Governing Body Item 11c Tuesday 26 th September 2017 Subject Lead Executive Author (s) Performance & Assurance Report Director of Operations CSU Contracting & 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 Committee 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 Aug-17 84.89% 0.89% No waits from decision to admit to admission (trolley waits) over 12 hours Aug-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 Jul-17 96.04% 0.54% Dir. Of Ops Jul-17 83.33% 5.91% Contract notice issued in 16/17 Dir. Of Ops 17/18 Recovery trajectory received Monthly CSU Jul-17 78.72% 12.06% Rpt 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. Jul-17 100.00% 0.00% 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. Jul-17 57.09% 0.39% Dir. Of Ops 2018-19 Jul-17 85.38% -0.16% Dir. Of Ops 2018-19 NHSE Monthly Jul-17 76.78% -1.01% RTT Rpt Referral To Treatment - Zero tolerance of over 52 week waiters Jul-17 45 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 Jul-17 99.28% 0.00% 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 Aug-17 77.14% -10.36% Monthly WVT Dir. Of Ops Stroke Rpt Aug-17 56.25% 2.92% 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 Jul-17 1.03% -0.02% Q1 17/18 3.20% 0.86% Jul-17-113 -32 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 Jul-17 51.65% 4.48% Q1 17/18 50.35% 4.24% 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 Jul-17 64.76% 5.28% Jul-17 78.10% -5.52% 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 Herefordshire CCG Targets - Schedule 4 Dementia Diagnosis Dementia - achieve a diagnosis rate of 67% for >65 yrs old on a GP register with a diagnosis of dementia. Aug-17 60.09% 0.24% Dir. Of Ops Performance against plan. Variance against plan- cumulative. Aug-17-6.06% -0.76% NHSE Monthly Dir. Of Ops Rpt Dementia - Number of patients >65 yrs old on a GP register with a diagnosis of Aug-17 1736 dementia. 7 Dir. Of Ops Performance against plan. Aug-17-175 -22 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 July HCCG performance 76.78%, WVT 75.52% (below trajectory by 2%). 52 week waiters: 45 at the end of July, 43 at WVT. Trust reviewing July performance, likely to be impacted on by reduced routine patient pathway validation due to Electronic Patient Record (Maxims) implementation. WVT failed the cancelled operations measures for July with 7 breaches of the 28 day standard despite the number of last minute cancellations (9) being within the requirement. Diagnostic waits continue to perform within the 6 week target with WVT performing particularly well at 99.9% against the 99% target. HCCG achieved the target but is continuing to investigate a small number of breaches at Birmingham Children s Hospital relating to MRI. Actions taken to Address Performance All main providers have been asked to provide information on patients waiting in excess of 18 weeks against the RTT target and a slide has been added to this report highlighting where Herefordshire patients are waiting beyond this target and in which specialties. The Trusts with the highest numbers are listed. Meetings are taking place with Consultants at WVT to discuss 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. Expected Improvements in Performance Improvement trajectories are agreed. WVT will deliver a minimum of 89.3% by the year end and will be reporting no over 52 week waiters from October. WVT is reviewing specialty level plans to ensure that the MOU trajectories are delivered. 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 variance 0-300 -318-516 2017/18 WVT Actual Waiting List 11,789 11,881 12,081 12,034 variance 0-541 -1,004-1,180 2017/18 WVT Performance 75.36% 75.99% 76.77% 75.52% variance 0.00% -1.50% -0.77% -2.09% 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 No.s waiting +6wks 15 10 15 14 No.s waiting less than 6wks 2111 2184 2055 1940 0 0 0 0 0 0 0 0 Diagnostic Waits - +6wks - WVT - HCCG Performance 99.29% 99.54% 99.28% 99.28% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Total Waiting List 1863 1933 1816 1694 No.s waiting +6wks 2 2 1 3 No.s waiting less than 6wks 1861 1931 1815 1691 0 0 0 0 0 0 0 0 Performance 99.89% 99.90% 99.94% 99.82% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! RTT Admiited - target 93% RTT Non-admitted - target - 95% 0-18 324 340 387 341 18+ 310 377 369 325 Total 634 717 756 666 % 0-18 51.10% 47.42% 51.19% 51.20% 0-18 1145 1401 1491 1227 18+ 222 236 262 216 Total 1367 1637 1753 1443 % 0-18 83.76% 85.58% 85.05% 85.03% Page 8 of 26
