NHS BOLTON CLINICAL COMMISSIONING GROUP … CCG Corporate Performance Report 1 Executive Summary 1.1...

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NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: ……10………………… Date of Meeting: …….24th March 2017……. TITLE OF REPORT:

CCG Corporate Performance Report

AUTHOR:

Melissa Laskey – Director of Service Transformation Mike Robinson – Associate Director Integrated Governance & Policy Victoria Preston – Senior Information Analyst Melissa Surgey – Head of Planning, Performance and Policy

PRESENTED BY:

Barry Silvert - Clinical Director of Commissioning

PURPOSE OF PAPER: (Linking to Strategic Objectives)

The purpose of the attached report is to highlight performance against all the key delivery priorities for the CCG in 2016/17 against which NHS Bolton Clinical Commissioning Group is nationally measured

LINKS TO CORPORATE OBJECTIVES (tick relevant boxes):

Delivery of Year 1 Locality Plan. Joint collaborative working with Bolton FT and the Council.

Supporting people in their home and community.

Shared health care records across Bolton. Regulatory Requirement Standing Item X

RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting)

Members are requested to note the content of the report and actions being taken where required to improve performance

COMMITTEES/GROUPS PREVIOUSLY CONSULTED:

Performance is reported to: CCG Clinical Executive Contract Performance Group Quality and Safety Committee

REVIEW OF CONFLICTS OF INTEREST:

N/A

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VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT:

Patients’ views are not specifically sought as part of this monthly report, but it is recognised that many of these targets such as waiting times are a priority for patients. The report does include performance against the ‘Friends and Family Test’ at Bolton FT

OUTCOME OF EQUALITY IMPACT ASSESSMENT (EIA) AND ANY ASSOCIATED RISKS:

N/A

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CCG Corporate Performance Report 1 Executive Summary 1.1 This report highlights NHS Bolton Clinical Commissioning Group’s performance

against all the key delivery priorities for the month of January 2017 (Month 10).

1.2 Appendix 1 contains the detailed reports for each set of performance indicators the CCG is measured against: - Bolton CCG Objectives - Board Assurance Framework - NHS Constitution Standards - Key NHS Contractual Measures - Outcome & Quality Framework Indicators - Community Services Key Performance Indicators - CCG Quality Indicators - Mental Health Dashboard

1.3 Section 2 exception reports against all indicators. 2 Exception Reporting 2.1 Quality & Safety – Board Lead, Dr Colin Mercer 2.1.1 Healthcare Associated Infections

There were four Bolton FT apportioned Clostridium Difficile toxin (CDT) positive cases in January. This takes the annual figure to 34 against the NHS England set target of 19. The FT’s Harm Free Care panel identified two cases where there were no lapses in care. In the other two cases the panel identified delays in diagnosis and isolation that could have been prevented, although treatment was appropriate. In all cases to date there is no evidence of cross transmission. Current initiatives that are in place to reduce CDT cases were reported in last month’s Corporate Performance Report. The FT are commissioning an external review of their infection control practice to ensure improvement plans are appropriately focused. The FT continues to play a valuable role in the Bolton Infection Prevention and Control Committee (IPCC). Their Community Team has played an integral role in the management of a number of influenza outbreaks in care homes over the winter months. There were no Bolton FT apportioned MRSA cases in January and work continues to prevent further cases. The IPCC has determined that high risk patients discharged from hospital care will receive prophylaxis and education as required from the Community IPC and district nursing teams. The CCG and Bolton Council are ensuring advice and education is in the service specifications for providers of drug and alcohol services in Bolton. A number of

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these bacteraemia are contaminants often linked to urgent care, so the FT are working closely with teams in this area to encourage good practice and prevention. All MRSA cases undergo a full Root Cause Analysis (RCA) which is shared at the IPCC.

2.1.2 Serious Incidents (SIs)

There were three SIs at Bolton FT reported in January. Two related to neonatal care and one related to a blood transfusion. These are being fully investigated by the FT and will be reviewed by the CCG’s SI Review Group. The management of SIs by Bolton FT continues to be open, transparent and timely with reviews of a good quality.

2.1.3 Falls

Patient falls were above threshold in January with 117 incidents reported against a threshold of 82. There have been 1010 cases reported against a year to date (YTD) threshold of 820. The overall trend of harms resulting from falls continues to reduce. Bolton FT and the CCG are part of the Bolton Falls Collaborative. As part of any RCA investigators consider the reasons for and appropriateness of admission.

2.1.4 Workforce

Sickness absence measured on a 12 month rolling average basis has reduced slightly to 5.27% compared to 5.34% in December. Actions to remedy this as detailed in last month’s Corporate Performance Report include:

• Understanding that short term absence has increased and that many of the FT’s peers do better against this measure

• Boosting compliance with return to work interviews • Reviewing our occupational health service • Informal interventions to address dignity at work issues • Offering mindfulness training to staff • Noting the impact organisational change and work related pressure can

have on sickness absence 2.1.5 Mixed Sex Accommodation (MSA)

There were a further 18 breaches of the standard in January. Five were in the Adult Acute division and were due to delays in specialty bed availability. Two were in the Elective division and also due to delays in specialist beds. YTD there have been 95 reported cases. This has been escalated to the Greater Manchester Health and Social Care Partnership (GMHSCP) who are supporting the CCG and FT in minimising breaches.

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2.2 Commissioning – Board Lead, Dr Barry Silvert

2.2.1 Reduce Non-Elective Admissions

The CCG has a target for a reduction of 2.1% of non-elective admissions in 2016/17 (based on 2015/16 outturn). In January there were 2,909 non-elective admissions across all providers. This represents a decrease of 18 non-elective admissions compared to January 2016 (2,927). This gives a YTD position of 29,073 emergency admissions compared to 28,952 for the same period last year (a 0.4% increase). Ongoing work continues between the CCG and FT to support the reduction in non-elective admissions, with the key programmes being: • Expansion of the Ambulatory Care Unit (ACU) at Royal Bolton Hospital to

cover medical and surgical specialties 7 days a week. Progress is being made with this and activity is increasing due to improvements in pathways and processes.

• Ongoing development of Intermediate Tier services (including the Admission Avoidance Team and full use of the Integrated Neighbourhood Teams).

• Work with NWAS on the extended use of ‘hear and treat’ and ‘see and treat’ including additional referral pathways for paramedics to use to reduce conveyances to hospital.

• Work with BARDOC and NWAS on the development of a “Clinical Hub” to align with GM strategic direction of travel.

• Work with BARDOC and NWAS on Alternative to Transfer services in and out of hours, which went live on the 23rd February and activity is being monitored. This will be reported in future Corporate Performance Reports.

2.2.2 Reduce Non-Elective Length of Stay

The target for non-elective length of stay for 2016/17 is 4.4 days. In January the length of stay increased to 4.8 days (from 4.6 days in December 2016). The YTD position is 4.6 days. The CCG, Bolton FT and Bolton Council are working collaboratively to reduce delayed transfers of care (DTOC), medical outliers in the hospital and streamline the discharge process. These are the main contributing factors to the increase in length of stay against the strategic plan. The DTOC lists are closely monitored and action taken jointly by health and social care partners.

2.2.3 Reduce Emergency Readmissions

The number of emergency readmissions in January was 461 which is a decrease of 4 from December 2016 (465). The YTD position is 8.88% below plan.

2.2.4 NHS Constitution Targets

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A&E 4 hour performance (target 95%) for February 2017 was 85.24%, an improvement in the performance of January. This is in part as a result of the new streaming model and improvement in flow within the hospital. The CCG and Bolton FT continue to work closely together to implement a series of actions to help to alleviate the pressure across the urgent care system including the pilot model of streaming primary care appropriate patients within the A&E Department. As previously reported to Board this model expanded its operating hours in December 2016. The initial data that has been analysed as part of the evaluation of the pilot shows that 2401 patients have been streamed to primary care, between the 15th December 2016 and the 28th February 2017. The scheme continues and a sustainable long term model for the continuation of the pilot is currently being considered in line with emerging national guidance. In February, NWAS failed the national target for Emergency Response arriving within 8 minutes with performance of 70.1% (against the Red 1 target of 75%). This does however show a significant improvement from January performance which was 58.8%.The two other national targets also failed. Red 2 performance for February was 58% (against a target of 75%) and the Category A 19 minute response performance was 89.6% (against a target of 95%). Again, although both targets have failed, there has been some improvement from performance in January. The CCG continues to encourage the use of the NWAS ‘see and treat’ and ‘hear and treat’ as alternatives to ambulance conveyances to A&E. January’s performance for ‘see and treat’ (23%) had remained consistent whereas ‘hear and treat’ (14%) has increased by 1%. Both 16/17 YTD performance figures remain above plan and compare positively across Greater Manchester. As mentioned earlier in the report, Bolton is now live with the NWAS and BARDOC, 24/7 Alternative to Transfer service, enabling appropriate patients to receive primary care treatment rather than being conveyed to A&E by an ambulance crew.

Performance for the incomplete RTT pathway standard for January was 90.5% of patients waiting less than 18 weeks for planned procedures, against a threshold of 92%. It has previously been highlighted to Board that performance against this standard has continued to show a steady decline throughout 2016/17. This is coupled with an increase in referrals in certain specialties. Of all admitted patients treated in January, 83.4% were seen and treated within 18 weeks (against a threshold of 90%). This is a 1.2% increase compared to the December 2016 position. Of all non-admitted patients treated in January, 90.6% were treated within 18 weeks (against a threshold of 95%). Analysis continues to demonstrate that this position is largely due to availability of beds at Royal Bolton Hospital, with a noted relationship between high emergency demand, delayed transfers of care, medical outliers and elective cancellations. A recovery plan has been developed by the Elective Division at Royal Bolton Hospital, but this will be heavily impacted upon due to continued pressures arising from non-elective demand. The 6 week diagnostic waiting time standard for all Bolton CCG providers was failed in January with 1.29% of patients waiting longer than 6 weeks for their

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diagnostic procedure, against a threshold of 1%. This is a deterioration of 0.16% on the position seen in December 2016. However Bolton FT achieved performance of this standard for January. Notable pressure areas remain around endoscopy due to the known increase in demand nationally. The commissioning team is currently working with Bolton FT to facilitate inter-provider pathway developments with In Health to make best use of all commissioned endoscopy capacity. An updated recovery positon is awaited from Central Manchester NHS Foundation Trust, with pressure areas also noted to be endoscopy. The CCG failed the 62 day target for wait from referral from an NHS screening programme to first definitive treatment for cancer in January with performance of 88.2% against 90%. This represents two breaches of 17. A full analysis of these breaches is currently being undertaken. However the CCG is meeting all national cancer targets YTD.

2.2.5 NWAS 111 Performance/OOH

Most recent data from February indicates 2,739 calls were triaged through the 111 system. This is a decrease of 502 calls from January 2017 (3,241 calls). Of the 2,739 patients triaged, 269 (10%) were recommended to attend A&E, 411 (15%) resulted in an ambulance being dispatched, 1,411 (52%) were referred to primary or community care services and 586 (21%) were advised for no further treatment or services. The development of the “Clinical Hub” model will help to stream appropriate patients to other services to meet their needs rather than A&E. The CCG are currently working with Greater Manchester colleagues, BARDOC and NWAS to scope this model and implementation.

2.2.6 Contractual Performance

In February there were 267 patient handovers (from ambulances to A&E) where patients waited between 30 and 59 minutes and 157 handovers where patients who waited more than 60 minutes (against a target of 0 for both). Although these targets continue to fail, February has seen some improvement, particularly in the reduction of patients who have waiting more than 60 minutes (42% reduction from January 17). As previously highlighted to the Board, work is ongoing through a collaborative group to focus on Urgent Care Key Priority 3: The Ambulance Response Programme. Regular operational meetings are in place with Bolton FT and NWAS with the support of the CCG and work is underway to establish best practice across Greater Manchester with a view to learn and improve processes. Stroke performance data is available up to December 2016, when the service saw a decline in performance, with 60.6% of patients spending at least 90% of their stay on a stroke unit against the target of >80%. The performance for patients arriving within a designated stroke bed within 4 hours of arrival also declined to 60.7% against the target of >80% due to non-elective bed pressures.

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2.2.7 Mental Health The January position for CPA was 100% against a target of 95% with performance improving from the December position of 93.3%. The YTD remains above target at 97.6%. There were no 7 day follow up breaches in January. Performance against the Improving Access to Psychological Therapies (IAPT) recovery rate (combined figures for GMMH and 1 Point) was achieved in January with performance of 55% against a target of 50%. The YTD recovery rate is 51.2%. The access rate has risen slightly but the IAPT service failed the 15% target in January, with performance at 11.9%. There were significantly lower numbers reported ‘entering treatment’ and a lower number of referrals being reported compared to the expected volume. The YTD position has further deteriorated to 13.6% in January as a result. A provider/commissioner meeting was held to review performance and an urgent action plan is in progress. GMMH also noted some staffing vacancies which may have contributed to a decreased number of contacts, but assurance has been given that the service will be fully staffed with full caseloads by the end of April. The combined IAPT service continued to achieve both the 6 week and 18 week access targets in January with 90.9% of people beginning treatment in 6 weeks (against a target of 75%) and 100% beginning treatment within 18 weeks (against a target of 95%). Key performance highlights from the mental health dashboard for January include:

• Acute OATS (Out of Area Treatments) – no new patients were placed out of area in January.

• The RAID service in Bolton achieved all response time targets seeing 89.3% of referrals within 1 hour (against a target of 75%), 97.2% within 2 hours and discharged (against a target of 95%), and 93.3% of referrals within the 4 hour target (against a target of 95%), this percentage has fallen due to periods of high activity (particularly outside of office hours) when RAID received multiple referrals. There have also been a number of clinically complex cases that have resulted in waits over 4 hours (but not over 12 hours).

• The Early Intervention in Psychosis (EIP) service exceeded the 50% access target with 92.3% of people accessing the service within 2 weeks during January 2017. Activity has decreased in comparison with previous months (average now is 13 per month compared to an average of 19 per month from April – November).

2.2.8 Maternity The national 12+6 target is for 90% of women to receive a full health and social care risk assessment and booking by a midwife before 12 weeks and 6 days of pregnancy. The 12+6 data for February is not yet available and will reported in next month’s Corporate Performance Report. The performance reported in last month’s Corporate Performance Report of 79.8% for all bookings at trust level and 82.2% at

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CCG level has been found to have data quality issues since publication of the last report. This is due to how patients transferring to Bolton FT maternity care after 12+6 were being recorded. Bolton FT and the CCG are aware of this issue and appropriate action is being taken to rectify this error. Accurate performance data for January and February will be reported in next month’s Corporate Performance Report. 2.2.9 Community Services Dashboard Detailed below are the key highlights from the overarching community services dashboard for January.

Overall waiting times for community services (adults) have seen a slight improvement during January when compared with the previous monthly position of 72.4%, with performance across the services at aggregate level now at 74.9% for referrals seen within agreed targets. Children’s services wait times year to date are closer to plan at 78.9% against the default 90% target. Referrals to children’s community teams have progressively increased over the last few months with a further increase seen in January (2,300 GP and Other source against a target of 2,148). Referrals to Adult services from a GP source are below plan in January 2017 at 2,371 compared to a target of 2,601. ‘Other’ sourced referrals are above plan YTD mostly to the diabetes service.

Referrals to the Integrated Neighbourhood Teams increased in January 2017 to 217 (from 158 in December) however was still below the monthly target of 293. Cumulative year to date referral activity is 2,226 referrals against a plan of 2,930 (75.9%). The Joint Commissioning Data Group which meets monthly have produced a single source of data ‘core’ KPI’ report covering the top 10 selected KPIs for performance monitoring the service which is in the final stages of development. The CCG, Bolton Council and the FT have all contributed to the definitions and resolved several issues relating to the data sources and quality of the data captured.

