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University Hospitals Plymouth NHS Trust University Hospitals Plymouth NHS Trust Use of Resources assessment report Derriford Road, Crownhill, Plymouth, PL6 8DH Tel: 01752 202082 www.plymouthhospitals.nhs.uk Date of publication: 15 August 2018 This report describes our judgement of the Use of Resources and our combined rating for quality and resources for the trust. Ratings Overall quality rating for this trust Requires improvement Are services safe? Requires improvement Are services effective? Requires improvement Are services caring? Outstanding Are services responsive? Requires improvement Are services well-led? Requires improvement Our overall quality rating combines our five trust-level quality ratings of safe, effective, caring, responsive and well-led. These ratings are based on what we found when we inspected, and other information available to us. You can find information about these ratings in our inspection report for this trust and in the related evidence appendix. (www.cqc.org.uk/provider/RK9/Reports) Are resources used productively? Requires improvement Combined rating for quality and use of Requires improvement resources We award the Use of Resources rating based on an assessment carried out by NHS Improvement. Our combined rating for Quality and Use of Resources summarises the performance of the trust taking into account the quality of services as well as the trust’s productivity and sustainability. This rating combines our five trust-level quality ratings of safe, effective, caring, responsive and well-led with the Use of Resources rating. Page 1 of 15 Use of Resources assessment and rating NHS Improvement are currently planning to assess all non-specialist acute NHS trusts and foundation trusts for their Use of Resources assessments. The aim of the assessment is to improve understanding of how productively trusts are using their resources to provide high quality and sustainable care for patients. The assessment includes an analysis of trust performance against a selection of initial metrics, using local intelligence, and other evidence. This analysis is followed by a qualitative assessment by a team from NHS Improvement during a one-day site visit to the trust. Combined rating for Quality and Use of Resources Our combined rating for Quality and Use of Resources is awarded by combining our five trust-level quality ratings of safe, effective, caring, responsive and well-led with the Use of Resources rating, using the ratings principles included in our guidance for NHS trusts. This is the first time that we have awarded a combined rating for Quality and Use of Resources at this trust. The combined rating for Quality and Use of Resources for this trust was requires improvement, because: • we rated safe, effective, responsive, and well-led as requires improvement; and caring as outstanding; • we took into account the current ratings of the three core services not inspected at this time. Hence, one core service is rated overall as inadequate, three are rated overall as requires improvement, and the remaining five services are rated good; • the overall ratings for each of the trust’s acute locations remained the same; and • the trust was rated as Requires Improvement for Use of Resources. Page 2 of 15 University Hospitals Plymouth NHS Trust Use of Resources assessment report Date of site visit: Derriford Road, Crownhill, Plymouth, PL6 8DH 8 May 2018 Tel: 01752 202082 Date of publication: www.plymouthhospitals.nhs.uk/ 15 August 2018 This report describes NHS Improvement’s assessment of how effectively this trust uses its resources. It is based on a combination of data on the trust’s performance over the previous twelve months, our local intelligence and qualitative evidence collected during a site visit comprised of a series of structured conversations with the trust's leadership team. The Use of Resources rating for this trust is published by CQC alongside its other trust-level ratings. All six trust-level ratings for the trust’s key questions (safe, effective, caring, responsive, well-led, use of resources) are aggregated to yield the trust’s combined rating. A summary of the Use of Resources report is also included in CQC’s inspection report for this trust. How effectively is the trust using its resources? Requires improvement How we carried out this assessment The aim of Use of Resources assessments is to understand how effectively providers are using their resources to provide high quality, efficient and sustainable care for patients. The assessment team has, according to the published framework, examined the trust’s performance against a set of initial metrics alongside local intelligence from NHS Improvement’s day-to-day interactions with the trust, and the trust’s own commentary of its performance. The team conducted a dedicated site visit to engage with key staff using agreed key lines of enquiry (KLOEs) and prompts in the areas of clinical services; people; clinical support services; corporate services, procurement, estates