Jill Shattock Director of Commissioning

Appendix 4.3 MEETING: Haringey Clinical Commissioning Group Shadow Governing Body Meeting DATE: Thursday 14 March 2013 TITLE: Performance Report - Month 10 LEAD DIRECTOR/MANAGER: Jill Shattock Director of Commissioning AUTHOR: Jill Shattock CONTACT DETAILS: jill.shattock@nclondon.nhs.uk SUMMARY: This report provides a summary update to the Governing Body on a range of Key Performance Indicators (KPIs), as at the end of January 2013 and detail concerning Trust specific issues that have arisen for local Trusts; - A&E waiting times at North Middlesex University NHS Trust - A serious incident was declared by Whittington Health -An unexpected rise in diagnostic waits at University College London Hospitals Foundation Trust. - Deterioration of cancer waits at Whittington Health. This time the non acute section focuses on Mental Health service indicators and the Public health section shares some good news on recent Teenage pregnancy figures. National performance measures cover a wide range of quality and performance standards as set out in the Operating Framework for the NHS in England 2012/13. The CCG will continue to develop performance reporting across the transition period to ensure an accurate reflection of CCG performance is presented across all areas. Monthly Integrated Performance review meetings continue between Haringey CCG and NHS North Central London. It is expected that these meetings will be lead by the Local Area Team of the NHS Commissioning Board in due course. SUPPORTING PAPERS: Appendix 1 Slide pack showing KPI summary, acute provider specific targets, Mental Health, Community Services and Public Health KPIs. The RAG rating status denotes the achievement as at that data collection period. Performance is risk rated using a traffic-light system of green for performance that is on track; amber for performance falling below agreed threshold and red where

there are serious concerns about attainment. This RAG-rating is consistent with the NHS London Performance Framework and follows national thresholds for achievement. It should be noted that some areas are also reported via the Quality Report ( item 6.2 on the agenda) RECOMMENDED ACTION: The Governing Body is asked to: NOTE the contents of this report and COMMENT on the ongoing development of performance reporting Objective(s) / Plans supported by this paper: This report is for information only. Audit Trail: This report is for information only. Patient & Public Involvement (PPI): This report is for information only. Equality Impact Assessment: This report is for information only. Risks: This report is for information only. Resource Implications: This report is for information only. Next Steps: The ongoing development of future performance reporting for the Governing Body to ensure an accurate and informative view is provided across all areas. Abbreviations: The following abbreviations for the acute trusts are used in the tables throughout this section: BCFH Barnet & Chase Farm Hospitals RFH Royal Free Hampstead GOSH Great Ormond Street Hospital RNOH Royal National Orthopaedic Hospital MEH - Moorfields Eye Hospital UCLH University College London Hospitals NMUH North Middlesex University Hospital Whit Whittington Health

1. Summary This report provides a summary update to the Governing Body on a range of Key Performance Indicators (KPIs). National performance measures cover a wide range of quality and performance standards as set out in the Operating Framework for the NHS in England 2012/13 and can be grouped as below: Acute Performance - Four hour maximum waiting standard in A&E - Diagnostic waits for over 6weeks - 18 week Referral to Treatment (RTT) performance - Infection control - VTE assessment (shown on the acute provider specific sheet) - Cancer waiting times - Mixed sex accommodation - Maternity Access at 12 weeks Non Acute Performance - Health visitor numbers - Mental health - Long term conditions - Choose and Book usage - Patient satisfaction Public Health - Health checks - Childhood obesity recording - Immunisation - Smoking quitters and prevalence - Maternity Access at 12 weeks - Under 18 conception rate per 1,000 females 15-17yrs rolling average quarterly average. Some indicators appear in more than one grouping as applicable to multiple organisations and the data collection period also varies depending on the indicator. The RAG rating status denotes the current achievement and the direction of change indicates performance against previous reporting periods. 2. Areas to Note 2.1 Acute Performance Generally, across Haringey as a whole, performance continues at an acceptable level, however four significant issues have arisen from our local Trusts, A&E waiting times at NMUH continued to deteriorate, a serious incident was declared by Whittington Health, an unexpected rise in diagnostic waits at UCLH and the deterioration of cancer waits at Whittington health details of both are outlined below. 2.1.1. North Middlesex University Hospital (NMUH) NHS Trust A&E waiting times performance

