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EALING CCG MONTH 10 INTEGRATED PERFORMANCE AND QUALITY REPORT

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MONTH 10 PERFORMANCE AND QUALITY HIGHLIGHT REPORT

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2

KEY PROVIDER PERFORMANCE RISKS

3 3

EALING CCG OPERATING PLAN KPI PERFORMANCE

3.1 KPI schedule 8 3.2

Exception Report Summary

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APPENDICES

Appendix A CCGs' Commissioner Performance Measures Dashboard

M08 PCT Dashboard

Appendix B

Acute Performance KPI Dashboard

M08 Acute KPI Dashboard

Appendix C

Acute Quality Dashboard

Quality Metrics Report M8

Appendix D

Ealing Hospital Trust Performance and Quality Report

Ealing Performance Quality Report M8

Appendix E Imperial College Hospitals Performance and Quality Report

Imperial Performance Quality Report M8

Appendix F West London Mental Health Trust KPI Performance

WLMHT Performance Quality Report M06

Appendix G ICO Ealing Community Services ICO Q2 Performance

and Quality Report

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Ealing CCG Month 10 Quality and Performance Highlight Report

CCG Operating Plan KPI Performance Acute Provider Performance KPIs

KPI Plan Actual Trend Further details KPI Plan Actual Trend Further details

MRSA M10: 10 7 ↔ EHT: 62 Day Cancer Urgent GP referral

M9: 85%

79.6% ↑ 60.3% in M2 (May).

C. Difficle M10: 77 54 ↔ ICHT: 62 Day Cancer Screening Referral

M9: 90%

82.6% ↑ 47.6% in M2 (May).

18 weeks RTT: Admitted Care

M9: 90% 90.6% ↑ Non-admitted and incomplete pathway standards achieved.

ICHT: 31 Day Cancer Waits

M9: 96%

97.5% ↑ Steady improvement since M2.

Cancer 62 Day: Urgent GP/ Consultant/Screening Referrals

M9: 86% 83.7% ↑ YTD: 81.8%. Consistent improvement at EHT and ICH.

EHT: A&E type 1 M8: 95%

94.6% ↓ All types activity exceeds plan.

IAPT: % pop. receiving PTs Q3 YTD:

6.3% 5% ↔

Recruitment to vacant posts will increase capacity to meet targets.

ICHT: A&E type 1 M8: 95%

93.4% ↓ All types activity exceeds plan.

Aged 5: completed immunisation for MMR

Q2: 89% 83.7% ↔ Of the other 5 childhood immunisations 4 are amber and 1 is green.

Acute Provider Quality KPIs Mental Health, Community and Screening KPIs KPI Plan Actual Trend Further details KPI Plan Actual Trend Further details

EHT: Hospital Standardised Mortality Rate

89.8 N/A Lower than expected mortality but high relative to benchmark hospitals

WLMHT Never Events

0 0 N/A

EHT: Maternal Mortality 33.38 N/A One death following presentation at EHT A&E of Imperial maternity patient.

WLMHT: Patient survey-ommunity

6.2/10 N/A Annual survey.

EHT: Inpatient Survey 11-12: 4/5 0/5 ↔ Results are consistent with past surveys. Further benchmarking to follow.

ICO: New birth visits 10-14 days

95% 91% ↔ Performance consistent during 12/13.

EHT: Never Events 0 YTD: 2 N/A Reports on Q2 NEs not yet complete. Trust has reported to CQG that neither event resulted from systemic issues.

ICO: Never Events 0 0 N/A

ICHT: Never Events 0 YTD: 3 N/A Remedial actions and governance arrangements to be confirmed.

Adult Safeguarding Training

80% 67% ↑ Increased from 25% in June.

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2. KEY PROVIDER PERFORMANCE RISKS Further detail on provider performance, including exception reporting, is provided in the appendices.

