Integrated Quality and Performance Report · p7 66% Ambulance Red 1 ... BaNES Integrated Quality...

Integrated Quality and Performance Report

August 2015 Report

Using Best Intelligence : Nationally verified data and data from providers at Month 3 – June 2015

BaNES Integrated Quality and Performance Report August 2015 2

Contents

Month 3 Report

This is the month 3 (June 2015) report as this is the latest month for which most nationally verified and provider

data is available.

Some services can be tracked more frequently and where more recent performance is known it may be included or commented on in the

report.

1. Executive Summary 3

2. Quality 4 to 6

Complaints & PALS 5

Serious Incidents Framework 6

3. Unplanned Care 7 to 10

4. Planned Care 11 to 15

NHS Constitution Standards Update 14-15

5. Social Care 16

6. Mental Health 17 to 20

Substance Misuse 2014/15 18-20

7. Learning Disabilities 21

8. Adult Safeguarding 22

9. Children’s Services 23 to 26

10. Medicines Management 27 to 28

11. Glossary for Indicators 29 to 38


Executive Summary

3 areas of good performance

99.2% Diagnostics, % of patients seen in 6 week

target p11

59

per 10,000

population

Admissions of people aged 65+ to permanent

residential and nursing care p16

7.4% Delayed transfers of care attributable to

mental health service p17

3 areas of challenging performance

92.3

% A&E 4 hour standard continues below target p7

66% Ambulance Red 1 (8 minute) response time p7

9 52 week waiters at NBT, 8 T&O, 1

Neurosurgery p11

Service Updates

Planned Care Demand Management – Orthopaedics and

General Surgery pathways to be reviewed by Clinical

Commissioning Reference Board sub group (following

completion of Dermatology and Gastroenterology)

p13

Musculoskeletal Programme – MSK steering group to have first

meeting in September p13

NHS Constitution Standards reporting to change – Referral to

Treatment Time admitted and non-admitted measures to be

abolished

p14

Community Alcohol and Drug services show improvement in

2014/15 with higher recovery driven by mutual aid (such as

peer support)

p18

Quality Updates

HCAI - C difficile infection rates are above the trajectory again in

June, and this is being addressed across the whole economy

working with Public Health. The single case of MRSA in June at

the Royal United Hospital is currently being investigated

p4

Complaints – 2 received by CCG in Q1 relating to PTS and

retrospective CHC fees, both upheld and closed p5

SI Framework – new version published March 2015, main

changes to simplify reporting are; remove grading, single

timescale, CCG responsible for closure

p6


Quality Dashboard – June 2015

Indicator MeasureData

FrequencyTarget

Month of

Data

To

Improve

RU

H

NB

T

UH

B

GW

H

CC

G

BM

I

Circ

le

AW

P

Ba

NE

S C

AM

HS

Ba

NE

S p

CA

MH

S

Siro

na

Commentary & context to results

Staff Friends and Family Test Score (Work) Score => National average MonthlyScore => National

averageJune 71.10% 46.40% 61.80% 64.90% 67.70%

NBT has reported that it has undertaken a review of nurse staffing which has identified the need for an additional 60

nurses, to which it is recruiting. This will have an impact on the FFT scores for work and care.

Staff Friends and Family Test Score (Care) Score => National average MonthlyScore => National

averageJune 84.10% 65.50% 85.80% 79.90% 67.70% As Above

VTE Assessment - Percentage who have had an

assessment on admissionAchieved for at least 95% patients Quarterly 95% June 96.50% 94.50% 99.10% 97.30% 100.00% On Target

VTE Assessment - Percentage at risk of VTE

receiving chemical/ physical thromboprophylaxisAchieved for 100% patients Monthly 100% June 94.90% #N/A 94.30% 100.00%

RUH: Lower percentage indicative of missed doses. Further work needed around drug administration. However no

hospital-acquired thromboses reported.

Fractured Neck of Femur % in theatre within 36 hours Monthly 80% June 81.10% no data 66.70% #N/A

UHB: A theatre transformation programme, focused on theatre utilisation and efficiency started in May. A clear

escalation plan is also in place when theatre. capacity is a reason to delay patients with fractured neck of femur

getting to theatre. Main issues include consistent access to theatre and Ortho-geriatrician review on admission. A

Quality visit is planned and a locum geriatrician is starting in September.

Friends and Family Test Score (Inpatient) Score => National average MonthlyScore => National

averageJune 96.29% 95.54% 96.27% 96.08% 99.19% 97.39% On Target

Friends and Family Test Score (A&E) Score => National average MonthlyScore => National

averageJune 95.97% 93.48% 70.36% 93.98%

Friends and Family Test Score (Maternity-

AntenatalScore => National average Monthly

Score => National

averageJune 97.73% 93.33% 98.55% 100.00%

Friends and Family Test Score (Birth) Score => National average MonthlyScore => National

averageJune 100.00% 96.36% 98.51% 100.00%

Friends and Family Test Score (Postnatal) Score => National average MonthlyScore => National

averageJune 99.01% 93.62% 94.74% 100.00% On Target

Friends and Family Test Score (Community) Score => National average MonthlyScore => National

averageJune 100.00% 100.00% 98.72% 92.31%

Mixed sex accommodation (MSA) Breaches Number of breaches = 0 Monthly 0 June 0 0 0 0 0 0 0 0 0 On Target

Healthcare acquired infection (HCAI) measure -

MRSA Number of infections = 0 Monthly 0 June 1 0 1 0 1 0

RUH: 1 MRSA infection in June. A full root cause analysis investigation is underway to identify the opportunities for

learning.

UHB: A multidisciplinary Post Infection Review meeting with commissioners for the single case of MRSA in June

was scheduled for the 28th July with the aim of identifying any learning and preventative actions to be in place if

required.

CCG: Count of all cases involving BaNES CCG patients, irrespective of where MRSA was attributable

Healthcare acquired infection (HCAI) measure -

C.difficile (Post 72 hours)

Number of infections (see threshold

for Provider)Monthly see provider target June 5 7 3 0 11 0

RUH: C. Diff working group set up to oversee improvements alongside the performance reviews.

NBT: There is a current focus within the Trust on appropriate testing and re-enforcement of the requirement for

cleaning and de-cluttering.

CCG: A pan Bristol working group has been set up by BaNES CCG to look at both provider and community acquired

cases linking in to Public Health England who are currently reviewing GP prescribing.

Number of Never Events Number of events = 0 Monthly 0 June 0 0 0 0 0 0 0 0 0NBT: The retained foreign object Never Event from May continues to be investigated and is due for discussion at

the August CRC meeting.

Number of Serious IncidentsNumber of reported serious

incidentsMonthly n/a June n/a 4 2 4 4 1 0 0 4 6 No Target Set

NHS Patient Safety Thermometer No Harm (composite measure) - % Monthly 94% June 95.71% 93.61% 98.19% 91.61% 100.00% 95.65% 95.24% 94.07% On Target

NHS Patient Safety Thermometer Pressure ulcers -% (no) Monthly 4.30% June 2.54% 5.02% 0.52% 6.31% 0.00% 0.00% 0.79% 4.49%

NBT: Pressure ulcer incidence for June has increased slightly (4.21% in May). Prevention of pressure ulcers

continues as part of the Trust’s Safety and Quality agenda; with programmes of training and awareness continuing

across the multidisciplinary teams.

NHS Patient Safety Thermometer Falls -% (no) Monthly 0.70% June 0.00% 0.34% 0.77% 0.47% 0.00% 0.00% 1.59% 0.87%

NHS Patient Safety Thermometer UTI & Catheter -% (no) Monthly 0.70% June 0.79% 1.03% 0.52% 1.32% 0.00% 4.35% 0.00% 0.72% RUH: Work being undertaken to review and understand trends with Catheter and UTI harms.

