NHS Milton Keynes CCG Board Meeting

Subject: Meeting: Quality & Performance Report NHS Milton Keynes CCG Board Meeting Date of Meeting: Tuesday 28 th November 2017 Report of: Neve Patel Head of Performance Is this document: Commercially Sensitive For the Public or Private Agenda To be publically available via the CCG Website N Public Y 1. Summary 1.1.1 The attached report provides an overview of Milton Keynes CCG current month performance against the following standards: Everyone Counts: Annex B - NHS Constitution Measures Annex C NHSE Improvement & Assessment Framework NHS Quality Premium Measures Milton Keynes CCG Quality Dashboard Report 1.1.2 Performance is reported by exception only detailing the main issues causing underperformance, actions taken by the Commissioner and Provider and the expected recovery date. 1.2 NHS Constitution Measures Key Areas to note: Diagnostics achieved against the National target in ust at CCG (0.95%) and Trust (0.80%) levels. A&E exceeded the National 95% Target with achievement of 96.3% in ust. Seven out of eight Cancer measures achieved their target. Key Areas for Improvement: RTT Incomplete Constitution measure did not meet the national target at CCG level with 91.08%. RTT Measures (admitted and non-admitted) / Cancer 62 day wait / Ambulance Red 1,2 and Red 3/ Cancelled ops not rebooked within 28D and 52 ww (2 patients in total in ust). Page 1 of 2

2. NHSE Improvement & Assessment Framework Updated assessment from an overall Requires Improvement to Good Greatest need for Improvement - Maternity Services Requires Improvement Cancer, Learning disability / Diabetes / Dementia (improved from greatest need for improvement at the last assessment). Local performance updates The Dementia diagnosis performance for has achieved with 67.80%. Mental Health IAPT access underachieved in ust with 1.24%. IAPT recovery performed to target with 50%. IAPT performance is due to capacity issues with the Provider. It should be noted that both measures are annual. 3. Quality Premium 3.1 2017/18 - NHS Quality Premium Measures NHS Constitution Measures impact on the Quality Premium in the current month is 75% with constitution measures were met either to National targets or agreed STF levels. Currently, two out of nine measures are achieving the target. 3.2 2016/17 - NHS Quality Premium Measures update Reported prevalence of hypertension on GP registers as % of estimated prevalence (target 12.5%) This measure was underachieved with 12.21%. Stroke return to usual place of residence using SUS Pbr data this measure has achieved its target. This has yet to be confirmed by NHSE with National Data. 4. Next Steps 4.1 To monitor and track and report on Commissioner Actions and progress against underperforming standards. 5. Recommendations - The Board is asked to: Note the contents and performance detailed within this report Approve actions and progress against the CCG performance standards Identify any areas where further action or information is required Page 2 of 2

Milton Keynes Clinical Commissioning Group - Board Performance Report Presented: November 2017 - Reporting Period: ust 2017 () 1. Introduction This report provides an overview of current CCG performance and key work streams in place with our partners to ensure delivery of performance standards. Performance throughout this report is detailed by exception; therefore whilst all measures are presented in the summary and dashboards; only red or amber rated indicators will be detailed in the main body of the report, including plans and actions in place to recover or improve performance. CCG Performance Summary at a glance ust 2017 2016/17 17/18 Performance Tracker - MK CCG Constitution Performance against the National Target in a 12 month period No. Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Measure M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 RTT Admitted 22 RTT Non-Admitted 22 52 Wk RTT 19 Cancelled Ops -Not Seen <28 Days 12 Ambulance Clinical Quality -Red 2-8 Min 11 A&E 4 Hour Waits 11 Ambulance Clinical Quality -Red 3-19 Min 9 Ambulance Clinical Quality - Red 1-8 Min 7 Cancer 62 DW -GP Referral 5 RTT Incomplete 5 Cancer 62 DW -Screening 5 Diagnostics 3 Cancer 2 WW -Breast Symptomatic Referrals 2 Ambulance Handover Delays > 60 minutes 2 MH CPA (Quarterly Measure) 2 TBC Cancer 31 DW -Subsequent Treatment -Surgery 1 Cancer 31 DW -Subsequent Treatment -Radiotherapy 1 Cancer 2 WW -Suspected Cancer Referrals 1 Crew Clear > 60 minutes 1 Cancer 31 DW -Subsequent Treatment -Chemotherapy/drug 1 MSA Breaches 1 Cancer 31 DW -First Definitive Treatment 0 Trolley Waits in A&E >12 hours 0 Urgent Ops Cancelled Second Time 0 Red - 6+ under performances within last 12 months Amber - 3-5 under performances within last 12 months Green - 0-2 under performances within last 12 months The grid shows MK CCG performance over the last 12 months, identifying consistent positive and negative performance as well as ad hoc performance. The number of under performances within a 12 month period is also noted. It is clear that the CCG is under achieving in areas related to activity/volume and throughput and achieving more robust, positive performance in areas related to quality. Page 1 of 11

