Is this document Commercially Sensitive. Has this proposal been approved by Finance

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1 Subject: Meeting: Quality & Performance Cover Report CCG Board Meeting Date of Meeting: Tuesday 24th July 218 Report of: Neve Patel Head of Performance Is this document Commercially Sensitive Has this proposal been approved by Finance N Y 1. Summary 1.1 The attached report provides an overview of Milton Keynes CCG current month / end of year performance against the following standards and performance measures: BLMK STP footprint - NHS Constitution Measures MK CCG - NHS Constitution Measures MK CCG NHSE Improvement & Assessment Framework MK CCG - NHS Quality Premium Measures MK CCG Quality Dashboard 1.2 MK CCG Performance is reported by exception only detailing the main issues causing underperformance, actions taken by the Commissioner and Provider and the expected recovery date. 2. BLMK Footprint NHS Constitution Measures CCG Wide MK CCG is currently meeting 1/5 constitution targets, with BCCG and Luton CCG both meeting 2/5 measure each. Trust Wide - MKUHT along with Bucks Healthcare are currently meeting 2/5 constitution targets, BHT are meeting 2/4, The L&D are meeting 4/5 targets, NGH are meeting 1/4 and OUH are meeting /5 targets. Where performance is out of 4 targets, this will exclude Cancer 62 days waits due to data lag time. Overall IAF Assessment MK CCG has achieved an overall Good standard for MK CCG - NHS Constitution Measures Key Areas to note: A&E 4 hour waits exceeded the national target of 95%, with 96% in April. Ambulance Clinical Quality - Category 1 and 2 achieved April targets (4 measures in total). RTT Incomplete Constitution measure did not meet the national target at CCG level with 84.3%. Diagnostics under achieved with 1.73% against a target of <1%. Cancer 62 day s waits underachieved with 82.3% at CCG level Cancer 31 day s surgery underachieved with 87.5% at CCG level. Commissioning Delivery Group Page 1 of 2

2 The CCG had a total of 27, 52 week waits, (18 from MKUHT and 9 from OUH). Other underperforming measures - RTT Measures (admitted and non-admitted) / Cancelled ops not rebooked within 28D / Ambulance Handover delays >6mins (3) and Crew Clear (5). 4. MK CCG - NHSE Improvement & Assessment Framework The National IAF assessment has been updated see pages 18/19 of performance report. Local performance updates The Dementia diagnosis performance for April has under achieved its target with 65.5%. Mental Health IAPT access has underachieved with 1.47% (YTD target is 19%). IAPT recovery has achieved against target in April with 54%. The Provider is working towards an action plan with a trajectory to meet 19% for Access and sustain the 5% recovery rate over 18/ MK CCG - Quality Premium 217/18 - NHS Quality Premium Measures NHS Constitution gateway impact on the Quality Premium in the current month is 1% with 2/2 gateway measures underachieving against the National requirements. In April, out of the 11 individually payable QP measures, five measures are rated as Red, three as Amber and three as Green. 6. MK CCG - Quality Dashboards (MKUHT & CNWL) MKUHT MKUHT under performed on the following measures: Friends and Family A&E test score and response rate, VTE Risk assessments, Carotid imaging and Transfers from the HASU. DToCs were a total of 519 days for the Trust in April this contributes towards the CCG overall planned figure from the Better Care fund of 5,31 days for 18/19. CNWL There are no issues regarding CNWL performance. Many measures are reported quarterly and therefore have yet to be released. 7. Next Steps To continue to monitor, track and report on CCG and Commissioner Actions relating to underperforming standards. 8. Recommendations - The Board is asked to: Note the contents and performance detailed within this report Approve actions and progress against the CCG performance standards Identify any areas where further action, information or assurance is required Commissioning Delivery Group Page 2 of 2

3 Milton Keynes Clinical Commissioning Group Quality & Performance Report Presented: July 218 Period: April 218 (M1) Page 1 of 29

4 MILTON KEYNES CLINICAL COMMISSIONING GROUP PERFORMANCE REPORT April 218 This report provides overview of current CCG performance and key work streams in place with our partners to ensuree delivery of performance standards. 1. CCG Perfo pe ormance erformance throughout trend this report over is detailed 12 months by exception; whilst all measures may be presented in dashboards; only red or amber rated indicators will be detailed in the main body of the report, including key plans and actions in place to recover or improve performance Month CCG Performance Tracker 58% Met over 217/18 17/18 18/19 Performance Tracker MK CCGConstitution Performance against the National Target in a 12 month period No. May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Measure M2 M3 M4 M5 M6 M7 M8 M9 M1 M11 M12 M1 RTT Admitted 3 RTT Non Admitted 3 Ambulance Handover Delays > 6 minutes 3 Crew Clear > 6 minutes 3 Cancelled Ops Not Seen <28 Days 2 52 Wk RTT 27 A&E 4 Hour Waits 11 RTT Incomplete 1 Cancer 62 DW Screening 6 Ambulance Clinical Quality Category 1 Life threatening injuries and illness SCAS Level MEAN 5 Cancer 62 DW GP Referral 5 Diagnostics 5 MSA Breaches 4 Ambulance Clinical Quality Category 2 Emergency Calls SCAS Level MEAN 3 Ambulance Clinical Quality Category 2 Emergency Calls SCAS Level 9th Percentile 2 Cancer 31 DW Subsequent Treatment Chemotherapy/drug 2 Cancer 31 DW Subsequent Treatment Surgery 2 Cancer 2 WWW Breast Symptomatic Referrals 1 / / MH CPA (Quarterly Measure) 1 1% Q2 17/18 1% 96.15% Q4 9% Cancer 31 DW Subsequent Treatment Radiotherapy Cancer 2 WWW Suspected Cancer Referrals Cancer 31 DW First Definitive Treatment Ambulance Clinical Quality Category 1 Life threatening injuries and illness SCAS Level 9th Percentile Trolley Waits in A&E >12 hours Urgent Ops Cancelled Second Time Red 6+ under performances within last 12 months The CCG faces challenges in areas related to activity/volume and Amber 3 5 under performances within last 12 months throughput, whilst achieving more robust, positive performance in Green 2 under performances within last 12 months areas related to clinical quality. 1.2 Executive Summary Priority Points & Performance Risk Page 2 of 29

5 2. STP FOOTPRINT - NHS CONSTITUTION MEASURES DASHBOARD (CCGs and Acute Trust) This dashboard details performance of the Constitution Measures for the CCG s Sustainability and Transformation Plan (STP) footprint covering Bedford Luton and Milton Keynes (BLMK). Also detailed below is the performance of MK CCG s main Providers contributing towards MK CCG s overall achievement of the NHS Constitution measures. 2.1 BLMK STP Footprint NHS Constitution Performance (CCG Level) Apr-18 BLMK CCG Level NHS Constitution Measures BLMK STP FOOTPRINT No. Description Target Beds Luton frequency CCG CCG MK CCG 18 Week RTTT Incomplete Pathways E.B.3a <18 Weeks 92% 91.41% 91.93% 84.36% E.B.4a Diagnostic Waits >6 Weeks 1% 1.57% 2.32% 1.73% A&E Waits Seen Within 4 Hours 95% E.B.5a **STP combined level** STP level 96.34% Cancer 62 Day Waits - First Definitive 85% E.B.12a Treatment -GP Referral 1/4 target 94.7% 97.14% 82.35% Number of 52 Week Referral to E.B.S.4a Treatment Incomplete Pathways * Cancer 62 Day wait data has a one month time lag, therefore may not be shown for all CCGs / Trusts in the data table above or below. 2.2 MK CCG Provider Performance (Trust Level) Apr-18 TRUST Level NHS Constitution Measures BLMK STP FOOTPRINT MKUHT BHNHST L&D OUH NGH Bucks No. Description Target frequency MK CCG Beds Luton Oxford N'hampto H/Care 18 Week RTT Incomplete Pathways 92% 84.2% 89.49% 9.71% 85.25% 88.76% 89.9% E..B.3a <18 Weeks E..B.4a Diagnostic Waits >6 Weeks 1% 1.8%.59%.88% 1.73%.1%.% A&E Waits Seen Within 4 Hours 95% 96.% 91.45% 98.6% 86.3% 89.37% 85.87% E..B.5a Cancer 62 Day Waits - First Definitive 85% 85.8% One month 9.2% 8.% One month 74.48% E..B.12a Treatment -GP Referral 1/4 target Data lag Dataa lag Number of 52 Week Referral to E..B.S.4a Treatment Incomplete Pathways 2.3 BLMK STP Progress Dashboard - Across Hospital Performance Patient Focused Change Transformation STP Overall STP Averag ge STP Progress Dashboard Measures Target progress Sept 17 Data Frequency of reporting July 217 (Q1) (Q2) % of patients admitted, transferred or discharged from A&E within 4 hours Patients waiting 18 weeks or less from referral to hospital treatment NHS Providers in special measures within STP boundaries 95.% 92.% None 95.1% 92.6% None 95.28% 91.8% None Cases of MRSA per 1, acute trust bed days 1 STP Ave. Zero.6 (for September) p/6 m 17/ /18 STP Cases of c-difficile per 1, acute trust bed days 6 STP Ave. threshold 5.5 (for September) p/6 m Total = 182 % of GP's meeting minimum access requirements No. of respondents satisfied with their GP opening times % of IAPT patients recovering following at least two treatment contacts People with first episode of psychosis starting treatment with a NICE recommended package of care treated within 2 weeks of referral % of cancer diagnosed at an early stage Delayed transfers of care (delayedd days) for all reasons per 1, population System Leadership status CCG/Trust combined surplus or deficit vs. total resource avoidable (control total) (In year financial performance - IAF reported) 1% by end of 218/19 5.% 5.% 78.4% 91.6% 6% by end of 218/19 People with urgent GP referral having first definitive treatment for cancer within 62 days of referral Average cancer patient experience, case-mix adjusted Total emergency spells per 1, population agesex standardised Emergency bed days per 1, population, agesex standardised Total emergency spells per 1, population agesex standardised Emergency bed days per 1, population, age-sex standardised 85.% 83.2% 8.7 * 1,4 * 5, % 8.7 1,12 6, IAF Ave = 8.97% 13.% 17.3% 74.5% 74.5% 5.5% rolling ave. for Q4 16/ % 54.7% 49.8% STP for Aug 49.% 52.% 17 Varies by CCG 3,636 Trust Sept Ave 6,419 5,532 = 893 (quarterly figure = 3,572) Advanced Advancedd Advanced Advanced.6%.6% STP Average Dec 17 Data (Q3) STP Average March 18 Data (Q4) 92.22% 92.12% 85.17% 82.% None None % 32.36% 74.5% 74.5% 87.75% 85.71% 54.86% 54.86% 54.86% 83.7% %.6% RAG Page 3 of 29

