Trust Board, Part I - Public Date€¦ · 1 Meeting: Trust Board, Part I - Public Date: 2 9 September 2016 Report Title: Integrated Quality and Performance Report (IQPR): August 2016

1

Meeting: Trust Board, Part I - Public

Date: 29 September 2016

Report Title: Integrated Quality and Performance Report (IQPR): August 2016

Agenda Item: TB/16/17/79

Enclosures: Appendix 1 Overview IQPR: August 2016 Appendix 2 IQPR Full Report August 2016

Report Author: Vicky Boswell, Director of Performance

Presenter: Ivan McConnell Executive Director of Commercial Development and Transformation

Report History: N/A

Board Lead Ivan McConnell Executive Director of Commercial Development and Transformation

Purpose of the Report

The purpose of the report is to review the Trusts performance.

Performance

Policy

Assurance

Strategy

Strategic Objective

1 Enhance service user engagement and patient experience

2 Become an exemplary employer, enabling staff to reach their full potential

3 Ensure sound financial management without compromising the quality of care

4 Develop dynamic and innovative clinical models, enhancing the quality, safety and effectiveness of services

5 Maintain and further establish our position as the provider of choice for mental health services

6 Enhance the quality and safety of the services by maintaining or exceeding required standards of care

7 Incorporate sustainability and environmental management as an essential element of healthcare delivery

2

Seven

Legal or regulatory implications

The Trust has achieved 6 of the 8 Regulatory targets in May, with the exceptions of CPA 12 month review and Delayed Transfer of Care (DToC). Early Intervention in Psychosis waiting time target achieved compliance in June for the second consecutive month.

Financial or resource implications

There is a continued pressure on out of area placements due to levels of demand and capacity. Management actions are in place which aim to minimise the use of out of area beds. KMPT continues to manage the allocation of the costs to the health economy of placing K&M clients into private acute units when there is no capacity in the Trust with Kent and Medway CCGs.

Engagement / Consultation

The IQPR forms the basis of discussions with Service Lines at the monthly performance management meetings. There is a particular focus on progress against financial and CRES plans and reduction in temporary staff spend, and for Service Lines, CQC QIP implementation and performance against trajectories for IQPR priorities and waiting time targets.

Risks identified Performance review arrangements have been strengthened to ensure that actions are being taken to minimise identified risks in achieving performance standards. Risk management is through the Service Line Performance Management meetings and the Operations Board.

Links to the Board Assurance Framework or Risk Register

The Board Assurance Framework (BAF) identifies risks to the strategic objectives to the Trust. The main risks associated with the IQPR are:

ID 4190 Financial control and delivery of CRES (current rating 20)

ID 4211 Ensuring all service users has a person centred and effective care plan (current rating 9)

ID 3746 Recruitment, retention and development of staff with suitable skills and competencies (current rating 6); and

ID 3808 Recruitment and retention to safe clinical staffing levels to enable adequate shift cover, including NHSP/Agency cover (current rating 16).

Impact on Quality

A balanced scorecard of indicators will highlight areas where quality improvement is required, and help direct efforts in areas where there may be a cause for concern.

Equality & Diversity

Access to IQPR data at service and team level may help to identify areas of inequality to be addressed.

Recommendation / Action required

The Board is asked to discuss the report.

Approval

Discussion

Consideration

Noting

Information

3

IQPR Overview for reporting period: August 2016

The trust achieved five out of eight Regulatory targets in August, the exceptions being

7 Day Follow Up, Delayed Transfers of Care (DToC) and CPA 12 Month Reviews.

7 Day Follow Up fell below 95% for the first time in over 18 months, this was due to 9 out of 128 discharged care coordinated in CRSL not being successfully followed

up. Some of the incomplete follow ups were due to lack of patient engagement.

DToC reduced to 7.54%, marginally above the 7.5% target, this is an improvement from July 2016 which was 7.6%. This accounts for 1,116 bed days lost across the

trust in month. (full summary on bed pressures below)

CPA reviews below 95% for the fifth consecutive month with performance continuing to reduce by a further 1.6% to 86.5%. This is solely an issue for the Community

Recovery Service Line.

It is positive to note that the new Early Intervention in Psychosis target to commence treatment within 2 weeks for all those with first episode psychosis has been

achieved for the fourth successive month at 69.2% with 18 out of 26 patients commencing treatment within 2 weeks.

The trust continues to experience considerable pressure on its workforce within the Community Recovery Service Line where high levels of vacancies and ongoing

challenges in recruitment exist. Particular pressure has been reported for Ashford, Canterbury and Medway. The trust continue to experience issues recruiting to

inpatient wards in Dartford.

Following consultation, NHS Improvement’s (NHSI) Single Oversight Framework (SOF) was published on 13th September 2016. The SOF aims to provide an integrated

approach for NHSI to oversee both NHS foundation trusts and trusts, and identify the support they need to deliver high quality, sustainable healthcare services. It aims

to help providers attain and maintain CQC ratings of ‘good’ or ‘outstanding’. In carrying out its role NHSI will oversee and assess providers’ performance against five

themes: Quality of Care, Finance and use of resources, Operational performance, Strategic change and Leadership and improvement capability (well-led).

