Leeds West CCG Governing Body Meeting

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Agenda Item: LW2015/41 FOI Exempt: N

Leeds West CCG Governing Body Meeting

Date of meeting: 6 May 2015

Title: Integrated Quality & Performance Report (IQPR) – April 2015

Lead Governing Body Member: Sue Robins, Director of Commissioning, Strategy & Performance / Diane Hampshire, Director of Quality & Nursing

Category of Paper Tick as

appropriate

()

Report Author: Various

Decision and Approval

Reviewed by SMT: N/A

Information

Reviewed by Assurance Committee: 1 April 2015

Discussion

Checked by Finance: N/A

Approved by Lead Governing Body member (Y/N): Y

Strategic Objectives – that this report relates to Tick as appropriate

() 1. To tackle the biggest health challenges in West Leeds, reducing health

inequalities

2. To transform care and drive continuous improvement in quality and safety

3. To use commissioning resources effectively

4. To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can

Joint Health & Wellbeing Strategy Outcomes – that this report relates to

Tick as appropriate

() 1. People will live longer and have healthier lives

2. People will live full, active and independent lives

3. People will enjoy the best possible quality of life

4. People are involved in decisions made about them

5. People will live in healthy and sustainable communities

Assurance Framework - to which risks on the GBAF does this report relate?

Ref. 1A: Sub-Optimal Quality Provider Ref. 1B: Sub-Optimal Quality Primary Care

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KEY MESSAGES

1. This report accompanies the IQPR dashboard and provides the latest information on the quality and performance of services being commissioned for our patients against a range of metrics.

2. Several new dashboards have been incorporated this month, including a dashboard for Urgent care, medicines optimisation and the CSU.

3. This IQPR cover paper highlights specific areas for information and associated assurance, it is focussed on action and mitigation.

4. The report provides assurance to the organisation that we are delivering against the requirements of the NHS Mandate and Constitution which embed the priorities of our local populations.

5. The report provides a number of dashboards giving a high level view of how the CCG is progressing in delivering is strategic objectives alongside how each of the sectors (acute, primary care, community and mental health) are performing/contributing to the delivery of our objectives. The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.

6. Future reports will detail how providers are delivering against quality improvement plans and cost improvement schemes, to assure the organisation that financial constraints are not adversely affecting care quality and patient experience.

7. Additional metrics will be added to support monitoring of delivery of the City Wide Strategic Plan and use of the Better Care Fund when plans are finalised

Where provider performance falls below expected standards, remedial action and action plans will be described in the narrative.

The Governing Body is asked to: (a) RECEIVE the IQPR.

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Performance Area Actions Responsible Body

Lead Manager Projected Timescale to Delivery

A&E 4hr Emergency Care Standard (ECS)

The Strategic Urgent Care Board (SUCB), hosted by leeds North CCG continues to oversee city-wide actions to reduce delays and support diversion, with additional funding being made available through the national Strategic Resilience Funding.

SUCB Debra Taylor Tate (Leeds North CCG (LNCCG))

Expected to maintain achievement of ECS by July 2015

Ambulance Targets Leeds North CCG continues to work with the Yorkshire Ambulance Service (YAS) through contract management board to support delivery of the Ambulance targets. Handover times in A&E can be an issue when A&E is busy. LNCCG has an action plan with YAS regarding the 8 and 15 minute response times.

SUCB Debra Taylor Tate (LNCCG )

Not known

Referral to Treatment Time (RTT)

Waiting times for first outpatient appointments are now monitored on a monthly basis at the Elective Care working group with Leeds Teaching Hospitals NHS Trust (LTHT). LTHT have also commenced a review of productivity in outpatients. Standards in outpatients are also the subject of a Transformation Board Elective care work-stream project. Given the deterioration in the LTHT position, the contract management board has requested an updated recovery plan. LTHT has also raised concerns about the substantial increase in referral demand in some key specialties, and the ability to create sufficient capacity. Detailed performance monitoring of LTHT actions and delivery through Elective Care Performance meeting. LTHT has been asked to refresh the plans for those

APMG Helen Lewis (Leeds West CCG (LWCCG))

July 2015

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specialties which are not reducing the numbers of patients delayed for follow-ups. There have been significant improvements in gastroenterology and colorectal surgery but deterioration in other specialties, including dental specialties. Where possible, the CCG is supporting work on redesigning these pathways to minimise unnecessary demand and a joint workshop is scheduled for March to share best practice and drive further improvements. In March 2013 there were 7500 patients with a delayed follow up. In September this had fallen to 5000.

