NHS Milton Keynes CCG Private Board. Jill Wilkinson, Director of Nursing & Quality

Subject: Meeting: CCG Board Performance Report NHS Milton Keynes CCG Private Board Date of Meeting: 23 rd September 2014 Report of: Jill Wilkinson, Director of Nursing & Quality Is this document: Commercially Sensitive For the Public or Private Agenda To be publically available via the CCG Website N Public Y Purpose: This report provides a comprehensive overview of CCG performance against Everyone Counts: Annex A -Outcomes Measures, Annex B -NHS Constitution, and Annex C -Activity Measures. Performance is reported by exception. Only indicators rated red or amber on the performance dashboards are included in the main body of the report. Details of key provider performance are enclosed within the report, together with mitigating actions to bring performance in line with the national performance and quality measures Key points to note: The key points to note focus on areas on underperformance. As a result CCG priorities in response to this report include: Improving patient experience in A&E and GP surgeries; Reducing C difficile infections within the community setting and within MKHFT; Improving 18 week performance for non-admitted pathways; Reducing 4 hour waits; Improving access to treatment for patients referred to Oxford on 18 weeks and cancer pathways; Improving direct access to the stroke unit within 4 hours. The Board is asked to note: Areas of underperformance and mitigating actions. Risks to achievement of the CCG quality premium

CCG Board Performance Report September 2014 Enc No 14/32

Table of Contents 1 Executive Summary... 3 2 Everyone Counts - Annex A: Outcomes Measures... 6 2.1 Annex A - Outcomes Measures Dashboard... 6 2.2 Patient experience of hospital care (E.A.5)... 7 2.3 Friends and Family Test (MKHFT)... 7 3 Patient experience of primary care (E.A.7)... 8 3.2 Healthcare acquired infection measure (MRSA) (E.A.S.4)... 8 3.3 Healthcare acquired infection measure (clostridium difficile) (E.A.S.5)... 9 4 Everyone Counts - Annex B: NHS Constitution Measures... 11 4.1 Annex B - NHS Constitution Dashboard... 11 4.2 18 weeks RTT admitted pathways <18 weeks (E.B.1)... 12 4.3 18 weeks RTT non-admitted pathways <18 weeks (E.B.2)... 12 4.4 Diagnostic test waiting times (E.B.4)... 13 4.5 A&E waits seen within 4 hours (E.B.5)... 13 4.6 Cancer 2 week waits -breast symptomatic referrals (E.B.7)... 15 4.7 Cancer 31 day waits -first definitive treatment (E.B.8)... 15 4.8 Cancer 31 day waits -subsequent treatment -surgery (E.B.9)... 15 4.9 Cancer 62 day waits -first definitive treatment -GP referral (E.B.12)... 16 4.10 Number of 52 week referral to treatment incomplete pathways (E.B.S.4)... 16 4.11 Ambulance handover delays (MKHFT) (E.B.S.7)... 16 5 Everyone Counts - Annex C: Activity Measures... 17 5.1 A&E attendances (E.C.7-8)... 17 6 Patient Safety, Quality & Experience... 18 6.1 Quality s Dashboard... 18 6.2 Friends and Family Test (MKHFT)... 18 6.3 All Pressure Ulcers... 19 6.4 Dementia assessments (MKHFT)... 19 6.5 Stroke patients -time in hospital on a stroke ward... 20 7 Quality Premium... 21 7.1 Patients admitted to a stroke ward <4hrs (MKHFT)... 22 Page 2 Final Version: 02/09/14

1 Executive Summary This report provides a comprehensive overview of CCG performance against Everyone Counts: Annex A - Outcomes Measures, Annex B -NHS Constitution, and Annex C -Activity Measures. The report will expand in future months to encompass a wider scope of Patient Safety, Quality and Experience targets and priorities for the CCG. Performance against the Quality Premium is shown separately. Performance is reported by exception so only indicators rated red or amber on the performance dashboards are included in the main body of the report. Annex A -NHS Outcomes Measures High performing areas include: Potential Years of Life Lost from causes considered amenable to health. Performance has improved 8.1% from the 2011 baseline position. This represents 643 fewer years of life lost. IAPT. Between April and July 4.35% of patients with depression and/or anxiety entered the service, this is above (better than) the 2.75% planned level. That said, the proportion of people who complete treatment and move to recovery (37.5%) remains consistently below (worse than) the 50% national expectation. Emergency admissions composite measure. The indirectly standardised rate of admissions for ambulatory care sensitive conditions fell by 1.3% from the 2011/12 baseline. MRSA. There have been no reported cases of MRSA in. Challenging areas include: Friends and Family Test. MKHFT inpatient response rates continue to perform above the 25% national CQUIN expectation. In contrast the A&E survey response rate was 2.4% between April and June. This is set against the 15% national CQUIN expectation in quarter 1. Actions: Assurance on improvements methods are sought through the Clinical Quality Review Meeting. The Trust continues to explore options to improve performance, and has agreed an improvement trajectory with the CCG. The CCG has issued the Trust with a Contract Query Notice. Patient experience of primary care. The CCG is ranked 203 rd of 211 based on satisfaction with GP services. The GP out-of-hours survey returns similarly poor results. 58.7% of respondents to the latest survey rated the service good. Actions: The CCG is working with the Area Team to review GP services data and link with the GP locality teams to implement the required improvements. The Friends and Family Test will be introduced into Primary Care later this year, which will allow thematic reviews to better understand causes of poor/positive experience. Performance is monitored through the Clinical Quality Review meeting. Clostridium difficile. The CCG is exceeding its target number of infections. Between April and July there were 16 infections against a plan of 24. Actions: The CCG is working with Milton Keynes Public Health to provide Infection Prevention and Control (IPC) training updates for GP s and practice nurses and develop public health messages for patients. An objective for is to strengthen the Route Cause Analysis process within Primary Care, thereby maximising the learning across the health economy and supporting the development of detailed trend analysis. Whole system measures continue to be discussed at the health economy wide Infection Prevention Control Committee, and performance is reported to the Quality Committee. Annex B -NHS Constitution Measures High performing areas include: 18 Weeks. Admitted Waits. MKHFT achieved the admitted waits target at speciality-level in July (with the exception of urology, which will be delivered from October). The reported 94.3% was the highest rate achieved since April 2013. Diagnostic waits. The 99% target was met at CCG level in July (99.4%) and is being delivered year to date (99.0%). Performance at Oxford University Hospitals NHS Trust for Milton Keynes patients improved in July (98.1%) but remains below target. MKHFT have achieved this indicator for the last 14 consecutive months. Year to date South Central Ambulance Service (SCAS) are meeting the Red 1 (78.8%) and Category A 19 minutes (95.8%) national ambulance standards (75%). However, the Red 2 target (75%) is not being delivered (74.1%). Local data for the first 21 weeks of the financial year shows that 85.6% of Milton Keynes Red 1 calls have been responded to within 8 minutes and 83.2% of Red 2 calls (75% target). Page 3 Final Version: 02/09/14