2.1 Cancer 62 Day Waits

Ealing CCG Performance Year end measure

Period

Ealing

Plan/ Target Outcome

Cancer 62 days - GP/consultant /screening programme referrals (aggregate) YTD

M9 86% 83.7%

Cancer 62 days - GP/consultant /screening programme referrals (aggregate) YTD 86% 81.8%

Cancer 62 Day Waits: Ealing Hospital Trust

Description Reporting Frequency

Threshold

Ealing Hospital NHS Trust

In mth/qtr YTD

Cancer 62 Day Waits

Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral for suspected cancer

Monthly 85% 72.4% 82.0%

Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service

Monthly 90% 100.0% 60.0%

Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

Monthly 85% 93.9% 94.4%

Context & Risks The breaches of the 62-day standard for the first definitive treatment following an urgent GP referral result from patient choices about the preferred course of treatment.

CSU / EHT Actions Date for completion

CCGs to be consulted, and if they agree, a performance notice will be raised for breaches of the 62-day standard for first definitive treatment of an urgent GP referral.

January

CCG Actions

To be confirmed.

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Cancer 62 Day Waits: Imperial College Hospitals Trust

Description Plan

Imperial College Healthcare NHS Trust

M1 M2 M3 M4 M5 M6 M7 M8 M9 YTD

Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral for suspected cancer

85% 77.0% 60.3% 64.3% 61.5% 70.3% 67.7% 79.4% 77.0% 79.6% 69.2%

Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service

90% 71.4% 47.6% 93.5% 82.9% 71.0% 100% 92.0% 84.6% 82.6% 78.7%

Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

85% 75.0% 85.7% 85.7% 94.4% 73.3% 88.9% 80.0% 92.3% 100% 85.4%

Context & Risks

The Trust recommenced national reporting against Cancer waiting times performance from April following the IST’s assurance of data quality. Further IST assurance was required and a revised PTL was implemented in June 2012.

The Trust has breached a milestone to deliver demand and capacity modelling at tumour site level, this information was due 5

th November and at 21

st November this was provided for just 5 tumour sites and further

work is required. A more detailed model was received on the 22nd

Jan 2013

Financial penalties worth approximately £1.5m are being pursued from the Trust.

CSU / ICHT Actions Date for completion

Summary of actions taken

Single point of access established for 2 week wait referrals. Further action required Trust to provide a remedial action plan the delivery of which will be managed by the CQG and escalated to the PCE as necessary.

Complete Commenced

CCG Actions

To be confirmed.

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2.2 Key Performance Risks: A&E Ealing Hospital A&E Performance

Domain Performance

Measure Description

Reporting Frequency

Threshold Ealing Hospital NHS Trust

In mth/qtr YTD

4.

Ensu

rin

g th

at

pe

op

le h

ave

a

po

siti

ve e

xpe

rie

nce

o

f ca

re

A&E

Total time spent in A & E < 4 hours (all activity types)

Monthly 98% 97.28% 97.43%

Total time spent in A & E < 4 hours (all activity types)

Monthly 95% 97.28% 97.43%

Total time spent in A & E < 4 hours (type 1)

Monthly 95% 93.35% 94.54%

Context & Risks The largest numbers of breaches were for patients waiting for a bed, for patients flowing into and out of A&E for clinical reasons and for A&E assessment waits. The underlying activity rates are not higher than during the summer months but the flow is volatile and peaks in demand are presenting problems for the Trust.

CSU / ICHT Actions

EHT is taking the following action to remedy its performance against the standard for time spent in A&E by type 1 patients:

Ambulatory Care Conditions pathways have been introduced for Cellulitis and PE to prevent admissions, allowing a more effective use of ED clinical staff time in completion of diagnosis;

An increase in consultant ward rounds, with at least two and often three wards rounds on weekdays and two

consultant wards rounds in Surgery at weekends, improving rates of discharge and reducing A&E 4 hour

breaches resulting from a lack of beds.

CCG Actions

To be confirmed.

Imperial College Hospitals Trust: A&E Performance

Domain Performance

Measure Description

Reporting Frequency

Threshold

Imperial College Healthcare NHS Trust

In mth/qtr YTD

4.