NHSI have made a number of changes to the SOF since the publication of their consultation document in June 2016. NHSI plan to introduce the framework from 1

October 2016, at which point the Monitor Risk Assessment Framework and the TDA Accountability Framework will no longer formally apply and NHSI will be collecting

information from the provider sector using the SOF. The sector’s segmentation is then likely to be publicly available from November 2016. A shadow segmentation

process has already begun and providers will be discussing their shadow segment with NHSI’s regional teams over the coming weeks.

The IQPR will continue to develop to enable the monitoring of SOF metrics from September 2016.

Single Oversight Framework Update

Headlines

Page 1 of 7

2016-06 2016-07 2016-08 YTD 2016-06 2016-07 2016-08 YTD

Bed days Lost to DToC 639 730 720 2089 1323 793 968 3081

DToC £ @ £756/day £483,084 £551,880 £544,320 £1,579,284 £1,000,188 £599,508 £729,540 £2,329,236


DToC £ @ £780/day £379,080 £318,240 £301,860 £999,180 £140,400 £58,500 £3,120 £202,020


DToC £ @ £960/day £0 £0 £8,640 £8,640 £555,840 £522,240 £518,400 £1,596,480

£862,164 £870,120 £854,820 £2,587,104 £1,696,428 £1,180,248 £1,251,060 £4,127,736

Private Bed Use Trajectories

Delayed Transfers of Care Private Bed Usage

Bed Pressures

£ Private Bed Use

YA

Acu

teP

ICU

OP

Acu

te

DToC Cost

Private Bed £ @ £756/day



Private Beds

Private Beds

Private Beds

August saw 1,511 private bed days used, this relates to 48.7 beds per day which is an increase of 3.7% compared to July but below the monthly average of 2016/17 of

55.1. The trust has set a target of not having greater than 15 private placements a day by November 2016, this target will be managed via the Patient Flow Programme

(see details below)

Page 2 of 7

The trust has now implemented the new waiting time measures within the IQPR. This brings the trust in line with other nationally reported metrics. The change

fundamentally reflects the need for the initial assessment to be a face to face contact and no clock restarts are allowed within the national approach.

As expected and previously measured in shadow form within previous reports this has led to a reduction in reported performance levels with CRSL undergoing the

greatest reduction.

Waiting Times

Patient Flow Programme

The Patient Flow Programme has been established to achieve, with the opening of Pinewood, a reduction in private bed usage to a maximum of 15 beds by end

October 2016 and a further reduction in private bed usage to 0 by end December 2016 for acute mental health and psychiatric intensive care unit [PICU] beds.

Governance of the programme is provided by the Patient Flow Programme Board [PFPB] which was established on 3 August 2016 and meets weekly. It is chaired

jointly by the Executive Medical Director and Executive Director Operations, with clinical leadership provided by the Associate Medical Director Acute, and with cross

service line (acute, community recovery and older adult) representation at a senior level. The PFPB reports in to the Operations and Transformation Board. A number

of work streams have been established to reflect the whole system approach needed to deliver change and achieve the objectives.

CRSL Target Operating Model

The CRSL Target Operating Model (TOM) will be developed to reduce unwarranted variation in the standard of care and support staff who feel overwhelmed and under

pressure. An initial plan has been developed to articulate vision, description, outcomes, impact, delivery plan and milestones, key risks as well as resourcing. This draft

plan will be discussed when the group meets for the 1st time on September 21st.

As part of this work a review of performance trends has been carried out that can be found in appendix A.

Page 3 of 7

Balanced Scorecard

Measure Target 2016-08 MovementNext Month

Forecast

Trend

(Last 12 months where available, left to right)

7 Day Follow Up 95% 94.4%

CPA Review 95% 86.5%

DToC 7.5% 7.54%

EIP Wait Times 50% 69.2%

Sickness Absence 3.9% 4.0%

Staff Vacancies 15% 10.4%

Staff Turnover 14% 16.0%

Agency Spend 5% 6.1%

% in Employment 13% 14.2%

% in Settled Accommodation 75% 83.7%

4 week Referral to Assessment 95% 80.2%

18 Week Referral to Treatment 95% 88.9%

Serious Incidents N/A 8 N/A

Never Events 0 0 0 Never events in last 12 months

Complaints N/A 43 N/A

Care Plans Distributed to Service

User75% 39.3%

* See full IQPR report for full measure descriptions

Car

ing

The new waiting time measures introduced in August 2016 has had a detrimental impact on

performance levels as anticipated. No Service line achieved the waiting time standards for

assessment and treatment. Forensic and Specialist Services have not achieved this target due to

lack of commissioned capacity in specialist services, although 4 week wait compliance improved

by 15.7%. CRSL compliance with the 4 week wait has reduced to 62% from 82.7% in August, 294

out of 774 who underwent initial assessment in CRSL were not seen within 4 weeks.

Re

gula

tory

Issues / Risks and Mitigating Actions

Org

anis

atio

nal

He

alth Service Lines are supporting Health and Wellbeing initiatives to reduce absence, improve staff

engagement and reduce turnover.

Long term sickness absence is reducing in Service Lines and is being proactively managed by

line managers, supported by HR. The Trust has implemented a number of recent actions to

improve recruitment and retention. Cohesion are supporting recruitment in North Kent to

improve the staffing situation.