Mixed sex accommodation breaches. No MSA breaches have been reported in. Cancelled operations. In the first quarter all patients at MKHFT whose initial operation was cancelled were rescheduled within 28 days of their cancellation. Challenging areas include: 18 Weeks - Non Admitted Waits. 4 specialties performed below the 95% national expectation in July. Actions: Data review of all non-admitted pathways has been commissioned by the Trust. Once this process is complete a review of the relevant medical speciality clinical pathways will be undertaken. CCG representation at the weekly 18 week meeting ensures that risks to delivering improvements in pathways are mitigated at the earliest opportunity. A&E - As at the end of July 94.94% of Milton Keynes patients attending A&E were admitted, transferred or discharged within 4 hours of arrival. This compares to 95.26% in the same period. Year to date attendances have risen by 4.9% (2,064). Actions - MKCCG has submitted a contract Query Notice regarding the performance against the 4 hour standard. Whole system work will continue to improve discharge. This will be spearheaded by the Assertive In Reach Team provided by CNWL. The CCG has also just launched a communications/social marketing campaign aimed at re-directing patients to more appropriate providers of care than A&E. However, though MKCCG acknowledges the role to be played by the whole system in achieving this target, the trajectory played out over the last 2 years has shown a continued deterioration from this point in the year onwards. Accordingly, it is imperative that, in tandem with the whole system work, a clear Remedial Action Plan from MKHFT is in place detailing actions to be undertaken to address the performance and a trajectory for recovery of the standard. Cancer 2 week waits -breast symptomatic referrals. The 93% target was achieved in June (96.5%). Actions: The CCG Head of Quality now meets with the Head of Cancer Services at MKHFT each month to review performance against all of the cancer indicators. Lengthy cancer waits are reviewed at patient-level and reasons for the breaches ascertained. Cancer 31 day waits -first definitive treatment. For the last 6 consecutive month s performance has fallen below the 96% target (89.9% in June). This is largely attributable to delays at Oxford. Actions: Performance at Oxford University Hospitals will be challenged at the forthcoming contract meeting. Cancer 31 day waits -subsequent treatment -surgery. Patient choice resulted in this indicator not being met in June. Cancer 62 day waits -first definitive treatment -GP referral. The national standard (85%) was missed in June (78.4%) for the sixth consecutive month. MKHFT were accountable for 6 of the 8 breaches. The longest of these waits was 156 days. The reason given was Patient referred to Oxford after breach date for surgery. Actions: RCA s are submitted for individual 62 day waits and learning identified. Delays attributable to Oxford are raised through the contracting route. 52 week incomplete waits. As at the end of June 3 CCG registered patients had waited greater than 52 weeks for treatment. All 3 patients are awaiting treatment at Oxford. Actions: All patients on an incomplete pathway who have waited greater than 40 weeks for treatment are now routinely flagged each month. This information is shared with the CCG contracting team who are responsible for liaising with the provider to ensure that all patients have a TCI (to come in) date and will not breach the 52 week standard. Contractual levers are applied in full and an RCA requested for all 52 week waits. Annex C -Activity Measures Number of A&E attendances. Year to date (as at 13 th July) attendances have increased by 6.8% (2,139) compared to the same period. Type 1 attendances increased by 4.4% (797). Patient Safety, Quality & Experience High performing areas include: NHS Safety Thermometer -All pressure ulcers. Year-to-date CNWL (3.2%) and MKHFT (4.7%) are performing better than the national average (4.9%). VTE risk assessments. Year to date 96.8% of patients admitted to an MKHFT bed were risk assessed for VTE (95% target). Dementia assessments. Performance at MKHFT has shown significant improvement. The Trust achieved the 90% standard for the first time in June (90.2%). The Trust has committed to achieving 80% by Aug-14, rising to 85% in Sep-14 and 90% from Oct-14. Page 4 Final Version: 02/09/14

Stroke. Between April and July 79.7% of patients who suffered a stroke spent at least 90% of their time in MKHFT on a stroke ward (80% national standard). In the same period the proportion of high risk stroke TIA patients scanned and treated within 24 hours (83.0%) was also above the target level of performance (60%). Challenging areas include: Friends and Family Test. The MKHFT A&E response rate (2.3% in June) is significantly below the national average (20.8%). To achieve the national CQUIN the Trust should have surveyed at least 15% of all attendances in Quarter 1. Actions: Improvement actions are described above in the Annex A -NHS Outcomes Measures section. Quality Premium The CCG is currently forecast to achieve a Quality Premium payment of 586,040 for. This could rise to 911,618 upon delivery of the A&E 4 hour wait indicator, which is currently slightly below the 95% target level of performance. Action: Improvement actions are described in Annex B -NHS Constitution Measures. Local Priority indicator. Year to date 30.4% of patients presenting at MKHFT with a stroke have been admitted to the acute stroke unit within 4 hours of arrival. This is considerably below the planned 70% rate. Actions: Contract levers have been agreed with the Trust in the form of a CQUIN to support the admission of stroke patients to the stroke unit within 4 hours of arrival at A&E. Performance continues to be monitored monthly and quarterly reports are received at the Clinical Quality Review Meeting (CQRM). Performance was discussed at the CQRM in July where it was agreed that the action plan will be strengthened and re-submitted to the CCG. To support this process a quality review of the stroke pathway took place in August 2014 and recommendations will be fed into the reviewed action plan. The Trust has in place a plan to ring fence 2 stroke beds and to establish a process for Director approval for admission of stroke patients into ring-fenced beds. Page 5 Final Version: 02/09/14

