Executive Summary: This report focuses on month 10 data of the 2017/18 financial year, January 2018, unless otherwise indicated.

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1 Agenda item: 3.1 Paper No: 8 Committee: Venue: Governing Body The Boardroom, Dominion House : 27/03/2018 Status: FOR REVIEW AND DISCUSSION Title of Report Performance Report: Month 10, January 2018 Presented by Author Finance Lead Sign off (Detail to be included in Implications Financial/Resource) Conflict of Interest Identified Governance and Reporting at which other meeting has this paper been discussed Vicky Stobbart, Managing Director Adam Binnie - Senior Information Analyst Karen McDowell, Chief Finance Officer, Surrey Heartlands s No Commissioning, Finance, and Performance Committee, 20/03/2018 APPROVED 20/03/2018 Executive Summary: This report focuses on month 10 data of the /18 financial year, January 2018, unless otherwise indicated. The s performance against the NHS Constitution standards improved at month 10 compared with month 9, with the number of green metrics increasing from 7 to 9. The number of red metrics decreased from 5 to 4 and the number of amber metrics decreased from 3 to 2. The performance at Royal Surrey County Hospital NHS Foundation Trust (RSCH) remained the same at month 10 compared with month 9, with the number of green metrics remaining at 10, amber at 2 and red at 6. On 22nd November SECAmb implemented the new national response standards for ambulance services as part of the Ambulance Response Programme. The Red 1, 2, and A19 metrics have now been replaced. See Section 4 of this report for information relating to the new national response standards. The key risks (rated red and amber) highlighted are: Number of patients waiting more than 52 weeks () A&E 4 hour target (RSCH) Mixed Sex Accommodation breaches () Cancer waits: 31 days to subsequent treatment (Radiotherapy) () Cancer waits: 62 days from Screening Service referral () Performance Report, Month 10, /18, Governing Body 1

2 Cancer waits: 62 days from urgent GP referrals (RSCH) Ambulance Handovers: over 30 minute breaches (RSCH) Ambulance Handovers over 60 minute breaches (RSCH) C. difficile infections (RSCH) Cancelled operations (RSCH) Diagnostic Waiting Times (RSCH & ) Cancer waits: 62 days from Screening Service referral (RSCH) Cancer waits: 62 days from urgent GP referrals () Implications: Health/ strategic objectives Financial/Resource Legal/compliance Equality Analysis Patient and Public Engagement Risk (including reputational) and rating We will improve the health of our local population. We will improve and continually check the quality and safety of patient services. Quality Premium /18: The will receive a reduced Quality Premium (QP) if there is adverse performance in: the Financial Gateway, Quality Gateway, four NHS Constitution measures or 7 QP measures. An overview of the schemes is highlighted in a summary table in Section 4 of this report, with an assessment of the predicted achievement of the various measures, where data is available. This will be based on Quarter 4 /18 performance only. Compliance against statutory targets is affected by adverse performance as reported for month, January Not indicated. The commissions services in order to meet the equality requirements of all protected groups. No specific issues within this report. There are risks described within the Board Assurance Framework (BAF) which cover the performance issues. Poor performance against some of the targets will lead to deterioration in the balanced scorecard performance of the and increased scrutiny by the Local Area Team. Recommendation(s): TO NOTE the areas of adverse performance and the actions identified to rectify. Next Steps: To note the contents of the Performance Report, the action within it, and the risks. Performance Report, Month 10, /18, Governing Body 2

3 NHS Guildford & Waverley Clinical Commissioning Group Performance Report for the Period to 31 January 2018 Performance Report, Month 10, /18, Governing Body 3

4 1. Guildford and Waverley Clinical Commissioning Group Performance Report Month 10: January 2018 data (where available) 1.1. This report reflects formal reporting against performance targets and Key Performance Indicators as outlined in the Improvement and Assessment Framework / It summarises performance against the key areas listed below and forms the basis of the Local Area Team s quarterly assurance meetings: NHS Constitution Quality Premium Outcome Indicator Set Operating plan 1.3. A RAG rating has been applied to each indicator using the tolerances set nationally for each indicator The table below illustrates the summary of performance against the indicators for January 2018 (or latest data available, where specified). Number of indicators with RAG (Arrow indicates increase or decrease on previous month's position.) Constitution Group Red Amber Green Total G&W : NHS Constitution RSCH: NHS Constitution Performance Report, Month 10, /18, Governing Body 4

