The Delivery Dashboard

Transcription

1 Meeting Date: 1st June The Delivery Dashboard This report resembles the balanced scorecard produced by NHS England Area Team as part of its quarterly assurance process for CCGs. In addition to this report, the Operational Executive will be monitoring the full set of metrics contained in the various NHS related Outcomes Frameworks, and if there are any issues of concern they will be escalated to the Governing Body. Quality Premium RAG Count National Quality Premium Local Quality Premium Health Outcomes RAG Count Preventing People Dying Early Enhancing Quality of Life Helping recovery from ill health and injury Positive Experience of Care Protecting people from avoidable harm Others NHS Constitution & Pledges RAG Count Referral to Treatment Diagnostic Waits Cancer Waits - 2 Weeks Cancer Waits - 31 days Cancer Waits - 62 days Ambulance Calls Mixed Sex Accomodation Breaches Cancelled Operations Mental Health

2 Key Issues Background Key performance issues have been identified for escalation to the Governing Body within the narrative below. To support the Governing Body in understanding the current performance position, additional narrative and graphical representation has been included within the later section of the performance report. 1) A&E The TRFT Year-to-date A&E position (Type 1 TRFT) as at 22 nd May was 92.04%. Improvements in A&E performance have been sustained during April and May, which is positive and relates to a number of key posts now being filled within the department and consultant numbers increasing towards the required establishment. The agreed A&E improvement action plan continues to be monitored closely by the CCG with assurance being provided by TRFT. Local comparison to other Trust's in South Yorkshire can be found in the A&E Exceptions report. The Q4 national position for England was 88.7% with the North of England position at 84.2%. All local providers have seen improvement in April. Governing Body members should note that STHFT have now re-established reporting against the 4 hour standard. For 4 hour performance both Sheffield and Doncaster are routinely reporting a cumulative performance position, which incorporates activity from both A&E and Walk In Centre/Urgent Care centre provision. At this point in time RCCG will still monitor the local TRFT and Walk In Centre 4 hour position separately, ensuring continued assurance and review at an individual provider level. Governing Body members should note that if RCCG would have reported a cumulative position for TRFT A&E and Rotherham WIC our local health economy would have achieved 95.5% in April. 2) YAS YAS are currently participating in an NHS England-led Ambulance Response Programme (ARP), which went live from the 21 st April. The pilot will run for 3 months initially with evidence reviewed on a bi weekly basis. This review involves a change in how calls are recorded from the previous current Red/Green system to: Red - Life-threatening: Time critical life-threatening event needing immediate intervention and/or resuscitation. Amber - Emergency: Potentially serious conditions that may require rapid assessment, urgent on-scene intervention and/or urgent transport. Green - Urgent: Urgent problem (not immediately life-threatening) that needs transport within a clinically appropriate timeframe or a further face-to-face or telephone assessment and management. A full report on ARP progress and the impact on performance will be shared at the July meeting. The 15 minute turnaround performance at RFT is 78% on handovers on target (average handover time as c.12mins), there was a decline in handovers at the Northern General Hospital at 42% (c.5% down from February) in the 15 minutes threshold. 3) Improving Access to Psychological Therapies (IAPT) - 6 and 18 week waiting time The national target for patients accessing IAPT services is 75% within 6 weeks and 95% within 18 weeks. The 6 week wait position for Rotherham CCG as at w/c 16 th May was 71.3%. The expected numbers of patients waiting above 6 weeks is 0; the actual number is 39 (see exception charts). The 18 week wait position for the service has improved from 80% in September to 100% as at w/c 16 th May. Again a positive sign that long waiters on the list are now accessing the service. The CCG continues to have in place a formal contract performance notice with RDASH and has a clear improvement action plan in place. It has been agreed that the Intensive Support Team will work with RDASH to identify areas of improvement that can be implemented. 4) Cancer In March the 62 day GP referral to treatment target was marginally under the national standard of 85% at 84.21%. Further information regarding breaches can be found in the exception report. This remains under close monitoring and further details can be found within the Cancer Exception section of this report. The 31 day subsequent treatment (surgery) measure underperformed in March with performance at 92.86%