Quality Premium Measure Enc No 14/32 2 Everyone Counts - Annex A: Outcomes Measures Within the five domains in the NHS Outcomes Framework, NHS England identified the measures best placed to provide assurance in planning and delivery, where CCG data exists and a baseline could be determined. Everyone Counts: Planning for Patients to 2018/19 translates these outcomes into specific measurable ambitions which NHS England believes are critical indicators of success and against which progress can be tracked. These are set out in the Annex A measures below. Supporting measures are denoted by E.A.S in the indicator reference number. 2.1 ANNEX A - OUTCOMES MEASURES DASHBOARD Description Target / Plan YTD Plan Latest Period YTD Trend Below 2,096.50 E.A.1 PYLL from Causes Considered Amenable to Health 1,926.90 (2012) (2011) baseline Above 0.75 (Jul11- E.A.2 Health-Related Quality of Life for People w ith LTCs 0.76 (Jul12-Mar13) Mar12) baseline Above 3.75% in 1.08% E.A.3 Improved Access to Psychological Services (IAPT) Roll-Out 4.35% Q4 Below 1,950.00 E.A.4 Emergency Admissions Composite Measure 1926.00 (2012/13) (2011/12) baseline Below 172.80 E.A.5 Patient Experience of Hospital Care (MKHFT) 129.90 () () 68 (Jun- E.A.6 Friends and Family Test -Score (MKHFT) 68 N/A 62 E.A.7.i Patient Experience of Primary Care -GP Services E.A.7.ii Patient Experience of Primary Care -GP Out of Hours E.A.8 Hospital Deaths Attributed to Problems in Care published Autumn 2015. 14) (Jul11-Mar12) Mar14) Above 83.1% Above 62.3% 78.4% (Jul13-58.7% (Jul13- (Jul11-Mar12) Mar14) in development. Should be E.A.9 Improving the Reporting of Medication-Related Safety Incidents E.A.S.1 Estimated Diagnosis Rate for People w ith Dementia Above 44.0% () 43.6% (2012/13) E.A.S.2 Improved Access to Psychological Services (IAPT) Recovery Rate Above 50.0% 40.20% () 37.54% E.A.S.3 Proportion of People (65+) Still at Home, 91 Days after Discharge from Hospital into Reablement/Rehabilitation Services E.A.S.4 Healthcare Acquired Infection Measure (MRSA) 0 0 0 (Jul- 14) 0 E.A.S.5 Healthcare Acquired Infection Measure (Clostridium Difficile) 63 16 2 (Jul- 14) 24 Trend Key: = Little or no change, = Improvement, = Deterioration Page 6 Final Version: 02/09/14

2.2 PATIENT EXPERIENCE OF HOSPITAL CARE (E.A.5) Definition: This indicator captures patient experience of hospital care, as reported by patients in responses to the Care Quality Commission Inpatient Survey. Average number of negative responses per 100 patients (selected questions, weighted, crude rate). 180 170 160 150 140 130 120 110 E.A.5: Patient Experience of Hospital Care CCG Plan England CCG Actual 2012/13 2015/16 2016/17 2017/18 2018/19 Comments: As part of the planning round all CCG s were required to set 5 year trajectories for improving patient experience of hospital care. Plans were set using baseline data provided by NHS England. This measure cannot be calculated locally. NHS England has since identified an error in the methodology used to calculate the baseline values for this measure, which has now been corrected. The CCG is now below (better than) its 2018/19 ambition, because of the changes to the baseline data. The CCG is therefore rated green on the Annex A dashboard despite MKHFT being in the top (worst) decile of providers based on poor hospital experience. It is expected that CCGs will be asked to revise their plans. Actions: The trust achieved an improved performance in the staff friends and family test in and has expanded the specialties in which patient experience data is captured. CQUINs and contract levers are in place. Performance against the phased expansion of friends and family test, and implementation of CQUIN s is monitored through the Clinical Review meeting. 2.3 FRIENDS AND FAMILY TEST (MKHFT) Definition: The friends and family test measures whether people receiving NHS treatment would recommend the place where they received care to their friends and family. The test was implemented in inpatient wards and A&E departments from April 2013, and extended to maternity services in October 2013. NHS England has yet to determine how CCG s will be rated against this indicator, however, it is expected that providers increase the number or proportion of positive recommendations to friends and family. The table below shows the combined A&E and inpatient FFT scores for MKHFT. Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD Planned Response Rate 15% 15% 15% 15% 15% 15% 15% 15% 15% 25% 25% 25% - Eligible patients 5,188 5,291 4,887 4,786 4,554 4,849 4,966 4,360 4,993 4,586 4,740 4,905 14,231 Total responses 494 399 322 401 324 307 397 387 430 584 415 513 1,512 Promoters 352 283 231 297 231 226 288 265 304 387 287 348 1,022 Passive 114 78 74 81 65 56 83 92 90 117 102 102 321 Detractors 21 23 6 11 21 18 15 16 26 73 19 25 117 Response rate % 9.5% 7.5% 6.6% 8.4% 7.1% 6.3% 8.0% 8.9% 8.6% 12.7% 8.8% 10.5% 10.6% FFT Score 68 68 72 74 66 69 71 67 66 54 66 68 62 National average -response % 16.1% 17.1% 18.6% 19.6% 20.9% 19.9% 22.2% 24.0% 24.0% 24.0% 24.5% 26.3% 25.0% National average -score 64 65 62 64 65 64 65 64 63 64 63 63 63 Comments: The Trust response rate rose to 10.5% in June with 513 of 4,905 patients attending the hospital asked for their opinion of the service. The FFT score improved to 68. Actions: Performance improvement actions are as outlined in section 6.2. Page 7 Final Version: 02/09/14

