Integrated Performance Report

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1 ENC Bii ENC Bi Integrated Performance Report M1 2013/14 27 June 2013

2 ENC Bii Contents 1. Structure of the Document Southwark CCG and Providers Performance Summary Dashboard Southwark CCG Dashboard (M1) Provider Dashboards (M1 Performance / Q4 Quality & Safety)... 6 a. King s College Hospital NHS Foundation Trust... 6 b. Guy s & St. Thomas NHS Foundation Trust... 7 c. Guy s & St. Thomas NHS Foundation Trust Community Health Services... 8 d. South London & Maudsley NHS Foundation Trust Performance and Quality and Safety Trackers a. Monthly Performance Tracker b. Quarterly Quality and Safety Tracker Performance Variance and Assurance Information Southwark CCG QIPP Performance and Variance Tracker Southwark CCG Finance Report (M2) Glossary of Performance Indicators P age

3 ENC Bii 1. Structure of the Document The report is written to enable the CCG to review the key domains of finance, QIPP, performance, quality and safety in an assimilated format. The purpose of reporting in this way is to support CCG s committees in their consideration of the current status of above domains as well as the interdependencies between them. The report focuses on the current status of all key domains of quality & safety; finance & QIPP; and performance. It is structured to focus on the performance of the CCG but additionally provides a comprehensive overview of the range of indicators used to assess our main provider organsiations: King s College Hospital NHS Foundation Trust, Guy s & St. Thomas NHS Foundation Trust (including community health services) and South London & Maudsley NHS Foundation Trust. Performance dashboards are included in sections 2, 3 and 4 to provide a high level overview of all performance domains, highlighting where performance is reported to have hit or exceeded target (green rated); where there is some variance from plan (amber rated) or where there is significant variance from plan (red rated). Dashboards are included for the CCG and for the four providers noted above. Performance and quality and safety indicator trackers are included in section 5 to provide on going monitoring of key indicators. In Section 6, the report focuses in detail on those areas that are shown on the dashboards as having deviated from target. The tables included in Section 6 set out a description of these performance issues and include details of the forums the CCG uses to monitor and address these issues. An overview of the CCG s QIPP and current financial position will be included in Sections 7 & 8 from M3 13/14. A glossary of all the performance indicators referred to in this report can be found in Section 9. The indicator definitions and targets have been taken from the Department of Health s Technical Guidance for the 2012/13 Operating Framework and the NHS Commissioning Boards Everyone Counts: Planning for Patients 2013/14 Technical Definitions document. Definitions for locally agreed targets have been taken from provider contract agreements. The data and information included in the Integrated Performance Report is sourced from provider contract monitoring and finance reports, CCG QIPP and finance reports and provider quality, safety and performance reports. The reporting period included varies as some reports are quarterly and other monthly, although the data included in this report is as follows unless otherwise stated in the report: Table 1: Integrated Performance Report Data Sources and Period Covered Data Source Period Covered Quality & Safety Finance Trust Quality & Safety reports SLCSU Acute Contract Report Community Contract Report Quality & Safety Report CCG Complaints Report Serious Incidents Reports CCG Finance Report Acute Finance Report Finance Report Q4 2012/13 Q4 Q4 Q4 Q4 M2 Performance Indicators & Targets SLCSU Acute Contract Report SLCSU Performance Report M1 3 P age

4 ENC Bii 2. Southwark CCG and Providers Performance Summary Dashboard 4 P age

5 ENC Bii 3. Southwark CCG Dashboard (M1) Amber and red rated issues are reviewed in further detail in Section 6. 5 P age

6 ENC Bii 4. Provider Dashboards (M1 Performance / Q4 Quality & Safety) a. King s College Hospital NHS Foundation Trust 6 P age

7 ENC Bii b. Guy s & St. Thomas NHS Foundation Trust 7 P age

8 ENC Bii c. Guy s & St. Thomas NHS Foundation Trust Community Health Services 8 P age

9 ENC Bii d. South London & Maudsley NHS Foundation Trust 9 P age

10 5. Performance and Quality and Safety Trackers a. Monthly Performance Tracker 10 P age

