MEETING: Governing Body Item Number: 9.1 DATE: 28 April ......3. WORKING WELL (Theresa Grant, CE, Trafford Council) Theresa Grant is the Lead CE for Greater Manchester employment and

MEETING: Governing Body Item Number: 9.1 DATE: 28 April 2015

REPORT TITLE:

GM Association of CCGS: Association Governing Group Summary of Meeting held on the 7 April 2015

CORPORATE OBJECTIVE ADDRESSED:

Supporting our population to stay healthy and live longer in all areas of the Borough

REPORT AUTHOR:

Hamish Stedman, Chair

PRESENTED BY:

Dr Tim Dalton

RECOMMENDATIONS/DECISION REQUIRED:

To be received for information.

EXECUTIVE SUMMARY The Governing Body is asked to receive the summary of the meeting of the GM Association of CCGS (AGG) held on the 7 April 2015 for information.

FURTHER ACTION REQUIRED:

None

EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a

result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.

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GM ASSOCIATION OF CCGs: Association Governing Group (AGG) SUMMARY Tuesday, 7 April 2015

1.30-5.30pm The Boardroom, 7th Floor, Regent House, Stockport

Attendance: Steve Allinson NHS Tameside &Glossop CCG Trish Anderson NHS Wigan Borough CCG Wirin Bhatiani NHS Bolton CCG Andrew Bibby NHS England – Specialised Commissioning Alan Campbell NHS Salford CCG Tim Dalton NHS Wigan Borough CCG Denis Gizzi NHS Oldham CCG Nigel Guest NHS Trafford CCG Martin Whiting NHS North Manchester CCG Alan Higgins - for W Meredith NHS Oldham CCG Gina Lawrence NHS Trafford CCG Lesley Mort NHS Heywood, Middleton & Rochdale CCG Gaynor Mullins NHS Stockport CCG Joanne Newton-Acting CO NHS Central Manchester CCG Stuart North NHS Bury CCG Kiran Patel NHS Bury CCG Hamish Stedman (Chair) NHS Salford CCG Bill Tamkin NHS South Manchester CCG Apologies: Ivan Bennet – for M Eeckelaers NHS Central Manchester CCG Alan Dow NHS Tameside & Glossop CCG Chris Duffy NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers NHS Central Manchester CCG Ranjit Gill NHS Stockport CCG Caroline Kurzeja NHS South Manchester CCG

Su Long NHS Bolton CCG Wendy Meredith Bolton Council – Public Health Ian Wilkinson NHS Oldham CCG Simon Wootton NHS North Manchester CCG In Attendance: Alison Bali (minutes) GM Association of CCGs Rob Bellingham NHSE - GM & Lancs Sub Region Team Sir Howard Bernstein Manchester City Council (Devolution session) Andrea Dayson GM Association of CCGs Teresa Grant Trafford Council (Working Well) Warren Heppolette Health & Social Care Reform Alex Heritage Service Transformation Karen Proctor NHS Salford CCG (HOCs Chair) Melissa Surgey GM Association of CCGs Annette Walker NHS Bolton CCG (CFO’s Chair) Leila Williams Service Transformation Ian Williamson GM Devolution

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1.WELCOME & APOLOGIES FOR ABSENCE

The Chair welcomed members to the meeting.

2. MINUTES OF THE LAST MEETING (3.3.15)

The minutes of the last meeting were accepted as an accurate record.

3. WORKING WELL (Theresa Grant, CE, Trafford Council)

Theresa Grant is the Lead CE for Greater Manchester employment and skills reform: Working Well. This programme has been operating since March 2014, supporting GM residents with health barriers to employment. TG presented a brief update and noted the links to GM devolution in terms of early priorities.

Working Well is built around a keyworker model and access to a range of integrated local services

The programme takes a person cantered approach, developing bespoke packages of support

Coordinated, sequenced support focused on the specific needs of each participant rather than multiple competing interventions

Health colleagues are engaged in supporting each area GM, ensuring clients can access the services they need

Between March 2014 – Feb 2015, 2172 people joined Working Well

Working together, local teams are supporting participants to access the right support to tackle the wide range of barriers to work they face

We are on track to see 1000 people enter work (with a goal of seeing at least 750 people sustain work for up to a year

Summary

The staged expansion of Working Well from summer 2015. By the time it is fully rolled out, the programme will cover 50,000 individuals to include a pilot supporting older workers with long-term health conditions back to work.

Government designing the Work Programme in a way that allows GM to be a joint commissioner.

Devolution of the AGE Grant to GM from April 2015.

Though not included in the GM Agreement, ensuring alignment of Skills Capital is fundamental in to the reshaping of the GM FE sector

The support of GM partners, including CCGs will be fundamental to ensuring we are able to deliver on this ambition

Examples provide a powerful message to support the programme

AGREED: Support to continuance/roll out of the Working Well programme.

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4. HEALTHIER TOGETHER GATEWAY REVIEW RECOMMENDATIONS

4.1 Implementation Presentation Principles for Implementation:-

Led at a single service level wherever possible – formation of single teams of clinicians for general surgery, A&E, critical care and anaesthetics

Some elements will only need to be ‘done once’ for GM

Oversight and management at a GM level and there will be an on-going requirement for programme assurance, programme management, clinical leadership and decision making.

Considerations for:-

Implementation Approach

Resourcing Implementation

Governance Conclusions & Recommendation

To consider the content of the report

To identify any enhancements or additions to the content of the report

Confirm support to commissioning the Service Transformation Directorate

Request that CCGs and sectors decide how best to resource each component which will be variable and report progress to May AGG meeting

All agreed to support the budget required to provide oversight and assurance/GM delivery for the for hospital element of HT implementation. 4.2 GM Service Transformation Team The paper presented by IW addresses the actions previously agreed at AGG namely that the future of the Service Transformation team be clarified

. A number of principle aims have been identified to help guide the option appraisal process:

The need to secure long term sustainability of staff members and retain their skills and experience within the NHS;

Value for Money should be secured at every stage to ensure maximum use of public money;

Full alignment of legal and hosted service arrangements should be sought to avoid any conflicts of employment and management responsibilities;

Mitigating and minimising the financial liability to the 12 GM CCGs;

Increased independence of the Directorate - to reduce the reliance on GM CCGs;

Open, transparent and robust processes should be pursued at every stage of the process. In preparation for a decision about Healthier Together implementation and the need to secure greater security of the Directorate an option appraisal has been conducted in collaboration with the SRO, the Service Transformation Senior Team and Salford Royal NHS Foundation Trust. Option 3 has been proposed as the most appropriate transferring financial management and oversight from Central CCG to SRFT creating a fully hosted service. Consensus for Option 3 agreed with the understanding that the full option appraisal is shared. Also there needs to be consideration in the agreed model of how GM is prioritised against any other competing demands for support.

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ACTION:

HT Implementation support needed to mitigate the risk of challenge

HT Implementation Planning Assumptions (budget) to be presented to the next meeting

Progress of Service Transformation team – planning assumptions, next phase, business model for further development and discussion update to be given at the next meeting

AGREED:

To support the HT Implementation (in-hospital) budget from April 2016.

To the GM Service Transformation team to be hosted by SRFT – to share full options appraisal

5. GM DEVOLUTION

Opening Comments by IW

Members asked to note the following:- o GM leadership community (CCGs, LA, Providers) event 22 April o GM wider leadership team (CCGs, LA executive leadership) meeting 24 April o Standing conference of CCGs/LA/elected leaders and providers to be held bi-

monthly. o Communications lead to be appointed o 3 secondment posts advertised – Assistant CO, CFO, Strategic Director (Deliver

Comments by Sir Howard Bernstein

Devolution is up and running and are currently creating a team for delivery.

Engaging with national stakeholders and understanding the key components of an overall financial and sustainability plan – the key inter relationships between the plan (the ‘ask’ as part of the CSR) with the internal NHSE process to justify the “ask”.

Essential to have a platform to scope out locality plans to ensure these correspond with the process at a strategic level.

Programme board to meet monthly leading to the Autumn when there is a desire to make bold statements to confirm what in practice devolution will mean for the population of GM.

Early priorities are described within the paper and there has been a lot of support to include dementia and to scale up the pilot undertaken by Salford.

The wider leadership team at executive level is essential in order to deliver cohesion where locality plans are developed.

Also important to have a wider stakeholder group to ensure there is an inclusive approach to devolution policy and practice. It is important to have a democratic oversight group to ensure contribution and overall approval of direction of travel.

WH paper provided an update of developments to date since the agreement of the Memorandum of Understanding (MOU) between Greater Manchester (GM) and NHS England. The update describes:

The inaugural meeting of the Programme Board

The development of a dedicated team to support the work arising from the Agreement

The development of the Work Programme to support devolution

The Early Implementation Priorities to start to capture the benefits of devolution

The approach to communications and engagement

The approach to Organisational & Leadership Development

The development of supplementary agreements and joint working arrangements with other National Arms-Length Bodies

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The AGG is asked to:

1 Consider the update report; 2 Confirm a fourth nomination to the Programme Board; 3 Support the proposed principles underpinning the Resource plan (recognising that

the indicative figures are subject to further discussion & refinement). 4 Confirm Support for the approach taken to prioritising the Early Implementation

Priorities; and 5 Consider the proposed short term communications and engagement priorities.

ACTION:

(Recommendation 2) Confirmation of 4th nomination to the Devolution Programme Board to be progressed outside of the meeting

(Recommendation 3) The proposed principles underpinning the resource plan are to be discussed by the CFOs

AGREED/NOTED:

(Recommendation 1) AGG noted the update report and the inaugural meeting of the Devolution Programme Board, appointment of Ian Williamson as Chief Officer and his intention to establish dedicated team

(Recommendation 4) confirmed support for the approach taken to prioritising the Early Implementation Priorities and to include Dementia

(Recommendation 5) AGG noted the proposed short term communications and engagement priorities including the meetings to be held on 22 and 24 April.

6. PRIMARY CARE CO-COMISSIONING

GM presented a paper that sets out proposed next steps for primary care co-commissioning, issues in relation to delivery and Devolution:-

Description of existing governance structure

Proposal to establish Co-Commissioning Management Board

Number of areas identified for discussion:- o Future models of care – are we clear what we need to address to achieve that o Short/medium term priorities for action o What issues need to be addressed o Where it makes sense to work together at GM level to collectively take forward primary

care and how that fits locally o What a primary care development/commissioning system needs to look like in the

context of devolution

Primary care now need to be described as part of devolution process and members noted the continuance of existing primary care leads, CFOs and governance groups. Commissioning systems to be developed over the next few months which will deliver transparent decision making with a Devolution provider forum to include LMCs. Need to approach the new system in a very radical way to realise ambition of genuine integrated care and innovative thinking and begin to explore the system requirements at locality/GM level.

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Recommendations:- o To agree the ToR for the Co-Commissioning Management Board o To discuss and agree the process for taking this forward in the context of devolution

AGREED:

GM/RB to undertake further work to develop proposals for a system wide commissioning framework in the context of devolution

Terms of Reference for the Primary Care Co-Commissioning Management Board

To include HoC (whose portfolio includes primary care commissioning) representative to aid communication

7.1 Procurement– PTS

Noted proposals to be discussed by UCCL group and for discussion at the next AGG meeting.

ACTION:

PTS procurement for discussion at the next AGG meeting

7.2 Procurement – Military Veterans

Procurement process now complete and preferred bidders/successful candidates to be notified by the end of this week.

Thanks extended to Bolton and Trafford for their support.

ACTION:

SN to notify AGG of the outcome of the Military Veterans Procurement

8. AOB 8.1 LATE PAPERS

Supported in principle that late papers should be excluded from the agenda unless there are exceptional circumstances.

AGREED:

Late papers to be excluded from the agenda unless there are exceptional circumstances

8. AOB 8.2 Maternal/Neonatal Deaths at Pennine Acute

Trusts currently collating data but would be useful across all CCGs

It is unclear the impact of pre- and post- MiB and potential impact on the 1:28 midwife to birth ratio.

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8. AOB 8.3 Quality

Discussion on the quality in the context of devolution:- o System for scrutinising provider quality/how it is reported/shared/accountability o How will this be policed across GM and what is the connection to the AGG o Noted that the QSG has a standardised approach/scorecards across GM o Queried if this should form part of the AGG work programme. o Queried the inclusion of patient experience o It may be possible to include this in the AHSN utilisation management o Noted that only 2 HoC have quality within their portfolios o Potentially could be led by a Nursing Executive on behalf of AGG. o Agreed to discuss issue at a COO meeting

ACTION:

Quality agenda to be discussed at a future COO meeting.

Connecting the QSG reporting matrix to AGG for information.

9. ITEMS FOR INFORMATION ONLY

Noted.

NEXT MEETING

DATE: Tuesday, 5 May 2015

TIME: 08.30am-12.30pm

VENUE: The Director’s Lounge, Leigh Sports Village Stadium, Sale Way, Leigh WN7 4JYk

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MEETING: WBCCG Governing Body Item Number: 9.2 DATE: Tuesday 28th April 2015

REPORT TITLE:

Month 12 Corporate Report

CORPORATE OBJECTIVE ADDRESSED:

All

REPORT AUTHOR:

Trish Anderson / Mike Tate / Julie Southworth

PRESENTED BY:

Mike Tate

RECOMMENDATIONS/DECISION REQUIRED:

To note the contents of the paper.

EXECUTIVE SUMMARY The report is designed to give the Governing Body a regular monthly update on how the CCG is performing against its local priorities. Furthermore, the report details CCG performance against the Everyone Counts Planning Guidance Indicators and the CCG Outcomes Indicator Set.

FURTHER ACTION REQUIRED:

EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a

result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.

