A request was made for personal breast cancer health records from October 2015 onwards, but the authority responded that not all information was held and instead provided a 49-page Manx Care KPI report covering theatre and surgical performance from April to September 2021.
Key Facts
The request sought specific health records for breast cancer diagnosis and treatment starting in October 2015.
Manx Care stated that some information was sent but not all was held.
The provided documents consist of a 49-page Integrated Performance Report for September 2021.
The report details theatre session cancellations, late starts, and utilization rates rather than individual patient data.
Staffing shortages, specifically the unavailability of anaesthetists, were cited as a cause for cancelled theatre sessions in September 2021.
Data Disclosed
10/2015
2022-07-19
2022-08-12
116 pages
3 documents
September 2021
18 theatre sessions
13 cancellations
733
714
3,907
4,282
85%
70.0%
75.0%
83.0%
74.0%
69.0%
67.0%
Original Request
Health records pertaining to Breast cancer diagnosis and treatment 10/2015 onwards
NON‐CLINICAL CANCELLATIONS ON DAY
(EXCLUDES WEEKENDS)
Administrative error
Anaesthetist unavailable
3% 2%
Appointment inconvenient
DNA
13%
14% Equipment failure/unavailable
ICU/HDU bed unavailable
8%
8% List over‐run
6% Operation not wanted (patient)
8% Postponement (Lack of theatre
2% time)
Surgeon unavailable
13%
10%
Theatre staff unavailable
13%
Unfit for surgery ‐ patient
cancellation
Wardbedsunavailable
Misc (No other listing)
32
22
30
30
30
16
12
18
11
1
4
4
4
4
6
41
7
2
711
26,3
9,3
16,3
66,2
,3
145,2
3
984,
286,
201,5
840,5
3
52,5
6
6
46,3
CLINICAL CANCELLATIONS ON DAY
(EXCLUDES WEEKENDS)
Administrative error
Deaceased
9% 12%
Emergency case took priority
6% Operation not necessary (Hospital)
4%
Pre‐operative guidance not followed
2%
Pre‐existing medical condition
40% Procedure carried out elsewhere
21% Surgeon unavailable
Unfit with acute illness
6%
Unsuitable for Day Surgery
Ward beds unavailable
TheatresNarrative ‐September 2021
Theatre Sessions:
The Care Group continued to deliver post COVID‐19 theatre schedule until mid‐September where sessions were 18 theatre
sessions were cancelled in response to the unavailability of anaesthetists to support the operating lists which has resulted in a
slight reduction to the theatre utilisation. Sickness and vacancies have limited the return to full theatre capacity however
recruitment is in progress for substantive staff and there has been a recruitment drive for Agency staff which aim to increase
activity in theatres from October 2021. A review of the current theatre schedule and staffing establishment is in progress and
supported by Develop Consulting to ensure that we are utilising our current resources efficiently. During this period no sessions
were re‐utilised because the limiting factor on theatre activity was anaesthetic cover and therefore lists were not available for
reuse.
Page 5 of 49
MAIN THEATRE INFORMATION - 2021-22
Clinical Cancellation on the day of surgery:
Clinical Cancellations on the day have increased significantly in line with an increase in clinical decision cancellations. Progress
has been made in improving surgical pathways of care to reduce clinical cancellations on the day sustainably. Support has been
gained for the introduction of a Surgical Assessment Unit, Surgical Admissions unit (based on Day Procedures Suite) and these
improvement projects are currently in the scoping phase of delivery.
Non‐Clinical cancellation on the day of surgery:
Bed and workforce pressures have combined to severely impact elective activity in September resulting in 13 cancellations due
to unavailability of ward beds, a combination of medical outliers on surgical wards and the re‐allocation of staff from ward 12
(Elective Orthopaedic, ward) has led to regular cancellations throughout the month of September. Wards continue to focus on
recruitment and a review of the current nursing establishment is in place. Processing time to advertise roles is impeding
services ability to maintain safe staffing levels as well as a reduced ability to secure UK agency nursing staff.
Early Finishes and Late Starts
Late starts have increased in the month of September linked to anaesthetic staffing and the fluctuating bed state and last
minute changes to lists required following non‐clinical on the day cancellations. Early Finishes have equally increased in line
with on the day non‐clinical cancellations linked to bed and workforce pressures. Due to the significant period of time that
specialities have focused on day case and local anaesthetics waiting lists there are limited patients left that can be seen when
the hospital is unable to support inpatient elective activity.
Budget
Due to the lack of activity the main theatres spend on non‐pay consumables, is lower than budgeted for this year. Spend in
Endoscopy consumables and equipment maintenance has however increased during August and September due to increase in
the management of ERCP’s and introduction of waiting list initiatives on Island and the associated costs involved in rental costs
for equipment and accessories to manage these procedures. The overspend in Endoscopy should be partly mitigated by a usual
annual tertiary spend of £250,000 for specialist ERCP services in the UK which are currently being provided on island.
Additionally staff retirement and resignation means that theatres have been carrying vacancies that have not been covered by
agency. This has not been addressed due to the current bed situation however requests for agencies have been approved
allowing the employment of agency throughout September and the department hope to recover some lost activity in the early
stages of Q3.
It is acknowledged that greater control is required across the Care Group on financial control, as such integration of finance
business partners in to care group governance is in process. In addition to this a training and development plan is being
developed to address the identified skills gap within the area of financial control within frontline services managers.
Agency spend has reduced this month due to lack of availability further compounding lack of activity able to be supported by
main theatres. Work continues to secure agency staff whilst recruitment is ongoing. The anaesthetic staffing position is
challenging and will represent a significant cost pressure for the care group for the remainder of this financial year.
86
74
74
69
51
56
878,
48
77
357,2
127,2
8,2
7,2
,2
2
18
9
8
178,1
978,1
87,1
97,1
7,1
857,1
80
503,
055,
728,2
568,2
281,31
8,11
21
21
1
1
%9
%0
%4.
%
%8
%
.65
.65
16
4.45
.55
9.15
%2
%
%0
%
%
%1
%7
%
%
%
%
%
%
%
%4
%3
%
%
.01
9.4
.21
9.9
5.7
.01
.01
5.7
5.9
4.9
6.5
8.8
9.8
8.5
.01
.11
3.5
2.9
55.5
44.2
50.8
32.4
40.7
5.4
5.4
32.6
4.7
4.7
4.9
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Medicine Services
1,270 1,108 (162) (15%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Medicine Services
7,174 6,407 (767) (12%)
MONTH £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Hospital Planned Care Services ‐ Narrative ‐ September 2021
Number of patients waiting for a first appointment
The number of patients waiting for a first inpatient hospital appointment has continued to increase gradually indicating a slight
discrepancy between capacity and demand. This is in part driven in year by a higher than normal annual leave burden carried
over from the 1st year of the COVDI‐19 pandemic leading to a reduction in availability of clinical teams to deliver clinical
activity. Work with Medefer designed to increase Manx Cares capacity for outpatient appointments is ongoing and pathways
have been agreed with, Cardiology, Neurology, Gastroenterology, Respiratory, Pain clinic and ENT. Capacity issues have been
identified within General Practice, diagnostics and allied healthcare professionals which Manx Care are working with Medefer
to mitigate.