NMUH reported that they missed the 95% standard for A&E waiting times for 4 consecutive weeks in January 2013. As per escalation procedures a meeting was convened on 12 th February 2013 with NMUH to discuss A&E performance and the Trust s Recovery Plan. At the meeting, the Trust provided assurance that significant changes have been made to systems and processes over the past few weeks and that they are working to ensure sustainable improvement. The Trust has adopted a range of measures as part of their action plan to improve A&E performance, and has benefitted from the additional Winter Pressures funds, including: Weekly Emergency Care Standards Board, chaired by CEO. Including a look back exercise for all breaches, to enable robust scrutiny and review. The board will also commit resources to eradicate identified blockages and enable flow, if required. In January 2013, the Trust implemented a 7-day Acute Care Unit Hospital at Home scheme, with a focus on more out of hours working In January 2013, the Trust opened an Emergency Admissions Unit for patients who do not require admission but require a level of care which is over and above that of A&E. The unit is operating well and medical cover is provided by the A&E multi-professional team Intensive Care Unit bed expansion (7 to 10 beds), which went live on 21/01/13 An extra resuscitation bed has been placed in A&E The Trust has increased the availability of patient transport with a 2-person team available from morning time, 7 days a week to aid timely discharge of patients An additional paediatric registrar and senior nurse are available between 17:00-22:00 each evening The most recent data available shows that the Trust has met the standard for A&E waiting times for three consecutive weeks (up to week ending 17/02/13); the Trust has also provided assurance that they expect to meet the overall Q4 2012/13 target (see table 1). 13-Jan 20-Jan 27-Jan 03-Feb 10-Feb 17-Feb Q3 Q4TD NMU H 92.58% 92.90% 94.23% 95.35% 96.02% 95.57% 95.13% 94.43% Table 1: A&E Recent Performance 2.1.2 Whittington Health Diagnostics Serious Incident On 24 th January 2013, Whittington Health declared a Serious Incident (SI) following the discovery of unexpected breaches of the six week diagnostic target in endoscopy. Further scrutiny revealed that there are a large number of patients waiting beyond acceptable timescales for an endoscopy, dating back to July 2012. Upon investigation there were 785 patients on the waiting list for an endoscopy, which includes those who have been referred for suspected cancer via the two week

wait route, routine referrals and patients who have been referred for endoscopy tests as part of their outpatient care. It is not thought that patients referred directly via the National Screening Programme are affected but confirmation on this is awaited from the Trust. Clearing the backlog has been calculated on worst case scenario (i.e. it has been assumed that all patients on the waiting list require an endoscopy in March) and it is expected that 95% of patients on the waiting list will be booked for Endoscopy by 1 st March. This will ensure that all patients who attend for their endoscopy appointment will be seen by the end of March 2013. The investigation into the endoscopy SI is continuing and it is required to be completed and a report submitted to NHS London in March. In parallel Whittington Health has put in place a range of measures as part of their action plan, including; A Trust wide review of 18 week systems and processes has been commissioned from an independent auditor An interim service manager for endoscopy has been recruited and is in post Additional clinical capacity has been freed up for the 3 types of procedures under endoscopy A full clinical review will be held for patients whose tests have been delayed and are subsequently diagnosed with cancer and/or where harm has occurred as a result of the delay The main access policy and associated SOPs for the Trust are currently being reviewed (covering all departments) Patients have been notified of the delay to their diagnostic test and offered the opportunity to speak to a clinical nurse specialist or consultant if they are concerned or worried The Trust has also spoken to NHS London, National Commissioning Board (NCB) and NHS Trust Development Authority (NTDA). The Joint Advisory Group (JAG) for Endoscopy will also be informed of the SI. The Trust has provided assurance that clearing the backlog of patients on the waiting list will not impact on the time for new referrals to be seen as additional clinics and lists are being set up to address the backlog. Weekly trajectories are being monitored via the CSU team to ensure the recovery remains as planned. 2.1.3 Diagnostic Wait Increase at UCLH January data shows a deteriorating position at UCLH for 6 week diagnostic waits, with 6.0% of patients having waited over 6 weeks. The Trust has confirmed that the performance issue relates to endoscopy and a weekly recovery trajectory has been agreed to recover the position. The 6 week waiting time target is not a clinically driven requirement, but is deemed to be an enabling target to support the achievement of the overall 18 week pathway. The Trust has confirmed that the backlog issue arose in November of 2012, so there is no implication that any potential risk to patients waiting in excess of 6 weeks is a long standing problem and all patients within the backlog were classified as routine, with urgent cases continuing to be seen in line with the 2 week wait target. The trust has agreed to provide progress reports to NCL with weekly retrospective and prospective activity against this plan. On 21 st February the trust provided an

