Governing Body Tuesday 23 rd January 2018 Item 11 c Subject Lead Executive Author (s) Performance and Assurance Report Director of Operations Contracting and Information, Service Development PURPOSE OF THE REPORT To provide the HCCG Governing Body with the latest available performance information, highlight areas of risk and outline associated actions for key areas. KEY POINTS There are areas that are below expected performance against national targets. Corrective action is underway to address the risks identified, with some performance reaching planned trajectories. Areas of concern are: Urgent Care RTT Cancer Waits 62 day and 2ww breast symptomatic waits Dementia diagnosis IAPT Access, Recovery and waiting lists RECOMMENDATION TO THE COMMITTEE For Information Discussion Assurance/Review Decision Procurement Decision The Governing Body is asked to note the report and make any recommendations for further actions to mitigate risk. Page 1 of 26
CONTEXT & IMPLICATIONS Financial Potential financial penalties can be applied to providers for poor performance. Legal Health and Social Care Act 2008 Children Act 1989, 2004 Mental Capacity Act 2005 Mental Health Act 1983, 2007 Risk and Assurance (Risk Register/BAF) HR/Personnel Processes for identify risk are inherent in the quality assurance framework. Any risks identified will be placed on the corporate risk log. No issues identified Equality & Diversity Promotes equality and diversity Strategic Objectives Meets the strategic objectives in relation to Governance and Quality Healthcare/National Policy (e.g. CQC/Annual Health Check) Meets the requirements of national policy in relation to quality Consultation Communications and Patient Involvement Partners/Other Directorates Carbon Impact/Sustainability NHSE Area Team Local Authority Providers of commissioned services CQC N/A Governance Process/Committee approval with date(s) (as appropriate) Conflicts of Interest Issues Page 2 of 26
Contents Executive Summary 4 Risk & Recovery Analysis...6 Performance Update: Delivery of RTT Targets...7 Performance Update: Delivery of Urgent Care...11 A&E Recovery 12 Emergency Admissions 14 Performance Update: Cancer overview..15 Cancer 62 and 104 day overview 16 2wk Cancer waits Breast Symptomatic Recovery 18 62 day Cancer Waits Recovery...19 Performance Update: Local Stroke Care Overview..20 Performance Update: Living Well with Dementia. 22 Performance Update: Improving Access to Psychological Therapies..24 IAPT Access & Recovery.25 IAPT Waiting Times..26 Page 3 of 26
EXECUTIVE SUMMARY Commissioned Services Risk This dashboard summarises the highest risk areas for the key constitutional targets which are performing below the required standard. Further details are below. KPI Title Description Data Up To Update Urgent care - A&E and Ambulance A&E Attendances Cancer Waits All Cancer 2 week wait referrals Breast symptomatic 2WW 62 day Cancer Waits Number of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge. All activity Dir. of Travel on prev. mth Variance on prev. Mth Dec-17 72.02% -10.33% No waits from decision to admit to admission (trolley waits) over 12 hours Nov-17 0 0 The percentage of patients urgently referred with suspected cancer by their GP who were first seen within 14 calendar days within a period The percentage of patients urgently referred for evaluation/investigation of breast symptoms where cancer is not initially suspected who were first seen within 14 calendar days during the period. The percentage of patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer. Data Source WVT Daily Sitrep NHSE Monthly A&E Rpt Dir. of Travel on last 3 mth ave 12 Mth Performance Actions WVT now part of STP. Monitored through SDIP WVT now part of STP. Monitored through SDIP Trend based on 12 mth rolling perf. Owner Dir. Of Ops Dir. Of Ops Improvement Trajectory 17/18 Recovery trajectory received Oct-17 95.01% 0.40% Dir. Of Ops Oct-17 86.36% -5.94% Contract notice issued in 16/17 Dir. Of Ops Monthly CSU 17/18 Recovery trajectory received Rpt Oct-17 92.50% 8.41% Dir. Of Ops Expected Date for Progress Mar-18 Jun-17 Year End Forecast 62 day - Screening NHS Cancer Screening - The percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service. Oct-17 