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Papers Trust Board 27 May 2021

Description: Date Time Location Chair Agenda Trust Board – Open Session 27/05/2021 9:00 - 13:00 Microsoft Teams Peter Hollins 1 Chair’s Welcome, Apol
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2021-Trust-document/TB-papers/Papers-Trust-Board-27-May-2021.pdf

Papers Sept 2020 held in closed session due to Covid-19

Description: Date Time Location Chair Agenda - Trust Board Meeting 29/09/2020 9:00 - 16:00 Microsoft Teams Peter Hollins 1 Chair’s Welcome, Apologies
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2020/papers-sept-2020-held-in-closed-session-due-to-covid-19.pdf

Papers Trust Board - 30 January 2020

Description: Date Time Location Chair Apologies Agenda Trust Board – Open Session 30/01/2020 9:00 - 11:45 Conference Room, Heartbeat Education Centre, F Lev
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2020/Papers-Trust-Board-30-January-2020.pdf

Healthy weight assessment for children - patient information

Description: This factsheet explains why it is important for children to maintain a healthy weight.
Url: /Media/UHS-website-2019/Patientinformation/Childhealth/Healthy-weight-assessment-for-children-2531-PIL.pdf

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

Finance and Performance Reports 2024-25 Month 7 October 2024

Description: Report to the Trust Board of Directors, 29 November 2024 Title: Finance Report 2024-25 Month 7 Sponsor: Ian Howard, Chief Financial Officer Author: Philip Bunting, DoOF and Anna Schoenwerth, ADOF Purpose (Re)Assurance Approval Ratification Information x Strategic Theme Outstanding patient outcomes, safety and experience Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future x Executive Summary: The Trust monthly finance report provides insight and awareness of the financial position and the key drivers for any variance to plan. It also provides commentary around future risks and opportunities. This covers the three key domains of income and expenditure, capital and cash. The headlines for the October report are as follows: • The Trust has reported a £4.5m deficit in month and a £12.5m deficit YTD. The Trust is now £9.2m behind plan YTD. • UHS continues to deliver significant levels of financial savings, particularly from UHS transformation programmes on patient flow, theatres and outpatients. • UHS benchmarks as providing good value for money across a range of metrics. • One of the main drivers of the deficit continues to be the non-delivery of system transformation initiatives. In particular, Non-Criteria to Reside (NCTR) numbers have increased rather than reduced. • The Trust continues to overtrade – undertaking activities beyond funding levels being received. • The Trust financial position remains off-plan, with monthly improvements required to deliver our Financial Recovery Plan. • There are further risks to the Trusts financial position regarding ERF income levels, staffing costs and winter pressures. • Additional rigour continues to be applied around financial grip and governance ensuring strong controls are in place. The Trust also continues to work with Deloitte around non pay savings opportunities. • Cash has increased in month to £52m, noting this is a temporary increase with income received in advance of making all pay award payments. There is a significant risk in Q4 that cash will reduce close to zero and cash support will be required. • The Trust’s capital programme is £6.3m behind plan YTD, with £38m to be spent in the remainder of the financial year. Slippage risks on schemes are currently being reviewed with the capital planning process for 2025/26 and 2026/27 having now commenced. Contents: Finance Report Risk(s): 5a (financial breakeven) Equality Impact Consideration: N/A Page 1 of 4 UHS Finance Report – M7 Headlines As reported last month, following the receipt of £11.2m of deficit support funding, UHS is now being measured against an annual plan of £3.3m deficit. This deficit is fully phased into the first half of the year with the prevailing plan for the second half of the year a monthly breakeven target. The below table illustrates both the in-month and YTD reported I&E position both before and after the deficit support funding: Financial Position – Pre-Deficit Support Plan Actual Surplus / (Deficit) Variance M7 YTD Annual 0.0 (14.5) (14.5) (4.5) (23.6) (4.5) (9.2) Financial Position - After Deficit Support Re-set Plan Actual Surplus / (Deficit) Variance M7 YTD Annual 0.0 (3.3) (3.3) (4.5) (12.5) (4.5) (9.2) Financial Improvements The Trust is continuing to substantively deliver on financial improvements from its savings and transformation programmes. For example: • The Trust has delivered length of stay improvements for P0 patients of 5%. • We have delivered a significant improvement to our outpatient ratio, undertaking more first appointments, procedures and advice & guidance. • The Trust has implemented new workforce controls embedded within Divisions, which have been widely supported. We are below our pay expenditure plan YTD with all divisions operating within workforce control totals. • We are currently utilising agency for 0.8% of our total workforce, significantly below the national target of 3.2%. Our temporary staffing remains below plan. • UHS is performing well on ERF activity through transformation programmes and other initiatives, with YTD performance at 127% of baselines, above the overall national target of 107% (although below our internal plan target of 133%). • UHS has delivered £37.7m (> 6% of addressable spend) of CIP by M7, which is above the trajectory from 23/24. • Since March 24, our ERF performance has increased by 11%, and at the same time our staffing levels have reduced by 2%. • The Trust has recently received benchmarking information which highlights its relative efficiency, notably: o National Cost Collection score of 89 – 11% more efficient than national average. o Model Hospital data for 22/23 – further improvement to 15th national performance, above peer organisations. o Back-office benchmarking highlighting efficient use of resources. Page 2 of 4 Key Drivers The key drivers for the £9.2m variance to plan YTD are as follows: • System Transformation programmes targeted delivery of reductions to Non-Criteria to Reside (NCTR) and Mental Health numbers attending the hospital. Despite best endeavours of UHS and system partners, patient numbers remain above planned levels, meaning the Trust continues to incur additional temporary staffing costs and is maintaining additional bed capacity above funded levels. Savings of £6.5m have not been delivered YTD. • Following the finalisation of the October payroll the Agenda for Change pay award impact is now known. Resident doctors pay arrears will be paid in November so this remains estimated. The combined impact of pay awards is estimated to be an in-year funding shortfall of c£2m with c£1m impacting in month and YTD. Full confirmation will be provided next month once all elements are confirmed. • The UHS ERF target with Specialised Commissioning was increased by £1.2m after the plan was submitted (£0.7m YTD). This was related to movement in the target of another Trust. This was challenged but upheld by NHS England. • Non pay cost pressures including the impact of inflation above planned levels continues to cause pressure. • The Combined Heat and Power (CHP) units have broken down on several occasions, meaning electrical power is imported from the national grid at a higher cost. This has had an in-year impact of £1m YTD. One of the units has recently been serviced with the aim of reducing the number of breakdowns. • Non-Elective growth and staffing challenges have resulted in under-performance against our elective income plan in Cardiac Surgery. • An underspend on pay in the early part of the year has helped supress the above cost pressures with pay £3m favourable to plan YTD after removing the impact of the pay award. This position is not expected to continue, with staffing numbers increasing by c100 WTE in month linked to recruitment to nursing and midwifery posts. In some areas we would anticipate a future reduction in temporary staffing once supernumerary periods are complete. Other Headlines Income performance dipped slightly in month although remains strong YTD. Elective Recovery Funding performance was 125% in month and is 127% YTD. This has generated income of £17m in overperformance YTD. A reduction in month was thought to be due to October half term week and the challenge of utilising theatres when there was significant consultant annual leave prior to the end of their leave year. October also has a high target compared to previous months due to the baseline period in 19/20 being the highest month of the year. Non pay expenses (excluding pass through) are reporting a £17.5m adverse variance YTD with the majority of this relating to unidentified CIP that was planned for within this category (£12m YTD / £20m FY). Savings have however been achieved in other areas partially offsetting this variance. We are also currently working with Deloitte to review further non pay savings opportunities. The underlying position, removing all further one-off items of income and expenditure, shows consistency at c£6m per month deficit. This is because of a one-off movement in month relating to VAT supressing the reported position. The underlying trend continues to be refreshed for any backdated costs and benefits. Page 3 of 4 An assessment of YTD performance highlights that the trust delivered over £17m of valued activity above block contracts in months 1 - 7. There is currently no funding solution within HIOW to resolve this problem. Financial Recovery UHS Trust Board considered a Financial Recovery Plan for H2 following a request from NHS England. The Trust I&E position in M7 was consistent with the trajectory set out for H2. However, month on month improvements are required for the remainder of the year. Risks • ERF data has now been received by NHS England for months 1-4. We are still validating the data received across HIOW ICS; however, early indications are that it is below the value locally assessed using our data. There are some data anomalies in M4 that we expect to be corrected in future iterations of the national data. However, a negative backdated adjustment may be required in M8 reporting. • As outlined above, there remains a risk that the funding received in relation to national pay awards does not fully cover the additional costs incurred by the Trust. There are other risks associated with staffing costs in-year that may also materialise. • There are seasonality risks that may mean surge capacity costs increase and elective income cannot be maintained at prior month levels. Notably NCTR levels have increased in month. This has risks for both increased expenditure and reduced ERF income. Cash The Trusts underlying deficit continues to drive a deterioration in the month-on-month cash position. Although cash increased in month to £52m, this is distorted by cash received in lieu of further pay award payments to be made to resident doctors in November and pay overs related to October pay arrears for NI and Pension elements that are paid in the month following. Following final pay award payments being made in November it is expected there will be much more certainty in the cash forecast for the remainder of the financial year. This will be shared in more detail at the December meeting. At present the cash forecast reduces very near to zero in quarter 4 representing a significant risk that cash support may be required. Capital Capital expenditure of £21.2m YTD is £6.3m (22%) behind plan, leaving over £38m to be spent across the remainder of 24/25 (excluding IFRS 16 capital additions/remeasurements). Changes to the Building Safety Act have created delays and overspends in several key projects notably the Neonatal expansion. The Community Diagnostic Centre (CDC) development is the other project facing slippage risks with costs £3.1m behind plan YTD. Trust Investment Group reviewed the most likely forecast that illustrated a projection that the capital expenditure plan for 24/25 would be delivered, although noted slippage risks that may need managing in year by bringing forward equipment spend from 25/26 plans. The capital prioritisation for 25/26 and 26/27 has now commenced with services and will be shared early in 2025. Page 4 of 4 Report to the Trust Board of Directors, 29 November 2024 Title: Performance KPI Report 2024/25 Month 7 Sponsor: David French, Chief Executive Author: Sam Dale, Associate Director of Data and Analytics Purpose (Re)Assurance Approval Ratification Information x x Strategic Theme Outstanding patient outcomes, safety and experience Pioneering research and innovation World class people Integrated networks and collaboration Foundations for the future x x x x x Executive Summary: This report covers a broad range of trust performance metrics. It is intended to assist the Board in assuring that the Trust meets regulatory requirements and corporate objectives, whilst providing assurance regarding the successful implementation of our strategy and that the care we provide is safe, caring, effective, responsive, and well led. Contents: The content of the report includes the following: • An ‘Appendix,’ which presents monthly indicators aligned with the five themes within our strategy • An overarching summary highlighting any key changes to the monthly indicators presented and trust performance indicators which should be noted. • An ‘NHS Constitution Standards’ section, summarising the standards and performance in relation to service waiting times Risk(s): Any material failures to achieve Trust performance standards present significant risks to the Trust’s long-term strategy, patient safety and staff wellbeing. Equality Impact Consideration: NO Page 1 of 17 Report to Trust Board in November 2024 Performance KPI Board Report Covering up to October 2024 Sponsor – David French, Chief Executive Officer Author – Sam Dale, Associate Director of Data and Analytics Page 2 of 17 Report to Trust Board in November 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 17 Report to Trust Board in November 2024 Introduction The Performance KPI Report is prepared for the Trust Board members 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: • 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. • As there is no board meeting taking place for the Month 5 report, the regular ‘Spotlight’ section of this performance paper is not included for discussion. Page 4 of 17 Report to Trust Board in November 2024 Summary Summary Areas of note in the appendix of performance metrics include: 1. The trust reported 12,763 attendances to the Main ED department in October 24. This is the highest volume of monthly attendances seen, a 5% increase on September (11,587) and a 10% increase on October 2023 (12,183). 