Buckinghamshire Clinical Commissioning Groups Joint QIPP & Performance Report, April 2013

Transcription

1 Buckinghamshire Clinical Commissioning Groups Joint QIPP & Performance Report, April Introduction This report highlights the key issues and risks in the 2012/13 QIPP Plan and provides assurance of performance against the national Operating and Outcome framework indicators, for which the Buckinghamshire Clinical Commissioning Groups hold joint responsibility. The report provides a summary of QIPP delivery and performance against national performance indicators during Month 11 (February). 2. QIPP The table below provides a high level assessment of current and forecast delivery of the QIPP challenge in 2012/13 for each of the constituent programmes. Due to the timing of data availability QIPP delivery has been assessed using Month 11 activity to project a Month 12 position. Assessment of QIPP programme delivery is made purely on achievement of the required activity reduction aligned to delivery of the QIPP projects; it does not take into account whether provider contracts are being managed within agreed financial envelopes. It is possible to be under achieving on QIPP delivery but to be delivering within contract and financial plan. Therefore this report should be read in conjunction with the Finance Report to understand the impact of QIPP on achieving financial balance within the year. The risk assessment is against anticipated delivery of efficiency savings in 12/13 at current reporting month and forecast to year-end. The body of the report provides a summary highlight report for each programme and includes a breakdown of QIPP achievement by project, exception reports on milestones that have not been achieved and details of key risks to delivery. 2.1 QIPP Finance Table One below provides a summary of Month 12 QIPP achievement by programme and a forecast position for year end. At Month 12, for CCG responsible programmes, 12.2m has been achieved against a target of 17.3m (a deficit of 5.1m). However the 5.1m of slippage on expected savings from QIPP programmes is offset by 6.1m of mitigating schemes (meaning about 35% of the total CCG QIPP target will be through mitigation). Under performance by QIPP programmes was supported by non-recurrent funding during 2012/13 invested in the main provider contracts. It should be noted that non-recurrent investment in 2012/13 was also expected to support change within the health economy; while this investment is supporting over performance the ability to ensure change happens is diminished. 1 P a g e

2 Table 1: QIPP Delivery at Month 12 CCG Responsible Programmes Annual Budget Year to Budget Year to Actual Year to Achieved Year to % Actual Achieve ment Impact Rating % Risk Rating - IMPACT 6,991 6,991 1,250 (5,741) 18% Red 1,250 (5,741) 18% Red - 7,844 7,844 2,562 (5,282) 33% Red 2,562 (5,282) 33% Red - Maternity (425) 0% Red 0 (425) 0% Red - Joint Care 1,016 1, (450) 56% Red 566 (450) 56% Red - Continuing Care 1,100 1,100 1, % Green 1, % Green - Prescribing 3,270 3,270 8,298 5, % Blue 8,298 5, % Blue - QIPP Invest Reserve (3,321) (3,318) (1,579) 1,741 48% Blue (1,580) 1,741 48% Blue Total Programmes 17,325 17,328 12,197 (5,128) 70% Red 12,197 (5,128) 70% Red Mitigating Schemes/Agreements - Block Contract Agreements 0 0 3,057 3,057 Blue 3,057 3,057 Blue - QIPP Schemes supported by SIRF 0 0 3,083 3,083 Blue 3,083 3,083 Blue Total Mitigation 0 0 6,140 6,140 35% Blue 6,140 6,140 35% Blue TOTAL CCG 17,325 17,328 18,337 1, % Blue 18,337 1, % Blue PCT Cluster Responsible Programmes - Primary Care Green % Green - Running Costs 1,200 1,200 1,200 0 Green 1, % Green Total PCT Programme 1,660 1,660 1,660 0 Green 1,660 0 Green Total QIPP Programme 18,985 18,988 19,997 1,012 Blue 19,997 1,012 Blue Key: High Impact/Risk of not achieving plan (variance 25%/ 250k or over against plan) Red Medium Impact/Risk of not achieving plan (variance against plan below 25%/ 250k%) Amber On target or marginally positive Green Positive variances against plan Blue 2.2 QIPP Programme Highlight reports This section provides a detailed summary of QIPP savings by project within each programme, project delivery milestones that have not been achieved/are forecasting slippage and risks that require escalation to the Executive Team Table 2 below provides a summary of current achievement by projects within the Programme. At Month 12, 33% of planned savings have been realised. Approximately 1.5m (20%) of planned savings to Month 12 are aligned to schemes that are not progressing/were not agreed during the contracting process (reducing variation in gastroenterology and transfer of daycase to outpatient procedures); the impact of these schemes not progressing is mitigated by non-recurrent funding in 2012/13. 2 P a g e

