Report to: Paper number:. Report for: Trust Board (Public) Information/Discussion Date: 7 September 8 Report authors: Report of: FoI status: Astley Scutcher, Acting Performance and Compliance Manager & Andy Rogers, Chief Operating Officer Andy Rogers, Chief Operating Officer Report can be made public Strategic priorities supported: Cultural pillars supported: Early and effective Intervention / Helping People to live well We value each other / We are empowered / We keep things simple / We are connected Title: Board Performance Report August 8 - Month 5, 8/9 Executive Summary. With the exception of the IAPT Recovery Standard for Camden, which has fallen below target, the Trust has hit all other NHSI Performance KPI s in M5.. M5 has been challenging in respect of ability to move patients into C&I beds as quickly as we would have liked and progress seen in previous months has not been maintained into M5. This has predominantly been due to demand pressures. There are though further process issues to address and this report covers recovery actions.. There is still one indicator where it has not been possible to provide data for M5, the data maturity index. Although important, this is a relatively low risk indicator and data will be provided in the M6 report. Recommendation to the Board The Board of Directors is requested to: RECEIVE, CONSIDER and ACCEPT this report.
Risk Implications Increase in patients waiting in local EDs in month creates flow issue for acute colleagues and brings additional regulatory oversight Finance Implications If you feel there are financial implications of the report please complete this section and then speak to finance to confirm the figures you are giving. Length of Stay, WPICU and recovery of overseas visitor income projects are main providers of CIP. There are also Divisional CIP projects of lesser values. Usage of non C&I beds is expensive by comparison to Trust beds and is largely at a cost pressure. Equality and Diversity Impact / Single Equalities Impact Assessment No specific Impact..
Target Area Source Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8. Background This report provides assurance to the Trust Board on Trust-wide performance matters for Month 5 (August 8. It is a style of report that follows the Guidance of the Single Oversight Framework (SOF) for Trusts (NHSI Sep 6). It is intended that this will be a standing item for every board.. NHS Improvement Single Oversight Framework Service Performance Indicator (Trust) Target Q Q Jul-8 Aug- 8 Care Programme Approach (CPA) service users receiving follow-up contact within seven days of discharge from hospital Admissions to inpatient services had access to crisis resolution home treatment teams People experiencing a first episode of psychosis treated with a NICE approved care package within two weeks of referral 95 99. 96.5 9.9 95 98. 97. 98.8 97. 5 7. 7.9. 6. MHSDS: Identifier metrics 95 99. 99. 99. 99. MHSDS: Priority metrics 85 89.7 9. 9. 89.9 Data Quality Maturity Index (DQMI) MHSDS dataset score 95 98.7. C&I has hit all NHSI oversight framework targets for M5 (August) where data is available and due in month, with the exception of the Camden IAPT access indicator.. It has not been possible to provide a MHSDS Data Quality Maturity Index score at the time of writing the report. Issues surrounding this are in the final stage of rectification and it is expected that this data will be available both for the month and retrospectively for completion of the M6 report.. As there was not an August Board, this is the first opportunity to formally report the under performance against target of the Early Intervention in Psychosis access target in M. This failure was due to issues within the referral management process. These have been identified and corrective action put in by management. The target was achieved in M5.. IAPT Performance IAPT Service Performance Indicator Waiting time to begin treatment within 6 weeks of referral 75 Camden Islington Kingston Local 87 87 87 85 8 8 8 85 85 85 88 NHSD 88 8 86 86 8 8 8 85 85 Local 85 88 89 9 85 87 88 89 9 87 9 NHSD 8 87 88 88 85 88 88 89 89 Local 9 9 95 95 9 9 9 9 95 9 9 NHSD 89 9 9 95 9 9 9 9 9
