March 2017 Incomplete - Nottingham North · NHS Nottingham North & East G Monthly Quality & Performance ReportRTT March 2017 Summary (Pages 1 to 2) Key Issues and oncerns Improvement

1

The table above displays a current view of performance against a range of standards for Nottingham North & East, Nottingham West and Rushcliffe Clinical Commissioning Groups. Indicators where a national standard has not been defined are not traffic lighted. A summary of key issues and concerns can be found overleaf.

NHS Nottingham North & East CCG Monthly Quality & Performance Report

March 2017

Summary (Pages 1 to 2) Key Issues and Concerns

Improvement and Assessment

Framework (Page 3 to 7)

CCG Improvement and Assessment

Framework

Level 1 (Page 8 to 12) Summary of CCG Performance

Level 2 (Page 13 to 43) Summary of Provider Performance

Quality Premium (Page 44) CCG Quality Premium

BCF (Page 45 to 48) Better Care Fund

The above table displays the standards contained within the CCG Improvement and Assessment Framework where either one or more of the South Nottinghamshire CCGs are currently performing within the lowest quartile. Commentary relating to these standards is contained within the IAF section of this performance report.

CCG Improvement and Assessment Framework - Lowest Quartiles

NNE NW Rush

CancerPeople with urgent GP referral having first definitive treatment for cancer

within 62 days of referralQ2 16/17 H 82.3% 73.4% 82.6% 80.2%

Reliance on specialist inpatient care for people with a learning disability

and/or autism (per 1 million pop.)Q2 16/17 L 84 84 84

Neonatal mortality and stillbirths (per 1000 births) 2014 L 7.1 3.1 9.1 2.9

Choices in maternity services 2015 H 62.8 61.6 64.8

Urgent & Emergency

Care

Achievement of milestones in the delivery of an integrated urgent care

serviceAug-16 H 1 1 1

Urgent & Emergency

Care

Percentage of patients admitted, transferred or discharged from A&E within

4 hoursNov-16 H 88.4% 81.7% 81.4% 79.8%

Primary Medical

CarePrimary care access Q3 16/17 H 0.0% 0.0% 0.0%

BE

TT

ER

CA

RE

Learning Disability

Maternity

Lowest Quartile

Theme Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Area Indicator Standard NNE NW Rush NNE NW Rush

4 Hour Standard % Achievement - A&E and Eye Cas 95% Jan-17 81.80% 81.06% 82.00% 82.11% 81.01% 81.47%

Left without being seen 5% Jan-17 2.82% 2.56% 2.28% 3.30% 2.87% 3.10%

Unplanned Re-attendance rate 5% Jan-17 0.84% 1.05% 0.97% 0.83% 0.87% 1.05%

Time to initial assessment (95th percentile) 15 mins Jan-17 01:10 01:12 01:10 01:10 01:13 01:11

Time to treatment decision (median) 60 mins Jan-17 00:48 00:52 00:46 00:43 00:47 00:42

Time to departure (admitted) (95th percentile) 4 hours Jan-17 12:24 11:52 12:15 12:11 12:04 12:12

Time to departure (non-admitted) (95th percentile) 4 hours Jan-17 05:04 05:17 05:04 05:06 05:12 05:11

Time to departure (admitted & non-admitted) (95th percentile) 4 hours Jan-17 08:06 08:24 08:17 07:42 07:57 07:56

Cancer 2ww 93% Jan-17 93.02% 94.57% 93.03% 93.47% 94.80% 94.47%

Cancer 31d DTT 96% Jan-17 95.59% 97.87% 100.00% 95.43% 95.53% 95.18%

62d Urg RTT 85% Jan-17 70.97% 78.26% 92.59% 79.76% 81.44% 83.49%

Cancer 2ww - Breast Symptoms 93% Jan-17 95.83% 95.65% 100.00% 96.41% 94.87% 89.11%

Diagnostics % patients waiting longer than 6 weeks 1% Jan-17 0.40% 0.62% 0.16% 0.47% 0.33% 0.34%

Red 1 calls responded to within 8 minutes 75% Jan-17 67.74% 64.10% 66.67% 66.98% 63.88% 59.90%




MRSA 0 Jan-17 0 0 0 3 0 1

C-Diff - YTD standard: NNE=47 NW=21 Rush=24 <<< notes Jan-17 3 0 1 31 12 31

Admitted % 90% Jan-17 81.77% 82.29% 82.98% 86.71% 85.57% 84.21%

Non-Admitted % 95% Jan-17 95.52% 96.21% 96.26% 96.11% 95.92% 95.62%

Incomplete % 92% Jan-17 95.21% 95.26% 94.74% 95.83% 95.27% 95.27%

Incomplete number of 52 week waiters 0 Jan-17 1 0 0 6 0 1

Care Programme Approach: 7 day follow up 100% Q3 2016-17 100% 100% 100% 97% 96% 100%

Crisis Resolution Home Treatment: Gate kept by CR Teams 100% Q3 2016-17 100% 100% 100% 100% 100% 98%

IAPT IAPT - Standard: NNE = 3.76% NW = 3.76% Rush = 3.76% <<< notes Dec-16 1.26% 1.24% 1.42% 4.56% 4.69% 5.08%

Treated within two weeks % 100% Jan-17 50.00% 50.00% 100.00% 58.06% 55.00% 73.91%

Incomplete waiting less than two weeks % 100% Jan-17 0.00% 0.00% 0.00% 50.00% 41.18% 44.44%

Dementia Dementia Diagnosis Rate 67% Jan-17 70.38% 74.64% 78.56%

YTD

A&E

Cancer

Waiting

Times

Latest

data

period

RTT

Ambulance

HCAIs

Latest period dataCCG Performance Snapshot

EIP

Mental

Health

2

Summary – Key issues and concerns

CCG Improvement and Assessment Framework CCG performance against IAF indicators is available on pages 3-6. Individual CCG’s performance against IAF Mental Health Transformation areas is shown on page 7.

CCG Indicators out of trajectory - Cancer (page 8) – Performance for January 2017 highlights that Nottingham North & East CCG is below standard

for the following pathways - 62 Day Urg RTT (70.97% against a standard of 85%) 31 Day DTT (95.59% against a standard of 96%) 31 Day DTT - Subs: Surgery (90.91% against a standard of 94%)

A&E (Page 11) – Nottingham North & East CCG failed to achieve the A&E standard for January 2017 with performance at 74.11% against a standard of 95%

NUH Indicators out of trajectory -

Cancer (Page 13-14) – The following pathways failed to meet their respective standards during January 2017 -

62 Day Urgent RTT - 74.01% (standard = 85%)

31 Day DTT - Subs: Surgery - 91.46% (standard = 94%)

2 Week Wait: Breast Symptoms - 91.41% (standard = 93%) A&E (Page 16-17) – February 2017 A&E performance was below standard at 78.71% A&E 12 Hour Trolley Wait (Page 17) - NUH experienced 2 breaches of the A&E 12 hour trolley wait standard in

January 2017 Cancelled Ops (Page 18) - NUH breached the Cancelled Ops standard in January 2017 with 0.81% of elective

operations cancelled against a standard of 0.80% Appointment Slot Issues (Page 19) - NUH had a ratio of 0.16 slot issues per successful booking in December 2016

which is a breach of the 0.04 standard Ambulance Handovers (Page 21) - Performance for January 2017 shows that 978 handovers took longer than 30

minutes and 140 exceeded 60 minutes. This is against a standard of 0 Venous Thromboembolism (Page 21) - December 2016 performance shows that 94.15% of eligible patients were

assessed for VTE within 24 hours which is below the 95% standard Pressure Ulcers (Page 23) - NUH failed to meet the standard for the reduction of grade 4 pressure ulcers in January

2017 Falls (Page 23) - January 2017 performance for falls was above the threshold of 0.98 with 1.00 falls per 1000

occupied bed days resulting in harm at NUH SFHT (Page 25-26) - Sherwood Forest performance is available on pages 25-26

Circle (Page 27-31) - Circle performance is available on pages 27-31

NHCT (Page 32-34) - Nottinghamshire Health Care Trust performance is available on pages 32-34

EMAS (Page 35-40) – Red 1 and Red 2 performance remains below standard for the 8 and 19 minute targets. Comparative

performance and outcomes across ambulance trusts is shown on pages 39 & 40

Arriva (Page 41) - Performance for Arriva patient transport services is now available

NHS 111 (Page 42-43) – Performance is available for the key NHS 111 indicators

Quality Premium (Page 44) - Performance against the quality premium is summarised for the CCG

Better Care Fund (Page 45-48) - BCF monitoring at Nottinghamshire County Local Authority Level

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CCG Improvement and Assessment Framework

The table above shows how each CCG is performing for the IAF indicators within the Better Health section. None of the three CCGs are currently within the lowest quartile nationally for any of these indicators.

The table above shows how each CCG is performing for the IAF indicators within the Sustainability section.

Lowest Quartile


The CCG Improvement and Assessment Framework (IAF) is intended to align key national objectives and priorities whilst providing a focal point for joint work, support and dialogue between NHS England and CCGs.

The IAF is a tool with which to measure CCG performance against the “triple aim” outlined by NHS England. These aims are:

1. Improving the health and wellbeing of the whole population 2. Better quality for all patients, through care redesign 3. Better value for taxpayers in a financially sustainable system Below is how the three South Nottinghamshire CCGs are presently performing against the indicators within the IAF and also how their performance compares against the average for England. There are no fixed targets to meet within the IAF, rather the focus is that CCGs meet and perform beyond the expectations that are relative to their individual positions.

NNE NW Rush

Smoking Maternal smoking at delivery Q2 16/17 L 10.4% 11.6% 9.7% 5.2%

Child Obesity Percentage of children aged 10-11 classified as overweight or obese 2014/15 L 33.2% 31.4% 31.2% 21.1%

Diabetes patients that have achieved all the NICE recommended treatment

targets: Three for adults and one for children2014/15 H 39.8% 37.8% 39.7% 40.1%

People with diabetes diagnosed less than a year who attend a structured

education course2014/15 H 5.7% 7.0% 8.3% 4.1%

Falls Injuries from falls in people aged 65 and over (per 100,000 pop.) Jun-16 L 1985 2258 2145 2044

Utilisation of the NHS e-referral service to enable choice at first routine

elective referralSep-16 H 51.1% 95.4% 88.7% 101.6%

Personal health budgets (per 100,000 pop.) Q2 16/17 H 18.7 8.6 8.4 8.0

Percentage of deaths which take place in hospital Q1 16/17 <> 47.1% 51.6% 50.9% 44.8%

People with a long-term condition feeling supported to manage their

condition(s)2016 H 64.3% 66.1% 70.1% 65.4%

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive

conditionsQ4 15/16 L 929 958 759 800

Inequality in emergency admissions for urgent care sensitive conditions Q4 15/16 L 2168 1943 1798 1520

Anti-microbial resistance: appropriate prescribing of antibiotics in primary

careSep-16 <> 1.1 1 0.9 0.90

Anti-microbial resistance: Appropriate prescribing of broad spectrum

antibiotics in primary careSep-16 <> 9.1% 10.6% 9.0% 8.6%

Carers Quality of life of carers 2016 H 80.0% 82.2% 79.3% 83.7%

Anti-microbial

Resistance

Health Inequalities

BE

TT

ER

HE

ALT

H

Diabetes

Personalisation and

choice


Latest

Data

Period

EnglandPerformanceBetter Is

(H/L)

NNE NW Rush

Financial plan 2016 <> GREEN GREEN GREEN

In-year financial performance Q2 16/17 <> AMBER GREEN GREEN

Outcomes in areas with identified scope for improvement Q2 16/17 H Not Incl. Not Incl. Not Incl.

Expenditure in areas with identified scope for improvement Q2 16/17 H Not Incl. Not Incl. Not Incl.

Local digital roadmap in place Q3 16/17 <> YES YES YES

Digital interactions between primary and secondary care Q3 16/17 H 73.1% 67.8% 69.0%

Estates Strategy Local strategic estates plan (SEP) in place 2016-17 YES YES YES

Better Is

(H/L)Theme Area Indicator Name

Latest

Data

Period

England

Paper-free at the

point of care

SU

ST

AIN

AB

ILIT

Y

Financial

sustainability

Allocative efficiency

Performance

4


The table above shows how each CCG is performing for the IAF indicators within the Better Care section. Nottingham North & East CCG are in the lowest quartile nationally for five of these indicators. Further information relating to underperformance of these indicators can be found overleaf.

Lowest Quartile

The table above shows how each CCG is performing for the IAF indicators within the Well Led section.

NNE NW Rush

Probity & corporate

governanceProbity and corporate governance Q2 16/17 H

Fully

Complia

Fully

Complia

Fully

Complia

Staff engagement index (1 to 5 - 5 good) 2015 H 3.8 3.9 3.9 3.9

Progress against workforce race equality standard (0 = equality) 2015 L 0.2 0.2 0.2 0.2

CCGs’ local

relationshipsEffectiveness of working relationships in the local system 2015/16 H 71.8% 81.5% 84.1%

Quality of leadership Quality of CCG leadership Q2 16/17 <> GREEN GREEN GREEN

Better Is

(H/L)Indicator Name

Latest

Data

Period

EnglandPerformance

WE

LL L

ED Workforce

engagement

Theme Area

NNE NW Rush

Care Ratings Provision of high quality care Q3 16/17 H 62 64 63

Cancers diagnosed at early stage 2014 H 50.7% 52.1% 57.4% 51.7%

People with urgent GP referral having first definitive treatment for cancer


One-year survival from all cancers 2013 H 70.2% 69.6% 69.0% 71.0%

Cancer patient experience 2015 H 87.0% 89.0% 87.3% 86.8%

Improving Access to Psychological Therapies recovery rate Sep-16 H 48.4% 56.2% 55.4% 63.8%

People with first episode of psychosis starting treatment with a NICE-

recommended package of care treated within 2 weeks of referralNov-16 H 77.2% 78.6% 77.8% 100.0%

Children and young people’s mental health services transformation Q2 16/17 H 75.0% 75.0% 75.0%

Crisis care and liaison mental health services transformation Q2 16/17 H 52.5% 52.5% 52.5%

Out of area placements for acute mental health inpatient care -

transformationQ2 16/17 H 87.5% 87.5% 87.5%


and/or autism (per 1 million pop.)Q2 16/17 L 84 84 84

Proportion of people with a learning disability on the GP register receiving an

annual health check2015/16 H 37.1% 33.9% 41.6% 35.0%


Women’s experience of maternity services 2015 H 82.2 77.4 77.4


Estimated diagnosis rate for people with dementia Nov-16 H 68.0% 70.7% 74.0% 80.0%

Dementia care planning and post-diagnostic support 2015/16 H 81.5% 80.3% 80.8%



Emergency admissions for urgent care sensitive conditions (per 100,000

pop.)Q4 15/16 L 2359 2145 2232 1621


4 hoursNov-16 H 88.4% 81.7% 81.4% 79.8%

Delayed transfers of care per 100,000 population Nov-16 L 15.0 7.8 6.3 8.2

Population use of hospital beds following emergency admission (days per

1000 pop.)Q1 16/17 L 1.0 1.10 1.1 1.0

Management of long term conditions (emergency admissions per 100,000

pop.)Q4 15/16 L 795 773 776 563

Patient experience of GP services H1 2016 H 85.2% 84.3% 89.9% 88.2%

Primary care access Q3 16/17 H 0.0% 0.0% 0.0%

Primary care workforce (FTE per 1000 weighted patients) H1 2016 H 1 1.1 0.93 1.33

Elective Access Patients waiting 18 weeks or less from referral to hospital treatment Nov-16 H 90.6% 95.7% 95.8% 95.8%

NHS Continuing

HealthcarePeople eligible for standard NHS Continuing Healthcare (per 50,000 pop.) Q2 16/17 <> 46.2 48.4 36.2 41.1

Better Is

(H/L)

Performance

Mental Health


Latest

Data

Period

England

BE

TT

ER

CA

RE

Cancer

Primary Medical

Care

Dementia

Urgent & Emergency

Care

Learning Disability

Maternity

5


Nottingham North & East CCG was in the lowest quartile nationally in Quarter 2 of 2016-17 for Reliance on specialist inpatient care for people with a learning disability and/or autism (per 1 million pop.) Rather than individual CCGs being measured, the performance of the Nottinghamshire Transforming Care Partnership is assessed as a whole. The footprint of this organisation encompasses 7 CCGs, 2 Local Authorities, and NHS England Specialised Commissioning. Performance across the cluster has improved from the Quarter 1 of 2016-17 position of 87 people with a learning disability and/or autism (per 1 million population) relying on specialist inpatient care. Trajectories have been agreed with the area team to improve performance to 57 people by the end of 2017/18 and to 36 people come the end of 2018/19. Actions are being taken to ensure this trajectory is met. These include:

Commissioners continuing to liaise regularly with inpatient units and other members of the multi-disciplinary team to expedite discharges where this is clinically indicated.

