CKWCB-12-156_Quality___Performa

Agenda item:08 Enclosure: CKWCB/12/156

DATE OF MEETING: 3rd July 2012

Category of Paper Tick()

Paper Title: CKW Cluster Quality And Performance Report

Decision and Approval

Position statement

Responsible Director: Executive Director of Quality and Governance [email protected] Director of Performance & Commissioning Intelligence [email protected]

Discussion

Information

Paper Author: Natalie Ackroyd, Business Reporting/Planning Manager, NHS Kirklees [email protected] Laura Elliott, Head of Quality and Engagement, NHS Wakefield [email protected]

FOI Status:

Executive Summary:

To inform NHS CKWD Cluster Board of NHS Calderdale (NHSC), NHS Kirklees (NHSK) and NHS Wakefield District (NHSWD) PCTs performance against the 2012/13 NHS Operating Framework PRINCIPAL headline outcomes/measures and key quality and safety metrics:-

- Any proposed changes or actions required to improve performance will be assessed for any financial implications

- NHS risk assessment ‘traffic light’ system incorporated within the performance report

- No legal implication/links to legislation have been identified

- Meeting performance targets enables patients to access services appropriately.

- No impact on staffing / workforce

Outcome of Equality Impact Assessment: Not applicable

Sub Group/Committee: NHS CKW individual PCTs Finance and Performance and Quality Groups

Recommendation (s):

NOTE the performance of NHS Calderdale, NHS Kirklees and

NHS Wakefield District PCTs against key PRINCIPAL

outcomes/measures for 2012/13 and key quality and safety

metrics;

APPROVE the action being taken to address areas of

under/over performance; and

AGREE additional actions required to address areas of over/under performance.

mailto:[email protected]




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1.0 Purpose of Report

To inform NHS CKW Cluster Board of NHS Calderdale (NHSC), NHS Kirklees (NHSK) and NHS Wakefield District (NHSWD) PCTs performance against the 2012/13 NHS Operating Framework Principal headline outcomes/measures and key quality and safety metrics.

These outcomes/measures contribute towards the Primary Care Trusts 2011/12 Single Assurance Assessment Process with the Strategic Health Authority and the national annual PCTs National Benchmarking Dataset. The key quality and safety metrics reflect the routine measures that have been regularly reported to the Cluster Board since June 2011. A number of these measures are also identified within the NHS North of England (NoE) quarterly quality dashboards.

2.0 Background

The NHS North of England document “New system working from 1 April 2012” offers guidance to the changing role of a PCT Cluster in the transition year of 2012/13. During this time it is expected that Clinical Commissioning Groups (CCGs) will increasingly lead the key aspects of the local health economy. Therefore the role of a PCT Cluster should be to move to a position where the CCGs have local visibility and are seen as effective leaders taking decisions. This is deemed to be crucial for CCGs to be able to lead the system going forward.

However, as the Cluster Board is still the accountable body, it needs to be assured that key performance and quality & safety areas are being delivered, as well as being assured that the CCGs are dealing with the remainder of the performance and quality challenges. The CCGs have already taken responsibility for the wider performance and quality agenda through their Finance and Performance Groups and Quality Groups with an escalation process in place for areas of concern to their CCEs. In addition, CCGs are fully represented and taking a lead role in the key contract management meetings with our main providers. To achieve a balance, the attached Quality and Performance report sets out a summary position of Commissioner and Provider performance against the key 2012/13 NHS Operating Framework principal headline outcomes/measures and key quality and safety metrics, details the actual activity against plan, year-to-date position and forecast outturn (end-year position forecast based on year-to-date activity). The main driver for inclusion of the performance indicators is that they are those indicators by which the North of England (NoE) SHA will determine the organisation performance of a PCT Cluster. These indicators are principal indicators and are subject to change, a recent addition to the list is NHS Health Checks. The performance team will ensure that amendments are made to the report in line with the view that the NoE SHA take. The quality and safety measures are also identified within the NHS North of England quarterly quality dashboards. The summary incorporates the existing risk management “traffic light” system (RAG) to performance monitor/manage progress being made to achieve delivery of the outcomes/measures:-

Green - target being achieved/no risk to delivery; Amber - below/above target, situation needs reviewing, remedial action needs

Investigation; and Red - serious deviation from target, corrective action plan required.

