Agenda Item No: 4.6 REPORT TO: PREPARED Y: PRESENTED Y: NHS Governing ody Cath Coughlan Pendle Locality Manager Designate/Head of usiness Assurance Tim Mansfield, Chief Operating Officer DATE: 25 February 2013 NHS East Lancashire Performance Report Report Category: Formal Receipt Debate Action Information Which Strategic Objective does the report relate to: 1. Commission the right services for patients to be seen at the right time, in the right place, by the right professional. 2. Optimise appropriate use of resources and remove inefficiencies 3. Improve access, quality and choice of service provision within Primary Care 4. Work with colleagues from Secondary Care and Local Authorities to develop seamless care pathways. 1
Agenda Item No: 4.6 NHS Governing ody 25 February 2013 NHS East Lancashire Performance Report 1. Introduction 1.1 This paper reports on the performance against the 2012/13 Operating Framework and Supporting Measures for NHS East Lancashire as at November 2012. 2. Purpose 2.1 The NHS Operating Framework sets out the national priorities for 2012/13 including maintaining performance on key waiting times, continuing to reduce healthcare associated infections and reducing emergency readmission rates. 2.2 NHS East Lancashire Performance: The attached reporting structure enables the Shadow oard to monitor performance against key performance indicators on a monthly basis. 2.3 Added rigour is provided in terms of each performance lead being required to offer exception narrative for any indicator that is RAG rated AMER or RED (see appendix 1). 2.4 On behalf of the Lancashire Cluster, lackpool has been commissioned to produce an automated report for each which is produced on a monthly basis. As this process is still in its infancy, the data is scrutinised by NHS data analysts to ensure the data is valid prior to requesting exception narratives (see appendix 2). 2.5 In addition to this, the Local Delivery Group (LDG) receive a quarterly position statement on the Operating Plan. The LDG are notified of any problem areas that are raised which may impact on requirements of the Operating Plan being met. 3. Conclusion 3.1 The report demonstrates the work taking place to ensure performance improvements in commissioning capabilities and outcome improvements and ideally should provide a basis for further development to support the Shadow oard towards achieving its strategic commitments for 2012-13. 4. Recommendations 4.1 The oard are asked to: Note the performance to date against the 2012-13 targets and the actions in place to improve performance for our local population. Catherine Coughlan Pendle Locality Manager Designate/Head of usiness Assurance 2
Appendix 1: A&E CLINIC INDICATORS (HE11, HQU09-HQU13) A&E clinical quality indicators LTH S&O UHM TH HT 94.06 A&E 4 Hour Target Wk 9 th Dec 2012 A&E 4 Hour Target Position Q3 12/13 to 96.12 date Operational Problems during Past 24 0 Hours (29 th Aug 2012) Source: A&E sitrep - http://nww.northwest.nhs.uk/performance/infopack/week/, Daily Sitrep, uploaded by trusts daily to Unify Summary emailed out by Paul Ansboro at the SHA (can t be viewed on Unify) East Lancashire YTD: Fail Admitted (4hrs) current position underachieving, however an improvement when compared with the previous month (5.16 compared with 5.39 in September) Unplanned re-attendance Unplanned re-attendance at A&E within 7 days of original attendance currently 9.5 above target of 5, which is an improvement when compared with the month of August which was 10.6 PCT Contact: John Rotherham Work continues on development of an Integrated Urgent Care Streaming Pilot with planned commencement date of 14 th January 2013. Operational group meeting weekly to progress. Development of an Unscheduled Care Strategy supported by an Integrated Needs Assessment for Unscheduled Care continues. A data workshop is taking place on 13 th December 2012. Work continues on the framework, with regular reports on progress submitted to Clinical Transformational oard Unscheduled Care Action Plan continues to be updated regularly and exceptions reported to Clinical Transformation oard. Mental Health Assessments additional in-reach into HT from LCFT Crisis Response Team overnight commenced on 3 rd December 2013. The impact of this is being monitored weekly. Unplanned re-attendance HT undertook an audit to provide an understanding of patient cohort, focusing on access and reviewing demand. Following the escalation to Director of Operations at HT as results of audit had not been received, a response has now been received the audit is complete it will need review prior to presentation. The results with be discussed at the next meeting of the Pennine Lancashire Unscheduled Care Group in November 2012. Activity Secondary Care Activity (SRS9-SRS15) Activity PHS11_01: Number of elective FFCEs - ordinary admissions PHS11_02: Number of elective FFCEs - day cases PHS11_03: Total number of FFCEs in the period SRS09: Proportion of elective FFCE's which are day cases PHS07: Number of GP written referrals in the period PHS08: Number of other (non-gp) referrals for a first consultant outpatient episode in the period PHS09: Number of 1st outpatient attendances (consultant-led) following GP referral in general and acute specialties PHS10: All first outpatient attendances (consultant-led) in general and acute specialties Source: MAR data Nov-12 YTD Nov-12 YTD Nov-12 YTD Nov-12 YTD Nov-12 YTD Nov-12 YTD Nov-12 YTD Nov-12 YTD 7903 31550 39453 80.35 59738 20697 47686 81352 F&W 3