Overall rating for service CQC: Inspection Overall (Rating) Annually Outstanding / GoodCQI Insp

Date Feb-15

Dec

2014Dec-13 May 2013

Feb

2014

NHS Patient Safety Thermometer VTE -% (no) Monthly 0.40% June 0.95% 0.11% 0.00% 0.66% 0.00% 0.00% 2.38% 0.00%

PREVENT - Lead PREVENT lead identified Quarterly yes June n/a yes a/w a/w n/k yes yes a/w yes yesEach provider is required to have a Prevent Lead. This is being discussed with Providers to raise awareness and

understanding about Prevent.

WHO Surgical Safety Checklist completed for

100% of procedures

% of surgical procedures that

include safety checklistMonthly 100% June 99.40% 97.10% 100.00% #N/A #N/A #N/A

NBT: key factors influencing the comparatively lower WHO surgical checklist percentage have been investigated

and results show this is due to lack of evidence rather than non completion of the checklist itself. Follow up is being

done by exception with the relevant clinical teams.

CL

INIC

AL

EF

FE

CT

IVE

NE

SS

PA

TIE

NT

EX

PE

RIE

NC

EP

AT

IEN

T S

AF

ET

Y


Complaints and PALS – Quarter 1

Quarterly activity The following activity was recorded between 1st April and 30th June 2015.

Themes & learning from Complaints 2 complaints were received by the CCG in Quarter 1, 2015/16. These were acknowledged and responded to within the agreed

timescales. One complaint was about non-urgent patient transport services (PTS) and the other was about the delay in payment of

retrospective continuing healthcare (CHC) fees. Both complaints were upheld and have now been closed.

These are both areas in which the CCG has been monitoring performance and making considerable changes including :

• The service has been undergoing significant change in recent months including additional staff and vehicles; additional processes

relating to journey planning and dispatching, and revision of eligibility criteria for non-urgent transport to enable allocation of

appropriate vehicles for patients.

• A new process has been introduced for managing the continuing healthcare fees payments.

Themes & learning from PALS The CCG received a total of 41 contacts into the Patient Advice and Liaison Service (PALS). The majority of the queries related to

general issues (41%), followed by queries or concerns about the Patient Transport Service (15%). The CCG contract lead for patient

transport is working closely with the PALs and Complaints team to monitor concerns, responses and remedial actions.

The CCG also received a total of 3 enquires from MPs regarding the following:

• Future levels of funding for Mental Health Services.

• Interlinking relationships between Mental Health Services and Physical Health Services.

• Poor understanding by healthcare staff of Autistic Spectrum Disorders.

* Learning outcomes from PALS can be found in the Complaints and PALS Quarter 1 report.

Activity April

2015

May

2015

June

2015

Q1 BaNES

Patients Only Complaints 1 0 1 2

PALS 15 6 20 41

Patien

t E

xperie

nce


Serious Incidents Framework – Update Summary P

atien

t S

afe

ty

The new Serious Incidents (SI) Framework was published in March 2015, and replaced the previous versions published by

the National Patient Safety Agency (NPSA) and NHS England. It applies to serious incidents which occur in all services

providing NHS funded care and will apply to all contracts delivered from 2015/16.

With the aim of simplifying the process of reporting and monitoring serious incidents, three key operational changes have

been made:

1: Removal of grading – Under the new framework Serious Incidents are not defined by grade – all incidents meeting

the threshold of a Serious Incident must be investigated and reviewed according to the principles set out in the framework.

2: Timescale – A single timeframe (60 working days) has been agreed for the completion of investigation report (RCA).

This will allow providers and commissioners to monitor progress in a more consistent way. This also provides clarity for

patients and families in relation to completion dates for investigations.

3. Closure – The CCG will now be solely responsible for the closure of all serious incidents. Previously, any ‘grade 2’

incidents were required to be submitted to the NHS England local Area Team for sign-off and closure. Commissioners are

required to undertake a quality assurance review of the RCA within 20 calendar days of receipt.


Unplanned Care Performance

The provider splits are the total Trust figures not just for BaNES patients.

Short Description Target Trend

RUH UHB NBT Sirona

Supporting Narrative

Jun

Jun

Jun

Jun

Jun

Jun

Jun

Jun

Jun

Jun

This indicator is still indicative for June but May has now been

reported on target.

on target

92% A 92%

66%

Provider split YTD

G

A

G

R

A

To

imp

rovePerformance

G 25.2

92% G 87%

78% A 82%

G

G

G

96.8Unplanned hospitalisation for chronic

ambulatory care sensitive conditions

Stroke indicator - Proportion of people at

high risk of Stroke who experience a TIA are

assessed and treated within 24 hours (RUH)

Stroke indicator - Proportion of people who

have had a stroke who spend at least 90%

of their time in hospital on a stroke unit

(RUH)

Ambulance clinical quality – Category A

(Red 1) 8 minute response time (B&NES)

A

R

Ambulance clinical quality - Category A 19

minute transportation time (B&NES)

Ambulance clinical quality – Category A

(Red 2) 8 minute response time (B&NES)

90.5%

95%

75%

75%

95%

A&E Department - % of A&E attendances

under 4 hours (RUH)

65.9%

Year to

dateIn period

92% 94% 90% 100%

Further internal action has been agreed with the RUH as part

of the SRG’s 4 hour recovery plan to try and recover the 4

hour standard. This remains extremely challenging with the

combined targets of elective activity and non-elective activity

placing pressure on the RUH’s reduced bed base due to their

Summer bed plan closures. The RUH continues to experience

significant A&E 4 hour breaches with the main cause

recorded as bed management. The failure to achieve QTR 1

and the high risk of QTR 2 failure places delivery of the 4 hour

standard for 2015/16 at risk.

SWASFT continue to report increased activity above the

contract level for the north division and within BaNES, placing

additional pressure on the Red1 and Red 2 targets for

BaNES. Red 1 remains on targets at 75% for the YTD. The

South West commissioners have completed the contract

variation order to reflect the new 70% Red 2 target for 2015/16

to recognise the Dispatch on Disposition (DoD) impact on

Red 2. SWSAFT have agreed with Commissioners the Red 2

recovery plan. A 19 has seen an increase in June, however

this still remains below target for the YTD.

75%

65.5% R

2.5

91%

80%

29.9

60%

25.7 G

These 4 measures are tracked individually and as a

composite, as reducing avoidable emergency / unplanned

admissions. This composite is a national ambition and a

quality premium measure.

These indicators are all targeted to be lower than last year.

All indicators have improved in the month but only 2 are below

the same period last year. Further analysis of these

admissions is due in August.

Emergency admissions for acute conditions

that should not usually require hospital

admission

59.3 66.7 R 228.7 R

Unplanned hospitalisation for asthma,

diabetes and epilepsy in under 19s18.5 25.2 R 70.7 R

4.6Emergency admissions for children with

Lower Respiratory Tract Infections (LRTI)


Urgent Care System Update 1

50%

60%

70%

80%

90%

100%

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

Weekly acute % 4 Hr Performance From 2013/14 to 2015/16 YTD

RUH 1516 RUH 1415 RUH 1314

1000

1100

1200

1300

1400

1500

1600

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

Weekly acute A&E Attendances

From 2013/14 to 2015/16 YTD

RUH 1516 RUH 1415 RUH 1314

The RUH A&E attendance activity is currently tracking below 2014/15

demand levels. In April and May demand activity was also under

2013/14 levels. The conversion to admission rate from this reduced

attendance has however risen significantly, indicating an increase in the

number of patients with complex needs requiring admission. This rise in

non-elective admissions has been accompanied with a rise in the non-

elective length of stay at the RUH, across all CCGs. It should be noted

that BaNES LOS currently remains at 2014/15 levels.

Despite early signs in May of a recovery in the RUH’s A&E 4 Hour

Performance, June and July’s performance has fallen significantly below

the 4 Hour Standard. This fall in performance has coincided with the

RUH’s internal summer bed closure plan and the admission rate and

LOS impact explained above. This position has further been

exacerbated by additional bay closures due to internal maintenance

requirements. While the DTOC position is significantly improved from

2014/15, there are continuing bed management challenges due to

delays in setting up complex packages of care. These also indicate an

increase in the complexity of patients requiring Urgent Care.

