Paper 19/31 23 May 2019 Page 1 of 30 Oxfordshire Clinical Commissioning Group OXFORDSHIRE CLINICAL COMMISSIONING GROUP BOARD Date of Meeting: 23 May 2019 Paper No: 19/31 Title of Paper: Integrated Performance Report Paper is for: (please delete tick as appropriate) Discussion Decision Information Conflicts of Interest (please delete tick as appropriate) No conflict identified Conflict noted: conflicted party can participate in discussion and decision Conflict noted, conflicted party can participate in discussion but not decision Conflict noted, conflicted party can remain but not participate in discussion Conflicted party is excluded from discussion Purpose and Executive Summary: To update the Board on quality and performance issues to date. The Integrated Performance Report is designed to give OCCG Board assurance of the processes and controls around quality and performance. It contains analysis of how OCCG and associated organisations are performing. The report is comprehensive, but seeks to direct members to instances of exception. The Integrated Performance Report has been discussed in Executive and Quality Committees and had much more internal time and an action-oriented focus. Engagement: clinical, stakeholder and public/patient: Not applicable Financial Implications of Paper: The financial overview is provided on slide 2 Action Required:
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Paper 19/31 23 May 2019 Page 1 of 30
Oxfordshire Clinical Commissioning Group
OXFORDSHIRE CLINICAL COMMISSIONING GROUP BOARD
Date of Meeting: 23 May 2019 Paper No: 19/31
Title of Paper: Integrated Performance Report
Paper is for: (please delete tick as appropriate) Discussion Decision Information
Conflicts of Interest (please delete tick as appropriate)
No conflict identified
Conflict noted: conflicted party can participate in discussion and decision
Conflict noted, conflicted party can participate in discussion but not decision
Conflict noted, conflicted party can remain but not participate in discussion
Conflicted party is excluded from discussion
Purpose and Executive Summary: To update the Board on quality and performance issues to date. The Integrated Performance Report is designed to give OCCG Board assurance of the processes and controls around quality and performance. It contains analysis of how OCCG and associated organisations are performing. The report is comprehensive, but seeks to direct members to instances of exception. The Integrated Performance Report has been discussed in Executive and Quality Committees and had much more internal time and an action-oriented focus.
Engagement: clinical, stakeholder and public/patient: Not applicable
Financial Implications of Paper: The financial overview is provided on slide 2
Action Required:
Paper 19/31 23 May 2019 Page 2 of 30
Board is asked to note the paper and agree if there are other areas of assurance required from Executive Committee and/or Quality Committee arising from IPR.
OCCG Priorities Supported (please delete tick as appropriate) Operational Delivery Transforming Health and Care Devolution and Integration Empowering Patients Engaging Communities System Leadership
Equality Analysis Outcome: Not applicable
Link to Risk: The Integrated Performance Report links to risks: Assurance Framework 19 – Demand and Performance Challenges Assurance Framework 22 – Quality Risk 758 – Delayed Transfers of Care (DTOC) Reduction Risk 735 – OUHFT Tests Results Risk 771 – Inpatient Discharge Summaries Risk 798 – Performance in Referral to Treatment (RTT) and Cancer NHS Constitution Standards Risk 770 – Outpatient Communication between Primary and Secondary Care Risk 797 – A&E 4 Hour Wait Risk 800 – Learning Disability Service in Transition
Total MRSA incidents listed by each provider may include non-OCCG patients & may also include cases with shared responsibility
Period OUHFT RBFT OHFT National NHS
Q2 18/19 83% 88% 79% 81%
M10 96% 100% NA 96%
M10 90% 99% NA 86%Accident & Emergency (Patient) NA
Friends and Family
Patients likely or extremely likely to recommend
(January 2019)
Independent
Providers
The care given at this organisation (Staff) NA
Inpatient (Patient) 99%
Measure
OCCG Rating OUHFT Rating RBFT Rating
RTT Incomplete Pathways 18 Week - All patients M10 92% 83.8% Red 83.0% Red 92.2% Green
6.3 - Cancer Two week waits M10 93% 94.3% Green 97.4% Green 93.3% Green
6.4 - Breast symptoms Two week waits M10 93% 87.9% Red 87.8% Red 97.8% Green
7.4 - 31 Day First Treatment M10 96% 93.3% Red 90.8% Red 98.2% Green
7.11 - 31 Day Subsequent Treatment (Surgery) M10 94% 92.7% Red 95.2% Green 90.3% Red
7.11 - 31 Day Subsequent Treatment (chemotherapy) M10 98% 100.0% Green 100.0% Green 98.9% Green
7.11 - 31 Day Subsequent Treatment (radiotherapy) M10 94% 96.6% Green 96.3% Green 94.3% Green
8.4 - Cancer Plan 62 day standard (Tumour) M10 85% 71.6% Red 65.4% Red 83.1% Red
9.4 - CRS 62 Day screening standard (Tumour) M10 90% 58.8% Red 57.1% Red 95.6% Green
Oxford University Hospitals NHS Foundation Trust M10 95% 86.0% Red
Royal Berkshire NHS Foundation Trust M10 95% 88.4% Red
Oxford Health Foundation Trust M10 95% 97.0% Green
Cat 1(C1) Mean M10 00:07:00 00:07:11 Red
Cat 1 (C1) 90th percentile M10 00:15:00 00:13:38 Green
Cat 2 (C2) Mean M10 00:18:00 00:15:52 Green
Cat 2 (C2) 90th percentile M10 00:40:00 00:29:43 Green
Cat 3 (C3) 90th percentile M10 02:00:00 01:40:27 Green
Cat 4 (Cat 4) 90th percentile M10 03:00:00 02:46:11 Green
2 week
Performance Overview
Period TargetTotal Commissioner Total Provider Total Provider
31 Day
62 Day
4 hour wait
*Oxford
Ambulance
Response Time
(hour:minutes:sec
onds)
Quality and Performance Dashboard 1
3
Oxfordshire Clinical Commissioning Group (unless otherwise stated)
*62 day upgrade Activity counts are very low which can cause large fluctuations in performance rate.
