Leeds West CCG Integrated Quality & Performance Report ... · CONTENTS Page 1 Leeds West CCG Integrated Quality & Performance Report November 2014 (September data) CONTENTS Page Strategic

CONTENTS

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Leeds West CCG

Integrated Quality & Performance Report

November 2014

(September data)

CONTENTS Page

Strategic Priorities 2

Acute Sector 5

Primary Care 15

Community Sector 19

Mental Health 24

STRATEGIC PRIORITIES DASHBOARD

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Strategic Objective

latest data Metric

Latest YTD Trend

Proj FYE

Plan Act Plan Act

TRANSFORMING CARE (SYSTEM)

LWSO1 2012 Potential Years of Life Lost N/A 2222 Info published annually

LWSO3 June Composite measure of number of potentially avoidable emergency admissions (n/100,000)

1468 1092 TBC TBC

LWSO3 June Emergency readmissions within 30 days of discharge from hospital** (% of patients readmitted)

11% 13.4% 12.5% 13.4%

HEALTHY LIVING

LWSO1 2012 Early death (under 75s) from cardiovascular disease (n/100,000) N/A 67.2 Info published annually

LWSO1 August Alcohol dependent drinkers provided with specialist treatment (target is 12% of estimated number of dependant drinkers)

12% 12% 12% 11%

lWSO1 2012/13 Rate of alcohol related admissions to hospital (per 100,000) N/A 1890 Info published annually

LWSO1 June Emergency admissions for alcohol related liver disease (rate per 100K)

16 45.4 23 42

LWSO1 TBC Smoking Prevalence 18+ (national target 15%) 20% 20.8% Frequency TBC

LWSO1 June Smoking Referrals U/K 403 U/K 1448

LWSO1 2007-11 Infant Mortality Rate (per 1000 births) U/K 3.9 Info published annually

LWSO1 12/13 Excess Weight in 10-11 Year Olds U/K 32.7% Info published annually

SEXUAL HEALTH

LWSO1 June Teenage Pregnancy Rate TBC

LWSO1 June Chlamydia positivity per 1,000 population 2.3 4.8 U/K 16.4

LWSO1 June Chlamydia positivity per 1,000 screens U/K 79.03 U/K 79.75

LONG TERM CONDITIONS

LWSO2 June EQ5D Reported quality of life for patients with LTCs 74.2 74.2 74.75 N/A

LWSO1 June NHS Health Checks – All eligible adults 40-70 years (PH target 75%)

TBC 2,987 n/a 2,987 16,922

MENTAL HEALTH

LWSO2 April Dementia diagnosis rate N/A 52.35% Info published annually

CANCER

LWSO1 2010-12 Early death from cancer (under 75s) (n/100,000) N/A 110.8 Info published annually

LWSO1 April Uptake for screening programmes – bowel 60% 52.4% 60% 54%

LWSO1 June Uptake for screening programmes – breast 75% 70.1% 75% 71.3%

END OF LIFE

LWSO2 N/A People dying in place of choice Indicators under development by EOL Board

LWSO3 N/A Numbers of pharmacies participating in palliative care drugs Indicators under development by EOL Board


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scheme

LWSO2 N/A Number of patients registered on EPCR Indicators under development by EOL Board

LWSO4 N/A Number of practice staff trained Will report in 2015

ORGANISATION - Build commissioning capacity and capability

LWSO3 June Sickness absence rates 1.6% 1.6% 2.5% 1.3%

LWSO3 June Staff Turnover 1.2% 0% 1.2% 0.7%

LWSO3 June Evaluation from GP locality sessions 3 3 3 3

LWSO3 June Number of practice peer reviews N/A N/A N/A N/A


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STRATEGY DELIVERY SUMMARY The strategic priorities indicators have moved into a routine reporting mechanism now and so are reflected in the dashboard. In this quarter there are no updates on the public health indicators from Leeds City Council (data reflected are the final figures for 2013/14 when referring to YTD figures). The dashboards include intended indicators (whether information available currently or otherwise) and where possible have been updated. The staff turnover and sickness rates have been updated this month but changes are not significant. Links with the CCG OIS, H&WB board indicators or transformation priorities are updated again in this report As refreshed version of the planned figures is also included in this report. This is because the annual bench marking figures have been recently released form the HSCIC. The approach taken is that the Plan = best in quartile figure, Actual = the actual rates for Leeds West CCG (most recent) and the YTD (plan) the national averaged rate or the mid-range of best to worst quartile. The board is requested to comment on this approach and provide feedback as appropriate. Leeds City Wide 5 Year Strategic Plan 2015-19: As reported for last month the three Leeds Clinical Commissioning Groups have been working with Leeds City Council, the NHS England Local Area Team and local provider services to describe our future direction for health care services over the next five years. This was delivered on time to NHS England on 20 June 2014 and we are awaiting feedback on the submission. Moving forward the strategic priorities will also reflect the Transformation Programme indicators which are being developed using an Outcomes Based Accountability (OBA) methodology. These are still being refined and will be reported to the next Transformation Board to be held on 6 August 2014. Once these have been agreed then a summary can be included in this report. Although it is worth noting that an online ‘results scorecard’ is being used and so duplication of effort is to be avoided. BOWEL SCREENING Nationally the bowel screening programme has extended its age range to include 70 – 74 year olds. LTHT are the one hospital nationally that have not yet done this extension. The Area Team are working with LTHT on an action implementation plan. They have to deliver three consecutive months of delivery to target of 60%. They have improved this month to 54%. LTHT are aiming to deliver to target in September, October and November. LTHT have been advised by the Area Team that should this delivery not reach target that an alternate provider may be procured.

