north central london acute services performance and ... · training programme for template biopsies...

North Central London

Acute Services Performance and Quality Report

November 2018

Lead Director: Paul Sinden –Director of Performance,

Planning and Primary Care for NCL CCGs

Report Author, Helen Boswell (Associate Director of

Performance Management NEL CSU)

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Contents

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Section Page Number

Introduction 3

Executive Summary 4

Dashboards 8

Patient Experience 10

Never Events 14

Serious Incidents 15

Infection Control 17

Urgent and Emergency Care 19

London Ambulance Service 25

Integrated Urgent Care 26

Cancer Waiting Time 28

Referral to Treatment 32

Diagnostics 38

Appendix One ( Referral to Treatment Delivery Group) 40

Introduction

This report provides a summary of national and local performance measures and the actions being taken to deliver sustainable improvementacross the sector. The report also includes ratings from the Care Quality Commission, information on patient safety and patient experiencemeasures, delivery of NHS Constitutional Standards and service quality concerns that may result from poor service performance.

Focussing on the acute services within North Central London, performance and quality issues within the following provider organisations isdiscussed:

• North Middlesex University Hospital

• Royal Free London

• University College London Hospital

• Whittington Health

• Royal National Orthopaedic Hospital and Moorfields Foundation Trust (by exception)

• Integrated Urgent Care service (NHS 111 and GP out-of-hours) provided by London Central and West Unscheduled Care Collaborative

• London Ambulance Service.

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Executive Summary

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Key Issues

Cancer In September 2018 the NCL providers achieved aggregate performance of 74.7% against the 85% 62-day cancer waiting time operational standard. This equates to 32 breaches from target and a decline in performance from the previous month. Urology referral numbers remain high in volume and a capacity challenge; the key influence on performance in the sector.

Notably this month, North Middlesex hospital performance has improved and is a reflection of hard work by the Trust team. With a supported training programme for template biopsies from visiting clinicians this should improve performance resilience.

CCG Performance against the 2-week and 62-day GP referral cancer wait standards remains challenged, reflecting capacity constraints and pathway issues within NCL particularly, University College London Hospital and Royal Free London.

University College London Hospital Cancer Collaborative has now shared with the Trust management teams the findings of the clinical review of 22 breach reports for Head & Neck patients breaching in Quarter One 2018/19 (University College London Hospital, North Middlesex University Hospital and Royal Free London), identifying key themes.

A number of actions aimed at addressing the inconsistencies in the prostate pathway were agreed extra-ordinary meeting held on 9 November 2018. These will be taken forward by the North Central and East London Task and Finish Group and are expected include a review of the current specialist Multi - Disciplinary Team model and inter-trust referrals.

DiagnosticsAs an aggregate NCL CCGs did not meet the diagnostic standard with a performance of 98.95%. NCL providers have had a variable performance against the standard with poor performance in endoscopy, magnetic resonance imaging and echo cardiology services, particularly at University College London Hospital and Royal Free London. Improvement plans are being implemented to deliver an improved position in the next few months.

Executive Summary

5

Key Issues

Referral to TreatmentOverall, NCL CCGs have not met the national referral to treatment NHS Constitutional standard. This under-performance was primarily due the reported positions at University College London Hospital, Royal Free London and Imperial College Health Care.

NCL Referral-to-Treatment Delivery Group The NCL Referral-to-Treatment Delivery Group has been established to focus on maintaining waiting lists within March 2018 levels (as per Operating Plan) through mutual aid across NHS Trusts, implementation of STP initiatives including clinical advice and navigation, and insourcing or outsourcing capacity where mutual aid cannot provide sufficient NHS capacity. At the first meeting of the Delivery Group Trusts identified specialities where additional capacity was required and specialities where mutual aid could be offered. A summary of this is appended to the report.

Royal Free London Royal Free London have now received the new Referral to Treatment script from MBI to remove data completeness errors. However, there is a significant number of un-validated entries on this Patient Tracking List which will require manual validation. The Trust are working up the different options available based on resource limitations and the degree of statistical confidence required, which will be discussed and decided at the November Executive Board. Regardless of option picked, this process will take several months to complete. In the meantime, further work is continuing on formulating and delivering recovery plans for the most operationally challenged specialities.

University College London Hospital University College London Hospital failed to achieve the 18 Weeks Referral to Treatment target in September at 90.2%. Plans have been shared with a trajectory to meet the list size in March 2019 and the 92% RTT target in January 2019 however they gave insufficient detail to give confidence as to how the Trust will deliver this performance. The Camden commissioning team are requesting more detail on the inpatient and outpatient programmes and additional activities planned to meet the list size and improve the performance.

Executive Summary

6

Key Issues

Urgent and Emergency CarePerformance against the 4-hour A&E standard in 2018/19 has been variable with a deteriorating position in September 2018. Local A&E Delivery Boards have been charged with responsibility for delivery of system-wide plans to achieve sustained improvements.

Winter plan updates for each A&E Delivery Board were submitted to NHS England and NHS Improvement on 16 November 2018 alongside a response to key lines of enquiry (KLOEs) that will form the basis of national evaluation of our plans. Winter plans build on existing recovery plans and the KLOEs focus on key risks for workforce(addressing shortfalls in rotas), coping with sustained cold weather, and escalation plans for system pressure

In addition detailed plans covering Christmas and New Year were submitted on 20 November to provide assurance on system capacity over the Bank Holidays and in the run up to peak period of demand on emergency pathways in January;

Plans for winter 2018/19 are augmented compared to winter 2017/18 for the following:

• The roll-out of discharge to pathways in all five CCGs/Boroughs• Additional primary care hub capacity in Barnet and Enfield• Strengthened escalation processes to respond to pressure – platinum for escalation of intractable individual cases of delayed discharge

(mental health and cross-STP borders) and gold for NCL system response to pressure within an individual A&E Delivery Board• SMART – real-time access to performance and capacity in acute, mental health and community settings, plus a predictive model for

urgent and emergency care system pressure• Escalation - STP command and control and informing all A& E Delivery Boards across the STP of the pressures in the affected part of

the system• Feedback from NHS England on the winter assurances and how these gaps have been closed.

Executive Summary

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Key Issues

Patient Experience

North Middlesex University Hospital continues to have the lowest Friends and Family score in London. North Middlesex University Hospital has patient experience

improvement plans in place with progress reported to the Clinical Quality Review Group meeting monthly. The October Clinical Quality Review Group meeting

received assurance that the recommendations of the Health watch Haringey Patient Experience report are being implemented.

Never Events

There were three ‘Never Event’ incidents reported across NCL acute providers in September 2018 which met the relevant criteria. Two of these were at University

College London Hospital and there was a further never event at Royal Free London.