5 1.5. Based on the latest monthly data, the performance for all metrics in the NHS Constitution at and provider level is set out as in the following table. The 14 key risks highlighted in the report focus on indicators not highlighted in grey (indicators 2.1 to 2.10 and 3.1 to 3.3). For year to date performance across all metrics in the NHS Constitution Dashboard, please refer to Appendices B, C and D at the end of this report. Indicator Performance Risks RSCH G&W SECAmb 2.1 Number of patients waiting more than 52 weeks G R N/A 2.2 A&E 4 hour target R N/A N/A 2.3 Mixed Sex Accommodation breaches G R N/A 2.4 Cancer waits: 31 days to subsequent treatment (Radiotherapy) G R N/A 3.2 / 2.5 Cancer waits: 62 days from Screening Service referral A R N/A 3.3 / 2.6 Cancer waits: 62 days from urgent GP referrals R A N/A 2.7 Ambulance Handovers: over 30 minutes R N/A N/A 2.8 Ambulance Handovers: over 60 minutes R N/A N/A 2.9 C.difficile infections R G N/A 2.10 Cancelled operations (Quarter 3) R N/A N/A 3.1 Diagnostics Waiting Times (within 6 weeks) A A N/A 4.1 Referral to Treatment Pathways: Incomplete (within 18 weeks) G G N/A 4.2 Cancer waits: 2 week rule (Urgent GP referral) G G N/A 4.3 Cancer waits: 2 week wait (Exhibited Non-Cancer breast symptoms) G G N/A 4.4 Cancer waits: 31 days to first treatment G G N/A 4.5 Cancer waits: 31 days to subsequent treatment (Drugs) G G N/A 4.6 Cancer waits: 31 days to subsequent treatment (Surgery) G G N/A 4.7 MRSA Bacteraemia G G N/A 4.11 Care Programme Approach (CPA) N/A G N/A TOTAL Performance Report, Month 10, /18, Governing Body 5

6 2.1 Number of Patients waiting more than 52 Weeks: 2 Below Performance Standards: RED [G&W ] Performance Metrics Number of Patients Waiting More Than 52 Weeks Provider Issue Updates and actions being taken Timescale Owner Imperial College Healthcare NHS Trust (ICHT) The is sent a list of 52 week breaches by NHS Brent for all breaches at Imperial College Healthcare NHS Trust. The Maxillo-Facial Surgery patient was identified through waiting list validation and the patient has been sent a validation letter by the Trust. Imperial College reported 1 G&W RTT patient waiting more than 52 weeks for definitive treatment under the speciality Other (Maxillo- Facial Surgery) 2.2 Mixed Sex Accommodation breaches: The Trust is reporting a total of 267 breaches in January. Each patient is subject to a clinical review to make sure that their care plan is appropriate in view of the time they have waited for treatment, and the Trust are expediting the treatment of all long-waiting patients wherever possible. On-going Contracts, G&W, Senior Information Analyst, G&W [G&W ] Performance Metrics Mixed Sex Accommodation (MSA) Provider Issue Updates and actions being taken Timescale Owner Epsom & St Helier University NHS Trust The three breaches occurred at Epsom and St Helier University Hospitals NHS Trust. There were 3 reported Mixed Sex Accommodation Breach involving a G&W patient. For the first time in a number of years the Trust has reported a number of mixed sex accommodation breaches. The Trust always works very hard to ensure they do not place patients of mixed sexes in the same bays to sleep or share bathrooms. During January 2018 the Trust had unprecedented numbers of emergency admissions and in order to manage the admissions safely they had to mix sexes on some occasions. This involved 75 patients over a 3 week period. Each time the Trust had to breach mixed sex accommodation guidance the decision was agreed with either the Chief Nurse or Chief Executive. The Trust also informed regulators NHSI. Contracts, G&W Senior Information Analyst, G&W The Trust developed a leaflet to give to patients advising them why they had to be nursed in a mixed sex bay and also wrote a protocol to ensure only those patients who were able to mobilise and get dressed would be looked after in mixed sex accommodation. Complete Performance Report, Month 10, /18, Governing Body 6

7 2.3 A&E 4 hour target 2 Below Performance Standards: RED [RSCH] Performance Metrics A&E Monthly Performance 95.0% 93.2% 91.3% 94.2% 97.6% 95.4% 93.6% 95.3% 100% [RSCH] - A&E Monthly & Quarterly Performance 95% 90% 85% 80% 75% March April May June July August September October November December January 2018 February hr Performance AE Provider Issue Update and actions being taken Timescale Owner RSCH RSCH did not achieve the 95% standard in December (94.2%). The Trust did not achieve the national 4 hour standard in January for the third consecutive month; however year to date the Trust is still rated as green. Although the Trust delivered a performance of 94.2% they were listed as the 5th best performing acute Trust in the country. The contributing factors relating to underperformance in January are consistent with the previous couple of month s themes with the additional pressure of increased activity in the week following New Year s day. Delayed Transfers of Care (DTOCs) had steadily increased in December which contributed to the poor performance in the first week of January; however over the month of January the Trust along with Community and Adult social care continued to work closely to expedite discharges and reduce the number of DTOCs. Continuing from late December in to early January there were a number of small outbreaks of flu in care homes which impacted on RSCH s ability to discharge patients. Deputy Commissioning, G&W and Chief Operating Officer for Royal Surrey County Hospital There are additional service delivery shifts in place in the emergency department, a discharge team at the weekend with additional matron support which continued until the end of February. End of Feb 18 Additional CHC support has been implemented to support discharges and improve flow. Performance Report, Month 10, /18, Governing Body 7