Oxfordshire Ambulance Response Time: Data source only contains quarter to date figures rather than year to date figures, so this is what is shown in the YTD column.
†999 Targets are proposed CQUIN trajectories for TV as follows: Calls closed by telephone advice: Q1 6.2%, Q2 6.3%, Q3 6.4%, Q4 6.5% Incidents managed without transport to A&E: Q1 31.1%, Q2 31.2%, Q3 31.3%, Q4 31.5%
Target Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18 Jul '18 Aug '18 Sep '18 Oct '18 Nov '18 Dec '18 Jan '19 YTD
Oxfordshire Clinical Commissioning Group (unless otherwise stated)
† Assessed within two weeks. Target 50% prior to Apr '18.
* Learning Disability Healthchecks: Data completion varies greatly between quarters as many practices leave their register value blank. This causes large uncertainty in the
values shown.
**Targets for these indicators are for quarter 4 2018/19.
*** Children and Young People Eating Disorders: latest data is available for Q1 2018/19. Please note that the target is not mandatory until 2020/21.
IAPT/CAMHS: always one month behind other sources.
Delayed Transfers of Care from hospital per 100,000 pop. per month 707 756 694 651 569 503 639 636 578 521 502 487 532 562
Cancer waits – 62 days (85%) Sharon Barrington -50% 71.6% Finance Gateway Jenny Simpson Pass
The Quality Premium is a Clinical Commissioning Group financial incentive based on achievement of the Quality Premium measures. As with previous
years the 2018/19 Quality Premium is worth £5 per head of population. The total awarded then reduced by 50% for each NHS Constitutional Standards
classed as “not met”. The scheme is divided amongst Emergency Demand Management Indicators and Quality Indicators – which include 5 national & 1
RightCare Indicator.
Indicator Owner Weighting Measure YTD position Comments
Emergency Demand Management Indicators (75%)
Emergency Demand Planning Sara Wilds
50%
Type 1 A&E Attendances ≤ planned number 110164 /109942
Number of non-elective admissions with LOS=0 ≤planned
number23289 / 20411 (see executive summary)
50%Number of non-elective admissions with LOS≥1 ≤planned
number32942 / 31477 (see executive summary)
Quality Indicators (25%)
Early Cancer Diagnosis Sharon Barrington 17% Cancer Stage 1 & 2 Diagnosis N/A No proxy identified
GP Appointment Satisfaction Julie Dandridge 17% Overall satisfaction with making an appointment N/A No proxy identified
Continuing Healthcare Rachel Pirie 17%
Continuing Healthcare Decision 28 Days (80%) 263/419 (62.7%) (see executive summary for
summary of issues)
Data representative of Q1-3 2018/19Continuing Healthcare Assessments in Hospital (<15%) 61/419 (14.6%)
Improved Access to Children and
Young People’s Mental HealthSarah Breton 17%
37.9% of children and young people to receive treatment in
NHS funded mental health community services when needed
(target 3499)
4110/3499
(117.5%)
Provisional data up to Jan. 2019
Denominator taken from operational
planning document
Bloodstream Infections Sara Wilds 17%
20% reduction in E.coli (463 in 2016) 395 / 370From HCAI DCS – 370 is whole year
target reduction
Collection of Primary Care Dataset for E.coli (Y/N) Yes Collected for Q2 by OUHFT
30% reduction in Trimethoprim items prescribed (70 years &
older) 9745/13302
Data available up to December 2018Items per STAR-PU ≤1.161
0.816Items per STAR-PU ≤0.965
Reported to estimated prevalence of
COPD (%)Sharon Barrington 15%
Increase in QOF Prevalence – reduction of gap by 20%
compared to 2016/17N/A No proxy identified
*Data for a number of indicators are validated and published on an annual basis. Local proxies, which reflect the indicator have been established to provide an in year predicted position. These are subject to change due to validation and publication. N.B. Further information
on Quality Premium indicators and definitions can be found: https://www.england.nhs.uk/publication/technical-guidance-annex-b-information-on-quality-premium/
10
Project Update
Scheme Name Scheme Description
Target
FYE
£'000
Plan
£'000
Actual
£'000
C
o
l
u
m
Delivery
RAG Comments Savings Trend
Activity Trend (3
Month Moving
Average)
GP-led Cardiac
Community Clinics
Implementing a community clinic led by specialist cardiology
GPs (GP-Cs) for patients with symptoms appropriate for care in
the community
140 TBC TBC Green
Savings have not been realised for this service in the north of the county. The activity levels
