ckwcb-12-59b_performance_report

NHS Calderdale, Kirklees and Wakefield District (NHS CKW)

6th March 2012

Performance Report against Key Performance Indicators for 2011/12

1. Purpose

To inform NHS CKW Cluster Board of NHS Calderdale (NHSC), NHS Kirklees (NHSK) and NHS Wakefield District (NHSWD) PCTs performance against the 2011/12 NHS Operating Framework headline outcomes/measures, together with other identified national supporting outcomes/measures. These outcomes/measures contribute towards the Primary Care Trusts 2011/12 Single Assurance Assessment Process with the Strategic Health Authority and the national annual PCTs National Benchmarking Dataset. Also, to advise the CKW Cluster Board of individual PCT performance against locally identified priorities.-

2. Performance Summary

Appendix A sets out a summary position of Commissioner performance against the key 2011/12 NHS Operating Framework headline outcomes/measures (highlighted in „blue‟) and supporting outcomes/measures, details the actual activity against plan, year-to-date position and forecast outturn (end-year position forecast based on year-to-date activity).

The summary incorporates the existing risk management “traffic light” system (RAG) to performance monitor/manage progress being made to achieve delivery of the outcomes/measures:-

Green - target being achieved/no risk to delivery; Amber - below/above target, situation needs reviewing, remedial action needs

Investigation; and Red - serious deviation from target, corrective action plan required.

Appendix B sets out a summary position of Provider performance against the key 2011/12 NHS Operating Framework headline and identified supporting outcomes/measures. Appendix B1 details the new A & E Clinical Quality Indicators at site level for Calderdale & Huddersfield Foundation Trust (CHFT) and Mid Yorkshire Hospital Trust (MYHT). To judge compliance against the thresholds, the 5 new indicators are divided into 2 Groups, Timeliness & Patient Impact. Trusts will be assessed as achieving compliance if the minimum threshold has been achieved for at least one indicator in each of the 2 Groups.

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A point to note in relation to the new Clinical Quality Indicators data source is that it is recognised that not all A & E sites and organisations currently submit A & E Commissioning Data Set (CDS) information to the Secondary Uses Service (SUS) which underpins A & E Hospital Episodes Statistics (HES) and where data is sourced by the Commissioner.

3. National Priorities - Performance Issues Highlighted

Issues highlighted within the performance report:-

Reference

No. Outcome/Measure

Aggregate

CKW

RAG

Calderdale

RAG*

Kirklees

RAG*

Wakefield

RAG*

HQU01 MRSA

HQU02 Clostridium Difficile

HQU03 Category „A‟ - Ambulance Response

Times (8 Minutes)

HQU08 Eliminate Mixed Sex Accommodation

HQU05a 18 Week RTT Admitted

HQU05b 18 Week RTT Admitted – 95th Percentile

HQU09 A&E 4 Hour Wait

SQU05_02 Cancer 31 Days - Surgery

HQU15_01 Cancer 62 Days

HQU15_02 Cancer 62 Days – Screening Programme

HQU15_03 Cancer 62 Days – Consultant Upgrade

SQU06_02 Stroke: TIA within 24 hours

SQU09 Access to NHS Dentistry

SQU16_01

Mental Health: % of people with

depression referred for psychological

therapy

SQU16_02 Mental Health: % referred for

psychological therapy receiving it

SQU18 Smoking Quitters

SQU19_01 Prevalence of breastfeeding at 6-8

weeks

SQU19_02 Coverage of breastfeeding at 6-8 weeks

SQU27 NHS Health Checks : Coverage

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* *RAG status based on Periodic Review thresholds (previously known as Annual Health Check) where known, if not known, then actual versus plan is used.

3.1 MRSA

The over-performance highlighted is with NHS Wakefield District and is predominantly at MYHT.

Refer to Quality Report for reasons and actions being taken to address.

3.2 Clostridium Difficile

The over-performance highlighted is with NHS Kirklees and NHS Wakefield District and is predominantly at MYHT.


