NHS Fylde and Wyre CCG Performance Dashboard

Governing Body January 2016 NHS Fylde and Wyre CCG Performance Dashboard October 2015 (Month 7)

Governing Body This report provides a high level summary of performance and activity and across Fylde and Wyre CCG for the most recent reporting period for which data is available. The report highlights key issues, current performance and key actions. Key performance indicators and metrics have been RAG Rated for both the CCG and the four major healthcare providers in Fylde and Wyre CCG (Blackpool Teaching Hospitals, Lancashire Teaching Hospitals, Lancashire Care Foundation Trust and Spire Fylde Coast Hospital). Members of the Governing Body are asked to note the contents of the report. The Acute Contract year to date total variance is an overperformance of 1,064,983 Cumulatively GP Referrals for year to date across all providers have increased by 1.3% (279) when compared the same period in 2014/15. In the of October 2015, GP referrals were consistent with the same the previous year (table 1 below). Table 1 GP referrals across all specialties to Blackpool Teaching Hospitals for year to date, compared to the previous year, have increased by 2% (390). Market share has increased by 0.8% compared to the previous year GP referrals across all specialties to Spire Hospitals for year to date, compared to the previous year have increased 7% (108), there has been a 24.4% increase in GP Referrals to the specialty of Trauma & Orthopaedics. Market share has increased by 0.4% compared to the previous year.

Blackpool Teaching Hospital: At 7 the Trust is overperforming against the planned contract value by 220,926, this is a significant reduction compared to the previous. Cumulatively, Daycase activity is 8% above planned levels, however, Dermatology activity previously coded as a Daycase has now been correctly recorded as an outpatient procedure at 7. Elective activity is broadly in line with planned levels and Non Elective activity continues to underperform. Spire: At 7 Spire is over performing against the planned contract value by 626,954 (41%). The majority of overperformance is in the specialty of Trauma & Orthopaedics in the Points of Delivery of Day Case, Elective, Outpatient First and Follow Up attendances. The level of overperformance at Spire has significantly increased compared to the previous ( 6, 490k). The CCG raised a formal contract query as the overperformance does not appear to correlate entirely with the increase in GP referrals. An Executive level meeting was held with Spire on 27 November 2015 to discuss the queries in more detail. A number of issues and actions were discussed, a further formal response is awaited from Spire. Lancashire Teaching Hospitals: At 7 Lancashire Teaching Hospitals is overperforming against the contract value by 271,560 (5%). The majority overperformance is against planned levels of Elective activity 181,289 (20%) and Critical Care 83,748 (36%). There are performance concerns in respect of the following areas:- Referral to Treatment (RTT) times for non-urgent consultant led treatment 62 Day Cancer Wait 31 Day Cancer Wait Two Week Cancer Wait for breast symptoms NWAS Targets Ambulance Handovers IAPT Recovery Estimated diagnosis rate for people with dementia Health Care Acquired Infections (HCAI) Mortality and Mortality Reporting Serious Incidents Never Events Mixed Sex Accommodation Breaches Description of Risk/Issue: In the of October 2015 and for year to date the CCG achieved the RTT incomplete pathway standard of 92%. However, Lancashire Teaching Hospitals did not achieve the target in with performance of 89.9%. The RTT Admitted and Non Admitted standards and sanctions have now been abolished; however, performance against these standards has been included in the dashboard for information. Further actions identified: Following a recent review and update of the RTT recovery plan by Lancashire Teaching Hospitals a deep dive into the RTT waiting list was launched. The review identified a number of patients who had not been monitored

and treated in line of with RTT guidance, 53 of which were highlighted as waiting over 52 week waits, none of the over 52 week waiters are Fylde & Wyre CCG patients. The Trust also identified a total of 715 admitted patients waiting over 18 weeks, 36 of which relate to Fylde & Wyre CCG. Both Monitor and NHS England have been informed of the situation and are supportive of the actions identified by the Trust to recover the RTT position. A formal contract performance notice will be issued to the Trust by the Host Commissioner to help provide a framework for the recovery plan process. The Intensive Support Team visited the Trust on 16 December 2015 and are assured that the Trust is following the IST s review of RTT processes and that access polices reflect current RTT guidance. The Governing Body is asked to note that the target is currently being achieved at CCG level. However, there are performance issues at Lancashire Teaching Hospitals which are likely to have a negative impact on CCG performance in quarter 3, until the recovery plan is implemented in full. Description of Risk/Issue: The CCG is achieving the target both in and for year to date. However, in the of October 2015, Lancashire Teaching Hospitals did not achieve this target with performance of 82.5% against a target of 85%. Year to date, Lancashire Teaching Hospitals is also failing this target with performance at 70.2%. Further actions being taken to improve performance are detailed in the narrative in the following sections. Description of Risk/Issue: In the of October 2015, the CCG marginally did not achieve the 31 day cancer target for subsequent treatment (surgery) with a performance of 93.8% against a target of 94%. There was 1 breach of the target at Lancashire Teaching Hospitals. The Trusts have confirmed that the breach was due to medical reasons as the patient had not stopped their Aspirin prior to surgery. Year to date, the CCG is achieving the target with performance of 95.9% against the target of 94%. Lancashire Teaching Hospitals also failed the target in the of October 2015 with a position of 85.7%; however they are achieving the position with performance of 94.4%. Previous actions undertaken and impact: The CCG investigates all breaches with the cancer managers at the relevant Trust sites that occur in order that root causes can be determined and any corrective actions taken. A copy of Lancashire Teaching Hospitals improvement plan for cancer has been received by the CCG, which was in response to the 8 key priorities issued by Monitor, the Trust Development Authority and NHS England. Lancashire Teaching Hospital will be monitored against this plan to achieve full compliance of these 8 priorities. The Governing Body is asked to note that the CCG is currently achieving the target for year to date, whilst there remain some performance concerns at Lancashire Teaching Hospitals, the position has improved compared to the previous as the actions within the improvement plan are implemented.