3 against an 94% target - this is due to small numbers on the pathway with 1 breach. 5) Referral to Treatment RTT Incomplete Pathway continues to meet the 92% national standard in April, with performance at 94.36%. Where underperformance has occurred in certain specialties, further details can be found under the exceptions section of the report. The CCG continues to see strong Referral to Treatment performance; details at speciality level are identified within the report. 6) Referral to Treatment - 52 week waits In April there have been 2 52 week waiters reported for Rotherham from the provider Rotherham Foundation Trust. The CCG has engaged with TRFT to fully understand the position, which relates to patients being placed on 'active monitoring' instead of closing their '18ww pathway'. Further information can be found in the CCG's Quality Report. 7) Eliminating Mixed Sex Accommodation Breaches (EMSA) There remains to be zero breaches in April. 8) Diagnostic Waiting Times The April position for the CCG has not met the national standard, 2.59% against the target of 1%. A total of 20 breaches occurred at TRFT (Audiology 4, Colonoscopy 6, Cystoscopy 1, Flexi Sig 3, Gastro 4, Sleep Studies 2). A total of 10 breaches occurred at STHT (Colonoscopy 4, Flexi Sig 2, Gastro 4). 2 breaches occurred at Doncaster both in Non Obstetric Ultrasound. 1 breach occurred at Leeds Teaching Hospital in MRI. Another MRI breach occurred at Pennine Acute Hospitals. 10) Incidence of C.Difficile in April was 1 cases against a target of 6 for the month for the CCG overall. This case was at Barnsley Hospital Foundation Trust. This takes Rotherham's YTD position for -17 to 1 case against an end of year target of 63. TRFT -17 YTD performance is zero cases against their annual target of 26.

4 Rotherham CCG Quality Premium _16 National Priorities Monthly Indicators Target Latest DoT YTD Date Further Information Delayed transfers of care which are an NHS responsibility per 100,000 population 1, , (delayed days) Number of patients admitted to hospital for non-elective reasons discharged at Nov-15 weekends/bank holiday % of patients attending A&E with a diagnosis of mental health-related needs seen within 4hrs % 4 hour A&E waiting times - seen within 4 hours - CCG (Monthly) % 4 hour A&E waiting times - seen within 4 hours (Type 1 RFT) Latest Monthly Position 1% reduction in the number of antibiotic prescribed compared to 13/14 value Reduction in the proportion of broad spectrum antibiotics as a total of all antibiotics in 14/ % % % % % % *See Glossary for further 16 details Proxy for the QP CCG A&E % % % (as runs 1 month in May-16 arrears). Latest data showing May as at 15th Local Priorities Local Indicator 1 Target Latest DoT Date Further Information People who have had a stroke who are admitted to acute stroke unit in 4 hrs of arrival to hospital % % 16 Local Indicator 2 Target Latest DoT Date Further Information Alcohol related admissions to hospital per 100,000 population (standardised) - Quarterly 1, , Provisional data available quarterly. Latest data is YTD as at Q3 15/16. Full year target Indicators reported Quarterly & Annually will be added above when required, these are listed below: Potential Years of Life Lost (PYLL) from causes considered amendable to healthcare, per 100,000 The Quality Premium indicators listed below are highlighted elsewhere within this report: % Patients on incomplete non-emergency pathways waiting no more than 18 weeks (Commissioner) Cancer - % Patients seen within 2wks referred urgently by a GP CatA (Red 1) 8 min response time (Yorkshire Ambulance Service - YAS) Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment Proportion of people waiting 18 weeks or less from referral to entering a course of IAPT treatment

