NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 10. Date of Meeting:.24 th March 2017.

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1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 10 Date of Meeting:.24 th March TITLE OF REPORT: CCG Corporate Performance Report AUTHOR: Melissa Laskey Director of Service Transformation Mike Robinson Associate Director Integrated Governance & Policy Victoria Preston Senior Information Analyst Melissa Surgey Head of Planning, Performance and Policy PRESENTED BY: PURPOSE OF PAPER: (Linking to Strategic Objectives) LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) COMMITTEES/GROUPS PREVIOUSLY CONSULTED: REVIEW OF CONFLICTS OF INTEREST: Barry Silvert - Clinical Director of Commissioning The purpose of the attached report is to highlight performance against all the key delivery priorities for the CCG in 2016/17 against which NHS Bolton Clinical Commissioning Group is nationally measured Delivery of Year 1 Locality Plan. Joint collaborative working with Bolton FT and the Council. Supporting people in their home and community. Shared health care records across Bolton. Regulatory Requirement Standing Item X Members are requested to note the content of the report and actions being taken where required to improve performance Performance is reported to: CCG Clinical Executive Contract Performance Group Quality and Safety Committee N/A 1

2 VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: OUTCOME OF EQUALITY IMPACT ASSESSMENT (EIA) AND ANY ASSOCIATED RISKS: Patients views are not specifically sought as part of this monthly report, but it is recognised that many of these targets such as waiting times are a priority for patients. The report does include performance against the Friends and Family Test at Bolton FT N/A 2

3 1 Executive Summary CCG Corporate Performance Report 1.1 This report highlights NHS Bolton Clinical Commissioning Group s performance against all the key delivery priorities for the month of January 2017 (Month 10). 1.2 Appendix 1 contains the detailed reports for each set of performance indicators the CCG is measured against: - Bolton CCG Objectives - Board Assurance Framework - NHS Constitution Standards - Key NHS Contractual Measures - Outcome & Quality Framework Indicators - Community Services Key Performance Indicators - CCG Quality Indicators - Mental Health Dashboard 1.3 Section 2 exception reports against all indicators. 2 Exception Reporting 2.1 Quality & Safety Board Lead, Dr Colin Mercer Healthcare Associated Infections There were four Bolton FT apportioned Clostridium Difficile toxin (CDT) positive cases in January. This takes the annual figure to 34 against the NHS England set target of 19. The FT s Harm Free Care panel identified two cases where there were no lapses in care. In the other two cases the panel identified delays in diagnosis and isolation that could have been prevented, although treatment was appropriate. In all cases to date there is no evidence of cross transmission. Current initiatives that are in place to reduce CDT cases were reported in last month s Corporate Performance Report. The FT are commissioning an external review of their infection control practice to ensure improvement plans are appropriately focused. The FT continues to play a valuable role in the Bolton Infection Prevention and Control Committee (IPCC). Their Community Team has played an integral role in the management of a number of influenza outbreaks in care homes over the winter months. There were no Bolton FT apportioned MRSA cases in January and work continues to prevent further cases. The IPCC has determined that high risk patients discharged from hospital care will receive prophylaxis and education as required from the Community IPC and district nursing teams. The CCG and Bolton Council are ensuring advice and education is in the service specifications for providers of drug and alcohol services in Bolton. A number of 3

4 these bacteraemia are contaminants often linked to urgent care, so the FT are working closely with teams in this area to encourage good practice and prevention. All MRSA cases undergo a full Root Cause Analysis (RCA) which is shared at the IPCC Serious Incidents (SIs) There were three SIs at Bolton FT reported in January. Two related to neonatal care and one related to a blood transfusion. These are being fully investigated by the FT and will be reviewed by the CCG s SI Review Group. The management of SIs by Bolton FT continues to be open, transparent and timely with reviews of a good quality Falls Patient falls were above threshold in January with 117 incidents reported against a threshold of 82. There have been 1010 cases reported against a year to date (YTD) threshold of 820. The overall trend of harms resulting from falls continues to reduce. Bolton FT and the CCG are part of the Bolton Falls Collaborative. As part of any RCA investigators consider the reasons for and appropriateness of admission Workforce Sickness absence measured on a 12 month rolling average basis has reduced slightly to 5.27% compared to 5.34% in December. Actions to remedy this as detailed in last month s Corporate Performance Report include: Understanding that short term absence has increased and that many of the FT s peers do better against this measure Boosting compliance with return to work interviews Reviewing our occupational health service Informal interventions to address dignity at work issues Offering mindfulness training to staff Noting the impact organisational change and work related pressure can have on sickness absence Mixed Sex Accommodation (MSA) There were a further 18 breaches of the standard in January. Five were in the Adult Acute division and were due to delays in specialty bed availability. Two were in the Elective division and also due to delays in specialist beds. YTD there have been 95 reported cases. This has been escalated to the Greater Manchester Health and Social Care Partnership (GMHSCP) who are supporting the CCG and FT in minimising breaches. 4

5 2.2 Commissioning Board Lead, Dr Barry Silvert Reduce Non-Elective Admissions The CCG has a target for a reduction of 2.1% of non-elective admissions in 2016/17 (based on outturn). In January there were 2,909 non-elective admissions across all providers. This represents a decrease of 18 non-elective admissions compared to January 2016 (2,927). This gives a YTD position of 29,073 emergency admissions compared to 28,952 for the same period last year (a 0.4% increase). Ongoing work continues between the CCG and FT to support the reduction in non-elective admissions, with the key programmes being: Expansion of the Ambulatory Care Unit (ACU) at Royal Bolton Hospital to cover medical and surgical specialties 7 days a week. Progress is being made with this and activity is increasing due to improvements in pathways and processes. Ongoing development of Intermediate Tier services (including the Admission Avoidance Team and full use of the Integrated Neighbourhood Teams). Work with NWAS on the extended use of hear and treat and see and treat including additional referral pathways for paramedics to use to reduce conveyances to hospital. Work with BARDOC and NWAS on the development of a Clinical Hub to align with GM strategic direction of travel. Work with BARDOC and NWAS on Alternative to Transfer services in and out of hours, which went live on the 23 rd February and activity is being monitored. This will be reported in future Corporate Performance Reports Reduce Non-Elective Length of Stay The target for non-elective length of stay for 2016/17 is 4.4 days. In January the length of stay increased to 4.8 days (from 4.6 days in December 2016). The YTD position is 4.6 days. The CCG, Bolton FT and Bolton Council are working collaboratively to reduce delayed transfers of care (DTOC), medical outliers in the hospital and streamline the discharge process. These are the main contributing factors to the increase in length of stay against the strategic plan. The DTOC lists are closely monitored and action taken jointly by health and social care partners Reduce Emergency Readmissions The number of emergency readmissions in January was 461 which is a decrease of 4 from December 2016 (465). The YTD position is 8.88% below plan NHS Constitution Targets 5

6 A&E 4 hour performance (target 95%) for February 2017 was 85.24%, an improvement in the performance of January. This is in part as a result of the new streaming model and improvement in flow within the hospital. The CCG and Bolton FT continue to work closely together to implement a series of actions to help to alleviate the pressure across the urgent care system including the pilot model of streaming primary care appropriate patients within the A&E Department. As previously reported to Board this model expanded its operating hours in December The initial data that has been analysed as part of the evaluation of the pilot shows that 2401 patients have been streamed to primary care, between the 15 th December 2016 and the 28 th February The scheme continues and a sustainable long term model for the continuation of the pilot is currently being considered in line with emerging national guidance. In February, NWAS failed the national target for Emergency Response arriving within 8 minutes with performance of 70.1% (against the Red 1 target of 75%). This does however show a significant improvement from January performance which was 58.8%.The two other national targets also failed. Red 2 performance for February was 58% (against a target of 75%) and the Category A 19 minute response performance was 89.6% (against a target of 95%). Again, although both targets have failed, there has been some improvement from performance in January. The CCG continues to encourage the use of the NWAS see and treat and hear and treat as alternatives to ambulance conveyances to A&E. January s performance for see and treat (23%) had remained consistent whereas hear and treat (14%) has increased by 1%. Both 16/17 YTD performance figures remain above plan and compare positively across Greater Manchester. As mentioned earlier in the report, Bolton is now live with the NWAS and BARDOC, 24/7 Alternative to Transfer service, enabling appropriate patients to receive primary care treatment rather than being conveyed to A&E by an ambulance crew. Performance for the incomplete RTT pathway standard for January was 90.5% of patients waiting less than 18 weeks for planned procedures, against a threshold of 92%. It has previously been highlighted to Board that performance against this standard has continued to show a steady decline throughout 2016/17. This is coupled with an increase in referrals in certain specialties. Of all admitted patients treated in January, 83.4% were seen and treated within 18 weeks (against a threshold of 90%). This is a 1.2% increase compared to the December 2016 position. Of all non-admitted patients treated in January, 90.6% were treated within 18 weeks (against a threshold of 95%). Analysis continues to demonstrate that this position is largely due to availability of beds at Royal Bolton Hospital, with a noted relationship between high emergency demand, delayed transfers of care, medical outliers and elective cancellations. A recovery plan has been developed by the Elective Division at Royal Bolton Hospital, but this will be heavily impacted upon due to continued pressures arising from non-elective demand. The 6 week diagnostic waiting time standard for all Bolton CCG providers was failed in January with 1.29% of patients waiting longer than 6 weeks for their 6

7 diagnostic procedure, against a threshold of 1%. This is a deterioration of 0.16% on the position seen in December However Bolton FT achieved performance of this standard for January. Notable pressure areas remain around endoscopy due to the known increase in demand nationally. The commissioning team is currently working with Bolton FT to facilitate interprovider pathway developments with In Health to make best use of all commissioned endoscopy capacity. An updated recovery positon is awaited from Central Manchester NHS Foundation Trust, with pressure areas also noted to be endoscopy. The CCG failed the 62 day target for wait from referral from an NHS screening programme to first definitive treatment for cancer in January with performance of 88.2% against 90%. This represents two breaches of 17. A full analysis of these breaches is currently being undertaken. However the CCG is meeting all national cancer targets YTD NWAS 111 Performance/OOH Most recent data from February indicates 2,739 calls were triaged through the 111 system. This is a decrease of 502 calls from January 2017 (3,241 calls). Of the 2,739 patients triaged, 269 (10%) were recommended to attend A&E, 411 (15%) resulted in an ambulance being dispatched, 1,411 (52%) were referred to primary or community care services and 586 (21%) were advised for no further treatment or services. The development of the Clinical Hub model will help to stream appropriate patients to other services to meet their needs rather than A&E. The CCG are currently working with Greater Manchester colleagues, BARDOC and NWAS to scope this model and implementation Contractual Performance In February there were 267 patient handovers (from ambulances to A&E) where patients waited between 30 and 59 minutes and 157 handovers where patients who waited more than 60 minutes (against a target of 0 for both). Although these targets continue to fail, February has seen some improvement, particularly in the reduction of patients who have waiting more than 60 minutes (42% reduction from January 17). As previously highlighted to the Board, work is ongoing through a collaborative group to focus on Urgent Care Key Priority 3: The Ambulance Response Programme. Regular operational meetings are in place with Bolton FT and NWAS with the support of the CCG and work is underway to establish best practice across Greater Manchester with a view to learn and improve processes. Stroke performance data is available up to December 2016, when the service saw a decline in performance, with 60.6% of patients spending at least 90% of their stay on a stroke unit against the target of >80%. The performance for patients arriving within a designated stroke bed within 4 hours of arrival also declined to 60.7% against the target of >80% due to non-elective bed pressures. 7

8 2.2.7 Mental Health The January position for CPA was 100% against a target of 95% with performance improving from the December position of 93.3%. The YTD remains above target at 97.6%. There were no 7 day follow up breaches in January. Performance against the Improving Access to Psychological Therapies (IAPT) recovery rate (combined figures for GMMH and 1 Point) was achieved in January with performance of 55% against a target of 50%. The YTD recovery rate is 51.2%. The access rate has risen slightly but the IAPT service failed the 15% target in January, with performance at 11.9%. There were significantly lower numbers reported entering treatment and a lower number of referrals being reported compared to the expected volume. The YTD position has further deteriorated to 13.6% in January as a result. A provider/commissioner meeting was held to review performance and an urgent action plan is in progress. GMMH also noted some staffing vacancies which may have contributed to a decreased number of contacts, but assurance has been given that the service will be fully staffed with full caseloads by the end of April. The combined IAPT service continued to achieve both the 6 week and 18 week access targets in January with 90.9% of people beginning treatment in 6 weeks (against a target of 75%) and 100% beginning treatment within 18 weeks (against a target of 95%). Key performance highlights from the mental health dashboard for January include: Maternity Acute OATS (Out of Area Treatments) no new patients were placed out of area in January. The RAID service in Bolton achieved all response time targets seeing 89.3% of referrals within 1 hour (against a target of 75%), 97.2% within 2 hours and discharged (against a target of 95%), and 93.3% of referrals within the 4 hour target (against a target of 95%), this percentage has fallen due to periods of high activity (particularly outside of office hours) when RAID received multiple referrals. There have also been a number of clinically complex cases that have resulted in waits over 4 hours (but not over 12 hours). The Early Intervention in Psychosis (EIP) service exceeded the 50% access target with 92.3% of people accessing the service within 2 weeks during January Activity has decreased in comparison with previous months (average now is 13 per month compared to an average of 19 per month from April November). The national 12+6 target is for 90% of women to receive a full health and social care risk assessment and booking by a midwife before 12 weeks and 6 days of pregnancy. The 12+6 data for February is not yet available and will reported in next month s Corporate Performance Report. The performance reported in last month s Corporate Performance Report of 79.8% for all bookings at trust level and 82.2% at 8

