• Abstract and Figures
• Public Full-text

Section 1 Executive Summary Nationally the NHS has struggled to achieve the four hour target in the Emergency Department, the three 18 week referral to treatment targets and the cancer 62 day cancer target. In response to this Monitor and the Trust Development Authority released guidance called the Operational Resilience and Capacity Planning for 2014/15. The aim of this document is get health and social care systems to undertake year-round capacity and demand planning which is ongoing and robust.

The Trust has already undertaken robust system wide planning alongside partner organisations in health and social care putting it in a strong position moving forwards. The system wide planning and focus on the Emergency Department has enabled the Trust to deliver the four hour Emergency Department for six consecutive months. The Trust has also undertaken capacity and demand planning across a number of specialties and put in place the resource to meet the demand where possible. For example, an additional colorectal consultant was appointed with agreement from the Clinical Commissioning Group. The Trust also has an 18 week reduction plan agreed with the Clinical Commissioning Group and Trust Development Authority to enable the Trust to attain a position where it can deliver sustainable achievement of the 18 week target in line with increasing demand. The cancer 62 day target was achieved in line with the plan, and ongoing work is being undertaken internally and with the local specialist centres to ensure pathways for patients are of high quality and effective.

Alongside this work on operational performance, there is a requirement to continue to provide high quality and sustainable care. The focus on pressure ulcers and falls has led to a reduction across April and May 2014. It is important the Trust remains focussed and delivers the necessary actions to continue the improvement trajectory. To remain sustainable the Trust has a savings requirement of £4.5 million for the year which represents 4.45% of expenditure budgets. A Programme Management Office has been set-up to monitor performance against the quality programmes. This office reports into a monthly Business Review meeting which is overseeing delivery and triangulating operational, financial and quality performance to ensure the Trust improves on all fronts.

1.0 Monitor Scorecard

1.1 Summary Scorecard

Data reported in arrears - *

Section 2 Quality & Patient Safety

Quality and Patient Safety Summary Headlines

 The Trust is currently below the trajectory for Clostridium difficile with one case reported in April. Three cases of MSSA were reported in the first two months of 2014/15. The Trust has not had a case of MRSA this financial year.

 The increased focus on pressure ulcer and falls prevention has delivered improvements in both areas, with the level of grade 2-4 pressure ulcers and the number of falls both reducing. The Trust will continue to monitor performance closely to ensure the improvement trajectory continues.

 In May the Trust achieved the national target for the completion of VTE risk assessments for the first time in 14 months with a score of 95.8%. Plans are in place to continue to improve performance.

2.1. Patient Story Patient Story from the Emergency Department The story relates to a patient who was admitted as an emergency to the Medical Assessment Unit. The family were extremely concerned that whilst their mother was in hospital changes were made to her medication which could have had a devastating outcome for her. It appeared to the family that the decision had been made without full knowledge of the patient’s history. During the investigation it was confirmed that the Consultant had acted appropriately in stopping the medications at that time. The Consultant had believed that the family had been given a full and clear explanation of the management plan by the junior doctor and that the junior doctor was following that plan. Upon further investigation and by inviting the complainant to talk to members of staff directly about the concerns raised it was apparent that the junior doctor had not communicated clearly or adequately to the family and this was the reason why the family had become concerned that their mother’s medication had been stopped. On review of the medical notes it was also identified that the junior doctor had not reviewed the patient’s notes before completing the discharge summary and as a result was not fully aware of the treatment plan that had been agreed. Actions Taken As a result of this family sharing their experience, the Consultant has spoken to the individual doctor to highlight the shortcomings in their communication with the patient and their family to emphasise the additional distress and anxiety this caused. The Consultant has reminded his team of the importance of reviewing patient notes before communicating with families and completing discharge summaries to ensure that they are fully aware of the treatment plan that has been agreed and as a check that this is being followed.

2.2 Registration with Care Quality Commission (CQC) The Trust is compliant with all five of the CQC’s essential core standards of: 1. Treating people with respect and involving them in their care 2. Providing care, treatment and support the meets people’s needs 3. Caring for people safely and protecting them from harm 4. Staffing 5. Quality & suitability of management The essential standards of quality and safety set by the CQC government body are central to our work as a Trust. 2.3 Nursing Metrics Providing a safe and caring environment for patients is a key aim for the Trust. To support this, the following section brings together nurse staffing metrics with care sensitive outcome indicators under the following sections:  Acuity & Dependency  Staffing  Quality  Patient Experience This enables triangulation of the available data to ensure the Trust board is aware of nurse staffing issues and the impact on patients, and receives assurance over actions to address nurse staffing matters. The nursing metrics and care sensitive outcome indicators for April and May 2014 do not show any new areas of specific concern. The highest number of vacancies remains to be Surgical Assessment Unit/Clinical Decision Unit where posts have been recruited and are awaiting start dates. Both bank and agency nurse usage have decreased with fill rates for Registered Nurses being lower in April than May as Registered Nurse numbers were purposefully aligned to reducing bed numbers. Quality of care metrics show some improvements though they demonstrate the need to continue the focus on reducing pressure ulcers, falls and catheter associated infections. Patient reported satisfaction with nursing care was high in both months. Figure 1:

CAUTI – catheter associated urine infection; MRSA – Meticillin resistant Staphylococcus aureus bacteraemia Figure 2:

Figure 3:

2.4 Incident Reporting Incident reporting systems and policies are integral to patient safety and enable the Trust to analyse the type, frequency and severity of incidents that occur. The Trust’s open and honest reporting demonstrates a commitment to our patients and their safety. The information arising from these reports is used to make active changes, to improve our provision of quality care and to safeguard the wellbeing of our staff and patients. 2.4.1 Patient Incidents Figure 4 depicts the number of patient incidents reported each month, compared to previous years. Figure 4:

There were a total of 693 patient incidents reported over the 2 months, 309 in April and 384 in May. Closer analysis shows that the top 3 themes were pressure sores, falls and medication. A total of 184 pressure sores were reported in April and May (total number of community and hospital acquired), accounting for 27% of all patient incidents. The Trust reported 44 hospital acquired pressure sores, 3 of which were grade 3 and required a Serious Investigation. The Trust informs Safeguarding Adults Leads across the healthcare community of the community acquired pressure ulcers it finds, so that any services (for example nursing or care homes) can be risk assessed and supported by commissioning and local authority colleagues. 122 slips, trips, falls & collisions occurred within April and May. The wards with the most falls reported were Kewstoke (25), Medical Assessment Unit (18) Berrow and Harptree (14). Actions taken by the Trust include the appointment of a Falls Lead Nurse from the beginning of April. All falls incidents are now reviewed by the Matrons to ascertain whether there was any learning. 73 medication incidents were reported. These errors included administration (meaning medication administered orally or intravenously) from a clinical area (such as ward areas), medication error during the prescription process and preparation and/or dispensing of medicines in pharmacy. 2.4.2 Daily Situation Report The daily situation report (SitRep) continues to be circulated by the Quality Improvement Team on a daily basis. Data is presented to help operational leads focus on any areas of concern. The main theme from the SitRep continues to be the number of reported pressure sores (both community and hospital acquired) and patient falls. There was a slight increase in medication incidents reported in April and May, with Kewstoke, Harptree, Uphill, Steepholm, Cheddar and Theatre all being highlighted on the SItRep for medication incidents. Actions taken by the Trust include all nurses to now be competency checked for administration and calculation and the completion of the medicine management policy. 2.4.3 Staff Incidents The Trust Health and Safety Committee reviews incident trends and receives reports on incidents reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995. Figure 2 depicts the number of staff incidents reported each month, compared to previous years. Figure 5:

There were 26 staff incidents reported in April and 40 incidents reported in May, a total of 66. Incidents reported involving abuse of staff continued to be high with 23 being reported. It should be noted that 8 of the incidents reported involved patients with dementia, or patients with cognitive impairment. As a result the Trust continues with the convened working group, looking at Trust processes for management of patient aggression/violence towards staff members. Currently, updates are being undertaken on the Security policy to provide further guidance and risk management strategies to support ward and department managers to assess the security risks in their areas. In support of a CQUIN for the Mental Health Trust, a programme of collaborative training has been agreed for implementation which will support staff management of patients with challenging behaviour. 2.4.4 Serious Incidents (SIRIs) A Serious Incident is defined in the http://www.england.nhs.uk/ourwork/patientsafety/ (2013) as an incident that occurred in relation to NHS-funded services and care resulting in:  Unexpected or avoidable death of one or more patients, staff, visitors, or members of the public.  Serious harm to one or more patients, staff, visitors, or members of the public or when the outcome requires life saving intervention, major surgical/medical intervention, permanent harm or will shorten life expectancy or result in prolonged pain or psychological harm (this includes incidents graded under the NPSA definition of severe harm)  A scenario that prevents or threatens to prevent a provider organisations ability to continue to deliver healthcare services, for example, acute or potential loss of personal/organisational information, damage to property, reputation or the environment, IT failure or incidents in population programmes like screening and immunisation where harm potentially may extend to a large population.  Allegations of abuse  Adverse media coverage or public concern about the organisation or the wider NHS.  One of the core set of Never Events Figure 6 depicts the number of serious incidents reported to the Trust Figure 6:

Resultant investigation reports are reviewed by the local Clinical Commissioning Group and, for the most serious cases, also reviewed by the NHS Trust Development Authority. Between the 1st April and 31st May 11 serious incidents (April 6 and May 5) were reported and an investigation commissioned. The 11 investigations are classified in Table 1: Table 1: Category Grade 1 Grade 2 Operational (e.g. unit closure) 1 0 Adverse media attention 0 0 Information Governance (e.g. loss of 0 0 data) Clinical Care of patient (e.g. pressure 9 0 ulcer, delayed diagnosis, avoidable severe harm) Safeguarding (e.g. allegation of abuse) 0 1 Avoidable severe harm to staff 0 0 2.5 Inpatient Falls Data

Patients fall in hospital for a variety of reasons. These reasons can encompass the following factors:  Chronic health conditions, such as heart disease, dementia and low blood pressure (hypotension), which can cause dizziness;  Impairments, such as poor vision or muscle weakness;  Disabilities that can affect balance. Through April and May 2014 the Trust has seen a reduction in the number of patient falls from 64 in April and further reduction to 57 in May. There was also a reduction in patients who fell more than once, five patients fell twice in April and four patients fell twice in May. Kewstoke and Cheddar wards continue to experience the highest level of falls, although the Medical Assessment Unit experienced a higher than usual number of falls in May. The proportion of patients who fell who were admitted to hospital due to a fall sustained at home rose to 36% in May. During April and May there were two patients that sustained a fractured hip due as a result of a fall in hospital. Both have been investigated as serious incidents with a full root cause analysis being undertaken. One of the investigations has been completed and it was concluded that it was unavoidable. Figure 7:

Trust Actions: During April the orthopaedic nurse practitioner took over the lead for falls prevention. She has attended a convention and bought ideas into the Trust to help prevent patients who are at risk of repeated falls. Kewstoke ward is being supported, and has been identified as a pilot ward for actions to help prevent recurrent falls. The falls prevention care guide has been reviewed and updated. Ward sisters continue to ensure that assessments for enhanced supervision are completed, enabling Matrons to certify support for 1-1 observation. Kewstoke ward received this level of support during April and May. 2.6 Pressure Ulcers A pressure ulcer is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shearing. A number of contributing or compounding factors are also associated with pressure ulcers: the significance of all these factors is yet to be elucidated (European Pressure Ulcer Advisory Panel, 2009). Pressure ulcers are graded in severity from grade 1 which is early signs of skin damage, i.e. localised redness of the area, to grade 4, where damage extends beyond the skin to underlying tissue e.g. muscle. Since February the number of Grade 2-4 pressure ulcers reduced by 21.74%, with 19 in April and 18 in May. Figure 8:

The split of community and hospital acquired pressure ulcers in February and March 2014 is illustrated in Figure 9. Figure 9:

Trust Action:  The strategic pressure ulcer group have developed a training programme called the ‘Pressure Ulcer Trolley Dash’ where senior nurses will be undertaking interactive training sessions on the wards for a month.  The Trust will be investing in pressure relieving devices that support the nursing teams to prevent pressure ulcers for high risk patients.  A programme of micro teaching sessions called ‘Teaching Thursdays’ has been set-up with sessions on nutritional hydration and equipment training taking place in June, specifically aimed to improve pressure ulcer prevention.  The Trust will undergo a peer review of the tissue viability service in July, where a full review of the service will be undertaken to ensure all national best practice is in place. This review had been scheduled for June but has been delayed by the peer review team.  A full root cause analysis is undertaken for all patients that receive a hospital acquired pressure ulcer. Wards sisters are presenting the findings at a weekly round table meeting with Grade 2s reviewed by the Matrons and Grade 3+ reviewed by the Director of Nursing.

2.7 Patient Feedback

2.7.1 Complaints Complaints management is critical to ensuring the Trust not only responds to the complainant in a timely manner, but to ensure the learning from complaints is translated into action. Complaints data enables the Trust to determine if there are any trends in subject matter, location or personnel. Table 2 portrays that the total number of complaints received in April and May was 15 and 27 respectively. The number of complaints received equate to 1.3% of all inpatients in over this period. This is against inpatient activity of 3,159; Emergency Department attendance of 8,770; Outpatient Department attendance of 15,482 and Day case activity of 2,380. All complainants are offered the opportunity to meet with relevant staff should they wish. Six complaint resolution meetings were held in May resulting in satisfactory resolution for the complainant. Should complainants remain unsatisfied with the final response from the Trust, and all options for internal resolution have been exhausted, complainants are advised of the option to refer their complaint to the Complaints Ombudsman. No new complaints were referred to the Complaints Ombudsman in May.

Table 2: Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total t 278 2012 22 28 26 16 36 25 25 18 26 21 19 16 208 2013 17 22 21 19 11 14 17 21 12 24 12 18 118 2014 16 22 38 15 27

The Trust aims to provide a full response to all complainants within 30 working days. The response time to complaints as demonstrated in Figure 10 demonstrates the commitment of the Trust to resolve complaints in a timely manner. The response rate of 73% in May achieved by the Trust did not meet the 80% standard required. However the Head of Nursing for the Emergency Division made a significant improvement this month achieving 85%. A complaint redesign event will take place on 19th June in which further improvements will be identified.

Figure 10: The volume of complaints received this month increased. The Emergency Department received the highest number of complaints (7). Berrow ward received a further two complaints. The Secretarially Team and Steepholm both received three complaints. The Medical Assessment Unit did not receive any new complaints. The Matron and Sister for Berrow ward are continuing to work with staff to adjust to the change in patient mix. The Sister on Steepholm ward has reviewed all of the complaints and identified that they are related to treatment provided by the Multi Disciplinary Team, and only one concern raised was linked to nursing care. One complaint related to treatment delivered in October 2013. The Medical Secretaries Team Leader investigates all complaints relating to the secretarial team. Although measures are in place to minimise the impact annual leave has on the standard of service, it is recognised that last month annual leave put additional pressure on teams which affected the service to patients. Figure 11: Figure 12 depicts the themes identified from the 42 complaints received in April & May 2014. Figure 12:

 Medical Treatment – 14 = 17.28% Medical treatment was a significant theme for complaints this month. 8 out of the 27 complaints mentioned medical treatment. Three of the complaints raised concern that the clinician did not appear to have a clear treatment plan, or that the plan was not appropriate. Two complaints related to a clinician not appearing to be appraised on the patient’s history. Further themes identified from complaints relate to; the timeliness of prescribing pain relief, level of cover by a clinician at weekends which delayed treatment, missed diagnosis of a fracture, patient not put at centre of end of life care.

The Model Ward project which is currently underway across the Trust will ensure that patients have a clear management plan.

 Communication – 22 = 27.16% The main theme of complaints was communication. Patients have raised concerns with communication between teams in four complaints; wherein information was inaccurate or inconsistent. The other main reasons for concern related to urgent follow-ups that were not actioned in two cases, the information on appointments or results not being provided in a timely manner in two cases. Concerns were raised in two complaints relating to not keeping the family informed and updated on care and treatment.

The Model Ward project which is underway across the Trust continues to have a focus on medical staffing communication with patients and their families. One aspect of this project is aimed at improving communication with patients and their family regarding discharge. A checklist is being used on admission to set out expectations and the treatment plan.

 Nursing Care – 7 = 8.64% The number of complaints linked to nursing care increased slightly but remains low.

 Discharge – 6 = 7.41% This month there was a significant increase in the number of complaints related to discharge in the Emergency Division. Patients and their families raised concerns about the lack of planning in two cases, transport in three cases, communication and medication.

The Trust has an action plan to improve the discharge of patients. Currently there is a focus on preparing discharge summaries before the day of discharge to ensure that medication and transport are in place. Pharmacists are now checking patient’s medication on the day of admission to make sure that the patient has an adequate supply that is kept in the medication locker ready for discharge.

In June the Discharge Lounge started gathering feedback to determine the satisfaction of patients with their discharge through this route. 2.7.2 Compliments The Trust is not able to report at this time on the number of compliments received in May. A new system of reporting and recording this information is being introduced. The system has not yet been fully implemented. Wards are continuing to focus on gathering patient feedback and it is hoped that reviewing the exit cards weekly will encourage staff to make sure patients are given the opportunity to provide feedback before leaving the hospital. The Compliments formally recorded are received via email or letter. Table 3 depicts three examples of compliments received by the Trust in April. Where appropriate, each compliment receives a letter to thank the individual for taking time to comment. Table 3: COMPLIMENTS

A thank you from I was in your ward during May – unconscious for some of the time. I want to a long stay thank you and all the staff for the nursing care I received. When I came to I patient on was very happy on the ward. Thank you so much. Harptree ward There are often letters of complaint in local papers with regards to the service and care received at our local hospital and I for one would like to redress some of the balance Praise of and express my thanks for all of the care I recently received. Just 10 days ago I Weston General discovered a lump in my breast. Since that time I have had an appointment with my Hospital and its local GP and an appointment at Weston General Hospital with immediate treatment. All in all the whole experience was quick, clean and efficient and the staff at Weston staff. General were lovely. A huge thank you to all the staff concerned. You all helped to make a very anxious time as quick and painless as possible. I was discharged from hospital on 4th June. While I was in every ward I had exceptional nursing care and I want some way to broadcast it so other people A thank you from will know I was in several wards and care in each was of such high standard I a patient would like to comment more. They looked after me with kindness and dignity and with great care your nursing staff are a supreme credit to you. I would recommend your hospital to anyone. 2.8 Patient Feedback

2.8.1 Exit Questionnaires The Trust is committed to improving the experience of patients in support of meeting the Friends and Family Test National CQUIN and to align with Domain four of the NHS Outcomes Framework to continually improve the care and treatment which patients receive. In addition to the Friends and Family test score, the information gathered on in-patient experiences allows the Trust to gain real time commentary to drive up choice and quality. Figure 13:

In May there was a steady increase in overall patient satisfaction with all patients reporting overall satisfaction with how they were treated with dignity and respect as very good.

