Report to the Merton Clinical Commissioning Group Governing Body

Transcription

1 MCCG GB Pt1 Att 09 Report to the Merton Clinical oning Group Governing Body Date of Meeting: 16 th September 01 Agenda No: 8.1 Attachment: 09 Title of Document: Performance Framework and Balanced Scorecard Purpose of Report: To Receive and Note Report Author: Murrae Tolson Lead Director: Cynthia Cardozo Executive Summary: This paper sets out the system levers, Merton CCG reporting structures and information that are captured to inform the CCG Balanced Scorecard, which is also attached. It includes the CCGs Self Certification to NHS England for Domain 1 of the Balanced Scorecard and the Integrated Quality and Performance Report which informs domains and of the Balanced Scorecard. Key sections for particular note (paragraph/page), areas of concern etc: The CCG Assurance Framework is currently in draft form. The CCG self-assessment has been answered within the constraints of the NHS England submission template, which currently does allow CCGs to identify where the answer to certain questions is Not Applicable. The CCG has raised this issue with NHS England. Recommendation(s): The Merton Clinical oning Group Governing Body is requested to: 1. Agree the Merton CCG Performance Framework. Receive and Note the Quarter 1 Balanced Scorecard Committees which have previously discussed/agreed the report: Clinical Quality Committee Financial Implications: A Quality Premium of approximately 960k for is dependent on the CCG meeting all constitutional pledges and improving the quality of health for local people in These indicators are captured and monitored in the CCG Balanced Scorecard. Other Implications: (including patient and public involvement/legal/governance/ Risk/ Diversity/ Staffing) None Equality Analysis: Not completed Information Privacy Issues: None Communication Plan: (including any implications under the Freedom of Information Act or NHS Constitution) Page 1 of 1

2 Merton Clinical oning Group Performance Framework 1. Introduction From April 01, the NHS Outcomes Framework (Appendix 1) forms part of the way in which the Secretary of State holds the NHS England to account for the commissioning system in the English NHS. Improving health outcomes forms a core part of the mandate, which asks NHS England to make continuous progress against all the five domains and the outcome indicators in the NHS Outcomes Framework. Everyone Counts: Planning for Patients 01/14 outlines the incentives and levers that will be used to improve services. It introduces the Quality Premium (Summary and calculations provided in Appendix ) as an incentive to reward excellent commissioning. In May 01 the CCG Assurance Framework (Appendix ) was published, outlining how NHS England will gain assurance that Clinical oning Groups deliver the best possible services and outcomes for patients within their financial allocation. This paper describes how Merton CCG will monitor and manage performance in order to provide assurance to the Governing Body and NHS England that demonstrates compliance with its statutory obligations.. Merton CCG Performance Framework Contract monitoring and Clinical Reference Groups are the initial reporting channels for quality and performance monitoring for the CCG. Whilst contract monitoring will monitor all the contractual Key Performance indicators, a summary report: Merton CCG Quality and Performance Report will report those indicators which align with Everyone Counts and NHS England s CCG Balanced Scorecard. This report will initially be presented to the EMT to scrutinise for accuracy and ensure rectifying measures align with the organisations commissioning strategy. Once approved, the report will be presented to the Merton Quality Committee. The information contained within the Merton CCG Quality and Performance report, alongside information provided to the Finance Committee will be used to inform the CCG Balanced Scorecard, to be produced bi-monthly by the CCG and quarterly by NHS England for reporting to the CCG Governing Body. The following flowchart depicts the reporting and monitoring arrangements that will ensure the CCG uses appropriate information to deliver the best possible services and outcomes for patients within its financial allocation. Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 1

3 Table 1: Performance Reporting Structure Contract Monitoring CSU St. Georges NHS Trust Epsom and St. Helier NHS Trust Kingston Hospital Foundation Trust Contract Monitoring: Director of oning and Planning South West London and St. Georges Foundation Trust Sutton and Merton Community Services Clinical Quality Reference Groups Director of Quality St. Georges NHS Trust Epsom and St. Helier NHS Trust South West London and St. Georges Foundation Trust Sutton and Merton Community Services Kingston Hospital Foundation Trust CCG Finance and Contract Report CCG Quality and Performance Report Executive Management Team Finance Committee Clinical Quality Committee CCG Balanced Scorecard CCG Governing Body Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business.

4 . Performance Reporting.1. CSU Integrated Report (Acute): As an associate commissi for St. Georges NHS Trust, Epsom and St. Helier NHS Trust and Kingston Hospital Foundation trust, Merton CCG commissions South London oning Support unit to manage these contracts and report their performance. performance reporting by the CSU includes those indicators outlined in the Everyone Counts framework as well as patient s Constitutional rights. This aligns with reporting of the Quality Premium indicators outlined in Appendix 4. The CSU Integrated report will be received and responded to by the CCG s Executive Management Team in accordance with Acute Contract monitoring arrangements... CCG Performance and Quality Report Merton CCG will produce a monthly Performance and Quality report (Q1 attached in Appendix 5) to be scrutinised by the Executive Management team and following approval will be reported to the Quality Committee. This report will be structured to: Monitor the CCG s self-assessed progress towards achieving the Quality Premium Provide evidence to support completion of the CCG Self-Assessment required for submission as part of NHS England s Balanced Scorecard. The CCG Quality and Performance report will be structured using the following headings:..1. Performance according to Constitutional rights: Domain of CCG Assurance, Quality Premium indicators 1-0. Reported by the CSU.... Progress towards improving Health Outcomes for our local population: Domain of CCG Assurance (Appendix 5). Reported by the CCG.... Monitor Quality and Performance of our 5 main providers, both Acute and Non-Acute, to provide evidence required for CCG self-assessment: Domain 1 of CCG Assurance. Reported by the CSU, Director of oning and Director of Quality... Balanced Scorecard The information contained in the CCG Quality and Performance Report will be used to populate the CCG s bi-monthly and quarterly Balanced Scorecard. This scorecard is the same format used by NHS England to evaluate and inform quarterly assurance discussions with the CCGs and it is believed will be used to inform Quality Premium calculations. It is therefore structured under the following domains: 1. Are local people getting good quality care? This information is supplied to NHS England by the CCG through a self-assessment. The self-assessment is conducted based on monthly performance reporting regarding the CCGs main providers and is reported monthly to the Merton Clinical Quality Committee (MCQC).. Are patient s rights under the NHS Constitution being promoted? Performance reported to and monitored by the MCQC. Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business.

