2014/15 CORE PERFORMANCE DASHBOARD. April - August 2014 Published for Governing Body Meeting 2nd October 2014

Transcription

1 214/15 CORE PERFORMANCE DASHBOARD April - August 214 Published for Governing Body Meeting 2nd October 214

2 Contents Page Number Glossary 3 Finance and Contract Position Summary 9 Better Care Fund Summary 11 Quality Premium Summary 13 Performance Dashboard Summary 15 Performance Exception Report 17 Performance Dashboard 2 Page 2

3 Glossary Page 3

4 Reducing years of life lost from causes amenable to healthcare Glossary Key Trend Performance against Target (R/A/G) Symbols and acronyms = Increase from last period On or better than target > Greater than, >= Greater than or equal to = Remained the same as last period Between target and 5% below (Except where stated) < Less than, <= Less than or equal to = Decrease from last period Worse than target minus 5% (Except where stated) YTD = Year to date QTD = Quarter to date Column Key CCG = In CCG Outcome Indicator Set (Monitored at CCG Level and contribute to the overarching aims of the five domains in the NHS Outcomes Framework) NHS CR = Constitutional Requirements BCF = Better Care Fund Metric QP = Either a Quality Premium measure or a constitutional requirement where under performance will reduce the Quality Premium CTR = Contractual Requirement / Provider Performance Frequency A = Annual 6m = 6 monthly Q = Quarterly M = Monthly Denotes Data will not be published for the period Indicator Name Potential years of life lost from causes considered amenable to healthcare Target description Difference between expected life expectancy and age at death where death relates to specific (listed) conditions per 1, population Under 75 mortality rate from cardiovascular disease Number of deaths relating to cardiovascular disease per 1, GP registered population under the age of 75 Under 75 mortality rate from respiratory disease Number of deaths relating to respiratory disease per 1, GP registered population under the age of 75 Under 75 mortality rate from liver disease Number of deaths relating to liver disease per 1, GP registered population under the age of 75 Under 75 mortality rate from cancer Number of deaths relating to cancer per 1, GP registered population under the age of 75 Emergency admissions for alcohol-related liver disease Adult emergency admissions for alcohol-related liver disease (Rate per 1,) Unplanned hospitalisation for chronic ambulatory care sensitive Unplanned hospital admissions for chronic ambulatory sensitive conditions (ACS) conditions (Rate per 1,) Unplanned hospitalisation for asthma, diabetes and epilepsy (under 19s) Unplanned hospital admissions for asthma, diabetes and epilepsy for - 19 year olds (Rate per 1,) Adult emergency admissions for acute conditions (ear/nose/throat Emergency admissions for acute conditions that should not usually infections, kidney/urinary tract infections, heart failure) that should not require hospital admission usually require hospital admission (rate per 1,) Emergency admissions for children with lower respiratory tract infections Emergency admissions for children with the preliminary diagnosis of (Rate per 1, population) respiratory tract infection. (Rate per 1,) Basis of Target 12% reduction from 212 to 218/19. Straight line trajectory to achieve that reduction. Reduction in the numbers of patient deaths from cardiovascular disease Reduction in the numbers of patient deaths from respiratory disease Reduction in the numbers of patient deaths from liver disease Reduction in the numbers of patient deaths from cancer disease Reduction in the numbers of patient emergency admissions from alcohol-related liver disease Reduction in the numbers of unplanned admissions for chronic ambulatory sensitive conditions Reduction in the numbers of unplanned admissions for under 19's for asthma, diabetes and epilepsy Reduction in the numbers of emergency admissions for acute conditions where they would not normally incur a hospital admission Reduction in the numbers of emergency admissions for children with lower respiratory tract infections A&E waiting time - total time in the A&E department: HARROGATE A&E waiting time - total time in the A&E department: YORK Percentage of patients treated, discharged, or transferred within 4 hours at Harrogate Hospital Percentage of patients treated, discharged, or transferred within 4 hours at York Hospital 95% threshold (nationally mandated) 95% threshold (nationally mandated) Page 4

