1 NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: ……10………………… Date of Meeting: …….24 th March 2017……. TITLE OF REPORT: CCG Corporate Performance Report AUTHOR: Melissa Laskey – Director of Service Transformation Mike Robinson – Associate Director Integrated Governance & Policy Victoria Preston – Senior Information Analyst Melissa Surgey – Head of Planning, Performance and Policy PRESENTED BY: Barry Silvert - Clinical Director of Commissioning PURPOSE OF PAPER: (Linking to Strategic Objectives) The purpose of the attached report is to highlight performance against all the key delivery priorities for the CCG in 2016/17 against which NHS Bolton Clinical Commissioning Group is nationally measured LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): Delivery of Year 1 Locality Plan. Joint collaborative working with Bolton FT and the Council. Supporting people in their home and community. Shared health care records across Bolton. Regulatory Requirement Standing Item X RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) Members are requested to note the content of the report and actions being taken where required to improve performance COMMITTEES/GROUPS PREVIOUSLY CONSULTED: Performance is reported to: CCG Clinical Executive Contract Performance Group Quality and Safety Committee REVIEW OF CONFLICTS OF INTEREST: N/A
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: ……10………………… Date of Meeting: …….24th March 2017……. TITLE OF REPORT:
CCG Corporate Performance Report
AUTHOR:
Melissa Laskey – Director of Service Transformation Mike Robinson – Associate Director Integrated Governance & Policy Victoria Preston – Senior Information Analyst Melissa Surgey – Head of Planning, Performance and Policy
PRESENTED BY:
Barry Silvert - Clinical Director of Commissioning
PURPOSE OF PAPER: (Linking to Strategic Objectives)
The purpose of the attached report is to highlight performance against all the key delivery priorities for the CCG in 2016/17 against which NHS Bolton Clinical Commissioning Group is nationally measured
LINKS TO CORPORATE OBJECTIVES (tick relevant boxes):
Delivery of Year 1 Locality Plan. Joint collaborative working with Bolton FT and the Council.
Supporting people in their home and community.
Shared health care records across Bolton. Regulatory Requirement Standing Item X
RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting)
Members are requested to note the content of the report and actions being taken where required to improve performance
COMMITTEES/GROUPS PREVIOUSLY CONSULTED:
Performance is reported to: CCG Clinical Executive Contract Performance Group Quality and Safety Committee
REVIEW OF CONFLICTS OF INTEREST:
N/A
2
VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT:
Patients’ views are not specifically sought as part of this monthly report, but it is recognised that many of these targets such as waiting times are a priority for patients. The report does include performance against the ‘Friends and Family Test’ at Bolton FT
OUTCOME OF EQUALITY IMPACT ASSESSMENT (EIA) AND ANY ASSOCIATED RISKS:
against all the key delivery priorities for the month of January 2017 (Month 10).
1.2 Appendix 1 contains the detailed reports for each set of performance indicators the CCG is measured against: - Bolton CCG Objectives - Board Assurance Framework - NHS Constitution Standards - Key NHS Contractual Measures - Outcome & Quality Framework Indicators - Community Services Key Performance Indicators - CCG Quality Indicators - Mental Health Dashboard
1.3 Section 2 exception reports against all indicators. 2 Exception Reporting 2.1 Quality & Safety – Board Lead, Dr Colin Mercer 2.1.1 Healthcare Associated Infections
There were four Bolton FT apportioned Clostridium Difficile toxin (CDT) positive cases in January. This takes the annual figure to 34 against the NHS England set target of 19. The FT’s Harm Free Care panel identified two cases where there were no lapses in care. In the other two cases the panel identified delays in diagnosis and isolation that could have been prevented, although treatment was appropriate. In all cases to date there is no evidence of cross transmission. Current initiatives that are in place to reduce CDT cases were reported in last month’s Corporate Performance Report. The FT are commissioning an external review of their infection control practice to ensure improvement plans are appropriately focused. The FT continues to play a valuable role in the Bolton Infection Prevention and Control Committee (IPCC). Their Community Team has played an integral role in the management of a number of influenza outbreaks in care homes over the winter months. There were no Bolton FT apportioned MRSA cases in January and work continues to prevent further cases. The IPCC has determined that high risk patients discharged from hospital care will receive prophylaxis and education as required from the Community IPC and district nursing teams. The CCG and Bolton Council are ensuring advice and education is in the service specifications for providers of drug and alcohol services in Bolton. A number of
4
these bacteraemia are contaminants often linked to urgent care, so the FT are working closely with teams in this area to encourage good practice and prevention. All MRSA cases undergo a full Root Cause Analysis (RCA) which is shared at the IPCC.
2.1.2 Serious Incidents (SIs)
There were three SIs at Bolton FT reported in January. Two related to neonatal care and one related to a blood transfusion. These are being fully investigated by the FT and will be reviewed by the CCG’s SI Review Group. The management of SIs by Bolton FT continues to be open, transparent and timely with reviews of a good quality.
2.1.3 Falls
Patient falls were above threshold in January with 117 incidents reported against a threshold of 82. There have been 1010 cases reported against a year to date (YTD) threshold of 820. The overall trend of harms resulting from falls continues to reduce. Bolton FT and the CCG are part of the Bolton Falls Collaborative. As part of any RCA investigators consider the reasons for and appropriateness of admission.
2.1.4 Workforce
Sickness absence measured on a 12 month rolling average basis has reduced slightly to 5.27% compared to 5.34% in December. Actions to remedy this as detailed in last month’s Corporate Performance Report include:
• Understanding that short term absence has increased and that many of the FT’s peers do better against this measure
• Boosting compliance with return to work interviews • Reviewing our occupational health service • Informal interventions to address dignity at work issues • Offering mindfulness training to staff • Noting the impact organisational change and work related pressure can
have on sickness absence 2.1.5 Mixed Sex Accommodation (MSA)
There were a further 18 breaches of the standard in January. Five were in the Adult Acute division and were due to delays in specialty bed availability. Two were in the Elective division and also due to delays in specialist beds. YTD there have been 95 reported cases. This has been escalated to the Greater Manchester Health and Social Care Partnership (GMHSCP) who are supporting the CCG and FT in minimising breaches.
5
2.2 Commissioning – Board Lead, Dr Barry Silvert
2.2.1 Reduce Non-Elective Admissions
The CCG has a target for a reduction of 2.1% of non-elective admissions in 2016/17 (based on 2015/16 outturn). In January there were 2,909 non-elective admissions across all providers. This represents a decrease of 18 non-elective admissions compared to January 2016 (2,927). This gives a YTD position of 29,073 emergency admissions compared to 28,952 for the same period last year (a 0.4% increase). Ongoing work continues between the CCG and FT to support the reduction in non-elective admissions, with the key programmes being: • Expansion of the Ambulatory Care Unit (ACU) at Royal Bolton Hospital to
cover medical and surgical specialties 7 days a week. Progress is being made with this and activity is increasing due to improvements in pathways and processes.