Commissioners continuing to carry out blue light reviews as necessary with the aim of avoiding admissions where possible or expediting discharge.

A new City and County wide Care and Treatment Review service with new enhanced specification has been commissioned. This started on the 2nd of January.

Meetings are taking place to finalise the Intensive Community Assessment and Treatment Team service which will be in place by quarter 1 of 2017/18.

Nottingham North & East CCG was in the lowest quartile nationally in August 2016 for the Achievement of milestones in the delivery of an integrated urgent care service. This performance is shared across the three South Nottinghamshire CCGs. There are 8 key elements to achieving fully Integrated Urgent Care services. These are:

A single call to get an appointment Out of hours Data can be shared between providers The capacity for NHS 111 and Out of hours is jointly planned The Summary Care Record (SCR) is available in the hub and elsewhere Care plans and special patient notes are shared Appointments can be made to in-hours GPs There is joint governance across Urgent and Emergency Care Suitable calls are transferred to a Clinical Hub containing GPs and other health care professionals.

The three South Nottinghamshire CCGs have consistently been within the lowest national quartile for the percentage of patients meeting the 4 hour A&E waiting time target. This is because most people attending A&E from Nottingham North & East CCG, Nottingham West CCG, and Rushcliffe CCG present at Nottingham University Hospitals which has continually struggled to meet high overall demand and therefore performs below standard. Further information relating to issues affecting A&E at NUH can be found within Level 2 of the performance report on pages 16 and 17.

All three South Nottinghamshire CCGs scored 0% when measured on the ability of their practices to offer full provision for pre-bookable appointments on Saturdays and Sundays, plus on each weekday for at least 1.5 hours either before 8am or after 6pm. However, in Quarter 3 of 2016/17 some practices within the three CCGs were able to offer partial provision. 50% of Nottingham North & East CCG practices, and 75% of Nottingham West CCG and Rushcliffe CCG practices were able to offer partial provision of access to pre-bookable appointments either at weekends or early mornings and evenings during the week.

NNE NW Rush


and/or autism (per 1 million pop.)Q2 16/17 L 84 84 84Learning Disability

Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

NNE NW Rush

Urgent & Emergency

Care



Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

NNE NW Rush

Urgent & Emergency

Care


4 hoursNov-16 H 88.4% 81.7% 81.4% 79.8%

Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

NNE NW Rush

Primary Medical

CarePrimary care access Q3 16/17 H 0.0% 0.0% 0.0%

Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

6


Nottingham West CCG was within the bottom quartile for the Choices in maternity services indicator having scored 61.6 in 2015. The performance is calculated from a CQC survey of which answers to six questions reflecting several points across the care pathway are used. Scores are adjusted for age and for parity (the number of times a woman has given birth). The national maternity review ’Better Births’, published in February 2016, sets out a five year plan for improving maternity services. Commissioners and NUH have been working closely over the past 18 months to progress a number of pathway improvements in relation to maternity care and therefore are well placed to begin implementation of Better Births.

Nottingham West CCG was within the bottom quartile for Neonatal mortality and stillbirths (per 1000 births) in 2014. During Quarter 2 of 2016/17 (the time period in the IAF) 9.7% (23 smokers) of women were smokers at the time of delivery. Other challenges remain around information sharing across the maternity service as community midwives use SystmOne whilst the hospital maternity service at NUH uses Medway. Plans are afoot to roll Medway out into the community. The national maternity review ’Better Births’, published in February 2016, sets out a five year plan for improving maternity services. Commissioners and NUH have been working closely over the past 18 months to progress a number of pathway improvements in relation to maternity care and therefore are well placed to begin implementation of Better Births.

NNE NW Rush


Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Maternity

NNE NW Rush


Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Maternity

NNE NW Rush

CancerPeople with urgent GP referral having first definitive treatment for cancer


Area Indicator Name

Latest

Data

Period

Better Is

(H/L)England

Performance

Nottingham North & East CCG was within the bottom quartile for People with urgent GP referral having a first definitive treatment for cancer within 62 days of referral in Quarter 2 of 2016/17. The CCG achieved 73.4% with the national average at 82.3%. Most patients from the CCG use cancer services at NUH which have continually failed to meet the 85% target for 62 day RTT. Actions are in place to improve performance at the provider which should in turn lift NNE’s performance. These actions can be found in section 2 of this report on page 13.

7


To deliver improvements in ratings across the CCGIAF overall rating and

transformation measures CCGs should ensure that by 2020 they –

1. Commission additional psychological therapies so that at least 25% of people with

anxiety and depression access treatment each year, the majority of which is integrated

with physical healthcare.

2. Deliver better employment support for people with mental health problems; with improved

employment support in psychological therapies services and a doubling of Individual

Placement Support for people with severe mental illness in secondary care services.

3. Commission additional high-quality mental health services for children and young

people, so that at least an extra 70,000 people nationally are able to access services by

2020. This should include all areas being part of CYP IAPT by 2018.

4. Ensure all women can access evidence-based specialist perinatal mental health care

locally.

5. Implement a suicide reduction plan together with local government and other local

partners that reduces suicide rates by 10% against the 2016/17 baseline.

6. Expand capacity so that more than 60% of people experiencing a first episode of

psychosis receive treatment within two weeks of referral.

7. Commission community eating disorder teams so that children and young people to

receive treatment within four weeks of referral for routine cases, and one week for urgent

cases.

8. Commission effective 24/7 mental health crisis response services in all areas; Crisis

Response and Home Treatment Teams as an alternative to acute admissions, supporting

the elimination of out of area placements for nonspecialist acute care.

9. At least half of all acute hospitals locally should meet the ‘core 24’ standard for mental

health liaison as a minimum, with the remainder aiming for this level.

The table above shows the progress each CCG has made against the three mental health transformation areas contained within the CCG Improvement and Assessment Framework. The three areas are self-assessed and updated quarterly to reflect the ongoing transformation programme taking place within mental health services. Below is a list of expected improvements that CCGs are measured against to formulate the percentages shown above:

Rushcliffe CCG

75%

53%

88%

75% 75%

53% 53%

88% 88%

Nottingham West CCG

Compliance w ith a self-assessed list of minimum service expectations for Children and

Young People’s Mental Health, w eighted to reflect preparedness for transformation

Compliance w ith a self-assessed list of minimum service expectations for Crisis Care,

w eighted to reflect preparedness for transformation

Transformation AreaNottingham North and

East CCG

Children and Young

People's Mental Health

Crisis Care

Out of Area PlacementsCompliance w ith a self-assessed list of minimum service expectations for Out of Area

Placements, w eighted to reflect preparedness for transformation

Level 1 – Summary of CCG Performance

8

1.1 Cancer - CCG

All three South Nottinghamshire CCGs experienced breaches of standard for January 2017. Please see the table below for a breakdown of patients seen and breaches by CCG.

NHS Nottingham North & East CCG failed three standards in January 2017, details of the breaches for these pathways are below. 62 Day Urg RTT: 8 Breaches

7 x NUH - 5 x Complex Case, 1 x Capacity, 1 x Patient Choice 1 x Circle - 1 x Patient Choice

31 Day DTT: 3 Breaches 2 x Circle - 1 x Patient Choice, 1 x Patient Unfit 1 x NUH - 1 x Capacity

31 Day DTT: Subs - Surgery: 1 Breach 1 x NUH - 1 x Capacity

CCG Description of Standard Period Target CCGPeriod

Perf

Last 12

months

2016/17

YTD

NNE 70.97% 79.76%

NW 78.26% 81.44%

Rush 92.59% 83.49%

NNE 100.00% 93.65%

NW 100.00% 75.00%

Rush 100.00% 95.40%

NNE 100.00% N/A 84.21%

NW 100.00% N/A 90.00%

Rush 100.00% N/A 90.91%

NNE 95.59% 95.43%

NW 97.87% 95.53%

Rush 100.00% 95.18%

NNE 90.91% 92.44%

NW 100.00% 93.10%

Rush 92.31% 93.52%

NNE 100.00% 98.28%

NW 100.00% 99.26%

Rush 93.33% 99.11%

NNE 100.00% 99.07%

NW 100.00% 100.00%

Rush 100.00% 98.48%

NNE 93.02% 93.47%

NW 94.57% 94.80%

Rush 93.03% 94.47%

NNE 95.83% 96.41%

NW 95.65% 94.87%

Rush 100.00% 89.11%

62d Urg RTT Cons Upgrade Jan-17 N/A

62d Urg RTT Jan-17 85%

62d Urg RTT - Screening Service Jan-17 90%

Po

sit

ive

exp

eri

en

ce o

f

care

96%

Cancer 31d DTT - Subs: Surgery Jan-17 94%

Cancer 31d DTT - Subs: Drugs Jan-17 98%

Cancer 31d DTT Jan-17

94%

Cancer 2ww Jan-17 93%

Cancer 2ww - Breast Symptoms 93%

Cancer 31d DTT - Subs: Radiotherapy Jan-17

Jan-17

Pre

ven

tin

g p

eo

ple

fro

m d

yin

g p

rem

atu

rely

Patients

seenBreaches %

Patients

seenBreaches %

Patients

seenBreaches %

62d Urg RTT 30 8 73.33% 23 5 78.26% 27 2 92.59%

62d Urg RTT - Screening Service 5 0 100.00% 4 0 100.00% 4 0 100.00%

62d Urg RTT Cons Upgrade 2 0 100.00% 1 0 100.00% 2 0 100.00%

Cancer 31d DTT 68 3 95.59% 47 1 97.87% 52 0 100.00%

Cancer 31d DTT - Subs: Surgery 11 1 90.91% 7 0 100.00% 13 1 92.31%

Cancer 31d DTT - Subs: Drugs 16 0 100.00% 16 0 100.00% 15 1 93.33%

Cancer 31d DTT - Subs:

Radiotherapy21 0 100.00% 9 0 100.00% 23 0 100.00%

Cancer 2ww 444 31 93.02% 258 14 94.57% 330 23 93.03%

Cancer 2ww - Breast Symptoms 24 1 95.83% 23 1 95.65% 11 0 100.00%

Nottingham North & East Nottingham West Rushcliffe


9

1.1 Cancer - CCG (Cont.) Cancer 62 Day Urgent RTT - Long Waiters

The indicator above displays the number of 62 Day Urgent RTT patients who have been waiting 104 days and longer. This is measured by CCG and encompasses patients being treated by all providers. At the time of reporting in January 2017, Nottingham North & East CCG had 3 patients waiting 104 days or longer whilst on a 62 Day Urgent RTT pathway. All 3 patients were being treated at NUH. Details relating to the delays are below -

Lower Gastrointestinal - 117 Days - Complex case and patient choice Lung - 116 Days - Complex case Lower Gastrointestinal - Complex Case

Year-to-date Nottingham North & East CCG have had 25 patients on a Cancer 62 Day Urgent RTT pathway waiting 104 days or longer.

CCG Description of Standard Period Standard CCG PatientsLast 12

Months

2016/17

YTD

NNE 3 25

NW 0 11

Rush 0 12

Positive

Experience

of Care

Cancer 62 Day Urg RTT - Patients

Waiting 104+ DaysJan-17 0


10

1.2 Referral To Treatment (RTT) - CCG

Referral to Treatment Standards Nottingham North & East CCG achieved the 92% Incomplete standard in January 2017 with performance at 95.21%. However, four specialties did not meet this standard, these were General Surgery (90.15%), Plastic Surgery (89.19%), Cardiothoracic Surgery (88.24%), and Dermatology (90.57%). The table below shows the performance of individual specialties for Nottingham North & East CCG in January 2017:

Referral to Treatment - Activity v Plan

The above table shows the number of completed admitted and non-admitted pathways during the month. In January 2017, Nottingham North & East CCG was 4.92% above plan for completed admitted pathways. Meanwhile completed pathways for non-admitted patients was above plan by 15.02%.


Perf

Last 12

months

NNE 95.21%

NW 95.26%

Rush 94.74%

NNE 87.59%

NW 88.86%

Rush 88.36%

NNE 3414

NW 2156

Rush 2515Po

sit

ive e

xp

eri

en

ce o

f care RTT - Incomplete pathways (% within 18

weeks)Jan-17 92%

RTT - Incomplete pathways with a

Decision to Admit (% within 18 weeks)Jan-17 N/A

New RTT Periods During the Month Jan-17 N/A

New RTT

Periods

Patients 18Wks+ Perf Patients 18Wks+ Perf Patients

203 20 90.15% 72 12 83.33% 104

315 15 95.24% 49 6 87.76% 175

690 44 93.62% 309 29 90.61% 297

555 25 95.50% 110 17 84.55% 255

883 56 93.66% 287 44 84.67% 344

1 0 100.00% 0 0 0

25 0 100.00% 8 0 100.00% 11

37 4 89.19% 10 2 80.00% 27

17 2 88.24% 11 2 81.82% 10

54 2 96.30% 6 0 100.00% 28

388 19 95.10% 46 3 93.48% 197

344 20 94.19% 91 19 79.12% 130

403 38 90.57% 250 35 86.00% 190

216 8 96.30% 1 0 100.00% 93

203 2 99.01% 0 0 77

87 2 97.70% 2 0 100.00% 64

58 0 100.00% 0 0 40

374 7 98.13% 65 3 95.38% 263

1726 51 97.05% 263 24 90.87% 1109

6579 315 95.21% 1580 196 87.59% 3414

Plastic Surgery

Nottingham North & East

Incomplete

Standard = 92%

Incomplete

With Decision to Admit

General Surgery

Urology

Trauma & Orthopaedics

ENT

Ophthalmology

Oral Surgery

Neurosurgery

Number of patients

waiting over 18 Weeks

Total

Cardiothoracic Surgery

General Medicine

Gastroenterology

Cardiology

Dermatology

Thoracic Medicine

Neurology

Rheumatology

Geriatric Medicine

Gynaecology

Other

CCG Description of Standard Period CCG Activity Plan % DiffLast 12

months

NNE 768 732 4.92%

NW 497 551 -9.80%

Rush 652 652 0.00%

NNE 2144 1864 15.02%

NW 1214 1464 -17.08%

Rush 1631 1592 2.45%

Acti

vit

y v

Pla

n RTT - Completed Pathways for Admitted

PatientsJan-17

RTT - Completed Pathways for Non-

Admitted PatientsJan-17


11

1.3 A&E 4 hour waiting time standard - CCG

NUH performance for A&E Type 1 (consultant-led 24 hour service with full resuscitation facilities) waiting times was below standard during January 2017, which caused failure to achieve 95% for all three South Nottinghamshire CCGs. The performance above does not take into account performance in the Eye Casualty department. Please see Level 2 (page 13-14) for details of actions to improve NUH performance.

The graphs below show the level of A&E Type 1 performance at each CCG since April 2013 and the volume of attendances in the lower graph.


