This report provides an update to the Trust Board on National and local performance indicators.

Transcription

1 Trust Board Performance Overview Report Month /19 This report provides an update to the Trust Board on National and local performance indicators. National Performance Single Oversight Framework (SOF): The NHS Improvement (NHSI) SOF was implemented on 1 October The framework follows five themes which are linked to those of the Care Quality Commission (CQC). By focussing on these five themes, NHSI will support providers to attain and/or maintain a CQC good or outstanding rating. National Contractual Requirements (NQRs): There are a number of NQRs that are applicable across multiple Trust contracts. Local Performance Contractual Performance; the Trust is contracted by a number of commissioners to provide a range of services across the 4 clinical directorates below. This report provides a summary of performance against the performance indicators within each of the Trust s contracts. All Ages Mental Health Oxfordshire (includes Swindon, Wilts and BaNES) All Ages Mental Health - Buckinghamshire Community Services Specialised Services Joint Management Groups (JMGs): The Trust reports performance against a number of indicators to the Oxfordshire and Buckinghamshire JMGs. The JMGs provide oversight and management of pooled budget spending and activity. Indicators In total, the Trust routinely reports information and performance relating to 2133 indicators. Directorate Indicators with defined targets Monthly Quarterly Yearly Bi-Annual/ Seasonal Total Indicators with no target Totals National Performance Single Oversight Framework Local JMG Performance Joint Management Groups Local Contractual Performance Community Services All Ages Mental Health Oxon and SWB Page 1 of 33

2 All Ages Mental Health Buckinghamshire Specialised Services Local Contractual Total Grand Total Performance Scorecard 74% (225/303) of targeted local contractual indicators were achieved in month 5. SOF data is not fully published and JMG indicators are reported one month in arrears, therefore the M5 FY19 Trust performance % position relates to contractual KPI performance only. Directorate Below target >1 Below -1-9% Met No Total % Met National Performance Single Oversight Framework % Local JMG Performance Joint Management Groups % Local Contractual Performance Community Services % All Ages Mental Health Oxon and SWB % All Ages Mental Health Buckinghamshire % Specialised Services % Local Contractual Performance Total % Investigating and managing under-performance All indicators that have been below target by more than 1 for two consecutive months or more will be investigated. Reasons for under-performance and plans to address will be reported to the Board at the end of the month. Page 2 of 33

3 No of Indicators Performance Trend Month 5 FY18/19 The number of reportable indicators varies each month. In month 5, 74% of local contractual indicators were achieved. The performance has remained the same as previous month. This is mainly attributable to indicators that would have previously been excluded from the report (due to the timing of their publication) now being included. Whilst the number of red indicators appears to have increased this month against previous months, this is due to the new reporting approach and the ability to now include all indicators. On this basis, red indicators that would have been previously excluded from the report are now included. Total number of red indicators (>1 under target) trend M1/FY19 M2/FY19 M3/FY19 M4/FY19 M5/FY M1/FY19 M2/FY19 M3/FY19 M4/FY19 M5/FY19 Month/Year Met Not Met Page 3 of 33

4 National: Single Oversight Framework (SOF) Month /19 NATIONAL: Single Oversight Framework (SOF) FY17 & FY18 In Sept 2016 NHS Improvement (NHSI) published the first SOF which replaced Monitor s Risk Assessment Framework, to help NHSI identify where NHS Trusts/Foundation Trusts may benefit from, or require, improvement support. It sets out how NHSI will identify providers potential support needs under the following four themes (linked to, but not identical to CQC themes); Quality of Care, Finance Score, Operational Performance and Organisational Health. The Trust is required to perform against a set of qualitative and quantitative performance indicators under each theme as follows; Theme Monthly Quarterly Yearly No /Not reported Quality of Care Operational Performance Organisational Health Sub-Totals Grand Total 46 In the majority of cases NHSI will be sourcing Trust performance data from publicly available sources e.g. CQC, NHS Digital, NHS England, and Unify. The majority of the indicators do not have targets/thresholds, so where information is available the published performance has been measured against the average position for England. Single Oversight Framework (SOF) Performance Scorecard In August, 16 indicators were due to be reported, however, there is a time lag of when data is published nationally. At end of August only 7 of the 16 indicators had been published with August s data. The remaining 9 indicators have yet to be reported with the August position. Therefore, for these 9 indicators the last reported position is reflected in the table below. Service Below target >1 Below 1-9% Met No Total % Met Quality of Care % Operational Performance % Organisational Health Total % Page 4 of 33