Did Not Attend Rate
Did not attend rates remain largely stable with an increase in DNAs for Consultant led appointments in September, this DNA
rate is comparable to UK services with NHS England report between 8.5 & 10 % thought FY 19/20. The Clinical Administration
Service groups is currently defining a piece of work identifying areas for improvement within our existing booking and
notification services. This work will identify potential improvements to the DNA rate within planned care.
% of Urgent GP referrals seen within 6 weeks
% of Patients seen within 6 weeks of GP referral Demand for 2WW (Cancer) referrals has remained higher than baseline post
COVID‐19 surges and subsequent lockdowns. This has meant that more of our outpatient capacity has been focused on
maintaining cancer waiting time targets impacting on our Urgent wait targets. An access policy is being developed within Manx
Care that will improve the clarity of access pathways and improve the active management of demand and capacity within out
outpatient clinics.
Page 8 of 49
Planned Care 2021-22
Average Length of Stay
Average length of stay remains stable in Nobles of 5.4days and Ramsey has sustained a reduction in ALOS achieving 32.6 days
in August. The sustained reduction is an indication is linked to appropriate use of criteria for patients being transferred to
Martin ward reducing patients being moved that will become stranded whilst awaiting capacity in step down care facilities.
This position is however being pressured daily by demand for inpatient beds on the nobles site and the need to make acute
beds available for Emergency Admissions. A number of improvement programs are working to address this inclusive of the
pilot of CHS supporting complex discharges, the recent launch of Medical Ambulatory Care and the propsed development of a
Surgical Assessment Unit & Surgical Ambulatory Care.
%
%
%
%3
%0
%0
3.57
5.77
0.77
.97
.08
8.67
%4.
%5
%
%4
%0.
%7.
12
.81
5.71
.81
12
02
0
0
00:
00:
0:40
00:
0
0:9
25:0
35:00
:10
65:00
0:93
5:00
0
:00
00:
00:
00:4
00:
00
00:
15:30
84:30
5:30
54:30
:63:3
54:30
0
3,672
735
661
626,
739,2
050,3
897,2
075,
587,2
2
2
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Urgent Care
673 591 (82) (14%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Urgent Care
3,618 3,279 (339) (10%)
MONTH £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Urgent& Emergency Care ‐Narrative ‐September 2021
MEDICINE
Number of patients awaiting first appointment
The number of patients awaiting their first appointment remains stable and comparable to the previous months. Allied Health
Professionals and Nurse outpatients waiting times have decreased, however, Consultants waiting times such as Cardiology and
Gastroenterology have slightly increased. Waiting times in Cardiology are expected to slightly increase further as we are losing
one Cardiac Consultant in November, with a locum secured for 6 weeks (whilst recruitment takes place); this will mean some
clinics will be cancelled. Medefer will begin virtual clinics in Cardiology, Respiratory and Gastroenterology within the next
month, with Neurology starting at the beginning of next year.
DNA Rate
DNA rates for Consultant led clinicshave increased by over 2% whilst nurse led clinics remain stable. Work is ongoing with the
Patient Information Centre regarding the reminders sent to patients about their upcoming appointments as many
appointments are booked months in advance. The late cancellations or failures to attend might be attributable to increased
rates of Covid infections, however, if this were the case we would expect to commensurate increases in Nurse led clinics as
well.
% of Urgent GP referrals that are seen for their first appointment within 6 weeks
Urgent referrals seen within 6 weeks has decreased by 4%. Extra clinics have been provided in Medicine such as Neurology
where a waiting time initiative has just taken place. As these figures aren’t broken down between Medicine and Surgery it is
hard to understand or account for the decrease. We are aware that Surgery have made a big push on bringing their waiting
lists under control especially is breast cancer, so this will contribute to the positive performance.
Number of spells where patient has had length of stay longer the 21 days
The number of patients with a stay longer than 21 days is still decreasing compared to July and August. As there has been a
substantial push on making sure that patients can be discharged at the earliest opportunity which has included a focus on
improved support of daily ward rounds on all medical wards and surgical wards where there are medical outliers by
consultants and Social Care colleagues.
Long length of Stay Board Rounds with Social Care representation along with the Geriatric Consultant, the Complex Discharge
Co‐ordinator and Occupational Therapy continue to be conducted every Wednesday with updates fed back to patients, their
families and senior management.
CHS have now also started their work within Nobles with their main focus on tracking patients through their inpatient journey
who enter the hospital with a frailty score between 4‐9 (Rockwood scoring system). They work closely with Patient Flow and
other Manx Care stakeholders to provide effective discharges where possible for patients that are medically fit for discharge.
The impact of their work is to be assessed monthly as part of the contract monitoring process.
Average Length of Stay
Average length of stay remains stable in Nobles and has decreased slightly from 5.4 to 4.9 days –still short of our target of 3
days. Unfortunately Ramsey District Cottage Hospital Average Length of Stay has significantly increased from 32.6 to 50.8 days.
Reasoning for such a significant rise is due to the transfer of the complex patients from Nobles to Ramsey and the closure of
some Nursing Homes due to Covid infection. Additionally, assessments for Nursing Homes only take place irregularly and often
there can be a delay in assessment for homes which impact the ability to discharge patients to their care. The issue of
unsupportive legislation remains.
Page 12 of 49
Urgent and Emergency Care -2021-22
URGENT AND EMERGENCY CARE
% of Patients, Admitted, Transferred or Discharged within 4 hours of arrival at the Emergency Department (Nobles &
Ramsey)
The percentage of patients Admitted, Transferred or Discharged within 4 hours of arrival at the Emergency Department
decreased to 76.8% from 80% the previous month giving Nobles a breach compliance of 69.3%. The drop in performance can
to attributed to the increase in attendances within the Emergency Department throughout September, as we saw 215 more
patients compared to the previous month. This performance remains comparable to NHS England, where in September 2021
around 74% of patients were seen within 4 hours. However, with a lack of beds within the hospital is causing delays in
admission this contributed significantly to driving up waiting times and affecting 4 hour performance figures as staff were
nursing patients awaiting admission to hospital beds.
Nobles: AED Admission Rate
The admission rate remained stable compared to the previous month with 0.3% decrease. This approximately 25% below the
NHS England admission rate. The work being done with Medicine to provide ED in‐reach and ensure senior clinical decision
making is happening earlier, is avoiding admissions where it is safe and in the best interests of the patient to do so. The work
undertaken in the Medical Ambulatory Care Unit and by the Ambulatory Emergency Clinic and Acute Oncology is also a
significant contribution to keeping admission numbers low and ensuring ED deals only with those who need their attention the
most and in enabling early discharge to their care from the hospital bed base. However, even with the focus on admission
avoidance and early discharge, pressure on medical beds in the acute settings is constant and sustained. Manx Care have
moved to the OPEL framework to evaluate hospital pressures on a four times daily basis. In the future the OPEL framework will
be used to communicate these pressures, both internally (within Manx Care) and externally (to the public).
