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NHS Rotherham Clinical Commissioning Group
Operational Executive 17 October 2016
Strategic Clinical Executive 19 October 2016
GP Members Committee 26 October 2016
Governing Body 2 November 2016
Commissioning Plan Performance Report: Quarter 2
Lead Executive: Ian Atkinson, Deputy Chief Officer
Lead Officer: Lydia George, Planning and Assurance Manager
Alex Henderson-Dunk, Performance and Intelligence Manager
Lead GP: N/a
Purpose:
For Governing Body to note the progress with delivery of the CCGs Commissioning Plan as at the end of Quarter 2.
Background:
In 2013 a performance framework for the Commissioning Plan was developed so that the CCG could assess its progress against key priorities and on its implementation of the plan. The report has been refined each year but has broadly remained the same.
In Quarter1 of 2016/17, in line with the new CCG Improvement and Assessment Framework
and the revision of the GB overall performance report the Commissioning Plan performance
Report was revised to provide a fuller picture of delivery. The key changes were:
Each of the 15 priority areas from the Commissioning Plan are reported
Each priority area has clear milestones and targets aligned to the Commissioning Plan
Each priority area includes Key Performance Indicators taken from the new CCG
Improvement and Assessment Framework metrics, the new Governing Body
Performance report, Quality Premiums, the Better Care Fund or are regular key local
metrics already reported
QIPP information is included for those priority areas that are subject to QIPP
Any associated risks from the GB Assurance Framework are reported
Lead GP and Lead officers are reported
From 2016/17 the performance framework will be reported 4 times a year and will be received
at Governing Body in August, November, February with a final year- end report in May.
Analysis of key issues and of risks
Lead officers have provided commentary against the milestones where performance is off track. In quarter 2 officers were asked to identify any milestones where the direction of travel had the potential to deteriorate or improve.
In addition, in line with the GB performance report, commentary is provided for Key Performance Indicators that are not on track.
Milestones
There are 52 milestones in total, see breakdown below:
RAG rate Number of milestones
%
Red 1 2
Amber 4 8
Green 47 90
Total 52 100
The number of milestones on track has increase from 82% in quarter 1 to 90% in quarter 2.
RAG rate
No. Milestone description Commentary
Q1 position
Red 1 1. Extension of virtual
clinics from
haematology to other
areas such as
endocrinology (M18).
1. TRFT have concerns over
recording of activity. Work needs
to take place to resolve the issue
with the Meditech system. The
CCG has asked for formal notice
of when this will be resolved.
Green in
Q1
Amber 4 1. Primary care self-care
pilot complete tele-
health evaluation
(M28).
2. Delivery the required
number of bed
reductions as per
Rotherham element of
the LD plan (M29).
3. Involvement of the
care co-ordination
centre in the EOLC
pathway (M39).
4. Achieve 40%
implementation of the
Case Management
Palliative Care
Template in Primary
Care (M40).
1. Delay in commencing due to
provider (‘EE’) connection,
however the position is improving
and is now on track to report the
final evaluation in November.
2. Moved from green to amber,
NHSE have flagged the over
performance across the wider
footprint target as a risk.
3. The position has improved from
red in Q1 to amber in Q2,
discussions continue to take place
and it is still the intention for the
CCC to be a single point of access
for EOLC.
4. Decision to be included only
recently made, therefore
implementation is just starting
Same as
Q1
Green in
Q1
Red in
Q1
Same as
Q1
It is worth noting that whilst the RAG rate for the following milestones remains the same as Q1, it has been highlighted that there is the potential for the direction of travel to change.
Q1 / 2
RAG rate
Direction of travel
Milestone description Commentary
Amber Primary Care Self-Care pilot – complete tele-health evaluation (M4).
Whilst there was a delay initially due to the provider (‘EE’), the position is improving and is now on track to report the final evaluation in November.
Green Implement 10 clinical thresholds (M17).
Whilst on track for Q4, there was an aspiration for 1 December implementation and negotiations with TRFT are taking place to address.
Green RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan (M25)
Whilst on track for Q3, there is some concern over the level of assurance that the plan will be produced, this is being managed via the QIPP committee.
Key Performance Indicators (KPIs)
There are 48 milestones in total, see breakdown below:
RAG Rate Number of
KPIs %
Red 9 19
Amber 5 10
Green 14 29
*WD 16 34
**TBC 4 8
Total 48 100
* these KPIs are awaiting further data nationally
** Q2 data is not available yet for these KPIs
Overall there are approximately 29% of KPIs on track, which has increased from 27% in Q1, however there are still a high number of KPIs still awaiting national data.