5 R Red Indicators The following indicators were showing below target at the most recent available data: Theme Ref Measure Organisational Health Quality of Care (Mental Health) Quality of Care (Mental Health) 2 Staff turnover (rolling 12 months) 9 Occurrence of any Never Event 15 % of clients in settled accommodation / Eng. Average 12% (Trust) Not targeted 57.5% Trend Graph Narrative 14.19% Aug 18 2 Aug % June 18 (latest data) Staff turnover in August was 14.19%, a slight decrease compared to July s figure of 14.23%. During 2017/18 & 2018/19 to date the two top reasons for leaving the Trust or moving internally were lifestyle/relocation and better prospects/career development During August 2 Never Events have been reported; investigations into both are underway. Creation of an in-house solution for MHSDS has enabled us to review the logic for our reporting to ensure that it accurately reflects operational processes. We anticipate seeing an improvement on this measure. Page 5 of 33

6 Operational Performance 23b Priority Metric % coded Adults ethnicity, employment Adults accommodation 85% 51.2% 51.2% June 18 (latest data) Performance has decreased from 52.3% in April (no figure available in May due to problems at NHS Digital). Work continues in the Trust to improve data completeness and quality. The development of the in-house solution will support this, as we develop automated and data quality reports. Page 6 of 33

7 Local: Joint Management Groups (JMGs) Month /19 The Trust also reports performance against a number of indicators to the Oxfordshire and Buckinghamshire Joint Management Groups (JMGs). Oxfordshire and Buckinghamshire County Councils have existing and long-standing agreements under Section 75 of the National Health Services Act 2006 with the Clinical Commissioning Groups to pool resources and deliver shared objectives, often referred to as pooled budgets. Pooling budgets enable better integration of health and social care, leading to a better experience and outcomes for people and their carers. The pooled budgets are governed by Joint Management Groups which provide oversight and management of spending and activity in improving outcomes and meeting needs. In total, there are 147 indicators for 2018/19 applicable to the Trust broken down by county as follows. 36 indicators have a defined target and 111 indicators are supplied for information only. Performance of the Trust is measured in relation to the targeted indicators only. County Monthly Quarterly Yearly Not ed Oxfordshire JMG Buckinghamshire JMG Sub-Totals Grand Total 147 The reporting cycle for the JMGs is different to the contractual and National indicators and is also reported one month in arrears. Additionally, a number of the indicators reported to the JMGs are also contractual indicators. Joint Management Groups - Performance Scorecard The Trust was required to perform against 15 indicators to the Oxfordshire JMG and 21 to the Buckinghamshire JMG. The JMG data is reported one month in arrears. Buckinghamshire JMG data is reported quarterly therefore will be included into the M6 Board Report. 87% of Oxfordshire JMG indicators were achieved in month 5. County Below Below >1 1-9% Met % Met Total % Oxfordshire JMG % Buckinghamshire JMG n/a n/a n/a n/a Below are the indicators that were below target by more than 1. The flag indicates how many month s the indicators has been below target by more than 1 (see key at end of the report). Page 7 of 33

