Portsmouth Governing Board Performance Report · Organisation Frequency Target Oct-19 Nov-19 Dec-19 Perf Dir Q2 2019/20 Q3 ... Category 4 - 180 minutes 90th percentile response time

GOVERNING BOARD

Date of Meeting 18 March 2020 Agenda Item No

6b

Title

Portsmouth Governing Board Performance Report

Purpose of Paper

The Performance Report provides the Governing Board with a high-level view of;

CCG performance against key constitutional targets and other standards that define an effective commissioner.

Key performance related risks and mitigating actions where applicable.

Additionally, the Board are asked to note the following performance exceptions;

Increase in calls relating to Covid-19 impacting on SCAS 111 call answer performance.

Ambulance holds at QAH remain an issue with an increase in delays noted for January 2020 when compared to December 2019.

Improvements noted in the CCG’s RTT waiting list size, this has reduced for the third consecutive month but remains off target.

Achievement of the Cancer 62 Day Waiting Time standard from GP referral to Treatment.

The diagnostic 6 week wait standard continues to improve but remains off target. Extended waiting times for MRI at Portsmouth Hospitals NHS Trust impacting on performance.

Recommendations/ Actions requested

The Board are asked to accept the contents of the Performance Report.

Engagement Activities – Clinical, Stakeholder and Public/Patient

Not Applicable

Item previously considered at

Not Applicable

Potential Conflicts of Interests for Committee Members

Not Applicable

Author

Michael Drake Director of Planning and Performance

Sponsoring member Michelle Spandley Chief Finance Officer

Date of Paper 6 March 2020

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NHS Portsmouth CCG

Governing Board Meeting

18th March 2020

Performance Report

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Report Contents

1. Performance Summary ....................................................................................................................... 3 2. Performance Exceptions ..................................................................................................................... 4 Unscheduled Care ................................................................................................................................... 4 Scheduled Care ..................................................................................................................................... 10 Mental Health ....................................................................................................................................... 16

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1. Performance Summary

The table below details the CCG’s performance in the last three months in relation to NHS Constitution standards and other key performance indicators;

Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/ , NHS Digital https://digital.nhs.uk/search/document-type/publication/publicationStatus/true?area=data&sort=date , GOV.uk

https://www.gov.uk/government/statistics

Organisation Frequency Target Oct-19 Nov-19 Dec-19 Perf Dir Q2 2019/20 Q3 2019/20 2019/20 Trend111 Calls answered within 60 seconds SCAS M 95.0% 90.8% 91.1% 85.4% 92.7% 88.9% 91.1%

Category 1 - 7 minutes mean response time SCAS M 00:07:00 00:07:28 00:07:25 00:07:31

Category 1 - 15 minutes 90th percentile response time SCAS M 00:15:00 00:13:20 00:13:34 00:13:38

Category 2 - 18 minutes mean response time SCAS M 00:18:00 00:19:27 00:18:59 00:19:47




Trolley Waits in A&E - Total (>12 Hours) PHT M 0 0 0 0 0 0 0

Cancer: 2 Week Wait CCG M 93.0% 95.5% 97.5% 95.3% 96.7% 96.1% 96.1%

Cancer: 2 Week Wait (Breast Symptoms) CCG M 93.0% 95.3% 95.6% 96.4% 97.3% 95.8% 94.8%

Cancer: 31 Day Wait for First Treatment CCG M 96.0% 98.8% 100.0% 95.5% 98.4% 98.2% 97.4%

Cancer: 31 Day Subsequent Surgery CCG M 94.0% 94.7% 88.0% 100.0% 96.6% 93.3% 95.5%

Cancer: 31 Day Subsequent Anti Cancer Drug Regimen CCG M 98.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Cancer: 31 Day Subsequent Radiotherapy CCG M 94.0% 100.0% 91.2% 100.0% 93.9% 97.0% 96.1%

Cancer: 62 Day Wait for First Treatment CCG M 85.0% 83.3% 90.3% 93.1% 80.5% 88.5% 82.22%

Cancer: 62 Day Wait for First Treatment Screening Referral CCG M 90.0% 33.3% 100.0% 100.0% 95.8% 66.7% 93.1%