5 t Safety Urgent Care Response Indicator Name Target description The percentage of Category A Red 1 incidents (presenting conditions that may be immediately life -threatening and the most time critical), which resulted in an emergency response arriving at the scene of the incident Ambulance: Cat A (Red 1) - 8 minute response time (YAS Trust Level) within 8 minutes. At Ambulance Provider level - the CCG will have its Quality Premium Reduced if the Yorkshire Ambulance Trust does not meet the target The percentage of Category A Red 2 incidents (presenting conditions which may be life threatening but less time critical than Red 1), which resulted in an emergency response arriving at the scene of the incident Ambulance: Cat A (Red 2) - 8 minute response time (YAS Trust Level) within 8 minutes. At Ambulance Provider level - the CCG will have its Quality Premium Reduced if the Yorkshire Ambulance Trust does not meet the target The percentage of Category A Red 1 incidents resulting in an ambulance Ambulance: Cat A (Red 1) - 19 minute response time (YAS Trust Level) arriving at the scene within 15 minutes The percentage of Category A Red 2 incidents resulting in an ambulance Ambulance: Cat A (Red 2) - 19 minute response time (YAS Trust Level) arriving at the scene within 15 minutes Handovers between ambulance and A&E taking place within 15 minutes, The number of instances where handover of a patient's care from the no one waiting more than 3 minutes ambulance crew to A&E takes longer then 3 minutes Handovers between ambulance and A&E taking place within 15 minutes, The number of instances where handover of a patient's care from the no one waiting more than 6 minutes ambulance crew to A&E takes longer then 6 minutes Following handover ambulance crew should be ready to accept new calls within 15 minutes The number of instances where an ambulance crew, following handover of a patient, is not ready to accept new calls within 3 minutes Basis of Target 75% threshold (nationally mandated) 75% threshold (nationally mandated) 95% threshold (nationally mandated) 95% threshold (nationally mandated) > threshold (nationally mandated) > threshold (nationally mandated) > threshold (nationally mandated) Following handover ambulance crew should be ready to accept new calls within 15 minutes Trolley waits in A&E not longer than 12 hours Avoidable emergency admissions (Composite Indicator for the Quality Premium) Avoidable emergency admissions per 1, population (average per month) BCF Area Friends and Family test for A&E - Harrogate and District The number of instances where an ambulance crew, following handover of a patient, is not ready to accept new calls within 6 minutes The number of instances where a patient who has been assessed in A&E has waited longer than 12 hours to be admitted following the decision to admit being made. Number of emergency admissions deemed avoidable (list of conditions) per 1, population. Composite indicator built using unplanned admissions for asthma, lower respiratory tract infections, diabetes and epilepsy. Average number of emergency admissions deemed avoidable per month per 1, population (The composite measure will match that used in the Quality Premium except it will be based on Local authority (using resident population) rather than CCG geography (GP registered population). It will also be the crude rate rather than the indirectly standardised rate used in the Quality Premium. The Friends and Family Test (FFT) is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care > threshold (nationally mandated) > threshold (nationally mandated) To earn the QP, this must be a % change or a reduction on the baseline Agreed with CCG and local Health and Well Being Board. Improvement in year from 213/14 and full roll out at Provider level. Friends and Family test for A&E - York The Friends and Family Test (FFT) is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care Improvement in year from 213/14 and full roll out at Provider level. Mixed Sex Accommodation Breaches (Rate per 1 FCEs) Incidence of healthcare associated infection (HCAI): MRSA Incidence of healthcare associated infection (HCAI): Clostridium difficile Total number of breaches of the same sex accommodation guidelines per Nationally Mandated (Zero tolerance) 1 Finished Consultant Episodes Total number of patients of that acquired MRSA as a result of a Nationally Mandated reduction on baseline (set nationally for each healthcare intervention provider and for each CCG) Total number of patients of that acquired Clostridium Difficile as a result of Nationally Mandated reduction on baseline (target to be defined - from a healthcare intervention for the whole year. NHS England) Page 5

6 Waiting Times Quality & Patient Indicator Name Patient Safety Incidents reported Increased reporting of medication errors VTE risk assessment: all inpatient Service Users undergoing risk assessment for VTE - Harrogate VTE risk assessment: all inpatient Service Users undergoing risk assessment for VTE - York Target description Total number of safety incidents (ie, any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care) reported within the reporting period Actual number of reported medication errors, to maximise learning and provide guidance on minimising harm for both medication and medical device errors Actual numbers of inpatient service users (adults) that are risk assessed for Venous thromboembolism Actual numbers of inpatient service users (adults) that are risk assessed for Venous thromboembolism Basis of Target Expect to see increased reporting. Expect to see increased reporting. 95% threshold (nationally mandated) 95% threshold (nationally mandated) Referral to Treatment pathways: admitted Referral to Treatment pathways: non admitted Referral to Treatment pathways: incomplete Number of >52 week Referral to Treatment in Admitted, Non-Admitted & Incomplete Pathways Diagnostic test waiting times All Cancer 2 week waits Breast Cancer 2 week waits Cancer 31 day waits: first definitive treatment Cancer 31 day waits: subsequent cancer treatments - surgery CCG Position Cancer 31 day waits: subsequent cancer treatments - anti cancer drug regime Cancer 31 day waits: subsequent cancer treatment - radiotherapy CCG Position Cancer 62 day waits: % receiving first definitive treatment within two months of an urgent GP referral for suspect cancer (incl 31 day Rare cancers) Cancer 62 day waits: % receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service CCG Position Cancer 62 day waits: % receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status Actual numbers of patients whose treatment started during the period and 9% threshold (nationally mandated) involved admission to hospital Actual numbers of patients whose treatment started during the period and 95% threshold (nationally mandated) did not involve admission to hospital Actual numbers of patients waiting to start treatment at the end of the 92% threshold (nationally mandated) month. Total numbers of patients on RTT pathways for either Admitted, Non Admitted or Incomplete pathways that have been waiting longer than 52 > threshold (nationally mandated) weeks. Total numbers of patients that have received Diagnostic Test results 99% threshold (nationally mandated) within 6 weeks Actual numbers of patients urgently referred for suspected cancer by their 93% threshold (nationally mandated) GP were seen by a specialist within 14 days of referral Actual numbers of patients urgently referred by their GP with exhibited breast symptoms (where cancer was not initially suspected) were seen by 93% threshold (nationally mandated) a specialist within 14 days of referral. Actual numbers of patients, who have had their first definitive treatment for cancer within 31 days of a cancer diagnosis (also known as their 96% threshold (nationally mandated) 'Decision to Treat') Actual numbers of patients, who waited 31 days or less for a second or 94% threshold (nationally mandated) subsequent treatment, where the treatment modality was surgery Actual numbers of patients, who waited 31 days or less for a second or subsequent treatment, where the treatment modality was an anti-cancer 98% threshold (nationally mandated) regime Actual numbers of patients, who waited 31 days or less for a second or subsequent treatment, where the treatment modality was radiotherapy Actual numbers of patients, who have had their first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer. This is inclusive of 31 day rare cancer cases. Actual numbers of patients, who have had their first definitive treatment for cancer within 62 days of an NHS Cancer Screening Service having referred them for treatment Actual numbers of patients, who have had their first definitive treatment for cancer within 62 days of a consultants decision to upgrade their priority status 94% threshold (nationally mandated) 85% threshold (nationally mandated) 9% threshold (nationally mandated) 9% threshold (nationally mandated) Breast feeding prevalence at 6-8 weeks Antenatal assessments < 13 weeks Actual number of patient prevalence of breastfeeding at 6 to 8 weeks. NB Quarterly dataset, delayed (first data available December 214 due to indicator construction. I.e. Babies born and monitored for 8 weeks, plus a month for data collection = one quarter delay ) A measure of the number of maternities compared with how many antenatal assessments were carried out before 13 weeks gestation An increase in the prevalence of new mothers breastfeeding at 6 to 8 weeks An increase in the % volume of antenatal assessments, when compared with the number of maternities Page 6