Incomplete Pathways - 18+ Week Waiters - WVT & Top 3 Providers WYE VALLEY NHS TRUST WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST UNIVERSITY HOSPITALS BIRMINGHAM NHS FT ROBERT JONES & AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FT Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2905 2853 2806 2946 112 105 105 113 37 39 29 27 20 21 26 24 Incomplete Pathways - 18+ Week Waiters - WVT & Top 3 Providers by Specialty Ophthalmology 298 311 337 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar WYE VALLEY NHS TRUST Other 298 295 337 Trauma & Orthopaedics 768 700 717 652 Urology 282 289 Dermatology 28 27 26 24 WORCS ACUTE HOSPITALS NHS TRUST ENT 14 20 General Surgery 14 11 Trauma & Orthopaedics 29 24 28 23 Dermatology 4 4 5 4 UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST Neurosurgery 18 19 14 14 Other 7 8 4 3 ROBERT JONES & AGNES HUNT HOSPITAL NHS FT Trauma & Orthopaedics 19 20 25 23 Page 9 of 26
Data Used: RECONCILED FROZEN FLEX FORECAST FORECAST FORECAST FORECAST FORECAST FORECAST FORECAST FORECAST FORECAST Activity POD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Daycase 957 1,005 1,073 1,035 955 1,112 1,052 1,128 974 1,057 1,033 1,201 Elective 206 295 263 266 245 234 285 269 270 256 317 350 Emergency 1,250 1,415 1,318 1,302 1,267 1,346 1,401 1,346 1,448 1,437 1,365 1,482 Other Non-Elective 186 202 161 193 173 197 198 196 193 181 170 189 Outpatients 12,883 15,629 15,190-50 -36-9 28-24 -18 0-17 -15 A&E 4,036 4,232 4,171 4,126 3,812 3,895 3,998 3,656 3,713 3,869 3,517 4,140 Critical Care 106 102 91 104 96 93 111 106 104 100 122 135 Pathology 124,701 152,776 151,945 152,844 128,265 148,977 157,779 143,956 134,113 156,050 147,335 165,851 Diagnostics 3,733 4,232 4,384 4,142 3,835 4,007 3,956 3,735 4,008 4,282 4,411 4,735 Excluded Drugs 0 0 0 0 0 0 0 0 0 0 0 0 Maternity 284 193 286 274 239 294 285 230 238 281 238 263 Other Variable 31 37 49 41 37 36 43 41 41 39 48 53 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 149,266 181,011 179,824 165,170 139,781 161,074 170,029 155,532 145,977 168,445 159,433 179,277 Activity - Monthly Movement POD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Daycase 48 68-38 -80 157-60 76-154 83-23 168 Elective 89-32 3-21 -11 51-15 1-14 61 32 Emergency 165-97 -16-36 79 56-56 102-11 -72 117 Other Non-Elective 16-41 32-20 25 0-2 -3-12 -11 20 Outpatients 2,746-439 -15,240 14 27 37-52 6 18-17 2 A&E 196-61 -45-314 82 104-342 57 156-352 623 Critical Care -4-11 13-8 -3 18-5 -1-4 22 12 Pathology 28,075-831 899-24,578 20,712 8,802-13,823-9,843 21,938-8,716 18,516 Diagnostics 499 152-242 -307 173-51 -222 273 273 130 323 Excluded Drugs 0 0 0 0 0 0 0 0 0 0 0 Maternity -91 93-12 -35 54-9 -54 8 42-43 25 Other Variable 6 12-8 -3-1 7-2 -1-2 9 5 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 31,745-1,187-14,653-25,389 21,292 8,956-14,497-9,555 22,468-9,012 19,844 Page 10 of 26
Performance Update: Delivery of Urgent Care Performance Issues with Service Performance against the 4 hour target at WVT in the past 3 months: June: 88.79%, July: 84.00%, August: 84.89%. This is below the recovery trajectory which is expected to be a 90%. The first 3 months of the year saw a significant increase in reported levels of emergency admissions with ambulance conveyances up by 5% in the ytd. The increases in admissions are being reviewed to assess whether there is an impact from pathway changes. The Trust is reporting a levelling off in July and early August. 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. WVT reports the main challenges to delivering the 4 hour target as being issues within ED (in particular medical staffing) and delayed transfers of care, in particular in non-acute beds. The A&E Delivery Board is now receiving monthly information on the reasons for delays, including the split by commissioner. July saw 858 (245 Acute, 613 Community) bed days at WVT lost to delayed transfers of care and this equates to 7.8% of all available bed days.. Winter Planning has now commenced with a draft plan submitted to NHSE on 12th September. 