and rates of triage are better than expected, but OUHFT have failled to control the referral
process effectively, and GPs are still referring directly into the OUH outside of the GPwSI
triage service. Discussions are underway to identify a way to control the referral routes and so
protect the savings and integrity of this service. Until this has happened and the service can
demonstrate a financially sustainable model, the pilot will not be rolled out to the south of the
county. There are clinical reasons related to urgent care and the rapid access chest pain clinic
why it would be good to speed this up.Musculoskeletal
(MSK)
Assessment,
Treatment and
Triage Service
(MATT)
Commissioning a new Musculoskeletal (MSK) Assessment,
Treatment and Triage Service (MATT). All referrals relating to
MSK will be triaged and treated on one of the MATT pathways
or, when specialist treatment is required, will be triaged and
referred onto secondary care.
2,200 1,833 1,967 Green
Self-referral rolled out, so far no unexpected increase in demand for Healthshare's services.
Savings appear to have slowed down due to the planning assumptions for 2018/19, however,
we are on target for £2.2m+ across the year.
GP-led Headaches
Community Clinic
Implementing a community GP Specialist led headache clinic for
patients with a primary headache. 50 46 125 Green
Pilot ended in October with a successful evaluation. Decision made to commission the
service from OUHFT. Interim measure to continue with Community Headache Clinics (CHC)
on same basis as pilot against a monthly block payment (£8,054 per month) agreed until
31/3/19 and CV signed. #OUH-CV67 Headache pilot extension- signed.pdf
New tariff agreed with Service, SCW CSU are drawing details to be included in new OUHFT
contract for signature.
Urgent Eye
Conditions Pathway
Implementing a Minor Eye Conditions Service (MECS); a
community service that uses Optometrists based in Opticians to
assess and treat recent onset eye conditions and vision
problems.
255 213 101 Amber
OUH have agreed to pilot triage in Eye Casualty, which is required to release the full savings
from this project. However, the CCG negotiating team with the OUH have struggled to identify
a way to accommodate the small amount of investment required to make this happen.
Savings are slipping as a result.
Gastro Community
EndoscopyImplementation of a community endoscopy service 244 203 313 Green
InHealth activity is increasing, and OUH endoscopy activity is decreasing. This is occuring
faster than anticipated. There are 2ww and waiting time performance issues as a result, which
are now mostly resolved. A third site in the south of the county is being considered.
2,889 2,295 2,507
YTDFY18/19 Schemes
Oxford University Hospitals NHS Trust 1
11
Oxford University Hospitals NHS Trust (OUHFT) – Planned Care
OUHFT Elective Inpatients and Day-Cases (Month 10)
Elective Inpatients and Day-Cases Elective inpatients and Day cases have collectively been under plan for most of the year to date. Elective inpatient and day cases show a slight decrease in
underperformance during January, now £4.4m (8.3%) under plan compared to £4.5m (9.5%) under plan at M9.
• Day case activity remains below plan by 530 spells, £308k (1%) underspent, (£596k under last month)• Elective Inpatient activity is significantly under plan at 13%, and £4m (19%) underspent, which represents a 1% decrease in underperformance in month.
• Most of the underspend for Elective Inpatients sits within T&O (£2m below plan), General Surgery (£659k below plan) and Colorectal Surgery (£563k below plan). • Compared to January 2017, overall Elective activity is 4% lower.
• Respiratory remains the highest overspend at £521k over plan. As previously reported the main group of HRGs driving the overspend is day case activity against DZ29. The Trust have shared
additional background on the source of this activity, which relates to patients initiated onto a new drug commissioned by NHSE, where the patient needs to be admitted for observation post
initiation. A meeting has been held with NHSE to seek resolution. A number of actions came out of the meeting including NHSE to share 17/18 and 18/19 drug data so the wider pathway can
be reviewed including Elective and NEL admissions for Oxfordshire, as NHSE believe there will be savings elsewhere in the system the CCG would benefit from. Investigation is ongoing.