ACUTE SECTOR DASHBOARD

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Strategic Objective

latest data ACCESS Latest YTD Trend Proj FYE

Plan Actual Plan Actual LWSO2 Aug A&E Waiting times -Type 1 seen in 4 hours) 95% 94.93% 95% 95.34%

LWSO2 Aug Patients Waiting > 12 Hours in A&E for Admission 0 0 0 0

LWSO2 July Category A calls responded to within 8 minutes 75% 64.4% 75% 65.4%

LWSO2 July Category A calls responded to within 19 minutes 95% 96.9% 95% 97.6%

LWSO2 July Time to hand patient over from Ambulance to A&E > 15 Mins 0 591 0 2316

LWSO2 July

Time from A&E Handover to Ambulance Clear > 15 Mins 0 745 0 3030

LWSO2 July 18 week RTT - % admitted 90% 91.83% 90% 90.45%

LWSO2 July 18 week RTT - % non-admitted 95% 96.75% 95% 96.69%

LWSO2 July 18 week RTT - % incomplete < 18 weeks 92% 95.29% 92% 95.30%

LWSO2 July No. of > 52 week wait incompletes 0 0 0 1

LWSO2 July Diagnostic > 6 week breaches 99% 98.1% 99% 97.5%

LWSO2 July Cancer – 2 week urgent referral to first outpatient

appointment 93% 94.2% 93% 94.0%

LWSO2 July Cancer – 2 week urgent referral for breast symptoms 93% 90.7% 93% 88.4 LWSO2 July Cancer - 31 day standard diagnosis to treatment times 96% 97.3% 96% 97.2%

LWSO2 July

Cancer 31 day standard for subsequent treatment – Surgery 94% 95.0% 94% 97.2%

LWSO2 July Cancer 31 day standard for subsequent treatment – Drug 98% 100.0% 98% 100.0%

LWSO2 July Cancer 31 day standard for subsequent treatment –

Radiotherapy 94% 100.0% 94% 100.0%

LWSO2 July Cancer - 62 day standard referral to start of 1st treatment 85% 81.3% 85% 85.7%

LWSO2 July Cancer 62 day wait for first treatment - ref from Screening 90% 100.0% 90% 100.0%

LWSO2 July Cancer 62 day wait for first treatment - consultant upgrade 90% 87.5% 90% 90.5%

LWSO2 Q1 Cancelled Ops % readmitted within 28 Days 100% 95.2% 100% 95.2

LWSO2 Q1 Cancelled Ops (Urgent Operations Cancelled twice) 0 0 0 0

LWSO2 July Audiology completed pathways non admitted <18weeks 90% 62.9% 44.4%

LWSO2 July Audiology: incomplete pathways waiting < 18 weeks 90% 93.9% 89.7%


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Strategic Objective

latest data QUALITY AND SAFETY Latest YTD Trend Proj FYE

Plan Actual Plan Actual

LWSO1 Oct 2012- Sep 2013

Mortality Rate (SHMI) 100 100.8

LWSO2 Aug MRSA (LTH) 0 4* 0 4

LWSO2 Aug C.diff (LTH) 9 11* 53 53

LWSO2 Q1 Stroke – scan within 1 hour of clock start 43.1% 40.0% N/A N/A

LWSO2 Q1 Stroke – scan within 12 hours of clock start 87.1% 91.3% N/A N/A

LWSO2 Q1 Stroke – proportion of eligible patients given thrombolysis 80% 91.2% N/A N/A

LWSO2 Q1 Stroke - admission to stroke unit within 4 hours 58.0% 53.9% N/A N/A

LWSO2 Q1 Stroke – Patients spending 90% of time on stroke unit 82.4% 79.9% N/A N/A

LWSO2 Patient Safety: NHS Safety Thermometer all providers

LWSO2 Aug Harm Free Care 93.66% 93.7% N/A N/A

LWSO2 Aug Pressure Ulcers - new 1.01% 1.74% N/A N/A

LWSO2 Aug VTE - new 0.42% 0.47% N/A N/A

LWSO2 Aug Falls with harm 0.71% 0.34% N/A N/A

LWSO2 Aug Catheter and new UTIs 0.38% 0.13% N/A N/A

LWSO2 Aug Serious Incidents (including pressure ulcers) N/A 6 N/A 35

LWSO2 Aug Never Events 0 0 N/A 7

LWSO2 May Maternity Caesarean Section Rate 22% 19.2% N/A N/A

LWSO2 May Birth Before Arrival (LTH) 1.0% 1.10% 1.0% 1.10%

LWSO2 Safer Staffing: % of planned level

LWSO2 July Leeds General Infirmary 90% N/A N/A

LWSO2 July St James’s Hospital 91% N/A N/A

LWSO2 July Chapel Allerton 103% N/A N/A

LWSO2 July Wharfedale 119% N/A N/A

LWSO2 July Mid Yorkshire NHS Trust

LWSO2 July Pinderfields 86% N/A N/A

LWSO2 July Dewsbury and District 84% N/A N/A

LWSO2 July Pontefract 105% N/A N/A


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Strategic Objective

latest data PATIENT EXPERIENCE (LTH): Friends and Family test (FFT)

Latest YTD Trend Proj FYE Plan Actual Plan Actual

LWSO2 July FFT - IP – score 74 73 N/A N/A

LWSO2 July FFT – IP - Response 38.2% 37.9% N/A N/A

LWSO2 July FFT - A/E - Score 53 54 N/A N/A

LWSO2 July FFT - A/E Response 20.2% 20.2% N/A N/A

LWSO2 July FFT Ante Natal - Score 62 65 N/A N/A

LWSO2 July FFT Ante Natal - Response N/A N/A

LWSO2 July FFT Birth - Score 77 89 N/A N/A

LWSO2 July FFT Birth - Response 22.7% 9.6% N/A N/A

LWSO2 July FFT Post Natal Ward - Score 65 64 N/A N/A

LWSO2 July FFT Post Natal Ward - Response

LWSO2 July FFT Post Natal Community Services - Score 75 69 N/A N/A

LWSO2 RESOURCES

LWSO2 Aug LTHT Staff Sickness and Absence rates 3.63% 4.2% 3.63% 4.1%

LWSO2 Aug LTHT Financial Position (£) red text = deficit N/A N/A £26,346 £25,667

LWSO2 Aug CIP Delivery N/A N/A £19,505 £13,270

latest data ACTIVITY Plan (YTD)