8 2 Below Performance Standards: RED 2.4 Cancer Waits: 31 Days to subsequent Treatment (Radiotherapy) 2.5 Cancer Waits: 62 Days from screening service referral: [G&W ] Performance Metrics Cancer Waits: 31 Days to subsequent Treatment (Radiotherapy) 94.0% 85.7% 85.7% 84.6% 94.3% 90.5% 90.2% 91.2% [G&W ] Performance Metrics Cancer Waits: 62 Days from Screening service referral 90.0% 100.0% 85.7% 80.0% 100.0% 87.5% 94.4% 92.1% 100% [G&W ] - Cancer Waits: 31 Days to subsequent Treatment (Radiotherapy) 95% 1 Patient 90% 4 Patients 85% 80% February March April May June July August September October November December January 2018 CWT 31 Day PercMeeting Standard Provider Issue Updates and actions being taken G&W 31 Days to subsequent Treatment (Radiotherapy): The did not meet the national standard in January (84.6% achieved). There were a total of 4 patients waiting more than 31 days for subsequent treatment for Radiotherapy. Three of the breaches were due to patient choice and one was a complex clinical pathway. G&W holds monthly contract and quality review meetings with RSCH. It enables the to assure itself on progress around recovery trajectories, systems and processes. Due to the nature of the breaches for 31 Day Radiotherapy the has taken no action around seeking assurance for this month. Timescale Weekly at RSCH APMG, and PTL meetings, monthly at G&W Cancer Sub- Group. Owner Chief Operating Officer RSCH; and Contracts, Interim Quality & Improveme nt, G&W, Senior Information Analyst, GW Provider Issue Updates and actions being taken G&W G&W did not meet the national standard (80.0%) in January. There was 1 patient waiting more than 62 days for treatment from screening service referral. G&W holds monthly contract and quality review meetings with RSCH. It enables the to assure itself on progress around recovery trajectories, systems and processes. The G&W breach is counted in the RSCH data and assurance is provided on Page 13 Section 3.2 of this report. Timescale Weekly at RSCH APMG and PTL meetings; monthly at G&W Cancer Sub- Group. Owner Chief Operating Officer RSCH; and Contracts, Interim Quality & Improvement G&W, Senior Information Analyst, G&W Performance Report, Month 10, /18, Governing Body 8

9 2.6 Cancer waits: 62 days from urgent GP referrals: RSCH 2 Below Performance Standards: RED [RSCH] Performance Metrics Cancer Waits: 62 Days from Urgent GP referrals 85.0% 72.3% 78.2% 74.8% 79.0% 76.4% 75.8% 76.8% 90% [RSCH] - Cancer Waits: 62 Days from Urgent GP referrals 85% 80% 75% 70% 65% February March April May June July August September October November December January 2018 CWT 62 Day Urg GP PercMeeting Standard Provider Issue Updates and actions being taken Timescale Owner RSCH 62 Days from - GP referrals: RSCH did not meet the national standard (74.8% achieved) in January. There were a total of 28 patients waiting more than 62 days for treatment from urgent GP referral. The vast majority were due to late referrals from other Cancer Centres (17) with 6 being due to complex pathways and the remaining 5 being due to a variety of reasons. G&W holds monthly contract and quality review meetings with RSCH. It enables the to assure itself on progress around recovery trajectories, systems and processes. In January RSCH performance for Cancer 62 days from Urgent GP Referral declined. Shadow monitoring re-allocation of breaches for January puts performance at 84%; however the actual reported performance was 74.8%. The main reason for breaching the target continues to be late referrals from other Cancer Centres, with the majority of breaches being received by RSCH after the 62 day target. The Inter Trust Pathway Facilitator has been in post since November. They are supporting management of patients being referred from other Cancer Centres and analysis of delayed referrals is being shared with those centres in order to develop options to improve the their timeliness. The Trust is to appoint a Urology 24 Day Tracker with money from NHSI to provide dedicated support to delivery of the urology cancer pathway. Weekly at RSCH APMG and PTL meetings; monthly at G&W Cancer Sub- Group. On-going The impact of the breaches were categorised as delayed surgery (15), drugs regimens (9), teletherapy (4), chemoradiotherapy (3) and brachytherapy (1) RSCH continue daily review meetings for Urology, Head and Neck, Gynae, Breast and GI alongside a weekly all tumour site review meeting. Delayed diagnostics due to Patient Choice Clinical Nurse Specialists are speaking to patients to support their decision making in most circumstances, working with Clinicians and GP s in managing patient responsibility to attend/referral as appropriate. On-going On-going Chief Operating Officer RSCH; and Contracts, Interim Quality & Improvement, G&W, Senior Information Analyst, GW Performance Report, Month 10, /18, Governing Body 9

10 2 Below Performance Standards: RED 2.7 Ambulance Handovers: over 30 minutes: RSCH 2.8 Ambulance Handovers over 60 minutes: RSCH [RSCH] Performance Metrics All handovers between ambulance and A&E must take place within 15 minutes with none taking over 30 minutes [RSCH] Performance Metrics All handovers between ambulance and A&E must take place within 15 minutes with none taking over 60 minutes [RSCH] - All handovers between ambulance and A&E must take place within 15 minutes with none taking over 30 minutes 35 [RSCH] - All handovers between ambulance and A&E must take place within 15 minutes with none taking over 60 minutes February March April May June July August September October November December January February March April May June July August September October November December January 2018 Total Total Provider Issue Updates and actions being taken Timescale Owner RSCH There were 200 breaches over 30 minutes and 12 breaches over 60 minutes in December. In January the number of hospital handover delays over 30 minutes and 60 minutes improved when compared with December. The number of handover delays continues to be over double the maximum level that was agreed with commissioners, however the Trust are in line with performance at the other commissioned acute trusts. Handover delays, particularly those over 60 minutes continue to have a detrimental impact on patient experience and availability of resources to respond to 999 calls. The issues during December and January have been reflected pretty much across the country so are not specific to the South East region. 30/04/18 SECAmb have established a Hospital Handover Project which will look at reducing the hours lost at ambulance handover with specific focus on reducing delays over 30mins and 60 minutes. The aim of the project is to also reduce the response times in the community. Work continues in conjunction with the s by SECAmb s strategy team to reduce handover delays, returning hours back into the system with the support of a dedicated programme manager. Monthly meetings are taking place with colleagues from the acute sector to review new ways of collaborative working to aim for an improved handover position. Locally we have a targeted approach to ensuring we adhere to the Standard Operating Procedure for handovers. Please see Section 4 of this report on the new Ambulance Response Times which have an impact on hospital handovers. Executive Lead, SECAmb AD of Contract, RSCH; Head of Non-Acute Contracts G&W Performance Report, Month 10, /18, Governing Body 10