RTT: Incomplete Waiting List Size CCG M 12313 13674 13419 13307

RTT: Incomplete Performance CCG M 92.0% 81.2% 80.8% 80.3% 83.7% 80.7% 82.90%

RTT: Patients waiting more than 52 Weeks CCG M 0 1 1 0 1 2 3

Diagnostic Test Waiting Times CCG M 99.0% 97.1% 97.8% 98.3% 95.3% 97.7% 96.2%

Audiology: Incomplete Waiting List Performance CCG M 92.0% 58.0% 59.9% 61.8% 54.1% 59.8% 53.7%

Incidents of C.Diff CCG M 31 2 2 2 5 6 11

Incidents of MRSA CCG M 0 0 0 0 0 0 0

Mixed Sex Accommodation Breaches CCG M 0 0 0 0 3 0 4

Dementia Diagnosis Rate CCG M 66.7% 68.7% 68.2% 67.8% 68.6% 68.2% 68.6%

IAPT: People entering treatment CCG M 4.75% 4.8% 5.12% #N/A 4.4% 5.0% 4.5%

IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 56.1% 56.3% #N/A 56.6% 56.2% 57.6%

IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 86.4% 87.4% #N/A 86.7% 86.9% 88.3%

IAPT: First Appointment Within 18 Weeks of Referral CCG M 95.0% 99.3% 99.2% #N/A 100.0% 99.3% 99.8%

Early Intervention in Psychosis - Started Treatment CCG M 56.0% #N/A #N/A #N/A 90.9% #N/A 76.7%

Out of Area Placements for Mental Health Active at Period End CCG M 0 0 0 #N/A 5 0 15

NHS Portsmouth CCG Constitutional Target Performance

https://www.england.nhs.uk/statistics/statistical-work-areas/

https://digital.nhs.uk/search/document-type/publication/publicationStatus/true?area=data&sort=date

https://www.gov.uk/government/statistics

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2. Performance Exceptions

The report outlines the performance exceptions across key constitutional standards and operating plan

commitments and related risks.

The paper provides a summary of the latest nationally published data and any local intelligence relating to ‘in month

performance’ or ‘latest positions’.

Unscheduled Care

South Central Ambulance Service (SCAS) 111 Calls Answered within 60 Seconds

In January 2020, the 111 Calls answered within 60 seconds target was met for the first since March 2019. Demand

was down by 10.6% in January 2020 compared with the previous month. However compared with the same period

last year, demand was up by 3.2%.

Early indications suggest that performance has deteriorated in February 2020 mainly as a result of the outbreak of Covid-19. Provisional data as at the week ending on the 15/02/20 places the Trust’s performance at 84.4%. SCAS’ performance was trending around 46% and nationally performance is averaging 56% during the week commencing 23/02/2020 hence the month end position is likely to be adversely impacted.

The SPC chart above illustrates the Trust’s weekly performance over time. It shows a deterioration in performance over the Christmas period but this has since improved and the Trust has achieved the standard in January 2020. However, significant deterioration in the trend is anticipated as a result of the Covid-19 outbreak once February 2020 data has been fed through. Action(s)

The Trust is continuing to focus on call length as well as utilising benchmarking to identify opportunities to

reduce call handling times.

Managers continue to closely manage sickness absence across the Trust. Sickness levels are now low.

Organisation Frequency Target Nov-19 Dec-19 Jan-20

111 Calls answered within 60 seconds SCAS M 95.0% 91.1% 85.4% 95.6%

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Quality Assurance Coaches (QACs) have been embedded into the call centre to provide support to new staff.

QACs focused on helping new staff to reduce their call length times.

SCAS 999 Ambulance Response Times (ARP)

Source: NHS England https://www.england.nhs.uk/statistics/statistical-work-areas/

SCAS achieved 5 of the 6 national response time targets in January 2020, marginally failing the Category 1 (7

minutes mean response time) by 0.05 seconds. No Trust achieved the Category 1 Mean Response time target in

January 2020

The Trust however met all 6 national standards in relation to the SHP contract in January 2020. The table below

provides the details in relation to SCAS’ performance for the SHP contract.