BaNES SRG continues to provide focus and leadership and the

combined CCGs have funded increased external capacity through

increased Reablement, Discharge to Assess at scale and are working

with partners to improve discharge by the creation of an Integrated

Hospital Discharge Service (IHDS) at the RUH. All of these actions are

part of the SRG 4 Hour Recovery Plan and this approach is being

reviewed as part of a tripartite approach lead by NHSE.


Urgent Care System Update 2

48%

30%

35%

40%

45%

50%

April May June July

BaNES CCG - % SWAST conveyance to ED

2014/15 2015/16 Target

0

200

400

600

800

1000

April May June July

BaNES CCG – Number of SWAST conveyances to ED

2014/15 2015/16

Ambulance Service Demand

The ambulance service is seeing increased demand in 2015/16 :

• Increasing ambulance calls including disposition %s from 111.

• Improved call management at SWASFT including dispatch on

disposition that is reducing the proportion of calls leading to a

dispatch.

• Improved conveyance %: once ambulance crew see patients they

are conveying a lower proportion to ED but the higher demand

means the volumes conveyed are actually in line with 2014/15.

• The improved triaging means that the patients reaching ED are

likely to have higher acuity.

0%

2%

4%

6%

8%

10%

12%

14%

Apr May Jun Jul

NHS111: % of BaNES Wilts 999 Dispositions

% of Calls 2014/15 % of Calls 2015/16


NHS 111 – Service Statistics Q1

80%

85%

90%

95%

100%

105%

% Calls answered within 60 seconds Target

0%

20%

40%

60%

80%

100%

% Calls warm transferred Target

0%

5%

10%

15%

% Calls referred to ED Target

0%

5%

10%

15%

20%

25%

Ambulance dispatches as a percentage of total calls Target


Planned Care Performance

The provider splits are the BaNES patients for RTT 18 weeks.

Short Description Target Trend RUH UHB NBT Sirona Supporting Narrative

Jun

Jun

Jun

Jun

Jun

Jun

In period Year to date

Performance

To

imp

rov

e Provider split YTD

i. The percentage of admitted pathways

within 18 weeks for admitted patients whose

clocks stopped during the period on an

adjusted basis

90% 83.8% R

iii. The percentage of incomplete pathways

within 18 weeks for patients on incomplete

pathways at the end of the period

92% 92.7% G 93% G

G

16

81% 80% -For admitted Q1 was off target as planned as the providers

clear the patients waiting the longest.

Recent National changes in 18 weeks RTT measurement mean

that the key measure going forwards is the incomplete

pathways %.

There is still a backlog of BaNES patients with long waiting

times. The total numbers of patients waiting over 18 weeks has

increased from 723 (May) to 773 at the end of June with

increases at RUH and NBT. The largest specialty backlogs are

in Other at 157 (includes: paeds & pain) , T&O with 119 and

Gastro with 116.

ii. The percentage of non-admitted pathways

within 18 weeks for non-admitted patients

whose clocks stopped during the period

95% 95% G 95.4%

85% R 69%

93% 88% 86% 99%

94% 99% 95% 92%

16 0

There were 9 52 week waiters at the end of June at NBT, 8

waiting for T&O treatment and 1 for Neurosurgery. The T&O

spinal surgery waiting list at NBT has been closed to new

referrals and the breaches are planned to be cleared by Jan

2016.

Diagnostic test waiting times - under 6 week

waits99.0% 99.2% G 99.2% G

R 0 0

Number of 52 week RTT incomplete

pathways greater than 52 weeks for patients

on incomplete pathways at the end of the

period

0 9 R

88.4%

29 BaNES patients had been waiting for more than 6 weeks at

the end of June. 16 breaches were waiting for

Echocardiography, with 12 at Sirona. Sirona have put in place

increased heart failure clinics from July to prevent future

backlogs.

99.7% 98.6% 95.2%

Local indicator for cancer waiting times

performance0% -100% R -100% R

One amber for June - 11 breaches for breast symptom 2 week

wait all patient choice.

One red for June - 1 breach for 62 day screening due to clinical

need. But this is the 2nd breach this year for a patient initially

seen at Salisbury and then transferred to RUH for treatment,

waiting for RUH review.


Planned Care Update 1

10%

12%

14%

16%

18%

20%

22%

24%

0

50

100

150

200

250

300

350

01

-Ap

r

15

-Ap

r

29

-Ap

r

13

-May

27

-May

10

-Ju

n

24

-Ju

n

08

-Ju

l

22

-Ju

l

05

-Au

g

BaNES patients at RUH Admitted Pathway Performance

# >18 weeks % > 18 wks

18 week Referral to Treatment (RTT) Targets

It was noted in the last report that the RUH had committed to providing specialty level RTT plans by the end of July 2015, and

that they would be developed using an IMAS demand modelling tool (NHS Interim Management and Support) provided by

Monitor. The full model outputs should be available for the next RTT Assurance Group meeting on 24 August 2015.

The CCG has agreed to commission additional elective surgery capacity for 2015/16 in order to meet the RTT targets . The

RUH were originally planning to meet these targets at a Trust-wide level by the end of Quarter 1, however, they reported in

July that it would be the end of Quarter 2 due to the pressure on beds from unplanned care cases admitted in Q1. A further

report received this month suggested that longer will be required to clear the admitted backlog.

RUH RTT Open Pathway Performance Forecast

2014/2015 2015/2016

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

93.1% 92.4% 92.3% 91.2% 92.8% 93.0% 93.2% 93.4%

Target 8%

90%

91%

92%

93%

94%

0

200

400

600

800

01

-Ap

r

15

-Ap

r

29

-Ap

r

13

-May

27

-May

10

-Ju

n

24

-Ju

n

08

-Ju

l

22

-Ju

l

05

-Au

g

BaNES patients at RUH Open Pathway Performance

# >18 weeks % <18 weeks

From October 2015, the national RTT reporting (see following slide) will change and there will be a single, national target for

Incomplete Open pathways (92%) at Trust level.


Planned Care Update 2

Demand management

It was noted in the last report that work is underway with the Clinical Commissioning Reference Board Sub-Group (CCRB) to

develop action plans for challenged specialties. Work to date has focused on Dermatology and Gastroenterology as the RUH was

experiencing a significant rise in referrals. The focus will now be on Orthopaedics and General Surgery as both specialties have

seen an increasing problem with managing RTT waiting times. This is partly due to increased referrals but also to non-elective

activity putting pressure on availability of elective beds and theatre sessions. This work will be progressed through the RTT

Assurance Group and the CCRB Sub-Group.

Update on Dermatology

Following the request from the RUH to manage 8 dermatological conditions in primary care, the CCG commissioned a short term

arrangement with BEMS+ to provide support to GPs with managing these patients. The BEMS+ service triages and treats patients

and is restricted to the 8 conditions identified by the RUH. Any other conditions are referred to secondary care.

In July, the Joint Commissioning Committee approved an extension to the arrangement for a further 6 months whilst the current

service is reviewed. As noted in the last report, the intention is to work with local providers to develop a community model. Scoping

work has started with the BEMS+ lead and RUH Dermatology clinicians and managers.

MSK programme

The MSK (muscoloskeletal) Steering Group will begin to meet in September and initial membership of the group and the work

stream sub-groups has been agreed. The PMO lead is currently collating the activity and financial baseline position for discussion at

the first meeting. This will describe the current expenditure and case mix by provider and identify trends. The original benchmarking

information which informed the Strategic Plan will also be refreshed to reflect the latest position.


