Governing Body Quality Update Urgent Care and Patient Flow May 2015

Contents Updated performance and activity information Trust and system actions to improve quality and performance

Current performance – 95% Standard 95% performance - WRH 13/14 14/15 15/16 YTD 89.5% 89.2% 74.9% Worcestershire Royal Hospital Performance in Apr / May 15 is much worse than in previous years. Performance in previous years circa 90% YTD in Mid May. This year circa 75%. Performance shows a similar pattern to the prior year, but at a lower level.

Current performance – 95% Standard 95% performance - WRH 95% performance - ALX 13/14 14/15 15/16 13/14 14/15 15/16 YTD 89.5% 89.2% 74.9% YTD 85.0% 96.7% 88.3% Worcestershire Royal Hospital Performance in Apr / May 15 is much worse than in previous years. Performance in previous years circa 90% YTD in Mid May. This year circa 75%. Performance shows a similar pattern to the prior year, but at a lower level. Alexandra Hospital Performance down on last year, but improved on 13/14. Similar pattern and recovery shown as in 13/14. Performance significantly better than WRH.

Emergency Department Attendances Number of A&E Attendances - WRH Attendances -9.4% / -2.6% 13/14 14/15 15/16 YTD 8871 9534 8636 Number of A&E Attendances – Patients >75 - WRH Attendances -5.9% / +7.9% 13/14 14/15 15/16 YTD 1230 1406 1323

Emergency Department Attendances Number of A&E Attendances - WRH Number of A&E Attendances - ALX Attendances +5.8% / +7.9% 13/14 14/15 15/16 YTD 7157 7299 7723 Attendances -9.4% / -2.6% 13/14 14/15 15/16 YTD 8871 9534 8636 Number of A&E Attendances – Patients >75 - WRH Number of A&E Attendances – Patients >75 - ALX Attendances +20.6% / +3.8% 13/14 14/15 15/16 YTD 994 856 1032 Attendances -5.9% / +7.9% 13/14 14/15 15/16 YTD 1230 1406 1323

Emergency Admissions Number of Admissions - WRH -9.7% / -9.2% 13/14 14/15 15/16 YTD 3856 3875 3500 Number of Admissions – Patients >75 - WRH 13/14 14/15 15/16 Admissions -9.7% / +2.3% YTD 912 1033 933

Emergency Admissions Number of Admissions - WRH Number of Admissions - ALX 13/14 14/15 15/16 Admissions -7.9% / -6.9% YTD 2492 2520 2320 Admissions -9.7% / -9.2% 13/14 14/15 15/16 YTD 3856 3875 3500 Number of Admissions – Patients >75 - WRH Number of Admissions – Patients >75 - ALX 13/14 14/15 15/16 Admissions +4.0% / -2.3% YTD 684 642 668 13/14 14/15 15/16 Admissions -9.7% / +2.3% YTD 912 1033 933

PFC Discharges and DTOCs Delayed Transfers of Care Changes to reporting methodology in October 14 have made comparisons difficult. Counting methodology in April 15 now compliant with the requirements of the Care Act. DTOC - April ‘14 = 48, April ‘15 = 57. DTOC numbers and delays are higher the Alexandra Hospital than they are at Worcestershire Royal, yet A&E waiting times are significantly better.

PFC Discharges and DTOCs 120 121 97 91 March 75 Feb 63 April 57 37 49 48 48 48 51 48 96 59 59 79 63 75 57 Delayed Transfers of Care Changes to reporting methodology in October 14 have made comparisons difficult. Counting methodology in April 15 now compliant with the requirements of the Care Act. DTOC - April ‘14 = 48, April ‘15 = 57. DTOC numbers and delays are higher the Alexandra Hospital than they are at Worcestershire Royal, yet A&E waiting times are significantly better. PFC Discharges (Not shown in chart) PFC discharges account for circa 15% of all acute discharges. When PFC weekly discharges exceed 100, DTOC figures generally fall. When they are 90 or less DTOCs generally rise. Improvement plan to get PFC discharges to circa 130 per week.

Trust and System Actions The SRG has led the development of a system wide urgent care and patient flow plan. Based on the numerous external reports, internal quality walkthroughs and recognised best practice. Designed to prevent numerous, fragmented plans. SRG to take lead in ensuring delivery. Essential component is the Trust’s Patient Care Improvement Plan (PCIP).

Elements of the plan Three Key Outcomes Avoiding inappropriate hospital admission. Treating patients with the best care, in the best place, in the fastest time. Discharge patients as soon as possible, improving patient flow.

Elements of the plan Seven Key Actions Seven Day Health and Care services, physical and mental health services, including diagnostics. Timely and efficient Admission Prevention Services. Improved access to Urgent Care services with referrals for assessment and not admission. Best practice urgent care and patient flow within Acute services. Facilitating effective discharge (including PFC, Pathways 1, 2, 3 and DTOC reduction plan). Ensure Mental Health support is consistent with national standards. Winter Resilience Planning.

Elements of the plan Executive leads for each element of the plan. Measurable KPIs throughout the plan. Delivery plans monitored monthly, through Best Practice Urgent Care Committee. Monthly SRG summary report on key outcomes and actions. PMO being implemented to support process. 10 key actions for focus from within plan being agreed to see early improvements.

Challenging outcomes set by SRG EAS 95% 4 hour target by end of June. DTOC(delayed transfers of care) reduced to 50 by end of May: Correct reporting of DTOC figures Weekly monitoring board Weekly case management process for complex patients Escalation to senior leads for “executive action”