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Analytics
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Mental Health
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111 and Out of Hours
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Integrated Performance Dashboard: Published June 2014
Contents
Section
Quality & Safety
Glossary
The Month 3 Report is for June 2014 and contains the following information for Haringey CCG:
- Month 3 Income & Expenditure position at May 2014
- Financial performance of QIPPs at May 2014
- Performance against KPIs as at May 2014 (April 2014 position reported across some indicators)
- Performance against key Quality Indicators at CCG level for May 2014 (Trust position is reported for May 2014)
The report focuses on the following key providers:
- North Middlesex University Hospital NHS Trust (NMUH)
- Whittington Health (WH)
- University College London Hospital NHS Foundation Trust (UCLH)
NHS Haringey CCG is the coordinating commissioner for NMUH, and these three providers account for circa 90% of the annual acute care budget of the CCG.
The report now includes details on Mental Health Services commissioned by the CCG.
Initial information is included on 111 and OOH. Community Services will be included in future months.
Additionally, the report is intended to develop further and report on the CCG's performance against the agreed Local Priorities.
Key Messages
Finance Dashboard
Performance
Measure YTD performance Measure
Achieved Target
Referral to treatment times (18
weeks incomplete) 91.8% N 92%
A&E waits - All types* 95.8% Y 95%
Cancer Waits - 62 days Data not Available 85%
Category A Red 1 ambulance
calls 76.8% Y 75% Rating AMBER-GREEN AMBER - RED GREEN RED No RAG Rating Finance:
The overall reported YTD position shows an over performance of £1,118,000
Key Performance Indicators:
18 weeks Referral to Treatment times
Whittington Health has identified data quality issues with the incomplete pathway data which is further delaying national reporting. The Trust did not meet the non-admitted standard in May.
North Middlesex and UCLH are contributing to the CCGs current RTT underperformance with higher backlog volumes, although NMUH is still meeting all standards at Trust level.
Actions: Whittington Health is validating incomplete pathways and expects to upload data in July. North Middlesex and was asked to submit an RTT recovery plan however this has been superseded by the national RTT initiative to reduce waiting times. UCLH meets regularly with Camden CCG and NHS England and a clinical harm review process is being put in place.
Cancer Waiting times
The CCG met 6 out of 8 of the standards. The CCG did not meet either the Breast (87.1%) or GP Referral (91.7%) two week wait standards against the target of 93%. These were both attributable to Whitting ton Health. There were 25 breaches for the Two Week Wait Breast: 19 due to patient choice and 6 for capacity reasons. There were 32 breaches for the Two Week Wait GP Referral: 29 due to patient choice and 3 for capacity reasons.
Actions: Whittington Health has reviewed its capacity in the Breast clinic and added additional clinics as a result. They expect to achieve the 2 week breast standard in August.
A&E Performance
Having met the standard in April, the North Middlesex did not meet it in May or in June. However the performance margin that had been built up during April was sufficient for the Trust to meet the standard for Q1. NHSE and the TDA called a teleconference with the Trust and CCGs on 9 July and the system was required to provide a Recovery and Improvement Plan by Friday, 18 July. Actions and recommendations from the recent Deep Dive are being incorporated into this. These include –
• Increasing UCC activity
• Improving discharge volumes at weekends • Monitor discharges before 10am and midday
Quality Indicators: C. Difficile
3 cases of C. Diff were reported for the CCG's patients in April. At Trust level there were 6 cases at North Middlesex, 4 at the Whittington and 10 at UCLH. Near time information shows that NMUH experienced an outbreak on Charles Coward Ward which was closed to admission for 10 days in June.
Action: All providers report regularly on HCAI to CQRGs and new trajectories have been set for 14/15.
Mixed Sex Accommodation
There were 7 MSA breaches reported against Haringey CCG in May, of which 6 were at the Whittington. Action: Action plan has been presented and guidance improved. Progress to be monitored going forward
Key Messages - Haringey CCG Integrated Performance Dashboard- Month 3
Key Performance Indicators:
18 weeks Referral to Treatment times
At provider level the North Middlesex achieved all three RTT standards in May. Whittington Health achieved the admitted standard only in May.
Cancer Waiting Times
Haringey CCG achieved 6 out of 8 cancer standards for April.
4 hour A&E standard
Whittington Health and North Mid achieved the standard for Quarter 1. Whittington Health met the standard in June.
Quality Indicators:
Healthcare Acquired Infection
No MRSA cases were reported at CCG or provider level in May.
Friends and Family Test
NMUH has shown significant improvement in the FFT score in May and is now above the London average for A&E and in-patients. Whittington Health is currently scoring around the London average on both measures.
Mixed Sex Accommodation
North Middlesex reported no mixed sex accommodation breaches in May 2014.
Achievements
Performance Issues
Domain 1: Are local people getting good quality care?
Domain 2: Are patient rights under the NHS Constitution being promoted? Domain 3: Are health outcomes improving for local people?
Domain 4: Are CCGs delivering services within their financial plans?
