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NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: ………13……………… Date of Meeting: ……………27th November 2015…….. TITLE OF REPORT:
CCG Corporate Performance Report
AUTHOR:
Melissa Laskey - AD Commissioning Mike Robinson - AD Integrated Governance & Policy Lynda Helsby - AD Primary Care Victoria Preston – Senior Information Analyst
PRESENTED BY:
Dr Barry Silvert (other Board leads available to answer questions)
PURPOSE OF PAPER: (Linking to Strategic Objectives)
The purpose of the attached report is to indicate performance against all the key delivery priorities for the CCG in 2015/16 against which NHS Bolton Clinical Commissioning Group is nationally measured
RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting)
Members are requested to : Note the formal month end position for September 2015 (unless stated otherwise) in respect of performance against key delivery priority targets
COMMITTEES/GROUPS PREVIOUSLY CONSULTED:
Performance is reported to: CCG Clinical Executive Contract Performance Group Quality and Safety Committee
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
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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 September 2015 (Month 6).
1.2 Appendix 1 contains the detailed reports for each set of performance indicators the CCG is measured against: - Bolton CCG Objectives - NHS Constitution Standards - Key NHS Contractual Measures - Outcome & Quality Framework Indicators - Community Services Key Performance Indicators - Quality Premium Metrics - CCG Quality Indicators
1.3 The Integration Performance Report is included at Appendix 2. This report details performance against the key BCF outcome metrics as well as progress made and key next steps for the programme.
1.4 Section 2 exception reports against all indicators.
2. Exception Reporting 2.1 Quality Premium 2015/16 2.1.1 The performance update for Quarter 2 for the Quality Premium metrics will be
brought to the January Board meeting, with details of specific actions being taken as required to ensure delivery of the targets.
2.2 Quality & Safety – Board Lead, Dr Colin Mercer
2.2.1 MRSA bacteraemia There has been 1 FT apportioned bacteraemia in September. This case was comprehensively reviewed by the FT and presented to the CCG accordingly. It was agreed on the basis of the evidence that this result was a clinical contaminant and the patient did not have a clinical infection. 2.2.2 Falls Progress is being made in relation to the benefits of the Falls Strategy implementation. Focused e-learning has been developed for all clinical staff and face to face sessions are being delivered by the falls coordinator to specific areas of
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concern. Since April 2015 150 members of front line staff have received falls training. 107 face to face and 43 through the newly developed e-learning package. Assessment criteria for the allocation of a ‘Special’, has been developed and is currently being trialled on a number of wards. This should influence the support needed for complex patients being risk assessed as a high risk of falling. The FT aim for 80% of staff identified for training to have completed the e learning package by March 2016. Falls leading to serious harm are classed as serious incidents and full RCAs are shared with the CCG which are reviewed at the serious incident review group. 2.2.3 Serious Incidents & Never Events There were 2 SIs reported in September. One of these relates to a failure to prescribe insulin to a diabetic patient with concerns regarding escalation. Another was a Never Event reported in September relating to the retention of a throat pack post nasal surgery. Investigations are underway in both cases and expected next month. An earlier reported Never Event relating to the misplacement of a nasogastric tube in a neonate has been downgraded following the investigation and consultation with the CCG and NHS England. 2.2.4 Royal College of Surgeons (RCS) Review of Theatres at Bolton FT On the 27th & 28th of July the RCS reviewed theatres at Bolton FT in response to a number of surgical never events that had occurred since April 2014. The aim was to assess the culture, processes, procedures and behaviours across themes. The findings of the report were summarised to the FT’s Quality Assurance Committee in October and the Board in November. This was also considered by the CCG’s Quality and Safety Committee in November and the FT will present both the findings and the action plan relating to the recommendations at the December Quality and Safety Committee. The review team did not consider there to be an overarching theme to the never events and that investigations had been thorough and rightly identified where improvements could be made. However, compliance with the WHO checklist and the five steps to safer surgery, the induction of locum staff, and the development and implementation of Standard Operating Procedures was reported as being variable. The review team made 15 recommendations and the FT have produced an initial action plan which will be further reviewed at the FT’s December Quality Assurance Committee.
2.3 Commissioning – Board Lead, Dr Barry Silvert
2.3.1 Reduce Non-Elective Admissions The CCG, in its 5 year plan, set a target for a reduction of 2.9% of non-elective
admissions in 2015/16 (based on 2014/15 outturn). In September 2015 there were 2,794 admissions across all providers. This represents a decrease of
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1.17% of non-elective admissions compared to September 2014 and year to date the figure is 16,947 non-elective admissions which is a reduction of 0.18% compared to the same period last year. Bolton FT repeated the Perfect Week exercise on the 23rd September, to reinforce the process improvements that need to be made to ensure flow through the hospital and to assist in reducing emergency admissions. Work is continuing on the operational roll out of the Ambulatory Care pathways with a focus on delivering elements of this early in 2016. This will also help to reduce pressure on the A&E department by pulling appropriate patients through to the Unit for assessment, treatment and discharge. This will be allied with specialist in reach to facilitate discharge directly from the Unit without the need for a full admission.
2.3.2Reduce Non-Elective Length of Stay
The target for non-elective length of stay for 2015/16 is 4.65 days. In September, the length of stay increased to 4.39 days (from 4.0 days in August). The current YTD length of stay is 4.41.
The CCG is working with Bolton FT to introduce new processes to help to
reduce length of stay, including weekly meetings to monitor individual wards and to assist with partners in unblocking any delays in transfer of care/discharges. The key lessons learned from the September iteration of the perfect week were to further embed the SAFER Bundle which assists with expediting patient flow. This has now translated into a key CQUIN proposal for 2016/17 to further embed these principles.
2.3.3Reduce Emergency Readmissions
The number of emergency readmissions in September 2015 was 521. This represents a 2.96% increase on the same period last year. The reasons for this are being investigated. The year to date position is 3,191 readmissions which is a 3.07% increase on the same period in 2014/15.
2.3.4NHS Constitution Targets
A&E 4 hour performance for September 2015 was 93.84% (against the target of 95%). Work continues with the trust to mitigate the risk of non delivery of this national target. Conference calls have been stepped up to 3 times per week, an A&E deflection scheme is being proposed with a November Pilot and the new NHS 111 service went live on the 10th November (with the impact on A&E being assessed).
NWAS achieved all of their 3 targets in September - with performance of 83.5% for Emergency Response arriving within 8 minutes (Red 1) and 75.3% within 8 minutes (Red 2) - against a target of 75% for both. The Category A 19 minute response standard also achieved with performance of 95.5% (against a target of 95%).
The 6 week diagnostic waiting time standard was achieved for September 15, for the first time since M1. The CCG will continue, however, to work closely with
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CMFT where there are known capacity issues, predominantly affecting endoscopy performance – action plans and trajectories are in place. Demand for endoscopy services is known to have increased recently as a result of public health cancer awareness campaigns.
The cancer standard for maximum 31 day wait from diagnosis to first definitive treatment was failed in September with 5 patients out of 120 having breached. The year to date position for this standard is achieving at 97.7% against a threshold of 96%. The CCG is working closely with the relevant providers to ensure actions are in place to address any current performance issues. The cancer standard for maximum 31 day wait for treatment where treatment is for surgery was failed in September with 1 patient out of 9 having breached at Salford Royal due to capacity issues. The CCG is working with SRFT to ensure capacity meets demand, along with assurance around timescales to resolution. The year to date position for this standard is 96.6% (against a threshold of 94%). The cancer standard for 62 day wait from urgent GP referral to first definitive treatment was failed in September, with 8 out of 10 patients affected due to late onward referral. The year to date position for this standard is achieving at 86.2% against a threshold of 86%. The CCG is working closely with providers to understand the reasons behind this, along with any future mitigating actions required.
2.3.5Contractual Performance
In August there were 100 patient handovers (from ambulances to A&E) where patients waited between 30 and 59 minutes and 13 patients waited more than 60 minutes (against a target of 0 for both). The Trust is continuing to work with NWAS to drive improvements in this area and until recently had started to see improvements in the handover times.
Bolton FT failed all 3 of the stroke targets in August. 70.0% of patients were admitted to a designated stroke bed within 4 hours (against a target of 80%), 76.9% of patients spent 90% of the stay in hospital on a stroke unit (against a target of 80%) and 50.0% of TIA cases were investigated and treated within 24 hours (against a target of 60%). The remedial action plan being implemented is being monitored through the Quality and Performance Group and the ODN is currently reviewing the performance of the new hyper acute stroke pathway. The CCG Executive has recently approved work to commence on exploring the potential of commissioning the TIA service from an alternative provider.
2.4 Community Services Dashboard – Board Lead, Dr Barry Silvert 2.4.1 Detailed below are the key highlights from the overarching community services
dashboard for October 2015.
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2.4.2 The update on the 3 services areas of concern previously discussed at Board (Rheumatology, Neurological Long terms Conditions and Tissue Viability) are subject to a separate Board discussion under the procurement item.
2.4.3 Community services continue to see some improvements in all areas, particularly waiting times, staff sickness and staff turnover. A significant improvement has been shown in the Falls service for waiting times - with 88% of patients seen within 4 weeks during October compared with only 50% in September.
2.4.4 Referrals to services are comparable to last year’s activity for both adult and children’s services.
2.4.5 The performance report continues to report waiting times against 4, 12 and 18 weeks rather than against service specific waiting times agreed through the service specifications. The Trust has provided assurance that the report will be further developed to reflect service specific waiting times. This includes recognition that further work is required for the recording of activity relating to urgent referrals seen on a daily basis in accordance to clinical need as this data is not routinely captured against this target.
2.4.6 Waiting times across the services at aggregate level are above target with 65.8% of routine referrals seen within 4 weeks. The CCG is working with the FT on key actions to reduce waiting times for key services as required.
2.5 Primary Care – Board Lead, Dr Stephen Liversedge 2.5.1 The next progress report for the Bolton Quality Contract (Quarter 2 2015/16)
will be brought to the January Board meeting, following review at the Primary Care Co Commissioning Committee.
3. Recommendations
3.1 The Board is asked to note the performance for September 2015 and the
actions being taken to rectify areas of performance which are below standard.