2.8.2 Friends & Family Test To improve the experiences of patients in line with Domain four of the NHS Outcomes Framework, and in support of meeting a national CQUIN, Weston Area Health NHS Trust is engaging in the delivery of the Friends and Family Test (FFT). Friends and Family Test is a single question survey which asks patients ‘how likely are you to recommend this organisation to friends and family if they needed care or treatment?’ Patients are invited to provide Friends and Family test responses in all inpatient wards including Emergency Department attendees and Maternity Service users-(antenatal care birth, care on postnatal ward and postnatal community provision) on their discharge from hospital. Figure 14 to 16 provide a breakdown of performance by the various reporting groups and Figure 17 provides an overview of all areas. Figure 14:

Figure 15: Figure 16:

Figure 17:

* Net Promoter is shown via the bars whilst the response rate is the line. The target for the response rate (15%) is illustrated. * (Blue=Wards; Red=Emergency, Yellow=Maternity, Grey=Not Currently Submitted.

The Accident and Emergency Department increased their net promoter score 83 in April and 92 in May. A drop in Accident and Emergency response rates from 18% in April to 13.8% in May has resulted in missing the National indicator of 15% for May. MAU also significantly improved their net promoter from 52 in April to 84 in May. The overall net promoter for acute wards, emergency care and maternity dropped marginally from 63 in April to 59 in May. The overall response rate for acute wards marginally dropped from 37.5 in April to 34.7% in May. Harptree, Hutton, Uphill, Waterside, MAU, Births, Post Natal Care and Post Natal Community Care all increased their response rates in May. However, Berrow, Cheddar, Kewstoke, Steepholm, Stroke Unit, A&E/AEC and Antenatal response rates were lower than in April. Actions:  Introduction of the Model Ward- improving quality and patient experience-Berrow Ward.  Daily review of Exit Cards to enable prompt action to address negative response from patients.  Wards will engage carers to complete Friends and Family test question on behalf of patients’ with a cognitive impairment-all wards  Enlist support of discharge facilitators to remind patients on discharge to complete Friends and Family test question on Exit Cards in -hours (Mon-Fri)  Daily Board Rounds will identify patients’ with an expected discharge date and provide patient with an Exit Card.  Exit Card will be collected from patient before patient leaves ward.  Ward Sisters on Kewstoke and Stroke Unit are piloting sending patients Exit Cards in stamped addressed envelopes if not completed prior to discharge. 2.9 Mortality Data

The latest iteration of the SHMI is illustrated in Figure 18. The value of 0.99 lies well within the parameters expected given the age and co-morbidities of the patients treated, and represents the best showing by the Trust since the first publication of the SHMI in 2012. The current figure of 0.99 indicates that the number of deaths was nine fewer than anticipated (actual deaths = 960; expected deaths 969). The SHMI has now been published six times and Table 4 summarises the data for each period. Figure 18:

Table 4: Period SHMI % of Deaths Deaths Deaths Elective Emergency deaths with within 30 within 30 occurring patient patient a palliative days of days of in hospital activity activity care code elective emergency (%) admission Admission (%) (%) July 2011 – 1.07 19.89 20 (1) 920 (5.62) 657 (69.82) 1995 16364 June 2012 October 2011 1.05 20.39 17 (0.87) 915 (5.51) 657 (70.74) 1963 16616 – September 2012 January 2012 1.03 21.08 12 (0.63) 913 (5.71) 633 (68.43) 1890 15996 – December 2012 April 2012 – 1.01 18.58 12 (0.65) 919 (6.01) 645 (69.28) 1833 15279 March 2013 July 2012 – 1.02 18.18 10 (0.56) 969 (6.44) 664 (67.82) 1776 15051 June 2013 October 2012- 0.99 19.38 8 (0.46) 952 (6.36) 651 (67.81) 1747 14964 September 2013

Whilst the SHMI describes the overall picture for hospital and community deaths Figure 2 illustrates the Trust’s position (red dot) relative to the national picture for those deaths which occurred only in the hospital setting for the period March 2013 to February 2014. Again the Trust’s performance is better than expected. Figure 19:

2.10 Infection Prevention & Control Performance

2.10.1 Clostridium Difficile

The Trust has been set a trajectory of 17 hospital attributable cases of Clostridium difficile for the financial year 2014/15. Prevention of avoidable hospital attributed cases is a priority for the Infection Prevention and Control Team and a recovery plan has been implemented to give assurance that the Trust can work within this target. No cases of hospital attributable Clostridium difficile were reported in April, however, one case developed on the Stroke Unit in May. There were some recurrent themes with this case around antibiotic prescribing which are being addressed by the Consultant Microbiologist. The patient had previously had a Clostridium difficile infection some years ago whilst in a Bristol hospital which we had been unaware of. Moving forward, with the introduction of a more sophisticated and intra-operable computer system, we will be able to acquire this crucial information on our patients from the time that they are admitted. This will, in turn, lead to greater vigilance when consideration is given to the prescription of antibiotic treatment. The work on stewardship around the use of inappropriate antibiotics is progressing. An antimicrobial pharmacist is now in post and daily rounds are being undertaken to focus on whether antibiotics that are prescribed are necessary and if so, whether they are being prescribed appropriately and for the correct duration. The Consultant Microbiologist has set up an Antibiotic Stewardship Group which has its inaugural meeting in July 2014. Figure 20:

2.10.2 MRSA / MSSA Bacteraemia

The Trust has a zero trajectory for MRSA bacteraemia and has not reported any cases in the financial year 2014/15. Three cases of MSSA bacteraemia have been reported during April and May 2014. Our threshold for these blood stream infections is three for the whole of this financial year. This is of great concern for the Trust, and a recovery plan is being developed to give assurance that all preventative measures can be implemented and embedded in process. Following robust root cause analysis of these cases; two were identified as contamination of the blood culture specimen, either by technique or inadequate preparation of the skin. The policy relating to this procedure has been updated and will be ratified at the Infection Prevention and Control Committee in July 2014. The Consultant Microbiologist has attended the Junior Doctor forum and discussed this issue and the implication of contamination rates on the Trust in detail. Quarterly auditing of contaminated specimens continues and more training will be focussed in areas where a problem is identified, particularly in the Emergency Department. In the third case the patient had previously been colonised with MSSA. The patient was septic on admission but blood cultures were not taken in a timely fashion. This has been identified and addressed with the Emergency Department.

2.10.3 Hand Hygiene Audit Monthly internal audits are undertaken by Infection Prevention and Control Link Practitioners. The audits look at three areas of hand hygiene – environment, observation and technique. A minimum expectation is that ten audits of each aspect are carried out each month. The Director of Infection Prevention and Control is supporting the completion of these audits by releasing time for the link practitioners to undertake and submit these audits. Overall Trust wide compliance against the question ‘Are hands decontaminated at the 5 moments for hand hygiene as determined by the World Health Organisation?’ was reported at 97% in both April and May. A working hand hygiene action plan is in use and external validators have given us assurance that we are reporting accurately. Compliance with the ‘Bare Below the Elbow’ initiative has noticeably increased amongst our medical colleagues.

2.10.4 Carbepenemase Producing Enterobacteriaceae (CPE) A toolkit for the early detection, management and control of Carbepenemase Producing Enterobacteriaceiae (CPE) has been released by Public Health England. These bacteria are of international concern due to the extremely limited antibiotics that are effective in treating infections. CPE can cause infections in wounds, urinary tract, blood stream and pneumonia. To date the Trust has cared for one patient with this organism who was known to have the infection prior to admission. A new Infection Prevention and Control risk assessment has been introduced into the admission document in June 2014 to identify patients at risk of CPE. Screening of these patients will then be undertaken, ensuring that the patient is isolated until we can prove that they do not have CPE. A policy for care and management of patients has been produced and will be ratified by the Infection Prevention and Control Committee in July 2014.

2.10.5 Outbreaks There were no outbreaks in April or May 2014. 2.11 Maternity The maternity team achieved both its national targets for instantiating breastfeeding in-hospital and mothers not smoking at the time of delivery in April and May.

2.12 Venous Thrombo-Embolism (VTE) The completion of the VTE risk assessment and the necessary actions as a result of the assessment is vital for patient safety to ensure that patients are not at risk of unnecessary harm from avoidable DVT or pulmonary embolism. The Trust is aiming to achieve 100% of inpatients receiving a VTE risk assessment according to NICE guidance in 2014/15. In May the Trust achieved the national target of 95% with 95.8% of appropriate patients receiving a VTE risk assessment. This was the first time the target has been achieved in 14 months. Trust Action: The Executive Medical Director for the Trust has identified performance against the VTE target as her key priority for 2014/15 and is undertaking a number of actions to continue to improve performance:  A programme of micro teaching sessions has been set-up called ‘Teaching Thursdays’ with a session on VTE booked to increase nursing knowledge of the importance of strong VTE management.  VTE committee continue to meet, review performance and agree and undertake necessary actions.  The Trust auditor of VTE will continue to undertake daily prospective audit of VTE assessments and challenge teams where performance does not meet 100%.  Patient leaflets are being produced to educate patients on how to self manage within hospital to reduce the risk. Section 3 Operational Performance

3.1 Executive Summary Headlines

 The Trust achieved the four hour Emergency Department target for the sixth consecutive month.