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. Streaming in A&E to be introduced from September/October. Capital to support remodelling in A&E has been confirmed and building works will be completed by end of December. Limited streaming model will be introduced prior to completion of these works to ensure that appropriate support is in over the full winter period. Additional funding secured through STP to support implementation of streaming. 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. Expected Improvements in Performance Plans to implement Streaming model in A&E from September. Evidence from perfect week suggests that this should enable improvement in delivery. 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 for Out of County (OOC) patients. NHSE has agreed to facilitate a further workshop with OOC commissioners and providers in September. WVT meeting with colleagues in Powys to discuss their improvement plans. 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 Patients >4 hour wait 619 912 834 1166 773 Performance 91.79% 88.64% 88.79% 84.00% 84.89% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Variance against plan 7.26% 1.19% 1.20% -6.00% -5.11% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Page 12 of 26
All handovers between ambulance and A&E must take place within 15 minutes. 0-15 mins All handovers between ambulance and A&E must take place within 15 minutes. 15-30 mins All handovers between ambulance and A&E must take place within 15 minutes. 30-45 mins (16/17 figures relate to 30-60mins) All handovers between ambulance and A&E must take place within 15 minutes. 45-60 mins All handovers between ambulance and A & E must take place within 15 minutes. Over 1 Hour Arrival to handover Ave Time h:m:s - The average time from arrival to patient handover per month taken from WMAS activity data. No waits from decision to admit to admission (trolley waits) over 12 hours Target Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 N/A 596 683 622 573 542 3016 0 652 706 714 700 704 3476 0 158 182 172 255 218 985 0 32 43 30 57 33 195 0 10 14 6 25 14 69 Achieve <= 15 mins 00:19:37 00:19:41 00:19:33 00:22:30 00:20:56 0 0 0 0 0 0 0 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. Winter planning is now underway and WMAS has reported to the A&E Delivery Board that it is intending to fund additional WMAS staff to work within A&E Departments at times of significant pressure to support reductions in handover delays Page 13 of 26
Performance Update: Delivery of Urgent Care Emergency Admissions 2014/15 2014/15 2015/16 2015/16 2016/17 2016/17 2017/18 2017/18 A&E attends Emg. Adms A&E attends Emg. Adms A&E attends Emg. Adms A&E attends Emg. Adms Apr 4341 1315 4310 962 4299 977 4515 1008 May 4518 1300 4517 1016 4957 1031 4747 1160 Jun 4601 1294 4527 997 4541 957 4662 1086 Jul 4821 1356 4670 1040 4892 1031 4894 1176 Aug 4371 1275 4654 1055 4612 1041 4705 1109 Sep 4383 1322 4587 1031 4570 1011 Oct 4231 1353 4479 1031 4504 989 Nov 4121 1269 4447 1013 4397 1037 Dec 4469 1447 4293 1021 4490 1131 Jan 3959 1404 4393 1176 4224 1078 Feb 3686 1150 4272 1029 3908 1032 Mar 4220 1225 4820 1104 4618 1158 5500 5000 4500 4000 3500 3000 2500 Year on Year Comparison of A&E Attendences 2014/15 2015/16 2016/17 2017/18 Comparison of A&E attends to Emergency Admissions with 2016/17 2000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 5500 2016/17 A&E attends 2017/18 A&E attends 2016/17 Emg. Adms 2017/18 Emg. Adms Year on Year Comparison of Emergency Admissions 5000 2014/15 2015/16 2016/17 2017/18 4500 1600 4000 1400 3500 1200 3000 1000 2500 2000 1500 800 600 1000 400 500 200 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Page 14 of 26
Performance Update: Cancer overview Performance Issues with Service Following a period of improved performance at WVT during April and May, June s performance has deteriorated in a number of areas. This level of performance will continue in to July for a number of the standards however performance is expected to return to the required standard in August. WVT continued to deliver on 2 week waits and also delivered 62 days screening and 31 days Rare Cancers. The Trust failed to deliver the 2 week breast symptomatic waits and 62 day targets. It also failed to deliver 31 days, 31 Days Subsequent Treatments and 62 days upgrades. HCCG performance in July was below target on 62 day waits due to breaches at both WVT and Gloucestershire. Small numbers and capacity issues in individual specialties and also in supporting diagnostic services will continue to be a challenge. 