80.00% 30.00% Dir. Of Ops Elective Waits & Elective Care RTT - 18 week waits for treatment Diagnostic Waits and Tests Stroke indicator The percentage of admitted pathways within 18 weeks for admitted patients whose clocks stopped during the period on an adjusted basis The percentage of non-admitted pathways within 18 weeks for non-admitted patients whose clocks stopped during the period. The percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the period. Nov-17 63.87% -0.94% Dir. Of Ops 2018-19 Nov-17 83.31% 0.58% Dir. Of Ops 2018-19 Nov-17 81.06% 0.89% Referral To Treatment - Zero tolerance of over 52 week waiters Nov-17 17 1 The percentage of patients waiting 6 weeks or more for a diagnostic test (15 key diagnostic tests) at the end of the period The percentage of people who have had a stroke who spend at least 90% of their time in hospital on a stroke unit The percentage of people at high risk of Stroke who experience a TIA are assessed and treated within 24 hours NHSE Monthly RTT Rpt Nov-17 99.81% 0.30% WVT now part of STP. Monitored through SDIP WVT now part of STP. Monitored through SDIP WVT now part of STP. Monitored through SDIP Dir. Of Ops Dir. Of Ops Dir. Of Ops 17/18 Recovery trajectory received 17/18 Recovery trajectory received 2018-19 2018-19 Nov-17 64.71% -13.87% Dir. Of Ops Monthly WVT Stroke Rpt Nov-17 51.43% -2.86% Contract notice issued in 16/17 - RAP agreed. Wider STP discussions in progress Dir. Of Ops TBC Page 4 of 26
KPI Title Description Data Up To Update Dir. of Travel on prev. mth Variance on prev. Mth Data Source Dir. of Travel on last 3 mth ave 12 Mth Performance Actions Trend based on 12 mth rolling perf. Owner Improvement Trajectory Expected Date for Progress Year End Forecast Mental Health Care - IAPT Targets IAPT Services - Access rates The proportion of people who have depression and/or anxiety disorders who receive psychological therapies. The proportion of people who have depression and/or anxiety disorders who receive psychological therapies. Quarterly The proportion of people who have depression and/or anxiety disorders who receive psychological therapies. Variance against plan- cumulative Nov-17 1.29% -0.03% Q2 17/18 3.55% 0.35% Nov-17-93 6 IST revisiting service to review how to deliver on national targets IST revisiting service to review how to deliver on national targets IST revisiting service to review how to deliver on national targets Dir. Of Ops TBC Dir. Of Ops TBC Dir. Of Ops TBC IAPT Services - Recovery rate The number of people who have completed treatment having attended at least two treatment contacts and are moving to recovery The number of people who have completed treatment having attended at least two treatment contacts and are moving to recovery Quarterly Nov-17 56.90% 6.90% Q2 17/18 47.32% -3.03% 2g Monthly IAPT Rpt IST revisiting service to review how to deliver on national targets IST revisiting service to review how to deliver on national targets Dir. Of Ops TBC Dir. Of Ops TBC IAPT Services - 6wk & 18wk waits The percentage of ended referrals that finish a course of treatment in the reporting period who received their first treatment appointment within 6 weeks of referral The percentage of ended referrals that finish a course of treatment in the reporting period who received their first treatment appointment within 18 weeks of referral Herefordshire CCG Targets - Schedule 4 Nov-17 59.54% 4.17% Nov-17 74.05% 11.24% IST revisiting service to review how to deliver on national targets IST revisiting service to review how to deliver on national targets Dir. Of Ops TBC Dir. Of Ops TBC Dementia - achieve a diagnosis rate of 67% for >65 yrs old on a GP register with a diagnosis of dementia. Performance against 'estimated prevalence' Nov-17 59.63% -0.56% Performance against estimated prevalence. Variance against target. Nov-17-7.37% -0.56% Dementia Diagnosis Dementia - achieve a diagnosis rate of 67% for >65 yrs old on a GP register with a Nov-17 60.57% diagnosis of dementia. -0.38% NHSE Monthly Dir. Of Ops Performance against plan. Variance against plan- cumulative. Nov-17-6.30% -0.38% Rpt Dir. Of Ops Dementia - Number of patients >65 yrs old on a GP register with a diagnosis of dementia. Nov-17 1750-11 Dir. Of Ops Performance against plan. Nov-17-182 -11 Dir. Of Ops Page 5 of 26