Further development of the KLOE comprehensive integration dashboard is underway to map the outcomes of the Better Care Fund schemes against the services contributing towards these outcomes. This visually demonstrates the overall impact of schemes in place and will be used for monitoring performance against plan. Intermediate Tier services have been included in the latest iteration of this KLOE report along with a number of supporting measures for the local and GM priorities to investigate the redrafted measures in more detail. Admission avoidance referrals seen within 48 hours are performing at 91% YTD against a plan of 90% however there are a number of services failing to meet the required thresholds in particular the seen within 5 working days target most notably Integrated Neighbourhood Teams, District Nursing Treatment Rooms, MSK Physio, Neurology Long Term Conditions and Rheumatology. 2.4 TIA Services The CCG Executive has considered the future provision of TIA services, given the ongoing concerns that have been reported to Board previously, with regard to the poor performance of the TIA service in Bolton.

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Bolton FT recently put forward a proposal to provide a 7 day service, however this did not include a full 7 day model with weekend Doppler access.

The Executive has recommended that discussions commence with Salford Royal Foundation Trust (SRFT) regarding the future provision of the service so that Bolton patients receive their investigations and treatment from Salford Royal hospital. The rational for this is as follows:

• Salford Royal is the hyper acute unit for stroke and the public are aware of the specialist nature of the Trust.

• SRFT’s performance against the current TIA target is consistently at 100%. • The SRFT model that has been agreed gives assurance, that if the Bolton activity

transfers, the service will be developed to a 7 day service via an ambulatory care model with a one stop shop including Doppler access on all 7 days.

2.5 Child and Adolescent Mental Health Service (CAMHS) The CCG has commenced a programme of work to develop a new service specification for CAMHS and will secure a new provider through an open procurement process in order to ensure the ongoing sustainability of the service. A comprehensive outcome based service specification has been drawn up by CCG and Bolton Council commissioners, based on best practice and national evidence. This has been supported by clinicians and service users and will be further refined through the planned wider engagement in co-design during March and April 2017. The new model moves away from the traditional clinically-focussed service delivery and focuses on the I-thrive model, which puts the individual at the heart of decision making. High level timescales for the completion of an open procurement process begins with a Request For Information (RFI) which is due to be published by 24th March 2017. Consultation and engagement of the proposed service model is underway and will conclude by mid-April. The Invitation To Tender will be issued to bidders by end June 2017 and the expected start date of the new service will commence on or before April 2018. 3 Recommendations

The Board is asked to note the performance for January 2017 and the actions being taken to rectify areas of performance which are below standard.

Melissa Laskey – Director of Service Transformation 22nd March 2017

Appendix 1

2 Bolton CCG Objectives

3 Board Assurance Framework dashboard

4-5 NHS Constitution Standards

6-8 Key NHS Contractual Measures

9 Outcome & Quality Framework Indicators

10-13 Community Services Key Performance Indicators

14-16 CCG Quality Indicators

17-21 Mental Health Dashboard

Appendix 2

22-33 Integrated Care Performance Report

Index

Objective Key Measures of Success (Goals)

From (2011/12)

2015/16 for

Emergency

admissions)

To 2015 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD YTD Position Comments

Reduce the gap in life expectancy

between Bolton and England 2.05 years (2010)

1.85 years

(2015)

For 2010-2012 Male 1.8 Female 1.6

Reduce the gap in life expectancy

between the most and least deprived

areas in Bolton 1

m13.5 f11.5 m13

f11

Data not yet

available

For 2006-2010 Male 13.5 Female 11.3

Achievement of all key targets / NHS

Constitution Several failing All achieved 7 7 7 7 10 10 7 8 9 8

Running

total

Number of failing targets out of 17

National measures

See NHS Constitution report,

8 for January, A&E 4 Hour, RTT

Admitted, None admitted, Incompletes,

Diagnostics and all NWAS targets.

Bolton patients and carers would

recommend health services

(combination of A&E and Inpatient)

90% Local

target90.7% 90.4% 90.2% 88.5% 91.6% 91.3% 91.1% 90.5% 91.4% 92.8% 91% 91%

New measure 'percentage

recommended' rather than 'net

promoter score'

Best Value:

Reduce emergency admissions 34,765 34,035 2,847 2,982 2,813 2,930 2,738 2,868 2,985 3,061 2,940 2,909 29,073 0.4%

As per year 2 of the 5 year strategic

plan

Comparative to same period for the

previous year

Shift care closer to

home El 3.3 (baseline -

strategic plan)El 3.0 16/17 3.1 3.2 2.9 2.7 3.4 2.7 3.0 2.6 2.3 2.5 2.86 2.89


plan

NE 4.9 (baseline -

strategic plan)NE 4.4 16/17 4.8 4.6 4.6 4.2 4.8 4.5 4.6 4.7 4.6 4.8 4.6 4.6


plan

Reduce emergency readmissions 6,086 3% Reduction 505 545 496 517 479 460 445 437 465 461 4,810

BOLTON CCG CORPORATE REPORT - 5 YEAR AIMS

Improve Health

Outcomes

Improve quality of

care and patient

experience of care

Reduce elective & non elective length

of stay

(Ave LOS)

-8.88%


plan

Comparative to same period for the

previous year

Data rebased due to GMW no longer

submitting and a shift in code for

admission method.

Bolton CCG Board Assurance Framework Dashboard - January 2017

Strategic Objective Milestones and Key Performance Indicators Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Comment/ Current Position

Appraisal of locality plan (and supporting of CBAs) by all organisations and sign off by H&WBB HWBB signed off 9.12.16

Transformation Fund proposal approvalTarget date

£28.8m approved for Bolton March 17. Exec meeting with GM/JR & Chief Execs 6.3.17

Receipt of Transformation FundingTarget date

16/17 funding announced March 2017

Implementation of identified work programme milestones for 16/17 Target date

Implementation plans in development

Aligned Incentive Contract in place and monthly monitoring

17/18 contract signed

Agreement of LCO model for phased implementation from 17/18 Target date

Development of integrated commissioning models for implementation from 17/18

Target date

CCG & Council commissioning leads are working in a collaborative manner.

Discussions about more formal arrangements are taking place with

HWB Exec

Establish 7 day GP access

People still in own home 91 days post discharge from reablement *

Target for 16/17 set at 86%

INT Activity meeting Plan Ongoing work to strengthen INTs working in primary care. Oct 2016

data shows target for INTs achieved for first time.

Reduced admissions to permanent placements in residential/nursing homes **

Bolton BCF2. Benchmarking data from June 2016 placed Bolton as the second highest in GM.

Hospital Activity Reducing (changed Q3 from Elective Activity)

-2.1% reduction on previous year activity end Qtr 3

Partners engaged and signed up to information sharing

43 of 50 GP Practices signed up. Info Sharing Protocol signed by Partner organisations

Communications messages developed and shared with staff, professionals and patients Target date

Engagement ongoing from Aug 2016 - website now live.

System live in early adopter practicesTarget date

9 Early Adopter practices covering 25% population due March 17

System in use in A&E and Out of HoursTarget date

On Track

KEYGreen Achieved

Yellow On Track

Red Off Track ** ICS&P Group agreed original target for this measure was unachievable due to baseline year activity changes. Therefore, plan will be amended for 2017/18

1. Deliver Year 1 of Bolton Locality Plan

2. Show that Bolton is truly working together: New type of contract with Bolton FT, Jointly develop with Bolton Council new commissioning models

3. Support more people in their own homes and communities, improve patient safety through better GP access, community services, INTs

4. Enable shared health & social care records across Bolton

*Data source for this measure still being updated since migration to liquid logic by Bolton Council Sept 2016

NHS Constitution Indicators January 17

Indicator Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 YTDForecast

Achieve/FailExceptions Trend (Apr13-Jan17)

Admitted patients to start treatment within a maximum

of 18 weeks from referral 90% 89.6% 87.9% 83.5% 82.9% 82.2% 83.0% 81.4% 83.2% 82.9% 83.4% 84.1% A

Aggregated target failed, the only specialties to achieve

are Cardiothoracic Surgery, General Med,

Ophthalmology and Thoracic Medicine. Orthopaedics is

currently failing on 79.3%.

Bolton FT failed the target in Month (82.3%) will all

breached specilaties significantly below the target of

90%.

Non-admitted patients to start treatment within a

maximum of 18 weeks from referral95% 94.7% 95.6% 94.2% 94.4% 93.6% 92.4% 92.3% 92.1% 92.8% 90.6% 93.6% A

Aggregated target failed, specialties achieved for

January are Cardiothoracic Surgery, Geriatric Medicine,

Gynae, Rheumatology, Thoracic Medicine, Urology, ENT

and Other. Bolton FT failed the target 90.24%

specialties failed are, Dermatolgoy, General Medicine,

General Surgery, Ophthalmology, Plastic Surgery,

Orthopaedics and ENT.

Patients on incomplete non emergency pathways (yet

to start treatment) 92% 94.2% 93.9% 92.8% 92.2% 91.6% 91.6% 92.1% 91.9% 90.8% 90.5% 92.1% A

Total incomplete position failed for January, In month

Incomplete with decision to admit 78.42% and without

decision to admit 92.2%. Year to date 'with decision to

admit' 81.3% 'without decision to admit' 93.47%

Patients waiting for a diagnostic test should have been

waiting less than 6 weeks from referral 1% 2.14% 1.44% 1.27% 0.82% 1.62% 1.08% 0.90% 1.30% 1.13% 1.29% 1.38% F

Target breached in month, 46 over 6 weeks (target

breached by 11), Bolton FT achieved for January

(0.92%).

Main breaches at Bolton FT (24) and Central

Mancheser (14).

Patients should be admitted, transferred or discharged

within 4 hours of their arrival at an A&E department -

Bolton FT

95% 80.20% 81.40% 85.30% 81.90% 86.10% 87.10% 81.50% 79.50% 79.20% 79.23% 82.15% F1,875 patients waited more than 4 hours (Denominator

9,029) Indicator breached by 1,424 patients.

Maximum two-week wait for first outpatient

appointment for patients referred urgently with

suspected cancer by a GP

93% 99.2% 99.1% 98.3% 99.5% 98.8% 99.0% 98.9% 98.9% 98.3% 98.5% 98.8% A

Maximum two week wait for first out patient

appointment for patients referred urgently with breast

symptoms (where cancer was not initially suspected)

93% 100.0% 97.3% 94.0% 96.6% 93.8% 94.7% 98.4% 96.6% 90.1% 96.9% 95.9% A 0

Maximum one month (31 day) wait from diagnosis to

first definitive treatment for all cancers 96% 96.2% 99.1% 96.6% 99.1% 94.4% 95.0% 96.7% 97.0% 100.0% 100.0% 97.3% A

Maximum 31 day wait for subsequent treatment where

that treatment is surgery 94% 94.4% 100.0% 96.6% 88.2% 86.7% 88.2% 100.0% 100.0% 100.0% 100.0% 95.9% A

Referral to Treatment waiting times for non urgent consultant led

treatment - All Providers

Cancer patients - 2 week wait -All Providers

Cancer patients - 31 day wait -All Providers

Diagnostic test waiting times All providers

A & E waits - Bolton FT

NHS Constitution Indicators January 17



Referral to Treatment waiting times for non urgent consultant led

treatment - All ProvidersMaximum 31 day wait for subsequent treatment where

the treatment is an anti-cancer drug regimen98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A

Maximum 31 day wait for subsequent treatment where

the treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A

Maximum two month (62 day) wait from urgent GP

referral to first definitive treatment for cancer 85% 96.2% 96.0% 92.3% 93.2% 92.1% 88.7% 92.6% 94.5% 96.0% 97.9% 93.9% A

Maximum 62 day wait from referral from an NHS

screening service to first definitive treatment for all

cancers

90% 100.0% 87.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 88.2% 96.7% A 2 breaches out of 17

Maximum 62 day wait for first definitive treatment

following a consultants decision to upgrade the priority

of the patients (all cancers)

None set 100.0% 100.0% 100.0% 80.0% 100.0% 100.0% 87.5% 88.9% 85.7% 85.0% 89.6% A

Category A calls resulting in an emergency response

arriving within 8 minutes (Red 1) 75% 76.47% 74.30% 73.10% 70.45% 72.60% 69.49% 64.59% 62.80% 61.63% 61.79% 68.29% F

Category A calls resulting in an emergency response

arriving within 8 minutes (Red 2)75% 67.46% 66.30% 66.20% 62.69% 65.25% 61.75% 63.05% 60.35% 57.31% 58.78% 62.76% F

Category A calls resulting in an ambulance arriving at

the scene within 19 minutes 95% 92.01% 91.50% 91.50% 89.81% 91.09% 89.04% 88.23% 86.79% 85.42% 85.74% 88.99% F

Cancer waits - 62 days - All Providers

Category A ambulance calls NWAS

CCG Performance Report - January 17

Commissioner Performance Dashboard



Admitted patients to start treatment within a maximum of 18

weeks from referral 90% 89.6% 87.9% 83.5% 82.9% 82.2% 83.0% 81.4% 83.2% 82.9% 83.4% 84.1% F

Aggregated target failed, the only specialties to achieve are

Cardiothoracic Surgery, General Med, Ophthalmology and

Thoracic Medicine. Orthopaedics is currently failing on 79.3%.

Bolton FT failed the target in Month (82.3%) will all breached

specilaties significantly below the target of 90%.

Non-admitted patients to start treatment within a maximum of 18

weeks from referral95% 94.7% 95.6% 94.2% 94.4% 93.6% 92.4% 92.3% 92.1% 92.8% 90.6% 93.6% F

Aggregated target failed, specialties achieved for January are

Cardiothoracic Surgery, Geriatric Medicine, Gynae,

Rheumatology, Thoracic Medicine, Urology, ENT and Other.

Bolton FT failed the target 90.24% specialties failed are,

Dermatolgoy, General Medicine, General Surgery, Ophthalmology,

Plastic Surgery, Orthopaedics and ENT.

Patients on incomplete non emergency pathways (yet to start

treatment, includes 'with decision to admit') 92% 94.2% 93.9% 92.8% 92.2% 91.6% 91.6% 92.1% 91.9% 90.8% 90.5% 92.1% A

Total incomplete position failed for January, In month Incomplete

with decision to admit 78.42% and without decision to admit

92.2%. Year to date 'with decision to admit' 81.3% 'without

decision to admit' 93.47%

Number of patients waiting more than 52 weeks - (Bolton FT only)

Incomplete0 0 0 0 0 0 3 2 1 0 3 9 F

Number of patients who are not offered another binding date

within 28 days0 0 6 3 6 10 1 1 7 10 18 62 F

Patients waiting for a diagnostic test should have been waiting

less than 6 weeks from referral 1% 2.14% 1.44% 1.27% 0.82% 1.62% 1.08% 0.90% 1.30% 1.13% 1.29% 1.29% F

Target breached in month, 46 over 6 weeks (target breached by

11), Bolton FT achieved for January (0.92%).

Main breaches at Bolton FT (24) and Central Mancheser (14).

Patients should be admitted, transferred or discharged within 4

hours of their arrival at an A&E department - Bolton FT95% 80.20% 81.40% 85.30% 81.90% 86.10% 87.10% 81.50% 79.50% 79.20% 79.23% 82.2% F

1,875 patients waited more than 4 hours (Denominator 9,029)

Indicator breached by 1,424 patients.