11 2.9 C. difficile infections: RSCH [RSCH] Performance Metrics 2 Below Performance Standards: RED C difficile Infections (Apportioned to Trust) In month [RSCH] - C.difficile infections (Apportioned to Acute Trust) in Month Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 [RSCH] - C.Difficile infections (Apportioned to Acute Trust) YTD (not including this month) [RSCH] - C.Difficile infections (Apportioned to Acute Trust) In Month Annual Provider Issue Updates and actions being taken Timescale Owner Acute and Community providers Reviewed monthly RSCH had 2 cases of Trust Acquired C. difficile. The maximum number of permitted cases for /18 is 21. This brings the year to date total to 18. All cases of C difficile at Royal Surrey are subject to a Root Cause Analysis multi-disciplinary meeting chaired by the Consultant Microbiologist and attended by the Associate Quality and Improvement, the Designate for the Quality. Once the Root Cause Analysis Meeting has been held, the paperwork is submitted to the s Serious Incident Committee. They review it and either confirm or reject or seek further clarification of the recommendation around the lapse in care decision. The Committee reviews C. difficile cases that occur at the Royal Surrey as well as Guildford and Waverley patients regardless of where they were treated. If there is more than one case that is linked e.g. on a ward, the hospital also holds a Period of Increased Incidence (PII) meeting which considers the increased prevalence and this is chaired by RSCH Infection Control. In cases of C. difficile acquired in the community, there is the same level of review which is led by the Designated Nurse for Safeguarding Adults. A report on the lessons learned is presented to the Serious Incident Committee and the learning is shared with the relevant Trust and GP. The Surrey Infection Prevention and Control Committee oversee the infection rates and learning across Surrey as a whole. The Associate Quality attends its bi-monthly meetings as the Designate for the Quality. Interim AD of Quality and Improve -ment, and Medical Director, RSCH Performance Report, Month 10, /18, Governing Body 11

12 3.1 Diagnostics within 6 weeks RSCH [RSCH] Performance Metrics Diagnostic Waiting Times (Within 6 weeks) 99.0% 98.6% 97.4% 96.9% 92.7% 97.6% 98.6% 96.1% 3 Below Performance Standards: AMBER [G&W ] Performance Metrics Diagnostic Waiting Times (Within 6 weeks) 99.0% 98.6% 97.5% 96.8% 93.0% 98.3% 98.6% 96.5% [RSCH] - DM01 Diagnostic Waiting Times (within 6 Weeks) [G&W ] - DM01 Diagnostic Waiting Times (within 6 weeks) 102% 102% 100% 100% 98% 98% 96% 96% 94% 94% 92% 92% 90% 90% 88% 88% 86% February March April May June July August September October November December January 86% February March April May June July August September October November December January Performance Performance Provider Issue Updates and actions being taken Timescale Owner RSCH At RSCH, the national standard was not G&W holds monthly contract and quality review meetings with RSCH. It enables the Reviewed met (96.9%) with 98 of patients waiting to assure itself on progress around recovery trajectories, systems and processes. monthly at longer than 6 weeks. Contract 87% (85) of the Trusts breaches were in Underperformance in January for both RSCH and the was primarily due to breaches Review Cardiology Echocardiography. 6 in Echocardiography which accounted for 87% of all the RSCH s six week breaches. Meeting breaches were in Cystoscopy and the and APMG at remainder of the breaches (7) were RSCH across the other modalities. G&W At G&W, the national standard was not met (96.8%), with 83 G&W patients waiting longer than 6 weeks. The majority of breaches were in Cardiology - Echocardiography (64). The remainder of breaches (19) were across the other modalities. The issues were primarily around a lack of sufficient capacity to meet demand and inconsistencies in bookings with patients being booked out of sequence. There have also been inconsistencies with the way referrals have been triaged in the specialty, typically with those tests performed by the Associate Specialist which has led to batching issues. The Head of Appointments Centre is ensuring the team is booking all tests correctly and is having daily meetings with the booking team and the Interim Head of Service for Medicine. A new trajectory has been modelled using the Intensive Support Team backlog reduction tool which projects the Trust will be compliant in April following the additional capacity in February, which is scheduled to continue through March and April. April 2018 Associate Contracts, RSCH and Contracts, G&W, Senior Information Analyst, G&W RSCH Performance Report, Month 10, /18, Governing Body 12