Average Minutes in Nobles AED (Time to see First Doctor)
There has been an increase of 20 minutes for average time to first see a doctor. This is a consequence of a higher attendance
rate than that seen in previous months, coupled with the shortage of medical doctors; under current staffing pressures, the
department is 2 doctors short on some shifts. The Service Manager and Clinical Director for ED are currently working on
addressing the recruitment issues with jobs to be advertised immediately. We have also secured 3 more Locum doctors going
into November that will bring stability to the doctor rota.
Average Minutes in Nobles AED (Time in Department)
Despite seeing more attendances and the already articulated lack of medical doctor cover in the department, the average time
patients were spending in the department within September has only slightly increasedby 9 minutes. This mitigation of the
impact of increased attendances and staff shortages can be attributed to the introduction of the AEC and AOclinics in MACU
with medical doctors actively redirecting patients from the ED triage process that can be treated in the clinics and safely
discharged. Also the ED in‐reach by medical Consultants Monday to Friday 5‐8pm also has a positive impact on early decision
making for patients.
Number of Unplanned Attendances (Nobles & Ramsey)
With an average increase of attendances of approx. 11 patients per day in the month of September this has meant that
Ramsey and Nobles have seen an average of 123 patients per day. The Care Group continues to look at ways to mitigate this
the rise in attendances and subsequent demand, including the use of medical specialties in‐reach into the ED (to speed up
senior clinical decision making) and the increased and sustained use of the Medical Ambulatory Care Unit and the Ambulatory
Emergency Clinic, which has now also incorporated in to its facilities the Acute Oncology team as well. However, space (the
real estate available to us for use) and staffing remains the rate limiting factor. These issues are being addressed.
In the longer term Manx Care will seek to redefine patient pathways and ensure that clinical input is provided earlier in the
patient journey to facilitate the more appropriate delivery care, in the most appropriate locations, but the most appropriate
people. This is part of the ongoing transformation work.
87
956
83
108
105
110
92
87
97
97
91
880
819
971
918
867
773
Number of Category 1 Number of
Cases
45
41
39
40 2 38
37
36 36
4 3
35 2 4 1
3
4
6 6 4
30
13 8 1
7
7
25 7
West
4
South
20
North
15 East
28
10 22 23 21 23 24
5
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Number of Urgent Calls by Area
37
113 East
North
282 South
West
104
Referrals received per modality
XA 95
US 1,884
RF 86
NM 75
MDT 243
MG 259
MRI 755
IO 23
XC 0
ENDO 8
CT 1,278
CR 3,910
BD 79
0 500 1000 1500 2000 2500 3000 3500 4000 4500
Referral to Completed ‐length of time waiting before
examination
3,385
3500
3000
2500
2000
1500
1,175
881
1000
506
367
500 252
165 79 97 102 82 73
0
Same 1‐4 5‐7 8‐14 15‐21 22‐28 29 Days35 Days42 Days49 Days56 Days63 Days
Day Days Days Days Days Days + + + + + +
1,291
868
847
629 594
448 448
162
Referral source
AE
Community
1,692
Day Case
2,825
Dental
28
96 GP
173
In Patient
1,583
Other Hospital
743
24
Out Patient
Activity per Modality
BD
65 109 CR
CT
ENDO
1,639 XC
IO
MRI
68
MG
48 3,351
222 MDT
190 NM
RF
571
US
18
0 875 XA
8 NBSS
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Integrated Women, Children
& Family Services
1,486 1,301 (185) (14%)
Management & Support
Services
115 83 (32) (39%)
Women's Services
584 525 (59) (11%)
Children's Services
629 488 (141) (29%)
157 205 48 23%
Community Services
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Integrated Women, Children
& Family Services
8,000 7,716 (285) (4%)
Management & Support
Services
391 496 106 21%
Women's Services
3,302 3,148 (154) (5%)
Children's Services
3,332 2,917 (415) (14%)
976 1,154 178 15%
Community Services
MONTH £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
%2.
81
%5.
%8.
%9.
%0.
%2.
%1.
%1.
%8.
%2.
%4.
%3.
%0.
%3.
%7.
%5.
%0.
%0.
%9.
%3.
%4.
%8.
%0.
%8.
07
95
24
57
85
66
75
18
17
46
33
07
76
35
62
03
57
27
33
76
85
52
72
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Community Care
Services
693 664 (29) (4%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Community Care
Services
3,953 3,982 29 1%
MONTH £'000
Actual Budget Var (£) Var (%)
2
3
873,2
273,2
37,2
945,2
57,2
891,
2
%1
%1
%1
%1
%1
%0
.6
.6
.6
.6
.6
.6
07
67
39
86
04
.25
.61
.73
.42
.96
8,95
2,47
5,94
8,08
5,97
£
£
£
£
£
69
65
69
50
25
8
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Management &
Support Services
104 158 54 34%
Primary Care Services
1,603 1,592 (10) (1%)
Pharmaceutical
Services
1,749 1,680 (69) (4%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Management &
Support Services
832 948 116 12%
Primary Care Services
9,648 9,729 82 1%
Pharmaceutical
Services
10,320 10,082 (238) (2%)
MONTH £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
63
43
50
38
12
19
343
341
345
338
339
808
841
808
782
788
800
978
976
971
976
997
973
1538
1563
1597
3
4
1585
30
1586
24
1584
1096
30
1142
36
1167
1176
1155
1132
% of People Discharged from MH
Inpatient Services to have a 3 day
Follow Up Appointment
Target 100%
100%
90%
80%
70%
60%
%0.001 %0.001 %0.001
%7.19 %0.29 %0.19 50%
40%
30%
20%
10%
0%
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Total number of Mental Health
Incidents
70
60
50 2
3
1
40
30 61
51
48
45
20 40
37
10
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Number of which were serious
%0
%0
%0
.001
%7.19
.001
%0.29
%0.19
.001
2
3
1
61
45
51
48
40
37
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Integrated Mental
1,839 1,797 (42) (2%)
Health Services
Management & Support 115 142 27 19%
Services
1,229 1,299 70 5%
Mental Health Services
Nursing Care Placements 211 167 (44) (27%)
(s115)
UK Placements 284 189 (95) (50%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Integrated Mental
11,222 10,781 (441) (4%)
Health Services
Management & Support 650 854 203 24%
Services
7,302 7,792 489 6%
Mental Health Services
Nursing Care Placements 1,268 1,000 (268) (27%)
(s115)
UK Placements 2,002 1,136 (866) (76%)
MONTH £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Number of Section 46 Enquiries
60
Target between 17 and 21
50
40
30
20
10
21 29 52 39 7 21
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Proportion of people offered
Reablement Services following
discharge from acute or community
hospital (65 years or older)
10%
8%
6%
%0.2
4%
%6.5 %0.5
%0.3 %0.3 %0.3
2%
0%
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
%0.
