integrated performance report - southwark ccg · the data and information included in the...

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Integrated

Performance Report M6 2013/14

28 November 2013

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The best possible outcomes for Southwark people 2 | P a g e

Contents 1. Structure of the Document ....................................................................................................... 3

2. Southwark CCG and Providers Performance Summary Dashboard .......................................... 4

3. Southwark CCG Dashboard (M6) .............................................................................................. 5

4. Provider Dashboards (M6 Performance Q2 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 .............................................................................. 9

5. Performance and Quality and Safety Trackers ....................................................................... 10

a. Monthly Performance Tracker ........................................................................................................... 10

b. Quarterly Quality and Safety Tracker ................................................................................................ 11

6. Performance Variance and Assurance Information ................................................................ 12

7. Southwark CCG QIPP Performance ......................................................................................... 23

a. Performance and Variance Tracker ................................................................................................... 23

b. CCG-led New Outpatient QIPP .......................................................................................................... 24

c. CCG-led A&E QIPP .............................................................................................................................. 25

d. CCG-led SLaM Risk Share QIPP .......................................................................................................... 26

8. Southwark CCG Finance Report (M7) ..................................................................................... 27

9. Glossary of Performance Indicators ....................................................................................... 28

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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 the CCG’s committees in their consideration of the current status of the 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 is included in sections 7 & 8 and Appendix 1. CCG finance report. 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 others 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

Trust Quality & Safety reports SLCSU Acute Int Performance Report Community Contract Report SLaM Quality & Safety Report Serious Incidents Reports

Q2 2013/14 M6 Q2 Q2 Q2

Finance CCG Finance Report Acute Int Performance Report SLaM Finance Report

M7 M6

Performance Indicators & Targets SLCSU Acute Int Performance Report SLCSU Performance Report

M6 M6

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2. Southwark CCG and Providers Performance Summary Dashboard

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3. Southwark CCG Dashboard (M6)

Amber and red-rated issues are reviewed in further detail in Section 6.

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4. Provider Dashboards (M6 Performance Q2 Quality & Safety)

a. King’s College Hospital NHS Foundation Trust

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b. Guy’s & St. Thomas’ NHS Foundation Trust

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c. Guy’s & St. Thomas’ NHS Foundation Trust – Community Health Services

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d. South London & Maudsley NHS Foundation Trust

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5. Performance and Quality and Safety Trackers

a. Monthly Performance Tracker

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b. Quarterly Quality and Safety Tracker

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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.

Issu

e

Synopsis of Issue Current Status SC

CG

GST

KC

H

GST

CS

SLaM

Forum Issue is Addressed Date Responsible CCG Officer and CCG

Clinical Lead

Finance

Fin

anci

al o

ver-

pe

rfo

rman

ce Acute over-performance for M7 was -£2,710k.

Likely YEP of -£7,455k (M7 report).

Community services over-performance for M7 was -£759k (urgent care centre

-£460; walk in centre -£290; other community services -£9).

See finance report in appendix 1.

YTD (M7) Position

Acute -£2,710k

Comm. -£759k

Client Groups

-£829k

Acute Contract Monitoring Meetings

6 Dec (GST)

5 Dec (KCH)

Dr Jonty Heaversedge,

Tamsin Hooton and SLCSU Acute Contracting Team

Performance & Quality

RTT

ad

mit

ted

KCH

A planned failure of the admitted performance target on a monthly basis is

expected to support backlog clearance.

The trust is using a combination of outsourcing to private providers and

additional elective capacity on the PRUH and Orpington sites.

The trust is transferring some existing orthopaedic waiters, subject to patient

agreement, to GST for treatment. The trust should be in a sustainable position

from April 2014.

Progress against trajectory

The admitted backlog figure at the end of October was 1451 compared to a

trajectory of 1362 - 89 adrift of trajectory. Two main drivers behind this are

bed availability and critical care availability.

By the end of November all 3 wards in Infill 4 will be open which will provide

more inpatient bed capacity.