Maximum two-week wait for first outpatient appointment for

patients referred urgently with suspected cancer by a GP 93% 99.2% 99.1% 98.3% 99.5% 98.8% 99.0% 98.9% 98.9% 98.3% 98.5% 98.8% A

Maximum two week wait for first out patient appointment for

patients referred urgently with breast symptoms (where cancer

was not initially suspected)

93% 100.0% 97.3% 94.0% 96.6% 93.8% 94.7% 98.4% 96.6% 90.1% 96.9% 95.9% A

Number of patients who are not offered another binding date within 28 days Bolton FT

Referral to Treatment waiting times for non urgent consultant led treatment - All Providers

Diagnostic test waiting times All providers

A & E waits - Bolton FT

Cancer patients - 2 week wait -All Providers





Maximum one month (31 day) wait from diagnosis to first

definitive treatment for all cancers 96% 96.2% 99.1% 96.6% 99.1% 94.4% 95.0% 96.7% 97.0% 100.0% 100.0% 97.3% A

Maximum 31 day wait for subsequent treatment where that

treatment is surgery 94% 94.4% 100.0% 96.6% 88.2% 86.7% 88.2% 100.0% 100.0% 100.0% 100.0% 95.9% A

Maximum 31 day wait for subsequent treatment where the

treatment is an anti-cancer drug regimen98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A

Maximum 31 day wait for subsequent treatment where the

treatment is a course of radiotherapy 94% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% A

Maximum two month (62 day) wait from urgent GP referral to first

definitive treatment for cancer 85% 96.2% 96.0% 92.3% 93.2% 92.1% 88.7% 92.6% 94.5% 96.0% 97.9% 93.9% A

Maximum 62 day wait from referral from an NHS screening

service to first definitive treatment for all cancers90% 100.0% 87.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 88.2% 96.7% A 2 breaches out of 17

Maximum 62 day wait for first definitive treatment following a

consultants decision to upgrade the priority of the patients (all

cancers)

none set 100.0% 100.0% 100.0% 80.0% 100.0% 100.0% 87.5% 88.9% 85.7% 85.0% 89.6% A

Category A calls resulting in an emergency response arriving

within 8 minutes (Red 1) 75% 76.47% 74.30% 73.10% 70.45% 72.60% 69.49% 64.59% 62.80% 61.63% 61.79% 68.29% F

Category A calls resulting in an emergency response arriving

within 8 minutes (Red 2)75% 67.46% 66.30% 66.20% 62.69% 65.25% 61.75% 63.05% 60.35% 57.31% 58.78% 62.76% F

Category A calls resulting in an ambulance arriving at the scene

within 19 minutes 95% 92.01% 91.50% 91.50% 89.81% 91.09% 89.04% 88.23% 86.79% 85.42% 85.74% 88.99% F

All handovers between ambulance and A&E must take place

within 15 minutes (no of patients waiting >30 mins<59 mins)

Bolton FT

0 215 198 161 218 173 172 274 276 255 293 2235 F

All handovers between ambulance and A&E must take place

within 15 minutes (no of patients waiting >60 mins) Bolton FT0 132 165 89 139 88 115 206 217 259 269 1679 F

Cancer patients - 31 day wait -All Providers

Cancer waits - 62 days - All Providers

Category A ambulance calls NWAS position





Zero tolerance MSA breaches 0 3 6 3 4 9 15 12 18 7 18 95 F

Care Programme Approach (CPA): The proportion of people

under adult mental illness specialties on CPA (functional) -

Completed

95% 96.60% 95.50% 98.60% 97.40% 95.60% 96.40% 96.50% 97.30% 97.10% 97.00% 96.80% A

Care Programme Approach (CPA): The proportion of people

under adult mental illness specialties on CPA - 7 day follow up95% 96.80% 100.00% 97.10% 100.00% 100.00% 97.10% 97.50% 95.80% 95.10% 100.00% 97.90% A

IAPT Recovery rate - (GMW, 1 point and Think Positive)

Internal data50% 47.93% 45.41% 47.19% 50.22% 51.53% 51.29% 52.89% 52.79% 57.98% 54.22% 50.76% A

IAPT Access rate - (GMW, 1 point and Think Positive)

Internal data15.0% 12.50% 14.90% 15.50% 17.60% 15.10% 15.40% 10.60% 12.70% 9.40% 12.00% 13.60% At Risk

Number of ongoing waiters >18 weeks 0 0 0 0 0 0 0 0 0 0 0 0 A

HCAI-Healthcare Associated Infections

MRSA-Post 48 hrs (Hospital) 0 0 0 0 0 0 1 0 1 0 0 2 F

CDIFF-Post 72 hrs (Hospital) 19 3 2 1 2 5 4 6 3 4 4 34 F

A&E Percentage Recommended tbc 82.0% 80.7% 82.3% 80.0% 85.4% 84.6% 82.7% 80.2% 80.9% 84.0% 82.2% A

A&E Response Rate 15% 13.8% 10.4% 14.5% 13.9% 13.1% 10.2% 9.7% 9.0% 8.0% 9.5% 11.3% FFrom April 2016, Children's A&E data is added to the

denominator, work is ongoing at Bolton FT to improve the capture

of feedback, however the metric continues to breach.

Inpatient Recommended tbc 98.0% 98.0% 96.8% 96.7% 97.0% 97.0% 96.7% 96.3% 97.2% 98.0% 97.1% A

Inpatient Response Rate 15% 35.7% 38.1% 35.8% 34.8% 32.8% 25.2% 30.5% 29.7% 28.7% 30.0% 32.0% A

Never events 0 1 0 0 1 0 0 0 0 1 0 2 F

Friends and family

Annual target

Never events

Mixed sex accommodation breaches - Bolton FT

Mental Health - GMW

Domain 1 - Preventing people from dying prematurely

This domain captures how successful the NHS is in reducing the number of avoidable deaths.

2009 2010 2011 2012 2013 2014 14/15 TargetPotential years of life lost (PYLL) from causes considered amenable -

healthcare CCG (Direct Standard Rate) 2667 2644 2240 2531 2326 2348 2564

Latest data released Sept 15 - next due Dec 16

Domain 2 - Enhancing quality of life for people with long-term conditions

This domain captures how successfully the NHS is supporting people with long-term conditions to live as normal a life as possible.

GP Patient Survey (GPPS) via HSCIC

2011/12 2012/13 2013/14 2014/15 2015/16

Health related quality of life for people with long term conditions CCG0.71 0.72 0.72 0.70 0.72 Latest data for July 15-March 16 released Aug 16

People feeling supported to manage their condition CCG67.90 67.20 68.20 65.40 66.00 Latest data for July 15-March 16 released Aug 16

Health-related quality of life for carers, aged 18 and above CCG0.79 0.80 0.78 0.78 0.77 Latest data for July 15-March 16 released Aug 16

Domain 3 - Helping people to recover from episodes of ill health or following injury

This domain captures how people recover from ill health or injury and wherever possible how it can be prevented.

HES via HSCIC

2010/11 2011/12 2012/13 2013/14 2014/15Emergency admissions for acute conditions that should not usually

require hospital admission - CCG 1047.8 1080 1291 1434 1528 Latest data for 14/15 next release Feb 17

Domain 4 - Ensuring that people have a positive experience of care

This domain looks at the importance of providing a positive experience of care for patients, service users and carers.

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Patient experience of GP Services (released Aug 16) (4ai)88.8 88.1 86.8 86.0 87.0 Next version due August 17

Patient experience of GP Out of Hours (released Sep 15) (4aii)74.7 74.3 73.8 75.6 Next version to be confirmed

Patient experience of hospital care (Bolton FT) (4b)74.7 77.6 77.6 79.5 78.3 81.0 Next version due August 17

Responsiveness to inpatients' personal needs (Bolton FT) (4.2) 66 69.6 68.9 70.9 69.3 73.4 Next version due August 17

Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm

This domain explores patient safety and its importance in terms of quality of care to deliver better health outcomes.

Indicator in development

2010/11 2011/12 2012/13 2013/14 For 14/15 the indicator has changed to per 1000 bed days

*Patient safety incidents (rate per 100 admissions) (Bolton FT) 5.3 3.6 6.3 6.3 HSCIC November 15 - 5.6 NHS Outcomes Framework

*The Number resulting in severe harm or death 11 8 9 11 HSCIC November 15 - 5.6 NHS Outcomes Framework

* 6 monthly reporting (October to March)

OUTCOME AND QUALITY INDICATORS

GP registered population from NHAIS (Exeter), the

Primary Care Mortality Database (PCMD) and ONS mid -

year census based England population estimates

National Inpatient Survey Programme via HSCIC

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

Target Actual Target Actual

Community Services - Adults

Referrals

Referrals - GP 2,689 2,514 2,467 2,388 2,572 2,445 2,654 2,729 2,679 2,670 2,167 2,371 2,321 28,618 27,463 2,601 2,321

Referrals - Other 4,074 3,834 4,409 4,521 4,338 4,654 4,536 4,571 4,913 4,760 4,131 4,889 4,078 39,850 49,800 3,622 4,078

Re-referrals < 90 Days 828 804 812 895 772 731 765 759 764 816 708 785 594 - 8,401 - 594

Re-referrals < 90 Days Rate 12.2% 12.7% 12.7% 14.0% 11.8% 11.0% 11.4% 11.0% 10.7% 11.6% 12.0% 11.6% 9.9% - 11.6% - 9.9%

Waiting Times

Referrals Seen < Target 0% 0% 68.6% 70.3% 67.9% 65.4% 65.4% 61.6% 67.0% 70.9% 77.0% 72.4% 74.9% 90.0% 69.1% 90.0% 74.9%

Activity and Access

Activity - First 7,758 7,327 7,758 7,554 7,702 8,974 9,667 9,938 10,055 10,329 8,191 10,640 8,957 81,889 99,765 7,444 8,957

DNA - First 403 408 523 563 543 612 658 662 705 683 597 755 625 - 6,926 - 625

DNA Rate - First 4.9% 5.3% 6.3% 6.9% 6.6% 6.4% 6.4% 6.2% 6.6% 6.2% 6.8% 6.6% 6.5% 5.0% 6.5% 5.0% 6.5%

Activity - Follow-up 42,789 42,423 46,021 45,846 44,598 43,361 44,206 42,730 42,224 43,896 38,788 40,310 34,021 494,021 466,001 44,911 34,021

DNA - Follow-up 1,352 1,487 1,732 1,676 1,820 1,867 1,731 1,543 1,623 1,717 1,591 1,485 1,276 - 18,061 - 1,276

DNA Rate - Follow-up 3.1% 3.4% 3.6% 3.5% 3.9% 4.1% 3.7% 3.5% 3.7% 3.8% 4.0% 3.6% 3.6% 8.0% 3.7% 8.0% 3.6%

Telephone Clinics 1,100 1,345 1,474 1,290 1,292 1,309 1,190 1,161 1,022 920 904 1,117 988 11,731 12,667 1,066 988

Appointments Cancelled < 1 Week of Due Date

0.7% 0.8% 0.7% 0.8% 0.8% 0.6% 0.7% 0.7% 0.9% 0.9% 0.8% 0.8% 0.8% 3.0% 0.8% 3.0% 0.8%

Patient Experience and Outcomes

Friends and Family - Recommend Rate 89.6% 91.1% 87.9% 88.2% 89.6% 90.2% 91.1% 94.4% 95.0% 94.3% 94.3% 95.1% 94.8% 85.0% 90.9% 85.0% 94.8%

Complaints 2 5 2 0 0 1 1 1 0 1 2 1 0 - 9 - 0

Complaints - Responded < 35 Days 100% 100% 100% 100% 100% 100% 0% 95.0% 83.3% 95.0% 0%

Compliments 1,264 1,052 1,235 978 1,261 1,245 912 306 283 331 282 349 - 7,182 - 349

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Community Summary 2016/2017



Staffing

WTE in Post 645.06 652.07 694.05 706.78 707.45 699.01 713.79 715.58 719.30 717.18 718.27 721.17 724.46 - 724.46 - 724.46

WTE v Establishment 93.9% 94.9% 93.3% 94.4% 94.6% 92.8% 93.3% 93.1% 93.6% 93.3% 93.5% 93.8% 94.6% 95.0% 93.7% 95.0% 94.6%

Sickness Absence Rate 5.0% 3.9% 4.1% 4.6% 3.9% 5.1% 4.3% 3.3% 5.5% 6.0% 5.3% 6.1% 4.2% 4.8% 4.2% 6.1%

Staff Turnover 12.8% 11.7% 10.7% 10.4% 12.4% 11.2% 11.1% 13.2% 12.9% 13.7% 13.3% 13.1% 13.2% 10.0% 12.3% 10.0% 13.2%

Appraisals 85.5% 86.9% 85.4% 85.0% 86.2% 82.1% 84.5% 82.9% 82.6% 86.4% 86.6% 82.8% 85.1% 85.0% 84.5% 85.0% 85.1%

Mandatory Training Compliance 90.8% 91.2% 91.8% 92.8% 91.4% 89.9% 90.0% 91.0% 91.9% 92.4% 92.7% 93.0% 93.6% 85.0% 91.9% 85.0% 93.6%

Statutory Training Compliance 94.6% 95.0% 95.4% 94.8% 91.8% 91.0% 91.6% 92.5% 93.7% 94.6% 94.8% 95.6% 95.6% 95.0% 93.8% 95.0% 95.6%

Safeguarding Compliance 97.2% 96.9% 97.3% 95.2% 89.1% 89.9% 91.4% 92.8% 94.0% 94.6% 94.7% 95.1% 96.1% 95.0% 93.7% 95.0% 96.1%

Harm-free Care

Incidents 175 167 158 226 223 234 190 213 221 211 215 232 213 - 2,336 - 213

Incidents - Moderate or Severe Rate 3.4% 0.6% 2.5% 4.9% 2.2% 1.7% 2.1% 0.5% 1.8% 3.3% 2.3% 1.3% 2.8% 3.0% 2.3% 3.0% 2.8%

Pressure Damage - Grade 2 4 16 5 15 11 7 14 8 7 6 3 8 3 0 87 0 3



Patient Falls 11 11 12 13 20 22 8 12 18 12 19 19 16 0 171 0 16

Hand Hygiene 99.4% 96.0% 98.7% 99.2% 97.8% 99.0% 98.5% 99.1% 99.5% 97.7% 99.6% 99.5% 99.7% 98.0% 98.9% 98.0% 99.7%





Community Services - Children

Referrals

Referrals - GP 673 614 577 588 623 535 505 522 534 572 459 569 578 5,960 6,062 541 578

Referrals - Other 1,721 1,633 1,523 1,705 1,761 1,666 1,491 1,668 1,897 2,011 1,681 1,663 1,722 17,687 18,788 1,607 1,722

Re-referrals < 90 Days 195 161 153 158 162 176 153 150 187 187 190 180 160 - 1,856 - 160

Re-referrals < 90 Days Rate 8.1% 7.2% 7.9% 7.4% 7.3% 8.6% 8.2% 7.4% 8.3% 7.7% 9.7% 8.7% 7.6% - 8.1% - 7.6%

Waiting Times

Referrals Seen < Target 0% 0% 75.9% 77.3% 77.8% 77.6% 75.9% 74.2% 80.5% 78.9% 77.8% 71.6% 78.9% 90.0% 76.9% 90.0% 78.9%

Activity and Access

Activity - First 2,897 2,694 2,705 2,902 2,927 2,697 2,813 2,778 2,687 2,900 2,648 2,675 2,399 29,355 30,131 2,668 2,399

DNA - First 102 134 162 148 134 121 134 136 112 124 144 131 99 - 1,445 - 99

DNA Rate - First 3.4% 4.7% 5.7% 4.9% 4.4% 4.3% 4.4% 4.7% 4.0% 4.1% 5.2% 4.7% 4.0% 5.0% 4.6% 5.0% 4.0%

Activity - Follow-up 12,766 11,332 16,732 13,883 16,661 12,337 10,685 17,803 13,700 15,992 10,317 17,046 11,868 135,737 157,024 12,339 11,868

DNA - Follow-up 518 466 545 494 540 570 592 602 451 465 502 475 411 - 5,647 - 411

DNA Rate - Follow-up 3.9% 3.9% 3.2% 3.4% 3.1% 4.4% 5.3% 3.3% 3.2% 2.8% 4.6% 2.7% 3.3% 8.0% 3.5% 8.0% 3.3%

Telephone Clinics 1,020 1,058 1,157 1,172 1,141 1,278 1,124 1,349 1,222 1,532 1,407 1,561 1,348 12,263 14,291 1,114 1,348

Appointments Cancelled < 1 Week of Due Date

0.2% 0.3% 0.2% 0.4% 0.3% 0.3% 0.3% 0.2% 0.5% 0.3% 0.3% 0.2% 0.3% 3.0% 0.3% 3.0% 0.3%

Patient Experience and Outcomes

Friends and Family - Recommend Rate 94.9% 85.7% 89.5% 85.2% 89.7% 94.2% 93.9% 80.5% 92.6% 92.7% 90.0% 96.2% 92.9% 85.0% 91.3% 85.0% 92.9%

Complaints 0 0 1 0 0 1 0 0 0 1 0 1 0 - 4 - 0

Complaints - Responded < 35 Days 100% 100% 95.0% 100% 95.0% 100%

Compliments 55 29 40 23 41 104 35 6 19 18 14 12 - 312 - 12





Staffing

WTE in Post 226.66 227.58 263.42 265.98 260.94 265.29 264.69 265.19 265.47 263.26 264.01 264.31 264.35 - 264.35 - 264.35

