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HSC BOARD PERFORMANCE REPORT – 2019/20 End of Year Assessment (IoPs)

and Month 1 (2020/21) Performance

Purpose

The purpose of this paper is to provide HSCB Board members with an end of year

assessment of Trusts’ performance against the indicators set out in the Indicators of

Performance Direction 2019/20. The position regionally and by Trust at the end of March

2020 for the indicators that the HSCB is responsible for monitoring, and where end of year

monitoring information is currently available, is set out in Annex A.

Board members should however note that due to the pressures within Trusts associated

with the ongoing COVID-19 (coronavirus) outbreak, end of year performance monitoring

information is not yet available for a number of indicators. Furthermore, due to the three

month period allowed to facilitate coding within Trusts, the end of year performance in

relation to a number of indicators is not yet available. There are also a number of

indicators (e.g. those relating to school-aged children in care), where performance is

reported annually in arrears therefore the position in 2019/20 will not be available until

2020/21. An update on performance in areas where 2019/20 performance is not yet

available will be provided at a future Board meeting.

In light of the COVID-19 situation, the Department has suspended work on the

development of the Commissioning Plan Direction (CPD) for 2020/21. Until such times as

the 2020/21 CPD can be finalised, Trusts have been advised to continue to plan and

deliver services in line with the CPD for 2019/20. It is however recognised that the

pressures that staff are facing and the current operating environment means that it will not

be possible to meet all of the requirements outlined and on that basis, patient safety and

clinical risk should be prioritised.

Given that Board members received a comprehensive end of year update on Trusts’

performance against the full range of 2019/20 CPD standards and targets at last month’s

meeting, this report provides a summary update on Trusts’ performance in Month 1 of

2019/20 across a small number of areas.

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Performance

The COVID-19 outbreak has placed unprecedented demands on the HSC with a range of

services reduced or postponed in an attempt to free up capacity including staff, beds and

critical care services. The need to prioritise resources for coronavirus patients has had a

direct impact on those non-coronavirus patients who have been waiting to access HSC

services. As a result there has been deterioration in performance across many of the CPD

target areas.

1. Elective Care (including Diagnostics)

As indicated in the charts and tables below, there has been a marked deterioration in

waiting times for elective care (including diagnostics) as a direct result of the COVID-19

outbreak.

At the end of April 2020, 13% of people waiting for a first outpatient appointment were

waiting less than nine weeks compared to 21% at the end of the previous month;

263,601 were waiting longer than nine weeks compared to 242,864 at the end of March

(+20,737); and, 121,815 were waiting longer than 52 weeks compared to 117,066 at the

end of March (+4,749).

25% 25% 25% 25% 23% 24% 24% 23% 22% 21% 23% 21%

13%

0%

20%

40%

60%

80%

100%

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20

Outpatients - % waiting <9 weeks

Trust Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20

Belfast 27% 27% 27% 26% 24% 25% 25% 24% 23% 22% 24% 22% 14%

Northern 27% 26% 26% 25% 23% 24% 23% 23% 21% 20% 22% 21% 13%

South Eastern 19% 19% 19% 19% 18% 19% 20% 19% 18% 17% 18% 16% 10%

Southern 27% 28% 30% 30% 27% 29% 29% 28% 25% 25% 27% 24% 14%

Western 28% 27% 27% 26% 25% 26% 25% 25% 22% 23% 25% 22% 14%

2019/20 25% 25% 25% 25% 23% 24% 24% 23% 22% 21% 23% 21% 13%

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219,805 224,971 224,130 226,096 236,097 232,239 229,965 230,889 239,130 238,951 234,710 242,864263,601

100,736 103,687 105,450 106,436 109,234 108,582 109,256 109,930 111,963 111,500 112,607 117,066 121,815

0

50,000

100,000

150,000

200,000

250,000

300,000


Outpatients - Number of patients waiting longer than 9/52 weeks

>9 weeks >52 weeks


Belfast 69,949 73,635 74,568 76,294 79,129 78,798 79,309 80,019 83,791 83,888 82,391 84,465 92,559

Northern 31,434 32,754 33,371 34,114 35,594 35,704 35,787 36,378 37,207 37,348 36,417 37,265 40,859

South Eastern 56,799 57,617 57,372 56,747 57,501 55,177 54,245 52,828 53,496 54,642 54,836 55,960 59,491

Southern 33,780 32,423 29,965 30,768 32,829 31,730 30,851 31,394 32,432 32,552 31,909 33,432 38,174

Western 27,843 28,542 28,854 28,173 31044 30,830 29,773 30,270 32,204 30,521 29,157 31,742 32,518

2019/20 219,805 224,971 224,130 226,096 236,097 232,239 229,965 230,889 239,130 238,951 234,710 242,864 263,601 Trust Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20

