System Resilience Dashboard

NHS Dorset Clinical Commissioning Group - Business Intelligence System Resilience Dashboard Produced by: Phil Dove Data source: SUS/National Data Date published: 28/1/215 Supporting people in Dorset to lead healthier lives Supporting people in Dorset to lead healthier lives

NHS DORSET CLINICAL COMMISSIONING GROUP SYSTEM RESILIENCE DASHBOARD CONTENTS 1 Headlines.. 3 Page 2 Dashboard 4 3 111 Service 5 4 Ambulance Service 6 5 Emergency Department (A&E).. 7 6 Emergency Admissions.. 8 7 Referrals and Waiting List.. 9

NHS DORSET CLINICAL COMMISSIONING GROUP SYSTEM RESILIENCE DASHBOARD Headlines:- Note: December updates for SUS data are currently unavailable Weekly Sit Rep Comparison - w/e 18-Jan-15 Delayed discharges remain high across all local providers when compared to the same week last year. Number of escalation beds open is significantly higher at & SFT. No Urgent Ops cancelled 2nd time, 1 cancelled in the previous week 111 Service (Whole Dorset Service) 1% increase in calls received and triaged by 111 service with a 39% increase in ambulance dispatches compared to 213/14. The total number of Ambulances dispatched by the 111 service in week ending 25th January is slightly up, rate of conveyance remains the same (5.2%) compared to the same period in January 214 Current recommendations to attend A&E remain consistent. Recommendations to attend primary care has dropped back down to early December levels. Calls answered within 6 seconds was notably below target in December 214, whilst performance has improved this is still notably below target. Ambulance Service Hear & Treat outcomes continue to be significantly above last years levels (up 36%). Total calls are 9% above the same period in 213/14. See & Conveys have increased by 9% resulting in on average an extra 5 conveyances per month compared to same period in 213/14. However as a percentage of total calls, See & Convey is only slightly higher (5.2%) than in 213/14 (49.8%). See and Treat up 3%. Red 1 performance is above Target at 82.6% for Dec-14 for Dorset CCG patients. SWAST has dropped below the 75% target for the year to date period to December 214 at 74.7% National benchmarking indicates excellent levels of Non Conveyance. Emergency Department Delivery of the 95% seen in 4 hours standard in Quarter 3 was met by (96.4%), with attaining 92.% & 92.3%. Attendances year to date 214/15 remain above levels seen in 213/14 ( 1%, 8%, 2%) however comparison with the last 6 weeks from 213/14 and 214/15 show a larger increase of ( 11%, 13%, 9%). Conversion rate of A&E attendances to Emergency Admissions are marginally higher than the National average. attendances in hours are up 8% whilst is -2.5% under last year's figures. OOH attendances are up at all 3 providers - 8%; 4%; 4% Emergency Admissions Emergency admissions remain significantly higher than 213/14 levels - 1%; 7%; 14%. There has been a significant