Quality, Performance and Finance Report May 2014

Quality, Performance and FinanceReport

May 2014

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Contents

Slide Number Title

3 Background and Timetable

4 Executive Summary

5 – 12 Domains 1 & 5 - Quality Performance including exception reports

13 – 26 Domain 2&3 - NHS Constitution Performance including exception reports

27 – 30 Quality Premium & Outcomes Framework

31 – 55 Domain 4 Finance & Activity• CCG Board Summary• Provider Analysis Overview• County Durham And Darlington NHS FT POD Analysis• North Tees and Hartlepool NHS FT POD Analysis• City Hospitals Sunderland NHS FT• South Tees Hospitals NHS FT• NEAS• Mental Health• Other Healthcare

56 – 57 Glossary

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Please find attached the Quality, Performance and Finance report (QPF) for NHS Durham Dales, Easington and Sedgefield CCG for May 2014. Activity and finance data used in the report is for month 12 (March 2014) .

The report uses the latest published metric data for quality and performance, and where possible if later unpublished data (white text) is available this has been included. If information is not available it has been flagged within the report.

NECS will continue to work with the CCG to ensure the content and format of the report fits with the needs of the organisation.

In addition to the formal QPF report the Quality and Performance published data is now available in RAIDR.

Background and Timetable

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Report Amendments

Future developments:• On-going development as per CCG requirements

Recommendation:This report is for the CCG to note current performance and the risks to national indicators in 2013/14. The committee is asked to endorse the actions to address underperformance and suggest further remedial action if appropriate.

Executive Summary

HeadlinesThe headlines for this report are summarised as follows:

Performance Indicator Provider/CommissionerDescription of

Performance Failure Exception Report No.A&E CDDFT Failed 13-14 CDDFT ER01A&E CHSFT Failed 13-14 CHSFT ER01Hospital Handovers CDDFT Numerous breaches CDDFT ER02Hospital Handovers CHSFT Numerous breaches CHSFT ER02Cancer 62 days DDES CCG Failed 13-14 DDES ER01Cancer 31 days CHSFT Monthly breaches CHSFT ER03Ambulance Response Times Cat A NEAS Failed 13-14 NEAS ER01Mental Health IAPT Performance TEWV / MH Providers Failed 13-14 MH ER01

Quality Indicator Provider/CommissionerDescription of

Performance Failure Exception Report No.CQC Enforcement NEAS CQC Visit QER01MONITOR NEAS Monitor Risk QER02SHMI CHSFT / NTHFT Negative Outlier QER03HSMR CHSFT / NTHFT Negative Outlier QER04Friends & Family CDDFT / CHSFT / NTHFT Poor performance QER05Serious incidents All Unclosed SIs QER06HCAI All Various breaches QER07

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Quality Performance

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OVERALL l l l l l lRegulators

Has any local provider been subject to local enforcement action by the CQC? Y/N Apr-14 Monthly l l l l l l QER01Has any local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider lisence conditions? Y/N Apr-14 Monthly l l l l l l QER02

Has any local provider been subject to enforcement action by the NHS TDA based on 'quality' risk? Y/N No Data Monthly l l l l l l

Clinical effectiveness

Has any provider been identified as a 'negative outlier' on SMHI? Y/N Apr-14 Monthly l l l l l l QER03Has any provider been identified as a 'negative outlier' on HSMR? Y/N Apr-14 Monthly l l l l l l QER04

Patient experience

Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern for any provider? Y/N Mar-14 Monthly l l l l l l QER05

Safety

Does any provider currently have any unclosed Serious Untoward Incidents (45 days)? Y/N Apr-14 Monthly l l l l l lDoes any provider currently have any unclosed Serious Untoward Incidents (60 days)? Y/N Apr-14 Monthly l l l l l lHas any provider experienced any 'Never Events' during the last month ? Y/N Apr-14 Monthly l l l l l lCCG

Does the CCG have any outstanding conditions of authorisation in place on clinical governance? Y/N No Data Quarterly l l l l l lHas the CCG self assessed and identified any risks associated with concerns around quality issues discussed regularly by the CCG governing body?

Y/N No Data Quarterly l l l l l lHas the CCG self assessed and identified any risks associated with concerns around the arrangments in place to proactively identify early warnings of a failing service?

Y/N No Data Quarterly l l l l l lHas the CCG self assessed and identified any risks associated with concerns around the arrangements in place to deal with and learn from serious untoward incidents and never events? Y/N No Data Quarterly l l l l l lHas the CCG self assessed and identified any risks associated with concerns around being an active participant in its Quality Surveillance Group?

Y/N No Data Quarterly l l l l l lIf there was an emergency event in the last quarter, has the CCG self assessed and identified any areas of concern on the arrangments in place for dealing with such an event?

Y/N No Data Quarterly l l l l l lHas the CCG self assessed and identified any risk to progress against its Winterbourne View action plan?

Y/N No Data Quarterly l l l l l l

QER06

Exception Report QER01 – CQC Enforcement

CCG CDDFT CHSFT NTHFT NEAS TEVW

Has any local provider been subject to any enforcement action by the CQC?

Performance Update:

NEAS

The CQC published their report on 26.04.14 following their inspection visit to the Trust in February 2014. The CQC found that 4 of the 6 standards inspected were not being met and enforcement action has been issued against the Trust. The areas of concern identified by the CQC are as follows:

• Management of Medicines – the CQC found that medicines, other than controlled drugs, were not always stored safely. Medications requiring refrigeration were not always stored properly and securely, fridge temperatures not maintained and stored in vehicles at room temperature. The CQC judged that this has minor impact on people who use the services and advised the Trust that action is required.

• Requirement Relating to Workers – the CQC found that since 2009 effective recruitment procedures have not been in place and as a result DBS checks had not been carried out on staff at time of employment or on a rolling basis. The CQC were reassured by the recovery plan and actions in place which was on target for completion by the Trust in April. The CQC judged this moderate impact on people who use the services and issued enforcement action to the Trust. The Trust is also required to provide weekly updates on progress until the recovery plan has reached a conclusion.

• Supporting Workers – the CQC found that a significant number of staff had not received one to one supervision sessions. The CQC judged this to have minor impact on people who use the services and advised the Trust that action is required.

• Accessing and monitoring the quality of service provision – the CQC found that there was no effective governance process in place to monitor/oversee the complaints system and ensure that all complaints were dealt with in a timely manner in line with Trust policy. A shortfall in availability of investigating officers was also identified. The CQC judged that this had a moderate impact on people who use the service and advised the Trust that action is required.

Remedial actions:

NEAS

The CQC findings will be discussed at the next NEAS CQRG in May 2014..

CCG Comments

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Exception Report QER02 – Monitor


Has any local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider licence conditions?

Performance Update:

NEAS

Monitor are currently investigating concerns in relation to the recent CQC visits outlined in exception report QER01

Remedial actions:

NEAS

Concerns will be reviewed at the forthcoming CQRG in May 2014. ..

CCG Comments

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Exception Report QER03 – Mortality (SHMI)


Has any provider been identified as a 'negative outlier' on SHMI?

Performance Update:

The North of England Quality Dashboard March 2014 (published April 2014), indicates for the period January 2013 to December 2013 that • CHSFTs overall HSMR rate is worse than expected at 117.8 and• NTHFTs overall rate is worse than expected at 113.4.

Remedial actions:CHSFT:

A number of actions have been taken by the Trust to improve the reported rates for HSMR including:• all deaths are discussed regionally and peer reviews are carried out to identify any preventable actions,• all case notes are reviewed and deaths scored, • Review of coding underway as differences with approach to use of palliative care coding is main contributing factor

NTHFT:• The Trust is continuing to review each death as part of a planned mortality review process to ensure that lessons are learned from avoidable deaths. The

tool used as part of this process has been provided from the national team involved in the Keogh review to facilitate local monitoring and national benchmarking.

• The Trust is developing a Trust policy to support the activity for ensuring reviews are undertaken; ensuring appropriate structures are in place to ensure information obtained and lessons learned are shared across all levels. Regular updates are provided to clinical teams regarding the current information, which assists in providing an early warning of any changes in mortality.

• NHS England and NEQOS are providing support to the Trust in introducing a Pneumonia process measures project; which will allow the Trust to introduce a different approach towards the management of Pneumonia. A deep dive for some re-admissions will commence as part of the Pneumonia process. The project commenced in February 2014 and will run for the duration of 2014 /15.

• The Trust is involved with regional work on mortality which is being supported externally by NEQOS. This work has a focus on the overall health within the region and how this has an affect on mortality. The regional group is developing a tool to support reviewing across all Trusts in order to allow direct comparisons as well as peer review. Queries have been raised with the Trust in relation to the anticipated impact of the regional work; the Trust assures that the benefits of the work of the Task and Finish group established following the Keogh report should be visible over the summer period.

• The CCG attended an NTHFT review, with 39 patient records reviewed using a criteria based tool and further analysis undertaken as necessary. For the cases reviewed, it was reported that one case out of the 39 could have had an avoidable death outcome.

• Trust report to Board to be shared with CCG following Board approval which includes the timeline for the impact of current actions. • CCG requested in May 2014 clarification of coding ( including ambulatory coding), and consideration of any gaps in the context of wider health and social

care factors or required actions. Trust have confirmed ambulatory coding is not included

CCG Comments 8

Exception Report QER04 – Mortality (HSMR)


Has any provider been identified as a 'negative outlier' on HSMR?

Performance Update:

The North of England Quality Dashboard March 2014 (published April 2014), indicates for the period December 2012 to November 2013 that • CHSFTs overall SHMI rate is worse than expected at 108.98 and • NTHFTs overall SHMI rate is worse than expected at 111.82

Remedial actions:

CHSFT:

A number of actions have been taken by the Trust to improve the reported rates for SHMI including:• all deaths are discussed regionally and peer reviews are carried out to identify any preventable actions,• all case notes are reviewed and deaths scored, • As reported with HSM a review of coding is underway

NTHFT:• Monitoring of HSMR continues through the CQRG. The Trust has identified a target review of cases within the diagnosis groups (within the

HSMR indicator set), these are; Pneumonia, Aspiration Pneumonitis, Congestive Heart Failure and Urinary Tract Infection. • The Trust is continuing to review each death as part of the planned mortality reviews, where all deaths in hospital are reviewed to ascertain if

an individuals death was avoidable. The tool used as part of this review has been provided from the national team involved in the Keogh review.

• The Trust is developing a Trust policy to support the activity for ensuring reviews are undertaken; ensuring appropriate structures are in place to ensure information obtained and lessons learned are shared across all levels. Regular updates are provided to clinical teams regarding the current information, which assists in providing an early warning of any changes in mortality.

• NHS England and NEQOS are providing support to the Trust in introducing a Pneumonia process measures project; which will allow the Trust to introduce a different approach towards the management of Pneumonia. A deep dive for some re-admissions will commence, as part of the Pneumonia process.

Monitoring continues through the respective CQRGs.

CCG Comments

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Exception Report QER05 - Friends and Family TestIndicatorDoes feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern for any provider?


Performance Update:

March published indicates the following concerns :

CDDFT:

In patient response rates - UHND at 29.67% remains below the England average of 34.8.

In patient score - DMH obtained a score of 69, UHND 71 both sites continue to remain slightly below the England average of 73.

A&E response rates - DMH increased their response to 14.79% but still remain below the national average and target.

A&E Scores - both hospitals scored 41 which is an improvement on previous month but these still continue to remain significantly below the national average of 54.

CHSFT: only area to highlight in relation to FFT is that the A&E response rate for CHSFT fell to 14.66 taking it below the national target of 15%.

NTHFT: only area to highlight is that the in-patient score at North tees hospital site at 68 fell below the England average of 73.

Remedial actions:

CDDFT: FFT remains a standing agenda item at the CQRG. As reported previously CDDFT identified an issue regarding the accuracy of the FFT in-patient and A&E data. A re-count of the Trust’s FFT data from April 2013 has taken place and NHS England is expected to publish the revised data in late May 2014. This will be shared with CCGs when this is available.

CHSFT: Performance regarding A&E response rate will be monitored through forthcoming FFT data and discussed at the CQRG.

NTHFT: Performance regarding the In patient score at the North Tees site will be monitored through forthcoming FFT data and discussed at the CQRG.

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CCG Comments

Exception Report QER06 - Unclosed Serious Incidents Indicator

Does any provider currently have any unclosed Serious Untoward Incidents (45 days)?

Does any provider currently have any unclosed Serious Untoward Incidents (60 days)?


Performance Update:

Remedial actions:

The majority of providers nationally continue to experience problems in achieving the 45 and 60 day targets. Breaches are a consequence of internal governance systems within providers delaying the release of reports to the Commissioner. Performance related activity continues to be monitored through the serious incident panel and informal 1:1 meetings with providers. The CQRGs are also responsible for formally monitoring this activity. CCGs have incorporated SI performance into the quality requirements of the 2014/15 contract with providers.

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Provider No of 45 day reports due

45 day reports received in timeframe

No of 60 day reports due

60 day reports received in timeframe

CDDFT 16 9 0 0

CHSFT 15 12 0 0

NTHFT 3 0 1 0

NEAS 1 1 0 0

TEWV 1 0 0 0

CCG Comments

Exception Report QER07 - HCAI

Performance Update:

MRSA

There is a zero tolerance of MRSA which means that all commissioner and provider targets are zero.

DDES CCG reported 1 case in September and 1 case in January

CDDFT reported 1 case in September

CHSFT reported 1 case in April, August, September and 1 unpublished case in March – 4 in total

NTHFT are reporting zero cases

C.Diff

DDES CCG – 73 cases identified to 31st March against an annual target of 87

CDDFT – 27 cases identified to 31st March against an annual target of 40

CHSFT – 40 cases identified to 31st March against an annual target of 36

NTHFT – 30 cases identified to 31st March against an annual target of 40

Remedial actions:

All breaches are discussed through monthly Clinical Quality Review Group meetings. The post infection review process has been followed for

all identified cases with relevant lessons learnt identified and actions implemented as appropriate.