2. The overall RTT waiting list increased by 2% compared to the previous month, reporting 60,879 in October 2024 compared to 59,653 for September 2024 with 63.4% of patients receiving treatment within 18 weeks of referral. The volume of GP referrals received by the Trust reflects the highest month since the pandemic. 3. The trust reported five patients waiting over 78 weeks for October 2024. All patients were within Ophthalmology and awaiting national release of corneal transplant tissue by the NHS Blood and Transfusion service. 4. The trust reported 24 patients waiting over 65 weeks for October 2024 against the national ambition of zero. Twenty of these patients were also awaiting corneal tissue release - the remaining four patients were in ENT, Paediatric Cardiac Surgery and Neurosurgery. These surgical cases were all planned for October but stood down due to late patient complications or to prioritise a more urgent case. The latest comparator information available for this metric (September 2024) showed that UHS ranked in second place when compared to twenty equivalent teaching hospitals across the UK. 5. The organisation reported 82.4% for 28 day faster diagnosis, 93.1% for 31 day standard and 78.1% for 62 day standard for cancer sevices. The Trust ranks in the top quartile for two metrics and second quartile for the third metric when compared to peer teaching hospitals for all key cancer metrics for the latest available month (September 2024). 6. The average number of patients per day not meeting the Criteria to Reside in hospital increased by 7% to 230 in October 2024 compared to 214 in September 2024. 7. The volume of virtual appointments being reported is still artificially low. This is due to an administration backlog that is being worked through. 8. The trust reported one case of MRSA, one Never Event and two Patient Safety Incident Investigations for October 2024. Ambulance response time performance The latest unvalidated weekly data is provided by the South Central Ambulance Service (SCAS). In the week commencing 18th November 2024, our average handover time was 17 minutes 27 seconds across 789 emergency handovers and 17 minutes 58 seconds across 47 urgent handovers. There were 43 handovers over 30 minutes and 19 handovers taking over 60 minutes within the unvalidated data. Across October the average handover time was 17 minutes 34 seconds. Page 5 of 17 Report to Trust Board in June 2024 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 6 of 17 Report to Trust Board in November 2024 NHS Constitution Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Monthly target 75% 62.3% 63.4% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Teaching hospital average (& rank of 20) South East average (& rank of 17) 50% 6 6 5 4 4 4 4 4 4 4 4 3 4 4 ≥92% Cancer waiting times 62 day standard - 100% 74.7% 78.1% Urgent referral to first definitive treatment (Most recently externally reported data, 10 6 9 7 6 4 3 7 4 9 7 6 4 5 39 unless stated otherwise below) UHSFT Teaching hospital average (& rank of 19) 6 1 1 2 3 2 2 1 3 3 5 5 South East average (& rank of 17) 40% 2 2 ≥70% 39 - As of April 2024, YTD and Monthly targets changed from 85% to 70% in line with latest operational guidance 95% 57.5% 64.4% Patients spending less than 4hrs in ED - (Type 1) 28 UHSFT 8 12 10 11 8 4 4 4 9 6 8 6 10 6 6 ≥95% Teaching hospital average (& rank of 16) South East average (& rank of 16) 5 7 7 7 5 2 3 2 5 2 4 5 6 4 4 30% 40% 19.0% 13.0% % of Patients waiting over 6 weeks for diagnostics 37 UHSFT Teaching Hospital average (& rank of 20) 10 8 7 7 7 7 5 5 5 4 5 5 5 5 9 7 7 6 7 5 5 4 5 5 5 6 6 6 South East Average (& rank of 18) 0% ≤5% 37 - As of April 2024, YTD and Monthly Target changed from 1% to 5% to reflect latest guidance YTD 63.6% 75.0% 67.2% 11.59% Page 7 of 17 Report to Trust Board in November 2024 Outstanding Patient Outcomes,Safety and Experience Outcomes Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 95.0 85.8 90.7 1 HSMR (Rolling 12 Month Figure) - UHS HSMR (Rolling 12 Month Figure) - SGH 84.3 75.0 2.8% 3.0% 88.8 2.5% 2 HSMR - Crude Mortality Rate Monthly target ≤100 <3% YTD 88.4 2.2% 2.2% 15% 3 Percentage non-elective readmissions within 28 days of discharge from hospital 10% 12.4% Cumulative Specialties with 4 Outcome Measures Developed (Quarterly) Q4 2023/2024 80 72 70 Q1 2023/2024 73 Q2 2023/2024 75 Q3 2024/2025 76 11.5% - 11.7% Q4 2024/2025 Quarterly target 76 +1 Specialty per quarter Developed Outcomes RAG ratings (Quarterly) 5 Red Amber Green 100% 37 41 41 36 39 75 67 62 77 79 75% - 333 335 334 342 319 50% 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 Appendix YTD target ≤100 <3% - Page 8 of 17 Report to Trust Board in November 2024 Outstanding Patient Outcomes,Safety and Experience Safety Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Cumulative Clostridium difficile 6 Most recent 12 Months vs. Previous 12 Months 110 5560 6569 7379 7785 8493 9 12 1419 2229 2738 3751 4761 71 55 0 5 7 MRSA bacteraemia 00 0 1 2 1 2 0 1 1 0 0 0 0 1 0 80 Monthly target ≤8 0 8 Gram negative bacteraemia ≤19 0 21 15 28 20 18 22 19 16 31 25 25 29 22 35 23 1 0.42 0.30 9 Pressure ulcers category 2 per 1000 bed 0.5 days 0 1 0.52 10 Pressure ulcers category 3 and above per 1000 bed days 0 10 2 <0.3 0.25 <0.3 3 11 Medication Errors (severe/moderate) 0 3,500 Watch & Reserve antibiotics, usage per 12 1,000 adms Most recent months vs. 2023/24 1,500 12 - Beginning June 2024, target and comparison changed in accordance with National Action Plan. ≤3 2,465 2,626 <2675 YTD 71 2 190 0.39 0.31 14 2,498 Appendix YTD target ≤56 0 ≤125 <0.3 <0.3 21 <2549 Page 9 of 17 Report to Trust Board in November 2024 Outstanding Patient Outcomes,Safety and Experience Appendix Safety Monthly Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct target YTD Patient Safety Incident Investigations 5 2 13 (PSIIs) (based upon month reported, excluding 2 - 6 Maternity) 0 5 0 1 13a Never Events 0 4 YTD target - 0 0 14 Patient Safety Incident Investigations 5 (PSIIs)- Maternity 0 0 - 0 - 0 0.07 0.12 15 Number of falls investigated per 1000 0.30 bed days 0.10 0.15 0.07 0.00 0.14 0.14 0.03 0.16 0.12 0.12 0.03 0.09 0.20 0.20 0.12 - 0.12 - 0.00 100% % patients with a nutrition plan in place 96.8% 95.9% 16 (total checks conducted included at ≥90% 94% ≥90% chart base) 844 772 770 932 935 962 961 1,012 930 973 977 930 869 826 964 80% 50 12 23 17 Red Flag staffing incidents - 123 - 0 Maternity Monthly Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct target YTD 700 Birth rate and Bookings 18 Birth Rate - total number of women birthed Bookings - Total number of women booked - - YTD target - 523 438 403 410 480 400 501 390 517 379 633 415 448 411 409 428 429 401 483 406 392 428 469 409 446 467 442 400 424 400 300 15 12 19 Staffing: Birth rate plus reporting / opel status - number of days (or shifts) at Opel 4. 8 8 6 3 3 4 4 1 1 0 3 0 2 6 - - - 0 100.00% 41.10% 48.40% 43.90% 42.44% 44.25% 43.00% 44.80% 44.40% 53.03% 35.88% 46.51% 39.04% 45.99% 43.80% 46.73% 40.89% 50.62% 38.90% 47.29% 39.16% 49.30% 38.55% 45.23% 43.52% 44.33% 43.47% 43.50% 43.00% 44.75% 44.75% Mode of delivery 20 % number of normal birthed (women) 50.00% % number of caesarean sections (women) - - - 0.00% Page 10 of 17 Report to Trust Board in November 2024 0.00% Outstanding Patient Outcomes,Safety and Experience Patient Experience Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 3% 0.4% 0.3% Monthly target 21 FFT Negative Score - Inpatients ≤5% 0% 10% 1.9% 0.8% 22 FFT Negative Score - Maternity (postnatal ward) 0% 30% 23 Total UHS women booked onto a continuity of carer pathway 12.0% 15.8% 0% 100% 21.7% 21.2% 24 Total BAME women booked onto a continuity of carer pathway 0% 100% 87.6% 89.1% 25 % Patients reporting being involved in decisions about care and treatment 80% 100% 88.7% % Patients with a disability/reporting 26 additional needs/adjustments met (total questioned at chart base) 249 214 234 336 208 272 304 268 339 340 280 258 317 221 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. 100 76 Overnight ward moves with a reason 27 marked as non-clinical (excludes moves from admitting wards with LOS<12hrs) 0 88.2% 353 71 ≤5% ≥35% ≥51% ≥90% ≥90% - YTD 0.7% 2.2% 13.7% 20.9% 88.0% 88.3% 423 Appendix YTD target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - Page 11 of 17 Report to Trust Board in November 2024 Outstanding Patient Outcomes,Safety and Experience Access Standards Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Patients spending less than 4hrs in ED - 95% 57.5% (Type 1) 28 UHSFT 8 12 10 11 8 4 4 4 9 6 8 Teaching hospital average (& rank of 20) 5 South East average (& rank of 16) 30% 7 7 7 5 2 3 2 5 2 4 05:00 03:33 29 Average (Mean) time in Dept - nonadmitted patients 02:00 07:00 06:24 30 Average (Mean) time in Dept - admitted patients 03:00 75% 62.3% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT Teaching hospital average (& rank of 20) 4 4 4 4 4 4 4 4 4 4 4 South East average (& rank of 18) Total number of patients on a 6 50% 6 5 4 4 4 4 4 4 4 4 65,000 59151 32 waiting list (18 week referral to treatment pathway) 55,000 Patients on an open 18 week pathway (waiting 52 weeks+ ) 8,000 1877 3 3 2 2 2 2 3 3 4 3 2 33 UHSFT 8 8 8 8 9 10 9 10 10 10 9 Teaching hospital average (& rank of 20) South East average (& rank of 18) 0 Jul Aug Sep Oct 64.4% 6 10 6 6 5 6 4 4 03:22 05:38 63.4% 4 4 4 3 4 4 60879 1243 2 2 2 9 8 9 Monthly target ≥95% ≤04:00 ≤04:00 ≥92% - ≤1393 YTD 67.2% 03:17 05:30 63.6% 60,879 1243 Appendix YTD target ≥95% ≤04:00 ≤04:00 ≥92% - ≤1393 Page 12 of 17 Report to Trust Board in November 2024 0 Outstanding Patient Outcomes,Safety and Experience Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 378 24 Patients on an open 18 week pathway 2,000 5 5 3 (waiting 65 weeks+ ) 3 3 3 34 UHSFT Teaching hospital average (& rank of 20) 3 3 3 2 2 1 1 South East average (& rank of 18) 2 9 0 9 8 8 8 6 7 8 6 5 4 4 4 6 23 5 Patients on an open 18 week pathway 250 (waiting 78 weeks+ ) 35 UHSFT 7 6 5 6 5 5 5 Teaching hospital average (& rank of 20) South East average (& rank of 18) 0 10 9 9 9 9 8 10 10 10 11 9 8 10 10 10 11 7 9 6 4 6 6 1 0 Patients on an open 18 week pathway (waiting 104 weeks+ ) 9 11 1 1 1 1 35a UHSFT Teaching hospital average (& rank of 20) 13 14 10 1 1 1 1 South East average (& rank of 18) 15 16 12 0 13 13 1 1 1 1 1 1 1 1 1 1 11,500 8188 9341 Monthly target 0 0 0 36 Patients waiting for diagnostics - YTD 24 5 0 9,341 7,500 19.0% 13.0% 40% % of Patients waiting over 6 weeks for diagnostics 37 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 18) 10 8 7 7 7 7 5 5 5 4 5 5 5 5 9 7 7 6 7 5 5 4 5 5 5 6 6 6 ≤5% 0% 37 - As of April 2024, YTD and Monthly Target changed from 1% to 5% to reflect latest guidance 11.6% Appendix YTD target 0 0 0 - ≤5% Page 13 of 17 Report to Trust Board in November 2024 Outstanding Patient Outcomes,Safety and Experience Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 100% Cancer waiting times 62 day standard - 74.7% 78.1% Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) 10 6 9 7 6 4 3 7 4 9 7 6 4 5 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 18) 1 1 2 3 2 2 1 3 3 5 5 6 40% 2 2 39 - 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 Upgrade routes. As of April 2024, YTD and Monthly targets changed to 70% in line with latest operational guidance 100% 82.5% 82.4% Cancer 28 day faster diagnosis Percentage of patients treated within 40 standard UHSFT 4 1 2 3 3 1 2 2 2 2 2 2 2 1 Teaching hospital average (& rank of 20) South East average (& rank of 18) 3 1 1 1 1 1 1 1 1 1 5 6 5 2 60% 40 - As of April 2024, YTD and monthly targets changed from 75% to 77% in line with latest operational guidance 100% 83.8% 93.1% 31 day cancer wait performance decision to treat to first definitive treatment (Most recently externally reported data, 14 15 14 15 13 11 10 15 14 11 7 13 11 11 41 unless stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 17 12 14 9 8 10 6 13 13 8 7 7 6 8 South East average (& rank of 18) 78% 41 From October 2023 data onwards, the 31 day standard metric published in NHS england data combines First Treatment and Subsequent Treatment routes. Monthly target ≥70% ≥77% ≥96% YTD 75.0% 83.1% 83.1% Appendix YTD target ≥70% ≥77% ≥96% Page 14 of 17 Report to Trust Board in November 2024 Pioneering Research and Innovation R&D Performance 43 Comparative CRN Recruitment Performance - non-weighted 44 Comparative CRN Recruitment Performance - weighted Monthly Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct target YTD 25 21 17 17 16 15 15 15 15 9 9 98 10 Top 10 - 7 6 0 15 15 12 11 12 9 11 8 9 10 10 10 10 11 11 6 Top 5 - 0 150% 45 Study set up times - 80% target for 100% issuing Capacity & Capability within 40 Days of Site Selection 50% 46% 60% 67% 46% 88% 55% 50% 64% 50% 55% 100% 47% 44% 38% 78% - - 0% 190% 157.6% Achievement compared to R+D 46 Income Baseline Monthly income increase % 140% 90% 45.8% 133.3% 133.3% 84.7% 65.2% 75.0% 119.5% 70.7% 51.2% 90.2% 80.5% ≥5% - YTD income increase % 40% 26.8% 26.8% -10% 19.0% 3.8% Appendix YTD target - - - - Page 15 of 17 Report to Trust Board in November 2024 Integrated Networks and Collaboration Appendix Local Integration Number of inpatients that were 47 medically optimised for discharge (monthly average) Monthly Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct target 250 202.8 229.4 ≤80 0 Emergency Department 48 activity - type 1 This year vs. last year 14000 12,763 - 12,183 10000 Percentage of virtual appointments as a 35% 49 proportion of all outpatient consultations 25% This year vs. last year 15% 29.2% ≥25% 22.2% YTD 147 83,339 26.3% YTD target - - ≥25% Page 16 of 17 Report to Trust Board in November 2024 Foundations for the Future Appendix Digital Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Monthly target My Medical Record - UHS patient 250,000 178011 220168 50 accounts (cumulative number of accounts in place at the end of each - month) 150,000 My Medical Record - UHS patient 50000 51 logins (number of logins made within each month) 20000 33060 51 - The YTD Figure shown represents a rolling average of MMR logins per month within the current financial year 39503 - 3210 Average age of IT estate 3000 2570 1980 1900 52 Distribution of computers per age in years 2000 1000 0 0 23 31 64 112 285 685 899 1120 - 0 14 13 12 11 10 9 8 7 6 5 4 3 2 1 100% CHARTS system average load times 53 - % pages loaded <= 5s - % pages loaded <= 3s 98% 99.8% 99.8% 99.7% 99.8% 99.8% 99.8% 99.8% 99.8% 99.3% 99.2% 99.3% 99.3% 99.4% 99.4% 99.4% YTD 220,168 254,468 - YTD target - - - 53 - From April 2024 , metric was changed from % loading times under 5s to % loading times under 3s Page 17 of 17
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2024-Trust-documents/Finance-and-Performance-Reports-2024-25-Month-7-October-2024.pdf