Description of Risk/Issue: The CCG is not achieving the target in (88.5%) or year to date (91.6%), against a target of 93%. There were 3 breaches of the target at Blackpool Teaching Hospitals, all due to patient re-arranges. Blackpool Teaching Hospitals is not achieving the target in the (87%) or for year to date, with (91%). Previous actions undertaken and impact: The CCG investigate all breaches with the cancer managers at the relevant Trust sites that occur in order that root causes can be determined and any corrective actions taken. Further actions identified: Discussions take place at the Fylde Coast Cancer Steering Group regarding further actions which can be undertaken within primary care to reinforce the importance of patients attending their appointment. The CCG has asked the Trust to notify the GP if the patient re-arranges, a response is awaited from the Trust regarding whether a notification system can be put in place. Blackpool Teaching Hospitals continue to work towards reducing waits for urgent referrals for breast symptoms, at present only 5.32% of patients receive an appointment within day 1-7, the vast majority are offered an appointment between days 7-14 which means that the likelihood of the patient being rebooked within 14 days if they need to re-arrange is much lower. Blackpool Teaching Hospitals have a Cancer Improvement Plan in place, the CCG has asked the Trust to confirm the timescales for implementing timed pathways for each tumour site. It is anticipated that the implementation of timed pathways will reduce the number of patient re-arranges outside of 2 weeks and will also improve performance. The CCG continues to work with the Trust and Primary Care colleagues to develop further actions to emphasise the importance of patients attending their appointment. No further action is required by the Governing Body, at this stage. Description of Risk/Issue: This exception narrative focuses on the response times for Category A (Red 1 and Red 2) calls target 75% to be responded to within 8 minutes, Red 1 Actual performance: Month 7 2015/16 59.02% for Fylde and Wyre CCG & 71.93% for Lancashire (75.85% for NWAS as a whole). This is an increase in performance locally for Fylde and Wyre, but a decrease for Lancashire and NWAS performance as a whole, compared to Month 6 (50.0% for Fylde and Wyre CCG, 76.1% Lancashire and 78.4% for NWAS as a whole). Red 2 Actual performance: Month 7 2015/16 58.53% for Fylde and Wyre CCG, 71.81% for Lancashire (72.45% for NWAS as a whole). This is a decrease in performance locally for Fylde & Wyre, Lancashire and NWAS performance as a whole, compared to 6 (60.7% for Fylde and Wyre CCG, 72.8% Lancashire and 74.9% for NWAS as a whole).

Target for all Category A: 95% to be responded to within 19 minutes. (All Reds) Actual performance: Month 7 2015/16 91.12% for Fylde and Wyre CCG and 93.47% for Lancashire (94.08% for NWAS as a whole). This is an increase for Fylde & Wyre and Lancashire compared to the previous but a reduction for NWAS as a whole (Month 6 91.2% for Fylde and Wyre CCG, 93% Lancashire and 94.6% for NWAS as a whole). Further actions identified: Whilst 7 shows an improvement in Red 1 performance for Fylde & Wyre locality Red 2 and A19 (All Reds) have decreased. Across the Fylde Coast and the North West winter pressures have impacted on A&E and NWAS performance. Delays in A&E at Blackpool Teaching Hospitals had a detrimental effect on Ambulance performance in November 2015. There were some issues with batching of ambulances at A&E between Christmas and New Year which caused significant pressures on A&E performance and this continued into early part of January 2016. There has been further pressure on A&E as a result of increased numbers of patients being referred on from Primary care, the CCG have issued newsflashes to request that GPs contact the A&E Consultant prior to referring on. There has also been an increase on ambulance requests from 111 following the changes in service. The table below demonstrates that ly A&E performance for the s of October and November 2015, which is much lower compared to the same period the previous year. A&E performance has further deteriorated in early January 2016, with weekly performance as at 8 January 2016 of 83.26%. 100.0% 98.0% 96.0% 94.0% 92.0% 90.0% 88.0% 86.0% 84.0% Monthly A&E Performance 14/15 v 15/16 Apr May Jun Jul Aug Sep Oct Nov 14/15 Performance 15/16 Performance Threshold Prior to the Christmas period NWAS were asked for a performance improvement plan to address the performance issues they were experiencing on a sustainable basis. An initial step within this was the agreed deployment of Non-Pathways Operators. Teleconference calls were held with NWAS on a regular basis to monitor the clinical prioritisation and safety of the service and also to review performance levels and probe further regarding service delivery, particularly around clinical safety, prioritisation and the management of patients who were waiting for a call back from a clinician to complete their assessment. NWAS actively contacted Out of Hours Services over the holiday period to establish if there were any particular concerns or problems. To date, commissioners are not aware of any serious incidents that have occurred during this period or any significant change in the patterns. Blackpool CCG, as Lead Commissioners, met with NWAS on 4 January 2016, with members of the North West NHS 111 Programme Board. A formal Contract Performance Notice was issued on 8 January 2016, as