9 CCG level has been found to have data quality issues since publication of the last report. This is due to how patients transferring to Bolton FT maternity care after 12+6 were being recorded. Bolton FT and the CCG are aware of this issue and appropriate action is being taken to rectify this error. Accurate performance data for January and February will be reported in next month s Corporate Performance Report Community Services Dashboard Detailed below are the key highlights from the overarching community services dashboard for January. Overall waiting times for community services (adults) have seen a slight improvement during January when compared with the previous monthly position of 72.4%, with performance across the services at aggregate level now at 74.9% for referrals seen within agreed targets. Children s services wait times year to date are closer to plan at 78.9% against the default 90% target. Referrals to children s community teams have progressively increased over the last few months with a further increase seen in January (2,300 GP and Other source against a target of 2,148). Referrals to Adult services from a GP source are below plan in January 2017 at 2,371 compared to a target of 2,601. Other sourced referrals are above plan YTD mostly to the diabetes service. Referrals to the Integrated Neighbourhood Teams increased in January 2017 to 217 (from 158 in December) however was still below the monthly target of 293. Cumulative year to date referral activity is 2,226 referrals against a plan of 2,930 (75.9%). The Joint Commissioning Data Group which meets monthly have produced a single source of data core KPI report covering the top 10 selected KPIs for performance monitoring the service which is in the final stages of development. The CCG, Bolton Council and the FT have all contributed to the definitions and resolved several issues relating to the data sources and quality of the data captured. Further development of the KLOE comprehensive integration dashboard is underway to map the outcomes of the Better Care Fund schemes against the services contributing towards these outcomes. This visually demonstrates the overall impact of schemes in place and will be used for monitoring performance against plan. Intermediate Tier services have been included in the latest iteration of this KLOE report along with a number of supporting measures for the local and GM priorities to investigate the redrafted measures in more detail. Admission avoidance referrals seen within 48 hours are performing at 91% YTD against a plan of 90% however there are a number of services failing to meet the required thresholds in particular the seen within 5 working days target most notably Integrated Neighbourhood Teams, District Nursing Treatment Rooms, MSK Physio, Neurology Long Term Conditions and Rheumatology. 2.4 TIA Services The CCG Executive has considered the future provision of TIA services, given the ongoing concerns that have been reported to Board previously, with regard to the poor performance of the TIA service in Bolton. 9

10 Bolton FT recently put forward a proposal to provide a 7 day service, however this did not include a full 7 day model with weekend Doppler access. The Executive has recommended that discussions commence with Salford Royal Foundation Trust (SRFT) regarding the future provision of the service so that Bolton patients receive their investigations and treatment from Salford Royal hospital. The rational for this is as follows: Salford Royal is the hyper acute unit for stroke and the public are aware of the specialist nature of the Trust. SRFT s performance against the current TIA target is consistently at 100%. The SRFT model that has been agreed gives assurance, that if the Bolton activity transfers, the service will be developed to a 7 day service via an ambulatory care model with a one stop shop including Doppler access on all 7 days. 2.5 Child and Adolescent Mental Health Service (CAMHS) The CCG has commenced a programme of work to develop a new service specification for CAMHS and will secure a new provider through an open procurement process in order to ensure the ongoing sustainability of the service. A comprehensive outcome based service specification has been drawn up by CCG and Bolton Council commissioners, based on best practice and national evidence. This has been supported by clinicians and service users and will be further refined through the planned wider engagement in co-design during March and April The new model moves away from the traditional clinically-focussed service delivery and focuses on the I-thrive model, which puts the individual at the heart of decision making. High level timescales for the completion of an open procurement process begins with a Request For Information (RFI) which is due to be published by 24th March Consultation and engagement of the proposed service model is underway and will conclude by mid-april. The Invitation To Tender will be issued to bidders by end June 2017 and the expected start date of the new service will commence on or before April Recommendations The Board is asked to note the performance for January 2017 and the actions being taken to rectify areas of performance which are below standard. Melissa Laskey Director of Service Transformation 22 nd March

11 Index Appendix 1 2 Bolton CCG Objectives 3 Board Assurance Framework dashboard 4-5 NHS Constitution Standards 6-8 Key NHS Contractual Measures 9 Outcome & Quality Framework Indicators Community Services Key Performance Indicators CCG Quality Indicators Mental Health Dashboard Appendix Integrated Care Performance Report

12 BOLTON CCG CORPORATE REPORT - 5 YEAR AIMS From (2011/12) To 2015 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD YTD Position Comments Objective Key Measures of Success (Goals) for Emergency admissions) Improve Health Outcomes For Male 1.8 Female 1.6 Reduce the gap in life expectancy between Bolton and England 2.05 years (2010) 1.85 years (2015) Reduce the gap in life expectancy between the most and least deprived areas in Bolton 1 m13.5 f11.5 m13 f11 Data not yet available For Male 13.5 Female 11.3 Improve quality of care and patient experience of care Achievement of all key targets / NHS Constitution Several failing All achieved Running total Number of failing targets out of 17 National measures See NHS Constitution report, 8 for January, A&E 4 Hour, RTT Admitted, None admitted, Incompletes, Diagnostics and all NWAS targets. Bolton patients and carers would recommend health services (combination of A&E and Inpatient) 90% Local target 90.7% 90.4% 90.2% 88.5% 91.6% 91.3% 91.1% 90.5% 91.4% 92.8% 91% 91% New measure 'percentage recommended' rather than 'net promoter score' Best Value: As per year 2 of the 5 year strategic plan Reduce emergency admissions 34,765 34,035 2,847 2,982 2,813 2,930 2,738 2,868 2,985 3,061 2,940 2,909 29, % Comparative to same period for the previous year Shift care closer to home Reduce elective & non elective length of stay (Ave LOS) El 3.3 (baseline - strategic plan) NE 4.9 (baseline - strategic plan) El / NE / As per year 2 of the 5 year strategic plan As per year 2 of the 5 year strategic plan As per year 2 of the 5 year strategic plan Reduce emergency readmissions 6,086 3% Reduction , % Comparative to same period for the previous year Data rebased due to GMW no longer submitting and a shift in code for admission method.

13 Bolton CCG Board Assurance Framework Dashboard - January 2017 Strategic Objective Milestones and Key Performance Indicators Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Comment/ Current Position Appraisal of locality plan (and supporting of CBAs) by all organisations and sign off by H&WBB HWBB signed off Deliver Year 1 of Bolton Locality Plan 2. Show that Bolton is truly working together: New type of contract with Bolton FT, Jointly develop with Bolton Council new commissioning models Transformation Fund proposal approval Receipt of Transformation Funding Implementation of identified work programme milestones for 16/17 Aligned Incentive Contract in place and monthly monitoring Agreement of LCO model for phased implementation from 17/18 Development of integrated commissioning models for implementation from 17/18 Establish 7 day GP access Target date Target date Target date Target date Target date 28.8m approved for Bolton March 17. Exec meeting with GM/JR & Chief Execs /17 funding announced March 2017 Implementation plans in development 17/18 contract signed CCG & Council commissioning leads are working in a collaborative manner. Discussions about more formal arrangements are taking place with HWB Exec 3. Support more people in their own homes and communities, improve patient safety through better GP access, community services, INTs People still in own home 91 days post discharge from reablement * INT Activity meeting Plan Reduced admissions to permanent placements in residential/nursing homes ** Hospital Activity Reducing (changed Q3 from Elective Activity) Partners engaged and signed up to information sharing Target for 16/17 set at 86% Ongoing work to strengthen INTs working in primary care. Oct 2016 data shows target for INTs achieved for first time. Bolton BCF2. Benchmarking data from June 2016 placed Bolton as the second highest in GM. -2.1% reduction on previous year activity end Qtr 3 43 of 50 GP Practices signed up. Info Sharing Protocol signed by Partner organisations 4. Enable shared health & social care records across Bolton Communications messages developed and shared with staff, professionals and patients System live in early adopter practices Target date Target date Engagement ongoing from Aug website now live. 9 Early Adopter practices covering 25% population due March 17 System in use in A&E and Out of Hours Target date On Track KEY Green Achieved Yellow On Track *Data source for this measure still being updated since migration to liquid logic by Bolton Council Sept 2016 Red Off Track ** ICS&P Group agreed original target for this measure was unachievable due to baseline year activity changes. Therefore, plan will be amended for 2017/18

14 NHS Constitution Indicators January 17 Indicator Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Jan17) Referral to Treatment waiting times for non urgent consultant led treatment - All Providers Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 89.6% 87.9% 83.5% 82.9% 82.2% 83.0% 81.4% 83.2% 82.9% 83.4% 84.1% A Aggregated target failed, the only specialties to achieve are Cardiothoracic Surgery, General Med, Ophthalmology and Thoracic Medicine. Orthopaedics is currently failing on 79.3%. Bolton FT failed the target in Month (82.3%) will all breached specilaties significantly below the target of 90%. Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 94.7% 95.6% 94.2% 94.4% 93.6% 92.4% 92.3% 92.1% 92.8% 90.6% 93.6% A Aggregated target failed, specialties achieved for January are Cardiothoracic Surgery, Geriatric Medicine, Gynae, Rheumatology, Thoracic Medicine, Urology, ENT and Other. Bolton FT failed the target 90.24% specialties failed are, Dermatolgoy, General Medicine, General Surgery, Ophthalmology, Plastic Surgery, Orthopaedics and ENT. Patients on incomplete non emergency pathways (yet to start treatment) 92% 94.2% 93.9% 92.8% 92.2% 91.6% 91.6% 92.1% 91.9% 90.8% 90.5% 92.1% A Total incomplete position failed for January, In month Incomplete with decision to admit 78.42% and without decision to admit 92.2%. Year to date 'with decision to admit' 81.3% 'without decision to admit' 93.47% Diagnostic test waiting times All providers Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1% 2.14% 1.44% 1.27% 0.82% 1.62% 1.08% 0.90% 1.30% 1.13% 1.29% 1.38% F Target breached in month, 46 over 6 weeks (target breached by 11), Bolton FT achieved for January (0.92%). Main breaches at Bolton FT (24) and Central Mancheser (14). A & E waits - Bolton FT Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department - Bolton FT 95% 80.20% 81.40% 85.30% 81.90% 86.10% 87.10% 81.50% 79.50% 79.20% 79.23% 82.15% F 1,875 patients waited more than 4 hours (Denominator 9,029) Indicator breached by 1,424 patients. Cancer patients - 2 week wait -All Providers Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93% 99.2% 99.1% 98.3% 99.5% 98.8% 99.0% 98.9% 98.9% 98.3% 98.5% 98.8% A Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93% 100.0% 97.3% 94.0% 96.6% 93.8% 94.7% 98.4% 96.6% 90.1% 96.9% 95.9% A 0 Cancer patients - 31 day wait -All Providers Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers 96% 96.2% 99.1% 96.6% 99.1% 94.4% 95.0% 96.7% 97.0% 100.0% 100.0% 97.3% A Maximum 31 day wait for subsequent treatment where that treatment is surgery 94% 94.4% 100.0% 96.6% 88.2% 86.7% 88.2% 100.0% 100.0% 100.0% 100.0% 95.9% A

15 NHS Constitution Indicators January 17 Indicator Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Jan17) Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A Cancer waits - 62 days - All Providers Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85% 96.2% 96.0% 92.3% 93.2% 92.1% 88.7% 92.6% 94.5% 96.0% 97.9% 93.9% A Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers 90% 100.0% 87.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 88.2% 96.7% A 2 breaches out of 17 Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers) None set 100.0% 100.0% 100.0% 80.0% 100.0% 100.0% 87.5% 88.9% 85.7% 85.0% 89.6% A Category A ambulance calls NWAS Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) 75% 76.47% 74.30% 73.10% 70.45% 72.60% 69.49% 64.59% 62.80% 61.63% 61.79% 68.29% F Category A calls resulting in an emergency response arriving within 8 minutes (Red 2) 75% 67.46% 66.30% 66.20% 62.69% 65.25% 61.75% 63.05% 60.35% 57.31% 58.78% 62.76% F Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 92.01% 91.50% 91.50% 89.81% 91.09% 89.04% 88.23% 86.79% 85.42% 85.74% 88.99% F