East Lancashire Elective Daycase activity is above plan by 1,789 (6). This is due to an increase in activity for diagnostic endoscopy procedures which have historically impacted on the hospitals ability to meet the 18 weeks referral to treatment target. Elective activity is below plan by 1,816 which offsets the increase in daycase activity when all elective activity is looked at in its entirety. Total elective activity is 259 (0.65) below plan. Other referrals are over plan by 2230 (12). This can be attributed to the improved data collection of the community paediatrics as seen with the GP referrals. Other increases have been observed in Urology and Cardiology. Patients are referred to Cardiology as part of the 18 weeks pathway to ensure they are clinically fit to be operated on and as more patients are treated then referrals to this specialty will increase. PCT Contact: Janet Dodd No action is required to meet national targets for both 18 weeks and cancer. As above the provider is currently seeking authorisation from the department to resubmit the figures. Non Elective FFCEs (PHS06) Activity PHS06: Number of G&A non-elective FFCEs in the period Source: MAR data 34 days approx. Nov-12 YTD F&W 29796 24056 East Lancashire PCT Contact: John Rotherham YTD: Fail Number of G&A non-elective FFCEs in the period Number of G&A non-elective FFCEs in the period 29,796 against a target of 28,034 (over performance of The Unscheduled Care Action Plan Unscheduled 1762) Care Action Plan continues to be implemented and Growth in paediatrics, general medicine and zero length exceptions reported to the Clinical Transformation of stay oard next update February 2013. Paediatric HOT Clinics and Telephone consultations, pilot commenced 19 th November 2012. Impact of monitoring being undertaken current uptake low. Plans are in place to promote the service across Primary Care. Review of Emergency Care Pathway took place on 17 th December. A proposed action plan and report is being presented at the Pennine Lancashire Clinical Transformation oard in February 2013. Acute Visiting Scheme proposals for pilot being considered by localities, following planned implementation of pilot model in in Febraury. Plans are under development to undertaken a further readmission audit across Pennine Lancashire. Take Home and Settle Scheme is being developed with Age UK within ED/UCC/MAU to support discharge of patients who may have previously been admitted due to lack of support at home. reastfeeding at 6 8 weeks (SQU19/HN16) F&W SQU19_06: The number of children being breastfed at 6 8 weeks Q2 YTD 23.27 Source: IPMR quarterly return (20 days after quarter) or (http://www.dh.gov.uk/en/publicationsandstatistics/statistics/statisticalworkareas/statisticalpublichealth/dh_124185#_1 approx. 54 days after end of quarter) 4
Pan Lancashire working; a Lancashire Care Foundation Trust Policy for central, east and areas is to be finalised for ratification by the end of February 2012. The need for a Lancashire acute and community policy is being reassessed because almost all trusts have UNICEF (UK) aby Friendly compliant policies which are regularly assessed as part of the accreditation process. Policies for North Lancashire and lackpool are in place across the Community and Acute Trust Providers. A statement of strategic intent for infant feeding has been developed for Lancashire; this focuses on the 10 priority actions most likely to make the difference needed in addressing health inequalities. This brief document draws on local, national and international evidence. East Lancashire YTD: Fail Prevalence: Actual Q2 (Sept 12) = 23.3. Health visitor data at 4-6weeks Q2 = 38. The coverage of IPMR 2- breastfeeding at 6-8 wks has increased from 71.74 to 80.2 this has improved but is still below the target for the prevalence to be published (95). Capacity within CHIS red slip returns reported and monitored each quarter. Followed up with practices time permitting. Not sustainable in the long-term. FI progressing reast Feeding Pathway review Task & Finish group mapping out all provider activities that support breastfeeding across Pennine Lancashire Improve GP engagement in reast Feeding Activities considered necessary to increase prevalence flyer and information for e-learning package circulated to all practices PCT Contact: Tim Mansfield Data completeness to improve data coverage at 6-8 weeks Practices to be kept informed of missing data status. Continue to follow up with practices. Report to be produced highlighting implications. reastfeeding support to plan for continuation and improvement of service in HT from April 2013 under the new maternity tariff. Evaluate support in antenatal clinics to promote breastfeeding Continue to work towards achievement of aby Friendly Initiative progressing to stage 1 assessment for community services To launch a new version of the red book with guidance which will improve the quality of data collected and improve information sharing between health professionals Cancer Screening Screening: owel (SQU21) SQU21: of Adult population aged 70-75 invited for owel Screening CSR, GP Q2 YTD 85.45 Waiting list for colonoscopy Sep-12 182 Waiting list for flexible sigmoidoscopy Sep-12 163 Source: Open Exeter for screening, waiting list data - (37 days after end month) F&W ACUTE TRUSTS LTH S&O TH UHM (RXN) (RVY) (RXL) (RXR) (RTX) Maximum waiting time for 6 Sep-12 8 Weeks 5 Weeks 6 Weeks colonoscopy Weeks 13+ Weeks Maximum waiting time for flexible 6 Sep-12 9 Weeks 5 Weeks 6 Weeks sigmoidoscopy Weeks 13+ Weeks Source: http://www.dh.gov.uk/en/publicationsandstatistics/statistics/performancedataandstatistics/hospitalwaitingtimesandliststatistics/diagnostics/index.htm (37 days after end month) 5
