nhs rotherham clinical commissioning group body papers... · from 2016/17 the performance framework...

NHS Rotherham Clinical Commissioning Group

Operational Executive 23 January 2017

Strategic Clinical Executive 25 January 2017

GP Members Committee 25 January 2017

Governing Body 1 February 2017

Commissioning Plan Performance Report: Quarter 3

Lead Executive: Ian Atkinson, Deputy Chief Officer Lead Officer: Lydia George, Planning and Assurance Manager

Alex Henderson-Dunk, Performance and Intelligence Manager Lead GP: N/a

Purpose:

For the Governing Body to note the progress with delivery of the CCGs Commissioning Plan as at the end of Quarter 3.

Background:

In 2013 a performance framework for the Commissioning Plan was developed so that the CCG could assess its progress against key priorities and on its implementation of the plan. The report has been refined each year but has broadly remained the same.

In Quarter1 of 2016/17, in line with the new CCG Improvement and Assessment Framework and the revision of the GB overall performance report the Commissioning Plan performance Report was revised to provide a fuller picture of delivery. The key changes were:

• Each of the 15 priority areas from the Commissioning Plan are reported • Each priority area has clear milestones and targets aligned to the Commissioning Plan • Each priority area includes Key Performance Indicators taken from the new CCG

Improvement and Assessment Framework metrics, the new Governing Body Performance report, Quality Premiums, the Better Care Fund or are regular key local metrics already reported

• QIPP information is included for those priority areas that are subject to QIPP • Any associated risks from the GB Assurance Framework are reported • Lead GP and Lead officers are reported

From 2016/17 the performance framework will be reported 4 times a year and will be received at Governing Body in August, November, February with a final year- end report in May.

Analysis of key issues and of risks Lead officers have provided commentary against the milestones where performance is off track. From quarter 2 officers were asked to identify any milestones where the direction of travel had the potential to deteriorate or improve.

In addition, in line with the GB performance report, commentary is provided for Key Performance Indicators that are not on track.

Milestones There are 52 milestones in total, see breakdown below:

RAG rate Number of milestones %

Red 0 0 Amber 3 6 Green 49 94 Total 52 100

The number of milestones on track or completed has increase from 90% in quarter 1 to 94% in quarter 3.

Amber milestones are summarised below:

RAG rate

No. Milestone description Commentary Q1 position

Amber 3 M29: Delivery the required number of bed reductions as per Rotherham element of the LD plan

M39: Involvement of the care co-ordination centre in the EOLC pathway

M40: Achieve 40% implementation of the Case Management Palliative Care Template in Primary Care

M29: Moved from green to amber in Q1, the local target is being met but we are measured on the TCP trajectory which is not on track

M39: Discussions continue to take place and it is still the intention for the CCC to be a single point of access for EOLC.

M40: Decision to be included only recently made, therefore implementation is just starting

M29: same as Q2 M39: Same as Q2 M40:Same as Q2

To note:

• M4: Primary Care Self-Care Pilot: moved from Amber in Q2 to Green in Q3 • M18: Extension of Virtual clinics from haematology to other areas such as

endocrinology: from Red in Q2 to Green in Q3

It is worth noting that whilst the RAG rate for the following milestones remains the same as Q2, it has been highlighted that there is the potential for the direction of travel to change.

Q 2

RAG rate

Direction of travel Milestone description Commentary

Green Completion of Business Case for the re-ablement village

There are delays due to the timing of decisions through organisations governance structures. Strategically, through the Rotherham Place Plan this area is on track, however there is a risk of not achieving this target set through BCF.

Green RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan

On track, some concern that the plan will not be produced, assurance being monitored via the MH/LD QIPP Committee.

Key Performance Indicators (KPIs) There are 48 milestones in total, see breakdown below:

RAG Rate Number of KPIs %

Red 7 14 Amber 6 13 Green 20 42 *WD 15 31 Total 48 100

* these KPIs are awaiting further data nationally

Overall there are approximately 42% of KPIs on track, which has increased from 29% in Q2.There still remains a significant number of KPIs still awaiting national data, however this number has decreased from 25 in Q1.

Below is a list of the red and amber KPIs, commentary on performance can be found in the Governing Body Performance Report or Governing Body Quality Report.