16 CCG Performance Report - January 17 Commissioner Performance Dashboard Indicator Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Jan17) Referral to Treatment waiting times for non urgent consultant led treatment - All Providers Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 89.6% 87.9% 83.5% 82.9% 82.2% 83.0% 81.4% 83.2% 82.9% 83.4% 84.1% F Aggregated target failed, the only specialties to achieve are Cardiothoracic Surgery, General Med, Ophthalmology and Thoracic Medicine. Orthopaedics is currently failing on 79.3%. Bolton FT failed the target in Month (82.3%) will all breached specilaties significantly below the target of 90%. Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 94.7% 95.6% 94.2% 94.4% 93.6% 92.4% 92.3% 92.1% 92.8% 90.6% 93.6% F Aggregated target failed, specialties achieved for January are Cardiothoracic Surgery, Geriatric Medicine, Gynae, Rheumatology, Thoracic Medicine, Urology, ENT and Other. Bolton FT failed the target 90.24% specialties failed are, Dermatolgoy, General Medicine, General Surgery, Ophthalmology, Plastic Surgery, Orthopaedics and ENT. Patients on incomplete non emergency pathways (yet to start treatment, includes 'with decision to admit') 92% 94.2% 93.9% 92.8% 92.2% 91.6% 91.6% 92.1% 91.9% 90.8% 90.5% 92.1% A Total incomplete position failed for January, In month Incomplete with decision to admit 78.42% and without decision to admit 92.2%. Year to date 'with decision to admit' 81.3% 'without decision to admit' 93.47% Number of patients waiting more than 52 weeks - (Bolton FT only) Incomplete F Number of patients who are not offered another binding date within 28 days Bolton FT Number of patients who are not offered another binding date within 28 days F Diagnostic test waiting times All providers Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1% 2.14% 1.44% 1.27% 0.82% 1.62% 1.08% 0.90% 1.30% 1.13% 1.29% 1.29% F Target breached in month, 46 over 6 weeks (target breached by 11), Bolton FT achieved for January (0.92%). Main breaches at Bolton FT (24) and Central Mancheser (14). A & E waits - Bolton FT Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department - Bolton FT 95% 80.20% 81.40% 85.30% 81.90% 86.10% 87.10% 81.50% 79.50% 79.20% 79.23% 82.2% F 1,875 patients waited more than 4 hours (Denominator 9,029) Indicator breached by 1,424 patients. Cancer patients - 2 week wait -All Providers Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93% 99.2% 99.1% 98.3% 99.5% 98.8% 99.0% 98.9% 98.9% 98.3% 98.5% 98.8% A Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93% 100.0% 97.3% 94.0% 96.6% 93.8% 94.7% 98.4% 96.6% 90.1% 96.9% 95.9% A

17 CCG Performance Report - January 17 Indicator Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Jan17) Cancer patients - 31 day wait -All Providers Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers 96% 96.2% 99.1% 96.6% 99.1% 94.4% 95.0% 96.7% 97.0% 100.0% 100.0% 97.3% A Maximum 31 day wait for subsequent treatment where that treatment is surgery 94% 94.4% 100.0% 96.6% 88.2% 86.7% 88.2% 100.0% 100.0% 100.0% 100.0% 95.9% A Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A Cancer waits - 62 days - All Providers Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85% 96.2% 96.0% 92.3% 93.2% 92.1% 88.7% 92.6% 94.5% 96.0% 97.9% 93.9% A Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers 90% 100.0% 87.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 88.2% 96.7% A 2 breaches out of 17 Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers) none set 100.0% 100.0% 100.0% 80.0% 100.0% 100.0% 87.5% 88.9% 85.7% 85.0% 89.6% A Category A ambulance calls NWAS position Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) 75% 76.47% 74.30% 73.10% 70.45% 72.60% 69.49% 64.59% 62.80% 61.63% 61.79% 68.29% F Category A calls resulting in an emergency response arriving within 8 minutes (Red 2) 75% 67.46% 66.30% 66.20% 62.69% 65.25% 61.75% 63.05% 60.35% 57.31% 58.78% 62.76% F Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 92.01% 91.50% 91.50% 89.81% 91.09% 89.04% 88.23% 86.79% 85.42% 85.74% 88.99% F All handovers between ambulance and A&E must take place within 15 minutes (no of patients waiting >30 mins<59 mins) Bolton FT F All handovers between ambulance and A&E must take place within 15 minutes (no of patients waiting >60 mins) Bolton FT F

18 CCG Performance Report - January 17 Indicator Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTD Forecast Achieve/Fail Exceptions Trend (Apr13-Jan17) Mixed sex accommodation breaches - Bolton FT Zero tolerance MSA breaches F Mental Health - GMW Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA (functional) - Completed 95% 96.60% 95.50% 98.60% 97.40% 95.60% 96.40% 96.50% 97.30% 97.10% 97.00% 96.80% A Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA - 7 day follow up 95% 96.80% % 97.10% % % 97.10% 97.50% 95.80% 95.10% % 97.90% A IAPT Recovery rate - (GMW, 1 point and Think Positive) Internal data 50% 47.93% 45.41% 47.19% 50.22% 51.53% 51.29% 52.89% 52.79% 57.98% 54.22% 50.76% A IAPT Access rate - (GMW, 1 point and Think Positive) Internal data 15.0% 12.50% 14.90% 15.50% 17.60% 15.10% 15.40% 10.60% 12.70% 9.40% 12.00% 13.60% At Risk Number of ongoing waiters >18 weeks A HCAI-Healthcare Associated Infections Annual target MRSA-Post 48 hrs (Hospital) F CDIFF-Post 72 hrs (Hospital) F Friends and family A&E Percentage Recommended tbc 82.0% 80.7% 82.3% 80.0% 85.4% 84.6% 82.7% 80.2% 80.9% 84.0% 82.2% A A&E Response Rate 15% 13.8% 10.4% 14.5% 13.9% 13.1% 10.2% 9.7% 9.0% 8.0% 9.5% 11.3% F From April 2016, Children's A&E data is added to the denominator, work is ongoing at Bolton FT to improve the capture of feedback, however the metric continues to breach. Inpatient Recommended tbc 98.0% 98.0% 96.8% 96.7% 97.0% 97.0% 96.7% 96.3% 97.2% 98.0% 97.1% A Inpatient Response Rate 15% 35.7% 38.1% 35.8% 34.8% 32.8% 25.2% 30.5% 29.7% 28.7% 30.0% 32.0% A Never events Never events F

19 OUTCOME AND QUALITY INDICATORS Domain 1 - Preventing people from dying prematurely This domain captures how successful the NHS is in reducing the number of avoidable deaths /15 Target Potential years of life lost (PYLL) from causes considered amenable - healthcare CCG (Direct Standard Rate) Latest data released Sept 15 - next due Dec 16 Domain 2 - Enhancing quality of life for people with long-term conditions This domain captures how successfully the NHS is supporting people with long-term conditions to live as normal a life as possible. Health related quality of life for people with long term conditions CCG People feeling supported to manage their condition CCG Health-related quality of life for carers, aged 18 and above CCG 2011/ / / /15 GP registered population from NHAIS (Exeter), the Primary Care Mortality Database (PCMD) and ONS mid - year census based England population estimates GP Patient Survey (GPPS) via HSCIC Latest data for July 15-March 16 released Aug Latest data for July 15-March 16 released Aug Latest data for July 15-March 16 released Aug 16 Domain 3 - Helping people to recover from episodes of ill health or following injury This domain captures how people recover from ill health or injury and wherever possible how it can be prevented. HES via HSCIC 2010/ / / / /15 Emergency admissions for acute conditions that should not usually require hospital admission - CCG Latest data for 14/15 next release Feb 17 Domain 4 - Ensuring that people have a positive experience of care This domain looks at the importance of providing a positive experience of care for patients, service users and carers. National Inpatient Survey Programme via HSCIC 2010/ / / / /15 Patient experience of GP Services (released Aug 16) (4ai) Patient experience of GP Out of Hours (released Sep 15) (4aii) Patient experience of hospital care (Bolton FT) (4b) Next version due August Next version to be confirmed Next version due August 17 Responsiveness to inpatients' personal needs (Bolton FT) (4.2) Next version due August 17 Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm This domain explores patient safety and its importance in terms of quality of care to deliver better health outcomes. Indicator in development 2010/ / / /14 For 14/15 the indicator has changed to per 1000 bed days *Patient safety incidents (rate per 100 admissions) (Bolton FT) HSCIC November NHS Outcomes Framework *The Number resulting in severe harm or death HSCIC November NHS Outcomes Framework * 6 monthly reporting (October to March)

20 Community Summary 2016/2017 Indicator Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb YTD Current Target Actual Target Actual Community Services - Adults Referrals Referrals - GP 2,689 2,514 2,467 2,388 2,572 2,445 2,654 2,729 2,679 2,670 2,167 2,371 2,321 28,618 27,463 2,601 2,321 Referrals - Other 4,074 3,834 4,409 4,521 4,338 4,654 4,536 4,571 4,913 4,760 4,131 4,889 4,078 39,850 49,800 3,622 4,078 Re-referrals < 90 Days , Re-referrals < 90 Days Rate 12.2% 12.7% 12.7% 14.0% 11.8% 11.0% 11.4% 11.0% 10.7% 11.6% 12.0% 11.6% 9.9% % - 9.9% Waiting Times Referrals Seen < Target 0% 0% 68.6% 70.3% 67.9% 65.4% 65.4% 61.6% 67.0% 70.9% 77.0% 72.4% 74.9% 90.0% 69.1% 90.0% 74.9% Activity and Access Activity - First 7,758 7,327 7,758 7,554 7,702 8,974 9,667 9,938 10,055 10,329 8,191 10,640 8,957 81,889 99,765 7,444 8,957 DNA - First , DNA Rate - First 4.9% 5.3% 6.3% 6.9% 6.6% 6.4% 6.4% 6.2% 6.6% 6.2% 6.8% 6.6% 6.5% 5.0% 6.5% 5.0% 6.5% Activity - Follow-up 42,789 42,423 46,021 45,846 44,598 43,361 44,206 42,730 42,224 43,896 38,788 40,310 34, , ,001 44,911 34,021 DNA - Follow-up 1,352 1,487 1,732 1,676 1,820 1,867 1,731 1,543 1,623 1,717 1,591 1,485 1,276-18,061-1,276 DNA Rate - Follow-up 3.1% 3.4% 3.6% 3.5% 3.9% 4.1% 3.7% 3.5% 3.7% 3.8% 4.0% 3.6% 3.6% 8.0% 3.7% 8.0% 3.6% Telephone Clinics 1,100 1,345 1,474 1,290 1,292 1,309 1,190 1,161 1, , ,731 12,667 1, Appointments Cancelled < 1 Week of Due Date Patient Experience and Outcomes 0.7% 0.8% 0.7% 0.8% 0.8% 0.6% 0.7% 0.7% 0.9% 0.9% 0.8% 0.8% 0.8% 3.0% 0.8% 3.0% 0.8% Friends and Family - Recommend Rate 89.6% 91.1% 87.9% 88.2% 89.6% 90.2% 91.1% 94.4% 95.0% 94.3% 94.3% 95.1% 94.8% 85.0% 90.9% 85.0% 94.8% Complaints Complaints - Responded < 35 Days 100% 100% 100% 100% 100% 100% 0% 95.0% 83.3% 95.0% 0% Compliments 1,264 1,052 1, ,261 1, , /03/ :12 Page: 1 of 4 XRBH\gyoung2

21 Community Summary 2016/2017 Indicator Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb YTD Current Target Actual Target Actual Staffing WTE in Post WTE v Establishment 93.9% 94.9% 93.3% 94.4% 94.6% 92.8% 93.3% 93.1% 93.6% 93.3% 93.5% 93.8% 94.6% 95.0% 93.7% 95.0% 94.6% Sickness Absence Rate 5.0% 3.9% 4.1% 4.6% 3.9% 5.1% 4.3% 3.3% 5.5% 6.0% 5.3% 6.1% 4.2% 4.8% 4.2% 6.1% Staff Turnover 12.8% 11.7% 10.7% 10.4% 12.4% 11.2% 11.1% 13.2% 12.9% 13.7% 13.3% 13.1% 13.2% 10.0% 12.3% 10.0% 13.2% Appraisals 85.5% 86.9% 85.4% 85.0% 86.2% 82.1% 84.5% 82.9% 82.6% 86.4% 86.6% 82.8% 85.1% 85.0% 84.5% 85.0% 85.1% Mandatory Training Compliance 90.8% 91.2% 91.8% 92.8% 91.4% 89.9% 90.0% 91.0% 91.9% 92.4% 92.7% 93.0% 93.6% 85.0% 91.9% 85.0% 93.6% Statutory Training Compliance 94.6% 95.0% 95.4% 94.8% 91.8% 91.0% 91.6% 92.5% 93.7% 94.6% 94.8% 95.6% 95.6% 95.0% 93.8% 95.0% 95.6% Safeguarding Compliance 97.2% 96.9% 97.3% 95.2% 89.1% 89.9% 91.4% 92.8% 94.0% 94.6% 94.7% 95.1% 96.1% 95.0% 93.7% 95.0% 96.1% Harm-free Care Incidents , Incidents - Moderate or Severe Rate 3.4% 0.6% 2.5% 4.9% 2.2% 1.7% 2.1% 0.5% 1.8% 3.3% 2.3% 1.3% 2.8% 3.0% 2.3% 3.0% 2.8% Pressure Damage - Grade Pressure Damage - Grade Pressure Damage - Grade Patient Falls Hand Hygiene 99.4% 96.0% 98.7% 99.2% 97.8% 99.0% 98.5% 99.1% 99.5% 97.7% 99.6% 99.5% 99.7% 98.0% 98.9% 98.0% 99.7% 16/03/ :12 Page: 2 of 4 XRBH\gyoung2