increase in emergency admissions Via A&E at of 21%. Comparison of Emergency Admissions in the past six weeks (compared to 213) show increases at (12.6%) and (14.9%), decreases by.8% Short stay admissions via A&E (defined as zero length of stay) are up 35% at and 23% at. Overall length of stay as a result is down by just under 1 day at both providers. Increased same day treatment of patients with ambulatory care conditions is contributing to this trend. Delayed Transfers of Care Oct to Dec 214, local Providers reported on average approximately 5, bed days lost a month due to DToC. Residential home placements account for the majority of delays followed by Care Packages in Own Home & Patient/Family Choice. All providers are failing to achieve the 3.5% benchmark standard. Referrals and Waiting List Referrals have increased at all local providers in 214/15 with up 6%, 5% and 4% higher than the same period last year. Overall GP referrals are up 5% with a third of this increase related to Fast Track referrals. 18 Week RTT positions are beginning to improve following the NHS England backlog clearing exercise and performance improved further in November 214. Non-admitted 18 week RTT backlog at has increased in recent weeks - related mainly to Neurology & Paediatric Ophthalmology. Trajectory now agreed and in place to recover this position for Neurology. 3

Triage & Conveyance Dec-14 Emergency Admission Conversion Rates 4hr Breaches SWAST Red 1 (8) 77.6% 75.1% 74.7% 69.6% England Week ending 4-Jan 11-Jan 18-Jan 25-Jan Q3 213/14 32% 32% 26% 28% 111 Calls (6 secs) 62.6% 77.% 9.4% 83.1% Q3 214/15 31% 29% 28% 28% Routes into ED:- Data up to End unless otherwise stated ED Attendances by Referral Source - % Difference to 213/14 (Dorset CCG Patients) 111 Service Ave. Diff per Week 213/14 V 214/15 YTD SWASFT Comparison of 13/14 YTD v 14/15 YTD % Diff % Diff % Diff % Diff % Diff As at 25/1/15 % Diff Diff As at end Dec-14 % Diff Diff All Attendances 1% 232 8% 319 2% 834 1% 335.3% 1 Calls Triaged 9% 326 Calls 9% 8,395 Self Referral -2% -337 4% 116 % -117 Ambulance Dispatches 39% 115 Hear & Treat 36% 2,57 Emergency Services - 15% 1681-5% -512 Recommended to Attend A&E Recommended to Attend Primary Care Emergency Admissions (data up to End ) Data up to End unless otherwise stated Emergency Admissions Via A&E with days Length of Stay 23% 42 Conveyances 9% 4,617 OOHs Attendances 4% 599 9% 216 5% 21 See & Treat 3% 1,271 6% 132 ED Outcome SCASFT Jul-Oct 1314 to Jul-Oct 1415 % Diff Diff % Diff % Diff % Diff Conveyances to 6% 7 Discharged-No GP Follow U 4% 561 24% 1453 2% 218 (213/14 only available from ) Admitted % 19 1% 1149 13% 1337 Transferred -17% -29-16% -65 5% 21 Emergency Admissions by Source Comparison - Apr-Nov 13/14 to Apr-Nov 14/15 Comparison - Apr-Nov 13/14 to Apr-Nov 14/15 YTD 13/14 YTD 14/15 Diff % Diff % Diff % Diff % Diff 1569 193 334 21% All EM Admiss 1% 995 7% 119 14% 295 296 2822-84 -3% Via ED 5% 345 6% 662 21% 1824 2889 3877 988 34% Via GP 13% 27 3% 177 3% 158 Delayed Transfers of Care Emerg Admiss with LoS - Diff to Ave. per Month 214/15 YTD Conditions Respiratory Skin Circulation Neurological SYSTEM RESILIENCE DASHBOARD Referrals Data up to : Trend 3724 15%: 28 12%: 34 16%: 267 *All providers includes,,, SFT, YDH, BMI, Ramsey 12%: 187 4%: 136 31%: 39 12%: 139 %: 6 21%: 4 1%: 26 6%: 212-1%: -21 Weekly Sit Rep Comparison Q3 14/15 96.4% 92.% 92.3% Provider 4-Jan-15 93.3% 85.1% 82.5% Diff to YTD 213/14 All Providers* 7484 % Diff 1172 5% 185 11-Jan-15 88.9% 91.4% 93.9% MIU 5% 4% 6% 18-Jan-15 92.4% 91.7% 92.4% Walk In Centre* *Boscombe & Springbourne KPI Provider (Mar14 figure) Dec-14 Number of Beds Days Lost in Month Dorset County (158) Poole (561) Royal Bournemouth (299) Salisbury (555) Yeovil (25) Ave. Escalation Beds Open per day Ave. No. of Delayed Discharges per day Norovirus - Ave. No. Beds Closed each day Elective Ops Cancelled (weekly total) Urgent Ops Cancelled (weekly total) 18 174 253 22 187 354 339 541 Week Ending 19-18-Jan-15 19-18-Jan-15 19-18-Jan-15 19-18-Jan-15 19-18-Jan-15 536 466 66 63 626 817 861 868 16 17 9 25 5 3 8 1 3 369 184 386 415 6 625 586 575 47 83 32 42 3 8 13 5 2 794 837 715 581 621 543 519 628 5 2 16 35 1 8 7 196 282 349 556 873 1,36 8 912 SFT 15 41 23 28 1 1 8 6 1 DHUFT (1,269) 1,583 1,25 1,335 1,57 1,423 1,811 1,549 1,363 YDH 1 18 17 27 5 8 4

May-12 May-12 May-12 12/5/13 26/5/13 May-12 23/6/13 14/7/13 4/8/13 1/9/13 22/9/13 2/1/13 1/11/13 1/12/13 19/1/14 16/2/14 9/3/14 May-12 Attendances Activity data = Dept Type ED; First & Unplanned Follow Up attendances Emergency Department (A&E) Emergency Departments Weekly Attendances 4 Hour Wait in ED 14-Dec-14 21-Dec-14 28-Dec-14 4-Jan-15 11-Jan-15 18-Jan-15 % Seen in 4 Hours 79 821 751 792 722 713 Week Ending 21-Dec-14 28-Dec-14 4-Jan-15 11-Jan-15 18-Jan-15 1,225 1,31 1,226 1,23 1,97 1,142 92.1% 94.4% 93.3% 88.9% 92.4% 1,65 1,596 1,538 1,539 1,459 1,475 83.7% 83.% 85.1% 91.4% 91.7% 86.6% 9.5% 82.5% 93.9% 92.4% 15-22- 29-5- 12-19- 718 684 653 75 686 685 1,141 1,11 1,5 1,29 1,32 1,38 1,491 1,398 1,34 1,353 1,376 1,457 Comparison of 214/15 YTD to 213/14 (data up to end ) Difference to Previous Year 13/14 YTD 14/15 YTD Diff % Diff 24,583 24,815 232 1% 25 % Diff to Prev Year 72 137 98 87 36 28 (6 week total) 84 176 174 65 Provider 14 % 38,539 41,729 319 8% 37,848 38,682 834 2% 15 5 11% 114 198 198 186 83 18 13% 9% 14-Dec-14 21-Dec-14 28-Dec-14 4-Jan-15 11-Jan-15 18-Jan-15 6 5 4 3 Emergency Department Attendances (Monthly SUS data) 35 3 25 214/15 YTD & 213/14 YTD 319; 8.3% 15 5 232;.9% 834; 2.2% 6 45 4 5 35 4 3 25 3 15 5 Average(mean) ED Self Attendances Referral ED - Attendances Self Referral 1 8 6 4 - -4-6 214/15 YTD & 213/14 YTD -337; -2.3% 116; 4.4% -117; -.4% 3 25 15 5 ED Attendances In Hours - Diff 213/14 V 214/15 YTD -367; - 3.6% 1174; 7.4% -159; - 1.