Item Number: 6.1

Governing Body Meeting: 4 February 2016

Report Sponsors John Pattinson, Director of Quality Anthony Fitzgerald, Director of Strategy Dilani Gamble, Chief Finance Officer

Report Author Suzanne Savage Assistant Commissioning Manager

1. Title of Paper: Corporate Dashboard 2. This Paper is for:

Approval Decision Assurance – For Discussion

Assurance – For Information Only

X

3. CCG Strategic Objectives supported by this paper

CCG Strategic Objective X

1 Engage and enable local people to be involved in decisions made about the healthcare we commission

2 Commission services to ensure and improve quality and safety of services and improve outcomes

X

3 Achieve a sustainable Health Economy X 4 Deliver our 2 year Operational and 5 year Strategic plan to transform

services X

5 Strengthen and develop partnerships to collectively deliver our shared strategic objectives

X

6 The continuous development of a strong, sustainable, successful and accountable Clinical Commissioning Group

4. CCG Values Underpinned in this paper

CCG Values X

1 Respect and Dignity X 2 Commitment to Quality of Care X 3 Compassion X 4 Improving Lives X 5 Working Together for Patients X 6 Everyone Counts X

1

5. Does this paper provide evidence of assurance against the Governing BodyAssurance Framework?

YES x NO

If you answered yes above, please indicate which principle risk and outline

Principle Risk No

Principle Risk Outline

3 – 1 Failure to deliver effective commissioning within available resources, including the delivery of the Better Care Fund.

6. Does this paper mitigate risk included in the CCGs Risk Registers? If Yes,please outline.

Ref: Risk No Outline YES FPCC 8 The Performance Dashboard is a Key Control for the

risk: Failure to deliver effective commissioning within available resources, including the delivery of the Better Care Fund.

YES FPCC 12 The Performance Dashboard is a Key Control for the risk: On behalf of the CCG, the FPCC does not meet the statutory and regulatory requirements specifically related to the business of the committee.

7. Executive Summary

This month the Governing Body is asked to consider the performance dashboard for January 2016 (see Appendix 1). The Governing Body can assume indicators that are rated green are performing well.

Points to note regarding Quality indicators:

• Quality Premium – The majority of indicators continue to achieve thresholdshowever Ambulance, mental health and non-elective admissions remain achallenge and the CCG will be monitoring these closely to understand whetherany of the indicators pose a risk of failure to achieve by year end.

• Incidence of healthcare associated infection (HCAI): Clostridium difficileWe have agreed a specification for enhanced services to support patients withC-Diff and root cause analyses are up to date. Some lapses in care have beenidentified although these numbers are small.

Serious Incident Reporting The current position for Serious Incidents can be found in Appendix 2. 20 new incidents have been reported in December 2015 for HaRD CCG (103 YTD total). The Appendix also includes the December 2015 position across all providers.

2

Points to note regarding Performance indicators:

• Ambulance Performance:Cat A (Red 1) - 8 minute response time (YAS Trust Level) HaRD CCG YTDperformance remains above target at 76.1%. At Trust level, performanceimproved in November to 73.8%.Cat A (Red2) - 8 minute response time (YAS Trust Level) althoughperformance at CCG level saw an improvement in November, fluctuatingdemand profiles and the impact of the roll out of the training on the electronicPatient Report Form (ePRF) means that the 75% threshold has not been met.Performance continues to be monitored by commissioners at regional 999collaborative Contract Management Board meetings with local discussions heldwith the provider at sub group meetings.Ambulance Handover Delays: Numbers continue to be comparatively lowcompared to national and regional performance. Commissioners continue toreview monthly breach analysis report with the provider to identify possiblelessons learned and opportunities for improvement. This is also discussed bythe Systems Resilience Group.

• Increasing Access to Psychological Therapies: Proportion of peopleentering therapy. Raising awareness of the need to refer to the IAPT serviceremains a priority within the CCG. Access and recovery targets continue to bemet.

• Delayed transfers of care (delayed days) from hospital per 100,000population (average per month) BCF Area. The acute trust and localauthority continue to focus on ways to minimise delayed transfers of care. TheCCG are reporting to NHS England on a weekly basis the numbers of delaysand actions being taken. This is regularly reported and discussed at SystemResilience Group.

Locally monitored indicators:

• Patient Transport Service Pick up after appointment within 120 mins (SNand OD journeys only) YAS North Consortium. Performance at HaRD CCGlevel is achieving. North Consortium level performance is affected bygeographical difficulties outside of the HaRD area.

Points to note regarding Finance indicators:

The CCG continues to forecast a breakeven position for 2015/16, maintaining the 1% surplus brought forward from 2014/15.

There continues to be significant over performance against acute contract plans which is currently been offset by contingency funds, uncommitted resources and underspends in other areas.

There continues to remain a number of risks that will need to be managed in year, in order to deliver the forecast breakeven position. The main risks continue to be the delivery of the overall QIPP programme and managing the level of demand for acute services.

3

8. Any statutory / regulatory / legal / NHS Constitution implicationsThe CCG has a duty to ensure delivery against the Quality and Outcomes framework and the NHS Constitution.

9. Equality Impact AssessmentAll services contained within the report have been subject to equality impact assessment.

10. Implications / actions for Public and Patient EngagementN/A

11. Recommendations / action requiredGoverning Body is asked to accept the contents of the report.

12. MonitoringReports are brought to each Governing Body meeting and also monitored via the following CCG Committees:

• Quality & Clinical Governance Committee• Finance, Performance & Commissioning Committee.

Action plans are monitored through the relevant Provider contract meetings.