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3.0 Quality Issues highlighted

3.1 Healthcare Associated Infections: MRSA

The under-performance highlighted is an issue across the CKW Cluster.

3.1.1 NHS Calderdale

There have been two cases of MRSA attributed to NHS Calderdale to date. In both instances, the same patient was affected. Initially this was following acute abdominal surgery in CHFT and subsequent management of an infected hip prosthesis from a previous total hip replacement in 2006 and the second episode was 2 weeks following discharge home and early investigations suggest this is again associated with the hip prosthesis. Both episodes count towards the NHSC objective as the blood cultures were more than 14 days apart. However, should this patient have a further episode, it would be appealable. The RCA investigation for the first episode is complete and the investigation for the second episode is underway. It should be noted that the likelihood of a breach of trajectory for NHS Calderdale is high.

3.1.2 NHS Kirklees Three pre 48 hour MRSA bacteraemias have been reported since the beginning of the financial year against an objective of 10. April LTHT reported a pre 48 hour MRSA bacteraemia in a Kirklees resident. No care was undertaken in primary care, the patient received ongoing care and support from LTHT / MYHT. The case will be presented at Kirklees and Wakefield Health Economy HCAI group to deem if avoidable or unavoidable. May LTHT reported two post 48 hour MRSA bacteraemias in Kirklees residents. There is no information yet available from LTHT around the learning to be taken forward from the RCA investigations and whether the cases were avoidable/unavoidable.

3.1.3 NHS Wakefield District Two pre 48 hour MRSA bacteraemias have been reported since the beginning of the financial year against an objective of 10. April A pre 48 hour MRSA bacteraemia case was reported in a Wakefield resident. The RCA was led by MYHT as the patient was in an intermediate care bed provided by MYHT. The DIPC panel deemed the case avoidable due to the patient becoming colonised with MRSA whilst in the facility. When the patient was re-catheterised no antibiotic cover was prescribed and there was a missed opportunity to discuss this with the microbiologist. An action plan is in place to address the issues identified. May A pre 48 hour MRSA bacteraemia case was reported in a Wakefield resident. The RCA investigation is still ongoing - the patient had been an inpatient in MYHT prior to the bacteraemia and received discharge care/support from the GP, social worker and community services.

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Within Wakefield there are a small number of patients screened for MRSA colonisation within MYHT who are discharged before screening results are known. In-depth discussions have taken place with GPs and the Local Medical Committee in order that these patients can access MRSA suppression treatment in a timely manner. The outcome of these discussions is that several community pharmacists across a large geographical spread of Wakefield will participate in a Local Enhanced Service to provide a consultation for these patients and dispense MRSA suppression treatment. Pharmacists will offer domiciliary visits, where appropriate, and refer to Single Point of Access if they feel patients are not able to self-administer the treatment. This process, facilitated by MYHT, began at the end of May 2012 and will be audited after six months. 3.1.4 Mid Yorkshire Hospitals Trust (MYHT) One post 48 hour MRSA bacteraemia has been reported since the beginning of the financial year against an objective of 7. The MRSA bacteraemia reported in April was in a Leeds resident. Due to the complexity of the patient advice was taken on the care of the patient from the transplant unit at Leeds Teaching Hospitals NHS Trust (LTHT). The DIPC panel debated the case and, due to the complexity of the patient, external review has been sought from Professor Walid Al-Wali (Consultant Microbiologist / Director of Infection Prevention and Control) at Rotherham NHS Foundation Trust to conclude if the case was avoidable or unavoidable. The review is ongoing and information awaited. Following a visit to South Tees NHS Trust MYHT’s MRSA action plan has been refreshed. Stephen Eames, Chief Executive has commissioned Professor Brain Deurden and Professor Janice Stevens to undertake a review of HCAI in MYHT which will take place on 28 June 2012. The aim of the review is to provide assurance that all actions are being taken to reduce MRSA and Clostridium difficle.