NHS Constitution Standards – Change in reporting 1

Sir Bruce Keogh Recommends changes to waiting time measures

On 4th June, Sir Bruce Keogh wrote to Simon Stevens in reply to a request to review the current waiting time measures to

ensure they make sense for patients and are not provoking perverse behaviours. The key recommendations are below and

were accepted in full by Simon Stevens and the Secretary of State:

• Abolish the referral to treatment time (RTT) admitted and non-admitted measures and make the incomplete standard

which captures the experience for all patients on the waiting list the only measure.

“In the last year, we announced a temporary suspension of the admitted and non-admitted standards to encourage hospitals

to treat long-wait patients. The results were compelling with record numbers of long-wait patients treated. It is absurd,

however, to find ourselves in a situation where we had to suspend our own waiting time targets to do what is right for

patients”

• Expand the dispatch on disposition pilot currently in the South West (including BaNES) that increases the time allowed

assessing a call’s urgency by up to 120 seconds reducing the number of dispatches, making more vehicles available for

genuinely urgent calls. A further recommendation on the national standards (i.e. % attended within 8/19 minutes) by

Autumn 2016.

• Accident & Emergency - Review 4 hour access standard to include the impact of reducing minor complaints seen in

hospitals in communities with good out of hospital services and bring in a wider range of clinical standards, both

alongside the implementation of redesigned urgent and emergency care services in areas around the country this year.

• Cancer waiting time and diagnostics standards are appropriate.

• Mental Health - waiting times standards are starting in 2015/16 and will continue to be introduced across the range of

services over five years.

• Standardise reporting arrangements so that statistics for A&E, RTT, cancer, diagnostics, ambulances, 111 and delayed

transfers of care are all published on the same day of the month. Mental health waiting time statistics to join this pattern

once available.


NHS Constitution Standards – Change in reporting 2

What do the changes to reporting operational standards mean for us?

On 24th June, NHS England, Monitor and the TDA wrote to CCGs and Providers to explain the operational impacts of the

changes to the waiting time measures:

• RTT sanctions - From the end of June there will be no sanctions including fines for CCGs or providers failing the admitted

or non-admitted standards. Commissioners should not levy any financial sanctions from 1st April 2015 for these standards.

• RTT contract changes - NHS England will consult on a variation to the national contract to remove the sanctions for these

pathways and propose increasing the value of the sanction for not meeting the incomplete standard. This is intended to be

completed for 1st October. To remove the standards themselves will require the standing rules regulations to be revised by

Parliament.

• RTT data collection – Providers are expected to continue to submit the RTT monthly collections as normal. Minor

amendments are expected to add some items (number of clock starts, decisions to admit and validation removals). There

is consultation with CCG’s and providers on these changes during August.

• A&E data collection – weekly collection and publication of A&E data stopped on 1st July.

• Mandatory data reporting – there will be a more stringent approach to non-reporting of mandatory data particularly for

providers about to undergo patient administration system upgrades. This is to ensure reporting is ceased only in the most

exceptional circumstances.


Social Care Performance

Short Description Target Trend Supporting Narrative

Jun

Jun

May

May

Jun

Jun

Jun

Carers receiving a service or advice and

information as an outcome of an assessment

or review- cumulative target

Timeliness of social care packages -

proportion receiving careplan in less than 28

days.

95% 91% A

G 89% ATimeliness of social care assessment -

proportion in less than 28 days. 90% 90%

This is a cumulative target and is on track year to date.

There has been a slight impact on performance since April 2015 in

response to changes to internal Sirona processes. The assessments and

careplan timings are linked and interdependent. An improvement in care

plan timings needs to be seen as well. This will continue to be monitored

in performance meetings

Since April 2015 there has been a reduction in the achievement against

this target. The disparity between timing of assessments and careplans

suggests a "waiting list" has resulted from internal process changes in

Sirona. This will be investigated through the contract meetings.

90% A

Adults aged 18-64 admitted on a permanent

basis in the year to residential or nursing care

per 10,000 population

1.5 0.0 G 0.0

G

5% 7% G 7% G

95 59 G 67

Admissions of people to permanent

residential and nursing care - people aged

65+ per 10,000 population

G

G

G

Proportion of people using social care who

receive self-directed support, and those

receiving direct payments.

65% 74.3% G 74.3%

Proportion of older people (65 and over) who

were still at home 91 days after discharge

from hospital into reablement/ rehabilitation

services (Sirona only)

85% 83% A 85%


Performance continues above target indicating a high level of adult social

care users in receipt of a direct payment .

Note this is a financial year to date indicator so was reset in April.

Performance

To

imp

rove

This area needs to show sustained improvement over Q2 and Q3 to

provide assurance of improvements to the pathway. This will be

managed through the contract meetings.

Performance in May continues better than target for the Better Care

Fund plan with only 17 admissions.

No admissions year to date

Cumulative indicators reset to zero at the beginning of 2014/15.

Details on the indicators can be found in the glossary at the end of this report


Mental Health Performance


Jun

Jun

Jun

Jun

Jun

Jun

Jun

G

G

99.3%

75% G

G

8.1% A

98% G

% of delayed transfers of care from

hospital, attributable to community

mental health services.

7.5% 7.4% G

% of referrals to mental health

inpatients beds that have an

assessment by the mental health crisis

team

95% 100% G 100%

% of mental health referral to treatment

pathways completed within 13 weeks

Mental Health Service users

discharged from hospital, % followed

up in the community within 7 days.

98% G

95% 99%

Proportion of adults in contact with

secondary mental health services living

independently, with or without support

70% 74% G

Mental Health Crisis service: % of

urgent referrals in which service user is

contacted within 4 hours.

98% 100% G

95% 97% G

Proportion of adults in contact with

secondary mental health services in

paid employment

10% 11% G 11% G


Performance

To

imp

rove

On target.

On target

On target

The work taking place to manage the acute care pathway has

been effective this month although the demand, especially on

older adults dementia residential and nursing beds, remains

volatile.

On target

On target

This target is variable in achievement depending on the cohort

of clients in the period.

Details on the indicators can be found in the glossary at the end of this report.


Mental Health Update – Substance Misuse 2014/15 1

In 2014/15 there was:

• substantial growth in the number of clients seeking support

for problematic alcohol misuse, up from 388 in 2012/13 to

647 in 2014/15. The increase in numbers in Alcohol

Treatment reflects the development of the RUH Alcohol

Liaison Service and increased awareness of, and need for,

the service.

• excellent rates of clients completing alcohol treatment

programmes at 51% of alcohol clients and 60% of alcohol

misusing parents (with children living at home), both are

considerably above the national average; The increased

outcomes are being driven by better and more effective

services (including peer support see slide 3) and attracting

motivated clients. 52.5%

49.7% 50.5% 48.5% 51.0%

0%

10%

20%

30%

40%

50%

60%

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

Alcohol Successful Completions 2013/14 - 2014/15

Alcohol only National average

388 453 428

512

584 647

0

100

200

300

400

500

600

700

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

All Alcohol clients in treatment 2012/13-2014/15

73

44

No. of Alcohol only clientswho have children living at

home

No. of successfulcompletions

Alcohol misusing Parents Treatment Outcomes 2014/15

Community Drug and Alcohol services – Activity and Completions



In 2014/15 there was:

• significant progress in increasing the

proportion of all clients in treatment who

successfully completed treatment and did not

re-present within 6 months (PHOF 2.15). With

B&NES now the top performing partnership

for clients recovering from opiate use (when

compared to 32 local area comparator (LAC)

partnerships). The service was remodelled

and providers were asked to focus on client

recovery which has improved outcomes for

clients who were motivated.

• excellent support to reduce the harm caused

by Blood Borne Viruses with 95% of previous

or current injectors being tested for Hepatitis

C (i.e. only 5% have not been tested in

B&NES compared to 20% of clients

nationally). This support is provided by a

specialist blood borne virus nurse

supplemented in the first half of the year by a

project to focus on expanding the reach of

support and encouraging high risk clients to

be tested and immunised.