WTE v Establishment 95.9% 96.3% 94.2% 95.2% 93.4% 94.9% 92.6% 93.7% 93.8% 93.0% 93.3% 93.4% 93.4% 95.0% 93.7% 95.0% 93.4%

Sickness Absence Rate 5.1% 5.4% 5.4% 4.9% 4.7% 4.6% 2.4% 2.5% 3.5% 4.3% 3.7% 3.3% 4.2% 3.9% 4.2% 3.3%

Staff Turnover 13.8% 10.3% 10.5% 11.5% 11.0% 11.4% 12.0% 11.4% 12.0% 11.9% 11.3% 9.8% 11.0% 10.0% 11.3% 10.0% 11.0%

Appraisals 94.7% 95.9% 95.2% 92.2% 84.9% 91.1% 88.7% 90.2% 94.6% 96.6% 95.7% 93.7% 94.0% 85.0% 92.5% 85.0% 94.0%

Mandatory Training Compliance 94.7% 96.2% 95.6% 95.3% 97.4% 96.9% 95.5% 94.6% 95.8% 96.4% 95.6% 96.8% 95.8% 85.0% 96.0% 85.0% 95.8%

Statutory Training Compliance 97.5% 98.4% 97.5% 97.2% 98.0% 97.2% 97.3% 96.9% 97.2% 97.6% 97.6% 98.0% 97.6% 95.0% 97.5% 95.0% 97.6%

Safeguarding Compliance 99.4% 99.4% 97.9% 98.1% 98.7% 98.0% 98.0% 98.2% 97.7% 98.0% 98.2% 98.4% 97.7% 95.0% 98.1% 95.0% 97.7%

Harm-free Care

Incidents 48 35 31 24 22 23 17 19 15 15 22 17 18 - 223 - 18

Incidents - Moderate or Severe Rate 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 3.0% 0% 3.0% 0%




Patient Falls 0 0 0 0 1 0 0 0 0 1 0 0 0 0 2 0 0

Hand Hygiene 99.6% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98.0% 100% 98.0% 100%



Area Performance Indicator 2016/17 Annual

Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Cumulative YTD Trend (Apr 14-Jan 17)

REDUCING MORTALITY

Summary Hospital Mortality Indicator (SHMI) <1.1 1.040 1.040 1.045 1.045 1.000 1.000 1.000 1.004 1.016 1.016 1.016

PATIENT SAFETY

MRSA bacteraemia 0 0 0 0 0 0 1 0 1 0 0 2

Rates of C Difficile maximum 19 for full year 3 2 1 2 5 4 6 3 4 4 34

Number of falls (all patient falls safeguard) 982 113 92 88 103 88 109 107 81 112 117 1010

Moderate 1 0 1 0 1 3 1 0 1 2 10

Severe 2 1 1 1 0 1 0 2 3 1 12

Fatal 0 0 0 0 0 0 0 1 0 0 1

Percentage of Harm (Safety thermometer) GM (rolling 12 months) <5% Harm 6.04% 4.92% 4.66% 4.84% 4.41% 3.43% 2.77% 1.82% 2.93% 2.29% 2.29%

Percentage of Harm (Safety thermometer) Bolton FT (rolling 12 months) <5% Harm 2.29% 3.70% 1.72% 1.92% 2.01% 4.58% 4.58% 4.93% 4.89% 5.05% 5.05%

% of adults who receive a falls screening within 6 hours of admission (5.3) 90% 92.0% 98.0% 96.0% 95.0% 93.0% 96.0% 97.0% 94.0% 91.0% 95.0% 94.7%

All patients will receive a Waterlow risk assessment within 6 hours of admission

(8.2)90% 94.0% 97.0% 93.0% 95.0% 98.0% 94.0% 96.0% 94.0% 96.0% 92.0% 94.9%

All patients identified as being at risk will have a body map completed and

appropriate individualised care plan (8.3)90% 84.0% 90.0% 93.0% 89.0% 90.0% 93.0% 91.0% 86.0% 88.0% 89.0% 89.30%

All patients will have a nutritional assessment within 6 hours of admission (6.3) 90% 90.0% 93.0% 94.0% 93.0% 92.0% 93.0% 95.0% 87.0% 94.0% 92.0% 92.30%

Medication Incidents 1200 FYE 104 101 139 83 85 106 124 101 120 110 1073

Total Incidents 12,000 1137 1199 1235 1275 1227 1243 1348 1317 1328 1321 12630

% Total incidents with no harm (Apr13-Sept13) NPSA 50% 66.5% 70.8% 76.8% 69.7% 65.2% 64.4% 63.3% 68.4% 61.9% 68.8% 68.1%

Nursing (nurses/midwifes) shifts (% Actual Vs Planned) Day need to agree tolerance 92.2 92.5 95.2 92.6 89.7 85.7 87.8 91.2 89.2 87.6 90.3

Nursing shifts (% Actual Vs Planned) Night need to agree tolerance 94.6 96.5 96.0 98.2 97.2 94.9 94.5 93.1 93.1 95.6 95.3

Care Staff shifts (% Actual Vs Planned) Day need to agree tolerance 103.8 99.0 96.2 95.9 99.9 99.1 101.3 101.9 101.4 101.2 99.9

Care Staff shifts (% Actual Vs Planned) Night need to agree tolerance 117.2 105.5 102.7 102.6 104.9 103.0 105.1 108.9 107.5 108.0 106.3

Number of SUIs 0 1 1 2 3 0 1 1 2 1 3 15

Number of never events 0 0 0 0 1 0 0 0 0 0 0 1

QUALITY REPORT

HCAI - Trust only

Falls and Incidents

Falls with at least moderate harm



Complaints Responded to within time period 95% 96.1% 89.6% 96.0% 93.3% 100.0% 86.0% 100.0% 100.0% 90.9% 100.0% 95.0%

A&E Percentage recommended 82.0% 81.0% 82.3% 80.0% 85.4% 84.6% 82.7% 80.2% 80.9% 84.0% 82.2%

A&E Response Rate 15% 13.8% 10.4% 14.5% 13.9% 13.1% 10.2% 9.7% 9.0% 8.0% 9.5% 11.3%

Inpatient Percentage recommended 97.8% 97.7% 96.8% 96.7% 97.0% 97.0% 96.7% 96.3% 97.2% 98.0% 97.1%

Inpatient Response Rate 15% 35.7% 38.1% 35.8% 34.8% 32.8% 25.2% 30.5% 29.7% 28.7% 30.0% 32.0%

Maternity Q1 Antenatal Care % recommended No target set 100% 97% 100% 93% 100% 95% 100% 94% 95% 100% 97%

Maternity Q2 Birth % recommended No target set 96.0% 98.0% 94.0% 94.0% 92.0% 91.0% 92.0% 91.7% 90.9% 95.0% 93.6%

Maternity Q2 Birth Response Rate No target set 24.4% 20.0% 20.0% 15.5% 16.1% 15.5% 14.5% 15.2% 11.1% 11.9% 16.4%

Maternity Q3 Postnatal % recommended No target set 96.0% 100.0% 93.0% 89.0% 85.1% 82.0% 96.0% 97.2% 92.5% 87.9% 92.3%

Maternity Q4 Postnatal Community % recommended No target set 92.0% 92.0% 94.0% 97.1% 97.4% 94.0% 83.0% 95.0% 92.0% 95.0% 92.8%

Friends and family staff (Quarterly)Percentage recommended - work No target set 72.0%

Friends and family staff (Quarterly)Percentage recommended - Care No target set 82.0%

Friends and family - Outpatient Percentage Recommended No target set 92.0% 90.3% 92.0% 91.5% 89.0% 90.7% 91.0% 91.6% 89.9% 92.1% 91.0%

Friends and family - GMW Acute Percentage Recommended No target set 73.0% 100.0% 94.2% 94.5% 94.5% 64.7% 83.0% 83.3% 92.7% 78.7% 86.3%

Friends and family - GMW Primary Care Percentage Recommended No target set 92.1% 100.0% 42.9% 94.0% 82.0% 100.0% 93.0% 94.4% No data 81.0% 87.3%

GMW Friends and Family

83%

PATIENT EXPERIENCE (Bolton FT)

Complaints and Friends & Family

(Bolton FT only)

66%

81%

72% awaiting national data

awaiting national data



STAFFING

Sickness Absence 3.75% 4.79% 4.40% 4.30% 4.75% 4.26% 4.37% 5.18% 5.25% 5.34% 5.27% 5.27%

Mandatory Training - Compliance 100% 91.10% 91.30% 91.30% 90.10% 88.70% 88.00% 88.90% 88.80% 89.00% 89.20% 89.60%

Appraisals Completed 80% 84.4% 85.6% 84.1% 83.7% 82.9% 80.4% 79.3% 82.6% 82.1% 82.2% 82.7%

Induction Attendance 100% 81.34% 81.42% 82.60% 82.00% 82.80% 77.80% 77.83% 74.70% 72.90% 72.60% 78.60%

Substantive staff turnover Headcount (rolling average 12 months) <=10% 9.2% 9.2% 9.5% 9.8% 9.8% 9.95% 10.21% 10.21% 10.57% 10.56% 10.56%

Theatre list team INBRIEF 99% 100.0% 100.0% 99.0% 99.0% 100.0% 100.0% 99.0% 98.0% 100.0% 100.0% 100.0%

Theatre SIGN IN 99% 100.0% 100.0% 97.0% 99.0% 99.0% 100.0% 100.0% 100.0% 99.0% 99.0% 99.0%

Theatre TIME OUT 99% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 99.0%

Theatre SIGN OUT 99% 97.0% 96.0% 97.0% 97.0% 100.0% 97.0% 97.0% 97.0% 100.0% 99.0% 100.0%

Theatre list team OUTBRIEF 99% 77.0% 91.0% 93.0% 99.0% 99.0% 98.0% 94.0% 99.0% 99.0% 100.0% 99.0%

BEAUMONT

Number of SUIs 0 0 0 0 0 0 0 0 0 0 0 0

Number of never events 0 0 0 0 0 0 0 0 0 0 0 0

Friends and family - Inpatient Percentage Recommended 0 99.0% 99.0% 99.2% 99.3% 99.1% 99.2% 99.3% 98.9% 99.0% 99.4% 99.1%

Friends and family - Outpatient Percentage Recommended 0 98.0% 98.4% 99.0% 99.2% 100.0% 100.0% 99.0% 96.9% 98.7% 98.0% 98.7%

PRIMARY CARE

Number of practices with a review identified (General Practice Outcome

Standards)Running Total 1 3 3 3 3 3 3 3 4 4 4

10 practices approaching review, 4 with review

identified

Number of patients registered at a GP Practice with a diagnosis of Dementia

(deined by the QOF dementia register code cluster) >=65 years

Need to agree denominator

and tolerance2,033 1,912 2,215 2,233 2,244 2,241 2,269 2,291 2,311 2,305 2,305

Dementia diagnosis rate 79..1% compared to

national rate of 67.4%

Primary Care

Quality Impact Indicators

CLINICAL EFFICIENCY AND EFFECTIVENESS

Better Care, Better Value

Independent Sector

BASELINE

2015/16

TARGET

2016/17Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

YTD

TOTALS

ACHIEVING

/FAILING?EXCEPTIONS

TRENDLINE v TARGET

since April 2015

Care Programme Approach (CPA): The

proportion of people under adult mental

illness specialties on CPA - 7 day follow up

97.8% 95.0% 96.8% 100.0% 97.1% 100.0% 100.0% 96.7% 97.3% 94.7% 93.3% 100.0% 97.6% A

No breaches in month of CPA follow up within 7 days.

Improving Access to Psychological Therapies

(IAPT) Access Rate

(Combined GMW and 1Point)

15.6% 15.0% 12.5% 14.9% 15.5% 17.6% 15.1% 15.4% 10.6% 12.7% 9.4% 11.9% 13.6% F

The IAPT service failed the 15% access rate target in January with lower

numbers entering treatment and lower than expected number of

referrals into IAPT


(IAPT) Recovery Rate

(Combined GMW and 1Point)

48.0% 50.0% 47.9% 45.4% 47.2% 50.1% 51.6% 51.3% 52.9% 52.8% 58.0% 55.0% 51.2% A

The IAPT service achieved the over 50% reported recovery target for

the seventh consecutive month


(IAPT) 75% treated within 6 weeks of referral

(GMW and 1Point)

90.2% 75.0% 88.2% 86.5% 87.2% 86.9% 91.2% 89.5% 90.8% 88.6% 86.5% 90.9% 88.6% A

The IAPT service hit both of the access targets in January 2017 with

90.9% of people completing treatment in month having had their 1st

appointment within 6 weeks and 100% having had their 1st

appointment within 18 weeks.


(IAPT) 95% treated within 18 weeks of

referral (GMW and 1Point)

98.9% 95.0% 100.0% 100.0% 99.1% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.8% A

The IAPT service hit both of the access targets in January 2017 with

90.9% of people completing treatment in month having had their 1st

appointment within 6 weeks and 100% having had their 1st

appointment within 18 weeks.

EIP

Early Intervention Psychosis (EIP)

% treated with a NICE approved care package

within two weeks of referral.

New for

2016/1750.0% 77.3% 78.3% 82.4% 100.0% 100.0% 100.0% 95.2% 95.5% 84.6% 92.3% 90.6% A

No issues to report in relation to the EI service. Activity levels down in

comparison to previous levels (average now is 13 per month compared

to an average of 19 per month from Apr-Nov)

RA

ID

Rapid Assessment Interface and Discharge

model (RAID) - % of A&E emergency

referrals assessed within 1 hour

87.7% 75.0% 80.3% 83.4% 74.8% 74.1% 80.3% 78.1% 89.8% 87.6% 91.4% 89.3% 82.5% A

93.3% of RAID referrals were discharged from A&E within 4 hours, this

percentage has fallen due to periods of high activity

(particularly outside of office hours) when RAID received multiple

referrals.

DEM

ENTI

A

Estimated dementia diagnosis rate for people

with dementia of the total estimated

prevalence (ages 65+)

76.9% 70.0% 76.6% 76.4% 76.0% 76.6% 77.0% 76.9% 77.8% 78.6% 79.3% 79.1% 79.1% A

Dementia diagnosis rate is increasing in 2016/17 YTD with a slight

plateeau observed in the lates monthly data for January 2017.

MH

MD

S National HSCIC Mental Health Minimum

Data Set (MHSDS) data completeness (NHS

Number)

99.9% 97.0% 99.8% 99.7% 99.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.9% A

With the exception of Employment and Settled status being reported

the rest of the MHSDS is meeting required targets each month.

Total SPOA Referrals received

(GP, SELF, OTHER)5887 TBC 422 357 633 447 465 484 193 184 175 197 3557

from Oct this has been BAS data only and only the ones put through

as eligible from SPOA. GMMH Bi team to report on all SPOA and use

BAS as a reporting line.

% Emergency referrals seen within 24hrs 71.9% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 99.0% A

Bolton Assessment Service accepted a total of 197 referrals from

Primary Care in Jan with 36% of referral categorised as urgent or

emergency. DQ issue in month that has reduced normally 100% RAG

to 90% which GMMH are working to resolve.

