Paper No: SET/55/15 OUTLINE PERFORMANCE UPDATE 15
Contents Introduction...3 HOSPITAL SERVICES...4 South Eastern Trust - Elective Waiting Times... 10 PRIMARY CARE AND OLDER PEOPLE SERVICES... 12 ADULT SERVICES... 15 CHILDREN S SERVICES... 21
Introduction The change in date for Trust Board in August 2015 means that a full Performance Scorecard for July can t be presented as there is insufficient time to allow full of the data before the issue of Trust Board papers. This document presents provisional performance data for July. Some figures may change following, although it is likely that any variation will be minimal. Page 3
HOSPITAL SERVICES HOSPITAL SERVICES Page 4
Inpatient & Daycase Waits Diagnostic waits Outpatient Waits HOSPITAL SERVICES From April 2015, at least 60% of patients to wait no longer than nine weeks for their first outpatient appointment with no-one to wait longer than 18 weeks. No patient should wait longer than 9 weeks for a diagnostic test. % = outpatients waiting less than 9 wks as a % of total waiters. [n] = total waiting (n) = waiting > 9 wks {n} = waiting >18 wks (from Apr 15) Imaging (9 wk target) These figures relate to Imaging waits only. [n] = total waiting (n) = breaches Physiological Measurement (9wk) These figures relate to Physiological Measurement; ie all diagnostics with the exception of Imaging and Endoscopy. 32.9% [43501] (29197) {20123} 95.5% [4268] (191) 57.2% (1619) As demand continues to increase and the increased urgency of prioritisation, the routine waiters will unfortunately experience longer waiting times. As above No patient should wait longer than 9 weeks for a day case endoscopy for sigmoidoscopy, ERCP, colonoscopy, gastroscopy. No patient should wait longer than 13 weeks for other endoscopies. Diagnostic Endoscopies Inpatient / Day Case (9 wk target) Diagnostic Endoscopies Inpatient / Day Case (13 wk target) [n] = total waiting (n) = breaches 42% [3032] (1758) 65.8% [660] (226) As above From April 2015, at least 65% of inpatients and day cases to wait no longer than 13 weeks to be treated and no patient to wait longer than 26 weeks for treatment. Inpatients / Daycase 13 wk target % = % waiting < 13 weeks (n) = breaches All Specialties 26 wk target % = % treated within 26 weeks (n) = breaches (26 wks) 50.7% (3954) 72.5% (2201) As above. The capping of elective activity due to unprecedented demand for emergency admissions has also impacted on tis target. Page 5
Non Complex Discharges Emergency Departments Diagnostic Reporting HOSPITAL SERVICES All urgent diagnostic tests to be reported within 2 days of the test being undertaken. In July 2015, 1498 total urgent tests reported, 1433 were reported in < 2 days (n) = breaches > 2 days [n] = total urgent tests SET attendances include Ards & Bangor Minor Injury Units. 95.7% (65) [1498] SET 12456 [10488] 84.2% (24) 95% of patients attending any Emergency Department to be either treated and discharged home, or admitted, within 4 hours of their arrival in the department. No patient attending any Emergency Department should wait longer than 12 hours. SET & Downe Hospital attendances include attendances at Downe Minor Injuries Unit. n = total new and unplanned review attendances. [n] = seen within 4 hours % = % seen within 4 hours (n) = 12 hour breaches UH 7285 [5636] 77.4% (22) LVH 1882 [1682] 89.4% (0) DH 1677 [1559] 93.0% (2) All non-complex discharges to be discharged within 6 hours of being declared medically fit. All qualifying patients in SET beds. Main reason for delay is patient awaiting transport from friends, family or ambulance service. 90.8% Page 6
Stroke Services Other Operative Fractures Hip Fractures HOSPITAL SERVICES 95% of patients should, where clinically appropriate, wait no longer than 48 hours for inpatient treatment for hip fractures. 95% of all other operative fracture treatments should, where clinically appropriate, wait no longer than 48 hours for inpatient fracture treatment. No patient to wait longer than 7 days for operative fracture treatment (inc. day cases) From April 2015, ensure that at least 13% of patients with confirmed ischaemic stroke receive thrombolysis. (2014/15 Target = 12%) % = % treated within 48 hours. n = number of fractures (n) = number < 48 hours [n] = number >48 hours % is performance against 48 hour target. n = number of fractures (n) = number < 48 hours [n] = number >48 hours {n} = number > 7days % = % treated with thrombolysis n = number treated with thrombolysis (n) = number confirmed Ischaemic strokes 68% 40 (27) [13] 69% 84 (58) [26] {6} 5.7% 2 (35) July 2014 performance was 84% - dealing with 25 hip fractures among 133 adms. July 2015 performance of 68% was dealing with 40 among 144 adms. In July 15 activity has increased overall, total admissions, total through theatre, Neck of Femurs, slight increase on daily average, increased number of days when admissions were >7, high number of paediatric cases, high number of complex cases. Extra lists facilitated an extra 9 cases. The sustained bed pressures throughout July compounded this position. All patients presenting within the appropriate timeframe were assessed for thrombolysis, those deemed suitable received treatment. Page 7
