Acute Quality and Performance Metrics For the period ending 31st May 2013 APPENDIX 1 Measures Target M1 M2 YTD Weston UHB NBT Exception RAG / DoT M1 M2 YTD RAG / DoT M1 M2 YTD RAG / DoT Reference RTT: Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 93.1% 94.6% 93.9% 93.5% 93.3% 93.4% 90.1% 90.0% 90.0% RTT: Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 95.5% 98.0% 96.7% 95.8% 96.0% 95.9% 95.7% 97.7% 96.7% RTT: Patients on incomplete non-emergency pathway should have been waiting no more than 18 weeks from referral 92% 94.4% 94.6% 94.5% 92.3% 93.0% 93.1% 93.5% 92.7% 93.1% Diagnositic: Patients waiting for a dignostic test should be waiting less that 6 weeks from referral 99% 98.2% 99.5% 98.9% 97.9% 98.3% 98.4% 97.5% 99.5% 98.6% 3.1 Cancelled Ops: Last minute cancellations 0.8% 3.4% 1.8% 2.6% 1.7% 1.0% 1.3% 1.4% 0.9% 3.2 Cancelled Ops: 28 days rebooking 95.0% 100.0% 100.0% 100.0% 89.6% 81.3% 84.8% 14 pts 29 pts 43 pts 3.2 Cancer waits: Maximum 2 week wait for first OP appt from GP referral for suspected cancer 93% 94.0% 97.6% 96.1% 96.8% 93.5% 95.5% 93.5% 3.7 Cancer waits: Maximum 2 week wait for first OP appt from GP referral with breast symptoms 93% 100.0% 96.3% 97.5% 96.3% Cancer waits: Maximum 31 days wait from diagnosis to first definitive treatment for all cancers 96% 100.0% 98.1% 98.2% 98.1% 97.0% 98.7% 97.0% Cancer waits: Maximum 31 days wait for subsequent treatment where that treatment is surgery 94% 100.0% 83.8% 100.0% 92.9% 96.6% 100.0% 96.6% Cancer waits: Maximum 31 days wait for subsequent treatment where that treatment is an anti-cancer drug regimen 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Data Not Available Data Not Available Cancer waits: Maximum 31 days wait for subsequent treatment is a course of radiotherapy 94% 98.9% 98.9% 98.9% Cancer waits: Maximum 62 days wait from GP referral to first definitive treatment for all cancers 85% 80.8% 82.7% 77.6% 79.9% 79.9% 83.2% 79.9% 3.3 Cancer waits: Maximum 62 days wait from referral from an NHS screening service to first definitive treatment 90% 80.0% 96.3% 89.3% 92.7% 100.0% 100.0% 100.0% 80% No data No data No data 69.0% 83.7% 76.5% No data No data No data Stroke patients spending 90% of their stay on a Stroke Unit 60% No data No data No data 40.0% 81.3% No data No data No data No data High risk TIA patients assessed and treated within 24 hours A&E Attendances: 4 hour standard 95% 80.3% 94.89% 87.60% 91.0% 95.4% 93.2% 86.9% 97.2% 91.0% 3.5 Ambulance Handover Delays >30 minutes 0 60 35 95 133 75 208 230 106 336 3.6 HCAI: Incidence of MRSA 0 0 0 0 0 1 1 0 0 0 3.8 95% No data No data No data 100.0% 100.0% 100.0% No data No data No data MRSA Screening: Elective Admissions 90% No data No data No data 95.8% 94.8% 95.3% No data No data No data MRSA Screening: Non - Elective Admissions HCAI: Incidence of CDiff WAHT traj not set, UHB traj not set, NBT traj not set various 0 1 1 6 4 10 5 7 12 Mixed Sex Accomodation Breaches 0 0 0 0 0 0 0 0 0 0 VTE Risk Assessment on admission 90% 80.8% No data No data 97.9% 97.1% 97.5% 94.30% No data No data KEY TO NOTES "Not reported" - this target is no longer regularly reported against and so there is no reporting "No data" - no data is availaible at the time of writing Quality Unplanned Care LTCs Cancer ned