For further information please contact: John Pattinson (Director of Quality) Anthony Fitzgerald (Director of Strategy and Delivery) Dilani Gamble (Chief Finance Officer) 01423 799300

4

2015/16 CORE PERFORMANCE DASHBOARD

Published for Governing Body Meeting 4th February 2016

April 2014 - November 2015

Contents

Page Number

Quality Summary 3

Quality Premium 7

Performance Summary 9

Finance and Contract Position Summary 14

Better Care Fund Summary 17

Quality and Performance Exception Report 19

Page 2

Quality

Page 3

Quality Summary and Key Messages

The following exceptions are those which are of concern either Year To Date (YTD) or in month:

 

Quality Premium – Commissioners continue to work collectively with YAS in improving the ambulance service to our population and performance has improved in month (November 2015). The difference

between contract consortium performance and local CCG performance does mean an anticipated impact on the Quality Premium. The RTT, A&E 4 hour waits, Delayed Transfers of Care (NHS) and Mental

Health A&E coding indicators have seen a small shift in performance levels, however it should be noted that all these standards continue to achieve YTD - the CCG will keep this under review. The indicator in

relation to 95% of Mental Health patients attending A&E meeting the 4 hour target has also seen a small shift in performance in November and evaluation of the urgent care pathway for mental health

patients continues. The CCG have raised this issue at the appropriate forums and recognise there is still some analysis to be undertaken. In relation to the indicator Increase in the number of patients

admitted for non-elective reasons, who are discharged at weekends or bank holidays, November data represents a marginal shift to 18.2% (from 18.3% in October) - the numbers of patients discharged has

remained similar each month however in October there was an increase in the number of non-elective admissions which has affected the YTD percentage. In November the number of non-elective

admissions returned to levels seen in previous months. The CCG will be monitoring this closely to understand if this is natural variation and if there are risks to failing to achieve this indicator although failure

to do so at this stage is not anticipated.

Incidence of healthcare associated infection (HCAI): Clostridium difficile: To date, 38 cases have been attributed to the CCG; 18 of which are community cases. The CCG has agreed a specification for

enhanced services to support patients with CDiff and root cause analyses are up to date. We have identified some lapses in care although these numbers are small (3).

Inpatient Care: Total health gain as assessed by patients for elective procedures b) knee replacement and c) groin hernia

Data for June 2015 has been supressed due to low number of records (less than 30). At March 2015 the level of health gain for knee replacements and groin hernias was slightly below the position in March

2014. Q2 15/16 data is expected in Q4.

Friends and Family Test for A&E - % recommended - Harrogate and District

In November, 85.3% of patient responses recommended Harrogate A&E (Target 86%).The national average was 87%. HDFT's performance for this measure averages at 89.6% (range from 85.3% to 92.5%

over 8 months) which is above the national average for the same period at 87.9%.

Friends and Family Test for A&E - % not recommended - Harrogate and District

In November, 9.4% of patient responses did not recommend Harrogate A&E (Target 5%). The national average was 7%. HDFT's performance for this measures averages at 5.1% (range from 2.6% to 9.4% over

8 months) which is above the national average over the same period at 6.3%.

Friends and Family Test for A&E - % recommended - York

In November, 76.1% of patient responses recommended York Trust A&E (Target 86%). York's performance for this measure averages at 81.1% (range from 76.1% to 85.1% over 8 months) which is below the

national average over the same period at 87.9%. York Hospital NHS Foundation Trust are focusing on improving their position across all FFT indicators through reinvigorating their Patient Experience Team;

co-producing an action plan with key directorates to improve response rates which will be monitored by the lead commissioner.

Friends and Family Test for A&E - % not recommended - York

In November, 16.9% of patient responses did not recommend York Trust A&E (Target 5%). The national average was 7%. York's performance for this measure averages at 13.1% (range from 9.4% to 16.9%

over 8 months), which is above the national average over the same period at 6.3%.

Friends and Family Test for inpatient acute - % recommended - Harrogate and District

In November, 95.5% recommended Harrogate Trust inpatient acute services, just short of the monthly target (96%) but above the national average which was 95%. The YTD position is currently 95.8%.

HDFT's performance for this measure averages at 95.8% (range from 93.7% to 98% over 8 months) which is above the national average for the same period at 95.7%.

Friends and Family Test for inpatient acute - % not recommended - Harrogate and District

In November, 0.9% did not recommend Harrogate Trust inpatient acute services, which is just below the 1% target. The national average for that month was 1%. The YTD figure is marginally over the 1%

target at 1.2%. HDFT's performance for this measure averages at 1.2% (range from 0.5% to 3% over 8 months) which is below the national average for the same period at 1.2%.

Friends and Family Test for inpatient acute - % recommended - York

In November, 95.5% recommended York Trust inpatient acute services. (Target 96%). The YTD position is over target currently at 96.4%. York's performance for this measure averages at 96.4% (range from

95.5% to 97% over 8 months) which is above the national average for the same period at 95.7%.

Friends and Family Test for inpatient acute - % not recommended - York

In November, 1.3% did not recommend York Trust inpatient acute services (Target 1%) The YTD figure is marginally over the 1% threshold at 1.1%. York's performance for this measure averages at 1.1 %

(range from 0.9% to 1.8% over 8 months) which is below the national average for the same period at 1.2%.

Page 4

The following exceptions are those which are of concern either Year To Date (YTD) or in month:

 

Quality Premium – Commissioners continue to work collectively with YAS in improving the ambulance service to our population and performance has improved in month (November 2015). The difference

between contract consortium performance and local CCG performance does mean an anticipated impact on the Quality Premium. The RTT, A&E 4 hour waits, Delayed Transfers of Care (NHS) and Mental

Health A&E coding indicators have seen a small shift in performance levels, however it should be noted that all these standards continue to achieve YTD - the CCG will keep this under review. The indicator in

relation to 95% of Mental Health patients attending A&E meeting the 4 hour target has also seen a small shift in performance in November and evaluation of the urgent care pathway for mental health

patients continues. The CCG have raised this issue at the appropriate forums and recognise there is still some analysis to be undertaken. In relation to the indicator Increase in the number of patients

admitted for non-elective reasons, who are discharged at weekends or bank holidays, November data represents a marginal shift to 18.2% (from 18.3% in October) - the numbers of patients discharged has

remained similar each month however in October there was an increase in the number of non-elective admissions which has affected the YTD percentage. In November the number of non-elective

admissions returned to levels seen in previous months. The CCG will be monitoring this closely to understand if this is natural variation and if there are risks to failing to achieve this indicator although failure

to do so at this stage is not anticipated.

