Trust Board 26 th July 2018 Integrated Performance Dashboard: June 2018 R Purpose of the report This report provides the integrated performance dashboard for month three of the 2018/19 financial year. The Integrated Performance Dashboard is produced on a monthly basis to monitor key quality, patient safety and financial performance. The report provides assurance to the Committee of ongoing monitoring against key performance indicators (KPI), allowing the Committee to gain assurance regarding performance, and remedial actions. Analysis of the issue KPI demonstrate how effectively the organisation is performing within core business areas, against its corporate objectives and in relation to strategic plan. The Integrated Performance Dashboard adopts a balanced scorecard approach on one page, and is supported through a by exception commentary. Targets exist where regulatory, contractual or corporate objectives are identified, with respective Red, Amber, and Green (RAG) ratings incorporated to reflect YTD performance against these targets. A refresh of the Dashboard will commence shortly through Quality & Governance and Performance Committee including consideration of the latest updates to the NHSI Single Oversight Framework. Proposal Performance drivers include both contractual and regulatory measures. In certain cases, failure to meet these may result in financial penalties, and / or a contract performance notice (CPN). The Integrated Performance Dashboard covers: - Quality: through a number of views, contractual indicators with our main CCG Commissioners; Commissioning for Quality and Innovation (CQUIN); and local quality metrics. - Workforce: which provides a key link to quality, and incorporates KPIs reported monthly to NHS Improvement. - Finance, covering key reporting and regulatory areas. - Performance Operational: focuses on investment into services and wider transformation. - Performance Corporate Objectives: aligns progress on our Strategy, DIGBQ. Decision required The Trust Board is asked: - To confirm assurance regarding performance and remedial actions. 1
Governance Table For Board and Board Committees: Trust Board Paper sponsored by: Richard Wheeler Finance Director Paper authored by: Executive Team Date submitted: 23.07.18 State which Board Committee or other forum N/A within the Trust s governance structure, if any, have previously considered the report/this issue and the date of the relevant meeting(s): If considered elsewhere, state the level of N/A assurance gained by the Board Committee or other forum i.e. assured/ partially assured / not assured: State whether this is a one off report or, if not, N/A when an update report will be provided for the purposes of corporate Agenda planning DIGB Q strategic alignment*: Develop Innovate Grow Build Quality Organisational Risk Register considerations: List risk number and title of risk N/A False and misleading information (FOMI) None believed to apply. considerations: Equality considerations: None believed to apply. 2
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Metrics Target National Standard or Operational Plan RAG, Red Not achieving target or planned delivery Amber Target or planned delivery expected to be achieved next month Green On target or planned delivery Trend Sparkline, shows performance change over the period Quality Q1 Q2 Q3 Q4 Q5 Q6 NEWS Triggers, following further review, the audit sample and process between the two operational directorates is being further aligned, to support improvement. The Trust is additionally reviewing the recently published NEWS 2 with a view to implementing in future. Action plans are being reviewed through the Quality Forum, following challenge at the Operational Performance Review meeting. Q1 NEWS data shows that completion of NEWS has improved; there were 3 wards which required further action to ensure vital signs were taken as care planned. Since the beginning of 2018 the patient safety team has updated the Internal Assurance Meeting (IAM) process enabling wider discussion and consultation on incidents which has allowed the Trust to be more effective in the review and declaration of SI s. In previous years our rate of requesting downgrading has been relatively high; by ensuring more information is available and discussed with the operational teams the decision to declare has been more accurate. SI submission extensions can be requested for a number of valid reasons, such as annual leave, a witness leaving the Trust and the involvement of more than one Trust or agency. In April there were three extension requests, a further one in May and three in June. All of these were agreed with Commissioners, bar one in April 2018. This incident was originally reported by HMP Onley on: 18th June 2018 via Datix. The incident related to controlled drug documentation and did not reflect a patient safety incident. This incident will be reviewed at the Medicine Safety Group (24.07.18), who will determine any remedial actions. The number of complaint and PALs received in Q1 was consistent with the same quarter last year. Complaints and PALS are well publicised around the trust and members of staff promote our services effectively to services users, carers and relatives. This is also supported by our page on the external website and posts on social media (Facebook and Twitter). In addition to this the complaints and PALs team continue to work with services to ensure that complainants are treated fairly and that learning from concerns assists in improvements across all clinical areas. The Datix incident reporting system has been amended to incorporate a new method of categorising deaths based upon the circumstances. This helps inform the level of review required. The process involves a clinical decision being made of what type of death has occurred, based on the circumstances, and is broken into 6 categories. The categories have been created by Mazars during their work with Southern Health NHS Trust. Each reported death will be categorised, and will inform the Trust how many expected and unexpected 4