3 Patient experience of primary care (E.A.7) Definition: Percentage of patients who have a positive experience of i. GP services and ii. GP Out of Hours based on responses to the GP Patient Survey. 3.1.1 GP Services (E.A.7.i) This indicator is based on the percentage of people responding Good or Very Good to the following question: Overall, how would you describe your experience of your GP Surgery? Jul11-Mar12 Jan12-Sep12 Jul12-Mar13 Jan13-Sep13 Jul13-Mar14 Patients satisfied 3,881 3,661 3,533 3,358 3,254 Total responses 4,670 4,425 4,374 4,239 4,149 Satisfied % 83.1% 82.7% 80.8% 79.2% 78.4% National ranking* 194 189 195 201 203 National average 88.3% 87.6% 86.7% 86.2% 85.7% * National rank: there are 211 CCGs. 1=best and 211=w orst Comments: Based on the results of the latest GP Patient Survey, Milton Keynes CCG were ranked 203 rd out of 211 CCG s. Satisfaction scores have declined in the last 5 consecutive surveys. Almost 4 in 5 respondents rated their GP surgery good. This compares to 85.7% nationally and 84.4% within Hertfordshire and South Midlands Area Team. Actions: The CCG is working with the Area Team to review GP services data and link with the GP locality teams to implement the required improvements. The Friends and Family Test will be introduced into Primary Care later this year, which will allow thematic reviews to better understand causes of poor/positive experience. Performance is monitored through the Clinical Quality Review meeting. 3.1.2 GP Out of Hours Services (E.A.7.ii) This indicator is based on the percentage of people responding Good or Very Good to the following question: Overall, how would you describe your experience of out-of-hours GP services? Jul11-Mar12 Jan12-Sep12 Jul12-Mar13 Jan13-Sep13 Jul13-Mar14 Patients satisfied 0 321 300 325 Total responses 0 536 530 554 Satisfied % 62.3% 59.7% 56.7% 58.7% National ranking* 190 200 198 179 National average 70.3% 70.2% 67.5% 66.2% * National rank: there are 211 CCGs. 1=best and 211=w orst Comments: Patients report a low level of satisfaction with GP out-of-hours services. The CCG national rank reflects this dissatisfaction with Milton Keynes ranked 179 th. Actions: The urgent care centre has developed a detailed independent patient satisfaction survey which is reported to the contract and quality review meetings, and which demonstrates high levels of assurance concerning patient satisfaction levels. Performance against this survey is monitored closely and indicators have been aligned with the aim of improving performance against the national survey published July 2014. The CCG undertook a quality visit in June 2014 the results of which provided high levels of assurance concerning a number of quality indicators including patient experience. The Quality Team is participating in each phase of the common front door transformation project to ensure positive patient experience is maintained. 3.2 HEALTHCARE ACQUIRED INFECTION MEASURE (MRSA) (E.A.S.4) Definition: The number of cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia. 3.2.1 Milton Keynes CCG Planned Trajectory 0 0 0 0 0 0 0 0 0 0 0 0 0 New MRSA cases 0 0 0 0 0 0 0 1 0 0 0 0 0 Variance to plan 0 0 0 0 0 0 0-1 0 0 0 0 0 Page 8 Final Version: 02/09/14

Comments: In three MRSA bacteraemia cases were assigned to the CCG and investigated using the Post Infection Review (PIR) process. The outcome of all cases was unavoidable. Provisional data shows that there have been no reported cases in the first 5 months of. Actions: The CCG Quality team continue to work collaboratively with providers to reduce MRSA prevalence. Whole system measures are discussed at the health economy wide Infection Prevention Control Committee. The position will continue to be monitored and assurances on standards of care continue to be reviewed through the national Post Infection Review process. 3.2.2 Milton Keynes Hospital NHS Foundation Trust Planned Trajectory 0 0 0 0 0 0 0 0 0 0 0 0 0 New MRSA cases 0 0 0 0 1 0 0 1 0 0 0 0 0 Variance to plan 0 0 0 0-1 0 0-1 0 0 0 0 0 Comments: Three cases were assigned to MKHFT during. One case was a contaminant. Lessons have been learnt and shared within the Maternity department. The final two cases were found to be unavoidable with no lessons to be learnt identified. Actions: The quality team continue to meet monthly with the Trust to explore measures which improve care. Performance improvement actions are as outlined above. 3.3 HEALTHCARE ACQUIRED INFECTION MEASURE (CLOSTRIDIUM DIFFICILE) (E.A.S.5) Definition: Number of Clostridium difficile infections (CDIs) for patients aged 2 or more; defined as a case where the patient shows clinical symptoms of C. difficile infection and has a positive laboratory test results for CDI recognised as a case according to the Trusts diagnostic algorithm. Providers are only attributed cases where the sample was taken post 72 hours of admission. 3.3.1 Milton Keynes CCG NHS England in conjunction with the Health Protection Agency set a CCG target based on 2012/13 outturn. The CCG must not exceed 63 cases in. Planned Trajectory 3.7 3.7 3.7 3.7 3.7 3.7 3.7 3.7 3.0 3.0 4.0 6.0 16.0 New Cdiff cases 5 7 10 6 9 7 4 9 7 11 4 2 24 Variance to plan 1.3 3.3 6.3 2.3 5.3 3.3 0.3 5.3 4.0 8.0 0.0-4.0 8.0 Comments: Year to date there has been 24 reported infections against a threshold of 16. Provisional data shows that there were a further 5 cases in August, bringing the year to date total to 29 compared to a plan of 22. Actions: The CCG is working with Milton Keynes Public Health to provide Infection Prevention and Control (IPC) training updates for GP s and practice nurses and develop public health messages for patients. An objective for is to strengthen the Route Cause Analysis process within Primary Care, thereby maximising the learning across the health economy and supporting the development of detailed trend analysis. Whole system measures continue to be discussed at the health economy wide Infection Prevention Control Committee, and performance is reported to the Quality Committee. 3.3.2 Milton Keynes Hospital NHS Foundation Trust MKHFT must not exceed 19 cases of Clostridium difficile in. Providers were not required to submit plans and as a result the target is profiled linearly. Planned Trajectory 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.6 1.6 1.6 1.6 6.3 New Cdiff cases 1 2 4 3 10 3 3 4 3 5 2 0 10 Variance to plan -0.1 0.9 2.9 1.9 8.9 1.9 1.9 2.9 1.4 3.4 0.4-1.6 3.7 Comments: The Trust has reported 10 infections in. Provisional data shows that there were 3 cases in July brining the year to date total to 13 against a threshold of 7.9. Page 9 Final Version: 02/09/14

Actions: MKHFT continues to review of all cases. The results of the Trust commissioned external review of IPC processes has been considered by the hospital Trust Board and learning shared with the CCG. A CCG panel reviews all Clostridium difficile Route Cause Analysis (RCA) to determine provider avoidable/unavoidable status. Contractual levers designed to support a reduction in avoidable infections are in place for. Performance and improvements are monitored through the Clinical Quality Review meeting. Page 10 Final Version: 02/09/14

