Integrated Performance Report

Transcription

1 Integrated Performance Report January Patient focused, Providing quality, improving outcomes

2 Contents: Page: Executive Summary 3 Assurance Framework Scorecard 4 NHS Outcomes Domains are health outcomes improving for Local people? 5 NHS Constitution are patient rights being promoted? 6 Quality - Are people getting good quality care? 7 Local Outcomes Indicators 7 Recovery Plan 9 Finance Indicators 10 Financial Individual Outcomes Indicators: Overall Financial Position 11 Resource Limit 12 Cash 13 Running Costs 14 Capital 15 Budget Breakdown 16 Deployment of headroom 2.5% 2014/15 18 CCG Risks 2014/15 19 Appendix A Outcomes Indicators 20 Appendix B Glossary of acronyms 22 Appendix C Better Payment Practice Code 23 Appendix D Quality Premium status 24 2

3 Performance Report January 15 Executive Summary Key performance issues arising in Month 10 include: Overall performance is rated Red for NHS Constitution 4 hour A&E waits YTD performance drops further below target (page 6) Peak in Mixed-sex accommodation breaches (page 6) CCG remains above C.Diff ceiling (page 5) Zero x 52 week waiters (page 6) Both Local indicators achieve target (page 7 ) Financial performance is currently forecast to achieve our new increased planned surplus target of 6.676m due to the return of Continuing Healthcare national risk pool monies not utilised by NHS England (page 11) 2.76m of available headroom monies is being utilised to support the CCG s position (page 18) and the 2.47m available contingency is being deployed in full (page 17) The net risk to WKCCG, should all risks arise, will be delivery of a reduced surplus of 0.34m below target, i.e. 6.34m (page 19) 3

4 Scorecard WKCCG Assurance Framework Indicator Target 2013/14 YTD Movement Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Target Are health outcomes improving for local people? G A/R A/R G CCG Assurance Framework Are local people getting good quality care? Are patient rights under the NHS Constitution being promoted? G A/G A/G G G A/R R G Finance G A/G G G Local Local G A/G G G Are health outcomes improving for local people? G All relev ant indicators on track for achiev ement of quality premium Not all indicators on track for achiev ement of the At least one indicator statistically significantly off track for achiev ement of A/G A/R R quality premium the quality premium All indicators statistically significantly off track for achiev ement of the quality premium Are local people getting good quality care? One or More 'Yes' responses w ith action plan One or More 'Yes' responses and no action plan in place/plan does not G All 'No' responses A/G A/R R that successfully mitigates patient risk significantly mitigate patient risk Enforcement action is being undertaken by the CQC, Monitor or TDA and CCG is not engaged in proportionate action planning to address patient risk Are patient rights under the NHS Constitution being promoted? G No indicators rated red A/G No indicator rated red but future concerns A/R One indicator rated red R Two or more indicators rated red 4

5 WKCCG Performance against the 5 NHS Outcomes Domains QP green shaded cell = quality premium indicator Overall RAG rating: A/R National and local Quality measures - Monthly data Period Target CCG last month CCG this month D4.4 Friends and family test for acute Inpatient care Response Rate Dec-14 30% 40.0% 29.3% D4.5 Friends and family test for A&E. Response Rate Dec-14 20% 20.0% 23.2% Movement Graph D5.1 Incidence of healthcare associated infection: MRSA D5.2 Incidence of healthcare associated infection: C difficile Acutal number of breaches Acutal number of breaches Dec Dec National and local Quality measures - Quarterly data Period Target CCG last quarter CCG this quarter Movement Graph D2.3 Unplanned hospitalisation for chronic ambulatory care sensitive conditions Jun D2.4 Unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s Jun D3.1 D3.3 Emergency admissions for acute conditions that should not usually require hospital admission Emergency admissions for children with lower respiratory tract infections Jun Jun D3.5 PROMs for elective procedures: hip replacement % of improvement Aug % 87.9% 89.4% D3.7 PROMs for elective procedures: knee replacement % of improvement Aug % 80.5% 81.3% D3.9 PROMs for elective procedures: groin hernia % of improvement Aug % 49.9% 50.3% D4.1 Patient experience of GP services % who report their % 88% 87% experience as "very D4.2 Patient experience of GP out of hours services good" or "fairly good" % 63% 68% National and local Quality measures - Annual data Period Target D1.1 D1.2 D1.3 Potential years of life lost from causes considered amenable to healthcare Potential years of life lost from causes considered amenable to healthcare: Male Potential years of life lost from causes considered amenable to healthcare: Female D1.4 Under 75 mortality from cardiovascular disease D1.5 Under 75 mortality from respiratory disease D1.6 Under 75 mortality from liver disease D1.7 Under 75 mortality from cancer D2.1 Health-related quality of life for people with long-term conditions D2.2 People feeling supported to manage their condition D2.5 Estimated diagnosis rate for people with dementia* D3.2 Emergency readmissions within 30 days of discharge from hospital CCG last year CCG this year Movement ,704 1,858 1, ,700 2,050 2, ,499 1,746 1, / / / % 46.0% 48.7% 2011/ D3.4 PROMs for elective procedures: hip replacement health gain 2013/ D3.6 PROMs for elective procedures: knee replacement health gain 2013/ D3.8 PROMs for elective procedures: groin hernia health gain 2013/ Weighted av e at CCG's D4.3 Patient experience of hospital care 2013/14 77% 77% 80% 5 main providers *National figures for previous years; 66.7% is the expected target for WKCCG for Data Updated this month Graph 5