Incidence of healthcare associated infection (HCAI): Clostridium difficile: To date, 38 cases have been attributed to the CCG; 18 of which are community cases. The CCG has agreed a specification for

enhanced services to support patients with CDiff and root cause analyses are up to date. We have identified some lapses in care although these numbers are small (3).

Inpatient Care: Total health gain as assessed by patients for elective procedures b) knee replacement and c) groin hernia

Data for June 2015 has been supressed due to low number of records (less than 30). At March 2015 the level of health gain for knee replacements and groin hernias was slightly below the position in March

2014. Q2 15/16 data is expected in Q4.

Friends and Family Test for A&E - % recommended - Harrogate and District

In November, 85.3% of patient responses recommended Harrogate A&E (Target 86%).The national average was 87%. HDFT's performance for this measure averages at 89.6% (range from 85.3% to 92.5%

over 8 months) which is above the national average for the same period at 87.9%.

Friends and Family Test for A&E - % not recommended - Harrogate and District

In November, 9.4% of patient responses did not recommend Harrogate A&E (Target 5%). The national average was 7%. HDFT's performance for this measures averages at 5.1% (range from 2.6% to 9.4% over

8 months) which is above the national average over the same period at 6.3%.

Friends and Family Test for A&E - % recommended - York

In November, 76.1% of patient responses recommended York Trust A&E (Target 86%). York's performance for this measure averages at 81.1% (range from 76.1% to 85.1% over 8 months) which is below the

national average over the same period at 87.9%. York Hospital NHS Foundation Trust are focusing on improving their position across all FFT indicators through reinvigorating their Patient Experience Team;

co-producing an action plan with key directorates to improve response rates which will be monitored by the lead commissioner.

Friends and Family Test for A&E - % not recommended - York

In November, 16.9% of patient responses did not recommend York Trust A&E (Target 5%). The national average was 7%. York's performance for this measure averages at 13.1% (range from 9.4% to 16.9%

over 8 months), which is above the national average over the same period at 6.3%.

Friends and Family Test for inpatient acute - % recommended - Harrogate and District

In November, 95.5% recommended Harrogate Trust inpatient acute services, just short of the monthly target (96%) but above the national average which was 95%. The YTD position is currently 95.8%.

HDFT's performance for this measure averages at 95.8% (range from 93.7% to 98% over 8 months) which is above the national average for the same period at 95.7%.

Friends and Family Test for inpatient acute - % not recommended - Harrogate and District

In November, 0.9% did not recommend Harrogate Trust inpatient acute services, which is just below the 1% target. The national average for that month was 1%. The YTD figure is marginally over the 1%

target at 1.2%. HDFT's performance for this measure averages at 1.2% (range from 0.5% to 3% over 8 months) which is below the national average for the same period at 1.2%.

Friends and Family Test for inpatient acute - % recommended - York

In November, 95.5% recommended York Trust inpatient acute services. (Target 96%). The YTD position is over target currently at 96.4%. York's performance for this measure averages at 96.4% (range from

95.5% to 97% over 8 months) which is above the national average for the same period at 95.7%.

Friends and Family Test for inpatient acute - % not recommended - York

In November, 1.3% did not recommend York Trust inpatient acute services (Target 1%) The YTD figure is marginally over the 1% threshold at 1.1%. York's performance for this measure averages at 1.1 %

(range from 0.9% to 1.8% over 8 months) which is below the national average for the same period at 1.2%.

Page 5

Quality Summary

Green Amber Red

Total (including those

where no in year

performance data

available)

Reducing years of life lost from causes

amenable to healthcare 0 0 0 0 (10)

Urgent Care Response 5 3 7 15 (16)Quality & Patient Safety 4 0 3 7 (7)Waiting Times 12 1 0 13 (13)Inpatient Care 7 1 6 14 (17)Community / Primary Care and Integrated

Care 1 0 1 2 (7)

Mental Health 3 0 1 4 (4)Locally Monitored 8 1 1 10 (10)Grand Total 40 6 19 65 (84)

Number of Indicators (Based on YTD Performance)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Indicator Summary NHS Constitutional Requirements

G A R

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Trend Summary NHS Constitutional Requirements

Improving Static Deteriorating

Page 6

Quality Premium

Page 7

Quality Premium 2015/16

Pre-Qualifying Criteria

Financial Governance*

Indicator** Period Target Performance

Change from

last period

Adjustment to

Funding

RTT Incomplete PathwayNovember YTD

2015/1692% 95.0% Deteriorating -30%

A&E 4 hour WaitsNovember YTD

2015/1695% 95.7% Deteriorating -30%

Cancer 14 day waitNovember YTD

2015/1693% 96.7% Improving -20%

Ambulance Cat A Red 1 (8 minute response)November YTD

2015/1675% 71.9% Improving -20%

Subject Area Indicator Period Target Performance

Change from

last period

% of Quality

Premium

Reducing premature

mortalityReduce potential years of life lost (PYLL) from

causes considered amenable to healthcare over timeCY 2014

1.2% reduction in

the average trend

fom 2012-2015

1,812.5 Improving 10%

Delayed transfers of care which are an NHS

responsibility.

Average delayed transfers of care (delayed days)

per 100,000 population, attributable to the NHS, per

month.

Nov YTD

2015/16

<2,215 days for

the FY 2015/16

(Average Delayed

Days per month

per 100k - 114.4)

1364 Days YTD

(Average Delayed

Days per month

per 100k - 105.7)

Deteriorating 10%

Increase in the number of patients admitted for non-

elective reasons, who are discharged at weekends

or bank holidays.

2015/16 YTD

2015/16

18.8%

(0.5% higher than

2014/15)

18.2% Deteriorating 20%

90% of primary

diagnosis codes

at A&E to have

valid code

97.7% Deteriorating

95% of people

attending A&E

meet the 4 hour

target

88.2% Deteriorating

Increase in the proportion of adults in contact with

secondary mental health services who are in paid

employment.