Income and Expenditure Position For the period ending 30th June 2013 APPENDIX 2 Acute Budget ( 000) Actual ( 000) Year to Date Forecast Variance ( 000) Budget ( 000) Actual ( 000) Variance ( 000) North Bristol Trust 7,495 7,495 0 29,980 29,980 0 University Hospitals Bristol NHS Foundation Trust 9,153 9,592 439 36,611 36,611 0 Weston Area Health NHS Trust 15,239 15,631 392 60,957 60,957 0 South Western Ambulance Service NHS Trust 1,628 1,628 0 6,511 6,511 0 Emersons NHS Treatment Centre 921 921 0 3,682 3,682 0 NHS Out of Area Contracts 263 263 (0) 1,052 1,052 0 NHS Non Contracted Activity 343 343 0 1,374 1,374 0 Various Other Acute 492 588 97 1,967 1,967 0 35,534 36,461 928 142,134 142,134 0 Primary Care Primary Care Prescribing 7,938 7,910 (28) 31,753 31,753 0 Urgent Care (Out of Hours) Services 590 590 0 2,361 2,361 0 Locally Enhanced Services inc. RSS 573 570 (3) 2,291 2,291 0 9,101 9,070 (31) 36,405 36,405 0 Mental Health Avon and Wiltshire Mental Health Partnership NHS Trust 3,879 3,879 0 15,516 15,516 0 Other Mental Health and Learning Disability Services 1,996 1,966 (29) 7,983 7,983 0 5,875 5,845 (29) 23,498 23,498 0 Community Health Services North Somerset Community Health Services 5,358 5,358 0 21,433 21,433 0 Other Community Services 695 693 (2) 2,782 2,782 0 6,054 6,051 (2) 24,215 24,215 0 Continuing Care Continuing Healthcare 2,006 1,974 (32) 8,024 8,024 0 NHS Funded Nursing Care 1,084 1,049 (36) 4,337 4,337 0 Other Continuing Care 557 532 (25) 2,226 2,226 0 3,647 3,554 (93) 14,588 14,588 0 Corporate Running Costs 1,287 1,281 (6) 5,150 5,150 0 Other Non Acute Commissioning 672 683 11 2,687 2,687 0 Non-Recurrent Reserves (2,519) (3,196) (677) (10,077) (10,077) 0 (1,848) (2,513) (665) (7,390) (7,390) 0 Surplus 1,169 1,169 0 NORTH SOMERSET CLINICAL COMMISSIONING GROUP (CCG) 59,650 59,750 100 239,769 239,769 0
Appendix 3 000 NCB Cash limit: 242,724 North Somerset CCG Cash Flow Position as at June 2013 Less Prescription Pricing Authority Other Central / BSA payments Remaining Cash limit 242,724 2013/14 April May June July Aug Sep Oct Nov Dec Jan Feb Mar Total Revised Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 Receipts Balance b/fwd 0 1,678 2,254 1,039 2,405 1,846 2,351 2,469 2,587 1,839 1,249 812 BACS 0 64 82 3,306 500 500 500 0 4,952 CHAPS 0 0 0 NCB-Drawdown 242,722 33,986 30,060 18,976 16,600 18,976 16,600 18,976 20,061 20,061 20,061 20,061 20,061 20,061 20,061 20,061 242,724 242,724 NCB-Drawdown additional 0 0 0 Other 0 0 0 PCS Payments Reimbursements 0 0 0 VAT 0 18 5 5 5 5 5 5 5 5 0 58 Capital Receipts? 0 0 0 0 0 Total Receipts 33,986 30,060 18,976 18,342 18,976 18,954 23,321 22,471 22,412 22,917 23,035 22,653 21,905 21,315 20,878 242,724 247,734 Payments Creditors NHS 159,600 13,300 11,969 13,300 12,953 13,300 13,163 15,300 14,977 14,300 14,800 14,800 14,953 14,953 14,800 15,092 159,600 172,060 Creditors CHAPS 77,900 20,517 16,412 5,517 2,911 5,517 4,559 5,252 5,253 5,153 5,253 5,253 5,253 4,953 4,953 5,034 77,914 70,239 Salary CHAPS 1,356 113 113 155 113 97 113 113 113 113 113 113 113 113 113 1,350 1,269 Pensions 0 27 29 31 31 31 31 31 31 31 31 0 304 Tax & NI 456 38 38 42 38 67 38 38 38 38 38 38 38 38 38 450 451 Standing Orders /Direct Debits 0 0 0 PCS Payments 0 0 0 Other 0 0 0 Capital Payments? 3,410 0 1 0 0 213 213 426 213 213 426 568 568 570 3,410 3,411 Total -Expenditure 33,968 28,382 18,968 16,088 18,968 17,915 20,916 20,625 20,061 20,448 20,448 20,814 20,656 20,503 20,878 242,724 247,734 Balance c/fwd 1,678 2,254 1,039 2,405 1,846 2,351 2,469 2,587 1,839 1,249 812 0 0 0