deaths occur and provide an increased focus on mortality surveillance. There may be occasions when deaths are not yet classified if there is not enough information to reach a decision. Q7 Q8 Please note that Suicides are now identified as Self Harm, Resulting in Death, following review by the Trust Mortality Lead and Patient Safety Team. The self-harm resulting in death increase may be due to an increased level of reporting compared to the previous financial year. This is due to the implementation of the National Quality Board Learning from Death guidance. The Trust has reinforced the need to report deaths onto Datix across the directorates. Prone Restraints: The integrated dashboard report, details restraint incidents (excluding prone) and prone restraint incidents separately. There are no national or local target in relation to the number of restraint incidents. As such; a comparison figure for the same period in the last financial year (FY17/18) has been included in the target column. Restraint data is currently refreshed weekly and prone restraint data is monitored through the Mental Health Act committee. Reports will now be refreshed daily, as this will make it easier for the wards to monitor their restraint figures via SMART reporting tool and check for questionnaires that need to be signed off as final version. The Head of Quality Surveillance will contact all wards to identify any further support required. The figures included in this report cover the period Apr-Jun FY18/19 and were extracted as of 13.07.18. Data analysis of restraints against patient acuity shows that number of patient numbers remained static whilst number of detained patients has increased. CQUIN Performance is assessed quarterly. The CQUIN outcomes (Q4 FY17/18) were received on the 7th June 2018 with the RAG rating reflecting overall outcome. The CCG confirmed Q4 achievement in June 2018. The CCG took into account the confidence ratio in the NCAP audit for CQUIN 3a which gave us payment, however; they only allocated partial achievement for CQUIN 5 due to low numbers of patients responding to the post transition survey. CQ1 CQUIN 1a (Improving Staff Health and Wellbeing): was dependant on achieving a 5% improvement (based upon 2015 results) in two of the three NHS annual staff survey questions on health and wellbeing, MSK and stress. The Trust showed a 5% improvement in the following area; organisation definitely takes positive action on health and well-being, but not in the other 2, this has subsequently been revised to 4.79% improvement based upon detailed data now published. CQ2 The project lead is working collaboratively across the pathways to develop practices and reduce variation. CQUIN 3a (Cardio metabolic assessment and treatment for patients with psychoses): The CQUIN result was generated from the NCAP audit for community and inpatient areas which significantly reduced the sample size. To be compliant with the CQUIN all aspects of the assessment must be documented and interventions documented if the intervention point reached. The audit demonstrated improvements in practice but further consistency is required and monitoring will take place through the CQUIN Board to Transformation Committee. 5
CQUIN 3b (Collaborating with primary care clinicians): The audit completed demonstrated some issues and variation with meeting the timescales set out in the CQUIN of sending communications within 48 hours for inpatients and within 2 weeks for community patients, monitoring will take place through the CQUIN Board to Transformation Committee. CQ3 CQ4: CQUIN 5 (Transitions out of Children and Young People s Mental Health Services (CYPMHS)): partial achievement due to low numbers of patients responding to the post transition survey. CQUIN 8 (Supporting Proactive and Safe Discharge Acute Providers): This is a joint CQUIN between NHFT, NGH and KGH, to increase by 2.5%, the number of acute unplanned admissions for those 65 and above, who are discharged to their place of usual residence before the eighth day of their stay. Initial Q2 milestone of mapping the existing system position and agreeing an improvement programme (system winter plan 2017/2018) was achieved and payment received. Workforce The second part of CQUIN was payable in two parts, one half each for a 2.5% improvement at NGH and one half for a 2.5% improvement at KGH. This was set as a two year CQUIN but NHS England national team advised at start of Q4 that it would be removed for the second year as the targets were not aligned to national and local system priorities. Locally we were directed by NHS England to focus on patients who were delayed transfers of care and who have become stranded i.e. already above seven day length of stay. We have been successful in Q4 in increasing the number of persons discharged to place of usual residence compared to 2016/2017, itself successful evidence of the focus requested by NHSE and the joint