There will be some additional critical care capacity coming on line in January

2014 and a 3rd theatre is opening in Orpington in January 2014.

The phasing of the reduction of the backlog has shifted into Q4 2013/14,

however the Trust is confident of meeting trajectory by the end of Q4 13/14.

SCCG 87.3%

KCH 88.7%

(M6)

Target 90%

KCH Acute Contract Monitoring

Meeting

Monthly Performance Meeting

(for escalation)

5 December

21 November



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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

52

wee

ks lo

ng

wai

ters

SCCG There were 8 Southwark patients waiting more than 52 weeks on incomplete

pathways in M6.

All 8 of the long waiters are waiting at KCH. 1 in general surgery/bariatric

surgery and 7 gastroenterology for benign HpB surgery.

KCH There were 29 patients waiting more than 52 weeks on incomplete pathways

in M6 compared to 36 in M5.

The trust is outsourcing a cohort of the HpB patients to a private provider with

the remaining patients being treated at KCH.

Infill Block 4, which has now been delayed until mid-November, will have

additional bed and theatre capacity for HpB but the limiting factor is the

availability of critical care beds. The service is relooking at the patients waiting

to see if there is any further flexibility in terms of outsourcing, however a

realistic assessment of when long waiters will be cleared is likely to be the end

of the financial year.

SCCG 8 KCH 29

(M6)

Target 0

KCH Acute Contract Monitoring Meeting

Monthly Performance Meeting (for escalation)

5 December

21 November




Can

celle

d O

per

atio

ns

– 2

8 d

ays

KCH

The number of cancelled operations (28 days) at KCH has decreased in Q2 to 6

from 9 in Q1.

The Trust have been a national outlier for cancelled operations.

The Trust are looking at their processes for capturing data properly.

A Unify reporting review will be presented at the next performance meeting.

GST

The number of cancelled operations (28 days) at GST has increased in Q2 to 8

from 1 in Q1.

The Trust are also querying the numbers of urgent cancellations.

This will be reviewed at the next performance meeting.

KCH 6

GST 8

(Q2)

Target 0



5 December

21 November



GST Acute Contract Monitoring Meeting


6 December

22 November


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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Can

cer

62

day

s –

GP

ref

erra

l

SCCG

Performance in M5 has dropped to 83.3% from 96.3% in M4.

This performance relates to 5 of 30 patients not being treated within the

required performance threshold. 2 patients started their journey at KCH and

finished at GST, and the remaining 3 were internal to GST.

GST

Performance in M5 improved slightly to 80.0% from 77.9% in M4. There were

17.5 breaches out of 87.5 pathways.

Of the externally initiated referral pathways, 11 of the breaches were caused

by late referrals and 3 were caused by delayed diagnostics (not necessarily at

GST). The internal referral pathway breaches were caused by patients

transferring between services, patient choice to delay treatment and

inadequate elective capacity.

For internal referral pathways the trust has received, and is working to

implement action plans from the DH Intensive Support Team (IST) review.

The IST has recently reviewed all SEL providers. Agreed actions plans will be

drawn up following the receipt of final IST reports in November 2013.

KCH

Performance in M5 dropped to 83.1% from 97.2% in M4. There were 6.5

breaches from 38.5 pathways.

Breaches were caused by admin errors, late referrals and delays in diagnostics.

SCCG 83.3%

GST 80.0%

KCH 83.1%

(M5)

Target 85%



6 December

22 November





5 December

21 November

Can

cer

62

day

s –

scre

enin

g

GST

Performance has dropped from 80.0% in M4 to 71.4% in M5.

Due to the low number of pathways, an evaluation of this performance

indicator will take place with Q2 data.

GST 71.4%

(M5)

Target 90%



6 December

22 November


KCH


Due to the low number of pathways, an evaluation of this performance

indicator will take place with Q2 data.

KCH 86.1%

(M5)

Target 90%



5 December

21 November



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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Am

bu

lan

ce r

esp

on

se 8

min

ute

s

SCCG

Performance has dropped to 72.4% in M6 from 76.5% in M5

The drop in performance has been as a result of increased activity.