Target Performance

Cat 1 (7 minute) 00:07:00 07:00

Cat 1 (15 minute) 00:14:00 12:09

Cat 2 (18 Minutes) 00:18:00 14:54

Cat 2 (40 Minutes) 00:40:00 30:04:00

Cat 3 (2 hr) 02:00:00 01:28.2

Cat 4 (3 hr) 03:00:00 02:15:44

Provisional data for February 2020 month to date (23/2/20) suggests that the Trust is meeting 4 of the 6 national targets at SCAS level and 5 out of 6 at SHP contract level. The Trust is failing the Category 1 (7 minutes mean response time) standard at both SCAS and SHP Contract level. The tables below provide the details; SCAS Level Performance

SCAS Level Target As at 23/2/20

Cat 1 - Mean 0:07:00 0:07:26 Cat 1 - 90th Percentile 0:15:00 0:13:20 Cat 2 - Mean 0:18:00 0:17:54 Cat 2 - 90th Percentile 0:40:00 0:35:44 Cat 3 - 90th Percentile 2:00:00 2:07:03 Cat 4 - 90th Percentile 3:00:00 2:52:24


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SHP Contract Level Performance

SHP Contract Target As at 23/2/20

Cat 1 - Mean 0:07:00 0:07:17 Cat 1 - 90th Percentile 0:15:00 0:12:39 Cat 2 - Mean 0:18:00 0:17:39 Cat 2 - 90th Percentile 0:40:00 0:35:42 Cat 3 - 90th Percentile 2:00:00 1:50:21 Cat 4 - 90th Percentile 3:00:00 2:21:23

Demand has continued to grow in January 2020 in relation to the SHP Contract but the pace has slowed with

demand 0.5% above plan in January 2020 and up 2% when compared with the same period last year. YTD as at the

end of January 2020 demand was 7.0% above plan and 9.0% above the same period last year.

Handover delays continue to be a significant challenge.

There was an increase in the number of reported ambulance delays in January. This increased to 1,193 hours

(1192:54:07) compared to 815 (815:20:23) hours in December 2019. The highest number of reported delays was on

1st January, where 117 hours (116:32:31) were lost due to delays. There were 23 delays of 30-60 minutes and 50

delays of 60+ minutes. The hours lost on 1st January 2020 are the equivalent of 5 ambulances being held for just

under 24 hours each waiting to handover.

The Trust has taken the following actions in response to the challenge of increasing demand and ambulance availability; Action(s)

In response to recommendations made following a review into fleet operating capacity, fifteen new double

crewed ambulances are now in operation across SCAS.

A comprehensive fleet improvement action plan is now in place.

Weekly ‘forward looks’ now in place with operations to manage vehicle availability.

Recruitment of Paramedics from India and overtime incentives for key periods being utilised to support

availability.

The following chart shows the 30-60 minute ambulance holds at QAH. We can see that there is still a significant

amount of variability in the data reflecting the fragility of the system. Looking at the 7 day rolling average, the

number of holds throughout January and February 2020 have remained high.

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In response PHT has in place an Ambulance Handover Recovery plan but report that the following actions relating to capacity and flow are currently off trajectory; Action(s)

PHT’s Gold command structure has remained in place throughout January, supported by all Divisional leadership

teams focusing on the 4 key areas outlined in the Ambulance Handover Recovery Plan

Use of existing and additional community capacity to support improvement in Medically Fit for Discharge list

and patient flow.

Full utilisation of Discharge to Assess (D2A) and Integrated Intermediate Care (IIC) Capacity to sustain pull into

alternative urgent care pathways from the Emergency Department.

SCAS has reported that it does not expect to achieve full compliance until the beginning of 2020/21 financial year despite the actions being taken.

A&E

Portsmouth Hospitals NHS Trust participation in the ongoing national pilot in relation to the new national urgent

and emergency care access standard is still taking place. Consequently, the Trust is not reporting their A&E 4 hour

performance during the period of the pilot in line with national directive. The latest 2020/21 planning guidance does

not give an indication of the future waiting time target or timescales as to when this will be rolled out. The guidance

states that for 2020/21; “all providers should plan to deliver a material improvement against a 2019/20 benchmark.