5. EVERYONE COUNTS: ANNEX B - NHS CONSTITUTION MEASURES 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 2014/15 to 2018/19. Supporting measures are denoted by E.B.S in the indicator reference number. E.B.1 E.B.2 No. Description Target Reporting frequency Data Level M3 June Data Trend 18 Week RTT Admitted Pathways <18 Weeks 90% CCG 82.43% 82.61% 81.13% 81.90% 81.97% 18 Week RTT Non-Admitted Pathways <18 Weeks 95% CCG 89.87% 88.05% 88.26% 80.12% 89.33% Q1 Data Comments MKUHT Specialty level: Lowest performers T&O 39% / ENT 61.9% / Urology 76.6% MKUHT Specialty level: Lowest performers Urology 74% / Cardiology 74% / T&O 81% / ENT 86% / Thoracic 63.6% E.B.3a E.B.3b E.B.3c 18 Week RTT Incomplete Pathways <18 Weeks (CCG) 92% CCG 91.64% 91.42% 91.08% 91.97% 91.87% 18 Week RTT Incomplete Pathways <18 Weeks (MKUHT - Whole Provider) 92% MKUHT 91.85% 92.11% 92.14% 92.27% 92.23% 18 Week RTT Incomplete Pathways <18 Weeks (MKUHT - Trusts Own Trajectory) 92% MKUHT 91.85% 92.10% 92.10% NA NA MKUHT Specialty level: Lowest performers T&O 75% / ENT 90% RAG is against National target of 92% MKUHT's own data used until Nationally published data becomes available E.B.4a Diagnostic Waits >6 Weeks (CCG) 1% CCG 0.79% 0.53% 0.95% 0.87% 0.81% September had 31 CCG breaches E.B.5a E.B.5b E.B.6 E.B.7 E.B.8 E.B.9 E.B.10 E.B.11 E.B.4b Diagnostic Waits >6 Weeks (MKUHT-Whole Provider performance) 1% MKUHT 0.70% 0.43% 0.80% NA NA MKUHT was responsible for 26 breaches A&E Waits Seen Within 4 Hours (CCG / MKUHT) 95% CCG 91.20% 90.30% 96.31% 92.00% 92.47% A&E Waits Seen Within 4 Hours (STF Trajectory) Cancer 2 Week Waits -Suspected Cancer Referrals (CCG level) 93% Cancer 2 Week Waits -Breast Symptomatic Referrals (CCG level) 93% Cancer 31 Day Waits -First Definitive Treatment (CCG 96% level) Cancer 31 Day Waits -Subsequent Treatment - Chemotherapy/drug (CCG level) 98% Cancer 31 Day Waits -Subsequent Treatment - Radiotherapy (CCG level) 94% Cancer 31 Day Waits -Subsequent Treatment -Surgery (CCG level) 94% STF Trajectory MKUHT 89.40% 89.70% 89.90% NA NA CCG 96.75% 94.87% 97.31% 96.79% 96.18% CCG 96.97% 97.22% 95.56% 96.96% 96.63% CCG 100.00% 98.91% 98.65% 100.00% 99.05% CCG 97.30% 100.00% 100.00% 98.85% 99.36% CCG 100.00% 100.00% 95.35% 100.00% 98.65% CCG 100.00% 100.00% 100.00% 98.48% 99.11% Includes UCS and A&E figures RAG is against National target of 95% (not STF agreement of 90% by September and 95% by March 2018) STF for 17/18 - MKUHT must achieve performance before or in September that is above 90%, sustain this, and return to 95% by March 2018 Page 2 of 11

No. Description Target E.B.12a E.B.12b E.B.13 E.B.15.i E.B.15.ii E.B.16 Cancer 62 Day Waits - First Definitive Treatment -GP Referral (CCG level) 85% Cancer 62 Day Waits - First Definitive Treatment -GP Referral (MKUHT-Whole Provider performance) 85% Cancer 62 Day Waits -Treatment from Screening Referral (CCG level) 90% Reporting frequency Data Level M3 June Data Trend Q1 CCG 88.24% 91.49% 84.62% 84.85% 84.27% MKUHT 90.24% 95.41% 88.54% 87.21% 87.97% CCG 100.00% 83.33% 100.00% 100.00% 95.45% Data Comments September had 10/47 breaches MKUHT's own data used until Nationally published data becomes available 1/2 breaches in September Ambulance Clinical Quality -Category A (Red 1) 8 Minute - SCAS Level 75% SCAS 74.70% 75.50% 72.40% 75.52% 74.00% North Cluster - 70.6% / MK CCG Level -76% Ambulance Clinical Quality -Category A (Red 2) 8 Minute - SCAS Level 75% SCAS 71.80% 71.00% 69.50% 72.70% 71.70% Ambulance Clinical Quality -Category A (Red 3) 19 Minute - SCAS Level 95% SCAS 93.90% 94.80% 93.90% 94.91% 94.70% E.B.S.1 Mixed Sex Accommodation (MSA) Breaches 0 CCG 0 0 0 5 6 North Cluster -69.4% / MK CCG Level - 74.2% Figures have a period of 2 months for validation North Cluster -93.2% / MK CCG Level - 93% Figures have a period of 2 months for validation E.B.S.2 E.B.S.3 E.B.S.4a E.B.S.4b Cancelled Operations -Not Seen <28 Days (MKUHFT) 0 MKUHT 6 4 9 13 36 Mental Health Measure -Care Programme Approach 95% CNWL Q1-100% Q2-100% 100.00% 100.00% (CPA) Number of 52 Week Referral to Treatment Incomplete Pathways - CCG Level 0 CCG 6 3 2 6 Number of 52 Week Referral to Treatment Incomplete Pathways - (MKUHT-Whole Provider performance) 0 MKUHT 6 2 1 6 E.B.S.5 Trolley Waits in A&E >12 hours 0 MKUHT 0 0 0 0 0 Urgent Operations Cancelled for a Second Time E.B.S.6 0 MKUHT 0 0 0 0 0 (MKUHFT) E.B.S.7 E.B.S.8 2 at the end of Q2 2 at the end of Q2 4 MK CCG Patients all MK CC patients. 2 x out of theatre time and 2 x Anaesthetist unavailable 1 x MKUHT TCI booked (Pat choice) and 1 x OUH - rescheduled TCI from Sept to 2/10. 1 x MK CCG patient (T&O). TCI date in place. 1 x Other CCG patient - TCI date also booked. Ambulance Handover Delays > 60 minutes 411 SCAS 5 7 2 35 52 No more than 34 per month to remain within threshold Crew Clear > 60 minutes 60 SCAS 2 4 4 12 27 No more than 5 per month to remain within threshold OR 15 per quarter Page 3 of 11