It should be noted that, the following KPI is awaiting data, however it was red in Q1 and it is likely that it will be red again in Q2 which will worsen the positon:
Number of A&E attendances by care home residents
Below is a list of the red and amber KPIs, commentary on performance can be found in the Governing Body Performance Report or Governing Body Quality Report.
RAG rate
No. Key Performance Indicator Description Q1 position
Red 9 1. Utilise NHS e-referral service to enable choice at 1
st routine
elective referral (K2).
2. Contain growth in the number of non elective
admissions (K3).
3. Achieve A&E 4 hour access standard (K5).
4. People who have had a stroke who are admitted to the
acute stroke unit in 4 hours of arrival to hospital (K7).
5. Emergency readmissions within 30 days of discharge from
hospital (K8).
6. Cat A ambulance response calls within 8 minutes (K13).
7. Achievement of outpatient follow up ratios (K16).
8. Proportion of people waiting 6 weeks or less from
referral to entering a course of IAPT treatment (K23)
9. Cancer (all) diagnosed at stage 1 and 2 (K44).
1. Same as Q1
2. Not known in Q1
3. Same as Q1 4. Same as Q1
5. Same as Q1
6. Same as Q1 7. Not known in
Q1 8. Amber in Q1
9. Same as Q1
Amber 5 1. Contain growth in A&E attendances (K4).
2. Percentage of people who are moving to recovery of those
who have completed IAPT treatment (K21).
3. Reduce the number of people admitted in line with the
South Yorkshire and North Lincolnshire LD TCP
trajectory (K28).
4. Patients requiring a Continuing Healthcare assessment will
have an eligibility assessment within 28 days from the
receipt of the continuing healthcare checklist – Adults
(K40).
5. Patients requiring a Continuing Healthcare assessment will
have an eligibility assessment within 6 weeks from the
receipt of the continuing healthcare checklist – Childrens
(K41).
1. Not known in Q1
2. Same as Q1
3. Green in Q1 4. Same as Q1
5. Same as Q1
Finance
The position in terms of QIPP savings reported in Q1 remains the same in Q2 with the following exceptions:
Commissioning Priority QIPP Scheme Q1 Q2
Transforming Community Services
Reducing levels of activity in emergency admission – neuro rehab, integrated rapid response and integrated locality teams
Clinical Referrals Reducing levels of activity growth in direct access pathology in line with clinical pathways
Reduce IHAM NHSE growth assumption in line with local trend analysis
Medicines Management Nationally negotiated Price Reductions
Risk
There are no new risks since Q1 and the scores remain the same as reported in Q1. The following three risks were overlooked on the Q1 report, but the position has not changed:
Failure to meet the National cut-off date for Previously Unassessed Periods of Care
Failure to meet the National cut-off date of 1st March 2017 for Previously Unassessed Periods of Care (PUPoC) - previously known as CHC Retrospective Claims
15
CHC overspend Overspend due to high costs of individual patients of continuing care
12
CAMHS Services Failure to improve Child and Adolescent Mental Health Services (CAMHS)
12
Approval history:-
OE 17 10 2016
SCE 19 10 2016
GPMC 26 10 2016
CCG GB 02 11 2016
Recommendations:
CCG GB are asked to note the report and to note:
1. The position in term of milestones is positive and has improved from Q1.
2. The position in terms of KPIs is positive and has improved from Q1. However there are
a high number of KPIs which are waiting for national data.
Commissioning Plan Performance
Report 2016/17
Q2
Meeting Date
Operational Executive 17 10 2016
Strategic Clinical Executive 19 10 2016
GP Members Committee 26 10 2016
CCG Governing Body 02 11 2016
Definitions for RAG Ratings:
Red KPI Milestones QIPP
Less than 2% achieved Not started or significant issues Not started or Started but still high risk
Amber
KPI Milestones QIPP
Within 2% achieved Started but not on track OK with medium risk
Green
KPI Milestones QIPP
Achieved On track Achieving as planned
Please note
That there are a significant number of KPIs from the new Improvement and Assessment Framework where data is not available yet.
There are some KPIs where quarter 2 data is not available yet.
1 Primary Care Lead GP: Jason Page Lead Officer: Jacqui Tufnell
Funding in 2016/17 = £0.6m for the LIS, £1.2m for Case Management and funding for the CCG Commissioned LES’s
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M1 Primary Care Quality Contract – implement and monitor 3 standards for 2016/17.
Com / primary care plan
Q1 G G On track
M2 Primary Care Quality Contract – develop remaining standards for 2017/18
Com / primary care plan
Q3 G G On track
M3 Primary Care Quality Contract – Agree contracts for 2017/18 standards
Com / primary care plan
Q4 G G On track
M4 Primary Care Self-care pilot – complete tele-health evaluation
Com / primary care plan
Q2 A A Off track, delay starting due to provider (‘EE’) connection. However, position improving and final evaluation report to be complete by end of October, and be presented to OE, SCE and Primary Care Committee mid November.
