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MDT Leaflet_Young Lives vs Cancer Eligibility Criteria 2021

Description: YOUNG LIVES VS CANCER ELIGIBILITY FOR HEALTH PROFESSIONALS YOUNG LIVES VS CANCER: WHO WE ARE Cancer is shocking, overwhelming, isolating... and completely unfair. Especially when you’re young. It takes over your life. Treatment is gruelling and your ambitions and dreams – education, relationships, career, travel – suddenly seem very far away. We get that. That’s why Young Lives vs Cancer fights tirelessly to stop cancer destroying young lives. We provide grants and free accommodation at our Homes from Home to help with spiralling costs. Our care teams are on hand to help families with everything from getting benefits to treatment closer to home (when clinically appropriate). And we lobby the government to make sure they get the support they’re entitled to. We’re here to make sure young cancer patients can focus on getting their lives back on track. YOUNG LIVES VS CANCER: WHO WE SUPPORT 1. Children and young people are eligible for services if they have had a confirmed cancer or bone marrow failure disorder and were under 25 years of age at diagnosis. 2. The child or young person must be eligible for free NHS cancer treatment within the UK, including members of (or child of) HMS Armed Forces and diplomatic core/embassies. 3. NHS MDTs can request support for patients with benign and low grade diagnoses which have cancer-like behaviour where there is a high burden of treatment1 The type of support we deliver is based on individual assessed need. 1 Treatment burden is a term used by clinicians to describe the short and long term impact of treatment e.g. surgery, chemotherapy, radiotherapy, immunotherapies and sometimes the disease itself (tumour burden). Examples include: health impact, psycho-social, socio-economic, education or lost work days, hospital visits, and carer burden. High treatment burden is usually something that impacts on multiple areas or for a long duration. Low treatment burden may be short term incapacity for something like surgical removal of a benign tumour with no, or minimal, longer term effects. The eligibility criteria is the same irrespective of whether a child or young person is under the care of paediatric, teenage & young adult, or adult service. UNCERTAINITY AND RARE CASES The Young Lives vs Cancer team will work with the NHS cancer team to help resolve uncertainty or manage rare cases. Every type of cancer and bone marrow failure disorder is eligible. Please discuss benign or uncertain cases with your local Young Lives vs Cancer team if the disease is very cancer-like and has a high burden of treatment. FURTHER GUIDANCE AND ADVICE You can obtain a full copy of the Eligibility Guidelines and Frequently Asked Questions from the Young Lives vs Cancer Social Care Team Leader or Service Manager at your main principal treatment centre. If you have any questions, please contact your local Young Lives vs Cancer team: Team Manager: Tel: Email:
Url: /Media/UHS-website-2019/Docs/Services/Cancer-care/mdt-leaflet-young-lives-vs-cancer-eligibility-criteria-2021.pdf

UHS AR 23-24 Final

Description: 2023/24 Incorporating the quality account University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2023/24 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2024 University Hospital Southampton NHS Foundation Trust Contents Welcome from our chair and chief executive 6 Overview and performance 8 Performance report 9 Overview 10 Accountability report 37 Directors’ report 38 Remuneration report 62 Staff report 75 Annual governance statement 95 Quality account 111 Statement on quality from the chief executive 112 Priorities for improvement and statements of assurance from the board 115 Other information 180 Annual accounts 207 Statement from the chief financial officer 208 Auditor’s report 210 Foreword to the accounts 217 Statement of Comprehensive Income 218 Statement of Financial Position 219 Statement of Changes in Taxpayers’ Equity 220 Statement of Cash Flows 221 Notes to the accounts 222 5 Welcome from the Chair and Chief Executive Officer This has been another busy and undoubtedly challenging year across the NHS and UK health and social care system, and much of what has impacted the national picture has been reflected in the operational focuses and patient and people priorities for University Hospital Southampton NHS Foundation Trust (‘UHS’ or the ‘Trust’) over the last year. Meeting and continuing to overcome the challenges we have faced has required an organisation-wide team effort, and looking back at the successes we feel incredibly proud of the achievements of our 13,000 staff. Particular highlights include: • In the top ten in the country (7th) against government targets for elective recovery performance with 118% of activity compared with 2019. • Top-quartile performance against most performance metrics compared to similar sized teaching hospitals, including Emergency Department access, long-waiting patients on Referral to Treatment pathways, Diagnostics and Cancer performance. • Significant investment in new capacity through building new wards and theatres and refurbishing existing areas of the hospital. • Delivery of our highest ever Cost Improvement Programme saving. These achievements place us among the best performing trusts in England in several areas and are even more remarkable against a backdrop of continued periods of industrial action and increasing demand for our services, with many people coming to us with higher levels of acuity than ever before. The Trust’s performance in terms of elective recovery places it as one of the best-performing trusts in England and demonstrates the impact of the Trust’s decision to invest in additional capacity in prior years by building new wards and theatres. The Trust’s Emergency Department performance in respect of its four-hour waiting target at the end of March 2024 has attracted additional capital funding as part of an incentive scheme. Some of this funding will be used to increase the department’s same-day emergency care capacity during 2024/25. From a financial perspective, balancing the complexities of today’s challenges alongside the need to protect and ensure the long-term stability and quality of our service provision, has required the Board to take a number of considered and crucial efficiency improvement actions this year. Whilst challenging, the Trust has seen significant progress in delivering on both its forecasted finance position for 2023/24 and productivity targets. Achieving long-term financial stability is key to us continuing to invest in much needed upgrades and improvements to the parts of our estate that are ageing, and to developing new state-of-the-art facilities and infrastructure that increases our capabilities and capacity into the future. In the last year parts of the hospital have been transformed, with the opening of new wards, theatres and a skybridge to link the estate. Construction of a sterile services and aseptics facility has begun at Adanac Park and the expansion of our neonatal department, where we treat and care for some of our most vulnerable babies and their families, is underway. The development of a new aseptic facility at Adanac Park will have capacity to serve other hospitals within the region and is a significant opportunity for improved system-wide working. 6 We have also worked with our people to design spaces where they can rest, relax and recharge - including a new wellbeing hub and rooftop garden on the Princess Anne Hospital site. In addition, 40 staff rooms across the site have been refurbished thanks to funding from Southampton Hospitals Charity. During the year, the Trust worked to establish the Southampton Hospitals Charity as a separate charitable company to improve its ability to both raise and spend funds. This process completed on 1 April 2024. Work was carried out to refurbish a children’s ward during the year in partnership with the charity. Our people are our greatest asset, and we are pleased to see improvements from the annual staff survey in several areas - such as how people can work more flexibly, access to learning and development and improved satisfaction in support from line managers. We recognise the pressures and demands that come with working in this environment and will continue to ensure everyone working here feels heard, encouraged and supported when raising concerns. At UHS, every opportunity is taken to recognise and celebrate the incredible things our people do here every day, including the return of our in-person annual awards ceremony, monthly staff recognition events and the first ever ‘We Are UHS Week’. These occasions are an important reminder that, even when faced with challenges, there is so much to be proud of and celebrate across the whole Trust. Working together, both within the Trust and across organisational boundaries, remains one of our core values. The partnership between UHS and the University of Southampton is as strong as it has ever been, with more than 250,000 individuals having now taken part in research studies in Southampton. As the lead partner member for Acute Hospital Services on the Hampshire and Isle of Wight Integrated Care Board, we are proactively working with other trusts and healthcare providers in the region to improve the health of the community we serve. In addition, the Trust has continued to work in partnership with other providers across the system to build a shared elective orthopaedic hub in Winchester. It is anticipated that the health and social care system will continue to be a challenging environment in 2024/25. We recognise that many of the big challenges we face can only be solved in partnership with wider local partners, and we are committed to actively playing our part in delivering system-wide solutions. Equally, we will continue to focus on improving whatever is within our internal control, and to work collaboratively with our people to ensure our patients’ experience, safety and outcomes remain central to our decision-making and the actions of everyone at UHS. Jenni Douglas-Todd Chair 19 July 2024 David French Chief Executive Officer 19 July 2024 7 PERFORMANCE REPORT Performance report Introduction from the Chief Executive Officer As with 2022/23, this was another challenging year with continued increasing demand for the Trust’s resources and the need to balance this with the need to deliver quality patient care and at the same time maintain a sustainable financial position. Demand for non-elective care continued to increase with an average of 375 attendances per day to our main Emergency Department. In addition, the number of patients on the 18-week Referral to Treatment pathway rose to 58,000. Patients having no clinical criteria to reside in hospital, but unable to be discharged due to the lack of funded care in a more suitable location, posed and continues to pose a significant challenge for the Trust. The number of patients within this category was as high as 270 at times and was consistently higher throughout the year when compared to 2022/23. Despite this the Trust continued to perform well when compared to other comparable organisations, achieving some of the best Emergency Department and elective recovery fund performance in England. The Trust’s financial position continued to be difficult, which required some difficult decisions in respect of spending controls and controls on recruitment. The Trust focused in particular on controlling spending on temporary and agency staff, but in view of the overall workforce numbers compared to the 2023/24 plan, further controls were implemented in respect of substantive recruitment. Due to the additional controls and the Trust’s best delivery to date on its Cost Improvement Programme (£63.4m), the Trust achieved an end of year deficit of £4.5m, compared to the deficit of £26m anticipated in its 2023/24 plan. 9 Overview About the Trust Our services University Hospital Southampton NHS Foundation Trust is one of the largest acute teaching trusts in England with a turnover of more than £1.3 billion in 2023/24. It is based on the coast in south east England and provides services to over 1.9 million people living in Southampton and south Hampshire and specialist services, including neurosciences, respiratory medicine, cancer care, cardiovascular, obstetrics and specialist children’s services, to nearly four million people in central southern England and the Channel Islands. The Trust is also a designated major trauma centre, one of only two places in the south of England to offer adults and children full major trauma care provision. As a leading centre for teaching and research, the Trust has close working relationships with the University of Southampton, the Medical Research Council, National Institute for Health and Care Research (NIHR), Wellcome Trust and Cancer Research UK. The Trust is consistently one of the UK’s highest recruiting trusts of patients to clinical trials and one of the top nationally for research study volumes as ranked by the NIHR Clinical Research Network. Every year the Trust: treats around 155,000 inpatients and day patients, including about 70,000 emergency admissions sees over 750,000 people at outpatient appointments deals with around 150,000 cases in our emergency department The Trust provides most of its services from the following locations: • Southampton General Hospital – the Trust’s largest location, where a great number of specialist services are based alongside emergency and critical care and which includes Southampton Children’s Hospital. • Princess Anne Hospital – located across the road from Southampton General Hospital and providing maternity care and specialist care for women with medical problems during pregnancy and babies who need extra care around birth across the region. • Royal South Hants Hospital – although the Trust does not operate this site near the centre of Southampton it provides a smaller number of services from this location. • New Forest Birth Centre – located at Ashurst on the edge of the New Forest and run by experienced midwives and support staff it acts as a community midwifery hub. The services provided by the Trust are commissioned and paid for by the Hampshire and Isle of Wight Integrated Care System (ICS) and, in the case of more specialised services (such as treatments for rare conditions), by NHS England. Trust services are supported by clinical income, of which 54% is paid for by NHS England and 43% by integrated care boards, predominantly the Hampshire and Isle of Wight Integrated Care Board (ICB). These are provided under a standard NHS contract, which incorporates ongoing monitoring of the Trust and the quality of the services provided. 