RISK & RECOVERY ANALYSIS Performance Update - Delivery of Constitutional Targets Page 6 of 26
Performance Update: Delivery of RTT Targets Performance Issues with Service November HCCG performance - 81.06%, WVT - 80.10% (October HCCG: 80.17%, WVT - 79.16%). We are still waiting for the WVT recovery plan to secure 89.3% by year end (MOU commitment) 52 week waiters: 17 at the end of November, 17 at WVT (October: 16, WVT: 15). December 10 at WVT; projecting 11 for January, but position could deteriorate further due to Winter Pressures. Growth in the overall size of the waiting list at WVT despite reduced referrals full explanation from WVT awaited. Actions taken to Address Performance We are now in the final stages of making amendments to the CCG s Treatment Policy and to review the criteria being used and the descriptions of exceptionality. These discussions have been very productive in ensuring that we have a shared understanding and in achieving greater clarity for referrals and patients. Any significant amendments to the policy will be taken through the appropriate governance routes. Winter Pressures have led to an instruction from NHSE to cease all non urgent and non cancer planned care activity releasing capacity (staff and beds) to support patients requiring urgent and emergency care. WVT had planned reductions in planned care during December and January and the CCG is seeking assurances that planned transfers to other providers (IS) will continue through this period as part of the recovery plan to deliver the MOU commitments. Expected Improvements in Performance Improvement trajectories are agreed. WVT will deliver a minimum of 89.3% by the year end (31st March 2018). It is expected that there will still be a small number of over 52 week waiters in the next few months reflecting the wishes of patients who wish to delay surgery to accommodate other commitments. The work on the sustainable level of commissioning for RTT is progressing and will feed into 2018/19 contract discussions. Page 7 of 26
WVT Recovery Plan Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% RTT - Incomplete Pathways +18wks 2,905 2,553 2,488 2,430 2,276 1,909 1,522 1,265 1,135 1,014 999 925 Total WVT Waiting List - Plan 11,789 11,340 11,077 10,854 10,503 9,930 9,400 8,981 8,836 8,675 8,618 8,635 2017/18 WVT Recovery traj. 75.36% 77.49% 77.54% 77.61% 78.33% 80.78% 83.81% 85.91% 87.15% 88.31% 88.41% 89.29% 2017/18 WVT Actual Activity - +18wks 2,905 2,853 2,806 2,946 2,823 2,869 2,781 2,668 variance 0-300 -318-516 -547-960 -1,259-1,403 2017/18 WVT Actual Waiting List 11,789 11,881 12,081 12,034 12,355 13,086 13,344 13,405 variance 0-541 -1,004-1,180-1,852-3,156-3,944-4,424 2017/18 WVT Performance 75.36% 75.99% 76.77% 75.52% 77.15% 78.08% 79.16% 80.10% variance 0.00% -1.50% -0.77% -2.09% -1.18% -2.70% -4.65% -5.82% Diagnostic Waits - +6wks - HCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% Total Waiting List 2126 2194 2070 1954 1611 1966 2016 2054 No.s waiting +6wks 15 10 15 14 11 17 10 4 No.s waiting less than 6wks 2111 2184 2055 1940 1600 1949 2006 2050 0 0 0 0 Diagnostic Waits - +6wks - WVT - HCCG Performance 99.29% 99.54% 99.28% 99.28% 99.32% 99.14% 99.50% 99.81% #DIV/0! #DIV/0! #DIV/0! #DIV/0! Total Waiting List 1863 1933 1816 1694 1337 1681 1733 1780 No.s waiting +6wks 2 2 1 3 4 5 7 1 No.s waiting less than 6wks 1861 1931 1815 1691 1333 1676 1726 1779 0 0 0 0 Performance 99.89% 99.90% 99.94% 99.82% 99.70% 99.70% 99.60% 99.94% #DIV/0! #DIV/0! #DIV/0! #DIV/0! RTT Admiited - target 93% RTT Non-admitted - target - 95% 0-18 324 340 387 341 575 644 568 580 18+ 310 377 369 325 338 401 372 397 Total 634 717 756 666 913 1045 940 977 % 0-18 51.10% 47.42% 51.19% 51.20% 62.98% 61.63% 60.43% 59.37% 0-18 1145 1401 1491 1227 1234 1451 1600 1785 18+ 222 236 262 216 180 307 332 371 Total 1367 1637 1753 1443 1414 1758 1932 2156 % 0-18 83.76% 85.58% 85.05% 85.03% 87.27% 82.54% 82.82% 82.79% Page 8 of 26