11 b. Quarterly Quality and Safety Tracker 11 P age

12 6. Performance Variance and Assurance Information The table below includes all key red and amber rated performance, quality & safety and financial domains included in the above dashboards. The table states the domain concerned, provides a synopsis of the matter arising and includes details of the forum in which the issue is addressed and monitored. This table is provided as a comprehensive overview and it is anticipated that CCG commissioners and committees should direct detailed questions to commissioning leads and and/or further reference the South East London Integrated Performance Reports or the reports listed in Section 1. Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Performance & Quality Performance dropped slightly in M1 13/14 to 88.8% from 89.3% in M12 12/13. RTT admitted A planned failure of the admitted performance target on a monthly basis is expected to support backlog clearance until the trust is in a sustainable position. have a plan to manage their capacity as part of their plans to acquire PRUH through the TSA arrangements. If all goes to plan this should be operational from 1 October. 88.8% Target 90% Acute Contract Monitoring Monthly Performance (for escalation) 4 th July 20 th June Dr Simon Fradd, Tamsin Hooton and SLCSU Acute Contracting Team. The Trust has supplied a trajectory for the first 2 quarters of 2013/14, which is currently being revised to take account of the April position. 52 weeks long waiters There were 49 patients waiting more than 52 weeks on incomplete pathways in M1 13/14 compared to 57 in M12 12/13. reduced the number of 52 weeks waiters throughout 12/ There were 14 patients waiting more than 52 weeks on incomplete pathways in M1 13/14 compared to 11 in M12 12/13. reduced the number of 52 weeks waiters throughout 12/13. By March, did not report any 52 weeks waiters for Southwark, and this reflects a significant reduction trust wide. Target 0 Acute Contract Monitoring Monthly Performance (for escalation) Acute Contract Monitoring Monthly Performance (for escalation) 4 th July 20 th June 5 th July 21 st June Dr Simon Fradd, Tamsin Hooton and SLCSU Acute Contracting Team Tamsin Hooton and SLCSU Acute Contracting Team 12 P age

13 Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Cancer 2 weeks Breast symptoms Performance for M1 13/14 decreased to 92.3% from a performance position of 97.4% in M12 12/13. The Trust missed the monthly target by 1 breach. The quarterly performance position will provide a more accurate gauge of performance due to the higher number of pathways 92.3% Target 93% Acute Contract Monitoring Monthly Performance (for escalation) 5 th July 21 st June Tamsin Hooton and SLCSU Acute Contracting Team Cancer 31 days Drug treatments Performance for M1 13/14 decreased to 97.4% from a performance position of 100% in M12 12/13. The performance position is based on 1 breach from 38 pathways. Performance for M1 13/14 decreased to 96.0% from a performance position of 100% in M12 12/ % 96.0% Target 98% Acute Contract Monitoring Monthly Performance (for escalation) 4 th July 20 th June Tamsin Hooton and SLCSU Acute Contracting Team The performance position is based on 2 breaches from 50 pathways. 83.3% Cancer 62 days GP referral Performance for M1 13/14 decreased to 83.3% from a performance position of 87.5% in M12 12/13. The performance position was based on 4 breaches from 24 pathways. Performance for M1 13/14 decreased to 68.6% from a performance position of 77.8%in M12 12/13. The trust has invited the DH Intensive Support Team (IST) to review the pathways for 62 days, with particular focus on urology and lower GI. Informal feedback from the IST indicates a need to address the management of the early part of the pathway, including diagnostics. Formal feedback is anticipated at the next Monthly Performance Report on the 21 st June. Target 85% 68.6% Target 85% Acute Contract Monitoring Monthly Performance (for escalation) 5 th July 21 st June Tamsin Hooton and SLCSU Acute Contracting Team 13 P age