% 35 3 25 15 5 ED Attendances - Out of Hours 3 599; 4.2% 216; 8.9% 993; 4.5% Diff 213/14 V 214/15 YTD 18 16 14 1 8 6 4 ED Attendances - Discharged - No GP Follow Up 16 14 1 8 6 4 Difference 213/14 V 214/15 561; 4.3% 1453; 23.5% 218; 2.3% Weymouth Wimborne Bridport Swanage Shaftesbury Memorial Yeatman, Sherborne MIU First Attendances per Hour (Apr-Nov14) Portland.5 1 1.5 2 2.5 3 1.2 ph; 4,14 1st atts 1.2 ph; 2,227 1st atts 1.1 ph; 1,971 1st atts.9 ph; 1,868 1st atts 1.8 ph; 3,29 1st atts 1.8 ph; 4,717 1st atts Adjusted for Opening hours ph = per hour 2.6 ph; 9,3 1st atts Blandford.8 ph; 1,531 1st atts 7

Days Via A&E Emerg Admiss Emergency Admission Conversion Rates Emergency Admissions (from A&E Type 1 attendances) England 14-Dec-14 21-Dec-14 28-Dec-14 4-Jan-15 11-Jan-15 18-Jan-15 Q3 213/14 32.3% 32.% 26.4% 27.6% 386 42 364 45 374 36 Q4 213/14 33.1% 31.5% 27.9% 27.7% 638 67 616 617 543 597 Q1 214/15 3.2% 28.2% 28.% 26.4% 651 623 587 626 61 585 Q2 214/15 28.4% 27.4% 26.2% 26.4% Emergency Admissions Q3 214/15 31.1% 29.3% 28.1% 27.6% 15-22- 29-5- 12-19- Latest Week 18-Jan-15 38.8% 28.8% 29.5% 29.9% 34 344 322 351 31 352 Data Source: Sitreps 659 633 66 591 594 628 565 57 538 557 531 572 Comparison of 214/15 YTD to 213/14 Data Source :- SUS 15 (data up to end 13/14 14/15 13-2- 27-3- 1- % Diff to 17- Prev Year ) YTD YTD Diff % Diff (6 week total) Provider % 1189 11184 995 1% 46 76 42 54 73 8 5 Difference to Previous Year 15% 1833 19493 119 7% -21 37 1 26-51 -31-1% 1456 16655 295 14% 86 116 49 69 79 13 13% 3, 2,5 2, 1,5 1, 5 16 14 1 8 6 4 7 7345 345 5% 14% 22% 13% 15% 24% 2% 1876 11538 662 6% - -3% 6% 2% 4% -9% -5% 8567 1391 1824 21% 14-Dec-14 21-Dec-14 15% 28-Dec-14 23% 4-Jan-15 9% 11-Jan-15 12% 18-Jan-15 15% 2% -5 All Emergency Admissions (Data source SUS) Emergency Admissions Via A&E 25 15 5 15 5 214/15 YTD & 213/14 YTD 995; 1% 214/15 YTD & 213/14 YTD 1824; 21% 345; 5% 119; 7% 662; 6% 295; 14% Emergency Admissions Via A&E with a Length of Stay of Zero Days 6 5 4 1 214/15 YTD & 213/14 YTD 988; 34% 3 8 6 4-334; 21% -84; -3% 7 6 5 4 Emergency Admissions Average Length Of Stay.2. -.2 214/15 YTD & 213/14 YTD.; 1.2% 3 -.4 2 1 -.6 -.8-1. -.8; -16.4% -.9; -15.2% 8

26/5/13 23/6/13 14/7/13 4/8/13 1/9/13 22/9/13 2/1/13 1/11/13 1/12/13 19/1/14 16/2/14 9/3/14 13/7/14 2/7/14 27/7/14 3/8/14 1/8/14 17/8/14 24/8/14 31/8/14 7/9/14 14/9/14 21/9/14 28/9/14 5/1/14 12/1/14 19/1/14 26/1/14 2/11/14 9/11/14 23/11/14 3/11/14 7/12/14 21/12/14 4/1/15 11/1/15 18/1/15 25/1/15 26/5/13 23/6/13 14/7/13 4/8/13 1/9/13 22/9/13 2/1/13 1/11/13 1/12/13 19/1/14 16/2/14 9/3/14 13/7/14 2/7/14 27/7/14 3/8/14 1/8/14 17/8/14 24/8/14 31/8/14 7/9/14 14/9/14 21/9/14 28/9/14 5/1/14 12/1/14 19/1/14 26/1/14 2/11/14 9/11/14 23/11/14 3/11/14 7/12/14 21/12/14 4/1/15 11/1/15 18/1/15 25/1/15 26/5/13 23/6/13 14/7/13 4/8/13 1/9/13 22/9/13 2/1/13 1/11/13 1/12/13 19/1/14 16/2/14 9/3/14 13/7/14 2/7/14 27/7/14 3/8/14 1/8/14 17/8/14 24/8/14 31/8/14 7/9/14 14/9/14 21/9/14 28/9/14 5/1/14 