ENC C(i) - CCG Performance Summary Report M3

ENC Ci
Variance Against CCG
Performance Priorities and NHS
Constitution Standards
Month 3, 2014/15
Governing Body
11 September 2014
Background and Contents
•
This document is a highlight report, which is written to provide the IG&P with an overview of current CCG and
provider performance across a range of priority national and local standards. The highlight report focuses on
areas of performance variance and covers Q1 2013/14 up to June/July 2014; the period for which we have the
most recent validated data.
•
The report covers the ‘Big 8’ performance areas that have been identified by NHS England as performance
standards that are significant performance concerns nationally and in London. Other standards that have a
significant impact on quality, safety and patient experience are also included.
CCG Performance Highlight Report Contents
The Big 8 performance standards
1. Urgent care
2. Cancer waiting times
3. Referral-to-Treatment
4. Diagnostic waiting times
5. IAPT
6. Winterbourne view
7. Dementia
8. Health visiting
Other performance areas
1. Serious Incidents & Never Events
2. Healthcare acquired infections (MRSA and clostridium difficile)
3. Friends & Family
2
THE BIG 8
3
Urgent Care Performance – A&E Waits
A&E waits all types (target 95%) - % of patients who spent 4 hours or less in A&E before treatment or admission
KCH (Trust
wide)
Q3
Jan
Feb
Mar
Q4
Apr
May
Jun
Q1
Jul
89.4
87.6
87.3
87.5
87.5
87.4
89.4
89.9
89.0
91.0
92.0
93.3
93.1
92.9
92.6
97.1
97.0
96.4
96.8
96.2
KCH (Den Hill)
95.0
94.2
93.3
93.95
92.2
93.1
GSTT
95.7
96.8
96.9
96.8
96.2
96.7
2014/15
Q2
A&E waits type 1 (target 95%) - % of patients who spent 4 hours or less in A&E before treatment or admission
KCH (Trust
wide)
Q3
Jan
Feb
86.1
83.3
Mar
Q4
Apr
May
Jun
Q1
Jul
82.4
82.9
82.8
85.6
86.2
85.0
87.5
90.7
92.1
91.8
91.5
91.2
96.2
96.2
95.2
95.8
94.95
KCH (Den Hill)
94.1
93.07
91.9
92.7
91.7
GSTT
94.4
95.8
96.0
95.8
95.7
2014/15
Q2
4
Urgent Care Performance – Local Weekly Performance
Weekly A&E waits all types (target 95%) - % of patients who spent 4 hours or less in A&E before treatment or admission
20/7/14
27/7/14
3/8/14
10/8/14
17/8/14
Est to meet
target in
Q2
KCH (Trust wide)
89.2
92.0
92.6
92.7
91.8
99.3
KCH (Den Hill)
91.4
92.6
91.2
91.3
94.2
GSTT
95.8
96.0
97.0
96.0
97.5
93.5
London
94.8
95.2
96.2
95.3
95.4
94.6
Weekly A&E waits type 1 (target 95%) - % of patients who spent 4 hours or less in A&E before treatment or admission
20/7/14
27/7/14
3/8/14
10/8/14
17/8/14
KCH (Trust wide)
85.0
88.8
89.8
89.9
88.6
KCH (Den Hill)
89.9
91.2
89.6
89.8
93.1
GSTT
94.6
94.8
96.1
94.7
96.7
5
Urgent Care Performance – Summary of Q1 Position
Reported Performance Position
•
GSTT have met the performance standard in all four quarters of 2013/14 and in quarter 1 2014/15.
•
King’s (Denmark Hill) failed the last three quarters. There are a number of issues which caused this performance
including; fluctuations in demand, acuity of patients, mental health pathways, repatriation delays and discharges.
•
The trust and commissioners have developed a revised recovery plan, linked to the trust’s overall plans, to better align
trust capacity across all its sites with the demand for services. In addition, further external reports from ECIST have
been completed and look at length of stay and overall care pathway productivity and efficiency. A number of enhanced
and further actions are planned as a result of this.
