Transcript Slide 1

Merton CCG
Balanced Scorecard
Month 9 – 2014/15
Performance Summary
Are patient’s rights under the NHS Constitution being promoted?
 A&E (Target 95%) – The CCG did not meet the A&E standard in M9 performing at 88.4%.
This is due to St. Georges University Hospitals NHS Foundation Trust not meeting the
standard (84.84%) and Epsom & St Helier University Hospital NHS Trust (92.2%).
 RTT 18 weeks – ( Target Admitted patients 90% & Non- Admitted 95%) – The CCG did not
meet the admitted and non-admitted standard in M9. This is expected due to the national
monies allocated for backlog clearance
 Cancer – Merton CCG has met 8 of the 9 Cancer Waiting times standards for M9. The
CCG did not meet the 62 day Urgent referral Standard with performance of 68.8% against a
threshold of 85%.
 Diagnostics ( Target 99%) – The CCG did not meet the standard in M9 performing at 98.3%.
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Performance Summary
Are health outcomes improving for local people?
 IAPT (Quarterly Target 46.89%) – The CCG is below trajectory for access
to IAPT in M9 performing at 32.9%
 Dementia ( Target 67%) – The diagnoses rate for Merton CCG in M9
(53.5%) has increased compared to M8 (52.3%)
 Winterbourne – 4 admitted patients, 1 discharge is planned for later this
month.
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Domain 1 - Are patients receiving clinically commissioned,
high quality services?
Source: Monthly & Quarterly CSU Scorecard. Monthly source Open Exeter and Quarterly source: NHSE.
Quarterly data will include retrospective adjustments to previous months data. YTD source: Open Exeter.
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Domain 1 - Are patients receiving clinically commissioned,
high quality services?
Quality Issue
Provider
Description of
Quality Issue
Issues
The main driver of underperformance is at St. Georges. All Trusts have
been partaking in a backlog reduction exercise to reduce the number of
RTT 18 weeks
88.7% (admitted
patients waiting over 18 weeks and this led to an expected drop in
(admitted
Epsom & St.
patients
performances.
patients) and
Helier, St
94.8% (non(non admitted George's Hospital
admitted patients)
patients )
Kinston Hospital
Diagnostic tests
and Epsom and St.
waiting time
Helier.
98.3% against a
target of 99%
Rectifying actions
Commissioners agreed that St. George's would fail
performance until December but achieve in Q4,
however, bed pressures over winter have meant there
have been significant elective cancellations and the SRG
is reviewing the trajectory for achieving performance.
Kingston hospital was marginally below the target with performance of Kingston Hospital has provided a recovery plan and
98%. And reported problems in Endoscopy due to unexpected long-term indicated that the service was still affected in January.
sickness and the departure of the admin team leader in the Endoscopy However, normal service has resumed in February and
service in November. This resulted in administrative element of the
the trust anticipates meeting the target from February.
service being less functional than usual, which has generated a backlog ESH identified and dealt with the issue quickly. Regular
of patients waiting to be booked for diagnostic testing.
meeting were scheduled with the providers to ensure no
Epsom & St Helier had problems with timely appointments for MRI. The further slippage in performance. The trust has indicated
trust outsourced some MRI work, however, the contracted provider did that this issue will not affect performance past
not adhere to guidelines and booked patients past breach date, resulting December.
in underperformance.
Epsom and St Helier reported consistently high attendances and
In order to mitigate the issues, St George’s put a number
emergency admissions , with patient activity remaining high . There were of actions in place; SRG wide escalation calls are taking
also high numbers of ambulance arrivals and patients requiring
place three times per week, with emergency escalation
treatment in the resuscitation area of A&E. The trust continued to
calls in periods of significant pressure to assess
experience issues with bed capacity.
opportunities to reduce demand. All elective lists were
reviewed, with only those patients identified as urgent
ESH = 92.2% against St George’s continued to reported high attendances and admissions
Epsom & St.
A and E waiting
a target of 95% above predicted. The trust experienced challenging bed positions most being planned throughout the week. The trust ran in
Helier, St
business continuity with mobilisation of all managerial
times
SGH= 84.8% against days, with demand outstripping capacity. This was not only a result of
George's Hospital
a target of 95% the increased admissions, but the trust also had low discharge profiles and clinical staff on a number of occasions, as well as
on many days; slowing patient flow through the hospital. This ultimately cancellation of some non- -urgent electives. In addition
impacted on the front end, resulting in large numbers of breaches. These to this, the trust has opened further escalation with a
issue culminated in what the trust reported as one of the most pressured number of off -site beds now available, with a further 6
weekends seen in recent years.
to open by mid January.
