item number: 6.1 governing body meeting meeting date: 30 ... · was approved by ccgs and was...

Our Vision – to Improve the Health & Wellbeing of our Communities

Item Number: 6.1

GOVERNING BODY MEETING Meeting Date: 30 March 2016

Report’s Sponsoring Governing Body Member: Carrie Wollerton, Executive Nurse

Report Author: Prepared by the CCG Quality and Performance Team

1. Title of Paper: Commissioning for Quality and Outcomes – Quarter 3 Report 2015/16

2. Strategic Objectives supported by this paper: (check those which apply) ☒ To create a viable & sustainable organisation, whilst facilitating the development of a different,

more innovative culture

☒ To commission high quality services which will improve the health & wellbeing of the people in

Scarborough & Ryedale

☒ To build strong effective relationships with all stakeholders and deliver through effectively

engaging with our partners

☐ To support people within the local community by enabling a system of choice & integrated care

☒ To deliver against all national & local priorities incl QIPP and work within our financial resources

3. Executive Summary: This report provides an overview of our progress and activities in respect of our commissioning for quality and outcomes predominantly between 1 October and 31 December 2015. Over this quarter we have seen further improvement towards meeting referral to treatment time targets, with our main provider reducing the number of patients who have waited the longest for treatment and meeting national targets. In cancer we have continued to miss certain targets, not always linked to patient choice, but due to later referrals to tertiary providers within complex pathways and capacity within the teams. Although the quarter 3 performance from an infection control perspective has been relatively steady, we have over more recent weeks (in Quarter 4) seen a deteriorating position in respect of infection prevention and control in terms of noro virus on the Scarborough Hospital site. An additional paper is provided to assure the Governing Body of the actions underway to support the management of this and bring the hospital back to normal operating. We continue to struggle to achieve the 4 hour waiting times target in the accident and emergency (A&E) department on the Scarborough Hospital site. The whole system; local authorities, CCGs, primary care, the ambulance providers and YFT are working together to try to get on top of the pressures. We are being support by a national emergency care improvement team to work through the multiple issues facing the A&E and wider system.

Our Vision – to Improve the Health & Wellbeing of our Communities

For further information please contact: Name: Carrie Wollerton Title: Executive Nurse ☎: 01723 343654

We have seen positive improvements in stroke care on the Scarborough site which has resulted in an overall increase in the rating across and number of care standards and while we welcome this, the Scarborough site remains behind York in terms of overall standards and we continue to work with our clinical network teams and YFT to improve on this and move towards greater parity. 4. Risks relating to proposals in this paper: This paper provides an update to the Governing Body. Risks relating to Quality and Outcomes are managed through the Quality and Performance Committee where detailed discussions and action planning takes place. A risk register is maintained by the Quality and Performance Committee. 5. Summary of any finance / resource implications: N/A 6. Any statutory / regulatory / legal / NHS Constitution implications: N/A 7. Equality Impact Assessment: N/A 8. Any related work with stakeholders or communications plan: N/A 9. Recommendations / Action Required The Governing Body is asked to note this report. 10. Assurance The Quality and Performance Committee receives monthly reports relating to the quality and outcomes of patient care on a wide range of different subject areas.

NHS SCARBOROUGH AND RYEDALE CLINICAL COMMISSIONING GROUP Commissioning for Quality and Outcomes Quarter Three Report 2015/16

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Contents 1. Introduction ........................................................................................................ 3

2. Quality and Performance – Patient Safety ......................................................... 3

2.1 Maternity Services Update ................................................................................. 3

2.2 Mortality - Summary Hospital Mortality Index (SHMI) ......................................... 3

2.3 Ambulance Service ............................................................................................ 4

2.3.1 Response times ................................................................................................. 4

2.3.2 Handover times .................................................................................................. 4

2.4 Serious Incidents (SIs) and Never Events .......................................................... 6

2.4.1 YFT .................................................................................................................... 7

2.4.2 Falls and Pressure Ulcers .................................................................................. 8

2.4.3 Yorkshire Doctors Urgent Care .......................................................................... 8

2.5 Healthcare Associated Infection (HCAI) ............................................................. 8

2.5.1 Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia ................... 8

2.5.2 Clostridium Difficile (C Diff/CDI) SRCCG Cases ................................................ 8

2.5.3 Provider Organisations ..................................................................................... 10

2.5.4 Review of YFT RCAs and ‘No Lapse in Care’ appeals .................................... 10

3. Strategic Clinical Network (SCN) Development ............................................... 11

3.1 Quality & Safety .............................................................................................. 11

3.1.1 Cardiovascular ................................................................................................. 11

3.1.2 Cancer ............................................................................................................. 13

4. Children and Young People update ................................................................. 14

4.1 Looked After Children Activity Dataset ............................................................. 14

4.2 Children and Families Act (Part 3) 2014 .......................................................... 15

4.3 Children’s Autism Diagnostic Assessment Services ........................................ 15

4.4 Future in Mind Local Transformation Plan ....................................................... 16

4.5 Child and Adolescent Mental Health Services.................................................. 16

4.6 Attention deficit hyperactivity disorder (ADHD) ................................................ 16

5. Quality and Performance - Patient Experience ................................................ 16

5.1 CCG Patient Relations ..................................................................................... 16

5.2 Provider Complaints / Feedback ...................................................................... 17

5.2.1 YFT Complaints and Feedback ........................................................................ 17

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5.2.1.1 New Complaints in Quarter 3 (YFT) ................................................................. 18

5.2.1.2 Complaints by Directorate in Quarter 3 (YFT) .................................................. 18

5.2.1.3 Complaints by Primary Subject in Quarter 3 (YFT) .......................................... 19

5.2.1.4 PALS by subject in Quarter 3 (YFT) ................................................................. 19

5.2.2 Tees, Esk and Wear Valley (TEWV) Mental Health Provider .......................... 20

5.2.2.1 Complaints over Quarter 3 ............................................................................... 20

5.2.2.2 PALS for North Yorkshire Services .................................................................. 21

5.3 Referral to Treatment Times (RTT) .................................................................. 21

5.4 Cancer Waiting Times ...................................................................................... 23

5.5 Accident & Emergency Services (A&E) ............................................................ 23

5.5.1 A&E 4 Hour waiting time target ........................................................................ 24

5.6 Friends and Family Test (FFT) ......................................................................... 25

5.6.1 YFT .................................................................................................................. 25

5.6.1.2 Emergency Department ................................................................................... 25

5.6.1.3 Recommendation Rates ................................................................................... 25

5.6.1.4 Commentary ..................................................................................................... 27

5.7 Yorkshire Doctors Urgent Care Service (YDUC) - Patient Experience ............. 28

5.8 Mixed Sex Accommodation (MSA) breaches ................................................... 28

5.9 Continuing Healthcare (CHC) ........................................................................... 28

6. Commissioning for Quality and Innovation (CQUIN) ........................................ 29

7. Care Quality Commission (CQC) ..................................................................... 29

8. Safeguarding Children ..................................................................................... 30

8.1 Section 11 Audit ............................................................................................... 30

8.2 Looked After Children ...................................................................................... 30

8.3 Primary Care .................................................................................................... 30

9. Safeguarding Adults ......................................................................................... 30

9.1 Prevent Duty and CCG Compliance ................................................................. 30

9.2 Channel Panel .................................................................................................. 31

9.3 CQC Engagement meetings ............................................................................ 31

9.4 Adult Safeguarding in Partnership with Continuing Health Care ...................... 31

9.5 Suicide Prevention ........................................................................................... 32

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1. Introduction

The purpose of this report is to provide an overview to the Scarborough and Ryedale Clinical Commissioning Group (the CCG) in relation to the Quality and Outcomes in our main provider services, including examples of improvement work underway. The main focus of the report continues to be related to NHS constitution standards and the Outcomes Framework. This report is additional to the performance exceptions report that is provided bi-monthly to the Governing Body, and aims to give the Governing Body insight into, and overview of some of the proactive and reactive work of the quality and performance team and the measures used to promote patient safety, patient experience and clinical effectiveness.