Royal Free London presented their updated a Never Events assurance plan for each site at October 2018 Clinical Quality Review Group. Actions arising from this

include the Trust training staff on the new Swab counting policy and Site marking policy and purchasing more equipment, for example nebulisers.

Barnet CCG (as lead commissioner), NHS England, NHS Improvement and Royal Free London Executive Team are currently considering how best to support the

Trust to deliver an improvement.

CCG Dashboard

Overall, NCL CCGs have not met the national referral to treatment NHS Constitutional standard. This measures how many patients with non-urgent conditions receive consultant-led treatment within a maximum of 18-weeks from referral. This under-performance was primarily due the reported positions at University College London Hospital, Royal Free London and Imperial College Health Care.

CCG Performance against the 2-week and 62-day GP referral cancer wait standards remains challenged, reflecting capacity constraints and pathway issues within NCL particularly, University College London Hospital and Royal Free London.

As an aggregate NCL CCGs did not meet the diagnostic standard with a performance of 98.95%. This was primarily due to performance pressures at University College London Hospital and Royal Free London. Data Source: NHS Digital via North East London Information exchange

Measure Date%Const

Standard

Referral to Treatment: 90% admitted

performance n/a 76.15% 82.12% 66.57% 74.25% 82.46% 75.53%

Referral to Treatment: 95% non-admittedn/a 88.45% 91.13% 86.44% 91.88% 92.55% 89.93%

Referral to Treatment: 92% incomplete92% 80.99% 85.46% 80.05% 89.96% 91.14% 84.69%

Cancer waits: 2 week All Cancers93% 87.00% 92.20% 86.50% 90.70% 92.20% 89.20%

Cancer waits: 2 week breast symptomatic 93% 89.80% 76.20% 85.20% 92.10% 89.70% 87.40%

Cancer waits: 31 days diagnosis to

treatment 96% 97.10% 96.90% 97.10% 98.80% 96.90% 97.40%


treatment subsequent drug treatment 98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%


treatment subsequent surgery 94% 92.90% 100.00% 100.00% 94.70% 86.70% 94.40%

Cancer waits: 31 days treatment

subsequent radiotherapy 94% 100.00% 100.00% 96.20% 96.30% 100.00% 98.40%

Cancer waits: 62 days referral to treatment85% 80.30% 81.10% 78.40% 85.40% 75.00% 80.10%

Cancer waits: 62 days referral to treatment

-referral from screening90% 100.00% 100.00% 100.00% 80.00% 100.00% 95.00%

Cancer waits 62 days upgraden/a 100.00% 100.00% 97.00% 93.80% 66.70% 94.40%

Diagnostic waits less than 6 weeks99% 98.57% 98.33% 99.42% 99.20% 99.01% 98.95%

Sep-18

NCL STPIslingtonHaringeyEnfieldBarnet Camden

Provider Dashboard

Performance against the 4-hour A&E standard in 2018/19 has been variable with a deteriorating position in September 2018. Local A&E Delivery Boards have been charged with responsibility for delivery of system-wide plans to achieve sustained improvements.

Both Royal Free London and University College London have continued to underperform against the referral to treatment standard. At the end of September 2018, the Patient Tracking List was negligibly smaller than the August 2018 position, at 3.59% above the March 2018 baseline. The Trust with the most notable increase was Royal Free London, whilst North Middlesex University Hospital was the only provider to have a smaller list in September 2018 than in March 2018.

A number of recovery actions are being implemented to improve pathways and delivery against the 62-day cancer waiting standard across NCL. University College London Hospital and Whittington Health are implementing improvement plans to deliver the six week diagnostic standard.Data Source: NHS Digital via North East London Information exchange 9

Measure Date %Const

Standard

Four-hour max wait in A&E Oct-18 99.66% 87.15% 87.54% 86.67% 88.20% 89.01%

RTT: 90% admitted performance n/a 78.32% 81.91% 58.77% 71.53% 74.96% 82.35% 71.38% 77.63%

RTT: 95% non-admitted n/a 90.80% 93.91% 94.04% 83.39% 86.79% 91.24% 91.20% 90.66%

RTT: 92% incomplete 92% 92.24% 93.86% 95.58% 88.65% 75.31% 90.21% 92.10% 85.84%

Cancer waits: 2 week All Cancers 93% 0.00% 100.00% 93.70% 96.40% 84.80% 92.99% 90.10% 88.70%

Cancer waits: 2 week breast symptomatic 93% 93.20% 88.00% 71.70% 100.00% 86.40%

Cancer waits: 31 days 1st Definitive

Treatment 96% 100.00% 91.70% 100.00% 93.30% 97.40% 93.20% 100.00% 95.70%

Cancer waits: 31 days diagnosis to treatment

subsequent drug treatment 98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% Cancer waits: 31 days diagnosis to treatment

subsequent surgery 94% 83.30% 100.00% 100.00% 98.00% 84.90% 100.00% 91.80%

Cancer waits: 31 days treatment subsequent

radiotherapy 94% 100.00% 100.00% 100.00% 96.30% 98.00%

Cancer waits: 62 days referral to treatment 85% 100.00% 100.00% 86.40% 57.90% 77.10% 65.90% 86.20% 74.70%

Cancer waits: 62 days referral to treatment -

referral from screening 90% 100.00% 95.10% 71.40% 93.30%

Cancer waits 62 days upgrade n/a 91.70% 100.00% 92.30% 83.30% 94.50% 90.60% 75.00% 92.30%

Diagnostic waits > 6 wks 99% 94.14% 100.00% 99.69% 99.78% 98.36% 98.94% 99.03% 98.69%

Sep-18

NCL

STP WhittGOSH Moorfields NMUH RNOH RFL UCLH

Patient Experience

How a patient and their family experience NHS Services is an important aspect of service quality .The key measure of patient satisfaction with provider services is the ‘Friends and Family Test’. This is an important feedback tool which supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on the services they receive.

It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the Friends and Family Test provides a mechanism to highlight both good and poor patient experience.

This kind of feedback is vital in transforming NHS services and supporting patient choice key service areas, such as ‘Inpatients’, ‘Outpatients’ and ‘A&E’. Patient experience measures can be an early indicator of wider patient quality concerns.

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Friends and Family Test

Provider Performance –A&E

North Middlesex University Hospital continues to have the lowest Friends and Family score in London. North Middlesex University Hospital has patient

experience improvement plans in place with progress reported to the Clinical Quality Review Group meeting monthly. The October Clinical Quality Review

Group meeting received assurance that the recommendations of the Healthwatch Haringey Patient Experience report are being implemented.