Actual (YTD)

Plan (FOT)

Actual FOT)

Trend Proj FYE

LWSO3 A&E 28,510 29,108 85,000 86,792

LWSO3 July Outpatient Firsts 24,877 26,421 74,167 78,760

LWSO3 July Outpatient Follow Ups + 55,227 55,462 164,577 165,317

LWSO3 July Outpatient DNA 0 12% 0 12%

LWSO3 July Outpatient Procedures 6,011 6,717 17,932 20,034

LWSO3 July Elective 12,662 12,697 37,803 37,915

LWSO3 July Non Elective 9,409 9,492 28,187 28,441


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ACCESS A&E – 4 Hour Emergency Care Standard: LTHT has continued to deliver the Emergency Care Standard since May, but this continues to be under pressure for a range of reasons. There are work programmes in place to support improvements in patient flow. Pressures are more acute at St James’s which takes the bulk of admissions of acute and elderly medicine patients. A&E attendances have been high (up 4% on last year) as have delayed transfers of care, both of which have added to pressure on the provider. Performance has been slightly less good at LGI in recent weeks and work is ongoing to ensure processes are robust going into Winter. Referral to Treatment Waiting Times: The Trust at LTHT continue to make good progress work toward their clearance trajectory agreed with the TDA to meet the 90% admitted standard. LTHT delivered the 90% standard for admitted patients in June, July and August. The 92% incomplete standard continues to be exceeded. The main outstanding inpatient areas of pressures are spinal, vascular, and plastic surgery and the main outpatient pressures are in gastroenterology. We remain concerned regarding the long first out patient wait times in gastroenterology and LTHT is continuing to work through a recovery plan for these. Waiting times for first outpatient appointments are now monitored on a monthly basis at the Elective Care working group with LTHT. LTHT have also commenced a review of productivity in outpatients. Standards in outpatients are also the subject of a Transformation Board Elective care work-stream project. Additional funding has been agreed with WYLAT to help further address waiting times over the summer. Clearance has slowed slightly over the summer, but more activity is planned for September to make further progress towards achieving RTT standards sustainably. In Addition Acute commissioners are in discussion with Wakefield CCG about wait lists at Mid Yorkshire Hospitals NHS Trust. Key Actions:

Detailed performance monitoring of LTHT actions and delivery through Elective Care Performance meeting.

Working with Wakefield CCG to address 18 week wait issues at Mid Yorkshire.

Event planned early October with all associate CCG’s to the LTHT contract to update them regarding LTHT position and pressures. Late Inter-provider referrals from other hospitals remain a concern to LTHT.

Diagnostic wait times including Endoscopy: LTHT has continued to fail the 99% six week diagnostic wait target but the


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numbers of over 6 week waiters has improved each month with a detailed action plan in place to deliver improvements in the endoscopy services. The endoscopy services are due to achieve 99% from September 2014. There are some pressures on the MRI services, which the Trust is addressing in September with additional capacity and the CCGs are working to help with the additional provision commissioned to replace the capacity from Eccleshill Treatment Centre. Key Actions:

Recovery plans in place being overseen by the LTHT Board and NHS England.

CCG pathways being rolled out to help minimise growth in demand for tests.

CCG communications to advise GPs of alternative capacity to LTHT.

The application of sanctions will be applied via the contract management board. Cancer: Performance against the two week wait standards has been volatile in recent months but appears to be improving. However there are significant remaining challenges on the 62 day pathways. Detailed improvement plans for Cancer have been submitted to the LTHT Trust Board and a Cancer Board has now also been established to ensure that all plans are developed and delivered. The areas which are most underperforming are urology, Gynaecology and Lung surgery. It is likely that LTHT will not deliver the 62 day standard until Q1 2015/16 and that delivery is also dependent on an improvement in the number of late referrals from District General Hospitals. LTHT has met with each of the referring units and asked them to supply improvement plans to support this improvement, and there is also focus on this from the Cancer Network. The city has developed a Leeds Integrated cancer Services Steering group. This is underpinned by a vision to develop a comprehensive cancer centre in Leeds, with primary and secondary care working together. Key Actions:

LTHT addressing capacity and pathway constraints in thoracic surgery, gynaecology and urology.

CCG will continue to press commissioners to ask them to include minimum waits for cancer pathways that cross between providers in quality requirements for their own providers for N/A to help lever improved performance.

Delayed Follow-ups: While there have been significant improvements in gastroenterology and colorectal surgery there continue to be unacceptable numbers of delays for follow up appointments. This is the subject of ongoing work within these specialties, supported by the CCG’s work on redesigning these pathways to minimise unnecessary demand.


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Ambulance Turnaround: Patient Handovers (Ambulance - A&E) Between 10 and 15% of patients are waiting 15 minutes or more to get from ambulance to A&E handover. An ambulance handover area is being developed for patient flows through the resuscitation area. BEDS LTHT have been asked for their plans on bed numbers. CLINICAL EFFECTIVENESS, QUALITY AND SAFETY Health Care Associated Infections (HCAIs): The C difficile threshold for 2014-15 is 127; the MRSA bacteraemia threshold is 0. The number of C.difficile infections for LTHT in the current financial year is 53 against a year to date threshold of 53; this total includes 6 cases which have been deemed unavoidable in accordance with a regionally agreed process in line with guidance from NHS England. These cases will remain in the overall 2014/15 total for LTHT, but not count towards a total to which financial sanctions will apply, should the annual threshold be exceeded. There have been a total of 4 MRSA infections to date; no cases have been reported to date in Q2. Key Actions

The Infection Control team have undergone a reconfiguration to encourage more local accountability within the Clinical Service Units, and move towards a facilitative approach rather than a reactive one.