3.3 Cat A: 8 Minutes- Ambulance Response Times

The under-performance highlighted is across the CKW Cluster for in-month activity and for NHS Kirklees only, year-to-date activity. It is the year-to-date position that is used in the national performance assessment process. The issues are with Yorkshire Ambulance Service (YAS).

In October and December 2011, YAS failed to achieve the required 75% of R1 and R2 (Category A) calls within 8 minutes; the October actual performance was 74.23% and the December actual performance was 72.46%. As a consequence, Performance Notices have been served on YAS, and in line with the contract sanctions, for each

HRS06 Non Elective FFCEs

SRS10 Delayed transfer of care

SRS11 GP written referrals to hospital

SRS12 Other referrals for a first outpatient

appointment

SRS13 First outpatient attendance following GP

referral

SRS14 All first outpatient attendances

SRS15 Elective FCEs

SRS19 Staff Absence

SRF12 Proportion of GP referrals to first

outpatient appointment booked using

choose and book

SRF14 Information to Patients

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failure, 2% of the monthly contract value (£246,177 across all commissioners) has been withheld. The withheld monies will be paid at year end if YAS achieves the 75% target for the year – otherwise it will be retained by commissioners.

3.4 Mixed Sex Accommodation

The over-performance highlighted is across the CKW Cluster - the issues are predominantly at Mid Yorkshire Hospitals Trust (MYHT).


3.5 HQU05a/b - 18 Week RTT - Admitted, 95th Percentile

The under-performance highlighted is with NHS Kirklees and NHS Wakefield District – the issues are predominantly at MYHT.

3.5.1 Mid Yorkshire Hospital Trust

The following information provides board members with a summary of Mid Yorkshire Hospitals NHS Trust (MYHT) current elective care performance against national 18 Week Referral to Treatment (RTT) waiting time targets and progress against the MYHT Local Health Community (LHC) 18 Weeks Recovery Plan. The latest published waiting time performance data, which is for December 2011, shows the Trust performed within the median waiting time thresholds for completed admitted, non-admitted and incomplete pathways. However, significant underperformance continues against the 95th percentile threshold for completed admitted pathways, something which is symptomatic of treating backlog patients and reflective of the over 18 weeks “tail”. The Trust also performed outside of the 95th percentile waiting time threshold of <18.3 weeks for completed non-admitted pathways, which can also be attributed to efforts to reduce the backlog of patients waiting over 18 weeks on non-admitted pathways and to improve the Decision to Treat (DTA) profile. The published December 2011 performance is summarised in Table 1. For completeness, NHS Wakefield District, NHS Kirklees and NHS Calderdale‟s performance against these indicators has also been included. It should be noted the areas of underperformance identified for NHS Wakefield District and NHS Kirklees relate predominantly to issues at MYHT.

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Table 1

Completed Admitted Pathways Completed Non Admitted Pathways

Incomplete Pathways

Indicator Median 95th

Percentile 18

Weeks Median

95th Percentile

18 Weeks

Median 95th

Percentile

Threshold <11.1 <23.0 ≥90% <6.6 <18.3 ≥95% <7.2 <28.0

MYHT 10.1 26.1 82.2% 3.7 17.7 95.03% 6.4 22.11

NHSWD 8.4 26 85.6% 3.8 17 95.96% 5.3 19.3

NHSK 9.2 22.2 87.8% 3.49 15.06 97.7% 6.4 21.4

NHSC 8.8 20.9 91.% 2.6 12.9 99% 6.4 21.0

Latest un-validated data, which is for week ending 5 February 2012, reports an over 18 week backlog on incomplete admitted pathways of 662 at MYHT. This is a reduction in backlog of 1233, which equates to 65.1%, since implementation of the Recovery Plan in May 2011. Performance at specialty level also continues to be monitored by the 18 Week RTT Board. Analysis suggests that Ophthalmology, General Surgery and ENT specialties are achieving a more sustainable position with regard to backlog clearance however Plastic Surgery, Urology and Orthopaedics continue to be at variance in relation to both backlog clearance and sustainability. Specialty level plans detailing activity profiles and actions to address performance variance by March 2012 have been developed and shared with Service Managers at the Trust. The LHC is also utilising the additional funding made available by the Department of Health in December 2011 to maximise all available capacity to further accelerate the backlog reduction in line with national requirements.