M5 Monitor and evaluate the effectiveness of the Care Home Alignment with GP practices
Com / primary care plan
Q4 G G On track
Key Performance Indicators (KPIs) 2016/17 Target
Q1 Q2 Q3 Q4
K1 Patient experience of GP services I&A Framework
Quality premium
85% or a 3% increase on
Jul-16
WD WD Jul 15 – Mar 16 performance = 69.5%
K2 Utilise NHS e-referral service to enable choice at 1
st routine elective
referral
I&A Framework
Quality premium
80% or 20% increase on
Mar-16
65.3% June YTD
56.9% July 16
Performance has decreased since last report. Agreed action plan in place with TRFT which we continue to monitor. There has been significant improvement across specialities, but 2 remain challenging. IT team are working with GPs to increase utilitsation.
QIPP
APMS Core Contract Values QIPP Plan £125,000 G G
Premises Costs reimbursements QIPP Plan £118,000 G G
Property Services QIPP Plan £274,000 G G
Risks Risk Description Risk Score
GP quality and Efficiency GB Assurance Framework
Failure to improve GP quality and efficiency in partnership with NHS England (current concerns are due to overall GP capacity and morale)
12
CQC inspection of practices GB Assurance Framework
Worst case scenario, a practice may be identified as so inadequate that emergency arrangements have to be enacted
12
Impact of changes to primary care support England from NHS to Capita contract
GB Assurance Framework
Issues in relation to collection and delivery of medical records, this is a national not local issue
16
To note, the following KPIs are within the I&A Framework but are not currently in publication
Primary care access
Primary care workforce
2 Unscheduled Care Lead GP: David Clitherow Lead Officer: Dominic Blaydon/ Sarah Lever
Funding in 2016/17 = £60.1m
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M6 Completion of the capital Build for the Emergency Centre (Q2 2017/18)
Com Plan STP
Q4 G G On track - Handover from Kier planned for May 17 (currently ahead of schedule likely April 17). Once handed over, infrastructure (IT and equipment) will be put in place before cleaning ready for decant from B1.
M7 Implement new IT system Com Plan Q3 G G On track for Oct 16
M8 Full implementation of the Emergency Centre Model
Com Plan STP
Q3 G G On track - scheduled for 6th July 17
M9 Expand role of the Care Co-ordination Centre (CCC) to manage the interface between acute /community
Com Plan STP
Q3 A G Expansion of CCC on track but further discussions to take place around the clinician to clinician proposals still ongoing.
M10 Ensure replacement Risk Stratification Tool is in place to support the reduction in emergency admissions
Com Plan Q3 G G On track – expected roll out completion by mid-November
Key Performance Indicators (KPIs)
K3 Contain growth in the number of non-elective admissions
Contractual target
Meet contracted
levels
Includes all contract activity at all acute providers where the CCG has a contract. £0.6m above contract as at July 16
K4 Contain growth in A&E attendances Contractual target
Meet contracted
levels
Includes all contract activity at all acute providers where the CCG has a contract. £0.2m above contract as at July 16
K5 Achieve 4 hour access standard for A&E
Constitutional GB Report
95% by Q4 91.6% YTD as
at 30/06
91.7% YTD as
at 02/10
TRFT Year-to-date A&E position (Type 1 TRFT) as at week ending 23rd October 2016 was 91.3%. October to date has seen a dip in performance from September (92.8% for September and 86.3% October month to date). The position remains therefore very challenged. The agreed A&E improvement action plan continues to be monitored closely by the CCG with assurance being provided through the contractual mechanism and A&E delivery board. Local comparison to other Trust's in South Yorkshire can be found in the A&E Exceptions report. more detail can be found in the GB report
K6 Reduce unplanned hospitalisation for chronic Ambulatory Care Sensitive conditions
I&A Framework GB Report
1,074 WD WD Still awaiting data publication
QIPP
Delivery of A and E Assessments through the Clinical Decision Unit
QIPP Plan £286,000 G G
Reducing levels of Activity growth in A&E QIPP Plan £280,000 A A
Reduce IHAM NHSE growth assumption in line with local trend analysis
QIPP Plan £226,000 R R
Risks Risk Description Risk Score
Unscheduled Care QIPP GB Assurance Framework
Failure to deliver system wide efficiency programme for unscheduled care
20
A&E target GB Assurance Framework
Failure to meet A&E targets 16
3 Transforming Community Services Lead GP: Phil Birks Lead Officer: Dominic Blaydon
Funding in 2016/17 =£28.5m