5 . Are health outcomes improving for local people? The majority of these indicators are annual indicators, only available 6 1 months after the relevant reporting period. Therefore, proxy measures have been proposed to monitor in-year progress and to inform areas for improvement. See section 4 for further detail. 4. Are CCGs delivering services within their financial plans? Reported monthly by the Director of Finance. 5. Are conditions of CCG authorisation being addressed and removed (where relevant)? Not relevant as Merton CCG is now authorised without conditions. 4. Quality Premium The Quality Premium is intended to reward CCGs for improvements in the quality of the services commissioned and for associated improvements in health outcomes and reducing inequalities. It will be a pre-qualifying criterion for any payment that Merton CCG manages within its total resource envelope for 01/14 and does not exceed the agreed level of surplus drawdown. The total payment will be reduced if the CCGs main providers do not meet the NHS Constitution rights or pledges for patients in relation to: maximum 18-week waits from referral to treatment, maximum four-hour waits in A&E departments, maximum 6-day waits from urgent GP referral to first definitive treatment for cancer, and maximum 8-minute responses for Category A red 1 ambulance calls. NHS England will reserve the right not to make any payment where there is a serious quality failure during 01/14. The total amount payable for achievement of the quality premium will be 5 per patient in the CCG, according to the same formula as the payment of the running costs allowance. (Calculations shown in Appendix ) The quality premium paid to CCGs in 014/15 will be based on four national measures and three local measures. The four national measures, all of which are based on measures in the NHS Outcomes Framework, are: Reducing potential years of lives lost through amenable mortality (1.5 per cent of quality premium): the overarching objective for Domain 1 of the NHS Outcomes Framework; Reducing avoidable emergency admissions (5 per cent of quality premium): a composite measure drawn from four measures in Domains and of the NHS Outcomes Framework; Ensuring roll-out of the Friends and Family Test and improving patient experience of hospital services (1.5 per cent of quality premium), based on one of the overarching objectives for Domain 4 of the NHS Outcomes Framework; Preventing healthcare associated infections (1.5 per cent of quality premium), based on one of the objectives for Domain 5 of the NHS Outcomes Framework. The three local measures Merton CCG has agreed with NHS England: Reablement new pathway to support recovery and independence after illness or injury. Linked to integrated services and reduction of admissions. Number of patients referred to Local Authority Reablement service. Target is 5 referrals. Reduce premature mortality from COPD by better diagnosis and treatment; reduce the gap between the recorded and expected prevalence by 10% by improving the ratio of recorded: Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 4

6 expected prevalence from 0.4 to 0.44% as a CCG overall by coding review, recurrent admissions on register and increased screening of smokers. Increasing immunisation uptake by 4% on year age group immunisations: DTaP/IPV/HiB (90.% at Q 1/1), MMR (8.8% at Q 1/1) and PCV (89.% at Q 1/1). Q 1/14 data will be used as the comparator. Data source is Merton practice level data recorded on RIO. 5. In-year Proxy Measures The NHS Outcomes Framework and NHS Constitution set out the goals and responsibilities of commissioning organisations, but it is accepted that the approaches for delivery will vary and local commissis have the freedom to develop those that work in each community. Healthcare success will be judged on the quality of outcomes. Domain of the CCG Assurance Framework sets out the improvements that CCG s are expected to deliver in Health outcomes for local people. A number of these indicators are able to be monitored on a monthly/quarterly basis: Incidence of healthcare associated infection i) MRSA and ii) C.difficile () Providers meeting 15% response rates in FFT () Local Priorities o Number of patients referred to Reablement. () o Improved diagnoses and treatment of people with COPD. () IAPT Coverage performance against plan. (Quarterly) However, the majority of the indicators are annual indicators and are only publicized 6 1 months after the period being reported. As 5% of the Quality Premium is dependent on achieving improvements in health outcomes for local people (Quality Premium indicators -5), it is therefore recommended that the CCG introduces in-year proxy measures to be monitored by the EMT and Quality committee to monitor progress towards achieving these improvements. These measures have been presented to the Quality Committee and further discussion will be held with the Clinical Reference Group to ensure they are accurate proxy measures. 6. NHS England Assurance NHS England has produced and shared with Merton CCG the first Balanced Scorecard (Appendix 7), which will be used as the basis of discussion for Quarterly assurance meetings. Key messages from this report are: Domain : Amber/Red. This rating is due to a Red rating for Mixed Sex Accommodation 11 Cases in Quarter 1. The CCG are challenging this RAG rating with NHS England as the technical definition implies a tolerance of 0 MSA breaches over the quarter. Domain : Green. There is a risk to this indicator changing after the annual reporting period because: 1. The CCG has declared that it is not on track to meet the IAPT trajectory.. In-year data is not available for the majority of the indicators in this domain as they are annual indicators published a significant time after the reporting period. Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 5

7 7. Merton Governing Body is asked to Receive the Quarter 1 Balanced Scorecard Agree the performance framework 8. Conclusion The Quality Committee will receive monthly Quality and Performance Reports which, in addition to information submitted to the Finance committee, will inform the CCGs Self reporting and the content of the CCGs Balanced Scorecard. The quarterly Balanced Scorecard has been and will be produced by NHS England for CCG Assurance. The CCG will produce a bi-monthly balanced Scorecard for Governing Body reporting purposes. 9. References NHS Outcomes Framework: NHS-Outcomes-Framework pdf Everyone Counts: Quality Premium: CCG Assurance Framework: NHS Constitution: Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 6

8 Appendix 1: NHS Outcomes Framework 01/14 at a glance Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 7

9 Appendix : Quality Premium Overview and calculations Quality Premium calculation, indicators and performance management arrangments Measure Target discripton Target value Percentage of premium Value Monitored by Notes Pre-Qualifying: it will be a pre-qualifying criterion for any payment that a CCG manages within its total resources envelope for 01/14 and does not exceed the agreed level of surplus drawdown; Meets Total resource envelope % - 99,45 CCG Fi na nce Pre-Qualifying. The NHS CB will reserve the right not to make any payment where there is a serious quality failure during 01/14. No serious quality failures % - 99,45 CCG Quality Reducing potential years of lives lost through amenable mortality : the overarching objective for Domain 1 of the NHS Outcomes Framework;.% reduction from 1 to % 14,00.6 CCG Performa nce Reducing avoidable emergency admissions: a composite measure drawn from four measures in Domains and of the NHS Outcomes Framework; 0% reduction or or the Indirectly Standardised Rate of admissions in 01/14 is less than 1,000 per 100,000 population 5.0% 48,061.5 CCG Performance 1) All relevant local providers of services commissioned by a CCG have delivered the nationally agreed roll-out Ensuring roll-out of the Friends and Family Test and improving patient experience of hospital services, plan to the national timetable. ) an improvement in average FFT scores for acute inpatient care and A&E based on one of the overarching objectives for Domain 4 services between Q1 01/14 and Q1 014/15 for acute of the NHS Outcomes Framework; hospitals that serve a CCG s population. 1.5% 14,00.6 CSU Performance Preventing healthcare associated infections, based on one of the objectives for Domain 5 of the NHS Outcomes Framework. Local Priorities: Reablement new pathway to support recovery and independence after illness or injury. Linked to integrated services and reduction of admissions. Number of patients referred to Local Authority Reablement service. Reduce premature mortality from COPD by better diagnosis and treatment; reduce the gap between the recorded and expected prevalence by 10% by improving the ratio of recorded: expected prevalence from 0.4 to 0.44% as a CCG overall by coding review, recurrent admissions on register and increased screening of s mokers 1. There are O cases of MRSA bacteraemia assigned to the CCG; and. C. difficile cases are at or below defined thresholds for the CCG. 1.5% 14,00.6 CSU Performance Agreed by local area team Agreed by local area team 5 referrals 1.5% 14,00.6 CCG Performa nce Reported by Local Authority to CCG The contribution that can be delivered by the NHS is best measured by potential years of life lost from causes considered amenable to healthcare. CCGs will be able to determine which aspects of premature mortality are of greatest relevance in their local population. Composite measure of: 1. unplanned hospitalisation for chronic ambulatory care sensitive conditions (all ages).. unplanned hospitalisation for asthma, diabetes and epilepsy in children. emergency admissions for acute conditions that should not usually require hospital admission (all ages). 4. emergency admissions for children with lower respiratory tract infection. 10% i mprove ment in ratio 1.5% 14,00.6 CCG Performa nce Need to set up access to in-year GP QOF data Increasing immunisation uptake by 4% on year age group immunisations: DTaP/IPV/HiB (90.% at Q 1/1), MMR (8.8% at Q 1/1) and PCV (89.% at Q 1/1). Q 1/14 data will be used as the comparator. Data source is Merton practice level data recorded on RIO. Agreed by local area team Consitutional rights: Reduction in allocation of quality premium if CCG fails to meet: Overall 4% increase in imms 1.5% 14,00.6 CCG Performa nce SMCS through CCG Immunisation lead maximum 18-week waits from referral to treatment 9% -5.0% - 48,061.5 CSU Performance maximum four-hour waits in A&E departments 95% -5.0% - 48,061.5 CSU Performance maximum 6-day waits from urgent GP referral to first definitive treatment for cancer 95% -5.0% - 48,061.5 CSU Performance maximum 8-minute responses for Category A red 1 ambulance calls. 75% -5.0% - 48,061.5 NWL CSU Any activity that is under 1% of the trust's overall activity will be ignored in this mapping. Amount payable: 5 per head of population Population based on January finance allocation ,45 Maximum payment possible. Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 8