6 WKCCG Performance against the NHS Constitution QP green shaded cell = quality premium indicator Overall RAG rating: R Indicator - Monthly data Period Operational CCG CCG Target last month this month Movement C1 Admitted patients to start treatment within a maximum of 18 weeks from referral Dec-14 90% 93.3% 93.3% C2 Non-admitted patients to start treatment within a maximum of 18 RTT waiting times for nonurgent weeks from referral Dec-14 95% 97.0% 96.9% consultant-led treatment Patients on incomplete non-emergency pathways (yet to start C3 treatment) should have been waiting no more than 18 weeks Dec-14 92% 95.3% 94.9% from referral C4 Number of patients waiting more than 52 weeks Dec C5 Diagnostic test waiting times Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral Dec-14 1% 0.18% 0.51% C6 Patients should be admitted, transferred or discharged within 4 w/e 01/02/15 95% 76.3% 84.4% A&E waits C7 hours of their arrival at an A&E department - MTW YTD 95% 93.2% 92.6% C8 Category A calls resulting in an emergency response arriving w/e 04/02/15 75% 77.5% 73.8% C9 within 8 minutes (Red 1) - SECAMB YTD 75% 75.3% 75.2% C10 Category A calls resulting in an emergency response arriving w/e 04/02/15 75% 71.7% 76.0% C11 within 8 minutes (Red 2) - SECAMB YTD 75% 74.0% 74.3% C12 Category A calls resulting in an ambulance arriving at the scene w/e 04/02/15 95% 98.9% 99.3% C13 within 19 minutes (Red 1) - SECAMB YTD 95% 98.5% 98.5% Category A ambulance calls C14 Category A calls resulting in an emergency response arriving w/e 04/02/15 75% 66.7% 70.6% within 8 minutes (Red 1) - CCG - for information only, does not C15 form part of assessment framework YTD 75% 67.9% 67.8% C16 Category A calls resulting in an emergency response arriving w/e 04/02/15 75% 61.7% 73.8% within 8 minutes (Red 2) - CCG - for information only, does not C17 form part of assessment framework YTD 75% 67.9% 68.2% C18 Category A calls resulting in an ambulance arriving at the scene w/e 04/02/15 95% 97.5% 100.0% within 19 minutes (Red 1) - CCG - for information only, does not C19 form part of assessment framework YTD 95% 97.7% 97.7% C20 Mixed Sex Accommodation Dec Minimise breaches C21 Breaches YTD Graph Indicator - Quarterly data C22 Cancer waits 2 week wait C23 C24 Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers Period Operational Target CCG last Qtr CCG this Qtr Movement Qtr 2 YTD 93% 96.0% 95.7% Qtr 2 YTD 93% 94.6% 94.4% Qtr 2 YTD 96% 96.5% 98.0% Graph C25 C26 Cancer waits 31 days Maximum 31-day wait for subsequent treatment where that treatment is surgery Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen Qtr 2 YTD 94% 97.0% 95.9% Qtr 2 YTD 98% 98.4% 100.0% C27 C28 C29 C30 Cancer waits 62 days Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers Maximum 62-day wait for first definitive treatment following a consultant s decision to upgrade the priority of the patient (all cancers) Qtr 2 YTD 94% 99.1% 96.5% Qtr 2 YTD 85% 85.4% 87.9% Qtr 2 YTD 90% 93.3% 95.6% Qtr 2 YTD No operational standard set 86.2% 92.3% 6 C31 C32 Cancelled Operations Mental Health All patients who have operations cancelled, on or after the day of admission, for non-clinical reasons to be offered another binding date within 28 days, or the patient s treatment to be funded at the time and hospital of the patient s choice. Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period Blue font indicates data update this month Qtr 2 YTD Not Rated - MTW total Qtr 3 YTD 95% 96.0% 96.6%

7 WKCCG Performance against Local Indicators QP green shaded cell = quality premium indicator Overall RAG rating: G Local Quality Measures Period Target CCG last quarter CCG this quarter L1 Local Outcomes Indicators Cardiac Rehabilitation Completion Q2 2014/15 65% 90.1% 90.1% Movement Graph L2 Others IAPT Coverage - performance against plan Q3 2014/15 15% 13.8% 15.6% Are local people getting good quality care? Overall RAG rating: A/G Indicator Period MTW KMPT KCHT SECAMB Q1 Has local provider been subject to enforcement action by the CQC? Dec-14 No No No No Q2 Q3 Q4 Has local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider licence conditions? Has local provider been subject to enforcement action by the NHS TDA based on 'quality' risk? Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern? Dec-14 N/A N/A N/A No Dec-14 No No No No Dec-14 No No No No Q5 Has the provider been identified as a 'negative outlier' on SHMI or HSMR? Dec-14 No No No No Providers Do provider level indicators from the National Quality Dashboard show that: Q6 MRSA cases are above zero Dec-14 No No No No Q7 the provider has reported more C difficile cases than trajectory Dec-14 No No No No Q8 MSA breaches are above zero Dec-14 Yes No No N/A Q9 Does the provider currently have any unclosed Serious Untoward Incidents (SUIs)? Dec-14 Yes Yes Yes Yes Q10 Has the provider experienced any 'Never Events' during the last quarter? Dec-14 No No No No Clinical Governance Q11 Does the CCG have any outstanding conditions of authorisation in place on clinical governance? Dec-14 No Has the CCG self-assessed and identified any risks associated with the following: Q12 Concerns around quality issues being discussed regularly by the CCG governing body Dec-14 No Q13 Concerns around the arrangements in place to proactively identify early warnings of a failing service Dec-14 No Q14 CCG Concerns around the arrangements in place to deal with and learn from serious untoward incidents and never events Dec-14 No Q15 Concerns around being an active participant in its Quality Surveillance Group Dec-14 No EPRR Q16 If there was an emergency event in the last quarter, has the CCG self-assessed and identified any areas of concern on the arrangements in place for dealing with such an event? Dec-14 No Winterbourne Review Q17 Has the CCG self-assessed and identified any risk to progress against its Winterbourne View action plan? Dec-14 Yes 7

