Appendix 4.3 MEETING: DATE: TITLE: LEAD DIRECTOR/ MANAGER: AUTHOR: CONTACT DETAILS: Haringey Clinical Commissioning Group Governing Body meeting Wednesday 4 June 2014 Integrated Performance Dashboard – Month 1 2014/15 Jennie Williams, Director of Quality and Integrated Governance Cassie Williams, Head of Quality and Performance Bhavdeep Oberoi, Assistant Director of Contracts, CSU [email protected] SUMMARY: The Integrated Performance Dashboard (IPD) provides an overarching picture of the performance of Haringey Clinical Commissioning Group (HCCG) and its main providers in relation to finance, key performance indicators (KPIs) and quality metrics. GB members are asked to note that community KPIs will be included in future IPDs. The data for performance and quality metrics is for month 11 and 12 2013/14 but the narrative with the IPD and cover sheet provides as much near time feedback as possible. Performance and Quality Metrics The Governing Body is asked to note the following: Referral to Treatment Times (RTT) Haringey CCG did not meet the Quality Premium standard for 18 weeks incomplete RTT pathways for 2013/14. This was largely due to underperformance at Whittington Health but also Barnet and Chase Farm.  Barnet and Chase Farm (BCF) continues to be unable to report on RTT and there are ongoing delays in patients being seen. The CSU is working to receive up to date Haringey specific information from BCF regarding the length of waits and number of patients who continue to be affected.  Whittington Health (WH) applied the latest fix for the electronic patient record at the beginning of May and the Trust has confirmed that it will be able to upload data to unify at the next submission date. Internal reporting shows that the Trust achieved the admitted and non-admitted targets in March. The Trust has confirmed that there is no current risk to patients.  North Middlesex University Hospital (NMUH) have seen a significant increase in referrals in recent months and March figures would indicate that NMUH’s performance is vulnerable with targets being met by only 0.1%. The Trust is also not currently compliant at specialty level. The CSU are monitoring this performance closely through the Contract Review Meetings to ensure that performance is maintained. 0  University College London Hospital (UCLH) has failed to achieve the targets for admitted and non-admitted pathways. The Trust has developed an improvement plan to manage the waiting list. It is expected that admitted and non-admitted pathways will be compliant by September and the incomplete pathway by March 2015. The Trust has confirmed that there is no current risk to patients. Cancer Targets In February the 2 week wait standard for GP referral of suspected cancer and for breast cancer failed at CCG level.  WH failed the breast symptomatic standard. This is an ongoing issue despite attempts to work with Primary Care to remediate. The Trust Development Agency (TDA) has recently agreed with the Trust that they can refer those who DNA two reasonable appointments back to the GP. There is some concern that this may present a risk to women. It does not appear that this decision was made in conjunction with either Haringey or Islington CCG and this committee is asked to consider whether it would like to further discuss this matter with the TDA to understand the reasons behind the decision.  NMUH are now achieving the breast target however due to recent capacity concerns in RTT and cancer pathways a letter is being drafted to the Trust that will request an update on referral volumes, an 18 week plan which is aligned to the 1 million pound contract uplift, timescales and plans with trajectories to achieve compliance in both areas to specialty level and regular reporting at specialty level on the data. This will be sent to the CCG for sign off w/b 19 May 2014. A&E 4 Hour waits Performance is currently strong at both WH and NMUH. There is a question over the sustainability of the NMUH performance and the CSU have been conducting a Deep Dive into this. The analysis will consider how the Trust manages initial access to A&E as well as discharge in the whole hospital pathway. The discharge process is also an area of focus for a May Insight visit and June CQRG. Ambulance Handovers Ambulance handovers continue to be very delayed across NCL with NMUH having two 60 minute delays and WH one. NMUH’s performance in this area is particularly weak. A crew manager from the London Ambulance Service is now sitting in NMUH to examine and resolve the issues. Further information will be presented to the Urgent Care Working Group at the end of May. C Difficile NMUH’s C-Difficile annual target remains at 17 despite an increase in activity. In addition the Trust is now fully applying the guidance over reporting and are including ever case of C-Difficile, even when there are no clinical indications of infection. The Trust currently has 9 cases YTD. Not all of these cases are likely to be counted against the Trust however because they are only considered when there is evidence of a lapse in care (e.g. linked cases) or errors in prescribing. In accordance with recently publish guidance, the CCG is now conducting a secondary review of every C Diff RCAs to determine whether a case is counted and a financial sanction is applied. Two cases have been linked to date but the RCAs are incomplete so this is yet to be confirmed. 