In November a new intelligent conveyancing system will be introduced which

will help manage flows of ambulances across the system and improve response

times.

SCCG 72.4%

(M6)

Target 75%

Lambeth and Southwark Urgent Care Working Group 20 November

Tamsin Hooton, Ali Young and Harprit Lally

Am

bu

lan

ce H

AS

com

plia

nce

90% of all patient handover times are recorded via the Patient Handover Button on the Hospital Based Alert and Handover System.

KCH

Performance at KCH has improved for a second month in a row from 84.6% in

M5 to 86.5% in M6.

HAS compliance has been part of the system wide assessment and is being

monitored.

KCH 86.5%

(M6)

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


TBC

5 December

Tamsin Hooton, Ali Young and Harprit Lally

Tru

st-A

ttri

bu

tab

le P

ress

ure

Ulc

ers

GST

There were 2 grade 3 attributable pressure ulcers reported in Q2 13/14.

Lambeth CCG are leading the review on these 2 incidents.

KCH

There was 1 grade 3 attributable pressure ulcer reported in Q2 13/14

This will be reviewed in the December Serious Incident Committee meeting.

SLaM

There were 4 grade 3 attributable pressure ulcers reported in Q2 13/14

compared to 0 in Q1 13/14 (not Southwark patients).

These incidents will be reviewed at future Serious Incident Committee

Meetings

GST 2 G3

KCH 1 G3 SLaM 4 G3

(Q2 13/14)

Target 0

Serious Incident Committee Meetings

KCH (5 Dec) GST (12 Dec)

SLaM (11 Dec) Jacquie Foster

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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Falls

KCH

There were 8 falls that resulted in major injury in Q2 13/14.

These will be discussed at the Serious Incident Committee Meeting on 5

December.

KCH 8 major

(Q2 13/14)

Target 0

KCH Serious Incident Committee Meeting

5 December

Jacquie Foster

KCH

There were 2 falls that resulted in death in Q2 13/14.

1 Incident involved a Croydon patient in August. This case will be reviewed in

December’s Serious Incident Committee meeting.

The second incident involved a Southwark patient. The investigation has been

reviewed in September and the action plans will be reviewed in February 2014.

KCH 2 death

(Q2 13/14)

Target 0

GST

There were 4 falls that resulted in fractures in Q2 13/14 (not Southwark

patients).

Falls will soon be covered as a substantive agenda item in a CQRG meeting.

Lambeth CCG will be leading the reviews of these incidents.

GST 4 fractures

(Q2 13/14)

Target 0

GST Serious Incident Committee (fall resulting in death) and the joint GST acute and Community Health Services CQRG (falls resulting in major injury)

12 December

Dia

gno

stic

wai

ts >

6 w

eeks

During 2012/13 problems with waits for some diagnostic procedures emerged, as demand outstripped available diagnostic capacity - this has continued for some services into 13/14.

SCCG


Under performance is mainly being driven by endoscopy at GST.

GST

Diagnostic waits at GST have improved from 5.13% in M5 to 4.44% in M6.

The main driver for this under performance is endoscopy.

Although GST has opened a new larger endoscopy suite, poor staffing levels has resulted in an increase in the number of waiters over 6 weeks. The trust has put additional sessions in place to increase staffing capacity using clinical fellows.

The Trust anticipates it will take until December to fully clear the backlog of long waiters.

Target <1%

SCCG 2.48% GST 4.44%

(M6)

Target <1%

GST Acute Contract Monitoring Meeting Monthly Performance Meeting

(for escalation)

6 December

22 November


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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Ch

ild s

afe

guar

din

g tr

ain

ing

KCH

Performance has been under the target of 80% for levels 2 and 3.

Child safeguarding level 2 training compliance is 71% and level 3 compliance is 76%.

This has been repeatedly addressed at the Southwark Safeguarding Executive Meeting.

The Trust have commissioned extended training capacity to improve compliance.