Pan Lancashire owel Cancer Screening Programme expansion; the expansion of the programme to 70-74 s (up to the 75 th birthday) is phased over 4 years. Expansion commenced in each PCT area upon completion of the first complete round of screening for the 60-69 cohort as per the guidance. The owel Screening Commissioning Group meets quarterly and is chaired by NHS lackpool as the lead commissioner. Timing of invitations. Performance at end Q3 2012/13 was within standard, with invitations currently being sent out one week ahead of due date. owel Cancer Screening Programme expansion continues to be on track. 6
Screening: Cervical (SQU22/V09) SQU22: All women to receive results of cervical screening tests within 2 weeks Source: LASCA Nov-12 99.6 F&W 7
Pan Lancashire Pan Lancashire a Programme oard for the Pan-Lancashire programme has been established and meets bimonthly. Terms of Reference for the oard are being finalised. Cluster PCT s have local Programme oards/steering Groups and are planned to become operational type groups with reporting to the Pan Lancashire Programme oard. Pennine Lancashire have established structures in the form of a Programme oard and an Operational Group which have defined their terms of reference and membership to ensure a collaborative approach to the delivery and monitoring of the programme within Pennine Lancashire Cancer Waits Two Weeks, 31 and 62 days (PHQ24/HQU15/HN11) PHQ24: of patients seen within two weeks of an urgent GP referral for suspected cancer (target 93) PHQ25: of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not initially suspected (target 93) PHQ06: of patients receiving definitive treatment within one month of a cancer diagnosis (target 96) PHQ07: of patients receiving subsequent treatment for cancer within 31 days where that treatment is Surgery (target 94) PHQ08: of patients receiving subsequent treatment for cancer within 31 days where that treatment is an Anti-cancer Drug Regime (target 98) PHQ09: of patients receiving subsequent treatment for cancer within 31 day where that treatment is Radiotherapy (target 94) PHQ03: of patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer (target 85) PHQ04: of patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service (target 90) PHQ05: of patients receiving first definitive treatment for cancer within 62 days of consultant decision to upgrade their priority (target 86) Perio d Nov- 12 95.44 YTD 95.72 Nov- 12 92.0 YTD 94.91 Nov- 12 97.40 YTD 98.18 Nov- 12 100 YTD 97.83 Nov- 12 100 YTD 99.58 Nov- 12 100 YTD 96.28 Nov- 12 85.37 YTD 85.92 Nov- 12 100 YTD 94.67 Nov- 12 95.24 YTD 95.62 F&W Source: Open Exeter (approx. 37 days after month) Cancer Mortality (HN22) 1. Preventing people from dying prematurely Cancer Mortality 2010-11 124.5 Rate per 100,000 population. Data Source: IC Indicator Portal F&W East Lancashire YTD: Fail Outcome data is published on annual basis, so no change from previous report. The data given above is for the period 2008-2010. Next data update available in December 2012 PCT Contact: Mark Smith Awareness and early detection. All GP practices in East Lancashire being approached, by primary care cancer lead and/or the cancer network manager, to have a professional development discussion about urgent cancer referrals and fill in an action plan. So far 21 out of 64 practices have prepared an action plan. Strategic development. A draft action plan for cancer prevention, detection and management has been prepared for Pennine Lancashire. This is undergoing further development and prioritisation. East Lancashire. A JSNA Health Profile showing higher than average premature mortality from cancer was received by East Lancashire Informal oard in August 2012. The oard has agreed to prioritise this health issue 8
Cancer inequalities. The PCTs in Lancashire and South Cumbria are working in collaboration with L&SCCN to refresh and review the cancer inequalities action plan. This will include sections on prevention, screening and cancer awareness. Chlamydia Screening (HN17) Chlamydia prevalence: screened Q2 YTD 7.9 Positivity (community tests) Q2 YTD 9.1 F&W Source: PCT data tables http://www.chlamydiascreening.nhs.uk/ps/data/data_tables.html (approx. 2.5 months after quarter) Pan Lancashire Influenced by the direction of travel nationally and locally for sexual health, via the sexual health commissioner s network, sexual health commissioners and public health are working more closely together in an attempt to facilitate a consistent approach, wherever possible pan- Lancashire, to sexual health. This includes chlamydia screening and the sharing of good practice as appropriate. Sexual health commissioners and public health are working more closely together in an attempt to facilitate a consistent approach, wherever possible pan- Lancashire, to sexual health. This includes chlamydia screening and the sharing of good practice as appropriate. East Lancashire PCT Contact: Tim Mansfield YTD: Fail NHS oard has made the decision not to pursue the 35 chlamydia screening target, on the basis that it is difficult to Fail evidence the benefits of screening low and not risk children and young people Priority has been to focus chlamydia screening on people attending core services, and