3.2 Hospital Standard Mortality Rate (HSMR)

Although the current HSMR for MYHT shows 99.4, the annual rebasing exercise for 2011/12 is likely to show MYHT as a significant negative outlier with an HSMR as high as 110. Analysis shows that comparatively HSMR at MYHT has not fallen in line with picture nationally. Actions being taken to address the increasing HSMR include weekly meetings to review all patient deaths; review of case notes in outlying diagnostic groups; and review adequacy of weekend medical cover. Progress reports have been regularly presented to ECB and an update was given at the most recent meeting on 21 June 2012. The cluster have requested a meeting with the Trust once the analysis of the latest data has been undertaken, and NHS Wakefield CCG have asked to be involved in those discussions.

3.3 CQUINs

The overview of the development of local CQUIN schemes including implementation, trajectories setting, improvement plans and recommending these to the relevant Contract Management Boards continues to be managed through the Clinical Quality Board arrangements. All providers submitted Quarter 4 returns by the specified deadline (30 April 012). For Quarter 4, our main providers achieved the following performance:

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Provider Q1 Q2 Q3 Q4 Q4 comments

Calderdale and Huddersfield Foundation Trust (CHFT) - acute

92% 96% 96% 82% Did not achieve maternity indicators (C-section/bookings by 11 weeks), Partially achieved pressure ulcers, UTI & falls.

CHFT - community 79% 67% 75% 79% Partially achieved CAF, pressure ulcers

Mid Yorkshire Hospitals Trust (MYHT) – acute

100% 85% 90% 77.5% Did not achieve end of life, asthma in A&E and length of stay for primary hip replacement indicators.

MYHT – community 90% 80% 80% 80% Did not achieve end of life, pressure ulcers, nutritional screening and antenatal contacts indicators.

South West Yorkshire Partnership Foundation Trust (SWYPFT)

75% 81% 75% 69.5% Did not achieve access (acute, non-acute, and psychological therapies) and nutritional screening.

Locala Community Partnerships Community Interest Company (CIC)

Not reported

in Q1

60% (Q1&2)

Data submitted

65% Partially achieved End of Life, Common Assessment Framework and discharge planning. Did not achieve Pressure Ulcers indicator.

Spire Elland Hospital

Schemes did not

start until Q2

79% 100% 100%

BMI Huddersfield 86% 65% 80% Partially achieved safeguarding training and did not achieve pain control.

Spire Methley Park 86% 36% 60% Did not achieve VTE risk assessment, pain control and smoking cessation indicators.

Yorkshire Ambulance Service (YAS)

100% 82% 100% 80% Provider challenging achievement level with lead commissioner

3.4 Patient Reported Outcome Measures (PROMs)

The quarterly PROMs report from the Yorkshire and Humber Quality Observatory published in December 2011 shows that participation rates for MYHT between April-June 2011 were lower than the previous period reported – 35.9% for groin hernia repair (compared to 53.4%), 49.7% for hip replacement (compared to 65.9%), and 53% for knee replacement (compared to 61.1%). Participation rates are below the national and regional average for all three procedures – the data for varicose veins is not included due to the low numbers of procedures conducted.

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The Quality Observatory have offered to work with individual organisations to understand their findings and the Trust attended the first regional PROMs network in February. The following actions are being taken by the Trust to improve participation rates and understand the outcome data related to health gain. These include:-

Meeting with the commissioning lead for PROMs to discuss the current process for collecting PROMs, the participation rates and health gain outcomes.

Ensuring independent sector providers subcontracted by the Trust to undertake these procedures are issuing the PROMs questionnaires.

Working with the Quality Observatory to breakdown the data on health gain further, including to consultant level, and identify areas for further focus.

The next quarterly report was due to be published in May 2012, although at the time of writing was not available. This report will be reviewed through the MYHT Quality Review Group and participation rates will be monitored on a quarterly basis. 2011 Survey of Adult Inpatients The indicator included in the dashboard shows the composite score for ‘responsiveness to inpatients’ personal needs’ comprising five key questions utilised for the national CQUIN indicator. It shows that both Trusts score below the SHA average. The table below shows the response rate plus the number of questions RAG rating for both providers.

