Newham Borough Summary report Item K1 September 2013 Prepared on 30/09/2013 by Support team
GREEN Finance and Activity Millions AMBER RED Headlines M5 Financial position M4 activity data The QIPP net savings target of 10.2m is revised to forecast of 7.4m CCG assessed ytd delivery of 3.35m (ytd plan 5m) M5 CCG Budget: a favourable variance of 162k above the target BH contract currently shows an underspend of 221k (based on removal of non-ccg activity and any expected slippage in QIPP targets) Virtual ward: total admissions and bed days (highest figure for 12mths ) although rehab activity remains significantly higher than plan. MH occupancy at 90% (lowest figure for 12 months) Continuing care forecast for M5 is 100k over budget YTD Budget 000 YTD Actual 000 Newham Headlines September 2013 YTD (Under)/ Overspend 000 RAG Improvement/ Deterioration vs Month 4 Acute 80,906 81,143 237 2 (316) Mental Health 19,009 19,134 125 3 80 Community Health 19,541 19,328 (212) 3 (37) Other Non Acute 7,851 7,655 (196) 3 150 Prescribing 15,408 15,373 (35) 3 86 Other Primary Care Services 1,294 1,212 (82) 3 37 TOTAL CCG 144,008 143,845 (163) 3 0 TOTAL CORPORATE 3,429 3,429 0 3 0 GRAND TOTAL 147,436 147,274 (162) 3 0 TOTAL RESOURCE LIMIT (149,684) (149,684) 0 3 0 (SURPLUS)/DEFICIT (2,248) (2,410) (162) 3 0 Financial run rate - based on monthly planned spend Vs. actual 38,000 36,000 34,000 32,000 30,000 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Planned spend Actual spend Risks (significant issues or events which may occur) 1. Continuing data quality issues make it difficult to quantify the true cost pressure and absence of agreed plans make it difficult to determine overperformance. 2. QIPP target variance increased to 2.8m 3. Potential delays to AQP procurement pipeline will impact savings forecast General CSU actions (actions to address generic issues or mitigate risks) Data quality has been raised at senior level at Barts Health and is expected to improve in coming months Letters to providers outlining high-level intentions to be submitted by Oct 1 st. Planning for 14/15 intentions continues with scoping papers to be completed Sep and a prioritisation process developed to determine final CI list. DIU support requested on 7 areas of delivery. Scoping paper developed for Virtual Ward, AQP referral handbook & reducing inappropriate outpt referrals. Issues 1.Virtual ward 123 admissions in July. M4 elderly rehab activity significantly higher than plan; VW bed days was below plan. Cumulative over performance of YTD 1,062k above plan. 2. IAPT access rate and recovery rate target may not be achieved in Q1 3.Older Adult average LOS reported as 96 days ( exceeds 45 days threshold) 1.Diagnostic activity InHealth M4 spend is at 82k, YTD spend is 297k 2.CHN - Improvement in the Continuing Healthcare Case management, although still a slight underperformance against some of the KPIs. 1.Mental health adult acute inpatient occupancy reduced to 90%, remains under threshold of 90% for 2 nd month. Actions 1.More robust activity reporting measures that link performance of VW to the closure of the rehab beds are being developed & work on the reviewing of the VW spec is progressing 2&3. CSU have requested that this area is looked at by BH for areas to spend winter money 1.Activity levels will not change but may be allocated to different months between May- July (to address error with In-Health data recording ) 2. Continue to monitor improvement 1.Re-Admission and DNA rates to be monitored through SPR & CQRM for investigation
Newham QIPP Plan Delivery Report Work streams Outcome Required Savings Ytd plan Ytd actual Forecast saving *LoD Community Acute Partnership Mental Health Transformation Working Group (Prescribing, Urgent Care, Integrated Care) Reduced length of stay in hospitals & other nursing/ care establishments Supporting more people to live at home Increased partnership working, integrated services, systems and pathways Reduction in hospital admissions & readmission rates Better integrated pathways for elderly care Increased uptake of physical activity among high risk groups Improve patient experience Reduce the overall spend in Continuing Care Improve productivity of secondary care psychological therapies Improve efficiency & performance of secondary care psychological therapies Improve services promoting prevention and resilience for young population NICE Guidance compliance and maximise prescribing effectiveness Reduce medicines wastage & hospital admissions and referrals Improve quality and safety of patient care A new Urgent Care strategy produced for Newham Reduce avoidable admissions Deliver best value UC System through commissioning new model 3,713 1,433 285 2,263 4,878 3,170 2,641 3,843 (249) (104) (104) (250) 580 242 242 580 1,364 284 284 1,033 Total 10,202 5,025 3,345 7,401 Key messages CCG assess 3.35m delivered to date out of possible 5m QIPP saving forecast 7.4m (down from 8.5m) from a target of 10.2m Green/Amber rated savings increase (due to provider productivity) but forecast lower due to unplanned referrals to acute, unplanned activity in rehab beds (and lower than planned referral rates to virtual ward) Note that the Integrated Care Transformation Working Group includes Diabetes and Anti-coag. Total QIPP Green Delivered Outstandi ng Amber/ Green Delivered