2. Quality and Performance – Patient Safety

The CCG Quality & Performance Committee continues to meet monthly and discuss a variety of standing and new items at each meeting. The Committee manages a risk matrix which feeds into the corporate risk register. The safety of our patients is fundamental to the business of the CCG. The monitoring of our commissioned services is through contractual arrangements, via national reporting at Trust level, and through the triangulation of data coming into, and sought by the CCG team.

2.1 Maternity Services Update

Service user engagement to inform the strategy for commissioning maternity services was approved by CCGs and was launched week commencing 11th January 2016. This includes paper and online surveys as well as some smaller scale Discover! events within localities. Phase 2 of this work will be the co-production of a maternity strategy in 2016/2017. This work will link to the NHS 5 Year Forward View planning guidance, and will look to support the CCG in consideration of the choice and personalisation agenda in maternity services, and perinatal mental health services. 2.2 Mortality - Summary Hospital Mortality Index (SHMI) There are no updated positions available to report in this quarter beyond that reported

in Quarter two, however we are working on understanding the differences between the

two sites and looking more closely at the weekend vs weekday splits.

As part of the closure of the Yorkshire and Humber Commissioning Support Unit and

the move to a new commissioning support provider we expect to be able to drill down

further into mortality data and we will report further on this and the Trust responses over

the coming quarters.

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2.3 Ambulance Service

2.3.1 Response times

Overall, SRCCG continue to perform reasonably well against the agreed ambulance targets. The Quarter 3 position for both Red 1 and Red 2, 8 minute response time performance was within national targets. As previously reported, Cat A 19 minutes transportation times remain a challenge across the wider geographical patch. Performance for SRCCG, in the past 2 quarters has now fallen below the regional level of performance. Activity within Quarter 3 is now the highest it has been since the formation of CCGs in 2013.

Ambulance Performance Targets

Indicator (SRCCG) Target Oct 15 Nov 15 Dec 15

Red 1 8 minutes 75% 76.9% 73.1% 76.7%

Red 2 8 minutes 75% 78.5% 75.0% 75.1%

Cat A 19 minutes

(transportation time) 95% 89.2% 88.6% 87.2%

We continue to work with Yorkshire Ambulance Service (YAS) to understand reasons where we experience poor performance and support them to put in place improvement measures. Action plans will continue to be monitored and updated as part of the contract monitoring arrangements between commissioners and YAS.

2.3.2 Handover times

Handover and turnaround time - Patient handover is where the professional

responsibility and accountability for the care of the patient is transferred from the

ambulance crew to the medical/nursing staff at the hospital. Timely handover of patient

care can help reduce delays and improve the service offered to patients.

Turnaround time is the overall time taken for the ambulance crew to handover the

patient, and then clean, restock and make the vehicle available to respond to another

call. This is important as it increases the number of patients that YAS can respond to in

a timely manner.

In line with the NHS Contract, YAS are reporting handover times to the Accident and Emergency Department (A&E) staff, with the aim of completing the process within 15 minutes.

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Graph 1 below show the percentage of calls categorised as Red 1 & Red 2 per month that the ambulance crew ‘handed over’ within the target of 15 minutes. The chart also shows the number of calls split by those who were within the target and those outside of it. Graph 2 shows the percentage of calls categorised as Red 1 & Red 2 per month that the ambulance crew turned around, therefore ‘handed over the patient to A&E, cleaned the ambulance and were ready to take the next call’, within the target of 25 minutes. It also shows the number of calls split by those who were within the target and those who fell outside of the target. Graph 1 Graph 2

Delays to handovers of longer than 30 minutes and 60 minutes incur financial penalties. During Quarter 3 (October 15 – December 15), YFT has continued to make reductions in the number of delayed handovers longer than 30 minutes. The graph below shows performance by the Trust for handovers within 15 minutes since April 2015. Handovers within 15 minutes

30%

40%

50%

60%

70%

80%

90%

100%

% w

ith

in 1

5m

ins

Performance for week ending

York District Scarborough General Hospital

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A weekly summary including the proxy number of breaches beyond 30 and 60 minutes is shown below since 4 October 2015 – 3 January 2016. This shows improved performance over the quarter in the number of longer delays with no patient waiting over 120 minutes for 6 weeks out of the 13 weeks.

2.4 Serious Incidents (SIs) and Never Events

The serious incident management process is administered on behalf of the North Yorkshire CCGs by Hull CCG. The team have been collating the number of serious incidents reported by each NHS provider who deliver a service for our patients, plus those patients from surrounding CCGs. The team provide a comprehensive report which is presented each month at our Quality and Performance Committee meeting, the purpose of the monthly report is to allow the North Yorkshire and York (NYY) CCGs to identify emerging themes or trends between providers. The quality leads from each of the NYY CCGs meet together every 4 weeks to discuss each SI in detail, agree challenges to be put back to the provider where further clarification is needed, share learning and best practice, monitor action plans and close off SIs.

Scarborough General Hospital - Performance by Week

Week ending % within 15mins

% 15 to 30 mins

% 30 to 60 mins

% 60 to 120 mins

% > 120 mins

Quarter 3

4/10/2015 64.3% 26.0% 5.3% 4.3% 0.0%

11/10/2015 60.8% 23.1% 11.5% 3.1% 1.4%

18/10/2015 63.5% 24.9% 10.2% 0.6% 0.9%

25/10/2015 60.1% 22.6% 8.2% 7.5% 1.6%

01/11/2015 53.4% 27.5% 15.8% 3.3% 0.0%

08/11/2015 65.3% 23.3% 9.5% 1.9% 0.0%

15/11/2015 64.9% 21.2% 10.1% 3.8% 0.0%

22/11/2015 63.9% 24.6% 7.9% 3.0% 0.7%

29/11/2015 75.9% 20.2% 3.6% 0.3% 0.0%

06/12/2015 53.3% 25.5% 13.5% 6.9% 0.9%

13/12/2015 59.1% 27.3% 10.9% 2.7% 0.0%

20/12/2015 62.6% 21.3% 11.9% 3.5% 0.6%

03/01/2016 61.5% 20.2% 10.9% 6.2% 1.2%

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Since 1 April 2015 there have been 48 SI’s reported involving SRCCG patients. Listed below is each provider who reported an SI concerning an SRCCG patient for the period ending 31 December 2015.

NHS Provider A

pril 2

015

Ma

y 2

015

Ju

ne

20

15

Ju

ly 2

01

5

Au

g 2

015

Se

p 2

015

Oct

201

5

Nov 2

01

5

Dec 2

01

5

YT

D

York Hospital – Acute 1 0 0 0 0 2 4 1 0 8

York Hospital – Community 0 0 0 0 0 0 0 0 0 0

Scarborough Hospital – Acute 2 4 1 1 0 2 2 2 3 17

Scarborough Hospital – Community

1 0 0 0 3 2 0 1 0 4

Scarborough Hospital – Community Hospitals

0 2 0 0 0 0 2 0 0 4

Hull and East Yorkshire Hospitals - Acute

0 0 0 1 0 0 0

0 0 1

Tees Esk and Wear Valley 1 0 1 2 1 0 0 1 0 6

Yorkshire Ambulance Service 0 0 0 0 0 0 0 0 0 0

Out of Hours Provider 1 1 0 0 0 0 1 1 1 5

2.4.1 YFT

As Scarborough and Bridlington Hospitals are the main providers for our CCG the majority of SI’s are reported from these services. The most frequently reported SIs continue to be related to falls and pressure ulcers. The chart below shows the total number of SIs for the period ending 31 December 2015 that have occurred at Scarborough Hospital, Malton Hospital and Bridlington Hospital.