Provider CHFT MYHT

Response rate (national 53%) 58% 45%

Green (highest 20% of Trusts) 5 – feeling threatened; posters on hand washing; availability of hand gels; nurses talking in front of them; nurses washing hands between patients

1 – privacy for examination or treatment

Amber (middle 60% of Trusts) 59 60

Red (lowest 20% of Trusts) 0 3 – posters on hand washing and how to complain, information about medicines

Mid Yorkshire Hospitals Trust (MYHT) The survey results illustrate an overall improvement in patient experience of care and treatment – for 22 questions the improvement in score from last year is statistically significant. An improvement plan has been agreed, and shared with the Quality Review Group in June 2012, covering waiting times; communication and provision of information on medications; delays in discharge; communication and provision of information on discharge; complaints and views on the quality of care; provision of information on hand washing; and staffing levels.

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3.5 CQC Reviews of Compliance

3.5.1 Yorkshire Ambulance Service (YAS) Following visits to three ambulance stations in Hull, Goole and Wakefield the CQC concluded improvements needed to be made to maintain compliance with Outcome 8 (Cleanliness and infection control).

The actions identified include:

Ensuring all cleaning equipment is effectively stored and maintained to be fit for use for cleaning ambulances and other vehicles; and

Provide education to managers and staff on the safe and effective use of cleaning equipment and cleaning products.

The action plan and report were received at YAS Clinical Review Group on 29 May 2012.

3.5.2 Novus Health Ltd The CQC concluded improvements needed to be made to maintain compliance with Outcome 12 (Requirements relating to workers) as some recruitment practices were not followed, references not sought and blood borne virus status of staff not checked.

The provider has introduced new systems to strengthen recruitment processes for directly employed staff, and for seeking assurance from clinicians about the evidence used for their main NHS employment checks. A root cause analysis investigation report and assurance that the resulting actions had been taken was submitted to the commissioner in November 2011. The report from the CQC inspection was only published in May 2012.

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4.0 National Priorities - Performance Issues Highlighted

Issues highlighted within the performance report:-

* *RAG status based on Periodic Review thresholds (previously known as Annual Health Check) where known, if not known, then actual versus plan is used.

4.1 Healthcare Associated Infections: Clostridium Difficile (C.Diff)

The under-performance highlighted is with NHS Kirklees, with issues at both Mid Yorkshire Hospitals Trust (MYHT) and Calderdale and Huddersfield Foundation Trust (CHFT). 4.1.1 NHS Kirklees

April activity highlights 12 C.Diff infections. The breakdown by CCG is 4 allocated to Greater

Huddersfield and 8 allocated to North Kirklees. The breakdown by NHS Organisation is:

- 4 - CHFT - 3 – MYHT - 4 GP’s - 1 LTHT

The cumulative total for April is 12, against a target of no more than 104 cases. The forecast outturn based on the current actual is calculated at 144 cases.

The CKW health economy CDI Action Plan is monitored by NHS North of England. NHS Kirklees provides NHS North of England on a weekly basis the number of CDI cases to identify the previous weeks cases, this is data is not validated.

4.1.2 Calderdale & Huddersfield Foundation Trust (CHFT)

4 post cases 72 hour C.Diff infections reported. April cumulative total of 4, against a target of no

more than 33 cases for 2012/13. Forecast outturn based on actual activity level is projecting 48

cases.

Due to the number of 72 post hour cases, CHFT has established an Antibiotic Collaborative as part of their Healthcare Associated Infection Action Plan

4.1.3 Mid Yorkshire Hospital Trust (MYHT)

7 post 72 hour C.Diff infections. April cumulative total of 7 cases against a target figure of 78 cases for 2012/13. Forecast Outturn based on actual data is projecting 84 cases.

Outcome/Measure Calderdale

RAG* Kirklees

RAG* Wakefield

RAG*

Clostridium Difficile

Eliminate Mixed Sex Accommodation

Health Visitors

NHS Health Checks

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As part of MYHT CDI action plan an internal summit will be held before the end of Quarter one (June 2012).

