integrated performance report - haringey ccg papers/20150603/item 5.3b... · beh mht key quality...

Haringey CCG MDT Integrated

Contract Monitoring Report

May 2015

Executive Summary

2

Executive Dashboard

3

The data below is for the reported month or quarter only and not cumulative

Executive Summary

Contents

4

Title page

Overview and Performance 6

Quality Summary 10

HCCG Quality Issues 11

NMUH Key Quality Issues 14

UCLH Key Quality Issues 17

Whittington Key Quality Issues 20

Whittington Community Summary 23

BEH MHT Key Quality Issues 24

LAS Performance Summary 25

HCCG Finance Heat Map 26

Executive Summary

5

Overview and Performance Issues & Priorities

Summary

As at Month 1 - 2015/16, the year to date and forecast financial position is breakeven.

Contract negotiations with the North Middlesex University Hospital (MNUH) are on-going although the financial elements have now been agreed.

Contracts have been signed with the Central and North West London and Camden & Islington Foundation Trusts.

The following providers have agreed contracts but as yet they remain unsigned: Whittington Hospital (WH), Royal National Orthopaedic Hospital (RNOH),

St Georges Hospital, Royal Marsden and BMI Healthcare Hospitals.

Performance

A&E

The CCG failed to meet the standard for the full year (2014/15), with performance at 94.39%. March 2015 performance was 93.03%, which was the sixth

consecutive month below the standard. NMUH and Whittington make up approximately 80% of CCG activity, both Trusts failed the standard in March 2015

and for the full year. Attendance numbers in March 2015 were 11,565 (up from 10,830 in the previous month), the number of breaches fell to 806 (from

866 in February 2015).

To improve weekend discharge rates, the NMUH has implemented the following: nurse-led discharge process; reviewing ‘Acute Medical Intervention

Complete’ (AMIC) lists on daily basis to increase visibility of AMIC patients, use of Matron weekend cover to expedite discharges and increase discharges

before 10am to alleviate bed management pressures. It is recommended that HCCG monitor the effectiveness of the Whittington’s ‘Rapid Assessment and

Treatment area’ (in Emergency Department) through contact with the lead CCG. The aim is to redirect primary care and ambulatory care patients to the

appropriate pathway rather than through A&E.

The CCG continues to monitor the effectiveness of the NMUH specific and the system wide plans to improve A&E performance, including, but not

exclusive to reducing ambulance arrivals, and increasing the availability of community beds.

Executive Summary

6

A&E Performance Tables

2.7%

44.1%

3.4%

30.9%

4.7% 14.2%

2013-14 Haringey CCG A&E activity by trust 2013-14

BCF NMH RFH Whitt UCLH Others

2.7%

38.9%

3.5%

31.6%

4.5% 18.8%

2014-15 Haringey CCG split of A&E activity by trust 2014-15

BCF NMH RFH WHIT UCLH Others

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

0

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15

Total attendances % Within 4 hrs (All types) Target

Executive Summary

7

Performance Issues & Priorities

RTT

CCG wide data is available from the central system a month earlier than the published Trust wide position for the RTT standards (as shown on page 4),

so we are able to report that HCCG achieved all the standards for the month of March 2015, and the full year RTT performance is as follows:

• Admitted – 89.5% (Failed – Standard 90%)

• Non admitted – 95% (Achieved – Standard 95%)

• Incomplete – 91.4% (Failed – Standard 92%)

The failure for the year for the admitted and incomplete standards was caused by the HCCG’s patients having to wait longer for treatment. A programme

of work at hospitals ensured that extra patients were treated and the CCG has finished the year having achieved the three standards for the last four

months and this performance is expected to continue.

Incomplete

• 788 breaches in March 2015 (Whit: 339; NMUH: 190; Others: 112; UCLH: 94; RFL: 53;)

• Main specialty breaches: General Surgery (152 breaches); Trauma & Orthopaedic (120); Other (111); Opthalmology (93).

RFL: National reporting will follow within the first six months of the reporting year (2015/16). A provisional date has been agreed with Barnet CCG and will

be publicised once the demand and capacity assumptions have been proved.

The outlook for 2015/16 appears positive for Haringey in as much as the CCG has achieved each of the three RTT standards in the last three months of

2014/15.

Diagnostics

The diagnostic tests 6 weeks standard was not met in February 2015 (98.8%). As anticipated, the CCG did not meet the 99% standard for the full year

(98.6%). In the last 4 months of the year (2014/15) the combined underperformance of UCLH (mainly) and RFL have impacted negatively on the CCG

performance, resulting in the CCG failing the standard 3 out of the last 4 months.