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2.4.2 Falls and Pressure Ulcers

The CCG continue to work with YFT to gain assurance about their processes to support learning from falls and pressure ulcer serious incidents. The work is being led by the Chief Nurse team and ensures that we can review the strategic action plans so that further learning from additional scrutiny of the Route Cause Analysis (RCA) is captured.

2.4.3 Yorkshire Doctors Urgent Care

There have been 3 serious incidents reported in Quarter 3 captured in the information in regard to total numbers above. The CCG is working closely with the provider to ensure that the RCA process is systematic and describes action to ensure that the learning is embedded.

2.5 Healthcare Associated Infection (HCAI)

As commissioners we assure ourselves that the services which we commission are compliant with legislation and have plans in place to monitor and review all health care associated infections that occur within their jurisdiction, and look at the systems and processes our providers have in place to prevent HCAIs. We also seek to work across agencies and communities to look at commonalities and share best practice and learn lessons. The CCG commission the services of an Infection Prevention and Control (IPC) operational services team from Harrogate and District Foundation Trust (HDFT) which focuses on our primary care and community settings, and a strategic assurance service from an IPC expert.

2.5.1 Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia

From 1 April to end of December 2015 there have been two SRCCG cases reported at YFT. Below is a comparison of MRSA cases against previous year’s cases. SRCCG MRSA Bacteraemia Cases from 2012 – 2015/16

MRSABacteraemia

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

pt

Oct

Nov

Dec

Ja

n

Feb

Ma

r

Total

2012/13 0 0 0 0 0 0 0 0 1 0 0 0 1

2013/14 1 1 0 0 1 0 0 0 1 0 0 0 4

2014/15 0 0 0 0 0 0 0 0 0 1 0 3 4

2015/16 1 1 0 0 0 0 0 0 0 2

There have been no further cases reported for SRCCG and we reported the actions that the Trust are taking to mitigate against reoccurrence in the Q1 report.

2.5.2 Clostridium Difficile (C Diff/CDI) SRCCG Cases

NHS England set annual reducing Clostridium Difficile objectives for all NHS organisations. SRCCG’s objective for 2015/16 is no more than 31 cases and a rate of 28.1 per 100 000 head of population. The objective has decreased by 3 cases from the 2014/15 objective.

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The national HCAI mandatory reporting database records that 13 cases of CDI have been assigned to SRCCG, showing a decline (ie worse performance) from the 2014/15 position at the same time last year. There have been 8 cases of Clostridium Difficile Infection (CDI) assigned to SRCCG during Quarter 3 of 2015/16; 4 Community attributed cases and 4 Trust attributed cases (3 assigned to YTHFT & 1 to HEYHT). This represents an increase of 2 cases compared with Quarter 1 this year (6 cases in Quarter 1) and a decrease of 5 cases compared with Quarter 2 this year (13 cases, 9 of which were community attributed in Quarter 2). The total number of cases for Quarters 1, 2 and 3 2015/16 stands at 27 against a year-end threshold of 31 (representing 87% of the threshold for 2015/16). Sixteen out of the 27 are community attributed and 11 Trust attributed (10 to YTHFT, 1 to HEYHT). Epidemiology prediction data from Public Health England (PHE) for Quarter 3 based on performance to date is that SR CCG will be over its threshold at year end. SR CCG C Difficile cases from 2012 – 2015/16 (acute and community)

CDI

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Feb

Ma

r

Tota

l ca

se

s

Annual Objecti

ve

2012/13 4 4 4 6 3 4 3 2 0 3 1 2 36

2013/14 2 2 3 3 2 6 7 6 4 2 6 2 45

2014/15 3 1 2 0 1 7 2 3 5 3 5 3 35 34

2015/16 3 3 0 5 6 2 0 5 3 27 31

2015/16 monthly trajectory

2 1 2 1 1 4 4 4 4 1 5 2

All pre 72 hour of admission to hospital cases are reviewed by the Community Infection Prevention and Control (IPC) Team and key themes from the Community attributed cases are identified and discussed at the Quality and Performance Committee. RCA summary reports from the HDFT Community IPC Team were received for 15 out of a total of 16 cases that occurred during the first three quarters of 2015/16 (all 3 cases that occurred in Quarter 1, 8 out of a total of 9 cases that occurred in Quarter 2 and all 4 cases that occurred in Quarter 3). Of the 15 cases, 5 (33%) had an acute admission within the 12 weeks prior to the infection, and 9 (60%) had attended an outpatient appointment. One patient (7%) was a care home resident. The majority of patients, 12 (80%), were noted to have antibiotics prescribed in the 12 weeks preceding the infection. In 3 cases (20%), no antibiotics were prescribed in the preceding 12 weeks. Of the 12 cases in which antibiotics were prescribed, 7 (58%) were noted as being compliant with formulary, and in 4 (33%) of cases it was noted as compliance non known. In 6 (40%) of cases the infection was a relapse, with the patient having experienced

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at least one previous episode of CDI. Three deaths within 30 days were noted. The newly established local review group will be starting to pick up issues and actions arising from the RCAs.

2.5.3 Provider Organisations

The table below, demonstrates that of SRCCG’s providers, HDFT & Leeds Teaching Hospitals Trust (LTHT) have seen a decline in performance compared to the same Quarter in the previous year. HEY, South Tees and YFT have all seen an improvement in performance against the same period in 2014/15. All providers except HEY have seen a decline in performance over the first three Quarters of 2015/16, compared to the same period of the previous year. CDI cases: SR CCG Provider organisations (taken from national HCAI website)

CDifficile Period

Month

To

tal

YT

D

A

pr

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

York Teaching Hospitals Foundation Trust

14/15 4 2 6 1 3 6 2 4 10 7 9 5 38

15/16 7 8 6 3 8 3 5 3 7 50 48

Harrogate & District NHS Foundation Trust

14/15 0 2 1 1 0 2 0 1 1 0 1 0 8

15/16 0 2 2 2 5 5 3 1 1 21 12

Hull & East Yorkshire Hospitals NHS Trust

14/15 3 6 4 7 6 1 10 1 0 5 8 6 38

15/16 5 5 4 2 5 5 5 3 0 34 53

Leeds Teaching Hospitals NHS Trust

14/15 10 13 9 10 11 7 12 9 12 5 9 14 93

15/16 15 7 16 13 11 12 10 9 16 109

119

South Tees Hospitals NHS Trust

14/15 4 7 4 4 1 4 6 7 13 6 11 9 50

15/16 5 8 5 4 7 3 3 7 7 49 50

2.5.4 Review of YFT RCAs and ‘No Lapse in Care’ appeals

This year has seen the implementation of processes with providers to agree on cases of C Difficile Infection which, following Post Infection Review, are deemed to have had “no lapses in care” that could have led to the infection. This is in line with the NHS England guidance 2015 “Clostridium Difficile Infection Objectives for NHS organisations in 2015/16 and guidance on sanction implementation”. The guidance gives commissioners the option to discount, from the year-end total, those infections where

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they are in agreement with the Trust that there have been “no lapses in care.” Where the Trust has exceeded its annual C Difficile target, commissioners then have the discretion to not impose sanctions for these cases. Processes for review of cases have been put in place with YFT using a collaborative approach by Vale of York CCG (VOYCCG), SRCCG and East Riding of Yorkshire CCG (ERYCCG). The processes have enabled useful discussion between the Trusts and commissioners of cases where there have been potential lapses in care, including those potential lapses that did not contribute to the C Difficile infections and lessons learned. In response to the current infection prevention position a local review group has been established to consider all matters relating to HCAI in the CCG locality. This will have representation from Primary Care, the Medicines Management Lead and specialist Infection Prevention Leads for Hospital and Community.