1 Mixed Sex Accommodation (MSA) In March WH reported 16 MSA breaches which is an ongoing improvement on the previous month. The Trust continues to work to resolve issues in this area. Friends and Family Test (FFT) WH and NMUH achieved just above and below respectively the London average for the A&E FFT score in March 2014. The London score was +50 with WH scoring 53 and NMUH scoring 47. The London Inpatients score was +65 which WH was exactly equal to. NMUH only scored 38 which is second lowest in the country. The Trust have indicated that this score has been affected by the opening of a number of new wards as part of the BEH strategy. This poor performance continues to be challenged at CQRG and is also being examined at ward level. GB is asked to note that unpublished data for April shows the inpatient score at NMUH to have significantly improved although the Trust remains a significant outlier. Mental Health Improving Access to Psychological Therapies (IAPT) WH met the targets for IAPT in relation to Access and Recovery for Q4. The Mental Health Commissioner for the CCG is currently working with WH to agree targets for next year. Delayed Transfers of Care (DTOC) There are ongoing difficulties with the DTOCs from BEH particularly in the Crisis and Emergency and Dementia and Cognitive Impairment Service. These also have an impact on the Average Length of Stay. The attribution to NHS is usually for three reasons; incomplete clinical reports within the Trust, awaiting the return of panel reports and the time taken to identify housing where the service user is not entitled to Social Care provision. The CCG mental health nurse is currently attending DTOC meetings to ensure that any delays where the CCG has a role are quickly resolved. Meetings are also being held with the Trust and the local authority to map pathways with a view to improving the DTOC process. It is noted that a whole system approach is required and the Trust will need to be involved in the whole system. CAMHS The Trust is yet to provide an action plan to address the delays in the waiting list for CAMHS which was requested in the April Contract Review Meeting. If this is not provided by 16th May 2014 a contract query notice will be sent to the Trust. 111 LCW have continued to improve performance over the last period. All key performance indicators other than those identified below have been achieved. The continued poor performance against the Warm Transfer (LQR7) and Time taken for call back (LQR10) indicators in April has been challenged at the 111 Contract / Performance meeting and the CQRG. Underperformance in relation to warm transfers should be considered in the context of call prioritisation. LCW manages call back queues based on prioritisation of clinical need. 2 There is no significant adverse effect of not meeting this target. These KPI’s will be revised in the new 111 specification and split between urgent and routine. LCW has agreed to include urgent and on-urgent figures in future reporting. LCW slipped below the ‘Call Waiting Time’ target of 95% answered within 60 seconds, reporting 94.2% in April. This will be discussed at the forthcoming Contract and Performance meeting and considered alongside the on-going workforce and telephony work streams reported weekly as part of their on-going Performance Recovery Plan. Concerns have also been raised around ambulance conveyances resulting from 111 in April. The 111 Clinical Lead for NCL is currently assembling a report that will describe 111 dispositions to ED and LAS and comparing the corresponding ED and ambulance activity. The aim of this report will be to demonstrate that whilst 111 may make a referral this may not always result in an attendance or conveyance. The report should provide some indication on the impact on the system and will be available in June. Barndoc Barndoc have achieved compliance on all quality indicators over this last period (April). The work undertaken in March which lead to Barndoc achieving compliance is now embedded in the rota pattern. This is particularly positive for April – the four day Easter period and a total activity second only to December, it remains one of the most challenging months of the year. Additional resources have been put in to ensure compliance is maintained, particularly on NQ9 (urgent and routine telephone calls) which the committee sought assurance on in April. The committee also sought clarification on the 1st line antibiotics KPI, It has been confirmed that this refers to appropriate use of antibiotics from the formulary. A serious incident involving a Haringey resident was reported back in February. The investigation has now concluded with the report shared on STEIS, with commissioning leads and LCW. The completion of actions is being monitored by the Barndoc’s Clinical Governance Group. Barndoc are now awaiting LCW’s serious incident report to produce a joint summary for the family. Barndoc have continued to underperform in terms of total activity in the region of 30%. The 10% cap and collar has been applied, with further discussions at the recent performance meeting around a potential review of the contract. The CCG has asked Barnet CCG as lead commissioner to devise a paper detailing the contractual options available. This will be available in June for discussion. SUPPORTING PAPERS: Integrated performance dashboard Month 1 2014/15 RECOMMENDED ACTION: The Governing Body is asked to NOTE the findings of this report. 3 Objective(s) / Plans supported by this paper: Our objective to commission high quality valued and responsive services working in partnership with the public to make the best use of resources. Audit Trail: The Integrated Performance Report was previously reviewed by the Finance and Performance Committee on 22 May 2014. Patient & Public Involvement (PPI): There was no patient involvement in this paper Equality Analysis: N/A Risks: N/A Resource Implications: There are no particular resource implications. 4