22 Community Summary 2016/2017 Indicator Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb YTD Current Target Actual Target Actual Community Services - Children Referrals Referrals - GP ,960 6, Referrals - Other 1,721 1,633 1,523 1,705 1,761 1,666 1,491 1,668 1,897 2,011 1,681 1,663 1,722 17,687 18,788 1,607 1,722 Re-referrals < 90 Days , Re-referrals < 90 Days Rate 8.1% 7.2% 7.9% 7.4% 7.3% 8.6% 8.2% 7.4% 8.3% 7.7% 9.7% 8.7% 7.6% - 8.1% - 7.6% Waiting Times Referrals Seen < Target 0% 0% 75.9% 77.3% 77.8% 77.6% 75.9% 74.2% 80.5% 78.9% 77.8% 71.6% 78.9% 90.0% 76.9% 90.0% 78.9% Activity and Access Activity - First 2,897 2,694 2,705 2,902 2,927 2,697 2,813 2,778 2,687 2,900 2,648 2,675 2,399 29,355 30,131 2,668 2,399 DNA - First , DNA Rate - First 3.4% 4.7% 5.7% 4.9% 4.4% 4.3% 4.4% 4.7% 4.0% 4.1% 5.2% 4.7% 4.0% 5.0% 4.6% 5.0% 4.0% Activity - Follow-up 12,766 11,332 16,732 13,883 16,661 12,337 10,685 17,803 13,700 15,992 10,317 17,046 11, , ,024 12,339 11,868 DNA - Follow-up , DNA Rate - Follow-up 3.9% 3.9% 3.2% 3.4% 3.1% 4.4% 5.3% 3.3% 3.2% 2.8% 4.6% 2.7% 3.3% 8.0% 3.5% 8.0% 3.3% Telephone Clinics 1,020 1,058 1,157 1,172 1,141 1,278 1,124 1,349 1,222 1,532 1,407 1,561 1,348 12,263 14,291 1,114 1,348 Appointments Cancelled < 1 Week of Due Date Patient Experience and Outcomes 0.2% 0.3% 0.2% 0.4% 0.3% 0.3% 0.3% 0.2% 0.5% 0.3% 0.3% 0.2% 0.3% 3.0% 0.3% 3.0% 0.3% Friends and Family - Recommend Rate 94.9% 85.7% 89.5% 85.2% 89.7% 94.2% 93.9% 80.5% 92.6% 92.7% 90.0% 96.2% 92.9% 85.0% 91.3% 85.0% 92.9% Complaints Complaints - Responded < 35 Days 100% 100% 95.0% 100% 95.0% 100% Compliments /03/ :12 Page: 3 of 4 XRBH\gyoung2

23 Community Summary 2016/2017 Indicator Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb YTD Current Target Actual Target Actual Staffing WTE in Post WTE v Establishment 95.9% 96.3% 94.2% 95.2% 93.4% 94.9% 92.6% 93.7% 93.8% 93.0% 93.3% 93.4% 93.4% 95.0% 93.7% 95.0% 93.4% Sickness Absence Rate 5.1% 5.4% 5.4% 4.9% 4.7% 4.6% 2.4% 2.5% 3.5% 4.3% 3.7% 3.3% 4.2% 3.9% 4.2% 3.3% Staff Turnover 13.8% 10.3% 10.5% 11.5% 11.0% 11.4% 12.0% 11.4% 12.0% 11.9% 11.3% 9.8% 11.0% 10.0% 11.3% 10.0% 11.0% Appraisals 94.7% 95.9% 95.2% 92.2% 84.9% 91.1% 88.7% 90.2% 94.6% 96.6% 95.7% 93.7% 94.0% 85.0% 92.5% 85.0% 94.0% Mandatory Training Compliance 94.7% 96.2% 95.6% 95.3% 97.4% 96.9% 95.5% 94.6% 95.8% 96.4% 95.6% 96.8% 95.8% 85.0% 96.0% 85.0% 95.8% Statutory Training Compliance 97.5% 98.4% 97.5% 97.2% 98.0% 97.2% 97.3% 96.9% 97.2% 97.6% 97.6% 98.0% 97.6% 95.0% 97.5% 95.0% 97.6% Safeguarding Compliance 99.4% 99.4% 97.9% 98.1% 98.7% 98.0% 98.0% 98.2% 97.7% 98.0% 98.2% 98.4% 97.7% 95.0% 98.1% 95.0% 97.7% Harm-free Care Incidents Incidents - Moderate or Severe Rate 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3.0% 0% 3.0% 0% Pressure Damage - Grade Pressure Damage - Grade Pressure Damage - Grade Patient Falls Hand Hygiene 99.6% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98.0% 100% 98.0% 100% 16/03/ :12 Page: 4 of 4 XRBH\gyoung2

24 QUALITY REPORT Area Performance Indicator 2016/17 Annual Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Cumulative YTD Trend (Apr 14-Jan 17) REDUCING MORTALITY Summary Hospital Mortality Indicator (SHMI) < PATIENT SAFETY MRSA bacteraemia HCAI - Trust only Rates of C Difficile maximum 19 for full year Number of falls (all patient falls safeguard) Moderate Falls with at least moderate harm Severe Fatal Percentage of Harm (Safety thermometer) GM (rolling 12 months) <5% Harm 6.04% 4.92% 4.66% 4.84% 4.41% 3.43% 2.77% 1.82% 2.93% 2.29% 2.29% Percentage of Harm (Safety thermometer) Bolton FT (rolling 12 months) <5% Harm 2.29% 3.70% 1.72% 1.92% 2.01% 4.58% 4.58% 4.93% 4.89% 5.05% 5.05% % of adults who receive a falls screening within 6 hours of admission (5.3) 90% 92.0% 98.0% 96.0% 95.0% 93.0% 96.0% 97.0% 94.0% 91.0% 95.0% 94.7% All patients will receive a Waterlow risk assessment within 6 hours of admission (8.2) 90% 94.0% 97.0% 93.0% 95.0% 98.0% 94.0% 96.0% 94.0% 96.0% 92.0% 94.9% All patients identified as being at risk will have a body map completed and appropriate individualised care plan (8.3) 90% 84.0% 90.0% 93.0% 89.0% 90.0% 93.0% 91.0% 86.0% 88.0% 89.0% 89.30% Falls and Incidents All patients will have a nutritional assessment within 6 hours of admission (6.3) 90% 90.0% 93.0% 94.0% 93.0% 92.0% 93.0% 95.0% 87.0% 94.0% 92.0% 92.30% Medication Incidents 1200 FYE Total Incidents 12, % Total incidents with no harm (Apr13-Sept13) NPSA 50% 66.5% 70.8% 76.8% 69.7% 65.2% 64.4% 63.3% 68.4% 61.9% 68.8% 68.1% Nursing (nurses/midwifes) shifts (% Actual Vs Planned) Day need to agree tolerance Nursing shifts (% Actual Vs Planned) Night need to agree tolerance Care Staff shifts (% Actual Vs Planned) Day need to agree tolerance Care Staff shifts (% Actual Vs Planned) Night need to agree tolerance Number of SUIs Number of never events

25 Area Performance Indicator 2014/15 Annual Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Cumulative YTD Trend (Apr 14-Jan 17) PATIENT EXPERIENCE (Bolton FT) Complaints Responded to within time period 95% 96.1% 89.6% 96.0% 93.3% 100.0% 86.0% 100.0% 100.0% 90.9% 100.0% 95.0% A&E Percentage recommended 82.0% 81.0% 82.3% 80.0% 85.4% 84.6% 82.7% 80.2% 80.9% 84.0% 82.2% A&E Response Rate 15% 13.8% 10.4% 14.5% 13.9% 13.1% 10.2% 9.7% 9.0% 8.0% 9.5% 11.3% Inpatient Percentage recommended 97.8% 97.7% 96.8% 96.7% 97.0% 97.0% 96.7% 96.3% 97.2% 98.0% 97.1% Inpatient Response Rate 15% 35.7% 38.1% 35.8% 34.8% 32.8% 25.2% 30.5% 29.7% 28.7% 30.0% 32.0% Complaints and Friends & Family (Bolton FT only) Maternity Q1 Antenatal Care % recommended No target set 100% 97% 100% 93% 100% 95% 100% 94% 95% 100% 97% Maternity Q2 Birth % recommended No target set 96.0% 98.0% 94.0% 94.0% 92.0% 91.0% 92.0% 91.7% 90.9% 95.0% 93.6% Maternity Q2 Birth Response Rate No target set 24.4% 20.0% 20.0% 15.5% 16.1% 15.5% 14.5% 15.2% 11.1% 11.9% 16.4% Maternity Q3 Postnatal % recommended No target set 96.0% 100.0% 93.0% 89.0% 85.1% 82.0% 96.0% 97.2% 92.5% 87.9% 92.3% Maternity Q4 Postnatal Community % recommended No target set 92.0% 92.0% 94.0% 97.1% 97.4% 94.0% 83.0% 95.0% 92.0% 95.0% 92.8% 66% 72% awaiting national data Friends and family staff (Quarterly)Percentage recommended - work No target set 72.0% 81% Friends and family staff (Quarterly)Percentage recommended - Care No target set 82.0% 83% awaiting national data Friends and family - Outpatient Percentage Recommended No target set 92.0% 90.3% 92.0% 91.5% 89.0% 90.7% 91.0% 91.6% 89.9% 92.1% 91.0% Friends and family - GMW Acute Percentage Recommended No target set 73.0% 100.0% 94.2% 94.5% 94.5% 64.7% 83.0% 83.3% 92.7% 78.7% 86.3% GMW Friends and Family Friends and family - GMW Primary Care Percentage Recommended No target set 92.1% 100.0% 42.9% 94.0% 82.0% 100.0% 93.0% 94.4% No data 81.0% 87.3%

26 Area Performance Indicator 2014/15 Annual Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Cumulative YTD Trend (Apr 14-Jan 17) STAFFING Sickness Absence 3.75% 4.79% 4.40% 4.30% 4.75% 4.26% 4.37% 5.18% 5.25% 5.34% 5.27% 5.27% Mandatory Training - Compliance 100% 91.10% 91.30% 91.30% 90.10% 88.70% 88.00% 88.90% 88.80% 89.00% 89.20% 89.60% Quality Impact Indicators Appraisals Completed 80% 84.4% 85.6% 84.1% 83.7% 82.9% 80.4% 79.3% 82.6% 82.1% 82.2% 82.7% Induction Attendance 100% 81.34% 81.42% 82.60% 82.00% 82.80% 77.80% 77.83% 74.70% 72.90% 72.60% 78.60% Substantive staff turnover Headcount (rolling average 12 months) <=10% 9.2% 9.2% 9.5% 9.8% 9.8% 9.95% 10.21% 10.21% 10.57% 10.56% 10.56% CLINICAL EFFICIENCY AND EFFECTIVENESS Theatre list team INBRIEF 99% 100.0% 100.0% 99.0% 99.0% 100.0% 100.0% 99.0% 98.0% 100.0% 100.0% 100.0% Theatre SIGN IN 99% 100.0% 100.0% 97.0% 99.0% 99.0% 100.0% 100.0% 100.0% 99.0% 99.0% 99.0% Better Care, Better Value Theatre TIME OUT 99% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 99.0% Theatre SIGN OUT 99% 97.0% 96.0% 97.0% 97.0% 100.0% 97.0% 97.0% 97.0% 100.0% 99.0% 100.0% Theatre list team OUTBRIEF 99% 77.0% 91.0% 93.0% 99.0% 99.0% 98.0% 94.0% 99.0% 99.0% 100.0% 99.0% BEAUMONT Number of SUIs Number of never events Independent Sector Friends and family - Inpatient Percentage Recommended % 99.0% 99.2% 99.3% 99.1% 99.2% 99.3% 98.9% 99.0% 99.4% 99.1% Friends and family - Outpatient Percentage Recommended % 98.4% 99.0% 99.2% 100.0% 100.0% 99.0% 96.9% 98.7% 98.0% 98.7% PRIMARY CARE Primary Care Number of practices with a review identified (General Practice Outcome Standards) Running Total practices approaching review, 4 with review identified Number of patients registered at a GP Practice with a diagnosis of Dementia (deined by the QOF dementia register code cluster) >=65 years Need to agree denominator and tolerance 2,033 1,912 2,215 2,233 2,244 2,241 2,269 2,291 2,311 2,305 2,305 Dementia diagnosis rate 79..1% compared to national rate of 67.4%