Melissa Laskey - Associate Director of Commissioning 20th November 2015
Appendix 1
2 Quality Premium
3-5 Quality Report
6 Corporate Objectives
7-9 NHS Constitution Deliverables
10-13 Performance Report
Appendix 2
14-50 Integration Report
Index
£839,697
ACHIEVED* Patient Population: 279,899
* Subject to quality and budget contraints Total Quality Premium Available: £1,399,495
* please note the population figures maybe adjusted14 15 16 17 18 19 20 21 22 23 24 25 26 27
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD / Forecast Target £ Potential £ Achieved* Notes
Reducing PYLL through amenable mortality10% of
QP2325 £139,950
Latest data released Sept 15 for
01/01/14-31/12/14 (Next
publication Sept 16)
Improving antibiotic prescribing in primary and secondary care: Part a)
Reduction in the number of antibiotics prescribed in Primary care by
1% or more
17,284 15,921 16,035 15604 13721 188,556 14/15 = 226108 *.99=223846 £139,950
Improving antibiotic prescribing in primary and secondary care: Part b)
number of co-amoxiclav, cephalosporins and quinolones as a % of the
total number of selected antibiotics prescribed in primary care to be
reduced by 10%
9.70% 10.16% 8.76% 9.47% 9.82% 9.58%14/15=9.92% reduction =
8.92%
Achieving a reduction in avoidable emergency admissions 561 490 497 508 425 513 2994 vs 3014 ly15% of
QPA reduction or zero % change £209,924 £209,924 HWB - awaiting data
An increase in the level of Non Elective discharges at weekends and
Bank Holidays22.89% 28.47% 17.01% 17.85% 25.83% 19.35% 21.9%
5% of
QP
>0.5% higher than 14/15
21.5%£69,975 £69,975
Reducing NHS responsible delayed transfers of care 348 303 346 371 422 230 4,04010% of
QP
less than 14/15 figure. 4332
Bolton FT (Excludes social
care)
£139,950 £139,950
Reduction in the number of patients with A&E breaches who have
attended with a mental Health need together with a defined
improvement in coding of patients attending A&E - Data quality, valid
A&E diagnosis > 90%
97.6% 97.6% 97.7% 97.0% 97.2% 98.0% 96.0% >90% £69,975 £69,975
Reduction in the number of patients with A&E breaches who have
attended with a mental Health need together with a defined
improvement in coding of patients attending A&E. 4 Hour wait
component MH diagnosis
84.11% 91.90% 94.11% 87.40% 92.28% 89.16% A
14/15 = 85% for MH
diagnosis< 4 hours. Figure is
92.5% for non MH
Reduction in the number of patients with A&E breaches who have
attended with a mental Health need together with a defined
improvement in coding of patients attending A&E. 4 Hour wait
component Non MH Diagnosis
92.00% 96.50% 97.90% 95.80% 95.28% 93.10% A
Improvement in the health related quality of life for people with a long
term mental health condition0.48 vs 0.704 A
15% of
QP
A reduction in the difference
between LTC compared to
those with a mental health
LTC
£209,924 £209,924GP Patient Survey (GPPS)/
HSCIC Portal 2.16 CCGOIS
September 2016 vs Sept 2015
Reduction in the number of people with sever mental illness who are
smokers
2% of
QP
Comparison between March
15 and March 16£27,990 GP data extracted by GPES
Increase in the proportion of adults with secondary mental health
conditions who are in paid employment
8% of
QP
Comparison of the proportion
within paid employment
between Q4 14/15 and Q4
15/16
£111,960 MHMDS
IAPT Recovery following talking therapies for people of all ages 44.90% 51.47% 50.45% 53.45% 44.70% 51.10% A10% of
QP>46.73% £139,950 £139,950
Emergency readmissions within 30 days of discharge from hospital 525 557 511 562 515 521 F10% of
QP<6086 £139,950 £0
£1,399,495 £839,697
18 week RTT - Admitted (monthly) 95.4% 95.7% 95.9% 94.6% 95.3% 94.3% A 90% -10% £0
18 week RTT - Non Admitted(monthly) 97.2% 96.8% 96.8% 97.0% 96.4% 96.0% A 95% -10% £0
18 week RTT - Incomplete (monthly) 95.7% 96.2% 96.4% 95.6% 95.7% 95.6% A 92% -10% £0
A&E <4h CCG level (monthly) 92.0% 96.8% 98.3% 95.9% 95.6% 93.8% A 95% -30% £0
Cancer 14 day waits from an urgent referral for suspected cancer 93.4% 98.2% 96.8% 95.1% 96.9% 98.2% A 93% -20% £0
Amb response <8 min (monthly) 71.2% 81.6% 79.8% 79.3% 77.7% 74.9% A 75% -20% £0
Adjusted Total £839,697
* Please note that this report is draft and currently work in progress. Awaiting guidance from NHSE regarding 18week penalties impact on Quality Premium.
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BOLTON CCG QUALITY PREMIUM RESULTS 2015/16 D R A F T
£559,798
MISSED
2326 Latest data released
June 15
2348 Latest data released
Sep 15
Area Performance Indicator 2014/15 Annual Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Cumulative YTD Trend (Apr 14-Sept15)
Summary Hospital Mortality Indicator (SHMI) <1.1 1.072 1.072 1.072 1.068 1.068 1.068 1.068
MRSA bacteraemia 0 1 2 0 0 0 1 4
Rates of C Difficile maximum 19 for full year 4 2 2 1 2 1 12
Number of falls (all patient falls safeguard) 982 93 80 88 97 80 92 530
Moderate 0 1 2 1 1 0 5
Severe 0 0 1 2 0 2 5
Fatal 0 0 0 0 0 0 0
Percentage of Harm (Safety thermometer) GM (rolling 12 months) <5% Harm 4.74% 4.58% 4.40% 4.40% 4.62% 4.47% 4.47%
Percentage of Harm (Safety thermometer) Bolton FT (rolling 12 months) <5% Harm 3.19% 1.52% 2.69% 2.29% 2.28% 2.24% 2.24%
% of adults who receive a falls risk assessment using an assessment too approved by
the commissioner (3a)>=95% 97.60% 98.00% 98.60% 97.70% 98.60% 96.30% 97.80%
% of adults assessed as being at risk of falling that have a care plan which reflects
best practice (3c)>=95% 92.50% 92.40% 96.50% 95.70% 96.20% 93.60% 94.40%
Medication Incidents >636 FYE 90 107 77 107 99 73 553
Total Incidents 10,786 907 895 967 1228 993 1055 6045
% Total incidents with no harm (Apr13-Sept13) NPSA 50% 69.1% 71.4% 68.3% 69.5% 71.6% 71.5% 70.0%
% of all adult patients who receive a tissue viability risk assessment using an
assessment tool approved by the commissioner (5a)>=95% 98.8% 98.1% 99.2% 98.1% 98.7% 98.4% 98.5%
% of adults assessed as being at risk of developing a pressure ulcer that have a care
plan (5c)>=95% 94.3% 92.0% 97.3% 97.2% 98.6% 94.5% 95.5%
Nursing (nurses/midwifes) shifts (% Actual Vs Planned) Day need to agree tolerance 95.1 94.9 95.8 95.5 93.9 95.3 94.0
Nursing shifts (% Actual Vs Planned) Night need to agree tolerance 98.7 97.2 97.7 98.1 95.6 95.5 96.0
Care Staff shifts (% Actual Vs Planned) Day need to agree tolerance 112.6 111.8 108.9 104.0 102.9 102.5 102.6
Care Staff shifts (% Actual Vs Planned) Night need to agree tolerance 133.2 133.9 124.5 116.8 113.7 116.1 119.7
Number of SUIs 0 3 0 3 3 0 2 11
Number of never events 0 2 0 2 0 0 1 5
Falls with at least moderate harm
QUALITY REPORT
REDUCING MORTALITY
PATIENT SAFETY
HCAI - Trust only
Area Performance Indicator 2014/15 Annual Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Cumulative YTD Trend (Apr 14-Sept15)
Complaints Responded to within time period 95% 100% 100% 100% 100% 97% 93% 98%
A&E Percentage recommended 85.0% 87.0% 87.0% 86.2% 86.4% 84.3% 86.0%
A&E Response Rate 15% 21.9% 21.9% 19.6% 20.2% 19.0% 20.1% 20.5%
Inpatient Percentage recommended 97.0% 96.0% 98.0% 98.1% 95.8% 96.2% 96.9%
Inpatient Response Rate 15% 26.8% 28.0% 27.7% 29.6% 28.8% 39.1% 30.0%
Maternity Q1 Antenatal Care % recommended
No target set No Responses No Responses No Responses No Responses No Responses 89% 89% Data supressed for very low numbers
Maternity Q2 Birth %e recommended
No target set 90.0% 94.0% 91.0% 91.8% 89.0% 91.1% 91.2%
Maternity Q2 Birth Response Rate
No target set 20.7% 19.1% 21.2% 16.6% 16.6% 16.6% 18.8%
Maternity Q3Postnatal % recommended
No target set 95.1% 91.8% 93.9% 82.8% 90.7% 93.6% 90.8%
Maternity Q4 Postnatal Community % recommended
No target set 92.5% 100.0% 95.0% 94.9% 90.7% 94.3% 94.5%
Friends and family staff (Quarterly)Percentage recommended - work
No target set 63.0%
Friends and family staff (Quarterly)Percentage recommended - Care
No target set 79.0%
62% 64%
78%79%
PATIENT EXPERIENCE (Bolton FT)
Area Performance Indicator 2014/15 Annual Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Cumulative YTD Trend (Apr 14-Sept15)
Sickness Absence 3.75% 4.38% 4.31% 4.52% 4.87% 4.66% 4.40% 4.52%
Mandatory Training - Compliance 100% 92.40% 93.30% 93.90% 94.20% 93.00% 94.00% 93.50%
Appraisals Completed 80% 82.1% 79.4% 78.4% 78.9% 79.4% 82.7% 80.1%
Induction Attendance 100% 68.90% 67.93% 70.69% 70.80% 73.30% 72.20% 70.64%
Substantive staff turnover Headcount (rolling average 12 months) <=10% 9.6% 10.0% 9.7% 9.8% 9.9% 10.3% 9.9%
Surgical WHO Checklist compliance (Elective)
100% 99.0% 99.8% 99.8% 99.8% 99.0% 99.0% 99%
Surgical WHO Checklist compliance (Emergency)
100% 98.0% 98.0% Not available Not available Not available 99.0% 99.0%
Number of SUIs 0 0 0 0 0 0 0 0
Number of never events 0 0 0 0 0 0 0 0
Number of practices with 5 red indicators on the Primary Care Dashboard (Practices
with review identified)Running Total 6 6 2 2 2 2 2
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 tolerance2,077 2,146 2,115 2,163 2,163
CLINICAL EFFICIENCY AND EFFECTIVENESS
BEAUMONT
Primary Care
PRIMARY CARE
Better Care, Better Value
Independent Sector
Quality Impact Indicators
STAFFING
Objective Key Measures of Success (Goals)
From (2011/12)
2013/14 for
Emergency
admissions)
To 2015 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 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
For 2006-2010 Male 13.5 Female 11.3
Achievement of all key targets / NHS
Constitution Several failing All achieved 5 2 2 2 3 4
Running
total
Number of failing targets out of 17
National measures
See NHS Constitution report
4 for September, A&E 4 Hour, 31 day
cancer for first definitive,31 day cancer
for surgery and 62 day for urgent gp
referal
Bolton patients and carers would
recommend health services
(combination of A&E and Inpatient)
90% Local
target90.1% 90.7% 92% 91.6% 90.6% 90.8% 91% 90%
New measure 'percentage
recommended' rather than 'net
promoter score'
Reduce emergency admissions 33,498 32,511 2,758 2,888 2,826 2,939 2,742 2,794 16,947 -0.2%
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 15/16 3.3 3.3 3.5 3.0 3.2 2.8 3.2
As per year 2 of the 5 year strategic
plan
NE 4.9 (baseline -
strategic plan)NE 4.65 15/16 4.8 4.7 4.2 4.3 4.0 4.4 4.4
As per year 2 of the 5 year strategic
plan
Reduce emergency readmissions 6,086 3% Reduction 525 557 511 562 515 521 3,191
BOLTON CCG CORPORATE REPORT
Improve quality of
care and patient
experience of care
Reduce elective & non elective length
of stay
(Ave LOS)
Improve Health
Outcomes
3.07%
As per year 2 of the 5 year strategic
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.
Best Value:
NHS Constitution Indicators - September 15
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
Admitted patients to start treatment within a maximum of
18 weeks from referral 90% 95.4% 95.7% 95.9% 94.6% 95.3% 94.3% 95.2% A
Aggregated target achieved, Cardiology failed at total Provider level (50%). Bolton
FT failed Orthopaedics (83.2%). Other breaches for September are Gen Surgery at
South Man (33%); Orthopaedics at Salford (83%); Ophthalmology at Central Man
(75%); Plastics at Christie (67%) and South Man (84%); Cardiology at South Man
(36.4%);Thoracic Medicine at South Man (50%); Gynae at Central Man (75%) and
Other Specs at Central Man (63.3%).
Non-admitted patients to start treatment within a
maximum of 18 weeks from referral95% 97.2% 96.8% 96.8% 97.0% 96.4% 96.0% 96.7% A
Aggregated target achieved, specialties failed for all Providers are Orthopaedics
Cardiothoracic, Gastro Cardiology and Other Specs. Bolton FT failed
Orthopaedics(92.6%) and Ophthalmology (90.7%); Other breaches for September are
Urology at Pennine (50%), Salford (83%) and South Manchester (50%); Orthopaedics
at Central Man (85.7%) and Salford (83%); ENT at Lancs Teaching (80%);
Cardiothoracic at South Man (66.7%); Gastro at Pennine (0% - 1 patient who has
breached), Salford (89%) and South Man (0% - 1 patient who has
breached)Cardiology at Salford (80%), South Man (80%) and WWL
(83%);Dermatology at Salford (82.4%); Thoracic at South Man (89%); Rheumatology
at WWL (89%); Gynae at Central Man (75%) and Other Specs at Central Man (86%)
and Salford (80.6%).