10 Appendix : CCG Assurance Framework Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 9

11 Appendix 4: Constitutional Rights Operational Standard Lower System Threshold Lever Collection freq Assurance Constitutional Rights Referral To Treatment waiting times for non-urgent consultant-led treatment 1 Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 85% Quarterly CSU Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 90% Quarterly CSU Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral 9% 87% QP:failure = -5% Quarterly CSU 4 Number of patients waiting more than 5 weeks 0% 10% Quarterly CSU Diagnostic test waiting times 5 Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 99% 94 Quarterly CSU A&E waits Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E 6 department 95% QP:failure 90% = -5% Weekly Quarterly CSU Cancer waits week wait Maximum two-week wait for first outpatient appointment for patients referred urgently with 7 suspected cancer by a GP 9% 88% Quarterly Quarterly CSU Maximum two-week wait for first outpatient appointment for patients referred urgently with 8 breast symptoms (where cancer was not initially suspected 9% 88% Quarterly Quarterly CSU Impacts on Cancer waits 1 days mortality 9 Maximum one month (1-day) wait from diagnosis to first definitive treatment for all cancers 96% 91% Quarterly Quarterly CSU QP Domian 10 Maximum 1-day wait for subsequent treatment where that treatment is surgery 94% 89% Quarterly Quarterly CSU 1. Maximum 1-day wait for subsequent treatment where that treatment is an anti-cancer drug 11 regimen 98% 9% Quarterly Quarterly CSU Maximum 1-day wait for subsequent treatment where the treatment is a course of 1 radiotherapy 94% 89% Quarterly Quarterly CSU Cancer waits 6 days Maximum two month (6-day) wait from urgent GP referral to first definitive treatment for 1 cancer 85% 80% Quarterly Quarterly CSU Maximum 6-day wait from referral from an NHS screening service to first definitive treatment 14 for all cancers 90% 85% QP: Failure = -5% Quarterly Quarterly CSU Maximum 6-day wait for first definitive treatment following a consultant s decision to upgrade 15 the priority of the patient (all cancers) None set None set Quarterly Quarterly CSU Category A ambulance calls 16 Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) 75% 70% QP:Failure Quarterly CSU 17 Category A calls resulting in an emergency response arriving within 8 minutes (Red ) 75% 70% = - 5% Quarterly CSU 18 Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 70% Quarterly CSU Mixed Sex Accommodation Breaches 19 Minimise breaches Zero <10 Quarterly CSU Cancelled Operations All patients who have operations cancelled, on or after the day of admission (including the day of surgery),for non-clinical reasons to be offered another binding date within 8 days, or the Not rated Not rated Quarterly CSU 0 patient s treatment to be funded at the time and hospital of the patient s choice. Mental Health Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient 1 care during the period. 95% 90% Quarterly Quarterly CSU Data Availability Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 10

12 Appendix 5: CCG Assurance Domain. (Outcomes Framework Indicators) Outcomes Framework Preventing people from dying prematurely Potential years of life lost (PYLL) from causes considered amendable to healthcare Under 75 mortality rate from cardiovascular disease 4 Under 75 mortality rate from respiratory disease 5 Under 75 mortality rate from liver disease 6 Under 75 mortality rate from cancer Enhancing quality of life for people with long term conditions 7 Health-related quality of life for people with long-term conditions 8 Proportion of people feeling supported to manage their condition 9 *Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) 0 *Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 1 Estimated diagnosis rate for people with dementia Helping people to recover from episodes of ill health or following injury *Emergency admissions for acute conditions that should not usually require hospital admission Emergency readmissions within 0 days of discharge from hospital Total health gain assessed by patients i) Hip replacement ii) Knee replacement iii) Groin hernia 4 iv) Varicose veins 5 Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) Ensuring that people have a positive experience of care 6 Patient experience of primary care i) GP Services ii) GP Out of Hours services CSU 7 Patient experience of hospital care CSU 8 Friends and family test.% decrease 1. Roll out. Improve QP 1.5% QP 1.5% Quarterly CSU Treating and caring for people in a safe environment and protecting them from avoidable harm 9 Incidence of healthcare associated infection (HCAI) i) MRSA Quarterly CSU QP: 1.5% 40 Incidence of healthcare associated infection (HCAI) ii) C.difficile Quarterly CSU Others 41 IAPT Coverage - performance against plan To plan Quarterly Quarterly CCG Local Priorities Reablement new pathway to support recovery and independence after illness or injury. Linked 4 to integrated services and reduction of admissions. 5 Referrals QP 1.5% Quarterly Reduce premature mortality from COPD by better diagnosis and treatment; reduce the gap between recorded and expected prevalence by 10% from 0.4 to 0.44% as a CCG overall total 10% change moving the 11 practices towards the target by coding review, recurrent admissions on register in ratio QP 1.5% Proxy Quarterly CQRS 4 and increased screening of smokers Increasing immunisation uptake by 4% on year DT&P/IPV/HiB, MMC (87% to 91%) and HiP 44 MenC Booster & PCV Booster, MMR (77% to 81%). 4% increase QP 1.5% Quarterly CCG Annual Annual Decrease QP 1.5% Annual CCG CCG CCG via Reablement Merton Clinical oning Group. September 01. Performance Framework M. Tolson, Head of Health Systems, Performance and Business. 11

13 Region CCG: London NHS Merton CCG Last Refresh Date 0 August 01 17/06/01 16:06 CCG Assurance Framework Balance Scorecard Summary Domain Buttons Domain Titles Domain RAG Status Domain RAG Summary Status Domain 1 Domain Domain 4 Domain 5 Are local people getting good quality care? Are patient rights under the NHS Constitution being promoted? Are health outcomes improving for local people? Are CCGs delivering services within their financial plans? Are conditions of CCG authorisation being addressed and removed (where relevant)? AMBER-GREEN The number of indicators triggering a AMBER-GREEN 10 Self-certification complete AMBER-RED The number of indicators triggering a AMBER-RED 1 RED No self-certification data GREEN All indicators met 0 Self-certification complete AMBER-GREEN The number of indicators triggering a AMBER-GREEN 0 Self-certification complete No RAG Total number of outstanding conditions 0 Fully Authorised