Perf

Last 12

months

2016/17

YTD

NNE 74.11% 73.98%

NW 72.37% 71.88%

Rush 73.80% 73.14%

Positive

experience

of care

A&E waiting time (Type 1 Only) Jan-17 95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

A&E Type 1 4hr Achievement by CCG

Nottingham North & EastNottingham WestRushcliffeStandard

0

500

1000

1500

2000

2500

3000

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

A&E Type 1 Attendances by CCG

Nottingham North & East Nottingham West Rushcliffe


12

1.5 Healthcare Associated Infections (HCAIs) - CCG

Nottingham North & East CCG did not experience any cases of MRSA in February 2017.

February’s standard for Clostridium Difficile infections was also within the threshold with 3 cases against a standard of 6. Year-to-date Nottingham North & East CCG have experienced 31 cases of C-Diff which is below the threshold of 43.

1.4 Diagnostics Waiting Times - CCG

In January 2017 Nottingham North & East CCG achieved the 1% national standard with performance at 0.40%. Nottingham West CCG and Rushcliffe CCG were also within the standard at 0.62% and 0.16% respectively.

1.6 Continuing Healthcare - CCG

NHS Continuing Healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a "primary health need".

The Continuing Healthcare indicators include activity that is both fast track and non-fast track. The eligible totals are taken from snapshot figures. Quarter 3 of 2016-17 shows that Nottingham North & East CCG had 92 CHC packages that were newly agreed as eligible in the quarter. Meanwhile, the CCG had 172 newly eligible CHC packages at the end of the quarter.

CCG Period CCG Eligible Previous Perf

NNE 92

NW 58

Rush 99

NNE 172

NW 86

Rush 137

Continuin

g

Healthcare

Description of Standard

CHC - Newly Eligible in Quarter

CHC - Newly Eligible at end of

Quarter

Q3 16-17

Q3 16-17


Perf

Last 12

months

NNE 0.40%

NW 0.62%

Rush 0.16%

1%

Positive

experience

of care

Diagnostics (% of patients waiting over

six weeks)Jan-17

Feb-17 NNE 0 0 0 3

Feb-17 NW 0 0 0 0

Feb-17 Rush 0 0 0 1

Feb-17 NNE 6 3 43 31

Feb-17 NW 2 0 20 12

Feb-17 Rush 3 0 22 31

Period

Perf

HC

AIs

MRSA

C-Diff

YTD

Standard

2016/17

YTDCCG Description of Standard Period

Period

StandardLast 12 monthsCCG

Level 2 – NUH Performance

13

NUH 2.1 Cancer Waiting Times

In January 2017, NUH failed to achieve the Cancer 62 day standard with performance at 74.01% against the national standard of 85%. This is the 15th consecutive month that the standard has been breached. NUH also did not meet the targets for 31 Day Subsequent Treatment: Surgery and 2 Week Wait - Breast Symptoms. NUH achieved all other standards in January 2017. Year-to-date the Trust are currently below the standard for 62 day referral to treatment.

The table above shows NUH 2ww activity broken down by suspected tumour site for 2015-16 and 2016-17. All but three tumour sites have seen an increase in activity. In terms of activity breast cancer has seen the largest increase with 413 (9.30%) extra patients during 2016-17 year to date compared to the same period in 2015-16. However, there has been a decrease of 105 (35.23%) in breaches. Overall 2ww performance at NUH across the two periods has increased by 2.10%.

The table above details 2 week wait performance at NUH compared to peer hospitals up to December 2016, and shows the change in activity compared to the same period in 2015-16.

2ww Peer Comparison - Total

Provider Patients Breaches Performance Patients Breaches Performance Performance

Cambridge University Hospitals FT 12036 962 92.01% 12603 699 94.45% 567 4.71% -263 -27.34% 2.45%

Central Manchester University Hospitals FT 6562 322 95.09% 7138 417 94.16% 576 8.78% 95 29.50% -0.93%

Lancashire Teaching Hospitals FT 10354 634 93.88% 10285 557 94.58% -69 -0.67% -77 -12.15% 0.71%

Leeds Teaching Hospitals 19062 1211 93.65% 20911 1207 94.23% 1849 9.70% -4 -0.33% 0.58%

Nottingham Treatment Centre - Circle 7285 442 93.93% 7359 411 94.42% 74 1.02% -31 -7.01% 0.48%

Nottingham University Hospitals 11925 1025 91.40% 13136 863 93.43% 1211 10.16% -162 -15.80% 2.03%

Oxford Radcliffe Hospitals 16288 897 94.49% 16242 1101 93.22% -46 -0.28% 204 22.74% -1.27%

Royal Liverpool and Broadgreen University Hospitals 10785 444 95.88% 10886 491 95.49% 101 0.94% 47 10.59% -0.39%

Sheffield Teaching Hospitals FT 12948 809 93.75% 13686 740 94.59% 738 5.70% -69 -8.53% 0.84%

Southampton University Hospitals 11669 437 96.26% 12252 725 94.08% 583 5.00% 288 65.90% -2.17%

The Newcastle Upon Tyne Hospitals FT 16336 691 95.77% 16512 766 95.36% 176 1.08% 75 10.85% -0.41%

University Hospital Birmingham FT 8960 238 97.34% 10111 426 95.79% 1151 12.85% 188 78.99% -1.56%

University Hospitals Bristol FT 8897 376 95.77% 10035 560 94.42% 1138 12.79% 184 48.94% -1.35%

University Hospitals of Leicester 19438 1995 89.74% 20972 1470 92.99% 1534 7.89% -525 -26.32% 3.25%

Total 172545 10483 93.92% 182128 10433 94.27% 9583 5.55% -50 -0.48% 0.35%

2015-16 2016-17 Difference

Patients Breaches

Jan-17 Q3 2016-17

62d Urg RTT 85% 74.01% 77.19% 76.23%

62d Urg RTT - Screening Service 90% 100.00% 88.24% 90.95%

62d Urg RTT Cons Upgrade N/A 75.86% 77.57% 83.03%

Cancer 31d DTT 96% 96.77% 96.43% 96.39%

Cancer 31d DTT - Subs: Surgery 94% 91.46% 96.19% 94.91%

Cancer 31d DTT - Subs: Drugs 98% 99.08% 99.13% 99.02%

Cancer 31d DTT - Subs: Radiotherapy 94% 99.32% 98.41% 99.19%

Cancer 2ww 93% 93.54% 94.86% 93.44%

Cancer 2ww - Breast Symptoms 93% 91.41% 95.57% 93.69%

2016/17

YTD

PeriodP

reven

tin

g p

eo

ple

fro

m d

yin

g p

rem

atu

rely

Po

sit

ive

exp

eri

en

ce

of

care

NUH Description of Standard TargetLast 12

months

2ww NUH Activity

Tumour (suspected) Patients Breaches Performance Patients Breaches Performance Performance

Brain/central nervous system tumours 225 5 97.78% 176 4 97.73% -49 -21.78% -1 -20.00% -0.05%

Breast cancer 4443 298 93.29% 4856 193 96.03% 413 9.30% -105 -35.23% 2.73%

Children's cancer 118 7 94.07% 143 7 95.10% 25 21.19% 0 0.00% 1.04%

Gynaecological cancer 806 40 95.04% 956 42 95.61% 150 18.61% 2 5.00% 0.57%

Haematological malignancies (exc. acute leukaemia) 269 16 94.05% 269 8 97.03% 0 0.00% -8 -50.00% 2.97%

Head & neck cancer 1975 127 93.57% 2131 132 93.81% 156 7.90% 5 3.94% 0.24%

Lower gastrointestinal cancer 1383 309 77.66% 1572 285 81.87% 189 13.67% -24 -7.77% 4.21%

Lung cancer 763 15 98.03% 925 35 96.22% 162 21.23% 20 133.33% -1.82%

Sarcoma 247 19 92.31% 306 6 98.04% 59 23.89% -13 -68.42% 5.73%

Skin cancer 1 0 100.00% 1 0 100.00% 0 0.00% 0 0.00%

Testicular cancer 85 3 96.47% 88 1 98.86% 3 3.53% -2 -66.67% 2.39%

Upper gastrointestinal cancer 1122 238 78.79% 1256 136 89.17% 134 11.94% -102 -42.86% 10.38%

Urological malignancies (exc. testicular) 1723 63 96.34% 1804 101 94.40% 81 4.70% 38 60.32% -1.94%

Total 13160 1140 91.34% 14483 950 93.44% 1323 10.05% -190 -16.67% 2.10%

2015-16 2016-17 Difference

Patients Breaches


14

NUH 2.1 Cancer Waiting Times (cont.) Cancer 62 day RTT Performance by Tumour Site

The above table shows the performance of 62 day cancer (excluding rare cancers) at NUH for all patients by tumour site for

January 2017. There are two tumour sites where performance has been consistently below standard over the last 12 months—

Lower Gastrointestinal and Lung.

Escalation Due to continued below standard performance a Remedial Action Plan (RAP) is in place for 62 day, actions include - Focus on Lung, Upper GI, Lower GI, and Urology Plans for reducing backlog of >62 day patients in place for major tumour sites Restatement of actions expected by referring Trusts before acceptance of late tertiary referrals Direct booking for Computed Tomography / Ultrasound in clinic to reduce waiting times in radiology, with further

extension to MRI in January New MRI scanner opened at City Hospital in December Additional private sector capacity in place for Endoscopy Predictive tool for 62 day pathway used to improve capacity planning Cancer Taskforce in place focusing on underperforming elements of the cancer pathway and oversight of action plans Productive Endoscopy project commenced December Future plans: non-specific cancer symptoms pilot commences January 2017 to reduce pressure on cancer diagnostic

capacity.

Patients % Chart Patients %

Brain/Central Nervous System Jan-17 85% 0 N/A 2.5 60.00%

Breast Jan-17 85% 35 95.71% 334.5 95.81%

Gynaecological Jan-17 85% 11 68.18% 113 85.84%

Haematological (Excluding Acute

Leukaemia)Jan-17 85% 11.5 95.65% 126.5 86.96%

Head & Neck Jan-17 85% 13 73.08% 114.5 70.74%

Lower Gastrointestinal Jan-17 85% 14 50.00% 162 56.48%

Lung Jan-17 85% 20 37.50% 247 56.28%

Other Jan-17 85% 0 N/A 11 63.64%

Sarcoma Jan-17 85% 2.5 0.00% 25 72.00%

Skin Jan-17 85% 2.5 40.00% 30 63.33%

Upper Gastrointestinal Jan-17 85% 10.5 80.95% 140.5 64.41%

Urological (Excluding Testicular) Jan-17 85% 32 84.38% 428 81.54%

Total (Excluding Rare Cancers) Jan-17 85% 152 74.01% 1734.5 76.33%

Last 12 MonthsNUH Tumour Site Period Standard

Latest Period

Ca

nce

r 6

2 D

ay R

TT

Pe

rfo

rma

nce

by T

um

ou

r S

ite

fo

r a

ll C

CG

pa

tie

nts

at N

UH

(A

dm

itte

d

& N

on

Ad

mitte

d)


15

NUH 2.2 Referral To Treatment (RTT)

During January 2017 the 92% Incomplete standard was achieved for all specialties except for General Surgery (91.20%).

Incomplete with Decision to Admit does not currently have a national standard, but does show that 86.65% of patients with a

decision to admit are currently waiting under 18 weeks.

The table below shows the number of patients still waiting at NUH at the end of January 2017 segmented by time band and upload specialty.

Jan-17 26-40 Wks 40-48 Wks 48-52 Wks 52 Wks+

General Surgery 4 1 0 0

Urology 8 0 0 0

Trauma & Orthopaedics 62 13 1 0

Ear, Nose & Throat (ENT) 29 1 0 0

Ophthalmology 37 2 0 0

Oral Surgery 4 2 1 0

Neurosurgery 10 0 0 0

Plastic Surgery 5 0 0 0

Cardiothoracic Surgery 3 0 1 0

General Medicine 0 1 0 0

Gastroenterology 5 2 0 0

Cardiology 25 0 0 0

Geriatric Medicine 0 0 0 0

Other 32 1 1 0

Total 226 23 4 0

NUH Description of Standard Period TargetPeriod

Perf

Last 12

months

RTT - Incomplete pathways (% within 18

weeks)Jan-17 92% 95.96%

.RTT - Incomplete pathways with a

Decision to Admit (% within 18 weeks)Jan-17 N/A 87.32%

.

New RTT Periods During the Month Jan-17 N/A 15396

Po

sit

ive

exp

eri

en

ce o

f care

New RTT

Periods


284 25 91.20% 107 18 83.18% 172

1047 42 95.99% 175 13 92.57% 646

3193 225 92.95% 1309 149 88.62% 1280

3028 166 94.52% 563 109 80.64% 1389

4647 286 93.85% 1550 233 84.97% 1844

1146 20 98.25% 139 11 92.09% 636

466 32 93.13% 135 11 91.85% 263

411 20 95.13% 205 13 93.66% 227

200 15 92.50% 123 14 88.62% 108

54 1 98.15% 12 0 100.00% 22

624 21 96.63% 103 2 98.06% 427

1747 126 92.79% 457 117 74.40% 583

0 0 0 0 0

695 6 99.14% 13 0 100.00% 334

1480 15 98.99% 0 0 678

0 0 0 0 0

256 1 99.61% 4 0 100.00% 180

843 5 99.41% 99 2 97.98% 567

8623 154 98.21% 1143 86 92.48% 6040

28744 1160 95.96% 6137 778 87.32% 15396

Jan-17

Incomplete

Standard = 92%

Incomplete


Ophthalmology

ENT


Urology

General Surgery

Number of patients


General Medicine


Plastic Surgery

Neurosurgery

Oral Surgery

Neurology

Thoracic Medicine

Dermatology

Cardiology

Gastroenterology

Total

Other

Gynaecology

Geriatric Medicine

Rheumatology


16

NUH 2.3.1 A&E 4 hour waiting time standard

In February 2017 the national 95% performance level was not met with NUH performance at 78.71%, the standard has not been met in any of the last 12 months. There is a Remedial Action Plan (RAP) in place. Actions being taken to improve performance are bulleted below -

Deliver 95% non-admitted performance - January performance = 87.5%, minor’s performance = 96.7%

Reduce non-admitted breaches related to medical wait to be seen to less than 20%

Implementation of GP Front Door at weekends and evenings commenced on 5th January 2017

Implementation of Frailty Service resilience bid

Average triage time to be 30 minutes or below and 80% of patients to have a triage time of 40 minutes or less and 80% of patients to have a triage time of 40 minutes or less

Average time from arrival to earliest seen by doctor to be 60 minutes or below

Review “To Take Out” process

Roll out of the Exemplar Ward programme

Trial of Red/Green days on 2x Medicine / HCOP wards

Reduce inappropriate use of assessment areas and increase availability of assessment beds pre-noon

Implementation of Professional Standards Patients ready for pick up by Patient Transport Services at arranged time TTO completed by 3pm day prior to expected discharge Where NUH is responsible for provision, equipment shall be provided to the patient 24 hours prior to

medical fitness date

Domain Description of Standard Target Feb-17Last 12

months

2016/17

YTD

A&E waiting time - QMC + Eye Cas95%

STF (89%)78.71% 75.88%

A&E waiting time - QMC only 95% 76.31% 73.17%

A&E waiting time - Eye Cas only 95% 98.61% 98.85%

Positiv

e

experience o

f

care

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

NUH - A&ENational TrajectoryLocal TrajectoryPerformance

Contract Query Notice, which was raised on 21/06/2012, closed on 01/08/2013 as NUH made 95% standard in 3 consecutive months

Contract Query Notice raised on 05/08/2014

Contract Query Notice closed on 13/05/2015 due to improved performance in April and May

Remedial Action Plan raised on 12/01/2016


17

NUH 2.3.1 A&E 4 hour waiting time standard (cont.)

NUH 2.3.2 A&E 12 Hour Trolley Waits

The chart below shows A&E performance and attendances at NUH between 1st April 2016 and 3rd March 2017.