Incomplete Pathways - 18+ Week Waiters - WVT & Top 3 Providers Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar WYE VALLEY NHS TRUST 2905 2853 2806 2946 2823 2869 2781 2668 WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST UNIVERSITY HOSPITALS BIRMINGHAM NHS FT ROBERT JONES & AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FT 112 105 105 113 94 104 87 82 37 39 29 27 15 20 16 14 20 21 26 24 25 27 35 42 Incomplete Pathways - 18+ Week Waiters - WVT & Top 3 Providers by Specialty Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ophthalmology 298 311 337 313 337 333 318 WYE VALLEY NHS TRUST Other 298 295 337 255 278 282 290 Trauma & Orthopaedics 768 700 717 652 589 616 607 561 Urology 282 289 Dermatology 28 27 26 24 24 17 WORCS ACUTE HOSPITALS NHS TRUST ENT 14 20 18 21 16 17 General Surgery 14 11 14 12 Trauma & Orthopaedics 29 24 28 23 19 23 25 21 Dermatology 4 4 5 4 2 3 2 2 UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST Neurosurgery 18 19 14 14 5 9 9 7 Other 7 8 4 3 3 2 2 Plastic Surgery 2 ROBERT JONES & AGNES HUNT HOSPITAL NHS FT Trauma & Orthopaedics 19 20 25 23 25 27 35 42 Page 9 of 26
Data Used: RECONCILED RECONCILED RECONCILED RECONCILED RECONCILED FROZEN FORECAST FORECAST FORECAST FORECAST FORECAST FORECAST Activity POD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Daycase 957 1,012 1,110 1,146 1,493 1,530 1,710 2,035 1,180 2,187 1,653 1,675 Elective 206 293 217 207 164 287 240 291 145 305 261 295 Emergency 1,250 1,416 1,330 1,279 1,304 1,356 1,345 1,333 1,358 1,318 1,250 1,402 Other Non-Elective 186 187 162 184 187 188 220 190 193 188 178 199 Outpatients 12,883 15,625 15,240 13,670 12,641 12,943 13,748 19,232 11,773 19,613 14,725 14,198 A&E 4,036 4,232 4,174 4,369 4,183 4,143 4,299 4,012 3,984 3,913 3,707 4,287 Critical Care 106 102 91 160 143 104 176 126 126 126 126 126 Pathology 124,701 152,776 151,945 140,981 146,330 140,945 150,280 143,994 143,994 143,994 143,994 143,994 Diagnostics 3,733 4,232 4,384 3,945 3,853 3,685 4,140 3,996 3,996 3,996 3,996 3,996 Excluded Drugs 0 0 0 0 0 0 0 0 0 0 0 0 Maternity 284 193 286 298 296 310 307 282 282 282 282 282 Other Variable 31 36 47 43 44 58 22 40 40 40 40 40 Block 893 893 893 893 893 893 893 893 893 893 893 893 CQUIN 0 0 0 0 0 0 0 0 0 0 0 0 Total 149,266 180,997 179,879 167,175 171,531 166,442 177,380 176,424 167,964 176,854 171,105 171,387 Activity - Monthly Movement POD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Daycase 55 98 36 347 37 180 325-855 1,007-534 22 Elective 87-76 -10-43 123-47 51-146 160-44 34 Emergency 166-86 -51 25 52-11 -12 25-40 -68 152 Other Non-Elective 1-25 22 3 1 32-30 4-6 -10 21 Outpatients 2,742-385 -1,570-1,029 302 805 5,484-7,458 7,839-4,887-527 A&E 196-58 195-186 -40 156-287 -28-71 -206 580 Critical Care -4-11 69-17 -39 72-50 0 0 0 0 Pathology 28,075-831 -10,964 5,349-5,385 9,335-6,286 0 0 0 0 Diagnostics 499 152-439 -92-168 455-144 0 0 0 0 Excluded Drugs 0 0 0 0 0 0 0 0 0 0 0 Maternity -91 93 12-2 14-3 -25 0 0 0 0 Other Variable 5 11-4 1 14-36 18 0 0 0 0 Block 0 0 0 0 0 0 0 0 0 0 0 CQUIN 0 0 0 0 0 0 0 0 0 0 0 Total 31,731-1,118-12,704 4,356-5,089 10,938-956 -8,459 8,890-5,749 282 Page 10 of 26
Performance Update: Delivery of Urgent Care Performance Issues with Service Performance against the 4 hour target at WVT : November 82.35%, December 72.02%. December performance was very poor due to an increase in conveyances and increased out of county delays (Powys in particular), and in the w/b 11th December, impacts of extreme weather. Contractually, emergency admissions are continuing to show an increase with the main areas being short stay admissions. Discussion is underway with 111 and WMAS to review the pattern of referrals from 111 to ambulance dispositions and to review opportunities to increase non-conveyances. Performance in the first week of January has continued to be significantly challenged and the system has operated in escalation since late December. The introduction of streaming in A&E has been delayed due to problems accessing sufficient GP hours to provide cover, however, WVT is working closely with Taurus and Primecare. Pressures on primary care have reduced availability of GP cover for streaming. AHPs and ANPs are also being used to support streaming to considerable effect. Actions taken to Address Performance Key programmes: introduction of Streaming in A&E; Discharge Pathway improvement and Community Services redesign. BCF and ibcf (Improved BCF) include support to