RCCG/GB/18/039 NHS Rushcliffe CCG Governing Body Meeting 15 March 2018 Introduction 1. This paper provides the Governing Body with an update on the progress being made by the Greater Nottingham CCGs in respect to the performance metrics specified in NHS England s Improvement & Accountability Framework. Background 2. This paper provides the Governing Body with an update on the progress being made by the Greater Nottingham CCGs in respect to the performance metrics specified in NHS England s Improvement & Accountability Framework. 3. NHS England introduced the first Improvement & Accountability Framework in 2016/17 in order to align the key objectives and priorities of CCGs whilst providing a mechanism to manage the relationships with commissions. 4. The framework consists of a range of metrics, in the main being published from nationally collected data from both providers and commissioners. This is supplemented by more qualitative information collected through stakeholder surveys and intelligence captured from NHS England team locally. 5. NHS England typically reported progress against the IAF on a quarterly basis with a formal letter reporting their annual assessment of the CCGs. Members will recall a summary of the annual letter being report as part of the Accountable Officers report towards the end of 16/17. Since then NHSE have not published further updates, most probably as the shift to considering STPfootprint performance is increasingly the norm. 6. However, the importance of maintaining service standards for patients remains alongside the requirement for the CCGs, internally, to confirm the progression of strategic objectives. Consequently, this report provides a local update on the progress being made and provides members with assurance of continued focus. Progress during 2017/18 7. The 51 indicators are categories into four domains: a. Better Health b. Better Care c. Sustainability d. Leadership Governing Body Page 1 March 2018
8. Locally each metric is assessed in three ways: whether the performance has achieved any relevant national standard (not applicable to all metrics); whether the trend is for an improving position; and how the performance of the CCG compares to all other CCGs across England. 9. For the purposes of the IAF, NHS England only consider the latter aspect, and specifically whether CCGs are in the Worst Quartile performance. Where this is the case the CCGs are required to provide assurances to the DCO that plans exist to improve performance. 10. A high-level summary of the most recent published data shows: CCG Number of Indicators Worst Best Improving Deteriorating Quartile Quartile Nottingham City 12 6 17 15 Nottingham North & East 4 11 18 14 Nottingham West 4 15 19 13 Rushcliffe 3 19 13 19 11. A detailed assessment of all indicators is shown in Appendix A (NHS Nottingham City) through to Appendix D (NHS Rushcliffe CCG), with a summary comparison for all four CCGs shown in Appendix E. 12. For Rushcliffe CCG The 3 indicators featuring in the worst quartile are: a. LD - reliance on specialist IP care: Rather than individual CCGs being measured, the performance of the Nottinghamshire STP is assessed as a whole. The footprint of Nottinghamshire Healthcare NHS Trust encompasses 7 CCGs, 2 Local Authorities, and NHS England Specialised Commissioning. Performance across the cluster has improved further with 77 people with a learning disability and/or autism (per 1 million population) relying on specialist inpatient care. Trajectories have been agreed with the area team to improve performance. Actions are being taken to ensure this trajectory is met. These include: Commissioners continuing to liaise regularly with inpatient units and other members of the multi-disciplinary team to expedite discharges where this is clinically indicated. Commissioners continuing to carry out blue light reviews as necessary with the aim of avoiding admissions where possible or expediting discharge. A new City and County wide Care and Treatment Review service with new enhanced specification has been commissioned. This started on the 2nd of January. Meetings are taking place to monitor the Intensive Community Assessment and Treatment Team service. b. IAPT Access: Members will be aware of the change in prevalence (for patients who are estimated to suffer from depression or anxiety) which occurred at the beginning of 2017/18. A series of discussions with NHS England have not resolved this issue for 2017/18 resulting in an artificially poor performance reported throughout the year. The Draft 2018/19 Operational Plan submitted on 7 March 2018 has provided Regulators with a more accurate, locally-derived, denominator for this indicator. This will significantly improve the reported performance against this indicator. Governing Body Page 2 March 2018
