Operational Plan Scorecard NHS NHS Board 24 July Item 4.9 a Report by George McCaig, on behalf of Deborah Jones, Director of Strategic Commissioning, Planning and This report recommends that the Board review the performance recorded in the scorecard at Annex B identifying any areas requiring further information or exception reports 1.0 Background 1.1 The purpose of this report is to present the Operational Plan Scorecard for 2017/18. As previous agreed by the Board, this Scorecard reflects the new requirement for all Boards to submit an Operational Plan to the Scottish Government for /19 whilst a review of standards for all Boards is undertaken over this year. This replaces the precious LDP Scorecard. It also includes a number of indicators that have been discussed/requested in previous Boards/Committees. 2.0 Monitoring and Reporting 2.1 The Operational scorecard is at Annex A. A guide to interpretation is at Annex B. Updates are summarised below. 2.2 The full year performance data for the following 3 indicators will be issued by Information Services Division by the end of July and therefore not available at the time of writing. They will be provided in a future scorecard (or a verbal update will be provided should they be issued before the meeting of the Board) Detect Cancer Early (PI 1.1) Early Access to Antennal Services (PI 1.2) Smoking Cessation (PI 1.3) 2.3 Alcohol Brief Interventions (PI 1.4). has surpassed baseline, the Scottish average and the Government target with 4838 interventions equivalent to 131% for 2017/18. 2.4 Sickness Absence (PI 2.1). has slightly reduced (5.19%) over the year in comparison to baseline ((5.08%) and is consequently below Government target (4%), but better than the Scottish average of 5.39%. 2.5 Workforce Statistics (PI 2.2). The Whole Time Equivalent (WTE) number of staff in has reduced during 2017/18 to 8,103.5. The number of WTE staff has been decreasing since Quarter 3 2016/17 (WTE at December 2016 was 1
8,233.3). National comparisons need to be interpreted with care given the vastly different staffing numbers involved. Staff turnover for NHS for the period March 201 to March is -1.4% in comparison to a national figure of 0.3%. 2.6 Complaints (PI 2.3 and 2.4). The number of complaints received in 2017/18 (766) is higher than the number received in 2016/17. The percentage dealt within 20 days has reduced from a baseline of 46% to 36%. 2.7 All Cancer Treatments 31 days (PI 3.1). has reduced (93.25) over the year below the start of year baseline (97.8%) and consequently below Government target (95%), but similar to the Scottish average of 93.5%. 2.8 Suspicion of cancer referrals 62 days (PI 3.2). has reduced (81.4%) over the year below baseline (87.2%) and consequently below Government target (95%) and the Scottish average of 85%. 2.9 18 Weeks Referral to Treatment (PI 3.3). has improved (81.7%) over the year above baseline (78.2%), but below Government target (90%) and similar to the Scottish average of 81.2%. has oscillated between 74.7% and 82% throughout the year and hence the reason that the trend line shows reducing trend over the year However, more recently, performance in the period January to March has shown a consistent improvement. 2.10 New Outpatient Waiting Times (PI 3.4). has improved (80.7%) considerably over the baseline (63.3%). The Government target (95%) has not been met, but NHS performance exceeds the Scottish average (75.1%). 2.11 Treatment Time Guarantee (PI 3.5). has reduced (65%) over the year below baseline (81.1%) and consequently below Government target (100%) and the Scottish average of 75.9%. 2.12 Drug & Alcohol Treatment Waiting Times (PI 3.6). has improved (86.6%) in comparison baseline (79.6%). It is below Government target (90%) and the Scottish average of 93.5%. 2.13 CAHMS Waiting Times (PI 3.7). has improved (80.8%) considerably over the baseline (77.3%). The Government target (90%) has not been met. NHS performance exceeds the Scottish average (70.6%). However, data quality issues and a lack of consistency in recording of this data nationally means that the national figure should only be viewed as an approximate guide. 2.14 Psychological Therapies Waiting Times (PI 3.8). has reduced (78.7%) over the year below baseline (90.9%) and consequently below Government target (90%) and the Scottish average of 81.4%. However, data quality issues and a lack of consistency in recording of this data nationally means that the national figure should only be viewed as an approximate guide. It is also possible that the baseline figure of 90.9% was inflated due to data quality issues. 2