Patients on incomplete non emergency pathways (yet to
start treatment) 92% 95.7% 96.2% 96.4% 95.6% 95.7% 95.6% 95.9% A
Aggregated target achieved, specialty failed for all Providers are Ophthalmology
(90.7%) and Cardiology (91.8%). Bolton FT failed Ophthalmology (90.4%). Other
breaches for September are General Surgery at Salford (89.5%), Stockport (50%) and
South Man (85.7%); Urology at Central Man (87.5%); Orthopaedics at The Alexandra
BMI (66.7%), Pennine (87.5%), RLBG (66.7%), Salford (91%), Stockport (50%) and
Robert Jones (50%); ENT at Central Man (91%), Pennine (75%) and South Man (83%);
Plastics at St Helen's and Knowsley (85.7%); Cardiology at Lancs Teaching (87.5%)
and South Man (83%);Rheumatology at Central Man (75%); Gynae at Central Man
(91.3%) and Liverpool Women's (66.7%) and Other Specs at Central Man (89%) and
Sheffield Children's (75%).
Patients waiting for a diagnostic test should have been
waiting less than 6 weeks from referral 1% 1.00% 1.04% 1.59% 1.13% 1.05% 0.93% 1.12% A
Patients should be admitted, transferred or discharged
within 4 hours of their arrival at an A&E department -
Bolton FT
95% 92.00% 96.80% 98.30% 95.90% 95.60% 93.84% 95.00% A 605 patients waited more than 4 hours (Denominator 9,215) Breached by 144 patients
Referral to Treatment waiting times for non urgent consultant led
treatment - All Providers
Diagnostic test waiting times All providers
A & E waits - Bolton FT
NHS Constitution Indicators - September 15
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
Maximum two-week wait for first outpatient appointment
for patients referred urgently with suspected cancer by a
GP
93% 93.4% 98.2% 96.8% 95.1% 96.9% 98.2% 96.4% A
Maximum two week wait for first out patient appointment
for patients referred urgently with breast symptoms
(where cancer was not initially suspected)
93% 98.1% 100.0% 99.2% 97.5% 99.2% 98.3% 98.7% A
Maximum one month (31 day) wait from diagnosis to first
definitive treatment for all cancers 96% 97.7% 98.9% 97.3% 97.5% 99.1% 95.8% 97.7% A 5 breaches out of 120, late transfers and capacity issues
Maximum 31 day wait for subsequent treatment where
that treatment is surgery 94% 100.0% 100.0% 94.4% 100.0% 92.3% 88.9% 96.6% A
1 patient out of 9 breached. Elective capacity inadequate (patient unable to be
scheduled for treatment within target time)
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% 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% A
Maximum two month (62 day) wait from urgent GP referral
to first definitive treatment for cancer 85% 90.5% 80.6% 85.5% 92.1% 84.6% 82.8% 86.2% A Ten breaches of which 2 are complex patients the remaining 8 are for late referrals.
Maximum 62 day wait from referral from an NHS
screening service to first definitive treatment for all
cancers
90% 75.0% 100.0% 80.0% 100.0% 100.0% 100.0% 94.3% A
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% 87.5% 50.0% 100.0% 72.7% 96.1% A 3 breaches out of 11, all late referrals
Cancer patients - 2 week wait -All Providers
Cancer patients - 31 day wait -All Providers
Cancer waits - 62 days - All Providers
NHS Constitution Indicators - September 15
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
Category A calls resulting in an emergency response
arriving within 8 minutes (Red 1) 75% 71.20% 81.60% 79.80% 79.30% 77.70% 78.40% 78.00% A
Category A calls resulting in an emergency response
arriving within 8 minutes (Red 2)75% 72.10% 79.40% 78.20% 76.00% 75.40% 74.90% 76.00% A Target failed for NWAS, however Bolton achieved with 75.3%.
Category A calls resulting in an ambulance arriving at the
scene within 19 minutes 95% 93.30% 96.40% 95.90% 94.60% 95.10% 94.60% 95.00% A Target failed for NWAS, however Bolton achieved with 95.5%.
Category A ambulance calls NWAS
NHS Bolton Key Contract Performance Dashboard - September 2015.
Commissioner Performance Dashboard
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
Admitted patients to start treatment within a maximum of 18 weeks
from referral 90% 95.4% 95.7% 95.9% 94.6% 95.3% 94.3% 95.2% A
Aggregated target achieved, Cardiology failed at total Provider level (50%). Bolton FT failed
Orthopaedics (83.2%). Other breaches for September are Gen Surgery at South Man (33%);
Orthopaedics at Salford (83%); Ophthalmology at Central Man (75%); Plastics at Christie (67%) and
South Man (84%); Cardiology at South Man (36.4%);Thoracic Medicine at South Man (50%); Gynae
at Central Man (75%) and Other Specs at Central Man (63.3%).
Non-admitted patients to start treatment within a maximum of 18
weeks from referral95% 97.2% 96.8% 96.8% 97.0% 96.4% 96.0% 96.7% A
Aggregated target achieved, specialties failed for all Providers are Orthopaedics Cardiothoracic,
Gastro Cardiology and Other Specs. Bolton FT failed Orthopaedics(92.6%) and Ophthalmology
(90.7%); Other breaches for September are Urology at Pennine (50%), Salford (83%) and South
Manchester (50%); Orthopaedics at Central Man (85.7%) and Salford (83%); ENT at Lancs Teaching
(80%); Cardiothoracic at South Man (66.7%); Gastro at Pennine (0% - 1 patient who has breached),
Salford (89%) and South Man (0% - 1 patient who has breached)Cardiology at Salford (80%), South
Man (80%) and WWL (83%);Dermatology at Salford (82.4%); Thoracic at South Man (89%);
Rheumatology at WWL (89%); Gynae at Central Man (75%) and Other Specs at Central Man (86%)
and Salford (80.6%).
Patients on incomplete non emergency pathways (yet to start
treatment) 92% 95.7% 96.2% 96.4% 95.6% 95.7% 95.6% 95.9% A
Aggregated target achieved, specialty failed for all Providers are Ophthalmology (90.7%) and
Cardiology (91.8%). Bolton FT failed Ophthalmology (90.4%). Other breaches for September are
General Surgery at Salford (89.5%), Stockport (50%) and South Man (85.7%); Urology at Central
Man (87.5%); Orthopaedics at The Alexandra BMI (66.7%), Pennine (87.5%), RLBG (66.7%), Salford
(91%), Stockport (50%) and Robert Jones (50%); ENT at Central Man (91%), Pennine (75%) and
South Man (83%); Plastics at St Helen's and Knowsley (85.7%); Cardiology at Lancs Teaching
(87.5%) and South Man (83%);Rheumatology at Central Man (75%); Gynae at Central Man (91.3%)
and Liverpool Women's (66.7%) and Other Specs at Central Man (89%) and Sheffield Children's
(75%).
Number of patients waiting more than 52 weeks - (Bolton FT only)
Incomplete0 0 0 0 0 0 0 0 A
Number of patients who are not offered another binding date within
28 days0 1 1 0 0 0 0 2 F
Patients waiting for a diagnostic test should have been waiting less
than 6 weeks from referral 1% 1.00% 1.04% 1.59% 1.13% 1.05% 0.93% 1.12% A
Patients should be admitted, transferred or discharged within 4
hours of their arrival at an A&E department - Bolton FT95% 92.00% 96.80% 98.30% 95.90% 95.60% 93.84% 95.0% A 605 patients waited more than 4 hours (Denominator 9,215) Breached by 144 patients
Referral to Treatment waiting times for non urgent consultant led treatment - All
Providers
Diagnostic test waiting times All providers
A & E waits - Bolton FT
Number of patients who are not offered another binding date within 28 days Bolton FT
NHS Bolton Key Contract Performance Dashboard - September 2015.
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
Maximum two-week wait for first outpatient appointment for
patients referred urgently with suspected cancer by a GP 93% 93.4% 98.2% 96.8% 95.1% 96.9% 98.2% 96.4% A
Maximum two week wait for first out patient appointment for
patients referred urgently with breast symptoms (where cancer
was not initially suspected)
93% 98.1% 100.0% 99.2% 97.5% 99.2% 98.3% 98.7% A
Maximum one month (31 day) wait from diagnosis to first definitive
treatment for all cancers 96% 97.7% 98.9% 97.3% 97.5% 99.1% 95.8% 97.7% A 5 breaches out of 120, late transfers and capacity issues
Maximum 31 day wait for subsequent treatment where that
treatment is surgery 94% 100.0% 100.0% 94.4% 100.0% 92.3% 88.9% 96.6% A
1 patient out of 9 breached. Elective capacity inadequate (patient unable to be scheduled for
treatment within target time)
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% 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% A
Maximum two month (62 day) wait from urgent GP referral to first
definitive treatment for cancer 85% 90.5% 80.6% 85.5% 92.1% 84.6% 82.8% 86.2% A Ten breaches of which 2 are complex patients the remaining 8 are for late referrals.
Maximum 62 day wait from referral from an NHS screening service
to first definitive treatment for all cancers90% 75.0% 100.0% 80.0% 100.0% 100.0% 100.0% 94.3% A
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% 87.5% 50.0% 100.0% 72.7% 96.1% A 3 breaches out of 11, all late referrals
Cancer patients - 2 week wait -All Providers
Cancer patients - 31 day wait -All Providers
Cancer waits - 62 days - All Providers
NHS Bolton Key Contract Performance Dashboard - September 2015.
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
Category A calls resulting in an emergency response arriving within
8 minutes (Red 1) 75% 71.20% 81.60% 79.80% 79.30% 77.70% 78.40% 78.00% A
Category A calls resulting in an emergency response arriving within
8 minutes (Red 2)75% 72.10% 79.40% 78.20% 76.00% 75.40% 74.90% 76.00% A Target failed for NWAS, however Bolton achieved with 75.3%.
Category A calls resulting in an ambulance arriving at the scene
within 19 minutes 95% 93.30% 96.40% 95.90% 94.60% 95.10% 94.60% 95.00% A Target failed for NWAS, however Bolton achieved with 95.5%.
All handovers between ambulance and A&E must take place within
15 minutes (no of patients waiting >30 mins<59 mins) Bolton FT0 74 59 25 39 56 100 353 F Deterioration from last month
All handovers between ambulance and A&E must take place within
15 minutes (no of patients waiting >60 mins) Bolton FT0 18 16 1 21 7 13 76 F Improvement from last month
Zero tolerance MSA breaches 0 4 0 0 0 2 1 7 F 1 Bolton CCG patient
Care Programme Approach (CPA): The proportion of people under
adult mental illness specialties on CPA -Completed95% 97.80% 97.40% 96.60% 95.80% 96.00% Not available 96.70% A
Care Programme Approach (CPA): The proportion of people under
adult mental illness specialties on CPA - 7 day follow up95% 91.10% 100.00% 100.00% 100.00% 100.00% 100.00% 98.30% A
IAPT Recovery rate - (GMW, 1 point and Think Positive)
Internal data50% 44.90% 51.47% 50.45% 53.45% 44.70% 51.10% 49.54% A
IAPT Access rate - (GMW, 1 point and Think Positive)
Internal data15.0% 17.50% 13.50% 17.80% 18.00% 15.60% 15.40% 16.30% A
Number of ongoing waiters >18 weeks 0 0 0 0 0 0 0 0 A
Mixed sex accommodation breaches - Bolton FT
Mental Health - GMW
Category A ambulance calls NWAS
NHS Bolton Key Contract Performance Dashboard - September 2015.