8 R Red Indicators Service/ Contract Flag Ref Measure Trend Graph Narrative Oxon OBC 9 Adult CMHTs - Percentage of referrals categorised as urgent that are assessed within 7 calendar days 84% (85/101) April May June July This month breaches consisted of the following. 7 patients declined first appointment. 2 patients were seen by turning point. 3 did not attended and other 4 were not breaches but admin error on system. % % Oxon OBC 10 Adult CMHTs - Percentage of referrals categorised as nonurgent that are assessed within 28 calendar days 9 61% (133/217) April May June July % Series % Agreed with CCG that target has been changed to 8 weeks for a further 3 months. The 8-week performance was 98%. There was no clinical risk to any of the patients that were seen with the extended period. Only 4 patients were seen over 56 days, 2 wanted to been seen in Bicester and other 2 refused appointments but were seen within 70 days. Page 8 of 33

9 All Ages Mental Health Oxfordshire and Swindon, Wilts & Banes Month 5 FY19 The All Ages Mental Health Oxfordshire Directorate is required to perform against a set of qualitative and quantitative performance indicators relating to the contracts commissioned by: Oxfordshire Clinical Commissioning Group (OCCG) Swindon, Wilts and BaNES Clinical Commissioning Groups and; Oxfordshire County Council (OCC) In total, there are 477 indicators for 2018/19 applicable to the directorate (excluding JMG indicators which are reported in the JMG section). 134 indicators have a defined target and 343 indicators are supplied for information only. Performance of the directorate is measured in relation to the targeted indicators only. All Ages Mental Health - Oxfordshire Performance Scorecard The All Ages Mental Health Oxfordshire Directorate was required to perform against 112 indicators in month 5 (excluding JMG indicators which are reported in the JMG section). 66% of reported indicators were achieved in month 5: Service/Contract Below target >1 Below -1-9% Met Oxfordshire Clinical Commissioning Group (CCG) No Total Outcomes Based Commissioning (OBC) Sch % Outcomes Based Commissioning (OBC) Incentivised Child and Adolescent Mental Health Service (CAMHS) Integrated Access to Psychological Therapies (IAPT) % Met % Wellbeing % Oxon Community & Mental Health Contract % Older People Adults Eating Disorders Oxon Sch EDPS Oxon Sch Oxfordshire CCG Totals Swindon, Wilts and BaNES Clinical Commissioning Group (CCG) Child and Adolescent Mental Health Service (CAMHS) % Wiltshire Adult Eating Disorders (ED) % SWB CCG Totals % Oxfordshire County Council (OCC) Page 9 of 33

10 Joint Management Group (JMG) % Overall Directorate Performance (excl JMG) % On the next page are the indicators that were below target by more than 1 in June. The flag indicates how many months the indicator has been below target by more than 1 (see key at end of the report). Page 10 of 33

11 R Red Indicators Service/ Contract OBC (Sch 4) 1 Flag Ref Measure Trend Graph Narrative % of people that have had their cluster reviewed within the agreed timescale Oxfordshire Clinical Commissioning Group 85% 63% (32/51) April May June July Aug % % P&I team have pulled together data on clustering to show current snapshot and to allow for further analysis. Internal meetings arranged with Clinical leads and business services. Action points to follow on from meeting and update to be provided in October. OBC (Sch 4) 5 Percentage of outpatient letters that are sent back to GPs (uploaded to Care Notes) within 10 calendar days 67% (55/82) April May June July Aug % % Business Services are working with the service to identify problem areas and causes of underperformance. Monthly reports of consultant performance are being monitored and clinical leads informed of areas of underperformance. Annual Leave in August also caused a drop in performance. Action plan to be provided in October Page 11 of 33

12 OBC (Sch 4) 10 OBC (Sch 4) 15 A Adult CMHTs - Percentage of referrals categorised as non-urgent that are assessed within 28 calendar days Part 1 and Part 2 summaries should be issued to the service user s GP within 10 days of discharge from care under this specification 9 79% (161/203) 64% (23/36) April May June July Aug % % April May June July Aug % % Agreed with CCG that target has been changed to 8 weeks for a further 3 months. The 8- week performance was 98%. There was no clinical risk to any of the patients that were seen with the extended period. Only 4 patients were seen over 56 days, 2 wanted to been seen in local area and were seen with 65 days and other 2 refused appointments within the 56- day period due to patient choice Business Services are working with Clinical leads/ consultants to look in to the process of amalgamation of Part 1 and Part 2 Summaries to the service users. This process is ongoing and updates will be provided next month OBC (Sch 4) 14 % of service users who have had a comprehensive physical health assessment covering BMI, blood pressure, smoking status, blood sugar levels, alcohol intake and exercise levels in the previous 12 months (audit of 20 patients' notes) 85% 7 14/20 April May June July Aug % % As the CCG are aware we have designed a new physical health form and are working to collect this data. Reporting for the new physical form will start from October. Page 12 of 33