14 Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Cancer 62 days Screening Performance for M1 13/14 decreased to 80.0% from a performance position of 100% in M12 12/13. M1 13/14 performance position was due to low numbers as there was 1 breach from 5 pathways. Performance for M1 13/14 decreased to 83.3% from a performance position of 100% in M12 12/13. M1 13/14 performance position was due to 1 shared breach from a total of 3 pathways. 80.0% 83.3% Target 90% Acute Contract Monitoring Monthly Performance (for escalation) 5 th July 21 st June Tamsin Hooton and SLCSU Acute Contracting Team Ambulance HAS compliance 90% of all patient handover times are recorded via the Patient Handover Button on the Hospital Based Alert and Handover System. Performance at dropped in M1 13/14 to 79.3% from 81.9% in M12 12/13. Performance at dropped in M1 13/14 to 89.9% from 92.4% in M12 12/ % 89.9% Target 90% Lambeth and Southwark recovery and improvement plan has been developed and will be pursued through the Lambeth and Southwark Urgent Care Network meetings 17 th July Tamsin Hooton, Ali Young and Harprit Lally A&E waits Performance decreased in M1 13/14 to 94.6% from 95.3% in M12 12/13. Nationally, over Q4 12/13 and into M1 13/14, the urgent and emergency care system has been experiencing pressure, and this is reflected in the local performance. 94.6% Target 95% Lambeth and Southwark recovery and improvement plan has been developed and will be pursued through the Lambeth and Southwark Urgent Care Network meetings 17 th July Tamsin Hooton, Ali Young and Harprit Lally 14 P age

15 Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Trust Attributable Pressure Ulcers There was 1 grade 3 pressure ulcer reported in Q4 12/13. Grade 3 and 4 pressure ulcers are reported as serious incidents and will be addressed at Serious Incident Committee meetings. There were 2 grade 3 pressure ulcers reported in Q4 12/13 There were 3 grade 4 pressure ulcers reported in Q4 12/13 carries out root cause analysis for all serious pressure ulcers and these will be reviewed at Serious Incident Committee s 1 G3 2 G3 (Q4 12/13) Target 0 3 G4 (Q4 12/13) Target 0 Serious Incident Committee 20 th June Jacquie Foster Serious Incident 10 th July Serious Incident 10 th July Gwen Kennedy and Jacquie Foster Gwen Kennedy and Jacquie Foster Falls There were 2 falls that resulted in major injury in Q4 12/13. Falls will be reviewed at the next CQRG meeting. CHS 1 major fall was reported by CHS in Q4 12/13 A Trust wide falls audit was undertaken in Q3 12/13, the results of which were due to be published in Q Major: 2 CHS 1 (Q4 12/13) Target 0 Serious Incident Committee CHS Serious Incident Committee Both meetings are on the 20 th June Jacquie Foster There was 1 fall that resulted in major injury and 1 fall that resulted in death in Q4 12/13. The fall that resulted in death will be investigated through the serious incident root cause analysis process and should be reviewed at the next Serious Incident Committee meeting on the 20 th June. 1 major and 1 death (Q4 12/13) Target 0 Serious Incident Committee (fall resulting in death) and the joint acute and Community Health Services CQRG (falls resulting in major injury) Both meetings are on the 20 th June 15 P age

16 Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead There were 49 MSA breaches in M1 13/14 compared to 19 in M12 12/13 Mixed sex accommodation 11 of the breaches were patients. breaches are all related to ICU delayed discharge/step down. have declared that these breaches were due to the non availability of beds in general wards for patients who no longer required intensive care. The medium term solution will be the implementation of additional general ward capacity which is due to come on stream during 2013/14. This will initially be when Infill Block 4 is fully operational later this year; this is currently in the process of being installed. There were 5 MSA breaches at in M1 13/14 compared to 0 in M12 12/13. One of the breaches was a patient. Breaches: Target 0 Mixed sex accommodation has been discussed at previous Acute Contract Monitoring s. An Improvement plan has been discussed and agreed. Acute Contract Monitoring Monthly Performance (for escalation) On going monitoring 5 th July 21 st June Dr Simon Fradd, Tamsin Hooton and SLCSU Acute Contracting Team. Tamsin Hooton and SLCSU Acute Contracting Team Diagnostic waits > 6 weeks During 2012/13 problems with waits for some diagnostic procedures emerged, as demand outstripped available diagnostic capacity this has continued for some services into 13/ % Target <1% 3.00% 2.00% Target <1% Acute Contract Monitoring Monthly Performance (for escalation) Acute Contract Monitoring Monthly Performance (for escalation) 4 th July 20 th June 5 th July 21 st June Dr Simon Fradd, Tamsin Hooton and SLCSU Acute Contracting Team Tamsin Hooton and SLCSU Acute Contracting Team 16 P age