Rolling Year to

Dec 15

Increase on

2014/1515.2% Improving 5%

a) reduction in the number of antibiotics prescribed

in primary care

Rolling Year to

Oct 15

1.059

(1% reduction on

the 2013/14 value)

1.002 Improving 5%

b) reduction in the proportion of broad spectrum

antibiotics prescribed in primary care

Rolling Year to

Oct 15

Below 2013/14

median proportion

(11.3%)

6.2% Same 3%

c) secondary care providers validating their total

antibiotic prescription data

Provider to

validate their

antibiotics

prescribing data

Validated 2%

CCG OIS C2.2 Proportion of people feeling

supported to manage their conditions (based on

responses to one question from the GP Patient

Survey)

Year End

2014/15>64.4% 76.6% Improving 10%

PHOF 2.24i Injuries due to falls over 65s (Directly

standardised rate per 100,000 - Harrogate District

UA)

Year End

2013/141,711 1,661 Improving 10%

25%

NHS Constitution

Requirement

The 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.

The maximum quality premium payment for a CCG will be expressed as £5 per head of population,

calculated using the same methodology as for CCG running costs. (This is in addition to a CCG’s main

financial allocation for 2015/16 and in addition to its running costs allowance.) For each measure where

the identified quality threshold is achieved, the CCG will be eligible for the indicated percentage of the

overall funding available to it.

Comments

Patient Safety

Reduction in the number of patients attending an

A&E department for a mental health-related needs

who wait more than four hours to be treated and

discharged, or admitted, together with a defined

improvement in the coding of patients attending A&E.

Nov YTD

2015/16

Urgent and emergency

care

Mental health

Local Measures

Page 8

Performance

Page 9

Performance Summary and Key Messages

The following exceptions are those which are of concern either Year To Date (YTD) or in month:

Reducing years of life lost from causes amenable to healthcare: Q1 2015/16 data has been received since the last report although not for all indicators, as detailed below.

Performance appears as rate per 100,000 population:  

- Under 75 mortality rate from respiratory disease - 26.6 against a target of 15.4 (Q3 14/15)

- Under 75 mortality rate from cancer - 102.1 against a target of 101.1 (Q3 14/15)

- Emergency admissions for alcohol-related liver disease - 18.2 against a target of 10.9 (Q1 15/16)

- Unplanned hospitalisation for chronic ambulatory care sensitive conditions (ACS) – 710.8 against target of 571.1 (Q1 15/16)

- Unplanned hospitalisation for asthma, diabetes and epilepsy (under 19s) - 272.5 against a target of 257.9 (Q1 15/16)

- Emergency admissions for acute conditions that should not usually require hospital admission - 1,290 against a target of 1,187.9 (Q1 15/16)

- Emergency admissions for children with lower respiratory tract infections - 634.0 against a target of 605.0 (Q1 15/16)

Although not meeting the targets, the majority of Q1 15/16 performance was an improvement on the position at Q4 14/15. Urgent care admission data is being discussed at practice

visits and evaluations of the CAT service, Care Planning and BCF schemes is underway. Reduction in unplanned hospitalisation and emergency admissions is a key priority of the New

Care Models Vanguard implementation.

A&E waiting time - total time in the A&E department: YORK

Contextually less than 1% of the A&E attendances at York are for HaRD patients. November performance was below the 95% standard (91.8%) and YTD performance is 89.7%. There

have been bed pressures related to infection control issues and York Trust have implemented a reprofiled workforce in ED.

Ambulance: CAT A (Red1) - 8 minute response time (YAS Trust Level)

HaRD CCG YTD remains above target at 76.1%. In month performance at CCG level has seen a decrease from 81.8% in October to 68.8% in November. Performance at Trust level (YAS)

has seen slight improved in month from 73.7% in October to 73.8% in November against a target of 75%. Trust YTD performance remains below target at 72.0% in November.

November’s overall performance had seen an impact from reduced staffing against increased demand.

The Electronic Patient Report Form (ePRF) training continued to have impact in the first half of November in terms of staffing. The training was postponed in mid-November and is not

likely to re-commence until the new financial year.

The demand profile also showed noticeable fluctuation with some days in November which saw significant increase in predicted demand between certain hours, (e.g. One day saw 10

out of the 24 hours with a higher demand than expected including a run between 04:00 and 07:59 needing 9 responses instead of the expected 1 response).

Page 10

Performance Summary and Key Messages

Ambulance: CAT A (Red2) - 8 minute response time (YAS Trust Level)

Trust level (YAS) YTD performance has remained steady at 71.6% in November. In month Trust level (YAS) performance has improved from 72.5% in October to 73.3% in November.

Performance at CCG level has seen further improvement in month from 67.4% in October to 69.8% in November. HaRD CCG YTD performance remains below target at 71.0%.

Combined Red 1 and Red 2 performance achieved 78.2% within a 10 minute response time at CCG level. Performance continues to be monitored by commissioners at regional 999

collaborative Contract Management Board meetings with local discussions held with the provider at sub group meetings.

Handovers between ambulance and A&E taking place within 15 minutes, no one waiting more than 30 minutes (HDFT trust level)

There were 15 breaches reported in November which is an improved position on previous months and is attributed by the Trust to various improvement initiatives within the ED

department . Numbers continue to be comparatively low compared to national and regional performance. Commissioners continue to review monthly breach analysis report with the

provider to identify possible lessons learned and opportunities for improvement. This is also discussed by the Systems Resilience Group.

Handovers between ambulance and A&E taking place within 15 minutes, no one waiting more than 60 minutes (HDFT trust level)

No breaches have been reported since May 2015. The YTD total reflects 2 breaches reported in April 2015.

Following handover ambulance crew should be ready to accept new calls within 15 minutes. Number between 30 and 60 mins (YAS at Harrogate District Hospital)

7 breaches were reported in November 2015, this is a reduction in comparison to October which saw 14 beaches. The average time for the crew to be clear is 10 mins 31 seconds

against a target of 15 minutes in this period. The Electronic Patient Report Form training continued to have an impact on turnaround times in the first half of November with some

staff utilising these for the first time. Looking ahead December’s performance should not see any impact of the ePRF training and rollout as this was postponed for the winter period.