10 Our structure UHS gained foundation trust status on 1 October 2011. A foundation trust is a public benefit corporation providing NHS services in line with the core NHS principles: that care should be universal, comprehensive and free at the point of need. The Trust is licensed as a foundation trust to provide these services by NHS England and the healthcare services we provide are regulated by the Care Quality Commission. Since 1 July 2022, the Trust has been part of the Hampshire and Isle of Wight Integrated Care System when this was established through the Health and Social Care Act 2022. Each ICS has two statutory elements: an integrated care partnership (ICP) and an integrated care board. The ICP is a statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP brings together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area. The ICB is a statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The Trust has been a university teaching hospital since 1971. The diagram below provides an overview of the overall organisational structure of the Trust. Public and foundation trust members Council of Governors Board of Directors Executive Directors Division A Division B Division C Division D Surgery Critical Care Opthalmology Theatres and Anaesthetics Cancer Care Emergency Medicine Helicopter Emergency Medical Services Medicine and Medicine for Older People Pathology Specialist Medicine Women and Newborn Maternity Child Health Clinical Support Cardiovascular and Thoracic Neurosciences Trauma and Orthopaedics Radiology Trust Headquarters Division 11 Our values The Trust’s values describe how things are done at UHS and act as a guide to all staff working with colleagues to deliver high quality patient care and a great patient experience every day. These values are: Patients, their families and carers are at the heart of what we do. Their experience of our services will be our measure of success. Partnership between clinicians, patients and carers is critical to achieving our vision, both within hospital teams and extending across organisational boundaries in the NHS, social care and the third sector. We will ensure we are always improving services for patients through research, education, clinical effectiveness and quality improvement. We will continue to incorporate new ideas, technologies and create greater efficiencies in the services we provide. 12 Our strategy 2021-25 The Trust’s strategy was updated during 2020/21 to take account of everything its staff had experienced during the COVID-19 pandemic and what had been learnt from this. The vision for UHS is to become an organisation of world class people delivering world class care. The Trust’s strategy is organised around five themes and for each of these it describes a number of ambitions UHS aims to achieve by 2025. Theme Ambitions Outstanding patient outcomes, • We will monitor clinical outcomes, safety and experience of our experience and safety patients regularly to ensure they are amongst the best in the UK By 2025 we will strengthen our and the world. national reputation for outstanding • We will reduce harm, learning from all incidents through our patient outcomes, experience and proactive patient safety culture. safety, providing high quality care • We will ensure all patients and relatives have a positive experience and treatment across an extensive of our care, as a result of the environment created by our people range of services from foetal and our facilities. medicine, through all life stages and conditions, to end-of-life care. Pioneering research • We will recruit and enable people to deliver pioneering research in and innovation Southampton. We will continue to be a leading teaching hospital with a growing, reputable and innovative research and development portfolio • We will optimise access to clinical research studies for our patients. • We will enable innovation in everything we do, and ensure that ‘cutting edge’ investigations and treatments are delivered in Southampton. that attracts the best staff and efficiently delivers the best possible treatments and care for our patients. World class people • We will recruit and develop enough people with the right Supporting and nurturing our knowledge and skills to meet the needs of our patients. people through a culture that values • We will provide satisfying and fulfilling roles, growing our talent diversity and builds knowledge and through development and opportunity for progression. skills to ensure everyone reaches • We will empower our people, embracing diversity and embedding their full potential. We must provide compassion, inclusion and equity of opportunity. rewarding career paths within empowered, compassionate, and motivated teams. Integrated networks and collaboration We will deliver our services with partners through clinical networks, collaboration and integration across geographical and organisational boundaries. • We will work in partnership with key stakeholders across the Hampshire and Isle of Wight integrated care system. • We will strengthen our acute clinical networks across the region, centralising when necessary and supporting local care when appropriate. • We will foster local integration with primary and community care as well as mental health and social care services for seamless delivery across boundaries. • We will build on our successful partnership with University of Southampton (UoS), growing our reputation as a national leading university teaching hospital. 13 Theme Foundations for the future Making our enabling infrastructure (finance, digital, estate) fit for the future to support a leading university teaching hospital in the 21st century and recognising our responsibility as a major employer in the community of Southampton and our role in broader environmental sustainability. Ambitions • We will deliver best value to the taxpayer as a financially efficient and sustainable organisation. • We will support patient self-management and seamless care across organisational boundaries through our ambitious digital programme, including real time data reporting, to inform our care. • We will expand and improve our estate, increasing capacity where needed and providing modern facilities for our patients and our people. • We will strengthen our role in the community as an employer of choice, a partner in delivery of services to our population and by leading the Greener NHS agenda locally. During each year of the strategy the Trust sets out a more detailed series of objectives to achieve and progress towards the delivery of its ambitions. In 2023/24 these objectives included: Outstanding patient outcomes, experience and safety Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future • Increasing the number of reported Shared Decision-Making conversations. • Increasing the number of specialities reporting outcomes that matter to patients. • Rolling out the Patient Safety Incident Reporting Framework across the Trust. • Working with patients as partners to improve patient satisfaction. • Treating patients according to need but aiming for no patient to wait, other than through patient choice, more than 65 weeks for treatment. • Delivering national metrics for site set-up time to target for clinical research studies. • Improving the Trust’s position against peers. • Delivering year three of the Trust’s research and innovation investment plan. • Developing the five-year research and development strategy implementation plan and delivery of the first year. • Strengthening and broadening the partnership between the Trust and the University of Southampton. • Supporting delivery of the Trust’s workforce plan for 2023/24. • Reducing turnover and sickness absence rates. • Increasing overall participation in the NHS staff survey and maintaining overall staff engagement score. • Increasing the proportion of appraisals completed. • Delivering the first year objectives of the Inclusion and Belonging strategy. • Working in partnership with acute trusts to agree and implement the acute services strategy. • Producing and embedding an internal framework for network development. • Working with the local delivery system on vertical integration to reduce the number of patients without criteria to reside. • Working with system partners to open a surgical elective hub. • For the Trust to be seen as an ‘anchor institution’ in the local area. • Delivering the Trust’s financial plan for 2023/24. • Engaging the organisation in the challenge to manage demand so that capacity and demand are in equilibrium. • Delivery of the Always Improving strategy priorities. • Delivering the Trust’s capital programme in full. • Entering into a new energy performance contract and delivering the first year of the Public Sector Decarbonisation Scheme. Performance against these objectives was monitored and reported to the Trust’s Board on a quarterly basis. 14 At the end of 2023/24, the Trust had met the objectives set as follows: Corporate Ambition Outstanding patient outcomes, safety and experience Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future Totals Number of Objectives 5 5 5 5 5 25 Achieved in full 4 3 2 3 2 14 Partially achieved 1 2 2 1 3 9 Not achieved 0 0 1 1 0 2 Particular areas to highlight where the Trust has achieved strong delivery during the year include: • Delivery of quality priorities in Shared Decision-Making and the roll out of the Patient Safety Incident Response Framework. • Achieving the Trust’s 65-week waiter glide path. • Successful delivery of a number of research and development priorities, including work with the University of Southampton. • Maintaining sickness absence and turnover well below the targets set at the beginning of the year, and successfully delivering the first year of the Trust’s Inclusion and Belonging strategy. • Delivery of the Trust’s full available capital budget and completion of the first year of the Trust’s decarbonisation scheme. 15 Principal risks to our strategy and objectives The Board has identified and manages the principal risks to the delivery of its strategy and objectives through its board assurance framework. The principal risks to the delivery of its strategy and objectives identified by the Trust during 2023/24 were that: • There would be a lack of capacity to appropriately respond to emergency demand, manage the increasing waiting lists for elective demand, and provide timely diagnostics, that results in avoidable harm to patients. • Due to the current challenges, the Trust fails to provide patients and their families or carers with a highquality experience of care and positive patient outcomes. • The Trust would not effectively plan for and implement infection prevention and control measures that reduce the number of hospital-acquired infections and limit the number of nosocomial outbreaks of infection. • The Trust does not take full advantage of its position as a leading university teaching hospital with a growing, reputable and innovative research and development portfolio, attracting the best staff and efficiently delivering the best possible treatments and care for its patients. • The Trust is unable to meet current and planned service requirements due to unavailability of qualified staff to fulfil key roles. • The Trust fails to develop a diverse, compassionate and inclusive workforce, providing a more positive experience for all staff. • The Trust fails to create a sustainable and innovative education and development response to meet the current and future workforce needs identified in the Trust’s longer-term workforce plan. • The Trust does not implement effective models to deliver integrated and networked care, resulting in sub-optimal patient experience and outcomes, increased numbers of admissions and increases in patients’ length of stay. • The Trust is unable to deliver a financial breakeven position, resulting in: inability to move out of the NHS England Recovery Support Programme; NHS England imposing additional controls/undertakings; and a reducing cash balance, impacting the Trust’s ability to invest in line with its capital plan, estates and digital strategies and in transformation initiatives. • The Trust does not adequately maintain, improve and develop its estate to deliver its clinical services and increase capacity. • The Trust fails to introduce and implement new technology and expand the use of existing technology to transform its delivery of care through the funding and delivery of the digital strategy. • The Trust fails to prioritise green initiatives to deliver a trajectory that will reduce its direct and indirect carbon footprint by 80% by 2028-2032 (compared with a 1990 baseline) and reach net zero direct carbon emissions by 2040 and net zero indirect carbon emissions by 2045. During 2023/24, the Trust saw continued increased demand for its services, particularly in the Emergency Department In addition, the number of patients having no clinical criteria to reside in hospital, but unable to be discharged due to a lack of appropriate care packages was higher than anticipated and spiked during winter, which significantly impacted patient flow through the hospital and required the Trust to engage additional temporary staff. The number of patients in this category peaked at 270 during the winter. There were particular challenges in respect of those patients with a primary mental health care need who would be better cared for in a more suitable alternative setting. 