KCH does not recognise staff who have completed the training at another trust as being compliant. This means all new recruits are classified as non-compliant which lowers compliance levels.

This indicator will also be monitored at a newly created health sub-group of the Southwark Safeguarding Children Board which will focus on quality.

KCH Level 2 – 71% Level 3 – 76%

M6

Target 80%

Southwark Safeguarding Executive Meeting

Health sub-group

January

TBC

Gwen Kennedy

Bir

ths/

mid

wif

e r

atio

GST

The ratio has increased from 29.2 in M5 to 31.5 in M6.

Maternity was covered as a substantial item at the September CQRG meeting and this indicator will continue to be monitored.

GST 31.5

(M6)

Target <27

GST CQRG Meeting GST Acute Contract Monitoring Meeting

12 December

6 December

Jacquie Foster


Mat

ern

ity

– To

tal

C-s

ect

ion

GST

The total proportion of C-sections has increased slightly at GST to 30.2% in M6 from 32.4% in M5.

The Trust attributes its high C-section rate to it’s higher than average proportion of first time mothers.

KCH

The total proportion of C-sections has increased slightly at KCH to 26.2% in M6 from 23.4% in M5.

GST 30.2% KCH 26.2%

(M6)

Target 26%

Joint GST acute and Community Health Services CQRG KCH CQRG Meeting

12 December

18 December

Jacquie Foster

Bo

oki

ngs

<1

3 w

eeks

(un

-ad

just

ed)

KCH

Performance for M6 was 72.0% which was below the target of 90%.

King’s figures do not take into account the number of referrals of women who are already more than 13 weeks into their pregnancy.

KCH 72.0%

(M6)

Target 90%

KCH CQRG Meeting

18 December Jacquie Foster

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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Frie

nd

s &

Fam

ily t

est

– A

&E

A&E response rate

GST & KCH

In M6 GST and KCH have recorded A&E response rates below the target of 15% (5.5% and 9.5% respectively).

Commissioners are assured that every effort has been made to increase response rates at KCH.

KCH has implemented the following means of collecting responses in A&E

- Token box system in the to vote for scores - Text back system so patients can text responses - Volunteers asking patients with ipads - Online surveys - Cards to fill in responses

A&E resp. rate

GST 5.5%

KCH 9.5%

(M6)

Target 15%

GST CQRG Meeting

KCH CQRG Meeting

12 December

18 December

Jacquie Foster

A&E score

KCH – Denmark Hill

The A&E score for M6 was 40 which is below the national average score of 52.

Few patients report that they were unlikely or very unlikely to recommend KCH. The Trust may be receiving a proportionately higher number of neutral responses which do not contribute towards the overall score.

A&E score

KCH 40

(M6)

Co

mp

lain

ts

KCH

204 complaints were received in Q2 13/14.

Complaints are being continuously monitored during CQRG meetings.

The Trust will soon be asked to provide an update on progress made in implementing improvements plans.

GST

There were 224 new formal complaints opened at GST in Q2 13/14 compared to 265 in Q1 13/14.

Complaints are being continuously monitored at CQRG meetings.

KCH 204

GST 224

(Q2 13/14)

KCH CQRG Meeting

18 December Jacquie Foster

Joint GST acute and Community Health Services CQRG 12 December Jacquie Foster

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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Co

vera

ge o

f N

HS

hea

lth

che

cks

NHS Health Checks received

% eligible people who have received an NHS Health Check in Q1 13/14 was 40.7% which was below the locally agreed target of 50% but higher than the Q4 12/13 performance position of 35.0%.

The PH team are working with the DH and PHE to develop invitation letters and text messaging to improve take up and reduce DNAs.

They are also working with clusters of practices to try to establish provider support i.e. by providing a mobile unit in a practice car park or at Greenwich hospital.

SCCG 40.7%

(Q1 13/14)

Target 50%

Joint Public Health Targets Meeting TBC Tamsin Hooton

IAP

T

Referrals

M6 performance position for the proportion of people with depression referred for psychological therapy is 0.92% against the M6 target of 1.06%.