Cancer Services Card Before You Leave HOSPITAL SERVICES There were 35 SET CBYL referrals received during July 2015. All were offered appointments within 24 hours. Ensure that all adults and children who self-harm and present for assessment at ED are offered a follow-up appointment with appropriate mental health services within 24 hours. There were also 12 Belfast Trust patients who attended the Ulster Hospital ED all were passed on to the Belfast Trust s CBYL Service. 1 DNA 100% (35) [0] At least 95% of patients urgently referred with a suspected cancer should begin their first definitive treatment within 62 days. % = percentage compliance (n) = number of people who presented with self-harm [n] = number of breaches % = % who began treatment within 62 days n = (n) = number of patients seen breaches In July 2015, 62 patients were seen. There were 23 breaches involving 31 patients, of whom 16 were shared. 63% 62 (23) All urgent breast cancer referrals should be seen within 14 days. % = % referrals seen within 14 days n = (n) = number of referrals breaches 90.1% 141 (14) At least 98% of patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat. % = % who began treatment within 31 days (n) = breaches June was 95% (6) now 96% (5) 97% (3) Page 8
Specialist Drug Therapies HOSPITAL SERVICES From April 2014, no patient should wait longer than 3 months to commence NICE-approved specialist therapies for rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. % = percentage waits <13 weeks (n) = total waiting [n] = breaches 100% (3) [0] From April 2014, no patient should wait longer than 3 months to commence NICE approved specialist therapies for psoriasis. % = percentage waits < 13 weeks (n) = total waiting [n] = breaches 75% (8) [2] Page 9
HOSPITAL SERVICES South Eastern Trust - Elective Waiting Times OUTPATIENTS Specialty Anticipated end of August 15 position- Suspect Cancer/Red Flag Anticipated end of August 15 position- Routine Symptomatic Breast Clinic 3 weeks 19 weeks Cardiology N/A 36 weeks Dermatology 5 weeks 55 weeks ENT 3 weeks 52 weeks General Medicine /Gastroenterology 11 weeks 60 weeks General Surgery 6 weeks 30 weeks Geriatric Medicine N/A 28 weeks Gynaecology 2 weeks 62 weeks Haematology 2 weeks 13 weeks Nephrology 2 weeks 9 weeks Neurology 4 weeks 57 weeks Maxillo Facial 3 weeks 80 weeks Paediatrics 2 weeks 55 weeks Paediatric Asthma N/A 12 weeks Paediatric Surgery N/A 9 weeks Pain Management N/A 25 weeks Plastic Surgery 7 weeks 48 weeks Thoracic Medicine 3 weeks 46 weeks Rheumatology N/A 55 weeks Urology 2 weeks 90 weeks Note: Ophthalmology & Paediatric Cardiology Services are managed by Belfast Health & Social Care Trust Page 10
HOSPITAL SERVICES IN-PATIENTS / DAY CASES Specialty Cardiology Dermatology ENT General Surgery Gynaecology Maxillo Facial Paediatrics Paediatric Surgery Pain Management Plastic Surgery Urology Diagnostic Scope Anticipated end of August 15 position 20 weeks 13 weeks 38 weeks 52+ weeks 52+ weeks 52+ weeks 13 weeks 36 weeks 18 weeks 52+ weeks 52+ weeks 52 weeks Page 11
PRIMARY CARE AND OLDER PEOPLE SERVICES PRIMARY CARE AND OLDER PEOPLE SERVICES Page 12
Complex Discharges Complex Discharges AHP Waits PRIMARY CARE AND OLDER PEOPLE SERVICES No patient to wait longer than 13 weeks from referral to commencement of treatment (was 9 weeks up to March 2015). 90% of complex discharges should take place within 48 hours. At 31 st July 2015 of 7567 patients on the AHP waiting list, 254 are waiting longer than 9 weeks. Service No on W/L Waiting >9 wks Compliance Physio 3839 11 99.7% OT 1205 71 94.1% Orthoptics 261 3 98.9% Podiatry 903 2 99.8% S< 550 7 98.7% Dietetics 809 160 80.2% [n] = total waiting (n) = breaches All qualifying patients from SET Trust of Residence in NI acute beds. (Source: HSCB Web Portal). (n) = 48 hr breaches SET Key reasons:- No Domiciliary Care Package Patient / Family resistance 96.6% [7567] (254) 75.8% (82) 77.6% 90% of complex discharges should take place within 48 hours. All qualifying patients in SET beds. (n) = complex discharges. BHSCT reasons:- No Domiciliary Care Package Community Equipment Delays (598) >48 hrs By Trust of res SET 92 BT 38 ST 2 NT 1 NK 1 Page 13