 In May the 62 day cancer target was achieved in line with the planned trajectory.

 The Trust continues to be on course to reduce the numbers of patients waiting over 18 weeks in Urology and Trauma & Orthopaedics to zero by the end of July 2014.

 Delayed transfers of care reduced to their lowest levels in 26 months.

3.2 Operational Performance

The following sections detail the Trust performance against a number of key indicators. The report is divided into:  Clinical Indicators  Clinical Pathways  Emergency Access  Elective Access  Patient Flow

3.3 Clinical Indicators This section analyses the clinical indicators which directly influence operational performance.

3.3.1 Emergency Readmissions

An emergency readmission is defined as an unplanned readmission within an identified time of leaving the hospital. The ideal readmission rate is zero however this is not always possible as patients can have multiple co-morbidities or long-term conditions which require frequent medical attention. Monitoring emergency readmission rates is important to the Trust as it can help to prevent or reduce unplanned readmissions to hospital.

The Trust monitors emergency readmissions within 14 days and 30 days. As illustrated in Figure 21 performance continued to improve across April & May.

Figure 21: Trust Action:

To provide additional assurance that emergency readmissions are not related to the original episode of care, the Divisional Director for the Emergency & Urgent Care Division will be undertaking an audit with the results presented to the Executive Management Group.

3.3.2 Average Length of Stay

The average length of stay (ALOS) refers to the average number of days that patients spend in hospital. The Trust strives to have a length of stay below the Trust target as it demonstrates proactive planning of the whole process of care, as well as active discharge planning. In April and May (Figure 22) the Trust experienced a length of stay below Trust target. It was also 0.8 and 0.6 days respectively below the previous year. This demonstrates that the programme of work undertaken to improve patient pathways has had a significant difference, enabling patients to recover quicker and return home. Figure 22:

The Trust also monitors the percentage of patients with a length of stay (LOS) over 10 days. The programme of work to improve patient pathways and the level of care alongside the focus on the Green to Go List has enabled the Trust to experience a considerable reduction of 5.02% if April 2014/15 is compared to 2013/14 as illustrated in Figure 23.

Figure 23: Trust Action: As part of the Trusts Business Plan, a number of quality work streams have been developed which continue to strengthen the improvements made to the patient pathway:

 Model Ward Workstream: This work stream was successfully trialled on Berrow ward where best practice structures were put in place, ensuring that patients are cared for by the right team, in the right place for the right amount of time. This led to a reduction in LOS on the ward of 20%. This is in the process of being rolled out across all medical and surgical wards.

 Discharge Planning Workstream: This work stream puts in place a culture where discharge plans for patients are made at the point of admission to ensure that when patients are medical fit to leave an acute care setting, they are have the plans in place enabling a safe and timely transfer to the most appropriate setting which supports the continued recovery of the patient. 3.4 Clinical Pathways

This section sets out performance indicators related to key clinical pathways, including cancer, stroke and fractured neck of femur.

3.4.1 Cancer Services

The Trust strives to achieve the national cancer waiting times as they are important to patients clinical outcomes, are a measure of how the Trust is responding to demands for services, and highlights where there are delays in the system. In April the Trust experienced an improvement in the achievement against the eight national cancer waiting time targets with the 62 day target accomplished in line with the Trust set performance trajectory.

3.4.1.1 Cancer Two Week Wait

The two week wait target was achieved in April for the tenth consecutive months with a percentage of 95.7%. Unfortunately the Trust was unable to achieve the two week wait target for referrals with breast symptoms for the second consecutive month but improved compared to the previous month.

Trust Action:

A number of actions are being undertaken to improve performance against the Breast Symptomatic target:

 There was a 15% increase in referrals from 2012/13 to 2013/14. The Cancer manager is undertaking a capacity and demand analysis alongside the Breast Multi-Disciplinary Team. The results of this analysis will inform a redesign of the service to meet the increasing demand.

 The main cause of breaches was patient choice, where patients were not made aware of the need to attend their appointment within two weeks. To support GP's and other health care professionals to inform patients of the need to attend within two weeks, the Cancer team have developed a patient fast track leaflet which will explain the process to patients. This has been approved by Somerset CCG. North Somerset CCG is currently reviewing the leaflet with their membership.

 A review is being undertaken into how the Trust processes the breast symptomatic referrals to ensure that it is streamlined and does not delay patients from receiving an appointment.

3.4.1.2 31 Day Target

The Trust achieved 100% for all three of the 31 day targets in April demonstrating the Trusts ability to effectively treat patients once diagnosed with cancer.

Trust Action:

Daily monitoring of performance by the MDT Coordinator and cancer team leader.

Weekly monitoring at the Waiting List Forward Planning meeting.

3.4.1.3 62 Day Target

The Trust achieved the 62 day target in April with performance of 85.9%. This is a target where performance relies on close working with specialist centres to undertake treatment and diagnostics within the target time. In April the NHS failed the target nationally, demonstrating the significant work undertaken by the Trust to achieve the national standard. Unfortunately the Trust did not achieve the 62day upgrade standard. This was as a result of only two patients being treated in month with one choosing to wait longer through personal choice.

Trust Action:

Daily monitoring of performance by the MDT Coordinator and cancer team leader.

Weekly monitoring at the Waiting List Forward Planning meeting. 3.4.2 Stroke The Trust continued its strong finish to 2013/14 with the stroke target of patients diagnosed with a stroke spending 90% of their time on the Stroke Unit for 80% of patients achieved in both April and May (Figure 24). This is a significant improvement on the last financial year where the target was not achieved. Achieving the target remains a key focus for the Trust patient flow teams.

Figure 24:

Trust Action: Performance reviewed daily at the Operational Performance Meeting. The Emergency & Urgent Care Division continues to hold regular meetings with the Stroke team to monitor performance, work through any issues and agree actions to improve. The meeting also ensures that actions and changes agreed are delivered. 3.5 Emergency Access

3.5.1 Emergency Department (ED) Performance The NHS constitution set the national standard wherein 95% of all patients attending NHS Emergency Department’s spend a maximum of four hours in the department before being discharged, referred/transferred to other services or admitted to the hospital and transferred to an inpatient bed. The target was achieved in April and May with 96.6% and 96.3% respectively (Figure 25). This is a significant improvement on the previous financial year. Figure 25: Trust Action: The Trust continues to run daily performance meetings for patients flow to facilitate continuous learning and improvement and to engage the teams to understand their business, enabling the art of accurate prediction and early intervention. Daily system wide conference calls continue to take place with the health and social care partners in North Somerset. Performance is reviewed on a daily basis and actions are agreed to fully utilise all resources. 3.6 Elective Access This section reviews the key elective access targets to understand the effectiveness and the quality of care throughout the elective care pathways.

3.6.1 Referral to Treatment (RTT) The NHS constitution states that patients have the legal right to start their NHS consultant-led treatment within a maximum of 18 weeks from referral, unless the patient chooses to wait longer or it is clinically appropriate to wait longer. For the months of April and May the following sub-sections will review the Trust performance against the three national 18 week targets.

3.6.2 Referral to Treatment (RTT) Admitted The Trust did not achieve the admitted 18 week target in April and May in line with a plan agreed with the Clinical Commissioning Group and the Trust Development Authority to enable the Trust to treat all patients over 18 weeks for Urology and Trauma & Orthopaedics.

Figure 26:

Trust Action:

The Trust continues to reduce the numbers of patients over 18 weeks for Trauma and Orthopaedics and Urology in line with the agreed trajectory.

The Trust continues to undertake weekly waiting list forward planning meetings where the waiting list for each specialty and the theatre timetable is reviewed by the Assistant Divisional Manager of Planned Care, Access Manager and Theatre Manager. From the new financial year this has been strengthened with the Director of Operations in attendance.

3.6.3 Referral to Treatment (RTT) Non-Admitted The Trust continued to achieve the non-admitted target in April and May as illustrated in Figure 27.

Figure 27:

Trust Action: The Trust will continue to undertake waiting list forward planning meetings where the waiting list for each specialty and the theatre timetable is reviewed on a weekly basis with the Assistant Divisional Manager of Planned Care, Access Manager and Theatre Manager. This has been strengthened with attendance of the Director of Operations to ensure improvement trajectories are delivered moving forward.

3.6.4 Referral to Treatment (RTT) Incomplete The 92% target was achieved for both April and May 2014 as illustrated in Figure 28.

Figure 28: Trust Action: The Trust will continue to undertake waiting list forward planning meetings where the waiting list for each specialty and the theatre timetable is reviewed on a weekly basis with the Assistant Divisional Manager of Planned Care, Access Manager and Theatre Manager, attendance has now been strengthened with the Director of Operations in attendance. 3.6.5 Choose and Book In April and May the Trust did not achieve the 96% National target for Choose and Book slot availability target as depicted in Figure 29. Current performance is caused by a number of factors:  The planned closure and transfer of two clinical services to specialist providers has impacted on the ability to provide slots ahead of the move.  The Trust has experienced a continued increase in two week wait referrals resulting in choose and book slots being used to provide additional urgent appointments  Capacity provided by visiting Trusts has not been enough to match demand leading to no slots being available for patients.

Figure 29:

Trust Action: A plan is being developed to redesign the entire Planned Care pathway from referral to treatment as it forms a key part of the Trust's Business Plan. As part of this work demand and capacity and the process of referral is being reviewed which will significantly improve performance against the Choose & Book target in the long-term.