17 Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Child Safeguarding Training Child safeguarding training levels at for Q4 12/13 are: Level 2 74% Level 3 76% Performance has remained at around 75% for Q3 and Q4 12/13 which is an improvement on the Q1 12/13 performance position (Level 2 49% and Level 3 61%). Child safeguarding training levels will be raised at the next CQRG meeting where improvement plans will be expected. Level 2 74% Level 3 76% (Q4 12/13) Target 80% CQRG 21 st June Jacquie Foster HCAIs MRSA There was 1 case of MRSA for patients in M1 13/14 against a target of 0. and There were 2 cases of MRSA at both and in M1 13/14 against a target of 0. The 12/13 outturn position for both Trusts was 2 cases of MRSA, so M1 13/14 performance is out of line with previous performance trends Target 0 CQRG Joint acute and Community Health Services CQRG 21 st June 18 th June Dr Simon Fradd and Gwen Kennedy (infection control lead) Dr Sian Howell and Gwen Kennedy (infection control lead) Complaints There were 155 new formal complaints opened at for Q4 12/13 compared to 176 in Q3 12/13. There were 155 complaints received, which is 20 over target for the quarter but a decrease of 21 compared to Q3. Total complaints for 12/13 were 651 against a target of 540 and up 10% compared to 2011/12 when there were 590 complaints. There were 322 new formal complaints opened at in December to March 12/13. Women s services (37), abdominal medicine and surgery (26), acute medicine (25) and surgery (20) are the directorates which regularly receive the most complaints. 155 (Q4 12/13) 322 (Dec Mar12/13) Acute Contract Monitoring Monthly Performance (for escalation) Acute Contract Monitoring Monthly Performance (for escalation) 4 th July 20 th June 5 th July 21 st June Dr Simon Fradd, Tamsin Hooton and SLCSU Acute Contracting Team Tamsin Hooton and SLCSU Acute Contracting Team 17 P age

18 Issue Synopsis of Issue NHS Health Checks offered % people eligible for the NHS Health Check programme who have been offered an NHS Health Check. Performance has increased from 5.4% in Q3 to 6.6% in Q4. Current Status 6.6% (Q4 12/13) CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Coverage of NHS health checks The annual outturn performance position for health checks offered was 26.7% which is above the annual target of 20%. NHS Health Checks received % people eligible for the programme who have received an NHS Health Check. Performance has increased from 1.6% in Q3 to 1.7% in Q4. The annual outturn performance position for health checks received was 8.2% which is above the annual target of 8% % people who have received an NHS Health Check after being offered it was 26.0% which was below the locally agreed target of 40% Target 6.9% % received from eligible 1.7% Target 2.7% % received from offered 26.0% Target 40% Joint Public Health Targets 18 th June Tamsin Hooton (Q4 13/14) Referrals 330 (0.79%) IAPT M1 13/14 performance position for the proportion of people with depression referred for psychological therapy is 0.79% against the M1 target of 0.93%. The change in the definition of this indicator during Q3 12/13 led to a reduction in the numbers entering treatment affecting Q3 and Q4 by significantly reducing the numbers that could be counted towards the trajectory. Moving to recovery M 1 13/14 performance position of the proportion who complete therapy who are moving to recovery was 42.1% against the end of year target of 50%. The high levels of need of the Southwark population may be a contributing factor, where people may be better after therapy than they were before, but still meet the caseness definition. Target for M1 389 & 0.93% 42.1% Target 50% QIPP and Core Contract meeting 27 th June Gwen Kennedy Control of Medicines 22 Incidents in total were reported across a range of settings. 13 of these were reported incidents within community health services directly. 9 incidents are attributable to other agencies but were reported by community staff. CHS 22 (Q4 12/13) Joint acute and Community Health Services CQRG 18 th July Jean Young 18 P age