Whittington Health Patient Experience team continue to work with the emergency department matron on a patient experience action plan. Ongoing actions

towards improving the recommend and response rates include the implementation of an Friends and Family survey for emergency department paediatrics

that enhances accessibility for children. This will be hosted on a handheld iPad used for Friends and Family collection. The emergency department matron

has also introduced a library trolley to the Clinical Decision Unit to enhance the range of activities offered to patients in the area.11

Data Source: NHS Digital via North East London Information Exchange

KPI/Measure Providers Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

North Middlesex University Hospital NHS Trust 58.19% 65.58% 62.50% 67.39% 69.40% 66.37% 60.32% 59.77% 70.93% 69.53% 72.44% 65.56%

Royal Free London NHS Foundation Trust 84.16% 84.33% 82.70% 83.70% 82.81% 80.92% 85.20% 83.83% 84.97% 84.64% 86.33% 83.52%

Royal National Orthopaedic Hospital N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

University College London Hospital NHS Foundation Trust 84.03% 82.00% 83.10% 82.35% 83.41% 81.49% 82.61% 82.47% 80.57% 84.19% 87.21% 84.52%

Whittington Health 81.57% 83.27% 83.10% 81.86% 82.60% 76.87% 78.75% 80.38% 81.87% 83.69% 83.51% 82.82%

Moorfields Eye Hospital NHS Foundation Trust 93.42% 92.14% 96.70% 95.30% 92.81% 91.19% 92.27% 95.35% 91.70% 92.59% 95.69% 94.50%

NCL 80.06% 79.66% 77.17% 81.29% 76.80% 79.15% 82.32% 82.46% 83.29% 83.93% 86.32% 83.00%

Accident and

Emergency

Positive FFT

Responses (%)


Provider Performance – Inpatients

Royal Free London were ranked the worst performing provider in London in September 2018 for the Inpatient Friends and Family Test. Royal FreeLondon has an action plan in place, which includes follow up conversations with patients in the areas found to be of particular concern, includingpaediatrics. The action plan is being overseen by the Clinical Quality Review Group.

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Royal National Orthopaedic Hospital 94.88% 94.70% 96.35% 97.73% 94.98% 94.46% 94.93% 96.62% 97.04% 92.25% 96.31% 95.31%




NCL 95.23% 94.40% 93.68% 94.61% 94.48% 93.99% 95.28% 94.32% 94.19% 93.40% 93.60% 94.97%

Inpatient

Positive FFT

Responses (%)


Provider Performance – Outpatients

North Middlesex University Hospital has an improvement plan in place to improve patient experience in outpatient settings. This is monitored bythe Clinical Quality Review Group and includes actions, such as providing timely and accurate information about appointment times and clinicdelays.

The Patient Experience team at Whittington Health utilise support from the volunteer team to help obtain patient feedback. However, during thesummer months, there was reduced volunteer support and this has had an impact on collection of feedback and performance from inpatients.

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Royal National Orthopaedic Hospital 93.75% 95.57% 99.08% 93.29% 98.08% 97.02% 96.72% 97.12% 94.79% 97.35% 98.15% 99.58%




NCL 92.49% 92.68% 92.90% 94.16% 93.16% 93.46% 93.55% 91.92% 91.29% 91.65% 91.93% 91.83%

Outpatient

Positive FFT

Responses (%)

Never Events

Provider Performance

There were three ‘Never Event’ incidents reported across NCL acute providers in September 2018 which met the relevant criteria. The ‘Never Event’ incidents will be investigated by each of the Trust’s as per the Serious Incident procedure which includes producing a final written investigation report and associated action plan.

The Never Event incidents were reported as follows:

University College London Hospital Two Never Event incidents were reported by the Trust relating to ‘wrong site surgery’ and a ‘retained foreign object post operation’.

Royal Free London One Never Event incident was reported by the Trust relating to ‘wrong site surgery.

The Trust presented their updated a Never Events assurance plan for each site at October 2018 Clinical Quality Review Group. Actions arising from this include the Trust training staff on the new Swab counting policy and Site marking policy and purchasing more equipment, for example nebulisers.

The Group Medical Director and Group Director of Nursing meet weekly to review Never Events and implementation of the assurance plan. Barnet CCG (as lead commissioner), NHS England, NHS Improvement and Royal Free London Executive Team are currently considering how best to support the Trust.

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Serious Incidents


Across NCL, 16 serious incidences were reported in September 2018. The top two categories that incidents reported related to ‘diagnosticincident including delay’ and ‘surgical/invasive procedure’.

Clinical Quality Review Groups for each provider scrutinise and challenge on a monthly basis the serious incidents reports so that a month bymonth account takes place of trends and new incidents.

Data Source: NEL CSU Patient Safety Team

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KPI/Measure ProvidersYTD

(18/19)Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

North Middlesex University Hospital NHS Trust 37 10 8 5 9 3 14 4 12 9 3 4 7 2

Royal Free London NHS Foundation Trust 51 5 8 7 10 9 8 10 11 11 8 10 6 5

Royal National Orthopaedic Hospital 7 0 1 5 0 0 0 1 4 1 0 1 1 0

University College London Hospital NHS Foundation Trust 21 1 2 2 1 8 2 1 2 2 4 5 2 6

Whittington Health 19 2 5 2 0 7 1 2 4 8 3 1 1 2

Moorfields Eye Hospital NHS Foundation Trust 3 0 0 1 0 3 0 0 0 1 0 2 0 0

London Central & West Unscheduled Care Collaborative 2 1 0 0 0 0 0 0 0 0 0 1 0 1

North Central London 140 15 17 17 19 12 22 15 33 32 18 24 17 16

Serious Incident

Opened In Month

Serious Incidents


North Middlesex University HospitalNorth Middlesex University Hospital reported two Serious Incidents in September 2018. Both incidents were reported within the Diagnostics category. Good progress is being made with reducing the number of investigations overdue for submission. At the end of September 2018 there were 16 reports overdue. Haringey CCG and North Middlesex University Hospital meet regularly to review the Trust’s progress with managing the Serious Incidents process. The Trust has programme of learning events in train for the rest of the year. Commissioners have been invited to attend learning events.

Whittington HealthIn order to ensure learning is shared widely across the organisation, a dedicated site has been created on the Whittington Health intranet detailing a range of patient safety case studies. Whittington Health also run a series of multi-disciplinary learning workshops throughout the year to share the learning from serious incidents and complaints, and learning is disseminated through ‘Spotlight on Safety’, the organisation wide patient safety newsletter. Themes from serious incidents are captured in quarterly learning reports and an annual review, outlining areas of good practice and areas for improvement and organisation wide learning.

Royal Free LondonIn September 2018, Royal Free London reported five Serious Incidents, including one surgical and one suboptimal care of the deteriorating patient. There were also 18 overdue serious incident reports at the end of the month and six open further information requests. A root cause analysis is conducted for all serious incidents. Reports are presented at Clinical Quality Review Group. Incident investigations take at least 60 days to be completed. The overdue status of reports is being monitored weekly by Royal Free London Executive Committee. Additional resource has been obtained by the Trust in order to help reduce the backlog of overdue reports.