•
Ernst and Young conducted a Demand and Capacity review. This has been used to drive an appraisal of options aimed
at closing the bed gap through securing the optimal utilisation of the Trust’s Denmark Hill, PRUH, QMS and Orpington
sites alongside improvements in internal and external productivity and efficiency to enable the delivery of sustained
performance across A&E and RTT targets.
•
Next steps are: monitoring of performance trajectories and recovery plans, providing certainty for the year;
implementation of internal recovery plan; continued commissioner led action on whole system support focusing on;
discharge, mental health, repatriations and rehab; completing the winter review process, and ensuring lessons learnt
are taken forward; Strategic Review, including review of balance and capacity resource across King’s sites.
6
Urgent Care Performance – Summary of Q1 Actions
1.
Denmark Hill site capacity: Commissioners worked with all trusts across SE London to do a demand and capacity
analysis for each site. This work was a specialty-by-specialty review on how many beds are likely to be needed to meet
demand on a quarter by quarter basis. For Denmark Hill, a bed gap of 68 was identified. As a result a number of actions
were initiated, including transferring work to Orpington and PRUH from Denmark Hill, improving internal efficiency, and
making full use of increased community capacity in order to decompress the site.
2.
Mental Health: Additional bed capacity commissioned as part of 2013/14 contract and psychiatric liaison nurse post
funded by CCG.
3.
Southwark & Lambeth Integrated Care (SLiC) Simplified Discharge Workstream Programme: Identification of
priorities following stocktake in Q1.
4.
Primary care access: The CCG agreed to commission primary care access, 8am-8pm, 7 days a week. The CCG was
notified that it’s application for the Prime Minister’s Challenge Fund had been successful. This funding (approx.
£1million) will be used for setup and infrastructure costs. The CCG has also invested a further £2.1m recurrently to
support enhanced access to primary care.
5.
MDT Assessment/social Care: Evaluation of weekend social care worker pilot at GSTT to support seven day working.
6.
Repatriations: Agreement was reached with GSTT to extend catchment area. Ongoing discussions with King’s to
consider medium term solutions. Neuro-rehabilitation has been highlighted as an issue with NHS England Area Team
and specialised commissioning.
7.
Guy’s Urgent Care Centre: Change in provider from Q1, with service now delivered by GSTT. Primary care partner
secured for initial phase
7
Urgent Care Performance – Actions in progress
1.
Development and agreement of System Resilience Plans: These cover both elective and non-elective across
Lambeth, Southwark and Bromley. The meeting in July included plans for the allocation and use of winter monies. NHS
England have provided feedback and a refreshed plan was submitted on 21st August.
2.
Denmark Hill site: Plans are in place to release capacity throughout the year, with several service moves taking place
in the next two months. Representatives of the CCGs and KCH are also meeting with Lewisham and Greenwich NHS
Trust to discuss repatriation protocols as these have proved to be problematic over the last 12 months and have
disrupted patient flows at Denmark Hill.
3.
Mental Health: Three month audit of mental health presentations to be presented to the sub-group in September and
inform future plans.
4.
Southwark & Lambeth Integrated Care (SLiC): Simplified Discharge Workstream programme: options appraisal for
unified point of access to be developed and considered by Operations Board in September.
5.
Extended Primary care access:
6.
•
Service specification to be signed off at August steering group – providers have developed detailed pathways
•
Service mobilisation: ongoing actions around staffing, IT and premises ahead of first site launching on 1st October
•
Contractual discussions initiated and assurance process for mobilisation agreed.
King’s Urgent Care Service: Revision of service specification and confirmation of procurement route in September.
8
Urgent Care Performance – Planned actions
Information from the weekly Denmark Hill exception report
•
Whilst there is some variation in the main drivers for underperformance, a key issue has continued to be bed pressures
resulting in poor outflow from ED. There have been several particularly difficult days where a poor discharge profile in
medicine has caused delays in beds becoming available. This has resulted in longer than optimal waits for beds and
A&E breaches as a result.
•
Acuity has also appeared higher. In the week beginning 4 August there was 13-17% increase in numbers of resus
patients on Monday, Tuesday and Friday and 23% on Thursday. This level of acuity can lead to more staff being needed
to cover resus and an increase in the wait times for majors and minors patients.
•
Medium term plans are in place to free up capacity and to move activity to Orpington to decompress the site. A Safer,
Faster, Hospital ‘perfect’ week is planned for the first week of September to improve processes and embed internal
professional standards.
