Board of Directors - Lancashire Care NHS Foundation … Board/Trust...FORMAL BOARD (PUBLIC MEETING) Part One Reference Item Lead Action Enc. FOIA Exempt TB 068/17 Welcome and opening

Board of Directors Thursday 1 June 2017

08:30am

Boardroom, Sceptre Point

Board of

Directors

Quality Committee

Finance & Performance Committee

Nomination / Remuneration

Committee

Audit Committee

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Board of Directors

Meeting Board of Directors Meeting

Location Boardroom, Sceptre Point

Date Thursday 01 June 2017

Time 8:30am

FORMAL BOARD (PUBLIC MEETING)

Part One

Reference Item Lead Action Enc. FOIA

Exempt

TB 068/17 Welcome and opening comments Deputy Chair Verbal

TB 069/17 Apologies for absence and confirmation of quoracy

Deputy Chair Verbal

TB 070/17 Declarations of Interest Deputy Chair Verbal

TB 071/17 Minutes of the previous meetings Deputy Chair Decision Paper

TB 072/17 Action Tracker Deputy Chair Decision Paper

SCRUTINY & ASSURANCE

TB 073/17 Patient Story Deputy Director of Nursing Noting Verbal

TB 074/17 Chief Executive Report Chief Executive Noting Paper

TB 075/17 Quality and Performance Report Chief Operating Officer Noting Paper

TB 076/17 Naylor Review Property Services Director Noting Paper

Part Two

TB 077/17 Chief Executive Report Chief Executive Noting Paper

TB 078/17 Date and time of next meeting Board Away Day 20 June 2017

Board of Directors 8:30am, 6 July 2017

Deputy Chair Noting Verbal

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Declaration of Interest – Board of Directors

Date of Declaration

Surname First Name

Job Title Nature of Interest

Do you envisage a conflict of interest between outside employment and

your NHS employment?

Nil Declaration

21/02/2017 Eva David Trust Chair Employed by Union Learn as National Manager

Yes TUC funds learning in relation to apprenticeship and Trade Union representation.

06/02/2017 Tierney-Moore Heather Chief Executive

1. Director of Lancashire Sport Partnership2. Trustee of Community Integrated Care3. Macmillan Allumni Patron4. Retained Consultant Glenview5. Patron Breakthrough Mental Health Charity

Yes Potential risk of CIC bidding to provide services in Lancashire that are also of interest to LCFT

13/02/2017 Furlong Gwynne Non-Executive Director & SID

1. NED - Prospect (GB) Ltd. (Subsidiary ofRiverside Housing Association)

2. NED - Progress Housing Group3. NED – Together Housing Group4. CEO of Regain Sports Charity5. Trustee of Chorley Youth Zone

No

13/02/2017 Ballard Peter Deputy Chair & Non-Executive Director Chief Executive DSE Service No

29/03/2017 Dickinson Louise Non-Executive Director

1. Director at Talegar Limited2. Consultancy Services at Talegar Limited3. Foundation Governor and Finance Chair at

St.Vincents Primary School

No

03/02/2017 Wilson Isla Non-Executive Director

1. NED - Progress Housing Group2. Shareholder – FSquared Ltd3. Shareholder - Ruby Star Associates Ltd4. Consultancy/Advisory Work – Ruby Star

Associates

No

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Declaration of Interest – Board of Directors

03/02/2017 Curtis David Non-Executive Director 1. Director at Clinical and Corporate Governance

Limited2. Clinical Associate at MIAA (Advisory Section)

No

07/02/2017 Gregory Bill Chief Finance Officer

1. Trustee of Healthcare Financial ManagementAssociation

2. Governor of Stockport College3. Co-opted member of Lancaster University

Financial and General Purpose Committee.4. Director of Red Rose Corporate Services

No

25/01/2017 Possener Julia Non-Executive Director (Start date 01.02.2017)

1. Sole director and shareholder of JC PossenerLimited. Provides management consultancyservices. No formal/informal contracts with theTrust nor any other NHSorganisations/organisations providing servicesto the NHS.

2. Lay member of the Lancaster UniversityManagement School and Faculty of Arts andSocial Science Ethics Committee. Although theTrust and LU have a working relationship andcollaborate such matters do not fall usuallywithin these Faculties.

3. My partner's sister is the owner of a domiciliarycare business which does have contracts withThe Trust. I am including this for the sake ofcompleteness. Bluebird Lancaster and SouthLakeland Ltd. I have no formal nor informalinvolvement in that business.

No No business with the Trust or other NHS organisation or organisations providing services to NHS No unrelated faculties or formal or informal business.

13/02/2017 Roach Dee Executive Director of Nursing & Quality

06/02/2017 Marshall Max Medical Director

06/02/2017 Moore Sue Chief Operating Officer

07/02/2017 Gallagher Damian Director of HR

06/02/2017 Winterson Steve Director of Strategic

Partnership & Engagement

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BOARD OF DIRECTORS

Minutes of the Part One Board of Directors meeting held on 04 May 2017 at The Harbour

PRESENT: David Eva, Trust Chair (chair) Heather Tierney-Moore, Chief Executive Sue Moore, Chief Operating Officer Damian Gallagher, Director of HR Bill Gregory, Chief Finance Officer Julia Possener, Non-Executive Director Louise Dickinson, Non-Executive Director Jo Alker, Company Secretary David Curtis, Non-Executive Director Dee Roach, Director of Nursing & Quality Peter Ballard, Non-Executive Director Isla Wilson, Non-Executive Director Steve Winterson, Director of Strategic Partnerships & Engagement

IN ATTENDANCE: Julie-Ann Bowden, Associate Director of Compliance & Assurance Bev Howard, Head of Communications Ashley Christian, Executive Assistant to CEO (minutes) Liz Mear, Innovation Agency Chief Executive (item TB 051/17 only)

OBSERVERS: Ayesha Rahim (Consultant Psychiatrist) Deborah Wiltshire (Temporary Staffing Coordinator)

TB 039/17 WELCOME & OPENING COMMENTS The Chair welcomed everyone to the meeting.

TB 040/17 PATIENT STORY The Board heard a patient story from a former service user of inpatient services at Guild Lodge and his journey through secure services leading to his current placement in an independent living flat in Blackpool.

TB 041/17 APOLOGIES FOR ABSENCE & CONFIRMATION OF QUORACY Apologies for absence had been received from Gwynne Furlong.

TB 042/17 DECLARATIONS OF INTEREST Bill Gregory declared an interest in Red Rose Corporate Services reporting and Heather Tierney-Moore declared an interest in Innovation Agency reporting.

TB 043/17 MINUTES OF THE LAST MEETING The minutes of the meeting held on 06 April 2017 were accepted as a true and accurate record subject to including one addition to the apologies (IW).

TB 044/17 ACTION TRACKER The action tracker was reviewed and noted.

TB 045/17 QUALITY CTTE CHAIR REPORT The Chair of Quality Committee introduced the Chair Report and described the progression of Serious Incident work. The Board noted David Curtis was the lead Non-Executive Director for mortality. Work around A&E breaches and

CONFIRMED

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contributions to the Carter Review for community & mental health trusts was described. The important role of staff in promoting quality impact assessments was emphasised and details were provided about the upcoming quality conference.

Some slippage in mandatory training had been noted including some role specific training for certain staff groups. The Quality Committee had begun a review of the structure and frequency of its meetings as part of an effectiveness review. Final arrangements for holding more regular Quality Committee meetings would be shared with the Board once the effectiveness reviews are complete.

The Chief Executive provided an update to the Board on the recent Carter visit to the Trust and Executive Directors each outlined the key areas of focus during the visit from NHS Improvement.

TB 046/17 FINANCE & PERFORMANCE COMMITTEE CHAIR REPORT The Chair of Audit Committee presented the chair report as she had chaired the most recent Finance & Performance Committee meeting on behalf of Peter Ballard. The key areas of discussion and focus at the Committee included the estates plan and the scale of the e-PR programme, for which important assurances had been received related to staff engagement and governance. An explanation was provided about the DTS programme in the context of the wider financial plans for 2017/18. The Board noted a discussion on the future role of the Financial Recovery Group was planned for July.

TB 047/17 AUDIT COMMITTEE CHAIR REPORTS The Chair of Audit Committee highlighted the detailed commentary on year-end progress, noting both the process and current position were positive. A more in depth analysis would be provided to the Board when the Annual Report and Accounts are presented to the Board at the end of May.

The Head of Internal Audit opinion had been received; overall the Trust had received significant assurance.

An explanation was provided about new data protection legislation and what the impact would be for the Trust’s information governance arrangements. It was noted that additional routine assurance had been commissioned by the Audit Committee through the governance ‘health checks’.

The Audit Committee also received assurance from the substantial value for money (VfM) report it received. The Trust has been proactively reporting on VfM for three years and is well placed to respond to new guidance requiring a more specific focus on VfM going forwards. The Board noted that an overview of the role of clinical audit and the distinction of Audit Committee and Quality Committee reporting was planned.

TB 048/17 CHIEF EXECUTIVES REPORT The Chief Executive provided an overview of the report which included a range of examples of visits and quality improvements to ensure people are at the heart of everything we do. In particular an explanation about how the new Acute Therapy Service (ATS) would contribute both to quality of services for patients

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and contribute to reducing the financial impact of OATs as well. It would be important to ensure the thorough review of ATS as a unique service offering records the benefits to patients in order that this may be shared more widely with peers.

An overview was provided of the Workforce Race Equality Standards data and how the Trust’s senior leaders have considered the findings as part of work to focus on both success and further improvements. The Director of HR discussed the action plan prepared in response to the WRES findings and the commissioning of a related thematic review of disciplinary cases.

The Chief Executive discussed the receipt of the internal reviews of Specialist Services and The Harbour and formally presented them to the Board alongside the action plan for Specialist Services. It was highlighted that there were no systematic control failures identified for Specialist Services and that those areas identified which could benefit from further strengthening and improvements had already been picked up through the organisational re-set.

The Board noted the general refresh of the Decision Rights Framework and Matters Reserved for the Board. Further work was planned to communicate the final documents to staff. The Board also noted the progress of the three remaining actions from the Well-Led review and considered how the new approach to well-led from the CQC and NHS Improvement would develop.

An update was provided on the positive induction programme for new staff joining as part of the Southport & Formby contract. The Executive Team had been fully involved and would be attending the induction to welcome new staff.

The Board noted the Trust had been awarded the perinatal contract and the decision was now in public domain. The importance of the work needed to establish the service and the complexity of pathways was noted. The service presented fantastic opportunities for the North West provision of inpatient perinatal beds outside of Manchester.

A progress update was provided on the STP and the impact of the five year forward view on supporting the rapid establishment of ACSs. The current political view of STPs in the run up to the general election was noted.

The Chief Executive updated the Board on the first quarterly review meeting with the new NHS Improvement locality team.

An explanation of the withdrawal from the homecare contract was provided by the Chief Operating Officer following a query from a Non-Executive Director.

Non-Executive Director Louise Dickinson encouraged the Board to use the Specialist Services review to reflect on the importance of robust assurance and being sufficiently demanding of the Trust’s assurance framework. However it was fully recognise that the organisational reset had strengthened those areas were perceived gaps existed.

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TB 049/17 QUALITY & PERFORMANCE REPORT The Chief Operating Officer introduced the report. The Memory Assessment Service waiting times were currently based on diagnostic assessment guidelines and an explanation was provided of the work taking place to date-profile patients waiting over 12 weeks to establish those who opt to wait. An explanation of the intended approach to reporting waiting times going forward was provided and has been approved by commissioners.

The Chief Operating Officer described the significant improvements for IAPT over recent years. The Trust had exceeded the recovery target for IAPT wait and a description of the improvements in cumulative prevalence was provided, particularly how this has the greatest positive impact on patients quality of life.

The continuing focus on 7-day follow up by clinical teams was acknowledged as a key performance indicator which remains under close monitoring by the Board because of its impact on patient quality experience. In addition, the new data on CPA would be a measure to re-visit in future once patterning could be established.

TB 050/17 WORKFORCE REPORT The Director of HR introduced the report and explained the content of the network level reports received by senior leaders. There had been an increase in bank staff usage in March related to the pattern of staff taking annual leave prior to the end of the financial year. Safer employment work continues to be positive.

A discussion was held about sickness absence, the improvement plan and the targeted audit undertaken to help identify improvement actions which had shown the breadth of work undertaken demonstrated a considerable reduction for the Trust. However in the context of other organisations the Trust remains higher than average for sickness rates. A broader and more detailed strategic discussion would be undertaken by the Board on workforce later on the agenda and would take account of workforce absence management.

Appraisal rates and transition to the new PDR year were outlined and the core skills figures continue to improve as a result of improvement activity within the networks. The compliance rate is currently running consistently above 95%.

Liz Mear joined the meeting.

TB 051/17 INNOVATION AGENCY FOIA Exempt under Commercial Interest

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Max Marshall joined the meeting. Liz Mear left the meeting.

TB 052/17 FINANCE REPORT The Chief Finance Officer confirmed the achievement of Trust control total and noted that had triggered the availability of the Sustainability & Transformation Funding (STF) as well as an additional £1.4m income from national STF pot.

The expected final position was a surplus of circa £200k although some impairments mainly related to valuation of estates, whilst disregarded from control total, remain relevant for the year end accounts.

The Trust use of resources rating was confirmed at 2. The cash position was slightly ahead of plan with the £3.4m STF payment only being received during 2017/18. There were no material issues expected from the external audit.

The Deputy Chair acknowledged the significant effort to manage the financial position to a surplus. Formal recognition would be communicated to the organisation from the Board to thank staff and highlight the benefits to the organisation of achieving the control total.

TB 053/17 BOARD ASSURANCE FRAMEWORK The Director of Compliance & Assurance outlined the impact of the strategy refresh which had informed the risk appetite statement. The Board approvedthe risk appetite statement.

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An overview of the Quarter 4 BAF position of the BAF and the end of year review was provided. An explanation of the enduring risks and how this has informed the development of 2017/18 risks was provided. The Board signed off the Q4end of year position.

The Board had been fully involved in the development of the 2017/18 risk profile and the proposed BAF risks. The detail and rationale for the transfer of risk from 2016/17 to 2017/18 was provided to the Board for assurance. A discussion about transfer of risk related to compliance with the provider licence took place. Clarity was provided on how the content of the Board Assurance Framework would be tailored for the Board to take account of operational risk management but allow for appropriate Board enquiry about the controls in place. The Board approvedthe 2017/18 BAF Risk Register.

TB 054/17 DATE & TIME OF NEXT MEETING Tuesday 30 May 2017, 11:00am

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Board of Directors

Agenda Item TB 074/17 Date: 01/06/2017

Report Title Chief Executive’s Report

FOIA Exemption Part Exemption

Prepared by Heather Tierney-Moore, Chief Executive

Presented by Heather Tierney-Moore, Chief Executive

Action required Discussion

Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose The purpose of this report is to provide Board members with an overall summary of the Trust position and highlight areas for further discussion.

Strategic Objective(s) this work supports

To provide high quality services

Board Assurance Framework risk 2.1 – The Trust does not receive assurance of the accuracy, timeliness and consistency of data and reporting with the potential to compromise decision making and service quality

CQC domain Well-led

Introduction This report aims to give Board members an overview of the activity undertaken since the last Board meeting, both within the Trust and externally.

QUALITY AND SAFETY

Serious Incidents

During April 2017, six serious incidents were reported: (Brief information is provided to protect confidentiality, the term suicide is only used once a Coroner’s Inquest has returned a verdict of suicide).

Grade 3 Pressure Ulcer in District Nursing Services; Grade 4 Pressure Ulcer in District Nursing Services; Death of two patients (suspected suicide) under the care of the Crisis Resolution and

Home Treatment Team; Death of a patient (suspected suicide) under the care of the Clinical Treatment Team; Attempted suicide of a prisoner at HMP Liverpool.

In all cases, a formal investigation is now underway and the incidents have been reported to Commissioners, NHS England and regulators as required under the NHS Serious Incident Framework.

Serious Incident Learning Panel In May, the Trust implemented a new approach to the formal sign off process for post incident reviews following serious incidents. This change involved the formation of a panel to review completed serious incident reports and subsequent improvement plans, with the primary aim of strengthening the quality of improvement work and identifying opportunities for organisational improvement and transformation. The panel is attended by the Non-Executive Director responsible for chairing the Quality Committee (David

Business Development

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Curtis), the Executive Medical Director (Professor Max Marshall) and Executive Director of Nursing and Quality (Dee Roach). Representatives from both Lead Commissioners also attend.

National Patient Safety Alert: Misplaced Nasogastric and Orogastric Tubes In October 2016, NHS Improvement issued a National Patient Safety Alert concerning misplaced nasogastric and orogastric tubes. This national alert required all NHS Trusts to assess their clinical practice against national learning from serious incidents. The Safety and Quality Governance Department led this assessment process across the Trust. The outcome of this assessment is that the Trust is compliant with national learning, however, further improvement could be made to standardise procedures across services and improve the recording of staff competency. This work will be taken forward by the relevant Trust working group.

Raising Concerns

During April 2017, eleven concerns were reported:

Fraudulent working of a staff member whilst off sick; Electro-convulsive therapy (ECT) being used outside of normal diagnostic guidelines; Use of monitoring devices under desks; Two separate concerns of bullying across two separate services; Condition of the roadway entering Guild Lodge; Timekeeping of a staff member; Two separate concerns around quality and safeguarding in two separate services (one is not a

Trust operated service); The cost of food for inpatient staff in one service; Continued concerns (further to those previously raised) in regards to a named senior manager

and the overall culture of one Network.

In all cases a review of proportionate scale has been commissioned. The findings from each review are individually fed back to the person raising the concern if they have provided their name. The findings from every concern is summarised in the Quality Matters bulletin.