Community Drug and Alcohol services – Drug outcomes and Harm Reduction

8.74%

6.22%

7.68%

10.83% 11.90% 11.70%

0%

2%

4%

6%

8%

10%

12%

14%

Q4 2012/13 Q4 2013/14 Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 2014/15

PHOF: Indictor 2.15 Opiates Outcomes.

Top of top quartile range Bottom of top quartile range

baseline

0%

5%

10%

15%

20%

25%

30%

35%

Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15

2014-15 - Clients with NO record of a HCV test as a proportion of all clients in treatment at the end of the reporting period who were eligible to receive one.

All clients in treatment

New presentations totreatment

National average all clientsin treatment

National average newpresentations to treatment



One approach to understanding how recovery might be achieved is to focus on the concept of ‘recovery capital’, which the

2010 national drugs strategy defines as “the resources necessary to start, and sustain recovery from drug and alcohol

dependence.” (HMG, 2010) Since this time, recovery support has been developed which seeks to optimise building recovery

capital for clients.

The following chart compares Q4 2013/14 (blue) with Q4 2014/15 (grey). Of particular note is the significant increase in

Mutual Aid being provided, which is a core part of developing recovery capital in sustaining abstinence. This is provided by

peer mentors, better links with NA and AA and more SMART recovery and has been a significant driver in the service’s

improved outcomes.

Community Drug and Alcohol services – Recovery Capital

23

199

41 31

101

46 40 2

225

100

36 34 46

467

58 29

175

103 86

1

217 159

72 36

050

100150200250300350400450500

Recovery Capital: Q4 2013/14 compared to Q4 2014/15

Q4 2013/14


Learning Disabilities Performance


Jun

Jun

The reported number of people in paid employment has risen by 6 to 43,

the total number of adults with learning disabilities (18-64) receiving long

term support iincreased slightly to 428. So the proportion in employmnet

has increased significantly this month

The 2015/16 results are calculated slightly differently due to a change in

national definitions.


Performance

To

imp

rove

Proportion of adults with learning disabilities

in paid employment10% 10.0% G 10.0% G

The reported number of people living in settled accommodation has

increased to 299 out of the 428 adults with learning disabilities (18-64)

receiving long term support.

The 2015/16 results are calculated slightly differently due to a change in

national definitions.

G Proportion of adults with learning disabilities

who live in their own home or with their family68% 69.9% G 69.9%


Adult Safeguarding Performance

Short Description Target Trend Sirona AWP Supporting Narrative

Jun

Jun

Jun

Jun

94% 94%

91% 87%

68% 94%


Performance

To

imp

rove Providers YTD

R 89% A

95% 89% A

% of adult safeguarding strategy

meetings/discussions held within 5 working

days from date of referral.

90% 83% A 74%

% of adult safeguarding decisions made in 48

working hours from the time of referral95% 81%

There is an expectation in the Care Act that the views of the service user

are taken into account when making safeguarding decisions. The

Safeguarding Board have agreed that the timescale’s can be extended, if

the Safeguarding Chair confirm that this is required to obtain the

individuals views and wishes. Proceses are currently being put in place

torefelct this decision and performance reporting will also need to be

adjusted.

The number of concerns being raised has escalated significantly since

the Care Act 2014 went live and this is having an impact on timescales;

progress against this is being monitored alongside the information

provided above.

There were 64 decisions made in 48 hours out of 79.

89 out of 108 activities were held in the expected timescales so most of

the delays were at the initial decision making stage.

Though the number of assessments, planning meetings and first reviews

were much lower than normal, this is being reviewed.% of overall activities/events to timescale 90% 82% A

R

87% A

94% A

% of adult safeguarding strategy

meetings/discussions held within 8 working

days from date of referral.

87% 88%


Children’s Services – Community Services Performance

Details on the indicators can be found in the glossary at the end of this report. Please note these are all local indicators


Jun

#N/A

Jun

Jun

Jun

Jun

#N/A


Health Visitor - No. of new Common

Assessment Frameworks (CAFs) completed

by HV staff in the month

0 15 B 44

Performance

To

imp

rov

e

Health Visitors are continually encouraged to complete CAFs to allow

appropriate information sharing.B

School Nurse: % of pupils seen within 10

school days from referral 0% 0% 0

G 98% G

0% 0

School Nurse: Number of contacts made with

individual children and young people - Total0 1942 B 5826 B

Safeguarding: % of Child Protection

conferences with health professional

attendance

95% 98%

41 B B

Paediatricians: Total number of Referrals

from all sources0 61

Paediatricians: % of children or young people

treated within 18 weeks of referral.100% 98%

Paediatricians: Total number of follow ups

overdue at month end (all CCGs)0 0

98% A A

0 0 0

Q4 and Q1 data not available. Being discussed at monitoring meeting w/b

17.08.15

Data for last 5 months not provided. Being discussed at monitoring

meeting w/b 17.08.15


Children’s Services – Mental Health Performance

Please note these are all local indicators.

CAMHS – Children and Adolescent Mental Health Services

PCAMHS – Primary Children and Adolescent Mental Health Services (first level - Tier 2)

OSCA – The Outreach service for Children and Adolescents

Details on the indicators can be found in the glossary at the end of this report.


#N/A

#N/A

Jun

Jun

Jun

Jun

#N/A

CAMHS Tier 3 Direct patient contacts

completed0% 194 B 662 B

Oxford Health Foundation NHS Trust are currently implementing a new

Electronic Patient Record system. Referral to assessment times are not

currently available but will be back dated asap.

PCAMHS Tier 2 number of referrals 81

PCAMHS Tier 2 Direct patient contacts

completed131 56


PCAMHS/CAMHS continue to receive some inappropriate referrals.

Attempts to improve referrals have been taken – CAMHS have met GP

safeguarding leads, head teachers and children’s Social Care Team

leaders. In September EHWB hubs will commence at 6 secondary schools

providing opportunities for school staff to directly consult with CAMHS

practitioners. Written guidance re the EHWB pathway has also been sent

to all secondary schools and there are plans to eventually publish these on

the Map of Medicine for GPs.







100% 0

82% AA

0% 0

266 G

0

CAMHS Tier 3 new referrals assessed within

4 weeks of referral 0% 45% 0 0%

Performance

To

imp

rove

0

0% 0

Continuing decreasing trend - being followed up with provider

CAMHS OSCA new referrals assessed within

4 weeks of referral 0%

PCAMHS Tier 2 / Tier 3 caseload % of

referrals accepted85%

G

R 176 R

77%

PCAMHS Tier 2 Waiting Times: % Service

Users offered an assessment within 4 weeks

from referral

0% 60%


Children and Young People’s Update 1

Child and Adolescent Mental Health Service (CAMHS)

• Following the publication of ‘Future In Mind’ in March 2015, a significant amount of national funding to

improve/transform community CAMHS has been allocated to B&NES. The funding is dependent on national

approval of a local multi-agency ‘Transformation Plan’. Detailed guidance was issued early August and the plan

must be submitted by October 16th. The plan must include promotional and preventative services, generic

CAMHS, and more specialised support for Eating Disorders and Early Intervention in Psychosis. Children’s

commissioners will create the plan by collaborating closely with members of the multi-agency strategic Emotional

Health and Wellbeing Group and other stakeholders.

Community Health Services

• Health Visitor Service commissioning arrangements moving into the Local Authority from the NHS is going ahead

as per the project plan.


Children and Young People’s Update 2

Special Educational Needs and Disabilities (SEND)

SEND reforms introduced by the Children and Families Act 2014 continue to be implemented.

• Pathway for medical reports to advise the Education Health and Care Panel is a success and has reduced the

time community paediatricians were spending submitting reports.

• The additional time required by Occupational and Speech & Language therapists to fully contribute to the

Educational, Health and Care Plans is being investigated.

• A review of the requirements of the District Medical Officer/Deputy Chief Medical Officer role within the CCG

continues.

Personal Health Budgets and IPC

• Integrated Personal Health Commissioning (IPC) aims to demonstrate how personalisation can improve

outcomes for children with complex needs. The aim is to develop 10 personalised support plans in 2015/16 that

may include a personal budget if appropriate. Two personal budgets are in place.