3. Strategic Clinical Network (SCN) Development

The Strategic Clinical Network service has transitioned from the former North Yorkshire and the Humber Commissioning Support Unit to new hosting arrangements at SRCCG. The team will continue to work on behalf of a number of CCGs and will promote the service as an extension of each of the CCGs commissioning team and will attend regular team meetings within each of the organisations represented. In addition it is anticipated that the Macmillan funded programme team will also transition across to SRCCG on 1st of March, under the auspices of the Network service.

3.1 Quality & Safety

3.1.1 Cardiovascular

Stroke

The potential to develop intra -arterial therapies IAT is being discussed. At this point a local provider for this (specialised) service has not been identified. Development of IAT would increase the need for rapid local scanning and delivery of thrombolysis and an increase in reporting capabilities for CT angiography. Whilst IAT is likely to be specialised commissioning, some costs of the pathway, such as the increase in ambulance travel may not be covered by NHS England.

The regional contingency and repatriation protocols have been drafted and circulated for comment. Providers will need to comment on ability to implement. It has been flagged that CCGs need to be assured that there are no financial implications and that plans support delivery of the best possible services for patients. It may be useful for the urgent and emergency care networks (UECNs) need to be sighted on these plans.

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It has been agreed that the Stroke Quality Improvement Network System (SQuINS) data will continue to be collected, and all providers have signed up to this. In addition to the Sentinel Stroke National Audit Programme (SSNAP) data, this provides commissioners with more in depth workforce information as well as an annual report and action plan. The SCN may not have capacity to analyse the data but this could be done by either CCGs or the networks team alongside the SSNAP analysis as part of the planning round. It is recommended that UECNs are also sighted on this so that any issues which may affect regional sustainability can be identified and mitigated.

The increase in the overall SSNAP rating at the Scarborough Hospital site from E to D is a positive improvement but it should be noted that there are gaps remaining, for example the % of patients at Scarborough who have continence planning, mood and cognition screening, and nutrition and hydration screening by discharge, are lower than for York. This is also the case for the number of patients who have rehabilitation goals agreed within 5 days. This will be discussed with the trust at the monthly stroke meeting.

Acute Kidney Injury

Actions to reduce avoidable Acute Kidney Injury (AKI). Alerts for primary care will be

in place from 01 April 2016 but more needs to be done to make sure that alerts are

acted upon and medicines management is optimal.

A national algorithm, standardising the definition of AKI has been agreed. It

provides the ability to ensure that a timely and consistent approach to the detection

and diagnosis of patients with AKI is taken across the NHS. The algorithm has been

integrated into Acute Trust Laboratory Information Management System’s (LIMS) to

identify potential cases of AKI from laboratory data in real time and produce a test

result (AKI e-alert). The laboratory system has been sending e-alerts to secondary

care clinicians for several months and there is now a plan to roll this reporting

process out to primary care from 1 April 2016. The AKI e-alert will alert GPs to

those patients suspected of having AKI or at risk of AKI enabling them to take the

necessary action to manage the patient.

Hypertension

Work in Bradford has produced a 2% increase in recorded prevalence of hypertension through automated searches in SystmOne for either those with previously raised readings which looked suspicious for hypertension, or those on medications for hypertension without likely other comorbidities (like heart failure, angina) and who therefore may not have been coded correctly as hypertensive.

The programme will now be looking at developing a simplified treatment protocol in line with the US and Canada Million Hearts programme. There is emerging evidence from the SPRINT study to support more aggressive targets in some high risk populations (down to 128/80), at the expense of some increase in side effects.

SRCCG - NHS Scarborough and Ryedale CCG ranks 176 out of 209 CCGs for the combined lifestyle risk factors for hypertension. In NHS Scarborough and Ryedale

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CCG the QOF target for blood pressure at practice level varies between 66.1% and 91.6%.There are around 3,600 people with hypertension not controlled to 150/90.

The full profile can be accessed here: http://www.yhpho.org.uk/hypertensionccg/pdfs/03M_hypertension.pdf

A regional hypertension dashboard could be created to provide regional benchmarking as a further drive towards sharing best practice and creating change. West Yorkshire has created an Atrial Fibrillation (AF) dashboard which shows the treatment gap and treatment type broken down at regional, CCG and practice level. Initial evaluation of this suggests the dashboard has supported a reduction in the treatment gap from 36% to 30% and has created and estimated £1m in savings. There may be potential for the tool to be scaled up to cover the NYH region. This development would not require any financing (if the information can be provided by commissioning support services as part of current agreements) but would require a commitment to regional discussion of the data.

3.1.2 Cancer

The national cancer taskforce is developing priorities for implementation of the new cancer strategy. These include: development of cancer alliances, embedding patient experience and quality of life outcomes as central in quality cancer services, testing innovative collaborative models of cancer provision and commissioning through the vanguard sites as well as unlocking diagnostic capacity to achieve earlier diagnosis and the 4 week standard.

At the North Yorkshire and Humber (NYH) Cancer Summit, it was an agreed to formalise the establishment of a Cancer Alliance on the NYH footprint. Emerging priorities included: facilitating straight to test, pathway re-design to achieve 28 day diagnosis, aligning strategic capital planning, supporting CCG’s to understand the level of resource/programme budget. The network team will be working with CCGs and the SCN to support development of the Alliance.

The review of the Yorkshire and the Humber cancer service provision for the over 75s is not conclusive in terms of access to surgery or provider level provision of care. It notes that there is an opportunity to consider use of decision making tools for older people and interventions which offer alternatives to surgery and to target sub groups of the population more effectively. CCGs are being asked to consider support for further work on this area and further details will follow.

Workforce remains a concern in term of ability to deliver sustainable cancer services in the future. There is potential to work with providers to understand the current workforce picture and to look at succession planning and where integration and innovation within services will be required in order to achieve sustainability.

Understanding the capacity and demand within diagnostic services will be crucial in delivering 28 day pathways. Each CCG will need to work with providers to develop a trajectory for achieving the capacity required by 2020.

http://www.yhpho.org.uk/hypertensionccg/pdfs/03M_hypertension.pdf

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CCG “deep dive” cancer profiles have been developed. For SRCCG, the profiles show that the incidence of breast cancers is lower than the national average and the lowest in the CCG comparator group, yet the mortality rate is higher than both the national average and the best performing CCG in the cluster. The mortality rate from lung cancer is higher than the national average and the best performing CCG in the cluster and there is further opportunity to reduce mortality from lower Gastro Intestinal and urological cancers if the performance of the best in the cluster is matched. Whilst achievement in relation to screening and emergency presentations is mostly better than or comparable to the national average, there is scope for further improvement to match the achievement of the best performing CCGs in the cluster. One year survival rates for the age ranges 15-99 and 55-64 are lower than the England average and the best performing CCG in the cluster, whilst the oldest age range 75-99 fares slightly better. The deep dive report will be discussed at the next Cancer Locality Meeting.

A 2 week wait referral form ‘task and finish’ group centred on York/Scarborough provision has been formed to oversee the smooth implementation of new referral forms and to consider the supporting pathways. The initial focus has been on dermatology.

A programme board has recently been established to provide oversight and direction to the Brain and CNS Cancer Improvement Programme. GPs and nurses interested in this work stream can find out more via the report author.