Day Cases and Electives Variance by Specialty >+/- £50k
Grand Total 47,660 46,236 -1,424 -3.0% £53,296,439 £48,871,549 -£4,424,890 -8.3%
Oxford University Hospitals NHS Trust 2
12
Oxford University Hospitals NHS Trust (OUHFT) – Planned Care
2. OUHFT Outpatient Main Under and Overspends Month 10
Outpatient attendances and Outpatient Procedures Outpatient attendances and Procedures all continue to show a position over plan
First attendances remain relatively stable with a position over plan of £1.4m (6.9%), representing an increase from 6.6% last month.
Follow ups have a 1% increased run rate as well as financial performance against plan.
Outpatient Procedures overspend has continued to reduce towards plan. In January Outpatient Procedures are now £114k or 1.2% over plan compared to 3.4% in December 4.1% in November,
5.3% in October, 6.4% in September, 6.7% in August and 7.9% in July.
Initial queries regarding Physiotherapy have been raised with the Trust and the issue has been considered at FIG. Significant values relate to paediatric physio activity where plan values have
been understated. No further investigation planned
a) First Attendances Variance by specialty > +/- £10k b) Follow Up Attendance variance by speciality > +/-£10k
Grand Total 61,008 59,621 -1,387 -2.3% £9,902,275 £10,017,007 £114,732 1.2%
Oxford University Hospitals NHS Trust 3
13
Oxford University Hospitals NHS Trust (OUHFT) – Urgent Care
The cost of activity over plan at month 10 is £7.9m (2.8%) compared to £6.1m, (2.4%) at month 9, giving an in-month movement of £1.8m, and an increased run rate. Cost of activity is £41m (16%)
higher than the M10 last year. The bottom line position after financial adjustments is £4.5m overspent (1.6%), compared to £3m (1.2%), last month.
The most significant pressure continues with the NEL PODs at £7.5m over plan, with approximately £5.2m of the NEL overspend driven by a richer case mix. Overall the run rate for activity remains
stable at 2.8% over plan. Ambulatory follow up attendances have seen a reduction in Month 10, now 12.9% over plan in terms of price compared to 19% in M9.
NEL Inpatient activity still shows a position under plan of 221 spells (-1%) (last month 285 spells, -1% below plan). Spend remains significantly higher, now £5.1m (7.7%) above plan. The overall
position maintains the case mix pressures highlighted over the last year.
Accident and Emergency (A&E) Attendances - January (M 10) 2018/19
A&E shows a stable position in January compared to previous months with year to date activity over plan by 3010 attendances, (2.8%) and cost above plan by £988k, (6.6%).
Compared to YTD January 2017 activity is 4% higher overall – similar position over the last few months
The cost variance remains driven by a combination of less activity flowing through the type 3 GP streamed service than planned (54% under), with activity at around 15 attendances per day
(last month 13 on average per day), and an increase in high cost HRG’s.
The highest activity and financial pressure still lies within VB08Z (Category 2 Investigation with Category 1 Treatment) 3,109 attendances and £454k (13%) above plan
Ambulatory Care Pathways
Ambulatory activity is recorded under NEL as an admission. Any further activity on the ambulatory pathway is recorded and charged under a local tariff. Activity and spend have decreased this
month. Month 10 shows an overspend of £214k, and 12.9% attendances over plan (last month £259k, and 19.4%).Within this value:
Adams Ambulatory Unit (AAU) is over Plan by £220k (44%),
Surgical Assessment Unit (SAU) ambulatory under plan by £126k (19%) *
And Daily Discharge Unit ( DDU) over plan by £119k (25%). Activity recorded against DDU in January at 115 attendances, up from December (109).
Further joint investigation of Ambulatory activity is being undertaken to understand patient flows and associated charges for 2019/20, a meeting took place on 21st February to progress this.
* SAU triage is no longer charged, but the SAU ambulatory price has increased to include the SAU triage price, and therefore SAU values cannot be directly compared to 2017/18. SAU activity is
captured within Ambulatory POD in 2018/19. The price will be subject to in year validation for 2019/20.
Non-Elective (NEL) Overall
NELs continue to be the highest pressured POD now £7.5m over plan
The other NEL PODs (Short stay, same day and non-emergency) also contribute additional cost pressures of £2.4m mainly driven by activity growth of 21% (compared to the same time last
year) within short stay spells.
Overall activity is 5% higher than the same period last year, and proportionately most of this increase sits within short stay.
NEL average tariff at £1912, is 5% higher than the same period last year (£1814), and 5% higher than the average for last year (£1828).
The sub-chapter and corresponding HRG’s within NEL with the highest over-spends and case mix pressures remain similar to previous months:
DZ – Respiratory System Procedures and Disorders £2.8m (37%) over plan, with activity 14% above plan – this accounts for approximately 54% of the total NEL PODs overspend. PD -: Paediatric Respiratory Disorders, which is now £594k (72%) over plan
AA – Nervous System Procedures and Disorders £546k (9%) over plan, and activity 13% below plan.