performance did not improve following the initial meeting. The next stage is for the two parties to meet formally within the next ten operational days to discuss the Contract Performance Notice and any related issues. NWAS continue to undertake a number of actions in the interim as part of their previous performance improvement plan. A formal Remedial Action Plan is awaited. The Governing Body is asked to note the enactment of formal contractual process in order to address sustained NWAS performance issues. Governing Body is also asked to note the negative impact Ambulance performance will have on achievement of the A&E performance indicator during late quarter 3, early quarter 4. Description of Risk/Issue: All handovers between ambulance and A&E must take place within 15 minutes. There are financial penalties for handovers longer than 30 and 60 minutes. 100% of all handovers must take place within 15 minutes this includes Ambulance Arriving at A&E, Ambulance Crew Notifies Arrival through Hospital Arrival Screen (HAS), Acute Accepting Handover through HAS Screen, Crew Clears and is available for next incident. The indicator applies to Acute Trusts, it should be noted that there are separate penalties for North West Ambulance Service. BTH Month 7 - October 2015 95.35% which equates to a 1.73% reduction to the previous September 2015 97.08%. (2015-2016 Average 97.24% compared to 2014-2015 Year to Date Average 96.14%). LTH Month 7 - October 2015 91.87% which equates to a 0.80% reduction to the previous August 2015 92.67%. (2015-2016 Average 94.35% compared to 2014 2015 Year to Date Average 92.24%). Previous actions undertaken and impact: The calculation and application of penalties was discussed at the Blackpool Teaching Hospitals Contract Subgroup Meeting on 18 November 2015. A discussion regarding reinvestment of penalties was held at the System Resilience Group meeting in December 2015, however, no final decision has been made, as of yet. Further actions identified: Turnaround & Handover times have increased during October and November 2015 due to increase in A&E Attendances and admissions being above planned levels. During November 2015 the turnaround times were breaching 30minutes but have now reduced to under or around 27mins. The Ambulance Liaison Officer continues to support and ensure breaches are kept to a minimum and are working with Blackpool Teaching Hospitals. The Governing Body is asked to note the impact of early winter pressures on Ambulance Handover Times and that discussions regarding reinvestment of penalties are ongoing.

Description of Risk/Issue: Performance for Fylde and Wyre CCG has dipped by 0.4% compared to the previous, from 37.7% in September 2015 to 37.3% in October 2015 against a target of 50%. This is as expected as the impact of previous actions agreed to improve the rate, is predicted to be seen in Quarter 4. Previous actions undertaken and impact: All actions to enable GP Practice submission of data to the HSCIC have been completed. The Village Practice has submitted data for all three practices for November 2015 within the planned timescale. However, the quality of the data submission cannot be assured until the national publication in February 2016. The pathway is now in place for direct referral from LCFT to Big White Wall, it is anticipated that this will result in an increased uptake of live therapy from the Big White Wall. Further actions identified: Lancashire Care Foundation Trust (LCFT) has been asked to consider the impact of introducing a post therapy call and assessment questionnaire to those patients who drop out of the service. This is to ensure that those leaving because they feel better, are captured in the data. Presently those who drop out are not routinely assessed for recovery. The Trust is currently operating on silver command due to significant mental health bed pressures across Lancashire; therefore any development activity within Minds Matter has been ceased until 18 January to enable redeployment of capacity to manage bed pressures. To continue to progress the waiting times initiative with the expectation that the impact of this will be realised in Quarter 4. The Governing Body is asked to note that further actions identified are not expected to impact on performance until quarter 4 and that new developments cannot be progressed at the current time due to capacity pressures at LCFT. Description of Risk/Issue: Performance has improved this by 0.6% rising from 61.4% in September to 62% for October 2015 against a target of 67%. As the business case to increase capacity for the Memory Assessment Service was approved by the Clinical Commissioning Committee in November 2015 LCFT is taking three approaches to maximise diagnosis rates across Fylde and Wyre: continuing the targeted approach to case finding and diagnosis in care homes, increasing the efficiency of MAS referral management by utilising EMIS and to work with practices to cleanse their registers and ensure diagnoses are coded correctly. In addition to this work MAS have begun to recruit substantively to the recurrent investment, as a part of the redesign model they have already successfully recruited a non- medical prescriber and they will be increasing the band 6 capacity to MAS, MAS will continue to up skill their existing staff to enable them to work in the consultation model and to align practitioners to work more closely with Primary Care and the neighbourhoods. Previous actions undertaken and impact: The business case to increase capacity for the Memory Assessment Service was approved by the Clinical Commissioning Committee in November 2015 and the provider is now in the process of implementation. The impact of this will be seen by early quarter 4.