to support this by continued media and marketing campaigns Choose and ook Activity Choose and ook - ookings to services where named consultant led team was available (even if not selected) Choose and book utilisation, of outpatient booking CSR, GP Nov-12 81.8 Nov-12 (w/e 2/12/12) Source: Weekly utilisation reports column V http://nww.chooseandbook.nhs.uk/staff/reports 55.4 F&W East Lancashire YTD: Fail NHS is currently at 55.37 against a target of 90. This is slightly below Octobers performance level and above or similar to other PCTs in Lancashire and NW Despite the relatively low utilisation for bookings all NHS GP practices are still using Choose & ook PCT Contact: Jane Tebby Action Plan developed with Choose & ook Team for NHS and NHS (joint post) this includes:- Ensuring Choose & ook support training is available to all GP practices across. Practices can request this if/when needed.. Recent Choose & ook training for urnley practices linked to the commencement of the Advice and Navigation LES has helped to refresh relevant practice staff. Re-focus with HT on specialty level plans to reduce T levels (slot issues) at HT, via Access oard meeting, specialty level action plans requested for specialties with high T rates but not yet received from HT. 9
HT reported that there are Choose & ook slot issues for key specialties at main hospital sites, but that there is OP clinic slot availability for most specialties at outlying HT hospital sites which are not always fully utilised (e.g. at AVH, Clitheroe Hospital, etc). Information has been circulated which will encourage Choose & ook users in GP Practices to ensure they search all HT sites on Choose & ook and ensure patients are offered a choice of hospital site. CVD Mortality (HN23) Cardio Vascular Mortality 2010-11 82.22 F&W Source: NCHOD - https://indicators.ic.nhs.uk/webview/ (update Jan 12) East Lancashire YTD: Under Achieve Mortality from all circulatory diseases (under 75) have fallen dramatically within East Lancashire over recent years In common with most PCTs within Lancashire, the rate of decline has however slowed down It is acknowledged that the National Support Team for Health Inequalities in 2010 reflected that there was still substantial progress that could be made in the short term through a) optimizing the care of people with CVD related conditions in general practice Following on from this a proposal to implement a QOF and beyond scheme was considered by both the NHS East Lancashire Executive Management Team and NHS East Lancashire PEC in Spring 2011 and a view taken not to proceed with such a scheme on grounds of both feasibility and affordability In the absence of such a scheme it remains to be seen how PCT Contact: Aidan Kirkpatrick AAA Screening: Work is progressing regarding the implementation of a local AAA screening programme Health Checks: in respect of above, although the NHS average uptake of the NHS Health Checks Scheme is broadly encouraging but there is a substantial inequity of provision/uptake across the local health economy. To try and mitigate against this inequity of uptake there was a plan to commission a community outreach service but it now looks if this will be delayed until 2013/14. Commissioners have implemented a pharmacy outreach scheme which has been slow to provide the expected outcomes. Further awareness raising in respect of the NHS Health Checks programme is planned in the coming months across the locally community Work is on-going regarding improvements in secondary prevention e.g. through improved care for patients with AF through use of the GRASP-AF tool much further progress can still be made through treatment interventions without further addressing wider lifestyle issues and Implementing updated NICE guidelines on managing obtaining greater influence on the wider social determinants of hypertension work programme coordinated through the CSNLC health which largely lie outside the direct influence of the NHS and during 2012/13 to embed guidance within general practice for which there are no substantial additional NHS funding streams currently available to commit to this agenda Identification of peripheral arterial disease via leg cafes; this will ensure that those at risk have the opportunity to take secondary prevention guidance Improvements in the East Lancashire stroke/tia pathway and improved access to other cardiac interventions e.g. PPCI, will all impact on the CVD mortality within East Lancashire. Series of CVD related training events for primary care teams covering lifestyle interventions, medicine management issues and new guideline developments 10
Delayed Transfers of Care (SRS10) ACUTE TRUSTS LTH S&O TH HT UHM SRS10: Delayed transfers of care acute and non acute- delayed days Nov-12 185 Patient choice Nov-12 11 Completion of assessment Nov-12 114 Awaiting residential or nursing home Nov-12 0 Awaiting further NHS non acute care Nov-12 60 Source: http://transparency.dh.gov.uk/2012/07/11/delayed-transfers-of-care-2012-13/ NHS North West has confirmed that the target for PCTs is the national upper quartile (based on 2009 population data) with the achieve threshold at 5.1 per 100,000 population, aged 18+ and the under achieve threshold at 8.3. East Lancashire Delayed Transfer of Care (per 100,000 population) Currently performing above target Delayed assessments due to capacity Lack of clarity from HT in relationship to communication of CHC Assessments PCT Contact: John Rotherham Delayed Transfer of Care (per 100,000 population) Delayed transfers of care will be raised at the health Economy Intermediate Care oard. An agreed step-down protocol was not fully understood at the hospital which will be raised at the next Intermediate Care oard. Step Down and CHC Assessments process being revisited/ revised to ensure clear understanding by all stakeholders. There is an Integrated Discharge Steering Group and action plan. Monthly updated reports are provided to the group which include DTOC. Dentistry (SQU09 / HN02) SQU09: NHS Dentistry (24 month measure) Source: NHS usiness Authority 13 days approx. WD Sep-12 214,602 F&W East Lancashire YTD: Fail PCT Contact: Sharon Young 11