16 Performance overview The Trust monitors a broad range of key performance indicators within its departments, divisions, directorates and through Trust executive committees. On a monthly basis, the Board and executive committee receives a performance report containing a variety of indicators intended to provide assurance in respect of the Trust’s strategy and that the care provided is safe, caring, effective, responsive and well-led. This report also includes the Trust’s performance against the national targets set by NHS England. The performance reports include a ‘spotlight’ section, which provides more detailed analysis of a particular area. Typically, this is one of either the national targets or the Trust’s performance against the expectations set out in the NHS Constitution. The monthly performance report is also published on the Trust’s website. The Chief Executive Officer provides a regular report on performance to the Council of Governors, which includes a range of non-financial and financial performance information. Capacity The Trust continued to experience high demand for its services, especially in the Emergency Department, with average demand during the year being around 375 patients presenting per day in the main adult and children’s emergency department. In addition, the Trust experienced a significant impact on flow within the hospital due to a high number of patients having no clinical criteria to reside in hospital but unable to be discharged. This number was as high as 270 at times during winter: an increase of around 50 patients when compared to the prior year. The Trust also saw an increase in the number of referrals with the number of patients on a waiting list under the 18-week Referral to Treatment pathway rising from approximately 55,000 to 58,000 by the end of the year. In common with other trusts, the ongoing industrial action also impacted the Trust’s ability to provide urgent care and deliver on its elective recovery programme. Quality and compliance Despite the challenges, the Trust’s Emergency Department performance was one of the highest in England in March 2024, which resulted in additional capital funding being awarded. In addition, the Trust’s elective recovery performance was one of the best in England at 118% compared to 2019. The Trust continued to monitor the quality of care delivered throughout 2023/24 through a number of established quality assurance programmes. Clinical leaders monitored key quality, safety and patient experience indicators such as falls, pressure ulcers and venous thromboembolisms. Quality peer reviews were carried out, most significantly through Matron-led Quality Walkabouts every week in and out of hours focusing on the five key CQC questions – safe, effective, responsive, caring, and well-led. The Trust’s Clinical Accreditation Scheme builds on this intelligence, with clinical areas completing self-assessments of performance and review teams completing onsite visits. Patient representatives were included in these review teams. Learning was shared at the Clinical Leaders’ Group and via quarterly reports. The Trust was an active partner in a South-East accreditation network, offering advice and a steer to providers who are just setting up or looking to develop their own scheme, and extended that advice and support to other providers in England. 17 On 15 May 2023, the CQC inspected the maternity and midwifery service at Princess Anne Hospital as part of their national maternity inspection programme. The inspection report was published 11 August 2023, and the Trust retained its overall rating of ‘good’. This year UHS introduced its Fundamentals of Care (FOC) initiative. Whilst this is not a new concept, there were concerns that missed fundamental care had been amplified during the COVID- 19 pandemic. This initiative aims to empower and educate staff at all levels to ensure fundamental care is at the heart of what the Trust does. The Trust completed its transition to the Patient Safety Incident Response Framework (PSIRF) and collaborated with the ICB to develop a PSIRF plan and policy to underpin the change. The Trust implemented the requirements in respect of ‘Martha’s Rule’ where patients, relatives and carers have a legal right to a rapid review by a critical care outreach team during an acute deterioration episode in and out of hours. The Trust continued its focus on infection prevention and control, responding rapidly to rises in infection over the winter, and successfully flexing initiatives and innovations to achieve successful management in a responsive manner. The Trust progressed its Always Improving strategy and successfully supported the identification and implementation of further quality improvement projects. This included improvements across theatres, inpatient flow and outpatient programmes. During the year, average length of stay was reduced by 1.64%, day theatre cancellations were reduced by 200, and 42,350 patients were placed onto Patient Initiated Follow Up (PIFU) pathways. Further information can be found in the Quality Account. Partnerships The Trust works within the Hampshire and Isle of Wight Integrated Care System, and is an active member of a number of partner groups including the Acute Provider Collaborative Board and the Health and Wellbeing Board. The Trust develops and agrees its annual financial plans with the Integrated Care Board. The Trust is a member of a number of specific partnership groups for particular services, including the Central and South Genomics Medicine Service, the Children’s Hospital Alliance and the Southern Counties Pathology Network. The Trust works actively as a partner with other provider organisations around clinical networks, particularly with acute Trusts within the Integrated Care System and others closely located geographically. The Trust also links closely with the University of Southampton on a number of topics including research, commercial development and education and has a developed meeting structure to oversee this. 18 Workforce The Trust’s key areas of focus during 2023/24 were in respect of increasing the substantive workforce whilst also reducing reliance on bank and agency usage, and reducing staff turnover and sickness. Although the Trust was successful in recruiting to substantive posts, the expected reduction in reliance on bank and agency staff did not materialise, which meant that the Trust was 331 whole-time equivalents above its plan for 2023/24. The Trust was successful in reducing staff turnover from 13.5% in 2022/23 to 11.4%, achieving the local target of . Cancer Waiting Times - 2 Week Wait Performance Cancer Waiting Times - 2 Week Wait Performance 100% 90% 80% 70% 60% 50% 40% Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Performance % standard met The national target was for 96% of patients to commence treatment within 31 days of diagnosis. In March 2024, the Trust achieved 92% and performed in the range of 86%-94% throughout the year. The Trust has continued to make progress against the target for treatment of cancer within 62 days of an urgent GP referral, improving performance from 64% in April 2023 to 76% in March 2024 (NHS average: 69%). First definitive treatment for cancer within 31 days of a decision to treat % standard met Cancer waiting times 31 day RTT performanceUHS vs. NHSE average Cancer waiting times 31 day RTT performance UHS vs. NHSE average 96% 94% 92% 90% 88% 86% 84% 82% 80% 78% 76% Apr-23 May-23 Jun-2 3 Jul-2 3 Aug-23 Sep-2 3 Oct-23 Nov-2 3 Dec-23 Jan-24 Feb-2 4 Mar-24 Performance NHS Average 27 Treatment for Cancer within 62 days of an urgent GP referral to hospital Cancer Waiting Times 62 Day RTT Performance UHS vs NHSE Average Cancer Waiting Times 62 Day RTT Performance UHS vs NHSE Average % standard met 1 00% 80% 60% 40% 20% 0% Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Performance NHS Average 28 Quality priorities Priorities for improvement 2023/24 Last year the Trust continued its ambition to deliver the highest quality care shaped by a range of national, regional, local, and Trust-wide factors. During the year the Trust continued to experience unprecedented demand on its services, with flow, capacity, infection prevention and safety all presenting challenges. However, the Trust was confident in its ability to keep a focus on its quality priorities, and its teams worked hard to achieve their goals even in these difficult circumstances. Priorities are aligned to the three core dimensions of quality: • Patient experience – how patients experience the care they receive. • Patient safety – keeping patients safe from harm. • Clinical effectiveness – how successful is the care provided? Out of the six priories set, the Trust achieved five and partially achieved one. Overview of success Quality Priority One Improving care for people with learning disabilities and autistic (LDA) people across the Trust. Supporting staff delivering this care. Outcome against goals: achieved Key achievements: • LDA working group reestablished. • Development of an improvement plan using the NHS Learning Disability Improvement standards. • The LDA team has moved to the virtual enhanced care group in Division B where operational and governance support, leadership, and peer support/learning opportunities has been strengthened. • Sensory Boxes have been introduced for all clinical areas, funded by the Hampshire and Isle of Wight (HIOW) Integrated care board (ICB). These boxes include noise cancelling headphones, fidget toys, communication books and visual cards to support patients and wards. • Recruited additional Learning Disability Champions. • Established links with the parent carer forum (PCF) for the local area and are now attending regular events. A representative from the PCF sits on the LDA working group. The LDA team are working with the Trust lead for patient experience to develop this aspect of the LDA workplan over the next year. Quality Priority Two Supporting patients, service users and staff to overcome their tobacco dependence via a smoking cessation programme. Outcome against goals: achieved Key achievements: • Package of support available to patients who may be smokers and who need to be supported not to smoke during their treatment. • Fully trained team of tobacco advisors working in the hospital and an advisor working in the outpatient setting supporting the patients once they have returned home. • Devised the IT changes the Trust would like to implement to improve its service and referral process. • Recruited 30 smoke-free champions. • Successfully supported 1,131 patients with a self-confirmed quit rate of 45.6% at 28 days. • Supported 109 outpatients who have successfully achieved a 60% quit rate. • On track to achieve the goal to go smoke-free by April 2024 including the removal of smoking shelters. 