7 Community / Primary Care and Integrated Care Inpatient Care Indicator Name Total health gain as assessed by patients for elective procedures a) hip replacement b) knee replacement c) groin hernia d) varicose veins Cancelled Operations - Harrogate and District Cancelled Operations - York No Urgent Operation should be cancelled for a second time - Harrogate No Urgent Operation should be cancelled for a second time - York Patient experience of hospital care - Harrogate and District Patient experience of hospital care - York Friends and Family Test for inpatient acute - Harrogate and District Friends and Family Test for inpatient acute - York Delayed transfers of care (delayed days) from hospital per 1, population (average per month) Better Care Fund Area Target description Patient reported outcomes for their inpatient care in one (or more) of the 4 procedural areas (hip replacement / knee replacement / groin hernia / varicose vein) Assessment of the overall actual number of procedures that have been cancelled within the period Assessment of the overall actual number of procedures that have been cancelled within the period Assessment of the actual number of urgent procedures that have been cancelled on more than one occasion within the period Assessment of the actual number of urgent procedures that have been cancelled on more than one occasion within the period Assessment of patient experience across a range of inpatient hospital care questions (communications, cleanliness, information, etc ) for patients aged 16 and over Assessment of patient experience across a range of inpatient hospital care questions (communications, cleanliness, information, etc ) for patients aged 16 and over The Friends and Family Test (FFT) is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care The Friends and Family Test (FFT) is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care Measure of effective joint working of local partners, and is a measure of the effectiveness of the interface between health and social care services. Basis of Target An increase in the overall total health gain assessments from patients in relation to at least one of the following, hip replacement, knee replacement, groin hernia or varicose vein procedures. A reduction in the actual numbers of procedures cancelled A reduction in the actual numbers of procedures cancelled Nationally Mandated Nationally Mandated Based on a.1% improvement year on year Based on a.1% improvement year on year Achievement of FFT is based on improved score from to and full roll out at Provider level. Achievement of FFT is based on improved score from to and full roll out at Provider level. The level of ambition set as part of the Better Care Fund planning as agreed by the Health and Well Being Board Falls in the over 65s - CCG Area Measure for those aged 65 years and over identifying all hospital admissions due to unintentional (accidental) fall Based on a 1.4% reduction Falls in the over 65s - Better Care Fund Area Measure for those aged 65 years and over identifying all hospital admissions due to unintentional (accidental) fall Based on a 1.4% reduction Improved health related quality of life for people with long-term conditions A measure to show the health status score for individuals aged 18 and over that have a LTC This measure is an assessment of the status that leads towards the avoiding of permanent placements in residential and nursing care homes Permanent admissions of older people (aged 65 and over) to residential and is a good indication of delaying dependency on local health and and nursing care homes, per 1, population. Better Care Fund Area social care services who work together to reduce avoidable admissions. Uses the BCF area Population. Proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services. Better Care fund Area Patient experience of Primary Care - GP services Patient experience of Primary Care - GP Out of Hours Services This measures the benefit to individuals from reablement, intermediate care and rehabilitation following a hospital episode, by determining whether an individual remains living at home 91 days following discharge. Performance at a Local Authority level for the BCF metric Patient experience of GP services, measured by scoring the results of one question from the GP Patient Survey (GPPS) Patient experience of GP out-of-hours services, measured by scoring the results of one question from the GP Patient Survey (GPPS) Based on an 8% increase from /19. 1% per year improvement. Level of ambition set as part of the Better Care Fund planning as agreed by the Health and Well Being Board Level of ambition set as part of the Better Care Fund planning as agreed by the Health and Well Being Board A reduction in the numbers of patients reporting a poor overall experience of GP services CCG PR says.1% is this correct?.1% reduction of patients reporting a poor experience of GP Care in relation to OOH services. % of people who are moving to recovery The number of people who are moving to recovery as a proportion of those who have completed a course of psychological treatment National suggested level of achievement is 5% Locally agreed target of 5% Page 7