Belfast 33,097 35,203 36,059 36,680 37,475 37,605 39,232 39,992 40,742 40,086 40,679 41,774 43,674

Northern 13,279 13,811 14,406 14,814 15,112 15,468 15,907 16,434 16,795 16,952 17,074 17,196 18,273

South Eastern 28,936 29,712 30,621 30,633 30,825 29,796 28,937 27,697 28,164 29,070 29,891 31,348 32,638

Southern 11,839 11,058 10,021 10,177 10,740 10,545 10,139 10,551 10,688 11,003 11,290 11,878 13,008

Western 13,585 13,903 14,343 14,132 15,082 15,168 15,041 15,256 15,574 14,389 13,673 14,870 14,222

2019/20 100,736 103,687 105,450 106,436 109,234 108,582 109,256 109,930 111,963 111,500 112,607 117,066 121,815

At the end of April 2020, 32% of patients were waiting less than nine weeks for a

diagnostic test compared to 46% at the end of March; 78,509 patients were waiting

longer than nine weeks compared to 58,639 at the end of March (+19,870); and, 32,783

were waiting longer than 26 weeks, an increase of 4,653.

49% 48% 48% 45%42% 43% 46% 46% 43% 44%

48% 46%

32%

0%

20%

40%

60%

80%

100%


Diagnostics - % <9 weeks

4


Belfast 44% 45% 45% 42% 40% 41% 44% 43% 40% 39% 40% 39% 31%

Northern 45% 42% 42% 39% 35% 36% 38% 39% 40% 49% 61% 67% 38%

South Eastern 58% 56% 55% 54% 51% 52% 54% 55% 51% 50% 52% 49% 33%

Southern 43% 42% 43% 39% 35% 37% 40% 40% 36% 35% 37% 33% 27%

Western 78% 79% 79% 78% 76% 75% 76% 76% 68% 68% 75% 70% 38%

2019/20 49% 48% 48% 45% 42% 43% 46% 46% 43% 44% 48% 46% 32%

59,730 62,397 63,880 66,636 69,600 69,318 67,542 65,72269,620

64,12156,577 58,639

78,509

27,026 29,618 31,435 33,577 35,724 37,011 36,558 35,328 36,57330,580

27,169 28,13032,783

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000


Diagnostics - Number of patients waiting longer than 9/26 weeks

>9 weeks >26 weeks


Belfast 18,012 18,133 18,909 19,297 20,095 19,986 19,374 19,019 21,216 21,089 20,508 21,329 26,276

Northern 17,220 18,777 19,429 20,450 21,225 20,828 20,345 19,388 17,846 12,236 7,046 5,052 10,354

South Eastern 6,908 7,404 7,341 7,458 7,879 8,002 7,925 7,694 8,543 8,549 7,784 8,851 12,162

Southern 15,428 15,910 16,062 17,138 17,911 17,788 17,196 16,925 18,341 18,682 18,539 20,152 22,572

Western 2,162 2,173 2,139 2,293 2,490 2,714 2,702 2,696 3,674 3,565 2,700 3,255 7,145


Belfast 10,020 10,278 10,771 10,863 11,209 11,111 10,679 10,374 11,371 10,860 10,817 11,504 12,505

Northern 9,032 10,733 11,717 12,619 13,256 13,580 13,467 12,521 11,375 6,350 3,269 2,017 2,853

South Eastern 1,420 1,669 1,763 1,978 2,287 2,727 2,791 2,805 3,092 2,949 2,679 3,080 4,357

Southern 6,256 6,689 6,914 7,757 8,511 9,007 8,981 9,022 9,973 9,753 9,953 11,201 11,264

Western 298 249 270 360 461 586 640 606 762 668 451 328 1,804

2019/20 27,026 29,618 31,435 33,577 35,724 37,011 36,558 35,328 36,573 30,580 27,169 28,130 32,783

In relation to waiting times for inpatient or day case treatment, at the end of April 2020,

23% of patients were waiting less than 13 weeks compared to 29% at the end of March;

73,432 patients were waiting longer than 13 weeks compared to 66,872 at the end of

March (+6,560); and, 33,028 patients were waiting longer than a year for surgery

compared to 30,696 at the end of March (+2,332)..