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Page 112

Chief Officer

Trish Anderson

Corporate

Report

March 2015

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Page Responsibility Director Associate Director Committee

3 CCG Corporate Dashboard

4 Chief Officer Overview Trish Anderson

5 Programmes Trish Anderson John Marshall Corporate Governance

6 Adult & Children Safeguarding Julie Southworth Sally Forshaw Clinical Governance

7 Quality Julie Southworth Sally Forshaw Clinical Governance

8 Prescribing & Continuing Healthcare Julie Southworth Linda Scott Clinical Governance

9 Workforce Julie Southworth Corporate Governance

10 Finance Mike Tate Craig Hall Finance & Performance

11 QIPP Mike Tate Chris Melling Finance & Performance

12 Commissioned Services Mike Tate Kim Godsman Finance & Performance

14 - 55 Performance Mike Tate Chris Melling Finance & Performance

Wigan Borough CCG: Corporate Report Month 12: 2014/15

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Green Amber Red None Green Amber Red None

0 2 2 6 13 1 2 1

Green Amber Red None Green Amber Red None

3 8 0 0 0 1 1 3

Executive Summary

Outcomes Ambitions: Headline Indicators NHS Constitution: Headline Indicators

Acute Activity: Headline Indicators Better Care: Headline Indicators

Many of the indicators used to measure Outcomes Ambitions are only published on an annual basis; often with a time-lag. As such, it is not yet possible to assess performance against six of the ten indicators; these are shown as white (None). Of the remaining four indicators, two are rated Red and 2 are rated Amber. The indicators rated Red are IAPT Access Rate and Avoidable Emergency Admissions Composite Measure. The Q2 IAPT rate of 2.31% is below the target of 3.75%. NHS England are reviewing IAPT closely and new standards will be introduced in 2015/16. The indicators rated as Amber are the Friends & Family (F&F) A&E score and Inpatient score. Both of which are below target at Q3. However, February F&F A&E score of 73.19 is above target.

Indicator Summary Virtually all of the NHS Constitution indicators are performing better than standard. The exceptions are the three ambulance indicators; 8 Minute Ambulance Response time for Red 1 incidents, 8 Minute

Ambulance Response time for Red 2 incidents and the 19 minute ambulance response time. Two of the indicators are rated as Red they are the 8 Minute Ambulance Response times for Red 1 and Red 2 incidents, both remain below the standard of 75%.The February performance for Red1 calls is 67.54%. Performance for Red2 calls is slightly lower with a February result of 66.22%. The February19 Minute Ambulance Response times performance for all Red calls is below the standard of 95% at 91.38% and is rated Amber.

Indicator Summary

The CCG has developed stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts. Of the eleven activity indicators none have achieved year-to-date plan at February. Three of the indicators have achieved plan in the latest quarter: Ordinary Admissions, Other Referrals and A&E Attendances at WWL. Eight of the indicators are rated as Amber (within 5% of plan): Daycase Admissions, Total Admissions, Non-Elective Admissions, First Outpatient Attendances Following a GP Referral, All First Outpatient Attendances, Subsequent Outpatient Attendances, GP Refs and Total Refs.

Indicator Summary The headline metrics used to measure performance against of the Better Care Fund initiative are comprised of both health and social care indicators. With the exception of the local pick metric (Readmissions) all indicators measure performance at local authority (LA) level. It is not yet possible to assess performance against the Care Home Admissions, Reablement and Avoidable Admissions indicators. The indicator rated Red ; Delayed Transfer Days was above plan in February with the year-to-date figure also remaining above plan. The number of Readmissions is above plan in January.The year- to-date position also remains above plan and is rated Amber (within 5% of plan).

Indicator Summary

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Chief Officer Overview

1. Current Performance 1.1 This dashboard is designed to give the Governing Body a regular monthly update on how well the CCG is performing against the key areas outlined in the NHS England Everyone Counts planning guidance and Better Care Fund guidance. Each of the planning areas is underpinned by a basket of key performance indicators. A summary of performance across these

four areas is given below. 1.2 Outcomes Ambitions – Many of the indicators used to measure Outcomes Ambitions are only published on an annual basis; often with a time-lag. As such, it is not yet possible to assess performance against six of the ten indicators. In summary, therefore, two of the indicators are currently rated RED, two are AMBER and the other six are unrated. The indicators rated Red are IAPT Access Rate and Avoidable Emergency Admissions Composite Measure. The Q2 IAPT rate of 2.31% is below the target of 3.75%. NHS England are reviewing IAPT closely and new standards will be introduced in 2015/16. The indicators rated as Amber are the Friends & Family (F&F) A&E score and Inpatient score. Both of which are below target at Q3. However, February F&F A&E score of 73.19 is above target. 1.3 NHS Constitution – In summary, thirteen of the indicators are currently rated GREEN, two are RED, one is AMBER and the other one unrated. The three indicators below standard are the three ambulance indicators; 8 Minute Ambulance Response time for Red 1 incidents, 8 Minute Ambulance Response time for Red 2 incidents and the 19 minute ambulance response time. The 8 Minute Ambulance Response times for Red 1 and Red 2 incidents, both remain below the standard of 75%. The February performance for Red1 calls is 67.54%. Performance for Red2 calls is slightly lower with a February result of 66.22%. The February 19 Minute Ambulance Response times performance for all Red calls is below the standard of 95% at 91.38%. 1.4 Acute Activity – The CCG has developed stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts. Three of the indicators are currently rated GREEN, eight are rated AMBER and none are rated RED. The three indicators that have achieved plan and rated GREEN are Ordinary Admissions, Other Referrals and A&E Attendances at WWL. The eight indicators rated as Amber (within 5% of plan) are Daycase Admissions, Total Admissions, Non-Elective Admissions, First Outpatient Attendances Following a GP Referral, All First Outpatient Attendances, Subsequent Outpatient Attendances, GP Refs and Total Refs. 1.5 Better Care – The headline metrics used to measure performance against of the Better Care Fund initiative are comprised of both health and social care indicators. With the exception of the local pick metric (Readmissions) all indicators measure performance at local authority (LA) level. In summary, one of the indicators is currently rated RED, one is rated as Amber and the other three are unrated.The indicator rated Red, Delayed Transfer Days was above plan in February with the year-to-date figure also remaining above plan.The number of Readmissions is above plan in January with the year- to-date position also remaining above plan. This indicator is rated Amber (within 5% of plan). 2. Emerging Challenges 2.1 On going contract negotiations with WWL FT and the consequences of potential arbitration 2.2 The impact of the election next month 2.3 Continuing pressure on the acute sector which may result in significant contract over trading in 2015/16 2.4 Implementing QIPP projects to meet the in year QIPP gap of £7.1m and developing the programme for 2016/17 2.5 Resourcing and managing the co-commissioning of Primary Care with NHS England 2.6 Mitigationg any potential financial shortfall in delivering co - commissioning 2.7 Demographic pressures on continuing Health care 2.8 Any future delegation of Specialised Commissioning 2.9 Implementing the five year forward view 210 Community care providers developing enough capacity to recieve patients and services deflected from Acute Hospita care 2.11 The emerging GM devolution agenda 2.12 Finding alternatives for the CSU functions, particularly information technology Trish Anderson Chief Officer

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May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

1.Progression Of All Programmes & Projects To Agreed Timescale

For 2015/16amber amber amber amber amber green green Green green green green

2.All Programmes & Projects To Be Aligned To Corporate

Objectives and NHS Outcomes For 2015/16amber amber amber amber green green green Green green green green

3.Active Programme & Projects Capable Of Achieving Savings

Objectives For 2015/16amber amber amber amber amber amber amber amber amber amber amber

4. Overall Progression Against Five Year Plan amber amber amber amber amber green green Green green green green

14 - 40

Programmes John Marshall / Trish Anderson

Priority Areas

1. Progression Of All Programmes & Projects To Agreed Timescale For 2015/16 The tender proposals relating to the first tranche of the Commissioning Intentions have been delayed by 6 weeks due to external challenge against the specification. The protracted delay is to ensure that the challenge is handled in a fair, open and transparent way for all bidders. The evaluation process has absorbed the delay and the contract award remains timetabled for 3 Aug 2015. The second tranche of work in CI15/16 continues as described in the Outpatients concept paper, with Work-Up phase due to be completed by Sep 2015, in order to support CI16/17. The 'Community Nursing & Therapy Services Project' is being worked up by the Provider Partnership, with some area of implementation well underway. 2. All Programmes & Projects To Be Aligned To Corporate Objectives and NHS Outcomes For 2015/16 The strategic portfolio is fully aligned with the Corporate Objectives and NHS Outcomes. Within the reviewed CCG project Governance, the Senior Leadership Team (SLT) will provide management and assurance that performance in this area will remain GREEN. 3. Active Programme & Projects Capable Of Achieving Savings Objectives For 2015/16 The profiling of the CCG saving objectives remains under review. All of the programmes and projects have a risk of variance against plan that reduces as the activity approaches procurement/implementation. After the first tranche of procurements has cycled through to commissioning this variance can be more accurately assessed. Unless projects are associated with a known contract reduction, the prevailing 'project risks' will affect this performance area which is expected to remain AMBER (Awaiting a final endorsement of the revised QIPP list). 4. Overall Progression Against Five Year Plan The CCG Five Year plan continues successfully: a. CI15/16 Phase one approaching evaluation stage (plan remains achievable despite major delays) b. CI15/16 Phase two concept approved, design underway (both 'Outpatients & Diag Project' and 'Community Nursing & Therapies Project') c. CI16/17 Concept design underway, resources in allocation Progression remains GREEN. The spare capacity of the CI15/16 procurement process is now exhausted, any further delays will impact contract award date.

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1.Successful Delivery Of All Actions Outlined In The Safeguarding

Policygreen green green green green green green green green

2.Meet Statutory Responsibilities Around Safeguarding Adults &

Childrenamber green green green green green Green Amber Amber

Adults & Children

3. Implementation Of Strategic Programme amber amber amber amber amber amber amber amber Amber

4.Training Frontline Staff With The Skills & Knowledge On How To

Act On Concernsgreen green green green green green green Green green

14 - 40

Adult & Children Safeguarding Sally Forshaw/Julie Southworth

Priority Areas

1. Successful Delivery Of All Actions Outlined In The Safeguarding Policy The designated nurse for children is currently reviewing progress against the Safeguarding Policy and will report through the Clinical Governance Committee. 2. Meet Statutory Responsibilities Around Safeguarding Adults & Children Training staff to recognise and report safeguarding issues. Accountability for safeguarding, properly reflected in the CCG governance arrangements. Quarterly reports are submitted to the Clinical Governance Committee. A Safeguarding Children 's Health Collaborative has been established and TOR approved. Clear and appropriate arrangements to co-operate with local authorities in the operation of LSCBs, SABs and health and wellbeing boards with effective arrangements for information sharing . The role of the CCG Designated doctors is currently under review . The Designated nurse for safeguarding children is seconded to the CCG from Bridgewater Community Foundation Trust. A Designated paediatrician for unexpected deaths in childhood is in post. The CCG has recently recruited to the post of designated adult safeguarding manager (DASM) who will join the organisation on the 27.4.15. All relevant policies and training are in place. 3. Implementation Of Strategic Programme As per the 5 year commissioning plan, safeguarding is intergral to all the CCG's priorities and the safeguarding team continue to further develop and implement a strategic programme. 4. Training Frontline Staff With The Skills & Knowledge On How To Act On Concerns All members of the CCG have received level 1 Safeguarding Training, leads are working to establish a compliance reporting system. A training programme plan for Prevent WRAP 3 is currently being rolled out across the CCG to achieve a minimum 95% compliance by 31.3.15. Provider training compliance assurance is obtained via QSSG. MCA & DOLs training for Primary Care has been commissioned by the CCG and will be delivered through 2015/16 Quarter 2.

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1. Quality & Safety Delivery Plan 2014/15 - Forecast Against Plan green green green Green Green Green Green Green

2. Treating & Caring For People In A Safe Environment amber Amber Amber Amber Amber amber amber amber

3. Positive Experience of Care green Green Green Green Green Green Green Green

4. NHS Provider CQUIN Schemes 2014/15 amber Amber Green Amber Amber amber Green Green

14 - 40

Quality Sally Forshaw / Julie Southworth

Priority Areas

1. Quality & Safety Delivery Plan 2014/15 - Forecast Against Plan The CCG Quality and Safety Delivery Plan 2014/2015 sets out the key priority areas and identifies specific work streams. The plan is reviewed and modified if required to ensure that the modes of delivery remain sustainable and centred on patients’ needs whilst focused on providing assurances on the quality safety and effectiveness. Forecast against the plan has remained on target during the year and on review the key objectives have been met at 31 March 2015. The Quality Team is currently finalising the 2015/16 plan to reflect on current national guidance to realign the key quality objectives going forward . 2. Treating & Caring For People In A Safe Environment The CCG holds the responsibility for ensuring that patients are cared for in a safe environment and that the treatment they receive is safe and clinically effective. Outlined below are the vehicles that the CCG utilise as a means of assurance : - NHS Provider Assurance Frameworks (Acute/Community/Mental Health). - Quality Safety and Safeguarding Group (QSSG) for each NHS Provider (Acute/Community/Mental Health). - Serious Incident and Never Events (SINE) Dashboard - Concern in relation to BCFT SI process is to be escalated to the next Executive to Executive meeting. - Health Care Associated Infections (HCAI) Dashboard - Following Miaa review of Infection Control Systems WBCCG has received significant assurance. The CCG will continue to monitor the impact of current system pressures on patient safety/quality and this will be reported via the Clinical Governance Committee and GM QSG. This information is reviewed by the CCG Clinical Governance Committee (ClGC). 3. Positive Experience of Care The CCG will listen to and act on patient and staff feedback, ensuring the patient and carer voice is heard and directly influences improvements in local NHS services. Outlined below are some of the key mechanisms that the CCG currently utilises to capture patient and staff experience. - Friends and Family Test (FFT): Further roll out to Community and Mental Health Trusts as of 1.1.15 and the Acute Trust Out Patient facilities is to be commenced by 1.4.15 . - Commissioner Visits: Capture patient; carer and staff experiences of care. These are reported through the Provider QSSGs and the ClGC. - Service User Experience of Care (SUE) - Ulysses: Most practices are achieving the SCEOS target. Reports have been received by ClGC. Other mechanisms for the collation of Patient Experience are Patient Opinion and other Patient Engagement activities. Patient Opinion provided the CCG with a Q3 report; however there was insufficient data to enable any themes and trends to be identified. The Q4 data has been received and is currently being analysed. Patient Opinion reports will continue to be reviewed on a quarterly basis to identify areas of concern and good practice. Patient and Staff feedback on experiences of care will continue to be discussed with Providers via the QSSGs and reported through the chairpersons report to ClGC. 4. NHS Provider CQUIN Schemes 2014/15 The framework aims to embed quality within commissioner- provider discussions and to create a culture of continuous quality improvement, with stretching goals agreed in contracts on an annual basis. The NHS Provider CQUIN schemes are monitored by the Provider QSSG meetings. Quarter 3 evidence has been received. Following a review the Acute, Community and Mental Health Trusts have met their agreed targets. Q4 evidence is currently being collated and analysed. CQUIN is included with the QSSG reports received by the ClGC. The RAG status in Green based on the Q3 position the final Q4 position will not be reported on until the end of April 2015.

