Newham Borough Summary report March 2013 Prepared on 18/03/13 by Commissioning Support team
Finance and Activity Millions Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Newham Headlines March 2013 Feb-12 Apr-12 Jun-12 Aug-12 Oct-12 Dec-12 Feb-13 GREE N RED AMBER Headlines (M11 Ledger M10 SLAM) Risks (significant issues or events which may occur) Delegated budget overspend stands at + 611k ( 868k reduction from M10) due to underspend in prescribing, community health and other non-acute Forecast delegated budget year end overspend: 2.7m (QIPP non delivery 2.5m) Acute overspend driven by UCLH, RNOH, NCAs, and non delivered QIPP. Barts Health position for Newham is -0.1m below plan (after 3.2m productivity measures applied); whilst the total WELC position is + 4.5m (+0.98%) above plan CBS forecast underperformance; 409k (Revised from Dec position of break even due to CCG decision to de/re-commissioning of certain services) YTD Budget YTD Actual YTD (Under)/ Overspend Forecast (Under)/ Overspend RAG Financial run rate - based on monthly spend Vs actual Improvement/ Deterioration vs Month 10 '000 Acute 227,957 230,188 2,231 2,624 97 Mental Health 41,659 41,861 202 221 0 Community Health 48,499 48,606 107 117 (127) Other Non Acute 30,903 30,211 (693) (755) (281) Prescribing 36,135 34,296 (1,838) (2,019) (495) Non Core Primary Care Services 3,432 3,381 (51) (55) (55) QIPP to be delivered (653) 0 653 2,565 0 TOTAL DELEGATED 387,932 388,542 611 2,691 (868) TOTAL NON-DELEGATED 43,119 43,150 31 34 0 GRAND TOTAL 431,050 431,692 642 2,725 (868) 46,000 44,000 42,000 40,000 38,000 36,000 34,000 32,000 30,000 Planned spend Actual spend 1. QIPP 4.3m outstanding ( 2.5m unlikely to be delivered) 2. 2012/13 non delivered acute activity QIPPs could impact 2013/14 baseline 3. BH/Newham site above plan (activity only); ytd 2.3m forecast 2.8m (could impact 2013/14 contract negotiations) 4. Retrospective reviews for Continuing Healthcare funding may incur 1.1-2.2m cost pressure. Estimates will be refined as claims progress. New deadline of March 31 st 5. Additional A&E staffing (paid for with winter monies) will not be funded post April a may result in performance issues 6. MH M10 occupancy at 105.8% (target 90%) 7. Drugs and Devices cost pressure ( 262k) Newham is plan but a pan CCG risk share could generate a cost pressure General actions (actions to address generic issues or mitigate risks) CCG to set up Task and Finish Group to address MH bed occupancy along with a proposal from ELFT. Cluster leads to be sighted on MH issues Leads to respond to recommendations from star chamber sessions Discussions are currently on-going regarding a Drugs & Devise risk share across CCGs Key issues 1. BH /Newham site Unplanned variance + 653k (14% higher); non elective (General med 1841k, General Surgery 423k, Geriatric medicine 1048k, Paeds, 277k, Cardiology 460k Excess bed days 122k). Planned + 2.586m (19%higher) Elective activity 1327k, Direct Access 304k above plan; Outpatients 955k above plan. 2. UCLH (variance + 1074k) Overspend driven by high cost Elective patients, Chemo, Non- Elective and Maternity activity. 3. NCAs (variance + 774k ) 37k deterioration in forecast. Highest: South Lon. Healthcare & Lewisham 4. Newham CHS (+0.3m) WTE Health Visiting funding validated and remains a cost pressure. Significant increase in admissions to Virtual Ward (94 for Jan compared to 70 in Dec) but still at a lower rate than Q2 1. RNOH (variance + 254k) Overspend driven by high cost elective reconstructive procedure 2. Guys and St Thomas (variance + 211k) Actions 1. BH/N: (Unplanned) Agreed to pay charges for Hyperbaric Centre (Planned) Referrals report format currently being agreed (Barts) to be provided on a monthly basis. 2. UCLH: UCLH state no changes to pt pathway CSU can provide identifiable data if GP practices wish to investigate 3.NCAs: NCCG finance actively reviewing NCA data 4. HV: CSU to review impact when NCB decision on hand-over date to NCB is agreed. VW: CSU to review drop in referrals to virtual ward by NUH site of Barts RNOH CSU to continue to monitor variance on contracts. 1. Pharmacy QIPP 1.4m savings delivered. Forecast underspend - 0.5m 1. Prioritising top 22 practices with 2-18% overspend