• Ongoing development of Intermediate Tier services (including the Admission Avoidance Team and full use of the Integrated Neighbourhood Teams).
• Work with NWAS on the extended use of ‘hear and treat’ and ‘see and treat’ including additional referral pathways for paramedics to use to reduce conveyances to hospital.
• Work with BARDOC and NWAS on the development of a “Clinical Hub” to align with GM strategic direction of travel.
• Work with BARDOC and NWAS on Alternative to Transfer services in and out of hours, which went live on the 23rd February and activity is being monitored. This will be reported in future Corporate Performance Reports.
2.2.2 Reduce Non-Elective Length of Stay
The target for non-elective length of stay for 2016/17 is 4.4 days. In January the length of stay increased to 4.8 days (from 4.6 days in December 2016). The YTD position is 4.6 days. The CCG, Bolton FT and Bolton Council are working collaboratively to reduce delayed transfers of care (DTOC), medical outliers in the hospital and streamline the discharge process. These are the main contributing factors to the increase in length of stay against the strategic plan. The DTOC lists are closely monitored and action taken jointly by health and social care partners.
2.2.3 Reduce Emergency Readmissions
The number of emergency readmissions in January was 461 which is a decrease of 4 from December 2016 (465). The YTD position is 8.88% below plan.
2.2.4 NHS Constitution Targets
6
A&E 4 hour performance (target 95%) for February 2017 was 85.24%, an improvement in the performance of January. This is in part as a result of the new streaming model and improvement in flow within the hospital. The CCG and Bolton FT continue to work closely together to implement a series of actions to help to alleviate the pressure across the urgent care system including the pilot model of streaming primary care appropriate patients within the A&E Department. As previously reported to Board this model expanded its operating hours in December 2016. The initial data that has been analysed as part of the evaluation of the pilot shows that 2401 patients have been streamed to primary care, between the 15th December 2016 and the 28th February 2017. The scheme continues and a sustainable long term model for the continuation of the pilot is currently being considered in line with emerging national guidance. In February, NWAS failed the national target for Emergency Response arriving within 8 minutes with performance of 70.1% (against the Red 1 target of 75%). This does however show a significant improvement from January performance which was 58.8%.The two other national targets also failed. Red 2 performance for February was 58% (against a target of 75%) and the Category A 19 minute response performance was 89.6% (against a target of 95%). Again, although both targets have failed, there has been some improvement from performance in January. The CCG continues to encourage the use of the NWAS ‘see and treat’ and ‘hear and treat’ as alternatives to ambulance conveyances to A&E. January’s performance for ‘see and treat’ (23%) had remained consistent whereas ‘hear and treat’ (14%) has increased by 1%. Both 16/17 YTD performance figures remain above plan and compare positively across Greater Manchester. As mentioned earlier in the report, Bolton is now live with the NWAS and BARDOC, 24/7 Alternative to Transfer service, enabling appropriate patients to receive primary care treatment rather than being conveyed to A&E by an ambulance crew.
Performance for the incomplete RTT pathway standard for January was 90.5% of patients waiting less than 18 weeks for planned procedures, against a threshold of 92%. It has previously been highlighted to Board that performance against this standard has continued to show a steady decline throughout 2016/17. This is coupled with an increase in referrals in certain specialties. Of all admitted patients treated in January, 83.4% were seen and treated within 18 weeks (against a threshold of 90%). This is a 1.2% increase compared to the December 2016 position. Of all non-admitted patients treated in January, 90.6% were treated within 18 weeks (against a threshold of 95%). Analysis continues to demonstrate that this position is largely due to availability of beds at Royal Bolton Hospital, with a noted relationship between high emergency demand, delayed transfers of care, medical outliers and elective cancellations. A recovery plan has been developed by the Elective Division at Royal Bolton Hospital, but this will be heavily impacted upon due to continued pressures arising from non-elective demand. The 6 week diagnostic waiting time standard for all Bolton CCG providers was failed in January with 1.29% of patients waiting longer than 6 weeks for their
7
diagnostic procedure, against a threshold of 1%. This is a deterioration of 0.16% on the position seen in December 2016. However Bolton FT achieved performance of this standard for January. Notable pressure areas remain around endoscopy due to the known increase in demand nationally. The commissioning team is currently working with Bolton FT to facilitate inter-provider pathway developments with In Health to make best use of all commissioned endoscopy capacity. An updated recovery positon is awaited from Central Manchester NHS Foundation Trust, with pressure areas also noted to be endoscopy. The CCG failed the 62 day target for wait from referral from an NHS screening programme to first definitive treatment for cancer in January with performance of 88.2% against 90%. This represents two breaches of 17. A full analysis of these breaches is currently being undertaken. However the CCG is meeting all national cancer targets YTD.
2.2.5 NWAS 111 Performance/OOH
Most recent data from February indicates 2,739 calls were triaged through the 111 system. This is a decrease of 502 calls from January 2017 (3,241 calls). Of the 2,739 patients triaged, 269 (10%) were recommended to attend A&E, 411 (15%) resulted in an ambulance being dispatched, 1,411 (52%) were referred to primary or community care services and 586 (21%) were advised for no further treatment or services. The development of the “Clinical Hub” model will help to stream appropriate patients to other services to meet their needs rather than A&E. The CCG are currently working with Greater Manchester colleagues, BARDOC and NWAS to scope this model and implementation.
2.2.6 Contractual Performance
In February there were 267 patient handovers (from ambulances to A&E) where patients waited between 30 and 59 minutes and 157 handovers where patients who waited more than 60 minutes (against a target of 0 for both). Although these targets continue to fail, February has seen some improvement, particularly in the reduction of patients who have waiting more than 60 minutes (42% reduction from January 17). As previously highlighted to the Board, work is ongoing through a collaborative group to focus on Urgent Care Key Priority 3: The Ambulance Response Programme. Regular operational meetings are in place with Bolton FT and NWAS with the support of the CCG and work is underway to establish best practice across Greater Manchester with a view to learn and improve processes. Stroke performance data is available up to December 2016, when the service saw a decline in performance, with 60.6% of patients spending at least 90% of their stay on a stroke unit against the target of >80%. The performance for patients arriving within a designated stroke bed within 4 hours of arrival also declined to 60.7% against the target of >80% due to non-elective bed pressures.