Of the 64 patients waiting more than 6 weeks:

• 27 breaches were at UCLH (91.6% - standard not achieved); 11 breaches at RFL (97.0% - standard not achieved); 11 breaches at WH (standard ;

achieved); 13 at NMUH (standard achieved); The main breaches by modality: Colonoscopy (13), Gastroscopy (13), and MRI (11)

Executive Summary

8

Performance Issues & Priorities

Diagnostics (contd)

NMUH and WH to maintain standards of performance.

UCLH to improve performance; they have provided a trajectory and an action plan to their lead CCG, which is monitored reviewed biweekly with the Trust.

RFL are failing the standard mainly due to Barnet & Chase Farm endoscopy capacity. A remedial action plan was submitted to NELCSU, the plan was

discussed at the performance review meeting in April 2015 with Barnet CCG and NELCSU.

UCLH reduced the number of breaches in February and March 2015. This progress should continue into the new year (2015/16) given the improvement

action plan that is currently in place should increase the chances of HCCG achieving the Diagnostics standard in each month for 2015/16.

Cancer Waits

The CCG met 7 out of 8 cancer wait standards in February 2015; it did not meet the 62 day Urgent GP referral (81.3% - standard is 85%).

Year to date the CCG is achieving all the standards except the 2 week wait standard (92.96%). The CCG should meet all the cancer targets for the full

year, provided it maintains its current levels of monthly performance in March 2015. For the two week wait, it needs to achieve approximately 95% in March

2015 to achieve the standard for the full year.

UCLH is improving cancer waiting performance against 2 week wait breast, 31 days (first treatment) and 62 day GP referrals over the short and medium

term to reduce the chances of HCCG from underperforming against any of the Cancer standards.

UCLH progress is discussed at the following:

• Weekly review at Cancer waits group meetings

• Progress reports reviewed at CQRG meetings

• Bi-monthly joint programme Boards meetings

• CCSG quarterly meetings

• Risk register maintained

Executive Summary

9

Haringey CCG Quality Summary

Quality Standards

Theme KPI / Measure

Month Target Month YTD Month YTD Month YTD Month YTD

MRSA reported infections Feb-15 0 0 0 0 2 1 2 0 5

C. Difficile reported infections Feb-15 37 (CCG) 3 42 0 15 11 100 7 58

Mixed Sex Accommodation (MSA) (Number of breaches) Mar-15 0 0 0 0 30 19 223 9 36

VTE (% admitted patients assessed for VTE risk) Feb-15 N/A 85% N/A 94% N/A 91% N/A 92% N/A

Friends and Family Test Inpatients - Score Feb-15 94% 90% N/A 86% N/A 96% N/A 88% N/A

Friends and Family Test Inpatients - Response Rate Feb-15 N/A 31% N/A 48% N/A 39% N/A 44% N/A

Friends and Family Test A&E - Score Feb-15 87% 53% N/A 92% N/A 94% N/A 87% N/A

Friends and Family Test A&E - Response Rate Feb-15 N/A 23% N/A 24% N/A 21% N/A 47% N/A

Complaints – number received in latest reported quarter Q4 N/A 59 677 71 340 Q3: 225 622 N/A N/A

Complaints - % responded to within 25 working days

SHIMI rate July13-June14 N/A 87 87 54 54 80 80 89 89

Number of acquired pressure ulcers grade 3&4 New Feb-15 N/A 7 N/A 0 N/A 1 N/A 1 N/A

Pressure ulcers All (2,3,4) Feb-15 N/A 41 N/A 17 N/A 16 N/A 54 N/A

Serious incidents Mar-15 N/A 16 97 3 103 36 264 23 376

The number of patient falls with severe harm Feb-15 N/A 1 N/A 0 N/A 0 N/A 0 N/A

Safer Staffing – Qualified Day Feb-15 N/A 88% N/A 104% N/A 96% N/A 94% N/A

Safer Staffing – Non Qualified Day Feb-15 N/A 79% N/A 115% N/A 123% N/A 106% N/A

Safer Staffing – Qualified Night Feb-15 N/A 94% N/A 101% N/A 99% N/A 100% N/A

Safer Staffing – Non Qualified Night Feb-15 N/A 93% N/A 124% N/A 140% N/A 117% N/A

NMUH Whittington UCLH RFH

Qu

alit

y

Executive Summary

10

Quality Issues & Priorities

Clostridium Difficile (C-diff)

Haringey CCG’s target for total numbers of acquired infections for the year is 37 – by November 2014 that target had already been exceeded. The total

number to date (February 2015) is now 51, of which 24 were allocated to the community.

At NMUH the number of hospital acquired C-diff infections is higher than the annual target. For the full year, 46 cases were reported and 12 of these have

been found to be caused by lapses of care. As in all such cases a detailed analysis of the cause of each lapse of care attributed infection is undertaken

jointly by the CCG and the Trust and agreed remedial actions are put in place at the Trust. This remedial action plan approach has resulted in a steady

reduction in the numbers allocated to hospital lapses of care.