9
Cancer Waiting Time Standards
2 weeks GP referral (93%) - % patients seen within 2 weeks of an urgent GP referral for suspected cancer
31 days treatment (96%) - % patients receiving first definitive treatment within 31 days of a cancer diagnosis
62 days treatment (85%) - % patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer
Aug
Sep
Q2
Oct
Nov
Dec
Q3
Jan
Feb
Mar
Q4
Apr
May
Jun
Q1
2 weeks
97.5
93.7
95.9
95.7
95.2
94.7
96.0
95.3
94.6
97.5
96.6
96.3
96.8
97.9
97.3
97.3
31 days
100
98.4
96.8
98.4
94.5
95.9
95.8
95.5
94.5
100
96.9
97.1
98.5
98.5
98.1
98.4
62 days
100
83.3
81.1
86.3
78.4
94.4
86.4
86.8
90.3
90.6
81.1
87.1
89.1
90.3
96.4
90.8
2014/15
Jul
Reported Performance Position
•
Southwark CCG is green rated on all cancer targets for April, May and June. King’s (Denmark Hill) is green rated for all targets in
June.
•
Performance is regularly reviewed at monthly contract monitoring meetings and monthly provider performance meetings.
•
GSTT failed the 62 days GP referral target. 62 days waits have been a consistent area of performance variance at GSTT; this is
covered in more detail on the next slide.
10
Cancer Waits: 62 Days Pathway
Target = 85%
Aug
Sep
Q2
Oct
Nov
Dec
Q3
Jan
Feb
Mar
Q4
Apr
May
Jun
SCCG
100
83.3
81.1
86.3
78.4
94.4
86.4
86.8
90.3
90.6
81.1
87.1
89.1
90.3
96.4
KCH
97.2
83.1
92.5
88.1
86.2
84.0
93.9
85.2
93.1
89.8
83.2
85.3
94.3
77.9
80.1
GSTT
77.9
80.0
70.1
70.8
71.0
78.0
74.0
72.2
77.2
79.2
78.2
76.1
82.4
77.1
77.5
2014/15
Jul
Cause of Reported Performance Position
•
This target is being met for Southwark patients.
•
62 days pathway performance variance at GSTT is associated with receipt of tertiary referrals and for some patients with pathways
within the trust.
•
Internal performance at GSTT in Q4 2013/14 – i.e. patients whose cancer pathway starts and ends (through treatment) within the
trust was above target at 88.5%.
Actions Agreed to Meet Performance Standard
•
Department of Health Intensive Support Team (IST) has reviewed processes at GSTT for patients whose total journey is within
GSTT.
•
The IST has also recently separately reviewed all old South London Healthcare Trusts (SLHT) providers focussing on pathway
access issues for 62 days patients who start their journey at the old SLHT and are referred to GSTT.
•
The final report was received by trusts in December 2013 and the CSU has organised a review group to ensure recommendations
from the report are taken forward. The first meeting was held in mid-January and has been held quarterly from that date.
•
Monitoring of trust produced action plans occurs on a monthly basis in monthly performance meetings
11
Referral-to-Treatment: 18 Weeks Performance
RTT admitted (target 90%) - The percentage of admitted pathways completed within 18 weeks
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
SCCG
89.3
88.4
87.3
86.0
87.3
89.0
88.2
84.1
81.5
84.4
84.4
82.3
KCH DH
88.1
87.1
88.6
87.7
88.7
89.0
87.8
83.6
81.7
84.5
83.3
GST (trust wide)
92.6
93.1
90.9
90.9
90.6
93.4
91.0
91.7
90.8
91.9
91.0
2014/15
Jul
90.7
RTT Admitted
Sep
Oct
Revised admitted backlog
trajectory
Total admitted backlog actual
1,483
1,451
Nov
Dec
Jan
Feb
Mar
1,419
1,421
1,153
813
550
1,445
1,483
1,624
1,693
1,771
2014/15
King’s DH is below the performance threshold. The Trust has an agreed planned failure to Q3 in order to reduce current backlog
Apr
May
Jun
1,580*
1,410
1,200
1,846
1,859
1,760
*Start of 2014/15 trajectory
•
The backlog increased in April and May 2014/15 but was reduced in June.