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1. Delivery Of Medicines Management QIPP To Forecast Milestones amber amber amber amber amber amber amber amber amber amber amberamber AMBER amber

2.Delivery Of Medicines Management Budget To Forecast

Milestonesgreen green green green amber amber amber amber amber amber amber

amber amber AMBER

3. Delivery Of Continuing Healthcare Budget To Forecast Milestones green green amber amber amber amber amber amber amber amber amber

4.Continuing Healthcare Retrospective Claims To Be Completed By

April 2016amber amber amber amber amber amber green green GREEN green green

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Prescribing/Continuing Healthcare Linda Scott / Julie Southworth

Priority Areas

1. Delivery Of Medicines Management QIPP To Forecast Milestones Savings for work completed to end March 2015: £2,085,980 (83 % of forecast target). In January ,the MMT was refocused on specific target areas to achieve greater savings. Achievement increased from 78 % to 83%. Of the 13 QIPP areas under review: 3 areas were over the pre-set target, 8 were moving close to achieving the pre-set targets and 2 were not close to achieving pre-set target. 2. Delivery of Medicines Management Budget to Forecast Milestones In month 12, the forecast overspend on the total Medicines Management budget is £1.5 million which is the NHS BSA forecast based upon February 2015 actual expenditure. During May to July, all Practices attended a peer review meeting with the Senior Medicines Management Team and their appropriate Locality GP Medicines Management Clinical Champion. This supports the delivery of QIPP and achievement of the prescribing budget. 3. Delivery Of Continuing Healthcare Budget To Forecast Milestones There is a forecast over spend on this budget of £0.99m. There is a movement in month of £180k to allow for provision for additional restitution commitments. At 31/03/15 the CHC has 619 patients in receipt of Continuing Healthcare and 343 patients in receipt of Funded Nursing Care. This is an increase of 20 CHC patients in month and a decrease of 7 FNC patients in month. 4. Continuing Healthcare Retrospective Claims To Be Completed By April 2016 The CCG initially received 365 requests for assessment of eligibility. 210 cases are to be fully assessed, 2 are still awaiting information to determine if they should be assessed: 153 are not proceeding. The CCG has recruited fixed term staff to support the CHC management team to assess and determine eligibility for these claims. To 31/03/15: 52 cases have been assessed; of which 20 are fully eligible, 19 part eligible and 13 not eligible. The CHC is working to a plan to deliver completion of this work by March 2016 which will be one year ahead of the deadline set by NHS England.

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1. Organisational Profile green green green green green green green green green green green

2. Organisational Movement green green green green green green green green green green greenamber

3. Organisational Behaviour green amber amber green green green amber green green green green

4. Organisational Development green green green green green green green green green green green

14 - 40

Workforce (Human Resources) Julie Southworth

Priority Areas

1. Organisational Profile Total headcount, staff in post (FTE), composition of workforce (e.g. substantive, fixed term, bank), equality and diversity – age, gender, disability: Overall, the organisations profile is green. The CCG's headcount and FTS compostion is145 and 127.83 respectively and is within budget. There is a decrease of 1 to the overall headcount (from 146) and a decrease to the FTE (from 129. 03 ). This headcount includes substantive posts, fixed term posts, governing body members and clinical leads. There is no significant change to the age profile, gender split or ethnic origin of CCG staff. * please note that the figures for February have been amended to reflect a change in leave date from February to March). 2. Organisational Movement Total number of leavers, total number of new starters, turnover rate (average), active vacancy rate: Overall the organisations performance in this area remains green. During March there were two substantive staff leavers and one fixed term staff starter. Five vacancies were advertised externally during March. 3. Organisational Behaviour Sickness absence rates and costs, agency staff costs: Overall, CCG performance in this area remains green. The management information for February has identified an increase in sickness absence to 3.32% from 2.54% in January. The cost of sickness absence increased from £10,833 to £16,113 between January and February and reflects a seasonal absence pattern. Agency costs remain within budget. 4. Organisational Development Staff satisfaction/engagement, number of grievances, number of disciplinaries, learning and development including mandatory training compliance, PDR completion rate: Performance remains at green. There were no disciplinaries or grievances during March. Mandatory Fire Awareness training has been delivered and an additional session has been arranged for the few who could not attend. PDR interim reviews were completed and a skill gap analysis is being undertaken.

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1. Underlying Recurrent Surplus green green green green green green green green green green green

2. Surplus: Year To Date Performance green green green green green green green green green green green

3. Surplus: Full Year Forecast green green green green green green green green green green green

4. Running Costs green green green green green green green green green green green

14 - 40

Finance Craig Hall / Mike Tate

Priority Areas

1. Underlying Recurrent Surplus - The CCG have achieved the underlying recurrent surplus. 2. Surplus: Year To Date Performance - The CCG achieved the required in year surplus of £5.4m 3. Surplus: Full Year Forecast - The CCG achieved the required in year surplus of £5.4m 4. Running Costs - The CCG running costs were within the £25 per head allocation. A final underspend of £0.46m was transferred to use within programme budgets. Key messages 2014/15 There were no material movements across any areas of spend in month 12. This has allowed the CCG to close down its financial position within the national deadlines and to meet its required surplus. As reported above, the CCG has delivered all financial targets in 2014/15. In addition, the CCG is on target to meet NHS England deadline of 23rd April for submission of the draft annual accounts.

Page 122


1. QIPP: Full Year Forecast Against Plan amber amber amber amber amber amber amber amber amber amber amber

2. QIPP: Delivery Against 2015/16 Plan amber amber amber amber amber amber amber amber amber amber amber

3. Schemes To Support The Five Year Plan Have Been Identified amber amber amber amber amber amber amber amber amber amber amber

4.Plans To Switch Activity To Community Providers From Acute

Are On Targetamber amber amber amber amber amber amber amber amber amber amber

14 - 40

QIPP Chris Melling / Mike Tate

Priority Areas

1. QIPP: Full Year Forecast Against Plan QIPP savings and financial mitigations so far this year are £20,000,000. This equates to 100% of the original full year target . This is due to the agreement and settlement of the acute contract with WWL. As previously reported there are a number of agreed QIPP schemes that have not performed to the expected level required to meet the full year target of £20m and this has resulted in the use of £5,808k of financial mitigation to underpin these schemes. The reason this indicator is classed as amber is due to the in year financial mitigation. 2. QIPP: Delivery Against 2015/16 Plan The plan for 2015/2016 QIPP schemes is being compiled and will be reviewed regularly. The current commissioning intentions are being agreed and will make up the baseline for the QIPP programme for 15/16. The amber indicator is due to the fact the plan has £7.1m of unidentified QIPP schemes. 3. Schemes To Support The Five Year Plan Have Been Identified Within the 5 year Commissioning Plan a number of schemes have been identified and further work is being undertaken to model these in line with the schemes being delivered in 15/16 and beyond. 4. Plans To Switch Activity To Community Providers From Acute Work is currently being undertaken to move activity from an Acute setting to a Community setting. A robust plan needs to be established to map the potential changes in activity to ensure the CCG is on track with the five year strategy.

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1. Meeting Urgent Care Targets red red red green green green red red

2. Ensuring Provider Performance Meets Contracts Objectives amber amber amber amber amber amber amber amber amber amber amber

3. Delivery Of Commissioned Services QIPP amber green amber amber amber amber amber amber amber amber amber

4. Delivery Against Commissioning Plan amber green amber amber amber amber amber amber amber amber amber

14 - 40

Commissioned Services Kim Godsman / Mike Tate

Priority Areas

1. Meeting Urgent Care Targets

- Wrightington, Wigan and Leigh NHS Foundation Trust (WWL FT) met the A & E performance target of 95% of patients admitted, treated or transferred within 4 hours of arrival achieving 96.6% in March and 94.62% year to date meaning the Trust have not achieved the target for the year.

CCG commissioning leads have provided system review, challenge, and hands on support via activities such as grand ward rounds and daily teleconferences however patient flow relating to the Trust discharging patients has been the underlying cause and remains an issue.

2. Ensuring Provider Performance Meets Contracts Objectives

- WWL FT contract - non-elective activity is currently above the contract plan, elective activity is increasing through increased referrals, particularly in Trauma & Orthopaedics.

- The CCG has made challenges to Bridgewater Community Healthcare Foundation Trust (BCHFT) and the 5 Boroughs Partnership NHS Foundation Trust (5BP) where performance targets have not been achieved, and reviews remedial action plans and the performance against the plans at contract meetings.

- The CCG is in the final stage of contract negotiations with the three main providers. The CCG has signed the contract with BCHFT and 5BP by the revised national deadline of 31st March. Discussion with WWL FT are ongoing at Exec to Exec level.

3. Delivery Of Commissioned Services QIPP

- The significant QIPP schemes are being monitored on a weekly basis with the teams that are implementing the pathways that will deliver the QIPP savings. The key schemes are Transforming Community Services (TCS) and Rapid Access Interface and Discharge (RAID).

- Providers are reporting that the demand management schemes are achieving their targets. However, the activity deflected is not being fully reflected in a reduction in outpatient, A&E and Non Elective activity. The CCG has received WWL's transition plan that shows a delay in implementing bed closures by 6 months.

- The CCG is working closely with providers to make sure that the Rapid Assessment Interface Discharge (RAID) model is working effectively and operating as planned, the team from the Birmingham RAID service are a making a peer review visit in February to the 5BP service as part of the evaluation process. Data has been shared with the evaluation team to allow the evaluation of the service and the impact of the service in reducing length of stay.

4. Delivery Against Commissioning Plan

- Continued progress is being made , with clear strategies for improving urgent care and a robust systems resilience plan which has been approved by NHS England.

Page 124

.

Page 125

2014/15 Performance Framework Overview

The Everyone Counts Planning For Patients Guidance issued by NHS England lays out four areas to be performance measured: Outcomes Ambitions This includes 7 overall ambitions supported by headline indicators and supporting indicators. NHS Constitution Measures Self-certification of the delivery of all NHS Constitution rights and pledges, which includes headline indicators and supporting indicators. Activity Indicators Includes trajectories for Elective first finished consultant episodes (FFCEs), Non elective FFCEs, Outpatient attendances, A&E attendances and Referrals. Better Care Fund Indicators Measures improvement against the agreed Better Care Fund measures.

In addition to the four areas laid out in the Everyone Counts Planning For Patients Guidance, the CCG is required to report performance against the CCG Outcomes Indicator Set. The CCG Outcomes Indicator Set provides clear, comparative information for CCGs, Health and Wellbeing Boards, local authorities, patients and the public about the quality of health services commissioned by CCGs and the associated health outcomes. 2014/15 CCG Outcomes Indicator Set is grouped under the five domains of the NHS Outcomes Framework: Domain One: Preventing people from dying prematurely Domain Two: Enhancing the quality of life of people with long term conditions Domain Three: Helping people to recover from ill health or following injury Domain Four: Ensuring that people have a positive experience of care Domain Five: Treating and caring for people in a safe environment and protecting them from harm

Page 126

Current Performance

Month Last Qtr Year/YTD

Potential Years Of Life Lost: Amenable To Healthcare Wigan Borough CCG N/A N/A 2013 N/A N/A 2,485.60Latest 5

Years

Quality Of Life: People With Long Term Conditions Wigan Borough CCG N/A N/A 2013/14 N/A N/A 69.20Latest 3

Surveys

Plan N/A 3.75% 7.50%

Actual N/A 2.31% 5.42%

Plan 693 2,070 6,686

Actual 673 2,202 6,605

Patient Experience: Hospital Care Wigan Borough CCG N/A N/A 2013 N/A N/A 99.64Latest 2

Years

Friends & Family: A&E Overall Score WWL FT 70.47 66.95 Feb 15 73.19 70.19 69.54Latest 8

Months 2

Friends & Family: Inpatient Overall Score WWL FT 79.15 75.19 Feb 15 74.16 77.12 77.68Latest 8

Months 3

Friends & Family: Maternity Overall Score WWL FT N/A N/A Feb 15 78.81 76.00 74.81Latest 8

Months

Patient Experience: Primary Care Wigan Borough CCG N/A N/A 2013/14 N/A N/A 5.03Latest 2

Years

Safety: Number Of Medication Incidents Reported WWL FT N/A N/A Sep 14 N/A N/A 363Latest 7

½ Years

Everyone Counts: Planning For Patients 2014/15

Outcomes Ambitions: Headline IndicatorsOrganisation

Monitored

Green

Threshold

Amber

ThresholdPeriod

Performance

Trend

Ambition 1: Securing Additional Years Of Life For The People Of England With Treatable Mental And Physical Health Conditions

Ambition 2: Improving The Health Related Quality Of Life Of The 15+ Million People With One Or More Long-Term Conditions Including Mental Health Conditions

Mental Health: IAPT Access Rate Wigan Borough CCG 1.00% Q2 14/15Latest 8

Quarters 1

Ambition 3: Reducing The Amount Of Time People Spend Avoidably In Hospital Through Better And More Integrated Care In The Community Outside Of Hospital

Avoidable Emergency Admissions: Composite Measure Wigan Borough CCG 5.00% Jan 15Latest 8

Months

Ambition 4: Increasing The Proportion Of Older People Living Independently At Home Following Discharge From Hospital

Awaiting Indicators

Ambition 5: Increasing The Number Of People Having A Positive Experience Of Hospital Care

Ambition 6: Decreasing The Number Of People With Mental And Physical Health Conditions Having A Negative Experience Of Care In General Practice And The Community

Ambition 7: Making Significant Progress Towards Eliminating Avoidable Deaths In Our Hospitals Caused By Problems In Care

Page 127

Current Performance

Month Last Qtr YTD

Plan N/A N/A 60.00%

Actual N/A N/A 61.51%

Plan N/A 50.00% 50.00%

Actual N/A 55.26% 52.01%

Reablement: Still In Service After 91 Days Wigan Borough CCG N/A N/A 2013/14 N/A N/A 79.51%Latest 3

Years

Healthcare Associated Infections: MRSA Wigan Borough CCG 0 1 Feb 15 0 0 2Latest 8

Months

Plan 9 27 99

Actual 8 26 90

Plan 271 819 2,703

Actual 264 838 2,501 4

Plan 14 78 216

Actual 19 72 211

Plan 379 1,061 3,594

Actual 355 1,198 3,728

Plan 29 112 173

Actual 35 95 166

Friends & Family: A&E Response Rate WWL FT 15.00% 10.00% Feb 15 24.35% 11.58% 13.23%Latest 8