London Central West Unscheduled Care Collaborative The serious incident reported in September 2018 has been investigated by London Central West and the report in pending final internal governance sign off. Learning will be shared with London Central West staff and NHS Pathways. 16

Infection Control

Provider Performance Year to Date 2018/19

Data Source NEL CSU Patient Safety Team

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Infection Control/Trust

Year to Date September 2018

North Middlesex

University

Hospital NHS

Trust

Royal Free

London NHS

Foundation Trust

Royal National

Orthopaedic

Hospital

University

College London

Hospital NHS

Foundation Trust

Whittington

Health

Moorfields Eye

Hospital NHS

Foundation Trust

North Central

London

Clostridium difficile 19 35 1 35 6 0 96

Escherichia Coli Bacteraemia (E. coli)128 249 4 170 64 0 615

Meticillin Resistant Staphylococcus

Aureus (MRSA) Bacteraemia0 2 0 0 1 0 3

NCL CCGs remain around the national average for attributed Methicillin-resistant Staphylococcus Aureus bacteraemia (MRSA). The target for allproviders is zero cases. Before April 2018 all MRSA bloodstreaminfection surveillance cases underwent a formal post-infection review.

From April 2018, NHS Improvement has modified this requirement so that formal reviews must only be undertaken for organisations with thehighest rates of infection (excluding specialist trusts). This change has been made to refocus trusts and CCGs to concentrate more on infectionprevention. NCL CCGs do not currently fall within the high MRSA rate threshold. However, all MRSA bloodstream Infection surveillance cases willstill be subject to robust clinical review and reporting.

Overall, there is evidence of an increase in the number of Clostridium Difficile infection cases that are community attributable for NCL CCGs.However, it should be noted that Root Cause Analyses on non-trust apportioned cases are not undertaken by NEL Infection Control Preventionteam, and therefore other available information sources, for example antibiotic usage and antimicrobial stewardship should be considered formonitoring and assurance purposes by the CCGs.

Infection Control


North Middlesex University HospitalGeneral medical admissions to the stroke unit were temporarily affected by a case of Carbapenemase producing Enterobacteriaceae(CPE) in May 2018. In response to the outbreak the Trust reported an extensive programme of deep cleaning and additional training for staff. Following four weeks without transmission the outbreak was declared over on 3 August 2018. In response to the identification of additional incidences of CPE, there were further temporary bed closures. To date all cases were due to colonisation; no incidences of infection have been reported.

North Middlesex University Hospital undertook a Point Prevalence Survey during July 2018. The survey noted a small number of previously unknown colonisations which resulted in some additional bed closures. There have been 19 cases of Clostridium Difficile infection reported during 2018/19 against a trajectory of 33.

The 2018/9 Flu vaccination campaign has commenced. At the end of week one over 400 staff had been vaccinated.

Royal National Orthopaedic HospitalGram-negative bacteria such as Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa are the leading causes of healthcare associated bloodstream infections. Gram-negative bacteria can be resistant to antibiotics and in some cases will be multi-resistant rendering most available antibiotics useless. There were two cases of unrelated gram negative bacteraemia infections in August 2018

.

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Urgent & Emergency Care

The operational standard for A&E waiting times is that 95% of patients should be admitted, transferred or discharged within 4 hours of theirarrival at an A&E department.

The 12 hour standard refers to patients waiting to be admitted for an Emergency Admission via A & E from decision to admit to admission ortransfer.

The delivery of these standards is dependant on system wide approach with local acute trusts and CCGs leading A&E Delivery Boards workingwith community and mental health trusts, local authorities, ambulance services and other local partner organisations to develop and implementsystem improvement plans.

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A&E Performance

Provider Performance Throughout 2018/19, provider performance has fluctuated, however sector-wide performance showed a slight improvement to 89% in October 2018

All Trusts have had exceptional days of both highand low performance and are working with systempartners through the A&E Delivery Boards to deliversustained improvement.

Local A&E Delivery Boards have been charged withresponsibility for delivery of system-wide plans tosupport provider A&E departments in the delivery ofimprovement trajectories. The NCL Urgent andEmergency Care Board is co-ordinating thedevelopment and delvery of an NCL wide winterplan.

The plan includes actions to improve patient flow byreducing extended lengths of stay, developingambulatory emergency care services, eliminatingbreaches for patients requiring type four and fivelevels of care (minor patients), improvingambulance handovers and implementing effectivedemand management schemes.

Data Source: NHS Digital via North East London Information exchange

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A&E Performance

NCL Winter Plan

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Winter plan updates for each A&E Delivery Board were submitted to NHS England and NHS Improvement on 16 November 2018 alongside a response to key lines of enquiry (KLOEs) that will form the basis of national evaluation of our plans. Winter plans build on existing recovery plans and the KLOEs focus on key risks for workforce(addressing shortfalls in rotas), coping with sustained cold weather, and escalation plans for system pressure

In addition detailed plans covering Christmas and New Year were submitted on 20 November to provide assurance on system capacity over the Bank Holidays and in the run up to peak period of demand on emergency pathways in January. Plans for winter 2018/19 are augmented compared to winter 2017/18 for the following:

• The roll-out of discharge to pathways in all five CCGs/Boroughs

• Additional primary care hub capacity in Barnet and Enfield

• Strengthened escalation processes to respond to pressure – platinum for escalation of intractable individual cases of delayed discharge (mental health and cross-STP borders) and gold for NCL system response to pressure within an individual A&E Delivery Board

• SMART – real-time access to performance and capacity in acute, mental health and community settings, plus a predictive model for urgent and emergency care system pressure

• Escalation - STP command and control and informing all A&E Delivery Boards cross the STP of the pressures in the affected part of the system

• Feedback from NHS England on the winter assurances and how these gaps have been closed.

A&E Performance


University College LondonA&E performance remained low in October at 86.7%. There have been positive signs of improvement with performance on some days reaching over 90%; however the performance fluctuations continue to cause concern with performance on some days as low as 75.97%. There were however, no breaches of the 12 hour decision to admit target.

The current problems reported by the Trust relate to department congestion caused by poor flow to get patients into beds in the tower; this impacts the A&E department with backlog and loss of function within the department. Additionally staff shortages in the department and the tower contribute to delays.

Recent reported availability of mental health beds appears to have improved and delayed patients have been mentioned less often.

NHS England and NHS Improvement placed University College London Hospital Urgent and Emergency care in escalation in August 2018 with remedial actions by Trust and CCG in a shared system improvement plan. GE Healthcare have been commissioned to provide a capacity and demand analysis to identify constraints. An operational group to review and advance the actions within the plan has been formed and will report to the A&E delivery board.