6. Constitution Exception Report: 6.1- RTT 18 week Incomplete pathways No. Description Target Reporting frequency Data Level M3 June Data Trend Q1 Data Comments E.B.3a E.B.3b 18 Week RTT Incomplete Pathways <18 Weeks (CCG) 92% CCG 91.64% 91.42% 91.08% 91.97% 91.87% 18 Week RTT Incomplete Pathways <18 Weeks (MKUHT - Whole Provider) 92% MKUHT 91.85% 92.11% 92.14% 92.27% 92.23% MKUHT Specialty level: Lowest performers T&O 75% / ENT 90% RAG is against National target of 92% MKUHT's own data used until Nationally published data becomes available Issues impacting performance: The CCG underperformed against this measure in ust, and for the third month in a row. This is due to a number of contirbuting Providers underacheiveing against the 92% standard for MK CCG patients. MK CCG elective refferrals are underplan, due to improved use of RMS, this will have an impact on overall RTT acheivement for all Trusts. Actions to mitigate: Contract meetings and where appropriate, contract levers are used to address and understand issues for all providers. Work is being done to analyse RTT achievement in contributing Trusts in particular OUH who are facing significant RTT challenges. OUH, who are the CCG s main tertiary provider (approximately 6% of RTT activity), have been issued with an enforcement notice by NHSI, with on-going work to improve overall position. 6.2 - Planned Care Points of Delivery ust 2017 Issues impacting performance: Overall activity is under plan. Electives: This includes QIPP reduction of 116 spells per month for the Procedures of Limited Clinical Value Project. This is supported by the RMS, thereby maximising the use of community services. Outpatients First: There has been slippage on schemes PV1701Q (Polcv) and SI1711Q (C2C), these are now live from Q2 and will develop throughout the year. GP Referrals: Seen primarily across T&O and Respiratory where QIPP schemes commenced at the start of the year. 6.3 - Cancer 62 Day Waits - First Definitive Treatment -GP Referral No. Description Target E.B.12a E.B.12b Cancer 62 Day Waits - First Definitive Treatment -GP Referral (CCG level) 85% Cancer 62 Day Waits - First Definitive Treatment -GP Referral (MKUHT-Whole Provider performance) 85% Reporting frequency Data Level M3 June Data Trend Q1 CCG 88.24% 91.49% 84.62% 84.85% 84.27% MKUHT 90.24% 95.41% 88.54% 87.21% 87.97% Data Comments September had 10/47 breaches MKUHT's own data used until Nationally published data becomes available Issues impacting performance: The CCG has underachieved against the target in ust with 84.64% and 6 / 39 breaches. MKUHT achieved this target with 88.54% and 5.5 / 48 breaches. There were no patients over 104 days, all patients are analysed and RCAs are requested for those over 104 days. Page 4 of 11

6.4 Ambulance Clinical Quality Red 1 No. Description Target E.B.15.i Issues impacting performance: The CCG has underachieved against the target in ust with 72.4%, however achieved the target at MK CCG level. The South Central Ambulance Service (SCAS) will be implementing changes to the coding of incidents resulting in improved efficiency and supporting the achievement of targets moving forward. 6.5 52 week waits Reporting frequency Data Level M3 June Issues impacting performance: The CCG has 2 patients waiting over 52 weeks for treatment. One is within MKUHT this patient had a TCI date in October. One is from OUH, this patients is awaiting a TCI. Data Trend Q1 Data Comments Ambulance Clinical Quality -Category A (Red 1) 8 Minute - SCAS Level 75% SCAS 74.70% 75.50% 72.40% 75.52% 74.90% North Cluster - 73.1% / MK CCG Level -79.4% No. Description Target E.B.S.4a Reporting frequency Data Level M3 June Data Trend Number of 52 Week Referral to Treatment Incomplete Pathways - CCG Level 0 CCG 6 3 2 6 Q1 6 at the end of Q1 Data Comments 1 x MKUHT No TCI due to paient choice and 1 x OUH - rescheduled TCI from Sept to 2/10. Page 5 of 11