RAG rate

No. Key Performance Indicator Description Q1 position

Red 7 K2: Utilise NHS e-referral service to enable choice at 1st routine elective referral K3: Contain growth in the number of non elective admissions K5: Achieve A&E 4 hour access standard K7: People who have had a stroke who are admitted to the acute stroke unit in 4 hours of arrival to hospital K13: Cat A ambulance response calls within 8 minutes K17: Reduction in the number of antibiotics prescribed in primary care K44: Cancer (all) diagnosed at stage 1 and 2

K2: Same as Q2

K3: Same as Q2 K5: Same as Q2 K7: Same as Q2

K13: Same as Q2 K17: Not known in Q2 K44: Same as Q2

Amber 6 K1: Patient experience of GP services K4: Contain growth in A&E attendances K28: Reduce the number of people admitted in line with the South Yorkshire and North Lincolnshire LD TCP trajectory K 40: Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 28 days from the receipt of the continuing healthcare checklist – Adults (K40). K41: Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 6 weeks from the receipt of the continuing healthcare checklist – Childrens K46: Percentage seen within 62 days after a referral by GP

K1:Not known in Q2 K4: Same as Q2 K28: Same as Q2

K40: Same as Q2 K41: Same as Q2 K46: Red in Q2

To note:

• K21: Percentage of people ‘moving to recovery’ of those who have completed IAPT treatment: moved from amber in Q2 to green in Q3.

• K23: Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment: moved from red in Q2 to green in Q3.

Finance The position in terms of QIPP savings reported in Q2 remains the same in Q3 with the following exceptions, narrative for the QIPP position can be found in the Finance and Contracting Governing Body report:

Commissioning Priority QIPP Scheme Q1 Q2 Q3 Unscheduled Care Reducing levels of activity growth in

A&E

Transforming Community Services

Reducing levels of activity in emergency admission – neuro rehab, integrated rapid response and integrated locality teams

Clinical Referrals Reducing levels of activity growth in direct access pathology in line with clinical pathways

Reduce IHAM NHSE growth assumption in line with local trend analysis

Medicines Management Unidentified Rebates and contract efficiencies

Risk There are no new risks since Q2 and the scores remain the same as reported in Q2 with the exception of the following:

Risk Risk Description Q2 position

Q3 position

Impact of changes to primary care support England from NHS to Capita contract

Issues in relation to collection and delivery of medical records, this is a national not local issue

16 12

Approval history:-

OE 23 01 2017

SCE 25 01 2017

GPMC 25 01 2017

CCG GB 01 02 2017

Recommendations:

The Governing Body are asked to note the report and to note:

1. The position in term of milestones is positive and has improved from 90% Q2 to 94% in Q3, however there are 2 milestones with the potential to go off track.

2. The position in terms of KPIs is positive and has improved from 29% in Q2 to 42% in Q3. However there are still a number of KPIs which are waiting for national data.

Commissioning Plan Performance Report 2016/17

Q3

Meeting Date

Operational Executive 23 01 2017 Strategic Clinical Executive 25 01 2017 GP Members Committee 25 01 2017 CCG Governing Body 01 02 2017

Definitions for RAG Ratings:

Red KPI Milestones QIPP

Less than 2% achieved Not started or significant issues Not started or Started but still high risk

Amber

KPI Milestones QIPP

Within 2% achieved Started but not on track OK with medium risk

Green

KPI Milestones QIPP

Achieved or complete On track Achieving as planned

Please note

• That there are a number of KPIs from the new Improvement and Assessment Framework where data is not available yet.

1

1 Primary Care Lead GP: Jason Page Lead Officer: Jacqui Tufnell

Funding in 2016/17 = £0.6m for the LIS, £1.2m for Case Management and funding for the CCG Commissioned LES’s

Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments

M1 Primary Care Quality Contract – implement and monitor 3 standards for 2016/17.

Com / primary care plan

Q1 G G G On track

M2 Primary Care Quality Contract – develop remaining standards for 2017/18


Q3 G G G On track

M3 Primary Care Quality Contract – Agree contracts for 2017/18 standards


Q4 G G G On track

M4 Primary Care Self-care pilot – complete tele-health evaluation


Q2 A A G The evaluation has been completed and it has been approved by the primary care committee to roll-out introduction to all practices.

M5 Monitor and evaluate the effectiveness of the Care Home Alignment with GP practices


Q4 G G G On track

Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4

K1 Patient experience of GP services (I&AF 128b)

I&A Framework Quality

premium

85% or a 3% increase on Jul-

16

WD WD A Performance from two most recent survey waves is 84.8% - wave 1 was Jul-Sep 15 / wave 2 was Jan-Mar 16. Almost achieved

K2 Utilise NHS e-referral service to enable choice at 1st routine elective referral (I&AF 105a)


premium

80% or 20% increase on

Mar-16

R 61.6%

R 73.1%

R 67.3%

October 16

Agreed action plan in place with TRFT which we continue to monitor. There has been significant improvement across specialities, but 2 remain challenging. IT team are working with GPs to increase utilitsation.