Indicator Threshold CCG CDDFT CHSFT NTHFT

Incidence of MRSA 0 2 1 4 0

Incidence of C.Diff 87 73 27 40 30

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CCG or Director Comments

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NHS Constitution Performance Summary

Indicator Description Frequency Data Period Threshold

Referral to treatment access times

% of patients initial treatment within 18 weeks for admitted pathways 90.0% 92.1% 91.1% 91.1% 92.9%

% of patients initial treatment within 18 weeks for non- admitted pathways 95.0% 98.4% 98.5% 98.2% 98.9%

% patients waiting for initial treatment on incomplete pathways within 18 weeks 92.0% 93.9% 93.5% 93.6% 97.4%

Number patients waiting more than 52 weeks for treatment 0 2 1 0 0

Diagnostic waits

% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology) Monthly Mar-14 1.00% 0.18% 0.01% 0.32% 0.08%

A&E waits

% patients spending 4 hrs. or less in A&E or minor injury unit w/e 30th Mar-14 95.0%94.9% 94.4% 96.1%

CDDFT ER01CHS ER01

Handover between ambulance and A&E over 30 minutes 0 2402 1013 25 4537

Handover between ambulance and A&E0ver 60 minutes or more 0 898 250 3 1318

Cancer patients 2 week wait

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 95.6% 96.5% 94.3% 94.5%

% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0% 93.4% 94.1% 93.3% 94.7%

Cancer patients - 31 days

% of patients treated within 31 days of a cancer diagnosis 96.0% 98.5% 99.5% 97.8% 99.5% CHS ER03

% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0% 97.2% 99.7% 99.5% 98.0%

% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0% 99.8% 100.0% 100.0% 100.0%% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy 94.0% 98.2% 100.0% 100.0% 100.0%Cancer patients - 62 days

% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 83.9% 88.2% 85.5% 87.6% DDES ER01

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service 90.0% 96.8% 91.3% 100.0% 96.8%% of patients treated for cancer within 62 days of consultant decision to upgrade status 85.0% 100.0% 100.0% 95.6% 100.0%

Ambulance response times

Cat A response in 8 mins (red 1&2) 71.0% 67.8% 78.5%

Cat A Response within 19 mins 95.0% 93.7% 97.0%

Number of crew clear delays over 30 mins 0 10,760

Number of crew clear delays over 60 mins 0 555

Mixed Sex accommodation

Mixed Sex accommodation - number of unjustified breaches Monthly YTD Mar -14 0 0 0 0 0

Mental Health

% people followed up within 7 days of discharge from psychiatric in patient care Monthly YTD Feb-14 95.0% 97.7%

HCAIIncidence of MRSA (QP) 0 2 1 4 0Incidence of C Diff (QP) - threshold relates to CCG performance 87 73 27 40 30

Monthly YTD Feb-14

DDES CCG - Performance Summary

DDES

CDDF

T

NTHF

T

NEAS

Exce

ption

Rep

ort

YTD Mar-14CDDFT ER02

CHS ER02

CHSF

T

Weekly To Mar -14

Monthly

QER07

YTD Mar-14

YTD Mar-14

Monthly

YTD Mar-14

YTD Mar-14

Monthly

Monthly

Monthly

NEAS ER01

YTD Mar-14

NHS Constitutional Indicators by month - DDES CCG

Quality Indicator Operational Standard

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 YTD Exception Report No.

Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 93.70% 93.20% 92.50% 92.50% 91.60% 92.10% 91.30% 91.30% 91.30% 91.30% 91.80% 92.10%Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 98.90% 98.80% 98.10% 98.30% 98.30% 98.30% 98.50% 98.00% 98.20% 98.20% 98.40% 98.40%Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more 92% 95.60% 95.10% 94.40% 93.50% 93.80% 94.10% 94.60% 94.60% 93.80% 94.40% 93.90% 93.90%Number of patients waiting more than 52 weeks 0 0 0 0 0 0 1 1 1 0 0 0 2

Percentage of patients waiting 6 weeks and over 1% 0.10% 0.00% 0.00% 0.00% 0.10% 0.40% 0.10% 0.30% 1.10% 0.40% 0.30% 0.18%

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

93% 96.30% 96.20% 96.10% 96.30% 96.50% 96.50% 94.30% 96.23% 97.10% 93.60% 95.50% 93.90% 95.60%

Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

93% 95.50% 92.00% 93.30% 96.40% 94.90% 89.80% 94.50% 87.28% 92.90% 93.30% 94.50% 95.20% 93.40%

Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers 96% 98.30% 99.10% 98.20% 97.90% 93.20% 100.00% 99.20% 98.50% 100.00% 98.20% 99.20% 99.10% 98.50%Maximum 31 day wait for subsequent treatment where that treatment is surgery 94% 100.00% 93.50% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 92.90% 100.00% 92.00% 97.20%Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen 98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.40% 100.00% 100.00% 98.00% 100.00% 100.00% 99.80%Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 90.20% 94.28% 95.50% 100.00% 100.00% 100.00% 98.20%

Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85% 90.00% 89.80% 84.80% 80.50% 80.60% 81.70% 80.30% 84.28% 83.10% 83.70% 81.70% 87.30% 83.90% DDES ER01

Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers 90% 100.00% 100.00% 88.90% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 92.30% 100.00% 85.70% 96.80%

Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers)

85% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Category A calls resulting in an emergency reponse arriving within 8 minutes (Red 1&2) 71% 67.58% 68.58% 70.71% 68.51% 67.36% 71.55% 70.08% 69.42% 62.45% 67.75% 66.83% 63.17% 67.79%Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 94.25% 93.84% 96.40% 94.76% 95.40% 94.17% 93.75% 95.33% 91.97% 91.87% 92.35% 90.37% 93.68%

Minimise MSA breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Care Programme Approach (CPA): The proportion of people under adult mental i l lness specialities on CPA 95% 100.00% 100.00% 90.48% 97.00% 99.40% 97.30% 98.71% 98.71% 98.05% 98.18% 97.96% 97.12% 97.74%

Incidence of MRSA to 31st March 2014 0 0 0 0 0 0 1 0 0 0 1 0 0 2Incidence of CDIFF to 31st March 2014 87 6 7 6 7 7 6 8 3 3 6 6 8 73

Referral to Treatment waiting times for non urgent consultant led treatment

Diagnostic test waiting times

NEAS ER01

QER07

Mental Health

HCAI Incidence

Cancer patients - 2 week wait

Cancer waits - 31 days


Category A ambulance calls

Mixed sex accomodation breaches

NHS Constitutional Indicators by month - CDDFT


Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 YTD Exception Report

% of patients initial treatment within 18 weeks for admitted pathways

90.00% 91.80% 92.60% 91.90% 91.60% 90.70% 91.70% 90.20% 90.20% 90.20% 90.40% 90.30% 91.10%

% of patients initial treatment within 18 weeks for non- admitted pathways

95.00% 98.70% 98.90% 98.50% 98.20% 98.90% 98.80% 98.70% 98.00% 98.30% 97.90% 98.40% 98.50%

% patients waiting for initial treatment on incomplete pathways within 18 weeks

92.00% 95.70% 95.70% 95.50% 94.90% 94.70% 93.90% 94.40% 93.90% 93.80% 93.70% 93.50% 93.50%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 0 0 0 0 0 0 0 1 0 0 0 1

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

1% 0.07% 0.00% 0.04% 0.04% 0.05% 0.19% 0.20% 0.20% 0.70% 0.30% 0.00% 0.01%

% patients spending 4 hrs. or less in A&E or minor injury unit to 30th March 2014

95% 91.78% 96.01% 97.64% 97.01% 95.36% 94.73% 93.04% 95.96% 95.68% 92.39% 93.28% 96.58% 94.90% CDDFT ER01

Handover between ambulance and A&E over 30 minutes 0 196 166 149 153 159 165 222 147 222 289 278 256 2,402Handover between ambulance and A&E over 60 minutes or more

0 87 39 29 33 62 35 75 62 97 159 129 91 898

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

93% 97.40% 97.20% 97.30% 96.60% 96.20% 96.20% 97.00% 96.70% 96.70% 94.50% 97.20% 95.30% 96.50%

% of patients seen within 2 weeks of an urgent referral for breast symptoms

93% 89.20% 95.30% 96.90% 96.00% 93.50% 92.30% 94.70% 89.80% 95.80% 94.60% 93.30% 96.60% 94.10%

% of patients treated within 31 days of a cancer diagnosis 96% 100.00% 100.00% 100.00% 98.40% 98.40% 100.00% 98.60% 100.00% 100.00% 99.40% 100.00% 100.00% 99.50%% of patients receiving subsequent treatment for cancer within 31 days - surgery

98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.90% 100.00% 100.00% 99.70%

% of patients receiving subsequent treatment for cancer within 31 days - drugs

94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

% of patients treated within 62 days of an urgent GP referral for suspected cancer

85% 88.40% 90.00% 88.90% 88.10% 93.40% 88.80% 88.30% 84.60% 85.00% 86.20% 91.00% 87.00% 88.20%

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

90% 100.00% 100.00% 100.00% 88.90% 100.00% 100.00% 75.00% 50.00% 100.00% 84.60% 100.00% 100.00% 91.30%

% of patients treated for cancer within 62 days of consultant decision to upgrade status

85% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Mixed Sex accommodation - number of unjustified breaches0 0 0 0 0 0 0 0 0 0 0 0 0 0


QER07



A & E waits

CDDFT ER02



Mixed sex accommodation breaches

HCAI Incidence

NHS Constitutional Indicators by month - CHSFT




90.00% 93.30% 91.60% 92.30% 90.60% 91.40% 90.10% 89.90% 90.10% 90.70% 91.50% 90.30% 91.10%


95.00% 99.50% 97.70% 96.90% 98.10% 97.90% 98.00% 97.90% 98.40% 98.60% 98.10% 98.30% 98.20%


92.00% 95.50% 94.30% 93.20% 92.20% 92.00% 93.70% 94.70% 94.80% 94.00% 93.50% 93.60% 93.60%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 0 0 0 0 0 0 0 0 0 0 0 0


1% 1.66% 0.00% 0.00% 0.00% 0.02% 0.00% 0.00% 0.20% 1.00% 0.50% 0.41% 0.32%

% patients spending 4 hrs. or less in A&E or minor injury unit to 30th March 2014

95% 96.48% 93.27% 92.04% 94.37% 94.63% 96.52% 93.92% 94.26% 95.25% 93.24% 93.77% 96.11% 94.40% CHS ER01

Handover between ambulance and A&E over 30 minutes 0 65 88 81 69 41 32 97 44 82 141 138 135 1,013Handover between ambulance and A&E over 60 minutes or more

0 19 16 41 16 9 5 23 9 20 30 40 22 250


93% 94.00% 93.90% 93.90% 95.60% 95.30% 94.10% 92.50% 94.20% 94.70% 93.20% 94.50% 96.20% 94.30%


93% 97.00% 97.50% 91.40% 93.40% 98.70% 93.30% 95.20% 88.70% 85.40% 90.60% 93.90% 94.50% 93.30%

% of patients treated within 31 days of a cancer diagnosis 96% 98.70% 100.00% 100.00% 99.40% 100.00% 98.70% 98.40% 100.00% 98.00% 92.10% 94.30% 95.60% 97.80%% of patients receiving subsequent treatment for cancer within 31 days - surgery

98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 95.70% 100.00% 100.00% 99.50%


94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%


94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%


85% 91.20% 89.30% 93.00% 89.50% 85.90% 80.10% 89.00% 78.90% 88.90% 83.10% 78.20% 78.50% 85.50%


90% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%


85% 100.00% 100.00% 100.00% 100.00% 50.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 95.60%

Mixed Sex accommodation - number of unjustified breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0


QER07



A & E waits

CHS ER02





HCAI Incidence

CHS ER03

NHS Constitutional Indicators by month - NTHFT


Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 YTD Exception Report No.