7. IAF: Annex D - IMPROVEMENT AND ASSESSMENT FRAMEWORK The Improvement and assessment Framework (IAF) is an annual assessment of every CCG, drawing together in one place, the NHS Constitution, core performance, outcome and finance metrics and transformational challenges. The IAF supports delivery of the NHS s triple aim of improving the health and wellbeing of the whole population, providing better quality services and better value for all patients. The IAF will be used by the CCG as a self-assessment tool, identifying well performing areas and highlighting areas in need of improvement. Performance will be updated as released and reported by exception. 7.1 IAF Better Care Cancer Measures Issues impacting performance: This data has been refreshed leading to reduced performance for the CCG. Q1 in 2016 achieved 51%. Our revised target for the 2016 calendar year will be to achieve 57.8%. (Q4 and Q1) the CCG have achieved 49.8%. 7.2 IAF Better Care Mental Health Clinical Priority Area Mental Health IAPT Recovery Rate Description Overall IAF RAG Rating 2016 IAF data RAG IAF THEME - BETTER CARE Performing Well Jan 2017 2017 IAF data RAG IAF data RAG Nov 2016-2016-17 Cross references People who have attended 2or> sessions, discharged and moving to recovery 52.38% ranking for both 42.5% 52% 52.70% 50.97% 49% measures IAPT Access Rate These measures are T hese measures are Constitution Constitution measures and Annual target (16%) / Quarterly target (4%) 1.10% 1.03% 1.24% 0.72% measures and are are not within the IAF not within the IAF M6 Sept Latest direction of travel Performance Requirements to achieve "Performing Well" performance 50.51% Top performing = >55% Performing well = 50-55% performance 5.96% This metric is not within the IAF Actions / Comments The 2017/18 annual target for Access is 15% (+1%). Issues impacting performance: The Provider, Central & North West London (CNWL) has underachieved both the access and Recovery target for ust. This is due to capacity issues within the service. CNWL have in place a number of actions to address performance: A manager has been appointed to manage the Access service, staffing and recruitment. CNWL can confirm that sufficient referrals are being received to meet the end of year target. CNWL are also interviewing for 3 posts in November, and if successful, the service will be at full capacity by end of Jan 18. They are also recruiting bank staff to clear backlog, and establishing their own internal bank staff supply to manage future vacancies. Page 6 of 11

8. Quality Premium Measures Dashboard The Quality Committee are leading on a number of work streams to ensure that all measures within the 2017/18 Quality Premium are tracked and managed on a regular basis. This will allow early identification of risks and implementation of action plans to improve performance and achievement of the QP. The total amount of the 2017/18 Quality premium is expected to be: 1,440,660. The CCG will be awarded the QP value of each national measure achieved, with the appropriate 25% reduction for each Constitution Measure not achieved by Q4. 8.1 Quality Premium National Measures Dashboard 2017/18 QP Ref QP Measure / Description Required Achievement QP value Target By When Latest Period Data Overall forecast to Achieve Data Comments / Update QP 1 NM 1 Early Stage Cancer 1. Demonstrate a 4 percentage point improvement in the proportion of cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the Cancer - New cases of cancer diagnosed at 2017 calendar year compared to the 2016 calendar year. stage 1 and 2 as a proportion of all new Or cases of cancer diagnosed (specific cancer 2. Achieve greater than 60% of all cancers sites, morphologies and behaviour*) (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the 2017 calendar year. * - invasive malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary, uterus, non-hodgkin lymphomas, and invasive melanomas of skin. 17% 244,912.20 1. TBC - awaiting 2016 outcome OR 2. 60+% 2017 Calendar Year Total Average Figures between Jan - Dec 17 Q4 2014-54.6% Q1 2015-50.3% Q2 2015-51.9% Q3 2015-58.0% 2015 Calendar year = 53.8% Q4 2015-48.5% Q1 2016-51.0% Target looks at 2016 Calendar year acheivement Dec 2016 due out Q4 from NHSE QP assessment Amber Last data released for this measure is Q1 2015. The data for 2015 calendar year will be released by 2017. This will then need to be compared to the 2016 calendar year. Up to date data is being sourced via the NCIN website. Action: The Cancer Steering Group is monitoring prevention and public awareness programmes and diagnostic capacity to support achievement of this target. The CCG have requested current Cancer diagnosis data from the Trust and the Cancer Network to obtain a more updated view of performance. The Quality Committee is leading on driving Quality Premium improvements. QP 2 NM 2 Patient Experience GP Patient Survey - Question 18: Overall, In 2018 publication, either: how would you describe your experience of 1. Achieve a level of 85% of respondents who said making an appointment? they had a good or very good experience of making an appointment or 2. A 3 percentage point increase from 2017 publication on the percentage of respondents who said they had a good or very good experience of making an appointment 17% 244,912.20 1. 