Domain 5: Are conditions of CCG authorisation being addressed and removed (where relevant)? (NHS Constitution rights and pledges)
QUALITY PREMIUM (YTD position)
* For the purposes of the quality premium, the percentage of Incomplete pathways within 18 weeks will be calculated by summing the numerators (patients waiting within 18 weeks) from each month end and then dividing by the sum of all the denominators (patients waiting) from each month end. NHS England has not yet supplied the Providers/CCGs mappings that will be derived from Hospital Episodes Statistics (HES) figures for A&E waits all types.
Domain DetailsBalanced Scorecard (Q2 Position from NHS England dashboard)
Budget Actual Variance Trajectory Budget Actual Variance Trajectory Budget Actual Variance Trajectory Acute £18,090 £18,999 £909
£53,507 £54,726 £1,218
£215,030 £216,010 £980
Mental Health £2,976 £2,976 (£)
£8,929 £8,944 £15
£35,717 £35,733 £15
Community Health £381 £401 £20
£1,142 £1,147 £5
£4,569 £4,627 £58
Continuing Care £1,554 £1,676 £122
£4,661 £4,783 £122
£18,645 £18,645 (£)
Primary Care £2,631 £2,613 (£18)
£7,523 £7,580 £57
£30,091 £30,148 £57
Other programme costs £407 £363 (£43)
£1,249 £1,199 (£50)
£4,995 £4,885 (£110)
Reserves and Contingencies £83 £0 (£83)
£250 £0 (£250)
£5,659 £4,659 (£1,000)
Sub Total Programme Costs £26,121 £27,028 £907
£77,262 £78,379 £1,118
£314,707 £314,706 (£)
Corporate Running Costs £547 £547 £0
£1,619 £1,619 £0
£6,942 £6,942 £0
Total Expenditure £26,668 £27,575 £907
£78,880 £79,998 £1,118
£321,649 £321,648 (£)
Planned Saving Actual Saving Variance Trajectory Planned Saving Actual Saving Variance Trajectory Planned Saving Actual Saving Variance Trajectory
Savings v Plan £713,106 £584,891 £128,215 £1,400,233 £1,229,192 £171,041 £8,950,934 £7,821,778 £1,129,156
Budget Actual Variance Trajectory Budget Forecast Variance Trajectory
£18,425 £18,170 (£255)
£73,700 £74,425 £725
£17,500 £18,349 £849
£70,000 £72,000 £2,000
£3,035 £3,125 £90
£12,140 £12,440 £300
£4,125 £4,858 £733
£16,500 £17,500 £1,000
£193 £231 £38
£772 £969 £197
£704 £1,178 £474
£2,814 £3,457 £643
£43,982 £45,911 £1,929
£175,926 £180,791 £4,865
Forecast Outturn
As at Month 2, the overall reported forecast deficit is break even. The break even position has been achieved by releasing £1M from the CCG's contingency and £2.2M from the Acute Demand Reserve to mitigate the over performance relating
to Acute contracts.
QIPP
The CCG has received month 2 activity and financial data and this, along with workbook tracking performance to the end of June, provides an indication of which schemes are having an impact and which are not.
In month 2 against a plan of £1,396k there has been a saving of £1,210k, which means the QIPP Programme is currently £186k behind plan. £120k of the £186k shortfall is due to cancellation of budget management schemes.
Some of the new schemes are not meeting their performance management milestone targets including gastroenterology, dermatology and paediatrics community services.
Run-rate (000s) (June)
The Whittington Hospital NHS Trust University College London Hospital NHS Foundation Trust Great Ormond Street Hospital NHS Foundation Trust
Finance & QIPP Commentary
YTD Forecast Outturn
North Middlesex University Hospital NHS Trust
Total
Royal Free London NHS Foundation Trust King's College Hospital NHS Foundation Trust
Finance Position at Month 3
This report incorporates actual data to the end of month 2, with forecasts for month 3.
The overall reported YTD position shows an over performance of £1.118k
Acute Contract - Run Rates
UCLH - The year to date over spend is £733k (17.8%) above plan. The forecast over spend is £1M (6% above plan). The forecast out-turn position of £1 million over budget has been mitigated as it is believed the YTD over performance will not continue in the remainder of the year due to QIPP schemes and referral management.
The Whittington - A block Contract agreement is in place for Q1 with a potential move to PbR if Trust data submission is clean for Q1. The year to date under spend is £255k (1.4% below plan) with a forecast over spend of £725k (1% above plan). There are clearly still issues with the quality of the data from the trust. The CSU is working actively with the trust to resolve these issues.
NMUH - The year to date over spend is 849k (4.9% above plan) with a forecast overspend of £2M (2.8% above plan). The FOT position has been mitigated down to a £2m overspend as it is believed the existing levels of activity will be reduced through the QIPP schemes.
GOSH - The year to date over spend is £38k (19.7% above plan) with a forecast over spend of £197k (25.5% above plan). The main area of over performance is in Out patient Follow Ups and Non elective cases.
Barnet & Chase Farm Hospital -The current YTD over spend is £474k (67% above plan) with a forecast over spend of £643k (23% above plan). The forecast out-turn position of £643k over budget has been mitigated as it is believed the YTD over performance will not continue in the remainder of the year.
Royal Free Hospital - The year to date over spend is £90k (3% above plan) with a forecast over spend of £300k (2.5% above plan).
