GOVERNING BODY MEETING. Performance Dashboard

GOVERIG BODY MEETIG Date of meeting 18 July 2017 Agenda item number 12 Title of report Paper Presented by: Paper prepared by: CCG strategic objective supported by this paper: (please tick ) Purpose of report Performance Dashboard Mr P Tinson, Chief Operating Officer Mrs J Aldridge, Chief ursing Officer icola Walmsley, Head of Delivery and Planning Claire Lewis, Head of Quality Develop and maintain an effective organisation Commission high quality, safe and cost effective services which reduce health inequalities and improve access to healthcare Effectively engage patients and the public in decision making Develop excellent partnerships which lead to improved health outcomes Make the best use of resources This report provides a summary of current performance and activity across Fylde and Wyre CCG including key issues and actions. Key performance indicators and metrics have been RAG rated for the CCG and the four major healthcare providers in Fylde and Wyre CCG (Blackpool Teaching Hospitals, Lancashire Teaching Hospitals, Lancashire Care Foundation Trust and Spire Fylde Coast Hospital). Recommendation The Governing Body is asked to note the content of the report and approve the actions being taken. Please indicate which Group this has been discussed with (please tick ) Executive Management Team Quality Improvement and Governance Cttee Clinical Commissioning Committee Finance and Performance Committee Audit Committee Remuneration Committee Council of Members Other/ot Applicable Resource Implication(s): one Equality Impact Assessment: Patient and Public Engagement: For further information please contact: Key performance indicators reflect improvements in health inequalities Supports transparency and openness Peter Tinson, Jennifer Aldridge, Claire Lewis or icola Walmsley

Governing Body Meeting July 2017 HS Fylde and Wyre CCG Performance Dashboard April 2017 (Month 1)

Governing Body ITEM 12 This report provides a summary of current performance across Fylde and Wyre CCG, including key issues and actions. Key performance indicators and metrics have been RAG Rated for the CCG and the four major healthcare providers for Fylde and Wyre patients. The Acute Contract total variance at month 1 is an underperformance of - 201,084. GP Referrals for month 1 across all providers have decreased by -19.9% (-622) compared to the same period in 2016/17 Blackpool Teaching Hospitals are below the planned contract value by - 49,243 Spire Fylde Cost Hospital are below the planned contract value by - 80,094 Lancashire Teaching Hospitals are below the contract value by - 28,088 Below is a summary of performance against indicators within the CCG Assurance Domains. Data is currently not available for a number of indicators as these are measured on a quarterly or annual basis. There are performance concerns in respect of the following areas:- o o o o A&E waiting times Ambulance response Red 1, Red 2 and 19 minutes. RTT, incomplete pathways waiting less than 18 weeks. Cancer 62 day waits; % patients with a maximum 62 day wait from referral from an HS screening service to first definitive treatment for cancer. Page 2 of 14

The Indicator Recall section of the report is utilised to provide periodic updates regarding indicators which have previously been reported as breached in order to update and assure the Governing Body that actions undertaken to improve performance have been completed. Ambulance Response Times Ambulance Response times for Fylde & Wyre CCG were not achieved in April 2017, with performance of 56.14% for Red 1, 48.45% for Red 2 and 84.42% for All Reds. WAS Lancashire response times were not achieved in the month of April 2017 with performance of 70.08% for Red 1, 68.94% for Red 2 and 92.54% for All Reds. It has previously been recognised that performance is measured at a regional level. However, the Governing Body has requested further assurance that response times are not demonstrably impacting on the quality of service received, the Host Commissioner is attending a Governing Body Development session on 11 July 2017 to discuss. Cancer Performance % patients with a maximum 62 day wait from referral from an HS screening service to first definitive treatment for cancer. In the month of April 2017, the CCG did not achieve the target with performance at 87.5% against a target of 90%. There was one breach of this standard, due to a delay caused by equipment failure. Although not yet validated, early indications suggest that the performance for May 2017 is 81.14% and June is 80%, with predicted performance for Quarter 1 of 82.13%. Further