Plan Actual Variance % Var Plan Actual Variance % Var
GP Streamed Type 3 9,926 4,367 5,559- -56.0% 688,105 302,720 385,384-£ -56.0%
Total 105,768 108,778 3,010 3% 15,054,382 16,042,241 987,859 7%
Activity Price
SCAS Provider Summary
14
South Central Ambulance Service Summary of performance: 999
Activity was 38 incidents above baseline for January, totalling 7,869 incidents against the 7,831 anticipated. The case mix change continues in month 10 leading to an overspend in January of £68k
and a YTD overspend of £349K.
Achievement of the new ambulance targets has started to improve. Performance was achieved for all categories at contract and SCAS level. Unfortunately SCAS failed to achieve the target for Cat
1 (mean) at CCG level.
Summary of Performance: Integrated Urgent Care (IUC) Contract
Oxfordshire:
In the Thames Valley IUC contract, the 95% target was not reached with performance at 80.70% for call answer within 60 seconds in January This was a significant improvement on the December 18
when performance against the target was 65.66%. There was under performance of 5,245 calls (-9.2%) against the January plan. Overall across Thames Valley activity has decreased by 6.79% in
January compared to last year. Call abandonment rate improved in January within the target of >3.5% (2.38%) achieved for the first time since September 2018.
Main issues:
From November SCAS has been resourcing additional hours from Conduit to assist in covering challenging hours between 2pm-5pm, in addition to the hours that they are already contracted for
however, Conduit staffing has declined significantly over the last few months due to the closure of the Chatham site, impacting attrition. And therefore performance
From the 2nd of February funding has been allocated for an additional two clinicians to cover evenings and weekends Monday to Thursday 4pm to midnight, and weekends 8am till 5pm. This resource
Calls Answered in 60 Seconds >95% 80.70% 80.38% 78.23% 78.01%
Transfer to 999 (LQR3) < 10% 12.96% 12.82% 10.74% 10.98%
OHFT Provider Summary 1
Oxford Health Foundation Trust (OHFT)
Out of Hours (OOH) (Cost and Volume Service)
Costed activity in January 2019 is 7.9% (£39k) below the profiled budget of £501 for the month. YTD, overall activity is 2.4% below the seasonally adjusted plan and 3.6% below the same period
last year.
The OOHs KPIs have been reviewed and remodelled in line with the Integrated Urgent Care KPIs. In month 9 all KPIs were met with the exception of:
1. IUC 13b – 95% of Patients receive a Face to Face Consultation in an IUC Treatment Centre within 2 hours. M10 performance (88% ) - M 9 = 88%).
1.
Overall there has been a slight increase in performance for M10 in particular for UTC6 – Walk ins urgent management. The process for management of urgent base visits is embedded at most sites.
The service continues to work with individual staff to ensure patients are managed by clinical risk and urgency rather than arrival time. All clinical lists were changed so that patients appear and are
managed in Adastra in order of clinical priority. Patients in base remain safe in all locations with clinicians close at hand.
This KPI is under review as it is not aligned to the current A&E targets and may be monitored for information only.
15
0%
20%
40%
60%
80%
100%
Series1 Target FY18
OHFT Provider Summary 5Oxford Health Foundation Trust (OHFT)
Community Services
The following key performance indicators are reported by exception as all are 10% or more below target.
• The Chief Executives agreed performance reporting on KPI’s to be scaled back over the winter period ( November to end March). All KPIs have been reviewed for
2019/20. Some of the suspended KPIs have been permanently removed based on data OCCG already receives (DTOC, LOS) and the quality monitoring process.
• The % of physical disability physiotherapy patients waiting less than 12 weeks to first appointment has dropped again. The CCG has agreed a reduced tolerance of
performance against this KPI against the target of 95% but this is a further drop. A review of the Parkinson’s service is due to report end of March which may impact
on the delivery of this service. The Head of Planned care has re-iterated the service review is due to be finished end March and any recommendations will be
contingent on affordability across the system. The KPI may need reviewing as this takes place.
• Performance in achieving the LAC KPI for children over 5 out of county continues to be problematic. A full report was presented at OH February QRM by OH lead
for Looked After Children. It was accepted that OH are doing what can be done in improving this KPI while also raising this issue both locally through the
Oxfordshire Corporate Parenting panel and Safeguarding Boards, and also nationally through NHSE. A position paper update has been received from OH which
provides assurance that OH are fully aware of Counties where LAC are less likely to receive their review. Discussions are taking place with Children’s
commissioning lead and OH.
16
KPIs achieved
OHFT Provider Summary 2Oxford Health Foundation Trust (OHFT)Adult Mental Health Services
Current system focus:
Oxford Health continues to report an increased demand which is creating pressure on assessment teams, in particular the city team, they have been working to an 8 week routine access target for
the past year which has resulted in the 28 day routine access breach, the 8 week access will continue into March and is performing at 87% at M10. GPs have been updated by OH of their decision
to work to 8 weeks and assurance given that risk mitigation plans are in place. All associated underperformance relating to the OH reported demand and capacity issues continues to be monitored
through QRM. A resolution to system funding of MH is a priority for OCCG and all partners. A number of workstreams continue to be progressed to better understand demand, capacity, future
needs and sustainable delivery model for adult MH to inform the approach to investment. These are being brought together through a task and finish sub group of the Distributing the Oxfordshire
Pound meeting and a workshop is being planned for May.
