Community Services Quality Update Report. Melissa Laskey, AD Commissioning Jackie Bene, Chief Executive, Bolton FT (action plan)

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1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 10 Date of Meeting: 23 rd October 2015 TITLE OF REPORT: AUTHOR: PRESENTED BY: Community Services Quality Update Report Melissa Laskey, AD Commissioning Jackie Bene, Chief Executive, Bolton FT (action plan) Su Long, Chief Officer, Bolton CCG PURPOSE OF PAPER: (Linking to Strategic Objectives) RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) COMMITTEES/GROUPS PREVIOUSLY CONSULTED: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: EQUALITY IMPACT ASSESSMENT (EIA) COMPLETED & OUTCOME OF ASSESSMENT: To respond to the CCG Board requirement for assurance from Bolton FT of the effective and safe delivery of community services, and trust milestones for improvement in key quality measures. Recommendations are included in section 5 CCG Board CCG Executive Contract and quality meetings between Bolton FT and Bolton CCG This report is intended to respond to concerns which were initiated from GPs reports of deteriorating quality of community services on behalf of their patients. Users and carers would be expected to be engaged by Bolton FT in their plans to introduce improved models of care in community. There is no information to suggest that protected characteristic groups are disproportionately affected by the quality concerns or action plan. 1

2 Community Services Quality Update to Board 1. Background 1.1 This is an update to Board on the current position with community services following reports each month on the CCG s ongoing quality concerns and relevant actions to be taken by Bolton FT. 1.2 Bolton CCG is responsible for commissioning high quality services for the people of Bolton and takes concerns about service quality very seriously. 1.3 Community services are a strategic priority for Bolton CCG with: a community review being conducted in 2014/15, increased investment through Intermediate Care Redesign, Integration and System Resilience funding in 2014/15 and further recurrent investment through the BCF assured from 2015/ Following contractual escalation in January 2015, an action plan was received from Bolton FT to respond to all CCG concerns on quality of community services. Key areas of concern raised by the CCG Board in 2014/15 in relation to community services were; high rates of sickness, long waiting times, high vacancy rates and high staff turnover rates. 1.5 The full community services review and redesign has been a lengthy process which has involved reviewing current service provision, working in collaboration with Bolton FT clinicians and service managers to develop service specifications, the development of provider service models and the implementation of service redesign to address the key areas of concern raised by the CCG Board. Board to Board meetings have also highlighted the level of importance of the improvement in community services. 1.6 The review also included the development of new Key Performance Indicators (KPIs) for each service and the services as a whole by the CCG. Monthly reporting against these new specific KPIs commenced in April The Trust presented to the CCG Board in December 2014 and again in March 2015 on the areas of concern (with the greatest issue raised being the District Nursing Service) and stated that the focus of the Trust s Executive and Board would see improvements to the level of CCG expectation from June 2015 data. These metrics have been subject to monthly monitoring to CCG Board and improvements have been noted month on month for the majority of areas. 1.8 At the last detailed update using June 2015 data, the CCG Board was not assured that community services quality had improved to the level where this increased focus could be reduced. 2

3 2. Summary of Current Position 2.1 Bolton FT submitted a new RAP in mid October 2015 (attached) in order to assure the CCG Executive and Board of progress made in most areas and the revised actions being implemented to address the residual areas of concern. The community services dashboard is also attached to this report and is summarised below. 2.2 CCG Board members will recall that Bolton FT has separated community services from the acute adults division with separate divisional management. 2.3 In terms of the District Nursing service, the Trust has implemented a full service redesign and staffing structure remodelling over recent months. Significant improvements have been seen in the two main areas of concern - with staff sickness reducing from 6.3% in March 2015 to 2.7% in September 2015 and staff turnover reducing to 6.9% (from 10.6% in March). However, GPs have raised ongoing concerns about a lack of alignment of district nursing teams to GP practices which needs to be addressed. The RAP also needs to be expanded to include actions being taken to address low rates for staff appraisals and mandatory training. 2.4 Improvements have been seen in the following services which were raised as a concern for quality in 2014/15: Speech and Language Therapy (long waiting times), Nutritional Support (long waiting times), Paediatric Occupational Therapy (long waiting times), Bladder and Bowel (high sickness rates and long waiting times), District Nursing Treatment Room service and the Falls service (which is undergoing redesign as part of the Integrated Neighbourhood Teams) 2.5 Some of the actions (specifically for areas where KPIs are not being achieved) are not due for completion until end October 2015 to end December Therefore CCG Executive and Board will not see performance data for these areas until December 2015 at the earliest (due to reporting being 6 weeks in arrears). 2.6 The following services have not improved sufficiently to provide assurance to Board: Neurological Long Term Conditions (specifically in relation to waiting times, which have remained static over the past twelve months with approximately 28% of patients referred waiting 12 weeks or more) Rheumatology (specifically relating to long waiting times). Work has been progressed to collaboratively develop a service specification however no positive impact has been seen on waiting times and more recently the service are stating that to bring waiting times in line with agreed thresholds, the service will need further investment. Further work is required to develop a service delivery model and subsequent service redesign to bring waiting times within agreed thresholds within the current cost envelope for the service. 3