Agency spend has increased Trust-wide by 0.1% in August

Effe

ctiv

eSa

fe

7 day follow up - OPMH achieved the target and in CRSL 9 breached

CPA review - CPA Reviews fell by a further 1.6% overall with CRSL at 85.4%. 337 reviews

outstanding in the service line - close monitoring and risk review in place.

DToC - Performance continues to improve with ongoing productive liaison with partners to

facilitate appropriate discharge. This is having a positive impact on private beds

EIP wait times - NHS(E) project with CCGs to provide whole system focus

Serious incidents reduced from a 12 monthly high of 22 in May to 8 in August which is

considerably below the average of 15 per month.

Care plan distribution increased 3.2% in month and improved in each Service Line, with the

Forensic and Specialist Service Line at 91.4%. The new RiO Care Plan has been added to open

RiO and the old care plan template will be switched off on October 1st. This will improve

compliance and quality.

Page 4 of 7

Trust Wide Financial Position

Ref Measure Target Aug-16 Jul-16 MovementAnnual

Plan

Annual

Forecast

1.1 Income (£000) (15,440) (15,350) (15,638) (185,279) (179,146)

1.2 Pay Expenditure (£000) 11,396 11,660 11,462 136,750 138,127

1.3 Non Pay Expenditure (£000) 4,458 4,118 4,377 52,859 45,349

1.4 Retained (Surplus) / Deficit (£000) 414 428 201 4,330 4,330

1.5 CRES achieved in month (£000) 406 354 622 5,559 5,559

1.6 Capital spend (£000) 390 257 596 4,357 4,357

1.7 Month end cash balance (£000) 653 2,853 3,276 116 116

The Trust continues to report a deficit in line with the improved control total. In month the deficit was £0.4m after technical adjustments and year to date the deficit is

£2.2m after technical adjustments.

The Trust continues to recognise Sustainability and Transformation Funding based on performance being on plan year to date, and is forecasting to receive the full £1.1m

in 2016/17.

The cash position has remained favourable, with the month end balance £2.2m better than planned. However the Trust has received a cash advance in June on block

contract for March 2017 which means that the underlying cash position continues to be monitored closely to ensure that this can be maintained in the latter quarter of

the year.

The forecast position for year end is to deliver the planned deficit of £4.1m after technical adjustments.

Page 5 of 7

Trajectories

Measure Target CurrentPeriod not met

(months)

Proposed date of

achievementTrajectory Owner Actions

DToC 7.5% 12.8% 22 November 2016Service Line

Director

As part of the Patient Flow Programme, the Acute Service Line have established a daily internal bed

management call to review all delayed transfers of care. Each barrier to discharge is discussed with the

Community and Recovery Service Line to ensure discharge takes place at the earliest possible time to

improved patient experience / carer satisfaction and reduce time in inpatient care.

Emergency

Readmissions5% 13.6% >24 November 2016

Business

Manager

There has been a continued issue with data quality on the recording of emergency readmissions as

currently there are 12 national codes available, 8 of which relate to emergency readmissions. National

reporting has been reviewed to ensure any changes to Rio to simplify process have no negative impact and

as a result the service line is reviewing how best this may work on RiO to support operational process

Target Ave Daily

Private Beds 15 48.5 >24

15 beds by end of

October 2016, 0

by end December

2016

Service Line

Director

The Patient Flow Programme Board has been established, with the opening of Pinewood, a reduction in

private bed usage of 15 beds by end October 2016 and a further reduction in private bed usage to 0 by end

December 2016 for acute mental health and psychiatric intensive care beds (PICU)

The Programme has put trajectories in place in order to meet these targets.

Agency 5% 9.3% >6 Dec-16Service Line

Director

Agency usage in the Acute Service Line continues to be an issue due to an increasing number of vacancies.

A recruitment and retention group has been set up to focus specifically on Acute Service Line issues in

order to see the number of vacancies decrease and to help to retain the current workforce.


(months)

Proposed date of


CPA Review 95% 85.4% 8 November 2016Service

Managers

The Service Managers are reviewing processes in teams to ensure that there is a designated administrator

who monitors and books all CPA reviews in advance to avoid breaching and provide weekly reminders to

staff. It is worth noting that DGS CMHT has been able to sustain the compliance and remains in excess of

97%.

4 Week Referral to

Assessment95% 62.0% >24 March 2017

Service

Managers

The change in the waiting time methodology has had an impact on the overall compliance and Service

managers are working with the Senior Management Team on local action plans to support the teams.

Admin staff monitor the waiting list and highlight potential breaches to clinical staff. The CMHTs have a

number of vacancies, which are high in Ashford and Medway. The SMT and HR have put an action plan

together to support teams with the recruitment process.

18 Week Referral to

Treatment95% 85.4% 1 December 2016

Service

Managers

CRSL was previously compliant; however due to the change in the waiting time methodology the overall

compliance has dropped below 95%. Its is also worth adding that the staffing issues have had an impact on

performance. The Service Managers have reviewed processes to ensure more robust systems. Admin staff

monitor the waiting list and highlight potential breaches to clinical staff.

% Care Plans 95% 86.7% 8 March 2017Service

Managers

There has been a dip in performance following the introduction of the new care plan due to a recording

issue; however staff have been reminded of the correct procedure and an improvement is expected.