Actual number of patients accessing dental services in a 24 month period at November is 215,814, against YTD target 230,301 (6.3 below target). Whilst there remains a gap between the actual and the trajectory the number of patients accessing dental services in a 24 month period continues to rise month on month. The shortfall is a result of service implementation for 2 new practices being behind the timescales in the agreed plan. The gap between the actual and trajectory has reduced slightly in Q3. The trajectory was set based on estimated demand for access and whilst services to meet estimated demand are in place, actual demand has reduced. The number of patients on the PCTs access allocation database currently stands at < 500, which is the lowest since the database was introduced. Dental Access Plan: All new capacity outlined in the agreed dental access plan is now fully mobilized and work continues to allocate/signpost patients to those dental practices accepting new NHS patients. The number of patients waiting on the access allocation database has significantly decreased and demand has reduced. Access allocation reports are monitored monthly to identify any pressure areas. Additional UDAs have been commissioned in areas where demand is not currently being met and there are no reported problems with patients accessing dental services. Communication to raise awareness of the availability of access to NHS dental services is on-going and targeted in those areas where demand for access has fallen. A poster has been produced in collaboration with our neighbouring PCT (lackburn with Darwen) and this has been distributed widely across the East Lancashire health economy. Monitoring: The frequency of interval of attendance and multiple FP17s per patient are being monitored through vital signs with E reporting used to evidence reporting patterns that limit dental access. A performance framework for Lancashire is currently being developed in accordance with developments at a national level. 12
Diabetic Retinopathy (SQU23 / HE01) SQU23: of eligible people offered screening for the early detection of diabetic retinopathy in the previous twelve months Source: IPMR return Q2 12/13 107.5 F&W Diagnostic Waits (V03) PCT POSITION Diagnostics Waits 15 Key Diagnostic Tests: No. over 6 Wks 15 Key Diagnostic Tests: No. over 13 Wks 15 Key Diagnostic Tests: Total Waiting List 15 Key Diagnostic Tests Over 6 Week Wait (PHQ22_01) CSR GP & WL Nov-12 3 Nov-12 0 Nov-12 5459 Nov-12 0.1 Non obstetric ultrasound 6 weeks+ Nov-12 0 Diagnostic Activity F&W No. of Diagnostic Endoscopy Tests (PHS14) Nov-12YTD 7492 No. of Diagnostic Non-Endoscopy Tests (PHS15) Nov-12YTD 69994 Source: http://www.dh.gov.uk/en/publicationsandstatistics/statistics/performancedataandstatistics/hospitalwaitingtimesandliststatistics/diagnostics/index.htm CL data V03 (37 days after month) OVERL TRUST POSITION LTH S&O TH HT UHM 15 Key Diagnostic Tests: No. over 6 Wks Nov-12 0 15 Key Diagnostic Tests: No. over 13 Wks Nov-12 0 15 Key Diagnostic Tests: Total Waiting List Nov-12 6567 15 Key Diagnostic Tests Over 6 Week Wait Nov-12 0 Non obstetric ultrasound over 6 weeks Nov-12 0 Source: http://www.dh.gov.uk/en/publicationsandstatistics/statistics/performancedataandstatistics/hospitalwaitingtimesandliststatistics/diagnostics/index.htm East Lancashire Diagnostic Activity YTD: Fail No of endoscopy tests November 12.4 over plan YTD No of non-endoscopy tests November 6.8 over plan YTD PCT Contact: Angela Dunne Activity to reduce 18 week waits increased diagnostic tests was undertaken in early part of the year Pennine Lancs demand management group is due to commence a piece of work to reduce inappropriate diagnostic test 13
Emergency Re-admissions (HQU16) w D CC G CSR GP CC G WL Emergency Readmissions within Nov-12 7.57 30 days of discharge PCT Source: 35 days approx., narrative LN F&W East Lancashire YTD: Fail, Forecast: HT are currently performing at 10.8 YTD. Performance in November 2012 was 7.43 which has improved from October 2012 which was 8.65 PCT Contact: John Rotherham Scoping of Acute Visiting Scheme (AVS) will also impact on improving this area. lackburn will commence pilot of AVS in February. Evaluation of pilot to be shared with E LANCS localities, to support roll out across E Lancs. The Health Economy Discharge Steering Group are linking in with the Admission Avoidance and Rapid Assessment Teams within HT in order to work towards more integration across services, and linking in current initiatives. Health Checks (SQU27 / V20) F&W PHQ31: of eligible people that were Q2 offered an NHS Health Check in 2011/12 12/13 7.86 PHQ31: of eligible people that have Q2 received an NHS Health Check in 2011/12 12/13 5.89 Source: IPMR return/ http://www.dh.gov.uk/en/publicationsandstatistics/statistics/performancedataandstatistics/integratedperfomancemeasuresmonitoring/dh_129481 