work is being carried out to validate the breaches and to ensure that all treatments are recorded. A meeting is being held on 12 July 2017 to discuss and agree the Fylde Coast cancer priorities and action plan. This will include actions required to improve Cancer 62 Day Performance. % patients on incomplete pathway waiting less than 18 weeks In the month of April 2017, the CCG did not achieve this target with performance of 90.86% against a target of 92%. Blackpool Teaching Hospitals marginally did not achieve this target in month with performance of 91.57%. The specialities in which the target was not achieved were Cardiology, Cardiothoracic, Urology and Trauma & Orthopaedics. The current position is 89.56% and although not yet fully validated it is predicted that the Trust will not achieve the target for the month June 2017 and Quarter 1. The pressure areas are those specialties listed above and Ophthalmology, Gynaecology and General Surgery. Each divisional team within the Trust is completing an assurance template to recover the position. The improvement and maintenance of the RTT position falls within the scope of the Planned Care workstream, the required actions to improve performance will be discussed at the first meeting of the group on 8 August 2017. The performance concerns will also be raised at a future Fylde Coast Informal Executives meeting. Lancashire Teaching Hospitals HS Foundation Trust also did not achieve the target in month with performance at 83.82%. Lancashire Teaching Hospitals HS Foundation Trust have met with HS England and HS Improvement to agree an action plan which is being closely monitored by the host commissioner and HS Improvement. The current recovery trajectory for RTT is to achieve 92% by March 2018. The trajectory for April 2017 was 83.8% which has been achieved. Page 3 of 14

Dementia ITEM 12 In the month of April 2017, the CCG achieved the target with a performance of 75.4% against a target of 67% As outlined in previous dashboards the methodology used to calculate dementia prevalence across the country has been revised. This methodology uses GP registered populations rather than geographical populations and has therefore reduced our prevalent population. This reduction in prevalence should not detract from the achievement of this target, over the last 3 years the CCG has made great progress in increasing the number of patients who are diagnosed with dementia from 1473 patients on the Quality Outcomes Framework (QoF) register in April 2014 (55.3%) to 1949 (75.4%) in April 2017. Mixed Sex Accommodation Breach Blackpool Teaching Hospitals HS Foundation Trust reported 1 Mixed Sex Accommodation breach during April 2017, which affected a Fylde and Wyre patient and was upheld by the CCG. The patient concerned was identified for step down from the High Dependency Unit on 23 April 2017, however, no medical beds were available. The patient was transferred to Ward 2 on 24 April 2017. The patient was informed of the situation and their privacy and dignity were maintained. C. difficile During April 2017, 4 new cases of C. difficile were reported in relation to Fylde and Wyre patients, one of which was attributed to University Hospital of South Manchester (UHSM) HS Foundation Trust, while the other 3 cases were community-acquired. The UHSM acute case was discussed at the CCG s Post-Infection Review Panel (PIR) meeting on 13 June 2017. The Trust indicates that it completes Root Cause Analysis reports, as opposed to post-infection reviews, in relation to C. difficile cases and a copy of the relevant report was made available to the CCG in relation to this case. The RCA concluded that this case was unavoidable, as anti-microbial prescribing had been appropriate and no lapses in care had been identified. For the 3 community-acquired cases, the PIR decisions were deferred due to the need to confirm details and gather further information. The CCG s month 1 position against trajectory for avoidable cases will therefore be reported next month. A&E 12 Hour Decision to Admit Breaches During April 2017, 5 breaches of the 12-hour standard were reported, which occurred on 17 April 2017 (4 breaches) and 25 April 2017 (1 breach). These breaches affected 3 Fylde and Wyre patients and 2 Blackpool CCG patients. Timeline documents have been received in relation to all of the breaches, which have been escalated as appropriate. one of the timelines for the April breaches indicated any patient harm. The Root Cause Analysis reports for the April breaches (1 per date of breach), due on 18 and 27 June 2017, were received on 29 June, following an update request made via