Transforming Care Transforming Care Month 5  Report 2 October 2012 Transforming Care Executive Report Transforming Care Executive Summary Governance • The DELIVERY phase of the Trusts Transformation portfolio of change has been straplined as follows: Transforming Care for the future – Delivering Change. • The programme governance has been reviewed in light of the move to delivery stage and the Transforming Care Governance Board redefined. • Programmes have been aligned into three areas; ‘Peoples programmes’ covering workforce transformation, medical and nursing productivity, ‘Clinical patient programmes’ covering patient flow, variation of care and utilisation of investigative sciences, and ‘Support programmes’ covering the remainder. Achievements • Patient Flow – case management has been rolled out on to G3 and level 8 wards. • Patient Flow – A detailed ‘bed predictor’ tool is in place. • Patient flow – Agreement has been reached with the PCT to fund ambulatory care pathways into the hospital. • Patient Flow – Plans are in place to extend acute physician presence in ED until 2200hrs on week nights and between 1200hrs and 1800hrs at weekends • Workforce Transformation – A Performance Evaluation Tool has been launched with all staff being evaluated by the end of September. • Medical Productivity – leave planning using MAPS went live in ED, plastics, Neurosurgery and radiology. • Nursing Productivity – Consultation to begin this month on the transfer of all specialist nurses onto standardised job descriptions and pay banding. • Procurement and Supply Chain - Work to streamline the physical supply chain has begun this month, implementation starting in September. • Recording care – A total of 31 Consultant – Coder 1:1s have been completed. • Recording care – eDischarge non-completion rate has fallen from 12% to 3.5% • Portfolio Strategy – Agreement has been reached with the Specialist Commissioning group to repatriate additional paediatric activity from GOS. • A clinically led Quality and Safety risk revue has been carried out across all programmes. 98% of projects on CIP tracker had a Q&S rating approved by a lead clinician. 2 Transforming Care Executive Report Transforming Care Finances •Actual YTD have increased from £4.32m last month (July 2012) to £5.53m. The two key areas that have underperformed are the workforce transformation programme (see below) and the patient flow programme. Here the current actions to reduce length of stay (LOS) are restoring the situation to the baseline LOS (start of year) position, once that has been achieved the financial benefit of additional reductions will be accredited to the programme. •The FY forecast of recurrent CIPs has been refined to £23.8m against a budget of £31.9m. This figure now reflects just the total of the amber and green value of savings (where proposed plans to deliver savings are in place or the savings are already ‘in the bag’ ) in the programme assurance values, rather than the total of red, amber and green (£33.3m) last month and thus more conservative in outlook. •The report now shows savings aligned to Divisions rather than some being unallocated in a separate ‘Amber’ Division on CIP tracker. Risks Lack of awareness of staff will hinder implementation progress. •Mitigation. A Trust – wide ‘Transforming Care ‘call to action’ is being implemented during October 2012, using corporate channels, champions and a compelling visual campaign with staff raising awareness of the transformation story. It will target 500- 600 managers across the Trust, provide a briefing and tools to support their on-going discussions with their teams. Lack of capacity hinders programme delivery •Mitigation. The Transformation Director is revising a detailed resource plan for necessary skills and capability Lack of pace leading to the financial position deteriorating further •Mitigation . The Transformation Director is revising the governance system to focus on successful delivery as well as a review of current detailed delivery plans. 