Months 8

Friends & Family: Inpatient Response Rate WWL FT 15.00% 10.00% Feb 15 36.55% 26.68% 30.86%Latest 8

Months

Friends & Family: Maternity Response Rate WWL FT 15.00% 10.00% Feb 15 20.38% 15.45% 18.17%Latest 8

Months


Outcomes: Supporting IndicatorsOrganisation

Monitored

Green

Threshold

Amber

ThresholdPeriod

Performance

Trend

Latest 8

Quarters

Dementia: Diagnosis Rate Wigan Borough CCG 5.00% Feb 15Latest 8

Months

Mental Health: IAPT Recovery Rate Wigan Borough CCG 5.00% Q2 14/15

Admissions: Chronic ACS Conditions Wigan Borough CCG 5.00% Jan 15Latest 8

Months

Healthcare Associated Infections: Clostridium Difficile Wigan Borough CCG 10.00% Feb 15Latest 8

Months

5

Admissions: Acute ACS Conditions Wigan Borough CCG 5.00% Jan 15Latest 8

Months 6

Admissions: Asthma, Diabetes & Epilepsy (C&YP) Wigan Borough CCG 5.00% Jan 15Latest 8

Months

7Admissions: Lower Respiratory Tract Infections (C&YP) Wigan Borough CCG 5.00% Jan 15

Latest 8

Months

Page 128

Month Last Qtr YTD

18W RTT: Admitted Pathways Wigan Borough CCG 90.00% 85.00% Feb 15 92.54% 92.04% 93.50%Latest 8

Months

18W RTT: Non-Admitted Pathways Wigan Borough CCG 95.00% 90.00% Feb 15 97.53% 97.13% 97.49%Latest 8

Months

18W RTT: Incomplete Pathways Wigan Borough CCG 92.00% 87.00% Feb 15 96.76% 96.47% 96.49%Latest 8

Months

Diagnostics: 6+ Week Waiters Wigan Borough CCG 1.00% 6.00% Feb 15 0.22% 0.72% 1.80%Latest 8

Months

A&E Waits: Total Time Within 4 Hours WWL FT 95.00% 90.00% Mar 15 96.60% 95.72% 94.62%Latest 8

Months

Cancer: Seen Within 14 Days Of An Urgent GP Referral Wigan Borough CCG 93.00% 88.00% Feb 15 99.31% 98.13% 98.13%Latest 8

Months

Cancer: Breast Symptoms Seen Within 14 Days Wigan Borough CCG 93.00% 88.00% Feb 15 97.14% 96.03% 96.05%Latest 8

Months

Cancer: Treatment Within 31 Days Of Decision To Treat Wigan Borough CCG 96.00% 91.00% Feb 15 97.69% 97.54% 97.86%Latest 8

Months

Cancer: Subsequent Surgery Treatment In 31 Days Wigan Borough CCG 94.00% 89.00% Feb 15 100.00% 96.77% 98.58%Latest 8

Months

Cancer: Subsequent Drug Treatment In 31 Days Wigan Borough CCG 98.00% 93.00% Feb 15 100.00% 100.00% 100.00%Latest 8

Months

Cancer: Subsequent Radiotherapy Treatment In 31 Days Wigan Borough CCG 94.00% 89.00% Feb 15 100.00% 96.55% 99.28%Latest 8

Months

Cancer: GP Referral To Treatment In 62 Days Wigan Borough CCG 85.00% 80.00% Feb 15 87.76% 88.73% 89.26%Latest 8

Months

Cancer: NHS Screening Referral To Treatment In 62 Days Wigan Borough CCG 90.00% 85.00% Feb 15 100.00% 95.12% 96.32%Latest 8

Months

Cancer: Consultant Upgrade To Treatment In 62 Days Wigan Borough CCG None None Feb 15 86.49% 84.00% 87.70%Latest 8

Months

Ambulance: Category A (Red 1) 8 Minute Response Time NWAS 75.00% 70.00% Feb 15 67.54% 65.35% 69.20%Latest 8

Months 9

Ambulance: Category A (Red 2) 8 Minute Response Time NWAS 75.00% 70.00% Feb 15 66.22% 66.67% 69.79%Latest 8

Months 10

Ambulance: Category A 19 Minute Response Time NWAS 95.00% 90.00% Feb 15 91.38% 91.18% 93.32%Latest 8

Months 11


Constitution: Headline IndicatorsOrganisation

Monitored

National

Standard

Lower

ThresholdPeriod

Current Performance Performance

Trend

Page 129

Current Performance

Month Last Qtr YTD

Mixed Sex Accommodation: Breaches Wigan Borough CCG 0 10 Feb 15 0 2 N/ALatest 8

Months 12

Cancelled Operations: Not Treated In 28 Days WWL FT 5.60% 11.60% Q3 14/15 N/A 6.44% 6.65%Latest 8

Quarters 13

Mental Health: Care Programme Approach Wigan Borough CCG 95.00% 90.00% Q3 14/15 N/A 92.59% 94.84%Latest 8

Quarters 14

18W RTT: Admitted Patients Waiting > 52 Weeks Wigan Borough CCG 0 10 Feb 15 0 0 N/ALatest 8

Months

18W RTT: Non-Admitted Patients Waiting > 52 Weeks Wigan Borough CCG 0 10 Feb 15 0 1 N/ALatest 8

Months 15

18W RTT: Incomplete Patients Waiting > 52 Weeks Wigan Borough CCG 0 10 Feb 15 1 0 N/ALatest 8

Months 16

A&E Waits: Trolley Waits > 12 Hours WWL FT 0 1 Mar 15 0 0 0Latest 8

Months

Ambulance: Handover > 30 Minutes WWL FT 4.76% 5.76% Feb 15 4.75% 9.37% 6.89%Latest 8

Months 17

Ambulance: Handover > 60 Minutes WWL FT 0.55% 1.05% Feb 15 0.22% 1.93% 1.23%Latest 8

Months 18


Constitution: Supporting IndicatorsOrganisation

Monitored

Standard/

Plan

Lower

ThresholdPeriod

Performance

Trend

Page 130

Current Performance

Month Last Qtr YTD

Plan 595 1,946 6,945

Actual 581 1,855 6,972

Plan 3,329 9,925 36,532

Actual 3,291 10,316 36,760

Plan 3,924 11,871 43,477

Actual 3,872 12,171 43,732

Plan 2,514 7,965 29,050

Actual 2,357 8,153 29,770

Plan 8,261 26,506 94,866

Actual 8,551 27,098 98,985

Plan N/A 65,295 192,225

Actual N/A 65,757 198,896

Plan 7,517 21,004 85,345

Actual 7,584 20,666 88,317

Plan 6,266 18,513 67,667

Actual 6,510 19,211 71,641

Plan 3,381 10,658 38,474

Actual 3,362 10,653 40,644

Plan 9,647 29,171 106,141

Actual 9,872 29,864 112,285

Plan 5,161 16,464 58,805

Actual 5,397 16,993 61,235


Activity IndicatorsOrganisation

Monitored

Green

Threshold

Amber

ThresholdPeriod

Performance

Trend

Inpatient Admissions: Elective Daycase Wigan Borough CCG 5.00% Feb 15Latest 8

Months 19

Inpatient Admissions: Elective Ordinary Wigan Borough CCG 5.00% Feb 15Latest 8

Months

Inpatient Admissions: Non-Elective Wigan Borough CCG 5.00% Feb 15Latest 8

Months 20

Inpatient Admissions: Total Elective Wigan Borough CCG 5.00% Feb 15Latest 8

Months

21

Subsequent Outpatient Attendances: All Referrals Wigan Borough CCG 5.00% Q3 14/15Latest 3

Quarters 22

First Outpatient Attendances: All Referrals Wigan Borough CCG 5.00% Feb 15Latest 8

Months

23

Referrals: GP Wigan Borough CCG 5.00% Feb 15Latest 8

Months 24

Accident & Emergency: Attendances At WWL WWL FT 5.00% Mar 15Latest 8

Months

25

Referrals: Total Wigan Borough CCG 5.00% Feb 15Latest 8

Months

Referrals: Other Wigan Borough CCG 5.00% Feb 15Latest 8

Months

26First Outpatient Attendances: GP Referrals Wigan Borough CCG 5.00% Feb 15

Latest 8

Months

Page 131

Current Performance

Month Last Qtr Year/YTD

Residential Care: Permanent Admissions Aged 65+ Wigan Local Authority N/A N/A 2013/14 N/A N/A 811.53Latest 3

Years

Reablement: Still In Service After 91 Days Wigan Local Authority N/A N/A 2013/14 N/A N/A 79.51%Latest 3

Years

Plan 140.46 151.48 149.47

Actual 151.39 182.49 192.17

Avoidable Admissions: Rate Per 100k Population Wigan Local Authority N/A N/A Sep 13 162.30 486.89 1,018.55Latest 6

Months

Plan 460 1,305 4,504

Actual 420 1,340 4,722

Better Care Fund: Non-Financial Metrics 2014/15

Better Care IndicatorsOrganisation

Monitored

Green

Threshold

Amber

ThresholdPeriod

Performance

Trend

27

Emergency Readmissions: Within 30 Days Of Discharge Wigan Borough CCG 5.00% Jan 15Latest 8

Months 28

Delayed Transfer Days: Rate Per 100k Population Wigan Local Authority 5.00% Feb 15Latest 8

Months

Page 132

Potential Years Of Life Lost: Amenable To Healthcare 2013 Sep 14 Sep 15 2,027.4 2,530.3 2,485.6

Under 75 Mortality Rate: Cardiovascular Disease 2013 Sep 14 Sep 15 64.90 83.20 71.90

Diabetes: Myocardial Infarction, Stroke & Stage 5 Kidney Disease 2012/13 Mar 15 Mar 16 100.0 113.3 85.1

Under 75 Mortality Rate: Respiratory Disease 2013 Sep 14 Sep 15 28.10 38.50 38.90

Under 75 Mortality Rate: Liver Disease 2013 Sep 14 Sep 15 15.50 22.70 24.30

Emergency Admissions: Alcohol Related Liver Disease 2013/14 Mar 15 Jun 15 24.1 45.8 55.3

Under 75 Mortality Rate: Cancer 2013 Sep 14 Sep 15 122.10 137.60 125.40

One Year Survival Rate: All Cancers 2011 Jun 14 Jun 15 68.18 68.94 67.61

One Year Survival Rate: Breast, Lung & Colorectal Cancers 2011 Jun 14 Jun 15 69.46 70.20 68.86

Maternity: Antenatal Assessment By 13 Weeks Q4 2013/14 Mar 15 Jun 15 93.0% 93.9% 92.9%

Maternity: Smoking At Time Of Delivery Q2 2014/15 Mar 15 Jun 15 12.0% 13.5% 16.3%

Maternity: Breastfeeding Prevalence At 6-8 Weeks Q2 2014/15 Mar 15 Jun 15 45.0% 40.3% 32.2%

Cancer: Record Of Stage At Diagnosis 2012 Sep 14 Sep 15 59.4% 75.9% 78.1%

Cancer: Detected at Stage 1 and 2 2012 Sep 14 Sep 15 41.6% 46.5% 49.0%

Breast Cancer: Mortality 2011-2013 Jun 14 Jun 15 34.7 33.5 33.3

Admissions: Hip Fracture (Age 60+) 2013/14 Mar 15 Jun 15 439.1 466.8 488.2

CCG Outcomes Indicator Set 2014/15: Published HSCIC Data

Domain 1: Preventing People From Dying Prematurely

Overarching Indicator Data PeriodLatest

Publication

Next

PublicationEngland

Greater

ManchesterWBCCG

WBCCGImprovement Areas Data PeriodLatest

Publication

Next

PublicationEngland

Greater

Manchester

Page 133

Health Related Quality Of Life: People With Long Term Conditions Jul 13 - Mar 14 Sep 14 Sep 15 0.74 0.71 0.71

Long Term Conditions: People Feeling Supported To Manage Their LTC Jul 13 - Mar 14 Sep 14 Sep 15 65.1% 65.5% 66.5%

Diabetes: Referred For Structured Education Within One Year 2011/12 Mar 14 Sep 15 14.1% 3.7% 2.0%

Emergency Admissions: Chronic ACS Conditions 2013/14 Mar 15 Jun 15 780.9 1,070.8 905.5

Emergency Admissions: Asthma, Diabetes & Epilepsy (C&YP) 2013/14 Mar 15 Jun 15 307.4 434.0 349.5

Admissions: Complications Associated With Diabetes 2012/13 Mar 15 Mar 16 100.0 120.5 142.0

Health Related Quality Of Life: Carers Jul 13 - Mar 14 Sep 14 Sep 15 0.80 0.78 0.78

Health Related Quality of Life: People with Long Term Mental Hlth Cond. Jul 13 - Mar 14 Sep 14 Sep 15 0.53 0.48 0.49


Domain 2: Enhancing Quality Of Life For People With Long-Term Conditions

Overarching Indicator Data PeriodLatest

Publication

Next

PublicationEngland

Greater

ManchesterWBCCG


Publication

Next

PublicationEngland

Greater

Manchester

Page 134

Emergency Admissions: Acute ACS Conditions 2013/14 Mar 15 Jun 15 1,164.7 1,617.2 1,304.5

Readmissions: 30 Days Of Discharge From Hospital 2011/12 Mar 14 TBC 11.8 12.3 12.8

Increased Health Gain For Elective Procedures: Hip Replacement 2012/13 Sep 14 Sep 15 0.423 0.419 0.387

Increased Health Gain For Elective Procedures: Knee Replacement 2012/13 Sep 14 Sep 15 0.313 0.323 0.305

Increased Health Gain For Elective Procedures: Groin Hernia 2012/13 Sep 14 Sep 15 0.084 0.077 0.067

Emergency Admissions: Lower Respiratory Tract Infections (C&YP) 2013/14 Mar 15 Jun 15 368.6 475.7 320.5

Admissions To An Acute Stroke Unit Within Four Hours Of Arrival To

Hospital2013/14 Dec 14 Dec 15 59.9% 61.2% 55.6%

Patients Receiving Thrombolysis Following An Acute Stroke 2013/14 Dec 14 Dec 15 11.6% 7.1% 10.3%


Domain 3: Helping People To Recover From Episodes Of Ill Health Or Following Injury