As well as the Remedial Action Plan there continues to be bi-weekly monitoring of the updated System Resilience Plan, which is centred around the following themes - Front Door

New model of front door primary care Development of integrated urgent care

Internal Flow NUH led actions to embed Safer bundle across Trust wards Multi agency discharge events have taken in place on Trust wards, these have identified opportunities for improvement

External Flow Focus on interface with external capacity for medically fit for discharge patients System-wide capacity and flow review

Enablers Development of system wide dashboard Development of System Resilience Group process for allocation of resilience funding

During January 2017 there were 2 breaches of the 12 hour trolley wait standard at NUH. One of these was due to a lack of bed availability and the other was due to a mixture of failing to undertake processes, admin error, and overcrowding in the emergency department. Year to date there has been one non-NUH responsible breach, and four NUH responsible breaches.

NUH Description of Standard Period Target

NUH

Responsible

Breaches in

period

NUH Responsible

Breaches:

Last 12 months

NUH

Responsible

Breaches

YTD

Non-NUH

Responsible

Breaches

YTD

Number of 12 hour trolley waits in A&E Jan-17 0 2 4 1

0

100

200

300

400

500

600

700

800

900

1000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17A

tte

nd

ance

s

Pe

rfo

rman

ce

NUH A&E Performance Apr16-Mar17Attendances BreachesPerformance Standard


18

NUH 2.4 Cancelled Operations

In total, there were 351 cancelled operations in January 2017 of which 71 were on the day of admission and 280 were cancelled

prior to the day of admission. There were 8779 elective procedures undertaken at NUH during the same period, which equates

to a total of 4.00% of elective admissions being cancelled either on the day or prior to the day of admission.

The cancelled operations national standard was not achieved during January 2017 in which there were 71 ‘on the day’

cancellations. The main reasons for these were Staffing (26) and List Overrun - Clinical Reasons (19). The number of operations

cancelled due to staffing was because of staff sickness. Additionally, some cases of routine surgery were postponed to

accommodate more clinically urgent surgical cases. This has been exacerbated by capacity limitations due to planned and

unplanned theatre maintenance.

All cancelled operations were rebooked within 28 days which meets the national standard.

The table below shows the number of on the day cancellations at NUH broken down by reason.

The table below shows the total number of cancelled operations for NUH over the most recent 12 month period available.

Over the past 12 months, list overrun - clinical reasons and staffing are the most common reasons given for on the day

cancellations at NUH. Administrative error, other, and replaced by emergency patient are also cited by NUH as frequent reasons

for cancellation.

NUH 2.5 Diagnostics Waiting Times

NUH achieved the Diagnostics standard for the thirteenth consecutive month in January 2017 with performance at 0.22%. There

were 16 breaches in January with 10 relating to Gastroscopy, 4 to Non-Obstetric Ultrasound, 1 to Colonoscopy, and 1 to

Cystoscopy.


Perf

Last 12

months

Cancelled Ops - % of elect act Jan-17 0.8% 0.81%

Cancelled Operations - Rebooked 28

days+Jan-17 0 0

Number of urgent operations cancelled

for a second timeJan-17 0 0

Positiv

e

experience o

f

care

Reason for Cancellation Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17Last 12

Months

Administrative Error 9 8 8 8 6 12 10 7 4 3 7 4 86

Equipment Unavailable 2 6 2 5 8 3 9 2 0 1 0 4 42

Hospital Clinical Cancellation 0 0 0 0 0 0 0 0 0 0 0 0 0

External Issues 2 0 1 0 0 0 0 0 0 0 0 0 3

ICU/HDU Bed Unavailable 1 4 1 0 5 2 5 0 1 2 2 1 24

List overrun - clinical reasons 13 8 7 3 3 7 13 7 11 14 7 19 112

List overrun - non-clinical reasons 1 0 1 13 9 2 0 1 1 0 1 0 29

Other 11 0 1 1 0 26 2 2 0 12 22 2 79

Replaced by emergency patient 4 8 8 12 9 7 3 2 1 7 9 6 76

Replaced by other patient 0 1 0 0 3 1 0 0 0 1 0 0 6

Staffing 13 9 6 4 15 7 3 1 7 1 9 26 101

Theatre unavailable 0 0 0 1 0 0 0 0 0 0 0 0 1

Ward Bed Unavailable 8 9 6 10 4 0 2 4 2 4 4 9 62

Unknown 0 0 0 6 0 0 0 0 0 0 0 0 6

Total 64 53 41 63 62 67 47 26 27 45 61 71 627


Perf

Last 12

months


six weeks)Jan-17 1% 0.22%

Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17Last 12

Months

On the day Cancelled Operations 64 53 41 63 62 67 47 26 27 45 61 71 627

Prior to the day Cancelled Operations 332 320 313 221 185 236 274 218 187 204 193 280 2963

Total Cancelled Operations 396 373 354 284 247 303 321 244 214 249 254 351 3590


19

NUH 2.7 NHS E-Referral Report

The NHS E-Referral report details how long it takes the Trust to contact patients who have had slot issues. During January 2017, 115 patients had slot issues, 5 of these were waiting longer than 7 working days with all patients being contacted within 14 working days.

NUH 2.6 Appointment Slot Issues

During the appointment booking process, the NHS e-Referral Service will allow the referral to enter the Appointment Slot Issues process if there are no slots available for booking at the time of the appointment search. The above indicator displays the ratio of slot issues per successful Directly Bookable Service (DBS) booking. It is not necessarily the same as the ratio of patients encountering slot issues, as some patients may encounter multiple issues. NUH failed to meet the slot unavailability standard of 0.04 issues per successful DBS booking with performance at 0.16. The trust are also below target year-to-date with performance at 0.15. The specialties with the largest number of slot issues are: Neurology - 235 slot issues Diagnostic Physiological Measurement - 182 slot issues Ophthalmology - 180 slot issues Ear, Nose, Throat - 161 slot issues Child & Adolescent Services - 102 Slot Issues


Perf

Last 12

months

2016/17

YTD

Ratio of slot issues per successful DBS

bookingDec-16 0.04 0.16 0.15


Perf

Last 12

months

Patients waiting less than 7 working

days to arrange an appointmentJan-17 95% 96%

Patients waiting less than 14 working

days to arrange an appointmentJan-17 100% 100%

NH

S E

-

Refe

rral A

SIs


20

NUH 2.8 Delayed Transfers of Care

The number of delays is measured as at midnight on the last Thursday of the reporting month. During December 2016 there were 24 delays, which is below the average of 32 per month during 2015/16.

The number of days delayed in December 2016 was below the average of 1421 per month during 2015/16 with 1059 days delayed during the month. This indicator is a total of delayed days in the month as opposed to a snapshot.

The above table shows that NUH has been deemed responsible for the majority of DTOCs in December 2016. The most common reason for delays was due to a lack of capacity in further non acute NHS care. This was affecting 18 patients on the last Thursday of the month with a total of 692 days delayed during the month.

There is a threshold of 3.5% for the rate of delays affecting occupied bed days during the month. NUH experienced delayed transfers of care in 2.5% of all occupied bed days in December 2016. This is the third time in the last 12 months that NUH has achieved the target.

Domain Description of Standard Period TargetPeriod

Perf

Last 12

months

DToC - % Rate of Occupied Bed Days Dec-16 3.5% 2.5%


Perf

Last 12

months

DToC - Acute/Non-Acute 18+ - Delays Dec-16 Minimum 24

DToC - Acute/Non-Acute 18+ - Days

DelayedDec-16 Minimum 1059P

osit

ive

exp

eri

en

ce

of

care

Nottingham University

Hospitals

Reason For Delay

December 2016

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

A) Completion of assessment 5 158 0 0 0 0

B) Public Funding 0 0 0 0 0 7

C) Further non acute NHS care

(including intermediate care, rehab, etc)18 692 0 0 0 0

Di) Aw aiting Residential Care Home

Placement1 47 0 0 0 0

Dii) Aw aiting Nursing Home Placement 0 33 0 0 0 0

E) Care package in ow n home 0 47 0 0 0 0

F) Community Equipment/adaptions 0 5 0 0 0 0

G) Patient or family choice 0 69 0 0 0 0

H) Disputes 0 0 0 0 0 0

I) Housing - patients not covered by

NHS and Community Care Act0 1 0 0 0 0

Total 24 1052 0 0 0 7

NHS Responsible for DelaySocial Care Responsible for

Delay

Both NHS & Social Care

Responsible for Delay


21

NUH 2.12 Venous Thromboembolism (VTE)

NUH 2.11 Ambulance Handovers

NUH 2.10 Mixed Sex Accommodation Breaches (MSA)

Ambulance handovers to the Emergency Department (ED) remain above the national standards, the key reasons for this include: High levels of occupancy in ED cubicles Continuing increase in ambulance attendances There are a high proportion of vacancies To improve performance there is an action plan in place.

December 2016 performance is below standard for the seventeenth consecutive month with performance at 94.15% of eligible patients for VTE assessed within 24 hours. Actions to improve performance include - VTE Clinical Nurse Specialist commenced her role on the 31st October 2016. Key focus on initiatives to drive compliance

with 95% standard. Undertaking ward visits to areas with poorer compliance VTE risk assessment will move to Nervecentre from early 2017 - easier access to complete, review, and update Review of clinically low-risk exempt cohorts to identify whether further groups should be cohorted out Performance can be accessed in real-time across the Trust via Qlikview. Wards can be made aware of patients approaching

24 hours

During January 2017, there were no Mixed Sex Accommodation breaches at NUH.

NUH 2.9 Healthcare Associated Infections (HCAIs)

Please be aware that the trust will only be penalised for MRSAs that are considered avoidable and Clostridium Difficile infections that are considered to be due to lapses in care. During January 2017 NUH had 9 Clostridium Difficile infections. Information is forthcoming as to whether any of these were due to lapses to care. Year to date there have been 19 Clostridium Difficile infections due to lapses in care, this is against a standard of 75. NUH had 0 cases of MRSA during January 2017. Year to date there has been 3 cases of MRSA that were deemed clinically avoidable.

AllAvoidable /

LapseAll

Avoidable /

Lapse

MRSA (Full year standard = 0) Jan-17 0 0 0 4 3

C-Diff(YTD standard = 75)

(Current month standard = 9)Jan-17 75 9 TBC 87 19

2016/17 YTDLast 12 months

Avoidable / Lapse

HC

AIs

NUH Description of Standard PeriodYTD

Standard

Period Perf


Perf

Last 12

months

2016/17

YTD

Percentage of patients assessed for risk

of VTE on admissionDec-16 95% 94.15% 93.99%


Perf

Last 12

months

Mixed Sex Accommodation Breaches Jan-17 0 0


Perf

Last 12

months

Ambulance A&E handovers over 30

minutesJan-17 0 978

Ambulance A&E handovers over 60

minutesJan-17 0 140

Am

bula

nce

Handovers


22

NUH 2.14 Publication of Formulary

NUH 2.13 Friends & Family Test The Friends and Family score is calculated using the proportion of patients who would strongly recommend minus those who

would not recommend, or who are indifferent.

NUH failed to achieve the Friends and Family Test response rate standards for Maternity Questions 1-3 during January 2017.

The Trusts’ formulary is published by the Nottinghamshire Area Prescribing Committee. The formulary aims to provide

information on medicines available to prescribers in Nottinghamshire reflecting safe, evidence-based and cost-effective choices.

NUH 2.15 Duty of Candour breaches

NUH have had no Duty of Candour breaches during 2016/17.

NUH 2.16 Never Events

There were no Never Events at NUH in January 2017. Year-to-date there has been 6 Never Events.

NUH TargetJan-17

Perf

Last 12

months

2016/17

YTD

% Recommended 68% 94.13% 90.45%

Number of Responses 1840 20861

Response Rate 20% 21.31% 21.64%

% Recommended 68% 97.89% 97.44%


Response Rate 30% 37.74% 38.40%

% Recommended 100% 98.42%


Response Rate 25% 16.43% 20.45%

% Recommended 98.60% 98.19%


Response Rate 25% 20.25% 7.45%



Response Rate 25% 17.71% 18.94%



Response Rate 25% 33.00% 31.92%

Description of Standard

Friends &

Fam

ily T

est

A&E: How likely are you to recommend

our A&E department to friends and family

if they needed similar care or treatment?

Inpatient: How likely are you to

recommend our w ard to friends and

family if they needed similar care or

treatment?

Maternity Q1: How likely are you to

recommend our antenatal service to

friends and family if they needed similar

care or treatment?


recommend our labour w ard to friends

and family if they needed similar care or

treatment?


recommend our postnatal w ard to friends

and family if they needed similar care or

treatment?


recommend our postnatal community

service to friends and family if they

needed similar care or treatment?


Perf

Last 12

months

Publication of Formulary Jan-17 Yes Yes


Perf

Last 12

months

2016/17

YTD

Duty of Candour Breaches Dec-16 0 0 0


Perf

Last 12

months

2016/17

YTD

Never Events Jan-17 0 0 6


23

NUH 2.19 Falls

NUH 2.17 Summary Hospital Level Mortality Indicator (SHMI)

The Summary Hospital Level Mortality Indicator (SHMI) standard has been achieved during December 2016.

NUH 2.18 Pressure Ulcers

NUH 2.20 Mandatory Training

The Trust failed to achieve the Falls per 1000 Occupied Bed Days resulting in harm indicator for January 2017 with performance

at 1.00 against a standard of 0.98. The standard was revised down from 1.70 to 0.98 in June 2016.

The Trust are not achieving the rolling 12 months to January 2017 with performance at 85% against a standard of 90%. The

reason for below standard performance is a result of operational pressures.

To improve performance, a piece of work for the majority of Cancer and Specialities staff, whose training is out of date, has been

undertaken and dates to attend have been organised for February. Other divisions continue to be challenged on performance at

monthly meetings.

NUH 2.21 Appraisals

The Trust has a target to deliver appraisals to 90% of staff over a rolling 12 month period. The past rolling twelve months from

February 2016 — January 2017 period is achieving the 90% standard. Monthly performance for January 2017 is not currently

available.

NUH achieved the standards for the reduction in grade 2 and 3 pressure ulcers but did not meet the target for the reduction in

grade 4 pressure ulcers during January 2017.