8
2.2.7 Mental Health The January position for CPA was 100% against a target of 95% with performance improving from the December position of 93.3%. The YTD remains above target at 97.6%. There were no 7 day follow up breaches in January. Performance against the Improving Access to Psychological Therapies (IAPT) recovery rate (combined figures for GMMH and 1 Point) was achieved in January with performance of 55% against a target of 50%. The YTD recovery rate is 51.2%. The access rate has risen slightly but the IAPT service failed the 15% target in January, with performance at 11.9%. There were significantly lower numbers reported ‘entering treatment’ and a lower number of referrals being reported compared to the expected volume. The YTD position has further deteriorated to 13.6% in January as a result. A provider/commissioner meeting was held to review performance and an urgent action plan is in progress. GMMH also noted some staffing vacancies which may have contributed to a decreased number of contacts, but assurance has been given that the service will be fully staffed with full caseloads by the end of April. The combined IAPT service continued to achieve both the 6 week and 18 week access targets in January with 90.9% of people beginning treatment in 6 weeks (against a target of 75%) and 100% beginning treatment within 18 weeks (against a target of 95%). Key performance highlights from the mental health dashboard for January include:
• Acute OATS (Out of Area Treatments) – no new patients were placed out of area in January.
• The RAID service in Bolton achieved all response time targets seeing 89.3% of referrals within 1 hour (against a target of 75%), 97.2% within 2 hours and discharged (against a target of 95%), and 93.3% of referrals within the 4 hour target (against a target of 95%), this percentage has fallen due to periods of high activity (particularly outside of office hours) when RAID received multiple referrals. There have also been a number of clinically complex cases that have resulted in waits over 4 hours (but not over 12 hours).
• The Early Intervention in Psychosis (EIP) service exceeded the 50% access target with 92.3% of people accessing the service within 2 weeks during January 2017. Activity has decreased in comparison with previous months (average now is 13 per month compared to an average of 19 per month from April – November).
2.2.8 Maternity The national 12+6 target is for 90% of women to receive a full health and social care risk assessment and booking by a midwife before 12 weeks and 6 days of pregnancy. The 12+6 data for February is not yet available and will reported in next month’s Corporate Performance Report. The performance reported in last month’s Corporate Performance Report of 79.8% for all bookings at trust level and 82.2% at
9
CCG level has been found to have data quality issues since publication of the last report. This is due to how patients transferring to Bolton FT maternity care after 12+6 were being recorded. Bolton FT and the CCG are aware of this issue and appropriate action is being taken to rectify this error. Accurate performance data for January and February will be reported in next month’s Corporate Performance Report. 2.2.9 Community Services Dashboard Detailed below are the key highlights from the overarching community services dashboard for January.
Overall waiting times for community services (adults) have seen a slight improvement during January when compared with the previous monthly position of 72.4%, with performance across the services at aggregate level now at 74.9% for referrals seen within agreed targets. Children’s services wait times year to date are closer to plan at 78.9% against the default 90% target. Referrals to children’s community teams have progressively increased over the last few months with a further increase seen in January (2,300 GP and Other source against a target of 2,148). Referrals to Adult services from a GP source are below plan in January 2017 at 2,371 compared to a target of 2,601. ‘Other’ sourced referrals are above plan YTD mostly to the diabetes service.
Referrals to the Integrated Neighbourhood Teams increased in January 2017 to 217 (from 158 in December) however was still below the monthly target of 293. Cumulative year to date referral activity is 2,226 referrals against a plan of 2,930 (75.9%). The Joint Commissioning Data Group which meets monthly have produced a single source of data ‘core’ KPI’ report covering the top 10 selected KPIs for performance monitoring the service which is in the final stages of development. The CCG, Bolton Council and the FT have all contributed to the definitions and resolved several issues relating to the data sources and quality of the data captured.
Further development of the KLOE comprehensive integration dashboard is underway to map the outcomes of the Better Care Fund schemes against the services contributing towards these outcomes. This visually demonstrates the overall impact of schemes in place and will be used for monitoring performance against plan. Intermediate Tier services have been included in the latest iteration of this KLOE report along with a number of supporting measures for the local and GM priorities to investigate the redrafted measures in more detail. Admission avoidance referrals seen within 48 hours are performing at 91% YTD against a plan of 90% however there are a number of services failing to meet the required thresholds in particular the seen within 5 working days target most notably Integrated Neighbourhood Teams, District Nursing Treatment Rooms, MSK Physio, Neurology Long Term Conditions and Rheumatology. 2.4 TIA Services The CCG Executive has considered the future provision of TIA services, given the ongoing concerns that have been reported to Board previously, with regard to the poor performance of the TIA service in Bolton.
10
Bolton FT recently put forward a proposal to provide a 7 day service, however this did not include a full 7 day model with weekend Doppler access.
The Executive has recommended that discussions commence with Salford Royal Foundation Trust (SRFT) regarding the future provision of the service so that Bolton patients receive their investigations and treatment from Salford Royal hospital. The rational for this is as follows:
• Salford Royal is the hyper acute unit for stroke and the public are aware of the specialist nature of the Trust.
• SRFT’s performance against the current TIA target is consistently at 100%. • The SRFT model that has been agreed gives assurance, that if the Bolton activity
transfers, the service will be developed to a 7 day service via an ambulatory care model with a one stop shop including Doppler access on all 7 days.
2.5 Child and Adolescent Mental Health Service (CAMHS) The CCG has commenced a programme of work to develop a new service specification for CAMHS and will secure a new provider through an open procurement process in order to ensure the ongoing sustainability of the service. A comprehensive outcome based service specification has been drawn up by CCG and Bolton Council commissioners, based on best practice and national evidence. This has been supported by clinicians and service users and will be further refined through the planned wider engagement in co-design during March and April 2017. The new model moves away from the traditional clinically-focussed service delivery and focuses on the I-thrive model, which puts the individual at the heart of decision making. High level timescales for the completion of an open procurement process begins with a Request For Information (RFI) which is due to be published by 24th March 2017. Consultation and engagement of the proposed service model is underway and will conclude by mid-April. The Invitation To Tender will be issued to bidders by end June 2017 and the expected start date of the new service will commence on or before April 2018. 3 Recommendations
The Board is asked to note the performance for January 2017 and the actions being taken to rectify areas of performance which are below standard.
Melissa Laskey – Director of Service Transformation 22nd March 2017
Appendix 1
2 Bolton CCG Objectives
3 Board Assurance Framework dashboard
4-5 NHS Constitution Standards
6-8 Key NHS Contractual Measures
9 Outcome & Quality Framework Indicators
10-13 Community Services Key Performance Indicators
14-16 CCG Quality Indicators
17-21 Mental Health Dashboard
Appendix 2
22-33 Integrated Care Performance Report
Index
Objective Key Measures of Success (Goals)
From (2011/12)
2015/16 for
Emergency
admissions)
To 2015 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD YTD Position Comments
Reduce the gap in life expectancy
between Bolton and England 2.05 years (2010)
1.85 years
(2015)
For 2010-2012 Male 1.8 Female 1.6
Reduce the gap in life expectancy
between the most and least deprived
areas in Bolton 1
m13.5 f11.5 m13
f11
Data not yet
available
For 2006-2010 Male 13.5 Female 11.3
Achievement of all key targets / NHS
Constitution Several failing All achieved 7 7 7 7 10 10 7 8 9 8
Bolton CCG Board Assurance Framework Dashboard - January 2017
Strategic Objective Milestones and Key Performance Indicators Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Comment/ Current Position
Appraisal of locality plan (and supporting of CBAs) by all organisations and sign off by H&WBB HWBB signed off 9.12.16
Transformation Fund proposal approvalTarget date
£28.8m approved for Bolton March 17. Exec meeting with GM/JR & Chief Execs 6.3.17
Receipt of Transformation FundingTarget date
16/17 funding announced March 2017
Implementation of identified work programme milestones for 16/17 Target date
Implementation plans in development
Aligned Incentive Contract in place and monthly monitoring
17/18 contract signed
Agreement of LCO model for phased implementation from 17/18 Target date
Development of integrated commissioning models for implementation from 17/18
Target date
CCG & Council commissioning leads are working in a collaborative manner.