Indicator Target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 YTDForecast
Achieve/FailExceptions Trend (Apr13-Sept15)
HCAI-Healthcare Associated Infections
MRSA-Post 48 hrs (Hospital) 0 1 2 0 0 0 1 4 F 1 Bolton patient on ward E3
CDIFF-Post 72 hrs (Hospital) 19 4 2 2 1 2 1 12 F 1 Bolton patient on ward C2
A&E Percentage Recommended tbc 85.2% 86.6% 87.5% 86.2% 86.4% 84.3% 86.0% A
A&E Response Rate 15% 21.9% 21.9% 19.6% 20.2% 19.0% 20.1% 20.5% A
Inpatient Recommended
tbc 96.9% 96.4% 98.0% 98.1% 95.8% 96.2% 96.9% A
Inpatient Response Rate
15% 26.8% 28.0% 27.7% 29.6% 28.8% 39.1% 30.0% A
Never events 0 2 0 2 0 0 1 4 F
% Stroke admissions spending 90% of time on stroke unit 80% 78.4% 77.1% 83.8% 96.3% 76.9% 76.9% 82.4% A 6 patients out of 26 breached
Stroke patients arriving in a designated stroke bed within 4 hours 80% 71.0% 65.5% 76.7% 76.5% 70.0% 70.0% 71.70% F 6 patients out of 20 breached
Transient Ischaemic Attack (TIA) cases with a higher risk of stroke
treated within 24 hours60% 50.0% 25.0% 40.0% 31.3% 37.5% 50.0% 37.1% F 5 patients out of 10 breached
Never events
Stroke - Bolton FT
Annual target
Friends and family
Bolton Health & Social Care
Integration
Monthly Report
November 2015
Section 1 – Executive Summary Overall Programme Update There are significant issues regarding delivery of the integration schemes against the BCF targets.
The evidence around the current performance of the schemes indicates that the BCF targets will
not be achieved by the end of the year which will potentially incur significant financial penalties.
Performance Summary
The following provides an overview of some of the key performance metrics:
- There was under performance against the non-elective target in the month of September,
as emergency admissions were 66 (2.4%) above the BCF Target. This brings the year to
date admissions to 563 (3.4%) above the BCF target. This is particularly concerning and
urgent work is required by providers to clarify the actions that will be taken to improve
performance.
- The A&E target remains on track to deliver, in the month of September A&E attendances
were 68 (-0.9%) below plan. Performance against the year to date target remains positive
as attendances were 425 (-0.9%) below plan.
Scheme Summary
The key highlights of the work undertaken this month across the core and enabling work streams
include:
- Integration of hospital discharge services was due to commence in November 2015 to
include a pilot on complex care wards to extend the hospital discharge service to 7 days a
week. However, Confirmation has been sought from providers as to the date this service
will commence.
- The Care Homes Service is now fully resourced and is delivering services to care home
residents across 17 care homes out of 33 within the Borough. Following a meeting with
providers clarification was agreed on the service model in respect of, Admissions
avoidance planning, the GP enhanced service and the provision of proactive care.
- Intermediate Tier Services have seen further reductions this month in Non Elective
Admissions and in A&E attendances but are still below the agreed targets
- The Intermediate Tier Home based pathway has seen an increase in referrals and work
has been in progress to ensure all GP Practices are aware of the Admissions Avoidance
team and the referral pathway.
- Work is underway following the recent bed utilisation audit to increase GP referrals to step
up beds in Darley Court.
- At Greater Manchester Public Health Network (GMPHN) The Staying Well model was
selected as a best practice example, because of its preventative, integrated and enabling
approach.
- The procurement for the Complex Lifestyles Service has now gone live on The Chest on
22nd October. The procurement is due to be completed by the end of November 2015.
3
Issues
As noted above there are significant concerns about current performance against BCF targets.
There are a number of outstanding issues that need to be resolved by providers to include:
- The INT report that each GP Practice in the borough has a named practice coordinator so
there is full roll out across the borough. However, there is no evidence of full engagement
with all GP Practices which is demonstrated by the fact the number of referrals accepted by
the service is still well below the agreed trajectory and there is clear evidence that there are
no referrals received from some practices in the borough. Adrian Crook and Helen Clarke
are to review the GP Practice coordinator role and engage with all the GP Practices in the
borough in order to make improvements.
- There is assurance from providers that recruitment to the INT’s continues to be in progress
but there are vacancies within the integrated neighbourhood teams, some of which are due
to staff leaving. Vacancies are evident in social care, Bolton Foundation Trust and GMW.
Agreement was also confirmed for funding to back fill maternity leave in August 2015 but to
date backfill of the maternity leave has not been confirmed.
- A key risk noted in the workforce update is that Staff on fixed term contracts up to 31st
March 2016 will seek other opportunities if assurance of an extension to their contract is not
provided – potentially destabilising the service. Providers were required to assure their
respective staff. Confirmation is needed to ensure this assurance has been given to all
staff affected.
- The ABC integrated Care Plan which has been agreed for use within the INT’s, the Care
Home service and GP Practices is not consistently being used. This is being actively
addressed.
- The colocation of the Intermediate Care at Home and Reablement is delayed. Discussions
have taken place to develop an interim solution to enhance the joint provision of services
and plans are being progressed along with other integration estate issues by the estates
work stream. However, there are delays in implementation of the estates plan. A request
has been made for a summary of the estates plan with timescales.
- Although the Staying Well service are demonstrating an increase in referrals. As of the 1st
November the service had not yet rolled out to include more GP Practices than the original
11 that were included in the pilot. This being addressed by the Staying Well Steering
Group.
4
Section 2 – Performance Headlines
National Indicators
Emergency admissions (Bolton CCG patients, all providers)Trend from Apr13-Sep15
Target Actual Target Actual
2,728 2,794 16,384 16,947
Permanent admissions of older people to nursing and residential care homes222 2013/14 2014/15 2015/16 Q1 2015/16 Q2 Trend (annual ) - target in red
380 377 392 394
378.0 361 361 361
Proportion of patients still at home 91 days after discharge from hospital in to reablement services2010/112011/122012/132013/14 2014/15 2015/16 Q1 2015/16 Q2 Trend (annual ) - target in red
78.5% 79.9% 79.1% 79.1%
82.1% 86% 86%
Delayed transfers of care (total delayed days)Trend from Apr13-Aug15
Plan Actual Plan Actual
308 382 1,577 2,029
Note: due to a change in national reporting,
this measure is one month behind others
Referrals to home based intermediate careTrend from Apr14-Sep15
Last year This year Last year This year
85 144 519 752
Local Indicators
A&E attendances (Bolton CCG patients, all providers)Trend from Apr13-Sep15
Plan Actual Plan Actual
7,600 7,532 47,053 46,628
30 day readmissions (Bolton CCG patients, all providers)Trend from Apr13-Sep15
Last year This year Last year This year
506 521 3,096 3,191
Non-elective average length of stay (Bolton CCG patients, all providers)Trend from Apr13-Sep15
Plan Actual Plan Actual
4.65 4.39 4.65 4.41
Non-elective average length of stay (Bolton CCG patients, medical specialties at Bolton FT)Trend from Apr13-Sep15
Last year This year Last year This year
4.19 4.19 4.09 4.14
YTD (Apr-Sep)In Month (Sep)
There was an increase in the number of permanent admissions of older
people to nursing and residential care homes when comparing Q2
2015/16 with Q1 2015/16 (roll ing 12 month totals). The Better Care Fund
target for this measure was to decrease the number of permanent
admissions to residential and nursing care homes to 361 in 2015/16.
There was a decrease in the proportion of patients stil l at home 91 days
after discharge from hospital in to reablement services in Q2 2015/16
compared with 2014/15. The Better Care Fund target for this measure
was 82.1% in 2014/15 and is 86.0% in 2015/16.
A Better Care Fund target has been set for this measure, which accounts
for an anticipated increase in the number of delayed transfers of care
due to more accurate recording. For the current year to date, the number
of delayed days is significantly above plan. DTOCs this YTD are lower
than the figure for 2014/15 (2,943).
In Month (Sep) YTD (Apr-Sep)
In Month (Sep) YTD (Apr-Sep)
The Better Care Fund target is to reduce the number of emergency spells
by 3.5% in 2015/16 compared to 2014/15. In the month of September, the
number of emergency admissions was 66 (+2.4%) above target. Year to
date (Apr-Sep) the number of emergency admissions was 563 (+3.4%)
above target.
The CCG's 5 year plan target is to reduce the number of A&E attendances
by 3.2% from 2014/15 to 2015/16. In the month of September, the number
of A&E attendances was 68 (-0.9%) below plan. Year to date (Apr-Sep) the
number of A&E attendances was 425 (-0.9%) below plan.
The number of referrals to home based intermediate care is 752 for the
current year to date (Apr-Sep). This is 45% higher than the number of
referrals in the same period last year (519 referrals).
In Month (Sep) YTD (Apr-Sep)
In Month (Aug) YTD (Apr-Aug)
The average non-elective length of stay (for Bolton CCG patients) in
medical specialties at Bolton FT is 4.14 days for the current year to date
(Apr-Jul). This is sl ightly higher than the average length of stay in the
same period last year (4.09 days).
In Month (Sep) YTD (Apr-Sep)
In Month (Sep) YTD (Apr-Sep)The number of 30 day readmissions is higher when comparing Apr15-
Sep15 with the same period in 2014. The readmission rate for this year to
date (Apr-Aug) is 9.9%, which is slightly higher than the same period last
year (9.7%).
The CCG's 2015/16 plan target for average non-elective length of stay is
4.65 days. For the current year to date (Apr-Sep) the average non-elective
length of stay is 4.41 days. The average length of stay for the same period
in 2014/15 was 4.92 days.
5
Section 3 – Work stream Performance and Update Intermediate Tier Services Project Contribution to High level Outcomes (using agreed proxy metrics)
Sept target Sept actual Year to Date target Year to date actual
NEL reduction 60 49 358 280
A&E reduction 81 76 483 448
Intermediate Tier Services are continuing to develop and embed the Admission Avoidance and
Home Based Pathway elements of the service. In terms of referrals and caseload activity, the
teams are performing well and pathways are being built with other services across the health
economy for example NWAS, Careline and the developing Integrated Neighbourhood Teams to
support admission avoidance and maintaining patients safely at home rather than being admitted
to hospital or long term care. September saw the management structure finally being fully in place
for intermediate tier services which will facilitate further service development.
Admission Avoidance Multi-disciplinary Teams - in September 144 referrals were made to the
team of those 144 who were assessed and treated 76 were from the community/GP practices and
the remainder from A/E. 88 of the total referrals were as a result of a fall or decline in functional
ability without a fall. 82 were unable to be discharged following first contact and required on-going
support from the Admission Avoidance Team, the average length of time on the caseload being 4
days. A further 9 of the original referral total were stepped up into intermediate tier community bed
to avoid an admission. 32 of the referrals to the Admission Avoidance Team in September had
been discharged from hospital within the previous 30 days and required support to prevent
readmission. Patient satisfaction is high with 100% rating the service as excellent via the Friends
and Family Test and 94% reporting it was extremely likely that they would recommend the service
to others and 6% saying it was likely.
Home Based Pathway – The reablement and intermediate care at home teams are working closely
together supporting an increase in caseload activity. There were 250 new referrals in September.
An increasing number are from community and GP referrals. The joint therapy and support worker
input to the reablement service provides the opportunity for patients to reach their maximum
potential to be independent and remain at home. The average length of stay in the home pathway
was 24 days in September. The majority of patients leave the home based pathway with no on-
going statutory services. The challenge surrounds co-location of the intermediate care at home
and reablement teams and a move to shared accommodation which will enhance the joint
provision of services with a single contact number being available for the home based and
admission avoidance teams, estates and facilities are supporting progressing this with scheduled
fortnightly meetings.
Bed Based Pathway- September saw the highest number of referrals since April this year to bed
based services with 105. There has been an increase in the number of step down referrals from
the hospital, this being as high as 88% limiting the ability to step patients up into an intermediate
6
care bed from the community. The majority of referrals to intermediate care beds have been from
the orthopaedic ward closely followed by the frailty unit at Royal Bolton Hospital. There has been
a high proportion of repeat admissions to intermediate care beds and the development of the
Integrated Neighbourhood Teams should have a positive impact on this in the future with
vulnerable patients being able to be supported by proactive management. The average length of
stay in the bed based units has reduced to 23 days which is lower than the bench marked average
of 27 days. 91% reported via the Friends and Family Test that they were very satisfied with the
service and 9% quite satisfied and overall 90.3% said it was extremely likely that they would
recommend the service to others.