8 WKCCG Performance Commentary Presentation of performance indicators has been updated this month to group Monthly, Quarterly and Annually updated indicators together. Additionally, all Outcomes and NHS Constitution indicators are presented on one page. The purpose of this is to provide greater simplicity in referencing these indicators and further clarity in longer term trends, particularly in annual data. Outcomes Domains - Are health outcomes improving for local people? This month uptake of the Friends and Family test for acute Inpatient care has dropped from 40% to 29.6%, below the acceptable target (30%) for the first time this year. This potentially risks 348k Quality Premium. There remains only 1 case of MRSA reported this year (in May). Incidence of C. Difficile (77) remains above the YTD ceiling for the year (74), with 7 new cases in December. Overall, performance remains Amber/Red, due to WKCCG under-performance against PROMS, GP Patient Experience, Potential Years of Life Lost and Under 75 mortality targets. NHS Constitution - Are patient rights being promoted? Overall performance is rated RED due to 2 material indicators being Red this month: 22 mixed-sex accommodation (MSA) breaches occurred in December MTW (Pembury) due to the need to use the Cath Lab as additional space for beds; MTW performance against the 95% target for 4 hour A&E waits has improved this month, but remains short of the target. Additionally, this puts at risk 580k of the quality premium. RTT and Diagnostic waiting times were above target in December despite fears of an impact from the A&E activity peak. There have been 0 (zero) 52 week breaches in December, a significant achievement against a YTD average of 7/month. SECAmb ambulance response times for Category A (8 minutes) Red 1 and Red 2 show a response to recover against target Trust-wide. WK CCG-specific performance has stabilised but remains below the lower thresholds for R1 and R2. Quality - Are local people getting good quality care? There were no reported incidents of MRSA Bacteraemia in December. There have been 7 C. Difficile cases reported for December making a total of 77 cases against a CCG trajectory of 74 YTD. The CCG is over the ceiling due to the number of cases occurring in non-acute settings; MTW is under-trajectory. 2 x Pre-72 hrs C.difficile case attributed to Hawkhurst Hospital, root cause analysis indicate that there was a lapse in care in the form of prescribing antibiotics without due indication. A delayed start or watch and review approach may have been more appropriate. There have been a number of outbreaks of confirmed influenza since December in Tonbridge Cottage Hospital and Sevenoaks Hospital, the CCG have been kept informed of the situation and outbreaks managed according to PHE advice. Local for West Kent - Outcomes Indicators The outcome for is Cardiac Rehab number of patients with coronary heart disease (CHD) who complete cardiac rehabilitation. Completion is defined as the end of the cardiac rehabilitation delivery phase and second assessment, as collected by the national audit of cardiac rehabilitation (NACR). This local outcomes indicator supports the CCG s Quality Premium at 384k and is the focus of a CQUIN incentive with MTW, which continues to provide this data regularly to NACR and year to date performance indicates achievement well above target. The CCG is monitoring IAPT coverage, this does not form part of the assurance framework but it is part of the Quality Premium ( 348k). Q3 performance has exceeded the 15% target for the first time, a result of the additional four providers accredited in the summer who have been treating additional patients and increased activity from existing providers. The Quality Premium is paid on Q4 performance, therefore this needs to continue to exceed 1,519 patients, a significant factor in achieving this will be GP referrals into the service. 8

9 Recovery Plan The financial Recovery Plan was approved by the Governing Body on 28 th October and is now being delivered. Project Leads are delivering action plans with support from Finance and the Programme Management Office (PMO). The status of these plans, with particular regard to financial savings delivery, continues to be monitored at the twice-monthly Internal PMO meetings, attended by the COO and CFO. Table 1 - Recovery Plan Delivery 1.1 Project Plans Due / received 1. Process 1.2 No Plan required Dec Jan M9 M10 Notes Plans due Category A & B only Plans received (ongoing) 41 68% 40 73% Live plans that have yet to deliver all their savings Plans 'completed' (savings delivered) 15 25% 15 27% No further updates required Plans overdue 4 7% 0 0% No plans should be overdue Total 100% 100% Removed to avoid duplication 4 6 Already in the position No savings possible 1 5 Closed 2. Financial 2.1 Savings delivery to date 2.2. Forecast Savings delivery Dec Jan M9 M10 Notes ( '000's) % ( '000's) % Target savings (risk adjusted - best 28/10) 9,300 9,300 Achieved: 2,562 4,171 Confirmed in the position sub-total - Completed 1,605 1,697 Will not change sub-total - Ongoing 957 2,474 Subject to change Outstanding to achieve Best Case 6,738 72% 5,129 55% Target outstanding to deliver Best Case Completed plans (confirmed value) 1,605 1,697 In the position Ongoing plans 7,783 7,603 In the process of being revised due to MTW agreement Total forecast Recovery Plan Delivery 10,107 9,300 PMO Commentary Financial Summary The total forecast savings of 9.3m from the implementation of the recovery plans continues to be embedded within the current financial position. The recovery plan is currently being updated following the risk share agreement with the 2014/15 MTW SLA. Risks The risks to the forecast savings positon is now linked to areas of expenditure outside of the acute care pathway eg primary care variation in medicines management and placements 9

10 Finance Indicators Finance Indicators Overall RAG rating: G Indicator Period YTD Plan YTD Actual YTD Variance FOT Plan FOT Actual FOT Variance YTD FOT Surplus - Year to Date ( '000) Jan-15 4,603 5,756 1,153 Surplus - Full Year Forecast ( '000) Jan-15 5,523 6,676 1,153 Running Costs ( '000) Jan-15 9,780 8,494 1,286 12,871 10,127 2,744 This covers Internal and external audit opinions, and an assessment of the timeliness and quality of returns Jan-15 Balance sheet indicators including cash management and BPPC Jan-15 10