the Quality Review Group meeting with the Trust on 28 June 2017. Page 4 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: The number of patients admitted, transferred or discharged from A&E within 4 hours as a percentage of the total number of attendances at A&E (for all types of A&E) ational Position Action to be undertaken Timescales RAG The Urgent Care network is leading on a Lancashire wide piece of July 2017 work which will focus on the Home of Choice policy and Discharge to Assess model. The policy will be called Supporting Patients Choices to avoid long hospital stays and workshops are continuing. Each organisation to report blockages in the system via On-going teleconferences Hospital flow meetings are being undertaken 3 times a week to improve flow through the hospital and to reduce DToCs. On-going until DToC and A&E performance increases The Liaison Mental health Services operational group meets monthly to respond to system-wide pressures, develop the Core 24 specification and progress 24/7 acute assessment service A&E Delivery Board meeting TOR reviewed to ensure operational traction; capital funding bid ( 2m) has been submitted to HSE for MH assessment/discharge Lounge and A&E upgrade. Revenue funding has been agreed with LCFT for BTH staffing uplift July-October 2017 On-going from May 2017 Timescale for when performance is expected to be achieved: A&E performance Sustainability and Transformation Fund (STF) Trajectory was not met for year-end 2016/17. ew STF target for Month 1 2017/18 is 92.9%. Currently, the Trust is at 88.74%. Weekly teleconferences continue with HS England Due to the volumes and high acuity of patients the bed capacity has continued to be an issue which has therefore impacted on the ambulatory care settings Due to tax changes for agency staff the trust is experiencing staffing issues throughout A&E. The trust has employed additional locum staff to ensure that there are sufficient levels of staffing at the front end. DTOC position remains challenging, but there are some signs of improvement during May and June 2017. Short term care beds and the outreach team continue to facilitate discharge for some patients waiting for packages of care but these have also reduced. Trust frailty pathway workshops have commenced. Fylde Coast review of SRG funded schemes (e.g., Rapid Response/Rapid Response Plus services) commencing June 2017 with BCCG/BTH Community Services) to be included in a review of BCF schemes for end July 2017 & report to H&WB Board Ongoing challenges with Mental Health Liaison services capacity and a substantial number of people with mental health needs awaiting either an assessment by MHL staff or admission to MHIP bed mirrored national. Overall bed capacity for BTH remains pressured Page 5 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: umber of patients who have experienced Delayed Transfer of Care (Provider level: Blackpool Teaching Hospital) The % of total delayed days by reason DTOC Key Stats April 2017 for the current month (April 2016/17) Delayed Days Reason for Delay % umber Total 640 HS 39.0% Social Care 43.3% Both 17.7% Acute 63.0% on Acute 37.0% this month compared to 850 last month and 935 in the same month last year this month compared to 48.6% last month and 58.7% in the same month last year this month compared to 34.1% last month and 27.3% in the same month last year this month compared to 17.3% last month and 14.0% in the same month last year this month compared to 63.2% last month and 71.6% in the same month last year this month compared to 36.8% last month and 28.4% in the same month last year Patient delayed snapshot* Patient snapshot measure has been removed from the April 2017 report. The snapshot only recorded the position on one day every month and was considered unrepresentative of the true picture of DTOC Completion Assessment 19.9% 128 ursing Home 8.7% 56 Care Package in home 29.0% 187 Patient Family Choice 27.8% 179 Further on-acute HS 8.7% 56 Public Funding 1.2% 8 Community Equipment Adapt 4.5% 29 Residential Home 0.2% 1 Housing 0.0% 0 Disputes 0.0% 0 See following pages for glossary Completion Assessment A) Public Funding B) Waiting further HS on-acute Care C) Awaiting residential care home placement Di) Awaiting nursing home placement Dii) Awaiting care package in own home E) Community equipment / adaptions F) Patient or family choice G) Disputes H) Housing I) Page 8 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: umber of patients who have experienced Delayed Transfer of Care (Provider level: Blackpool Teaching Hospital) Continued. Glossary for Delayed days Care Package in Home