QIPP APMS Core Contract Values QIPP Plan £125,000 G G G See GB Finance and Contracting report

Premises Costs reimbursements QIPP Plan £118,000 G G G See GB Finance and Contracting report Property Services QIPP Plan £274,000 G G G See GB Finance and Contracting report

Risks Risk Description Risk Score GP quality and Efficiency GB Assurance

Framework Failure to improve GP quality and efficiency in partnership with NHS England - current concerns are due to overall GP capacity

d l )

12

CQC inspection of practices GB Assurance Framework

Worst case scenario, a practice may be identified as so inadequate that emergency arrangements have to be enacted

12

Impact of changes to primary care support England from NHS to Capita contract

GB Assurance Framework

Issues in relation to collection and delivery of medical records, this is a national not local issue

12

To note, the following KPIs are within the I&A Framework but are not currently in publication • Primary care access (I&AF 128c) • Primary care workforce (I&AF 128d)

2 Unscheduled Care Lead GP: David Clitherow Lead Officer: Sarah Lever / Claire Smith

Funding in 2016/17 = £60.1m


M6 Completion of the capital Build for the Emergency Centre (Q2 2017/18)

Com Plan STP

Q4 G G G On track - Handover from Kier planned for May 17 (currently ahead of schedule likely April 17). Once handed over, infrastructure (IT and equipment) will be put in place before cleaning ready for decant from B1.

M7 Implement new IT system Com Plan Q3 G G G IT system went live October. Initial problems encountered in recording performance data were rectified in December 16. M8 Full implementation of the Emergency

Centre Model Com Plan

STP Q3 G G G On track - scheduled for 6th July 17

M9 Expand role of the Care Co-ordination Centre (CCC) to manage the interface between acute /community

Com Plan STP

Q3 A G G

Expansion of CCC on track, further discussions to take place around the clinician to clinician proposals still ongoing. Project group set up and action plan in development

M10 Ensure replacement Risk Stratification Tool is in place to support the reduction in emergency admissions

Com Plan Q4 G G G On track – target changed to Q4 (from Q3). There have been delays with the development by Dr Foster but roll-out is expected mid-February with full implementation by the end of March

2

Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)

K3 Contain growth in the number of non-elective admissions

Contractual target

Meet contracted

levels

R R 0.6m over-performance Apr-Nov YTD on emergency admissions and 0.7m on emergency assessments. Across all acute contracts.

K4 Contain growth in A&E attendances Contractual target

Meet contracted

levels

A A 0.3m over-performance Apr-Nov YTD on A&E attendances across all acute contracts.

K5 Achieve 4 hour access standard for A&E Constitutional GB Report

95% by Q4 R 91.6%

YTD as at 30/06

R 91.7%

YTD as at 02/10

R 79.2%

YTD as at Dec 16

TRFT were unable to report performance in November and part of December due to system issues following the change over to MEDITECH in A&E. The agreed A&E improvement action plan continues to be monitored closely by the CCG with assurance being provided through the contractual mechanism and A&E Delivery Board.

K6 Reduce unplanned hospitalisation for chronic Ambulatory Care Sensitive conditions (I&AF 106a)

I&A Framework GB Report

1,074 WD WD WD Still awaiting data publication

QIPP Delivery of A and E Assessments through the Clinical Decision Unit

QIPP Plan £286,000 G G G See GB Finance and Contracting report

Reducing levels of Activity growth in A&E QIPP Plan £280,000 A A R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.


QIPP Plan £226,000 R R R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.

Risks Risk Description Risk Score Unscheduled Care QIPP GB Assurance

Framework Failure to deliver system wide efficiency programme for unscheduled care

20

A&E target GB Assurance Framework

Failure to meet A&E targets 16

3 Transforming Community Services

Lead GP: Phil Birks Lead Officer: Claire Smith Funding in 2016/17 =£28.5m


M11 Implement and monitor the Integrated Locality Team at the Health Village

Com Plan Q2 G G G On track

M12 Implement and monitor the Integrated Rapid response Service

Com Plan Q2 G G G On track - Note that staff are integrated on one site a lead is now in post. Main concern is the lack of visibility on the KPIs

M13 Completion of the Business Care for the Re-ablement Village

Com Plan Q4 G G G

Significant analysis of the current position has been completed. A project group has been established. Joint approach required with RMBC, there have been delays due to timing of decisions. Strategically on track via Rotherham Place Plan, however risk of not achieving this BCF milestone


K7 People who have had a stroke who are admitted to the acute stroke unit in 4 hours of arrival to hospital

Quality Premium GB Report

90% national standard

R 50.0%

R TRFT

position = 55%

R TRFT

Position = 73%

TRFT position used for Q2 and Q3 (part of) as most up to date available and is reflective of overall CCG position

K8 Emergency readmissions within 30 days of discharge from hospital

BCF GB report

12.2% R Jun 16 YTD = 12.3%

G Sep 16 YTD = 12.2%

G Oct 16 YTD = 12.0%

On track but performance only just meets the target

K9 Delayed transfers of care from hospital (I&AF 127e)

I&A Framework BCF

GB Report Quality

Premium

Sep 16 Target YTD = 1477.2 delayed days

from hospital per 100,000

population ( 18+)

G Apr-Jun 16 YTD = 676

G Sep 16 YTD = 1345.3

G Oct 16 YTD =

1651.2

Performance YTD remains on track but recent months have been off track, which has the potential to impact on the YTD performance.