27 MHMDS DEMENTIA RAID EIP IAPT CPA NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA - 7 day follow up BASELINE NHS England» The Forward View into action TARGET 2016/17 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS 97.8% 95.0% 96.8% 100.0% 97.1% 100.0% 100.0% 96.7% 97.3% 94.7% 93.3% 100.0% 97.6% A ACHIEVING /FAILING? EXCEPTIONS No breaches in month of CPA follow up within 7 days. TRENDLINE v TARGET since April 2015 Improving Access to Psychological Therapies (IAPT) Access Rate (Combined GMW and 1Point) 15.6% 15.0% 12.5% 14.9% 15.5% 17.6% 15.1% 15.4% 10.6% 12.7% 9.4% 11.9% 13.6% F The IAPT service failed the 15% access rate target in January with lower numbers entering treatment and lower than expected number of referrals into IAPT Improving Access to Psychological Therapies (IAPT) Recovery Rate (Combined GMW and 1Point) 48.0% 50.0% 47.9% 45.4% 47.2% 50.1% 51.6% 51.3% 52.9% 52.8% 58.0% 55.0% 51.2% A The IAPT service achieved the over 50% reported recovery target for the seventh consecutive month Improving Access to Psychological Therapies (IAPT) 75% treated within 6 weeks of referral (GMW and 1Point) Improving Access to Psychological Therapies (IAPT) 95% treated within 18 weeks of referral (GMW and 1Point) Early Intervention Psychosis (EIP) % treated with a NICE approved care package within two weeks of referral. 90.2% 75.0% 88.2% 86.5% 87.2% 86.9% 91.2% 89.5% 90.8% 88.6% 86.5% 90.9% 88.6% A 98.9% 95.0% 100.0% 100.0% 99.1% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.8% A New for 2016/ % 77.3% 78.3% 82.4% 100.0% 100.0% 100.0% 95.2% 95.5% 84.6% 92.3% 90.6% A The IAPT service hit both of the access targets in January 2017 with 90.9% of people completing treatment in month having had their 1st appointment within 6 weeks and 100% having had their 1st appointment within 18 weeks. The IAPT service hit both of the access targets in January 2017 with 90.9% of people completing treatment in month having had their 1st appointment within 6 weeks and 100% having had their 1st appointment within 18 weeks. No issues to report in relation to the EI service. Activity levels down in comparison to previous levels (average now is 13 per month compared to an average of 19 per month from Apr-Nov) Rapid Assessment Interface and Discharge model (RAID) - % of A&E emergency referrals assessed within 1 hour Estimated dementia diagnosis rate for people with dementia of the total estimated prevalence (ages 65+) 87.7% 75.0% 80.3% 83.4% 74.8% 74.1% 80.3% 78.1% 89.8% 87.6% 91.4% 89.3% 82.5% A 76.9% 70.0% 76.6% 76.4% 76.0% 76.6% 77.0% 76.9% 77.8% 78.6% 79.3% 79.1% 79.1% A 93.3% of RAID referrals were discharged from A&E within 4 hours, this percentage has fallen due to periods of high activity (particularly outside of office hours) when RAID received multiple referrals. Dementia diagnosis rate is increasing in 2016/17 YTD with a slight plateeau observed in the lates monthly data for January National HSCIC Mental Health Minimum Data Set (MHSDS) data completeness (NHS Number) 99.9% 97.0% 99.8% 99.7% 99.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.9% A With the exception of Employment and Settled status being reported the rest of the MHSDS is meeting required targets each month. SINGLE POINT OF ACCESS (SPOA) Total SPOA Referrals received (GP, SELF, OTHER) 5887 TBC from Oct this has been BAS data only and only the ones put through as eligible from SPOA. GMMH Bi team to report on all SPOA and use BAS as a reporting line. % Emergency referrals seen within 24hrs 71.9% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 99.0% A Bolton Assessment Service accepted a total of 197 referrals from Primary Care in Jan with 36% of referral categorised as urgent or emergency. DQ issue in month that has reduced normally 100% RAG Average wait (days) for Emergency Referrals TBC A Average wait (days) for Urgent Referrals A Average wait (days) for Routine Referrals A Total number of emergency referrals

28 NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION BASELINE TARGET 2016/17 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS ACHIEVING /FAILING? EXCEPTIONS TRENDLINE v TARGET since April 2015 CAMHS Child and Adolescent Mental Health Services Staffing levels 95.0% 88.8% 88.0% 88.8% 84.1% 80.1% 78.3% 81.0% 81.5% 78.7% 83.3% F Sickness Absence Rate 4.2% 1.1% 0.9% 0.2% 2.2% 3.1% 0.0% 0.7% 0.3% Reported 1 month in arrears 1.1% A Monthly figure reported 1 month in arrears Sickness Absence Rate 4.2% 1.1% 1.0% 0.8% 1.7% 1.5% 1.5% 1.2% 1.1% Reported 1 month in arrears 1.2% A YTD value Mandatory Training 95.0% 99.0% 100.0% 99.0% 100.0% 98.9% 100.0% 98.0% 99.0% 97.8% 99.1% A Statutory Training 95.0% 98.1% 98.0% 99.5% 99.5% 96.5% 99.0% 97.6% 98.0% 98.5% 98.3% A Staff turnover (The % of staff who have remained in post for over a year) 90.0% 89.9% 84.4% 82.9% 82.7% 77.8% 82.0% 78.4% 78.1% 80.6% 81.9% F Staff turnover (The % of staff leaving in month) 5.0% 0.0% 2.7% 0.0% 2.5% 2.7% 0.0% 0.0% 0.0% 0.0% 0.9% A Tier 3 Activity Triage of Referrals: All referrals triaged within 1 working day 98.0% 100.0% 100.0% 100.0% 100.0% 98.0% 100.0% 97.0% 100.0% 100.0% 99.4% A Referral Wait Time: Emergency within 1 working day No baseline data available 90.0% % Reported 1 month in arrears 100.0% A Monthly figure reported 1 month in arrears Referral Wait Time: Routine within 20 working days No baseline data available 90.0% % Reported 1 month in arrears 92.0% A Monthly figure reported 1 month in arrears % of patients with ongoing treatment needs who had a follow-up appt within 28wks after initial appt /assessment. No baseline data available 70.0% % Reported 1 month in arrears 100.0% A DNAs - New < 5% 8.5% 4.0% 5.7% 5.8% 8.0% 8.9% 5.0% 7.1% 3.4% 6.3% F DNAs - FU < 5% 6.3% 6.3% 7.6% 10.5% 10.9% 7.4% 6.6% 6.3% 8.9% 7.9% F Monthly figure reported 1 month in arrears in a recent meeting between CCG and Provider the CAMHS Provider suggested that the threshold KPI of 5% is not in line with national averages for a service of this nature and would like the commissioners to review the target as nationally Bolton FT CAMHS is recognised as performing well in this area for DNA NEW and DNA Follow Ups % of Clinic appointments cancelled within 1 week of the due date < 3% 3.2% 1.5% 0.1% 1.6% 1.8% 2.0% 2.0% 1.3% 1.6% 1.7% A % of Patients who have their experience captured >20% 29.0% 22.0% 23.0% 22.0% 44.0% 38.0% 26.0% 34.6% 24.2% 29.2% A Patient Satisfaction with the service >85% 86.0% 87.1% 77.0% 81.5% 90.3% 75.8% 91.9% 88.6% 80.4% 84.3% F Family / Carer Satisfaction >85% 90.6% 93.8% 96.5% 96.8% 96.0% 100.0% 95.0% 86.4% 94.1% 94.4% A Complaints F % of young people 10 point improvement on CGAS >50% 55.0% 73.0% 58.0% 38.0% 56.0% 56.0% 61.0% 75.0% 75.0% 60.8% A

29 NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION PHQ9 / GAD7 - Percent of Clients showing Reliable Improvement ACP - (Psychiatric Adult Functional) Readmissions as a % of discharges BASELINE New for 2016/17 TARGET 2016/17 GREATER MANCHESTER WEST (GMW) Mental Health NHS Foundation Trust Higher Better Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS 65.4% 61.3% 72.2% 55.0% 59.5% 66.1% 66.9% 67.8% 70.2% 68.8% 65.3% 11.4% 10.7% 10.3% 5.7% 13.5% 3.0% 7.1% 5.9% 22.0% 8.2% 11.9% Reported 1 month in arrears ACHIEVING /FAILING? 9.7% A ACP - Directorate percentage bed occupancy 92.8% 80-90% 84.0% 94.2% 94.5% 96.5% 97.9% 93.6% 96.2% 92.9% 92.8% 91.0% 93.6% A EXCEPTIONS This measure has been included as an indicator of reliable improvement based on the entry to IAPT psychological questionnaires about their condition and again on discharge to assess how great the outcome score has improved There were 5 readmissions to report for January. One was within 7 days, and this was in relation to an overdose of prescribed medication. In relation to the other four, two involved the use of illicit substances, one related to selfneglect Occupancy levels remain high across all services however no new OAPs in January TRENDLINE v TARGET since April 2015 ACP - Directorate average length of stay (days) No issues target met. Significant reduction in PICU bed ALOS (104 days in Dec down to 11 in Jan) ACP - Incidents Level 4/ Community x 41 Inpatient Adult Functional x 1 (April) ACP - Total number of complaints The Bolton total complaints and concerns trend line has changed from a level trend to an upwards trend. Total delayed discharges as % of occupied bednights 0.5% < 7.5% 1.57% 2.03% 1.06% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.93% A There were no delayed discharges reported in January in Bolton. Gatekeeping % of Admissions (18-65yr) to Inpatient services with access to Crisis Resolution Home Treatment teams. % of Clients discharged from Inpatient Services that had a Discharge Notification finalised within 48 hours of discharge. Young People Under 18 Admitted to Adult Wards RAID Rapid Assessment Interface and Discharge 99.5% 95.0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% A No baseline data available 90.0% 84.2% 94.2% 97.2% 97.2% 91.3% 100% 90.9% 94.9% 93.8% 85.1% 92.9% A F No of completed assessments ,318 NWAS Ambulance Service Mental Health / Behavioural All 39 admissions were gatekept in January The service achieved the in month target for discharge notifications to GP for organic although functional had real issues in month 84.4% in month (combined 85.1% achieved against 90% target) This is due to the change over of Pharmacy and Junior doctors in month which has There was one under 18 admitted in April due to a lack of an appropriate NHS/private bed. The client was nursed as per agreed protocol and they were discharged after 3 days to CAMHS to complete 7 day follow up 93.3% of RAID referrals were discharged from A&E within 4 hours, this percentage has fallen due to periods of high activity (particularly outside of office hours) when RAID received multiple referrals. There have also been a number of clinically complex cases that have resulted in waits over 4 hours (but not over 12 Mental Health related condition Ambulance callouts for Bolton CCG to all A&E depts ,174 FOT 1,432 % of Mental Health related condition Ambulance callouts for Bolton CCG which are classed as Red (Emergency) Mental Health related condition Ambulance callouts for Bolton CCG as a % of total calls for all conditions and callouts. 10.0% 19.2% 10.0% 9.0% 7.1% 9.6% 11.0% 17.3% 16.7% 14.0% 18.0% 11.1% 5.5% 4.9% 7.1% 5.5% 6.6% 6.7% 5.7% 4.4% 4.5% 4.2% 4.3% 5.4% FOT Higher than 15/16 FOT Lower than 15/16

30 EIP RAID NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION STTB Board Measures Rapid Assessment Interface and Discharge model (RAID) - % of A&E emergency referrals assessed within 1 hour BASELINE TARGET 2016/17 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS 87.7% 75.0% 80.3% 83.4% 74.8% 74.1% 80.3% 78.1% 89.8% 87.6% 91.4% 89.3% 82.5% A ACHIEVING /FAILING? EXCEPTIONS 93.3% of RAID referrals were discharged from A&E within 4 hours, this percentage has fallen due to periods of high activity (particularly outside of office hours) when RAID received multiple referrals. TRENDLINE v TARGET since April 2015 ACP - Directorate percentage bed occupancy 92.8% 80-90% 84.0% 94.2% 94.5% 96.5% 97.9% 93.6% 96.2% 92.9% 92.8% 91.0% 93.4% A Occupancy levels remain high across all services however no new OAPs in January Suicide Mortality (proxy measure using ICD10 codes X6-X8 in TIS data up to 12th Diagnosis level and outcome was patient died) as above note: excludes suicide mortality where patient was brought into hospital already deceased Sickness absence % rate (rolling 12m ending total) GMW report A ACP - Incidents Level 4/ Percentage figures show time lost as a proportion of time contracted in a year (365 days or 366 in a leap year). Community x 41 Inpatient Adult Functional x 1 (April) Usage of section 136 suite (GMW report section 4.091) There were 17 x S136s in Bolton in January which is in line with the average per month of 17. Work is under way to look further into the discharge destinations. National benchmarking data shows Bolton is higher than average vol. of under 18s subject to a S136 Outcomes of section 136 suite - Assessed and Discharged as % of total (GMW report section 4.093) 71% 36% 47% 33% 33% 31% 26% 57% 38% 41% 36% Out of area Placements (OAPs) NEW The remaining 59% of activity is split between formal and informal admissions (32%) followed up by CMHT (23%) and other (4%) Both Patients are still out of area, one can t return until one of the other patients has been discharged from the PICU, due to vulnerability / Safeguarding issues and the second patient has commenced discharge planning from Cheadle. no new OATS reported as yet however 3 are awaiting JAP decision Out of area Transfers (OATs) NEW Out of area Transfers (OATs) EXISTING % Emergency referrals seen within 24hrs 71.9% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 100.0% A Early Intervention Psychosis (EIP) % treated with a NICE approved care package within two weeks of referral. Home Based Treatment Services - Treatment Episodes (Referrals plus two contacts) (GMW 4.082) Frequent attendees at A&E (rolling 12m Totals) New for 2016/ % 77.3% 78.3% 82.4% 100.0% 100.0% 100.0% 95.2% 95.5% 84.6% 92.3% 90.6% A A Friends & Family test (GMW directorate) 85.4% > 85.4% 83.8% 84.0% 81.4% 91.2% 91.0% 94.4% 91.5% 92.1% 86.9% 81.9% 87.8% A Although the number has reduced in January there are 3 additional patients on the Joint Assessment Panel list which may result in a new OAT placement before year end. This level of 58 for 16/17 is in line with expected levels based on Sept 2016 forecast Bolton Assessment Service accepted a total of 197 referrals from Primary Care in Jan with 36% of referral categorised as urgent or emergency. DQ issue in month that has reduced normally 100% RAG to 90% which GMMH are working to resolve. No issues to report in relation to the EI service. Activity levels down in comparison to previous levels (average now is 13 per month compared to an average of 19 per month from Apr-Nov) FOT 1,230 which is a 79% increase on baseline performance Measure being developed, Issue around diagnosis data collection in A&E is preventing regular reporting of MH related activity YTD rate for FFT performance is in line with national (88%) ACP - Directorate average length of stay for current inpatients (days) (GMW 4.022) Average length of stay is based on the average number of days that clients spend in designated wards as at end of each reporting month. Figures to date are refreshed each month. ACP - Total number of complaints The Bolton total complaints and concerns trend line has changed from a level trend to an upwards trend.