6 3. EVERYONE COUNTS: ANNEX B - NHS CONSTITUTION MEASURES The NHS Constitution sets out the universal rights and pledges for all NHS patients, along with expected national requirements and operational standards. Detailed below is how MK CCG performed against these measures, challenges faced and mitigating actions in place to improve performance and services for patients. No. E.B.1 E.B.2 E.B.3a E.B.5b E.B.3b E.B.3c Description 18 Week RTTT Admitted Pathways <18 Weeks 18 Week RTTT Non-Admitted Pathways <18 Weeks 18 Week RTTT Incomplete Pathways <18 Weeks (CCG) 18 Week RTT Incompletee Pathways <18 Week s (MK CCG Trajectory) 18 Week RTT Incompletee Pathways <18 Week s 92% (MKUHT - Whole Provider - Actual Performance) 18 Week RTT Incompletee Pathways <18 Week s (MKUHT - Trusts Own Trajectory) Target 9% 95% 92% CCG Trajectory Trust Trajectory frequency Data Level M1 April CCG 8.89% CCG 85.4% CCG 84.36% CCG 89.2% MKUHT 84.2% Data Commen nts MK CCG Specialty level lowest performers: ENT -49% / T&O - 57% / Gynaecology - 64% / Ophthalmology - 7% MK CCG Specialty level lowest performers: T&O - 71% / Urology - 71% / Resp.Med - 7% / Gynaecology - 72% MK CCG Specialty level lowest performers: T&O - 6% / Gynaecology 88% / ENT - 84% / General Surgery - 84% MK CCG equirement: Achievee 9% in Sept and 95% in March MKUHT Specialty level lowest performers: T&O % / General Surgery % / ENT % / Ophthalmology % MKUHT 89.7% Trust requirement: Achievee 9% in Sept E.B.4a Diagnostic Waits >6 Weeks (CCG) 1% CCG 1.73% MK CCG had a total of 8 breaches E.B.4b Diagnostic Waits >6 Weeks (MKUHT-Whole Provider Performance) 1% MKUHT 1.8% MKUHT had 64 breaches E.B.5a A&E Waits Seen Within 4 Hours (CCG / MKUHT actual achievement) 95% CCG 96.% E.B.5b A&E Waits Seen Within 4 Hours MK CCG Trajectory CCG Trajectory CCG 94.1% MK CCG equirement: Achievee 9% in Sept and 95% in March E.B.5c A&E Waits Seen Within 4 Hours MKUHT Trajectory Trust Trajectory MKUHT 94.1% Trust requirement: Achievee 9% in Sept E.B.6 E.B.7 E.B.8 E.B.9 E.B.1 E.B.11 E.B.12a E.B.12b Cancer 2 Week Waits -Suspected Cancer Referrals (CCG level) Cancer 2 Week Waits -Breast Symptomatic Referrals (CCG level) Cancer 31 Day Waits -First Definitive Treatment (CCG level) Cancer 31 Day Waits -Subsequent Treatment - Chemotherapy/drug (CCG level) Cancer 31 Day Waits -Subsequent Treatment - Radiotherapy (CCG level) Cancer 31 Day Waits -Subsequent Treatment -Surgery (CCG level) Cancer 62 Day Waits - First Definitive Treatment -GP Referral (CCG level) Cancer 62 Day Waits - First Definitive Treatment -GP Referral (MKUHT-Whole Providerr Performance) 93% 93% 96% 98% 94% 94% 85% 85% 1/4 target 1/4 target 1/4 target 1/4 target 1/4 target 1/4 target 1/4 target 1/4 target CCG 96.59% CCG 97.33% CCG 96.59% CCG 1.% CCG 97.78% CCG 87.5% CCG 82.35% MKUHT 86.96% A total of 8 patients were treated; 1 of which was treated after 31 days. A total of 51 patients received first treatment, of which 9 were seen after 62 days. E.B.13 Cancer 62 Day Waits -Treatment from Screening Referral (CCG level) 9% 1/4 target CCG 9.% Page 4 of 29

7 No. Description Target frequency Data Level M1 April Data Commen nts E.B.16.C1 Ambulance Clinical Quality - Category 1 - Life threatening injuries and illness - SCAS Level - MEAN Mean 7 mins SCAS :6:35 Cat 1 -MK CCG - Mean :5:24 - Green E.B.16.C2 Ambulance Clinical Quality - Category 1 - Life threatening injuries and illness - SCAS Level - 9th Percentile 9th Percentile within 15 mins SCAS :11 1:5 Cat 1 - MK CCG - 9th percentilee - :9:49 - Green E.B.16.C3 Ambulance Clinical Quality - Category 2 - Emergency Calls - SCASS Level - MEAN Mean 18 mins SCAS :14 4:13 Cat 2 -MK CCG - Mean :12:14 - Green E.B.16.C4 E.B.S.1 E.B.S.2 Ambulance Clinical Quality - Category 2 - Emergency Calls - SCASS Level - 9th Percentile Mixed Sex Accommodation (MSA) Breaches Cancelled Operations -Not Re-booked within 28 Days (MKUHFT) 9th Percentile within 4 mins SCAS :27 CCG MKUHT 24 7:46 Cat 2 - MK CCG - 9th percentilee - :24:1 - Green E.B.S.3 Mental Health Measure -Care Programme Approach (CPA) 95% CCG TBC Number of 52 Week Referral to Treatment Incomplete E.B.S.4a Pathways - CCG Level CCG are MKUHT and 9 are from OUH (8 Gynaecology and 1 T&O) Number of 52 Week Referral to Treatment E.B.S.4b Incomplete Pathways (MKUHT-Whole Provider Performance) MKUHT are MK CCG patients, 13 T& &O, 3 ENT and 1 Ophthalmology and 1 Gynaecology - 13 patients have TCI dates at the time of reporting. E.B.S.5 E.B.S.6 Trolley Waits in A&E >12 hours Urgent Operations Cancelled for a Second Time (MKUHFT) MKUHT MKUHT E.B.S.7 Ambulance Handover Delays > 6 minutes SCAS 3 E.B.S.8 Crew Clear > 6 minutes SCAS 5 Page 5 of 29