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35% 34% 33% 32% 31% 30% 32% 33% 31% 29% 29% 29%23%

0%

20%

40%

60%

80%

100%


Inpatient/Daycases - % waiting <13 weeks

% <13 weeks - IPDC


Belfast 25% 25% 24% 24% 23% 22% 24% 25% 24% 22% 21% 22% 18%Northern 54% 52% 51% 49% 47% 46% 47% 47% 43% 41% 42% 40% 32%South Eastern 53% 51% 50% 49% 47% 44% 48% 49% 47% 45% 45% 45% 41%Southern 41% 39% 40% 37% 35% 35% 37% 37% 35% 33% 31% 30% 24%Western 33% 31% 31% 30% 29% 30% 32% 32% 30% 29% 28% 28% 22%2019/20 35% 34% 33% 32% 31% 30% 32% 33% 31% 29% 29% 29% 23%

56,743 58,180 58,898 59,410 60,511 60,837 60,241 60,040 62,690 64,566 65,572 66,87273,432

22,638 23,193 24,002 24,141 24,629 25,279 25,928 26,582 27,135 28,045 29,010 30,696 33,028

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000


Inpatient/Daycases - Number of patients waiting longer than 13/52 weeks

>13 weeks >52 weeks


Belfast 28709 29145 29465 29625 29365 29128 28804 28,719 29,564 30,313 30,387 30,266 32,398

Northern 3975 4351 4657 4881 5195 5332 5371 5,395 5,904 6,018 6,080 6,380 7,512

South Eastern 4237 4272 4248 3995 4357 4554 4453 4,392 4,603 4,555 4,678 4,703 5,349

Southern 7678 7912 8012 8283 8700 8887 8890 8,939 9,567 10,206 10,692 11,241 12,477

Western 12144 12500 12516 12626 12894 12936 12723 12,595 13,052 13,474 13,735 14,282 15,696


Belfast 12,173 12,610 13,059 13,083 13,433 13,740 14,021 14,387 14,686 15,111 15,439 15,984 16,853

Northern 442 528 633 735 831 955 1,082 1,145 1,220 1,236 1,251 1,429 1,678

South Eastern 1,648 1,621 1,661 1,593 1,598 1,661 1,675 1,733 1,804 1,850 1,980 2,101 2,235

Southern 2,897 2,916 3,030 3,097 3,084 3,164 3,258 3,419 3,609 3,921 4,183 4,507 4,972

Western 5,478 5,518 5,619 5,633 5,683 5,759 5,892 5,898 5,816 5,927 6,157 6,675 7,290

2019/20 22,638 23,193 24,002 24,141 24,629 25,279 25,928 26,582 27,135 28,045 29,010 30,696 33,028

COVID-19 has placed unprecedented challenges on the HSC system and the need to

redirect HSC resources to respond to the COVID-19 pandemic has had an adverse

impact on waiting times for elective care, which prior to the pandemic were already

unacceptable.

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Elective activity was stood down moving into the Covid-19 delay phase with the

exception of time critical and red flag treatments in accordance with national guidelines.

Reset plans are underway for June 2020 in the first instance and secondly, July to

September 2020. Elective activity undertaken in any setting will be at a lower level of

productivity than previously due to the time taken to donn and doff PPE,

decontamination time both for equipment and air decontamination in theatres, and

social distancing.

2. Emergency Department (ED) (4-hour and 12-hour standards)

Regionally during April 2020, 233 patients waited longer than 12 hours in ED. While

this is a significant improvement on the same month last year (3,642), this is likely as a

result of the drop in attendances at EDs during April 2020, due to pandemic-related

concerns – 35,425 ED attendances in April 2020 compared to 71,955 in April 2019.

Trust Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-2019/20

CumApr-20

Belfast 635 508 562 393 334 668 762 1,029 976 1,247 966 437 8,517 15

Northern 815 534 455 456 273 499 440 858 1,138 918 874 480 7,740 127

South Eastern 782 577 595 701 572 774 938 949 1,035 1,183 977 514 9,597 21

Southern 895 1,210 870 684 668 995 1,096 1,272 1,211 1,467 1,224 692 12,284 33

Western 515 511 353 327 403 545 712 865 912 1,063 632 425 7,263 37

2019/20 3,642 3,340 2,835 2,561 2,250 3,481 3,948 4,973 5,272 5,878 4,673 2,548 45,401 233

In relation to the 4-hour standard, regionally during April 2020, 75% of patients were

treated and discharged, or admitted within four hours.

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66% 67% 67% 67% 68% 66% 65%60% 61% 64% 63%

67%75%

0%

20%

40%

60%

80%

100%


ED - % <4 hours

% <4 hours


CumApr-20

Belfast 63% 62% 63% 63% 62% 59% 59% 55% 57% 58% 58% 64% 60% 75%

Northern 64% 67% 69% 68% 69% 69% 71% 63% 65% 70% 67% 70% 68% 76%

South Eastern 70% 72% 70% 71% 74% 72% 70% 70% 67% 72% 70% 72% 71% 75%

Southern 66% 65% 65% 66% 68% 65% 64% 58% 59% 62% 63% 66% 64% 74%

Western 68% 69% 70% 70% 67% 63% 65% 57% 55% 56% 56% 60% 63% 73%

Region 66% 67% 67% 67% 68% 66% 65% 60% 61% 64% 63% 67% 65% 75%

In the last number of years investment has been made in domiciliary care and care

package provision for older people and NIAS has continued to develop Appropriate

Care Pathways, which provide access to a range of new services to offer alternatives to

bringing patients to an ED through treatment in the community or offering an alternative

destination. Whilst these interventions have made some impact a more comprehensive

response to the provision of urgent and emergency care services is required.

