CORPORATE PERFORMANCE REPORT. October 2018

Transcription

1 CORPORATE PERFORMANCE REPORT October 218

2 KEY 1 CORPORATE PERFORMANCE REPORT OCTOBER 218 EXECUTIVE SUMMARY Introduction This report provides the CCG with information on the key strategic and operational issues and developments related to the CCG's statutory requirements. Detailed reports can be seen at each relevant committee with corresponding actions, risks and mitigations. Achievement of recovery milestones for access standards remains a priority for 218/19. Standards relating to A&E and ambulance waits, referral to treatment, 62-day cancer waits (including securing adequate diagnostic capacity) along with mental health access standards account for four of the nine National must dos. Overall Assessment Activity The CCG is meeting its planned activity targets, albeit with large variations at individual trust level. Unplanned activity is above the affordable contracted level but in line with the plan agreed with NHS England, this is driven by significant levels of over performance at Whiston, the increases in A&E activity are particularly marked, particularly so when looked alongside the reduction in attendances at the urgent care centres. GP referrals have increased but broadly in line with expectations and in line with similar growth in outpatient and Daycase activity. Performance A number of constitutional standards have been missed in August; most significantly amongst these include the cancer standards to two week wait from referral to first consultation, 31-day waits from diagnosis to treatment and 62-day waits from referral to treatment. Also missed are the Referral to Treatment of 18 weeks and the 6- week diagnostic waiting time target. Non-constitutional standards missed include the Mental Health psychological therapy targets for access and recovery and ambulance response times. Although action plans have been developed in all these areas and resources made available it is unlikely that performance will be seen in these areas soon. and in some instances it will be 219 before the full action plans are in place.. 6-week Diagnostic waiting times The CCG is breaching the 6-week diagnostic waiting time throughout 218/19 The breaches relate to capacity issues at three trusts, these were detailed in the July corporate performance report and the additional diagnostic capacity actions being taken are not expected to show any impact until September 218 at the Royal Liverpool and February 219 at the Liverpool Heart and Chest. Referral to Treatment - 18 Weeks St Helens & Knowsley problems with the implementation of their new patient record system they will be unable to report RTT figures until Q3. On a partial dataset the CCG in meeting the standard but missed it in August. Halton patients at Warrington were treated within 18 weeks on 91.4% on occasions, At the Liverpool Women's on 86% of occasions at the Royal Liverpool on 83.6% on occasions and at Spire on 99.6% of occasions Referral to Treatment - 52 week breach The patient who was breaching the 52-week waiting time standard at the Liverpool Women's Hospital has now been treated. The CCG currently has no 52-week waiters. A&E activity There has been a 6.6% (+834) increase in the number of attendances at a type 1 A&E department compared with 17/18. This increase has only been seen at Whiston (+18%, +1114) with attendances at Warrington having fallen by 4% (-187). The CCG is examining options for the future provision of UCC/UTC care. Non-elective Activity Year-on-year growth exceeds 8% and an additional 466 emergency admissions have been witnessed. Increases are driven almost exclusively by St Helens trust (+19%) with a small reduction at Warrington (-2%) The CCG is working with MIAA and the trusts to understand the reasons behind the number of very short stay admissions and emergency readmissions with a view to developing alternatives. Actual performance Achieving target Adverse variance to target No target set Long term trend

3 2 CORPORATE PERFORMANCE REPORT OCTOBER 218 EXECUTIVE SUMMARY Ambulance Response times Performance is significantly below expectations but continues to improve with category 1 ambulances arriving 1 minute quicker (on average) than at the beginning of the year. 17 new ambulances are in place, 3 rapid response hours have been converted into ambulance hours and an advances paramedic is now in place in the control room to offer clinical support. Initial data shows performance for category 2 calls significantly below expectations. Category 2 calls are the bulk of ambulance calls and ambulances are currently almost 9 minutes over the standard. The industrial action in August has had an impact and although further strikes have been suspended an overtime ban is still in force, despite this NWAS are confident of an improvement in performance. Sickness Absence The CCGs monthly and rolling sickness absence rates remain above target, and have generally been higher than the national NHS trend % of all sickness absence is attributed to long term absence. Actions currently being undertaken to improve sickness absence include HR Business Partners working closely with and supporting managers in the discharge of the Management Absence Policy Stages. 62-day cancer treatment 8 breaches have been reported in August There does appear to be some seasonality with an increased breach rate during the summer months, however the majority (5 of the 8) were at a single trust (Clatterbridge) which suggests an issue with that provider. At time of going to press it is not known if Clatterbridge are experiencing any difficulties. Primary Care Quality, Contracting & Transformation visit programme: The Quality, Contracting & Transformation visits have been completed. A report outlining the themes and trends was presented to Primary Care Commissioning Committee in July 218. During the visit each practice reviewed the Quality Dashboard and identified three areas of good practice and three areas for improvement. These have been transferred into a tracker for ongoing review,. Cancer 2 week waits The CCG's 2 week wait performance continues to worsen with Halton's lowest ever performance reported in August at 89.5% against the target of 93%.Skin cancer referrals continue to be a major source of delays and the CCG and St Helens Trust have a number of plans in place to address. The CCG's has developed local lesion service ; this will operate from 2 sites on a weekly basis and will see the majority of dermatology referrals, this will reduce the demand on the acute provider and free up resource to accommodate the cancer referrals, The CCG are also trialling an enhanced cancerr eferral proforma with general practice, this contains more detailed information which will enable the trust to respond more appropriately. In addition St Helens and Knowsley Trust have also had a business case for additional nurses approved and two locum doctors have been given fixed term contracts which provide additional resource in the dermatology service. KEY Actual performance Achieving target Adverse variance to target No target set Long term trend

4 6 CORPORATE PERFORMANCE REPORT OCTOBER 218 CONSTITUTIONAL STANDARDS AT A GLANCE NHS is committed to ensuring that performance against constitutional measures and outcomes are consistently and rigorously maintained. It should be noted that not all of the indicators are reflected in the Corporate Performance Report. Cancer 2 week waits The CCG's 2 week wait performance continues to worsen with Halton's lowest ever performance reported in August at 89.5% against the target of 93%. 63 patients breached the standard; this is double the number who breached in May. Of the 63 patients who breached 46 of them attended St Helens & Knowsley Trust. The rate here was 85% of patients seen in two weeks; no other trust breached the performance standard. The majority of patients who breached the standard were seen within 7 days of breaching with 6 patients waiting more than a month from referral. Skin cancer referrals continue to be a major source of delays and the CCG and St Helens Trust have a number of plans in place to address this, however these are not likely to be in place until November at the earliest, therefore the CCG can continue to expect to miss this standard until December. ACTION - The CCG's business case to pilot a local lesion service has been approved; this will operate from 2 sites on a weekly basis and will see the majority of dermatology referrals, this will reduce the demand on the acute provider and free up resource to accommodate the cancer referrals, The CCG are also trialling an enhanced cancer referral proforma with general practice, this contains more detailed information which will enable the trust to respond more appropriately. In addition St Helens and Knowsley Trust have also had a business case for additional nurses approved and two locum doctors have been given fixed term contracts which provide additional resource in the dermatology service. In addition to missing the 2 week wait target the CCG has also missed the 31 day diagnosis to treatment target and the 62-day referral to treatment target. 31 day diagnosis to treatment The CCG had 4 patient breaches in August, (usually 1) these breaches were at 4 different trusts for three different types of cancer. There does not appear to be systemic cause for these breaches; however should this level of performance continue the CCG could miss the standard and it could be indicative of wider NHS pressures. 62 day referral to treatment 8 breaches have been reported in August (usually 1 or 2) the performance in August 18 was the lowest since August 17. In addition to the number of breaches, 4 of the 8 patients waited in excess of 91 days. There does appear to be some seasonality with an increased breach rate during the summer months, however the majority (5 of the 8) were at a single trust (Clatterbridge) which suggests an issue with that provider. At time of going to press it is not known if Clatterbridge are experiencing any difficulties. CANCER TWO WEEK WAITS 91.1% 93.% CANCER 62 DAY TREATMENT AMBULANCE RESPONSE TIME (CAT 1) 86.5% 8:21 AUG18 85.% 7: LESS THAN 4-HOUR A&E WAITS REFERRAL TO TREATMENT 92.7% 92.1% 9.% 92.% 6-WEEK DIAGNOSTIC WAIT DELAYED TRANSFERS OF CARE 98.8% 398 AUG18 99.% 437