Quality Premium Measure Standard Lower Threshold Enc No 14/32 4 Everyone Counts - Annex B: NHS Constitution Measures 4.1 ANNEX B - NHS CONSTITUTION DASHBOARD The NHS Constitution sets out the universal rights and pledges for all NHS patients. The national requirements, in terms of operational standards expected from the NHS Constitution, are shown in Annex B within Everyone Counts: Planning for Patients to 2018/19. Supporting measures are denoted by E.B.S in the indicator reference number. Description Latest Period YTD Trend E.B.1 18 Week RTT Admitted Pathw ays <18 Weeks 90% 85% 93.6% E.B.2 18 Week RTT Non-Admitted Pathw ays <18 Weeks 95% 90% 97.5% E.B.3 18 Week RTT Incomplete Pathw ays <18 Weeks 92% 87% 94.9% E.B.4 Diagnostic Waits >6 Weeks 99% 94% 99.4% E.B.5 A&E Waits Seen Within 4 Hours 95% 90% 93.6% E.B.6 Cancer 2 Week Waits -Suspected Cancer Referrals 93% 88% 95.6% E.B.7 Cancer 2 Week Waits -Breast Symptomatic Referrals 93% 88% 96.5% E.B.8 Cancer 31 Day Waits -First Definitive Treatment 96% 91% 89.9% E.B.9 Cancer 31 Day Waits -Subsequent Treatment -Surgery 94% 89% 91.7% E.B.10 Cancer 31 Day Waits -Subsequent Treatment -Chemotherapy 98% 93% 100.0% E.B.11 Cancer 31 Day Waits -Subsequent Treatment -Radiotherapy 94% 89% 100.0% E.B.12 Cancer 62 Day Waits -First Definitive Treatment -GP Referral 85% 80% 78.4% E.B.13 Cancer 62 Day Waits -Treatment from Screening Referral 90% 85% 85.7% E.B.14 Cancer 62 Day Waits -Treatment from Consultant Upgrade N/A N/A (May- 14) E.B.15.i Ambulance Clinical Quality -Category A (Red 1) 8 Minute (SCAS) 75% 70% 76.9% E.B.15.ii Ambulance Clinical Quality -Category A (Red 2) 8 Minute (SCAS) 75% 70% 71.7% E.B.16 Ambulance Clinical Quality -Category A 19 Minute (SCAS) 95% 90% 95.3% E.B.S.1 Mixed Sex Accommodation (MSA) Breaches 0 10 0 (Jul- 14) E.B.S.2 Cancelled Operations -Not Seen <28 Days (MKHFT) 0% N/A 0.0% (Q1) E.B.S.3 Mental Health Measure -Care Programme Approach (CPA) 95% 90% 100.0% E.B.S.4 Number of 52 Week Referral to Treatment Incomplete Pathw ays 0 N/A E.B.S.5 Trolley Waits in A&E (MKHFT) 0 N/A E.B.S.6 Urgent Operations Cancelled for a Second Time (MKHFT) 0 N/A E.B.S.7 Ambulance Handover Delays (MKHFT)* 395 N/A *Nationally it is expected that there are zero handover delays. (Q1) 3 (Jul- 14) 0 (Jul- 14) 0 (Jul- 14) 149 (Jul- 14) 90.8% 97.7% 94.1% 99.0% 94.9% 94.7% 92.0% 93.6% 94.6% 100.0% 94.3% 80.8% 87.1% 100.0% 78.8% 74.1% 95.8% 0 0.0% 100.0% 17 0 0 500 Page 11 Final Version: 02/09/14

4.2 18 WEEKS RTT ADMITTED PATHWAYS <18 WEEKS (E.B.1) Definition: The percentage of admitted (adjusted) pathways within 18 weeks should equal or exceed 90%. The following table shows the percentage of Milton Keynes patients admitted at MKHFT and completing their pathway within 18 weeks, with an indication of average monthly activity numbers. Category Avg activity General Surgery 131 100% 99.0% 99.4% 97.2% 100% 97.4% 99.0% 95.1% 95.5% 90.7% 89.8% 96.8% 93.3% Urology 74 95.2% 98.0% 85.7% 84.1% 77.9% 87.3% 58.2% 80.3% 82.1% 71.6% 73.6% 80.3% 76.6% Orthopaedics 146 75.4% 80.3% 86.7% 78.2% 74.0% 83.1% 72.4% 82.5% 80.9% 84.4% 85.0% 93.1% 85.9% ENT 71 93.8% 93.9% 96.8% 91.8% 94.4% 93.2% 91.5% 93.3% 92.8% 91.3% 92.9% 93.9% 92.8% Ophthalmology 83 95.5% 96.0% 98.6% 98.8% 94.9% 99.2% 97.9% 98.1% 97.6% 97.2% 98.5% 98.7% 97.9% General Medicine 6 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Gastroenterology 4 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Cardiology 4 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Thoracic Medicine 1 100% 100% 100% 100% 100% 100% Rheumatology 15 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Gynaecology 75 94.0% 97.2% 92.3% 100% 97.3% 98.8% 96.4% 94.7% 94.2% 92.8% 100% 98.8% 96.8% Other 49 88.6% 87.5% 72.5% 69.6% 88.6% 83.9% 67.3% 87.0% 73.5% 52.0% 73.8% 93.3% 72.5% All Specialties 658 92.0% 92.3% 92.3% 89.4% 88.9% 92.0% 83.9% 90.9% 89.4% 85.9% 88.3% 94.3% 89.5% Comments: MKHFT achieved the admitted waits target for Milton Keynes CCG patients in July. The reported 94.3% was the highest rate attained since the CCG came into being. Actions: In May 2014, the CCG issued MKHFT with a Contract Query Notice in response to consistent 18 week wait breaches at specialty-level throughout. Under the terms of the notice MKHFT were required to demonstrate how the Trust plans to recover specialty-level and aggregate level performance in the first quarter of and sustain this going forward. The Trust submitted recovery milestones which committed to delivering the 18 weeks target at speciality-level from July 2014, with the exception of urology, which will be delivered by October 2014. This milestone has been achieved. 4.3 18 WEEKS RTT NON-ADMITTED PATHWAYS <18 WEEKS (E.B.2) Definition: The percentage of non-admitted pathways within 18 weeks should equal or exceed 95%. The following table shows the percentage of non-admitted Milton Keynes patients at MKHFT completing their pathway within 18 weeks, with an indication of average monthly activity numbers. Category Avg activity General Surgery 325 100% 100% 98.7% 98.8% 98.3% 98.4% 98.6% 99.7% 99.4% 99.3% 98.7% 99.6% 99.2% Urology 95 97.3% 97.2% 96.0% 99.2% 100% 99.0% 98.4% 97.8% 96.0% 100% 97.5% 98.1% 97.9% Orthopaedics 123 96.8% 95.4% 98.1% 97.1% 97.9% 95.5% 100% 96.2% 94.8% 91.4% 96.7% 95.3% 94.5% ENT 160 100% 96.5% 98.8% 100% 98.9% 99.0% 97.9% 96.8% 97.6% 100% 94.9% 97.4% 97.4% Ophthalmology 203 98.7% 99.5% 99.1% 99.7% 99.5% 99.6% 100% 99.2% 98.0% 100% 100% 98.0% 99.1% General Medicine 128 100% 100% 99.5% 94.0% 96.8% 99.1% 98.6% 96.5% 95.8% 100% 96.7% 99.1% 98.0% Gastroenterology 60 100% 100% 100% 95.8% 96.4% 100% 100% 97.7% 95.3% 100% 92.7% 93.1% 96.2% Cardiology 73 96.0% 93.5% 97.3% 97.6% 94.0% 93.2% 97.1% 95.9% 90.0% 91.8% 93.0% 90.6% 91.5% Dermatology 269 99.5% 98.5% 97.7% 98.5% 97.1% 96.5% 96.0% 98.8% 96.8% 96.9% 98.3% 95.6% 97.1% Thoracic Medicine 82 81.6% 87.8% 93.4% 87.8% 92.2% 88.4% 98.0% 85.9% 91.0% 93.3% 90.5% 75.5% 89.2% Neurology 95 100% 97.4% 97.2% 100% 97.7% 97.0% 93.2% 99.2% 99.0% 98.5% 100% 99.0% 99.1% Rheumatology 82 100% 98.9% 98.3% 95.7% 98.9% 98.8% 100% 100% 95.3% 96.3% 100% 94.9% 96.5% Geriatric Medicine 0 100% Gynaecology 135 99.2% 100% 99.4% 96.9% 99.2% 94.8% 98.1% 99.2% 100% 100% 99.1% 97.5% 99.3% Other 372 100% 100% 99.8% 100% 100% 99.8% 100% 100% 100% 100% 99.7% 100% 99.9% All Specialties 2,205 98.8% 98.4% 98.5% 98.0% 98.2% 97.7% 98.3% 98.3% 97.5% 98.3% 98.0% 97.2% 97.8% Comments: The non-admitted target was achieved at Trust-level for Milton Keynes patients in July, however, 4 specialties failed to achieve the 95% target. Actions: Data review of all non-admitted pathways has been commissioned by the Trust. Once this process is complete a review of the relevant medical speciality clinical pathways will be undertaken. Page 12 Final Version: 02/09/14