31 NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION BASELINE TARGET 2016/17 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS ACHIEVING /FAILING? EXCEPTIONS TRENDLINE v TARGET since April 2015 Dementia (MATS) MATS - Total number of referrals accepted MATS - Clients offered assessment within 28 days The MATS service continues to hit the 12 weeks to diagnosis target but due to the one stop shop approach whereby the team gathers all scan and test info possible ahead of the appointment we struggle to meet the 6 week first contact target.work continues with RBH collegues to develop ways to speed up the scanning process and we endeavour to see everybody referred as quickly as possible. MATS - Number on waiting list MATS - Average Wait to First Appointment (Weeks) 76 (March 2016) delays at Bolton Ft with available spaces and admin time required are impacting on the ability to meet the 6wk targets MATS - Average Wait to Diagnosis (Weeks) MATS - Diagnosed MCI as % of total Diagnosed 26% 17% 30% 18% 35% 27% 29% 18% 33% 25% 22% 25.3% NEL Admissions Mental Health / Behavioural Activity NEL Admissions for Mental Health related ICD10 diagnosis codes (ages 0-18 incl) 335 < FOT Lower than NEL Admissions for Mental Health related ICD10 diagnosis codes (ages incl) 1868 < ,279 FOT Lower than NEL Admissions for Mental Health related ICD10 diagnosis codes (ages 65yrs + incl) 604 < FOT Higher than Bed Days (Total LOS) for Mental Health related ICD10 diagnosis codes (0-18) 493 < FOT Lower than Bed Days (Total LOS) for Mental Health related ICD10 diagnosis codes (19-64) 2988 < ,896 FOT Lower than Bed Days (Total LOS) for Mental Health related ICD10 diagnosis codes (65yr+) 6331 < ,999 FOT Higher than Average LOS for Mental Health related ICD10 diagnosis codes (0-18) 1.47 < FOT Lower than Average LOS for Mental Health related ICD10 diagnosis codes (19-64) 1.60 < FOT Lower than Average LOS for Mental Health related ICD10 diagnosis codes (65yr+) < FOT Higher than

32 NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION BASELINE TARGET 2016/17 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS ACHIEVING /FAILING? EXCEPTIONS TRENDLINE v TARGET since April 2015 A&E Mental Health / Behavioural activity A&E attendances to Bolton FT for Mental Health Presenting Conditions (All Ages) 4078 < TBC Data Quality issues have been identified with A&E data and are being rectified within the recording of Diagnosis text in the A&E department. For this reason the downward trend is incorrect and forecast outturn is unavailable at present A&E attendances to Bolton FT for Mental Health Presenting Conditions (All Ages) as % of 4.8% < 4.8% 3.4% 3.9% 3.4% 3.9% 4.3% 4.2% 3.6% 3.7% 3.4% 3.8% TBC total A&E attends for all conditions A&E attendances to Bolton FT for Mental Health Presenting Conditions (Ages 0-17yr) 643 < TBC A&E attends to Bolton FT for Mental Health Presenting Conditions (Ages 0-17yr) as % of 2.9% < 2.9% 2.3% 2.8% 2.4% 2.6% 2.0% 2.6% 2.6% 3.1% 2.4% 2.1% TBC total A&E attendances A&E attendances to Bolton FT for Mental Health Presenting Conditions (Ages 18-64) 3154 < TBC A&E attends to Bolton FT for Mental Health Presenting Conditions (Ages 18-64) as % of 6.6% < 6.6% 4.9% 5.4% 4.8% 5.6% 6.2% 6.0% 5.0% 4.9% 5.1% 5.7% TBC total A&E attendances for this group A&E attendances to Bolton FT for Mental Health Presenting Conditions (Ages 65yr+) 281 < TBC A&E attends to Bolton FT for Mental Health Presenting Conditions (Ages 65yr+) as % of 1.6% < 1.6% 1.3% 1.6% 1.0% 0.9% 1.3% 1.2% 1.3% 1.6% 0.8% 1.1% TBC total A&E attendances for this group Police Service A&E and inpatient data relating to mental Bolton Section 136 Detentions 206 < (including section 135 detentions) Data for this section not received since the reassignment of the GMP contact back to frontline services. Percentage of Police calls to RBH which were due to mental health concerns Percentage of Section 136 detention patients who were admitted or referred for further help. Accident and Emergency v Section 136 Detention Suite - % of all detentions used on first admission to 136 suite Missing Patients / Concern for Welfare A & E Department / Division of Medicine Missing / AWOL Patients Reported from Mental Health Wards < 62% 62.0% 74.3% 78.9% 58.8% 70.6% 68.6% 58.3% TBC 84.0% 95.0% 83.0% 68.8% 73.3% 80.0% 80.7% TBC 92.3% 52.3% 50.0% 87.5% 86.7% 80.0% 74.8% 252 < < Total Police Calls to RBH Number of persons taken to Royal Bolton Hospital following police interaction due to mental health concerns

33 BCF6 BCF5 BCF4 BCF3 BCF2 BCF1 BOLTON INTEGRATED CARE KEY LINES OF ENQUIRY (KLOE) PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION Better Care Fund (BCF) Metrics NEL ADMISSIONS (TNR DATA) Total Non-Elective Admissions NEL ADMISSIONS (MAR DATA) Total Non-Elective Admissions SUPPORTING MEASURE NEL ADMISSIONS (SUS DATA) Non-Elective Admissions Aged 65yrs+ SUPPORTING MEASURE Permanent admissions of older people aged 65+ to residential & nursing homes 2015 ASCOF definition Permanent admissions of older people aged 65+ to residential & nursing homes SUPPORTING MEASURE 2014 AQuA definition % of older people (aged 65+) who were still at home 91 days after discharge from reablement/ rehabilitation services Delayed transfers of care (DTOC) Total number of delayed days BASELINE TARGET 2016/17 Metric Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS ACHIEVING /FAILING PLAN 2,646 2,809 2,576 2,766 2,360 2,628 2,829 2,689 2,876 2,560 26,739 ACTUAL 2,642 2,803 2,689 2,758 2,573 2,701 2,738 2,864 2,806 2,712 27,286 % VAR -0.2% -0.2% 4.4% -0.3% 9.0% 2.8% -3.2% 6.5% -2.4% 5.9% 2.0% PLAN 2,774 2,774 2,774 2,774 2,774 2,774 2,774 2,774 2,774 2,774 27,740 34,765 33,288 ACTUAL 2,847 2,982 2,813 2,930 2,738 2,868 2,985 3,061 2,940 2,909 29,073 F 11, (per 100,000) (per 100,000) 70.1% (awaiting MH inclusion) 8,125 (3,731 per 100,000) -3.5% (per 100,000) 88.6% 3,696 (1,676 per 100,000) VAR % 2.6% 7.5% 1.4% 5.6% -1.3% 3.4% 7.6% 10.3% 6.0% 4.9% 4.8% 15/16 act , ,016 1, ,037 8,908 16/17 act 1,026 1, ,046 8,780 Variance% 8.0% 6.3% 2.5% -10.3% 2.9% -10.8% -7.0% -3.1% 0.9% -1.4% NUM DENOM Rate~100K NUM DENOM 47,439 47,439 47,439 47,439 47,439 47,439 47,439 47,439 47,439 47,440 47,439 Rate PLAN As Intermediate care data is not yet available from Liquid Logic 361 ACTUAL reporting system, Bolton Council are developing a manual update for 457 this indicator for year end reporting purposes. % VAR 78.8% 79.0% 79.0% PLAN ,080 ACTUAL ,016 1,145 1,067 1, ,521 % VAR 216.9% 198.1% 205.5% 171.8% 229.9% 271.8% 246.4% 232.5% 181.5% 137.0% 209.1% DTOC DELAYS - NHS RESPONSIBLE ACTUAL DTOC DELAYS - SOCIAL CARE RESPONSIBLE ACTUAL DTOC DELAYS - BOTH RESPONSIBLE 17 8 ACTUAL DTOC DELAYED DAYS - NHS RESPONSIBLE 6,177 2,764 ACTUAL ,392 DTOC DELAYED DAYS - SOCIAL CARE RESPONSIBLE 1, ACTUAL ,470 DTOC DELAYED DAYS - BOTH RESPONSIBLE ACTUAL F A F F F F F COMMENTS/EXCEPTIONS The performance in Jan 2016/17 year to date is 2.0% higher than plan (547 NEL admissions). January as a standalone month has shown a 5.9% increase against plan (152 x more NEL admissions). Emergency Admissions in Jan 2017 were -0.6% (18 x NELs) lower than the same period in 15/16 and YTD is 0.4% higher than the same period in 15/16. On a rolling 12m basis there is an increase of 215 admissions (0.62%) from the previous 12m. Overall 2016/17 NELs are 4.8% higher than plan (Apr-Jan). NEL admissions for population aged 65yrs+ has decreased in 2016/17 by -1.2% YTD compared to baseline from the same period. This indicates that the increases seen in the above MAR and TNR data are not wholly attributable to an ageing population. Annual metric at present using the new ASCOF definition. Awaiting Data The latest position for Jan 2017 is per 100,000 population (2014 Aqua definition). YTD to January 2017 is 4.6% lower than same period in. Benchmarking information published in October 2016 placed Bolton 2nd worst within Greater Manchester and 3rd worst in the whole North West. Latest performance for Qtr2 is 79.0% which is in line with Q1 performance but below the target value of 88.6% and also below the 87.0% as reported in Q2 of. only note: admissions up to 9th Sept due to migration from Carefirst to Liquid Logic. Benchmarked 15/16 position was 2nd worst in Gtr Manchester. The total number of DTOcs in January 2017 increased to 30 compared to 23 in Dec 2016 however the total number of delayed days reduced from 867 in December to 730 in January. This reduction may be partly attributable to the Spring Unit beds commissioned as part of discharge to assess at Four Seasons. NHS delays are forecast to be 5% lower than baseline year with social care and both responsible expected to exceed baseline performance. Social Care has shown the greatest increase compared to. NHS delays are forecast to be 5% higher than baseline year with social care and both responsible expected to significantly exceed baseline performance. Social Care has shown the greatest increase compared to. TRENDLINE Delayed transfers of care (DTOC) Medically Optimised Delays - Bolton FT SUPPORTING MEASURE no data PLAN ACTUAL % VAR Delayed transfers of care (DTOC) Medically Optimised Delays - Intermediate SUPPORTING MEASURE no data PLAN ACTUAL % VAR Overall satisfaction of people who use services with their care and support no data PLAN ACTUAL % VAR Data for this measure still unavailable Referrals to home based intermediate care 1,879 > 1,879 PLAN ,413 ACTUAL ,478 % VAR 10.2% 14.6% 7.0% -15.9% 4.5% -13.4% -3.8% 21.7% 16.6% 4.6% A As at December 2016, the current YTD totals are exceeding plan by 4.3%. (Includes referrals to IMC@ Home plus AAT discharges to Laburnum Lodge and Darley Court)

34 L12 L11 L10 L7 L6 L5 L4 L3 L2 L1 GM4 GM2 GM1 BOLTON INTEGRATED CARE KEY LINES OF ENQUIRY (KLOE) PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION Greater Manchester Priority Measures BASELINE A&E Attendances Total 95,861 TARGET 2016/17 < = 0% Change Metric Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS ACHIEVING /FAILING Attends 7,666 8,252 7,646 8,080 7,550 7,672 7,846 7,443 7,895 8,050 78,100 A COMMENTS/EXCEPTIONS Jan 2017 A&E attendances were 0.8% higher (67 x A&E attends) than Jan 2016 and YTD is -0.4% below the same period of (332 x fewer A&E attends). The GP divert front door service (type 3 activity) currently accounts for 11.8% of the total A&E activity at 955 attendances compared to 7,095 type 1 attends. TRENDLINE A&E attendances (TNR Data - All A&E) SUPPORTING MEASURE Attends 7,941 8,571 7,986 8,473 7,917 8,030 8,200 7,738 7,702 7,087 79,645 A&E attendances (Type 1 - Bolton FT) SUPPORTING MEASURE Attends 6,903 7,530 6,987 7,290 6,746 6,915 7,092 6,802 6,671 6,435 69,371 A&E attendances (Type 1 - Other Trusts) SUPPORTING MEASURE Attends ,217 A&E attendances (Type 3 Bolton FT) SUPPORTING MEASURE Attends , day emergency readmissions 9.7% Increasing the percentage of people that die in their usual place of residence. Bolton Priority Measures < = 8.6% Rate Rate % 8.9% 9.9% 8.7% 9.2% 8.7% 8.3% 8.2% 7.5% 8.8% 8.4% 8.76% F 46.0% Increase Rate % 45.0% 44.0% data due May 2017 data due Sep % F Avoidable emergency admissions 6,563 Reduction Admits ,506 F Average length of stay (non-elective) Reducing the number of admissions due to falls and fall related injuries (over 65s) 4.38 (days) 4.50 (days) Ave LOS DAYS F 872 Reduction Admits A 30 day readmissions in January 2017 were 461 out of 5,499 admissions (8.4%) which is a reduction from the 9.4% rate reported in the same period in 2016 and just below the 2016/17FY target rate of 8.6% readmissions. Year to date average reduced to 8.76% in January against the 8.60% target. In the rolling 12m Oct 2015 to Sep 2016, 44.0% of deaths in Bolton occurred in the person s usual place of residence. This was a slight decrease from the 45.0% value as reported in the Jul 2015 to Jun 2016 update. Although deaths in hospital are reducing the Hospice is absorbing the reduction instead of home The latest monthly update shows January was 6.7% lower than the same period in (41 fewer admisssions) and year to date in 16/17 is 1.4% higher than the same period in 15/16 (77 more admissions) therefore RED rating for year to date performance. FOT is 6,607 (+0.6% from baseline) The average LOS for Jan 2017 was above target at 4.78 days against 4.50 days plan. Year to date average is 4.61 days which remains slightly above plan level therefore amber rating however is 5.7% higher than the same period in which may be an indication of the increased acuity within NEL admissions. The latest monthly update is 65 falls in Jan 2017 which is 29 lower than the level reported in Dec 2016 and 18 lower than Jan Year to date the total number of NEL admissions for falls is -2.6% below the same position in Increasing the proportion of patients who experience harm free care (Total average of Bolton FT, Nursing Homes and BMI) Number of people aged 65 and over receiving residential care, nursing care and community based services Proportion of people using social care receiving direct payments Increasing the percentage of people receiving reablement or intermediate care at the point of discharge 96.8% 95.0% Rate % 98.5% 97.0% 95.8% 96.9% 92.3% 97.5% 96.0% 96.1% 97.1% 97.2% 96.3% A 2,826 Increase Actual 2,731 3,063 1,746 2,612 2,612 F 30.3% (average of all Qtr totals) Increase Rate % 31.2% 30.9% 24.8% 29.5% 29.1% F As Intermediate care data is not yet available from Liquid Logic 6.3% Increase Rate % 6.5% 6.5% reporting system, Bolton Council are developing a manual update for 6.5% A this indicator for year end reporting purposes. The latest performance from Jan 2017 shows that the average of providers within Bolton are exceeding the 95% The numbers represent a snapshot at quarter end. The total number of individuals receiving the service at any point in was 3,564. The quarterly snapshots shown here report a -7.6% decrease from baseline The latest reported position in Jan 2017 is 29.5% which is an increase from the past quarter but below baseline and target year to date. The latest local data for Qtr1 2016/17 suggests that 6.5% of all discharges are offered reablement which is the same rate as Q1 16/17 and a slight decrease from levels seen in Q2 of Improved health-related quality of life for carers 76.7% (July 15 to Mar 16) Increase Rate % Improved carer reported quality of life 8.4 (14/15 latest) Increase Rate % People feeling supported to manage their condition 66.7% (Jan 16 release) 66.2% data due July 2017 (as GP Survey has now become an annual measure) Increase Rate % 66.2% F GP Survey for January no longer published, now there is only one annual survey published in July