3.6 A & E 4 Hour Wait – 95% Waiting Time Standard

The underperformance highlighted is with NHS Wakefield District. Refer to Appendix B1 for site specific data for the additional Clinical Quality indicators. 3.6.1 Mid Yorkshire Hospitals Trust MYHT achieved 95% overall in Q3 and at each of its three hospital sites in the month of December. However MYHT performance to date in Q4 is only running at approximately 91.6%. There have been significant challenges due to the high volumes of A&E attendances and more particularly emergency admissions which have exceeded bed capacity. Some of this spike in activity has been related to the cold weather experienced in late January and early February. The majority of breaches have been for bed waits. The MYHT has an Emergency Care Recovery Board which meets regularly and actively monitors A&E performance and seeks to takes steps to manage A&E

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pressures. Due to the current performance issues these Emergency Care Recovery Board meetings are being extended on a fortnightly basis to include commissioners.

3.7 SQU05_02 – Cancer 31 Days: Surgery The under-performance highlighted is with NHS Calderdale NHS Calderdale

Patients who require surgical treatment following their initial treatment are expected to be seen within 31 days of referral. Of the 16 patients who required treatment, one patient breach of the waiting time standard was reported in December 2011.The delay was due to lack of capacity at CHFT. The patient has subsequently received their treatment. Overall performance remains strong for this indicator, year to date achieving 97%. The monthly position is expected to improve throughout the remainder of 2011/12 and surpass the expected threshold of 94%

3.8 HQU15_01/03 – Cancer 62 Days Standard and Consultant Upgrade

The underperformance highlighted is with NHS Wakefield District – the issues are predominantly at MYHT and Leeds Teaching Hospitals Trust (LTHT).

3.8.1 Mid Yorkshire Hospitals NHS Trust

The „traffic light‟ rating for Cancer performance across the Cluster providers remains at „green‟ with the major exception of 62 day performance at MYHT. The validated position for December for MYHT was 91 % with the YTD position at 87.2%. For 62 day performance for NHS Wakefield District patients seen and treated at MYHT, YTD position is 82.08% against a target of 85%. The target for the 38 day soft target for decision to treat or handover to tertiary care is 85%. The Q3 position for CHFT is 71% and for MYHT it is 62%. Both providers have an action plan for improving the 62 day position and these are currently being refreshed for confirm and challenge by the Yorkshire Cancer Network (YCN) board in March. An improved locality reporting process is being tried out to give commissioners a timelier alert to risks and issues to delivery. The main risk areas are Lung, Urology and Head and neck cancer pathways between secondary and tertiary care. The cancer commissioning team have also commenced weekly progress briefings for the Cluster Chief Executive to inform weekly performance discussions with the MYHT Chief Executive.

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HQU15_03 - Consultant Upgrade

The underperformance highlighted is with NHS Wakefield District.

Mid Yorkshire Hospitals NHS Trust

There is no national target applicable to Consultant upgrades and performance achieved by MYHT is a year-to-date average of around 75%. It should be noted this category affects relatively low numbers of patients and out of a total number of 15 patients upgraded this year at December 2011, 10 were of these were treated on time and there were 5 breaches.

3.9 HQU15_02 – Cancer 62 Days: Screening Programme

The under-performance highlighted is with NHS Calderdale

One breach of the pathway from an NHS screening service was reported in December 2011. Breach review has highlighted the patient chose to arrange their initial outpatient assessment at day 42 of the pathway. This delay placed pressure on the pathway to initiate first treatment within the 62 day standard. Year to date performance is 85% and is expected to improve throughout the remainder of 2011/12.