Green Areas Performance Amber areas areas Newham Headlines March 2012 Issue Cancer Recent performance of the 14 Day GP Referral target has been poor. At the end of January actual performance was 91.5% against the target of 93%. Performance of the 62 Day GP Referral has also been poor, at the end of January performance was 84.1% against the target of 85%. Lisa Hollins, Deputy COO, is providing operational leadership for the Cancer CAG for 3 months. Newham patients account for only 3-4 of the total estimated (94) Diagnostic Waits - Newham have the 6 week waiting times target for the 2 nd month. The failure is predominantly in General Ultrasound. Action Cancer: The 62 day performance is being discussed at an Escalation Meeting with the CSU, CCG, NTDA and Barts Health on Tuesday 19.03.13 Rorie Jefferies, Cancer Commissioner CSU, has fortnightly meetings with Deputy COO and a detailed update will follow on reasons for underperformance and improvement plans. Diagnostic waits: The CSU are monitoring this situation and have asked for the plans to resolve the problems Choose & book Barts Health continues to perform reasonably well against the Appointment Slot Issue threshold of 2%, although they are above standard. A&E Performance for Newham YTD (19.03.13) is 95.09% for Type 1 s, for all Types 96.6%. The Newham Emergency Care Improvement Programme Board continue to meet fortnightly and continues to work on the initiatives within the 4 work-streams. Ambulance handovers NUH is now achieving against the four standards, to note for February in relation to electronic recording of handover times Newham are at 89.5% against the 90% target. RTT Achieving overall on both the admitted and non admitted pathways. 12 +6 Maternity Newham is performing well on this measure. A&E: CSU attend the fortnightly ECIP Boards. Barts Health have been invited to a formal Escalation Meeting (as above) where the focus will be A&E Performance and the 62 Day Cancer waits on the 19.03.13. Ambulance handovers: The CSU will continue to monitor these targets via the HAS Portal.
QIPP Newham Headlines March 2013 Area Issue Action Overall Headline CHS -Learning Dis & Health Adv. (1.1& 1.2) Increasing Health Visiting Numbers (1.3) Diabetes (3.4) At 19 th March 4.3m of CCG QIPP remains outstanding of which 2.5m is assumed unlikely to be delivered. However delivery of all initiatives would still leave a gap of 100k Procurement of these services has been suspended thus the target levels of savings will not be achieved in 2012/13. Unlikely that ELFT will meet the challenging recruitment targets for 2012/13. ELFT have invoiced for recruitment of additional HVs but CCG have removed from budget as it was under the impression that target would not be delivered New LES not implemented due to lack of agreement. There are implications as 150k has been removed from the NUH contract predicated on delivery of this initiative. CCG will not be able to issue a LES next year, a different contract vehicle required. Star Chamber carried out to review key QIPP areas and strengthen business cases and plans. CSU reviewed 2012/13 QIPP and made recommendations to strengthen process for 2013/14. Mckinsey working with CCG to reviewed 29013/14 QIPP deliverability CCG are redesigning both services with provider. Workshop took place (01.03.13) to finalise LD service model. Service models for Advocacy not yet agreed. Discussed at CHS programme Board (15.03.13) Proposals for both services to be agreed with ELFT by 22.03.13 Due diligence process has taken place and CSU to challenge ELFT on numbers of WTE in post. Cost pressure identified as 0.3m CCG are liaising with the new lead from the NCB. Formal approval at LMC meeting Jan 13 for Type 2 Diabetes initiative and working with CSU to ensure National Standard contract will be effective from April 1 st. Structure Education initiative to be formally approved and procurement route identified. Both initiatives reviewed at Star Chamber Delivery Rating Non Contract Activity project (6.10) Re Commissioning CAMHS (7.4) Planned Care (9.3, 9.6, 9.9, 9.10) NCAs overspent by 339k (year end forecast 452k). Agreed a service redesign of CAMHS with ELFT instead of re-commissioning with a 280k full year effect (10% saving on the current contract) 30% of practices have reduced by target 10% but 70% have increased referral. No update received this month. NCCG finance reviewing NCA activity. CSU have not received a tracker since January. Service redesign exercise to take place to develop a new model of targeted and specialist CAMHS provision. Planning to realise 90k of savings in year. Negotiations on-going with provider.