4. Children and Young People update

4.1 Looked After Children Activity Dataset

During Quarter 3 there was a small increase in the total number of Looked After Children (LAC) for which SRCCG are the responsible commissioner. There was a very small decrease in the percentage of LAC placed outside of the CCG boundary (16% in Quarter 2 and 14% in Quarter 3). Completing Initial Health Assessments (IHAs) within the 20 working day period continues to be a challenge. In Quarter 3, 19 IHAs (95%) were completed outside the 20 working day time frame. Reasons for this are being discussed with the provider in appropriate forums. The number of Review Health Assessments (RHAs) which exceeded the required frequency remained the same (4 in Quarter 2, and 4 in Quarter 3). Reasons for not meeting the deadline may be a slow response from service providers including health professionals and also children and young people who are hard to reach. The CCG will continue to monitor this and follow up with the provider to better understand the reasons for these delays. The IHAs and RHAS continue to meet the quality standard and the LAC children’s specialist nursing team will return any that fail to do so.

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4.2 Children and Families Act (Part 3) 2014 – Special educational needs and

disability code of practice: 0 to 25 years

The reforms as a result of the Children and Families Act (Part 3) and resultant Code of Practice, are focussed on enabling children and young people to achieve the best they can with an emphasis on outcomes rather than processes. This is to be achieved by greater co-operation between education, health and social care working together. The majority of statutory duties rest at a local level, predominantly with local authorities but also with CCG’s, in particular; joint commissioning with local authorities, supporting the integrated Education, Health and Care needs assessment process, including the Designated Medical Officer and Clinical Lead roles and the provision of personal health budgets. A local internal audit was conducted to assess our CCG compliance with our responsibilities. The audit report offered the opinion of significant assurance on progress against the actions and the effectiveness of arrangements put in place to implement the CCG’s statutory duties contained within the Act. It was supplemented with a series of recommendations which the CCG are currently working on. Our Partnership Commissioning Unit (PCU) have commenced monthly CCG teleconferences to provide updates, advice and identify any risks and mitigating actions. There is to be a SEND Ofsted/CQC local area inspection expected to commence early 2016.

4.3 Children’s Autism Diagnostic Assessment Services

Quarterly meetings continue. These are beneficial as a forum for discussions around the commissioned services and to discuss emerging issues in a timely manner. The commissioned diagnostic service in Scarborough continues to provide data on a monthly basis. The Year to Date (YTD) number of referrals has increased compared to the same period last year. The service continues to have diagnosis rates around 83% this is higher than the total provider average across North Yorkshire of 65%. The number of children still waiting for a first appointment at the end of Quarter 3 is 32 and the decreasing waiting time trend continues. The average weeks wait from referral to first appointment offered in December 2015 was 32 weeks. The position as at the end of 2014/2015 was an average of 48 weeks across the year. The CCG have commissioned 10 additional assessments with an independent provider to commence early 2016 to relieve the waiting list further and support the local service in becoming NICE compliant. Our local provider has transferred 7 children to date and Socrates will commence the data gathering and assessment process during February and March 2016. We signalled a clear intention to bring our waiting times down to be NICE compliant by the end of March 2016, however the increasing referral rate has proved a limiting factor. The forecast position at the end of Quarter 3 indicates that achievement of NICE compliance will now be by the end of Quarter 1 16/17. We will

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continue to monitor performance and capacity in our providers and referral rates to make sure we can achieve this.

4.4 Future in Mind Local Transformation Plan

Following approval by NHS England on 18 November 2015, the Plan has been published on the CCG website http://www.scarboroughryedaleccg.nhs.uk/your-health/young-peoplers-emotional-and-mental-health/ and is also being published to the local authority websites.

4.5 Child and Adolescent Mental Health Services

Over the year we have seen developments in the CAMHs service which has enabled a consistent approach towards service delivery across all North Yorkshire localities, including a standard approach to out of hours response, clear waiting times, multi-disciplinary assessments, clearer signposting and an emphasis on involving children and young people in planning care. There is now a set of core performance monitoring data for the service.

4.6 Attention deficit hyperactivity disorder (ADHD)

The PCU is working with our providers, parents and families to improve access and experience of ADHD services. This includes analysing patient numbers and pathways and discussing the findings. These findings will be presented in a report being drafted to detail findings regarding the services. 5. Quality and Performance - Patient Experience

5.1 CCG Patient Relations

The following tables detail numerically the type of contact and complaints made to the

CCG and through the PCU during the course of October 1 2015 - December 31 2015.

The rolling year to date (YTD) total is shown alongside the final total for the previous

year 2014/15 to allow us to compare rates over each quarter.

Summary of type of

contact

Total

2014-15

YTD

2015-16

Quarter 1

2015-16

Quarter 2

2015-16

Quarter 3

2015-16

Complaints 15 4 1 3 7

PALS 122 62 27 35 10

Compliments 2 0 0 0 0

Parliamentary and

Health Service

Ombudsman

1

0

0

0

0

NHS England 19 14 4 10 0

Total 159 80 32 48 17

http://www.scarboroughryedaleccg.nhs.uk/your-health/young-peoplers-emotional-and-mental-health/

http://www.scarboroughryedaleccg.nhs.uk/your-health/young-peoplers-emotional-and-mental-health/

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During Quarter 3 (October 2015 - December 2015) 7 complaints were received for

SRCCG. These were 6 commissioning category complaints and 1 Clinical category

complaint.

Currently there is 1 on-going complaint for SRCCG. This has been carried forward in to

Quarter 4. There were 10 PALS contacts for Scarborough & Ryedale Clinical

Commissioning Group during Quarter 3.

The nature of PALS contacts during Q3 can be seen in the table below:

PALS contacts: Quarter

(Oct - Dec 2015)

CCG 1

York Teaching Hospitals NHS Foundation Trust (YFT) 3

Persistent and unreasonable 5

Patient transport 1

TOTAL 10

5.2 Provider Complaints / Feedback

5.2.1 YFT Complaints and Feedback

Information in this section of the report is extracted from YFT reporting with minor amendments and reformatting. Our main acute provider has a systematic approach to the collection and utilisation of patient experience data including regular monitoring and reporting on:

Complaints

PALS activity

Friends and Family Test (FFT)

National Patient Surveys

Local ward / department initiatives

All concerns and complaints are categorised to enable more detailed analysis of themes and have included categories such as care and treatment (medical and nursing), attitude of staff, choose and book, communication, discharge arrangements, and patient transport. The three directorates receiving the highest number of complaints for Q3 are:

Acute and General Medicine

General Surgery and Urology

Orthopaedics and Trauma There is no immediately obvious theme and no one ward/department with a significant proportion of the complaints. Issues include management of care pathways, management of long term conditions whilst in hospital, meeting care

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needs whilst in hospital and communication between patients/carers and nursing/medical staff. Positive feedback All directorates are encouraged to record the letters and other gestures of appreciation from patients. This enables the Trust to understand what patients most appreciate about their care and to recognise and reward excellent care. In Quarter 3 the Trust received 65 compliments; the majority of compliments were for Acute and General Medicine, Specialist Medicine and Emergency Medicine.