29 Quality Priority Three Ensure carers are fully supported, involved, and valued across all our services by developing the carers support service across the Trust in partnership with Southampton Hospitals. Outcome against goals: partially achieved Key achievements: • Carers now have a more comprehensive package of concessions and vouchers to help support their cared-for person (e.g. free parking available onsite for blue badge owners is now available). • Listening events were held to put patients at the centre of transforming the way we deliver care is delivered, enabling their voices to improve the quality of care and outcomes for all. • Developed joint working with local partners (e.g. Children’s Society and No Limits to support young carers). Not yet achieved: • The ‘pathway to support, has not yet been developed. Work is ongoing to develop a new strategy. • A charity-funded carers’ support worker has not yet been appointed. • The carers’ training package has not yet been relaunched. Quality Priority Four Put patients at the centre of transforming the way care is delivered, enabling their voices to improve the quality of care and outcomes for all. Outcome against goals: achieved Key achievements: • Work has continued to work across corporate and divisional services to embed patients and carers into quality and service improvement, creating new patient groups (e.g. Mesh Support Group). • Successfully developed our engagement with various local communities, working to ensure that a range of care experiences are considered ( e.g. there is now a Gypsy, Roma, and Irish Traveller community health liaison officer to ensure that these communities are engaged with and brought into work to improve the inclusivity of our services). • Attending multiple public engagement opportunities (Young Carers’ Festival, Mela, University Freshers’ Fayres, Carers’ Listening Lunch, Hoglands Park Play Day, visits to local temples and ‘Love Where You Live’). • Youth and Young Adult Ambassador involvement has increased, including attendance toat meetings of the Council of Governors, and supporting hospital projects. • A Celebration of Carers Week and Volunteers Week were run. • The Trust has analysed its reported outcome measures to identify health inequalities in its services. This information has been used to set a new quality priority for 2024/25. • An SMS friends and family test text survey has been introduced to improve the response rate on patient feedback from the Emergency Department. In the first three months following the survey launch, responses increased from 24 to 424. 30 Quality Priority Five To develop the Trust’s clinical effectiveness process, connecting to the Trust’s Always Improving approach to measuring, understanding, and using outcomes to improve patient care. Outcome against goals: achieved Key achievements: • The Trust has developed its clinical effectiveness process across the Trust with involvement of informatics, governance and management teams, clinical effectiveness leads as well as reporting committees. • Patient representation onhas been included in the clinical assurance meeting for effectiveness and outcomes (CAMEO) to ensure conversations focus on what matters to patients. • The CAMEO template has been changed to focus discussions on areas the specialty is proud of (strong or improving outcomes), areas for improvement (poorly benchmarked or worsening outcomes) and planned actions. • The Trust encourages the use of run and/or statistical process control charts along with benchmarking where available. • Details of NICE and quality standards and national and regional reviews are included to cover breadth of clinical effectiveness. • How the clinical effectiveness team works has been reorganised, aligning each of them to each division giving a named link which helps to deepen understanding and improve links with governance and improvement activities locally. • Working with informatics to establish a core set of clinical outcome measures which are meaningful to patients, which can be reported centrally (starting with surgical specialities). • Starting to develop an education strategy and platform to support staff with a number of tools used in clinical effectiveness as well as clarity on where and how to record and evidence audit and service improvement. • A revised strategy has been drafted. Quality Priority Six Developing a culture where all clinical staff have a basic knowledge of diabetes. Outcome against goals: achieved Key achievements: • Launch of the ‘Start with the Diabasics’ Initiative, designed to help give diabetes visibility across UHS. • Delivered an extensive education programme to clinical staff across the professions and bands, including the introduction of some e-learning and a Diabasics introductory video has been shown at all trust staff inductions since July 2023. • Supported the development of 45 diabetes link nurses, resulting in all ward areas now having a named diabetes link nurse. • Improved triage for referrals. • Established processes for ‘lessons learned’. • Developed IT solutions to improvingimprove alerts and guidance. • A ‘Ketone Wednesdays’ initiative has been created in response to overuse of blood ketone testing (estimated waste cost of £100,000 per year). • The Trust’s lead diabetes specialist nurse and the Diabasics Initiative were both shortlisted for National Quality in the Care Diabetes Awards (October 2023). • The Diabasics Initiative was mentioned as a case study on the Diabetes UK charity website as an example of good practice that could be reproduced elsewhere. More information can be found about how the Trust delivered and measured its quality priorities, including feedback from patients and staff and improvement aims and quality priorities for 2024/25, in the Trust’s Quality Account for 2023/24. 31 Financial performance The Trust delivered a deficit of £4.5m from a revenue position of over £1.3bn, following receipt of £24.6m one-off cash support from NHS England. UHS started the year with an underlying deficit as a result of a number of cost pressures, notably demand for services being above block contract levels and the cost of national pay awards being above funded levels. The Trust has also continued to face a number of pressures, including high numbers of patients who no longer meet the criteria to reside in the hospital, and high demand for patients with a primary mental health need. In 2023/24, the Trust delivered a record savings level of £63.4m (5%) across a range of programmes. Trust operating income rose by £107m from the previous financial year, most notably funding the NHS pay award, as well as additional elective recovery funding. Trust operating expenses rose by £89m, incorporating funded inflationary costs as well as costs relating to the cost pressures outlined above. The Trust has also continued its reinvestment of surplus cash into infrastructure for the Trust, with capital investment of over £75m, including investment in new wards, theatres, decarbonisation, digital infrastructure, neonatal expansion and backlog maintenance. Trust cash and cash equivalents finished the year at £79m, a reduction of £24m from the previous year due to the operating loss and capital investment outlined above. Whilst liquidity remained strong in 2023/24 supported by NHS England cash support, the underlying financial deficit means it is likely to decline further in 2024/25. The Trust is continuing to monitor its cash position closely and is considering whether additional cash support may be required in 2024/25. Sustainability The Trust recognises that everyone has a part to play in responding to the climate crisis. In March 2022, the Trust agreed its own green plan in response to the challenge of the NHS becoming the world’s first health service to reach carbon net zero. Now in its third year, the plan identifies the Trust’s key areas of focus and its ambitions and has seen progress across all areas of the plan. The plan sets out the scale of the challenge, the Trust’s commitment to reducing the impact on the environment and the steps to be taken across the following categories: • Estates and facilities • Clinical and medicines • Digital transformation • Supply chain and procurement • Travel and transport • Waste and resources • Food and nutrition • Adaptation • Biodiversity • Wider sustainability The Trust continues to progress through its green plan and has completed the ‘Greener NHS’ reporting tool for several quarters, which has demonstrated good progress. In addition, the Trust is planning to launch its ‘Our Sustainable UHS’ app for staff, which will give tips on sustainability and create personalised travel plans, including identifying potential contacts for car sharing. In addition, the Trust is considering proposals to implement additional solar power, smart metering and expanding the use of LED lighting. 32 In 2022/23, the Trust was successful in bidding for £29.4m of funding through the Public Sector DeCarbonisation Fund, which will be used to fund green initiatives as part of the Trust’s capital programme. During the year the Trust successfully bid for £823k in National Energy Efficiency Funding which has been used to upgrade the lighting at Princess Anne Hospital. Social, community, anti-bribery and human rights issues The Trust recognises its responsibilities under the European Convention on Human Rights (included in the Human Rights Act 1998 in the UK). These rights include: • right to life • right not to be subjected to inhuman or degrading treatment or punishment • right to liberty and freedom • right to respect for privacy and family life. These are reflected in the duty, set out in the NHS Constitution, to each and every individual that the NHS serves, to respect their human rights and the individual’s right to be treated with dignity and respect. The Trust is committed to ensuring it fully takes into account all aspects of human rights in its work. An equality impact assessment is completed for each Trust policy. For patients, the Trust’s safeguarding policies protect and support the right to live in safety, free from abuse and neglect and other policies and standards are designed to optimise privacy and dignity in all aspects of patient care. Feedback from patients and the review of complaints, concerns, claims, incidents and audit help to monitor how the Trust is achieving these objectives. The Trust’s green plan, approved by the board of directors in March 2022, recognises the Trust’s broader role and responsibility to address the issues of climate change, air pollution, waste and environmental decline present to the city of Southampton and the impact that these issues have on the health and wellbeing of the local population served. Although the Modern Slavery Act 2015 does not apply to the Trust, its green plan sets out an ambition to stop modern slavery. The Trust is also committed to maintaining an honest and open culture within the Trust; ensuring all concerns involving potential fraud, bribery and corruption are identified and rigorously investigated. The Trust has a Fraud, Bribery and Corruption Policy, a Standards of Business Conduct Policy and a Raising Concerns (Whistleblowing) Policy. These apply to all staff and to individuals and organisations who act on behalf of UHS. Anti-bribery is part of the Trust’s work to counter fraud. This work is overseen by the Audit and Risk Committee, which receives regular reports from the local counter fraud specialist on the effectiveness of these policies through its monitoring and reviews, providing recommendations for improvement, as well as an annual report from the freedom to speak up guardian. You can read more about the work of the Audit and Risk Committee and the Trust’s approach to counter fraud in the Accountability Report. Events since the end of the financial year There have been no important events since the end of the financial year affecting the Trust. Overseas operations The Trust does not have any overseas operations. 33 Equality in service delivery NHS trusts have an essential role in tackling health inequalities, both as part of the services they provide, but also through work with the wider system. By working with those in integrated care systems, local authorities and third sector organisations, the Trust can have a significant impact on the health of the local population. The national focus on health inequalities is growing. This comes with new legal duties around reporting information and expectations to report on improvement programmes. In September 2023, a health inequalities steering group was initiated, under the leadership of the Chief Medical Officer, with representation from clinical, operational, transformation, patient experience, research, organisational development and culture, informatics, public health and the Integrated Care Board. The group focused on scoping future priorities aligned to national guidelines, contractual obligations and priorities, regional priorities, feedback from clinical teams and patients, understanding where action is already being taken, and what the data is showing. Overall, the group
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Finance and Performance Reports 2024-25 Month 7 October 2024

Finance and Performance Reports 2024-25 Month 5 August 2024

Description: Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose: Finance Report 2024-25 Month 5
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Finance and Performance Reports 2024-25 Month 2 May 2024

Description: Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose: Finance Report 2024-25 Month 2
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Annual-report-and-quality-account-2019-20

Description: ANNUAL REPORT AND ACCOUNTS 2019/20 Incorporating the quality account 2019/20 Page 2 University Hospital Southampton NHS Foundati
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Total knee replacement HHFT - patient information

Description: Welcome to your guide to total knee replacement (TKR) surgery.