Referral to Treatment waiting times for non urgent consultant led treatment Admitted patients to start treatment within a maximum of 18 weeks from referral

90.00% 93.00% 94.73% 92.10% 93.10% 93.20% 92.90% 91.66% 92.90% 93.60% 92.60% 92.90% 92.90%

Non-admitted patients to start treatment within a maximum of 18 weeks from referral

95.00% 98.91% 99.31% 99.20% 99.10% 99.10% 98.90% 98.91% 98.40% 98.70% 98.50% 98.80% 98.90%

Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more

92.00% 97.10% 97.70% 97.20% 97.30% 97.00% 96.80% 97.47% 97.20% 97.00% 97.40% 97.40% 97.40%

Number of patients waiting more than 52 weeks 0 0 0 0 0 0 0 0 0 0 0 0 0

Diagnostic test waiting times Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

1% 0.02% 0.02% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.40% 0.20% 0.10% 0.08%

A & E waits % patients spending 4 hrs. or less in A&E or minor injury unit to 30th March 2014

95% 95.12% 97.32% 97.94% 96.55% 94.92% 95.75% 96.22% 95.93% 93.31% 96.15% 97.14% 97.13% 96.13%

Handover between ambulance and A&E between 30 and 60 minutes YTD

0 3 0 0 2 6 0 1 2 2 4 3 2 25

Handover between ambulance and A&E 60 minutes or more YTD

0 0 0 0 0 2 0 0 0 0 0 0 1 3



93% 93.70% 94.00% 93.90% 95.70% 94.20% 95.00% 94.50% 94.82% 95.20% 92.10% 94.60% 95.80% 94.50%


93% 90.51% 93.00% 93.40% 93.80% 94.40% 96.40% 97.20% 91.72% 95.60% 97.50% 94.10% 95.70% 94.70%

Cancer waits - 31 days Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers

96% 100.00% 99.00% 100.00% 99.40% 100.00% 100.00% 99.30% 99.12% 100.00% 97.40% 100.00% 100.00% 99.50%

Maximum 31 day wait for subsequent treatment where that treatment is surgery

94% 90.00% 97.00% 100.00% 100.00% 100.00% 100.00% 94.10% 100.00% 100.00% 94.10% 100.00% 94.70% 98.00%

Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen

98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy

94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Cancer waits - 62 days Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer

85% 82.54% 84.00% 91.80% 87.60% 88.20% 88.20% 89.10% 87.27% 88.40% 87.20% 84.20% 89.20% 87.60%

Maximum 62 day wait from referral from an NHS screenng service to first definitive treatment for all cancers

90% 100.00% 98.00% 93.30% 100.00% 100.00% 93.50% 98.50% 100.00% 94.40% 100.00% 86.00% 96.30% 96.80%


85% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%


Minimise MSA breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0

HCAI Incidence

Incidence of MRSA to 31st March 2014 0 0 0 0 0 0 0 0 0 0 0 0 0 0 QER07

Incidence of CDIFF to 31st March 2014 40 3 6 1 3 4 4 5 1 0 2 1 0 30

18

NHS Constitutional Indicators by month - NEAS

NHS Constitutional Indicators by month – TEWV / MH



Category A calls resulting in an emergency reponse arriving within 8 minutes (Red 1&2)

75.00% 79.88% 79.22% 81.06% 79.08% 80.16% 80.86% 79.38% 78.88% 75.67% 77.78% 75.60% 74.56% 78.46%

Category A calls resulting in an ambulance arriving at the scene within 19 minutes

95.00% 97.25% 97.45% 97.79% 97.12% 97.69% 97.77% 97.17% 97.66% 96.20% 96.41% 96.10% 95.43% 96.99%

No. of ambulance crews not ready to accept new calls within 30 minutes of handover to A&E (Clearance Time) YTD

0 2,365 2,489 2,715 1,688 351 325 139 154 144 152 125 113 10,760

No. of ambulance crews not ready to accept new calls within over 60 minutes of handover to A&E (Clearance Time)

0 105 141 129 80 19 14 12 7 14 15 9 10 555

Handover between ambulance and A&E over 30 minutes 0 425 371 299 285 286 263 369 309 407 504 488 531 4,537Handover between ambulance and A&E over 60 minutes or more 0 156 91 77 52 75 47 101 86 132 197 180 124 1,318

Category A ambulance calls

NEAS ER01

Mental Health IndicatorsOperational Standard

YTD Exception Report No.

People seen by Crisis Services before admission 95.00% 98.44%

CPA 7 day follow up 95.00% 98.04%The percentage of discharges on CPA who are followed up within 7 days that are done so on a face to face basis

95.00% 97.12%

Delayed transfers of care 7.50% 1.14%

IAPT IndicatorsOperational Standard

YTD Exception Report No.

Proportion of people that enter treatment against the level of need in the general population

12.000% 8.23%

Proportion of people who complete treatment who are moving to recovery 50.00% 45.37%MH ER01

Performance Update

CDDFT were below the target in January ( 92.4%) and February (93.3%), while the performance trend improved during March (96.6%) this wasn’t enough to

achieve the 95% target, and Q4 Performance to week 52 (30th March 2014) is 94.1%. Year end performance is 94.9%.

CDDFT have sustained an improvement in A&E performance since 3rd March. 2014/15 YTD and Q1 performance is 95.5% as at week ending 4th May 2014.

Remedial actions:

CDDFT – The Emergency Care Intensive Support Team (ECIST) visited the Trust in December 2013 and their initial feedback and recommendations included

within the ‘Whole System Letter’ has now been shared. The ECIST recommendations, together with the Trust’s Acute and Long Term Conditions Emergency

Department (ED) Recovery Plan have been considered by the County Durham and Darlington Urgent Care Working Group (UCWG) and agreement has been

reached that the remit of the Front of House Task Force will change to become an ECIST implementation Project Group, accountable to the UCWG.

CCG and NECS colleagues are continuing to support CDDFT to implement the ECIST recommendations.

A working group now meets monthly to review delayed transfers of care. A multidisciplinary team (MDT) pilot is being implemented at specific wards at UHND to

support discharge management processes and following evaluation will be considered for roll out across the Trust.

A bed predictor tool is being developed to improve the management of inpatient beds and a new bed management IT system is being implemented later in 2014.

Visits to other providers have taken place including North Tees & Hartlepool NHS FT ED and Emergency Assessment Unit (EAU) and City Hospitals Sunderland

NHS FT Intermediate Care Beds to learn from examples of good practice.

CDDFT have successfully reviewed and improved their ED Ambulatory and Rapid Assessment & Treatment (RAT) Streams for patients arriving at Emergency

Departments at Darlington Memorial Hospital and University Hospital North Durham. The aim of both streams is to ensure that each patient is seen by the right

clinician in the Emergency Department, first time, every time. Beginning with an initial decision by a Nurse Navigator (senior nurse/doctor), patients are guided to

the most appropriate practitioner for their needs. Successful pilots of this initiative across both hospital sites resulted in full implementation from 1st April 2014.

CCG Chief Officers are continuing to monitor A&E Performance and will re-introduce fortnightly meetings with the Trust and Area Team Chief Executives, to

agree actions if A&E Performance falls below the 95% target.

19

Indicator Threshold CDDFT – YTD Mar-14

% of Patients spending 4 hours or less in A&E or urgent care centre 95.0% 94.9%

Exception Report CDDFT ER01

Performance Update

CDDFT continues to experience consistently high levels of handover delays, resulting in poor performance in relation to the Ambulance handover target. Whilst Performance

in December, January and February remained high, there was a marginal improvement during March. However the provider continues to be an outlier across the region.

During March 2014, CDDFT are reporting 61.7% of handovers taking place within 15 minutes.

6.2% (256) experiencing 30-60 minute delays and

2.0% (84) experiencing 60-120 minute delays

There were 7 instances where handover delays exceeded 2 hours

Remedial Actions:The recommendations from a recent jointly commissioned review of handover and turnaround issues (the Pease Report) are taken into account in the Whole System Unscheduled Care Action Plan. CDDFT have also confirmed their intention to implement “quick win” recommendations from the recent ECIST review to improve patient flow and reduce pressure ‘Front of House’.

Additional winter monies were allocated to NEAS & CDDFT during 2013/14 to support close management of patient flow from the Ambulance Handover queue into urgent/emergency care and additional PTS discharge ambulance support for the University Hospital of North Durham to transport patients who are being discharged from Hospital.

The CDDFT Patient Safety Team have produced all Root Cause Analysis (RCA) reports for ambulance handover delays of 2 hours and over. CDDFT are required to share these RCA reports with Durham, Darlington and Tees Area Team.

NEAS are providing Hospital Ambulance Liaison Officer (HALO) at UHND to manage ambulance handover delays.

From 1st April 2014, a Senior Nurse or ED Consultant has responsibility for managing ambulance handovers.

CDDFT have successfully reviewed and improved their ED Ambulatory and Rapid Assessment & Treatment (RAT) Streams for patients arriving at Emergency

Departments at Darlington Memorial Hospital and University Hospital North Durham. The aim of both streams is to ensure that each patient is seen by the right

clinician in the Emergency Department, first time, every time. Beginning with an initial decision by a Nurse Navigator (senior nurse/doctor), patients are guided to

the most appropriate practitioner for their needs. Successful pilots of this initiative across both hospital sites resulted in full implementation from 1st April 2014.

20

Indicator Threshold CDDFT – YTD Mar-14

Handover between ambulance and A&E over 30 minutes0 2,402

Handover between ambulance and A&E over 60 minutes or more0 898

Exception Report CDDFT ER02

Performance Update

City Hospitals Sunderland (CHSFT) have continued to experience significant pressures within their A&E department due to an increased number of ambulance arrivals and more acute Type 1 attendances. Improvements have continued to be made from February onwards with March reaching 96.22% giving a year to date position of 94.44%.

The Trust attribute this position to the inability to recruit to additional medical and nursing staff in addition to the higher level of acuity patients presenting.

Remedial actions:Work continues between Provider and Commissioner to improve this position. Whilst Pallion Health centre is available to redirect patient for treatment, the acuity of patients presenting means that this is not always possible and has therefore not had the desired impact expected.

CHS are continuing with recruitment plans for both medical and nursing staff and confirm that an additional A&E consultant has been appointed. The Trust have flagged that recruitment of staff is still the main issue with ensuring the target is achieved.

The Trust met with Sunderland CCG and the Area Team in the week commencing 11 th May. It was agreed that CHS would compile a report to present the current position in terms of A&E generally. This report will be presented to the next QRG (June) and will cover activity comparisons from 12/13 against 13/14 as well as key quality metrics, what further work needs to be undertaken to assist in performance, narrative against the measure taken to date and how these have helped i.e. the opening of Pallion etc as well as details around complaints and incidents.

The Trust identified that some Sunderland GP practices were sending patients in via ambulance that could be managed in an alternative setting and this has been dealt with by Sunderland CCG who are working with practices to resolve this.

21

Indicator Threshold CHSFT – YTD Mar-14

% patients spending 4 hrs. or less in A&E or minor injury unit 95.0% 94.44%

Exception Report CHSFT ER01

Performance UpdateCity Hospitals Sunderland have experienced significant pressures within their A&E department and have continued to highlight the large volume of batched ambulance arrivals. The Trust highlighted they had received 28 within a 5 hour period during a week in April. These pressures have resulted in an increase in the number of ambulance delays.

Although the target has been breached there have been significant improvements in comparison to last year although the volume of ambulance arrivals have increased. In addition, although performance improved in November there was a spike in handovers waiting over 30 minutes and 60 minutes through December to March. This is being investigated by the Trust.

Remedial actions:Commissioners are working closely with CHSFT through the Unscheduled Care workstream to identify solutions to the high volumes of activity. The meeting has representation from a number of organisations including stakeholders from Sunderland and DDES CCG’s, CHSFT and NEAS.

The Trust have implemented a joint action plan with NEAS. GP awareness of ambulance categories has been improved, rapid sign on has been established, additional staff have been appointed and are awaiting a start date. Further work is ongoing with CHSFT reviewing ED nursing staff to ensure availability matches the streams in the service and the Trust are working with NEAS to ensure they can feed in directly to specific services, the governance issues for this are currently being addressed.

Sunderland CCG are working with NEAS, funding two specific schemes to help stream ambulances to alternative dispositions such as Minor Injury Units, Urgent Care Teams and district nurses etc. These schemes are now operational and work is ongoing with NEAS to understand the impact. In addition the unscheduled care board are working to allow 7 day discharges, funding additional ambulances to get patients home, commissioning 7 day working for social workers and a readmissions avoidance team. These have improved delayed transfers of care with the current delays being the lowest number in years which is improving flow in the Trust.

To ensure focus remains on achieving this target, a specific indicator has been included within the 14/15 CQUIN scheme within which the trust will be looking to achieve hitting a target based on a local average performance for each quarter.

22

Indicator Threshold CHSFT – YTD Mar-14

Handover between ambulance and A&E over 30 minutes0 1,013

Handover between ambulance and A&E over 60 minutes or more0 250


Performance UpdateCity Hospitals Sunderland continue to experience significant pressures within Urology resulting in breaches in cancer waiting times in January, February and March.

Remedial actions:CHS have placed the Directorate into internal escalation in order to resolve the ongoing issues. Weekly meetings are held with the Directorate to look at current waiting times, capacity and breaches.

The Directorate are continuing to utilise all available theatre capacity to reduce inpatient waiting times and have made personnel changes within the administrative team to enhance scheduling and waiting list management.

Commissioners, working with Sunderland CCG to ensure a joint approach, plan to meet with the Trust at the end of May / start of June to discuss what further actions can be taken and offer support to explore innovative solutions to resolve the ongoing issues.

23

Indicator Threshold CHSFT – Q4

% of patients treated within 31 days of a cancer diagnosis96.0% 94.0%

% of patients treated within 62 days of an urgent GP referral for suspected cancer85.0% 80.0%


Exception Report DDES ER01

Performance Update:

DDES CCG have failed this target in each of the last 9 months (Jun-Feb). Performance improved in March to 87.3% but the CCG still failed the 4 th Qtr overall (84%).

Patient level breach information is not yet available. However there still remain issues in respect of Urology capacity at CHS where patient choice of robotic surgery is causing delay and Upper GI surgery referrals to Newcastle are also failing to achieve the target.

In 4th Qtr, 26 patients breached the 62 day target in DDES CCG across the following specialties – Breast (1), Lung (7), Gynaecology (2), Upper GI (2), Lower GI (1), Urology (9), Head & Neck (2) Sarcoma (1) and Skin (1).

CHS and STHT both failed to achieve the 62 day target in 4 Qtr with 80% and 83.5% respectively.

Remedial actions:

South Tees FT has been reviewing a 12 months worth of cancer breaches in an attempt to identify the main themes within those breaching: The themes identified are:• Late referrals - including those patients that are not fully worked up before being referred• Patient choice• Slow pathways (14 day for 2ww and 14 day for diagnostic) • Complex pathways (more than 1 tumour site or unknown primary).

This analysis is to be used within the Trust to identify what can be done to resolve these issues going forward. In addition to this the Trust is working collaboratively with other

Providers to try and understand cancer pathways further to try and ascertain where changes are required to make a patients journey as efficient as possible.

Although South Tees and Newcastle are liaising regarding how late referrals should be managed, any movement in where the breach should be apportioned does not resolve

the problem. Further work is required to review pathways at a Network level to fully understand how/if pathways can be rationalised to ensure the target is achieved wherever

possible, patient choice not withstanding.