35 INT EIT SW IMCH HSR LL DC AAT BOLTON INTEGRATED CARE KEY LINES OF ENQUIRY (KLOE) PERFORMANCE DASHBOARD 2016/17 INDICATOR DESCRIPTION Intermediate Care Services BASELINE TARGET 2016/17 Metric Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS COMMENTS/EXCEPTIONS TRENDLINE Total Referrals ,969 Admission Avoidance Team (AAT) Admitted to Caseload ,780 Ave LOS Total Referrals Note - From August 2016, all bed based referrals are received by Darley Court Darley Court Admitted to Caseload Ave LOS Occupancy 87.6% 91.1% 88.8% 95.8% 93.5% 89.5% % Total Referrals Note - From August 2016, all bed based referrals are received by Darley Court Laburnum Lodge Admitted to Caseload Ave LOS Occupancy 95.7% 88.2% 82.9% 90.9% 94.8% 99.2% % Total Referrals ,037 Home Support Reablement Admitted to Caseload Ave LOS Total Referrals ,584 Intermediate Care at Home Admitted to Caseload ,376 Active Caseload ,697 Ave LOS Staying Well 44.9% (Oct - March) Increase QOL score % QOLBefore QOL After Var as % 39.0% 26.8% 30.5% 31.4% 47.3% 50.0% % Awaiting activity QOL Wheel data for October onwards 61% Accept rate Increase Accept rate % Invites out ,443 Accept % 42.3% 48.6% 37.3% 45.0% 52.4% 47.0% 50.7% 45.2% 38.0% 65.2% 47.2% Early Intervention Teams (Avoidance of Full Social Care Assessment, SCA) 42% avoided full SCA Increase No SCA % Referrals ,047 No SCA% 46.6% 39.1% 42.7% 41.8% 38.6% 38.1% 36.6% 34.4% 39.0% 41.6% 39.9% Target ,930 Integrated Neighbourhood Team Referrals (awaiting new dashboard report for full KPI list) Actual ,040 Variance% -27% -38% -44% -33% -38% -30% 13% -23% -49% -35% -30%

36 2010/ / / / /15 % still at home 91 days after discharge 2016/ / / /17 Manchester Bolton Salford Wigan Rochdale Bury Tameside Stockport Oldham Trafford % Still at home 91 days after discharge 2010/11 FY 2011/12 FY 2012/13 FY 2013/14 FY 2014/15 FY FY 2016/17 Qtr /17 Qtr2 2016/17 Qtr /17 Qtr 4 (Jan) Admissions per 100,000 population Manchester Stockport Trafford Tameside Wigan Rochdale Bury Oldham Bolton Salford Apr-2014 May-2014 Jun-2014 Jul-2014 Aug-2014 Sep-2014 Oct-2014 Nov-2014 Dec-2014 Jan-2015 Feb-2015 Mar-2015 Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Central Manchester Bury Wigan Borough Bolton Trafford Oldham Tameside & Glossop North Manchester Salford Stockport South Manchester Number of admissions NEL Admissions per 100,000 Heywood, Middleton & Rochdale Better Care Fund Indicators Page 4 of 9 BCF1. Emergency admissions Non-elective emergency admissions to all acute providers - Bolton CCG patients Non-elective emergency admissions per 100,000 population Greater Manchester CCGs (2016/17 Qtr. 2) TNR DATA Emergency Admissions in January 2017 were -0.6% (18 x NELs) lower than the same period in and year to date performance is now just 0.4% higher than the same period in. 3,400 3,200 4,500 4,000 On a rolling 12m basis the baseline activity Feb 2015 to Jan 2016 was 34,671 emergency admissions. The actuals for the latest rolling 12m Feb 2016 to Jan 2017 is 34,886 which is an increase of 215 admissions (0.62%). Overall 2016/17 NELs are 4.8% higher than plan (Apr-Jan). 3,000 2,800 2,600 3,500 3,000 2,500 2,000 The benchmarking of NEL per 100,000 across Greater Manchester for Qtr /17 shows Bolton 2,400 1,500 CCG in 4th lowest position at 4.0% below the median (previously 3rd lowest in Q1). 2,200 1, RED Month GREEN 0 CCG BCF2. (also GM3) Permanent admissions of older people (aged 65 and over) to residential and nursing care homes (Lower Better) In the BCF submission, Bolton was set an ambition to decrease the number of permanent admissions to nursing and residential care homes (per 100,000 population) to in and no more than in 2016/17. At the same time, the number of people aged over 65 in Bolton is projected to grow by 1.9% from 2014/15 to 2015/15 and by a further 1.1% in 2016/17. The methodology used to calculate this measure from 'actual admissions to residential care' to 'intended admissions to residential care' has changed in the last 12m which has led to a parallel running of this measure with the old and new outcomes. The latest position for Jan 2017 is per 100,000 population (2014 Aqua definition). YTD to January 2017 is 4.6% lower than same period in. Benchmarking information published in October 2016 placed Bolton 2nd worst within Greater Manchester and 3rd worst in the whole North West. BCF3. Proportion of older people (aged 65 and over) who were still at home 91 days after discharge from to reablement/ rehabilitation services In the final quarter of, 70.1% of patients were still at home 91 days after discharge to reablement/rehabilitation services which was a reduction from the 78.9% performance reported in Qtr3 and much lower than the target position of 86%. This figure however will be refreshed once the annual data has been published which also takes into account mental health activity. Latest performance for Qtr2 2016/17 is 79.0% which is in line with 2016/17 Q1 performance but below the target value of 88.6% as per the most recent submitted BCF ambitions and also below the 87.0% as reported in Q2 of. The aim is to increase the proportion of people still at home 91 days after discharge to reablement to meet the level seen in 2012/13 (86%) note that for Q2 this only includes data up to 9th September due to migration from Care first to Liquid Logic. Update March awaiting data for intermediate tier in liquid logic In relation to the benchmarking against Greater Manchester cluster median values Bolton Local Permanent admissions to residential and nursing care (per 100,000 population) 1,200 1,100 1, RED 2014 AQUA Definition BCF Ambition (AQUA definition) 2015 ASCOF Definition (Annual) 1, Proportion of older people (aged 65 and over) who were still at home 91 days after 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% RED 79.7% discharge from to reablement/ rehabilitation services 52.3% 85.9% 78.5% 79.9% 82.1% 79.1% 87.0% 78.9% 70.1% % 88.6% 78.8% 79.0% NOTE: Q4 15/16 awaiting annual refresh value as current % does not include mental health Long-term support needs of older adults (ages 65yrs+) met by admission to residential and nursing care homes per 100,000 population Local Authority rate Median 75th centile 90th centile 1, RED 0 Local Authority Proportion of older people (aged 65 and over) who were still at home 91 days after discharge from to reablement/ rehabilitation services Greater Manchester Local Authority rate Median 75th centile 90th centile RED Local Authority BCF KLOE Page 4

37 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 Number of referrals % of people satisfied with their care and support Manchester Oldham Bolton Salford Trafford Tameside Stockport Bury Wigan Rochdale Satisfaction score Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 Number of delayed days , Total delayed days Better Care Fund Indicators Page 5 of 9 BCF4. Delayed transfers of care (total number of delayed days) The first chart shows the trend in the number of delayed days for Bolton patients in relation to transfers of care. After four consecutive months of increases between Oct 2015 and Jan 2016, delayed days started to fall from Feb 2016 however since March 2016 performance has remained fairly static around 900 days on average but with a greater reduction reported in July. The total number of DTOcs in January 2017 increased to 30 compared to 23 in Dec 2016 however the total number of delayed days reduced from 867 in December to 730 in January. This reduction may be partly attributable to the Spring Unit beds commissioned as part of discharge to assess at Four Seasons. Bolton FT account for 89% with Salford(2%) and all others (3%). The benchmarking position within the GM Cluster maintains Bolton's position at mid-table (not shown) and Bolton is below average for delays (days) in the GM cluster which indicates that the increases seen over winter are not unique to Bolton. Care package in home is a primary reason for the social care delayed days and further non acute are a NHS delay primary reason RED 1,600 1,400 1,200 1, Delayed transfers of care - total delayed days for Bolton patients Actual total delayed days Average UCL LCL Target Month RED 1,400 1,200 1, Delayed transfers of care (total delayed days) Attributable to NHS Attributable to Social Care Attributable to Both Target Month BCF5. Overall satisfaction of people who use services with their care and support This metric was chosen because it is the nearest equivalent measure to a new metric which is under development for both the NHS Outcomes Framework and the Adult Social Care Outcomes Framework, Improving people s experience of integrated care. The metric is the proportion of respondents who say they are "extremely satisfied" or "very satisfied" in response to the question "Overall, how satisfied or dissatisfied are you with the care and support services you receive?. In 2014/15 Bolton scored 61.2%, below the median score for Greater Manchester. In 2013/14 Bolton scored 65.6%, just above the median. In the BCF submission, an ambition was set to reach 66.6% in 2014/15 and 67.6% in. Overall satisfaction of people who use services with their care and support 70% 68% 66% 64% 62% 60% 58% 56% 62.4% 58.4% NO RAG - Awaiting Data 64.3% 65.6% 66.6% 2010/ / / / /15 BCF ambition 67.6% BCF ambition Overall satisfaction of people who use services with their care and support (2014/15) RED Local Authority score GM 75th centile Local Authority GM Median GM 90th centile BCF6. Referrals to home based intermediate care The National Audit for Intermediate Care in 2012/13 identified that Bolton was an outlier with regard to the number of intermediate care beds commissioned and intermediate tier services are now being refocused on home based services. In 2012/13 the Greater Manchester average was 522 referrals per 100,000 population. This has been set as a target for Bolton to reach by, which equates to 1,136 actual referrals. The left chart shows that Bolton exceeded this target in 2014/15 and the second chart on the right shows the performance in which is also exceeding the planned target. The number of referrals to home based intermediate care was 1,879 for FY. As at January 2017, the current YTD totals are exceeding plan by 7.4%. (Data includes referrals to IMC@ Home plus AAT discharges to Laburnum Lodge and Darley Court.) Number of referrals to home based intermediate care in Bolton Number of referrals BCF ambition 2,500 1,879 2,000 1,879 1,500 1,288 1,000 1, / / / /17 GREEN Actual Number of referrals to home based intermediate care in Bolton Actual BCF Plan YTD actual YTD plan GREEN BCF KLOE Page 5