3 CAHO Workstream (categorised by workstream type) CCG Responsible QIPP Project Project Title & Brief Description (categorised by workstream type) Gross s Investment Net s Net Actual From Plan '000 '000 '000 '000 '000 '000 '000 '000 '000 Managing Variation Betw een Providers 1, ,574 1,574 0 (1,574) 1,574 0 (1,574) Ophthalmology - Glacoma Diagnosis (126) (126) Reducing variation Pathology (300) (300) ManagingElective Care Variation(Threshold Dependent Care) Reduction of follow up ratio to 1;1.5 1, ,072 1, (697) 1, (697) Managing MSK in the community and enhanced recovery (297) (297) Transfer of DC to OP Procedures (861) (861) Cardiology PCI: management of stable angina (118) (118) Reducing Inpatient Variation Gastroenterology (671) (671) Maintaining 18 w eeks - Activity reduction in EL/OP T& O , , Dermatology Service Redesign 940 (400) (540) (540) Direct Access Radiology (150) (150) Total 8, ,844 7,844 2,562-5,282 7,844 2,562-5,282 At Month 12 circa 41% of the available planned savings have been achieved; these are in reduction in MSK elective care, reduction in elective procedures (non NHS providers), reduction in the first to follow up ratio for Outpatients and Glaucoma Pathway. The principal schemes that are underperforming at Month 12 continue to be:- managing variation between providers (referrals and first outpatient activity), and direct access radiology & pathology Whilst the Dermatology Service Redesign has now been implemented it will not show an impact on activity and finance until the next financial year. Managing referrals and outpatient activity Outpatient activity across the main providers continued to over performed in March, although by less than in previous months. GP referrals remain about the same proportion. Action continues to be taken in the following areas to address this over activity. Data analysis, reporting mechanisms and review of practice are being developed to form part of continuous improvement and assessment. The use and effectiveness of all the intermediate services is being reviewed Consultant to consultant referrals is being comprehensively analysed Guidance to GPs is revisited to highlight any changes and to provide updates and recaps Alternative ways to meet first out-patient demand in key areas are being considered Dermatology Service Redesign This project was 6 months late in delivery due to consultation on the proposed service change (closure of inpatient capacity) and delays in contract negotiation. It is anticipated that upwards of 300k will be achieved from 2013/14. The tele-dermatology service was fully-implemented in February 2013 with further community clinics starting in 2013/14. A full implementation plan for this from BHT is awaited. 3 P a g e