85% 2. 69% 2016 Publication (Published in 2018) 60% - Sept 2015 64% - Sept 2016 66% Jan - Mar 2017 Red Amber rag because published data is historical and recent data improvements have been made. The new target for 2018 is 69%. Red rag because 2016/17 target was not met. QP 3 NM 3 Continuing Healthcare CHC 2 part Indicator Part 1. CCGs must ensure that more than 80% of all full NHS CHC assessments are completed within 28 days. Part 2. CCGs must ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital setting. Delivery of part 1: Develop protocols with services regularly involved in NHS CHC assessment processes that facilitate their timely participation in the comprehensive assessment. To include timely provision of assessment information, specialist assessments and attendance at the Multidisciplinary Team (MDT) meeting and prompt verification and eligibility decision making by the CCG in order to complete these processes within 28 days. Delivery of part 2: Assessment of eligibility for NHS Continuing Healthcare should usually be deferred until an accurate assessment of future needs can be made following post-acute recovery. To effect this accurate assessment, appropriate NHS-funded post-acute recovery provision should be routinely available and used. For example: therapy and/or rehabilitation, intermediate care interim package of support in an individual s own home, or in a care home. 8.5% 122,456.20 8.5% 122,456.20 >80% within 28 days in the 17/18 FY <15% in Hospital setting in the 17/18 FY Year (April 17 to March 18) Year (April 17 to March 18) Q1-16/17-55% Q2-16/17-69% Q3-16/17-73% Q4-16/17-56% Q1-16/17-30% Q2-16/17-19% Q3-16/17-29% Q4-16/17-24% April - 83.3% May - 76% June - 64.7% - 30.77% - 64.52% Sept - 48.39% April - 25% May - 24% June - 29.41% - 26.92% - 38.71% Sept - 32.26% 58.45% 30.28% Red Red Drop in performance due to data inputting issues relating to clock starts and stops and capacity within the team. Actions to mitigate: Data entry improvements are in place from ust 28 day assessment timelines have been agreed for community, acute and intermediate care assessments Roles and responsibilities have been reviewed to deliver each pathway Increased capacity in the team has been made available and all postholders will be fully in place by September. An improvement trajectory is in place and will be monitored closely The CHC team are working towards achievement of this target Red rag because performance is over the target. However, improvement plans are in place. Page 7 of 11

QP Ref QP Measure / Description Required Achievement QP value Target By When Latest Period Data Overall forecast to Achieve Data Comments / Update QP 4a NM 4a Mental Health Selected MH Measure - Option B Addressing inequitable rates of Older People and people from Black and Minority Ethnic (BAME) communities accessing the Improving Access to Psychological Therapies (IAPT) services Option B Part 1) Recovery rate of people accessing IAPT services identified as BAME; improvement of at least 5 percentage points or to same level as white British, whichever is smaller 17% 244,912.20 Part 1) BAME recovery rate = improvement of at least 5 percentage points or to same level as white British, whichever is smaller Target for 17/18 = either 56% or to the same rate at White British as at March 2018 Year (In April 17 to March 18) BAME Recovery Q4 16/17-51% BAME Recovery Q1 17/18-59% White British Recovery Q4 16/17-52% White British Recovery Q1 17/18-48% Green Amber - Must be meeting both measures to be considered Green The March 2016/17 closing recovery rate was 51% The 17/18 target will be whichever is the smaller figure as at March 2018. CNWL Actions: IAPT Workforce BAME profile is 16% of the total IAPT workforce. National BAME representation is 17%. CNWL IAPT have a 3-pronged approach: 1. Appointed BME lead who will outreach to community and faith organisations to raise awareness 2. Appointed service user lead; service now has a service user steering group, who will recruit BME users into this so they can raise awareness in their own communities 3. Establish Spot contract arrangements with local faith groups to provide clinical space with proviso to provide minimum number of referrals e.g. local Gurdwara QP 4b NM 4b Mental Health Part 2) Proportion of people