Average wait (days) for Emergency Referrals TBC 1.0 0.6 0.6 0.7 0.6 0.8 0.8 0.6 0.6 0.3 0.6 0.6 A

Average wait (days) for Urgent

Referrals7.7 7.0 29.6 3.4 2.6 3.7 9.9 6.9 2.8 1.3 1.7 1.9 6.4 A

Average wait (days) for Routine

Referrals27.5 28.0 36.2 36.8 27.9 26.3 23.5 14.0 5.7 6.3 14.2 4.6 19.6 A

Total number of emergency referrals 12 11 5 7 9 10 22 12 18 10 116

NHS England » The Forward View into action

NHS BOLTON CCG MENTAL HEALTH PERFORMANCE DASHBOARD 2016/17

IAP

TINDICATOR DESCRIPTION

CP

A

SINGLE POINT OF ACCESS (SPOA)

BASELINE

2015/16

TARGET


YTD

TOTALS

ACHIEVING

/FAILING?EXCEPTIONS

TRENDLINE v TARGET

since April 2015


INDICATOR DESCRIPTION

Staffing levels 95.0% 88.8% 88.0% 88.8% 84.1% 80.1% 78.3% 81.0% 81.5% 78.7% 83.3% F

Sickness Absence Rate 4.2% 1.1% 0.9% 0.2% 2.2% 3.1% 0.0% 0.7% 0.3%Reported 1

month in

arrears1.1% A

Monthly figure reported 1 month in arrears

Sickness Absence Rate 4.2% 1.1% 1.0% 0.8% 1.7% 1.5% 1.5% 1.2% 1.1%Reported 1

month in

arrears1.2% A

YTD value

Mandatory Training 95.0% 99.0% 100.0% 99.0% 100.0% 98.9% 100.0% 98.0% 99.0% 97.8% 99.1% A

Statutory Training 95.0% 98.1% 98.0% 99.5% 99.5% 96.5% 99.0% 97.6% 98.0% 98.5% 98.3% A

Staff turnover (The % of staff who have

remained in post for over a year)90.0% 89.9% 84.4% 82.9% 82.7% 77.8% 82.0% 78.4% 78.1% 80.6% 81.9% F

Staff turnover (The % of staff leaving in month) 5.0% 0.0% 2.7% 0.0% 2.5% 2.7% 0.0% 0.0% 0.0% 0.0% 0.9% A

Tier 3 Activity 1091 951 929 874 845 877 956 1086 913 8522 -

Triage of Referrals: All referrals triaged within 1

working day98.0% 100.0% 100.0% 100.0% 100.0% 98.0% 100.0% 97.0% 100.0% 100.0% 99.4% A

Referral Wait Time: Emergency within 1

working day

No baseline

data

available90.0% - - - - - - - 100.0%

Reported 1

month in

arrears100.0% A


Referral Wait Time: Routine within 20 working

days

No baseline

data

available90.0% - - - - - - - 92.0%

Reported 1

month in

arrears92.0% A


% of patients with ongoing treatment needs

who had a follow-up appt within 28wks after

initial appt /assessment.

No baseline

data

available70.0% - - - - - - - 100.0%

Reported 1

month in

arrears100.0% A


DNAs - New < 5% 8.5% 4.0% 5.7% 5.8% 8.0% 8.9% 5.0% 7.1% 3.4% 6.3% F

DNAs - FU < 5% 6.3% 6.3% 7.6% 10.5% 10.9% 7.4% 6.6% 6.3% 8.9% 7.9% F

% of Clinic appointments cancelled within 1

week of the due date< 3% 3.2% 1.5% 0.1% 1.6% 1.8% 2.0% 2.0% 1.3% 1.6% 1.7% A

% of Patients who have their experience

captured>20% 29.0% 22.0% 23.0% 22.0% 44.0% 38.0% 26.0% 34.6% 24.2% 29.2% A

Patient Satisfaction with the service >85% 86.0% 87.1% 77.0% 81.5% 90.3% 75.8% 91.9% 88.6% 80.4% 84.3% F

Family / Carer Satisfaction >85% 90.6% 93.8% 96.5% 96.8% 96.0% 100.0% 95.0% 86.4% 94.1% 94.4% A

Complaints 0 0 0 0 0 0 0 0 1 0 1 F

% of young people 10 point improvement on

CGAS>50% 55.0% 73.0% 58.0% 38.0% 56.0% 56.0% 61.0% 75.0% 75.0% 60.8% A

in a recent meeting between CCG and Provider the CAMHS Provider

suggested that the threshold KPI of 5% is not in line with national

averages for a service of this nature and would like the commissioners

to review the target as nationally Bolton FT CAMHS is recognised as

performing well in this area for DNA NEW and DNA Follow Ups

CAMHS Child and Adolescent Mental Health Services

BASELINE

2015/16

TARGET


YTD

TOTALS

ACHIEVING

/FAILING?EXCEPTIONS

TRENDLINE v TARGET

since April 2015



PHQ9 / GAD7 - Percent of Clients showing

Reliable Improvement

New for

2016/17

Higher

Better65.4% 61.3% 72.2% 55.0% 59.5% 66.1% 66.9% 67.8% 70.2% 68.8% 65.3%

This measure has been included as an indicator of reliable

improvement based on the entry to IAPT psychological questionnaires

about their condition and again on discharge to assess how great the

outcome score has improved

ACP - (Psychiatric Adult Functional)

Readmissions as a % of discharges11.4% 10.7% 10.3% 5.7% 13.5% 3.0% 7.1% 5.9% 22.0% 8.2% 11.9%

Reported 1

month in

arrears9.7% A

There were 5 readmissions to report for January. One was within 7

days, and this was in relation to an overdose of

prescribed medication. In relation to the other four, two involved the

use of illicit substances, one related to selfneglect

ACP - Directorate percentage bed occupancy 92.8% 80-90% 84.0% 94.2% 94.5% 96.5% 97.9% 93.6% 96.2% 92.9% 92.8% 91.0% 93.6% A

Occupancy levels remain high across all services however no new

OAPs in January

ACP - Directorate average length of stay (days) 35 31 31 32 33 39 35 43 37 46 27 36

No issues target met. Significant reduction in PICU bed ALOS (104

days in Dec down to 11 in Jan)

ACP - Incidents Level 4/5 42 2 4 5 4 5 8 2 5 3 4 42

Community x 41

Inpatient Adult Functional x 1 (April)

ACP - Total number of complaints 87 12 6 12 16 9 8 7 11 1 16 98

The Bolton total complaints and concerns trend line has changed from

a level trend to an upwards trend.

Total delayed discharges as % of occupied

bednights0.5% < 7.5% 1.57% 2.03% 1.06% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.93% A

There were no delayed discharges reported in January in Bolton.

Gatekeeping % of Admissions (18 - 65yr) to

Inpatient services with access to Crisis

Resolution Home Treatment teams.

99.5% 95.0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% A

All 39 admissions were gatekept in January

% of Clients discharged from Inpatient Services

that had a Discharge Notification finalised

within 48 hours of discharge.

No baseline

data

available90.0% 84.2% 94.2% 97.2% 97.2% 91.3% 100% 90.9% 94.9% 93.8% 85.1% 92.9% A

The service achieved the in month target for discharge notifications to

GP for organic although functional had real issues in month 84.4% in

month (combined 85.1% achieved against 90% target) This is due to

the change over of Pharmacy and Junior doctors in month which has

Young People Under 18 Admitted to Adult

Wards7 0 1 0 0 0 0 0 0 0 0 0 1 F

There was one under 18 admitted in April due to a lack of an

appropriate NHS/private bed. The client was nursed as per agreed

protocol and they were discharged after 3 days to CAMHS to complete

7 day follow up

No of completed assessments 3764 281 345 331 355 367 386 320 338 288 307 3,318

Mental Health related condition Ambulance

callouts for Bolton CCG to all A&E depts1459 104 160 111 141 146 118 98 96 100 100 1,174

FOT

1,432

% of Mental Health related condition

Ambulance callouts for Bolton CCG which are

classed as Red (Emergency)

10.0% 19.2% 10.0% 9.0% 7.1% 9.6% 11.0% 17.3% 16.7% 14.0% 18.0% 11.1%FOT

Higher than

15/16

Mental Health related condition Ambulance

callouts for Bolton CCG as a % of total calls for

all conditions and callouts.

5.5% 4.9% 7.1% 5.5% 6.6% 6.7% 5.7% 4.4% 4.5% 4.2% 4.3% 5.4%FOT

Lower than

15/16




referrals. There have also been a number of clinically

complex cases that have resulted in waits over 4 hours (but not over 12 NWAS Ambulance Service Mental Health / Behavioural

RAID Rapid Assessment Interface and Discharge

GREATER MANCHESTER WEST (GMW) Mental Health NHS Foundation Trust

BASELINE

2015/16

TARGET


YTD

TOTALS

ACHIEVING

/FAILING?EXCEPTIONS

TRENDLINE v TARGET

since April 2015



STTB Board Measures

RA

ID

Rapid Assessment Interface and Discharge

model (RAID) - % of A&E emergency referrals

assessed within 1 hour

87.7% 75.0% 80.3% 83.4% 74.8% 74.1% 80.3% 78.1% 89.8% 87.6% 91.4% 89.3% 82.5% A




referrals.

ACP - Directorate percentage bed

occupancy92.8% 80-90% 84.0% 94.2% 94.5% 96.5% 97.9% 93.6% 96.2% 92.9% 92.8% 91.0% 93.4% A

Occupancy levels remain high across all services however no new OAPs

in January

Suicide Mortality (proxy measure using ICD10

codes X6-X8 in TIS data up to 12th Diagnosis level and

outcome was patient died) as above

1 0 0 1 0 0 1 0 0 0 3

note: excludes suicide mortality where patient was brought into hospital

already deceased

Sickness absence % rate

(rolling 12m ending total)

GMW report 6.020

5.75 5.64 5.61 5.65 5.81 5.73 5.63 5.57 5.52 5.58 5.70 5.70 A

Percentage figures show time lost as a proportion of time contracted in

a year (365 days or 366 in a leap year).

ACP - Incidents Level 4/5 42 2 4 5 4 5 8 2 5 3 4 42

Community x 41

Inpatient Adult Functional x 1 (April)

Usage of section 136 suite

(GMW report section 4.091)14 22 19 18 18 13 19 14 16 17 170

There were 17 x S136s in Bolton in January which is in line with the

average per month of 17. Work is under way to look further into the

discharge destinations. National benchmarking data shows Bolton is

higher than average vol. of under 18s subject to a S136

Outcomes of section 136 suite -

Assessed and Discharged as % of total

(GMW report section 4.093)

71% 36% 47% 33% 33% 31% 26% 57% 38% 41% 36%

The remaining 59% of activity is split between formal and informal

admissions (32%) followed up by CMHT (23%) and other (4%)

Out of area Placements (OAPs) NEW 0 0 0 0 0 0 1 0 1 0 2

Both Patients are still out of area, one can’t return until one of the other

patients has been discharged from the PICU, due to vulnerability /

Safeguarding issues and the second patient has commenced discharge

planning from Cheadle.

Out of area Transfers (OATs) NEW 0 0 0 0 0 0 0 0 0 0 0

no new OATS reported as yet however 3 are awaiting JAP decision

Out of area Transfers (OATs) EXISTING 57 57 57 57 57 57 57 57 57 55 55

Although the number has reduced in January there are 3 additional

patients on the Joint Assessment Panel list which may result in a new

OAT placement before year end. This level of 58 for 16/17 is in line with

expected levels based on Sept 2016 forecast

% Emergency referrals seen within 24hrs 71.9% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 100.0% A

Bolton Assessment Service accepted a total of 197 referrals from Primary

Care in Jan with 36% of referral categorised as urgent or emergency. DQ

issue in month that has reduced normally 100% RAG to 90% which

GMMH are working to resolve.

EIP

Early Intervention Psychosis (EIP)

% treated with a NICE approved care package

within two weeks of referral.

New for

2016/1750.0% 77.3% 78.3% 82.4% 100.0% 100.0% 100.0% 95.2% 95.5% 84.6% 92.3% 90.6% A

No issues to report in relation to the EI service. Activity levels down in

comparison to previous levels (average now is 13 per month compared

to an average of 19 per month from Apr-Nov)

Home Based Treatment Services - Treatment

Episodes

(Referrals plus two contacts) (GMW 4.082)

689 70 78 113 124 106 102 94 113 88 137 1025 A

FOT 1,230 which is a 79% increase on baseline performance

Frequent attendees at A&E

(rolling 12m Totals)

Measure being developed, Issue around diagnosis data collection in A&E

is preventing regular reporting of MH related activity

Friends & Family test (GMW directorate) 85.4% > 85.4% 83.8% 84.0% 81.4% 91.2% 91.0% 94.4% 91.5% 92.1% 86.9% 81.9% 87.8% A

YTD rate for FFT performance is in line with national (88%)

ACP - Directorate average length of stay for

current inpatients (days) (GMW 4.022)55 64 57 59 65 65 66 68 66 68 63

Average length of stay is based on the average number of days that

clients spend in designated wards as at end of each

reporting month. Figures to date are refreshed each month.

ACP - Total number of complaints 87 12 6 12 16 9 8 7 11 1 16 98

The Bolton total complaints and concerns trend line has changed from a

level trend to an upwards trend.

BASELINE

2015/16

TARGET


YTD

TOTALS

ACHIEVING

/FAILING?EXCEPTIONS

TRENDLINE v TARGET

since April 2015



MATS - Total number of referrals accepted 664 60 57 57 72 50 73 64 63 62 58 616

MATS - Clients offered assessment within 28

days140 13 21 29 15 15 9 15 9 10 15 151

MATS - Number on waiting list

76

(March

2016)

69 72 57 87 70 89 90 89 92 81 92

MATS - Average Wait to First Appointment

(Weeks)6.7 5.7 4.6 5.2 6.1 6.0 5.6 5.5 5.9 5.8 5.5

delays at Bolton Ft with available spaces and admin time required are

impacting on the ability to meet the 6wk targets

MATS - Average Wait to Diagnosis (Weeks) 8.1 6.2 5.5 5.3 6.0 5.5 6.8 5.8 5.9 6.1 5.8 5.9

MATS - Diagnosed MCI as % of total

Diagnosed26% 17% 30% 18% 35% 27% 29% 18% 33% 25% 22% 25.3%

NEL Admissions for Mental Health related

ICD10 diagnosis codes (ages 0-18 incl)335 < 335 13 35 14 21 18 11 15 28 15 170

FOT

Lower than

2015/16


ICD10 diagnosis codes (ages 19-64 incl)1868 < 1868 125 153 149 146 150 161 149 126 120 1,279

FOT

Lower than

2015/16


ICD10 diagnosis codes (ages 65yrs + incl)604 < 604 53 74 53 56 49 45 46 59 61 496

FOT

Higher than

2015/16

Bed Days (Total LOS) for Mental Health

related ICD10 diagnosis codes (0-18)493 < 493 33 39 15 13 19 10 14 24 20 187

FOT

Lower than

2015/16

Bed Days (Total LOS) for Mental Health related

ICD10 diagnosis codes (19-64)2988 < 2988 146 160 177 247 168 203 402 228 165 1,896

FOT

Lower than

2015/16

Bed Days (Total LOS) for Mental Health related

ICD10 diagnosis codes (65yr+)6331 < 6311 849 973 522 500 594 674 525 765 597 5,999

FOT

Higher than

2015/16

Average LOS for Mental Health related ICD10

diagnosis codes (0-18)1.47 < 1.47 2.5 1.1 1.1 0.6 1.1 0.9 0.9 0.9 1.3 1.10

FOT

Lower than

2015/16


diagnosis codes (19-64)1.60 < 1.6 1.2 1.0 1.2 1.7 1.1 1.3 2.7 1.8 1.4 1.48

FOT

Lower than

2015/16


diagnosis codes (65yr+)10.48 < 10.48 16.0 13.1 9.8 8.9 12.1 15.0 11.4 13.0 9.8 12.09

FOT

Higher than

2015/16

NEL Admissions Mental Health / Behavioural Activity

Dementia (MATS)The MATS service continues to hit the 12 weeks to diagnosis target but

due to the one stop shop approach whereby the team gathers all scan

and test info possible ahead of the appointment we struggle to meet the

6 week first contact target.Work continues with RBH collegues to

develop ways to speed up the scanning process and we endeavour to

see everybody referred as quickly as possible.

BASELINE

2015/16

TARGET


YTD

TOTALS

ACHIEVING

/FAILING?EXCEPTIONS

TRENDLINE v TARGET

since April 2015



A&E attendances to Bolton FT for Mental

Health Presenting Conditions (All Ages)4078 < 4078 237 293 241 285 287 293 255 253 228 2372 TBC

Data Quality issues have been identified with A&E data and are being

rectified within the recording of Diagnosis text in the A&E department.