Waiting time to begin treatment within 8 weeks of referral 95 Camden Islington Kingston Local 98 NHSD 99 98 97 Local 99 99 98 98 99 96 99 98 98 98 97 99 98 98 97 97 97 99 99 NHSD 98 98 98 99 99 99 Local 98 97 99 99 99 98 NHSD 98 97 99 99 99 98 99 98 97 98 98 98 Proportion of people completing treatment who move to recovery 5 Camden Islington Kingston Local 5 5 7 5 56 6 9 7 NHSD 8 8 6 5 55 5 9 Local 6 7 8 5 7 57 5 5 6 5 5 NHSD 6 8 7 5 7 56 9 9 57 Local 6 5 57 5 56 5 57 56 5 59 NHSD 6 9 56 5 55 5 58 5 IAPT Recovery Rate (local) 65 6 55 5 5 5 Target 5 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Camden Islington Kingston Islington and Kingston IAPT services have continued to exceed recovery targets. Given the continued under performance to target of the Camden Service, additional narrative has been requested from and provided from the service as follows:
Camden IAPT Performance Factors influencing Performance and resulting actions are as follows:. The recovery rate of Psychological Wellbeing Practitioners (PWP) dropped from an average of 5 to.5 in August. Due to a high number of PWP s moving on to other training pathways, a data cleanse was completed prior to their departure. This resulted in an increase from around 8 discharges per month to around 6. It has effectively pulled forward the discharge of patients who did not want to or were unable to complete the programme and therefore not hitting the recovery standard and worsening performance in M5. Early indications for M6 to date are that this has improved somewhat from the M5 position.. Lower performance by partner agencies. Partners have tended to have a lower recovery rate in the Camden service. C&I is supporting improvement by additional support and training of clinical and admin staff on correct coding and data recording on IAPTUS. Delivering training to clinical staff to improve assessments to ensure that they are offering counselling to the appropriate people, leading discussions with commissioners and Nafsiyat about correctly coding a lot of the people they see as IAPT+ (this will be implemented from now was agreed with commissioners this month). These actions will take time to imbed but should start to show improvement through the remainder of the financial year.. Out of Cohort Patients. The Camden service in particular has seen a number of referrals for people who are too complex for an IAPT service but there has been nowhere for them to be assessed. We are being clearer in applying fidelity criteria to this cohort. It is also hoped that the development of the Practice Based Teams in Camden will improve this issue. 5
. Managing Patient Flow through our bed base In recent months we have been further developing our understanding and reporting to more accurately report on bed usage within the Trust as well as waiting times for admission and out of area placements.. National Target for reduction of Out of area placements The government has set a national ambition to eliminate inappropriate out of area placements in mental health services for adults in acute inpatient care by /. June ends the first quarter where reporting has been monitored. We have published the full trajectory to eliminate out of area placements by / and the first quarter performance. The indicator is next due for update upon availability of the September data (October Board report). Quarter ending Trajectory in bed days Actual Year (8/9) Jun-8, 89* Sep-8, Dec-8, Mar-9 89 Year (9/) Jun-9 78 Sep-9 67 Dec-9 56 Apr- 5 Year (/) Jun- 8 Sep- 5 Dec- Apr- *The 89 occupied bed days includes Rehab bed days for Controlled Access Rehabilitation. These are not beds which C&I provides and therefore technically outside of C&I trajectory. C&I is working with commissioners to develop a sustainable solution to this issue. They have been included in the Q data currently. 6
May-6 Jun-6 Jul-6 Aug-6 Sep-6 Oct-6 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 PICU Occuppied Bed Days PICU ward clients. Out of Area Placements M5 has been a challenging month in respect of out of area placements. The number of patients placed out of area has increased and spend has increased in month as reported in the finance report. This has predominantly been driven by increased demand, coupled with increasing percentage of patients who are being admitted under Section. The Trust has put in place a Gold Command structure to manage this heightened situation. This meets on a daily basis, reviewing capacity and demand.. PICU Out of Area Placements PICU - Number of OAP Clients Admitted and OBD 5 8 5 6 5 8 5 Male PICU Female PICU Male PICU OBD Female PICU OBD The above graph indicates the number of occupied bed days for OAP PICU clients. Following the opening of Ruby ward, demand for ECR beds by female PICU clients has almost entirely been met within the Trust s existing bed base, with the exception of where there has been a specific, usually clinical need that Ruby has been unable to accommodate. In line with the general pressure on beds, there has been an increase in external male PICU usage. This equated to just over an average of 5 beds occupied in M5. Patients are reviewed on a weekly basis by C&I staff and have felt to be clinically appropriate with minimal delays in stepping down to acute beds. 7