Following handover ambulance crew should be ready to accept new calls within 15 minutes. Number > 60 mins (YAS at Harrogate District Hospital)

No breaches were reported in November. The total number of breaches for 2015/16 remains as 2 breaches.

Referral to Treatment pathways: admitted

Changes to guidance mean that the CCG are measured against the incomplete RTT pathway only for which the threshold of 92% is being achieved (95.9% YTD).

Delayed transfers of care (delayed days) from hospital per 100,000 population (average per month) BCF Area

November saw a drop in the number of delays (from 1385 in October to 1,318 in November). November performance equates to 268.2 per 100,000 against a target of 206.1) and the

YTD figure is 222.9. The CCG, acute trust and local authority continue to work together to minimise the number of Delayed Transfers of Care, particularly over the winter period, and

are providing weekly updates to NHS England on actions being taken in support of this. This is regularly reported and discussed at System Resilience Group.

Page 11

Performance Summary and Key Messages

Increasing Access to Psychological Therapies: Proportion of people entering therapy

Performance for November was 13.3% against a target of 15%; performance in October was 14.1%. The current YTD performance is 12.9%. It should be noted that the CCG have

exceeded the access target of 75% - 100% were seen within 5 weeks or less and the recovery rate is 51% (50% target). Raising awareness of the need to refer is an ongoing piece of

work of which it is hoped will see an increase in the number of referrals.

Patient Transport Service (PTS)

The CCG performance dashboard reports North Consortia performance (North Yorkshire commissioners) with CCG level performance also noted within the exception report.

Performance continues to be monitored at contract meetings, with commissioners' continued work with the provider to understand breach analysis and remedial actions required:

Patient Transport Service Pick up after appointment within 90 mins (planned journey only) YAS North Consortium

At North Consortium and HaRD CCG levels, performance was below the 91% threshold in November 2015. YTD performance at HaRD CCG level is achieving the 91% threshold however

at Consortium level, previous performance means that the YTD performance is slightly under target at 90%.

Pick up after appointment within 120 mins (Short Notice and On Day journeys only) YAS North Consortium

Performance at HaRD CCG level continues to achieve the 96% threshold (98.8% in November and 98.1% YTD). At North Consortium level, performance improved to 91.1% (from

89.8% in October) and YTD performance is at 88.9%. Breaches relate in the main to geographical difficulties outside of the HaRD CCG area.

Page 12

Performance Summary

Green Amber Red

Total (including those

where no in year

performance data

available)

Reducing years of life lost from

causes amenable to healthcare0 0 0 0 (10)

Urgent Care Response 5 3 7 15 (16)

Quality & Patient Safety 4 0 3 7 (7)

Waiting Times 12 1 0 13 (13)

Inpatient Care 7 1 6 14 (17)

Community / Primary Care and

Integrated Care1 0 1 2 (7)

Mental Health 3 0 1 4 (4)

Locally Monitored 8 1 1 10 (10)

Grand Total 40 6 19 65 (84)

Number of Indicators (Based on YTD Performance)0%

10%20%30%40%50%60%70%80%90%

100%

Indicator Summary NHS Constitutional Requirements

G A R

0%10%20%30%40%50%60%70%80%90%

100%Trend Summary NHS Constitutional Requirements

Improving Static Deteriorating

Page 13

Finance and Contract Position Summary

Page 14

Finance and Contracting Summary and Key Messages

Based on information to the end of December 2015, the CCG continues to report a balanced forecast outturn position, as planned.

This position continues to maintain the £1.9million surplus brought forward from the previous year.

Acute Services

The CCG continues to experience a significant overtrade against plan on acute contracts, specifically at HDFT, and to a lesser degree at York FT, Leeds TH and BMI. The trend continues

to show overspends against contract plans, particularly on outpatient diagnostics, outpatient procedures, elective activity and non-elective activity. The contracting team, alongside the

business intelligence support, continue to validate and analyse these areas to support contractual discussions and challenges, and provide assurance through the Finance, Performance

& Commissioning Committee.

Mental Health

Information provided by the Partnership Commissioning Unit for the last several months is showing increased pressure in Mental Health out of contract placements. The contracting

and finance team continue to work with PCU colleagues to understand the reasons for the forecast overtrade, to explore any possible mitigating actions, and to bring in relevant

commissioning controls.

Prescribing

There is forecast overtrade of £0.4M against plan, down slightly from the previous report. This forecast is based on 7 months of activity information and forecast is as per Prescribing

Pricing Authority monitoring guidance. The medicines management team continue to work with all our practices to control prescribing and reduce prescribing costs. Updates on

initiatives are received and discussed at the Finance, Performance & Commissioning Committee.

Other Programme Costs

The CCG continues to report that there are no major issues or concerns to highlight on the mental health contracts, the continuing healthcare costs, ambulance contracts, primary

care or the voluntary sector. There are some underspends in these areas which is currently offsetting some of the acute activity pressures.

Running Costs

An underspend of £0.47M is forecast for 2015/16 against the running cost allocation of £3.6M.

Risks

There continue to be significant risks to delivering the reported forecast outturn position, the main areas being:

• Better Care Fund schemes impact on non-elective activity reductions.

• QIPP schemes impact on outpatient, elective and non-elective activity reductions.

• Acute activity growth exceeding current forecasts.

• Prescribing Costs exceed current forecasts.