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 N/A – No meeting Ian Howard – Chief Financial Officer Philip Bunting – Director of Operational Finance David O’Sullivan – Assistant Director of Finance – Financial Performance 27 September 2024 Assurance or reassurance Approval Ratification Information X Issue to be addressed: The finance report provides a monthly summary of the key financial information for the Trust. Response to the Headlines issue: UHS reported a headline financial position of: • Month 5 - £3.8m deficit (£2.1m adverse to plan) • Year to date - £20.6m deficit (£7.6m adverse to plan) Whilst the position remains extremely challenging, there continues to be an improving month on month trend with the in-month deficit reducing from £3.9m to £3.8m. Underlying financial improvement remains more significant with month-on-month improvement being illustrated over the first five months of 2024/25. Overall Narrative The Trust is continuing to substantively deliver on financial improvements where outcomes are within its direct control. For example: • The Trust has delivered LOS improvements for P0 patients of 5%, supporting surge capacity to remain closed. • We have delivered an increase in First Outpatient appointments of 10% and Advice and Guidance of 10%, supported by a reduction in follow-up appointments of 9%. Our Outpatient First/Procedure to Follow-up ratio has improved to 53%, above the 46% national target. • The Trust has implemented new workforce controls embedded within Divisions, which have been widely supported. We are significantly below our pay expenditure plan. • We are currently utilising agency for 0.6% of our total workforce, significantly below the national target of 3.2%. • Our temporary staffing (bank and agency) is below plan by £4m, and £6m below than the same point in 23/24. • UHS is performing well on ERF activity through transformation programmes and other initiatives, with YTD performance at 126% of baselines, above the overall national target of 107% (although marginally below our plan). • UHS has delivered £25m CIP by M5, which is £4m above the trajectory from 23/24. • Since March 24, our ERF performance has increased by 9%, and at the same time our staffing levels have reduced by 2%. Page 1 of 6 However, a number of issues have presented in year which has created a financial variance, some of which are outside of the organisations full control: • Industrial Action (£1.5m) – the junior doctor strike in late June / early July has dampened the level of ERF income by c£1m and resulted in additional direct costs of c£0.5m. • Consultant pay award (£0.9m YTD) – there is a gap between funding and estimated cost of implementing the consultant pay award. • Increase to the Specialist Commissioning ERF Target (£0.5m YTD) – due to a national imbalance a further increase was applied to the ERF target for UHS that will result in unremunerated activity of £1.2m for 24/25. • System Related CIPs undelivered (£3.9m) – the four system related CIP schemes (reducing NCTR patients / reducing MH patients / Corporate cost reductions / additional service development fund income) are working collaboratively across the system; however, output metrics that support reduction in provider costs have not yet materialised. • UHS have YTD performed circa £13.5m of activity above block contract levels, which is unfunded. Further to this, within the Trust a pay underspend YTD is offsetting non pay pressures and income shortfalls against plan. Additionally, several one-off benefits have helped support the position with a VAT benefit from prior years delivering £0.7m in month. Funding Uncertainty There are a number of items expected to impact the financial position in M6 or future months. These include: • Non-recurrent deficit support funding has recently been confirmed to be received in M6. This will result in a revised financial plan from M6-M12. UHS is anticipating receiving c£11m. • ERF final performance for 2023/24 has yet to be confirmed. We are expecting a reduction to our 24/25 target, which will give an upside to our current reported position. • ERF performance to date in 2024/25 has yet to be shared – it is normally 3 months in arrears. We are estimating performance using local data. For every month that information is delayed we are increasing the level of risk and potential variation within our reported numbers. • Industrial action – we are anticipating a share of national funding, which would improve our current position. • Specialised Commissioning ERF target – as mentioned above, this was increased unexpectedly in 24/25. We have submitted a challenge nationally as part of the contractual process for 24/25 and are awaiting the outcome. • Pay award funding – we are awaiting confirmation of the value of funding to be received in relation to confirmed 24/25 pay awards, including cash to support backdated payments being made in M6. These factors could cause some volatility in reported financial positions in coming months. We will ensure our underlying position takes these movements into account. Underlying Position The Trust started the year with an underlying deficit of circa £7m per month, with underlying pressures from 23/24 being added to by real-terms funding reductions. The position has improved month on month with August estimated to have an underlying deficit of £5.5m. The year-to-date underlying deficit is evaluated to be a £30.7m deficit with £10.1m of non-recurrent benefits supporting the position hence a position of £20.6m deficit reported. Page 2 of 6 Cash The Trusts underlying deficit continues to drive a deterioration in the month-on-month cash position. August ended with a cash balance of £23.8m that is marginally higher than the recently reforecast position. As per previous updates the cash recovery plan has been enacted and close working with commissioners has helped ensure cash inflows are timely. Capital Capital expenditure of £14.2m YTD is slightly behind plan (£1.9m variance), however leaves over £44m to be spent across the remainder of 24/25. Changes to the Building Safety Act have created delays and overspends in several key projects notably the Neonatal expansion. Trust Investment Group reviewed the most likely forecast that illustrated a high degree of certainty that the capital expenditure plan for 24/25 would be delivered, however did create challenge for 25/26 with slippage greater than planned. This will be reviewed in the context of capital planning and prioritisation for 25/26 over the coming months. Pay Awards Agenda for Change pay awards and junior doctor pay awards have now been proposed for 2024/25. The resident doctors pay award has now been ratified by the BMA. As stated above the Trust has yet to receive any official guidance on the funding envelope being made available for these and how this will be distributed to providers. No funding gap is assumed within the forecast scenario referred to above. Procurement Act 2023 The Transforming Public Procurement programme introduction within the NHS has been delayed from October 24 to February 25. This will provide additional time for our procurement team (WPL) to consider all aspects of the Act, particularly as not all schedules have yet been released nationally. The Transforming Public Procurement programme aims to improve the way public procurement is regulated in order to: • create a simpler and more flexible, commercial system that better meets our country’s needs while remaining compliant with our international obligations • open up public procurement to new entrants such as small businesses and social enterprises so that they can compete for and win more public contracts • embed transparency throughout the commercial lifecycle so that the spending of taxpayers’ money can be properly scrutinised. Transforming Public Procurement - GOV.UK (www.gov.uk) https://www.gov.uk/government/collections/transforming-public-procurement WPL will provide an update to Finance & Investment Committee on the implications once a full impact assessment has been undertaken and all schedules are available. A short guide is appended in appendix 1. Next Steps • We are continuing to prioritise focus on delivery of transformation programmes, with significant energy going in across the Trust. The Trust Executive Committee in September was repurposed to focus on this. Page 3 of 6 • We are maintaining our performance on workforce through robust controls and governance. • We are engaged and supporting Tim Briggs review within HIOW, focussing on a number of specialties. • We have requested and received support from the RSP programme to bring in additional resource to support GIRFT reviews. We have identified individuals who have now started to support this programme. • Reviews of productivity movements have been progressed, including a tool which compares cost growth to cost-weighted activity movements at Care Group level. This is currently being rolled out to Divisions as a support tool to identify areas for improvement. • The Trust Savings Group process continues to provide governance and direction to a number of improvement programmes across the Trust. • We are engaging with external consultants to provide additional focused resource and deliver improvements at pace on non-pay and external contracts. Implications: • Financial implications of availability of funding to cover growth, cost pressures and new activity. • Organisational implications of remaining within statutory duties. • Trust remains within the NHSE Recovery Support Programme, until the system collectively achieves a run-rate break-even position. 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. • 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. Summary: Trust Board is asked to: Conclusion / • Note the finance position. recommendation Page 4 of 6 Appendix 1 Transforming Public Procurement The Procurement Act 2023 – a short guide for senior leaders The rules governing public procurement are changing - the new Procurement Act will improve the way procurement is done, so that every pound goes further for our public services. This transformation of public procurement represents a big change for all public bodies, which between them spend £300bn per year. It will create simpler, more flexible and effective procurement. The Procurement Act brings a range of benefits, including: • creating a simpler and more flexible commercial system that better meets our country’s needs while remaining compliant with our international obligations • opening up public procurement to new entrants such as small businesses and social enterprises so that they can compete for and win more public contracts. Further details at gov.uk/ government/publications/benefitsfor-prospective-suppliers-to-thepublic-sector • taking tougher action on underperforming suppliers and excluding suppliers who pose unacceptable risks • embedding transparency throughout the commercial lifecycle so that the spending of taxpayers’ money can be properly scrutinised We expect the new regime will go live in October 2024, following a notice period of at least 6 months. Page 5 of 6 The Cabinet Office will be rolling out a comprehensive programme of learning and development for procurement and commercial teams and other staff whose work touches on procurement need to be aware of the changes - including contract managers, finance teams, service commissioners, legal advisers and reporting teams. In order to take full advantage of the new regime, organisations should treat this as an organisational change programme. We have asked procurement and commercial teams to: • think about future pipelines of work and which procurements in 12 months+ would benefit from new flexibilities • review commercial strategies including planning, governance, assurance and resources to enable the implementation of the new regime • consider who will attend funded training and work with us on operational rollout • share the aims of reform widely with senior stakeholders and change makers • help us communicate the changes with suppliers and encourage the market to come with us There is a great opportunity to make procurement processes better to deliver outcomes for taxpayer - this needs support from budget holders and policy designers. Senior leaders can support the process by encouraging: • a named individual in their organisation to take responsibility for co-ordinating and championing the change, including within their wider organisational family where appropriate • early engagement by policy with commercial teams - this is key to delivering innovation and getting the most from the market • use of the new flexibilities in procurement and champion this change across government and wider public sector in order for this reform to be effective, we need to drive behavioural change • commercial teams to take time for the learning and development when available The Procurement Act has the potential to make a huge difference, and your engagement is essential to the outcomes we all want to see. Make sure your organisation is ready to grasp the opportunity. The Transforming Public Procurement landing page provides further information about the new regime and the L&D, guidance and support that Cabinet Office is providing. We will continue to add material here, and share resources with our network of interested parties, as we move towards go-live. See gov.uk/government/collections/ transforming-public-procurement 2024 GUIDANCE Page 6 of 6 SUPPORT Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author Date: Purpose Issue to be addressed: Performance KPI Report 2024-25 Month 5 N/A – No meeting David French, Chief Executive Officer Sam Dale, Associate Director of Data and Analytics 27 September 2024 Assurance or reassurance Y Approval Ratification Information Y 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: (Clinical, Organisational, Governance, Legal?) Risks: (Top 3) of carrying out the change / or not: Summary: Conclusion and/or recommendation This report covers a broad range of trust performance metrics. It is intended to assist the Board in assuring that the Trust meets regulatory requirements and corporate objectives. This report is provided for the purpose of assurance. Trust Board is requested to note the report. Page 1 of 17 Report to Trust Board in September 2024 Performance KPI Report Performance KPI Board Report Covering up to August 2024 Sponsor – David French, Chief Executive Officer Author – Sam Dale, Associate Director of Data and Analytics Page 2 of 17 Report to Trust Board in September 2024 Report guide Chart type Example Cumulative Column Cumulative Column Year on Year Line Benchmarked Line & bar Benchmarked Control Chart Variance from Target Performance KPI Report 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 17 Report to Trust Board in September 2024 Performance KPI Report Introduction The Performance KPI Report is prepared for the Trust Board members 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: • 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. • As there is no board meeting taking place for the Month 5 report, the regular ‘Spotlight’ section of this performance paper is not included for discussion. Page 4 of 17 Report to Trust Board in September 2024 Performance KPI Report Summary Areas of note in the appendix of performance metrics include: 1. The Emergency Department performance for Type 1 attendances reduced from 70.6% in July 2024 to 67.4% in August 2024. The trust ranks in 6th place for Type 1 performance when compared to peer teaching hospitals. 