4.2 Eliminating Mixed Sex Accommodation

The under-performance highlighted is with NHS Calderdale and NHS Kirklees, the issues are with Calderdale and Huddersfield Foundation Trust (CHFT). The NHS Operating Framework for 2011/12 required that each year, on or by 1 April 2012, all organisations must publish a declaration on their website of whether they are compliant or not with the national definition of same sex accommodation - to eliminate mixed sex accommodation, except where it is in the overall best interest of the patient, or reflects their patient choice. CHFT, MYHT and SWYPFT completed the declaration exercise by 31 March 2012. EMSA remains a standing item on Clinical Quality Boards with CHFT and MYHT. Providers of NHS-funded healthcare reported 559 breaches of the MSA guidance in relation to NHS patients sleeping accommodation in England during April 2012 which is an increase from 461 breaches in March 2012. Overall there has been a downward trend in number of breaches nationally since October 2011 when 1236 breaches were reported. The range of breaches ranges from zero to 54 breaches in the month of April 2012. 4.2.1 NHS Calderdale

CHFT reported one clinically unjustified breach in April 2012. This occurred on the Calderdale Royal site on the Acute Stroke Unit (ASU) and was due to capacity issues. The Matron on duty authorised this breach. We are currently waiting clarification around the breach number as it is understood that there were three patients involved and therefore three breaches are required to be reported. We understand that one breach involved a Kirklees patient but are unsure where the other two patients reside. EMSA is a standing item at CHFT Clinical Quality Board and improvement actions will be monitored via this committee. Calderdale CCG Quality Group, monitor EMSA breaches as a standing item and it is an indicator on the developing Quality Dashboard.

The NHS Calderdale resident breach occurred at University Hospital of South Manchester (UHSM). NHS Manchester has confirmed that there has been an issue with Medical Assessment Unit and Intensive Care Unit. UHSM have provided an EMSA Recovery Action Plan which includes specific actions for Medical Admissions Unit, Bed Management and Acute Intensive Care team along with daily monitoring and escalation reports from Matrons. NHS Manchester are performance managing the implementation of this action plan.

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4.2.2 NHS Kirklees

As at the 11th June 2012, the Unify2 system is showing local and external provider breach activity for NHS Kirklees as follows:- The breach at Calderdale & Huddersfield Foundation Trust is on the Calderdale Royal Hospital site as stated above.

4.3 Health Visitors

The under-performance highlighted is with NHS Wakefield, issues are predominately at Mid Yorkshire Hospitals Trust (MYHT).

4.3.1 NHS Wakefield

This indicator should demonstrate a commitment to delivering an increase in the number of Health Visitors to ensure that families have a positive start, whilst working in partnership with other health services, GPs, Sure Start Children’s Centres and other early year’s services. This is a rolling programme with completion by 2015. Mid Yorkshire Hospitals NHS Trust are committed to this indicator, in 2011/12 they made progress in all areas to increase the workforce and achieve the trajectory set. The trust continues to have robust plans in place for this indicator with additional members of the work force expected the complete training in the autumn and further successful candidates expected by year end 2012/13. Because Health Visitor training necessitates prolonged study, this indicator remains difficult to monitor in year, but the commissioners are confident that the trusts plans are justified and robust to achieve a good year end position.

4.4 NHS Health Checks

The under-performance highlighted is an issue across the CKW Cluster. The NHS Health Check programme is a systematic programme that assesses an individual’s risk of developing cardiovascular disease. People aged 40-74 who have not been already diagnosed with a cardiovascular related condition are eligible for a health check. The health check consists of a face to face individual risk assessment followed by risk management advice and interventions. It was recommended that the Office of National Statistics (ONS) 2008 –resident based population projections for 2012 was used to calculate the PCTs eligible population, best practice would determine the eligible population at the beginning of the year acting as a baseline to aid planning. PCTs began a phased roll out of the NHS health check programme from April 2011/12 In 2012/13 full roll out should be reflective by a fairly stable number of NHS Health Checks being offered and

Provider April

Local - Calderdale & Huddersfield Foundation Trust 1

Local - Mid Yorkshire Hospital Trust 0

External 0

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conducted every year, as part of a five year rolling cycle – with every eligible being offered a check every five years. High levels of take up by all those eligible is an important part of the programme and PCTs should aspire to improve their take up rates progressively. The full roll out programme will be reached when PCTs are inviting at least a fifth of their eligible population every year as part of a five year rolling programme. Therefore PCTs should plan for a programme which will enable 20% of the eligible cohort to have an offer of a NHS Health Check in 2012/13.

4.4.1 NHS Calderdale

NHS Health Checks are a mandatory requirement stipulated in the Operating Framework for 2012/13 – the check is expected to be undertaken every 5 years for the eligible population with a systematic call/ recall system in operation. The eligible population in Calderdale is estimated to be 52,000. This will continue to be updated as accurate data from practices is received.