The Trust actively encourages all staff to raise concerns and has a number of means to support staff in doing so including the Dear David online form which is sent to the Trust Chair (David Eva), a Raising Concerns Guardian (Matthew Joyes) who can support staff in raising concerns and a dedicated email and post address. Concerns may also be raised with the Trust by regulators or commissioners if staff approach them direct. A regular report is sent to the Quality Committee outlining in more detail concerns raised and actions taken.

Care Quality Commission (CQC) Review into Children Looked After and Safeguarding in Blackpool The CQC conducted a review of safeguarding children and services for looked after children in the Blackpool area between Monday 08 May 2017 and Friday 12 May 2017. The reviews focused on the quality of health services for looked after children, and the effectiveness of safeguarding arrangements for all children in the area. The review was conducted under Section 48 of the Health and Social Care Act 2008 and focused on evaluating the experiences and outcomes for children, young people and their families who receive health services within the boundaries of Blackpool. This review is the same format as that conducted across the Lancashire areas last year. The Trust coordinated its involvement through the Safety and Quality Governance Department as part of its established procedures for inspections.

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A draft report will be shared with the Trust and other organisations involved in due course. High level verbal feedback, specific to the Trust, was provided and improvement areas included supervision, record keeping, multi-agency communication and risk assessment.

Core Skills The Trust continues to make progress to 85% compliance in all areas. Recovery plans are in place and additional sessions have been scheduled. It is anticipated the target will be achieved and maintained by the end of Quarter 1.

Trainee Nursing Associate Pilot The Trust continues to lead the Lancashire pilot and 17 Nursing Associates have commenced their training programme in placements across the organisation.

Supporting Students in Practice The Practice Education team have reallocated the significant number of students displaced by the moves in services in the Children and Young People Network to other placement areas (students had been displaced by the impact of travel distances to new service location). This is alongside a measured improvement across the Trust in student experience (which is very important in recruitment) and in placement audit completion and student course completion rates. The Quality Academy has supported a focused return to practice initiative in Secure Services in partnership with UCLAN.

Mindfulness Event Dr Gita Bhutani, Associate Director for Psychological Professions, was invited to participate in a Q&A session on Mindfulness organised by Mike Wedgeworth, Canon of Blackburn Cathedral. The two-day event was organised to showcase mindfulness and hear from a world-leader in this area: Dr Mark Williams. Other panel members included Chief Executive of Lancashire Mind and questions were around how mindfulness can help with a range of conditions and where it might be contra-indicated.

FINANCE AND PERFORMANCE

Quality & Performance and Finance Report The Quality and Performance report can be viewed under agenda item TB 075/17.

Finance Report A full financial analysis is not available at month 1 however this paper summarises the position which incorporates a number of estimates and assumptions that will need to be refined as the first quarter progresses which will also enable the development of a year-end forecast. The Trust is assuming at this stage that its performance is sufficient to attract the STF monies. Month 1 sees a surplus of £0.1m, broadly in line with plan.

Cyber Attack Update Further to the updates that the Board have received about the impact of the cyber-attack on the Trust, the position as at 26 May is positive. System access has been restored to at least the same level as before the cyber-attack and the installation of new kit for Southport is continuing according to the existing roll out plan. These measures continue to strengthen the Trusts security arrangements following the attack and the Trust has stepped down the escalation arrangements and returned to business as usual.

The lessons learned exercise and de-brief that will follow will be reported through the Infrastructure Sub-Committee and assurance provided up to the Board via chair reporting. The Trust will also be involved in, and receive the outcome of, a similar lessons learned exercise led by gold command.

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Red Rose Corporate Services Joint Venture A verbal update will be provided to the Board at the meeting.

GOVERNANCE AND ASSURANCE

Annual Report and Accounts, and Year End Reporting Following the Board of Directors meeting on 30 May 2017 to sign off the Annual Report and Accounts, all documentation will be submitted to NHS Improvement by the deadline of 31 May 2017. A verbal update will be provided at the meeting on 01 June to confirm the submission.

BUSINESS DEVELOPMENT

FOIA Exempt under Section 42 Commercial Interest

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Board of Directors


Report Title Trust Finance Brief as at Month 1 2017/18

FOIA Exemption No Exemption

Prepared by Dominic McKenna – Financial Management Director

Presented by Bill Gregory – Chief Finance Officer

Action required Noting

Supporting Executive Director Chief Finance Officer


Report purpose To inform the Board of the current financial situation and consider recommended actions


To provide excellent value for money in a financially sustainable way

Board Assurance Framework risk 5.1 The Trust does not have in place effective financial controls which could affect long term financial viability and sustainability

CQC domain Well-led

INTRODUCTION A full financial analysis is not available at month 1 however this paper summarises the position which incorporates a number of estimates and assumptions that will need to be refined as the first quarter progresses which will also enable the development of a year end forecast.

Month 1 The Trust is assuming at this stage that its performance is sufficient to attract the STF monies. Month 1 sees a surplus of £0.1m, broadly in line with plan.

CORPORATE REPORT APRIL 2017

TRUST SUMMARY

BUDGET DETAIL BUDGET ACTUAL £ %

TO DATE TO DATE VARIANCE VARIANCE

£'000 £'000 £'000

INCOME

CATEGORY A -24,526.7 -24,526.7 0.0 0.0PATIENT RELATED INCOME -764.0 -1,013.4 249.4 32.6NON-PATIENT RELATED -2,098.2 -2,037.3 -60.9 -2.9INTEREST -10.8 -3.5 -7.4 -68.0

TOTAL -27,399.7 -27,580.9 181.2 0.7

EXPENDITURE

PAY 19,942.8 20,820.8 -878.1 -4.4NON PAY 5,098.2 4,975.1 123.1 2.4RESERVES 1,063.2 351.6 711.6 66.9CAPITAL CHARGES 1,295.5 1,333.2 -37.6 -2.9

TOTAL 27,399.6 27,480.7 -81.0 -0.3

SURPLUS/(DEFICIT) FORECAST 0.0 100.2 100.2 0.4

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This overall position masks some significant under and over performance in the month.

Service Budget Actual Variance

£000s £000s £000s

Healthcare Income -

£24,526.7 -

£24,526.7 £0.0

Clinical Services

Mental Health £10,069.5 £10,894.8 -£825.3 Community & Wellbeing £4,017.2 £4,096.5 -£79.3 Children & Young Peoples £3,940.7 £3,700.1 £240.6

Support Service & Reserves £6,499.3 £5,735.1 £764.2

Total £0.0 £100.2 £100.2

The totality of the CIP target has been applied to each service which will have had an impact, particularly on clinical areas where schemes are still being developed. Additionally, all funding for posts released by the Organisational Reset have been withdrawn from services, although some costs for staff still requiring alternative roles are being incurred.

Key Variances

Mental Health – there remains a risk to financial position of the Network due to the shortfall in robust CIP schemes identified. No pressure is being experienced at this stage on Out of Area Placement (OAPs) and funding is anticipated to be sufficient for the need given the mobilisation of the alternative services commissioned by the CCGs. Pressure is however being experienced again on inpatient services which continue to operate at higher than contracted occupancy. This Network now includes Secure Services and those wards are similarly experiencing pressure on staffing.

Community & Wellbeing – As with mental health, the Network is behind on its financial plan in the main due to work still being in progress on CIP development. Additional, some costs for staff affected by the Organisational Reset are being incurred.

Children and Young People – The network has had some one off benefits in month 1, which have led to a favourable position, which couples with vacancies have supported the position, but again CIPs and reset costs are impacting. There sexual health contract appears to still be problematic.

Support Services and Reserves – There continue to be underspends in a number of support services. The favourable position on reserves is mainly related to the full transaction of CIP control totals to networks/support services and the currently centrally held benefits associated with the reset

Agency Spend

The Trust has an annual agency target of £7.695m which gives a monthly target of £0.641m. The April actual cost was £0.647m, a shortfall only £6k. This figure will be skewed by it being a 4 week month (with Easter which impacts on medic spend).

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Risks

There are a number of areas which require close monitoring in the future months and they will be familiar from previous years.

Although OAPs (Out of Area Placements) expenditure is expected to remain within funding, and with any surplus being available for ward acuity, we will need to assess the efficiency of the new services and their impact on OAPs to gauge the degree of overspend on mental health wards. Given these new services are being mobilised; their impact is as yet untested. This is being monitored monthly as part of the performance process.

CIPs – there remains some risk to the CIP outturn as a number of schemes are still in development. Full analysis is not available, but this will be a key area of focus in future month’s performance meetings.

Ward staffing (Adult mental health and Guild Park) – 16/17 saw significant pressures on the wards due to acuity, rostering and sickness. Until these are addressed, the financial position is at risk.

Sexual Health – the Trust is expecting a recovery of the deficit seen in 16/17 for this year. Current indications are that there remain significant challenges for this contract.

Reset – the Trust has made provision for some costs in respect of resolving some of the staffing issues. The precise detail is still being worked through and the financial consequences cannot be certain until then.

Summary

The month 1 position is generally used as a very early flag of areas which require greater scrutiny. What it shows is that the Trust has still to fully address a number of issues which have the potential to impact significantly on the finances. As expected these cover ward staffing, Out of Area Placements, Sexual Health income and the delivery of CIPs. Additional uncertainty is introduced by addressing the financial consequences of the reset. All of these issues need to be addressed if the trust is to hit the control total.

Bill Gregory

Chief Finance Officer

24th May 2017

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Board of Directors


Report Title Quality and Performance Report (QPR)

FOIA Exemption Part Exemption Service Delivery and Contracts

Prepared by Louise Corlett, Head of Delivery and Performance

Presented by Sue Moore, Chief Operating Officer


Supporting Executive Director Chief Operating Officer


Report purpose To appraise the Board of Directors of key elements and themes from the Month 1 QPR


To provide high quality services

Board Assurance Framework risk 2.1 The Trust is unable to reposition in the marketplace to become established as a provider of choice achieving excellence

CQC domain Well-led

PAPER DEVELOPMENT PROCESS:

Meeting Presented Action Date

BDD Sub-committee Louise Corlett Approved with amendments 23/05/17

The Board are asked to note the QPR for month 1 with following comments below.

The Board are also asked to note the following:

As indicated in last month’s covering report, this month sees the re-formatting of the BoardBalanced Scorecard (BBSC) to align with the Strategic Priorities. At this stage, the currentmetrics within the BBSC are re-aligned to our 6 priorities however further work will be conductedthroughout Quarter 1 to refresh the metrics. These will be reported from Quarter 2. The aim ofthis is to establish the key metrics that will inform the Board as to the progress towardsachieving our strategic priorities over the next 5 years.

Also from this month, as indicated in last month’s cover report, this report is presented in thecontext of the CQC domains and the information in the QPR is used to provide information andassurance to the Board in terms of our operational status against each domain. An exercise hasbeen conducted to map the key operational indicators to the CQC domains.

As indicated last month, for Month 1 workforce measures are reported at Trust level and not atNetwork level. This reflects the work required across source systems to adjust hierarchies andchange to service configuration resultant from the organisational reset.

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Are we SAFE?

The Trust continues to perform well in relation to HealthCare Acquired Infections, with no attributed Clostridium Difficile or MRSA cases reported in month 1.

In relation to Serious Incidents reported, the number reported in month 1 is 4, consistent with the overall downward trajectory over the last 12 months and maintenance of M12 position.

The most concerning element within this domain is the continued high levels of incidents relating to physical violence to staff with 155 incidents in month 1. A Positive and Safe Group has been established (which reports into Quality and Safety Sub-committee) to address this and the group is overseeing the implementation of a number of improvements which include the following: Introducing Positive Behavioural Support Plans, Violence Reduction Specialist Advisors supporting wards/teams with complex patients, review of the approach to supporting staff after incidents of violence, updated violence reduction training and increasing access to training.

Are we CARING?

The Trust has experienced a drop in both the overall number of complaints and those upheld in month 1 from the number seen in month 12. As a Trust, we recognise the importance of feedback from all sources and value hearing feedback received in complaints as a means of driving continued learning and improvement. Therefore the number of complaints is not a concern, instead the focus is on welcoming complaints as a source of feedback and increasing the number of complaints resolved through ‘rapid resolution’ - the proportion of complaints resolved through this route is reviewed quarterly.

Feedback received through the Friends and Family test continues to be positive at 93% and the number of compliments remains high.

Are we EFFECTIVE?

There are a number of different sources of information that provide intelligence as to our effectivity:

Harm Free Care - for both physical and mental health the target is 95% and whilst the physical health position has improved in month 1 to just under the 95% target, the position in mental health has decreased. The indicator is a cumulative position in relation to a number of composite measures and a Quality Improvement Programme ‘Promoting Health, Preventing Harm’ is underway to address areas requiring improvement within each Clinical Network. Clinical Directors provide assurance on the activities undertaken within this programme through the Quality & Safety committee.

Readmission rates, both 30 and 90 days, demonstrate whether the inpatient care we provide to patients is effective. Currently, the admissions to the assessment wards, where we provide short duration interventions which may result in the requirement for further future intervention, are included in our readmission data. This means that our performance is skewed by some patient readmissions that are appropriate and this is causing an increase in reported readmission rates at both 30 and 90 days. Nevertheless, patient level case reviews continue to identify improvement.

Average Length of stay across all areas has increased slightly – 34.7 days from 33 days in Adult Mental Health, 39.9 days from 37.8 days in PICU services and 122 days from 116 days in Older Adult services. A focus on discharge pathways is underway involving the Medical Consultants in both Adult

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and Older Adult Mental Health wards. This work will support the wider work to reduce out of area placements and occupancy.

PbR Clustering continues to be completed at greater than 95% across all Networks consistent with effective allocation of patients to the correct clinical cluster.

Allocation of a care coordinator within 2 weeks is a measure to indicate that patients are being effectively allocated to a care coordinator for treatment. An increase in the number of patients who are unallocated to a care coordinator within 2 weeks causes concern as it is unclear whether the treatment and care for these patients has been progressed. Performance in month 1 shows an improvement in overall numbers without a case coordinator from 443 patients to 305 patients. This continues to be monitored closely within Networks.

Are we RESPONSIVE?

The Trust continues to perform well against all NHS I indicators. We also demonstrate responsiveness in relation to our achievement of the 18 week referral to treatment standard for AHPs across all relevant services where this is measured and also dental waiting times within Adult Community Services, however a number of services within the Children and Young People’s wellbeing Network have performance challenges. Speech and Language therapy and psychology services for children have experienced significant waiting list challenges for some time and whilst some teams within each service demonstrate improved performance, other teams remain constrained by capacity shortfalls. Performance in Child Psychology for month 1 against the 95% Referral to Treatment standard for completed treatment pathways was 66.6%, an improvement on last month of 2%. For Speech and Language Therapy performance in month 1 was 84%- an improvement of 1.5% from the previous month against the 92% target for referral to treatment within 18 weeks for patients awaiting treatment. Actions are in place to address this under-performance and progress monitored through BDD sub-committee.

Memory assessment services continue to under-perform against the 6 week referral to assessment standard, however, a robust recovery plan is in place and has been agreed with commissioners. This recovery plan is generating an improvement in performance which has been seen in the last 2 months compared to the previous 10 months ( in Month 1, 47% was achieved compared to an average of 37% for the 10 months from May 16 to February 17).

IAPT services, whilst continuing to perform well against the recovery targets and the NHS I indicators for referral to treatment in 6 and 18 weeks, have fallen short of the prevalence target in Month 1 (1.04% achieved against 1.25% target in month). It is notable that the prevalence target was also not met in April last year and actions to recover the performance are being put into place.

Our ability to respond to all demand for inpatient beds continues to be a challenge as demonstrated through the number of out of area placements required for patients in April. Improvements seen since December have been maintained to achieve an in month position of 23.5 patients, however the implementation of the intensive support services initiatives across the early part of this financial year will be instrumental in enabling a further reduction to the number of OAPs. Bed occupancy overall remains high at 108% (including OAPs) demonstrating the continued pressure our mental health inpatient services are experiencing, which again the intensive support services initiatives are expected to have a positive impact upon.

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The responsiveness of our mental health liaison teams into A&E departments continues to be an area of challenge however some time-limited additional investment has delivered an improvement in month 1 with a drop in the number of 12 hour breaches attributed to mental health liaison services (24 in M12 to 6 in M1) and a drop in attributable 4 hour breaches (71 in M12 to 67 in M1). A bid for investment in Core 24 liaison services was successful which will go live in 2018/19 and in the meantime the Trust is endeavouring to secure in year non-recurrent funding to initiate Core 24 services in 2017/18.

Are we WELL-LED?

Sickness rates continue to be above the 4.5% target however the rate continues to decrease and in month 1 is 5.74% for the Trust as a whole. Individual Network and support services positions is not available for month 1 to track improvements against known hot spots however this will be available for month 2 reporting.

Performance against core skills training continues to perform well exceeding the 85% target.

Are we PRODUCTIVE?

There is no financial reporting in month 1, therefore this section will be developed further in month 2 reporting. In addition, whilst we report our activity at service line level in month 1, the comparison to plan cannot be made at this stage given the continued discussions to agree the baselines within the contract. This will be completed by the end of June to enable Quarter 1 reporting in July.

SUMMARY AND RECOMMENDATIONS The information in the QPR provides evidence of our performance against key metrics aligned to each CQC domains. From this, and the exception reporting against each measure, we are able to provide information that supports the assessment of our position against each domain (where reports are available in month 1).

Notable areas where improvement activity is underway relates to our responsiveness to inpatient demand and waiting times in a number of services and with regards to safety in relation to violence against staff.

The Board are asked to note this report and the QPR for month 1.