For this reason the downward trend is incorrect and forecast outturn is

unavailable at present


Health Presenting Conditions (All Ages) as % of

total A&E attends for all conditions

4.8% < 4.8% 3.4% 3.9% 3.4% 3.9% 4.3% 4.2% 3.6% 3.7% 3.4% 3.8% TBC


Health Presenting Conditions (Ages 0-17yr) 643 < 643 45 60 46 47 30 47 47 58 41 421 TBC

A&E attends to Bolton FT for Mental Health

Presenting Conditions (Ages 0-17yr) as % of

total A&E attendances

2.9% < 2.9% 2.3% 2.8% 2.4% 2.6% 2.0% 2.6% 2.6% 3.1% 2.4% 2.1% TBC


Health Presenting Conditions (Ages 18-64) 3154 < 3154 174 209 182 224 239 231 190 173 175 1797 TBC


Presenting Conditions (Ages 18-64) as % of

total A&E attendances for this group

6.6% < 6.6% 4.9% 5.4% 4.8% 5.6% 6.2% 6.0% 5.0% 4.9% 5.1% 5.7% TBC


Health Presenting Conditions (Ages 65yr+)281 < 281 18 24 13 14 18 15 18 22 12 154 TBC


Presenting Conditions (Ages 65yr+) as % of

total A&E attendances for this group

1.6% < 1.6% 1.3% 1.6% 1.0% 0.9% 1.3% 1.2% 1.3% 1.6% 0.8% 1.1% TBC

Bolton Section 136 Detentions

(including section 135 detentions)206 < 206 13 24 17 18 15 10 97

Data for this section not received since the reassignment of the GMP

contact back to frontline services.

Percentage of Police calls to RBH which were

due to mental health concerns< 62% 62.0% 74.3% 78.9% 58.8% 70.6% 68.6% 58.3%

Percentage of Section 136 detention patients

who were admitted or referred for further help. TBC 84.0% 95.0% 83.0% 68.8% 73.3% 80.0% 80.7%

Accident and Emergency v Section 136

Detention Suite - % of all detentions used on

first admission to 136 suite

TBC 92.3% 52.3% 50.0% 87.5% 86.7% 80.0% 74.8%

Missing Patients / Concern for Welfare

A & E Department / Division of Medicine252 < 252 26 23 20 35 25 35 28 192

Missing / AWOL Patients Reported from

Mental Health Wards106 < 106 7 8 11 11 13 9 10 69

Total Police Calls to RBH 92 101 90 102 85 102 102 674

Number of persons taken to Royal Bolton

Hospital following police interaction due to

mental health concerns.

57 75 71 60 60 70 393

A&E Mental Health / Behavioural activity

Police Service A&E and inpatient data relating to mental

BOLTON INTEGRATED CARE KEY LINES OF ENQUIRY (KLOE) PERFORMANCE DASHBOARD 2016/17

INDICATOR DESCRIPTIONBASELINE

2015/16

TARGET

2016/17Metric Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS

ACHIEVING

/FAILINGCOMMENTS/EXCEPTIONS TRENDLINE

Better Care Fund (BCF) MetricsPLAN 2,646 2,809 2,576 2,766 2,360 2,628 2,829 2,689 2,876 2,560 26,739

ACTUAL 2,642 2,803 2,689 2,758 2,573 2,701 2,738 2,864 2,806 2,712 27,286

% VAR -0.2% -0.2% 4.4% -0.3% 9.0% 2.8% -3.2% 6.5% -2.4% 5.9% 2.0%

PLAN 2,774 2,774 2,774 2,774 2,774 2,774 2,774 2,774 2,774 2,774 27,740

ACTUAL 2,847 2,982 2,813 2,930 2,738 2,868 2,985 3,061 2,940 2,909 29,073

VAR % 2.6% 7.5% 1.4% 5.6% -1.3% 3.4% 7.6% 10.3% 6.0% 4.9% 4.8%

15/16 act 950 966 929 1,087 927 1,016 1,028 968 1,037 8,908

16/17 act 1,026 1,027 952 975 954 906 956 938 1,046 8,780

Variance% 8.0% 6.3% 2.5% -10.3% 2.9% -10.8% -7.0% -3.1% 0.9% -1.4%

NUM

DENOM

Rate~100K

NUM 383 384 394 381 380 359 385 399 375 385 382

DENOM 47,439 47,439 47,439 47,439 47,439 47,439 47,439 47,439 47,439 47,440 47,439

Rate 807.4 809.5 830.5 803.1 801.0 756.8 811.6 841.1 790.5 811.6 805.7

PLAN 361

ACTUAL 457

% VAR 79.0%

PLAN 308 308 308 308 308 308 308 308 308 308 3,080

ACTUAL 976 918 941 837 1,016 1,145 1,067 1,024 867 730 9,521

% VAR 216.9% 198.1% 205.5% 171.8% 229.9% 271.8% 246.4% 232.5% 181.5% 137.0% 209.1%

DTOC DELAYS - NHS RESPONSIBLE 193 91 ACTUAL 22 19 12 16 12 10 25 12 9 16 153

DTOC DELAYS - SOCIAL CARE RESPONSIBLE 44 21 ACTUAL 9 9 11 8 11 17 30 18 13 13 139

DTOC DELAYS - BOTH RESPONSIBLE 17 8 ACTUAL 0 3 3 3 0 6 0 1 1 1 18

DTOC DELAYED DAYS - NHS RESPONSIBLE 6,177 2,764 ACTUAL 713 593 518 501 515 544 608 438 447 515 5,392

DTOC DELAYED DAYS - SOCIAL CARE RESPONSIBLE 1,531 685 ACTUAL 233 274 294 246 445 434 425 561 367 191 3,470

DTOC DELAYED DAYS - BOTH RESPONSIBLE 417 187 ACTUAL 30 51 129 90 56 167 34 25 53 27 662

PLAN

ACTUAL - - - - - - 59 41 41 141

% VAR

PLAN

ACTUAL - - - - - - 7 5 1 13

% VAR

PLAN

ACTUAL

% VAR

PLAN 157 157 157 157 157 157 157 157 157 1,413

ACTUAL 173 180 168 132 164 136 151 191 183 1,478

% VAR 10.2% 14.6% 7.0% -15.9% 4.5% -13.4% -3.8% 21.7% 16.6% 4.6%

11,913

Annual metric at present using the new ASCOF definition. Awaiting Data

8,125 (3,731 per

100,000)

The latest position for Jan 2017 is 811.6 per 100,000 population (2014 Aqua

definition). YTD to January 2017 is 4.6% lower than same period in 2015/16.

Benchmarking information published in October 2016 placed Bolton 2nd worst

within Greater Manchester and 3rd worst in the whole North West.

3,696 (1,676 per

100,000)

As Intermediate care data is not yet available from Liquid Logic

reporting system, Bolton Council are developing a manual update for

this indicator for year end reporting purposes.

Latest performance for Qtr2 is 79.0% which is in line with Q1 performance but

below the target value of 88.6% and also below the 87.0% as reported in Q2 of

2015/16. only note: admissions up to 9th Sept due to migration from Carefirst to

Liquid Logic. Benchmarked 15/16 position was 2nd worst in Gtr Manchester.

BC

F1

A

BC

F2

NEL ADMISSIONS (MAR DATA)

Total Non-Elective Admissions

SUPPORTING MEASURE

34,765 33,288 F

NEL ADMISSIONS (TNR DATA)

Total Non-Elective AdmissionsF

Permanent admissions of older people aged

65+ to residential & nursing homes 2015 ASCOF

definition

991.6(per 100,000)

NEL ADMISSIONS (SUS DATA)

Non-Elective Admissions Aged 65yrs+

SUPPORTING MEASURE

Data for this measure still unavailable

As at December 2016, the current YTD totals are exceeding plan by 4.3%. (Includes

referrals to IMC@ Home plus AAT discharges to Laburnum Lodge and Darley

Court)

Permanent admissions of older people aged

65+ to residential & nursing homes

SUPPORTING MEASURE 2014 AQuA definition

827.0

(per

100,000)

768.1

(per

100,000)

F

88.6%

78.8%

458

361

79.0%

457

361

The total number of DTOcs in January 2017 increased to 30 compared to 23 in

Dec 2016 however the total number of delayed days reduced from 867 in

December to 730 in January. This reduction may be partly attributable to the

Spring Unit beds commissioned as part of discharge to assess at Four Seasons.

F

F

F

-3.5%

NHS delays are forecast to be 5% lower than baseline year with social care and

both responsible expected to exceed baseline performance. Social Care has shown

the greatest increase compared to 2015/16.

NHS delays are forecast to be 5% higher than baseline year with social care and

both responsible expected to significantly exceed baseline performance. Social

Care has shown the greatest increase compared to 2015/16.

The performance in Jan 2016/17 year to date is 2.0% higher than plan (547 NEL

admissions). January as a standalone month has shown a 5.9% increase against

plan (152 x more NEL admissions).

Emergency Admissions in Jan 2017 were -0.6% (18 x NELs) lower than the same

period in 15/16 and YTD is 0.4% higher than the same period in 15/16. On a

rolling 12m basis there is an increase of 215 admissions (0.62%) from the previous

12m. Overall 2016/17 NELs are 4.8% higher than plan (Apr-Jan).

F

NEL admissions for population aged 65yrs+ has decreased in 2016/17 by -1.2%

YTD compared to 2015/16 baseline from the same period. This indicates that the

increases seen in the above MAR and TNR data are not wholly attributable to an

ageing population.

% of older people (aged 65+) who were still

at home 91 days after discharge from

reablement/ rehabilitation services

BC

F3

70.1% (awaiting MH

inclusion)

Delayed transfers of care (DTOC)

Medically Optimised Delays - Bolton FT

SUPPORTING MEASURE

no data


Total number of delayed days

A

BC

F5 no data

BC

F4B

CF6 1,879

no data

> 1,879Referrals to home based intermediate care

Overall satisfaction of people who use

services with their care and support


Medically Optimised Delays - Intermediate

SUPPORTING MEASURE



2015/16

TARGET

2016/17Metric Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS

ACHIEVING

/FAILINGCOMMENTS/EXCEPTIONS TRENDLINE

Greater Manchester Priority Measures

A&E Attendances Total 95,861< = 0%

ChangeAttends 7,666 8,252 7,646 8,080 7,550 7,672 7,846 7,443 7,895 8,050 78,100 A

Jan 2017 A&E attendances were 0.8% higher (67 x A&E attends) than Jan 2016 and

YTD is -0.4% below the same period of 2015/16 (332 x fewer A&E attends). The GP

divert front door service (type 3 activity) currently accounts for 11.8% of the total

A&E activity at 955 attendances compared to 7,095 type 1 attends.

A&E attendances (TNR Data - All A&E)

SUPPORTING MEASUREAttends 7,941 8,571 7,986 8,473 7,917 8,030 8,200 7,738 7,702 7,087 79,645

A&E attendances (Type 1 - Bolton FT)

SUPPORTING MEASUREAttends 6,903 7,530 6,987 7,290 6,746 6,915 7,092 6,802 6,671 6,435 69,371

A&E attendances (Type 1 - Other Trusts)

SUPPORTING MEASUREAttends 763 722 659 790 804 757 754 641 667 660 7,217

A&E attendances (Type 3 Bolton FT)

SUPPORTING MEASUREAttends 557 955 910 2,422

GM

2

30 day emergency readmissions 9.7%< = 8.6%

RateRate % 8.9% 9.9% 8.7% 9.2% 8.7% 8.3% 8.2% 7.5% 8.8% 8.4% 8.76% F

30 day readmissions in January 2017 were 461 out of 5,499 admissions (8.4%)

which is a reduction from the 9.4% rate reported in the same period in 2016 and

just below the 2016/17FY target rate of 8.6% readmissions. Year to date average

reduced to 8.76% in January against the 8.60% target.

GM

4 Increasing the percentage of people that die

in their usual place of residence.46.0% Increase Rate % 45.0% F

In the rolling 12m Oct 2015 to Sep 2016, 44.0% of deaths in Bolton occurred in the

person’s usual place of residence. This was a slight decrease from the 45.0% value

as reported in the Jul 2015 to Jun 2016 update. Although deaths in hospital are

reducing the Hospice is absorbing the reduction instead of home

Bolton Priority Measures

L1 Avoidable emergency admissions 6,563 Reduction Admits 540 520 525 507 475 513 561 677 620 568 5,506 F

The latest monthly update shows January was 6.7% lower than the same period in

2015/16 (41 fewer admisssions) and year to date in 16/17 is 1.4% higher than the

same period in 15/16 (77 more admissions) therefore RED rating for year to date

performance. FOT is 6,607 (+0.6% from baseline)

L2 Average length of stay (non-elective)4.38 (days)

4.50(days)

Ave LOS

DAYS4.75 4.69 4.62 4.15 4.68 4.54 4.58 4.69 4.60 4.78 4.61 F

The average LOS for Jan 2017 was above target at 4.78 days against 4.50 days

plan. Year to date average is 4.61 days which remains slightly above plan level

therefore amber rating however is 5.7% higher than the same period in 2015/16

which may be an indication of the increased acuity within NEL admissions.

L3

Reducing the number of admissions due to

falls and fall related injuries (over 65s)872 Reduction Admits 84 68 58 52 73 75 68 82 96 65 721 A

The latest monthly update is 65 falls in Jan 2017 which is 29 lower than the level

reported in Dec 2016 and 18 lower than Jan 2016. Year to date the total number of

NEL admissions for falls is -2.6% below the same position in 2015/16

L4

Increasing the proportion of patients who

experience harm free care (Total average of

Bolton FT, Nursing Homes and BMI)

96.8% 95.0% Rate % 98.5% 97.0% 95.8% 96.9% 92.3% 97.5% 96.0% 96.1% 97.1% 97.2% 96.3% A

The latest performance from Jan 2017 shows that the average of providers within

Bolton are exceeding the 95%

L5

Number of people aged 65 and over receiving

residential care, nursing care and community

based services

2,826 Increase Actual 2,612 2,612 F

The numbers represent a snapshot at quarter end. The total number of individuals

receiving the service at any point in 2015/16 was 3,564. The quarterly snapshots

shown here report a -7.6% decrease from 2015/16 baseline

L6

Proportion of people using social care

receiving direct payments

30.3% (average of all

Qtr totals)

Increase Rate % 29.5% 29.1% F

The latest reported position in Jan 2017 is 29.5% which is an increase from the past

quarter but below baseline and target year to date.

L7

Increasing the percentage of people receiving

reablement or intermediate care at the point

of discharge

6.3% Increase Rate % 6.5% A

The latest local data for Qtr1 2016/17 suggests that 6.5% of all discharges are

offered reablement which is the same rate as Q1 16/17 and a slight decrease from

levels seen in Q2 of 2015/16

L10 Improved health-related quality of life for

carers

76.7% (July 15 to

Mar 16)

Increase Rate %

L11

Improved carer reported quality of life8.4

(14/15 latest)Increase Rate %

L12 People feeling supported to manage their

condition

66.7%(Jan 16

release)

Increase Rate % 66.2% F

GP Survey for January no longer published, now there is only one annual survey

published in July

3,063 1,746

As Intermediate care data is not yet available from Liquid Logic

reporting system, Bolton Council are developing a manual update for

this indicator for year end reporting purposes.