12/1/14 19/1/14 26/1/14 2/11/14 9/11/14 23/11/14 3/11/14 7/12/14 21/12/14 4/1/15 11/1/15 18/1/15 25/1/15 26/5/13 23/6/13 14/7/13 4/8/13 1/9/13 22/9/13 2/1/13 1/11/13 1/12/13 19/1/14 16/2/14 9/3/14 13/7/14 2/7/14 27/7/14 3/8/14 1/8/14 17/8/14 24/8/14 31/8/14 7/9/14 14/9/14 21/9/14 28/9/14 5/1/14 12/1/14 19/1/14 26/1/14 2/11/14 9/11/14 23/11/14 3/11/14 7/12/14 21/12/14 4/1/15 11/1/15 18/1/15 25/1/15 14/7/13 22/9/13 2/1/13 1/12/13 9/3/14 13/7/14 27/7/14 1/8/14 24/8/14 7/9/14 21/9/14 5/1/14 19/1/14 2/11/14 3/11/14 11/1/15 25/1/15 14/7/13 22/9/13 2/1/13 1/12/13 9/3/14 13/7/14 27/7/14 1/8/14 24/8/14 7/9/14 21/9/14 5/1/14 19/1/14 2/11/14 3/11/14 11/1/15 25/1/15 111 Service Calls Answered within 6 seconds Week Ending 4/1/15 11/1/15 18/1/15 25/1/15 % Calls 5.7% 62.6% 77.% 9.4% 83.1% 11% % 9% 8% 7% 6% 5% 4% % Calls Answered within 6 Seconds Target Comparison of 214/15 YTD to 213/14 Weekly Ave. Ave. 13/14 Ave. 14/15 Diff % Diff Calls Answered 397 428 373 1% Calls Triaged 3725 451 326 9% Ambulance dispatches 292 47 115 39% Attend A&E 183 224 42 23% Attend primary care 2262 2394 132 6% Attend Other Service 152 17 18 12% Not recommended to attend another service 835 855 2 2% 14% 12% 1% 8% 6% 4% 2% % Week Ending % Of Triaged Calls Resulting in Ambulance Dispatch/Conveyance Conveyance 8.5% 4.9% Week Ending 12.2% 6.% 6 55 5 45 4 35 3 25 15 Average(mean) No. Calls Triaged Upper Limit: 4743 Average: 388 6 5 Average(mean) Ambulance Dispatches Upper Limit: 51 Average: 347 Lower Limit: 184 4 3 3 25 Average(mean) Recommended to Attend A&E Upper Limit: 263 Average: 23 Lower Limit: 142 15 5 4 35 3 25 15 5 Average(mean) Recommended to attend primary care Upper Limit: 2883 Average: 2325 Lower Limit: 1767 8

Handovers Over 3 mins Dec-14 SWAST Red 1 Performance (Target 75%) Dec-14 Dorset CCG 84.9% 85.6% 85.% 82.6% SWAST 77.6% 75.1% 74.7% 69.6% Ambulance Service 95% 9% 85% 8% 75% 7% 65% 6% SWAST Red 1 Performance Target Dorset CCG SWAST Comparison of 214/15 YTD to 213/14 YTD Monthly Averages 12/13 YTD 13/14 YTD 14/15 YTD Diff 14/15 V 13/14 % Diff Calls 97,866 98,567 16,962 8,395 9% Hear & Treat 6,166 6,999 9,56 2,57 36% See & Treat 41,86 42,473 43,744 1,271 3% See & Convey 5,614 49,95 53,712 4,617 9% 845 652 283-369 -57% Percentage of Calls Categorised as See & Convey 492 578 756 178 31% Total Calls See & Convey % See & Convey 346 32 712 392 123% 213/14 13,936 65,761 5.2% 214/15 YTD 16,962 53,712 5.2% 6% 5% 4% 3% 2% 1% % 53% 5% 43% 42% 42% SW IoW SE Cost East of Eng Non-Conveyances % of Total Incidents - 38% 37% 35% 32% 32% 31% 27% SC W Mids Eng London Yorkshire E Mids NE NW 14, Average (mean) Total Calls Upper Limit: 12,513 Average: 11,143 Lower Limit: 9,772 13, 12, 11, 1, 9, 8, May-12 Dec-14 7, Average (mean) See and Convey Upper Limit: 6,235 Average: 5,643 6,5 6, 5,5 5, 4,5 4, 3,5 3, May-12 Dec-14 5,5 Average (mean) See & Treat Upper Limit: 5,212 Average: 4,673 Lower Limit: 4,133 5, 4,5 4, 3,5 3, May-12 Dec-14 2, 1,8 1,6 1,4 1, 1, 8 6 4 Average (mean) Hear & Treat Upper Limit: 1,257 Average: 827 Lower Limit: 396 May-12 Dec-14 9