Staffing issues have also affected the teams' performance and the Service Managers and HR have put

together an action plan to support the recruitment process. It is worth noting that Ashford is expecting to

have 2 new staff by the end of October.

% Crisis Plans 95% 93.6% 9 March 2017Service

Managers

Performance is improving and it is expected that the service will be compliant by November. The new Care

Plans incorporate Crisis Plans, and therefore it will be easier for the staff to complete them concurrently.

EIS waits 50% 69.2% 0 N/AService

ManagersIt is anticipated that the national waiting time target will be reached each month.

The trajectories shown here have been reset since the last report, this is partly due to the new measurement of waiting time metrics as well as to reflect the refreshed approach developed within the

Patient Flow Programme and the CRSL Target Operating Model Programme

Community Recovery Service Line

Acute Service Line

Page 6 of 7

Trajectories


(months)

Proposed date of


4 Week Referral to

Assessment95% 82.0% >24 March 2017

Service

Managers

18 Week Referral to

Treatment95% 76.6% >24 March 2017

Service

Managers

Turnover 14% 17.2% >12 March 2017 SLD

Turnover within the service line has decreased since January 2016 with further reductions expected due to

ongoing actions aimed at improving staff engagement:

• Staff exit questionnaires

• Recruitment open days

• Monitoring recruitment

• Review skill mixing


(months)

Proposed date of


DToC 7.5% 9.3% 20 January 2017

Assistant

Director -

inpatient

Increase in therapeutic revised banding will enable increase in recovery model thus reducing overall

delayed discharges. OPMH Remain at 0 for Private Placements.

• Weekly Conference calls including KCC and CCGs

• All requests for beds have clear treatment plan

• Reviews of Crisis plans and ensuring that all CMHT options including CRHT are pursued

4 Week Referral to

Assessment95% 86.1% 1 January 2017

Assistant

Director -

community

Demand and capacity model implemented to support patient flows across community teams. All teams are

aware of the number of referrals received each week and job plan assessment slots accordingly. The

revised waiting time measurement, which now includes DNA and cancelled by client has had an impact on

the compliance and the service line is currently developing plans to address this issue and reduce DNAs

further.

18 Week Referral to

Treatment95% 88.9% 2 January 2017

Assistant

Director -

community

Demand and capacity model implemented to support patient flows across community teams. As above the

teams are aware of the number of appointments needed to ensure the timely throughput of patients.

When full compliance is not achieved, issues with medical staffing and diagnostic procedures are causing

delays and are being addressed.

% Care Plans 95% 96.0% 0 N/A

Assistant

Director -

community

Administrative and clinical processes in place to support all patients receiving a care plan from the first

appointment.

Agency 5% 7.7% >6 January 2017

Assistant

Director -

inpatient

• Therapeutic staffing is being e-rostered with new rules to improve control

• Increase in NHSP and reduction in Agency month on month 1-4

• Sickness on all acute wards monitored via dashboard monthly

• Use of Observation Policy being reviewed daily to reduce observations and increase group therapy

Graph key

Target

Actual

Trajectory

Older Persons Service Line

Forensics and Specialist Service Line

Because of the way that specialist services are commissioned, it is unlikely that they will be able to achieve

the 95% target during 2016/17. However, we do expect to see some improvement in staffing, funding and

strategy due to:

• Consistent monitoring and reporting of the IQPR and the prioritisation of booking appointments for

clients close to breach.

• The ongoing Trust wide Personality Disorder review

• Bids for service uplift for the Primary Eating Disorder and MIMHS services.

• The imminent start of consultant posts within the Personality Disorder and Neuropsychiatry services.

• The Personality Disorder team have reduced the maximum time in outreach groups from 24 months to

18 months (with an expectation that after 12 months patients will be considered for transfer into the 3 day

per week programme at Brenchley).