%2.
%4.
%9.
%6
%4
58
38
58
38
.87
.08
%7.
%1
%2.
%2
%
%2
28
.08
38
.18
1.47
.67
%4.0
%4.0
%4.0
%4.0
%2.9
%4.0
9
9
9
9
8
9
%0
%
%
%0.
%0.06
.08
0.07
0.07
%0.
54
54
%0.001
%7.5
%7.5
%0
8
8
%4
.57
%0.0
.63
%6.
%0.
%
%
%
5
5
0.3
0.3
0.3
Variance on Budget 2020-21
MONTH £'000
Actual Budget Var (£) Var (%)
Adult Social Care
Services
1,965 1,722 (243) (14%)
Management &
Support Services
21 16 (5) (32%)
Learning Disability
Services
741 761 20 3%
Older Person Services
1,203 945 (257) (27%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Adult Social Care
Services
10,713 10,333 (380) (4%)
Management &
Support Services
92 96 4 5%
Learning Disability
Services
4,477 4,565 88 2%
Older Person Services
6,144 5,672 (472) (8%)
MONTH £'000
Actual Budget Var (£) Var (%)
YEAR TO DATE £'000
Actual Budget Var (£) Var (%)
Adult Social Care ‐ Operational Services ‐Narrative ‐September 2021
The significant Covid outbreak in Reayrt Ny Baie was declared over on 28 August 2021, although there was a further two
weeks of restricted visiting whilst the necessary deep clean and covid protocols were updated/actioned. On 13 September
2021 an outbreak was declared in Southlands Resource Centre, the restrictions seen at Reayrt Ny Baie were not used at
Southlands, with all but the affected units remaining open to visits with a heightened vigilance and management of Covid
protocols. This outbreak was declared over on 5thOctober 2021. We currently have an outbreak in Cummal Mooar Resource
Centre declared on 25 October 2021 and all but the affected unit are restricting visiting, or residents leaving the home, again
extra vigilance, and Covid protocols are in place, and LFT surveillance is ongoing as it is in all ALD and OPS homes, dementia
units and service areas. All decisions were made following IPC and clinical guidance, whilst balancing the wellbeing of our
residents and protecting our staffing levels.
Page 42 of 49
Adult Social Care - Operational Services - 2021-22
We also have a Covid outbreak in one of our Adult Learning Disability Homes where three of the four residents tested
positive, all are doing well with two having completed their ten day isolation period. This and the outbreaks previously
mentioned have impacted considerably, adversely affecting staffing levels which were already problematic. We have
reduced some services to manage and maintain safe staffing levels across services on a temporary basis. At the moment the
only service directly affected by these reductions is ALD respite which has been reduced temporarily to free up staff. There is
little to no flex in Adult Social Care services in staffing numbers and being able to maintain safe/minimum staffing levels has
been an ongoing challenge, which has wider implications for our regulatory obligations.
We are currently finalising an updated Manx Care Residential Homes and Community Homes Visiting Policy which will outline
future responses to outbreaks in line with PHE guidance.
Number of acquired infections ‐ MRSA
Bacteraemia
5
4
3
2
1
0 0 0 0 0 0
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Hospital Community
Number of Hospital Complaints
Received
40
35
30
25
20
15
10
5
32 25 33 27 31 38
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
2
2
3
1
2
2
1
1
1
1
0
7
4
7
6
4
5
1
2
1
1
1
5.6
7.8
9.8
9.4
8
7.7
2.2
1.2
5.4
4.2
7.7
5.8
1.5
2.9
4
1
32
25
33
27
31
38
%
%
%
%
%
%
%
0.97
0.27
0.26
0.05
0.72
0.16
% Of Incidents Graded as Serious
15%
10% 7%
4%
5% 3% 3%
0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0%
0%
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Mental Health Services Community Health Adult Social Care
Total number of Community Care
Inpatient/Residential Placement
Incidents
225 200 196 199 205
185
176
150
114 128
127 129
124 113
75 25
22 18 32 26 15
61 47 43 38 51 48
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Mental Health Services Community Health Adult Social Care
Total number of Community Care
Inpatient/Residential Placement Falls
50 44 41
41 40
37 5
40 6 3 4
31
5
30 4
20 35 37 39 37
32
27
10
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Learning Disability (Residential)
Older People & Dementia Care (Residential)
114
127
124
129
128
113
25
61
22
18
32
26
15
47
43
38
51
48
6
3
5
4
35
37
32
39
37
27
Total number of Community Care
Inpatient/Residential Placement
Pressure Ulcers
1 1
1
0
1 0 0 1 1
0 0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
Learning Disability (Residential)
Older People & Dementia Care (Residential)
Total number of Acute Inpatient
Medicaton Errors
(Per 1000 bed days)
5
4
3
4.4 4.5
2
2.9 3.2
1
1.5 1.5
0
Apr‐21 May‐21 Jun‐21 Jul‐21 Aug‐21 Sep‐21
1
1
4.4
4.5
2.9
3.2
1.5
1.5
15.4
7.4
2.9
7.5
17
2
3
3
3
12
3
1
7
1
1
3
1
1
1
12
11
9
3
4
1
1
13
5
8
9
2
7
7
3
%0.
%0.
%0.
%0.
%0.
%0.
%0.
%0.
%0.41
%
%0.
%
001
001
001
001
001
001
001
001
0.52
001
Care Quality Narrative ‐ September 2021
FALLS
Total Number of Acute Inpatient Falls (Per 1000 Bed Days):
2 falls reported in month, resulting in no harm/low harm. Falls / Mobility risk assessments are subject to monthly audit to
ensure compliance. No falls were categorised as causing severe harm / meeting the criteria for a serious incident.
Older People & Dementia Care (Residential):
Of the 27 falls in residential settings 26 were no/low harm. The other fall was unwitnessed and took place in the garden. It
was originally recorded as low harm, but was upgraded to moderate as the service user was assessed as requiring stitches to
their lip. The service user was agitated and did not receive stitches at the time. A follow up call by the doctor the next day
confirmed an infection for which anti biotics were prescribed. It was deemed too late to stitch the wound at this stage.
Learning Disability (Residential):
3 of the 4 falls reported were no/low harm. The other fall was unwitnessed and took place in the service user's bedroom early
morning. This was a fall from bed resulting in a cut to the head which required staples. No long term impact has been noted.
The investigation identified that the bed had recently been changed to one that had been in use previously, but was being
used in a different room. A temporary side was introduced as an interim measure, and the bed has since been replaced.
MEDICATION ERRORS
Total Number of Acute Inpatient Medication Errors (Per 1000 Bed Days):
No errors resulted in harm or involved high risk medications
Page 48 of 49
Care Quality and Safety - Adult Social Care; Mental Health; Community. 2021-2022
Older People & Dementia Care (Residential):
All residential errors reported as no harm. One did involve warfarin, and was discussed with the medical staff leading this
aspect of care. Other notable medication involved were pregablin and co‐codamol. There were also 2 errors in the
community. The response to medication errors was as detailed in the ASC medication policy.