Income & Expenditure Summary - Data Source SUS NELIE (June 2014)
Under/Over-Spend (£000s) by Sector (June 14)
Month YTD FOT
QIPP Performance (000s) (May 2014)
Month YTD Forecast Outturn
May YTD May YTD May YTD May YTD* May May May YTD
A&E Type I Performance 95% 94.8% 95.4% 95.7% 96.2% 94.5% 95.2% 95.5% 92.8% 84.7% 85.6%
A&E All Types Performance 95% 94.8% 95.4% 95.7% 96.2% 94.5% 95.2% 99.5% 99.5% 95.5% 94.7% 81.7% 82.7%
May
Apr
May YTD Trajectory Apr YTD Apr YTD Apr YTD Apr YTD Apr YTD Apr YTD Apr YTD
18 Weeks RTT Adjusted Admitted 90% 92.7% 90.9% 91.1% 91.1% 90.5% 90.5% 84.7% 84.7% 79.1% 79.1% 91.3% 91.3% 90.6% 90.6%
18 Weeks RTT Non-Admitted 95% 95.3% 95.5% 97.4% 97.4% 95.1% 95.1% 94.1% 94.1% 94.6% 94.6% 97.6% 97.6% 95.3% 95.3%
18 Weeks RTT Incomplete Pathways 92% 91.9% 91.8% 94.0% 94.0% 88.2% 88.2% 92.4% 92.4% 92.1% 92.1% 92.9% 92.9%
>52 week waits 0 3 0 0 86 0 2 1
6 Weeks Diagnostic Waits 99% 97.9% 98.3% 100.0% 100.0% 99.0% 99.0% 97.7% 97.7% 100.0% 100.0% 96.0% 96.0% 99.1% 99.1% 98.6% 98.6% Cancelled operations (breaches of 28 day
standard over number of cancelled operations) 100%
National Average
Apr YTD Trajectory Apr YTD Apr YTD Apr YTD Apr YTD Apr YTD Apr YTD Apr YTD
2 Week Cancer Wait 93% 91.7% 91.7% 95.7% 93.3% 93.3% 90.6% 90.6% 94.7% 94.7% 100.0% 100.0% 97.2% 97.2% 100.0% 100.0% 93.9% 93.9%
2 Week Cancer Wait: Breast Symptoms 93% 87.1% 87.1% 96.2% 93.3% 93.3% 80.5% 80.5% 98.7% 98.7% 98.9% 98.9% 93.2% 93.2%
31 day Cancer Wait: 1st definitive treatment 96% 98.5% 98.5% 97.6% 100.0% 100.0% 100.0% 100.0% 99.4% 99.4% 100.0% 100.0% 96.4% 96.4% 83.3% 83.3% 98.6% 98.6% 31 Day Cancer Wait: Subsequent treatment
(Surgery) 94% 100.0% 100.0% 97.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.2% 95.2% 100.0% 100.0%
31 Day Cancer Wait: Subsequent treatment
(Chemotherapy) 98% 100.0% 100.0% 99.8% 100.0% 100.0% 100.0% 100.0% 99.5% 99.5% 100.0% 100.0%
31 Day Cancer Wait: Subsequent treatment
(Radiotherapy) 94% 100.0% 100.0% 98.0% 100.0% 100.0% 100.0% 100.0% 99.1% 99.1% 100.0% 100.0% 100.0%
62 Day Cancer Wait: GP Referral 85% 95.5% 95.5% 84.7% 85.0% 85.0% 97.4% 97.4% 73.3% 73.3% 85.2% 85.2% 71.4% 71.4% 83.1% 83.1%
62 Day Cancer Wait: Screening service 90% 100.0% 100.0% 94.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 75.0% 75.0% 89.7% 89.7%
62 Day Cancer Wait: Consultant Upgrade 0% 87.5% 87.5% 92.4% 97.7% 97.7% 0.0% 0.0% 62.5% 62.5% 50.0% 50.0% 100.0% 100.0% 96.7% 96.7%
May YTD May YTD May YTD May YTD Trajectory
% within 15 mins 100% 41.2% 35.2% 40.2% 37.9% 50.6% 50.6%
% within 30 mins 100% 94.1% 89.0% 94.7% 94.0% 94.6% 94.5%
30 minute validated and tracked breaches 0 27 132 10 15 2724 5578 60 minute validated and tracked breaches 0 0 4 0 0 215 380
% HAS completed 90% 92.2% 91.8% 92.7% 92.9% 91.7% 91.4%
Key providers: May
Other Providers:
WH UCLH
May
Ambulance Clinical Quality Response Time: May
Key Providers:
Apr
Key Providers: Apr
Cancer Waits
Other Providers: Apr
(Patients registered in Haringey only)
CCG Position:
Apr
(Patients registered in
Haringey only) NMUH
Category A calls resulting in emergency response arriving
within 19 mins 95% 96.4% 96.4% London Ambulance Target 75% 76.8%
Category A calls resulting in emergency response arriving
within 8 mins (RED 2) 75% 70.7% 70.7%
Category A calls resulting in emergency response arriving within 8 mins (RED 1)
Trajectory (NMUH)
76.8%
Key Performance Metrics (2014 - May)
KPI / Measure
KPI / Measure
18 Weeks Referral to treatment and Diagnostics
Target
Target
4 Hour A&E Standard
KPI / Measure Target NMUH
Target NMUH KPI / Measure
WH UCLH Moorfields RFH BCF BHRUT
YTD YTD
94.3% 95.3%
95.3% 95.8%
Other Providers:
Ambulance Handover Times : May
KPI / Measure
RNOH BCF
BCF RNOH
RFH
BCF were unable to submit RTT data Moorfields WH NMUH UCLH RFH Moorfields
CCG Position:
Whittington London Average
87.00% 88.00% 89.00% 90.00% 91.00% 92.00% 93.00% 94.00% 95.00% 96.00% 18 Weeks RTT Adjusted Admitted 18 Weeks RTT
Non-Admitted18 Weeks RTTIncomplete Pathways Haringey CCG: 18 Weeks RTT Target
& Achievement
Apr YTD Target
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 2 Week Cancer Wait
2 Week Cancer Wait: Breast Symptoms 31 day Cancer Wait: 1st definitive treatment 31 Day Cancer Wait: Subsequent treatment (Surgery) 31 Day Cancer Wait: Subsequent treatment (Chemotherapy) 31 Day Cancer Wait: Subsequent treatment (Radiotherapy) 62 Day Cancer Wait: GP Referral 62 Day Cancer Wait: Screening service 62 Day Cancer Wait: Consultant Upgrade
YTD Apr Target Haringey CCG: Cancer Wait Targets
93.5% 94.0% 94.5% 95.0% 95.5% 96.0% 96.5%
May YTD May YTD May YTD