Mental health commissioners have visited practices to discuss service developments in mental health and used this opportunity to encourage GPs and practice managers to use the new referral form.

Practices have been given notice that the model for commissioning IAPT services will be changed.

It is unlikely that the target will be achieved in 13/14 despite the implementation of recovery plans and additional investment that has been made. This is due to variances in providers’ performance in recruitment and retention earlier in the year and a previous focus on high intensity clients.

A task and finish group has been created to develop future commissioning models and future investment plans to meet the target in 14/15.

403 (0.96%)

(M6)

Target for M6

447 & 1.06%

SLaM QIPP and Core Contract meeting 28 November Gwen Kennedy

Moving to recovery

Note: There have been a greater number of high intensity patients being seen by the IAPT service. This has resulted in fewer patients being seen overall due to the high number of appointments they require.

The recovery rate has decreased slightly in M6 to 37.0% from 40.7% in M5. 2 additional psychological wellbeing practitioners were recently employed to

focus on low intensity patients which will provide greater access to the service, increasing numbers of patients being seen and moving to recovery.

37.0%

(M6)

Target 50%

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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Co

ntr

ol o

f M

edic

ine

s

31 incidents in total were reported across a range of settings. 17 of these were reported incidents within community health services directly. 14 incidents are attributable to other agencies but were reported by

community staff. There were two incidents relating to a controlled drug. GSTCH have provided a breakdown of all errors with improvement plans. The incidents will be discussed at the CHS Pharmacists meeting chaired by the

Head of Nursing and attended by relevant service managers, to disseminate learning across the directorate.

GSTCH 31

(Q2 13/14)

Joint GST acute and Community Health Services CQRG

(these incidents will be discussed at the next Community Health Patients Safety Forum and reported to the GST Medicines Safety Forum)

12 December

TBC Jean Young

Eth

nic

ity

at f

irst

con

tact

Performance has improved from 77.4% in M5 to 78% in M6. Commissioners are assured that performance is generally good. Under

performance is generally due to ethnicity not being taken when first contact is made over the phone.

Health Visiting and School Nursing identified as the two main areas of focus for improving performance.

GSTCH 78%

(M6)

Target 85%

GSTCH Contract Monitoring Meeting

17 December Jean Young

Pat

ien

t Fa

cin

g Ti

me

-

Hea

lth

Vis

itin

g

Health visiting patient facing time is below this year’s target of 40%. Performance has reduced slightly again in M6 to 25.0% from 26.7% in M5. There have been delays in registering agency staff on to RIO which has resulted

in some patient facing time not being recorded. Also agency staff have not been as efficient as permanent staff at recording patient facing time.

The Trust’s recruitment and retention plans have also been discussed in light of on-going national health visitor shortages and will continue to be closely monitored.

GSTCH 25%

(M6)

Target 40%



Pat

ien

t Fa

cin

g Ti

me

– A

du

lt C

om

mu

nit

y

Nu

rsin

g

Adult community nursing patient facing time has reduced from 41.3% in M5 to 38.0% in M6.

Fall in performance has been attributed to a fall in recorded activity which is currently being investigated.

GSTCH 38.0%

(M6)

Target 40%

GSTCH Contract Monitoring Meeting 17 December Jean Young

DN

As

The DNA rate has increased in M6 to 5.5% which is slightly over the 5% target. An analysis of DNAs has taken place which showed that the rise in DNAs has

occurred predominantly in orthotics. DNAs will again be monitored at the next Contract Monitoring Meeting on 17

December.

GSTCH 5.5%

(M6)

Target <5%



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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

RTT

- A

HP

% 1

8 w

ks

Under performance was due to a number of breaches in the children's speech and language therapy service. These beaches were due to non adherence to admin procedures and steps are being taken to address these issues.

GSTCH 94.3%

(M6)

Target 95%



CP

A 7

day

fo

llow

up

Performance has dropped to 94% in Q2 13/14, just below the target of 95%. The Mental Health team are currently querying the accuracy of this data with

SLaM. Provisional performance data for October shows 100% delivery.