and facilities; and finance. All KLOEs, initial metrics and prompts can be found in the Use of Resources assessment framework. We visited the trust on 8 May 2018 and met the trust’s executive team (including the chief executive) and relevant senior management responsible for the areas under this assessment’s KLOEs. Page 3 of 15 Findings Is the trust using its resources productively to Requires improvement maximise patient benefit? • We rated the trust’s use of resources as Requires Improvement. • The trust’s total cost per weighted unit of activity is £3,564 compared with a national median of £3,484. This means it spends marginally more on pay and other goods and services per weighted activity unit (WAU) than most other trusts nationally. • The trust has an improving financial position, reporting a deficit of £39.9m in 2016/17, which has improved to a deficit of £13.5m in 2017/18 (figures exclude Sustainability and Transformation Funding (STF). This improvement was in part due to the delivery of £31m of savings in 2017/18, of which £25m were recurrent. However, despite this improvement the trust still had a high level of cumulative borrowings at £85m at the end of 2017/18. • Whilst the trust has improved financially, operational performance has deteriorated, and the trust is not meeting any of its constitutional performance standards. • The trust has made improvements in procurement, use of agency and supplies and services, but whilst the trust has adopted a strong approach to the identification of operational and clinical productivity opportunities, it has not yet consistently realised these opportunities. • NHS Improvement’s Model Hospital data identifies that there remain further productivity gains to be made and opportunities for improvement were identified in supplies and services, medicines, medical pay and healthcare science and ‘other’ staff costs. • The trust engages well with national programmes such as Getting It Right First Time (GIRFT) and Model Hospital, and has initiated a number of promising projects, including theatre productivity and outpatients. How well is the trust using its resources to provide clinical services that operate as productively as possible and thereby maximise patient benefit? The trust is not meeting NHS constitutional performance standards and its emergency re- admission rates and pre-procedure bed days are above the national median. However, the trust has a good Did Not Attend (DNA) rate and an improving Delayed Transfers of Care (DTOC) position. The trust is fully engaged in the GIRFT programme and is a national leader in its use of Model Hospital. The trust has adopted a strong approach to the identification of operational and clinical productivity opportunities but has not yet consistently realised these. • During the 12 months up to the assessment in May 2018, the trust did not meet any of the constitutional performance standards. Using the most recent data available (March 2018), Referral to Treatment (RTT) performance was 79.7%, (92% standard), A&E performance was 75.8% (95% target), Cancer 62 day performance was 82% (standard of 85%) and Diagnostics performance was 87.7% (99% standard). • In addition, at March 2018, the trust had 108 patients waiting longer than 52 weeks for treatment; the fourth worst performer for long waiters in the South region. • The trust’s emergency re-admission rate within 30 days is 7.83%, slightly above the national median of 7%. Locally, the trust uses Healthcare Evaluation Data (HED) benchmarking and reports that this indicates that it is not an outlier. • Non-elective pre-procedure bed days at the trust were 1.17 at December 2017; this puts the trust in the highest (worst) quartile against a national median of 0.78 days. The trust’s local data reports that around 50% of patients do not have their operation or procedure Page 4 of 15 on the day of admission. The trust believes this to be due to waits for CT or MRI and is carrying out further analysis to understand how this can be improved and bed days reduced. • Elective pre-procedure bed days at the trust were 0.27 (worst quartile) at December 2017 (national median of 0.13). The trust states that this is driven by its tertiary centre services for which patients often have to travel long distances requiring overnight stays. Many patients are admitted for pre-procedure checks on the day before surgery and are then discharged to a local charitable facility to spend the night close to the hospital. The trust’s own local data reports admissions on the day of surgery for elective patients at 80%. • The trust has begun working on service integration projects with the local provider of community, children’s and mental health services including a review aimed at improving clinical productivity in hospital and community therapy and pharmacy. • Overall, the trust’s rate of DTOCs shows a reducing trend between December 2016 and March 2018 with performance at March 2018 of 5.65% against a target of 3.5%.
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