NMUH WH UCLH
A&E Type I Performance A&E All Types Performance Target
Key Providers: 4 Hour A&E Standard
Performance Commentary (Metrics on page 4)
18 weeks Referral to Treatment (RTT)
At CCG level the May data is incomplete due to ongoing reporting issues with Barnet and Chase Farm and Whittington. Although the Whittington has uploaded admitted and non-admitted RTT data successfully for a fourth month, the Trust has identified data quality issues relating to the incomplete pathway, the submission of which will now be delayed to July. The CCG is shown to be just failing on the incomplete pathway for RTT because UCLH is not achieving the RTT target and in some specialties (neurology) NMUH are not achieving the standard. Although NMUH is not achieving the standard in these specialties, their overall performance in RTT means that overall as a Trust they are compliant on all RTT pathways. NMUH have also failed RTT admitted targets Dermatology. Locums are being recruited for dermatology and neurology. NMUH were asked to submit an RTT recovery plan however this was superseded by the work required by the Trust for the national initiative to reduce waiting lists to 16 weeks. UCLH and Moorfields meet 2 weekly with commissioners and are both implementing strategies to increase clinical capacity and improve pathway administration. UCLH is establishing a clinical harm review process. Diagnostics
The diagnostic standard was not met at CCG level for the second month in succession in May with 87 breaches reported (15 related to the InHealth community diagnostic service). The majority (49) are in Audiology of which 48 were at Whittington Health. The Trust advised that this was due to delays in the logging of referrals. The Trust have advised that this is now resolved. There were 12 patients waiting longer than 6 weeks for cystoscopies at the Royal Free and 10 patients waiting for non-obstetric ultrasound at InHealth. The Royal Free has known problems with the cystoscopy service and is providing additional sessions to clear the backlog. The Trust is predicting compliance at the end of September. Cancer Waiting Times
The CCG achieved 6 out of 8 waiting times standards in April. The CCG did not meet either the Breast (87.1%) or GP Referral (91.7%) two week wait standards against the target of 93%. These were both attributable to Whitting ton Health.
At provider level, all NCL Trusts met the standard with the exception of the Whittington Health. The Trust is predicting to fail the standard for Quarter 1. There are some capacity issues as a result of a lack of diagnostic and histopathology capacity although WH has provided reassurance that thery that added an extra clinic to ensure that there is no backlog.Whittington Health have also reviewed their capacity in the Breast clinic and added additional clinics as a result. They expect to achieve the 2 week breast standard in August.
A&E Waiting Times (4-hour waiting time standard)
After achieving the 4 hour standard in April, NMUH did not meet the standard for May or June. Despite this the Trust were able to achieve the Q1 standard. The Trust reported some of the highest numbers of attendances since the closure of Chase Farm A&E and was recently on a high state of operational alert as a result. They continue to have the extra beds open which are usually only used to manage additional capacity requirements in winter. The Trust have advised that recent problems with out of hours staffing skill mix and clinical leadership has adversely impacted A&E flow. The discharge volumes have also been problematic. On-going poor performance in July has also been attributed to delays caused by staff becoming accustomed to the new electronic patient record system, which went live on 29 June. On 9 July NHSE called a teleconference with the Trust together with local CCGs. The CCG and the Trust were tasked with producing a Recovery and Improvement Plan by 18 July. Actions and recommendations from the recent Deep Dive are being incorporated into this. These include:
• Increasing Urgent Care Centre activity
• Improving the number of patients discharged at weekends
• Monitoring of the numbers of discharges have occur before 10am and midday Ambulance Clinical Quality Response Times
London Ambulance did not meet Red 2 (8 minute response time) in May. There is a current downward trend in performance. Commissioners issued a contract query notice in May and a meeting of the Strategic Contract Management Board took place on 30 June to discuss the options for improving performance.