8 3.1 NHSE & Quality Premium Requirements for Constitution measures over 218/19 Detailed below are the requirements set out upon the CCG by NHS England and the CCG s main Acute Provider (MKUHT) by NHS Improvement. Requirements are categorised into NHS Constitution and Quality Premium requirements. Actual and Planned figures will be reported within the body of this report under the Constitution measures or Quality Premium sections. 218/19 NHSE and NHSI Constitution and Quality Premium Requirements Measures RTT Incomplet te Waits Milton Keynes CCG Requirements NHS England Requirements The Waiting List to be sustained at March 18 levels in March 19 Quality Premium / Gateway Requirements No. of patients on the Incomplete pathway not to be higher in March 19 than in March 18 Milton Keynes University Hospital Requirements Quality Premium Local NHS Improvement Agreements Requirements *The QP is not applicable to Providers The Waiting List to be sustained at March 18 levels in March 19 92% to be achieved by March 19 No. of patients waiting at 52 Week Waits March 18 to be halved by March 19 No. of patients waiting at March 18 to be halved by March 19 Cancer 62 Day Waits 85 % to be achieved every Quarter 85 % to be achieved by Quarter 4 85 % to be achieved every Quarter 9% to be achieved by Part A) Type 1 A&E 9% to be achieved by September 218 attendances no greater than September 218 type 1 planned figures AND Local Agreement in place A&E 4 Hour Total NEL Admissions with Waits LoS = days no greater than planned figures Part B) Total NEL admissions 95% to be achieved by with LoS >=1 day no greater Local Agreement in place March 219 than planned figures A&E attendances calculated as follows: Difference between 18/19 actual and plan e. g. actual attendances minus planned attendances Page 6 of 29

9 3.2 - National 18 Weeks Referral to Treatment (RTT) Incomplete Standard No. E.B.3a E.B.5b E.B.3b E.B.3c Description Target M1 Data Level frequency April Data Commen nts MK CCG Specialty level lowest performers: 18 Week RTTT Incomplete Pathways <18 Weeks (CCG) 92% CCG 84.4% T&O - 6.2% / Neurosurgery % / ENT % / General Surgery % / Ophthalmology % 18 Week RTT Incompletee Pathways <18 Week s CCG MK CCG equirement: Achievee 9% in Sept and CCG 89.2% (MK CCG Trajectory) Trajectory 95% in March MKUHT Specialty level lowest performers: 18 Week RTT Incompletee Pathways <18 Week s 92% MKUHT (MKUHT - Whole Provider - Actual Performance) 84.2% T&O % / General Surgery % / ENT % / Ophthalmology % 18 Week RTT Incompletee Pathways <18 Week s Trust (MKUHT - Trusts Own Trajectory) Trajectory MKUHT 89.7% Trust requirement: Achievee 9% in Sept CCG - Total Incomplete WL in March 218 was 2,3 patients. March 219 WLL must either sustain this figure or be lower. Trust - Total Incomplete WL in March 218 was 2,8 patients. March 219 WLL must either sustain this figure or be lower. NOTE: The Quality Premium requirement for the Incomplete RTT measure is different too NHSE constitutionn requirement seee QP section for details. 218/19 Submitted Plans for CCG & Trust Mar-18 Apr /19 Submitted Plans for CCG & Trust Mar-18 Apr-19 RTT - CCG Incomplete Pathways PLAN RTT - CCG Performance ACTUAL Total Pathways Pathways < 18 Weeks Total on Waiting list 92% National Target Total Pathways Pathways < 18 Weeks 92% National Target Total on Waiting list Variance from Target 1,851 12, % 2,3 13,25 11,819 1, % 13,264 11, % 2,55 52 RTT - TRUST Incomplete Pathways PLAN RTT - TRUST Performance ACTUAL Pathways < 18 Weeks Total Pathways Total on Waiting list 92% National Target Pathways < 18 Weeks Total Pathways 92% National Target Total on Waiting list Variance from Target 12,65 13,45 1, % 11,429 11,492 13,59 13, % 84.2% 2,8 2, MK CCG achieved 84.4% in April. Out of a total 12,981 pathways, 1, 952 were seen within 18 weeks. A further 99 patients were required to be seen, across any / all acute trusts, to have achieved the 92% target. The CCG has a total of 2,29 patients waiting on the WL in April. Challenges: MK University Hospital Trust (MKUHT) T&O, General Surgery, ENT Actions / Updates: MKUHT RTT standardd is being pro-actively managed through both internal divisional and Trust-wide weekly RTT performance meetings, with executivee presence. The Trust is engaging with the prior approvals process and is reviewing whether or not this has been requested for patients on the waiting list. Where it has not, the Trust is applying for it; this will add further time to the patients Page 7 of 29

10 and Ophthalmology continue to be the most challenging areas in April. Elective day case referrals from the CCG are 14.5% under plan (6.2% under plan in March) ). Even with Community triaging in place, T&O continues to see adverse performance and recovery will take further time. Oxford University Hospital (OUH) This is the CCG s main tertiary provider. OUH have been issued with an enforcement notice by NHSI and continue to work with them until performance improves. The below table shows achievement for all Trusts, with 5 or more patients, who contribute to the CCG s overalll RTT performance. In April, two Trusts met the required 92% standard for MK CCG waitingg time. The CCG reviews updates on progress at monthly operational, strategic, contract and Commissioner level meetings, however as a result of the operational update from the NHS National Emergency Pressures Panel regarding reductions in Elective procedures to manage Non elective pressures, the CCG is likely to see further impact to the RTT measures into 218/19. OUH The Trust is taking appropriate actions to address their issues and bring them t under control. OUH have engaged a system wide improvement Director to manage the recovery plan, which is overseen by an established oversight group to ensure delivery. The Contract Manager has monthly meetings with the CCG and Trust to monitor progress. CCG action is being strengthened by input from the Director of Quality requesting informationn on recovery and risk including more detail d for all long waiters. OUH updates u for current month: All patients >18 w are tracked monthly via validations, and are informed at clinic that t RTT waits will be approx. 1 months, also aiming to reduced new additions to pathways by exploring non-surgical options as a choice. Total MK CCG patients at OUH 671 Total No. waiting < 18 weeks 546 (81%) Total No. waiting > 18 weeks 125 (19%) Page 8 of 29

11 week waits No. Description Target frequency Data Level M1 April Data Commen nts Number of 52 Week Referral to Treatment Incomplete E.B.S.4a Pathways - CCG Level CCG are MKUHT and 9 are from OUH (8 Gynaecology and 1 T&O) Number of 52 Week Referral to Treatment E.B.S.4b Incomplete Pathways (MKUHT-Whole Provider Performance) MKUHT are MK CCG patients, 13 T& &O, 3 ENT and 1 Ophthalmology and 1 Gynaecology - 13 patients have TCI dates at the time of reporting. 218/19 Submitted Plans for CCG & Trust 52 Week Waits - CCG PLAN Pathways >52 Weeks 52 Week Waits - CCG ACTUAL Pathways >52 Weeks 52 Week Waits - TRUST PLAN Pathways >52 Weeks 52 Week Waits - TRUST ACTUAL Pathways >52 Weeks Mar Apr The total number of patients waiting >52 weeks for treatment for both the CCG and the Trust in March 18 have to be halved by March 19 Both the CCG and the Trust have performed under plan for April. MK CCG had 27 patients who were waiting over 52 weeks for treatment in April. 18 of these were MKUHT patients and nine patients were waiting for treatment at OUH. MKUHT patients 23 patients in total, of these, 18 were MK CCG patients, 13 x T&O / 3 x ENT and one each in Ophthalmology and Gynaecology. 13 patients have a TCI date at the time of reporting. There is a cohort of long waiters at MKUHT who are approaching 52 weeks without prior approval. Commissioners have agreed for the Trust to forgo the prior approval process and to treat patients who are 4 weeks + to avoid them breaching 52 weeks. OUH Nine patients breaching, eight within Gynaecology and one T&O patient. Gynaecology Patients - two patients have been treated, two patients wish to speak with consultant before proceeding both with TCI dates booked, one patient D their FU apt, however wishes to discuss with consultant TCI booked. Two patients are awaiting TCI dates and the final patient has a TCI date. T&O patient Has had an MRI and is awaiting next steps, the patient has been chased with no response. OUH have a total of 23 MK CCG waiters over 36 weeks who may breach into 52 week waits over the following months. Actionss / Updates: Each patient waiting 52 weeks or more for treatment is discussedd with the responsible Trust. Details D about each patient pathway are given and themes are discussed in contractt meetings and monitored through CQRM meetings. MKUHTT The Trust is working with the CCG to revise their 52 week wait reports to provide sufficient assurance of patient safety. OUH Actions: All patients >5 w are tracked weekly via meetings and all 52 week waiters are being contacted with offers of TCI dates. y Specialty and CCG meetings being held from April 218 and additional funding has been allocated in 17/18 for 52 w waiters to be done at Nuffield over the next 4-55 months. OUH have ww as a trust 164 of which are Gynae. Plans to reduce by half by March 219. Survey of patients waiting 52weeks or more within a number of specialties (38 in Gynae) over April-June 217 carried out on 42 patients, half suffered no harm and half suffered minor clinical harm continuation of symptoms. Patient experiences and impact on o lives were also taken into account (pats experience lots of apt changes, some byy Trust and some Pat choice, Admin error and clinical cap were other issues and lackk of communication was raised. OUH has improved this by reviewing 5+w waiters every week. Page 9 of 29