GM

1

66.2% data due July 2017 (as GP Survey has now become an annual measure)

31.2% 30.9% 24.8%

6.5% 6.5%

45.0% 44.0% data due May 2017 data due Sep 2017

2,731



2015/16

TARGET

2016/17Metric Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 YTD TOTALS COMMENTS/EXCEPTIONS TRENDLINE

Intermediate Care Services

Total Referrals 174 209 213 237 203 172 236 205 177 143 1,969

Admitted to

Caseload172 206 204 200 178 160 186 178 155 141 1,780

Ave LOS 2.7 2.9 3.2 3.4 3.2 4.0 2.9 2.9 3.3 3.2 3.2

Total Referrals 48 78 88 81 115 63 90 89 92 120 864

Admitted to

Caseload29 31 33 28 30 26 30 25 32 27 291

Ave LOS 26.9 26.9 34.8 28.1 24.9 36.7 34.5 32.1 36.0 21.7 30.3

Occupancy 87.6% 91.1% 88.8% 95.8% 93.5% 89.5% - - - - 91.0%

Total Referrals 50 40 49 34 - - - - - - 173

Admitted to

Caseload33 30 35 33 32 34 29 32 30 35 323

Ave LOS 30.7 25.0 30.8 26.3 28.8 26.9 29.3 34.0 27.7 30.5 29.0

Occupancy 95.7% 88.2% 82.9% 90.9% 94.8% 99.2% - - - - 92.0%

Total Referrals 118 116 108 124 87 104 90 97 92 101 1,037

Admitted to

Caseload112 102 94 89 90 86 83 91 82 72 901

Ave LOS 27.3 26.4 32.6 37.5 36.4 40.8 48.2 36.8 36.6 39.0 36.1

Total Referrals 162 167 161 126 158 131 141 188 177 173 1,584

Admitted to

Caseload165 124 139 108 135 132 112 157 148 156 1,376

Active Caseload 261 268 254 233 262 261 256 301 294 307 2,697

Ave LOS 26.6 31.9 33.2 30.0 29.3 30.5 29.1 29.3 28.0 28.3 29.6

QOLBefore 1.84 1.66 1.96 1.88 1.82 1.79 - - - - 1.82

QOL After 2.55 2.11 2.56 2.47 2.68 2.69 - - - - 2.51

Var as % 39.0% 26.8% 30.5% 31.4% 47.3% 50.0% - - - - 37.5%

Invites out 267 257 314 280 271 253 205 241 171 184 2,443

Accept % 42.3% 48.6% 37.3% 45.0% 52.4% 47.0% 50.7% 45.2% 38.0% 65.2% 47.2%

Referrals 406 396 415 438 430 454 407 372 292 437 4,047

No SCA% 46.6% 39.1% 42.7% 41.8% 38.6% 38.1% 36.6% 34.4% 39.0% 41.6% 39.9%

Target 293 293 293 293 293 293 293 293 293 293 2,930

Actual 215 183 163 196 181 206 330 227 148 191 2,040

Variance% -27% -38% -44% -33% -38% -30% 13% -23% -49% -35% -30%

INT Integrated Neighbourhood Team Referrals

(awaiting new dashboard report for full KPI list)

EIT Early Intervention Teams

(Avoidance of Full Social Care Assessment, SCA)

42% avoided

full SCA

Increase

No SCA %

44.9% (Oct - March)

Increase

QOL score

%

Awaiting activity QOL Wheel data for October onwards

61% Accept rate

Increase

Accept rate %

AA

TH

SR Home Support Reablement

SW Staying Well

DC Darley Court

LL Laburnum Lodge

Admission Avoidance Team (AAT)

Note - From August 2016, all bed based referrals are received by Darley Court

Note - From August 2016, all bed based referrals are received by Darley Court

IMC

H

Intermediate Care at Home

Page 4 of 9Better Care Fund Indicators

Non-elective emergency admissions per 100,000 population

Greater Manchester CCGs (2016/17 Qtr. 2) TNR DATA

In the final quarter of 2015/16, 70.1% of patients were still at home 91 days after discharge to

reablement/rehabilitation services which was a reduction from the 78.9% performance reported in

Qtr3 and much lower than the target position of 86%. This figure however will be refreshed once the

annual data has been published which also takes into account mental health activity.

Latest performance for Qtr2 2016/17 is 79.0% which is in line with 2016/17 Q1 performance but

below the target value of 88.6% as per the most recent submitted BCF ambitions and also below the

87.0% as reported in Q2 of 2015/16. The aim is to increase the proportion of people still at home 91

days after discharge to reablement to meet the level seen in 2012/13 (86%) note that for Q2 this only

includes data up to 9th September due to migration from Care first to Liquid Logic. Update March

2017 - awaiting data for intermediate tier in liquid logic

In relation to the benchmarking against Greater Manchester cluster median values Bolton Local

BCF3. Proportion of older people (aged 65 and over) who were still at home 91 days after

discharge from to reablement/ rehabilitation services

Proportion of older people (aged 65 and over) who were still at home 91 days after

discharge from to reablement/ rehabilitation services

Non-elective emergency admissions to all acute providers - Bolton CCG patients

Emergency Admissions in January 2017 were -0.6% (18 x NELs) lower than the same period in

2015/16 and year to date performance is now just 0.4% higher than the same period in 2015/16.

On a rolling 12m basis the baseline activity Feb 2015 to Jan 2016 was 34,671 emergency admissions.

The actuals for the latest rolling 12m Feb 2016 to Jan 2017 is 34,886 which is an increase of 215

admissions (0.62%). Overall 2016/17 NELs are 4.8% higher than plan (Apr-Jan).

The benchmarking of NEL per 100,000 across Greater Manchester for Qtr. 2 2016/17 shows Bolton

CCG in 4th lowest position at 4.0% below the median (previously 3rd lowest in Q1).

BCF1. Emergency admissions

BCF2. (also GM3) Permanent admissions of older people (aged 65 and over) to residential

and nursing care homes (Lower Better)

In the BCF submission, Bolton was set an ambition to decrease the number of permanent admissions

to nursing and residential care homes (per 100,000 population) to 752.6 in 2015/16 and no more

than 768.1 in 2016/17. At the same time, the number of people aged over 65 in Bolton is projected to

grow by 1.9% from 2014/15 to 2015/15 and by a further 1.1% in 2016/17.

The methodology used to calculate this measure from 'actual admissions to residential care' to

'intended admissions to residential care' has changed in the last 12m which has led to a parallel

running of this measure with the old and new outcomes.

The latest position for Jan 2017 is 811.6 per 100,000 population (2014 Aqua definition). YTD to

January 2017 is 4.6% lower than same period in 2015/16. Benchmarking information published in

October 2016 placed Bolton 2nd worst within Greater Manchester and 3rd worst in the whole North

West.

Long-term support needs of older adults (ages 65yrs+) met by admission to

residential and nursing care homes per 100,000 population 2015/16

Proportion of older people (aged 65 and over) who were still at home 91 days after

discharge from to reablement/ rehabilitation services Greater Manchester 2015/16

Permanent admissions to residential and nursing care (per 100,000 population)

Manch

est

er

Bo

lto

n

Salfo

rd

Wig

an

Ro

chd

ale

Bury

Tam

esi

de

Sto

ckp

ort

Old

ham

Tra

ffo

rd

0

10

20

30

40

50

60

70

80

90

100

%

Still

at

ho

me 9

1 d

ays

aft

er

dis

charg

e

Local Authority

Local Authority rate Median

75th centile 90th centile

Manch

est

er

Sto

ckp

ort

Tra

ffo

rd

Tam

esi

de

Wig

an

Ro

chd

ale

Bury

Old

ham

Bo

lto

n

Salfo

rd

0

100

200

300

400

500

600

700

800

900

1,000

Ad

mis

sio

ns

per

100,0

00 p

op

ula

tio

n

Local Authority

Local Authority rate Median 75th centile 90th centile

2,200

2,400

2,600

2,800

3,000

3,200

3,400

Ap

r-2014

May-

2014

Jun-2

014

Jul-

2014

Aug

-2014

Sep

-2014

Oct

-2014

No

v-2014

Dec-

2014

Jan-2

015

Feb-2

015

Mar-

2015

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Num

ber

of

ad

mis

sio

ns

Month

So

uth

Manch

est

er

Sto

ckp

ort

Salfo

rd

Heyw

oo

d, M

idd

leto

n &

Ro

chd

ale

No

rth M

anch

est

er

Tam

esi

de &

Glo

sso

p

Old

ham

Tra

ffo

rd

Bo

lto

n

Wig

an B

oro

ug

h

Bury

Centr

al M

anch

est

er

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

NEL

Ad

mis

sio

ns

per

100,0

00

CCG RED

827.0 807.4

756.8

790.5 811.6

768.1

1,009.6 991.6

600

700

800

900

1,000

1,100

1,200

2010/1

1 F

Y

2011/1

2 F

Y

2012/1

3 F

Y

2013/1

4 F

Y

2014/1

5 F

Y

2015/1

6 F

Y

2016/1

7 Q

tr 1

2016/1

7 Q

tr2

2016/1

7 Q

tr 3

2016/1

7 Q

tr 4

(Ja

n)

2014 AQUA Definition BCF Ambition (AQUA definition)

2015 ASCOF Definition (Annual)

52.3%

79.7%

85.9%

78.5%

79.9%

79.1%

87.0%

78.9%

70.1%

78.8% 79.0%

82.1%

86.0% 88.6%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

2010/1

1

2011/1

2

2012/1

3

2013/1

4

2014/1

5

2015/1

6…

2015/1

6…

2015/1

6…

2015/1

6…

2016/1

7…

2016/1

7…

2016/1

7…

2016/1

7…

% s

till

at

ho

me 9

1 d

ays

aft

er

dis

charg

e

GREEN

RED RED

RED RED

NOTE: Q4 15/16 awaiting annual refresh value as current % does not include mental health

BCF KLOE Page 4

Page 5 of 9Better Care Fund Indicators

Non-elective emergency admissions per 100,000 population

Greater Manchester CCGs (2016/17 Qtr. 2) TNR DATA

Non-elective emergency admissions to all acute providers - Bolton CCG patientsBCF1. Emergency admissionsBCF4. Delayed transfers of care (total number of delayed days)

BCF6. Referrals to home based intermediate care

BCF5. Overall satisfaction of people who use services with their care and support

The National Audit for Intermediate Care in 2012/13 identified that Bolton was an outlier with regard

to the number of intermediate care beds commissioned and intermediate tier services are now being

refocused on home based services. In 2012/13 the Greater Manchester average was 522 referrals per

100,000 population. This has been set as a target for Bolton to reach by 2015/16, which equates to

1,136 actual referrals. The left chart shows that Bolton exceeded this target in 2014/15 and the

second chart on the right shows the performance in 2015/16 which is also exceeding the planned

target.

The number of referrals to home based intermediate care was 1,879 for 2015/16 FY. As at January

2017, the current YTD totals are exceeding plan by 7.4%. (Data includes referrals to IMC@ Home plus

AAT discharges to Laburnum Lodge and Darley Court.)

Overall satisfaction of people who use services with their care and support (2014/15)

Actual Number of referrals to home based intermediate care in Bolton

Overall satisfaction of people who use services with their care and support

Number of referrals to home based intermediate care in Bolton

This metric was chosen because it is the nearest equivalent measure to a new metric which is under

development for both the NHS Outcomes Framework and the Adult Social Care Outcomes

Framework, “Improving people’s experience of integrated care”.

The metric is the proportion of respondents who say they are "extremely satisfied" or "very satisfied"

in response to the question "Overall, how satisfied or dissatisfied are you with the care and support

services you receive?”.

In 2014/15 Bolton scored 61.2%, below the median score for Greater Manchester. In 2013/14 Bolton

scored 65.6%, just above the median. In the BCF submission, an ambition was set to reach 66.6% in

2014/15 and 67.6% in 2015/16.

Delayed transfers of care - total delayed days for Bolton patients

The first chart shows the trend in the number of delayed days for Bolton patients in relation to

transfers of care. After four consecutive months of increases between Oct 2015 and Jan 2016,

delayed days started to fall from Feb 2016 however since March 2016 performance has remained

fairly static around 900 days on average but with a greater reduction reported in July.

The total number of DTOcs in January 2017 increased to 30 compared to 23 in Dec 2016 however

the total number of delayed days reduced from 867 in December to 730 in January. This reduction

may be partly attributable to the Spring Unit beds commissioned as part of discharge to assess at

Four Seasons. Bolton FT account for 89% with Salford(2%) and all others (3%). The benchmarking

position within the GM Cluster maintains Bolton's position at mid-table (not shown) and Bolton is

below average for delays (days) in the GM cluster which indicates that the increases seen over winter

2015/16 are not unique to Bolton. Care package in home is a primary reason for the social care

delayed days and further non acute are a NHS delay primary reason

Manch

est

er

Old

ham

Bo

lto

n

Salfo

rd

Tra

ffo

rd

Tam

esi

de

Sto

ckp

ort

Bury

Wig

an

Ro

chd

ale

52

54

56

58

60

62

64

66

68

70

72

Satisf

act

ion s

core

Local

Authority

Local Authority score GM Median

GM 75th centile GM 90th centile

764

855

1,02

1

782

713

593

518

501

515

544

608

447

219 233

274 294 246

445 434 425

367

16

60

45

11 30

51 129 90

56 167 34

53

0

200

400

600

800

1000

1200

1400

0

200

400

600

800

1,000

1,200

1,400

Dec-

15

Jan-1

6

Feb-1

6

Mar-

16

Ap

r-16

May-

16

Jun-1

6

Jul-

16

Aug

-16

Sep

-16

Oct

-16

No

v-16

Num

ber

of

dela

yed

days

Month

Delayed transfers of care (total delayed days) Attributable to NHS Attributable to Social Care

Attributable to Both Target

-200

0

200

400

600

800

1,000

1,200

1,400

1,600

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Feb-2

017

Mar-

2017

To

tal d

ela

yed

days

Month

Actual total delayed days Average

UCL LCL

Target

62.4%

58.4%

64.3%

65.6% 66.6%

67.6%

56%

58%

60%

62%

64%

66%

68%

70%

2010/11 2011/12 2012/13 2013/14 2014/15

BCF

ambition

2015/16

BCF

ambition

% o

f p

eo

ple

satisf

ied

with t

heir c

are

and

sup

po

rt

505

798

1,288

1,879

967

1,288

1,879

0

500

1,000

1,500

2,000

2,500

2012/13 2013/14 2014/15 2015/16 2016/17

Num

ber

of

refe

rrals

Number of referrals BCF ambition

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Feb-2

017

Mar-

2017

Actual BCF Plan YTD actual YTD plan

RED RED

NO RAG - Awaiting Data RED

GREEN GREEN

BCF KLOE Page 5

Page 6 of 9Greater Manchester and locally selected metrics - A number of further metrics have been identified across Greater Manchester and locally within Bolton.

GM1. A&E attendances

Objective: To decrease

A&E attendances across all providers

The trend over time chart shows the number of A&E attends at all acute providers from Apr 2014, for

Bolton CCG patients. Target for 16/17 is zero % increase or reduction from previous year totals.

Jan 2017 A&E attendances were 0.8% higher (67 x A&E attends) than Jan 2016 and YTD is -0.4%

below the same period of 2015/16 (332 x fewer A&E attends). The GP divert front door service (type

3 activity) currently accounts for 11.8% of the total A&E activity at 955 attendances compared to

7,095 type 1 attends.

The rolling 12m benchmarking A&E attendances (type 1) by CCG per 100,000 population shows

Bolton in 3rd lowest position and lower than the median across GM cluster. (previously 4th lowest at

end of Q1 2016/17 on rolling 12m basis)

GM2. 30 day emergency readmissions


30 day emergency readmissions for Bolton patients across all acute providers 30 day readmission rate for Bolton patients compared to GM Cluster

The trend chart shows the number of emergency readmissions within 30 days of previous discharge

(following an elective, day case or non-elective admission). When comparing 2015/16 FY with

2014/15 FY, there was a 0.27% increase in the number of 30 day readmissions. This equated to an

approx 127 additional readmissions out of a total 64,334 discharges.

30 day readmissions in January 2017 were 461 out of 5,499 admissions (8.4%) which is a reduction

from the 9.4% rate reported in the same period in 2016 and just below the 2016/17FY target rate of

8.6% readmissions. Year to date average reduced to 8.76% in January against the 8.60% target.

The second chart shows the 30 day readmission rate across Greater Manchester CCGs in 2014/15

(awaiting updated source). Bolton CCG was below the median readmission rate (9.2%).

A&E Attendances (type 1) per 100,000 population

GM Cluster CCGs Rolling 12m Oct 2015 to Sept 2016 (TNR DATA)

GM4. Percentage of people who die in their usual place of residence

Objective: To increase

Proportion of deaths in usual place of residence – Bolton CCG patients Proportion of deaths in usual place of residence

Greater Manchester CCGs - Latest avaliable 12 months (to Sep '16)

In the rolling 12m Oct 2015 to Sep 2016, 44.0% of deaths in Bolton occurred in the person’s usual

place of residence. This was a slight decrease from the 45.0% value as reported in the Jul 2015 to Jun

2016 update. Although deaths in hospital are reducing the Hospice is absorbing the reduction instead

of home. Amber RAG rating due to 2nd consective reduction in performance.