Ambulance Handover Times
Pre validated ambulance hand over performance at NMUH has been one of the worst in NCL and across London. Recent joint working with London Ambulance Service has resulted in significant improvement throughout Q1. There were 105 thirty minute handover breaches in April an improvement on the 161 in March. In May 27 breaches were reported. It should be noted that these breaches have been identified as being caused by an administrative issue with lack of recording of the handover rather than high numbers of patients waiting more than 30 minutes to be recieved into A&E
Analytics (Attendances) Commentary
The charts on the left highlight some of the key trends for the Trust. This data includes estimates for Whittington from September 2013.
There has been a significant increase in the number of non-elective admissions for all providers. The largest growth is seen at North Middlesex where there are more than expected numbers of admissions compared to what was predicted in the plan. This has been raised with the Trust at a meeting on 15th July and further analysis is being undertaken to understand the reasons for this. We await further information.
Attendances Summary (May 2014)
Target
Provider
Q4 Actual
Trajectory
IAPT Access Rate
2%
Whittington
Health
10.40%
IAPT Recovery Rate
50%
Whittington
Health
50%
95%
BEH
98.9%
42
BEH
65
95%
BEH
96.40%
Target
Provider
May Actual
Trajectory
5%
BEH
0%
50% reduction
from 2013/14
BEH
2
9
BEH
14
Target
Provider
Q4
Trajectory
5%
T&P
1.90%
10%
T&P
7.00%
The proportion of people that enter treatment compared to the level of
need in the Borough
Mental Health Indicators
NATIONAL INDICATORS
Description of Indicator
IAPT
Readmission within 28 days
Proportion of discharges from acute inpatient mental health services who
had unplanned readmission within 28 days of discharge
Percentage of referrals moving to recovery
OTHER MENTAL HEALTH INDICATORS
CPA Follow Up
Proportion of patients on CPA that were followed up within 7 days of
discharge from inpatient acute mental health care
Early Intervention in Psychosis
Number of newly diagnosed cases of psychosis between the ages of 14 and
35 who are receiving early intervention in psychosis services
Crisis Resolution / Home Treatment Service
Proportion of service users admitted to acute inpatient mental health units,
who were gate-kept by crisis resolution services
LOCAL INDICATORS
Description of Indicator
Delayed Transfer of Care (DTOC)
Proportion of patients deemed medically fit to depart from their current
inpatient care, but unable due to do so due to non-clinical reasons
Early Intervention in Psychosis - Caseload
Number of cases of Psychosis (between the ages of 14 and 35) who are on
the caseload of the early intervention team
Description of Indicator
Percentage of Service Users waiting for over 11 weeks for 1st Appointment from
date of Referral
Percentage of Service Users who have waited for more than 11 weeks from
date of referral for first appointment
DNA Rates
Percentage of Service Users who did not attend a scheduled appointment
without providing appropriate notice to cancel appointment
IAPT
• Access Rate for Q4 for Haringey CCG reported 10.4% against the quarterly target of 8.0%, 7.3% against target of 6% in Q3, 5.0% against target of 4.0% in Q2 and 2.5% against target of 2.0% in Q1.
• IAPT Recovery rate: the Omnibus data reported 50.4% in Q4, 34% in Q3, 37% in Q2 and 40.4% in Q1 against the quarterly target of 50%.
Other Mental Health Indicators (National & Local)
• DTOCs - a working group has been established with the provider (BEH) to reduce the number of DTOCs through the year. The figure for May of 2 cases refers to
• New cases in Early Intervention in Psychosis and Acute admissions gate-kept by CR/HT (Crisis Resolution/Home Treatment) in all the three quarters. BEH overall reported 96.3% against target of 95% in Q4.
Development of Mental Health Indicators
• This portion of the report will be developed furhter in Month 4 to provide a greater depth of information to the CCG.
May YTD Trajectory May YTD
Annual
Target May YTD
Annual
Target May YTD
Annual
Target May YTD
Annual
Target May YTD
Annual
Target May YTD
Annual
Target May YTD
Annual Target 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CCG Target 8 (See individual Trust target) 7 10
6 9 16 4 6 10 10 14 39 0 0 0 1 3 33 0 0 3 6 11 25 0 7 9
0 0 0 7 14 0 3 3 0 0 0 0 2 2 0 3 3 0 19 20 0 May 95% 96.5% 95% 95.5% 95% 95.2% 95% 98.9% 95% 95.7% 95% 100.0% 95% 97.5% 95% 0 78 59 71 94 43 80 50 15% 40% 46% 30% 64% 47% 65% 25% 0 68 49 41 74 34 36 15% 17% 12% 37% 27% 43% 31% 15% 20% 16% 32% 27% 48% 48% 29% 0 0.0%Friends & Family Test: Scores & Response Rates: May 2014
Quality Commentary
Friends and Family Test - A&E ScoreFriends and Family Test - Overall Response Rate - Inpatients
Friends and Family Test: Inpatient Score
Friends and Family Test - Inpatient Response Rate
MRSA
• At CCG level there were no cases of MRSA reported in May. None of the providers reported MRSA cases in May.