K10 Number of unscheduled admissions of patients > 65 years out of hours

TCS reporting Threshold = -15%

R April / May =

270

TBC WD Qtr 2 data not confirmed, Q3 not available.

3

K11 Number of A&E attendances by care home residents

TCS reporting Threshold = 1250

R R WD Target per annum is 1250 with a current predicted outturn of 1503. Over the last 3 months the number of attendances has decreased from average of 136 per month to 116. Position is improving but remains red.

K12 GP satisfaction rate for the Integrated Community Nursing Service

TCS reporting Threshold = 80%

G G WD Predicted year end position is Green at 84%; awaiting data for Q3

QIPP Reducing levels of Activity in Emergency Admissions - neuro rehab, integrated rapid response and integrated locality teams

QIPP Plan £1,039,000 A R R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.

Risks Risk Description Risk Score None identified GB Assurance

Framework

4 Ambulance and Patient Transport Services

Lead GP: David Clitherow Lead Officer: Julia Massey


M14 Develop a process to understand the CPR performance delivered to support improved patient outcomes

Com Plan Q4 TBC G G YAS have identified the technology required to obtain accurate reporting on CPR standards from Defibrillators, reporting structure agreed and training needs identified.

M15 Improved hospital pre alert and treatment plans for patients with suspected Sepsis

Com Plan Q4 TBC G G Operational plan produced Audit undertaken to agree baseline.

M16 Commission a provider for PTS service Com Plan Q4 G G On track


K13 Response to category A (Red1) ambulance calls within 8mins (I&AF 127d)

I&A Framework GB report

75% R June = 59.3%

R Sep = 60.4%

R Nov = 58.6%

YAS are currently participating in an NHS England-led Ambulance Response Programme (ARP), which went live from the 21st April 2016. The pilot ran for 3 months initially and has subsequently been extended. This programme resulted in a change to call category classifications. These classifications have subsequently been revisited by the programme and further changes implemented during October. The only standard currently available to assess performance is 75% of category 1 calls under 8 minutes. In the first full month of monitoring this (November), YAS achieved 58.6% against the 75% standard.

QIPP None identified

Risks Risk Description Risk Score Ambulance Targets GB Assurance

Framework Failure of YAS to achieve RED 1 8 minute Target at CCG level and Yorkshire & Humber wide

20

5 Clinical Referrals (Diabetes is a clinical priority within the I&A Framework)

Lead GP: Anand Barmade Lead Officer: Janet Sinclair-Pinder Funding in 2016/17 = £66.7m


M17 Implement 10 clinical thresholds Com Plan Q4 G G G The Clinical Thresholds were implemented on the 1 December

M18 Extension of virtual clinics from haematology to other areas such as endocrinology

Com Plan Q2 G R G The Endocrinology Virtual clinic commenced on the 10 January 2017.

M19 Delivery of agreed audit programme and implementation of recommendations (6 in 2016/17 – 4 clinical thresholds, 1 cancer, 1 emergency admissions)


4

M20 Review and implement Rotherham Diabetes Care model around the Portsmouth care model which focuses around “super six” care.



K14 Patients waiting 18 weeks or less from referral to hospital treatment (I&AF 129a)

Constitution / I&A Framework

GB Report

92% G June 16 = 94.8%

G Sep 16

= 94.2%

G Nov 16 = 95.1%

% Patients on incomplete non-emergency pathways waiting no more than 18 weeks. On track with performance continuing to be above the target.

K15 Contain growth in elective activity Contractual Meet contracted

levels

TBC G G 0.4m below plan for elective activity, across all acute contracts.

K16 Achievement of outpatient follow up ratios

Contractual 11% reduction in follow ups from last year at RFT

TBC -3.6% G RFT are down 7% on last year’s follow up activity. We contracted for an 11% reduction in follow-up, therefore the trust are over planned activity. We have an agreed ratio in the contract above which the CCG will not pay. This is a £0.5m reduction at month 8 flex. RFT are reporting achievement of the ratio’s at year end but have not shared their plans for reducing to planned ratios.