The Trust continues to review and implement its comprehensive action plan which is monitored at the joint CCG/LTH Quality Meeting where update and challenge takes place at director level.

The programme of Hydrogen Peroxide decontamination continues, as does Trust monitoring of application and implementation of infection control protocols.

The Trust has employed a C difficile Nurse Specialist and is reporting improved patient management and support for ward staff as a result; this is also resulting in improved communication with the community Infection Control Team when patients are discharged from hospital.

The Trust HCAI action plan and performance is monitored at the joint CCG/LTHT Quality Group.

Stroke Care: Data is retrieved from the Sentinel Stroke National Audit Programme (SSNAP) and the figures included as ‘plan’ represent the national average as there is no national target for the indicators included. Where performance is below the national average figure presented, the RAG rating for the indicator represents that in the SSNAP published data. There is a significant time lag between data submission and publication; the data presented in this report is for Q1.


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Whilst LTHT have improved on both indicators, performance remains below the national average for ‘admission to a stroke ward within 4 hours’ and ‘patients spending 90% of time on stroke unit’. The Trust report data gathering issues for the ‘admission to stroke unit within 4 hours’ indicator and are following patients through the pathway to ensure accurate times for arrival onto the Hyper-Acute Stroke Unit are documented. LTHT have plans for centralising all stroke beds at the LGI in improved accommodation. This should help to resolve the failure to achieve 90% time on the stroke unit target. LTHT’s performance against Stroke indicators is monitored via the joint monthly Leeds CCGs/LTHT Quality Group. Patient Safety: NHS Safety Thermometer data used in this report is taken from a monthly point prevalence survey; thresholds for each indicator are therefore based on the England average rather than a monthly or annual objective. Trend arrows are used to show improvement/decline from the previous month. Pressure Ulcers: The number of new category three pressure ulcers remains slightly higher than the national average though has improved since last reported. Numbers continue to reduce in line with LTHT’s ongoing focus on this area of work. Key Actions

The CCG has agreed two further CQUIN indicators for 2014-15 which aim to reduce the numbers of category two and three ulcers still further; one of the indicators requires that the Trust co-ordinate a cross-city approach to reducing pressure ulcers.

Pressure ulcer numbers are now included in the LTHT Ward Healthcheck and reported on Patient Safety Boards on each wards; key actions are implemented where pressure ulcers are highlighted as a specific problem on a ward.

Numbers of pressure ulcers continue to be monitored at the joint monthly Leeds CCGs/LTHT Quality Group. Serious Incidents and Never Events: The cells on the dashboard relating to serious incidents and never events are not coloured. There are no nationally recognised targets or trajectories based on reporting of serious incidents. Incident management theory works on the principle of encouraging a reporting culture and the more issues that are reported the better the learning can be extracted and changes made. Incentivising reductions in reporting runs counter-intuitive to that. It reasonable to colour Never Events however due to the nature of these incidents and there unavoidability. Any Never Event should be red. Two never events have been reported year to date, both relating to wrong site surgery. An investigation and report into the first incident has been received by the CCG and reviewed at the Serious Incident Review Panel. The second incident is currently under investigation and a full report awaited by the CCG. Key Actions


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Serious incidents are discussed at the joint monthly Leeds CCGs/LTHT Quality Group.

SI reports are reviewed at the monthly Leeds CCG Serious Incident Review Panel meeting.

Mortality Ratios/Outlier Alerts: The CCG received a copy of two mortality outlier alerts from the CQC to LTH with regard to pathological fractures and coronary atherosclerosis. The CQC issues alerts to Trusts where it detects a mortality rate significantly higher than expected for any condition. Alerts do not necessarily indicate a problem, but must be investigated by the provider and a response given back to the CQC within a specified timeframe. Based on its own continued assessment of the data and the response of the provider the CQC will then either accept the provider response and cancel the alert, or request further investigation. The Trust reviewed the cases in both alerts and responded to the CQC as required. The CQC has written to the Trust to state that it is satisfied with the Trust’s review and will not be undertaking any further investigation. However, it requested an action plan in response to issues related to coding that the Trust had identified in its review of Pathological fractures. Key Actions

The Trust has submitted an action plan to the CQC in response to a request to review coding procedures.

The alerts and related findings have been discussed in detail at the joint monthly Leeds CCGs/LTHT quality meeting. Staffing: Leeds West CCG currently receives copies of LTH’s Ward Dashboard which includes staffing information by ward; this is reviewed at the joint CCG LTH Quality Meeting. The CCG is assured that the Trust has a robust mechanism in place for identifying areas where staffing may be an issue and responding quickly and appropriately. However, the data is presented by ward and not aggregated so impractical for inclusion in the IQPR. From June 2014 Trusts are required to submit to their Board a six-monthly report describing the staffing capacity and capability, following an establishment review, using evidence based tools where possible, and a monthly report containing details of planned and actual staffing on a shift-by-shift basis at ward level for the previous month. This measure shows the overall average percentage of planned day and night hours for registered and non-registered nurses and midwives in hospitals which are filled. The Trust has undertaken a major recruitment programme with circa 500 new staff due to commence employment from September onwards. PATIENT EXPERIENCE Friends and Family Test: The FFT will be extended to all NHS services in England by the end of March 2015. Planning has commenced at LTHT for the roll-out of the FFT to day cases, children's and outpatients ahead of the NHS England deadline. LTHT aims to ensure at least 20% of


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eligible patients respond to the Friends and Family Test (FFT) question. Ante-natal and Post-natal response rates are omitted from this report as denominator data has not been made available by NHS England. The ‘birth’ response rate for FFT remains significantly less than the national average at 9.6%, though this is an improving trend. Analysis of this issue by LTHT has shown:

Poor data returns from community services with regard to both the denominator (eligible women) and numerator (FFT responses).