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Performance Management


Quality and Performance Report

M1 – April 2017 19 May 2017

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Board Balance Score Card Trust Strategic Priorities

To become

recognised

for

excellence

To employ

the best

people

To provide

excellent

value for

money in a

financially

sustainable

way 23 of 121


Board Balance Score Card Trust Strategic Priorities

Strategic Priority Strategic blueprint

To provide high quality

services

We will ensure that people who use our services are at the heart of everything we do, and the people who deliver and support delivery of services are motivated, engaged and proud to provide high quality, compassionate, continually improving care. We will empower people to share their stories so that we know how we are doing and we will listen to learn and to improve quality together. We will continue to strive to be the best that we can be by upholding our 8 quality commitments and the ‘I’ statements, empowering everyone to embrace these personal pledges, for example:‘I connect to my knowledge, skills and experience to deliver the best quality’‘I have the courage and strength to do the right thing’‘I go the extra mile, whatever the situation, whomever the person’

To deliver sustainable

services that meet the needs

of local people

We will collaborate with partners to deliver system-wide transformation and we will be an active partner in delivering a bespoke offer to a number of Accountable Care Systems by being the prime provider of specialist, acute and community mental health services, and a lead provider in delivering new models of integrated physical and mental health out of hospital services, and realising the benefits of our geographical footprint to deliver system-wide sustainable infrastructure solutions

and organisational vehicles for new models of careWhilst our principal footprint for delivery of services is Lancashire and South Cumbria, we will continue to seek opportunities across North West STP footprints.

To become recognised for

excellence

Our service users and carers will tell us that our services are of high quality. Our people will recommend us to family and friends. We will be respected by our commissioners and other providers as a co-producing partner in shaping new service models that deliver our aligned strategies with an emphasis on place based care.

To employ the best people

We will develop an organisational culture and leadership team equipped to meet its strategic intent and the needs of both its workforce and the population it serves; in short, a culture of high performing, continually improving and compassionate care. Staff will be motivated, engaged, high performing and proud of the service they provide. We will proactively support staff to look after their own health and wellbeing and to reach their full potential. We will identify and grow our future leaders. People will want to work here.

To provide financially

sustainable services

We will restore and maintain financial balance and provide services that offer excellent value for money without compromising financial sustainability. We will work with local partners to delivery system-wide efficiency measures. We will actively seek business opportunities that add value for local people.

To innovate and exploit

technology to transform care

We will develop and promote digital enabled care and lead research and innovation to enhance patient experience, reduce costs and/or improve quality. We will have a culture where staff are given the time, training and resources to research and innovate. Research will validate innovations and innovations will direct research. Partnerships with third party organisations will enable rapid execution and exploitation of innovation projects.

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Mental Health Community Survey

Feb Mar Apr

Research Studies

Feb Mar Apr

125 201 79

National Audits & Accreditation

Schemes

Feb Mar Apr

Learning League

Feb Mar Apr

FFT

Feb Mar Apr

96% 96% 96%

Business Gained - Lost

Feb Mar Apr

£4.064k £868k

CQC Actions

Feb Mar Apr

0 0 0

OAPS

Feb Mar Apr

23 23 23

NHSI Compliance

Feb Mar Apr

100% 100% 100%

Annual Staff Survey

Feb Mar Apr

Staff FFT

Q2 Q3 Q4

3.81 3.82 3.77

Sickness Absence

Feb Mar Apr

6.25 5.93 5.74

Time to Recruit

Feb Mar Apr

40.93 46.34 46.22

Agency Ceiling

Feb Mar Apr

-3,223,666 -3,656,586 -6,206

UoR

Feb Mar Apr

3 2

Revenue Control Total

Feb Mar Apr

-0.1% 0.0%

CIP

Feb Mar Apr

100% 100%

Liquidity

Feb Mar Apr

1 1

Board Balance Score Card Month 1

Capital Control Total

Feb Mar Apr

57% 73%

Harm Free Care (Physical)

Feb Mar Apr

95% 93% 94%

Harm Free Care (Mental)

Feb Mar Apr

84% 85% 83%

Serious Incidents

Feb Mar Apr

40% -70% -78%

Violence Reduction

Feb Mar Apr

43% 0% 58%

EIP

Feb Mar Apr

81.4% 74.4% 69.0%

Contract Performance (MH)

Feb Mar Apr

6.88% 6.67%

Induction Attendance

Jan Feb Mar

95.77 96.15 94.4

Data Quality

Feb Mar Apr

96.37% 96.43% 96.45%

Contract Performance (Comm)

Feb Mar Apr

6.74% 7.69%

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Mental Health Community Survey Target - Top 25% of other Trusts Not achieved

Target not achieved in 2016. The Trust were in the middle 50% of organisations. 35% of organisations being better and 15% worse. Next survey results are due to be reported in the Autumn of 2017.

Learning League Target - Top 25% of other Trusts Achieved

The Trust was given a Good rating of openness and transparency in the 2016 Learning from Mistakes League Table produced by NHS Improvement. The Trust was ranked 23rd nationally and in the top 25% nationally.

Friends & Family Test Target - 95% Achieved - 96%

Target achieved.

Board Balance Score Card Quality & Safety - Month 1

Violence Reduction Target - 10% reduction Achieved - 58%

Violence to staff continued to be a significant quality priority. Overall levels of violence to staff have stabilised over the last year but remain higher than the baseline year of 2014/15. Quality improvement work continues to support the management of challenging behavior.

Serious Incidents Target - Over 10% reduction Achieved - -78%

The number of serious incidents remains lower than the baseline year of 2014/15.

Harm Free Care (Mental Health) Target - 90% Achieved - 83%

The inpatient wards continue to fall below the aspirational goal. A number of quality improvements are being progressed including further embedding of the violence reduction programme and the spread of positive behavioural support plans.

No. people recruited to Research Studies (National Institute for Health Research) Target - 100 participants monthly Achieved - 79

Data is subject to a 6-8 week lag as it is uploaded by research teams to a national system, retrospectively. Activity is currently forecast to meet this year’s annual target.

Harm Free Care (Physical Health) Target - 95% Achieved - 94%

94% of the 1,159 people surveyed in April experienced harm fee care. Focused quality improvement initiatives continue, for example, React2 Red and are being further developed in the area of pressure ulcer prevention and care in particular.

National Audits & Accreditation Schemes Target - 80% Not achieved

During April 2017, one national audit has been reported (Monitoring of patients prescribed Lithium) LCFT was in the lower quartile. A total of 10 national audits are expected to be reported in 2017/18.

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Board Balance Score Card Service Delivery - Month 1

FOIA exempt unders Section 43 Commercial Interest

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Annual Staff Survey Target - Top 25% of other Trusts Not achieved

2016/17 Staff Survey key performance indicators: Response Rate 35% (437 returned surveys from a sample of 1250. This is an improvement on the 29% response rate from the 2015/16 Staff Survey) Engagement Factor 3.81 (this is a slight decrease from the 2015/16 survey score of 3.87) Improvement Initiatives:

The Staff Survey results are currently being reviewed against the LCFT People Plan for the outcomes to be included in People Plan activities for the 2017/18 performance year.

Staff Friends & Family Test (FFT) Target - Top 25% of other Trusts Achieved – 3.77

Q4 2016/17 period results : Recommend LCFT as a place to receive treatment (Workforce Advocacy): Yes – 72.07%, No - 9.11%, Don’t Know – 18.81% Recommend LCFT as a good place to work: (Workforce Involvement and Motivation): Yes – 51.17%, No – 27.09%, Don’t Know – 21.74% Improvement Initiatives: The new staff FFT engagement measure is now implemented. A new staff FFT quarterly Trust performance report has been developed and was presented in quarterly reviews and to people sub committee in March. Work is now on going with Quality Academy to link the Staff FFT measurements to People Plan activity performance.

Sickness Absence Target - 4.5% Achieved – 5.74%

The sickness absence rate for April is 5.74% which is continuing to show a decrease to the rates from February and March. Please refer to the M1 QPR detailed slides for detailed information, which will be available in the M2 QPR report.

Time to Recruit Target - 60 working days Achieved – 46.22

• TRAC system – is now live, being implemented in stages• All band 5 and above vacancies will be advertised on LinkedIn, as well as regular job of the week tweets, the internet vacancies site has now been updated with a new TRAC microsite where all vacancies

are accessible • DBS policy and process is being reviewed at part of NW Streamlining Group, to consider mandating update service and annual checks • Targeted Staff Nurse Recruitment is ongoing, working in partnership with local HEIs• Proactively supporting the Medical and recruitment and Retention steering group• Further review of the WNS forms/redeployment process to identify and implement further improvements• Drafted Recruitment objectives and KPIs to be finalised

Agency Ceiling Target – 641,250 Achieved – -6,206

Following March’s expected peak due to the impact of ‘stored up’ annual leave, spend on Agency has continued the previous downward trend and stands at £6,206 over ceiling in month. The final Central Lancashire Prisons Agency invoices were processed in April and whilst the Southport & Formby community services, which tupe’d in on the 1st May, have Agency spend attached this is not anticipated to be at a level experienced in the prisons. As a result the reduction in Agency spend is expected to continue into May and beyond resulting in Agency spend within tolerance by June 2017.

Board Balance Score Card People & Leadership - Month 1

Induction Attendance Target – 95% Achieved – 94.4%

36 new starters in March of which 34 completed induction within 4 weeks. 30 staff attended on their first day with the Trust.

Feb Mar Apr YTD Target 7,122,157 7,695,000 641,250 YTD Actuals 10,345,823 11,351,586 647,456 Under/(Over)

Agency Usage -3,223,666 -3,656,586 -6,206

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Use of Resources (UoR) Target - 2 Achieved – N/A

Not reported in month 1.

Revenue Control Total Target ≥0% Achieved – N/A


Cost Improvement Programmes (CIP) Target ≥100 Achieved – N/A


Liquidity Target - 2 Achieved – N/A


Board Balance Score Card Finance - Month 1

Capital Control Total Target – 85-100% Achieved – N/A


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Quality and Performance Report:-

Section 1:- Performance and Data Quality

Section 1.1:- Executive Level Report

• NHS Improvement Indicators Dashboard• NHS Improvement Indicators Kite Marking• Key Exceptions• CCG level data• Network level summary • Key Network Exceptions

Section 1.2:- Patient Flow

• Occupancy• Readmissions• Mental Health Liaison Team

Section 1.3:- Data Quality

• PBR Clustering

Section 2:- Finance and Contracting

Section 2.1:- Financial Activity • Not reported this month

Section 2.2:- Community Contract Activity

• Community & Wellbeing – Network Line Totals• Community & Wellbeing – Service Line Totals• Community & Wellbeing – Total Activity Split by CCG• Children & Young People’s Wellbeing – Service Line Totals• Children & Young People’s Wellbeing – Total Activity Split by CCG• Mental Health – Activity Totals

9

Section 5:- Risk

• Board Assurance Framework 2016/17

Section 3:- Quality

• Quality Tile• Quality Surveillance - Safety • Quality Surveillance - Experience & Effectiveness• Leadership • Delivering the Strategy

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Performance and Data Quality

Section 1

10

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1. Performance and Data Quality

11

Section 1:- Performance and Data Quality

Section 1.1:- Performance Activity

• NHS Improvement Indicators Dashboard • NHS Improvement Indicators Kite Marking • Key Exceptions • CCG level data • Network level Summary • Key Network Exceptions

Section 1.2:- Patient Flow

• Occupancy • Readmissions • Mental Health Liaison Team Section 1.3:- Data Quality • PBR Clustering

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Performance Activity

Section 1.1

12

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1.1 Performance Activity

NHS Improvement Indicators Dashboard

13

Indicator Target May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Q1 17-18 YTD Rolling 12 Month Sparkline

MR01 - 7 Day Follow Up 95.00% 95.0% 96.7% 97.8% 98.1% 96.5% 96.0% 96.9% 98.2% 98.8% 96.1% 97.6% 98.6% 98.6% 98.60%

MR02 - CPA Review within 12 Months 95.00% 97.3% 97.1% 96.8% 96.7% 97.1% 97.7% 97.4% 97.8% 96.9% 97.1% 97.5% 97.0% 97.0% 96.97%

MR03 - Mental Health Delayed Transfers of Care ≤ 7.5% 3.59% 2.99% 2.42% 2.82% 4.18% 4.08% 3.68% 4.19% 3.81% 2.84% 2.59% 3.01% 3.0% 3.01%

MR05 - RTT - Consultant Led (Completed Pathway) 95.00% 98.5% 96.0% 98.0% 97.3% 93.2% 92.4% 95.2% 96.3% 96.7% 97.6% 100.0% 100.0% 100.0% 100.00%

MR06 - RTT - Consultant Led (Incomplete Pathway) 92.00% 98.6% 99.0% 96.4% 95.0% 95.7% 96.3% 95.2% 95.4% 97.3% 100.0% 99.2% 100.0% 100.0% 100.00%

MR07 - IP Access to Crisis Res. Home Treatment 95.00% 95.5% 96.6% 99.4% 99.4% 98.9% 98.3% 100.0% 100.0% 98.6% 99.4% 97.7% 100.0% 100.0% 100.00%

MR08 - MH Data Completeness - Identifiers 97.00% 99.6% 99.7% 99.6% 99.7% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.57%

MR09 - MH Data Completeness - Outcomes 50.00% 77.2% 77.6% 80.8% 82.0% 83.2% 83.7% 83.7% 83.8% 83.4% 83.2% 83.4% 83.7% 83.7% 83.74%

MR10 - CIDS Completeness - Referral Information 50.00% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00%

MR11 - CIDS Completeness - RTT Information 50.00% 99.6% 99.7% 99.7% 99.4% 99.3% 99.5% 99.6% 99.8% 99.1% 99.3% 99.1% 99.3% 99.3% 99.27%

MR12 - CIDS Completeness - Activity Information 50.00% 91.6% 91.1% 91.3% 93.4% 93.3% 93.3% 93.9% 94.3% 93.9% 92.9% 93.1% 94.2% 94.2% 94.20%

MR13 - 2 Week wait for Treatment for EIP Programme 50.00% 77.8% 86.7% 77.1% 67.7% 75.0% 69.0% 74.3% 76.7% 82.0% 81.4% 74.4% 69.0% 69.0% 68.97%

MR14 - RTT - IAPT 6 Weeks 75.00% 85.1% 86.0% 90.2% 92.1% 90.8% 95.0% 93.0% 96.5% 95.1% 95.7% 93.4% 96.4% 96.4% 96.38%

MR15 - RTT - IAPT 18 Weeks 95.00% 98.5% 98.8% 99.2% 99.5% 99.1% 99.3% 99.0% 99.8% 99.4% 99.8% 98.8% 99.4% 99.4% 99.43%

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NHS Improvement Indicators Kitemarking

Kitemarking Key:

• SOP – Does the indicator have an associated SOP that iswithin date

• External Audit – Has this measure been subjected to anexternal audit within the last 2 years

• Internal Audit – Has this measure been subjected to aninternal audit within the last 2 years

• Electronically Populated – Is this indicator produced usingelectronically generated numerators and denominators

• Manual Overrides – Has the performance for this indicatorbeen produced using manual overrides to indicate falsepositives or negatives

14

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NHS Improvement Indicators Kitemarking

15

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Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 98.5% against a target of 95% across 8 CCGs. CCG Position: - In Month 1, the Trust has underperformed in 1 CCG: Blackpool.

16

Note: The total figures in the tables above differ from page 11 as they are representative of only 8 contracted CCGs.

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 97.2% against a target of 95% across 8 CCGs. CCG Position: - In Month 1, the Trust has underperformed in 1 CCG: Lancashire North.

CPA 12 Month Review 7 Day Follow Up


NHS Improvement Indicators reported by CCG

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

93.1% 100.0% 100.0% 100.0% 100.0%

100.0% 97.8% 87.9% 97.4% 94.4%

100.0% 100.0% 94.7% 100.0% 100.0%

100.0% 98.1% 97.9% 95.9% 98.0%

100.0% 100.0% 94.4% 95.7% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 94.4% 100.0% 92.3% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

99.1% 98.7% 96.4% 97.5% 98.5%

NHS Fylde & Wyre CCG

NHS Greater Preston CCG

NHS Lancashire North CCG

NHS West Lancashire CCG

7 DFU CCG

NHS Blackburn with Darwen CCG

NHS Blackpool CCG

NHS Chorley & South Ribble CCG

NHS East Lancashire CCG

Total Figure - 8 CCGs


98.6% 99.2% 98.8% 99.0% 98.5%

96.7% 94.4% 95.2% 96.5% 96.6%

99.2% 100.0% 99.2% 98.5% 98.0%

97.6% 96.7% 96.2% 97.2% 96.1%

96.9% 95.7% 96.1% 96.5% 96.9%

97.5% 96.7% 98.4% 99.0% 98.8%

99.0% 98.3% 98.6% 95.7% 93.5%

96.7% 95.4% 95.9% 99.5% 100.0%

97.8% 97.1% 97.2% 97.7% 97.2%

12 month CPA


NHS Blackpool CCG








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Delayed Transfers of Care (DToC)

17


IP Access to Crisis Resolution Home Treatment

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 3.18% against a target of <7.5% across 8 CCGs. CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs.

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 100% against a target of 95% across 8 CCGs. CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs.


2.98% 2.66% 1.70% 3.61% 3.85%

1.84% 3.63% 1.51% 0.27% 1.72%

9.01% 7.73% 4.09% 4.52% 2.78%

4.09% 1.19% 1.81% 2.13% 3.98%

9.21% 5.68% 4.61% 3.13% 3.70%

4.02% 4.53% 4.51% 4.45% 4.84%

0.66% 0.00% 0.00% 0.00% 0.00%

6.42% 5.40% 4.63% 4.12% 0.00%

4.30% 3.54% 2.81% 2.74% 3.18%







DToC


NHS Blackpool CCG



100.0% 96.4% 94.7% 95.8% 100.0%

100.0% 100.0% 100.0% 97.4% 100.0%

100.0% 100.0% 100.0% 95.2% 100.0%

100.0% 96.6% 100.0% 98.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 94.4% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 98.6% 99.4% 97.6% 100.0%

% IP Access to CRHTT


NHS Blackpool CCG








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RTT – Consultant Led (Completed Pathway)

18

Note: The total figures in the tables above differ from page 11 as they are

representative of only 8 contracted CCGs. The symbol “–” denotes zero

patients.