In the short-term the Trust is working closely with the provider Trusts of the visiting services of ENT and Opthalmology to ensure that the Trust receives the capacity required. Also, work is ongoing to increase internal capacity trough additional waiting list initiatives and changes to job plans to facilitate increased capacity.

3.6.6 Cancelled Operations

Minimising the number of last minute cancelled operations for non clinical reasons is a key target for the Trust. Elective surgery can be cancelled for a number of reasons including:

 Hospital Beds unavailable

 Surgeon or Anaesthetist unavailable

 Emergency case needing theatre

 Theatre list over-ran

 Equipment failure

 Administrative error

In April and May the Trust did not achieve the internal Trust target for the cancellation of elective care operations for non-clinical reasons.

Trust Action: To reduce the level of non-clinical cancellations a Theatre Scheduling meeting has been introduced where the theatre team, access team and operational managers will meet to review all theatre lists to ensure that all the theatre kit is ordered, the patient mix and order is optimised and to provide an opportunity to learn from past mistakes through reviewing cancellations and putting in place actions to stop reoccurrence. 3.7 Patient Flow To support the delivery of key operational targets, it is vital that the Trust has good patient flow. An important aspect of ensuring good patient flow is the level of discharges throughout the day and at the weekend.

3.7.1 Delayed Transfer of Care A delayed transfer of care is defined as when a patient is ready for transfer from acute care, but is still occupying an acute bed. Patients can be delayed for the following reasons:

 Further assessment required before their discharge destination can be decided  Lack of capacity in local nursing/residential homes  They may require a specialist placement  Patient or their family/carer needs more time to make a decision about a long-term placement

The Trust monitors performance daily against delayed transfers of care as high levels can have a big impact on the daily numbers of discharges, causing delays in allocating beds for emergency admissions or planned operations. Performance in April fell slightly compared to the previous month, but significant reduced in May to 1.96% (Figure 30). This demonstrates that the introduction of the new case manager team and the use of the ‘Green to Go’ list is having the desired impact.

Figure 30:

Trust Action: The site manager and senior case manager are visiting both Clevedon community hospital and Burnham community hospital to further strengthen relationships and facilitate a streamlined process for the referral and acceptance of patients. The Trust continues to work with health and social care partners in North Somerset to manage the ‘Green to Go’ list, and where gaps in services are discovered, work with the Clinical Commissioning Group to identify how future commissioning can be organised to close these gaps, providing higher quality joined up care between all partners. The numbers on the list are monitored daily on the system operational calls which include all partner organisations.

Section 3 Workforce

4.1 Executive Summary Headlines

 The temporary staffing costs in April were 9% of the total pay bill and 9.2% in May.

 Sickness rates were 3.93% in April and 4.26% in May

 The appraisal rate decreased to 83.83% in April and 80.61% in May.

 The training compliance rate has increased from 81.61% in March to 82.77% in May

4.2 Workforce Figure 31 shows the pay expenditure for contracted staff, for agency staff, and for staff funded through winter monies. Figure 31:

Figure 32 shows the temporary staffing usage as a month on month comparator. April shows a significant decrease in temporary staffing usage for nursing; both bank and agency. This shows a considerable decrease compared to April 2013, and with the exception of January 2014, where there was winter funding support, this is the lowest month for temporary staffing usage in the last year. The decreased level of temporary staffing (WTE) continued in May; however the cost for both bank and agency increased.

As at 31st May 2014, there were 7.91 WTE Registered Nurse (Band 5) vacancies and this number will decrease further in June due to the closure of Cheddar ward, which happened on 6th June 2014. Advertising for Registered Nurses continues to ensure a steady supply to the Trust.

Temporary staffing usage within medical workforce is the highest cost in April due to vacancies which are currently being recruited to. A number of these vacancies are difficult to recruit posts including Emergency Department Staff Grades, Gastroenterology Consultant, Acute Physician and Community Paediatric Consultant.

We are exploring all avenues to attract high calibre candidates to make application for these roles as our goal remains to have substantive in post wherever possible. This provides a more stable workforce and manages costs within budget.

Figure 32: 4.2.1 Sickness Sickness in April has reduced to 3.93% however increased again in May to 4.26%. Comparatively the sickness for April and May are higher that this time last year, which shows a poor start to the year. The sickness rates are higher within the Planned Care Division which has had an impact on the overall sickness rate. During July the HR team will be auditing departments/wards with the highest sickness levels to ensure all sickness monitoring is being completed in accordance with the Trust policy.

Figure 33:

* Trust standard is ≤ 3.0% 4.2.2 Statutory/Mandatory Training The statutory/mandatory training compliance rate has increased from 81.65% in March to 82.75 in April and then 82.77% in May. Whilst the Trust has not achieved the target of >90% it should be noted that the overall level of performance has been maintained above 80% for 8 months. 4.2.3 Appraisal Whilst appraisal rates had increased during January to March to take the Trust appraisal rate to 87.43%, this has decreased over the past two months to 80.61%. The decrease in appraisal compliance is disappointing as maintaining a consistently high level of appraisal compliance is required. Managers will be encouraged to focus on appraisal completion as we have shown that we have capacity to undertake this important conversation with staff. 4.2.4 Friends and Family Test The implementation of a quarterly friends and family test for staff has been implemented during quarter one, the closing date for returns is 20th June 2014, analysis of the first set of results is due 28th July 2014. 4.2.5 Celebration of Success The Trust is in the process of arranging our inaugural celebration of success event, which will become an annual event. Nominations and judging of finalists has been concluded and all finalists have been invited to an Award Ceremony. The Award categories are listed below;

 Pride of Pride Award  Newcomer of the Year  Nurse of the Year  Nursing Assistant of the Year  Clinician of the Year  Gold Award  Team Spirit Award  Patients Ally  Volunteer Award

The awards ceremony will take place on 10th July where the winners for each category will be announced. Section 3 Finance

5.1 Executive Summary Headlines

 The financial position at Month 2 is that the Trust is reporting a year to-date deficit of £1,098k which is in line with the plan.

 Overall income is £2k under plan at the end of May.

 Overall expenditure is £4k over plan at the end of May.

 The Trusts plan for the year is a deficit budget of £4.95m

5.1.1 Statement of Comprehensive Income Position to Date

The financial position at Month 2 is that the Trust is reporting a £1,098k deficit which is in line with the annual plan.

Revenue from patient activity is £41k under plan for the 2 months to the end of May 2014. Other sources of income have generated £39k more than plan. Overall expenditure for pay, non pay and depreciation is £23k under plan at the end of May.

The Trust’s Service Improvement Programme (SIP) has a year to date achievement of £270k against the target of £508k.

The adjusted run rate for expenditure has reduced by £93k in May when compared with the April level.

5.1.2 Statement of Comprehensive Income Position in Month

Income from patient care activity is £20k less than plan whilst other sources of income generated £38k more than plan.

Pay and non pay expenditure, including the shortfall in savings delivery, is £23k above plan for the month of May.

The Trust’s Service Improvement Programme (SIP) delivered £155k in May against a plan of £304k. 5.1.3 Cash

The cash plan for 2014/15 is to hold a balance of £532k at 31st March 2015 and this will be delivered through the in year management of cash and working balances. The cash balance of £2,508k, as at 31st May, is £493k higher than the planned position of £2,015k.

The Trust has submitted an application in June 2014 for £4,950k Permanent Dividend Capital (PDC) Revenue Support, similar to the last financial year. The application will be via the NHS Trust Development Authority and for approval by the Independent Trust Financing Facility Committee which will ensure that there is sufficient cash to pay all commitments.

5.1.4 External Financing Limit

The Trust’s External Financing Limit will be achieved through the management of cash and working balances along with the planned level of Public Dividend Capital.

5.1.5 Capital Resource Limit

The capital resource limit is £3,858k and in addition to this the Trust is due to receive £124k matched funding from the NHS Safer Hospital, Safer Wards Technology Fund for the implementation of a new Order Communications system. Therefore the Trust’s anticipated forecast capital resource and spend on capital projects is £3,982k at 31st March 2015.

As at the 31st May the programme has delivered capital expenditure of £48k. The Trust will operate within its Capital Resource Limit and continued capital programme management will enable this to be achieved.

5.1.6 Capital Cost Absorption rate

The Trust’s Capital Cost Absorption (CCA) rate is fixed at 3.5% and this will be calculated based on 3.5% of actual balance sheet values at the end of the financial year.

5.1.7 Better Payment Practice Code (BPPC)

The Trust’s overall performance as at 31st May is 97.0% on the BPPC.

5.1.8 Forecast Outturn

The Trust is forecasting to deliver the plan for the year although this will require delivery of the Trusts savings plans and the continued management of the Trusts services within the available budgets. 5.1.9 Risk to Delivery of Financial Plan

The major financial risks are the delivery of the £4.5m savings programme and the delivery of NHS service income in line with plan.