A review of the data at GP Practice level highlighted practices where diagnosis rates are low. The CCG and LCFT will target the increased capacity to these areas initially. Further actions identified: The CCG formally requested support from the NHS England Intensive Support Team, in October and November 2015, a response is still awaited. A presentation is being given at the January 2016 Governing Body meeting to promote MAS and post diagnosis support services in an attempt to encourage GP practices to increase referrals where appropriate. To undertake further analysis regarding the feasibility of being able to achieve the target following release of the national data The Governing Body is asked to note the improvement in performance against this target and also that further actions identified will not impact on performance until early quarter 4. Description of Risk/Issue: C. difficile: During October 2015, 8 C. difficile cases were reported in relation to Fylde and Wyre patients, 5 attributed to Blackpool Teaching Hospitals Acute Trust; 3 are reported as community acquired infections. This means that the CCG is 19 cases in excess of its planned trajectory at Month 7, 2015-16. All cases attributed to Blackpool Teaching Hospitals Acute Trust and Community are subject to review to determine whether or not they were due to lapses in care. One of the cases above has been reviewed and concluded to be unavoidable the remainder are under review. There were no reported cases at Lancashire teaching Hospitals in relation to Fylde and Wyre patients during October 2015. MRSA: There have been no reported cases of MRSA Bacteraemia for Fylde and Wyre patients in this period Previous actions undertaken and impact: Monthly CCG-provider meetings jointly review and assign RCA outcomes, either as unavoidable or due to lapses in care. Lapses in care are often due to inappropriate antimicrobial prescribing. Blackpool Teaching Hospitals keep the CCG appraised of emergent issues and initiatives. The lead CCG (Chorley and South Ribble) for Lancashire Teaching Hospitals review all C. difficile cases attributed to the Trust, regardless of the patient s CCG of residence. A Fylde and Wyre CCG C. difficile action plan is in place. And it was last reviewed at a meeting on 30 November. Further actions identified: Plans for a CCG wide Anti-microbial Stewardship / public awareness campaign are well underway and will commence in mid-november. The CCG has circa 20k in order to impact across the footprint using in-surgery

advertising, public space advertising, newspaper advertorials, and advertising in community partner locations such as libraries and workplaces and via the School Nursing Service. This campaign has full backing from the Council of Members and will be maintained throughout the winter period. The Governing Body is asked to note current performance, for information. Description of Risk/Issue: Rolling 12- mortality measures at Blackpool Teaching Hospitals (BTH) are above 100 and as such are subject to improvement activity. Data received for Lancashire Teaching Hospitals (LTH) do not include SHMI and at present the Trust s HSMR data are 1 behind those received for BTH. LTH: Previously, the HSMR has been rebased on an annual basis, against national performance, often resulting in significant increases in the reported rate. HSMR is now rebased each, resulting in only minimal adjustment of previously reported rates. This has allowed the Trust to report HSMR with greater confidence. The year to date HSMR position to July 2015 remains within the expected range at 93. In addition, the four key indicators Monthly HSMR, 12-Month Rolling HSMR, Overall mortality and Weekend Mortality are all within the expected range. Particularly positive is the position relating to weekend HSMR which, after steady improvement since February, is now within the expected range at 109.5. BTH: The Trust's rolling 12- HSMR position has remained relatively static, ranging between 111 and 114 between November 2014 and the most recent available value in August 2015 (112). During the same period, the rolling 12- SHMI position also remained relatively unchanged, ranging between 115 and 118, but fell to 114 in July, 113 in September and 112 in October. BTH internal modelling shows continued improvement in SHMI (un-validated data). Previous actions undertaken and impact: LTH: Fylde and Wyre CCG have liaised with Chorley & South Ribble CCG (CSRCCG), the Host Commissioner for LTH with regard to improving the timeliness of reporting and dissemination of HSMR and also the possibility of receiving SHMI data to allow for comparison against BTH. The Trust s Mortality Committee held its inaugural meeting in August. This committee, which will be in addition to existing weekly mortality reviews, will oversee monitoring of and improvement activity in response to mortality rates and will report to the Safety and Quality Committee. BTH: With regard to HSMR calculation methodology, BTH has focussed on optimising the capture of palliative care within case notes, which may contribute to a downward trend in HSMR values. A quarterly publication issued on 28 October 2015 by the Health and Social Care Information Centre (HSCIC), considering the period from April 2014 to March 2015, identified BTH as an outlier with a higher than expected SHMI. The report also noted that, for those patients with a finished provider spell and for those deaths reported in SHMI, the element of palliative care coding was below the national average. Further actions identified: The CCG is continuing discussions to clarify and agree a consistent reporting system around mortality indicators. Work between BTH, its local CCGs and AQUA continues. AQUA has now identified five comparable Trusts where there has been an improvement in standardised mortality rates and a revised set of priority areas will be reported to the Lancashire Quality Surveillance Group on 28 th January 2016.