QIPP Reduction in follow-ups where TRFT are above peer average


Reducing levels of Activity growth in direct access pathology in line with clinical pathways

QIPP Plan £73,000 R A G See GB Finance and Contracting report


QIPP Plan £509,000 G R R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.

Risks Risk Description Risk Score Planned Care QIPP GB Assurance

Framework Failure to deliver system wide efficiency programme for planned care

20

6 Medicines Management

Lead GP: Avanthi Gunasekera Lead Officer: Stuart Lakin Funding in 2016/17 =£48.0m


M21 Potential savings of £447,500 have been identified by the introduction of a range of branded generic drugs. This figure will be adjusted as further schemes evolve. A target of 90% compliance has been set = annual savings £402,750.

Meds Management

Priority

90% G G G On track - £215K delivered up to October 2016

M22 12 projects to be delivered over the financial year two have been completed £273,000 savings identified this figure will evolve has schemes are still being evaluated

Meds Management

Priority

12 projects G G G On track - £214K delivered up to October 2016

M23 6 practices to have committed to become waste beacons and have begun the transformational work plan by September 2016. 9 practices have committed to the programme and timescales

Meds Management

Priority

Q3 TBC G G On track – 29 practices are on target to be signed up by 31/03/2017


K17 Reduction in the number of antibiotics prescribed in primary care (I&AF 107a)

Quality premium / I&A Framework

GB Report

4% reduction or 1.161 items per

STAR-PU

G 1.192

TBC R 1.210 Oct 16

Rotherham has a historically high use of antibiotics, and whilst our use of broad spectrum antibiotics is coming down, our overall volume is not. We have identified the practices with the highest use of antibiotics and are working with them to help them reduce.

K18 Appropriate prescribing of broad spectrum antibiotics in primary care (I&AF 107b)

Quality premium / I&A Framework

/ GB Report

lower than 10%, or to reduce by 20% from each CCG’s 2014/15

value

G 8.5

TBC G 7.4 Oct

16

As at October 2016 - Next update due end January 2017

5

K19 Number of finance and quality “green” indictors

Meds Management

75% og 1302 indicators to be

green 976

G 552

(42%)

TBC G 56%

Oct 16

As at October 2016 – increased to 56% of ‘green’ indicators, however, early indications are that this will not meet year end target. This is an area not directly managed by the medicines management team and requires practices to implement changes.

QIPP Medicines Waste reduction QIPP Plan £700,000 A A A See GB Finance and Contracting report Medicines Management QIPP QIPP Plan £550,000 A A A See GB Finance and Contracting report Branded Generics QIPP Plan £250,000 G G G See GB Finance and Contracting report Rebates and contract efficiencies. QIPP Plan £200,000 G G A See GB Finance and Contracting report Do not prescribe QIPP Plan £150,000 A A A See GB Finance and Contracting report Nationally Negotiated Price Reductions QIPP Plan £1,000,000 A G G See GB Finance and Contracting report Service redesign - Nutrition/Gluten Free QIPP Plan £90,000 A A G See GB Finance and Contracting report UNIDENTIFIED QIPP Plan £190,000 R R R The forecast at this stage is that these

schemes will achieve the required savings but they are flagged red to highlight the fact that not all schemes are fully in place.

Risks Risk Description Risk Score Prescribing QIPP GB Assurance

Framework Failure to deliver system wide efficiency programme for prescribing

20

7 Mental Health (Mental Health and Dementia are clinical priorities within the I&A Framework)

Lead GP: Russell Brynes (Adults) Richard Cullen (Childrens) Lead Officer: Kate Tufnell (Adults) Nigel Parkes (Childrens) Funding in 2016/17 =£35.0m


M24 Externally evaluate Adult Mental Health Liaison and MH Social Prescribing programmes

Com Plan STP

Q3 G G G On track, Adult MH Liaison evaluation received and considered by MH & LD QIPP group. MH Social prescribing evaluation received and considered by CCG

M25 RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan

Com Plan Q4 G G G On track, some concern that the plan will be produced, assurance being monitored via the QIPP Committee.

M26 Dementia – Implement and evaluation the Dementia LES

Com Plan Q3 G G G LES has been implemented and evaluated, however there has been low uptake and further work needs to take place

M27 Children and Young People - All children and young people will follow the agreed process in transitioning to adult services and all will have a transition plan in place.

Com Plan STP

Q4 G G G On track – A local CQUIN is in place for 2016/17 and a national CQUIN will apply for 2017/18. RDaSH have also completed the Transitions toolkit.