19 Issue Synopsis of Issue The Trust will report that the protocol is being followed and report any exceptions if the protocol is breached. Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Transition care plans Lists have been shared of children requiring a transition plan. There are still discrepancies in the list and further work by social care needs to be done. The number of young people who are successfully transitioned from children s to adults services. 18 children in Year 9 at a complex physical and learning difficulties school in Lambeth and Southwark do not have transition plans. CHS (Q4 12/13) Joint acute and Community Health Services CQRG 18 th July Jean Young Dressings Tissue viability A 2 cycle audit of adherence to dressings of those prescribed and recommended is performed in year. The Trust will try to improve performance by ensuring a preferred dressings list forms part of all tissue viability service training and advisory visits. Service managers are to monitor epact data and compare it with the preferred list. They will meet on a one to one basis with all prescribers to discuss their prescribing practice. CHS 65% (Feb 12/13) Target 80% Joint acute and Community Health Services CQRG 18 th July Jean Young Ethnicity at first contact In M1 13/ % of patients had their ethnicity recorded at first contact compared to 75.8% in M12 12/13. Performance has remained slightly under target; however Adult Therapies and Foot Health will be targeted for improvement. CHS 76.1% Target 85% Joint acute and Community Health Services CQRG 18 th July Jean Young Patient Facing Time Adult Community Nursing Adult community nursing patient facing time is below last year s target of 42.5%. There is a new method of calculating performance for this indicator which has impacted on the performance position. The target for 13/14 is to be confirmed. CHS 37.2% Target TBC CHS Contract Monitoring 12 th July Jean Young 19 P age

20 Issue Synopsis of Issue Current Status CS Forum Issue is Addressed Date Responsible CCG Officer and CCG Clinical Lead Patient Facing Time Health Visiting Health visiting patient facing time is below last year s target of 42.5%. There is a new method of calculating performance for this indicator which has impacted on the performance position. The target for 13/14 is to be confirmed. CHS 26.8% Target TBC CHS Contract Monitoring 12 th July Jean Young A&E breaches (Mental Health) There were 7 x 6 hour wait A&E breaches in M1 13/14 which is significantly below the M12 12/13 performance position of 31 The majority of these breaches are due to patients waiting for a bed to become available. are putting caps on activity which will mean that Boroughs will no longer be able to use more occupied bed days than contractually agreed which will benefit Southwark patients as more beds will be available, which should improve performance. 7 Target < 4 QIPP and Core Contract 27 th June Gwen Kennedy Delayed discharges 12.7% of patients experienced a delayed discharge from inpatient care in M1 13/14 which increased from 0% in M12 12/13. In M1 13/14 there were a greater number of discharges of 102 compared to 73 in M12 12/13. The Mental Health team will be monitoring this to ensure that performance returns to below 7.5%. Although the proportion of delayed discharges was high, the proportion of days lost due to delayed discharge was only 3.1% in M1 13/14 compared to 4.2% in M12 12/13. The Mental Health team have asked for detailed explanations for all delayed discharges from inpatient care for 13/ % Target <7.5% QIPP and Core Contract 27 th June Gwen Kennedy Patient received copy of care plan 93.0% of patients have been given a copy of their care plan against a target of 95%. The Trust continues its performance management process in respect of this indicator. Patient level data is monitored through the monthly Chief Executive Performance meetings to ensure that the relevant corrections are made at care coordinator level. 93.0% Target 95% QIPP and Core Contract 27 th June Gwen Kennedy 20 P age

21 ENC Bi 7. Southwark CCG QIPP Performance and Variance Tracker QIPP tracker tables will be included in this section from M3 13/14 8. Southwark CCG Finance Report (M2) A summary table will be provided in this section from M3 13/ P age

