Kingston Clinical Commissioning Group Report Summary

Transcription

1 Kingston Clinical Commissioning Group Report Summary Meeting Title Governing Body in public Date 6 th March 2018 Report Title Integrated Governance Report Agenda Item 11 Attachment F Purpose (please indicate with X) Approval/ Ratification Discussion / Comment X Information X Report Author: (name & job title) Brian Roberts Performance and Information Lead Presented by: (name & job title) Tonia Michaelides Managing Director Kingston & Richmond CCGs Summary and purpose of report This report contains the month 08 performance report from South West London and also includes feedback from the 16 th January 2018 and the 20 th February 2018 meetings of the Kingston CCG Integrated Governance Committee, and contains a summary of the latest Performance Assurance Report, the Quarter Improvement and Assessment (IAF) Dashboard, the year to date QIPP position and the draft Quality Premium position. Key sections for particular note NHS England monitors the performance of CCGs using the following Constitutional Standards: 1. Dementia Diagnosis Rate 2. Referral to Treatment (18 Weeks) and Diagnostics 3. Access to Cancer Services 4. Mixed Sex Accommodation breaches 5. Mental Health/ Improving access to Psychological Therapies (IAPT) 6. Health Outcome Frameworks (MRSA and C Difficile Breaches) 7. Urgent Care (A&E and Ambulance Response Times) 8. Cancelled Operations The performance scorecard focuses on these targets. The 2 main areas of concern are the Dementia Diagnosis rate and A&E waiting times. Report recommendation The Governing Body is asked to note this report. Financial and / or resource implications There is a financial implication regarding the Quality Premium and QIPP Delivery. Version: Final F - 1 Date:

2 Key risks identified & mitigation As per report Equality and / or privacy impact analysis Not applicable. Committees that have previously discussed / agreed the report and outcomes The Kingston CCG Integrated Governance Committee has previously discussed / agreed the report and outcomes. Communication plan / stakeholder involvement / patient engagement Not applicable. Assurance Not applicable. CORPORATE OBJECTIVES Please indicate below all the categories which the paper provides evidence for: 1. Better Health 2. Better Care 3. Sustainability 4. Leadership 5. Engagement Version: Final F - 2 Date:

3 Highlight Constitutional Standards South West London Performance Highlight Report Month 8 page 2 A&E -4 hour standard page 3 Referral to Treatment (RTT) 18 week Incomplete page 4 Cancer Waiting Times Two week wait (2WW) & 62 Day page 5 Diagnostics waits For: South West London Senior Management Team page 6 Ambulance Handovers- London Ambulance Service (LAS) page 7 NHS 111 service page 8 Improving Access to Psychological Therapies (IAPT) page 9 Dementia and Mental Health Sponsor: Director of Commissioning Operations, South West London Alliance Author: NELCSU / SW London Performance Management & Pressure Surge Team Version: FINAL /02/2018 page 10 Delayed Transfers of Care (DTOCs) page 11 Glossary page 12

4 Highlight Constitutional Standards (By CCG) A&E- All Type (4 hour standard By CCG) CCG Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Croydon 87.53% 84.86% 84.96% 85.25% 86.58% 88.57% 90.83% 90.48% 88.57% 90.07% 90.64% 93.57% 91.93% 88.60% Kingston 89.33% 87.22% 84.31% 88.25% 91.19% 91.10% 89.90% 91.01% 93.11% 91.75% 92.10% 92.60% 90.04% 87.05% Merton 93.31% 90.06% 88.34% 91.30% 90.93% 91.69% 91.33% 92.67% 91.54% 91.24% 91.69% 90.41% 89.62% 86.95% Richmond 91.78% 89.87% 88.01% 91.13% 92.56% 93.55% 92.39% 93.87% 94.77% 94.11% 93.60% 94.12% 93.08% 91.39% Sutton 95.22% 93.47% 93.73% 94.56% 95.52% 94.59% 94.97% 94.67% 94.56% 93.50% 94.68% 93.29% 93.28% 89.87% Wandsworth 91.57% 88.36% 86.34% 89.99% 89.33% 91.01% 90.10% 92.38% 91.02% 91.30% 90.96% 90.02% 89.24% 87.39% Data has been mapped from providers to CCGs using a mapping derived from Hospital Episode Statistics figures. This calculates what proportion of each provider can be attributed to a given CCG. Cancer- 62 day GP referral CCG Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Croydon 77.27% 88.68% 80.33% 84.00% 90.80% 86.79% 81.58% 89.04% 82.56% 84.62% 79.45% 78.67% 90.41% Plan 85.92% 85.92% 85.92% 85.92% 85.92% 86.44% 85.51% 86.11% 85.51% 86.11% 85.51% 86.11% 86.11% Kingston 87.10% 87.88% 85.71% 88.24% 91.30% 92.31% 100% 86.84% 92.59% 85.29% 87.50% 86.11% 82.93% Plan 88.00% 87.50% 88.46% 87.50% 88.46% 88.46% 86.67% 87.10% 86.67% 87.10% 86.67% 87.10% 87.10% Merton 86.67% 79.31% 83.33% 80.00% 92.00% 95.24% 82.14% 88.89% 75.86% 85.71% 89.66% 83.87% 93.55% Plan 85.71% 85.19% 87.10% 87.50% 87.88% 88.46% 86.67% 87.50% 86.67% 87.50% 86.67% 87.50% 87.50% Richmond 100% 96.97% 96.30% 90.00% 83.33% 92.31% 90.91% 92.59% 87.80% 82.86% 92.86% 91.18% 93.75% Plan 85.71% 85.71% 85.71% 85.71% 85.71% 86.21% 85.29% 85.71% 85.29% 85.71% 85.29% 85.71% 85.71% Sutton 86.49% 85.71% 80.00% 88.89% 90.91% 90.00% 91.18% 84.85% 89.13% 74.19% 86.11% 85.71% 89.74% Plan 87.18% 87.18% 87.18% 87.18% 87.18% 86.67% 85.71% 86.49% 85.71% 86.49% 85.71% 86.49% 86.49% Wandsworth 80.56% 85.00% 82.35% 88.57% 81.25% 87.10% 75.56% 82.35% 75.00% 82.76% 83.33% 91.18% 84.38% Plan 85.00% 86.36% 85.71% 86.36% 86.84% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% Period: M8 2017/18 Report: Date: 30/01/ Week Referral to Treatment (RTT) - Incomplete Pathways Diagnostics- Waits over 6 Weeks CCG Level Narrative CCG level narratives have been provided for the four Constitutional Standards that receive the most focus. Further detail is provided in subsequent pages about Trust level performance and any associated key actions. Croydon CCG: The CCG continues to achieve RTT standard. The diagnostics standard has been achieved, both at CCG and CHS, for the third, consecutive month. The national A&E performance standard was not achieved at CHS with performance of 89.4% in December, below the operating plan trajectory of 94.8% for the month. Performance on Type 1 A&E attendance has declined. The CCG achieved all cancer performance standards in November, which included the recovery of the Cancer 62 day GP referral standard which had previously been achieved in June. CCG Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Croydon 91.70% 90.81% 90.93% 90.91% 91.46% 91.22% 91.70% 91.91% 92.19% 92.06% 92.18% 92.80% 92.87% Plan 92.00% 92.00% 92.01% 92.00% 92.00% 90.75% 90.76% 90.78% 90.79% 90.78% 90.81% 90.82% 90.82% Kingston 93.89% 94.18% 94.03% 94.35% 94.52% 94.21% 94.18% 93.84% 93.74% 93.30% 92.97% 93.03% 93.71% Plan 93.01% 93.01% 93.00% 93.00% 93.01% 92.01% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% Merton 92.59% 91.55% 91.89% 92.26% 92.56% 91.74% 91.97% 91.39% 91.16% 90.26% 90.08% 89.85% 89.79% Plan 91.88% 92.00% 92.04% 92.15% 92.41% 91.97% 91.97% 92.06% 92.07% 91.96% 92.09% 92.08% 92.08% Richmond 92.84% 92.83% 92.97% 92.93% 93.14% 92.42% 93.53% 93.77% 93.48% 92.44% 90.90% 91.39% 92.37% Plan 94.87% 94.87% 94.87% 94.87% 94.87% 92.03% 92.03% 92.02% 92.03% 92.02% 92.03% 92.02% 92.02% Sutton 92.82% 92.48% 92.54% 93.13% 93.30% 92.91% 92.99% 92.05% 91.98% 90.96% 90.69% 90.41% 91.33% Plan 92.15% 92.15% 92.15% 92.15% 92.15% 91.87% 91.88% 92.16% 92.16% 91.82% 92.24% 92.24% 92.24% Wandsworth 90.21% 89.31% 90.72% 91.36% 90.67% 89.90% 90.36% 90.08% 89.58% 89.02% 88.72% 88.71% 88.78% Plan 91.81% 91.96% 91.95% 92.08% 92.39% 92.04% 92.01% 92.00% 92.00% 92.01% 92.00% 92.00% 92.01% CCG Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Croydon 0.33% 0.68% 0.91% 2.42% 3.81% 5.74% 5.40% 4.10% 2.93% 1.60% 0.34% 0.44% 0.83% Plan 0.99% 1.00% 0.99% 0.99% 0.99% 0.94% 0.97% 0.98% 0.97% 0.98% 0.97% 0.98% 0.98% Kingston 0.36% 1.16% 1.27% 0.96% 0.81% 1.32% 1.51% 0.57% 0.84% 1.16% 0.67% 0.59% 0.95% Plan 0.87% 0.87% 0.89% 0.88% 0.87% 0.99% 0.98% 0.98% 0.97% 0.97% 0.99% 0.99% 0.97% Merton 0.64% 3.38% 2.83% 1.74% 1.59% 2.03% 1.68% 1.08% 1.05% 0.68% 1.05% 0.38% 1.14% Plan 0.99% 0.99% 0.99% 0.99% 0.99% 0.92% 0.86% 0.88% 0.86% 0.88% 0.86% 0.88% 0.88% Richmond 0.57% 0.76% 0.89% 0.63% 1.28% 2.23% 1.49% 1.48% 1.43% 1.21% 1.09% 3.70% 4.09% Plan 0.92% 0.92% 0.92% 0.92% 0.92% 0.86% 0.86% 0.86% 0.86% 0.86% 0.86% 0.86% 0.86% Sutton 0.57% 7.05% 0.77% 0.45% 0.30% 0.52% 0.58% 0.39% 0.64% 0.54% 0.77% 0.58% 1.12% Plan 0.98% 0.98% 0.98% 0.98% 0.98% 0.89% 0.90% 0.93% 0.90% 0.93% 0.90% 0.93% 0.93% Wandsworth 0.60% 1.69% 3.33% 1.93% 2.42% 3.50% 2.70% 2.48% 2.77% 2.17% 1.31% 0.48% 1.25% Plan 1.00% 0.99% 1.00% 0.99% 1.00% 1.00% 1.00% 0.99% 0.99% 0.99% 0.99% 0.99% 0.99% Richmond CCG: Achieved the RTT performance standard in November with an outcome of 92.37% after two months of nonachievement. The CCG achieved all Cancer performance standards in November. Diagnostics performance continued the recent downward trend in November driven primarily by 91 Non-Obstetric Ultrasound breaches occurring at Chelsea and Westminster Trust. The Trust has a Recovery Plan in place with performance modelled to recover in January Kingston CCG: The performance standards for Diagnostics and RTT were achieved in December 2017, with the diagnostic standard being met every month year to date. However the 62 Day GP referral standard was not achieved with performance of 82.93% (7 patients breaching out of 41 patients.) in November 2017, which were related to patients with complex needs and late onward referrals. A&E performance at Kingston Hospital was 87.05% in December 2017, below the 88.0% operating plan trajectory for the month. Merton CCG: The 2 week wait / 2ww (See Page 5) and the 62 day GP referral standards were achieved in November. This was the fourth consecutive month for both 2WW cancer standards. RTT performance, which does not include SGH figures, has declined slightly compared to previous months with performance of 89.79% delivered. Reported under-performance is due to non-achievement at Epsom & St Helier and Moorfields for the CCG. Epsom & St Helier, a large provider to the CCG also did not achieve the standard, delivering performance of 89.30%. The Trust is developing a recovery plan for RTT based on a comprehensive demand and capacity analysis, however this is having to be reviewed by the Trust to take account of any impact on the plan from following national guidance to cancel non-urgent surgery until the end of January The CCG did not achieve the diagnostics standard in November with performance of 98.86% (37 breaches out of 3,240 patients waiting, narrowly missing the target by 5 patients). Sutton CCG: Continues to achieve the 2WW and 62 day GP referral Cancer performance standards. The A&E 4-hour standard was not achieved at ESTH for All Type attendances in December with performance of 90.3% down from 93.8% in November. This is the third consecutive month that performance has not been achieved at the Trust. The RTT standard, while not achieved by the CCG in November with performance of 91.33% is a slight improvement on the 90.4% in October. Overall this is driven mainly by performance at ESTH, which also did not achieve the performance standard, with. performance of 89.30%. The Trust is developing a recovery plan for RTT based on a comprehensive demand and capacity analysis. This is being reviewed by the Trust in view of the impact on the plan following the national guidance to cancel nonurgent surgery until end-january. Wandsworth CCG: With SGH not reporting, RTT performance is mainly affected by outcomes at Imperial, Chelsea and Westminster, Moorfields and GSTT Hospitals where performance for CCG patients was not achieved. Diagnostics performance was not achieved in November with an outcome of 98.75% (66 breaches out of 5,270 waits, missing the target by 13 breaches). All cancer standards with the exception of the 62 day GP referral cancer standard were achieved in November. The 62 day GP referral cancer standard had 5 patients breaching out of a total of 32 accountable patients, narrowly missing the 85% standard with an outcome of 84.38%. A&E performance of 85.0% was delivered at SGH in December, down from 87.17% the previous month against an operating plan trajectory of 92.9% for December. 2