13 2 Below Performance Standards: AMBER 3.2 Cancer Waits: 62 Days from screening service referral: 3.3 Cancer waits: 62 days from urgent GP referrals: RSCH [RSCH] Performance Metrics Cancer Waits: 62 Days from Screening service referral 90.0% 100.0% 72.7% 88.9% 88.9% 93.8% 88.6% 90.2% 2 Patients Provider Issue Updates and actions being taken RSCH 62 Days from - G&W holds monthly Screening: contract and quality review RSCH did not meetings with RSCH. It meet the enables the to assure national itself on progress around standard (88.9% recovery trajectories, achieved) in systems and processes. January. There were a total of 2 Both RSCH breaches were patients waiting due to complex clinical more than 62 pathways and due to the days for nature of these breaches for treatment from 62 Day Screening the screening has taken no action around service referral. seeking assurance for this month. The G&W breach is counted in the RSCH data. Timescale Weekly at RSCH APMG and PTL meetings; monthly at G&W Cancer Sub- Group. Owner Chief Operating Officer RSCH; and Contracts, Interim Quality & Improveme nt, G&W, Senior Information Analyst, G&W Provider Issue Updates and actions being taken GW & 62 Days from - GP referrals: G&W did not meet the national standard (84.0% achieved) in January. There were a total of 4 patients waiting more than 62 days for treatment from urgent GP referral. The impact of the breaches were categorised as delayed surgery (2) & drugs regimens (2). G&W holds monthly contract and quality review meetings with RSCH. It enables the to assure itself on progress around recovery trajectories, systems and processes. The 4 patients waiting longer than 62 days for treatment were all treated at the RSCH. Assurance for G&W is covered on Page 9 Section 2.6 of this report. Timescale Weekly at RSCH APMG and PTL meetings; monthly at G&W Cancer Sub- Group. Owner Chief Operating Officer RSCH; and Contracts, Interim Quality & Improvement, G&W, Senior Information Analyst, G&W Performance Report, Month 10, /18, Governing Body 13

14 4. Ambulance Response Programme (ARP) Standards December saw the first month of all English ambulance services reporting against the new ARP response standards. SECAmb went live with the new standards on the 22 nd November. Performance Expectations From September, the sanctions set out in the NHS Standard Contract which relate to the old Ambulance standards do not apply. Updated sanctions, reflecting the new standards currently being introduced, will be considered from 1 April NHS Improvement will similarly not investigate or intervene in ambulance trusts on the basis of performance standards whilst the old set are being phased out and the new set phased in. NHSE expect there to be a particular focus on Category 1 and key clinical quality indicators in these discussions, in order to ensure that the sickest patients continue to receive the fastest possible response. NHSE also expect there to be regional oversight of these arrangements, in line with winter planning and assurance processes. ARP Performance is relatively good. To date SECAmb has maintained a consistent response time to Categories 1 and 2 however much work is to be done in improving response times to Categories 3 and 4. SECAmb have provided an estimated breakdown of the activity into each of the new categories which was roughly split as follows; Category 1 Category 2 Category 3 Category 4 6% 44% 49% 1-2% January 2018 Total within 7 mins Cat 1 Cat 2 Cat 3 Cat 4 Late Mean Response Time Total within 18 mins Late Mean Response Time Total within 120 mins Late Mean Response Time Total within 180 mins Late Mean Response Time NHS East Surrey :08: :17: :12: :51:16 NHS Guildford and Waverley :08: :16: :56: :54:36 NHS North West Surrey :08: :15: :10: :56:22 NHS Surrey Downs :08: :18: :10: :43:44 NHS Surrey Heath :07: :16: :54: :32:20 SECAmb Commissioned :07: :16: :04: :41:23 Performance Report, Month 10, /18, Governing Body 14

15 5. Quality Premium -19 The Quality Premium (QP) scheme is about rewarding Clinical Commissioning Groups (s) for improvements in the quality of the services they commission. The scheme also incentivises s to improve patient health outcomes and reduce inequalities in health outcomes and improve access to services. As in previous years, it is important that we retain a focus on the fundamentals of everyday commissioning. These include delivery of the NHS Constitution commitments on Referral to Treatment (RTT) Times, A&E, Ambulance and Cancer Waiting Times; adhering to quality regulatory standards, and delivering financial balance. The QP scheme will view performance in the planning submissions round on the national and local priorities as well as on the fundamentals of commissioning to recognised standards. Under the Health Service Act 2006 (as amended by the Health and Social Care Act 2012), NHS England has the power to make payments to s to reflect the quality of services that they commission, the associated health outcomes and reductions in inequalities. In keeping with previous years, the maximum QP payment for a is expressed as 5 per head of population, calculated using the same methodology as for running costs, and made as a programme allocation. (This is in addition to a s main financial allocation and in addition to its running costs allowance). The Quality Premium is based on 5 national measures, worth 85% of the total Quality Premium available, as follows: Measures Indicator Names Weighting Early Cancer Diagnosis 17% GP Access and Experience 17% Continuing Healthcare 17% Mental Health 17% Bloodstream Infections 17% and 2 local measures, focused on the Right Care Programme, worth 15% of the Quality Premium and selected from the Commissioning for Value packs, as follows: Local Measures Indicator Detail Weighting This is a two year Quality Premium scheme. The QP paid to s in 2018/19 and 2019/20 reflects the quality of the health services commissioned by them in /18 and 2018/19. The QP award will be based on measures that cover a combination of national and local priorities, and on delivery of the gateway tests, as described below. Mental Health Measure Improve inequitable rates of access to Children & Young People s Mental Health Services 7.5% Gateways Financial: Effective use of public resources should be seen as an integral part of securing high quality services. A will not receive a quality premium if: Right Care Measure Category: Trauma & Injuries Detail: Injuries due to falls in people aged % in the view of NHS England, during the relevant financial year the has not operated in a manner that is consistent with the obligations and principles set out in Managing Public Money1; or the ends the relevant financial year with an adverse variance against the planned surplus, breakeven or deficit financial position, or requires unplanned financial support to avoid being in this position; or it receives a qualified audit report in respect of the relevant financial year Performance Report, Month 10, /18, Governing Body 15

