Contract and Performance Update - Durham Dales, Easington and

Report
Quality, Performance and Finance
Report
May 2014
Contents
Slide Number
Title
3
Background and Timetable
4
Executive Summary
5 – 12
Domains 1 & 5 - Quality Performance including exception reports
13 – 26
Domain 2&3 - NHS Constitution Performance including exception reports
27 – 30
Quality Premium & Outcomes Framework
31 – 55
Domain 4 Finance & Activity
• CCG Board Summary
• Provider Analysis Overview
• County Durham And Darlington NHS FT POD Analysis
• North Tees and Hartlepool NHS FT POD Analysis
• City Hospitals Sunderland NHS FT
• South Tees Hospitals NHS FT
• NEAS
• Mental Health
• Other Healthcare
56 – 57
Glossary
2
Background and Timetable
Please find attached the Quality, Performance and Finance report (QPF) for NHS Durham Dales,
Easington and Sedgefield CCG for May 2014. Activity and finance data used in the report is for
month 12 (March 2014) .
The report uses the latest published metric data for quality and performance, and where possible if
later unpublished data (white text) is available this has been included. If information is not
available it has been flagged within the report.
NECS will continue to work with the CCG to ensure the content and format of the report fits with the
needs of the organisation.
In addition to the formal QPF report the Quality and Performance published data is now available in
RAIDR.
3
Executive Summary
Report Amendments
Future developments:
•
On-going development as per CCG requirements
Headlines
The headlines for this report are summarised as follows:
Performance Indicator
A&E
A&E
Hospital Handovers
Hospital Handovers
Cancer 62 days
Cancer 31 days
Ambulance Response Times Cat A
Mental Health IAPT Performance
Provider/Commissioner
CDDFT
CHSFT
CDDFT
CHSFT
DDES CCG
CHSFT
NEAS
TEWV / MH Providers
Quality Indicator
CQC Enforcement
MONITOR
SHMI
HSMR
Friends & Family
Serious incidents
HCAI
Provider/Commissioner
NEAS
NEAS
CHSFT / NTHFT
CHSFT / NTHFT
CDDFT / CHSFT / NTHFT
All
All
Description of
Performance Failure
Failed 13-14
Failed 13-14
Numerous breaches
Numerous breaches
Failed 13-14
Monthly breaches
Failed 13-14
Failed 13-14
Description of
Performance Failure
CQC Visit
Monitor Risk
Negative Outlier
Negative Outlier
Poor performance
Unclosed SIs
Various breaches
Exception Report No.
CDDFT ER01
CHSFT ER01
CDDFT ER02
CHSFT ER02
DDES ER01
CHSFT ER03
NEAS ER01
MH ER01
Exception Report No.
QER01
QER02
QER03
QER04
QER05
QER06
QER07
Recommendation:
This report is for the CCG to note current performance and the risks to national indicators in 2013/14. The committee is asked to endorse the
actions to address underperformance and suggest further remedial action if appropriate.
4
Exception
report
required
TEWV
NEAS
NTHFT
CHSFT
CDDFT
CCG
Frequency
Reporting
period
Target
Quality Performance
l l l l l l
OVERALL
Regulators
Has any local provider been subject to local enforcement action by the CQC?
Y/N
Apr-14
Monthly
Has any local provider been flagged as a 'quality compliance risk' by Monitor and/or are
requirements in place around breaches of provider lisence conditions?
Y/N
Apr-14
Monthly
l l l l l l
l l l l l l
Y/N
No Data
Monthly
l l l l l l
Has any provider been identified as a 'negative outlier' on SMHI?
Y/N
Apr-14
Monthly
Y/N
Apr-14
Monthly
l l l l l l
l l l l l l
QER03
Has any provider been identified as a 'negative outlier' on HSMR?
Y/N
Mar-14
Monthly
l l l l l l
QER05
Does any provider currently have any unclosed Serious Untoward Incidents (45 days)?
Y/N
Apr-14
Monthly
Does any provider currently have any unclosed Serious Untoward Incidents (60 days)?
Y/N
Apr-14
Monthly
Has any provider experienced any 'Never Events' during the last month ?
Y/N
Apr-14
Monthly
Y/N
No Data
Quarterly
Y/N
No Data
Quarterly
l l l l l l
l l l l l l
Y/N
No Data
Quarterly
l l l l l l
Y/N
No Data
Quarterly
l l l l l l
Y/N
No Data
Quarterly
l l l l l l
Y/N
No Data
Quarterly
l l l l l l
Y/N
No Data
Quarterly
l l l l l l
Has any local provider been subject to enforcement action by the NHS TDA based on 'quality' risk?
QER01
QER02
Clinical effectiveness
QER04
Patient experience
Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes
for concern for any provider?
Safety
l l l l l l
l l l l l l
l l l l l l
QER06
CCG
Does the CCG have any outstanding conditions of authorisation in place on clinical governance?
Has the CCG self assessed and identified any risks associated with concerns around quality issues
discussed regularly by the CCG governing body?
Has the CCG self assessed and identified any risks associated with concerns around the
arrangments in place to proactively identify early warnings of a failing service?
Has the CCG self assessed and identified any risks associated with concerns around the
arrangements in place to deal with and learn from serious untoward incidents and never events?
Has the CCG self assessed and identified any risks associated with concerns around being an active
participant in its Quality Surveillance Group?
If there was an emergency event in the last quarter, has the CCG self assessed and identified any
areas of concern on the arrangments in place for dealing with such an event?
Has the CCG self assessed and identified any risk to progress against its Winterbourne View action
plan?
5
Exception Report QER01 – CQC Enforcement
CCG
CDDFT
CHSFT
NTHFT
NEAS
TEVW
Has any local provider been subject to any enforcement
action by the CQC?
Performance Update:
NEAS
The CQC published their report on 26.04.14 following their inspection visit to the Trust in February 2014. The CQC found that 4 of the 6
standards inspected were not being met and enforcement action has been issued against the Trust. The areas of concern identified by the CQC
are as follows:
•
•
•
•
Management of Medicines – the CQC found that medicines, other than controlled drugs, were not always stored safely. Medications
requiring refrigeration were not always stored properly and securely, fridge temperatures not maintained and stored in vehicles at room
temperature. The CQC judged that this has minor impact on people who use the services and advised the Trust that action is required.
Requirement Relating to Workers – the CQC found that since 2009 effective recruitment procedures have not been in place and as a
result DBS checks had not been carried out on staff at time of employment or on a rolling basis. The CQC were reassured by the recovery
plan and actions in place which was on target for completion by the Trust in April. The CQC judged this moderate impact on people who
use the services and issued enforcement action to the Trust. The Trust is also required to provide weekly updates on progress until the
recovery plan has reached a conclusion.
Supporting Workers – the CQC found that a significant number of staff had not received one to one supervision sessions. The CQC
judged this to have minor impact on people who use the services and advised the Trust that action is required.
Accessing and monitoring the quality of service provision – the CQC found that there was no effective governance process in place to
monitor/oversee the complaints system and ensure that all complaints were dealt with in a timely manner in line with Trust policy. A
shortfall in availability of investigating officers was also identified. The CQC judged that this had a moderate impact on people who use the
service and advised the Trust that action is required.
Remedial actions:
NEAS
The CQC findings will be discussed at the next NEAS CQRG in May 2014.
.
CCG Comments
6
Exception Report QER02 – Monitor
CCG
CDDFT
CHSFT
NTHFT
NEAS
TEVW
Has any local provider been flagged as a 'quality
compliance risk' by Monitor and/or are requirements in
place around breaches of provider licence conditions?
Performance Update:
NEAS
Monitor are currently investigating concerns in relation to the recent CQC visits outlined in exception report QER01
Remedial actions:
NEAS
Concerns will be reviewed at the forthcoming CQRG in May 2014. .
.
CCG Comments
7
Exception Report QER03 – Mortality (SHMI)
CCG
CDDFT
CHSFT
NTHFT
NEAS
TEVW
Has any provider been identified as a 'negative outlier'
on SHMI?
Performance Update:
The North of England Quality Dashboard March 2014 (published April 2014), indicates for the period January 2013 to December 2013 that
•
CHSFTs overall HSMR rate is worse than expected at 117.8 and
•
NTHFTs overall rate is worse than expected at 113.4.
Remedial actions:
CHSFT:
A number of actions have been taken by the Trust to improve the reported rates for HSMR including:
•
all deaths are discussed regionally and peer reviews are carried out to identify any preventable actions,
•
all case notes are reviewed and deaths scored,
•
Review of coding underway as differences with approach to use of palliative care coding is main contributing factor
NTHFT:
• The Trust is continuing to review each death as part of a planned mortality review process to ensure that lessons are learned from avoidable deaths. The
tool used as part of this process has been provided from the national team involved in the Keogh review to facilitate local monitoring and national
benchmarking.
• The Trust is developing a Trust policy to support the activity for ensuring reviews are undertaken; ensuring appropriate structures are in place to ensure
information obtained and lessons learned are shared across all levels. Regular updates are provided to clinical teams regarding the current information,
which assists in providing an early warning of any changes in mortality.
• NHS England and NEQOS are providing support to the Trust in introducing a Pneumonia process measures project; which will allow the Trust to introduce a
different approach towards the management of Pneumonia. A deep dive for some re-admissions will commence as part of the Pneumonia process. The
project commenced in February 2014 and will run for the duration of 2014 /15.
• The Trust is involved with regional work on mortality which is being supported externally by NEQOS. This work has a focus on the overall health within the
region and how this has an affect on mortality. The regional group is developing a tool to support reviewing across all Trusts in order to allow direct
comparisons as well as peer review. Queries have been raised with the Trust in relation to the anticipated impact of the regional work; the Trust assures that
the benefits of the work of the Task and Finish group established following the Keogh report should be visible over the summer period.
• The CCG attended an NTHFT review, with 39 patient records reviewed using a criteria based tool and further analysis undertaken as necessary. For the
cases reviewed, it was reported that one case out of the 39 could have had an avoidable death outcome.
• Trust report to Board to be shared with CCG following Board approval which includes the timeline for the impact of current actions.
• CCG requested in May 2014 clarification of coding ( including ambulatory coding), and consideration of any gaps in the context of wider health and social
care factors or required actions. Trust have confirmed ambulatory coding is not included
CCG Comments
8
Exception Report QER04 – Mortality (HSMR)
CCG
CDDFT
CHSFT
NTHFT
NEAS
TEVW
Has any provider been identified as a 'negative outlier' on
HSMR?
Performance Update:
The North of England Quality Dashboard March 2014 (published April 2014), indicates for the period December 2012 to November 2013 that
•
CHSFTs overall SHMI rate is worse than expected at 108.98 and
•
NTHFTs overall SHMI rate is worse than expected at 111.82
Remedial actions:
CHSFT:
A number of actions have been taken by the Trust to improve the reported rates for SHMI including:
•
all deaths are discussed regionally and peer reviews are carried out to identify any preventable actions,
•
all case notes are reviewed and deaths scored,
•
As reported with HSM a review of coding is underway
NTHFT:
• Monitoring of HSMR continues through the CQRG. The Trust has identified a target review of cases within the diagnosis groups (within the
HSMR indicator set), these are; Pneumonia, Aspiration Pneumonitis, Congestive Heart Failure and Urinary Tract Infection.
• The Trust is continuing to review each death as part of the planned mortality reviews, where all deaths in hospital are reviewed to ascertain if
an individuals death was avoidable. The tool used as part of this review has been provided from the national team involved in the Keogh
review.
• The Trust is developing a Trust policy to support the activity for ensuring reviews are undertaken; ensuring appropriate structures are in place
to ensure information obtained and lessons learned are shared across all levels. Regular updates are provided to clinical teams regarding the
current information, which assists in providing an early warning of any changes in mortality.
• NHS England and NEQOS are providing support to the Trust in introducing a Pneumonia process measures project; which will allow the Trust
to introduce a different approach towards the management of Pneumonia. A deep dive for some re-admissions will commence, as part of the
Pneumonia process.
Monitoring continues through the respective CQRGs.
CCG Comments
9
Exception Report QER05 - Friends and Family Test
Indicator
Does feedback from the Friends and Family test (or any other
patient feedback) indicate any causes for concern for any
provider?
CCG
CDDFT
CHSFT
NTHFT
NEAS
TEVW
Performance Update:
March published indicates the following concerns :
CDDFT:
In patient response rates - UHND at 29.67% remains below the England average of 34.8.
In patient score - DMH obtained a score of 69, UHND 71 both sites continue to remain slightly below the England average of 73.
A&E response rates - DMH increased their response to 14.79% but still remain below the national average and target.
A&E Scores - both hospitals scored 41 which is an improvement on previous month but these still continue to remain significantly below the
national average of 54.
CHSFT: only area to highlight in relation to FFT is that the A&E response rate for CHSFT fell to 14.66 taking it below the national target of 15%.
NTHFT: only area to highlight is that the in-patient score at North tees hospital site at 68 fell below the England average of 73.
Remedial actions:
CDDFT: FFT remains a standing agenda item at the CQRG. As reported previously CDDFT identified an issue regarding the accuracy of the FFT in-patient and
A&E data. A re-count of the Trust’s FFT data from April 2013 has taken place and NHS England is expected to publish the revised data in late May 2014. This
will be shared with CCGs when this is available.
CHSFT: Performance regarding A&E response rate will be monitored through forthcoming FFT data and discussed at the CQRG.
NTHFT: Performance regarding the In patient score at the North Tees site will be monitored through forthcoming FFT data and discussed at the CQRG.
CCG Comments
10
Exception Report QER06 - Unclosed Serious Incidents
Indicator
CCG
CDDFT
CHSFT
NTHFT
NEAS
TEVW
Does any provider currently have any unclosed Serious
Untoward Incidents (45 days)?
Does any provider currently have any unclosed Serious
Untoward Incidents (60 days)?
Performance Update:
Provider
No of 45 day
reports due
45 day reports
received in
timeframe
No of 60 day
reports due
60 day reports
received in
timeframe
CDDFT
16
9
0
0
CHSFT
15
12
0
0
NTHFT
3
0
1
0
NEAS
1
1
0
0
TEWV
1
0
0
0
Remedial actions:
The majority of providers nationally continue to experience problems in achieving the 45 and 60 day targets. Breaches are a consequence of
internal governance systems within providers delaying the release of reports to the Commissioner. Performance related activity continues to be
monitored through the serious incident panel and informal 1:1 meetings with providers. The CQRGs are also responsible for formally monitoring
this activity. CCGs have incorporated SI performance into the quality requirements of the 2014/15 contract with providers.
CCG Comments
11
Exception Report QER07 - HCAI
Indicator
Threshold
CCG
CDDFT
CHSFT
NTHFT
Incidence of MRSA
0
2
1
4
0
Incidence of C.Diff
87
73
27
40
30
Performance Update:
MRSA
There is a zero tolerance of MRSA which means that all commissioner and provider targets are zero.
DDES CCG reported 1 case in September and 1 case in January
CDDFT reported 1 case in September
CHSFT reported 1 case in April, August, September and 1 unpublished case in March – 4 in total
NTHFT are reporting zero cases
C.Diff
DDES CCG – 73 cases identified to 31st March against an annual target of 87
CDDFT – 27 cases identified to 31st March against an annual target of 40
CHSFT – 40 cases identified to 31st March against an annual target of 36
NTHFT – 30 cases identified to 31st March against an annual target of 40
Remedial actions:
All breaches are discussed through monthly Clinical Quality Review Group meetings. The post infection review process has been followed for all
identified cases with relevant lessons learnt identified and actions implemented as appropriate.