Perf

Last 12

months

2016/17

YTD

Summary Hospital Level Mortality

Indicator (SHMI)Dec-16

Not higher

than expected1.04 1.04


Perf

Last 12

months

2016/17

YTD

Falls per 1000 Occupied Bed Days

resulting in harmJan-17 0.98 1.00 1.10

Falls

NUH Description of Standard Period Target PerfLast 12 single

months

Mandatory Training12 Months

to Jan-1790% 85%

NUH Description of Standard Period Target PerfLast 12

months

Rolling 12

Months

Appraisals Jan-17 90% N/A 90%


Perf

Last 12

months

Reduction of grade 2 Pressure Ulcers

per 1000 Occupied Bed DaysDec-16 0.33 0.28


per 1000 Occupied Bed DaysDec-16 0.06 0.00


per 1000 Occupied Bed DaysDec-16 0.00 0.02P

ressure

Ulc

ers

24

Leve

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r

A&

E a

chie

vem

ent

95%

Month

Dec-1

681.2

8%

90.4

9%

78.0

2%

78.0

9%

75.3

7%

91.0

5%

85.8

2%

80.5

7%

86.9

1%

91.3

7%

76.9

4%

79.6

4%

75.5

4%

Cancer

62d U

rg R

TT

85%

Month

Dec-1

684.8

7%

76.0

9%

81.0

7%

77.2

7%

73.5

2%

77.7

5%

85.2

9%

79.0

1%

83.3

3%

88.1

5%

76.8

3%

81.5

2%

79.5

3%

Cancer

62d U

rg R

TT-S

cre

enin

g S

erv

ice

90%

Month

Dec-1

688.4

6%

100.0

0%

60.0

0%

92.7

5%

97.5

0%

88.8

9%

96.4

3%

100.0

0%

100.0

0%

88.4

1%

94.4

4%

100.0

0%

90.9

1%

Cancer

62d U

rg R

TT-C

ons U

pgra

de

94%

Month

Dec-1

6100.0

0%

88.8

9%

91.1

5%

74.2

9%

84.2

1%

83.3

3%

95.8

3%

89.6

6%

80.9

5%

80.0

0%

92.9

8%

82.1

4%

72.7

3%

Cancer

31d D

TT

96%

Month

Dec-1

696.8

1%

96.0

8%

96.5

6%

97.1

9%

96.5

1%

96.8

4%

97.0

6%

97.0

5%

97.6

4%

97.9

8%

98.5

9%

96.1

4%

92.4

2%

Cancer

31d D

TT -

Subs: S

urg

ery

94%

Month

Dec-1

6100.0

0%

100.0

0%

100.0

0%

91.1

1%

96.0

0%

95.6

5%

96.0

0%

98.5

5%

88.7

8%

96.8

8%

97.8

7%

95.9

2%

87.1

8%

Cancer

31d D

TT -

Subs: D

rugs

98%

Month

Dec-1

6100.0

0%

100.0

0%

100.0

0%

100.0

0%

98.9

6%

100.0

0%

100.0

0%

100.0

0%

100.0

0%

100.0

0%

100.0

0%

99.1

2%

100.0

0%

Cancer

31d D

TT -

Subs: R

adio

thera

py

94%

Month

Dec-1

697.0

0%

100.0

0%

100.0

0%

97.2

2%

98.5

3%

100.0

0%

97.4

5%

100.0

0%

99.0

0%

99.2

0%

98.2

2%

98.0

8%

Cancer

2w

w93%

Month

Dec-1

691.7

5%

92.7

7%

97.4

2%

96.5

5%

95.4

9%

91.8

0%

97.6

1%

96.4

1%

89.4

0%

94.9

0%

95.1

1%

96.0

0%

93.7

8%

Cancer

2w

w -

Bre

ast S

ym

pto

ms

93%

Month

Dec-1

696.2

7%

97.6

6%

98.2

7%

96.0

0%

83.3

3%

94.2

7%

97.7

8%

88.2

8%

94.4

4%

95.8

9%

91.1

1%

Dia

gnostic

Test W

T1%

Month

Dec-1

62.4

2%

6.9

4%

0.2

2%

0.4

9%

0.6

3%

1.2

0%

5.5

5%

0.1

8%

0.9

7%

1.3

0%

0.6

0%

1.7

7%

0.8

5%

DToC

- A

cute

/Non-A

cute

18+

Min

imum

Month

Dec-1

698

45

47

51

24

71

17

133

100

41

80

31

30

Friends &

Fam

ily -

A&

E (

% R

ecom

mended)

Local

Month

Dec-1

694.4

9%

83.5

4%

79.6

0%

80.9

4%

90.8

0%

89.5

6%

79.8

6%

85.3

8%

93.9

3%

93.8

4%

81.9

8%

74.0

6%

90.9

1%

Friends &

Fam

ily -

A&

E (

Response R

ate

)20%

Month

Dec-1

621.9

8%

4.4

1%

14.0

1%

13.5

7%

20.5

9%

20.5

2%

18.2

1%

23.5

2%

4.5

4%

3.0

6%

14.1

3%

15.3

7%

7.1

5%

Friends &

Fam

ily -

IP (

% R

ecom

mended)

Local

Month

Dec-1

695.8

3%

95.5

0%

90.2

3%

93.1

4%

97.9

2%

95.7

0%

91.2

7%

94.3

1%

96.8

4%

97.6

1%

97.8

1%

97.5

2%

96.7

3%

Friends &

Fam

ily -

IP (

Response R

ate

)20%

Month

Dec-1

65.6

2%

12.7

9%

26.9

3%

32.7

5%

31.6

0%

17.0

8%

27.0

2%

26.3

2%

19.4

8%

13.2

2%

17.3

1%

30.6

4%

27.5

5%

MR

SA

Local

YTD

Jan-1

72

71

12

65

23

05

01

1

C-D

iff

Local

YTD

Jan-1

740

63

48

97

87

47

45

92

30

68

77

31

48

MS

A B

reaches

Min

imum

Month

Jan-1

70

00

00

00

00

00

00

MS

A B

reach R

ate

(per

1000 f

in c

ons e

ps)

Min

imum

Month

Jan-1

70.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

00.0

0

RTT -

Adm

itted

90%

Month

Dec-1

678.4

3%

81.4

9%

72.6

8%

78.5

6%

84.1

3%

79.1

8%

73.3

2%

89.3

4%

83.6

2%

90.7

2%

87.8

2%

75.3

0%

80.0

6%

RTT -

Non a

dm

itted

95%

Month

Dec-1

688.4

4%

92.2

3%

84.7

8%

88.2

7%

97.2

2%

85.5

7%

87.8

1%

94.2

8%

92.2

0%

95.3

4%

86.6

3%

85.5

7%

88.2

8%

RTT -

Incom

ple

te92%

Month

Dec-1

690.1

5%

91.5

8%

84.1

2%

87.2

5%

96.0

3%

88.6

2%

88.6

8%

93.5

7%

90.6

5%

93.3

2%

92.0

7%

92.0

4%

91.3

2%

Level 2 – SFHFT Performance

25

SFHFT 2.1 Cancer Waiting Times

SFHT failed to achieve the standards for Cancer 31 day DTT with performance at 95.12%. The target for 31 day DTT -

Subsequent Treatment: Drugs was also not met with SFHT falling short at 95.24%. Aside from this, SFHT achieved all other

targets for Cancer in January 2017.

SFHFT 2.2 Referral To Treatment (RTT)

SFHT achieved the Incomplete 92% standard during December 2016 with performance at 92.07%. Incomplete pathways with

a decision to admit does not have a national standard but shows that 83.93% of incomplete patients who have a decision to

admit are waiting less than 18 weeks. In December 2016, there were 6878 new RTT pathways started at SFHT.

Domain Description of Standard Period TargetPeriod

Perf

Last 12

months


weeks)Dec-16 92% 92.07%


Decision to Admit (% within 18 weeks)Dec-16 N/A 83.93%

.

New RTT Periods During the Month Dec-16 N/A 6878

Po

sit

ive

exp

eri

en

ce o

f care

SFHT Description of Standard Period TargetPeriod

Perf

Last 12

months

2016/17

YTD

62d Urg RTT Jan-17 85% 85.16% 82.95%

62d Urg RTT - Screening Service Jan-17 90% 100.00% 90.16%

62d Urg RTT Cons Upgrade Jan-17 N/A 84.62% 90.64%

Cancer 31d DTT Jan-17 96% 95.12% 97.68%

Cancer 31d DTT - Subs: Surgery Jan-17 94% 100.00% 100.00%

Cancer 31d DTT - Subs: Drugs Jan-17 98% 95.24% 99.55%

Cancer 31d DTT - Subs: Radiotherapy Jan-17 94% N/A N/A

Cancer 2ww Jan-17 93% 96.35% 95.69%

Cancer 2ww - Breast Symptoms Jan-17 93% 94.74% 97.26%

Pre

ven

tin

g p

eo

ple

fro

m d

yin

g p

rem

atu

rely

Po

sit

ive

exp

eri

en

ce

of

care

Level 2 – SFHFT Performance

26

SFHFT 2.4 A&E 4 hour waiting time standard

SFHT failed to achieve the 95% A&E standard during January 2017 with performance at 92.32%. Year to date performance is

below the standard at 94.44%.

Actions to improve performance include:

The Trust have produced an internal recovery plan which will form the basis of a system-wide recovery plan

Community presence within A&E

Implementation of a “Single Front Door” system, this ensures patients are seen in the right place first time

Expansion of ambulatory emergency care at Kings Mill hospital

Re-launch of the acute physician and speciality consultant hotlines which are available to GPs and NEMS

Daily Board Rounds continue at the Trust. There is now a permanent Discharge Lounge, leaflets are being given to

patients advising them of alternative services within the community

SFHT 2.3 Diagnostics Waiting Times

SFHT failed to achieve the 1% diagnostics standard for December 2016 with performance at 2.00%. There were 97 breaches in

December with 35 relating to Gastroscopy, 16 to Echocardiography, 13 to Colonoscopy, 11 to Flexi sigmoidoscopy, 6 to MRI, 6 to

Cystoscopy, 5 to Dexa Scan, and 5 to Sleep Studies.


Perf

Last 12

months


six weeks)Dec-16 1% 2.00%


Perf

Last 12

months

2016/17

YTD

A&E waiting time - KMH (inc CNCS) +

NewarkJan-17 95% 92.32% 94.44%

A&E waiting time - KMH (inc. CNCS) Jan-17 95% 88.92% 92.52%

A&E waiting time - Newark Jan-17 95% 99.48% 99.11%

Po

sit

ive

exp

eri

en

ce o

f care

Level 2 – Circle Performance

27

Circle 2.1 Cancer

Circle failed to meet the 62 day and 31 day targets but achieved the 2 week wait standard in January 2017.

The graph above shows a breakdown of how long patients at Circle waited on the 2 week wait pathway, please note that this is the total days waited and not the number of days over 14 waited. Patients seen within 14 days are not shown. The longest wait on the pathway at the time of reporting was 58 days. This was due to patient choice.

Cancer 31 day DTT Performance by Tumour Site

The above table shows the performance of 31 day cancer at Circle for all patients by tumour site for January 2017 and for the last twelve months. It should be noted that small numbers for tumour sites besides skin have a negligible impact upon overall 31 day DTT performance for the last 12 months. Circle failed to achieve the standard in January 2017 with performance at 91.84%. Over the previous 12 months, performance is at 91.78% which is also below the target.

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+

Nu

mb

er o

f R

efer

rals

Wait (Days)

Circle - Cancer 2ww - Jan 2017

684 Patients Seen Within 14 Days

Domain Description of Standard Target Jan-17 Q3 2016-17Last 12

monthsYTD

62d Urg RTT 85% 79.78% 85.08% 86.64%

Cancer 31d DTT 96% 91.84% 87.18% 91.89%

Cancer 2ww 93% 93.19% 95.02% 94.30%

Pre

venting p

eople

from

dyin

g

pre

matu

rely

Patients % Chart Patients %

GynaecologicalJan-17 96% 0 N/A 5 100.00%

Lower GastrointestinalJan-17 96% 2 100.00% 12 91.67%

OtherJan-17 96% 0 N/A 1 100.00%

SarcomaJan-17 96% 2 100.00% 4 100.00%

SkinJan-17 96% 44 90.91% 544 91.36%

Upper GastrointestinalJan-17 96% 0 N/A 4 100.00%

UrologicalJan-17 96% 1 100.00% 14 100.00%

All CancersJan-17 96% 49 91.84% 584 91.78%

Circle Tumour Site

Ca

nce

r 3

1 D

ay D

TT

Pe

rfo

rma

nce

by T

um

ou

r S

ite

fo

r

all C

CG

Pa

tie

nts

at C

ircle

(A

dm

itte

d &

No

n-A

dm

itte

d)

Period StandardLast 12 MonthsLatest Period


28

Circle 2.1 Cancer (cont.)

Cancer 62 day RTT Performance by Tumour Site

The above table shows the performance of 62 day cancer (excluding rare cancers) at Circle for all patients by tumour site for

January 2017 and the last twelve months. There is one tumour site where performance has been consistently below standard

over the last 12 months—Lower Gastrointestinal.

During January 2017, 62 day RTT performance at Circle fallen further below the 85% national standard with performance at

79.78%. Performance over the past twelve months is however meeting the standard at 85.30%.

Patients % Charts Patient %

GynaecologicalJan-17 85% 3.5 71.43% 30.5 86.89%

HaemotologicalJan-17 85% 0.5 100.00% 4 62.50%

Head & NeckJan-17 85% 0 N/A 0 N/A

Lower GastrointestinalJan-17 85% 5 40.00% 49 58.16%

LungJan-17 85% 0 N/A 2.5 60.00%

OtherJan-17 85% 0 N/A 2 25.00%

SarcomaJan-17 85% 1 100.00% 2 75.00%

SkinJan-17 85% 18.5 86.49% 298.5 93.13%

Upper GastrointestinalJan-17 85% 3 83.33% 35.5 71.83%

UrologicalJan-17 85% 13 84.62% 106.5 82.63%

All Cancers (Excl. Rare

Cancers)Jan-17 85% 44.5 79.78% 530.5 85.30%C

ancer

62 D

ay R

TT

Perf

orm

ance b

y T

um

our

Site f

or

all

CC

G P

atients

(Adm

itte

d &

Non-A

dm

itte

d)

Period StandardLatest Period Last 12 Months

Circle Tumour Site


29

Circle 2.2 RTT

The only national standard for 2016/17 is the Incomplete 92% of patients to be waiting less than 18 weeks at the end of the

month. Circle have achieved this for each of the last 12 months.

The table below shows Incomplete, Incomplete With Decision to Admit and New RTT Periods by specialty:

Two specialties breached the 92% Incomplete standard in January 2017; these are Trauma & Orthopaedics and Ophthalmology.

Please note RTT performance is reported at provider level not contract level. Therefore Ophthalmology is included for

completeness although not commissioned via this contract.

Circle Description of Standard Period TargetPeriod

Perf

Last 12

months


weeks)Jan-17 92% 93.61%


Decision to Admit (% within 18 weeks)Jan-17 N/A 90.58%

.

New RTT Periods During the Month Jan-17 N/A 5345

Po

sit

ive

exp

eri

en

ce o

f care

New RTT

Periods


286 16 94.41% 82 14 82.93% 159

474 13 97.26% 54 0 100.00% 251

1767 145 91.79% 881 74 91.60% 984

0 0 0 0 0

11 1 90.91% 11 1 90.91% 15

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

294 19 93.54% 50 6 88.00% 149

1646 117 92.89% 92 7 92.39% 633

28 0 100.00% 0 0 37

2268 160 92.95% 1115 128 88.52% 1074

585 41 92.99% 6 2 66.67% 240

0 0 0 0 0

514 14 97.28% 8 1 87.50% 298

0 0 0 0 0

835 42 94.97% 370 35 90.54% 783

1387 77 94.45% 432 24 94.44% 722

10095 645 93.61% 3101 292 90.58% 5345Total


General Medicine

Gastroenterology

Cardiology

Dermatology

Thoracic Medicine

Neurology

Rheumatology

Geriatric Medicine

Gynaecology

Other

Plastic Surgery

Month = Jan-17

Incomplete

Standard = 92%

Incomplete


General Surgery

Urology


ENT

Ophthalmology

Oral Surgery

Neurosurgery

Number of patients



30

Circle 2.4 Cancelled Operations

During January 2017, Circle achieved the 0.8% national standard with 0.32% of operations cancelled. All cancelled operations

were rebooked within 28 days. The table below shows that the main reason for cancellation during the last 12 months is staffing

followed by administrative error.

Circle 2.3 Diagnostics Waiting Times

Circle achieved the Diagnostics standard in December 2016, during the month there were no breaches of the six week standard.

Circle 2.5 Complaints

Circle had 10 complaints during January 2017. Circle have a culture of encouraging patients to raise concerns and any

complaints made are used to increase the quality of clinical care and provide the best possible patient experience.


Perf

Last 12

months


six weeks)Dec-16 1% 0.00%


Perf

Last 12

months

2016/17

YTD

Cancelled Ops - % of elect act Jan-17 0.8% 0.32% 0.35%

Cancelled Operations - Rebooked 28

days+Jan-17 5% 0.00% 3.85%

Number of urgent operations cancelled

for a second timeJan-17 0 0 0

Positiv

e

experience o

f

care

Reason for Cancellation Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17Last 12

Months

Administrative Error 1 2 2 2 1 0 0 0 0 1 2 2 13

Clinical Priority 2 1 1 0 1 0 0 0 3 1 0 0 9

Equipment 0 3 2 0 2 0 0 0 0 0 0 0 7

ICU/HDU Bed Unavailable 1 1 0 0 0 0 0 0 0 1 0 0 3

Other 0 0 0 0 3 0 0 0 2 1 2 3 11

Staffing 3 4 3 1 1 0 6 2 0 1 5 0 26

Theatre Time 0 0 0 0 0 0 0 1 0 0 0 0 1

Ward Bed Unavailable 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 7 11 8 3 8 0 6 3 5 5 9 5 70

Circle Description of Standard Period StandardPeriod

Perf

Last 12

months

2016/17

YTD

Patient

ExperienceNumber of Complaints Jan-17 Minimum 10 141


31

Circle 2.6 HCAIs

Circle have not had any cases of MRSA or C-Diff during the last 12 months.