16 Quality: NHS England also reserves the right not to make any payment where there is a serious quality failure during /18. NHS Constitution: As in previous years, a may have its quality premium award reduced via the NHS Constitution gateway. In /18, some providers will continue to have agreed bespoke trajectories, as part of the operation of the Sustainability and Transformation Fund, for delivery of RTT, four hour A&E, 62 day cancer waits and Red 1 ambulance response times. On this basis, the gateway test in respect of these measures will be adjusted to reflect these differential requirements. In keeping with the need to keep the quality premium and assessment processes well aligned, it is important to ensure alignment between the Maximum 8 minute response for Category A (Red 1) ambulance calls 25% payment of the quality premium and the NHS Constitution Gateway. Should the measures in the NHS Constitution be updated, as occurred with RTT, or expectations around the operation of the Sustainability and Transformation Fund change, NHS England may amend the above criteria in order to maintain alignment. 5.1 Overall Performance of Quality Premium Measures /18 NHS Constitution Requirement Reduction to Quality Premium Maximum 18 weeks from referral to treatment - incomplete standard 25% Maximum four hour waits in A&E departments standard 25% Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer The Quality Premium Technical Guidance Annex B for NHS planning /18 and 2018/19, outlining the Quality Premium scheme to Clinical Commissioning Groups is available through the following link It should be noted that, following confirmation with NHS England, the financial gateway for the will be monitored against the control total deficit for the organisation, rather than our current plan. This puts the entire quality premium for 1718 at significant risk and this gateway is highly unlikely to be achieved resulting in the not being eligible for receipt of the Quality Premium. 25% Performance Report, Month 10, /18, Governing Body 16

17 6. Mental Health Dashboard for Guildford and Waverley Summary Table NHS Constitution Supporting Standards Expectation Frequency Apr-17 May-17 Jun-17 Q1 Jul-17 Aug-17 Sep-17 Q2 Oct-17 Nov-17 Dec-17 Q3 Jan-18 YTD Dementia % diagnosis rate 66.70% Monthly 59.2% 58.6% 59.0% 58.8% 58.7% 59.4% 60.0% 59.9% 60.2% 61.2% 60.7% 60.8% 60.4% 59.8% IAPT Access Proportion 16.8% Annually Monthly 0.86% 1.29% 1.24% 3.39% 1.21% 1.10% 1.19% 3.50% 1.17% 1.56% 0.95% 3.69% 1.24% 11.81% IAPT Recovery Rate 50% Monthly 44.1% 48.0% 52.5% 48.5% 46.4% 51.6% 56.3% 51.7% 45.2% 50.6% 54.8% 49.8% 47.8% 49.8% Proportion of people waiting <6 weeks from referral to a course of IAPT treatment vs the no. of people who finish a course of treatment in the reporting period The proportion of people that wait 18 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period 75% by April % by April 2016 Monthly 86.6% 84.1% 87.2% 85.9% 93.0% 93.3% 93.8% 93.4% 87.4% 92.3% 97.8% 92.2% 93.6% 90.9% Monthly 99.4% 99.2% 99.6% 99.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.8% More than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved are package within two weeks of referral (in development) >50% by April 2016 Monthly 50.0% 100.0% 100.0% 71.4% 0.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 88.9% 66.7% 86.7% Guildford & Waverley are performing well against the Mental Health Constitutional Standards with the exception of Diagnosis Dementia Rates and IAPT Access. Dementia Diagnosis The current action plan for improving Dementia Diagnosis Rates; IAPT Access GP Practices continue to carry out data harmonisation to improve accuracy of registers and Egton Medical Information Systems (EMIS) coding for dementia and mild cognitive impairment (MCI) is funding a specialist Dementia Nurse Practitioner to improve identification and diagnosis of dementia in nursing and residential care, working with specific practices and care home lists based on prevalence and practice diagnosis rate Regular interface meetings with the Clinical Lead, Commissioners and Older People s Community Mental Health Team (CMHT) at SaBP. Planned mental health clinical forum on 28 February 2018 focussing on dementia Older Age Psychiatrists practice visits to improve communication & address issues Older Age Psychiatrists to attend frailty forums Access has increased slowly; an additional 31 referrals in January would have achieved the target. Two-thirds of the increase in access over the next 3 years is expected from the developing work with long-term conditions (Five Year Forward View for Mental Health). The providers signed a Memorandum of Understanding (MoU) in September to work together on integrating IAPT and long-term conditions pathways. The MoU has facilitated providers attending STP workstreams and MDT meetings, and sharing the delivery of IAPT presentations at DESMOND courses. A workshop on IAPT and long-term conditions will be held in April with a focus on diabetes, with discussions on other long-term conditions to follow, whether in workshops or at the quarterly IAPT Provider Forum. Monthly teleconferences keep the s informed of the developing pathways. Working with GP practices for opportunities to co-locate IAPT providers to work with patients with long-term conditions and frequent attenders, as well as in the primary care service. Performance Report, Month 10, /18, Governing Body 17