5 CHS ESTH KHFT SGH Trust Provider A&E Type Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 A&E Performance -v- Attendance A&E Performance By Type A&E - 4 Hour Standard Croydon UH - T1 77.4% 78.3% 76.1% 80.1% 79.9% 85.0% 80.6% 75.3% 77.5% 79.4% 87.7% 83.0% 74.3% Croydon Health T2/T3 Urgent Care Centre % 98.0% 99.3% 96.4% 96.6% 96.7% 98.5% 97.7% 99.6% 99.5% 99.8% 99.7% 99.4% Services NHS Trust Provider All Type 84.9% 85.0% 84.4% 86.1% 88.4% 91.2% 90.6% 88.3% 90.1% 90.9% 94.8% 93.0% 89.4% Epsom And St Helier University Hospitals NHS Trust Kingston Hospital NHS FT St George's University Hospitals NHS FT Lead LDU:Sutton Period M9 2017/18 Named Lead:Sean Morgan Report: Date: 30/01/2018 A&E Performance Epsom - T1 94.9% 94.7% 93.7% 97.3% 96.3% 95.6% 96.1% 94.8% 95.5% 94.9% 92.7% 94.0% 88.7% St Helier - T1 93.2% 94.0% 95.9% 95.5% 94.3% 95.5% 94.0% 95.2% 92.5% 95.2% 93.5% 92.4% 88.2% Sutton - T2/T3 100% 100% 99.6% 99.1% 98.2% 99.8% 100% 100% 100% 100% 99.8% 100% 100% Provider All Type 94.1% 94.6% 95.2% 96.4% 95.2% 95.6% 95.0% 95.2% 94.0% 95.2% 93.7% 93.8% 90.3% Kingston - T1 84.6% 80.9% 85.4% 89.5% 89.4% 87.8% 89.0% 92.1% 90.2% 90.7% 91.8% 88.3% 85.0% Kingston REU - T2/T3 100% 100% 100% 99.7% 100% 100% 99.9% 100% 100% 100% 100% 100% 100% Provider All Type 85.9% 82.6% 87.0% 90.7% 90.4% 89.0% 90.2% 92.9% 91.3% 91.7% 92.6% 89.5% 86.3% St George's - T1 88.0% 85.2% 89.7% 87.6% 89.5% 88.6% 91.3% 88.9% 89.1% 89.0% 86.7% 85.9% 83.5% Q Mary Roe'ton - T2/T3 100% 100% 100% 100% 100% 100% 100% 99.4% 99.8% 99.9% 100% 100% 99.8% Provider All Type 89.1% 86.6% 90.6% 88.6% 90.5% 89.7% 92.1% 89.8% 90.0% 90.0% 88.0% 87.2% 85.0% South West London Total All Type 88.9% 87.6% 89.7% 90.6% 91.1% 91.5% 92.1% 91.3% 91.3% 91.9% 92.3% 91.0% 87.9% N.B. ALL DATA IS NHSE PUBLISHED DATA EXCEPT ESTH AT SITE LEVEL, WHICH IS BASED ON DAILY RETURNS AND NOT MONTHLY RETURN. A&E Attendance by Type Key Actions Actions Narrative Owner Due SW London Narrative SWL Overall performance has significantly deteriorated in December with aggregate All Type performance across the 4 SWL providers at 87.9% down from 91.0% in November. The operating plan December trajectory for the 4 main SWL providers was 93.05%. CHS Performance was 89.4% for 'all types' attendances in December, which was below the operating plan trajectory of 94.8%. Type 1 performance declined from 83.0% in November to 74.3% in December. This deterioration in Type 1 performance has continued with UNVALIDATED Type 1 performance of 65.4% for the period 1 st -17 th January, ranging between 82.4% to 52.2%. An Improvement Plan agreed at the A&E Delivery Board is being implemented. Further diagnostic work is being undertaken to inform key actions. Progress is monitored by the A&E Delivery Board. The CCG holds daily calls with the Trust to discuss performance and to support resolution of any issues impacting on its ability to deliver the agreed trajectory. The completion of the new ED at CHS has slipped from February 2018 to June ESTH Did not achieve the performance standard in December with performance of 90.3%, down from November s performance of 93.8%. The operating plan trajectory was 95% for the month. Additional escalation beds have been opened, funded from the national Winter monies, and community services capacity is also to be expanded. KHFT Delivered performance of 86.3% in December, down from 89.5% in November The operating plan trajectory for December 2017 was 88.0%. The main reasons for breaches were responses within the ED and from specialties, with minimal breaches relating to bed availability. An Emergency Care Programme Plan is in place. The Kingston, Richmond and Surrey A&E Delivery Board has been reviewed with the appointment of a new Chair and the Board has refreshed the work programme of work using the 8 pillars for improvement in Urgent & Emergency Care with progress achieved with the support to the 8 pillar leads from a new PMO. St. SGH - performance was 85.0% in December, down from 87.2% in November. The operating plan trajectory for December was 92.9%. At the January performance meeting the Trust reported challenges with inpatient flow, DTAs most mornings and red and black escalations along with issues with patient repatriations to neighbouring trusts. A paper supporting the Repatriation of Tertiary Patients from St. George s Hospital had been discussed at Merton and Wandsworth AEDB and then supported at the SWL UEC Board for roll out to other Providers / AEDBs In terms of staffing the Trust reported fewer unfilled locum shifts after changing pay rates. There is an improved focus on use of the discharge lounge and a prescribing pharmacist has been allocated to the discharge lounge to help improve flow. The recovery plan identifies high impact changes with greatest improvement expected from 1) Full scale review of patient flow and discharge processes utilising SAFER (SAFER patient flow bundle) and Multi Agency Discharge Event (MADE) initiatives to give greater focus and granularity of data, 2) The introduction of high impact changes for discharges, 3 ) Recruitment, retention and retraining of staff across ED. The action plan is monitored by the A&E Delivery Board. An ambulance turnaround group has been established to improve the efficiency of patients being handed over and to explore alternative appropriate care pathways, with improvements expected when the trust return to their ED from the decant. Staffing levels are being continually reviewed to ensure that all key posts are covered. The completion of the new ED at CHS has slipped from February 2018 to June John Goulston CEO, CHS and Chair of the Croydon A&EDB Additional capacity funded from Winter monies with the expectation of delivering a two percentage COO, Epsom & point improvement in performance. System-specific triggers are in development and actions within St Helier Sutton Director the OPEL framework to have prescribed actions for all parties at each trigger point - ideally of invoking a pre-agreed response. Focus on flow, discharges and stranded patients, with a deepdive into the super-stranded patient group (>21 days) with NHSI collaboration in progress. This will Commissioning help expedite recovery actions. Actions to address the recovery are part of the Emergency Care programme plan monitored via the Kingston and Richmond A&E Delivery board. The hospital to home work stream through Kingston Co-ordinated Care is being rolled out throughout Q , with a similar locality team model planned in Richmond. Update reports on the 8 pillars of the ECP are scrutinised at the K&R A&E Delivery board, although recruitment of staff is the predominant risk to delivery, which is borne out by the local breach reports. GP hubs are working well and utilisation has increased through the winter period, which has meant that the numbers into A&E are stable. The Trust continues to implement its Unplanned and Admitted Patient Care programme, (U&APC Programme) a Trust wide approach to improving flow for non-elective and admitted patients. The Trust reported at the January performance meeting while the performance target has not been achieved, unplanned care flow has improved. As well as redesigning the front door process, there has been an increase in rapid assessment leading to improvements in flow for patients likely to be admitted, in addition to hosting MADE events to focus on the collaborative discharge approach. LAS activity has been relatively stable and the AAA expansion building work is likely to complete on There are good demand and capacity plans and escalation plans in place, which have received positive feedback from NHSI. ECIST has visited the Trust recently and is to provide a detailed report on Patient flow. Chair, A&EDB COO St. George s Hospital 95% in Mar 18 June-18 Jan 18 95% in Mar 18 Current trajectory shows 95.0% Feb 18 3