delivery of Discharge pathway programme and community services redesign. The Frailty Pathway work is progressing well with the CCG sponsoring system participating in the Acute Frailty Network and a system wide group established (Dr Sarah Newey as Clinical Lead) to ensure a focus across all areas of care. Discharge pathway work underway, including analysis of detail behind reasons for delay to ensure focus is evidence based. CCG facilitated conference calls with Powys and with Shropshire to address increased OOC delays. Improvements seen for Shropshire. CCG will be facilitating a workshop between Powys and WVT in mid January to support improvement in referral and discharge pathways Expected Improvements in Performance Full implementation of Streaming model in first 3 months, mixed staffing model emerging of GP and ANP/AHP support. Work on Discharge Pathway should lead to reduced delayed transfers of care and thereby improve flow out of A&E. In particular focus on agreeing trusted assessor approaches and improved discharge pathways for Out of County (OOC) patients. Page 11 of 26
Performance Update: Delivery of Urgent Care A&E Recovery A&E Activity - (Type 1 & MIU ) Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 WVT Recovery Trajectory- 2017/18 Total patients seen 7563 8530 7740 8031 7562 7424 7559 7387 7570 7441 6855 7765 Patients >4 hour wait 1170 1070 960 803 756 742 680 591 757 595 411 388 Performance 84.53% 87.46% 87.60% 90.00% 90.00% 90.01% 91.00% 92.00% 90.00% 92.00% 94.00% 95.00% WVT Actual Perf. - 2017/18 Total patients seen 7537 8029 7443 7286 5117 4994 5172 4799 4696 Patients >4 hour wait 619 912 834 1166 773 998 1042 847 1314 Performance 91.79% 88.64% 88.79% 84.00% 84.89% 80.02% 79.85% 82.35% 72.02% #DIV/0! #DIV/0! #DIV/0! Variance against plan 7.26% 1.19% 1.20% -6.00% -5.11% -9.99% -11.15% -9.65% -17.98% #DIV/0! #DIV/0! #DIV/0! Page 12 of 26
Delays in patients being handed over from the ambulance crew to A&E staff cause delays in ambulances responding to new calls. The Trust and ambulance crews work closely together to ensure that patient care is not compromised by delays in handover. WVT continues to see delays but at a lower rate than neighbouring Trusts. WVT and WMAS are working together to improve handover and reduce delays. Significant increases in delays during December reflect increased conveyances and increased delayed transfers in the system as a whole. Page 13 of 26
Performance Update: Delivery of Urgent Care Emergency Admissions Page 14 of 26
Performance Update: Cancer overview Performance Issues with Service There is a strong focus on 62 days nationally. The CCG had been chairing weekly performance calls to support delivery of the target, which is reliant on effective relationships with tertiary providers as well as whole system focus on securing rapid support for patients. The Accountable Officer and Clinical Chair received a letter from the Secretary of State, Jeremy Hunt, in late December congratulating us on our considerable improvement in performance. 62 day Performance: October: HCCG total: 92.50%, WVT (Herefordshire patients): 93.55%; September HCCG: 84.09%, WVT: 85.71%. November predicting 90.7%; December predicting 85%. Breast Symptomatic 2 week performance dipped in September and deteriorated further in October. WVT has identified a spike in referrals and issues with Radiology capacity as issues. These are currently being reviewed. Actions taken to Address Performance The CCG and WVT have agreed to extend the remit of the Joint Planned Care Programme Board to include Cancer and the terms of reference for this Board have been reviewed to ensure a stronger focus on Performance. The appointment of the Macmillan Cancer GP Facilitator is moving forward again and we hope to be interviewing early in the new year. Currently waiting for confirmation of new Job Description by Macmillan Expected Improvements in Performance Trajectories for 2017/18 have been agreed for all key cancer standards. These are now incorporated in this report and performance will be measured against these trajectories as well as the national targets. Two week wait delivery is projected as continuing to be within the required standard for the full year. Page 15 of 26