5 Rotherham NHS Constitution & Pledges _16 Referral to Treatment Target Apr-16 Apr-16 DoT YTD YTD QP % Patients on incomplete non-emergency pathways waiting no more than 18 weeks (Commissioner) % % % Number of 52 week Referral to Treatment Pathways Incomplete (Commissioner) Number of 52 week Referral to Treatment Pathways Non Admitted (Commissioner) Diagnostic Waiting Times Target Apr-16 Apr-16 DoT YTD YTD QP % Patients waiting for diagnostic test waiting > than 6 wks from referral (Commissioner) 1.00 % 2.59 % 2.59 % A&E Waits Target May-16 May- 16 DoT YTD YTD QP % 4 hour A&E waiting times - seen within 4 hours (Type 1 RFT) Latest Monthly Position % % % Cancer - 2wk Waits Target DoT YTD YTD QP Cancer - % Patients referred with breast symptoms seen within 2 wks of referral % % % Cancer - % Patients seen within 2wks referred urgently by a GP % % % Cancer - 31 Days Wait Target DoT YTD YTD QP Cancer - % Patients seen within 31 days for subsequent treatment (Surgery) % % % Cancer - % Patients seen within 31 days for subsequent treatment (Drugs) % % Cancer - % Patients seen within 31 days for subsequent treatment (Radiotherapy) % % % Cancer - % Patients seen within 31 days from referral to treatment % % % Cancer - 62 Days Wait Target DoT YTD YTD QP Cancer - % Patients seen within 62 days of referral from GP % % % Cancer - % Patients seen from referral within 62 days (Screening Service: Breast, Bowel & Cervical) % % % Cancer - % Patients being seen within 62 days (ref. Consultant) % % % YAS - Ambulance Calls Target Apr-16 Apr-16 DoT YTD YTD QP Crew Clear delays of over 30 mins Ambulance handover delays of over 30 mins Mixed Sex Accomodation Target Apr-16 Apr-16 DoT YTD YTD QP Number of mixed sex accomodation breaches (Commissioner) Cancelled Operations Target DoT YTD YTD QP Cancelled operations rebooked within 28 days Mental Health Target Feb-16 Feb-16 DoT YTD YTD QP Proportion of people on Care Programme Approach (CPA) who were followed upwithin 7 days of discharge % % %

6 Rotherham Health Outcomes _16 Preventing Premature Mortality Target DoT Further Info. / QP Potential Years of Life Lost (PYLL) from causes considered Target based on 15/16 trajectory 2,378 2,500 amendable to healthcare, per 100,000 submitted in 2014/15 ( QP) Under 75 mortality rate from cardiovascular disease (CCG) Target = England Average Under 75 mortality rate from respiratory disease (CCG) Target = England Average Under 75 mortality rate from liver disease (CCG) Target = England Average Under 75 mortality rate from cancer (CCG) Target = England Average Enhancing Quality of Life Target /16 /16 DoT Further Info. / QP Health-related quality of life for people with long-term - Data as at March 15 (2014/15) conditions - Target = England Average Proportion of people feeling supported to manage their - Data is 6 Monthly (Apr-Sep) % % condition - Target = England Average Unplanned hospitalisation for chronic ambulatory care sensitive conditions 1,074 1,045 Target =RCCG 2014/15 outturn Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Target =RCCG 2014/15 outturn Diagnosis rate for people with dementia, expressed as a Latest data as at 29th February % % percentage of the estimated prevalence - monitored monthly. Helping Recovery Target /16 /16 DoT Further Info. / QP Emergency admissions for acute conditions that should not usually require hospital admission 1,542 1,619 Target =RCCG 2014/15 outturn Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) Target =RCCG 2014/15 outturn Patient Experience Target /16 /16 DoT Further Info. / QP Satisfaction with the quality of consultation at the GP practice Data shown is 2014/15 - /16 data only available at national level currently Satisfaction with the overall care received at the surgery /16 data from GP survey Satisfaction with accessing primary care /16 data from GP survey Protecting people from avoidable harm Target Apr-16 Apr-16 DoT YTD YTD Further Info. / QP Incidence of healthcare associated infection (HCAI) - MRSA (Provider) - RFT Incidence of healthcare associated infection (HCAI) - C.Diff (Commissioner) Incidence of healthcare associated infection (HCAI) - C.Diff (Provider) - RFT Mental Health: Monthly Indicators Target wc 9 May May-16 DoT YTD Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment % % % Proportion of people waiting 18 weeks or less from referral to entering a course of IAPT treatment % % Mental Health: Quarterly Indicators 15/16 Target Qtr 4 Qtr 4 DoT Further Info. / QP Improved Access to Psychological Services-IAPT: People entering treatment against level of need 3.75 % 5.08 % Improved Access to Psychological Services-IAPT: People who complete treatment, moving to recovery % % YTD Further Info. / QP

