community Healthcare NHS Trust

Quality and Performance Report

Report Date: 19th July 2012

Trust Scorecard June 2012

Trust Scorecard June 2012

Domain 1: Patient Safety

Domain Summary Patient Safety

Patient Safety watching brief

Patient Safety service update

Patient Safety service update

Source: Serious Incident Data

Domain 2: Use of Resources

Domain Summary Use of Resources

Patient Safety area of underperformance

Patient Safety area of underperformance

Patient Safety area of underperformance

Patient Safety area of underperformance

Patient Safety area of underperformance

Domain 3: Patient Experience

Domain Summary Patient Experience

Patient Experience service update

Patient Experience service update

5 Excellent 5 Excellent 4 Good 4 Good 4 Good 5 Excellent

5 Excellent 5 Excellent 5 Excellent 5 Excellent 5 Excellent 5 Excellent

5 Excellent 5 Excellent 5 Excellent 4 Good 4 Good 5 Excellent

Domain 4: Clinical Effectiveness

Domain Summary Clinical Effectiveness

Clinical Effectiveness watching brief

Clinical Effectiveness watching brief

Clinical Effectiveness watching brief

Domain 5: Efficiency and Productivity

Domain Summary Efficiency and Productivity

Efficiency and Productivity watching brief

Efficiency and Productivity watching brief

Appendix 1: Finance Report

Finance Performance Report Month 3 2012/13

Finance Board Report Index

Summary & Key Performance Indicators Executive Summary

In Year Income & Expenditure Plan & Year End Performance

Corporate Financial Risks

Working Capital Statement of Financial Position

Cash Flow Analysis 2011/12 - 2012/13 Plan vs Actual

Plan balance Actual balance

Dec-11 27.4 29.6

Jan-12 28.0 31.2

Feb-12 28.4 30.3

Mar-12 26.3 28.7

Apr-12 May-12 27.1 27.9 29.3 36.3

Jun-12 28.7 30.7

Current '000 2,044

Month 3 Total '000 4,397

Month 2 Total '000 4,439

Month 3 Total '000 7,565 2,777 10,342

Month 2 Total '000 6,799 5,233 12,032

Variance '000 766 (2,456) (1,690)

NHS Non NHS Total

2,993 911 3,904

1,733 311 305 5 1 2,044 279

276 260 256 4 0 536 114

1,082 140 136 2 2 1,222 98

149 83 51 7 25 232 122

3,586 811 762 21 28 4,397 701

Figure 13. Figure 3.