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Papers Trust Board - 7 January 2025

Description: Date Time Location Chair Observing Agenda Trust Board – Open Session 07/01/2025 9:00 - 13:00 Conference Room, Heartbeat/Micros
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Finance and Performance Reports 2023-24 Month 10 - January 2024

Description: Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose: Finance Report 2023-24 Month 10 10.3 Ian Howard – Chief Financial Officer Philip Bunting – Director of Operational Finance David O’Sullivan – Assistant Director of Finance – Financial Performance 29 February 2024 Assurance or reassurance Approval Ratification Information X Issue to be addressed: Response to the issue: The finance report provides a monthly summary of the key financial information for the Trust. It has recently been announced that NHS England is set to give around £650m to some health systems to offset planned financial deficits, and with that ease pressure on cashflow. We have since been informed by the HIOW ICB that a proportion of that money has been allocated to this system, and via that to UHS. The amount has recently been confirmed as £24.6m. We are grateful to be receiving funding which will reduce, but not eliminate, our financial deficit for financial year 23/24. Unfortunately, this still leaves us with, an albeit reduced, deficit going into the next financial year, so our work to restore financial balance for UHS remains key to supporting our recovery and protecting the interests of our patients and staff. Forecast Prior to the above announcement, UHS was forecasting an adjusted deficit of £29.7m. The impact of Industrial Action in December and January has been estimated at £4.8m (increased from £3.8m). Excluding the impact of Industrial Action, UHS was forecasting a deficit of £25m (previously £26m). A further deterioration in forecast is anticipated relating to further Industrial Action in February. UHS M10 Forecast Recovery Original Plan Plan Forecast Financial Position (26.0) (26.0) (29.7) • Note – forecast will change as a result of additional funding and impacts of further industrial action. In line with South East Region reporting guidelines, we expect to formally change our forecast to NHSE in our M10 reporting. M10 Financial Position UHS is reporting a financial position as outlined in the table below: UHS M10 Financial Position Original Plan (1.0) In Month Recovery Plan (2.2) Actual (4.7) Year to Date Original Recovery Plan Plan Actual (25.0) (23.9) (27.6) Page 1 of 4 The in-month position includes £3.2m of non-recurrent industrial action (IA) pressures, which trusts nationally have been advised to report as a variance. This has been offset by additional non recurrent savings of £0.7m resulting in the position being £2.5m adverse to the recovery plan trajectory. Impact of Industrial Action (IA) The impact of industrial action for December 2023 and January 2024 is shown in the table below. IA Impact M9 Cost of Cover (0.4) Impact of reduction on ERF & lost efficiency opportunity (1.2) Total (1.6) M10 Total (0.9) (1.3) (2.3) (3.5) (3.2) (4.8) ERF In month ERF performance was above target at 115% and is 117% YTD. The revised target is now 109% after a further 2% reduction has now been applied (so 4% reduction applied in year). This overperformance has generated c£1.1m of additional ERF income in month with overperformance now £14.5m YTD. Industrial action in the month of January has reduced activity and the scale of overperformance was lower than had been anticipated as part of financial recovery. In addition to IA pressures, significant non elective pressures continue to cause strain on elective delivery. Further industrial action is scheduled in February representing future risk to the delivery of ERF overperformance achievement with a run rate of £2m per month overperformance targeted. Underlying Position The underlying position for January deteriorated when compared to average levels for the YTD to £5.2m. Last months restated underlying deficit was £4m following ERF income being greater than had been first anticipated. The primary drivers of the month on month movement relate to: • Reduced ERF activity – this dropped by £1m following significant non elective pressures in January. Historically there has however been a lag in reported ERF once all activity is counted and coded. • Pay – the underlying rate of pay expenditure has been stable when removing one off costs for industrial action. This has remained flat for the last four months following the introduction of financial recovery plan actions followed by increased recruitment controls. • Non pay costs increased (£0.5m) offset by slightly increased other income (£0.3m). This mainly relates to increased energy costs and clinical supplies. The previous monthly average underlying deficit had been c£4.5m per month once the impact of industrial action and other one offs are removed. This includes ERF of c£1.5m per month overperformance. The target exit run rate for 2023/24 is a deficit of no worse than £4m per month, which could reasonably be delivered by improved ERF performance. Whilst pay costs, in an absolute sense, have increased in January by £0.7m, much of this relates to bank holiday enhancements, and TOIL provisions linked to industrial action. Adjusting for these items, pay costs have stabilised significantly in-month as a result of the additional controls implemented in December. Temporary staffing costs have increased marginally by £0.15m in month, but remain significantly below November levels, with the movement relating to the seasonal decrease seen in the December holiday period. Page 2 of 4 In month, some reduction on HCA agency and bank has been achieved following targeted efforts on the criteria of requests for mental health support staff and additional workforce controls taking effect. Deficit Drivers The underlying deficit continues to be driven by a number of underlying system pressures seen in 22/23, for which we have not been able to recover to date: • Non-pay inflation beyond funded levels • Impact of energy prices (with gas prices impacting UHS particularly hard) • High-cost drugs spend (previously pass-through) • Number of patients not meeting criteria to reside, impacting capacity (opening expensive “surge” capacity / bed capacity restricting elective activity) In 23/24, we are now seeing further pressures, notably: • Unfunded elements of pay awards - £0.4m per month. • Workforce pressures as substantive recruitment is not offset with temporary staffing reductions £0.9m per month. • Mental health nursing pressures - £0.2m per month. • Tariff efficiency reductions not offset by recurrent CIP delivery - £0.7m per month. • Further growth in the number of patients not meeting the criteria to reside. These have been consistently at 200 with some weeks peaking at over 250. This has generated costs in opening surge capacity. Unfunded additional activity is a further pressure for UHS where we are YTD providing activity above block funded level for free in the following areas: • £9.6m of outpatient follow up appointments • £10.0m of non-elective • £4.1m of other treatments This is likely to be between £25m and £30m across 2023/24 and remains a key component of the Trust’s deficit. This will form a key part of contracting discussions for 2024/25 as this is clearly unsustainable in the medium to long term with focused efforts required either to reduce demand or acknowledge costs that require mitigation via other means. Cost Improvement Plans The most-likely risk assessed position of cost improvement delivery sits at £64m (5%). This includes the £5.5m targeted improvement within the financial recovery plan. Whilst we have made good progress with CIP performance, it is heavily supported by non-recurrent delivery that cannot be relied upon for underlying financial improvement. The aim is now to shift this into recurrent delivery. Financial recovery plan actions continue to be monitored and are included within appendix 1. Capital The 2023/24 capital programme is currently £12.0m behind plan YTD (spend of £32.1m compared to planned delivery of £44.1m). Currently there is confidence in forecast delivery of the planned level of expenditure, which totals nearly £60m including externally funded schemes for 2023/24. This does however require spend of c£27m in the remaining two months of the year. A month-on-month trajectory has been developed and is being tracked with project managers particularly in estates to ensure risks are understood at the earliest opportunity and mitigations put in place where possible. Page 3 of 4 Prioritisation for 2024/25 and 2025/26 has been discussed at Trust Investment Group and will be shared with Trust Board in February. This presents significant challenges as demands for capital increase year on year correlating with increased critical infrastructure, equipment and capacity risks. Cash As reported in previous finance report the trusts cash balance remains a significant concern and for the first time has dropped below the internal target minimum threshold of £30m, being £25m as at the close of January. The forecast was £28m however timing delays to PDC drawdowns and donated income receipts means this was slightly below planned levels. This now means there are periods in the month when cash levels are below £10m and require day to day management and overview. Short term increases are expected as several significant payments are due from commissioners in addition to £10m of external funding relating to the Neonatal capital project which has already had some costs incurred. The year end forecast therefore is expected to close at £40m. The additional cash support outlined above will improve this position further. Moving into 2024/25 additional vigilance will be applied and early warning systems maintained in order to assess the ongoing viability of the capital programme and also ensure the NHS England draw down process is ready if and when required. Implications: • Financial implications of availability of funding to cover growth, cost pressures and new activity. • Organisational implications of remaining within statutory duties. Risks: (Top 3) of carrying out the change / or not: • Financial risk relating to the underlying run rate and projected potential deficit if the run rate continues. • Investment risk related to the above • Cash risk linked to volatility above • Inability to maximise CDEL (which cannot be carried forward) and the risk of a reducing internal CDEL allocation for 2024/25 due to the forecast deficit for 2023/24. Summary: Trust Board is asked to: Conclusion and/or • Note the finance position. recommendation Page 4 of 4 Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author Date: Purpose Performance KPI Report 2023-24 Month 10 10.1 David French, Chief Executive Officer Sam Dale, Associate Director of Data and Analytics 29 February 2024 Assurance or Approval reassurance Y Ratification Information Issue to be addressed: The report aims to provide assurance: • Regarding the successful implementation of our strategy • That the care we provide is safe, caring, effective, responsive, and well led Response to the issue: The Performance KPI Report reflects the current operating environment and is aligned with our strategy. Implications: This report covers a broad range of trust performance metrics. It is (Clinical, intended to assist the Board in assuring that the Trust meets Organisational, regulatory requirements and corporate objectives. Governance, Legal?) Risks: (Top 3) of carrying out the change / or not: This report is provided for the purpose of assurance. Summary: Conclusion and/or recommendation This report is provided for the purpose of assurance. Page 1 of 24 Report to Trust Board in February 2024 Performance KPI Board Report Covering up to January 2023 Sponsor – David French, Chief Executive Officer Author – Sam Dale, Associate Director of Data and Analytics Page 2 of 24 Report to Trust Board in February 2024 Report guide Chart type Example Cumulative Column Cumulative Column Year on Year Line Benchmarked Line & bar Benchmarked Control Chart Variance from Target Explanation A cumulative column chart is used to represent a total count of the variable and shows how the total count increases over time. This example shows quarterly updates. A cumulative year on year column chart is used to represent a total count of the variable throughout the year. The variable value is reset to zero at the start of the year because the target for the metric is yearly. The line benchmarked chart shows our performance compared to the average performance of a peer group. The number at the bottom of the chart shows where we are ranked in the group (1 would mean ranked 1st that month). The line shows our performance, and the bar underneath represents the range of performance of benchmarked trusts (bottom = lowest performance, top = highest performance) A control chart shows movement of a variable in relation to its control limits (the 3 lines = Upper control limit, Mean and Lower control limit). When the value shows special variation (not expected) then it is highlighted green (leading to a good outcome) or red (leading to a bad outcome). Values are considered to show special variation if they -Go outside control limits -Have 6 points in a row above or below the mean, -Trend for 6 points, -Have 2 out of 3 points past 2/3 of the control limit, -Show a significant movement (greater than the average moving range). Variance from target charts is used to show how far away a variable is from its target each month. Green bars represent the value the metric is achieving better than target and the red bars represent the distance a metric is away from achieving its target. Page 3 of 24 Report to Trust Board in February 2024 Introduction The Performance KPI Report is presented to the Trust Board each month to provide assurance: • regarding the successful implementation of our strategy; and • that the care we provide is safe, caring, effective, responsive, and well led. The content of the report includes the following: • The ‘Spotlight’ section, to enable more detailed consideration of any topics that are of particular interest or concern. The selection of topics is informed by a rolling schedule, performance concerns, and requests from the Board. • An ‘NHS Constitution Standards’ section, summarising the standards and performance in relation to service waiting times; and • An ‘Appendix,’ with indicators presented monthly, aligned with the five themes within our strategy. Adjustments of note within the report include: • 11 – Medication Errors (severe/moderate) were revalidated for December 2023 and reduced to four from five in the last publication • 54 – Cyber Security: the data labels used on the bar chart required correction to align with the multiplication factor stated in the description Page 4 of 24 Report to Trust Board in February 2024 Summary This month’s spotlight report covers diagnostic performance. It highlights that UHS has consistently reduced the diagnostic waiting list throughout the 2023 calendar year and the hospital’s waiting time performance is now consistently in the second quartile compared to peer teaching hospitals across the country. The paper describes the high level activity and performance trends for the hospital over recent months and explores modality sites in more detail, outlining the specific challenges and actions taken by Care Groups to understand and improve performance. Areas of note in the appendix of performance metrics include: 1. The Emergency Department (ED) four hour performance metric further improved in January 2024 increasing to 63.7% placing UHS as second highest performing trust when compared to twenty teaching hospitals across the country. The January performance is above our H2 recovery target for the month, but we recognise there is significant improvement required for the remainder of the year to reach our March 2024 target. 2. The trust is reporting zero patients waiting over 104 weeks for the first time this financial year as the longest waiting corneal patients have now been issued grafts by the national transplant service and treated. The trust reported 27 patients waiting over 78 weeks which mainly reflects the next cohort of corneal transplant patients waiting for national tissue to be issued. 3. UHS continues to focus on the national target of zero patients waiting over 65 weeks by March 2024. In December 2023, UHS ranked in the top quartile for patients waiting over 65 weeks and also patients waiting over 52 weeks compared to twenty comparative teaching hospitals across the country. 4. Cancer services have maintained strong waiting time performances in December 2023 as the Trust continues to rank as the top teaching hospital for 28 day faster diagnosis (87.2%) and second for 62 day performance (79.5%). Whilst the two week waiting times are no longer a nationally reported metric, the Trust continues to publish the metric and performance is now the highest of the year at 93.6%. 5. The volume of patients not meeting the Criteria to Reside in hospital increased further in January (averaging 234 across the month) continuing to place constraints on patient flow through the hospital. Ambulance response time performance The latest unvalidated weekly data is provided by the South Coast Ambulance Service (SCAS). Due to the significant challenges within the ED department, and the wider challenge with flow experienced in the trust since the New Year, we have seen a concerning increase in handover times. For all weeks commencing in January 2024, we averaged 32 handovers per week taking over 60 minutes and 67 handovers per week taking over 30 minutes. As a comparison, in the same period in 2023, we averaged just 3 handovers taking over 60 minutes per week. The graph below illustrates volumes of handovers reported by time cohort for the last two years. Page 5 of 24 Report to Trust Board in February 2024 The unvalidated aspect of the SCAS handover data is an ongoing concern caused by numerous factors including: • Overcrowding in the department causing delays to entry and exit flows particularly through the pitstop area. • Inaccurate recording of handover delays where multiple patients arrived under the responsibility of one ambulance crew • The impact of improved waiting room triage times (particularly for those self-presenting) which has created a bottle neck with patients waiting on chairs and trolleys within pitstop • General concerns around inaccuracy of handover time stamps captured by ambulance and hospital nursing staff during busy periods. A series of actions are being jointly worked on to address the situation which include the development of a Standard Operating Procedure (SOP) for patient cohorting to be approved and adopted by both NHS bodies. Pitstop processes are being scrutinised with the transformation team to improve efficiency and may include the allocation of an additional nurse within pitstop. The position has also highlighted the need for a renewed focus on recording accuracy from all responsible staff. Page 6 of 24 Report to Trust Board in February 2024 Spotlight – Diagnostic Performance Spotlight: Diagnostic Performance The following report is based on the validated January 2024 submission. Introduction Diagnostics are a critical component of a patient’s pathway, facilitating an accurate and complete diagnosis, personalised treatment plans and the appropriate monitoring of a patient’s condition. Timely access to diagnostic tests is essential for ensuring that patients receive an early diagnosis whilst improving patient experience and delivering an efficient use of NHS resources. The Elective Care guidance from NHS England and Improvement (NHSE/I) states the "ambition is that 95% of patients needing a diagnostic test receive it within six weeks by March 2025". This outcome is aligned with the principle that diagnostic activity levels must support plans to address elective and cancer backlogs as Trusts aim to eliminate waits of over 65 weeks for elective care by March 2024. This diagnostic target applies to 15 different diagnostic tests, although performance is measured at a Trust level. These tests are broadly divided into three categories: • endoscopy (e.g. gastroscopy, cystoscopy); • imaging (e.g. CT, MRI, barium enema); • physiological measurement (e.g. echocardiogram, sleep studies). This spotlight paper highlights the current diagnostic performance position for UHS against the national targets and other hospitals. It also describes the recent volumes of activity delivered and the impact on the waiting list. We explore the key modalities in more depth outlining the challenges faced by services and the mitigating actions being put in place for the remainder of the financial year and beyond. In summary, there has been a consistent reduction in the diagnostic waiting list throughout 2023 as UHS has been able to increase the delivery of diagnostic activity to manage current levels of demand. The diagnostic waiting list reduced to 8052 patients in January 2024. This is a reduction of 45% since the high levels seen in June 2022 (11,671 patients) and is the lowest waiting list size since July 2020. Throughout the 2023 calendar year, the waiting list has decreased by 2,473 patients which is a 31% reduction. Our January 2024 performance position is 85.5%. Page 7 of 24 Report to Trust Board in February 2024 Spotlight – Diagnostic Performance Activity and Waiting List Elective diagnostic activity being delivered at UHS has consistently increased throughout 2023/24 helping to reduce the waiting list despite high referral volumes and the complications caused by industrial action throughout the year. Whilst the consultant and junior doctor strikes have impacted endoscopic services, the impact on radiology activity has been limited. Graph 1 illustrates how recent diagnostic activity being delivered at UHS is approximately 33% higher than the 2019/20 baseline (approximately 18,000 procedures per month vs baseline of 13,500). There is a clear reduction in the diagnostic waiting list throughout the year (graph 2) with some levelling off in winter months attributed to the festive period. The waiting list reached its recent lowest point in December going below 8000 patients for the first time since July 2020. January’s finalised waiting list position was 8052 patients. The care groups developed plans at the start of 2023/24 to increase activity levels and appropriately manage service demand. These have proved successful in several areas particularly where transformation colleagues have supported with opportunity identification and clinician engagement. We have seen a reduction in DNAs in certain services, improved booking processes and served notice to Portsmouth and Salisbury for referrals within Cardiac MRI. Nevertheless certain services are still challenged due to vacancies and recruitment delays and the ongoing demand on services both electively and non electively. Graph 1: Diagnostic Activity Delivered by Month 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 We explore modality performance positions and service plans in