Overarching Indicators Data PeriodLatest

Publication

Next

PublicationEngland

Greater

ManchesterWBCCG


Publication

Next

PublicationEngland

Greater

ManchesterPage 135

Patient Experience: GP Out Of Hours Services Jul 13 - Mar 14 Sep 14 Sep 15 66.22% 70.99% 71.45%

Patient Experience of Hospital Care 2013/14 Sep 14 TBC 76.5 77.2 77.9

Responsiveness To Inpatients' Personal Needs 2013/14 Sep 14 TBC 68.40 69.10 68.20

Healthcare Associated Infections: MRSA Rate Apr 14 - Dec 14 Mar 15 Jun 15 1.06 1.25 0.62

Healthcare Associated Infections: Clostridium Difficile Rate Apr 14 - Dec 14 Mar 15 Jun 15 19.91 23.40 21.45


Domain 4: Ensuring That People Have A Positive Experience Of Care

Overarching Indicators Data PeriodLatest

Publication

Next

PublicationEngland

Greater

ManchesterWBCCG

WBCCG

Domain 5: Treating & Caring For People In A Safe Environment And Protecting Them From Avoidable Harm

Improvement Areas Data PeriodLatest

Publication

Next

PublicationEngland

Greater

ManchesterWBCCG

Improvement Areas Data PeriodLatest

Publication

Next

PublicationEngland

Greater

Manchester

Page 136

Mental Health: Improving Access To Psychological Therapies (IAPT) Access Rate Exception Report: 1

Trended Monthly Performance Performance By Greater Manchester CCG: Quarter 2 2014/15

Performance Comments Performance By Greater Manchester CCG: Quarter 2 2014/15

CCG Treated Patients Performance

NHS Salford CCG 1,755 36,357 4.83%

NHS Bury CCG 1,135 26,840 4.23%

NHS Bolton CCG 1,455 39,261 3.71%

NHS Tameside and Glossop CCG 1,360 36,775 3.70%

NHS Heywood Middleton & Rochdale CCG 1,130 32,015 3.53%

NHS Stockport CCG 1,295 41,008 3.16%

NHS Trafford CCG 980 31,485 3.11%

NHS Oldham CCG 920 32,976 2.79%

NHS Wigan Borough CCG 1,050 45,389 2.31%

NHS South Manchester CCG 420 26,631 1.58%

NHS North Manchester CCG 410 28,508 1.44%

NHS Central Manchester CCG 455 33,259 1.37%

Greater Manchester Total 12,365 410,504 3.01%

The Improving Access to Psychological Therapies (IAPT) Access Rate indicator measures the proportion of people that enter treatment against the level of need in the general population; i.e the proportion of people who have depression and/or anxiety disorders who received psychological therapies. Collection of this data demonstrates the extent to which this need is being met. Wigan Borough CCG performance fell below the target of 3.75% in Q2 achieving 2.31%. This was the second time since Q4 of 2012/13 that the target was not achieved. Looking at the CCGs across the Greater Manchester area, Salford CCG (4.83%) and Bury CCG (4.23%) are the only Greater Manchester CCGs to achieve the target. Wigan Borough CCG performance has fallen below the Greater Manchester average of 3.01%.

Q112/13

Q212/13

Q312/13

Q412/13

Q113/14

Q213/14

Q313/14

Q413/14

Q114/15

Q214/15

Q314/15

Q414/15

Performance 1.54% 1.82% 1.20% 1.24% 3.07% 3.30% 3.54% 3.55% 3.11% 2.31% 0.00% 0.00%

Plan 2.10% 2.20% 2.30% 2.40% 3.02% 2.77% 2.83% 3.38% 3.75% 3.75% 3.75% 3.75%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Performance Plan

3.7% 4.2% 1.4% 3.5% 1.4% 2.8% 4.8% 1.6% 3.2% 3.7% 3.1% 2.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Bolton Bury C Mcr HMR N Mcr Oldham Salford S Mcr Stockport Tameside Trafford Wigan

Value Target

Page 137

Friends & Family Test: A&E Overall Score At WWL Exception Report: 2

Trended Monthly Performance

Performance Comments GM Benchmarks: February 2015 Positive Negative Score

Wrightington, Wigan & Leigh 75.54 2.35 73.19

Central Manchester University Hospitals 79.93 6.90 73.03

Salford Royal 77.86 7.58 70.28

University Hospital Of South Manchester 74.41 9.12 65.29

Pennine Acute Hospitals 64.55 6.12 58.43

Stockport 66.81 12.29 54.52

Bolton 67.43 13.24 54.19

Tameside Hospital 52.15 13.60 38.55

GM Benchmarking Scores: February 2015

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Performance 65.50 63.31 66.89 67.08 69.77 73.12 68.98 70.80 70.55 73.37 73.19

Plan 70.47 70.47 70.47 70.47 70.47 70.47 70.47 70.47 70.47 70.47 70.47 70.47

60

62

64

66

68

70

72

74

Performance Plan

For the full year of 2013/14, WWL received an overall score of 70.47. Everyone Counts guidance defines success as "improving the number or proportion of positive recommendations to friends and friendly". As such, the figure of 70.47 is used as the plan against which 2014/15 will be measured. The February score of 73.19 was above plan by 2.72. However, the Q3 score of 70.19 and the year-to-date (April to February) score of 69.54 continues to remain below plan. Benchmarking the WWL score against other trusts across Greater Manchester indicates that WWL have achieved a higher score than any of their neighbours. The next highest scoring trust - Central Manchester University Hospital are marginally lower at 73.03.

Bolton Central Mcr Pennine Salford Stockport Tameside South Mcr WWL

Score 54.19 73.03 58.43 70.28 54.52 38.55 65.29 73.19

25

35

45

55

65

75

85

Score

Page 138

Friends & Family Test: Inpatient Overall Score At WWL Exception Report: 3


Performance Comments GM Benchmarks: February 2015 Positive Negative Score

The Christie 93.01 0.00 93.01

Pennine Acute Hospitals 86.89 0.64 86.25

Bolton 82.28 1.95 80.33

University Hospital Of South Manchester 81.42 2.61 78.81

Wrightington, Wigan & Leigh 77.70 3.54 74.16

Salford Royal 77.91 5.62 72.29

Central Manchester University Hospitals 76.62 6.50 70.12

Stockport 71.37 4.45 66.92

Tameside Hospital 64.96 5.28 59.68

GM Benchmarking Scores: February 2015


Performance 79.28 78.57 77.18 82.18 76.16 81.68 80.13 78.14 72.56 72.43 74.16

Plan 79.15 79.15 79.15 79.15 79.15 79.15 79.15 79.15 79.15 79.15 79.15 79.15

70

72

74

76

78

80

82

Performance Plan

For the full year of 2013/14, WWL received an overall inpatient score of 79.15. Everyone Counts guidance defines success as "improving the number or proportion of positive recommendations to friends and friendly". As such, the figure of 79.15 is used as the plan against which 2014/15 will be measured. The February score of 74.16 was below plan by 4.99, this is the seventh time in the current financial year where plan has not been achieved. This score is below the Greater Manchester average of 74.92, and above the National average of 72.90. The Q3 score of 77.12 and the year-to-date (April to February) score of 77.68 continues to remain below plan.

Christie Bolton Central Mcr Pennine Salford Stockport Tameside South Mcr WWL

Score 93.01 80.33 70.12 86.25 72.29 66.92 59.68 78.81 74.16

55

60

65

70

75

80

85

90

95

Score

Page 139

Emergency Admissions: Chronic ACS Conditions Exception Report: 4

Trended Monthly Admissions Proportion Of Admissions By Condition: April to January 2015

Performance Comments Year-On-Year Admissions By Gender: April to January 2015

Gender 2013/14 2014/15 Variance

Male 1,194 1,196 (2)

Female 1,233 1,304 (71)

Wigan Borough CCG Total 2,427 2,500 (73)

Admission Rate By CCG Locality: April to January 2015

CCG Locality Admissions List Size Rate Per 10k

Wigan Commissioning Consortium 668 78,060 85.58

United League Consortium 348 44,195 78.74

TABA 395 51,314 76.98

Atherleigh 341 44,355 76.88

Patient Focus 373 49,186 75.83

North Wigan 370 54,592 67.78

Unknown 5 N/A N/A


2014-15 270 256 241 224 204 204 239 283 316 264

Plan 308 264 246 289 249 257 303 236 280 271 236 214

100

130

160

190

220

250

280

310

340

2014-15 Plan

January performance of 264 admissions is below plan by 7. Year-to-date performance (April to January) of 2,500 is also below plan by 203. The largest number of admissions during the April to January relate to COPD (790) with the with the lowest number of admissions relating to Hypertension (49). Other conditions with high numbers of admissions are Heart Failure (331), Atrial Fibrillation (306) and Asthma (264). Year-on-year comparisons by gender reveal that the number of admissions for females has increased by 71 between 2013/14 and 2014/15, while admissions for males has increased by 2.

0%

10%

13%

7%

32%

9% 3% 2%

9%

3%

12%

Hepatitis B

Asthma

Heart Failure

Diabetes

COPD

Angina

Anaemia

Hypertension

Epilepsy

Dementia

Atrial Fibrillation

Page 140

Admissions: Asthma, Diabetes & Epilepsy (C&YP) Exception Report: 5

Trended Monthly Admissions Admission Rate Per 10k By Gender, Age Band & Condition: April to January 2015

Performance Comments Year-On-Year Admissions By Condition: April to January 2015

Condition 2013/14 2014/15 Variance

Asthma 112 120 (8)

Diabetes 41 40 1

Epilepsy 60 51 9

Wigan Borough CCG Total 213 211 2





Atherleigh 20 9,363 21.36

North Wigan 38 11,328 33.55

TABA 32 11,497 27.83



Admissions 22 19 19 16 21 23 21 21 30 19

Plan 22 17 15 28 18 24 29 26 23 14 20 18

12

14

16

18

20

22

24

26

28

30

32

Admissions Plan

January performance of 19 admissions is above plan by 5. Year to date performance (April to January) of 211 is below plan by 5. The majority of year-to-date admissions relate to Asthma (120), with the highest proportion occuring in males aged 0-10yrs (59). The second highest number of year to date admissions relate to Epilepsy (51) with the highest proportion once again occuring in males aged 0-10yrs (34). Diabetes has the lowest number of year to date admissions (40) with the highest proportion occuring in males aged 11-18yrs (15).

17.42

2.49 3.48

13.08

7.27 2.91

28.01

4.75

16.14

5.46

10.24

4.10

Asthma Diabetes Epilepsy

0

5

10

15

20

25

30

35

40

Female: 0-10 Female: 11-18 Male: 0-10 Male: 11-18

Page 141

Emergency Admissions: Acute ACS Conditions Exception Report: 6

Trended Monthly Admissions Proportion Of Admissions By Condition: April to January 2015

Performance Comments Year-On-Year Admissions By Gender: April to January 2015

Gender 2013/14 2014/15 Variance

Male 1,524 1,758 (234)

Female 1,706 1,971 (265)

Wigan Borough CCG Total 3,230 3,729 (499)




TABA 609 51,314 118.68

Patient Focus 579 49,186 117.72

North Wigan 606 54,592 111.01


Atherleigh 456 44,355 102.81

Unknown 16 N/A N/A


2014-15 369 381 348 385 348 345 386 344 468 355

Plan 384 347 331 378 365 349 362 334 365 379 372 369

320

340

360

380

400

420

440

460

480

2014-15 Plan

January performance of 355 admissions is below plan by 24. As a result, the year to date performance (April to January) of 3,728 is now above plan by 134. The two conditions with the largest number of admissions during January were Kidney & UTIs (105) and Flu & Pneumonia (96). The largest number of year to date admissions (April to January) relate to Kidney and UTIs (1093) with the with the lowest number admissions relating to Vaccine Preventable conditions (1). Other conditions with high numbers of year to date admissions are Flu & Pneumonia (753), Gastroenteritis (595) and Cellulitus (505). Year-on-year comparisons by gender reveal that the number of admissions for females has increased by 265 between 2013/14 and 2014/15, with admissions for males showing a smaller increase of 234.

20%

5%

2%

16%

29%

4%

13%

1%

10%

0% Flu & Pneumonia

Convulsions

Angina

Gastroenteritis

Kidney & UTIs

Perforated Ulcer

Cellulitus

Dental

Ear, Nose & Throat

Vaccine Preventable

Page 142

Emergency Admissions: Lower Respiratory Tract Infections (Children & Young People) Exception Report: 7

Trended Monthly Admissions Proportion Of Admissions By Condition & Gender: April to January 2015

Performance Comments Year-On-Year Admissions By Condition: April to January 2015

Condition 2013/14 2014/15 Variance

Bronchiolitis 136 116 20

Pneumonia 29 50 (21)

Wigan Borough CCG Total 165 166 (1)



TABA 35 11,497 30.44




North Wigan 22 11,328 19.42

Atherleigh 15 9,363 16.02

Unknown 1 N/A N/A


2014-15 16 5 3 5 3 4 13 27 55 35

Plan 7 6 4 5 3 7 14 38 60 29 16 9

0

10

20

30

40

50

60

70

2014-15 Plan

January performance of 35 admissions is above plan by 6. However, the year-to-date (April to January) position (166) is below plan by 7. Year-on-year comparisons by condition reveal that the number of admissions for Bronchiolitis has decreased by 20 between 2013/14 and 2014/15, while admissions for Pneumonia have increased by 21. Across both conditions the largest number of year to date admissions (April to January) relate to males (97) with admissions for females (69).