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Domain 1 - continue
Quality Issue
Provider
Description of
Quality Issue
Issues
Rectifying actions
The CCG did not to meet the 62 Day Urgent Referral
standard with performance of 68.8% against a threshold of
85%. This was due to 10 breaches from 33 patient pathways.
There were 4 internal breaches at SGH, 2 of these were
attributed to delays in work up and the other two due to
administrative delays. There were 2 shared breaches
Cancer first
between SGH and RMH and both of these breaches were
treatment 62 days, SGH, RMH, 68.8% against a attributed to late Inter Trust Referrals. (Patients referred on
Includes 31 day rare ESTH, KHFT threshold of 85% Day 62 & 92 respectively). 1 shared between ESTH and the
standards)
Royal Marsden attributed to Late Inter Trust referral; 1
internal breach at ESTH attributed to administrative delays.
The final 2 were shared between KHFT and RMH and were
attributed to administrative issues and Late Inter Referral.
SGH states that it will provide education on cancer waiting times for admin
booking staff. Ensure OPA bookings are action in the weekly PTL meeting;
expedite delays / capacity issue as soon as possible to minimize potential
delays to the pathway. There is an expectation that complex patients will
have an extended pathway, however a tolerance is built into the standard
for such patients. St George's ensures that all patients with multiple
comorbidities are worked up thoroughly in a timely manner. The trust
needs to establish a closer relationship with referring trusts to identify any
potential issues to enable the patient to be seen within target date. Joint
PTL meetings will eliminate these issues. of the breaches are over hundred
days. In view of the assurance work being undertaken on 62 day cancer
waits, the expectation from commissioners now is that all RCAs on 100 day
breaches are to be discussed at the Trusts relevant CQRG meetings
The Transforming Cancer Services Team (TCST) will continue to monitor
SGH’s Performance over the next Quarter.
St Georges: St Georges had 221 thirty minute handover
breaches in December.
Epsom & St Helier:- LAS handover breaches increased
significantly in December going from 34 to 125 thirty minute
breaches. 60 minute breaches also increased from 2 to 39.
SGH has an action plan to improve flow in A&E that should improve
handover performance. One of the key actions is a change in the triage
process, with reduction in the number of steps and an allocated nurse to
coordinate triage and ambulance handover. Despite this and as a result of
the performance in December, SE CSU is seeking a meeting with SGH to
discuss the significant deterioration in performance.
ESH: Despite the trust having an action plan to improve performance, with
key actions including; real time review of the handover process;
identification and implementation of best practice; clarifying improving
administrative element of the handover process, SE CSU will discuss the
drop in performance at the next SRG meeting in order to get assurance
from the trust.
Ambulance category
A (Red 1) 8 minute
LAS Cat A
response
performance
London
Ambulance category
remains a serious
Ambulance
A (Red 2) 8 minute
concern with YTD
Service
response
67.6 below target
(LAS)
Ambulance category
(75% within 8
A 19 min
minutes)
transportation time
Mixed
accommodation
Breaches
ESTH
Merton CCG has two MSA breaches in December both at
Epsom & St Helier. The trust encountered issues when
Endoscopy had to be used to bed patients whilst the trust
2 against a target tried to continue with urgent endoscopy procedures. All
of 0
possible measures were taken to segregate patients but
because there are no bays or cubicles in this area the
breaches occurred.
Merton CCG had two 52 ww reported in December, one at
SGH and one at Royal free. At SGH was a gyane patient. The
RTT 52 weeks
SGH, Royal 2 against a target patient is on a complex diagnostic pathway and has had a
Incomplete pathways
Free.
of 0
number of diagnostic appointments throughout the year.
All patients were advised of the issue and no concerns or complaints were
raised.
Patient pathway is currently being reviewed. Pending this review, the
patient will be discharged or an additional appointment will be scheduled
for February 2015.
An attempt has been made to ascertain information relating to the 52ww at
Royal free; this information will be supplied as soon as it is received.
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Domain 3 - Are CCG plans delivering better outcomes for
patients? (April – December)
*Data Source: SWL and St Georges trust
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Domain 3 - Are CCG plans delivering better outcomes for
patients?
Quality Issue
Increasing the IAPT
recovery rate
Increasing the
proportion of people
that enter IAPT
treatment against the
level of need in the
general population
Unplanned
hospitalisation for
chronic ambulatory care
sensitive conditions
Provider
SWL & St. Georges
SWL & St. Georges
Merton CCG
Description of Quality Issue
What's being done about it?