QIPP Detailed Position For the period ending 30th June 2013 APPENDIX 4 Programme Area Scheme Ref # Start Date Activity impact Urgent Care Weston Front Door ANP Community Heart Failure Service & BNP Full Year YTD YTD Actuals Variance Value 000 CCG Clinical Lead / Lead 1a July'13 A&E attendances at WAHT 300 Kevin Haggerty 1c Oct'13 Emergency Admissions ECGs at Weston (Direct Access and OP) COPD Pulmonary Rehab 1d Oct'13 Emergency Admissions 70 Residential Homes 1l Oct'13 Emergency Admissions from Care homes Community Wards 1b In place >65yr Emergency Admissions 375 Debbie Clark Collaborative Care Team 1g Oct'13 0&1 LoS at Weston & total bed days ned Care Under Review 5 / 9 TBC Outpatients / Inpatients 200 John Heather Contractual Items Crititcal Care 4 Oct'13 Critical Care Bed Days at Weston. Local tariff, classification and bed day implications 30 ACUTE CARE MA Debbie Clark / MA CSU Commissionin g Lead Commentary Angela Kell Goes live - 13th July 2013. Update to the August group based on proxy figures from weekly situation reporting. Angela Kell / Rachel Financial Impact includes cross charging CCGs Focus on early diagnosis and management of heart failure in the community 2 additional staff are being recruited, envisaged full service in place by October '13. Evaulation of impact on hospital activity will be progressed from November onwards. Paper on BNP service going to August Leadership Grp - October start date s to introduce a rolling program which increase capacity from 60 to 150 per annum. Adverts are out for staff with a September start date. 65 Angela Kell John Heather Employment of a specialist nurse to work with care homes to upskill in identifying patients that need input from (embedded as part of 375k Ruth Gazzane 125 Liam Williams exsisting health care services Current review of service being undertaken, analysisng overall impact. Capacity will be assessed with an aim to Elizabeth Williams highlight potential additional savings to be made. Current plan is to redesign the CCTs current model of work. Ellie Devine Key areas of work include: 1) Review ISTC uptake - RSS to enact list of actions to increase usage 2) Review with the CSU use of contract levers for 14/15 contracting round with local providers. 3) Practices incentivised to use Optimise for referral pathways 4) Peer reviews 5) Review exception reporting from ABI to share with practices to enable discussions. Cathy Boulton Review of Weston Bed usage within ITU and assess level of Clinical need of occupants RAG Rating Amber Red New GP OOHs 2 Apr'13 Contract Impact 11 Sarah Lloyd New service being provided by BRISDOC. Review increase in GP cover from 1 to 2. CSU to monitor impact. Total Acute Savings 1176 0 0 0 COMMUNITY IMPACTS Prescribing Budget reduction 3 Apr'13 Spend 900 225 225 0 Debbie Campbell Community Partnership 4% Cres 1e Ongoing QIPP Efficiencies 780 Mike Vaughton Monthly budget review s in early stages. To be reviewed as part of the contract. Review of the podiatry extensive wait list, potential secondary care impacts if not addressed. Reduction from 880k to reflect the transfers to Local Authority Red
Programme Area Scheme Ref # Start Date Activity impact Total Community Savings Maximise Clevedon Beds 1f Apr'13 Reduction in Rehab bed days at Weston For Info Rehab Project Integration Agenda Diabetes pathway Teledermatology Risk stratification Self Care Enabling Advice and Guidance Urgent Care in PC Full Year YTD YTD Actuals Variance Value 000 CCG Clinical Lead / Lead 144 Debbie Clark 3,000 225 225 - PIPELINE - TO BE UPDATED CSU Commissionin g Lead Commentary To be monitored transfer of 2 rehabiliation beds from Weston to Clevedon RAG Rating