4 The impact of lost savings as a result of this slippage is mitigated by a reduction in the required in-year investment in the new service and non-payment of CQUIN linked to the proposed service change IMPACT Table 3 below provides a summary of current achievement by projects within the IMPACT Programme. Table 3: IMPACT QIPP Summary CAHO Workstream (categorised by workstream type) CCG Responsible QIPP Project Project Title & Brief Description (categorised by workstream type) Gross s Investment Net s Net Actual From Plan '000 '000 '000 '000 '000 '000 '000 '000 '000 ImPACT ACHT Development (46) (46) ImPACT SMH Front Door (200) (200) ImPACT WYC Front Door (196) (196) ImPACT COPD 151 (53) (98) 98 0 (98) ImPACT Care Homes 765 (600) (165) (165) ImPACT WGH Admission avoidance (216) (216) ImPACT Aligning Health and Social Care 1,900 (200) 1,700 1,700 0 (1,700) 1,700 0 (1,700) ImPACT End of Life (300) (300) ImPACT Local Variation 2, ,820 2,820 0 (2,820) 2,820 0 (2,820) 7,844 (853) 6,991 6,991 1,250 (5,741) 6,991 1,250 (5,741) Mitigation HWP Block Contract Agreement ,057 3, ,057 3,057 Mitigation QIPP Schemes supported by SIRF in BHT Contract ,083 3, ,083 3,083 Mitigation Dermatology CQUIN not achieved due to slippage , Total Impact 7, ,991 6,991 7, ,991 7, At Month 12, circa 18% of the planned savings have been achieved from a reduction in nonelective excess and rehab bed days linked to supported discharge by Adult Community Health Teams (ACHTs), and the changes to the configuration of emergency services at Wycombe Hospital. The principal schemes that are underperforming at Month 12 are:- aligning health and social care, and locality variation. Reports on these are given below except for the locality variation project which has stopped. Aligning Health and Social Care Under achievement is forecast due to the scale of savings aligned to this project and the challenge of the proposed scope of change. There was 6 month slippage on the introduction of MAGs Teams and implementation has been on a smaller scale than initially planned ie in a smaller number of practices. However, MAGs are now operational in 4 practices. Further practices have expressed an interest in implementing this scheme in 2013/14. End of Life Care (EoLC) As reported previously, the preferred method for delivery of the EoLC register is now to integrate it with the special notes already held between GPs and OOH services. The timetable for implementation is now for testing from April with full implementation in July. 4 P a g e

5 Milestone Due End of Life Register is operational, providing access to patient information to urgent care/crisis response services to ensure patients are supported in their last year of life Due July 2012 July 2013 Impact Slippage included in overall Urgent Care slippage Unscheduled Care Pathway (previously SMH Front Door) A replacement project for the SMH Front Door has commenced. This is an in house programme for redesign Intermountain which will not report until June. Implementation of further changes will follow. However, the A&E 4 hour wait target has not been met for month 10 and the focus is on ensuring this target is achieved. Milestone Due Commission a service that effectively manages and appropriately re-directs activity at SMH A&E Due April Sept Impact The new model proposed should not result in clinical or financial risks if implemented as described Children and Young People Table 4 below provides a summary of current achievement by projects within the Paediatric Urgent Care Programme. Minimal savings associated with this project are expected this financial year. Table 4: Children & Maternity QIPP Summary Project Title & Brief Description (categorised by workstream type) Gross s Investment Net s Net Actual From Plan '000 '000 '000 '000 '000 '000 '000 '000 '000 Paediatric Urgent Care (425) (425) The project has reported slippage on the planned launch of three paediatric urgent care pathways. The first (fever) pathway has been agreed by the project group and signed off by the Quality Committee. However, the launch was delayed to March pending the successful system readiness testing of the NHS 111 system because the leaflets now signpost to 111 rather than NHS Direct. Following the public launch of 111 on 15 th March, the pathway is now being rolled out. As a result minimal savings will be made in 2012/13 but benefits should be realised from 2013/14. Milestone Due Due Impact 5 P a g e

6 Milestone Due Develop and implement 3 revised urgent care pathways for paediatrics Due Sept March for 1 st pathway April for other 2 Impact One pathway being implemented in March. Will impact on QIPP plan costing 425,000 Family Nurse Partnership The first phase of the programme has been implemented, the service is now up and running and has met all its initial milestones. Health Visitor implementation plan Permanent HV wte numbers did not reached the April 2012 target of 79 wte as per the delivery plan. As at January 2013, the permanent establishment of Health Visitors is 77.01, which is about the same as November but is 6 less than the target. Retention of existing staff and further recruitment in the next quarter is a risk to achieving the planned increase in establishment (further increase to 86 by March 2013). BHT have been asked for a report on this issue. Responsibility for achieving this target will transfer to the Area Team from 1 st April Joint Care Table 5 below provides a summary of current achievement within Joint Care. s associated with Joint Care are primarily efficiency initiatives within existing contracts and service budgets and are therefore agreed and on track to deliver. 341k of savings are not yet identified within Joint Care this is being addressed through the finance review process. Table 5: Joint Care QIPP Summary CAHO Workstream Project Title & Brief Description (categorised by workstream type) (categorised by workstream type) Gross s Investment Net s Net Actual From Plan '000 '000 '000 '000 '000 '000 '000 '000 '000 Joint Care Mental Health Contract Joint Care LD Joint Care Drugs & Alcohol CIP Joint Care Schemes to be Identified (450) (450) Total Joint Care 1, ,016 1, , Improving Services for People with Dementia The contract for this service was awarded to Care UK in October. However, the 3 month mobilisation period has had to be extended due to difficulty recruiting staff. The service has now commenced. Milestone Due Dementia Care Advisor Service to provide a single point of contact for people who live with Dementia and their carers from the beginning of their journey, right to the very end. The service will provide information and advice and support the person with Due Sept March Impact No financial impact is attached to this project 6 P a g e