A reduction in responses across all sites.

LGI services return rates are consistently better than those achieved at SJUH This will be followed up at the CCG/LTHT monthly Quality Group.

Key Actions:

Introduction of FFT ‘business cards’ to community staff from 1st July 2014. These allow women to complete the question online at a time of their choosing after birth. The Trust is also considering their use in hospital.

FFT co-ordinator to continue weekly visits to delivery suite to speak to staff and resolve issues.

Head of Patient experience exploring solutions for integrating FFT into current processes.

A new Patient Experience Lead is now in post to move forward this improvement work.

Friends and Family Test scores are monitored at the monthly CCG/LTH Quality group where appropriate challenge takes place on lower than expected performance.

RESOURCES Sickness and Absence: Sickness absence rates are below the regional average and in line with the national average but above the Trust's internal target. The dedicated Attendance Management Team continues to work with managers to ensure attendance is proactively managed at individual, department and CSU level. A current priority is to improve the timeliness of return to work interviews. Cost Improvement Programme (CIP): At the end of Month 5, the Trust reported a deficit of £26.4 million against a planned deficit of £26.9 million, resulting in a favourable variance against plan of £0.5 million. Though the Trust continues to perform in line with its financial plan, the key risk around achieving our financial performance outturn is CIP delivery. With some schemes not due to


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commence until later in the year, and with a proportion still unidentified, failure to deliver these will have a detrimental impact on the Trust's forecast position. At Month 5 the Trust remains behind on delivering its CIP plan, but this position is currently being mitigated by non-recurrent under spends elsewhere. The forecast plan assumes that all CIPs are fully delivered by the end of the year. Harrogate FT performance Harrogate consistently achieves against the National Operational standards. Mid Yorkshire NHS Trust MYHT achieved all Cancer standards in July 2014. It continues to fail all 4 RTT standards, and had 5 patients waiting over 52 weeks at the end of July. It has not yet achieved the national standard of at least 92% patients waiting less than 18 weeks (incomplete) and was at 90.6% at the end of July. The Trust is committed to achieving this standard by the end of September. The Trust has a detailed plan to recover 18 week performance by the end of September including validation, activity maximisation, specialty level plans and an improved governance arrangement for waiting list management which has now been centralised. A particular area of concern is the waits at Mid Yorkshire for Maxillary Facial patients. MYHT has had staffing issues and their wait times for this speciality are growing. This is also impacting on LTHT for this speciality as referrals are diverted. The emergency care standard is being exceeded. Members of the CCG commissioning team have met with managers at Mid Yorkshire in August to discuss the performance position.

PRIMARY CARE DASHBOARD

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Strategic Objective

latest data ACCESS Latest YTD Trend Proj FYE Plan Act Plan Act

LWSO2 July publication (July –Sept 13 & Jan-March 14)

The proportion of people reporting very poor experience of General Practice and Out-of-Hours

7% 8% 7% 8%

LWSO2 July publication (July –Sept 13 & Jan-March 14)

Satisfaction with accessing primary care 236 239 236 239

LWSO2 Number of additional appointments delivered within extended hours (extended primary care )

To begin reporting in 2014 upon project initiation

QUALITY AND SAFETY LWSO2 12/13

% new cancer cases referred using 2 week wait pathway

47.7% 43.7% 47.7% 43.7%

LWSO2 April-August Medication related safety incidents reported in primary care

190 53 190 53

LWSO2 Rates of achievement for the nine care processes for Type 2 Diabetes

To begin reporting in 2014 on receipt of information

after Q1

LWSO2 Number of dementia assessments completed in primary care

To begin reporting in 2014 on receipt of information

after Q1

PATIENT EXPERIENCE LWSO2 July 14 publication

(July –Sept 13 & Jan-March 14)

Satisfaction with the quality of consultation at the GP practice

599 603 599 603

LWSO2 July 14 publication (July –Sept 13 & Jan-March 14)

Satisfaction with the overall care received at the surgery

164 167 164 167

RESOURCE UTILISATION LWSO3 14/15

April - June GP Prescribing Budget (000,000s) 12 11.4 12 11.4

LWSO3 Productive General Practice – Modules completed

To begin reporting in 2014


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ACCESS Primary Care Development Steering group. Providing extended access is voluntary for practices and therefore we are offering a tiered approach to an enhanced service so that it provides flexibility for those practices that are keen to explore extended access: Level 1 – Increased Capacity through Extended Hours Level 2 – Increased Capacity through Extended Access (5 days) Level 3 – Increased Capacity through Extended Access (7 days) It is anticipated that most of the 38 member practices will participate in the scheme with practices ‘going live’ when they are ready. Practices unable to participate before 31st December 2014 will be asked to put plans in plans to manage demand over the winter period and take into account the 4 day bank holiday over Christmas 2014. The steering group in now working hard to implement the scheme and to swiftly establish a robust application process. Governance arrangements are being developed and a comprehensive evaluation programme will start at the projects commencement. CLINICAL EFFECTIVENESS, QUALITY AND SAFETY Cancer: For the period shown 43.7% of cancers in Leeds West CCG were identified as having been referred via a 2 week wait pathway (National Cancer Intelligence Network). This indicator is also monitored at practice level as part of the Primary Care Assurance Framework. A similar indicator is also available which provides more up to date information 13/14 Q4 – Percentage of new cancers cases treating that were not 2 week waits. This gives a % for Leeds West CCG OF 48% compared to the England value of 51.7%. Recommendations in the previous report have now been completed. In September 2014, Dr Adrian Rees, Clinical Lead for Cancer held a workshop on cancer within the Locality Development session which included peer review and updates on pathway improvements since the last session. Cancer data has also now been included within the Practice MOT. The Locality Team will work closely with NHS England and GP practices through the Primary Care Assurance Framework to address any areas of improvement.