2011/12

26 practices signed up to the LES; and

In Q4 2011/12, 19 practices have offered NHS Health Checks.

In total, NHS Health Checks have been offered to 3235 patients (6.5%) of the eligible population and 1483 (3.0%) have had a completed check.

NHS Calderdale had expected that approximately 11% of the eligible population would be offered a health check in 2011/12. The shortfall is due to a number of factors:

1. Overestimation of the number of health checks completed opportunistically between April

and October; 2. Lower level of delivery achieved given all but 2 practices signed for the LES; and 3. Impact of administering the requirements of the LES within context of winter pressures and

QoF returns.

2012/13

All practices have signed up to deliver NHS health checks in 2012/13.

The requirement is to ensure that 20% of the eligible population will be offered an NHS Health Check in 2012/13. The LES has stipulated that 10% must be offered by the end of Q2. Practices facing difficulties in reaching this level will be expected to escalate their concerns to the lead manager in the PCT so further action can be taken to support the practice or seek alternatives.

The LES has been amended to comply with patient wishes to receive results in a format of their choosing and the monitoring form has been amended to ensure accurate collection of data related to health checks offered.

Monitoring and quarterly updates will be provided to the Finance and Performance Group and the LMC.

A draft Memorandum of Understanding has been developed between the Public Health Directorate and the CCG and is presently out for consultation with the CCG. It includes a statement

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committing the CCG to ‘Work closely with the Public Health Directorate to ensure that people who are identified as high risk in CVD health checks or requiring additional testing or medical interventions are provided with the services they need’.

4.4.2 NHS Kirklees

A decision was taken by Business and Finance Group in June last year for an outreach–only NHS Health Checks service to be commissioned, within a set budget of £209,000. This included decommissioning of a number of practice-based Health Checks services in the North. The new NHS Health Checks Outreach service began on the 1st April 2011. The service is provided by a small team of Primary Prevention Nurses within Locala.

Due to the nature of the service being outreach-only and with limited resource, it was decided it should initially target communities in Kirklees with the worst health and deprivation, who are at greatest risk of vascular disease. Therefore, the service is currently not universally available for the whole 40-74 population within Kirklees.

When the service was commissioned a target of 7000 (1750 per quarter) Health Checks was set for 2011/12. This was agreed as a sensible number based on the budget and resource available at the time.

However, as part of the national formal monitoring return, the PCT was required by the SHA to sign-up to offering Health Checks for 18% of our eligible population, which was calculated at 4542 per quarter. We have already informed the SHA through formal performance channels, that NHS Kirklees will not meet their expected target of 4542 within the current service provision. The service would need the capacity to deliver more than 1750 a quarter if it was to make an offer of 4542.

CURRENT POSITION

Significant underperformance was highlighted during the 2011/12 Integrated Performance Measures Return (IPMR). Quarter 1 reported 240 Health Checks provided, against an NHS Kirklees target of 1750; quarter 2 reported 437 against an NHS Kirklees target of 1750, quarter 3 reported 402 against an NHS Kirklees target of 1750 and quarter 4 reported 596 again against the plan of 1750. Total number of health checks delivered in 2011/12 was 1675. In comparison to other PCTs within the Yorkshire and Humber region, NHS Kirklees are ranked 10th out of 13 PCTs. Three PCTs in the region still have no service and all reported zero. However, there is increasing pressure from the SHA for us all to be meeting the National target.

PROGRESS

During 2011/12 the service has been targeting communities within the Dewsbury, Batley, Ravensthorpe and Huddersfield Central areas, and has endeavoured to build links and foundations in these communities to reach the target population.

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There have also been huge efforts in marketing and embedding the service through advertising and canvassing with large employers and within close-knit communities. As a result, momentum is starting to build weekly and the service is becoming more well-known and established. The service now offers regular health checks in mosques, leisure centers, libraries and other community centers, as well as targeting large employing companies and sports stadiums in order to attract a higher footfall. However, some venues are not as successful as others and some clinic slots are going un-used. Locala are reviewing the current venue choices and their marketing plan, to try and encourage more people into the service.