3 Transforming Care Executive Report Transforming Care Issues Patient Flow – lack of case managers for training is delaying roll out programme and roll out of delivery in Medicine unclear. • Detail and Mitigation. The original case management roll out plans were to have introduced case managers onto three quarters of all wards by the end of October. However, despite case management having commenced on G3 and level 8, the programme is being effectively delayed by 3 weeks due to a lack of identified case managers to train. An accelerated recruitment process is underway and the programme is looking how to recover the plan to ensure operational bed capacity for the winter. Additionally there have been some unresolved issues and difference of views about delivery of case management in the Medicine Directorate. The Transformation Governance Board will be discussing this with the Medical Directorate. Workforce transformation - The year end forecast has been reduced by £1m. • Detail and Mitigation. There appears to be no Trust wide reduction in headcount, which was the basis of these savings assumptions. Analysis is being undertaken to separate growth in posts as a result of new areas of activity which might be masking underlying pay cost reduction through attrition, banding reductions and reduction in hours. • Further work is underway in understanding when the benefits of the performance management project can be expected to occur, specifically which financial year. The under delivery of financial benefits is being taken through to 2013/14. Drugs - Both the year to date and year end forecasts are deteriorating. • Mitigation. The Transformation Governance Board have directed that further management support be given to the programme to prevent further deterioration. Emergency and Periops Care Division remain significantly short in identifying recurrent CIPs at 29% of the agreed requirement. • Mitigation. A major piece of scoping work regarding the utilisation of orthopaedic theatres along with the theatres in Ely is being undertaken to address this. Programme Priorities for September/October • Test validity and robustness of delivery plans across key aspects of the programmes • Establish governance focused on successful delivery • Evaluate the risk of there being barriers to successful delivery of agreed plans in corporate and divisional services • A detailed resource plan for necessary skills and capability Recommendations: The Board is asked to note the overall progress, risks and issues in delivering the 2012/13 Transformation Programme. 4 Programme Summary Transforming Care STATUS SUMMARY STATUS TRACKING Quality &Safety Fin Benefits KPIs Milestones Q&S Fin Benefits KPIs Milestones Risks/Issues Risks/Issues G A A A A FINANCIAL BENEFITS (recurring) Programme SUMMARY KEY RISK & ISSUES Risk Mitigation Status Owner Due Lack of awareness of Call to arms programme JCCE Ongoing staff will hinder being rolled out. A implementation progress Lack of pace leading to Leadership at all levels JCCE Ongoing the financial position to ensure timely deteriorating further decision making and prioritization of A transformation activity. Concentration on KEY delivery plans. Milestone (M) or Benefit (B) planned, on track, delivered Lack of capacity hinders Director of Director Ongoing M or B off plan but recovery actions in place programme delivery Transformation of M or B overdue / not achieved undertaking a further Transfor review of resource A mation requirements MP Medical Productivity PF Patient Flow DRU Drugs PS Portfolio Strategy NP Nursing Productivity PSC Procurement & Supply Chain VOC Variation of Care RC Recording Care WT Workforce Transformation UIS Utilisation of IS 5 Executive Sponsor - Programme Assurance Values Transforming Care Category Interpretation Each Executive Sponsor was asked to risk score the achievement of his / her Green The saving is ‘in the bag’. We do not have to programme budget against the categories undertake significant steps for savings to happen. shown below to provide a high level risk assessment of CIP delivery. Amber ‘We will get there’. Further work is needed but plans are in place and are in hand and we are satisfied with progress. Costs were not included as they are budgeted separately. Red As yet we have ‘no detailed plans’ and as such confidence of recurrent delivery within year is low. 6 Consolidated Financial Benefits Transforming