C. Difficile Infections
7 cases of C. Difficle were recorded for Haringey CCG in May. This brings Haringey above the monthly trajectory of 3 for this month. The year to day number of C. Difficle cases was 10 against a yearly trajectory of 37. • NMUH: The Trust reported 6 cases in May. Root cause analyses were being undertaken and typing revealed that 2 patients had the same strain of CDI. In June NMUH reported an outbreak of C. Difficle and on 16.062014 the affected Ward, Charles Coward, was closed to admissions for 10 days until the outbreak was resolved. At the NMUH infection prevention and control meeting on July 23rd, the Trust reported a year to date figure of 18 C. Difficle cases which are toxin positive. Root cause analyses (RCAs) are being undertaken on all cases.
• WH: The trust reported 4 CDI cases in May. All incidents are being investigated through root cause analyses which are being reviewed by the lead CCG and the CSU infection control lead.
• UCLH: The Trust has reported 10 cases of CDI in May. Root cause analyses are undertaken for all cases. In view of the high number of CDI incidents last year the CQRG is monitoring CDIs closely at UCLH. • BCF: The Trust has reported 6 cases in May 2014. Root cause analyses are being undertaken on all incidents.
Mixed sex accommodation (MSA)
• 7 MSA breaches were reported at CCG level in May.
• WH: The published data for MSA shows Whittington Hospital reported 7 cases in May 2014, which has plateaued for the last 2 months. The Trust presented the Action Plan at the June CQRG and the actions are now complete in Mary Seacole and ITU. Written guidance has been developed to improve staff understanding of MSA breaches and communication has been improved.
• UCLH: The Trust reported 3 MSA cases in May 2014, compared with zero cases in April. These occurred at Queen’s Square. These have been attributed to a very high level of acuity needing to be transferred from the critical care unit to a neurological or neurosurgical ward and concerns about the ability of wards to meet the acuity of the particular patient. In order to address this, the Trust has taken the decision to convert 12 ward beds into 12 high observation beds. These beds will have a nurse to patient ratio of 1:3 and 11 staff are required for this which are currently being recruited to.
• RFH: 2 MSA breaches occurred at this trust in May with no breaches in April. • RNOH: 3 MSA breaches occurred at this trust in May with no breaches in April.
• BCF: 19 cases of MSA were reported for May which were linked by the Trust to bed pressures arising from insufficient capacity being available. The Trust was reviewing options for increasing elective activity at the Chase Farm site, and improved utilisation of bed capacity across the Trust. As reported previously the Trust had been had been over reporting MSA incidents due to misinterpreting the guidance. Following a revalidation exercise, the total numbers of MSA breaches for the period October 2013 to March 2014 were reduced from 248 incidents to 151. The Trust have put in place a daily review and validation process led by the Head of Nursing for Surgery.
Friends & Family Test (FFT)
• NMUH: There has been a significant improvement in the FFT inpatient net promoter (satisfaction) scores and the Trust is now above both the London averages for both inpatients and for Accident & Emergency. NMUH has shown reasonable scores in Maternity but the response rates are poor in the Antenatal Care service and Postnatal Care service.
• WH: Inpatient / A&E: Both scores are around the London average. There has been a reduction in the response rate in A&E. WH has shown improvement in Maternity response rates across all 4 questions.
Complaints
NMUH: For January - March 2014 NMUH received 143 formal complaints. 95% of all complaints were acknowledged within 3 working days and 35% of complaints were responded to within the set timeframe. Q4 complaints data for the Whittington Hospital is not available yet at point of writing this report (23.06.2014).
Quality Indicators (April 2014)
KPI / Measure Annual
Target
Key Providers
Other Providers
UCLH Moorfields RFH
CCG Position (Patients registered in Haringey
only) - NMUH
RNOH BCF
NMUH WH
Complaints - Number received
Complaints - Percentage Responded to within 25 working days
MRSA reported infections C. Difficile reported infections
Mixed Sex Accommodation (MSA) (No. of breaches)
Friends and Family Test - A&E Response Rate
MSA figures for *VTE (% admitted patients assessed for VTE risk)
0 0 0 0 0 0 0 68 49 41 74 34 0 36 40% 46% 30% 64% 47% 65% 25% 17% 12% 37% 27% 43% 0% 31% 20% 16% 32% 27% 48% 48% 29% 0 1 2 3 4 5 6 7 8 0% 10% 20% 30% 40% 50% 60% 70% 0 10 20 30 40 50 60 70 80
NMUH WH UCLH Moorfields RFH RNOH BCF
Inpatient Score A&E Score Inpatient Response Rate A&E Response Rate Overall Response Rate
Serious Incident
The Trust reported 1 (one) SI in May, a marked decline in reporting as compared to earlier months.