All patients whose assessment is complete but transfer is delayed due to awaiting a package of care in their own home. Community Equipment Adapt All patients whose assessment is complete but transfer is delayed due to awaiting the supply of items of community equipment. (ote that from 1 April 2015, the Care and Support (Charging and Assessment of resources) Regulations 2014 stipulate that all items of community equipment and minor adaptations must be provided free of charge.) Completion of Assessment All patients whose transfer is delayed due to them awaiting completion of an assessment of their future care needs and an identification of an appropriate care setting. This can include any assessment by health and/or social care professionals of a patient s future care needs. Therefore, delays can be due to either: HS, Local Authority or a combination HS bodies will want to identify with their Local Authority partners where in the process, and why, delays are occurring. Disputes This should be used only to record disputes between statutory agencies, either concerning responsibility for the patient s onward care, or concerning an aspect of the discharge decision, e.g. readiness for discharge or appropriateness of the care package. Further on Acute All patients whose assessment is complete but transfer is delayed due to awaiting further HS care, i.e. any non-acute (including community and mental health) care, including intermediate care. It also includes where a decision has been made to defer a decision on HS Continuing Healthcare eligibility, and to provide HS-funded care (in a care home, patient's own home or other settings) until an eligibility decision is made but the transfer into this care is delayed. Housing The Care Act emphasises the importance of local authorities and housing providers working together to provide suitable accommodation in order to meet people s needs for care and support. If there are delays in arranging the interim placement, the reason for delay should be recorded under that of the delayed interim package (e.g. residential care, care package in own home). ursing Home / Residential Home All patients whose assessment is complete but transfer is delayed due to awaiting ursing/residential home placement, because of lack of availability of a suitable place to meet their assessed care needs. Patient Family Choice All patients whose assessment is complete and who have been made a reasonable offer of services, but who have refused that offer. It would also include delays incurred by patients who will be funding their own care e.g. through insisting on placement in a home with no foreseeable vacancies. Public Funding All patients whose assessment is complete but transfer has been delayed due to awaiting Local Authority funding (e.g. for residential or home care), or HS funding (e.g. for HS-funded ursing Care or HS Continuing Healthcare). This should also include cases where the Local Authority and HS have failed to agree funding for a joint package or an individual is disputing a decision over fully funded HS Continuing Healthcare in the independent sector. It does not include delays due to arranging other HS services (residential or community) Page 9 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: Delayed Transfer of Care: ational and Regional Bed Occupancy Rate Overnight (Regional) ational and Regional Bed Occupancy Rate Overnight Q4 2016/17 (For wards open overnight an occupied bed day is defined as one which is occupied at midnight on the day in question.) Organisation Total General & Acute Available Occupied % Occupied Learning General & Learning General & Maternity Total Maternity Total Disabilities Acute Disabilities Acute Learning Disabilities England 131,060 131,666 1,190 7,782 116,598 94,773 821 4,537 89.0% 91.4% 69.0% 58.3% orth of England Commissioning Region 42,100 33,589 695 2,302 36,763 30,322 478 1,190 87.3% 90.3% 68.8% 51.7% Blackpool Teaching Hospital 799 760-39 702 678-24 87.8% 89.2% - 61.1% University Hospitals of Morecambe Bay 731 676-55 614 590-24 84.0% 87.3% - 43.2% Lancashire Teaching Hospitals 877 815-62 830 793-37 94.6% 97.2% - 59.5% East Lancashire Hospitals 975 896-79 882 841-41 90.4% 93.8% - 51.7% Maternity Page 10 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: Delayed Transfer of Care: Local and Regional Performance Continued. Patient snapshot measure has been removed from the April 2017 reporting The snapshot only recorded the position on one day every month and was considered unrepresentative of the true picture of DTOC Page 11 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: Delayed Transfer of Care: Local and Regional Performance and Exception Organisation BLACKPOOL TEACHIG HOSPITALS HS FOUDATIO TRUST LACASHIRE TEACHIG HOSPITALS HS FOUDATIO TRUST UIVERSITY HOSPITALS OF MORECAMBE BAY HS FOUDATIO TRUST EAST LACASHIRE HOSPITALS HS TRUST Region Overview as at March 17: Delayed bed days per occupied bed over 13 months Feb-17 Mar-17 Apr-17 Previous 12 month rolling Current 12 month rolling % of HS Responsible % of Social Care Responsible % of Both Responsible 5.1% 3.9% 3.1% 2.9% 4.5% 39.0% 43.3% 17.7% 6.6% 7.8% 9.1% 5.2% 6.8% 47.3% 52.3% 0.4% 6.9% 8.0% 6.3% 4.8% 6.1% 44.7% 54.7% 0.6% 4.9% 4.8% 4.8% 4.0% 4.8% 45.8% 54.2% 0.0% Lancashire Local Office has the highest percentage of bed day delays per occupied bed in the region with 5.5% for the current month. This is higher than regional value of 4.0% and is a decrease on last month by 0.1%. The HS was responsible for 45.4% of all bed day delays and Social Care being responsible for 50.3% with 78.6% being in an Acute setting. Healthier Lancashire and South Cumbria Hospital Flow & Discharge group is supporting CSU and other partners develop ibcf proposals to support patient discharge from hospital Provider Overview at March 2017 Blackpool Teaching Hospitals HS Foundation Trust has a delayed day per occupied bed percentage of 3.1% for the current month. This is lower than the national value of 4.8% and is a decrease on last month by 0.8%. The HS was responsible for 39.0% of all delayed days and Social Care being responsible for 43.3% with 63.0% being in an Acute setting. CCG Overview at Month 12 (March 2017) Discharge to Assess project is being scoped on a Lancashire wide basis; this will align with the Fylde Coast plans (part of the Urgent Care etwork). Following completion of The avoid longstay policy, discharge to assess will then be reviewed. Council leaders across localities have met to establish funding decisions and a standard timeline to implement this. Consultants (ewton Europe) have been secured by Lancashire County Council to help identify hotspots in Acute Trust which impact on DTOC. A further feedback meeting is planned in May 2017 to discuss the review. As part of the Better Care Fund / Improved Better Care Fund review, Lancashire wide benchmarking metrics are being developed to inform service provision and developments for 2017/18. From 30th June 2017, HS England is replacing this measure in some of the publication documents with a DTOC beds figure which will require acute care and CCGs reporting against agreed targets. Fylde and Wyre s trajectory target is 18 DTOC beds by the end of September 2017; 16 of these will be attributable to BTH patients and 2 to other providers. Funding of c 500k will be available via the Improved Better Care Fund (ibcf) and plans to invest were discussed at the Clinical Commissioning Committee meeting. Page 12 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: umber of patients who have experienced Delayed Transfer of Care (Provider level: Blackpool Teaching Hospital), period ending 30 th June 2017 (position at 27th. April 2017 and 29 th April 2016 presented as comparators) Cat Reason for Delay 29-Apr 16 27-Apr 17 22-Jun 23-Jun 26-Jun 27-Jun 28-Jun 29-Jun 30-Jun A Awaiting assessment by Health or Social Care Professional 13 12 6 7 9 10 9 9 8 B Awaiting funding for residential care/nursing home care/joint funding with Social Services & HS 2 C Awaiting further HS care (non-acute) including Intermediate Care 17 1 2 1 1 D Awaiting Residential/ursing Home placement/availability 3 1 2 2 7 7 7 6 7 E Awaiting domiciliary care package 10 16 12 9 12 6 4 6 8 F Awaiting community equipment 1 1 G Patient/family exercising choice with regard to residential/nursing home placement 10 18 9 8 5 6 9 8 7 H Disputes regarding readiness for discharge or appropriateness of care package I Housing - Patients not covered by HS and Community Care Act 1 1 Total 56 49 29 26 33 29 31 31 32 Page 13 of 14

Responsible Clinical Lead: Dr. Tom Marland Responsible Commissioning Lead: Sarah Camplin Indicator Definition: umber of patients who have experienced Delayed Transfer of Care (Provider level: BTH), period ending 30 June 2017 CCG live report narrative (period ending 30 th June 2017) Challenge: When the position is expected to improve? Improvement expected throughout 2017, with BTH having no more than 25 DTOCs on a daily basis by 30 th. September 2017 (nationally set DTOC trajectory for BTH) Challenge: Root causes of the problem? The increase in the number of LCC DTOCs in the run up to Easter was a result of LCC changing their domiciliary care provider this created a capacity issue, further impacted by LCC