40.4%

18.1%

29.5%

12.0%

Male: Bronchiolitis

Male: Pneumonia

Female: Bronchiolitis

Female: Pneumonia

Page 143

Friends & Family Test: A&E Response Rate At WWL Exception Report: 8

Trended Monthly Performance GM Benchmarks: February 2015 Responses Eligible Performance

Performance Comments Mode Of Collection: February 2015 Tameside Stockport WWL

SMS/Text/Smartphone App 488 505 0

Electronic Tablet/Kiosk: Point Of Discharge 54 0 0

Paper/Postcard: Point Of Discharge 756 104 1,024

Paper Survey: Sent To Patients Home 0 0 0

Telephone Survey: Once Patient Is Home 0 357 0

Online Survey: Once Patient Is Home 1 0 0

Other 0 0 0

Total 1,299 966 1,024

Tameside Hospital NHS Foundation Trust 1,299 3,442 37.74%

Stockport NHS Foundation Trust 966 3,470 27.84%

Pennine Acute Hospitals NHS Trust 3,241 11,785 27.50%

Salford Royal NHS Foundation Trust 876 3,473 25.22%

Wrightington, Wigan & Leigh 1,024 4,206 24.35%

Central Manchester University Hospital 1,963 8,717 22.52%

Bolton NHS Foundation Trust 1,061 4,947 21.45%

University Hospital of South Manchester 692 3,341 20.71%


Performance 14.9% 11.2% 15.5% 11.5% 10.2% 10.2% 9.5% 11.7% 13.7% 14.9% 24.4%

Standard 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% 15.0% 15.0%

9%

11%

13%

15%

17%

19%

21%

23%

25%

27%

Performance Standard

WWL February performance (24.4%) was above the national standard of 15%, this is the second time in the current financial year where plan has been exceeded. A total of 4,206 patients were eligible to respond to the friends and family questionaire, of which 1,024 supplied a response. WWL performance is below the Greater Manchester (25.6%) average, however above the England (21.2%) average. In an attempt to understand the difference in rates between the other trusts and WWL, a comparison was made between the different modes of response collection employed by the top two performing trusts: Tameside and Stockport. WWL used only paper/postcard at point of discharge as their mode of collection. In contrast, Tameside used a combination of SMS/Text/Smartphone App, Electronic Tablet/Kiosk, Paper/Postcard and Online Survey. Stockport used a combination of SMS/Text/Smartphone App, Paper/Postcard and Telephone Survey.

Page 144

Ambulance: Category A (Red 1) 8 Minute Response Time For NWAS Exception Report: 9

Trended Monthly Performance Performance By County: February 2015

Performance Comments Performance By Greater Manchester CCG: February 2015

CCG 8 Mins Total Performance

NHS Bolton CCG 58 92 63.0%

NHS Bury CCG 31 44 70.5%

NHS Central Manchester CCG 33 50 66.0%

NHS Heywood Middleton & Rochdale CCG 42 63 66.7%

NHS North Manchester CCG 74 95 77.9%

NHS Oldham CCG 59 84 70.2%

NHS Salford CCG 56 82 68.3%

NHS South Manchester CCG 33 49 67.4%

NHS Stockport CCG 53 77 68.8%

NHS Tameside and Glossop CCG 46 75 61.3%

NHS Trafford CCG 36 55 65.5%

NHS Wigan Borough CCG 70 104 67.3%

Greater Manchester Total 591 870 67.9%

Performance for all CCGs is assessed against total North West Ambulance Service (NWAS) performance. February performance of 67.54% remains below the national standard of 75% for the tenth consecutive month. Performance is below standard in all five counties, with Merseyside achieving the highest at 74.6% and Greater Manchester achieving the second highest at 67.9%. Looking at the CCGs across the Greater Manchester area, only one of the twelve achieved standard in the month; North Manchester CCG (77.9%).

58.7%

67.3%

62.0%

74.6%

67.9%

45%

50%

55%

60%

65%

70%

75%

80%

Cumbria Lancashire Cheshire Merseyside Greater Manchester

Standard


Performance 75.7% 73.4% 71.5% 68.5% 72.7% 71.5% 71.2% 68.0% 58.9% 65.5% 67.5% 0.0%

Standard 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0%

55%

60%

65%

70%

75%

80%


Page 145

Ambulance: Category A (Red 2) 8 Minute Response Time For NWAS Exception Report: 10

Trended Monthly Performance Performance By County: February 2015

Performance Comments Performance By Greater Manchester CCG: February 2015


NHS Bolton CCG 744 1,216 61.2%

NHS Bury CCG 572 815 70.2%


NHS Heywood Middleton & Rochdale CCG 708 1,005 70.5%

NHS North Manchester CCG 827 1,109 74.6%

NHS Oldham CCG 685 1,037 66.1%

NHS Salford CCG 687 1,138 60.4%


NHS Stockport CCG 789 1,204 65.5%

NHS Tameside and Glossop CCG 710 1,114 63.7%


NHS Wigan Borough CCG 836 1,246 67.1%


Performance for all CCGs is assessed against total North West Ambulance Service (NWAS) performance. February performance of 66.22% remains below the national standard of 75% for tenth consecutive month. Performance is below standard in all five counties, with Merseyside achieving the highest at 70.0% and Greater Manchester achieving the second highest at 66.8%. Looking at the CCGs across the Greater Manchester area, none of the twelve achieved standard in the month; the highest performance of 75.0% was reported for South Manchester CCG.

61.4%

65.8%

62.7%

70.0%

66.8%

50%

55%

60%

65%

70%

75%

80%


Standard


Performance 75.3% 74.7% 73.2% 69.2% 72.1% 73.3% 73.7% 69.6% 58.5% 65.5% 66.2% 0.0%

Standard 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%


Page 146

Ambulance: Category A 19 Minute Response Time For NWAS Exception Report: 11

Trended Monthly Performance Performance by County: February 2015

Performance Comments Performance by Greater Manchester CCG: February 2015


NHS Bolton CCG 1,182 1,308 90.4%

NHS Bury CCG 788 859 91.7%


NHS Heywood Middleton & Rochdale CCG 1,004 1,068 94.0%

NHS North Manchester CCG 1,150 1,204 95.5%

NHS Oldham CCG 1,064 1,121 94.9%

NHS Salford CCG 1,137 1,220 93.2%


NHS Stockport CCG 1,220 1,281 95.2%

NHS Tameside and Glossop CCG 1,102 1,189 92.7%


NHS Wigan Borough CCG 1,262 1,350 93.5%


Performance of all CCGs is assessed against total North West Ambulance Servive (NWAS) performance. February performance of 91.38% is below the national standard (95%) for a fifth consecutive month. As a result year-to-date performance (April to February) is also below the national standard at 93.32%. Performance is below standard in all 5 counties with Merseyside achieving the highest at 93.8% and Greater Manchester achieving the second highest at 93.5%. Looking at the CCGs across the Greater Manchester area, only three of the twelve achieved standard in the month; Central Manchester CCG (97.7%), North Manchester CCG (95.5%) and Stockport CCG (95.2%). The figure for ambulances despatched to the NHS Wigan Borough CCG area achieved 93.5%.

80.4%

89.1% 90.7%

93.8% 93.5%

75%

80%

85%

90%

95%

100%




Performance 96.2% 95.6% 95.4% 94.2% 95.3% 95.1% 93.6% 93.1% 87.7% 90.9% 91.4% 0.0%

Standard 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

86%

88%

90%

92%

94%

96%

98%

100%


Page 147

Mixed Sex Accomodation Exception Report: 12

Trended Monthly Performance Commissioner Benchmarked Performance: February 2015

Greater Manchester Clinical Commissioning Groups Breaches Breach Rate

NHS Bolton CCG 0 0.0

NHS Bury CCG 0 0.0

NHS Central Manchester CCG 0 0.0

NHS Heywood, Middleton And Rochdale CCG 0 0.0

NHS North Manchester CCG 0 0.0

NHS Oldham CCG 0 0.0

NHS Salford CCG 0 0.0

NHS South Manchester CCG 0 0.0

NHS Stockport CCG 0 0.0

NHS Tameside And Glossop CCG 0 0.0

NHS Trafford CCG 0 0.0

NHS Wigan Borough CCG 0 0.0

England Total 225 0.2

Performance Comments Provider Benchmarked Performance: February 2015

Greater Manchester NHS Provider Trusts Breaches Breach Rate

Bolton NHS Foundation Trust 0 0.0

Central Manchester University Hospitals NHS Foundation Trust 0 0.0

Greater Manchester West Mental Health NHS Foundation Trust 0 0.0

Manchester Mental Health And Social Care Trust 0 0.0

Pennine Acute Hospitals NHS Trust 0 0.0

Pennine Care NHS Foundation Trust 0 0.0

Salford Royal NHS Foundation Trust 0 0.0

Stockport NHS Foundation Trust 0 0.0

Tameside Hospital NHS Foundation Trust 0 0.0

The Christie NHS Foundation Trust 0 0.0

University Hospital Of South Manchester NHS Foundation Trust 0 0.0

Wrightington, Wigan & Leigh NHS Foundation Trust 0 0.0

Greater Manchester Total 0 0.0


Performance 0 0 1 2 0 0 1 0 1 1 0

Standard 0 0 0 0 0 0 0 0 0 0 0 0

1

2

3


There were no Mixed Sex Accommodation breaches reported in February for Wigan Borough CCG. Year-to-date (April to February) breaches total 6. No breaches were reported by any other CCG within Greater Manchester or any NHS Provider Trusts within Greater Manchester during February.

Page 148

Cancelled Operations: Not Treated In 28 Days at WWL Exception Report: 13


Performance Comments GM Benchmarks: Q3 2014/15 >28 Days Cancels Performance

Bolton NHS Foundation Trust 2 106 1.89%

Central Manchester University Hospital 36 319 11.29%

Pennine Acute Hospitals NHS Trust 1 226 0.44%

Salford Royal NHS Foundation Trust 1 89 1.12%

Stockport NHS Foundation Trust 7 127 5.51%

Tameside Hospital NHS Foundation Trust 3 72 4.17%

The Christie NHS Foundation Trust 0 0 0.00%

University Hospital South Manchester 5 173 2.89%

Wrightington, Wigan & Leigh 13 202 6.44%

GM Benchmarking Scores: Q3 2014/15

Q1 12/13 Q2 12/13 Q3 12/13 Q4 12/13 Q1 13/14 Q2 13/14 Q3 13/14 Q4 13/14 Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15

Performance 9.09% 6.21% 6.47% 5.74% 8.45% 6.56% 6.59% 5.61% 8.27% 5.48% 6.44%

Plan 9.09% 9.09% 9.09% 9.09% 7.33% 7.33% 7.33% 7.33% 5.60% 5.60% 5.60% 5.60%

4%

5%

6%

7%

8%

9%

10%

Performance Plan

All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons are to be offered another binding date within 28 days, or the patient's treatment to be funded at the time and hospital of the patient's choice. Everyone Counts guidance defines success as "reduction in the number of cancelled operations". Q3 performance at WWL (6.44%) is above plan by 0.84%. A total of 202 operations were

cancelled with 13 patients not treated within 28 days of the last minute elective cancellation.

Looking at the providers across the Greater Manchester area, Central Manchester University Hospital is the poorest performing trust (11.29%). The Christie Hospital reported no breaches of the standard. Q3 performance for the Greater Manchester Area Team is 5.18%.

Bolton C Mcr Pennine Salford Stockport Tameside Christie S Mcr WWL

Performance 1.89% 11.29% 0.44% 1.12% 5.51% 4.17% 0.00% 2.89% 6.44%

0%

2%

4%

6%

8%

10%

12%

Performance

Page 149

Mental Health: Care Programme Approach (CPA) Exception Report: 14

Trended Monthly Performance Performance By Greater Manchester CCG: Quarter 3 2014/15

Performance Comments Performance By Greater Manchester CCG: Quarter 3 2014/15

CCG Treated Patients Performance

NHS Oldham CCG 57 57 100.00%



NHS Heywood Middleton & Rochdale CCG 62 63 98.41%

NHS Bolton CCG 128 131 97.71%

NHS North Manchester CCG 83 85 97.65%

NHS Salford CCG 131 136 96.32%

NHS Bury CCG 42 44 95.45%

NHS Tameside and Glossop CCG 59 62 95.16%


NHS Stockport CCG 56 60 93.33%

NHS Wigan Borough CCG 200 216 92.59%


The Care Programme Approach (CPA) indicator measures the proportion of patients on CPA discharged from inpatient care who are followed up within 7 days. Collection of this data demonstrates the extent to which this need is being met. Wigan Borough CCG performance fell below the target of 95.00% in Q3 achieving 92.59%. This was the first time since Q2 of 2013/14 that the target was not achieved. Looking at the CCGs across the Greater Manchester area, three failed to achieve target. Wigan Borough is the lowest performing CCG (92.59%) with Oldham being the highest performing CCG achieving 100%. Wigan Borough CCG performance is also below the Greater Manchester average of 96.14%.

Q112/13

Q212/13

Q312/13

Q412/13

Q113/14

Q213/14

Q313/14

Q413/14

Q114/15

Q214/15

Q314/15

Q414/15

Performance 97.52% 96.67% 95.10% 95.52% 97.34% 93.72% 98.33% 95.67% 95.58% 96.19% 92.59% 0.00%

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

85.0%

88.0%

91.0%

94.0%

97.0%

100.0%

Performance Plan

97.7% 95.5% 94.5% 98.4% 97.7% 100.0% 96.3% 98.6% 93.3% 95.2% 98.9% 92.6%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Bolton Bury C Mcr HMR N Mcr Oldham Salford S Mcr Stockport Tameside Trafford Wigan

Value Target

Page 150

18W RTT: Non-Admitted Patients Waiting > 52 Weeks

Trended Monthly Performance Breach Details: April To February 2015

Central Manchester University Hospitals

Central Manchester University Hospitals

Wrightington, Wigan & Leigh

Performance Comments Long Waiters Treated: February 2015

And Movement On Previous Month

Wrightington Wigan & Leigh 4,100 q 7 q 1 q

Bolton 246 q 2 q 0 u

Salford Royal 188 q 1 u 0 u

Central Manchester University Hospitals 209 q 8 p 3 p

St Helens & Knowsley 140 q 0 u 0 u

Other NHS Providers 285 q 4 p 0 u

Independent Providers 139 q 0 q 0 u

Wigan Borough CCG Total 5,307 q 22 q 4 p

Exception Report: 15

TFC Month Number

Other May 2014 1

Other June 2014 2

Other October 2014 1

Total Treated 26+ Weeks 39+ Weeks


Performance 0 1 2 0 0 0 1 0 0 0 0

Standard 0 0 0 0 0 0 0 0 0 0 0 0

1

2

3


No Wigan Borough CCG patients are reported as waiting in excess of 52 weeks during February. Performance year-to-date (April to February) shows that a total of 4 patients have been waiting in excess of 52 weeks. Looking at the numbers waiting beyond six months (26 weeks), the number of such Wigan Borough patients has reduced by 12 to 22 from January to February. Of these 22 patients, a total of 4 had been waiting over 39 weeks. The largest absolute number of treated patients who had been waiting beyond 26 weeks is recorded by Central Manchester University Hospitals (8).