accessing IAPT services aged 65+; to increase to at least 50% of the proportion of adults aged 65+ in the local population or by at least 33%, whichever is greater in 2017/18 Part 2) 65+ access = to increase either to 50% or by 33% of the local 65+ population, whichever is greater in 2017/18 Year (In April 17 to March 18) Nationally Published data - Apr - 25.9% / May 26.7% / June 29.1% - Unify Q4 16/17-28.4% / Q1 2017/18-14% (IAPT dashboard) Local Provider data - Apr 3.2% / May 2.7% / June 3% / Q1 3% / 5% Red CNWL is looking to develop work with community partners and targeting Age U.K. This will involve a number of initiatives tailored to this group as well as a presence in their facilities and offering brief intervention training with referral pathway into IAPT services. QP 5 NM 5 Bloodstream Infections Three parts to Indicator: Part a1) reducing gram negative blood stream infections (BSI) across the whole health economy 45% weighting Part b) reduction of inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care Part a) a 10% reduction (or greater) in all E coli BSI based on 2016/17 performance Part a2) collection and reporting of a core primary care data set for all E coli BSI in Q2-4 2017/18. Part b1) a 10% reduction (or greater) in the Trimethoprim: Nitrofurantoin prescribing ratio based on CCG baseline data (June 2015-May 2016 was 1,423) 0 7.65% 45% weighting 110,210.49 7.65% 45% weighting 110,210.49 Part a1) 16/17 = 187. 10% reduction = 168 cases / 14 per month max Part a2) progressing 2017/18 Target 15/16 baseline with 10% reduction applied part b1) 1.281 2017/18 Target 15/16 baseline with 10% reduction applied part b2) 5,084 April 2017-21 cases 2016/17 total May 2017-12 numbers - 187 cases Year (Total number cases for MK June 2017-11 of cases between CCG cases April 17 to March 18) We need to 2017-24 achieve 168 total cases in 17/18 2017-19 cases Sept 2017-21 2015/16 Baseline April - 1.332 Year (April 17 to data May - 1.286 March 18) June - 1.225 performance over the part b1) 1.423-1.142 full year - 1.062 Year (April 17 to 2015/16 Baseline April - 5,276 March 18) data May- 5,229 performance over a June - 5,157 rolling 12 month part b2) 5,649-5,082 period - 4,981 2017/18 total target = 168 total = 108 The CCG have 60 cases left over 6 months (allowance of 10 cases per month) Green Green Red Green Work locally will focus on working collaboratively across the Whole Health Economy to: Identifying robust surveillance methodology Gathering baseline data via RCA s during quarter 2, and using this to identify gaps/themes Developing an improvement plan based on the thematic review Focusing on prevention of UTI s/cauti s as these are the biggest cause of infection locally and nationally Red rag because performance is 20% over the annual target. This measure is over achieving against the target. This measure is under achieving against the target. Overall Red rag has been assigned as NHSE has identified MK CCG as having not met the overall target for the latest published month. Part c) sustained reduction of inappropriate antibiotic prescribing in primary care - (STAR-PU) must be equal to or below England 2013/14 Part c) sustained reduction of inappropriate mean performance value of 1.161 items antibiotic prescribing in primary care per STAR-PU 1.7% 10% weighting 24,491.22 Equal to or below 1.161 items per STAR-PU Year (April 17 to March 18) performance over a rolling 12 month period Jan - 1.182 Feb - 1.166 Mar - 1.153 April - 1.149 May - 1.147 June - 1.142-1.137-1.133 Green Green The CCG are meeting this target in September. Action: The Commissioner has assured the CCG that Antimicrobial prescribing remains in the current Prescribing Incentive Scheme and is being discussed at all the practice visits currently under way. The Commissioner has also sent all GP Practices an email reminding all GPs to avoid the use of antibiotics unless there is likely to be clear clinical benefit and offer delayed prescriptions where possible. Work is also being done with Hospitals to prevent clinicians from directing patients to GPs for antibiotic prescriptions. Green rag as this measure is over achieving against the target. QP 6 NM 6 Right Care Indicator Maternity & Reproductive Health - Smoking at time of delivery 10.90% by Q4 2017/18 15% 216,099 10.90% by Q4 2017/18 Year (April 17 to March 18) Q4 performance 16/17 - Q2-10.31% 16/17 - Q3-11.61% 16/17 - Q4-14.06% 17/18 - Q1-11.57% Amber Amber rag because performance for this measure fluctuates across the year. A number of work streams and improvement plans are in place. This measure is monitored via the Children, young people and maternity programme board. Total Available (Best Estimate based January 17 MK CCG registered 1,440,660 population = 288,132) Best Estimate Eligible Quality Premium Funding (subject to achievement of NHS Constitution Rights and Pledges) 134,701 Based on achieving BSI Measure QP 5, parts b1, b2 and c Page 8 of 11