4 Tissue Viability this remains an area of concern with ongoing issues relating to data, reduction in activity, mandatory training compliance, high sickness and staff turnover. The remedial action plan does not address the concerns expressed by the CCG. 3 Discussion of next steps for Bolton CCG 3.1 The CCG Board is advised that the information provided cannot give full assurance that the concerns on quality of community services can be closed. 3.2 There are a number of actions which the CCG can now take. Views on these actions (or a combination) and timescales are sought from Board members: Continue to monitor the delivery of the actions to improve community services contractually and monthly through the board Invite Bolton FT to the CCG Board. Judge at this point whether to allow for those timescales and contractually manage the actions Consider alternative provision, testing the market for effective providers with the specifications already designed. 4

5 Tissue Viability Oct-15 Bolton NHS Foundation Trust Objective Action Required Provider Lead Person Start Date Completion Date Measurable Outcome Position/Progress Statement RAG Status To improve the data inputting process for the Tissue Viability Team, and ensure activity is reflected from both Community and Acute settings To improve the levels of mandatory training compliance To improve the completion rate for approval within the Team Development of activity analysis to reflect acute care referrals alongside community referrals. July and August Data submission to be completed. All team members to undertake their mandatory training by the 31st October 2015 All appraisals booked in for completion Nurse Consultant for Tissue Viability. Deputy Director of Nursing Oct-15 Activity data reflective of the Dec-15 whole service. Nurse Consultant for Tissue Viability. Deputy Director of Nursing Oct-15 Oct-15 % improvement in the levels of Mandatory Training for the Team Nurse Consultant for Tissue Viability. Deputy Director of Nursing Oct-15 % improvement in the appraisal Oct-15 rate for the team Deputy Director of Nursing meeting with the team on a weekly basis. Upload of July 2015 and August 2015 activity data expected to be completed by the 13th October 2015 All team members expected to complete their required training by the 31st October 2015 All appraisal dates now booked into the diary To Address the high sickness and turnover of staff within the TVN team Understand the reasons for sickness. completion of the return to work forms. Away day planned with the team in October to improve team working and capacity management Nurse Consultant for Tissue Viability. Deputy Director of Nursing Oct-15 % reduction in sickness rates Dec-15 across the team. Away day planned for October 2015.

6 Remedial action plan for "appraisals" and "waiting times" for the Falls service and community therapy team October 2015 Objective Action Required Provider Lead Person Start Date Completion Date All staff to have Appraisals completed No outstanding action Lynne Price Waiting time for treatment to be a maximum of 4 weeks Continue to bring waiting list down aiming for 1 week if possible over winter period using locum staff to ensure sustainability Lynne Price Measurable Outcome Position/Progress Statement RAG Status All appraisals showing as complete on ESR Waiting list showing less than 4 weeks consistently Last one completed for new AP in INT. Jenn Jackson ensuring all shown as complete Currently down to 4 weeks with the exception of a handful of patients who have been difficult to contact. Letters now sent so will be a definite 4 weeks max wait by GREEN