Discussions about more formal arrangements are taking place with
HWB Exec
Establish 7 day GP access
People still in own home 91 days post discharge from reablement *
Target for 16/17 set at 86%
INT Activity meeting Plan Ongoing work to strengthen INTs working in primary care. Oct 2016
data shows target for INTs achieved for first time.
Reduced admissions to permanent placements in residential/nursing homes **
Bolton BCF2. Benchmarking data from June 2016 placed Bolton as the second highest in GM.
Hospital Activity Reducing (changed Q3 from Elective Activity)
-2.1% reduction on previous year activity end Qtr 3
Partners engaged and signed up to information sharing
43 of 50 GP Practices signed up. Info Sharing Protocol signed by Partner organisations
Communications messages developed and shared with staff, professionals and patients Target date
Engagement ongoing from Aug 2016 - website now live.
System live in early adopter practicesTarget date
9 Early Adopter practices covering 25% population due March 17
System in use in A&E and Out of HoursTarget date
On Track
KEYGreen Achieved
Yellow On Track
Red Off Track ** ICS&P Group agreed original target for this measure was unachievable due to baseline year activity changes. Therefore, plan will be amended for 2017/18
1. Deliver Year 1 of Bolton Locality Plan
2. Show that Bolton is truly working together: New type of contract with Bolton FT, Jointly develop with Bolton Council new commissioning models
3. Support more people in their own homes and communities, improve patient safety through better GP access, community services, INTs
4. Enable shared health & social care records across Bolton
*Data source for this measure still being updated since migration to liquid logic by Bolton Council Sept 2016
Referral to Treatment waiting times for non urgent consultant led treatment - All Providers
Maximum one month (31 day) wait from diagnosis to first
definitive treatment for all cancers 96% 96.2% 99.1% 96.6% 99.1% 94.4% 95.0% 96.7% 97.0% 100.0% 100.0% 97.3% A
Maximum 31 day wait for subsequent treatment where that
treatment is surgery 94% 94.4% 100.0% 96.6% 88.2% 86.7% 88.2% 100.0% 100.0% 100.0% 100.0% 95.9% A
Maximum 31 day wait for subsequent treatment where the
treatment is an anti-cancer drug regimen98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A
Maximum 31 day wait for subsequent treatment where the
treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A
Maximum two month (62 day) wait from urgent GP referral to first
definitive treatment for cancer 85% 96.2% 96.0% 92.3% 93.2% 92.1% 88.7% 92.6% 94.5% 96.0% 97.9% 93.9% A
Maximum 62 day wait from referral from an NHS screening
service to first definitive treatment for all cancers90% 100.0% 87.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 88.2% 96.7% A 2 breaches out of 17
Maximum 62 day wait for first definitive treatment following a
consultants decision to upgrade the priority of the patients (all
cancers)
none set 100.0% 100.0% 100.0% 80.0% 100.0% 100.0% 87.5% 88.9% 85.7% 85.0% 89.6% A
Category A calls resulting in an emergency response arriving
within 8 minutes (Red 1) 75% 76.47% 74.30% 73.10% 70.45% 72.60% 69.49% 64.59% 62.80% 61.63% 61.79% 68.29% F
Category A calls resulting in an emergency response arriving
within 8 minutes (Red 2)75% 67.46% 66.30% 66.20% 62.69% 65.25% 61.75% 63.05% 60.35% 57.31% 58.78% 62.76% F
Category A calls resulting in an ambulance arriving at the scene
within 19 minutes 95% 92.01% 91.50% 91.50% 89.81% 91.09% 89.04% 88.23% 86.79% 85.42% 85.74% 88.99% F
All handovers between ambulance and A&E must take place
within 15 minutes (no of patients waiting >30 mins<59 mins)
Bolton FT
0 215 198 161 218 173 172 274 276 255 293 2235 F
All handovers between ambulance and A&E must take place
within 15 minutes (no of patients waiting >60 mins) Bolton FT0 132 165 89 139 88 115 206 217 259 269 1679 F
All patients identified as being at risk will have a body map completed and
appropriate individualised care plan (8.3)90% 84.0% 90.0% 93.0% 89.0% 90.0% 93.0% 91.0% 86.0% 88.0% 89.0% 89.30%
All patients will have a nutritional assessment within 6 hours of admission (6.3) 90% 90.0% 93.0% 94.0% 93.0% 92.0% 93.0% 95.0% 87.0% 94.0% 92.0% 92.30%
Awaiting activity QOL Wheel data for October onwards
61% Accept rate
Increase
Accept rate %
AA
TH
SR Home Support Reablement
SW Staying Well
DC Darley Court
LL Laburnum Lodge
Admission Avoidance Team (AAT)
Note - From August 2016, all bed based referrals are received by Darley Court
Note - From August 2016, all bed based referrals are received by Darley Court
IMC
H
Intermediate Care at Home
Page 4 of 9Better Care Fund Indicators
Non-elective emergency admissions per 100,000 population
Greater Manchester CCGs (2016/17 Qtr. 2) TNR DATA
In the final quarter of 2015/16, 70.1% of patients were still at home 91 days after discharge to
reablement/rehabilitation services which was a reduction from the 78.9% performance reported in
Qtr3 and much lower than the target position of 86%. This figure however will be refreshed once the
annual data has been published which also takes into account mental health activity.
Latest performance for Qtr2 2016/17 is 79.0% which is in line with 2016/17 Q1 performance but
below the target value of 88.6% as per the most recent submitted BCF ambitions and also below the
87.0% as reported in Q2 of 2015/16. The aim is to increase the proportion of people still at home 91
days after discharge to reablement to meet the level seen in 2012/13 (86%) note that for Q2 this only
includes data up to 9th September due to migration from Care first to Liquid Logic. Update March
2017 - awaiting data for intermediate tier in liquid logic
In relation to the benchmarking against Greater Manchester cluster median values Bolton Local
BCF3. Proportion of older people (aged 65 and over) who were still at home 91 days after
discharge from to reablement/ rehabilitation services
Proportion of older people (aged 65 and over) who were still at home 91 days after
discharge from to reablement/ rehabilitation services
Non-elective emergency admissions to all acute providers - Bolton CCG patients
Emergency Admissions in January 2017 were -0.6% (18 x NELs) lower than the same period in
2015/16 and year to date performance is now just 0.4% higher than the same period in 2015/16.