2.15 IVF Waiting Times (PI 3.9). No change from previous performance reports. is 100% and Government target achieved. 2.16 Accident & Emergency Waiting (PI 3.10). (96%) is just slightly below baseline (96.8%), but exceeds both the Government target (95%) and the Scottish average 90.5%. 2.17 SAB (PI 4.1). (0.24) is just slightly below baseline (0.30), but meets government target. 2.18 Clostridium Difficile Infections (PI 4.2). (0.32) is stable being the same as baseline and meeting Government target. 2.19 Clients Waiting for Care At Home (PI 4.3). has reduced over the year with the number of clients awaiting care at home increasing to 168 from a baseline of 137. No national comparators are currently available. 3.0 Ongoing Development of the Scorecard 3.1 For /19, two addition indicators with be added to the scorecard from Quarter 1: 6 weeks diagnostics required for the Operational Plan submitted to Government Returns waiting list requested by Board. 4. Governance Implications 4.1 Contribution to Board Objectives. The scorecard details performance as in line with the Board objectives in the /19 Operational Plan as agreed by the Board. 4.2 Financial. As agreed at the Board in March, financial performance is not included in this scorecard. 4.3 Staff Governance. A number of indicators under Outcome 2 (Efficiency) are pertinent for staff governance purposes. 4.4 Planning for Fairness. Accurate and timely performance information is key in assuring a planned approach to services and their provision. 4.5 Risk. Potential risk areas are highlighted in the scorecard using red arrows, with additional information given on trends and national comparisons where available. 4.6 Engagement and Communication. is reported to the Board, NHS North Health & Social Care Sub-Committee, The Council Adult Development and Scrutiny Sub-Committee (on demand only) and, 3
together with the Health & Wellbeing Scorecard, forms the basis for the Annual Statutory report provided for public scrutiny. 5. Recommendations 5.1 It is recommended that the Board review the performance recorded in the scorecard at Annex A identifying any areas requiring further information or exception reports. George McCaig Planning and Manager 28 June 4
NHS Operational Plan Scorecard KEY Ref. No. 1.1 improving Detect Cancer Early To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer. Outcome 1: Health Improvement declining is stable Target Local Baseline Benchmark 29% (Govt) 24.8% 25.5% Peer Group average is 23.7% against target Current performance Trendline Comment 24.8% Next reporting date from ISD for 17/18 is end July. Wherever possible Trendline represents performance over at least 1 year Annual Operational Plan Standard. Breast, colorectal and lung cancers were chosen as indicators by Scot Govt to be included as they are the most common in accounting for 45% of all cancers in 2011. This OP standard is used as a proxy indicator of survival outcome. Trend Period 2010/7. See 3.1/3.2 for peer group. 1.2 Early Access to Antenatal Services Pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation. Reports the Board deprivation quintile with the lowest antenatal booking rate ay 12 weeks. 80% (Govt) 90.9% 86% 91% Next reporting date from ISD for 17/18 is awaited. Quarterly OP Standard. There is evidence that those women at highest risk of poor pregnancy outcomes are less likely to access antenatal care early and/or have a poorer experience of that care. Trend period is 2011 to 2017. 1.3 Smoking Cessation Annual successful quits at 12 weeks post quit in the 40% most deprived board SIMD areas (the bottom two local SIMD quintiles). 430 quits (Govt - Board specific targets) 291 quits or a quit rate of 21% Scottish average quit rate is 21.4% 195 quits (3rd Qtr) Next reporting date from ISD for 17/18 is end July. Quit Rate Quit Rate Quits Quarterly OP Standard. Smoking remains a major influence on 's health. The prevalence gap between the most and least deprived is large, with the most deprived also suffering more smoking related ill health. Trend period is 2009 to 2017. 