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M11 Implement and monitor the Integrated Locality Team at the Health Village
Com Plan Q2 G G On track
M12 Implement and monitor the Integrated Rapid response Service
Com Plan Q2 G G On track - Note that staff are integrated on
one site a lead has been identified but not in place as yet
M13 Completion of the Business Care for the Re-ablement Village
Com Plan Q4 G G On track
Key Performance Indicators (KPIs)
K7 People who have had a stroke who are admitted to the acute stroke unit in 4 hours of arrival to hospital
Quality Premium
90% national standard
R 50.0%
R – Aug RFT
position –
57%
RFT position used as most up to date available and is reflective of overall CCG position
K8 Emergency readmissions within 30 days of discharge from hospital
BCF GB report
10% R Jun
16 YTD = 12.4%
R Aug
16 YTD = 30%
K9 Delayed transfers of care from hospital
I&A Framework
BCF GB Report
Quality Premium
Jul 16 Target
YTD = 1005.3 delayed days from hospital per 100,000 population (aged 18+)
G Apr-
Jun 16 YTD = 681.1
G Jul 16 YTD = 868.8
On track
K10 Number of unscheduled admissions of patients > 65 years out of hours
TCS reporting Threshold = -15%
WD WD Waiting for data
K11 Number of A&E attendances by care home residents
TCS reporting Threshold = 1250
R April / May = 270
TBC Qtr 2 data not available for 4-5 weeks
K12 GP satisfaction rate for the Integrated Community Nursing Service
TCS reporting Threshold = 80%
WD WD Q4 2015/16 achieved green, awaiting data for Q1
QIPP
Reducing levels of Activity in Emergency Admissions - neuro rehab, integrated rapid response and integrated locality teams
QIPP Plan £1,039,000 A R
Risks Risk Description Risk Score
None identified GB Assurance Framework
4 Ambulance and Patient Transport Services
Lead GP: David Clitherow Lead Officer: Julia Massey
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M14 Develop a process to understand the CPR performance delivered to support improved patient outcomes
Com Plan Q4 TBC G YAS have identified the technology required to obtain accurate reporting on CPR standards from Defibrillators, reporting structure agreed and training needs identified.
M15 Improved hospital pre alert and treatment plans for patients with suspected Sepsis
Com Plan Q4 TBC G Operational plan produced Audit undertaken to agree baseline.
M16 Commission a provider for PTS service
Com Plan Q4 G On track
Key Performance Indicators (KPIs) K13 Response to category A (Red1)
ambulance calls within 8mins
I&A Framework
75% R June = 59.3%
R August = 58.8%
Not on track - YAS are currently participating in an NHS England-led Ambulance Response Programme (ARP), which went live from the 21st April 2016. The pilot ran for 3 months initially and has subsequently been extended. This programme involves a change in how calls are recorded from the previous current Red/Green system. Currently the only standard in place to monitor these new call classifications against is 75% for Red calls under 8 minutes.
QIPP
None identified
Risks Risk Description Risk Score
Ambulance Targets GB Assurance Framework
Failure of YAS to achieve RED 1 8 minute Target at CCG level and Yorkshire & Humber wide
20
5 Clinical Referrals (Diabetes is a clinical priority within the I&A Framework)
Lead GP: Anand Barmade Lead Officer: Janet Sinclair-Pinder
Funding in 2016/17 = £66.7m
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M17 Implement 10 clinical thresholds Com Plan Q4 G G Note that whilst on track for Q4, there was an aspiration for 1 December implementation which is currently off track and negotiations with TRFT are taking place to address.
M18 Extension of virtual clinics from haematology to other areas such as endocrinology
Com Plan Q2 G R TRFT have concerns over the recording of activity, the issue with the Meditech system to enable correct recording needs resolving. CCG have asked for formal notice of when this will be resolved, but we have not received any indication of timescales as yet.
M19 Delivery of agreed audit programme and implementation of recommendations (6 in 2016/17 – 4 clinical thresholds, 1 cancer, 1 emergency admissions)
Com Plan Q4 G G On track
M20 Review and implement Rotherham Diabetes Care model around the Portsmouth care model which focuses around “super six” care.
Com Plan Q4 G G On track
Key Performance Indicators (KPIs) K14 Patients waiting 18 weeks or less
from referral to hospital treatment
Constitution / I&A
Framework GB Report
92% G June = 94.8%
G August = 93.7%
% Patients on incomplete non-emergency pathways waiting no more than 18 weeks. On track with performance continuing to be above the target.