National KPIs – Ref slide 4
National targets for early intervention in psychosis, dementia, CPA continue to be met. The IAPT access target has increased to 19% (4.75% per quarter) in 2018/19 ; slide 4 shows all KPIs being
met and our local un-validated M10 contract report of 19.3% access, demonstrates more recent performance, remains good.
Performance issues and remedial action:
The GP letter breaches continue to be reviewed by OH business services and an improvement trajectory has been established with each individual team and clinician; all underperformance is
being monitored by QRM for assurance of remedial action.
EDPS performance continues to be challenged and whilst analysis shows the targets were only just missed, at the JR breaches continue to be mainly due to night shift when staffing is less than
the day and referrals being received at the same time causes a delay. EDPS daily performance is also being monitored as part of winter reporting to NHSE.
17
OHFT Provider Summary 3 Oxford Health Foundation Trust (OHFT) Specialist LD Health Services
Commentary:
Underperformance of routine referrals linked to workforce availability issues. Staffing levels are expected to return to normal in February 2019. In the interim waiting lists are being actively
managed to ensure longest waiters are seen first, and available clinic appointments are maximised.
Learning Disability Annual Healthchecks (Primary Care DES)
Commentary:
OCCG is contacting practices to promote the Oxford Health LD primary care liaison service.
This supports practices to engage with their LD populations, including encouraging eligible
individuals to have annual health checks.
18
Transforming Care Programme Performance
*includes CYP and adult secure inpatients with LD and / or ASC
Commentary:
System partners – principally OCCG, OHFT and OCC – are working closely together to facilitate
discharges and prevent admissions under the Mental Health Act 1983. As a result the number of
people with LD in inpatient beds is significantly below the nationally set Transforming Care end of
programme target of 9 adults.
The principal risks to the delivery of Transforming Care in Oxfordshire are:
- NHSE commissioning of forensic services for LD – a working group is addressing this;
- Volatility of numbers of children in inpatient settings (currently 5);
- Complexity of discharges from adult secure beds and associated timescales / lengths of stay
Target
(March 19)Jan-19
CCG commissioned adult inpatients 9 6
Specialised Commissioning inpatients* 13 16
Overall 22 22
Oxford Health Foundation Trust (OHFT)
Children and Adolescent Mental Health Services (CAMHS)
.
The above KPIs are locally set with no national KPIs for CAMHS. The Eating Disorder KPIs will become mandatory in 2020 and we have set KPIs locally to ensure we have confidence the new
Service is set to deliver the KPIs for 2020.
Indicator a):. The Healios on-line Service is operational and children have been identified to be offered this service. This is part of the 4WW Pilot to eradicate the backlog for the Getting Help
Pathway. Train to recruit posts for the Getting More Help Pathway are being trained at Reading University as well as the trainees for the Mental Health Teams into Schools pilot.
Indicator b): There is still a programme in place transferring patients from the Getting More Help pathway to the new NDC pathway. We are anticipating on having a complete picture on the
number of children and young people in the NDC pathway by May 2019 and detailed plans to reduce waiting times. Additional funding from NHS England (£95,000) has been awarded to help
clear the longest waiters. Healios has got a new contract with OHFT for this additional work. Trajectory is currently being worked on with Healios.
Indicator c) &d) ): In January 2 out 5 Urgent referrals were breaches -One patient was seen in 1.1 weeks due to patient choice and the other breach is a data quality error and was seen within
mandated timeframe.
Indicator e): In this year we have also introduced the KPI for Looked After Children as we know that up to 60% of LAC will have mental health problems at some stage in their life. Performance
has improved this month. Two Breaches relate to DNA and the other two patients were seen with 2.4 weeks. There was no clinical risk identified to any patients.
Indicator f): The Eating Disorder Service exceeded the target for this reporting month and none were urgent.
Indicator h) & I) is new additional information from the PAF. Referrals continue to increase. Data for consultations has not been supplied for this month and this is being addressed with the Trust.
Early findings from the formal evaluation of the model shows that feedback has been positive about the SPA changes and indicates that families and professional are finding access to CAMHS
much improved.
OHFT Provider Summary 4
19
OHFT Provider Summary 6Oxford Health Foundation Trust (OHFT)
Community Services
The following services are more than 10% under plan Year To Date (YTD) at Month 10 and are reported by exception only:
20
Service
Line
YTD Activity
v PlanKey Issues Updates
Phlebotomy
City
Phlebotomy
Non-City
-25%
(-2,139 contacts)
-31%
(-2,355 contacts)
• All activity undertaken by the Adult Phlebotomy team for Oxford City is
accurate.