18 5. Recommendations The Commissioning, Finance and Performance Committee are asked to note the contents of the report and the actions described within it. 6. Appendices Appendix A: Glossary of Terms TERM ABBREVIATION ASSUMED MEANING Access Performance Management Group Ambulance Handovers APMG This is a meeting to review operational performance at RSCH which is chaired by the Chief Operating Officer. This meeting is attended by all divisional associate directors of operations, Head of Performance and includes representation from centralised patient access (outpatients and referrals management). The start time is the time of arrival of the ambulance at A&E. The end time is the time of handover of the patient to the care of A&E staff. It should occur within 15 minutes of the ambulance s arrival at A&E. Clinical Quality Review Meeting CQRM All parties (commissioner and provider) to jointly oversee the compliance of quality assurance and quality improvement. Commissioning for Quality and The CQUIN scheme is intended to deliver clinical quality improvements and drive transformational change. These will impact CQUIN Innovation on reducing inequalities in access to services, the experiences of using them and the outcomes achieved. HCAI covers a range of infections, including: methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C.difficile) and Escherichia coli (E. coli). HCAIs cover any infection Healthcare Associated Infection HCAI contracted: as a direct result of treatment in, or contact with, a health or social care setting; as a direct result of healthcare delivery in the community; as a result of an infection originally acquired outside a healthcare setting (e.g. in the community) and brought into a healthcare setting by patients, staff or visitors and transmitted to others within that setting (e.g. norovirus). NHS Constitution The Constitution for the NHS in England set out in Law and/or Guidance from time to time which establishes the principles and values of the NHS in England and sets out the rights, pledges and responsibilities for patients, the public and staff. NHS Guildford and Waverley G&W The commissioning organisation for the population of Guildford and Waverley. NHS North West Surrey NWS The commissioning organisation for the population of North West Surrey. Over-performance More activity seen by a provider over a given time period than planned for, causing them to over-perform. This might in turn lead to the over-spending on its budget for the contract concerned. Quality, Innovation, Productivity & A national, regional and local level programme designed to support clinical teams and NHS organisations to improve the QIPP Prevention quality of care they deliver while making efficiency savings that can be reinvested into the NHS Quality Premium QP It is intended to reward s for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. RAG Rating RAG Use of the traffic light system to categorise performance. Usually GREEN is good, AMBER is OK and RED is POOR. Red 1 calls R1 Red 1 calls (to 999) are the most time critical i.e. cardiac arrest, patients who are not breathing and don t have a pulse and other severe conditions eg.airway obstruction. Red 2 calls R2 Red 2 calls (to 999) are serious but less immediately time critical and cover conditions e.g. stroke, fits. Referral to Treatment RTT A standard of care that no patient should wait longer than 18 weeks from referral to the start of first definitive treatment (for non-malignant conditions). The target should be achieved for 90% of admitted patients and 95% of non-admitted patients. South East Coast Ambulance NHS Foundation Trust SECAmb Ambulance service which covers Brighton & Hove, East Sussex, West Sussex, Kent, Surrey and North East Hampshire. Surrey and Borders NHS One of the leading providers of specialist mental health, drug and alcohol and learning disability services for people of all ages SaBP Partnership Foundation Trust in southern England. Virgin Care Services Limited VCSL The main community healthcare services provider across north west and south west Surrey. date YTD Usually the accumulation of activity, cost or budget from April up to and including the most recent month. Performance Report, Month 10, /18, Governing Body 18