RTT – Consultant Led (Incomplete Pathway)



Note: NHS England guidance published in October 2015 confirmed that the incomplete pathway operational standard should became the sole measure of patients’ constitutional right to start treatment within 18 weeks. And whilst we are required to maintain reporting on the completed admitted pathway, the removal of the completed admitted pathway as an operational standard means that there is no longer any provision to report pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England. This means that patients choosing to cancel appointments can impact negatively on this measure.


100.0% 100.0% - - -

- - - - -

94.3% 97.4% 97.2% 100.0% 100.0%

100.0% 100.0% - - -

100.0% - - 100.0% 100.0%

97.5% 95.9% 97.8% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% - - - -

96.3% 96.7% 97.5% 100.0% 100.0%Total Figure - 8 CCGs






RTT Complete


NHS Blackpool CCG



100.0% 100.0% - - -

100.0% 100.0% - - -

95.3% 96.9% 100.0% 97.5% 100.0%

100.0% - - - -

- - 100.0% 100.0% -

95.0% 97.4% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

- - - - 100.0%

95.3% 97.2% 100.0% 99.2% 100.0%Total Figure - 8 CCGs






RTT Incomplete


NHS Blackpool CCG


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MH Identifiers

19

MH Outcomes

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 99.8% against a target of 97% across 8 CCGs.

CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs.

Unassigned CCG: In Month 1, there were 4572 records unassigned a CCG, of which 93.2% (4265) were completed.


CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs.

Unassigned CCG: In Month 1, there were 262 records unassigned a CCG, of which 79.9% (328) were completed.



99.8% 99.8% 99.8% 99.8% 99.8%

99.9% 99.9% 99.9% 99.9% 99.8%

99.6% 99.7% 99.7% 99.7% 99.7%

99.9% 99.8% 99.8% 99.8% 99.8%

99.8% 99.8% 99.8% 99.8% 99.8%

99.7% 99.8% 99.8% 99.8% 99.8%

99.7% 99.7% 99.8% 99.7% 99.7%

99.6% 99.5% 99.5% 99.5% 99.5%

99.8% 99.8% 99.8% 99.8% 99.8%

MH Identifiers


NHS Blackpool CCG









79.4% 79.9% 79.9% 79.6% 79.1%

78.4% 78.9% 78.7% 78.4% 78.8%

90.1% 89.6% 89.3% 89.8% 90.5%

84.9% 84.7% 84.1% 84.5% 85.3%

88.3% 87.6% 87.7% 87.4% 89.0%

82.5% 82.6% 82.4% 82.4% 82.4%

90.6% 89.1% 88.7% 90.4% 91.3%

81.0% 78.4% 79.5% 80.6% 80.8%

83.9% 83.6% 83.4% 83.7% 84.1%







MH Outcomes


NHS Blackpool CCG


40 of 121




CIDS - Referrals

20

CIDS - Referral to Treatment

CIDS - Activity

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 94.2% against a target of 50% across 8 CCGs. CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs. Unassigned CCG: - In Month 1, there were 218 records unassigned a CCG, of which 100% (218) were completed.

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 99.3% against a target of 50% across 8 CCGs. CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs. Unassigned CCG: - In Month 1, there were 83 records unassigned a CCG, of which 97.6% (81) were completed.

Trust position for Lancashire CCGs: - In Month 1, the Trust has achieved a Performance of 94.2% against a target of 50% across 8 CCGs. CCG Position: - In Month 1, the Trust has achieved compliance for all CCGs.



91.8% 91.8% 90.6% 89.7% 90.7%

91.8% 94.4% 89.7% 90.0% 90.7%

95.4% 94.9% 94.1% 94.8% 96.1%

94.3% 94.5% 93.7% 92.9% 84.2%

89.2% 86.6% 86.7% 86.8% 91.9%

89.2% 86.6% 86.7% 86.8% 91.9%

93.4% 90.2% 90.2% 90.6% 91.7%

66.3% 70.8% 76.7% 71.3% 68.1%

94.3% 93.9% 92.8% 93.0% 94.2%

CIDS Activity


NHS Blackpool CCG









99.7% 98.7% 98.8% 98.5% 98.4%

100.0% 100.0% 100.0% 100.0% 100.0%

99.8% 99.4% 99.4% 99.4% 99.8%

93.4% 100.0% 99.5% 100.0% 100.0%

100.0% 100.0% 96.8% 100.0% 100.0%

99.8% 99.0% 99.6% 99.0% 99.6%

100.0% 100.0% 100.0% 100.0% 100.0%

99.4% 100.0% 100.0% 100.0% 96.6%

99.8% 99.1% 99.3% 99.0% 99.3%

CIDS RTT


NHS Blackpool CCG









91.8% 91.8% 90.6% 89.7% 90.7%

91.8% 94.4% 89.7% 90.0% 90.7%

95.4% 94.9% 94.1% 94.8% 96.1%

94.3% 94.5% 93.7% 92.9% 84.2%

89.2% 86.6% 86.7% 86.8% 91.9%

89.2% 86.6% 86.7% 86.8% 91.9%

93.4% 90.2% 90.2% 90.6% 91.7%

66.3% 70.8% 76.7% 71.3% 68.1%

94.3% 93.9% 92.8% 93.0% 94.2%

CIDS Activity


NHS Blackpool CCG








41 of 121




EIS 2 Week Wait

21



CCG Position: - In Month 1, the Trust has underperformed in 2 CCGs: Chorley & South Ribble and West Lancashire.


66.7% 80.0% 93.3% 80.0% 85.7%

88.9% 71.4% - 85.7% -

100.0% 100.0% 87.5% 100.0% 40.0%

55.6% 83.3% 85.7% 50.0% 80.0%

71.4% 100.0% 75.0% 60.0% 100.0%

100.0% 60.0% 20.0% 83.3% 100.0%

100.0% 80.0% 100.0% 100.0% 100.0%

100.0% - 100.0% 0.0% 0.0%

76.7% 80.9% 81.0% 73.7% 76.9%

2ww EIS


NHS Blackpool CCG








42 of 121




IAPT – 6 Weeks

22


IAPT – 18 Weeks

Trust position for Lancashire CCGs: - In Month 12, the Trust has achieved a Performance of 96.1% against a target of 75.00% across 8 CCGs. CCG Position: - In Month 12, the Trust has performed to target within all 8 CCGs.

Trust position for Lancashire CCGs: - In Month 12, the Trust has achieved a Performance of 99.5% against a target of 95.00% across 8 CCGs. CCG Position: - In Month 12, the Trust has performed to target within all 8 CCGs.


98.9% 97.3% 98.7% 86.0% 95.6%

99.1% 98.9% 97.5% 98.0% 95.6%

96.0% 95.6% 97.2% 97.1% 96.8%

97.3% 93.5% 95.2% 90.1% 94.7%

94.5% 91.8% 93.5% 87.0% 94.6%

95.7% 95.2% 95.2% 96.3% 97.3%

94.2% 98.4% 93.4% 89.3% 98.5%

96.7% 95.6% 95.9% 93.1% 96.1%

Not Commissioned







RTT IAPT 6 Wks


NHS Blackpool CCG



100.0% 100.0% 100.0% 98.2% 100.0%

100.0% 100.0% 100.0% 100.0% 99.1%

100.0% 99.5% 100.0% 100.0% 100.0%

98.7% 98.7% 100.0% 96.0% 98.9%

100.0% 99.1% 100.0% 97.2% 99.1%

100.0% 98.8% 98.9% 100.0% 100.0%

98.8% 100.0% 100.0% 98.7% 98.5%

99.7% 99.4% 99.9% 98.8% 99.5%

RTT IAPT 18 Wks


NHS Blackpool CCG


Not Commissioned







43 of 121



Summary – Mental Health

23

Indicators achieved Target Type Target Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17Rolling 12 Month

Sparkline

NHS Improvement

CPA 7 Day Follow Up (Total Network Performance) NHSI 95.00% - - - - - - - 96.7% 98.1% 98.7% 96.7% 97.8% 98.5%

CPA 7 Day Follow Up (AMH) NHSI 95.00% 96.5% 95.4% 97.5% 97.5% 97.7% 96.7% 97.5% 96.8% 98.4% 98.5% 96.9% 98.4% 98.9%

CPA 7 Day Follow Up (OA) NHSI 95.00% 100.0% 100.0% 100.0% 100.0% 100.0% 80.0% 83.3% 95.5% 95.7% 100.0% 95.0% 93.5% 96.2%

CPA 7 Day Follow Up (SS) NHSI 95.00% - - - - - - - 100.0% 100.0% 100.0% 50.0% 100.0% -

CPA 12 Month Review (Total Network Performance) NHSI 95.00% - - - - - - - 97.3% 97.7% 96.7% 97.0% 97.5% 97.0%

CPA 12 Month Review (AMH) NHSI 95.00% 96.5% 96.7% 96.6% 96.4% 96.3% 96.8% 97.4% 96.9% 97.4% 96.3% 96.6% 97.3% 96.5%

CPA 12 Month Review (OA) NHSI 95.00% 100.0% 100.0% 99.4% 98.2% 98.1% 98.5% 98.8% 100.0% 99.7% 100.0% 100.0% 100.0% 99.7%

CPA 12 Month Review (SS) NHSI 95.00% 97.5% 98.8% 98.8% 98.2% 98.8% 99.4% 98.8% 100.0% 100.0% 98.2% 98.2% 97.0% 100.0%

Delayed Transfers of Care (Total Network Performance) NHSI ≤ 7.50% - - - - - - - 4.20% 4.79% 3.76% 2.60% 2.39% 3.11%

Delayed Transfers of Care (AMH) NHSI ≤ 7.50% 5.04% 4.16% 4.01% 2.55% 3.35% 2.96% 1.82% 1.23% 3.06% 3.66% 2.19% 2.27% 3.27%

Delayed Transfers of Care (OA) NHSI ≤ 7.50% 9.98% 5.50% 2.87% 2.71% 3.44% 11.77% 16.59% 14.48% 10.34% 4.11% 3.92% 2.70% 3.27%

Delayed Transfers of Care (SS) NHSI ≤ 7.50% 0.68% 1.33% 1.33% 2.02% 0.85% 1.66% 1.35% 2.41% 2.77% 3.91% 3.80% 3.08% 2.76%

IP Access to Crisis Res. Treatment (Gatekeeping) NHSI 95.00% 96.1% 95.5% 96.6% 99.4% 99.4% 98.9% 98.3% 100.0% 100.0% 98.6% 99.4% 97.7% 100.0%

MH Data Completeness - Identifiers NHSI 97.00% - - - - - - - - - - - - 99.6%

MH Data Completeness - Identifiers (AMH) NHSI 97.00% 99.7% 99.7% 99.7% 99.7% 99.7% 99.6% 99.6% 99.7% 99.7% 99.7% 99.8% 99.7% -

MH Data Completeness - Identifiers (SS) NHSI 97.00% 97.9% 97.8% 98.0% 98.0% 98.1% 97.9% 98.1% 98.1% 97.9% 98.4% 98.4% 98.5% -

MH Data Completeness - Outcomes NHSI 50.00% - - - - - - - - - - - - 85.8%

MH Data Completeness - Outcomes (AMH) NHSI 50.00% 78.6% 77.8% 78.0% 81.1% 82.2% 83.7% 84.4% 85.1% 85.3% 85.2% 85.2% 85.4% -

MH Data Completeness - Outcomes (SS) NHSI 50.00% 84.8% 83.3% 83.4% 82.9% 84.0% 84.2% 84.3% 85.1% 83.4% 82.5% 81.3% 79.6% -

Other Indicators

AQ Dementia (OA) NHSE 59.30% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.9% 100.0% 100.0% 100.0% 100.0% -

Memory Assessment Service (MAS) seen within 6 weeks (OA) NHSE 70.00% 47.4% 33.9% 39.3% 38.2% 34.4% 37.4% 40.5% 40.2% 39.5% 25.7% 40.3% 48.4% 47.0%

PBR Clustering NHSE 95.00% 89.8% 88.9% 90.2% 91.5% 93.5% 94.1% 94.2% 96.1% 96.4% 96.8% 96.4% 96.5% 96.5%

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (Total Network Performance)

NHSE 0388 426 432 437 355 418 407 331 307 313 255 260 267

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (AMH) NHSE 0294 308 363 355 284 326 324 292 266 262 222 253 245

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (SS) NHSE 0 94 118 69 82 71 92 83 39 41 51 33 7 22

MHLT

MHLT 1hr compliance Commissioners 95.00% - - - - 54.3% 55.2% 37.8% 52.6% 45.7% 46.9% 38.7% 51.8% 51.7%

No of 4hr breaches (Percentage of total) 5.00% - - - - 0.0% 0.0% 4.8% 10.1% 7.7% 11.2% 15.4% 9.7% 8.9%

No of 4hr breaches (Number of breaches) 38 - - - - - - 25 53 49 75 102 71 67

No of 12hr breaches (Percentage of total) 0.00% - - - - - - 1.5% 2.1% 0.9% 1.5% 1.2% 3.3% 0.8%

No of 12hr breaches (Number of breaches) 0 - - - - - - 8 11 6 10 8 24 6

Secure Mental Health Business Unit

Overall Gross Occupancy NHSE 93.00% 89.3% 88.8% 91.5% 90.3% 90.5% 90.7% 90.5% 90.5% 90.2% 91.8% 93.3% 93.7% 97.2%

Violent Incidents resulting in Restraint Stretch ≤ 20.00% 18.1% 14.0% 18.8% 18.0% 23.6% 35.4% 23.8% 20.3% 16.1% 20.8% 17.5% 20.5% 18.4%

% of SU that have had a CPA Review in last 6 months Stretch 100% 99.0% 100.0% 97.0% 97.0% 100.0% 99.3% 100.0% 100.0% 100.0% 100.0% 99.3% 99.3% 98.0%

% of service users who have a Care Coordinator allocated within 2 weeks Stretch 100% - - - - - - - 60.0% 62.5% 75.0% 77.8% 75.0% 66.7%

% of CPA reviews attended by Local Care Coordinators Stretch 80% - - - - - - - 37.5% 50.0% 25.0% 42.9% 39.3% 40.0%

% of service users who have Cardiometabolic risk factors assessed within 12 months

Stretch 90% - - - - - - - 94.4% 94.6% 96.0% 89.7% 96.8% 100.0%

25hrs Meaningful Activity - Offered NHSE 100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

25hrs Meaningful Activity - Uptake NHSE 70% 86.0% 89.9% 83.9% 82.3% 88.4% 80.7% 87.9% 82.4% 82.8% 85.0% 80.4% 79.9% 75.6%

Community Business Unit

% of caseload with a Local Care Coordinator allocated Stretch 100% - - - - - - - 89.8% 96.1% 96.0% 97.9% 100.0% 95.3%

% of caseload carried longer than 12 months post SMHBU discharge Stretch ≤ 20.00% - - - - - - - 57.1% 58.8% 72.0% 66.7% 74.0% 60.9%

% of CPA Reviews Attended by Local Care Coordinators / Local Teams Stretch 80% - - - - - - - 42.9% 50.0% 62.5% 75.0% 30.0% 33.3%

No of Incidents exceeding PACE Clock Commissioners 0 3 6 6 6 3 8 6 4 3 4 3 5 7

Health & Justice Business Unit - HMP Liverpool

GP Waits over 2 Weeks NHSE 0% 35.7% 33.3% 13.3% 45.8% 37.6% 44.9% 43.6% 52.6% 64.1% 55.0% 59.5% 64.2% 49.4%

NHS Health Checks NHSE 40.00% 0.0% 3.1% 7.7% 3.7% 8.4% 6.1% 13.5% 19.8% 3.6% 26.1% 13.2% 8.9% 1.9%

Well Man Assessment completed NHSE 100.00% - - - - - - - 98% 98% 97% 95% 89% 75%

Hep B Vaccinations completed NHSE - - - - - - - 0.0% 25.0% 30.4% 25.0% 0.0% 3.7%

Chlamydia Screening U25's Uptake NHSE 50.00% 25.4% 2.9% 2.9% 21.5% 2.2% 11.0% 8.8% 6.3% 20.7% 14.3% 33.3% 5.3% 13.0%

Men C Vaccinations Uptake NHSE 95.00% 0.0% 0.0% 6.8% 20.0% 9.6% 10.7% 12.8% 5.7% 5.7% 12.2% 4.9% 2.6% 2.4%

MMR Vaccinations Uptake NHSE 95.00% 0.0% 0.0% 16.7% 19.3% 17.5% 10.5% 21.7% 50.0% 4.4% 11.1% 0.0% 14.3% 23.8%

Prison 6 Month CPA Reviews NHSE 100.00% - 100.0% 100.0% 100.0% - 100.0% 100.0% 100.0% 100.0% - 100.0% 100.0% 100.0%

QOF NHSE 238 263 259 277 273 256 266 302 322 327 323 314 319 316

Stretch

Stretch

44 of 121



Summary – Community & Wellbeing

24

Indicators achieved Target Type Target May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17Rolling 12 Month

SparklineNHS Improvement

Delayed Transfers of Care NHSI <7.5% - - - - - - - - - - - 0.0%

RTT - Consultant Led (Completed Pathway) NHSI 95% 98.5% 96.0% 98.0% 97.3% 93.2% 92.4% 95.2% 96.3% 96.7% 97.6% 100.0% 100.0%