To achieve this, systems and organisations will be expected to reduce general and acute bed occupancy levels to a

maximum of 92%.”

In terms of A&E demand, progress has been made towards understanding and fixing the data quality issues affecting

the reported A&E activity numbers. The problem relates to PHT’s Emergency Commissioning Data Set upload and a

fix is currently being developed by the Trust. We are currently awaiting confirmation from the Trust on timescales to

fix and backdate the data. In the interim, the Trust has provided provisional data to support our analysis. This

provisional data has been used to ‘manually’ correct the data for Portsmouth Hospitals NHS Trust to provide the

following summaries.

CCG A&E Total Attendances

Total A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12)

2018-19 2019-20 Plan % %

APRIL 7,348 7,618 7,431 270 3.7% 187 2.5%

MAY 8,028 7,792 8,085 -236 -2.9% -293 -3.6%

JUNE 7,585 7,484 7,634 -101 -1.3% -150 -2.0%

JULY 8,019 8,005 8,315 -14 -0.2% -310 -3.7%

AUGUST 7,323 7,458 7,797 135 1.8% -339 -4.3%

SEPTEMBER 7,443 7,174 7,699 -269 -3.6% -525 -6.8%

OCTOBER 7,919 7,691 8,125 -228 -2.9% -434 -5.3%

NOVEMBER 7,521 7,347 7,727 -174 -2.3% -380 -4.9%

DECEMBER 7,726 7,788 7,895 62 0.8% -107 -1.4%

Grand Total 68,912 68,357 70,708 -555 -0.8% -2,351 -3.3%

2018-19 v

2019-20

2019-20 v

Plan

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The table above shows the overall A&E attendances from the CCG’s patients for the period April to December. The

data shows that the CCG’s overall A&E attendances for the period of review are down by -2,351/-3.3% against plan

and -555/-0.8% when compared to the same period last year;

The decrease in the CCG’s A&E attendances mainly at occurred at PHT where the CCG’s overall related attendances

are down by -931/-2.7% year on year.

CCG A&E Total Attendances by Provider

For Type 1 A&E attendances, the CCG’s related activity is showing a decrease by -117/-0.3% against plan but an

increase of +287/+0.8% compared with the same period last year;

CCG A&E Type 1 Attendances

Total A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12) By Provider

2018-19 2019-20 %

Frimley Health NHS Foundation Trust 85 97 12 14.1%

Hampshire Hospitals NHS Foundation Trust 164 160 -4 -2.4%

Other 3,147 3,190 43 1.4%

Portsmouth Hospitals NHS Trust 34,156 33,225 -931 -2.7%

Royal Surrey County Hospitals NHS Foundation Trust79 89 10 12.7%

Southampton NHS Treatment Centre 157 158 1 0.6%

Southern Health NHS Foundation Trust 109 122 13 11.9%

St Marys NHS Treatment Centre 30,241 30,579 338 1.1%

University Hospital Southampton NHS Foundation Trust438 418 -20 -4.6%

Western Sussex Hospitals NHS Foundation Trust 336 319 -17 -5.1%

Grand Total 68,912 68,357 -555 -0.8%

2018-19 v

2019-20

Total Type 1 A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12a)

2018-19 2019-20 Plan % %

APRIL 3,594 3,787 3,660 193 5.4% 127 3.5%

MAY 4,030 3,954 3,984 -76 -1.9% -30 -0.8%

JUNE 3,779 3,820 3,750 41 1.1% 70 1.9%

JULY 4,096 3,963 4,134 -133 -3.2% -171 -4.1%

AUGUST 3,740 3,791 3,857 51 1.4% -66 -1.7%

SEPTEMBER 3,698 3,645 3,796 -53 -1.4% -151 -4.0%

OCTOBER 3,968 3,957 4,019 -11 -0.3% -62 -1.5%

NOVEMBER 3,780 3,755 3,824 -25 -0.7% -69 -1.8%

DECEMBER 3,847 4,147 3,912 300 7.8% 235 6.0%

Grand Total 34,532 34,819 34,936 287 0.8% -117 -0.3%

2018-19 v

2019-20

2019-20 v

Plan

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Looking at the Type1 A&E Attendances by Provider, the year on year growth in the CCG’s attendances is mainly seen

at PHT where attendances have increased by +353/+1.1% year-on-year. The table below details the CCG’s Type1

attendance by provider;