CCG or Director Comments
12 12
Frequency
Data Period
NEAS
NTHFT
CHSFT
Exception Report
Indicator Description
DDES
DDES CCG - Performance Summary
CDDFT
NHS Constitution Performance Summary
Threshold
Referral to treatment access times
% of patients initial treatment within 18 weeks for admitted pathways
90.0%
92.1%
91.1%
91.1%
92.9%
% of patients initial treatment within 18 weeks for non- admitted pathways
95.0%
98.4%
98.5%
98.2%
98.9%
92.0%
0
93.9%
2
93.5%
1
93.6%
0
97.4%
0
1.00%
0.18%
0.01%
0.32%
0.08%
94.9%
94.4%
96.1%
0
2402
1013
25
0
898
250
3
% patients waiting for initial treatment on incomplete pathways within 18 weeks
Monthly
YTD Feb-14
Number patients waiting more than 52 weeks for treatment
Diagnostic waits
% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology)
Monthly
Mar-14
A&E waits
% patients spending 4 hrs. or less in A&E or minor injury unit
Handover between ambulance and A&E over 30 minutes
w/e 30th Mar-14
Monthly
YTD Mar-14
Handover between ambulance and A&E0ver 60 minutes or more
95.0%
CDDFT ER01
CHS ER01
4537 CDDFT ER02
1318 CHS ER02
Cancer patients 2 week wait
% of patients seen within 2 weeks of an urgent GP referral for suspected cancer
93.0%
95.6%
96.5%
94.3%
94.5%
93.0%
93.4%
94.1%
93.3%
94.7%
% of patients treated within 31 days of a cancer diagnosis
96.0%
98.5%
99.5%
97.8%
99.5%
% of patients receiving subsequent treatment for cancer within 31 days - surgery
94.0%
98.0%
94.0%
97.2%
99.8%
98.2%
99.7%
100.0%
100.0%
99.5%
100.0%
100.0%
98.0%
100.0%
100.0%
85.0%
83.9%
88.2%
85.5%
87.6%
90.0%
85.0%
96.8%
100.0%
91.3%
100.0%
100.0%
95.6%
96.8%
100.0%
71.0%
67.8%
95.0%
93.7%
% of patients seen within 2 weeks of an urgent referral for breast symptoms
Monthly
YTD Mar-14
Cancer patients - 31 days
Monthly
YTD Mar-14
% of patients receiving subsequent treatment for cancer within 31 days - drugs
% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy
Cancer patients - 62 days
% of patients treated within 62 days of an urgent GP referral for suspected cancer
% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service
% of patients treated for cancer within 62 days of consultant decision to upgrade status
Monthly
YTD Mar-14
CHS ER03
DDES ER01
Ambulance response times
Cat A response in 8 mins (red 1&2)
Cat A Response within 19 mins
Number of crew clear delays over 30 mins
YTD Mar-14
Monthly
YTD Mar-14
Number of crew clear delays over 60 mins
78.5%
97.0%
0
10,760
0
555
NEAS ER01
Mixed Sex accommodation
Mixed Sex accommodation - number of unjustified breaches
Monthly
YTD Mar -14
0
0
Monthly
YTD Feb-14
95.0%
97.7%
Weekly
To Mar -14
0
87
2
73
0
0
0
1
27
4
40
0
30
Mental Health
% people followed up within 7 days of discharge from psychiatric in patient care
HCAI
Incidence of MRSA (QP)
Incidence of C Diff (QP) - threshold relates to CCG performance
QER07
13
NHS Constitutional Indicators by month - DDES CCG
Quality Indicator
Operational
Standard
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
YTD
Exception Report No.
Referral to Treatment waiting times for non urgent consultant led treatment
Admitted patients to start treatment within a maximum of 18 weeks from referral
Non-admitted patients to start treatment within a maximum of 18 weeks from referral
Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more
Number of patients waiting more than 52 weeks
Diagnostic test waiting times
90%
95%
92%
0
93.70%
98.90%
95.60%
0
93.20%
98.80%
95.10%
0
92.50%
98.10%
94.40%
0
92.50%
98.30%
93.50%
0
91.60%
98.30%
93.80%
0
92.10%
98.30%
94.10%
1
91.30%
98.50%
94.60%
1
91.30%
98.00%
94.60%
1
91.30%
98.20%
93.80%
0
91.30%
98.20%
94.40%
0
91.80%
98.40%
93.90%
0
Percentage of patients waiting 6 weeks and over
Cancer patients - 2 week wait
1%
0.10%
0.00%
0.00%
0.00%
0.10%
0.40%
0.10%
0.30%
1.10%
0.40%
0.30%
0.18%
93%
96.30%
96.20%
96.10%
96.30%
96.50%
96.50%
94.30%
96.23%
97.10%
93.60%
95.50%
93.90%
95.60%
93%
95.50%
92.00%
93.30%
96.40%
94.90%
89.80%
94.50%
87.28%
92.90%
93.30%
94.50%
95.20%
93.40%
Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers
Maximum 31 day wait for subsequent treatment where that treatment is surgery
Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen
Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy
Cancer waits - 62 days
Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer
96%
94%
98%
94%
98.30%
100.00%
100.00%
100.00%
99.10%
93.50%
100.00%
100.00%
98.20%
100.00%
100.00%
100.00%
97.90%
100.00%
100.00%
100.00%
93.20%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
99.20%
100.00%
96.40%
90.20%
98.50%
100.00%
100.00%
94.28%
100.00%
100.00%
100.00%
95.50%
98.20%
92.90%
98.00%
100.00%
99.20%
100.00%
100.00%
100.00%
99.10%
92.00%
100.00%
100.00%
98.50%
97.20%
99.80%
98.20%
85%
90.00%
89.80%
84.80%
80.50%
80.60%
81.70%
80.30%
84.28%
83.10%
83.70%
81.70%
87.30%
83.90%
Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers
90%
100.00%
100.00%
88.90%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
92.30%
100.00%
85.70%
96.80%
85%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
71%
95%
67.58%
94.25%
68.58%
93.84%
70.71%
96.40%
68.51%
94.76%
67.36%
95.40%
71.55%
94.17%
70.08%
93.75%
69.42%
95.33%
62.45%
91.97%
67.75%
91.87%
66.83%
92.35%
63.17%
90.37%
67.79%
93.68%
0
0
0
0
0
0
0
0
0
0
0
0
0
Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a
GP
Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms
(where cancer was not initially suspected)
Cancer waits - 31 days
Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the
patients (all cancers)
Category A ambulance calls
Category A calls resulting in an emergency reponse arriving within 8 minutes (Red 1&2)
Category A calls resulting in an ambulance arriving at the scene within 19 minutes
Mixed sex accomodation breaches
Minimise MSA breaches
Mental Health
0
92.10%
98.40%
93.90%
2
Care Programme Approach (CPA): The proportion of people under adult mental illness specialities on CPA
95%
100.00%
100.00%
90.48%
97.00%
99.40%
97.30%
98.71%
98.71%
98.05%
98.18%
97.96%
97.12%
97.74%
HCAI Incidence
Incidence of MRSA to 31st March 2014
Incidence of CDIFF to 31st March 2014
0
87
0
6
0
7
0
6
0
7
0
7
1
6
0
8
0
3
0
3
1
6
0
6
0
8
2
73
DDES ER01
NEAS ER01
QER07
NHS Constitutional Indicators by month - CDDFT
Operational
Standard
Referral to Treatment waiting times for non urgent consultant led treatment
Quality Indicator
% of patients initial treatment within 18 weeks for admitted
pathways
% of patients initial treatment within 18 weeks for nonadmitted pathways
% patients waiting for initial treatment on incomplete
pathways within 18 weeks
Number patients waiting more than 52 weeks for treatment
(Incomplete pathways only)
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
YTD
Exception Report
90.00%
91.80%
92.60%
91.90%
91.60%
90.70%
91.70%
90.20%
90.20%
90.20%
90.40%
90.30%
91.10%
95.00%
98.70%
98.90%
98.50%
98.20%
98.90%
98.80%
98.70%
98.00%
98.30%
97.90%
98.40%
98.50%
92.00%
95.70%
95.70%
95.50%
94.90%
94.70%
93.90%
94.40%
93.90%
93.80%
93.70%
93.50%
93.50%
0
0
0
0
0
0
0
1
0
0
0
1
0
Diagnostic test waiting times
Patients waiting for a diagnostic test should have been
waiting less than 6 weeks from referral
1%
0.07%
0.00%
0.04%
0.04%
0.05%
0.19%
0.20%
0.20%
0.70%
0.30%
0.00%
0.01%
95%
91.78%
96.01%
97.64%
97.01%
95.36%
94.73%
93.04%
95.96%
95.68%
92.39%
93.28%
96.58%
94.90%
0
196
166
149
153
159
165
222
147
222
289
278
256
2,402
0
87
39
29
33
62
35
75
62
97
159
129
91
898
93%
97.40%
97.20%
97.30%
96.60%
96.20%
96.20%
97.00%
96.70%
96.70%
94.50%
97.20%
95.30%
96.50%
93%
89.20%
95.30%
96.90%
96.00%
93.50%
92.30%
94.70%
89.80%
95.80%
94.60%
93.30%
96.60%
94.10%
96%
100.00%
100.00%
100.00%
98.40%
98.40%
100.00%
98.60%
100.00%
100.00%
99.40%
100.00%
100.00%
99.50%
98%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
96.90%
100.00%
100.00%
99.70%
94%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
94%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
85%
88.40%
90.00%
88.90%
88.10%
93.40%
88.80%
88.30%
84.60%
85.00%
86.20%
91.00%
87.00%
88.20%
90%
100.00%
100.00%
100.00%
88.90%
100.00%
100.00%
75.00%
50.00%
100.00%
84.60%
100.00%
100.00%
91.30%
85%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
A & E waits
% patients spending 4 hrs. or less in A&E or minor injury
unit to 30th March 2014
Handover between ambulance and A&E over 30 minutes
Handover between ambulance and A&E over 60 minutes or
more
CDDFT ER01
CDDFT ER02
Cancer patients - 2 week wait
% of patients seen within 2 weeks of an urgent GP referral
for suspected cancer
% of patients seen within 2 weeks of an urgent referral for
breast symptoms
% of patients treated within 31 days of a cancer diagnosis
% of patients receiving subsequent treatment for cancer
within 31 days - surgery
% of patients receiving subsequent treatment for cancer
within 31 days - drugs
% of patients receiving subsequent treatment for cancer
within 31 days - radiotherapy
Cancer waits - 62 days
% of patients treated within 62 days of an urgent GP referral
for suspected cancer
% of patients treated within 62 days of an urgent GP referral
from an NHS Cancer Screening Service
% of patients treated for cancer within 62 days of consultant
decision to upgrade status
Mixed sex accommodation breaches
Mixed Sex accommodation - number of unjustified breaches
0
0
0
0
0
0
0
0
0
0
40
0
5
0
2
0
1
0
2
0
1
1
2
0
3
0
2
0
0
0
0
0
0
4
0
2
0
3
1
27
HCAI Incidence
Incidence of MRSA to 31st March 2014
Incidence of CDIFF to 31st March 2014
0
0
QER07
NHS Constitutional Indicators by month - CHSFT
Quality Indicator
Operational
Standard
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
YTD
Exception Report
Referral to Treatment waiting times for non urgent consultant led treatment
% of patients initial treatment within 18 weeks for admitted
pathways
% of patients initial treatment within 18 weeks for nonadmitted pathways
% patients waiting for initial treatment on incomplete
pathways within 18 weeks
Number patients waiting more than 52 weeks for treatment
(Incomplete pathways only)
90.00%
93.30%
91.60%
92.30%
90.60%
91.40%
90.10%
89.90%
90.10%
90.70%
91.50%
90.30%
91.10%
95.00%
99.50%
97.70%
96.90%
98.10%
97.90%
98.00%
97.90%
98.40%
98.60%
98.10%
98.30%
98.20%
92.00%
95.50%
94.30%
93.20%
92.20%
92.00%
93.70%
94.70%
94.80%
94.00%
93.50%
93.60%
93.60%
0
0
0
0
0
0
0
0
0
0
0
0
0
Diagnostic test waiting times
Patients waiting for a diagnostic test should have been
waiting less than 6 weeks from referral
1%
1.66%
0.00%
0.00%
0.00%
0.02%
0.00%
0.00%
0.20%
1.00%
0.50%
0.41%
0.32%
95%
96.48%
93.27%
92.04%
94.37%
94.63%
96.52%
93.92%
94.26%
95.25%
93.24%
93.77%
96.11%
94.40%
0
65
88
81
69
41
32
97
44
82
141
138
135
1,013
0
19
16
41
16
9
5
23
9
20
30
40
22
250
93%
94.00%
93.90%
93.90%
95.60%
95.30%
94.10%
92.50%
94.20%
94.70%
93.20%
94.50%
96.20%
94.30%
93%
97.00%
97.50%
91.40%
93.40%
98.70%
93.30%
95.20%
88.70%
85.40%
90.60%
93.90%
94.50%
93.30%
96%
98.70%
100.00%
100.00%
99.40%
100.00%
98.70%
98.40%
100.00%
98.00%
92.10%
94.30%
95.60%
97.80%
98%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
95.70%
100.00%
100.00%
99.50%
94%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
94%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
85%
91.20%
89.30%
93.00%
89.50%
85.90%
80.10%
89.00%
78.90%
88.90%
83.10%
78.20%
78.50%
85.50%
90%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
85%
100.00%
100.00%
100.00%
100.00%
50.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
95.60%
A & E waits
% patients spending 4 hrs. or less in A&E or minor injury unit
to 30th March 2014
Handover between ambulance and A&E over 30 minutes
Handover between ambulance and A&E over 60 minutes or
more
CHS ER01
CHS ER02
Cancer patients - 2 week wait
% of patients seen within 2 weeks of an urgent GP referral for
suspected cancer
% of patients seen within 2 weeks of an urgent referral for
breast symptoms
Cancer waits - 31 days
% of patients treated within 31 days of a cancer diagnosis
% of patients receiving subsequent treatment for cancer
within 31 days - surgery
% of patients receiving subsequent treatment for cancer
within 31 days - drugs
% of patients receiving subsequent treatment for cancer
within 31 days - radiotherapy
CHS ER03
Cancer waits - 62 days
% of patients treated within 62 days of an urgent GP referral
for suspected cancer
% of patients treated within 62 days of an urgent GP referral
from an NHS Cancer Screening Service
% of patients treated for cancer within 62 days of consultant
decision to upgrade status
Mixed sex accommodation breaches
Mixed Sex accommodation - number of unjustified breaches
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
36
1
4
0
1
0
7
0
3
1
4
1
7
0
3
0
2
0
0
0
2
0
3
1
4
4
40
HCAI Incidence
Incidence of MRSA to 31st March 2014
Incidence of CDIFF to 31st March 2014
QER07
NHS Constitutional Indicators by month - NTHFT
Quality Indicator
Referral to Treatment waiting times for non urgent
consultant led treatment
Admitted patients to start treatment within a maximum of 18
weeks from referral
Non-admitted patients to start treatment within a maximum
of 18 weeks from referral
Patients on incomplete non emergency pathways (yet to start
treatment) should have been waiting no more
Number of patients waiting more than 52 weeks
Diagnostic test waiting times
Patients waiting for a diagnostic test should have been
waiting less than 6 weeks from referral
A & E waits
% patients spending 4 hrs. or less in A&E or minor injury unit
to 30th March 2014
Handover between ambulance and A&E between 30 and 60
minutes YTD
Handover between ambulance and A&E 60 minutes or more
YTD
Operational
Standard
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
YTD
Exception Report No.