Care FINANCIAL BENEFITS – YEAR TO DATE (YTD) The financial value is the Actual; the % refers to the variance to the Budget. Corporate  Support  Emergency &  Investigative  Women's and  Cancer Services Periops Sciences Medicine Neurosciences Surgery Children's TOTAL Trust Month 5 ‐YTD £m % £m % £m % £m % £m % £m % £m % £m % £m % Drugs 0.23 39% 0.05 46% 0.02 0% 0.01 35% 0.35 65% 0.00 11% 0.04 12% 0.01 35% 0.72 42% Medical Productivity 0.04 1829% 0.01 60% 0.00 0% 0.00 0% 0.01 100% 0.00 5% 0.03 33% 0.04 63% 0.12 56% Variation of Care 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% Utilisation of IS 0.13 527% 0.00 0% 0.03 100% 0.00 0% 0.02 23% 0.07 144% 0.00 0% 0.12 950% 0.36 107% Procurement and Supply  Chain 0.00 0% 0.91 96% 0.11 58% 0.16 69% 0.10 69% 0.00 0% 0.05 44% 0.00 0% 1.33 82% Nursing Productivity 0.06 61% 0.04 217% 0.01 20% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.11 50% Patient Flow 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.34 110% 0.04 0% 0.38 24% Workforce Transformation 0.00 0% 0.23 52% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.23 50% Recording of Care 0.12 116% 0.00 0% 0.00 7% 0.00 7% 0.02 8% 0.35 371% 0.21 65% 0.31 92% 1.00 88% Portfolio Strategy 0.35 424% 0.01 58% 0.05 241% 0.01 13% 0.31 3738% 0.07 181% 0.30 0% 0.19 49% 1.29 197% Identified CIP Actual YTD ‐ TOTAL 0.92 101% 1.25 78% 0.23 64% 0.18 48% 0.81 82% 0.49 216% 0.96 86% 0.71 84% 5.53 70% Identified CIP Budget YTD ‐ TOTAL 0.91 1.61 0.35 0.37 0.98 0.23 1.11 0.84 7.89 7 Financial Benefits – Full Year Forecast Transforming Care FINANCIAL BENEFITS – FULL YEAR FORECAST The financial value is the Forecast; the % refers to the variance to the Budget. Corporate  Support  Emergency &  Investigative  Women's and  Cancer Services Periops Sciences Medicine Neurosciences Surgery Children's TOTAL Trust Month 5 ‐Full Year Forecast (FY  FCAST) £m % £m % £m % £m % £m % £m % £m % £m % £m % Drugs 0.58 41% 0.20 71% 0.05 0% 0.08 85% 0.90 72% 0.15 71% 0.23 32% 0.03 23% 2.23 52% Medical Productivity 0.10 617% 0.03 83% 0.11 78% 0.04 78% 0.06 136% 0.02 79% 0.28 84% 0.10 98% 0.71 98% Variation of Care 0.02 100% 0.00 0% 0.01 100% 0.00 100% 0.24 100% 0.13 100% 0.42 100% 0.18 100% 1.00 100% Utilisation of IS 0.31 126% 0.00 0% 0.10 100% 0.18 100% 0.04 5% 0.16 102% 0.00 0% 0.28 226% 1.07 35% Procurement and Supply Chain 0.00 0% 4.15 97% 0.66 77% 1.16 84% 0.58 91% 0.24 90% 0.50 90% 0.00 0% 7.29 95% Nursing Productivity 0.21 84% 0.08 217% 0.07 67% 0.00 0% 0.07 92% 0.02 57% 0.00 0% 0.00 0% 0.46 29% Patient Flow 0.05 78% 0.00 0% 0.00 0% 0.00 0% 1.52 ‐703% 0.00 0% 0.88 103% 0.30 0% 2.75 43% Workforce Transformation 0.00 0% 1.31 34% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 0.00 0% 1.31 34% Recording of Care 0.26 92% 0.13 100% 0.01 55% 0.00 7% 0.04 8% 0.79 353% 0.50 64% 0.64 80% 2.36 86% Portfolio Strategy 0.93 473% 0.07 89% 0.08 162% 0.06 26% 1.131131% 0.35 269% 1.04 0% 0.91 89% 4.56 255% FY CIP FORECAST 2.45 84% 5.97 81% 1.08 29% 1.52 66% 4.57 71% 1.86 197% 3.85 74% 2.44 80% 23.75 74% FY RECURRENT CIP BUDGET 2.90 7.41 3.70 2.30 6.40 0.94 5.20 3.05 31.90 8 Return on investment (savings/costs) Transforming Care Note: Return on investment is falling within year. However, this will need to be revisited when compared to 2013/14 forecast. 9 Transforming Care Non-Recurrent Implementation Costs CONSOLIDATED NON-RECURRENT IMPLEMENTATION COSTS – YTD AND FY FORECAST YTD FY FCAST £m Budget % achieved £m Budget % achieved PROGRAMME (0.01) (0.04) 15% (0.10) (0.14) 72% Drugs 0.00 0.00 0% 0.00 0.00 0% Medical Productivity (0.42) (0.64) 66% (0.75) (0.97) 77% Variation of Care 0.00 (0.06) 0% (0.28) (0.27) 100% Utilisation of IS (0.71) (0.74) 96% (1.40) (1.52) 92% Procurement and Supply Chain 0.00 (0.02) 0% (0.04) (0.06) 63% Nursing Productivity (0.53) (0.42) 127% (1.50) (1.03) 145% Patient Flow (0.22) (0.27) 82% (0.96) (1.26) 76% Workforce Transformation (0.09) (0.12) 75% (0.18) (0.30) 60% Recording of Care 0.00 0.00 0% 0.00 0.00 0% Portfolio Strategy (0.38) (0.54) 70% (0.56) (0.72) 78% Central T&T Programme (2.37) (2.87) 83% (5.77) (6.29) 92% Implementation Costs TOTAL Note. Patient Flow overspend due to continued Accenture support to deliver case management and continuing care projects. 10