11 Overall Financial Position Month 10 The reported position for month 10 shows a deterioration in the acute programme area which is being mitigated by improvements in the continuing care and mental health programme areas. The CCG is continuing to forecast the achievement of a planned surplus of 5.52m plus an additional 1.15m due to a reassessment of the CCG s CHC risk pool contribution, which has been reduced by 1.15m. Finance Report Month /15 Overall Financial Position Year To Date Year End Forecast Plan Actual Variance to plan Plan Forecast Variance to plan Variance to plan Movement in variance Expenditure Outturn Based on M10 Based on M9 As at M10 As at M10 As at M12 As at M12 As at M12 '000 '000 '000 '000 '000 '000 '000 '000 Overall Financial Position 418, ,843 5,756 Overall Financial Position 501, ,550 6,676 1,153 0 Year To Date Plan Actual Variance Year End Forecast Plan Forecast Variance Forecast Forecast '000 '000 '000 '000 '000 '000 '000 '000 Acute 231, ,199 (11,836) Acute 278, ,319 (15,068) (14,029) (1,039) Mental Health 33,867 34,087 (219) Mental Health 40,641 40,803 (163) (226) 63 Primary Care 63,180 62, Primary Care 75,817 75, Continuing Care 31,210 29,443 1,767 Continuing Care 37,452 35,331 2,121 1, Community Health Services 32,136 31, Community Health Services 38,563 38, Patient Transport/Reablement/Commissioning Non Acute 2,711 2, Patient Transport/Reablement/Commissioning Non Acute 2,959 2, (74) 421 Planned Programme Reserves-not yet deployed 3, ,413 Planned Programme Reserves-not yet deployed 4,361 (1,382) 5,743 5, Unidentified QIPP/Assumed income Unidentified QIPP/Assumed income (2,637) (653) (1,984) (814) (1,170) Total Programme costs 397, ,649 (5,768) Total Programme costs 475, ,723 (8,317) (7,057) (1,260) Headroom 4, ,580 Headroom 4, ,260 4,260 0 Contingency 2, ,055 Contingency 2, ,466 2,466 0 Total Programme Contingencies 6, ,635 Total Programme Contingencies 7, ,726 6,726 0 Corporate (Running Costs Allowance) 9,780 8,494 1,286 Corporate (Running Costs Allowance) 12,871 10,127 2,744 1,484 1,260 Total Administration 9,780 8,494 1,286 Total Administration 12,871 10,127 2,744 1,484 1,260 TOTAL 413, ,843 1,153 TOTAL 495, ,550 1,153 1,153 0 Surplus 4, ,603 Surplus 5, ,523 5,523 0 Grand Total 418, ,843 5,756 Grand Total 501, ,550 6,676 6,

12 Finance Report Month /15 Resource Limit There were no adjustments to the CCG's resource limit in Month 10. However, the Quality Premium award in respect of which was received last month was reassigned from Programme to Running Costs in accordance with the M10 NHS England guidance. Full Year Forecast Plan Forecast Variance '000 '000 '000 Resource Limit 493, ,227 6,888 Plan Actual Variance '000 '000 '000 Opening Resource Limit 476, ,809 0 Running Cost Allow ance 11,701 11, Closing Resource Limit 488, ,510 0 Confirmed Carry forw ard 4,659 4,659 0 GP IT 1,185 1,185 Interim Specialist Commissioning reduction (920) (920) RTT Funding 2,239 2,239 CEOV (181) (181) ORCP-Winter Resilience Funding Tranche 1 2,591 2,591 ORCP-Winter Resilience Funding Tranche ORCP-Winter Resilience Funding Tranche 3 1,500 1,500 Interim Specialist Commissioning reduction (62) (62) Quality Premium aw ards ,170 1,170 Confirmed Resource Limit 4,659 12,717 6,888 Total Resource Limit 493, ,227 6,888 12

13 Finance Report Month /15 Cash The CCG is holding a balance of cash at the month end of 0.05m. The Maximum Cash Drawdown has been adjusted in M10 and is now 502m. The NHS BSA payments of approximately 60m will be deducted from this figure to give the CCG the maximum amount of 442m permitted to draw down in cash. The CCG intends to draw down the maximum cash for 2014/15. and therefore the forecast has been adjusted accordingly. Year To Date Year End Forecast Plan Actual Variance Plan Forecast Variance '000 '000 '000 '000 '000 '000 Cash Balance (264) Cash Balance Year to Date Year End Forecast Plan Actual Variance Plan Forecast Variance '000 '000 '000 '000 '000 '000 Balance B/F Balance B/F Receipts Payments Receipts Draw dow n 362, ,000 12,000 Draw dow n 416, ,949 25,655 BACS BACS Chaps Chaps 0 RFT 3,534 3,534 RFT 4,241 4,241 Other 1, (389) Other 1, (467) 363, ,959 15, , ,894 30,388 Payments RFT (NHS) 360, ,942 (52,333) RFT 412, ,320 (50,033) BACS 2,420 68,189 65,769 BACS 4,744 81,827 77,083 Other 2,777 2,777 Other 3,332 3, , ,908 16, , ,480 30,383 Balance C/F (264) Balance C/F