22 ENC Bi 9. Glossary of Performance Indicators % Appointments Cancelled by Service (5%) The proportion of appointments cancelled by the service of the total number of appointments CH 52 weeks long waiters (0) The number of incomplete pathways greater than 52 weeks for patients on incomplete pathways at the end of the period Acute and A&E Attendance Avoidance (80%) Percentage of patients who have been on a community matron caseload for 12 weeks or more without any A&E attendances in the last quarter CH A&E breaches (4 hour wait) (3/month) Number of breaches in the A&E 4 hour wait due to mental health services A&E breaches (6 hour wait) (3/month) Number of breaches in the A&E 6 hour wait due to mental health services A&E waits (95%) Percentage of patients who spent 4 hours or less in A&E Acute Adult safeguarding training (80%) The proportion of staff who have achieved the required level of adult safeguarding training All providers AHP Goals (80%) Percentage of rehabilitation goals achieved from an annual audit of 200 patients or equivalent CH Alcohol Intervention Alcohol Brief Intervention in Reproductive & Sexual Health CH Ambulance HAS compliance (90%) All acute trusts to ensure that patient handover times are recorded via the Patient Handover Button on the Hospital based alert system (HAS) for 90% of all hospital turnarounds Acute Ambulance Response 8 minutes Red 2 (75%) Presenting conditions that may be life threatening but less time critical than Red 1 and should receive an emergency response within 8 minutes irrespective of location Ambulance Response 19 minutes (95%) Presenting conditions, which may be immediately life threatening and should receive an ambulance response at the scene within 19 minutes irrespective of location in 95% of cases Ambulance Response 8 minutes Red 1 (75%) Presenting conditions that may be immediately life threatening and the most time critical and should receive an emergency response within 8 minutes irrespective of location Ambulance wait > 60 minutes (0) The number of handover delays of longer than 60 minutes Acute Assertive Outreach (TBC) Number of new referrals to the Assertive Outreach service C Diff (trajectory) Number of Clostridium difficile infections for patients aged 2 or more on the date the specimen was taken Acute CAMHS 3 months < 18th birthday (95%) Percentage patients to which a transfer CPA has been completed 3 months prior to their 18 birthday CAMHS starting treatment < 12 weeks (90%) Percentage of looked after children referred to CAMHS services to be assessed and start treatment within 12 weeks of referral 22 P age

23 ENC Bi Cancelled Ops 28 days All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non clinical reasons to be offered another binding date within 28 days, or the patient s treatment to be funded at the time and hospital of the patient s choice Acute Cancer 2 week GP referral (93%) Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer Acute and Cancer 2 weeks breast symptoms (93%) Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer was not initially suspected Acute and Cancer 31 days first definitive treatment (96%) Percentage of patients receiving first definitive treatment within one month (31 days) of a cancer diagnosis (measured from date of decision to treat ) Acute and Cancer 31 days subsequent treatment (drug) (98%) Percentage of patients receiving subsequent treatment for cancer within 31 days, where that treatment is an Anti Cancer Drug Regimen Acute and Cancer 31 days subsequent treatment (radiotherapy) (94%) Percentage of patients receiving subsequent treatment for cancer within 31 days, where that treatment is a Radiotherapy Treatment Course Acute and Cancer 31 days subsequent treatment (surgery) (94%) Percentage of patients receiving subsequent treatment for cancer within 31 days, where that treatment is a Surgery Acute and Cancer 62 days first definitive treatment by a Consultant (85%) Percentage of patients receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status Acute and Cancer 62 days GP referral (85%) Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer Acute and Cancer 62 days referral NHS screening (90%) Percentage of patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service Acute and Child safeguarding training (80%) The proportion of staff who have achieved the required level of children safeguarding training All providers Complaints (Trajectory) Number of new formal complaints received in quarter All providers Control of Medicines (0) The number of controlled drug incidents CH Cost per Contact Adult Nursing ( 1% change) Percentage change in cost per contact in the district nursing services CH Cost per Contact Health Visiting ( 1% change) Percentage change in cost per contact in the health visiting services CH CPA 7 Day Follow Up (95%) The proportion of those patients on Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days Delayed Transfers of Care (OBDs) CHS TBC Delayed Transfers of Care (Patients) CHS TBC Dementia (851 a proportion of 53.2% against an expected prevalence of 1600) Dementia diagnosis rate Developing Standardised Care Plans Care Planning for Patients with Long Term Conditions CH 23 P age