5.2.1.1 New Complaints in Quarter 3 (YFT)

5.2.1.2 Complaints by Directorate in Quarter 3 (YFT)

New Complaints September October November December

York 25 24 22 13

Scarborough 30 13 15 13

Bridlington 2 1 1 2

Community* 1 4 0 0

TOTAL 58 42 38 28

Resolved outside procedure No longer use this classification

Q1 Q2 Oct Nov Dec Q3

Allied Health Professionals - - 4 0 1 5

Acute & General Medicine 21 19 8 11 2 21

Child Health 3 2 3 2 1 6

Community Services 7 3 3 0 0 3

Elderly Medicine 12 11 4 2 3 9

Emergency Medicine 15 23 1 2 6 9

Estates and Facilities 1 3 0 0 0 0

General Surgery & Urology 19 19 4 4 7 15

Head and Neck and Ophthalmology 11 5 3 3 2 8

Laboratory Medicine 0 0 0 0 1 1

Obstetrics & Gynaecology 9 11 3 4 2 9

Orthopaedics and Trauma 12 20 4 4 2 10

Pharmacy 0 1 0 0 0 0

Radiology 1 8 0 4 0 4

Specialist Medicine 3 2 3 2 1 6

Theatres, Anaesthetics & Critical Care 5 4 1 0 0 1

Other 0 5 1 0 0 1

TOTAL 119 136 42 38 28 108

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5.2.1.3 Complaints by Primary Subject in Quarter 3 (YFT)

Q1 Q2 Oct Nov* Dec* Q3

Access to treatment or drugs 0 0 1 1

Admissions, Discharge and Transfer Arrangements 5 6 5 2 3 10

Appointments, Delay/Cancellation 7 1 2 3 1 6

Attitude of Staff 13 12

All aspects of Clinical Treatment 78 86 15 30 24 69

Commissioning 0 1

Communications/information to patients (written and oral) 8 12 5 7 9 21

Privacy and Dignity 5 5

Complaints Handling 0 2

Personal Records 0 2

Others 3 9

End of Life Care 1 1 0 2

Mortuary 0 1 0 1

Patient Care 5 11 11 27

Prescribing 0 2 2 4

Staff Numbers 1 0 1 2

Trust Admin/Policies/Procedures inc pt record management 1 0 0 1

Values and Behaviours (Staff) 7 7 3 17

Waiting times 0 0 1 1

TOTAL 119 136 42 64 56 162

5.2.1.4 PALS by subject in Quarter 3 (YFT)

Sept Oct Nov Dec

Action Plan 0 4 2 9

Admissions, discharge, transfer arrangements 17 9 22 11

Aids / appliances / equipment 1 3 2 2

Appointments, delay/cancellation (inpatient) 11 11 19 14

Appointments, delay/cancellation (outpatient) 60 55 49 40

Staff attitude 19 17 18 13

Any aspect of clinical care/treatment 76 75 66 53

Communication issues 69 74 50 40

Compliment / thanks 29 50 32 44

Alleged discrimination (eg racial, gender, age) 1 1 2 2

Environment / premises / estates 5 5 3 3

Foreign language 0 1 1 0

Failure to follow agreed procedure (including consent) 1 0 1 4

Hotel services (including cleanliness, food) 2 1 1 3

Requests for information and advice 296 309 202 171

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Medication 2 6 3 3

Other 1 6 1 3

Car parking 4 5 4 2

Privacy and dignity 2 1 1 1

Property and expenses 13 16 9 14

Personal records / Medical records 12 17 10 9

Safeguarding issues 2 1 2 1

Signer 1 2 0

Support (e.g. benefits, social care, vol agencies) 2 3 2 4

Patient transport 5 10 4 4

Totals: 631 682 506 450

5.2.2 Tees, Esk and Wear Valley Foundation Trust (TEWV) Mental Health

Provider

5.2.2.1 Complaints over Quarter 3

The Trust wide position for complaints’ over the last 24 months is shown below.

Focusing on the services commissioned by North Yorkshire, the total number of complaints for North Yorkshire raised over the last 24 months is shown as follows:

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5.2.2.2 PALS for North Yorkshire Services

North Yorkshire position for PALS’ issues raised over the last 24 months is shown as

follows:

The reasons for raising a PALS issue in North Yorkshire over the last 6 months is outlined as follows:

Category Number of PALS

Clinical Care 49

General Advice 27

Attitude 8

Communication 5

Environment 2

Signposting 2

Staff Compliments 2

Unknown 2

Full details of the PALS issues raised are shared with CCGs and are included within the reports presented to the Contract management Boards.

5.3 Referral to Treatment Times (RTT)

The CCGs position against the 18 week referral to treatment time targets is monitored

monthly and reported through our bi-monthly Quality & Performance Exception Report.

Performance issues are discussed at the Quality & Performance Committee and at

each Governing Body meeting.

In June 2015, NHS England accepted a recommendation from Sir Bruce Keogh that the

incomplete pathway* operational standard, should became the sole measure of

patients’ constitutional right to start treatment within 18 weeks.

*‘’incomplete pathway’ means the number of patients whose clock was started at the

point of the GP referral onward to secondary care, and is still running (ie first treatment

has not been completed and or the patient not discharged) at the end of the reporting

month.

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Performance during Quarter 3 2015/16 for the CCG is shown in the table below:

RTT Waiting Times for non-urgent consultant led treatment

Indicator Target October 15 November 15 December 15

Referral to Treatment

Pathways: Incomplete 92% 93.6% 93.7% 93.4%

Number of >52 week

Referral to Treatment in

Incomplete Pathways

0 0 0 0

Performance over the last three quarters for the CCG is shown in the table below:

RTT Waiting Times for non-urgent consultant led treatment

Indicator Target Q1 15-16 Q2 15-16 Q3 15-16


Pathways: Incomplete

92% 92.4% 93.2% 93.4%

Number of >52 week


in Incomplete

Pathways

0 0 0 0

YFT is on target to meet the December 2015 trajectory across the majority of

specialties. Some pressures remain in Neurology, General Surgery and Dermatology

and as a consequence are likely to miss the target at year end within 2015-16 at

specialty level. HEY are currently underperforming against the incomplete target

across a number of specialties and are not expected hit the 92% target during 2015-16.

CCG Performance at specialty level against the 92% incomplete pathway target is

shown in the table below.

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5.4 Cancer Waiting Times

Quarterly Performance against the main cancer targets can be seen in the table below:

Performance during Quarter 2 generally saw an improvement over the previous

quarters but the CCG continued to miss two out of the four targets. Within the Cancer 2

week breast symptomatic pathway, there were 8 breaches in quarter 3, of which 7 were

as a result of patient choosing to wait longer. In total there were 22 breaches within the

62 day pathway. There were a variety of reasons given for breaching the 62 day

threshold, but in main these were down to complex diagnostic pathways and also late

referrals on from the initial provider to the final treating organisation.

We reported in the last quarter on the range of measures and initiatives underway to address the areas of underperformance and will provide an update on these in subsequent reports. Further information can also be found in Section 3 of this report covering Strategic Clinical Network updates.

5.5 Accident & Emergency Services (A&E)

Scarborough Hospital continues to experience underperformance against the A&E target. The CCG is working closely with the hospital, primary care, the System Resilience Group and the Emergency Care Improvement Programme (ECIP) to try and alleviate some of the pressure and understand in more depth what is causing the problems. From the breach analysis it is clear that there is no one solution and there are a combination of factors that are impacting on the Trusts ability to meet the 4 hour waiting time target. An ECIP concordat has been signed by leaders from each part of the system and the regional tripartite to demonstrate the overall commitment to the objectives set out. The System Resilience Group prioritise the following five areas for action:

Development of the front door model to integrate Urgent Care and GP Out of Hours services to ensure that patients who can be managed appropriately at the front door and avoid admission through A&E are actioned

SAFER (Senior medical review, All patients will have an expected discharge date, Flow of patients will commence at the earliest opportunity, more timely discharge from hospital, Review of patients waiting in hospital) care bundle & ‘No Waits’ process implemented on 5 wards per month (including community)

Cancer Treatment Targets

Indicator Target Q4 14-15 Q1 15-16 Q2 15-16 Q3 15-16

Cancer 2 week wait 93% 93.7% 95.7% 91.6% 96.0%

Cancer 2 week breast

symptomatic (where

cancer not suspected)

93% 89.1% 90.7% 92.0% 92.9%

Cancer 31 day main 96% 95.1% 93.7% 98.0% 98.1%

Cancer 62 day main 85% 70.3% 87.0% 87.1% 77.3%

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Expansion of the frailty pathway on both sites

Adult Social Care commissioners work with their domiciliary care to undertake reviews

Development of existing discharge portals into a home first/Discharge to Assess model

5.5.1 A&E 4 Hour waiting time target

The following table shows Scarborough and Ryedale CCG A&E waiting time

performance, at all providers across Quarter 3.