•
Backlog clearance performance over 2013/14 for Qs 1 and 2 was broadly in line with the agreed trajectory, noting that the level of
improvement agreed for these months was relatively small. Performance deteriorated after that with an increasingly significant
variance between plan and actual, driven by a combination of delays in operating Orpington at full capacity, winter pressures on the
DH site and the failure to outsource work, both to the private sector and GSTT.
•
A revised backlog clearance trajectory was signed off with the trust for the start of 2014/15, however this has been superseded by
the trajectory as part of the Operational Resilience Plan.
12
Referral-to-Treatment: 18 Weeks Performance – Actions
Actions Agreed to Meet Performance Standard and clear backlog
•
Monthly backlog targets and the expected monthly performance position for admitted patient care have been signed
off with King’s and a specialty and admission method risk assessment completed. Commissioners will monitor the
trust against these positions in year.
•
Both GSTT and KCH will be implementing additional national RTT monies from July - September to further clear
long waiting patients, this will mean there will also be a dip in performance at GSTT over the period.
•
Agreed transfer to Guys and St Thomas’ of Orthopaedic patients for the first two quarters of 2014/15 with a review at
that point.
•
Maximising internal trust capacity across Denmark Hill, PRUH and Orpington sites, to support the overall
decompression of the KCH acute hospital sites and the effective management of available emergency and elective
capacity across the trust. Key elective proposals cover: Orthopaedics - consolidation of the trust’s elective adult
Orthopaedic activity at Orpington; Gynaecology - consolidation of all elective inpatient Gynaecology activity at the
PRUH site; Non complex cataract surgery - consolidation of simple cataract activity at QMS; and General Surgery consolidation of the trust elective adult General Surgery activity at Orpington. Assumption is changes will be
implemented over 2014/15 in a phased way beginning with Orthopaedics and Gynaecology from start Q2.
•
The KCH start year position was that the continued outsourcing of activity to the private sector was unsustainable.
However, discussions are now taking place with private sector providers and also internally to secure agreement to
the funding and securing of additional in-house Saturday theatre lists.
•
Providing more information to primary care referrers to support conversations with patients and enabling informed
choice in relation to waiting times.
13
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Southwark CCG
7
3
8
8
10
6
14
14
18
13
KCH (Trust wide)
31
24
28
29
33
27
78
79
109
95
GSTT (Trust wide)
0
1
0
0
0
0
0
0
0
0
2014/15
Referral-to-Treatment: 52 + week waits
Apr
May
Jun
20
15
13
123
104
107
0
0
2
Cause of Reported Performance Position
•
In June the specialities with long waits for Southwark patients were all at KCH; 5 Bariatrics, 3 HpB, 2 Neurosurgery, 2
Orthopaedics and 1 Other. Despite treating long waiters over the last 15 months the number of over 52 week waiters has
increased due to the overall waiting list profile and demand and capacity pressures that have resulted in a constrained elective
bed base at KCH - DH, impacting particularly on neurosurgery, HpB and Bariatrics.
Actions Agreed to Meet Performance Standard
•
As part of 2014/15 contract the CSU agreed revised trajectories to reduce 52 week waiters to 0 by end Q1. This trajectory has now
been missed and has been revised to a target date of October 2014. Southwark CCG has written to the Trust on behalf of all
commissioners raising concerns in this area. The Trust is required to produce regular evidence of reviewing long waiters from a
clinical quality and outcomes perspective and supply evidence of patient level treatment plans and tracking.
•
Following agreed additional RTT funding from NHSE, KCH will be outsourcing patients in Neurosurgery and Bariatric Surgery to the
private sector.
•
Orthopaedics is continuing to use spare capacity at GSTT with around 30 patients transferred a month, there is also increased use of
the Orpington site as an elective Orthopaedic centre for KCH now expanding with Saturday lists.
•
HpB has 2 additional ring fenced critical care beds from the private ward, this has resulted in a reduction in waiters over the last 2
months
•
Expected impact of capacity changes and site service moves across KCH site will decompress DH and free up capacity. Opening of
Infill Block 4 (Centenary Wing) and Orpington during 13/14 and August 2014 site moves will extent available capacity.