Key Issues and Risks: A risk is that co-location of the home based Local Authority and Health
Teams are still split, although workshops have now been scheduled fortnightly led by Estates and
Facilities. Co-location will further enhance the service provision and deliver a more effective and
efficient service. IT access will be key with staff having access to both NHS and Local Authority
systems. Current recruitment and staff overcrowding in buildings and lack of IT kit in existing
bases is a growing problem with the team expansion leading to health and safety risks and the
potential for increased staff sickness due to stress.
Integrated Neighbourhood Teams
The Integrated Neighbourhood Teams are now implemented across the borough and continue to
establish themselves within each GP Practice. Referrals to the teams are steadily increasing but
the teams are currently below the expected referral trajectory.
The diagram below demonstrates the team’s performance against the agreed trajectory up to the
end of September 2015.
7
Work is therefore in progress to consult with all the GP Practices to review the GP Practice
Coordinator role and referral pathways from other services into the integrated neighbourhood
teams.
At the end of September the team had received 612 referrals (95 in September). This is an
increase of 25% on the referrals in August.
Throughout October work was completed to:
Refresh the Privacy Impact Assessment to inform information governance work
Refresh the Equality Impact Assessment
Develop and establish the role of the Advanced Nurse Practitioners in the team
Complete a Carefirst design document to ensure correct recording on Carefirst to support
performance reporting.
Work will continue to ensure all people in receipt of the service will have the opportunity to express
their views. The outcome of this engagement work will be included in performance reports on a
quarterly basis. The performance teams in each of the provider organisations are working with the
CCG to establish robust reporting against agreed performance metrics.
A pilot will be introduced in December to implement a single patient care plan located on the GP
primary care system, which will be used by the integrated neighbourhood teams and the GP.
Shared use of this care plan will support the implementation of hospital admission deflection
pathways with NWAS.
Providers are working together in the workforce work stream to develop joint training plans to
support staff to deliver new roles.
Care Homes
Sept target Sept actual Year to Date
target
Year to date
actual
NEL reduction 4 0 23 12
A&E reduction 9 1 36 8
The team is now fully resourced enabling the full roll out to be implemented without any
impediment. Further work has been undertaken in the last month to ensure that the service is in a
fit state to deliver the agreed outcomes, these include:
- A joint implementation steering group has been established that will meet fortnightly
- Work is in progress to develop a performance dashboard for the service in line with agreed
metrics
- The roll out plan submitted was not endorsed by IDG consequently the plan has now been
refreshed and was resubmitted to the CCG on the 2nd November as a draft.
8
The service has now completed phase one and two of the roll out plan and has progressed to a
further four in phase 3, the remaining homes in phase 3 are in progress. This will equate to 17 care
homes in total.
The intention is to roll the service out to all the care and residential homes in Bolton. The target for
completion is 22nd July 2016. The roll out plan is currently on target.
Next steps
Refreshed roll out plan to be endorsed at Integration Board and JTG
Wider communication plan to be developed in accordance to the implementation plan.
Performance dashboard to be finalised in line with agreed metrics and signed off at
Integration Board and JTG
Staying Well Period
Forecast
Clients
Contacted
Actual
Clients
Contacted
%
Increase/Decrease
Forecast
Clients
Visited
Actual
Clients
Visited
%
Increase/Decrease
Apr-15 180 65 -64% 108 35 -68%
May-15 180 122 -32% 108 77 -29%
June-15 180 103 -43% 108 65 -40%
July-15 180 147 -18% 108 51 -53%
Aug-15 180 202 12% 108 86 -20%
Sept-15 180 226 26% 108 144 33%
The Staying Well service continues to demonstrate positive outcomes. There are some staffing
changes to manage over the coming months.
A staged roll out programme is being formalised. We will link with INT colleagues to capitalise on
good work already done establishing INT Coordinators in Practices across the borough. We intend
to have Staying Well Coordinators introduced to phase 3 Practices and ready to make service
offers by the end of the year.
Greater Manchester Public Health Network (GMPHN) recently conducted a scoping exercise as
part of the health and social care devolution strategy. They selected 12 of the best examples of
national and international organisations who are demonstrating innovative ways of improving
community health and wellbeing using an asset-based approach. The Staying Well service was
selected as a best practice example because of its preventative, integrated and enabling
approach.
9
During October several members of the team attended a study visit with Innovation Unit
(commissioned to conduct the scoping exercise), at Bolton Town Hall. Discussions took place
around the Staying Well Coordinator role and tools developed that support an open, collaborative
conversation between the Coordinator and client. The case study was presented at the 5th Primary
Care Summit at the AJ Bell Stadium on 5th November.
Complex Lifestyles The Complex Lifestyles tender went ‘live’ on The Chest on the 22nd October 2015 (The Chest is an electronic advertising portal which is used to manage tenders). The tender will close on the 3rd November 2015 and evaluations will be complete by the 17th November 2015 with the intention of awarding the contract for the new Complex Lifestyles Service by 1st December 2015. It is also, intended for the service to have started before Christmas 2015.
Section 4 – Enabling Work stream Summary
Performance Monitoring
Progress Update
Work on the development of the ‘local’ performance dashboard for INTs and Intermediate Tier is ongoing. A draft document relating to INT performance has been circulated to IDG for comment. Performance leads from the CCG, FT and Local Authority met to agree a schedule for provision of operational data for the board report. The majority of the metrics identified for the INT workstream will be provided by the LA via the CareFirst system (where possible). It was agreed that a data group will be set up to discuss performance data on a monthly basis. Key Risks and Issues
If a number of performance metrics require additional data manipulation to source then this will cause delay in the production of the performance metrics. Key Activities to be completed next period
A reporting schedule to be provided to the LA and FT to ensure that the new dashboard becomes
operational within the next month or two – once formalised this will feed into a monthly workstream
performance dashboard.
Communications and Engagement
A branding exercise is presently being undertaken in partnership with key stakeholders to deliver by
December 2015, in order to provide an identity for Integration in Bolton. Full roll-out of this brand will
further enable a cohesive conversation with staff, stakeholders and residents, and provide an umbrella
brand which organisations can utilise to promote integration.
10
Workforce
Progress Update
A Team from the Steering Group attended the North West Regional Workforce Demonstrator site
event on 3rd November. The team presented the INT Toolkit, the Culture Club Programme and
the Staying Well Toolkit. At the event Bolton was selected as one of only two sites out of 24 sites
presenting their work at the event, for wider roll-out across the region. The Workforce Steering Group
will be reviewing its terms of reference and membership at its meeting on 4th November. The group
will also be considering the use of the WRAPT Workforce Repository and Planning Tool for long-term
strategic workforce planning for Integrated Care Services.
Key Risk and Issues
Remain the same: Staff on fixed term contracts up to 31st March 2016 will seek other opportunities if
assurance of an extension to their contract is not provided – potentially destabilising the service.
Providers are required to assure their respective staff.
Key activities for next period
Final recruitment to outstanding posts. Further Culture Club sessions planned.
Finance and Contracting
Progress Update The agreed Pooled Budget for Integration is £30.8m for 2015/16. The forecast expenditure was
estimated at £29.0m for Month 6. The forecast underspend of £1.8m is mostly attributable to
slippages in recruitment into new schemes, i.e. INTs and Intermediate Tier; and delays in project start
date for Complex Needs. However, with £802k of the P4P element of the BCF not released into the
Pool, this gives an overall forecast underspend of £1m against the revised pooled funds of £29.994m
at Month 6.
Bolton’s Q2 BCF performance is due to be reported to NHS England on 27th November 2015. The
release of £1.79m of the BCF into the Integration Pool is linked to the non-elective admissions
reduction target, i.e., Pay for Performance (P4P) funding. This P4P funding will only be released into
the Pool on a proportionate basis based on achievement of this target as set out in the BCF plan and
in accordance with BCF Guidance.
Key Risks and Issues Bolton continues to see an increase in NEL admissions. Integration schemes are not fully
implemented due to slippages in recruitment and fragmented delivery on integrated services. In spite
of various mitigating actions being taken, there is a risk that the BCF NEL target will not be achieved
this year. If Bolton delivers 2014/15 activity levels (which the CCG is currently forecasting), this would
cost the CCG an additional £3-£3.5m in 2015/16. The BCF only provides for £1.79m of this.
Therefore, the CCG would need to find an additional £1.2m-£1.7m This increase in NEL activity based
on previous year’s outturn will require close monitoring and management.
Key Activities to be completed next period Analyse Q2 performance and determine payment for performance release into the pool.
11
Estates
Key Risks and Issues
The Local Authority are currently working on the future locations of Health Visiting services within
Childrens Centres. This will free up accommodation at Waters meeting and Crompton H.C., for
integrated neighbourhood teams two and three, however this work needs to be concluded by Bolton
Council before we can implement the teams in these two locations. This is currently outside the
control of the Estates Workstream.
Source of monies for both the capital works and on-going revenue costs are yet to be confirmed – a
potential solution has been sourced (via legacy monies) this, however, may take a number of months
before it is made available to us (requires submission of a comprehensive PID).
IM&T and IG
Progress Update Detailed requirements for a short term and medium term solution have been articulated at a high level. Docman Collaborator to share care records – there are concerns about the ease of access which requires either terminal services (RDP) or citrix access. This is not feasible given the diverse stakeholder groups and Docman are currently looking in to an easier method of accessing the stored care plan possibly through a web front end. However there are no timescales as to when this might be done or even if it is possible. MIG, the business case was rejected by the CCG Exec and further analysis work needs to be undertaken before the business case can be resubmitted for consideration. Graphnet is used by the 3 Manchester CCGs for ePaCCS and shared care plans as well as for information sharing. A meeting has been arranged to review the product set. Key Risks and Issues There is currently no practical quick to implement solution for sharing of care plans. It has been
recommended that the care plans are held within the existing GP systems and INT staff attend the
practice to update.
NHS Mail has been suggested as a means of sharing the plans across the wider H&S care
economy. It should be noted that council staff should have secure email addresses:
http://systems.hscic.gov.uk/nhsmail/secure
Key Activities to be completed next period
Define processes to set up INT members on practice systems.
Define operational processes to support use of practice systems.
12
Work with Docman on proposal for easier access to Collaborator.
Further discussion with Clinical Directors.
Wigan has implemented MIG and Salford is starting their implementation. Further
investigation is required.
Bolton Health & Social Care IM&T Innovation Workshop – A technical workshop of IT leads is
to take to place on Monday 9th November to understand what systems are currently in place
and how these could be leveraged to provide a shared view of patients in Bolton. Outputs will
be a high-level systems catalogue and next steps for systems integration including the Bolton
footprint Digital Roadmap and high-level; strategy.
13
Section 5: Case Study
Client KSC is a 46 year old woman with 14 listed medical conditions who is registered disabled
and blind and has complex and multiple support needs. She is currently receiving CHC funding
and she has spent the funds on employing two full time carers. She lives with her husband and
daughter. She is very knowledgeable about her conditions and medication used to treat the
symptoms.
KSC is very intelligent and runs her own consultancy business for advice on disability matters and
is employed by NICE on committees to develop guidelines in relation to disability and re-ablement.
KSC attends specialist appointments in London every few months since the National Hospital,
London is the centre of specialism in Ehlers Danlos Hypermobility syndrome. She attends every 6
months as an NHS patient and pays privately in between for extra visits.
She is known to the local dietician since she is sometimes PEG fed and is at risk of re-feeding
syndrome.
When the Integrated Neighbourhood Team initially visited KSC, she was very frustrated that only
two specialists seemed to take her seriously and that she has had to fight so hard for every
intervention and resolution to her problems. She was extremely distressed and downhearted and
felt that she was facing battles on her own.
KSC has subsequently received a range of interventions from the INT which was led by the
Pharmacist who was her Key Worker. The outcome of which has resulted in improvements around
her medication, the fitting of ring splints to enable dexterity and assessments for equipment and
adaptions.