A&E waiting time -% of patients seen and discharged within 4 hours - SRCCG

Patients (ALL Providers)

Indicator Target Oct 15 Nov 15 Dec 15 Q3

-% of patients seen and discharged within 4 hours - SRCCG Patients (ALL Providers) 95% 92.5% 93.4% 91.6% 92.5%

SRCCG - 12 hour trolley waits Number of patients waiting over 12 hours from decision to admit (All providers)

0 2 3* 0 5

(*This position regarding the number of 12 hour trolley waits was misreported as 0 in

the last Quality and Performance Exception Report due to a data error.)

A&E 4 hour Performance for the CCG during Quarter 3 was below the national target

level of 95%. Minor Illness and minor injury patients, where clinically appropriate, were

streamed into the Urgent Care Centre from the end of September 2015 and this is

taking some pressure off the system, but performance within the Type 1 A&E remain

problematic both at the Scarborough and York Sites

The pressure on beds was challenging in the run up to Christmas, despite the

implementation and although YFT were successful in securing a number of Medical and

nursing appointments during the autumn, however increased demand in A&E and the

resulting requirement for admission continued to put pressure on the system.

The urgent care centre, based on the Scarborough hospital site, continues to see an

increase in activity taking minor illness and injury cases, however we continue to see

long waits in the emergency department. This reasons for long waits time, is often

linked to a shortage of bed capacity and availability of medical staff. The CCG is

planning to undertake a review and rapid improvement event, led by ECIP Team and

will involve clinicians from both primary care and secondary care to retrospectively

analyse a patient pathways through A&E for one day.

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5.6 Friends and Family Test (FFT)

5.6.1 YFT

For Quarter 3, the FFT relates to our main acute provider.

5.6.1.2 Emergency Department

5.6.1.3 Recommendation Rates

Across all services 90% were likely or extremely likely to recommend. 6% were unlikely

or extremely unlikely to recommend.

% recommend September October November National

Inpatient 95% 97% 95% 95%

ED 81% 78% 76% 87%

Community 95% 96% No

responses

95%

Maternity 98% 96% 98% 95%

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Areas with lower than average % recommend or higher than average % not

recommend

Site Ward Eligible Responses Rate

%

Recommen

d

% Not

recommen

d

York Ward 39 15 10 67% 70 0

Scarborough Oak 70 27 39% 78 0

York Ward 33 91 36 40% 86 6

Scarborough Maple 116 22 19% 86 5

Scarborough

Ann

Wright 36 29 81% 90 0

York Ward 17 498 10 2% 90 0

York G1 167 44 26% 91 5

Scarborough

Duke Of

Kent 235 22 9% 91 0

Scarborough Graham 71 23 32% 91 0

Scarborough Beech 106 58 55% 91 5

York

Day

Ward 1287 162 13% 93 3

York Ward 11 132 57 43% 93 0

York Ward 25 24 16 67% 94 0

York Ward 28 109 17 16% 94 0

Areas with 100% recommend

Site Ward Eligible Responses Rate % Recommend

York Coronary Care Unit 41 28 68% 100

Scarborough Stroke Unit 39 18 46% 100

York Ward 35 70 32 46% 100

Scarborough Willow 220 85 39% 100

Bridlington Johnson 59 22 37% 100

Bridlington Waters 21 7 33% 100

Bridlington Lloyd 193 64 33% 100

Scarborough

Ccu-Jane Caunt

Unit 131 42 32% 100

York Acute Stroke Unit 90 25 28% 100

Scarborough Chestnut 94 25 27% 100

Bridlington Kent 182 46 25% 100

York Intensive Care Unit 8 2 25% 100

York Ward 15 179 39 22% 100

York Ward 32 104 21 20% 100

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York Ward 31 64 12 19% 100

York Ward 26 47 8 17% 100

York Ward 29 70 8 11% 100

York Ward 16 114 13 11% 100

Scarborough Aspen Unit 104 11 11% 100

York Ward 37 14 1 7% 100

Scarborough Lilac Ward 273 12 4% 100

York Ward 18 225 5 2% 100

Scarborough Dales Unit 103 2 2% 100

5.6.1.4 Commentary

There was some disruption to FFT results throughout November in the handover between two suppliers. Results for inpatient and the emergency departments are significant, but cards for maternity, community and outpatient areas were not provided until late in the month meaning that November results have been affected. We anticipate December results to return to normal. A new ward-level report format has been developed and has been very well received. The distribution lists for these reports have been updated to ensure all those who need them are getting the correct reports. YFT have agreed a targeted approach to the Day Unit, the actions are:

Working on patient group directives nurses will be able to give pain relieving medication in a more timely manner.

Training needs analysis being undertaken for all staff to identify where gaps exist and additional training is required.

Matron will raise the issue of privacy at staff meetings.

Actions for Q4

Ensuring that cards are provided and collections are running smoothly in all areas, in particular maternity, community and outpatients.

Reviewing areas with low response rate where further support for the process may be required.

Building relationships with matrons and directorate management to ensure FFT feedback is used effectively within local teams and action plans to address themes and/or response rates are in place where required.

Look at how FFT reports are used to highlight and celebrate good practice and whether this could be developed further.

The patient experience strategy was launched on 21 September and communicated to

stakeholders. Across the Trust the Friends and Family Test have been achieving a

90%+ score for patients reporting they would recommend the Trust to their Friends and

Family if they needed similar care or treatment.

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Other work on quality is ‘Knowing How We Are Doing Boards’ to all wards and

departments across the Trust and reviewed on a rolling quarterly basis. 47 boards

were updated in October and November 2015 focusing on inpatient, maternity and

outpatient clinics.

5.7 Yorkshire Doctors Urgent Care Service (YDUC) - Patient Experience

Feedback on patient experience of the services provided continue to be gathered in a

number of ways including: on-line surveys, postal questionnaires, questionnaires at

treatment centres, compliments received, and complaints received. In addition

complaints received by the service are investigated and analysed.

The patient questionnaire in use within YDUC incorporates the Friends and Family test

to comply with CCG/NHS requirements.

The table below shows a 3 month rolling overview of complaints taken from the Quarter

1 report based on number of patient episodes of 9,111, which showed that on average

1.3 complaints were received per month within the quarter. Quarter 2 based on

episodes of care of 8,731 shows the average ratio to be 0.12%. A 3 month rolling

review has been added for Quarter 3 based on number of patient episodes of 10,607

which shows the average ratio to be 0.15%.

We continue to monitor the performance of YDUC at our monthly Contract Management meetings.

5.8 Mixed Sex Accommodation (MSA) breaches

There were no MSA breaches during Quarter 3.

5.9 Continuing Healthcare (CHC)

A CHC strategy has now been developed after an internal audit late last year. An

implementation plan has been developed that considers the overall approach to CHC,

standardisation of processes and the achievement of the 28 day National Framework

for completion of multi-disciplinary assessments following initial checklist. Work

continues on developing Standard Operating Procedures to standardise processes.

Complaints Scarborough Malton Total

Apr – Jun 2015 Total 3 1 4

July - 2015 2 1 3

August - 2015 4 1 5

Sept - 2015 2 1 3

Oct – 2015 2 2 4

Nov – 2015 6 2 8

Dec - 2015 2 2 4

Total 21 10 31

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The disabled children’s service for Children’s continuing Health Care has changed and

CHC are now working alongside disabled children’s services with complex health

needs. This work is being led by the Children’s and Transitions Lead Nurse with the aim

of improving and streamlining processes.