2. The overall RTT waiting list decreased by 1.3% from 60,461 (July 2024) to 59,649 (August 2024). This is the second month in a row that the waiting list has reduced since the peak level of 60,578 reported for June 2024. 3. The trust continues to report zero patients waiting over 104 weeks and reported nine patients waiting over 78 weeks for August 2024. We expect this number to continue to reduce to zero as corneal tissue has now been issued by the NHS Blood and Transfusion service to ensure our longest waiting ophthalmology patients are treated. 4. The trust reported 43 patients waiting over 65 weeks for August 2024 which reflects a continuous month on month reduction as we work towards the national target to have zero patients waiting over 65 weeks. Again the majority relate to corneal transplant delays. The trust ranks in first place for the latest comparative information for this metric compared to twenty equivalent teaching hospitals across the UK. 5. There was a small decline in Cancer performance for 28 day faster diagnosis (80.8%) but a significant improvement in the 31 day standard (93.4%). The Trust ranks in the second quartile when compared to peer teaching hospitals for all key cancer metrics for the latest available month (July 2024). 6. The average number of patients per day not meeting the Criteria to Reside in hospital reduced in both July (216) and August (201). 7. There were zero never events and zero Patient Safety Incident Investigations reported for August 2024. 8. The trust is reporting an increase in category 2 and category 3 pressure ulcers for August 2024. There is increased focus on educating staff on the importance of skin inspections throughout admission alongside the appropriate steps for patient repositioning throughout their spell. An update to the body map location on our Inpatient Noting system will also support that process and recording. 9. The hospital is reporting an increase in the digital metric for the number of patient logins for My Medical Record. This reflects the upload of past and future appointments for oncology patients into the system and appropriate notification to this cohort of patients. Ambulance response time performance The latest unvalidated weekly data is provided by the South Central Ambulance Service (SCAS). In the week commencing 16th September 2024, our average handover time was 16 minutes 29 seconds across 739 emergency handovers and 24 minutes 31 seconds across 45 urgent handovers. There were 47 handovers over 30 minutes and 15 handovers taking over 60 minutes within the unvalidated data. Across August the average handover time was 14 minutes 37 seconds. Page 5 of 17 Report to Trust Board in June 2024 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 6 of 17 Report to Trust Board in September 2024 NHS Constitution Monthly Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug target YTD 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT Teaching hospital average (& rank of 20) 62.8% 63.2% 4 54 4 4 4 4 4 4 4 4 4 44 ≥92% South East average (& rank of 17) 5 50% 6 6 6 5 4 4 4 4 4 4 4 4 3 63.7% Cancer waiting times 62 day standard - 100% Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) 67.0% 13 10 15 6 9 7 6 4 3 7 4 9 7 74.5% UHSFT 6 Teaching hospital average (& rank of 19) South East average (& rank of 17) 40% 7 3 6 1 2 3 2 2 1 3 5 3 5 6 ≥70% 39 - As of April 2024, YTD and Monthly targets changed from 85% to 70% in line with latest operational guidance 100% 63.66% Patients spending less than 4hrs in ED - (Type 1) 28 UHSFT 9 8 8 12 10 11 8 4 4 4 9 6 8 67.44% 6 10 ≥95% Teaching hospital average (& rank of 16) South East average (& rank of 16) 5 5 5 7 7 7 5 2 3 2 5 2 4 5 6 25% 40% % of Patients waiting over 6 weeks for diagnostics 37 UHSFT Teaching Hospital average (& rank of 20) 20.1% 11 10 10 8 8 7 9 7 7 7 7 6 7 7 7 5 5 5 4 5 5 5 5 5 6 4 5 5 12.8% ≤5% South East Average (& rank of 18) 0% 37 - As of April 2024, YTD and Monthly Target changed from 1% to 5% to reflect latest guidance 73.7% 68.1% 11.1% Page 7 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Outcomes 1 HSMR (Rolling 12 Month Figure) - UHS HSMR (Rolling 12 Month Figure) - SGH 2 HSMR - Crude Mortality Rate Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 86.72 91.18 89.58 75 3.1% 84.98 2.8% 2.5% 15% 2.6% 3 Percentage non-elective readmissions within 28 days of discharge from hospital 11.8% 12.2% 10% Monthly target ≤100 <3% - Cumulative Specialties with 4 Outcome Measures Developed (Quarterly) Q2 23-24 80 72 70 Q3 23-24 73 Q4 23-24 75 Q1 24-25 76 Q2 24-25 76 Quarterly target +1 Specialty per quarter YTD 86% 2.2% 11.9% Developed Outcomes 100% 37 41 41 36 39 RAG ratings (Quarterly) 75 67 62 77 75 5 Red 75% x Amber 333 335 334 342 327 Green 50% 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 Appendix YTD target ≤100 <3% Page 8 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Safety Cumulative Clostridium difficile 6 Most recent 12 Months vs. Previous 12 Months 5 7 MRSA bacteraemia 0 80 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 90 60 35 66 47 72 55 81 65 7391 7797 84105 4 12 1219 2729 3538 4951 0 00000012120110000 Monthly target ≤5 0 8 Gram negative bacteraemia 0 19 28 16 21 15 28 20 18 22 19 16 31 25 25 29 19 1 Pressure ulcers category 2 per 1000 bed 9 days 0.44 0.53 0 1 Pressure ulcers category 3 and above 10 0.30 per 1000 bed days 0 10 0.38 0.21 11 Medication Errors (severe/moderate) 3 0 3,500 Watch & Reserve antibiotics, usage per 12 1,000 adms Most recent months vs. 2023/24 1,500 12 - Beginning June 2024, target and comparison changed in accordance with National Action Plan. 2 2,567 2,789 ≤19 <0.3 <0.3 ≤3 <2665 YTD 51 1 129 0.39 0.29 11 2,545 Appendix YTD target ≤25 0 ≤87 <0.3 <0.3 15 <2662 Page 9 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Appendix Safety Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Patient Safety Incident Investigations (PSIIs) 13 (based upon month reported, excluding 2 0 Maternity) 0 5 13a Never Events 0 0 5 Patient Safety Incident Investigations 14 (PSIIs)- Maternity 0 0 0.2 0.18 15 Number of falls investigated per 1000 0.10 bed days 0.0 100% % patients with a nutrition plan in place 96.7% 96.2% 16 (total checks conducted included at chart base) 788 806 798 772 770 894 879 956 930 949 889 968 976 883 868 80% 100 17 Red Flag staffing incidents 10 26 0 Maternity Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Monthly target - 0 - - ≥90% - Monthly target 480 400 501 390 517 379 633 415 448 411 409 428 429 401 483 406 392 428 469 409 446 467 442 400 424 400 382 417 450 418 Birth rate and Bookings 600 18 Birth Rate - total number of women birthed Bookings - Total number of women booked - 300 10 8 8 6 6 19 Staffing: Birth rate plus reporting / opel status - number of days (or shifts) at Opel 4. 4 3 3 4 4 1 1 0 3 0 2 - 0 100% 43.0% 44.3% 44.4% 44.8% 35.9% 53.0% 39.0% 46.5% 43.8% 46.0% 40.9% 46.7% 38.9% 50.6% 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% Mode of delivery 20 % number of normal birthed (women) 50% % number of caesarean sections (women) - % other 0% YTD 4 2 0 0.11 95% 91 YTD - - - YTD target 0 - ≥90% - YTD target - - - Page 10 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Patient Experience 21 FFT Negative Score - Inpatients 22 FFT Negative Score - Maternity (postnatal ward) 23 Total UHS women booked onto a continuity of carer pathway Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 3% 1.0% 0.5% 0% 10% 2.7% 1.9% 0% 30% 15.6% 16.3% 0% Monthly target ≤5% ≤5% ≥35% 80% 24 Total BAME women booked onto a continuity of carer pathway 48.2% 19.3% 5% 100% % Patients reporting being involved in 25 decisions about care and treatment 86.0% 87.8% 80% 100% % Patients with a disability/reporting 94.0% 88.5% 26 additional needs/adjustments met (total questioned at chart base) 301 287 249 214 234 336 208 272 304 268 339 340 280 258 317 70% 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 73 27 marked as non-clinical (excludes moves 45 from admitting wards with LOS<12hrs) 0 ≥51% ≥90% ≥90% - YTD 0.7% 2.5% 13.6% 20.9% 87.8% 88.2% 281 Appendix YTD target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - Page 11 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Access Standards Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 100% 63.66% Patients spending less than 4hrs in ED - 67.44% (Type 1) 9 8 8 12 10 11 8 4 4 4 9 6 8 6 10 28 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 16) 5 5 5 7 7 7 5 2 3 2 5 2 4 5 6 25% 06:00 Average (Mean) time in Dept - non29 admitted patients 03:17 03:08 01:00 08:00 05:30 Average (Mean) time in Dept - admitted 30 05:11 patients 01:00 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT Teaching hospital average (& rank of 20) 62.8% 63.2% 4 54 4 4 4 4 4 4 4 4 4 44 South East average (& rank of 17) 5 50% 6 6 6 5 4 4 4 4 4 4 4 4 3 Monthly target ≥95% ≤04:00 ≤04:00 ≥92% Total number of patients on a 32 waiting list (18 week referral to treatment 60,000 pathway) 40,000 59,277 59,649 - Patients on an open 18 week pathway (waiting 52 weeks+ ) 8,000 4 3 3 3 2 2 2 2 3 3 4 3 2 2 33 UHSFT 1,934 1,206 ≤1393 Teaching hospital average (& rank of 20) 9 8 8 8 8 8 9 10 9 10 10 10 9 9 South East average (& rank of 17) 0 YTD 68.1% 03:12 05:27 63.7% 59,649 1206 Appendix YTD target ≥95% ≤04:00 ≤04:00 ≥92% - ≤1393 Page 12 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Monthly Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug target 2,000 4 4 5 5 3 Patients on an open 18 week pathway 3 3 3 3 (waiting 65 weeks+ ) 3 3 2 2 1 34 UHSFT 456 0 Teaching hospital average (& rank of 20) South East average (& rank of 17) 10 9 0 9 9 8 8 8 6 7 8 6 5 4 4 43 700 Patients on an open 18 week pathway (waiting 78 weeks+ ) 35 UHSFT Teaching hospital average (& rank of 20) 8 8 33 7 6 5 6 5 5 5 10 10 10 11 9 9 0 South East average (& rank of 17) 0 9 9 9 9 8 8 12 11 10 10 10 10 11 7 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) 14 17 15 16 12 13 13 1 1 1 1 1 1 1 0 0 13 17 13 14 10 11 9 1 1 1 1 1 1 1 11,500 36 Patients waiting for diagnostics 8,924 - 8,352 7,500 37 % of Patients waiting over 6 weeks for diagnostics 40% 22.8% 10 11 10 8 UHSFT Teaching hospital average (& rank of 20) 8 7 9 7 7 7 7 7 7 5 4 5 5 7 5 6 5 5 5 4 5 5 6 5 12.8% South East average (& rank of 18) 0% ≤5% 37 - As of April 2024, YTD and Monthly Target changed from 1% to 5% to reflect latest guidance YTD 43 9 8,352 11.1% Appendix YTD target 0 0 0 - ≤5% Page 13 of 17 Report to Trust Board in September 2024 Outstanding Patient Outcomes,Safety and Experience Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 100% Cancer waiting times 62 day standard - Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) 67.0% 13 10 15 6 9 7 6 4 3 7 4 9 74.5% 7 6 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 17) 7 3 6 1 2 3 2 2 1 3 3 5 5 6 40% 39 - 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 Upgrade routes. As of April 2024, YTD and Monthly targets changed to 70% in line with latest operational guidance 100% Cancer 28 day faster diagnosis Percentage of patients treated within 40 standard UHSFT Teaching hospital average (& rank of 20) 80.9% 7 6 1 2 3 3 1 2 2 2 2 80.8% 2 2 5 3 1 1 1 1 1 1 1 1 1 5 6 South East average (& rank of 17) 50% Monthly target ≥70% ≥77% 40 - As of April 2024, YTD and monthly targets changed from 75% to 77% in line with latest operational guidance 31 day cancer wait performance - 100% 93.9% 93.4% decision to treat to first definitive treatment (Most recently externally reported data, 15 13 13 11 15 13 14 11 10 11 15 14 11 11 41 unless stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 11 5 8 9 6 14 9 8 10 6 8 7 13 13 South East average (& rank of 17) 78% ≥96% 41 From October 2023 data onwards, the 31 day standard metric published in NHS england data combines First Treatment and Subsequent Treatment routes. YTD 73.7% 83.7% 90.2% Appendix YTD target ≥70% ≥77% ≥96% Page 14 of 17 Report to Trust Board in September 2024 Pioneering Research and Innovation R&D Performance 43 Comparative CRN Recruitment Performance - non-weighted Monthly Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug target YTD 25 19 19 21 17 17 16 15 15 15 15 9 9 9 Top 10 - 7 6 44 Comparative CRN Recruitment Performance - weighted 0 15 12 14 15 12 11 12 11 11 8 9 10 10 6 Top 5 - 9 11 0 150% 45 Study set up times - 80% target for 100% issuing Capacity & Capability within 40 59% 64% 46% 60% 67% 46% 88% 55% 50% 64% 50% 55% 100% 47% 44% - - 50% Days of Site Selection 0% 200% 157.6% Achievement compared to R+D 150% 104.1% 133.3% 133.3% 119.5% 90.2% 46 Income Baseline Monthly income increase % 100% 84.7% 50% 9.2% 45.8% 84.7% 65.2% 75.0% 26.8% 70.7% 18.0% 51.2% ≥5% - YTD income increase % 0% Appendix YTD target - - - - Page 15 of 17 Report to Trust Board in September 2024 Integrated Networks and Collaboration Appendix Local Integration Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Monthly target 250 194 Number of inpatients that were 47 medically optimised for discharge (monthly average) 0 201 ≤80 Emergency Department 48 activity - type 1 This year vs. last year 13000 11000 11,379 10,710 11,236 - 11,089 9000 Percentage of virtual appointments as a 49 proportion of all outpatient consultations This year vs. last year 40% 27.3% 29.4% 20% 29.4% ≥25% 24.9% YTD 214 58,989 25.9% YTD target - - ≥25% Page 16 of 17 Report to Trust Board in September 2024 Foundations for the Future Appendix Digital Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Monthly target My Medical Record - UHS patient 200,000 50 accounts (cumulative number of accounts in place at the end of each month) 100,000 170,987 213,476 - 50000 My Medical Record - UHS patient 40000 51 logins (number of logins made within 30000 each month) 20000 31,905 40,858 - 51 - The YTD Figure shown represents a rolling average of MMR logins per month within the current financial year 3200 Average age of IT estate 52 Distribution of computers per age in years 3000 2000 1000 0 0 2580 725 945 1150 0 23 32 68 118 289 1940 1510 - 14 13 12 11 10 9 8 7 6 5 4 3 2 1 YTD 209,848 36,203 - YTD target - - - 99.75% 99.72% 99.73% 99.81% 99.77% 99.82% 99.74% 99.79% 99.80% 99.79% 99.77% 99.78% 98.67% 98.64% 98.70% CHARTS system average load times - % 100% 53 of pages loaded under 3s 95% 53 -Data only available from April 2023 onwards. From April 2024 , metric was changed from % loading times under 5s to % loading times under 3s Page 17 of 17
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2024-Trust-documents/Finance-and-Performance-Reports-2024-25-Month-5-August-2024.pdf