14
Diagnostic Waits
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Southwark CCG
2.63
2.41
2.48
1.52
1.71
2.02
1.71
0.97
0.98
KCH (Den. Hill)
2.57
1.23
0.94
0.87
1.40
1.60
1.25
1.20
1.20
GSTT (Trust wide)
3.83
5.13
4.44
2.17
2.46
3.17
2.71
1.14
1.27
2014/15
Diagnostic wait less than 6 weeks (target <1%) - The % of patients waiting 6 weeks or more for a diagnostic test
Apr
May
Jun
1.03
1.30
0.58
1.20
1.30
0.89
1.69
1.75
1.30
Cause of Reported Performance Position
•
Southwark CCG marginally missed the target in April and May, however the CCG is green rated for June 2014.
•
King’s Denmark Hill is also green rated for June.
Actions Agreed to Meet Performance Standard
•
King’s has increased capacity in both paediatric and adult gastroscopy through additional weekly endoscopy lists and ad hoc
Saturday lists but further capacity is required to reduce long waits.
•
At GSTT endoscopy accounts for the majority of the patients waiting over 6 weeks. Plans are in place to reduce the waiting time for
special BRAVO endoscopy tests and also sleep studies for children.
15
Improving Access to Psychological Therapies (IAPT)
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Monthly 1st contacts to equal
15% trajectory
(12.5% in 2013/14)
431
447
454
454
436
454
454
465
465
465
465
465
Number of first contacts
322
403
438
465
308
488
326
411
529
510
606
637
Recovery Rate (target 50%)
40.4
37.0
31.3
40.7
36.5
37.5
48.0
39.4
39.0
36.2
33.5
39.1
2014/15
Month
Cause of Reported Performance Position
•
Growth in demand for IAPT services in Southwark and capacity limits in IAPT provision from SLaM. Performance has improved
significantly in 2014/15.
•
Identified variation from practice-based counsellors completing psychological therapy interventions.
Actions Agreed to Meet Performance Standard
•
Audit and review of all practice-based counselling completed.
•
Funding for additional temporary low intensity support by Psychological Well-being Practitioners (PWPs) has been in place at SLaM
since April 2014.
•
The recruitment of ten additional high intensity workers has been approved with five additional workers expected to be in place by
the end of August.
•
In February 2014, SLaM changed the booking system for first assessment/appointments. The change has helped improve patient
experience, reduce waiting times for initial contact and increase the number of first appointments being booked onto the system.
•
Additional administrative staff funded within SLaM to register referrals to counsellors and remove administration tasks from
counsellors.
•
Programme to increase IAPT-accredited activity being completed by practice-based counsellors.
16
Winterbourne View
Reported performance position
Southwark CCG Quarter 1 Winterbourne View Data submission returned on 14 July 2014 reported on seven clients meeting the
reporting criteria i.e. people in in-patient beds for mental and/or behavioural healthcare who have either learning disability and/or
autistic spectrum disorder (including Asperger’s syndrome).
Reviews
All seven clients have been reviewed within the last six months.
Discharge Dates
Client A
Ministry of Justice approved transfer to a medium secure unit on 6 August 2014. Funding and reporting on
this client transfer from Southwark CCG to NHSE Specialist Commissioning will commence from this date.
Client B
Risk currently too high to consider step down or transfer to the community. Timescale for discharge approx. 1216 months.
Client C
Discharged to step down facility planned, awaiting bed. Approx. timescale 2-3 months.
Client D
Currently has physical health issues alongside MH issues. Is being considered for gradual step down facility in
the future but timescales likely to be 12 months.
Client E
Discharge is subject to Ministry of Justice approval which is not currently granted due to index offence and lack
of engagement in treatment. Timescales approx. 2 years.
Client F
Moved to Community Locked Rehab in January 2014. Once settled the MDT plan to explore community
placements. Timescales approx. 12 months.
Client G
Admitted to specialist mental health assessment unit. Plan to discharge to EMI Residential Care. Timescales
approx. 2 months.
The Winterbourne View Steering Group receives a monthly update on all clients both health and social care funded and monitors
progress against agreed actions and timescales.