Learning Disability (Residential):
All residential errors reported as no harm. No high risk medications involved. There was also a further error in the respite unit;
again not high risk.
INCIDENTS
Mental Health Services:
All incidents reported as no harm or low harm.
Adult SocialCare:
61% of incidents were no harm. 22% were low harm. Of the moderate+ incidents, more than 2/3rds related to illness and/or
covid. All deaths over the period were expected.
COMPLAINTS
Mental Health Services:
Six complaints related to CAMHS, mainly concerned with access to services/waiting times. Five complaints relating to the
CMHSA and one for the Harbour Suite at Manannan Court.
Adult Social Care:
Complaint received in relation to a best interest process and the conduct of a social worker who was involved.
Community:
Third complaint received at end of Sept and is, therefore, still open.
Hon D M Anderson, MHK
Minister for Health
This chapter sets out the context for this Plan - it looks at:
Issues we are tackling.
What the public, patients, their carers and clinicians want in relation to cancer
services.
Working with Third Sector organisations.
Isle of Man issues.
Vision and Aim for cancer services in the Isle of Man.
Drivers for change.
Vision Statement
To provide a comprehensive Service for patients from the Isle of Man,
initially on a par with the best region in the UK.
Aim
Our aim is to reduce cancer incidence, morbidity and mortality for the
population of the Isle of Man and to improve the experience and
outcomes of cancer patients and their carers.
Cancer Intelligence is essential for two broad purposes:
Epidemiological.
Service planning and monitoring.
Strategic Objective
To implement the Somerset Cancer Register in the Isle of Man.
Priority Targets
To ensure accurate and complete data collections, including
staging data, on all Isle of Man cancer patients.
To ensure linkage between screening systems and hospital
systems to permit longitudinal follow-up.
To link finance data with activity data to enable appraisal of
cost-effectiveness and value for money.
Key Implementation Tasks
Implementation of the SCR and ensuring that it links with
other optimal systems.
Adequate training and back-up for all users to enable the
efficient use of the SCR.
Linkage of screening systems with the SCR or Medway.
Auditing the outcome for Isle of Man cancer patients in
comparison with those of the UK and Europe, standardised
for each stage.
Strategic Objectives
To introduce screening programmes in line with recommendations of the
UK National Screening Committee.
To monitor the developments in genetic screening, preventive medicine
and vaccines for cancer and introduce these interventions provided that
they meet the appropriate criteria.
To provide community education and information in a variety of formats
that are easily accessible to the public.
To undertake periodic audits of the information provided to ensure that
the information is accessed, is adequate, is easily understood and is
helpful to the public, and to modify the information in the light of audit
results.
To raise awareness of the conditions for which screening is offered and the
details of how to access the screening programme among professionals
and the public, to ensure a high uptake.
Priority Targets
Establishment of a co-ordinated QA programme to cover all screening
programmes.
Horizon scanning to identify new scanning programmes / techniques which
are being considered by the UK National Screening Committee with a view
to introduction locally.
Key Implementation Tasks
Ensure adequate QA mechanisms for all screening programmes.
Educate the population to ensure a high uptake of screening programmes
and to reduce socio-economic disparities.
Link the screening data with hospital data to assess the effectiveness of
the screening programmes.
Educate the public to prevent the introduction of untested and ineffective
screening projects.
Strategic Objectives
To ensure that the Isle of Man is in the lowest quartile for negative
lifestyle indicators (for example - smoking, alcohol consumption,
obesity) and the highest quartile for positive lifestyle indicators (for
example - five portions of fruit and vegetables per day, physical
activity) in comparison with the distribution of these indicators in
England.
To raise awareness of the signs and symptoms of cancer within the
population to enable them to seek medical advice as early as
possible.
To provide community education and information in a variety of
formats that are easily accessible to the public.
To undertake periodic audits of the information provided to ensure
that the information is accessed, is adequate, is easily understood and
is helpful to the public, and to modify the information in the light of
audit results.
Priority Targets
Increase and sustain positive multi-agency working with public,
private and the ‘Third’ sectors to raise awareness of prevention, and
to enable earlier recognition and presentations of cancer
symptoms.
Ensure the accessibility of services for prevention of cancer, in the
areas of smoking cessation, physical activity and screening.
Support the delivery of the Framework for Tackling Childhood
Obesity, and the Tobacco, Drug and Alcohol, and Physical Activity
Strategies.
Regulate the use of sun beds.
Improve public awareness of the main preventable factors for cancer.
Maintain the HPV vaccination programme and expand it, if
appropriate.
Key Implementation Tasks
Continue to implement wide-ranging programmes to reduce smoking
levels and exposure to second-hand smoke in the Isle of Man.
Work with other Government Departments to implement the
Framework for Tackling Childhood Obesity, and the Tobacco, Drug and
Alcohol, and Physical Activity Strategies.
Increase the rates of those who breastfeed for 3 months or longer.
Continue to deliver multi-agency weight management programmes
for children and adults to reduce obesity levels in the Isle of Man.
Contribute to a reduction in hazardous and harmful drink
consumption through education, training and publicity.
Work with primary and secondary schools and with the community
to promote the limitation of excessive - artificial and natural – ultra-
violet (UV) exposure.
Enable the public to access information from a variety of media
appropriate to their needs, should they choose to do so.
Implement health-related social marketing concepts and techniques to
achieve specific behavioural goals relevant to risk reduction and early
detection of cancers in the Isle of Man population.
Deliver the HPV programme.
Devise programmes to specifically address the needs of at-risk
groups - for example, those with learning, mental or physical
disability.
Strategic Objectives
To equip GPs and other healthcare professionals, through
educational programmes, with the skills to recognise the
early signs and symptoms of cancer.
To develop protocols to ensure early referral of suspected
cancer cases.
To ensure that all cancer referrals are ‘streamlined through’
to minimise the delay in diagnosis and staging.
To minimise the delay in initiating treatment.
To ensure that all patients have a comprehensive treatment
plan designed by the relevant MDT.
To provide as much treatment as possible in the Isle of Man,
subject to cost and quality considerations.
To ensure that all Isle of Man cancer patients are provided
with the opportunity to participate in cancer research
studies and clinical trials at Noble’s Hospital.
To ensure that the Isle of Man Cancer Services are a part of
the Merseyside and Cheshire Cancer Network and
implement similar care plans and protocols of treatment;
also, proactively influencing the network to ensure they take
into account Isle of Man patients in their planning process.
To undertake periodic patient feedback using a variety of
methods, and implement changes in services and
information provided based on the results of such feedback.
To provide the most recent information in a variety of
formats that is easily understood by both patients and
carers at every stage of the cancer journey.
Priority Targets
Develop a referral process for all cancer patients to enter
hospital by a number of routes.
Monitor waiting times for diagnosis and treatment.
