Newham Borough Summary report April 2013 Prepared on 17/04/13 by Commissioning Support team
Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12 Apr-12 Jun-12 Aug-12 Oct-12 Dec-12 Feb-13 GREE N Finance and Activity AMBER Millions RED Newham Headlines April 2013 Headlines (M12 Ledger M11 SLAM) Delegated budget overspend stands at 2,929k ( 318k increase from M10) driven primarily by Acute (UCLH, RNOH, BMIs, NCAs) and non delivered QIPP. YTD overspend; Acute 3,032k, CHS 138k, MH 336k Significant underspend - non acute portfolio( 1.5m)due to decommissioning of CBS Barts Health position for Newham is +52k above plan (after productivity measures applied); whilst the total WELC position is + 1.7m (+0.34%) above plan Agreed that total costs pressures for Drugs and Devices will be shared equally across ELC CCGs as agreed by CCG Finance Officers. Obstetrics overspend ( 409k) due to 352 caesareans against a plan of 54. Financial run rate - based on monthly spend Vs actual 46,000 Planned spend 44,000 42,000 Actual spend 40,000 38,000 36,000 34,000 32,000 30,000 YTD Budget YTD Actual YTD (Under)/ Overspend Forecast (Under)/ Overspend RAG Improvement/ Deterioration vs Month 11 '000 Acute 248,707 251,739 3,032 3,032 415 Mental Health 45,433 45,769 336 336 115 Community Health 52,507 52,645 138 138 21 Other Non Acute 35,392 33,319 (2,073) (2,073) (1,318) Prescribing 39,420 37,524 (1,896) (1,896) 123 Non Core Primary Care Services 3,744 3,510 (234) (234) (179) QIPP to be delivered (3,626) 0 3,626 3,626 1,061 TOTAL DELEGATED 421,576 424,505 2,929 2,929 238 TOTAL NON-DELEGATED 46,875 46,498 (377) (377) (411) GRAND TOTAL 468,451 471,003 2,552 2,552 (173) Risks (significant issues or events which may occur) 1. QIPP 8.8m delivered from a target of 12.1m 2. 2012/13 non delivered acute activity QIPPs could impact 2013/14 baseline 3. 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 4. Additional A&E staffing (paid for with winter monies) will not be funded post April and may result in performance issues General actions (actions to address generic issues or mitigate risks) 2013/14 QIPP review document to be revised by CSU following year end data. CSU and CCG working together to improve governance and monitoring of 2013/14 QIPP Continuing Care retrospective reviews closely monitored by CSU CSU have reviewed performance information from BH and there are no obvious signs of declining performance from April at NUH due to staff shortages. Consultants are working additional hours. Key issues 1. BH /Newham site Unplanned variance + 875k (25% higher); non elective overspend (General med + 2,241k, General Surgery 460k, Geriatric medicine 1,153k, Paeds, 264k, Cardiology 493k, Excess bed days 145k). Planned + 3,148m (18%higher) Elective activity 1564k, Direct Access 522k, Outpatients (driven by OP FUPs) 1062k above plan. 2. UCLH (variance + 1349k) Overspend increased with current trends. Chemo high (across 5 pts there is a total spend of 556k) 3. NCAs (overspend + 749k) factors in expected spike in March activity and delay in invoices. 4. Low admissions to Virtual Ward (70 for Feb compared to 94 in Jan) Variation across clusters. 5. Health Visiting out of Borough providers (5% notifications arrive after day 7) 6. MH M10 occupancy at 101.3% (target 90%) 1. RNOH (variance + 238k) 2. Guys and St Thomas (variance + 292k) 3. Newham CHS (Includes +312k to fund Health Visitors - 14 WTE recruited) Actions 1. BH/N: (Unplanned) CCG to implement urgent care QIPP and develop integrated care model 1. (Planned) CCG to implement demand management QIPP and develop integrated care model to impact planned care overspend 2.UCLH: CSU to monitor variance 3. NCAs: Refreshed demand management initiative for 2013/14 QIPP 4 VW: Meetings with clusters to improve communications. CCG reviewing specification, to be raised at Barts Health SPR. 5. CSU have raised with local provider and escalated to corp BH. 6. Task & Finish established. Reviewing business case for 15 bed triage ward pilot RNOH: CSU to continue to monitor Guys: variance CHS: CSU to review impact - NCB to agree on hand-over of service 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 April 2013 Issue Action Cancer: Provisional data is showing that the 2 week wait achieved but not verified. Validated position due W/E 21 st April. Previous report : 14 Day GP Referral target poor achievement; at end of Jan, actual performance was 91.5% against target 93%. The 62 Day GP Referral performance also poor, at the end of Jan performance was 84.1% against the target of 85%. Cancer: 62 day performance was discussed at the Escalation Meeting with the CSU, CCG, NTDA and Barts Health on 19.03.13. Performance on un-validated data suggest target has been met for 2012/13. Rorie Jefferies, Cancer Commissioner CSU, has fortnightly meetings with Deputy COO. 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 for March YTD is 95.09% for Type 1 s, for all Types 96.48%. 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 March in relation to electronic recording of handover times Newham are at 92%, 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. Diagnostic 6 week waits: The position for Newham has greatly improved, now with 0 patients waiting over the 6 week standard. A&E: CSU attend the fortnightly ECIP Boards. Barts Health attended a formal Escalation Meeting on 19.03.13 (as above) where the focus was A&E Performance and 62 Day Cancer waits. Ambulance handovers: The CSU will continue to monitor these targets via the HAS Portal.