update on patients seen against its weekly recovery trajectory which is included above. This shows that the trust is slightly ahead of its weekly trajectory but expects it to be closer to planned levels on the template next week due to half term break. To rectify the backlog position all patients are now being offered dates in order of wait. In addition the consultants who are fully aware of the situation are reviewing all the individual cases to identify whether any should now be expedited. To date there have been no untoward findings for any of the patients being managed to the corrected system following initial treatment by the clinicians. 2.1.4 Cancer Two Week Wait Performance at Whittington Health Whittington Health has struggled with the achievement of the two week wait targets throughout the year and has failed to achieve part of the target set in 7 out 9 months in 2012/13 up to Dec 2013. As a subset of this the 62 day pathway target has failed in 3 out of 9 months. The issues are linked and could partly be attributed to some internal staffing reorganisation and the subsequent capacity of the Cancer Services Manager. There are also issues around capacity in endoscopy, breast symptomatic clinics, accommodation of patient choice and grading of referrals for suspected skin cancers. The issues have been escalated to the Contract Management Group and a contract query has been issued. A special Deep Dive meeting is going to take place as a matter of urgency and the Trust have invited the National Intensive Support Team to do two, 2-day diagnostic visits, one for RTT and another for Cancer Access. Outcomes of the deep dive and areas of note will be reported to the CCG in due course. 2.2 Non Acute Performance Mental Health BEH MHT Update IAPT- The trust are continuing to exceed the target for the percentage of the population receiving treatment who are suffering from depression. However the numbers reaching recovery has dropped in quarter 3, marginally missing the target of 41.9% by obtaining 41%, this is disappointing as the trust exceeded this target in quarter 2. Early interventions in psychosis new cases -The trust has missed targets in quarters 2 and 3 but are confident in reaching the annual target by year end. Data quality issues from the previous year that resulted in problems with capturing these cases have now been resolved. Number of crisis resolution/ home treatment episodes - The target has been exceeded in quarters 1-3 by a considerable margin. The increase in these numbers may be due to an increase in home treatment care as a positive substitution to inpatient treatment. Care Programme Approach (CPA) 7 day follow up CPA means a detailed written care plan for all stakeholders involved in the service users care. This measure is taken as the number of people under adult mental illness specialities on CPA who were followed up (either by face to face contact or by phone discussion) within 7

days of discharge from psychiatric in-patient care. The trust continues to meet its target for CPA 7 day follow up. Gatekeeping of admissions- The gatekeeping target is around the number of admissions that were avoided by intensive support from the crisis response and home treatment teams- keeping a service user well in the community where appropriate. The trust has achieved 100 percent against this target for the previous quarters and continues to perform its gatekeeping function well. 2. 3 Public Health Some excellent news, and not yet reflected in the figures. 2010 figures for teenage pregnancy rates placed us highest in England and Wales. The ONS annual rates for under 18 conceptions released on 26 th February 2013 showed that Haringey s rate for 2011 was 36.2 per 1000 (152 actual numbers of conception). This is a significant decrease from our 2010 s high rate of 64.7 per 1000 and showed Haringey achieved the greatest reduction in London. This reduction has finally brought Haringey s rate closer to the rates for England and Wales (30.9 per 1000) and London (28.7 per 1000), however our local HWB target (the London average) remains challenging. Under 16 conception rates were also released and showed that Haringey s rate has continued to decrease to 9.3 per 1000, but still remains higher than the rates for England and Wales (6.1 per 1,000) and London (5.7 per 1,000). Trends in Under 18 Conceptions Figure 1. Under 18 conceptions in Haringey, England & Wales and London

Figure 2. Under 18 conceptions in Haringey and comparable boroughs The other Public Health KPIs have not changed in month as data collection periods have not been updated. The commentary below is the same as month 8 as quarter 3 figures are not yet available. a) Quarter 2 immunisations rates have reduced for two counts - DTaP/IPV/Hib or the 5-in-1 vaccine, this protects against: diphtheria, tetanus, pertussis (whooping cough), polio and Hib (haemophilus influenzae type B) and is given in 3 doses before the age of 1 year. - Pneumococcal Conjugate Vaccine (PCV) this protects against some types of pneumococcal infection and is given in 3 doses the last being at just over 1 year of age. Potential causes for the dip continue to be investigated by Public Health colleagues and in discussion with other Boroughs. It is expected that the overall target attainment will recover in quarter 3 as indicative rates in Haringey have improved. The work continues with getting accurate data from GP practices. b) Quarter 2 smoking cessation figures show a large increase, although the figures remain under trajectory for Haringey. There has been a significant improvement which is in line with the usual target attainment profile and an action plan has been agreed with the service provider, Innovision. Key actions include; targeting mental health both capturing status recording and training of staff in mental health units, marketing and communications strategies and improved web based IT systems. c) A new measurement included this month shows the number of drug users in treatment as significantly higher than target (879 v 549). d) Haringey achieved the quarter 2 year to date plan for NHS Health Checks, both offered and received.