14 Balances Scorecard All Indicator Domain RAG Criteria Domain Category Indicator Indicator Detail (incl. Numerator and Denominator where applicable) Freq Period Data Source Basis RAG Criteria Comments 1 Providers Has local provider been subject to local enforcement action by the CQC? Quarterly By providers 1-10; Unify Provider Yes/No/Enforcement Action 1 Providers Has local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in rterlyqua Unify Provider Yes/No 1 Providers Has local provider been subject to enforcement action by the NHS TDA based on 'quality' risk? Quarterly Unify Provider Yes/No 1 Providers Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes f Quarterly Unify Provider Yes/No 1 Providers Has the provider been identified as a 'negative outlier' on SMHI or HSMR? Quarterly Unify Provider Yes/No 1 Providers rd show that MRSA cases are above zero? Quarterly Unify Provider Yes/No 1 Providers ted more C difficile cases than trajectory? Quarterly Unify Provider Yes/No 1 Providers show that MSA breaches are above zero? Quarterly Unify Provider Yes/No Any Enforcement Action takes Domain rating to RED 1 Providers Does provider currently have any unclosed Serious Untoward Incidents (SUIs)? Quarterly Unify Provider Yes/No 1 Providers Has the provider experienced any 'Never Events' during the last quarter? Quarterly Unify Provider Yes/No 1 CCG Does the CCG have any outstanding conditions of authorisation in place on clinical governance? Quarterly Unify CCG Yes/No 1 CCG Has the CCG self assessed and identified any risks associated with concerns around quality issues discquarterly Unify CCG Yes/No 1 CCG Has the CCG self assessed and identified any risks associated with concerns around the arrangementsquarterly Unify CCG Yes/No 1 CCG Has the CCG self assessed and identified any risks associated with concerns around the arrangementsquarterly Unify CCG Yes/No 1 CCG Has the CCG self assessed and identified any risks associated with concerns around being an active paquarterly Unify CCG Yes/No 1 CCG If there was an emergency event in the last quarter, has the CCG self assessed and identified any areaquarterly Unify CCG Yes/No 1 CCG Has the CCG self assessed and identified any risk to progress against its Winterbourne View action plaquarterly Unify CCG Yes/No For Support/Intervention: Any Yes or Enforcement Action Domain 1 RAG Criteria Green - all 'No' responses Amber-Green - One or more 'Yes - Action in place' Amber-Red - One or more 'Yes - No action in place' Red - One or more 'Yes - Enforcement action' Indicator not part of the domain rating but pulls to the Support/Intervention tab if No Referral to Treatment waiting times for non urgent consultant led treatment Admitted patients to start treatment within a maximum of 18 weeks from referral Numerator: Total number of completed admitted pathways where the patient waited 18 weeks or less Denominator: Total number of completed admitted pathways RTT collection, Unify 90% AMBER: between 85% and 90% RED: less than 85% Referral to Treatment waiting times for non urgent consultant led treatment Non-admitted patients to start treatment within a maximum of 18 weeks from referral Numerator: Total number of completed non-admitted pathways where the patient waited 18 weeks or less Denominator: Total number of completed non-admitted pathways RTT collection, Unify 95% AMBER: between 90% and 95% RED: less than 90% Referral to Treatment waiting times for non urgent consultant led treatment Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more Numerator: Total number of incomplete pathways where the patient was still waiting 18 weeks or less Denominator: The total number of incomplete pathways at the end of the period RTT collection, Unify 9% AMBER: between 87% and 9% RED: less than 87% Referral to Treatment waiting times for non urgent consultant led treatment Diagnostic test waiting times A&E waits Number of patients waiting more than 5 weeks Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A & E department Numerator: Total number of incomplete pathways where the patient was still waiting 5 weeks or more Numerator: The number of patients waiting 6 weeks or more for a diagnostic test (15 key diagnostic tests) at the end of the period Denominator: The total number of patients waiting at the end of the period Numerator: The number of patients spending four hours or less in all types of A&E departments Denominator: The total number of patients attending all types of A&E departments Weekly Last month in the quarter Last month in the quarter RTT collection, Unify Diagnostics collection (DM01), Unify SitReps collection, Unify Provider GREEN: is Zero AMBER: 10 or fewer RED: more than 10 GREEN: lessor equal to 1% AMBER: between 1% and 6% RED: greater than 6% 95% AMBER: between 90% and 95% RED: less than 90% Data not collected on a commissi basis. But the performance of the 1st three providers in Domain will be used instead. Cancer patients - wk waits Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP Numerator: Patients urgently referred with suspected cancer by their GP (GMP or GDP) who were first seen within 14 calendar days within a period Quarterly Denominator: All patients urgently referred with suspected cancer by their GP (GMP or GDP) who were first seen within a period Cancer waits database 9% AMBER: between 88% and 9% RED: less than 9% Cancer patients - wk waits Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) Numerator: Patients urgently referred for evaluation/investigation of "breast symptoms" by a primary or secondary care professional during a period (excluding those referred urgently for suspected breast cancer) who were first seen within 14 calendar days during the period Denominator: All patients urgently referred for evaluation/investigation of "breast symptoms" by a primary or secondary care professional within a period, excluding those referred urgently for suspected breast cancer who were first seen within the period rterlyqua Cancer waits database 9% AMBER: between 88% and 9% RED: less than 9% Cancer waits - 1 days Maximum one month (1 day) wait from diagnosis to first definitive treatment for all cancers Numerator: Number of patients receiving first definitive treatment for cancer within 1 days of receiving a diagnosis (decision to treat) within a given period for all cancers (ICD-10 C00 to C97 and D05) Denominator: Total number of patients receiving first definitive treatment for cancer within a given period for all cancers (ICD-10 C00 to C97 and D05) Quarterly Cancer waits database 96% AMBER: between 91% and 96% RED: less than 91% Cancer waits - 1 days Maximum 1 day wait for subsequent treatment where that treatment is surgery Numerator: Number of patients receiving subsequent surgery within a maximum waiting time of 1-days during a given period, including patients with recurrent cancer Denominator: Total number of patients receiving subsequent surgery within a given period, including patients with recurrent cancer Quarterly Cancer waits database 94% AMBER: between 89% and 94% RED: less than 89% Cancer waits - 1 days Maximum 1 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen Numerator: Number of patients receiving a subsequent/adjuvant anti-cancer drug regimen within a maximum waiting time of 1-days during a given period, including patients with recurrent cancer Denominator: Total number of patients receiving a subsequent/adjuvant anti-cancer drug regimen within a given period, including patients with recurrent cancer Quarterly Cancer waits database 98% AMBER: between 9% and 98% RED: less than 9% Cancer waits - 1 days Maximum 1 day wait for subsequent treatment where the treatment is a course of radiotherapy Numerator: Number of patients receiving subsequent /adjuvant radiotherapy treatment within a maximum waiting time of 1-days during a given period, including patients with recurrent cancer Denominator: Total number of patients receiving subsequent/adjuvant radiotherapy treatment within a given period, including patients with recurrent cancer Quarterly Cancer waits database 94% AMBER: between 89% and 94% RED: less than 89%