14 Running Costs Finance Report Month /15 The CCG's running costs show an underspend against plan of 2.7m in M10. This is a significant movement from the reported forecast outturn position at M9, mainly due to the reallocation of the Quality Premium award for 2013/14 from programme into running costs. However, there was also a slight improvement in the year to date position which has also been reflected in the year end forecast. Year To Date Year End Forecast Plan Actual Variance Plan Forecast Variance Expenditure As at M9 Outturn As at M12 '000 '000 '000 '000 '000 '000 Running Costs 9,780 8,494 1,286 Running Costs 12,871 10,127 2,744 Year To Date Full Year Plan Actual Variance Plan Forecast Variance '000 '000 '000 '000 '000 '000 Cost Type Cost Type CCG Pay Costs 3,320 3,462 (142) Pay Costs 3,984 4,156 (172) CSU Recharge 3,581 3, Non-pay Costs-CSU Recharge 4,261 4, NHS Property Services re-charge Non-pay Costs-NHS Propco charge Other Non-pay 2, ,352 Non-pay costs-all other 3,911 1,089 2,822 Total Running Costs 9,780 8,494 1,286 Total Running Costs 12,871 10,127 2,744 14

15 Capital Finance Report Month /15 The CCG has a confirmed capital allocation of 1.44m for Despite some delays, the CCG is still expecting to spend its full capital allocation by the year end on the Care Plan Management System project. Year To Date Year End Forecast Plan Actual Variance Plan Forecast Variance '000 '000 '000 '000 '000 '000 Capital 1, Capital 1,440 1,440 0 Capital '000 Capital '000 Budget Actual Variance Budget Actual Variance Source of Funds '000 '000 '000 Source of Funds '000 '000 '000 Capital Funds Allocation 1,200 0 (1,200) Capital Funds Allocation 1,440 1,440 0 Legacy Capital Transfer 0 0 Legacy Capital Transfer 0 Transfer from Revenue 0 0 Transfer from Revenue 0 1,200 0 (1,200) 1,440 1,440 0 Application of Funds Application of Funds ITF ITF Data Warehouse Data Warehouse Care Plan Management (17) Care Plan Management 250 1,338 (1,088) Self Care Self Care GP IT GP IT HQ IT refresh HQ IT refresh , ,440 1,440 0 Total 1, Total 1,440 1,

16 Budget Breakdown Finance Report Month /15 Year To Date '000 '000 '000 Year End Forecast '000 '000 '000 Plan Actual Variance Plan at M10Forecast at M10Variance at M10 Overall Financial Position 418, ,843 5,756 Overall Financial Position 501, ,550 6,677 Year To Date Plan Actual Variance Year End Forecast Plan Forecast Variance '000 '000 '000 '000 '000 '000 MAIDSTONE AND TUNBRIDGE WELLS NFT 154, ,485 (8,602) MAIDSTONE AND TUNBRIDGE WELLS NFT 185, ,300 (12,148) GUY'S AND ST THOMAS'S NHS FOUNDATION TRUST 7,939 9,523 (1,584) GUY'S AND ST THOMAS'S NHS FOUNDATION TRUST 9,526 11,186 (1,660) KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 7,701 8,760 (1,058) KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 9,242 10,206 (964) MEDWAY NHS FOUNDATION TRUST 5,165 4, MEDWAY NHS FOUNDATION TRUST 6,199 5, EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST 3,951 3, EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST 4,741 4,751 (11) QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST 3,735 4,145 (410) QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST 4,482 4,849 (367) HORDER CENTRE 2,818 3,262 (444) HORDER CENTRE 3,382 3,922 (541) EAST SUSSEX HOSPITALS NFT 1,579 1, EAST SUSSEX HOSPITALS NFT 1,895 1, BMI HEALTHCARE LTD 1,022 1,225 (203) BMI HEALTHCARE LTD 1,226 1,473 (247) BENENDEN HOSPITAL TRUST 1,002 1,114 (112) BENENDEN HOSPITAL TRUST 1,203 1,339 (137) UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 992 1,017 (25) UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 1,190 1,209 (19) DARTFORD AND GRAVESHAM NFT (154) DARTFORD AND GRAVESHAM NFT 926 1,046 (120) SPIRE HEALTHCARE LTD (137) SPIRE HEALTHCARE LTD (166) ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST (127) ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST (144) MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST (88) MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST (100) LEWISHAM & GREENWICH NHS TRUST (22) LEWISHAM & GREENWICH NHS TRUST (22) GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRU GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION ST GEORGE'S HEALTHCARE NFT (37) ST GEORGE'S HEALTHCARE NFT (26) IMPERIAL COLLEGE HEALTHCARE NFT IMPERIAL COLLEGE HEALTHCARE NFT ACUTE COMMISSIONING (398) ACUTE COMMISSIONING (479) SOUTH EAST COAST AMBULANCE SERVICE NHS FT 11,783 11, SOUTH EAST COAST AMBULANCE SERVICE NHS FT 14,139 14,254 (114) SECAMB SECAMB ACUTE CHILDRENS SERVICES ACUTE CHILDRENS SERVICES END OF LIFE () () END OF LIFE HIGH COST DRUGS 7,273 7, HIGH COST DRUGS 8,727 8, NCAS/OATS 4,825 4, NCAS/OATS 5,781 5, PLANNED CARE 6,689 6, PLANNED CARE 8,027 7, URGENT CARE 2,798 2, URGENT CARE 3,357 2, CLINICAL ASSESSMENT AND TREATMENT CENTRES (165) 165 CLINICAL ASSESSMENT AND TREATMENT CENTRES ACUTE ELDERLY SERVICES (96) 60 (156) ACUTE ELDERLY SERVICES (115) (115) WINTER PRESSURES 2,754 2,754 WINTER PRESSURES 4,627 4,627 Acute 231, ,199 (11,836) Acute 278, ,319 (15,069) CENTRAL DRUGS 1,500 1, CENTRAL DRUGS 1,800 1, COMMISSIONING SCHEMES COMMISSIONING SCHEMES LOCAL ENHANCED SERVICES 2,456 2,593 (137) LOCAL ENHANCED SERVICES 2,947 3,111 (165) OUT OF HOURS 3,088 3, OUT OF HOURS 3,705 3, OXYGEN OXYGEN PRESCRIBING 53,642 53,878 (236) PRESCRIBING 64,370 64,654 (284) MEDICINES MANAGEMENT - CLINICAL MEDICINES MANAGEMENT - CLINICAL PRIMARY CARE IT PRIMARY CARE IT 1, Primary Care 63,180 62, Primary Care 75,817 75,