Page 151

18W RTT: Incomplete Patients Waiting > 52 Weeks

Trended Monthly Performance Breach Details:

April To February 2015


Salford Royal NHS Foundation Trust






North Bristol NHS Trust

North Bristol NHS Trust

Performance Comments Long Waiters: February 2015

And Movement Against Previous Month

Wrightington Wigan & Leigh 10,220 p 45 u 1 q

Bolton 968 p 5 q 0 u

Salford Royal 708 q 7 u 0 u

Central Manchester University Hospitals 734 q 27 q 8 u

St Helens and Knowsley 498 p 3 p 0 u

Other NHS Providers 960 p 33 p 6 q

Independent Providers 803 q 1 u 0 u

Wigan Borough CCG Total 14,891 p 121 p 15 q

Exception Report: 16

TFC Month Number

T&O April 2014 1

T&O April 2014 1

T&O May 2014 1

T&O May 2014 1

T&O June 2014 1

T&O July 2014 1

T&O September 2014 1

T&O January 2015 1

T&O February 2015 1

Total Waiters 26+ Weeks 39+ Weeks


Performance 2 2 1 1 0 1 0 0 0 1 1

Standard 0 0 0 0 0 0 0 0 0 0 0 0

1

2

3


One Wigan Borough CCG patient is reported as waiting in excess of 52 weeks during February. Performance year-to-date (April to February) shows that a total of 9 patients have been waiting in excess of 52 weeks. Looking at the number of long waiters waiting beyond six months (26 weeks), the number of such Wigan Borough patients has increased by 2 to 121 from January to February. Of these 121 patients, a total of 15 have been waiting over 39 weeks. The largest absolute number of long waiters are recorded at Wrightington Wigan and Leigh NHS Foundation Trust (45).

Page 152

Ambulance: Handover Delays Over 30 Minutes At WWL FT Exception Report: 17

Trended Monthly Performance Performance By Area: February 2015

Performance Comments Performance By Greater Manchester Hospital: February 2015

Fairfield General 25 1,566 1.60%

Manchester Royal Infirmary 134 1,652 8.11%

North Manchester General 81 1,330 6.09%

Royal Bolton 323 1,760 18.35%

Royal Oldham 77 1,566 4.92%

Salford Royal 16 1,592 1.01%

Stepping Hill 82 1,463 5.60%

Tameside General 31 1,205 2.57%

Wigan Infirmary 65 1,366 4.76%

Wythenshawe 67 1,574 4.26%

Greater Manchester Total 901 15,074 5.98%

Hospital >30 Mins Arrivals Performance Across the full year of 2013/14, WWL performance achieved 4.76%. Everyone Counts guidance defines success as "reductions expected in the numbers of handover delays". As such, the figure of 4.76% is used as the plan against which 2014/15 will be measured. WWL performance for February is equal to plan (4.76%). As a result year-to-date (April to February) performance is above plan by 2.13% at 6.89%. A total of 1,366 arrivals by ambulance were reported at Wigan Infirmary during February, of which 65 (4.76%) handover delays of longer than 30 minutes were reported. Looking at hospitals across the Greater Manchester area, two; Royal Bolton and Manchester Royal Infirmary had the greatest proportion of handover delays; 18.35% and 8.11% respectively. Wigan performance (4.76%) achieved better than the Greater Manchester average of 5.98%.

9.36%

14.36%

5.98%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Cheshire & Merseyside Cumbria & Lancashire Greater Manchester


Performance 5.48% 5.20% 3.67% 8.13% 4.42% 7.20% 4.31% 6.88% 16.22% 9.28% 4.76% 0.00%

Plan 4.76% 4.76% 4.76% 4.76% 4.76% 4.76% 4.76% 4.76% 4.76% 4.76% 4.76% 4.76%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Performance Plan

Page 153

Ambulance: Handover Delays Over 60 Minutes At WWL FT Exception Report: 18

Trended Monthly Performance Performance By Area: February 2015

Performance Comments Performance By Greater Manchester Hospital: February 2015

Fairfield General 2 1,566 0.13%

Manchester Royal Infirmary 16 1,652 0.97%

North Manchester General 11 1,330 0.83%

Royal Bolton 84 1,760 4.77%

Royal Oldham 12 1,566 0.77%

Salford Royal 0 1,592 0.00%

Stepping Hill 8 1,463 0.55%

Tameside General 2 1,205 0.17%

Wigan Infirmary 3 1,366 0.22%

Wythenshawe 11 1,574 0.70%

Greater Manchester Total 149 15,074 0.99%

Hospital >60 Mins Arrivals Performance Across the full year of 2013/14, WWL performance achieved 0.55%. Everyone Counts guidance defines success as "reductions expected in the numbers of handover delays". As such, the figure of 0.55% is used as the plan against which 2014/15 will be measured. WWL performance for February is below (better than) plan by 0.33% at 0.22%. As a result year-to-date (April to February) performance is above plan by 0.68% at 1.23%. A total of 1,366 arrivals by ambulance were reported at Wigan Infirmary during February, of which 3 (0.22%) handover delays of longer than 60 minutes were reported. Looking at hospitals across the Greater Manchester area, two; Royal Bolton and Manchester Royal Infirmary had the greatest proportion of handover delays; 4.77% and 0.97% respectively. Wigan performance (0.22%) achieved better than the Greater Manchester average of 0.99%.

2.27%

3.01%

0.99%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

Cheshire & Merseyside Cumbria & Lancashire Greater Manchester


Performance 0.99% 0.87% 0.30% 1.20% 0.84% 0.65% 0.20% 1.13% 4.23% 2.70% 0.22% 0.00%

Plan 0.55% 0.55% 0.55% 0.55% 0.55% 0.55% 0.55% 0.55% 0.55% 0.55% 0.55% 0.55%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

Performance Plan

Page 154

Elective Daycase Admissions Exception Report: 19

Trended Monthly Performance Activity Variance By Aggregate: April to February 2015

Performance Comments Activity By Provider: April to February 2015

Provider / Aggregate Last Year 2014/15 Plan This Year

Wrightington, Wigan & Leigh 26,280 25,852 26,384

Royal Bolton 1,964 1,920 1,757

Salford Royal 2,056 2,158 1,621

Central Manchester 1,089 1,094 1,245

Warrington & Halton 465 466 423

South Manchester 422 384 451

St Helens & Knowsley 930 1,039 1,093

Lancashire Teaching 250 219 268

Royal Liverpool & Broadgreen 216 204 233

Other NHS Acute Contract Providers 543 557 462

Other NHS Providers 113 108 110

Independent Providers 2,586 2,531 2,713

NHS Wigan Borough CCG 36,914 36,532 36,760

The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year. The number of Elective Daycase Admissions reported for February (3,291) is 38 below plan. Year to date (April to February) admissions are above plan by 228. The largest growth in year-to-date admissions is at Wrightington, Wigan & Leigh, which are above plan by 532. In contrast, a significant reduction in admissions to Salford (537 below plan) is reported along with a reduction of 163 at Royal Bolton.


Actual 3,185 3,225 3,287 3,504 3,167 3,427 3,669 3,273 3,374 3,358 3,291

Plan 3,474 3,247 3,372 3,455 3,012 3,325 3,569 3,311 3,045 3,393 3,329 3,640

2,600

2,800

3,000

3,200

3,400

3,600

3,800

Actual Plan

532

(488)

2 182

(600)

(400)

(200)

0

200

400

600

WWL Other Contracts Other NHS Independent

Variance

Page 155

Non Elective Admissions Exception Report: 20





Royal Bolton 3,670 3,546 3,386

Salford Royal 1,406 1,473 1,130

Central Manchester 500 496 486



St Helens & Knowsley 343 347 337





Independent Providers 0 0 0


The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year. The number of Non Elective Admissions reported for February (2,357) is 157 below plan, this is the second time in the current financial year that plan has not been exceeded. Year-to-date (April to February) admissions remain above plan by 720. Almost all of this variance can be attributed to Wrightington, Wigan and Leigh, where year-to-date admissions are above plan by 1142.


Actual 2,727 2,866 2,741 2,846 2,788 2,665 2,831 2,593 2,729 2,627 2,357

Plan 2,723 2,734 2,523 2,699 2,638 2,608 2,806 2,490 2,669 2,646 2,514 2,641

2,200

2,300

2,400

2,500

2,600

2,700

2,800

2,900

Actual Plan

1,142

(453)

31 0

(600)

(400)

(200)

0

200

400

600

800

1,000

1,200

1,400


Variance

Page 156

First Outpatient Attendances: All Referrals Exception Report: 21





Royal Bolton 5,538 5,427 5,097

Salford Royal 5,395 5,492 5,239


Warrington & Halton 1,172 1,182 1,057


St Helens & Knowsley 1,955 3,519 2,188



Other NHS Acute Contract Providers 1,511 1,510 1,436




The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year.

The number of first outpatient attendances (all referrals) reported for February (8,551) is 290 above plan. December is the only month in the current financial year where plan has not been exceeded. Year-to-date (April to February) attendances remain above plan by 4,119. This variance can be attributed to attendances at Wrightington, Wigan and Leigh, where year-to-date figures are above plan by 6,039. In contrast, the key out-of-area providers - Royal Bolton, Salford Royal and Central Manchester - are all reporting reductions in activity.


Actual 8,611 8,420 9,380 9,924 8,011 10,033 9,607 9,091 8,400 8,957 8,551

Plan 8,570 8,129 8,939 9,186 7,502 9,115 9,404 8,642 8,460 8,658 8,261 9,250

7,000

7,500

8,000

8,500

9,000

9,500

10,000

10,500

Actual Plan

6,039

(2,093)

32 141

(3,000)

(2,000)

(1,000)

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


Variance

Page 157

Subsequent Outpatient Attendances: All Referrals Exception Report: 22

Trended Monthly Performance Activity Variance By Aggregate: Quarter 3 2014/15

Performance Comments Activity By Provider: Quarter 3 2014/15



Salford Royal 3,335 5,405 3,694


Bolton 2,917 2,815 2,523





Aintree 343 286 346

Other NHS Contract Providers 1,432 1,335 1,283




The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year.

The number of subsequent outpatient attendances (all referrals) reported for Q3: October to December 2014 (65,757) is 462 above plan. Attendances compared to Q3 2013/14 (64,423) are also showing an increase of 1334. Attendances at WWL are above plan by 2,276 and also above the figure reported in Q3 2013/14 by 733. .

Q1 12/13 Q2 12/13 Q3 12/13 Q4 12/13 Q1 13/14 Q2 13/14 Q3 13/14 Q4 13/14 Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15

Actual 68,408 70,965 73,080 72,874 64,664 66,204 64,423 66,552 65,448 67,691 65,757

Plan 62,183 64,747 65,295 66,888

60,000

62,000

64,000

66,000

68,000

70,000

72,000

74,000

Actual Plan

2,276

(2,589)

12

763

(3,000)

(2,000)

(1,000)

0

1,000

2,000

3,000


Variance

Page 158

A&E: Attendances At WWL Exception Report: 23


Month Last Year 2014/15 Plan This Year

April 2014 7,801 7,411 7,493

May 2014 7,739 7,352 7,675

June 2014 7,423 7,052 7,809

July 2014 7,999 7,599 7,928

August 2014 7,370 7,002 7,093

September 2014 7,318 6,952 7,374

October 2014 7,661 7,278 7,541

November 2014 6,988 6,639 7,203

December 2014 7,427 7,056 7,535

January 2015 7,376 7,007 6,779

February 2015 6,821 6,480 6,303

March 2015 7,913 7,517 7,584

WWL Total 89,836 85,345 88,317

Performance Comments

A&E: Monthly Attendances At WWL

WWL A&E Attendances: 2013/14 & 2014/15


Attends 7,493 7,675 7,809 7,928 7,093 7,374 7,541 7,203 7,535 6,779 6,303 7,584

Plan 7,411 7,352 7,052 7,599 7,002 6,952 7,278 6,639 7,056 7,007 6,480 7,517

6,200

6,400

6,600

6,800

7,000

7,200

7,400

7,600

7,800

8,000

8,200

Attends Plan

The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year. A&E attendances for March were above plan by 67, however attendances were below the figure reported in March 2014 (7,913) by 329. Attendances for the full year (April to March 2015) are above plan by 2,972. However, attendances are 1519 lower than the same period of 2013/14 (89,836).


2013/14 7,801 7,739 7,423 7,999 7,370 7,318 7,661 6,988 7,427 7,376 6,821 7,913

2014/15 7,493 7,675 7,809 7,928 7,093 7,374 7,541 7,203 7,535 6,779 6,303 7,584

6,200

6,400

6,600

6,800

7,000

7,200

7,400

7,600

7,800

8,000

8,200

Page 159

Referrals: GP Exception Report: 24





Royal Bolton 3,849 3,808 3,482

Salford Royal 2,947 2,888 3,264











The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year. The number of GP written referrals reported for February (6,510) is 244 above plan. December is the only month in the current financial year where plan has not been exceeded. Year-to-date (April to February) attendances remain above plan by 3,974. The number of referrals to Wrightington Wigan and Leigh for the April to February period (54,104) are 3,769 above plan, which accounts for the majority of the plan variance. Other significant increases are recorded by Salford Royal (376) and Independent Providers (356).


Actual 6,515 6,529 6,921 6,941 5,810 6,787 7,218 6,289 5,704 6,417 6,510

Plan 6,033 5,943 6,182 6,412 5,652 6,335 6,802 5,939 5,772 6,331 6,266 6,579

5,400

5,600

5,800

6,000

6,200

6,400

6,600

6,800

7,000

7,200

7,400

Actual Plan

3,769

(184)

33

356

(500)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000


Variance

Page 160

Referrals: Other Exception Report: 25





Royal Bolton 2,690 2,667 2,162

Salford Royal 4,274 4,242 4,473




St Helens & Knowsley 574 572 575





Independent Providers 15 13 9


The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year. The number of written referrals from other sources reported for February (3,362) is 19 below plan. This is the second time in the current financial year where plan has not been exceeded. Year-to-date (April to February) attendances remain above plan by 2,170. The number of referrals to Wrightington Wigan and Leigh for the April to February period (27,881) are 2,333 above plan, which accounts for the majority of the plan variance. The other significant increase is recorded by Salford Royal (231).