On a rolling 12m basis the baseline activity Feb 2015 to Jan 2016 was 34,671 emergency admissions.
The actuals for the latest rolling 12m Feb 2016 to Jan 2017 is 34,886 which is an increase of 215
admissions (0.62%). Overall 2016/17 NELs are 4.8% higher than plan (Apr-Jan).
The benchmarking of NEL per 100,000 across Greater Manchester for Qtr. 2 2016/17 shows Bolton
CCG in 4th lowest position at 4.0% below the median (previously 3rd lowest in Q1).
BCF1. Emergency admissions
BCF2. (also GM3) Permanent admissions of older people (aged 65 and over) to residential
and nursing care homes (Lower Better)
In the BCF submission, Bolton was set an ambition to decrease the number of permanent admissions
to nursing and residential care homes (per 100,000 population) to 752.6 in 2015/16 and no more
than 768.1 in 2016/17. At the same time, the number of people aged over 65 in Bolton is projected to
grow by 1.9% from 2014/15 to 2015/15 and by a further 1.1% in 2016/17.
The methodology used to calculate this measure from 'actual admissions to residential care' to
'intended admissions to residential care' has changed in the last 12m which has led to a parallel
running of this measure with the old and new outcomes.
The latest position for Jan 2017 is 811.6 per 100,000 population (2014 Aqua definition). YTD to
January 2017 is 4.6% lower than same period in 2015/16. Benchmarking information published in
October 2016 placed Bolton 2nd worst within Greater Manchester and 3rd worst in the whole North
West.
Long-term support needs of older adults (ages 65yrs+) met by admission to
residential and nursing care homes per 100,000 population 2015/16
Proportion of older people (aged 65 and over) who were still at home 91 days after
discharge from to reablement/ rehabilitation services Greater Manchester 2015/16
Permanent admissions to residential and nursing care (per 100,000 population)
Manch
est
er
Bo
lto
n
Salfo
rd
Wig
an
Ro
chd
ale
Bury
Tam
esi
de
Sto
ckp
ort
Old
ham
Tra
ffo
rd
0
10
20
30
40
50
60
70
80
90
100
%
Still
at
ho
me 9
1 d
ays
aft
er
dis
charg
e
Local Authority
Local Authority rate Median
75th centile 90th centile
Manch
est
er
Sto
ckp
ort
Tra
ffo
rd
Tam
esi
de
Wig
an
Ro
chd
ale
Bury
Old
ham
Bo
lto
n
Salfo
rd
0
100
200
300
400
500
600
700
800
900
1,000
Ad
mis
sio
ns
per
100,0
00 p
op
ula
tio
n
Local Authority
Local Authority rate Median 75th centile 90th centile
2,200
2,400
2,600
2,800
3,000
3,200
3,400
Ap
r-2014
May-
2014
Jun-2
014
Jul-
2014
Aug
-2014
Sep
-2014
Oct
-2014
No
v-2014
Dec-
2014
Jan-2
015
Feb-2
015
Mar-
2015
Ap
r-2015
May-
2015
Jun-2
015
Jul-
2015
Aug
-2015
Sep
-2015
Oct
-2015
No
v-2015
Dec-
2015
Jan-2
016
Feb-2
016
Mar-
2016
Ap
r-2016
May-
2016
Jun-2
016
Jul-
2016
Aug
-2016
Sep
-2016
Oct
-2016
No
v-2016
Dec-
2016
Jan-2
017
Num
ber
of
ad
mis
sio
ns
Month
So
uth
Manch
est
er
Sto
ckp
ort
Salfo
rd
Heyw
oo
d, M
idd
leto
n &
Ro
chd
ale
No
rth M
anch
est
er
Tam
esi
de &
Glo
sso
p
Old
ham
Tra
ffo
rd
Bo
lto
n
Wig
an B
oro
ug
h
Bury
Centr
al M
anch
est
er
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
NEL
Ad
mis
sio
ns
per
100,0
00
CCG RED
827.0 807.4
756.8
790.5 811.6
768.1
1,009.6 991.6
600
700
800
900
1,000
1,100
1,200
2010/1
1 F
Y
2011/1
2 F
Y
2012/1
3 F
Y
2013/1
4 F
Y
2014/1
5 F
Y
2015/1
6 F
Y
2016/1
7 Q
tr 1
2016/1
7 Q
tr2
2016/1
7 Q
tr 3
2016/1
7 Q
tr 4
(Ja
n)
2014 AQUA Definition BCF Ambition (AQUA definition)
2015 ASCOF Definition (Annual)
52.3%
79.7%
85.9%
78.5%
79.9%
79.1%
87.0%
78.9%
70.1%
78.8% 79.0%
82.1%
86.0% 88.6%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
2010/1
1
2011/1
2
2012/1
3
2013/1
4
2014/1
5
2015/1
6…
2015/1
6…
2015/1
6…
2015/1
6…
2016/1
7…
2016/1
7…
2016/1
7…
2016/1
7…
% s
till
at
ho
me 9
1 d
ays
aft
er
dis
charg
e
GREEN
RED RED
RED RED
NOTE: Q4 15/16 awaiting annual refresh value as current % does not include mental health
BCF KLOE Page 4
Page 5 of 9Better Care Fund Indicators
Non-elective emergency admissions per 100,000 population
Greater Manchester CCGs (2016/17 Qtr. 2) TNR DATA
Non-elective emergency admissions to all acute providers - Bolton CCG patientsBCF1. Emergency admissionsBCF4. Delayed transfers of care (total number of delayed days)
BCF6. Referrals to home based intermediate care
BCF5. Overall satisfaction of people who use services with their care and support
The National Audit for Intermediate Care in 2012/13 identified that Bolton was an outlier with regard
to the number of intermediate care beds commissioned and intermediate tier services are now being
refocused on home based services. In 2012/13 the Greater Manchester average was 522 referrals per
100,000 population. This has been set as a target for Bolton to reach by 2015/16, which equates to
1,136 actual referrals. The left chart shows that Bolton exceeded this target in 2014/15 and the
second chart on the right shows the performance in 2015/16 which is also exceeding the planned
target.
The number of referrals to home based intermediate care was 1,879 for 2015/16 FY. As at January
2017, the current YTD totals are exceeding plan by 7.4%. (Data includes referrals to IMC@ Home plus
AAT discharges to Laburnum Lodge and Darley Court.)
Overall satisfaction of people who use services with their care and support (2014/15)
Actual Number of referrals to home based intermediate care in Bolton
Overall satisfaction of people who use services with their care and support
Number of referrals to home based intermediate care in Bolton
This metric was chosen because it is the nearest equivalent measure to a new metric which is under
development for both the NHS Outcomes Framework and the Adult Social Care Outcomes
Framework, “Improving people’s experience of integrated care”.