• Underperformance is due to reduced referrals and staffing.
• Team is now fully recruited to, new staff members will start to support and
increase contacts in the coming months. One staff member remains on
long term sick leave.
• General increase activity over the past 4 months for non-city.
Integrated
Children
Nursing
Service
-21%
(-2,333 contacts)
• Multiple IT/Care Notes issue identified through the OH report following
external review of all admin and electronic recording processes.
• Some vacancy issues which have now been resolved.
• OH taking multiple actions to address Care Notes issues.
• Improved activity from M7, however due to a sharp increase in the IAP for
M8, the monthly variance has increased.
• OCCG has provided a response to the OH reports seeking reassurance on
timescales against identified action.
• List of services for Care Notes optimisation has been shared with OCCG.
Children's Community Nursing is scheduled to be looked at during Q1
2019.
Tissue
Viability
-13%
(-492 contacts)
• This service is showing as -13% against plan, The service is reporting
accurately and all parties are happy with the way the service is working.
• Now the reporting is accurate, 18/19 actuals will be used to inform the
19/20 IAP.
Heart Failure
Service -12%
(-759 contacts)
• As requested by CRM, Datix is to be monitored to see whether any
issues are raised in regards to the quality of the service and the potential
impact/s staff vacancies may have on activity.
• Sharp increase in activity over the past 4 months, attributable to an
increase in staff. Full staffing compliment for M10, which is reflected by the
highest activity count to date.
• No Datix issues have been reported for this service. There is no waiting list
and all patients are being seen within 10 days.
Acute Provider Summary
Royal Berkshire Foundation Trust (RBFT)
Summary of performance month 10
For M10, reported underperformance of £104k (0.6%) which is a slight deterioration on the 0.7% reported at M9. Deterioration is noted in Excess Bed Days £44k and
Non-Elective £52k. The excess bed days costs relate to one patient with a 172 day length of stay, associated elective spell “JA20D Unilateral Major Breast
Procedures with CC Score 6+”. The Non-Elective position is showing higher patient acuity, activity is 1.2% under plan with price being 3.8% over plan. The highest
over performing sub-chapter is “AA - Nervous System Procedures and Disorders” which is £126k / 30.7% over plan. Analysis of all Non-Elective activity shows The
Bell Surgery is over performing by £231k / 26.1%.
RBH YTD (M9) by POD
21
Month 10 2018/19 Month 9 2018/19 Movement M9 to M10 2018/19
Grand Total 355,867 368,968 13,101 3.7% £18,205,265 £18,100,955 -£104,310 -0.6% 9,798 3.1% -£110,566 -0.7% 3,303 0.6% £6,256 0.1%
Acute Provider SummaryIndependent Acute Providers
Performance is for 2018/19 2018/19 Month 10 (flex)
Ramsay Horton: Based on the M10 flex position the FOT is currently £8,194,536. This represents only a slight recovery from the fall in actual spend in M09. At M10 YTD, Ramsay Horton is under-
performing by -£459k. The actual spend is approx. £6.8m against the plan of £7.2m; therefore in percentage terms, the contract is underperforming by 5.6%, whilst in M09; the underperformance
was 6.2% against the plan. Whilst knee procedures remain £238k above plan, this is more than mitigated by the underspend in shoulder procedures of £462k. Horton have asked that consideration
is given to commissioning Ophthalmology capacity from them in 19/20 and could mobilise extremely rapidly, and could also offer Gynaecology and Orthotics.
Nuffield, the Manor: The annual agreed contract value is £1,283,767 (including CQUIN). Based on the M10 flex position, the FOT is currently £735k, which is an overall under-performance of -
£457k (43%), all activity is T&O and therefore impacted by Healthshare triage. Nuffield continue to be concerned about whether they are consistently offered as a choice by Healthshare. Recent
decisions on BMI and commissioning of uni knees will reduce the number of rejected referrals.
Foscote : Based on the M10 flex position, the FOT will be £808k. There is an increasing current year to date under-performance of -£137k (-17%) at M10. Gynae activity 47% over plan is being
mitigated by activity under plan in physio and T&O. There is a transfer of ownership underway which is expected to take effect in April. First to follow up ratios are well within target.
Circle Reading: At M10 YTD Circle Reading continues its recovery and has shifted to over performance of £29.8k YTD (1.9% of plan) when compared to earlier months which saw
underperformances. The main reason for this is a decrease in the mitigation being provided by T&O specialty which has decreased the level of underperformance over the past few months, and is
currently at -£13.2k. General Surgery continues to over-spend at £33k (25%), mainly due to Hernia activity being higher than planned. Elective hernia activity in Oxford CCG overall is below plan (-
34 procedures , £57k) mainly due to significant underperformance at OUH (-£141k) so this is likely to represent shift in market share out to other providers. Pain Management specialty also over
spends by £22k (51%). Ophthalmology activity remains strong, over performing by £11k (23%), mainly for cataract surgery and Provider has recently reported they are at capacity.