Further work is required to gain assurance on the whole system improvement with a common plan, appropriate staffing, support from specialty, early discharge planning, streaming and utilisation of the services and system partners will be key to achieving a sustainable 4hr performance.

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A&E PerformanceProvider Performance

North MiddlesexIn October 2018, performance at North Middlesex University Hospital remained below the national standard and the local improvement trajectoryof 90%. Operational flow remained challenged, due to crowding in the fit-to-sit/treat zone, infection control issues putting pressure on side roomsand bed flow and staff vacancies. The focus of the Safer, Faster, Better work-streams remains on:

• Reducing avoidable breaches in the Emergency Department• Frailty, by developing and embedding a North Middlesex University Hospital frailty model that optimises care of frail elderly people• Increasing the number of patients accessing ambulatory care pathways.• Reducing stranded patients and working with the wider local health and care system to enable earlier discharges

A rebuild of the Emergency Department has started (November 2018), expected to be complete by 24 December 2018. Whilst the work isunderway this will result in loss of escalation space and will put pressure on the rest of the Trust to have no ‘decision to admit’ patients waiting. TheTrust anticipates performance to drop by 2% below the trajectory and bed flow will be key in maintaining expected levels of performance.

Whittington HealthPublished performance against the four hour A&E target at Whittington Health was 88.20% in October 2018. The performance recovery plan, which is managed by the local A&E delivery board is focussing on the following areas:

• Workforce challenges – recruitment and rostering with the aim of increasing the numbers of senior clinical decision makers available at key times

• Emergency Department streaming and redirection – increased use of primary care, frailty pathways and ambulatory emergency care and increased throughput in Clinical Decision Unit

• Admission Avoidance – both community based and in hospital• Improving pathways and outcomes for mental health patients 23

A&E Performance


Royal Free London Royal Free London missed the locally agreed A&E trajectory by margins in October 2018 with performance of 87.54% against the local standard of 88.5%. A&E performance was continue to be challenging at Barnet hospital as bed occupancy and delayed discharges remain higher than the standard threshold of 95% and 3.5% respectively. Staff capacity is a recurring theme in the Trust A&E exception reports.

Royal Free London is focusing on key priorities for winter this year, which include:

• Reducing the number of long stay patients (patient with length of stay over 21 days) by 27% in December 2018. • Reducing minor breaches to zero• Improving patient streaming from A&E to Urgent Care Centre, currently at 25% but plan to improve to 40% (locally agreed target)• Achieving ambulance 30 minute handover waiting time to 100%• Improving ambulatory care pathway • Improving workforce capacity• Improving Staff Flu vaccination compliance to 100%.

Royal Free London have included workforce in their respective Urgent and Emergency Care recovery & transformation plans. Trust is looking ways to re-design workforce model to fill existing medical and nursing vacancies.

The Royal Free A&E Delivery Board has been analysing the increasing volume in attendances at each site by CCG, GP Practice and age as well as exploring the demand for other urgent care services such as integrated urgent care, extended primary care, walk in centres, and LAS See and Treat and Rapid Response.

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London Ambulance Service

Data Source: LAS Performance Report September 2018 and NHS Digital National Reports

25

CCG Performance

Performance of the Ambulance Response Programme in North Central London has been challenging since its introduction. In September 2018 in North Central London three standards were not met compared with London performance of two noncompliant standards. There are also variable degrees of compliance within NCL. In September 2018 Barnet and Enfield only achieved two of the standards. Year to date Enfield has only achieved one standard and Barnet and Haringey achieved two standards, conversely Camden and Islington have consistently met three standards.Actions to deliver improvement include, using See and Treat and Hear and Treat for more patients (currently 27%), and reconfiguring the fleet to provide an additional 32 double crewed ambulances. These are required for Category Two incidents and half of these are being procured in 2018/19.

Integrated Urgent Care

Performance Dashboard

Data Source: London Central West Unscheduled Care Collaborative Reports

Please note: The Key Performance Indicators highlighted in grey are included for reference but not currently monitored in the contract. 26

Oct-18Qtr 3

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18

NCL-IUC NCL-IUC NCL-IUC NCL-IUC NCL-IUC NCL-IUC NCL-IUC

Engaged calls Performance Total number of calls engaged ≤0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Abandoned calls Performance Total number of calls abandoned <5% 2.4% 2.0% 2.3% 2.6% 2.7% 2.6% 2.9%

Answer Time Performance No of calls answered within 30 seconds ≥95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Average waiting time Performance Average of calls answered within 60 seconds <00:01:00 00:00:37 00:00:33 00:00:34 00:00:41 00:00:37 00:00:38 00:00:40

Call waiting time Performance No of calls answered within 60 seconds≥85% *Part of

Roadmap 85.8% 88.5% 88.4% 85.0% 86.1% 85.1% 85.3%

Life threatening referrals Performance

No of calls referred to Ambulance Service within 3

minutes which are life threatening (post automated

dispatch process fix only)

100%

100.0% 100.0% 100.0% 100.0% 100.0% 85.1% 100.0%

Meeting individuals needs QualityProvision of interpretation service/appropriate provision

where required within 15 minutes of initial contact.100%

100.0% 100.0% 100.0% 100.0% 100.0% 85.1% 100.0%

Safeguarding Quality

Frontline staff and advisors training in recognition of

safeguarding issues for adults and children to an

appropriate level

100%

100.0% 100.0% 100.0% 100.0% 100.0% 85.1% 100.0%

Triage rate Quality Percentage of answered calls triaged TBA 98.5% 97.9% 99.5% 98.8% 99.1% 85.1% 99.8%

Transfer to 999 Performance Percentage of answered calls transferred to 999 TBA 11.5% 11.5% 11.6% 10.7% 10.7% 85.1% 12.7%

Attend Accident & Emergency Department PerformancePercentage of patients advised to attend Accident &

Emergency DepartmentTBA

11.0% 12.0% 11.9% 12.9% 12.3% 85.1% 12.5%

Referred to Primary Care and other dispositionsPerformancePercentage of patients to primary care and other

dispositions with analysis to disposition levels.TBA

56.5% 53.9% 53.4% 53.2% 55.5% 85.1% 54.5%

Warm Transfers PerformanceWarm Transferred to IUC service Clinician where

required98%

83.5% 78.7% 76.0% 65.1% 66.0% 85.1% 70.7%

Time taken for call back Performance Time taken for call back <10 minutes 100% 50.6% 45.8% 34.6% 39.9% 49.3% 85.1% 48.8%

Notifications Quality

Provision of all consultations (including appropriate

clinical information) to the practice the patient is

registered with by 8am the next working day.