7 Milestone Due dementia throughout the dementia care pathway Due Impact Assistive Technology Two of the six projects for this programme have already been delivered (on time). The Self assessment function for self funders is running 4 months behind. Set up time for the system is expected to be around 3-4 months with software provider and local retailer support. Detail due to further detail required with the procurement exemption report. A decision has now been made to go through a closed tender for this system with completion and implementation by March Milestone Due Implementation of AT platform to support retail opportunity model for self funders Due Impact July Mar No financial impact is attached to this project Continuing Care Table 6 below provides a summary of current achievement within Continuing Health Care. The service continues to operate within existing budget envelope and deliver planned cost reductions. Table 6: Continuing Care QIPP Summary CAHO Workstream (categorised by workstream type) Project Title & Brief Description (categorised by workstream type) Gross s Investment Net s Net Actual From Plan '000 '000 '000 '000 '000 '000 '000 '000 '000 Continuing Care Continuing Care Continuing Care CHC Review s 1, ,000 1,000 1, ,000 1,000 0 Total Continuing Care 1, ,100 1,100 1, ,100 1,100 0 The CHC assessment nurses have continued to complete reviews as planned, and have undertaken full assessments as required. This has led to a number of patients being found not eligible for CHC funding, or in some cases a reduction in the amount of care required, e.g.1:1 as their needs have changed. As a result there are several cases going through the appeals process. Overall the forecast outturn is showing an under spend on Continuing Care and overspend on FNC. The increase spend on FNC is as a result of establishing clear processes for payment of nursing homes this year, and another home opening. It is planned that there will be 2 more nursing homes opening in 2013 which will put pressure on budgets in this area Medicine s Management Table 7 below provides a summary of current achievement within Medicines Management. Based on the data available (ten months) and using the national profiling model Medicine s Management is forecasting a 5m underspend. 7 P a g e

8 Table 7: Medicine s Management QIPP Summary CAHO Workstream (categorised by workstream type) Project Title & Brief Description (categorised by workstream type) Gross s Investment Net s Net Actual From Plan '000 '000 '000 '000 '000 '000 '000 '000 '000 Prescribing Prescribing Effective medicines management 3, ,270 3,270 8,298 5,028 3,270 8,298 5,028 3, ,270 3,270 8,298 5,028 3,270 8,298 5,028 8 P a g e

9 3. Performance The Operating Framework 2012/13 sets out the national measures and indicators against which the performance of the NHS will be judged. These indicators have been identified nationally as representative of quality, patient focussed services during the transition to the NHS Outcomes Framework for 2013/14. As part of the transition to new structures and commissioning arrangements in accordance with the Health and Social Care Act 2012, Buckinghamshire CCGs have been delegated responsibility for the management of national indicators that are relevant to the services they will commission. The purpose of the report is to give a high-level summary of the current indicators not delivering and other areas of concern, and provides assurance of the actions being taken to recover performance. The information in Section 4 below reflects the most up-to-date actions and position to July for indicators not achieving the required standard or at risk of under-performance. Section 5 provides a dashboard of the latest reported performance for all indicators. 3.1 Summary: Healthcare key performance indicators by exception Whilst 18 week targets continue to be largely met, performance remains below target in the other areas listed below: 18 Weeks -compliant at aggregate (all specialties) level for admitted, non-admitted and incomplete pathways; and now compliant at specialty level for T&O. However, specialty level targets were not met in Cardiothoracic Surgery, or Trauma and Orthopaedics (admitted pathways), Neurosurgery (non-admitted) and Trauma & Orthopaedics (incomplete pathways). A&E - A&E waiting times were below target at SMH in all four weeks of March, which is a continuing trend from November The combined BHT total was 86.6% of patients seen in less than 4 hours C difficile the 2012/13 target of 133 has been missed by 1 case but there is improvement from last year Ambulance Response Times - response times for Buckinghamshire are not achieving the required standard; recovery plans are being agreed GP referrals & outpatient attendances activity is consistently above plan; work with practices is on-going to reduce variation Diagnostic Activity significant year on year increase reported Choose and Book - utilisation remains low across the county Delayed Transfers of Care The number of delayed Transfers of Care is above plan 9