8.2 - Quality Premium Constitution Dashboard 2017/18 QP Ref NHS 1 NHS 2 NHS 3 NHS 4 QP Measure / Description Maximum 18 weeks from referral to treatment Incomplete standard Maximum four hour waits in A&E departments Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer Maximum 8 minute response for Category A (Red 1) ambulance calls Required National Achievement in 2017/18 2016/17 Q4 Data (STF criteria) CCG data 2017 National RAG Rated Provider RAG against STF / National target 92.00% 92.30% 91.10% 92.10% 95.00% 89.27% 96.30% 96.30% MKUHT STF >90% 85.00% 87.79% 84.62% 88.54% 75.00% 75.61% 72.40% 72.40% Adjustment for Underachievement of NHS Constitution this month 2017/18 = 75% Summary of risks and mitigating actions: Risk / Issue: Potential risk of not achieving the NHS Constitution measures in line with agreed targets and the subsequent financial impact on the overall Quality Premium amount awarded. As at ust 2017 (Q2), 1/4 constitution measures have achieved against either the National or STF required targets. This will have a 75% reduced impact on the values from the total national measures achieved. Mitigation: Performance and the Quality Committee are monitoring performance on a monthly basis in line with the National standards and or the A&E STF trajectory. All instances of underperformance are being followed up with the Commissioner(s) and remedial actions and updates are requested through programme boards and are reported above. There are nine Quality Premium measures against which funds can be received. These are ragged for the current month below: Red Amber Green 4 3 2 8.3 - Quality Premium 2016/17 Latest update on achievement Cancer Staging - data has been historically refreshed in October 2017. This has reduced our numbers, overall performance and end of year target from 58% to 54%. We now need to achieve 54% by December 2016 (data released in Q4 17/18). Latest data released (and revised) data for Q1 2016, shows performance at 48%. Hypertension Prevalence The target was 12.5%. The CCG under achieved with 12.21% in October 2017. This target was not achieved. Stroke return to usual place of residence Using Pbr SUS figures (and pending NHSE national publication), this measure has achieved the 2016/17 target. Page 9 of 11

9. Quality Committee Dashboard MKUHT These Quality Indicators for MKUHT have been selected by Commissioners to represent quality pledges for all NHS patients. The national requirements, in terms of operational standards expected are shown and all measures are reporting by exception only in the following report. No. QI Trust Description Target QIT12 QIT13 QIT14 Transfer from HASU to MKHFT ASU within 24 hours of notification % patients with high risk TIA treated within 24 hrs but not admitted % patients with low risk TIA with access to scan within 7 days of onset of symptoms M6 Sept Data Trend Q1 Q2 95% 50.00% 75.00% 50.00% 58.80% 58.33% 58.80% 60% 29.40% 38.10% 72.20% 49.33% 46.57% 49.33% 65% 70.00% 12.50% 90.00% 53.40% 57.50% 53.40% QIT15 Stroke -Time in Hospital on a Stroke Ward >90% 80% 72.20% 83.30% 84.20% 91.10% 79.90% 85.50% QIT16 Stroke -Admitted to an Acute Stroke Unit Within 4 Hours of Arrival 90% 66.70% 66.70% 47.40% 62.63% 60.27% 61.45% Stroke -Admitted to an Acute Stroke Unit Within 4 Hours of QIT17 60-65% 61.50% 62.00% 62.50% NA NA NA Arrival (MKUHT - Locally Agreed Trajectory) Stroke -Time in Hospital on a Stroke Ward >90% QIT17 80% 72.70% 75.27% 72.70% 74.63% Luton CCG QIT18 QIT19 QIT20 Stroke -Admitted to an Acute Stroke Unit Within 4 Hours of Arrival- Luton CCG Stroke -Time in Hospital on a Stroke Ward >90% Beds CCG Stroke -Admitted to an Acute Stroke Unit Within 4 Hours of Arrival - Beds CCG To be taken from 90% NA NA NA SSNAP data due Nov 80% 92.80% 66.67% 90.90% 90.07% 83.46% 90.00% 90% 85.71% 57.14% 90.90% 82.14% 71.43% 86.84% QIT22 Incident Reporting -Never Events NA 0 1 1 1 2 3 QIT23 Delayed Transfers of Care -Days Delayed (MKUHFT only) TBC 1,109 1,373 4,743 2,482 7,225 QIT33 Healthcare Acquired Infection Measure (MRSA) - CCG Level 0 cases 1 0 0 1 1 2 QIT34 Healthcare Acquired Infection Measure (MRSA) MKUHT level 0 cases 0 2 0 1 2 3 Below 81 QIT35 6 pm / 18 pq Healthcare Acquired Infection Measure (Clostridium cases in Difficile) - CCG Level 2016.17 4 7 3 11 14 25 QIT36 QIT37 QIT38 Healthcare Acquired Infection Measure (Clostridium Difficile) - MKUHT Level Healthcare Acquired Infection Measure (E-Coli) - CCG Level Healthcare Acquired Infection Measure (E-Coli) - MKUHT Level Below 39 cases in 2016.17 