Mixed Sex Accommodation (MSA)

Haringey CCG had five breaches in March 2015, all of which are attributable to UCLH. Breaches tend to occur at hospitals with large numbers of intensive

care beds, because when a patient becomes fit to return to a ward they have to be placed within 12 hours before they become an MSA breach. UCLH are

continuing with previous actions and the working group is meeting fortnightly until further notice. Some of the actions include daily meetings with the site

team and surgical specialities.

Venous Thromboembolism (VTE) – Percentage of admitted patients assessed for VTE risk

All local Trusts are achieving this standard year-to-date except UCLH, which achieved 91% in January 2015. UCLH is reviewing VTE to make sure that

assessments are made of appropriate patient cohorts and will provide an update to the Clinical Quality Review Meeting (CQRM) in April 2015. UCLH

achieved 91% in January 2015.

Friends & Family Test (FFT)

- Whittington Health achieved a score of 91.6% from A&E patients (and an improving response rate of 24.13%); and a score of 86.4% from inpatients

(response rate of 47.81%).

- NMUH achieved a score of 52.9% from A&E patients (the lowest in London) and a response rate of 22.74% (the previous month response rate was

66.36%); For inpatients the score was 90.3% and the response rate was 31.36%. In both cases these scores (not the response rates) represent a decline

from the previous month.

- UCLH achieved a score of 94.6% from A&E patients (down from the previous month) and 96.1% from inpatients (improved form the previous month).

- RFL achieved a score of 87.0% from A&E patients and 87.5% from inpatients. Both of these scores represent an improvement on the previous month’s

scores.

Executive Summary

11

Quality Issues & Priorities

Improving Access to Psychological Therapies (IAPT)

The IAPT service has met its access trajectory of 15% in the last quarter of 2014/15. Figures show that the IAPT service provided for 4,948 patients

entering treatment in 2014/15, exceeding the target of 4,776 by 4%. In 2014/15 the service achieved an access rate of 14.34%, exceeding the target of

13.85%. The recovery rate in March 2015 was 49.5%, just short of the 50% target, and 45% for the year as a whole. The service has developed a clinical

plan to help its clinicians continue to improve the recovery rate in 2015/16. Reliable recovery is 56% for the year as a whole. Early results for April 2015

show that the service has treated 370 patients, exceeding the target of 340.

Dementia Diagnostic Recording

Haringey CCG’s dementia diagnostic recording rate was 56.94% in December 2014. There has been a small but steady increase in recent months and a

sharp increase is expected in March 2015. 32 practices report signing up to the Enhanced Service and by the end of January 2015 27 practices reported

carrying out the data coding exercise. Visits have been made to three practices resulting in the identification of 30 further patients.

Executive Summary

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NHS HARINGEY CCG

2014-15

Referral to treatment times (18 weeks Incomplete) (April 2014 to March 2015)* 91.48% N 92%

A&E waits - All types (April 2014 to March 2015)** 94.38% N 95%

Cancer waits - 14 days (April 2014 to February 2015) 92.96% N 93%

Category A Red 1 ambulance calls (April 2014 to February 2015) 67.58% N 75%

QUALITY PREMIUM 2014-15

(NHS Constitution rights and pledges)

MeasureMeasure

achievedTarget

* For the purposes of the quality premium, the percentage of Incomplete pathways within 18 weeks will be calculated by summing thenumerators (patients waiting within 18 weeks) from each month end and then dividing by the sum of all the denominators (patients waiting)

from each month end.

**The A&E CCG Quality Premium is based on data mapping from NHSE, derived from HES figures. This calculates what proportion of eachprovider’s activity can be attributed to a given CCG. Any activity under 1% is ignored. The total number of attendances is divided by the totalnumber of 4 hour breaches over a 52 week period is used to calculate an overall percentage for the year.

Executive Summary

13

NMUH Key Quality Issues & Priorities

Quality Summary North Middlesex University Hospital

Safety Thermometer

The Trust has missed the Safety Thermometer uploading deadline for March 2015. The data has now been uploaded but shows a Harm Free rate of 77%

against a national average of 93.9% and 94 VTE events. April 2015 data shows a slight improvement, with 83.9% compared to a national average of

93.7%.

The Trust has been contacted and provided the explanation that incorrect data has been uploaded. From this, a new lead has taken on the responsibility of

the Safety Thermometer. The Trust has now put in place a training programme for newly employed staff to address data accuracy issues.

The Trust will present a report at the May CQRG regarding this issue.

Friends & Family Test (FFT)

Using Trust reported data, Inpatient FFT score has improved in March 2015 to 92% from 51% in January 2015 and the A&E FFT score is also slowly

improving, with 69% positive responses in March 2015 compared to 52.9% in February 2015.