90.00%
93.00%
94.73%
92.10%
93.10%
93.20%
92.90%
91.66%
92.90%
93.60%
92.60%
92.90%
92.90%
95.00%
98.91%
99.31%
99.20%
99.10%
99.10%
98.90%
98.91%
98.40%
98.70%
98.50%
98.80%
98.90%
92.00%
97.10%
97.70%
97.20%
97.30%
97.00%
96.80%
97.47%
97.20%
97.00%
97.40%
97.40%
97.40%
0
0
0
0
0
0
0
0
0
0
0
0
0
1%
0.02%
0.02%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.40%
0.20%
0.10%
0.08%
95%
95.12%
97.32%
97.94%
96.55%
94.92%
95.75%
96.22%
95.93%
93.31%
96.15%
97.14%
97.13%
96.13%
0
3
0
0
2
6
0
1
2
2
4
3
2
25
0
0
0
0
0
2
0
0
0
0
0
0
1
3
Cancer patients - 2 week wait
Maximum two-week wait for first outpatient appointment for
patients referred urgently with suspected cancer by a GP
93%
93.70%
94.00%
93.90%
95.70%
94.20%
95.00%
94.50%
94.82%
95.20%
92.10%
94.60%
95.80%
94.50%
Maximum two week wait for first out patient appointment for
patients referred urgently with breast symptoms (where
cancer was not initially suspected)
93%
90.51%
93.00%
93.40%
93.80%
94.40%
96.40%
97.20%
91.72%
95.60%
97.50%
94.10%
95.70%
94.70%
96%
100.00%
99.00%
100.00%
99.40%
100.00%
100.00%
99.30%
99.12%
100.00%
97.40%
100.00%
100.00%
99.50%
94%
90.00%
97.00%
100.00%
100.00%
100.00%
100.00%
94.10%
100.00%
100.00%
94.10%
100.00%
94.70%
98.00%
98%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
94%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
85%
82.54%
84.00%
91.80%
87.60%
88.20%
88.20%
89.10%
87.27%
88.40%
87.20%
84.20%
89.20%
87.60%
Maximum 62 day wait from referral from an NHS screenng
service to first definitive treatment for all cancers
90%
100.00%
98.00%
93.30%
100.00%
100.00%
93.50%
98.50%
100.00%
94.40%
100.00%
86.00%
96.30%
96.80%
Maximum 62 day wait for first definitive treatment following
a consultants decision to upgrade the priority of the patients
(all cancers)
85%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
Cancer waits - 31 days
Maximum one month (31 day) wait from diagnosis to first
definitive treatment for all cancers
Maximum 31 day wait for subsequent treatment where that
treatment is surgery
Maximum 31 day wait for subsequent treatment where the
treatment is an anti-cancer drug regimen
Maximum 31 day wait for subsequent treatment where the
treatment is a course of radiotherapy
Cancer waits - 62 days
Maximum two month (62 day) wait from urgent GP referral to
first definitive treatment for cancer
Mixed sex accommodation breaches
Minimise MSA breaches
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Incidence of MRSA to 31st March 2014
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Incidence of CDIFF to 31st March 2014
40
3
6
1
3
4
4
5
1
0
2
1
0
30
HCAI Incidence
QER07
NHS Constitutional Indicators by month - NEAS
Quality Indicator
Operational
Standard
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
YTD
Exception Report
Category A ambulance calls
Category A calls resulting in an emergency reponse arriving within 8
minutes (Red 1&2)
Category A calls resulting in an ambulance arriving at the scene within
19 minutes
No. of ambulance crews not ready to accept new calls within 30
minutes of handover to A&E (Clearance Time) YTD
No. of ambulance crews not ready to accept new calls within over 60
minutes of handover to A&E (Clearance Time)
Handover between ambulance and A&E over 30 minutes
Handover between ambulance and A&E over 60 minutes or more
75.00%
79.88%
79.22%
81.06%
79.08%
80.16%
80.86%
79.38%
78.88%
75.67%
77.78%
75.60%
74.56%
78.46%
95.00%
97.25%
97.45%
97.79%
97.12%
97.69%
97.77%
97.17%
97.66%
96.20%
96.41%
96.10%
95.43%
96.99%
0
2,365
2,489
2,715
1,688
351
325
139
154
144
152
125
113
10,760
0
105
141
129
80
19
14
12
7
14
15
9
10
555
0
425
371
299
285
286
369
309
407
504
488
531
0
156
91
77
52
75
263
47
101
86
132
197
180
124
4,537
1,318
NHS Constitutional Indicators by month – TEWV / MH
Mental Health Indicators
People seen by Crisis Services before admission
CPA 7 day follow up
The percentage of discharges on CPA who are followed up within 7 days that are
done so on a face to face basis
Delayed transfers of care
IAPT Indicators
Proportion of people that enter treatment against the level of need in the general
population
Proportion of people who complete treatment who are moving to recovery
Operational
Standard
95.00%
YTD
98.44%
95.00%
98.04%
95.00%
97.12%
7.50%
1.14%
Operational
Standard
Exception Report No.
YTD
12.000%
8.23%
50.00%
45.37%
Exception Report No.
MH ER01
18
NEAS ER01
Exception Report CDDFT ER01
Indicator
% of Patients spending 4 hours or less in A&E or urgent care centre
Threshold
CDDFT – YTD Mar-14
95.0%
94.9%
Performance Update
CDDFT were below the target in January ( 92.4%) and February (93.3%), while the performance trend improved during March (96.6%) this wasn’t enough to
achieve the 95% target, and Q4 Performance to week 52 (30th March 2014) is 94.1%. Year end performance is 94.9%.
CDDFT have sustained an improvement in A&E performance since 3rd March. 2014/15 YTD and Q1 performance is 95.5% as at week ending 4th May 2014.
Remedial actions:
CDDFT – The Emergency Care Intensive Support Team (ECIST) visited the Trust in December 2013 and their initial feedback and recommendations included
within the ‘Whole System Letter’ has now been shared. The ECIST recommendations, together with the Trust’s Acute and Long Term Conditions Emergency
Department (ED) Recovery Plan have been considered by the County Durham and Darlington Urgent Care Working Group (UCWG) and agreement has been
reached that the remit of the Front of House Task Force will change to become an ECIST implementation Project Group, accountable to the UCWG.
CCG and NECS colleagues are continuing to support CDDFT to implement the ECIST recommendations.
A working group now meets monthly to review delayed transfers of care. A multidisciplinary team (MDT) pilot is being implemented at specific wards at UHND to
support discharge management processes and following evaluation will be considered for roll out across the Trust.
A bed predictor tool is being developed to improve the management of inpatient beds and a new bed management IT system is being implemented later in 2014.
Visits to other providers have taken place including North Tees & Hartlepool NHS FT ED and Emergency Assessment Unit (EAU) and City Hospitals Sunderland
NHS FT Intermediate Care Beds to learn from examples of good practice.
CDDFT have successfully reviewed and improved their ED Ambulatory and Rapid Assessment & Treatment (RAT) Streams for patients arriving at Emergency
Departments at Darlington Memorial Hospital and University Hospital North Durham. The aim of both streams is to ensure that each patient is seen by the right
clinician in the Emergency Department, first time, every time. Beginning with an initial decision by a Nurse Navigator (senior nurse/doctor), patients are guided to
the most appropriate practitioner for their needs. Successful pilots of this initiative across both hospital sites resulted in full implementation from 1st April 2014.
CCG Chief Officers are continuing to monitor A&E Performance and will re-introduce fortnightly meetings with the Trust and Area Team Chief Executives, to
agree actions if A&E Performance falls below the 95% target.
19
Exception Report CDDFT ER02
Indicator
Threshold
CDDFT – YTD Mar-14
0
2,402
0
898
Handover between ambulance and A&E over 30 minutes
Handover between ambulance and A&E over 60 minutes or more
Performance Update
CDDFT continues to experience consistently high levels of handover delays, resulting in poor performance in relation to the Ambulance handover target. Whilst
Performance in December, January and February remained high, there was a marginal improvement during March. However the provider continues to be an
outlier across the region.
During March 2014, CDDFT are reporting 61.7% of handovers taking place within 15 minutes.
6.2% (256) experiencing 30-60 minute delays and
2.0% (84) experiencing 60-120 minute delays
There were 7 instances where handover delays exceeded 2 hours
Remedial Actions:
The recommendations from a recent jointly commissioned review of handover and turnaround issues (the Pease Report) are taken into account in the Whole
System Unscheduled Care Action Plan. CDDFT have also confirmed their intention to implement “quick win” recommendations from the recent ECIST review
to improve patient flow and reduce pressure ‘Front of House’.
Additional winter monies were allocated to NEAS & CDDFT during 2013/14 to support close management of patient flow from the Ambulance Handover queue
into urgent/emergency care and additional PTS discharge ambulance support for the University Hospital of North Durham to transport patients who are being
discharged from Hospital.
The CDDFT Patient Safety Team have produced all Root Cause Analysis (RCA) reports for ambulance handover delays of 2 hours and over. CDDFT are
required to share these RCA reports with Durham, Darlington and Tees Area Team.
NEAS are providing Hospital Ambulance Liaison Officer (HALO) at UHND to manage ambulance handover delays.
From 1st April 2014, a Senior Nurse or ED Consultant has responsibility for managing ambulance handovers.
CDDFT have successfully reviewed and improved their ED Ambulatory and Rapid Assessment & Treatment (RAT) Streams for patients arriving at Emergency
Departments at Darlington Memorial Hospital and University Hospital North Durham. The aim of both streams is to ensure that each patient is seen by the right
clinician in the Emergency Department, first time, every time. Beginning with an initial decision by a Nurse Navigator (senior nurse/doctor), patients are guided to
the most appropriate practitioner for their needs. Successful pilots of this initiative across both hospital sites resulted in full implementation from 1st April 2014.
20
Exception Report CHSFT ER01
Indicator
% patients spending 4 hrs. or less in A&E or minor injury unit
Threshold
CHSFT – YTD Mar-14
95.0%
94.44%
Performance Update
City Hospitals Sunderland (CHSFT) have continued to experience significant pressures within their A&E department due to an increased number
of ambulance arrivals and more acute Type 1 attendances. Improvements have continued to be made from February onwards with March
reaching 96.22% giving a year to date position of 94.44%.
The Trust attribute this position to the inability to recruit to additional medical and nursing staff in addition to the higher level of acuity patients
presenting.
Remedial actions:
Work continues between Provider and Commissioner to improve this position. Whilst Pallion Health centre is available to redirect patient for
treatment, the acuity of patients presenting means that this is not always possible and has therefore not had the desired impact expected.
CHS are continuing with recruitment plans for both medical and nursing staff and confirm that an additional A&E consultant has been appointed.
The Trust have flagged that recruitment of staff is still the main issue with ensuring the target is achieved.
The Trust met with Sunderland CCG and the Area Team in the week commencing 11th May. It was agreed that CHS would compile a report to
present the current position in terms of A&E generally. This report will be presented to the next QRG (June) and will cover activity comparisons
from 12/13 against 13/14 as well as key quality metrics, what further work needs to be undertaken to assist in performance, narrative against the
measure taken to date and how these have helped i.e. the opening of Pallion etc as well as details around complaints and incidents.
The Trust identified that some Sunderland GP practices were sending patients in via ambulance that could be managed in an alternative setting
and this has been dealt with by Sunderland CCG who are working with practices to resolve this.
21
Exception Report CHSFT ER02
Indicator
Threshold
CHSFT – YTD Mar-14
0
1,013
0
250
Handover between ambulance and A&E over 30 minutes
Handover between ambulance and A&E over 60 minutes or more
Performance Update
City Hospitals Sunderland have experienced significant pressures within their A&E department and have continued to highlight the large volume
of batched ambulance arrivals. The Trust highlighted they had received 28 within a 5 hour period during a week in April. These pressures have
resulted in an increase in the number of ambulance delays.
Although the target has been breached there have been significant improvements in comparison to last year although the volume of ambulance
arrivals have increased. In addition, although performance improved in November there was a spike in handovers waiting over 30 minutes and
60 minutes through December to March. This is being investigated by the Trust.
Remedial actions:
Commissioners are working closely with CHSFT through the Unscheduled Care workstream to identify solutions to the high volumes of activity.
The meeting has representation from a number of organisations including stakeholders from Sunderland and DDES CCG’s, CHSFT and NEAS.
The Trust have implemented a joint action plan with NEAS. GP awareness of ambulance categories has been improved, rapid sign on has been
established, additional staff have been appointed and are awaiting a start date. Further work is ongoing with CHSFT reviewing ED nursing staff
to ensure availability matches the streams in the service and the Trust are working with NEAS to ensure they can feed in directly to specific
services, the governance issues for this are currently being addressed.
Sunderland CCG are working with NEAS, funding two specific schemes to help stream ambulances to alternative dispositions such as Minor
Injury Units, Urgent Care Teams and district nurses etc. These schemes are now operational and work is ongoing with NEAS to understand the
impact. In addition the unscheduled care board are working to allow 7 day discharges, funding additional ambulances to get patients home,
commissioning 7 day working for social workers and a readmissions avoidance team. These have improved delayed transfers of care with the
current delays being the lowest number in years which is improving flow in the Trust.
To ensure focus remains on achieving this target, a specific indicator has been included within the 14/15 CQUIN scheme within which the trust
will be looking to achieve hitting a target based on a local average performance for each quarter.
22
Exception Report CHSFT ER03
Indicator
Threshold
CHSFT – Q4
96.0%
94.0%
85.0%
80.0%
% of patients treated within 31 days of a cancer diagnosis
% of patients treated within 62 days of an urgent GP referral for suspected cancer
Performance Update
City Hospitals Sunderland continue to experience significant pressures within Urology resulting in breaches in cancer waiting times in January,
February and March.
Remedial actions:
CHS have placed the Directorate into internal escalation in order to resolve the ongoing issues. Weekly meetings are held with the Directorate to
look at current waiting times, capacity and breaches.
The Directorate are continuing to utilise all available theatre capacity to reduce inpatient waiting times and have made personnel changes within
the administrative team to enhance scheduling and waiting list management.
Commissioners, working with Sunderland CCG to ensure a joint approach, plan to meet with the Trust at the end of May / start of June to
discuss what further actions can be taken and offer support to explore innovative solutions to resolve the ongoing issues.
23
Exception Report DDES ER01
Indicator
% of patients treated within 62 days of an
urgent GP referral for suspected cancer
Threshold
CCG – Q4
STHFT – Q4
CDDFT – Q4
CHSFT – Q4
NTHFT – Q4
85.0%
84.0%
83.5%
88.0%
80.0%
86.1%
Performance Update:
DDES CCG have failed this target in each of the last 9 months (Jun-Feb). Performance improved in March to 87.3% but the CCG still failed the 4th Qtr overall (84%).
Patient level breach information is not yet available. However there still remain issues in respect of Urology capacity at CHS where patient choice of robotic surgery is causing
delay and Upper GI surgery referrals to Newcastle are also failing to achieve the target.
In 4th Qtr, 26 patients breached the 62 day target in DDES CCG across the following specialties – Breast (1), Lung (7), Gynaecology (2), Upper GI (2), Lower GI (1), Urology (9),
Head & Neck (2) Sarcoma (1) and Skin (1).
CHS and STHT both failed to achieve the 62 day target in 4 Qtr with 80% and 83.5% respectively.
Remedial actions:
South Tees FT has been reviewing a 12 months worth of cancer breaches in an attempt to identify the main themes within those breaching: The themes identified are:
• Late referrals - including those patients that are not fully worked up before being referred
• Patient choice
• Slow pathways (14 day for 2ww and 14 day for diagnostic)
• Complex pathways (more than 1 tumour site or unknown primary).
This analysis is to be used within the Trust to identify what can be done to resolve these issues going forward. In addition to this the Trust is working collaboratively with other
Providers to try and understand cancer pathways further to try and ascertain where changes are required to make a patients journey as efficient as possible.
Although South Tees and Newcastle are liaising regarding how late referrals should be managed, any movement in where the breach should be apportioned does not resolve the
problem. Further work is required to review pathways at a Network level to fully understand how/if pathways can be rationalised to ensure the target is achieved wherever
possible, patient choice not withstanding.
CHS are known to have an internal escalation process in place in respect of Urology. Weekly meetings are in place to discuss current activity, performance, breaches etc and a
copy of their Urology action plan has been requested, along with any other cancer related action plans.