K15 Contain growth in elective activity Contractual Meet contracted
levels
Includes all contract activity at all acute providers where the CCG has a contract. £0.3 Million below contract as at July 16
K16 Achievement of outpatient follow up ratios
Contractual 11% reduction
in follow ups from last year at
RFT
TBC -3.6% Activity down 3.6% on last year’s activity at RFT. The CCG contracted for an 11% reduction in follow-ups however, there is an agreed ratio in the contract above which the CCG will not pay.
QIPP
Reduction in follow-ups where TRFT are above peer average
QIPP Plan £816,000 G G See K16 above.
Reducing levels of Activity growth in direct access pathology in line with clinical pathways
QIPP Plan £73,000 R A
Reduce IHAM NHSE growth assumption in line with local trend analysis
QIPP Plan £509,000 G R
Risks Risk Description Risk Score
Planned Care QIPP GB Assurance Framework
Failure to deliver system wide efficiency programme for planned care
20
6 Medicines Management Lead GP: Avanthi Gunasekera Lead Officer: Stuart Lakin
Funding in 2016/17 =£48.0m
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M21 Potential savings of £447,500 have been identified by the introduction of a range of branded generic drugs. This figure will be adjusted as further schemes evolve. A target of 90% compliance has been set = annual savings £402,750.
Meds Management
Priority
90% G G On track
M22 12 projects to be delivered over the financial year two have been completed £273,000 savings identified this figure will evolve has schemes are still being evaluated
Meds Management
Priority
12 projects G G On track
M23 6 practices to have committed to become waste beacons and have begun the transformational work plan by September 2016. 9 practices have committed to the programme and timescales
Meds Management
Priority
Q3 TBC G On track 12 practices are signed up against a target of 6.
Key Performance Indicators (KPIs) K17 Reduction in the number of
antibiotics prescribed in primary care
Quality premium / I&A
Framework GB Report
4% reduction or 1.161 items per
STAR-PU
G 1.192
TBC Qtr 2 data not available for 4-5 weeks
K18 Appropriate prescribing of broad spectrum antibiotics in primary care
Quality premium / I&A Framework / GB Report
lower than 10%, or to reduce by 20% from each CCG’s 2014/15
value
G 8.5
TBC Qtr 2 data not available for 4-5 weeks
K19 Number of finance and quality “green” indictors
Meds Management
75% og 1302 indicators to be
green 976
G 552
(42%)
TBC Qtr 2 data not available for 4-5 weeks
QIPP
Medicines Waste reduction QIPP Plan £700,000 A A
Medicines Management QIPP QIPP Plan £550,000 A A
Branded Generics QIPP Plan £250,000 G G
Rebates and contract efficiencies. QIPP Plan £200,000 G G
Do not prescribe QIPP Plan £150,000 A A
Nationally Negotiated Price Reductions QIPP Plan £1,000,000 A G
Service redesign - Nutrition/Gluten Free QIPP Plan £90,000 A A
UNIDENTIFIED QIPP Plan £190,000 R R
Risks Risk Description Risk Score
Prescribing QIPP GB Assurance Framework
Failure to deliver system wide efficiency programme for prescribing
20
7 Mental Health (Mental Health and Dementia are clinical priorities within the I&A
Framework) Lead GP: Russell Brynes (Adults) Richard Cullen
(Childrens) Lead Officer: Kate Tufnell (Adults) Nigel Parkes
(Childrens)
Funding in 2016/17 =£35.0m
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M24 Externally evaluate Adult Mental Health Liaison and MH Social Prescribing programmes
Com Plan STP
Q3 G G On track
M25 RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan
Com Plan Q3 G G On track, some concern that the plan will be produced, assurance being monitored via the QIPP Committee.
M26 Dementia – Implement and evaluation the Dementia LES
Com Plan Q3 G G On track
M27 Children and Young People - All children and young people will follow the agreed process in transitioning to adult services and all will have a transition plan in place.
Com Plan STP
Q4 G G On track - we now have a CQUIN relating to Transition, which monitors closely all transitions from CAMHS to Adult MH services.
M28 Review of out of area placements in partnership with RDASH
Com Plan STP
Q2 G G On track
Key Performance Indicators (KPIs) K20 People with 1
st episode of psychosis
starting treatment with a NICE- recommended package of care treated within 2 weeks of referral
I& A Framework
STP GB report
50% G 72.9%
G Aug-16
= 70.6%
On track
K21 Percentage of people who are "moving to recovery" of those who have completed IAPT treatment
I&A Framework GB Report
Quality Premium
51.3% A 47.6% at the end of
Q1
A Jul 16 YTD = 50.50%
Not on track YTD although monthly performance for July was 56.2% and met the standard. The IAPT service has undergone a visit by NHS Improvement. The report following this visit is currently being reviewed and actions discussed across stakeholders.