Under the Transformation agenda, following a population health needs assessment, the

Department has been undertaking a clinically led Review of Urgent and Emergency

Care services across Northern Ireland. The Review team was targeting submission of

its initial report and recommendations to the Department by April 2020, with the aim of

then holding a consultation exercise on proposals to develop a sustainable regional

care model for the next 10-15 years. Whilst the timeline for the completion of the review

has been interrupted by the Department’s handling of the response to the Covid-19

pandemic, it is envisaged that some of the early proposals emerging from the work of

review team will be considered as part of ongoing planning for the rebuilding of urgent

and emergency care services in the prevailing context of Covid-19.

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3. Cancer Services

Breast Cancer (14 days)

Regionally during April 2020, 77% of urgent breast cancer referrals were seen within 14

days compared to 79% in March. Where patients were not seen within 14 days during

April 2020, the longest wait was 43 days in the Northern Trust.

While regionally performance is below the required level, it should be noted that 100%

of urgent referrals were seen within 14 days during April 2020 in Belfast and Western

Trusts.


CumApr-20

Belfast 100% 100% 100% 100% 100% 100% 100% 100% 98% 100% 100% 100% 100% 100%

Northern 27% 21% 23% 24% 27% 86% 99% 100% 50% 24% 19% 22% 46% 26%

South Eastern 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 100% 99%

Southern 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 91%

Western 100% 99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

2019/20 83% 75% 80% 80% 77% 96% 100% 100% 89% 81% 78% 79% 86% 77%

As Board members are aware, the regional position (77%) is primarily as a result of

performance in the Northern HSC Trust (26%) which has been impacted by

increased demand and staffing issues.

A public consultation on the proposals for the future model of breast assessment

services for the population of Northern Ireland was undertaken during 2019/20. Any

changes to the service will be considered in the context of dealing with and

addressing the aftermath of the pandemic.

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27%21% 23% 24% 27%

86%

99% 100%

50%

24%19% 22%

26%

0%

20%

40%

60%

80%

100%


NHSCT - Urgent breast cancer referrals - % <14 days

% <14 days

Cancer (31 days)

Regionally during April 2020, 96% of cancer patients commenced treatment within 31

days of the decision to treat (standard: 98%).


CumApr-20

Belfast 88% 89% 87% 90% 91% 88% 87% 87% 91% 87% 91% 92% 89% 95%

Northern 98% 85% 92% 78% 94% 89% 92% 85% 96% 96% 95% 92% 91% 97%

South Eastern 90% 94% 93% 86% 93% 89% 93% 94% 91% 93% 91% 93% 92% 97%

Southern 100% 100% 99% 100% 98% 99% 96% 96% 98% 98% 97% 97% 98% 97%

Western 98% 99% 99% 100% 98% 99% 99% 99% 100% 100% 99% 100% 99% 95%

Region 93% 93% 93% 91% 94% 92% 92% 91% 94% 93% 94% 94% 93% 96%

Cancer (62 days)

Regionally during April 2020, 51% of patients urgently referred with a suspected cancer

began their first definitive treatment within 62 days (standard: 95%).

10


CumApr-20

Belfast 50% 33% 44% 39% 39% 42% 44% 41% 44% 32% 45% 48% 42% 43%

Northern 64% 64% 56% 58% 63% 51% 60% 57% 55% 60% 44% 66% 58% 56%

South Eastern 43% 40% 44% 40% 56% 33% 37% 50% 37% 31% 31% 50% 41% 51%

Southern 82% 60% 73% 73% 76% 62% 59% 59% 60% 61% 69% 58% 65% 59%

Western 59% 60% 64% 62% 62% 60% 56% 66% 61% 54% 67% 56% 61% 53%

2019/20 58% 49% 55% 53% 57% 49% 50% 52% 51% 44% 49% 54% 51% 51%

There has been a reduction in red flag demand in April due to the pandemic. As a

result, all Trusts with the exception of Belfast have reported that all cancer patients who

are suitable to be listed for surgery have a scheduled date, either locally, or within the

Independent Sector facilities secured by the HSC. Red flag demand is however starting

to increase again and this will result in an increase in the demand for surgery.