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 N/A – No meeting Ian Howard – Chief Financial Officer Philip Bunting – Director of Operational Finance David O’Sullivan – Assistant Director of Finance – Financial Performance 28 June 2024 Assurance or reassurance Approval Ratification Information X Issue to be addressed: The finance report provides a monthly summary of the key financial information for the Trust. Response to the issue: Financial Plan UHS submitted a final 2024/25 operational plan to NHSE on 12th June. Within the delegated authority approved at Trust Board, UHS submitted an improved financial plan of a £14.5m deficit. In year, UHS is anticipating receiving an additional £11.2m of cash support. To achieve the financial plan, a number of stretching assumptions need to deliver as expected, notably: • There will be no industrial action in 2024/25 (this is at risk in June). • System transformation programmes will deliver reduced levels of patients who no longer meet the criteria to reside, from 220 beds to 100 beds, delivering an £8.4m reduction in cost. This is phased from Q2. • System transformation programmes will deliver reduced levels of patients with a primary mental health need who would be better cared for in an alternative setting, reducing agency and bank costs by £1.9m. This is phased from Q2. • System transformation programmes will identify and deliver at least £3.4m of opportunities for collaboration within corporate services. • UHS internal transformation programmes will deliver significant stretch targets within outpatients, optimising operating services and inpatient flow. • Activity delivered within the Elective Recovery Fund (ERF) will increase from 118% in 23/24 to 136% in 24/25, which will be paid and result in additional income to the Trust. • Overall, UHS will deliver £85m of CIP, circa 8% of addressable spend. This includes identification of £20m that remained unidentified at the time of the planning submission, as well as 6% reductions in non-pay expenditure. • All pay awards are fully funded and inflation remains within funded levels. We have written to HIOW ICB to outline the risks outlined above as part of our planning submission. We have adapted our financial reporting to focus on the key delivery metrics that support the financial improvements required. Page 1 of 4 Key Operational Measures Non-Criteria to Reside – remains at circa 220. Impact of transformation targeted from Q2, but no sign of improvement currently, noting we remain above May 23 levels (200) and levels have not fully reduced following a spike over winter. Mental Health – our usage of temporary staffing to support patients with mental health needs has remained broadly static so far in 24/25. Our plan assumed benefits would be delivered from M6. 120 wte (for which 55 wte are agency) are being utilised to provide specialist care for these patients. Outpatients – We are continuing our trend of increasing our new/procedure to follow-up ratio; however, we have further to go to achieve our stretch target. Optimising Operating Services – theatre utilisation metrics are moving in the right direction, with utilisation increasing and on the day cancellations reducing. However, we have further to go to achieve our stretch targets. Inpatient Flow – LOS has been marginally below 23/24 levels, with more promising signs in the last 2 weeks achieving the 5% target. ERF – YTD our ERF position is 123%. Whilst this is above the 118% achieved in 23/24, our target has also increased by 4% due to the expectation of no industrial action in 24/25. The increase is therefore lower than our plan required. Underlying Financial Position The Trust underlying financial position was £13.4m in 2 months, on average circa £6.5m deficit per month. In 23/24, UHS operated at an average of £4.5m per month underlying deficit. Since 24/25, UHS income has reduced by an efficiency target and a “convergence” target, as well as repaying a prior year deficit. This has effectively resulted in a real-terms income reduction of £1.5m per month. The plan to deliver additional efficiencies to off-set the reduction in funding has not yet materialised into the overall I&E position. ERF activity has increased; however, the target has also increased linked to industrial action. Non-pay costs have increased as a result of the increased ERF activity. However, we remain below plan on pay costs as a result of the additional controls we implemented at the end of 23/24. This is particularly driven by reductions in the usage of bank staff. Surge capacity has reduced / remained closed in the last month as part of our inpatient LOS programme. The benefit has been reduced by funding for the 23/24 consultant pay award not matching our full costs, with the funding formula not reflecting UHS’ specialist nature and higher consultant cost base. M2 Financial Position Overall, the Trust delivered a YTD deficit position of £8.4m, £2m worse than plan. The underlying position has been offset by a number of one-off benefits, including an additional recovery of VAT from prior years. Page 2 of 4 Scenarios Within the plan submitted to Trust Board, we assessed the level of risk within the plan and highlighted a number of scenarios. These had a wide range of outcomes depending on the success of the system transformation programmes and internal stretch initiatives. • Best case – achieve plan • Moderate case - £44m deficit • Intermediate case - £66m deficit • High risk - £89m deficit Over the last 2 months we have tracked towards the intermediate risk scenario, albeit our plan assumed additional benefits being delivered as we move through the financial year. It is vital we start to see improvements to our financial position and the performance metrics over the next couple of months if we are to maintain a chance of delivering to our plan position. We have not yet fully agreed contract values with any commissioner and flag a risk that we may not be paid in line with our expectations aligned to the NHS planning guidance. There is a risk contracts remain unsigned by the national deadline of 5th July. Drivers of the Deficit The drivers of our underlying deficit have built up across a number of years, notably: • We are undertaking activity above block levels for HIOW ICB. With the real terms income reduction applied to our contracts in 24/25, this has grown to £33m and may grow further during 24/25. • In recent years, UHS has had £20m of funding reductions above standard NHS efficiency requires linked to “convergence to fair shares” of funding allocations. The activity levels undertaken by UHS has increased at the same time, with the majority of our funding being within fixed block values. • Growth in the number of patients with no criteria to reside (NCTR), resulting in additional costs of staffing bed capacity. • Growth in the number of patients presenting with a mental health condition, requiring additional temporary staffing, often requiring agency staff with specialist expertise. • Funding for nationally negotiated pay awards continues to fall short of our cost increases. • Non-pay inflation has outstripped funding levels in previous years. UHS was particularly exposed to gas price increases linked to our energy infrastructure. • Our physical estate causes some inefficiencies, for example downtime of theatres. • Whilst we have made progress with our digital infrastructure, we have lacked the funding to fully invest in digital transformation. We continue to benchmark as upper quartile within Model Hospital for our cost base compared to activity levels and scored a 91 in the last National Cost Collection exercise (operating 9% more efficiently that the national average). We are however striving for improvements where we know there are further opportunities that are within our control, which is where our focus is with our transformation programmes. Cash Our cash position has reduced to £49m, down from £79m since March. This reduction is broadly aligned to our plan and is driven by capital creditor payments from 23/24 as well as our underlying financial deficit. An additional £11.2m of cash support is anticipated from July, which will support our position. Page 3 of 4 There is a risk that further NHSE cash support will be required later in the financial year should our underlying financial position not improve as per our plan. We continue to be vigilant with our cash position and will keep Board updated. Capital Our capital programme remains broadly on track to date. However, the Building Safety Regulator (BSR) process is currently delaying our start dates, in particular putting the Neonatal programme at risk. The BSR recently requested a further 2-week extension. UHS has recently been awarded additional capital funding, which will be updated verbally. Given the timescales of the programme and potential BSR delays, we are therefore in a period of reprogramming to ensure we maximise our CDEL in 24/25. Implications: • Financial implications of availability of funding to cover growth, cost pressures and new activity. • Organisational implications of remaining within statutory duties. • Trust remains within the NHSE Recovery Support Programme, until the system collectively achieves a run-rate break-even position. 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. • 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. Summary: Trust Board is asked to: Conclusion • Note the finance position. and/or recommendation Page 4 of 4 Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author Date: Purpose Issue to be addressed: Performance KPI Report 2024-25 Month 2 N/A – No meeting David French, Chief Executive Sam Dale, Associate Director of Data and Analytics 28 June 2024 Assurance or reassurance Y Approval Ratification Information 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: (Clinical, Organisational, Governance, Legal?) Risks: (Top 3) of carrying out the change / or not: Summary: Conclusion and/or recommendation This report covers a broad range of trust performance metrics. It is intended to assist the Board in assuring that the Trust meets regulatory requirements and corporate objectives. This report is provided for the purpose of assurance. Trust Board is asked to note the report. Page 1 of 17 Report to Trust Board in June 2024 Performance KPI Report Performance KPI Board Report Covering up to May 2024 Sponsor – David French, Chief Executive Officer Author – Sam Dale, Associate Director of Data and Analytics Page 2 of 17 Report to Trust Board in June 2024 Report guide Chart type Example Cumulative Column Cumulative Column Year on Year Line Benchmarked Line & bar Benchmarked Control Chart Variance from Target Performance KPI Report 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 17 Report to Trust Board in June 2024 Performance KPI Report Introduction The Performance KPI Report is prepared for 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: • 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. • As there is no board meeting taking place in June, the regular ‘Spotlight’ section of this performance paper is not included for discussion. Changes of note within the report itself: - • 38 – The metric measuring two week wait performance for Cancer has been removed as this is no longer a nationally reported cancer metric with an associated target or published benchmarking. • 54 - The metrics reporting volume of Cyber security attacks have been removed from public publications in line with recommended processes. These will be presented within internal papers as appropriate. Page 4 of 17 Report to Trust Board in June 2024 Performance KPI Report Summary Areas of note in the appendix of performance metrics include: 1. Emergency Department attendance volumes (13,862 for all types in May) were the highest monthly volume since December 2022. Nevertheless ED performance for all attendance types was 71.3% and 69.1% for Type 1 which are the second highest positions since January 2022 on both metrics. 2. In May, the overall RTT waiting list increased by 0.6% from 59,485 (April 2024) to 59,812 (May 2024). We have seen a 3.6% increase seen since January 2024 which is predominantly driven by an increase in referrals particularly within specialties impacted by seasonal conditions. 3. The trust continues to report zero patients waiting over 104 weeks and reported 14 patients waiting over 78 weeks for May 2024. All 14 patients are within ophthalmology and impacted by the ongoing national shortage of corneal graft tissue which is being overseen by NHS Blood and Transplant service. 4. The trust reported 55 patients waiting over 65 weeks for May 2024 which is a 17% reduction since April 2024 (66 patients). Again the majority relate to corneal transplant delays (39 patients), a small cohort of complex patients waiting for surgery in Gynaecology and one off complex patients across single specialties who have now been treated in June. 5. Whilst there was a small decline in Cancer performance for both 28 day faster diagnosis (85.7%) and 31 day waits (90.8%), the Trust remains in the top half when compared to peer teaching hospitals for all cancer metrics and specifically ranked first for 28 day faster diagnosis. 