Medicines Optimisation – CCG benchmarking Q4 2014/15

• 18 of the 26 indicators improved in

Q4

• Only 4 Red indicators – same as

reported in the previous quarter

REDS:

Indicator 10 – Improved since last

quarter

Indicator 12 – Not in work

programme focus this year – slight

deterioration vs. last quarter

Indicator 13 – Slight Improvement on

last quarter

Indicator 23 – Improved vs. last

quarter. The CCG continues to carry

out on-going work on choice of

antibiotics, through a programme of

audit this year and this issue is being

tackled across the health community.

BaNES CCG Prescribing Dashboard

Domain Indicators Direction

to

improve

National

Q4

BaNES

CCG Q4

BaNES

CCG Q3

BaNES vs

National

BaNES

Quarterly

Trend

1 3 days Trimethoprim ADQ/Item 5.86 5.46 5.72 G 2 Anti bacterial Items STAR/PU (PU13) 0.32 0.273 0.267 G

3 Hypnotics ADQ/STAR PU (PU13) 4.000 0.252 0.263 G

4 % Hypoglycaemic Agents Items 81.89% 86.71% 87.80% G 5 Long-acting insulin analogues Items 79.4% 73.26% 74.44% G 6 NSAIDs ADQ/STAR PU (PU13) 1.41 1.36 1.39 G 7 NSAIDs :Ibuprofen & Naproxen Items 77.9% 79.0% 78.6% G 8 Bronchodilators ADQ/STAR PU (PU13) 1.96 1.44 1.53 G 9 Inhaled Corticosteroids ADQ/STAR PU (PU13) 0.69 0.57 0.61 G

10 % of Less preferred strong opiates 50.8% 58.6% 59.3% R 11 Enteral SIP Feeds NIC per PU £0.39 £0.29 £0.30 G 12 % Rosuvastatin and Ezetimibe of all regulating items 5.19% 6.03% 5.96% R 13 % Amlodipine of all calcium channel blockers 74.1% 69.9% 69.5% R 14 % Dutasteride items of all items 15.4% 4.7% 4.3% G 15 % Metformin MR Items 25.9% 23.4% 22.7% G 16 % Doxazosin MR 14.1% 9.5% 9.7% G 17 % Costeffective Triptans Items 84.3% 86.1% 85.2% G 18 Potential Generic Savings 0.43% 0.41% 0.38% G 19 % Less preferred anti-depressant Items 4.08% 3.62% 3.68% G 20 Less Preferred Lipid Treatment Cost per STAR PU £12.32 £7.35 £6.77 G 21 % Oxbutynin_HCL & Tolterodine_tab of all OAB Items 32.3% 41.9% 43.8% G 22 % Sildenafil Items 69.9% 73.1% 71.2% G

23 % CoAmoxiclav, Cephs & Quino of all items 9.8% 14.9% 15.9% R 24 Specials Cost per ASTRO PU (PU13) £94.9 £30.0 £32.5 G 25 % New oral anticoagulants items of all anticoagulants 13.9% 21.6% 17.0% 26 Dopamine Antagonist Cost per ASTRO PU £11.7 £6.21 £8.40 G

26 Proton Pump Inhibitors ADQ/STAR PU (PU13) 4.54 4.08 4.17 G

QIP

P

Savi

ngs

Q

ual

ity

&

Safe

ty

BaNES CCG Performance Summary - Quarter 4 2014/15


Medicines Optimisation Update

Electronic Prescribing Service Project

Roll out project is complete

• 24 practices have “gone live” with an average of 54% of

prescriptions being sent electronically by these practices

• This is better than NHS England overall and is the best in

BaNES, Gloucester, Swindon and Wiltshire.

• 15 practices have achieved > 40% e-transmitted (the project

target)

• 9 further > 20% e-transmitted rates

• There have been over 55k patient nominations of pharmacies in

BaNES

• 3 Practices are not going live as part of this roll out

• Post implementation reviews held and learning shared

Growth in BaNES Prescribing Costs Rising to England Average

• The graph shows that since January 2015

the gap between BaNES CCG and NHS

England growth in prescribing costs has

narrowed.

• The medicines team have planned

increased savings plans for 2015/16 and

are investigating what is driving growth in

BaNES

• CCG continues to have top 6% weighted

prescribing costs in England


Glossary for Indicators

Indicator dashboard format:

The indicator reports are comparing performance in the latest available period with the target for that period, and

performance financial year to date with the year to date target. The results use Red-Amber-Green (RAG) rating to highlight

whether the results are on target.

There are arrows showing the direction of travel of the results for the latest available period compared with the previous

reported period. After the trend line there is a column that shows the direction this arrow needs to move in to be showing an

improvement in the results.

The trend lines show the last 13 periods results where available, this is aimed at giving a simple idea of how this indicator

has been performing in the last year. Each trend line is automatically formatted to fit the data of that indicator so please read

in context with the last months results.


Quality Dashboard

Dashboard Detailed MeasureSource of indicator

definitionReference Detailed definition Source

QualityMixed Sex Accommodation

(MSA) Breaches

Everyone Counts

2013/14CB_B17 The number of breaches of mixed-sex accommodation (MSA) sleeping accommodation

Published on Knowledge and Information

Service website https://kis.southcentral.nhs.uk

from NHS England

Quality Number of Never Events Quality Quality 5Never Events are serious, largely preventable patient safety incidents that should not occur if the available

preventative measures have been implemented.

Reported as Serious Incidents on the Strategic

Executive Information System (STEIS)

Quality

% of all adult inpatients who

have had a VTE risk

assessment

Quality Quality 8Every patient admitted to hospital for medical reasons should have a documented risk assessment to identify

those at risk of Venous Thromboembolism (VTE).

The Knowledge and Information Services (KIS)

website

https://kis.southcentral.nhs.uk/sites/KIS/Dashb

oards

Quality

WHO Surgical Safety Checklist

completed for 100% of

procedures

Quality Quality 11This is a surgical checklist that the surgery team completes with listed tasks before it proceeds with the

operation.From the RUH Quality Scorecard

QualityFracture Neck of Femur - % in

theatre within 36 hoursQuality Quality 13

The best practice for Fractured Neck of Femur is the time to surgery within 36 hours from arrival in an

emergency department, or time of diagnosis if an inpatient, to the start of anaesthesia. From the RUH Quality Scorecard

QualityHealthcare acquired infection

(HCAI) measure (MRSA)

Everyone Counts

2013/14CB_A15 Number of cases of Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia

Health Protection Agency Healthcare Aquired

Infections website https://nww.hpanw.nhs.uk

QualityHealthcare acquired infection

(HCAI) measure (c. difficile)

Everyone Counts

2013/14CB_A16 Number of Clostridium difficile infections, for patients aged 2 or more on the date the specimen was taken

Health Protection Agency Healthcare Aquired

Infections website https://nww.hpanw.nhs.uk

Quality Friends and family test score Everyone Counts

The proportion of people who reported that they were either 'extermely likely' or 'likely' to recommend the

service to their friends and family, out of the total number of people who responded to the survey. Score is

displayed as a percentage.

NHS England website.

http://www.england.nhs.uk/statistics/statistical-

work-areas/friends-and-family-test/friends-and-

family-test-data/

Quality Patient Safety ThermometerNHS Contract (National

Quality Requirements)The number of instances of each type of harm reported in a month.

Health & Social Care Information Centre.

http://www.hscic.gov.uk/thermometer

Quality Complaints and MP Letters The combined number of formal complaints raised by patients and by MP's on behalf of patients in the month CCG Complaints and PALS team

Quality PALS Queries and Concerns The combined number of PALS contacts and concenrs received by the complaints and pals team in the month CCG Complaints and PALS team




Unplanned Care Dashboard



Unplanned

Care

Ambulance clinical quality –

Category A (Red 1) 8 minute

response time

Everyone Counts E.B.15.i

The total number of Category A Red 1 incidents, which resulted in an emergency response arriving at the scene of the incident

within 8 minutes. Category A Red 1 incidents are those where patients are presenting conditions that may be immediately life

threatening and the most time critical.