15 Domain Category Indicator Indicator Detail (incl. Numerator and Denominator where applicable) Freq Period Data Source Basis RAG Criteria Comments Cancer waits - 6 days Maximum two month (6 day) wait from urgent GP referral to first definitive treatment for cancer Numerator: Number of patients receiving first definitive treatment for cancer within 6-days following an urgent GP (GDP or GMP) referral for suspected cancer within a given period, for all cancers (ICD-10 C00 to C97 abd D05) Denominator: Total number of patients receiving first definitive treatment for cancer following an urgent GP (GDP or GMP) referral for suspected cancer within a given period, for all cancers (ICD-10 C00 to C97 abd D05) Quarterly Cancer waits database 85% AMBER: between 80% and 85% RED: less than 80% Cancer waits - 6 days Maximum 6 day wait from referral from an NHS screening service to first definitive treatment for all cancers Numerator: Number of patients receiving first definitive treatment for cancer within 6-days following referral from an NHS Cancer Screening Service during a given period (covers any cancer ICD-10 C00 to C97 and D05) Denominator: Total number of patients receiving first definitive treatment for cancer following referral from an NHS Cancer Screening Service within a given period (covers any cancer ICD-10 C00 to C97 and D05) Quarterly Cancer waits database 90% AMBER: between 85% and 90% RED: less than 85% Cancer waits - 6 days Maximum 6 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patient (all cancers) Quarterly Cancer waits database No threshold Category A Ambulance calls Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) Numerator: The total number of Category A (Red 1) incidents, which resulted in an emergency response arriving at the scene of the incident within 8 minutes Denominator: The total number of Category A (Red 1) incidents, which resulted in an emergency response arriving at the scene AmbSys collection, Unify Provider 75% AMBER: between 70% and 75% RED: less than 70% Data not collected on a commissi basis. CCGs will be allocated the overall performance of the Ambulance Trust that they are covered by. Category A Ambulance calls Category A calls resulting in an emergency response arriving within 8 minutes (Red ) Numerator: The total number of Category A (Red ) incidents, which resulted in an emergency response arriving at the scene of the incident within 8 minutes Denominator: The total number of Category A (Red ) incidents, which resulted in an emergency response arriving at the scene AmbSys collection, Unify Provider 75% AMBER: between 70% and 75% RED: less than 70% Data not collected on a commissi basis. CCGs will be allocated the overall performance of the Ambulance Trust that they are covered by. Category A Ambulance calls Category A calls resulting in an ambulance arriving at the scene within 19 minutes Numerator: The total number of calls resulting in an ambulance arriving at the scene of the incident within 19 minutes Denominator: The total number of Category A incidents with ambulance response arriving AmbSys collection, Unify Provider 95% AMBER: between 90% and 95% RED: less than 90% Data not collected on a commissi basis. CCGs will be allocated the overall performance of the Ambulance Trust that they are covered by. Mixed sex accommodation breaches Minimise breaches Numerator: The number of MSA breaches for the reporting month in question Cancelled operations All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 8 days, or the patient's treatment to be funded at the time and hospital of the patient's choice MSA collection, Unify GREEN = zero Amber = 10 or fewer breaches RED = more than 10 breaches (Not rated) The threshold is the last Month of the Quarter Data not collected on a commissi basis and cannot be mapped to CCG. Mental Health Care Programme Approach (CPA): The proportion of people under adult mntal illness specialities on CPA Numerator: The number of people under adult mental illness specialities on Care Programme Approach receiving follow up (by phone or face to face contact) within seven days of discharge from psychiatric in-patient care during the reference period Denominator: The number of people under adult mental illness specialities on Care Programme Approach discharged from psychiatric in-patient care during the reference period Quarterly MH Community Teams Activity Return 95% AMBER: between 90% and 95% RED: less than 90% Future Concerns Quarterly CCG Domain RAG Criteria Green - No indicators rated Red Amber-Green - No indicators rated Red but future concerns Amber-Red - One indicator rated Red Red - Two or more indicators rated Red Potential years of life lost (PYLL) from causes considered amenable to health care expressed as a rate per 100,000 population. Green: Yes Red: No Yes triggers the overall domain Rating to Amber Green, while No has no effect Preventing people from dying prematurely Potential years of life lost (PYLL) from causes considered amendable to healthcare The PYLL rate uses the average age-specific period life expectancy for each five-year age band for the relevant calendar year as the age to which a person in that age band who died from one of the amenable causes might have been expected to live in the presence of timely and effective health care. the age-specific period life expectancy is different from each calendar year, and will be published at alongside the data. These age-specific life expectancies are used to weight the number of deaths in that age band to give the number of years of life lost for that age band. Annual Assurance only ONS mortality and population estimates Data will not be used for Quarterly Reporting 011 mortality data were released in November 01. The ONS Statistical Bulletin on avoidable mortality for 011 will be published in March 01. Mid-year population estimates for 011 were released in September 01. Preventing people from dying prematurely Under 75 mortality rate from cardiovascular disease Data will not be used for Quarterly Reporting Preventing people from dying prematurely Under 75 mortality rate from respiratory disease Data will not be used for Quarterly Reporting Preventing people from dying prematurely Under 75 mortality rate from liver disease Data will not be used for Quarterly Reporting Preventing people from dying prematurely Under 75 mortality rate from cancer Data will not be used for Quarterly Reporting Enhancing quality of life for people with long term conditions Enhancing quality of life for people with long term conditions Enhancing quality of life for people with long term conditions Enhancing quality of life for people with long term conditions Enhancing quality of life for people with long term conditions Health-related quality of life for people with long-term conditions Proportion of people feeling supported to manage their condition Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adult) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Estimated diagnosis rate for people with dementia The measure is the proportion of persons admitted to hospital for conditions aggregated across the four indicators, expressed as a rate per 100,000 population. The NHS Outcome Framework contains four indicators measuring emergency admissions for those conditions (sometimes referred to as 'ambulatory care sensitive conditions') that could usually have been avoided through HES reports provisional data monthly, annual data by financial year is available in the autumn/win ter after the Quarterly and annual assurance HES, ONS population estimates Not used for Q1 assessment See indicator CB_A6 in Everyone Counts: Planning for Patients 01/14 - Technical Definitions for further details, including