The Governing Body is asked to note current performance, for information. Description of Risk/Issue: Providers identify and manage Serious Incidents through their management processes, demonstrating how the organisation has learned from incidents in order to prevent the likelihood of a recurrence of that harm. The position for October, in terms of New and Open Serious Incidents was as follows: Position at End Month 06: New SIs Open SIs Fylde & Wyre CCG Patients 6 45 Blackpool Teaching Hospitals NHS FT 5 30 Calderstones Partnership NHS FT 0 1 Lancashire Care NHS FT (Mental Health) 1 12 Lancashire Teaching Hospitals NHS FT 0 2 Previous actions undertaken and impact: Providers have 60 working days to investigate and analyse the issues raised regarding Serious Incidents, thereafter Commissioners work collaboratively with providers to be assured learning has been identified and disseminated appropriately once agreed incidents are closed. Fylde & Wyre CCG reviews and signs off Root Cause Analyses within the StEIS. LCFT-MH reported incidents are managed by Blackburn with Darwen CCG. Further actions identified: SI management is a learning rather than punitive system. Incident reviews are ongoing and at various stages of completion within the scope of the NHS E Serious Incidents Framework. Final Root Cause Analyses for each incident are jointly reviewed between the CCG and Trust in order to manage and close the reported incidents. The Governing Body is asked to note current performance, for information. Description of Risk/Issue: No Never Events were recorded in relation to Fylde and Wyre patients during October 2015. The Governing Body is asked to note current performance, for information.

Description of Risk/Issue: The 2015-16 year to date breach total in relation to Fylde and Wyre patients remains at 2, as there were no further occurrences during October 2015: BTH: No Mixed Sex Accommodation breaches were reported by the Trust during October. LTH: No Mixed Sex Accommodation breaches have been recorded year to date 2015-16. Previous actions undertaken and impact: Regular (bi-ly) Ending Mixed Sex Accommodation visits have been taking place, by representatives from Healthwatch Blackpool. During the most recent visit (August 2015), representatives from Healthwatch visited Wards 5 & 7 and conducted an EMSA review. Feedback has been provided to the wards following these visits to inform remedial action. Further actions identified: There have been no Eliminating Mixed Sex Accommodation Inspections with Healthwatch in September or October. Healthwatch is currently discussing future inspections with Blackpool CCG. The Governing Body is asked to note current performance, for information.

NHS Constitution Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** A&E Waits Measure Category A Ambulance Response Times (CCG performance based on NWAS performance however local response times are included in the exception report as these are below target). Referral to Treatment (RTT) times for non urgent consultant led treatment Responsible Committee Indicator No of waits from decision to admit to admission (trolley waits) over 12 hours. % category A calls resulting in an emergency response to arrive within 8 minutes (Red 1) % category A calls resulting in an emergency response to arrive within 8 minutes (Red 2) % category A calls resulting in an ambulance arriving at the scene within 19 minutes. Target Reporting Period 0 N/A N/A 0 0 0 0 Sep-15 * 75.0% 59.8% 59.0% Oct-15 N/A N/A N/A N/A - Y 75.0% 59.3% 58.5% Oct-15 N/A N/A N/A N/A - 95.0% 90.9% 91.9% Oct-15 N/A N/A N/A N/A - % admitted patients within 18 weeks. 90.0% 87.8% 88.2% Oct-15 86.8% 87.9% 78.9% 72.3% Oct-15 Y % non admitted patients within 18 weeks. 95.0% 95.6% 94.9% Oct-15 95.6% 95.7% 93.6% 87.4% Oct-15 Y % patients on incomplete pathway waiting less than 18 weeks. 92.0% 95.0% 94.4% Oct-15 95.3% 95.1% 92.6% 89.9% Oct-15 Y Trend BTH LTH Reporting Period 15/16 Quality Premium Diagnostic Waiting Times % patients waiting less than 6 weeks for diagnostic test. 99.0% N/A 99.4% Oct-15 N/A 99.8% N/A 97.8% Oct-15 Cancer Two Week Waits % patients with maximum two week wait for first outpatient appointment when referred urgently with suspected cancer by a GP % patients with maximum two week wait for first outpatient appointment when referred urgently with breast symptoms (cancer not initially suspected) by a GP 93.0% 94.7% 94.4% Oct-15 95.0% 94.8% 91.7% 96.2% Oct-15 Y 93.0% 91.6% 88.5% Oct-15 91.0% 87.0% 100.0% 100.0% Oct-15 Cancer 31 Day Waits % patients with maximum 31 day wait from diagnosis to first definitive treatment for all cancers % patients with maximum 31 day wait for subsequent treatment (surgery) % patients with maximum 31 day wait for subsequent treatment (anti-cancer drug regime) % patients with maximum 31 day wait for subsequent treatment (radiotherapy) % patients with a maximum 62 day wait from urgent GP referral to first definitive treatment for cancer. 96.0% 99.0% 100.0% Oct-15 99.6% 100.0% 96.7% 100.0% Oct-15 94.0% 95.9% 93.8% Oct-15 100.0% 100.0% 94.4% 85.7% Oct-15 98.0% 100.0% 100.0% Oct-15 100.0% 100.0% 100.0% 100.0% Oct-15 94.0% 97.6% 97.6% Oct-15 N/A N/A 97.5% 97.5% Oct-15 85.0% 85.6% 87.8% Oct-15 89.7% 92.7% 70.2% 62.5% Oct-15 Cancer 62 Day Waits % patients with a maximum 62 day wait from referral from an NHS screening service to first definitive treatment for cancer. 90.0% 97.5% 100.0% Oct-15 98.5% 100.0% 100.0% N/A Oct-15 Maximum 62 day wait for first definitive treatment following a consultant's decision to upgrade the priority of a patient (all cancers). N/A 92.0% 100.0% Oct-15 92.8% 100.0% 88.9% 100.0% Oct-15