Number of Admissions Number of days. Bed Wait times The following charts indicate the average waits for patients once an admission has been agreed as the best treatment option..5 Monthly average wait for bed by patient location group ( most frequent).5.5.5 Home Police/Prison A&E/S.6 Suite 7 6 5 6 5 7 Patients waiting hours or more for a bed by patient location 6 7 7 9 7 5 9 7 7 9 7 8 8 7 5 7 6 7 8 6 Police/Prison Other Medical Ward Home A&E/ S6 Referral location and admission month 8
Admissions from S.6 Suites or A&E waiting hours or longer (C Chart) 5 5 5 UCL 5.8 9 7 7 8 6 CL. 9 7 LCL. Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Admission Count CL UCL LCL C&I is committed to admitting patients to a local bed at the earliest opportunity. Taken together, the above graphs show that whilst we have been able to maintain improvements in admission times for patients admitted from home and community settings, there has been an increase in number of patients that have experienced delays being admitted to a C&I bed from A&E settings, including Places of Safety (Section 6 Suites) compared to those having been achieved in recent months. The figures show only patients attributable to C&I and not patients of other MH Trusts using local ED s and S6 Suites. C&I has committed to targeted activity with each of our acute trusts. The Trust has been in regular contact with our acute colleagues in respect of these issues, including to Chief Executive and Chief Operating Officer level. The following activity is in the process of being undertaken with each of our trusts. Whittington Health Activity at Whittington Health is currently focussed on optimising the use of the Mental Health Lounge, which has been developed on the site. This has involved reviewing clinical and acceptance protocols, risk management and staffing. It is supported by a weekly Joint Chief Operating Officer chaired conference call. In the last weeks the average number of patients admitted to the suite, which had previously only hit 5 in a week increased as shown by the table below. Week commencing: Total ED referrals: Patients transferred to MH Suite: August 5 August 5 7 August 7 August 55 5 August 7 September 5 The medium term aim is to increase this number to approximately 5 of ED referrals. 9
Number of days UCLH A session on mental health activity in UCLH ED took place on 9 August, attended by C&I CEO, COO and Acute Divisional Director. This focussed on communication, process and data. Following this there has been joint work on communication and escalation protocols as well as a focus on intoxicated patients as well as those with an Acquired Brain Injury. A facilitated senior clinical session is being pulled together to look at other improvements that can be made with the pathway and communication. Royal Free Escalation processes were jointly reviewed by Royal Free and C&I earlier in the year. Since this point there have been no hour breaches. C&I us in continuous contact with RFH..5 Monthly average wait for bed by patient location group ( most frequent).5.5.5 Home Police/Prison A&E/S.6 Suite. Delayed Transfers of Care (DTOC) 8 6 Trust proportion of DTOC occupied bed days (OBD) 5..6..6.5..9.....8.6 Q Q Q Q Q Q Q Q *Q *Q *Q *Q *Q 5/6 6/7 7/8 7/8 Trustwide DTOC Target
Count of DTOC individuals Number of DTOC OBD 5 Trustwide Quarterly DTOC occupied bed days (OBD) & DTOC individuals 8 5 5 Q Q Q Q Q Q Q Q *Q *Q *Q *Q *Q 5/6 6/7 7/8 7/8 6 8 6 DTOC OBD Number of DTOC individuals in the period *Methodology was changed at beginning of this year to include rehabilitation wards The proportion of occupied bed days (OBD) lost to each division in August was: Division Bed Days(OBD) DTOC OBD DTOC Acute 6 7.6 Recovery & Rehabilitation Services for Ageing & Mental Health 7 9. DTOCS continue to be reported within a normal range. There have been specific improvements in year to the pathway in Camden, with a weekly meeting chaired by the Director of Adult Social Care with all DTOCS being reviewed. There has also during August been a focussed session on DTOCS led by Peter Cartlidge as part of the RedGreen Programme.