RTT - Consultant Led (Incomplete Pathway) NHSI 92% 98.6% 99.0% 96.4% 95.0% 95.7% 96.3% 95.2% 95.4% 97.3% 100.0% 99.2% 100.0%

RTT - IAPT 6 Weeks NHSI 75% 85.1% 86.0% 90.2% 92.1% 90.8% 95.0% 93.0% 96.5% 95.1% 95.7% 93.4% 96.4%

RTT - IAPT 18 Weeks NHSI 95% 98.5% 98.8% 99.2% 99.5% 99.1% 99.3% 99.0% 99.8% 99.4% 99.8% 98.8% 99.4%

Waiting Times - AHP RTT

Adult Learning Disability Service NHSE 95% 91.9% 85.4% 83.7% 91.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Stroke Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Intermediate Care NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Podiatry NHSE 95% 100.0% 99.8% 95.9% 100.0% 100.0% 100.0% 99.9% 100.0% 100.0% 99.8% 100.0% 100.0%

Pulmonary Rehabilitation NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Rapid Assessment Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Adult Speech and Language Therapy NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0%

Community Neuro Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Respiratory Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Continence Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Domiciliary Physiotherapy NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Falls Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Nutrition & Dietetics NHSE 95% 100.0% 100.0% 98.8% 100.0% 97.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

IAPT

IAPT in Month Prevalence NHSE 1.25% 1.58% 1.49% 1.50% 1.53% 1.38% 1.39% 1.44% 1.39% 1.67% 1.28% 1.72% 1.05%

IAPT Cumulative Prevalence NHSE 1.25% 3.03% 4.52% 6.02% 7.56% 8.93% 10.32% 11.76% 13.15% 14.82% 16.10% 17.82% 1.05%

IAPT Waiting Times (Internal Target) Stretch0pts >26

wks8 10 37 18 38 47 45 73 46 5 12 22

IAPT Recovery NHSE 50% 46.7% 48.0% 51.0% 48.7% 52.2% 51.8% 56.3% 56.3% 53.8% 57.0% 53.4% 54.5%

Other Indicators

RTT Complete Learning Disablity Commissioner 95% 98.7% 100.0% 97.2% 99.3% 98.4% 97.3% 98.1% 98.8% 98.9% 98.9% 100.0% 98.7%

12 Week Dentist Waits - HMP Liverpool Commissioner 95% 63.6% 68.4% 94.8% 94.0% 93.0% 95.7% 100.0% 98.7% 100.0% 100.0% 100.0% 100.0%

Community Dental Waits Commissioner 95% 88.8% 83.5% 80.4% 88.8% 91.1% 88.9% 91.2% 95.2% 96.1% 98.0% 99.4% 97.1%

Unallocated Cases NHSE 0 7 18 11 11 15 8 12 11 12 12 7 15

45 of 121



Summary – Children & Young People’s Wellbeing

25


Sparkline

NHS Improvement

CPA 7 Day Follow Up NHSI 95.00% 92.31% 90.0% 88.9% 100.0% 100.0% 100.0% 75.0% 100.0% 100.0% 100.0% 100.0% 95.5% 100.0%

CPA 12 Month Review NHSI 95.00% 99.0% 99.5% 98.9% 98.3% 97.2% 98.2% 98.8% 97.6% 98.3% 99.5% 98.5% 97.9% 97.50%

MH Data Completeness - Identifiers NHSI 97.00% 99.8% 99.8% 99.8% 99.7% 99.7% 99.7% 99.6% 99.7% 99.7% 99.7% 99.7% 99.7% 99.6%

MH Data Completeness - Outcomes NHSI 50.00% 63.5% 62.4% 61.5% 67.7% 67.3% 67.3% 67.1% 67.2% 66.3% 64.8% 81.3% 64.9% 63.5%

2 Week wait for Treatment for EIP Programme NHSI 50.00% 73.1% 77.8% 86.7% 77.1% 67.7% 75.0% 69.0% 74.3% 76.7% 82.0% 81.4% 74.4% 69.0%

Waiting Lists - RTT 18 Weeks (Completed Outcomes)

Child Psychology - Total Network Performance NHSE 95.00% 74.0% 75.9% 71.8% 68.6% 68.6% 67.6% 70.7% 69.9% 70.9% 71.0% 60.3% 64.8% 66.6%

CAMHS Tier 3 - Total Network Performance NHSE 95.00% 97.5% 99.1% 99.7% 98.8% 96.7% 99.3% 96.4% 99.0% 97.5% 100.0% 98.1% 88.8% 79.4%

Waiting Lists - RTT 18 Weeks (Incompleted Outcomes)

CITNS - Occ Therapy - Total Network Performance NHSE 92.00% 64.2% 66.4% 67.5% 74.3% 67.1% 80.6% 83.1% 81.8% 81.8% 88.2% 91.2% 95.1% 94.9%

CITNS - Physiotherapy - Total Network Performance NHSE 92.00% 100.0% 98.1% 99.4% 98.6% 100.0% 100.0% 100.0% 100.0% 100.0% 98.1% 100.0% 100.0% 100.0%

CITNS - SLT- Total Network Performance NHSE 92.00% 90.2% 85.6% 81.3% 80.4% 85.5% 91.7% 92.6% 86.9% 86.9% 86.6% 83.6% 82.7% 84.2%

CAMHS Tier 4

Bed Occupancy Junction NHSE 85.00% 100.0% 96.7% 92.0% 100.0% 81.0% 99.6% 100.0% 83.0% 63.0% 65.0% 80.0% 100.0% 100.0%

Bed Occupancy Platform NHSE 85.00% 88.9% 87.0% 80.0% 77.4% 87.0% 78.0% 66.0% 47.0% 47.0% 66.0% 81.0% 81.0% 85.6%

Utilisation of Non-commissioned Beds Commissioners 65.00% 85.0% 84.0% 58.0% 82.0% 16.0% 45.0% 60.0% 23.0% 0.0% 0.0% 5.0% 87.0% 90.0%

Average Length of Stay (Days) Junction Bench 83 72.00 102.50 126.70 56.50 129.75 68.25 103.36 112.27 111.60 104.60 56.85 69.42 359.00

Average Length of Stay (Days) Platform Bench 83 13.40 17.10 18.30 16.20 22.11 25.90 36.30 23.00 27.20 16.50 17.20 15.81 25.30

Other Indicators

ADHD - NEW < 18 Weeks NHSE 95.00% 61.2% 62.7% 61.2% 58.0% 61.4% 57.5% 64.3% 61.7% 59.9% 63.9% 68.4% 62.3% 53.6%

PBR Clustering NHSE 95.00% 88.4% 88.0% 92.6% 95.4% 96.1% 97.0% 95.7% 94.9% 93.6% 96.2% 96.3% 95.4% 96.0%

Number of Patients without a Care Co-ordinator Allocated > 2 Weeks NHSE 0 7 7 9 27 14 16 16 13 14 8 18 29 23

46 of 121



Mental Health – Memory Assessment Service (MAS)

26

MAS: Actions:

Month 01 has achieved 47.02% of cases against the ‘seen within 6 weeks’ wait target. Although the percentage has fallen this month from the previous month, there is an upwards trend in all CCG areas except Central. Central team increased the number of patients seen from 84 in March to 108 in April, i.e., increased denominator in Central by 28.6%, however due to the waiting list size all but one patients have been waiting more than 6 weeks. This has led to a reduction in overall Trust compliance from M12.

North MAS are achieving above target at 97.73% an increase of 25.73% on M12, Blackpool, Fylde & Wyre each achieved 100% enhancing the overall Trust average. In April, 453 patients were seen with 213 being seen within 6 weeks.

M01 has seen a decrease in the number of referrals. At the time of reporting, 413 were accepted from a potential of 493 referrals. A further increase is likely as remaining referrals are processed. The average referral rate in 2016 was 607 per month. The average waiting time has improved from 58.2 days to 55.8 average days waiting.

There are currently 693 people waiting on the waiting list which is a significant improvement with a reduction of 241 people compared to M12. Analysis of longest waits remains in place to ensure effective waiting list management. The majority of people waiting over 19 weeks remain in Central Lancashire where the service has retained responsibility for annual reviews. Discussions continue with commissioners regarding this.

Commissioning colleagues served a contract query notice detailing actions against time scales by CCG. Detailed recovery action plans for each individual teams with SMART targets 15th WD April 2017. Recovery trajectory towards achievement of the 6 week target by the 15t WD August 2017, all responses were submitted within the time scales.

Significant redesign appraisal has been undertaken in March 2017 with MAS teams and commissioners. A baseline guarantee was agreed on a team-by-team basis which will dramatically improve performance within all teams. Lancaster, Fylde Coast & West Lancs have all achieved compliance against the seen in 6 week target in April this is expected to continue.

The backlog remains on course and to be eliminated by October 2017 in Pennine but the position remains unsustainable without further redesign to balance activity and demand, within the financial envelope or additional investment occurring. In Central additional temporary resource alone is insufficient to remove the backlog. Further review of these services for potential efficiencies is underway by the Clinical Lead and Deputy Head of Operations.

6 week wait (capacity / activity) and waiting

list:

Initiation of Task and Finish group with the following remit: • Review team skill mixes• Review productivity levels• Determine minimum number of assessments

per team per week• Review service against national models of

successful MAS delivery to understand whatcan be done differently

Local recovery action plans per team operating with the following remit: • Aspiration to elements of the model of redesign

where possible within the current system• Working to reduce recording requirements• Implementation of strategies with regard to the

duty system in order to involve other aspectsof service to provide assistance

• Optimisation of all professional contributions tothe aspect of front line assessments.

• Trialling of new delivery methods which reduceduplication of effort

• Consideration of where service can flex torespond to demand

• Action plans will be reviewed weekly to monitorprogress

• A Clinical Reference Group will also beestablished to consider changes to the modeland validate quality. This will comprisePsychology, nurse, Occupational Therapy andPharmacy Lead.

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Mental Health – MAS

27

Waiting list profile:

Number of

Patients /

Wks Wait

0 - 6

weeks

7- 9

weeks

10 - 12

weeks

13 - 18

weeks

19 - 24

weeks

25 - 30

weeks

31 - 40

weeks

31 30 1 0 0 0 0 0

361 122 94 50 63 28 4 0

236 171 52 8 4 1 0 0

24 24 0 0 0 0 0 0

25 25 0 0 0 0 0 0

17 17 0 0 0 0 0 0

Total 694 389 147 58 67 29 4 0

Lancaster MAS

West Lancs MAS

MAS Team / CCG / NHS Number

Blackpool MAS

Central Lancs MAS

East Lancs MAS

Fylde Coast MAS

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Mental Health – MAS

28

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1.2 Patient Flow

Mental Health – Mental Health Liaison Team (MHLT)

29

MHLT: Actions:

1 Hour Compliance: The Network is reporting low compliance in the target for patients to be seen within 1 hour of referral with 54.5% compliance in M1. This is an increase of 4.88% from M12's compliance. 4 Hours Breaches: The Network is reporting 67 actual 4 hour breaches in A&E for which LCFT were responsible in month 1, this is 8.9% of all A&E referrals to MHLT. This is an improved position from 9.7% in M12. This is likely to be related to additional short-term investment in A&E MHLT schemes, which ended at end April 2017. 12 Hours Breaches: The Network is reporting 4 actual 12 hour breaches in A&E from the decision to admit time in month 1, this is 0.53% of all A&E referrals to MHLT.

• Blackpool Teaching Hospitals have responded positively to proposal of having an LCFT CSU on the Blackpool Victoria Hospital site. Specifications to be provided to BTH for capital considerations with view to operationalising Blackpool CSU.

• Agreement with UHMBT that UHMBT will part-fund overnight MHLT nurse to continue 24/7 service, MH Network will re-align Lancaster Crisis Team rota to deliver this. Final confirmation from NHSE anticipated after Lancashire responses confirming ability to meet NHSE's queries regarding our bid.

• Action Plan being finalised between LCFT and ELHT following Royal College review of performance and quality at Royal Blackburn Hospital. The action plan will be presented to the Mental Health Operational Resilience Group for consideration county-wide.

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1.2 Patient Flow

Mental Health – Mental Health Liaison Team (MHLT)

30

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31

Violent Incidents resulting in Restraint: Actions:

In April 2017, staff reported a total of 141 incidents of verbal and physical violence within the inpatient unit. This is a reduction of 14.5% from March 2017.

In April, there was a decrease in the use of restraint with 18.4% of violent incidents ending in restraint compared to 20% in March 2017 (this does not include figures for restraint due to self-harm). The women's service on Elmridge ward continues to have above average levels of restraint with the majority (9) of these incidents occurring due to self-harming behaviours the other incidents occurred as a result of violence towards others.

Whinfell ward also has high levels of restraint that has been ongoing for a number of months due to the deterioration of certain service users. 88% of restraint on Whinfell relates to one service user who has this intervention written into his PBS plan, when staff observe a clear sign of deterioration in mental state that could result in violence.

• The security team continue to monitor and reportpatterns and trends of incidents to ensure that supportis offered to the areas that require it the most, thiscontinues to be reported back through the patientsafety group

• The trust wide developments continue for all ViolenceReduction Instructors.


Mental Health (Secure Services) – Violent Incidents resulting in

Restraint

Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17117 150 106 130 122 123 112 125 97 161 14122 27 25 46 29 25 18 26 17 33 26

18.80% 18.00% 23.58% 35.38% 23.77% 20.33% 16.07% 20.80% 17.53% 20.50% 18.44%81.20% 82.00% 76.42% 64.62% 76.23% 79.67% 83.93% 79.20% 82.47% 79.50% 81.56%

Use of physical intervention

% of incidents that USED intervention

% of incidents that DID NOT use intervention

No of violent or aggressive incidents

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32

CPA Reviews within 6 Months SMHBU: Actions:

In April, 3 service users within the Secure Mental Health Business Unit were outside the 6 month timeframe for having a CPA review.

1 CPA was re-scheduled due to an incident on the ward; however, the re-scheduled CPA did not go ahead due to the service user transferring ward and care team. This CPA is now scheduled to take place on 8th May.

1 CPA scheduled for 18th April had to be re-scheduled due to the service user transferring ward and care team. This CPA has been re-scheduled for the earliest available date on 4th May.

1 CPA did not take place due to the Responsible Clinician being unable to attend, having taken over the case in the days prior to the CPA. A date has been arranged ensuring that the new Responsible Clinician can attend.

The service continues to monitor all service users who are due a CPA review in the coming months to ensure that they have a meeting scheduled and that this falls within the 6 month timeframe. All the re-scheduled CPAs have not resulted in delays regarding care pathways.


Mental Health (Secure Services) – CPA Reviews within

6 Months SMHBU

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33

Local Care Co-ordinator >2weeks: Actions:

In April, 1 service user was admitted without a local care co-ordinator being allocated within 2 weeks of admission. This service user is from outside the Lancashire and South Cumbria catchment area and was referred to his local team on 28th April. The local team have confirmed receipt of the referral and will advise of their decision week commencing 8th May.

There is a process in place whereby the MDT secretary sends a referral for local care co-ordination as soon as service users are placed on the waiting list. The ongoing difficulties experienced with local care co-ordinators being allocated, within the timescales, are mostly for service users outside LCFT catchment area. If this is the case the ward manager will be placed as interim care co-ordinator. The Flow and Capacity Manager continues to escalate these concerns to the relevant CCTT managers, CCG and NHSE case managers.


Mental Health (Secure Services) – Local Care Co-ordinator

>2weeks


0.00% 0.00% 0.00% 0.00% 0.00% 60.00% 62.50% 75.00% 77.78% 75.00% 66.67%100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

%SU with CC allocated <2wksTarget

Service users admittedNumber of SU with a CC allocated <2wks

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34

Attendance of CPA reviews: Actions:

Of the 23 CPAs held in April, 15 local care co-ordinators attended and a further 6 offered their apologies. 6 did not attend or send apologies. • 4 CPAs for Preston CCTT – 1 attended (by teleconference), 2 sent

apologies, 1 DNA • 3 CPAs for Blackpool CCTT – 1 attended, 2 DNAs • 4 CPAs for Fylde & Wyre CCTT – 3 attended, 1 sent apologies • 1 CPA for Chorley & S Ribble CCTT – DNA • 3 CPAs for Blackburn CCTT – 2 attended, 1 DNA • 1 CPA for Blackburn EIS – sent apologies • 1 CPA for Hyndburn, Rossendale & Ribble Valley CCTT – DNA • 1 CPA for East Lancs EIS – attended • 1 CPA for West Lancs CCTT – sent apologies • 4 CPAs for out of area (Cumbria & NW) – 3 attended, 1 sent apologies

Work is to take place with adult services as part of the reset, in-line with the MH network to promote local care co-ordinator attendance for service users within secure services.


Mental Health (Secure Services) – Attendance of CPA reviews


0.00% 0.00% 0.00% 0.00% 0.00% 37.50% 50.00% 25.00% 42.86% 39.29% 40.00%0.00% 0.00% 0.00% 0.00% 0.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00%

Number of Planned CPAsNumber LCC attended% LCC attendedTarget

Attended Apologies DNA19 12 5 64 3 1 0

Breakdown of LCCNo of CPA

reviewsLCFT LCC

Non LCFT LCC

Apr-17

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35

Cardio Metabolic Risk Factors: Actions:

Compliance with this indicator has returned to 100% for April. A system is now in place whereby the Physical Health team are informed of any new admissions on a weekly basis so that a physical health assessment can be offered as soon as possible after admission.

The process will continue to be monitored to ensure it is embedded into routine practice.