13 OBC Incentivised OBC Incentivised - - Percentage of patients showing Reliable Improvement CORE- OM % of service users in clusters 4-17 under the care of OHFT with a reduction in intensity in HoNOS rating score at their most recent cluster review* 33% 3 22% (2/9) 24% (12/51) 3 1 April May June July Aug % % April May June July Aug % % This indicator is prone is monthly changes due the low volumes of the indicator. Service has noted performance drop and will monitor in coming months. Service explained that it is only after the refresh that the performance improves and data is more robust. No report currently available for Honos rating. The figures provided here relate to step down to a lower intensity cluster and there has been a 4% improvement this month. The service will look at the patient level details to understand the actions that may need to be taken. OBC Incentivised - Percentage of all referrals to adult mental health teams that are categorised as crisis/emergency where the patient (and carer where applicable) and the referring GP are contacted within 2 hours. 78% (7/9) April May June July Aug This KPI did not breach this was a data error on the reports for this month. Both patients were seen within two hours % % Page 13 of 33

14 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 CAMHS - Percentage of children/young person having their first routine appointment within 12 weeks of referral 75% 25% (42/166) % seen within OH and OCCG in discussion around the CAMHS waits backlog. Of the 166 assessments completed in August (seasonal variation), 42 of them were for patients waiting 12 weeks or less, 124 completed for those waiting over 12 weeks CAMHS - % of children that are seen within 4 weeks for routine eating disorders (change to Nationally mandated KPI) 75% 33% 2/6 % seen within 1 x breach by 1 day. 1 x breach due to family holiday, just over 4 weeks, assessed and discharged. 1 x breach as patient cancelled first appointment, next available appointment was within 5 weeks. 1 x breach, first offered within 2 weeks, family cancelled as went on holiday, family then cancelled 2nd appointment due to ill family member, attended at 5 weeks, assessed and to be f/up in GH. Page 14 of 33

15 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 CAMHS - Percentage of children that receive a diagnosis or treatment within 12 weeks of routine referral into NCD (Neurodevelopment). 75% 6% (0/4) % received within The NDC pathway is due to have more resource moving in during September 2018 as per mobilisation plan. The resources will concentrate on those waiting longest first, these will those waiting longer than 12 weeks. CAMHS - LAC will be seen within 2 weeks for all CAMHS services excluding the neurodevelopment pathway (0/8) % LAC starting Treatment in 10 wd The breaches occurred for the follow reasons: 2 x breaches 2.2 weeks and 2.8 weeks due to patient choice regarding holiday. 1 x breach as LAC not picked up by referred team. 1 x breach of 4 weeks due to no risk identified and staff availability. 1 x breach, 2 urgent appointments offered and declined by carer, 3rd appointment attended, no risks identified in this period by young person and carer. 1 x breach, placement move from city to north and new carer, urgent appointment DNA in city, took time to get new information for north to offer. 1 x breach patient moved into temporary Page 15 of 33

16 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 specialist support so delay in CAMHS involvement, back with foster placement and CAMHS assessed, discharged as no MH outcome. 1 x breach, LAC not identified in initial referral, school then indicated LAC. No social worker and not open to ATTACH as a private foster arrangement, took time to gain information but young person now offered and seen. CAMHS - Clinic letters sent to GP within 10 days 82% (87/106) Reduction in performance due to admin A/L in smaller teams during August % Sent within 10 Days CAMHS - % of CYP that are seen within 4 hours for emergency referrals 0/1 Was reviewed same day by duty clinician and crisis contact, showing incorrectly as a breach. % seen within Page 16 of 33