CHS are known to have an internal escalation process in place in respect of Urology. Weekly meetings are in place to discuss current activity, performance, breaches etc and a

copy of their Urology action plan has been requested, along with any other cancer related action plans.

Breaches at a specialty level will be discussed with the Providers through the contract / performance meetings.

24

Indicator Threshold CCG – Q4 STHFT – Q4 CDDFT – Q4 CHSFT – Q4 NTHFT – Q4


85.0% 84.0% 83.5% 88.0% 80.0% 86.1%


24

Exception Report NEAS ER01

Performance Update:The North East Ambulance Service (NEAS) continues to meet its regional contract-wide target to achieve response to 75% of Red1 and Red2 calls in 8 minutes and 95% in 19 minutes. NEAS is not contractually obliged to meet those targets at CCG level. DDES, North Durham and Northumberland CCGs rarely met the regional 75% target and it was agreed within the 2013/14 contract that NEAS would have a target of 71% R8 for those three CCGs. Local performance for Quarter 3 & 4 is detailed below.

Performance in DDES for March is above historical performance.

Performance is consistent with the seasonal trend experienced in previous years, though performance for the yearend, 67.79%, is above previous years’ performance.

Overall, during March, the 71% level of performance was missed by 113 incidents.

Remedial actions:Discussions continue with NEAS regarding initiatives to assist performance, including taking action to reduce conveyance rates to hospital and increasing the number of patients that can be seen and treated by NEAS. The Paramedic/GP 5 minute ring back initiative went live on Monday 2nd December 2013, providing rapid GP telephone support to paramedics across County Durham and Darlington. Feedback suggests that this initiative is having a positive impact in reducing the number of patients being conveyed to hospital.

NEAS are also performing significant work to focus on ‘frequent callers’ and identify how these patients can be supported to avoid frequent ambulance call-outs where possible.

Additional Winter Monies have been allocated to a range of organisations, including NEAS to assist in managing pressures over the winter period.

For 2014/15 and a separate contract for the Durham, Darlington and Tees CCGs is now being negotiated, rather than the current single North-East wide contract, to allow greater focus on the performance issues that exist in the south of the region.

25

Indicator Threshold DDES CCG NEAS

Red 8 minute response 71.0% 67.79% 78.46%


25

CCG October 13 November 13 December 13 Quarter 3 January 14 February 14 March 14 YTDNHS North Durham CCG 69.47% 71.81% 65.09% 68.80% 68.67% 66.46% 62.76% 70.24%NHS Durham Dales, Easington and Sedgefield CCG 70.08% 69.42% 62.45% 67.28% 67.75% 66.83% 63.17% 67.79%

NHS Darlington CCG 84.19% 82.09% 76.36% 80.84% 78.46% 81.84% 77.78% 81.42%

Exception Report MH ER01


Indicator Threshold DDES CCG

IAPT - Proportion of people that enter treatment against the level of need in the general population 12.0% 8.23%

IAPT - Proportion of people who complete treatment who are moving to recovery 50.00% 45.37%

26

Performance Update:

The proportion of people entering therapy target continues to be underachieved with the YTD figure reported as 8.23% against a target of 12.00% which is a rising trajectory. The number of people moving to recovery has seen a further improvement and the target of 50.0% was exceeded in March, the reported position was 59.84%.

It should be noted, as previously reported, that the CCG commissions additional talking therapies by way of a counselling service, which are not included in these figures. Therefore an additional proportion of the local population are receiving treatment above that reported via the IAPT service. It should be noted that the target for the proportion of people entering therapy is to achieve 15% of an estimated prevalence by 2015.

Remedial actions:A contract query was issued to the provider following the Quarter 1 contract meeting (1st August 2013).

The information was received within requested deadlines (23rd September 2013)

This data was presented and discussed at an interim contract performance meeting (4th October 2013).

The resulting action was to issue the provider with a formal performance notice requesting improved staffing levels, service promotion, caseload monitoring and analysis of the number of people not entering therapy from those referred. A remedial action plan was presented and agreed on 29th October and this was distributed to CCG chief officers for information.

The first review of the action plan took place on 8th December and a further reviews have been scheduled.

The year end position has seen the remedial action plan rectifying the mid-year reduction in performance. The target remains unachieved and as such the performance notice and remedial action plan will remain in place during 2014/15. Some actions have longer term implications, and an increase in performance is expected from 1st May following the implementation of actions to tackle service user retention on the scheme.

Quality Premium Introduction

The 'quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and the associated improvements in health outcomes and reducing inequalities. The quality premium paid to CCGs in 2014/15 will reflect the quality of the health services commissioned by them in 2013/14 and will be based on four national measures and three local measures. It will be a pre-qualifying criterion for any payment that a CCG manages within its total resources envelope for 2013/14 and does not exceed the agreed level of surplus drawdown.

The total payment for a CCG based on performance against the four national measures and the three local measures will be reduced if providers do not meet the NHS Constitutional rights or pledges for patients (RTT 18 week, A&E 4 hr, Cancer 62 day & 8 min Cat A ambulance calls).

The total amount possible for CCGS to receive in achievement of the Quality Premium will be £5 per patient in the CCG, according to the same formula as the payment of the running cost allowance. For DDES CCG this amounts to £1,439,290.

The following page highlights the indicators against which the quality premium will be determined, together with the relevant financial value attributed to each indicator and the latest assessment of performance.

27

28

National and Local Quality Premium Indicators

Population 287,858 £1,439,290

Measure

Percentage of Quality Premium Value for CCG's Threshold

Outcome and data published Measure Achieved/Forecast

Eligible QP Funding

Domain 1: Preventing people from dying prematurely 12.5 £179,911Reduction 3.2%

between 2012 and 20132013 dataAutumn 14

13/14 data unavailable at this stage £179,911

Domain 2&3 : Enhancing quality of life for people with long term conditions and helping people to recover from episodes of ill health or following injury

25 £359,823ISR 13/14 < ISR 12/13 or

ISR 13/14< 1,000 per 100,000 population 2013/14 dataSummer 14

All 4 indicators are showing a FOT for 13/14 lower than performance in 12/13

£359,823

Domain 4: ensuring that people have a positive experience of care

12.5 £179,911Implement FFT in Q13/14 and

Increase score between Q1 13/14 and Q1 14/15

Not yet known

Yes - see outcomes framework for data - risk as scores dropped

significantly from Q1 to Q2 & Q3. Q4 has shown an improvement and

achieved in all 3 individual months

£179,911 QER05

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm.

12.5 £179,911Zero MRSA and Decrease

C-diff on target2013/14 dataSummer 14

No - 2 cases of MRSA 0 QER07

Measure

Percentage of Quality Premium Value for CCG's Threshold

Outcome and data published Measure Achieved/Forecast

Eligible QP Funding

U75 mortality rate from cancer 12.5 £179,911 <142.8 per 100,000 population2013 dataAutumn 14

13/14 data unavailable at this stage £179,911

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 12.5 £179,911 <395 admissions per 100,000 population

2013 dataAutumn 14

13-14 - 332.52 £179,911

Emergency admissions for children with lower respiratory tract infections 12.5 £179,911 <586 admisisons per 100,000 population

2013 dataAutumn 14

13-14 - 403.95 £179,911

100 £1,439,290 £1,259,379

Exception Report

CDDFT ER01

DDES ER01

Total Adjustment -£629,689

Revised Total £629,689

Cancer waits - 62 days - 85% target No - 83.9% Mar-14 25% -£314,845

Category A Red 1 ambulance calls - 75% target Yes - 78.46% to Mar-14 0% £0

Referral to treatment times (18 weeks - Incomplete) - 92% target Yes - 93.9% to Feb - 14 0% £0

A&E waits - 95% target No - 94.9% to Mar-14 0% -£314,845

Total

NHS Consitutional rights and pledges Measures Achieved/Forecast Adjustment to funding Quality Premium Funding Adjustment

DDES

Quality Premium

Potential Fund

Indicator

DDES

Achievement Exception Report

Value

National

Indicator

Value AchievementException

Report

Quality Premium InformationRationale Value Threshold Technical Definition

Domain 1: Preventing people from dying prematurely

The overall aim of Domain 1 is to reduce premature mortality. This aim is shared between the NHS and public health frameworks. The contribution that can be

delivered by the NHS is best measured by potential years of l ife lost from causes considered amenable to healthcare. CCGs will be able to determine which aspects of

premature mortality are of greatest relevance in their local population.

In order to reduce premature mortality within the population, CCGs will need to address the physical health needs of people with mental health conditions and

learning disabilities.

12.5% of QP

To earn this portion of the quality premium, the potential years of l ife lost (adjusted for sex and age) from amenable

mortality for a CCG population will need to reduce by at least 3.2% between 2013 and 2014.

This is based on the 10-year average annual reduction in potential years of l ife lost from amenable mortality.

Causes considered amenable to healthcare are those from which premature deaths should not occur in the presence

of timely and effective health care. The concept of ‘amenable’ mortality generally relates to deaths under age

75, due to the difficulty in determining cause of death in older people who often have multiple morbidities. The

Office for National Statistics (ONS) produces mortality data by cause, which excludes deaths under 28 days. These

indicators therefore relate to deaths between 28 days and 74 years of age inclusive.

Domain 2&3 : Enhancing quality of l ife for people with long term conditions and

helping people to recover from episodes of i l l health or following injury

Good management of long term conditions requires effective collaboration across the health and care system to support people in managing conditions and to promote

swift recovery and reablement after acute il lness. There should be shared responsibility across the system so that all parts of the NHS improve the quality of

care and reduce the frequency and necessity for emergency admissions.

About a third of avoidable admissions are for people with a secondary diagnosis relating to mental health. Progress in reducing emergency admissions is l ikely to

need a strong focus on improving the physical health of people with mental health conditions.

25% of QP

To earn this portion of the quality premium, there will need to be a reduction or a zero per cent change in emergency

admissions for these conditions for a CCG population between 2012/13 and 2013/14, or the Indirectly

Standardised Rate of admissions in 2013/14 is less than 1,000 per 100,000 population.

The NHS Outcome Framework contains four indicators measuring emergency admissions for those conditions

(sometimes referred to as ‘ambulatory care sensitive conditions’) that could usually have been avoided through

better management in primary or community care. These are indicators 2.3i and 2.3ii focusing on chronic (ie long term) conditions and indicators 3a and 3.2 focusing on

acute conditions. For the purpose of the quality premium these complementary measures are being combined to

create a single composite measure.

Domain 4: ensuring that people have a positive experience of care

The Friends and Family Test is a simple, comparable test which, when combined with follow-up questions, provides a mechanism to identify poor performance and

encourage staff to make improvements where services do not live up to the expectations of patients. This leads to a more positive experience of care for patients.

The comparability of the data (through the use of a standardised question and methodology) will allow commissioners to understand overarching levels of patient

experience for the services that they commission.

12.5% of QP

To earn this portion of the quality premium, there will need to be:

1) assurance that all relevant local providers of services commissioned by a CCG have delivered the nationally

agreed roll-out plan to the national timetable2) an improvement in average FFT scores for acute inpatient care and A&E services between Q1 2013/14 and Q1 2014/15

for acute hospitals that serve a CCG’s population.

Aggregate responses will be attributed to CCGs using centrally available data.

Domain 5: treating and caring for people in a safe environment and protecting them

from avoidable harm.

Although the NHS has made significant improvement in recent years in reducing MRSA bloodstream infections and C. difficile infections, the rates of reductions in these

infections have been greater in the acute sector than for community onset cases (such as those acquired in care homes). Around half the numbers of MRSA and C. difficile infections are now community-onset cases. CCGs will have a pivotal role to play in

driving further improvements in reduction of healthcare associated infections.

12.5% of QP

A CCG will earn this portion of the quality premium if: there are no cases of MRSA bacteraemia assigned to the

CCG; and C. difficile cases are at or below defined thresholds for the

CCG.

Data on C. difficile infections and MRSA bacteraemia by CCG will be published monthly.

Please refer to Technical Guidance at the end of this document.

U75 mortality rate from cancer 12.5% of QP <142.8 per 100,000 population

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

12.5% of QP

<395 admissions per 100,000 populationEmergency admissions for children with

lower respiratory tract infections12.5% of QP

<586 admisisons per 100,000 population

Referral to treatment times (18 weeks) - 90% target

Data will be available by CCGs as providers will submit data on the basis of the CCG that is responsible for a given patient.

25% of achieved Measures

Achieved for at least 92% of patients over the course of the 2013/14 year. The position for 2013-14 will be measured

from the incomplete RTT pathway snapshots (patients waiting to start consultant-led treatment at month end) in

the monthly RTT returns from April 2013 to March 2014. The waiting time standard that at least 92% of patients are

waiting within 18 weeks should be achieved on average for the year. This will be calculated by summing the numerators (patients waiting within 18 weeks) from each month end and

then dividing by the sum of all the denominators (patients waiting) from each month end.

See line CB_B3 in Everyone Counts: Planning for Patients 2013/14 - Technical Definitions

A&E waits - 95% target

Data will be mapped from providers to CCGs using a mapping derived from Hospital Episode Statistics figures. This calculates what proportion of each provider can be attributed to a given CCG. Any activity that is under 1% of the trust's overall activity

will be ignored in this mapping.The mapping will be updated at regular intervals, with the latest mapping being used

to cover the whole period. Only organisations submitting on HES will have their activity mapped to CCGs. Therefore, any type 3 units that do not submit on HES will

not have their sitrep data allocated to any CCG.


Achieved for at least 95% of patients over the course of the 2013/14 year.

The position for 2013/14 will be measured from Weekly Situation Reports (sitreps) and will consist of data for all

types of A&E across 52 weeks of sitreps from week ending 7 April 2013 to week ending 30 March 2014.

The number of attendances (numerator) and number of 4 hour waits (denominator) will then be used to calculate an

overall percentage for the year.