7 Remedial Action Plan DN Domi-LP October 15 Bolton NHS FT Objective Action Required Provider Lead Person Start Date Completion Date Measurable Outcome Position/Progress Statement RAG Status To provide assurance re the overall reduction in GP referrals 1 Monitor and review to ensure seasonal variation in referrals received is in line with trends in previous years, currently on trejectory.2 Continue with DN implementation with integrated neighbourhood teams in line with INT service specification. 3 data entry is GP Referrals remain consistent accurate,complete and timely Lynne Price 01-Sep Apr-16 with trends in previous years Although at month 6 on plan with regard to GP referral activity in Domiciliary District Nursing, however noticeably there has been an increase in referral from GP's to the Treatment Room Service, this will account for some of the reduction of GP referrals to the Dn Domiciliary Service. However it should be noted that all though this has put significant pressure on the TR service, the shift in referral pattern has enabled the DN Domiciliary service to manage the increase in patient acuity. Furthermore going forward we may see further reductions of direct GP referrals to the DN Domiciliary Service in response to the development of pathways within adult community services (Which supports the national and local integration agenda). Invariably this will result in a change to traditional referral patterns into the service. For example the primary referral from the GP may be to Tier 2, INT etc. Consequently onward referral to the DN Domiciliary Service will constitute a secondary referral and will not be reported as a primary referral source. GREEN To provide understanding and assurance re the higher number of incidents reported 1. Confirm positive reporting of all incidents. 2 Review and analysis of all incidents, monitoring trends, governance process monthly. 3 Harm Free Care Panel to review all incidents of Pressure Ulcers and Duty of Candour. Monthly analysis shows increased incidents reported by DN not necessarily attributable to DN or FT services. Increased activity within community for example admission avoidance means that more pressure incidents are reported by DN (Pressure incidents come to DN to manage). 4 Quality Assurance Trust Board reporting. Jill Pinington 01-Apr-15 Incidents are managed and reported through due governance and HFC panel. Avoidable harm 30-Apr-15 attributable to BFT is reduced. The Trust actively encourages incident reporting and the trend overall through the Trust is increasing and approaching top quartile of all Trusts. Daily and weekly review of all incidents takes place. Monthly Quality Report reviewed at Divisions monthly Clin Gov & Quality Committee includes incident report and analysis. Over seen by Div Nurse Director The vast majority of all incidents are low or no harm. The themes are pressure ulcers, falls and medication incidents. Of the pressure ulcer incidents, all are scrutinised through the Harm Free Care panel process which includes CCG representation and the majority arise due to difficulties with patient or carer compliance. GREEN To provide assurance that all staff vacancies following consultation are being recruited to. 1 Recruiment tracker to show progress against vacancy and in line with new INT Hub model Lynne Price 01-Sep Nov-15 Vacancies filled In line with the consultation, staff realignments has now been confirmed and actioned. Residual vacancies have been proactively managed with three recent interviews panels. Further advert is out on NHS jobs for vacancies and we are managing all recruitment through the TRAC system. Weekly recruitment tracker is reviewed by the senior management team. Currently there are 13.85wte vacancies with 6.8 wte pending employment checks and should be in place imminently. Of the remaining 7.05wte vacancies, 6.0wte are for the relief team which leaves just 1.05wte of substantive posts actually vacant GREEN

8 Remedial Action Plan Bladder Bowel Service Oct 15 Bolton NHS FT Objective Action Required Provider Lead Person Start Date Completion Date Measurable Outcome Position/Progress Statement RAG Status Long Waiting Times No outstanding action Lynne Price 01-Sep Sep-15 Service waiting times to be under 4 weeks. Waiting list is now under 4 weeks, with the exception of some patients who have cancelled and rearranged due to their choice. Decrease in service activity No outstanding action Lynne Price 01-Apr Sep-15 Service Activity levels Low percentage of appraisals No outstanding action Lynne Price 01-Apr Sep-15 Appraisal percentages High staff sickness No outstanding action Lynne Price 01-Apr Sep-15 Staff Sickness Levels In 2013/2014 a proportion of the BBHS service staffing and activity was moved to another service, representing 1.7 FTE. Therefore the activity that is reported against this service is misleading. Proportionality the BBHS activity for the Integrated Community Services is on plan. Furthermore the acuity of patients within the service has risen, resulting in staff dealing with an increase complexity. This required additional time and resource. All team members now have up to date appraisals. Only 1 staff member has been off on long term sick. Unfortunately this represents a large percentage due to the small staffing numbers in the team. However this staff member has now returned to work