5 7 CORPORATE PERFORMANCE REPORT OCTOBER 218 CONSTITUTIONAL STANDARDS CANCER KPI 218/19 PERFORMANCE ACTIONS TWO WEEK WAITS The % patients seen within two weeks for an urgent GP referral for suspected cancer 98% 88% 89.5% TWO WEEK WAITS 17/18 18/19 93.% 93.9% 94.2% 91.1% There has been a significant increase in the number of dermatology 2WW referrals which have missed the 14-day standard, has developed a local dermatology service which will divert non- 2WW activity away from the trust, this will be in place in November, in addition the trust has employed additional nurses and locum doctors in the dermatology service TWO WEEK WAIT - BREAST Two week wait standard for patients referred with breast symptoms not covered by two week wait for breast cancer 93.1% TWO WEEK WAIT - BREAST SYMPTOMS Due to very small numbers there is a large degree of volatility in performance reporting. The CCG continues above the standard for performance. 93.% 9% 17/ % 94.4% 8% 18/ % 31 DAY TREATMENT The % of patients receiving their first definitive treatment within one month of diagnosis 93.7% 31 DAY TREATMENT 96.% 97.7% Although the CCG is meeting the standard the performance in August 18 was the lowest since August 17. There does not appear to be any single systemic issue behind these breaches as the breaches occurred at four different trusts for three different cancer specialties. 9% 17/18 18/ % 97.3% 62 DAY TREATMENT The % of patients receiving their first definitive treatment within two months of GP referral for suspected cancer 8% 6% 73.3% 62 DAY TREATMENT 17/18 18/19 85.% 84.97% 8.1% 86.5% The performance in August 18 was the lowest since August 17. In addition to the number of breaches, 4 of the 8 patients waited in excess of 91 days. There does appear to be some seasonality with an increased breach rate during the summer months, however the majority (5 of the 8) were at a single trust (Clatterbridge) which suggests an issue with that provider. At time of going to press it is not known if Clatterbridge are experiencing any difficulties.

6 8 CORPORATE PERFORMANCE REPORT OCTOBER 218 CONSTITUTIONAL STANDARDS MENTAL HEALTH KPI 218/19 PERFORMANCE ACTIONS DEMENTIA DIAGNOSIS Diagnosis rate for people with dementia, expressed as a percentage of estimated prevalence (aged 65+) 8% 7.3% DEMENTIA DIAGNOSIS 17/ % 72.4% 69.6% The CCG saw a steady decline over 217/18, and failed to achieve its local target, however the CCG met the national target of 66.7% For 18/19 the CCG will work with those practices which have reported the largest drops in the number of identified patients, to determine the reasons and implement solutions. 6% 18/19 7.8% IAPT ACCESS People who receive psychological therapies as a percentage of people who have depression and/or anxiety disorders (rolling 3 month) 5% 3% IAPT ACCESS 17/18 Q4 18/19 4.2% 4.8% 3.8% 4.26% 4.2% The target has increased for 18/19 and the CCG The CCG is investigating the possibility of having practitioners in primary care; and including the sessions being provided by Wellbeing Enterprise. To achieve the new target an additional 74 people would need to be seen per month, the current provision from Wellbeing is (on average) contracted to be 58 per month, however Wellbeing Enterprise have informed the CCG that they are not seeing the number of referrals anticipated. IAPT RECOVERY The proportion of people who complete treatment who are moving to recovery. 6% 4% 46.8% IAPT RECOVERY 5.% 45.% 17/ % 18/ % The IAPT recovery rate has improved from a low in July, the CCG is still below the standard. Recovery rates have historically improved in the winter months. The CCG continues to activity monitor performance against recovery. PSYCHOSIS 2WW The percentage of people experiencing a first episode of psychosis with a NICE approved care package within two weeks of referral. 4% 5.% PSYCHOSIS 2 WEEK WAIT 53.8% 74.% 17/ % 18/ % The CCG performs well with respect to people receiving treatment promptly after a first episode of psychosis. The low August figure relates to a single patient. The CCG continues to meet this standard

7 9 CORPORATE PERFORMANCE REPORT OCTOBER 218 CONSTITUTIONAL STANDARDS URGENT & EMERGENCY CARE KPI 218/19 PERFORMANCE ACTIONS AMBULANCE Category 1 calls: Mean response time (MM:SS) 14:24 11:31 8:38 5:46 2:53 : AMBULANCE Category 2 calls: Mean response time 43:12 : 8:21 25:39 AMBULANCE: CATEGORY 1: MEAN RESPONSE TIME 17/18 18/19 7: 8:42 AMBULANCE: CATEGORY 2: MEAN RESPONSE TIME 17/18 18/19 18: 26:48 3:39 9:54 Performance for category 1 calls is significantly below expectations but continues to improve with category 1 ambulances arriving 1 minute quicker (on average) than at the beginning of the year. 17 new ambulances are in place, 3 rapid response hours have been converted into ambulance hours and an advances paramedic is now in place in the control room to offer clinical support. As per category 1 performance, initial data shows performance for category 2 calls significantly below expectations. Category 2 calls are the bulk of ambulance calls and ambulances are currently almost 9 minutes over the standard. The industrial action in August has had an impact and although further strikes have been suspended an overtime ban is still in force, despite this NWAS are confident of an improvement in performance. TYPE 1 A&E ATTENDANCES The number of Halton patients attending a type 1 AED (Acute hospital site) 3, 2, 1, 2628 TYPE 1 AED ATTENDANCES Aug 18 2,434 Aug-16 2,418 Aug-17 2,558 2,628 Performance is both above plan and higher than witnessed in August 17. During 218/19 Attendances at both Urgent Care Centres has fallen compared with the same period last year. particularly at Widnes UCC. There has been a 6.6% increase in Type 1 A&E attendances and a 4.9% reduction in UCC attendances in the comparative positions. The CCG is examining options for the future provision of UCC/UTC care. 4-HOUR A&E WAITS The percentage of patients who spent less than four hours in A&E 85% 92.7% A&E 4-HOUR WAITS 17/18 18/19 9.% 93.1% 93.% 92.7% After reductions in performance across both local acute providers to March 218 improvements have been seen at both Whiston and Warrington. Warrington has achieved around the 9% target consistently since May, and whilst Whiston has yet to achieve the standard in 218/19it came close in August with 89.3%