Circle 2.7 Venous Thromboembolism (VTE) Risk Assessment

Circle achieved the VTE risk assessment standard in December 2016 with performance at 97.96%.

Circle 2.8 Never Events

There were no Never Events reported during January 2017.

Circle 2.9 Friends & Family Test (FFT)

There are currently no national standards for the FFT. However, Circle are consistently achieving high scores for both inpatient

and outpatient.

Circle Description of Standard Period Basis Standard PerformanceLast 12

months

FFT - Inpatient Score Dec-16 Monthly N/A 92.7

FFT - Inpatient Response Rate Dec-16 Monthly N/A 28.75%

FFT - Outpatient Score Dec-16 Monthly N/A 82.8

FFT - Outpatient Response Rate Dec-16 Monthly N/A 14.32%Friends &

Fam

ily T

est

(FF

T)

Circle Description of Standard Period StandardPeriod

Perf

Last 12

months

MRSA Bacteraemia Jan-17 0 0

C Difficile Jan-17 0 0

HC

AIs


Perf

Last 12

months

2016/17

YTD

Percentage of patients assessed for risk

of VTE on admissionDec-16 95% 97.96% 98.13%


Perf

Last 12

months

2016/17

YTD

Never Events Jan-17 0 0 0

Level 2 – NHCT Performance

32

NHCT 2.1 IAPT

IAPT - Patient Moving Towards Recovery (Recovery Rate)

The recovery rate is the number of people who are moving to recovery, divided by the number of people who have completed treatment, minus the number of people who have completed treatment who were not at “caseness” at initial assessment. An individual is said to be at caseness when their outcome score exceeds the accepted threshold for a standardised measure of symptoms. The CCG has an IAPT recovery rate standard of 50%. During December 2016 Nottingham North & East CCG achieved the 50% standard with performance at 54.90%, this is the sixteenth consecutive month that the CCG has achieved the standard.

The CCGs have set a target for 3.76% of patients who have depression and/or anxiety disorders to be seen each quarter during 2016/17. This equates to 194 patients per month for Nottingham North & East, 126 for Nottingham West and 127 for Rushcliffe. Nottingham North & East CCG achieved the required quarter to date standard of 3.76% for December 2016 with performance at 4.53%. The CCG has had an average of 234 patients treated per month in Quarter 3.

NHCT 2.2 Early Intervention in Psychosis

There is a national target for all patients referred onto the early intervention in psychosis pathway to be treated within 2 weeks with a NICE-recommended package of care. In January 2017, 50% of Nottingham North & East CCG patients started treatment within two weeks following referral. The CCG has achieved the standard three times in the last twelve months. During the month, there was 1 patient belonging to the CCG having awaited treatment for longer than two weeks at the end of the reporting period.

NHCT Description of Standard CCG Target Dec-16Last 12

months

NNE 50% 54.90%

NW 50% 60.00%

Rush 50% 70.37%

IAP

T

IAPT Recovery Rates

NHCT Description of Standard CCG Target Dec-16Last 12

months

NNE 3.76% 4.53%

NW 3.76% 4.50%

Rush 3.76% 5.07%

IAP

T The percentage of people who have

depression and/or anxiety disorders who

receive psychological therapies

CCG Description of Standard Period Target CCGNo. of

Referrals

Period

Perf

Last 12

months

NNE 4 50.00%

NW 2 50.00%

Rush 1 100.00%

NNE 1 0.00%

NW 1 0.00%

Rush 1 0.00%Positi

ve E

xperience

of C

are

Early Intervention in Psychosis (% of patients

aw aiting treatment w ith a NICE-recommended

package of care w ithin 2 w eeks of referral)

Jan-17 100%

Early Intervention in Psychosis (% of patients

starting treatment w ith a NICE-recommended

package of care w ithin 2 w eeks of referral)

Jan-17 100%


33

NHCT 2.5 Dementia During the planning round completed by CCGs in April 2016, Nottingham North & East CCG set ambitions to maintain their Dementia Diagnosis Rate at a minimum of 67% throughout 2016/17.

The table below shows that as at the end of January 2017 Nottingham North & East CCG has a Dementia Diagnosis Rate of 70%, which is above the 67% plan.

NHCT 2.4 Care Programme Approach

The Trust achieved the percentage of patients receiving follow-up contact within 7 days of discharge during June 2016.

CPA is usually for patients that have severe mental health problems and is a particular way of assessing, planning and reviewing their mental health needs. There should be a formal written care plan outlining any risks and including details of what should happen in an emergency or crisis, this should be reviewed annually.

NHCT Description of Standard Period Standard Period PerfLast 12

months

% of patients having a review last 12

monthsJun-16 95.0% 96.60%

% of patients receiving follow-up contact

within 7 days of dischargeJun-16 95.0% 98.10%

CP

A

NHCT 2.3 Children and Young Person’s Mental Health - Eating Disorder

Children and Young Person’s Mental Health - Eating Disorder is a new quarterly collection. Due to the low volume of referrals for these services, CCGs performance is to be measured on a rolling 6 months basis. The expectation is that by 2020, CCGs wil l have achieved a minimum of 95% of referrals waiting less than 1 week for urgent referrals, and 4 weeks for routine cases.

Nottingham North & East CCG has had no patients referred onto and complete a routine case pathway over the past six months. In the six months to the end of Quarter 3 2016-17, 100% of incomplete routine referrals from Nottingham North & East CCG had been waiting less than four weeks to start a NICE-recommended care package. Of completed urgent referrals, 100% of Nottingham North & East CCG patients have started a package of care within 1 week of referral.

NHCT Description of StandardRolling six

months to

Standard

(By 2020)CCG

No. of

Referrals

6 Month

Rolling PerfPrevious Perf

Q3 16-17 95% NNE 0 N/A

Q3 16-17 95% NW 2 50.00%

Q3 16-17 95% Rush 7 57.14%

Q3 16-17 95% NNE 1 100.00%

Q3 16-17 95% NW 2 100.00%

Q3 16-17 95% Rush 3 100.00%

Q3 16-17 95% NNE 1 100.00%

Q3 16-17 95% NW 1 0.00%

Q3 16-17 95% Rush 2 50.00%

Q3 16-17 95% NNE 0 N/A

Q3 16-17 95% NW 0 N/A

Q3 16-17 95% Rush 0 N/A

Positiv

e E

xperience o

f C

are

CYP ED pathways (routine cases)

completed (< 4 weeks)

CYP ED pathways (routine cases)

incomplete (< 4 weeks)

CYP ED pathways (urgent cases)

completed (< 1 week)

CYP ED pathways (urgent cases)

incomplete (< 1 week)

NHCT Description of Standard Plan Jan-17Last 12

months

Nottingham North & East 67% 70%

Nottingham West 67% 75%

Rushcliffe 67% 79%

Dementia

Diagnosis

Rate


34

NHCT 2.6 Delayed Transfers of Care

NHCT achieved the 7.5% standard for Delayed Transfers of Care during December 2016 with performance at 3.30%. Patients

have been delayed 411 days during December 2016, which is below the 2016-17 average of 746.

A reason for delay breakdown of the DTOCs for December 2016 is shown below, this also shows whether the NHS or Social Care

was responsible for the delay.

NHCT Description of Standard Period Standard Period PerfLast 12

months

DToC - % of Non-Acute Admissions Dec-16 7.5% 3.30%

DToC - Number of Days Delayed Dec-16 Minimum 411

DT

oC

Nottinghamshire Healthcare

Trust

Reason For Delay

December 2016

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

Number of

Patients

Delayed (last

Thursday of

month

snapshot)

Number of

Days Delayed

(total during

month)

A) Completion of assessment 1 9 0 0 0 0

B) Public Funding 0 0 0 0 0 0

C) Further non acute NHS care

(including intermediate care, rehab, etc)5 118 0 0 0 0

Di) Aw aiting Residential Care Home

Placement7 124 1 12 0 0

Dii) Aw aiting Nursing Home Placement 2 12 0 8 0 0

E) Care package in ow n home 1 3 0 0 0 0

F) Community Equipment/adaptions 0 0 0 0 0 0

G) Patient or family choice 3 45 0 0 0 0

H) Disputes 1 49 0 0 0 0

I) Housing - patients not covered by

NHS and Community Care Act1 31 0 0 0 0

Total 21 391 1 20 0 0

NHS Responsible for DelaySocial Care Responsible for

Delay

Both NHS & Social Care

Responsible for Delay

Level 2 – EMAS Performance

35

Monthly Performance of the Ambulance Indicators Red 8 minutes and Red 19 minutes

Performance against standard for Red 1 and Red 2 calls.

The chart above shows EMAS Red call volumes for the three South Nottinghamshire CCGs, comparing 2016-17 volumes to the

same periods of 2015-16. All three South Nottinghamshire CCGs have seen an increase in call volumes; Nottingham North & East

has increased by 21.67%, Nottingham West by 20.02% and Rushcliffe by 25.51%.

The table above shows the EMAS performance for local CCGs against the Red 1 and Red 2 standards. During January 2017 Nottingham North & East CCG failed to achieve the Red 1 8 minute 75% standard with performance at 67.74% from 31 responses. The CCG has achieved the standard twice in the last twelve months. The CCG also failed to achieve the Red 2 8 minute 75% standard. During January 2017 there were 869 responses of which 51.21% arrived within 8 minutes, 89.97% arrived within 19 minutes which is below the standard of 95%.

Responses Performance Responses Performance

M&A 55 72.73% 523 73.42%

N&S 28 50.00% 250 51.60%

City 111 74.77% 1091 80.93%

NNE 31 67.74% 321 66.98%

NW 39 64.10% 227 63.88%

Rush 27 66.67% 207 59.90%

M&A 55 100% 523 99.43%

N&S 27 96.30% 249 94.38%

City 111 100% 1090 99.54%

NNE 31 100% 320 98.75%

NW 39 97.44% 227 98.68%

Rush 27 96.30% 207 96.14%

M&A 1429 59.34% 11955 63.08%

N&S 710 41.97% 5719 42.86%

City 2422 66.02% 22618 66.84%

NNE 869 51.21% 7119 49.84%

NW 578 48.10% 4976 48.01%

Rush 476 47.27% 4266 44.16%

M&A 1429 90.55% 11940 93.32%

N&S 708 71.61% 5699 73.93%

City 2422 91.29% 22569 93.47%

NNE 867 89.97% 7106 89.97%

NW 577 90.64% 4973 91.92%

Rush 473 86.47% 4231 85.28%

January 2017 Year to DateCCG Level Description of Standard Target

Last 12

months

performance

CCG

Red 1 - Life

threatening

requiring

defibrillation

Call timer starts

w hen the 999 call is

connected to the

sw itchboard

Red 2 - Life

threatening

Call timer starts at

earliest of the

follow ing 1. The

point at w hich the

chief complaint of

the call has been

identif ied; 2. A

vehicle has been

assigned to the call;

3. A 60 second cap

from the Call

Connect time

8 Minute Response Time 75%




0

200

400

600

800

1000

1200

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

EMAS Call Volumes - Red Calls only - South Nottinghamshire CCGsComparison Between Years

NNE 15-16 NW 15-16 Rush 15-16NNE 16-17 NW 16-17 Rush 16-17


36

Percentiles The chart below shows the EMAS 75th percentile response time for Red calls for each of the South Nottinghamshire CCGs by

month. The standard is 8 minutes and, as can be seen from the chart, none of the CCGs have achieved this (please note, April

2014 data is unavailable).

Time to Respond The following chart shows the year to date response times for Red 1 & Red 2 calls across Nottingham North & East CCG. The

green line shows the expected performance if the 75% 8 minute and 95% 19 minute targets were to be met, the blue line shows

the current CCG performance.

The table within the chart shows the actual number of calls. During the specified period in total there has been 7441 Red 1 and

Red 2 calls in Nottingham North & East CCG, 4227 have been responded to within 8 minutes. 489 Red 1 and Red 2 calls have

been responded to in more than 19 minutes, and 4 calls have been responded to in over 1 hour.

Some calls are responded to within a minute, this is due to a number of reasons including - A defibrillator and someone who can

use it being close to the scene (which immediately stops the clock) and first responders arriving on the scene quickly.

00:00

01:00

02:00

03:00

04:00

05:00

06:00

07:00

08:00

09:00

10:00

11:00

12:00

13:00

14:00

15:00

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Min

ute

s

Total Red - 75th Percentile

Nottingham North & East CCG

Nottingham West CCG

Rushcliffe CCG

Standard

0

200

400

600

800

1000

1200

1400

0 1 2 3 4 5 6 7 8 9

10

11

12

13

14

15

16

17

18

19

Nu

mb

er o

f re

spo

nse

s

Time (in minutes) from call connect to arrival at the scene

Time to respond to calls (Red 1 & Red 2) - Nottingham North & East CCG YTD Apr16 - Jan17

Time Responses

Under 8 minutes 4227

Over 8 minutes 3214

Under 19 minutes 6952

Over 19 minutes 489

Over 1 hour 4

Total Calls 7441

Longest w ait (mins) 120


37

Remedial Action Plan

To improve EMAS performance, a Remedial Action Plan (RAP) which details issues and actions is in place. These are shown below -

Issue - Demand - Increased Red Activity Actions Level of clinical input into the Clinical Assessment Team (CAT) desk to be increased CAT desk ability to triage Red 999 calls to be protected , this will enable more calls to be downgraded to Green Collaboration with Derbyshire Health United to pilot a Ambulance Liaison Desk in NHS 111, utilising EMAS Clinical Hub staff, to

reduce number of calls transferred to EMAS Peer review of current activity/demand to identify any additional actions required Issue - Resources - Resource Availability Actions Increase utilisation of Private and Voluntary Ambulance Services, whilst ensuring patient safety - Ongoing collaboration with

Police and Fire services to provide additional Community First Responders Development of a workforce plan and trajectory to ensure 2193 WTE staff trained and operational by March 2017 - this has

been aided by an overseas recruitment campaign that took place in early October Reduction of the number of staff on alternative duties to support operational delivery Devolve resource planning function to the responsibility of the divisional management teams Dispatch to Disposition allows up to an additional 180 seconds for calls (excluding Red 1s) to be triaged allowing extra time to

determine the most clinically appropriate response required for the patient Issue - Quality & Performance - Improved Performance Actions Analysis of the impact of revised Ambulance Quality Indicators on Red performance Monitor impact of capacity management plan on performance and quality Issue - Handovers - Handover Delays Actions Work with commissioners and providers in Leicestershire to implement actions specific to that area Ensure rollout programme of 164 defibrillators matches requirements of each division, reduce vehicle downtime

Non-Conveyance Rates

The table above shows the proportion of EMAS responses resulting in non-conveyance for the three South Notts CCGs. There is a target to increase the proportion of emergency calls closed by telephone advice, and the number of incidents to be treated at the scene or conveyed to a destination that is not A&E. In January 2017, Nottingham North & East CCG saw 13.58% of calls closed by telephone advice and 28.89% of incidents managed without the need for transport to A&E. Year to date the CCG has seen an increase of 0.12% in the proportion of calls closed by telephone advice compared to the previous year. There has however been a 5.05% decrease in the proportion of incidents not resulting in conveyance to A&E.

CCG Description of Standard Period CCG TargetPeriod

Perf

Last 12

months

16/17

YTD

15/16

YTD

NNE 13.58% 14.83% 14.71%

NW 13.68% 14.76% 14.30%

Rush 13.13% 14.99% 15.61%

NNE 28.89% 30.28% 35.33%

NW 30.19% 31.34% 37.26%

Rush 29.41% 32.36% 38.40%

Increase

Proportion

Increase

Proportion

Proportion of calls closed by telephone

advice (%)

Proportion of incidents managed without

need for transport to Accident and

Emergency Departments (%)

Am

bula

nce Jan-17

Jan-17


38

The table below shows the average times of ambulance turnover for the latest month at QMC and City hospital.