KSC values the INT as a group of professionals who take her needs and concerns seriously, so
much so that she recently wrote the following in a thank you letter sent to Chris Vernon: (one of the
team managers)
“Having worked on numerous guideline committees for NICE in relation to health and social care,
as well as my work with people with long term health conditions on a national basis, the lack of co-
ordination in health and social care services is a consistently frustrating theme. However, I can
only say that if all health professionals were as responsive to the needs of their clients, as your
team have been to my needs, the work of the Guideline Committees would not be necessary. I am
so glad that I have been put in touch with your service and would like to highly commend your staff
team for their fantastic service to people with complex needs in Bolton.”
14
Appendix A – Detailed Performance Report
Better Care Fund metrics BCF1. Total emergency admissions Objective: to decrease The key measure which will be used for Better Care Fund (BCF) performance payments is emergency admissions. This is now the sole measure on which the pay for performance element of the BCF will be assessed. A target reduction of 3.5% has been set, which will be assessed by comparing the period January to December 2014 with January to December 2015 (shown in Chart 1 below). In the year January to December 2014, there were 34,385 emergency admissions. A 3.5% decrease would therefore equate to 1,203 admissions in a year. In the year to date (January to September 2015), there have been 25,418 admissions, an increase of 59 from the same period in 2014. Bolton CCG’s 5 year plan target for 2015/16 is a decrease of 2.8% from 2014/15. There was a 1.8% increase from 2013/14 to 2014/15.
Chart 1 - Emergency admissions to all acute providers (all Bolton CCG patients), including BCU admissions between April 2012 – December 2013
Please note chart 1 does not include admissions to Greater Manchester West Mental Health Foundation Trust; the data source (Monthly Activity Return) contains admissions to general and acute specialties only.
2,000
2,200
2,400
2,600
2,800
3,000
3,200
3,400
Ap
r-2
01
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20
12
Sep
-20
12
Oct
-20
12
No
v-2
01
2D
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20
12
Jan
-20
13
Feb
-20
13
Mar
-20
13
Ap
r-2
01
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3A
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20
13
Sep
-20
13
Oct
-20
13
No
v-2
01
3D
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20
13
Jan
-20
14
Feb
-20
14
Mar
-20
14
Ap
r-2
01
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ay-2
01
4Ju
n-2
01
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l-2
01
4A
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20
14
Sep
-20
14
Oct
-20
14
No
v-2
01
4D
ec-
20
14
Jan
-20
15
Feb
-20
15
Mar
-20
15
Ap
r-2
01
5M
ay-2
01
5Ju
n-2
01
5Ju
l-2
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5A
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20
15
Sep
-20
15
Nu
mb
er
of
adm
issi
on
s
Month
Non-elective emergency admissions to all acute providers - all Bolton CCG patientsIncludes BCU admissions between April 2012 - December 2013
BCF Target Actual number of admissions Average UCL LCL
15
Chart 2 – Emergency admissions per 100,000 population benchmarked across Greater Manchester CCGs
When compared with Greater Manchester CCGs, Bolton CCG benchmarked slightly above (+0.3%) the median rate in 2014/15. As part of the Better Care Fund submission, Health and Wellbeing Boards were also asked to identify their ambitions for improvement against wider performance metrics:
Permanent admissions of older people (aged 65 and over) to residential and nursing care homes
Proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital in to reablement/rehabilitation services (effectiveness of the service)
Delayed discharges (total number of delayed days)
Overall satisfaction of people who use services with their care and support
Referrals to home based intermediate care BCF2. Permanent admissions of older people (aged 65 and over) to residential and nursing care homes
Objective: To decrease
In the 12 months to September 2015 there were 394 permanent admissions to residential and nursing care homes in Bolton, this equated to 842.0 admissions per 100,000 population aged over 65. In the Better Care Fund submission, Bolton was set an ambition to decrease the number of permanent admissions to nursing and residential care homes (per 100,000 population) to 805.7 in 2014/15 and to reduce further to 752.6 in 2015/16. At the same time, the number of people aged over 65 in Bolton is projected to grow by 5.7% from 2013/14 to 2014/15 and by a further 2.2% in 2015/16.
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000Tr
affo
rd
Wig
an
Bu
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Tam
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de
& G
los.
Ce
ntr
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anc.
Bo
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anc.
HM
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Old
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No
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c.
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CCG
Non-elective emergency admissions per 100,000 population Greater Manchester CCGs (2014/15)
CCG Median 75th centile 90th centile
16
Chart 3 shows the number of permanent admissions to nursing and residential care homes, per 100,000 population from 2010/11 to date, along with the BCF ambition for 2015/16. Chart 3 - Admissions to nursing and residential homes - trend over time and BCF ambitions
Chart 4 shows that Bolton had the second highest rate of admissions to residential and nursing care homes in 2013/14 when benchmarked across Greater Manchester. Chart 4 – Admissions of older people to residential and nursing care homes benchmarked across Greater Manchester
BCF3. Proportion of older people (aged 65 and over) who were still at home 91 days after discharge to reablement/ rehabilitation services (effectiveness of the service)
Objective: To increase In the second quarter of 2015/16, 87.0% of patients were still at home 91 days after discharge to reablement/rehabilitation services. Chart 5 illustrates this measure over time from 2010/11 to 2015/16, along with the levels of ambition that were included in the BCF submission. The aim is to increase the proportion of people still at home 91 days after discharge to reablement to the level seen in 2012/13 (86%).
805.4 809.9793.1
858.4
825.6
854.8842.0 837.7 829.2
842.0 842.0
805.7
752.6
600
650
700
750
800
850
900
2010/11 2011/12 2012/13 2013/14 2014/15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
Ad
mis
sio
ns
pe
r 1
00
,00
0 p
op
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tio
n
Permanent admissions of older people (aged 65 and over) to residential and nursing care homes in Bolton, per 100,000 population - rolling 12 months
0
100
200
300
400
500
600
700
800
900
1,000
Tam
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Local Authority
Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population (2013/14)
Local Authority rate Median 75th centile 90th centile
17
Chart 5 – Proportion of people still at home 91 days after discharge – trend over time and BCF ambitions
Please note the data in chart 5 includes social care reablement services only. Chart 6 shows that in 2013/14 Bolton had the 4th lowest value for this measure, when compared across Greater Manchester. Chart 6 – Proportion of people still at home 91 days after discharge – benchmarked across Greater
Manchester
BCF4. Delayed transfers of care (total number of delayed days) Objective: To decrease Chart 7 shows the trend in the number of delayed days for Bolton patients. A marked increase can be seen from March 2014, which is due to a change in recording at Bolton FT. The reported number of delayed days decreased between September and December 2014, the data shows an increase in January, February and March 2015, with a fall back below the average in April, May and June 2015.
52.3%
79.7%85.9%
78.5% 79.9% 79.1%87.0%
82.1%86.0% 86.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Q1 2015/16 Q2Ad
mis
sio
ns
pe
r 1
00
,00
0 p
op
ula
tio
n
Proportion of older people (65 and over) who were still at home 91 days after discharge to reablement/rehabilitation services (effectiveness of the service)
0
10
20
30
40
50
60
70
80
90
100
Man
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Sto
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ort
Pro
po
rtio
n s
till
at h
om
e 9
1 d
ays
afte
r d
isch
arge
Local Authority
Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services (2013/14)
Local Authority rate Median 75th centile 90th centile
18
In the Better Care Fund submission, Bolton’s levels of ambition for 2014/15 allowed for the anticipated growth in the number of delayed transfers of care due to improved recording. The target for January to June 2015 was 321 (as shown in the chart below). The target for the remainder of 2015/16 is 308 delayed days per month. Chart 7 – Delayed transfers of care (total delayed days)
Chart 8 shows the number of delayed days over the last 12 months, broken down by attributable organisation. Over the 12 month period September 2014 to August 2015, 81% of delayed days were attributable to NHS, 14% were attributable to social care and 5% were attributable to both NHS and social care organisations. Chart 8 – Delayed transfers of care for Bolton patients, by attributable organisation
0
100
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Tota
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ays
Month
Delayed transfers of care - total delayed days for Bolton patients
Target Actual total delayed days Average UCL LCL
282
286
203
187
550
560
629
313
231
315
334
328
48
71
59
76
34
30
89
95
160
54
116
43
40
0
0 100 200 300 400 500 600 700 800
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Number of delayed days
Mo
nth
Delayed transfers of care (total delayed days)
Attributable to NHS Attributable to Social Care Attributable to Both
19
Chart 9 shows how the number of delayed transfers of care in Bolton compared across Greater Manchester in 2013/14. Bolton benchmarked above the Greater Manchester median rate. Chart 9 – Delayed transfers of care benchmarked across Greater Manchester
BCF5. Overall satisfaction of people who use services with their care and support Objective: to increase As part of the BCF submission, Health and Wellbeing Boards were required to select a patient experience metric. Bolton chose “overall satisfaction of people who use services with their care and support”. 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 2013/14 Bolton scored 65.6%, which was just above the Greater Manchester median, as illustrated in chart 10. In the BCF submission, an ambition was set to reach 66.6% in 2014/15 and 67.6% in 2015/16.
0
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Local Authority
Delayed transfers of care (total delayed days) per 100,000 populationGreater Manchester Local Authorities 2014/15
Local Authority Median 75th centile 90th centile
20
Chart 10 - Overall satisfaction of people who use services with their care and support benchmarked across Greater Manchester
BCF6. Referrals to home based intermediate care
Objective: to increase For the Better Care Fund submission, Health and Wellbeing Board areas were required to select a local metric. Bolton chose to monitor referrals to home based intermediate care. 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. Chart 11 shows that Bolton exceeded this target in 2014/15. Chart 11 – Referrals to home based intermediate care
60.761.6
63.1
65.2 65.4 65.5 65.6
67.568.8
70.6
54
56
58
60
62
64
66
68
70
72
Man
ches
ter
Tam
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ort
Bu
ry
Sati
sfac
tio
n s
core
Local Authority
Overall satisfaction of people who use services with their care and support (2013/14)
Local Authority score GM Median GM 75th centile GM 90th centile
505
798
1,288
1,504
967
1,136
300
500
700
900
1,100
1,300
1,500
1,700
2012/13 2013/14 2014/15 2015/16 (est. based onQ1 & Q2) YTD = 752
Nu
mb
er o
f re
ferr
als
Number of referrals to home based intermediate care in Bolton
Number of referrals BCF ambition
21
Greater 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 Chart 12 shows the number of A&E attendances at all acute providers from April 2012, for Bolton CCG patients. The number of attendances decreased significantly from August 2013 to February 2014, however there was a particularly high number of attendances between March and July 2014. January and February 2015 had fewer attendances than the average. Bolton CCG’s target for 2015/16 was to decrease the number of A&E attendances by -3.2% from 2014/15. For the year to date 2015/16, attendances have reduced by -4.1% when compared to 2014/15 (equal to 1,980 fewer attendances). Chart 12 – A&E attendances across all providers
In 2014/15, Bolton had a lower than average number of attendances per 100,000 population, when compared across Greater Manchester.
5,000
5,500
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7,000
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Month
A&E attendances - Bolton CCG patients at all providers
Target Actual number of attendances Average UCL LCL
22
Chart 13 – A&E attendances benchmarked across Greater Manchester
GM2. 30 day emergency readmissions Objective: To decrease Chart 14 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 YTD with the same period in 2014/15, there has been a +0.5% increase in the number of 30 day readmissions. Chart 14 – 30 day emergency readmissions for Bolton patients across all acute providers
To provide some context to the number of readmissions, chart 15 illustrates the crude readmissions rate (readmissions as a percentage of all discharges) by quarter, from Q1 2012/13 to Q2 2015/16.
0
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35,000
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55,000W
igan
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c.