17 Wellbeing - Q1 The service I received has helped me to better understand my problems 9 16/20) April May June July Aug There has been a 1 improvement in performance this month and the service expect to see an upwards trajectory on performance. % % Wellbeing - Q2 I got the help that matters to me 9 74% (39/53) April May June July Aug % % 33/39 responses Agree or Strongly Agree. 3 Neither Agree nor Disagree. And three disagreed but were provide guidance on where they can find support within partnership 18% IAPT - Access rates 19% 16.5% (835/5059) 16% 14% 12% We are continuing to work hard to increase referrals to ensure by year end we will reach the 19% target 1 April May June July Aug % % Page 17 of 33

18 Apr_18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Older Peoples C8 Percentage of interim inpatient discharge letters (MDT letter for Community Hospitals) that are sent back to GPs within 24 hours of discharge 83% (5/6) 9 85% 75% 7 65% P&I information shows that the % is impacted because of such lower numbers of discharges (not unusual for OPMH). This is based on 5 out of 6 being sent in time. The one not sent in time was because there were no junior doctors however, was sent within 2 days Swindon, Wilts and BaNES Clinical Commissioning Group SWB community CAMHS BANES SWB community CAMHS BANES - - Referral to treatment time. Those who have a wait time of 8 weeks or less Percentage of CYP having their first appointment (Excluding ED) % within 4 weeks 7 75% 37% (11/30) (19/47) 5 5 The waiting time breaches in BANES are in the Getting More Help service. A Service Manager has been assigned to undertake a review of the team s job plans to ensure the number of planned assessment slots consistently meets the number of referrals being received by the service SWB community CAMHS Wilts - Referral to treatment time. Those who have a wait time of 8 weeks or less. 7 42% (28/67) 5 There have been a number of vacancies that have now been recruited to so it is anticipated this should improve when people come into post. Page 18 of 33

19 SWB community CAMHS Wilts SWB community CAMHS Wilts - - Percentage of CYP having their first appointment (Excluding ED) % within 4 weeks Percentage of CYP having their first appointment (Excluding ED) % within 8 weeks 75% 85% 26% (24/92) 59% (54/92) 5 5 Waits are now being skewed by the Getting Help service which is below target in Melksham and Salisbury. This has been reviewed with Team Managers and the Service Manager and an action plan put in place. SWB community CAMHS Wilts - Percentage of CYP having their first appointment (Excluding ED) % within 12 weeks 78% (72/92) SWB community CAMHS Wilts - Percentage of CYP having their first routine appointment for ED% within 4 weeks (4/5) 5 This represents one patient SWB community CAMHS Swindon - Referral to treatment time. Those who have a wait time of 8 weeks or less 5 29% (8/28) 5 Summer is often a difficult period of time for waits as families will cancel or request later appointments due to the holiday period. Staff also take more holiday during this time. It is anticipated waiting Page 19 of 33

20 Apr-18 Jun-18 Aug-18 Oct-18 Dec-18 Feb-19 times will improve in September SWB community CAMHS Swindon - Percentage of CYP having their first appointment (Excluding ED) % within 4 weeks 45% 18% (5/28) 5 Summer is often a difficult period of time for waits as families will cancel or request later appointments due to the holiday period. Staff also take more holiday during this time reducing the number of assessment slots available during this time. Most are being seen be 6 weeks and it is anticipated waiting times will improve in September Wilts Eating Disorders - Percentage of referrals to assessment within 4 weeks (4/5) This represents one patient JMG Please refer to JMG section of the report Oxfordshire County Council Out of Area Placements (OAPs) Oxfordshire Quarter FY18/19 Variance Quarter Quarter Page 20 of 33