1.4 Alcohol Brief Interventions Annual brief interventions in the 3 priority areas of primary care, A&E and antenatal. 3,688 interventions equivalent to 80% of delivery in priority areas (Govt - Board specfic target) 4,674 interventions equivalent to 127% Scottish average for priority areas in 4838 interventions equivalent to 131% for 2017/18 is 90% 2017/18 Quarterly OP Standard. This standard helps tackle hazardous and harmful drinking, which contributes significantly to 's morbidity, mortality and social harm. The Govt expects high levels of ABI delivery to be maintained. Trend period is 2011 to. ANNEX B KEY Ref. No. 2.1 improving Financial Operate within agreed revenue resource and capital resource limits, and meet cash requirement. Cash Efficiencies Deliver a 7% efficiency saving to reinvest in frontline services Sickness Absence NHS Boards to achieve a sickness rate of 4% or less. declining Target Local Baseline Benchmark 4.0% or less (Govt) 5.08% Outcome 2: Efficiency is stable Wherever possible Trendline represents performance over at least 1 year against target Current performance Trendline Comment As previously agree by the Board - see Finance report As previously agree by the Board - see Finance report 5.39% for 2017/18 5.19% for 2017/18 OP Standard and Committee requested indicator. Sickness absence can result in cancelled appointments. It can also lead to increased pressure on staff and patients, increased costs of employing bank and agency staff, and reduced efficiency. Trend covers period 2011 to and is NHS data.
KEY improving Outcome 2: Efficiency (continued) declining is stable Wherever possible Trendline represents performance over at least 1 year Target Local Baseline Benchmark against target Current performance Trendline Comment 2.2 Workforce Statistics Target to be advised 8, 217.4 WTE @ 1 April 2017. No suitable national average Staff numbers have reduced in comparision to April 2017 baseline 8,103.5 WTE Non OP indicator. Trend period covers March 2016 to March. 2.3 Complaints Total number of complaints Target to be advised 613 (annual total) No suitable national average Numbers of complaints have increased. 766 (2017/18) National figures for 2017/18 are not yet available Non OP indicator. 2.4 Complaints Response Times (all complaints) Percentage dealt with within 20 days. 100% (Govt) 46.0% Scottish Average is 72% (2016/17). National figure for 2017/18 not yet available 36% National figures for 2017/18 are not yet available Non OP indicator. KEY Ref. No. 3.1 3.2 improving Cancer Waiting Times (31 days) For patients diagnosed with cancer, the maximum wait from first decision to treat will be 31 days. Suspicion of cancer referrals (62 days) For patients referred urgently with a suspicion of cancer, maximum wait from referral to treatment will be 62 days. declining Target Local Baseline Benchmark 95 % of all patients diagnosed with cancer (Govt) 95% of those referred urgently with a suspicion of cancer (Govt) 97.8% 87.2% Outcome 3: Access To Services is stable 93.5% Peer Group average is 90.6% at March 85%, Peer Group average is 81.6% at March Wherever possible Trendline represents performance over at least 1 year against target Current performance Trendline Comment 93.2% at March 81.4% at March NOSCAN NOSCAN Quarterly OP Standard. The time from when a suspicion of cancer is raised is a distressing and anxious time for both the patient and their family. Within NHS two standards are in place to support diagnostics and ensure treatments are delivered efficiently. The 31-day standard is from decision to treat to start of treatment for newly diagnosed primary cancers (whatever their route of referral). The 62-day standard from receipt of referral to start of treatment for newly diagnosed primary cancers. NOSCAN is NHS Grampian,, Orkney, Shetland, Tayside, Western Isles. Trend period covered is 2016/18. 3.3 18 Weeks Referral to Treatment Elective/planned patients to commence treatment within 18 weeks of referral. 90% of planned / elective patients (Govt) 78.2% 81.2% at March 81.7% at March - - - - - Quarterly OP Standard and Committee requested indicator. Shorter waits can lead to earlier diagnosis and better outcomes. It also reduces inequalities by addressing variations in waiting times between NHS Boards or individual hospitals. Trend period covered is Mar 17 to Mar 18.