Ramsay BIH: At M10 YTD Ramsay BIH is over-performing by £145k (31%) against plan which has bounced back from the smaller M09 (£108k or 25.7%). Whilst Urology activity continues to rise,
the main change in worsening the position recently was caused by a large financial shift in T&O seen in M08 caused by a relatively small number of higher cost procedures, with some reduction in
M09 but a rise again in M10. There is no sign that the introduction of Diagnostic MRI scans from Healthshare is contributing to this. Over-performances applies within Ophthalmology (£36k), Urology
(£35k), Gynaecology (£20k), Gastroenterology (£6k) and Spinal (£21k). T&O is also over-performing against plan by £28k (10.2%), mainly due to elective over performing by £32k.
Spire Dunedin: Spire Dunedin is under-performing by -£201k (35%) at M10 YTD. This is a sustained under-performance from M09 YTD, which was under plan by 35.53%.Following a very
significant drop in activity at the hospital over Christmas, this does not appear to have recovered much for M10. The main under-performing speciality is Trauma and Orthopaedics, which under-
19/20 – will be entering second year of a two year contract with optional extension.
NT244 - Nuffield, The Manor 973 £1,069,806 £612,882 -£456,924 £735,459 £1,283,767 19/20 – new 1 year contract will be issued with a 1 year optional extension
AH00 - The Foscote 1,479 £830,131 £673,055 -£157,106 £807,666 £972,474
19/20 – new 1 year contract will be issued with a 1 year optional extension
NV323 - Circle Reading
4,307 £1,599,728 £1,629,574 £29,864 £1,955,488 £1,919,674 19/20 – new 1 year contract will be issued by Coordinating Commissioner with a 1 year
optional extension
NVC02 - Ramsay Berkshire
Independent Hospital
1,756 £467,250 £612,624 £145,374 £735,149 £560,699 19/20 – new 1 year contract will be issued by Coordinating Commissioner with a 1 year
optional extension
NT344 - Spire Dunedin
Hospital
1,154 £575,927 £374,324 -£201,603 £449,189 £691,112 19/20 – new 1 year contract will be issued by Coordinating Commissioner with a 1 year
Continuing Care Caseload Total 316 317 341 349 349 362 359 365 370 381 381
Other ServicesMusculoskeletal (MSK) Assessment Triage and Treat (MATT) – Provider Healthshare
Self referral to the service has been available from 8 February 2019. So far, the pattern of demand has been within expectations. There are plans to expand services to Wantage from June.
This service received an average of 5,102 referrals per month during this financial year. Significant service development and improvement in activities has been successful in reducing wait list numbers.
Key KPI trajectories: Urgent waits to be compliant (95% seen within 7 operational days) from 1st February 19 onwards. Jan: 42.5%, up from 14% in December
Routine to be compliant (95% within 30 operational days) by end July 19.
Data from Healthshare, (Feb 19). The longest wait for a routine appointment is currently 28 weeks. If patients are able to travel, they can be seen in 8 weeks for a routine 1st appointment
90.4% of referrals were triaged within 48hours of receipt.
89.6% of patients demonstrated a positive improvement in at least one of their outcome measures.
InHealth Endoscopy
In January 2019, InHealth received 608 new referrals. The service provided 99 endoscopy session in January 2019, seeing 612 patients across Witney and Bicester. Referral numbers continue to
grow. If this continues the service will reach capacity by September 2019, at 117 sessions per month, which would accommodate 777 patients per month.
2ww performance remains the priority focus for the service.
24
52 week waits
25
Referral to treatment pathways January 18 to January 19
26
Referral to treatment pathways (Jan 18 to Jan 19)OCCG main providers
27
Data Quality and Concerns
Data Quality and Concerns
28
Data quality is evaluated across Accuracy, Validity, Reliability, timeliness, Relevance and Completeness. (Source: Audit Commission)
All dimensions are equally important
Validity
Reliability
Timeliness
Relevance
Completeness
Data quality tends to be highest where scrutiny has been intense and the dataset is nationally mandated and long established.
Providers traditionally working within costs and volume contracts tend to have higher data quality
Data should be sufficiently accurate for its intended purpose. It should be captured only once (COUNT - Collect Once and Use Numerous Times) and accuracy is most likely achieved if it is
captured as close to the point of activity as possible. Automated capture as part of routine clinical care is usually more accurate and always more consistent than manually capturing and Accuracy
Data should only be used in compliance with relevant requirements including the correct application of rules or definitions
Data should reflect stable and consistent data collection processes over time
Data should be captured as quickly as possible after the event and should be made available to support information needs and influence service or management decisions
Data should be clearly specified based on the information needs of the users. All specified data items should be populated with accurate, valid, reliable, timely and relevant data.
Data capture should be relevant to the purpose for which they are used