Performance and Quality Newham Headlines September 2013 Key achievements Performance issues Actions 18 weeks RTT: NCCG achieved on the waiting times for the Non admitted pathway (96.98%). A&E waiting times ( ): NUH achieved their All Types standard in June with 95.79%, (YTD = 97.5% at end August) NCCG failed against waiting times standard for admitted pathways 87.1% (target 90%), Incomplete pathways ( ) 89.1% (target 92%). n/a BH continue to hold fortnightly meetings with GMs to review activity, check validation position and ensure action plans from failing specialities are submitted and being acted on. Meeting intensive service team on 11 October to review plans. BH requested for a revised RTT recovery and Imp plan after feedback from CSU. CSU to attend task force meeting (internal). All sites have Emergency Care Improvement Programme. Bi-weekly meetings with the CSU, CCG and NTDA & Trust. Final submission for winter Planning Checklist, Demand and Capacity Checklist and the Bed Modelling Tool was submitted to NHSE on 23 Sept. 52 Week Waits: 1 NCCG pt. waiting over 52 weeks at BH (Aug) in T&O. BH overall reporting 26 pts. waiting 52 weeks or more in July (improvement) 2 hr meeting took place with TDA and BH to address issues. LAS: Category A conveyance KPIs achieved 77% YTD (target 75%) LAS: Handover: NUH failed KPI 1: 15 minute handover with (84.2%) and marginally underperformed against KPI 2 (99.3%) The pan London LAS/Emergency Department (ED) Joint Handover Initiative (JHI) went live from 7.09.13. CSU to change methodology for Trusts to review breaches with scrutiny on relevant Trusts. BH asked for updated plans on improving handovers overall. FFT: ( ) Newham In-pts 21.2% Newham overall performance 8.64% (A&E 4.42). Overall performance (combined in-pt. and A&E) was 11.57%. Q1 (revised) 7.80% (against 15% target). There has been significant improvement in A&E figures but this still falls short of fully contributing to the15% required. FFT improvement plan for ECAM reviewed at BH CQRM. CSU to investigate results of FTT for future report. MRSA: ( ) C.difficile: ( ) 21 YTD (25 threshold) Aug MSA: ( ) VTE: ( ) NUH 98.9%, BH 96.5% risk assessments for July Cancer Waiting Times: Achieved against all standards (July) except two 4 reported cases BH (1x May 2x June, 1x Sept.) BH 27 cases YTD (6 in August not validated) out of 31.25 10 breaches for NCCG (7x RLH 3x NUH). BH total= 40breaches 31 day Cancer wait, subsequent treatment for surgery at 80% (target 94%) and the 62 day Cancer Wait Screening at 80% (target 90%). All cases are subject to post infection review. Daily updates from BH to facilitate real time reporting (No cases at NUH) BH remain under the threshold to date. Monitored by CQRM. CSU to ensure the BH are following national guidance (01.09.13) to reduce MSA breaches & make national benchmarking comparable. CQUIN for 13/14 drives Trusts to ensure at least 95% of eligible patients have a VTE risk assessment No action required
Performance and quality - areas of concern Barts Health/Newham site Headlines Sept. 2013 Serious Incidents and Never Events Risks and Issues Barts Health reported 50 SIs in August, continuing to show improvement over the same period last year. 39 Overdue reports (reports not received by the CSU) 0 Never Events reported in the current month (6 YTD 4 retained swabs) Action Trust: Drop in the number of overdue reports between July and August (88 to 39) resulting from the Trust s trajectory to significantly reduce the SI backlog by August. CSU/CCG: The second WELC CCGs and CSU SI panel will take place in September, where the themes coming out of SI reports, including several Never Events, will be discussed. Children and Adult Safeguar ding Training Care Quality Commissi on (CQC) Safeguarding training levels not meeting targets. Agreed to reach 85% target by October 2013. August has seen some improvement Children s compliance to date: Level 1: 75%, Level 2: 50%, Level 3: 62% Adult s compliance to date: Level 1: 76%, Level 2: 62% The CQC report highlighted that action was needed in the following areas: Staffing (1 compliance action) Supporting workers (2 compliance actions) Trust has replied to CQC for all notices received Trust: Trust presented refreshed action plan at the CQRM, this incorporates Statutory and Mandatory booklet distributed to all staff (trajectory is improving) CSU/CCG: Due to improvement this will be monitored outside of the bi monthly performance meetings with the Trust. Trust: Full action plans provided by the Trust to the CQC and CCG/CSU which highlight how the compliance actions and enforcement actions will be met. CSU/CCG: The CSU/CCGs have met with the CQC to review outcomes and agree next steps. There has been attendance at the Clinical Fridays by a CCG Quality Lead Action plans will be reviewed and monitored at CQRM Additional actions: CQC has identified 18 NHS trusts representing the variation of care in hospitals in England. These will be the first hospitals to test the new CQC inspection regime. BH will be part of this first wave of inspections as they are considered a high risk rated trust by the CQC. Barts are carrying out internal inspections prior to these visits, CCG representation will be part of the inspections.