9 Remedial Action Plan Treatment Room Service Oct 15 Bolton NHS FT Objective Action Required Provider Lead Person Start Date Completion Date Measurable Outcome Position/Progress Statement RAG Status To reduce staff sickness rate No outstanding action Lynne Price 01-Sep Sep-15 Staff sickness percentage To reduce Staff Turnover No outstanding action Lynne Price 01-Apr Sep-15 Percentage Staff Turnover To reduce the number of Vacancies No outstanding action Lynne Price 01-Apr Dec-15 Number of Vacancies A number of staff have now returned form long term sickness and this should reflect in an improved sickness percentage in October. The residual sickness currently is 9.7% which is actually 2.6wte staff. The sickness relates to serious long term conditions and all are being managed strictly in accordance with the FT attendance policy, with full support from HR and Occupational Health.. All sickness is covered with additional hours from within the teams. Three staff have taken advantage of the flexible retirement arrangements within the trust. No other staff members have left the service. The existing vacancies resulting from the above turnover are now fully recruited which represented 2.46 FTE, with anticipated start dates of the 1st December 2015 (subject to notice periods). GREEN

10 Remedial Action Plan Paediatric OT Oct 15 Bolton NHS FT Objective Action Required Provider Lead Person Start Date To provide a responsive Paediatric OT Service To reduce the waiting times for access from weeks Ashley Mason Completion Date December 31st 2015 Measurable Outcome Position/Progress Statement RAG Status Waiting times for new appointments less than 6 weeks Additional locum hours secured as from which will reduce waiting times to under 6 weeks by December 2015 A capacity and demand exercise has now been completed and will be includued in service response to CCG in Nov 2015 GREEN

11 Nutritional Support Recovery Action Plan Bolton Foundation Trust October 2015 Objective Action Required Provider Lead Person Start Date Completion Date Measurable Outcome Position/Progress Statement RAG Rating meet demand Recruit to vacant posts Kathryn Morton Jul-15 Aug-15 Team fully established All vacant posts are now recruited to resulting in a fully established service so waiting times in October are expected to significantly improve. meet demand Recruited additional capacity above establishment Kathryn Morton Jul-15 Aug-15 Team over established by agreed number of posts Awaiting start date. HR to confirm by 15 th October 2015 meet demand Agree weight management pathway to remove duplication Kate McKenna Jun-15 Oct-15 Weight management pathway agreed and signed off Needs final sign off by working group them for wider circulation. meet demand Review referral criteria against new service specification Kathryn Morton Oct-15 Nov-15 All accepted referrals meet agreed criteria FT to sign off service specification and provide response meet demand Analyse cause for DNA to maximise capacity Kathryn Morton Sep-15 Nov-15 Reduction in DNA rate maximum use of clinic capacity Work commenced using bench marking data and qualitative assessment of previous month DNAs Workforce: Minimise loss of capacity due to sickness Manage sickness in accordance with Trust policy Kathryn Morton On-going On-going All staff are managed in line with the Trust sickness policy Recent audit shows team complaint with policy and all sickness is being managed meet demand staff are working to job plan to maximise efficiency Kathryn Morton On going On going Activity matches job plan All staff have job plans reviews are at supervision and appraisal meet demand Review skill mix and case load allocation to maximise efficiency Kathryn Morton/ Jane Johnson Oct-15 Dec-15 Activity is untaken by appropriately skilled staff Activity is reviewed monthly Review triage system to ensure effective work load allocation deflect inappropriate referrals Kate McKenna/ Kathryn Morton Oct-15 Nov-15 Confirmation that triage is effective as per service specification New triage system agreed and implemented in September 2014 to be reviewed against initial plan to ensure that it remains effective meet demand Review non clinical time in job plans to maximise patient facing capacity until longest waiting times have been reduced Kate McKenna/ Kathryn Morton Oct-15 Dec-15 Reduction in longest waiting times Discuss with staff the reduction in non clinical activities for a short period of time until patient waiting longest for intervention have been seen then maintain waiting times. Currently 996.3% patients are seen < 18 weeks and 79.6% < 12 weeks. meet demand