12 3.4 Diagnostics No. Description Target frequency Data Level M1 April Data Commen nts E.B.4a Diagnostic Waits >6 Weeks (CCG) 1% CCG 1.73% MK CCG had a total of 8 breaches E.B.4b Diagnostic Waits >6 Weeks (MKUHT-Whole Provider Performance) 1% MKUHT 1.8% MKUHT had 64 breaches The CCG had 8 breaches in April, across four Providers. The CCG underachieved against this target with 1.7%. The Trust also under achieved the target with 1.4% and 64 breaches. Total waits -6 Total breaches weeks MK CCG 4,628 8 MKUHT 3, All Others % of breaches 1% 8% 2% MKUHT 27 Gastroscopy, 21 Audiology, 7 colonoscopy, 2 non obs- ultrasound, 2 cystoscopy, 1 sleep studies, 1 Electrophysiology and 3 flexi- sigmoidology. OUH had 14 breaches; 1 in Echocardiography, 1 x Cystoscopy, 1 x Gastroscopy 1 x MRI and 2 x Audiology. UCL had two breaches with MRI and CT scans EXPECTED RECOVERY: In line with MKUHT and OUH RTT recovery Diagnostic delays are followed up by the Commissioner with Providers requesting details of delays and dates booked in. Issues are addressed with Providers through monthly contract meetings. Trust wide action plans and risk management programs remain in place and are on-goingup internal capacity. Outsourcing of reporting is in place where appropriate, freeing Performance of this measure is closely aligned to the Incomplete RTT standard. MKUHTT are currently experiencing a rise in demand for Endoscopy procedures over March and April. This is coupled with a decrease in capacity due to a consultant having left the Trust. The Trust is currently outsourcing these areas a as a part of their recovery plan. SERVICE LEAD: Primary Care / Contracts / Quality Team Page 1 of 29

13 3.5 - A&E Waits Seen Within 4 Hours No. Description Target frequency Data Level M1 April Data Commen nts E.B.5a E.B.5b E.B.5c A&E Waits Seen Within 4 Hours (CCG / MKUHT actual achievement) A&E Waits Seen Within 4 Hours MK CCG Trajectory A&E Waits Seen Within 4 Hours MKUHT Trajectory 95% CCG Trajectory Trust Trajectory CCG 96.% CCG 94.1% MKUHT MK CCG equirement: Achievee 9% in Sept and 95% in March 94.1% Trust requirement: Achievee 9% in Sept CCG To achieve 9% in September and 95% by March 219. Trust - To achieve 9% in September. NOTE: The Quality Premium requirements for the Emergency Demand measures are different to the NHSE constitution requirement see QP section for details. 218/19 Submitted Plans for CCG & Trust Mar-18 Apr /19 Submitted Plans for CCG & Trust Mar-18 Apr-19 A&E 4 Hour waits - CCG PLAN A&E 4 Hour waits - CCG ACTUAL Total A&E Attendances Number Waiting < 4 Hrs Number Waiting > 4 Hrs 95% Target Total A&E Attendances Number Waiting < 4 Hrs Number Waiting > 4 Hrs 95% Target Variance to plan 12,722 12, % 12,53 11, % -669 TRUST A&E 4 Hour waits PLAN TRUSTT A&E Performance ACTUAL Total A&E Attendances Number Waiting < 4 Hrs Number Waiting > 4 Hrs 95% Target Total A&E Attendances Number Waiting < 4 Hrs Number Waiting > 4 Hrs 95% Target Variance to plan 12,722 12, % 11,983 11, % -739 The CCG is required to achieve 9% by September 218 and 95% by March 219. Emergency demand management is a key focus in 218/19, also appearing in the Quality Premium as an additional set of indicators. EXPECTED RECOVERY: On-going work steams in place Actions: Commissioner: MKCCG has a number of demand management schemes in place which continue to mitigate the general increase in demand for A&E that is beingg seen locally, regionally and nationally. These continue to be well- January / used, with some in excess of their planned activity targets. MK system engaging in the 1% challenge initiative during February 218. The Seated Observation Unit in A&E opened January 218. SERVICE LEAD: Urgent Care Page 11 of 29

14 3.6 - Cancer 62 Day Waits - Cancer 62 Day Waits - First Definitive Treatment -GP Referral No. Cancer 62 Day Waits - First Definitive Treatment -GP E.B.12a Referral (CCG level) Cancer 62 Day Waits - First Definitive Treatment -GP E.B.12b Referral (MKUHT-Whole Providerr Performance) Description Target 85% 85% frequency 1/4 target 1/4 target Data Level M1 April CCG 82.35% MKUHT 86.96% Data Commen nts A total of 51 patients received first treatment, of which 9 were seen after 62 days. The CCG underachieved against the target in April with 82.35% and nine breaches. There were three patient breaches over 14 days see full breakdown below. The Trust also underachieved against this target with 83%. No. Treatment day Reason for breach Unknown 2 79 Other Reason (retired April 18) 3 77 Health Care Provider initiated delay to diagnostic test or treatment planning 4 12 Health Care Provider initiated delay to diagnostic test or treatment planning Health Care Provider initiated delay to diagnostic test or treatment planning 6 68 Other Reason (retired April 18) 7 63 Patient choice declined TCI date offered 8 79 Other Reason (retired April 18) 9 89 Other Reason (retired April 18) Provider Actions: The Head of Cancer services is working closely with clinical teams and has in place several s actions for managing the Cancer standard such as: The live Cancer PTL tool PTL meetings and Speciality level PTL meetings with division capacity and demand planning. Improved tracking of patients on the Cancer pathway, with two members of staff in place to manage and track patients. Regular pathway review meetings with tertiary centres alongside MDT meetings. Trust continues to review diagnostic support to ensure it is robust enough to manage current demand. Work is underway with the E of E Cancer Alliance and CCG to implement optimal pathways for lung, prostate and upper and lower GI. Commissioner Actions: The CCG continues to work closely with the trust to ascertain the reasons for failure to meet the target at patient level. RCA s are completed on all patients waiting more than 14 days for treatment. follow up and analysis of all patients who miss treatment or referral within target period is carried out between the Quality team (CCG) and the Head of Cancer services (MKUHT) to determine reasons for delays and any impact on patients. The length of meetings has been increased to ensure all patients and associated detail is addressed. Issues with other Providers are being addressed by Commissionerss Page 12 of 29

15 EXPECTED RECOVERY: On-going work streams in progress through monthly contract meetings with particular focus on diagnostic pathways at OUH The Quality Team are monitoring the nature of care for each breaching patient e.g. palliative / curative. SERVICE LEAD: Primary Care / Quality / Contracts 3.7 Cancer 31 Day Waits Subsequent Treatmentt Surgery (CCG Level) No. E.B.11 Description Cancer 31 Day Waits -Subsequent Treatment -Surgery (CCG level) Target 94% frequency 1/4 target Data Level M1 April CCG 87.5% Data Commen nts A total of 8 patients were treated; 1 of which was treated after 31 days. The CCG underperformed with 83.3%; this was a breach of one out of eight patients reason not listed. EXPECTED RECOVERY: On-going work streams in progress Provider Actions: See 622 day wait actions above. SERVICE LEAD: Primary Care / Quality / Contracts 3.8 Ambulance Clinical Quality (Categories 1-2) No. Description Target frequency Data Level M1 April Data Comments E.B.16.C1 Ambulance Clinical Quality - Category 1 - Life threatening injuries and illness - SCAS Leve el - MEAN Mean 7 mins SCAS :6:35 Cat 1 -MK CCG - Mean :5:24 - Green E.B.16.C2 E.B.16.C3 Ambulance Clinical Quality - Category 1 - Life threatening injuries and illness - SCAS Level - 9th Percentile Ambulance Clinical Quality - Category 2 - Emergency Calls - SCAS Level - MEAN 9th Percentilee within 15 mins Mean 18 mins SCAS SCAS :11:5 :14:13 Cat 1 - MK CCG - 9th percentile - :9:499 - Green Cat 2 -MK CCG - Mean :12:14 - Green E.B.16.C4 Ambulance Clinical Quality - Category 2 - Emergency Calls - SCAS Level - 9th Percentile 9th Percentilee within 4 mins SCAS :27:46 Cat 2 - MK CCG - 9th percentile - :24:1 - Green Page 13 of 29