East Lancashire YTD: Offer: Fail Take-up: Fail Claims from GPs for delivery in November have been submitted. Claims for delivery during December have not been submitted yet. GP are actively engaging with commissioners, providing more timely information and addressing issues in a timely manner PCT Contact: Susan Warburton Engagement with GP practices will continue Clinical commissioners locality groups are pro-actively encouraging improved practice and delivery at practice level There is evidence that individual GP practices are taking more ownership to improve delivery and reporting Hospital Acquired Infections C. Difficile (HQU02) PHQ28: Number of C. Difficile infections CSR, GP Nov-12 YTD 69 NHS LANCASHIRE 279 F&W Pan-Lancashire The PCT Infection prevention practitioners continue to meet monthly to share root cause analysis information and best practice to improve performance. A Clostridium Difficile newsletter is planned for dissemination to all Practices within the next month. Across the cluster feedback and actions required are provided to individual practices following a non-acute apportioned case of Clostridium difficile infection. In collaboration with Lancashire County Council, the Infection Prevention teams have delivered training to the Quality Compliance Officers on the infection prevention element of the quality monitoring framework for adult social care. 14
MRSA (HQU01) PHQ27: Number of MRSA infections Childhood Immunisation (HN15) Nov-12 YTD 2 NHS LANCASHIRE 14 F&W Childhood Immunisation; Age 1 (DTAp/IPV/Hib) (Target 95) Childhood Immunisation; Age 2 (PCV ooster) (Target 95) Childhood Immunisation; Age 2 (Hib/MenC ooster) (Target 95) Childhood Immunisation; Age 2 (MMR) (Target 95) Childhood Immunisation; Age 5 (DTaP/IPV ooster) (Target 95) Childhood Immunisation; Age 5 (MMR) (Target 95) HPV vaccination; Age 12-13; 2010-11 school year (Target 90) CSR, GP Q2 YTD 94.2 Q2 YTD 93.4 Q2 YTD 92.7 Q2 YTD 93.3 Q2 YTD 91.1 Q2 YTD 88.8 2010-11 93.1 F&W Source: Child Health information system 15 days approx. East Lancashire PCT Contact: Waheeda Abbas Overall YTD: Under Achieve Target poorest performing practices On-going Data audit exercise with CHIS and GP is being To achieve 95 target the GP Practices upper target implemented with individual practices to identify anomalies with data and to identify low uptake in GP practice.. payment level needs to be increased from 90 Data audit is on-going to identify all children outstanding Individual practices have been given lists of children who are MMR 1 and 2 outstanding or have uncertain immunisation status for each KPI for the practices to target and improve uptake rates for their Practices identified with data anomalies are being provided practice. with support to combat the issue. Capacity an issue due to IV co-ordinator on annual leave 18 Weeks Incomplete Pathways (PHQ19-21) RTT by Specialty 15
Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Target 90 95 92 90 95 92 90 95 92 90 95 92 90 95 92 Nov-12 Position 92.2 98.8 95.6 95.5 97.1 95.5 91.9 96.9 94.6 93.9 98.6 95.7 90.7 96.5 94.6 Cardiac Surgery 83.3 88.9 93.3 ENT General Surgery 89.5 90.4 Neurosurgery 89.2 87.0 89.3 82.1 88.7 Ophthalmology 88.5 89.2 87.5 Oral Surgery Plastic surgery 80.0 83.3 91.2 86.7 89.6 Trauma & Orthopaedics 87.9 90.4 89.2 85.4 91.3 Urology 93.0 Cardiology 88.2 Dermatology Gastroenterology 89.2 General Medicine 87.5 91.3 Geriatric Medicine Neurology 91.8 0.0 93.6 94.2 Rheumatology Thoracic Medicine 94.4 Gynaecology Other F&W Total Specialty reaches 4 1 2 2 1 2 4 1 2 3 1 1 3 3 3 RTT by Specialty Lancashire Acute Trusts Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Admitted Non-Admitted Incomplete Target 90 95 92 90 95 92 90 95 92 90 95 92 90 95 92 Nov-12 Position 85.8 95.5 93.3 95.4 97.3 96.0 93.5 99.4 96.4 91.2 96.5 94.1 86.5 97.4 92.6 Cardiac Surgery ENT 82.6 General Surgery 85.6 90.0 72.4 92.8 86.7 Neurosurgery 87.4 Ophthalmology 85.6 79.5 Oral Surgery Plastic surgery 91.7 90.8 Trauma & Orthopaedics 77.0 88.2 75.2 93.4 78.1 Urology 91.2 Cardiology Dermatology Gastroenterology 80.6 89.8 General Medicine Geriatric Medicine Neurology 91.9 Rheumatology Thoracic Medicine 88.1 Gynaecology University Hospitals Morecambe ay lackpool Teaching Hospitals East Lancashire Hospitals Lancashire Teaching Hospitals Southport & Ormskirk Hospitals Other 82.1 Total Specialty reaches 5 2 2 0 2 0 0 0 0 1 0 4 2 2 2 18 weeks: Incomplete pathways & over 52 week waits POSITION The number of incomplete Referral to Treatment pathways at the end of the period Number of incomplete pathways over 52 weeks RTT Incomplete Pathways - No. of Specialties reached the 92 target CSR,GP Nov-12 16198 Nov-12 3 Nov-12 1 F&W reakdown by Specialty of Incomplete Pathways over 52 weeks Position CSR,GP General Surgery Nov-12 1 1 Urology 1 T&O 1 3 1 1 ENT Ophthalmology 1 Oral surgery 1 Neurosurgery Plastic surgery Cardiothoracic Surgery General Medicine F&W 16