A Cancer Reset Cell has been established involving representatives from the

Department, HSCB, PHA, NICaN and Trusts to set out the approach to implementing

the reset of cancer services (assessment and treatments), taking into account the

potential need for the HSC to respond to further Covid-19 surge(s) in 2020 and the

existing capacity constraints in HSC. The objectives of the Cell will be to agree the

services to be restarted on a regional basis taking into account national guidance and

PPE, social distancing and decontamination constraints; develop proposals for

redistribution of cancer surgery across Trusts to maximise treatment capacity and

equalise waiting lists (based on clinical priority) where possible and taking into account

innovative practice embedded during the first Covid-19 wave; ensure equitable access

for red flag surgery and endoscopy within IS whilst Head of Terms contract is active –

ensuring that capacity is fully utilised and all clinically suitable patients are offered the

opportunity to be seen there; and, equalisation of red flag/ urgent imaging waiting lists

across the region.

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4. Mental Health Services

It should be noted that the end of April 2020 waiting time figures reported in the

following charts/tables are provisional and are therefore subject to change.

The uncertainty and concern about the pandemic combined with the impact of the

lockdown will have had an adverse impact on mental health, especially for the most

vulnerable in society. Additional support for mental health and resilience have been

provided, however it is likely that there will be significant need coming forward the

lockdown eases. In this context, delivering on the mental health action plan launched in

May 2020 will be essential.

Child and Adolescent Mental Health Services (CAMHS)

The number of patients waiting longer than nine weeks to access CAMHS has

increased – at the end of April 2020, 919 patients were waiting longer than nine weeks

compared to 707 at the end of March (+212).

612529

583

671735

629 606 625

745 745

603

707

919

0

200

400

600

800

1,000


CAMHS - Number of patients waiting longer than 9 weeks

CAMHS - >9 weeks

Trust Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20

Belfast 177 222 289 303 302 332 259 218 204 273 285 255 271 178

Northern 212 274 107 101 130 138 118 121 127 155 131 42 26 26

South Eastern 0

Southern 0 0 0 0 0 0 0 0 0 0 0 0 52 227

Western 98 116 133 179 239 265 252 267 294 317 329 306 358 488

Region 487 612 529 583 671 735 629 606 625 745 745 603 707 919

Regionally almost all patients (98%) waiting longer than nine weeks at the end of April

2020 were waiting to access PMHS Step 2 services (273), i.e. routine referrals for

children and young people who are experiencing mild/moderate mental health

difficulties and Step 3 services (633) (complex needs).

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ServiceBelfast Northern

South

EasternSouthern Western

Region

Total

Drug and Alcohol Mental Health Services (DAMHS) 0 0 0 0 2 2

Core CAMHS Step 3 130 3 0 101 399 633

Crisis Resolution/Home Treatment 0 0 0 0 0 0

Eating Disorder Services 0 0 0 0 0 0

Regional Gender Identity Service (KOI) 0 0 0 0 0 0

Primary Mental Health Services (PMHS) Step 2 37 23 0 126 87 273

Regional Trauma Services 11 0 0 0 0 11

Trust Total 178 26 0 227 488 919

CAMHS Services - Breach Analysis April 2020

Adult Mental Health Services (9 weeks)

Regionally at the end of April 2020, 1,596 patients were waiting longer than nine weeks

compared to 1,158 at the end of March 2020 (+438).

1,5571,493

1,267 1,246 1,209

996

830 796

993 1,018 957

1,158

1,596

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800


Adult Mental Health Services - Number of patients waiting longer than 9 weeks

Adult Mental Health - >9 weeks


Belfast 107 82 24 20 16 39 32 30 47 45 78 76 144 161

Northern 6 4 0 0 2 1 0 0 0 0 0 0 0 0

South Eastern 72 15 17 11 0 6 5 0 8 53 129 127 153 62

Southern 640 688 699 582 542 426 242 114 125 264 271 254 384 697

Western 704 768 753 654 686 737 717 686 616 631 540 500 477 676

2019/20 1,529 1,557 1,493 1,267 1,246 1,209 996 830 796 993 1,018 957 1,158 1,596

Regionally at the end of April 2020, the majority of patients waiting longer than nine

weeks, 1,086 (68%), were waiting to access primary care mental health teams, mainly

in the Southern (447) and Western (563) Trusts.

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ServiceBelfast Northern

South


Region

Total

Addiction Services 0 0 2 195 73 270

Community Mental Health Teams 1 0 60 16 0 77

Community Mental Health Teams for Older People 81 0 0 0 35 116

Eating Disorder Services 3 0 0 24 5 32

Forensic Services 0 0 0 0 0 0

Personality Disorder Services 0 0 0 15 0 15

Primary Care Mental Health Team 76 0 0 447 563 1086

Trust Total 161 0 62 697 676 1596

Mental Health Services - Breach Analysis April 2020

Dementia Services (9 weeks)

Regionally the number of patients waiting longer than nine weeks to access dementia

services has increased from 746 at the end of March 2020 to 1,127 at the end of April

2020 (+381).