6. The average number of patients per day not meeting the Criteria to Reside in hospital remained high but stable at 216 in May (215 in April). 7. There were zero never events reported for May 2024. 8. The trust reported an increase in medication errors (six in May 2024) although all reported cases have been categorised as moderate. 9. A maternity action plan was implemented during May to increase the service’s ability to provide antenatal screening by the recommended gestation and to offer women an antenatal booking appointment by 10 weeks of pregnancy. The successful implementation is illustrated in the increase in the number of women booked in May 2024. Ambulance response time performance The latest unvalidated weekly data is provided by the South Central Ambulance Service (SCAS). In the week commencing 3rd June 2024, our average handover time was 15 minutes 15 seconds across 751 emergency handovers and 16 minutes 24 seconds across 43 urgent handovers. There were 30 handovers over 30 minutes and four handovers taking over 60 minutes within the unvalidated data. The volume of weekly handovers over 60 minutes decreased by 60% from April 2024 (averaging 13 per week) to May 2024 (averaging 5.3 per week). Page 5 of 17 Report to Trust Board in June 2024 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 6 of 17 Report to Trust Board in June 2024 NHS Constitution Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT 65.2% 63.9% 4 44 4 5 4 4 4 4 4 4 4 4 4 ≥92% Teaching hospital average (& rank of 20) South East average (& rank of 17) 6 50% 6 5 5 6 6 6 5 4 4 4 4 4 4 63.3% Cancer waiting times 62 day standard - 100% Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) 64.0% 18 10 15 9 14 13 6 11 7 6 4 3 9 76.5% UHSFT 4 Teaching hospital average (& rank of 19) South East average (& rank of 17) 14 5 40% 9 7 3 6 1 2 3 2 2 4 1 3 ≥70% 39 - As of April 2024, YTD and Monthly targets changed from 85% to 70% in line with latest operational guidance 100% Patients spending less than 4hrs in ED - 69.2% (Type 1) 28 UHSFT 61.7% 4 9 12 9 8 8 12 10 11 8 4 4 4 9 6 ≥95% Teaching hospital average (& rank of 16) South East average (& rank of 16) 3 5 7 5 5 5 7 7 7 5 2 3 2 5 2 25% 40% 22.6% % of Patients waiting over 6 weeks for diagnostics 12 11 11 11 10 10 8 7 6 7 5 5 4 5 37 UHSFT Teaching Hospital average (& rank of 20) 8 7 7 8 7 9 7 7 7 7 7 5 5 5 10.0% ≤5% South East Average (& rank of 18) 0% 37 - As of April 2024, YTD and Monthly Target changed from 1% to 5% to reflect latest guidance 76.5% 67.6% 10.2% Page 7 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Outcomes 1 HSMR (Rolling 12 Month Figure) - UHS HSMR (Rolling 12 Month Figure) - SGH 2 HSMR - Crude Mortality Rate Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 86.93 91.45 89.84 75 3.1% 84.94 2.8% 2.7% Monthly target ≤100 <3% 2.5% 15% 13.4% 3 Percentage non-elective readmissions within 28 days of discharge from hospital 10% 12.4% - Cumulative Specialties with 4 Outcome Measures Developed (Quarterly) Q1 23-24 80 75 72 70 Q2 23-24 72 Q3 23-24 73 Q4 23-24 75 Q1 24-25 75 Quarterly target +1 Specialty per quarter Developed Outcomes RAG ratings (Quarterly) 5 Red Amber Green 100% 34 37 41 42 37 82 75 67 65 80 75% 340 333 337 338 343 50% YTD 91.5 2.7% 12.4% 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 8 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Safety Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD Cumulative Clostridium difficile 6 Most recent 12 Months vs. Previous 12 Months 90 1827 2435 49 28 60 35 66 47 72 55 81 65 7391 7797 84105 4 12 19 12 ≤5 19 0 5 7 MRSA bacteraemia 0 1 00 0 0 0 1 0 0 1 2 1 2 0 1 1 0 80 YTD target ≤10 0 8 Gram negative bacteraemia ≤18 56 ≤36 0 32 14 19 27 16 21 15 25 18 17 20 19 15 31 25 1 Pressure ulcers category 2 per 1000 bed 0.48 9 days 0 0.37 <0.3 0.43 <0.3 1 0.60 Pressure ulcers category 3 and above 10 per 1000 bed days 0 10 11 Medication Errors (severe/moderate) 3 0.59 0.23 <0.3 0.27 <0.3 6 ≤3 8 6 0 Watch & Reserve antibiotics, usage per 12 1,000 adms Most recent months vs. 2018*95.5% 3,500 1,500 2,877 2,692 2,569 2,662 2,569 5,420 5,335 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 9 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Monthly Safety Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD Patient Safety Incident Investigations 40 13 (PSIIs) (based upon month reported, excluding 7 - 4 2 Maternity) 0 5 13a Never Events 0 0 0 0 5 Patient Safety Incident Investigations 14 (PSIIs)- Maternity 0 - 0 0 0.2 15 Number of falls investigated per 1000 bed days 0.05 0.0 0.09 - 0.11 100% % patients with a nutrition plan in place 96.8% 94.1% 16 (total checks conducted included at ≥90% 95% chart base) 1600 844 871 788 806 798 772 770 894 879 956 930 949 889 968 80% 100 17 Red Flag staffing incidents 19 7 - 18 Maternity 0 Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD 633 415 448 411 409 428 429 401 483 406 392 428 469 409 446 467 442 400 424 400 382 417 450 418 477 402 449 416 513 387 Birth rate and Bookings 600 18 Birth Rate - total number of women birthed Bookings - Total number of women booked - - 300 10 6 6 19 Staffing: Birth rate plus reporting / opel status - number of days (or shifts) at Opel 4. 4 2 1 1 3 3 4 4 1 1 0 3 - 0 - 0 100% 39.0% 46.5% 43.8% 46.0% 40.9% 46.7% 38.9% 50.6% 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% Mode of delivery 20 % number of normal birthed (women) 50% % number of caesarean sections (women) % other - - 0% YTD target 0 - ≥90% - YTD target - - - Appendix Page 10 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Patient Experience Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 3% Monthly target 21 FFT Negative Score - Inpatients 0% 10% 22 FFT Negative Score - Maternity (postnatal ward) 0% 30% 23 Total UHS women booked onto a continuity of carer pathway 0% 0.2% 2.4% 13.5% 0.7% ≤5% 3.7% ≤5% 12.5% ≥35% 80% 24 Total BAME women booked onto a continuity of carer pathway 27.9% 22.3% 5% 100% % Patients reporting being involved in 25 decisions about care and treatment 87.0% 87.5% 80% % Patients with a disability/ additional 100% needs reporting those 90.0% 88.2% 26 needs/adjustments were met (total number questioned included at chart base) 209 209 300 301 287 249 214 234 336 208 272 304 268 339 322 70% 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 76 27 marked as non-clinical (excludes moves 61 from admitting wards with LOS<12hrs) 0 ≥51% ≥90% ≥90% - YTD 0.5% 2.0% 12.3% 21.9% 88.5% 82.8% 115 YTD target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - Appendix Page 11 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Access Standards Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Monthly target Patients spending less than 4hrs in ED - (Type 1) 28 UHSFT 61.7% 69.2% 4 9 12 9 8 8 12 10 11 8 4 4 4 9 6 ≥95% Teaching hospital average (& rank of 20) South East average (& rank of 16) 3 40% 5 7 5 5 5 7 7 7 5 2 3 2 5 2 06:00 Average (Mean) time in Dept - non- 29 admitted patients 03:21 01:00 03:16 ≤04:00 08:00 05:58 30 Average (Mean) time in Dept - admitted patients 05:30 ≤04:00 01:00 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT Teaching hospital average (& rank of 20) 65.2% 63.9% 4 44 4 5 4 4 4 4 4 4 4 4 4 ≥92% South East average (& rank of 17) 6 50% 6 5 5 6 6 6 5 4 4 4 4 4 4 60,000 Total number of patients on a waiting list 57,878 59,812 32 (18 week referral to treatment pathway) - 40,000 Patients on an open 18 week pathway (waiting 52 weeks+ ) 8,000 4 4 4 4 3 3 3 2 2 2 2 3 3 4 33 UHSFT 2,191 1,743 ≤1393 Teaching hospital average (& rank of 20) South East average (& rank of 17) 0 11 11 11 9 8 8 8 8 8 9 10 9 10 10 YTD 67.6% 03:17 05:44 63.3% 59,812 1,743 YTD target ≥95% ≤04:00 ≤04:00 ≥92% - ≤1393 Appendix Page 12 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 4,000 Monthly target Patients on an open 18 week pathway (waiting 65 weeks+ ) 34 UHSFT Teaching hospital average (& rank of 20) 5 4 4 4 4 5 5 3 3 3 3 3 480 3 3 0 55 South East average (& rank of 17) 0 12 11 11 10 9 9 9 8 8 8 6 7 8 6 700 Patients on an open 18 week pathway (waiting 78 weeks+ ) 35 UHSFT Teaching hospital average (& rank of 20) 4 4 5 21 8 8 7 6 5 6 5 5 5 10 10 14 0 South East average (& rank of 17) 0 12 10 11 12 11 10 9 99 9 8 8 10 10 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 1 8 14 17 15 16 12 13 13 1 1 1 1 0 0 11 13 13 17 13 14 10 11 9 1 1 1 1 11,500 10,033 36 Patients waiting for diagnostics 8,883 - 7,500 40% % of Patients waiting over 6 weeks for diagnostics 37 UHSFT Teaching hospital average (& rank of 20) 21.4% 12 11 8 7 11 11 10 10 8 76 7 5 5 7 8 7 97 7 7 7 7 5 4 5 5 5 10.0% ≤5% South East average (& rank of 18) 0% 37 - As of April 2024, YTD and Monthly Target changed from 1% to 5% to reflect latest guidance YTD 55 14 8,883 10.2% YTD target 0 0 0 ≤5% Appendix Page 13 of 17 Report to Trust Board in June 2024 Outstanding Patient Outcomes,Safety and Experience Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 100% Cancer waiting times 62 day standard - Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) 64.0% 18 9 10 15 14 13 6 11 7 6 4 3 76.5% 9 4 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 17) 14 5 9 7 3 6 1 2 3 2 2 4 1 3 40% 39 - 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 Upgrade routes. As of April 2024, YTD and Monthly targets changed to 70% in line with latest operational guidance 100% Cancer 28 day faster diagnosis Percentage of patients treated within 40 standard UHSFT Teaching hospital average (& rank of 20) 85.7% 7 74.3% 7 8 6 3 1 2 3 3 1 2 2 2 5 8 5 3 2 1 1 1 1 1 1 1 1 South East average (& rank of 17) 50% Monthly target ≥70% ≥77% 40 - As of April 2024, YTD and monthly targets changed from 75% to 77% in line with latest operational guidance 31 day cancer wait performance - decision 100% to treat to first definitive treatment (Most recently externally reported data, unless 16 86.8% 15 17 15 13 13 11 15 12 13 11 14 12 90.8% 11 41 stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 12 10 14 11 5 9 6 15 9 8 13 7 7 9 South East average (& rank of 17) 78% ≥96% 41 From October 2023 data onwards, the 31 day standard metric published in NHS england data combines First Treatment and Subsequent Treatment routes. YTD 76.5% 85.7% 90.8% YTD target ≥70% ≥77% ≥96% Appendix Page 14 of 17 Report to Trust Board in June 2024 Integrated Networks and Collaboration Appendix Local Integration Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Monthly target 250 188 Number of inpatients that were 47 medically optimised for discharge (monthly average) 0 215 ≤80 Emergency Department 48 activity - type 1 This year vs. last year Percentage of virtual appointments as a 49 proportion of all outpatient consultations This year vs. last year 13000 11000 11,501 11,225 9000 40% 29.0% 27.5% 20% 12,611 11,761 - 25.8% 25.4% ≥25% YTD 215 24,075 25.4% YTD target - - ≥25% Page 15 of 17 Report to Trust Board in May 2024 Pioneering Research and Innovation R&D Performance 43 Comparative CRN Recruitment Performance - non-weighted Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD 25 21 19 19 17 13 14 17 17 16 15 15 15 15 9 Top 10 - 7 44 Comparative CRN Recruitment Performance - weighted 0 15 12 14 15 12 11 11 11 9 9 9 8 6 12 11 6 Top 5 - 0 100% 88% Study set up times - 80% target for 59% 64% 60% 67% 47% 46% 46% 55% 50% 64% 50% 55% 45 issuing Capacity & Capability within 40 50% 25% - - Days of Site Selection 0% Achievement compared to R+D 46 Income Baseline Monthly income increase % 200% 150% 100% 50% 32.6% 104.1% 84.7% 35.6% 50.7% 65.2% 45.8% 133.3% 133.3% 157.6% 84.7% 65.2% 75.0% 119.5% 59.8% 26.8% ≥5% - YTD income increase % 0% Appendix YTD target - - - - Page 16 of 17 Report to Trust Board in June 2024 Foundations for the Future Digital Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Monthly target My Medical Record - UHS patient 200,000 accounts (cumulative number of 50 accounts in place at the end of each month) 100,000 159,743 202,621 - 40000 My Medical Record - UHS patient 51 logins (number of logins made within 30000 each month) 20000 31,064 34,354 - 51 - The YTD Figure shown represents a rolling average of MMR logins per month within the current financial year 3190 Average age of IT estate 52 Distribution of computers per age in years 3000 2000 1000 0 0 2590 770 1020 1190 0 24 35 69 120 310 1910 1170 - 14 13 12 11 10 9 8 7 6 5 4 3 2 1 YTD 202,621 34,354 - YTD target - - - #DIV/0! 99.75% 99.72% 99.73% 99.81% 99.77% 99.82% 99.74% 99.79% 99.80% 99.79% 99.77% 99.78% 98.67% 53 CHARTS system average load times - % 100% of pages loaded under 3s 95% 53 -Data only available from April 2023 onwards. From April 2024 , metric was changed from % loading times under 5s to % loading times under 3s Appendix Page 17 of 17
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2024-Trust-documents/Finance-and-Performance-Reports-2024-25-Month-2-May-2024.pdf

