nhs rotherham clinical commissioning group body papers... · key performance indicators (kpis)...

NHS Rotherham Clinical Commissioning Group Operational Executive 19 May 2017

Strategic Clinical Executive 24 May 2017

GP Members Committee 31 May 2017

Governing Body 7 June 2017

Commissioning Plan Performance Report: Quarter 4

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 GPMC to note the progress with delivery of the CCGs Commissioning Plan as at the end of Quarter 4.

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 BodyPerformance report, Quality Premiums, the Better Care Fund or are regular key localmetrics 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.

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

RAG rate Number of milestones %

Red 0 0 Amber 4 7 Green 48 93 Total 52 100

The number of milestones on track or complete has slightly decreased from 94% in Q3 to 93% in Q4.

There are no red milestones and amber milestones are summarised below: RAG rate

Milestone description

Commentary Q1 Q2 Q3 Q4

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

Moved from green to amber in Q4, tool was rolled out at the end of March 2017, there are some usability issues highlighted by practices which are being addressed through Dr Foster.

G G G A

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

Moved from green to amber in Q2 due to the TCP trajectory not being met. However, both local and TCP are now not achieving. A remedial action plan is in place to achieve both trajectories by June 2017.

G A A A

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

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

R A A A

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

Decision to be included was delayed at the start of the year, implementation starting to take traction.

A A A A

It is worth noting that both the RAG rate and direction of travel remains the same for the following milestones:

Q3

RAG rate

Direction of travel Milestone description Commentary

Green M13: 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 M25: 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 KPI’s in total, see breakdown below:

RAG Rate Number of KPIs %

Red 9 18 Amber 4 8 Green 18 37 *WD 17 36 Total 48 100

* these KPIs are awaiting further data nationally

Overall there are approximately 37% of KPIs on track, which has decreased from 42% in Q3. The three areas that have deteriorated to red are; Delayed Transfers of Care, 6 week IAPT and 62 day cancer – see table below.

KPIs that have deteriorated: KPI Description Q3 Q4 K9 Delayed transfers of care from hospital Green Red K21 Percentage of people who are "moving to recovery" of those who have

completed IAPT treatment Green Amber

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

Green Red

K46 Percentage seen within 62 days after a referral by GP (Cancer) Amber Red KPIs that have improved: KPI Description Q3 Q4 K2 Utilise NHS e-referral service to enable choice at 1st routine elective

referral Red Amber

K4 Contain growth in A&E attendances Amber Green K40 Patients requiring a Continuing Healthcare assessment will have an

eligibility assessment within 28 days from the receipt of the continuing healthcare checklist - Adults

Amber Green

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

Amber Green

There remains a significant number of KPIs still awaiting national data.

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 Q2 Q3 Q4

Red (9)

K3 Contain growth in the number of non-elective admissions

WD R R R

K5 Achieve A&E 4 hour access standard R R R R K7 People who have had a stroke who are admitted to the

acute stroke unit in 4 hours of arrival to hospital R R R R

K9 Delayed transfers of care from hospital G G G R K13 Cat A ambulance response calls within 8 minutes R R R R K17 Reduction in the number of antibiotics prescribed in

primary care G TBC R R


A R G R

K44 Cancer (all) diagnosed at stage 1 and 2 R R R R K46 Percentage seen within 62 days after a referral by GP G R A R

Amber (4)

K2 Utilise NHS e-referral service to enable choice at 1st routine elective referral

R R R A

K21 Percentage of people who are "moving to recovery" of those who have completed IAPT treatment

A A G A

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

G A A A

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

G G G A

Finance The position in terms of QIPP savings reported in Q3 remains the same in Q4 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 Q4

Medicines Management

Medicines waste reduction Medicines Management QIPP Rebates and contract efficiencies Do not prescribe

Continuing Care and Funded Nursing Care

Review of Children’s CHC packages Review of assessment tool for determining packages

Review of high cost care packages

Risk To maintain consistency of reporting for the 2016-17 Performance Framework, the risks represent the position as at the end of February 2017. The GB Assurance Framework was significantly revised in March 2017 and these changes will be reflected in the updated Commissioning Plan Performance Framework for 2017-18.

Approval history:-

OE 19 05 2017

SCE 24 05 2017

GPMC 31 05 2017

CCG GB 07 06 2017

Recommendations:

GPMC are asked to note the report and that:

1. The year-end position in term of milestones is very positive, although there has been a slight deterioration from 94% in Q3 to 93% in Q4.

2. The position in terms of KPIs is positive, but has deteriorated from 42% in Q3 to 37% in Q4, this is due to deterioration in 3 areas.

3. There are still a number of KPIs which are waiting for national data. 4. The final QIPP position can be found in the Finance and Contracting report received at

Governing Body. 5. The risk position is as at the end of February 2017.

Commissioning Plan Performance Report 2016/17

Q4

Meeting Date

Operational Executive 19 05 2017 Strategic Clinical Executive 24 05 2017 GP Members Committee 31 05 2017 CCG Governing Body 07 06 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.