Direct Payment HCAI Complex Discharges PRIMARY CARE AND OLDER PEOPLE SERVICES No Complex discharge should take longer than 7 days. All qualifying patients in SET beds. n = complex discharges (n) = discharges delayed by more than 7 days. 92.3% 598 (46) By March 2015, secure a further reduction of 9% in Clostridium Difficile and MRSA bloodstream infections in patients >= 2 years of age. C Diff MRSA 2014/15 Total Actual 67 Target <50 Actual 7 Target <11 2015/16 Target Target <55 Target <7 C Diff 12 (cum 32) MRSA 1 (cum 2) By March 2016, secure a 10% increase in number of Direct Payment cases across all programmes of care (Target = 437 and is shared with Adult Services) 506 Page 14
ADULT SERVICES MENTAL HEALTH SERVICES ADULT SERVICES Page 15
Resettlement Discharge And Follow-Up Waiting Times For Assessment And Treatment ADULT SERVICES MENTAL HEALTH SERVICES No patient to wait more than 9 weeks from referral to assessment and commencement of treatment in Adult Mental Health Services. % = % compliance (n) = number on waiting list [n] = number waiting > 9 weeks 100% (510) [0] 99% of discharges take place within 7 days of patient being assessed as medically fit for discharge. All patients to be discharged within 28 days of patient being assessed as medically fit for discharge. All discharged patients due to receive a continuing care plan in the community to receive a follow-up visit within 7 days of discharge. There were 83 discharges in July 2015, All were discharged within 7 days. 100% 7 patient discharge delays in July 2015 pending accommodation and this is being addressed. There were 75 SET discharges in July 2015 for follow up within 7 days. All were offered appointments within 7 days. 73 seen, 1 DNA,1 CNA 7 100% By March 2015, resettle the remaining long-stay patients in psychiatric hospitals to appropriate places in the community. Remaining long-stay population have now been resettled and the PFA target has been met in full. This has been acknowledged by Linus McLaughlin at HSCB. Target Met Page 16
Resettlement Discharge ADULT SERVICES DISABILITY SERVICES Ensure that 99% of discharges take place within 7 days of the patient being assessed as medically fit for discharge. No discharge taking longer than 28 days. By March 2015 resettle the remaining long-stay patients in learning disability hospitals to appropriate places in the community. One patient discharged within the target time during July. The Trust currently has 11 people awaiting discharge, 10 of whom have been waiting for more than 28 days. n = number awaiting discharge (n) = breaches 5 patients remain to be resettled 100% 11 (10) 5 people remain to be resettled Muckamore:- Delay in days May Jun Jul 0-7 1 0 0 8-28 0 1 1 29-90 2 0 1 91-365 1 3 3 >365 6 6 6 Total 10 10 11 Page 17
Emergenc y Care Inter- Prison Transfers Committal ADULT SERVICES PRISON HEALTHCARE SERVICES All prisoners to be a healthcare / keepsafe assessment to determine immediate health concerns on the day of first reception, and before spending their first night in prison, to include an assessment of the risk of suicide/ self-harm. % = performance n = total committals (n) = breaches Note: Magilligan Prison is not a committal prison so only receives transfers and is not covered by this target. % = performance n = total committals (n) = breaches 99.6% 292 (1) All prisoners to be a "Comprehensive Health Assessment" by a healthcare professional within 72 hours of committal. On prison transfer, all prisoners will receive a transfer health screen by Prison Healthcare staff on the day of arrival. In an emergency, prisoners will be seen by Prison Healthcare staff within an hour. Emergencies are defined as Code Blue or Code Red calls for assistance. Maghaberry Hydebank* May Jun Jul Committals 243 233 234 Breaches 0 0 1 Committals 58 48 58 Breaches 3 1 1 * July 15:- 6 of the Prisoners in Hydebank were bailed / released within 72 hours and therefore did not require a Comprehensive Health Assessment. % = performance n = total transfers (n) = breaches % = performance n = total emergencies (n) = breaches 99.3% 292 (2) 100% 66 (0) 100% 43 (0) Page 18
Addictions Services Routine Medical Appointmen ts ADULT SERVICES PRISON HEALTHCARE SERVICES Following triage by Healthcare staff, where a prisoner is found to require a non-urgent appointment with a doctor this will be accommodated within14 days. % = performance n = total appointment requests (n) = breaches All breaches in Maghaberry % = Compliance 92.8% 814 (59) No prisoner with an opiate or an intravenous drug addiction who wishes to be seen by the Addictions Team should wait longer than 9 weeks. (n) = number of prisoners with confirmed opiate or intravenous drug addiction who had their first face to face contact with Addictions Team. [n] = number of prisoners waiting >9wks for appointment 100% (15) [0] Page 19