Page 15

Finance and Contract Position Summary

Performance Assessment

Underlying Recurrent Position Green Elective Activity Amber

Operate within Running Costs envelope Green Non Elective Activity Amber

Not exceed cash limit Green Outpatients First Appointments Amber

QIPP Delivery Amber A and E Green

Budget Spend Variance Budget FoT Variance Risk

Acute & Ambulance Services 81,287 83,985 2,698 108,383 111,855 3,472 Red

Community Services 8,036 8,036 - 10,714 10,714 - Green

Mental Health Services 11,661 12,043 382 15,547 16,057 509 Amber

Continuing Care Services 10,386 9,356 (1,030) 13,745 12,475 (1,271) Green

Prescribing 19,247 19,575 327 25,663 26,099 436 Amber

Primary Care (inc Co-Commissioning) 18,124 17,914 (209) 24,165 23,886 (279) Green

Other Contracted Services 1,490 1,442 (49) 1,987 1,922 (65) Green

Running Costs 2,605 2,323 (282) 3,589 3,119 (470) Green

Better Care Fund/Projects/QIPP 4,553 3,519 (1,034) 6,070 4,691 (1,379) Green

Contingency 805 - (805) 953 - (953) Green

Total Expenditure 158,193 158,192 (0) 210,817 210,817 0

2015/16 Resource Allocation from NHSE 210,817

Under/Over Spend against Allocation 0

Acute Contract position (Year to Date Activity)Achievement of Financial Duties / Plans

Based on information received up to 31st December 2015. Financial performance targets for 2015/16 are projected to achieve

the following:

Financial Performance / Forecast

Full Year (£000's)Year to Date (£000's)

Based on SUS activity (Month 7 Freeze data and Month 8 Flex) HaRD activity for all contracted

trusts.

Performance Assessment

1,200

1,400

1,600

1,800

2,000

2,200

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Elective Activity

1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Non Elective Activity

3,000

3,500

4,000

4,500

5,000

5,500

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Outpatient First Appt

2,500

3,000

3,500

4,000

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

A and E Activity

2014/15 2015/16 2015/16 Flex Period

Page 16

Better Care Fund Summary

Page 17

Better Care Fund

Payment for Performance Metric - Non Elective Admissions Supporting Metrics

HWB Activity HWB Activity

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Actual 15,882 14,696 15,008 15,122 14,976 14,831 15,944 15,636 15,369 15,236

Ambition 15,944 14,234 14,626 13,224 13,881 13,033

Cumulative Performance Period

Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

Actual 15,636 31,005 46,241 #N/A Difference to Ambition 1,402 743 2,012 #N/A

Ambition 14,234 28,860 42,084 55,965 Cumulative difference 1,402 2,145 4,157 #N/A

Baseline 15,122 30,098 44,929 60,873 Achieving

Contributing CCG Activity Contributing CCG Activity

Contributing CCG Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Actual 3799 3744 3995 4046 3,964 3,734 4,064 4,022 4,078 3,917

Ambition 4,060 3,770 3,851 3,230 3,418 3,396

Cumulative Performance Period

Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

Actual 4,022 8,099 12,016 #N/A Difference to Ambition 252 226 687 #N/A

Ambition 3,770 7,621 10,850 14,268 Cumulative difference 252 479 1,165 #N/A

Baseline 4,046 8,010 11,744 15,808 Achieving

North Yorkshire HWB

NHS Harrogate and

Rural District CCG

2013/14 2014/15 2015/16

2013/14 2014/15 2015/16

Overarching BCF Metrics Period Target Performance

Change from

last period

Permanent Admissions to Residential and Nursing

Care - HWB

Year End

2014/15480.1 694.9

People still at home 91 days after reablement - HWBYear End

2014/1585.5 87.7

Delayed transfers of Care - HWBYear End

2014/15200.6 225.4

Patient Experience: People with a long term

condition who use their written care plan to

manage their day-to-day health - HWB

Year End

2013/1471.9 69.8

Injuries due to Falls (aged 65+) - HWBYear End

2013/14

8% reduction in

Rate1628 N/A

Overarching BCF Metrics Period Target Performance

Change from

last period

Permanent Admissions to Residential and Nursing

Care - HaRD

January YTD

2014/15400.1 327.7

People still at home 91 days after reablement - HaRD

Delayed transfers of Care - HaRD

Patient Experience: People with a long term

condition who use their written care plan to

manage their day-to-day health - HaRD

Injuries due to Falls (aged 65+) - HaRDYear End

2013/14

8% reduction in

Rate1661

Please Note: Metrics have been resubmitted in Nov 14 with updated baseline and targets as per above

Data to Follow

Data to Follow

Data to Follow

0

1000

2000

3000

4000

5000

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2013/14 2014/15 2015/16

BCF Payment for Performance Metric - Non Elective Admissions NHS Harrogate and Rural District CCG (NYCC Area)

Actual Ambition Trend (Based on Actual)

Q4 Q1 Q2 Q3

Baseline 4,046 8,010 11,744 15,808

Ambition 3,770 7,621 10,850 14,268

Actual 4,022 8,099 12,016

02,0004,0006,0008,000

10,00012,00014,00016,00018,000

BCF Payment for Performance Metric - Non Elective Admissions NHS Harrogate and Rural District CCG (NYCC Area)

0

5,000

10,000

15,000

20,000

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2013/14 2014/15 2015/16

BCF Payment for Performance Metric - Non Elective Admissions HWB

Actual Ambition Trend (Based on Actual)

Q4 Q1 Q2 Q3

Baseline 15,122 30,098 44,929 60,873

Ambition 14,234 28,860 42,084 55,965

Actual 15,636 31,005 46,241

010,00020,00030,00040,00050,00060,00070,000

BCF Payment for Performance Metric - Non Elective Admissions HWB

Page 18

Performance & Quality Exception Report

Page 19

Month YTD

Under 75 mortality rate from respiratory disease 15.4 26.6

Under 75 mortality rate from cancer 101.1 102.1

Emergency admissions for alcohol-related liver disease 10.9 18.2Q1 15/16 data shows an increase in the number of admissions since the reported position for Q4 2014/15

(12.9).

Unplanned hospitalisation for chronic ambulatory care

sensitive conditions (ACS)571.7 710.8 Q1 15/16 data is above the threshold although is an improvement on Q4 14/15 performance (730.2).