7 RMBC: Better Care Fund The Better Care Fund provides an opportunity to improve the lives of some of the most vulnerable people in our society, giving them control, placing them at the centre of their own care and support, and, in doing so, providing them with a better service and better quality of life. Below is the Dashboard to support Rotherham MBC Better Care Fund for /16. Non-elective FFCEs (First Finished Consultant Episode) (RMBC/HWB Calc) Apr- May- Jun- Jul- Aug- Sep- Actual 2,641 2,556 2,559 2,590 2,551 2,377 2,358 1,648 2,390 2,441 2,708 2,627 Target 2,530 2,541 2,443 2,608 2,341 2,433 2,453 2,547 2,670 2,532 2,409 2,697 Actual (YTD) 2,641 5,197 7,756 10,346 12,897 15,274 17,632 19,281 21,670 24,111 26,819 29,446 Target (YTD) 2,530 5,071 7,514 10,122 12,463 14,896 17,349 19,896 22,566 25,098 27,507 30,204 Oct- Nov- Jan- Feb- Delayed transfers of care from hospital per 100,000 population (number of days delayed) Apr- May- Jun- Jul- Aug- Sep- Actual Target Baseline: Apr13-Dec Oct- Nov- Jan- Feb- Emergency readmissions within 30 days of discharge from hospital Number of readmissions within 30 days of discharge from hospital Actual Target Baseline: Apr13-Dec13 Apr- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov May- Jun- Jul- Aug- Actual Target Sep- Oct- Nov- Jan- Jan- Feb- Feb- Permanent admissions of older people (aged 65+) to residential & nursing care homes, per 100,000 Actual Target Baseline: 2012/ Jun Sep Jun- Sep- The proportion of older people (65+)still at home 91 days after discharge into rehabilitation Inpatient Experience: Proportion of people reporting poor patient experience of inpatient care Actual Target Baseline: 2012/13 Actual Target Baseline

8 A&E 4 Hours Waits - RFT Patients % 4 hour A&E waiting times - seen within 4 hours (TRFT) A&E - 4 Hour Waits to Dec to Jan to Feb to Mar to Apr to May Actual % % % % % % Target % % % % % % Direction of Travel Actual 1 year ago % % % % % % Supporting Explanation Rotherham CCG data is used to monitor for the Quality Premium and is now published via NHS England on a monthly basis; however it runs 1 month in arrears. To monitor A&E in a timely manner it has been agreed to use TRFT's daily data as a proxy for the CCG measure. Year-to-date A&E position (Type 1 TRFT) as at 22nd May is 92.04%. A&E 4 Hours Waits - Local Trust and National Comparison