8 1 CORPORATE PERFORMANCE REPORT OCTOBER 218 KEY ACTIVITY AT A GLANCE NHS monitors performance against key activity metrics continuously. Significant variations to plan are raised through contract review meetings. It should be noted that not all activity levels being monitored are reflected in the Corporate Performance Report. Overview Data Quality A number of data quality issues have been identified which are making it difficult to gauge an accurate activity position, the two largest issues relate to the ongoing Medway implementation at STHK, which are impacting on referrals, outpatients, readmissions and causing large swings in historical activity as errors are corrected. STHK have informed the CCG's that normal service may not be resumed until December, A&E activity There has been a 6.6% (+834) increase in the number of attendances at a type 1 A&E department compared with 17/18. This increase has only been seen at Whiston (+18%, +1114) with attendances at Warrington having fallen by 4% (-187) the very large increase at Whiston is being investigated as the new PAS system may be returning a more accurate figure than in previous years, however at least some of the increase is likely to be genuine. Halton patient attendances at the Urgent Care Centre attendances has fallen at both sites, with Widnes down by 6.9% (-158) and Runcorn down by 2.8% (-33) non-halton attendances at both sites continues to increase GP REFERRALS Non elective admissions The CCG is in line to achieve the plan set with NHS England for non-elective activity, however year-on-year growth exceeds 8% and an additional 466 emergency admissions have been witnessed. Increases are driven almost exclusively by St Helens trust (+19%) with a small reduction at Warrington (-2%) and these increases are in excess of the affordable contracted amount creating a cost pressure for the CCG. The CCG is working with MIAA and the trusts to understand the reasons behind the number of very short stay admissions and emergency readmissions with a view to developing alternatives. Elective activity Both Overnight ordinary elective activity and elective Daycase activity are broadly on plan. Daycase admissions are 4% above plan, however overnight admissions are below plan. There is evidence however that waiting lists are beginning to increase. unfortunately due to the data quality issues at STHK the full waiting list picture is not known FIRST OUTPATIENTS URGENT CARE CENTRE ATTENDANCES NON-ELECTIVE ADMISSIONS 17/ A&E TYPE 1 ATTENDANCES ELECTIVE DAYCASE ADMISSIONS

9 11 CORPORATE PERFORMANCE REPORT OCTOBER 218 KEY ACTIVITY KEY ACTIVITY KPI 218/19 PERFORMANCE ACTIONS GP REFERRALS GP written referrals for a first outpatient appointment in G&A specialties 3,5 3, 2,5 278 GP REFERRALS 18/19 17/18 13,894 13,893 12,973 GP referrals are above plan by 2.8% however due to the data quality issues at STHK this may not be a true picture. overall referrals are above plan by just.8% which is in line with both outpatient increases and elective activity 2, 18/19 14,295 FIRST OUTPATIENTS All first outpatient activity G&A specialties 483 Outpatient attendances are slightly above plan (+2.6%) this is in line with the operational plan 5, FIRST OUTPATIENTS 4, 18/19 19,453 18,465 3, 17/18 18/19 19,137 19,963 REFERRAL TO TREATMENT The percentage of patients waiting at the period end, who have been waiting less than 18 weeks from referral to treatment 95% 9% 91.1% REFERRAL TO TREATMENT - 18 WEEKS 17/18 18/19 92.% 93.9% 92.7% 92.1% The CCG has failed the RTT standard in August. however this is only a partial picture and subject to change as no St Helens data has been included. Halton patients at Warrington were treated within 18 weeks on 91.4% on occasions, At the Liverpool Women's on 86% of occasions at the Royal Liverpool on 83.6% on occasions and at Spire on 99.6% of occasions NON-ELECTIVE ADMISSIONS Total non-elective FFCEs in general and acute specialties 1,7 1, NON-ELECTIVE ADMISSIONS 7,962 7,383 17/18 7,436 17/18 8,7 The CCG is in line to achieve the plan set with NHS England for non-elective activity, however year-on-year growth exceeds 8% and an additional 466 emergency admissions have been witnessed. The CCG is working with MIAA and the trusts to understand the reasons behind the number of very short stay admissions and emergency readmissions with a view to developing alternatives.

10 12 CORPORATE PERFORMANCE REPORT OCTOBER 218 KEY ACTIVITY KEY ACTIVITY KPI 218/19 PERFORMANCE ACTIONS 4 ELECTIVE ADMISSIONS Total ordinary elective admissions in general and acute specialties ORDINARY ELECTIVE ADMISSIONS 1,271 1,267 17/18 1,279 18/19 1,182 Overnight ordinary elective activity is on plan overall and at both main local acute providers. DAYCASE ADMISSIONS A Patient admitted electively during the course of a day who does not require the use of a bed overnight and who returns home as scheduled. 2, 1,5 1, 5 17/18 18/ DAY CASE ELECTIVE ADMISSIONS 6,712 7,334 6,969 6,99 The very large over performance seen in Daycase activity at the start of 218/19 has not continued into Q2, the Daycase activity is slightly over plan but should be looked at alongside the number of overnight elective admissions. DELAYED TRANSFERS The number of delayed days from acute or non-acute (including community and mental health) care 1, DELAYED TRANSFERS OF CARE 437 Aug Aug Focused work continues with regards to increasing Domiciliary Care capacity. The Reablement 1st approach continues to operate and the LA are currently working to increase capacity within this area. We have seen a positive impact at Warrington & Halton Hospitals Trust in the August figures as a result of the additional Ward 3 beds being made available CONTINUING HEALTH CARE Individuals eligible for NHS CHC (Standard NHS CHC and Fast Track) at quarter end per 5, GP patient list size - all types 72.9 Q1 18/19 CONTINUING HEALTHCARE (Per 5,) The CCG has seen a small but sustained and statistically significant fall in the number of people assessed as eligible for Continuing Health Care. England Ave Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18 Q1 18/

11 13 CORPORATE PERFORMANCE REPORT OCTOBER 218 QUALITY & SAFETY AT A GLANCE Mixed Sex Accommodation There have been seven mixed sex accommodation breaches seen so far in 218/19 this is significantly fewer than the 19 reported in the same period last year. All seven breaches reported in 218/19 to August have been at Warrington Hospital. Friends and Family A&E Friends and Family scores in A&E are broadly better at Whiston than Warrington however there is declining trend at St Helens and a positive trend at Warrington. The positive trend at Warrington is likely to be linked to improving 4-hour waiting time performance with the Trust achieving the target in May, June and July Although waiting time performance has also improved slightly at St Helens the department has been exceptionally busy and Halton has witnessed an 18% increase in the number of patients attending Whiston A&E department.. Health Care Acquired Infections MRSA There has been a single case reported in May, this has been reported at St Helens but as non-acute provider attributed, no MRSA cases have been reported since. C Difficile Nineteen cases have been reported to date, this is above plan but below the number of cases reported by the same period last year. E-coli bacteraemia There have been 54 cases of E-coli reported. This is similar to the number of reported infections for the same period last year Inpatient Patient satisfaction is broadly similar at both Trusts with 96-97% satisfaction, this is in line with historic levels of performance and the national average. C-Diff MRSA AUG18 1JUL

12 14 CORPORATE PERFORMANCE REPORT OCTOBER 218 QUALITY & SAFETY PATIENT SAFETY QUALITY MEASURES KPI 218/19 PERFORMANCE ACTIONS MRSA All reported MRSA bacteraemia cases are attributed to a CCG There has been a single case reported in May, this has been reported at St Helens but as non-acute provider attributed. 2 1 MRSA Aug 16 Aug 17 Aug C-DIFF All reported C-DIFF bacteraemia cases are attributed to a CCG 2 Nineteen cases have been reported to date, this is above plan but below the number of cases reported by the same period last year. 1 C-DIFF 14 Aug 16 2 Aug Aug E-COLI Monthly counts of Escherichia coli bacteraemia (E. coli) ECOLI May-18 Jun There have been 54 cases of E-coli reported. This is similar to the number of reported infections for the same period last year MIXED SEX BREACHES The total occurrences of unjustified mixing in relation to sleeping accommodation MIXED SEX BREACHES There have been seven mixed sex accommodation breaches seen so far in 218/19 this is significantly fewer than the 19 reported in the same period last year. All seven breaches reported in 218/19 to August have been at Warrington Hospital. 2 Aug 15 Aug 16 Aug

