Imperial board meeting 26th November 2014 Key Points
- Published: Friday, 05 December 2014 18:37
- Written by Una
find serif;">Project diamond predicted income at risk, shop if they don't get both components
Bill Shields " He believed the Trust would still receive £7.2M for Project Diamond but not necessarily £10M for market forces which would see the Trust reduce its surplus from £11.2M to £1.2M".
Jolly to USA (we found at meeting it is organised by McKinsey's)
"North West London CCG are paying for an international integrated care study tour from 29th November to 6th December to the US which will be attended by the CEO. Visits in Boston, New York, Baltimore and Richmond will be to innovative organisations who are renowned for excellent community care, integrated care and partnership models. Invitees to the tour include chief executives from acute and community providers and commissioners in the North West London sector. A report will be made to the next Trust Board meeting on the learning and outcomes of the visit."
Poorer financial performance than predicted
"The Trust’s financial position for the month was a surplus of £1.8m which is an adverse variance of £1.6m in month. The Year to Date (YTD) surplus of £0.8m represents an adverse variance against plan of £8.0m. Pay expenditure shows an adverse YTD variance of £18.9m as a result of under-achievement of CIPs, which are behind plan by £12.1m (53%) and the higher than planned bank and agency staff. Significant work is underway to look at our rostering practices across the Trust".
"There was an increase in volume of formal and PALS complaints in October."
Increase in length of stay for unplanned admissions in October
"the non-elective length of stay measure worsened in October to above the threshold of less than 4.5 days, to 4.9 days."
Reduction in Theatre utilisation
from 77% to 74% in October.
Unpredicted variance in A&E attendances leading to longer waiting times
Following the closure of the Hammersmith Emergency Unit as planned. The subsequent number of attendances at
the St Mary Hospital and Charing Cross Hospital sites has been as expected from the modelling that took place
prior to the closure. However, there has been huge variance in the volumes of patients attending A&E, particularly
at St Mary’s Hospital.
Variations in attendances between days can be as high as 120. These unprecedented surges in activity have
resulted in the Trust failing to meet the 95 per cent four-hour waiting time standard.
Measures Imperial taken to improve A&E waiting times
" The focus for the Trust is to action a targeted response aimed at boosting resilience. There are a number of
initiatives now in place which will improve the waiting times.
? Senior decision makers
The Trust has put in place additional GPs in the Urgent Care Centres, Emergency Nurse Practitioners, Intaking
Physicians, A&E consultants and management and nursing support. This will improve the pathway within the
emergency departments and reduce the time it takes for a clinical decision on the treatment options.
? Physical capacity
The Trust has opened up extra capacity at St Mary’s hospital to accommodate an increase in medical admissions.
The Trust is also in the process of completing some estates work to accommodate additional ambulatory care and
Urgent Care Centre capacity at the Charing Cross.
Delays in Referral to treatment (RTT) targets missed
There is currently a national amnesty on delivery of the three RTT standards. This has been put in place and
agreed at a national and local level to allow Trusts to clear as many over 18 week patients as possible to add
resilience into the system going into the winter period. The Trust has put on additional capacity to treat long
waiters and therefore a dip in performance is expected. This applies to data submitted for performance in October
and November. In October, as planned, all three standards were under delivered. As well as putting extra capacity
in some challenged specialities to reduce the numbers of patients waiting over 18 weeks, there have been a
number of data quality challenges that the Trust has experienced since the implementation of a new patient
administration system in April 2014 (Cerner).
Delay in cancer RTT and diagnostic waiting times
"In September the Trust achieved six of the eight cancer standards. The Trust under delivered on the 62-day first
treatment from GP referral standard. This was the result of a high number of patients being referred into the Trust
from other sites late in their pathways, plus a number of pathways being resolved after delays through the
summer period. The Trust also under delivered on the 31-day subsequent surgery standard as a result of a number
of delays caused by consultant absence over the summer period. It is expected that performance for both of these
standards will be recovered in Quarter 3.
The Trust continues to work with local providers to redesign their diagnostic pathways. This is to ensure that
patients are transferred to ICHT for treatment earlier in their pathways in order to reduce the number of shared
pathway breaches, the predominant cause of 62-day breaches for the Trust.
Diagnostic waiting times
The Trust has not yet submitted the data for the six week diagnostic standard (due for submission on Wednesday
19th November) but expects to under deliver on this standard in October.
Cost Improvement Plans behind schedule by £12..1m 53%
"The main reasons for the YTD adverse variance are:
? Cost Improvement Plans (CIPs) are behind plan by £12.1m (53%);
? Staff pay costs are significantly higher than planned and with an increase in month, indicating that the
previously instigated controls and agreed financial recovery controls are not being implemented.
There is on-going dialogue with the TDA about the impact of the proposed Project Diamond funding reductions on
the Trust’s financial position in both current and future years. Any reductions in funding will mean that the Trust’s
I&E control total will have to reduce.
Vacancy rate increased fr om 12.59% and Bank & Agency increased to 11.9% in October.
Threat to emergency surgery at CX?
The committee received an oral update on the action plan for Emergency Surgery at Charing Cross noting that
Divisional colleagues were developing proposals for the end of December 2014 for a plan around investment
across the three levels of cover required for a 3-5 year period to sustain the Charing Cross Hospital emergency
"Dr Tracey Batten advised that a decision was required by the end of the calendar year as to whether emergency
surgery at Charing Cross Hospital was a sustainable service and if not how to ensure the service at Charing Cross
Hospital would be sustainable. Prof Jamil Mayet would produce a detailed action plan by the end of October 2014
and Dr Tracey Batten noted that a sustainable plan needed to be put in place for the next 5-6 years as the
Business Case would not be implemented until 2020.
Surgery & Cancer
Prof Jamil Mayet noted that elective surgery at Charing Cross had moved from a Consultant of the day model to
Consultant of the week. The recruitment of Junior Doctors remained difficult but the rota was being actively
managed although would become an issue in the middle of 2015 as the rotation procedure would change
with Junior Doctors being given community placements resulting in a loss to the Trust of 15 Junior Doctors which
would be mapped for discussion at ExCo.
Call for less spin from Imperial (from a insider)
" Sir Gerald Acher stated that he had been very disappointed with the recent Trust press release which implied that the Trust
was doing well in the National Cancer Patient Experience Survey and suggested that the Trust needed to be open and clear
in its messages and not use "spin".
Bill Shields is frank about finance
"The month 5 figures indicated that there remained a year to date deficit despite improvement with issues around:
? Increase in both temporary and permanent staff;
? Increase in bank and agency and locum staff;
? A lack of effective controls with ineffective delegation;
? Capacity not returning to pre winter levels;
? Issues with Cerner:
o More money on implementation
o Inability to collect activity data effectively
? CIPs (which were the subject of a separate paper) being:
o Based on income and not the contractual position;
Plan to cut more beds
"He confirmed that there was already an outline plan in place which had started to be progressed and that there was a bed
reduction opportunity which could achieve another £0.5M saving."
"The Committee noted that the work would be likely to identify opportunities for services that were currently not profitable"