Cancelled Operations We continue to work with LTHT to minimise the requirement for late cancellations of surgery. This is monitored through the Elective Care Group.

Elective Care Group

Helen Lewis (LWCCG)

Ongoing

Audiology The percentage of patients waiting over 18 weeks at the end of November has now reduced substantially and improvements are ongoing with further additional capacity in place in LTHT in Quarter 4. The CCG has completed its procurement for ENT and hearing loss services to further increase capacity and choice.

Acute Provider Management Group (APMG)

Helen Lewis (LWCCG)

Completed

Cancer The city has developed a Leeds Integrated Cancer Services Steering Group. This is underpinned by a vision to develop a comprehensive cancer centre in Leeds, with primary and secondary care working together. The breast diagnostic pathway is the first pathway to be part of the Leeds Integrated Cancer Service review programme. The city-wide group is reviewing the potential implications on demand and capacity of the draft NICE guidelines which will

APMG Helen Lewis (LWCCG)

July 2015

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increase demand on diagnostics and on 2 week wait referrals for some pathways. The LWCCG position has been partly impacted on by work at LTHT to increase capacity and treat as many of the longest waiters as possible. Detailed improvement plans for Cancer have been submitted to the LTHT Trust Board and a Leeds integrated cancer service has now been established to ensure that all plans are developed and delivered. LTHT cannot guarantee delivery of the overall 62 day standard without an improvement in the number of late referrals from District General Hospitals. LTHT has met with each of the referring units and asked them to supply improvement plans to support this improvement, and there is also focus on this from the Cancer Network. The deterioration in the 31 day position is due to pressure on beds. Key Actions:

LTHT addressing capacity and pathway constraints in thoracic surgery, gynaecology and urology and in critical care.

CCG will continue to press commissioners to ask them to include minimum waits for cancer pathways that cross between providers in quality requirements for their own providers to help lever improved performance.

Regional work ongoing re late referrals.

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Cancer recovery plan in place monitored through the cancer steering group, and also through the APMG.

Healthcare Associated Infections (HCAI)

There have been no cases of MRSA bacteraemia since December 2014. Analysis of the most recent LTHT cases concluded that none of the cases were linked via ward area or staff. As MRSA bacteraemia is subject to a zero tolerance approach, this indicator will remain highlighted as red for both LTHT and Leeds Community Healthcare (LCH) until data from the new financial year is available (mid May). LTHT reported 121 cases of Clostridium difficile infection in 2014-15. This was within their annual threshold of 127 cases and does not include those which were agreed with commissioners as not associated with any lapse in care. LCH reported 3 cases of Clostridium difficile in 2014-15; these are under review by commissioners to determine if they were associated with any lapse in care. As a community Trust the organisation is not subject to a national threshold. One case of MRSA bacteraemia was reported by the organisation in 2014-15 and was related to poor urinary catheter management.

Quality Group Russell Hart Davies (LWCCG)

N/A

Stroke Care A recovery action plan has been implemented for stroke care and actions to improve and sustain performance are monitored internally through operational delivery meetings with the Clinical Service Unit. The action plan contains points on levels of rehab,

Elective working group

Catherine Foster (LWCCG)

Sept 2015

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TIA services, Early supported discharge and access to community services and discharge services. Stroke indicators are monitored via the joint monthly Leeds CCGs/LTHT Quality Group; specific feedback given at the most recent meeting is as follows:

- LTHT has centralised the majority of stroke beds at the LGI in improved accommodation

- The Trust is now providing patient data to the Stroke Association to initiate a 6 month follow up assessment for stroke patients.

- The Trust continues work to improve the proportion of patients scanned within 1 hour

- A business case has been put forward for additional psychology staffing

- Speech and language and occupational therapist staffing levels are improving

- A patient and carer forum is in development specifically for stroke services

Pressure Ulcers Performance continues along an overall improvement trajectory in line with LTHT’s extensive programme of work. March data from the Patient Safety Thermometer shows that LTHT had lower numbers of both newly acquired and existing pressure ulcers than the national average. Numbers of pressure ulcers and progress of the CQUIN continue to be monitored at the joint monthly Leeds CCGs/LTHT Quality Group. At the time of last reporting the Trust were on target to achieve a hospital

Quality group

Russell Hart Davies (LWCCG)

CQUIN delivery March 2015 (submission awaited)

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acquired pressure ulcer incidence of 0.6% of adult and paediatric inpatient admissions by March 2015. Work to reduce the citywide prevalence of Pressure ulcers will remain a key element of the 2015-16 local quality incentive scheme.

Leeds Community Healthcare: March pressure ulcer data shows a reduction in the number of new pressure ulcers, though LCH remain slightly above the national average. The 2014/15 CQUIN supporting a 40% reduction of all pressure ulcers was not achieved; this is thought to be due to the increase in awareness resulting in improved reporting. Partnership working is now established through a joint strategic group involving community and acute healthcare and the care home economy. These groups are progressing work relating to: Training for support staff and Allied Health

Professionals Understanding data to better identify the origin of

reported pressure ulcers Implementation of a citywide screening and

assessment tool A citywide awareness campaign Increasing patient and public representation A number of actions are in also place to reduce newly acquired pressure ulcers in LCH patients e.g.: • Mandatory pressure ulcer training • Comprehensive review of the failures associated with development of pressure ulcers e.g. training, record keeping, equipment provision, skin inspection and early intervention

LCH Quality Group

Russell Hart Davies (LWCCG)

Varying timescales as per citywide action plan

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• Timely root cause analysis so that learning is implemented sooner • Implementing new leadership structure across adult services with clearer lines of accountability and responsibility for the quality of pressure ulcer prevention and management Pressure Ulcer incidence and performance against action plans and CQUIN indicators are monitored via Leeds CCGs and LCH Quality Meeting. Reports for those pressure ulcers reported as serious incidents are reviewed at the monthly Leeds CCGs Serious Incident review panel.

Patient Experience End of Life Care – preferred place of death

Leeds Community Healthcare: Delivery against the target remains a focus within Adult services. There have been significant data collection problems. Key Actions:

• The Clinical Leads for the District Nursing service are supporting work to ensure reporting accuracy. • Work is ongoing to ensure coordination of care is prioritised. • Continued focus on ensuring improvements in the recording onto SystmOne with feedback provided in consistent cases of missing information.

Quality group Russell Hart Davies (LWCCG)

Serious Incidents and Never Events

Serious incidents (SIs) and never events are discussed at the joint monthly Leeds CCGs/LTHT Quality Group. Completed root cause analysis reports for SIs and never event reports are reviewed at the monthly Leeds CCG Serious Incident Review Panel meeting. There were 7 serious incidents in LTHT in February; 4


N/A

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of these were category 3 or 4 pressure ulcers. The remainder were falls resulting in harm. Two never events occurred in March (both retained swabs) and therefore are not included in the dashboard; an investigation into this has commenced. A second Never Event Assurance and Challenge meeting will be held in May to enable LTHT to demonstrate learning and provide assurance about improvement in their patient safety processes resulting from these incidents.