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. This Programme Board will include both the GP Clinical Lead for Planned Care and the new Macmillan GP Facilitator who we are in the process of recruiting. Dr Dominic Horne will take a strategic overview on Cancer and will support the new Macmillan GP. An STP footprint Cancer Group has been established which will oversee the delivery of the STP priorities. 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). Similar information has been requested from Gloucester Hospitals Trust and Worcester Royal to ensure that the CCG is able to track progress for all patients from Herefordshire. Actions taken to Address Performance The commissioning of template biopsy from WVT will have a temporary negative impact on performance as patients who had been waiting for this procedure are repatriated from Cheltenham and move through the appropriate treatment pathway. This is a significant improvement in the quality of care for this group of patients. 62 Day PTL - Pts without a decision to treat 62 Day PTL - Pts with a decision to treat Pts treated in the last week Patients will breach in Patients who have breached Patients will breach in Patients who have breached Week Ending 15-28 days 8-14 days Next 7 days The last 7 days Breach date has passed Breached beyond 104 days 15-28 days 8-14 days The next 7 days The last 7 days Breach date has passed Breached beyond 104 days Pts Pts not treated treated within 62 within 62 days days % Treated within target 11-Jun-17 87 25 21 11 50 2 7 2 2 1 7 1 5 3 62.50% 85.00% 18-Jun-17 89 26 24 11 44 2 5 3 2 2 9 1 4 0 100.00% 85.00% 25-Jun-17 76 34 20 10 41 3 4 1 1 2 12 1 4 0 100.00% 85.00% 02-Jul-17 60 20 29 11 37 5 2 3 2 0 9 2 3 4 42.86% 85.00% 09-Jul-17 79 19 20 13 39 3 1 3 3 1 8 3 5 0 100.00% 85.00% 16-Jul-17 89 22 14 11 39 0 0 1 3 1 9 2 4 2 66.67% 85.00% 23-Jul-17 77 30 17 9 33 0 1 2 2 3 12 2 2 0 100.00% 85.00% 30-Jul-17 104 27 26 9 35 1 4 0 2 1 12 2 4 1 80.00% 85.00% 06-Aug-17 103 24 23 13 37 3 4 0 2 0 12 2 3 2 60.00% 85.00% 13-Aug-17 85 32 18 15 45 2 3 4 1 1 7 1 8 5 61.54% 85.00% 20-Aug-17 95 21 25 9 37 2 2 1 6 1 5 0 4 1 80.00% 85.00% 27-Aug-17 93 26 22 15 54 4 1 2 1 3 7 0 2 0 100.00% 85.00% % target Page 16 of 26
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Performance Update: 2wk Cancer waits Breast Symptomatic Recovery 2WW cancer Wait - Breast Symp. Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% HCCG 2017/18 Actual Perf - All 95.65% 92.86% 77.42% 83.33% WVT 2017/18 Actual Perf - HCCG 95.45% 96.00% 75.86% 82.35% 2016/17 Actual Perf 81.48% 22.22% 30.43% 70.42% 55.17% 70.73% 89.80% 91.11% 84.38% 78.79% 86.49% 76.67% 2017/18 WVT Recovery traj. 80.00% 82.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% Variance 15.45% 14.00% -17.14% -10.65% -93.00% -93.00% -93.00% -93.00% -93.00% -93.00% -93.00% -93.00% Page 18 of 26
Performance Update: 62 day Cancer Waits Recovery 62 day Cancer wait Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% HCCG 2017/18 Actual Perf - All 83.33% 82.35% 66.67% 78.72% WVT 2017/18 Actual Perf - HCCG 85.53% 89.53% 67.19% 82.43% Glos 2017/18 Actual Perf - HCCG 78.57% 60.00% 64.29% 87.50% WVT 2016/17 Actual Perf 69.64% 84.85% 77.14% 86.67% 87.50% 78.05% 73.26% 75.00% 79.07% 79.17% 79.63% 78.13% WVT 2017/18 Recovery traj. 74.04% 75.96% 77.97% 85.00% 85.34% 85.00% 85.00% 85.00% 85.38% 85.34% 85.42% 85.26% Variance 11.49% 13.57% -10.78% -2.57% -85.34% -85.00% -85.00% -85.00% -85.38% -85.34% -85.42% -85.26% Page 19 of 26
Performance Update: Local Stroke Care Overview Performance Issues with Service Time spent on a Stroke unit has continued to deliver against target in July, however, performance against the 24 hour target to scan and treat dropped to 53.33% 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 supporting review and agreement of rapid solution. Project Governance: System wide Stroke Programme Board providing overview CQRF looking in detail at quality issues related to performance Expected Improvements in Performance Sustained improvement in performance is expected to be achieved during 2017/18 The Trust is reviewing its SSNAP performance and is seeking to sustain Band B delivery. Page 20 of 26