308357 343 331

513 498 480399

459

581 546

746

1,127

0

200

400

600

800

1,000

1,200


Dementia Services - Number of patients waiting longer than 9 weeks

Dementia Services - >9 weeks


Belfast 53 33 16 6 22 22 7 4 6 6 22 23 41 135

Northern 2 4 1 0 0 0 0 0 0 0 0 0 37 37

South Eastern 129 136 190 173 165 285 278 283 257 273 348 338 382 484

Southern 10 12 20 17 18 49 50 34 20 27 41 16 69 162

Western 87 123 130 147 126 157 163 159 116 153 170 169 217 309

2019/20 281 308 357 343 331 513 498 480 399 459 581 546 746 1,127

5. Psychological Therapies (13 weeks)

At the end of April 2020, 3,465 patients were waiting longer than 13 weeks for

psychological therapy compared to 3,162 at the end of March (+303).

14

2,186 2,323 2,346 2,473 2,548 2,572 2,686 2,7082,884 2,941 3,025 3,162

3,465

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000


Psychological Therapies - Number of patients waiting longer than 13 weeks

Psychological Therapies - >13 weeks


Belfast 753 759 746 767 810 819 856 804 811 856 890 907 951 1,003

Northern 73 115 135 126 145 137 80 50 37 54 74 90 57 57

South Eastern 413 442 510 570 622 670 706 861 867 897 880 883 943 1,011

Southern 279 299 323 263 224 195 181 191 200 226 231 249 274 327

Western 508 571 609 620 672 727 749 780 793 851 866 896 937 1,067

2019/20 2,026 2,186 2,323 2,346 2,473 2,548 2,572 2,686 2,708 2,884 2,941 3,025 3,162 3,465

The majority of patients (89%) waiting longer than 13 weeks regionally at the end of

April 2020 for psychological therapy services were in Belfast (1,003), South Eastern

(1,011) and Western (1,067) Trusts.

Service Belfast NorthernSouth


Region

Total

Adult Mental Health 197 4 635 197 605 1638

Primary Care Hub 0 0 0 0 0 0

Older People-Functional Services 0 0 44 0 8 52

Adult Learning Disability 51 12 41 36 123 263

Children's Learning Disability 4 1 25 15 148 193

Adult Health Psychology 272 40 198 79 27 616

Children's Psychology 28 0 68 0 156 252

Psychosexual Services 439 0 0 0 0 439

Neurodisability Services 0 0 0 0 0 0

Specialist Trauma Care 12 0 0 0 0 12

Trust Total 1,003 57 1,011 327 1,067 3,465

Psychological Therapies Services - Breach Analysis April 2020

Conclusion

More detail on the actions being taken in relation to these and other performance areas

will be provided by the relevant Directors at the board meeting.

Lisa McWilliams Interim Director of Performance Management and Service Improvement June 2020

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Annex A SUMMARY AGAINST THE HEALTH AND SOCIAL CARE (INDICATORS OF PERFORMANCE) DIRECTION (NORTHERN IRELAND) 2019/20

Indicator of Performance Trend Analysis

Outcome: Reduction of health inequalities

Child health and wellbeing

A19. Proportion of looked after children who have experienced more than two placement changes.

A20. Length of time for best interest decision to be reached in the adoption process.

SSource: CIB (AD1 Community Information Return) ('Year' is financial year). CIB will be publishing 2019/20 figures on 20 Nov 20

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A21. Number of school age children in care for 12 months or longer who have missed 25 or more school days by placement type.

Trust 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Residential Care 44 41 42 43 42 24 31 15 15

Non-Kinship Foster Care 22 25 28 20 34 35 33 23 23

Kinship Foster Care 34 25 24 24 39 48 45 47 47

Placed with Parent 35 23 20 30 37 37 40 33 33

Other 7 7 10 13 5 0 5 1 1

Northern Ireland 142 121 124 130 157 144 154 119 119

Source: CIB OC2 Return (these figures are based on Dept returns). CIB will be publishing these figures on 31st August 2020

NB: Due to Social Work Industrial Action and COVD-19 figures for 17/18 have been rolled over for 18/19

A22. Proportion of school aged children who have been in care for 12 months or longer who have a personal education plan.

Trust 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Belfast 83.0% 85.0% 92.0% 93.0% 93.0% 91.0% 91.0%

Northern 59.0% 71.0% 80.0% 81.0% 90.0% 86.0% 86.0%

South Eastern 79.0% 91.0% 91.0% 89.0% 82.0% 84.0% 84.0%

Southern 83.0% 95.0% 86.0% 88.0% 85.0% 82.0% 82.0%

Western 87.0% 84.0% 86.0% 92.0% 87.0% 94.0% 94.0%

Region 77.0% 84.0% 87.0% 89.0% 88.0% 88.0% 88.0%

Source: CIB OC2 Return (these figures are based on Dept returns). CIB will be publishing these figures on 31st August 2020

NB: Due to Social Work Industrial Action and COVD-19 figures for 17/18 have been rolled over for 18/19 Source: CIB OC2 Return (these figures are based on Dept returns). CIB will be publishing these figures on 31st August 2020

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A23. Percentage of care leavers aged 16-18 in education, training or employment by placement type.