Page 7 of 7

Monthly

Integrated Quality and Performance Report

August 2016

OPMH Service Line 17

Service Line Summaries

CONTENTS

Trust Summary 3

Finance Summary by Service Line 7

Acute Service Line 8

Community Recovery Service Line 11

Forensic & Specialist Service Line 14

TRUST SUMMARY PERFORMANCE SCORECARD

Ref. Measure Target Aug-16 Jul-16 MovementTrend


Previous

Forecast

Next Month

Forecast

1 Regulatory Targets

1.1 CPA patients receiving follow-up within 7 days of discharge 95% 94.4% 95.0%

1.2 CPA patients receiving formal 12 month Review 95% 86.5% 88.1%

1.3 Delayed Transfers of Care 7.5% 7.54% 7.6%

1.4 Admissions to Inpatient Services had Access to CRHTs 95% 100.0% 100.0%

1.5 Meeting commitment to serve new psychosis' cases by EIS 1 95% 140.9% 138.8%

1.6 MHMDS Data Completeness: Identifiers 97% 99.7% 99.7%

1.7 MHMDS Data Completeness: Outcomes for Patients on CPA 50% 81.5% 82.8%

1.8 EIP Waiting Time Proxy (Referral to Care coordinator in 2 weeks) 50% 69.2% 85.7%

1 Possible to achieve over 100% where new cases accepted to date exceeds average cases required per month to meet target



Previous

Forecast

Next Month

Forecast

2 Workforce

2.1 Sickness Absence 3.9% 4.0% 4.2%

2.2 Staff Vacancies 15% 10.4% 10.4%

2.3 Staff Turnover 14% 16.0% 15.8%

2.4 Agency Spend 5% 6.1% 6.0%

2.5 Appraisals and Personal Development plans 90% 83.5% 80.8%

3




Previous

Forecast

Next Month

Forecast

2.6 % mandatory training 85% 91.4% 90.9%

2.7 % Eligible staff with enhanced CRB check 100% 100.0% 100.0%



Previous

Forecast

Next Month

Forecast

3 Quality

3.1 Referral to assessment within 4 weeks 95% 80.2% 87.7%

3.2 18 Weeks referral to treatment 95% 88.9% 94.9%

3.3 % of patients with valid CPA care plan or plan of care 95% 91.2% 91.5%

3.4 Crisis Plans (all patients) 95% 95.7% 95.9%

3.5 % of Service users in employment 13% 14.2% 14.0%

3.6 % of Service Users in Settled Accommodation 75% 83.7% 83.9%

3.7 % Reviews undertaken within the maximum cluster review period 95% 73.8% 71.5%

3.8 % of service users assessed with cluster assigned 95% 94.5% 93.2%

3.9 % inpatients with a physical health check within 72 hours 100% 73.3% 76.2%

3.10 Number of Home Treatment Episodes 224 326 298

3.11 Emergency Readmission within 28 days 5% 13.4% 10.7%

3.12 Average Length of stay(Younger Adults) 25 30.5 25.1

3.13 Bed Occupancy: Internal Usage v's Internal Capacity (YA Acute) 98.4% 97.4% N/A N/A

Act

ual

s R

epo

rted

4




Previous

Forecast

Next Month

Forecast

3.14 Bed Occupancy: Internal & External Usage v's Internal Capacity (YA Acute) 116.8% 112.5% N/A N/A

3.15Bed Occupancy: Internal & External Usage v's Proposed 174 Capacity (YA

Acute)113.3% 109.2% N/A N/A

3.16 Bed Occupancy: Internal Usage v's Internal Capacity (YA PICU) 97.8% 98.9% N/A N/A

3.17 Bed Occupancy: Internal & External Usage v's Internal Capacity (YA PICU) 242.2% 245.2% N/A N/A

3.18 Average Length of stay(Older Adults) 52 86.8 107.7

3.19 Bed Occupancy: Internal Usage v's Internal Capacity (OP Acute) 96.0% 94.6% N/A N/A

3.20 Bed Occupancy: Internal & External Usage v's Internal Capacity (OP Acute) 96.1% 97.3% N/A N/A

3.21 Number of unplanned absences (AWOL and absconds on MHA) 0 0 0

3.22 Serious Incidents 8 11 N/A N/A

3.23 Number of Grade 1&2 Sis confirmed breached over 60 days 0 0 0 Grade 1&2 Sis breached in last 12 months N/A N/A

3.25 Complaints (level2-4 , MP enquiries & MP Complaints) 43 34 N/A N/A

3.26 Never Events 0 0 0 0 Never events in last 12 months

3.27 Information Governance Breaches 0 0 0

3.28 Safeguarding training Adult - Basic Introduction 85% 98.8% 98.2%

3.29 Safeguarding training - Children 85% 98.7% 97.9%

3.30 Safeguarding training - Children Level 2 85% 93.4% 92.7%

Act

ual

s R

epo

rted

Act

ual

s R

epo

rted

Act

ual

s

Rep

ort

ed

5




Previous

Forecast

Next Month

Forecast

3.31 IAPT Recovery Rate 50% 52.8% 51.8%

3.32 IAPT 0-6 Weeks referral to treatment 75% 98.7% 98.8%

3.33 IAPT 0-18 Weeks referral to treatment 95% 100.0% 100.0%

3.34 Care Plans Distributed to Service User 75% 39.3% 36.1%

KEY Description

Denotes performance improvement from last month's position

Denotes performance remains at the same level as last month

Denotes performance has decreased from last month

Performance is forecast to improve in following month

Performance is forecast to decrease in following month

6

TRUST SUMMARY PERFORMANCE SCRORECARD


Plan

Annual

Forecast

1.1 Income (£000) (15,440) (15,350) (15,638) (185,279) (179,146)

1.2 Pay Expenditure (£000) 11,396 11,660 11,462 136,750 138,127

1.3 Non Pay Expenditure (£000) 4,458 4,118 4,377 52,859 45,349

1.4Retained (Surplus) / Deficit (£000)