21 All Ages Mental Health Buckinghamshire Month 5 FY19 The All Ages Mental Health Buckinghamshire Directorate is required to perform against a set of qualitative and quantitative performance indicators relating to contracts commissioned by: Buckinghamshire Clinical Commissioning Group (BCCG) Buckinghamshire County Council (BCC) In total, there are 264 indicators for 2018/19 applicable to the directorate (excluding the JMG indicators which are reported in the JMG section of the report). 56 indicators have a defined target and 208 indicators are supplied for information only. Performance of the directorate is measured in relation to the targeted indicators only. All Ages Mental Health Buckinghamshire Performance Scorecard The All Ages Mental Health Buckinghamshire Directorate was required to perform against 47 indicators in month 5. 72% of indicators were achieved Service Below target >1 Below -1-9% Met No Buckinghamshire Clinical Commissioning Group (BCCG) Total % Met Adults & Older Adults CMHTs and Inpatients, IAPT, Perinatal and PIRLS % CAMHS % BCCG Totals % Buckinghamshire County Council (BCC) Joint Management Group n/a n/a n/a n/a n/a n/a Overall Directorate Performance (excl JMG) % Overleaf are the indicators that were below target by more than 1. The flag indicates how many month s the indicators has been below target by more than 1 (see key at end of the report). M02 FY18/19 Board Report v1.1 Page 21 of 33

22 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 R Red Indicators Service/ Contract Flag Measure Buckinghamshire Clinical Commissioning Group Trend Graph Narrative Adult CMHTs Emergency referrals to Mental Health Team will be seen within 4 hours for assessment 5 (2/4) Aylesbury 1/3 (33%) 1 x patient referred on 20 th, unable to contact patient on phone, patient called back late on 21 st and then seen on 22 nd. 1 x patient declined assessment within the emergency timescale and was seen on the 13 th. Chiltern 1/1 () Adult CMHTs Urgent referrals to Mental Health Team will be seen within 7 consecutive days for assessment 78% (29/37) Aylesbury 17/21 (81%) 3 x patients initially did not respond to calls and letters so received appointments outside of the timeframe. 1 x patient referral was downgraded to routine. Chiltern 12/16 (75%) 2 x patients initially did not respond to calls and messages, contact was however made and M02 FY18/19 Board Report v1.1 Page 22 of 33

23 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Adult CMHTs % people will have care review within the (timeframe) specified by the cluster package 52% (45/86) appointments arranged but outside of timeframe. 1 x patient DNA first appointment then cancelled two subsequent appointments and refused further offer of appointments. 1 x patient requested an appointment in a different location which resulted in the patient being seen outside of timeframe. P&I team have pulled together data on clustering to show current snapshot and to allow for further analysis. Internal meetings arranged with Clinical leads and business services. Action points to follow on from meeting and update to be provided in October. Older People CMHTs Memory Service Users with Diagnosis (F00, F01, F02, F03 and F06.7) will receive an assessment and diagnosis within 40 days of receipt of referral 85% 49% (20/41) Aylesbury 6/9 (67%) 3 x breaches due to clinic availability (staff annual leave) - patients seen at 42, 44 and 48 days. Chiltern 14/32 (44%) 18 x breaches due to clinic availability (staff annual leave) M02 FY18/19 Board Report v1.1 Page 23 of 33

24 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Older People CMHTs % people will have care review within the (timeframe) specified by the cluster package 83% (50/60) P&I team have pulled together data on clustering to show current snapshot and to allow for further analysis. Internal meetings arranged with Clinical leads and business services. Action points to follow on from meeting and update to be provided in October. Perinatal % women requiring non-emergency assessments will be completed within 2 weeks of referral (14 calendar days) 67% (4/6) 2 x breaches due to both patients cancelling their initial appointments. Both patients have now received an assessment. CAMHS Access: ed Pathway (Getting Help) - % DNAs 7% 16% 15% 1 5% Young people s activities and commitments during the school summer holidays has had an impact on the DNA rate M02 FY18/19 Board Report v1.1 Page 24 of 33