10 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb Indicator Exception Reports The dashboard below presents the latest available performance data for each of the national indicators where performance is not currently on track. A full list of all indicators is in Section 5. The RAG rating for each indicator is defined as: RED indicator off target/target won t be achieved AMBER indicator at risk Indicator: Outpatient Activity / Inpatient Activity / GP Indicator: Outpatient Activity / Inpatient Activity / GP referrals Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG 11,000 10,500 10,000 9,500 9,000 8,500 8,000 7,500 7,000 6,500 6,000 Number of written referrals from GPs for a first outpatient appointment in general & acute specialties - Feb 13 Actual Mean UCL LCL 2 Sigma below 1 Sigma below 1 Sigma above 2 Sigma above 6,500 6,000 5,500 5,000 4,500 4,000 3,500 3,000 2,500 Total elective G&A FFCEs - Mar 12 Actual Mean UCL LCL 2 Sigma below 1 Sigma below 1 Sigma above 2 Sigma above Plan 14,500 13,500 12,500 11,500 10,500 9,500 8,500 7,500 6,500 Number of all first outpatient attendances (consultant led) in G&A Actual Mean UCL LCL 2 Sigma below 1 Sigma below 1 Sigma above 2 Sigma above Plan Summary of Concerns The national elective activity indicators measure the number of referrals made by GPs and others to consultant led G&A specialties, the number of first outpatient attendances following referrals (to consultant led G&A specialties) and the total number of elective in-patient (day case and ordinary) episodes for consultant led G&A specialties. These indicators are used as a guide to how the system is managing demand and to identify pressure areas whether by specialty or by provider. The PCT also monitors these types of activity through local measures. There are definitional differences between the national and local measures (ie exclude or include some activity areas) and therefore the reported data may not correspond. Year-to data for April-February shows activity is above trajectory and reported performance for the same period in 2011/12 for all activity indicators. 10

11 Actions taken to recover performance CCG Clinical Leads continue the revisiting and reinvigorating the pathways for the intermediate service. This includes a more integrated approach between the intermediate service and BHT, including diagnostics. A specific project is being set up to provide a comprehensive review of the efficacy of the intermediate services. The continued roll out of the integrated dermatology service is being realised. Indicator: 18 weeks Referral to Treatment Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG Weekly 18 week reccovery T&O 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Weekly 18 Week Admitted 98.0% 94.0% 90.0% 86.0% Actual Activity Weekly Performance Plan backlog plan Actual backlog % seen within 18 weeks Summary of Concerns The NHS Constitution guarantees the right of patients to receive clinically appropriate treatment within 18 weeks of referral. During 2011/12 performance in Buckinghamshire fell below the required national standard of 90% of patients on an admitted pathway receiving treatment within 18 weeks of referral. Performance was recovered in January 2012 with the 18 weeks standards being achieved at the aggregate level for admitted and non-admitted pathways. In February, Buckinghamshire continued to achieve the 18 weeks standards at the aggregate level for admitted and non-admitted pathways and for all specialties. The Admitted target was met in all specialties. The Non-Admitted target was not met in T&O and Gastroenterology. Since the commencement of 2012/13, Buckinghamshire has also met the new standard of 92% of all incomplete 18 week pathways (ie patients who are waiting for treatment) waiting less than 18 weeks. In February this was met at an aggregate level, but was not met at specialty level for Trauma & Orthopaedics, Plastic Surgery, Rheumatology and Urology. 11