CCG A&E Type 1 Attendance by Provider

The following chart shows Type 1 A&E attendances at Portsmouth Hospitals NHS Trust over time. The average level

of weekly demand prior to May 2018 was 2,136 attendances per week. Post May 2018 this increased to 2,309

attendances per week (+7.6%). Overall demand is continuing to trend upwards;

Source: Portsmouth Hospitals NHS Trust Information Services

The system has Integrated Care Programme Urgent Care Programme in place. The programme aims to deliver safe

and effective urgent care flow throughout the system; ensuring people are in the right place for care, focusing on 4

main determinants of good flow outlined below:

1. Population health.

2. ED processes and admission avoidance.

3. Bed occupancy.

Total Type 1 A&E Attendances (Excluding Planned Follow-Up Attendances) (E.M.12a)

2018-19 2019-20 %

Frimley Health NHS Foundation Trust 85 94 9 10.6%

Hampshire Hospitals NHS Foundation Trust 147 145 -2 -1.4%

Other 1,885 1,802 -83 -4.4%

Portsmouth Hospitals NHS Trust 31,661 32,014 353 1.1%

Royal Surrey County Hospitals NHS Foundation Trust73 78 5 6.8%

University Hospital Southampton NHS Foundation Trust345 367 22 6.4%

Western Sussex Hospitals NHS Foundation Trust 336 319 -17 -5.1%

Grand Total 34,532 34,819 287 0.8%

2018-19 v

2019-20

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4. Out of hospital services.

In the past month there has been a continued focus across all live schemes to ensure the benefits and impact are

maximised;

Additional winter capacity - all additional winter capacity now mobilised;

o 10 additional beds at Jubilee House opened 10/01/2020 (Hampshire patients).

o 12 additional beds at Portsmouth Hospital NHS Trust opened 24/12/2019 providing net impact for

Medicines and Older Persons Medicine.

o 40 interim beds open in South East Hampshire (Hampshire patients).

o Capacity for 13 new starts per day through Hampshire IIC service.

Emergency Department Redirection pilot extended to March 2020. For the period 4th November - 19th January,

there have been a total of 1,820 patients redirected by the service averaging 24 per day against a target of 30

per day.

Integrated Urgent Care Programme – the system have worked with PHL to increase capacity within the

Hampshire CAS to enable increased numbers of cat 3&4 revalidations.

Urgent treatment centres (UTC) development - Agreement in place to incorporate wider UTC development at

Gosport and Petersfield into TRUE procurement programme.

South Central Ambulance Services redirection schemes now combined under single governance structure.

Continued focus on direct access to Acute Medical Unit (AMU) and Surgical Assessment Unit (SAU) plus updated

criteria for Ambulatory Emergency Care (AEC) pilot to increase referrals. Numbers remain small overall.

PHT Ward improvement: Medicine to take out (TTO) project work ongoing with further focus and education at

ward level. All care group improvement initiatives in PHT underway.

MIDOS (Software) – Business case to be presented to Unified Exec in March 2020. Work has commenced to

data assure 111 Directory of Service (DoS ) and engaged with Hampshire County Council and Portsmouth City

Council around community service directories. Working with general practice to scope how MIDOS can support

primary care.

All the current projects and schemes are undergoing evaluation as part of 2020/21 planning. This includes review of

all additional investment committed to schemes in 2019/20.

Risk: IF demand for A&E services at Portsmouth Hospitals NHS Trust continues to grow THEN there is a risk that patient waiting times will increase further impacting on performance and potentially patient outcomes.