changing their operational structure and unclear escalation arrangements. There are number of elderly people in hospital with complex physical and behavioural needs that are proving difficult to accommodate after discharge. Challenge: Action being taken right now to improve the position? Escalation arrangements have been clarified and CCG expectations made clear with LCC encouraging a more proactive approach with partners. Transactional approach seems to be having an impact A&E Delivery Board is sighted on DTOC and supportive of a more proactive approach. Daily review of DTOC list with teleconferences and face to face meetings 3 times a week - challenging issues to be escalated within the Health Economy. All stakeholders actively engaged in resolving challenges on an on-going daily basis. Challenge: In the short-to-medium term? HSE DTOC trajectories have been requested these have been agreed at provider, CCG and Partner level. Avoiding Long Hospital Stays policy should go live 1st August 2017, depending on levels of STP-wide engagement and agreement. Improved Better Care Fund Allocations are expected to be agreed between CCGs and LCC by the end of July 2017. Review of intermediate care beds ongoing. Clinical model will facilitate step-down and step up. Meetings between representatives from key partner organisations have been arranged via the consultancy ewton Europe as part of an HSE-sponsored review of arrangements at BTH as they relate to LCC and, hence, Fylde and Wyre CCG. The purpose of these meetings is to improve the DTOC position in line with the roll-out of Passport to Independence arrangements. Review scheduled for July 2017 Page 14 of 14

Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 1 (April 2017) Key Indicator performing under target Data not applicable for this indicator Indicator performing over or on target o Target for this indicator to RAG rate against Data not available currently /A ITEM 12 MOTHLY REPORTED IDICATORS OLY Measure Responsible Committee Included in CCG Improvement & assessment framework Indicator Target YTD CCG Performance Latest Month Reporting Period Trend Provider Performance** BTH LTH YTD Latest month YTD Latest month Reporting Period 16/17 Quality Premium Measure? A&E Waiting Times Y % patients admitted, transferred or discharged within 4 hours of arrival at A&E 95.0% 88.83% 88.83% Apr-17 88.7% 88.7% 90.2% 90.2% Apr-17 Y Y % category A calls resulting in an emergency response to arrive within 8 minutes (Red 1) 75.0% 56.14% 56.14% Apr-17 - Y Category A Ambulance Response Times (CCG performance based on WAS performance however local response times are included in the exception report as these are below target). Y % category A calls resulting in an emergency response to arrive within 8 minutes (Red 2) 75.0% 48.45% 48.45% Apr-17 - HS Constitution Y % category A calls resulting in an ambulance arriving at the scene within 19 minutes. 95.0% 84.42% 84.42% Apr-17 - % admitted patients within 18 weeks. 90.0% 77.22% 77.22% Apr-17 75.5% 75.5% 77.9% 77.9% Apr-17 Referral to Treatment (RTT) times for non urgent consultant led treatment % non admitted patients within 18 weeks. 95.0% 92.46% 92.46% Apr-17 93.9% 93.9% 82.0% 82.0% Apr-17 Y % patients on incomplete pathway waiting less than 18 weeks. 92.0% 90.86% 90.86% Apr-17 91.9% 91.9% 84.0% 84.0% Apr-17 Y Diagnostic Waiting Times % patients waiting less than 6 weeks for diagnostic test. 99.0% 99.57% Apr-17 99.5% 100.0% Apr-17 % patients with maximum two week wait for first outpatient appointment when referred urgently with suspected cancer by a GP 93.0% 93.66% 93.66% Apr-17 93.5% 93.5% 94.4% 94.4% Apr-17 Cancer Two Week Waits % patients with maximum two week wait for first outpatient appointment when referred urgently with breast symptoms (cancer not initially suspected) by a GP 93.0% 100.00% 100.00% Apr-17 100.0% 100.0% 0.0% A Apr-17 Page 1 of 7

Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 1 (April 2017) Key Indicator performing under target Data not applicable for this indicator Indicator performing over or on target o Target for this indicator to RAG rate against Data not available currently /A ITEM 12 MOTHLY REPORTED IDICATORS OLY Measure Responsible Committee Included in CCG Improvement & assessment framework Indicator Target YTD CCG Performance Latest Month Reporting Period Trend Provider Performance** BTH LTH YTD Latest month YTD Latest month Reporting Period 16/17 Quality Premium Measure? % patients with maximum 31 day wait from diagnosis to first definitive treatment for all cancers 96.0% 98.67% 98.67% Apr-17 98.2% 98.2% 100.0% 100.0% Apr-17 % patients with maximum 31 day wait for subsequent treatment (surgery) 94.0% 94.74% 94.74% Apr-17 100.0% 100.0% 91.7% 91.7% Apr-17 Cancer 31 Day Waits % patients with maximum 31 day wait for subsequent treatment (anti-cancer drug regime) 98.0% 100.00% 100.00% Apr-17 100.0% 100.0% 100.0% 100.0% Apr-17 HS Constitution Y % patients with maximum 31 day wait for subsequent treatment (radiotherapy) % patients with a maximum 62 day wait from urgent GP referral to first definitive treatment for cancer. 