(Pre Technical Adjustments) 414 428 201 4,330 4,330

1.5 CRES achieved in month (£000) 406 354 622 5,559 5,559

1.6 Capital spend (£000) 390 257 596 4,357 4,357

1.7 Month end cash balance (£000) 653 2,853 3,276 116 116

Acute Forensic & Spec Services


Plan

Annual

ForecastRef Measure Target Aug-16 Jul-16 Movement

Annual

Plan

Annual

Forecast

1.1 Income (£000) (792) (1,106) (855) (9,505) (13,190) 1.1 Income (£000) (166) (226) (247) (2,359) (2,392)

1.2 Pay Expenditure (£000) 2,177 2,474 2,481 26,337 30,833 1.2 Pay Expenditure (£000) 1,837 1,918 1,873 22,503 22,184

1.3 Non Pay Expenditure (£000) 1,045 1,400 1,119 12,366 12,581 1.3 Non Pay Expenditure (£000) 452 361 439 5,153 5,343

1.4 Net Position (£000) 2,429 2,768 2,744 29,198 30,224 1.4 Net Position (£000) 2,123 2,052 2,065 25,297 25,135

0 0 0 0

CRSL & PCPTS OPMH Services


Plan

Annual

ForecastRef Measure Target Aug-16 Jul-16 Movement

Annual

Plan

Annual

Forecast

1.1 Income (£000) (228) (134) (126) (2,738) (2,192) 1.1 Income (£000) (411) (231) (468) (4,937) (5,090)

1.2 Pay Expenditure (£000) 2,556 2,657 2,647 30,751 31,670 1.2 Pay Expenditure (£000) 2,104 2,252 2,247 25,117 26,890

1.3 Non Pay Expenditure (£000) 348 329 334 4,107 4,058 1.3 Non Pay Expenditure (£000) 309 356 266 3,824 4,335

1.4 Net Position (£000) 2,676 2,852 2,855 32,120 33,536 1.4 Net Position (£000) 2,002 2,378 2,045 24,004 26,135

7

ACUTE SERVICE LINE SUMMARY PERFORMANCE SCORECARD

Ref. Measure Target Aug-16 Jul-16 MovementNext Month

ForecastAsh

Cant &

Coast

South

Kent

Coast

Thanet DGS Med SwaleWest

Kent


1.3 Delayed Transfers of Care 7.5% 12.8% 12.9% 19.1% 19.0% 0.0% 5.3% 5.0% 21.8% 7.5% 14.9%

1.4Admissions to Inpatient Services had

Access to CRHTs 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

1.6MHMDS Data Completeness:

Identifiers97% 99.7% 99.7% 99.9% 99.8% 99.8% 99.6% 99.7% 99.6% 99.7% 99.8%


ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

2 Workforce

2.1 Sickness Absence 3.9% 3.7% 5.5% 4.5% 1.8% 6.4% 3.8% 2.3%

2.2 Staff Vacancies 15% 10.3% 9.3% 7.2% 4.8% 18.4% 13.5% 7.2%

2.3 Staff Turnover 14% 17.9% 17.5% 15.2% 15.7% 20.2% 25.7% 19.1%

2.4 Agency Spend 5% 9.3% 9.3% 0.5% 7.4% 7.1% 15.1% 12.2%

2.5Appraisals and Personal

Development plans90% 80.3% 78.7% 92.9% 90.4% 77.0% 72.1% 73.6%

2.6 % mandatory training 85% 89.8% 88.6% 91.9% 89.6% 92.3% 86.1% 87.4%

2.7% Eligible staff with enhanced CRB

check100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

8



ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

3 Quality

3.1Referral to assessment within 4

weeks95% 99.2% 98.9% 95.8% 100.0% 97.7% 100.0% 100.0% 100.0% 100.0% 98.2%

3.2 18 Weeks referral to treatment 95% 100.0% 99.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

3.7% Reviews undertaken within the

maximum cluster review period95% 82.8% 76.0% 91.3% 78.7% 82.2% 86.0% 91.4% 86.1% 81.5% 65.6%

3.8% of service users assessed with

cluster assigned95% 75.0% 55.6% 100.0% 100.0% 50.0%

3.9% inpatients with a physical health

check within 72 hours 100% 73.7% 77.4% 72.7% 81.5% 92.3% 89.3% 53.8% 58.1% 60.0% 83.3%

3.10Number of Home Treatment

Episodes224 326 298 20 43 38 37 47 49 25 60

3.11Emergency Readmission within 28

days5% 13.6% 11.5% 16.7% 3.4% 0.0% 16.1% 20.0% 26.5% 18.2% 7.1%

3.12Average Length of stay(Younger

Adults)25 30.5 25.1 61.6 28.5 30.1 20.0 19.0 29.5 25.1 40.7

3.13Bed Occupancy: Internal Usage v's

Internal Capacity (YA Acute)98.4% 97.4% N/A

3.14Bed Occupancy: Internal & External

Usage v's Internal Capacity (YA 116.8% 112.5% N/A


Usage v's Proposed 174 Capacity (YA 113.3% 109.2% N/A


Internal Capacity (YA PICU)97.8% 98.9% N/A


Usage v's Internal Capacity (YA PICU)242.2% 211.3% N/A

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Occupancy levels not reportable by CCG as specific beds are not assigned to a

particular CCG.