The service is showing a
downward trend this quarter
in improving this outcome.
The service is showing a
downward trend this quarter
in improving this outcome.
The CCG provided further investment in Q4 to increase capacity in the service.
The Trust is reporting that this increase in treatment will provide an increase in
recovery rates at the end of Q4 when patients have completed treatment.
1) Weekly performance reports are being provided by the Trust to the
commissioner for assurance of weekly referrarls received. Based on this the
Trust are advising that they will meet the target of 15% by Q4. 2) Weekly
performance reports are being submitted to NHS England. 3) GP Practice visits
have commenced to promote IAPT 4) Follow up phone calls have commenced
with GP Practices that have received a visit. 5) Letter was sent to all GP Practices
encouraging referrals to IAPT. 6) The Trust placed an advert for IAPT in the
Wimbledon Guardian. 7) The CCG has shared the same advert with its
stakeholder network.
Whilst 4 out of 9 reporting
Work is continuing to implement the Better Care Fund and QIPP initiatives which
months show these
impacts on a subset of these admissions. To date the Community Prevention of
admissions are to be on
Admission Team (CPAT) has been extended into care homes, Integrated Locality
target, overall the level
Teams and MDT working have been introduced and in-reach nursing from
admissions in this financial
Community Services at St George's was extended to also support prevention of
year have been greater than admission in the ED and short stay wards. Additional intermediate care beds
predicted so far.
were introduced from 1st February 2015 and further beds are planned for April
2015. It is expected that the introduction of the Holistic Investigation and Rapid
Investigation (HARI) service at the Nelson from April 2015 will have an impact on
the reduction of these admissions. Further analysis of this data indicates that
there may be value in commissioning further community support for Asthma
and this is currently being worked up.
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Domain 3 - Continue
Number of people
accessing expert
patient
programmes
The premises used for the course was unavailable and A new venue (St Saviours Church, Raynes Park) was found. Evaluation in progress
therefore was cancelled which had an impact on the
number of participants.
Merton CCG A low number of people on our waiting list with COPD Asking GP surgeries to arrange letters to be sent to a random selection of patients
and asthma
on their register.
Large drop out of course participants
In progress - Meeting with translator, and tutors to get feedback of session.
Arranging a meeting with translator and participants
Delayed Transfers Kingston and St DTOC has slightly increased compared to November DTOC figures are reported monthly to the Merton Integration Board and the One
of Care
Georges
figures and the reasons for this are a) completion of Merton Group. As Better Care Fund schemes go live and are further embedded
Hospital
assessment and b) public funding.
into operational procedures, DTOCs should continue to fall and monitoring will
continue as part of the overall BCF performance management process. The
majority of DTOCs are the result of awaiting assessment for continuing healthcare
needs with community health and social care delays at proportionately low levels.
Increasing the
Merton CCG
proportion of
people diagnosed
with Dementia
Progress for this indicator is substantially below
target, but improving month on month.
Improvements are thought to stem from a number of initiatives, although progress
does not appear to be sufficient to meet the target of 67% by the end of the
financial year. Next steps include: working with the Primary Care Support Team to
ensure that all practices reap the benefits from three key list cleansing approaches;
encouraging practices to deliver the recently launched care home scheme which
involves conducting reviews of care home residents and giving a diagnosis where
applicable; continuing to conduct focussed work with practices which have the
greatest dementia ‘gaps’ (in terms of numbers of patients) and practices which are
outliers as a result of having the lowest diagnosis rates.
Winterbourne
All 4 patients are still under the scope of Merton as
reported last month.
1. Currently placed in a specialist learning disability
locked rehab service.
2. Currently placed in a specialist inpatient treatment
service within the NHS.
3. Currently placed in a specialist Autistic Spectrum
Disorder (ASD) locked rehab service.
4. Currently placed in a specialist ASD locked rehab
service.
All patients are currently detained under the Mental Health Act, for the purpose of
treatment. An attempt to discharge 2 to intensively staffed community service in
February unfortunately failed, with the patient needing to be returned to
inpatients setting after a period of 5 days with support of police. Discharge will
however be attempted later this month. In respect to 3 and 4 a plan for on going
treatment in a hospital registered service has been identified as still being
required. It is anticipated that 3 will be discharged to a community setting, as yet to
be identified but closer to home, by September 2015. It has been confirmed
however that this will not be feasible for 4 who continues to pose a significant risk
to children and vulnerable females. The CTR for 1 is scheduled to take place on
March 3rd.
Danshell Group,
CNWL
Foundation
Trust, and
Cambian
Healthcare
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