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Medication related safety incidents reported in primary care: The Medicines Optimisation Scheme was released to practices in August 2014; it is through this scheme that practices are required to increase their recording of medication related safety incidences. We expect to now see a steady increase in reporting towards the trajectory over the next few months. August figures are already demonstrating an increase on previous months. There are still a number of practices who have yet to report an incident and the primary care and medicines management team will continue to review and support practices throughout the year including sharing learning as part of the Practice Manager forums. In addition the governance team is establishing the process for uploading patient safety incidents that are reported on Datix onto NRLS (National Reporting and Learning System). PATIENT EXPERIENCE Satisfaction with the quality of consultation of the GP practice The score is obtained from outputs of a range of questions and reflects a composite of scores from “The combined percentage of patients who answered positively to questions such as:

Last time you saw or spoke to a GP/nurse from your GP surgery, how good was that GP at giving you enough time?

Last time you saw or spoke to a GP from your GP surgery, how good was that GP/Nurse at Listening to you?

Last time you saw or spoke to a GP/Nurse from your GP surgery, how good was that GP at Explaining tests and treatment?

Last time you saw or spoke to a GP/Nurse from your GP surgery, how good was that GP at involving you in decisions about your care?

How good was that GP/nurse at treating you with care and concern? Excluding those who answered doesn’t apply.

Did you have confidence and trust in the GP/Nurse you saw or spoke to?

How confident are you that you can manage your own health? Satisfaction overall care received at the surgery The score is obtained from outputs of a range of questions and reflects a composite of scores from the combined percentage of patients who answered positively to the following questions: The % of patients who gave a positive answer to ‘Overall how would you describe your experience of your GP surgery?’ The % of patients who gave a positive answer to ‘Would you recommend your GP surgery to someone who has just moved to your local area?’ Satisfaction overall care received at the surgery


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The score is obtained from outputs of a range of questions and reflects a composite of scores from the combined percentage of patients who answered positively to the following questions: The % of patients who gave a positive answer to ‘Overall how would you describe your experience of your GP surgery?’ The % of patients who gave a positive answer to ‘Would you recommend your GP surgery to someone who has just moved to your local area?’ Overall, indicators measured through the National GP Patient Survey show a decline on the previous results which is reflected both at CCG and national level. Although satisfaction appears to have decreased, for Leeds West CCG results are higher than the England average (marked as plan). Leeds West CCG has provided comments cards for patients to complete at their GP practice. For those patients that have completed a card 59% felt they were involved as much as they wanted in decisions about their care. Recommendations The CCG is piloting the Year of Care approach in 3 West practices facilitates personalised care planning and shared decision making by patients and healthcare professionals working in partnership. Leeds West CCG will continue to promote the Leeds Let’s Change Making Every Contact Count Training programme to increase the effectiveness of conversations with patients and professionals particularly with regard to lifestyle behaviour change. Work on access will commence soon to understand demand and capacity in all practices RESOURCES GP Prescribing is on track to make savings as compared to budget. Forecast outturn at June 14 is £45.959million which is under the budget for 14/15 of £48.109million. Please note this is GP prescribing only. Wave 2 of Productive General Practice commenced on 9th September rolling the programme out to those participating in the South West locality. This brings the total number of practices actively participating in the programme to 18.

COMMUNITY SERVICES DASHBOARD

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Strategic Objective

latest data ACCESS

Latest YTD Trend

Proj FYE

Plan Act Plan

Act

LWSO2 July 18 week RTT - % non-admitted 95% 100% 95% 100%

LWSO2 TBC 18 week RTT - % non-admitted – Adult IAPT Service by Q4

95% 95.6% 95% N/A

LWSO2 July IAPT – Number entering service (LCH) 1280 786 4130 3609

LWSO2 July IAPT - Completion as moving to recovery (LCH) 308 219 992 920

On request Numbers referred to single point of access (SPOA)

On request % referrals accepted by SPOA

QUALITY AND SAFETY LWSO2 June MRSA 0 1 0 1

LWSO2 June C. Diff 0 0 0 0

LWSO1 July Looked After Children – Health Needs Assessed in 20 working days

95% 100% 95% 100%

LWSO2 Q1 Child Protection Supervision 85% 95.8% 85% 95.8%

LWSO2 July Dementia Screening – Community Matrons 90% 94.9% 90% 93.1%

LWSO2 July Dementia Screening – eligible Inpatients 90% 98% 90% 99%

LWSO2 Aug Patient Safety Thermometer: Harm free care 93.66% 89.76% N/A N/A

LWSO2 Aug Pressure Ulcers - new 1.01% 1.23% N/A N/A

LWSO2 Aug VTE – new 0.42% 0% N/A N/A

LWSO2 Aug Falls with harm 0.71% 1.47% N/A N/A

LWSO2 Aug Catheter and new UTIs 0.38% 0.25% N/A N/A

LWSO2 Aug Serious Incidents 0 4 N/A 27

LWSO2 Aug Never Events(LCH) 0 0 N/A 0

PATIENT EXPERIENCE LWSO2 July Patient Complaints 18 73

LWSO2 July Complaints Closed in agreed timeframe 100% 100% 100% 100%

LWSO2 July End of Life Care – Preferred Place of Death 90% 71.1% 90% 83.9%

RESOURCE UTILISATIONLWSO3 July LCH Sickness and Absence Rates 4.3% 5% 4.3% 4.8% LWSO3 July LCH Annualized Turnover Rate (%) 7-12 12% 7-12 11% WS03 July LCH Financial Position FOT (Surplus) N/A N/A 1,400 1,400