• To maintain consistency of reporting for this year, the risks scores reflect the position at the end of February 2017. From March 2017 a revised GB Assurance Framework was in place and this will be reflected in the updated Commissioning Plan Performance Framework for 2017-18.

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 G Complete

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


Q3 G G G G Complete

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


Q4 G G G G Complete

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


Q2 A A G G Complete - 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 G Complete

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 WD 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 (77%)

R 61.6%

R 73.1%

R 67.3%

October 16

A 74.2%

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. January performance was very high at 82%, February has fallen however to 74.2%. NHS Digital has not yet published March figures on which final achievement will be determined.

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

Premises Costs reimbursements QIPP Plan £118,000 G G G G See GB Finance and Contracting report Property Services QIPP Plan £274,000 G 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 G On track - Handover from Kier took place May. 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 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 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

G Expansion of CCC on track, further discussions to take place around the clinician to clinician proposals still ongoing. MH integration expected October 2017. Project group set up and action plan in development

2

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

Com Plan Q4 G G G A Risk strat tool was rolled out at the end of March 17. Some usability issues have been highlighted by practices, which are being worked through with Dr Foster.

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 R Emergency admissions as at February 17 YTD were £442k over plan. Emergency assessments were £645k over plan. RFT only, February provisional data only.

K4 Contain growth in A&E attendances Contractual target

Meet contracted

levels

A A G A&E attendances as at February 17 YTD were £296k under plan. RFT only, February provisional data.

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

R 88.6% 16/17

Full Year

The A&E standard of 95% hasn’t been met during the year, with 2016/17 performance at 88.6%. GP streaming has been implemented within the department, which has had an impact although maintaining staffing levels within the department remains challenging. The CCG continue to work closely with partners through the A&E delivery board to realise improvement. National performance against this standard remains challenged. The national position for England for February 17 was 87.6%.

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

I&A Framework GB Report

tbc WD WD WD WD Data has been published as part of the IAF but no standard or target has been indicated.

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

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

Reducing levels of Activity growth in A&E QIPP Plan £280,000 A A R R See GB Finance and Contracting report

Reduce IHAM NHSE growth assumption in line with local trend analysis

QIPP Plan £226,000 R R R R See GB Finance and Contracting report

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 G On track – discussions are taking place in regards to Leeds University undertaking an independent evaluation in June 2017.

M12 Implement and monitor the Integrated Rapid response Service

Com Plan Q2 G G G G On track - Note that staff are integrated on one site a lead is now in post.

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

Com Plan Q4 G 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%

R TRFT

Position = 54% as at

Feb 17

TRFT position used for Q2 to Q4 (part of) as most up to date available and is reflective of overall CCG position. Standard has not been met throughout the year.

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%

G Feb 17 YTD = 12.1%

Performance has been consistent throughout the year being just over or under plan. As at Feb 17 readmissions were under plan.

3

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

I&A Framework BCF

GB Report Quality

Premium

Feb 17 Target YTD = 2492.6 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

R Feb 17 YTD =

2698.7

Performance has gone off track. This is due to better processes across partners which better identify delayed transfers of care.

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

TCS reporting Threshold = -15%

R April / May =

270

TBC WD WD Some concern as data has not been available since October. CCG are aware and the issue is being addressed through contract performance meetings.

K11 Number of A&E attendances by care home residents

TCS reporting Threshold = 1250

R R WD WD Some concern as data has not been available since October. CCG are aware and the issue is being addressed through contract performance meetings.

K12 GP satisfaction rate for the Integrated Community Nursing Service

TCS reporting Threshold = 80%

G G WD WD Some concern as data has not been available since October. CCG are aware and the issue is being addressed through contract performance meetings.

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 R See GB Finance and Contracting report

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 G Complete

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

Com Plan Q4 TBC G G G Complete

M16 Commission a provider for PTS service Com Plan Q4 G G G Complete


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%

R Mar = 63.9%

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 March, YAS achieved 63.9% 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

4

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 G Complete

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

Com Plan Q2 G R G G Complete – now part of NHSE CQUIN

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

Com Plan Q4 G G G G Complete

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%

G 94.5%

1617 Full Year

% Patients on incomplete non-emergency pathways waiting no more than 18 weeks. Performance remained on track throughout 16/17.

K15 Contain growth in elective activity Contractual Meet contracted

levels

TBC G G G 1.1m below plan for elective activity – RFT only, Feb provisional data.

K16 Achievement of outpatient follow up ratios

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

TBC -3.6% G G RFT are down 6.5% on last year’s activity. We contracted for an 11% reduction in follow-up, therefore the trust are over planned activity. The over-performance continues in Cardiology, Respiratory Medicine, Geriatric Med, Ophthalmology, Dermatology, ENT, T&O, Rheumatology, Paediatrics and Paediatric Ophthalmology. An agreed ratio is in place in the contract above which the CCG will not pay. This is a £1.1m forecast reduction at month 11 flex.