8 Locally Monitored Mental Health Indicator Name Increasing Access to Psychological Therapies: Proportion of people entering therapy Dementia Diagnosis Rate % of those patients on a Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days Target description The number of people who have been referred into IAPT service in the period. Whole year, quarterly target is phased. A measure to assess the improvement in the numbers of people diagnosed with dementia in the period A measure to reduce risk in key groups which includes early follow up by mental health providers of people discharged from in-patient care Basis of Target National expectation of increased numbers with a target of 15% by the end of Locally agreed minimum of 6% for 214/15 National expectation of 67% by 215 Locally agreed minimum of 55% for 214/15 95% threshold (nationally mandated) % Stroke patients that spend at least 9% of their time in hospital on a dedicated stroke ward % non-admitted patients who have a Transient Ischaemic Attack and a higher risk of stroke, who are treated (including all relevant investigations) within 24 hours of contacting a healthcare professional % patients seen in the month who have not waited longer than 9 weeks for first appointment - Adult Mental Health Services % patients seen in the month who have not waited longer than 9 weeks for first appointment - Adult Learning Disability Services % patients seen in the month who have not waited longer than 9 weeks for first appointment - Children & Young Peoples Services % patients seen in the month who have not waited longer than 9 weeks for first appointment - Mental Health Services for Older People Patient Transport Service Pick up prior to appointment (within 12 mins) YAS North Consortium Patient Transport Service Arrival on time for appointment YAS North Consortium Patient Transport Service Pick up after appointment within 9 mins (planned journey only) YAS North Consortium Number of people being picked up within 12 minutes of their appointment time Number of people arriving within 12 minutes of their appointment time Number of people being collected for their homeward journey within 9 minutes of being 'marked ready' 8% threshold (locally monitored indicator) 6% threshold (locally monitored indicator) 9% threshold (locally monitored indicator) 9% threshold (locally monitored indicator) 9% threshold (locally monitored indicator) 9% threshold (locally monitored indicator) Threshold 9% Green rating= >9% threshold Amber rating less than 9% to 83% Red rating < 83% of patients Threshold 82% Green rating = >82% Amber rating less than 82% to 71% Red rating <71% Threshold 9% Green rating => 9% of patients should be collected for their homewards journey within 9 minutes of being marked ready If less than 9% but more than 83% of patients are collected within 9 minutes the performance will be rated amber If less than 83% of patients are collected within 9 minutes the performance will be rated red Patient Transport Service Pick up after appointment within 12 mins (SN and OD journeys only) YAS North Consortium Number of people whose discharge/transfer journey has been booked on the day who are collected within 12 minutes of being 'marked ready' Threshold 99% Green rating =>99% of patients should be collected within 12 minutes of being 'marked ready' If less than 99% but more than 98.5% of patients are collected within 12 minutes the performance will be rated ''amber'' if less than 98.5% of patients are collected within 12 minutes the performance will be rated ''red'' Page 8

9 Finance and Contract Position Summary Page 9

10 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Finance and Contract Position Summary Achievement of Financial Duties / Plans Based on information received up to 31st August 214. Financial performance targets for 214/15 are projected to achieve the following: Acute Contract position (Year to Date Activity) Based on SUS activity (Month 3 Freeze data and Month 4 Flex) HaRD activity for all contracted trusts Performance Assessment Performance Assessment Full Year Surplus (214/15) Green Elective Activity Amber Underlying Recurrent Position Green Non Elective Activity Red Operate within Running Costs envelope Green Outpatients First Appointments Amber Not exceed cash limit Green A and E Amber QIPP Delivery Amber Financial Performance / Forecast 213/14 214/15 Flex Period 214/15 Year to Date ('s) Full Year ('s) Budget Spend Variance Budget FoT Variance Risk Acute & Ambulance Contracts 43,737 44, ,968 14,968 - Amber Prescribing 1,314 1, ,754 24,754 - Green Community Services 3,798 3,798 () 9,115 9,115 - Green Mental Health 6,21 6, ,883 14,883 - Green Continuing Healthcare 7,189 7, ,254 17,254 - Green Primary Care 1,791 1, ,299 4,299 - Green Other (6) 1,912 1,912 - Green Running Costs 1,588 1,359 (228) 3,81 3,81 - Green Contingency 275 (1) (376) Green Total Expenditure 75,69 75,69 () 181, ,656 - Planned Surplus (763) 1,83 - (1,83) Overall Position (NHSE Allocation) 76,453 75,69 (763) 183, ,656 (1,83) Elective Activity 2,5 2, 1,5 1, 5 Outpatient First Appt 6, 5, 4, 3, 2, 1, 1,6 1,4 1,2 1, , 3,5 3, 2,5 2, 1,5 1, 5 Non Elective Activity A and E Activity Page 1