LWSO3 July CIP Savings £541 £504 £2,163 £2,073


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SUMMARY

CAMHS Leeds SE CCG are leading a city and organisational wide CAMHS review. CAMHS is one of the areas consistently expressed by GPs as being an area of concern. The TAMHS service will be expanded this month to more schools in Leeds. CAMHS is showing a 19% overtrade against contract as of September 2014. CIVAS The community intravenous antibiotic service (CIVAS) provided by LCH is now recurrently funded following the success of the pilot in 2013/14. The initiative brought together LTHT and LCH in providing a referrals hub and a clinical community service that enables patient to avoid admission of be discharged earlier to have IV antibiotics in the community. The pilot saw 84 patients treated saving 958 bed days. SPACE TO BREATHE This COPD service was launched in August 2014. It provides an integrated service between hospital and community staff and allows patients faster access to specialist care in the community, so avoiding admissions. The team also support the smoother discharge of respiratory patients who are admitted to LTHT. CONTINUING CARE The service continues to be very busy with ongoing high demand. They have developed a database and digitised patient records to support their work and communication. There is one block contract with Allied health care to deliver continuing care which will be supplemented by up to 15 other local providers as required. There are over 1000 patients on the continuing care caseload with a current backlog of appeals to process of 381. Staff are being recruited to support the appeals team of nurses. END OF LIFE CARE Multi professional training in EOL care has been delivered with over 26 practices attending. An EOL care service review is underway with differing options for future provision across the city being described and discussed. COMMUNITY BEDS REVIEW A review of all community sited beds in Leeds has commenced, it aims to assess the requirement in Leeds for short term beds,


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admission reasons, and demographic info on the use of the beds, occupancy levels, funding, costs, and admission reasons. The Strategy is to have a stratified bed base with improved and clearer pathways. COMMUNITY REHABILITATION A review of all elements of community rehabilitation has commenced, this will cover use of beds at St Marys Hospital, workforce, pathways, the 7 neurological rehabilitation beds at CRU, the use of the community and stroke rehabilitation community teams, out patients, day hospital services and early supported discharge. CLINICAL EFFECTIVENESS, QUALITY AND SAFETY LCH has undertaken a review of high risk areas, including the adult inpatients beds and community nursing using available evidence and professional judgment. In order to achieve safe staffing levels as recommended by NICE, a funding uplift has been agreed by the Senior Management Team for additional registered staff on the Community Intermediate Care Unit, Little Woodhouse Hall and for agency staff at the South Leeds Independence Centre whilst future funding requirements are being reviewed with commissioners. All Trusts are required to publish staffing levels form June 2014 onwards. Patient Safety: NHS Safety Thermometer data used in this report is taken from a monthly point prevalence survey; thresholds for each indicator are therefore based on the England average rather than a monthly or annual objective. Trend arrows are used to show improvement/decline from the previous month. Pressure ulcers: LCH reported slightly higher than national average new pressure ulcers in August, though the trend is improving. This continues to be monitored via the LCH Quality and Performance Meetings and three key themes have been identified; District Nurse capacity and patient complexity, Non-registered staff delivering complex wound care and poor implementation of best practice guidance, and appropriate delegation of nursing care to carers. An action plan is in place to address these themes and this will be reviewed by commissioners in November. Serious incidents: 27 serious incidents have been reported for 2014/15 to date. 19 of these relate to category 3 or 4 pressure ulcers, 2 related to slips, trips or falls, one related to an absconded patient, one to an MRSA bacteraemia and 4 incidents have occurred in prisoners in receipt of care. CQUIN: LCH remain fully compliant with all indicators. CQUINS for this year are:

1. Friends and family test 2. NHS Safety thermometer ( patient harm indicator)


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3. Dementia screening and diagnosis using risk assessment tool, to be increased to cover community beds 4. Best start - children with complex needs, pathway development 5. Integrated neighbourhood teams and MDT working 6. Joint review of discharge incidents between LCH and LTHT

IAPT The LCH targets for the Improving Access to Psychological Therapies have not been met; the service is currently undergoing transformation which will have a positive impact on waiting lists. This work has increased the number of telephone contacts the service makes which reduces the number entering the service. Leeds SE CCG contract with LCH who work with 3 voluntary sector providers to deliver the IAPT service. The plan in 2014/15 is to deliver more group based sessions and stratify patients based on their needs for individual or group sessions. Additional funding is also planned for IAPT workers to increase numbers of appointment slots. This should help with supporting the standards for the numbers of patients entering treatment. IAPT: Number of People Entering Treatment: This standard is not being comfortably achieved. An action plan is in place to sustain the improvement and increase capacity for new appointments. There is a requirement to submit a two year IAPT trajectory in CCG plans to meet 15% by March 2015. The current proposal is to meet 13.6% in 14/15 and 15% by 15/16. IAPT: Number of people entering recovery: The IAPT services nationally are expected to hit 50% of patients treated entering recovery by 2015. Leeds is achieving this standard. The following actions are being taken to support continued delivery of this standard:

Taking on additional staff (funding has been increased) to offer more appointment slots.

Development of more group work i.e. stress seminars

Purchase of new services such

Review of patient choice options Assessing IAPT unmet need will be discussed at the next Community services Provider manager group meeting. PATIENT EXPERIENCE Nine services are using the revised LCH Patient Satisfaction Survey (PSS) which contains the same question regarding overall satisfaction with service. Implementation of the Friends and Family Test is on track. Work is underway in some of the bigger services to learn from patient experience and improve performance against target.


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The percentage of patients dying at their preferred place of care is below target. LCH reported to commissioners that this is most likely a data error following the introduction of a new nationally introduced data collection system and will be monitored closely.

RESOURCES

LCH expects to achieve a surplus target of £1.4 m for 2014/15.

The Trust continues to face pressure in pay costs during the service review process as temporary staff are covering the higher than average levels of vacancies in order to maintain safe staffing levels, pending the outcome of the service reviews and implementation of new ways of working. Monitoring of the use of temporary staff has been escalated to the Senior Management Team (SMT) and action is being taken to minimise agency expenditure where possible.

The biggest risk to be the achievement of the surplus continues to be the delivery of the £8.0m cost savings. Plans are in place and work is progressing particularly on delivering the service review process.