Maternity FFT has risen by 2% to 88% of positive responses in March 2015 (Trust data).

FFT continues to be a standing item on all management meetings within A&E, maternity and poor response wards.

The senior management team are working with the team to improve communication, escalation of staff shortages, MDT working/ training, as stress in the

workplace has been a reported theme and is one of the leading causes for staff sickness/absence. An external peer review of maternity services has been

agreed by the Trust.

CQC Improvement Plan

The Trust has now completed all action points on the CQC improvement plan with quarterly discussions between the CQC and the Trust taking place.

The Trust has expressed a desire to be re-inspected soon.

Executive Summary

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CQUIN

Seven local and four national CQUINs are being taken forward with the Trust for 2015/16.

These include:

- Three prevention CQUINs: Smoking, Alcohol and Domestic Violence

- Four patient flow / discharge CQUINs: Medication on discharge, MDT working, discharge summaries and effective discharges (split into increasing

weekday discharged by 12 noon and weekend discharge numbers).

The National CQUINs include: Acute kidney injury, sepsis, dementia and Urgent Care / Ambulatory Care

All bar the Ambulatory Care CQUIN have now been agreed and signed off for inclusion into the contract.

Inspections and Visit

A Health and Safety Executive (HSE) visit took place in March 2015 and an Improvement Notice has been issued for hypodermic devices issued at the

Trust. This is an issue for a number of hospitals.

HSE has given a deadline of 1 June 2015 for making improvements in the use of hypodermic devices. Clinical trials with the new devices will begin in May

2015 with full implementation occurring in June 2015.

Anaesthetic Trainees

Health Education North Central London (HENCEL) have expressed concern about the quality of anaesthetic training trainees receive at NMUH and have

now fully withdrawn their anaesthetic trainees from placements at NMUH.

Weekly telephone conferences are taking place with attendance by commissioners, the TDA and the Trust. An anaesthetic dashboard has been developed

and is starting to show improvements.

In view of the assurance received from the NMUH the weekly teleconference, chaired by the TDA, to review the anaesthetic dashboard has now ceased.

There has been an agreement by all representatives that the oversight is to transfer fully to the CQRG.

The third meeting of the Comprehensive Review Panel was held on 5 May 2015. The Trust presented the outcome of the investigation into the 3 index

cases and reported progress of the departmental review. Commissioners and TDA assured that the Trust will continue to monitor improvements via the

internal Quality and Safety committee. The TDA prepared a letter to communicate the above to commissioners and regulators w/b 11 May 2015.

Executive Summary

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Clostridium Difficile (C-diff)

In March 2015, 4 cases had been noted by the Trust. By the end of Q4 2014/15, 12 lapses of care had been identified. For 2014/15 a total of 46 cases have

been reported. This exceeds the C-diff target of 21.

Key Actions for NMUH include regular audits of cleanliness of all clinical areas and weekly audits of hand hygiene in all clinical areas. The Trust has also

noted the incomplete recording of antibiotic prescribing action or deviation from the Trust antibiotic prescribing protocol were themes in Q3 and Q4 2014/15.

The hospital will ensure antimicrobial prescribing is covered more satisfactorily in the root cause analyses and aim for better protocol compliance.

The Trust has undertaken detailed analysis of the C-diff cases and has found that a substantial proportion are Enfield residents. From this, GP prescribing

has been identified as a potential contributing factor. The analysis has been shared with Enfield CCG.

Quality Account

The Trust has shared their first draft Quality Account with their key stakeholders.

Priorities for 2015/16 include reduction of sepsis, falls and pressure ulcers, improving patient experience in the areas of national surveys and Friends &

Family Test, End of Life Care and for patients with dementia; Effectiveness projects going forward with the focus of PROMs, speciality clinical outcomes

measures and the anaesthetic improvement plan.

A page turning exercise has been undertaken with the Trust requesting:

• Better articulation of targets and outcomes

• Inclusion of the Trust’s Quality Strategy

• Inclusion of Key Achievements/Awards and new approaches to Quality

• Inclusion of collaboration with other providers on quality issues.

The Trust will be issuing a revised version of the Quality Account on 11 May 2015, which will be reviewed and a CCG statement will be drafted by the CSU.

The CCG Quality Account statement will be provided to the Trust by 15 May 2015.

Executive Summary

16

UCLH Key Quality Issues & Priorities

University College London

Mixed Sex Accommodation (MSA)

In March 2015, UCLH reported 19 cases of Mixed Sex Accommodation (MSA). 18 of these were reported at the UCH site and one reported at Queens

Square. This is a reduction in number of breaches reported from the previous month.

The Trust is continuing with previous actions and the working group is meeting fortnightly until further notice. Some of the actions from the group include

daily meetings with the site team and surgical specialties. Going forward, the ward Matrons are to review activity and potential breaches to continue the

investigation into the number of MSAs at UCLH.