Gastroenterology Cardiology Dermatology Thoracic Medicine Neurology Rheumatology Geriatric Medicine Gynaecology Other 1 2 2 2 TOT 2 2 9 3 2 18 weeks: Incomplete pathways over 52 weeks detail- Trust TRUST POSITION LTH S&O TH HT UHM HRS07: The number of incomplete Referral to Treatment pathways at the end of the period Number of incomplete pathways over 18 weeks Number of incomplete pathways over 52 weeks Nov12 25311 9655 17075 15295 14742 Nov-12 1498 716 679 545 992 Nov-12 0 16 0 0 3 Trust Position LTH S&O TH HT UHM General Surgery 8 2 Urology 1 Trauma & Orthopaedics 6 1 ENT Ophthalmology 1 Oral surgery Neurosurgery Plastic surgery Cardiothoracic Surgery General Medicine Gastroenterology Cardiology Dermatology Thoracic Medicine Neurology Rheumatology Geriatric Medicine Gynaecology Other TOT Nov-12 0 16 0 0 3 Source: http://www.dh.gov.uk/en/publicationsandstatistics/statistics/performancedataandstatistics/referraltotreatmentstatistics/index.htm (45 days after month) East Lancashire YTD: Fail Number of Incomplete RTT pathways Plan 16,094 Actual 16,198 Variance +104 0.66 This represents a significant decrease on previous month (was +11.3) Incomplete Pathways over 52 weeks 1 x trauma & Orthopaedics 2 x other No of specialities breaching 92 target for incomplete pathways Neurosurgery PCT Contact: Angela Dunne Close monitoring of performance Follow with relevant Out of Cluster providers via host commissioners where NHS is an associate to the contract Monthly monitoring with HT to agree actions 17
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IAPT (SQU16) PHQ13_05: The proportion of people who have depression and/or anxiety disorders who receive psychological therapies PHQ13_06: The proportion of people who complete treatment who are moving to recovery PHQ13_07: The number of people waiting more than 28 days from referral to treatment Perio d Q2 12/13 Q2 12/13 Q2 12/13 2.63 43.2 829 F&W East Lancashire PCT Contact: Joy Arrandale YTD: Fail Funding awarded on average national prevalence Review of service in early stages rates however, NW prevalence is higher resulting in Under - utilization of PWP (step 2) needs less funding to commission sufficient therapists to meet addressing demand/targets Exploring utilisation of more group and online The national KPI has altered which has meant that therapy patients referred to IAPT are not counted until they Single point of access pilot, evaluation in pipeline. have entered and received regularly treatment. This is Learning / recommendations from pilot to be having an impact on all IAPT services nationally realised. Early indications are that majority of Above results in people entering IAPT but waiting list referrals are too complex for step 2 and to enter therapy consequently being referred to step 3 for more Complexity of mental health 16 of service users in intensive treatment. Hyndburn and Rossendale are being treated in complex PCT s not required to report on this target 13/14 clusters 5 + which is likely to reduce recovery rate and are in treatment for longer than lower clusters. Complexity in other teams of cluster 5 and above is at 10 with the exception of Ribble Valley who receive much lower complexity and are achieving recover rates of 62. New trajectories currently being set for 13/14 following guidance from regional IAPT team (Jan 13) Maternity Assessments (SQU12) SQU12: women who have seen a midwife by 12 weeks and 6 days of pregnancy Q4 11/12 CSR, GP 92.69 F&W Mixed Sex Accommodation (HQU08) The Department of Health has set a target of no unjustified sleeping accommodation breaches. 2012-13 Operating Framework: reach allowance of 0.049 per 1000 FCEs. EMSA MSA Rate (operating framework allowance 0.049) CSR, GP Nov-12 0.000 F&W Source: Current month http://www.dh.gov.uk/en/publicationsandstatistics/statistics/performancedataandstatistics/mixedsexaccommodation/index.htm. Year to date position: Unify Smoking (SQU18/HN13) Smoking Quitters SQU18: Number of 4-week smoking quitters that have attended NHS Stop Smoking Services Perio d Q2 12/13 YTD CSR, GP 1753 F&W 19
Source: http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/nhs-stop-smoking-services (58 days after quarter) Stroke (SQU06/HN05) a) of time on a Stroke Ward b) TIA assessment & Treatment a) SQU06: Proportion of people at high risk of Stroke who experience a TIA are assessed and treated within 24 hours (target 60) b) SQU06: Proportion of people who have had a stroke who spend at least 90 of their time in hospital on a stroke unit (target 80) Q2 12/13 Q2 12/13 CSR, GP 61.67 F&W 84.38 Source: IPMR/http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Integratedperfomancemeasuresmonitoring/DH_112544 20
Appendix 2: 1. Preventing people dying prematurely PCT PHQ24: of patients seen within two weeks of an urgent GP referral for suspected cancer PHQ25: of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not initially suspected PHQ06: of patients receiving definitive treatment within one month of a cancer diagnosis PHQ07: of patients receiving subsequent treatment for cancer within 31 days where that treatment is Surgery 93.0 93.0 96.0 94.0 95.4 92.0 97.4 100.0 Cancer Waiting Times PHQ08: of patients receiving subsequent treatment for cancer within 31 days where that treatment is an Anti-cancer Drug Regime PHQ09: of patients receiving subsequent treatment for cancer within 31 days where that treatment is a Radiotherapy Treatment Course 98.0 94.0 100.0 100.0 PHQ03: of patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer 85.0 86.6 PHQ04: of patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service 90.0 100.0 Ambulance Targets reastfeeding Smoking Quitters Screening PHQ05: of patients receiving first definitive treatment for cancer within 62 days of consultant decision to upgrade their priority PHQ01: Category A ambulance calls - responses within 8 minutes - NWAS PHQ02: Category A ambulance calls - responses within 19 minutes - NWAS PHQ01: Category A ambulance calls - responses within 8 minutes - PCT position PHQ02: Category A ambulance calls - responses within 19 minutes - PCT position SQU19_06: The number of children being breastfed at 6 8 weeks PHQ30: Number of 4-week smoking quitters that have attended NHS Stop Smoking Services SQU21: of Adult population aged 70-75 invited for owel Screening SQU22: All women to receive results of cervical screening tests within 2 weeks Chlamydia prevalence: screened Chlamydia prevalence: tests positive 86.0 75.0 95.0 75.0 95.0 98.0 No Targ et 95.2 76.6 94.6 75.65 95.95 23.27 1753 85.45 99.7 7.9 9.1 21