Financial Dashboards 2014/15: Month 2 March 2014 April 2014 May 2014

Annual Forecast Forecast Level 1 Financial Target Plan / Traffic Variance Plan / Traffic Variance Plan / Traffic Variance Outturn Outturn Indicator Calculation 14/15 Target Actual Light from Target Target Actual Light from Target Target Actual Light from Target Actual Traffic Light Financial duties Bottom line Statement of Bottom line Comprehensive Statement of Income against plan Comprehensive Surplus/ (Deficit) Cumulative Income before impairments -4950 -4950 -4683 Green 267 -584 -584 Green 0 -1098 -1098 Green 0 -4950 Green Bottom line Statement of Bottom line Comprehensive Statement of Income against plan Comprehensive Surplus/ (Deficit) In month Income before impairments -4950 -1068 -801 Green 267 -584 -584 Green 0 -514 -514 Green 0 -385 Green Achievement of Cash available External Financing against planned cash Cumulative Limit available 532 303 750 Green 447 1112 2023 Green 911 2015 2508 Green 493 532 Green Achievement of Capital Resource Capital Expenditure Cumulative Limit against plan 3982 3756 3746 Green 10 14 14 Green 0 48 48 Green 0 3982 Green

Subsidiary duties Capital cost Cumulative absorption rate 3.50% 3.50% Green 3.50% Green 3.50% Green 3.50% Green

Year to date performance against the prompt payment policy for Combined Better Payment NHS & Non-NHS Cumulative Practice Code suppliers (by number) 95.0% 95.0% 94.9% Amber -0.1% 95.0% 95.9% Green 0.9% 95.0% 97.0% Green 2.0% 95.0% Green

5.2 The Income and Expenditure Position of the Trust

5.2.1 The financial position at Month 2 is a deficit of £1,098k, which is in line with the plan.

Expenditure

5.3.1 The main points are:

 The position is that overall the Trust has overspent the expenditure budgets by £4k which includes non delivery of Savings (SIP) of £238k.  Pay expenditure is lower than budgeted with an underspend of £96k. The staff categories with significant underspends at the end of April were AHP’s (£83k), Admin and Clerical (£47k) and Medical staff (£36k).

 Non pay expenditure is £138k under budget for the month of May, excluding the underachievement of savings. There are underspends on Medical and Surgical equipment (£32k), Drugs (£24k), Training (£17k), Blood products (£16k), X ray expenditure (£13k) and Catering (£10k) offset by overspends on Internal recharges (£12k) and Utilities (£6k).

 Bank and agency expenditure on Nursing increased in May. In month the nurse agency expenditure is £112k (up from £106k in April) and nursing bank is £132k (up from £123k).

 In recent months the Trust has an increasing number of Medical staff vacancies which has led to an increase in the use of Agency locums to cover the Trusts regular bed base. In May £250k was spent, £4k less than April, and close to the highest level required for the regular bed base during the last 2 years.

5.3.2 At Month 2 the main points for the Divisional and Corporate performance are as follows:

 The Emergency Division has underspent by £30k. Of this, Pay expenditure was underspent by £24k whilst Non Pay is overspent by £42k. There is also SIP under delivery of £33k and a shortfall in the delivery of divisional income against plan of £14k.

 The Planned care Division has underspent by £5k. The pay underspend is £80k whilst non pay is underspent by £1k. The divisional income is £32k above the planned level. The SIP underachievement is £108k.

 The Estates and Facilities Division has overspent by £25k in month 2, mainly due to savings non- delivery which accounts for £66k, with a Pay overspend of £15k and a Non pay underspend of £55k.

 The Corporate Departments have underspent by £83k.

Reserves have been deployed to cover spend where there are agreed allocations such as the cover of Medical agency premiums.

5.3.3 The Trusts expenditure run-rate information has been rebased to neutralise the affect on both expenditure and budgets for variations in monthly NICE funded drugs expenditure which has no overall impact on the Trusts net financial position. There have also been some amendments for one-off exceptional items. The Trust’s expenditure run rate is shown in the table below compared to the adjusted expenditure level for each month of 2013/14. 7749 7700 Trust expenditure run rate against budget (Including SIP, after one-off adjustments)7689 7701 7698 7670

7650 7604 7600 7624 7622

7591 7584 7571 7577

7500 7516

7447 7400 7422 Total Budget 1314

£000 7300 Total Budget 1415 7298 7275 Total Expenditure 1314 7200 Total Expenditure 1415 7180 7171 7157 7142 7100 7125 7092 7080 7065 7000

6975 6970

6900 5 4 4 4 4 4 4 4 5 4 4 4 4 4 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / / / / / / 3 3 4 3 3 3 3 4 3 3 3 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1

l t t r r v y c i y y g n e b l r p c p a o e a a u a n e u p e O A J u F M J A N D M M A S J

The main points are: The budgeted adjusted run rate for April is £7.604m. The adjusted run rate for expenditure has reduced in May by £93k, from April £7.670m to £7.577m in May. Of the £51k in month reduction Drugs costs fell by £35k, Medical and Surgical equipment by £18k, X-ray expenditure fell by £16k and Rent and Rates by £11k. Some of these decreases were offset by increases in Nursing pay expenditure of £50k, Medical staff pay of £10k and Estates expenditure by £10k. 5. 4 Savings Plans (SIP)

5.4.1 The Trust has a savings requirement of £4,500k for the year which represents 4.45% of expenditure budgets. Savings plans have delivered £270k against the profiled plan of £508k for the two months. Of the SIP savings delivered £241k is from recurrent schemes and £29k from non-recurrent schemes. In month the Trust delivered £155k of the £304k required. The Trusts performance against its monthly SIP savings requirement is shown below along with the monthly phased plan.

The Trust will take actions to ensure that the savings plans are implemented and milestones are met, with mitigating action where needed, to maximise the delivery of savings. Progress of individual schemes will be reviewed at the monthly Business plan delivery meetings.

SIP planned savings & actual achievement by month 2014/15 4500

4000

3500 Planned SIP savings

e (Excludes c/f) v i t a

l 3000 u

m Actual Recurrent SIP u 2500 C savings

0 0 0

£ 2000 Total savings 1500

1000

500

0 0 2 1 2 3 4 5 6 7 8 9 1

1 1 1

h h h h h h h h h t t t t t t t t t h h h t t t M M M M M M M M M M 2014/15 M M

5. 5 Activity and Income

5.5.1 Overall patient activity income is assessed at £41k below plan at the end of May 2014. The main points regarding activity are:

 Income related to North Somerset CCG contract is £216k under plan.  Income related to the NHS Somerset contract is £27k over plan.  Income related to other CCG patient care activities is £49k over plan.  Income related to Specialist services contract is £104k over plan.  Income related to Local authorities is £11k over plan.  Income related to private patients is £16k under plan.

2 Months ending May 2014 Activity and Income Report

Annual YTD YTD YTD Plan Plan Actual Variance Variance £,000 £,000 £,000 £,000 %

Day cases 8,087 1,347 1,463 116 8.6% Elective Inpatients 5,762 955 1,004 49 5.1% Non Elective Inpatients 26,946 4,320 4,392 72 1.7% Non Elective Excess Bed Days 1,616 259 200 (59) -22.8% Emergency pathway reconfiguration 0 0 (13) (13) Elective Excess Bed Days 74 12 13 1 8.3% First Outpatients 6,181 1,023 992 (31) -3.0% Follow up Outpatients 5,697 946 873 (73) -7.7% Outpatient procedures 1,256 209 95 (114) -54.5% Unbundle OP radiodiagnostic 1,390 232 214 (18) -7.8% ED attendances 6,181 985 981 (4) -0.4% Critical Care 2,608 434 434 0 0.0% Rehabilitation 1,577 263 244 (19) -7.2% Children Services 2,631 439 439 0 0.0% Direct Access 3,142 524 572 48 9.2% Maternity Services 2,784 366 406 40 10.9% NICE income 3,202 534 552 18 3.4% Private patients 738 129 113 (16) -12.4% Other 4,937 821 863 42 5.1% QIPP schemes 0 0 0 0

Sub total 84,809 13,798 13,837 39 0.3%

Penalties 0 0 (20) (20) CQUINS 1,876 313 253 (60) -19.2%

Total 86,685 14,111 14,070 (41) -0.3%

The underperformance in Outpatients, Rehabilitation, Non elective excess bed days and the other category, mainly outpatient procedures, are under review at specialty level.

Significant volume variations in performance are shown in the table below: Significant over & under perform ance areas Volum e variances greater than 5% and m ore than 10 cases

Day cases Elective inpatients Overall Over perform ing General Medicine 171% Urology 42% Gastroenterology 37% Colorectal 24% Oncology 12% Urology 8%

Under perform ing Upper GI -45% Haematology -23% General Surgery -12% Gynaecology -11%

Non Elective inpatients Outpatient procedures

Over perform ing Gynaecology 87% Paediatrics 19% General Medicine 16% General Surgery 11% Trauma & Orthopaedics 11% Under perform ing Rheumatology -100% Dermatology -70% Colorectal -63% ENT -37% Gastroenterology -57% Trauma & Orthopaedics -25%

First Outpatient attendances F/U Outpatient attendances

Over perform ing Cardiology 175% Cardiology 71% Neurology 97% Urology 60% General Surgery 39% Haematology 35% Urology 11% Neurology 33% GUM 4% Anti-coagulation 31% Gastroenterology 28% Dermatology 14% Respiratory medicine 9% Oncology 7% Gynaecology 4% Under perform ing Upper GI Surgery -63% Upper GI Surgery -74% Dermatology -54% Upper GI surgery -60% General Medicine -31% Dermatology -40% Ophthalmology -26% Colorectal Surgery -32% Clinical Oncology -21% Breast Surgery -20% Paediatrics -20% Ophthalmology -17% Breast Surgery -20% Urology -13% Diabetes -19% Paediatrics -11% Colorectal Surgery -18% Rheumatology -11% Trauma & Orthopaedics -17% GUM -9% Ophthalmology -16% Diabetic Medicine -8% Respiratory medicine -14% Clinical Oncology -6% ENT -9% Trauma & Orthopaedics -6% Gynaecology -8% General Medicine -4%

Anti-coagulation Follow up over performance is caused by the change of attendances from General Medicine to Anti-coagulation and a contract variation to the planned activity for both specialties will be agreed with the Commissioners. 5.5.2 The following table shows the overall activity for the period ended 31st May 2014:

2 Months ending May 2014 Activity and Income Report Annual YTD YTD YTD Activity Activity Activity Activity Volume Volumes including ACC Plan Plan Actual variance Variance % Elective Day Cases 13,211 2,194 2,380 186 8.5% Elective Inpatients 1,635 269 298 29 10.8% Non-Elective Inpatients 15,319 2,450 2,757 307 12.5% First Outpatients 41,882 6,922 6,611 (311) -4.5% Follow Up Outpatients 63,423 10,512 9,871 (641) -6.1% Emergency department attendances 55,682 8,659 8,770 111 1.3%

5.6 CQUINS

5.6.1 A provision of £60k (19.2%) for CQUIN’s has been included in month 2 as a potential income underachievement and it will be reviewed during the year.