MRSA and Clostridium Difficile (C-diff)

The Trust has reported one case of MRSA in February 2015. The year to date figure for 2014/15 is now of two cases reported.

UCLH’s latest validated position reports 11 C-diff cases in February 2015. The year-to-date from April 2014 – February 2015 is 99 cases.

The CSU Infection Control Lead and the CCG meet with the Trust to review and discuss all reported C-diff cases. The one case of MRSA occurred at the

Heart Hospital. Root cause analysis indicates that the infection may have occurred due to the care and use of IV lines.

77 out of the 99 C-diff cases have been successfully appealed as not being lapses in care. 17 cases are still under review. Five cases of C-diff have been

found to be a lapse in care by the Trust.

Cancellations for Elective Surgery

At the March 2015 CQRG, the Trust provided analysis on last minute cancellations by reason for the cancellation and by division. This report revealed

capacity issues as the main reasons for cancellations, specifically bed unavailability and lack of theatre time.

Executive Summary

17


RTT Clinical Harm Review

The Trust provided an update at the April 2015 CQRG of all reported 40+ week wait patients which are clinically reviewed at month end. The process began

with the review of patients waiting 40 weeks or more as at November 2014 and will be on-going.

As at January 2015, there were 371 cases requiring a clinical review. Three of these cases were patients waiting over 52 weeks. The update reported that

half of them have been clinically reviewed and the other half are in the process of being reviewed. The Trust will continue to report progress on the clinical

harm review through the monthly CQRG meetings and clinical harm remains a substantive item for assurance on each CQRG agenda.

In relation to the 52 + week waits, the Trust will continue to chase divisions for the outstanding ones to be reviewed and ensure it is escalated via the weekly

Patient Tracker List (PTL) meetings. Medical Directors have been asked to prioritise these patients for review.

40 + week waits:

• Of 337 cases, 212 have been reported as completed pathways and 125 have been reported as incomplete pathways.

• 184 out of 337 cases have been clinically reviewed, and 153 cases are still outstanding.

• The Trust has not detected to date any evidence of deterioration or significant new morbidity related to delays in treatment for the patients.

52 + week waits:

• At the April 2015 CQRG, an update was also provided by the Trust on the total cases reviewed for patients waiting over 52 weeks, as at the end of

October 2014 there were 98 patients who hadn’t been clinically reviewed. 23 patients were found not to be genuinely waiting for longer than 52 weeks.

Of the 75 patients 41 have been reported as completed pathways and 34 have been reported as incomplete pathways.

• Of the 75 patients, 22 have been clinically reviewed so far, and 53 are still outstanding.

Venous Thromboembolism (VTE)

UCLH have not met the target of achieving 95% VTE compliance reported in August 2014, September 2014, October 2014, November 2014, December

2014 and January 2015. The latest position is 93.95% in January 2015 which has decreased from the previous month (94.13%).

Previous action still remains as a review is being undertaken. This action was originally due to be reported at the March 2015 CQRG. However this was

deferred and will now be reported in April 2015’s meeting. The Trust continues to remind all staff of the responsibility to complete VTE.

Executive Summary

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Safer Staffing

UCLH data shows the average fill rate for registered nurses/midwifes, within the day in February 2015, was 96.07% and 99.26% in the night. The average

fill rate data for care staff in the day is 122.82% and 139.83% in the night.

The CCG will continue to seek assurance through the CQRG and twice yearly board reports on staffing received.

Safety Thermometer

790 patients were surveyed in March 2015, three of whom had developed a new pressure ulcer. Root cause analysis will be completed for the grade 3

pressure ulcer and findings reported to the commissioners. It was highlighted that one patient developed a new grade 3 pressure ulcer in this time.

Serious Incidents (SI)

At the March 2015 CQRG, UCLH presented their internal SI tracker and reported 23 SI reports are being overdue. UCLH reported 36 SIs in March 2015.

The majority of these SIs (36) were relating to pressure ulcers.

The other 4 SIs related to: unexpected admission into NICU (x2), allegation against professional (x1), relating to a patient not in receipt of care (x1).

At the end of March 2015, the Trust had 32 overdue reports, which remains unchanged since February 2015. The CSU/CCG will continue to monitor SIs

through the CQRG and review completed SIs for final sign off and closure at the CSU/CCG SI panels. The Trust report that it has difficulties in identifying

the SI lead when consultants are away. However, there is a default position applied that the SI will sit within the responsibility of the divisional medical

director.