3.10 SQU06_01 Stroke: Transient Ischaemic Attack (TIA)

The underperformance highlighted is across the CKW Cluster NHS Calderdale Significant changes have been made to the Calderdale and Huddersfield Foundation Trust (CHFT) TIA service over the last year which has increased the levels of patient access to this service. Outpatient clinics are now held 7 days a week for two weeks of the month and 5 days a week for the other 2 weeks of the month. CHFT have employed an additional consultant and stroke nurses to help with the delivery of stroke and TIA (especially now that Thrombolysis is being delivered), which should improve patient flow so that they receive investigations and treatment within the timescales. A breach analysis is routinely undertaken to support improvements. In Q3 there were 7 patients that were not seen within the 24 hour time period. The reasons were:

- 1 patient was not referred within the correct timescale from primary care. - 1 patient was unavailable to be seen. - 5 patients did not have their assessments and investigations within the 24

hours period.

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Actions being taken

The PCT is working with the acute trust to resolve issues that are causing breaches.

Discussions have taken place to carry out further awareness within both secondary and primary care.

Consultant contacts primary care when inappropriate referral forms have been sent or they have not been sent in the appropriate timescales.

Clinics will be held 7 days a week from June when the additional Consultant starts.

Best Practice Tariff incentivises trusts to investigate and treat patients within 24 hours.

CHFT are currently undergoing an accreditation process for stroke and are required to demonstrate that they meet the 60% of High risk TIA being treated and investigated.

NHS Kirklees

In respect of TIA at Calderdale & Huddersfield Foundation Trust, 10 patients (out of 21) breached the standard for the following reasons:

- patient choice - timeliness of GP referral - timeliness of blood test results - timeliness of referral from A & E

If the patient choice patients had been seen then performance would have resulted in 58% achievement and if the GP referrals had been within time, performance would have exceeded the 60% national standard at 69%.

Action being taken

In addition to the actions being taken in association with NHS Calderdale (refer to NHS Calderdale action points), the NHS Kirklees Lead Manager for Stroke, Hayley Haycock, is intending to launch an awareness raising and education exercise in Primary Care around the stroke an TIA pathways in the New Year and planning will closely involve GPs and other Primary Care professionals to ensure greater spread and success

NHS Wakefield District Delivery of the TIA indicator (target – 60%) by the end of Q4, (Q3 – 22% Trust wide, 24% NHSWD and 20% NHSK). This indicator is slow to improve but the factors required to ensure delivery are now in place, or have robust plans. These are:

- 24/7 coverage of Stroke Assessment Nurses (SANs); - Prescribing of first dose of aspirin by SANs under a Patient Group Directive;

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- Consultant clinics on 6 days. Sunday is currently not covered but patients triaged by the SANs will receive first dose of aspirin and then be seen on Monday. This is in line with good practice around initiating treatment;

- Sunday cover by the on call neurologist is planned as part of the neurology service dependent on filling the additional consultant sessions with the Hyperacute Stroke and TIA business case;

- 4 week follow-up clinic with Stroke Nurse Consultant. 3.11 SQU09 – Access to NHS Dentistry The underperformance highlighted is with NHS Kirklees. NHS Kirklees

NHS Kirklees is still awaiting Department of Health (DoH) formal sign-off for the 2011/12 and 2012/13 dental toolkit generated plan figures for the number of patients accessing NHS dental treatment. (256,142 for 2011/12). Until such a time that the plans are accepted, the PCT is being performance monitored against the given DoH trajectory for 2011/12 of 286,650.

Actual Performance reported for Quarter 3 of 2011/12 (1st April – 31st December 2011) is showing a significant underperformance at 262,157

3.12 SQU16_01 – Mental Health, Proportion of patients referred for Psychological Therapy

The underperformance highlighted is with NHS Kirklees and NHS Wakefield District – the issues are with South West Yorkshire Partnership Foundation Trust (SWYPFT).