Secure Services – Cardio Metabolic Risk Factors


0.00% 0.00% 0.00% 0.00% 0.00% 94.37% 94.63% 95.97% 89.74% 96.84% 100.00%0.00% 0.00% 0.00% 0.00% 0.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

No SU with Cardiomet assessment <12mnts% SU with assessment <12 mntsTarget

Total Service Users

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Mental Health (Secure Services) – % of FCMHT Caseload with

Care Co-ordinator allocated

36

% of FCMHT Caseload with Care Co-ordinator allocated: Actions:

The FCPNs continue to complete the role as Care Co-ordinator for service users within the FCMHT. Close working relationships with the Local Care Co-ordinator is ensured and handover to local teams jointly considered in CPAs. There has been a continued improvement of allocation over recent months and in April the 3 service users without a care coordinator allocated are new requests.

• The team will continue to monitor allocations to Local Care Co-ordinators. If any concerns over allocation are experienced these will be escalated to the manager to resolve. Being within the wider Mental Health Network is expected to assist the allocation process.


0.00% 0.00% 0.00% 0.00% 0.00% 89.80% 96.08% 96.00% 97.92% 100.00% 95.31%0.00% 0.00% 0.00% 0.00% 0.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

No SU With LCC Allocated% FCMHT Caseload with LCC allocatedTarget

Total Caseload

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37

% of FCMHT Caseload >12 months: Actions:

There are currently 64 service users on the FCMHT case load, 39 of these service users have been on the FCMHT case load for over 12 months.

• A review is to take place of those service users that have been on the caseload for over 12 months and the new service manager will work with the team to review pathways and the continued need for intensive input by the FCMHT.


Mental Health (Secure Services) – % of FCMHT Caseload

>12 months


0.00% 0.00% 0.00% 0.00% 0.00% 57.14% 58.82% 72.00% 66.67% 74.00% 60.94%0.00% 0.00% 0.00% 0.00% 0.00% 20.00% 20.00% 20.00% 20.00% 20.00% 20.00%

No of SU on caseload >12 months%of SU on caseload > 12 monthsTarget

Total Caseload

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38

Attendance of CPA Reviews within Community Services: Actions:

In April, 4 out of 9 CPA reviews were attended by the local care co-ordinators. The FCMHT continue to work with all local care co-ordinators to improve attendance. Out of those not attended any actions/minutes will be communicated. No delayed transfers of care have resulted from local care co-ordinator non-attendance.

• The FCMHT continues to work towards joint working with localteams. Local care co-ordinators continue to be invited to all CPAmeetings for service users. Attendance will continue to bemonitored and escalated to teams not attending.


Mental Health (Secure Services) – Attendance of CPA Reviews

within Community Services


0.00% 0.00% 0.00% 0.00% 0.00% 42.86% 50.00% 62.50% 75.00% 30.00% 33.33%80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00%

No of LCC/Local teams attending% LCC/Local teams attendingTarget

Planned CPA's

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Mental Health (Secure Services) – Number of Incidents

exceeding PACE Clock

39

Number of Incidents exceeding PACE Clock: Actions:

There were 7 reported episodes of individuals being detained in Police Custody beyond the 24 hour limit. Of the breaches, 1 was in excess of 1 hour, 1 was in excess of 6 hours, 4 were in excess of 24 hours and 1 was in excess of 61 hours longer in Police custody than the PACE limit of 24hrs. Local Care Co-ordinators continue to be invited to CPA meetings for all service users and attendance will continue to be monitored to improve joint working and increase attendance.

• The PACE breach escalation plan continues to be followed for all PACE breaches. The level of incidents will continue to be monitored to ensure the process continues to deliver improvement.

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HMP Liverpool – HJIP Indicators: Actions:

GP Waiting Times There are currently 162 patients on the GP waiting list, a significant reduction on March’s position of 257, with the longest waiting time being 6 weeks and 2 days. Healthcare are still experiencing issues with DNAs and No Access visits, although this has substantially improved from 50.5% DNAs in March to 24% in April. As it is not possible to determine why a service user does not attend an appointment, they are automatically placed back on the waiting list. These re-additions to the waiting list impact on the number of patients on the waiting list and the length of time waiting to be seen. NHS Health Checks The new eligibility criteria for NHS Health Checks, is causing a problem within the SystmOne reporting due to the way that the system is designed to work. 13 appointments were offered, 8 men DNA and 3 declined. Wellman Screening During April there were 261 new receptions and 61 of those are still awaiting their reception screen. Staffs are still performing ‘catch up’ clinics to ensure all service users have had a Wellman Screen. During April staff performed 196 Wellman Screens. The March figure has been validated and adjusted accordingly from 111% to 89.33%. Immunisations and Vaccinations There are currently 62 service users waiting Under25s vaccination for either Men C or MMR. Immunisation & Vaccination clinics were affected by a 56% DNA rate for April. Chlamydia Screening The IPC pathway was ratified on 19th April 2017 and sessions are scheduled to start on 2nd May 2017.

DNA – Enablement Issues • These are now reported at the Prison morning meetings

daily and discussed weekly in a new formal forum on Friday between prison and healthcare staff. DNA reporting now forms part of the prison KPI and is being monitored more robustly. A dedicated email inbox has been created for prison staff to report back daily the reasons why patients did not attend the previous day’s appointments.

NHS Health Checks • Healthcare is currently seeking a NOMIS logon so that the

team can obtain an up to date sentence information report which can then be incorporated within the SystmOne reporting module. Until this has been obtained a manual trawl will be completed to obtain an accurate waiting list.

Wellman Screening • A new report is being generated to provide a current

population position of service users still eligible for a Wellman Screen and ensure that the ‘catch up’ waiting list is accurate and up to date.

Immunisations and Vaccinations • Additional clinics have been facilitated w/c 24th April 2017

and will continue in May targeting the Under 25s vaccinations primarily as these are NHSE HJIP indicators. Following on from this the Hep B criteria will be priority.

Chlamydia Screening • Closely monitor the recording of Chlamydia screening

results to ensure compliance.


Mental Health (Secure Services) – HMP Liverpool HJIP Indicators

40

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Mental Health (Secure Services) – HMP Liverpool HJIP Indicators

41

MonthJan-17Feb-17

Mar-17Apr-17

335

No of new receptions

No of Wellman Health checks completed

Physical & Mental Health Wellman Checks

261 196

% Completed97.46%95.11%

89.33%75.10%

276 269307 292

375

MonthPts vacc >4wks

Total Vaccs in month 1st dose 2nd dose 3rd dose Booster

Jan-17 7 29 11 7 6 5Feb-17 3 13 4 4 4 1Mar-17 0 7 2 3 2 0Apr-17 1 31 15 9 4 3

Breakdown of Vaccs given

No of new receptions

No of pts accepting Hep B

% pts accepting vacc within 4 wks

248260

2312

27261

30.43%25.00%0.00%3.70%

296 3

MonthJan-17Feb-17

Mar-17Apr-17

0-2 Days 3-7 days36 277 49

8016 41 3511 19 52

GP Waits

14+ days127169

165

8-14 days4159

Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17325 241 227 229 192 167 165 134 258 247 103

7.69% 3.73% 8.37% 6.11% 13.54% 19.76% 3.64% 26.12% 13.18% 8.91% 1.94%105 79 91 91 34 32 29 28 18 19 23

2.86% 21.52% 2.20% 10.99% 8.82% 6.25% 20.69% 14.29% 33.33% 5.26% 13.04%88 75 83 84 39 35 35 41 41 38 41

6.82% 20.00% 9.64% 10.71% 12.82% 5.71% 5.71% 12.20% 4.88% 2.63% 2.44%60 57 63 67 23 10 23 27 25 21 21

16.67% 19.30% 17.46% 10.45% 21.74% 50.00% 4.35% 11.11% 0.00% 14.29% 23.81%1 2 0 4 1 2 1 0 5 2 6

100.00% 100.00% - 100.00% 100.00% 100.00% 100.00% - 100.00% 100.00% 100.00%

Patients received NHS HC Screen

Patients Accpeting Men C Vacc

Patients Accpeting MMR Vacc

SU received CPA review <6 months

Total Eligible

% Screened

Total Eligible

% ScreenedTotal Eligible

% Screened

Total Eligible

% Recieved

Patients Screened for Chlamydia

Total Eligible

% Screened

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Community & Wellbeing – Improving Access to

Psychological Therapies (IAPT)

42

IAPT - Prevalence: Actions:

Prevalence Blackburn with Darwen, East Lancashire, Greater Preston, West Lancashire, Fylde & Wyre and St Helens did not meet prevalence in April 2017. This has been a significant drop in prevalence from March 2017. The data is being reviewed by the team at service level in order to recover the position and increase prevalence.

Prevalence • A high level analysis of data will be undertaken on a daily basis in order to appreciate areas of deficit in

prevalence and direct the focus and resource within each specific team • Each team will identify one person form each modality to meet 3 times per week in a ‘performance

huddle’ to review and action capacity activity and areas of vulnerability. This review will include: - Review of referrals based on demographic and referral data in order to target low referral groups. - Consistently offer monthly 'taster sessions' within local communities - Capacity to offer welcome calls in the same referral month to be managed at team level - Increase engagement in people with a long term condition • An action plan based on risks and interventions to mitigate against further deterioration and also to

enable improvement will be reviewed on a weekly basis by the service management team • The Head of Operations, Deputy Head of Operations, Care Group Manager and Service Manager will

oversee performance within thrice weekly skype calls • Develop capacity to increase prevalence monthly in preparation for the national increase to 16.8% by

17/18.

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43

IAPT - Waits: Actions:

Waits 22 people were waiting 26 weeks or over at the end of April, this is an increase from March's figures (12 people were waiting). The team and modality which has continued to increase is CBT in Fylde & Wyre. All other over 26 week waits have been reviewed and are due to patient delays from sickness and holidays. Waiting times across the other waiting periods have increased. This is currently being understood at team level.

Waits • A high level analysis of data will be undertaken on a daily basis in order to appreciate areas of

deficit and direct the focus and resource within each specific team • Each team will identify one person form each modality to meet 3 times per week in a

‘performance huddle’ to review and action capacity activity and areas of vulnerability. This review will include:

- Internal waiting times and blockages in appointments - Capacity and flow across the modalities and team - Diary management - Team performance and clinical contact hours • An action plan based on risks and interventions to mitigate against further deterioration and also

to enable improvement will be reviewed on a weekly basis by the service management team . • Measures will be employed to develop analysis and performance skills at team level and specific

refresher training will be available and attendance mandated • The Head of Operations, Deputy Head of Operations, Care Group Manager and Service Manager

will oversee performance within thrice weekly skype calls • Specific work to be undertaken with Fylde and Wyre to reduce the over 26 week waits • Women's Centre contract to be reviewed based on need in Fylde and Wyre.

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44

IAPT - Recovery: Actions:

Recovery All teams achieved recovery in April 2017, apart from Greater Preston (48%) and St Helens (49.6%). Greater Preston and St Helens have both achieved recovery four months out of the last six months. Greater Preston did not achieve recovery in Jan 17 (49.1%) and April 17 (48%). St Helens did not achieve recovery in March 17 (49.6%) and April 17 (49.6%). Work has been undertaken within both teams to understand the reduction in recovery in these months. Small numbers in both teams would have increased recovery above the 50% achievement threshold.

Recovery • Continue to support teams to achieve recovery on a monthly basis. This will be undertaken

by: - Line manager to have an oversight of all people that are due to be discharged that are not in recovery - All pre-discharges that are not in recovery to be discussed in supervision - Alternative interventions that could improve recovery to be considered prior to discharge - IAPTus recovery data to be reviewed to ensure all discharge data is accurately recorded - Referral criteria to be reviewed to ensure appropriate referrals are being received • Review recovery monitoring processes across Preston and St Helens to ensure these are in

place and are adhered to • Review a recovery action plan with St Helens and Preston • Develop action plan to increase recovery on a monthly basis across all teams below the

55% threshold

Recovery was achieved overall.

65 of 121



Children & Young People’s Wellbeing –

Child Psychology

45

Child Psychology (Total Network Performance): Actions:

In April 17, overall service performance increased to 66.6%. One out of the five teams’ performance remains above the target of 95% and four teams under the target. The total number of SUs on the waiting list reduced in M1 to 479 and is now at its lowest level since January 2016. 160 SUs are waiting over 18 weeks and 64% of waiters over 18 weeks are from Blackpool/Fylde & Wyre Team (102).

27 children (17%) over 18 weeks have a TCI date.

The longest waiter is currently at 43 weeks (Fylde and Wyre) and has a TCI date.

Issues affecting performance: • Team performance is affected by ongoing staffing capacity issues,

combined with the services inability to recruit to Clinical Psychologist posts on both a permanent and temporary basis. Blackpool/Fylde & Wyre team continues with significant pressures due to vacancies which are now out to advert, though plans that commence at the end of May will see performance begin improve in June 2017.

• Further improved performance is recorded in Lancaster (now at 65.2%) –a 30% increase from October 2016. The team continue to utilise asuccessful skill-mixed approach with CAMHS in reducing the waiting list.

• Preston Community performance increased by 2% in M1 to 53%, and thiswill continue to show improvement. The number of SUs on the waiting list(70) is at its lowest level in the previous year and has been achieved byimproved integrated working between CAMHS and CPS, plus the recentimplementation of 2+1 clinics which allows psychologists to deliver a moreconcentrated therapy to Sus, therefore increase throughput.

• Innovative alternative ways of working have beensuccessfully implemented as pilots and the 2+1 clinicshave been further rolled out to Preston and Lancaster.Blackpool Team will implement 2+1 clinics oncecapacity issues are addressed.

• Integrated working with CAMHS and CPS continues inFylde and Wyre, Lancaster and Preston to allowappropriate cases to be offered appointments inCAMHS.

• In Lancaster, a principal post has been “on hold” sincelast September, however this was made available forredeployment at the beginning of May 2017.

• On 30th May 2017, a maternity leave returns to Prestonwhich will further improve the waiting times.

• In Blackpool, interviews for a temporary Band 6therapist for 12 months to support the team to recoverperformance were unsuccessful and the post has beenre-advertised and will be interviewed 25 May 2017.

• Additional temporary support has been sourced forBlackpool to improve performance until recruitment topermanent posts is complete, which will commence on22 May 2017.

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Child Psychology

46 Snapshot: 19/05/17 at 8:00am

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CAMHS Tier 3

47

CAMHS Tier 3 Actions:

Chorley and South Ribble are the only team which are performing below target, with performance in M1 reduced from 83% in M12 to 65.3% against a target of 95%. This equates to 90 out of 259 service users on the waiting list above the 18 week target. Issues affecting performance: • Two long term sickness absences in the team has caused a deterioration

in performance • The change in admin processes through the Referral Assessment

Centre is not yet embedded fully in the service • The team manage large numbers of Autistic Spectrum Disorder referrals

(approx. 30% of all referrals received) which do not meet the criteria for Tier 3 CAMHS; this is custom practice and has not been resolved with commissioners or senior managers

• The team were unable to offer new case clinics during April offering urgent appointments only.

Future performance will also be affected as: • Chorley and South Ribble Team Leader left post on 30th March 2017.

This post is being filled through the organisational reset. • A Band 5 has handed in her notice and will leave on 1st May 2017.

• HR supporting the two long term sickness absences: one currently on a 4 week phased return whilst the other will go to capability hearing

• The Band 5 post out to recruitment 03/04/17 • A Band 6 from Preston to offer 0.5 to work on 2 ASD

referrals per week • Band 7 ADHD specialist to see 4 x ADHD cases per

month from the waiting list • Band 7 TL in Preston spending 1 day per week with the

team • Preston Team are also covering ward duties Depending on the timeliness of recruitment to the above posts it is forecast that the team will be compliant by August 2017.

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CAMHS Tier 3

48

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Children & Young People’s Wellbeing – CITNS

Speech & Language Therapy

49

CITNS SLT (Total Network Performance): Actions:

As a speciality, Speech & Language Therapy performance in M1was 84.2% against the 92% threshold for open RTT pathways, an increase of 1.5% from last month. The total waiting list size has decreased to 1471 in M1 from 1577 in M12, a reduction of 106. The total number waiting over 18 weeks is 232, a reduction of 41 from M12 (273), and the longest waiter is currently at 41 weeks which is an increase of 2 weeks from last month. These children are spread across BwD (41 weeks), B&P (25 weeks) and HRV&R (20 weeks); there has been significant improvement in BwD where there has been a reduction in waiters from 160 in M12 to 85 in M1. Three teams (West Lancs, Chorley South Ribble & Greater Preston) have now achieved the 92% target in M1, which is an increase from M12 as Chorley South Ribble have achieved 93% in M1. Below is detail of the position for the three teams with performance concerns who have not achieved 92%. BwD team’s performance has increased by 11.2% in M1, achieving 75.1%. Team capacity is still restricted with 4.9 WTE on mat leave. There are 85 children waiting over 18 weeks, of which 70 have a TCI appointment. This is an improvement from M12 where 160 were waiting. The longest wait is 41 weeks. Burnley Pendle team performance has decreased by 10.1% in M1 achieving 81.1% at month end. Team capacity remains an issue, however new staff have now been appointed. There are 75 children waiting over 18 weeks, of which 44 have a TCI appointment. The longest wait is currently 25 weeks; this was 23 weeks in M12. HRV&R team’s performance has decreased by 5%, achieving 82.8% in M1. Team capacity is restricted due to maternity leave and one vacancy. There are 59 children waiting over 18 weeks, of which 54 have a TCI appointment. The total number of children waiting has decreased in M1 by 48 and is now 344. The longest wait is 30 weeks.