LCH are overtrading for District Nurses by 4% against contract, but they are under-trading in other areas so the overall position is satisfactory. Sickness and Absence: LCH reported absence levels for July 2014 are 5% against a target of 4.3%. The sickness absence rate The year to date sickness absence figure is 4.8% against a target of 4.5%.

MENTAL HEALTH DASHBOARD

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Strategic Objective

Latest data ACCESS

Latest YTD Trend Proj FYE

Plan Act Plan Act LWSO2 TBC 18 week RTT - % non-admitted 95% 99.6% 95% 99.6%

LWSO2 TBC Adult Community Services % Referral to first face to face contacts within 14 working days

N/A 61.6% 60% (Q4)

N/A

LWSO2 TBC Early Intervention in Psychosis 10 9 114 132

QUALITY AND SAFETY

LWSO2 June

% of discharged in-patients who are on Care Programme Approach (CPA) followed up within 7 days of discharge (Leeds patients)

95% 96.6% N/A N/A

LWSO2 June Delayed Transfers of Care (Leeds patients) 7.5% 2.5% N/A N/A

LWSO2 Q1

Memory Services – time from referral to appointment: % of referrals receiving appointment within 6 weeks

29% 30.2% N/A N/A

LWSO2 June

95% of people assessed by crisis assessment service to have a summary and formulation within 24 hours (all LYPFT)

95% 100% 95% 99.6%

LWSO2 Aug Serious Incidents (Leeds patients) 0 2 0 6

LWSO2 Aug Never Events (Leeds patients) 0 0 0 0

PATIENT EXPERIENCE

LWSO2 June

Complaints: % of responses meeting response target of 30 days (all LYPFT)

N/A 85.7% N/A N/A

LWSO2 June

Number of service users admitted out of area for treatment

N/A 6 N/A

RESOURCES


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ACCESS LYPFT continues to meet access targets for RTT. The LYPFT Five year strategic plan focus is on recovery and care pathway development and moving towards a community based model, working more with the third sector in order to reduce the number of inpatient mental health beds. They will also be reviewing the provision of psychology and psychotherapy. CLINICAL EFFECTIVENESS (QUALITY AND SAFETY) The 2014/15 Mental Health CQUINS goals are agreed as: 1. Physical and mental health, improved recording of key physical health indicators such as smoking and nutrition. 2. Mental health payments system 3. Learning disability community services liaison with primary care 4. Dementia- ‘written communication of dementia diagnosis’- improved communication 5. Friends and Family test 6. NHS Safety thermometer 7. Physical health checks for MH patients and communication with the GP. Serious incidents: 2 serious incidents have been reported in August, totalling 6 in 2014/15 to date; One incident related to the death of a service user at home, and the second related to the death of an informal patient in a public place. All serious incidents are reviewed at the Leeds CCGs monthly Serious Incident panel. PATIENT EXPERIENCE Six service users were admitted out of area for a total of 54 days. There has been an increase in service users placed out of area in June. This increase in demand is not understood, it is being monitored and could be usual variance. The Trust continues to promote the Patient Opinion website to service users and carers and are committed to using the experiences of service users and carers to further improve services. LYPFT are due for a CQC inspection in early October and the CCG is taking part in a CC focus group.


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The city of Leeds has developed a mental health framework and an action plan for implementation is in development. A series of four workshops have been arranged and we will attend to represent the views of the Leeds west CCG and its members. Leeds North CCG who are the lead contractor for mental health have recently appointed four posts to support mental health commissioning. They will focus on IAPT, Mental health projects and personal health budgets. Leeds west CCG feedback from our member practices highlights the following issues as relevant for our population:

Patients need more information on how to access MH services

Increase self help and support and resilience training

Improve transition from child to adult MH services

Improve support for parents with MH issues who have children at home

Promote employment support and job retention schemes

Improve attention and response for MH crisis

Increase access to drug and alcohol services

Student mental health support

Dementia, improve early diagnosis

Increase suicide risk assessments

Develop pre IAPT services

Increase access for patients with learning disability to physical health screening and services. There issues above will be the focus of the commissioning team and medical directors focus going forward.

The Leeds West CCG has recently approved a business case to support mental health workers in the Leeds student medical practice. We are in discussion with Leeds University re matched funding. This initiative will provide significant input and support for students with mild mental health problems that can be managed in primary care. RESOURCES Staffing: It has been identified in the Trusts safer staffing publication that a number of wards in the Becklin and Newson Centres have low fill rates for qualified staff. This has been discussed with the Director of Nursing who has clarified that this is due to temporary challenges in recruitment to vacancies. However assurance was received that the wards have been risk assessed for impact on quality of care and appropriate arrangements put in place.


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Clarification Notes (relates to all tables): 1. N/A is indicated in indicator cells where information not available until coming year 2. U/K is included in indicator cells where the data is still being sought or clarified 3. LTHT is used in indicator description where performance is related to LTHT as provider only. Elsewhere performance relates to

CCG as commissioner 4. Where indicator relates to composite of a range of indicators e.g. safety thermometer ‘poor or under’ performance will be

reported in narrative by exception.

KEY FOR STRATEGIC DRIVERS Strategic Objective Description

LWSO1 Leeds West Strategic Objective 1: Priority Health Goals - To tackle the biggest health challenges in West Leeds, reducing health inequalities.

LWSO2 Leeds West Strategic Objective 2: Quality & Safety - To transform care and drive continuous improvement in quality and safety.

LWSO3 Leeds West Strategic Objective 3: Best use of Resources - To use commissioning resources effectively.

LWSO4 Leeds West Strategic Objective 4: Organisational Development - To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can.

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Documents

Leeds West CCG Integrated Quality & Performance Report ... · CONTENTS Page 1 Leeds West CCG Integrated Quality & Performance Report November 2014 (September data) CONTENTS Page Strategic