6 Referral to Treatment (RTT) 18 week Incomplete RTT- By Trust Provider Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 KHFT 95.20% 95.02% 94.80% 95.04% 95.11% 94.63% 94.67% 94.55% 94.36% 94.47% 93.69% 94.00% 94.63% CHS 92.80% 92.06% 92.03% 92.04% 92.14% 92.01% 92.24% 92.24% 92.01% 92.05% 91.60% 92.03% 92.01% ESTH 91.45% 90.52% 90.94% 91.40% 92.01% 91.24% 91.51% 91.01% 90.71% 89.54% 89.06% 89.05% 89.30% SGH RMH 96.76% 96.51% 96.82% 97.01% 96.58% 95.83% 96.73% 96.77% 96.75% 96.78% 97.22% 97.30% 97.15% Total 92.96% 92.34% 92.47% 92.71% 92.96% 92.48% 92.70% 92.44% 92.17% 91.74% 91.26% 91.44% 91.65% RTT By Specialty - (Commissioners) Treatment Function Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 November CCG Pass Rate Lead LDU: Merton and Wandsworth Period M8 2017/18 Named Lead: John Atherton Report: Date: 30/01/2018 SW London Narrative At CCG level in SW London: At 91.7% RTT performance was not achieved for November in SWL, however this is a slight improvement on the 91.3% in October. SGH activity continues to not be reported and therefore is not included in the SWL figures. Croydon, Kingston and Richmond CCGs achieved the performance standard in November. At provider level in SW London: Aggregate RTT Performance of 91.65%. for the 4 main SWL providers did not achieve the performance standard, for the fourth consecutive month. However November was a slight improvement on performance of 91.44% in October. The RTT performance standard was not achieved at ESTH for the 8th consecutive month, November's outcome of 89.30% is a slight improvement on October s outcome of 89.05%. SGH continues not to report RTT performance. However, it is worth noting that if RTT performance for the independent sector is included, SW London achieved the target with an outcome of 92.04%. CHS: Performance was maintained in November with an outcome of 92.01%. At Trust level ENT, Oral Surgery and T&O remain significantly below 92% largely due to reported capacity issues. Cardiology 95.3% 94.4% 95.5% 94.8% 94.6% 93.8% 93.6% 93.3% 93.1% 92.5% 91.7% 92.7% 92.7% 4/6 Cardiothoracic Surgery 85.5% 84.8% 91.1% 92.4% 86.6% 77.2% 75.0% 76.7% 80.0% 84.2% 82.1% 82.9% 79.7% 2/6 Dermatology 93.9% 92.3% 92.7% 94.4% 94.6% 94.3% 95.7% 95.6% 95.0% 93.7% 91.9% 91.7% 92.1% 4/6 ENT 87.7% 86.7% 87.8% 87.1% 87.4% 88.5% 89.1% 89.4% 88.8% 86.4% 85.4% 86.1% 86.7% 0/6 Gastroenterology 94.6% 94.3% 94.6% 94.8% 95.4% 94.1% 94.6% 94.3% 94.5% 93.4% 93.0% 93.3% 93.0% 3/6 General Medicine 97.3% 96.9% 97.6% 96.5% 96.1% 95.3% 97.1% 96.4% 95.2% 93.8% 92.7% 93.4% 95.4% 5/6 General Surgery 90.2% 90.0% 90.2% 90.0% 89.1% 89.0% 89.7% 89.5% 88.9% 89.1% 89.8% 89.2% 89.1% 0/6 Geriatric Medicine 97.2% 97.0% 97.2% 97.5% 98.8% 97.1% 98.9% 98.9% 97.1% 98.7% 97.8% 96.8% 94.3% 4/6 Gynaecology 90.6% 89.9% 89.7% 90.5% 90.0% 89.0% 89.2% 89.1% 89.7% 89.2% 88.8% 89.5% 90.7% 1/6 Neurology 91.5% 92.6% 92.7% 93.4% 94.4% 92.8% 92.5% 91.8% 92.0% 90.6% 90.0% 89.5% 90.2% 2/6 Neurosurgery 81.4% 81.0% 83.8% 80.4% 83.2% 84.1% 85.0% 87.1% 85.9% 82.2% 81.2% 85.9% 84.3% 1/6 Ophthalmology 95.6% 95.5% 95.9% 95.5% 95.6% 94.2% 94.0% 93.9% 93.0% 92.1% 91.2% 90.4% 90.6% 2/6 Oral Surgery % % 100.0% 100.0% % 100.0% 100.0% 100.0% - 0/0 Other 92.5% 92.1% 92.3% 92.8% 93.7% 93.2% 93.5% 93.1% 93.5% 93.6% 94.3% 94.6% 94.9% 6/6 Plastic Surgery 91.8% 91.0% 90.5% 90.2% 88.3% 88.0% 88.7% 88.9% 87.6% 87.8% 88.1% 86.5% 86.6% 0/6 Rheumatology 97.1% 96.5% 96.5% 96.1% 96.4% 96.3% 96.0% 96.3% 95.9% 95.6% 94.9% 95.9% 95.5% 5/6 Thoracic Medicine 97.0% 97.3% 97.1% 97.5% 97.6% 97.1% 97.6% 96.9% 97.0% 96.8% 95.1% 94.4% 92.6% 5/6 Trauma & Orthopaedics 88.0% 86.6% 86.6% 87.1% 86.7% 87.4% 87.7% 87.6% 87.9% 86.9% 87.5% 88.1% 89.1% 2/6 Urology 90.3% 90.1% 91.1% 91.7% 91.2% 90.8% 92.1% 91.6% 91.3% 91.8% 90.7% 90.6% 91.0% 3/6 Total 92.2% 91.6% 91.9% 92.2% 92.4% 91.9% 92.3% 92.1% 92.0% 91.4% 91.1% 91.3% 91.7% 3/6 RTT Incomplete Pathways ESTH: Performance was 89.30% in November. The Trust has undertaken a demand and capacity analysis for each specialty, using the IMAS Tool. This analysis suggests there is a significant capacity gap in a number of specialties. The Trust has re-profiled its elective work following the national guidance to cancel non-urgent surgery until end-january. SGH: The CCG and the Trust continue to attend fortnightly meetings with NHSI/E looking at RTT performance and recovery. The Trust have written out to 18,500 phase 1 patients where further information is required from the patient to validate / close their pathway. The Trust has also implemented a web based Pathway Management Module (PMM) for Out Patient first appointments, Continuing patients and Admitted patients. This Incomplete PTL will be reconciled with the current PTL. This system will allow validation comments in real time and will allow for the production of a daily PTL. The final validated position of Cohorts A&B will feed into current trajectories and will allow the Trust to finalise the exact volume of patients and the capacity needed to treat them. Outpatient caps (set at 30 weeks) and ers functionality are also being actioned. The plan remains principally focused on improving operational processes, validation and waiting list management. The Trust are continuing with their Cohort strategy and the associated trajectories. As at 05/01/2018 from Cohort A there were 28 patients from the original 1,803 patients waiting 40+ weeks and 2 patients from the original 212 waiting 52+ weeks, 52 Week Waits: At SWL CCG level there were 7 patients reported on UNIFY waiting over 52 weeks in November, (down from 15 patients in October). Of the 7 patients reported in November, 3 were at Imperial, 2 of which were Richmond CCG patients. One has a TCI in January and the other was treated/ removed. The other patient was from Croydon CCG with a TCI date in January. There were 2 patients waiting over 52 Weeks at ESTH one was a Merton CCG patient and the other was Sutton CCG patient. In addition there was 1 patient at GSTT and 1 patient at Kings College Hospital waiting over 52 weeks, both were Croydon CCG patients. The GSTT patient had a TCI in December and the Kings College Hospital patient was treated in December. At SGH validation continues. RTT Incomplete Pathways > 52 weeks by SW London Commissioners SWL CCGs Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 NHS CROYDON CCG NHS KINGSTON CCG NHS MERTON CCG NHS RICHMOND CCG NHS SUTTON CCG NHS WANDSWORTH CCG SWL Total Action Actions Narrative Owner Due CHS Reporting of Oral Surgery RTT data ESTH Recovery plan SGH RTT Reporting and recovery plan Key Actions The administrative issue within Oral Surgery reporting has been raised as a Serious Incident with NHS Improvement and the Trust is conducting an investigation. The Trust has undertaken an initial clinical harm review and not identified any harm as yet. NELCSU has requested an update from Croydon Healthcare Services on progress with the Report In addition efforts were being made to put on extra theatres and clinics. The Trust is producing a new RTT Recovery Plan, which will need to be discussed with commissioners and with NHS Improvement. The Trust has included activity for RTT backlog clearance in its 2018/19 contract proposal, which is anticipated to be funded from the additional funding announced in the Autumn Budget The Trust has split the Trust PTL into Cohorts. Cohort A includes all patients waiting over 40 weeks and aims to reduce this group from 2,015 patients in to 100 patients by 29/12/17. The Trust achieved this trajectory with 45 people waiting. Cohort B includes patients on the 3 RTT PTL's (First, Continuing and Admitted) with a 52 week breach date between 25/11/17 and 31/03/18. (Currently ahead of plan) The Trust reported at the January performance meeting that, as a result of the ongoing validation, it has written to 18,500 patients where further information is required to complete validation. Waiting time caps have been introduced and the Trust is not booking beyond 30 weeks Cerner will be implemented on the QMH site from September CHS / GM Cancer & RTT Performance Jan-18 ESTH / Feb-18 Director of Planned Care SGH/ Dec-17 Elective Care Recovery Board Mar-18 Dec-17 Feb-18 Sep-18 4