Infection NHS Constitution Supporting Measures Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** Measure Responsible Committee Indicator Target Reporting Period Trend BTH LTH Reporting Period 15/16 Quality Premium Mental Health: Care Programme Approach (CPA) The proportion of people under adult mental health specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period. 95.0% 92.7% 88.2% Q2 15/16 N/A N/A N/A N/A - Referral to Treatment Waiting Times Number of over 52 week waiters (incomplete pathways) 0 N/A 0 Oct-15 N/A 0 N/A 0 Sep-15 Mixed Sex Accommodation QIGEC Number of Breaches Minimise breaches 2 0 Oct-15 2 0 0 0 Oct-15 A&E Waiting Times % patients admitted, transferred or discharged within 4 hours of arrival at A&E 95.0% 96.3% 95.6% Sep-15 96.3% 95.6% 95.3% 96.0% Sep-15 Y Cancelled Operations Ambulance Handovers QIGEC All patients who have cancelled operations on or after the day of admission for non-clinical reasons to be offered another binding 0 breaches N/A N/A 0 0 48 19 Q2 15/16 * date within 28 days. No urgent operation to be cancelled for a 2nd time. 0 N/A N/A 0 0 0 0 Sep-15 * All handovers between ambulance and A&E must take place within 15 minutes. Financial penalties for over 30 min and 60 min delays 100.0% N/A N/A 97.2% 95.4% 93.3% 87.1% Oct-15 * Incidence of healthcare associated infecion QIGEC CDI (C Difficile Infections) Number of infections Maximum 44 55 12 Nov-15 50 10 4 1 Nov-15 0 MRSA: Number of infections 0 2 0 Nov-15 2 0 0 0 Nov-15

Mental Health Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** Measure Responsible Committee Indicator Target Reporting Period Dementia Estimated diagnosis rate for people with dementia 67.0% N/A 62.0% Oct-15 N/A N/A N/A N/A Trend BTH LTH Reporting Period 15/16 Quality Premium IAPT Access to services Q1 =3.75% (3.75%) Q2=3.75% (7.5%) Q3=3.75% (11.25%) Q4=3.75% (15%) 13.86% 1.30% Oct-15 N/A N/A N/A N/A Proportion of people IAPT services and recovery rate 50.0% 33.6% 37.3% Oct-15 N/A N/A N/A N/A The proportion of people that wait 18 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period 96.0% 70.7% 50.0% Aug-15 N/A N/A N/A N/A The proportion of people that wait 18 weeks or less from referral to their first IAPT treatment appointment against the number of people who enter treatment in the reporting period 96.0% 77.9% 79.3% Aug-15 N/A N/A N/A N/A IAPT - Mental Health Access Waits The proportion of people that wait 6 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period The proportion of people that wait 6 weeks or less from referral to their first IAPT treatment appointment against the number of people who enter treatment in the reporting period 76.0% 42.7% 18.8% Aug-15 N/A N/A N/A N/A 76.0% 64.2% 69.0% Aug-15 N/A N/A N/A N/A Number of ended referrals in the reporting period that received a course of treatment against the number of ended referrals in the reporting period that received a single treatment appointment N/A 74.4% 62.5% Aug-15 N/A N/A N/A N/A Early Intervention in Psychosis Liaison Psychiatry Average number of treatment sessions N/A 4.7 4.0 Aug-15 N/A N/A N/A N/A Re-focusing service provision on less severe cases (in development) N/A More than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package >50% by April 2016 within two weeks of referral (in development) Indicator currently in development by NHS England % of acute trusts with an effective model of liaison psychiatry (all ages, appropriate to the size, acuity and specialty of the hospital) 100% by 2020 (in development)

Better Care Fund Indicators Primary Care Outcomes & Quality Indicators Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** Measure Hospitals deaths attributable to problems in care Enhancing quality of life for people with long-term conditions Responsible Committee QIGEC Indicator Indicator in development, this should be available for measuring a national ambition in Autumn 2015 and local ambitions in 2016/17. Health-related quality of life for people with long-term conditions Target 0 Average EQ-5D Score 71.56 N/A 71.0 Reporting Period 2014/15 - Oct- 15 Trend BTH Indicator currently in development by NHS England LTH N/A N/A N/A N/A Never Events QIGEC Number of events 0 0 0 Oct-15 0 0 2 0 Oct-15 * Reporting Period 15/16 Quality Premium Hospital Mortality QIGEC Hospital Standardised Mortality Rate (HSMR) <100 N/A N/A 112 107 103 93 Aug-15 / Jul-15 Serious Incidents QIGEC Standardised Hospital Mortality Indicator (SHMI) <100 N/A N/A 112 86 N/A N/A Oct-15 * New Incidents 0 32 6 Oct-15 26 5 0 0 Oct-15 * Open Incidents N/A N/A 45 Oct-15 N/A 30 N/A 2 Oct-15 * Satisfaction with the quality of consultation at GP Practices 435 N/A 437 Jul-15 N/A N/A N/A N/A Positive experience of care QIGEC Satisfaction with the overall care received at the surgery 83.4% N/A 83.7% Jul-15 N/A N/A N/A N/A Satisfcation with access to Primary Care 70.9% N/A 71.2% Jul-15 N/A N/A N/A N/A Delayed transfer of care Delayed transfer of care from hospital per 100,000 (average per ) 969.2***** N/A 992.8 Q1 15/16 N/A N/A N/A N/A Non elective admissions Total non-elective admissions in to hospital (general & acute), allage, per 100,000 population 5540/2725***** 5627 2747 Q2 15/16 N/A N/A N/A N/A Admissions to residential and nursing care homes Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population 733.7***** N/A 707.9 Oct-14 to Sep- 15 N/A N/A N/A N/A Reablement / rehabilitation services Patient/User Experience Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services In the last 6 s, have you had enough support from local services or organisations to help you to manage your long-term health condition(s)? 15/16 - Improve on 14/15***** 79.3% N/A 14/15 Actual N/A N/A N/A N/A 9.3***** 9.1% N/A 14/15 Actual N/A N/A N/A N/A Dementia Lancashire Dementia Prevalence 67.0%***** N/A 67.6% Sep-15 N/A N/A N/A N/A