12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Indicator: Ambulance Response Times Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG Category A Calls < 8 Minutes - Trend Cat A > 19 mins - Trend 80% Actual Trend Trajectory 100% Actual Trend Trajectory 75% 70% 65% 95% 60% 55% 50% 90% 45% 40% 85% Summary of Concerns Based upon the early figures (the final scorecard is yet to be produced) to the end March 69.1% of Cat A calls were responded to within 8 minutes, and 94.60% within 19 minutes (the existing standards). The Red 8 figures represents a 0.2% deterioration (in month achievement was 67.6%), the first backward move in 3 months, whilst Red 19 has improved by further 0.1% in month. From 1st June, a new methodology for reporting ambulance response times was introduced nationally as a result the Cat A8 measure will be split into two parts, Red 1 and Red 2. This split reflects the way that ambulance trusts already sub-divide their Category A calls for operational purposes. Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions such as airway obstruction. Red 2 calls are serious but less immediately time critical and cover conditions such as stroke and fits. Red 1 patients account for less than 5% of all ambulance calls. The existing standard of performance will remain for 2012/13, i.e. 75% of calls should receive a response at the scene within 8 minutes. However, there is an expectation that trusts will demonstrate continuous improvement in performance to reach 80% for Red 1 calls by April 2013 as they update their operational dispatch and resource allocation procedures. It should be noted that it has been indicated that the target for 2013/14 will now be 75% rather than 80%. Against the new targets, performance to March 2013 is as follows Red % and Red % Buckinghamshire finished as the worst performing patch in respect to these shadow targets and remains one of only 2 areas where the Red 1 target is not being attained. In view of the winter pressures money passed to the Trust it is disappointing that figures have worsened in Red 8 Actions taken to recover performance Performance in the prior year to March 2012 was 67.38% for Red 8 and 94.15% for Red 19, year-onyear Red 8 improved by 1.72% and Red 19 by 0.45% alongside incident increases in excess of 10%. 12

13 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Some of the actions taken that have contributed to this improvement were: The ambulance CAD System has been updated following investigation which should redress the issue being experienced with CFR call allocation and improve performance. Extend the availability of co responder schemes and increase their RED 8 contribution from 1.5% to 2.5% The planned new rotas were introduced in January; the aim is to match resource to demand and increased use of private ambulance providers and SCAS believe that this has contributed to the improved performance. SCAS agreed handover plans with WGH and WPH; copies to be shared by SCAS. SCAS are introducing GPs into their EOCs with the aim of increasing Hear and Treat numbers an area where performance has dipped; it is hoped that there may also be an impact on See and Treat numbers also avoiding the need for onward conveyance. Indicator: Cases of Clostridium difficile Clostridium difficile Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG C difficile Year To Actual Trajectory Summary of Concerns The annual limit set by the Department of Health for Buckinghamshire for 2012/2013 was 133 cases. A 20% reduction from the number of cases that occurred in 2011/2012 was needed to achieve this limit. The cumulative total number of cases for 2012/2013 is 134. This is a 20% reduction in cases but is one case over the limit of 133 cases. Six cases occurred in March which is five cases below the monthly limit. This is the fifth consecutive month that the number of cases has been below the monthly limit. There was one community case occurring in a patient living in their own home. There were five cases occurring in the acute setting. One occurred at Stoke Mandeville Hospital. The other cases occurred in services outside the county; with 2 cases occurring at Wexham Park Hospital, one case occurring at Luton and Dunstable Hospital and one case occurring at 13