Ensu

rin

g

that

pe

op

le

hav

e a

po

siti

ve

exp

erie

nce

of

care

A&E

Total time spent in A & E < 4 hours (all activity types)

Monthly 98% 97.00% 97.65%

Total time spent in A & E < 4 hours (type 1)

Monthly 95% 94.56% 95.44%

CSU / ICHT Actions Date for

completion

Fast track of medical patients to wards for comprehensive assessment now extended to 24/7 supported by timely information on bed capacity on the wards.

Ambulatory Care Pilot and open week days 8am -5pm to manage A&E patients who are not for admission with potential DVT and cellulitis. The pilot will also support improved performance against the non admitted A&E Clinical Quality Indicator (CQI) threshold.

Ongoing

CCG Actions

To be confirmed

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2.3 Key Performance Risks: Ealing Hospital Mortality Rates

Indicator National / Local

Target Frequency Period Frequency

Hospital standardised mortality rate (HSMR)

Local National average is 100 Annual 10/11 89.8

Maternal mortality rate (based on the maternal death rate and time between deaths)

Local Lower than the London rate/and no two deaths within 31 days

Annual 10/11 33.38

Hospital standardised mortality ratio

CSU / EHT Actions Date for completion

For quarterly review at CQG 29th

January

CCG Actions

To be confirmed

Maternal mortality rate

Context and risks The Maternal mortality rate is red due to the death of one woman who gave birth at Queen Charlotte’s and subsequently attended A&E at EHT where she died. Although the death has been attributed to EHT the maternity care was provided at Queen Charlotte’sThe construction of the KPI definition is such that at EHT one death will cause a red rating for the full year.

CSU / EHT Actions Date for completion

The case has been reviewed at EHT CQG where assurance was provided that there were no underlying causes for concern about clinical care.

Complete

2.4 Key Performance Risks: ICO Health Visiting: New Birth Visits

KPI Target April May June July Aug Sept

Babies who received a new birth visit between 10-14 days 95% 85% 93% 90% 92% 93% 93%

CSU / ICO Actions Date for completion

Further response update expected by next contract meeting

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3. CCG OPERATING FRAMEWORK KPIs These indicators provide performance information on CCG the population rather than the activity at individual providers contaoined in the Key Risks section eg Cancer waits. (These indicators will be replaced by the CCG Outcomes Framework indicators from 1st April) 3.1 Key Performance Indicator Summary The KPI summary below shows the measure of performance that will be used by the NWL cluster to assess performance i.e.

a year to date figure is given for indicators that will be measured using cumulative performance throughout the year;

A monthly or quarterly figure has been used for indicators that will be measured on M12 or Q4.

3.2 Exception Report Summary

This provides a summary of the December exception reports provided by KPI leads.

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3.1 CCG Operating Framework Key Performance Indicator Summary