The one SI reported in May was a Grade 1 ‘Slips/Trips/Falls ‘ SI which had occurred and was identified in the Trust in April. This SI is the seventh Slips/Trips/Falls SI reported by the Trust since November 2013 with no Slips/Trips/Falls SIs reported between April – October 2013. Since November 2013, excluding pressure ulcers, ‘Slips/Trips/Falls’ has been the most frequent type of SI reported by the Trust. No Type A or Type B pressure ulcer SIs were reported on StEIS in April or May.
The Trust uploaded patient safety incidents to NRLS in May and has uploaded in five of the last six months.
KPIs in relation to the timely submission of SI reports and satisfactory responses to requests for further information from the CSU within an agreed specified time frame have been agreed with the Trust.
No actions reported.
NB: Any marked increase or decrease in the number of SIs the Trust are reporting, may be as a result of reasons other than worsening clinical practice and therefore caution is advised when interpreting increases or decreases of reported SI numbers
Whittington Health: April 2014
Key Risks & Issues Risks and Issues Actions
Serious Incident
The Trust reported 14 SIs in May – all of which were Grade 1 incidents. 4 of the 14 SIs reported were reported by the Trust’s Community Services, all of which were pressure ulcers acquired under the care of the community services (see pressure ulcer chart above). The remaining 10 SIs were reported by the acute sector of WH. Of the 10 SIs reported by the acute sector 4 were reported by the Maternity Services. Of the 14 SIs reported on StEIS in May, 4 incidents had been identified in the Trust in April and the remaining 10 were identified in May and reported in May. The Trust’s volume of overdue SI reports at the end of May 2014 (n=13) was an improvement on April 2014 (n=20), but still remains at a higher level than in any other month since May 2013 (when 17 reports were overdue). A meeting took place between the Trust, CSU and CCG colleagues on 12th May to review the evidence for four Grade 2 SIs (including three legacy cases). The Trust has agreed to submit additional information/ evidence to the CSU to work towards closure of these SIs.
The Trust has agreed to submit additional information/ evidence to the CSU to work towards closure of these SIs.
Serious Incident Reporting
North Middlesex University Hospital NHS Trust: April 2014
Key Risks & Issues Risks and Issues Actions
LCW NHS 111 Pilot and Barndoc Out of Hours
Abbreviation Term Definition A&E Accident and Emergency
Accident and Emergency department is the part of a hospital that is staffed and equipped to provide rapid and varied emergency care, especially for those who are stricken with sudden and acute illness or who are the victims of severe trauma. The emergency department may use a triage system of screening and classifying clients to determine priority needs for the most efficient use of available personnel and equipment. . (Also referred to as ED)
C.Diff Clostridium Difficile Clostridium Difficile is an infection that may occur within a healthcare environment. Often caused by antibiotics which wipe out the 'good' flora in the intestine, leading to diarrhoea. If not treated, C.Diff can lead to a serious infection of the colon.
CCG Clinical Commissioning Group
Clinical Commissioning Groups (CCGs) are responsible for implementing the commissioning of roles as set out by the Healthcare Act 2012. CCGs are groups of GP Practices that work in partnership with other healthcare professionals, local communities and Local Authorities to commission the majority of NHS services for patients within their local communities. CCGs hold their constituent GP Practices to account for stewardship of resources and the outcomes they achieve.
CPA Care Programme Approach
Anyone experiencing mental health problems is entitled to an assessment of their needs with a mental healthcare professional, and to have a care plan that's regularly reviewed by that professional. They should also be able to get a community care assessment from their local authority to look at their social care needs.
Anyone who has severe mental health problems, or a range of different needs, their care may be co-ordinated under a Care Programme Approach (CPA). This is a particular way of assessing, planning and reviewing someone's mental health care needs. Further details are available at:
http://www.nhs.uk/CarersDirect/guide/mental-health/Pages/care-programme-approach.aspx
CSU Commissioning Support Unit The Commissioning Support Units provide support services such as contract management, service redesign, analytical support as well as other professional services to CCGs to help in the overall commissioning function in the NHS. DNA Did Not Attend
Did not attends or DNAs have an enormous impact on the healthcare system in terms of cost and waiting time, significantly adding to delays along the patient pathway. A DNA occurs when a patient / service user fails to attend an appointment with an NHS staff member, without providing adequate notice to cancel the appointment.
ED Emergency Department See A&E above
FOT Forecast Outturn An assumption at a point in time of what the end of year position will be.
FY Financial Year A financial year is a period used for calculating annual financial statements in businesses and other organisations. The financial year runs from 1st April until 31st March, every year.
HCAI Healthcare Associated Infections Healthcare-Associated Infections (HCAI) are those infections that develop as a direct result of any contact in a healthcare setting. They occur in hospitals and in the community, and affect both patients and healthcare workers. HAS Hospital Alert System The Hospital Alert System is an electronic replacement to the paper forms used for documenting patient handover. The target performance measure is 90% completeness. IPD Integrated Performance
Dashboard
The Integrated Performance Report is published monthly and includes a set of indicators covering all aspects of Trust & CCG performance, including quality measures such as serious incidents (SIs), complaints and same-sex accommodation breaches IAPT Improving Access to Psychological Therapies
Improving Access to Psychological Therapies is an NHS programme rolling out services across England offering interventions approved by the National Institute of Health and Clinical Excellence (NICE) for treating people with depression and anxiety disorders.