Hospice as place of death in the rolling 12m to June 2016 were 6.9% compared to 6.2% in the

previous year and 4.4% in the year before. This is likely reflective of the success of Bolton Hospice and

increased capacity compared to earlier years. Deaths in Hospital in the rolling 12m to Sep 2016 were

47.5% compared to 48.6% in the previous year and 53.3% in the year before. Bolton CCG has remains

3rd highest for proportion of deaths in usual place of residence across Greater Manchester. National

average is currently 45.7% which remains the same rate as in the last report.

5%

6%

7%

8%

9%

10%

11%

Tam

esid

e &

…

Traf

ford

Hey

wo

od

,…

Bu

ry

Wig

an B

oro

ugh

Bo

lto

n

Old

ham

Sou

th…

Salf

ord

Cen

tral

…

Sto

ckp

ort

No

rth

…30 d

ay r

ead

mis

sio

ns

rate

CCG

35%

36%

37%

38%

39%

40%

41%

42%

43%

44%

45%

46%

47%

Mar-

11

Jun-1

1

Sep

-11

Dec-

11

Mar-

12

Jun-1

2

Sep

-12

Dec-

12

Mar-

13

Jun-1

3

Sep

-13

Dec-

13

Mar-

14

Jun-1

4

Sep

-14

Dec-

14

Mar-

15

Jun-1

5

Sep

-15

Dec-

15

Mar-

16

Jun-1

6

Sep

-16

Rolling 12m period end month

6,000

6,500

7,000

7,500

8,000

8,500

9,000

9,500

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Feb-2

017

Mar-

2017

Nu

mb

er o

f at

ten

dan

ces

Month

A&E attends Average UCL LCL Target

300

350

400

450

500

550

600

650

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Num

ber

of

read

mis

sio

ns

Month

Actual 30 day readmissions Average Target

NH

S T

am

esi

de a

nd

Glo

sso

p C

CG

NH

S T

raff

ord

CC

G

NH

S C

entr

al M

anch

est

er

CC

G

NH

S W

igan B

oro

ug

h

CC

G

N

HS S

outh

Manch

est

er

CC

G

NH

S S

alfo

rd C

CG

NH

S H

eyw

oo

d,

Mid

dle

ton a

nd

Ro

chd

ale

CC

G

N

HS O

ldham

CC

G

NH

S N

ort

h M

anch

est

er

CC

G

NH

S B

olto

n C

CG

NH

S S

tock

po

rt C

CG

NH

S B

ury

CC

G

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Pro

po

rtio

n o

f d

eath

s in

usu

al p

lace

of

resi

dence

(%

)

CCG

% Rate Median 75th centile 90th centile

GREEN GREEN

AMBER AMBER

GREEN AMBER

HEYW

. M

IDD

. &

RO

CH

DA

LE

BU

RY

BO

LTO

N

STO

CKPO

RT

WIG

AN

BO

RO

UG

H

TR

AFF

OR

D

CEN

TR

AL

MA

NC

HESTER

TA

MESID

E &

GLO

SSO

P

SO

UTH

MA

NC

HESTER

OLD

HA

M

SA

LFO

RD

NO

RTH

MA

NC

HESTER

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

CCG Median 75th centile 90th centile

GM & LOCAL KLOE 1 Page 6

Page 7 of 9Greater Manchester and locally selected metrics - A number of further metrics have been identified across Greater Manchester and locally within Bolton.

GM1. A&E attendances


A&E attendances across all providers A&E Attendances (type 1) per 100,000 population

GM Cluster CCGs Rolling 12m Oct 2015 to Sept 2016 (TNR DATA)

L2. Average length of stay (non-elective) Average length of stay for emergency admissions - Bolton CCG pts all providers Average length of stay for emergency admissions benchmarked

across Greater Manchester Apr to Dec 2016

The average LOS for Jan 2017 was above target at 4.78 days against 4.50 days plan. Year to date

average is 4.61 days which remains slightly above plan level therefore amber rating however is 5.7%

higher than the same period in 2015/16 which may be an indication of the increased acuity within

NEL admissions. Although the trend has been decreasing there will come a point in the future when

this will start to increase again as the complexity and acuity of pateints increases when integrated

services are fully up and running, only the patients who really need to be there will be admitted. The

second chart illustrates how Bolton CCG benchmarks against other Greater Manchester CCGs for

average non-elective length of stay. Year to date in 16/17 to Dec, Bolton CCG is placed 6th lowest

within Greater Manchester for average length of stay from a previous low position of 2nd lowest in

the rolling 12m to Aug 2016.

L3. Reducing the number of admissions due to falls and fall related injuries (over

65s)

Emergency admissions due to falls and fall related injuries at all providers

(patients aged 65 and over)

Emergency admissions due to falls and fall related injuries at all providers

Patients aged 65 and over - Sep 2015 to Aug 2016 - Greater Manchester CCGs

The trend chart illustrates the number of emergency admissions for Bolton patients aged 65 years

and over, to any hospital provider, with a fall related injury. Overall there is a slightly decreasing trend

in the number of falls admissions since a peak in Oct 2014. Comparing 2015/16 with 2014/15, the

number of admissions reduced by 3.1% from 900 in 2014/15 to 872 in 2015/16. This is a great

improvement considering the increase from 13/14 to 14/15 was an increase of 23%.

The latest monthly update is 65 falls in Jan 2017 which is 29 lower than the level reported in Dec 2016

and 18 lower than Jan 2016. Year to date the total number of NEL admissions for falls is -2.6% below

the same position in 2015/16 The bar chart shows how Bolton CCG compares across Greater

Manchester for the number of falls admissions per 1,000 population aged over 65. In the past 12m

Bolton has the second lowest rate of falls admissions per 100,000 across all Greater Manchester CCGs.

(TIS Data). The data corresponds to PHOF data from 2014/15 which shows the same position for

Bolton CCG

L1. Avoidable emergency admissions (NHSOF 3a) Avoidable emergency admissions for all Bolton CCG patients to any provider Avoidable emergency admissions per 100,000 benchmarked across Greater

Manchester (NHS Digital) Proxy measure July 2015 to June 2016 (rolling 12m)

This is a composite measure as per the key shown in the benchmarking chart (far right chart)

The trend over time chart shows the trend in avoidable emergency admissions for Bolton patients

across all hospital providers. There is a slight seasonal trend, with relatively more admissions in winter

months. Overall the long term trend is slightly increasing; there was a 5.1% increase from 2012/13 to

2013/14 and a 7.4% increase when comparing 2013/14 to 2014/15 however more recently there has

been a -0.3% reduction in 2015/16 compared to the previous year.

The latest monthly update shows January was 6.7% lower than the same period in 2015/16 (41 fewer

admisssions) and year to date in 16/17 is 1.4% higher than the same period in 15/16 (77 more

admissions) therefore RED rating for year to date performance.

The benchmarking chart illustrates how Bolton compares across Greater Manchester. Data for the

latest available 12 month period (Jul 2015 to Jun 2016) shows that Bolton had the 5th lowest rate of

avoidable admissions across Greater Manchester per 100,000 which is a deterioration from the

position of lowest in the previous rolling 12m period to March 2015 therefore AMBER rating

Bury

Bo

lto

n

No

rth M

anch

est

er

Heyw

oo

d, M

idd

leto

n &

Ro

chd

ale

Tam

esi

de &

Glo

sso

p

Tra

ffo

rd

Old

ham

Centr

al M

anch

est

er

Wig

an B

oro

ug

h

Sto

ckp

ort

So

uth

Manch

est

er

Salfo

rd

0

500

1000

1500

2000

2500

3000

3500

Ad

mis

sio

ns

per

100,0

00 p

op

ag

ed

65+

CCG


0

20

40

60

80

100

120

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Feb-2

017

Mar-

2017

Title

Title

Falls NELs Average UCL LCL

Heyw

oo

d, M

idd

leto

n &

Ro

chd

ale

Old

ham

Bury

So

uth

Manch

est

er

Salfo

rd

Bo

lto

n

Wig

an B

oro

ug

h

Sto

ckp

ort

No

rth M

anch

est

er

Tra

ffo

rd

Tam

esi

de &

Glo

sso

p

Centr

al M

anch

est

er

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Ave

LO

S f

or

Em

erg

ency

Ad

mis

sio

ns

CCG


3.00

3.50

4.00

4.50

5.00

5.50

6.00

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Feb-2

017

Mar-

2017

Title

Title

Ave LOS Average UCL LCL Target

0.0500.0

1000.01500.02000.02500.03000.03500.04000.04500.05000.0

NH

S W

igan B

oro

ug

h…

NH

S T

raffo

rd C

CG

NH

S B

ury

CC

G

NH

S N

ort

h…

NH

S B

olto

n C

CG

NH

S S

tock

po

rt C

CG

NH

S O

ldham

CC

G

NH

S S

alfo

rd C

CG

NH

S H

eyw

oo

d,…

NH

S C

entr

al…

NH

S T

am

esi

de a

nd…

NH

S S

outh

…

Unplanned hospitalisation

for asthma, diabetes and

epilepsy in under 19s

Emergency admissions for

children with lower

respiratory tract infections

Unplanned hospitalisation

for chronic ambulatory care

sensitive conditions

Emergency admissions for

acute conditions that should

not usually require hospital

admission

200

300

400

500

600

700

800

Ap

r-2015

May-

2015

Jun-2

015

Jul-

2015

Aug

-2015

Sep

-2015

Oct

-2015

No

v-2015

Dec-

2015

Jan-2

016

Feb-2

016

Mar-

2016

Ap

r-2016

May-

2016

Jun-2

016

Jul-

2016

Aug

-2016

Sep

-2016

Oct

-2016

No

v-2016

Dec-

2016

Jan-2

017

Feb-2

017

Mar-

2017

Title

Title

Number of admissions Average

Upper control Lower control

AMBER AMBER

AMBER AMBER

AMBER GREEN

GM & LOCAL KLOE 1 Page 7

Page 8 of 9

L6. Proportion of people using social care receiving direct payments

Objective: to increase

The trend chart shows the proportion of people using social care receiving direct payments at year

end. Latest data available shows that since 2013/14 the proportion of people using social care and

receiving direct payments has increased from 28.9% to 31.2% with a peak of 36.9% reported in Q4

2015/16.

The latest reported position as at the end of Q2 2016/17 is 30.9% which is a reduction from both the

past quarter (31.2%) and also a reduction from the Q2 position in 2015/16 of 32.2%.

Benchmarking the proportion of people using social care receiving direct payments chart on the right

shows that Bolton are the second highest for this measure and above the GM cluster average. In

addition to this another metric within ASCOF data (not shown) places Bolton at the lowest point of

the chart in relation to the proportion of carers receiving direct payments at 27.7% compared to the

average of 77% in GM Cluster

Locally selected metrics (continued)

L4. Proportion of patients who experience harm-free care


Proportion of patients who experience harm free care at Bolton Health Providers Proportion of patients who experience harm free care Bolton FT v GM Trusts

The left chart shows the proportion of patients who experienced harm-free care at Bolton NHS FT,

Bolton Nursing Homes and BMI Bolton Hospital between April 2015 and November 2016. The latest

performance from December 2016 shows that the average of providers within Bolton are exceeding

the 95% target.

This measure is taken from the NHS Safety Thermometer, which records the presence or absence of

four harms: pressure ulcers, falls, urinary tract infections (UTIs) in patients with a catheter, new venous

thromboembolisms (VTEs). The target, set nationally, is to achieve 95% harm-free care.

The right chart also shows the monthly harm-free care achievement for Bolton FT compared to the

average of Greater Manchester Provider Trusts (Bolton, Central Manchester, Pennine Acute, Salford,

South Manchester, Stockport, Tameside and Wrightington, Wigan & Leigh)

L5. Number of people aged 65 and over receiving residential care, nursing care and

community based services

Benchmarking data being sourced

The trend chart shows the number of people aged 65 and over receiving residential care, nursing

care and community based services in Bolton.

The numbers represent a snapshot at quarter end. The total number of individuals receiving the

service at any point in 2015/16 was 3,564 which is a 4.7% increase in the total number receiveing the

service in 2014/15 of 3,402. The quarterly snapshots shown here report an 11.7% increase from Q2

2015/16 position.

Benchmarking of Number of people aged 65 and over receiving residential care, nursing care and

community based services is shown to the right of the trend chart and Bolton performed higher than

average for the peer group similar local authorities in the chart and higher than England average.

2015/16 data unavailable in this format as yet.

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Ap

r-15

May-

15

Jun-1

5

Jul-

15

Aug

-15

Sep

-15

Oct

-15

No

v-15

Dec-

15

Jan-1

6

Feb-1

6

Mar-

16

Ap

r-16

May-

16

Jun-1

6

Jul-

16

Aug

-16

Sep

-16

Oct

-16

No

v-16

Dec-

16

% h

arm

fre

e c

are

Month

Nursing Homes (TOTAL) BMI Bolton FT Target

GREEN

92%

93%

94%

95%

96%

97%

98%

99%

100%

Ap

r-15

May-

15

Jun-1

5

Jul-

15

Aug

-15

Sep

-15

Oct

-15

No

v-15

Dec-

15

Jan-1

6

Feb-1

6

Mar-

16

Ap

r-16

May-

16

Jun-1

6

Jul-

16

Aug

-16

Sep

-16

Oct

-16

No

v-16

Dec-

16

% h

arm

fre

e c

are

Month

Bolton FT Target All GM Trusts

GREEN

37.9% 36.9% 36.6%

33.0%

25.4% 24.4%

16.6% 15.4% 12.9%

10.1%

0

1000

2000

3000

4000

5000

60002015/16 Qtr 4

num

denom

1C part 2a - Proportion of adults (clients) receiving direct payments

28.9

%

31.4

%

20.8

%

32.2

%

31.4

% 3

6.9

%

31.2

%

30.9

%

24.8

% 29.5

%

15%

20%

25%

30%

35%

40%

45%

Pro

po

rtio

n

Proportion of people using social care receiving direct

payments

2,681

3,402 3,562

2,723 2,741 2,789 2,826 2,731

3,063

1,746

2,612

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

2013/1

4

2014/1

5

2015/1

6

2015/1

6

Q1

2015/1

6

Q2

2015/1

6

Q3

2015/1

6

Q4

2016/1

7

Q1

2016/1

7

Q2

2016/1

7

Q3

2016/1

7

Q4

Nu

mb

er o

f p

eo

ple

No of people aged 65 and over receiving residential care,

nursing care and community based services

AMBER GREEN

AMBER GREEN

LOCA KLOE 2 Page 8

Page 9 of 9Locally selected metrics (continued)

L4. Proportion of patients who experience harm-free care


Proportion of patients who experience harm free care at Bolton Health Providers Proportion of patients who experience harm free care Bolton FT v GM TrustsL7. The proportion of older people aged 65 and over offered reablement services

following discharge from hospital Objective: to increase

The proportion of older people aged 65 and over offered reablement

services following discharge from hospital

The number of older people offered reablement services following discharge from hospital as a

proportion of all discharges (people aged 65 and over) figure for 2014/15 was 4.5% ASCOF 2B(2)

The measure includes social care-only placements, and excludes people who were only assessed by

the NHS. We have included a two-part measure to capture both the volume and success of the

reablement services that are delivered. This will prevent areas scoring well which offer reablement

services to only a very small number of people.

Note: ASCOF are not currently reporting on this measure as recent as the Q4 2015/16 report

therefore a local proxy measure is being used which is no longer directly comparable to ASCOF

baseline position. The latest local data for Qtr2 2016/17 suggests that 6.5% of all discharges are

offered reablement which is the same rate as Q1 16/17 and a slight decrease from levels seen in Q2

of 2015/16

5.5%

7.2% 6.7%

4.2%

9.0%

7.6%

6.6%

2.2%

6.5% 6.5%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

2014/1

5

Q1

2014/1

5

Q2

2014/1

5

Q3

2014/1

5

Q4

2015/1

6

Q1

2015/1

6

Q2

2015/1

6

Q3

2015/1

6

Q4

2016/1

7

Q1

2016/1

7

Q2

% o

ffere

d r

eab

lem

ent

GREEN RED

LOCA KLOE 2 Page 9

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