Develop patient care pathways and map the progress of the
patient’s journey through the pathway.
Develop the skills and abilities of professionals working with
cancer patients and their carers:
Maintain and update skills through continuing
professional development (CPD).
Train health professionals to take on the changes in
cancer services.
Keep roles (functions) under constant review.
Ensure all professionals working with cancer patients
and their carers attend advanced communication skills
training courses in order to improve communication
between health professionals and patient.
Monitor and analyse cancer survival and experience of
Isle of Man patients at regular intervals and compare
with UK and European figures.
Key Implementation Tasks
Develop referral criteria between Primary and Secondary
Care taking into account NICE Guidelines on who should be
referred urgently and how referrals should be made.
In clinical areas where cancer diagnoses are made, to
develop and establish a system ensuring the patient is
referred into the Cancer Care Service at the appropriate
place.
Strategic Objectives
To ensure that cancer services for children and young people,
including funding and resources at all levels, are equitable with
those available to adult cancer patients.
To ensure that cancer services for children and young people are
implemented according to the Children’s Cancer Measures (see
above), subject to peer review and underpinned by a ‘shared care
agreement’.
Priority Targets
Develop a care pathway for the 16 to 24-year-old age group.
Develop a pathway to manage the care of survivors of childhood
cancer who require long-term follow-up.
Develop the skills and abilities of professionals working with
children and young people in order to meet the peer review
measures:
Maintain and update skills through continuous
professional development.
Train health professionals working with children and young
people to take on the changes in cancer services.
To invest in adequate pharmacy support for children’s cancer as
recommended through liaison with the Principal Treatment
Centre (PTC), and peer review.
Key Implementation Tasks
Initially, to undertake an internal peer review with the PTC in
2012, with formal peer reviews in subsequent years.
To develop and implement a plan in collaboration with partner
agencies for adults who are childhood cancer survivors.
To sign a shared care agreement with the PTC and the CNG.
Strategic Objectives
To ensure that the needs of cancer survivors are identified and
met as far as possible.
To ensure that there is a seamless transfer of care from Tertiary
and Secondary Care to Primary Care.
To provide adequate help and advice for patients with long-term
complications following cancer treatment, including specialist
advice for specific complications if required.
To ensure that social care involvement starts at an early stage.
To ensure all patients receive an individualised assessment and
care plan focussed on their needs after treatment.
To ensure that psychological support continues even after the
patient has been formally discharged from the hospital.
To provide the most recent information in a variety of formats
that is easily understood by both patients and carers at every
stage of the cancer journey.
To ensure that the most recent information covers all aspects of
the cancer experience, including availability of practical help and
benefits.
Priority Targets
To continue to improve the experience of people living with and
beyond cancer by:
Supporting and informing patients to enable them to
understand their cancer and its management.
Involving them in decision-making, as they wish.
Giving them information and advice to make informed
choices about their care
Key Implementation Tasks
Address the specific needs of increasing numbers of cancer
survivors by:
Identifying the experiences and needs of local survivors.
Improving the care and support for cancer survivors with
a focus on recovery, health and well-being.
Improve the way healthcare and social care professionals view
and communicate with patients and carers, post-treatment:
Build on the existing partnerships between the
Department of Health, the Department of Social Care and
the Third Sector to meet the growing demands of
healthcare and social care in the Isle of Man.
Improve information for patients, their families and carers, as
appropriate, through a range of initiatives.
Ensure all patients receive an individualised assessment and care
plan focussed on their needs after treatment.
Develop and implement a plan to strengthen communication
between Primary and Secondary Care, Community Teams, Social
Care, Third Sector providers, the patient, their families and carers
- both formal and informal.
Ensure the delivery of high-quality training to equip professionals
in all sectors, and informal carers, with the skills necessary to
support cancer patients living with and beyond cancer.
Strategic Objectives
To ensure that all patients with cancer and their carers receive
psychological support at the appropriate level for their need
(levels 1 – 4, as defined in NICE guidelines).
To ensure that all healthcare workers likely to be dealing with cancer
patients and their carers are trained to provide psychological support
at levels 1 and 2.
To ensure that there is adequate input at level 4 for patients and
carers requiring support at this level.
To provide adequate facilities in the community so that patients have
complete choice of their place of death.
Priority Targets
Actively track patients through their cancer pathways and collect,
collate and provide cancer statistics.
Achieve ‘single patient, single record’ system in the Hospital, Hospice
and the community.
Provide high-quality care in the last few days of life by using the
‘Liverpool Care Pathway for the Dying Patient’ (LCP) in all clinical
settings.
Provide high-quality palliative care in Primary Care by embracing the
principles set out in the Gold Standards Framework project.
Invest in staff and services to continue to improve cancer services.
Establish sufficient and flexible care provision in all health settings so
that patients truly have a choice as to their preferred place of care
and death.
Key Implementation Tasks
Implement the Somerset Cancer Register to allow tracking of cancer
patients and provide statistical information to improve cancer
services.
Fully implement CCSS in the Hospital and Hospice, with the RiO
system in the community.
Encourage health professionals to utilise the ‘Liverpool Care Pathway
for the Dying Patient’.
Strategic Objectives
To ensure that the information systems are robust enough to provide data for the
introduction of commissioning.
To introduce commissioning for Secondary Care services, incorporating cancer
issues within the agreements for different specialities.
To monitor and evaluate the provision of cancer services provided to patients in
the Isle of Man.
Priority Targets
To link finance and activity data to enable meaningful commissioning.
To enhance health needs analysis so that services are re-designed to meet the
needs of the local population.
To develop provision for specific actions for cancer services.
Key Implementation Tasks
To review the commissioning arrangements for tertiary care with CCO and other
providers.
To ensure the availability of accurate data on health needs, Health Service activity,
and finance.
Monitor the quality of cancer services by working with professionals, patients and
carers, ensuring that the responses are incorporated into the planning process to
develop and improve services.
Year
Incidences
2019
83
2020
63
2021
83
First Treatment Type
Incidences
Surgery
168
Chemotherapy or Immunotherapy
29
Hormone
39
Palliative Care
*
Active Monitoring
*
Full Response Text
MANX CARE KPI REPORTING
INTEGRATED PERFORMANCE
REPORT
September 2021
Page 1 of 49
Page:
3
4
Theatres
7
Care Group 2 ‐ Medicine,
Urgent Care & Ambulance Service
10
11
14
Urgent Emergency Care
Ambulance Service
17
Care Group 3 ‐ Integrated
Diagnostics & Cancer Services
18
20
Integrated Cancer Services
Radiology
Pathology
26
Care Group 4 ‐ Integrated Women's
Children's and Families Services
27
Women & Family and Integrated Children's
Services
28
Care Group 5 ‐ Integrated Primary
and Community Care
29
Integrated Community Services
30
Primary Care
32
Integrated Mental Health Services
33
Mental Health Dataset
35
Social Care Services
36
Children & Families Social Work Services
39
Adult Social Care Social Work Services
41
Adult Social Care Operational Services
44
Combined Care Quality Dataset
CQ ‐ Hospital
47
CQ ‐ Community
CONTENTS
Care Group 1 ‐ Surgery, Theatres
Critical Care & Anaesthetics
Planned Care
23
Care Group/Service Area Dataset
45
Page 2 of 49
manxcare
Kiarail Vannin
Manx Care KPI Reporting
Surgery, Theatres,
Critical Care and Anaesthetics
Surgery. Theatres.