12 Community Neurology Rehabilitation Team Recovery Action Plan Bolton Foundation Trust October 2015 Objective Action Required Provider Lead Person Start Date Completio n Date Measurable Outcome Position/Progress Statement RAG Rating meet demand meet demand meet demand Workforce: Recruited additional capacity above establishment Review referral criteria / work with commissioning as still awaiting new service Analyse cause for DNA to maximise capacity Amanda Wardle/ Kate Mckenna Amanda Wardle Amanda Wardle / Dean Solanki Sep-15 Oct-15 Team over established by agreed number of posts Awaiting start date. HR to confirm by 15 th October 2015 Oct-15 Dec-15 All accepted referrals meet new agreed criteria FT to agree new referral criteria as part of new service specification. Sep-15 Nov-15 Reduction in DNA rate maximum use of clinic capacity Work commenced using bench marking data and qualitative assessment of previous month DNAs Minimise loss of capacity due to sickness Manage sickness in accordance with Trust policy Amanda Wardle On-going On-going All staff are managed in line with the Trust sickness policy Recent audit shows team fully complaint with policy and all sickness is being managed. All the sickness here is in admin & clerical staff - both of whom are now back at work so sickness expected to be significantly better in October reports. Work force: Review causes of sickness to identify trends meet demand meet demand meet demand meet demand Responsiven ess: Agree and implement best practice to manage waiting times. Work with workforce and Occ. Health to identify trends and agree team management Review all staff current case load and agree job plans with define new to follow up ratios Review skill mix and case load allocation to maximise efficiency Review triage system to ensure effective work load allocation deflect inappropriate Arrange meeting with business manager for INT to ensure there is no duplication of work load or Work with community falls team to learn from actions taken to improve waiting times with in that team Kate McKenna / Amanda Wardle Amanda Wardle Kate McKenna / Amanada Wardle Kate McKenna/ Amanda Wardle Kate McKenna/ Amanda Wardle / Lynne Price Kate McKenna / Sarah Rutherfor d/ Amanda Wardle Oct-15 Nov-15 Trends of cause of sickness identified Work to be commenced Oct-15 Jan-15 All staff have agreed job plans All staff have job plans Oct-15 Dec-15 Activity is untaken by appropriately skilled staff Review current skill mix and match against skill level required for the work. Oct-15 Nov-15 Confirmation that triage is effective as per service specification Manager and commissioner to review current referral criteria and triage to agree work that should no longer fall under remit of CNRT Oct-15 Dec-15 Agreement is reached regarding dovetailing of criteria for the two services Meeting to be arranged for week commencing 12 th October 2015 Oct-15 Nov-15 Waiting times reduced to within target Meeting to be arranged week commencing 12 th October 2015

13 Rheumatology Therapy: Long waiting times for Counselling Objective Action Required Provider Lead Person Start Date Completion Date Measurable Outcome Position/Progress Statement RAG Status To reduce waiting times for Counselling assessment. (current waiting time for assessment is up to 40 weeks). Previous action plan submitted outling current wait times; previous actions that have given short term reductions in waiting times; up to date Demand figures. Extra staffing required: 3 months of fulltime counsellor to assit with clearing backlog; on-going 0.6 WTE band 6 counsellor; on-going uplift of rotational band 5 physio to be replaced with Band 7 Physio. Julia Stell To reduce waiting times for the counsellingled Fibromyalgia Self-management Programme - following initial assessment As above Julia Stell To reduce wiaiting times for physiotherapy assessment and intervention (current waiting time is 10 weeks). As above Julia Stell As soon as funding agreed As soon as funding agreed As soon as funding agreed Reduction in waiting times Reduction in waiting times Reduction in waiting times Unable to progress with assessment wait times reduction until additional funding agreed for staffing. Implementing changes to running of self-management programme (e.g. compressing from 6 weeks programme to 4 weeks programme / possibility of implementiong opt-in process). Unable to progress with assessment wait times reduction until additional funding agreed for staffing. Unable to progress with assessment wait times reduction until additional funding agreed for staffing.

14 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Community Services - Adults Referrals Actual Actual Target Actual Target Actual Referrals - GP 2,652 2,631 2,727 2,162 13,635 13,456 Other referrals for Asylum Seekers are increasing due to the increase in the number of Asylum Seekers. Other referrals for Dermatology Surgery have increased during August due to the transfer of patients from RBH to Waters Meeting where there is see the patients. Referral and Assessment Team Other referrals have increased due to the presence of the team within the A&E Department now on a daily basis, deflecting hospital admissions. Intermediate Care Domiciliary Other referrals are double plan reflecting the activity delivered by the additional staff recruited to the service as part of BCF investment. Wheelchair Service referrals are expected to rise in the summer months and tend to reduce over winter. Referrals - Other 3,544 3,729 3,300 3,149 16,500 16,927 As above. Re-referrals < 90 Days ,626 See below. Re-referrals < 90 Days Rate 8.3% 8.9% 5.0% 8.6% 5.0% 8.6% Re-referral rates are affected by services applying the access policy of DNA patients being referred back to referrer (e.g. Adult SALT, Diabetes, MSK Therapy, Neuro LTC), emergency risk assessments (e.g. Stroke) and patients with deteriorating conditions (e.g. Palliative Care). The increase in District Nursing Domiciliary and Treatment Room re-referral rates are due to the on-going conditions of the patients and intermittent interventions as patients conditions fluctuate. 17/09/ :54 Page: 1 of 8 XRBH\gyoung2