16 Domain Category Indicator Helping people to recover Emergency admissions for acute from ill health or following conditions that should not usually injury require hospital admission Helping people to recover Emergency readmissions within 0 days from ill health or following of discharge from hospital injury Helping people to recover from ill health or following injury Total health gain assessed by patients i) Hip replacement, ii) Knee replacement, iii) Groin hernia, iv) Vericose veins Indicator Detail (incl. Numerator and Denominator where applicable) better management in primary or community care. These are indicators.i and.ii focusing on chronic (i.e. long term) conditions and indicators a and. focusing on acute conditions. For the purpose of the quality premium these complementary measures are being combined to crease a single composite measure. Freq Period ter after the end of the period. ONS population estimates available annually (calendar year). assurance Data Source estimates Basis RAG Criteria Comments details of the ICD-10 codes included in this measure. Helping people to recover Emergency admissions for children with from ill health or following Lower Respiratory Tract Infections (LRTI) injury Ensuring that people have a positive experience of care Ensuring that people have a positive experience of care Patient experience of primary care i) GP Services, ii) GP Out of Hours services Patient experience of hospital care Not used for Q1 assessment Not used for Q1 assessment Ensuring that people have a positive experience of care Friends and Family Test The Family and Friends Test is a simple, comparable test which, when combined with follow-up questions, providers a mechanism to identify poor performance and encourage staff to make improvements where services do not live up to the expectations of patients. this leads to a more positive experience of care for patients. Patients will be asked a standard question at the point of discharge from hospital. They will be asked to record a response against a six point scale: Extremely likely/likely/neither likely or unlikely/unlikely/extremely Unlikely/Don't know. The comparability of the data (through the use of a standardised questions and methodology) will allow commissis to understand overarching levels of patient experience for the services that they commission. (from April 01 for inpatient wards and A&E department s, and from October 01 for maternity services) Quarterly and annual assurance FFT collection, Unify Not used for Q1 assessment instead the Self cert question is used - "Are providers (defined in Domain 1) meeting the 15% response rates on FFT?" Green: Yes Red: No Not part of the overall domain scoring but if 'No' pulls into the support/intervention tab. Treating and caring for people in a safe environment an protecting them from avoidable harm Treating and caring for people in a safe environment an protecting them from avoidable harm Incidence of healthcare associated infection (HCAI) i) MRSA Incidence of healthcare associated infection (HCAI) i) C difficile The total number of MRSA cases assigned to CCGs The total number of C. difficile cases assigned to CCGs Quarterly and annual assurance Quarterly and annual assurance Public Health England Public Health England GREEN = 0 cases RED: Greater than Zero GREEN: less or equal to target RED: greater than target Others IAPT Coverage - performance against plan The primary purpose of this indicator is to measure improved access to psychological services (IAPS) for people with depression and/or anxiety disorders. This is done using two indicators: 1) The proportion of people that enter treatment against the level of need in the general population (the level of prevalence addressed or 'captured' by referral routs); and ) The proportion of people who complete treatment who are moving to recovery. Quarterly Quarterly assurance only Omnibus returns, NHSIC IAPT rated red/green against the yes/no self assessment answers Not part of the overall domain scoring but if 'No' pulls into the support/intervention tab. Local priorities Local Priority 1 Local priorities Local Priority Green: Yes Red: No Green: Yes Red: No Not part of the overall domain scoring but if 'No' pulls into the support/intervention tab. Local priorities Local Priority Green: Yes Red: No Domain - RAG rating Green:- No indicators rated Red Amber-Green: one indicator rating amber and one green Amber-Red: - Two indicator rated Amber Red or one rated red Red:- Two or more indicators rated Red 4 Financial Performance Underlying recurrent surplus 4 Financial Performance Surplus - year to date performance Unify 4 Financial Performance Surplus - full year forecast Unify 4 Financial Performance Management of % NR funds within agreed processes 4 Financial Performance QIPP** - year to date delivery Unify Unify Finance Team Finance Team Finance Team Finance Team RAG rated by Finance Team through the Unify collection and part of the overall Domain calculation 4 Financial Performance QIPP** - full year forecast Unify Finance Team 4 Financial Performance Activity trends - year to date 4 Financial Performance Activity trends - full year forecast 4 Financial Performance Running costs Unify 4 Financial Performance Clear identification of risks against financial delivery and mitigations Unify Finance Team Finance Team RAG rated by Finance Team through the Unify collection and part of the overall Domain calculation 4 Financial Management This covers internal and external audit opinions, and an assessment of the timeliness and quality of returns Unify CCG Collected through the CCG Self Cert Collection 4 Financial Management Balance sheet indicators including cash management and BPCC Domain 4 - RAG rating Green - No indicators rated Red Amber-Green - <= primary indicator are amber-red Amber-Red - One indicator rated Red or > are amber-red Red - Two or more indicators rated Red

17 NHS Merton CCG Domain 1 - Are local people getting good quality care? Please note that this Domain will be pre-populated through the self-certification carried out by the CCG PROV1 PROV PROV PROV4 PROV5 PROV6 PROV7 PROV8 PROV9 PROV10 EPSOM AND ST SOUTH WEST THE ROYAL KINGSTON HELIER UNIVERSITY LONDON AND ST MARSDEN NHS HOSPITAL NHS HOSPITALS NHS GEORGE'S MENTAL FOUNDATION TRUST No Provider No Provider No Provider No Provider No Provider ST GEORGE'S HEALTHCARE NHS TRUST Indicator Providers (where CCG commissioning constitutes more than 5% of the providers income) : RJ7 RVR RQY RPY RAX No Provider No Provider No Provider No Provider No Provider Please identify the percentage of provider income for CCG: No Provider No Provider No Provider No Provider No Provider Is this CCG the lead or associate commissi? Associate Associate Associate Associate Associate No Provider No Provider No Provider No Provider No Provider Has local provider been subject to local enforcement action by the CQC? No No No No No No Provider No Provider No Provider No Provider No Provider Has local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider licence conditions? No No No No No No Provider No Provider No Provider No Provider No Provider Has local provider been subject to enforcement action by the NHS TDA based on 'quality' risk? No No No No No No Provider No Provider No Provider No Provider No Provider Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern? No No No No Yes Action plan in place No Provider No Provider No Provider No Provider No Provider Has the provider been identified as a 'negative outlier' on SMHI or HSMR? No No No No No No Provider No Provider No Provider No Provider No Provider Do provider level indicators from the National Quality Dashboard show that MRSA cases are above zero? Yes Action plan in place Yes Action plan in place No Yes Action plan in place No No Provider No Provider No Provider No Provider No Provider Do provider level indicators from the National Quality Dashboard show that the provider has reported more C difficile cases than Yes Action plan trajectory? Yes Action plan in place No No No in place No Provider No Provider No Provider No Provider No Provider Do provider level indicators from the National Quality Dashboard show that MSA breaches are above zero? Yes Action plan in place Yes Action plan in place No No No No Provider No Provider No Provider No Provider No Provider Does provider currently have any unclosed Serious Untoward Incidents (SUIs)? Yes Action plan in place No No Yes Action plan in place No No Provider No Provider No Provider No Provider No Provider Has the provider experienced any 'Never Events' during the last quarter? No Yes Action plan in place No No Yes Action plan in place No Provider No Provider No Provider No Provider No Provider CCG: Clinical Governance Concerns about quality issues being discussed regularly by the CCG governing body Has the CCG self-assessed and identified any risks associated with the following: Concerns about the arrangements in place to proactively identify early warnings of a failing service Concerns around the arrangements in place to deal with and learn from serious untoward incidents and never events? Concerns around being an active participant in its Quality Surveillance Group? EPRR If there was an emergency event in the last quarter, has the CCG self assessed and identified any areas of concern on the arrangements in place for dealing with such an event? Winterbourne View Has the CCG self assessed and identified any risk to progress against its Winterbourne View action plan? Domain 1 Status Domain 1 - RAG Criteria No No No No No No AMBER-GREEN 0 Please select option Yes - Action plan in place Self-certification complete

18 Domain - Are patient rights under the NHS Constitution being promoted? Indicator Referral to Treatment waiting times for non urgent Admitted patients to start treatment within a maximum of 18 weeks from referral Non-admitted patients to start treatment within a maximum of 18 weeks from referral Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more NHS Merton CCG Operational Standard Lower Threshold Current QTD Performance YTD Performance 90% 85% 9.64% 9.64% 95% 90% 97.0% 97.0% 9% 87% 95.5% 95.5% Number of patients waiting more than 5 weeks Diagnostic test waiting times Percentage of Patients waiting 6 weeks or more for a diagnostic test A & E waits 1% 6% 0.14% 0.14% 1-14 Q1-14 YTD Q1 [Provider 1]Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department [Provider ]Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department [Provider ]Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department Cancer patients - week wait Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) Cancer waits - 1 days Maximum one month (1 day) wait from diagnosis to first definitive treatment for all cancers Maximum 1 day wait for subsequent treatment where that treatment is surgery Maximum 1 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen Maximum 1 day wait for subsequent treatment where the treatment is a course of radiotherapy Cancer waits - 6 days Maximum two month (6 day) wait from urgent GP referral to first definitive treatment for cancer Maximum 6 day wait from referral from an NHS screening service to first definitive treatment for all cancers 95% 90% 95.55% 95.55% 95% 90% 95.5% 95.5% 95% 90% 0.00% 0.00% 9% 88% 97.81% 97.81% 9% 88% 97.08% 97.08% 96% 91% 98.68% 98.68% 94% 89% 9.% 9.% 98% 9% % % 94% 89% 98.41% 98.41% 85% 80% 87.50% 87.50% 90% 85% % % ST GEORGE'S HEALTHCARE NHS TRUST EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST SOUTH WEST LONDON AND ST GEORGE'S MENTAL HEALTH NHS TRUST Maximum 6 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers) Category A ambulance calls Category A calls resulting in an emergency reponse arriving within 8 minutes (Red 1) Category A calls resulting in an emergency reponse arriving within 8 minutes (Red ) Category A calls resulting in an ambulance arriving at the scene within 19 minutes Mixed sex accomodation breaches No operational No operational % % 75% 70% 77.66% 77.66% 75% 70% 78.55% 78.55% 95% 90% 98.4% 98.4% Minimise breaches Cancelled Operations All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding data within 8 days, or Not Rated Not Rated the patient's treatment to be funded at the time and hospital of the patient's choice Mental Health Care Programme Approach (CPA): The proportion of people under adult mental illness specialities on CPA who were followed up within 7 days of discharge from psychiatric in patient care during the period 95% 90% 95.65% 95.65% Future Concerns N Do you have any future concerns on any of the above measures Do you have any future concerns on any of the above measures? N N Lndn Amblnce AMBER-RED Please select Y/N Yes No Domain - Indicator RAG Criteria Domain - RAG Criteria