KEY improving Outcome 3: Access To Services (continued) declining is stable Wherever possible Trendline represents performance over at least 1 year Target Local Baseline Benchmark against target Current performance Trendline Comment 3.4 New Outpatient Waiting Times Patients to wait no longer than 12 weeks for a first outpatient appointment. 3.5 Treatment Time Guarantee 3.6 Drug and Alcohol Treatment Waiting Times Clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. 95 % of patients. Boards to work towards 100% (Govt) 100% of patients to wait no longer than 12 weeks from the patient agreeing treatment (Govt). 90% of clients (Govt) 63.3% 81.1% 79.6% 75.1% at March 75.9% at March 93.5% at March 80.7% waited no longer than 12 weeks. 65% commenced inpatient/day case treatment within 12 weeks at March. 86.8% at March - - - - - - - - - - - - - - - Quarterly OP Standard and Committee requested indicator. Shorter waits can lead to earlier diagnosis and better outcomes. It also reduces inequalities by addressing variations in waiting times between NHS Boards or individual hospitals. Trend period covered is Mar 17 to Mar 18. Quarterly OP Standard and Committee requested indicator. A legislative requirement. It places a legal requirement on health boards that once planned inpatient and day case treatment has been agreed with the patient the patient must receive that treatment within 12 weeks. Trend period is Mar 16 to Mar 18. Quarterly OP Standard. To support sustained performance across all areas in, in both community and prison settings, we expect that 90% of individuals will be able to access appropriate treatment to support their recovery within 3 weeks of referral. Trend period is Mar 16 to Mar 18. 3.7 CAMHS Waiting Times Young people to commence treatment for specialist Child and Adolescent Mental Health services within 18 weeks of referral. 90% of young people (Govt) 77.3% 70.6% at March 80.8% commenced their treatment within 18 weeks at March Quarterly OP Standard. Timely access to is a key measure of quality. Early action is more likely to result in full recovery and in the case of children and young people will also minimise the impact on other aspects of their development such as their education.trend period is Jan 17 to Mar 18. Psychological Therapies Waiting Times Patients 3.8 to commence Psychological Therapy based treatment within 18 weeks of referral. 3.9 IVF Waiting Times Eligible patients to commence IVF treatment within 12 months of referral. Accident and Emergency Waiting Patients 3.10 to wait no longer than 4 hours from arrival to admission, discharge or transfer for A&E treatment. 90% of patients (Govt) 90% of all eligible patients (Govt) 95% of patients. Boards to work towards 98% (Govt) 90.9% 100.0% 96.8% 81.4% at March 78.7% of patients were seen within 18 weeks at March. 100% 100% 90.5% at March 96% waited less than 4 hours at March 100% compliance for all Scottish Boards - - - - - Quarterly OP standard. Timely access to healthcare is a key measure of quality and that applies equally in respect of access to mental health services. Data quality issues mean the the national trend should only be taken as an approximate guide. Trend period is Jan 17 to Mar 18. Quarterly OP Standard. Eligible patients should be able to access IVF treatment equitably. Longer waiting times for patients leads to poorer outcomes, as the effectiveness of IVF reduces with age.nhs commissions service for its residents from NHS Grampian and NHS Greater Glasgow and Clyde. Monthly OP Standard. This standard is seen as a milestone towards returning to the 98% standard. This is to ensure that all patients receive the appropriate treatment and support at the right time, in the right place by the right person. The National figure may be subject to change. Trend period is Mar 16 to Nov 17.