16 SCAS have now begun to report against revised Ambulance Response Programme categories, with the aim of making sure the best, high quality, most appropriate response is providedd for each patient first time. Category 1 Life threatening injuries and illness (responsee time average 7 minutes) Category 2 Emergency calls (response time average 18 minutes) Category 3 Urgent calls (at least 9/1 times before 12 minutes) Category 4 Less urgent calls (at least 9/1 times before 18 minutes) Categories 1 and 2 have both achieved the target performed under the time thresholds in April. Actions: It is anticipated these new targets will improve efficiency, effectiveness and overall performance. Contractual levers are not applicable this financial year whilst these nationally imposedd changes are embedded. The ARP changes have triggered a need to change the Ambulance fleet mix. This was initiated at the end of October but may take up to 12 months to fully transform. Page 14 of 29

17 4. NHSE IMPROVEMENT ASSESSMENT FRAMEWORK The Improvement and assessment Framework (IAF) is an annual assessment of every CCG, drawing together in one place, the NHS Constitution, core performance, outcome and finance metrics and transformational challenges. The IAF will be used by the CCG as a self-assessment tool, identifying well performing areas and highlighting areas in need of improvement. Performance will be b updated as released and reported by exception. Clinical Priority Area Cancer New cases of Cancer diagnosed at stage 1 and 2 as a proportion of all new cancer diagnosed People with urgent GP referral having first definitive treatment for cancer within 62 days of referral One year survival Rate Adults with any type of cancer still alive one year after diagnosis Cancer Taskforce national ambition of 75% by 22 - Rated according to required linear trajectory to achieve this standard Positive responses to rate your care?" Description IAF THEME - BETTER CARE Estimated diagnosis rate for people with dementia Dementia Care-planning/ post diagnostic support for people with dementia anked TBC Used Quartiles e.g. 25% of CCGs allocated to each category according to their ra performance. Proportion of people with a learning disability on the GP Learning register receiving an annual health check during the year Disabilities Measured as a % of the CCGs registered LD population the question "Overall how would you Completeness of the GP learning disability register frequency Target Based on National Average % 85% People with a learning disability and/or autism receiving specialist inpatient care per million population Based on cancer taskforce ambition of 75% by 22 (linear trajectory) Based on National 85.8% Average TBC 214/ % Based on National Average - 58 Based on National Average - 47% TBC Overall IAF RAG Rating July 216 IAF data RAG Nationally Published Q4-47.9% Requires Improvement - Amber rating on all metrics or a red rating on no more than 2 metrics Requires Improvement Both metrics ranked 1-3 according to performance then are cross referenced for an overall rating Requires Improvement Both metrics ranked 1-3 according to performance then are cross referenced for an overall rating 215/16 Q4-79.% % 63.3% 215/ % 56 58% 214/15 July 217 IAF data RAG This is a new measure introduced to the IAF in November 217. July 218 IAF data RAG CCG Performance % 5.8% 217/18 216/17 Q3 Q % 85.8% % /1 Feb % 216/ % Q3-216/ % 216/ % /1 Feb % 216/ % Q3-217/ % 216/17.4% 216/17 M11 Feb 213-Q4 51.% % 91.49% 82.35% % % 65.9% 65.49% 78.5% Q2-215/16 7 people in Feb 15.2% 215/16 M12 March 214-Q1 47.1% % 78.5% Q2-215/16 7 people in March 15.2% 215/16 M1 April Current Performance 216-Q3 53.5% % /1 216/ % 4 people in April 15% 216/17.4% 216/17 Latest direction of travel Performance Requirements to achieve "Performing Well" Actions / Comments This is a Quality Premium Measure = 53.8% The Target for 216 = 57. 8% This is a Constitution measure - On going actions in place Green rating on 1 or 2 metrics and CCG's meeting this target by 1% or less have been rated no red ratings - Amber The CCG were assessed as This is an Outcomes Measure. Performance has increased by 2% since 212. England national Average for assessed period was having 3 Ambers and 1 Red 7.2% = Needs Improvement This measure is taken from the NHS England National Cancer Patient Experience Survey Last published: July 217. Eng Ave was 8.7/1 MK CCG STP Rank: 1/3 Top performing = % Milton Keynes % / Luton %/ Bedford % Performing well = % STP level -61.3% / Eng. Ave % Needs Improvement = % 25% of CCGs have been allocated to categories according to Top performing = % ranked performance. Performing well = % This is QoF data and is not released periodically. Next release Needs Improvement = % date TBC Greatest Need = -75.6% This figure is calculated by the number of people. This is for MK CCG in patients only. One or both metrics need to be significantly below the national This is an annual measure. average rate, the second can be either a 1 (significantly below nat. ave.), 2 (similar to nat. ave.) or 3 (significantly above nat. ave.). This is a new measure as of 217/18 and as such, no target has been set. Page 15 of 29

18 Clinical Priority Area Maternity Mental Health Diabetes The score out of 1 for women s experience of maternity services based on the 215 CQC Nationa al Maternity Services Survey Women offered choice in maternity services (Score out of 1 from the CQC Nat. Mat. Survey) Neonatal mortality and stillbirths per 1, births - The IAF rating given is combined for both measures % of women who were smokers at the time of delivery (with a NICE-recommended package) IAPT Recovery Rate Description IAF THEME - BETTER CARE People who have attended 2or> sessions, discharged and moving to recovery IAPT Access Rate target (16.8%) / Quarterly target (4.2%) IAF THEME - BETTER HEALTH %ofgppracticesthat participated in the National Diabetes Audit Newly diagnosed diabetes patients attending a structured education course The percentage of diabetes patients that have achieved all 3 of the NICE-recomme ended treatment targets Assessed using NDA to give CCGs a RAG rating - see guidance for rating bandings frequency Quarterly Target Based on National mean performance - TBC Based on National mean performance - 6% Based on National mean performance - TBC Based on National mean performance - 1.6% People with first episode of psychosis (EIP) treated within 2 weeks of referral 53% 5% 16.8% p/a 4.2% p/q 1.4% p/m People with first episode of psychosis (EIP) incomplete pathways 5% Less than 25% participation will be rated as "greatest need" Based on National Average - 5.7% Based on National Average % Overall IAF RAG Rating Greatest Need for Improvement Cross references ranking for all measures This measure is a Constitution measures and is not within the IAF July 216 IAF data RAG Nationally Published CCG Performance Performing Well Cross references ranking for both measures % 15/16 - Q3 75.% 52.38% 5.% Nationally Published CCG Performance Requires Improvement Cross references ranking for all measures 44.4% 214/15.5% 214/ % 214/15 July 217 IAF data RAG % 16/17 - Q % % July 218 IAF data RAG % Q Feb % Dec 17-48% This became an IAF 2.3% measure in November 217 Q This measure is a Constitution measures and is not within the IAF 88.9% 88.9% participation in participation in NDA NDA.8% 215/ % participation in NDA 38.8% 215/16.5% - calendar year % NDA Audit Year - Ja n 2 16 to Ma r 17 M11 Feb % 16/17 - Q3 1.% 1.% 5.% % 51.49% 54% 1.33% 1.37% 1.47% 1.% 1.% 75.% 88.9% participation in NDA. 5% 214/ % 214/15 M12 March % 16/17 - Q4 88.9% 215/16 1% 215/ % 215/16 M1 April Current Performance % 17/18 - Q4 Current Performance 1% 216/17.5% 216/ % 216/17 Latest direction of travel Performance Requirements to achieve "Performing Well" 1 or no metrics to be significantly This score was effected by the lack of a Midwifery Led Unit in MK, worse than the national mean rate; which is unlikely to be resolved until the outcome of the Healthcare and of the remaining 3, at least 2 review is understood, however MKUHFT have now established a to be in line with the national mean home births team to provide greater choice for women regardingg or better performing Commissioners continue to review and monitor this figure on a monthly basis with the Trust through CQRM meetings. The CCG is working towards becoming a 'high' performing area and are working with MKUHFT to implement Saving Lives Care Bundle to support Commissioners are monitoring this data on a monthly basis through the maternity dashboard and are working with MKUHT to implement Saving Lives Care Bundle of which reducing SATOD is YTD performancee 49.49% The target for this measure has increased to 53% as Top performing = >55% of April 218. Performing well = 5-55% Full YTD performance is 5.25% (target 5% %) Full YTD performance is 15.2% (target 16.8% %) This metric is not within the IAF This is an annual measure. 27/27 practices have "opted in" for the Less than 25% participation will be NDA audit (1%) rated as "greatest need" irrespective of performance in other 2 metrics This is an annual measure last audit August % of R - <5.7% - sig. below nat.ave patients attending a structured education course within 12 months of diagnosis based on 27/27 GP practices data. A - 5.7% - same as nat.ave. G->5.7% - sig. above nat.ave R - <37.8% A % G->4.2% Actions / Comments MKUHFT has developedd an action plan which is being monitored through the operational clinical quality review meetings held between the CCG and MKUHFT. In addition a gap analysis of the recommendations from Better Births has been undertaken by CCG and MKUFT which is being developed with Maternity:MK the Maternity Services Liaison Committee to agree priorities. This is an annual measure last audit August % with 27/27 GP practices participating. Page 16 of 29