25 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 CAMHS Access: Specialist (Getting More Help) - % DNAs 7% 11% 15% 1 5% Young people s activities and commitments during the school summer holidays has had an impact on the DNA rate CAMHS Access-Specialist: Neurodevelopmental - % DNAs 7% 11% 15% 1 5% Young people s activities and commitments during the school summer holidays has had an impact on the DNA rate JMG Please refer to JMG section Buckinghamshire County Council Out of Area Placements (OAPS) Buckinghamshire Quarter FY18/19 Variance Quarter Quarter M02 FY18/19 Board Report v1.1 Page 25 of 33

26 Community Services Directorate Month 5 FY19 The Community Services Directorate is required to perform against a set of qualitative and quantitative performance indicators relating to contracts commissioned by: Oxfordshire Clinical Commissioning Group (OCCG) Buckinghamshire Clinical Commissioning Group (BCCG) Oxfordshire County Council (OCC) In total, there are 953 indicators for 2018/19 applicable to the directorate. 177 indicators have a defined target and 776 indicators are supplied for information only. Performance of the directorate is measured in relation to the targeted indicators only. Community Services Directorate Performance Scorecard The Community Services Directorate was required to perform against 73 indicators in month 5. 75% of indicators were achieved. Service/Contract Below target >1 Below 1-9% Met No Total % Met Oxfordshire County Council (OCC) College Nursing n/a n/a n/a 180 n/a n/a School Health Nursing n/a n/a n/a 159 n/a n/a Health Visiting n/a n/a n/a 83 n/a n/a Immunisations OCC Totals Oxfordshire Clinical Commissioning Group (OCCCG) Community Adults % Community Children Community other (trust, training etc) % AQP Podiatry OCCG Totals % Buckinghamshire Clinical Commissioning Group (OCCCG) Continuing Health Care Directorate Performance % Overleaf are the indicators that were below target by more than 1. The flag indicates how many months the indicators has been below target by more than 1 (see key at end of the report). M02 FY18/19 Board Report v1.1 Page 26 of 33

27 R Red Indicators Service/ Contract Out of Hours Flag Ref Measure Trend Graph Narrative NQR 7 OOHs % of unfilled clinical shifts Oxfordshire Clinical Commissioning Group </= 2% 1 (108/1094) 15% 1 5% FY18 The service is actively marketing to recruit to both flexible and substantive contracts for all staff groups to increase the pool of available workforce. In addition, work is ongoing to seek opportunities to increase clinical cover by skill mixing. Following the UAC KPIs review in collaboration with the commissioners, this KPI will be removed from the Quality schedule. Community Hospitals C8 Interim patient discharge letter that are sent back to GPs within 24hrs of discharge 77% (95/123) Changes to Care notes were introduced on that now permits the initial discharge letter to be linked via to the patient s GP. M05 FY18/19 Board Report v0.1 Page 27 of 33

28 Continuing health care 1 Eligibility decisions are made within 28 days of accepting a referral. All assessments required for eligibility decisions are to be completed within this timeframe. 59% (26/44) The service has experienced a significant increase in the referral rate in August (12% above expected referral rate which equates to 49 more referrals than the previous month). Last year the expected referral rate was 160 and from April 2018 this was increased to 195 without any increase to the staffing establishment. At the end of 2017/8 the referral rate was 21% expected activity. Using the 160 (from 2017/18) expected referral rate the August referrals demonstrated a 37 % increase with no additional resource. The service continues to work as leanly as possible whilst maintaining CHC National Framework compliance. The service is however limited on what can be achieved with available resources. The service has 1.6 WTE on maternity leave and 1.8 WTE long term sickness. Agency staff usage has increased but due to the specialist skills M05 FY18/19 Board Report v0.1 Page 28 of 33