2018/19 and 2019/20 position is not yet available

A24. Percentage of care leavers at age 18, 19 and 20 years in education, training or employment. Q4 2019/20 position is not currently available.

76.9% 78.1% 78.4% 78.6% 78.8% 78.1% 79.0% 78.2% 78.4% 78.6% 78.6% 77.2%

77.1% 77.8% 78.0% 76.4% 78.1% 77.0% 78.3% 78.6% 79.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

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

Percentage of Care leavers at age 18, 19 and 20 years in education, training and employment

2018/19 2019/20

Trust Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

Belfast 79.9% 81.3% 84.3% 83.3% 83.7% 83.3% 82.4% 80.4% 82.1%

Northern 72.3% 73.3% 72.7% 67.9% 72.5% 69.7% 72.2% 78.2% 77.9%

South Eastern 77.8% 78.7% 78.9% 77.2% 79.6% 79.6% 79.3% 80.0% 80.0%

Southern 81.0% 78.4% 76.0% 77.9% 78.9% 79.7% 81.3% 80.1% 84.1%

Western 75.9% 77.8% 77.8% 76.8% 76.7% 74.6% 77.6% 74.8% 74.3%

Region 77.1% 77.8% 78.0% 76.4% 78.1% 77.0% 78.3% 78.6% 79.5%

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Outcome: People using health and social care services are safe from avoidable harm

Hospital Care

B2. Number of records audited achieving 95% compliance of the accurately completed NEWS charts in all adult inpatient wards (excluding theatres and critical care departments).

Due to Trust submission dates for this information, this will be provided at a later date.

B3. Number of incidents of hospital-acquired pressure ulcers (grade 3 and 4) occurring in all adult inpatient wards, and are classed as unavoidable from the current baseline data.

B4. Percentage compliance with the falls safe improvement bundle specified settings including adult acute inpatient and elderly care settings.

Outcome: Health and social care services are centred on helping to maintain or improve the quality of life of people who use them

Primary Care

D2. Percentage of routine GP “out of hours” calls triaged within one hour.

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D3. Total out of hours GP attendances.

D4. Number of GP referrals to emergency departments.

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NI Ambulance Service

D6. (i) Patient handover times and (ii) ambulance turnaround times by length of time (less than 15 minutes; 15-30 minutes; 31-60 minutes; 61-120 minutes; and more than 120 minutes)

NB - Due to NIAS changing their recording procedures there was no daily returns submitted

for the period of 11th-17th November. Therefore a November position is incomplete and unable to be reported on.

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Acute Care

D8. Percentage of new and unplanned review attendances at emergency care departments waiting: less than 30 minutes, 30 minutes to 1 hour, 1 to 2 hours, 2 to 3 hours, 3 to 4 hours, 4 to 6 hours, 6 to 8 hours, 8 to 10 hours, 10 to 12 hours and 12 hours or more, before being treated and discharged or admitted.

D9. Total time spent in emergency departments including the median, 95

th percentile and

single longest time spent by patients in the department, for admitted and non-admitted patients.

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24


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D10. (a) Number and percentage of attendances at emergency departments triaged (initial

assessment) within 15 minutes; (b) time from arrival to triage (initial assessment) for (i) ambulance arrivals and (ii) all arrivals; and (c) time from triage (initial assessment) to start of treatment in emergency departments.

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27


28


29


30


31


32


D11. Percentage of patients triaged at levels 1, 2, 3, 4 and 5 of the Manchester Triage scale

at Type 1 or 2 Emergency Departments.

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D12. Time waited in emergency departments between decision to admit and admission including the median, 95

th percentile and single longest time.

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D13. Percentage of people who leave the emergency department before their treatment is complete.

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D14. Percentage of unplanned re-attendances at emergency departments within seven days of original attendance.

Elective Care

D19. Number of GP and other referrals to consultant-led outpatient services.

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D20. Percentage of routine diagnostic tests reported on (i) within two weeks and (ii) within

four weeks of the test being undertaken.

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Specialist drug therapies

D21. Number of patients waiting longer than three months to commence NICE approved specialist therapies for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or psoriasis.

March 2020 position is not currently available.

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21

8

28

46

12

6

0

10

20

30

40

50

Jun Sep Dec Mar

Number of patients waiting longer than 3 months to commence NICE-approved specialist therapies for rheumatoid arthritis, psoriatic arthritis, ankylosing

spondylitis or psoriasis.