15 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Waiting Times Actual Actual Target Actual Target Actual Referrals Seen < 4 Weeks - Routine 66.2% 67.0% 90.0% 67.8% 90.0% 68.7% Falls service waiters were addressed during Community Perfect Week with discussions also to improve the processing of referrals to this service. An action plan has been agreed between the FT and CCG to reduce the wait time to 4-6 weeks for MSK Therapy. Although not reflected in these numbers, the waiting times for this service are reducing and patients are expected to be seen within 8 weeks. The waiting times are also affected by patient choice. BI will work with the service to data-cleanse this activity. Podiatry patients are being seen within 6 weeks - data cleansing will assist in improving this indicator percentage. Waiting times are expected to reduce with the end of AQP. Review of the service spec with the CCG is on-going. Referrals Seen < 4 Weeks - Urgent 65.3% 70.8% 95.0% 84.1% 95.0% 71.1% There are a number of services with high patient volumes where patients are always seen in a timely manner in accordance with clinical need, e.g. District Nursing Domiciliary, Anticoagulation and District Nursing Treatment Room. This activity is not captured as "urgent" referrals and therefore does not contribute to this indicator. Of the services which do capture urgent referrals, the numbers are low and therefore percentage achievement is likely to vary significantly. Referrals Seen < 12 Weeks 95.2% 95.6% 95.0% 95.4% 95.0% 95.4% Wheelchair services performance for this indicator will be improved with data-cleansing. The service has agreed an action plan with the CCG around powered wheelchairs which will have a negative impact on waiting times through September. Referrals Seen < 18 Weeks 97.7% 97.9% 95.0% 98.2% 95.0% 97.8% Podiatry waiting times are expected to improve following data-cleansing. 17/09/ :54 Page: 2 of 8 XRBH\gyoung2

16 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Activity and Access Actual Actual Target Actual Target Actual Activity - First 7,645 7,554 7,824 6,533 39,120 36,131 District Nursing Domiciliary activity is affected by seasonal variation. A decrease in activity during August was expected. Rheumatology Therapy activity has increased due to the central booking service now recording patients. Previously all activity was linked to a Rheumatology medical referral, now every new patient received is logged as new to Rheumatology Therapy. Rheumatology Department activity has reduced due to consultant leave and the SPR vacancy from August rotation. Activity for Active Case Management has decreased significantly due to service redesign and the care now being delivered by the integrated neighbourhood team community nursing model. Dietetics Community Weight Management service follows a quarterly cycle based on the 8 week programmes offered to patients which explains the monthly variation observed. A change in the LA commissioned service should see a drop in Face to Face attendances and an increase in telephone activity in the months ahead. DNA - First ,066 See below. DNA Rate - First 6.9% 7.4% 5.0% 7.2% 5.0% 6.8% MSK Therapy DNA rates will reduce as the waiting times reduce. Podiatry has already identified and noted the high DNA rate this month and are working with BI on identifying problem areas. Activity - Follow-up 45,489 47,844 43,690 38, , ,825 See Activity - First DNA - Follow-up 1,508 1,651-1,365-7,358 See DNA Rate - First DNA Rate - Follow-up 3.5% 3.6% 8.0% 3.7% 8.0% 3.5% See DNA Rate - First Telephone Clinics , ,120 4,701 Activity is below plan by 8.2%. Plans are in place to ensure improved utilisation of this service such as Intermediate Care Domiciliary which has increased Telephone Contacts with patients to discuss care, offer advice and reviews over the phone. Appointments Cancelled < 1 Week of Due Date 0.8% 0.8% 3.0% 0.8% 3.0% 0.8% Performance is consistently below plan. 17/09/ :54 Page: 3 of 8 XRBH\gyoung2