This data is only available at whole provider level i.e. there is no CCG split.

From South Western Ambulance

Service NHS Foundation Trust

report

Unplanned

Care

Ambulance clinical quality –

Category A (Red 2) 8 minute

response time

Everyone Counts E.B.15.ii

The total number of Category A Red 2 incidents, which resulted in an emergency response arriving at the scene of the incident

within 8 minutes. Category A Red 2 incidents are those where patients are presenting conditions that may be immediately life

threatening but less time critical than red 1.




report

Unplanned

Care

Ambulance clinical quality -

Category A 19 minute

transportation time

Everyone Counts E.B.16

The total number of Category A incidents, which resulted in a fully equipped ambulance vehicle (car or ambulance) able to

transport the patient in a clinically safe manner arriving at the scene within 19 minutes of the request being made. Category A

incidents are those where patients are presenting conditions that may be immediately life threatening.




report

Unplanned

Care

A&E Department - % of A&E

attendances under 4 hoursEveryone Counts E.B.5.iiii

% of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge.

Combined for type 1, type 2 and type 3 A&E departments.


Published on Knowledge and

Information Service website

https://kis.southcentral.nhs.uk

Unplanned

Care

Stroke indicator - Proportion of

people who have had a stroke

who spend at least 90% of their

time in hospital on a stroke unit

Local Local 6 CCG level data Is not available for this indicator so the RUH whole Trust result is being shown, usually lagged one month. From the RUH Quality Scorecard

Unplanned

Care

Stroke indicator - Proportion of

people at high risk of Stroke who

experience a TIA are assessed

and treated within 24 hours

Local Local 7 CCG level data Is not available for this indicator so the RUH whole Trust result is being shown. From the RUH Quality Scorecard

Unplanned

Care

Unplanned hospitalisation for

chronic ambulatory care

sensitive conditions

Everyone Counts E.A.4.i

This is the rate per 100,000 of people aged over 18 with chronic conditions admitted to hospital as an emergency admission.

The conditions include: Asthma, Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, Angina,

Anaemia, Hypertension, Epilepsy, and Dementia

Analysis on CS CSU SUS Data

Warehouse

Unplanned

Care

Unplanned hospitalisation for

asthma, diabetes and epilepsy in

under 19s

Everyone Counts E.A.4.iiThis is the rate per 100,000 of people aged under 19 with asthma, diabetes or epilepsy admitted to hospital as an emergency

admission where this condition was the primary diagnosis.


Warehouse

Unplanned

Care

Emergency admissions for acute

conditions that should not

usually require hospital

admission

Everyone Counts E.A.4.iii

Total number of emergency admissions episodes for people of all ages where an acute condition that should not usually require

hospital admission was the primary diagnosis. The indicator shows information on the number of emergency admissions per

100,000 population. This indicator has been indirectly age and sex standardised.


Warehouse

Unplanned

Care

Emergency admissions for

children with Lower Respiratory

Tract Infections (LRTI)

Everyone Counts E.A.4.iv

Total number of emergency admission episodes for people under 19 (0 to 18 years) where lower respiratory tract infection was

the primary diagnosis. The indicator shows information on the number of emergency admissions per 100,000 population. This

indicator has been indirectly age and sex standardised.


Warehouse



Planned Care Dashboard



Planned CareLocal indicator for cancer waiting

times performanceEveryone Counts Cancer 1

A composite indicator based on all 2 week, 31 day and 62 day cancer waits. One or no ambers with the rest green will show as

green overall. If more than one indicator is amber, but the rest are green, the overall indicator is amber. If any indicator is red,

the overall indicator is red.

The cancer waiting time data is

accessed from Open Exeter.

Planned Care

i. The percentage of admitted

pathways within 18 weeks for

admitted patients whose clocks

stopped during the period on an

adjusted basis

Everyone Counts E.B.1The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted pathways. Where the

pathway can be adjusted after it is stopped to reflect nationally defined pauses in the pathway.

Central Southern Commissioning

Support Unit RTT monthly report.

Original data uploaded by

providers to Unify2

Planned Care

ii. The percentage of non-

admitted pathways within 18

weeks for non-admitted patients

whose clocks stopped during the

period

Everyone Counts E.B.2 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted pathways




providers to Unify2

Planned Care

iii. The percentage of incomplete

pathways within 18 weeks for

patients on incomplete pathways

at the end of the period

Everyone Counts E.B.3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways




providers to Unify2

Planned Care

Number of 52 week RTT

incomplete pathways greater

than 52 weeks for patients on

incomplete pathways at the end

of the period

Everyone Counts E.B.S.4.iiiThe number of Referral to Treatment (RTT) pathways with patients waiting 52 weeks or more and still waiting (incomplete) at

the end of the period reported.




providers to Unify2

Planned CareDiagnostic test waiting times -

over 6 week waitsEveryone Counts E.B.4

The number of patients waiting 6 weeks or more for a diagnostic test (15 key tests) at the end of the month reported, based on

monthly diagnostics data provided by NHS and independent sector organisations and signed off by NHS commissioners as a

percentage of the total waiting list at the month end.


Support Unit DM01 monthly

report. Original data uploaded by

providers to Unify2



Adult Social Care Dashboard

Detailed Measure

Source of

indicator

definition

Reference Detailed definition Source

Proportion of people using

social care who receive self-

directed support, and those

receiving direct payments.

Adult Social

Care Outcomes

Framework

1C

(NI130)

This indicator represents the number of adult social care users who are eligible for a Personal Budget with

which to purchase social care services. The indicator relates to people who do not live in residential or

nursing care but rather who receive services and support in their own home to maintain their

independence.

The numerator is the number of people who receive a Personal Budget. The denominator is the total

number of people in receipt of all types of social care services, this number will fluctuate monthly.

Sirona (provider) from Care

First system

Proportion of older people

(65 and over) who were still

at home 91 days after

discharge from hospital into

reablement/ rehabilitation

services (Sirona only)

Adult Social

Care Outcomes

Framework

2B

(NI125)

The proportion of older people aged 65 and over discharged from hospital to their own home or to a

residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will

move on/back to their own home (including a place in extra care housing or an adult placement scheme

setting), who are at home or in extra care housing or an adult placement scheme setting 91 days after the

date of their discharge from hospital.


First system

Admissions of people to

permanent residential and

nursing care - people aged

65+ per 10,000 population

Adult Social

Care Outcomes

Framework

2A i

Numerator: Number of council-supported permanent admissions of older people (aged 65 and over) to

residential and nursing care during the year (excluding transfers between residential and nursing care).

Denominator: Size of older people population (aged 65 and over) in area (ONS mid year population

estimates).

This indicator excludes people funding their own residence in a care home with no support from the

council.


First system (including AWP

results)

Adults aged 18 to 64

admitted on a permanent

basis in the year to

residential or nursing care

per 10,000 population

Adult Social

Care Outcomes

Framework

2A ii

Numerator: The number of council-supported permanent admissions of younger adults (aged 18-64) to

residential and nursing care during the year (excluding transfers between residential and nursing care).

Denominator: Size of younger adult population (aged 18-64) in area (ONS mid year population estimates).



results)

Timeliness of social care

assessment - proportion in

less than 28 days.

tbc NI132 The proportion of people whose social care assessment is delivered within 28 days of referral.



results)

Timeliness of social care

packages - proportion

receiving careplan in less

than 28 days.

tbc NI133 The proportion of people who are assessed for social care and deemed suitable for a social care package

receive their care plan within 28 days of referral.



results)

Carers receiving a service or

advice and information as an

outcome of an assessment

or review- cumulative target

tbc NI135 ii The number of carers being assessed / reviewed and receiving any aspect of the available support

including advice, signposting and the provision of breaks services.



results)



Mental Health and Learning Disabilities Dashboards

Detailed Measure

Source of

indicator

definition


Proportion of adults in contact

with secondary mental health

services in paid employment

Adult Social

Care Outcomes

Framework

1F

(NI150)

Of working age adults in contact with secondary mental health services this measures the proportion in paid

employment.