NHS Kirklees The under achievement of the Improved Access to Psychological Therapies (IAPT) outcomes/measures with the current provider are under monthly review. A remedial action plan has been developed, to show ongoing improvement through the final quarter of the current financial year. This is being supported by the performance clauses included within the contract, which includes the implementation of a financial penalty at the end of quarter 4 calculated on the % of underperformance. Actions taken to date include:

- A GP event held by the service – to raise awareness & improve the knowledge of the service & inclusion thresholds;

- Development of the single point of Access into services – the aim is to ensure that individuals are directed into the service at the right point & time; and

- Improvement plan for data capture and reporting - SWYPFT has provided evidence of internal issues which has had an impact

on service capacity/delivery.

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Further actions agreed:

Revised trajectories set for 2012/13 – 2014/15, based on publication of National Guidance and reliable service assumptions that have been submitted, to the Department of Health and the SHA, as part of the 2012/13 formal planning process;

At end of February 2012, SWYPFT to supply remedial action plan to demonstrate progress to Q4 and intentions for achievement for 2012/13;

SWYPFT performance team reviewing and evaluating the quality of their data systems and processes.

The two clinical commissioning Groups within Kirklees have agreed to undertake an IAPT service review during 2012, to develop proposals regarding the re-tendering of the service at the end of the current contract period.

NHS Wakefield

Rightsteps, the local IAPT provider for Wakefield has recently held a GP engagement session and attended local Target event to publicise the service offer and the tiered approach to care. Sufficient capacity exists within the service to manage the required number of referrals, particularly within Step 2 treatment options. Whilst there are significant waiting time issues within the high Intensity Step 3 element of the service, this is not significantly impacting on this performance indicator. Other option being explored by the service to improve the proportion of those accessing treatment is to move to a guided self referral system. Rightsteps are also actively networking with other locality services to ensure that the model of service is adopting effective methods of patient engagement based on the experiences of other services

SQU16_02 – Mental Health, Proportion of people referred for therapy receiving it The underperformance is across the CKW Cluster - Predominantly with South West Yorkshire Partnership Foundation Trust (SWYPFT) CKW Cluster Remedial action plan developed with the Provider, for each Commissioner, to show ongoing improvement in the final quarter of the current financial year. This is being supported by the performance clauses included within the contract, which includes the implementation of a financial penalty at the end of quarter 4 calculated on the % of underperformance. NHS Calderdale

This is an indicator of access to improved access to psychological therapies. The IAPT objective established nationally expected every PCT to see a minimum of 15% of the population who have depression and/or anxiety disorders in the local population by 2014/15.

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The local estimate (from the Psychiatric Morbidity Study) suggests Calderdale has 25,992 people with depression and/or anxiety disorders. This would mean 3,900 patients would need to be seen annually to achieve the nationally set standard and this is reflected in our contract with the provider, Oakdale.

Calderdale has consistently achieved against this standard. Although pressures associated with the volume of demand has led to the service seeing more patients than the 15% standard. There is no benchmarking dataset available to assess the performance of all PCTs against this standard but anecdotal evidence suggests that Calderdale is one of a minority of PCTs that achieve against this standard on a regular basis. The unit costs for the service are also generally lower than other areas. This reflects good and cost effective local services which are regarded as effective and efficient by general practice.

In 2011-12, following agreement with the provider and the Local Medical Committee we introduced a series of demand management measures to manage the ongoing use of the service whilst still meeting the local demand. These measures included ensuring that referrals were appropriate using the standard assessment tool, and managing patients progress through the IAPT service to improve capacity and reduce waiting times.

Latest figures for the percentage of patients who receive psychological therapies reflect the success of these measures in managing demand but consequently this has begun to impact on the achievement of the national standard. Year to date performance is 11.2%, which is below the expected milestone of 12.5%

However, local contract management meetings and monitoring indicate that the volume of patients now being treated in quarter 4 is consistent with the requirements to achieve the national objective and our local contract.