17 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Patient Experience and Outcomes Actual Actual Target Actual Target Actual Friends and Family - Recommend Rate 94.0% 93.3% 85.0% 85.0% 94.0% Adults' services are currently achieving the target with a recommended rate of 94% against a target of 85%. Complaints The complaint against Rheumatology Department is being handled directly by the Operational Business Manager and relates to an unconfirmed diagnosis. Complaints - Responded < 35 Days 100.0% 95.0% 95.0% 90.0% All 3 complaints received in June were responded to within time scale. Complaints - Per 1,000 Contacts On average there are only 0.1 complaints per 1,000 contacts. Compliments ,167 Envoy have advised that they have had technical issues which have resulted in a lower than expected response rate being recorded. We expect that this figure will be revised in next month's report. Referrer Feedback GP Satisfaction with Service 85.0% 0.0% 85.0% 0.0% The Trust is in discussion with the CCG regarding collection of GP satisfaction data. Staffing WTE in Post All workforce figures are now being reported one month in arrears to allow more time for services to analyse the data and provide meaningful commentary. WTE v Establishment 91.4% 91.9% 95.0% 95.0% 92.0% In total there are currently 45.6 WTE vacancies in Adult community services resulting in an underperformance against this indicator. Sickness Absence Rate 5.0% 5.0% 4.2% 4.2% 4.9% Sickness absence rate is above target for the quarter. The Trust has a comprehensive programme in place to improve sickness absence rates through the implementation of the People Strategy. It is anticipated that over time this indicator will improve as a result of this. Staff Turnover 11.7% 11.4% 10.0% 10.0% 11.7% Staff turnover remains above target. Appraisals 74.3% 78.3% 80.0% 80.0% 78.8% Appraisals were below target for July 15. Action is being taken to ensure that the target is maintained going forward. Mandatory Training Compliance 87.3% 89.5% 85.0% 85.0% 87.0% The target is consistently being achieved Statutory Training Compliance 92.6% 94.0% 98.0% 98.0% 92.5% Performance has decreased further and this is being addressed. Safeguarding Compliance 95.4% 96.0% 95.0% 95.0% 95.6% The target is consistently being achieved 17/09/ :54 Page: 4 of 8 XRBH\gyoung2

18 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Harm-free Care Actual Actual Target Actual Target Actual Incidents The number of reported incidents have reduced slightly in August. Staff are being encouraged to report incidents. Incidents - Moderate or Severe Rate 1.9% 1.6% 3.0% 1.2% 3.0% 1.4% The proportion of incidents that result in moderate or severe harm is well below target. Pressure Damage - Grade The Grade 4 ulcer was considered avoidable, but this is subject to Senior Review. The Grade 3 was unavoidable. Of the Grade 2s, three were avoidable, although one of these was not attributable to the Trust, and four were unavoidable. Pressure Damage - Grade As above. Pressure Damage - Grade As above. Patient Falls The number of falls continues to increase as expected in line with the overall increase in incident reporting. Hand Hygiene 98.8% 98.7% 98.0% 99.1% 98.0% 98.6% The target is being achieved. 17/09/ :54 Page: 5 of 8 XRBH\gyoung2

19 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Community Services - Children Referrals Actual Actual Target Actual Target Actual Referrals - GP ,540 2,436 Referrals to Children's services are term-time affected. We expect to see a decrease in referrals across many Children's community services. Referrals - Other 1,735 1,821 1,710 1,280 8,550 8,194 As above. Re-referrals < 90 Days See below. Re-referrals < 90 Days Rate 7.5% 6.8% 5.0% 6.6% 5.0% 7.2% The high numbers within Paediatric Audiology are due to the implementation of an opt-in policy in order to reduce DNAs. Waiting Times Referrals Seen < 4 Weeks - Routine 75.8% 76.7% 90.0% 75.4% 90.0% 75.8% All Divisions have been asked to draw up a plan to achieve a maximum 4 week wait within a defined timescale. For some services this can be done within existing resources, for others non recurrent investment is required, and for a number of services further discussion is required with the CCG around the requirements of services specifications and how these can be met as the service is currently configured. Services with problematic waiting times data have been targeted during the Community Perfect Week beginning 08 September. There are vacancies in services which are affiliated to the unsuccessful 5-19 tender. The Trust will be in discussion with the new provider regarding these however any delays in recruitment may result in longer waits. Referrals Seen < 4 Weeks - Urgent 100.0% 95.0% 0.0% 95.0% 55.6% Of the services which do capture urgent referrals, the numbers are low and therefore percentage achievement is likely to vary significantly. Referrals Seen < 12 Weeks 92.4% 92.8% 95.0% 92.6% 95.0% 92.1% As above. Referrals Seen < 18 Weeks 93.9% 94.7% 95.0% 96.0% 95.0% 94.1% There are a number of services with high patient volumes where patients are always seen in a timely manner in accordance with clinical need, e.g Health Visiting. The waiting times for these services are very short. Data-cleansing with assistance from the BI will improve this indicator. 17/09/ :54 Page: 6 of 8 XRBH\gyoung2