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CCG
A&E attendances per 100,000 population Greater Manchester CCGs (2014/15)
CCG Median 75th centile 90th centile
0
100
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300
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600
700
Ap
r-2
01
2M
ay-2
01
2Ju
n-2
01
2Ju
l-2
01
2A
ug-
20
12
Sep
-20
12
Oct
-20
12
No
v-2
01
2D
ec-
20
12
Jan
-20
13
Feb
-20
13
Mar
-20
13
Ap
r-2
01
3M
ay-2
01
3Ju
n-2
01
3Ju
l-2
01
3A
ug-
20
13
Sep
-20
13
Oct
-20
13
No
v-2
01
3D
ec-
20
13
Jan
-20
14
Feb
-20
14
Mar
-20
14
Ap
r-2
01
4M
ay-2
01
4Ju
n-2
01
4Ju
l-2
01
4A
ug-
20
14
Sep
-20
14
Oct
-20
14
No
v-2
01
4D
ec-
20
14
Jan
-20
15
Feb
-20
15
Mar
-20
15
Ap
r-2
01
5M
ay-2
01
5Ju
n-2
01
5Ju
l-2
01
5A
ug-
20
15
Sep
-20
15
Nu
mb
er o
f re
adm
issi
on
s
Month
30 day readmissions - Bolton CCG patients at all providers
Target Actual 30 day readmissions Average UCL LCL
23
Chart 15 – 30 day readmission rate for Bolton patients across all acute providers
It should be noted that the number of readmissions shown in charts 14 and 15 includes patients who were discharged from one provider and readmitted in an emergency to a different provider, as well as patients admitted to the same provider twice. However, this measure does not include emergency admissions to Greater Manchester West Mental Health Foundation Trust, as admissions with no national tariff are excluded. There are also some further exclusions for this measure, full details of which can be found at the end of this report. Chart 16 shows the 30 day readmission rate across Greater Manchester CCGs in 2014/15. Bolton CCG was below the median readmission rate (9.2%). Chart 16 – 30 day readmission rate benchmarked across Greater Manchester
8.1%
7.6% 7.7%
8.0%
8.5%
8.9%8.4%
9.1%
9.9%
9.0% 9.3%
8.8%
9.6%9.4%
6%
7%
8%
9%
10%
11%
Ap
r -
Jun
20
12
Jul -
Sep
20
12
Oct
- D
ec2
01
2
Jan
- M
ar2
01
3
Ap
r -
Jun
20
13
Jul -
Sep
20
13
Oct
- D
ec2
01
3
Jan
- M
ar2
01
4
Ap
r -
Jun
20
14
Jul -
Sep
20
14
Oct
- D
ec2
01
4
Jan
- M
ar2
01
5
Ap
r -
Jun
20
15
Jul -
Sep
20
15
Re
adm
issi
on
rat
e
Quarter
30 day emergency readmission rate (% of discharges) - Bolton patients at all providers
% readmission rate
5%
6%
7%
8%
9%
10%
11%
Tam
esi
de
&G
loss
op
Traf
ford
Hey
wo
od
,M
idd
leto
n&
Ro
chd
ale
Bu
ry
Wig
anB
oro
ugh
Bo
lto
n
Old
ham
Sou
thM
anch
este
r
Salf
ord
Cen
tral
Man
ches
ter
Sto
ckp
ort
No
rth
Man
ches
ter
30
day
re
adm
issi
on
s ra
te
CCG
30 day emergency readmissions (crude % rate)Greater Manchester CCGs (2014/15)
CCG Median 75th centile 90th centile
24
GM4. Percentage of people who die in their usual place of residence Objective: To increase Chart 17 shows a rolling 12 month position for the proportion of deaths occurring in the person’s usual place of residence in Bolton. There has been a steady increase from 37.1% in the year 2010/11, with a slight fall in the last four data points. Chart 17 – Proportion of deaths in usual place of residence – Bolton CCG patients
In the year January 2014 to December 2014, 40.8% of deaths in Bolton occurred in the person’s usual place of residence. Bolton CCG ranked 6th across Greater Manchester, as illustrated in Chart 18.
Chart 18 – Proportion of deaths in usual place of residence – benchmarked across Greater Manchester
37.1%37.7% 37.9%
38.7% 38.8%
39.8%40.6% 40.5% 40.7%
42.3% 42.4%
43.9% 44.0%
41.4% 41.5%40.7% 40.7%
32%
34%
36%
38%
40%
42%
44%
46%
Apr '10to
Mar '11
Jul '10to
Jun '11
Oct '10to
Sep '11
Jan '11to
Dec '11
Apr '11to
Mar '12
Jul '11to
Jun '12
Oct '11to
Sep '12
Jan '12to
Dec '12
Apr '12to
Mar '13
Jul '12to
Jun '13
Oct '12to
Sep '13
Jan '13to
Dec '13
Apr '13to
Mar '14
Jul '13to
Jun '14
Oct '13to
Sep '14
Jan '14to
Dec '14
Apr '14to
Mar '15
Pro
po
rtio
n o
f d
eat
hs
in u
sual
pla
ce o
f re
sid
en
ce
Period
Proportion of deaths in usual place of residence (%) - Bolton CCG
Proportion of deaths in usual place of residence
25
30
35
40
45
50
Tam
esi
de
&G
los.
Traf
ford
Ce
ntr
al M
anc.
Salf
ord
Wig
an
Bo
lto
n
Sou
th M
anc.
Old
ham
No
rth
Man
c.
Sto
ckp
ort
HM
R
Bu
ry
Pro
po
rtio
n o
f d
eat
hs
in u
sual
pla
ce o
f re
sid
en
ce (
%)
CCG
Proportion of deaths in usual place of residenceGreater Manchester CCGs - Latest avaliable 12 months (to Mar'15)
Indicator Median 75th centile 90th centile
25
L1. Avoidable emergency admissions Objective: To decrease This is a composite measure of:
chronic ambulatory care sensitive conditions
acute conditions that should not usually require hospital admission
asthma, diabetes and epilepsy in children
children with lower respiratory tract infection. A full list of the conditions included can be found in at the end of this report. Chart 19 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 (December 2013 to January 2014 and October 2014 to December 2014). Overall the trend is 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. There has been a -0.7% reduction YTD in 2015/16 when compared to the same period in the previous year.
Chart 19 – avoidable emergency admissions to all providers
It should be noted that the types of conditions which are included in this measure could in the past have been admitted to the Bolton Community Unit, which closed in December 2013.
0
100
200
300
400
500
600
700
800
900
Ap
r-2
01
2M
ay-2
01
2Ju
n-2
01
2Ju
l-2
01
2A
ug-
20
12
Sep
-20
12
Oct
-20
12
No
v-2
01
2D
ec-
20
12
Jan
-20
13
Feb
-20
13
Mar
-20
13
Ap
r-2
01
3M
ay-2
01
3Ju
n-2
01
3Ju
l-2
01
3A
ug-
20
13
Sep
-20
13
Oct
-20
13
No
v-2
01
3D
ec-
20
13
Jan
-20
14
Feb
-20
14
Mar
-20
14
Ap
r-2
01
4M
ay-2
01
4Ju
n-2
01
4Ju
l-2
01
4A
ug-
20
14
Sep
-20
14
Oct
-20
14
No
v-2
01
4D
ec-
20
14
Jan
-20
15
Feb
-20
15
Mar
-20
15
Ap
r-2
01
5M
ay-2
01
5Ju
n-2
01
5Ju
l-2
01
5A
ug-
20
15
Sep
-20
15
Nu
mb
er o
f ad
mis
sio
ns
Month
Avoidable emergency admissions for all Bolton CCG patients to any provider
Number of admissions Average Upper control limit Lower control limit
26
Chart 20 illustrates how Bolton compares across Greater Manchester. Data for the latest available 12 month period (October 2012 – September 2013) shows that Bolton had the second lowest rate of avoidable admissions across Greater Manchester. Chart 20 – Avoidable emergency admissions benchmarked across Greater Manchester
L2. Average length of stay (non-elective) Objective: To decrease In the year 2013/14, the average length of stay for an emergency admission across all hospital providers was 5.1 days for Bolton CCG patients. The target for 2014/15 was 4.8 days, however the average length of stay in 2014/15 was sustained at 5.1 days. Average length of stay has fallen since June 2015, for the year to date 2015/16 the average length of stay is 4.4 days. Chart 21 – Average length of stay for emergency admissions across all providers
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Traf
ford
Bo
lto
n
Wig
an
Salf
ord
Bu
ry
Man
che
ste
r
Sto
ckp
ort
Old
ham
Ro
chd
ale
Tam
esi
de
Ind
ire
ct s
tan
dar
dis
ed
rat
e
CCG
Avoidable emergency admissions per 100,000 populationGreater Manchester Local Authorities - Oct 2012 - Sep 2013
Median 75th centile 90th centile
3.5
4.0
4.5
5.0
5.5
6.0
6.5
Ap
r-2
01
2M
ay-2
01
2Ju
n-2
01
2Ju
l-2
01
2A
ug-
20
12
Sep
-20
12
Oct
-20
12
No
v-2
01
2D
ec-
20
12
Jan
-20
13
Feb
-20
13
Mar
-20
13
Ap
r-2
01
3M
ay-2
01
3Ju
n-2
01
3Ju
l-2
01
3A
ug-
20
13
Sep
-20
13
Oct
-20
13
No
v-2
01
3D
ec-
20
13
Jan
-20
14
Feb
-20
14
Mar
-20
14
Ap
r-2
01
4M
ay-2
01
4Ju
n-2
01
4Ju
l-2
01
4A
ug-
20
14
Sep
-20
14
Oct
-20
14
No
v-2
01
4D
ec-
20
14
Jan
-20
15
Feb
-20
15
Mar
-20
15
Ap
r-2
01
5M
ay-2
01
5Ju
n-2
01
5Ju
l-2
01
5A
ug-
20
15
Sep
-20
15
Ave
rage
len
gth
of
stay
(d
ays)
Month
Average length of stay for emergency admissions - Bolton CCG patients at all providers
Annual target Average length of stay Average UCL LCL
27
Chart 22 illustrates how Bolton CCG benchmarks against other Greater Manchester CCGs for average non-elective length of stay. In 2014/15, Bolton CCG was above the Greater Manchester median length of stay. Chart 22 – Average length of stay for emergency admissions benchmarked across Greater Manchester
L3. Emergency admissions due to falls and fall related injuries (over 65s) Objective: To decrease Chart 23 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 an increasing trend in the number of falls admissions. Comparing 2014/15 with 2013/14, the number of admissions increased by 23%, from 730 in 2013/14 to 900 in 2014/15. There have been 12 more admissions in the year to date 2015/16 when compared with 2014/15, an increase of 2.9%. It should be noted however that the closure of the BCU in December 2013 may affect these figures, as this cohort of patients may have been treated in BCU in the past.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Salf
ord
Sou
thM
anch
este
r
Cen
tral
Man
ches
ter
Traf
ford
No
rth
Man
ches
ter
Wig
anB
oro
ugh
Old
ham
Hey
wo
od
,M
idd
leto
n&
Ro
chd
ale
Sto
ckp
ort
Bu
ry
Bo
lto
n
Tam
esi
de
&G
loss
op
30
day
re
adm
issi
on
s ra
te
CCG
Average length of stay (non-elective)Greater Manchester CCGs (2014/15)
CCG Median 75th centile 90th centile
28
Chart 23 – Emergency admissions due to falls and fall related injuries.