100%

100.0% 100.0% 100.0% 100.0% 100.0% 85.1% 100.0%

Patient Education Quality

Percentage of frequent users (who call 111 more than

4 times a month) whose use is immediately highlighted

to their registered GP

100%

100.0% 100.0% 100.0% 100.0% 100.0% 85.1% 100.0%

Quality and Performance

IndicatorsKPI Type

Qrt 1 Qrt 2Indicator Descriptions Target

Integrated Urgent Care

Performance and Quality Update

27

London Central West Unscheduled Care Collaborative is meeting all of the agreed national and local key performance indicators. The Key Performance Indicators highlighted in grey are included for reference but not monitored in the contract. Performance of ‘Time taken for call back’ and ‘Warm transfers’ had been deteriorating since April 2018 but showed a slight upturn in the last 2 months.

The gap analysis of the national service specification and revised national KPIs is ongoing with the provider and commissioner working collaboratively. The provider will commence reporting against the new KPIs once the proposed contract variation is agreed.

Commissioners and London Central West have agreed a revised suite of quality indicators for monthly reporting; the template is currently being reviewed by the provider business intelligence team to commence reporting as soon as possible.

Cancer Waiting Times

There are eight NHS Constitutional targets for Cancer waiting times. These are based on the principles that all patients should receive high-quality care without any unnecessary delay and that patients can expect to be treated at the right time and according to their clinical priority.

The delivery of the standards is dependant upon partnership working by acute trusts across North Central London and North East London. This is because Trusts provide different elements of the care pathways depending upon their specialist expertise and diagnostic service provision.

The North Central London Performance Leadership Group represents acute trusts, CCGs across North London and the University College London Hospital Cancer Collaborative and is the leading the actions required to improve performance with cancer access services.

28


In September 2018 the NCL providers achieved aggregate performance of 74.7% against the 85% 62-day cancer waiting time operational standard. This equates to 32 breaches from target and a decline in performance from the previous month.

Urology referral numbers remain high in volume and a capacity challenge; the key influence on performance in the sector.

Notably this month, North Middlesex hospital performance has improved and is a reflection of hard work by the Trust team. With a supported training programme for template biopsies from visiting clinicians this should improve performance resilience.

29

CCG and Provider Performance

Data Source: Transforming Cancer Services Team Reports

Data Source: Transforming Cancer Services Team Reports

Cancer Waiting Times - Summary Position (Provider)

All

Cancers

Symptomatic

Breast

Patients

1st Treat2nd/Sub

(Surgery)

2nd/Sub

(Chemo)2nd/Sub (RT)

Urgent

ReferralScreening

Cons

Upgrade

Operational Standard 93% 93% 96% 94% 98% 94% 85% 90% N/A

GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST #DIV/0! 100.0 83.3 100.0 #DIV/0! 100.0 #DIV/0! 91.7

MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST 100.0 #DIV/0! 91.7 100.0 #DIV/0! 100.0 #DIV/0! #DIV/0! 100.0

NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 93.7 93.2 100.0 100.0 100.0 100.0 86.4 100.0 92.3

ROYAL FREE LONDON NHS FOUNDATION TRUST 84.8 88.0 97.4 98.0 100.0 100.0 77.1 95.1 94.5

ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST 96.4 #DIV/0! 93.3 #DIV/0! #DIV/0! #DIV/0! 57.9 #DIV/0! 83.3

UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 93.0 71.7 93.2 84.9 100.0 96.3 65.9 71.4 90.6

THE WHITTINGTON HOSPITAL NHS TRUST 90.1 100.0 100.0 100.0 100.0 #DIV/0! 86.2 #DIV/0! 75.0

North Central London 88.7 86.4 95.7 91.8 100.0 98.0 74.7 93.3 #DIV/0!

Two-Week Wait 31-Day Wait 62-Day Wait


Breach Analysis

.

30

Patients on a prostate cancer pathway accounted for approximately half of all breaches in September 2018, followed by skin, breast, lowergastro Intestinal and head and neck as shown in table below with number of breaches are noted in brackets.

Of the 79.5 reported breaches, close to 50% related to shared pathways between two or more providers, principally on the prostatepathway and attributable to delays in diagnosis and a shortfall in treatment capacity. Other reasons for delays include;

• Patient choice• Complexity• Administrative delays

Capacity constraints with breast and lower Gastro intestinal services have also adversely impacted on two-week wait performance.

Top

5 b

reac

h p

ath

wa

ys

July 2018 August 2018 September 2018

Urology (32.5) Urology (38) Urology (36)

Lower GI (12.5) Upper GI (6.5) Skin (9)

Breast (6) Lower GI (6.5) Breast (6.5)

Upper GI (5.5) Head & Neck (4.5) Lower GI (5)

Lung (4.5) Haematology (3.5)Lung (3.5)

Head & Neck (4.5)


Progress update & actions

31

Progress has been made in following areas in recent weeks:

• Further improvements have been made to the lower gastro intestinal straight to test pathway resulting in further reductions in long waiters and backlogs

• Template biopsy training for North Middlesex University Hospital has progressed well and is due to be completed at the end of November 2018. This increases prostate biopsy capacity across the STP.

• Backlog levels continue to reduce due to improving management processes• The North Central and East London Task and Finish Group to oversee performance recovery has been established since late October 2018. • The new breast unit (and the new equipment) at Royal Free London has increased system capacity.

University College London Hospital Cancer Collaborative has now shared with the Trust management teams the findings of the clinical review of 22 breach reports for Head & Neck patients breaching in Quarter One 2018/19 (University College London Hospital, North Middlesex University Hospital and Royal Free London), identifying key themes.

A number of actions aimed at addressing the inconsistencies in the prostate pathway were agreed extra-ordinary meeting held on 9 November 2018. These will be taken forward by the North Central and East London Task and Finish Group and are expected include a review of the current specialist Multi - Disciplinary Team model and inter-trust referrals.

The STP has been awarded £130K by NHS England to fund additional prostate cancer-related diagnostic and treatment capacity and accelerate performance recovery, in recognition of the unexpected surge in referrals earlier in the year.

System-wide and provider level plans continue to monitored closely on an ongoing basis including a refresh of key performance metrics to predict performance and recovery trajectories.

Referral to Treatment

CCG & Provider Performance



This constitutional standard reflects the right of patients to be seen and start any consultant-led treatment within a maximum of 18 weeks from referral for non-urgent condition.

32

There continue to be challenges for NCL CCGs with meeting the 18 week referral to treatment standard. This under-performance was primarily due the reported positions at University College London Hospital and Royal Free London.

Commissioners are reviewing referral to treatment performance, the size and shape of the waiting lists and the proactive management of long waiting patients by provider and CCG at speciality level each month.

This analysis will support the development of an NCL Elective Care plan.