Plan/

Target Outcome

1 MRSA YTD M10 YTD 10 7 ↔2 C.difficile YTD M10 YTD 77 54 ↔3 Ambulance response time - Cat A 8 mins YTD M9 YTD 75% 73.7% ↔4 Ambulance response time - Cat A 19 mins YTD M9 YTD 95% 98.0% ↔5 18 weeks RTT - admitted performance within 18 weeks M12 M9 90% 90.6% ↑6 18 weeks RTT - non-admitted performance within 18 weeks M12 M9 95% 98.0% ↔7 18 weeks RTT - incomplete pathways performance within 18 weeks M12 M9 92% 93.9% ↔8 Cancer 2ww - all urgent referrals & breast symptoms (aggregate) M9 93% 94.9% ↔9 Cancer 2ww - all urgent referrals & breast symptoms (aggregate) YTD 93% 94.4% ↔10 Cancer 62 days - GP/consultant /screening programme referrals (aggregate) M9 86% 83.7% ↑11 Cancer 62 days - GP/consultant /screening programme referrals (aggregate) YTD 86% 81.8% ↑12 Cancer waits - 2 weeks - urgent GP referral M9 93% 94.8% ↔13 Cancer waits - 2 weeks - urgent GP referral YTD 93% 95.0% ↔14 Cancer waits - 2 weeks - breast symptoms M9 93% 95.3% ↑15 Cancer waits - 2 weeks - breast symptoms YTD 93% 92.5% ↑16 Cancer waits - 62 days - urgent GP referral M9 85% 80.6% ↑17 Cancer waits - 62 days - urgent GP referral YTD 85% 78.9% ↑18 Cancer waits - 62 days - screening service referral M9 90% 75.0% ↓19 Cancer waits - 62 days - screening service referral YTD 90% 79.1% ↓20 Cancer waits - 62 days - consultant upgrade M9 85% 100.0% ↑21 Cancer waits - 62 days - consultant upgrade YTD 85% 89.4% ↑22 Cancer Waits - 31 days - RTT from cancer diagnosis M9 96% 98.5% ↔23 Cancer Waits - 31 days - RTT from cancer diagnosis YTD 96% 95.2% ↔24 Cancer waits - 31 days - subsequent surgery M9 94% 100.0% ↑25 Cancer waits - 31 days - subsequent surgery YTD 94% 93.9% ↑26 Cancer waits - 31 days - subsequent drugs M9 98% 100.0% ↑27 Cancer waits - 31 days - subsequent drugs YTD 98% 97.5% ↑28 Cancer waits - 31 days - subsequent radiotherapy M9 94% 100.0% ↔29 Cancer waits - 31 days - subsequent radiotherapy YTD 94% 98.7% ↔30 Choose & Book - proportion of GP referrals M10 90% 34% ↔31 Choose & Book - bookings where named consultant team available M10 70% 87% ↑32 6 week diagnostic waits YTD M9 1.0% 0.1% ↔33 MH - CPA 7 day follow-up Q3 95% 98.6% ↑34 MH - CPA 7 day follow-up YTD 95% 98.1% ↑35 MH - IAPT proportion of population receiving psychological therapies Q3 YTD 6.4% 5.0% ↔36 MH - IAPT proportion completed moving to recovery Q3 34.7% 34.6% ↔37 MH - Early Intervention in psychosis (new cases) YTD Q3 YTD 51 69 ↔38 MH - Crisis resolution home treatment episodes YTD Q3 YTD 651 896 ↔39 NHS Health Checks - % of people aged 40-74 offered a health check Q3 14.0% 16.9% ↔40 NHS Health Checks - % of people aged 40-74 receiving a health check Q3 6.5% 10.7% ↔41 Smoking Quitters - number of 4 week smoking quitters YTD Q2 863 1,068 ↔

TrendSummary Headline and Local Measures 2011-12 & 2012-13Year end

measurePeriod

Ealing

Headline Measures

YTD

YTD

YTD

YTD

YTD

YTD

YTD

YTD

YTD

YTD

YTD

YTD

Q4

YTD

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A rating of ‘passable’ has been introduced by NHSL for services achieving 50% against the choose and book

utilisation indicator

Plan/

Target Outcome

4212 week maternity access (calculated using originally reported Q1

assessment number)Q4

Q1

assessments/

Q3 maternities90% 89.0% ↑

43 Access to Dentistry M12 M10 201,866 194,315 ↓44 Bowel Screening - extension to ages 70 to 75 YTD Q3 30% 81.0% ↔45 Breast Feeding at 6-8 weeks - coverage YTD Q3 95.0% 95.8% ↓46 Breast Feeding at 6-8 weeks - coverage YTD YTD 95.0% 95.7% ↓47 Breast Feeding at 6-8 weeks - prevalence Q3 64.0% 67.1% ↓48 Breast Feeding at 6-8 weeks - prevalence YTD 63.3% 66.1% ↓49 Breast Screening - coverage 53-70 age groups Q4 Q4 70% 68.0% ↔50 Cervical Screening - test results within 2 weeks YTD M6 98.0% 98.7% ↔51 Cervical Screening - women screened within last 3.5 years (age 25-49) Q4 70.0% 68.5% ↔52 Cervical Screening - women screened within last 5 years (age 50-64) Q4 75.0% 74.4% ↔53 Deaths at Home Q4 Q3 33.6% DNA