Cancer waits - 62 days - 85% target Data will be available by CCG as providers will submit data on the basis of the CCG that is responsible for a given patient.



This will be calculated by summing data for the four quarters of 2013/14 to produce one annual figure against

which the CCG will be assessed.As the patient is only reported in the period they are treated irrespective of when their pathway of care started, quarters

can be added together.


Category A Red 1 ambulance calls - 75% target

Each CCG will be judged by the performance of the ambulance trust that serves its geographic area.



The percentage will be calculated by summing the numerator (the number of Category A (Red 1) calls resulting

in an emergency response arriving at the scene of the incident within 8 minutes) over the 12 months April-March

and also summing the denominator (the number of Category A (Red 1) calls resulting in an emergency response arriving

at the scene of the incident) over the same period. The percentage will then be calculated using the usual numerator/denominator method for the whole year.

See line CB_B15_01 in Everyone Counts: Planning for Patients 2013/14 - Technical Definitions

Indicator

National

Local

4 Constitutional rights & pledges

DDES CCG - Outcome Framework IndicatorsQuality Indicator Threshold 2010/11 2011/12 2012/13 2009 2010 2011 2012 2013 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 YTD 13-14 13-14 FOT

Exception Report

Under 75 mortality rate per 100,000 from cardiovascular disease

Trend81.2 83.8 89.8 73.0 TBC

Under 75 mortality rate per 100,000 from respiratory disease

Trend35.3 35.1 39.2 39.7 TBC

Under 75 mortality rate per 100,000 from liver disease

Trend17.0 19.2 20.5 21.3 TBC

Under 75 mortality per 100,000 rate from cancer

Trend150.6 138.5 145.3 148.1 TBC

Unplanned hospitalisation for chronic ambulatory care sensitive conditions rate per 100,000

Trend1,104.9 1,053.3 1,049.3 85.49 87.89 85.98 83.18 75.76 80.41 85.79 73.54 97.22 91.90 84.77 63.55 903.40 903.40

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s rate per 100,000

Trend438.6 406.6 447.4 21.46 33.00 29.69 29.68 19.56 41.77 24.88 15.97 32.60 37.70 23.19 23.03 332.52 332.52

Emergency admissions for acute conditions that should not usually require hospital admission

Trend1,570.5 1,564.0 1,655.2 155.80 123.66 125.25 138.68 112.07 119.66 119.89 118.60 133.80 131.91 129.36 127.24 1,372.81 1,372.81

Emergency readmissions within 30 days of discharge from hospital

Trend0.128 0.133 0.141 0.131 0.131 0.134 0.127 0.137 0.138 0.126

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI)

Trend566.7 603.3 497.2 38.77 11.42 15.23 11.17 0.00 6.66 18.19 31.70 160.87 55.50 58.34 25.85 403.95 403.95

% of people who enter treatment against the level of need in the general population (IAPT)

12% 6.5% 7.4% 7.2% 7.1% 7.0% 7.0% 7.1% 6.9% 5.7% 9.3% 7.5% 7.1% 8.2%

% of people who complete treatment who are moving to recovery (IAPT)

50% 43.0% 40.3% 43.1% 43.0% 43.2% 43.5% 45.1% 45.1% 45.8% 46.2% 50.0% 59.8% 45.4%

Total Health gain Hip replacement Trend 0.435

Total Health gain Knee replacement Trend 0.281

Total Health gain Groin hermia Trend 0.083

Total Health gain Varicose veins Trend 0.000

FFT Combined Response (CDDFT) 15% 5.6% 9.0% 18.0% 19.0% 18.0% 30.2% 29.6% 22.9% 26.7% 37.0% 20.4% 23.00%FFT Combined Score (CDDFT) 50 66 72 62 57 44 31 29 36 30 51 52 58FFT A&E Response (CDDFT) 15% 0.5% 2.0% 8.0% 5.0% 6.0% 23.6% 26.0% 16.8% 24.5% 35.3% 16.4% 16.70%FFT A&E Score (CDDFT) 50 0 46 39 41 19 9 8 16 12 38 29 41FFT Inpatient Response (CDDFT) 15% 15.1% 20.0% 38.0% 47.0% 43.0% 43.3% 36.1% 33.5% 30.4% 39.8% 27.7% 35.00%FFT Inpatient Score (CDDFT) 50 73 76 71 60 52 52 53 51 55 69 74 72FFT Combined Response (CHSFT) 15% 11.7% 16.0% 18.0% 24.0% 25.0% 23.5% 22.4% 22.0% 17.5% 20.0% 26.0% 24.40%FFT Combined Score (CHSFT) 50 83 80 76 79 78 78 75 78 82 80 75 79FFT A&E Response (CHSFT) 15% 6.3% 12.7% 8.5% 12.7% 16.4% 15.5% 14.3% 14.0% 10.1% 10.3% 19.6% 16.70%FFT A&E Score (CHSFT) 50 90 80 73 79 75 75 80 78 78 77 70 76FFT Inpatient Response (CHSFT) 15% 24.4% 24.7% 43.6% 43.9% 39.1% 35.2% 33.6% 33.7% 28.8% 37.0% 38.0% 38.00%FFT Inpatient Score (CHSFT) 50 79 81 78 80 79 81 71 77 84 81 80 82

FFT Combined Response (NTHFT) 15% 8.0% 12.1% 10.7% 8.8% 11.9% 10.2% 7.8% 13.5% 13.1% 14.5% 21.4% 24.40%FFT Combined Score (NTHFT) 50 57 61 73 63 61 69 67 66 66 72 67 66FFT A&E Response (NTHFT) 15% 0.1% 5.0% 2.9% 1.9% 5.0% 8.6% 5.0% 8.2% 5.9% 5.1% 9.7% 11.90%FFT A&E Score (NTHFT) 50 100 70 60 64 70 72 70 67 64 77 64 59FFT Inpatient Response (NTHFT) 15% 18.8 21.0% 22.0% 19.0% 18.0% 12.5% 11.80% 20.30% 22.6% 26.1% 37.5% 43.30%FFT Inpatient Score (NTHFT) 50 61 73 63 71 66 65 65 66 71 67 69

Healthcare acquired infection (HCAI) measure (MRSA) to 31st March 2014

0 0 0 0 0 0 1 0 0 0 1 0 0 2

Healthcare acquired infection (HCAI) measure (clostridium difficile infections) to 31st March 2014

54 6 7 6 7 7 6 8 3 3 6 6 8 73

Domain 1 - Preventing people from dying prematurely

Domain 2 - Enhancing quality of life for people with long-term conditions

Domain 3 - Helping people to recover from ill health or injury

MH ER01

Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm

QER07

Domain 4 - Enusring that people have a positive experience of care

QER05

No data available

Finance & Activity

OverviewThis report provides an update on the position of the contracts held by NHS Durham Dales, Easington and Sedgefield CCG for the 2013/14 financial year. Finalised performance for the acute contracts is not yet known as the data contained within this report is based on 11 months freeze and one months flex data.

This report is intended to provide an understanding of the underlying contractual position, without risk share arrangements applied in order to provide an understanding of the likely impact of current year performance on 2014/15 contract negotiations.

Risk share arrangements are in place for the three largest providers of commissioned services – County Durham and Darlington FT, North Tees and Hartlepool FT and City Hospitals Sunderland FT.

The County Durham and Darlington FT contract is currently showing a significant over performance at this point in the year. The risk share arrangement mitigates this overperformance in year, but any overtrade will inform negotiations for the next financial year.

City Hospitals Sunderland FT and Gateshead FT are both experiencing significant issues with their PAS systems at this point.

South Tees, Newcastle and BMI Woodlands acute contracts are all overperforming. Patients appear to be exercising patient choice more frequently in choosing independent sector providers, possibly due to better facilities and waiting time.

Prescribing costs and Continuing Healthcare are two areas of significant in year risk to the CCG. The transformation fund is currently significantly underspent.

Referrals data for CDDFT has been included at the end of this section of the QPF for the first time this month. Referrals into CDDFT are showing a year on year increase at aggregate level.

Finance & Activity

County Durham And Darlington NHS FT Overview

Contract Update

• This contract is risk share for 2013/14. The contract has now been signed.

• Negotiations are ongoing with the provider for 2014/15. Significant differences exist between commissioner and provider positions covering a range of items.

Data Issues

• Known business rules have been applied to the data. Work is still ongoing on smaller reconciliation issues. Data is currently being reconciled at patient record level to resolve the remaining issues.

• High levels of uncoded data are currently being submitted to SUS by this provider. Flex data (of which there is one month included in this report) is potentially understated.

Financial Performance

• The underlying position on the contract is £2,005k overspent at the end of month 12 before readmissions, penalties and threshold adjustments are applied.

• No demand plan was agreed with the provider for 2013/14, resulting in differences in variances reported by commissioner and provider.

• Pressure areas across the contract include Outpatient procedures (£1,091k) (mainly ophthalmology) and excess bed days £1,250k (predominantly general medicine).

• Referrals are significantly up on 2012/13 (c9.9% in total) across a number of specialties including dermatology, general surgery, cardiology and general surgery.

• Despite ongoing negotiations around new to review ratios as part of 14/15 contracting, the Trust have agreed to progress the new to review outpatient workstream from commissioning intentions. Initial meetings are happening in May.

Action Points

• Continue work around new to review ratios with the Trust

Plan Actual Plan Actual VariancePOD SummaryAccident and Emergency 40,060 39,326 3,590£ 3,688£ 98£ Elective 23,178 22,682 21,174£ 21,406£ 232£ Non Elective 22,564 22,149 35,279£ 35,542£ 263£ Excess Beddays 7,163 12,694 1,654£ 2,904£ 1,250£ Outpatient First 64,927 66,686 8,658£ 8,895£ 238£ Outpatient Follow Up 120,047 115,215 9,180£ 8,900£ 280-£ Outpatient Procedures 11,902 20,409 1,834£ 2,925£ 1,091£ Outpatient Diagnostics 0 0 3,163£ 3,163£ -£ Maternity Pathways 3,714 4,112 3,470£ 3,387£ 82-£ Other Cost Per Case Services 0 0 -£ -£ -£ Other Services 2,008,164 2,192,641 20,305£ 19,262£ 1,042-£ Quality Payments 2,558£ 2,797£ 239£ Total before adjustments 110,865£ 112,870£ 2,005£

Penalties -£ 538-£ 538-£

Total after penalties 110,865£ 112,332£ 1,467£

Emergency Readmissions -£ 1,766-£ 1,766-£ Emergency Threshold 106-£ 106-£

Total after adjustments 110,865£ 110,460£ 405-£

Risk Share Value (benefit)/cost 405£ 405£

Total 110,865£ 110,865£ -£

Activity (YTD) £000s (YTD)

£-

£2,000

£4,000

£6,000

£8,000

£10,000

£12,000

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

Total Cost Trend for County Durham and Darlington NHS Foundation Trust

Plan

Actual

Finance & Activity

City Hospitals Sunderland NHS FT Overview

Contract Update

• This contract has a risk share arrangement for 2013/14. Negotiations for 14/15 are ongoing with only minor issues now preventing contract sign off at time of publication.

Data Issues

• This provider is experiencing serious ongoing problems with its Patient Administration System and data submissions should be treated as incomplete. The analysis below is based on the information available.


• This contract is underperforming by £124k YTD. This underperformance is offset by the risk share agreement in place with this provider. No adjustments have been made for readmissions or penalties.

• Key areas of overperformance are within excess bed days (specifically non elective) within admissions recorded via A&E (£142k), T&O (£66k) and Geriatric Medicine (£40k). Outpatient follow ups also show as a pressures area (£1,275k) particularly in Ophthalmology(c£250k), Rheumatology (£228k), T&O (£114k) and Physio £427k (Physio contacts have been recorded with Outpatients, but the plan sits within ‘other services’ this will be resolved for 14/15 reporting.

• Key areas of under performance are non elective, outpatient first and ‘Other services’ – specifically Therapies, Physio and SALT services.

• Non elective T&O admissions are significantly below plan (£284k) as are Nephrology (£319k), Geriatric Medicine (£467k) and Cardiology (£569k). Admissions recorded via A&E are significantly over performing (£1,342k) – indicating a change in the way non elective inpatients have been recorded is likely.

Plan Actual Plan Actual VariancePOD SummaryAccident and Emergency 17,549 17,203 1,452£ 1,448£ 3-£ Elective 9,718 9,587 8,776£ 8,773£ 3-£ Non Elective 6,470 6,214 10,695£ 9,773£ 922-£ Excess Beddays 2,760 4,582 640£ 1,059£ 419£ Outpatient First 25,918 16,867 2,760£ 2,001£ 759-£ Outpatient Follow Up 26,227 56,798 2,129£ 3,405£ 1,276£ Outpatient Procedures 2,618 4,018 472£ 663£ 191£ Outpatient Diagnostics 10,561 0 794£ 794£ 0-£ Maternity Pathways 918 916 812£ 807£ 5-£ Other Services 142,915 146,657 3,054£ 2,735£ 319-£ Quality Payments 788£ 788£ -£ Total 32,372£ 32,247£ 124-£

Penalties -£ -£ -£

Total after penalties 32,372£ 32,247£ 124-£

Emergency Readmissions -£ -£ -£ Emergency Threshold -£ -£ -£

Total after adjustments 32,372£ 32,247£ 124-£

Risk Share Value (benefit)/cost 124£ 124£

Total 32,372£ 32,372£ -£


£-

£500

£1,000

£1,500

£2,000

£2,500

£3,000

£3,500


Total Cost Trend for City Hospitals Sunderland NHS Foundation Trust

Cost of Risk Share

Benefit of Risk Share

Plan

Finance & Activity

North Tees and Hartlepool NHS FT Overview

Contract Update

• This contract has a risk share arrangement for 2013/14. However, additional costs of circa £124k have arisen in respect of specialist respiratory activity, where the commissioning responsibility has transferred back to CCGs in 2013/14.