Acute Contract Financial Position For the period ending 31st May 2013 APPENDIX 5 Weston UHB NBT Actual Var Actual Var Actual Var Comments / Exception Reference OP Firsts 611 669 58 528 477 (51) WAHT: Overstated due to ACC coding OP Follow ups 721 726 5 628 640 12 OP Procedures 27 26 (1) 205 238 33 UHB: OP Procedures in Opthalmology, review ISTC usage Daycases 1,031 1,062 31 806 900 94 Not yet available WHAT / UHB: Clinical Heam and Oncology overspend will be Inpatients 715 736 21 594 602 8 reviewed as part of the specialist commissioning transfer Excess beddays 10 19 9 36 29 (7) UHB DC: Diagnositc backlog being undertaken to deliver 6 week Total 3,115 3,238 123 2,797 2,886 89 target ned Care A&E Attends 750 735 (15) 265 285 20 WAHT/UHB: Review transfer re SWAST Protocols Non-Elective Admissions 3,036 3,188 152 555 585 30 UHB: Cardiology and Gen Med review of activity Emerg Admissions: Short stay 0 237 248 11 WAHT: Emergency is not currently split by Not yet available Emerg Admissions: Long stay 0 1,101 1,199 98 short / long stay Excess beddays 151 221 70 91 107 16 WAHT: ACC activity review application of tariff. Increased Total 3,937 4,144 207 2,249 2,424 175 number of Pneumonia cases CQUINs 248 248 0 160 160 0 CQUINS set to plan as monitoring established Penalties (76) (73) 3 (108) (120) (12) Not yet available UHB: Emergency tariff and Readmissions set to plan Total 172 175 3 52 40 (12) Critical Care 350 350 0 192 209 17 WAHT: Critcal care audit to review service configuration NICE 137 137 0 462 626 164 UHB: NICE based on actuals not risk share Other Quality Unplanned Care Not yet available Other 2,325 2,588 263 686 692 6 WAHT: Other includes Non-PbR, Maternity & CCT support Total 2,812 3,075 263 1,340 1,527 187 Provider reported NSCCG Total Position 10,036 10,632 596 6,438 6,877 439 Challenges Adjustment (204) TBC NSCCG Total Position 10,036 10,428 392 6,438 6,877 439
NSCCG Resolution Actions List : Summary For the Period ending 31st May 2013 Programme Area Ref Number Issue Synopsis YTD Status Finance Mitigating Actions APPENDIX 6 Deadline Dates NSCCG WAHT UHB NBT AWP SWAS QIPP Acute: ned Care 1.1 Outpatient news and follow ups Day Cases / Inpatients Month 2 overspend a a a a Analyse current M2 data and identify any counting issues. To be discussed via the relevant CPMGs Acute: Unplanned Care 1.2 Emergency Admissions Month 2 overspend a a a a Link any potential QIPP impacts and identify potential contract limiters for 2014/15 planning Performance ned Care 3.1 Diagnostics Breach of 6 week diagnostics target at UHB in relation to available capacity and waiting list backlog a Clear action plan in place, with Trust looking to source additional capacity. The Trust is currently ahead of its trajectory to meet the 99% standard by June 2013. ned Care 3.2 Cancelled Operations Same day cancellations of surgery due to non-clinical reasons. Linked to Emergency care demand and therefore bed availability due to operational pressure ned Care 3.3 Cancer Non delivery of the 62 day urgent referral to treatment target. NBT note this is due to capacity and process issues within urology. a a a Recovery actions include: Implementing 4 hour recovery plan which should reduce cancellations related to bed availability. Improvements to patient flow which include, a review of bed occupancy and understand how the number of medical outliers can be reduced thereby reducing impact on the elective bed base. Refreshing bed capacity model to forecast future bed requirements, including review of intensive care demand. NB: UHB failed 28 day rebooking target in May a a NBT: Performance is linked to a number of capacity and process issues, particularly in Urology. Interim General