Scheduled Care

Cancer Standards

The CCG achieved 7 of the 8 National Cancer Standards in December 2019, failing 31 Day Wait for First Treatment

with a performance of 95.5% against a target of 96%. There were a total of 67 patients treated of which 64 were

treated within standard. The standard was therefore missed by 1 patient.

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PHT achieved all the National Cancer Standards in December 2019. Below are the details in relation to the Trust’s

Cancer performance;

Referral to Treatment (RTT)

Incomplete Waiting List Size

The CCG’s RTT incomplete waiting list size reduced by 0.8% in December 2019 when compared with the previous

month. The list size as at the end of December 2019 was 13,307 pathways against a monthly trajectory of 13,340

and year-end threshold of 12,313 pathways. There was no reported breach of the 52 week incomplete standard.

Provisional data for January 2020 places the waiting list size at 13,509. No breach of the 52 weeks standard is

anticipated in January 2020

Looking at the data for key providers;

Provider March 2019

baseline October 2019

November 2019

December 2019

St. Marys Treatment Centre

3,534 3,405 3,049 3,212

PHT 33,052 36,043 36,195 35,270

December 2019 data for Care UK showed an increase in the overall waiting list size by +163/+5.3% compared with

the previous month. Care UK’s waiting list jumped from 3,049 in November 2019 to 3,212 in December 2019.

However, Care UK’s overall waiting list size remains below the March 2019 threshold.

Organisation Frequency Target Oct-19 Nov-19 Dec-19RTT: Incomplete Waiting List Size CCG M 12313 13674 13419 13307

RTT: Incomplete Performance CCG M 92.0% 81.2% 80.8% 80.3%

RTT: Patients waiting more than 52 Weeks CCG M 0 1 1 0


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In Contrast, PHT’s overall waiting list size decreased by -2.6%/-925 pathways in December 2019 to 35,270, down

from 36,195 in November 2019. PHT’s position however, remains above the year end threshold of 33,052 pathways.

The following chart details the waiting list trend over time for the specialties highlighted, the growth seen in

Cardiology is relatively small however the other specialties are on an increasing trajectory;


In response to the issues highlighted the Trust has taken the following actions;

Action(s)

The Trust is participating in a national validation exercise, and the offer also includes external validators and on-

line RTT training which will commence in March 2020. 3 external validators, have been identified to support the

Trust

Specialties are working on recruitment to address clinical and administrative shortfalls and reviewing pathways

to optimise potential for early clock stops and with commissioners to manage increased demand for some

services.

Speciality level action plans to deliver improvement are being developed and progressed within divisions, this includes pathway improvements and options to affordably increase capacity and reduce waiting list size.

The system has agreed a priority programme to address the underlying demand and capacity mismatch, linking with

the NHS Long Term Plan and informed by GIRFT, RightCare data, High Impact Intervention Programmes, best

practice from Elective Care Speciality Based Transformation Handbooks, current contractual performance and

waiting lists, local system pressures and BI information. The standardised approach includes implementation of

digital first such as advice & guidance as the first point of contact, common condition pathways to support primary

care management and forming speciality working groups within identified areas to discuss opportunities. Additional

capacity realised as a result of the programme will be used to support back log reduction. Key programme highlights

and actions include;

Action(s)

Ophthalmology – Agreement to work with local optometrist service to become a pilot site for setting up

optometrists to use Electronic Referral Service (eRS). Next steps – Medical Retina Service to move to Referral

Assessment Service from Mid-March 2020.


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Urology - Digital First service delivery model for all routine referrals went live on 27th January (including virtual

single point of access stone clinic). Early indications of significant reduction in conversion from triage to first

appointment. Next steps – Monitor pathway changes and regular engagement with the speciality. Follow up

meeting to be scheduled.

Respiratory – Common Conditions Optimal cancer pathway launched with positive results. Following a joint

discussion with Primary Care Network (PCN) leads, Clinical Director for Respiratory and Clinical Record

Interactive Search (CRIS) team representatives a virtual multidisciplinary team (MDT) clinic pilot is going to be

designed to take place in the 20/21. This will allow practice nurses from one PCN to discuss cases via virtual

MDT consisting of secondary and community service staff. Next steps are co design pilot specification and

associated pathways, communications to PCN staff in preparation for go live.