Chart 24 shows how Bolton CCG compares across Greater Manchester for the number of falls admissions per 1,000 population aged over 65. In the year 2014/15 Bolton had the third lowest rate of falls admissions across all Greater Manchester CCGs. Chart 24 – Emergency admissions due to falls and fall related injuries benchmarked across Greater Manchester
0
20
40
60
80
100
120
Ap
r-2
01
2M
ay-2
01
2Ju
n-2
01
2Ju
l-2
01
2A
ug-
20
12
Sep
-20
12
Oct
-20
12
No
v-2
01
2D
ec-
20
12
Jan
-20
13
Feb
-20
13
Mar
-20
13
Ap
r-2
01
3M
ay-2
01
3Ju
n-2
01
3Ju
l-2
01
3A
ug-
20
13
Sep
-20
13
Oct
-20
13
No
v-2
01
3D
ec-
20
13
Jan
-20
14
Feb
-20
14
Mar
-20
14
Ap
r-2
01
4M
ay-2
01
4Ju
n-2
01
4Ju
l-2
01
4A
ug-
20
14
Sep
-20
14
Oct
-20
14
No
v-2
01
4D
ec-
20
14
Jan
-20
15
Feb
-20
15
Mar
-20
15
Ap
r-2
01
5M
ay-2
01
5Ju
n-2
01
5Ju
l-2
01
5A
ug-
20
15
Sep
-20
15
Nu
mb
er o
f ad
mis
sio
ns
Month
Emergency admissions due to falls and fall related injuries at all providers (patients aged 65 and over)
Number of admissions Average Upper control limit Lower control limit
0
5
10
15
20
25
30
Tam
esi
de
&G
loss
op
Bu
ry
Bo
lto
n
Hey
wo
od
,M
idd
leto
n&
Ro
chd
ale
Traf
ford
Wig
anB
oro
ugh
Ce
ntr
alM
anch
este
r
Old
ham
No
rth
Man
ches
ter
Sto
ckp
ort
Sou
thM
anch
este
r
Salf
ord
Ad
mis
sio
ns
pe
r 1
,00
0 p
op
ula
tio
n
CCG
Emergency admissions due to falls and fall related injuries at all providers Patients aged 65 and over - 2014/15 - Greater Manchester CCGs
CCG Median 75th centile 90th centile
29
L4. Proportion of patients who experience harm-free care Objective: to increase Chart 25 shows the proportion of patients who experienced harm-free care at Bolton NHS FT between April 2013 and September 2015. 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. Chart 25 also shows the monthly harm-free care achievement for all Greater Manchester Trusts combined. Chart 25 – Patients experiencing harm-free care at Bolton NHS FT
L5. Number of people aged 65 and over receiving residential care, nursing care and community based services
Chart 26 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 people receiving the service at any point in 2014/15 was 3,402.
90%
91%
92%
93%
94%
95%
96%
97%
98%
99%
Ap
r-2
01
3
May
-20
13
Jun
-20
13
Jul-
20
13
Au
g-2
01
3
Sep
-20
13
Oct
-20
13
No
v-2
01
3
De
c-2
01
3
Jan
-20
14
Feb
-20
14
Mar
-20
14
Ap
r-2
01
4
May
-20
14
Jun
-20
14
Jul-
20
14
Au
g-2
01
4
Sep
-20
14
Oct
-20
14
No
v-2
01
4
De
c-2
01
4
Jan
-20
15
Feb
-20
15
Mar
-20
15
Ap
r-2
01
5
May
-20
15
Jun
-20
15
Jul-
20
15
Au
g-2
01
5
Sep
-20
15
% h
arm
fre
e ca
re
Month
Proportion of patients who experience harm free care at Bolton NHS FT
Bolton Foundation Trust All Greater Manchester Trusts Target
30
Chart 26 - Number of people aged 65 and over receiving residential care, nursing care and community based services
L6. Proportion of people using social care receiving direct payments Objective: to increase Chart 27 shows the proportion of people using social care receiving direct payments at year end. Chart 27 – Proportion of people using social care receiving direct payments
2,681
2,654
2,699
2,7332,723
2,741
2,600
2,620
2,640
2,660
2,680
2,700
2,720
2,740
2,760
2013/14 2014/15Q1
2014/15Q2
2014/15Q3
2014/15Q4
2015/16Q1
2015/16Q2
Nu
mb
er
of
pe
op
le
Number of people aged 65 and over receiving residential care, nursing care and community based services
28.9%
31.4%
32.2%
25%
27%
29%
31%
33%
35%
2013/14 2014/15 2015/16Q1
2015/16Q2
Pro
po
rtio
n
Proportion of people using social care receiving direct payments
31
L7. The proportion of older people aged 65 and over offered reablement services following discharge from hospital Objective: to increase The number of older people offered reablement services following discharge from hospital as a proportion of all discharges (people aged 65 and over). The full year figure for 2014/15 was 4.3%. L8. Percentage of people finishing Intermediate care or reablement who have a reduced package of care Objective: to increase Data to follow L9. Percentage of people finishing reablement or intermediate care who have no package of care Objective: to increase Data to follow L10. Health-related quality of life for carers Objective: to increase Chart 29 shows the latest available health-related quality of life scores for Bolton CCG and its statistical peers, taken from the 2013/14 GP Patient Survey. Bolton had the fifth lowest score out of the 16 statistical peer organisations. The score has been relatively consistent over the last three years: In 2011/12 Bolton scored 0.786, in 2012/13 the score was 0.792 and in 2013/14 Bolton’s score was 0.78. Chart 29 – Health-related quality of life for carers – average health status scores
0.7
8
0.73
0.74
0.75
0.76
0.77
0.78
0.79
0.8
0.81
0.82
St. H
ele
ns
Salf
ord
Bra
dfo
rd
Tam
esi
de
Bo
lto
n
Old
ham
Ro
the
rham
Wig
an
Wak
efi
eld
Bu
ry
Ro
chd
ale
San
dw
ell
Wal
sall
Co
ven
try
Kir
kle
es
Du
dle
yDir
ect
ly s
tan
dar
dis
ed
ave
rage
he
alth
sta
tus
sco
re
Local Authority
Health-related quality of life for carers (April 2013 - March 2014)
Local Authority score Median 75th centile 90th centile
32
L11. Carer reported quality of life Objective: to increase Chart 30 shows quality of life scores for carers in Bolton, as reported in the biennial carers’ survey. In 2012/13, when the survey was last carried out, Bolton had the 4th highest scores among it statistical peer organisations. Chart 30 – Carer reported quality of life
L12. People feeling supported to manage their condition
Objective: to increase
Chart 31 shows the percentage of people who answered “yes” to the following question in the GP
Patient Survey:
“In the last 6 months, have you had enough support from local services or organisations to help
you to manage your long-term health condition(s)?”
Bolton CCG had the highest proportion of patients responding positively (68.0%) when compared
across Greater Manchester CCGs. This measure has been relatively consistent over the last three
years.
6.5
7
7.5
8
8.5
9
Wal
sall
Old
ham
Co
ven
try
Kir
kle
es
Salf
ord
Wig
an
San
dw
ell
Wak
efi
eld
Tam
esi
de
Ro
chd
ale
Du
dle
y
Bra
dfo
rd
Bo
lto
n
Bu
ry
St. H
ele
ns
Ro
the
rham
Qu
alit
y o
f lif
e s
core
Local Authority
Carer reported quality of life (2012/13)
Local Authority score Median 75th centile 90th centile
33
Chart 31 – proportion of people feeling supported to manage their condition
L14. Reducing the gap in life expectancy between Bolton and the England average Objective: to decrease Life expectancy in Bolton is currently 76.5 years for men and 80.6 years for women. The gap in life expectancy between Bolton and England now stands at 2.1 years for men and 2.0 years for women. Chart 32 illustrates this gap between Bolton and England. Chart 32 – Life expectancy at birth – Bolton vs. England
60
.5%
62
.3%
62
.5%
63
.6%
63
.7%
64
.6%
64
.7%
64
.8%
65
.3%
65
.8%
67
.8%
68
.0%
50%
52%
54%
56%
58%
60%
62%
64%
66%
68%
70%N
ort
hM
anch
este
r
Ce
ntr
alM
anch
este
r
Sou
thM
anch
este
r
HM
R
Tam
esi
de
an
dG
loss
op
Sto
ckp
ort
Traf
ford
Bu
ry
Salf
ord
Old
ham
Wig
anB
oro
ugh
Bo
lto
n
Pe
rce
nta
ge f
ee
ling
sup
po
rte
d
CCG
People feeling supported to manage their condition (aggregated data Jan-Mar '14 and Jul-Sep '14)
CCG England Greater Manchester
76.5
80.6
78.6
82.6
73
74
75
76
77
78
79
80
81
82
83
84
Male Female
Life
exp
ect
ancy
(ye
ars)
Life expectancy at birth: Bolton vs. England
Bolton England
2.1 year gap
2.0 year gap
34
L15. Reducing the gap in life expectancy across Bolton Objective: to decrease
Within Bolton there is a significant gap between the most deprived and least deprived areas. The most deprived decile in Bolton has a life expectancy of 69.2 years for men and 74.8 years for women. The least deprived decile in Bolton has a life expectancy of 81.7 years for men and 85.2 years for women. This is a gap of 12.5 years for men and 10.4 years for women, as illustrated in chart 33. Chart 33 – Life expectancy at birth – gap within Bolton
69.2 74.881.7 85.250
55
60
65
70
75
80
85
90
Male Female
Life
exp
ect
ancy
(ye
ars)
Life expectancy at birth within Bolton
Bolton averageMost deprived decile Least deprived decile
12.5 year gap
10.4
year gap
35
KPI Definitions
L1. Avoidable emergency admissions
The avoidable emergency admissions measure is a composite measure of four categories:
Chronic ACS conditions (adults), including: o COPD/ emphysema o Atrial fibrillation and flutter o Heart failure o Asthma o Angina o Epilepsy o Diabetes o Anaemia o Bronchiectasis o Hypertension
Acute conditions not normally requiring admission (adults), including: o Urinary tract infections o Pneumonia o Gastroenteritis o Cellulitis o Convulsions o Gastro-oesophageal reflux disease (GORD) o Viral intestinal infection o Tubulo-interstitial nephritis not spec as acute or chronic o Tonsillitis o Volume depletion o Cutaneous abscess, furuncle and carbuncle
Children with lower respiratory tract infections (LRTIs), including: o Bronchiolitis o Pneumonia o Influenza
Asthma, diabetes and epilepsy in under 19s
GM2. 30 day emergency readmissions
The following exclusions apply to the 30 day readmissions KPI:
Excludes spells with a primary diagnosis of cancer
Excludes spells with an obstetrics HRG
Excludes patients aged under 4
Excludes patients who self discharged from the initial admission
Excludes spells which do not have a national tariff
Where a readmission rate is shown, the following exclusions apply to the denominator:
Excludes spells which do not have a national tariff
Excludes patients aged under 4
Excludes spells where the patient died.
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Data Sources
KPI Data Source Comments
Better Care Fund Indicators
BCF1. Emergency admissions Monthly Activity Return (MAR)
BCF2/ GM4. Permanent admissions of older people (aged 65 and over) to residential and nursing care homes
Adult Social Care Outcomes Framework (ASCOF)/ CareFirst
BCF3. Proportion of older people (aged 65 and over) who were still at home 91 days after discharge from to reablement/ rehabilitation services
Adult Social Care Outcomes Framework (ASCOF)/ CareFirst
BCF4. Delayed transfers of care (total number of delayed days)
Unify
BCF5. Overall satisfaction of people who use services with their care and support
Adult Social Care Outcomes Framework (ASCOF)
BCF6. Referrals to home based intermediate care National Audit for Intermediate Care (NAIC)
Greater Manchester Indicators
GM1. A&E attendances Patient Level SLAM/ SUS
GM2. 30 day emergency readmissions Patient Level SLAM/ SUS
GM3. See BCF2. -
GM4. Increasing the percentage of people that die in their usual place of residence.
ONS, via National End of Life Care Intelligence Network
Local Indicators
L1. Avoidable emergency admissions Patient Level SLAM/ SUS
L2. Average length of stay (non-elective) SUS
L3. Reducing the number of admissions due to falls and fall related injuries (over 65s)
Patient Level SLAM/ SUS
L4. Increasing the proportion of patients who experience harm free care
NHS Safety Thermometer
L5. Number of people aged 65 and over receiving residential care, nursing care and community based services
CareFirst
L6. Proportion of people using social care receiving direct payments
CareFirst
L7. Increasing the percentage of people receiving reablement or intermediate care at the point of discharge
TBC
L8. Increasing the percentage of people finishing Intermediate care or reablement who have a reduced package of care
Bolton Council
L9. Increasing the percentage of people finishing reablement or intermediate care who have no package of care
Bolton Council
L10. Improved health-related quality of life for carers
HSCIC/ GP Patient Survey
L11. Improved carer reported quality of life HSCIC/ Carers’ survey
L12. People feeling supported to manage their condition
HSCIC/ GP Patient Survey
L13. See BCF5. -
L14. Reducing the gap in life expectancy between Bolton and the England average
Public Health Intelligence Team
L15. Reducing the gap in life expectancy across Bolton
Public Health Intelligence Team
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