54 Diabetic Retinopathy screening - eligible people offered screening Q4 Q3 95.0% 107.1% ↔55a People with LTC feeling independent and in control of condition Q4 Q2 69.0% 75.2%

56 Stroke - time spent on a stroke unit YTD Q3 80% 93.3% ↔57 Stroke - TIA treated within 24 hours YTD Q3 60% 100.0% ↔58 All age all cause mortality - males Annual 2009 657 675

59 All age all cause mortality - females Annual 2009 444 446

60 CVD Mortality Annual 2007-09 89 87

61 Cancer Mortality Annual 2007-09 101 109

62 - % aged 1 who have completed imms for DTaP,IPV & Hib Q4 Q2 95.0% 93.0% ↓

63 - % aged 2 who have received PCV Booster Q4 Q2 92.0% 87.7% ↓

64 - % aged 2 who have received Hib and MenC Booster Q4 Q2 92.0% 89.1% ↓

65 - % aged 2 who have received MMR - 1 dose Q4 Q2 92.0% 90.1% ↔

66 - % aged 5 who have received DTaP and IPV Q4 Q2 89.0% 87.1% ↔

67 - % aged 5 who have completed immunisation for MMR Q4 Q2 89.0% 83.7% ↔

68 % aged 12-13 who have completed immunisation for HPV Annual 2010/11 95.0% 76.5% ↔69 Childhood Obesity: % of children in Reception recorded obese Annual 2010-11 12.6% 11.2%

70 Childhood Obesity: % of children in Year 6 recorded obese Annual 2010-11 22.6% 21.1%

71 Chlamydia Screening Coverage YTD Q2 6% 6.7%

72 Chlamydia Screening Positivity YTD Q2 5% 7.9%

73 Teenage Conception (rate per 1,000 females aged 15-17) Annual 2010 27.4 25.7

74 18 weeks RTT - admitted 95th percentile M12 M9 23 w eeks 21.93 ↑

75 18 weeks RTT - non-admitted 95th percentile M12 M9 18.3 w eeks 16.04 ↔

76 18 weeks RTT - incomplete 95th percentile M12 M9 28 w eeks 19.48 ↔

77 18 weeks RTT - admitted median M12 M9 11.1 w eeks 7.73 ↔

78 18 weeks RTT - non-admitted median M12 M9 6.6 w eeks 4.85 ↔

79 18 weeks RTT - incomplete median M12 M9 7.2 w eeks 5.39 ↔

TrendYear end

measurePeriod

Ealing

Q3 12/13

(prov)

Local Measures

YTD

Child immunisations

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3.2 Ealing CCG Exception Report Summary December 2012

Breast Screening Target Ealing Q4

70% 68.59%

2012/13 outcome The service did not meet the 70% target at the end of 2012/13. West of London Breast Screening Service (WoLBSS) Commissioners monitor performance against the following key aspects of the service’s performance:

3-year screening action plan;

access to the service;

appointment scheduling;

patient experience (user surveys).

Cervical Screening Target Ealing Q3

25-49 years (within 3.5 years) (Q2) 70% 68.50%

50-64 years (within 5 years) (Q2) 75% 74.73%

Ealing’s eligible population continues to increase: from 105,861 to 108,311 in the last quarter . During the transition period work has focused on ensuring continuity of service delivery and monitoring: maintaining collaborative, supportive working with call-recall departments, laboratories and GP practice staff to promote quality of service throughout the pathway:

Accuracy of patient registration database Monitor returned mail;

Failsafe facilitator chasing women with abnormal results lost to programme;

Participate in pan-London list maintenance programme.

Identification of eligible women Monitor robustness of e-PNL returns and call-recall system;

Promotion of screening Target hard to reach groups;

Survey eligible population to gain understanding of their knowledge and awareness of risk;

Robustness of practice systems Databases updated from Open Exeter;

Printed HMR101;

Follow-up of women.