9



ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

3.21Number of unplanned absences

(AWOL and absconds on MHA)0 0 0

3.22 Serious Incidents 2 2 N/A

3.23Number of Grade 1&2 Sis confirmed

breached over 60 days0 0 N/A

3.25Complaints (level2-4 , MP enquiries &

MP Complaints)9 10 N/A

3.26 Never Events 0 0 0


3.28Safeguarding training Adult - Basic

Introduction85% 99.6% 98.4% 100.0% 100.0% 100.0% 97.6% 100.0%

3.29 Safeguarding training - Children 85% 99.6% 98.4% 100.0% 100.0% 100.0% 97.6% 100.0%

3.30Safeguarding training - Children Level

285% 93.9% 93.0% 95.6% 93.0% 97.3% 95.9% 89.2%

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ual

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It is not currently possible to provide breakdowns to team/CCG level, work in

progress to identify a solution to allow granularity of reporting

10

COMMUNITY RECOVERY SUMMARY PERFORMANCE SCORECARD


ForecastAsh

Cant &

Coast

South Kent

CoastThanet DGS Med Swale

West

Kent


1.1CPA patients receiving follow-up

within 7 days of discharge95% 93.0% 94.7% 90.9% 82.4% 80.0% 100.0% 100.0% 95.5% 87.5% 96.7%

1.2CPA patients receiving formal 12

month Review95% 85.4% 87.1% 77.9% 85.0% 85.9% 81.9% 96.8% 82.4% 91.5% 83.4%


1.5Meeting commitment to serve new

psychosis' cases by EIS95% 140.9% 138.8%


Identifiers97% 99.7% 99.7% 99.9% 99.9% 99.8% 99.8% 99.7% 99.8% 99.9% 99.8%


Outcomes for Patients on CPA50% 80.7% 82.0% 73.4% 81.3% 77.1% 79.7% 93.5% 79.8% 83.0% 77.9%

1.8EIP Waiting Time Proxy (Referral to

Care coordinator in 2 weeks)50% 69.2% 52.0% 0.0% 75.0% 75.0% 0.0% 60.0% 0.0% 100.0% 75.0%


ForecastAsh

Cant &

Coast

South Kent


West

Kent

2 Workforce

2.1 Sickness Absence 3.9% 3.2% 3.4% 2.5% 3.0% 0.8% 6.4% 5.9% 1.6% 5.6% 3.5%

2.2 Staff Vacancies 15% 11.3% 11.1% 13.4% 8.6% 37.9% 10.1% 3.2% 14.6% 16.9% 17.8%

2.3 Staff Turnover 14% 16.4% 16.8% 23.1% 13.1% 37.8% 3.3% 15.2% 22.2% 15.7% 18.1%

2.4 Agency Spend 5% 7.0% 6.6% 15.8% 0.5% 21.9% 7.3% 3.8% 7.1% 11.3% 12.8%

11 14

11



ForecastAsh

Cant &

Coast

South Kent


West

Kent


Development plans90% 76.8% 73.9% 73.3% 78.6% 84.4% 39.2% 76.7% 77.0% 86.4% 78.0%

2.6 % mandatory training 85% 88.2% 87.6% 86.7% 86.5% 81.9% 85.5% 89.0% 89.1% 89.9% 88.6%


check100% 100.0% 100.0% 100% 100% 100% 100% 100% 100% 100% 100%


ForecastAsh

Cant &

Coast

South Kent


West

Kent

3 Quality


weeks95% 62.0% 80.7% 66.7% 61.4% 57.4% 66.2% 62.5% 51.7% 82.8% 58.2%


3.3% of patients with valid CPA care

plan or plan of care95% 86.7% 87.7% 83.5% 84.7% 90.1% 84.5% 92.4% 89.1% 84.7% 84.2%

3.4 Crisis Plans (all patients) 95% 93.6% 93.9% 97.6% 98.6% 95.9% 91.2% 95.0% 87.7% 98.9% 90.6%

3.5 % of Service users in employment 13% 14.1% 13.8% 19.4% 15.4% 9.9% 9.4% 16.0% 13.9% 15.3% 16.5%

3.6% of Service Users in Settled

Accommodation75% 82.7% 82.8% 84.8% 83.4% 83.8% 85.2% 84.0% 83.7% 88.3% 78.9%




cluster assigned95% 91.8% 89.4% 93.8% 94.7% 91.7% 90.1% 91.1% 90.8% 94.1% 90.7%


check within 72 hours 100% 0.0% 0.0% 0.0% 0.0%

12



ForecastAsh

Cant &

Coast

South Kent


West

Kent




3.25Complaints (level2-4 , MP enquiries

& MP Complaints)30 19 N/A




Introduction85% 99.6% 99.2% 100.0% 100.0% 100.0% 93.8% 100.0% 100.0% 100.0% 100.0%

3.29 Safeguarding training - Children 85% 99.1% 98.0% 100.0% 100.0% 80.0% 93.8% 100.0% 100.0% 100.0% 100.0%


285% 91.3% 88.9% 93.3% 94.9% 88.5% 88.1% 93.5% 93.1% 93.8% 87.1%

3.31 IAPT Recovery Rate 50% 52.8% 51.8% 44.0% 57.4%

3.32 IAPT 0-6 Weeks referral to treatment 75% 98.7% 98.8% 66.7% 98.8% 0.0% 99.5%

3.33IAPT 0-18 Weeks referral to

treatment95% 100.0% 100.0% 100.0% 98.8% 100.0% 100.0%

3.34Care Plans Distributed to Service

User75% 26.3% 25.2% 16.1% 35.9% 18.9% 17.6% 40.9% 23.2% 35.9% 24.1%

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13

FORENSIC AND SPECIALIST SUMMARY PERFORMANCE SCORECARD


ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

NHS

England



within 7 days of discharge95% 100.0% 100.0%


month Review95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%



Identifiers 1 97% 99.2% 99.2% 100.0% 99.6% 99.8% 99.6% 98.6% 99.7% 99.7% 98.9% 93.5%



1 Totals presented lower than CCG's represented due to impact of unknown and out of area CCG's not represented in the report.


ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

NHS

England

2 Workforce

2.1 Sickness Absence 3.9% 4.1% 3.5% 4.5%

2.2 Staff Vacancies 15% 16.6% 13.0% 15.8%

2.3 Staff Turnover 14% 17.2% 17.5% 15.7%

2.4 Agency Spend 5% 1.3% 1.1% 0.3%


Development plans90% 95.1% 93.1% 94.6%

2.6 % mandatory training 85% 96.0% 95.7% 96.4%


check100% 100.0% 100.0% 100.0%

14

FORENSIC AND SPECIALIST SUMMARY PERFORMANCE SCORECARD


ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

NHS

England

3 Quality


weeks95% 82.0% 66.3% 66.7% 86.7% 83.8% 86.7% 90.7% 81.8% 80.8% 65.6%




3.4 Crisis Plans (all patients) 95% 94.9% 94.0% 57.1% 100.0% 100.0% 100.0% 100.0% 50.0% 98.1%











Introduction85% 100.0% 98.7% 100.0%

3.29 Safeguarding training - Children 85% 100.0% 98.3% 100%

3.30Safeguarding training - Children

Level 285% 96.8% 95.6% 96.1%


User75% 91.4% 90.5% 80.0% 100.0% 100.0% 100.0% 75.0% 100.0% 92.2%



Act

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15

OLDER PERSONS PERFORMANCE SCORECARD


ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent



within 7 days of discharge95% 100.0% 96.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


month Review95% 94.4% 96.2% 100.0% 100.0% 97.6% 94.1% 90.9% 100.0% 87.9% 93.5%



Identifiers97% 99.88% 99.86% 99.9% 99.9% 99.9% 99.9% 99.7% 99.9% 99.9% 99.8%




ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

2 Workforce

2.1 Sickness Absence 3.9% 5.7% 5.8% 10.5% 5.9% 2.0% 1.2% 9.4% 9.9% 6.9% 7.4%

2.2 Staff Vacancies 15% 4.0% 4.6% 4.6% 0.3% 4.7% 9.2% 5.6% 12.5% 6.1%

2.3 Staff Turnover 14% 13.6% 13.0% 12.2% 17.3% 7.5% 14.0% 18.9% 6.9% 14.9% 10.8%

2.4 Agency Spend 5% 7.7% 7.7% 0.0% 10.6% 0.0% 9.2% 9.4% 2.3% 11.7% 7.1%


Development plans90% 79.6% 75.8% 100.0% 91.1% 90.6% 77.2% 74.2% 73.7% 65.9% 86.1%

16



ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

2.6 % mandatory training 85% 92.9% 92.4% 95.4% 94.3% 97.6% 93.5% 91.9% 93.8% 88.9% 92.8%


check100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%


ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

3 Quality


weeks95% 86.1% 98.3% 84.0% 89.0% 87.2% 93.8% 67.3% 79.0% 91.5% 88.6%




3.4 Crisis Plans (all patients) 95% 98.0% 98.2% 99.0% 99.1% 97.2% 99.5% 96.4% 98.5% 95.7% 97.1%

3.6% of Service Users in Settled

Accommodation75% 90.0% 91.2% 90.1% 87.7% 90.0% 89.4% 97.3% 94.3% 87.5% 90.1%




cluster assigned95% 97.7% 98.0% 98.6% 98.6% 98.6% 98.4% 97.2% 97.5% 97.6% 95.4%


check within 72 hours 100% 63.6% 74.4% 33.3% 85.7% 66.7% 25.0% 100.0% 100.0% 50.0% 62.5%

3.11Emergency Readmission within 28

days5% 12.1% 7.0% 0.0% 14.3% 0.0% 50.0% 0.0% 0.0% 12.5%

17



ForecastAsh

Cant &

Coast

South

Kent

Coast


Kent

3.18 Average Length of stay(Older Adults) 52 86.8 107.7 34.0 95.1 257.0 52.4 30.6 53.0 98.5


Internal Capacity (OP Acute)96.0% 94.6% N/A


Usage v's Internal Capacity (OP 96.1% 97.3% N/A











Introduction85% 98.8% 98.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.4% 100.0%

3.29 Safeguarding training - Children 85% 98.5% 98.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.4% 100.0%


285% 96.0% 96.6% 94.1% 96.9% 100.0% 94.6% 94.7% 100.0% 94.7% 95.0%


User75% 51.7% 46.6% 45.7% 49.9% 58.0% 50.3% 55.1% 45.8% 45.0% 56.6%

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ual

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Act

ual

s

Rep

ort

ed

It is not currently possible to provide breakdowns to team/CCG level,

work in progress to identify a solution to allow granularity of

reporting

18

Documents

Trust Board, Part I - Public Date€¦ · 1 Meeting: Trust Board, Part I - Public Date: 2 9 September 2016 Report Title: Integrated Quality and Performance Report (IQPR): August 2016