19 4.1 IAF Exception where data has been updated since the July 217 IAF publication. Dementia Diagnosis The estimated diagnosis rate for peoplee with dementia in Milton Keynes as at the end of April is 65.49% %. This is lower than the Prime Ministers challenge, tasking CCGs with improving the diagnosis rate for people with dementia to at least 66.7%. The England estimated rate for April was 67.3%. Actions: The Dementia Pathway Working Group is overseeing this measure key work streams include implementation of the Dementia Business Case, including: Requested CCG Primary Care to publish a reminder in the Practice Newsletter regarding the dementia diagnosis target and raise as a discussion point in the Practice Manager s meeting about coding on the QOF. Requested dementia diagnosiss target to be raised with the Care Homes through the care homes newsletter / Care Home forum The SMS will send a flyer about their service to all GPs and offer to come talk about dementia to the surgeries SMS and Alzheimer s Society will through to me any positive stories about dementia patients living well that we can then feed into GPs and / or care homes Dementia Action Week is 21st 27th May where both SMS and the Alzheimer s Society are holding events where they will promote diagnosis where possible Mental Health - IAPT Recovery and Access IAPTT Access and IAPT Recovery: The local IAPT recovery rate performed to target in April with 53.7%. The local IAPT access rate has achieved against its monthly trajectory in April with 1.48% (the planned figure was 1.23%). The YTS performance totalled 15.8%, underachieving against the annual target of 16.8%. IAPTT Access The Provider has been working towards a recovery trajectory and an action plan for both measures and has succeeded in meeting the recovery positon. This action plan will carry forward into 218/19 in order to meet the increased access targett of 19% by March 219. The Provider is working towards the below performance targets for 218/19. Recover 5% Access Q1-15.5% / Q2 16.9% / Q3 19% / Q4 19% Page 17 of 29

20 The IAF has been updated in June 218. Below is a summary of the previous three years assessment for MK CCG. IAF Area IAF Name Overall Performance of MK CCG assessment in England RI RI Good BETTER CARE MEASURES - This area focuses on care redesign and performance against constitutional standards and outcomes in important clinical areas Provision of Hospital high quality Primary medical services care Adult social care Cancers diagnosed at early stage 47.9% 47.9% 5.8% People with urgent GP referral having first definitive Cancer treatment for cancer within 62 days of referral 79.% 78.1% 85.8% One-year survival from all cancers 7.% 7.% 71.8% Cancer patient experience 85.8% 8.6% 8.5% Improving Access to Psychological Therapies Recovery 5.% 42.5% 48.% Improving Access to Psychological Therapies Access 2.3% People with first episode of psychosis starting treatment with a NICE-recommended package of 9.% 5.% 93.6% Mental Health care treated within 2 weeks of referral Children and young people (CYP) receiving treatment from NHS funded community services as a proportion of the CYP population with a diagnosable mental health disorder Mental health out of area placements Mental health crisis team provision Reliance on specialist inpatient care for people with Learning disability learning disability and/or autism Proportion of people with a learning disability on the GP register receiving an annual health check Completeness of the GP learning disability register 58% 15% 25%.4% IAF Area IAF Name Overall Performance of MK CCG assessment in England RI RI Good BETTER HEALTH MEASURES - This area looks at how the CCG is helping to improve the health and wellbeing of its population Child Obesity Percentage of children aged 1-11 classified as overweight or obese 33.8% 33.8% 33.7% Diabetes patients that have achieved all the NICErecommended treatment targets: Three (HbA1c, 39.2% 39.2% 37.1% Diabetes cholesterol and blood pressure) for adults and one (HbA1c) for children People with diabetes diagnosed less than a year who attend a structured education course.5%.5%.5% Falls Injuries from falls in people aged 65 and over 975 1,157 1,359 Personalisation and choice Personal health budgets Inequality in unplanned hospitalisation for chronic Health ambulatory care sensitive and urgent care sensitive inequalities conditions 2, ,42 Antimicrobial resistance Appropriate prescribing of antibiotics in primary care Appropriate prescribing of broad spectrum antibiotics in primary care 6.8% 6.6% 7.2% Carers The proportion of carers with a long term condition who feel supported to manage their condition % Page 18 of 29

21 IAF Area IAF Name Overall Performance of MK CCG assessment in England RI RI Good Sustainability - This area looks at how the CCG is maintaining financial balance and securing good value for patients and the public Financial Green Green Amber sustainability In-year financial performance Paper-free at Utilisation of the NHS e-referral service to enable 64.6% 74.1% 82.3% the point of care choice at first routine elective referral Leadership - This area assesses the quality of the CCG s leadership and its plans, how the Probity and corporate governance Workforce engagement CCGs local relationships Patient and community engagement Quality of leadership Probity and corporate governance Fully Compliant Fully Complia nt Staff engagement index Progress against the Workforce Race Equality Standard Effectiveness of working relationships in the local system Compliance with statutory guidance on patient and public participation in commissioning health and care Quality of CCG leadership Amber Green Green IAF Area IAF Name Overall Performance of MK CCG assessment in England RI RI Good BETTER CARE MEASURES - This area focuses on care redesign and performance against constitutional standards and outcomes in important clinical areas Estimated diagnosis rate for people with dementia 62.3% 65.6% 66.7% Dementia Dementia care planning and post-diagnostic support 78.5% 77.6% Emergency admissions for urgent care sensitive conditions 2,428 2,312 1,766 Percentage of patients admitted, transferred or Urgent and discharged from A&E within 4 hours 95.7% 91.6% 88.6% emergency care Delayed transfers of care attributable to the NHS per 1, population Population use of hospital beds following emergency admission End of life care Percentage of deaths with three or more emergency admissions in last three months of life Patient experience of GP services 77.% 78.9% 8.% Primary care access - percentage of registered Primary care population offered full extended access 52.% 97.1% Primary care workforce - GP and Practice Nurses per 1K population Patients waiting 18 weeks or less from referral to Elective access hospital treatment 89.% 92.7% 87.8% 7 day services Achievement of clinical standards in the delivery of 7 day services NHS Continuing Healthcare Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting 33.% 24.1% 37.4% Areas of concern: Better Health Diabetes / Falls / Health Budgets / Carers Better Care MH / LD / Maternity / Dementia / Elective Access Page 19 of 29

22 5. QUALITY PREMIUMM 218/19 The Quality Premium (QP) scheme incentivises CCGs to improve and reduce inequalities in patient health outcomes and improve accesss to services. As in previous years, the QP retains focus on the fundamentals of everyday commissioning. This includes delivery of the NHS Constitution commitments and in 18/19, moderation of emergency care demand. The total amount of the 18/19 Quality premium is circa: 1,464,585. The CCG will be awarded the QP value of each national measure achieved, with the appropriate quality gateway reduction forr each Constitution Measure not achieved by Q4. QP Ref EDM A1/ A2 and B Emergency Demand Management Indicators QP Ref NHS 1 NHS 3 QP Measure / Description A1 - Type 1 A&E attendances A2 - Non elective admissions with zero length of stay B - Non elective admissions with length of stay of 1 day or more QP Measure / Description Maximum 18 weeks from referral to treatment Incomplete standard Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer Emergency Demand Management Indicators What we need to Required Achievement QP value By When achievee Actual number of Type 1 A&E Actual to be attendances to be no greater than the Full 218/19 equal or below planned number of Type 1 A&E Financial Year 18/19 Plan attendances. 5% Weighting Actual number of non-elective TBC Actual to be admissions with LOS = to be no Full 218/19 equal or below greater than the planned number of Financial Year 18/19 Plan non-elective admissions with LOS =. Actual number of non-elective admissions with LOS of 1 day or more to Actual to be 5% Weighting Full 218/19 be no greater than the planned equal or below TBC Financial Year number of non-electivee admissions with 18/19 Plan LOS of 1 day or more. These will be measured as simply the difference between actual and plan e.g. [218/19 actual attendances] - [218/19 planned attendances] NHS Constituion Gateway National Requirem ment in 218/19 The number of patients on an incomplete pathway not to be higher in March 219 than in March 218 Total patients on the pathway in March , % The QP is based on overall aggregated CCG performance data Redcution of QP due to NHS Constitution Gateway = 1% Actual Data April - 6,78 April April - 1,611 QP Weighting g 5.% 5.% Planned data April - 6,341 April - 76 April - 1,595 CCG data April 218 RAG based on National Requireme ent 13, patients over target 82.35% RAG RAG Page 2 of 29