Performance Update: Local Stroke Care Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD 2016/17 Perf 88.57% 77.78% 85.19% 74.36% 78.38% 75.00% 81.48% 66.67% 73.47% 75.68% 85.71% 78.26% 78.28% People admitted who have had a stroke 35 36 27 39 37 24 27 27 49 37 35 46 419 Those admitted spend at least 90% of their time on a 31 28 23 29 29 18 22 18 36 28 30 36 328 stroke unit 2017/18 Perf 84.00% 84.00% 90.00% 87.50% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 86.54% People admitted who have had a stroke 25 25 30 24 104 Those admitted spend at least 90% of their time on a stroke unit 21 21 27 21 90 2016/17 Perf 16.67% 18.92% 13.79% 46.67% 44.00% 42.31% 60.00% 45.00% 50.00% 45.45% 53.57% 3.85% 36.21% Number of people who have a TIA who are high risk 24 37 29 30 25 26 30 20 18 22 28 26 315 Number of people who have a TIA who are scanned and 4 7 4 14 11 11 18 9 9 10 15 1 113 treated within 24 hours 2017/18 Perf 8.00% 34.78% 61.90% 53.33% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 36.90% Number of people who have a TIA who are high risk 25 23 21 15 84 Number of people who have a TIA who are scanned and treated within 24 hours Time spent on a Stroke Unit TIA Performance 2 8 13 8 31 Page 21 of 26
Performance Update: Living Well with Dementia Performance Issues with Service National target of 67% and this represents a challenging ambition to achieve 67% in 2017/18. There is a monthly increase in diagnosis, however the net impact on the diagnosis levels is affected by deaths and removal from QOF register. Achievement in August of 60.09% against a trajectory of 66.15% Actions taken to Address Performance The focus is on implementing a robust plan for 2017/18: Identification of people residing in care homes with CCG Quality Team audits, 2gether NHS Foundation Trust Care Home assessments and liaison with primary care. Care homes are currently re-auditing their residents. Picking up the actions arising from coding harmonization (this includes actions for GPs, pharmacists and dementia nurses). GP education on diagnosis and post-diagnosis support took place 19 th July 2017 Review of CCG action plan completed to identify further actions to close the gap IST review took place 7 th September 2017 Expected Improvements in Performance Monthly gains expected through the above actions - Additional improvement to be identified through IST involvement in Quarter 2 Page 22 of 26
Performance Update: Living Well with Dementia Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Prevelance @+65 2889 2889 2889 2889 2889 2889 2889 2889 2889 2889 2889 2889 Target 1796 1824 1853 1882 1911 1932 1932 1932 1932 1932 1932 1932 Target 62.17% 63.14% 64.14% 65.14% 66.15% 66.87% 66.87% 66.87% 66.87% 66.87% 66.87% 66.87% Actual 1714 1717 1726 1729 1736 Actual 59.33% 59.43% 59.74% 59.85% 60.09% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Variance -82-107 -127-153 -175-1932 -1932-1932 -1932-1932 -1932-1932 Page 23 of 26
Performance Update: Improving Access to Psychological Therapies Performance Issues with Service Performance in Recovery rate achieved the target of 50% - 51.65% performance in July, however the 2 nd quarter target achievement depends on sustainability of the service. Access rate not achieved for monthly trajectory, this target is monitored on a quarterly basis, so improvement sought in subsequent months. Performance on 6 weeks waiting times are improving. Actions taken to Address Performance Intensive contract monitoring using contract levers in place. Service improvement plan in place. Re-modelling of capacity required for 2017/18 and 2018/19 Improved intelligence and reporting on IAPT HCCG Quality & Patient Safety Committee briefed on progress. IST review in September 2017 Expected Improvements in Performance Seeking further assurance that Trust can achieve and sustain delivery through 2017/18. IST to review position during 2017/18 and offer further support if required. Page 24 of 26
Performance Update: IAPT Access & Recovery 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% IAPT Access Rate - Cumulative 0.96% 2.15% 3.20% 4.22% IAPT Access Rate - Quarterly - 3.75% 3.20% 1.03% The number of people who have completed treatment (minimum 2 treatment contacts). The number of people who are moving to recovery (of those who have completed treatment). 81 95 106 91 47 45 50 47 IAPT Recovery Rate 58.02% 47.37% 47.17% 51.65% IAPT Recovery Rate - Quarterly - 50.00% 50.35% 51.65% Q1 Q2 Q3 Q4 Page 25 of 26
Performance Update: IAPT Waiting Times Page 26 of 26