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 G See GB Finance and Contracting report

Reduce IHAM NHSE growth assumption in line with local trend analysis

QIPP Plan £509,000 G R R R See GB Finance and Contracting report

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 G On track - £470K delivered April 2016 - Feb 2017

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 G On track - £370K delivered April 2016 - Feb 2017

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

Meds Management

Priority

Q3 TBC G G G On track - £414K delivered April 2016 - Feb 2017. 29 practices on target to be signed up by 31/03/2017.

5

programme and timescales


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

R 1.244 Jan 17

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

G 7.1 Jan

17

On track

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

G As at October 2016 – increased to 56% of ‘green’ indicators.

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

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 G Complete - 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 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 G Complete - LES has been implemented and referral numbers are increasing.

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 G Complete – 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 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%

G Jan-17 = 100%

Performance has been on track throughout 1617.

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%

A 16/17

Full Year = 50.5%

1617 full year did not meet the quality premium stretch target of 51.3%. It did meet the 50% national standard of 50% however.

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%

G 1617 Year End = 75.9%

Standard has been on track during 1617. Final year end snapshot also met the national target.

6


GB Report Health

Outcomes

75% A 71.8%

R 67.2%

G Nov = 78.0%

R 1617 Full

Year = 70.7%

1617 full year did not meet the national standard of 75%. Recent performance has been more positive however with 5 of the last 6 weeks (to w/c 8th May) achieving the standard.

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 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 WD No data available

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

QIPP Plan £369,000 R R R R This was not 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 A Q4 local and TCP trajectories are off track. Remedial action plan in place to achieve both trajectories by June 2017.

M30 Deliver GP training to support the Annual Health check DES

Com plan Q2 G G G G Complete


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 G On track.

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 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 A Q4 local and TCP trajectories are off track. Remedial action plan in place to achieve both trajectories by June 2017.

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)

7

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 G 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. Local maternity System group in place and 4 Task and Finish Groups established.

M32 Complete a revised strategy and service specification for maternity services

Com Plan

Q3 G G G G Draft service spec has been completed (taking patient feedback into account) and shared with TRFT Clinical Director, Head of Midwifery for initial comment. Comments received from TRFT, final draft to go through contracting process for final sign off.

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 G On track -Parent Carers Forum consultation exercise ongoing. Draft Spec for Childrens Community Services completed and shared internally. Draft service spec for CCN shared with TRFT and comments received. TRFT looking at CCN models around the country, following this the spec will be agreed.


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


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

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


TBC WD WD WD WD Latest available position – Q3 16/17 - 19.9%

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


TBC WD 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 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 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

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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 G Complete - report to next AQA meeting.

M35 Children Q3

G G G G Complete – commences May 2017

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 G Complete

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 G Complete

M38 Children Q3

G G G G On track - new CHC strategic group for childrens with RMBC. Away day arranged for June to address issues.

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

I&A Framework GB report

TBC WD WD WD WD

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

TBC WD WD G G Target is for 250 to be achieved by 2020

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

CHC Key Performance

Indicators

Adults 25-30%

outstanding

G G G A Physical and MH (CCGs CHC team) are below 25% LD (commissioned by RDaSH) is 46%

K38 Children 0%

outstanding

G G G G Complete

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

CHC Key Performance

Indicators

100% Q4

G G G G Meeting the standard but reporting system does not provide evidence. New reporting system will be in place by May 2017.

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 G On track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction. New reporting system will be in place by May 2017.

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 G On track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction. Vast majority are on track, however, new reporting system will be in place by May 2017 which will be able to provide accurate data.

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

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

Review of High Cost Care packages QIPP Plan £100,000 A A A G 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.

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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

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CHC overspend GB Assurance Framework

Overspend due to high costs of individual patients of continuing care

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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 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 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 WD 2015/16 Q2 - 2016/17 Q1 – 46.1%

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



Framework

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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 Risks Risk Description Risk Score

Collaborative commissioning GB Assurance Framework

Effective collaborative commissioning of specialised services

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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 G On track M43 Develop and deliver the local place

based plan STP Q3 G G G G On track

M44 Oversee the implementation of the BCF with RMBC

Com Plan / BCF Plan

Q4 G 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 G Complete.

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


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

Com Plan Q1-Q4 G G G G Complete

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

Com Plan Q1- Q4 G G G G Complete


- None identified QIPP

None identified Risks Risk Description Risk Score

None identified GB Assurance Framework

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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 G Now part of STP cancer alliance

M50 Implementation of NICE Cancer Guidelines

Com Plan STP


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


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

Com Plan STP



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


Premium

>60% or 4 % point

improvement

R 2014 - 36.5%

R R R Off track but inconclusive as the latest reporting period was 2014 – Update as at May 17 – 2014 still latest published data

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%

G Mar = 96.5%

On track all year

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%

R Mar = 78.2%

Standard was met in February with performance at 85.7%, this has dipped however in March and February was the only month in the previous 7 where the standard was achieved

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

I&A Framework Com Plan GB Report

Q1 G G G WD 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 WD 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

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