• Team Leader has been appointed temporarily to the vacant B7 post within the Hyndburn Ribble Valley & Rossendale (HRV&R) team – start date 1st June

• SLT review of thresholds and

caseload validation is on-going to further increase capacity

• Finalising workforce review for each

team • Staffing: one B6 fixed term contract

commencing in July in BwD, one B5 commencing in B&P in July, one B5 commencing mid-May in HRV&R. Some staff have been mobilised in order to alleviate capacity issues

• Whilst notable improvement in performance was recorded in BwD, it is predicted that the 3 teams will not recover to meet the 92% target before September

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Children & Young People’s Wellbeing – CITNS

Speech & Language Therapy

50

Snapshot: 19/05/17 at 8:00am 71 of 121




CAMHS Tier 4 - Occupancy

51

CAMHS Tier 4 - Occupancy Actions:

In M1, bed occupancy at The Junction remained at 100%, against a target of 85%. The CAMHS Outreach Team admitted 2 SUs, with one discharge from The Junction in April 2017. In M1, bed occupancy at The Platform increased to 85.6%, from 81% in M12, against the target of 85%. The CAMHS Outreach Team admitted 7 SUs, with 7 discharges.

• Both services were open to admissions through April and were running at full capacity. The performance remains reflective of the national picture in generic CAMHS beds availability, however, improvement in performance have been made in the last two months.

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CAMHS Tier 4 – Average Length of Stay

52

CAMHS Tier 4 – Avg LOS Actions:

Length of stay of discharges in April 2017 was 21 days at the Platform and 97 days at the Junction, against the national benchmark of 83 days.

• Both services were open to admissions through April and were running at full capacity. The performance remains reflective of the national picture in generic CAMHS beds availability, however, improvement in performance have been made in the last two months.

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Children & Young People’s Wellbeing– ADHD

53

ADHD: Actions:

In April, 167 appointments were offered. 108 people were seen, the breakdown of these is 11 seen off the waiting list and 97 follow ups. The caseload as at the end of April was 680. There are 289 people on the waiting list (207 New & 82 Transitions)

• We currently have staff vacancies which are impacting on team capacity. We have 1 x band 7 NMP and 1x band 6 permanent staff in place. We have 1x band 7 NMP on induction and training and the Trust is in a position to advertise 1x band 7 NMP post. Following successful recruitment, ADHD service will have 3x band 7 NMPs, 1x band 6 assessor and 4x sessions Consultant Psychiatrist.

• The current Consultant Psychiatrist who works 4x sessions retires shortly but a replacement for his time has been identified.

Snapshot: 19/05/17 at 8:00am

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Children & Young People’s Wellbeing– ADHD

54

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Patient Flow

Section 1.2

55

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1.2 Patient Flow

Summary – Patient Flow

56


Sparkline

Patient Flow

Average Number of Patients (OAPS) Commissioner 15 25.80 35.84 40.16 40.42 32.23 28.93 22.65 33.10 27.42 22.48 23.29 23.42 24.27

OAPS Occupied Bed Days Commissioner 460 774 1111 1245 1253 999 868 702 993 850 697 652 726 728

LCFT and OAPS Occupancy % (Total Network Performance) Commissioner 85.00% - - - - - - - - - - - - 105.7%

Number of LCFT and OAPS Occupied Bed Days (Total Network Performance) Commissioner 9519 - - - - - - - - - - - - 10593

LCFT and OAPS Occupancy % (AMH) 103.4% 106.8% 110.9% 110.8% 105.0% 104.7% 102.4% 107.1% 101.0% 102.9% 102.8% 101.2% 108.6%

Number of LCFT and OAPS Occupied Bed Days (AMH) 7765 8246 8284 8260 8516 8260 8351 8481 8297 7799 7630 8317 8148

LCFT and OAPS Occupancy % (OA) 99.0% 100.7% 99.5% 99.3% 100.3% 99.2% 97.7% 97.7% 99.2% 96.5% 85.8% 85.0% 97.0%

Number of LCFT and OAPS Occupied Bed Days (OA) 2495 2622 2508 2586 2613 2499 2544 2462 2583 2868 2379 2610 2445

LCFT only Occupancy % (Total Network Performance) NHSE 85.00% 99.1% 98.9% 100.3% 100.3% 98.3% 99.6% 99.5% 99.6% 96.9% 98.7% 100.1% 98.5% 98.5%

Number of LCFT only Occupied Bed Days (Total Network Performance) Stretch 9519 6996 7174 7041 7007 7517 7412 7649 9950 10030 9970 9357 10201 9865

LCFT only Occupancy % (AMH) 99.1% 98.9% 100.3% 100.3% 98.3% 99.6% 99.5% 100.3% 96.1% 99.6% 99.9% 99.1% 99.2%

Number of LCFT only Occupied Bed Days (AMH) 6996 7174 7041 7007 7517 7412 7649 7491 7447 7102 6990 7679 7437

LCFT only Occupancy % (OA) - - - - - - - 97.6% 99.2% 96.5% 100.6% 96.9% 96.3%

Number of LCFT only Occupied Bed Days (OA) - - - - - - - 2459 2583 2868 2367 2522 2428

Secure Overall Gross Occupancy NHSE 93.00% 89.3% 88.8% 91.5% 90.3% 90.5% 90.7% 90.5% 90.5% 90.2% 91.8% 93.3% 93.7% 97.2%

Average Episode Length of Stay (LOS) - (Total Network Performance) - - - - - - - - - - - - 74.60

Average Episode Length of Stay (LOS) (AMH) Bench 31 30.74 39.70 38.80 39.00 33.20 35.10 41.70 31.30 31.20 29.72 40.23 33.00 34.70

Average Ward Length of Stay (LOS) (PICU) 43.71 36.82 43.88 111.53 56.25 34.20 47.70 58.50 45.08 58.50 55.20 37.80 39.90

Average Episode Length of Stay (LOS) (OA) 88.12 131.40 111.80 91.90 91.10 107.70 119.60 109.40 144.50 123.56 95.35 115.60 122.30

Re-Admission Rates - 30 Days (AMH) % NHSE <8.7% 12.7% 10.6% 8.6% 8.4% 8.6% 11.1% 9.9% 8.2% 15.5% 7.1% 11.3% 8.8% 15.3%

Re-Admission Rates - 30 Days (AMH) Number of patients NHSE 18 28 19 15 16 17 21 20 22 37 18 24 23 31

Re-Admission Rates - 30 Days (OA) % NHSE <8.7% - - - - - - - 0.0% 4.5% 0.0% 0.0% 3.4% 8.0%

Re-Admission Rates - 30 Days (OA) Number of patients NHSE 2 - - - - - - - 0 1 0 0 1 2

Re-Admission Rates - 90 Days (AMH) % NHSE 15% 15.5% 12.8% 17.1% 13.2% 16.2% 19.5% 17.7% 11.6% 23.1% 15.1% 20.8% 18.4% 20.7%

Re-Admission Rates - 90 Days (AMH) Number of patients NHSE 30 34 23 30 25 32 37 36 31 55 38 44 48 42

Re-Admission Rates - 90 Days (OA) % NHSE 15.00% - - - - - - - 0.0% 4.5% 0.0% 0.0% 13.8% 0.0%

Re-Admission Rates - 90 Days (OA) Number pf patients NHSE 4 - - - - - - - 0 1 0 0 4 -

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1.2 Patient Flow

Out of Area Placements (OAPS)

57

OAPS: Actions:

The average number of OAPs rose marginally in April by 0.06, this was also reflected with a marginally increased OAP OBD position of 728, a rise of 2 from March.

Network managed the May Bank Holiday Weekend with no significant increase in OAPs.

It is anticipated that OAPs will remain around the current trajectory, with no significant decrease prior to operationalisation of the next phase of alternatives to admission (East ATS, 2 CSU, Crisis House and Crisis Beds). All these alternatives are in the 2017/18 contract and commissioners are aware of the requirement for these units in order to drive sustained reduction in OAPs and total occupancy.

A trajectory in line with the anticipated opening of each of the alternatives to admission has been developed and progress will be monitored and reported through BDD.

There is a noted shift in balance towards PICU OAPs. MHN raised via ORG the need to address PICU LOS in collaboration with commissioners, recognising the challenge of specialist provision. Appropriate placement of long-stay PICU patients would reduce PICU OAPs pressures. Commissioners have committed to focussed case reviews to address blocks to discharge.

• Establish new focussed case review panel with seniorcommissioning managers

• Daily bed calls with Service Managers to address blocksto discharge such as funding delays

• Service Manager attendance at FED meetings to identifypatients whose care can transfer to hospital at homewith the Home Treatment Team

• Identification and escalation of all 180+ day LOSinpatients to focussed case review panel.

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1.2 Patient Flow OAPS

58

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1.2 Patient Flow OAPS Occupied Bed Days

59

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1.2 Patient Flow

Occupancy – Adult Mental Health

60

Occupancy – AMH: Actions:

LCFT and OAPs Occupancy position in April improved slightly from the March position and was in line with trajectory. Notably, the occupancy for LCFT beds reduced to 98.45% in April.

Network review of performance compared to NELFT indicates that LCFT are absorbing Learning Disability and Rehabilitation demand that is not within NELFT acute & PICU bed stock.

• Establish new focussed case review panel with seniorcommissioning managers.

• Daily bed calls with Service Managers to address blocks todischarge such as funding delays.

• Service Manager attendance at FED meetings to identifypatients whose care can transfer to hospital at home with theHome Treatment Team.

• Identification and escalation of all 180+ day LOS inpatients tofocussed case review panel.

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1.2 Patient Flow

Occupancy – Adult Mental Health

61

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1.2 Patient Flow

Occupancy – Older Adults

62

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1.2 Patient Flow

Occupancy – Mental Health Total

63

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1.2 Patient Flow

Mental Health – Average Length of Stay - PICU

64

Average Ward Length of Stay - PICU: Actions:

The Network average length of stay is currently 39.90 days. This is an increase of 2.10 days from last month’s figure. PICU LOS is included within the average Network LOS and it is noted that overall average LOS has also slightly increased in April. The complexities of service users and finding placements on discharge from PICU has contributed to long stays in PICUs. However, the Network is maintaining a range of between 40 and 60 days LOS for PICU, indicating a level of stability. Clinical Director has initiated review and improvement of protocols for management of patients with Emotionally Unstable Personality Disorder, with a specific aim of introducing evidence based practice across all service lines. Focussed case reviews with senior commissioning managers are aimed at removing discharge blocks, which will lower average PICU LOS.

• Weekly escalation meetings taking place with Commissioning Support Unit to discuss PICU patients, identifying and addressing funding issues that contribute to delays.

• Agreement with Lead Commissioner to operationalise a regular (likely weekly) meeting to review cases which remain on wards despite usual funding and commissioning processes. The meeting will include senior commissioners, CSU and Local Authority representatives and will include both Acute and PICU cases.

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1.2 Patient Flow

Mental Health – Average Episode LOS - Adult

65

Average Episode Length of Stay - Adult: Actions:

The Network is above the Trust set target of average 30 day length of stay for Acute Beds, reporting an average LOS of 34.70 days for April. This is a slightly declined position from March of 1.7 days. This pattern of a reducing LOS following a spike in February, as apparent in April, is reflective of the pattern following a previous spike in October where a period of lower LOS is followed by a spike.

• Network review of impact of sectorised RCs in Lancaster on LOS.

• Home Treatment Team Managers to continue to attend Ward FED meetings in order to actively pull patients from Ward to Home Treatment as early as clinically appropriate.

• The Network is completing Consultant workshops regarding Facilitating Early Discharge in order to unite the process across the Network.

• A review of all patients with a LOS over 60 days will take place by SMT. This will tie in with the Consultants workshops and focussed case reviews with commissioners.

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1.2 Patient Flow

Mental Health – Average Episode LOS – Older Adult

66

Average Episode Length of

Stay – Older Adult:

Actions:

Month 1 has seen a further an increase in LOS. The throughput of patients continues to increase, however due to unavailability of specialist units to accommodate several patients, this has impacted on their length of stay. Continued efforts in proactive discharge management across all the wards, discharge team (with further recruitment having taken place) and the robust daily conference calls between community and inpatient leaders continues.

• A daily review of patients subject to both formal and informal delays is underway. A further staff member is due to join the discharge team at The Harbour which means the 2 wards with the highest LOS will have a discharge worker each, with the view of intensive focus on the discharge process.

• Consultant skype reviews are organised to expedite discharge.

• An assertive approach to discharge planning is undertaken and led by the senior matron. A third member of staff has joined the discharge team and we aim to get more momentum and traction with each ward having this dedicated time to complex discharges.

• Escalation routes have been formalised. The flow and capacity manager is to be utilised to further expedite any difficulties.

• Daily conference calls with community continue to expedite discharge

• Band 6 and 7 nurses attend MDT/CPAs now to support leadership of discharge

• Home of choice policy is utilised to assist this process.

• Complex case reviews are increasing to support any disagreements between services and/or family

choice issues. Discharge team engaging well with CSU.

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1.2 Patient Flow

Mental Health – Average Episode LOS – Older Adult

67

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1.2 Patient Flow

Mental Health – Readmission Rate (30 days)

68

Re-Admission Rate (30 days): Actions:

The Network failed to achieve compliance with the target of 8.7% in M1 with a rate of 14.47%. This is a declined position from 8.28% in M12. There have been 32 readmissions within 30 days, Two of these were Older Adult Mental Health patients and the remainder were Adult Mental Health patients. Average time between admissions was 12.13 days, though 10 cases were re-admitted within 7 days. 34% of re-admissions were from the female assessment ward. 25% of re-admissions were from the male assessment ward.

• Deputy Head of Operations visited assessment ward for feedback from the clinical team. The view was that there is variance in the threshold for admission from community teams. This is currently anecdotal, and requires further exploration, but would explain to a degree the tendency for repeated admissions of individual patients. This will be discussed with community teams and consultants. It indicates that the solution needs to support clinicians in making the right clinical decision where this carries a degree of short-term risk rather than being based on additional management action, and requires a system-wide understanding of the balance between managing acute and chronic risk. This view was discussed and agreed with commissioners at the Crisis Concordat Meeting in April.

• Opening of Chorley Crisis House (May 2017). • Analyse 30 day re-admissions for geographical and clinical themes.

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1.2 Patient Flow


69

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1.2 Patient Flow


70

Re-Admission Rate (90 Days): Actions:

The Network is achieving compliance with the 90 day re-admission rate this month with 10.96% for M1. This includes Older Adult ward data. The underlying position with Adult Wards has declined slightly from M12 with a compliance of 20.69%. Older Adults had 2 re-admissions in M1. 43 cases were re-admitted within 90 days. These include the 32 cases re-admitted within 30 days. 11 cases were re-admitted 31-90 days after discharge.

• Deputy Head of Operations visited assessment ward for feedback from the clinical team. The view was that there is variance in the threshold for admission from community teams. This is currently anecdotal and requires further exploration but would explain to a degree the tendency for repeated admissions of individual patients. This will be discussed with community teams and consultants. It indicates that the solution needs to support clinicians in making the right clinical decision where this carries a degree of short-term risk rather than being based on additional management action, and requires a system-wide understanding of the balance between managing acute and chronic risk. This view was discussed and agreed with commissioners at the Crisis Concordat Meeting in April.

• Opening of Chorley Crisis House (May 2017). • Analyse 30 day re-admissions for geographical and clinical themes.

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1.2 Patient Flow


71

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Data Quality

Section 1.3

72

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1.3 Data Quality

Summary – Data Quality

73

Indicators achieved Actual Target Performance Exception Reports Additional comments

PBR Clustering

Trust PBR Clustering 96.45% 95.00% Achieved NoMH PBR Clustering 96.47% 95.00% Achieved NoCYP PBR Clustering 95.99% 95.00% Achieved NoUnallocated Patients

Trust Unallocated Patients > 2 Weeks 305 0 Underperforming YesMH Unallocated Patients > 2 Weeks 267 0 Underperforming YesCWB Unallocated Patients > 2 Weeks 15 0 Underperforming YesCYP Unallocated Patients > 2 Weeks 23 0 Underperforming Yes

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1.3 Data Quality PBR Clustering

74

PBR Clustering: Actions:

PBR clustering has been achieved by April for all Networks. Further data quality measures will be added in year.

May-2016 Jun-2016 Jul-2016 Aug-2016 Sep-2016 Oct-2016 Nov-2016 Dec-2016 Jan-2017 Feb-2017 Mar-2017 Apr-2017

Trust 91.65% 92.90% 93.86% 94.88% 95.44% 95.66% 96.06% 96.28% 96.75% 96.37% 96.43% 96.45%

AMH 88.93% 90.19% 91.47% 93.49% 94.10% 94.22% 96.12% 96.43% 96.78% 96.37% 96.48% 96.47%

CWB 94.60% 95.57% 96.09% 96.10% 96.63% 97.1%

CYP 87.98% 92.59% 95.44% 96.12% 97.01% 95.7% 94.92% 93.56% 96.16% 96.31% 95.35% 95.99%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95% 95% 95% 95% 95%

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Finance and Contracting

Section 2

75

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76

Section 2:- Finance and Contracting

Section 2.1:- Financial Activity - not reported in month 1.