Performance Update: Cancer 62 and 104 day overview Performance Issues with Service Anonymised patient level information relating to patients who have waited over 62 days and over 104 days is shared by WVT with the CCG and issues relating to delays are discussed at the Cancer Board, and where appropriate through the other assurance structures (see Governance diagram above). Actions taken to Address Performance WVT has made considerable improvements in its tracking of patients across the complex tertiary pathways and has used the links with the Cancer Alliance to build effective relationships with all key providers. Page 16 of 26
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Performance Update: 2wk Cancer waits Breast Symptomatic Recovery Page 18 of 26
Performance Update: 62 day Cancer Waits Recovery Issues: The CCG is now commissioning Template Biopsy from WVT (previous provision was from Cheltenham). In addition, there have been capacity issues relating to Endoscopy which have caused delays on the Colorectal pathway. This issue has now been resolved. Page 19 of 26
Performance Update: Local Stroke Care Overview Performance Issues with Service Time spent on a Stroke unit deteriorated to improved to 64.71% in November. Performance against the 24 hour target to scan and treat deteriorated slightly to 51.43%. The numbers of patients are relatively small and therefore variation is likely. WVT has confirmed that the Stroke service has undertaken a review of all patients who were not seen within the required time during March to identify if any avoidable harm to patients occurred. No harm to patients was identified. Regular information on harm reviews related to TIA is received by the CCG and reviewed by the Quality team. The SSNAP (Sentinel Stroke National Audit Programme) scores for Q4 of 2016/17 have recently been released and grade WVT at Band B (the highest band is A, with the lowest being D). This is a national rating framework which looks at performance across a range of domains and aims to give an all round picture of Stroke services. Actions taken to Address Performance A solution on an STP footprint basis is being sought, with all partners involved in the discussions. NHSE are supporting the review and agreement of a solution. Project Governance: System wide Stroke Programme Board providing overview CQRF looking in detail at quality issues related to performance Expected Improvements in Performance Improvement in performance as not been delivered in 2017/18 and further review is required to deliver this on a sustained basis. WVT is reviewing its SSNAP performance and is seeking to sustain Band B delivery. A key area for improvement is for additional Speech and Language Therapy input to wards and the Trust is reviewing whether it can achieve this. Page 20 of 26
Performance Update: Local Stroke Care Page 21 of 26
Performance Update: Living Well with Dementia Performance Issues with Service National target of 67% with a challenging ambition to achieve this target by Q2 2017/18. CCG performance is measured against estimated prevalence figure which is revised each month. Performance in November 59.63% Performance against plan - 60.57% against an agreed trajectory of 66.87% Actions taken to Address Performance Dec 2017 ICAB approved structure and approach to deliver revised Dementia Improvement Programme 2018/19: Herefordshire Dementia Programme Board to oversee delivery of Living Well with Dementia focusing on: Findings and recommendations shared via review of dementia care undertaken by the IST Build system leadership in context of Primary Care Home Build on and align work with existing partnerships and Dementia Action Alliance. Number of Dementia Friends growing & Champions programme planned March 2018 Pro-active case finding & identification including care homes residents via CCG Quality Team Audits, 2gether NHS Foundation Trust assessments, caseload reviews. On-going data quality and coding harmonization: practices reviewing lists/updating registers Workforce development & education: Domiciliary Care Spring 2018. Practice Nurse Programme Jan 25th Scoping of Admiral Nurse roles to support Programme delivery Expected Improvements in Performance Monthly gains expected through the above actions Page 22 of 26