Breaches at a specialty level will be discussed with the Providers through the contract / performance meetings.
CCG or Director Comments
24 24
Exception Report NEAS ER01
Indicator
Red 8 minute response
Threshold
DDES CCG
NEAS
71.0%
67.79%
78.46%
Performance Update:
The North East Ambulance Service (NEAS) continues to meet its regional contract-wide target to achieve response to 75% of Red1 and Red2 calls in 8 minutes
and 95% in 19 minutes. NEAS is not contractually obliged to meet those targets at CCG level. DDES, North Durham and Northumberland CCGs rarely met the
regional 75% target and it was agreed within the 2013/14 contract that NEAS would have a target of 71% R8 for those three CCGs. Local performance for
Quarter 3 & 4 is detailed below.
CCG
NHS North Durham CCG
NHS Durham Dales, Easington
and Sedgefield CCG
NHS Darlington CCG
October 13
69.47%
November 13
71.81%
December 13
65.09%
Quarter 3
68.80%
January 14
68.67%
February 14
66.46%
March 14
62.76%
YTD
70.24%
70.08%
69.42%
62.45%
67.28%
67.75%
66.83%
63.17%
67.79%
84.19%
82.09%
76.36%
80.84%
78.46%
81.84%
77.78%
81.42%
Performance in DDES for March is above historical performance.
Performance is consistent with the seasonal trend experienced in previous years, though performance for the yearend, 67.79%, is above previous years’
performance.
Overall, during March, the 71% level of performance was missed by 113 incidents.
Remedial actions:
Discussions continue with NEAS regarding initiatives to assist performance, including taking action to reduce conveyance rates to hospital and increasing the
number of patients that can be seen and treated by NEAS. The Paramedic/GP 5 minute ring back initiative went live on Monday 2nd December 2013, providing
rapid GP telephone support to paramedics across County Durham and Darlington. Feedback suggests that this initiative is having a positive impact in reducing
the number of patients being conveyed to hospital.
NEAS are also performing significant work to focus on ‘frequent callers’ and identify how these patients can be supported to avoid frequent ambulance call-outs
where possible.
Additional Winter Monies have been allocated to a range of organisations, including NEAS to assist in managing pressures over the winter period.
For 2014/15 and a separate contract for the Durham, Darlington and Tees CCGs is now being negotiated, rather than the current single North-East wide
contract, to allow greater focus on the performance issues that exist in the south of the region.
CCG or Director Comments
25
25
Exception Report MH ER01
Indicator
IAPT - Proportion of people that enter treatment against the level of need in the
general population
IAPT - Proportion of people who complete treatment who are moving to recovery
Threshold
DDES CCG
12.0%
8.23%
50.00%
45.37%
Performance Update:
The proportion of people entering therapy target continues to be underachieved with the YTD figure reported as 8.23% against a target of
12.00% which is a rising trajectory. The number of people moving to recovery has seen a further improvement and the target of 50.0% was
exceeded in March, the reported position was 59.84%.
It should be noted, as previously reported, that the CCG commissions additional talking therapies by way of a counselling service, which are not
included in these figures. Therefore an additional proportion of the local population are receiving treatment above that reported via the IAPT
service. It should be noted that the target for the proportion of people entering therapy is to achieve 15% of an estimated prevalence by 2015.
Remedial actions:
A contract query was issued to the provider following the Quarter 1 contract meeting (1st August 2013).
The information was received within requested deadlines (23rd September 2013)
This data was presented and discussed at an interim contract performance meeting (4th October 2013).
The resulting action was to issue the provider with a formal performance notice requesting improved staffing levels, service promotion, caseload
monitoring and analysis of the number of people not entering therapy from those referred. A remedial action plan was presented and agreed on
29th October and this was distributed to CCG chief officers for information.
The first review of the action plan took place on 8th December and a further reviews have been scheduled.
The year end position has seen the remedial action plan rectifying the mid-year reduction in performance. The target remains unachieved and as
such the performance notice and remedial action plan will remain in place during 2014/15. Some actions have longer term implications, and an
increase in performance is expected from 1st May following the implementation of actions to tackle service user retention on the scheme.
CCG or Director Comments
26
Quality Premium Introduction
The 'quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and the associated
improvements in health outcomes and reducing inequalities. The quality premium paid to CCGs in 2014/15 will reflect the quality of the health
services commissioned by them in 2013/14 and will be based on four national measures and three local measures. It will be a pre-qualifying
criterion for any payment that a CCG manages within its total resources envelope for 2013/14 and does not exceed the agreed level of surplus
drawdown.
The total payment for a CCG based on performance against the four national measures and the three local measures will be reduced if providers
do not meet the NHS Constitutional rights or pledges for patients (RTT 18 week, A&E 4 hr, Cancer 62 day & 8 min Cat A ambulance calls).
The total amount possible for CCGS to receive in achievement of the Quality Premium will be £5 per patient in the CCG, according to the same
formula as the payment of the running cost allowance. For DDES CCG this amounts to £1,439,290.
The following page highlights the indicators against which the quality premium will be determined, together with the relevant financial value
attributed to each indicator and the latest assessment of performance.
27
National and Local Quality Premium Indicators
Quality Premium
Population 287,858
Potential Fund
£1,439,290
DDES
Value
Measure
Achievement
Indicator
Domain 1: Preventing people from dying prematurely
Domain 2&3 : Enhancing quality of life for people with
long term conditions and helping people to recover from
episodes of ill health or following injury
National
Percentage of
Quality Premium
Value for CCG's
Threshold
Reduction 3.2%
between 2012 and 2013
Outcome and
data published
2013 data
Autumn 14
12.5
£179,911
25
£359,823
ISR 13/14 < ISR 12/13 or
ISR 13/14< 1,000 per 100,000 population
12.5
Measure Achieved/Forecast
Eligible QP
Funding
13/14 data unavailable at this stage
£179,911
2013/14 data
Summer 14
All 4 indicators are showing a FOT for
13/14 lower than performance in 12/13
£359,823
£179,911
Implement FFT in Q13/14 and
Increase score between
Q1 13/14 and Q1 14/15
Not yet known
Yes - see outcomes framework for
data - risk as scores dropped
significantly from Q1 to Q2 & Q3. Q4
has shown an improvement and
achieved in all 3 individual months
£179,911
QER05
12.5
£179,911
Zero MRSA and Decrease
C-diff on target
2013/14 data
Summer 14
No - 2 cases of MRSA
0
QER07
Domain 4: ensuring that people have a positive
experience of care
Domain 5: treating and caring for people in a safe
environment and protecting them from avoidable harm.
Value
Measure
Achievement
Indicator
DDES
U75 mortality rate from cancer
Unplanned hospitalisation for asthma, diabetes and
epilepsy in under 19s
Emergency admissions for children with lower respiratory
tract infections
Total
NHS Consitutional rights and pledges
Referral to treatment times (18 weeks - Incomplete) - 92% target
A&E waits - 95% target
Cancer waits - 62 days - 85% target
Category A Red 1 ambulance calls - 75% target
Exception
Report
Percentage of
Quality Premium
Value for CCG's
Threshold
12.5
£179,911
<142.8 per 100,000 population
12.5
£179,911
<395 admissions per 100,000 population
12.5
£179,911
100
£1,439,290
<586 admisisons per 100,000 population
Outcome and
data published
2013 data
Autumn 14
2013 data
Autumn 14
Measure Achieved/Forecast
Eligible QP
Funding
13/14 data unavailable at this stage
£179,911
13-14 - 332.52
£179,911
2013 data
Autumn 14
13-14 - 403.95
£179,911
Exception
Report
£1,259,379
Quality Premium Funding Adjustment
Exception
Report
Measures Achieved/Forecast
Adjustment to funding
Yes - 93.9% to Feb - 14
0%
£0
No - 94.9% to Mar-14
0%
-£314,845
CDDFT ER01
No - 83.9% Mar-14
25%
-£314,845
DDES ER01
Yes - 78.46% to Mar-14
0%
£0
Total Adjustment
-£629,689
Revised Total
£629,689
28
Quality Premium Information
Indicator
Domai n 1: Preventi ng peopl e from dyi ng
prematurel y
Rationale
The overal l ai m of Domai n 1 i s to reduce premature mortal i ty. Thi s ai m i s shared
between the NHS and publ i c heal th frameworks. The contri buti on that can be
del i vered by the NHS i s best measured by potenti al years of l i fe l ost from causes
consi dered amenabl e to heal thcare. CCGs wi l l be abl e to determi ne whi ch aspects of
premature mortal i ty are of greatest rel evance i n thei r l ocal popul ati on.
Value
12.5% of QP
In order to reduce premature mortal i ty wi thi n the popul ati on, CCGs wi l l need to
address the physi cal heal th needs of peopl e wi th mental heal th condi ti ons and
l earni ng di sabi l i ti es.
Thi s i s based on the 10-year average annual reducti on i n
potenti al years of l i fe l ost from amenabl e mortal i ty.
25% of QP
The NHS Outcome Framework contai ns four i ndi cators
measuri ng emergency admi ssi ons for those condi ti ons
(someti mes referred to as ‘ambul atory care sensi ti ve
condi ti ons’) that coul d usual l y have been avoi ded through
better management i n pri mary or communi ty care. These
are i ndi cators 2.3i and 2.3i i focusi ng on chroni c (i e l ong
term) condi ti ons and i ndi cators 3a and 3.2 focusi ng on
acute condi ti ons. For the purpose of the qual i ty premi um
these compl ementary measures are bei ng combi ned to
create a si ngl e composi te measure.
Domai n 4: ensuri ng that peopl e have a
posi ti ve experi ence of care
The Fri ends and Fami l y Test i s a si mpl e, comparabl e test whi ch, when combi ned wi th
fol l ow-up questi ons, provi des a mechani sm to i denti fy poor performance and
encourage staff to make i mprovements where servi ces do not l i ve up to the
expectati ons of pati ents. Thi s l eads to a more posi ti ve experi ence of care for pati ents.
The comparabi l i ty of the data (through the use of a standardi sed questi on and
methodol ogy) wi l l al l ow commi ssi oners to understand overarchi ng l evel s of pati ent
experi ence for the servi ces that they commi ssi on.
12.5% of QP
To earn thi s porti on of the qual i ty premi um, there wi l l need
to be:
1) assurance that al l rel evant l ocal provi ders of servi ces
commi ssi oned by a CCG have del i vered the nati onal l y
agreed rol l -out pl an to the nati onal ti metabl e
2) an i mprovement i n average FFT scores for acute i npati ent
care and A&E servi ces between Q1 2013/14 and Q1 2014/15
for acute hospi tal s that serve a CCG’s popul ati on.
Aggregate responses wi l l be attri buted to CCGs usi ng
central l y avai l abl e data.
Domai n 5: treati ng and cari ng for peopl e i n
a safe envi ronment and protecti ng them
from avoi dabl e harm.
Al though the NHS has made si gni fi cant i mprovement i n recent years i n reduci ng MRSA
bl oodstream i nfecti ons and C. di ffi ci l e i nfecti ons, the rates of reducti ons i n these
i nfecti ons have been greater i n the acute sector than for communi ty onset cases (such
as those acqui red i n care homes). Around hal f the numbers of MRSA and C. di ffi ci l e
i nfecti ons are now communi ty-onset cases. CCGs wi l l have a pi votal rol e to pl ay i n
dri vi ng further i mprovements i n reducti on of heal thcare associ ated i nfecti ons.
12.5% of QP
A CCG wi l l earn thi s porti on of the qual i ty premi um i f:
there are no cases of MRSA bacteraemi a assi gned to the
CCG; and
C. di ffi ci l e cases are at or bel ow defi ned threshol ds for the
CCG.
National
About a thi rd of avoi dabl e admi ssi ons are for peopl e wi th a secondary di agnosi s
rel ati ng to mental heal th. Progress i n reduci ng emergency admi ssi ons i s l i kel y to
need a strong focus on i mprovi ng the physi cal heal th of peopl e wi th mental heal th
condi ti ons.
U75 mortal i ty rate from cancer
Local
To earn thi s porti on of the qual i ty premi um, the potenti al
years of l i fe l ost (adjusted for sex and age) from amenabl e
mortal i ty for a CCG popul ati on wi l l need to reduce by at
l east 3.2% between 2013 and 2014.
Technical Definition
Causes consi dered amenabl e to heal thcare are those from
whi ch premature deaths shoul d not occur i n the presence
of ti mel y and effecti ve heal th care. The concept of
‘amenabl e’ mortal i ty general l y rel ates to deaths under age
75, due to the di ffi cul ty i n determi ni ng cause of death i n
ol der peopl e who often have mul ti pl e morbi di ti es. The
Offi ce for Nati onal Stati sti cs (ONS) produces mortal i ty data
by cause, whi ch excl udes deaths under 28 days. These
i ndi cators therefore rel ate to deaths between 28 days and
74 years of age i ncl usi ve.
To earn thi s porti on of the qual i ty premi um, there wi l l need
to be a reducti on or a zero per cent change i n emergency
admi ssi ons for these condi ti ons for a CCG popul ati on
between 2012/13 and 2013/14, or the Indi rectl y
Standardi sed Rate of admi ssi ons i n 2013/14 i s l ess than
1,000 per 100,000 popul ati on.
Domai n 2&3 : Enhanci ng qual i ty of l i fe for
peopl e wi th l ong term condi ti ons and
hel pi ng peopl e to recover from epi sodes of
i l l heal th or fol l owi ng i njury
Good management of l ong term condi ti ons requi res effecti ve col l aborati on across the
heal th and care system to support peopl e i n managi ng condi ti ons and to promote
swi ft recovery and reabl ement after acute i l l ness. There shoul d be shared
responsi bi l i ty across the system so that al l parts of the NHS i mprove the qual i ty of
care and reduce the frequency and necessi ty for emergency admi ssi ons.
Threshold
12.5% of QP
<395 admissions per 100,000 population
12.5% of QP
25% of
achi eved
Measures
Referral to treatment ti mes (18 weeks) - 90%
target
Data wi l l be avai l abl e by CCGs as provi ders wi l l submi t data on the basi s of the CCG
that i s responsi bl e for a gi ven pati ent.
A&E wai ts - 95% target
Data wi l l be mapped from provi ders to CCGs usi ng a mappi ng deri ved from Hospi tal
Epi sode Stati sti cs fi gures. Thi s cal cul ates what proporti on of each provi der can be
attri buted to a gi ven CCG. Any acti vi ty that i s under 1% of the trust's overal l acti vi ty
wi l l be i gnored i n thi s mappi ng.
The mappi ng wi l l be updated at regul ar i nterval s, wi th the l atest mappi ng bei ng used
to cover the whol e peri od. Onl y organi sati ons submi tti ng on HES wi l l have thei r
acti vi ty mapped to CCGs. Therefore, any type 3 uni ts that do not submi t on HES wi l l
not have thei r si trep data al l ocated to any CCG.
25% of
achi eved
Measures
Cancer wai ts - 62 days - 85% target
Data wi l l be avai l abl e by CCG as provi ders wi l l submi t data on the basi s of the CCG
that i s responsi bl e for a gi ven pati ent.
25% of
achi eved
Measures
Category A Red 1 ambul ance cal l s - 75%
target
<142.8 per 100,000 population
12.5% of QP
Unplanned hospitalisation for asthma,
diabetes and epilepsy in under 19s
Emergency admi ssi ons for chi l dren wi th
l ower respi ratory tract i nfecti ons
4 Constitutional
rights & pledges
Data on C. di ffi ci l e i nfecti ons and MRSA bacteraemi a by
CCG wi l l be publ i shed monthl y.
Pl ease refer to Techni cal Gui dance at the end of thi s
document.
Each CCG wi l l be judged by the performance of the ambul ance trust that serves i ts
geographi c area.