20 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Activity and Access Actual Actual Target Actual Target Actual Activity - First 2,899 3,064 2,840 2,573 14,200 14,395 Referrals to Children's services are term-time affected. We expect to see a decrease in referrals across many Children's community services. DNA - First See below. DNA Rate - First 7.1% 6.8% 5.0% 6.5% 5.0% 6.7% The DNA Rate for children's services continues to decrease. A ring and remind pilot in underway in Paediatrics; intelligence received from this will be reviewed and will inform an action plan. DNAs within Children's services are affected by term-time patterns. Failed home visits within services e.g. Health Visiting are more noticeable during the summer months. Activity - Follow-up 17,106 14,660 14,765 9,532 73,825 73,739 See Activity - First. DNA - Follow-up ,618 See below. DNA Rate - Follow-up 2.6% 3.4% 8.0% 3.8% 8.0% 3.1% See DNA Rate - First Telephone Clinics 1,559 1,480 1,025 1,089 5,125 7,026 Paediatric Continuing Care telephone contacts have increased due to being embedded for improved efficiency and now includes the respiratory team that uses self management and empowerment as part of their delivery model. Telephone contacts are being embedded across services to improve efficiency and the services are developing a model of care based on self-help and family empowerment. Appointments Cancelled < 1 Week of Due Date Patient Experience and Outcomes 0.3% 0.3% 3.0% 0.5% 3.0% 0.3% Performance is consistently below plan. Friends and Family - Recommend Rate 92.5% 91.8% 85.0% 85.0% 91.0% Envoy have advised that they have had technical issues which have resulted in a lower than expected response rate being recorded. We expect that this figure will be revised in next month's report. Complaints No complaints were received in August for children's services. Complaints - Responded < 35 Days 100.0% 95.0% 95.0% 100.0% Complaints - Per 1,000 Contacts On average there are only 0.1 complaints per 1,000 contacts. Compliments Compliments are now being systematically collected and this has resulted in a continued increase. Referrer Feedback GP Satisfaction with Service 85.0% 0.0% 85.0% 0.0% The Trust is in discussion with the CCG regarding collection of GP satisfaction data. 17/09/ :54 Page: 7 of 8 XRBH\gyoung2

21 Community Summary 2015/2016 Indicator Trend Jun Jul Aug YTD Commentary Staffing Actual Actual Target Actual Target Actual WTE in Post See below. WTE v Establishment 95.2% 94.5% 95.0% 95.0% 94.8% The target is slightly below plan with a total of 15.0 WTE vacancies. The Trust will be in discussion with the new provider of 5-19 services regarding vacancies in affected services. Sickness Absence Rate 4.8% 4.5% 4.2% 4.2% 4.8% Sickness absence rate is above target for the quarter. The Trust has a comprehensive programme in place to improve sickness absence rates through the implementation of the People Strategy. It is anticipated that over time this indicator will improve as a result of this. Staff Turnover 12.2% 11.4% 10.0% 10.0% 11.5% Staff turnover remains slightly above target. Appraisals 88.3% 86.2% 80.0% 80.0% 89.2% Appraisal rates have increased this month to 89.2%. Action is being taken to ensure that the target is maintained going forward. Mandatory Training Compliance 94.1% 95.3% 85.0% 85.0% 93.7% The target is consistently being achieved Statutory Training Compliance 97.6% 97.1% 98.0% 98.0% 97.4% Performance remains slightly below plan. Safeguarding Compliance 98.3% 98.7% 95.0% 95.0% 98.4% The target is consistently being achieved Harm-free Care Incidents Staff are being encouraged to report incidents. The numbers have reduced during August 2015, due to seasonal effects (eg term-time). Incidents - Moderate or Severe Rate 0.0% 0.0% 3.0% 0.0% 3.0% 0.7% The proportion of incidents that result in moderate or severe harm is well below target. Pressure Damage - Grade There were no pressure damage incidents in Children's services. Pressure Damage - Grade As above. Pressure Damage - Grade As above. Patient Falls There were no patient falls in August. Hand Hygiene 98.0% 99.8% 98.0% 96.6% 98.0% 98.5% The target has failed this month in services Health Visiting, LAC and School Nursing. 17/09/ :54 Page: 8 of 8 XRBH\gyoung2