Performance Update: Living Well with Dementia Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Planned Prevelance @+65 2889 2889 2889 2889 2889 2889 2889 2889 2889 2889 2889 2889 Planned activity Target 1796 1824 1853 1882 1911 1932 1932 1932 1932 1932 1932 1932 Planned PerformanceTarget 62.17% 63.14% 64.14% 65.14% 66.15% 66.87% 66.87% 66.87% 66.87% 66.87% 66.87% 66.87% Performance against plan 59.33% 59.43% 59.74% 59.85% 60.09% 60.12% 60.96% 60.57% variance against plan -82-107 -127-153 -175-195 -171-182 Estimated Prevalance 2889 2896 2906 2910 2919 2926 2926 2935 67% of estimated prevalance 1936 1940 1947 1950 1956 1960 1960 1966 Actual 1714 1717 1726 1729 1736 1737 1761 1750 Performance against Rptd data 59.33% 59.29% 59.39% 59.42% 59.47% 59.36% 60.18% 59.63% variance against plan data 0.00% -0.14% -0.35% -0.43% -0.62% -0.76% -0.77% -0.95% Page 23 of 26
Performance Update: Improving Access to Psychological Therapies Performance Issues with Service The performance for the IAPT service has improved since 2016/17 and this quarter, the progress is improved. The monthly performance for access and recovery was achieved. The service is reporting consistent effort to manage the patient flow, however it appears that slight reduction in staffing has a significant impact. This is the only area of the mental health targets with 2gether NHS Foundation Trust has requires improvement. Actions taken to Address Performance The intensive contract monitoring using contract levers remains in place. This consists of monthly reporting and a dedicated contract board for the purpose of deep dives into the activity. This has been in place since June 2016 and the provider has achieved all of the required actions outlined in the agreed service improvement plan. The revised focus will be on generating capacity in new ways, such as digital platforms. Expected Improvements in Performance The progress in recovery target is likely to be maintained. The access target will be affected by staffing availability. This is a concern for the resilience of the small service and shall be examined in 2018/19 contract negotiations The activity in 2017/18 suggest that it is unlikely that waiting times will reduce to achieve the national target without further capacity generated. This is a concern. The Provider and CCG are exploring digital solutions to provide alternatives to address the demand and plan for increasing access target in 2018/19. Page 24 of 26
Performance Update: IAPT Access & Recovery Q1 Q2 Q3 Q4 IAPT Access & Recovery Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Herefordshire target population 14520 14520 14520 14520 14520 14520 14520 14520 14520 14520 14520 14520 IAPT Access Rate target 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% 1.25% IAPT Access Rate 0.96% 1.18% 1.05% 1.03% 1.45% 1.07% 1.32% 1.29% IAPT Access Rate - Cumulative 0.96% 2.15% 3.20% 4.22% 5.67% 6.75% 8.07% 9.37% IAPT Access Rate - Quarterly - 3.75% 3.20% 3.55% 2.62% The number of people who have completed treatment (minimum 2 treatment contacts). 81 95 106 91 141 104 114 116 The number of people who are moving to recovery (of those who have completed 47 45 50 47 55 57 57 66 treatment). IAPT Recovery Rate 58.02% 47.37% 47.17% 51.65% 39.01% 54.81% 50.00% 56.90% IAPT Recovery Rate - Quarterly - 50.00% 50.35% 47.32% 53.48% Page 25 of 26
Performance Update: IAPT Waiting Times Q1 Q2 Q3 Q4 IAPT Waiting Times Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 6wk Waits - Quarterly Target - 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% No. of referrals seen within 6 weeks 35 46 69 68 90 73 67 78 No. of referrals 88 107 116 105 154 117 121 131 Monthly Performance 39.77% 42.99% 59.48% 64.76% 58.44% 62.39% 55.37% 59.54% Qrt performance 48.23% 61.44% 57.54% #DIV/0! variance -26.77% -13.56% -17.46% #DIV/0! 18wk Waits - Quarterly Target - 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% No. of referrals seen within 18 weeks 74 86 97 82 113 84 76 97 No. of referrals 88 107 116 105 154 117 121 131 Monthly Performance 84.09% 80.37% 83.62% 78.10% 73.38% 71.79% 62.81% 74.05% Qrt performance 82.64% 74.20% 68.65% #DIV/0! variance -12.36% -20.80% -26.35% #DIV/0! Page 26 of 26