7 Cancer -Two week wait (2WW) & 62 Day 2 Week Wait (Provider) Lead LDU:SWL Alliance Period M8 2017/18 Named Lead:Maggie Lam Report: Date: 30/01/ Day Wait (CCG) Provider Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 CHS 98.40% 95.73% 93.74% 97.33% 98.66% 98.15% 97.08% 96.46% 96.87% 95.51% 95.10% 97.71% 96.82% ESTH 96.72% 97.97% 96.15% 97.85% 95.95% 93.33% 94.74% 95.50% 95.45% 96.44% 96.61% 96.10% 96.70% KHFT 98.51% 99.11% 98.54% 97.96% 99.35% 99.05% 99.41% 98.22% 98.96% 97.89% 98.88% 97.72% 98.50% SGH 85.71% 93.27% 87.90% 87.94% 86.00% 75.44% 76.64% 67.39% 80.27% 89.71% 93.98% 96.05% 97.35% RMH 98.70% 99.16% 97.74% 97.36% 98.03% 97.77% 96.55% 97.99% 97.47% 97.32% 96.20% 97.88% 95.74% Total 94.62% 96.62% 93.84% 95.11% 94.86% 90.84% 91.09% 88.86% 92.16% 94.88% 95.95% 96.95% 97.16% 2 Week Wait by Tumour Site (CCG) Tumour Site Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Brain/Central Nervous System 95.8% 100.0% 92.9% 100.0% 99.1% 90.9% 96.3% 95.0% 90.9% 91.7% 93.3% 96.0% 100.0% 4/4 Breast 97.7% 97.1% 97.6% 96.0% 96.5% 94.8% 92.9% 88.2% 90.3% 97.6% 97.5% 98.8% 98.3% 6/6 Childrens 84.6% 100.0% 100.0% 100.0% 98.6% 87.5% 96.0% 86.4% 96.8% 91.7% 100.0% 96.3% 96.3% 5/6 Gynaecological 96.8% 98.4% 91.7% 93.7% 96.4% 89.4% 89.9% 90.3% 96.9% 96.3% 95.7% 94.4% 97.1% 5/6 Haematological 95.1% 100.0% 100.0% 98.3% 97.9% 88.0% 98.6% 93.9% 98.4% 100.0% 100.0% 98.6% 100.0% 6/6 Head & Neck 97.8% 97.3% 98.7% 98.5% 97.4% 94.2% 93.5% 93.1% 93.5% 91.1% 95.9% 96.1% 98.9% 6/6 Lower Gastrointestinal 94.6% 92.7% 87.6% 94.1% 94.4% 89.6% 91.8% 81.9% 87.2% 87.9% 93.9% 96.3% 94.9% 4/6 Lung 99.1% 99.0% 99.2% 100.0% 99.0% 98.4% 94.4% 93.9% 95.8% 95.5% 98.0% 98.4% 99.2% 6/6 Other 100.0% 100.0% 100.0% % 100.0% 100.0% % 100.0% 100.0% % 1/1 Sarcoma 100.0% 100.0% 96.8% 92.3% 96.0% 100.0% 97.3% 84.0% 88.9% 96.2% 89.5% 96.8% 96.0% 5/6 Skin 85.0% 92.6% 87.7% 88.1% 85.2% 79.7% 80.7% 85.7% 88.4% 95.7% 96.7% 97.4% 96.0% 6/6 Testicular 100.0% 100.0% 94.7% 100.0% 96.3% 83.3% 95.0% 100.0% 100.0% 95.0% 95.2% 96.0% 100.0% 5/5 Upper Gastrointestinal 94.9% 94.7% 91.1% 97.8% 95.4% 92.8% 95.1% 94.2% 97.3% 94.0% 89.8% 94.1% 96.4% 6/6 Urological (exc. testicular) 99.0% 97.5% 97.5% 98.1% 97.8% 97.7% 95.2% 92.8% 98.0% 97.4% 96.5% 96.2% 98.7% 6/6 Total 94.2% 95.7% 93.1% 94.7% 94.3% 90.4% 90.4% 88.5% 91.6% 94.1% 95.8% 96.6% 97.2% 6/6 SW London Narrative The 2WW Performance Standard: At SW London CCG level: The performance standard was achieved at 97.2%. All CCGs achieved both 2WW performance standards. At SW London provider level: The performance standard was achieved for the fourth consecutive month with 97.16% in November. The Breast Symptomatic standard was also achieved in all SW London providers in November at 98.3% against the National performance of 95.6% and above a London performance of 96.7%. The 62day Performance Standard: At SW London CCG level: The performance standard was achieved at 89.1% (27 breaches out of 248 patients). Both Kingston and Wandsworth CCGs did not achieve the performance standard. For Kingston CCG there were 7 breaches against 41 pathways with complex diagnostics and late referrals for treatment. Wandsworth CCG had 5 breaches against 32 pathways with the main breach reason being delay in clinical work-up. Croydon CCG achieved performance in November with 90.4%, the first time the CCG has achieved performance since June 17. At SW London Provider level: The performance standard was achieved in November at 86.1% (43 breaches out of 309 patients). This is above London's performance of 83.4% and a National performance of 82.3%. St George s did not achieve the standard with 80.6% along with The Royal Marsden 78.6%. Both The Royal Marsden and St Georges delivered performance internally with St Georges at 90% and The Royal Marsden 97%. Performance at Royal Marsden was 87.2% on reallocation and St Georges was 82.0% on reallocation. Looking forward, there are a number of challenges that present a risk to delivering compliance for 62 days, these are: Administration and clinical vacancies at Croydon Health Services Lower GI capacity Epsom & St Helier Sustainability of performance at St George s Shared patient pathways across SWL. Early sight of week 2 data for December shows that the SW London sector is non-compliant with the 62 day standard. However this will be subject to change and validation as more data becomes available. November CCG Pass Rate 62 Day Wait by Tumour Site (CCG) Key Actions Action Narrative Owner Due Compliance against 62 day Standard Improved performance against 38 day trajectories within SWL Recruitment to staff vacancies at CHS Prostate pathway at ESTH Lung Pathway at ESTH Tumour Site Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Brain/Central Nervous System % % % 2/2 Breast 100.0% 97.5% 100.0% 100.0% 97.6% 96.8% 100.0% 100.0% 97.6% 97.4% 95.3% 95.2% 90.6% 5/6 Childrens % % 100.0% 0.0% /0 Gynaecological 91.7% 88.9% 75.0% 88.9% 62.5% 86.7% 76.9% 81.3% 53.8% 81.8% 80.0% 92.3% 86.7% 3/5 Haematological (inc. acute leukaemia) 94.7% 81.8% 87.5% 85.7% 100.0% 100.0% 71.4% 88.9% 93.3% 81.8% 85.7% 76.9% 100.0% 3/3 Head & Neck 42.9% 80.0% 58.3% 41.7% 71.4% 55.6% 61.5% 33.3% 65.0% 71.4% 75.0% 73.3% 78.6% 3/6 Lower Gastrointestinal 78.3% 85.0% 81.3% 75.0% 75.0% 86.7% 92.3% 78.3% 93.8% 96.3% 84.2% 100.0% 96.4% 5/6 Lung 75.0% 83.3% 69.2% 86.7% 61.5% 91.7% 73.3% 61.5% 64.7% 60.0% 78.6% 52.6% 65.4% 1/6 Other 25.0% 50.0% 100.0% 100.0% % 0.0% 100.0% 100.0% - 0.0% 100.0% - 0/0 Sarcoma 0.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 60.0% 50.0% 100.0% 1/1 Skin 93.0% 100.0% 100.0% 95.7% 96.2% 97.7% 98.0% 100.0% 96.7% 90.0% 92.5% 92.6% 95.5% 5/6 Upper Gastrointestinal 58.8% 81.8% 30.8% 83.3% 92.9% 81.3% 66.7% 92.3% 80.0% 58.8% 50.0% 90.0% 90.0% 3/4 Urological (inc. testicular) 83.0% 79.7% 83.6% 84.1% 88.1% 88.4% 80.6% 85.4% 79.2% 81.5% 85.4% 81.7% 90.5% 4/6 Total 83.8% 87.4% 83.8% 86.4% 88.7% 90.0% 85.3% 87.5% 83.6% 83.1% 85.0% 84.9% 89.1% 4/6 All providers have been asked to provide details for recovery of the standard and what additional support is required. Data is being reported monthly for compliance against 38 day ITT and treatment within 24 days. SWL are focusing on 3 challenged tumour groups Urology, Lung and Head & Neck. CHS have advertised administrative vacancies and an internal plan has been developed to backfill whilst these posts are recruited to. The Trust introduced a new prostate pathway on 6 November, which is expected to be compliant with the 62- day standard however some patients starting their pathway before that date will have breached the standard in November and December. Agreed at the SLF meeting on 10th Jan 18 for RMH to discuss potential support with prostate with ESTH. RMP to support ESTH with clinical engagement for the lung optimal pathway. (November performance was 64.3%) Cancer General Manager s Cancer General Managers, CSU, Cancer General Manager CHS Jan 18 Jan 18 Feb 18 Jan - 18 Cancer General Impact from Jan 18 manager, ESTH End Jan 18 Cancer General End-Feb 18 manager, ESTH November CCG Pass Rate 5

8 SW London Diagnostic Performance (By CCG) SWL CCG Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 NHS CROYDON CCG 99.7% 99.3% 99.1% 97.6% 96.2% 94.3% 94.6% 95.9% 97.1% 98.4% 99.7% 99.6% 99.2% NHS KINGSTON CCG 99.6% 98.8% 98.7% 99.0% 99.2% 98.7% 98.5% 99.4% 99.2% 98.8% 99.3% 99.4% 99.0% NHS MERTON CCG 99.4% 96.6% 97.2% 98.3% 98.4% 98.0% 98.3% 98.9% 99.0% 99.3% 98.9% 99.6% 98.9% NHS RICHMOND CCG 99.4% 99.2% 99.1% 99.4% 98.7% 97.8% 98.5% 98.5% 98.6% 98.8% 98.9% 96.3% 95.9% NHS SUTTON CCG 99.4% 93.0% 99.2% 99.5% 99.7% 99.5% 99.4% 99.6% 99.4% 99.5% 99.2% 99.4% 98.9% NHS WANDSWORTH CCG 99.4% 98.3% 96.7% 98.1% 97.6% 96.5% 97.3% 97.5% 97.2% 97.8% 98.7% 99.5% 98.7% Total 99.5% 97.7% 98.3% 98.4% 97.9% 96.9% 97.2% 97.9% 98.1% 98.6% 99.2% 99.2% 98.6% SW London Diagnostic Waiting List and Performance Diagnostic waits Lead LDU:Merton and Wandsworth Period M8 2017/18 Named Lead:John Atherton Report: Date: 30/01/2018 SW London Diagnostics Waits < 6 Weeks (By Test) Diagnostic Test Name Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Audiology Assessments 99.8% 99.7% 98.1% 98.1% 98.6% 96.1% 95.1% 97.5% 97.8% 96.8% 97.7% 98.9% 99.9% 5/6 Barium Enema 100.0% % 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% % 100.0% 2/2 Colonoscopy 99.2% 96.9% 93.8% 96.9% 96.4% 97.3% 97.4% 97.8% 97.2% 98.1% 98.0% 98.0% 99.0% 3/6 CT 99.9% 99.6% 99.5% 99.9% 99.7% 99.6% 99.6% 99.9% 99.8% 99.7% 99.2% 99.6% 99.7% 6/6 Cystoscopy 92.7% 87.1% 91.9% 93.3% 93.2% 87.9% 90.9% 83.8% 91.0% 91.8% 88.4% 94.4% 95.1% 0/6 DEXA Scan 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 6/6 Echocardiography 99.9% 99.9% 99.9% 93.3% 90.1% 83.4% 79.6% 89.0% 91.2% 95.7% 99.7% 99.7% 99.2% 3/6 Electrophysiology 100.0% 100.0% 100.0% 90.9% 77.8% 100.0% 87.5% 62.5% 75.0% 55.6% 75.0% 100.0% 100.0% 1/1 Flexi Sigmoidoscopy 99.0% 93.4% 89.5% 94.5% 96.9% 97.9% 99.5% 98.4% 96.5% 98.6% 98.1% 98.8% 99.0% 3/6 Gastroscopy 98.8% 96.7% 97.0% 98.6% 98.1% 94.2% 95.3% 95.4% 95.3% 96.4% 98.0% 98.2% 97.9% 1/6 MRI 99.3% 99.3% 97.2% 98.5% 98.9% 98.9% 99.4% 99.3% 99.4% 99.6% 99.6% 99.3% 99.3% 4/6 Non Obstetric Ultrasound 99.8% 96.6% 99.2% 99.5% 99.1% 98.8% 99.2% 99.8% 99.6% 99.6% 99.9% 99.3% 99.1% 5/6 Peripheral Neurophys 99.6% 100.0% 99.5% 100.0% 100.0% 99.2% 98.3% 99.3% 98.0% 98.9% 98.8% 99.4% 99.8% 6/6 Sleep Studies 100.0% 97.1% 94.3% 100.0% 98.4% 98.1% 97.4% 100.0% 94.6% 98.5% 98.6% 96.8% 73.6% 0/6 Urodynamics 96.6% 96.2% 94.6% 91.6% 88.3% 86.5% 77.1% 77.9% 82.0% 80.1% 84.8% 93.8% 95.5% 3/6 Total 99.5% 97.7% 98.3% 98.4% 97.9% 96.9% 97.2% 97.9% 98.1% 98.6% 99.2% 99.2% 98.6% 2/6 SW London Diagnostic Waiting List and Performance (By Provider) Provider Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 KHFT 99.54% 99.27% 99.68% 99.73% 99.79% 99.27% 99.27% 99.45% 99.18% 99.06% 99.53% 99.27% 99.21% CHS 99.93% 99.62% 99.79% 97.50% 96.01% 93.79% 94.37% 95.67% 97.08% 98.40% 99.89% 99.88% 99.78% ESTH 99.63% 94.65% 99.29% 99.78% 99.87% 99.73% 99.72% 99.82% 99.67% 99.69% 99.33% 99.54% 99.58% SGH 99.29% 97.81% 94.83% 97.22% 97.10% 95.87% 96.67% 97.79% 97.28% 98.01% 98.64% 99.69% 98.11% Total 99.59% 97.53% 98.00% 98.46% 98.12% 97.05% 97.39% 98.14% 98.25% 98.73% 99.30% 99.62% 99.11% November CCG Pass Rate SW London Narrative At CCG Level in SW London: Performance was not achieved at aggregate level across SW London CCGs with an outcome of 98.6%. This decline in performance comes after two consecutive months where performance has been achieved at sector level. Performance was achieved at both Croydon and Kingston CCGs. Non achievement of the target at SGH in November has impacted on performance at the other CCGs with the exception of Richmond which was affected by performance at Chelsea and Westminster Hospital Trust (C&W). Merton, Sutton and Wandsworth CCGs narrowly missed the target in November. Richmond CCG: The diagnostic standard has not been achieved at the CCG since March 17. In November 17, there were 111 breaches out of 2,654 waits (97 breaches occurred at C&W, 91 of which were in Non Obstetric Ultrasound). Richmond and Kingston LDU colleagues have been reviewing the Richmond CCG M8 Diagnostics position of 95.9% along with CSU BI colleagues. Richmond CCG performance is primarily affected by performance at C&W and Imperial for the CCG s patients. The main issue is non-obstetric ultrasound, predominately at West Middlesex site, which is having a significant impact on Richmond patients compared to other SW London CCGs. Workforce issues are the main reason for the decline in performance and the Trust have an action plan in place to address and are planning to return to compliance during January Key Actions Objective Actions Narrative Owner Due SGH - Performance Recovery SGH are providing additional Urodynamics clinics to clear the backlog and provide on-going capacity and additional endoscopy capacity through waiting list initiatives. Recruitment is on-going to staff 2 additional rooms. There is recentralisation of management at the QMH site and SGH Tooting site is being offered capacity to help recover the position. At the Commissioners & Provider Performance Meeting held in January, the Trust reported that it had introduced weekly meetings to support and challenge service managers, implementing a zero tolerance policy for breaches. The Trust also previously reported that it was internally focusing on breaches at 4 weeks against the 6 week standard. St George's Hospital / Lead Director for Diagnostics / COO SGH expects to achieve the diagnostics target by 31/12/17 At Provider level in SW London: Performance was achieved at SWL provider level in November for the third consecutive month with an outcome of 99.11%. SGH: The Trust did not achieve the diagnostic target in November. The Trust had already highlighted this outcome following the identification of some previously unreported tests that should have been included in the DM01 return (i.e. sleep studies and stress echo). A plan has been developed to address this. The Trust reported at the January performance meeting that they will be reporting a compliant position for December as outlined in the recovery trajectory. The Trust have introduced weekly challenge meetings and are confident that performance will be achieved on a sustainable basis going forward. CHS: The Trust highlighted recently that they were planning to replace one of their two CT scanners. In order to mitigate against a material lengthening in CT scan waits during the 8-12 weeks of the replacement programme, Croydon Healthcare Services increased CT activity, so that currently CT waits are around one week, providing a buffer to protect performance during the reduction in capacity. An enhanced maintenance contract has been put in place on the remaining operational CT scanner to protect that capacity whilst CHS has only one CT scanner operating.. Richmond CCG Performance Recovery CHS - CT Delivering Diagnostics whilst Replacing one of two CT Scanners Ongoing work with host commissioners for C&W to review and improve current performance. A Recovery Plan is in place which has the Trust recovering performance for January 2018 CHS have commenced replacement of one of their two CT scanners. Waits have been reduced to protect performance and an enhanced maintenance and support contract is in place to protect the remaining capacity provided by the remaining one operational CT scanner. Progress with the replacement as well as with CT waits will be monitored at each of the two monthly meetings with Croydon Healthcare Services. Richmond & Kingston LDU & NW London CCGs. CHS General Manager Cancer and RTT / Diagnostic /Radiology Manager Feb 18 Jan March 18 Trust Performance Meetings 6