3 pm / 9 pq Below168 cases / 14 per month max 1 3 0 1 4 5 24 19 21 44 64 108 4 1 1 8 6 14 9.5 QIT15 and 16 Stroke Measures (Time spent on ward and Admitted within 4 hours) - MKUHT ust 2017 UPDATE - ISSUES and ACTIONS QIT15 - MKUHT performance has increased from 72.2% to 83.3%, with 15 out of 18 patients meeting the target. QIT16 MKUHT has achieved the local target with 66.70% (12/18 patients). Actions: MKUHT is working towards the implementation of improved pathways for stroke patients supported by strengthened processes to ring fence stroke beds. Demand for medical admissions continues to present challenges to the ring fencing process and as a result is being overseen at executive level. MKUHT has appointed a stroke champion in A&E to support the functions of the Stroke Advanced nurse practitioner which will support timely identification and management of stroke patients in A&E. The CCG continues to work with MKUHT to improve patient flows. STP discussions within the STP continue to develop stroke pathways in line with best clinical practice. 9.5 QIT15 and 16 Stroke Measures (Time spent on ward and Admitted within 4 hours) - MKUHT ust 2017 UPDATE - ISSUES and ACTIONS QIT15 - MKUHT performance has increased from 72.2% to 83.3% of patients admitted with stroke or suspected stroke spending 90% of time on ASU from arrival. MKUHT has achieved the 80% national target with 15 out of 18 patients meeting the target. QIT16 MKUHT has agreed a local performance trajectory for this measure of between 60 and 65%. In ust, MKUHT has achieved this target with 66.70% (12/18 patients). Contractual penalties are applied as and where appropriate. Actions: MKUHT is working towards the implementation of improved pathways for stroke patients supported by strengthened processes to ring fence stroke beds. Demand for medical admissions continues to present challenges to the ring fencing process and as a result is being overseen at executive level.. MKUHT has appointed a stroke champion in A&E to support the functions of the Stroke Advanced nurse practitioner which will support timely identification and management of stroke patients in A&E. The CCG continues to work with the MKUHT to improve patient flows. STP discussions within the STP continue to develop stroke pathways in line with best clinical practice. Page 10 of 11

9.6 QIT 22 Never Event ust 2017 UPDATE - ISSUES and ACTIONS MKUHT suffered one never event in ust categorised as a wrong site surgery. This is the second Never event for MKUHT. Actions: The RCA is currently being reviewed by the CCG & NHSE. 9.8 QIT23 Delayed transfers of Care - MKUHT ust 2017 UPDATE - ISSUES and ACTIONS MKUHT have had a total of 1,373 DToC days this month, this is a 24% increase on DToC days. The planned number of DToC days for the CCG as a whole has been agreed as 6,079 for the full year. Total DToC days stand at 6,877. This is 13% over the annual plan with 7 months remaining in the year. BCF system wide actions - The Recuperation Pathway / a daily Ready to Transfer call, chaired by the CCG / early discharge planning / EDDs that drive the discharge planning process, part of Red2Green and SAFER implementation. The CCG has addressed CHC issues by commissioning step down bed into which potential CHC funded patients can be moved, and streamlining the acute and intermediate CHC process. As reported previously, the move to a Community Pull model will also mean that discharge arrangements and issues preventing it will be identified by the community teams earlier in the patient s stay, so that they can be moved to the intermediate service as soon as possible once medically safe to do so. 10. Quality Committee Dashboards CNWL No. QI CN Description Target CNWL have presented no issues and have met all Quality Committee measures for ust 2017 Many measures are quarterly, therefore not released yet. Due to the new information schedule, some data is still being sourced. M6 Sept Data Trend QICN8 Delayed Transfers of Care -Days Delayed (CNWL only) TBC 277 192 2,139 QIT33 QIT34 QIT35 QIT36 QIT37 QIT38 Healthcare Acquired Infection Measure (MRSA) - CCG 0 cases Level 1 0 0 2 Healthcare Acquired Infection Measure (MRSA) CNWL 0 cases level 0 0 0 0 Below 81 Healthcare Acquired Infection Measure (Clostridium cases in Difficile) - CCG Level 2016.17 4 7 3 25 6 pm / 18 pq Healthcare Acquired Infection Measure (Clostridium Difficile) - CNWL level Healthcare Acquired Infection Measure (E-Coli) - CCG Level Healthcare Acquired Infection Measure (E-Coli) - CNWL level Below168 cases / 14 per month max 0 0 0 0 23 20 21 108 0 0 0 38 The commissioning of the step down beds will also support the non-weight bearing pathway, which traditionally has been a cause of delays. Page 11 of 11