Waiting Times For Assessment And Treatment ADULT SERVICES PSYCHOLOGY No patient of any age to wait more than 13 weeks from referral to assessment and commencement of treatment in Psychological Therapies % = % compliance (n) = number on waiting list [n] = number waiting > 13 weeks Breaches Jun Jul Adult Mental Health 299 284 Older People 13 25 Adult Learn Dis 11 13 Children s Learn Dis 1 3 Adult Health Psych 100 111 Children s Psych 0 0 Total 424 436 51.8% 904 [436] - Adult Mental Health continue to hold breach and slight improvement. Two psychology posts offered due to commence end September 2015. Two CBT posts shortlisted - interview dates scheduled - Older Adult continue to pursue recruitment to vacant post - Learning Disability interviews for vacant post 4 September. Consultant on 8 weeks sick leave following surgery - Adult Health Psychology meeting with Pain Service to increase resource discussions ongoing Page 20
CHILDREN S SERVICES CHILDREN S SERVICES Page 21
Children In Care CHILDREN S SERVICES All children admitted to residential care should, prior to admission:- (1) Have been the subject of a formal assessment to determine the need for residential care. (2) Have had their placement matched through the Children s Resource Panel Process. % = % compliance (n) = No of children admitted to care this month Two children were admitted to care during July 2015. All placements were formal assessment and went through the Children s Resource Panel. 100% (2) For every child taken into care, a plan for permanence and associated timescales should be agreed within 6 months and formally agreed at the first sixmonthly LAC review. There were 16 children taken into care during January 2015. Three children were respite / shared care, 8 children were discharged from care. Of the remaining 5 children, all had a permanence plan in place at the end of July 2015. The child without a plan in place at the end of May still does not have a plan in place, a LACR is scheduled for 10 th August. % = % compliance 83.3% 6 (1) n = number of children requiring a plan (n)= number of children without permanence plan within 6 months. Page 22
Assessment Of Children At Risk Or In Need CHILDREN S SERVICES All child protection referrals to be allocated within 24 hours of receipt of referral. All child protection referrals to be investigated and an initial assessment completed within 15 working days from the date of the original referral being received. Following the completion of the initial child protection assessment, a child protection case conference to be held within 15 working days of the original referral being received. All Looked After Children Initial assessments to be completed within 14 working days from the date of the child becoming looked after. All family support referrals to be allocated to a social worker within 30 working days for initial assessment. All family support referrals to be investigated and an initial assessment completed within 10 working days from the date the original referral was allocated to the social worker. On completion of the initial assessment 90% of cases deemed to require a Family Support pathway assessment to be allocated within a further 30 working days. % = compliance (n) = total referrals [n] = number allocated within 24 hrs % = % compliance (n) = number initial assessments completed in month. [n] = number completed within 10 working days of original referral being received. %= % compliance (n) = number of initial case conferences held [n] = number within 15 days % = % compliance (n) = number of initial assessments completed. [n] = number completed within 10 working days. % = % compliance (n) = number of referrals allocated [n] = number within 20 days % = % compliance (n) = number of assessments completed [n] = number completed within 10 working days % = % compliance (n) = number allocated [n] = number allocated within 20 working days. 100% (84) [84] 97.6% (83) [81] 96.4% (28) [27] 93.3% (15) [14] 88.3% (197) [174] 33.1% (172) [57] 83.5% (115) [96] Page 23
Unallocated Cases Autism CHILDREN S SERVICES No child to wait more than 13 weeks for assessment following referral. No child to wait more than 13 weeks for the commencement of specialist treatment following assessment. At 31 st July 2015, 148 children were on the waiting list specifically for diagnostic assessment for ASD. 61 children waiting > 13 wks (longest wait 246 days) % = compliance (n) = breaches 31 st July 2015 - total waiters:- 0 4 wks 4 >4 8 wks 18 >8 13 wks 22 > 13 wks 0 Total 44 Longest wait = 79 days % = compliance (n) = breaches 58.8% < 13 wks (61) 100% (0) Monitor the number of unallocated cases in Children s Services n = unallocated over 20 days (n) = total awaiting allocation at 30 th June 15 Gateway Disability FIT TOTAL 59 0 145 204 204 (272) Gate way Disa bility FIT Total < 1 wk 6 0 5 11 1-4 wks 21 8 28 57 4-8 wks 30 0 28 58 > 8 wks 29 0 117 146 Total 86 8 178 272 Page 24