9 Ambulance Handovers - London Ambulance Service (LAS) Lead LDU: Croydon Period M9 2017/18 Named Lead:Elaine Clancy Report: Date: 30/01/2018 LAS Conveyances by Provider LAS patient handover within 15 minutes Data is not validated LAS 30 Minute Breaches By Provider Data is post validation LAS 60 Minute Breaches By Provider Data is post validation This section reports upon and considers London Ambulance Service (LAS) conveyances only. Some Hospital sites will also have conveyances from SECAMB and/or others, however these are not included in the above data. SW London Narrative December saw LAS handover breaches (30 and 60 minutes) increase across all sites in South West London. This corresponds with the drop in 4 hour A&E performance in the same month. 15 minute handovers in SWL dropped from 46.3% in November to 40.2% in December. 30 minute breaches increased from 255 in November to 440 in December. 60 minute handover breaches totalled 72 in December, in SWL, 61 of which were at St Helier. St Helier experienced capacity issues in the ED from higher acuity conveyances due to a reported rise in acuity as winter took hold. Volumes, whilst high on some days were not up sharply overall, but the increases in LOS and ITU use reflect the a shift in acuity. SWL Urgent & Emergency Care Transformation Delivery Board has requested greater visibility of South East Coast Ambulance (SECAM) Service data in SWL. Whilst the SWL Surge hub have sight of this on a daily basis to support A&E calls, the local data set on handover delays does not include this. Whilst SGH are likely to receive the majority of SECAMB conveyances, this has been raised by ESH and KCH also. There is a SW London demand management plan aimed at reducing demand for LAS and therefore, conveyances to ED. This contains measures such as use of Rapid Response and frailty in-reach teams, in addition to appropriate care pathways with patients transported directly to services, bypassing EDs. The SWL LAS Working Group are seeking to validate all Appropriate Care Pathways (ACP) in SWL to ensure the Directory of Services (DoS) contains accurate information to support the roll-out of electronic devices to crews. Increases in 'Hear and Treat' and 'See and Treat' also contribute to demand management. In Month 9 'Hear & Treat' rates for LAS were 9% compared with the 7% national average. The proportion of face to face calls managed without the need to transport a patient to a type 1 or 2 A&E department was 26% compared to 30% national average. From the new ambulance system indicators time series data for December Trust Actions Narrative Owner Due Croydon Health Services Kingston Hospital St Helier St George's Key Actions CHS has an improvement plan via optimised ED layout, standardising core processes, managing queue situations effectively. Care Homes use of 111 has reduced conveyances 20%. Temporary location of the ED is causing issues. Jayne Black Chief Operating Officer Handovers are monitored via daily information provided by KHFT, Tracey Moore including conveyances, % handover within 15mins, >30 minutes, AD Emergency >60 minutes and data completeness. The Trust wishes to work more Care closely with SECAMB on delays. Work on a frailty in-reach and rapid response / re-ablement model is in development to improve the flow in the ED. Modifications to the estate will also reduce pressure on ED. Actions to release capacity in ED for ambulance arrivals include, increasing ambulatory care capacity, using consultant rapid assessment on the front door, and transfers to AMU for patients requiring a medical specialty assessment. The Trust are reviewing ambulance handover processes to reduce delays. There is a capital project to provide additional capacity for ambulatory care away from the ED to reduce pressure and ensure sufficient capacity for urgent patients. Dan Bradbury Chief Operating Officer James Friend Director of Delivery Completion of ED layout improvements is now expected June 2018 Mar-18 Mar-18 Mar-18 7

10 NHS 111 percentage Clinical Contact NHS 111 service Lead LDU: Sutton CCG Period M9 2017/18 Named Lead: Sean Morgan Report: Date: 30/01/2018 SW London Narrative Overall: The Integrated Urgent Care Service for South West London includes 111/Clinical Assessment Service (CAS) and GP OOHs and is provided by SELDOC and Vocare, with Vocare as the prime contractor. The relationship with the Provider is constructive with collaborative and effective working to deliver the Improvement Plan, which has a trajectory to compliance with the calls answered within 60 seconds performance standard by the end of March % 93.4% 94.5% 93.7% 94.5% 94.7% 89.1% Calls Answered Within 60 Seconds & Calls Abandoned After 30 Seconds 94.0% London- Answered in 60 seconds SWL- Answered in 60 seconds Target- Answered (95%) 89.2% 88.1% 87.2% 92.6% 92.1% 91.7% 92.5% 84.2% 85.2% 88.0% 87.8% 88.5% 90.7% 89.5% 70.8% 7.2% 2.2% 2.8% 3.0% 2.8% 2.0% 1.9% 2.0% 2.2% 1.9% 2.4% 2.7% 4.0% 1.2% 2.5% 1.4% 1.1% 1.2% 1.1% 1.2% 1.3% 1.3% 1.4% 1.3% 1.7% 1.8% Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 London Abandoned after 30 seconds SWL - Abandoned after 30 seconds Target- Abandoned (5%) Volume of Calls 86.9% 85.5% 84.6% 95% 81.5% Dec-17 Answered in 60 seconds NEL 93.2% SEL 89.3% NCL 77.4% NWL 73.3% SWL 70.8% London 81.5% Dec-17 Abandoned after 30 seconds SEL 1.0% NEL 2.2% NCL 3.7% NWL 6.3% SWL 7.2% London 4.0% Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 London- Calls Offered 173, , , , , , , , , , , , ,031 London- Calls Answered 169, , , , , , , , , , , , ,051 London- Ambulance Dispatches 16,579 16,316 12,404 13,237 13,168 13,852 12,509 13,227 12,412 12,762 14,586 14,644 17,786 SWL- Calls Offered 32,250 30,129 25,067 26,963 30,957 29,913 26,795 28,267 26,038 25,853 27,598 27,866 35,425 SWL- Calls Answered 30,929 29,209 23,984 25,719 29,416 28,369 25,410 27,110 25,024 24,876 26,448 26,601 32,398 SWL- Ambulance Dispatches 3,222 2,924 2,107 2,279 2,402 2,524 2,173 2,454 2,304 2,380 2,646 2,827 3,423 SWL- Recommended to attend A&E 2,212 2,338 1,910 2,127 2,307 2,451 2,302 2,517 2,180 2,257 2,418 2,352 2,460 SWL- Recommended to attend Primary Care 14,242 13,088 10,922 11,428 13,710 13,014 11,453 12,549 11,528 11,639 12,795 12,581 16, Dispositions (Outcomes)- Top 3 At Month 9: % Calls transferred to Clinical Contact: 40.9% of calls were transferred in December / M9 2017/18. SW London is currently achieving the required performance of 40% by the end of Q3 2017/18. % Calls Abandoned after 30 seconds: 7.2% of calls were abandoned after 30 seconds. SW London has consistently achieved the required performance standard, better (i.e. a lower %) than the required 5% up to November. December s underperformance is seen as a blip reflecting unexpected surge in activity together with rota challenges. Performance appears to be back on track and the latest data for w/e 14 th Jan sets abandonment rate back below 5% at 2.18% % Calls Answered within 60 seconds. 70.8% of calls were answered within 60 seconds in November. This compares to 81.5% across London overall. An improvement plan is in place with Vocare to achieve the required 95% performance standard by the end of March Improvement Plan: A robust Improvement Plan is in place with Vocare which prioritises actions that will have the most impact on performance. Elements include: 1. Improved forward modeling informed by an accurate activity forecast coupled with the number and skill mix of staff required to deliver the required and contracted performance and KPIs. 2. Improved recruitment and retention of the required number and skill mix of staff in the face of London-wide competition for staff. 3. Reducing levels of staff sickness and staff absence. 4. Reviewing and refreshing the format of performance management and performance reporting to better reflect the contract, the KPIs and the needs of the commissioners. (This has advanced with draft proposals to be shared with commissioners shortly) 5. A robust trajectory to compliance / achievement of the required performance standards by the end of March Vocare is working collaboratively and effectively on delivering the Improvement Plan with the commissioners and contracting staff. % Calls Transferred to Clinician & % Calls Leading to Ambulance Call Out: Both indicators have become closely aligned with the wider London performance, due in part to the new contract settling and the service becoming less risk-averse. Dispositions: Month 9 is likely to show expected rises in Ambulance disposition and Emergency Department attendances during winter. This is in line with other sectors. Looking ahead: The Senior Commissioning Manager - SWL Integrated Urgent Care is in post and working with the Senior Contract Manager and colleagues at NELSCU and the Director of Commissioning Operations - SWL Alliance on confirming: 1. Business as usual activity. 2. Priorities for Q4 2017/ Developing leaner, smarter commissioning, contracting and performance reporting processes, with effective governance arrangements. 3. Developing performance, quality and outcome priorities for 2018/19, including transformation where appropriate. Key Actions Action Action narrative Owner Due CPN issued in relation to a number of performance issues. Response is to address identified issues collaboratively through the Improvement Plan. No further action at his time, but performance and the outcomes of the Improvement Plan will be monitored monthly and further action under the CPN will be taken if no improvement is seen. Monitored at monthly Contract Management Meeting. Commissioners Jan-18 At Contract Management Meeting Reformat Monthly Performance Reports Performance Reports required reformatting to better present and narrate current and predicted future performance. Meetings have been held between NELCSU and Vocare Regional Director and information team to develop new model. Commissioners will be presented with new model for review at Contract Management Meeting January Vocare Regional Director Jan-18 Implementation and Outcomes of Improvement Plan Improvement Plan continues to be refined in the light of additional information to inform actions and in response to changes in performance as a result of the actions taken. NELCSU / Senior Contract Manager engaged with Vocare Regional Director. Monitored at monthly Contract Management Meeting Vocare Region al Director & Commissioners Mar-18 8