Critical Care and
Anaesthetics
Care Group Reporting
(September 2021)
Contents:
Theatre's KPI Dataset
Planned care KPI Dataset
Page 3 of 49
MAIN THEATRE INFORMATION - 2021-22
1
5
7
3
17
0
2
6
1
1
0
69
86
97
84
81
80
0
20
40
60
80
100
120
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
THEATRE SESSIONS
(EXCLUDES WEEKEND TRAUMA)
Count of Cancelled Theatre Sessions
Count of Re‐utilised Theatre sessions
Count of Actual theatre Sessions delivered
16
22
30
18
32
30
1
4
12
30
11
4
0
5
10
15
20
25
30
35
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
THEATRE CANCELLATIONS ON DAY
(EXCLUDES WEEKENDS)
Clinical Decision
Non‐Clinical Decision
2%
13%
8%
6%
2%
13%
13%
10%
8%
8%
14%
3%
NON‐CLINICAL CANCELLATIONS ON DAY
(EXCLUDES WEEKENDS)
Administrative error
Anaesthetist unavailable
Appointment inconvenient
DNA
Equipment failure/unavailable
ICU/HDU bed unavailable
List over‐run
Operation not wanted (patient)
Postponement (Lack of theatre
time)
Surgeon unavailable
Theatre staff unavailable
Unfit for surgery ‐ patient
cancellation
Ward beds unavailable
Misc (No other listing)
2,662
3,117
3,626
3,914
2,541
3,617
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
LATE STARTS IN MINUTES
(EXCLUDES WEEKEND TRAUMA)
5,102
5,048
3,643
5,253
6,489
6,682
0
1000
2000
3000
4000
5000
6000
7000
8000
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
EARLY FINISHES IN MINUTES
(EXCLUDES WEEKEND TRAUMA)
70.0%
75.0%
83.0%
74.0%
69.0%
67.0%
Target 85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
% UTILISATION
(EXCLUDES WEEKEND TRAUMA)
Page 4 of 49
MAIN THEATRE INFORMATION - 2021-22
Variance on Budget 2020-21
Actual
Budget
Var (£)
Var (%)
Theatre Services
733
714
(19)
(3%)
Actual
Budget
Var (£)
Var (%)
Theatre Services
3,907
4,282
375
9%
MONTH £'000
YEAR TO DATE £'000
12%
6%
4%
2%
21%
6%
40%
9%
CLINICAL CANCELLATIONS ON DAY
(EXCLUDES WEEKENDS)
Administrative error
Deaceased
Emergency case took priority
Operation not necessary (Hospital)
Pre‐operative guidance not followed
Pre‐existing medical condition
Procedure carried out elsewhere
Surgeon unavailable
Unfit with acute illness
Unsuitable for Day Surgery
Ward beds unavailable
1,329
1,454
2,185
2,194
1,575
1,345
0
500
1000
1500
2000
2500
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
LATE FINISHES IN MINUTES
(EXCLUDES WEEKEND TRAUMA)
Theatres Narrative ‐ September 2021
Theatre Sessions:
The Care Group continued to deliver post COVID‐19 theatre schedule until mid‐September where sessions were 18 theatre
sessions were cancelled in response to the unavailability of anaesthetists to support the operating lists which has resulted in a
slight reduction to the theatre utilisation. Sickness and vacancies have limited the return to full theatre capacity however
recruitment is in progress for substantive staff and there has been a recruitment drive for Agency staff which aim to increase
activity in theatres from October 2021. A review of the current theatre schedule and staffing establishment is in progress and
supported by Develop Consulting to ensure that we are utilising our current resources efficiently. During this period no sessions
were re‐utilised because the limiting factor on theatre activity was anaesthetic cover and therefore lists were not available for
reuse.
Page 5 of 49
MAIN THEATRE INFORMATION - 2021-22
Clinical Cancellation on the day of surgery:
Clinical Cancellations on the day have increased significantly in line with an increase in clinical decision cancellations. Progress
has been made in improving surgical pathways of care to reduce clinical cancellations on the day sustainably. Support has been
gained for the introduction of a Surgical Assessment Unit, Surgical Admissions unit (based on Day Procedures Suite) and these
improvement projects are currently in the scoping phase of delivery.
Non‐ Clinical cancellation on the day of surgery:
Bed and workforce pressures have combined to severely impact elective activity in September resulting in 13 cancellations due
to unavailability of ward beds, a combination of medical outliers on surgical wards and the re‐allocation of staff from ward 12
(Elective Orthopaedic, ward) has led to regular cancellations throughout the month of September. Wards continue to focus on
recruitment and a review of the current nursing establishment is in place. Processing time to advertise roles is impeding
services ability to maintain safe staffing levels as well as a reduced ability to secure UK agency nursing staff.
Early Finishes and Late Starts
Late starts have increased in the month of September linked to anaesthetic staffing and the fluctuating bed state and last
minute changes to lists required following non‐ clinical on the day cancellations. Early Finishes have equally increased in line
with on the day non‐clinical cancellations linked to bed and workforce pressures. Due to the significant period of time that
specialities have focused on day case and local anaesthetics waiting lists there are limited patients left that can be seen when
the hospital is unable to support inpatient elective activity.
Budget
Due to the lack of activity the main theatres spend on non‐pay consumables, is lower than budgeted for this year. Spend in
Endoscopy consumables and equipment maintenance has however increased during August and September due to increase in
the management of ERCP’s and introduction of waiting list initiatives on Island and the associated costs involved in rental costs
for equipment and accessories to manage these procedures. The overspend in Endoscopy should be partly mitigated by a usual
annual tertiary spend of £250,000 for specialist ERCP services in the UK which are currently being provided on island.
Additionally staff retirement and resignation means that theatres have been carrying vacancies that have not been covered by
agency. This has not been addressed due to the current bed situation however requests for agencies have been approved
allowing the employment of agency throughout September and the department hope to recover some lost activity in the early
stages of Q3.
It is acknowledged that greater control is required across the Care Group on financial control, as such integration of finance
business partners in to care group governance is in process. In addition to this a training and development plan is being
developed to address the identified skills gap within the area of financial control within frontline services managers.
Agency spend has reduced this month due to lack of availability further compounding lack of activity able to be supported by
main theatres. Work continues to secure agency staff whilst recruitment is ongoing. The anaesthetic staffing position is
challenging and will represent a significant cost pressure for the care group for the remainder of this financial year.