4.4 DIAGNOSTIC TEST WAITING TIMES (E.B.4) Definition: The percentage of patients waiting 6 weeks or more for a diagnostic test (15 key diagnostic tests). The table below shows the proportion of CCG registered patients waiting 6 weeks or less for a diagnostic test, with an indication of average monthly waiters. Provider Avg w aiters 01 - MKHFT 2,752 99.7% 99.3% 99.8% 99.7% 99.5% 99.8% 99.6% 99.7% 99.8% 99.3% 99.2% 99.4% 99.4% 02 - Oxford Uni 227 94.3% 94.2% 97.6% 97.0% 91.7% 87.8% 94.8% 94.1% 92.6% 92.2% 88.9% 98.1% 93.0% 03 - Northants 105 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 04 - CNWL 42 100% 100% 100% 100% 100% 100% 100% 100% 100% 97.9% 100% 100% 99.4% 05 - Inhealth 89 100% 94.4% 100% 100% 100% 100% 92.3% 92.7% 100% 100% 99.3% 97.8% 06 - Bedford 12 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 07 - UCL 9 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 08 - Luton 12 80.0% 100% 100% 92.9% 97.8% 94.1% 100% 75.0% 100% 100% 100% 100% 100% 09 - Horton TC 5 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 10 - Royal Free 5 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 11 - Guys 4 100% 100% 100% 100% 100% 50.0% 100% 100% 100% 100% 100% 90.0% 94.7% 12 - Royal National 3 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 13 - Cambridge 4 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 14 - Great Ormond 2 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 15 - Barts 2 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 16 - Coventry 2 100% 100% 100% 100% 100% 100% 100% 100% 100% 17 - Imperial 3 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 18 - Papw orth 2 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 19 - North Staff 2 100% 100% 100% 100% 100% 100% ZZZ - Other 18 100% 100% 100% 100% 100% 95.0% 100% 95.7% 94.7% 100% 100% 100% 99.0% All Providers 3,299 99.4% 98.9% 99.5% 99.6% 99.0% 98.9% 99.3% 99.2% 99.2% 98.9% 98.7% 99.4% 99.0% Comments: The 99% national threshold was missed at CCG level in July. For the 14 th consecutive month MKHFT achieved the 99% expectation for Milton Keynes CCG patients. Performance at Oxford University Hospitals NHS Trust remains challenging, however, the 98.1% reported in July is the highest rate recorded. The Trust was responsible for 4 Milton Keynes patients breaching the 6 week target in July compared to 20 in June. Actions: The CCG contracting team attend the Oxford contract meeting and at this forum is holding the provider to account for the underperformance. Much of the activity sent to Oxford is specialist and as a result inherently more complex and subject to delays. That said, the provider has introduced a number of measures to improve performance including additional anaesthetic MRI clinics on Saturdays to clear the current backlog. The Trust has been asked to provide a trajectory to reduce the waiting times for echocardiography s, which is an issue affecting all commissioners. 4.5 A&E WAITS SEEN WITHIN 4 HOURS (E.B.5) Definition: The percentage of patients who spent 4 hours or less in A&E. 95% of A&E attendances for all A&E types (including Minor Injury Units and Walk-in Centres) should be discharged, admitted or transferred within 4 hours of arrival with a lower threshold of 90%. 4.5.1 Milton Keynes CCG CCG performance is calculated based on a DH mapping table which was used to convert provider based SitRep data into CCG based information. CCG's are attributed a proportion of A&E attendances and breaches at providers where they make up greater than 1% of total activity. The CCG is attributed 79.6% of MKHFT, and 1% of Northampton General. Operational Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% Low er Threshold 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Attendances <4hrs 9,919 7,758 9,961 7,673 8,103 9,535 7,858 8,234 8,511 10,427 8,875 10,391 38,204 Attendances 10,271 8,265 10,482 8,238 8,633 10,193 8,714 9,030 8,921 10,940 9,278 11,102 40,241 Attendances <4hrs % 96.6% 93.9% 95.0% 93.1% 93.9% 93.5% 90.2% 91.2% 95.4% 95.3% 95.7% 93.6% 94.94% National average 96.3% 95.8% 95.7% 95.9% 95.3% 95.1% 94.6% 95.7% 95.2% 94.8% 95.1% 95.1% Page 13 Final Version: 02/09/14

Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Enc No 14/32 E.B.5: A&E Waiting Time - Total Time in the A&E Department (Milton Keynes) 100% 98% 96% 94% 92% 90% 88% 86% CCG Target Comments: In the first 4 months of the financial year, 94.94% of Milton Keynes patients were admitted, transferred or discharged within 4 hours of arrival. Provisional data covering the period up to 25 th August shows that year to date performance has fallen further to 94.79%. Actions: MKCCG has submitted a contract Query Notice regarding the performance against the 4 hour standard. Whole system work will continue to improve discharge. This will be spearheaded by the Assertive In Reach Team provided by CNWL. The CCG has also just launched a communications/social marketing campaign aimed at re-directing patients to more appropriate providers of care than A&E. However, though MKCCG acknowledges the role to be played by the whole system in achieving this target, the trajectory played out over the last 2 years has shown a continued deterioration from this point in the year onwards. Accordingly, it is imperative that, in tandem with the whole system work, a clear Remedial Action Plan from MKHFT is in place detailing actions to be undertaken to address the performance and a trajectory for recovery of the standard. 4.5.2 Milton Keynes Hospital NHS Foundation Trust A&E performance at MKHFT (all commissioners) is shown separately. This includes urgent care centre activity, as reported to SitRep. Operational Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% Low er Threshold 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Attendances <4hrs 12,342 9,653 12,393 9,546 10,091 11,875 9,789 10,242 10,596 12,967 11,047 12,923 47,533 Attendances 12,772 10,279 13,035 10,250 10,748 12,684 10,843 11,234 11,102 13,605 11,544 13,807 50,058 Attendances <4hrs % 96.6% 93.9% 95.1% 93.1% 93.9% 93.6% 90.3% 91.2% 95.4% 95.3% 95.7% 93.6% 94.96% National average 96.3% 95.8% 95.7% 95.9% 95.3% 95.1% 94.6% 95.7% 95.2% 94.8% 95.1% 95.1% E.B.5: A&E Waiting Time - Total Time in the A&E Department (MKHFT) 100% 98% 96% 94% 92% 90% 88% 86% Provider Target Comments: Year to date 94.96% of patients presenting at MKHFT were admitted, transferred or discharged within 4 hours of arrival. Actions: Implementation of the urgent care centre co-location project (linked to the common front door project) will enable diversion of minors away from A&E and support improved performance. Page 14 Final Version: 02/09/14

4.6 CANCER 2 WEEK WAITS -BREAST SYMPTOMATIC REFERRALS (E.B.7) Definition: Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer was not initially suspected. Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD Operational Standard 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% Low er Threshold 88% 88% 88% 88% 88% 88% 88% 88% 88% 88% 88% 88% 88% First seen in the period 99 74 63 84 76 80 89 96 94 112 77 86 275 First seen <14 days 95 69 61 83 76 77 85 84 89 97 73 83 253 First seen <14 days % 96.0% 93.2% 96.8% 98.8% 100% 96.3% 95.5% 87.5% 94.7% 86.6% 94.8% 96.5% 92.0% National Average 94.7% 93.7% 94.8% 96.2% 94.9% 95.6% 94.2% 94.5% 93.3% 89.5% 90.0% 91.7% 90.4% Comments: The 93% national standard was achieved in June. 3 patients urgently referred for evaluation/investigation of breast symptoms by their GP waited greater than 2 weeks to be seen. MKHFT were responsible for all 3 breaches. The explanation given for 2 of these was other reason. The final delay was attributed to a patient cancellation. Delays ranged from 15 to 28 days. Actions: The CCG Head of Quality now meets with the Head of Cancer Services at MKHFT each month to review performance against all of the cancer indicators. Lengthy cancer waits are reviewed at patient-level and reasons for the breaches ascertained. A demand and capacity review of breast services took place in April in order to address underperformance. 4.7 CANCER 31 DAY WAITS -FIRST DEFINITIVE TREATMENT (E.B.8) Definition: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis (measured from date of decision to treat ). Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD Operational Standard 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% Low er Threshold 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% Total patients treated 83 61 95 68 50 70 81 40 61 98 66 69 233 Patients treated <31 days 77 56 92 66 43 68 76 38 58 94 62 62 218 Treated <31 days % 92.8% 91.8% 96.8% 97.1% 86.0% 97.1% 93.8% 95.0% 95.1% 95.9% 93.9% 89.9% 93.6% National Average 98.2% 98.4% 98.3% 98.2% 98.0% 98.2% 97.6% 98.0% 97.3% 98.0% 97.5% 97.5% 97.7% Comments: Performance fell below the 96% national expectation for the sixth consecutive month. MKHFT were fully responsible for 3 of the 7 breaches, Oxford was accountable for 2 delays, and a further 2 were shared between the 2 Trusts. The longest wait for first definitive treatment was 104 days. Oxford were unable to offer an earlier brachytherapy date. Actions: Performance at Oxford University Hospitals will be challenged at the forthcoming contract meeting. 4.8 CANCER 31 DAY WAITS -SUBSEQUENT TREATMENT -SURGERY (E.B.9) Definition: The proportion of patients receiving subsequent surgery within 31 days, including patients with recurrent cancer. Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD Operational Standard 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% Low er Threshold 89% 89% 89% 89% 89% 89% 89% 89% 89% 89% 89% 89% 89% Total patients treated 12 7 9 17 26 12 10 6 8 15 10 12 37 Patients treated <31 days 12 7 9 16 25 11 9 6 8 14 10 11 35 Treated <31 days % 100% 100% 100% 94.1% 96.2% 91.7% 90.0% 100% 100% 93.3% 100% 91.7% 94.6% National Average 97.8% 97.8% 97.1% 97.4% 96.8% 96.7% 96.3% 96.8% 97.0% 97.0% 95.6% 97.7% 96.8% Comments: Year to date performance is above the 94% national standard. The June breach resulted from patient choice. Page 15 Final Version: 02/09/14