19 NHS Merton CCG Domain - Are health outcomes improving for local people? NHS Outcomes Framework measures which the NHS oning Board and CCGs will use in annual assurance as described in Annex A of Everyone Counts Q YTD Indicator Baseline position Current QTD Indicator Value YTD Indicator Value Unit 1. Preventing people from dying prematurely Indicator used in quarterly checkpoints Indicator included in Quality Premium Threshold Potential years of life lost (PYLL) from causes considered amendable to healthcare 0.0 No Yes To earn this portion of the quality premium, the potential years of life lost (adjusted for sex and age) from amenable mortality for a CCG population will need to reduce by at least.% between 01 and 014. This is based on the 10-year average annual reduction in potential yesars of life lost from amenable mortality. 0.0 Under 75 mortality rate from cardiovascular disease Under 75 mortality rate from respiratory disease 0.0 Under 75 mortality rate from liver disease 0.0 Under 75 mortality rate fro cancer 0.0. Enhancing quality of life for people with long term conditions Health-related quality of life for people with long-term conditions 0.8 Proportion of people feeling supported to manage their condition 0.4 Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adult) Annual Assurance indiciators only 0.0 Per 100,000 population Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Estimated diagnosis rate for people with dementia 0.6. Helping people to recover from ill health or following injury Emergency admissions for acute conditions that should not usually require hospital admission Emergency readmissions within 0 days of discharge from hospital 0.1 Total health gain assessed by patients i) Hip replacement, ii) Knee replacement, iii) Groin hernia, iv) Vericose veins 0.8 Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) Ensuring that people have a positive experience of care Patient experience of primary care i) GP Services, ii) GP Out of Hours services Patient experience of hospital care 0.0 Per 100,000 population Per 100,000 population No. of individuals receiving the procedures multiplied by the assessed average risk-adjusted improvement in health status 0.0 Per 100,000 population 0.0 Combined measure: Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults), Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, Emergency admissions for acute conditions that should not usually require hospital admission. Emergency admissions for children with LRTI, Emergency readmissions within 0 days of discharge from hospital. Combined measure: Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults), Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, Emergency admissions for acute conditions that should not usually require hospital admission. Emergency admissions for children with LRTI, Emergency readmissions within 0 days of discharge from hospital. To earn this position of the quality premium, there will need t be a reduction or a zero percent change in emergency admissions for these conditions for a CCG population between 01/1 and 01/14. NHS England may apply an adjustment for CCGs with the highest baseline levesl of emergency admissions. Friends and Family Test An improvement in average FFT scores for acute inpatient care and A&E services between Q for acute hospitalsthat serve a CCG population Score out of 100 Yes Yes 5. Treating and caring for people in a safe environment an protecting them from avoidable harm Incidence of healthcare associated infection (HCAI) i) MRSA Number of Cases Yes Yes To earn this portion of the quality premium, there will need to be: 1) assurance that all relevant local providers of services commissioned by a CCG have delivered the nationally agreed roll-out plan to the national timetable ) an improvement in average FFT scores for acute inpatient care and A&E services between Q1 014/15 for acute hospitals that serve a CCG's population A CCG will earn this position of the quality premium if there are no cases of MRSA bacteraemia for the CCG's population. Incidence of healthcare associated infection (HCAI) i) C difficile 6. Others Are providers (defined in Domain 1) meeting the 15% response rates on FFT? Is the CCG progressing as expected in the IAPT tragectory submitted during the planning round? Local priorities (Self-Certification) LOCAL PRIORITY Number of Cases Yes Yes 0 Yes No No 0 Yes No Are you on track to deliver against this local priority? Yes A CCG will earn this position of the quality premium if C. difficile cases are at or below defined thresholds for CCG's. "To earn this portion of the quality premium, there will need to be: 1) assurance that all relevant local providers of services commissioned by a CCG have delivered the nationally agreed roll-out plan to the national timetable ) an improvement in average FFT scores for acute inpatient LOCAL PRIORITY LOCAL PRIORITY Further development required Further development required Domain Status Domain - RAG rating GREEN Self-certification complete

20 NHS Merton CCG June Financial Performance No. Indicator 1 Undelying recurrent surplus Primary Domain 4 - Are CCGs delivering services within their financial plans? Primary/Supporting Indicator 01/14 Q1 Performance Individual indicator RAG rating threshold Green Amber-Green Amber-Red Red >= % 1% % 0% % < 0% Surplus - year to date performance Primary Variance <= 0.1% 0.1% > variance <= 0.5% 0.5% > variance < 0.5% Variance => 0.5% G Surplus - full year forecast Primary Variance <= 0.1% 0.1% > variance <= 0.5% 0.5% > variance < 0.5% Variance => 0.5% G 4 Management of % NR funds within agreed Supporting G Yes No 5 QIPP** - year to date delivery Primary AG >= 95% of plan >= 80% of plan >= 50% of plan < 50% of plan 6 QIPP** - full year forecast Primary G >= 95% of plan >= 80% of plan >= 50% of plan < 50% of plan 7 Activity trends - year to date Supporting < 101% of plan < 10% of plan < 10% of plan >= 10% of plan 8 Activity trends - full year forecast Supporting < 101% of plan < 10% of plan < 10% of plan >= 10% of plan 9 Running costs Primary G <= RCA > RCA Indicator met in full Indicator partially met - Indicator partially met - Indicator not met Clear Identifications of risks against financial 10 Primary limited uncovered risk material uncovered risk delivery and mitigations G **QIPP to include transactional and transformational schemes Financial Management (Self-Certification) No. Indicator 11 1 Assessment of internal and external audit opinions and on the timeliness and quality of returns Balance sheet indicators including performance against planned Cash Limit and BPPC performance Primary/Supporting Indicator Supporting Supporting Overiding rule: Qualified audit opinion would lead to an overall RED rating 01/14 Q1 Performance G Q Board satisfied Self-certification incomplete Individual indicator RAG rating threshold Green Amber-Green Amber-Red Red No non-satisfactory audit reports in relation to finance related systems and processes and all finance returns submited on time and of One or two non-satisfactory audit reports in relation to finance related systems and processes and/or finance returns sometimes submited late and/or of a A number of nonsatisfactory audit reports in relation to finance related systems and processes and/or finance returns often submited Significant number of nonsatisfactory audit reports in relation to finance related systems and processes and/or finance returns consistently To be defined To be defined To be defined To be defined Domain 4 Status AMBER-GREEN Domain 4 - RAG rating