17 KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST 24,605 24, KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST 29,526 29, CHILD AND ADOLESCENT MENTAL HEALTH 2,962 3,058 (96) CHILD AND ADOLESCENT MENTAL HEALTH 3,555 3,670 (115) DEMENTIA DEMENTIA IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES 1,452 1,957 (504) IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES 1,743 2,092 (349) LEARNING DIFFICULTIES LEARNING DIFFICULTIES MENTAL CAPACITY ACT MENTAL CAPACITY ACT MENTAL HEALTH CONTRACTS (321) MENTAL HEALTH CONTRACTS (429) MENTAL HEALTH SERVICES - ADULTS 3,442 3, MENTAL HEALTH SERVICES - ADULTS 4,130 3, MENTAL HEALTH SERVICES - ADVOCACY MENTAL HEALTH SERVICES - ADVOCACY MENTAL HEALTH SERVICES - NOT CONTRACTED ACTIVITY (137) MENTAL HEALTH SERVICES - NOT CONTRACTED ACTIVITY (158) MENTAL HEALTH SERVICES - OTHER MENTAL HEALTH SERVICES - OTHER MENTAL HEALTH SERVICES - COLLABORATIVE COMMISSIONING (16) MENTAL HEALTH SERVICES - COLLABORATIVE COMMISSIONING (20) Mental Health 33,867 34,087 (219) Mental Health 40,641 40,803 (163) CHC AD FULL FUND PERS HLTH BUD CHC AD FULL FUND PERS HLTH BUD CHC ADULT FULLY FUNDED 22,031 21, CHC ADULT FULLY FUNDED 26,437 25,252 1,185 CHC ADULT JOINT FUNDED CHC ADULT JOINT FUNDED CHC CHILDREN 1,892 1, CHC CHILDREN 2,270 2, CONTINUING HEALTHCARE ASSESSMENT & SUPPORT (6) CONTINUING HEALTHCARE ASSESSMENT & SUPPORT (8) FUNDED NURSING CARE 6,084 5, FUNDED NURSING CARE 7,301 6, CHC CHILD PERS HLTH BUD (1) CHC CHILD PERS HLTH BUD (1) CHC AD JNT FUND PERS HLTH BUD 2 2 CHC AD JNT FUND PERS HLTH BUD 2 2 Continuing Care 31,210 29,443 1,767 Continuing Care 37,452 35,331 2,121 KENT COMMUNITY HEALTH NHS TRUST 27,634 27, KENT COMMUNITY HEALTH NHS TRUST 33,161 33, CARERS CARERS COMMUNITY SERVICES COMMUNITY SERVICES HOSPICES 1,509 1,516 (7) HOSPICES 1,811 1,819 (8) LONG TERM CONDITIONS LONG TERM CONDITIONS WHEELCHAIR SERVICE 1,223 1,223 () WHEELCHAIR SERVICE 1,468 1,468 PALLIATIVE CARE PALLIATIVE CARE Community Health Services 32,136 31, Community Health Services 38,563 38, PATIENT TRANSPORT 2,187 1, PATIENT TRANSPORT 2,330 2,326 4 REABLEMENT REABLEMENT COMMISSIONING - NON ACUTE COMMISSIONING - NON ACUTE GENERAL RESERVE - PROGRAMME 3,413 3,413 GENERAL RESERVE - PROGRAMME 1,723 (2,035) 3,758 HEADROOM 4, ,580 HEADROOM 4, ,260 CONTINGENCY 2,055 2,055 CONTINGENCY 2,466 2,466 Other 12,459 2,878 9,582 Other 12,109 1,277 10,832 Corporate 9,780 8,494 1,286 Corporate 12,871 10,127 2,744 Corporate 9,780 8,494 1,286 Corporate 12,871 10,127 2,744 1% surplus 4,603 4,603 1% surplus 5,523 5,523 Total 418, ,843 5,756 Total 501, ,550 6,676 17

18 Deployment of headroom 2.5% 2014/15 As part of business planning by the CCG a level of non-recurrent spending in 2014/15 has been increased to create funds for service change and prepare for 2015/16. The CCG has set aside 2.5% for non-recurrent spending (including 1% for transformation) in 2014/ m shown below in the YTD actual has already been embedded in the financial position reported at month 10. CCG Risks 2014/15 18

19 The financial risk of the CCG s current activities is assessed each month and at Month 10 the CCG is able to mitigate 0.5m of current assessed risk of 0.84m that arises from potential WKCCG forecast year end performance. Appendix A Outcomes Indicators 19