25% of
achi eved
Measures
<586 admisisons per 100,000 population
Achi eved for at l east 92% of pati ents over the course of the
2013/14 year. The posi ti on for 2013-14 wi l l be measured
from the i ncompl ete RTT pathway snapshots (pati ents
wai ti ng to start consul tant-l ed treatment at month end) i n
the monthl y RTT returns from Apri l 2013 to March 2014. The
wai ti ng ti me standard that at l east 92% of pati ents are
wai ti ng wi thi n 18 weeks shoul d be achi eved on average for
the year. Thi s wi l l be cal cul ated by summi ng the numerators
(pati ents wai ti ng wi thi n 18 weeks) from each month end and
then di vi di ng by the sum of al l the denomi nators (pati ents
wai ti ng) from each month end.
Achi eved for at l east 95% of pati ents over the course of the
2013/14 year.
The posi ti on for 2013/14 wi l l be measured from Weekl y
Si tuati on Reports (si treps) and wi l l consi st of data for al l
types of A&E across 52 weeks of si treps from week endi ng 7
Apri l 2013 to week endi ng 30 March 2014.
The number of attendances (numerator) and number of 4
hour wai ts (denomi nator) wi l l then be used to cal cul ate an
overal l percentage for the year.
Achi eved for at l east 85% of pati ents over the course of the
2013/14 year.
Thi s wi l l be cal cul ated by summi ng data for the four
quarters of 2013/14 to produce one annual fi gure agai nst
whi ch the CCG wi l l be assessed.
As the pati ent i s onl y reported i n the peri od they are treated
i rrespecti ve of when thei r pathway of care started, quarters
can be added together.
Achi eved for at l east 75% of pati ents over the course of the
2013/14 year.
The percentage wi l l be cal cul ated by summi ng the
numerator (the number of Category A (Red 1) cal l s resul ti ng
i n an emergency response arri vi ng at the scene of the
i nci dent wi thi n 8 mi nutes) over the 12 months Apri l -March
and al so summi ng the denomi nator (the number of Category
A (Red 1) cal l s resul ti ng i n an emergency response arri vi ng
at the scene of the i nci dent) over the same peri od. The
percentage wi l l then be cal cul ated usi ng the usual
numerator/denomi nator method for the whol e year.
See l i ne CB_B3 i n Everyone Counts: Pl anni ng for Pati ents
2013/14 - Techni cal Defi ni ti ons
See l i ne CB_B5 i n Everyone Counts: Pl anni ng for Pati ents
2013/14 - Techni cal Defi ni ti ons
See l i ne CB_B12 i n Everyone Counts: Pl anni ng for Pati ents
2013/14 - Techni cal Defi ni ti ons
See l i ne CB_B15_01 i n Everyone Counts: Pl anni ng for
Pati ents 2013/14 - Techni cal Defi ni ti ons
DDES CCG - Outcome Framework Indicators
Quality Indicator
Threshold
2010/11
2011/12
2012/13
2009
2010
2011
2012
2013
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
YTD 13-14
13-14 FOT
Exception
Report
Domain 1 - Preventing people from dying prematurely
Under 75 mortality rate per 100,000 from
cardiovascular disease
Under 75 mortality rate per 100,000 from
respiratory disease
Under 75 mortality rate per 100,000 from
liver disease
Under 75 mortality per 100,000 rate from
cancer
Trend
Trend
Trend
Trend
81.2
83.8
89.8
73.0
TBC
35.3
35.1
39.2
39.7
TBC
17.0
19.2
20.5
21.3
TBC
150.6
138.5
145.3
148.1
TBC
Domain 2 - Enhancing quality of life for people with long-term conditions
Unplanned hospitalisation for chronic
Trend
ambulatory care sensitive conditions rate
1,104.9
per 100,000
Unplanned hospitalisation for asthma,
Trend
diabetes and epilepsy in under 19s rate
438.6
per 100,000
Domain 3 - Helping people to recover from ill health or injury
Emergency admissions for acute
conditions that should not usually require
hospital admission
Emergency readmissions within 30 days
of discharge from hospital
Emergency admissions for children with
Lower Respiratory Tract Infections (LRTI)
% of people who enter treatment against
the level of need in the general
population (IAPT)
% of people who complete treatment who
are moving to recovery (IAPT)
1,053.3
1,049.3
85.49
87.89
85.98
83.18
75.76
80.41
85.79
73.54
97.22
91.90
84.77
63.55
903.40
903.40
406.6
447.4
21.46
33.00
29.69
29.68
19.56
41.77
24.88
15.97
32.60
37.70
23.19
23.03
332.52
332.52
1,564.0
1,655.2
133.80 131.91 129.36
127.24
1,372.81
1,372.81
403.95
Trend
1,570.5
Trend
155.80 123.66 125.25 138.68 112.07 119.66 119.89 118.60
0.128
0.133
0.141
0.131
0.131
0.134
0.127
0.137
0.138
0.126
38.77
11.42
15.23
11.17
0.00
6.66
18.19
31.70
160.87
55.50
58.34
25.85
403.95
12%
6.5%
7.4%
7.2%
7.1%
7.0%
7.0%
7.1%
6.9%
5.7%
9.3%
7.5%
7.1%
8.2%
50%
43.0%
43.2% 43.5% 45.1%
45.1%
45.8%
46.2% 50.0%
59.8%
45.4%
Trend
566.7
603.3
497.2
MH ER01
Total Health gain Hip replacement
Trend
0.435
Total Health gain Knee replacement
Trend
0.281
Total Health gain Groin hermia
Trend
0.083
Total Health gain Varicose veins
Trend
0.000
40.3% 43.1% 43.0%
No data available
Domain 4 - Enusring that people have a positive experience of care
FFT Combined Response (CDDFT)
15%
FFT Combined Score (CDDFT)
50
FFT A&E Response (CDDFT)
15%
FFT A&E Score (CDDFT)
50
FFT Inpatient Response (CDDFT)
15%
FFT Inpatient Score (CDDFT)
50
FFT Combined Response (CHSFT)
15%
FFT Combined Score (CHSFT)
50
FFT A&E Response (CHSFT)
15%
FFT A&E Score (CHSFT)
50
FFT Inpatient Response (CHSFT)
15%
FFT Inpatient Score (CHSFT)
50
FFT Combined Response (NTHFT)
15%
FFT Combined Score (NTHFT)
50
FFT A&E Response (NTHFT)
15%
FFT A&E Score (NTHFT)
50
FFT Inpatient Response (NTHFT)
15%
FFT Inpatient Score (NTHFT)
50
Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm
5.6%
66
0.5%
0
15.1%
73
11.7%
83
6.3%
90
24.4%
79
8.0%
57
0.1%
100
18.8
9.0%
72
2.0%
46
20.0%
76
16.0%
80
12.7%
80
24.7%
81
12.1%
61
5.0%
70
21.0%
61
18.0%
62
8.0%
39
38.0%
71
18.0%
76
8.5%
73
43.6%
78
10.7%
73
2.9%
60
22.0%
73
19.0%
57
5.0%
41
47.0%
60
24.0%
79
12.7%
79
43.9%
80
8.8%
63
1.9%
64
19.0%
63
18.0%
44
6.0%
19
43.0%
52
25.0%
78
16.4%
75
39.1%
79
11.9%
61
5.0%
70
18.0%
71
30.2%
31
23.6%
9
43.3%
52
23.5%
78
15.5%
75
35.2%
81
10.2%
69
8.6%
72
12.5%
66
29.6%
29
26.0%
8
36.1%
53
22.4%
75
14.3%
80
33.6%
71
7.8%
67
5.0%
70
11.80%
65
22.9%
36
16.8%
16
33.5%
51
22.0%
78
14.0%
78
33.7%
77
13.5%
66
8.2%
67
20.30%
65
26.7%
30
24.5%
12
30.4%
55
17.5%
82
10.1%
78
28.8%
84
13.1%
66
5.9%
64
22.6%
66
37.0%
51
35.3%
38
39.8%
69
20.0%
80
10.3%
77
37.0%
81
14.5%
72
5.1%
77
26.1%
71
20.4%
52
16.4%
29
27.7%
74
26.0%
75
19.6%
70
38.0%
80
21.4%
67
9.7%
64
37.5%
67
23.00%
58
16.70%
41
35.00%
72
24.40%
79
16.70%
76
38.00%
82
24.40%
66
11.90%
59
43.30%
69
QER05
Healthcare acquired infection (HCAI)
measure (MRSA) to 31st March 2014
0
0
0
0
0
0
1
0
0
0
1
0
0
2
Healthcare acquired infection (HCAI)
measure (clostridium difficile infections)
to 31st March 2014
54
6
7
6
7
7
6
8
3
3
6
6
8
73
QER07
Finance & Activity
Overview
This report provides an update on the position of the contracts held by NHS Durham Dales, Easington and Sedgefield CCG
for the 2013/14 financial year. Finalised performance for the acute contracts is not yet known as the data contained
within this report is based on 11 months freeze and one months flex data.
This report is intended to provide an understanding of the underlying contractual position, without risk share
arrangements applied in order to provide an understanding of the likely impact of current year performance on 2014/15
contract negotiations.
Risk share arrangements are in place for the three largest providers of commissioned services – County Durham and
Darlington FT, North Tees and Hartlepool FT and City Hospitals Sunderland FT.
The County Durham and Darlington FT contract is currently showing a significant over performance at this point in the
year. The risk share arrangement mitigates this overperformance in year, but any overtrade will inform negotiations for
the next financial year.
City Hospitals Sunderland FT and Gateshead FT are both experiencing significant issues with their PAS systems at this
point.
South Tees, Newcastle and BMI Woodlands acute contracts are all overperforming. Patients appear to be exercising
patient choice more frequently in choosing independent sector providers, possibly due to better facilities and waiting
time.
Prescribing costs and Continuing Healthcare are two areas of significant in year risk to the CCG.
The transformation fund is currently significantly underspent.
Referrals data for CDDFT has been included at the end of this section of the QPF for the first time this month. Referrals
into CDDFT are showing a year on year increase at aggregate level.
Finance & Activity
County Durham And Darlington NHS FT Overview
Total Cost Trend for County Durham and Darlington NHS
Foundation Trust
Contract Update
£12,000
•
This contract is risk share for 2013/14. The contract has now been
signed.
£10,000
•
Negotiations are ongoing with the provider for 2014/15. Significant
differences exist between commissioner and provider positions
covering a range of items.
£8,000
£6,000
Plan
Data Issues
Actual
•
Known business rules have been applied to the data. Work is still
ongoing on smaller reconciliation issues. Data is currently being
reconciled at patient record level to resolve the remaining issues.
•
High levels of uncoded data are currently being submitted to SUS
by this provider. Flex data (of which there is one month included in
this report) is potentially understated.
£4,000
£2,000
£Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Financial Performance
Activity (YTD)
Plan
Actual
Plan
POD Summary
Accident and Emergency
40,060
39,326
Elective
23,178
22,682
Non Elective
22,564
22,149
Excess Beddays
7,163
12,694
Outpatient First
64,927
66,686
Outpatient Follow Up
120,047
115,215
Outpatient Procedures
11,902
20,409
Outpatient Diagnostics
0
0
Maternity Pathways
3,714
4,112
Other Cost Per Case Services
0
0
Other Services
2,008,164 2,192,641
Quality Payments
Total before adjustments
£
£
£
£
£
£
£
£
£
£
£
£
£
Penalties
£
Total after penalties
£
Emergency Readmissions
Emergency Threshold
£
Total after adjustments
£
Risk Share Value (benefit)/cost
Total
£000s (YTD)
Actual
£
3,590
21,174
35,279
1,654
8,658
9,180
1,834
3,163
3,470
20,305
2,558
110,865
£
£
£
£
£
£
£
£
£
£
£
£
£
- -£
110,865
£
3,688
21,406
35,542
2,904
8,895
8,900
2,925
3,163
3,387
19,262
2,797
112,870
Variance
£
£
£
£
£
-£
£
£
-£
£
-£
£
£
98
232
263
1,250
238
280
1,091
82
1,042
239
2,005
538 -£
538
£
1,467
1,766 -£
106 -£
1,766
106
£
110,460 -£
405
£
405 £
405
110,865 £
110,865 £
-
- -£
-£
110,865
112,332
•
The underlying position on the contract is £2,005k overspent at the
end of month 12 before readmissions, penalties and threshold
adjustments are applied.
•
No demand plan was agreed with the provider for 2013/14, resulting
in differences in variances reported by commissioner and provider.
•
Pressure areas across the contract include Outpatient procedures
(£1,091k) (mainly ophthalmology) and excess bed days £1,250k
(predominantly general medicine).
•
Referrals are significantly up on 2012/13 (c9.9% in total) across a
number of specialties including dermatology, general surgery,
cardiology and general surgery.
•
Despite ongoing negotiations around new to review ratios as part of
14/15 contracting, the Trust have agreed to progress the new to
review outpatient workstream from commissioning intentions. Initial
meetings are happening in May.
Action Points
•
Continue work around new to review ratios with the Trust
Finance & Activity
City Hospitals Sunderland NHS FT Overview
Total Cost Trend for City Hospitals Sunderland NHS
Foundation Trust
Contract Update
•
£3,500
£3,000
£2,500
Data Issues
£2,000
•
Cost of Risk Share
Benefit of Risk Share
£1,500
Plan
£1,000
This provider is experiencing serious ongoing problems with
its Patient Administration System and data submissions
should be treated as incomplete. The analysis below is
based on the information available.
Financial Performance
£500
£-
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Activity (YTD)
Plan
Actual
POD Summary
Accident and Emergency
Elective
Non Elective
Excess Beddays
Outpatient First
Outpatient Follow Up
Outpatient Procedures
Outpatient Diagnostics
Maternity Pathways
Other Services
Quality Payments
Total
17,203
9,587
6,214
4,582
16,867
56,798
4,018
0
916
146,657
Feb
£000s (YTD)
Actual
Plan
Variance
£
£
£
£
£
£
£
£
£
£
£
£
1,448
8,773
9,773
1,059
2,001
3,405
663
794
807
2,735
788
32,247
-£
-£
-£
£
-£
£
£
-£
-£
-£
£
-£
3
3
922
419
759
1,276
191
0
5
319
124
£
-
£
-
£
-
Total after penalties
£
32,372
£
32,247 -£
124
Emergency Readmissions
Emergency Threshold
£
£
-
£
£
Total after adjustments
£
32,372
Risk Share Value (benefit)/cost
£
•
This contract is underperforming by £124k YTD. This
underperformance is offset by the risk share agreement in
place with this provider. No adjustments have been made
for readmissions or penalties.
•
Key areas of overperformance are within excess bed days
(specifically non elective) within admissions recorded via
A&E (£142k), T&O (£66k) and Geriatric Medicine (£40k).
Outpatient follow ups also show as a pressures area
(£1,275k)
particularly
in
Ophthalmology(c£250k),
Rheumatology (£228k), T&O (£114k) and Physio £427k
(Physio contacts have been recorded with Outpatients, but
the plan sits within ‘other services’ this will be resolved for
14/15 reporting.
•
Key areas of under performance are non elective, outpatient
first and ‘Other services’ – specifically Therapies, Physio and
SALT services.
•
Non elective T&O admissions are significantly below plan
(£284k) as are Nephrology (£319k), Geriatric Medicine
(£467k) and Cardiology (£569k). Admissions recorded via
A&E are significantly over performing (£1,342k) – indicating
a change in the way non elective inpatients have been
recorded is likely.
Mar
1,452
8,776
10,695
640
2,760
2,129
472
794
812
3,054
788
32,372
Penalties
17,549
9,718
6,470
2,760
25,918
26,227
2,618
10,561
918
142,915
Jan
£
£
£
£
£
£
£
£
£
£
£
£
Total
This contract has a risk share arrangement for 2013/14.
Negotiations for 14/15 are ongoing with only minor issues
now preventing contract sign off at time of publication.