Actual 3,528 3,580 3,912 4,202 3,497 4,165 3,956 3,387 3,310 3,745 3,362

Plan 3,376 3,479 3,358 3,861 3,038 3,777 3,766 3,362 3,530 3,546 3,381 3,656

2,800

3,000

3,200

3,400

3,600

3,800

4,000

4,200

4,400

Actual Plan

2,333

(231)

72

(4)

(500)

0

500

1,000

1,500

2,000

2,500


Variance

Page 161

First Outpatient Attendances: GP Referrals Exception Report: 26





Royal Bolton 3,224 3,178 3,015

Salford Royal 3,022 3,026 3,328

Central Manchester 898 916 750










The CCG reported significant reductions in acute activity during 2013/14, which resulted in the achievement of all activity indicator plans. The CCG has now developed further stretching activity plans, which reflect initiatives to prevent or divert activity from acute trusts, on top of the reductions seen last year. The number of first outpatient attendances following a GP Referral reported for February (5,397) is 236 above plan. Plan has been exceeded in each month of the 2014/15 financial year. As a result, year-to-date (April to February) attendances are now above plan by 2,430. This variance can be attributed to attendances at Wrightington, Wigan and Leigh, where year-to-date figures are above plan by 3,627.


Actual 5,329 5,165 5,752 6,051 4,900 6,100 5,987 5,784 5,222 5,548 5,397

Plan 5,145 4,923 5,566 5,627 4,742 5,725 5,898 5,423 5,143 5,452 5,161 5,760

4,400

4,600

4,800

5,000

5,200

5,400

5,600

5,800

6,000

6,200

Actual Plan

3,627

(1,393)

13 183

(2,000)

(1,000)

0

1,000

2,000

3,000

4,000


Variance

Page 162

Delayed Transfer Of Care: Days Per 100k Population Exception Report: 27

Disputes

Housing: Patients Not Covered By NHS & Community Care Act

Total Days

Trended Monthly Performance Number Of Delayed Days By Responsible Organisation: February 2015

Performance Comments Number Of Delayed Days By Reason For Delay: February 2015

Completion Of Assessment 23

Public Funding 7

Waiting Further NHS Non-Acute Care 142

Awaiting Residential Home Placement Or Availability 0

Awaiting Nursing Home Placement Or Availability 121

Awaiting Care Package In Own Home 28

Awaiting Community Equipment And Adaptions 0

Patient Or Family Choice 0

Non-Acute 222

0

67

388

Number Of Delayed Days By Type Of Care Received: February 2015

Acute 166


Rate 150.70 206.43 209.56 204.46 165.22 198.97 199.36 151.48 196.61 279.36 151.39

Plan 151.48 151.48 151.48 151.48 151.48 151.48 151.48 151.48 151.48 140.46 140.46 140.07

130

150

170

190

210

230

250

270

290

Rate Plan

The rate of delayed transfer of care recorded for February (151.39) is above plan. Year-to-date figure also continues to be above plan at 192.17. There were a total of 388 delayed days during February, of which 265 were NHS responsibility, 103 were Social Care responsibility and the remaining 20 were both. A total of 166 days were recorded as acute care and 222 recorded as non-acute care. The number of days recorded in acute care settings has reduced from the 530 days recorded in January. However, there was an increase in the non-acute figure recorded in January (186). The two most significant reasons for the delays were attributed to: "Waiting Further NHS Non-Acute Care" (142), "Awaiting Nursing Home Placement or Availability (121).

265 103

20

NHS Social Care Both

Page 163

Emergency Readmissions: 30 Days Of Discharge Exception Report: 28

Trended Monthly Readmissions Proportion Of Readmissions By Age Band: April to January 2015

Performance Comments

Gender Readmissions List Size Rate Per 10k

Male 2,143 160,923 133.17

Female 2,334 160,385 145.52

Unknown 245 N/A N/A

CCG Locality Readmissions List Size Rate Per 10k

Wigan Commissioning Consortium 1,211 77,868 155.52

TABA 747 51,069 146.27

North Wigan 740 54,601 135.53

Patient Focus 638 49,190 129.70

Atherleigh 571 44,430 128.52


Unknown 268 N/A N/A

Readmissions By Gender: April to January 2015

Readmission Rate By CCG Locality: April to January 2015


Readmissions 459 545 483 520 459 496 469 421 450 420

Plan 438 490 433 504 468 406 438 397 470 460 423 374

360

380

400

420

440

460

480

500

520

540

560

Readmissions Plan

A total of 420 readmissions within 30 days have been reported for CCG patients during January, the figure is 40 readmissions below plan. The year-to-date (April to January) readmissions figure (4,722) continues to be above plan by 218. The largest proportion (29.8%) of readmissions relate to patients the 65-79 year age band. After considering the 80+ population group, as well, more than half (53%) of all readmitted patients are aged 65+. Year-to-date readmission rates are higher in females (145.52) with the rate for males (133.17). Most localities reported similar year-to-date readmission rates but there is a higher rate reported for Wigan Commissioning Consortium (155.52), with the rate for United League Consortium being the lowest (123.90).

3.9% 13.3%

24.0%

29.8%

24.0%

04-18 years

19-39 years

40-64 years

65-79 years

80+ years

Page 164

** Full Definitions for all indicators can be found via the following link: http://www.england.nhs.uk/wp-content/uploads/2013/12/every-count-tech-def.pdf

Glossary Of Performance Indicators

Potential Years Of Life Lost (PYLL) From Causes Amenable To Health Care: The number of years of life lost per 100,000 registered patients from conditions which are usually treatable. Quality Of Life For People With Long-Term Conditions: Health-related quality of life for people who identify themselves as having one or more long-standing health conditions. Improving Access To Psychological Therapies (IAPT) Acces Rate: Proportion of people that enter treatment against the level of need in the general population i.e. the proportion of people who have depression and/or anxiety disorders who receive phsychological therapies. Avoidable Emergency Admissions Composite Measure: Composite measure of - Unplanned hospitalisation for chronic ambulatory care sensitive conditions; Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s; Emergency admissions for acute conditions that should not usually require hospital admission and Emergency admissions for children with lower respiratory tract infections (LRTI). Patient Experience of Hospital Care: Based on a selection of questions from the National Inpatient Survey, which is completed by a sample of patients aged 16 years and over who have been discharged from an acute or specialist trust, with at least one overnight stay. Friends & Family Overall Score: The Friends and Family Test (FFT) for patients is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care. Patients use a descriptive six point response scale to answer the questions.The scoring methodology is based on the underlying 'Net Promoter Score' (NPS) calculation:

NPS=(extremely likely-extremely unlikely-unlikely-neither)/(extremely likely+likely+neither+unlikely+extremely unlikely) x 100 Patient Experience of Primary Care: Measured by scoring the results of one question, from the GP Patient Survey. The proportion of people who report their overall experience of GP out-of-hours services as good or very good. Reporting of medication-related safety incidents: The number of patient safety incidents at each provider during the reporting period is taken from the National Reporting and Learning System (NRLS) data and a rate per 1,000 total provider bed days is calculated. Dementia Diagnosis Rate: Measures the number of people diagnosed (people on the dementia register) against the dementia prevalence rates publised in Dementia UK report (2007). Improving Access To Psychological Therapies (IAPT) Recovery Rate: The proportion of people who complete treatment who are moving to recovery. Reablement: Still in Service After 91 Days: The proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services. Healthcare Associated Infections MRSA: Number of cases of Methicillin-resistant Staphylococcus aureus (MRSA) both hospital aquired and community aquired. Healthcare Associated Infections Clostridium Difficile: Number of Clostridium Difficile infections both hospital and community aquired. Admissions for Chronic ACS Conditions: Number of people with chronic conditions admitted to hospital as an emergency admission. Admissions for Asthma, Diabetes & Epilepsy (C&YP): Number of emergency admissions for people under 19yrs where asthma, diabetes or epilepsy was the primary diagnosis. Admissions for Acute ACS Conditions: Number of emergency admissions for people with acute conditions (ear/nose/throat infections, kidney/urinary tract infections, heart failure, among others) that usually could have been avoided through better management in primary care. Friends & Family Response Rate: The Friends and Family Test (FFT) for patients is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care. The response rate is calculated as a percentage using the total number of responses received / the total number of of patients eligible to respond to the questionaire. 18W Referral To Treatment (RTT) Admitted Patients: Percentage of admitted pathways within 18 weeks for admittted patients whose clocks stopped during the period on an adjusted basis. Operational standards state that 90% of admitted patients should start Consultant-Led treatment within 18 weeks of referral.

Page 165

http://www.england.nhs.uk/wp-content/uploads/2013/12/every-count-tech-def.pdf

Glossary New for 15-16.xlsx


18W Referral To Treatment (RTT) Non-Admitted Patients: Percentage of non-admitted pathways within 18 weeks for non-admittted patients whose clocks stopped during the period. Operational standards state that 95% of non-admitted patients should start Consultant-Led treatment within 18 weeks of referral. 18W Referral To Treatment (RTT) Incomplete Pathways: Percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the period. Operational standards state that the percentage of incomplete pathways within 18 weeks should equal or exceed 92%. Diagnostics 6+ Week Waiters: Percentage of patients waiting 6 weeks or more for a diagnostic test should be less than 1%. A&E Waits: Total Time Within 4 Hours: Percentage of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge. Cancer: Seen Within 14 Days Of An Urgent GP Referral: Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer. Cancer: Breast Symptoms Seen Within 14 Days: Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer was not initially suspected. Cancer: Treatment Within 31 Days of Decision To Treat: Percentage of patients receiving first definitive treatment within one month (31 days) of a cancer diagnosis (measured from 'date of decision to treat'). Cancer : Subsequent Surgery Treatment In 31 Days: Percentage of patients receiving subsequent surgery within a maximum waiting time of 31 days, including patients with recurrent cancer. Cancer : Subsequent Drug Treatment In 31 Days: Percentage of patients receivng a subsequent/adjuvant anti-cancer drug regimen within a maximum waiting time of 31 days, including patients with recurrent cancer. Cancer : Subsequent Radiotherapy Treatment In 31 Days: Percentage of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31 days, including patients with recurrent cancer. Cancer: GP Referral To Treatment In 62 Days: Percentage of patients receiving first definitive treatment for cancer within 62 days following an urgent GP referral for suspected cancer (All Cancers). Cancer: NHS Screening Referral To Treatment In 62 Days: Percentage of patients receiving first definitive treatment for cancer within 62 days of referral from an NHS Cancer Screening Service for suspected cancer (All cancers). Cancer: Consultant Upgrade To Treatment In 62 Days: Percentage of patients receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status. Ambulance: Category A (Red 1) 8 Minute Response Time: Patients presenting conditions that may be immediately life threatening and the most time critical should receive an emergency response within 8 minutes irrespective of location in 75% of cases. Ambulance: Category A (Red 2) 8 Minute Response Time: Patients presenting conditions that may be life threatening but less time critical than Red 1 should receive an emergency response within 8 minutes irrespective of location in 75% of cases. Ambulance: Category A 19 Minute Response Time: Patients presenting conditions that may be immediately life threatening should receive an ambulance response at the scene witihin 19 minutes irrespective of location in 95% of cases. Mixed Sex Accommodation (MSA) Breaches: All providers of NHS funded care are expected to eliminate mixed-sex accommodation, except where it is in the overall best interest of the patient . The number of occurrences of unjustified mixing in relation to sleeping accommodation (breaches) must be resported for each patient affected. Cancelled Operations Not Treated In 28 Days: Percentage of patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons . Patients should be offered another binding date with 28 days, or the patient's treatment to be funded at the time and hopsital of their choice. If after 28 days of a last minute cancellation the patient has not been treated then a breach is recorded.

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18W Referral To Treatment (RTT) Admitted Patients Waiting >52 weeks: The number of admitted pathways greater than 52 weeks for admitted patients whose clocks stopped during the period on an un-adjusted basis. 18W Referral To Treatment (RTT) Non-Admitted Patients Waiting >52 weeks: The number of non-admitted pathways greater than 52 weeks for non-admitted patients whose clocks stopped during the period. 18W Referral To Treatment (RTT) Incomplete Pathways Waiting >52 weeks: The number of incomplete pathways greater than 52 weeks for patients on incomplete pathways at the end of the period. A&E Trolley Waits >12 Hours: Total number of patients who have waited over 12 hours in A&E from decision to admit to admission. Ambulance Handover >30 Minutes: Percentage of handover delays of longer than 30 minutes. Handover should be fully completed and the patients physically transferred onto hospital apparatus. Ambulance apparatus must have been returned, enabling the ambulance crew to leave the department. Ambulance Handover >60 Minutes: Percentage of handover delays of longer than 60 minutes. Handover should be fully completed and the patients physically transferred onto hospital apparatus. Ambulance apparatus must have been returned, enabling the ambulance crew to leave the department. Inpatient Admissions: Elective Ordinary: Number of general & acute (G&A) elective ordinary admissions. Inpatient Admissions: Elective Daycase: Number of general & acute (G&A) daycase admissions. Inpatient Admissions: Total Elective: Total number of general & acute (G&A) all elective admissions (ordinary + daycase). Inpatient Admissions: Non-Elective: Number of general & acute (G&A) non-elective episodes. First Outpatient Attendances: All Referrals: Total of all first outpatient attendances (consultant-led) in general & acute (G&A) specialties. Subsequent Outpatient Attendances: All Referrals: Total number of consultant-led subsequent attendance appointments, in general & acute (G&A) specialties. Accident & Emergency: Attendances At Wrightington Wigan & Leigh NHS Foundation Trust (WWL): Total number of attendances at WWL Accident & Emergency department. Referrals GP: Number of GP written referrals for a first outpatient appointment in G&A specialties. Referrals Other: Number of Other referrals for a first outpatient appointment in G&A specialties. Referrals Total: Total number of all referrals for a first outpatient appointment in G&A specialties. First Outpatient Attendances: GP Referrals: Number of first outpatient attendances (consultant-led) following a GP referral in G&A specialties. Residential Care: Permanent Admissions Aged 65+: Rate of permanent admissions to residential and nursing care homes, per 100,000 population. Reablement: Still In Service After 91 Days: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services Delayed Transfer Days: Rate Per 100k Population: Rate of delayed transfer days per 100,000 population. Number of delayed days reported when the patient is ready to depart from an acute or non-acute setting and is still occupying a bed. Avoidable Admissions: Rate Per 100k Population: Rate of avoidable admissions per 100,000 population. Emergency Readmissions: Within 30 Days Of Discharge: Number of emergency admissions for people who returned to hospital as an emergency within 30 days of the last time they left hospital after a stay.

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MEETING: Governing Body Item Number: 9.1 DATE: 28 April ......3. WORKING WELL (Theresa Grant, CE, Trafford Council) Theresa Grant is the Lead CE for Greater Manchester employment and

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