11 Better Care Fund Summary Page 11

12 Better Care Fund Summary Information to follow - summarising BCF Metric performance and savings forecast Page 12

13 Quality Premium Summary Page 13

14 Quality Premium Pre-Qualifying Criteria Financial Governance* Assured Indicator** Period Target Performance Change from last period Adjustment to Funding August YTD RTT Incomplete Pathway 214/15 92% 96.3% -25% August YTD A&E 4 hour Waits 214/15 95% 97.6% -25% August YTD Cancer 14 day wait 214/15 93% 98.2% -25% August YTD Ambulance Cat A Red 1 (8 minute response) 214/15 75% 69.6% -25% Preventing people from dying prematurely Improving Access to psychological therapies (IAPT) Avoidable emergency Admissions composite measure Friends and family test and patient experience Improved reporting of medication related safety incidents Injuries due to Falls in the over 65s Indicator Period Target Performance Change from last period % of Quality Premium Comments Preventing people from dying prematurely CY % Improving Access to psychological therapies (IAPT) May YTD 214/15 15% 5.9% 15% Avoidable emergency Admissions composite Awaiting Data (Sep 14) measure 25% Patient experience indicator to be selected Friends and family test and patient experience 15% Improved reporting of medication related safety incidents August YTD 214/15 5% 11.2% N/A 15% Awaiting Data (Sep 14) Injuries due to falls over 65s 15% * A CCG will not receive a quality premium if: a) in the view of NHS England, during 214/15 the CCG has not operated in a manner that is consistent with the obligations and principles set out in Managing Public Money; or b) during 214/15 it incurs an unplanned deficit, or requires unplanned financial support to avoid being in this position; or c) it receives a qualified audit report in respect of 214/15. * Where a CCG does not deliver the identified patient rights and pledges on waiting times, a reduction of 25 per cent for each relevant NHS Constitution measure will be made to the quality premium payment. Page 14

15 Performance Dashboard Summary Page 15

16 Performance Dashboard Summary Reducing years of life lost from causes amenable to healthcare Number of Indicators (Based on YTD Performance) G A R Urgent Care Response % 8% 6% 4% 2% Indicator Summary R A G NHS Constitutional Requirements Quality & Patient Safety 5 2 % Waiting Times 13 1 Inpatient Care 6 1 Community / Primary Care and Integrated Care Mental Health 1 1 Locally Monitored Grand Total % 9% 8% 7% 6% 5% 4% 3% 2% 1% % Trend Summary Improving Static Deteriorating NHS Constitutional Requirements Page 16

17 Performance Exception Report Page 17

18 Target / Threshold Performance Period Exception applies to Indicator Name Contract Sanctions / Levers Relevant Commentary Year to Date 214/15 A&E waiting time - total time in the A&E department: YORK Financial, 2 per breach beyond threshold 95% 93.4% Declining position since April. An action plan is in place and being monitored by the lead commissioner and is a top priority for the Urgent Care Working Group. Less than 1% of the A&E attendances at York are for HaRD registered patients. Year to Date 214/15 Ambulance: Cat A (Red 1) - 8 minute response time (YAS Trust Level) Withholding of 2% of monthly contract value, with annual reconciliation and total withholding of 2% if targets not met (no interest) 75% 69.6% The YTD performance of the Trust (YAS) is 69.6% for this measure; the monthly performance is reported to be at 71.3% in August, which is and improvement on 69.2% reported in July. Both YTD and in month performance at HaRD CCG level are above target (8.% and 79.5%). A recovery plan is in place for the broader YAS geographical area which is being closely monitored by commissioners. Year to Date 214/15 Year to Date 214/15 Year to Date 214/15 Year to Date 214/15 Year to Date 214/15 Ambulance: Cat A (Red 2) - 8 minute response time (YAS Trust Level) Handovers between ambulance and A&E taking place within 15 minutes, no one waiting more than 3 minutes (HDFT trust level) Withholding of 2% of monthly contract value, with annual reconciliation and total withholding of 2% if targets not met (no interest) Financial, 2 per wait over 3 min Following handover ambulance crew should be ready to accept new calls within 15 minutes. Number between 3 and 6 mins (YAS at Harrogate District Hospital) Financial, 2 per event > 3 minutes Following handover ambulance crew should be ready to accept new calls within 15 minutes. Number > 6 mins (YAS at Harrogate District Hospital) Friends and Family test for A&E - Harrogate and District Financial, 1 per event > 6 minutes CQUIN 75% 69.4% The YTD performance at Trust Level (YAS) is 69.4%; the monthly performance is reported at 7.3% in August which is an improvement on the 68% reported in July. The CCG performance is above target for both YTD (75.5%) and in the month of August (75.7%).The aforementioned recovery plan is being closely monitored by commissioners. 9 new breaches reported for July of which 7 patients were seen between 31 and 4 minutes and 2 were seen between 41 and 5 minutes. There were 6 breaches in August which is an improvement on the 12 breaches in the July. However, within the target of 15 minutes, the average time taken for crew to be clear in August was 9 minutes and 23 seconds; an improvement on July. In August, 86.2% of handovers met target (669 occasions), which is also an improvement on the July figure of 83.6%. Although YTD performance stands at 39 against a zero tolerance, this is an improvement on the average monthly figure for 13/14. 5 YTD position totals 5 breaches with 2 new breaches in August with a handover time of between 1-2 hours Whilst HDFT s YTD performance is currently 8% below target, July performance was significantly above national average (74% against 53%). Year to Date 214/15 Friends and Family test for A&E - York CQUIN Whilst YTD performance is below target (49% against 59%), July performance shows improvement from 47% to 55% which is above national average.