The pre-handover time is the responsibility of the hospital and is the time between the ambulance arriving at the hospital and

the patient being handed over. The post-handover time is the responsibility of EMAS and is the time between the patient being

handed over and the ambulance being ready for the next call.

Turnaround times

The main issue affecting performance remains outflow from the Emergency Department (ED), patients are continuing to wait in ED for inpatient beds. This creates capacity issues within Majors and the Initial Assessment Unit (IAU), which are then unable to receive all Majors referrals, with the exception of direct to Resus and Children’s. Subsequently, staff are unable to move away from the Majors area, and the escalation process to move staff to IAU can not be enacted. Actions to improve performance include -

Actively recruiting to nursing vacancies, any current shortfall covered by agency staff Reduction in ambulance waiting space caused by building works is monitored on a daily basis to ensure safe and

effective transfers If the ambulance crew is waiting more than 10 minutes then there is an internal escalation to the ED Nurse in charge An additional 30 minute escalation to nurse in charge to reduce chances of 60 minute turnaround delays

NUH Description of Standard Period StandardPeriod

Perf

Last 12

months

Queens Medical Centre - Pre-Handover Jan-17<15mins = G

>20Mins = R22:50

Queens Medical Centre - Post-Handover Jan-17<15mins = G

>20Mins = R13:41

Queens Medical Centre - Total Jan-17<30mins = G

>40Mins = R36:31

Nottingham City Hospital - Pre-Handover Jan-17<15mins = G

>20Mins = R21:04

Nottingham City Hospital - Post-Handover Jan-17<15mins = G

>20Mins = R12:01

Nottingham City Hospital - Total Jan-17<30mins = G

>40Mins = R33:06

Am

bula

nce H

andover

Tim

es

(in m

inute

s)

39

Leve

l 2 –

EM

AS

Pe

rfo

rman

ce

Am

bu

lan

ce

Se

rvic

e P

erf

orm

an

ce

Co

mp

ari

so

n

Am

bu

lan

ce S

erv

ice

Pe

rfo

rman

ce C

om

par

iso

n:

Syst

em

Ind

icat

ors

Ou

t o

f 1

1 A

mb

ula

nce

ser

vice

’ EM

AS

are

ran

ked

9th

or

wo

rse

in 1

ou

t o

f th

e 1

1 m

on

thly

ind

icat

ors

an

d 2

ou

t o

f th

e 4

yea

r to

dat

e in

dic

ato

rs s

ho

wn

ab

ove

. EM

AS

are

faili

ng

to a

chie

ve

the

stan

dar

ds

for

Pro

po

rtio

n o

f R

ed 1

cal

ls r

esp

on

ded

to

wit

hin

8 m

inu

tes

mo

nth

ly (

66

.31

%)

& Y

TD (

68

.68

%),

Pro

po

rtio

n o

f R

ed 2

cal

ls r

esp

on

ded

to

wit

hin

8 m

inu

tes

mo

nth

ly

(51

.36

%)

& Y

TD (

56

.93

%)

and

Pro

po

rtio

n o

f C

ateg

ory

A c

alls

res

po

nd

ed t

o w

ith

in 1

9 m

inu

tes

mo

nth

ly (

80

.03

%)

& Y

TD (

84

.38

%).

Sys

tem

In

dic

ato

rs

Are

aIn

dic

ato

r

Late

st

Mo

nth

= D

ec-1

6P

eri

od

Targ

et

EM

AS

Ran

k

(ou

t o

f 11)

1 =

Be

st

11 =

Wo

rst

East

Mid

lands

Am

bula

nce

Serv

ice

East of

Engla

nd

Am

bula

nce

Serv

ice

Isle

of

Wig

ht

London

Am

bula

nce

Serv

ice

Nort

h E

ast

Am

bula

nce

Serv

ice

Nort

h W

est

Am

bula

nce

Serv

ice

South

Centr

al

Am

bula

nce

Serv

ice

South

East

Coast

Am

bula

nce

Serv

ice

South

Weste

rn

Am

bula

nce

Serv

ice

West

Mid

lands

Am

bula

nce

Serv

ice

York

shire

Am

bula

nce

Serv

ice

Month

75%

466.3

1%

70.0

8%

52.5

0%

66.2

7%

67.4

0%

61.6

3%

74.4

7%

63.8

5%

YTD

75%

768.6

8%

68.1

4%

62.3

9%

69.4

0%

66.2

0%

69.1

5%

72.5

9%

64.3

9%

72.7

3%

76.2

1%

69.6

9%

Month

515.5

14.4

25.1

13.7

14.3

19.2

13.7

16.9

Month

75%

751.3

6%

62.2

0%

67.9

4%

64.0

0%

52.8

6%

57.3

1%

72.0

6%

50.3

9%

YTD

75%

956.9

3%

60.9

8%

70.8

9%

65.1

7%

64.2

0%

63.2

3%

72.7

1%

53.6

9%

56.8

7%

73.8

8%

74.1

6%

Month

95%

880.0

3%

91.1

2%

90.6

5%

91.8

9%

82.7

5%

85.4

2%

94.3

9%

87.1

3%

YTD

95%

11

84.3

8%

90.4

1%

92.3

7%

93.4

8%

90.2

4%

89.3

8%

94.4

9%

89.6

5%

86.0

7%

97.1

3%

95.7

1%

Month

71.4

%1.1

%1.3

%0.1

%0.6

%7.8

%0.5

%4.7

%1.8

%0.7

%1.6

%

YTD

81.8

%0.7

%1.5

%0.3

%0.4

%2.7

%1.1

%2.8

%2.2

%1.0

%0.9

%

Media

nM

onth

82

11

01

13

32

11

95th

Perc

entil

eM

onth

949

22

53

38

47

28

62

61

11

33

99th

Perc

entil

eM

onth

8111

80

16

49

80

145

90

119

135

52

90

Media

nM

onth

813

74

79

87

8

95th

Perc

entil

eM

onth

629

23

17

22

32

37

21

26

99th

Perc

entil

eM

onth

550

34

23

51

52

82

36

43

Cate

gory

A

Calls

Call

Abandonm

ent

Pro

port

ion o

f calls

abandoned b

efo

re b

ein

g a

nsw

ere

d

Tim

e to a

nsw

er

call

(in s

econds)

Tim

e to tre

atm

ent fo

r C

ate

gory

A

calls

(in

min

ute

s)

95th

centil

e o

f re

sponse tim

e f

or

Red 1

calls

(in

min

ute

s)

Pro

port

ion o

f R

ed 2

calls

responded to w

ithin

8 m

inute

s

Pro

port

ion o

f R

ed 1

calls

responded to w

ithin

8 m

inute

s

Pro

port

ion o

f C

ate

gory

A c

alls

responded to w

ithin

19

min

ute

s

Tim

elin

ess

40

Clin

ica

l O

utc

om

es

Leve

l 2 –

EM

AS

Pe

rfo

rman

ce

Am

bu

lan

ce

Se

rvic

e P

erf

orm

an

ce

Co

mp

ari

so

n

Am

bu

lan

ce S

erv

ice

Pe

rfo

rman

ce C

om

par

iso

n:

Clin

ical

Ou

tco

me

s

On

ly t

he

Uts

tein

gro

up

is s

ho

wn

in t

he

Car

dia

c A

rre

st in

dic

ato

rs. T

he

'Uts

tein

co

mp

arat

or

gro

up

' pro

vid

es a

co

mp

arab

le a

nd

sp

ecifi

c m

easu

re o

f th

e m

anag

emen

t o

f ca

rdia

c ar

rest

s

for

the

sub

set

of

pati

ents

wh

ere

tim

ely

and

eff

ecti

ve e

mer

gen

cy c

are

can

par

ticu

larl

y im

pro

ve s

urv

ival

(e.

g. 9

99

cal

ls w

her

e th

e ar

rest

was

no

t w

itn

ess

ed a

nd

th

e p

atien

t m

ay h

ave

gon

e in

to a

rres

t se

vera

l ho

urs

bef

ore

th

e 9

99

cal

l are

exc

lud

ed f

rom

th

e U

tste

in c

om

par

ato

r gr

ou

p fi

gure

).

Ou

t o

f 1

1 A

mb

ula

nce

ser

vice

’ EM

AS

are

ran

ked

9th

or

wo

rse

in 1

ou

t o

f th

e 6

mo

nth

ly in

dic

ato

rs a

nd

1 o

ut

of

the

6 y

ear

to d

ate

ind

icat

ors

sh

ow

n a

bo

ve.

Are

aIn

dic

ato

r

Late

st

Mo

nth

= S

ep

-16

Pe

rio

d

EM

AS

Ran

k

(ou

t o

f 11)

1 =

Be

st

11 =

Wo

rst

East

Mid

lands

Am

bula

nce

Serv

ice

East of

Engla

nd

Am

bula

nce

Serv

ice

Isle

of

Wig

ht

London

Am

bula

nce

Serv

ice

Nort

h E

ast

Am

bula

nce

Serv

ice

Nort

h W

est

Am

bula

nce

Serv

ice

South

Centr

al

Am

bula

nce

Serv

ice

South

East

Coast

Am

bula

nce

Serv

ice

South

Weste

rn

Am

bula

nce

Serv

ice

West

Mid

lands

Am

bula

nce

Serv

ice

York

shire

Am

bula

nce

Serv

ice

Month

545.9

5%

63.6

4%

33.3

3%

37.1

4%

72.0

0%

73.3

3%

58.0

6%

44.1

2%

39.1

3%

34.6

2%

45.6

5%

YTD

849.0

6%

57.0

6%

23.0

8%

55.6

4%

69.4

1%

62.0

7%

45.1

3%

54.4

0%

44.6

2%

49.2

8%

51.2

9%

Month

916.6

7%

27.5

9%

33.3

3%

11.7

6%

41.6

7%

34.6

2%

30.7

7%

30.0

0%

16.2

8%

19.2

3%

33.3

3%

YTD

10

20.2

8%

31.9

0%

15.3

8%

26.2

9%

44.3

0%

30.5

6%

24.4

0%

28.8

2%

20.6

6%

23.1

9%

32.0

2%

Month

556.4

9%

47.3

3%

55.5

6%

61.3

8%

55.5

6%

59.6

3%

46.1

5%

62.5

8%

35.5

2%

60.6

4%

42.0

0%

YTD

655.4

3%

50.8

0%

65.7

1%

63.6

9%

59.5

6%

53.7

6%

43.0

6%

67.2

7%

35.2

9%

56.6

9%

47.1

3%

Month

498.1

4%

97.7

3%

94.7

4%

97.0

3%

98.1

1%

99.6

7%

99.0

5%

95.6

1%

93.2

5%

96.8

1%

98.8

3%

YTD

398.6

9%

99.1

3%

97.2

0%

96.7

6%

97.6

7%

99.6

7%

98.4

6%

96.0

0%

94.3

0%

97.6

9%

98.4

9%

Month

293.3

3%

96.6

3%

33.3

3%

93.3

3%

93.1

0%

85.3

4%

83.3

3%

86.6

7%

72.4

8%

89.1

1%

84.6

9%

YTD

192.0

5%

91.2

4%

35.7

1%

91.6

3%

92.0

4%

81.9

2%

87.5

4%

90.8

6%

71.7

0%

87.6

2%

85.5

9%

Month

191.5

1%

88.3

9%

37.5

0%

74.2

4%

78.6

9%

85.8

0%

71.6

2%

76.6

4%

74.3

7%

81.3

7%

82.2

0%

YTD

485.0

6%

91.1

9%

61.5

4%

70.5

2%

81.7

3%

86.8

2%

70.5

0%

69.2

0%

77.6

1%

80.2

0%

87.0

9%

Pro

port

ion o

f patie

nts

who w

ere

resuscita

ted

who h

ad r

etu

rn o

f sponta

neous c

ircula

tion

on a

rriv

al a

t hospita

l

Pro

port

ion o

f patie

nts

who w

ere

dis

charg

ed

from

hospita

l aliv

e f

ollo

win

g r

esuscita

tion b

y

am

bula

nce s

erv

ice f

ollo

win

g a

card

iac a

rrest

Retu

rn o

f

Sponta

neous

Circula

tion

Surv

ival t

o

Dis

charg

e

Card

iac

Arr

est

(Uts

tein

gro

up)

Str

oke

Pro

port

ion o

f FA

ST p

ositi

ve p

atie

nts

pote

ntia

lly e

ligib

le f

or

str

oke

thro

mboly

sis

arr

ivin

g a

t a h

ypera

cute

str

oke

unit

with

in

60 m

inute

s

Pro

port

ion o

f suspecte

d s

troke

patie

nts

assessed f

ace to

face w

ho r

eceiv

ed a

n a

ppro

priate

care

bundle

Acute

STEM

I

Pro

port

ion o

f patie

nts

with

definite

ST-e

levatio

n m

yocard

ial

infa

rctio

n w

ho r

eceiv

ed p

rim

ary

angio

pla

sty

with

in 1

50

min

ute

s o

f call

connectin

g to a

mbula

nce s

erv

ice

Pro

port

ion o

f patie

nts

with

ST-e

levatio

n m

yocard

ial i

nfa

rctio

n

who r

eceiv

ed a

n a

ppro

priate

care

bundle

Level 2 – Arriva Performance

41

Arriva Patient Transport Services

The table above shows the Arriva Patient Transport Service (PTS) performance over the past 12 months for the 5 KPIs for Nottinghamshire. The performance for KPI1, the time in which a patient spends in the vehicle split by the distance that the patient lives from the point of care, has achieved each standard for this month. This includes the standard that patients within 10 miles of the point of care spend no longer than 60 minutes on the vehicle. Prior to this, this standard had failed once in the previous twelve months. KPI2, KPI3 and KPI5 have been below their relevant standards every recorded month over the last year. To improve performance Arriva have created a Service Improvement Plan for Nottinghamshire which has identified several areas for improvement - Improve partnership working along the patient pathway

Improve partnership working with points of care

Reduce number of aborted journeys at hospital for hospital triggered reason codes

Reduction in Crew wait times for patient at pick up from Unit

On the day patient transport changes - changes to patient clinic locations and patient collection points

Support the discharge pathway to improve the co-ordination of transport & TTOs

Improve understanding of mobility types when booking journeys

Confirmation required on the Patient support provided when a clinic has closed but the patient is not yet due to be collected by transport

Renal transport

Improve Renal performance Improve call centre performance

Improve site/HPs access to Cleric to book transport and making patients ready for collection

Reduce the number of abandoned calls and call waiting times into the Call Centre Improve performance of patient inward KPIs

Patients travelling in on crews first run not always meeting KPIs Improve internal performance management processes

The resource vs. demand peaks are only escalated on the day of travel, resulting in third party resources being engaged too late to be optimised efficiently and meet demand

More focus needed on how individual roles support and impact the KPIs Internal communication

Improve the internal communication & resolution of reoccurring service delivery issues that impact the KPIs

Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Patients w ithin 10 miles spend no longer than 60

mins on the vehicle97.0% 96.0% 97.0% 96.0% 96.0% 96.0% 96.0% 95.7% 96.7% 95.8% 96.1% 96.3%

10-35 miles spend no longer than 90 minutes on

the vehicle95.0% 96.0% 96.0% 95.0% 95.0% 96.0% 95.0% 95.0% 95.2% 94.1% 94.6% 95.5%

35-80 miles spend no longer than 120 minutes on

the vehicle92.0% 92.0% 93.0% 91.0% 91.0% 96.0% 96.0% 91.8% 92.5% 90.2% 90.1% 93.6%

KPI 2Arrival Times at

Point of Care

Patients shall arrive w ithin 60 minutes prior to their

appointment/zone time at the point of care79.0% 79.0% 82.0% 80.0% 79.0% 76.0% 76.0% 74.4% 78.2% 72.0% 70.1% 69.6%

OP Return patients shall be collected w ithin 60

mins of request or agreed transport/or zone time70.0% 72.0% 80.0% 72.0% 72.0% 65.0% 68.0% 68.1% 71.0% 65.0% 64.1% 65.4%

Discharge patients shall be collected w ithin 120

mins of request or agreed transport/or zone time68.0% 65.0% 73.0% 66.0% 61.0% 56.0% 56.0% 62.0% 60.0% 53.6% 52.2% 55.2%

Calls requesting PTS answ ered w ithin 10 seconds

by a booking agent, not an automated message36.0% 40.0% 38.0% 48.0% 40.0% 41.0% 55.0% 29.3% 32.1% 46.1% 49.7% 33.6%

Maximum percentage of calls requesting Non-

Emergency PTS are abandoned24.0% 19.0% 9.0% 15.0% 22.0% 17.0% 12.0% 26.7% 28.4% 16.3% 15.1% 22.1%

Nottinghamshire Patient Transport Service (PTS) Summary

Departure times

from Point of

Care

Time on Vehicle

- Patients w ithin

a certain radius

of the point of

care

Customer

Service

KPI 3

KPI 1

KPI 5

42

Leve

l 2 -

NH

S 1

11

Pe

rfo

rman

ce

Acc

ess

& Q

ua

lity,

Co

sts

and

Pati

en

t Ex

pe

rie

nce

Pe

rfo

rman

ce C

om

par

iso

n

No

ttin

gham

shir

e ar

e p

erfo

rmin

g w

ith

in t

he

top

10

fo

r 2

of

the

4 P

atien

t Ex

per

ien

ce in

dic

ato

rs. 9

0%

of

pati

ents

rep

ort

ed t

o b

e v

ery

or

fair

ly s

atisfi

ed w

ith

th

e 1

11

exp

erie

nce

, th

is

com

par

es

to 8

8%

wit

h t

he

nei

ghb

ou

rin

g ar

ea o

f D

erb

ysh

ire

Co

un

ty.