9 Referral to Treatment - Incomplete Pathway RTT Incomplete Pathway - RCCG Patients % Patients on incomplete nonemergency pathways waiting no more than 18 weeks (Commissioner) Nov Jan-16 Feb Apr-16 Actual % % % % % % Target % % % % % % Direction of Travel Actual 1 year ago % % % % % % RTT Incomplete Pathways by Specialty - RCCG Patients Apr Actual Target Direction of Travel All specialties - Incomplete Cardiology Cardiothoracic Surgery Dermatology ENT Gastroenterology General Medicine General Surgery Geriatric Medicine Gynaecology Neurosurgery Neurology Ophthalmology Oral Surgery Other Plastic Surgery Rheumatology Thoracic Medicine Trauma & Orthopaedics Urology Supporting Explanation Latest provisonal data shows the specialty pathways not meeting the 92% standard are General Medicine, Gastroenterology and Cardiology. General Medicine had 35 breaches (321 out of 356 patients). 28 breaches were at Rotherham Foundation trust (RFT) (89.19%). 7 breaches at Sheffield Teaching Hospital (STH). Gastroenterology had 59 breaches (606 out of 665 patients) with 40 occurring at Rotherham Foundation Trust. 18 breaches were at STH (85.48%). One breach was at University Hospitals Of Morecambe Bay NHS Foundation Trust. Cardiology had 71 beaches (706 out of 777 patients) with 45 breaches occurring at RFT (91.46%). 24 breaches were at /STH. 1 breach at Doncaster and Bassetlaw Hospital. 1 breach at Barnsley Hospital FT. Rotherham CCG benchmarks favourably against other CCG's in South Yorkshire for RTT Incomplete waits in April: Barnsley CCG % / Bassetlaw CCG % / Doncaster CCG % / Sheffield CCG % * '?' Represents that no calculation is to be made for the specialty in question, as no patients were due to be treated in month

10 IAPT 6 Week Wait - RCCG Patients Proportion of people waiting 6 weeks or less from referral to entering IAPT treatment (weekly) IAPT Waiting Times W/E --> 17/04/16 24/04/16 01/05/16 08/05/16 15/05/16 22/05/16 Actual % % % % % % Target % % % % % % IAPT 6 Week Wait Waiting List IAPT Incomplete Waits - waiting IAPT Incomplete Waits - waiting 0-6 weeks W/E --> 17/04/16 24/04/16 01/05/16 08/05/16 15/05/16 22/05/16 Actual Actual IAPT Incomplete Waits - waiting over 6 weeks Actual Supporting Explanation Local comparison (using published data as at January ) shows the following benchmark position: Barnsley CCG % Bassetlaw CCG % Doncaster CCG % Sheffield CCG % National %

11 Cancer 62 Days Cancer 62 Days GP Referral - RCCG Patients Oct-15 Nov Jan-16 Feb Actual % % % % % % Cancer - % Patients seen within 62 days of referral from GP Target % % % % % % Direction of Travel Actual 1 year ago % % % % % % Cancer 62 Days GP Referral - The Numbers - RCCG Patients Oct-15 Nov Jan-16 Feb Cancer patients seen within 62 days from Actual GP referral cancer patients waiting to be been Actual seen within 62 days of GP referral Supporting Explanation The latest data shows improvement on February's performance; however the target remains marginally under the national standard in March. Quarter 4's position was 85.5%, meeting the national standard of 85%. TRFT saw an improvement drop in performance, with performance at 96.2% in March from 83.3% in February. National performance remains under the national standard at 83.8%. There were 3 breaches in March for RCCG Patients: 1 due to elective capacity inadequate at RHQ 2 were due to Inter Provider Transfer (IPT) at RFR with one combined with elective capacity inadequate at RHQ and the other combined with patient choice (RFR - Rotherham Foundation Trust/RHQ - Sheffield Teachings Hospital)