KEY Ref. No. improving Dementia Post Diagnostic Support People newly diagnosed with dementia will have a minimum of 1 years post-diagnostic support. declining Target Local Baseline Benchmark Outcome 4: Treatment is stable Wherever possible Trendline represents performance over at least 1 year against target Current performance Trendline Comment National data collection systems are under development. Nothing has been published by ISD since 2014/15. As previously agreed by the Board this indicator will not be included in performance reports until the national data collection system is in place. There is a indicator for clients/patients who have dementia receiving an early diagnosis in the Health & Wellbeing Scorecard (Indicator 5.2). 4.1 SAB (MRSA/MSSA) NHS Boards' rate of SAB (staphylococcus aureus bacteraemia (including MRSA)) cases are 0.24 or less per 1,000 acute occupied bed days. Clostridium Difficile Infections NHS Boards' rate of CDI (clostridium difficile infections) in patients 4.2 aged 15 and over is 0.32 cases or less per 1,000 total occupied bed days. 0.24 per 1,000 acute hospital bed days 0.32 cases or less per 1,000 ocupied bed days 0.30 0.32 0.33 (2016/17 average) 0.24 0.28 (2016/17 average) 0.32 Data for trendlines not currently available. Data for trendlines not currently available. Quarterly OP Standard. These OP standards provide professional and clinical guidance in reducing Healthcare Associated Infection (HAI) in hospitals and other settings ensuring safe and effective care 4.3 Clients Waiting for Care At Home Total numbers waiting for a care at home service. New indicator - target to be advised. measured against baseline. 137 National comparator currently not available. 168 at March Committee requested indicator. Trend period covers April 2017 to March. National trend not currently available. New indicator to this scorecard. Currently North figures only.
Operational Plan Scorecard Guide to Interpretation KEY TO SCORECARD Column Definition/guide Column Definition/guide Ref number Indicator unique reference number. declining against target against target at or above target and improving unchanging target Target currently looking to achieve If a national target Govt is shown in brackets. Current performance Latest quarterly performance figure available (unless specifically stated as 6 monthly or annual) Local baseline at the start of the financial year Trendline over the period stated in the Comments box. National performance is always the dotted line trendline. A trendline is not a graph line and therefore actual performance would show greater variability over time. Benchmark Scottish average or average peer group performance Comments Purpose of indicator plus any other useful information 1. EXAMPLE 1. Detect Cancer Early. The Govt target is not currently being met and performance has generally been decline over the period 2010 to date. National performance has improved over that period. However, NHS s performance is better than the average performance of its peer group. 2. EXAMPLE 2. Early access to Antenatal Services. NHS is exceeding Govt targets and the national average performance by an appreciable amount and has done so for a considerable period. Average national performance is now approaching NHS performance. KEY improving Detect Cancer Early To increase the proportion of people diagnosed and 1.1 treated in the first stage of breast, colorectal and lung cancer. Early Access to Antenatal Services Pregnant women in each SIMD quintile will have booked 1.2 for antenatal care by the 12th week of gestation. Reports the Board deprivation quintile with the lowest antenatal booking rate ay 12 weeks. Outcome 1: Health Improvement declining is stable Wherever possible Trendline represents performance over at least 1 year Target Local Baseline Benchmark against target Current performance Trendline Comment 29% (Govt) 24.8% 80% (Govt) 90.9% Scottish average is 25.5% Peer Group average is 23.7% Scottish average is 86% 24.8% Next reporting date for 16/17 end July. Figures are currently for NHS and not NHS North. 91% Figures are currently for NHS and not NHS North. Annual LDP Standard. Breast, colorectal and lung cancers were chosen as indicators by Scot Govt to be included as they are the most common in accounting for 45% of all cancers in 2011. This LDP standard is used as a proxy indicator of survival outcome. Trend Period 2010 to 2017. See 3.1/3.2 for peer Quarterly LDP Standard. There is evidence that those women at highest risk of poor pregnancy outcomes are less likely to access antenatal care early and/or have a poorer experience of that care. Trend period is 2011 to 2017. NHS Board 24 July OP Scorecard ANNEX B