14 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 John Radcliff Hospital. A 50% reduction in the number of cases occurring at BHT during 2011/2012 has been achieved. There were a total of 31 cases in 2012/2013 which is 14 cases below their annual target of 45 cases. Actions taken to recover performance NHSBs Medicines Management Team and Lead Nurse for Infection Control are reviewing community cases on an individual basis with primary care teams to identify learning that can be used to reduce cases. Learning has been shared across the health economy through the Buckinghamshire Infection Control Committee Meeting. Prescribing rates for antibiotics with high risk for C. difficile are being monitored by practice. Ongoing actions to achieve reduction in the number of cases include: o The implementation of NHSBs county wide C. difficile recovery action plan. o progress meetings with the BHTs Director for Infection Prevention and Control. Indicator: Diagnostic Activity Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG 12,000 10,000 8,000 6,000 Diagnostic Activity - Endoscopy based - Feb 13 Trend Target Actual 160, , , ,000 80,000 60,000 Diagnostic Activity Non-Endoscopy based - Feb 13 Trend Target Actual 4,000 40,000 2,000 20, Summary of Concerns: Year-to data for April-February shows activity is 13.3% above trajectory for non-endoscopy diagnostic procedures and 8.5% above plan for non-endoscopies. Procedures that are over performing include audiology assessments, CT and Non-Obstetric Ultrasound Scans. Actions taken to recover performance BHT are the main provider for CT and Ultrasound in Bucks. There has been a steady rise in activity through 2012 for CT and Ultrasound. The CCGs provide reports to highlight usage of diagnostics per practice and those practices which have raised activity will be asked to audit their requests. This will encourage focus on clinically appropriate diagnostic requests and drive down activity. In addition to this the utilisation of the intermediate services is being reviewed against the pathways, and the dermatology service redesign work is beginning implementation of some key deliverables. A more integrated approach between the intermediate service and BHT is being implemented developed for diagnostics. The rise in activity of ultrasound scans will be added to the right care steering group meeting with the aim of agreeing a more in depth review of the activity with BHT and Care UK. 14

15 Indicator: Choose and Book Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG Summary of Concerns Time-pressured GPs still see it as an extra task. Memories of it taking a long time have not yet faded. isoft practices (15 in Bucks) unsettled by the demise of their clinical systems. Choose and Book likely to be put onto a back burner here, whilst new systems are chosen and sourced. Missing services and past shortage of slots at BHT. Perception that urgent referrals are not treated differently from others. Creation of telephone appointments for MusIC difficult to achieve if it is not booked by the GP during the consultation. Many practices have chosen to fax MusIC referrals as a result. Actions taken to recover performance Training is being rolled out to practices to demonstrate how different the C&B system is now. Possible involvement of admin staff to support GPs being explained. Champion GPs effective in demonstrating how quickly and easily it can be done. Training being integrated with clinical system training in order to avoid delays following system updates. Westongrove and others building back utilisation. Recommending to practices that they book a MusIC appointment and send/give it to the patient if this is an admin task. Patients can change it if necessary. Negotiating with MusIC to try to get them to look again at the system they use. Gold Standard Project at BHT should assure people that there will be no resurgence of appointment slot issues, and increase services available so that it is not necessary to use Choose and Book for some referrals and paper for others. BHT working to ensure that there are urgent slots available for all services. Work beginning with BHT on the introduction of Advice and Guidance. This may be seen by many as a Choose and Book bonus. Indicator: A&E Responsible Director: Directors Of Operations Aylesbury Vale CCG and Chiltern CCG Summary of Concerns There is continued failure to meet A&E Waits - everyone treated within 4 hours of arrival. During all the weeks of March A&E waiting times were below target at BHT, averaging across the month 86.6% of patients being seen in less than 4 hours. The A&E monthly target has not been met since October. It is acknowledged that this is Actions taken to recover performance The Emergency Care Team have visited BHT and reviewed the A&E pathway. They fed back to both providers and commissioners. Louise Patten, Chief Officer NHS Aylesbury Vale CCG as SRO, is working with the Director of Operations at BHT, to ensure these issues are resolved as soon as possible. 15