KPI Key Performance Indicator
Key Performance Indicators (KPIs) help define and measure progress towards organisational goals. As the primary means of communicating performance across the organisation, KPIs focus on a range of areas. Once an organisation has analysed its mission, identified all its stakeholders and defined its goals, KPIs offer a way of measuring progress toward these goals. Full guidance on KPIs can be found at http://www.england.nhs.uk/everyonecounts/
MRSA Methicillin Resistant Staphylococcus Aureus
MRSA is a type of bacterial infection that is resistant to a number of widely used antibiotics. This means it can be more difficult to treat than other bacterial infections. MRSA infections are more common in people who are in hospital or nursing homes. Doctors often refer to this as healthcare-associated MRSA
MSA Mixed Sex Accommodation
All providers of NHS funded care are expected to eliminate mixed-sex accommodation, except where it is in the overall best interest of the patient. Since April 2011, all providers of NHS funded care have routinely reported breaches of sleeping accommodation, as set out in national guidance, and hence attract contract sanctions in respect of each patient affected. NCL North Central London North Central London (NCL) is a collective descriptor for five Clinical Commissioning Groups (CCGs), which are Barnet, Camden, Enfield, Haringey and Islington, as well as the geographical area they cover.
NHS Constitution
The NHS constitution for England is a formal constitution which, in one document, lays down the objectives of the National Health Service, the rights and responsibilities of the various parties involved in health care, (public, patients and staff) and the guiding principles which govern the service. Full details can be found at
https://www.gov.uk/government/publications/the-nhs-constitution-for-england TDA Trust Development Authority
The NHS Trust Development Authority (TDA) is responsible for providing leadership and support to the non-Foundation Trust sector of NHS providers. This includes 99 NHS Trusts, providing around £30bn of NHS funded care each year. The TDA oversees the performance management of these NHS Trusts, ensuring they provide high quality sustainable services, and will provide guidance and support on their journey to achieving Foundation Trust status
OP Outpatients A patient who receives medical treatment without being admitted to a hospital: "attending a clinic as an outpatient". PIR Post Infection Review
As of 1 April 2013, all NHS organisations reporting positive cases of methicillin-resistant Staphylococcus
aureus (MRSA) bacteraemia via the Healthcare Associated Infections Data capture system ( HCAI DCS) will be required to complete a Post Infection Review (PIR).
QIPP Quality, Innovation, Productivity and Prevention
Quality, Innovation, Productivity and Prevention (QIPP) is a set of 'stretch' targets, varying from Trust to Trust, which aim to achieve more efficient commissioning and higher levels of productivity e.g. reducing pressure ulcer cases to a lower number or spending less on follow-up appointments.
Quality Premium
The ‘quality premium’ is intended to reward Clinical Commissioning Groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. Full details can be found at http://www.england.nhs.uk/wp-content/uploads/2013/05/qual-premium.pdf
RCA Root Cause Analysis
Every day a million people are treated safely and successfully in the NHS. However, when incidents do happen, it is important that lessons are learned to prevent the same incident occurring elsewhere. Root Cause Analysis investigation is a well recognised way of doing this. Investigations identify how and why patient safety incidents happen. Analysis is used to identify areas for change and to develop recommendations which deliver safer care for our patients.
RTT Referral to Treatment
RTT data is collected from NHS providers (NHS Trusts and other providers) and signed off by commissioners (CCGs). The RTT data measures referral to treatment (RTT) waiting times in weeks, split by treatment function. The length of the RTT period is reported for patients whose RTT clock stopped during the month.
SI Serious Incident A serious incident is defined by the National Patient Safety Agency as an incident that occurs in NHS-funded services and care resulting in various levels of harm. SLA Service Level Agreement A Service Level Agreement outlines specific services and products delivered by the CSU.
SUS Secondary Users Service
The Secondary User Service is designed to provide anonymous patient based data for purposes other than direct clinical care such as healthcare planning, commissioning, public health, clinical audit and governance, benchmarking, performance improvement, medical research and national policy development.
VTE Venous Thromboembolism
Venous Thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a common, lethal disorder that affects hospitalised and non-hospitalised patients, recurs frequently, is often overlooked, and results in long-term complications including chronic thromboembolic pulmonary hypertension (CTPH) and the post-thrombotic syndrome (PTS).
YTD Year to Date Year-to-date is a period, starting from the beginning of the current financial year, and continuing up to the present day. The financial year starts on 1st April. Abbreviations of Trust Names
BCF
BEH Barnet Enfield & Haringey NHS Mental Health Trust BHRUT
LAS NMUH
RFH RNOH
T&P Tavistock & Portman NHS Foundation Trust UCLH
WH University College London Hospitals NHS Foundation TrustWhittington Health Royal Free Hospital NHS Foundation Trust
Royal National Orthopaedic Hospital NHS Trust
Glossary of Abbreviations
Barnet and Chase Farm Hospitals NHS Trust
Barking, Havering and Redbridge University Hospital NHS Trust London Ambulance Service NHS Trust
North Middlesex University Hospital NHS Trust