19 Target / Threshold Performance Period Exception applies to Indicator Name Contract Sanctions / Levers Relevant Commentary Year to Date 214/15 Number of >52 week Referral to Treatment in Admitted, Non-Admitted & Incomplete Pathways Financial, 5 per breach 1 This relates to 1 breach at HDFT in General Surgery within the admitted (unadjusted) pathway. It relates to patient choice with their adjusted wait at 33 weeks. Year to Date 214/15 Delayed transfers of care (delayed days) from hospital per 1, population (average per month) BCF Area In July, the largest proportion of delays related to "Awaiting Nursing Home Placement or Availability" and "Awaiting Care Package in own home" Year to Date 214/15 Year to Date 214/15 Year to Date 214/15 Year to Date 214/15 Year to Date 214/15 Increasing Access to Psychological Therapies: Proportion of people entering therapy % of those patients on a Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days % patients seen in the month who have not waited longer than 9 weeks for first appointment - Adult Mental Health Services % patients seen in the month who have not waited longer than 9 weeks for first appointment - Adult Learning Disability Services % patients seen in the month who have not waited longer than 9 weeks for first appointment - Mental Health Services for Older People 15% 5.9% 95% 91.9% Although 5.9% is below the required in month performance to reach the national 15% target, May performance is in line with the planned trajectory and is an improvement on the equivalent period last year. This relates to 3 breaches in Q1, reported in June 214; a further update on Q2 performance will be available at the end of October. 9% 8.8% Improvement as the year has progressed and substantial performance improvement in July at 96.3%. 9% 69.2% 9% 78.9% There were 2 breaches in July relating to Data Quality Issues that have now been rectified. The people were both seen within 9 weeks. July's performance of 78.9% relates to 24 breaches due to staff capacity issues expected to be resolved by September. Year to Date 214/15 Patient Transport Service Arrival on time for appointment YAS North Consortium 82% 79.2% Whilst YTD performance at North Consortium level is below target, CCG performance has improved again in month (75.6% in August, 75.1% in July) Year to Date 214/15 Patient Transport Service Pick up after appointment within 9 mins (planned journey only) YAS North Consortium 9% 88.8% YTD performance for HaRD CCG is above target at 92.2%. Year to Date 214/15 Patient Transport Service Pick up after appointment within 12 mins (SN and OD journeys only) YAS North Consortium 99% 95.8% YTD performance for HaRD CCG is below target at 98.6%.

20 Performance Dashboard Page 2

21 Reducing years of life lost from causes amenable to healthcare CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Potential years of life lost from causes considered amenable to healthcare Y Y A 13/14 data Sep-14 PYLL Awaiting 13/14 outturn 27.7 Under 75 mortality rate from cardiovascular disease Y A 13/14 data Sep-14 PYLL Awaiting 13/14 outturn 6.22 Under 75 mortality rate from respiratory disease Y A 13/14 data Sep-14 PYLL Awaiting 13/14 outturn Under 75 mortality rate from liver disease Y A 13/14 data Sep-14 PYLL Awaiting 13/14 outturn Under 75 mortality rate from cancer Y A 13/14 data Sep-14 PYLL Awaiting 13/14 outturn Emergency admissions for alcohol-related liver disease Y Q Q4 13/14 data Sep-14 PYLL Reduction in admission s 1.9 Unplanned hospitalisation for chronic ambulatory care sensitive conditions (ACS) Y Q Q4 13/14 data Sep-14 PYLL Reduction in admission s Unplanned hospitalisation for asthma, diabetes and epilepsy (under 19s) Y Q Q4 13/14 data Sep-14 PYLL Reduction in admission s Emergency admissions for acute conditions that should not usually require hospital admission Y Q Q4 13/14 data Sep-14 PYLL Reduction in admission s Emergency admissions for children with lower respiratory tract infections (Rate per 1, population) Y Q Q4 13/14 data Sep-14 PYLL Reduction in admission s 552. Page 21