-
£
£
-
£
32,247 -£
124
£
124 £
124
32,372 £
32,372 £
-
Finance & Activity
North Tees and Hartlepool NHS FT Overview
Total Cost Trend for North Tees and Hartlepool NHS
Foundation Trust
Contract Update
£3,500
•
£3,000
£2,500
£2,000
Cost of Risk Share
Data Issues
Benefit of Risk Share
£1,500
Plan
•
£1,000
None identified
Financial Performance
£500
£Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Activity (YTD)
Plan
Actual
POD Summary
Accident and Emergency
6,711
Elective
7,639
Non Elective
9,183
Excess Beddays
4,289
Outpatient First
12,434
Outpatient Follow Up
28,863
Outpatient Procedures
3,045
Outpatient Diagnostics
12,102
Maternity Pathways
1,465
Other Cost Per Case Services
0
Other Services
274,110
Quality Payments
Total
6,960
6,385
7,510
3,053
12,199
31,145
2,532
9,590
1,174
0
283,495
£
£
£
£
£
£
£
£
£
£
£
£
£
Jan
Feb
Plan
£000s (YTD)
Actual
657
7,272
12,791
980
1,958
2,405
750
1,208
1,624
5,755.52
836.32
36,236
£
£
£
£
£
£
£
£
£
£
£
£
£
700
7,442
10,648
680
1,909
2,500
634
887
1,317
5,758.92
752.52
33,228
£
£
-£
-£
-£
£
-£
-£
-£
£
£
-£
-£
-
43
171
2,142
300
49
95
117
321
307
3
84
3,009
£
-
£
£
-
£
36,236
£
33,228 -£
3,009
Emergency Readmissions
Emergency Threshold
£
£
- -£
- £
502 -£
- £
502
-
Total after adjustments
£
32,726 -£
3,510
£
3,009 £
3,009
36,236 £
36,236 £
-
£
This contract is underperforming by £3.510m as at M12
flex. This underperformance is offset by the risk share
agreement in place with this provider. The plan for
North Tees & Hartlepool NHS FT was based on 7
months of data from the previous financial year.
•
Key areas of underperformance are Non Elective
(£2.382m), Outpatient Diagnostics (£321k) and
Maternity Pathways (£307k).
•
One area of over-performance is elective admissions
(£180k) over, with orthopaedics accounting for most of
this over-performance..
Variance
Total after penalties
Risk Share Value (benefit)/cost
•
Mar
Penalties
Total
This contract has a risk share arrangement for 2013/14.
However, additional costs of circa £124k have arisen in
respect of specialist respiratory activity, where the
commissioning responsibility has transferred back to
CCGs in 2013/14.
36,236
£
Forecast outturn
•
Specialist respiratory activity is outside of the risk share
and represents an additional cost of circa £124k
including CQUIN (to be confirmed at final M12 freeze).
Finance & Activity
Newcastle Upon Tyne Hospitals NHS FT Overview
Total Cost Trend for Newcastle upon Tyne
NHS Foundation Trust
Contract Update
£600
•
£500
This contract is based on full PbR principles and as
such
any over/underperformance
will
be
a
pressure/benefit to the CCG’s financial position.
Data Issues
£400
•
Actual
£300
Plan
£200
£100
Business rules not yet applied have been identified and
were applied at month 10, these business rules seemed
to be working as expected, ongoing work continues to
ensure that all business rules have been applied
correctly
Financial Performance
£-
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Activity (YTD)
Plan
Actual
POD Summary
Accident and Emergency
Elective
Non Elective
Excess Beddays
Outpatient First
Outpatient Follow Up
Outpatient Procedures
Outpatient Diagnostics
Maternity Pathways
Other Services
Quality Payments
Total
806
1,763
515
438
1,746
5,482
552
1,320
0
304
680
1,705
534
610
1,998
6,304
902
1,602
1
503
Dec
Jan
Mar
£000s (YTD)
Actual
Plan
£
£
£
£
£
£
£
£
£
£
£
£
Feb
71
1,820
1,089
111
270
538
98
157
597
112
4,864
£
£
£
£
£
£
£
£
£
£
£
£
68 -£
2,061 £
1,042 -£
154 £
297 £
489 -£
148 £
187 £
3 £
927 £
121 £
5,497 £
2
241
47
43
27
49
51
30
3
329
9
633
£
-
£
-
£
-
Total After Penalties
£
4,864
£
5,497
£
633
Emergency Readmissions
Non elective threshold adjustment
£
£
64 -£
- £
64
-
Total
£
Risk share arrangements
£
Total after risk share
£
4,864
£
- -£
4,864
£
5,433
£
569
69 -£
69
5,364
Day Cases has over performed by £241k at month 12,
the main HRG Chapters where this is occurring are H
Musculoskeletal System, L Urinary Tract & Male
Reproductive System and Q Vascular Syste,;
•
High Cost Drugs (£125k), ITU (£107k) and Medical
Devices (£65k) are also areas where there has been an
overspend at month 12;
•
Outpatient Procures is an area where over performance
has occurred, the main HRG Chapters where this is
occurring is E Cardiac Surgery and J Skin, Breast &
Burns.
Variance
Penalties
- -£
- £
•
£
500
Finance & Activity
South Tees Hospitals NHS FT Overview
Total Cost Trend for South Tees Hospitals
NHS Foundation Trust
Contract Update
£1,200
£1,000
£800
£600
•
This contract is based on full PbR principles and as such any
over/under performance will be a pressure/benefit to the CCGs
financial position.
•
Contractual penalties such as RTT and ambulance handovers are
built in to the position, as is the CQUIN amounts not achieved.
•
Diagnostic imaging risk shares is built in to the position.
Actual
Data Issues
Plan
•
£400
Work is being carried out with the trust to produce a final
reconciliation of the data for the year end.
Financial Performance
£200
•
The current YTD position is £713k above contract at the end of
month 12 (flex), including readmissions and risk share adjustments.
•
A number of areas are showing pressure on this contract:
•
Other services – drugs (£90k), neurorehab (£175k), ITU (£112k),
HDU (£91k)
•
Non elective are over plan by £202k. Pressures are in: HRG chapter
V – multiple trauma, emergency and urgent care procedures (136K),
H – musculoskeletal (121K), D – respiratory system (72k) and A –
nervous system (51k).
•
Outpatient procedures are over plan by £156k. Pressures are in:
HRG chapter E - cardiac surgery procedures (£66k) and in C –
month, head, neck and ears (£47k).
£-
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Activity (YTD)
Plan
Actual
POD Summary
Accident and Emergency
Elective
Non Elective
Excess Beddays
Outpatient First
Outpatient Follow Up
Outpatient Procedures
Outpatient Diagnostics
Maternity Pathways
Other Services
Quality Payments
Total
1,120
2,856
777
807
4,417
10,452
3,102
1,730
0
917
1,147
2,184
800
949
3,973
11,055
4,042
2,330
22
1,632
Jan
£
£
£
£
£
£
£
£
£
£
£
£
£
Total After Penalties
£
-£
£
Total
£
Risk Share
£
Total
£
Feb
Mar
£000s (YTD)
Actual
Plan
Penalties
Emergency Readmissions
Non elective threshold adjustment
Dec
121
3,400
1,829
188
576
928
431
227
1,842
213
9,756
£
£
£
£
£
£
£
£
£
£
£
£
- -£
9,756
£
53 -£
- £
9,704
£
- -£
9,704
£
Variance
127 £
3,326 -£
2,031 £
226 £
552 -£
1,038 £
588 £
273 £
9 £
2,253 £
217 £
10,639 £
85 -£
10,553
6
75
202
38
24
109
156
46
9
411
4
882
85
£
797
106 -£
- £
53
-
10,448
£
744
31 -£
31
10,416
£
713
Finance & Activity
BMI Woodlands Overview
Total Cost Trend for BMI Woodlands
Contract Update
£250
•
£200
DDES USS pilot is being utilised by many practices.
It’s review will help the CCG to determine if they wish to
formally commission the service.
Data Issues
•
£150
Actual
Financial Performance
Plan
£100
•
Costs are higher than plan in all PODs, particularly
elective lines and daycase. The year end costs are
overspent by £935k.
•
Year to date pressures are within, trauma and
orthopaedics (£201k), pain management (£31k) and
gastroenterology (£23k) for the daycase POD. Within
the elective POD, the pressures are trauma and
orthopaedics (£315k) and gynaecology (£41k).
£50
£Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Activity (YTD)
Plan
Actual
POD Summary
Accident and Emergency
Elective
Non Elective
Excess Beddays
Outpatient First
Outpatient Follow Up
Outpatient Procedures
Outpatient Diagnostics
Maternity Pathways
Other Cost Per Case Services
Other Services, inc Block,
CQUIN, penalties
Quality Payments
Total
Dec
Jan
Feb
Mar
£000s (YTD)
Actual
Plan
None identified
Variance
Forecast Outturn
•
0
518
0
0
650
2,139
58
247
0
0
0
914
0
2
1,314
5,088
231
1,094
0
0
£
£
£
£
£
£
£
£
£
£
922
85
116
11
24
-
£
£
£
£
£
£
£
£
£
£
1,589
0
172
185
57
72
-
£
£
£
£
£
£
£
£
£
£
667
0
86
69
45
48
-
9
0
£
£
£
5
29
1,193
£
£
£
- -£
52 £
2,127 £
5
23
935
The outturn was over plan at year end by £935k.
Action Points
•
The demand file has been set correctly for 2014/15.
Finance & Activity
North East Ambulance Services POD Analysis
Total Cost Trend for North East Ambulance NHS
Foundation Trust
Contract Update
•
£800
This contract is a block, with activity driven element, penalties
and a risk share arrangement
£700
Data Issues
£600
•
£500
Financial Performance
Actual without risk share
£400
•
The activity element of the NEAS contract has over
performing £234k at month 12. This over performance is
taken into account any marginal rates within the contract and
the risk share agreement.
•
£30k of penalties have been issued for Durham Dales,
Easington and Sedgefield CCG.
Plan
£300
£200
£100
£Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Activity (YTD)
Plan
Actual
POD Summary
Block
Calls
Hear and Treat
Neo-Natal
See and Treat
See, Treat and Convey
Marginal rate adjustment
CQUIN
Mar
£000s (YTD)
Actual
Plan
Variance
0
54,908
1,512
64
8,522
32,185
0
0
0
41,372
1,195
0
9,309
31,616
0
0
£
£
£
£
£
£
£
£
£
40 £
275 £
18 £
24 £
1,278 £
6,019 £
- -£
200 £
7,854 £
40
207
14
1,396
5,912
128
208
7,650
£
-£
-£
-£
£
-£
-£
£
-£
68
4
24
118
106
128
8
204
Penalties
Total
0
0
£
£
- -£
7,854 £
30 -£
7,620 -£
30
234
Risk Share Value (benefit)/cost
0
0
£
- £
-
7,854 £
7,620 -£
234
Total
0
£
None identified
Finance & Activity
Tees, Esk and Wear Valleys FT Finance
Annual Budget
£
Budget to
Date
£
Spend to Date
£
Variance
£
Finance
Main Block
CAMHS
IAPT
43,739,638
1,012,099
1,143,312
43,739,638
1,012,099
1,143,312
43,720,972
994,924
1,158,747
-18,666
-17,175
15,435
Total
45,895,049
45,895,049
45,874,643
-20,406
Contract Update
These contract are block.
Data Issues
None.
Financial Performance
As these contracts are block there is no financial risk to the CCG.
Forecast Outturn
The IAPT contract is showing a £15K overspend which is due to a budget shortfall compared to
the agreed contract value.
The Block contract is showing an underspend of £18K as part of the CQUIN was recovered due
to non achievement.
The CAMHS element of the contract is showing an underspend of £17K as the variation for
ASD was amended to charge a fair share to Darlington CCG
Finance & Activity
Tees, Esk and Wear Valleys FT Activity
Annual Target
Activity - Occupied Bed Days
LD - Children & Young People - Intermittent Care Sevices
LD - Specialised Services - Adult Rehab Forensic LD In Patient Services
LD - Working Age Adults - In Patient Assessment & Treatment & Rehab Services
MH - Older Persons - Challenging Behaviou In Patient Services
MH - Older Persons - In Patient Assessment & Treatment Services
MH - Working Age Adults - Locked Rehabilitation and Recovery Unit
MH - Working Age Adults - 24 Hour Nursed Care Services
MH - Working Age Adults - Acute In Patient Services
MH - Working Age Adults - Challenging Behaviour IP Services
MH - Working Age Adults - PICU Services
MH - Working Age Adults - Rehabilitation Services
MH - Working Age Adults - Crisis and Recovery
LD - Working Age Adults - CHC Residential Services
YTD Target
YTD Actual
Variance
654
1,553
2,307
3,981
7,098
0
3,512
9,499
2,290
1,442
2,138
0
0
654
1,553
2,307
3,981
7,098
0
3,512
9,499
2,290
1,442
2,138
0
0
907
883
1,573
2,703
6,971
914
1,633
11,572
2,314
992
1,315
0
0
253
-670
-734
-1,278
-127
914
-1,879
2,073
24
-450
-823
0
0
Total
34,474
34,474
31,777
-2,697
Community Contacts
MH - Adult MH - ADHD
LD - Child LD - Challenging Behaviour Services
LD - Child LD - Specialist LD CAMHS Tier 3 Community Services
LD - Foresnic LD - Adult Forensic Day Services
LD - Adult LD - Autism Team
LD - Adult LD - Challenging Behaviour Team Service
LD - Adult LD - Community Assertive Outreach & Crisis Team
LD - Adult LD - Community LD Team Services
LD - Adult LD - CHC Residential Services
LD - Adult LD - Health Facilitation
LD - Adult LD - Day Services
MH - Childrens & Young Persons Services - Specialist Tier 3 CAMHS Service
MH - Childrens & Young Persons Services - Specialist Tier 2 CAMHS Service
MH - MH Services for Older People - CMHT Services
MH - MH Services for Older People - Acute Liaison Service
MH - MH Services for Older People - YOD Service
MH - Adult MH - Community Intervention (Affective Disorders) Service
MH - Forensic MH - Criminal Justice Liaison & Custody Diversion
MH - Adult MH - Crisis Resolution & Home Treatment Services
MH - Childrens & Young Persons Services - Early Intervention in Psychosis
MH - Adult MH - Primary Care MH Services
MH - Adult MH - Psychoanalytical Psychotherapy Services
MH - Adult MH - Specialist Personality Disorder Service
MH - Adult MH - Adult Eating Disorder Community Team Services
MH - Childrens & Young Persons Services - Community Forensic Services
MH - Childrens & Young Persons Services - Tier 4 Eating Disorder Community Team Services
MH - Adult MH - Assertive Outreach Services
MH - Adult MH - Community Intervention (Psychosis) Services
160
213
4,594
656
650
709
3,484
3,842
10
896
0
14,193
0
45,308
2,224
290
24,474
298
7,655
5,395
2,527
944
0
201
12
302
6,214
17,127
160
213
4,594
656
650
709
3,484
3,842
10
896
0
14,193
0
45,308
2,224
290
24,474
298
7,655
5,395
2,527
944
0
201
12
302
6,214
17,127
176
294
5,494
250
260
860
1,124
1,639
618
658
0
19,222
3
31,218
5,194
642
32,944
308
7,789
4,381
2,448
60
0
1,334
14
472
2,955
21,944
16
81
900
-406
-390
151
-2,360
-2,203
608
-238
0
5,029
3
-14,090
2,970
352
8,470
10
134
-1,014
-79
-884
0
1,133
2
170
-3,259
4,817
142,378
142,378
142,301
-77
Total
Finance & Activity
Northumberland Tyne and Wear NHS FT
Northumberland Tyne & Wear
NHS FT Full Year Overspend
£265k
The activity and finance reports
have been received for Month 12
showing a further increase in the
overspend to £265k over
contract (M11 £249k).