2018/19 2019/20

Trust of Residence Mar-19 Jun-19 Sep-19 Dec-19

Belfast 0 0 0 0

Northern 0 5 0 3

South Eastern 0 0 0 1

Southern 14 17 0 0

Western 14 24 12 2

Region 28 46 12 6

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D22. Number of patients waiting longer than 13 weeks to commence NICE-recommended therapies for Multiple Sclerosis (MS), or therapies under the UK Risk Sharing Scheme for disease modifying treatments for MS.

10

6

0 00 0 0 00

10

20

Jun Sep Dec Mar

Number of patients waiting longer than 13 weeks to commence NICE-recommended therapies for multiple sclerosis (MS)

2018/19 2019/20

Trust of Residence Mar-19 Jun-19 Sep-19 Dec-19 Mar-20

Belfast 0 0 0 0 0

Northern 0 0 0 0 0

South Eastern 0 0 0 0 0

Southern 0 0 0 0 0

Western 0 0 0 0 0

Region 0 0 0 0 0 D23. Number of patients waiting longer than six weeks to commence specialist drug

treatment for wet AMD for the first eye, and six weeks for the second eye.

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Maternity

D24. Intervention rates, including percentage of babies born by caesarean sections.

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D25. Number of babies born in midwife-led units.

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Outcome: People, including those with disabilities, long term conditions, or who are frail, receive the care that matters to them

Supporting Independence

E1. Number of client referrals passed to reablement; number of clients starting a reablement scheme; and number of clients discharged from reablement with no ongoing care package required.

February and March 2020 position not currently available.

8,068

630 740 640 678 677 659 664 685 669 764

6,806

0

2,000

4,000

6,000

8,000

10,000

12,000Number of clients screened as meeting re-ablement criteria

Trust 2018/19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 2019/20

Belfast 1,857 181 212 179 196 185 169 179 194 192 185 1,872

Northern 1,420 114 121 101 132 143 132 131 108 128 141 1,251

South Eastern 1,037 42 57 75 51 47 32 34 68 61 75 542

Southern 1,609 127 141 132 128 133 129 145 145 129 168 1,377

Western 2,145 166 209 153 171 169 197 175 170 159 195 1,764

Region 8,068 630 740 640 678 677 659 664 685 669 764 6,806

5,768

435 476 447 454 496 498 478 458 439 541

4,722

0

2,000

4,000

6,000

Number of clients who started on a re-ablement scheme


Belfast 1,390 109 124 106 128 154 145 143 133 152 139 1,333

Northern 1,193 116 108 86 101 118 134 110 97 102 125 1,097

South Eastern 963 38 51 73 48 44 28 34 55 41 63 475

Southern 1,203 100 100 106 90 98 96 106 106 78 124 1,004

Western 1,019 72 93 76 87 82 95 85 67 66 90 813

Region 5,768 435 476 447 454 496 498 478 458 439 541 4,722

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2,572

200 236 228 216 220 197 222 212 195 256

2,182

0

500

1,000

1,500

2,000

2,500

3,000

Number of clients discharged from reablement with no on-going care package required


Belfast 579 55 69 44 62 69 69 67 64 74 77 650

Northern 370 39 45 26 38 38 33 28 28 19 39 333

South Eastern 457 11 15 34 9 13 12 13 27 21 14 169

Southern 719 64 63 82 66 57 52 67 57 57 81 646

Western 447 31 44 42 41 43 31 47 36 24 45 384

Region 2,572 200 236 228 216 220 197 222 212 195 256 2,182

Outcome: Supporting those who care for others

F1. Number of carers assessments offered, by Programme of Care. Q4 2019/20 position not currently available. 17,765

12,494

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

2018/19 Q1 Apr-Jun 19 Q2 Jul - Sep 19 Q3 Oct-Dec 19 Q4 Jan- Mar 20 2019/20 Cum

Number of carers’ assessments offered, by Programme of Care

Trust 2018/19Q1 Apr-

Jun 19

Q2 Jul -

Sep 19

Q3 Oct-

Dec 19

Q4 Jan-

Mar 20

2019/20

Cum

Belfast 3,099 710 740 845 2,295

Northern 5,994 1,630 1,751 1,732 5,113

South Eastern 2,347 555 668 633 1,856

Southern 4,292 896 681 727 2,304

Western 2,033 369 293 264 926

Region 17,765 4,160 4,133 4,201 12,494

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F2. Number of short break hours offered, as reported in HSCB Adult Short Breaks Activity Report.

Q4 2019/20 position not currently available.

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Outcome: Ensure the sustainability of health and social care services.

Hospital Efficiency

G1. Number, rate and ratio of new and review outpatient appointments cancelled by hospitals.

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G2. Number and percentage of hospital cancelled appointments in the acute programme of

care with an impact on the patient. This information is currently unavailable.

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G3. Rate of new and review outpatient appointments where the patient did not attend, by HSC Trust.

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G8. Percentage of operations cancelled for non-clinical reasons. February and March 2020 position not currently available.

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