NHS England has issued guidelines for all retrospective CHC cases to be completed by

March 2017. The retrospective team continues to work on cases being returned by the

organisation that has been commissioned to assist in pulling together all relevant

historical files and documents needed for the CHC team to complete the assessments.

The CCG must ensure that all retrospective cases where the patient is living are

prioritised and SRCCG expect to have all such patients assessed by the end of January

2016.

Further information in regard to overdue reviews of fully funded CHC patients can be found in section 9 below.

6. Commissioning for Quality and Innovation (CQUIN)

The monitoring of the CQUIN framework takes place through the Contract Management

Board and Sub Contract Management Board meetings and the Quality & Performance

Groups on a monthly basis, with the majority of schemes reporting actual performance

on a quarterly basis. Plans for the CQUIN offer in 2016/17 are underway and will be

reported on in Quarter 4 after agreement through the relevant contract management

processes.

Performance against the 2015/16 CQUINs for Quarter 1, Quarter 2 was reported in the

Quarter 2 report. Quarter 3 achievements will be reported to the Quality & Performance

Committee when all data validated, and a full overview of CQUIN achievement will be

published in the Quarter 4 report.

7. Care Quality Commission (CQC)

CQC have reported on approximately 16 Inspections relevant to local services in Q3. These include 7 organisations that have been identified as requiring improvement and 9 organisations that have been received an overall rating of good. The CCG continue to work with Care Homes as part of sustaining improvements across this sector. Our main acute and mental health providers and some GP services continue to work through action plans where any improvements needed as a result of their earlier inspections. We continue to meet with CQC at a strategic level (quarterly) and operational level (monthly) and also via the Quality Surveillance Group.

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8. Safeguarding Children

8.1 Section 11 Audit

Section 11 of the Children Act 2004 places a duty on agencies to safeguard and

promote the wellbeing of children and young people. The Children Act 2004 also places

a duty on Local Safeguarding Children Boards to coordinate the work of agencies

represented on the Boards and to monitor the effectiveness of the work of its partners.

North Yorkshire and City of York have undertaken their annual joint Section 11 Audit to

monitor the effectiveness of agencies’ arrangements to safeguarding of children and

young people. The audit was completed by the Designated Nurses for Safeguarding

Children on behalf of the four CCGs and shows good compliance with statutory

requirements.

8.2 Looked After Children

Joint funding has been agreed between the Local Authorities in York and North

Yorkshire and the four CCGs to develop a short video which helps younger children

understand what is involved in an Initial Health Assessment. Work on the project has

now commenced with young people and the Specialist Nursing Team for Looked After

Children. It is hoped that this will improve the take up rates.

8.3 Primary Care

The Safeguarding Children Policy for adoption by individual practices has now been

reviewed and endorsed by the Local Medical Committees (LMC). This will be

disseminated to Practices for use. The Adult Safeguarding policy for Primary Care is

currently out for consultation with the Safeguarding Practice Leads. The consultation

ends this week after which the policy will be sent to the LMC for review.

A Primary Care Safeguarding Training Strategy is currently being developed which will

give Practices guidance on the required levels of training and competency for all levels

of staff in relation to safeguarding. ‘Hot Topics’ safeguarding adult and children events

are currently being planned for 2016-2017 across all CCG’s in North Yorkshire and

York.

9. Safeguarding Adults

9.1 Prevent Duty and CCG Compliance

The Regional Coordinator for Prevent has circulated new assurance reporting templates for the Quarterly Prevent Return (QPR). Providers have been reporting on Prevent activity for some time but there is now a mandatory requirement for CCGs to complete the QPR.

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The QPR requires information on training, referrals, partnerships, policies and procedures, and details on providers. Prevent/counter terrorism sits firmly within Adult Safeguarding and the Designated Professional for Adult Safeguarding will take a lead on this work ensuring that the CCG can report that it has the required infrastructure and resources in place. As part of the Children and Families Act (2014) Section 11 audit CCGs are also required to have a Prevent Strategy. The Designated Lead for Adult Safeguarding is in the process of developing this strategy for the CCG.

9.2 Channel Panel

Channel is the process for cases that have been subject to Prevent (i.e. pre-criminality where increased support and monitoring works towards moving the vulnerable person away from extremist views and behaviour) but where there is evidence of escalating risk. More assertive multi-agency strategies and information sharing processes can be put in place via the Channel process. These meetings are attended by the Designated Professional for Adult Safeguarding for the CCG. There will now be regular monthly Channel Panel meetings to review all new and on-going Channel cases.

9.3 CQC Engagement meetings

These meetings involve the Adult safeguarding team on behalf of the CCGs. Previously held quarterly and now moving to monthly. Hard and soft intelligence is shared in this meeting. The meeting is attended by Care Quality Commission (CQC), North Yorkshire County Council (NYCC), North Yorkshire Police and NHS/Health staff. 9.4 Adult Safeguarding in Partnership with Continuing Health Care The CHC Team are working to complete all over-due reviews of clients in receipt of full funding and set a strategy that aims to ensure all future reviews are completed in a timely way. The team are working with The Safeguarding Adults Team to achieve a targeted approach to this, in that those individuals considered as being most at risk will be prioritised. This risk is categorised by safeguarding activity involving the service provider they receive care from. The Safeguarding Adults Team are providing an overview of all historic concerns (the last 12 months) and any current issues that exist with care providers. It will include all service providers where there is a current suspension in place that limits the client admissions on behalf of the CCGs and Local Authority as well as those that fall under the remit of the local authorities Collective Care processes. This will ensure that those individuals living in care provision that is already under scrutiny will be prioritised for review. The reviewing CHC Assessor will then feedback any issues relating to the individual or the service provider and this information will then be shared with the Safeguarding Adults Team. In addition to this there is to be a renewed emphasis on the use of the CCG’s Soft Intelligence Reporting tool so that all issues that fall below the threshold for safeguarding will be captured.

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There is also further opportunity to develop, support and guide the practice of the CHC team in relation to adult safeguarding through a monthly supervision session. This is facilitated by the Safeguarding Adults Team Leader and allows discussion, advice and education on general safeguarding matters whilst also reminding practitioners of their responsibility to ensure that immediate concerns are communicated effectively and in a timely way to the local authorities.

9.5 Suicide Prevention

A Senior Suicide Prevention Co-ordinator (SSPC) was recruited last Summer on a 12

month contract. The role was created to provide co-ordination of the North Yorkshire

and City of York Suicide Prevention Task Group (SPTG) which was set up in 2014.

One of the SPTG’s key priorities was for the SSPC to lead a five year suicide audit,

reviewing coroners’ files of deaths by suicide which occurred in North Yorkshire and

York between 2010 and 2014 in accordance with national best practice.

The North Yorkshire element of that audit was completed in December 2015 and the

SSPC and NYCC Public Health colleagues are in the process of producing a draft

report following detailed analysis of information arising from the audit. This report will

provide information on the key characteristics of deaths by suicide in North Yorkshire

including demographical information, common methods and location hot-spots, extent

of contact with various statutory and voluntary services, links to alcohol and drug use

and prevalent triggers or stresses.

This will provide useful comparison information to that available at national level to

indicate where North Yorkshire suicide patterns resemble or differ markedly from those

known nationally or regionally. The report will also provide an indication of which

population groups are at highest risk of suicide and any common features where there

may have previously been missed opportunities to identify individuals at risk, intervene

or provide improved support or where there may be clear gaps in service provision

which, if addressed, may prevent or reduce further loss of life through suicide.

item number: 6.1 governing body meeting meeting date: 30 ... · was approved by ccgs and was...

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