16 5. Indicator Dashboard Buckinghamshire Indicator / Measure Frequency Latest data target Actual Percent from target Movement Incidence of MRSA Bacteraemia Mar % Incidence of C difficile Mar % Incidence of MSA (PCT) 2 Mar Incidence of VTE 3 Jan-13 90% 96.40% 7.1% Number of Elective FFCEs (G&A Specialties, consultant led) Number of GP Written referrals to hospital (G&A Specialties, consultant led) Number of Other referrals for a first outpatient appointment (G&A Specialties, consultant led) All First Outpatient Attendance following GP referral All First Outpatient Attendances (G&A Specialties, consultant led) Cancer seen within 2 weeks of urgent GP referral Cancer breast symptoms seen within 2 weeks Cancer first treatment within 31 days of diagnosis Cancer subsequent Drug treatment within 31 days Cancer subsequent Radiotherapy treatment within 31 days Cancer subsequent Surgery treatment within 31 days Cancer treated within 62 days of urgent GP referral Cancer treated within 62 days of screening referral Cancer - treated within 62 days of hospital specialist referral (consultant upgrade) Feb-13 53,683 55,355 Feb-13 78,870 89,508 Feb-13 30,733 31,516 Feb-13 63,878 70,990 Feb , ,975 Jan-13 93% 98.60% Jan-13 93% 97.60% Jan-13 96% 98.50% Jan-13 98% 99.70% Jan-13 90% 96.70% Jan-13 94% 99.20% Jan-13 85% 89.10% Jan-13 90% 96.70% Jan-13 85% % 3.1% 13.5% 2.5% 11.1% 1.9% 6.0% 4.9% 2.6% 1.7% 7.4% 5.5% 4.8% 7.4% 17.6% Diagnostic 6 week waits 1 Feb-13 1% 1.3% 30.0% Diagnostic Activity - endoscopy based Feb-13 10,285 11, % Diagnostic Activity - non- endoscopy based Feb , , % 16

17 Referral to treatment within 18 weeks admitted Referral to treatment within 18 weeks non-admitted Referral to treatment within 18 weeks incomplete Buckinghamshire Feb-13 90% 93.20% Feb-13 95% 98.60% Feb-13 92% 95.40% RTT-admitted (95th percentile) 1 Feb % RTT-non-admitted (95th percentile) 1 Feb % RTT-incomplete (95th percentile) 1 Feb % Number of incomplete RTT pathways 1 Feb , % Delayed Transfers of Care (DTOC) Feb % Non-elective FFCEs (G&A Specialties, Consultant Led) A&E Waits treated within 4 hours of arrival 1 Feb-13 38,062 40,275 Feb-13 95% 90.57% A&E (95th percentile) admitted 1 Jan % Ambulance response times meeting 8 mins for cat A Ambulance response times meeting 19 mins for cat A Ambulance response times meeting 8 mins for cat A Red 1 Ambulance response times meeting 8 mins for cat A Red 2 Mar-13 75% 69.10% Mar-13 95% 94.60% Mar-13 80% 72.50% Mar-13 80% 68.90% Unplanned hospitalisation for asthma diabetes and epilepsy (under 19s) Feb-13 N/A 209 Emergency admissions for acute conditions that should not normally require admission Feb-13 N/A % 3.8% 3.7% 5.8% -4.7% -7.9% -0.4% -9.4% -13.9% Emergency Readmissions N/A The proportion of people who have depression and/or anxiety disorders who enter into treatment for psychological therapies Quarterly Q3 2012/13 7.5% 8.3% 10.7% The proportion of people who complete treatment who are moving to recovery Care Programme Approach Early Intervention of Psychosis Crisis Resolution/ Home Treatment for people with mental health difficulties Quarterly Quarterly Quarterly Quarterly Q3 2012/13 45% 47.9% 6.4% Q3 2011/13 N/A Q % Q % 17

18 Buckinghamshire Health visitor numbers 1 Jan % Bookings to services where named consultant led team was available 1 Mar-13 80% 83% 3.7% Trend in value/volume of patients being treated at non-nhs hospitals 1 Mar-13 10% 11% 10.0% Q Maternity - % seen by 12 weeks Quarterly 13 90% 104% 15.6% Key The RAG rating for each indicator is defined as: RED indicator off target/target won t be achieved AMBER indicator at risk GREEN target likely to be achieved 1 Actual data for this indicator is based on the most recent period, rather than a cumulative or annualaverage 2 Incidence of MSA (Mixed Sex Accommodation) relates to all Bucks PCT patients. From April 2011, all providers of NHS funded care must routinely report breaches of sleeping accommodation, as set out in national guidance, and will attract contract sanctions in respect of each patient affected. 3 Incidence of VTE data for this line only relates to incidences at BHT, irrespective of the commissioning PCT 18