SCCG 94%

(Q2 13/14)

Target 95%

SLaM QIPP and Core Contract Meeting 28 November Gwen Kennedy

A&

E b

reac

hes

– 4

ho

urs

(Men

tal H

ealt

h)

There were 6 x 4 hour wait A&E breaches in M6, 2 less than in M5. A&E has experienced a greater than anticipated number of patient admissions. 50% of admissions are out of hours emergency admissions. High level discussions are underway with SLaM regarding creation of overspill

capacity and enhancement of Home Treatment Teams – contingent upon 4 borough agreement.

The CCG has made additional investment to improve performance (see below regarding 6 hour breaches)

SLaM 6

(M6)

Target < 4


A&

E b

reac

hes

– 6

ho

urs

(Men

tal H

ealt

h)

There were 11 x 6 hour wait A&E breaches in M6 compared to 20 in M5. SLaM’s in-patients is currently operating at full capacity and so they are

struggling to find beds for patients being referred by the A&E Liaison Team. The CCG recently funded a pilot where an additional PLN and senior registrar or

consultant psychiatrist were employed to cover the busy periods. Winter pressures funding has been approved to provide additional consultant

and RMN cover during out of hours, 7 days a week. The impact of this will be reviewed in December 2013.

SLaM 11

(M6)

Target < 11


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Issu

e


CG

GST

KC

H

GST

CS

SLaM


Clinical Lead

Inp

atie

nt

nu

trit

ion

scr

een

Performance has dropped in Q2 to 86% from 93% in Q1 This performance variance has been included in the commissioner’s response

requesting reasons for under performance and improvement plans. This will be reviewed at the next contract monitoring meeting on 28

November.

SLaM 86%

(Q2)

Target 95%


Pat

ien

t re

ceiv

ed

cop

y o

f ca

re p

lan

Performance has been under target at 92% for both Q1 and Q2. The Trust has identified the patients that need to receive a copy of their care

plan and will prioritise ensuring this happens. There is a sanction of 0.25% of contract associated with this indicator.

SLaM 92%

(Q2)

Target 95%


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7. Southwark CCG QIPP Performance

a. Performance and Variance Tracker

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b. CCG-led New Outpatient QIPP

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c. CCG-led A&E QIPP

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d. CCG-led SLaM Risk Share QIPP

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8. Southwark CCG Finance Report (M7)

See Appendix 1 for full M7 Finance Report

Budget Annual Budget

(£k) Variance to

Month 7 (£k) Predicted End

of Year (£k)

Best Case F/cast Year

End Var'ce (£k)

Worst Case F/cast Year End

Var'ce (£k)

Total Acute 203,749 -2,710 -7,455 -4,106 -11,755

Client Groups 69,536 -829 -1,580 -1,000 -3,953

Prescribing 31,617 263 446 600 200

Community and other Services

29,738 -759 -1,300 0 -1,300

Corporate Costs 4,078 42 40 60 -8

Earmarked Budgets and reserves

14,137 3,993 9,849 4,446 7,200

Planned Surplus 3,972 2,317 3,972 3,972 3,972

Total 356,827 2,317 3,972 3,972 3,972

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9. Glossary of Performance Indicators

% end of life (35%) - % of end of life patients on Southwark Gold Patient Register/CMC with a known preferred place of death. 2012/13 baseline 87/498 = 17.5%, 2013/14 annual target 293/836 = 35% - SCCG % smoking quitters (COPD) (10%) - % Confirmed Smokers on COPD Registers who quit smoking. 2012/13 baseline: No baseline (4,141 on COPD register, 1,659 smokers), 2013/14 annual target: 165 / 1,659 = 10% - SCCG

% diabetes (21.3%) - % of patients on diabetes practice registers with a blood glucose level of 75 mmol/mol IFCC (HbA1C 9) or more (no exceptions). 2012/13 baseline (projected from current position): 3,316 / 13,020 = 25.4%, 2013/14 annual target: 2,816 / 13,200 = 21.3% (500 patients with better managed diabetes) - SCCG