07/04/13 21/04/13 05/05/13 19/05/13 02/06/13 16/06/13 30/06/13 14/07/13 28/07/13 11/08/13 25/08/13 08/09/13 22/09/13 06/10/13 20/10/13 03/11/13 17/11/13 01/12/13 15/12/13 29/12/13 12/01/14 26/01/14 09/02/14 23/02/14 09/03/14 23/03/14 06/04/14 20/04/14 04/05/14 18/05/14 01/06/14 15/06/14 29/06/14 13/07/14 27/07/14 10/08/14 Enc No 14/32 4.9 CANCER 62 DAY WAITS -FIRST DEFINITIVE TREATMENT -GP REFERRAL (E.B.12) Definition: Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer. Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD Operational Standard 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% Low er Threshold 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% Total patients treated 48 31 51 35 20 38 42 19 35 51 32 37 120 Patients treated <62 days 38 28 42 31 17 33 36 12 27 42 26 29 97 % first seen under 62 days 79.2% 90.3% 82.4% 88.6% 85.0% 86.8% 85.7% 63.2% 77.1% 82.4% 81.3% 78.4% 80.8% National Average 86.8% 87.4% 85.6% 84.7% 84.9% 86.6% 83.1% 83.5% 85.4% 85.7% 83.0% 82.4% 83.7% Comments: The national standard (85%) was missed in June for the fifth consecutive month. MKHFT were fully accountable for 6 of the 8 breaches, sharing responsibility with Oxford University Hospitals for the remaining 2 excess waits. 4 of the breaches spanned 100 days. The longest of these waits was 156 days. The reason given was Patient referred to Oxford after breach date for surgery. 4.10 NUMBER OF 52 WEEK REFERRAL TO TREATMENT INCOMPLETE PATHWAYS (E.B.S.4) Definition: The number of Referral to Treatment (RTT) incomplete pathways greater than 52 weeks. Operational Standard 0 0 0 0 0 0 0 0 0 0 0 0 0 Low er Threshold 10 10 10 Incomplete >52w ks 3 0 1 3 2 3 1 3 4 6 4 3 17 Comments: NHS England has advised that CCG s will be rated based on the number of incomplete pathways reported each March. All 3 reported breaches in July relate to patients awaiting treatment at Oxford. Actions: All patients on an incomplete pathway who have waited greater than 40 weeks for treatment are now routinely flagged each month. This information is shared with the CCG contracting team who are responsible for liaising with the provider to ensure that all patients have a TCI (to come in) date and will not breach the 52 week standard. Contractual levers are applied in full and an RCA requested for all 52 week waits. 4.11 AMBULANCE HANDOVER DELAYS (MKHFT) (E.B.S.7) Definition: The number of handover delays (within the A&E department) of longer than 30 minutes and of those the number over one hour. Operational Standard 0 0 0 0 0 0 0 0 177 104 60 54 395 Pre-handover delays 30-60mins 48 100 107 105 104 86 128 129 103 108 77 114 402 Pre-handover delays >60mins 8 31 26 42 31 17 21 41 22 27 14 35 98 Total pre-handover delays 56 131 133 147 135 103 149 170 125 135 91 149 500 60 50 40 30 20 10 0 30-60mins >60mins Ambulance Handover Delays: MKHFT Comments: Since April there has been 500 pre-handover delays lasting in excess of 30 minutes at MKHFT. Hospitals are subject to a 200 penalty for each 30 to 60 minutes delay and 1,000 for those lasting over 60 minutes. To date the cost of these delays in totals 178,400. Page 16 Final Version: 02/09/14

08/04/12 22/04/12 06/05/12 20/05/12 03/06/12 17/06/12 01/07/12 15/07/12 29/07/12 12/08/12 26/08/12 09/09/12 23/09/12 07/10/12 21/10/12 04/11/12 18/11/12 02/12/12 16/12/12 30/12/12 13/01/13 27/01/13 10/02/13 24/02/13 10/03/13 24/03/13 07/04/13 21/04/13 05/05/13 19/05/13 02/06/13 16/06/13 30/06/13 14/07/13 28/07/13 11/08/13 25/08/13 08/09/13 22/09/13 06/10/13 20/10/13 03/11/13 17/11/13 01/12/13 15/12/13 29/12/13 12/01/14 26/01/14 09/02/14 23/02/14 09/03/14 23/03/14 06/04/14 20/04/14 04/05/14 18/05/14 01/06/14 15/06/14 29/06/14 13/07/14 27/07/14 10/08/14 Quality Premium Measure Lower Threshold Enc No 14/32 5 Everyone Counts - Annex C: Activity Measures The activity measures against which CCGs will be monitored are contained in Annex C of Everyone Counts: Planning for Patients to 2018/19. Description YTD Target E.C.1 Elective Ordinary Admission First Consultant Episodes* 1,729 N/A E.C.2 Daycase First Consultant Episodes* 8,213 N/A E.C.3 Elective Finished First Consultant Episodes* 9,942 N/A E.C.4 Non-Elective Finished First Consultant Episodes* 9,899 N/A E.C.5 All First Outpatient Attendances* 18,536 N/A E.C.6 All Subsequent Outpatient Attendances* 26,435 N/A E.C.7 Number of Attendances at Type 1 A&E Departments 24,147 N/A E.C.8 Number of Attendances at All A&E Departments 42,225 N/A E.C.9 GP Written Referrals* 12,544 N/A E.C.10 Other Referrals for First Outpatient Appointment* 8,655 N/A E.C.11 Total Referrals* 21,199 N/A E.C.12 First Outpatient Attendances Follow ing GP Referral* 10,487 N/A *Activity data relates to General and Acute specialties and w ill therefore be inconsistent w ith other activity based reports. Latest Period -2.5% +5.1% +3.8% -17.1% +27.9% -0.5% (Q1) W/E 17/08/14 W/E 17/08/14 +33.0% +9.0% +23.0% +37.4% YTD Trend -5.7% (1,631) -0.6% (8,165) -1.5% (9,796) -10.6% (8,848) +13.3% (21,005) -0.5% (26,301) +2.9% (24,836) +4.9% (44,289) +22.6% (15,376) +4.3% (9,028) +15.1% (24,404) +22.4% (12,833) 5.1 A&E ATTENDANCES (E.C.7-8) Definition: The definitive data source for this indicator is the weekly provider-based SitRep collection. CCG performance has been derived using the Department of Health mapping methodology which assigns providers to commissioners, based on historical SUS outturn. This is the same methodology used to calculate CCG 4-hour wait performance. 2,600 2,400 2,200 2,000 1,800 1,600 1,400 Ytd Atts: +4.9% E.C.7-8: A&E Attendances Milton Keynes CCG CCG Attendances Comments: Year to date the number of people attending A&E has increased by 4.9% (2,064) compared to the same period. Attendances at A&E (Type 1) grew by 2.9% (689) whilst the number of patients presenting at the urgent care centre increased by 7.6% (1,375). Page 17 Final Version: 02/09/14