partner delivery of the Northamptonshire winter plan, and we further identified that when this over activity was removed then we had also improved the % of discharges to place of usual residence above the target 2.5%. W1 W2 W3 W4 Sickness absence continues to be challenging however it has reduced from last month s figure and is only 0.03% away from being green. Employee wellbeing continues to be a key focus for the organisation as we look to Grow our staff capability, to be the employer of choice and a great place to work, known for a diverse and inclusive culture where staff feel valued. To support this, a Leadership Matters event will take place at Wicksteed Park, over 400 staff attending (18.07.18). The focus of this event will be staff wellbeing and include keynote speakers, alongside activities for staff including: fitness classes, demonstrations, and mindfulness sessions with two keynote speakers. Turnover turnover has increased slightly from the previous month s position, and is just above target level. Staff Appraisals The staff appraisal rate is now showing performance above target level at 92.4%. Appraisals are now recorded through the Electronic Staff Record (ESR) system, with improved compliance demonstrating the positive impact of the new process. Mandatory Training Performance is above target. Trend demonstrates sustained improvement across previous months. All face to face classes and e-learning can be accessed 6
Finance online via the ESR system. On the basis of the significant improvement in appraisal, and supervision the approach adopted for these indicators is being used to improve the position on mandatory training. F1 F2 Cost Improvement Plan. Work continues to support implementation and delivery across all areas. Progress will be monitored on a monthly basis through the Transformation Committee. Capital Expenditure. The Capital Board met to consider plans for the year and initial priorities are have been finalised now the year end STF has been confirmed. The full scope of the capital plan is being considered through the Capital Board. Performance - Operational P1 P2 P3 P4 P5 IAPT, the Trust has met access monthly and in the rolling quarter. IAPT, Continued monthly increase in recovery reflecting stable growth towards targets. Further plans are in place to support a continued increase through groups, webinars and follow up sessions for those who have not yet achieved recovery prior to discharge. Supervisors have more informed data around which cases have reached recovery, whilst; group work and silver cloud are getting higher recovery rates, so as these increase, a higher and prolonged recovery rate is anticipated. Focus on 2018/19 will be reaching and sustaining recovery, with February figures looking much stronger at 48% for Nene and 51% for Corby in March we dipped to 46.63%. In April performance reached 52.16%. Contracting discussions are focussed on achieving 50% recovery within Q3 of 2018/19. Individual Packages of Care, Work to review and reduce the packages that were transferred is working well, with a reduction in these packages being demonstrated. New packages are subject to full review and determination of the clinical requirements and, where possible, alternative lower level of packages (including supported accommodation and community support) are agreed. The sub-contracts are still to be issued to the providers on the framework for locked and open rehab which puts us at some risk of delivering service. Delayed Transfers of Care. The system wide DTOC tracker continues to provide daily reporting and periodic escalation calls for the system with NHS England. The DTOC are much lower than in previous years, which has been achieved through internal and external changes. Plans are currently being developed to ascertain if there is a possibility to reduce any internal delays. MH Acute Outflows. Significant financial risk sits with the Trust in this area. The Trust COO has outlined work planned to Trust Board, Quality and Governance and Performance Committee. Daily bed meetings and weekly confirm and challenge with COO. To date, work has focussed on delayed discharge and peer review in place for 100 day stays. Detailed tracking of every bed and flow in the system is recorded akin to how acute Trusts manage their flow and this has been presented to exec board. Scrutiny and close management continues and there are now further plans to operate a Mental Health Red to Green model (project currently being scoped with LGSS). 7
P6 P7 Intermediate Care Team, enhanced service. The team continues to over perform on the original contracted numbers and subsequent additional activity through winter funding, which has contributed to the reduced DTOC performance. Agreement is expected to progress to fund the service at the extended level, through CCG and local MRET review. Diabetes Multi-disciplinary team, our contract included funding for Diabetes MDT for the first quarter of 2017/18. The CCG wrote to the Trust on 22 nd February to advise that the Diabetes MDT would return to the block contract from 1 st April 2018 on a recurrent basis, with a 6 months notice period. This is now included in the FY18/19 contract variation. Performance Corporate Objectives The Board previously agreed to receive the next progress update at the end of Q2, as a separate report so this has now been removed. Care Quality Commission Inspection Ratings We have extracted the latest reported information from the Model Hospital on CQC Inspections. 8