% Appointments Cancelled by Service (5%) – The proportion of appointments cancelled by the service of the

total number of appointments - GSTCH

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 SCCG

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 - GSTCH

A&E breaches (4 hour wait) (3/month) - Number of breaches in the A&E 4-hour wait due to mental health

services - SLaM

A&E breaches (6 hour wait) (3/month) - Number of breaches in the A&E 6-hour wait due to mental health

services - SLaM

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 - GSTCH

Alcohol Intervention - Alcohol Brief Intervention in Reproductive & Sexual Health - GSTCH

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 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 - SCCG 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 - SCCG 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 - SCCG Ambulance wait > 60 minutes (0) - The number of handover delays of longer than 60 minutes - Acute

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Assertive Outreach (TBC) - Number of new referrals to the Assertive Outreach service - SLaM Births/midwife (1:28) – The Royal College of Midwives recommends a ratio for national planning (i.e. based upon expected national birth rate) of 28 births : 1 w.t.e. midwife for hospital births – Acute Bookings<13 weeks (90%) - The percentage of women who have seen a midwife or a maternity healthcare professional for health and social care assessment of needs, risks and choices before 13 weeks of pregnancy - Acute KCH figures do not take into account the number of referrals of women who are already more than 13 weeks into their pregnancy. GST measure their compliance with this target slightly differently to other trusts. They have a target booking number each month based on predicted births in 6 months time and hence if they exceed this target their performance is in excess of 100%. Due to their case mix and referrals of complex cases from elsewhere, this measurement has been agreed. C Diff (trajectory) - Number of Clostridium difficile infections for patients aged 2 or more on the date the specimen was taken - Acute 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 - SLaM

CAMHS Transition CPA - % of cases transitioned to AMH with CPA review 6 months prior to 18th birthday -

SLaM

CAMHS Transition Planning - % of cases with evidence of transition planning prior to 18th birthday - SLaM

Cancelled Ops 28 days (0) - 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 SCCG 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 SCCG 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 SCCG 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 SCCG 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 SCCG 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 SCCG 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 SCCG

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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 SCCG 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 SCCG 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 - GSTCH

Cost per Contact - Adult Nursing (-1% change) - Percentage change in cost per contact in the district nursing

services - GSTCH

Cost per Contact - Health Visiting (-1% change) - Percentage change in cost per contact in the health visiting

services - GSTCH

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 - SCCG

Dementia - Ensure appropriate recording of the needs of people with Dementia referred to community

services - GSTCH

Dementia diag rate (851 - a proportion of 53.2% against an expected prevalence of 1600) - Dementia

diagnosis rate – SCCG and SLaM

Developing Standardised Care Plans - Care Planning for Patients with Long Term Conditions – GSTCH

Diagnostic wait > 6 weeks (99%) - The percentage of patients waiting 6 weeks or more for a diagnostic test – Acute and SCCG Discharge Plan in Place (100%) - An indicative discharge plan shall be agreed within 4 weeks of admission -

SLaM

DNAs (<5%) – Proportion of patient appointments where the patient did not attend without providing

adequate notice - GSTCH

Dressings (trajectory) - Adherence to dressings of those prescribed and recommended – GSTCH

Early Intervention (TBC) - Number of new cases of psychosis served by Early Intervention teams - SLaM

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 -

SLaM

- 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 - SLaM

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Employment assessments (95%) - Percentage of service users on CPA to have an employment assessment -

SLaM

End of life care –

To show evidence of co-ordinated End of Life Care by the continued use of the Co-ordinate My Care

electronic EOLC register.

Patients who have chosen to die in their own home should routinely benefit from the sustained quality

offered by the Liverpool Care Pathway - GSTCH

Ethnicity at First Contact (85%) - Percentage of new clients with one or more first contacts for whom

ethnicity is known - GSTCH

Falls (minimal – major falls are amber rated, falls resulting in death are red rated) – Incidence of falls

resulting in injury – Acute and GSTCH

Falls (0) - Falls from unrestricted windows - SLaM

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.