Unplanned hospitalisation for asthma, diabetes and epilepsy

(under 19s)257.9 272.5 Q1 15/16 data is above the threshold although is an improvement on Q4 14/15 performance (318.2).

Emergency admissions for acute conditions that should not

usually require hospital admission1,187.9 1,290.0 Q1 15/16 data is above the threshold although is an improvement on Q4 14/15 performance (1294.3).

Emergency admissions for children with lower respiratory

tract infections (Rate per 100,000 population)605.0 634.0 Q1 15/16 data is above the threshold although is an improvement on Q4 14/15 performance (659.0).

A&E waiting time - total time in the A&E department: YORK Financial, £200 per breach

beyond threshold95% 88.9%

Contextually less than 1% of the A&E attendances at York are for HaRD patients. Performance has been

below the 95% standard since August 2015; YTD performance is 88.9%.

Ambulance: Cat A (Red 1) - 8 minute response time (YAS

Trust Level)

Withholding of 2% of

monthly contract value,

with annual reconciliation

and total withholding of

2% if targets not met (no

interest)

75% 71.9%

HaRD CCG YTD remains above target at 76.1%. In month performance at CCG level has declined from 81.8%

in October to 68.8% in November. Performance at Trust level (YAS) has seen a slight improvement in month

from 73.7% in October to 73.8% in November against a target of 75%.Trust level (YAS) YTD performance

improved from 71.6% in October to 72.0% in November.

Ambulance: Cat A (Red 2) - 8 minute response time (YAS

Trust Level)

Withholding of 2% of

monthly contract value,

with annual reconciliation

and total withholding of

2% if targets not met (no

interest)

75% 71.6%

Trust level (YAS) YTD performance has remained steady at 71.6% November. In month Trust level (YAS)

performance has improved from 72.5% in October to 73.3% in November. Performance at HaRD CCG has

seen a further improvement in month from 67.4% in October to 69.8% in November. HaRD CCG YTD

performance is below target at 71.0%. Combined Red 1 and Red 2 performance achieved 78.2% within a 10

minute response time at HaRD CCG level.

Handovers between ambulance and A&E taking place within

15 minutes, no one waiting more than 30 minutes (HDFT

trust level)

0 73 There were 15 breaches reported in November which is a reduction on previous months.

Handovers between ambulance and A&E taking place within

15 minutes, no one waiting more than 30 minutes (HDFT

trust level)

0 2 There were no breaches in November. The YTD total reflects 2 breaches reported in April 2015.

Following handover ambulance crew should be ready to

accept new calls within 15 minutes. Number between 30

and 60 mins (YAS at Harrogate District Hospital)

Financial, £20 per event >

30 minutes0 78

7 breaches were reported in November 2015. This is a reduction in comparison to October which saw 14

breaches. The average time for the crew to be clear is 10 mins 31 seconds against a target of 15 minutes in

this period.

Commentary

Quality and Performance Exception Report

Period Exception

applies to

Indicator Name

Contract Sanctions /

Levers Relevant Targ

et

/

Thre

sho

ld

Per

form

ance

This data has not changed since the last report in November 2015. The introduction of a Clinical Assessment

Team (CAT) at Harrogate and District NHS Foundation Trust in 2014/15 has meant changes to coding;

thresholds were previously set based on activity in 2013/14. There is a time lag in receiving updated data.

Page 20

Month YTD Commentary

Quality and Performance Exception Report

Period Exception

applies to

Indicator Name

Contract Sanctions /

Levers Relevant Targ

et

/

Thre

sho

ld

Per

form

ance

Following handover ambulance crew should be ready to

accept new calls within 15 minutes. Number > 60 mins (YAS

at Harrogate District Hospital)

0 2No further breaches were reported in November. The total number of breaches for 2015/16 remains as 2

breaches.

Friends and Family Test for A&E - % recommended -

Harrogate and District86% 85.3% In November, 85.3% of patient responses recommended Harrogate A&E (Target 86%).

Friends and Family Test for A&E - % not recommended -

Harrogate and District5% 5.1% In November, 9.4% of patient responses did not recommend Harrogate A&E (Target 5%).

Friends and Family Test for A&E - % recommended - York 86% 81.1% In November, 76.1% of patient responses recommended York Trust A&E (Target 86%).

Friends and Family Test for A&E - % not recommended -

York5% 13.1% In November, 16.9% of patient responses did not recommend York Trust A&E (Target 5%).

Friends and Family Test for inpatient acute - %

recommended - Harrogate and District96% 95.8%

In November, 95.5% recommended Harrogate Trust inpatient acute services, just short of the monthly

target. The YTD position is currently 95.8%.

Friends and Family Test for inpatient acute - % not

recommended - Harrogate and District1% 1.2%

In November, 0.9% did not recommend Harrogate Trust inpatient acute services. The YTD figure is

marginally over the 1% threshold at 1.2%.

Friends and Family Test for inpatient acute - %

recommended - York96% 95.5%

In November, 95.5% recommended York Trust inpatient acute services. The YTD position is over target

currently at 96.4%.

Friends and Family Test for inpatient acute - % not

recommended - York1% 1.1%

In November, 1.3% did not recommend York Trust inpatient acute services. The YTD figure is marginally

over the 1% threshold at 1.1%.

Incidence of healthcare associated infection (HCAI):

Clostridium difficile34 38

To date, 38 cases have been attributed to the CCG; 18 of which are community cases. We have agreed a

specification for enhanced services to support patients with CDiff and root cause analyses are up to date.

We have identified some lapses in care although these numbers are small (3).

Referral to Treatment pathways: admitted

CCG Position90% 88.8%

Changes in guidance mean that the CCG are measured against the incomplete RTT pathway only for which

the threshold of 92% is being achieved (95.0% in November & YTD)

Delayed transfers of care (delayed days) from hospital per

100,000 population (average per month) BCF Area206.1 222.9

The number of delays fell to 1,318 in November (from 1,385 in October) which equates to 268.2 per

100,000 against a target of 206.1. The CCG, acute trust and local authority continue to work together to

minimise the number of Delayed Transfers of Care, particularly over the winter period.