M28 Review of out of area placements in partnership with RDASH

Com Plan STP

Q2 G G G Complete


K20 People with 1st episode of psychosis starting treatment with a NICE- recommended package of care treated within 2 weeks of referral (I&AF 123b)

I& A Framework STP

GB report

50% G 72.9%

G Sep-16 = 57.1%

G Oct-16 = 87.5%

On track

K21 Percentage of people who are "moving to recovery" of those who have completed IAPT treatment (I&AF 123a)


Quality Premium Health Outcomes

51.3% A 47.6%

Q1 YTD

A 50.1%

Sep YTD

G Oct 16 = 51.5%

Standard is generally being met or close to but performance is not consistently on track.

K22 Diagnosis rate for people with dementia, as a percentage of the estimated prevalence (I&AF 126a)

GB Report I&A Framework

67% G June = 73.85%

G Sep = 75.1%

G Nov = 75.5%

On track – note data is a snapshot as at month end

K23 Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment

GB Report Health

Outcomes

75% A 71.8%

R 67.2%

G Nov = 78.0%

November performance was positive however YTD performance is still off track at 68.2% and December performance is expected to also be off track.

K24 95% of children and young people who present at A&E in crisis will be seen within 1 hour

STP Com plan

No existing data

WD WD WD No data available

K25 95% of adults who present at A&E in crisis will be seen within 1 hour

STP Com plan

No existing data

WD WD WD No data available

6

QIPP MH and LD – joint risk share with RDASH to reduce the Out of Area activity

QIPP Plan £369,000 R R R This is unlikely to be achieved following a review by RDaSH / CCG to establish whether any OOA could be cared for more appropriately in a more local setting – see finance and contracting report for further detail.

Risks Risk Description Risk Score IAPT Waiting Times GB Assurance

Framework Failure to deliver the National IAPT waiting times standards for 6 and 18 weeks

16

CAMHS Reconfiguration GB Assurance Framework

Inability to deliver CAMHS reconfiguration in a timely manner

16

CAMHS Transformation GB Assurance Framework

Delivery of the CAMHS Local Transformation Plan 12

CAMHS Services GB Assurance Framework

Failure to improve Child and Adolescent Mental Health Services (CAMHS)

12

8 Learning Disability (Learning Disabilities is a clinical priority within the I&A Framework)

Lead GP: : Russell Brynes (Adults) Richard Cullen (Childrens) Lead Officer: Kate Tufnell


M29 Deliver the required number of bed reductions as per Rotherham element of the plan

Com plan Q4 G A A As at end Q3 the local trajectory is being met, however we are measured at a TCP level and the wider TCP trajectory is not on track.

M30 Deliver GP training to support the Annual Health check DES

Com plan Q2 G G G On track - completed


K26 Ensure that patients receive a CTR prior to a planned admission to an Assessment and Treatment Unit or mental health inpatients

Com Plan STP

95% G G G On track. No planned admissions in quarter 3

K27 Ensure that patients in an Assessment and Treatment Unit receive a Care and Treatment Review (CTR) every 6 months

Com Plan STP

100% G G G On track

K28 Reduce the number of people admitted in line with the South Yorkshire and North Lincolnshire LD TCP trajectory

Local Reporting Target = 3 – CCG funded

LD beds

5 – NHSE funded secure

LD beds

G A A CCG funded LD beds is currently at 3,. The NHSE funded beds currently at 4 with target being met The rationale for performance moving to amber is due to the over performance on the wider footprint target

QIPP Review of Assessment and Treatment Unit capacity in block purchase or spot purchase



Framework

To note, the following KPIs are within the I&A Framework but are not currently in publication • % of people with a learning disability on a GP register having annual health check (124b) • Reliance on specialist inpatient care for people with learning disability/autism (124a)

9 Maternity and Children’s Services (Maternity is a clinical priorities within the I&A Framework)

Lead GP: Richard Cullen Lead Officer: Emma Royle


M31 Complete a gap analysis and ‘next steps’ against the National Maternity Review: Better Births

Com Plan

Q3 G G G On track – gap analysis completed and shared with NHSE as well as through the Working Together workstream. SY&B meetings are taking place to agree how to take forward Better Births on an STP footprint looking at common pathways /guidance, jointly monitoring populations health outcomes, joined up services, care, family support and development of self-management support.

7

M32 Complete a revised strategy and service specification for maternity services

Com Plan

Q3 G G G On track - Draft service spec has been completed (taking patient feedback into account) and shared with TRFT Clinical Director, Head of Midwifery for initial comment. Once initial comments are received, the draft spec will be circulated more widely for comment and then taken through the CCG/TRFT governance processes for agreement.

M33 Develop new community services specifications for children’s community nursing and specialist nurses to support the Care Closer to Home work-stream

Com Plan

Q3 G G G On track -Parent Carers Forum consultation exercise ongoing. Draft Spec for Childrens Community Services completed and shared internally. To be shared with TRFT 26 Jan at Transformation of Childrens Services meeting. TRFT to present thoughts around Therapies and Child Development Centre to CCG Jan 17.