Mortality Immunisation Cancer Mortality ( 2008-2010) Cardio Vascular Mortality ( 2008-2010) Childhood Immunisation; Age 1 (DTAp/IPV/Hib) Childhood Immunisation; Age 2 (PCV ooster) Childhood Immunisation; Age 2 (Hib/MenC ooster) Childhood Immunisation; Age 2 (MMR) Childhood Immunisation; Age 5 (DTaP/IPV ooster) Childhood Immunisation; Age 5 (MMR) HPV vaccination; Age 12-13; 2010-11 school year 95.0 95.0 95.0 95.0 95.0 95.0 90.0 124.32 82.22 94.2 93.4 92.7 93.3 91.1 88.8 93.1 2.Enhancing quality of life for people with long term conditions PCT Retinopathy SQU23: of eligible people offered screening for the early detection of diabetic retinopathy in the previous twelve months 95 107.51 NHS Health Checks Mental Health Measures Unplanned Hospitalisation PHQ31_01: of eligible people that have received an NHS Health Check in 2011/12 PHQ31_02: of eligible people that have been offered an NHS Health Check in 2011/12 PHQ10: The Number of new cases of psychosis served by early interventions teams year to date PHQ11: Number of episodes of CR/HT PHQ12: of people under adult mental illness specialities on CPA followed up within 7 days of discharge from psychiatric in-patient care PHQ13_05: The proportion of people who have depression and/or anxiety disorders who receive psychological therapies PHQ13_06: The proportion of people who complete treatment who are moving to recovery PHQ13_07: The number of people waiting more than 28 days from referral to treatment PHQ15: Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults - over 18's) Rate per 100,000 population PHQ16: Unplanned hopitalisation for asthma, diabetes & epilepsy in under 19's (0-18 Yrs) 5.89 7.86 64 430 96.27 2.63 43.20 829 132.39 63.23 22
3.Helping people to recover from episodes of ill health or following injury PCT Stroke SQU06: Proportion of people who have had a stroke who spend at least 90 of their time in hospital on a stroke unit SQU06: Proportion of people at high risk of Stroke who experience a TIA are assessed and treated within 24 hours 80.0 60.0 84.38 61.67 Progress on delivery of QIPP PHQ17: Emergency admissions for acute conditions that should not usually require hospital admission Rate per 100,000 Population HQU16: Emergency Readmissions within 30 days of discharge 5.6 132.78 9.62 4. Ensuring that people have a positive experience of care PCT EMSA PHQ26: Mixed Sex Accommodation - MSA breach rate (MSA reaches per 1,000 FCE's) <0.0 49 0.000 Dentistry SQU09: NHS Dentistry (24 month measure) 214,602 Health Visitors PHS17: Number of Health Visitors (FTE) - NHS LANCASHRE 337. 96 338.31 PHS17: Number of Health Visitors (FTE) 92.20 RTT - 18 Weeks HQU05: RTT - Admitted 95th centile <23 18.6 HQU06: RTT - Non-admitted 95th centile <18. 3 14.0 HQU07: RTT - Incomplete 95th centile <28 17.6 PHS16: The number of incomplete Referral to Treatment pathways at the end of the period 16,934 SQU024: RTT - Admitted median <11. 1 7.9 SQU025: RTT - Non-admitted median <6.6 3.4 SQU026: RTT - Incomplete median <7.2 4.9 PHQ19: RTT - Admitted Target 90.0 94.40 PHQ20: RTT - Non Admitted Target 95.0 98.70 PHQ21: RTT - Incomplete Target 92.0 95.40 RTT Incomplete Pathways Over 36 Weeks 52 23
RTT Incomplete Pathways Over 52 Weeks 0 5 RTT Incomplete Pathways - No. of Specialties reached 92 Target 0 1 PHQ22: RTT 6 Week Diagnostic Target - over 6 Wk Waits <1.0 0.05 PHS14: RTT 6 Week Diagnostic Target -Total number of endoscopy tests 7472 PHS15: RTT 6 Week Diagnostic Target -Total number of non-endoscopy tests 69810 5. Treating and caring for people in a safe environment and protect them from avoidable harm PCT HCAI VTE Maternity A&E PHQ27: Number of MRSA acteraemias 2 PHQ28: Number of C. Difficile infections 69 PHQ27: Number of MRSA acteraemias - NHS LANCASHIRE 14 11 PHQ28: Number of C. Difficile infections - NHS LANCASHIRE 285 254 PHQ29: of all adult inpatients who have had a VTE risk assessment 90.0 94.74 SQU12: women who have seen a midwife by 12 weeks and 6 days of pregnancy (denominator - maternities) PHQ23: Timeliness: A&E 4 Hour Target 90.0 95.0 92.69 96.1 Activity Activity PCT Progress on delivery of QIPP PHS06: Number of G&A non-elective FFCEs in the period PHS11_01: Number of elective FFCEs - ordinary admissions PHS11_02: Number of elective FFCEs - day cases PHS11_03: Total number of FFCEs in the period SRS09: Proportion of elective FFCE's which are day cases PHS07: Number of GP written referrals in the period PHS08: Number of other (non-gp) referrals for a first consultant outpatient episode in the period 29797 7905 31544 39449 80.3 59736 20,699 24
PHS09: Number of 1st outpatient attendances (consultant-led) following GP referral in general and acute specialties PHS10: All first outpatient attendances (consultant-led) in general and acute specialties 47688 81357 PHF07: Choose and ook - ookings to services where named consultant led team was available (even if not selected) - 81.8 PHF078 Choose and ook - Utilisation - Percentage of Outpatient booking 90.0 0 55.2 25