94.0% 100.00% 100.00% Apr-17 100.0% 100.0% Apr-17 85.0% 88.57% 88.57% Apr-17 88.9% 88.9% 83.3% 83.3% Apr-17 Y Cancer 62 Day Waits % patients with a maximum 62 day wait from referral from an HS screening service to first definitive treatment for cancer. 90.0% 87.50% 87.50% Apr-17 87.5% 87.5% #DIV/0! A Apr-17 Maximum 62 day wait for first definitive treatment following a consultant's decision to upgrade the priority of a patient (all cancers). 85.0% 94.12% 94.12% Apr-17 85.7% 85.7% 100.0% 100.0% Apr-17 Mental Health: Care Programme Approach (CPA) Y? The proportion of people under adult mental health specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period. 95.0% 100.00% 100.00% Apr-17 - Referral to Treatment Waiting Times umber of over 52 week waiters (incomplete pathways) 0 0 0 Apr-17 0 0 0 0 Apr-17 Mixed Sex Accommodation QIGEC umber of Breaches 0 0 1 Apr-17 0 1 0 0 Apr-17 Page 2 of 7

Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 1 (April 2017) Key Indicator performing under target Data not applicable for this indicator Indicator performing over or on target o Target for this indicator to RAG rate against Data not available currently /A ITEM 12 MOTHLY REPORTED IDICATORS OLY Measure Responsible Committee Included in CCG Improvement & assessment framework Indicator Target YTD CCG Performance Latest Month Reporting Period Trend Provider Performance** BTH LTH YTD Latest month YTD Latest month Reporting Period 16/17 Quality Premium Measure? Dementia Y Estimated diagnosis rate for people with dementia 67.00% 75.4% Apr-17 - IAPT Y Access to services Q1 =3.75% (3.75%) Q2=3.75% (7.5%) Q3=3.75% (11.25%) Q4=3.75% (15%) 1.69% 1.69% Apr-17 - Y Proportion of people IAPT services and recovery rate 50.00% 59.00% 59.00% Apr-17 - Supplementary Indicator: Mental Health IAPT - Mental Health Access Waits IAPT - Mental Health Access Waits IAPT - Mental Health Access Waits The proportion of people that wait 18 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period The proportion of people that wait 18 weeks or less from referral to their first IAPT treatment appointment against the number of people who enter treatment in the reporting period The proportion of people that wait 6 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period 95.00% 95.30% 100.00% Feb-17-99.20% 97.83% Feb-17-76.00% 84.70% 92.86% Feb-17 - IAPT - Mental Health Access Waits The proportion of people that wait 6 weeks or less from referral to their first IAPT treatment appointment against the number of people who enter treatment in the reporting period 90.90% 95.65% Feb-17 - IAPT - Mental Health Access Waits umber of ended referrals in the reporting period that received a course of treatment against the number of ended referrals in the reporting period that received a single treatment appointment 126.70% 85.71% Feb-17 - Page 4 of 7

Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 1 (April 2017) Key Indicator performing under target Data not applicable for this indicator Indicator performing over or on target o Target for this indicator to RAG rate against Data not available currently /A ITEM 12 MOTHLY REPORTED IDICATORS OLY Measure Responsible Committee Included in CCG Improvement & assessment framework Indicator Target YTD CCG Performance Latest Month Reporting Period Trend Provider Performance** BTH LTH YTD Latest month YTD Latest month Reporting Period 16/17 Quality Premium Measure? Referrals F&P Total referrals for a first outpatient appointment (General and Acute). E.M.7 65328 /5428 4,830 4830 Apr-17 - Data Validation Ongoing F&P Total elective spells (total activity) E. M. 4 32464 / 3044 11897 2381 Jul-16 - F&P Total elective spells (Specific Acute) E. M. 10 32464 / 3044 28334 2446 Mar-17 - Elective F&P Total ordinary elective spells (Specific Acute) E. M. 10a 4058 / 381 3441 303 Mar-17 - Supplementary Indicator: Activity Measures on-elective F&P F&P Total day case elective spells (Specific Acute) E. M. 10b Total non-elective spells (total activity) E. M. 5 28406 / 2663 24893 2143 Mar-17 - Data Validation Ongoing 17417 / 1451 7756 1611 Jul-16 - F&P Total non-elective spells (specific acute) E.M. 11 15574 /1377 16492 1395 Mar-17 - F&P Consultant led first outpatient attendances (total activity) E.M. 2 53254 / 4438 1756 4459 Jul-16 - F&P Consultant led follow-up outpatient attendances (total acitivity) E. M. 3 Data Validation Ongoing 131133 / 10928 41970 10147 Jul-16 - Outpatient F&P Consultant led first outpatient attendances (Specific Acute) E.M. 8 50483 / 4735 16885 4282 Jul-16 - F&P Consultant led follow-up outpatient attendances (Specific Acute) E. M. 9 125314 /11757 123342 10893 Mar-17 - Page 5 of 7

Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 1 (April 2017) Key Indicator performing under target Data not applicable for this indicator Indicator performing over or on target o Target for this indicator to RAG rate against Data not available currently /A ITEM 12 MOTHLY REPORTED IDICATORS OLY Measure Responsible Committee Included in CCG Improvement & assessment framework Indicator Target YTD CCG Performance Latest Month Reporting Period Trend Provider Performance** BTH LTH YTD Latest month YTD Latest month Reporting Period 16/17 Quality Premium Measure? A&E F&P Total A&E Attendances E. M. 6 34219 / 2852 2,684 2684 Apr-17 2506 2506 178 178 Apr-17 F&P Endoscopy activity E.M.13 7954 / 649 605 605 Apr-17 533 533 27 27 Apr-17 Supplementary Indicator: Activity Measures Diagnostic Cancer F&P Diagnostic activity excluding endoscopy E. M. 14 51664 / 4077 4,160 4160 Apr-17 3,473 3473 338 338 Apr-17 F&P Cancer two week waits E. M. 16 5969 /486 489 489 Apr-17 449 449 36 36 Apr-17 F&P Cancer 62 day waits E. M. 17 549 / 36 35 35 Apr-17 27 27 6 6 Apr-17 RTT umber of completed admitted RTT pathways E. M. 18 umber of completed non-admitted RTT pathways E.M. 19 12,775 /1127 821 821 Apr-17 556 556 149 149 Apr-17 29,397 / 2350 1670 1670 Apr-17 1339 1339 206 206 Apr-17 2016/17 Quality Premium Indicators Increase in the proportion of GP referrals made by e-referrals Local indicator 3: % of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services Y Meet a level of 80% by March 2017 (March 2017 >80% at March 2017 performance only) and demonstrate a year on year OR March 2017 > March increase in the % of referrals made by e-referrals (or 2016 by 20% achieve 100% e-referrals) OR (March 2016 March 2017 performance to extend March 2016 performance 84.4%) performance by 20% % of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services (Lancashire Summary) 82% to align with current Better Care Fund Target 80.0% Mar-17 - Y 83.76% 2016/17 Q4 - Y Improvement & Assessment Framework 2016/17 Better Care Y Sustainability Y Patients waiting 18 weeks or less from referral to hospital treatment Outcomes in areas with identified scope for improvement: Access to IAPT services: People entering IAPT services as a % of those estimated to have anxiety/depression 92% 90.86% 90.86% Apr-17 91.9% 91.9% 84.0% 84.0% Apr-17 Y Q1 =3.75% (3.75%) Q2=3.75% (7.5%) Q3=3.75% (11.25%) Q4=3.75% (15%) 1.69% 1.69% Apr-17 - Y Page 6 of 7

Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 1 (April 2017) Scheduled Care Year to date - Activity Volume 16/17 17/18 Variance GP Referrals 3,127 2,505-622 -19.9% Other Referrals inc. Hospital 2,777 2,498-279 -10.0% Total Referrals 5,904 5,003-901 -15.3% GP Referrals year to date across all providers have decreasedby -19.9% (-622) Activity and Finance Increase in GP referrals for: Breast Surgery Vascular Surgery Gynae' For same YTD Point of Delivery Year to date - Activity Volume Year to date - Cost Plan Actual Variance Plan Actual Variance First Attendances 2,821 2,928 107 3.8% 465,563 481,507 15,944 3.4% Follow-up Attendances 7,023 7,312 289 4.1% 524,775 537,800 13,025 2.5% Outpatient Procedures 1,628 1,528-100 -6.1% 218,174 224,974 6,800 3.1% Point of Delivery Year to date - Activity Volume Year to date - Cost Plan Actual Variance Plan Actual Variance Elective Admissions 236 223-13 -5.5% 760,237 726,242-33,995-4.5% Daycase Admissions 1,708 1,767 59 3.5% 1,139,300 1,133,490-5,810-0.5% Excess Bed Days 45 10-35 -77.8% 10,550 2,337-8,213-77.8% Unscheduled Care Point of Delivery Year to date - Activity Volume Year to date - Cost Plan Actual Variance Plan Actual Variance Accident & Emergency 2,758 2,779 21 0.8% 376,242 335,352-40,890-10.9% on Elective Admissions 1,088 1,040-48 -4.4% 2,389,050 2,457,987 68,937 2.9% Excess Bed Days 446 404-42 -9.4% 102,836 93,421-9,415-9.2% Cost Variance over plan for: BTH 5,259,608 (5.3%) Year to date - Cost on-pbr Items Plan Actual Variance All on-pbr Lines 4,881,133 4,646,517-234,616-4.8% SPIRE 760,988 (24.5%) Overall Position Year to date - Cost Acute Contracts Total Plan Actual Variance All Points of Delivery 10,272,720 10,223,477-49,243-0.5% Page 7 of 7