19 Appendix B NHS Constitution: NHS G&W Performance Scorecard, January 2018 [G&W ] Performance Metrics Mixed Sex Accommodation (MSA) 0 Care Programme Approach (CPA) 95.0% April May June July RTT Incomplete Patients (RTT within 18 weeks) 92.0% 91.2% 92.5% 92.5% 92.5% Number of Patients Waiting More Than 52 Weeks Diagnostic Waiting Times (Within 6 weeks) 99.0% 91.6% 92.3% 95.3% 97.9% Cancer Waits: 2 Week Rule (Urgent GP Referral) 93.0% 98.9% 97.7% 98.8% 99.7% Cancer Waits: 2 Week Wait (Exhibited Non-Cancer Breast Symptoms) 93.0% 98.1% 98.0% 98.6% 99.1% Cancer Waits: 31 Days to First Treatment 96.0% 95.7% 98.1% 100.0% 100.0% Cancer Waits: 31 Days to subsequent Treatment (Drugs) 98.0% 100.0% 100.0% 100.0% 100.0% Cancer Waits: 31 Days to subsequent Treatment (Radiotherapy) 94.0% 94.4% 96.2% 92.0% 87.5% Cancer Waits: 31 Days to subsequent Treatment (Surgery) 94.0% 100.0% 100.0% 90.9% 100.0% Cancer Waits: 62 Days from Screening service referral 90.0% 100.0% 100.0% 100.0% 100.0% Cancer Waits: 62 Days from Urgent GP referrals 85.0% 100.0% 95.7% 94.7% 88.5% MRSA Bacteraemia (All cases) In month C difficile Infections (All cases) In month August September October November December January 92.3% 91.9% 92.1% 92.7% 91.6% 92.4% % 99.2% 99.5% 98.6% 97.5% 96.8% % 99.4% 98.1% 97.4% 98.9% 97.5% 89.3% 91.4% 97.0% 97.7% 93.8% 93.8% 98.4% 100.0% 100.0% 96.6% 96.6% 96.3% 100.0% 100.0% 97.4% 91.7% 100.0% 100.0% 92.0% 92.0% 95.0% 85.7% 85.7% 84.6% 100.0% 100.0% 100.0% 83.3% 86.7% 95.5% 75.0% 100.0% 100.0% 100.0% 85.7% 80.0% 79.2% 96.3% 88.9% 87.5% 95.5% 84.0% Apr-Jun Jul-Sep Oct-Dec 92.1% 92.2% 92.1% 92.2% % 98.3% 98.6% 96.5% % 99.2% 98.1% 98.5% 98.3% 93.0% 96.4% 95.7% 97.9% 99.4% 97.8% 98.1% 100.0% 100.0% 97.4% 99.4% 94.3% 90.5% 90.2% 91.2% 97.6% 100.0% 91.4% 96.1% 100.0% 87.5% 94.4% 92.1% 96.9% 88.3% 90.2% 91.4% 100.0% 100.0% 95.7% 98.2% Appendix C: NHS Constitution: Royal Surrey County Hospital Performance Scorecard, January 2018 [RSCH] Performance Metrics RTT Incomplete Patients (RTT within 18 weeks) 92.0% 91.5% 92.7% 92.6% 92.5% Number of Patients Waiting More Than 52 Weeks Diagnostic Waiting Times (Within 6 weeks) 99.0% 91.3% 91.8% 95.2% 97.0% A&E Monthly Performance 95.0% 97.7% 97.8% 97.5% 96.1% Mixed Sex Accommodation (MSA) 0 April May June July Cancer Waits: 2 Week Rule (Urgent GP Referral) 93.0% 98.7% 98.3% 99.1% 99.4% Cancer Waits: 2 Week Wait (Exhibited Non-Cancer Breast Symptoms) 93.0% 97.9% 97.5% 98.5% 97.5% Cancer Waits: 31 Days to First Treatment 96.0% 97.8% 96.6% 97.0% 99.0% Cancer Waits: 31 Days to subsequent Treatment (Drugs) 98.0% 100.0% 99.1% 99.5% 100.0% Cancer Waits: 31 Days to subsequent Treatment (Radiotherapy) 94.0% 93.3% 94.0% 94.1% 95.5% Cancer Waits: 31 Days to subsequent Treatment (Surgery) 94.0% 100.0% 95.6% 100.0% 100.0% Cancer Waits: 62 Days from Screening service referral 90.0% 87.5% 100.0% 87.5% 100.0% Cancer Waits: 62 Days from Urgent GP referrals 85.0% 76.3% 78.7% 81.8% 77.1% August September October November December January 92.7% 92.1% 92.1% 92.5% 91.6% 92.0% % 99.1% 99.6% 98.6% 97.4% 96.9% 94.6% 95.6% 96.2% 93.2% 91.3% 94.2% 99.1% 99.2% 97.6% 97.7% 98.9% 97.8% 89.2% 93.4% 97.9% 98.4% 93.0% 93.9% 96.6% 96.6% 99.0% 99.5% 98.3% 96.2% 99.5% 100.0% 100.0% 100.0% 99.3% 99.0% 96.8% 96.1% 95.5% 95.0% 97.8% 94.0% 100.0% 94.2% 98.0% 93.3% 94.9% 95.3% 83.3% 100.0% 91.7% 100.0% 72.7% 88.9% 74.8% 77.3% 77.5% 72.3% 78.2% 74.8% Apr-Jun Jul-Sep Oct-Dec 92.2% 92.4% 92.0% 92.2% % 97.6% 98.6% 96.1% 97.6% 95.4% 93.6% 95.3% 98.7% 99.2% 98.0% 98.5% 98.0% 93.3% 96.7% 95.8% 97.1% 97.4% 98.9% 97.6% 99.5% 99.8% 99.8% 99.6% 93.8% 96.1% 96.0% 95.1% 98.5% 97.6% 95.8% 97.1% 88.9% 93.8% 88.6% 90.2% 79.0% 76.4% 75.8% 76.8% All handovers between ambulance and A&E must take place within 15 minutes with none taking over 30 minutes All handovers between ambulance and A&E must take place within 15 minutes with none taking over 60 minutes Cancelled Operations MRSA Bacteraemia (Apportioned to Trust) In month C difficile Infections (Apportioned to Trust) In month Performance Report, Month 10, /18, Governing Body 19

20 Appendix D: Performance Management Process The escalation process relating to red RAG indicators is as per NHS England definitions. Contract Management Process: Month 1: Action Plan requested Month 2: Escalate to Executive meeting if continue to be red at month 2 If metric Red in months 1 and 2 If amber gone back to red Issue Performance Notice Escalate to Executive meeting If If amber or green Monitor Performance Report, Month 10, /18, Governing Body 20

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