11 IAPT (By CCG) Lead LDU: Kingston and Richmond Period M6 2017/18 Named Lead: Fergus Keegan Report: Date: 30/01/2018 % Waited Less than 6 Weeks for Treatment (75% threshold) % Waited Less than 18 Weeks for Treatment (95% threshold) Waiting Times (6 weeks) Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 NHS CROYDON CCG 93.3% 94.0% 94.3% 92.5% 97.7% 95.0% 98.0% 92.7% 93.6% 93.6% 95.0% 90.9% 95.6% NHS KINGSTON CCG 92.3% 94.3% 95.2% 92.6% 96.7% 96.4% 96.3% 100% 96.7% 94.3% 90.6% 90.6% 97.1% NHS MERTON CCG 95.7% 92.3% 85.7% 89.2% 85.7% 89.2% 90.3% 87.9% 81.0% 80.0% 71.4% 69.3% 74.7% NHS RICHMOND CCG 100% 96.3% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99.4% 100% NHS SUTTON CCG 95.7% 96.3% 95.5% 97.0% 92.9% 100% 94.6% 96.2% 96.2% 100% 96.2% 98.0% 100% NHS WANDSWORTH CCG 93.4% 95.3% 93.8% 93.7% 94.2% 92.6% 89.6% 81.6% 80.5% 76.6% 81.9% 90.1% 93.4% South West London 100% 99.5% 99.0% 98.8% 100% 99.1% 100% 100% 99.5% 99.1% 99.8% 99.5% 99.8% Waiting times (18 weeks) Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 NHS CROYDON CCG 100% 100% 100% 100% 100% 97.5% 100% 100% 100% 100% 100% 100% 100% NHS KINGSTON CCG 100% 100% 100% 96.3% 100% 100% 100% 100% 96.7% 97.1% 99.2% 97.4% 99.3% NHS MERTON CCG 100% 100% 96.4% 100% 100% 97.3% 100% 100% 100% 100% 99.0% 100% 100% NHS RICHMOND CCG 100% 96.3% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99.4% 100% NHS SUTTON CCG 100% 100% 100% 97.0% 100% 100% 100% 100% 100% 100% 100% 100% 100% NHS WANDSWORTH CCG 100% 100% 97.9% 98.4% 100% 100% 100% 100% 100% 97.9% 100% 99.6% 99.5% South West London 100% 99.5% 99.0% 98.8% 100% 99.1% 100% 100% 99.5% 99.1% 99.8% 99.5% 99.8% Recovery Rate (50% threshold) IAPT Recovery Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 NHS CROYDON CCG 45.2% 45.5% 43.8% 45.0% 48.7% 40.5% 50.0% 50.0% 53.5% 46.3% 50.7% 43.3% 51.7% NHS KINGSTON CCG 47.8% 45.2% 44.4% 52.2% 50.0% 50.0% 46.2% 42.1% 44.8% 45.5% 44.1% 45.9% 49.6% NHS MERTON CCG 50.0% 50.0% 48.0% 57.6% 45.0% 45.5% 46.7% 43.3% 50.0% 47.4% 48.0% 50.6% 51.8% NHS RICHMOND CCG 45.5% 56.0% 50.0% 60.9% 70.0% 57.7% 50.0% 58.8% 56.3% 56.4% 51.3% 61.7% 57.9% NHS SUTTON CCG 45.0% 48.0% 47.4% 45.2% 53.8% 52.0% 57.6% 45.8% 52.2% 46.9% 48.8% 48.9% 45.9% NHS WANDSWORTH CCG 38.9% 39.5% 39.5% 41.5% 42.2% 39.3% 31.7% 34.4% 34.3% 36.6% 46.5% 47.6% 51.8% South West London 44.3% 46.5% 44.5% 48.4% 50.0% 45.7% 46.4% 46.6% 47.6% 46.3% 48.3% 49.6% 51.3% IAPT DATA FOR OCT-DEC 2017 IS FROM LOCAL UNVALIDATED DATA RETURNS TO NHS ENGLAND SW London Narrative Key Actions Kingston CCG: Kingston CCG has agreed additional funding for staffing with the Kingston service, enabling increased access to the with the expectation of reducing waiting times. Staff have been recruited, bringing waiting list numbers down, as well beginning to increase access rates. The service is reducing the waiting list backlog, which is adversely affecting recovery. Recovery has increased in December 2017, where the access target was missed by 1 person. While access for December was below target, it is the highest access rate seen for a December in Kingston since the service began. Croydon CCG: Croydon CCG / Provider met with the NHS Intensive Support Team (21st September 2017) to look at the service and identify action points and improvements to the service. The provider has developed an action plan which will support an increase in activity throughout Qtr. 4. This aims to achieve the compliant run rate of 4.2% in Qtr. 4, and is approved by the CCG. The final annualised position is expected to be increased to 12.52%. The action plan requires inputs from both commissioner and provider to achieve the Qtr. 4 increased run rate. These include; staff recruitment, supporting practices to increase referrals, promoting increased capacity within the service and the provider looking at their other services where attrition rates between referral and treatment is much lower. The use of 300k from NHSE to increase performance to 4.2% in Q4 2017/18, has been agreed with SLAM. The CCG has budgeted to maintain this level of performance from Q1 Q3 of 2018/19, at which point, the national performance standard changes to 19%. Performance in September was impacted by staff leaving the service. One Psychological Wellbeing Practitioner (PWP) and four trainees left for alternative employment Merton CCG: The Merton IAPT provider submitted a backlog clearance plan at the beginning of September. The aim of the plan is to clear a backlog of first appointment and follow up appointments and improve performance against the access standard with a Q4 exit rate of 4.1%. The Q3 plan to achieve 3.2% access has been achieved (based on monthly provider data). Sutton CCG: There has been an increase in drop-out rates which has contributed to the reduction in recovery target. There has also been an issue with recruitment because of 2 vacancies, which are being covered by locums. An audit is planned to look at reasons for drop-outs. Rolling Quarterly Access Rate (3.75% for , 4.20% for ) CCG Action Actions Narrative Owner Due IST Action plan and reduction of waiting list (Kingston) Increasing Access Rate for Q4 (Croydon) Service Mobilisation post-re-procurement (Wandsworth) Increased capacity through two provider model (Merton) Increased workforce/ capacity (Sutton) IAPT Access Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 NHS CROYDON CCG 2.60% 2.94% 2.70% 2.44% 2.00% 1.92% 2.31% 2.60% 2.69% 2.41% 2.50% 2.44% 2.40% NHS KINGSTON CCG 4.04% 3.75% 3.75% 4.10% 3.70% 3.60% 3.81% 4.28% 4.33% 3.94% 4.06% 4.11% 3.93% NHS MERTON CCG 1.98% 2.50% 2.70% 2.87% 2.44% 2.02% 1.69% 2.08% 2.19% 2.58% 2.87% 3.33% 3.55% NHS RICHMOND CCG 3.41% 3.57% 3.64% 4.05% 4.35% 4.60% 4.76% 4.46% 4.58% 4.42% 4.75% 4.76% 4.51% NHS SUTTON CCG 2.27% 2.22% 2.57% 3.82% 4.70% 5.21% 5.11% 5.23% 5.44% 5.60% 5.41% 5.30% 4.73% NHS WANDSWORTH CCG 2.83% 2.85% 2.70% 3.04% 2.77% 2.94% 2.90% 3.34% 3.62% 3.89% 3.87% 3.75% 3.52% South West London 2.79% 2.93% 2.91% 3.20% 3.06% 3.11% 3.18% 3.45% 3.61% 3.63% 3.72% 3.73% 3.56% An action plan has been agreed with the Kingston provider from the IST review. Staffing has been increased to bring down the waiting list, as well as to increase the access rate. The Croydon IAPT Service have recruited additional therapists using the 300k from NHSE. The CCG is working to ensure that demand is increased in line with additional capacity. The service is being promoted with GPs, Voluntary Sector Groups, including SLaM issuing leaflets to Croydon residents. Progress against, recruitment, referrals and a weekly trajectory is monitored via regular conference calls. The new provider (SWL & St Georges) is continuing to mobilise the service following the recent re-procurement, and plans to only be compliant in quarter , as per the Operating Plan Submission. The Merton IAPT provider has recently agreed to commission an online IAPT provider to increase capacity and access from November 17 to March 18. They have committed to delivering 3.75% in Q4 under this new two provider arrangement. Additional funding for the increased IAPT access target for 17/18, will increase capacity and reduce waiting times, which should improve recovery. Additional workforce capacity is expected to be in place in early Feb 18 with an impact on performance expected from early March 18 which is being managed through the contract management process. The CCG has issued a formal Contract Query Notice requesting an action to recover performance for Q4. Sylvie Ford Head of Mental Health Commissioning Complete Leo Ongoing Whittaker- Head of (Mar-18) Performance, Assurance and Emergency Planning Mark Robertson Commissioning Redesign Lead Mental Health John Atherton Director of Performance Improvement Wandsworth CCG and Merton CCG Clare Wilson Director of Commissioning Sutton CCG Jan-18 On-going Feb-18 9