13 15 CORPORATE PERFORMANCE REPORT OCTOBER 218 QUALITY & SAFETY PATIENT EXPERIENCE QUALITY MEASURES KPI 218/19 PERFORMANCE ACTIONS Friends & Family - Inpatient stays - STHK 98% 97% 96% 95% 94% Oct 16 Dec 17 Feb 18 May 18 July 18 Aug % Friends & Family - Inpatient Stays: STHK Nat Ave Feb-18 May % 96.% 95.% 97.% 96.% Patients at St Helens & Knowsley Hospitals NHS Trust would recommend the inpatient service in 96% of cases, this is slightly above average and in line with historical levels of performance Friends & Family - Inpatient stays - WHHFT 98% 97% 96% 95% 94% 93% 92% Oct 16 Dec 17 Feb 18 May 18 July 18 Aug 18 Nat Ave Feb-18 May % 95.6% 95.% 94.% 95.% Friends & Family - Inpatient Stays: WHHFT 97.% Patients at Warrington & Halton Hospitals NHS Foundation Trust would recommend the inpatient service in 97% of cases, this is above average and better than historical levels of performance Friends & Family - A&E - STHK 95% 9% 85% 8% 75% Oct 16 Dec 17 Feb 18 May 18 July 18 Aug 18 Nat Ave Feb-18 May % Friends & Family A&E: Whiston 86.5% 86.% 82.% 86.% 89.% A&E Friends and Family performance has increased in recent months and is now better than the England average Friends & Family - A&E - WHHFT 95% 9% 85% 8% 75% Oct 16 Dec 17 Feb 18 May 18 July 18 Aug 18 Nat Ave Feb-18 May % Friends & Family A&E: Warrington 86.5% 8.% 83.% 82.% 85.% A&E Friends and Family performance has been improving since December and whilst still below the England average is showing an improvement in performance. This should be looked at alongside 4-hour performance which has also been improving.

14 16 CORPORATE PERFORMANCE REPORT SEPTEMBER 218 PRIMARY CARE AT A GLANCE The Quality dashboard supports the CCGs statutory duty to improve the quality of its general practice services as well as the commissioning duties delegated from NHS England. The dashboard includes a range of indicators under the Patient Experience, Patient Safety and Clinical Effectiveness quality areas, whilst also including activity data. The Dashboard is currently being updated to include national patient survey data. Also, the 217/18 QOF Achievement and Exception Reporting data will shortly be circulated by NHS Digital and therefore available for review and inclusion in the dashboard. Patient Satisfaction Above average patient satisfaction continues in both 'making an appointment' and 'would recommend their GP' by patients from Hough Green, Oaks Place, Brookvale and Heath Road practices. Bowel Screening Data illustrates that uptake across practices ranges from 45% (Heath Road Medical Centre) to 63% (Upton Rocks), with a CCG average of 53%. This shows an increase from 51% Quarter 3 214/15 (the last data available.) Flu Uptake in patients aged over 65 years illustrates that only Brookvale and Grove House met the national target of 75%. Practice uptake ranged from 63% (Newtown) to 75% (Brookvale.) Uptake is generally lower for the Widnes practices with four practices under 7% (Bevan Group Practice, The Beeches, Newtown Surgery and Upton Rocks.) Vaccinations Only three practices (Brookvale, Murdishaw and Bevan Group Practice) achieving the 95% national target for Pre School Booster uptake (range 84% to 98%.) Coronary Heart Disease: Prevalence rates vary from 2.21% at Upton Rocks to 4.73% at Castlefields, Grove House and Tower House Practices. All but three practices (Heath Road, The Beeches and Newtown) meet the 93% maximum payment threshold for BP in the last 12 months < 15/9. Exception reporting for this indicator ranges from.72% at Hough Green to 1.93% at Weaver Vale. COPD prevalence: Ranges from 1.35% (Upton Rocks) to 5.14% Murdishaw. All practices exceeded the maximum payment threshold of 75% for record of FEV1 in the last 12 months. Exception reporting of this indicator ranges from 1.35% at Upton Rocks 4.49% at Peel House Medical Plaza, 41.13% at Hough Green and 49.3% at Tower House. Diabetes Prevalence: Ranges from 4.24% at Oaks Place Surgery to 7.67% at Castlefields and Murdishaw. All but three practices (The Beeches, Heath Road and Murdishaw) exceeded the maximum payment threshold of 75% for IFCC is 59mmol/mol in last 12 months. Exception reporting for this indicator ranges from 1.77% at Heath Road through to 31.41% at Peel House Medical Plaza. Atrial Fibrillation Prevalence: Ranges from 1.1% at Oaks Place to 3.12% at Appleton Village Surgery. All practice achieved the 7% maximum payment threshold for patients treated with an anticoagulation drug if a CHADS2-VASc score of 2 or more. Exception reporting ranges from % at Upton Rocks and Heath Road through to 22.86% at Weavervale. Quality, Contracting & Transformation visit programme: The Quality, Contracting & Transformation visits have been completed. A report outlining the themes and trends was presented to Primary Care Commissioning Committee in July 218. During the visit each practice reviewed the Quality Dashboard and identified three areas of good practice and three areas for improvement. These have been transferred into a tracker for ongoing review, As noted above the Quality Dashboard is currently being updated. Planning has also commenced on developing the 218/19 Quality, Contracting & Transformation visit programme which will again utilise the Quality Dashboard along with specific areas for review identified by the Quality team (Medicine Management and nursing.) In order to validate the increasing rise in s population, work is being undertaken with two practices to ensure patient's registration status has been accurately updated by Primary Care Support England. PRACTICE POPULATION PATIENTS PER WHOLE TIME EQUIVALENT GP 131,112 Mar18 Sep Dec 'GOOD' OVERALL EXPERIENCE GP 'GOOD' EXPERIENCE MAKING AN APPOINTMENT 85%July 17 National 85% National 73% 65%July 17 Jul-16 85% Jul-16 63%

15 17 CORPORATE PERFORMANCE REPORT SEPTEMBER 218 PRIMARY CARE SCREENING, PATIENT EXPERIENCE KPI 217/18 PERFORMANCE ACTIONS BOWEL SCREENING Proportion (%) of eligible 6-74 year old population screened for bowel cancer in last 2.5 years (PHOF 2.2iii) 55.1% BOWEL SCREENING Mar-17 6.% The Halton health improvement team continue to work with the practices to improve screening uptake. Whilst still behind target it is encouraging to see an increase since % Q3 14/15 51.% Jun % Mar % FLU VACCINATION Proportion (%) of stated population who received vaccination 73.7% Sep 17 to Jan 18 FLU VACCINATION (65+) 75.% 14/ % 15/ % 71.5% 17/ % The Flu group continue to oversee performance and areas for improvement. It is anticipated that the Care Home Alignment scheme will improve flu vaccination rates amongst the over 65's OVERALL EXPERIENCE OF GP The % of patients responding to the GP patient survey reporting 'very good' or 'fairly good' when asked to rate their Overall experience of GP surgery 85% OVERALL EXPERIENCE OF GP National 84.% Jul % Jul % Jul % 85.% It is positive to note that performance is in line with the national average. It is anticipated that transformation work, in line with the GP forward View will improve patient experience OVERALL EXPERIENCE OF MAKING APPOINTMENT The % of patients responding to the GP patient survey reporting 'very good' or 'fairly good' when asked to rate their Overall experience making an appointment 64% OVERALL EXPERIENCE OF MAKING AN APPOINTMENT National Jul-15 Jul-16 Jul % 62.% 63.% 65.% 64.% Although below the national average, improvement over the last two years has been noted. It is anticipated that the expansion of online consultations and improved telephone access via call queuing will improve patient experience when making an appointment.