InP RCODOX M(66) cyclophosphamide doxorubicin methotrexate rituximab vincristine

Description: Chemotherapy Protocol LYMPHOMA CYCLOPHOSPHAMIDE-DOXORUBICIN-METHOTREXATE-RITUXIMAB-VINCRISTINE (RCODOX-M) 66 years and above Inpatient Regimen There are multiple versions of this protocol in use. The choice of protocol depends on the age of the patient and whether there is CNS disease present at diagnosis. Please ensure you have the correct version and prescribe the correct number of cycles. Regimen • Lymphoma – InP-RCODOX-M(65)-Cyclophosphamide-Doxorubicin-MethotrexateRituximab-Vincristine Indication • Non Hodgkin’s Lymphoma including Burkitt’s lymphoma either as a single regimen or alternating with R-IVAC Toxicity Drug Adverse Effect Cyclophosphamide Dysuria, haemorrragic cystitis (rare), taste disturbances Doxorubicin Cardiomyopathy, alopecia, urinary discolouration (red) Methotrexate Rituximab Vincristine Stomatitis, conjunctivitis, renal toxicity Severe cytokine release syndrome, increased incidence of infective complications, progressive multifocal leukoencephalopathy Peripheral neuropathy, constipation, jaw pain The presence of a third fluid compartment e.g. ascites, pleural effusion or other oedema may delay the clearance of methotrexate and increase toxicity and should be resolved before methotrexate administration. The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Version 1.2 (Sept 2018) Page 1 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Monitoring Drugs R-CODOX-Cyclophosphamide-Doxorubicin-Rituximab-Vincristine • FBC, LFTs and U&Es (including uric acid and phosphate) prior to day one of treatment • Ensure adequate cardiac function before starting therapy. Baseline LVEF should be measured in patients with a history of cardiac problems, cardiac risk factors or in the elderly. Discontinue doxorubicin if cardiac failure develops • Intensive post chemotherapy biochemical monitoring is mandatory in patients with bulky disease and should be strongly considered in all patients during days 1 to 5 of treatment. This includes daily serum electrolytes, urea, creatinine, calcium and phosphorus • Check hepatitis B status before starting treatment with rituximab Methotrexate • FBC, LFTs and U&Es prior to day one of treatment • GFR measurement either by EDTA or 24 hour urine collection prior to methotrexate infusion. The creatinine clearance must be 50ml/min or more for the methotrexate in this regimen to be administered • Methotrexate levels taken every 24 hours starting 48 hours after the start of the infusion until the level is below 0.1micromol/L • Urinary pH every two hours as a minimum until the methotrexate level is below 0.1micromol/L • Strict fluid balance chart to be maintained throughout methotrexate administration with appropriate action taken if positive by more than 2kg/L. • Ensure the patient has no ascites, pleural effusion or oedema prior to administration of high dose methotrexate. Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Version 1.2 (Sept 2018) Page 2 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Haematological There are no dose modifications for haematological toxicity. New treatment cycles should be delayed until minimum criteria detailed below are reached (day 10 methotrexate will be given irrespective of the neutrophil or platelet count). Criteria Neutrophil Platelets Eligible Level equal to or more than 1x109/L equal to or more than 75x109/L Consider blood transfusion if the patient is symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Hepatic Impairment Please note that the approach may be different if the abnormal liver function tests are due to disease involvement. There is a higher risk of toxicity in patients with concomitantly impaired renal function, consider dose reduction. Drug Cyclophosphamide Bilirubin µmol/L N/A AST/ALT units/L N/A Dose (% of original dose) Evidence suggests no dose reduction is necessary Doxorubicin less than 30* *30-51 and/or 51-85 2-3xULN more than 3xULN N/A more than 85 N/A 75% 50% 25% omit Methotrexate less than 50 and 51-85 or more than 85 less than 180 more than 180 N/A 100% 75% omit Rituximab N/A N/A No dose adjustments required *30-51 or 60-180 50% Vincristine more than 51 and normal more than 51 and more than 180 * Limits reflect local practice and may vary from published sources 50% omit Version 1.2 (Sept 2018) Page 3 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Transient increases in bilirubin and transaminases, lasting up to two weeks, are likely following methotrexate infusion and should not be considered an indication to stop treatment. Persistent hyperbilirubinaemia and/or grade 3/4 hypertransaminasemia for longer than three weeks should result in discontinuation of the drug. Renal Impairment Drug Cyclophosphamide Creatinine Clearance (ml/min) more than 20 10-20 less than 10 Dose (% of original dose) 100% 75% 50% Doxorubicin N/A Consider dose reduction in severe renal failure Methotrexate *50 or greater 100% Rituximab N/A No dose adjustment needed Vincristine N/A No dose adjustment needed * Limits reflect local practice and may vary from published sources A creatinine clearance of 50ml/min or more is required to proceed with the methotrexate element of this regimen. Consider the appropriateness of regimen if dose reductions due to impaired renal function are required for other agents. Consider mesna in patients with pre-existing bladder disorders. Give an oral dose of 40% of the cyclophosphamide dose (rounded upwards to the nearest 400mg for oral mesna) at 0, 2 and 6 hours after the administration of cyclophosphamide. Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. Where appropriate, if dose reductions made at cycle one are well tolerated, dose increases can be considered on subsequent cycles according to tolerability. Cyclophosphamide Consider mesna in patients with pre-existing bladder disorders. Doxorubicin Discontinue doxorubicin if cardiac failure develops Version 1.2 (Sept 2018) Page 4 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Methotrexate Methotrexate can cause severe renal impairment that can then lead to raised levels and further toxicity. Renal function must be monitored daily until levels are below 0.1micromol/L. It is imperative that urinary pH is maintained above pH 7, through the administration of sodium bicarbonate, before starting and during the administration of methotrexate, and continued until methotrexate levels are less than 0.1micromol/L. Monitor fluid balance carefully and give intravenous furosemide if fluid overload occurs or urine output falls to less than 400ml/m2 in any 4-hour period. Folinic acid 30mg every 3 hours intravenous beginning 36 hours after the start of the methotrexate infusion and continued until the methotrexate levels are below 0.1micromol/L. This may be given orally from dose 5 onwards if the patient is able to tolerate oral therapy. If levels of methotrexate are above 2micromol/L at 72 hours additional folinic acid may be necessary. Always seek advice from a senior member of staff (consultant should always be informed of raised methotrexate levels or if a rapid deterioration in renal function occurs). Glucarpidase can be considered for methotrexate toxicity. The decision to prescribe glucarpidase must only be made by a consultant and in accordance with the NHSE commissioning policy on glucarpidase. The presence of a third fluid compartment e.g. ascites, pleural effusion or other oedema may delay the clearance of methotrexate and hence increase toxicity and should be resolved before methotrexate administration. In addition to the renal and hepatic dysfunction described above methotrexate can also cause significant mucositis. Ensure the patient has adequate mouthwashes and good oral hygiene practices. Rituximab Infusion related adverse reactions have been observed in 10% of patients treated with rituximab. Rituximab administration is associated with the onset of cytokine release syndrome. This condition is characterised by severe dyspnoea, often accompanied by bronchospasm and hypoxia, in addition to fever, chills, rigors, urticaria, and angioedema. It may be associated with some features of tumour lysis syndrome such as hyperuricaemia, hyperkalaemia, hypocalcaemia, acute renal failure, elevated lactate dehydrogenase (LDH) and can lead to acute respiratory failure and death. This effect on the lungs may be accompanied by events such as pulmonary interstitial infiltration or oedema, visible on a chest x-ray. Cytokine release syndrome frequently occurs within one or two hours of initiating the first infusion. Hypersensitivity reactions, including anaphylaxis, have been reported following the intravenous administration of proteins. In contrast to cytokine release syndrome, true hypersensitivity reactions typically occur within minutes of starting the infusion. Medicinal products for the treatment of allergic reactions should be available for immediate use in the event of hypersensitivity developing during the administration of rituximab. Use of rituximab maybe associated with an increased risk of progressive multifocal leukoencephalopathy (PML). Patients must be monitored at regular intervals for any new or Version 1.2 (Sept 2018) Page 5 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine worsening neurological, cognitive or psychiatric symptoms that may be suggestive of PML. If PML is suspected, further dosing must be suspended until PML has been excluded. If PML is confirmed the rituximab must be permanently discontinued. The presence of a viral upper respiratory tract infection prior to treatment may increase the risk of rituximab associated hepatotoxicity. Patients should be assessed for any cold or flu like symptoms prior to treatment. Vincristine Reduce the vincristine dose from 2mg to 1mg if a NCI-CTC grade 2 motor or grade 3 sensory neurological toxicity occurs. For higher toxicity grades or if toxicity increases despite dose reduction stop the vincristine. Regimen 3 cycles in low risk disease 2 cycles in high risk disease alternating with 2 cycles of R- IVAC 1 cycle will be set in Aria The next cycle begins on the day that the unsupported neutrophil count is more than 1x109/L and the unsupported platelet count is more than 75x109/L. Drug Dose Days Cyclophosphamide 800mg/m2 1 Administration Intravenous bolus over 10 minutes Cyclophosphamide 200mg/m2 2,3,4,5 Intravenous bolus over 10 minutes Doxorubicin 40mg/m2 1 Rituximab Vincristine Methotrexate 375mg/m2 1 1.5mg/m2 (max 2mg) 1, 8 100mg/m2 10 Methotrexate 900mg/m2 Drug (intrathecal) Dose Cytarabine 70mg 10 Days 1, 3 Intravenous bolus over 10 minutes Intravenous infusion in 500ml sodium chloride 0.9% as per local guidelines Intravenous bolus in 50ml sodium chloride 0.9% over 10 minutes Intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Intravenous infusion in 1000ml sodium chloride 0.9% over 23 hours Administration Intrathecal Methotrexate 12.5mg 15 Intrathecal An intensified intrathecal treatment is required for patients with CNS disease at diagnosis. This is given for the first cycle of R- CODOX-M and the first cycle of R-IVAC. Version 1.2 (Sept 2018) Page 6 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine For R-CODOX-M this is as follows: Drug (intrathecal) Dose Cytarabine 70mg Days 5 Methotrexate 12.5mg 17 Administration Intrathecal Intrathecal Intrathecal doses that fall on a weekend should be deferred until the next working day Dose Information • Cyclophosphamide will be dose banded in accordance with the national bands (20PM) • Doxorubicin will be dose banded in accordance with the national bands (2PM) • The maximum lifetime cumulative dose of doxorubicin is 450mg/m². However prior radiotherapy to the mediastinal / pericardial area should receive a lifetime cumulative doxorubicin dose of no more than 400mg/m². • Methotrexate (intravenous) will be dose banded in accordance with the national bands (methotrexate HD) • Rituximab dose will be rounded to the nearest 100mg (up if halfway) • Vincristine will be dose banded in accordance with the national bands (1mg/ml) • The maximum dose of vincristine is 2mg Administration Information Extravasation • Cyclophosphamide – neutral • Doxorubicin – vesicant • Methotrexate – inflammitant • Rituximab - neutral • Vincristine - vesicant Other • The methotrexate infusion must not be started until the urinary pH is above 7. This urinary pH must be maintained throughout the methotrexate infusion and until the methotrexate level is 0.1micromol/L or below • The methotrexate infusion must be stopped 24 hours after the start of the first infusion regardless of the dose given Version 1.2 (Sept 2018) Page 7 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine • The rate of administration of rituximab varies. Please refer to the rituximab administration guidelines Additional Therapy This is an inpatient regimen please ensure all supportive and take home medicines are prescribed on the inpatient chart or general electronic prescribing system. Day 1 - R-CODOX – Cyclophosphamide-Doxorubicin-Rituximab-Vincristine • Premedication 30 minutes prior to rituximab - chlorphenamine 10mg intravenous - hydrocortisone 100mg intravenous - paracetamol 1000mg oral • Rituximab infusion reactions - hydrocortisone 100mg intravenous when required for rituximab infusion related reactions - salbutamol 2.5mg nebule when required for rituximab related bronchospasm - consider pethidine 25-50mg intravenous for rituximab related rigors that fail to respond to corticosteroids. • Antiemetics Starting 15-30 minutes prior to chemotherapy - dexamethasone 4mg twice a day for 7 days oral or intravenous - metoclopramide 10mg three times then when required oral or intravenous - ondansetron 8mg twice a day for 7 days oral or intravenous Day 10 - Methotrexate (Intravenous) • Hydration The following fluid regimen is recommended as hydration. Fluid hydration should start at least six hours prior to methotrexate. This schedule should be repeated every 12 hours until the methotrexate level is below 0.1 micromol/L - Furosemide 40mg once only dose oral or intravenous when required for the treatment of fluid overload or to maintain urine output - Sodium chloride 0.9% with 20mmol potassium chloride 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 Version 1.2 (Sept 2018) Page 8 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine - Sodium chloride 0.9% with 20mmol potassium chloride 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - Glucose 5% (with or without potassium chloride 20 or 27mmol) 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 • Antiemetics Starting 15-30 minutes prior to intravenous methotrexate - dexamethasone 4mg twice a day for 3 days oral or intravenous - metoclopramide 10mg oral three times a day when required oral or intravenous - ondansetron 8mg twice a day for 3 days oral or intravenous • Post-treatment with intravenous methotrexate - folinic acid 30mg every 3 hours intravenous beginning 36 hours after the start of the methotrexate infusion and continued until the methotrexate levels are below 0.1micromol/L. This may be given orally from dose 5 onwards if the patient is able to tolerate oral therapy. If levels of methotrexate are above 2micromol/L at 72 hours additional folinic acid may be necessary. Seek advice from a senior member of staff. • Growth factor to be continued until the neutrophil count is above 1x109/L. For example: - filgrastim or bioequivalent 30 million units once a day from day 13 subcutaneous - lenograstim or bioequivalent 33.6 million units once a day from day 13 subcutaneous - pegfilgrastim or bioequivalent 6mg once only day 13 subcutaneous • Folinic acid 15mg four times a day oral for one day starting 24 hours after the administration of the intrathecal methotrexate dose, according to local practice • Mouthwashes according to local or national policy on the treatment of mucositis • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. • In female patients consider norethisterone 5mg three times a day oral to delay menstruation • Tumour lysis prophylaxis with cycle one only including: - appropriate hydration - rasburicase for high risk patients - allopurinol 300mg once a day for the first cycle only Version 1.2 (Sept 2018) Page 9 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine • Anti-infective prophylaxis as follows: - aciclovir 400mg twice a day oral - pentamidine 300mg nebule once a month - fluconazole 50mg once a day oral Some centres avoid the use of azole antifungal agents due to the risk of peripheral neuropathy when combined with vinca alkaloids. Additional Information • A significant number of drugs interact with intravenous methotrexate. At the doses used in this protocol this can lead to significant toxicity or reduction in efficacy. Always check for drug interactions before prescribing any additional medication. • HSC 2008/001: Updated national guidance on the safe administration of intrathecal chemotherapy must be followed. • The National Patient Safety Agency report NPSA/2008/RRR04 must be followed in relation to intravenous administration of vinca alkaloids. Coding (OPCS) • Procurement – X71.5 • Delivery – not required References 1. NCRI Lymphoma Group. A Clinicopathological Study in Burkitt’s and Burkitt-Like Non-Hodgkin’s Lymphoma. LY10. Protocol Version 2.0. September 2002. 