No. Referrals No. Referrals No. Referrals No. Referrals 25, 2, 15, 1, 5, Referrals & Waiting List Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 213/14 18884 19692 18414 2396 17713 1828 7 1877 16528 19962 17968 19256 214/15 19444 19635 2414 21754 18117 253 21494 18315 4, Referrals to Main Providers (,,, SFT, YDH, BMI, Ramsey) Dorset County Hospital NHS Foundation Trust Year to Date Variance 14/15 vs 13/14: 7484 (5%) Year to Date Variance 14/15 vs 13/14: 1172 (5%) 3,5 3, 2,5 2, 1,5 1, 5 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 213/14 39 393 2982 321 2821 318 3336 316 2648 3349 2847 3127 214/15 3195 3191 3247 349 333 3269 3496 2898 The Royal Bournemouth & Christchurch Hospitals Foundation Trust Year to Date Variance 14/15 vs 13/14: 3724 (6%) 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 213/14 7946 8125 7468 8236 7133 7187 7846 745 6424 7863 7364 7785 214/15 813 8124 8113 928 726 8476 8634 735 % 9% 8% 7% 6% 5% 4% 3% 2% 1% % % 9% 8% 7% 6% 5% 4% 3% 2% 1% % % 9% 8% 7% 6% 5% 4% 3% 2% 1% % % Split by Referral Source - Year to date 1% 1% 11% 11% 2% 21% 59% 58% 213/14 214/15 Financial Year 8% 1% 5% 5% 11% 11% 76% 73% 213/14 214/15 12% 11% 6% 5% 25% 26% 58% 58% 213/14 214/15 Other Urgent Care Consultant GP Other Urgent Care Consultant GP Other Urgent Care Consultant GP 8, 7, 6, 5, 4, 3, 2, 1, Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 213/14 64 6551 6131 689 5972 6298 6819 6188 5767 685 616 643 214/15 6197 636 6966 7 5958 684 796 6258 Pathway Performance (Dorset CCG Patients) Poole Hospital NHS Foundation Trust Year to Date Variance 14/15 vs 13/14: 185 (4%) Planned Care % 9% 8% 7% 6% 5% 4% 3% 2% 1% Diagnostic Performance (Dorset CCG Patients) % 9% 8% 23% 22% 2% 22% 48% 48% 213/14 214/15 Other Urgent Care Consultant GP Admitted Adjusted Non Admitted Incomplete Pathways Total Waiting List Over 6 Weeks % Seen in 6 Weeks 85% 98% 95% 3394 4 98.8% 94% 97% 98% 373 4 99.9% 89% 97% 95% 343 9 99.7% DHUFT 96% 98% 99% DHUFT 1212.% SFT YDH 95% % 94% 89% 95% 94% SFT YDH 489 96.%.% 18 Week RTT Backlog - Week Ending 3 November 214 Total PTL Admitted Backlog Total PTL Non-Admitted Backlog Dorset County Hospital NHS Foundation Trust 3-Mar 21-Sep 28-Sep 5-Oct 12-Oct 19-Oct 26-Oct 2-Nov 9-Nov 16-Nov 23-Nov 3-Nov 445 259 238 232 248 273 278 36 342 347 34 311 371 245 29 314 327 37 432 382 41 455 472 53 Total PTL Admitted Backlog Total PTL Non-Admitted Backlog Total Combined PTL Backlog Poole Hospital NHS Foundation Trust 3-Mar 21-Sep 28-Sep 5-Oct 12-Oct 19-Oct 26-Oct 2-Nov 9-Nov 16-Nov 23-Nov 3-Nov 54 73 79 73 64 62 69 7 69 77 67 63 193 171 155 146 146 157 164 149 157 152 167 171 Royal Bournemouth Hospital NHS Foundation Trust 3-Mar 21-Sep 28-Sep 5-Oct 12-Oct 19-Oct 26-Oct 2-Nov 9-Nov 16-Nov 23-Nov 3-Nov 679 757 68 637 682 66 698 698 678 71 682 694 9