Executive Summary

19

Whittington Key Quality Issues & Priorities

Whittington Health Trust

Serious Incidents

At the CQRG in April 2015 the Trust stated that the overdue Root Cause Analysis Report position had improved from 12 overdue to 9. This was accepted

as a positive reflection of the hard work and determination the Trust had invested in bringing this target back in line. The CCG and CSU SI Panel, held the

week after the April 2015 CQRG, reported that in March 2015 the Trust had 15 reports overdue and no reports had been submitted on time by the hospital.

This gives a very different picture on how the Trust is progressing with investigating serious incidents. This position will be clarified with the Trust and

updated at the next CQRG.

Infection Prevention & Control

For the period 2014/15 there has been two attributable MRSA bacteraemia episodes; one in a surgical patient and one on the Critical Care Unit. These two

infections occurred during the latter half of the year and prior to this the Trust had been MRSA-free for over 14 months.

For the period of 2014/15 there has been 16 attributable Clostridium Difficile (C-diff) cases. The agreed threshold for the Trust was set at 19 cases, which

means the Trust has performed positively against this target and remained below the threshold.

Education sessions, specifically on C-diff prevention and management, continues on all wards and departments to ensure strict compliance with Infection

Prevention and Control (IPC) protocols and procedures.

The Trust continue to take Infection Prevention and Control (IPC) very seriously and 75% of staff at the Trust have received IPC Mandatory Training. Most

of the training is now delivered via E-Learning which has enabled more staff to complete this exercise and improve knowledge of preventative measures.

Probable root causes of both these bacteraemias have been identified and the infection Control Team will continue to monitor, investigate, and feedback

on MRSA colonisation in the Trust.

The agreed threshold for 2015/16 has been set at no more than 17 cases.

Executive Summary

20


Pressure Ulcers

The Trust has continued to demonstrate that hospital Grade 2 acquired pressure ulcers from inpatient care have significantly reduced in comparison to

figures from 2013/14. From April 2013 to January 2014 there were 32 Grade 2 incidents recorded, in the same time period in 2014/15 the Trust recorded 16

incidents, which demonstrates a 50% reduction. The figures for grade 3 inpatient acquired pressure ulcers have not decreased from the previous year and

have in fact increased from 3 in 2013/14 to 7 in 2014/15. The results for grade 4 pressure ulcers has not changed, there were 2 reported in 2013/14 and 2 in

2014/15.

The incidents of grade 2 and 3 pressure ulcers in the community is demonstrating a downward trend in January 2015. The incidents of all grades of

pressure ulcers in the community has been high during 2015/16 with no real general trend of this decreasing.

A safeguarding alert has been raised regarding the care of a patient who had developed a pressure ulcer whilst under the care of Whittington Health. Measures have been implemented in the Emergency Department once the incidence had been recognised to prevent very frail patients from developing

pressure ulcers by ensuring all these patients are transferred to beds with appropriate pressure relieving equipment if their stay in the department is over 6

hours.

A new Pressure Ulcer Safeguarding Pathway was introduced by NHS England in October 2014 which the Trust has now fully implemented into its practices

and pathways and encourages staff to raise alerts where there has been avoidable harm in relation to a pressure ulcer. This new initiative is being

embedded via the Tissue Viability Leads.

The Trust have implemented the SSKIN bundle initiative to support the prevention of pressure ulcers, the components of which are:

Surface

Skin inspection

Keep moving (repositioning)

Incontinence and moisture

Nutrition and hydration

The success of the SSKIN bundle and the increased education has had a significant positive impact on the incidents of grade 2 pressure ulcers on the

wards. The Trust believes the increased incidents of grade 3 pressure ulcers is attributed to an increase in bed stock and patient acuity during the winter

months.

Executive Summary

21


Safeguarding

Safeguarding alerts raised by Whittington Health have not been consistent and to the level that inspires confidence that this policy and procedure has been

widely utilised. In 2014/15 Q1, the Trust reported 15 alerts. However, this decreased to 7 in Q2, and increased to 15 in Q3. In Q3 most of the alerts raised

were by either the District Nursing Team or by the Tissue Viability Team.

Safeguarding training before November 2014 was recorded as a combined figure for level 1 and level 2. This was separated out and it was revealed that the

Level 2 training, which is for all clinical staff, was extremely low at approximately 10% in November 2014 and 28% in December 2014. An external

Safeguarding Review was at the request of the Director of Nursing. This report recognised that the raising of alerts is an issue and that these are mainly

raised by District Nursing Services. It is expected that with an increase in training nurses in the hospital and other professions will begin to raise alerts as

well.

As a result of these figures:

1. All new staff are to receive level 1 and 2 training in their Trust induction.

2. Continued supplementary face to face training for existing employees.

3. Targeted training for areas with low compliance.

The Trust has been without an Adult Safeguarding lead for some time. However it was reported at the April 2015 Clinical Quality Review Group (CQRG)

that this post has now been filled. The recruitment of a matron with experience in the process of Deprivation of Liberty (DOLs) referrals has also made a

significant difference in the number of referrals being made over the last Quarter. The Trust is looking to recruit a named doctor as an Adult Safeguarding

lead.