23 Quality Premium Measuress - 218/219 QP Ref QP Measure / Description Required Achievement QP value What we need to achieve By When Latest Period Data RAG QP 1 NM 1 Early Stage Cancer Cancer - New cases of cancer diagnosedd at stage 1 and 2 as a proportion of all new cases of cancer diagnosed (specific cancer sites, morphologies and behaviour*) * - invasive malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary, uterus, non-hodgkin lymphomas, and invasive melanomas of skin. 1. Demonstrate a 4 percentage point improvement in the proportion of cancers (specific cancer sites, mor phologies and behaviour*) diagnosed at stages 1 and 2 in the 218 calendar year compared to the 217 calendar year. Or 2. Achieve greater than 6% of all cancers (specific cancer sites, morph hologies and behaviour*) diagnosed at stages 1 and 2 in the 218 calendar year. 17% of total QP 248, TBC - awaiting 217 outcome OR 2. 6+% 218 Calendar Year Data will be a rolling window of one years worth of data. The data will be lagged by 12 months. Q % Q % Q % Q % 215 Calendar year = 53.8% Q % Q % Q % Q % 216 Calendar year = 51.% AMBER QP 2 NM 2 Patient Experience In July 219 publication, either: GP Patient Survey - Question 18: Overall, 1. Achieve a level of 85% of respondents who how would you describe your experience of said they had a good or very good experience of making an appointment? making an appointment Very good or Fairly good 2. A 3 percentage point increase from July Neither good nor poor 218 publication on the percentage of Fairly poor respondents who said they had a good or Very poor very good experience of making an appointment 17% of total QP 248, % 2. TBC% July 218 Publication (Published in July 219) 62.21% - July % - July % - July 217 AMBER QP 3 NM 3 Continuing Healthcare CHC 2 part Indicator Part 1. CCGs must ensure that more than 8% of all full NHS CHC assessments are completed within 28 days. Part 2. CCGs must ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting. Delivery of part 1: Develop protocols with services regularly involved in NHS CHC assessment processes that facilitate their timely participation in the comprehe ensive assessment. To include timely provision of assessment information, specialist assess sments and attendance at the Multidiscip linary Team (MDT) meeting and prompt verificat tion and eligibility decision making by the CCG in order to complete these processes within 28 days. Delivery of part 2: Assessment of eligibility for NHS Continuing Healthcare should usually be deferred until an accurate assessment of future needs can be made following post-acute recovery. To effect this accurate assessment, appropriate NHS-funded post-acute recovery provision should be routinely available and used. For example: therapy and/or rehabilitation, intermediate care interim package of support in an individual s own home, or in a care home. 8.5% of total QP 124, % of total QP 124,489 >8% within 28 days measured in aggregate across the full year 18/19 <15% in Hospital setting measured in aggregate across the full year 18/19 Full year aggregate (April 18 to March 19) Full year aggregate (April 18 to March 19) 217/18 April % / May - 76% June % / July % Aug % / Sept % Oct % / Nov % Dec % / Jan % Feb - 1% / March - 1% 217/18 April - 25% / May - 24% June / July % Aug % / Sept % Oct % / Nov % Dec - 25.% / Jan % Feb - % / March % 218/19 April - 1% 218/19 April - % GREEN GREEN Page 21 of 29

24 QP Ref QP Measure / Description Required Achievement QP value What we need to achieve By When Latest Period Data RAG QP 4a NM 4a Mental Health Selected MH Measure - Option B Addressing inequitable rates of Older People and people from Black and Minority Ethnic (BAME) communities accessing the Improving Access to Psychological Therapies ( IAPT) services Option B Part 1) Recovery rate of people accessing IAPT services identified as BAME; improvement of at least 5 percentage points (against Q4 of Year 1) OR to the same level as white British (for the CCG), whichever is smaller in Q4 Year 2. 17% of total QP 248,979 Part 1) BAME recovery rate = improvement of at least 5 percentage points or to same level as white British, whichever is smaller Target for 18/19 = either 54% or to the same rate at White British as at March /19 Quarter 4 Nationally Published data BAME Recovery - Q4 16/17-51% / Q1 17/18-43% / Q2 17/18-54% / Q3 17/18-42% / Q4 17/18-49% White British Recovery - Q4 16/17-52% / Q1 17/18-48% / Q2 17/18-5% / Q3 17/18-49% / Q4-56% Local Provider Data BAME Recovery - Q1-29.5% / Q2-36.8% Q3-44% / Q4-19.2% / YTD - 31% White British Recovery - Q2-25.9% / Q3-31.8% Q4-22.2% / YTD - 26% Nationally Published data 18/19 Local Provider data - 18/19 RED QP 4b NM 4b Mental Health Part 2) Proportion of peoplee accessing IAPT services aged 65+; to increase to at least 7% of the proportion of adults aged 65+ in the local population in Q4 Year 2 OR If 7% has been achieved, to achieve the same % in Q4 Year 2 as achieved in Q4 Year 1. Part 2) 65+ access = to increase either to 7% in Q4 year 2 218/19 Quarter 4 Nationally Published data Q4 16/ % / Q1 217/18-14% / Q2-31.3% / Q3-31.3% / Q % (IAPT dashboard) Local Provider data - Q1 3% / Q2-3.75% / Q3-5.6% / Q4-3.46% (YTD 3.72%) Nationally Published data 18/19 Local Provider data - 18/19 QP 5 NM 5 Bloodstream Infections 7.65% of total QP 45% BSI weighting Part a1) 216 = ( 112,4) % reduction = 168 Part A1) a 1% reduction (or greater) in all E coli Part A1-3% cases / 14 per Three parts to Indicator: BSI based on 216 performance data payable as month max <1% = % / % - 2% / % - 25% / Part a2) Parts A1 and A2) Reducing gram negative 2% + - 3% progressing blood stream infections (BSI) across the 74,693 whole health economy Part A2-15% - payable Part A2) collection and reporting of a core as 1% for Q2 and 5% for primary care data set for all E coli BSI as follows: Q3) 218/19 Part A2) Total 37,346 Q2-1% (1% weighting) progressing Q3-5% (5% weighting) Q2-24,346 Q3-12,448 March 219 (Total number of cases between April 18 and March 19 Financial Year) Part A2) Collect and report a minimum core primary care data set for 1% of all E coli BSI cases in Q2 & 5% of E coli BSI cases in Q3 218/ total numbers cases for MK CCG Need to achieve at or below FY data cases in total over 18/19 April /18 achieved 173 casess (5 cases over taeget / 7.4% reduction) Work is progressing in this area 218/19 target is 168 cases Threshold remaining: 149 cases RED AMBER Part B1) a 3% reduction (or greater) in the Part B) Reduction of inappropriate antibiotic number of trimethoprim items prescribed to prescribing for urinary tract infections (UTI) patients aged 7 years or greater on baseline in primary care data (June 215-May 216) 3.4% of total QP 2% BSI weighting 49, /18 Target 15/16 baselinee with 3% reduction applied Part B1) 3, /18 Financial Year Original 215/16 Baseline data = (April 17 to March 18) 5,649 performance over a rolling 12 month period 3% reduced target = 3,954 April - 5,276 / May- 5,229 June - 5,157 / July - 5,82 Aug - 4,981 / Sept - 4,779 Oct - 4,683 / Nov - 4,561 Dec - 4,415 / Jan - 4,33 Feb - 4,149 / Mar - 3,976 RED Part C1) Items per Specific Therapeutic group Age-Sex Related Prescribing Unit (STAR-PU) must be equal to or below England 213/14 mean performance value of items per STAR-PU Part C) Sustained reduction of inappropriate antibiotic prescribing in primary care 1.7% of total QP 1% BSI weighting 24,897 Equal to or below items per STAR-PU 217/18 Financial Year (April 17 to March 18) Equal to or below items per Performance over a rolling STAR-PU 12 month period April / May June / July Aug / Sept Oct / Nov Dec / Jan Feb / Mar GREEN Further stretch on Part C1 Part C2) Additional reduction in Items per Specific Therapeutic group Age-Sex Related Prescribing Unit (STAR-PU) equal to or below.965 items per STAR-PU. Thi s threshold is additional for 218/ % of total QP 25% BSI weighting 62,244 Equal to or below.965 items per STAR-PU 217/18 Financial Year (April 17 to March 18) Equal to or below.965 items per Performance over a rolling STAR-PU 12 month period April / May June / July Aug / Sept Oct / Nov Dec / Jan Feb / Mar RED 213/ % QP 6 To increase the number of people 18+ on the Full year aggregate (April 214/ % Local Measure Hypertension Reported Prevalence: 15% of total QP disease register for Hypertension as a proportion 12.39% 18 to March 19) 215/ % Right Care Disease Register and Population 18yrs + 219,687 of the reported prevalence 216/ % Indicator 217/18 - TBC Total Available (Best Estimate based January 18 MK CCG registered population 1,464,585 Based on achieving the following QP Measures: CHC Measures x 2 and BSI part C1 = 292,917) Best Estimate Eligible Quality Premium Amount (Before impact of the QP Gateways: NHS Constitution, Finance and Quality) Total Amount 273,875 RED Page 22 of 29