Employment outcomes are a predictor of quality of life, and are indicative of whether care and support is

personalised. Employment is a wider determinant of health and social inequalities.

AWP- Avon & Wiltshire Mental

Health Partnership (provider)

Proportion of adults in contact

with secondary mental health

services living independently,

with or without support

Adult Social

Care Outcomes

Framework

1H

(NI149)

Of working-age (aged 18-64) adults in contact with secondary mental health services, this indicator measures

the proportion who are living independently (with or without support) AWP (provider)

Mental Health Crisis service: %

of urgent referrals in which

service user is contacted within

4 hours.

tbc MH 1

When a service user is considered to be in crisis they are referred for crisis support as follows:

All referrals between 8-8pm come through the Primary Care Liaison service.

Out of hours referrals come from A&E, self referrals from existing clients, the Emergency Duty team and criminal

justice agencies.

N.B. The definition of a crisis and hence the need for crisis services is being reviewed.

AWP (provider)

Mental Health Service users

discharged from hospital, %

followed up in the community

within 7 days.

Everyone

Counts tbc AWP (provider)

% of delayed transfers of care

from hospital, attributable to

community mental health

services.

tbc MH 3

This indicator relates to discharge from the mental health wards and not from the general hospital wards. It

measures the proportion of patients who when ready to leave hospital to move to mental health community

services are delayed as a place is not available for them to move to.

AWP (provider)

% of mental health referral to

treatment pathways completed

within 13 weeks

tbc MH 4 Mental health community services are on a referral to treatment pathway but due to the need for prompt

engagement with the service users the target is set nationally at 13 weeks. AWP (provider)

% of referrals to mental health

inpatients beds that have an

assessment by the mental

health crisis team

tbc MH 5 This measure is to check what proportion of potential in-patients the mental health crisis team are assessing to

confirm they can not be managed in the community before the patient is referred for in-patient treatment. AWP (provider)

No. of adult drug users in

effective treatment. Effective

treatment for all clients in

contact with tier 3 or 4 services

with a modality start date who

are retained in treatment for 12

or more weeks from their triage

date or have a planned

discharge

tbc NI040

This is a quarterly measure.

One of the key measures for success in effective treatment is that the service user remains in treatment for 12 or

more weeks or as long as planned.

Providers: Developing Health and

Independence (DHI), Specialist

Drug & Alcohol Service (SDAS)

from AWP and Homeless Health

Care.



Learning Disability

Detailed Measure

Source of

indicator

definition


Proportion of adults with

learning disabilities in

paid employment

Adult Social

Care

Outcomes

Framework

1E

(NI146)

The measure shows the proportion of all working-age (aged 18 - 64) adults with a learning

disability who are known to the council, who are recorded as being in paid employment during

the current reporting period (i.e. April 2013 to March 2014)


First system

Proportion of adults with

learning disabilities who

live in their own home or

with their family

Adult Social

Care

Outcomes

Framework

1G (NI145) Of the working-age (aged 18-64) learning disabled clients known to the council, this indicator

measures the proportion who are living in their own home or with their family.


First system



Adult Safeguarding

Detailed Measure

Source of

indicator

definition


% of adult safeguarding

decisions made in 48

working hours from the time

of referral

tbc SG1 This is a national target. Sirona (provider) from Care

First system


strategy

meetings/discussions held

within 5 working days from

date of referral.

tbc SG2a This is a national target. Sirona (provider) from Care

First system


strategy

meetings/discussions held

within 8 working days from

date of referral.

tbc SG2b This is a national target. Sirona (provider) from Care

First system

% of overall activities/events

to timescale tbc SG3

Overall activities and events include: decisions, strategy meetings / discussions, assessment,

planned meetings and first reviews.


First system



Children’s Dashboards

Detailed Measure

Source of

indicator

definition


CAMHS Tier 3 new referrals assessed

within 4 weeks of referral Local CS-CAMHS10

Children and Adolescents Mental Health Services are often split into 4 tiers. Tier 3 is a specialised service for

more severe, complex or persistent disorders.

Oxford Foundation NHS Health

Trust: Wiltshire & BaNES CAMHS

Monitoring Monthly PAF Report

2012/2013

CAMHS OSCA new referrals assessed

within 4 weeks of referral Local CS-CAMHSO10

The Outreach Service for Children and Adolescents (OSCA) provides extra support to the tier 2 and 3 services as

required often to prevent further exacerbation.




2012/2013

CAMHS Tier 3 Direct patient contacts

completed Local CS-CAMHS4




2012/2013

PCAMHS Tier 2 / Tier 3 caseload % of

referrals accepted Local CS-PCAMHS3ii


Trust BaNES Tier 2 PAF reporting

PCAMHS Tier 2 number of referrals Local CS-PCAMHS2 Children and Adolescents Mental Health Services are often split into 4 tiers. Tier 2 will offer an intervention to any

child that; has an identified emotional, mental health or behavioural concern.

PCAMHS Tier 2 Direct patient contacts

completed Local CS-PCAMHS5



PCAMHS Tier 2 Waiting Times: %

Service Users offered an assessment

within 4 weeks from referral

Local CS-PCAMHS8 Oxford Foundation NHS Health


Health Visitor - No. of new Common

Assessment Frameworks (CAFs)

completed by HV staff in the month

Local CS-SHV3 Sirona Children's services

Scorecard

School Nurse: % of pupils seen within

10 school days from referral Local CS-SSN1

Sirona Children's services

Scorecard

School Nurse: Number of contacts

made with individual children and young

people - Liaison

Local CS-SSN4 Sirona Children's services

Scorecard

Safeguarding: % of Child Protection

conferences with health professional

attendance

Local CS-SG1 Sirona Children's services

Scorecard

Paediatricians: Total number of

Referrals from all sources Local CS-SP3


Scorecard

Paediatricians: % of children or young

people treated within 18 weeks of

referral.

Local CS-SP5 Sirona Children's services

Scorecard

Paediatricians: Total number of follow

ups overdue at month end (all CCGs) Local CS-SP6


Scorecard



Medicines Management

Detailed Measure

Source of

indicator

definition


Antibiotics -Volume tbc The volume and choice of antibiotics is our proxy marker for quality and this is an area of focus for the

team. High volume is viewed as inappropriate and will lead to antibiotic resistance. Wrong choice is

linked to higher incidence of Cdif in the community. The problem is because we low users are proportion

of the antibiotics which have been linked to CDiff in the community is proportionally higher.

Derived from National Data Sets

available on the NHS Business

Authorities Information Portal.

Antibiotics Choice tbc




NSAIDs - Volume tbc The volume and choice of Non Steroidal Anti Inflammatory Drugs (NSAIDS) is our proxy measure for

safety and an area of focus for the team. High volumes are viewed as inappropriate because these

drugs have a high side effect profile including GI problems. The choice is now using the NSAIDs which

have a better cardiovascular risk profile. This indicator we have made some significant progress on but

are continuing to focus on. Other CCGs are catching up with the early work place like B&NES have

implemented.




NSAIDS - Choice tbc




Inhalers - Relievers tbc There is lots of evidence that inhalers are the device that has the lowest levels of patient compliance. It

is estimated that over 50% of prescribed inhalers are not used as intended. The team has been

focusing on reviewing High Dose Steroid (preventer) prescribing to make sure it is appropriate and

steeped down. The Team has also been working with the local health care system to raise awareness

of good inhaler technique.




Inhalers - preventers tbc




weighted prescribing costs tbc This indicator looks at our weighted prescribing costs vs. the other 210 CCGs.




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