Manager is undergoing detailed work with the Urology speciality. Next contractual steps considered and Exec Team to Exec Team Meeting held on 16 July 2013. UHB: 85% 62-day GP referred standard remains at risk for the quarter but national standard should be achieved if breaches are reallocated to late referring providers. Long Term Conditions 3.4 Stroke - patients 90% of time spent on Stroke Unit TIA - assessed and treated within 24hrs Breaches of the stroke target at Weston relate to pressures to avoid mixed sex accomodation. a a Previous - underperformance Action plan in place, actions include training frontline staff to identify and escalate potential stroke patients. Raise awareness of the issue to all staff members and the introduce new ward documentation. Update for Jun 13 board report - these standards are no longer considered in the NHS constitution and therefore reporting has been interrupted - commissioners are working to restore this
NSCCG WAHT UHB NBT AWP SWAS QIPP Programme Area Ref Number Issue Synopsis YTD Status Unplanned Care 3.5 4 hour A&E attendance standard 4 hour standard not being met at any acute hospitals due to pressures in the urgent care system Unplanned Care 3.6 Ambulance Handover Delays Numerous breaches of the new zero tolerance 30 minute standard from the NHS Constitution, and the existing 15 minute standard ned Care 3.7 Cancer Commissioners are chasing a national policy decision to allow access to the Exeter system to allow independent validation of cancer waits Healthcare Associated Infections 3.8 MRSA University Hospitals Bristol NHS Foundation Trust has failed against the national zero tolerance expectation in April 2013 with 1 case reported. Early indications are that Weston has reported 1 case in June 2013. This is the first case recorded in over 18 months. Mitigating Actions a a a WAHT: Achievement of 94.89% in May 2013 demonstrated a significant improvement and the Trust are on track with the set trajectory to achieve the 95% standard in June. UHB: In recent weeks performance has been much improved. It remains to be seen whether or not this is sustained. 8 projects in place to address ssue of patient flow NBT: Although Trust has achieved 95% standard in the most recent week (at time of writing) it is not yet clear if this is sustainable with some dips in performance in June 2013. CCG recently submitted an Urgent Care Recovery for whole health community to NHS England. The actions identified for the provider were included in this plan. a a a a Performance will be improved by the actions taken to address the 4 hour standard (highlighted above), there have also been some issues with ambulances batching (large volumes of vehicles arriving at certain periods). It should be noted that Trusts will be liable for fines for excess handovers in 13/14. UHB reviewing and implementing SWASFT standard operating procedures. NBT has reviewed no. of cubicles available for handover and refreshed escalation policy. a a a a a a Commissioners still do not have access to independently validated and CCG specific cancer wait times due a national policy decision to turn off accesss to the Open Exeter system WAHT: Post infection review completed TDA team assisting UHB: Patients identified with MRSA are subject to comprehensive Post Infection Review from 1 April 2013. Post-48 hour cases treated as never event Yellow spots feature on electronic boards alerting staff to infection control alert. Screening of inpatients every 14 days. Deadline Dates Monitored closely Monitored closely