Data Issues

• None identified


• This contract is underperforming by £3.510m as at M12 flex. This underperformance is offset by the risk share agreement in place with this provider. The plan for North Tees & Hartlepool NHS FT was based on 7 months of data from the previous financial year.

• Key areas of underperformance are Non Elective (£2.382m), Outpatient Diagnostics (£321k) and Maternity Pathways (£307k).

• One area of over-performance is elective admissions (£180k) over, with orthopaedics accounting for most of this over-performance..

Forecast outturn

• Specialist respiratory activity is outside of the risk share and represents an additional cost of circa £124k including CQUIN (to be confirmed at final M12 freeze).

Plan Actual Plan Actual VariancePOD SummaryAccident and Emergency 6,711 6,960 657£ 700£ 43£ Elective 7,639 6,385 7,272£ 7,442£ 171£ Non Elective 9,183 7,510 12,791£ 10,648£ 2,142-£ Excess Beddays 4,289 3,053 980£ 680£ 300-£ Outpatient First 12,434 12,199 1,958£ 1,909£ 49-£ Outpatient Follow Up 28,863 31,145 2,405£ 2,500£ 95£ Outpatient Procedures 3,045 2,532 750£ 634£ 117-£ Outpatient Diagnostics 12,102 9,590 1,208£ 887£ 321-£ Maternity Pathways 1,465 1,174 1,624£ 1,317£ 307-£ Other Cost Per Case Services 0 0 -£ -£ -£ Other Services 274,110 283,495 5,755.52£ 5,758.92£ 3£ Quality Payments 836.32£ 752.52£ 84-£ Total 36,236£ 33,228£ 3,009-£


Total after penalties 36,236£ 33,228£ 3,009-£

Emergency Readmissions -£ 502-£ 502-£ Emergency Threshold -£ -£ -£

Total after adjustments 36,236£ 32,726£ 3,510-£

Risk Share Value (benefit)/cost 3,009£ 3,009£

Total 36,236£ 36,236£ -£


£-

£500

£1,000

£1,500

£2,000

£2,500

£3,000

£3,500


Total Cost Trend for North Tees and Hartlepool NHS Foundation Trust

Cost of Risk Share

Benefit of Risk Share

Plan

Finance & Activity

Newcastle Upon Tyne Hospitals NHS FT Overview

Contract Update

• This contract is based on full PbR principles and as such any over/underperformance will be a pressure/benefit to the CCG’s financial position.

Data Issues

• Business rules not yet applied have been identified and were applied at month 10, these business rules seemed to be working as expected, ongoing work continues to ensure that all business rules have been applied correctly


• Day Cases has over performed by £241k at month 12, the main HRG Chapters where this is occurring are H Musculoskeletal System, L Urinary Tract & Male Reproductive System and Q Vascular Syste,;

• High Cost Drugs (£125k), ITU (£107k) and Medical Devices (£65k) are also areas where there has been an overspend at month 12;

• Outpatient Procures is an area where over performance has occurred, the main HRG Chapters where this is occurring is E Cardiac Surgery and J Skin, Breast & Burns.

Plan Actual Plan Actual VariancePOD SummaryAccident and Emergency 806 680 71£ 68£ 2-£ Elective 1,763 1,705 1,820£ 2,061£ 241£ Non Elective 515 534 1,089£ 1,042£ 47-£ Excess Beddays 438 610 111£ 154£ 43£ Outpatient First 1,746 1,998 270£ 297£ 27£ Outpatient Follow Up 5,482 6,304 538£ 489£ 49-£ Outpatient Procedures 552 902 98£ 148£ 51£ Outpatient Diagnostics 1,320 1,602 157£ 187£ 30£ Maternity Pathways 0 1 -£ 3£ 3£ Other Services 304 503 597£ 927£ 329£ Quality Payments 112£ 121£ 9£ Total 4,864£ 5,497£ 633£


Total After Penalties 4,864£ 5,497£ 633£

Emergency Readmissions -£ 64-£ 64-£ Non elective threshold adjustment -£ -£ -£

Total 4,864£ 5,433£ 569£ Risk share arrangements -£ 69-£ 69-£

Total after risk share 4,864£ 5,364£ 500£


£-

£100

£200

£300

£400

£500

£600


Total Cost Trend for Newcastle upon TyneNHS Foundation Trust

Actual

Plan

Finance & Activity

South Tees Hospitals NHS FT Overview

Contract Update

• This contract is based on full PbR principles and as such any over/under performance will be a pressure/benefit to the CCGs financial position.

• Contractual penalties such as RTT and ambulance handovers are built in to the position, as is the CQUIN amounts not achieved.

• Diagnostic imaging risk shares is built in to the position.

Data Issues

• Work is being carried out with the trust to produce a final reconciliation of the data for the year end.


• The current YTD position is £713k above contract at the end of month 12 (flex), including readmissions and risk share adjustments.

• A number of areas are showing pressure on this contract:

• Other services – drugs (£90k), neurorehab (£175k), ITU (£112k), HDU (£91k)

• Non elective are over plan by £202k. Pressures are in: HRG chapter V – multiple trauma, emergency and urgent care procedures (136K), H – musculoskeletal (121K), D – respiratory system (72k) and A – nervous system (51k).

• Outpatient procedures are over plan by £156k. Pressures are in: HRG chapter E - cardiac surgery procedures (£66k) and in C – month, head, neck and ears (£47k).

Plan Actual Plan Actual VariancePOD SummaryAccident and Emergency 1,120 1,147 121£ 127£ 6£ Elective 2,856 2,184 3,400£ 3,326£ 75-£ Non Elective 777 800 1,829£ 2,031£ 202£ Excess Beddays 807 949 188£ 226£ 38£ Outpatient First 4,417 3,973 576£ 552£ 24-£ Outpatient Follow Up 10,452 11,055 928£ 1,038£ 109£ Outpatient Procedures 3,102 4,042 431£ 588£ 156£ Outpatient Diagnostics 1,730 2,330 227£ 273£ 46£ Maternity Pathways 0 22 -£ 9£ 9£ Other Services 917 1,632 1,842£ 2,253£ 411£ Quality Payments 213£ 217£ 4£ Total 9,756£ 10,639£ 882£

Penalties -£ 85-£ 85-£

Total After Penalties 9,756£ 10,553£ 797£

Emergency Readmissions 53-£ 106-£ 53-£ Non elective threshold adjustment -£ -£ -£

Total 9,704£ 10,448£ 744£

Risk Share -£ 31-£ 31-£

Total 9,704£ 10,416£ 713£


£-

£200

£400

£600

£800

£1,000

£1,200


Total Cost Trend for South Tees HospitalsNHS Foundation Trust

Actual

Plan

Finance & Activity

BMI Woodlands Overview

Contract Update

• DDES USS pilot is being utilised by many practices. It’s review will help the CCG to determine if they wish to formally commission the service.

Data Issues

• None identified


• Costs are higher than plan in all PODs, particularly elective lines and daycase. The year end costs are overspent by £935k.

• Year to date pressures are within, trauma and orthopaedics (£201k), pain management (£31k) and gastroenterology (£23k) for the daycase POD. Within the elective POD, the pressures are trauma and orthopaedics (£315k) and gynaecology (£41k).

Forecast Outturn

• The outturn was over plan at year end by £935k.

Action Points

• The demand file has been set correctly for 2014/15.

Plan Actual Plan Actual VariancePOD SummaryAccident and Emergency 0 0 -£ -£ -£ Elective 518 914 922£ 1,589£ 667£ Non Elective 0 0 -£ -£ -£ Excess Beddays 0 2 -£ 0£ 0£ Outpatient First 650 1,314 85£ 172£ 86£ Outpatient Follow Up 2,139 5,088 116£ 185£ 69£ Outpatient Procedures 58 231 11£ 57£ 45£ Outpatient Diagnostics 247 1,094 24£ 72£ 48£ Maternity Pathways 0 0 -£ -£ -£ Other Cost Per Case Services 0 0 -£ -£ -£ Other Services, inc Block, CQUIN, penalties 9 0 5£ -£ 5-£ Quality Payments 29£ 52£ 23£ Total 1,193£ 2,127£ 935£


£-

£50

£100

£150

£200

£250


Total Cost Trend for BMI Woodlands

Actual

Plan

North East Ambulance Services POD Analysis

Finance & Activity

Contract Update

• This contract is a block, with activity driven element, penalties and a risk share arrangement

Data Issues

• None identified


• The activity element of the NEAS contract has over performing £234k at month 12. This over performance is taken into account any marginal rates within the contract and the risk share agreement.

• £30k of penalties have been issued for Durham Dales, Easington and Sedgefield CCG.

Plan Actual Plan Actual VariancePOD SummaryBlock 0 0 40£ 40£ -£ Calls 54,908 41,372 275£ 207£ 68-£ Hear and Treat 1,512 1,195 18£ 14£ 4-£ Neo-Natal 64 0 24£ -£ 24-£ See and Treat 8,522 9,309 1,278£ 1,396£ 118£ See, Treat and Convey 32,185 31,616 6,019£ 5,912£ 106-£ Marginal rate adjustment 0 0 -£ 128-£ 128-£ CQUIN 0 0 200£ 208£ 8£

7,854£ 7,650£ 204-£

Penalties 0 0 -£ 30-£ 30-£ Total 7,854£ 7,620£ 234-£

Risk Share Value (benefit)/cost 0 0 0 -£ -£

Total 7,854£ 7,620£ 234-£


£-

£100

£200

£300

£400

£500

£600

£700

£800


Total Cost Trend for North East Ambulance NHS Foundation Trust

Actual without risk share

Plan

Tees, Esk and Wear Valleys FT Finance

Finance & Activity

Annual BudgetBudget to

Date Spend to Date Variance£ £ £ £

FinanceMain Block 43,739,638 43,739,638 43,720,972 -18,666CAMHS 1,012,099 1,012,099 994,924 -17,175IAPT 1,143,312 1,143,312 1,158,747 15,435

Total 45,895,049 45,895,049 45,874,643 -20,406

Contract Update

These contract are block.

Data Issues

None.


As these contracts are block there is no financial risk to the CCG.

Forecast OutturnThe IAPT contract is showing a £15K overspend which is due to a budget shortfall compared to the agreed contract value.

The Block contract is showing an underspend of £18K as part of the CQUIN was recovered due to non achievement.

The CAMHS element of the contract is showing an underspend of £17K as the variation for ASD was amended to charge a fair share to Darlington CCG

Finance & Activity

Tees, Esk and Wear Valleys FT ActivityAnnual Target YTD Target YTD Actual Variance

Activity - Occupied Bed DaysLD - Children & Young People - Intermittent Care Sevices 654 654 907 253LD - Specialised Services - Adult Rehab Forensic LD In Patient Services 1,553 1,553 883 -670LD - Working Age Adults - In Patient Assessment & Treatment & Rehab Services 2,307 2,307 1,573 -734MH - Older Persons - Challenging Behaviou In Patient Services 3,981 3,981 2,703 -1,278MH - Older Persons - In Patient Assessment & Treatment Services 7,098 7,098 6,971 -127MH - Working Age Adults - Locked Rehabilitation and Recovery Unit 0 0 914 914MH - Working Age Adults - 24 Hour Nursed Care Services 3,512 3,512 1,633 -1,879MH - Working Age Adults - Acute In Patient Services 9,499 9,499 11,572 2,073MH - Working Age Adults - Challenging Behaviour IP Services 2,290 2,290 2,314 24MH - Working Age Adults - PICU Services 1,442 1,442 992 -450MH - Working Age Adults - Rehabilitation Services 2,138 2,138 1,315 -823MH - Working Age Adults - Crisis and Recovery 0 0 0 0LD - Working Age Adults - CHC Residential Services 0 0 0 0

Total 34,474 34,474 31,777 -2,697

Community ContactsMH - Adult MH - ADHD 160 160 176 16LD - Child LD - Challenging Behaviour Services 213 213 294 81LD - Child LD - Specialist LD CAMHS Tier 3 Community Services 4,594 4,594 5,494 900LD - Foresnic LD - Adult Forensic Day Services 656 656 250 -406LD - Adult LD - Autism Team 650 650 260 -390LD - Adult LD - Challenging Behaviour Team Service 709 709 860 151LD - Adult LD - Community Assertive Outreach & Crisis Team 3,484 3,484 1,124 -2,360LD - Adult LD - Community LD Team Services 3,842 3,842 1,639 -2,203LD - Adult LD - CHC Residential Services 10 10 618 608LD - Adult LD - Health Facilitation 896 896 658 -238LD - Adult LD - Day Services 0 0 0 0MH - Childrens & Young Persons Services - Specialist Tier 3 CAMHS Service 14,193 14,193 19,222 5,029MH - Childrens & Young Persons Services - Specialist Tier 2 CAMHS Service 0 0 3 3MH - MH Services for Older People - CMHT Services 45,308 45,308 31,218 -14,090MH - MH Services for Older People - Acute Liaison Service 2,224 2,224 5,194 2,970MH - MH Services for Older People - YOD Service 290 290 642 352MH - Adult MH - Community Intervention (Affective Disorders) Service 24,474 24,474 32,944 8,470MH - Forensic MH - Criminal Justice Liaison & Custody Diversion 298 298 308 10MH - Adult MH - Crisis Resolution & Home Treatment Services 7,655 7,655 7,789 134MH - Childrens & Young Persons Services - Early Intervention in Psychosis 5,395 5,395 4,381 -1,014MH - Adult MH - Primary Care MH Services 2,527 2,527 2,448 -79MH - Adult MH - Psychoanalytical Psychotherapy Services 944 944 60 -884MH - Adult MH - Specialist Personality Disorder Service 0 0 0 0MH - Adult MH - Adult Eating Disorder Community Team Services 201 201 1,334 1,133MH - Childrens & Young Persons Services - Community Forensic Services 12 12 14 2MH - Childrens & Young Persons Services - Tier 4 Eating Disorder Community Team Services 302 302 472 170MH - Adult MH - Assertive Outreach Services 6,214 6,214 2,955 -3,259MH - Adult MH - Community Intervention (Psychosis) Services 17,127 17,127 21,944 4,817

Total 142,378 142,378 142,301 -77

Finance & Activity

Northumberland Tyne and Wear NHS FT Northumberland Tyne & Wear NHS FT Full Year Overspend £265k

The activity and finance reports have been received for Month 12 showing a further increase in the overspend to £265k over contract (M11 £249k).