17
Dementia Diagnosis Rate
2013/14 estimate prevalence = 1,600 and 2014/15 estimated prevalence = 1,664.
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Trajectory –
diagnoses
851
873
895
917
939
961
983
1,005
1,027
1,049
1,071
1,093
1,115
Actual number
diagnosed
922
955
919
907
904
Trajectory - %
diagnosed
53.2
52.5
53.8
55.1
56.4
57.8
59.1
60.4
61.7
63.0
64.4
65.7
67.0
Actual %
diagnosed
57.6
57.4
55.2
54.5
54.3
2014/15
13/14
Data extracted from EMIS Web and subject to further validation.
Reported Performance Position
•
The CCG is below trajectory as of 31 July. The number of patients on the dementia register has decreased from 955 in April 2014 to
904 in July 2014, a drop of 51 patients. This is associated with the change in registration of patients at a care home, who are now
registered with a Lambeth GP following procurement of a new primary care service at that home.
•
The SLaM dementia service estimates that it can diagnose around 12-14 patients per month, which would result in 96–112
additional diagnoses for the rest of the year (August 2014 – March 2015). At this rate the CCG would end the year under trajectory
because the register would need to increase by 211 patients to meet the target.
•
However, a number of the diagnoses made in 2014/15 by the SLaM dementia service have not yet been added to the register by
the patient’s GP. The service confirmed that 42 diagnoses have been made in 2014/15, with only 7 have so far added to the
register. These additions would mean that there would be 939 people on the register in July, which would exceed the trajectory
target in July. The service is also checking if there are diagnoses made at King’s and GSTT that have not been added to the
dementia register.
18
Dementia Diagnosis Rate – Action plans
Actions recently completed
1.
Capacity uplift of 2 WTE band 6 nurses effective from February 2014.
2.
Proportion of outpatient appointments to home visits increased to provide a net increase of 2 appointments per week.
3.
Action plan to be monitored at the monthly Mental Health of Older Adult Sub Group. The next meeting is scheduled to
take place on Thursday 21 August.
4.
Meet with Lambeth commissioners w/c 11 August to negotiate proportion of assessments completed for patients of each
borough.
Planned actions
1.
CCG to work with SLaM service and Southwark GP practices to enhance numbers diagnosed by the service that are
then added to dementia registers.
2.
CCG to scope options for capacity increase in SLaM dementia service in order to increase throughput in the remainder
of the year (Q3 and Q4).
19
Health Visitors
Southwark Health Visitor establishment 1 July 2014
Note: The Health Visiting service is commissioned by NHS England
Locality
WTE
Vacancies
Bermondsey
12.98
1.98
Borough & Walworth
19.00
1.80
Dulwich
14.80
1.20
Peckham & Camberwell
17.00
4.00
Reported performance position
•
Figures include 4 team leader posts that have a 40% clinical component
•
Vacancies are currently being covered by agency Health Visitors
Planned actions
•
Many of the vacancies will be filled in September/October when current students qualify
20
Other Performance Areas
Q1 Serious Incidents & Never Events requiring investigation
Points to Note
SIs logged at the PRUH have not been included in the below figures as NHS Bromley CCG review and assure these incidents.
None of the PRUH SIs were for Southwark residents.
Q1 2014/15
Provider SIs (EXCL NEs)
April
May
June
KCH – All SIs (Southwark
patients in brackets)
7(2)
9 (4)
6 (2)
GSTT hospital and
community - Southwark
patients only
3
1
5
SLaM - Southwark patients
only
0
1
1
Other Commissioned
Provider - Southwark patients
only
0
1
0
22
SCCG
Q1
Q2
Oct
Nov
Dec
Jan
Feb
Mar
13/14
1
0
0
1
1
0
0
0
3
2014/15
Healthcare Acquired Infections – MRSA
Apr
May
Jun
0
0
0
•
This table only shows cases assigned to the CCG following Post Infection Review (PIR).
•
All MRSA bacteraemia cases reported via the HCAI Data Capture System (DCS) are assigned to either an
acute Trust or a CCG through the completion of a PIR. A case is deemed to be CCG assigned where the
completed PIR indicates that a CCG is the organisation best placed to ensure that any lessons learned are
completed.