QIPP Newham Headlines April 2013 Area Issue Action Overall Headline CHS -Learning Dis & Health Adv. (1.1& 1.2) Increasing Health Visiting Numbers (1.3) Diabetes (3.4) Non Contract Activity project (6.10) Re Commissioning CAMHS (7.4) Planned Care (9.3, 9.6, 9.9, 9.10) In April 8.8m has been delivered from a target of 12.1m. Currently CCG/CSU validating a potential additional 100-300k which will reduce the undelivered sum. 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 Review of 2012/13 QIPP to be revised with end of year data and shared with CCG. CSU to meet with CCG Quality lead to agree governance processes for monitoring 2013/14 QIPP Revised proposals are currently being negotiated with ELFT by the CCG. Expected delivery in 2013/14 for both initiatives. ELFT recruited 14 WTE with the project spend totaling 326.14k out of an expected 350k. Initiative to transfer to NCB in 13/14 New LES not implemented due to lack of agreement. National Standard Contract will replace 12/13 LES to improve There are implications as 150k has been removed from Quality Management of Type 2 Diabetes, from 1 st April. the NUH contract predicated on delivery of this initiative. Structure Education initiative to be formally approved and CCG will not be able to issue a LES next year, a different procurement route identified. contract vehicle required. NCAs forecast overspent for 2012/13 is 749k. A spike in March caused by delays in receiving invoices. No trackers have been received since January 2013 to monitor progress. Agreed a service redesign of CAMHS with ELFT instead of re-commissioning with a 280k full year effect (10% saving on the current contract) 49 (77%) of practices above referral plan.12 of these are causing 65% of over performance. ELFT have been invoiced for savings of 93K for 12/13. Balance of full year effect savings to be achieved in 13/14. Service redesign implementation commences April 2013. This initiatives has been refreshed for 2013/14 QIPP. Finance and activity analysis has been carried out by CCG and CSU finance. Delivery Rating Green
Amber Area Quality Area Barts Health/Newham Headlines April 2013 Issue Action Child Safeguarding Training Levels (Barts): Trust report progress being made. Action plan and trajectory to reach at least 80% levels by Aug 13 th submitted. (March achievement is Level 1-69%; Level 2-53%; Level 3-52%.) NUH paediatric staff achievement reported >90%. Action plan was reviewed at BH overarching CQRM 19.03.13. Never Events (Barts): Review undertaken by CQC of Never Events since Jan 2011 (23 across all sites). 17 were surgery related so surgery CAG taking lead on embedding learning. Serious Incident investigations: 7 new SI s reported in March. NUH has 5 legacy reports where NHSL requested additional assurance before closing. BH overall had total 82 SIs overdue at end March 13, of which 18 NUH. BH currently Trust of concern regarding investigation process management, especially as backlog of overdue reports has not decreased over past two quarters despite recovery plans. Safeguarding: Action plan and trajectory achievement to continue monitoring at BH CQRM. Never Event: Report of review reviewed at CQRM March 2013. Actions include review of governance structures and reporting systems. Surgical team are addressing compliance with WHO checklist urgently. Progress and further actions to be implemented will be monitored via CQRM. Serious Incident investigations: This will be performance managed and monitored at CQRM. MSA (Barts): Cross site action plan in place. BH report improvements noted. 28 breaches report in NUH (Dec 15, Jan 4, Feb 0, March 9). C. Diff (Barts): NUH s annual 2012-13 tolerance is max 6 cases. YTD 12 cases reported. Presentation from the lead infection control nurse at CQRM confirmed all cases have been reviewed for appropriate antibiotic prescribing against the hospital policy and all were appropriate. MSA: To be followed up at site specific NUH CQR 16.04.13. C.Diff: A BH-wide HCAI action plan has been in place which is being monitored at CQRM. The C Diff trajectory for 2013/14 is 75 for the Trust. To be divided by CAGs based on outturn from 12/13. Green Area MRSA: NUH has an annual 2012/13 tolerance of max 2 cases, & ended year with total 2 cases. VTE: 90.47% Feb, YTD 91.43% against a target of 90% - this is the 11 th month in a row where NUH has achieved the target MRSA: BH HCAI monitored at BH CQRM. Target for 2013.14 will be 0 tolerance. The Trust also has an internal target of 25% reduction of all septicaemia (including MSSA and E coli). VTE: Performance against above targets are monitored by CQRM.
Quality Amber Area Area ELFT (MHS and CHN) Newham Headlines April 2013 Issue SI management (ELFT/MH): at end March 13, ELFT has 66 open SIs: 13 overdue reports (no report submitted was 16 in Feb), 15 reports newly completed & submitted for review, 38 reports awaiting closure following additional assurance from workshop covering suicides, physical health, safeguarding and safety scheduled for 15.04.13. NPSA reporting rates: latest data release for March-Sept 2012 shows that whilst median rate for all 58 MH Trusts raised from 19.9 to 23.8 across period, ELFT rate did not change from 9.9 incidents per 1,000 bed days. Organisations reporting more incidents usually have better and more effective safety culture. Action SI management: NEL CSU holding workshop 15.04.13 to gain additional assurance in Trust processes. NPSA reporting rates: issue to be explored via CQRM. None given. None given. NHS Litigation Authority: Trust has achieved Level 3 (highest level) of the NHSLA s risk management standards. The Trust is the first and only Mental Health and Community Services Trust in the country to obtain level 3. Green Area 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 and has none open on the CAS site.