The final outturn for this contract is an improvement of £6k from the M11 forecast ( £271k) due to continued reduced activity in the Roker unit and a range of smaller reductions in activity., The accompanying schedule sets out the major over and under spending services.

Finance & Activity

Continuing Care Packages of Care


• The year end position is showing an overspend of £578k which includes a cost for the risk share arrangement of £352k

• During the month of March we have been notified of 76 new CHC packages with a cost impact of £870k, 15 new FNC clients with a cost of £26k, 79 deaths and 17 discharges giving an overall reduction in cost of £741k

Action Points

• The validation of the finance spreadsheet is complete however this has resulted in a number of patient queries which are currently being investigated by the CHC team.

• Finance staff have received training to enable access to the QA system which is proving very useful in resolving provider queries and will be used to perform regular validation checks.

Plan Actual VariancePOD SummaryCHC - Management costs 529£ 529£ -£ CHC Fast Track 1,100£ 855£ 245-£ Continuing Care - Joint Packages 2,045£ 1,962£ 83-£ Continuing Care - Section 117 2,078£ 2,082£ 4£ Continuing Health Care 7,664£ 8,637£ 972£ Free Nursing Care 2,939£ 2,517£ 422-£

16,355£ 16,581£ 226£

Risk Share CHC -£ 352£ 352£

Total 16,355£ 16,933£ 578£

£000s (YTD)

Finance & Activity

Continuing Care High Cost Packages and Restitution

• The above table shows the current calculation for the Risk Sharing scheme resulting in a cost of £352k

• Based on the latest information available for restitution cases of 319 initial requests 173 have been completed or closed with 176 remaining in the system for a full assessment. 8 cases have been agreed and 7 cases have appealed the original decision.

• During the financial year we have paid £119,903 in reimbursements for 8 cases

• The current provision stands at £5.3m

Initial requestsCompleted or removed following assessment

Completed cases eligible for CHC

Payments made to date for eligible cases

Cases requiring full needs portrayal

Cases completed and requiring panel decision

319 173 8 £119,903 176 7

CCGNumber of Packages

Total cost of packages

% share of cost of packages per risk share agreement

Risk shared value

Annual Impact of risk share

YTD Impact of risk share

DDES 12 1,500,245£ 44.31% £1,852,601 £352,357 £352,357North Durham 12 1,524,867£ 35.27% £1,474,639 -£50,228 -£50,228Darlington 7 1,155,889£ 20.42% £853,760 -£302,129 -£302,129Total 31 4,181,001£ 100.00% £4,181,001 £0 £0

High cost packages (>£100k)

Mental Health and Learning Disability Packages

Finance & Activity

Annual BudgetBudget to

Date Spend to Date Variance£ £ £ £

NHS Packages of Care 449,126 449,126 625,457 176,331Non NHS Packages of Care 1,970,260 1,970,260 1,782,235 -188,025

Total 2,419,386 2,419,386 2,407,692 -11,694

Contract UpdateThe overspend on the NHS Packages relates to costs associated with the Fulmar and KirkdaleWards within TEWV and some individual learning disability placements which TEWV provide.There was a reduction in the overspend at the year end as a package which had been due to start in February had still not been finalised by the end of March 2014.

Non NHS Packages of Care were underspent at the end of the financial year. This is in linewith previous months forecasts.

Risk Share Impact – CHC, Mental Health and LD Packages

Finance & Activity

Mental Health

Total Costs without Risk Share

Total Costs with Risk Share

Impact of Risk Share

Number of Packages


% share of cost of packages as per risk share agreement

Risk shared value

Impact of risk share

DDES 1,817,725£ 1,753,720£ 64,005-£ 10 1,407,066 52.00% 1,343,062£ 64,005-£ North Durham 897,885£ 1,095,785£ 197,900£ 3 602,771 31.00% 800,671£ 197,900£ Darlington 731,262£ 597,367£ 133,895-£ 4 572,973 17.00% 439,078£ 133,895-£ Total 3,446,872£ 3,446,872£ 0£ 17 2,582,811£ 100.00% 2,582,811£ 0£

LD




Number of Packages



Risk shared value


DDES 800,267£ 713,101£ 87,166-£ 5 707,407 62.70% 620,241£ 87,166-£ North Durham -£ 183,995£ 183,995£ 0 0 18.60% 183,995£ 183,995£ Darlington 331,078£ 234,248£ 96,829-£ 2 281,813 18.70% 184,984£ 96,829-£ Total 1,131,344£ 1,131,344£ -£ 7 989,220£ 100.00% 989,220£ -£

CHC




Number of Packages



Risk shared value


DDES 16,003,039£ 16,355,395£ 352,357£ 12 1,500,245 44.31% 1,852,601£ 352,357£ North Durham 12,880,388£ 12,830,160£ 50,228-£ 12 1,524,867 35.27% 1,474,639£ 50,228-£ Darlington 9,356,683£ 9,054,554£ 302,129-£ 7 1,155,889 20.42% 853,760£ 302,129-£ Total 38,240,110£ 38,240,110£ -£ 31 4,181,001£ 100.00% 4,181,001£ -£

Total Packages




Number of Packages



Risk shared value


DDES 18,621,031£ 18,822,217£ 201,186£ 27 3,614,718£ 46.62% 3,815,904£ 201,186£ North Durham 13,778,273£ 14,109,940£ 331,667£ 15 2,127,638£ 27.44% 2,459,305£ 331,667£ Darlington 10,419,022£ 9,886,170£ 532,853-£ 13 2,010,675£ 25.93% 1,477,822£ 532,853-£ Total 42,818,326£ 42,818,326£ -£ 55 7,753,031£ 100.00% 7,753,031£ -£

All packages High cost packages (>£100k)

High cost packages (>£100k)All packages



Community Services – County Durham and Darlington

Finance & Activity

Contract Update

• This is a risk share contract. Most elements of this contract are block, with the exception of Urgent Care. Urgent care overperformance is built into the block value for 2013/14

Data Issues

• We have now received activity for this contract.


• The contract for this year is 100% risk share, so there will be no variance from plan.

• The percentage change since 2012/13 shows the change for North Durham, DDES & Darlington as the data from previous years is not split by CCG.

• Overall, activity is up by 7% against the previous year’s figures.

Forecast Outturn

• The contract will breakeven this year

Service2013/14 Activity

Community Nursing 296,374 +10.2%

Integrated Children's Services 100,459 +9.2%

Urgent Care 118,731 +1.7%

Community Hospitals 23,648 -1.4%Intermediate Care 2,526 +17.8%Podiatry 24,896 +11.9%Podiatric Surgery 4 -78.9%Community Rehabilitation 43 -4.5%

Palliative/End of Life Care 25,875 +10.0%

Coronary Heart Disease 22,346 -2.1%Home Equipment Loans 31,068 +13.4%Physiotherapy 697 +13.0%Continence 3,318 +14.8%Pain Management 166 +10.4%

Wheelchair Service 1,961 +2.2%

Adult SALT 2,209 -0.2%Primary Care Psychology 69 +14.6%Paediatric Occupational Therapy 2,698 -8.0%Musculo Skeletal 413 +24.3%Dermatology (Tier 2) 5,031 +29.6%

Nutrition & Dietetics 2,115 -38.6%

Diabetes Type 2 388

+14.4%Paediatric Physiotherapy 1,716 +42.1%

GP Choices & Occupational Health - -100.0%

Paediatric SALT 7,073 +42.0%Occupational Therapy 13,868 +1.5%COPE 1 +6.2%Falls & Osteoporosis 8,335 +141.3%Retinal Screening 6,937 +26.1%CFS/ME 606 +5.9%Tissue Viability 2,050 +39.8%Neurological Services (Epilepsy) 289 +10.1%Neurological Services (MS) 1,552 -4.7%Stroke 4,099 +20.4%Respiratory Services 1,797 -37.0%Vasectomy 44 -48.0%Lymphoedema 1,047 +40.1%Older peoples urgent care assessment 4 +29.4%Orthotics 7 -94.6%Enteral Feeding 1,076 +33.1%Childrens Equipment in the Community - +1.3%TB Contact Tracing Service 241 +51.9%Minor Surgery 298 -60.5%

Change since

1213 (%)

Finance & Activity

Non NHS Community ServicesServices continue to operate on trend as previously reported and illustrate a £385k potential forecast outturn variance.A large overspend is anticipated on the Intrahealth Walk in Centre contract where no budget has been identified. This is eased by underspends on Oral Surgery, ENT, Gynae, OOH, CHD and Healthcare at Home.services.A significant overspend is anticipated on Children’s OT however this service is currently out for procurement which should drive savings and improve service quality.

Hospice ServicesHospice Services continue to operate on trend with Marie Curie and St Teresa’s continuing to show forecast outturn underspends as previously reported.

FOT Annual Budget FOT VarianceService £ £ £Alternative Therapies 30,788 68,520 -37,732Anti Coag 692,905 737,000 -44,095Audiology 691,202 648,000 43,202Children's OT 141,633 99,660 41,973Diagnostics 50,656 0 50,656DVT 44,200 0 44,200Healthcare at Home 51,189 148,110 -96,921Home Oxygen 115,092 107,661 7,431Minor Surgery 77,294 45,732 31,562Ophthalmology 83,800 82,474 1,326Orthotics 70,037 20,900 49,137Physio 165,537 17,188 148,349Podiatry 27,621 0 27,621Stroke 96,149 35,298 60,851Vasectomy 56,707 52,505 4,202Care for the Elderly 966,880 1,220,800 -253,920Gynae 0 20,897 -20,897Liquid nitrogen 0 8,820 -8,820CHD 0 26,982 -26,982OOH 0 926 -926ENT 0 44,238 -44,238Oral Surgery Contract 0 346,633 -346,633Child Cases 52,163 52,163 0Urology 16,756 32,718 -15,962ANP 420,000 420,000 0Nursing Home Patients 9,506 0 9,506Intrahealth Darzi Ctre 762,000 0 762,000

4,622,115 4,237,225 384,890

FOT Annual Budget FOT VarianceService £ £ £Butterwick Hospice 267,515Willowburn Hospice 277,917St Teresa's Hospice 271,381 894,413 -77,600Marie Curie 390,066 712,454 -322,388St Cuthbert's Hospice 316,788 316,788 0St Benedicts Hospice 138,324 138,325 1Hartlepool Hospice 232,921 232,921 0Other 672 0 672

1,895,584 2,294,901 -399,315

DDES CCG - Non NHS Community Contracts - Financial Performance

Hospice Services - Financial Performance

Finance & ActivityPrimary Care - Prescribing


• 10 months of data is now available for prescribing.

• Prescribing costs per head of weighted population has increased since 2012/13 across all localities.

• Costs relating to services commissioned by other public bodies (substance misuse, smoking cessation etc.) are still included within the prescribing numbers, agreement on levels of recharging to LA has been reached with the result that only LARC cost will be funded by the LA.

• The latest forecast outturn from the PPA indicates that GP Practice prescribing will amount to £52,821k driving an overspend in 2013/14 of £3,887.

• The overall prescribing forecast outturn is anticipated to amount to £55,532k with an overspend of £3,658k in 2013/14.