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”) 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 - SLaM

Home Treatment Episodes YTD (TBC) - Number of episodes served by Home Treatment teams - SLaM

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 -

GSTCH

IAPT % moving to recovery (50%) - The proportion of people who complete treatment who are moving to recovery – SLAM and SCCG

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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 SCCG Inpatient Nutrition Screen (95%) - Percentage of inpatients who have had a full nutrition screen - SLaM

Last Minute Cancelled Ops - Number of last minute cancelled elective operations for non clinical reasons -

Acute

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 SLaM 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 - GSTCH

Mortality - Summary Hospital-level Mortality Indicator (SHMI) (<1)- Gives an indication for each hospital

trust in England whether the observed number of deaths within 30 days of discharge from hospital were

higher than expected, lower than expected or as expected when compared to the national baseline.

Higher than expected mortality rate > 1 As expected mortality rate = 1 Lower than expected mortality rate < 1 MRSA - Number of cases of Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia - Acute and SCCG Near Time Patient Experience (TBC) - Replacement of annual patient experience survey with near time

patient experience - GSTCH

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 – GSTCH

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 - SLaM

NHS Health Checks offered (20% of eligible population) - Percentage of eligible people who have been

offered an NHS Health Check in 2012/13. The Department of Health target stipulated that the Health Check

Programme was a five year rolling programme where 20% of the eligible population should be offered a

Health Check each year - SCCG

NHS Health Checks received (Locally agreed target of 40%)- Percentage of eligible people that have received

an NHS Health Check in 2012/13. This is the proportion of people who received an NHS Health Check from

20% of the eligible population - SCCG

NICE – The number of NICE guidance awaiting response – Acute

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

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Obesity - Reduction in percentage of children who are obese or overweight - GSTCH

Patient Experience - This indicator seeks to assess and evaluate quality of inpatient services (both acute and

rehab) through service user focus groups - SLaM

Patient Facing Time (CQUIN) - Increase in reported Patient Facing Time in the Sickle Cell service - GSTCH

Patient received copy of care plan (95%) - Percentage of patients who have been given a copy of their CPA

care plan - SLaM

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.

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 - SLaM

Percentage of delayed discharges (>7.5%) - Percentage of delayed discharges from inpatient care as per the

monitor definition - SLaM

Physical Health - Antipsychotics - Physical Health Checks for in-patients on anti-psychotic medication. This

excludes triage only admissions - SLaM

Physical Health - New Admissions - Physical Health Checks for new admission's. This excludes triage only

admissions – SLaM

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 - GSTCH

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

Pt Facing Time - Adult Comm Nursing – GSTCHS – There is a new method of calculating performance for this

indicator, details of which will be confirmed - GSTCH

Pt Facing Time - Health Visiting – GSTCHS – There is a new method of calculating performance for this

indicator, details of which will be confirmed - GSTCH

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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 - GSTCH

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 - GSTCH

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 - SLaM

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 - GSTCH

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 SCCG 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 SCCG 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 SCCG Safeguarding adults and children - To ensure that Community services comply with all relevant Safeguarding

Acts for both vulnerable adults and children and comply with the Safeguarding policies as detailed in the

contract - GSTCH

Smoking cessation training (33%) - Percentage of relevant inpatient & community staff working at SLaM for

over 6 months to have undertaken smoking cessation level 1 training - SLaM

Smoking quitters – Number of clients of NHS Stop Smoking Services who report that they are not smoking

four weeks after setting a quit date – SCCG

Summary care records - Number of patients on CPA where the summary care record has identified gaps in

health screening in the last year or the patient is not registered with a GP – SLaM

Total C-section (<26% for KCH and < 27% for GST) – Elective and non-elective caesarean sections as a

percentage of all births - Acute

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 - GSTCH

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

integrated performance report - southwark ccg · the data and information included in the...

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