The final outturn for this contract
is an improvement of £6k from
the M11 forecast ( £271k) due to
continued reduced activity in the
Roker unit and a range of smaller
reductions in activity., The
accompanying schedule sets out
the major over and under
spending services.
Finance & Activity
Continuing Care Packages of Care
£000s (YTD)
Actual
Plan
POD Summary
CHC - Management costs
CHC Fast Track
Continuing Care - Joint Packages
Continuing Care - Section 117
Continuing Health Care
Free Nursing Care
Variance
£
£
£
£
£
£
£
529
1,100
2,045
2,078
7,664
2,939
16,355
£
£
£
£
£
£
£
529 £
855 -£
1,962 -£
2,082 £
8,637 £
2,517 -£
16,581 £
245
83
4
972
422
226
Risk Share CHC
£
-
£
352
£
352
Total
£
16,355
£
16,933
£
578
Financial Performance
•
The year end position is showing an overspend of £578k which includes a cost for the risk share arrangement of £352k
•
During the month of March we have been notified of 76 new CHC packages with a cost impact of £870k, 15 new FNC clients with a cost of £26k, 79 deaths and 17
discharges giving an overall reduction in cost of £741k
Action Points
•
The validation of the finance spreadsheet is complete however this has resulted in a number of patient queries which are currently being investigated by the CHC team.
•
Finance staff have received training to enable access to the QA system which is proving very useful in resolving provider queries and will be used to perform regular
validation checks.
Finance & Activity
Continuing Care High Cost Packages and Restitution
CCG
DDES
North Durham
Darlington
Total
•
The above table shows the current calculation for the Risk Sharing scheme resulting in a cost of £352k
Initial requests
319
Number of
Packages
12
12
7
31
High cost packages (>£100k)
% share of cost
of packages per
Total cost of risk share
Risk shared Annual Impact YTD Impact of
packages
agreement
value
of risk share risk share
£ 1,500,245
44.31%
£1,852,601
£352,357
£352,357
£ 1,524,867
35.27%
£1,474,639
-£50,228
-£50,228
£ 1,155,889
20.42%
£853,760
-£302,129
-£302,129
£ 4,181,001
100.00%
£4,181,001
£0
£0
Completed or
removed following
assessment
173
Completed cases
eligible for CHC
8
Payments made to
date for eligible
cases
£119,903
Cases requiring full
needs portrayal
176
Cases completed
and requiring panel
decision
7
•
Based on the latest information available for restitution cases of 319 initial requests 173 have been completed or
closed with 176 remaining in the system for a full assessment. 8 cases have been agreed and 7 cases have
appealed the original decision.
•
During the financial year we have paid £119,903 in reimbursements for 8 cases
•
The current provision stands at £5.3m
Finance & Activity
Mental Health and Learning Disability Packages
Annual Budget
£
Budget to
Date
£
Spend to Date
£
Variance
£
NHS Packages of Care
Non NHS Packages of Care
449,126
1,970,260
449,126
1,970,260
625,457
1,782,235
176,331
-188,025
Total
2,419,386
2,419,386
2,407,692
-11,694
Contract Update
The overspend on the NHS Packages relates to costs associated with the Fulmar and Kirkdale
Wards within TEWV and some individual learning disability placements which TEWV provide.
There was a reduction in the overspend at the year end as a package which had been due to
start in February had still not been finalised by the end of March 2014.
Non NHS Packages of Care were underspent at the end of the financial year. This is in line
with previous months forecasts.
Finance & Activity
Risk Share Impact – CHC, Mental Health and LD Packages
Mental Health
All packages
Total Costs
without Risk Share
DDES
£
1,817,725
North Durham £
897,885
Darlington
£
731,262
Total
£
3,446,872
Total Costs with
Risk Share
£
1,753,720
£
1,095,785
£
597,367
£
3,446,872
Impact of
Risk Share
-£
64,005
£
197,900
-£
133,895
£
0
Number of
Packages
10
3
4
17
High cost packages (>£100k)
% share of cost of
Total cost of
packages as per risk Risk shared
packages
share agreement
value
1,407,066
52.00% £
1,343,062
602,771
31.00% £
800,671
572,973
17.00% £
439,078
£ 2,582,811
100.00% £
2,582,811
Impact of
risk share
-£
64,005
£ 197,900
-£ 133,895
£
0
Number of
Packages
5
0
2
7
High cost packages (>£100k)
% share of cost of
Total cost of
packages as per risk Risk shared
packages
share agreement
value
707,407
62.70% £
620,241
0
18.60% £
183,995
281,813
18.70% £
184,984
£
989,220
100.00% £
989,220
Impact of
risk share
-£
87,166
£ 183,995
-£
96,829
£
-
Number of
Packages
12
12
7
31
High cost packages (>£100k)
% share of cost of
Total cost of
packages as per risk Risk shared
packages
share agreement
value
1,500,245
44.31% £
1,852,601
1,524,867
35.27% £
1,474,639
1,155,889
20.42% £
853,760
£ 4,181,001
100.00% £
4,181,001
Impact of
risk share
£ 352,357
-£
50,228
-£ 302,129
£
-
Number of
Packages
27
15
13
55
High cost packages (>£100k)
% share of cost of
Total cost of
packages as per risk Risk shared
Impact of
packages
share agreement
value
risk share
£ 3,614,718
46.62% £
3,815,904 £ 201,186
£ 2,127,638
27.44% £
2,459,305 £ 331,667
£ 2,010,675
25.93% £
1,477,822 -£ 532,853
£ 7,753,031
100.00% £
7,753,031 £
-
LD
All packages
Total Costs
without Risk Share
DDES
£
800,267
North Durham £
Darlington
£
331,078
Total
£
1,131,344
Total Costs with
Risk Share
£
713,101
£
183,995
£
234,248
£
1,131,344
Impact of
Risk Share
-£
87,166
£
183,995
-£
96,829
£
-
CHC
All packages
Total Costs
without Risk Share
DDES
£
16,003,039
North Durham £
12,880,388
Darlington
£
9,356,683
Total
£
38,240,110
Total Costs with
Risk Share
£
16,355,395
£
12,830,160
£
9,054,554
£
38,240,110
Impact of
Risk Share
£
352,357
-£
50,228
-£
302,129
£
-
Total Packages
All packages
Total Costs
without Risk Share
DDES
£
18,621,031
North Durham £
13,778,273
Darlington
£
10,419,022
Total
£
42,818,326
Total Costs with
Impact of
Risk Share
Risk Share
£
18,822,217 £
201,186
£
14,109,940 £
331,667
£
9,886,170 -£
532,853
£
42,818,326 £
-
Finance & Activity
Community Services – County Durham and Darlington
Se rvice
Community Nursing
2013/14
Activity
Change
since
1213 (%)
Contract Update
296,374
+10.2%
Integrated Children's Services
100,459
Urgent Care
118,731
Community Hospitals
Intermediate Care
Podiatry
Podiatric Surgery
Community Rehabilitation
23,648
2,526
24,896
4
43
Palliative/End of Life Care
25,875
Coronary Heart Disease
Home Equipment Loans
Physiotherapy
Continence
Pain Management
22,346
31,068
697
3,318
166
W heelchair Service
1,961
Adult SALT
Primary Care Psychology
Paediatric Occupational Therapy
Musculo Skeletal
Dermatology (Tier 2)
2,209
69
2,698
413
5,031
Nutrition & Dietetics
2,115
+1.7%
-1.4%
+17.8%
+11.9%
-78.9%
-4.5%
+10.0%
-2.1%
+13.4%
+13.0%
+14.8%
+10.4%
+2.2%
-0.2%
+14.6%
-8.0%
+24.3%
+29.6%
-38.6%
Diabetes Type 2
Paediatric Physiotherapy
GP Choices & Occupational Health
Paediatric SALT
Occupational Therapy
COPE
Falls & Osteoporosis
Retinal Screening
CFS/ME
Tissue Viability
Neurological Services (Epilepsy)
Neurological Services (MS)
Stroke
Respiratory Services
Vasectomy
Lymphoedema
Older peoples urgent care assessment
Orthotics
Enteral Feeding
Childrens Equipment in the Community
TB Contact Tracing Service
Minor Surgery
388
1,716
+14.4%
+42.1%
7,073
13,868
1
8,335
6,937
606
2,050
289
1,552
4,099
1,797
44
1,047
4
7
1,076
241
298
•
+9.2%
-100.0%
+42.0%
+1.5%
+6.2%
+141.3%
+26.1%
+5.9%
+39.8%
+10.1%
-4.7%
+20.4%
-37.0%
-48.0%
+40.1%
+29.4%
-94.6%
+33.1%
+1.3%
+51.9%
-60.5%
This is a risk share contract. Most elements of this contract are block,
with the exception of Urgent Care. Urgent care overperformance is
built into the block value for 2013/14
Data Issues
•
We have now received activity for this contract.
Financial Performance
•
The contract for this year is 100% risk share, so there will be no
variance from plan.
•
The percentage change since 2012/13 shows the change for North
Durham, DDES & Darlington as the data from previous years is not
split by CCG.
•
Overall, activity is up by 7% against the previous year’s figures.
Forecast Outturn
•
The contract will breakeven this year
Finance & Activity
DDES CCG - Non NHS Community Contracts - Financial Performance
FOT
Annual Budget
FOT Variance
Service
£
£
£
Alternative Therapies
30,788
68,520
-37,732
Anti Coag
692,905
737,000
-44,095
Audiology
691,202
648,000
43,202
Children's OT
141,633
99,660
41,973
Diagnostics
50,656
0
50,656
DVT
44,200
0
44,200
Healthcare at Home
51,189
148,110
-96,921
Home Oxygen
115,092
107,661
7,431
Minor Surgery
77,294
45,732
31,562
Ophthalmology
83,800
82,474
1,326
Orthotics
70,037
20,900
49,137
Physio
165,537
17,188
148,349
Podiatry
27,621
0
27,621
Stroke
96,149
35,298
60,851
Vasectomy
56,707
52,505
4,202
Care for the Elderly
966,880
1,220,800
-253,920
Gynae
0
20,897
-20,897
Liquid nitrogen
0
8,820
-8,820
CHD
0
26,982
-26,982
OOH
0
926
-926
ENT
0
44,238
-44,238
Oral Surgery Contract
0
346,633
-346,633
Child Cases
52,163
52,163
0
Urology
16,756
32,718
-15,962
ANP
420,000
420,000
0
Nursing Home Patients
9,506
0
9,506
Intrahealth Darzi Ctre
762,000
0
762,000
4,622,115
4,237,225
384,890
Hospice Services - Financial Performance
FOT
Annual Budget
Service
£
£
Butterwick Hospice
267,515
Willowburn Hospice
277,917
St Teresa's Hospice
271,381
894,413
Marie Curie
390,066
712,454
St Cuthbert's Hospice
316,788
316,788
St Benedicts Hospice
138,324
138,325
Hartlepool Hospice
232,921
232,921
Other
672
0
1,895,584
2,294,901
FOT Variance
£
-77,600
-322,388
0
1
0
672
-399,315
Non NHS Community Services
Services continue to operate on trend as previously
reported and illustrate a £385k potential forecast
outturn variance.
A large overspend is anticipated on the Intrahealth
Walk in Centre contract where no budget has been
identified. This is eased by underspends on Oral
Surgery, ENT, Gynae, OOH, CHD and Healthcare at
Home.services.
A significant overspend is anticipated on Children’s
OT however this service is currently out for
procurement which should drive savings and
improve service quality.
Hospice Services
Hospice Services continue to operate on trend with
Marie Curie and St Teresa’s continuing to show
forecast outturn underspends as previously
reported.
Finance & Activity
Primary Care - Prescribing
Financial Performance
Cost per weighted head of
poulation
Cost per weighted head of population by locality
£14.50
£14.00
£13.50
£13.00
£12.50
£12.00
£11.50
£11.00
£10.50
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
•
10 months of data is now available for prescribing.
•
Prescribing costs per head of weighted population
has increased since 2012/13 across all localities.
•
Costs relating to services commissioned by other
public bodies (substance misuse, smoking
cessation etc.) are still included within the
prescribing numbers, agreement on levels of
recharging to LA has been reached with the result
that only LARC cost will be funded by the LA.
•
The latest forecast outturn from the PPA indicates
that GP Practice prescribing will amount to
£52,821k driving an overspend in 2013/14 of
£3,887.
•
The overall prescribing forecast outturn is
anticipated to amount to £55,532k with an
overspend of £3,658k in 2013/14.