more detail in section four. Graph 2: Waiting List Size by Month Page 8 of 24 Report to Trust Board in February 2024 Spotlight – Diagnostic Performance Performance Position The Trust submitted performance position (Graph 3) demonstrates a continuous and positive, upward trajectory reaching 85.5% in January 2024. This reflects significant progress throughout the year and contradicts the dip in performance seen over the festive period this time last year. When benchmarking our performance against other peer teaching hospitals (graph 4), the Trust has historically been in the third quartile. Our December performance is in the second quartile and UHS has ranked seven out of twenty teaching hospitals for the last three months. It should be noted there is a wide spread of diagnostic performance with some trusts delivering fewer than 50% of tests within the six-week target. Graph 3: Graph Diagnostic Performance % by Month 90% 85% 80% 75% 70% 65% 60% 55% 50% Jan-21 Jul-21 Jan-22 Jul-22 Jan-23 Jan-24, 85.5% Jul-23 Jan-24 Graph 4: UHS Diagnostic Performance compared to peer teaching hospitals Page 9 of 24 Report to Trust Board in February 2024 Spotlight – Diagnostic Performance Modality Focus: Physiological modality This modality includes Audiology, Echocardiography, Neurophysiology and Sleep Studies. Across the modality group, the performance position and waiting list has improved significantly following a decline in the performance position in the first half of the 2023 calendar year. The January 2024 performance position is 74.5% with the waiting list at 1,925 patients. This compares to the position in August 2023, where the reported performance had dipped to 53.7% and the waiting list was 2,395 patients which reflects a 20% reduction. Audiology performance remains consistently at 100%, but overall performance is offset by continued pressures across other key services in particular sleep studies (60%) and neurophysiology (66%). Graph 5: Performance trend and waits for all physiological metrics:- The neurophysiology department has been under service review since June 2023 which is a collaboration between the department and the transformation team this has been instrumental in addressing some long term performance issues including the legacy of a COVID backlog. By fostering open communications and leveraging the team’s own expertise, a series of bottlenecks and inefficient work practices were identified and addressed. The result has seen performance improve from 47% in June 2023 to 66% in January 2023. This will be further enhanced by the introduction of an internally built Apex system that will aid in day to day patient flow management. A decision was made to invest in an insourcing solution at weekends from November 2023 which has reduced the neurophysiology waiting list from 1083 to 723. The focus is now on developing a more sustainable solution with a focus on department capacity versus demand and a review of consultant job plans. The sleep study service has seen referral numbers increase from on average 15 a week to 35 over the last two years. Overall performance is continuing to improve supported by actions again developed by the transformation and operational teams. Within the previous twelve months the highest number of diagnostic breaches reached 215, since September 2023 total breaches average at 136 per month. The project reviewing the DNA rate within sleeps studies is also complete. The DNA rate prior to project completion was 22.5% and this has now reduced to 8%. Root causes were the distance to travel to Lymington, text reminder services not fully established and mutually agreed appointments not being fully implemented. The services have also completed recruitment of a band 6 Physiologist with an expected start date in February, this will supported an upward trajectory for activity and support backlog reduction. The service is also scoping out the purchase of another inpatient testing kit through charitable funding. Page 10 of 24 Report to Trust Board in January 2023 Spotlight Modality Focus: Imaging Services This modality includes include computed tomography (CTs), MRIs, Barium Enema and Non-Obstetric Ultrasounds The Trust has seen an improved performance position across the 2023 calendar year. Performance in January 2024 was 89.9% and recent levels came close to achieving the national target (95%) by reaching 92.4% in November 2023. Activity levels have remained consistent in recent months averaging 13855 per month across all imaging services despite the interruptions caused by the industrial action and winter pressures. The waiting list has reduced by 22% across the last twelve months from 6,898 in February 2023 to 5,405 in January 2024. Graph 6: Performance trend and waits for all imaging services CT performance is extremely positive achieving the national target in the last three months and reporting 98% in January 2024 with a waiting list of 741 compared to 1113 in February 2023. MRI performance has remained at around 85% in recent months and this is predominantly driven down by Cardiac MRI performance (53% in January 2024). Whilst we served notice to Salisbury and Portsmouth to originally prevent Cardiac MRI referrals to UHS from November 2023, we agreed a staggered timescale to ensure both hospitals were in a position to appropriately deliver both stress and non-stress MRIs fully by March 2024. Recent performance has also been impacted by urgent equipment repairs and recruitment delays which were planned to enable a seven day service. General MRI performance is consistently at 96% or above supported by the use of a relocatable MRI scanner seven days a week and additional in-house lists. Despite the positive performance across all imaging services, the recent demand on non elective work alongside current recruitment restrictions and high staff sickness levels may impact the ability to consistently maintain high levels of performance across all services. Page 11 of 24 Report to Trust Board in January 2023 Spotlight Modality Focus: Endoscopy This modality includes colonoscopy, cystoscopy, flexi-sigmoidoscopy and gastroscopy across both adult and paediatric services. Diagnostic performance was 82% in January 2024 and has been in the range of 80-85% over the last six months which is a significant improvement since the first half of the year where performance averaged at 78%. Graph 7: Performance trend and waits for all endoscopy services Historically the cystoscopy service has been the key endoscopic service significantly reducing the overall modality performance. The service reported 49% at the start of this financial year (April 2023) but this has now improved significantly to 76% in December 2023 and 70% in January 2024. During that same period, the waiting list for adult and paediatric cystoscopies reduced from 406 patients (April 2023) to 101 patients (January 2024). The success is attributed to the service embedding a clerk solely dedicated to booking processes for cystoscopy patients. This is alongside additional capacity solely assigned to addressing the concerning back log of patients. The paediatric endoscopy service has continued to face demand and capacity challenges throughout 2023. January 2024 performance stands at 45% which is a significant improvement since June 2023 where performance was as low as 24% due to scope equipment failure and lists taken down for strikes and anaesthetic gaps. The service continues to use waiting list initiatives to maintain the position alongside regular consultant engagement and patient validation to ensure patient prioritisation processes are improving the waiting time position. Further long term demand and capacity modelling is underway and a business case for an additional consultant is also being explored. Page 12 of 24 Report to Trust Board in January 2023 NHS Constitution NHS Constitution - Standards for Access to services within waiting times The NHS Constitution* and the Handbook to the NHS Constitution** together set out a range of rights to which people are entitled, and pledges that the NHS is committed to achieve, including: The right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible • Start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions • Be seen by a cancer specialist within a maximum of 2 weeks from GP referral for urgent referrals where cancer is suspected The NHS pledges to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution • All patients should receive high-quality care without any unnecessary delay • Patients can expect to be treated at the right time and according to their clinical priority. Patients with urgent conditions, such as cancer, will be able to be seen and receive treatment more quickly The handbook lists eleven of the government pledges on waiting times that are relevant to UHS services, such pledges are monitored within the organisation and by NHS commissioners and regulators. Performance against the NHS rights, and a range of the pledges, is summarised below. Further information is available within the Appendix to this report. * https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england ** https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england Page 13 of 24 Report to Trust Board in February 2024 NHS Constitution Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target YTD 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT 63.2% 62.5% 5 5 5 5 4 4 4 4 5 4 4 4 4 ≥92% Teaching hospital average (& rank of 20) South East average (& rank of 17) 5 50% 5 5 5 6 6 5 5 6 6 6 5 4 63.0% 100% % Patients following a GP referral for suspected cancer seen by a specialist within 17 14 13 15 17 17 17 16 16 16 13 2 weeks (Most recently externally reported 79.5% 38 data, unless stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 18 10 11 13 16 19 18 16 13 9 10 South East average (& rank of 17) 55% 93.6% ≥93% Cancer waiting times 62 day standard - 100% Urgent referral to first definitive treatment 79.5% (Most recently externally reported data, 39 unless stated otherwise below) 14 17 18 14 14 9 14 13 10 15 6 11 7 6 UHSFT Teaching hospital average (& rank of 19) South East average (& rank of 17) 40% 7 551.62% 11 7 14 5 9 7 3 6 1 3 2 2 ≥85% 100% Patients spending less than 4hrs in ED - (Type 1) 28 UHSFT 6 61.5% 7 6 5 4 9 12 9 8 63.7% 8 12 10 11 8 4 ≥95% Teaching hospital average (& rank of 16) South East average (& rank of 16) 4 4 3 3 3 5 7 5 5 5 7 7 7 5 2 25% 40% 29.6% % of Patients waiting over 6 weeks for diagnostics 37 UHSFT Teaching Hospital average (& rank of 20) 11 12 12 12 12 11 11 11 7 9 7 7 7 6 10 7 8 8 8 7 7 8 10 10 8 7 7 14.5% 7 ≤1% South East Average (& rank of 18) 0% 76.7% 66.7% 61.1% 19.5% Page 14 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Outcomes 1 HSMR - UHS HSMR - SGH 2 HSMR - Crude Mortality Rate Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 89.77 87.52 88.07 86.11 75 3.1% 2.8% 2.7% Monthly target ≤100 <3% 2.5% 15% 3 Percentage non-elective readmissions within 28 days of discharge from hospital 10% 11.4% 12.0% - Cumulative Specialties with 4 Outcome Measures Developed (Quarterly) Q4 22-23 75 71 70 65 Q1 23-24 72 Q2 23-24 72 Q3 23-24 73 Q4 23-24 74 Quarterly target +1 Specialty per quarter Developed Outcomes RAG ratings (Quarterly) 5 Red Amber Green 100% 35 34 37 41 41 81 82 75 67 64 75% 336 340 333 337 338 50% YTD 90.7 2.7% 12.2% Red : below the national standard or 10% lower than the local target Amber : below the national standard or 5% lower than the local target Green : within the national standard or local target YTD target ≤100 <3% Appendix Page 15 