16 18 CORPORATE PERFORMANCE REPORT SEPTEMBER 218 PRIMARY CARE QOF KPI 217/18 PERFORMANCE ACTIONS CORONARY HEART DISEASE CHD2The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 15/9 mmhg or less QoF Achievement threshold 53-93% 82.4% CORONARY HEART DISEASE: BP last 12 months <=15/9 Threshold 14/15 15/16 93.% 89.1% 89.1% 82.4% All but three practices (Heath Road, The Beeches and Newtown) meet the 93% maximum payment threshold. Exception reporting ranges from.7% at Hough Green to 1.9% at Weavervale Prevalence rates vary from 2.2% at Upton Rocks to 4.7% at Castlefields, Grove House and Tower House CHRONIC OBSTRUCTIVE PULMANORY DISEASE COPD4 The percentage of patients with COPD with a record of FEV1 in the preceding 12 months QoF Achievement Threshold 4-75% DIABETES DM7: The percentage of patients with diabetes, on the register, in whom the last IFCC- HbA1c is 59 mmol/mol or less in the preceding 12 months. QoF Achievement Threshold 35-75% 78.1% 68% COPD: FEV1 in last 12 months Threshold 14/15 15/16 75.% 67.7% 67.55% 78.1% DIABETES: last IFCC is 59 mmol/mol in last 12 months Threshold 14/15 15/16 75.% 61.1% 57.2% 68.4% All practices exceeded the maximum payment threshold of 75%. There are large variations in exception reporting ranging from 1.3% at Upton Rocks to 49.3% at Tower House The content of the Quality and Contracting visiting programme will include the wide variation in exception reporting All but three practices (The Beeches, Heath Road and Murdishaw) exceeded the maximum payment threshold of 75%. There are large variations in exception reporting, from 1.7% at Heath Road to 31.4% at Peel House. The Quality and contracting visiting programme will look at the reasons behind these variations ATRIAL FIBRILATION AF7: In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anti-coagulation drug therapy. QoF Achievement Threshold 4-7% 78% ATRIAL FIBRILATION Threshold 14/15.% 15/16 7.% 78.5% 78.4% All practices achieved the maximum payment threshold. large variations in exception reporting were apparent, with % at Upton Rocks to 22.9% at Weavervale. The large variations will be investigated through the Quality & Contracting visiting programme.

17 19 CORPORATE PERFORMANCE REPORT SEPTEMBER 218 MEDICINES MANAGEMENT AT A GLANCE Prescribing Budget Performance Dashboard Q1 Position (June 218) 218/19 prescribing budget 22,65,271 (excluding QIPP) 1. Total actual prescribing cost by month in 18/19 against the same period in 17/18 and the monthly budget profile. 2. cumulative total prescribing actual cost in 18/19 against budget and 17/18 spend. NHS Q1 underspend against budget (inc local adjustments):

18 2 CORPORATE PERFORMANCE REPORT SEPTEMBER 218 MEDICINES MANAGEMENT Items which should not be routinely prescribed - NHSE Guidance Items which should not be routinely prescribed in primary care: Guidance for CCGs - November 217 In November 217 NHSE published guidance for CCGs with regards to a list of 18 treatments deemed to be ineffective, over-priced or of low clinical value. In the majority of cases there are other more effective, safer and/or cheaper alternatives available. The report below details the Q1 18/19 prescribing data for these 18 treatments for NHS. The APC and the MMT have been reviewing prescribing for the majority of these areas and ensuring local formulary reflects this guidance. For Lidocaine patches we are currently awaiting the APC statement before progressing the work in this area, but it is anticipated that there will be significant challenges in terms of changing Prescribing for Minor Ailments and Self-limiting Conditions Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs was published by NHSE at the end of March 218 following a national consultation. The CCG have included prescribing of medicines for minor ailments as part of their work plan for 218/19 and within this will pay due regard to the national recommendations. By reducing spend on treating conditions that are self-limiting or which lend themselves to self-care, or on items for which there is little evidence of clinical effectiveness, these resources can be used for other higher priority areas that have a greater impact for patients, support improvements in services and/or deliver transformation that will ensure the long-term sustainability of the NHS. The primary focus for NHS will be raising public awareness regarding the most appropriate place to seek advice and treatment and promotion of the local NHS Minor Ailments Scheme, Care at the Chemist (CATC), as an option for patients to consider. There will be significant engagement with the public and patient groups as well as with healthcare professionals and local organisations. The guidance and any associated support materials will be made available on the CCG website once finalised and approved.

19 1 CORPORATE PERFORMANCE REPORT OCTOBER 218 HUMAN RESOURCES AT A GLANCE Staff Turnover The rolling turnover rate is 2.2%. This is due to the TUPE of staff into the organisation (Finance Team) and a small number of leavers. Sickness Absence The CCGs monthly and rolling sickness absence rates remains above target and has generally been higher than the national trend % of all sickness absence is attributed to long term absence. Actions currently being undertaken to improve sickness absence include HR Business Partners working closely with and supporting managers to implement the Absence Management Policy Stages. Statutory and Mandatory Training The CCG's training compliance rate continues below target. However we have seen a slight month on month increase that has been attributed to reminder notifications from both the LMS system and Corporate Services with escalation to line management. STATUTORY AND MANDATORY TRAINING 78.8% Staff Turnover actions Further work is to be undertaken via the CSU HR leads and CCGs HR Operations Group to identify the reasons for turnover, which includes Review the CCG Exit Procedure & analysis of reasons for leaving data in order to take corrective action as required. Further promotion of the procedure via the HR Communication updates. Consider the CCGs Health & Wellbeing agenda including Staff Recognition and Rewards in order to attract and retain talent Sickness Absence Actions Development sessions for all line managers focusing on key steps to supporting staff absences in line with the CCG Attendance Management policy and procedure are in the HR & OD development plan for 218/19 Promotion of key HR policies linked to wellbeing, including stress management guidance, Alcohol and Substance Misuse, Attendance Management Promotion of Occupational Health Services. Statutory and Mandatory Training Actions A number of actions are being instigated by the CCGs HR Operations Group to improve compliance as follows Reminders for completion of outstanding modules are sent to staff directly via the CCGs Learning Management system Further communications and targeted reminders will continue to be circulated via the CCGs HR Update Briefing SICKNESS ABSENCE RATE 8.%

20 11 CORPORATE PERFORMANCE REPORT OCTOBER 218 HUMAN RESOURCES KEY ACTIVITY KPI 217/18 PERFORMANCE ACTIONS Staff in Post (FTE) STAFF IN POST: FTE 6 Apr-16 Apr Apr 17 Jan-18 Jan Turnover Rate Rolling 12 month average monthly turnover % 3% 2% 1% % Apr 17 Jan % ROLLING 12 MONTH AVEE MONTHLY TURNOVER RATE Apr-16 Apr-17 Jan-18.8% 1.8% 2.5% 1.8% 2.2% The latest monthly turnover for the CCG is currently 1.1% for July 218 and 2.2% for rolling 12 months.. A number of actions, detailed in the narrative, are being undertaken to understand and address the turnover rate. Sickness Absence Rate Rolling 12 month average sickness rate 5% 4% 3% 2% Apr 17 Jan-18 8.% ROLLING 12 MONTH AVEE SICKNESS RATE Apr-16 Apr-17 Jan-18 3.% 3.7% 3.% 3.6% 4.3% The CCGs monthly and rolling sickness absence rates remain above target % of all sickness absence is attributed to long term absence. Actions currently being undertaken to improve sickness absence are detailed on the HR narrative page Statutory & Mandatory Training Compliance 75% 5% Apr-16 Apr 17 Jan % STATUTORY AND MANDATORY TRAINING RATE Apr-16 Apr-17 Jan % 86.4% 69.4% 7.9% 78.8% The CCG's training compliance rate continues below target. However, a slight month on month increase has been attributed to reminder notifications from both the LMS system and Corporate Services with escalation to line management.