Amber Area Quality Area Barts Health/Newham Headlines March 2013 Issue Action CQC unannounced visit 8th August (Barts): NUH not compliant on 4 of 5 standards reviewed. Never Events (Barts) : no new Never Event reported since December retained swab. 2012-13 total Never Events to date = 3. RCA investigations are due in March 2013. Child Safeguarding Training Levels (Barts) the Trust has submitted an action plan and trajectory to reach at least 80% levels by Aug 13 th (latest child safeguarding training levels for NUH site Level 1-55%; Level 2-38%; Level 3-41%.) CQC Action plan reviewed at CQRM and has now been accepted by the CQC and been shared on their website. Further monitoring of the action plan to come back through future CQRMs. Never Event CQC held meeting with Barts Health to review systemic issues from the 23 Never Events reported since Jan 2011 and investigation reports will be reviewed when submitted. Embedding of Never Event recommendation following CQC meeting to be tracked at CQRM. Surgery CAG taking lead on embedding learning. Safeguarding Action plan and trajectory under review by designated nurse and will be followed up by Barts Health CQRM agenda 18.03.13 MRSA (Barts): NUH Annual tolerance of 2 cases, YTD= 2 (reported in February 13 and July 12) EMSA (Barts): NUH reported 4 breaches in Jan (15 breaches in Dec). All breaches were in ITU step down C. Diff (Barts) : NUH s annual 2012-13 tolerance is max 6 cases. YTD = 12 cases reported (1 Apr, 1 June, 2 July, 2 Aug, 1 Sept, 1 Dec, 3 Jan, 1 Feb). MRSA Barts Health HCAI monitored at Barts Health CQRM. The last case was identified as a contaminant and appropriate feedback has been given to the staff member involved regarding cultures. EMSA Reviewing processes for counting and reporting breaches occurring in ITU across all sites. Action plan drafted. Standard operating procedure to be implemented. C.DIFF Barts Health wide HCAI action plan has been in place since November. NELC continues to monitor progress through CQRM. The Trust has formed a working group to standardise practice across all hospital sites. All cases have been reviewed for appropriate antibiotic prescribing against the hospital policy and all were appropriate. Green Area Serious Incident investigations 0 overdue SI s for which no report has been received and 13 overdue non-legacy incidents. VTE:91.19% January, YTD 91.53%, against a target of 90% - this is the 10 th month in a row where NUH has achieved the target SI NHSL Patient Safety Manager met with Director of Nursing to agree recovery plan. Overdue SI reports to be submitted by 31.03.13. Ongoing SI management responsibility will ensure that commissioners periodically monitor the implementation of actions arising from Sis. The site has advised that it has not been able to gather the evidence for the status of actions, and has deferred the report to April CQRM. VTE: Performance against above targets are monitored by CQRM.
Amber Area Quality Area ELFT (MHS and CHN) Newham Headlines March 2013 Issue Action SI management (ELFT/MH): 20 overdue SI reports at end Jan 13 (10CHS, 10MH), most overdue since Nov. Also 50 open incidents (10CHS, 40MH), being reviewed and some designated for themed workshops. 60% action plan recommendations are outstanding. Service User-Led Standards Audit Q2 (ELFT/MH) Three standards are often rated as poor ; regular, quality 1:1 time (standard 7) and the provision of information and quality of information (standards 8 and 9). Medications. Patient feedback Audit Results (ELFT/MH) Responses were received from 27/115 Newham patients using adult inpatient wards in Oct 12 Have you been given information about your medication? (37% no) Was this during a conversation with a member of staff? (37%no) Was the information clear and easy to understand? (22% no) Health Visitor recruitment (ELFT/CHN): Current capacity of services is 29% of recommended levels in national strategy (to be achieved by 2015).This equates to 100 additional posts required. Medical Supervision (ELFT/CHN): ELFT s medical supervision compliance rate <90% (target 100%), CHN still only directorate failing supervision target 37.5%. SI management Workshops taking place to address issues raised. Service User-Led Standards The Trust is considering carrying out interviews at patients homes so users from each borough can provide 1:1 feedback to the Trust. Medications. Patient feedback Audit Results (ELFT) The Trust is considering carrying out interviews at patients homes so users from each borough can provide 1:1 feedback HV recruitment In negotiation with the CSU as part of 2013/14 contract (March2013). Intensive work on recruitment and number of channels opened up. Commitment to recruit all suitable candidates that can be attracted in a fiercely competitive market. Joint working group with commissioners to maximise the benefits of increased Health Visitor numbers. Medical supervision Directorate management team to address low performance at regular meetings. Not discussed at February CQRM, CSU to place item on next CQRM agenda & request regular recovery plan from Trust. Child Safeguarding Training (ELFT):Q3 Staff compliance rates (target 80%) Level 2 76% and Level 3 at 77%. Historically had good compliance rates at this level, mandatory training may be due for renewal. Safeguarding: The CSU will continue to monitor this training through the CQRM process. Service User-Led Standards Audit Q2 (ELFT/MH) Of the ten standards, two standards are consistently rated highly by service users; standard1 - accessing ward staff/treated with respect and dignity and standard 6 regular access to therapeutic groups and activities. Newham scores high on both standards Green Area Child Safeguarding training: During Q3, the Trust reported good staff compliance rates against the target of 80%: Level 1: 94% and Level 4: at 100% CCQ Compliance: To date, ELFT has reported that they are fully compliant with all Essential Standards of Quality & Safety Central Alert System (CAS Alerts relating to medicines, patient safety, estates and equipment): To date ELFT has reported having implemented action plans on time for all CAS Alerts