Durham Dales £12.6 £12.8 £11.9 £13.2 £12.4 £12.6 £13.8 £12.6 £13.8 £12.8
Easington
£12.8 £13.3 £12.3 £13.7 £13.1 £12.7 £14.0 £13.2 £14.0 £13.7
Sedgefield
£12.5 £13.1 £11.7 £13.3 £12.6 £12.4 £13.7 £12.5 £12.9 £12.8
Prescribing M10 YTD Costs per Weighted List Size by Locality
£140.00
Cost per weighted list size
£120.00
£100.00
£80.00
£60.00
£40.00
£20.00
£-
Durham Dales
Easington
Sedgefield
13/14 Cost per Weighted List Size
£128.84
£133.24
£128.03
12/13 Cost Per Weighted list Size
£123.78
£125.48
£122.82
Finance & Activity
Primary Care – Prescribing – Durham Dales
Cost per Weighted List Size
A83021
Durham Dales
AUCKLAND MEDICAL GROUP
Year to Date
Costs
£ 2,174,826
A83046
BARNARD CASTLE SURGERY
£ 1,297,708
11,256 £
115.29 £
113.75
5
A83025
BISHOPGATE MEDICAL CENTRE
£ 2,153,447
16,109 £
133.68 £
123.00
5
A83032
COCKFIELD SURGERYTHE SURGERY
£
371,443
3,002 £
123.72 £
122.36
5
Y00643
DALES SUBSTANCE MISUSE
£
-
0 £
-
£
-
Y00866
DURHAM DALES DERMATOLOGY
£
13,791
0 £
-
£
13.59
Y01792
£
6,249
0 £
-
£
-
A83626
DURHAM DALES MEDICAL
PRACTICE MEDICAL PRACTICE
EVENWOOD
£
358,314
2,429 £
147.54 £
140.03
5
A83061
GAINFORD SURGERYMAIN ROAD
£
389,714
3,713 £
104.95 £
100.09
5
A83020
NORTH HOUSE SURGERYNORTH
£ 2,043,975
HOUSE
SURGERY
OLD
FORGE
SURGERYTHE SURGERY £ 414,494
PALLIATIVE CARE CLINIC
£
14
PINFOLD MEDICAL PRACTICE
£ 415,158
15,055 £
135.77 £
125.37
5
3,127 £
132.56 £
129.66
5
A83043
Y00017
A83060
£
A83015
RICHARDSON COMMUNITY
HOSPITALVIEW MEDICAL CENTRE
STATION
A83035
THE WEARDALE PRACTICE
£
Y00943
URGENT CARE CENTRE/DAYTIME
Y02352
WEARDALE COMMUNITY
HOSPITAL
WILLINGTON MEDICAL GROUP
Y02115
A83003
Total
Weighted List
Movement
Size
YTD Cost 2013/14 YTD Cost 2012/13
vs 12/13
15,438 £
140.87 £
134.84
5
0 £
3,460 £
-
£
119.99 £
-
£
113.12
5
9,141
0 £
£ 1,560,097
12,025 £
129.74 £
125.64
5
961,347
9,104 £
105.60 £
101.40
5
£
135
0 £
-
£
-
£
7,189
0 £
-
£
-
£ 1,364,869
£ 13,541,911
10,388 £
105,106 £
131.39 £
128.84 £
-
121.47
123.78
5
5
Finance & Activity
Primary Care – Prescribing – Easington
Cost per Weighted List Size
A83041
A83075
A83616
A83017
A83042
A83004
A83007
A83019
A83619
Y02203
Y03574
Y02614
A83068
A83051
Y01014
A83057
A83627
A83044
A83071
A83012
A83610
Easington
DR D S RANGAR & PARTNERS
DR KV REDDY
DR M D RAMAKRISHNA GUPTA
DR MAHTO & PARTNERS
DR. C.P. FAIRLAMB & PARTNERS
DR. K R KAPOOR & PARTNER
DR. P. BURRELL & PARTNERS
DR. R.G. ABBOTT AND DR. PATEL
DR. S H S MANSOUR
EASINGTON DERMATOLOGY
CLINIC
HAWTHORNS
SPINAL UNIT
INTRAHEALTH AT HEALTHWORKS
JUPITER HOUSE
MARLBOROUGH SURGERY
PALLIATIVE CARE MEDICINE
SHINWELL MEDICAL GROUP
SILVERDALE FAMILY PRACTICE
THE HORDEN GROUP PRACTICE
THE NEW SEAHAM MEDICAL
GROUP BROWN CENTRE
WILLIAM
WINGATE MEDICAL PRACTICE
INTRAHEALTH
Total
Year to Date
Costs
£ 1,434,243
£ 773,978
£ 388,531
£ 1,175,790
£ 675,696
£ 469,637
£ 1,570,661
£ 844,803
£ 410,209
£
4,112
£ 136,809
£ 133,679
£ 368,539
£ 1,746,127
£
3
£ 929,102
£ 626,138
£ 1,114,007
£ 618,690
£ 2,449,157
£ 412,756
£ 16,282,667
Weighted List
Size
9,513
5,748
3,059
10,025
6,495
4,200
11,342
6,536
3,261
0
0
885
2,510
12,107
0
6,263
4,508
7,638
5,810
18,859
3,448
122,208
YTD Cost 2013/14
£
150.77
£
134.65
£
126.99
£
117.29
£
104.04
£
111.81
£
138.48
£
129.25
£
125.80
£
£
£
151.00
£
146.82
£
144.22
£
£
148.34
£
138.90
£
145.85
£
106.48
£
129.87
£
119.70
£
133.24
YTD Cost 2012/13
£
139.84
£
131.65
£
122.97
£
110.92
£
119.21
£
113.46
£
132.14
£
116.63
£
110.47
£
£
£
114.96
£
139.82
£
136.70
£
£
143.55
£
119.01
£
123.91
£
104.00
£
120.89
£
114.43
£
125.48
Movement
vs 12/13
5
5
5
5
6
6
5
5
5
5
5
5
5
5
5
5
5
5
5
Finance & Activity
Primary Care – Prescribing – Sedgefield
Cost per Weighted List Size
A83066
A83037
A83638
A83054
A83045
A83603
A83052
A83008
A83074
Y03525
A83001
A83634
Year to Date
Sedgefield
Costs
£ 1,116,315
JUBILEE MEDICAL GROUP
£ 2,130,858
BEWICK CRESCENT SURGERY
£ 220,831
DR.BALIGA
£ 1,946,142
DR.JONES & PARTNERS
£ 2,433,434
DR.OAKENFULL & PARTNERS
£ 380,819
DR.ROY
£ 1,397,656
DR.WOOD & PARTNERS
£ 992,922
HALLGARTH SURGERY
£ 1,525,819
PEASEWAY MEDICAL CENTRE
£
103
SEDGEFIELD ASSESSMENT UNIT
£
1,401,389
ST ANDREW'S MEDICAL PRACTICE
£ 476,346
WEST CORNFORTH MEDICAL
Total
£ 14,022,634
Weighted List
Size
9,094
16,081
1,739
18,514
17,196
2,916
9,827
7,127
12,350
0
11,501
3,182
109,527
YTD Cost 2013/14
£
122.76
£
132.51
£
126.96
£
105.12
£
141.51
£
130.59
£
142.23
£
139.31
£
123.55
£
£
121.85
£
149.70
£
128.03
Movement
YTD Cost 2012/13
vs 12/13
£
117.00
5
£
127.40
5
£
100.46
5
£
95.92
5
£
136.77
5
£
127.46
5
£
134.60
5
£
134.03
5
£
118.93
5
£
£
127.29
6
£
142.47
5
£
122.82
5
Finance & Activity
Referrals – CDDFT
The following slides shows referrals made by GPs and others of NHS Durham Dales, Easington and Sedgefield (DDES) CCG
patients to County Durham & Darlington NHS Foundation Trust (CDDFT)
Referrals reported here include only those for 'General and acute specialities' as defined for the Monthly Activity Returns
(MAR) and therefore excludes referrals to Obstetrics, Neuropsychology, Physiotherapy, Allied Health Professional Episodes,
Podiatry, Dietetics and Orthoptics
DDES practices make a significant number of referrals to providers other than CDDFT, particularly practices in Easington
(and also Dr Jones & Partners in Sedgefield) tending to refer to Sunderland, Hartlepool and North Tees. Users should be
aware that looking only at CDDFT referrals will not always provide a complete picture, particularly for these areas. Referrals
information has been requested from other providers to allow more complete monitoring of referrals but Sunderland has
confirmed that this will be unavailable for 2013/14 due to problems with their information systems.
52
Finance & Activity
Referrals - CDDFT
Only those specialties which have seen an increase or decrease of at least five GP referrals are shown in
this chart.
Finance & Activity
Referrals - CDDFT
Caveats - Date in this pack is sourced
from local unvalidated datasets.
Referrals include only those for
'General and acute specialties' as
defined for the Monthly Activity
Returns (MAR) and therefore exclude
referrals into Obstetrics,
Neurophysiology, Physiotherapy,
Allied Health Professional Episodes,
Podiatry, Dietetics and Orthoptics.
April - January
1213 YTD
1314 YTD
Variance
%Change YTD
General and Acute referrals by source
Other Source
GP / GDP
Total
27340
16851
44191
30039
18026
48065
+2699
+1175
+3874
+9.9%
+7.0%
+8.8%
Finance & Activity
Referrals - CDDFT
The funnel chart below shows referral rates for DDES practices for all General and Acute specialties during the 12 months to
January 2014. Easington practices and Dr Jones & Partners, Sedgefield are excluded as CDDFT is not their main OP provider.
NB – with the large number of referrals made it is possible to identify that most practices are
statistically above or below average at 95% significance in their referrals rate to CDDFT.
Glossary
CONSTITUTIONAL INDICATORS
Measure(s)
Referral to treatment access times
% of patients initial treatment within 18 weeks for Admi tted pati ents to s tart treatment wi thi n a maxi mum of 18 weeks from
admitted pathways
referral
% of patients initial treatment within 18 weeks for Non-admi tted pati ents to s tart treatment wi thi n a maxi mum of 18 weeks from
non- admitted pathways
referral
% patients waiting for initial treatment on
Pati ents on i ncompl ete non emergency pathways (yet to s tart treatment)
incomplete pathways within 18 weeks
s houl d have been wai ti ng no more than 18 weeks
Number patients waiting more than 52 weeks for
Number of 52 week Referral to Treatment Pathways
treatment
Diagnostic w aits
% patients waiting less than 6 weeks for the 15
Pati ents wai ti ng for a di agnos ti c tes t s houl d have been wai ti ng l es s than 6
diagnostics tests (including audiology)
weeks from referral
A&E w aits
% patients spending 4 hrs. or less in A&E or
Pati ents s houl d be admi tted, trans ferred or di s charged wi thi n 4 hours of thei r
minor injury unit
arri val at an A&E department
Handover between ambulance and A&E over 30
The number of handover del ays of over 30 mi nutes /1 hour
minutes
Threshold
Green: Greater than or equal to 90%
Red: less than 90%
Green: Greater than or equal to 95%
Red: less than 95%
Green: Greater than or equal to 92%
Red: less than 92%
Green is zero
Red is more than zero
Green: less than or equal to 1%
Red: greater than 1%
Green: Greater than or equal to 95%
Red: less than 95%
0
Handover between ambulance and A&E0ver 60
minutes or more
% of patients seen within 2 weeks of an urgent
GP referral for suspected cancer
% of patients seen within 2 weeks of an urgent
referral for breast symptoms
% of patients
cancer within
% of patients
cancer within
% of patients
cancer within
% of patients
diagnosis
receiving subsequent treatment for
31 days - surgery
receiving subsequent treatment for
31 days - drugs
receiving subsequent treatment for
31 days - radiotherapy
treated within 31 days of a cancer
Cancer patients 2 w eek w ait
Maxi mum two-week wai t for fi rs t outpati ent appoi ntment for pati ents
referred urgentl y wi th s us pected cancer by a GP
Maxi mum two week wai t for fi rs t out pati ent appoi ntment for pati ents
referred urgentl y wi th breas t s ymptoms (where cancer was not i ni ti al l y
s us pected)
Cancer patients - 31 days
Maxi mum one month (31 day) wai t from di agnos i s to fi rs t defi ni ti ve
treatment for al l cancers
Maxi mum 31 day wai t for s ubs equent treatment where that treatment i s
s urgery
Maxi mum 31 day wai t for s ubs equent treatment where the treatment i s an
anti -cancer drug regi men
Maxi mum 31 day wai t for s ubs equent treatment where the treatment i s a
cours e of radi otherapy
Cancer patients - 62 days
Maxi mum two month (62 day) wai t from urgent GP referral to fi rs t defi ni ti ve
treatment for cancer
Maxi mum 62 day wai t from referral from an NHS s creenng s ervi ce to fi rs t
defi ni ti ve treatment for al l cancers
% of patients treated within 62 days of an urgent
GP referral for suspected cancer
% of patients treated within 62 days of an urgent
GP referral from an NHS Cancer Screening
Service
% of patients treated for cancer within 62 days of Maxi mum 62 day wai t for fi rs t defi ni ti ve treatment fol l owi ng a cons ul tants
consultant decision to upgrade status
deci s i on to upgrade the pri ori ty of the pati ents (al l cancers )
Ambulance response times
RED 1 response in 8 mins
Cal l s res ul ti ng i n an emergency repons e arri vi ng wi thi n 8 mi nutes (Red 1)
RED 2 response in 8 mins
Cal l s res ul ti ng i n an emergency repons e arri vi ng wi thi n 8 mi nutes (Red 2)
Green: Greater than or equal to 93%
Red: less than 93%
Green: Greater than or equal to 93%
Red: less than 93%
Green: Greater than
Red: less than 96%
Green: Greater than
Red: less than 94%
Green: Greater than
Red: less than 98%
Green: Greater than
Red: less than 94%
or equal to 96%
or equal to 94%
or equal to 98%
or equal to 94%
Green: Greater than or equal to 85%
Red: less than 85%
Green: Greater than or equal to 90%
Red: less than 90%
Green: Greater than or equal to 85%
Red: less than 85%
Frequency
Quality Premium
Link
Monthl y
Nati onal
Monthl y
Nati onal
Monthl y
Nati onal
Monthl y
Monthl y
Weekl y
Monthl y
Monthl y
Monthl y
Monthl y
Monthl y
Monthl y
Monthl y
Monthl y
Nati onal
Monthl y
Nati onal
Monthl y
Nati onal
Monthl y
Nati onal
Green: Greater than or equal to 75%
Red: less than 75%
Local Target Threshold Green: Greater than or
equal to 72%
Green: Greater than or equal to 75%
Red: less than 75%
Monthl y
Cat A Response within 19 mins
Number of crew clear delays over 30 mins
Category A cal l s res ul ti ng i n an ambul ance arri vi ng at the s cene wi thi n 19
mi nutes
Crew cl ear del ays of over 30 mi nutes /1 hour
Local Target Threshold Green: Greater than or
equal to 72%
Green: Greater than or equal to 95%
Red: less than 95%
0
Number of crew clear delays over 60 mins
Mixed Sex accommodation - number of
unjustified breaches
% people followed up within 7 days of discharge
from psychiatric in patient care
Mixed Sex accommodation
The number of MSA breaches for the reporti ng month i n ques ti on
Mental Health
Care Programme Approach (CPA): The proporti on of peopl e under adul t
mental i l l nes s s peci al i ti es on CPA
Nati onal
Monthl y
Monthl y
Green: zero
Red: more than zero
Monthl y
Green: Greater than or equal to 95%
Red: less than 95%
Monthl y
Glossary
OUTCOMES FRAMEWORK INDICATORS
Measure(s)
Under 75 mortality rate from cardiovascular
disease
Under 75 mortality rate from respiratory disease
Domain 1 - Preventing People from dying prematurely
Mortality rate from cardiovascular disease, ages under 75, per 100,000
population
Mortality rate from respiratory disease, ages under 75, per 100,000
population
Mortality rate from liver disease, ages under 75, per 100,000 population
Under 75 mortality rate from liver disease
Under 75 mortality rate from cancer
Mortality rate from cancer, ages under 75, per 100,000 population
Threshold
Frequency
Trend
Annually
Trend
Annually
Trend
Annually
Trend
Annually
Domain 2 - Enhancing Quality of life for people with long term conditions
The proportions of people with chronic conditions admitted to hospital as an
Unplanned hospitalisation for chronic ambulatory emergency admissions
Trend
care sensitive conditions
Unplanned hospitalisation for asthma, diabetes
and epilepsy in under 19s
Emergency admissions for acute conditions that
should not usually require hospital admission
Emergency readmissions within 30 days of
discharge from hospital
Rate of emergency admissions episodes in people under 19 (0-18 years) for
asthma, diabetes or epilepsy per 100,000 population
Domain 3 - Helping people to recover from ill health or injury
Emergency admissions to hospital of persons with acute conditions
(ear/nose/throat infections, kidney/urinary tract infections, heart failure,
among others) that usually could have been avoided through better
management in primary care
Percentage of emergency admissions to any hospital in England occuring
within 30 days of the last, previous discharge from hospital after admission
Mothly via
Hospital Episode
Statistics
Trend
Mothly via
Hospital Episode
Statistics
Trend
Mothly via
Hospital Episode
Statistics
Emergency admissions to hospital of children with selected types of Lower
Respiratory Tract Infections (bronchiolitis, bronchopneumonia and
Trend
pneumonia)
% of people who enter treatment against the level % of people who enter treatment against the level of need in the general
Green: Greater than 12%
of need in the general population (IAPT)
population
% of people who complete treatment who are
% of people who complete treatment who are moving to recovery
Green: Greater than 50%
Total Health gain Hip replacement
Patient reported outcome measure for elective procedures
Trend
Total Health gain Knee replacement
Trend
Total Health gain Groin hermia
Trend
Total Health gain Varicose veins
Trend
Domain 4 - Enusring that people have a positive experience of care
Test will measure whether people recievieving NHS treatment would
Green: Greater than 15% response rate
FFT Combined Response
recommend the place where they received care to their friends and family.
Green: Greater than 50 satisfaction score
FFT Combined Score
Green: Greater than 15% response rate
FFT A&E Response
Green: Greater than 50 satisfaction score
FFT A&E Score
Green: Greater than 15% response rate
Local (12.5% or
Quality premium)
Mothly via
Hospital Episode
Statistics
Trend
Emergency admissions for children with Lower
Respiratory Tract Infections (LRTI)
Quality Premium
Link
Mothly via
Hospital Episode
Statistics
Local (12.5% or
Quality premium)
Local (12.5% or
Quality premium)
Monthly
Monthly
Annually
Annually
Annually
Annually
Monthly
National
Monthly
National
Monthly
National
Monthly
National
Monthly
National
Monthly
National
Weekly
National
Weekly
National
FFT Inpatient Response
Green: Greater than 50 satisfaction score
FFT Inpatient Score
Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm
Healthcare acquired infection (HCAI) measure
Number of cases of Methicillin-resistant Staphylococcus aureus (MRSA)
Green: zero cases
(MRSA)
bacteraemia
Red: Greater than zero
Healthcare acquired infection (HCAI) measure
Number of Clostidium difficile infections, for patients aged 2 or more on the
Green: less or equal to target
(clostridium difficile infections)
date the specimen was taken
Red: greater than target

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