21 Metric Preventing People from Dying Prematurely - Performance Report Reporting Level Information Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 18/19 TREND Cancer 191: % Patients seen within two weeks for an urgent GP referral for suspected cancer (MONTHLY) The percentage of patients first seen by a specialist within two weeks when urgently referred by their GP or dentist with suspected cancer 17: % of patients seen within 2 weeks for an urgent referral for breast symptoms (MONTHLY) Two week wait standard for patients referred with 'breast symptoms' not currently covered by two week waits for suspected breast cancer 535: % of patients receiving definitive treatment within 1 month of a cancer diagnosis (MONTHLY) The percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer 26: % of patients receiving subsequent treatment for cancer within 31 days (Surgery) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Surgery) 117: % of patients receiving subsequent treatment for cancer within 31 days (Drug Treatments) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments (Drug Treatments) 25: % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Radiotherapy) 539: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (MONTHLY) The % of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer 54: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (MONTHLY) Percentage of patients receiving first definitive treatment following referral from an NHS Cancer Screening Service within 62 days. = 93% = 93% = 96% = 94% = 98% 541: % of patients receiving treatment for cancer within 62 days upgrade their priority (MONTHLY) % of patients treated for cancer who were not originally referred for suspected cancer, but have been seen by a clinician who suspects cancer, who has upgraded their status = 94% = 85% = 9% No national target set G G G G G G G G R G R R R R Actual 95.2% 95.3% 94.7% 94.% 93.2% 94.6% 94.9% 93.% 91.8% 94.2% 89.8% 9.5% 89.5% 91.1% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% R G G R G G G G G G G R G G Actual 92.1% 93.6% 94.3% 9.% 97.4% 97.7% 1.% 1.% 96.2% 93.8% 94.3% 91.3% 93.1% 93.5% 93.% 93.% 93.% 93.% 93.% 93.% 93.% 93.% 93.% 93.% 93.% 93.% 93.% G G R R G R R G G G G G R G Actual 98.7% 96.6% 92.5% 92.6% 97.5% 91.4% 93.4% 97.% 98.7% 98.6% 97.% 98.3% 93.7% 97.3% 96.% 96.% 96.% 96.% 96.% 96.% 96.% 96.% 96.% 96.% 96.% 96.% 96.% G R G G G G G R G R G G G G Actual 1.% 9.% 1.% 1.% 1.% 1.% 1.% 84.6% 1.% 85.7% 1.% 1.% 1.% 97.9% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% R R G G G R G G G G G G G G Actual 96.% 88.2% 1.% 1.% 1.% 95.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% 98.% G G G G G G G G G G G G G G Actual 1.% 95.7% 96.7% 1.% 1.% 96.1% 1.% 1.% 1.% 97.2% 1.% 1.% 1.% 99.1% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% 94.% R R G R G R R G G G R G R G Actual 69.7% 73.1% 86.2% 79.3% 88.% 75.% 77.8% 88.9% 93.8% 91.4% 82.8% 9.% 73.3% 86.5% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% G R G G G G G G G G G R G G Actual 67% 67% 92.3% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% Actual 1.% 1.% 1.% 1.% 1.% 1.% 75.% 1.% 1.% 1.% 85.7% 1.% 83.3% 9.5% 98% 88% 9% 8% 9% 9% 8% 9% 8% 9% 8% 6% 8% 6% 4% 8% 6% 4% Ambulance Ambulance response programme: Category 1 calls: Mean responses time Ambulance response programme: Category 1 calls: 9th Percentile time = 7 min = 15 min Actual Actual R R R R R R R R A R A A A A 8:43 1: 9:1 9:49 11:14 1:34 9:5 9:46 8:17 9:13 8:49 8:48 8:21 8:42 7: 7: 7: 7: 7: 7: 7: 7: 7: 7: 7: 7: 7: 7: G A A A A A A A G A G G G G 13:16 17:6 15:4 16:57 18:23 16:27 14:56 18:24 14:39 16:52 14:41 15: 14:28 14:47 14:24 : 28:48 : 15: 15: 15: 15: 15: 15: 15: 15: 15: 15: 15: 15: 15: 15:

22 Metric Ambulance response programme: Category 2 calls: Mean response time Ambulance response programme: Category 2 calls: 9th Percetntile time Ambulance response programme: Category 3 calls: 9th Percetntile time Ambulance response programme: Category 4 calls: 9th Percetntile time - Performance Report Reporting Level Enhancing Quality of Life for People with Long Term Conditions Information = 18 min = 4 min Actual Actual Actual = 12 min Actual = 18 min 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND R R R R R R R R A R R R R R 43:12 28:15 26:17 26:4 24:45 35:52 33:52 31:11 38:58 24:4 29:1 28:25 26:52 25:39 26:48 : 18: 18: 18: 18: 18: 18: 18: 18: 18: 18: 18: 18: 18: 18: R R R R R R R R R R R R R R 1:55:12 1:5:14 :59:1 :57: :49:2 1:22:28 1:9:34 1:7:16 1:32:32 :49:4 1:2:1 1::12 :54:32 :52:1 :56:13 :: :4: :4: :4: :4: :4: :4: :4: :4: :4: :4: :4: :4: :4: :4: G G G G R R R R R R R R R R 3:36: 1:44:31 1:58:2 1:53:2 1:41:18 2:2:47 2:43:6 2:3:25 3:53:9 2:16:57 2:22:37 2:11:31 2:49:8 3::31 2:28:16 :: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: 2:: G R G R A G R G G R G R R G 4:19:12 2:13:51 3:28:27 2:35:11 3:56:7 3::55 2:46:8 3:15:3 2:56:46 2:36:23 3:33:34 2:51:53 3:25:33 3:43:35 2:5:52 :: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: 3:: Mental Health Estimated diagnosis rate for people with dementia (PHOF 4.16 / NHS OF 2.6i) Improving access to psychological therapies (QP2) - Access Quarterly position (sum of current and previous 2 month's %, where available) Improving access to psychological therapies (QP2) - Recovery Month Actual The proportion of people that wait 6 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period (EH1 - A1) The proportion of people that wait 18 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period (EH2 - A2) 138: Proportion of patients on (CPA) discharged from inpatient care who are followed up within 7 days (LOCAL DATA USED) (LOCAL DATA USED) - Monthly (LOCAL DATA USED) - Monthly (LOCAL DATA USED) - Monthly (LOCAL DATA USED) - Monthly 17/18 = 4.2% 18/19 = 4.8% 17/18 = 75.% 18/19 = 83.3% = 95% = 95% G G G G A R R R A A R R R R Actual 74.9% 75.2% 74.9% 72.9% 72.5% 71.2% 7.9% 69.6% 71.% 71.7% 71.% 7.1% 7.3% 7.8% 72.% 72.% 72.2% 72.8% 73.5% 74.% 74.7% 75.% 73.8% 73.8% 74.% 74.2% 74.3% R R R A R R R G R A R A A A Actual 3.8% 3.4% 3.8% 4.17% 3.8% 3.7% 3.1% 4.3% 3.7% 4.3% 3.8% 4.5% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.8% 4.8% 4.8% 4.8% 4.8% 4.8% G G G G G A G G R G G R R A Actual 52.1% 5.6% 5.7% 51.8% 57.% 49.6% 52.6% 5.7% 45.8% 51.4% 57.% 42.3% 46.8% 48.7% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% 5.% G G G G G G G G G G G G G G Actual 1.% 1.% 99.2% 99.1% 1.% 97.4% 98.4% 98.8% 99.3% 99.3% 98.4% 1.% 97.2% 98.8% 75.% 75.% 75.% 75.% 75.% 75.% 75.% 75.% 83.3% 83.3% 83.3% 83.3% 83.3% 83.3% G G G G G G G G G G G G G G Actual 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% 95.% G G R G G Actual 97.6% 1.% 9.9% 1.% 1.% 8% 6% 5% 3% 6% 4% 8% 6% 8% 6% 299: First episode of psychosis within two weeks of referral The percentage of people experiencing a first episode of psychosis with a NICE approved care package within two weeks of referral. 17/18 = 53.8% 18/19 = 76.9% G G G G G G G G G G G G R G Actual 83.3% 66.7% 1.% 1.% 66.7% 1.% 66.7% 1.% 1.% 8.% 1.% 1.% 5.% 84.6% 4% 53.8% 53.8% 53.8% 53.8% 53.8% 53.8% 53.8% 53.8% 76.9% 76.9% 76.9% 76.9% 76.9% 76.9%