2.Mead GM, Sydes MY, Walewski J et al. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitts lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol 2002; 13 (8): 1264-1274. - Version 1.2 (Sept 2018) Page 10 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine REGIMEN SUMMARY InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Other than those listed below, supportive medication for this regimen will not appear in Aria as prescribed agents. The administration instructions for each warning describes the agents which must be prescribed on the in-patient chart or general electronic prescribing system Day 1 1. Warning – Check supportive medication prescribed Administration Instructions 1. Dexamethasone 4mg twice a day, days 1 to 7 oral or intravenous 2. Metoclopramide 10mg three times a day when required oral or intravenous 3. Ondansetron 8mg twice a day, days 1 to 7 oral or intravenous 4. Aciclovir 400mg twice a day oral 5. Pentamidine nebule 300mg once a month 6. Fluconazole 50mg once a day oral (consider – interacts with vincristine) 7. Tumour lysis prophylaxis including appropriate hydration (cycle one only) 8. Consider gastric protection 9. Consider mouthwashes 10.Consider norethisterone 5mg three times a day in menstruating women 11.Consider pethidine 25-50mg intravenous for rituximab related rigors that fail to respond to corticosteroids 2. Chlorphenamine 10mg intravenous 3. Hydrocortisone 100mg intravenous 4. Paracetamol 1000mg oral Administration Instructions Please check if the patient has taken paracetamol. Maximum dose is 4g per 24 hours. There should be 4 hours between doses 5. Rituximab 375mg/m2 intravenous infusion in 500ml sodium chloride 0.9% (administer according to local guidelines) 6. Doxorubicin 40mg/m2 intravenous bolus over 10 minutes 7. Vincristine 1.5mg/m2 (max dose 2mg) intravenous bolus in 50ml sodium chloride 0.9% over 10 minutes 8. Cyclophosphamide 800mg/m2 intravenous bolus over 10 minutes 9. Warning – Prescribe intrathecal on intrathecal chart Administration Instructions Prescribe cytarabine 70mg intrathecal. This must be prescribed on an intrathecal chart to comply with national guidance. This warning is a reminder not a prescription. National intrathecal guidance and local intrathecal policies must be followed at all times. 10. Hydrocortisone 100mg intravenous once only when required for the relief of rituximab infusion related reactions 11. Salbutamol 2.5mg nebule when required for rituximab related bronchospasm Version 1.2 (Sept 2018) Page 11 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Day 2 12. Warning – Check supportive medication prescribed Administration Instructions 1. Dexamethasone 4mg twice a day, days 1 to 7 oral or intravenous 2. Metoclopramide 10mg three times a day when required oral or intravenous 3. Ondansetron 8mg twice a day, days 1 to 7 oral or intravenous 4. Aciclovir 400mg twice a day oral 5. Pentamidine nebule 300mg once a month 6. Fluconazole 50mg once a day oral (consider – interacts with vincristine) 7. Tumour lysis prophylaxis including appropriate hydration (cycle one only) 8. Consider gastric protection 9. Consider mouthwashes 10.Consider norethisterone 5mg three times a day in menstruating women 11.Consider pethidine 25-50mg intravenous for rituximab related rigors that fail to respond to corticosteroids 13. Cyclophosphamide 200mg/m2 intravenous bolus over 10 minutes Day 3 14. Warning – Check supportive medication prescribed Administration Instructions 1. Dexamethasone 4mg twice a day, days 1 to 7 oral or intravenous 2. Metoclopramide 10mg three times a day when required oral or intravenous 3. Ondansetron 8mg twice a day, days 1 to 7 oral or intravenous 4. Aciclovir 400mg twice a day oral 5. Pentamidine nebule 300mg once a month 6. Fluconazole 50mg once a day oral (consider – interacts with vincristine) 7. Tumour lysis prophylaxis including appropriate hydration (cycle one only) 8. Consider gastric protection 9. Consider mouthwashes 10.Consider norethisterone 5mg three times a day in menstruating women 11.Consider pethidine 25-50mg intravenous for rituximab related rigors that fail to respond to corticosteroids 15. Cyclophosphamide 200mg/m2 intravenous bolus over 10 minutes 16. Warning – Prescribe intrathecal on an intrathecal chart Administration Instructions Prescribe cytarabine 70mg intrathecal. This must be prescribed on an intrathecal chart to comply with national guidance. This warning is a reminder not a prescription. National intrathecal guidance and local intrathecal policies must be followed at all times Day 4 17. Warning – Check supportive medication prescribed Administration Instructions 1. Dexamethasone 4mg twice a day, days 1 to 7 oral or intravenous 2. Metoclopramide 10mg three times a day when required oral or intravenous 3. Ondansetron 8mg twice a day, days 1 to 7 oral or intravenous 4. Aciclovir 400mg twice a day oral 5. Pentamidine nebule 300mg once a month 6. Fluconazole 50mg once a day oral (consider – interacts with vincristine) 7. Tumour lysis prophylaxis including appropriate hydration (cycle one only) 8. Consider gastric protection 9. Consider mouthwashes 10.Consider norethisterone 5mg three times a day in menstruating women 11.Consider pethidine 25-50mg intravenous for rituximab related rigors that fail to respond to corticosteroids 18. Cyclophosphamide 200mg/m2 intravenous bolus over 10 minutes Version 1.2 (Sept 2018) Page 12 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine Day 5 19. Warning – Check supportive medication prescribed Administration Instructions 1. Dexamethasone 4mg twice a day, days 1 to 7 oral or intravenous 2. Metoclopramide 10mg three times a day when required oral or intravenous 3. Ondansetron 8mg twice a day, days 1 to 7 oral or intravenous 4. Aciclovir 400mg twice a day oral 5. Pentamidine nebule 300mg once a month 6. Fluconazole 50mg once a day oral (consider – may interact with vincristine) 7. Tumour lysis prophylaxis including appropriate hydration (cycle one only) 8. Consider gastric protection 9. Consider mouthwashes 10.Consider norethisterone 5mg three times a day in menstruating women 11.Consider pethidine 25-50mg intravenous for rituximab related rigors that fail to respond to corticosteroids 20. Cyclophosphamide 200mg/m2 intravenous bolus over 10 minutes 21. Warning – CNS disease extra intrathecal cycle 1 only Administration Instructions For patients presenting with CNS disease please prescribe an additional cytarabine 70mg intrathecal on day 5 cycle one only Intrathecal chemotherapy must be prescribed on an intrathecal chart. This is a warning, not a prescription. National intrathecal guidance and local intrathecal policies must be followed at all times. Day 8 22. Warning – Check supportive medication prescribed Administration Instructions 1. Aciclovir 400mg twice a day oral 2. Pentamidine nebule 300mg once a month 3. Fluconazole 50mg once a day oral (consider – may interact with vincristine) 4. Tumour lysis prophylaxis including appropriate hydration (cycle one only) 5. Consider gastric protection 6. Consider mouthwashes 7. Consider norethisterone 5mg three times a day in menstruating women 23. Vincristine 1.5mg/m2 (max dose 2mg) intravenous bolus in 50ml sodium chloride 0.9% over 10 minutes Day 10 24. Warning – Check supportive medication prescribed Administration Instructions 1. Furosemide 40mg when required oral or intravenous 2. Fluids repeated on a 12 hourly cycle to maintain fluid balance, urine output and pH above 7 until methotrexate level is below 0.1micromol/L - sodium chloride 0.9% with potassium chloride 20mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - sodium chloride 0.9% with potassium chloride 20mmol 1000ml intravenous infusion over 240 minutes with 50-100mmol sodium bicarbonate adjusted to maintain urinary pH above 7 - glucose 5% 1000ml (with or without potassium chloride 20 or 27mmol) intravenous infusion over 240 minutes with 50- 100mmol sodium bicarbonate adjusted to maintain urinary ph above 7 3. Dexamethasone 4mg twice a day for 3 days oral or intravenous 4. Metoclopramide 10mg three times a day when required oral or intravenous 5. Ondansetron 8mg twice a day for 3 days oral or intravenous 6. Folinic acid 30mg every 3 hours intravenous beginning 36 hours after the start of the methotrexate infusion and continued until the methotrexate levels are below 0.1micromol/L. This may be given orally from dose 5 onwards. Methotrexate levels taken every 24 hours starting 48 hours after the start of the infusion until the level is below 0.1micromol/L. 7. Growth factors started and continued until the neutrophil count is above 1x109/L - filgrastim or bioequivalent 30 million units once a day from day 13 subcutaneous - lenograstim or bioequivalent 33.6 million units once a day from day 13 subcutaneous - pegfilgrastim or bioequivalent 6mg once only on day 13 subcutaneous 8. Aciclovir 400mg twice a day oral 9. Pentamidine 300mg nebule once a month 10.Fluconazole 50mg once a day oral 11.Tumour lysis prophylaxis including appropriate hydration (cycle one only) 12.Consider gastric protection 13.Consider mouthwashes 14.Consider norethisterone 5mg three times a day in menstruating women Version 1.2 (Sept 2018) Page 13 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine 25. Methotrexate 100mg/m2 intravenous infusion in 250ml sodium chloride 0.9% over 1 hour Administration Instructions Monitor fluid balance, urine output, weight and urinary pH. Methotrexate levels taken every 24 hours starting 48 hours after the start of the infusion until the level is below 0.1micromol/L. 26. Methotrexate 900mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% over 23 hours Administration Instructions Monitor fluid balance, urine output, weight and urinary pH. Methotrexate levels taken every 24 hours starting 48 hours after the start of the infusion until the level is below 0.1micromol/L. Day 15 27. Warning – Prescribe intrathecal on intrathecal chart Administration Instructions Prescribe methotrexate 12.5mg intrathecal. This must be prescribed on an intrathecal chart to comply with national guidance. This warning is a reminder not a prescription. National intrathecal guidance and local intrathecal policies must be followed at all times Day 17 28. Warning – CNS disease extra intrathecal cycle 1 only Administration Instructions For patients presenting with CNS disease please prescribe an additional methotrexate 12.5mg intrathecal at cycle 1 only. Intrathecal chemotherapy must be prescribed on an intrathecal chart. This is a warning, not a prescription. National intrathecal guidance and local policies must be followed at all times. Folinic acid 15mg four times a day oral for one day starting 24 hours after the administration of intrathecal methotrexate, according to local practice Version 1.2 (Sept 2018) Page 14 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine DOCUMENT CONTROL Version Date Amendment Written By Approved By Check for additional fluid compartment added Renal toxicity added Dose bands changed to national bands 1.1 Aug 2018 Potassium changed to being optional in the glucose 5% methotrexate hydration Fluconazole interaction added Dr Deborah Wright Pharmacist Donna Kimber Pharmacy Technician Paracetamol administration instructions Methotrexate levels added to administration instructions Intrathecal changed to a warning Disclaimer updated Header changed Toxicities removed Hepatic and renal impairment guidance updated Antiemetics clarified Administration information for hydrocortisone pre med removed Metoclopramide dose and duration updated “Bolus” removed from “intravenous bolus” for supportive medication Donna Kimber throughout text 1.1 Sept 2016 Start of methotrexate levels changed from 24 hours after the end of the infusion 48 hours after the start of the Pharmacy Technician Rebecca Wills Dr Deborah Wright Pharmacist infusion Pharmacist Growth factor units updated Mucositis recommendation changed OPCS code updated 27mmol potassium chloride added to glucose hydration fluid “according to local practice” and “oral” added to folinic acid instructions following intrathecal methotrexate CSSCN agreed bands removed Regimen summary numbering updated. Disclaimer added Dr Andrew Davies Rebecca Wills Consultant Medical 1 August 2012 None Pharmacist Dr Deborah Wright Oncologist Dr Alison Milne Pharmacist Consultant Haematologist Version 1.2 (Sept 2018) Page 15 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors that occur as a result of following these guidelines. These protocols should be used in conjunction with other references such as the Summary of Product Characteristics and relevant published papers. Version 1.2 (Sept 2018) Page 16 of 16 Lymphoma- InP-RCODOX-M(66)-Cyclophosphamide-Doxorubicin-Methotrexate-Rituximab-Vincristine
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lymphoma/InP-RCODOX-M66-cyclophosphamide-doxorubicin-methotrexate-rituximab-vincristine.pdf

InP RCODOX M(65) cyclophosphamide doxorubicin methotrexate rituximab vincristine

Description: Chemotherapy Protocol LYMPHOMA CYCLOPHOSPHAMIDE-DOXORUBICIN-METHOTREXATE-RITUXIMAB-VINCRISTINE (RCODOX-M) 65 years and below Inpatient Regimen There are multiple versions
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lymphoma/InP-RCODOX-M65-cyclophosphamide-doxorubicin-methotrexate-rituximab-vincristine.pdf

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InP RCODOX M(66) cyclophosphamide doxorubicin methotrexate rituximab vincristine

InP RCODOX M(65) cyclophosphamide doxorubicin methotrexate rituximab vincristine

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