Patient feedback so far has rated the service very well in terms of it meeting expectations, being accessible, prompting people to follow-up areas of risk with their GP practice and people recommending the service to family/friends. The majority of people seen so far, heard about the service either through newspaper adverts, via their employer/work colleagues or through the library.

Locala understand that they need to spread messages about the service further and would welcome feedback around this to incorporate into their marketing plan.

Where risk factors have been identified as a result of a health check, the service has been actively referring people onto their GP practice for further investigations and other services where they can get help to reduce their risk of vascular disease in the future and make the necessary lifestyle changes. So far there have been:

23 referrals to Weight Management

77 to GP

222 to Practice Nurse

22 to Physical Activity Programme

5 to stop smoking clinic

Performance has been discussed at a recent Contract Management Group meeting and Locala have been asked to produce an action plan around how they intend to increase numbers.

RISKS AND ISSUES

The service has limited capacity to deliver Health Checks. The service operates with only 3.61 whole time equivalent cardiac nurses at full capacity, currently with vacancies this is down to 2.2 whole time equivalent. One key risk is that communications and engagement needs to continue to be a focus for this service as there is a need to continually embed links, create opportunities and build trust to successfully encourage people into the service. This is very time-consuming and resource intensive for such a small-scaled service. In working within our existing resources it was always clear that we would be unable to meet the SHA target of offering an NHS Health Check to 20% of our eligible population per year. However, the service will not reach the local target of 7000 health checks for 2011/2012. 1079 Health checks have been completed at the end of quarter 3 but hopefully the steps in quarter 4 can show an increase on past monthly figures.

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National guidance suggests that the future commissioning of NHS Health Checks will be the responsibility of Public Health when they move into the Local Authority, and this needs to be considered in any medium and long-term planning.

NEXT STEPS In order to meet national targets regarding the health check offer NHS Kirklees will implement a LES across all GP practices within Kirklees for 2012-2013. CCG and GPs are aware of this and the existing outreach service has had notice that they will be decommissioned and have been given six months notice. Standard Operating Procedures (SOP) are to go out to all practices W/E 22nd June. Existing outreach team will engage in training workshops for practices during their notice period. We envisage that health check quarterly reporting will be suspended during quarter 1 because of this period of change but practices will be ready to report for quarter 2 (2012-2013). From quarter 2 onwards we aim to work towards achieving the 5 year target of systematically offering all the target population a health check. All practices to report on health checks offered and received from quarter 2 2012-2013.

3.4.2 NHS Wakefield Locally in 2011/12 the PMS contract was agreed and “offered NHS Checks”, was the only target for (PMS) GP practices. The PMS “offered” target for 2011/12 was 19,800, however 26,992 NHS Health Checks were offered, therefore exceeding the target set. However the number of Health checks received under performed at 9.8% against the national target of 13.6% In 2012/13, a trajectory of NHS Health Checks received was reduced to 8,000 to align with the more difficult to reach communities. However, the offer target remained high at 22,000, to reflect the additional number of offers required to achieve the target number of health checks received. This is in line with the DH target of 20% of the eligible population to be offered a Health Check per year over the 5 year programme; we have 2 more years to deliver this programme within a full 5 year cycle. We are undertaking a second Health Equity Audit to understand the delivery of the programme in more detail, the results will demonstrate where we need to improve our efforts in continuing to achieve the numbers offered and received over the next two years of this round of the programme. We are about to undertake a patient satisfaction questionnaire to identify any areas that patients feel require improving. The Health Trainers and the Health and Well Being workers have received training on Cardiovascular Risk Assessments and this has included training on blood pressure to engage with clients from the more difficult to access areas, these clients can be signposted for a full risk assessment at the GP surgery, thus increasing the opportunity to achieve the targets year on year.

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5.0 Recommendations

The CKW Cluster Board is asked to: - NOTE NHS Calderdale, NHS Kirklees and NHS Wakefield District PCTs performance against the

principal headline outcomes/measures; - APPROVE the action being taken to address areas of under/over performance; and

AGREE additional actions required to address areas of over/under performance. Report Owner: Peter Flynn; Director of Performance & Commissioning Intelligence Report Author: Natalie Ackroyd; Business Performance Reporting and Planning Manager (NHS Kirklees)

Documents

CKWCB-12-156_Quality___Performa