K22 Diagnosis rate for people with dementia, as a percentage of the estimated prevalence
GB Report I&A
Framework
67% G June = 73.85%
G July =
75.11%
On track – note data is a snapshot as at month end
K23 Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment
GB Report I&A
Framework
75% A 71.8%
R 67.2%
Performance has deteriorated and remains significantly off track.
K24 95% of children and young people
who present at A&E in crisis will be seen within 1 hour
STP Com plan
No existing data –
awaiting STP
WD WD No data for Q2
K25 95% of adults who present at A&E
in crisis will be seen within 1 hour
STP Com plan
No existing data –
awaiting STP
WD WD No data for Q2
QIPP
MH and LD – joint risk share with RDASH to reduce the Out of Area activity
QIPP Plan £369,000 R R
Risks Risk Description Risk Score
IAPT Waiting Times GB Assurance Framework
Failure to deliver the National IAPT waiting times standards for 6 and 18 weeks
16
CAMHS Reconfiguration GB Assurance Framework
Inability to deliver CAMHS reconfiguration in a timely manner
16
CAMHS Transformation GB Assurance Framework
Delivery of the CAMHS Local Transformation Plan 12
CAMHS Services GB Assurance Framework
Failure to improve Child and Adolescent Mental Health Services (CAMHS)
12
8 Learning Disability (Learning Disabilities is a clinical priority within the I&A
Framework) Lead GP: : Russell Brynes (Adults) Richard Cullen
(Childrens) Lead Officer: Kate Tufnell
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M29 Deliver the required number of bed reductions as per Rotherham element of the plan
Com plan Q4 G A Not delivering against planned trajectory to achieve Q4 target. NHSE have flagged the wider footprint at risk of delivery.
M30 Deliver GP training to support the Annual Health check DES
Com plan Q2 G G On track - completed
Key Performance Indicators (KPIs)
K26 Ensure that patients receive a CTR prior to a planned admission to an Assessment and Treatment Unit or mental health inpatients
Com Plan STP
95% G G On track. No planned admissions in quarter 2
K27 Ensure that patients in an Assessment and Treatment Unit receive a Care and Treatment Review (CTR) every 6 months
Com Plan STP
100% G G On track
K28 Reduce the number of people admitted in line with the South Yorkshire and North Lincolnshire LD TCP trajectory
Local Reporting
Target = 3 – CCG
funded LD beds
5 – NHSE
funded secure LD
beds
G A CCG funded LD beds is currently at 5, of which 2 patients are awaiting funding approval and 1 patient is awaiting an appropriate placement. The NHSE funded beds currently at 3 with target being met. The rationale for performance moving to amber is due to the over performance on the wider footprint target
QIPP
Review of Assessment and Treatment Unit capacity in block purchase or spot purchase
QIPP Plan £483,000 G G
Risks Risk Description Risk Score
None identified GB Assurance Framework
To note, the following KPIs are within the I&A Framework but are not currently in publication
% of people with a learning disability on a GP register having annual health check
Reliance on specialist inpatient care for people with learning disability/autism
9 Maternity and Children’s Services (Maternity is a clinical priorities within the I&A Framework)
Lead GP: Richard Cullen Lead Officer: Emma Royle
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M31 Complete a gap analysis and ‘next steps’ against the National Maternity Review: Better Births
Com Plan
Q3 G G On track - TRFT have undertaken and shared a gap analysis.
M32 Complete a revised strategy and service specification for maternity services
Com Plan
Q3 G G On track - The draft strategy is to be reviewed to take in to account ne guidance including the reduction in still births: a care bundle.
M33 Develop new community services specifications for children’s community nursing and specialist nurses to support the Care Closer to Home work-stream
Com Plan
Q3 G G On track - Consultation has taken place with staff, and the parent carers forum are undertaking a consultation exercise and utilising commissioning tools.
Key Performance Indicators (KPIs)
K29 Reduce the number of neonatal mortality and still births
I&A Framework Outcomes Framework
TBC WD WD Latest position is 9 per 1000 births for 2014. Awaiting more data to be published.
K30 % of children aged 10-11 classified as overweight or obese
I&A Framework
Public Health
TBC WD WD Latest position is 35.3% in 2014/15
K31 Maternal smoking at delivery I&A Framework
Public Health
TBC WD WD Latest available position – Q1 16/17
K32 Improve Women’s experience of maternity services (national maternity services survey)
I&A Framework
Outcomes Framework
TBC WD WD 2015 score of 7.87 is latest available position. AHD - Consider adding additional narrative when next score is published to explain how score is calculated.