12 Glossary Rotherham Gov Body Rep Glossary /16 Better Care Fund Avoidable emergency admissions:non-elective admission data are derived from the Monthly Activity Return (MAR). It is collected from providers (both NHS & IS) broken down by Commissioner. Delayed transfers of care from hospital per 100,000 population:average delayed transfers of care (delayed days) per 100,000 population (attributable to either NHS, social care or both). Emergency readmissions within 30 days of discharge from hospital (all ages):per 100,000 population standardised, for people registered with a Rotherham GP. Inpatient experience: Proportion of people reporting poor patient experience of inpatient care Permanent admissions of older people (65+) to residential care & nursing homes, per 100,000: Annual rate of council-supported permanent admissions of older people to residential & nursing care. Proportion of older people (65+) who were still at home 91 days after discharge from hospital:increase in effectiveness of these services whilst ensuring that those offered services does not decrease. Older people discharged to residential or nursing home or extra care housing for rehabilitation, with a clear intention that they will move back to own their own home. Health Outcomes Emergency admissions for acute conditions that should not usually require hospital admission:emergency admissions could have been avoided through better management in primary care, over 19 years. (E.g. ENT infections, Kidney/ Urinary Tract Infections, heart failure etc.). Comparisons made with England averages & improvements expected. Emergency admissions for children with lower respiratory tract infections:comparisons made with England averages & improvements expected. IAPT - The proportion of people that enter treatment against level of need in the general population:the number of people who receive psychological therapies divided into the number of people who have depression (local estimate based upon national audit) IAPT - The proportion of people who complete treatment who are moving to recovery:number of people who are moving onto recovery divided into the Number of people who have completed at least 2 treatment contacts Satisfaction at a GP practice:the aggregation of patients who gave positive answers to five selected questions in the GP survey about the quality of appointments at the GP practice Satisfaction at a surgery:the percentage of patients who gave positive answers to the GP survey question 'Overall, how would you describe your experience of your GP surgery?' Satisfaction with access to primary care:the percentage of patients who gave positive answers to the GP survey question 'Overall, how would you describe your experience of making an appointment?' Under 75's Mortality Rates(CVD, Respiratory Disease, Liver Disease & Cancer): Comparisons made with England averages & Improvements expected year on year. Unplanned Hospitalisation for asthma, diabetes & epilepsy in under 19's per 100,000 population:comparisons made with England averages & improvements expected. Unplanned hospitalisation for chronic ambulatory care sensitive conditions:comparisons made with England averages & improvements expected. NHS Constitution & Pledges YAS Category A Ambulance Calls Red 2:Other Time Critical calls eg Serious breathing difficulties or suspected stroke with serious symptoms Quality Premium A&E 4 hour waits in A&E (CCG): Data published one month behind. A proxy measure has been added to the QP scorecard to show TRFT's daily positon to highlight latest positon for A&E for Rotherham patients. A&E 4 hours waits for patients with mental health needs: primary diagnosis of mental health-related needs or poisoning spending over 4 hours in A&E is over 95%, together with primary diagnosis codes at A&E with a valid 2 character A&E diagnosis or 3 digit ICD-10 code will be at least 90% Alcohol related admissions to hospital per 100,000 population standardised:rate to meet target trajectory. Cancer:% Patients referred (within 14 days) by a GP to their first outpatient appointment for suspected cancer. Hospital discharges at weekend/bank holiday:increase in the Number of patients admitted for non-elective reasons, who are discharged at weekends or bank holidays. IAPT - The proportion of people that wait 18 weeksor 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. IAPT - The proportion of people that wait 6 weeksor 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. Potential Years of Life Lost from causes considered amenable to health care & life expectancy at 75 (PYLL):Premature deaths that should not occur in most cases in the presence of timely & effective health care. A 3.2% reduction based upon the Directly Standardised Rate required year on year. Rotherham has an excess of 6000 years of life lost. Stroke 4 hour target:people who've had a stroke that are admitted to an acute stroke unit within 4 hours of arrival to hospital. YAS Category A Ambulance Calls Red 1:Most Urgent time critical calls e.g. Cardiac Arrest patients who are not breathing & don't have a pulse or life threatening trauma.