12 Estimated Dementia Diagnosis Rate (66.7% threshold) Dementia and Mental Health Lead LDU: Kingston and Richmond Period M6 2017/18 Named Lead: Fergus Keegan Report: Date: 30/01/2018 Care Programme Approach (CPA) 7 Day IAPT ACCESS NHS CROYDON CCG Q Q Q Q Q % 97.73% 98.91% 97.78% 95.88% Q % NHS KINGSTON CCG 94.05% 94.81% 95.35% 96.92% 96.00% 97.44% NHS MERTON CCG 97.47% 96.91% 96.70% 96.88% 95.65% 98.81% NHS RICHMOND CCG 98.67% 97.44% 96.05% 93.98% 97.85% 95.16% NHS SUTTON CCG 94.44% 95.83% 96.61% 100% 98.46% 98.46% NHS WANDSWORTH CCG 95.65% 95.10% 94.87% 95.81% 94.42% 95.95% SWL New Referrals Received (Mental Health Service Data Set) SWL Total 96.09% 96.22% 96.25% 96.69% 95.97% 96.77% Early Intervention in Psychosis (50% of people start treatment within 2 weeks) Dementia: SW London Narrative Key Actions Action Actions Narrative Owner Due Kingston: The Kingston dementia nurse is in post, and has reviewed potential dementia patients in all Kingston GP Practices. The nurse has also liaised with Kingston Memory Assessment Service, provided by SWL & St Georges. A practice Mental Health KPI has been developed and implemented in GP Practices which includes a dementia KPI in order to raise rates. A dedicated GP is assessing the cognition of patients in nursing homes and will notify their GP of the diagnosis if found to have dementia. The dementia diagnosis rate has dropped slightly for December 2017 compared to November 2017, which is as a result of a small reduction in those on the register, but a larger increase of the estimated dementia list size (the denominator), provided by NHS Digital. CPA 7 Day Access: Wandsworth CCG missed the CPA 7 day standard in Quarter by one person. CPA follow up is a standing agenda item on the monthly South West London and St Georges performance meeting, with a report on each breach and actions shared with commissioners at that point. Review of patients in Care Homes. (Kingston) Employment of dedicated Dementia nurse. (Kingston) Dedicated GP resources are assessing patients in care and nursing homes to ensure that they are correctly recorded as having dementia. Kingston CCG Has employed a dementia nurse to increase diagnosis rate by: 1. Liaising with stroke rehab team, falls service and Parkinson s clinic to discuss if cognitive function is reviewed and communicated back to GP 2. Working with substance misuse teams/services and consider joint working with CMHT as cognitive impairment in patients with alcohol misuse is often missed. Head of Mental Health Commissioning - Sylvie Ford Head of Mental Health Commissioning - Sylvie Ford Continuing Completed: Nurse in post All CCGs achieved the 7 day standard for Information sharing from HRCH and SWL & St Georges. (Richmond) Devising a standard template for HRCH to use to feedback dementia diagnosis confirmation to surgeries to enable them to update their QOF registers. Continue to send out the patient lists from SW London St. George's MHT Memory Clinics on a monthly basis and to include those with mild cognitive impairment for follow up assessment. Senior Commissioning Manager - Amanda McGlennon Dec-17 10

13 DTOCs - KHFT DTOCs - SGH FT DTOCs ESTH DTOCs - CHS Delayed Transfers of Care Lead LDU: Sutton CCG Period M8 2017/18 Named Lead: Sean Morgan Report: Date: 30/01/2018 Key Actions CCG Action Narrative Owner Due Establish multiagency working group Croydon: Awaiting social care placement responsible for 172 days (acute). Patients not covered by NHS and Community Care Act (NHS) for 120 days.(acute) 183 patients were awaiting completion of assessment (NHS non-acute). CCG/ESTH Task and Finish group has been set up Sutton CCG: Waiting for further NHS nonacute care for 41 days and patient or family choice (NHS acute)) responsible for 44 days. Awaiting care package in own home (Social Care acute) 60 days. Non-acute DToCs were 8 days all attributable to Social Care. Implement refreshed Joint Delivery Plan Richmond CCG: The majority of DTOCs were related to Further non acute NHS care, Care homes, Patient choice or Completion of assessments in almost equal measure. Richmond Council is ahead of the NHS England winter 2017 DToC trajectory, Richmond CCG is above planned levels. 1. Mental health patients processes being reviewed, to reduce waits and evaluate potential for weekend admissions. 2. ADASS supporting Croydon bid for funding for a social worker for the hospital discharge team leading on out of area patients 3. The new DOO at CHS is the lead for the High Impact Changes Program (HICP) which incorporates all the DToC actions. 4. Regular MADE events to expedite DTOCs with long LoS. CCG and LA providing on-site support. 5. Discharge to Assess pathway 2 rolled out on all wards, design work on pathway 3 underway. 1. High Impact Change Model implementation is in progress/action plan developed. 2. Improve communication/unblock process issues twice weekly multi agency, MDT discharge meeting at St Helier Hospital 3. Weekly Director level escalation meetings commenced (super stranded reviews) 4. LBS and SCCG have agreed to place without prejudice based on checklist outcome with the use of the shorter DST form 5. Work with community and social care providers to ensure robust recruitment /retention procedures in place. LBS is implementing a new Adult Social Care commissioning strategy to improve homecare capacity 1. Support the developments against the High Impact Change Model to improve services to support people ready for discharge from hospital, including developing the Discharge to Assess model, Better at Home and enhance equipment provision to support earlier discharges. 2. This includes additional social work posts in the RRR Team to increase capacity to support improvements in transfers of care from hospital, reduce waiting times for assessment and reduction in DToCs. 3. Actions in progress on-going & being closely monitored by AEDB Increase in enablement capacity 1. Increase in enablement capacity to support hospital discharges Wandsworth CCG: Awaiting care package including a plan to facilitate weekend discharges into Enablement Service in own home responsible for 79 days (acute) Mitigate by step-down beds and 24-hour enablement packages / care of which NHS for 47 and Social Care for 32, packages in own home investment from the ibcf to increase staff / Patient or family choice (NHS) for 59 days and waiting further NHS non-acute for 48 number of PoC. days. NHS responsible for 63 non-acute 2. Daily calls and weekly escalation call in place (mostly awaiting residential placement, 59) and Social Care for 80 days Awaiting nursing home placement for 42). Reduce DToCs Merton CCG: Waiting for further NHS nonacute care responsible for 66 (acute) and awaiting care package in own home (Social Care) for 60 (acute). Non-acute DToCs was 66 days of which NHS was responsible for 8, Social Care for 28, and awaiting care package in own home (Social Care) for 15 days. Review of DToC information Kingston CCG: The majority of DToCs were related to non-acute NHS care, the vast majority of these were waits for Neurorehabilitation bed, or waits for CHC. Kingston CCG and The Royal Borough of Kingston are ahead of the NHSE DToC trajectory. CCGs average daily rate (as per the London expectation) is 5.1, compared to the trajectory of 8.5 for Nov The RBK average is 0.8 compared to the 1.5 target 1. Improve communication / unblock process issues A daily conference call between CLCH, CHC and LB Merton to discuss patient discharges. 2. Daily call and weekly escalation meeting CLCH and LB Merton and Merton CCG. 3. LB Merton and Merton CCG have agreed to place without prejudice based on checklist outcome with the use of the shorter DST form. 4. Reablement capacity LB Merton increased by 100 hours W/C 20 December 17 Kingston DToC information is sent from Kingston Hospital and is reviewed by community teams and adult social care for response. Director of Operations, Croydon Health Services, Sam Goldberg Chair, Sutton A&EDB Chair, Richmond Accident and Emergenc y Delivery Board Chair, Wandswort h and Merton A&EDB 1. On-going 2. Feb On-going 4. On-going 5. Mar 18 Reviewed at the Sutton A&EDB April 2018 Reviewed monthly at the Richmon d A&EDB 1. Reviewed monthly at the AEDB Completed Nov 17 2.On-going Chair, 1.On-going Wandswort 2.On-going h and 3.On-going Merton 4.Done A&EDB Chair, Kingston A&EDB Reviewed monthly at the Kingston A&EDB 11

14 Glossary Commonly used NHS Acronyms Acronym Definition Acronym Definition ABT Assessment and brief treatment teams NELCSU North & East London Commissioning Support Unit AEDB A&E Delivery Board NHS ENGLAND National Health Service England ASIP Accelerated service improvement NHS IMPROVEMENT National Health Service Improvement AWOL Absent without leave OAP Out of Area Placements CAMHS Child and Adolescent Mental Health Service OPEL Operational Pressures Escalation Levels Framework CCG Clinical Commissioning Group OPI Operational Performance Indicators CHS Croydon Healthcare Services PALS Patient Advice and Liaison Service CMHTs Community Mental Health Teams PICU Paediatric intensive care unit CPA Care Programme Approach PMO Programme Management Office CPN Contract Performance Notice PTL Patient Tracking List CQUIN Commissioning for Quality and Innovation QIAs Quality Impact Assessments CRT Community recovery teams QMH Queen Mary Hospital, Roehampton CSU Commissioning Support Unit RMH Royal Marsden Hospital DoLS Deprivation of liberty standards RMP Royal Marsden Partners DTOC Delayed Transfer of Care RRR Richmond Rapid Recovery ECIST Emergency Care Intensive Support Team RRT Rapid Response Teams ECP Emergency Care Programme RTT Referral to Treatment EIP Early intervention in psychosis SGH St George's University Hospitals NHS Foundation Trust ESTH Epsom & St Helier Hospital NHS Foundation Trust SI Serious incidents HCH Hillingdon Community Health SLAM South London and Maudsley NHS Foundation Trust HRCH Hounslow and Richmond Community Health SLF South London Forum (Cancer) HTT Home Treatment Team SOF Single Oversight Framework IAPT Improved access to psychological therapies SPA SPA - Single Point of Access IST Intensive Support Team SSOC Shifting settings of care KHFT Kingston Hospital Foundation NHST Trust SWL South West London KPI Key Performance Indicator TCI To Come in LD Learning Disabilities UEC Urgent and Emergency Care MHA Mental Health Act click here to find more > NHS Acronym Buster App The NHS has produced a new jargon busting App. The free App, produced by the NHS Confederation spells out what things mean and gives definitions for more than 700 commonly used acronyms and abbreviations in the NHS. You can download it for free from itunes to your iphone/ipad or from Google Play Store to your Android phone/tablet so you have the definition of over 700 commonly used NHS acronyms and abbreviations at your fingertips. Just search NHS Acronym in the itunes app or Google Play Store

15 FOR FURTHER INFORMATION: NEL Commissioning Support Unit Performance Management & Pressure Surge South West London 120 The Broadway, 1st Floor The Broadway, Wimbledon, London SW19 1RH

16 Introduction This report highlights issues from the Integrated Governance Committee meeting held on 16 th January 2018 and the 20 th February Integrated Performance Report As at 22 nd February 2018 Kingston CCG was showing the following overall position against the following areas, and is achieving 111 of the indicators (77.2%) as shown: NHS England monitors performance of CCGs against the following constitutional Standards: 1. Dementia Diagnosis Rate 2. Referral to Treatment (18 Weeks) and Diagnostics 3. Access to Cancer Services 4. Mixed Sex Accommodation breaches 5. Mental Health/ Improving access to Psychological Therapies (IAPT) 6. Health Outcome Frameworks (MRSA and C Difficile Breaches) 7. Urgent Care (A&E and Ambulance Response Times) 8. Cancelled Operations 9. Health Visitor Numbers 10. Winterbourne View The scorecard overleaf shows performance against these targets with the exception of: Health Visitor numbers this is the responsibility of Public Health and Winterbourne, which is monitored on a STP footprint Commentary on these targets, and other areas where the achievement of targets is at risk, is detailed below. A full scorecard and copies of action plans is available to CCG members on GPTeamNet or upon request. Version: Final F - 3 Date:

17 Performance against Constitutional and Local Standards Indicator Reporting Latest Latest YTD YTD Frequency Actual target Actual Target Period Trend/ Direction Constitutional Standards Dementia Diagnosis Rate Estimated diagnosis rate for people w ith dementia (NHS OF 2.6i) Monthly 63.1% 66.7% 63.1% 66.7% Jan-18 Referral to Treatment (18 Weeks) and Diagnostics RTT 18 w eeks incomplete pathw ays Monthly 93.3% 92.0% 93.5% 92.0% Jan-18 Number of 52 w eek Referral to Treatment Pathw ays: incomplete pathw ays Monthly 0.01% 0.05% 0.02% 0.05% Jan-18 Diagnostic tests w aiting less than 6 w eeks Monthly 99.6% 99.0% 99.1% 99.0% Jan-18 Access to Cancer Services Cancer 1 st treatment 62 days: GP Urgent Referral Monthly 89.7% 85.0% 99.2% 85.0% Dec-17 Cancer 1 st treatment 62 days: Screening Referral Monthly NO DATA 90.0% 88.7% 90.0% Dec-17 Cancer 1 st treatment 62 days: Consultant upgrade Monthly 100.0% 75.0% 90.2% 75.0% Dec-17 Cancer 1 st treatment 31 days Monthly 100.0% 96.0% 98.5% 96.0% Dec-17 Cancer subsequent treatment w ithin 31 days for surgery Monthly 100.0% 94.0% 98.3% 94.0% Dec-17 Cancer subsequent treatment w ithin 31 days for cancer drugs Monthly 100.0% 98.0% 99.5% 98.0% Dec-17 Cancer subsequent treatment w ithin 31 days for radiotherapy Monthly 100.0% 94.0% 94.95% 94.0% Dec-17 All cancer 2 w eek w aits Monthly 99.7% 93.0% 98.3% 93.0% Dec-17 Cancer 2 w eek for breast symptoms (cancer not initially suspected) Monthly 97.4% 93.0% 98.9% 93.0% Dec-17 Mixed Sex Accommodation Mixed Sex Accommodation (MSA) Breaches Monthly Jan-18 Mental Health/ Improving access to Psychological Therapies (IAPT) Care Programme Approach Follow Up Quarterly 97.2% 95.0% 96.9% 95.0% 17/18 Q3 IAPT - Patient numbers as % of Population w ith Depression etc. Monthly 1.54% 1.40% 13.60% 14.00% Jan-18 IAPT proportion moving to recovery Monthly 57.0% 50.0% 47.4% 50.0% Jan-18 Proportion w aiting 6 w eeks or less from referral to entering a course of IAPT treatment Monthly 95.2% 75.0% 96.1% 75.0% Jan-18 Proportion w aiting 18 w eeks or less from referral to entering a course of IAPT treatment Monthly 99.3% 95.0% 99.4% 95.0% Jan-18 Percentage of people experiencing a first episode of psychosis treated w ith a NICE approved care package w ithin tw o w eeks of referral Monthly 100.0% 50.0% 74.4% 50.0% Dec-17 Health Outcome Framew orks Incidence of healthcare associated infection: MRSA (NHS OF 5.2.i) Monthly Jan-18 Incidence of healthcare associated infection: C Difficile (NHS OF 5.2.ii) Monthly Jan-18 Urgent Care A&E w aiting time >4 hours (Kingston Hospital) - Latest actual is 4 w eek rolling average Monthly 86.1% 95.0% 90.0% 95.0% 18-Feb Trolley w aits in A&E Monthly Jan-18 Ambulance clinical quality Category A (Red 1) 8 minute response time (LAS-w ide) Monthly 73.5% 75.0% 73.9% 75.0% Oct-17 Ambulance clinical quality Category A (Red 2) 8 minute response time (LAS-w ide) Monthly 68.7% 75.0% 70.4% 75.0% Oct-17 Ambulance clinical quality - Category A 19 minute transportation time (LAS-w ide) Monthly 94.9% 95.0% 94.6% 95.0% Oct-17 Cancelled Operations Cancelled Operations not treated w ithin 28 days of cancelation (Kingston Hospital) Quarterly 0.0% 5.0% 0.0% 5.0% 17/18 Q3 Other Standards Delayed Transfers of Care Bed days lost to Delayed Transfers of Care Monthly ,348 3,287 Dec-17 Version: Final F - 4 Date:

18 1.1 Estimated diagnosis rate for people with dementia Kingston CCG needs to both increase the current rate of diagnosis for dementia of 63.1% (as at 31 st January 2018) to achieve the national target of 66.7% and to minimise the variation between practices. A recovery plan is in place achieve the 66.7% target within , incorporating the following actions: Dementia information packs were circulated to every practice in Kingston CCG during May 17. The packs also highlight areas and actions that can be taken. Examples of this include advice on compiling a register for patients in their practice with Mild Cognitive Impairment (MCI) and to ensure these people are reviewed annually. A dementia specialist nurse has been employed to visit the lowest performing practices initially and assess patients that have been identified with cognitive impairment to be included on the registers. She will then move on to support other practices that require support. The dementia specialist nurse commenced working two days per week on 22nd June 2017, and the dementia specialist nurse has met with the MAS and agreed a standard set of tools and templates with which to conduct the dementia screening reviews to ensure it dovetails with Memory assessment Service (MAS) assessment processes. A dedicated clinician is assessing the cognition of patients in nursing homes and notify their GP of the diagnosis if found to have dementia. A Mental Health KPI is being implemented which supports practices to increase their dementia diagnosis rate. Practices will receive a payment for either reaching or maintaining the rate above the threshold or making an improvement of 5% or more compared to their current performance. 1.2 Referral to Treatment (RTT) and Diagnostic Waits Kingston CCG has achieved the incomplete RTT standard for January 2018 with performance of 93.5% against the 92% standard, and with year to date performance of 93.6%. Kingston CCG last missed the incomplete standard in July The 6 week diagnostics standard has been achieved for January 2018 and YTD against the 99% standard, despite some issues with nonobstetric ultrasound and audiology at St Georges at the beginning of Cancer Standards Eight of the nine cancer standards were achieved for October 2017, with seven of the nine cancer standards have been met year to date. For 62 day waits resulting from a screening referral, YTD performance of 87.5% against the 90% standard has meant that the year to date the performance is below the threshold. This was as a result of 5 complex patients over 40 pathways, across several providers. The Radiotherapy (Subsequent) treatment standard is at 93.7% year to date against the 94% target. The breaches were all at the Royal Marsden, and relate mainly (10 of the 11 breaches over 175 pathways) to patient requested delays in treatment. 1.4 Mixed sex Accommodation Breaches There was a mixed sex accommodation breach reported in December 2017 relating to a Kingston patient at Imperial College (on the Hammersmith site). This has been linked to winter pressures felt by Imperial for that period. Previously, there have been no MSA breaches reported for Kingston patients between April and November 2017, and none reported for January Mental Health/ Improving Access to Physiological Therapies (IAPT) The proportion of people on the Care Plan Approach (CPA) being followed up within 7 days of - discharge was 97.2% for quarter , and 96.9% YTD Version: Final F - 5 Date:

19 The IAPT access and recovery standards are behind trajectory as at January There is a recovery plan in place to recover both standards, and the plan is being monitored through the monthly performance meetings. Additional funds have been agreed to deliver the increasing access standards for and , and additional staff and locums have been recruited to bring down the waiting list. This has meant that the recovery rate has fallen as those who have been seen after a longer wait are less likely to recover. The backlog has been cleared as at December 2017, and the service shows achievement of all IAPT standards for January Healthcare Acquired Infections There have been 3 MRSA healthcare associated infections between April 2017 and January 2018, all of which were in quarter 1. There have been 27 C-Difficile infections for the same period, which is just above the YTD trajectory of 25 cases. For each case a post-infection review is carried out by the North East London CSU (NELCSU) Infection Control Team, commissioned by the CCG. The NELCSU also meets with Trusts monthly to assure Infection Prevention and Control (IPC) compliance and lessons learned are being embedded. Kingston CCG also receives monthly IPC reports from the NELCSU which identifies any lapses of care. 1.7 Accident and Emergency waiting times: In , Kingston Hospital have not met the standard of 95% on a monthly basis of patients spending less than 4 hours between arrival in the A&E department and admission, transfer or discharge. Kingston Hospital s year to date performance to the 18 th February 2018 of 89.74%. The monthly accident and emergency 4 hour waits performance can be seen in the chart below: Below are the breaches shown as a proportion of total monthly breaches. The main causes from July 2015 onwards are delays within the Emergency Department and breaches relating to specialties. Version: Final F - 6 Date:

20 The Kingston, Richmond and Surrey A&E Delivery Board has been reviewed with the appointment of a new chair. The board has refreshed its programme of work under the heading of the 8 pillars for improvement in Urgent & Emergency Care. Progress has been made in the last two months with the implementation of a Project Management Office to support the named leads for the 8 pillars. The 8 pillars for improvement in Urgent & Emergency Care are: 1. NHS 111 Online: Throughout 2017 NHSE will be working to design online triage services that enable patients to enter their symptoms and receive tailored advice or a call back from a healthcare professional, according to their needs. 2. NHS 111 Calls: By March % of all callers to 111 will be offered clinical advice. By March 2018 this will increase to 50%. Increase booking to primary care appointments. 3. GP Extended Access: Provision of urgent appointments with general practice in hours and provision of urgent services by general practice outside of core hours. This might include attending an out of hours centre or a home visit. 4. Urgent Treatment Centres: By December 2019 patients and the public will be able to access Urgent Treatment Centres open 16 hrs per day (London) with simple diagnostics. 5. Ambulance: Patients with life-threatening conditions will receive the fastest response, with more telephone advice, treatment on scene & alternative referral pathways. 6. Hospital: Kingston Hospital to deliver 90% performance of 4 hour standard by September & 95% in March Hospital to Home: Ensure that patients are sent home as soon as possible and if home is not the best place then they will be transferred promptly to the most appropriate care setting. 8. Mental Health: Timely assessment & Treatment of Mental Health Patients. The development of the Urgent Care Centre at Kingston Hospital is reported to be ahead of plan, to open at the end October Recruitment to the frailty and in-reach services at Kingston Hospital with input from Adult Social Care and community providers has been completed. The A&E Delivery Board is providing oversight for the development of the winter plan and this will be approved by the A&E Delivery Board with endorsement from all appropriate partner organisations. Version: Final F - 7 Date:

21 1.8 Ambulance clinical quality Category A response times and Ambulance Handover time (Global London Ambulance Service performance) The performance of the London Ambulance Service (LAS) has improved significantly in , despite staffing issues, and high demand across London. There are a range of actions being managed on a weekly basis by North West London Collaboration of Clinical Commissioning Groups, reported back to chief officers and performance leads in CCGs. 1.9 Cancelled Operations (Kingston Hospital) The proportion of cancelled operations not treated within 28 days of cancelation at Kingston Hospital for Quarter (and YTD ) was 0% against the 5.0% expectation Proportion of Bed days lost to Delayed Transfers of Care (per 100,000 adult population) The bed days lost to Delayed Transfers of Care YTD December 2017 was 2,348 against the BCF plan of 3,287. As can be seen from the chart below, there has been a marked reduction from February 2017, which is due to reductions at both Kingston Hospital and at South West London and St Georges MH Trust. The rise in May 2017 was related almost entirely to housing delays, both at Kingston Hospital and South West London and St Georges. As well as the normal bed and ward rounds, with community and Adult Social Care partners working to discharge patients as proactively as possible, aggregated DTOC information by reason and Local Authority is sent by Kingston Hospital on a daily basis. Version: Final F - 8 Date: