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Wednesday 25th February 2009

Hertfordshire County Council

County Health Scrutiny Committee

Standards for Better Health Topic Group

Item No 3.1

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Background - 2007/08 Healthcare Commission Ratings

Area Sub Sections Number 2007/08

Quality of Resources

Core Standards 39 Criteria Almost Met

Existing National Targets 4 Targets Not Met

New National Targets 5 Targets Excellent

Use of Resources(Auditors’ Local Evaluation (ALE))

1 Financial Reporting 2 KLoEs Performing Well

2 Financial Management 3 KLoEs Inadequate Performance

3 Financial Standing 1 KLoEs Performing Well

4 Internal Control 3 KLoEs Adequate Performance

5 Value for Money 4 KLoEs Adequate Performance

Area 2007/08

Quality of Services WEAK

Use of Resources WEAK

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Performance Improvement Plan

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Performance Improvement Plan – Core Services

Domain Standard 2008/09Correctedby 31/3/08

Comments

Patient Safety

C04b

Safe use of Medical Devices

Not Met No Now fully resolved

GovernanceC07e

DiscriminationInsufficient Assurance

Yes Resolved in 2007/08

Patient Focus

C14a

Complaints procedure

Insufficient Assurance

Yes Resolved in 2007/08

Patient Focus

C14b

Complaints discrimination

Insufficient Assurance

Yes Resolved in 2007/08

Domain CompliantInsufficient Assurance

NotMet

N/A Total

1 Patient Safety 6 0 1 2 92 Clinical & Cost Effectiveness 5 0 0 0 53 Governance 11 1 0 0 124 Patient Focus 5 2 0 2 95 Accessible & Responsive Care 2 0 0 0 26 Care Environment & Amenities 3 0 0 0 37 Public Health 3 0 0 1 4 Total 35 3 1 5 44

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Performance Improvement Plan – Existing National Targets

Indicator 2007/08HCC

Points

Parameter

Achieved Failed

1 Category A8Data Not Returned*

0 >75% <70%

2 Category A19 95.73% 3 >95% <90%

3 Category B19 92.74% 2 >95% <80%

4 Thrombolysis - 60 minute Call-to-Needle time

58.62%(+10% improvement)

3Either >=68% or >=38% with

a 10% point increase between 04/05 and 07/08

<38% without a 10% point increase between

04/05 and 07/08

Overall Rating Not Met 8

* Actual performance for Cat A8 2007/08 = 75.09% = 3 points. This would have delivered a score of “Almost Met”

Commentary:The Trust has taken a robust measures to improve performance.•Remodelled service delivery through implementation of front loaded model and mobilisation of RRVs •Implemented Special Measures – Gold Cell at Trust HQ, Silver Cells in NSC and Essex. Escalated to REAP level 3 over Christmas and New Year•Implemented outputs from increased management information e.g. Lightfoot, ORH reports. Resulted in Dynamic Deployment, tethered cars etc.•Implemented weekly monitoring to PCTs and NHS EoE

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What did we do?

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Implementation of 7 Key Work Streams

• In response to the Weak/Weak rating in October 2008, the Trust implemented a Programme Management Office (PMO) to deliver 7 key work streams (each headed by an Executive Director)

• Two objectives :1. Ensure the Healthcare Commission Annual Health Check

Rating for 2008/09 delivers a minimum score of:Quality of Service FAIRUse of Resources FAIR

2. Develop the infrastructure and building blocks required to ensure the Trust is prepared for the 1st April 2009 to deliver the Trust’s objectives in 2009/10

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7 Key Work Streams

1. Deliver Key Operational Targets

2. Improve Financial Management

3. Deliver the 2009/10 Business Plan

4. Improve Financial Reporting

5. Improve Risk Management & Governance

6. Ensure Value for Money

7. Improve Communication &Engagement

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Work Streams – Objectives

Work Stream Exec Objectives HCC Target(s)

1Deliver

operational targets

CEO

Deliver of the 3 Call Connect targets 2008/09.Determine a sustainable delivery model for 2009/10 Determine plans to deliver local clinical performance indicators and new national clinical performance indicators (NCPIs)

QoS - Existing National targets (Call Connect) and New National Targets

2Improve financial

managementDoF

Improve and embed financial management within the Trust and future planning

ALE: 2 – Fin Mgt 3 – Fin Standing

3Deliver 2009/10 Business Plan

DBD

Deliver a costed, realistic Annual Plan for 2009/10 (agreed with stakeholders) before the end of March 2009.Develop strategic objectives and performance management framework to ensure delivery.

QoS – All targetsALE: 2 – Fin Mgt 4 – Internal Control 5 – VFM

4Improve financial

reportingDoF

Ensure the Trust meets the requirements for final accounts and is prepared for the implementation of IFRS.

ALE: 1 – Fin Reporting

5Improve Risk

Management & Governance

MD

Reinforce the internal controls (integrated Governance arrangements) and Controls Assurance Framework Map and mitigate the key risks to delivering strategic objectivesEmbed risk management ethos into the organisationDevelop CPIs and work on national group re NCPIs

QoS – All TargetsALE: 4 - Internal Control

6Ensure Value for

Money (VfM)CIO

Support business planning through embedding of performance management with good data quality.

ALE: 5 – Value for Money

7Improve

CommunicationsDHR

Underpins & supports all other work streamsImprove both internal & external communication

ALE: 5.2 – Value for Money

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Weekly Monitoring – SHA & PCTs

• Weekly performance report to SHA highlighting:– Key operational & financial targets both:

Year to Date; andForecast Out-turn

– Analysis of reported performance– Variance analysis– Corrective actions being implemented– Risk assessment on delivery of 7 work streams

• Signed off by Executive Team

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Risk Assessment of 7 Key Work Streams

Work streams Risk Commentary

1Deliver Operational Targets

A

The Trust is comfortably within the HCC performance parameters for delivering a "Partly Met" for Existing National Targets for the Call Connect Targets. This will ensure the organisation remains on track to deliver a "Fair" for Quality of Service.NB1 - Minimum levels are A8 (70%), A19 (90%) and B19 (85%)NB2 - Core and New National Targets are covered in Workstream 'Risk Mgt & Governance' below

2Demonstrable Financial Management

AIncludes all statutory financial targetsHighest risk is deliverability of break-even linked to delivery of CIPs and agreement of additional income with commissioners. Working closely with External Auditors to clarify specific targets.

3Deliver Annual Plan 2009/10

GOn target to deliver an annual plan.Requires focus on Activity/HR/Finance modelling and service & supporting strategies

4Improve Financial Reporting

GIncludes the process to deliver the Annual accounts and Annual report within the shortened timetable and understanding the impact of IFRS impact etc.

5Ensure Risk Management & Governance

AIncludes "Internal Control" ALE targets and changes to Assurance FrameworkFocus upon the Trust's compliance with the 42 Core targets and 8 New National Targets (NB - still awaiting measurement parameters from HCC)

6Deliver Value for Money

AIncludes all the "VFM" ALE targets. Working with new External Auditors regarding improvements in VFM.Focus upon embedding a more robust performance management framework.

7

Improve Communication & Engagement (internal & external)

GIncludes process for improving both internal & external communications.The Trust has developed and is implementing a Communications & Engagement Strategy and has already commenced a wide scale staff engagement programme led by the Chief Executive.

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Performance Improvement Plan – Cat A8 Performance Nationally

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Performance Improvement Plan – East of England Cat A8 & Cat B Cumulative Performance

Christmas & New Year

Christmas & New Year

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2008/09 Healthcare Commission

Self Assessment

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2008/09 HCC Self Assessment

Area Sub Sections Number 2008/09

Quality of Resources

Core Standards 42 Criteria Partly Met

Existing National Targets 4 Targets Partly Met

New National Targets 7 Targets TBC

Use of Resources(Auditors’ Local Evaluation (ALE))

1 Financial Reporting 2 KLoEs Performing Well

2 Financial Management 3 KLoEs Adequate Performance

3 Financial Standing 1 KLoEs Performing Well

4 Internal Control 3 KLoEs Adequate Performance

5 Value for Money 4 KLoEs Adequate Performance

Area 2008/09

Quality of Services FAIR

Use of Resources FAIR

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h2008/09 HCC ‘Quality of Service’ Self AssessmentCore Targets Predicted Overall Score – “PARTLEY MET”

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Patient Safety 2008/09

C01a – Incidents - reporting & learning In Ass

C01b - Safety alerts Comp

C02 - Safeguarding children NM

C03 – NICE Intervention procedures Comp

C04a - Infection control In Ass

C04b - Safe use of medical devices NM

C04c – Decontamination In Ass

C04d - Medicines mgt In Ass

C04e - Clinical waste Comp

Clinical & cost effectiveness

C05a - NICE technology appraisals Comp

C05b - Clinical supervision Comp

C05c - Updating clinical skills Comp

C05d - Clinical audit & review Comp

C06 - Partnership Comp

Accessible & Responsive Care 2008/09

C17 - Patient & public involvement Comp

C18 - Equity, choice Comp

C19 – Access N/A

Care Environ & Amenities

C20a - Safe, secure environ Comp

C20b - Privacy and confidentiality Comp

C21 - Clean, well designed environment Comp

Public health

C22a & c - Public health partnerships Comp

C22b - Local health needs Comp

C23 - Public health cycle Comp

C24 - Emergency preparedness Comp

Governance 2008/09C07a and c – Governance In AssC07b - Honesty, probity CompC07e – Discrimination In AssC08a - Whistle-blowing CompC08b - Personal development In AssC09 - Records management In AssC10a - Employment checks CompC10b - Profes codes of conduct CompC11a - Recruitment and training CompC11b - Mandatory training CompC11c - Professional development CompC12 - Research governance Comp

Patient focusC13a - Dignity and respect CompC13b – Consent CompC13c - Confidentiality of information CompC14a - Complaints procedure CompC14b - Complainants discrimination CompC14c - Complaints response In AssC15a&b - Food provision & needs N/AC16 - Accessible information Comp

Comp – Compliant, In Ass – Insufficient Assurance, NM – Not Met, N/A – Not Applicable

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2008/09 Self Assessment – Existing National Targets – C19 Access

Target FOT Rating Points Achieved Not Met

1 Category A8 73.8% Under Achieved 2 >=75% <70%

2 Category A19 95% Achieved 3 >=95% <90%

3 Category B19 93.03% Under Achieved 2 >=95% <85%

4a Thrombolysis Call to Needle <60 min**

70% AchievedUnder

Achieved2

>=68% <48%

4b Data Completeness MINAP Data Under Achieved >=80% TBC

OVERALL RATING PARTLY MET 9

During December 2008 and January 2009, the Trust was ranked in the top 4 nationally for Cat A8

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2008/09 Self Assessment – C19 – Access COMPLIANT

• 24/48 hr primary care access (GMS)• OOH National Quality Requirements• Call Connect/national ambulance targets for call pick

up, identification of life threatening conditions and response:– Cat A – 8 / 19 minutes– Cat B – 19 minutes– Cat C – locally agreed (45 minutes)

• Stroke, MI, Asthma, Stroke (FAST), thrombolysis, PCI

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2008/09 Self Assessment – C22a&c – Public Health Partnerships COMPLIANT

• All audits and surveys sent to Expert Strategic Clinical Group for monitoring and actions

• Trust public health lead sits on this group• Links with Directors of Public Health• Local cancer networks engaged to improve patient

pathways• Stroke pathway

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2008/09 Self Assessment – New National Targets

New National Targets 2008/09

1 Management of Stroke and TIA TBC*

2 Management of Hypoglycaemic Attacks TBC*

3 Management of Asthma TBC*

4 Management of Patients with Cardiac Arrest TBC*

5 Management of acute Myocardial Infarction TBC*

6 Repair & Safe Environment of Ambulances N/A - Withdrawn

7 Experience of Patients TBC

8 NHS Staff Satisfaction TBC

OVERALL RATING (DEFAULT) TBC

* Clarification required re scoring matrix and definition of indicators which make up the targets.

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Conclusions

• Deliver, as a minimum, a Fair/Fair HCC score• Future direction:

– Knowledge Management / Business Intelligence (ePCR)– Directory of Service (DoS)– Single Point of Contact (SPoC)

• Ruthlessly monitor and drive delivery, holding individuals to account

• Report weekly to the SHA• Prioritise our objectives and embed risk management• Implement a robust performance management framework• Enhance financial management & accountability