Serious Incidents CHN MH Key areas updated ELFT Patient Experience Safety LOS IAPT ELFT (MH) Newham Headlines September 2013 Risks and Issues The IAPT data for Q1 for Newham CCG; IAPT Access rate is 2.8% against the quarterly target of 3.4% Older Adult: Average LOS for NCCG Older adult inpatients exceeded the 45 days threshold and reported as 96 days ( when compared to July) Safeguarding Adults: Audit currently underway by LBN within Newham that will investigate the procedural pathway surrounding ELFT response to safeguarding adult queries. An action plan will follow. Serious Incident management: Backlog is now cleared and reporting is consistently of good quality due to holding learning lessons seminars 3 times a year and are attended by 80% of consultants. These sessions review 3-4 SIs so that learning can take place. Other Trusts in London are now interested in this approach. Quality Indicators: The Trust has developed a number of quality indicators and the CQRM noted that these did not include anything about physical well being. It was agreed that this would be reported on in the September CQRM. CQC visit to Emerald Ward: There was an unannounced CQC visit in April 18th to Emerald ward. Copy of the Trusts formal response dated June 12th was provided to the CQRM and no issues were raised. Action CSU have requested that this area is looked at by BH for areas to spend winter money Trust: To report on outcome of safeguarding audit by LBN. Trust to continue to focus on reducing overdue SI reports. CSU and CCG: To consider review and track any action plan Trust: To provide further details on how they promote physical activity and health to the next CQRM. CSU and CCG: To monitor patient experience and feedback. Service User Led Audit It was noted that standards nine and ten were rated red due to poor performance and this had been the case for some months now. The Trust advised that they were about to undertake some qualitative work to understand why. 1 x SI, 0 x Never events, 9 x overdue SI reports and 1 x CAS Alert Trust: ELFT continues to report low numbers of SIs each month. 3 x SIs, 0x Never event, 13x Overdue reports and 1 x CAS Alert CSU and CCG: A new SI review and feedback process is being developed with C&H CCG. 26 legacy SIs closed following a thematic workshop and subsequent receipt of evidence from the Trust.
Safety Patient Experience Other Quality Issues ELFT (CHN) Newham Headlines September 2013 Risks and Issues CQUIN: Discussions are still taking place and sign-off is expected by September to be reported on from Q2. CQUIN Proposals are: CQUIN 1 Improving the Experience of Patients CQUIN 2 Promoting effective Cardiac Rehabilitation CQUIN 3 - Promoting effective Self Care and Management of Long Term Conditions CQUIN 4 Enhancing GP Communication CQUIN 5 Improving End of Life Care PROMS and PREMS: Q1 report provided to a future meeting as part of the CQUIN schedule and will cover : EPCT, VW, Day Hospital, Continence, MSK, Stroke, Cardiac Rehab, Wheelchair Services, Venous Leg Ulcer Clinic. Bed Occupancy: Bed occupancy May June Cazaubon Unit 54% 62% Fothergill Unit 69% 70% Sally Sherman Unit (Physical Health) 55% 57% Action Trust: To report in Q2 CSU and CCG: to monitor when agreed. Trust: To provide further details of PROMS and PREMs scores to the September meeting. CSU and CCG: to monitor patient experience and feedback. Audit: Trust reported 100% compliance with VTE assessments (clinical audit). Audited Phlebotomy service for waiting times, complaints & patient satisfaction. Audit data showed that all centres perform consistently above national guidance (6 mins. patient facing time per blood test) Complaints: There were only three complaints received from Aug12-March 13. All were investigated and none of them were upheld. This is a marked improvement from last year; Patient satisfaction survey results were as follows: 88% positive responses, 3% negative responses and 9% N/A. The Trust also reported on an audit on their compliance with CQC standards. Trust: To report on audits and provide more detailed outcome reporting. CSU and CCG: to review as required.