CCG Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-182018-19

YTD

Standard 92% 92% 92% 92% 92% 92% 92% 92%

NHS BARNET CCG 85.22% 85.60% 85.43% 83.93% 84.26% 82.41% 80.99% 83.75%

NHS CAMDEN CCG 90.17% 89.95% 89.60% 88.73% 88.23% 86.71% 85.46% 88.09%

NHS ENFIELD CCG 83.87% 84.02% 83.95% 81.98% 83.31% 82.07% 80.05% 82.58%

NHS HARINGEY CCG 90.90% 90.83% 91.37% 90.76% 90.93% 90.53% 89.96% 90.73%

NHS ISLINGTON CCG 91.81% 91.99% 92.47% 92.16% 91.95% 91.42% 91.14% 91.86%

NCL Aggregate 87.76% 87.88% 87.88% 86.70% 87.11% 85.87% 84.69% 86.69%


Performance at Speciality Level

The specialties that achieved the standard in September 2018 were general medicine, geriatric medicine and ophthalmology.

Across NCL, there continues to be increases in waiting lists for all specialties except Ear, Nose and Throat, and ‘other’.

There was a notable reduction in ‘other’ compared to July 2018, but this is still higher than the March 2018 baseline. The decrease in other relates mostly to University College London Hospital.

Data Source: NHS Digital via North East London Information exchange 33


CCG Waiting Lists


34

As at the end of September 2018, the Patient Tracking List was negligibly smaller than the August 2018 position, at 3.59% above the March 2018 baseline. The Trust with the most notable waiting list increase was Royal Free London, whilst North Middlesex University Hospital was the only provider to have a smaller waiting list in September 2018 than in March 2018. Associate Providers are also contributing to the overall growth in PTL, particularly Great Ormond Street Hospital, BMI (London Independent Hospital), BMI (Cavell) and BMI (Hendon).

Performance has been declining at NCL level, taking into account the core NCL providers and associate provers. UCLH and RFL are not achieving the standard, whilst NMUH and WH are achieving the standard.


Patients Waiting more than 52 weeks


For NCL CCGs there was further increase in 52 week waiters, from 41 in August to 55 in September 2018; this is higher than the March 2018 baseline of 43. Barnet CCG (17) and Enfield CCG (21) had the highest number of 52+ week waiters in September 2018 . This is a particularly significant increase for Enfield CCG, where it increased from 11 in August 2018 to 21 in September 2018.

For Trusts the number of 52 week waiters has increased from 60 in August 2018 to 62 in September 2018. Of these, 53 were at Royal Free London and the rest spread evenly over NCL Providers and Associate Providers.

35


NCL STP

NCL Referral-to-Treatment Delivery Group The NCL Referral-to-Treatment Delivery Group has been established to focus on maintaining waiting lists within March 2018 levels (as per Operating Plan) through mutual aid across NHS Trusts, implementation of STP initiatives including clinical advice and navigation, and insourcing or outsourcing capacity where mutual aid cannot provide sufficient NHS capacity.

At the first meeting of the Delivery Group Trusts identified specialities where additional capacity was required and specialities where mutual aid could be offered. A summary of this is appended to the report.

Royal Free London Royal Free London have now received the new Referral to Treatment script from MBI to remove data completeness errors. However, there is a significant number of un-validated entries on this Patient Tracking List which will require manual validation. The Trust are working up the different options available based on resource limitations and the degree of statistical confidence required, which will be discussed and decided at the November Executive Board. Regardless of option picked, this process will take several months to complete. In the meantime, further work is continuing on formulating and delivering recovery plans for the most operationally challenged specialities.

University College London HospitalUniversity College London Hospital failed to achieve the 18 Weeks Referral to Treatment target in September at 90.2%. The waiting list size has continued to grow from the 17/18 closing position with an in month increase of 802 patients. Positive progress has been made in clearing the backlog of patients that have been waiting longest with no patients waiting beyond the 52 Week standard in September 2018.Plans have been shared with a trajectory to meet the list size in March 2019 and the 92% Referral to treatment target in January 2019 however they gave insufficient detail to give confidence as to how the Trust will deliver this performance. The Camden CCG commissioning team are requesting more detail on the inpatient and outpatient programmes and additional activities planned to meet the list size and improve the performance. With performance below the required standard since July 2017, a missed trajectory for compliance by Quarter Two and a revised plan to meet the target by January 2019, fuller assurance is needed. 36


University College London

University College London Hospital failed to achieve the 18 Weeks Referral to Treatment target in September at 90.2%. The waiting list size has continued to grow from the 17/18 closing position with an in month increase of 802 patients. Positive progress has been made in clearing the backlog of patients that have been waiting longest with no patients waiting beyond the 52 Week standard in September.

Plans have been shared with a trajectory to meet the list size in March 2019 and the 92% RTT target in January 2019 however they gave insufficient detail to give confidence as to how the Trust will deliver this performance. The Camden commissioning team are requesting more detail on the inpatient and outpatient programmes and additional activities planned to meet the list size and improve the performance.

With performance below the required standard since July 2017, a missed trajectory for compliance by Q2 and a revised plan to meet the target by January 2019, fuller assurance is needed.

University College London Hospital

University College London Hospital failed to achieve the 18 Weeks Referral to Treatment target in September at 90.2%. The waiting list size has continued to grow from the 17/18 closing position with an in month increase of 802 patients. Positive progress has been made in clearing the backlog of patients that have been waiting longest with no patients waiting beyond the 52 Week standard in September.

Plans have been shared with a trajectory to meet the list size in March 2019 and the 92% RTT target in January 2019 however they gave insufficient detail to give confidence as to how the Trust will deliver this performance. The Camden commissioning team are requesting more detail on the inpatient and outpatient programmes and additional activities planned to meet the list size and improve the performance.

With performance below the required standard since July 2017, a missed trajectory for compliance by Q2 and a revised plan to meet the target by January 2019, fuller assurance is needed.

37

Diagnostics

CCG Performance

The 6-week timeframe for the diagnostic standard is from when the request for a diagnostic test or procedure is made, to when the patient receives the diagnostic test/procedure. The constitutional standard does not include the time it takes for the diagnostic report to be prepared and sent to the referrer. Trusts will have operational standards to ensure that diagnostic reports are provided in a timely manner particularly for cancer patients. As an aggregate NCL CCGs did not meet the diagnostic standard with a performance of 98.95%. Enfield, Haringey and Islington CCGs were compliant with the standard.