Friends & Family Test (FFT) and Maternity

The FFT in Maternity has been challenging in some parts of the pathway, namely the Post Natal Ward and the Post Natal Care in the community. The

combined score for maternity in December 2014 was 87% which only increased very slightly in February 2015 to 88.6%. The London benchmark on the

combined Maternity score puts Whittington Health second from the bottom of all applicable hospitals.

This area of concern was raised at the April 2015 CQRG to discuss the benchmarked figures and reasons why the Post Natal pathway is recording so low in

comparison to other parts of the pathway and other Trusts. The mixed methods of data collection is thought to have had a negative influence on the number

of responses obtained. The Head of Midwifery and the Maternity CCG Lead are reviewing the data for FFT to develop a way forward for the Department.

The Chief Operating Officer has stated that much of the poor feedback has been regarding the fabric of the Post Natal Ward, and that there are plans to

rectify this in the Capital plan for 2015/16.

Key Messages

Musculo-Skeletal (MSK)

Significant improvement has been

achieved in MSK physiotherapy and

consultant led services as a result of

validation work that has now been

completed by Whittington Health.

Service Cancellations

Whittington Health Trust are working on a

data quality resolution in relation to the

recorded level of community service

cancellations. However, as the Trust

does not yet have the “open RiO” version

of their electronic patient record, changes

to the drop down lists cannot be made

locally. The Trust will get the open

version in October 2015 and the system

will then be configurable at a local level.

The Trust reports that often clinics are

adjusted in the patients’ favour.

Community Appointment with no

Outcome

Performance against this target is above

the threshold and the Trust has not been

able to achieve performance below the

threshold throughout the year. The Trust

reports delays in updating the outcome of

appointments on the system and those

teams with high levels of un-outcomed

appointments are identified and the

processes to update the system within 48

hours are re-enforced. This issue is

discussed weekly at the Patient Tracker

List meeting.

Theme KPI / Measure Apr-14 May-

14 Jun-14 Jul-14

Aug-

14

Sep-

14

Oct-

14

Nov-

14

Dec-

14

Jan-

15

Feb-

15

2014-

15

Target

Co

mm

un

ity H

ea

lth

(W

hit

tin

gto

n)

Community Dental Service

(Patient Involvement) 96.0% 98.0% 93.0% 94.0% 93.0% 98.0% 95.0% 99.0% 98.0% 97.0% 97.0% 90%

Community Dental Service

(Patient Experience) 99.0% 100.0% 99.0% 100.0% 97.0% 98.0% 99.0% 99.0%

100.0

%

100.0

% 96.0% 90%

Service Cancellations -

Community 4.6% 4.9% 4.5% 4.3% 5.1% 4.3% 7.7% 7.7% 7.7% 7.9% 8.4% 2%

MSK Physiotherapy 93.1% 93.7% 91.1% 93.2% 92.8% 94.7% 93.4% 85.1% 89.7% 88.7% 95.0% 100%

MSK Consultant Led 99.6% 96.6% 91.0% 91.5% 82.7% 72.3% 80.0% 89.0% 99.3% 99.6% DNS 95%

DNA Rates - Community 6.8% 7.3% 7.8% 9.2% 8.0% 8.2% 7.9% 7.6% 6.9% 6.5% 6.8% <=10%

Community Appointment with

no outcome 1.6% 2.1% 4.1% 1.4% 3.5% 1.3% 1.2% 3.4% 1.0% 1.6% 2.0% <0.5%

District Nursing Waiting

Times 98.4% 97.8% 96.6% 98.1% 96.0% DNS 100% 100% 100% 100% DNS

No

Thresh

old

New birth visits 92.8% 92.7% 92.0% 91.7% 89.0% 94.1% 89.8% 91.4% 88.7% 89.3% DNS 95%

Whittington Health Trust

Quality and Performance Dashboard Community Services for Haringey CCG

Executive Summary

23

Barnet Enfield & Haringey MHT Key Quality Issues & Priorities

Barnet Enfield & Haringey Mental Health Trust (BEHMHT)

Serious Incidents (SI)

The number of overdue reports has reduced from eleven in February 2015 to nine in March 2015. The number of open SIs requiring further

information/action has reduced to zero in March 2015. However, the CSU has identified that in March 2015 the reports submitted are not of sufficient

quality to be closed and so this number will rise.

Particular issues include:

• Action plans need to reflect recommendations.

• Duty of Candour not reported

• Reports are not comprehensive – root cause not identified or not appropriate

• Chronology is insufficient

The Trust has investigated and found that:

• Reports were reviewed by borough based SI Groups recently implemented

• Some reports hadn’t been reviewed properly.