25 5.1 Quality Premium Exception Red Measures Mental Health IAPT Access - BAME The target for March 218 is to improve by 5% or to match the White British recovery rate, whichever is smaller. Latest published data (Q4 17/18) shows BAME recovery as 49% and White British as 56%. Actions: CNWL have appointed a BAME therapist / promoting servicess in local BAME communities / offering online therapy / single access route as of October / appointed a service user lead. Continued focus over 18/19 will include discussions at Contract meetings. Mental Health IAPT Access - 65yrs+ The target is to increase access either to 5% or by 33% whichever is bigger. Latest published data (Q4 17/18) shows achievement of 25%. Actions: CNWL are working with community partners including Age UK offering a presence in their facilities and brief intervention training with referral pathway into the IAPT service. Continued focus over 18/19 will include discussions at Contract meetings. Amber Measures Bloodstream Infections 3 parts (A1 and A2 / B1 / C1 and C2) Part A Reducing BSI across the whole health economy A1 Reducing E-Coli cases 17/18 total was 173 (5 cases over target). The 18/19 target is to achieve 168 cases over FY 218/19. April 19 cases, this is 5 cases over the average number of cases per month to remain within threshold. There is a threshold of 149 cases remaining over 11 months. A2 Collection and reporting of core primary care data Work is progressing in this area update will be given end of Q2. Partt B - Reduction of inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care B1-3% reduction (or greater) in the number of trimethoprim items prescribed to patients aged 7 years + on baseline data (June 215- Mayy 216) = 3,954 April yet to be released. March 18 figures were 3,976 this is above the target Partt C - Sustained reduction of inappropriate antibiotic prescribing in primary care C1 - Items per STAR-PU must be equal to or below England 213/14 mean performance value of April yet to be released. March 18 figures met this target with C2 - Additional reduction in STAR-PU equal to or below.965 April yet to be released. March 18 figures did not meet this target with Cancer Diagnosis stage 1 and 2 Latest published dataa shows achievement of 53.5% for Q3 216, with a target of 55% by the end of 217. On-goinresolving data quality issues. actions and work is progressing towards GP Patient Survey The target for 17/18 is 68.8%. July 216 achievement was not met. Outcome will be published in July 218. This will then set the target for the 18/19 QP. Prevalence of Hypertension The target is to meet 12.39% by March 219. Latest published data shows achievement of 12.21% at 16/17. Next release of data will be in November 2188 for 17/18. Green Measures CHCC - Part 1) > 8% of CHC assessments are completed within 28 days. YTD figures show that 64.52% of assessments are completed within 28 days. October performance met the target with 81.25%. CHC - Part 2) <15% of CHC assessments take place in an acute setting. In October, this figure under achieved with 4.63%. YTD figures show that 34.1% of assessments are completed within an acute setting. Page 23 of 29

26 6. MK CCG QUALITY DASHBOARD These Quality Indicators for MKUHT have been selected by Commissioners to represent quality pledges for all NHS patients. The national requirements, in terms of operational standards expected are shown and all measures are reporting by exception only in the following report. No. QI Trust QIT1 QIT2 QIT3 QIT4 QIT5 QIT6 QIT7 QIT8 Description Friends & Family Test Score - A&E Friends & Family Response Rate - A&E Friends & Family Test Score - Inpatients Target frequency 9% 15% 9% Friends & Family Response Rate - In patients 15% Number of Cancer 62 Day Waits - First Definitive Treatment -GP Referral breaches over 14 days (MK CCG) Dementia Assessments -Case Finding 9% Dementia Assessments -Diagnostic Assessment 9% Venous Thromboembolism (VTE) Risk Assessments 95% Quarter 1-18/19 Data M1 Data Comments Level April MKUHT 84.83% MKUHT 5..% Contractual rate is 15% but levers apply from 1% or lower. MKUHT 97.16% MKUHT 19.21% Contractual rate is 15% but levers apply from 1% or lower. This figure includes all CCG breaches of which MKUHT will have at least a shared part. CCG 3 This is addressed with Cancer 62 day waits. MKUHT MKUHT MKUHT 78.7% April release 4/7 April release 4/7 This figure is to be reported quarterly and YTD from Unify and monthly from the Trust. The Trust will carry out a manual process until automoated in April 218. QIT12 Incident -Serious Incidents MKUHT 5 QIT13 Incident -Never Events MKUHT Aug & Sept Never events weree surgical incidents. 3rd Never Event YTD. QIT14 Delayed Transfers of Care -Days Delayed (MKUHFT only) TBC MKUHT 519 QIT15 QIT24 QIT25 QIT26 QIT27 QIT28 NHS Safety Thermometer -Harm Free Care 95% Healthcare Acquired Infection Measure (MRSA) - CCG Level cas ses Healthcare Acquired Infection Measure (MRSA) MKUHT level cases Below 81 Healthcare Acquired Infection Measure (Clostridium casess in Difficile) - CCG Level pm / 18 pq Below 39 Healthcare Acquired Infection Measure (Clostridium casess in Difficile) - MKUHT Level pm / 9 pq Healthcare Acquired Infection Measure (E-Coli) - CCG Below w168 cases / 14 per Level month max MKUHT 95.3% CCG MKUHT CCG 3 MKUHT 1 CCG 19 June - MKCCG CDI panel have found no lapse in care This is a 217/18 Quality Premiumm Measure As at December, no more than 9 per month to remain within threshold for the year QIT29 Healthcare Acquired Infection Measure (E-Coli) - MKUHT Level MKUHT 3 Page 24 of 29

27 6.1 MKUHT Quality Exception Report April 218 Friends & Family A&E Test score The FFT score for MKUHT has slightly increased to 84.8%, nationally, the score was 86.6%. The Trust has underachieved against this measure for the last 12 months +. FFT is monitored via the Clinical Quality Review Meeting (CQRM, with regular progress updates given on the MKUHT recovery action plan. The Trust has stated that the Emergency Department continues to promote FFT throughout to support improvement in this indicator. VTE Risk Assessments MKUHT scored 78.7%. MKUHT have confirmed that improvement will not be seen until new system is implemented in Q1 218/19. Manual data collection continues. Assurance for this measure is gained through the CQRM. Delayed Transfers of Care MKUHT have had a total of 519 DToC days in April. The target for the full year for the CCG is 5,31. The Trust has exceeded the CCG s monthly threshold by 78 days. The remainder of Q1 has an allowance of 86 days. ACTIONS TO IMPROVE PERFORMANCE: The daily whole system Ready to Transfer call is ensuring that discharge planning and focus is for patients prior to becoming delayed. As a consequence, there is increased flow and lower conversion to DTOC becoming evident. 3 people, with a reduction on delayedd bed days. An experienced work with the processes. discharge co-ordinator form another area is scheduled to come to new Trust Lead for Discharge to support learning and new The Community-pull discharge and flow team, previously reported, is now in place in ED and MAU. Plans are in place to support tracking across the acute Trust. Community Equipment Services are ensuring that any equipment required to support hospital discharge can be ordered for a same day delivery. This will make sure that patients requiring equipment to enable them to return home will not be unnecessarily delayed in hospital. Significant work on redesigning the CHC pathway continues, in order to minimise the number of assessments carried out in an acute environment. The CCG has commissioned additional capacity to accommodate flow form the acute for patients who are likely to be health funded for their long term care We have now moved to use the DTOC local codes, agreed by all parties on the daily call, as the basis for our reporting. This has enabled more granular analysis and addressing of our issues. The Council has increased the number of social workers based in Milton Keynes Hospital to 7, to speed up assessments and secure attendance at ward rounds in the general medical wards to help ensure timely discharge and consideration of community alternatives on discharge The third party service to help people who are either health, or self-funded, commenced in December. To date, it has helped place or find packages for over 6.2 MKUHT Quality Schedule Report April 218 Quality Schedule Reports No issues to report too soon for quarterly reports to be submitted. Page 25 of 29