The metric is the proportion of respondents who say they are "extremely satisfied" or "very satisfied"
in response to the question "Overall, how satisfied or dissatisfied are you with the care and support
services you receive?”.
In 2014/15 Bolton scored 61.2%, below the median score for Greater Manchester. In 2013/14 Bolton
scored 65.6%, just above the median. In the BCF submission, an ambition was set to reach 66.6% in
2014/15 and 67.6% in 2015/16.
Delayed transfers of care - total delayed days for Bolton patients
The first chart shows the trend in the number of delayed days for Bolton patients in relation to
transfers of care. After four consecutive months of increases between Oct 2015 and Jan 2016,
delayed days started to fall from Feb 2016 however since March 2016 performance has remained
fairly static around 900 days on average but with a greater reduction reported in July.
The total number of DTOcs in January 2017 increased to 30 compared to 23 in Dec 2016 however
the total number of delayed days reduced from 867 in December to 730 in January. This reduction
may be partly attributable to the Spring Unit beds commissioned as part of discharge to assess at
Four Seasons. Bolton FT account for 89% with Salford(2%) and all others (3%). The benchmarking
position within the GM Cluster maintains Bolton's position at mid-table (not shown) and Bolton is
below average for delays (days) in the GM cluster which indicates that the increases seen over winter
2015/16 are not unique to Bolton. Care package in home is a primary reason for the social care
delayed days and further non acute are a NHS delay primary reason
Manch
est
er
Old
ham
Bo
lto
n
Salfo
rd
Tra
ffo
rd
Tam
esi
de
Sto
ckp
ort
Bury
Wig
an
Ro
chd
ale
52
54
56
58
60
62
64
66
68
70
72
Satisf
act
ion s
core
Local
Authority
Local Authority score GM Median
GM 75th centile GM 90th centile
764
855
1,02
1
782
713
593
518
501
515
544
608
447
219 233
274 294 246
445 434 425
367
16
60
45
11 30
51 129 90
56 167 34
53
0
200
400
600
800
1000
1200
1400
0
200
400
600
800
1,000
1,200
1,400
Dec-
15
Jan-1
6
Feb-1
6
Mar-
16
Ap
r-16
May-
16
Jun-1
6
Jul-
16
Aug
-16
Sep
-16
Oct
-16
No
v-16
Num
ber
of
dela
yed
days
Month
Delayed transfers of care (total delayed days) Attributable to NHS Attributable to Social Care
Attributable to Both Target
-200
0
200
400
600
800
1,000
1,200
1,400
1,600
Ap
r-2015
May-
2015
Jun-2
015
Jul-
2015
Aug
-2015
Sep
-2015
Oct
-2015
No
v-2015
Dec-
2015
Jan-2
016
Feb-2
016
Mar-
2016
Ap
r-2016
May-
2016
Jun-2
016
Jul-
2016
Aug
-2016
Sep
-2016
Oct
-2016
No
v-2016
Dec-
2016
Jan-2
017
Feb-2
017
Mar-
2017
To
tal d
ela
yed
days
Month
Actual total delayed days Average
UCL LCL
Target
62.4%
58.4%
64.3%
65.6% 66.6%
67.6%
56%
58%
60%
62%
64%
66%
68%
70%
2010/11 2011/12 2012/13 2013/14 2014/15
BCF
ambition
2015/16
BCF
ambition
% o
f p
eo
ple
satisf
ied
with t
heir c
are
and
sup
po
rt
505
798
1,288
1,879
967
1,288
1,879
0
500
1,000
1,500
2,000
2,500
2012/13 2013/14 2014/15 2015/16 2016/17
Num
ber
of
refe
rrals
Number of referrals BCF ambition
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Ap
r-2016
May-
2016
Jun-2
016
Jul-
2016
Aug
-2016
Sep
-2016
Oct
-2016
No
v-2016
Dec-
2016
Jan-2
017
Feb-2
017
Mar-
2017
Actual BCF Plan YTD actual YTD plan
RED RED
NO RAG - Awaiting Data RED
GREEN GREEN
BCF KLOE Page 5
Page 6 of 9Greater Manchester and locally selected metrics - A number of further metrics have been identified across Greater Manchester and locally within Bolton.
GM1. A&E attendances
Objective: To decrease
A&E attendances across all providers
The trend over time chart shows the number of A&E attends at all acute providers from Apr 2014, for
Bolton CCG patients. Target for 16/17 is zero % increase or reduction from previous year totals.
Jan 2017 A&E attendances were 0.8% higher (67 x A&E attends) than Jan 2016 and YTD is -0.4%
below the same period of 2015/16 (332 x fewer A&E attends). The GP divert front door service (type
3 activity) currently accounts for 11.8% of the total A&E activity at 955 attendances compared to
7,095 type 1 attends.
The rolling 12m benchmarking A&E attendances (type 1) by CCG per 100,000 population shows
Bolton in 3rd lowest position and lower than the median across GM cluster. (previously 4th lowest at
end of Q1 2016/17 on rolling 12m basis)
GM2. 30 day emergency readmissions
Objective: To decrease
30 day emergency readmissions for Bolton patients across all acute providers 30 day readmission rate for Bolton patients compared to GM Cluster
The trend chart shows the number of emergency readmissions within 30 days of previous discharge
(following an elective, day case or non-elective admission). When comparing 2015/16 FY with
2014/15 FY, there was a 0.27% increase in the number of 30 day readmissions. This equated to an
approx 127 additional readmissions out of a total 64,334 discharges.
30 day readmissions in January 2017 were 461 out of 5,499 admissions (8.4%) which is a reduction
from the 9.4% rate reported in the same period in 2016 and just below the 2016/17FY target rate of
8.6% readmissions. Year to date average reduced to 8.76% in January against the 8.60% target.
The second chart shows the 30 day readmission rate across Greater Manchester CCGs in 2014/15
(awaiting updated source). Bolton CCG was below the median readmission rate (9.2%).
A&E Attendances (type 1) per 100,000 population
GM Cluster CCGs Rolling 12m Oct 2015 to Sept 2016 (TNR DATA)
GM4. Percentage of people who die in their usual place of residence
Objective: To increase
Proportion of deaths in usual place of residence – Bolton CCG patients Proportion of deaths in usual place of residence
In the rolling 12m Oct 2015 to Sep 2016, 44.0% of deaths in Bolton occurred in the person’s usual
place of residence. This was a slight decrease from the 45.0% value as reported in the Jul 2015 to Jun
2016 update. Although deaths in hospital are reducing the Hospice is absorbing the reduction instead
of home. Amber RAG rating due to 2nd consective reduction in performance.