29 Continuing health care 2 Individuals eligible for CHC will receive a case review which will include care plan review 3 months after eligibility decision 59% (17/29) required, the pool of competent assessors is very limited. The service continues to prioritise work on a daily basis and use the available staff in the most effective way to meet competing pressures. The service is meeting with the Business Services team later this month to seek support with requesting an increase in staffing establishment which will enable the service to have a more realistic opportunity to achieve KPIs 2 and 3 on a more consistent basis. Continuing health care 3 Individuals eligible for CHC will receive a case review which will include care plan review every 12 months 61% (27/44) The above comments for KPI 2 also apply to this indicator Continuing health care 5 If eligible the package of care for Fast Track individuals will be in place within 2 working days 35% (7/20) OHFT is commissioned to assess eligibility for Fast Track packages of care. The responsibility for providing packages of care which are in place within 2 working days, sits outside of the remit of The M05 FY18/19 Board Report v0.1 Page 29 of 33

30 Trust. On this basis, the Trust has requested the withdrawal of this indicator. A system triggered escalation meeting was held in June with all key stakeholders with several short term and longterm actions agreed to be led and co-ordinated by commissioners at OCCG. Contract governance is also being deployed to ensure greater oversight and focus to achieve a timely resolution to this issue and proposed removal of this KPI from the Trust s contract but retention at a system level. Looked After Children (Phoenix team) E1c Every child over five years of age will receive a review health assessment annually 9 77% (23/30) 3 x young people did not respond to multiple attempts to contact, refusers pathway followed 1 x young person declined a review, refusers pathway followed 2 x young people are out of county placements l young person has now received their review, awaiting confirmation M05 FY18/19 Board Report v0.1 Page 30 of 33

31 Jun- Aug- Oct- Dec- Feb- of review date for the other young person 1 x appointment cancelled due to illness. Child then going on holiday. Appointment rescheduled for early September. Buckinghamshire Clinical Commissioning Group Continuing health care DST completed in acute hospital </= 15% 28% (10/36) 3 1 No D2A beds or other type of Health step down beds available. BHT used community beds for rehabilitation, which has a long waiting list. M05 FY18/19 Board Report v0.1 Page 31 of 33

32 Specialised Services Directorate Month 5 FY19 The Specialised Services Directorate is required to perform against a set of qualitative and quantitative performance indicators relating to contracts commissioned by: Oxfordshire Clinical Commissioning Group (OCCG) National Health Service England (NHSE) Specialised In total, there are 246 indicators for 2018/19 applicable to the directorate. 130 indicators have a defined target and 116 indicators are supplied for information only. Performance of the directorate is measured in relation to the targeted indicators only. Dental Services report mid-month to mid-month for commissioning purposes however, they provide an end of month snapshot to the Business Team, to enable inclusion in the monthly Board Report. Specialised Services Directorate Performance Scorecard The Specialised Services Directorate was required to perform against 70 indicators in month 5. 87% of indicators were achieved. Service/Contract Below >1 Below 1-9% Met No % met Total % Oxfordshire Clinical Commissioning Group (OCCG) Learning Disabilities % National Health Service England (NHSE) - Specialised Dentistry Forensic Medium Secure Unit (MSU) Forensic Low Secure Unit (LSU) CAMHS Tier 4 Inpatients % Eating Disorders (ED) Inpatients Overleaf are the indicators that were below target by more than 1. The flag indicates how many month s the indicators has been below target by more than 1 (see key at end of the report). M05 FY18/19 Board Report v0.1 Page 32 of 33

33 R Red Indicators None Out of Area Placements (OAPS) Learning Disabilities Quarter FY18/19 Variance Quarter 1 Ceiling target of Quarter 2 Ceiling target of Key: Flag Description Action Required Indicator has been >1 under plan for 1 month Noted by Board, if a material dip is reported, causation to be explored and explained, otherwise watching brief with limited action Indicator has been >1 under target for 2 consecutive months Indicator has been >1 under target for 3+ consecutive months Initial root-cause analysis required with remedial actions defined, with date for improved performance confirmed. Reported to Board for information and oversight Deep dive required; confirmation of actions required, responsible officer confirmed, delivery dates detailed with improvement trajectory as appropriate, any additional requirements to be agreed in advance. Month 5 FY18/19 Board Report v0.1 Page 33 of 33