Page 6 of 49
Planned Care 2021-22
56.9%
56.0%
61.4%
54.4%
55.8%
51.9%
Target 85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
% of Urgent GP referrals that are seen
for their first appointment within 6
weeks
11,808
12,305
12,550
12,827
12,865
13,182
1,758
1,871
1,879
1,789
1,798
1,781
2,753
2,721
2,884
2,777
2,922
2,878
16,319
16,897
17,313
17,393
17,585
17,841
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Number of Patients waiting for First
Hospital Appointment
Allied health Professional Referrals
Nurse Outpatient Referrals
Consultant Outpatient Referrals
10.2%
9.9%
10.7%
9.4%
8.9%
11.3%
4.9%
7.5%
7.5%
5.6%
5.8%
5.3%
12.0%
10.1%
9.5%
8.8%
10.4%
9.2%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
DNA Rate
Consultant led New and Follow up outpatient appointments
Nurse led New and Follow up outpatient appointments
Allied Health Professional New and Follow up appointments
74
51
56
86
74
69
0
10
20
30
40
50
60
70
80
90
100
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Number of Spells where a patient has
had a length of stay over 21 days.
Page 7 of 49
Planned Care 2021-22
Variance on Budget 2020-21
Actual
Budget
Var (£)
Var (%)
Medicine Services
1,270
1,108
(162)
(15%)
Actual
Budget
Var (£)
Var (%)
Medicine Services
7,174
6,407
(767)
(12%)
MONTH £'000
YEAR TO DATE £'000
Hospital Planned Care Services ‐ Narrative ‐ September 2021
Number of patients waiting for a first appointment
The number of patients waiting for a first inpatient hospital appointment has continued to increase gradually indicating a slight
discrepancy between capacity and demand. This is in part driven in year by a higher than normal annual leave burden carried
over from the 1st year of the COVDI‐19 pandemic leading to a reduction in availability of clinical teams to deliver clinical
activity. Work with Medefer designed to increase Manx Cares capacity for outpatient appointments is ongoing and pathways
have been agreed with, Cardiology, Neurology, Gastroenterology, Respiratory, Pain clinic and ENT. Capacity issues have been
identified within General Practice, diagnostics and allied healthcare professionals which Manx Care are working with Medefer
to mitigate.
Did Not Attend Rate
Did not attend rates remain largely stable with an increase in DNAs for Consultant led appointments in September, this DNA
rate is comparable to UK services with NHS England report between 8.5 & 10 % thought FY 19/20. The Clinical Administration
Service groups is currently defining a piece of work identifying areas for improvement within our existing booking and
notification services. This work will identify potential improvements to the DNA rate within planned care.
% of Urgent GP referrals seen within 6 weeks
% of Patients seen within 6 weeks of GP referral Demand for 2WW (Cancer) referrals has remained higher than baseline post
COVID‐19 surges and subsequent lockdowns. This has meant that more of our outpatient capacity has been focused on
maintaining cancer waiting time targets impacting on our Urgent wait targets. An access policy is being developed within Manx
Care that will improve the clarity of access pathways and improve the active management of demand and capacity within out
outpatient clinics.
4.9
4.7
4.7
5.4
5.4
4.9
55.5
32.4
40.7
44.2
32.6
50.8
0
10
20
30
40
50
60
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Average Length of Stay (Days)
ALOS (Average Length of Stay) ‐ Nobles
ALOS (Average Length of Stay) ‐ Ramsey
Page 8 of 49
Planned Care 2021-22
Average Length of Stay
Average length of stay remains stable in Nobles of 5.4days and Ramsey has sustained a reduction in ALOS achieving 32.6 days
in August. The sustained reduction is an indication is linked to appropriate use of criteria for patients being transferred to
Martin ward reducing patients being moved that will become stranded whilst awaiting capacity in step down care facilities.
This position is however being pressured daily by demand for inpatient beds on the nobles site and the need to make acute
beds available for Emergency Admissions. A number of improvement programs are working to address this inclusive of the
pilot of CHS supporting complex discharges, the recent launch of Medical Ambulatory Care and the propsed development of a
Surgical Assessment Unit & Surgical Ambulatory Care.
Page 9 of 49
manxcare
Kiarall Vannin
Manx Care KPI Reporting
Medicine, Urgent Care
& Ambulance Service
Medicine, Urgent Care
and Ambulance Service
Care Group Reporting
(September 2021)
Contents:
Urgent & Emergency care KPI Dataset
Ambulance Service KPI Dataset
I
Page 10 of 49
Urgent and Emergency Care -2021-22
Variance on Budget 2020-21
Actual
Budget
Var (£)
Var (%)
Urgent Care
673
591
(82)
(14%)
Actual
Budget
Var (£)
Var (%)
Urgent Care
3,618
3,279
(339)
(10%)
MONTH £'000
YEAR TO DATE £'000
75.3%
77.5%
77.0%
79.3%
80.0%
76.80%
Target 95%
0%
20%
40%
60%
80%
100%
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
% of Patients, Admitted, Transferred or
Discharged within 4 hours of arrival at the
Emergency Department (Nobles &
Ramsey)
21.4%
18.5%
17.5%
18.4%
21.0%
20.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Nobles: AED Admission Rate
00:52:00
00:53:00
01:04:00
00:56:00
00:39:00
00:59:00
00:00:00
00:10:00
00:20:00
00:30:00
00:40:00
00:50:00
01:00:00
01:10:00
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Average Minutes in Nobles AED
(Time to see First Doctor)
2,626
2,937
3,050
2,798
2,570
2,785
661
735
826
1009
919
899
3,287
3,672
3,876
3,807
3,489
3,684
0
1000
2000
3000
4000
5000
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Number of Unplanned Attendances
(Nobles & Ramsey)
Nobles
Ramsey
03:51:00
03:48:00
03:54:00
03:45:00
03:36:00
03:45:00
00:00:00
00:30:00
01:00:00
01:30:00
02:00:00
02:30:00
03:00:00
03:30:00
04:00:00
Apr‐21
May‐21
Jun‐21
Jul‐21
Aug‐21
Sep‐21
Average Minutes in Nobles AED
(Time in Department)
Page 11 of 49
Urgent and Emergency Care -2021-22
Urgent & Emergency Care ‐ Narrative ‐ September 2021
MEDICINE
Number of patients awaiting first appointment
The number of patients awaiting their first appointment remains stable and comparable to the previous months. Allied Health
Professionals and Nurse outpatients waiting times have decreased, however, Consultants waiting times such as Cardiology and
Gastroenterology have slightly increased. Waiting times in Cardiology are expected to slightly increase further as we are losing
one Cardiac Consultant in November, with a locum secured for 6 weeks (whilst recruitment takes place); this will mean some
clinics will be cancelled. Medefer will begin virtual clinics in Cardiology, Respiratory and Gastroenterology within the next
month, with Neurology starting at the beginning of next year.
DNA Rate
DNA rates for Consultant led clinics have increased by over 2% whilst nurse led clinics remain stable. Work is ongoing with the
Patie
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