c. Cancer Patient Experience: Linked with the improving performance of the 62-day Cancer standard, there are a range of changes taking place in Cancer services for patients. These include: Improving the waiting times for first appointment. Modifying pathways to allow GPs to access straight-to-test diagnostics for patients. Working with peripheral providers to improve timescales for tertiary referrals. Implementing decision support tools to promote earlier diagnosis. Recommendations 13. The Governing Body is asked to: a. Note that NHS England no longer publish CCGs individual dashboards for the Improvement & Assessment Framework; b. Note the continued need to improve services for patients which will result in the required improvements for subsequent years; c. Note the plans discussed as part of the Operational Plan, STP, Contracts and performance management processes to improve this position; and d. Note future updates will be provided as appropriate. Andy Hall Director of Performance & Information 08 March 2018 Governing Body Page 3 March 2018
Appendix A NHS Nottingham City CCG IAF Published November 2017 Governing Body Page 4 March 2018
Key R Worst quartile in England Best quartile in England Interquartile range Data refreshed since last report Governing Body Page 5 March 2018
Appendix B NHS Nottingham North & East CCG IAF Published November 2017 Governing Body Page 6 March 2018
Key R Worst quartile in England Best quartile in England Interquartile range Data refreshed since last report Governing Body Page 7 March 2018
Appendix C NHS Nottingham West CCG IAF Published November 2017 Governing Body Page 8 March 2018
Key R Worst quartile in England Best quartile in England Interquartile range Data refreshed since last report Governing Body Page 9 March 2018
Appendix D NHS Rushcliffe CCG IAF Published November 2017 Governing Body Page 10 March 2018
Key R Worst quartile in England Best quartile in England Interquartile range Data refreshed since last report Governing Body Page 11 March 2018
Leadership Better Care Better Health Rushcliffe CCG Appendix E Greater Nottingham CCGs IAF Summary Sustainability Indicator Latest period Standard NHS Nottingham City CCG NHS Nottingham North and East CCG NHS Nottingham West CCG NHS Rushcliffe CCG 102a % 10-11 classified overweight /obese 2013/ 14 t o 2015/ 16 37.5% 31.2% 30.7% 21.7% 103a Diabetes patients who achieved NICE targets 2015-16 34.6% 37.4% 39.5% 38.7% 103b Attendance of structured education course 2014 9.2% 12.0% 10.4% 6.3% 104a Injuries from falls in people 65yrs + 16-17 Q4 1,440 1,281 1,504 1,175 105b Personal health budgets 17-18 Q1 50 85 100 91 106a Inequality Chronic - ACS & UCSCs 16-17 Q4 2,813 1,853 1,463 1,538 107a AMR: appropriate prescribing 2017 06 1.161 0.980 1.036 0.915 0.889 107b AMR: Broad spectrum prescribing 2017 06 10.0% 7.7% 9.6% 7.9% 7.7% 121a High quality care - acute 17-18 Q1 61 60 60 60 121b High quality care - primary care 17-18 Q1 66 66 77 71 121c High quality care - adult social care 17-18 Q1 61 61 61 63 122a Cancers diagnosed at early stage 2015 48.7% 53.5% 52.7% 52.8% 122b Cancer 62 days of referral to treatment 16-17 Q4 85.0% 76.6% 77.5% 75.9% 84.3% 122c One-year survival from all cancers 2014 67.5% 70.6% 70.7% 71.5% 122d Cancer patient experience 2016 8.4 8.9 8.6 8.5 123a IAPT recovery rate 2017 06 50.0% 51.8% 59.3% 57.9% 60.9% 123b IAPT Access 2017 07 2.7% 2.2% 2.9% 2.0% 123c EIP 2 week referral 2017 08 50.0% 62.1% 69.4% 65.0% 88.9% 124a LD - reliance on specialist IP care 17-18 Q1 77 77 77 77 124b LD - annual health check 2015-16 28.1% 33.9% 41.6% 35.0% 125d Maternal smoking at delivery 17-18 Q1 16.7% 15.1% 12.4% 5.6% 125a Neonatal mortality and stillbirths 2015 6.0 3.5 4.2 0.0 125b Experience of maternity services 2015 78.6 82.2 77.4 77.4 125c Choices in maternity services 2015 67.7 62.8 61.6 64.8 126a Dementia diagnosis rate 2017 08 66.7% 84.3% 70.5% 87.3% 74.0% 126b Dementia post diagnostic support 2015-16 81.3% 81.5% 80.3% 80.8% 127b Emergency admissions for UCS conditions 16-17 Q4 2,682 2,186 2,138 1,769 127c A&E admission, transfer, discharge within 4 hours 2017 09 95.0% 86.6% 87.5% 86.8% 86.5% 127e Delayed transfers of care per 100,000 population 2017 08 17.3 6.1 5.0 6.8 127f Hospital bed use following emerg admission 16-17 Q4 510.9 509.0 517.5 505.8 128b Patient experience of GP services 2017 83.7% 83.6% 91.1% 91.9% 128d Primary care workforce 2017 03 1.00 0.95 1.03 1.41 129a 18 week RTT 2017 08 92.0% 94.9% 95.4% 94.4% 94.4% 131a % NHS CHC assesments taking place in acute hospital sett16-17 Q4 54.8% 64.1% 51.7% 64.6% 141b In-year financial performance 17-18 Q1 Green Green Green Green 144a Utilisation of the NHS e-referral service 2017 06 93.0% 95.6% 97.3% 101.8% 162a Probity and corporate governance 17-18 Q1 Green Green Green Green 163a Staff engagement index 2016 3.80 3.81 3.81 3.81 163b Progress against WRES 2016 0.14 0.14 0.14 0.14 164a Working relationship effectiveness 16-17 72.52 73.85 75.29 90.80 165a Quality of CCG leadership 17-18 Q1 Green Amber Amber Amber In Worst Quartile In Best Quartile Governing Body Page 12 March 2018