Staffing The CCG is assured that LTHT has a robust mechanism in place for identifying areas where staffing may be an issue, and responding quickly and appropriately. Over 400 band 5 nurses have now begun employment across the Trust following a recruitment programme in 2014; when taking leavers into account this has resulted in a net gain of 224 WTE nurses. Regular reports regarding staffing are received at the LTHT Trust Board and are reviewed by the CCG Quality Team. LTHT’s programme of recruitment continues. Staffing data is reviewed as a standing agenda item at the joint CCG/LTHT Quality Meetings.


Ongoing

GP Cancer Referrals This indicator is also monitored at practice level as part of the Primary Care Assurance Framework. Each practice receives a quarterly practice MOT containing referral data and their practice performance profile. These will be enhanced in 2015 to incorporate referral and activity costing data. The Locality Team will work closely with NHS England and GP practices through the Primary Care Assurance

APMG Kirsty Turner (LWCCG)

March 2016

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Framework to address any areas that can be improved.

IAPT The service has a recovery task group. It continues to review current performance and the reasons behind the current under performance against the KPIs. Telephone screening – the service has identified the need to re-focus on ensuring the telephone screening is both as effective as possible and operating at sufficient volume to meet incoming demand. Work to date has been very effective in reducing wastage of referrals before and after screening. However due to staffing problems (detailed below) it has not been operating to its full potential in terms of volume. The aim is to increase the number of screenings each week, which will have a subsequent positive impact on the KPIs. Staffing capacity - A key focus of the recovery plan has been to employ temporary Psychological Wellbeing Practitioners (PWPs) to ensure there is enough capacity across the whole IAPT system. Unfortunately throughout October it has been difficult maintaining a full complement of staff due to staff sickness, turnover and recruitment challenges. This has meant that to date the service has not been operating to its full capacity. Unused seminar capacity - Another focus of the recovery plan has been to promote the seminars and classes at step 2 as there is unused capacity in these interventions despite evidence demonstrating that outcomes are just as effective as 1:1 interventions. We

Community Provider Management Group (PMG)

Jane Bathgate Roche (LWCCG)

March 2016

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are now promoting seminars as a preferred treatment option to all those appropriate for seminars with revised service protocols, renewed staff briefings, and staff training. Fully utilising this treatment option will be the only way targets will be met in future. Referrals – The 8 week marketing campaign is underway for Leeds IAPT. The campaign has included advertisements in and on buses, at train stations, door drops, radio commercials and online marketing.

CAMHS Additional capacity has been contracted to help deliver wait times within 18 weeks by the end of March 2015. The emotional mental review has completed and recommendations accepted by the Integrated Commissioning Executive.

Community PMG

Jane Bathgate Roche (LWCCG)

March 2016

Leeds and York Partnership NHS Foundation Trust (LYPFT) Complaints Response Times

Complaints management by LYPFT was highlighted as a ‘must do’ area for improvement by the Care Quality Commission (CQC). As a result the following actions have been developed: Review of the complaints policy Improve availability of information for service users or

their advocates on how to raise a complaint, comment, compliment or concern – including via information on website

Raise staff awareness of the above Streamline the complaints process to remove

bottlenecks and include an escalation process. Include within this:

o Improved allocated investigator process

Quality group Russell Hart Davis (LWCCG)

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o Provision of named contacts o Severity assessment o Tailored resolution timelines o Locally managed processes

Improving the mechanisms for recording complaints and ‘lessons learnt’ including using Datix and keeping a cumulative action plan.

Review internal training for complaints handling Performance regarding complaints will be highlighted at the Leeds CCGs and LYPFT Quality Meeting led by Leeds North CCG.

Satisfaction with Primary Care

Between February and March (to date), the following comments were received via NHS choices:

40% of comments relate to access / appointments

47% of comments relate to general care at the surgery

13% of comments relate to communication at the practice

47% of comments relate to positive experiences of care, particularly with regard to accessing services

There is a pattern of comments from particular surgeries which is being addressed through visits with the locality manager.

Primary care development steering group

Kirsty Turner (LWCCG)

March 2016

Documents

Leeds West CCG Governing Body Meeting