Hospice as place of death in the rolling 12m to June 2016 were 6.9% compared to 6.2% in the
previous year and 4.4% in the year before. This is likely reflective of the success of Bolton Hospice and
increased capacity compared to earlier years. Deaths in Hospital in the rolling 12m to Sep 2016 were
47.5% compared to 48.6% in the previous year and 53.3% in the year before. Bolton CCG has remains
3rd highest for proportion of deaths in usual place of residence across Greater Manchester. National
average is currently 45.7% which remains the same rate as in the last report.
5%
6%
7%
8%
9%
10%
11%
Tam
esid
e &
…
Traf
ford
Hey
wo
od
,…
Bu
ry
Wig
an B
oro
ugh
Bo
lto
n
Old
ham
Sou
th…
Salf
ord
Cen
tral
…
Sto
ckp
ort
No
rth
…30 d
ay r
ead
mis
sio
ns
rate
CCG
35%
36%
37%
38%
39%
40%
41%
42%
43%
44%
45%
46%
47%
Mar-
11
Jun-1
1
Sep
-11
Dec-
11
Mar-
12
Jun-1
2
Sep
-12
Dec-
12
Mar-
13
Jun-1
3
Sep
-13
Dec-
13
Mar-
14
Jun-1
4
Sep
-14
Dec-
14
Mar-
15
Jun-1
5
Sep
-15
Dec-
15
Mar-
16
Jun-1
6
Sep
-16
Rolling 12m period end month
6,000
6,500
7,000
7,500
8,000
8,500
9,000
9,500
Ap
r-2015
May-
2015
Jun-2
015
Jul-
2015
Aug
-2015
Sep
-2015
Oct
-2015
No
v-2015
Dec-
2015
Jan-2
016
Feb-2
016
Mar-
2016
Ap
r-2016
May-
2016
Jun-2
016
Jul-
2016
Aug
-2016
Sep
-2016
Oct
-2016
No
v-2016
Dec-
2016
Jan-2
017
Feb-2
017
Mar-
2017
Nu
mb
er o
f at
ten
dan
ces
Month
A&E attends Average UCL LCL Target
300
350
400
450
500
550
600
650
Ap
r-2015
May-
2015
Jun-2
015
Jul-
2015
Aug
-2015
Sep
-2015
Oct
-2015
No
v-2015
Dec-
2015
Jan-2
016
Feb-2
016
Mar-
2016
Ap
r-2016
May-
2016
Jun-2
016
Jul-
2016
Aug
-2016
Sep
-2016
Oct
-2016
No
v-2016
Dec-
2016
Jan-2
017
Num
ber
of
read
mis
sio
ns
Month
Actual 30 day readmissions Average Target
NH
S T
am
esi
de a
nd
Glo
sso
p C
CG
NH
S T
raff
ord
CC
G
NH
S C
entr
al M
anch
est
er
CC
G
NH
S W
igan B
oro
ug
h
CC
G
N
HS S
outh
Manch
est
er
CC
G
NH
S S
alfo
rd C
CG
NH
S H
eyw
oo
d,
Mid
dle
ton a
nd
Ro
chd
ale
CC
G
N
HS O
ldham
CC
G
NH
S N
ort
h M
anch
est
er
CC
G
NH
S B
olto
n C
CG
NH
S S
tock
po
rt C
CG
NH
S B
ury
CC
G
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pro
po
rtio
n o
f d
eath
s in
usu
al p
lace
of
resi
dence
(%
)
CCG
% Rate Median 75th centile 90th centile
GREEN GREEN
AMBER AMBER
GREEN AMBER
HEYW
. M
IDD
. &
RO
CH
DA
LE
BU
RY
BO
LTO
N
STO
CKPO
RT
WIG
AN
BO
RO
UG
H
TR
AFF
OR
D
CEN
TR
AL
MA
NC
HESTER
TA
MESID
E &
GLO
SSO
P
SO
UTH
MA
NC
HESTER
OLD
HA
M
SA
LFO
RD
NO
RTH
MA
NC
HESTER
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
CCG Median 75th centile 90th centile
GM & LOCAL KLOE 1 Page 6
Page 7 of 9Greater Manchester and locally selected metrics - A number of further metrics have been identified across Greater Manchester and locally within Bolton.
GM1. A&E attendances
Objective: To decrease
A&E attendances across all providers A&E Attendances (type 1) per 100,000 population
GM Cluster CCGs Rolling 12m Oct 2015 to Sept 2016 (TNR DATA)
L2. Average length of stay (non-elective) Average length of stay for emergency admissions - Bolton CCG pts all providers Average length of stay for emergency admissions benchmarked
across Greater Manchester Apr to Dec 2016
The average LOS for Jan 2017 was above target at 4.78 days against 4.50 days plan. Year to date
average is 4.61 days which remains slightly above plan level therefore amber rating however is 5.7%
higher than the same period in 2015/16 which may be an indication of the increased acuity within
NEL admissions. Although the trend has been decreasing there will come a point in the future when
this will start to increase again as the complexity and acuity of pateints increases when integrated
services are fully up and running, only the patients who really need to be there will be admitted. The
second chart illustrates how Bolton CCG benchmarks against other Greater Manchester CCGs for
average non-elective length of stay. Year to date in 16/17 to Dec, Bolton CCG is placed 6th lowest
within Greater Manchester for average length of stay from a previous low position of 2nd lowest in
the rolling 12m to Aug 2016.
L3. Reducing the number of admissions due to falls and fall related injuries (over
65s)
Emergency admissions due to falls and fall related injuries at all providers
(patients aged 65 and over)
Emergency admissions due to falls and fall related injuries at all providers
Patients aged 65 and over - Sep 2015 to Aug 2016 - Greater Manchester CCGs
The trend chart illustrates the number of emergency admissions for Bolton patients aged 65 years
and over, to any hospital provider, with a fall related injury. Overall there is a slightly decreasing trend
in the number of falls admissions since a peak in Oct 2014. Comparing 2015/16 with 2014/15, the
number of admissions reduced by 3.1% from 900 in 2014/15 to 872 in 2015/16. This is a great
improvement considering the increase from 13/14 to 14/15 was an increase of 23%.
The latest monthly update is 65 falls in Jan 2017 which is 29 lower than the level reported in Dec 2016
and 18 lower than Jan 2016. Year to date the total number of NEL admissions for falls is -2.6% below
the same position in 2015/16 The bar chart shows how Bolton CCG compares across Greater
Manchester for the number of falls admissions per 1,000 population aged over 65. In the past 12m
Bolton has the second lowest rate of falls admissions per 100,000 across all Greater Manchester CCGs.
(TIS Data). The data corresponds to PHOF data from 2014/15 which shows the same position for
Bolton CCG
L1. Avoidable emergency admissions (NHSOF 3a) Avoidable emergency admissions for all Bolton CCG patients to any provider Avoidable emergency admissions per 100,000 benchmarked across Greater
Manchester (NHS Digital) Proxy measure July 2015 to June 2016 (rolling 12m)
This is a composite measure as per the key shown in the benchmarking chart (far right chart)
The trend over time chart shows the trend in avoidable emergency admissions for Bolton patients
across all hospital providers. There is a slight seasonal trend, with relatively more admissions in winter
months. Overall the long term trend is slightly increasing; there was a 5.1% increase from 2012/13 to
2013/14 and a 7.4% increase when comparing 2013/14 to 2014/15 however more recently there has
been a -0.3% reduction in 2015/16 compared to the previous year.