K29 Reduce the number of neonatal mortality and still births (I&AF 125a)


TBC WD WD WD Latest position is 9 per 1000 births for 2014. Awaiting more data to be published.

K30 % of children aged 10-11 classified as overweight or obese (I&AF 102a)


TBC WD WD WD Latest position is 35.8% in 2015/16

K31 Maternal smoking at delivery (I&AF 101a)


TBC WD WD WD Latest available position – Q2 16/17 - 12.1%

K32 Improve Women’s experience of maternity services (national maternity services survey) (I&AF 125b)


TBC WD WD WD 2015 score of 7.87 is latest available position.

K33 Emergency admissions for children with lower respiratory tract infections

Health Outcomes GB Report

541.8 WD WD WD Latest position is 372.3 in 2015/16

K34 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19’s

Health Outcomes GB Report

364 WD WD WD Latest position is 272 in 2015/16


Risks Risk Description Risk Score Health Assessments for Children in Care GB Assurance

Framework NHS RCCG reputation as responsible commissioner for Children in Care - not having initial health assessments within statutory framework

12

10 Continuing Care and Funded Nursing Care

Lead GP: Richard Cullen Lead Officer: Alun Windle


M34 Put in place a comprehensive range of agreed local policies and protocols in line with any contemporary guidance

CHC Standards AQuA

Assurance Report

Adults Q4

G G G Target amended to Q4 (from Q3) due process change in ratification of policy, on track for completion by end of Q4

M35 Children Q3

G G G Completed

M36 Develop a CHC training package for health and social care staff regarding local process and provision of CHC

CHC Standards AQuA

Assurance Report

Q4 G G G Completed

M37 Implement processes fit for purpose with identified panels having an appropriate number, scope, size and membership

CHC Standards AQuA

Assurance Report

Adults Q1

G G G On track

M38 Children Q3

G G G On track


K35 People eligible for standard NHS continuing healthcare (I&AF 135a)

I&A Framework GB report

TBC WD WD WD Not currently in publication

K36 Personal Health Budgets (I&AF 105b) I&A Framework GB report

TBC WD WD G

K37 Patients in receipt of CHC will have a completed annual review

CHC Key Performance

Indicators

Adults 25-30%

outstanding

G G G

K38 Children 0%

outstanding

G G G

8

K39 Patients referred by Fast Track referral will receive a funding decision within 48 hours

CHC Key Performance

Indicators

100% Q4

G G G Meeting the standard but reporting system does not provide evidence.

K40 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 28 days from the receipt of the continuing healthcare checklist - Adults

CHC Key Performance

Indicators

100% Q4

A A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.

K41 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 6 weeks from the receipt of the continuing healthcare checklist – Childrens

CHC Key Performance

Indicators

100% Q4

A A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.

QIPP Review of Children's CHC packages QIPP Plan £250,000 A A A See GB Finance and Contracting report Review of Assessment tool for determining care packages

QIPP Plan £150,000 A A A See GB Finance and Contracting report

Review of High Cost Care packages QIPP Plan £100,000 A A A See GB Finance and Contracting report Risks Risk Description Risk Score

Equipment via IFR/CHC GB Assurance Framework

Equipment provided by RCCG via IFR/CHC - failure to have a procurement service to ensure cost effectiveness and service that ensures that the purchased equipment has a record of maintained and safety.

15

Failure to meet the National cut-off date for Previously Unassessed Periods of Care

GB Assurance Framework

Failure to meet the National cut-off date of 1st March 2017 for Previously Unassessed Periods of Care (PUPoC) - previously known as CHC Retrospective Claims

15

CHC overspend GB Assurance Framework

Overspend due to high costs of individual patients of continuing care

12

11 End of Life Care (EOLC)

Lead GP: Avanthi Gunasekera Lead Officer: Nigel Parkes Funding in 2016/17 =£3.0m


M39 Involvement of the Care Co-ordination Centre in the EOLC pathway

Com Plan Q4 R A A Started but not on track – discussions are still ongoing. It is still the intention for the CCC to be a single point of access for EOLC.

M40 Achieve 40% implementation of the Case Management Palliative Care Template in Primary Care

Com Plan Q4 A A A Started but not on track, target = Q2 20%, Q3 30%, Q4 40%. Awaiting data.


K42 Percentage of deaths which take place in hospital (I&AF 105c)


TBC WD WD WD 2015/16 Q2 - 2016/17 Q1 – 46.1%

K43 Percentage of deaths not in hospital Public health 54% by Q4 WD WD WD Awaiting latest data.