5.7 Penalties

5.7.1 A provision of £20,400k for fines has been included as an estimate of the potential penalties for the period ending 31st May 2014 for Referral to Treatment, Cancer access, Emergency Department 4 & 12 hour waits and Ambulance handovers. The detailed assessment is shown in the table below. This will be updated as the validation of performance in these areas is finalised. April £ May £ Total £ Comment RTT Actual Estimate 18 weeks - Admitted £400 in respect of each excess breach above Total 0 0

18 weeks - Non Admitted £100 in respect of each excess breach above Total 600 600 1,200

18 weeks - Incomplete £100 in respect of each excess breach above Total 200 200 400

RTT waits over 52 weeks £5000 per patient 100% 0 5,000 5,000 estimate

6 week Diagnostics £5000 per month 99% 0 0 0

£200 in respect of each excess breach above ED attendances within 4 hrs threshold upto maximum of 8% 95% 0 0 0 April achieved Trolley wait<12 hrs £1000 per event 100% 1,000 0 1,000 1- 12 hr trolley wait

Ambulance handovers <15 minutes £200 per event 100% 1,400 400 1,800 estimate Ambulance handovers <60 minutes Additional £800 per event 100% 3,200 0 3,200 estimate

Percentage of Service Users referred urgently with suspected cancer by a GP waiting no more than two £200 in respect of each excess breach above weeks for first outpatient appointment threshold 93% 0 0 0 estimate Percentage of Service Users referred urgently with breast symptoms (where cancer was not initially £200 in respect of each excess breach above suspected) waiting no more than two weeks for first outpatient appointment threshold 93% 900 900 1,800 estimate Percentage of Service Users waiting no more than one month (31 days) from diagnosis to first definitive £1,000 in respect of each excess breach above treatment for all cancers threshold 96% 0 0 0 estimate Percentage of Service Users waiting no more than 31 days for subsequent treatment where that £1,000 in respect of each excess breach above treatment is surgery threshold 94% 0 0 0 estimate Percentage of Service Users waiting no more than 31 days for subsequent treatment where that £1,000 in respect of each excess breach above treatment is an anti-cancer drug regimen threshold 98% 0 0 0 estimate Percentage of Service Users waiting no more than 31 days for subsequent treatment where the £1,000 in respect of each excess breach above treatment is a course of radiotherapy that threshold 94% 0 0 0 estimate Percentage of Service Users waiting no more than two months (62 days) from urgent GP referral to first £1,000 in respect of each excess breach above definitive treatment for cancer threshold 85% 3,000 3,000 6,000 estimate Percentage of Service Users waiting no more than 62 days from referral from an NHS screening service £1,000 in respect of each excess breach above to first definitive treatment for all cancers threshold 90% 0 0 estimate Total 3,900 3,900 7,800

Mixed sex accommodation breaches £250 per day per Service User affected 0% 0 0 0 estimate

VTE Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold 95% 0 0 0 100% April

£10,000 in respect of each incidence in the MRSA relevant month 100% 0 0 0 0 cases in April £10,000 in respect of each excess breach above C-Diff threshold 0 0 0 0 cases in April

Total 10,300 10,100 20,400 Specialty April £ May £ Total £ Actual Actual RTT Actual Estimate 18 weeks - Admitted £400 in respect of each excess breach above threshold 90% Urology 2,800 2,800 2,800 Reinvestment agreement -2,800 -2800 -2,800 18 weeks - Admitted £400 in respect of each excess breach above threshold Total 0 0 0

18 weeks - Non Admitted £100 in respect of each excess breach above threshold 95% Urology 100 100 200 Neurology 600 600 1,200 Reinvestment agreement -700 -700 -1,400 Cardiology 300 300 600 General Surgery 100 100 200 Dermatology 100 100 200 ENT 100 100 200 18 weeks - Non Admitted £100 in respect of each excess breach above threshold Total 600 600 1,200

18 weeks - Incomplete £100 in respect of each excess breach above threshold 92% Urology 3,000 3,000 3,000 Trauma & Orthopaedics 6,800 6,800 6,800 Neurology 2,800 2,800 2,800 Reinvestment agreement -12,600 -12,600 -12,600 Ophthalmology 100 100 200 Rheumatology 100 100 200 18 weeks - Incomplete £100 in respect of each excess breach above threshold Total 200 200 400

5.8 Statement of Financial Position

5.8.1 The Trust’s main accounting statements are shown in the appendices of this report and see Appendix B for the Statement of Financial Position as at 31st May 2014.

Cash

5.8.2 The External Financing Limit will be achieved by in year management of cash and working balances. The cash balance of £2,508k, as at 31st May, is £493k higher than the planned position of £2,015k.

The forecast balance as at 31st March 2015 is £532k which will ensure that the Trust meets its requirement to remain within its External Financing Limit.

Debtors

5.8.3. The figures from the debtors system represent invoices raised for which cash has yet to be received. The total outstanding debt as at 31st May is £892k, which is divided between NHS £643k, Private Patients £88k and non NHS £386k. Debts over 250 days represent £71k which is 6.4% of the total debt.

Creditors

5.8.4 The measure for the better payment practice code is to pay all NHS and non-NHS trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later), unless other payment terms have been agreed. The compliance is for at least 95% of invoices to be paid (by the bank automated credit system or date and issue of a cheque) within thirty days, or within agreed contract terms. For May the performance against the target is: Number Value % % Non-NHS 97.4 99.0 NHS 88.5 94.5 Combined 97.0 98.1

5.9 Capital Programme and Performance against Capital Resource Limit

5.9.1 The Trust will operate within its Capital Resource Limit and detailed capital programme management will enable the capital expenditure to be delivered within resources and the Trust’s cash plans for the year.

5.9.2 As at 31st May 2014 there has been £48k capital expenditure.

5.9.3 The Capital Planning Committee continues to monitor the capital priorities and projects and the detail is included on Appendix D.

5.10 Foundation Trust Indicative Financial Risk Rating

5.10.1 The Financial risk rating for the Trust, if operating as a Foundation Trust, as at the 31st May 2014 is a level 1, and the liquidity ratio is 9.9 days which also achieves a level 1.

5.10.2 The Continuity of Services risk metrics, if operating as a Foundation Trust, as at the 31 st May 2014 is a level 1.

5.10.3 The calculation for the Financial risk rating, after applying the over-riding rules, and for the Continuity of Services risk metrics, for the annual plan, year to date and forecast outturn for the Trust is a 1, which is a result of the Trust’s overall financial sustainability issues.

Plan 2014/15 Year to date 2014/15 - Month 2 Year to date Monitor Weighted 2014/15 - Monitor Weighted Monitor Financial Measures Weighting Plan 2014/15 Rating rating Month Rating rating Achievement of Plan EBITDA achieved 10% 216.8 5 0.50 106.3 5 0.50 Underlying performance EBITDA margin 25% 0.8 1 0.25 (1.0) 1 0.25 Return on assets Financial Efficiency excluding dividend 20% (8.7) 1 0.20 (2.0) 2 0.40 I&E Surplus 20% (5.2) 1 0.20 (7.1) 1 0.20 Liquidity Liquidity Ratio (days) 25% 13.1 2 0.50 9.9 1 0.25

Monitor weighted criteria 1.65 1.60

Financial Risk rating after applying over-riding rules 1 1

Key Achievement of Plan EBITDA achieved (% of plan) Underlying Performance EBITDA Margin (% underlying income) Return on asset excluding dividend (%) Financial Efficiency I&E Surplus Margin Liquidity Ratio (days) Cash plus trade debtors minus creditors expressed in number of days operating expenses. Ratio has been adjusted for 30 working days capital borrowing facility as would be available to a Foundation Trust.