Increasing Access to Psychological Therapies: Proportion of

people entering therapy15% 12.9%

Performance for November was 13.3% against a target of 15%; performance in October was 14.1%. The

current YTD performance is 12.9%.

Total health gain as assessed by patients for elective

procedures b) knee replacement0.34 0.335

Total health gain as assessed by patients for elective

procedures c) groin hernia0.09 0.07

Patient Transport Service Pick up after appointment within

90 mins (planned journey only) YAS North Consortium91% 90.0%

At North Consortium and HaRD CCG levels, performance was below the 91% threshold in November 2015.

YTD performance at HaRD CCG level is achieving the 91% threshold however at Consortium level, previous

performance means that the YTD performance is slightly under target at 90%.

Patient Transport Service  Pick up after appointment within

120 mins (SN and OD journeys only) YAS North Consortium96% 88.9%

Performance at HaRD CCG level continues to achieve the 96% threshold (98.8% in November and 98.1%

YTD). At North Consortium level, performance improved to 91.1% (from 89.8% in October) and YTD

performance is at 88.9%. Breaches relate in the main to geographical difficulties outside of the HaRD CCG

area.

The most recent data has been supressed due to low case numbers (under 30). Data at March 2015 shows

the level of health gain for knee replacements and groin hernias slightly below the position in March 2014.

Page 21

Appendix 2

Serious Incident Breakdown by Provider for HaRD CCG – as at December 2015

Note: Scarborough Hospital is part of York Teaching Hospital NHS FT but the figures are not double-counted – a Trust total for the CCG would be obtained by combining the two monthly figures

Harrogate and Rural District CCG Apr 2015

May 2015

Jun 2015

Jul 2015

Aug 2015

Sep 2015

Oct 2015

Nov 2015

Dec 2015

Jan 2016

Feb 2016

Mar 2016

Total

York Teaching Hospital NHS FT - acute 0 0 0 0 0 0 1 0 1 2

York Teaching Hospital NHS FT - community 0 0 0 0 0 0 0 0 0 0

Scarborough Hospital - acute 0 0 0 0 0 0 0 0 0 0

Scarborough Hospital - community 0 0 0 0 0 0 0 0 0 0

Harrogate and District NHS FT - acute 4 3 8 3 4 7 7 5 4 45

Harrogate and District NHS FT - community 1 2 2 4 8 5 6 2 12 42

South Tees Hospitals NHS FT - acute 0 0 0 0 0 0 0 0 0 0

South Tees Hospitals NHS FT - community 0 0 0 0 0 0 0 0 0 0

Leeds Teaching Hospitals NHS FT - acute 0 0 0 0 0 0 0 0 0 0

Leeds York Partnership NHS FT 0 0 0 0 0 0 0 0 0 0

Tees Esk Wear Valley NHS FT 1 1 0 2 2 1 1 1 2 11

Yorkshire Ambulance Service 0 0 0 0 1 0 0 0 1 2

Co-commissioning Primary Care & CCG SIs 0 1 0 0 0 0 0 0 0 1

TOTAL 6 7 10 9 15 13 15 8 20 103

Serious Incidents YTD by provider

York Hospital

Scarborough Hospital

TEWV Yorkshire Ambulance Service NHS

Trust

South Tees FT

LYPFT HDFT Co-commissioning

Serious incidents reported during 2014/15

113 88 14 8 34 14 76 -

Serious incidents YTD 79 55 29 9 8 7 92 2

Never Events (NE) 1 0 0 0 0 0 1 0

Retained foreign object post operation

0 0 0 0 0 0 0 0

Drug Incident (Chemotherapy) 0 0 0 0 0 0 0 0

Surgical error 0 0 0 0 0 0 0 0

Wrong Site Surgery 1 0 0 0 0 0 1 0

Alleged/actual abuse on child patient by third party

0 0 0 0 0 0 0 1

12 Hour breach 4 2 0 0 0 0 0 0

Diagnostic incident including delay (including failure to act on test results)

1 0 0 0 0 0 2 1

Disruptive/ aggressive/ violent behaviour

0 0 0 0 0 1 0 0

Environmental Incident 0 1 0 0 0 0 0 0

Incorrect patient x-rayed 0 0 0 0 0 0 0 0

Information governance – confidential info. Leak

0 0 0 0 1 0 0 0

Intrauterine Death 0 0 0 0 0 0 1 0

Injury received by patient during restraint

0 0 1 0 0 0 0 0

Medication Incident meeting SI Criteria

1 0 0 0 0 0 0 0

Maternity services 0 0 0 0 0 0 1 0

Other (organisational) 0 2 0 0 0 0 0 0

Pending confirmation of category

0 3 1 0 0 0 0 0

Pressure ulcer (grade 4) 2 2 0 0 1 0 0 0

Pressure ulcer (grade 3) 21 19 0 0 5 0 71 0

Slip, Trips & Falls 39 22 4 0 1 0 13 0

Sub-optimal Care of Deteriorating Patient

2 2 0 0 0 0 0 0

Surgical error - not a NE 1 0 0 0 0 0 0 0

Surgical/invasive procedure – not a NE

2 1 0 0 0 0 2 0

Apparent/actual/suspected self-inflicted harm

2 0 8 0 0 1 0 0

Apparent/actual/suspected homicide

0 0 1 0 0 0 0 0

Suspected Suicide 0 0 0 0 0 2 0 0

Treatment delay 1 0 0 9 0 0 1 0

Unexpected/potentially avoidable death

0 1 7 0 0 3 0 0

Unexpected Death Community patient (in receipt)

0 0 4 0 0 0 0 0

Unexpected Death of Community patient (not in receipt)

0 0 1 0 0 0 0 0

Unexpected Death of Outpatient (in receipt)

0 0 1 0 0 0 0 0

Unexpected Death of Inpatient (in receipt)

0 0 1 0 0 0 0 0

TO NOTE: NEVER EVENT declared at YTHFT concerns an ERYCCG patient NEVER EVENT declared at HDFT concerns a VOYCCG patient