Framework

12 Specialised Services

Lead GP: Richard Cullen Lead Officer: Jacqui Tufnell


M41 Ensure robust arrangements for tier 3 Obesity in readiness for the transfer of tier 4 bariatric surgery in collaboration with public health


Key Performance Indicators (KPIs) 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)

- n/a No KPIs QIPP

None identified

9

Risks Risk Description Risk Score Collaborative commissioning GB Assurance

Framework Effective collaborative commissioning of specialised services

12

13 Joint Work – local and Regional

Lead GP: Julie Kitlowski Lead Officer: Ian Atkinson/Keely Firth Funding in 2016/17 = BCF is £24.3m


M42 Develop and deliver the STP STP Q3 G G G On track M43 Develop and deliver the local place

based plan STP Q3 G G G On track

M44 Oversee the implementation of the BCF with RMBC

Com Plan / BCF Plan

Q4 G G G On track


- Achievement of BCF KPIs – see BCF Plan Com Plan / BCF Plan

Q4 Please see BCF page of GB report


Risks Risk Description Risk Score Funding for BCF GB Assurance

Framework Resources reduced through introduction of BCF 12

14 Child Sexual Exploitation

Lead GP: Lee Oughton Lead Officer: Catherine Hall


M45 As part of the annual update for GPs and practice staff, ensure minimum training level 3 is delivered

Com Plan Q1 G G G Complete. For Q4 we will be sending out an update to GP practices to ensure that they are kept informed of referral pathways and contact details etc

M46 Offer the same training as above to the remainder of primary care, social care and providers

Com Plan Q1 G G G Complete. For Q4 we will be sending out an update to GP practices to ensure that they are kept informed of referral pathways and contact details etc

M47 Provide ongoing support to current and emerging SYP and NCA historic investigations

Com Plan Q1-Q4 G G G On track

M48 Provide 2 members to be part of the Multi Agency Safeguarding Hub team

Com Plan Q1- Q4 G G G On track


- None identified QIPP

None identified Risks Risk Description Risk Score

None identified GB Assurance Framework

15 Cancer (Cancer is a clinical priorities within the I&A Framework)

Lead GP: Richard Cullen Lead Officer: Janet Sinclair-Pinder


M49 Support on-going delivery of the TRFT Cancer Improvement action plan focusing on one year survival rates.

Com Plan STP

Q4 G G G On track

M50 Implementation of NICE Cancer Guidelines

Com Plan STP

Q4 G G G On track

M51 Fully engage with the Macmillan Living With and Beyond Cancer (LWABC) Programme to identify gaps in service and develop an action plan

Com Plan STP

Q3 G G G On track

M52 Focus work on awareness raising / early diagnosis / 2 week wait

Com Plan STP

Q3 G G G On track

10


K44 Cancer (all) diagnosed at stage 1 and 2 (I&AF 122a)


Premium

>60% or 4 % point

improvement

R 2014 - 36.5%

R R Off track but inconclusive as the latest reporting period was 2014

K45 Percentage seen within 2 weeks following an urgent referral by GP for suspected cancer

Constitution GB Report

93% G 95.9%

G Sep = 93.4%

G Oct = 95.3%

On track

K46 Percentage seen within 62 days after a referral by GP (I&AF 122b)

Quality Premium

I&A Framework

85% G June = 89.2%

R Sep = 78.9%

A Oct = 83.6%

This is the third consecutive month that the standard has not been met at a CCG level. Breaches of the standard were due to a number of reasons but most related to pathway delays or complexities. 6 of the 9 breaches related to pathways split between TRFT and STH.

K47 Patient satisfaction rates >89% (Secondary care) (I&AF 122d)

I&A Framework Com Plan GB Report

Q1 G G G On track – note this is annual data

K48 Percentage of patients satisfied with support from their GP during treatment >66%

Com Plan STP

Q1 G G G On track – note this is annual data



Framework

To note, the following KPIs are within the I&A Framework but are not currently in publication • Cancer one year survival rates – 2013 data (I&AF 122c)

Glossary

APMS Alternative Provider Medical Services BCF Better Care Fund CCC Care Co-ordination Centre CHC Continuing Healthcare

CAMHS Child and Adolescent Mental Health Services CQC Care Quality Commission EOLC End of Life Care GB Governing Body IFR Individual Funding Request I&A Improvement and Assessment LES Local Enhanced Services ‘Q’ ‘Quarter’

QIPP Quality Innovation Productivity and Prevention RMBC Rotherham Metropolitan Borough Council STP Sustainability and Transformation Plan TRFT The Rotherham Foundation Trust WIC Walk in Centre IHAM Indicative hospital activity model

11

nhs rotherham clinical commissioning group body papers... · from 2016/17 the performance framework...

Documents