Agenda item

Operational Performance Report

Jim O’Connell, Chief Operating Officer


The Board considered the operational performance report which provided an update on performance against key national and local performance standards in addition to progress against key work streams and remedial recovery plans with headlines as follows: -


Emergency Department (ED) 4 hour standard (95%)  (combined – Emergency Department, Minor Injuries Unit (MIU) & Urgent Care Centre (UCC))        


November 86.1% (not achieved)

Referral to Treatment Incomplete standard (92%)

November 90.2% (not achieved)

6 Week Diagnostic Wait

November 96.6% (not achieved)

Cancer Targets

2 week waits (93%)

2 week wait breast symptomatic (93%)

31 day treatment (96%)

62 day treatment (85%)

October Achieved






In advance of presenting the report, JO advised that the format and content of the report would be reviewed in consultation with CN, SN and PH.


Emergency Department (ED) Performance

JO reported that performance was above 80% which was in line with the region.  JO referred to the significant operational pressures each day commenting on the excellent work being undertaken by the staff teams to maintain patient safety.


JO reported that all escalation areas were open and the site pressures were being managed on a day to day basis.


JO reported that the ability to achieve the 4 hour performance standard was dependent on bed availability and that bed occupancy was an issue. 


JO referred to the volume of patients noting that it was challenging to cope with over 90 attendances in the Urgent Care Centre and yet there had been 120 plus patients. It had not been possible to get all the staff needed.  Notwithstanding this and the site pressures, performance was satisfactory compared to the national picture.


Referral to Treatment Times (RTT)

JO reminded the Board that RTT was not one of the three priorities set by NHS Improvement (NHSI) and as such there had been informal agreement that circa 90% performance would be acceptable.   JO highlighted that this would be challenging going forward dueto a recent direction from NHSI that routine elective cases should be cancelled during January. 


JO advised that day surgery would continue as far as possible, however the Recovery 2 area was being used as an escalation area and this could impact the Trust’ ability to carry out day cases.


JM advised that it was across the national papers that operations were cancelled.  NV explained that there were instructions issued nationally to cease elective cases during January and that it was important for the Trust to comply with the directive. NV commented that it was also critical to ensure that urgent, essential or cancer cases were treated.  HW advised that the reason for cancellation of routine elective work was to free up staff to support the winter pressures.


RH questioned communication to the public around cancellations.  NV responded that the message given was that if a patient did not hear from the Trust then they should attend as planned.   In response to a comment from JM, it was noted that further communication was being worked through.  


NLB commented that he was not sure what could be achieved from freeing up an Ophthalmologist.  NV agreed commenting that the Trust would need to make sure cancellations were made knowing what the gain would be. This was currently being worked through in terms of redeployment of consultants.


RH questioned whether cancelling elective work would improve ED performance. JO responded that he thought that it might support maintaining performance levels rather than improve them. 


AC referred to bed availability, commenting that there were some things within the Trust’s control which were not being addressed.  AC questioned what was preventing achievement of timely first assessments and discharges as examples.  JO responded that this was an area for focus through the Right Patient Right Place work.  JO explained that there were a range of patients who might need another doctor review or something else as part of their care before they could go home.  These needs were increasing.  JO reassured the Board that efforts were continually made to ensure timely discharges.


GR advised that Directors were looking at percentages but that they should also look at the numbers because they were going up.  GR confirmed that there was a strong focus on timely assessments and timely discharges.


KJ questioned how productive were the medically fit for discharge (MFFD) meetings were with the clinical commissioning groups. JO advised that the meetings were continuing and they were effective in that the numbers of MFFD patients remaining in the hospital were coming down.   JO commented that there was now better system level engagement and support. 



JO was pleased to report that the Trust had achieved all the standards in October.  JO explained that the November performance data was not yet finalised but that it was likely that the position had been maintained in November.  JO advised that sustainable performance would be achieved when all elements of the pathway were standardised.  There was more work to do but JO commended Cancer Services for their hard work and effort to turn the position around.


In response to a question from RH, JO advised that one area of concern was Gynaecology due to the complexity of patients although numbers of patients was small.


Stroke Performance

JO advised that it was difficult to ring fence beds given the signification operational pressures.  JO advised that there was a need to look at the whole bed compliment and ring fencing.  JO noted that stroke performance was not where it needed to be but at present the focus was on the priorities set by NHS Improvement.  However, notwithstanding this there was a plan to revisit the stroke actions.


Patients who Did Not Attend (DNA)

JS referred to DNAs commenting that it might be beneficial to have more public communication around this to reduce DNAs and enable patient slots to be rebooked for others.


Swindon Community Services

It was noted that referrals to community nursing remained high.  It was flagged that there had been an increase in the number of completed daily care plans by about 12% which was good.  It was noted that in the recent bad weather community nurses had made all of their ordinary visits with staff supporting each other and working collectively.


KM explained that there were more patients requiring urgent referrals to community services with more transfers to SWICC by 5pm being achieved (currently 92%).  In response to a comment from JM around the timing, KM clarified that this was for patients going from the hospital to SwICC and not the timing for patients going home but nevertheless this was an area for focus.


It was highlighted that an ambulance had been secured to take patients to SwICC and for those patients requiring outpatient appointments in the hospital.


KM highlighted that the length of stay in SwICC had come down from 40 days in May to less than 18 in November which was excellent progress.  Patient choice had been a factor in delays.  There needed to be a sustained focus with Council of MFFD patients including those in SwICC.


KM reported that the Out of Hours service would transfer to Medvivo from 1 February 2018. This was commissioner requested transfer.


JM was joined by members of the Board in thanking KM and all the community staff for their hard work and efforts to make improvement.   The Board also recorded its thanks to the continuing hard work of all staff during significant operational pressures.




that the report be received and the ongoing plans to maintain and improve performance be accepted, acknowledged and supported.

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