Continuity of Services Risk metrics Plan 2014/15 Year to date 2014/15 Monitor Weighted Year to date Monitor Weighted Weighting Plan 2014/15 Rating rating 2014/15 Rating rating Liquidity Liquidity Ratio (days) 50% (16.9) 1 0.5 (20.1) 1 0.5 Revenue available for Capital service capacity debt service 50% 0.4 1 0.5 (0.5) 1 0.5 Annual debt service Continuity of Services Risk metrics 1 1.0 1 1 5.11 Recommendation

The Board is asked to note the Trust’s Month 2 financial performance for 2014/15 regarding the revenue, capital and cash positions. Appendix A – Statement of Comprehensive Income – Accumulated Variances as at Month 2 - May 2014 YEAR TO DATE MONTH 2 ACTUAL MONTH 12 FORECAST AS AT MONTH 2 PERIOD PERIOD PERIOD REVISED YEAR TO YEAR TO YEAR TO YEAR TO FORECAST MAY MAY VARIANCE ANNUAL ANNUAL DATE DATE VARIANCE DATE DATE VARIANCE BUDGET ACTUAL Fav/ (Unfav) BUDGET BUDGET BUDGET ACTUAL Fav / (Unfav) BUDGET ACTUAL Fav / (Unfav) £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

INCOME 5,163 4,933 -230 CCGs - North Somerset 62,963 63,182 10,258 10,042 -216 63,182 63,182 0 1,188 1,222 34 CCGs - Somerset 13,980 14,182 2,303 2,330 27 14,182 14,182 0 170 222 52 CCGs - Other 2,372 2,370 388 437 49 2,370 2,370 0 435 560 125 Specialist Services 4,973 4,973 828 932 104 4,973 4,973 0 109 114 5 Local Authorities 1,239 1,239 205 216 11 1,239 1,239 0 0 0 0 NICE 230 0 0 0 0 0 0 0 64 58 -6 Private Patients 738 738 129 113 -16 738 738 0 0 0 0 Overseas patients 1 1 0 0 0 1 1 0 7,129 7,109 -20 Revenue from patient care activities 86,496 86,685 14,111 14,070 -41 86,685 86,685 0 253 253 0 Education, Training & Research 3,044 3,044 507 507 0 3,044 3,044 0 34 48 14 Road Traffic Accident income 400 400 67 95 28 400 400 0 421 445 24 Other Income 6,087 5,725 914 925 11 5,725 5,725 0 708 746 38 Other operating revenue 9,531 9,169 1,488 1,527 39 9,169 9,169 0

7,837 7,855 18 Total Income 96,027 95,854 15,599 15,597 -2 95,854 95,854 0

EXPENDITURE

5,543 5,524 19 Pay Expenditure 65,877 65,597 11,059 10,963 96 65,597 65,597 0 2,334 2,376 -42 Non-Pay Expenditure 23,388 24,204 4,690 4,790 -100 24,204 24,204 0 0 0 0 Reserves 6,025 5,316 0 0 0 5,316 5,316 0 7,877 7,900 -23 Total Expenditure 95,290 95,117 15,749 15,753 -4 95,117 95,117 0

-40 -45 -5 Earnings before Interest and Depreciation 737 737 -150 -156 -6 737 737 0

-322 -322 0 Depreciation -3,858 -3,858 -643 -643 0 -3,858 -3,858 0 1 1 0 Interest Receivable 8 8 1 2 1 8 8 0 -1 -1 0 Interest Payable & Unwinding of Discount -12 -12 -2 -2 0 -12 -12 0 -166 -166 0 Dividends Payments on PDC -1,985 -1,985 -331 -331 0 -1,985 -1,985 0 0 5 5 Gain/ Loss on disposal 0 0 0 5 5 0 0 0 0 0 0 Fixed Asset Impairment 0 0 0 0 0 0 0 0 -528 -528 0 Retained deficit for Accounting purposes -5,110 -5,110 -1,125 -1,125 0 -5,110 -5,110 0 0 0 0 Impairments 0 0 0 0 0 0 0 0 -528 -528 0 Net deficit after Impairments -5,110 -5,110 -1,125 -1,125 0 -5,110 -5,110 0 13 13 0 Donated assets 160 160 27 27 0 160 160 0 -514 -514 0 Net deficit for NHS accountability -4,950 -4,950 -1,098 -1,098 0 -4,950 -4,950 0

Appendix B – Statement of Financial Position as at 31st May 2014 As at 31 March 2014 May-14

£000's £000's

Non-current assets 64,387 Property, plant and equipment 63,842 1,738 Intangible Assets 1,688 368 Trade and other receivables 368 66,493 65,898 Current assets 1,178 Inventories 1,206 3,904 Trade and other receivables 1,521 750 Cash and cash equivalents 2,493 5,832 Total current assets 5,220

Current liabilities (9,298) Trade and other payables (9,246) (74) Provisions (74) (3,540) NET CURRENT ASSETS (LIABILITIES) (4,100) 62,953 TOTAL ASSETS LESS CURRENT LIABILITIES 61,798 Non-current liabilities (220) Provisions (221) 62,733 TOTAL ASSETS EMPLOYED 61,577

Financed by taxpayers' equity:

62,983 Public dividend capital 62,983 (12,748) Retained earnings (13,904) 12,591 Revaluation reserve 12,591 (93) Other reserves (93)

62,733 61,577

Appendix C - 12 Month statement of rolling cash flow APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR TOTAL £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s Summary 2014/15 Plan Inflows 9,137 9,251 8,015 8,012 8,014 9,768 8,034 8,072 10,055 8,061 9,302 8,813 104 ,534

Outflows 8,715 8,348 8,308 8,373 8,224 9,413 9,004 8,566 8,200 9,426 8,501 9,614 104 ,692

MOVEMENT IN PERIOD 422 903 ( 293) ( 361) ( 210) 355 ( 970) ( 494) 1,855 ( 1,365) 801 ( 801) ( 158 )

BALANCE B/FWD 690 1 ,11 2 2 ,01 5 1 ,72 2 1 ,36 1 1 ,15 1 1 ,506 5 36 42 1,89 7 5 32 1,333 BALANCE C/FWD 1,112 2 ,01 5 1 ,72 2 1 ,36 1 1 ,15 1 1 ,50 6 5 36 42 1 ,89 7 532 1,333 5 32

Summary 2013 14 Actual Inflows 9,102 9,020 8,015 8,012 8,014 9,768 8,034 8,072 10,055 8,061 9,302 8,813 104 ,534

Outflows 7,769 8,535 8,801 8,373 8,224 9,413 9,004 8,566 8,200 9,426 8,501 9,614 104 ,692

MOVEMENT IN PERIOD 1,333 485 ( 786) ( 361) ( 210) 355 ( 970) ( 494) 1,855 ( 1,365) 801 ( 801) ( 158 )

BALANCE B/FWD 690 2 ,02 3 2 ,50 8 1 ,72 2 1 ,36 1 1 ,15 1 1 ,506 5 36 42 1,89 7 5 32 1,333 BALANCE C/FWD 2,023 2 ,50 8 1 ,72 2 1 ,36 1 1 ,15 1 1 ,50 6 5 36 42 1 ,89 7 532 1,333 5 32

Difference 911 ( 418) 0 0 0 0 0 0 0 0 0 0

CUMULATIVE CHANGE 911 493 0 0 0 0 0 0 0 0 0 0

Represented by:

INCOME CCG INCOME ( 97) 1,200 1,103 SHA INCOME / EXCEPTIONAL PERMANENT DIVIDEND CAPITAL ( 12) ( 1,249) ( 1,261) OTHER INCOME 74 ( 182) ( 108)

EXPENDITURE PAY COSTS 283 349 632 CREDITORS/ADVANCES 313 ( 292) 21 CAPITAL 350 ( 244) 106 LOAN / DIVIDEND 0 0 0 Total 911 ( 418) 0 0 0 0 0 0 0 0 0 0 493

Appendix D - Capital Programme 31st May 2014 Forecast Approved Actual spend spend to Plan to 31.05.14 31.03.15 £ £ £ FUNDING Initial capital allocation 3,858,000 Technology Fund Safer Hospital, Safer Wards year 2 124,000 Book value of disposed assets 0 Donated Assets 0 3,982,000

CAPITAL EXPENDITURE

1. Carry forward 2013/14 schemes West switch room upgrade - Linking generators 300,000 0 300,000 STOR bringing generators on-line to reduce demand on grid 120,000 0 120,000

Sub totals 420,000 0 420,000

2. Capital Schemes - Estates Works Ward refurbishment programme ITU 550,000 0 550,000 Ward refurbishment programme Theatres 550,000 0 550,000 Recovery space for Endoscopy 500,000 0 500,000 Legionella works including replacing water tanks 100,000 0 100,000 Compliance: (Fire, DDA) 100,000 4,135 100,000 Estates capital project manager 40,000 0 40,000 Theatres laminar flow/ventilation 40,000 0 40,000 Central Storage Area For Waste bins & Soiled Linen (by 25,000 0 25,000 Pathology) Theatres electrical upgrade 10,000 0 10,000

Sub totals 1,915,000 4,135 1,915,000

3. Capital Schemes - Medical Equipment Other medical equipment 241,000 241,000 Main ED & inpatient plain film room. 300,000 300,000 Replacement for obstetric ultrasound machine used by imaging 75,000 75,000 in ultrasound room 2 for obstetric screening.

Sub totals 616,000 0 616,000

4. IM&T - Hardware / systems IT Infrastructure / hardware PC's 50,000 50,000 IT Infrastructure / hardware 10,000 10,000

Sub totals 60,000 0 60,000

5. IM&T - Software and systems development Order Communications (n.b. £124,000 with 50% fund match 248,000 37,083 248,000 from Tech Fund) Intranet 50,000 0 50,000 Replacement PAS / EPR 2015 607,296 6,695 607,296

Sub totals 905,296 43,778 905,296

Capital funding to be allocated / (reduced) 65,704 65,704

TOTAL 3,982,000 47,913 3,982,000

HIGHLIGHTS 1 - Confirmed capital available for 2013/14 £3,982,000. 2 - Capital spent to date 48k 3. Expenditure to date is 1 % of capital allocation of £3,982k.

Load more

  78

Copy Link