24 ENC Bi Diagnostic wait > 6 weeks (99%) The percentage of patients waiting 6 weeks or more for a diagnostic test Acute and Discharge Plan in Place (100%) An indicative discharge plan shall be agreed within 4 weeks of admission DNAs (<5%) Proportion of patient appointments where the patient did not attend without providing adequate notice CH Dressings (trajectory) Adherence to dressings of those prescribed and recommended CH Easy in Applies to discharges of patients from AMH (excluding triage). % of users when being discharged from secondary care have the following documentation sent to their GP within 7 working days of discharge Community a completed Recovery and Support Plan. This support plan includes an advanced statement and is signed by the user. Inpatients an inpatient discharge summary detailing a summary of intervention. Easy out Questionnaire sent to GPs to measure GP experience of referral, communication and discharge arrangements PbR 13/14 is a developing year for PbR for mental health. This CQUIN requires development of a shared understanding between commissioners and the provider on: Service specifications for each care package The relevant information to collect The quality of the information collected (accuracy and completeness) Related quality outcomes The quality assurance systems in place to monitor performance of PbR The cluster costs for each of the 21 clusters Benchmarking process identified to validate cluster costs Payment will be awarded on successful completion of deliverables agreed at Q1 workshop Employment assessments (95%) Percentage of service users on CPA to have an employment assessment Ethnicity at First Contact (85%) Percentage of new clients with one or more first contacts for whom ethnicity is known CH Falls (minimal major falls are amber rated, falls resulting in death are red rated) Incidence of falls resulting in injury Acute and CH Falls (0) Falls from unrestricted windows Friends & Family The Friends and Family Test (FFT) aims to provide a simple headline metric which, when combined with follow up questions, can drive a culture change of continuous recognition of good practice and potential improvements in the quality of the care received by NHS patients and service users. 24 P age

25 ENC Bi The test asks the following standardised question: How likely are you to recommend our ward/a&e department to friends and family if they needed similar care or treatment? Patients will use a descriptive six point response scale to answer the questions with the following response categories: 1. Extremely likely 2. Likely 3. Neither likely nor unlikely 4. Unlikely 5. Extremely unlikely 6. Don t know The scoring methodology being adopted will be based on the underlying Net Promoter Score calculation, which was considered to be the most effective at delivering the benefits of the Friends and Family Test outlined above. Proportion of respondents who would be extremely likely to recommend (response category: extremely likely ) likely would not recommend (response MINUS Proportion of respondents who would not recommend (response categories: neither likely nor unlikely, unlikely & extremely unlikely ). Gate kept (TBC) Percentage of inpatient admissions gate kept by the crisis resolution / home treatment team Gatekept CR/HT The proportion of admissions to the Trust s acute ward that were gatekept by the crisis resolution home treatment teams Home Treatment Episodes YTD (TBC) Number of episodes served by Home Treatment teams Hospital Admission Avoidance (80%) Percentage of patients who have been on a community matron caseload for 12 weeks or more and have avoided any emergency hospital admissions in the last quarter CH IAPT % moving to recovery (50%) The proportion of people who complete treatment who are moving to recovery SLAM and IAPT % receiving (5,241 against 41,929) The proportion of people entering treatment (target 5,241 annually) against the level of need in the general population (the level of prevalence addressed or captured' by referral routes 41,929) SLAM and Inpatient Nutrition Screen (95%) Percentage of inpatients who have had a full nutrition screen Mixed sex accommodation (0) All providers of NHS funded care are expected to eliminate mixed sex accommodation, except where it is in the overall best interest of the patient, in accordance with the definitions set out in the Professional Letter CNO/2010/3 Acute and MMR1 The proportion of children under the age of 5 who are unregistered or identified to not have had their MMR1 within 4 months of the recommended schedule date (13 months) who were subsequently identified and recorded as having a recorded MMR1 immunisation CH Mortality TBC MRSA Number of cases of Methicillin resistant Staphylococcus aureus (MRSA) bacteraemia Acute and 25 P age