23 Metric EH9 2a: Total number of children receiving treatment by NHS funded community services - Performance Report Reporting Level Information 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND R R R R R R R R G G R G Aug-17 Jan 18 May-18 Ensuring that People Have a Positive Experience of Care EMSA 167: Mixed sex accommodation breaches - All Providers No. of MSA breaches for the reporting month in question for all providers = R R R R R R R R R G G R R R Actual Referral to Treatment (RTT) & Diagnostics 1291: Referral to Treatment RTT (Incomplete) Percentage of patients waiting at period end (RTT) for incomplete pathways (Commissioner) Referral to Treatment RTT (Incomplete) Percentage of patients waiting at period end (RTT) for incomplete pathways: WARRINGTON TRUST Referral to Treatment RTT (Incomplete) Percentage of patients waiting at period end (RTT) for incomplete pathways: ST HELENS TRUST 1839: Referral to Treatment RTT - No of Incomplete Pathways Waiting >52 weeks The number of patients waiting at period end for incomplete pathways >52 weeks 1828: % of patients waiting 6 weeks or more for a diagnostic test The % of patients waiting 6 weeks or more for a diagnostic test = 92% = 92% = 92% = = 1% G G G G G G G G G G G G R G Actual 92.7% 92.% 92.7% 92.6% 92.4% 92.8% 92.4% 92.4% 92.8% 92.4% 92.1% 92.1% 91.1% 92.1% 9% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% G G G G G G G G G G G G R G Actual 92.8% 92.1% 92.3% 92.6% 92.3% 92.7% 92.8% 92.4% 92.2% 92.4% 92.1% 92.1% 91.4% 92.% 9% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% G G G G G G G G G R R R R R Actual 93.1% 92.8% 93.4% 93.5% 93.2% 93.3% 93.5% 94.% 94.3% NO SUBMISSION NO SUBMISSION NO SUBMISSION NO SUBMISSION 9% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% G R G G G G G G R R R R G R Actual G G G G G R G G R R R R R R Actual.6%.6%.7%.7%.9% 1.1%.9%.8% 1.7% 1.3% 1.9% 2.4% 1.7% 1.8% 94.3% 95% 95% 95% 4% 2% % 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% Treating and Caring for People in a Safe Environment and Protect them from Avoidable Harm HCAI 497: Number of MRSA Bacteraemias Incidence of MRSA bacteraemia (Commissioner) (in month) 24: Number of C.Difficile infections Incidence of Clostridium Difficile (Commissioner) (in month) = R R G R G R G G G R G G G R R G G G G G G G G R R G G R

24 Accident & Emergency Metric - Performance Report Reporting Level Information 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND 4-hour A&E waiting time, aggregate all types all providers 431: 4-Hour A&E Waiting Time (Monthly Aggregate for Total Provider) % of patients who spent less than four hours in A&E (Total Acute position from Unify Weekly SitReps) -Local calculation ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST 2 95% 217/18 9% 9% G G G G G A G A G G G G G G Actual 95.5% 94.3% 93.6% 93.% 9.4% 89.8% 91.1% 89.% 91.5% 92.1% 93.2% 92.3% 92.7% 92.7% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% 9.% G R R R R R R R R R A R A R Actual 9.5% 88.9% 88.1% 88.1% 85.5% 77.3% 78.9% 67.7% 85.% 84.6% 88.% 86.2% 89.3% 86.6% 85% 8% 6% WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% G G R R R R R R R G G G A A Actual 94.4% 9.9% 89.5% 87.5% 83.8% 83.% 8.5% 78.6% 86.7% 9.9% 91.% 9.5% 87.5% 89.3% 9% 8% 7% A&E Attendances: Type 1 Line 1: Number of attendances Type 1 A&E depts. at ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST (LOCAL DATA) 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% R R R R R R R R R R R R R R Actual , ,5 at WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST (local data) G G G R A A A G A G G G G G Actual , ,5 R R R R R R R R R R R A R R 5, total Actual , A&E Attendances: Type 3/4 Line 1: Number of attendances Type 3/4 Urgent Care Centres (LOCAL DATA) A&E Attendances: All Types Line 2: Number of attendances at all A&E depts. Activity at Runcorn Urgent care Centre (LOCAL DATA) at Widnes Urgent Care Centre (LOCAL DATA) (LOCAL DATA) Actual ,513 Actual ,339 R G R R R R G G G G G G G G Actual % -1.4% 11.3% 4.5% 8.4% 4.3% -15.% -5.7% -9.1% Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 2,5 1,5 4, 2, 9, 8, 7, 6, Activity E-Referrals on R R R R R R R R R R R R R Actual 49.6% 48.4% 49.7% 48.4% 48.7% 43.% 44.% 7.% 71.8% 7.6% 66.4% 62.1% 67.6% 8.% 8.% 8.% 8.% 8.% 8.% 8.% 8.% 1.% 1.% 1.% 1.% 1.% 1.% %

25 Metric GP Written Referrals (MAR) GP written referrals for a first outpatient appointment in G&A specialties - Performance Report Reporting Level Information 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND A G R R G R R R R G R R A R 4, 2,733 2,53 2,872 2,864 2,259 2,89 2,67 2,918 2,718 2,876 2,863 3,58 2,78 14,295 2, Other Referrals for First Outpatient Appointments (MAR) Number of other referrals for a first outpatient appointment in G&A specialties G G G G G G G G G R A G G G 1,784 1,651 1,889 1,918 1,499 1,925 1,747 1,884 1,698 2,44 1,93 1,921 1,741 9, , 1, 1936: Total Referrals (MAR) Total number of referrals (GP written referrals made & other referrals - MAR) G G A A G G A R G A R A G A 4,517 4,154 4,761 4,782 3,758 4,734 4,417 4,82 4,416 4,92 4,793 4,979 4,521 23, , 3, Elective - ordinary admissions (NHS AM1) (EC1) (MAR) R R R R R R R R R G A G G G Elective - ordinary admissions (NHS AM1a) HCCG at WHHFT (MAR) at WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST G G R R G G G G R G G G G G Elective - ordinary admissions (NHS AM1b) HCCG at StH&K (MAR) at ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST G G G G R G R G G A R G A G Elective - day cases (NHS AM2) (EC2) R A R R R R R R R R A G R R 2, Elective - day cases (NHS AM2a) HCCG at WHHFT at WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST G G R G A G G G G A G G R G , ,444 1, Elective - day cases (NHS AM2) HCCG at StH&K at ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST G G R R A A R G R R G G A R EM11 Non-elective admissions (SUS) R R R R A R G R A G G G R R 1, EM11a Non-elective admissions: Zero day length of stay % -3.9% -6.3% -5.2% -1.5% -.8% 6.9% -8.5% 1,2 1, , ,314