20 NHS OF Objective Outcomes Indicator Threshold Current Performance Target Clinical Rationale Monitoring Frequency Potential years of life lost from causes considered amenable to healthcare: Male Potential years of life lost from causes considered amenable to healthcare: Female Causes considered amenable to health care are those from which premature deaths should not occur in the presence of timely and effective health care. The concept of amenable mortality generally relates to deaths under age 75, due to the difficulty in determining cause of death in older people who often have multiple morbidities. The Office for National Statistics (ONS) produces mortality data by cause, which excludes deaths under 28 days (for which cause of death is not classified by ICD-10 codes). These indicators therefore relate to deaths between 28 days and 74 years of age inclusive. Domain 1 Preventing people from dying prematurely Under 75 mortality from cardiovascular disease The potential years of life lost (adjusted for sex and age) from amenable mortality for a CCG will need to reduce by at least 3.2% between 2013 and Under 75 mortality from respiratory disease (rate per 100,000 pop) One of four improvement areas which account for the large portions of the disease burden amenable to health care. Progress in these outcomes therefore provides a useful initial analysis of what accounts for progress in the overarching indicators. This indicator measures premature mortality from cardiovascular disease, and seeks to encourage measures such as the prompt diagnosis and effective management of cardiovascular conditions and treatments to reduce the re-occurrence of cardiovascular disease events and to prevent or to slow the process of chronic cardiovascular conditions. The detection of risk factors for, and the diagnosis and effective treatment of, cardiovascular disease will influence mortality associated with cardiovascular disease. One of four improvement areas which account for the large portions of the disease burden amenable to health care. Progress in these outcomes therefore provides a useful initial analysis of what accounts for progress in the overarching indicators. This indicator measures premature mortality from respiratory disease, and seeks to encourage measures such as early and accurate diagnosis, optimal pharmacotherapy, physical interventions, prompt access to specialist respiratory care, structured hospital admission and appropriate provision of home oxygen. The detection of risk factors for, and the diagnosis and effective treatment of, respiratory disease will influence mortality associated with respiratory disease. Annual Under 75 mortality from liver disease NB Information available at CCG level will involve small numbers Under 75 mortality from cancer One of four improvement areas which account for the large portions of the disease burden amenable to health care. Progress in these outcomes therefore provides a useful initial analysis of what accounts for progress in the overarching indicators. This indicator measures premature mortality from cancer, and seeks to encourage measures such as early and accurate diagnosis, optimal pharmacotherapy, physical interventions, prompt access to specialist cancer care, structured hospital admission and appropriate provision of home oxygen. Health-related quality of life for people with long-term conditions The overarching indicator (together with complementary improvement indicators) provide a picture of the NHS contribution to improving the quality of life for those affected by long-term conditions. Domain 2 People feeling supported to manage their condition Enhancing the quality Unplanned hospitalisation for chronic of life for people with ambulatory care sensitive conditions long-term conditions Unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s Reduction or a zero per cent change in emergency admissions for these conditions for a CCG between 2012/13 and 2013/14. (rate per 100,000 pop) 52% 52% Together with the overarching indicator, this improvement indicator should provide a picture of the NHS contribution to improving the quality of life for those with long-term conditions. The intent of this indicator is to measure effective management and reduced serious deterioration in people with ambulatory care sensitive (ACS) conditions. Active management of ACS conditions such as COPD, diabetes, congestive heart failure and hypertension can prevent acute exacerbations and reduce the need for emergency hospital admission. Estimated diagnosis rate for people with dementia To be developed 20

21 Emergency admissions for acute conditions that should not usually require hospital admission Preventing conditions such as ear, nose or throat infections; kidney or urinary tract infections or heart failure) from becoming more serious. Some emergency admissions may be avoided for acute conditions that are usually managed in primary care. Rates of emergency admissions are therefore used as a proxy for outcomes of care. Emergency readmissions within 30 days of discharge from hospital Effective recovery from illnesses and injuries requiring hospitalisation. Some emergency re-admissions within a defined period after discharge from hospital result from potentially avoidable adverse events, such as incomplete recovery or complications. Emergency re-admissions are therefore used as a proxy for outcomes of care. Domian 3 Helping people to recover from episodes of ill health or following injury Emergency admissions for children with lower respiratory tract infections Reduction or a zero per cent change in emergency admissions for these conditions for a CCG between 2012/13 and 2013/14. (rate per 100,000 pop) Preventing lower respiratory tract infections (LRTIs) in children from becoming more serious, for example, by preventing complications in vulnerable children and improving the management of conditions in the community, whilst taking into account that some children's conditions and cases might require an emergency hospital admission as part of current good clinical practice. For example, a clinical guideline for bronchiolitis published in November recommends that children showing low oxygen saturation as measured by pulse oxymetry should be admitted to in-patient care. 1 SIGN - Scottish Intercollegiate Guidelines Network (November 2006). Guideline 91. Bronchiolitis in Children - a national clinical guideline. Accessed: Quarterly and Annual PROMs for elective procedures: hip replacement PROMs for elective procedures: knee replacement Measuring health gained as assessed by patients for planned treatments. PROMs for elective procedures: groin hernia Patient experience of GP services 90% CCGs not responsible for commissioning services. Data will be available for transparency purposes. Patient experience of GP out of hours services 69% Improvement in patients experiences of GP out of hours services. Patient experience of hospital care Improvement in patients experiences of NHS inpatient care. Domain 4 Ensuring that people have a positive experience of care Friends and family test for acute inpatient care and A&E. NHS OF indicator in development There will need to be: 1) assurance that all relevant local providers of services commissioned by a CCG have delivered the nationally agreed roll-out plan to the national timetable, 2) an improvement in average FFT scores for acute inpatient care and A&E services between Q1 2013/14 and Q1 2014/15 for acute hospitals. 81% Improving the number of positive recommendations to friends and family by people receiving NHS treatment for the place where they received this care. Quarterly and Annual Domian 5 Treating and caring for people in a safe environment and protecting them from harm Incidence of healthcare associated infection: MRSA Incidence of healthcare associated infection: C difficile No cases of MRSA bacteraemia for the CCG s (rate per 100,000 pop) C. difficile cases are at or below defined thresholds for CCGs. (rate per 100,000 pop) Reducing the incidence of healthcare associated infections (HCAI) Reducing the incidence of healthcare associated infections (HCAI). Quarterly and Annual 21