Ac

ce

ss

& Q

uali

ty,

Co

sts

an

d P

ati

en

t E

xp

eri

en

ce

The

follo

win

g p

age

s d

etai

l per

form

ance

of

key

ind

icat

ors

fo

r th

e N

HS

11

1 s

ervi

ce a

cro

ss t

he

Mid

lan

ds

and

Eas

t re

gio

n.

All

dat

a is

ap

pro

xim

ate

as D

erb

ysh

ire

Hea

lth

Un

ited

(D

HU

) as

sign

cal

ls b

ased

on

th

e ST

D C

od

e/lo

cati

on

of

mo

bile

ph

on

e m

ast,

an

d t

her

efo

re t

her

e w

ill b

e cr

oss

bo

rder

cal

ls a

nd

resi

den

ts o

f o

ther

are

as c

allin

g fr

om

wit

hin

No

ttin

gham

shir

e in

clu

ded

in t

he

figu

res.

Ad

diti

on

ally

th

e p

ho

ne

syst

em is

un

able

to

iden

tify

th

e lo

cati

on

of

5-1

0%

of

all c

alls

nati

on

ally

, th

ese

calls

are

allo

cate

d t

o a

ny

on

e o

f th

e 1

11

cen

tres

wh

o a

nsw

er

them

un

der

th

eir

loca

l co

ntr

acts

(th

is s

ho

uld

bal

ance

ou

t as

oth

er p

rovi

der

s w

ill a

nsw

er c

alls

fro

m N

otti

ngh

amsh

ire

resi

den

ts).

DH

U a

re w

ork

ing

to p

rovi

de

CC

G le

vel r

epo

rts

bu

t th

e sa

me

cav

eats

as

abo

ve w

ill a

pp

ly.

NC

A =

No

t cu

rren

tly

avai

lab

le

Are

aIn

dic

ato

r

Late

st

Mo

nth

= D

ec-1

6

No

tts

Ran

k

(ou

t o

f 17)

1 =

Be

st

17 =

Wo

rst

Lincolnshire

Luton

Nottinghamshire

Derbyshire

Great Yarmouth

Hertfordshire

Norfolk

Suffolk

South Essex

North Essex

Northamptonshire

Milton Keynes

West Midlands

Cambridgeshire &

Peterborough

Leicstershire &

Rutland

Staffordshire

Bedfordshire

-238

229

244

269

306

336

343

267

267

249

282

235

199

330

208

277

134

-238

229

221

256

295

233

297

267

261

245

282

235

196

203

208

250

134

14

1%

1%

2%

2%

1%

2%

4%

1%

1%

1%

2%

1%

1%

1%

2%

2%

2%

13

94%

92%

91%

90%

95%

95%

89%

93%

94%

92%

90%

95%

94%

96%

91%

92%

92%

782%

80%

86%

89%

82%

78%

80%

85%

86%

87%

91%

82%

87%

79%

92%

80%

72%

-22%

15%

24%

29%

24%

22%

23%

21%

23%

25%

25%

21%

25%

23%

25%

30%

14%

10

63%

32%

49%

48%

51%

75%

64%

49%

51%

45%

42%

51%

50%

72%

41%

77%

33%

900:0

1:4

400:0

1:2

000:0

0:5

200:0

0:3

600:0

3:3

100:0

0:4

700:0

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900:0

0:5

100:0

2:2

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4:2

200:0

0:1

800:0

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0:4

100:0

0:4

600:0

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0:0

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9

-N

CA

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CA

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CA

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CA

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CA

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CA

NC

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12

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11%

14%

15%

10%

12%

7%

15%

7%

9%

13

44%

53%

33%

36%

33%

67%

50%

50%

28%

28%

32%

45%

49%

59%

31%

38%

51%

-00:1

3:0

900:3

4:1

800:1

4:2

100:1

4:4

400:1

5:4

100:1

0:0

600:1

2:2

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2:5

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7:5

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900:1

2:4

700:1

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700:1

4:5

800:1

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400:3

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7

Costs

-36%

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11

90%

88%

90%

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90%

92%

91%

85%

93%

91%

88%

81%

91%

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90%

93%

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11

87%

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88%

91%

90%

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90%

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91%

90%

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88%

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year

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Qualit

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secs)

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43

Leve

l 2 -

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Suffolk

South Essex

North Essex

Northamptonshire

Milton Keynes

West Midlands

Cambridgeshire &

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Leicstershire &

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Bedfordshire

13

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53%

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34%

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Am

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hes

Quality Premium

44

The Quality Premium is £5 per head of running cost population and will be payable to CCGs in 2016/17 based on the quality of health services commissioned during 2015/16. This will be based on several measures that cover a combination of national and local priorities. This initial value will be reduced if providers, from which the CCG commissions services, are unable to meet the 4 key areas of the NHS Constitution and pledges for its population. As well as achieving the above there are 3 prerequisites for the Quality Premium to be payable. A CCG will not achieve a quality premium if it: a. is not considered in a manner that is consistent with Managing Public Money during 2015/16; or b. Incurs an unplanned deficit during 2015/16, or requires unplanned financial support to avoid being in this position; or c. Incurs a qualified audit in respect of 2015/16. The table below provides an overview of the Quality Premium for the CCG.

Nottingham North & East

£130,535

Percentage

of Quality

Premium

Potential

ValueAchieve by

Latest

Performance

Latest

Period

Available

Trend Award

Premature

Mortality10% £72,520

Less than

or equal to1984.6

2015 Calendar

Year2116.9 2014 £0

Unplanned hospitalisation for chronic ambulatory care

sensitive conditions

Less than

or equal to1000 2015/16 788.6 2015/16

Unplanned hospitalisation for asthma, diabetes and

epilepsy in children

Less than

or equal to1000 2015/16 164.9 2015/16

Emergency admissions for acute conditions that

should not usually require hospital admission

Less than

or equal to1000 2015/16 1137.1 2015/16

Emergency admissions for children with lower

respiratory tract infection

Less than

or equal to1000 2015/16 388.2 2015/16

Avoidable Emergency Admissions Composite 10% £72,520Less than

or equal to1000 2015/16 887.5 2015/16 £72,520

10% £72,520More than

or equal to22.52% 2015/16 23.39%

Apr-15 -

Mar-16£72,520

10% £72,520 Less than 2709 2015/16 2421 Mar-16 £72,520

Improvement in coding of patients attending A&EMore than

or equal to90% 2015/16 98.60%

Apr-15 -

Mar-16

Reduction in the number of patients with A&E 4 hour

breaches who have attended with a mental health need

More than

or equal to89.63% 2015/16 72.12%

Apr-15 -

Mar-16

10% £72,520 Less than 0.157 2015/16 0.228 2015/16 £0

10% £72,520 Less than 37.3% 31-Mar-16 37.3% 2014/15 £72,520

5% £36,260More than

or equal to6.5 Q4 2015/16 5 2015/16 £0

5% £36,260Less than

or equal to1.10 2015/16 1.11 2013/14 £0

3% £21,756 Less than 12.23% 2015/16 13.51% 2013/14 £0

2% £14,504 Validated Yes 2015/16

Local

Measure 1C3.9

Patients who have had an acute stroke who spend 90%

or more of their stay on a stroke unit10% £72,520 More than 89.2% 2015/16 90.2% 2015/16 £72,520

Local

Measure 2C5.4

Incidence of healthcare associated infection (HCAI)

Clostridium Difficile10% £72,520

Less than

(YTD)47

Less than 47

by 2015/1632

Apr-15 -

Mar-16£72,520

100% £725,195 £435,117

Percentage

of Quality

Premium

Potential

ReductionAchieve by

Latest

Performance

Latest

Period

Available

Trend Reduction

RTT -30% -£130,535More than

or equal to92% 2015/16 97.33%

Apr-15 -

Mar-16£0

A&E -30% -£130,535More than

or equal to95% 2015/16 89.55%

Apr-15 -

Mar-16-£130,535

Cancer -20% -£87,023More than

or equal to93% 2015/16 91.67%

Apr-15 -

Mar-16-£87,023

Ambulance -20% -£87,023More than

or equal to75% 2015/16 69.12%

Apr-15 -

Mar-16-£87,023

-100% -£435,117 -£304,582

CCG Name

Measure

Reducing NHS-responsible delayed transfers of care (days delayed

per 100,000 population)

Improvement in the health-related quality of life for people with a

long-term mental health condition

Reduction in the number of people with severe mental illness who

are smokers

Urgent &

Emergency

Care Menu

Mental

Health

Menu

An increase in the level of discharges at weekends and bank

holidays

Reducing Potential Years of Life Lost (PYLL) from causes

considered amenable to healthcare over time

Quality Premium

Forecast

N/A

A&E 5%

Increase the proportion of adults with secondary mental health

conditions who are in paid employment

Reduction in the number of antibiotics prescribed in primary care

Composite

Measure

Performance

Needed

N/A

£0£36,260

N/A

Performance

Needed

Improving

Antibiotic

Prescribing

Patients on incomplete pathways (yet to start treatment) should

have been waiting no more than 18 weeks from referral

Total

Reduction in the proportion of broad spectrum antibiotics prescribed

in primary care

Secondary care providers validating their total antibiotic prescription

data

Total

Patients should be admitted, transferred or discharged within four

hours of their arrival at an A&E department

Maximum two week (14-day) wait from urgent GP referral to first

outpatient appointment for suspected cancer

Red 1 ambulance calls resulting in an emergency response arriving

within 8 minutes (Total EMAS not CCG)

NHS Constitution Right and Pledges

Better Care Fund

45

The Better Care Fund creates a local single pooled budget to incentivise the NHS and local government to work more closely

together around people, placing their well-being as the focus of health and care services.

The BCF is a critical part of the NHS 2 year operational plans and the 5 year strategic plans as well as local government planning.

Within the BCF there are six indicators as shown below, which are supported by a range of schemes that contribute towards

delivery of the required standards.

Please note, the data is monitored and reported at Nottinghamshire County Local Authority level in line with the requirements

of the BCF. Therefore commentary may relate to organisations other than the CCG to which this report relates.

The latest data available is for Q2 2016/17.

REF Indicator 2016/17 Target

2016/17 (to date)

RAG rating

and trend

BCF1 (pg 5)

Total non-elective admissions in to hospital (general & acute), all-age, per 100,000 population

20,038 Q2

21,679 (proxy)

Q2

R

BCF2 (pg 9)

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population

578.9 284 Q2

G

BCF3 (pg 12)

Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services

91.2% 85.53%

Q2 R

BCF4 (pg 14)

Delayed transfers of care (delayed days) from hospital per 100,000 population (average per month)

1,086 Q2

978 Q2

G

BCF5 (pg 19)

Percentage of users satisfied that the adaptations met their identified needs

75% 100%

Q1 G

BCF5 (pg 19)

BCF5: Question 32 from the GP Patient Survey: In the last 6 months, have you had enough support from local services or organisations to help manage long-term health condition(s)

65.4% 64.4% YTD

R

BCF6 (pg 20)

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes directly from a hospital setting per 100 admissions of older people (aged 65 and over) to residential and nursing care homes

34% 19.1%

Q2 G

Better Care Fund

46

BCF 1 - Total non-elective admissions into hospitals (general and acute), all ages

Numerator All non-elective admissions into hospital (all ages)

Denominator Nottinghamshire resident population Reporting Monthly, two months in arrears (targets quarterly). Low values are good.

Source Secondary Uses Service (SUS), NHS England.

Current RAG rating

and trend

2016/17

R

▼

21,679

19,707

19,866

20,038

19,743

Planned Actual

Apr 16 - Jun 16

Jul 16 - Sep 16

Oct 16 - Dec 16

Jan 17 - Mar 17

21,457 (proxy)

21,679 (proxy)

Comments

Monitored by CCG boards and System Resilience Groups

This data is provisional from SUS (national data published monthly by NHS England)

SUS data is not currently available for CCGs outside of Nottinghamshire, MAR data presented as a

proxy

Better Care Fund

47

BCF 3 - Proportion of older people (65 and over) who were still at home 91 days after discharge from

hospital into reablement / rehabilitation services

Planned Actual Current RAG rating and trend

Baseline rate 88.8% April – March 2013/14

R

85.53% Q2

2014/15 Target

89.8% 89.7%

2015/16 Target

90.7% 91.93%

2016/17 Target 91.2% 83.86%

Comments Data reported three months in arrears due to indicator definition

Monitored by Nottinghamshire County Council ASCH&PP

This data is provisional (national data published annually).

Key issues Overall performance is below target. New data collection methodology in place for 16/17 and discrepancies are being addressed with individual service areas. Small numbers and data validation means that variation against target on a monthly basis can impact significantly on RAG rating. The target requires the denominator i.e. people receiving reablement/rehabilitation services to be maintained.

Mitigating actions This year we are able to include step down services such as transfer to assess that are provided at the care and support centres as these are now recorded on FWi. This has increased the number of people that are included in this indicator as being discharged from hospital into reablement services however the percentage still at home after 91 days has reduced. The START service are maintaining performance at 91.4% (as measured in 2015/16), however the new step down discharge services are performing at 71%, which has reduced the overall figure to 82%. This indicator is currently off target.

The graph below shows Quarter 2 performance by CCG.

Better Care Fund

48

BCF 5 - Question 32 from the Patient GP Survey: In the last 6 months, have you had enough support from

local services or organisations to help manage long-term health condition(s)

Question 32 from the GP Patient Survey: In the last 6 months, have you had enough support from local services or organisations to help manage long-term health condition(s)

2013/14 Baseline 65.8%

2014/15 target 67.1%

2015/16 target 68.5%

2015/16 actual 64.4%

2016/17 target 65.4%

Latest performance (July 2016 weighted) 64.4%

Reporting Data is reported six monthly, four months in arrears. High values are good

Source NHS England six monthly reporting

Documents

March 2017 Incomplete - Nottingham North · NHS Nottingham North & East G Monthly Quality & Performance ReportRTT March 2017 Summary (Pages 1 to 2) Key Issues and oncerns Improvement