MID STAFFORDSHIRE NHS FOUNDATION TRUST Report to: Report of: Joint Health Scrutiny Accountability Session Antony Sumara Chief Executive Date: 20 April 2011 Subject: Mid Staffordshire NHS Foundation Trust progress Purpose of the Report To brief Health Scrutiny members on the following: 1 Introduction by Chief Executive. Oral report covering key current issues and priorities, programmes and projects, including: Appointment of Chief Executive Non Executive Director appointments Public Inquiry NHSLA Level 1 Business Plan 2011/12 Review of Clinical Services /Surgery in Partnership. 2 Patient Safety and Quality of Care a) Issues raised by Health Scrutiny in February Orthodontics: There was concern that the Orthodontic service was experiencing delays in treating patients and that these are due to clinical staff shortages. The Trust s Orthodontic Service Action Plan is attached as Appendix 1. Endoscopy and perforated intestine incidents: has the Trust had any further incidents in this area? There have been no further incidents in this area. How many staff in A&E been disciplined? One member of staff (Admin. & Clerical) has been disciplined in the last 12 months in A&E.
Readmission rates explanation: why is the readmission rate is the 2 nd highest in our comparator group The table provided within the Trust s Progress Report presented in February, has been updated below to include performance up until September 2010: 28 Day Re-admission Rate comparison with comparable sized Trusts 28 Readmission rate % (Dr Foster) Trust April 2010 to September 2010 Burton Hospitals NHS Foundation Trust 7.10% East Sussex Hospitals NHS Trust 7.30% Mid Staffordshire NHS Foundation Trust 6.10% North Cumbria University Hospitals NHS Trust 6.10% Peterborough and Stamford Hospitals NHS Foundation Trust 6.10% South Warwickshire NHS Foundation Trust 5.20% Worcestershire Acute Hospitals NHS Trust 6.60% The Trusts highlighted in italics (including MSFT) have risk ratings that are within the expected parameters and are currently performing above the benchmark. Therefore, the Trust s performance in relation to re-admission rates is within expectation parameters and is not currently of concern. However, the Trust has reviewed all re-admissions to ensure that there are not any high levels of re-admission occurring within the same specialty or for the same consultant and we can confirm that there are no patterns to cause concern. b) Performance Operational Performance Indicator Target5 10/11 Performance Maximum 18 week Referral to >=90% Achieved - 97.6% Treatment wait (Admitted patients) Maximum 18 week Referral to >=95% Achieved 99.4% Treatment wait (non-admitted patients) Incidence of MRSA bacteraemia No more than 3 Achieved 2 cases C.diff Positive Samples No more than 35 Achieved 30 cases Cancer 2 week waits 93% Achieved 94.2% One month wait for diagnosis to 96% Achieved 99.7% treatment for all cancers Two month GP urgent referral to 85% Achieved 90.1% treatment for all cancers Urgent referrals for breast 93% Achieved 93% symptoms 31 day second or subsequent 94.8% Achieved 100% treatment (surgery) 31 day second or subsequent 98% Achieved 100% treatment (drug) One month referral to treatment (Rare Cancers) 85% Achieved 100%
62 day referral to treatment from hospital specialist Rapid access chest pain clinic - 2 week wait Average length of stay for Emergency patients 85% Achieved 94.4% 100% of patients seen within 2 Achieved - 100% weeks 4.6 days Achieved 4.23 days Indicator Target5 10/11 Performance A&E 4 hour maximum wait A&E 4 hour maximum wait Under Achieved - 92.47% time>=95% time>=95-92.47% Maximum 6 week wait for 100% Under Achieved - 99.99% diagnostic tests Cancelled Operations Readmitted 100% of cancelled patients Under Achieved 99.5% within 28 days of cancellation readmitted in 28 days Average length of stay for Elective 3 days Under Achieved - 3.22 days patients GUM % seen within 48 hours 100% Under Achieved 73.58% Fracture Neck of Femur: time to 100% Under Achieved- 76.6% surgery within 2 days Delayed transfer of Care 3.5% Under Achieved- 5.8% Governance - Assurance Framework 72 objectives completed in 2010/11 (out of original 86) 8 objectives linked to strategy 6 objectives linked to operational improvements: E-outpatient letters to GPs Level one surgical facility E-real time patient observation Hospital at night (out of hours) Skill-mix review for Allied Health Professionals (AHPs) Benchmarking for Pharmacists and Scientists Actions to address those objectives not completed: 8 strategic objectives all in progress supporting Clinical Services Improvement Plan 6 operational objectives: E-outpatient letters / E-real time patient observations operational directorate / IT plans Skill-mix review / benchmarking operational directorate / HR plans Level one / hospital at night Financial The Trust has also seen a higher cost than planned for our Insurance scheme (Clinical Negligence Scheme for Trusts) of 0.13m and because the Trust has not delivered the cost improvement plan as expected this has led to a budgetary pressure of 0.4m.
Despite this large and unacceptable overspend the Trust remains committed to delivering safe and high quality patient care and in the short term the budgetary over spend reflects this commitment. The Trust is still forecasting a year end deficit of 14.2m against a planned deficit of 7.4m, however work continues to control expenditure and if possible, reduce the year end deficit. Examples of the work include improved financial controls, re-educating staff as to the importance of financial rigour, reinforcing the existing rules, ensuring compliance checks through accountability sessions. The Trust has established an investment committee that will authorise any expenditure over 50,000 as per the new financial rules. c) Quality and Safety Serious Incidents New Incident Reporting Policy Review of old serious incidents re timescales and agreement with PCT Summary reports considered by Executive Team on weekly basis Detailed reports considered monthly by Incident Review Group See attached Appendix 2 for details of all open Serious Incidents as at mid March. Emergency Care Improvement Plan To support improvement of patient flow, in conjunction with Discharge Improvement Plan Aims: Improve quality of patient experience Achieve an immediate improvement in performance against the 4 hour target Develop A&E department as a positive place to work, staff displaying Trust values Develop robust and meaningful Key Performance Indicators and performance management Develop integrated pathways with primary and community care Ensure correct infrastructure and support tools are in place Work stream themes: Staffing and organisation Training and education Process improvement Support services Management and governance Emergency care vision and strategy Timescales: Q1->Q2->Q3
Hospital Out of Hours 24/7 Outreach service Staff in post by 1st September 2011 Fully established by 1st December 2011 Provision of assessments for patients at risk of deterioration, critical care needs outside of Critical Care Unit (CCU) and/or recently discharged from CCU Consultant and junior doctor cover Nursing cover Senior management cover Level One Surgical Facility Operational by 1st June 2011 To accommodate elective surgical patients that require a level of care above basic nursing care but not high dependency (level 2) or intensive (level 3) Nurse staffing agreed using acuity tool Converting 4 beds on ward 6 from general acute to level 1 Will operate similarly to level 1 facilities on Cardiology and Respiratory Medicine d) Patient and public feedback and engagement Complaints Complaints are reported to Trust Board each quarter. The most recent report was in January 2011, which is attached as Appendix 3. The next report goes to Trust Board on 28 th April and will be available on our website www.midstaffs.nhs.uk at that time.