22 Urgent Care Response CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 A&E waiting time - total time in the A&E department: HARROGATE A&E waiting time - total time in the A&E department: YORK Y Y Y M 95% 97.3% 97.7% Financial, 2 per breach beyond threshold Y Y Y M 95% 94.9% 94.7% 96.5% 94.1% 97.6% 93.2% 98.3% 92.8% 98.% 92.4% 98.2% 97.6% 92.6% 93.4% Ambulance: Cat A (Red 1) - 8 minute response time (YAS Trust Level) Y Y Y M 75% 77.4% 69.8% 69.6% 68.% 69.2% 71.3% 7.2% 69.6% Ambulance: Cat A (Red 2) - 8 minute response time (YAS Trust Level) Ambulance: Cat A (Red 1) - 19 minute transportation time (YAS Trust Level) Withholding of 2% of monthly Y Y M contract value, 75% 75.% 7.6% with annual reconciliation and total withholding Y Y M of 2% if targets not met (no 95% 96.9% 97.2% interest) 69.5% 97.% 68.4% 96.7% 68.% 96.1% 7.3% 96.9% 69.1% 69.4% 96.5% 96.8% Ambulance: Cat A (Red 2) - 19 minute transportation time (YAS Trust Level) Y Y M 95% 97.3% 96.1% 95.8% 95.5% 95.% 96.1% 95.5% 95.7% Handovers between ambulance and A&E taking place within 15 minutes, no one waiting more than 3 minutes (HDFT trust level) Y M Financial, 2 per wait over 3 min Handovers between ambulance and A&E taking place within 15 minutes, no one waiting more than 6 minutes (HDFT trust level) Y M Financial, 1 per wait over 6 min 7 Following handover ambulance crew should be ready to accept new calls within 15 minutes. Number between 3 and 6 mins (YAS at Harrogate District Hospital) Y M Financial, 2 per event > 3 minutes Following handover ambulance crew should be ready to accept new calls within 15 minutes. Number > 6 mins (YAS at Harrogate District Hospital) Y M Financial, 1 per event > 6 minutes Trolley waits in A&E not longer than 12 hours Y M Financial 1 per incident Avoidable emergency admissions per 1, of the population (Composite Indicator for the Quality Premium) Y M Sep-14 Reduction of 13/14 position (1682) Avoidable emergency admissions per 1, population (average per month) BCF Area Y M Awaiting Q1 position from NYCC to Sep to Mar Page 22

23 CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Friends and Family test for A&E - Harrogate and District Y Y Y M CQUIN Friends and Family test for A&E - York Y Y Y M CQUIN Page 23

24 Quality & Patient Safety CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Mixed Sex Accommodation Breaches (Rate per 1 FCEs) Y Y M Financial, 25 per day per service user Incidence of healthcare associated infection (HCAI): MRSA Y Y Y Y M Financial, 1k per incidence in month 5 Incidence of healthcare associated infection (HCAI): Clostridium difficile Y Y Y Y M Financial, Quarterly 1k per incidence beyond threshold Patient Safety Incidents reported Y 6M Sep-14 Should be investigated RCA as appropriate Increase in reporting Increased reporting of medication errors Y 6M Sep-14 Should be investigated RCA as appropriate Increase in reporting VTE risk assessment: all inpatient Service Users undergoing risk assessment for VTE - Harrogate Y M Financial - 2 for each breach above threshold 95% 97.1% 97.5% 97.8% 97.9% 97.7% 97.7% VTE risk assessment: all inpatient Service Users undergoing risk assessment for VTE - York Y M Financial - 2 for each breach above threshold 95% 96.5% 95.8% 97.1% 97.6% 96.8% 96.8% Page 24

25 Waiting Times CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Referral to Treatment pathways: admitted Referral to Treatment pathways: non admitted Referral to Treatment pathways: incomplete Y Y* M Y Y M Y Y Y M By Provider, Specialty Level 4 per breach beyond threshold By Provider, Specialty Level 1 per breach beyond threshold At Provider, Specialty Level 1 per breach beyond threshold 9% 93.5% 93.1% 95% 97.4% 97.1% 92% 96.1% 97.1% 94.3% 96.9% 94.2% 97.% 97.1% 96.9% 94.% 97.1% 96.7% 91.7% 96.9% 96.3% 93.% 93.5% 97.% 97.% 96.3% 96.3% Number of >52 week Referral to Treatment in Admitted, Non-Admitted & Incomplete Pathways Y Y M Financial, 5 per breach Diagnostic test waiting times Y Y M Financial - 2 for each breach above threshold 1%.3%.4%.5%.3%.4%.2%.2%.2% All Cancer 2 week waits Y Y Y M Financial - 2 for each breach above threshold 93% 98.7% 98.% 98.6% 98.2% 97.8% 97.8% 98.2% Breast Cancer 2 week waits Y Y M Financial - 2 for each breach above threshold 93% 97.1% 93.3% 88.9% 97.1% 94.9% 94.9% 93.5% Cancer 31 day waits: first definitive treatment Y Y M Financial - 1 for each breach above threshold 96% 98.9% 1.% 1.% 96.9% 96.1% 96.1% 98.2% Cancer 31 day waits: subsequent cancer treatments - surgery Y Y M Financial - 1 for each breach above threshold 94% 99.1% 1.% 94.1% 1.% 1.% 1.% 98.5% Cancer 31 day waits: subsequent cancer treatments - anti cancer drug regime Y Y M Financial - 1 for each breach above threshold 98% 1.% 1.% 1.% 1.% 1.% 1.% 1.% Cancer 31 day waits: subsequent cancer treatment - radiotherapy Y Y M Financial - 1 for each breach above threshold 94% 97.6% 96.7% 1.% 1.% 1.% 1.% 99.1% Cancer 62 day waits: % receiving first definitive treatment within two months of an urgent GP referral for suspect cancer (incl 31 day Rare cancers) Y Y M Financial - 1 for each breach above threshold 85% 88.5% 92.3% 88.9% 89.7% 88.6% 88.6% 89.9% Cancer 62 day waits: % receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service Y Y M Financial - 1 for each breach above threshold 9% 95.1% 1.% 1.% 1.% Nil Return Nil Return 1.% Page 25

26 CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Cancer 62 day waits: % receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status. CCG Position Y Y M 9% 1.% 1.% 1.% 1.% Nil Return Nil Return 1.% Page 26