Activity Measures Tramsforming Care Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** Measure Responsible Committee Indicator Target Reporting Period 0 QIGEC Total number of patients in in-patient beds for mental and/or behavioural healthcare who have either learning disabilities and/or autistic spectrum disorder (including Asperger s 0 syndrome) 0 QIGEC Numbers of admissions to in-patient beds for mental and/or behavioural healthcare who have either learning disabilities and/or autistic spectrum disorder (including Asperger s 0 Indicator currently in development by NHS England syndrome). 0 QIGEC Numbers of patients discharged to community settings 0 0 QIGEC Patients without a care coordinator 0 0 QIGEC Patients not on the register 0 0 QIGEC Patients without a review in the last 26 weeks 0 F&P GP written referrals from GPs for a first outpatient appointment in general and acute specialties E.C.12 20636 / 3185 19982 2771 Oct-15 15992 2137 1288 177 Oct-15 Referrals Other referrals for a first outpatient appointment in general and F&P acute specialties E.C.10 18995 / 2931 16515 2667 Oct-15 13935 2262 1335 206 Oct-15 F&P Total referrals in general and acute specialties1 E.C.11 39631 / 6116 36497 5438 Oct-15 29927 4399 2623 383 Oct-15 Elective Non-elective Outpatients F&P Elective ordinary admissions in all specialties (spells) E.C. 21-22. 1894 / 327 2282 385 Sep-15 1510 241 365 65 Sep-15 F&P Of which: Elective admissions ordinary admissions in general and acute specialties (spells) E.C 1-3 Trend BTH LTH Reporting Period 2264 / 379 2497 395 Oct-15 1584 249 420 58 Oct-15 F&P Elective day cases in general and acute specialties2 (spells) 11949 / 1980 14239 2101 Sep-15 11396 1640 1324 211 Sep-15 F&P Of which: Elective day cases in general and acute specialties (spells) 14261 / 2369 17277 2502 Oct-15 13807 1990 1566 194 Oct-15 F&P Total elective admissions in all specialties (spells) 3 13843 / 2307 16521 2486 Sep-15 12906 1881 1689 276 Sep-15 F&P Of which: Total elective admissions in general and acute specialties (spells)4 E.C 1-3 16525 / 2748 19774 2897 Oct-15 15391 2239 1986 252 Oct-15 F&P Non-elective admissions in all specialties (spells) E.C.23 9136 / 1513 14313 2226 Sep-15 12744 1959 910 149 Sep-15 F&P Of which: Non-elective admissions in general and acute specialties (spells) E.C.4 9082 / 1370 9201 1322 Oct-15 8204 1198 595 74 Oct-15 F&P First outpatient attendances following GP referral all specialties 17696 / 2673 17681 2572 Oct-15 14197 2052 1123 165 Oct-15 F&P Of which: First outpatient attendances following GP referral in general and acute specialties 17276 / 2636 17474 2526 Oct-15 14026 2010 1090 161 Oct-15 F&P All first outpatient attendances in all specialties 24226 / 4155 25969 4339 Sep-15 19602 3335 2516 414 Sep-15 F&P Of which: All first outpatient attendances in general and acute specialties 27189 / 4159 31782 4650 Oct-15 26514 3875 2175 307 Oct-15 F&P All subsequent outpatient attendances in all specialties 54940 / 9380 67777 11534 Sep-15 51106 8840 7347 1233 Sep-15 A&E F&P A&E attendances Total all types 17677 / 2851 17089 2802 Sep-15 14076 2302 1504 255 Sep-15 15/16 Quality Premium