21 Please select Domain 5 - Are conditions of CCG authorisation being addressed and removed (where relevant)? Londo CCG: NHS Merton CCG Q _June Domain 1: A strong clinical and multi-professional focus which brings real added value Total number of outstanding conditions in Domain 1 Quality is at the heart of governance, decision-making and planning arrangements, with examples of CCGs delivering local quality improvements. Member practices are involved in making and implementing decisions, and views and input are sought, heard and valued from a range of professionals across all providers, not just GPs. Domain : Meaningful engagement with patients, carers and their communities CCG is an active member of its Health and Wellbeing Board, and sees engagement with patients, carers and members of the public and developing an open and transparent culture, as intrinsic to what it does. Examples of how CCG systematically monitors and acts on patient feedback, particularly in identifying quality issues. Domain : Clear and credible plans which continue to deliver the QIPP challenge within financial resources, in line with national requirements (including excellent outcomes) and local joint health and wellbeing strategies Total number of outstanding conditionsin Domain Total number of outstanding conditions in Domain 0 0 CCG has detailed financial plan that delivers against the financial business rules, sets out how it will manage within its management allowance and is integrated with its commissioning plan, and CCG can demonstrate progress and delivery against its plan. There are ongoing discussions between CCG, its neighbouring CCGs and provider organisations about long-term strategy and plans, and member practices understand their local plans and priorities and are engaged in their delivery. 0 Domain 4: Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and resposibilities including financial control, as well as effectively commission all the services for which they are responsible a) ability to manage all aspects of quality b) ability to commission the full range of services c) use of information to deliver an open and transparent culture d) financial control and capacity Total number of outstanding conditions in Domain 4 0 Domain 5: Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS CB, as well as apporpriate external commissioning support Total number of outstanding conditions in Domain 5 CCG has deep collaborative ties to their local authority, clinical senates and area teams, with shared governance of joint comissioning with area teams and, where relevant, strong integrated commissioning with their local authority partner. The CCG has developed a strong and insightful working partnership with their local Health and Wellbeing Board. CCG has contract in place with an assured commissioning support services provider, and can articulate clear plans for its commissioning support services between 01 and 016. Domain 6: Great leaders who individually and collectively can make a real difference Total number of outstanding conditions 0 CCG has individual and collective leadership who demonstrate commitment to partnership working and have the necessary skillset to lead commissioning and drive transformational change. Distributed leadership throughout the culture of the CCG and the governing body means that there is extensive engagement and communication across practices, with effectie processes for two-way accountability in use. 0 Total number of outstanding conditions 0

22 CCG Assurance Balanced Scorecard - Proposed Escalation Framework Note: The support and intervention rules should not delay or prevent a CCG as a commissi from taking action to intervene in a provider if there are significant quality concerns. It should also not prevent NHS England from taking intervention action where the CCG cannot demonstrate the capacity to swiftly address quality concerns.

23 Intervention should not be considered lightly and the threshold for use should be high. CCG Support/Intervention Discussion (by Domain & Indicator) Area Team London CCG: NHS Merton CCG For each Red or Amber- Red Domain, Area Teams must to fill in additional questions highlighted in yellow below. For each Green or Amber Green Domain, Area Teams may fill in additional questions highlighted in yellow, if proactive support is felt to be appropriate. DOMAIN 1 RAG STATUS For each Green or Amber Green Domain, Area Teams may fill in additional questions highlighted in yellow, if proactive support is felt to be to be appropriate AMBER-GREEN THE NUMBER OF INDICATORS TRIGGERING AMBER-GREEN 10 Assurance questions MUST BE DISCUSSED AT CHECKPOINT MEETINGS FOR ALL R/AR DOMAINS Indicator that has been breached ST GEORGE'S HEALTHCARE NHS TRUST EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST SOUTH WEST LONDON AND ST GEORGE'S MENTAL HEALTH NHS TRUST THE ROYAL MARSDEN NHS FOUNDATION TRUST KINGSTON HOSPITAL NHS TRUST Does the CCG and Area team agree on the underlying cause/s? Is there an agreed plan for action/recovery Has a timeline for improvement been agreed? Support/Interven tion agreed Has local provider been subject to local enforcement action by the CQC? FALSE FALSE FALSE FALSE FALSE Has local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider licence conditions? FALSE FALSE FALSE FALSE FALSE Has local provider been subject to enforcement action by the NHS TDA based on 'quality' risk? FALSE FALSE FALSE FALSE FALSE Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern? FALSE FALSE FALSE FALSE Yes - Action plan in place Has the provider been identified as a 'negative outlier' on SMHI or HSMR? Do provider level indicators from the National Quality Dashboard show that MRSA cases are above zero? Yes - Action plan in place FALSE FALSE FALSE FALSE FALSE Yes - Action plan in place FALSE Yes - Action plan in place FALSE Please Select Do provider level indicators from the National Quality Dashboard show that the provider has reported more C difficile cases than trajectory? Yes - Action plan in place FALSE FALSE FALSE Yes - Action plan in place Do provider level indicators from the National Quality Dashboard show that MSA breaches are above zero? Does provider currently have any unclosed Serious Untoward Incidents (SUIs)? Yes - Action plan in place Yes - Action plan in place FALSE FALSE FALSE Yes - Action plan in place FALSE FALSE Yes - Action plan in place FALSE Has the provider experienced any 'Never Events' during the last quarter? FALSE Yes - Action plan in place FALSE FALSE Yes - Action plan in place CCG: Concerns about quality issues being discussed regularly by the CCG governing body FALSE Concerns about the arrangements in place to proactively identify early warnings of a failing service FALSE Concerns around the arrangements in place to deal with and learn from serious untoward incidents and never events? FALSE Please Select Concerns around being an active participant in its Quality Surveillance Group? FALSE If there was an emergency event in the last quarter, has the CCG self assessed and identified any areas of concern on the arrangements in place for dealing with such an event? FALSE Has the CCG self assessed and identified any risk to progress against its Winterbourne View action plan? FALSE Yes No action plan in place Yes Enforcement Action DOMAIN For each Green or Amber Green Domain, Area Teams may fill in additional questions highlighted in yellow, if proactive support is felt to be to be appropriate Yes Action plan in place RAG STATUS AMBER-RED THE NUMBER OF INDICATORS TRIGGERING AMBER-RED 1 RED Y Indicator that has been breached Does the CCG and Area team agree on the underlying cause/s? Is there an agreed plan for action/recovery? Has a timeline for improvement been agreed? Has Support/Intervention been agreed Please Select Minimise breaches DOMAIN RAG STATUS For each Green or Amber Green Domain, Area Teams may fill in additional questions highlighted in yellow, if proactive support is felt to be to be appropriate GREEN ALL INDICATOR MET 0 Indicator that has been breached Does the CCG and Area team agree on the underlying cause/s? Is there an agreed plan for action/recovery? Has a timeline for improvement been agreed? Has Support/Intervention been agreed Are providers (defined in Domain 1) meeting the 15% response rates on FFT? IAPT Coverage - Moving to Recovery Please Select DOMAIN 4 For each Green or Amber Green Domain, Area Teams may fill in additional questions highlighted in yellow, if proactive support is felt to be to be appropriate RAG STATUS AMBER-GREEN THE NUMBER OF INDICATORS TRIGGERING AMBER-GREEN 0 Indicator that has been breached Does the CCG and Area team agree on the underlying cause/s? Is there an agreed plan for action/recovery? Has a timeline for improvement been agreed? Has Support/Intervention been agreed Please Select