26 ENC Bi Near Time Patient Experience (TBC) Replacement of annual patient experience survey with near time patient experience CH Never Events (0) Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. New Birth Visits (95%) Percentage of new born babies who received a new birth visit or attempted visit between 10 and 14 days inclusive after birth CH New patients offered HIV test (30%) Percentage of new patients with the ability to consent that are admitted to AMH and ADD inpatient services offered a HIV test NHS Health Checks offered Percentage of eligible people who have been offered an NHS Health Check in 2012/13 NHS Health Checks received Percentage of eligible people that have received an NHS Health Check in 2012/13 NICE The number of NICE guidance awaiting response Acute Obesity Reduction in percentage of children who are obese or overweight CH Patient Experience This indicator seeks to assess and evaluate quality of inpatient services (both acute and rehab) through service user focus groups Patient Facing Time Increase in reported Patient Facing Time in the Sickle Cell service CH Patient received copy of care plan (95%) Percentage of patients who have been given a copy of their CPA care plan Patient Safety Thermometer 1. To collect data on pressure ulcers. 2. To develop a service development plan at Q2 outlining the work planned to reduce the number of pressure ulcers and report at Q4 on progress. Percentage Early Intervention (TBC) Percentage of patients receiving Early Intervention Percentage of delayed discharges (>7.5%) Percentage of delayed discharges from inpatient care as per the monitor definition Physical Health Antipsychotics Physical Health Checks for in patients on anti psychotic medication. This excludes triage only admissions Physical Health New Admissions Physical Health Checks for new admission's. This excludes triage only admissions Pre school booster The proportion of children who are unregistered or do not have a recorded DTaP/IPV or dtap/ipv (preschool booster) immunisation by four months from the recommended schedule date (3 years 4 months) who were subsequently identified and recorded as having a recorded DTaP/IPV or DTaP/IPV (preschool booster) immunisation CH Pressure Ulcers (Grade 2 are not rated; Grade 3 are rated amber; Grade 4 are rated red) Number of pressure ulcers in quarter All providers 26 P age

27 ENC Bi Pt Facing Time Adult Comm Nursing CHS There is a new method of calculating performance for this indicator, details of which will be confirmed CH Pt Facing Time Health Visiting CHS There is a new method of calculating performance for this indicator, details of which will be confirmed CH Pts with learning disabilities Ensure appropriate treatment of patients with learning difficulties i.e. making reasonable adjustments where necessary and to ensure appropriate recording of the needs of people with learning disabilities referred to community services CH Public and Pt Engagement To show evidence of involving patients and the public in relation to service delivery including service changes or new service proposals CH Recovery The Recovery and Support plan is a recovery focussed plan that seeks to place the service user at the centre of the care/support planning process whereby they are supported to define their own goals based on their personal needs and aspirations RTT AHP % 18 wks Percentage of patients on Allied Health Professional led pathways who received their first definitive treatment within 18 weeks in the Community CH RTT admitted (90%) The percentage of admitted pathways within 18 weeks for admitted patients whose clocks stopped during the period on an adjusted basis Acute and RTT incomplete pathway (92%) The percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the period Acute and RTT non admitted (95%) The percentage of non admitted pathways within 18 weeks for non admitted patients whose clocks stopped during the period Acute and Notified Serious Incidents (0) The total number of Serious Incidents notified to the CCG, a review of the SI investigation report may result in a de escalation which may therefore result in an adjusted total figure All providers Smoking cessation training (33%) Percentage of relevant inpatient & community staff working at for over 6 months to have undertaken smoking cessation level 1 training Smoking quitters Number of clients of NHS Stop Smoking Services who report that they are not smoking four weeks after setting a quit date Transition care plans All young people aged 17 have transitional care plans indicating agreed clinical diagnosis and future treatment requirements and that the NHS and Local Authority commissioners are notified of transition patients in line with local protocol CH VTE risk assessment (90%) % of all adult inpatients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool Acute 27 P age

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