38 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 Jun-12 Sep-12 Dec-12 Mar-13 Jun-13 Sep-13 Dec-13 Mar-14 Jun-14 Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Proportion of deaths in usual place of residence (%) NHS Tameside and Glossop CCG NHS Trafford CCG NHS Central Manchester CCG NHS Wigan Borough CCG NHS South Manchester CCG NHS Salford CCG NHS Heywood, Middleton and Rochdale CCG NHS Oldham CCG NHS North Manchester CCG NHS Bolton CCG NHS Stockport CCG NHS Bury CCG Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Tameside & Trafford Heywood, Bury Wigan Borough Bolton Oldham South Salford Central Stockport North Number of readmissions 30 day readmissions rate Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 HEYW. MIDD. & ROCHDALE BURY BOLTON STOCKPORT WIGAN BOROUGH TRAFFORD CENTRAL MANCHESTER TAMESIDE & GLOSSOP SOUTH MANCHESTER OLDHAM SALFORD NORTH MANCHESTER Number of attendances Greater Manchester and locally selected metrics - A number of further metrics have been identified across Greater Manchester and locally within Bolton. Page 6 of 9 GM1. A&E attendances Objective: To decrease The trend over time chart shows the number of A&E attends at all acute providers from Apr 2014, for Bolton CCG patients. Target for 16/17 is zero % increase or reduction from previous year totals. A&E attendances across all providers A&E attends Average UCL LCL Target 9,500 9, A&E Attendances (type 1) per 100,000 population GM Cluster CCGs Rolling 12m Oct 2015 to Sept 2016 (TNR DATA) CCG Median 75th centile 90th centile Jan 2017 A&E attendances were 0.8% higher (67 x A&E attends) than Jan 2016 and YTD is -0.4% below the same period of (332 x fewer A&E attends). The GP divert front door service (type 3 activity) currently accounts for 11.8% of the total A&E activity at 955 attendances compared to 7,095 type 1 attends. 8,500 8,000 7,500 7,000 6, The rolling 12m benchmarking A&E attendances (type 1) by CCG per 100,000 population shows 6, Bolton in 3rd lowest position and lower than the median across GM cluster. (previously 4th lowest at end of Q1 2016/17 on rolling 12m basis) GREEN Month GREEN GM2. 30 day emergency readmissions Objective: To decrease The trend chart shows the number of emergency readmissions within 30 days of previous discharge (following an elective, day case or non-elective admission). When comparing FY with 2014/15 FY, there was a 0.27% increase in the number of 30 day readmissions. This equated to an approx 127 additional readmissions out of a total 64,334 discharges. 30 day readmissions in January 2017 were 461 out of 5,499 admissions (8.4%) which is a reduction from the 9.4% rate reported in the same period in 2016 and just below the 2016/17FY target rate of 8.6% readmissions. Year to date average reduced to 8.76% in January against the 8.60% target. 30 day emergency readmissions for Bolton patients across all acute providers 30 day readmission rate for Bolton patients compared to GM Cluster Actual 30 day readmissions Average Target % 10% 9% 8% 7% 6% 5% The second chart shows the 30 day readmission rate across Greater Manchester CCGs in 2014/15 (awaiting updated source). Bolton CCG was below the median readmission rate (9.2%). AMBER Month AMBER CCG GM4. Percentage of people who die in their usual place of residence Objective: To increase In the rolling 12m Oct 2015 to Sep 2016, 44.0% of deaths in Bolton occurred in the person s usual place of residence. This was a slight decrease from the 45.0% value as reported in the Jul 2015 to Jun 2016 update. Although deaths in hospital are reducing the Hospice is absorbing the reduction instead of home. Amber RAG rating due to 2nd consective reduction in performance. Hospice as place of death in the rolling 12m to June 2016 were 6.9% compared to 6.2% in the previous year and 4.4% in the year before. This is likely reflective of the success of Bolton Hospice and increased capacity compared to earlier years. Deaths in Hospital in the rolling 12m to Sep 2016 were 47.5% compared to 48.6% in the previous year and 53.3% in the year before. Bolton CCG has remains 3rd highest for proportion of deaths in usual place of residence across Greater Manchester. National average is currently 45.7% which remains the same rate as in the last report. 47% 46% 45% 44% 43% 42% 41% 40% 39% 38% 37% 36% 35% Proportion of deaths in usual place of residence Bolton CCG patients AMBER Rolling 12m period end month Proportion of deaths in usual place of residence Greater Manchester CCGs - Latest avaliable 12 months (to Sep '16) % Rate Median 75th centile 90th centile 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% GREEN CCG GM & LOCAL KLOE 1 Page 6

39 Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 Bury Bolton North Manchester Heywood, Middleton & Rochdale Tameside & Glossop Trafford Oldham Central Manchester Wigan Borough Stockport South Manchester Salford Title Admissions per 100,000 pop aged 65+ Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 Heywood, Middleton & Rochdale Oldham Bury South Manchester Salford Bolton Wigan Borough Stockport North Manchester Trafford Tameside & Glossop Central Manchester Title Ave LOS for Emergency Admissions Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 Oct-2015 Nov-2015 Dec-2015 Jan-2016 Feb-2016 Mar-2016 Apr-2016 May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 NHS Wigan Borough NHS Trafford CCG NHS Bury CCG NHS North NHS Bolton CCG NHS Stockport CCG NHS Oldham CCG NHS Salford CCG NHS Heywood, NHS Central NHS Tameside and NHS South Title Greater Manchester and locally selected metrics - A number of further metrics have been identified across Greater Manchester and locally within Bolton. Page 7 of 9 L1. Avoidable emergency admissions (NHSOF 3a) Avoidable emergency admissions for all Bolton CCG patients to any provider Avoidable emergency admissions per 100,000 benchmarked across Greater Manchester (NHS Digital) Proxy measure July 2015 to June 2016 (rolling 12m) This is a composite measure as per the key shown in the benchmarking chart (far right chart) The trend over time chart shows the trend in avoidable emergency admissions for Bolton patients across all hospital providers. There is a slight seasonal trend, with relatively more admissions in winter months. Overall the long term trend is slightly increasing; there was a 5.1% increase from 2012/13 to 2013/14 and a 7.4% increase when comparing 2013/14 to 2014/15 however more recently there has been a -0.3% reduction in compared to the previous year. The latest monthly update shows January was 6.7% lower than the same period in (41 fewer admisssions) and year to date in 16/17 is 1.4% higher than the same period in 15/16 (77 more admissions) therefore RED rating for year to date performance. The benchmarking chart illustrates how Bolton compares across Greater Manchester. Data for the latest available 12 month period (Jul 2015 to Jun 2016) shows that Bolton had the 5th lowest rate of avoidable admissions across Greater Manchester per 100,000 which is a deterioration from the position of lowest in the previous rolling 12m period to March 2015 therefore AMBER rating L2. Average length of stay (non-elective) Average length of stay for emergency admissions - Bolton CCG pts all providers Average length of stay for emergency admissions benchmarked The average LOS for Jan 2017 was above target at 4.78 days against 4.50 days plan. Year to date average is 4.61 days which remains slightly above plan level therefore amber rating however is 5.7% higher than the same period in which may be an indication of the increased acuity within NEL admissions. Although the trend has been decreasing there will come a point in the future when this will start to increase again as the complexity and acuity of pateints increases when integrated services are fully up and running, only the patients who really need to be there will be admitted. The second chart illustrates how Bolton CCG benchmarks against other Greater Manchester CCGs for average non-elective length of stay. Year to date in 16/17 to Dec, Bolton CCG is placed 6th lowest within Greater Manchester for average length of stay from a previous low position of 2nd lowest in the rolling 12m to Aug AMBER Number of admissions Upper control Title Average Lower control Ave LOS Average UCL LCL Target AMBER across Greater Manchester Apr to Dec 2016 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Emergency admissions for children with lower respiratory tract infections Unplanned hospitalisation for chronic ambulatory care sensitive conditions Emergency admissions for acute conditions that should not usually require hospital admission CCG Median 75th centile 90th centile AMBER Title 0.0 AMBER CCG L3. Reducing the number of admissions due to falls and fall related injuries (over 65s) The trend chart illustrates the number of emergency admissions for Bolton patients aged 65 years and over, to any hospital provider, with a fall related injury. Overall there is a slightly decreasing trend in the number of falls admissions since a peak in Oct Comparing with 2014/15, the number of admissions reduced by 3.1% from 900 in 2014/15 to 872 in. This is a great improvement considering the increase from 13/14 to 14/15 was an increase of 23%. The latest monthly update is 65 falls in Jan 2017 which is 29 lower than the level reported in Dec 2016 and 18 lower than Jan Year to date the total number of NEL admissions for falls is -2.6% below the same position in The bar chart shows how Bolton CCG compares across Greater Manchester for the number of falls admissions per 1,000 population aged over 65. In the past 12m Bolton has the second lowest rate of falls admissions per 100,000 across all Greater Manchester CCGs. (TIS Data). The data corresponds to PHOF data from 2014/15 which shows the same position for Bolton CCG Emergency admissions due to falls and fall related injuries at all providers (patients aged 65 and over) Falls NELs Average UCL LCL AMBER Title Emergency admissions due to falls and fall related injuries at all providers Patients aged 65 and over - Sep 2015 to Aug Greater Manchester CCGs 3500 CCG Median 75th centile 90th centile GREEN 0 CCG GM & LOCAL KLOE 1 Page 7

40 Proportion 20.8% 24.8% 28.9% 31.4% 32.2% 31.4% 31.2% 30.9% 29.5% 36.9% 2013/ /15 Q1 Q2 Q3 Q4 2016/17 Q1 2016/17 Q2 2016/17 Q3 2016/17 Q4 Number of people Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 % harm free care % harm free care Locally selected metrics (continued) Page 8 of 9 L4. Proportion of patients who experience harm-free care Objective: to increase The left chart shows the proportion of patients who experienced harm-free care at Bolton NHS FT, Bolton Nursing Homes and BMI Bolton Hospital between April 2015 and November The latest performance from December 2016 shows that the average of providers within Bolton are exceeding the 95% target. This measure is taken from the NHS Safety Thermometer, which records the presence or absence of four harms: pressure ulcers, falls, urinary tract infections (UTIs) in patients with a catheter, new venous thromboembolisms (VTEs). The target, set nationally, is to achieve 95% harm-free care. The right chart also shows the monthly harm-free care achievement for Bolton FT compared to the average of Greater Manchester Provider Trusts (Bolton, Central Manchester, Pennine Acute, Salford, South Manchester, Stockport, Tameside and Wrightington, Wigan & Leigh) Proportion of patients who experience harm free care at Bolton Health Providers Nursing Homes (TOTAL) BMI Bolton FT Target 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% GREEN Month Proportion of patients who experience harm free care Bolton FT v GM Trusts Bolton FT Target All GM Trusts 100% 99% 98% 97% 96% 95% 94% 93% 92% GREEN Month L5. Number of people aged 65 and over receiving residential care, nursing care and community based services The trend chart shows the number of people aged 65 and over receiving residential care, nursing care and community based services in Bolton. The numbers represent a snapshot at quarter end. The total number of individuals receiving the service at any point in was 3,564 which is a 4.7% increase in the total number receiveing the service in 2014/15 of 3,402. The quarterly snapshots shown here report an 11.7% increase from Q2 position. 4,000 3,500 3,000 2,500 2,000 1,500 1,000 No of people aged 65 and over receiving residential care, nursing care and community based services 2,681 3,402 3,562 2,723 2,741 2,789 2,826 2,731 3,063 1,746 2,612 Benchmarking data being sourced Benchmarking of Number of people aged 65 and over receiving residential care, nursing care and community based services is shown to the right of the trend chart and Bolton performed higher than average for the peer group similar local authorities in the chart and higher than England average. data unavailable in this format as yet AMBER GREEN L6. Proportion of people using social care receiving direct payments Objective: to increase The trend chart shows the proportion of people using social care receiving direct payments at year end. Latest data available shows that since 2013/14 the proportion of people using social care and receiving direct payments has increased from 28.9% to 31.2% with a peak of 36.9% reported in Q4. 45% 40% 35% Proportion of people using social care receiving direct payments % 36.9% 36.6% 33.0% Qtr % 24.4% 16.6% 15.4% 12.9% 10.1% The latest reported position as at the end of Q2 2016/17 is 30.9% which is a reduction from both the past quarter (31.2%) and also a reduction from the Q2 position in of 32.2%. 30% 25% Benchmarking the proportion of people using social care receiving direct payments chart on the right shows that Bolton are the second highest for this measure and above the GM cluster average. In addition to this another metric within ASCOF data (not shown) places Bolton at the lowest point of the chart in relation to the proportion of carers receiving direct payments at 27.7% compared to the average of 77% in GM Cluster 20% 15% AMBER GREEN num denom 1C part 2a - Proportion of adults (clients) receiving direct payments LOCA KLOE 2 Page 8

41 2014/15 Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 Q1 Q2 Q3 Q4 2016/17 Q1 2016/17 Q2 % offered reablement Locally selected metrics (continued) Page 9 of 9 L7. The proportion of older people aged 65 and over offered reablement services following discharge from hospital Objective: to increase The number of older people offered reablement services following discharge from hospital as a proportion of all discharges (people aged 65 and over) figure for 2014/15 was 4.5% ASCOF 2B(2) The measure includes social care-only placements, and excludes people who were only assessed by the NHS. We have included a two-part measure to capture both the volume and success of the reablement services that are delivered. This will prevent areas scoring well which offer reablement services to only a very small number of people. Note: ASCOF are not currently reporting on this measure as recent as the Q4 report therefore a local proxy measure is being used which is no longer directly comparable to ASCOF baseline position. The latest local data for Qtr2 2016/17 suggests that 6.5% of all discharges are offered reablement which is the same rate as Q1 16/17 and a slight decrease from levels seen in Q2 of The proportion of older people aged 65 and over offered reablement 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% RED 5.5% services following discharge from hospital 7.2% 6.7% 4.2% 9.0% 7.6% 6.6% 2.2% 6.5% 6.5% GREEN LOCA KLOE 2 Page 9

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