27 Inpatient Care CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Breast feeding prevalence at 6-8 weeks Y Q Q1 due Dec % Antenatal assessments < 13 weeks Y Q Q1 due Dec % Total health gain as assessed by patients for elective procedures a) hip replacement Total health gain as assessed by patients for elective procedures b) knee replacement Total health gain as assessed by patients for elective procedures c) groin hernia Total health gain as assessed by patients for elective procedures d) varicose veins Y M Y M Y M Y M M1 due Oct 14 M1 due Oct 14 M1 due Oct 14 M1 due Oct 14 PROMS Link to Best Practice Tariff PROMS Link to Best Practice Tariff PROMS Link to Best Practice Tariff PROMS Link to Best Practice Tariff An Increase in overall health gain An Increase in overall health gain An Increase in overall health gain An Increase in overall health gain Cancelled Operations - Harrogate and District Y Y Q Q1 due Aug 14 Financial Sanction.%.%.%.%.% Cancelled Operations - York Y Y Q Q1 due Aug 14 Financial Sanction 6.%.2% 1.1% 1.1% 1.1% No Urgent Operation should be cancelled for a second time - Harrogate Y M Financial - 5 per incidence in month No Urgent Operation should be cancelled for a second time - York Y M Financial - 5 per incidence in month Patient experience of hospital care - Harrogate and District Y Y Y A Sep-14 CQUIN Patient experience of hospital care - York Y Y Y A Sep-14 CQUIN Friends and Family Test for inpatient acute - Harrogate and District Y Y Y M CQUIN Page 27

28 CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Friends and Family Test for inpatient acute - York Y Y Y M CQUIN Delayed transfers of care (delayed days) from hospital per 1, population (average per month) BCF Area Y M Page 28

29 Community / Primary Care and Integrated Care CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Falls in the over 65s - CCG Area Y M Aug-14 QP Falls in the over 65s - BCF Area Y M Awaiting Q1 position from NYCC LOCAL BCF 1% reduction 1696 Improved health related quality of life for people with long-term conditions Y A 13/14 data due June 14 1% improvem ent (78.2 people in year) 79.4 Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 1, population - NORTH YORKSHIRE Y A 13/14 data due July 14 < 476 (annual figure) Proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services - NORTH YORKSHIRE Y A Patient experience of Primary Care - GP services Y Y A Patient experience of Primary Care - GP Out of Hours Services Y Y A 13/14 data due July 14 Awaiting data from GP Patient Survey Awaiting data from GP Patient Survey 85.9% 85.5% Reduction in the numbers of patients reporting.1% reduction of patients reporting a poor Page 29

30 Mental Health CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 % of people who are moving to recovery Y M Jul-14 5% 5.7% Increasing Access to Psychological Therapies: Proportion of people entering therapy Y M 15% 5.2% 5.9% 5.9% 11.8% 11.8% Dementia Diagnosis Rate A 13/14 data in Oct 14 55% 57% % of those patients on a Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days Y Y Q Aug-14 95% 97.9% 91.9% 91.9% 91.9% Page 3

31 Locally Monitored CCG NHS CR BCF QP CTR Frequency Date Updates Due / Data Expected Links and Contract Sanctions / Levers Relevant Target / Threshold Latest Data / Outturn Quarter To Date YTD Month, Trend ( Increase Remained the same Decrease) and Performance against Target (On Target Within 5% Worse than 5%) Indicator Name Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 % Stroke patients that spend at least 9% of their time in hospital on a dedicated stroke ward M 8% 87.% 9.5% 8.% 91.7% 87.9% 87.9% % non-admitted patients who have a Transient Ischaemic Attack and a higher risk of stroke, who are treated (including all relevant investigations) within 24 hours of contacting a healthcare professional M 6% 78.7% 73.3% 56.3% 82.4% 7.6% 7.6% % patients seen in the month who have not waited longer than 9 weeks for first appointment - Adult Mental Health Services M 9% 81.7% 72.3% 73.8% 79.1% 96.3% 8.8% 8.8% % patients seen in the month who have not waited longer than 9 weeks for first appointment - Adult Learning Disability Services M 9% 95.7% 5.% 57.1% 77.8% 66.7% 69.2% 69.2% % patients seen in the month who have not waited longer than 9 weeks for first appointment - Children & Young Peoples Services M 9% 99.7% 1.% 1.% 9.% 92.9% 95.6% 95.6% % patients seen in the month who have not waited longer than 9 weeks for first appointment - Mental Health Services for Older People M 9% 96.5% 89.% 75.3% 78.% 74.5% 78.9% 78.9% Patient Transport Service Pick up prior to appointment (within 12 mins) YAS North Consortium M 9% 91.5% 93.4% 92.1% 91.3% 91.4% 91.4% 91.9% Patient Transport Service Arrival on time for appointment YAS North Consortium M 82% 77.9% 8.3% 8.7% 79.7% 77.4% 78.6% 79.2% Patient Transport Service Pick up after appointment within 9 mins (planned journey only) YAS North Consortium M 9% 89.6% 89.4% 88.3% 89.9% 86.8% 88.5% 88.8% Patient Transport Service Pick up after appointment within 12 mins (SN and OD journeys only) YAS North Consortium M 99% 98.7% 95.9% 95.7% 96.2% 91.3% 94.% 95.8% Page 31