22 Appendix B - Glossary Glossary A&E Accident and Emergency MRSA Methicillin-resistant Staphylococcus aureus BACS Bankers' Automated Clearing Services MSA Mixed Sex Accommodation BPPC Better Payments Practice Code MTW Maidstone and Tunbridge Wells Hospitals NHS Trust C Diff Clostridium difficile NCB National Commissioning Board CCG Clinical Commissioning Group NHS TDA NHS Trust Development Agency Chaps Clearing House Automated Payment System NHSE NHS England CQC Care Quality Commission NR Non Recurrent EKHUFT East Kent Hospitals University Foundation Trust PROMs Patient Reported Outcome Measures EPRR Emergency preparedness, resilience and response QIPP Quality, Innovation, Productivity and Prevention GP General Practitioner RA Running Yearly Average Guy s Guy's and St Thomas' NHS Foundation Trust RAG Red, Amber, Green HSMR Hospital Standardised Mortality Ratio SUIs Serious Untoward Incidents IAPT Increasing Access to Psychotherapy Treatment RFT Internal NHS BACS payment KCHT Kent Community Health NHS Trust SECAMB South East Coast Ambulance NHS Foundation Trust Kings King's College Hospital NHS Foundation Trust SHMI Summary Hospital-level Mortality Indicator KMCS Kent and Medway Commissioning Support SLAs Service Level Agreements KMPT Kent and Medway NHS and Social Care Partnership Trust YTD Year to Date LA Local Authority 22

23 West Kent CCG - 99J Jan-15 Appendix C - Better Payment Practice Code Non NHS Cumulative Performance by Value '000s Value of Non-NHS Bills paid within target 6,054 Value of Non-NHS Bills paid 6,281 % of all Bill paid in target (by value) 96.4% Cumulative Performance by Volume Volume of Non-NHS Bills paid within target 1,101 Volume of Non-NHS Bills paid 1,165 % of all Bill paid in target (by volume) 94.5% NHS Cumulative Performance by Value '000s Value of NHS Bills paid within target 27,711 Value of NHS Bills paid 28,049 % of all Bill paid in target (by value) 98.8% Cumulative Performance by Volume Volume of NHS Bills paid within target 227 Volume of NHS Bills paid 272 % of all Bill paid in target (by volume) 83.5% 23

24 Appendix D: Quality Premium The Quality Premium rewards clinical commissioning groups for improvements in the quality of health services they commission and for associated improvements in health outcomes and reducing inequalities. The quality premium paid to CCGs in 2015/16 (to reflect the quality of the health services commissioned in 2014/15) is based on six measures. The total payment will be reduced if a CCG s Providers do not meet four NHS Constitution requirements. The entire payment of the Quality Premium is at risk if there is a serious quality failure during 2014/15. WKCCG Quality Premium Tracker West Kent Population 464,000 Allocation of 5 per head 1. Potential life years lost Domain Threshold % available The CCG will receive this portion of the QP if it achieves a specific reduction between 2013 and Maximum value ( '000's) M10 forecast % Forecast value ( '000's) 15% % IAPT Achieve IAPT access levels of at least 15% by 31st March % % Avoidable emergency admissions 4. Friends & Family test CCG to achieve either: a) a reduction or 0% change in emergency admissions for the composite measures (see note) OR b) Indirectly Standardised Rate of admissions less than 1,000 per 100,000. Support Providers to address issues identified in FFT and support roll out of FFT showing improvement in a selected indicator. 25% % % % 348 Commentary (See IPR D1.1, D1.2, D1.3) Actions supporting this to be identifed. Data for 2014 performance will be released September (See L2) Surpassed target in Q3 (15.6%); QP relies on maintaining this in Q4. Robust action plan needed. (See D2.3, D2,4, D3.1, D3.3) On track with composite measure. (Will not achieve ISR of 1%) (See D4.4, D4.5) Currently on track for both indicators. 5. Local - Reporting of medicationrelated safety incidents Earned if the CCG agrees (and specified providers achieve) a specified increased level of reporting of medication errors between Q and Q may include improved levels of reporting from Primary Care. 15% % 348 (No IPR reference) All actions completed and can be evidenced. 6. Local - Cardiac Rehab 65% - Number of patients with coronary heart disease (CHD) who completed cardiac rehabilitation. 15% % 348 TOTAL 100% 2, % 2,320 (See L1) On track. 24

25 NHS Constitution rights and pledges Referral to treatment times (18 weeks) A&E waits Cancer waits 14 days Category A Red 1 ambulance calls Total Adjustment Predicted Net Total payable Threshold Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral. Achieved for at least 92% of patients in 2014/15 Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department - MTW Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) - SECAMB Adjustment to funding risk Value ( '000's) M10 Measure being achieved? Funding Adjustment ( '000's) -25% -580 Y 0-25% -580 N % -580 Y 0-25% -580 Y ,740 (see C3) On track. Commentary (See C7) The CCG remains at risk of not meeting its 95% target for 4 hour waits across the whole of (See C22) On track. (See 14.2) Downward trend placing 75% at risk; performance still above target. Financial Impact There are risks this month in Constitution elements of the QP calculation. Constitution A&E waits performance has materially degraded from the 95% target due to pressures reflected nationally placing 580k at risk. The total forecast Quality Premium payment is 1.74m. The net Quality Premium payment at risk is deemed to be 580k (negative variance to maximum possible payment). Action Plan The risk to A&E waits is a national issue felt locally and is being addressed by the CCG with daily sitrep calls, system-wide meetings, and working closely with provider and Area Team colleagues. 25