K33 Emergency admissions for children with lower respiratory tract infections
I&A Framework
541.8 WD WD Latest position is 541.8 in 2014/15
K34 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19’s
I&A Framework
364 WD WD Latest position is 364.0 in 2014/15
QIPP
None identified
Risks Risk Description Risk Score
Health Assessments for Children in Care GB Assurance Framework
NHS RCCG reputation as responsible commissioner for Children in Care - not having initial health assessments within statutory framework
12
10 Continuing Care and Funded Nursing Care
Lead GP: Richard Cullen Lead Officer: Alun Windle
Deliverable Milestones for 2016/17 Source 2016/17 Target
Q1 Q2 Q3 Q4 Comments
M34 Put in place a comprehensive range of agreed local policies and protocols in line with any contemporary guidance
CHC Standards
AQuA Assurance
Report
Adults Q3
G G On track
M35 Children Q3
G G On track
M36 Develop a CHC training package for health and social care staff regarding local process and provision of CHC
CHC Standards
AQuA Assurance
Report
Q4 G G On track
M37 Implement processes fit for purpose with identified panels having an appropriate number, scope, size and membership
CHC Standards
AQuA Assurance
Report
Adults Q1
G G On track
M38 Children Q3
G G On track
Key Performance Indicators (KPIs) K35 People eligible for standard NHS
continuing healthcare
I&A Framework GB report
TBC WD WD Not currently in publication
K36 Personal Health Budgets I&A Framework GB report
TBC WD WD Not currently in publication
K37 Patients in receipt of CHC will have a completed annual review
CHC Key Performance
Indicators
Adults 25-30%
outstanding
G G
K38 Children 0%
outstanding
G G
K39 Patients referred by Fast Track referral will receive a funding decision within 48 hours
CHC Key Performance
Indicators
100% Q4
G G
K40 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 28 days from the receipt of the continuing healthcare checklist - Adults
CHC Key Performance
Indicators
100% Q4
A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.
K41 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 6 weeks from the receipt of the continuing healthcare checklist – Childrens
CHC Key Performance
Indicators
100% Q4
A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.
QIPP
Review of Children's CHC packages QIPP Plan £250,000 A A
Review of Assessment tool for determining care packages
QIPP Plan £150,000 A A
Review of High Cost Care packages QIPP Plan £100,000 A A
Risks Risk Description Risk Score
Equipment via IFR/CHC GB Assurance Framework
Equipment provided by RCCG via IFR/CHC - failure to have a procurement service to ensure cost effectiveness and service that ensures that purchased equipment has a record of maintenance.
15
Failure to meet the National cut-off date for Previously Unassessed Periods of Care
GB Assurance Framework
Failure to meet the National cut-off date of 1st March 2017 for Previously Unassessed Periods of Care (PUPoC) - previously CHC Retrospective Claims
15
CHC overspend GB Assurance Framework
Overspend due to high costs of individual patients of continuing care
12
11 End of Life Care (EOLC) Lead GP: Avanthi Gunasekera Lead Officer: Nigel Parkes
Funding in 2016/17 =£3.0m
Deliverable Milestones for
2016/17 Source
2016/17 Target
Q1 Q2 Q3 Q4 Comments
M39 Involvement of the Care Co-ordination Centre in the EOLC pathway
Com Plan Q4 R A Not on track – discussions continue to take place around implementation and it is still the intention for the CCC to be a single point of access for EOLC.
M40 Achieve 40% implementation of the Case Management Palliative Care Template in Primary Care
Com Plan Q4 A A Started but not on track, target = Q2 20%, Q3 30%, Q4 40%. The decision for this to be part of the case management template was taken recently so implementation is just starting traction.