The latest monthly update shows January was 6.7% lower than the same period in 2015/16 (41 fewer
admisssions) and year to date in 16/17 is 1.4% higher than the same period in 15/16 (77 more
admissions) therefore RED rating for year to date performance.
The benchmarking chart illustrates how Bolton compares across Greater Manchester. Data for the
latest available 12 month period (Jul 2015 to Jun 2016) shows that Bolton had the 5th lowest rate of
avoidable admissions across Greater Manchester per 100,000 which is a deterioration from the
position of lowest in the previous rolling 12m period to March 2015 therefore AMBER rating
L6. Proportion of people using social care receiving direct payments
Objective: to increase
The trend chart shows the proportion of people using social care receiving direct payments at year
end. Latest data available shows that since 2013/14 the proportion of people using social care and
receiving direct payments has increased from 28.9% to 31.2% with a peak of 36.9% reported in Q4
2015/16.
The latest reported position as at the end of Q2 2016/17 is 30.9% which is a reduction from both the
past quarter (31.2%) and also a reduction from the Q2 position in 2015/16 of 32.2%.
Benchmarking the proportion of people using social care receiving direct payments chart on the right
shows that Bolton are the second highest for this measure and above the GM cluster average. In
addition to this another metric within ASCOF data (not shown) places Bolton at the lowest point of
the chart in relation to the proportion of carers receiving direct payments at 27.7% compared to the
average of 77% in GM Cluster
Locally selected metrics (continued)
L4. Proportion of patients who experience harm-free care
Objective: to increase
Proportion of patients who experience harm free care at Bolton Health Providers Proportion of patients who experience harm free care Bolton FT v GM Trusts
The left chart shows the proportion of patients who experienced harm-free care at Bolton NHS FT,
Bolton Nursing Homes and BMI Bolton Hospital between April 2015 and November 2016. The latest
performance from December 2016 shows that the average of providers within Bolton are exceeding
the 95% target.
This measure is taken from the NHS Safety Thermometer, which records the presence or absence of
four harms: pressure ulcers, falls, urinary tract infections (UTIs) in patients with a catheter, new venous
thromboembolisms (VTEs). The target, set nationally, is to achieve 95% harm-free care.
The right chart also shows the monthly harm-free care achievement for Bolton FT compared to the
average of Greater Manchester Provider Trusts (Bolton, Central Manchester, Pennine Acute, Salford,
South Manchester, Stockport, Tameside and Wrightington, Wigan & Leigh)
L5. Number of people aged 65 and over receiving residential care, nursing care and
community based services
Benchmarking data being sourced
The trend chart shows the number of people aged 65 and over receiving residential care, nursing
care and community based services in Bolton.
The numbers represent a snapshot at quarter end. The total number of individuals receiving the
service at any point in 2015/16 was 3,564 which is a 4.7% increase in the total number receiveing the
service in 2014/15 of 3,402. The quarterly snapshots shown here report an 11.7% increase from Q2
2015/16 position.
Benchmarking of Number of people aged 65 and over receiving residential care, nursing care and
community based services is shown to the right of the trend chart and Bolton performed higher than
average for the peer group similar local authorities in the chart and higher than England average.
2015/16 data unavailable in this format as yet.
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Ap
r-15
May-
15
Jun-1
5
Jul-
15
Aug
-15
Sep
-15
Oct
-15
No
v-15
Dec-
15
Jan-1
6
Feb-1
6
Mar-
16
Ap
r-16
May-
16
Jun-1
6
Jul-
16
Aug
-16
Sep
-16
Oct
-16
No
v-16
Dec-
16
% h
arm
fre
e c
are
Month
Nursing Homes (TOTAL) BMI Bolton FT Target
GREEN
92%
93%
94%
95%
96%
97%
98%
99%
100%
Ap
r-15
May-
15
Jun-1
5
Jul-
15
Aug
-15
Sep
-15
Oct
-15
No
v-15
Dec-
15
Jan-1
6
Feb-1
6
Mar-
16
Ap
r-16
May-
16
Jun-1
6
Jul-
16
Aug
-16
Sep
-16
Oct
-16
No
v-16
Dec-
16
% h
arm
fre
e c
are
Month
Bolton FT Target All GM Trusts
GREEN
37.9% 36.9% 36.6%
33.0%
25.4% 24.4%
16.6% 15.4% 12.9%
10.1%
0
1000
2000
3000
4000
5000
60002015/16 Qtr 4
num
denom
1C part 2a - Proportion of adults (clients) receiving direct payments
28.9
%
31.4
%
20.8
%
32.2
%
31.4
% 3
6.9
%
31.2
%
30.9
%
24.8
% 29.5
%
15%
20%
25%
30%
35%
40%
45%
Pro
po
rtio
n
Proportion of people using social care receiving direct
payments
2,681
3,402 3,562
2,723 2,741 2,789 2,826 2,731
3,063
1,746
2,612
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2013/1
4
2014/1
5
2015/1
6
2015/1
6
Q1
2015/1
6
Q2
2015/1
6
Q3
2015/1
6
Q4
2016/1
7
Q1
2016/1
7
Q2
2016/1
7
Q3
2016/1
7
Q4
Nu
mb
er o
f p
eo
ple
No of people aged 65 and over receiving residential care,
nursing care and community based services
AMBER GREEN
AMBER GREEN
LOCA KLOE 2 Page 8
Page 9 of 9Locally selected metrics (continued)
L4. Proportion of patients who experience harm-free care
Objective: to increase
Proportion of patients who experience harm free care at Bolton Health Providers Proportion of patients who experience harm free care Bolton FT v GM TrustsL7. The proportion of older people aged 65 and over offered reablement services
following discharge from hospital Objective: to increase
The proportion of older people aged 65 and over offered reablement
services following discharge from hospital
The number of older people offered reablement services following discharge from hospital as a
proportion of all discharges (people aged 65 and over) figure for 2014/15 was 4.5% ASCOF 2B(2)
The measure includes social care-only placements, and excludes people who were only assessed by
the NHS. We have included a two-part measure to capture both the volume and success of the
reablement services that are delivered. This will prevent areas scoring well which offer reablement
services to only a very small number of people.
Note: ASCOF are not currently reporting on this measure as recent as the Q4 2015/16 report
therefore a local proxy measure is being used which is no longer directly comparable to ASCOF
baseline position. The latest local data for Qtr2 2016/17 suggests that 6.5% of all discharges are
offered reablement which is the same rate as Q1 16/17 and a slight decrease from levels seen in Q2