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Safety Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target YTD Cumulative Clostridium difficile 6 Most recent 12 Months vs. Previous 12 Months 90 7177 7484 94 1112 1827 2435 49 28 60 35 66 47 72 55 6581 7391 ≤5 91 0 5 7 MRSA bacteraemia 0 7 01 1 0 0 0 0 0 0 1 0 0 1 2 1 2 80 YTD target ≤50 0 8 Gram negative bacteraemia ≤18 192 0 24 16 17 14 32 14 19 27 16 21 15 25 18 17 20 Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target YTD 1 0.56 9 Pressure ulcers category 2 per 1000 bed days 0.46 <0.3 0.41 0 ≤173 YTD target <0.3 1 Pressure ulcers category 3 and above 10 0.25 per 1000 bed days 0 10 0.52 0.32 <0.3 0.42 <0.3 11 Medication Errors (severe/moderate) 3 3 ≤3 23 30 0 Watch & Reserve antibiotics, usage per 12 1,000 adms Most recent months vs. 2018*95.5% 3,500 1,500 2,7625,769 2,787 2,900 2,787 27,617 25,859 12 - For 2022/23 and forward, a new requirement is applied: Reduction of 4.5% from calendar year 2018 usage in combined WHO/NHSE AWaRE subgroups for “watch” and “reserve” agents. The performance data relate to successive FINANCIAL years, however the comparator denominator remains CALENDAR year 2018 (we are not using 2020 or 2021 due to the disruptive effect of COVID on both usage and admissions). Appendix Page 16 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Safety Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target YTD Serious Incidents Requiring 40 13 Investigation (SIRI) (based upon month 3 reported as SIRI, excluding Maternity) 0 - 27 0 13 From October 2023, as part of move to PSIRF, reporting of SIRIs was stopped. Patient Safety Incident Investigations (PSII) are reported going forward 5 Serious Incidents Requiring 14 Investigation - Maternity 0 0 0.2 Number of falls investigated per 1000 15 0.12 bed days 0.0 - 4 0 0.11 - 0.09 100% % patients with a nutrition plan in place 93.1% 94.2% 16 (total checks conducted included at ≥90% 95% chart base) 669 711 1624 780 1600 844 871 788 806 798 772 770 894 879 956 80% 100 17 Red Flag staffing incidents 28 26 - 169 Maternity 0 Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target YTD 600 Birth rate and Bookings 18 Birth Rate - total number of women birthed Bookings - Total number of women booked - - 483 406 392 428 469 409 446 467 442 400 424 400 382 417 450 418 477 402 449 416 513 387 432 383 453 436 363 440 498 412 300 10 19 Staffing: Birth rate plus reporting / opel status - number of days (or shifts) at Opel 4. 1 5 1 0 2 1 1 4 6 1 3 3 1 4 4 - - 0 100% 39.2% 47.3% 38.6% 49.3% 43.5% 45.2% 43.5% 44.3% 43.0% 43.5% 44.8% 44.8% 43.7% 38.6% 43.3% 43.3% 32.6% 53.0% 40.6% 46.9% 36.7% 48.8% 36.0% 54.8% 37.2% 49.3% 37.5% 48.2% 35.7% 48.5% Mode of delivery 20 % number of normal birthed (women) 50% % number of caesarean sections (women) % other - - 0% YTD target - - ≥90% - YTD target - - - Appendix Page 17 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Patient Experience 21 FFT Negative Score - Inpatients Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 3% 1.0% 0.8% 0% 10% FFT Negative Score - Maternity 22 (postnatal ward) 1.5% 2.7% 0% 50% 23 Total UHS women booked onto a continuity of carer pathway 0% 80% 24 Total BAME women booked onto a continuity of carer pathway 12.9% 85.9% 16.6% 21.9% 5% 100% % Patients reporting being involved in 25 87% 87% decisions about care and treatment 80% % Patients with a disability/ additional needs reporting those 87% 26 needs/adjustments were met (total 86% number questioned included at chart base) 80% 26 - Performance is a scored metric with a "Yes" response scoring 1, "Yes, to some extent" receiving 0.5 score and other responses scoring 0. 200 Overnight ward moves with a reason 78 96 27 marked as non-clinical (excludes moves from admitting wards with LOS<12hrs) 0 Monthly target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - YTD 0.6% 2.4% 13.8% 28.6% 87.2% 90.2% 692 YTD target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - Appendix Page 18 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Access Standards Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 100% Patients spending less than 4hrs in ED - (Type 1) 28 UHSFT 6 61.75% 5 6 4 9 12 9 8 63.7% 8 12 10 11 8 4 Teaching hospital average (& rank of 20) South East average (& rank of 16) 4 4 3 3 3 5 7 5 5 5 7 7 7 5 2 25% Monthly target ≥95% 05:00 29 Average (Mean) time in Dept - nonadmitted patients 02:00 08:00 30 Average (Mean) time in Dept - admitted patients 03:07 05:50 04:37 ≤04:00 06:39 ≤04:00 01:00 75% % Patients on an open 18 week pathway (within 18 weeks ) 64.0% 62.5% 31 UHSFT 5 5 5 4 4 4 4 5 4 4 4 4 Teaching hospital average (& rank of 20) 5 4 South East average (& rank of 17) 5 50% 5 5 5 6 6 5 5 6 6 6 5 4 4 ≥92% 60,000 Total number of patients on a waiting list 32 (18 week referral to treatment pathway) 54,254 57,725 - 40,000 Patients on an open 18 week pathway (waiting 52 weeks+ ) 8,000 5 5 5 5 4 4 4 4 3 3 3 2 2 2 33 UHSFT 2,156 1,672 ≤2,011 Teaching hospital average (& rank of 20) South East average (& rank of 17) 0 12 12 12 12 11 11 11 9 8 8 8 8 8 9 YTD 61.1% 03:39 06:01 63.0% 57,725 1,672 YTD target ≥95% ≤04:00 ≤04:00 ≥92% - ≤2011 Appendix Page 19 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target 4,000 Patients on an open 18 week pathway (waiting 65 weeks+ ) 6 6 6 5 5 4 4 4 4 5 5 3 3 3 34 UHSFT 827 - Teaching hospital average (& rank of 20) 245 South East average (& rank of 17) 0 13 12 13 12 12 11 11 10 9 9 9 8 8 8 Patients on an open 18 week pathway 1,400 7 7 7 (waiting 78 weeks+ ) 6 35 UHSFT Teaching hospital average (& rank of 20) 271 4 4 5 8 8 7 6 5 6 5 27 0 South East average (& rank of 17) 0 15 15 15 15 12 10 11 12 11 10 9 9 9 9 200 Patients on an open 18 week pathway (waiting 104 weeks+ ) 35a UHSFT 0 Teaching hospital average (& rank of 20) South East average (& rank of 17) 1 0 1 0 1 0 1 1 0 1 0 8 1 14 4 157 15 2 16 2 12 1 13 1 13 1 0 0 0 11 1 1 1 1 13 13 17 13 14 10 11 9 15,500 36 Patients waiting for diagnostics 11,500 10,634 - 8,052 7,500 % of Patients waiting over 6 weeks for diagnostics 40% 28.7% 12 12 11 12 12 11 11 11 7 9 7 7 6 7 37 UHSFT Teaching hospital average (& rank of 20) 10 7 8 8 8 77 8 10 10 8 7 14.5% 7 7 ≤1% South East average (& rank of 18) 0% YTD 245 27 8,052 19.5% YTD target - 0 0 ≤1% Appendix Page 20 of 24 Report to Trust Board in February 2024 Outstanding Patient Outcomes,Safety and Experience Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target % Patients following a GP referral for 100% suspected cancer seen by a specialist within 17 2 weeks (Most recently externally reported 14 13 79.5% 15 17 17 17 16 16 16 13 38 data, unless stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 18 10 11 13 16 19 18 16 13 9 10 93.6% ≥93% South East average (& rank of 17) 55% YTD 76.7% YTD target ≥93% Beginning December 2023, NHSE published Cancer data no longer includes 2 week wait as a cancer standard for benchmarking. Data shown for October 2023 onwards will 38 reflect internally reported UHS position for each month, but will not include Teaching Hospital/South East Hospital data 100% Cancer waiting times 62 day standard - Urgent referral to first definitive treatment 79.5% (Most recently externally reported data, 39 unless stated otherwise below) 14 17 14 18 14 9 14 13 10 15 6 11 7 6 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 17) 40% 7 551.62% 11 7 14 5 9 7 3 6 1 3 2 2 ≥85% 66.7% ≥85% From October 2023 data onwards, the 62 day standard metric published in NHS england data combines Urgent Suspected Cancer and Breast Symptomatic with previously excluded Screening and 39 Upgrade routes. 100% Cancer 28 day faster diagnosis 87.2% Percentage of patients treated within 40 standard UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 17) 78.6% 3 8 4 7 8 7 7 6 3 1 2 3 3 2 5 5 5 8 7 5 3 2 1 1 1 1 ≥75% 81.5% ≥75% 50% 100% 31 day cancer wait performance - decision to treat to first definitive treatment (Most 16 16 89.5% 16 18 16 15 17 15 13 13 11 15 12 13 recently externally reported data, unless 90.0% 41 stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 13 12 20 12 10 14 11 5 14 9 6 9 15 8 South East average (& rank of 17) 78% ≥96% 88.4% ≥96% 41 From October 2023 data onwards, the 31 day standard metric published in NHS england data combines First Treatment and Subsequent Treatment routes. Appendix Page 21 of 24 Report to Trust Board in February 2024 Pioneering Research and Innovation R&D Performance 43 Comparative CRN Recruitment Performance - non-weighted Monthly Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan target YTD 25 21 19 19 17 14 15 15 13 14 17 17 16 15 15 Top 10 - 7 44 Comparative CRN Recruitment Performance - weighted 0 15 10 10 10 11 9 9 12 14 15 12 11 12 9 6 11 Top 5 - 0 100% Study set up times - 80% target for 45 issuing Capacity & Capability within 40 50% Days of Site Selection 0% 88% 59% 64% 60% 67% 47% 46% 46% 55% 25% - - 200% 166.3% Achievement compared to R+D 150% 85.2% 104.1% 133.3% 133.3% 46 Income Baseline Monthly income increase % 100% 71.4% 79.2% 50% 69.5% 84.7% 65.2% 35.6% 50.7% 45.8% 84.7% 65.2% ≥5% - 6.5% YTD income increase % 0% Appendix YTD target - - - - Page 22 of 24 Report to Trust Board in February 2024 Integrated Networks and Collaboration Appendix Local Integration Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Monthly target 250 197 Number of inpatients that were 47 medically optimised for discharge (monthly average) 0 234 ≤80 Emergency Department 48 activity - type 1 This year vs. last year 13000 11000 9000 10,116 10,089 11,591 - 10,459 Percentage of virtual appointments as a 49 proportion of all outpatient consultations This year vs. last year 40% 29.8% 29.9% 20% 29.8% 29.4% ≥25% YTD 202 114,095 29.3% YTD target - - ≥25% Page 23 of 24 Report to Trust Board in February 2024 Foundations for the Future Digital Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan My Medical Record - UHS patient 200,000 50 accounts (cumulative number of accounts in place at the end of each 100,000 month) 0 144,668 188,436 40000 My Medical Record - UHS patient 51 logins (number of logins made within 30000 each month) 20000 30,515 34,454 3090 Average age of IT estate 3000 2490 52 Distribution of computers per age 2000 863 1080 1170 in years 1000 0 0 27 39 84 136 375 0 1820 730 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Monthly target - - - YTD 188,436 32,150 - YTD target - - - 99.75% 99.72% 99.73% 99.81% 99.77% 99.82% 99.74% 99.79% 99.80% 99.79% 100% 53 CHARTS system average load times - % of pages loaded under 5s 95% 53 Data only available from April 2023 onwards Q4 22-23 Q1 23-24 Q2 23-24 Q3 23-24 Q4 23-24 Cyber attacks / phishing / incidents blocked 30 Average # Malware attempts blocked 25 per month (10s) 20 25 22 20 54 Average # Phishing emails blocked per 15 10 month (100s) 10 61 Average # Ransomware attempts 5 2 blocked per month 0 71 3 40 1 - 10 26 1 70 - - Inpatient noting progress Left axis: 55 IP Noting data recorded (100s) IP Noting unique user views Right axis: IP pages scanned (1000s) NEU go live 5000 EYE go live CV&T gTo&liOvego live 4000 3000 2000 1000 0 Med go live Sur go live 55 IP Noting went live in Oct-22. CGs going live are marked on green line. Can go live 800 600 - - - 400 200 0 Page 24 of 24 Appendix
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2024-Trust-documents/Finance-and-Performance-Reports-2023-24-Month-10-January-2024.pdf

Having a total hip replacement - patient information

Description: This leaflet contains important information about having a total hip replacement.
Url: /Media/UHS-website-2019/Patientinformation/Muscles,jointsandbones/Having-a-total-hip-replacement-4038-PIL.pdf

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