Key Performance Indicators (KPIs)
K42 Percentage of deaths which take place in hospital
I&A Framework GB
Report
TBC WD WD 2014/15 Q4 - 2015/16 Q3 – 47.1% AHD comment - Can’t immediately find a target for this – perhaps a reduction
K43 Percentage of deaths not in hospital Public health 54% by Q4 WD WD Please note - 5 month lag on data. 2016 has started well with January to March all above 2015 average and above 2015 January to March values. This has maintained the upturn in the 12 month moving averages. However, January and February are provisional and March and April are incomplete therefore liable to change. Q1 2016 provisional 55%
QIPP
None identified
Risks Risk Description Risk Score
None identified GB Assurance Framework
12 Specialised Services Lead GP: Richard Cullen Lead Officer: Jacqui Tufnell
Deliverable Milestones for
2016/17 Source
2016/17 Target
Q1 Q2 Q3 Q4 Comments
M41 Ensure robust arrangements for tier 3 Obesity in readiness for the transfer of tier 4 bariatric surgery in collaboration with public health
Com Plan Q4 G G On track
Key Performance Indicators (KPIs)
- n/a No KPIs
QIPP
None identified
Risks Risk Description Risk Score
Collaborative commissioning GB Assurance Framework
Effective collaborative commissioning of specialised services
12
13 Joint Work – local and Regional Lead GP: Julie Kitlowski Lead Officer: Ian Atkinson/Keely Firth
Funding in 2016/17 = BCF is £24.3m
Deliverable Milestones for
2016/17 Source
2016/17 Target
Q1 Q2 Q3 Q4 Comments
M42 Develop and deliver the STP STP Q3 G G On track M43 Develop and deliver the local place
based plan
STP Q3 G G On track
M44 Oversee the implementation of the BCF with RMBC
Com Plan / BCF Plan
Q4 G G On track
Key Performance Indicators (KPIs)
- Achievement of BCF KPIs – see BCF Plan
Com Plan / BCF Plan
Q4 Please see BCF page of GB report
QIPP
None identified
Risks Risk Description Risk Score
Funding for BCF GB Assurance Framework
Resources reduced through introduction of BCF 12
14 Child Sexual Exploitation Lead GP: Lee Oughton Lead Officer: Catherine Hall
Deliverable Milestones for
2016/17 Source
2016/17 Target
Q1 Q2 Q3 Q4 Comments
M45 As part of the annual update for GPs and practice staff, ensure minimum training level 3 is delivered
Com Plan Q1 G G On track
M46 Offer the same training as above to the remainder of primary care, social care and providers
Com Plan Q1 G G On track
M47 Provide ongoing support to current and emerging SYP and NCA historic investigations
Com Plan Q1-Q4 G G On track
M48 Provide 2 members to be part of the Multi Agency Safeguarding Hub team
Com Plan Q1- Q4 G G On track
Key Performance Indicators (KPIs)
- None identified
QIPP
None identified
Risks Risk Description Risk Score
None identified GB Assurance Framework
15 Cancer (Cancer is a clinical priorities within the I&A Framework) Lead GP: Richard Cullen Lead Officer: Janet Sinclair-Pinder
Deliverable Milestones for
2016/17 Source
2016/17 Target
Q1 Q2 Q3 Q4 Comments
M49 Support on-going delivery of the TRFT Cancer Improvement action plan focusing on one year survival rates.
Com Plan STP
Q4 G G On track
M50 Implementation of NICE Cancer Guidelines
Com Plan STP
Q4 G G On track
M51 Fully engage with the Macmillan Living With and Beyond Cancer (LWABC) Programme to identify gaps in service and develop an action plan
Com Plan STP
Q3 G G On track
M52 Focus work on awareness raising / early diagnosis / 2 week wait
Com Plan STP
Q3 G G On track
Key Performance Indicators (KPIs)
K44 Cancer (all) diagnosed at stage 1 and 2
I&A Framework
Quality Premium
>60% or 4 % point
improvement
R 2014 - 36.5%
R Off track but inconclusive as the latest reporting period was 2014
K45 Percentage seen within 2 weeks following an urgent referral by GP for suspected cancer
GB Report 93% G 95.9%
G July = 95.7%
On track
K46 Percentage seen within 62 days after a referral by GP
Quality Premium
I&A Framework
85% G June = 89.2%
G July = 85.1%
On track, Performance has decreased but remains within the standard
K47 Patient satisfaction rates >89% (Secondary care)
Com Plan STP
Q1 G G On track – note this is annual data
K48 Percentage of patients satisfied with support from their GP during treatment >66%
Com Plan STP
Q1 G G On track – note this is annual data
QIPP
None identified
Risks Risk Description Risk Score
None identified GB Assurance Framework
To note, the following KPIs are within the I&A Framework but are not currently in publication
Cancer one year survival rates – 2013 data
Cancer patient experience – 2014 data
Glossary (AHD refers to Alex Henderson-Dunk)
APMS Alternative Provider Medical Services BCF Better Care Fund CCC Care Co-ordination Centre CHC Continuing Healthcare
CAMHS Child and Adolescent Mental Health Services
CQC Care Quality Commission
EOLC End of Life Care GB Governing Body IFR Individual Funding Request I&A Improvement and Assessment LES Local Enhanced Services ‘Q’ ‘Quarter’ QIPP Quality Innovation Productivity and
Prevention RMBC Rotherham Metropolitan Borough Council
STP Sustainability and Transformation Plan TRFT The Rotherham Foundation Trust WIC Walk in Centre IHAM Indicative hospital activity model