Actions Agreed with Providers to Meet Performance Standard
•
Infection control (including MRSA) cases are discussed at the monthly Clinical Quality Review meetings at
King’s and GSTT. These meetings are chaired by CCG Clinical Leads in Southwark and Lambeth. King’s and
GSTT undertake a Root Cause Analysis (RCA) on all MRSA cases and all CDI cases attributed in their
organisation.
•
The Lambeth and Southwark Public Health Team review local HCAI data regularly. Post Infection Reviews of
MRSA bacteraemias are producing information on the detail of local cases and learning. Most cases are very
complex with numerous healthcare contacts.
•
Southwark CCG undertook a ‘Deep-Dive’ review of infection control within its local acute and community
providers. It included recommendations on how to improve local infection control arrangements.
23
Healthcare Acquired Infections – c.difficile
SCCG
Oct
Nov
Dec
Jan
Feb
Mar
13/14
Apr
May
Jun
Q1
14/15
Target
5
4
5
3
0
2
36
4
1
10
15
42
5
8
9
22
42
5
5
8
18
37
KCH DH
13
7
6
6
2
2
5
49
GSTT
15
6
4
3
3
3
6
43
2014/15
Q2
Actions Agreed with Providers to Meet Performance Standard
•
Infection Control including MRSA and Clostridium difficile (CDI) information is made available at the monthly Clinical Quality Review
Group (CQRG) meetings at King’s and GSTT. These meetings are chaired by CCG Clinical Leads in Southwark and Lambeth.
King’s and GSTT undertake a Root Cause Analysis (RCA) on all MRSA cases and all CDI cases attributed to their organisation.
•
Infection control was a main agenda item at the GSTT CQRG meeting in May and at the King’s CQRG meeting in June. Public
Health were present at both meetings.
•
At Denmark Hill, there has been a reduction in compliance with the time to isolation for MRSA and CDI cases. Priority has been
given to increasing side room capacity in an attempt to increase compliance. The trust have purchased additional isolation pods
which have increased overall isolation capacity. The trust has increased the use of hydrogen peroxide, especially after a patient has
been discharged with CDI.
•
GSTT have invited the Department of Health expert advisor to conduct a review of Trust processes, which will occur in August. The
CDI Action Group continues to review all cases that occur. The Trust has said that no evidence of poor practice has been
demonstrated to account for the increased incidence in 2014/15.
•
Both trusts are disputing their annual targets as they deem them to be too low.
24
Friends & Family Test – Response Rates
KCH –
Den. Hill
GSTT
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
32%
34%
40%
50%
35%
43%
41%
46%
35%
32%
36%
35%
33%
28%
26%
27%
35%
35%
2014/15
Inpatient Response Rates (target Q1 25%)
Apr
May
Jun
40%
35.0%
47.7%
40%
37.1%
40.5%
Apr
May
Jun
A&E Response Rates (target Q1 15%)
Aug
Sep
Oct
Nov
Dec
Jan
Feb
KCH –
Den. Hill
5.0%
12.9%
9.5%
9.9%
12.8%
9.6%
16.8% 15.1% 17.6%
GSTT
4.3%
5.4%
5.5%
5.5%
10.8%
16.1%
14.8%
27.7%
Mar
10.1%
2014/15
Jul
21.8% 26.0% 27.8%
11.0%
6.1%
17.6%
The 2014-15 National Patient Experience CQUIN focuses predominantly on response rates and extending
the test to outpatient and day case areas in the Autumn.
25
Friends & Family Test – Scores
KCH –
Den. Hill
GSTT
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
62
62
61
60
64
63
57
67
62
78
79
79
79
82
79
77
76
2014/15
Inpatient Score
Apr
May
Jun
67
66
62
Jun nat.
ave.
73
81
77
82
79
Apr
May
Jun
48
48
45
72
49
46
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
KCH –
Den. Hill
30
43
40
47
51
49
53
52
42
GSTT
34
52
63
60
62
61
73
85
68
2014/15
A&E Score
Jun nat.
ave.
55
The 2014-15 National Patient Experience CQUIN focuses predominantly on response rates and extending
the test to outpatient and day case areas in the Autumn.
26

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