By 16 April 2015 the reports had been rewritten and the BEHMHT were to meet with the CSU Patient Safety Team, Mental Health Clinical Specialist,

Senior Clinical Quality Assurance Manager and Enfield CCG Head of Quality to discuss SIs.

Governance Structure

It is suggested that the Governance Structures for BEHMHT are revised with the Technical and Performance meeting held early in the month at the Trust.

Any issues that cannot be resolved would be escalated to the CQRG/CRM. The CRM and the CQRG would be combined and held later in the month.

The two meetings, one focussed on the Mental Health contract with associate commissioners, NHSE and TDA represented and one focussed on

Community Services with Enfield CCG, NHSE and TDA represented would take place. This governance structure would allow for more in depth analysis at

the CQRG/CRM.

For April 2015, a proposed structure will be presented at the Extended Round Table meeting on 7 May 2015. This structure is to be implemented by Q2

2015/16.

LAS Summary

30

LAS Performance Dashboard Target Monthly

Trajectory

March 2015

Performance

Year to Date

Trajectory

Year to Date

Performance

Red 1 Performance (8 minutes) 75% 61.9% 64.6% Red

Red 2 Performance (8 minutes) 75% 52.1% 52.7% Red

Cat A Performance (19 minutes) 95% 92.8% 92.7% Amber

Green 1 Performance (20 minutes) 90% 78.4% 31.7% 78.4% 41.8% Red


Green2 Performance (30 minutes) 90% 71.2% 42.2% 71.2% 45.4% Red






Local CCG Cat A Performance

(08:45 minutes) 75% 58.1% 59.1% Red

Key Messages

The data opposite shows the LAS

performance dashboard with a

Haringey CCG focus. Performance

has deteriorated across all

categories since February 2015.

The recruitment programme will

continue throughout 2015/2016.

LAS as predicted, did not achieve

the 8min target for 2014/15

For year 2014/15 Haringey had

20,741 ED conveyances, 65% were

from NMUH and 28% from the

WHITT. There were 1,674

conveyances to an ED in March

2015, (an increase of 179 since

February 2015), 1,085 conveyances

within Haringey went to NMUH and

455 to the Whittington This equates

to 92% of all ambulance

conveyances from Haringey to an

Emergency Department Care

Pathway location.

The graph opposite shows

performance against LQR category

A (8 minutes and 45 seconds)

including last year’s performance

and London average. 50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

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

Cat A Performance - LAS Total

2013/14 2014/15 Target

40%

50%

60%

70%

80%

90%

100%

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

Cat A Performance - Haringey CCG

2013/14 2014/15 Target

Executive Summary

25

HCCG Finance Heat map by Provider

Annual Variance in Price by Service Provider

POD Group Overview

Barnet and Chase

Farm Hospitals

NHS Trust

Royal Free London

NHS Foundation

Trust

North Middlesex

University Hospital

NHS Trust

Moorfields Eye

Hospital NHS

Foundation Trust

University College

London Hospitals NHS

Foundation Trust Grand Total

Outpatients 690,432£ 190,167£ 1,276,969£ 1,829-£ 582,336£ 2,738,076£

Non-Elective 730,102£ 103,527£ 2,068,703£ 52,729-£ 463,850-£ 2,385,753£

Adj. including RTT & Readmiss ions 498,471£ 481,646£ 367,991-£ 429,046£ 768,070£ 1,809,242£

Elective 682,531£ 316,046£ 124,420£ 106,041-£ 791,975£ 1,808,931£

Diagnostic Imaging 21,255£ 31,092-£ 306,380£ 309-£ 170,511£ 466,745£

Drugs and Devices 43,226£ 61,772£ 268,991£ 236,033£ 170,458-£ 439,564£

Uncoded -£ -£ 253,523£ -£ -£ 253,523£

CQUIN 72,070£ 26,765£ 80,697£ 16,019£ 42,527£ 238,078£

Regular Attenders 44,771-£ 122,759£ 77,988£

PTS 0£ 0£ 13,359£ 12,147£ 25,506£

Maternity 48,328£ 26,317£ 145,095-£ 72,891£ 2,441£

Community 3,395-£ 43,602-£ 46,997-£

Accident and Emergency 252,510£ 14,220£ 624,379-£ 32,647-£ 25,139£ 365,157-£

Cri tica l Care 102,626£ 308,706-£ 33,850£ 202,476-£ 374,706-£

Penalties 1,172,724-£ 1,172,724-£

Grand Total 3,141,552£ 832,496£ 2,182,504£ 500,901£ 1,628,812£ 8,286,265£

To know more

If you would like to discuss any element

of this presentation, please contact Eileen

Moore.

Tel: 020 3688 1983

Email: [email protected]

www.nelcsu.nhs.uk

Report Version: 1.74

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