Durham Dales

12.6366905790345

12.8369360455

16

11.9378056438262

13.2137175803475

12.4687934085

59

12.6320857039

56

13.8294483664111

12.6337792323

94

13.8537952162579

12.7974616101

84

NaN NaN

Easington

12.8751900652052

13.3704929118423

12.3168717349739

13.7386519350688

13.1021963690447

12.7572191228631

14.0788586284734

13.2341025624

66

14.0025461495748

13.7611299942082

NaN NaN

Sedgefield

12.5881778600952

13.1596705512721

11.7371929769781

13.3275101228

27

12.5995905492343

12.4268480864253

13.7584532647184

12.5949067816116

12.9504166133694

12.8860033958685

NaN NaN

£10.75 £11.75 £12.75 £13.75

Cost per weighted head of population by locality

Cost per w

eighted head of poulation

Durham Dales Easington Sedgefield

13/14 Cost per Weighted List Size £128.84 £133.24 £128.03

12/13 Cost Per Weighted list Size £123.78 £125.48 £122.82

£-

£20.00

£40.00

£60.00

£80.00

£100.00

£120.00

£140.00

Cost per w

eigh

ted list size

Prescribing M10 YTD Costs per Weighted List Size by Locality

Finance & Activity

Primary Care – Prescribing – Durham Dales

Durham Dales Year to Date Costs

Weighted List Size YTD Cost 2013/14 YTD Cost 2012/13

Movement vs 12/13

A83021 AUCKLAND MEDICAL GROUP 2,174,826£ 15,438 140.87£ 134.84£ 5

A83046 BARNARD CASTLE SURGERY 1,297,708£ 11,256 115.29£ 113.75£ 5

A83025 BISHOPGATE MEDICAL CENTRE 2,153,447£ 16,109 133.68£ 123.00£ 5

A83032 COCKFIELD SURGERYTHE SURGERY 371,443£ 3,002 123.72£ 122.36£ 5

Y00643 DALES SUBSTANCE MISUSE -£ 0 -£ -£

Y00866 DURHAM DALES DERMATOLOGY 13,791£ 0 -£ 13.59£

Y01792 DURHAM DALES MEDICAL PRACTICE

6,249£ 0 -£ -£

A83626 EVENWOOD MEDICAL PRACTICE 358,314£ 2,429 147.54£ 140.03£ 5

A83061 GAINFORD SURGERYMAIN ROAD 389,714£ 3,713 104.95£ 100.09£ 5

A83020 NORTH HOUSE SURGERYNORTH HOUSE SURGERY

2,043,975£ 15,055 135.77£ 125.37£ 5

A83043 OLD FORGE SURGERYTHE SURGERY 414,494£ 3,127 132.56£ 129.66£ 5

Y00017 PALLIATIVE CARE CLINIC 14£ 0 -£ -£

A83060 PINFOLD MEDICAL PRACTICE 415,158£ 3,460 119.99£ 113.12£ 5

Y02115 RICHARDSON COMMUNITY HOSPITAL

9,141£ 0 -£ -£

A83015 STATION VIEW MEDICAL CENTRE 1,560,097£ 12,025 129.74£ 125.64£ 5

A83035 THE WEARDALE PRACTICE 961,347£ 9,104 105.60£ 101.40£ 5

Y00943 URGENT CARE CENTRE/DAYTIME 135£ 0 -£ -£

Y02352 WEARDALE COMMUNITY HOSPITAL

7,189£ 0 -£ -£

A83003 WILLINGTON MEDICAL GROUP 1,364,869£ 10,388 131.39£ 121.47£ 5Total 13,541,911£ 105,106 128.84£ 123.78£ 5

Cost per Weighted List Size

Finance & Activity

Primary Care – Prescribing – Easington

Easington Year to Date Costs


Movement vs 12/13

A83041 DR D S RANGAR & PARTNERS 1,434,243£ 9,513 150.77£ 139.84£ 5

A83075 DR KV REDDY 773,978£ 5,748 134.65£ 131.65£ 5

A83616 DR M D RAMAKRISHNA GUPTA 388,531£ 3,059 126.99£ 122.97£ 5

A83017 DR MAHTO & PARTNERS 1,175,790£ 10,025 117.29£ 110.92£ 5

A83042 DR. C.P. FAIRLAMB & PARTNERS 675,696£ 6,495 104.04£ 119.21£ 6

A83004 DR. K R KAPOOR & PARTNER 469,637£ 4,200 111.81£ 113.46£ 6

A83007 DR. P. BURRELL & PARTNERS 1,570,661£ 11,342 138.48£ 132.14£ 5

A83019 DR. R.G. ABBOTT AND DR. PATEL 844,803£ 6,536 129.25£ 116.63£ 5

A83619 DR. S H S MANSOUR 410,209£ 3,261 125.80£ 110.47£ 5

Y02203 EASINGTON DERMATOLOGY CLINIC

4,112£ 0 -£ -£ Y03574 HAWTHORNS SPINAL UNIT 136,809£ 0 -£ -£ Y02614 INTRAHEALTH AT HEALTHWORKS 133,679£ 885 151.00£ 114.96£ 5

A83068 JUPITER HOUSE 368,539£ 2,510 146.82£ 139.82£ 5

A83051 MARLBOROUGH SURGERY 1,746,127£ 12,107 144.22£ 136.70£ 5

Y01014 PALLIATIVE CARE MEDICINE 3£ 0 -£ -£ A83057 SHINWELL MEDICAL GROUP 929,102£ 6,263 148.34£ 143.55£ 5

A83627 SILVERDALE FAMILY PRACTICE 626,138£ 4,508 138.90£ 119.01£ 5

A83044 THE HORDEN GROUP PRACTICE 1,114,007£ 7,638 145.85£ 123.91£ 5

A83071 THE NEW SEAHAM MEDICAL GROUP

618,690£ 5,810 106.48£ 104.00£ 5

A83012 WILLIAM BROWN CENTRE 2,449,157£ 18,859 129.87£ 120.89£ 5

A83610 WINGATE MEDICAL PRACTICE INTRAHEALTH

412,756£ 3,448 119.70£ 114.43£ 5Total 16,282,667£ 122,208 133.24£ 125.48£ 5


Finance & Activity

Primary Care – Prescribing – Sedgefield

Sedgefield Year to Date Costs


Movement vs 12/13

A83066 JUBILEE MEDICAL GROUP 1,116,315£ 9,094 122.76£ 117.00£ 5A83037 BEWICK CRESCENT SURGERY 2,130,858£ 16,081 132.51£ 127.40£ 5A83638 DR.BALIGA 220,831£ 1,739 126.96£ 100.46£ 5A83054 DR.JONES & PARTNERS 1,946,142£ 18,514 105.12£ 95.92£ 5A83045 DR.OAKENFULL & PARTNERS 2,433,434£ 17,196 141.51£ 136.77£ 5A83603 DR.ROY 380,819£ 2,916 130.59£ 127.46£ 5A83052 DR.WOOD & PARTNERS 1,397,656£ 9,827 142.23£ 134.60£ 5A83008 HALLGARTH SURGERY 992,922£ 7,127 139.31£ 134.03£ 5A83074 PEASEWAY MEDICAL CENTRE 1,525,819£ 12,350 123.55£ 118.93£ 5Y03525 SEDGEFIELD ASSESSMENT UNIT 103£ 0 -£ -£ A83001 ST ANDREW'S MEDICAL PRACTICE 1,401,389£ 11,501 121.85£ 127.29£ 6A83634 WEST CORNFORTH MEDICAL 476,346£ 3,182 149.70£ 142.47£ 5

Total 14,022,634£ 109,527 128.03£ 122.82£ 5


52

Referrals – CDDFT

The following slides shows referrals made by GPs and others of NHS Durham Dales, Easington and Sedgefield (DDES) CCG patients to County Durham & Darlington NHS Foundation Trust (CDDFT)

Referrals reported here include only those for 'General and acute specialities' as defined for the Monthly Activity Returns (MAR) and therefore excludes referrals to Obstetrics, Neuropsychology, Physiotherapy, Allied Health Professional Episodes, Podiatry, Dietetics and Orthoptics

DDES practices make a significant number of referrals to providers other than CDDFT, particularly practices in Easington (and also Dr Jones & Partners in Sedgefield) tending to refer to Sunderland, Hartlepool and North Tees. Users should be aware that looking only at CDDFT referrals will not always provide a complete picture, particularly for these areas. Referrals information has been requested from other providers to allow more complete monitoring of referrals but Sunderland has confirmed that this will be unavailable for 2013/14 due to problems with their information systems.

Finance & Activity

Referrals - CDDFT

Only those specialties which have seen an increase or decrease of at least five GP referrals are shown in this chart.

Finance & Activity

Referrals - CDDFT

Finance & Activity

GP / GDP Other Source Total1213 YTD 27340 16851 441911314 YTD 30039 18026 48065Variance +2699 +1175 +3874%Change YTD +9.9% +7.0% +8.8%

General and Acute referrals by sourceApril - January

Caveats - Date in this pack is sourced from local unvalidated datasets. Referrals include only those for 'General and acute specialties' as defined for the Monthly Activity Returns (MAR) and therefore exclude referrals into Obstetrics, Neurophysiology, Physiotherapy, Allied Health Professional Episodes, Podiatry, Dietetics and Orthoptics.

Referrals - CDDFT

Finance & Activity

The funnel chart below shows referral rates for DDES practices for all General and Acute specialties during the 12 months to January 2014. Easington practices and Dr Jones & Partners, Sedgefield are excluded as CDDFT is not their main OP provider.

NB – with the large number of referrals made it is possible to identify that most practices are statistically above or below average at 95% significance in their referrals rate to CDDFT.

Glossary

Threshold FrequencyQuality Premium

Link


Admitted patients to start treatment within a maximum of 18 weeks from referral

Green: Greater than or equal to 90%Red: less than 90%

Monthly National


Non-admitted patients to start treatment within a maximum of 18 weeks from referral


Monthly National


Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks


Monthly National

Number patients waiting more than 52 weeks for treatment

Number of 52 week Referral to Treatment PathwaysGreen is zeroRed is more than zero

Monthly

% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology)


Green: less than or equal to 1%Red: greater than 1%

Monthly

% patients spending 4 hrs. or less in A&E or minor injury unit

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department


Weekly National

Handover between ambulance and A&E over 30 minutes

Handover between ambulance and A&E0ver 60 minutes or more




Monthly



Green: Greater than or equal to 93%Red: less than 93% Monthly

% of patients receiving subsequent treatment for cancer within 31 days - surgery

Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers


Monthly


Maximum 31 day wait for subsequent treatment where that treatment is surgery


Monthly


Maximum 31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen


Monthly

% of patients treated within 31 days of a cancer diagnosis

Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy


Monthly


Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer


Monthly National


Maximum 62 day wait from referral from an NHS screenng service to first definitive treatment for all cancers

Green: Greater than or equal to 90%Red: less than 90% Monthly National




Monthly National

RED 1 response in 8 mins Calls resulting in an emergency reponse arriving within 8 minutes (Red 1) Green: Greater than or equal to 75%Red: less than 75%

Local Target Threshold Green: Greater than or equal to 72%

Monthly National

RED 2 response in 8 mins Calls resulting in an emergency reponse arriving within 8 minutes (Red 2) Green: Greater than or equal to 75%Red: less than 75%

Local Target Threshold Green: Greater than or equal to 72%

Monthly

Cat A Response within 19 mins Category A calls resulting in an ambulance arriving at the scene within 19 minutes


Monthly

Number of crew clear delays over 30 mins

Number of crew clear delays over 60 mins

Mixed Sex accommodation - number of unjustified breaches

The number of MSA breaches for the reporting month in question Green: zeroRed: more than zero

Monthly

% people followed up within 7 days of discharge from psychiatric in patient care

Care Programme Approach (CPA): The proportion of people under adult mental i l lness specialities on CPA


Monthly

Mixed Sex accommodation

Mental Health

Cancer patients 2 week wait



Ambulance response times

Crew clear delays of over 30 minutes/1 hour

0 Monthly

CONSTITUTIONAL INDICATORSMeasure(s)

Referral to treatment access times

Diagnostic waits

A&E waits

The number of handover delays of over 30 minutes/1 hour

0

Monthly

Glossary

Threshold FrequencyQuality Premium

Link

Under 75 mortality rate from cardiovascular disease

Mortality rate from cardiovascular disease, ages under 75, per 100,000 population

Trend Annually

Under 75 mortality rate from respiratory diseaseMortality rate from respiratory disease, ages under 75, per 100,000 population

Trend Annually

Under 75 mortality rate from liver disease

Mortality rate from liver disease, ages under 75, per 100,000 populationTrend Annually

Under 75 mortality rate from cancer Mortality rate from cancer, ages under 75, per 100,000 population Trend AnnuallyLocal (12.5% or

Quality premium)

Unplanned hospitalisation for chronic ambulatory care sensitive conditions

The proportions of people with chronic conditions admitted to hospital as an emergency admissions

TrendMothly via

Hospital Episode Statistics

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Rate of emergency admissions episodes in people under 19 (0-18 years) for asthma, diabetes or epilepsy per 100,000 population Trend

Mothly via Hospital Episode

Statistics

Local (12.5% or Quality premium)

Emergency admissions for acute conditions that should not usually require hospital admission

Emergency admissions to hospital of persons with acute conditions (ear/nose/throat infections, kidney/urinary tract infections, heart failure, among others) that usually could have been avoided through better management in primary care

TrendMothly via


Emergency readmissions within 30 days of discharge from hospital

Percentage of emergency admissions to any hospital in England occuring within 30 days of the last, previous discharge from hospital after admission

TrendMothly via


Emergency admissions for children with Lower Respiratory Tract Infections (LRTI)

Emergency admissions to hospital of children with selected types of Lower Respiratory Tract Infections (bronchiolitis, bronchopneumonia and pneumonia)

TrendMothly via


Local (12.5% or Quality premium)

% of people who enter treatment against the level of need in the general population (IAPT)

% of people who enter treatment against the level of need in the general population

Green: Greater than 12%Monthly

% of people who complete treatment who are % of people who complete treatment who are moving to recovery Green: Greater than 50% MonthlyTotal Health gain Hip replacement Trend AnnuallyTotal Health gain Knee replacement Trend AnnuallyTotal Health gain Groin hermia Trend AnnuallyTotal Health gain Varicose veins Trend Annually

FFT Combined ResponseGreen: Greater than 15% response rate

Monthly National

FFT Combined ScoreGreen: Greater than 50 satisfaction score

Monthly National

FFT A&E ResponseGreen: Greater than 15% response rate

Monthly National

FFT A&E ScoreGreen: Greater than 50 satisfaction score

Monthly National

FFT Inpatient Response

Green: Greater than 15% response rateMonthly National

FFT Inpatient ScoreGreen: Greater than 50 satisfaction score

Monthly National

Healthcare acquired infection (HCAI) measure (MRSA)

Number of cases of Methicil l in-resistant Staphylococcus aureus (MRSA) bacteraemia

Green: zero casesRed: Greater than zero

Weekly National

Healthcare acquired infection (HCAI) measure (clostridium difficile infections)

Number of Clostidium diffi cile infections, for patients aged 2 or more on the date the specimen was taken

Green: less or equal to targetRed: greater than target

Weekly National

Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm

Measure(s)

Domain 3 - Helping people to recover from ill health or injury

Patient reported outcome measure for elective procedures

Domain 4 - Enusring that people have a positive experience of careTest will measure whether people recievieving NHS treatment would recommend the place where they received care to their friends and family.

OUTCOMES FRAMEWORK INDICATORS

Domain 1 - Preventing People from dying prematurely

Domain 2 - Enhancing Quality of life for people with long term conditions

Documents

Quality, Performance and Finance Report May 2014