Gynaecology - Menstrual bleeding pathway (including new one-stop hysteroscopy service) launched 18th

November. PHT admin infrastructure issues have led to utilisation issues of the new service, which have now

been resolved. Next steps – Development of long term plans to redesign the women`s health continence service

provision, ensuring robust provision of physio provision.

Gastroenterology - Gastro audit results are expected to be received in early March ahead of FIT implementation

from April 2020. Next Steps – Gastro strategy meetings continue to be held on a monthly basis along with

smaller working groups to finalise the process for Faecal Immunochemical Test (FIT) implementation.

100 day outpatient transformation programme –

Nephrology: Having gained primary care input from local GPs for the roll out of the agreed pathways, the

Nephrology working team is now working with partners from Salisbury and West Sussex.

Dermatology: Three projects and key individuals to work up each project have been identified and project

groups are underway. It is anticipated a teledermatology service extension will be piloted as part of the 100 day

challenge. Next steps – Agreement around the details of the pilot to be worked up during March 2020.

RDS/Cancer workshops - Rapid Diagnostics Service (RDS) Task & Finish groups looking at referral criteria,

commissioning and finance and demand and capacity in relation to the RDS are taking place over the coming

months ahead of launch in April 2020. The Sovereign PCN has been successful in its application to become a

pilot site for the project.

ENT - Microsuction leaflet is now ready to be circulated. Engagement with ENT department around

transformation programme is ongoing. Further audits to be undertaken before scope of project can be agreed.

Next steps – Advice and Guidance Audit is in the process of being set up. Final meeting with nursing team

around revised microsuction criteria to be held ahead of leaflet launch with GP communications to support role

out.

Advice and Guidance - Primary care knowledge survey and additional admin practice training has been

completed. Training guidelines have been reviewed which identified a gap in application of knowledge to

practice identified. Next steps - Development of virtual Skype training, Advice & Guidance in development

within PHT Minestrone single clinical system.

Risk: IF the imbalance between elective demand and capacity at PHT is not addressed THEN the there is a risk to delivery of the RTT standard, the CCGs operating plan commitment in relation to RTT waiting list size and an increased risk of long waiting patients.

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Diagnostics Waiting Times


The Diagnostics standard remains a challenge. The CCG missed the Diagnostic standard in December 2019, reporting

98.3% against the 99% standard. There were a total of 43 breaches with the majority occurring at PHT (31). The CCG

missed the standard by 18 diagnostics. Significant reduction in the over 6 weeks breaches at St. Marys Treatment

Centre compared with the previous month as a result of exclusion of audiology breaches in line with national

guidelines. Provisional data for January 2020 places the CCGs performance at 98%.

The table below provides details in relation to the diagnostic breaches by provider as at the end of December 2019.

> 6 Weeks Breaches

PORTSMOUTH HOSPITALS NHS TRUST 31

ST MARY'S NHS TREATMENT CENTRE 7 UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 3

BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST 1

INHEALTH LIMITED 1

TOTAL BREACHES 43

The table below shows PHT’s overall performance (Total Trust / All Commissioners) by test. The majority of reported

breaches were in MRI and Ultrasound;

Organisation Frequency Target Oct-19 Nov-19 Dec-19

Diagnostic Test Waiting Times CCG M 99.0% 97.1% 97.8% 98.3%


< 6 Weeks > 6 Weeks Total Performance

MRI 1121 56 1177 95.2%

Non Obstetric Ultrasound 2067 36 2103 98.3%

Colonoscopy 274 8 282 97.2%

Gastroscopy 266 5 271 98.2%

Echocardiography 357 2 359 99.4%

Cystoscopy 71 2 73 97.3%

Flexible Sigmoidoscopy 109 2 111 98.2%

CT 622 1 623 99.8%

Sleep Studies 1 0 1 100.0%

Dexa Scan 135 0 135 100.0%

Audiology 264 0 264 100.0%

Peripheral Neurophysiology 359 0 359 100.0%

Barium Enema 130 0 130 100.0%

5776 112 5888 98.1%


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The Trust has undertaken a number of actions to address these issues including the following;