26 Metric EM11b Non-elective admissions: 1 day + length of stay - Performance Report Reporting Level Information 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! 2, ,631 Non-elective admissions (NHS AM 3a) HCCG at WHHFT (SUS) at WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST ,743 #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! R R G R G G G G G G G G G G , , Non-elective admissions (NHS AM 3b) HCCG at StH&K (SUS) at ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST R A R R A R G R R R R R R R , 5 EM8 All first outpatient attendances R G R R G R R G G R G R R A 5, , , All first outpatient attendances (NHS AM 4a) HCCG at WHHFT G&A (MAR) at WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST R R R R G R R G A R A G G A , 1, All first outpatient attendances (NHS AM 4b) HCCG at StH&K (G&A (MAR) at ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST G G G G G G G G G A G A A G , 1, EM9 Consultant led Follow up outpatient attendances: A A G A G G 15, , ,787 5, Others Delayed Transfers of care - days (BCF 11.3) in month figure (Halton UA) EN1.1 Number of personal health budgets in place at the beginning of the quarter Halton LA (LOCAL DATA) Halton NHS plan =236: 17/18 = 45 18/19 = 155 R R R R R G R R R R R R G R ,

27 Metric EN1.2 Number of new personal health budgets that began during the quarter - Performance Report Reporting Level Halton NHS plan Information 18/19 = 5 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND EO1. Children waiting more than 18 weeks for a wheelchair - The percentage of children whose episode of care was closed in the quarter where equipment was delivered in 18 weeks or less Halton NHS plan from referral 18/19 = 5 5 EK3. LD Health Checks - The percentage of patients aged 14 or over on the GP's Learning Disability register receivnig a health check in the quarter Halton NHS plan 18/19 = R 9.6% 14.2% 17.6% Quality Premium 18/19 Emergency Demand Management A1: Type 1 A&E attendances below plan A2: Non-elective admissions with zero length of stay below plan Award 232,5 A1 and A2 must both be achieved for the quality premium amount to be awarded R R R A R R G G G G G B: Non-elective admissions with length of stay of 1 day or more below plan Award 232,5 R G G G G Quality Indicators 1: Early Cancer Diagnosis: Demonstrate a 4 percentage point improvement in the proportion of cancers (specific cancer sites, morphologies and behaviour*) that are diagnosed at stages 1 and 2 in the 218 calendar year compared to the 217 calendar year. OR Achieve greater than 6% of all cancers (specific cancer sites, morphologies and behaviour*) that are diagnosed at stages 1 and 2 in the 218 calendar year. 26, = 42.8% 213 =46.% 214 =51.1% 215 =49.7%: 216=49.1% (annually reported figure only) R R R R R R R R 49.1% 49.1% 49.1% 49.1% 49.1% 49.1% 49.1% 49.1% 53.7% 53.7% 53.7% 53.7% 53.7% 53.7% 53.7% 53.7% 53.1% 53.1% 53.1% 53.1% 53.1% 53.1% 2: Overall experience of making an appointment: Achieve a level of 85% of respondents who said they had a good experience of making an appointment, or Achieve a 3 percentage point increase from July 218 publication on the percentage of respondents who said they had a good experience of making an appointment. 26,35 3a: Continuing Healthcare: >8% cases an eligability decision is made in 28 days 13,175 >8% R R G G G 47.% 55.% 92.% 86.% 86% 8.% 8.% 8.% 8.% 8% 3b: Continuing Healthcare: <15: of full CHC assessments take place in an acute setting 13,175

28 Metric 4: Mental Health OOA stays see 33% reduction - Performance Report 26,35 Reporting Level Information 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND 5ai: Bloodstream infections: reduction in E-coli (rolling 12 months) 5aii: Bloodstream infections: collection and reporting of primary care data 7,95 3,952 Baseline = 86, 1% reduction target = 77 53, 15% reduction = , 2% reduction = 68 = 795 Yes = 3952, No = R R R R R R R R R R R R R R G G G G G G Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 5b: Antibiotic prescribing for UTI's: A 3% reduction (or greater) in the number of Trimethoprim items prescribed to patients aged 7 years or greater on baseline data (June15-May16) 5,27 5ci: Inapropriate prescribing: Reduce to STAR PU 5cii: Inapropriate prescribing: Reduce to.965 STAR PU 2,635 6,587 Rolling 12 months QP target 2629 target G G G G G R R R R R R R R R R R R R R R R R R R R R R R R R R : Diabetes pateints entering structured education (local choice metric - target set of 7.4% as this is the national average) 23,25 7.4% R R R R 1.8% 1.7% 1.6% 1.8% 1.7% 1.8% 1.7% 1.7%.3%.8% 1.% 1.%.6% 1.2% 1.8% 2.4% 3.% 7.4% Quality Gateway (reductions which can be applied to the quality premium for failure to achieve) A local provider has been subject to enforecement action by the CQC - 62, A local provider has been flagged as a quality compliance risk and/or has requirements in place related to breaches of provider licence conditions - 62, G G G G G G No No No No No No G G G G G G No No No No No No A local provider has been subject to enforcement action based on a quality risk AND it has been identified through NHSE s assessment of the CCG that the CCG is not considered to be making an appropriate proportionate response AND this continues to be the case for the CCG at the end of year Improvement and Assessment Framework assessment - 62, G G G G G G No No No No No No Financial Gateway (reductions which can be applied to the quality premium for failure to achieve) In the view of NHS England the CCG has not operated in a manner that is consistent with the principles in Managing Public Money - 62, The CCG ends the year in adverse financial variance to their approved planned financial position, OR requires financial support to avoid being in this position - 62, G G G G G G No No No No No No No No No No No No G G G G G G No No No No No No No No No No No No

29 Metric The CCG receives a qualified audit report - Performance Report - 62, Reporting Level Information 18/ Q2 Q3 Q4 Q1 Q2 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 TREND G G G G G G No No No No No No If relevant, the CCG does not meet the requirements set out in the commissioner Sustainability Fund guidance - 62, No No No No No No G G G G G G No No No No No No No No No No No No Constitution Gateway (reductions which can be applied to the quality premium for failure to achieve) 539: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (MONTHLY) The % of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer - 77, = 85% R R G R G R R G G G R G R G Actual 69.7% 73.1% 86.2% 79.3% 88.% 75.% 77.8% 88.9% 93.8% 91.4% 82.8% 9.% 73.3% 86.5% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% 85.% RTT Waiting list size: Waiting list (patients on an incomplete RTT pathway) at March 219 is below the March 218 value - 77, Below 17/18 Actual R R R R R R Note: Due to issues in implmenting the Medway system at STHK the trust are unable to provide wating list information until December 218. In order to provide some level of information the rating to December is based on 'no change' on the 17/18 values for STHK, but includes the changes at the other provider trusts 11, 1, 9, 8,