Section 2.2:- Community Contract Activity

• Community & Wellbeing – Network Line Totals • Community & Wellbeing – Service Line Totals • Community & Wellbeing – Total Activity Split by CCG • Children & Young People’s Wellbeing – Service Line Totals • Children & Young People’s Wellbeing – Total Activity Split by CCG • Mental Health – Activity Totals

2. Finance and Contracting

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Contract Activity

Section 2.2

77

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78

2.2 Contract Activity – Variance to Plan

Community & Wellbeing - Network Line Totals

FOIA Exempt under Section 43 Commercial Interest and Section 22 Information Intended for Future Publication

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79


Community & Wellbeing - Service Line Totals

Service Apr-17

Adult Learning Disability Service Total 1,533 Adult Speech and Language Therapy Total 349 CHESS Total 307 Children's Learning Disability Service Total 1,199 Community IV Service BwD Total 84 Community Matrons Total 1,261 Community Neuro Team Total 1,049 Community Respiratory Service Total 1,967 Community Stroke Service Total 339 Complex Case Management Total 409 Continence Service Total 226 Dermatology Service Total 453 DESMOND Total 63 Diabetes Specialist Nursing Total 832 District Nursing Total 41,043 Domiciliary Physiotherapy Total 691 Falls Team Total 424 Heart Failure Service Total 148 Intermediate Care Total 2,778 Nutrition & Dietetics Total 267 Oxygen Service Total 237 Phlebotomy Total 16,742 Podiatry Total 4,386 Pulmonary Rehabilitation Total 441 Rapid Assessment Team Total 1,659 Rheumatology Total 1,321 Specialist Ear Care Total 82 Specialist Nurse TB Total 549 Tissue Viability Service Total 153 Treatment Room Total 8,785 Viral Hepatitis Service Total 79 Community Wellbeing Total Against Plan 89,856

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Community & Wellbeing – Total Activity split by CCG

Community & Wellbeing - Total Activity split by CCG Apr-17

Central Lancs Locality Total 16,742 NHS Blackburn with Darwen CCG Total 21,726 NHS Blackpool CCG Total 150 NHS Chorley and South Ribble CCG Total 26,167 NHS East Lancashire CCG Total 730 NHS Fylde & Wyre CCG Total 249 NHS Greater Preston CCG Total 23,367 NHS Lancashire North CCG Total 330 NHS West Lancashire CCG Total 395 Community & Wellbeing Totals 89,856

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Children & Young People’s Wellbeing - Service Line

Totals

81

Service Apr-17

Children's Occupational Therapy Total 556

Children's Physiotherapy Total 479

Children's Speech & Language Therapy Total 1,733

Paediatric Liaison Total 136

Children & Young People’s Wellbeing Total Against Plan 2,904

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Children & Young People’s Wellbeing - Total Activity

split by CCG

82

Children & Young People’s Wellbeing - Total Activity split by

CCG Apr-17

NHS Blackburn with Darwen CCG Total 518

NHS Chorley and South Ribble CCG Total 671

NHS East Lancashire CCG Total 708

NHS Greater Preston CCG Total 654

NHS West Lancashire CCG Total 353

Children & Young People’s Wellbeing Total Against Plan 2,904

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Mental Health – Activity Totals

Metric Apr-17

Adult Ward Occupied Bed Days Total 5,741

Adult/PICU Ward Admissions Total 168

Adult/PICU Ward Discharges Total 167

CCTT Teams - Accepted Referrals Total 153

CCTT Teams - Contacts Total 7,901

CMHT Contacts Total 2,453

CMHT Referrals Total 86

Community Restart Teams - Accepted Referrals Total 127

CRHT Face to Face Contacts - 18 to 65 Total 3,631

CRHT Face to Face Contacts - Below 18 Total 120

CRHT Face to Face Contacts - Over 65 Total 65

CRHT Teams - Referrals Total 702

CRHT Telephone Contacts - 18 to 65 Total 2,122

CRHT Telephone Contacts - Below 18 Total 66

CRHT Telephone Contacts - Over 65 Total 37

Criminal Justice Liaison - Contacts Total 565

Eating Disorder Service - Contacts Total 1,016

Eating Disorder Service - Referrals Total 72

Hospital Liaison Contacts Total 598

Hospital Liaison Referrals Total 147

MAS Teams - Referrals Total 5,854

Older Adult (Dementia) Inpatient Ward Admissions Total 7

Older Adult (Dementia) Inpatient Ward Discharges Total 10

Older Adult (Dementia) Ward Occupied Bed Days Total 812

Older Adult (Functional) Inpatient Ward Admissions Total 11

Older Adult (Functional) Inpatient Ward Discharges Total 12

Older Adult (Functional) Ward Occupied Bed Days Total 1,034

PICU Ward Occupied Bed Days Total 817

PICU Wards - Transfers In Total 16

RITT Contacts Total 1,902

RITT Referrals Total 166

Mental Health Metric Total 36,578

Metric Apr-17

Older Adult (Functional) Inpatient 30 Day ReAdmissions 1Older Adult (Functional) Inpatient 90 Day ReAdmissions 1Adult Inpatient 30 Day ReAdmissions Total 9.58%Adult Inpatient 90 Day ReAdmissions Total 14.97%

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84


Mental Health – Activity Totals

FOIA Exempt under Section 43 Commercial Interest and Section 22 Information Intended for Future Publication

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Quality

Section 3

85

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86

Section 3:- Quality

Quality

• Quality and Safety Tile • Quality Surveillance – Safety • Quality Surveillance – Experience & Effectiveness • Quality Surveillance – Leadership • Delivering the Strategy

3. Quality

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3. Quality

Quality & Safety Tile

87

103 1397

0 288

43 93%

2 7440

0

12

4

1692

94%

82%

SAFETY

QUALITY AND SAFETY TILE

EXPERIENCE

Number of upheld complaints

F&F Test - Patients

Number of complaints

Number of RIDDOR incidents

Number of serious incidents

Number of Never Events

Number of compliments

Avoidable MRSA incidents

CQC Intelligence Monitoring Risks

Compliance with Core Skills

CQC Overdue Actions

LEADERSHIP

Other serious HCAI incidents

Regulation 28 Notices received

EFFECTIVENESS

Avoidable C. Diff. incidents

Physical violence to staff

Due to the Network Re-design historical data prior to 15 May 2017 is recorded in the four Network structure and has been aggregated in this report to provide the best available comparison.

CQC Overall Trust Rating

Data provided shows the following 12 month figure (where a number) or the rolling 12 month average (where a percentage).

Physical Health Harm Free Care Rate

12 Risks

Good

Number of overdue 7 day reviews

Number of overdue 3 day reviewsMental Health Harm Free Care Rate

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3. Quality

Safety

88

Domain Indicator Target May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr12 months

total

12 months

averageSparkline Risk

Number of serious incidents n/a 11 11 14 11 6 15 6 6 7 8 4 4 103 8.6

% reduction from 2014/15 >10% -31% -75% -18% -45% -54% 15% -65% -57% -70% 60% -60% -78% - -39.83%

Number of RIDDOR incidents n/a 8 8 4 3 4 2 2 6 2 0 2 2 43 3.6

Number of Never Events 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Duty of candour breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

C. Diff. incidents 0 0 0 1 0 1 0 0 0 0 0 0 0 2 0.2

MRSA incidents 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Other serious HCAI incidents n/a 1 1 0 1 0 1 1 4 1 0 1 1 12 1.0

Overdue CAS alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Mixed sex breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Use of restraint n/a 263 238 253 279 215 257 349 252 189 263 308 327 3193 266.1

Potentially avoidable grade 3

and 4 pressure ulcersn/a 0 0 2 0 0 0 0 0 0 1 0 0 3 0.3

Physical violence to staff from

patients n/a 160 113 138 137 122 148 162 137 140 128 152 155 1692 141.0

% reduction from 2014/15 >10% 74% 5% 52% 80% 77% 20% 42% 19% 32% 42% 3% 58% - 42.00%

Legal Regulation 28 Notices received n/a 0 3 0 0 0 0 0 0 0 0 1 0 4 0.3

Regulatory Inspection Visits or Enforcement

Action:

None.

QUALITY AND SAFETY SURVEILLANCE - Safety

QUALITATIVE INDICATORS

QUANTITATIVE INDICATORS

Staff safety

Incidents

IPC

Patient safety

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3. Quality

Experience & Effectiveness

89


total

12 months


Number of complaints n/a 96 96 103 110 90 118 126 160 119 112 167 100 1397 116.4

Number of upheld complaints n/a 24 21 32 27 35 7 38 23 16 16 27 22 288 24.0

Number of reopened

complaintsn/a 3 7 5 2 5 2 3 3 3 4 2 1 40 3.3

Number of PHSO complaints n/a 1 2 0 1 1 1 0 0 1 2 3 1 13 1.1

Number of MP enquiries n/a 7 10 15 8 7 12 8 7 13 9 15 7 118 9.8

F&F Test - Patients 95% 95% 91% 94% 97% 97% 91% 85% 87% 96% 96% 96% 96% - 93.41%

F&F Test - Response Rate n/a 3450 2820 1934 2666 2004 2517 3371 1744 1659 2042 1562 1263 27032 2252.7

Compliments Number of compliments n/a 865 709 551 897 565 549 562 469 433 667 646 527 7440 620.0

QUALITY AND SAFETY SURVEILLANCE - Experience


Complaints

Friends & Family


total

12 months


Physical Health HFC Rate 95% 92% 95% 96% 94% 94% 94% 93% 94% 95% 95% 93% 94% 94% 98%

Mental Health HFC Rate 90% 80% 77% 82% 82% 83% 81% 82% 83% 86% 84% 85% 83% 82% 83%

CQUIN Exception Report: None.

QUALITY AND SAFETY SURVEILLANCE - Effectiveness



Harm Free Care

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3. Quality

Leadership

90


total

12 months


Overall Trust Rating Good RI RI RI RI RI RI RI RI Good Good Good Good

Intelligent Monitoring Risks

(six monthly reporting)n/a - - - - - - - - - - - -

Number of overdue CQC actions 0 76 82 0 0 0 0 0 0 0 0 0 0 158 24.31

Number of raising concerns

(six monthly reporting)n/a - - - -

Compliance with Core Skills 85% 82.02% 83.25% 83.01% 86.19% 86.19% 86.56% 87.72% 88.24% 89.07% 89.41% 90.68% 90.33% - 86.89%

Compliance with Care

Certificate80% 25.00% 24.00% 24.00% 39.00% 35.00% 38.00% 36.00% 54.00% 62.00% 63.00% 67.00% 64.00% - 44.25%

No. of overdue 7 day reviews 0 1652 1305 1176 4133 2066.50

No. of overdue 3 day reviews 0 105 80 71 256 128.00

QUALITY AND SAFETY SURVEILLANCE - Leadership


CQC

Core Skills

Good

12 Risks

* NEW *

Incident

Investigation

Data to be provided from Q1 2017/18

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3. Quality

Leadership

91

Healthwatch Enter and View Visits (year to date):

Internal Quality Assurance visits (year to date):

Commissioner Quality Visits (year to date):

Community Wellbeing - 1

Children & Families - 0

Adult Mental Health - 1

Please refer to the network report for further details

Community Wellbeing - 0




Community Wellbeing -




June 2016 - The CQC conducted an unannounced review of safeguarding children and services for looked after children across Lancashire. The report has now been

published and an action plan developed.

July 2016 - HMP Liverpool. The CQC were looking specifically at the four previously issued requirement notices. The report has now been published on the CQC website

and an action plan developed by the Trust.

September 2016 - The CQC undertook a comprehensive inspection of the Trust resulting in an overall rating of 'Good'. The inspection reports have now been published

and our action plan response submitted to the CQC. The Quality Summit was held as planned on the 21st February. The Trust presented its acton plan and approach to

improvement based on the inspection team's findings, whilst also seeking system-wide support to help make improvements and continue our journey of continuous

quality.

October 2016 - A joint HMIP/CQC inspection was undertaken of HMP Wymott. The final inspection report has now been published and a Requirement Notice issued

against Regulation 17. The action plan in response to this Requirement Notice was returned to the CQC on the 28th February. Prison healthcare services transferred to

the new provider, GMW/Bridgewater, on the 1st April 2017.

January 2017 - A joint HMIP/CQC inspection was undertaken of HMP Garth. The final inspection report has now been published and the final requirement notice letter

received. In view of the fact that we are handing over this service on the 1st April to GMW/Bridgewater, we will not be submitting the formal Requirement Notice Action

Plan. However, we will respond with what actions have been completed, actions that have been started but not completed and what has been handed over to the new

provider.

March 2017 - A joint HMIP/CQC inspection was undertaken of HMP Preston. Infomation in relation to the outcome of the inspection was received on the 29th March. This

was sent in advance of the joint inspection report as areas of practice were found whether the Trust needs to make improvements. This will be handed over to the new

provider, Spectrum, on the 1st April 2017.

CQC Mental Health Act Monitoring Visits (year to

date):


CQC Inspection Visits (year to date):

Community and Wellbeing - 0




April 2017 - Please also note, the CQC is undertaking an appreciative inquiry through a programme of focused Mental Health Act (MHA) one day visits to contribute new

evidence in the following areas: (1) Information on the local uses of compulsory MH Act powers, looking at activity changes, the reasons for increases or decreases of

detentions, and the response by local services, including commissioning bodies. (2) Identify how local Approved Mental Health Professional (AMHP) services are being

managed, what information is collected and current local issues impacting on AMHP provision and the ability to run a 24 hour AMHP service. The visit was held at the

Harbour on the 27th April. The CQC are currently collating all the information acquired durng the visit and will forward a report over the coming weeks.

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3. Quality

Delivering the Strategy

92

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93

3. Quality


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3. Quality


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3. Quality


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Risk

Section 5

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Board Assurance Framework 2016/17 Q4

5. Risk

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Board of Directors


Report Title Naylor Review of NHS Property & Estates

FOIA Exemption Part Exemption

Prepared by Suzanne Wood & Steve Jameson, Property Services Director

Presented by Steve Jameson, Property Services Director


Supporting Executive Director Chief Finance Officer


Report purpose To advise on implications of the Naylor Report on LCFT


To provide excellent value for money in a financially sustainable way

Board Assurance Framework risk 5.2 If we do not work with partners to deliver system wide efficiencies this will undermine our own financial position and that of the STP

CQC domain Well-led

1. Introduction

On the 31st March 2017, Sir Robert Naylor published his independent report ‘NHS Property and Estates: Why the estate matters for patients’ for the Secretary of State for Health. This paper summarises the specific implications and opportunities of his report for LCFT.

2. Key Recommendations from Naylor

The report sets out a vision for how the NHS could best utilise its estate, taking advantage of opportunities to release value and transform infrastructure to deliver the NHS’s plan for change, the Five Year Forward View (5YFV). It highlights opportunities available to support sustainability and transformation plans (STPs) and recommends that the form of the estate must align with service strategies evolving through local STPs.Whilst there are many recommendations in the report, essentially it recommends:

NHS Property Co and Community health properties are brought together, and considerationgiven to these organisations transferring legacy PCT estate back to local health economies

The significant backlog maintenance and accommodation that is not fit for purpose should beaddressed and STPs are likely to be the vehicle to ensure a strategic approach is taken

Resources for investment (above) should be generated by disposal of surplus and underutilisedproperty

The NHS estate should be used to unlock land for residential development with a particularfocus on social housing and key worker accommodation

4. LCFT Position and 5. Healthier Lancashire and South Cumbria (STP) Position

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3. Background

Critical to realising Naylor’s vision is investment to ensure the estate is fit for purpose and facilities support patient care. The report estimates that STP capital requirements might total around £10bn, with a conservative estimate of backlog maintenance at £5bn and a similar sum likely to be required to deliver the 5YFV.

It suggests funding could be through property disposals, private capital (for primary care) and from HM Treasury. The report emphasises the need for the NHS (through the STP process) to rapidly develop robust capital and estate plans which are aligned with clinical strategies, maximise opportunity for value for money (including land sales) and address backlog maintenance.

The recommendations fall into three categories. They set out how to improve capability and capacity; support action at a local level (including the mix of incentives and sanction required for delivery) and develop a robust and sustainable strategy that enables the estate to support transformation in the NHS.

The Naylor Report is a view, not a plan or a commitment on the DoH and comes with the rider “The Government welcomes the review and will consider the recommendations carefully and respond in due course.” Some of the Naylor recommendations are in hand, including:

Plans to create a new NHS Property Board and body by merging NHSPS and CHP. These staffare working closer together but there won’t be a merger until September 17 at the earliest.

Making a £325m capital investment over the next 3 years available to support and develop localSTPs (LCFT have bid for £5.7M from this allocation for MH wards in Chorley, although the fundis heavily over-subscribed.)

In addition the review makes a strong recommendation for the development of an incentive scheme to guarantee that proceeds of sales are available for reinvestment as set out in recommendation 11:

“At a minimum, the Department of Health (DH) and HM Treasury (HMT) should provide robust

assurances to STPs that any sale receipts from locally owned assets will not be recovered centrally

provided the disposal is in agreement with STP plans”

The government will consider a further multi-year capital allocation for the STP in the autumn statement. This will be post general election and will need to be reviewed subject to the elected government plans and policies.

The Naylor Review concluded that the existing NHS estate is not configured to maximise benefits for patients or taxpayers and that key considerations should focus on the size of the opportunity (building on the Carter Report on efficiency) including substantial potential capital receipts from the disposal of inefficiently used land and property; significant service reconfigurations to maximise value and resultant ongoing revenue savings. It did make the point that most of the NHS land disposal value is in London, with the smallest London disposal larger than the largest disposal value outside London.

LCFT was identified as one of the pilot Trusts for the Lord Carter Community and Mental Health review and this visit took place on 27 April. The session with the LCFT Exec and senior management team was very positive and in regards to Estates LCFT were favourable compared to the median line across

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all the metrics and the Property Services Director was invited to take part in a national group that would focus on Estates data and review of ERIC.

4. LCFT position

FOIA Exempt under Section 43 Section Commercial Interest

Healthier Lancashire and South Cumbria (STP) Position

FOIA Exempt under Section 43 Section Commercial Interest5.

6. Summary and Recommendations

The general positioning of the Naylor Review is one of pragmatic asset utilisation, LCFT have made good progress in this area over recent years and our future plans will ensure we continue to do so.

The steps LCFT have already taken are in line with Naylor’s recommendations, particularly STP engagement and influence, disposal activity (including housing interest) and planned reinvestment in schemes that will progressively reduce backlog maintenance. As such we are not recommending any major departure from our current estate strategy as a result of the report, but we will keep this under review especially once government responds to the findings after the general election.

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Documents

Board of Directors - Lancashire Care NHS Foundation … Board/Trust...FORMAL BOARD (PUBLIC MEETING) Part One Reference Item Lead Action Enc. FOIA Exempt TB 068/17 Welcome and opening