38

CCG Diagnostic

Performance

Constitutional

StandardSep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

Barnet CCG 99% 98.84% 98.70% 99.50% 99.16% 99.40% 99.40% 99.42% 99.37% 99.46% 99.47% 99.38% 98.97% 98.57%

Camden CCG 99% 98.03% 98.79% 98.90% 99.16% 99.11% 99.22% 99.43% 99.19% 99.37% 99.15% 99.00% 98.46% 98.33%

Enfield CCG 99% 99.50% 99.37% 99.60% 99.48% 99.67% 99.63% 99.41% 99.22% 99.27% 99.28% 99.47% 99.54% 99.42%

Haringey CCG 99% 99.15% 99.30% 99.60% 99.41% 99.41% 99.44% 99.09% 99.08% 99.01% 99.10% 99.43% 98.72% 99.20%

Islington CCG 99% 99.14% 99.17% 99.50% 99.11% 99.26% 99.43% 99.30% 99.26% 99.29% 98.96% 98.95% 98.78% 99.01%

NCL STP (above CCGs) 99% 99.00% 99.15% 99.46% 99.28% 99.41% 99.44% 99.34% 99.23% 99.28% 99.21% 99.27% 98.95% 98.95%

39

Diagnostics


University College London HospitalUniversity College London Hospital missed the target by a small margin (0.1%) and improved on previous months’ performance. The trust has been increasing diagnostic capacity, particularly in MRI, and expects to return to compliance in by November 2018.Royal Free LondonRoyal Free London did not achieve the diagnostics standard in September 2018 with 98.36% of patients having a diagnostic test within 6 weeks of referral. This is due to staff shortages in echo cardiology and endoscopy services. The Trust is exploring options for further outsourcing for both services.

Provider Performance Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

ROYAL FREE LONDON NHS

FOUNDATION TRUST98.44% 98.48% 99.13% 98.96% 99.34% 99.43% 99.59% 99.49% 99.70% 99.75% 99.60% 99.02% 98.36%

UNIVERSITY COLLEGE

LONDON HOSPITALS NHS

FOUNDATION TRUST

99.14% 99.17% 99.24% 99.24% 99.06% 99.37% 98.14% 98.20% 98.17% 97.67% 98.35% 98.78% 98.94%

WHITTINGTON HEALTH NHS

TRUST99.10% 99.11% 99.24% 99.07% 98.99% 99.12% 99.22% 99.09% 99.04% 99.05% 99.10% 98.68% 99.03%

NORTH MIDDLESEX

UNIVERSITY HOSPITAL NHS

TRUST

99.35% 99.39% 99.75% 99.77% 99.41% 99.24% 98.35% 98.25% 98.41% 98.66% 99.25% 99.31% 99.69%

ROYAL NATIONAL

ORTHOPAEDIC HOSPITAL NHS

TRUST

99.71% 99.31% 99.82% 99.74% 99.63% 99.50% 99.90% 99.60% 99.57% 98.75% 99.69% 99.79% 99.78%

NCL STP (above providers) 98.88% 98.86% 99.29% 99.18% 99.26% 99.36% 99.12% 98.98% 99.07% 98.88% 99.20% 98.65% 98.69%

NCL RTT Delivery Group – Notes and actions from meeting held 15 November 2018

41

Notes Action

Latest monthly NCL RTT pack to be distributed to the Group Paul Sinden

Updated terms of reference to be distributed to the group for comment and sign-off (see below) Paul Sinden

Capacity summary by speciality to be distributed to the Group. Analysis supported by Trust intelligence and median waits by specialty in RTT reports

Paul Sinden

Redefine pathways coded “Other” to Specialties where possible Provider reps

Contact NHSE and NHSI about access to insourcing procurement framework Paul Sinden

Scope capacity surplus and deficits by specialty to support mutual aid across NCL providers Provider reps

Link to Cancer Alliance recovery plan – prostate, lower GI breaches, and service changes for straight-to-test pathways, lower thresholds for prostate referrals (demand up), introduction of qFIT for bowel cancer diagnosis

All

NCL Referral to Treatment Delivery Group – Draft Terms of Reference

Development of an agreed plan for North Central London (NCL) to deliver the national operating plan requirement to ensure waiting lists (patient tracking lists) in 2018/19 are within March 2018 levels across NCL.

The Delivery Group will support delivery of the operating plan requirement by building on existing workstreams within NCL:• The planned care workstream interventions developed within NCL Sustainability and Transformation Plan;• Individual Trust plans for elective services including recovery plans where required;• A&E Delivery Board Winter Plans for 2018/19.

The Delivery Group will build on these existing plans by:• Identifying opportunities for mutual aid across providers;• Locally managing the application of capacity alerts within NCL;• Ensuring service developments are cost effective for the system and individual organisations;• Ensuring plans represent value for money and maximise the use of local NHS resources and capacity;• Identification of repatriation opportunities where capacity exists;• Agreeing the impact of STP interventions on patient tracking lists including clinical advice and navigation and changes to cancer pathways; • Agreeing referral trend analysis to apply to patient tracking list projections;• Agreeing collective NCL response to plans and trajectories requested by regulators (NHS England / NHS Improvement);• Ensuring all of the above is carried out in the best interest of patients (this may include changing pathways at source (referral) rather than mid-

pathway).

The Delivery Group will report into the STP Directors of Finance Group for any contract items.

Membership of the Delivery Group will include representatives from:• Providers of (material levels) of elective care;• Planned Care Workstream from NCL STP;• CCG representatives;• Clinical engagement for any changes to clinical pathways will be sourced by participants and/or through any short life task and finish groups

established

The Delivery Group will be Co-Chaired by a Provider and CCG representative and meet once per month. Supporting short life task and finish groups may be formed to work on priorities identified by the Delivery Group.

Future of the Delivery Group to be considered in quarter four 2018/19 in light of operating plan requirements and extent terms of reference for the group can be embedded elsewhere in planned care Workstream governance structure

42

Provider capacity summary for mutual aid / capacity alerts

43

T&O Pain Dermatology

Gynaecology

Urology Gastroenterology

ENT GeneralSurgery

Ophthalmology

Other

MEH Capacity for mutual aid

NMUH Deficit (hand surgery)

Capacity for mutual aid

via Concordia contract


Deficit due to clinical

capacity

RFL Chase Farm physical

capacity (not staff)

eves/Fridays/Weekend

Deficit in capacity

Deficit in capacity

Deficit in capacity

Deficit in capacity

UCLH Deficit in capacity

Deficit in capacity

Deficit (increase in

referrals for non-

admittedpathways

/MESH capacity)

Deficit in capacity

(juniordoctor

capacity)

Deficit in capacity (GI)

Deficit with neuro

(spinal) and dental

(restorative)

WH Deficit in capacity

including spines

Deficit in capacity

Capacity for mutual aid?

Watchingbrief on

endoscopy capacity

Recovery plan in place

(supported by UCLH)


Recoveryplans for

thoracic and rheumatolog

y

north central london acute services performance and ... · training programme for template biopsies...

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