Action(s)

Continued use of Waiting List Initiatives (WLI) in Ultrasound to maintain waiting times

Current capacity for Cardiac MRI to increase from 65 slots 81 slots per month from March 2020

Ultrasound - additional WLI capacity commenced February 2020 and being planned for March 2020

Computer tomography (CT) - Continue to work with clinical teams to ensure robust demand management. The mobile unit will be operational for six days a week from the end of February 2020

Development of cardiac MRI plan to be delivered by April 2021

The ICP team held a strategy meeting with leaders from PHT diagnostics to discuss 20/21 strategy for the

programme. The next step is to produce co-written plan which will then be submitted to Executive Contract

Review Meeting for agreement. Aspects will include a focus on pathway driven diagnostic access and alignment

of strategic direction.

Audiology Waiting Times

The CCG continues to miss the Audiology Incomplete pathway standard but showing steady improvement albeit

small progress. The CCG’s performance improved from 59.9% in November 2019 to 61.8% in December 2019.


The CCG’s performance continues to be impacted by capacity issues at PHT. The Trust’s Audiology waiting time

performance improved to 57.9% in December from 55.9% in November 2019.

Provisional data suggest that there has been significant improvement in the waiting list size and the number of

patients waiting in excess of 52 weeks. The waiting list size has fallen from 4,068 as at 06/11/2019 to 3,606 as at

05/02/2020. The number of patients waiting in excess of 52 weeks has also dropped from 133 to 7 for the same

period. The table below provide details of the trends;

As a result of workforce challenges and the resulting capacity issues, there is a risk that the waiting list size may

grow.

In response, the following actions have been taken;

Action(s)

Locum capacity now in place at the Trust with a focus on reducing the backlog of long waiting patients.

Discussions relating to the longer term sustainability of the Audiology service delivered by the Trust remain

ongoing.


Audiology: Incomplete Waiting List Performance CCG M 92.0% 58.0% 59.9% 61.8%


Snapshot Date 06/11/2019 13/11/2019 20/11/2019 27/11/2019 04/12/2019 11/12/2019 18/12/2019 27/12/2020 02/01/2020 08/01/2020 15/01/2020 22/01/2020 29/01/2020 05/02/2020

Total Waiting Lis t 4068 3977 3808 3723 3721 3690 3627 3597 3605 3593 3625 3629 3637 3606

WL Increase -1.4% -2.2% -4.2% -2.2% -0.1% -0.8% -1.7% -0.8% 0.2% -0.3% 0.9% 0.1% 0.2% -0.9%

Over 18 Weeks 1972 1912 1809 1744 1628 1557 1528 1519 1524 1521 1493 1455 1456 1433

Over 26 Weeks 1457 1397 1281 1227 1110 1053 996 1001 1024 1039 1013 974 963 947

Over 35 Weeks 903 825 718 690 583 511 492 480 496 512 480 463 464 445

Over 52 Weeks 133 104 65 86 32 19 17 18 18 11 19 10 9 7


16

Mental Health

The CCG is currently meeting all the mental health standards. This is set out in the table below:

Data source: NHS Digital


Dementia Diagnosis Rate CCG M 66.7% 68.7% 68.2% 67.8%

IAPT: People entering treatment CCG M 4.75% 4.8% 5.12% #N/A

IAPT: People moving into recovery as a % of those finishing treatment CCG M 50.0% 56.1% 56.3% #N/A

IAPT: First Appointment Within 6 Weeks of Referral CCG M 75.0% 86.4% 87.4% #N/A

IAPT: First Appointment Within 18 Weeks of Referral CCG M 95.0% 99.3% 99.2% #N/A

Out of Area Placements for Mental Health Active at Period End CCG M 0 0 0 #N/A


Documents

Portsmouth Governing Board Performance Report · Organisation Frequency Target Oct-19 Nov-19 Dec-19 Perf Dir Q2 2019/20 Q3 ... Category 4 - 180 minutes 90th percentile response time