Competence of test-takers Test-taker training programme;

NWL register.

TATs Management of test-taker and laboratory performance;

Direct referral systems Colposcopy units failsafe overlapping with call-recall and primary care fail safes.

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Childhood Immunisations Performance Q1-2 12/13

Q1 Q2

Q1-2 variance

Plan Actual Plan Actual

Aged 1: DTaP / IPV / Hib 95% 94.20% 95% 93% -1.2%

Aged 2: PCV 91% 89.80% 92% 87.7% -1.9%

Aged 2: HIb / Men C 91% 91.20% 92% 89.1% -2.1%

Aged 2: MMR 91% 90.10% 92% 90.1% -

Aged 5: DTaP / IPV 87% 87.10% 89% 87.1% -

Aged 5: MMR 87% 83.70% 89% 83.7% -

The Q2 COVER data shows decreases on the previous quarter for all 6 antigens averaging 1.7%. The recent deterioration in performance resulted largely from the failure of two practices to submit data either electronically or manually. A process of technical and GP peer support has resolved the problem.

Chlamydia Screening

Q2

Plan Actual

Coverage: 6% Positivity: 5%

Coverage: 6.7% Positivity: 7.9%

High volume outreach work is no longer commissioned as NHS Ealing aim to embed chlamydia testing within core services; primary care service providers are supported to assess risk amongst their young patients and offer chlamydia testing where appropriate. Services have been remodelled following DH guidance (1) advising PCTs to integrate chlamydia screening into core services. Coverage rates continue to fall as forecast to 6.7% with a significant increase in positivity to 7.9%.

Funds have not been identified to support the introduction of a Sexual Health GP LES integrating chlamydia testing with the overall management of sexual health in primary care.

Concerns have been raised with the HPA about not all screens having been counted in data collected directly from laboratories.

Data about treatment and partner notification remains a PCT function although it is not clear how returns will be gathered. The Sexual Health Commissioner is overseeing submissions of data to the HPA from 1st April 2012.

1 www.dh.gov.uk/en/aboutus/features/DH_128779 The future direction of the National Chlamydia Screening Programme Last modified date: 27 July 2011

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Choose and Book

Target 90%

M10 actual 34%

Good More than 90%

Passable > 50% < 90%

Amber > 40% < 50%

Poor < 40%

Although the national target for choose and book utilisation remains 90% a threshold of 50% for ‘passable’ performance has been established which is scored above as amber. The service’s goal, agreed with the LMC and part of the QIPP plan, is to increase the proportion of outpatient referrals going through Ealing Referral Facilitation service (RFS) from the current 60% to 80% by April 2013. This will be achieved through the redevelopment of the RFS alongside the redevelopment of pathways, protocols and referral criteria. Ealing RFS will use C&B to book all incoming outpatient referrals.

Dental Access

Ealing M10

Plan Actual

201,866 194,315

The NWL Cluster Primary Care Commissioning Team (PCCT) is analysing capacity within ONWL to identify areas in which marketing might be used to increase the number of UDAs provided to new patients. The PCCT is also addressing the following the booking of patients for more frequent re-attendances than are recommended by NICE and split courses of treatment.

IAPT Ealing M9

Plan M9 YTD Actual M9 YTD

Proportion eligible pop. in therapy 6.4% 5%

Proportion who are moving to recovery 34.6% 34.7%%

The Service does not currently have the staff capacity to reach its targets despite rigorous management of individual caseloads. Shortages of CBT therapists and Psychological Wellbeing Practitioners are delaying the commencement of treatment. Recruitment to these posts has started. Two temporary Psychological Wellbeing Practitioners have being recruited in the short term to assist with the growing waiting list and two more will be recruited in January. An increase in the severity/complexity of difficulties/presenting problems that are referred/presenting has resulted in an increase in the number of clients are that referred elsewhere rather than entering treatment in the IAPT. A Clinical review was undertaken in September 2012 and a new service specification will be completed in January 2013.