2015/16 Quality Premium Indicators Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** Measure Preventing people from dying prematurely Responsible Committee Indicator Reduce the Potential Years of Life Lost (PYLL) for causes amenable to healthcare. Target Reduction of >=1.2% from 2012 to 2015 2012 = 2507 2013 = 2496.9 2014 = 2486.9 2015 = 2476.9 N/A 2402.0 Reporting Period 2014 Data - Oct- 15 Trend BTH LTH Reporting Period 15/16 Quality Premium N/A N/A N/A N/A Y Urgent and Emergency Care Delayed transfer of care from hospital 28 per 155 25 Sep-15 N/A N/A N/A N/A Y Mental Health Increase in the proportion of adults in contact with secondary mental health services who are in paid employment. >2.60% 2.3% 1.9% Aug-15 N/A N/A N/A N/A Y Reduction in the number of antibiotics prescribed in primary care (Rate) 1.19 N/A 1.12 Aug-15 N/A N/A N/A N/A Y Improved antibiotic prescribing in primary and secondary care - Composite QIG Reduction in the proportion of broad spectrum antibiotics prescribed in primary care (%) 11.3% N/A 5.4% Aug-15 N/A N/A N/A N/A TBC Secondary care providers validating their total antibiotic prescription data >=10% of providers validated data Public Health England are currently developing this metric directly with Acute Providers TBC Local Priorities To scope, commission and develop a service to provide stroke follow up reviews of the health and social care needs of stroke patients and their carers, for all patients who have undergone a stroke within 6 s of their initial admission. Q1: Scope Service Q2: Implement Service Q3: Estimation of Volume Q4: TBC Yes Yes Q2 15/16 N/A N/A N/A N/A Y Improved quality of life for Carers as a result of interaction with the carers centre. Indicator currently in development by NHS England 0 Y

2014/15 Quality Premium Indicators Month Fylde and Wyre Clinical Commissioning Group Quality and Performance Summary - Month 7 (October 2015) CCG Performance Provider Performance** Measure Responsible Committee Indicator Target Reporting Period Trend BTH LTH Reporting Period 15/16 Quality Premium Unplanned hospitalisation for chronic ambulatory care sensitive conditions 753**** N/A 738.0 2014/15 N/A N/A N/A N/A Composite of all emergency admissions Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 399.2**** N/A 397.0 2014/15 N/A N/A N/A N/A Emergency admissions for acute conditions that should not usually require hospital admission 1020**** N/A 1245.0 2014/15 N/A N/A N/A N/A Emergency admissions for children with lower respiratory tract infections (LRTI) 359.5**** N/A 523.0 2014/15 N/A N/A N/A N/A Accident & Emergency (Types 1 & 2) N/A N/A N/A N/A 92.6% N/A 84.3% Sep-15 * Inpatient N/A N/A N/A N/A 96.0% N/A 92.0% Sep-15 * Maternity - Antenatal Care N/A N/A N/A N/A 100.0% N/A 91.9% Sep-15 * Friends and Family QIGEC Maternity - Birth N/A N/A N/A N/A 95.8% N/A 94.6% Sep-15 * Maternity - Postnatal Ward N/A N/A N/A N/A 92.7% N/A 97.6% Sep-15 * Maternity - Postnatal Community Provision N/A N/A N/A N/A 90.0% N/A 88.6% Sep-15 * Medical Related Incidents QIGEC Count of reported medication error incidents as % of all reported incidents for that provider (Note: data shown are medication error totals for each provider) N/A N/A N/A 428 59 259 35 Performance improved from previous reporting period (ie previous of quarter). Notes ** Provider Performance. Based on Fylde & Wyre CCG population unless marked with * if based on all CCGs population. Performance declined from previous reporting period (ie previous or quarter) Sep-15 (BTH) * Oct-15 (LTH) ***Preliminary Proxy Actual used for this indicator for reporting purposes. This will be updated with True Actual once available Performance same as previous reporting period **** 2012/13 Rates against 2013/14 data, 2014/15 data due to be published approximately Oct 2015. *****These numbers are Lancashire Wide and taken straight from BCF Report N/A No current target/operational standard.

Activity and Finance Fylde and Wyre Clinical Commissioning Group Contracted Activity & Finance - Month 7 Scheduled Care Year to date - Activity Volume 14/15 15/16 Variance GP Referrals 20,969 21,248 279 1.3% Other Referrals 18,742 18,577-165 -0.9% Total Referrals 39,711 39,825 114 0.3% Point of Delivery Year to date - Activity Volume Year to date - Cost Plan Actual Variance Plan Actual Variance First Attendances 22,306 24,751 2,445 11.0% 3,183,924 3,392,848 208,924 6.6% Follow-up Attendances 59,801 63,309 3,508 5.9% 5,090,098 5,199,556 109,458 2.2% Outpatient Procedures 13,050 14,049 999 7.7% 8,552,077 9,358,332 806,255 9.4% Point of Delivery Year to date - Activity Volume Year to date - Cost Plan Actual Variance Plan Actual Variance Elective Admissions 2,172 2,195 23 1.0% 5,862,063 6,517,453 655,390 11.2% Daycase Admissions 6,199 7,924 1,725 27.8% 1,149,195 1,264,068 114,873 10.0% Excess Bed Days 602 453-149 -24.7% 134,791 99,072-35,718-26.5% Unscheduled Care Point of Delivery Year to date - Activity Volume Year to date - Cost Plan Actual Variance Plan Actual Variance Accident & Emergency 19,561 19,195-366 -1.9% 1,939,324 2,026,673 87,349 4.5% Non Elective Admissions 10,181 10,649 468 4.6% 16,438,444 16,198,395-240,049-1.5% Excess Bed Days 7,993 4,618-3,375-42.2% 1,647,137 957,933-689,204-41.8% Year to date - Cost Non-PBR Items Plan Actual Variance All Non-PBR Lines 23,971,443 24,019,149 47,706 0.2% Overall Position Year to date - Cost Acute Contracts Total Plan Actual Variance All Points of Delivery 67,968,494 69,033,477 1,064,983 1.6%