NHS Kirklees

Refer to commentary in section SQU16_01 above.

NHS Wakefield District

Refer to commentary in section SQU16_01 above.

3.13 SQU18 - Smoking Quitters

The underperformance highlighted is with NHS Kirklees and NHS Wakefield District

NHS Kirklees

Reported quits to date (November 2012) are below target at 1334 against a target of 1724, this is due to a combination of an aspirational and challenging target and the delayed reporting system for the Intermediate Advisor service. The Specialist Stop Smoking Service has achieved near to its target with 332 quits against a target of 360 and has a 54% quit rate. The Intermediate service reports 1002 quits (a 47% quit rate) against a target of 1364, Q3 data will not be complete until March. It is expected that performance will be improved but remain below target when

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complete figures are available. The Intermediate service target accounts for 80% of the Kirklees target. Measures are planned to increase usage of the Intermediate service and thus improve quit numbers. The Locally Enhanced Service Schemes have been reviewed for both GP practices and pharmacies and a new pricing structure is to be introduced. A voucher scheme to improve access to NRT is to be introduced to be used by Pharmacist Intermediate Advisors and Specialist Advisors. A Stop Smoking LES for Dental Practices is also being introduced to widen availability of stop smoking services in Kirklees. Training for Intermediate Advisors is being promoted widely among other workforce groups to offer new routes to quit. The Stop Smoking Service is implementing learning points from pilot work with routine and manual workers carried out 2010-11 to improve acceptability of the service to this target population. NHS Wakefield District

There is a high smoking prevalence in Wakefield with a local culture of smoking. The Smoke Free Wakefield Tobacco Control Strategy features key pieces of work that are being undertaken in partnership to reduce the number of smokers. There is also a 2 months time lag in the reporting of quitters due to the dosage and minimum intervention period to achieve a measurable outcome. We are achieving 50% quits from routine and manual groups and prisons. We are working closely in partnership with Wakefield council, community groups, MYHT, Trading Standards, West Yorkshire Fire Service, Wakefield District Housing and regional networks on the tobacco control agenda to reduce smoking prevalence within our District. Actions to mitigate risk include:

In negotiation for a CQUIN on “Stop B4 UR OP” with MYHT

In negotiation for a CQUIN on “training all clinical staff on brief advice using interactive e-learning programme” with MYHT

Every Contact Counts training

Revising current service specification and Local Enhanced Services for 2012/13

Work with MYHT on smoking cessation before elective surgery

We are doing a commissioning review on all smoking cessation services provided in Wakefield with a revised spec for next year.

Social norms pilot in Featherstone currently ongoing

E-learning training for brief advice in smoking cessation rolled out across Yorkshire & Humber

Smoking cessation in secondary care pilot ongoing

Partnership working with West Yorkshire fire service for increased referrals

Looking at the feasibility of buying and using a live database designed for smoking cessation services

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3.14 SQU19_01/02 Breastfeeding 6-8 Weeks – Prevalence & Coverage

The under-performance for Prevalence is highlighted with NHS Kirklees and NHS Wakefield

3.14.1 Breastfeeding 6-8 weeks - Prevalence

NHS Kirklees

The difference in prevalence between North and South Kirklees continues, indicating that progress to address the wider cultural and socio-economic factors associated with different communities in Kirklees have been limited. These deprivation linked wider determinants of health are intractable and difficult to address in the short term. Actions being taken Ensure that the Children and Young People Plan identifies and utilises the interdependencies between programmes to address inherent cultural and socio-economic factors in areas with low Breast Feeding prevalence. Moving towards Stage 2 of the BFI accreditation process is the next stage which focuses on breastfeeding knowledge and skills in all health visiting teams across Kirklees and will be assessed to BFI best practice standards. The development of an infant feeding training package conducive to community practice will soon be made available to support the learning and development of all relevant staff in the community. Collaboration with Kirklees Partnership continues to develop since the first workshop in Jan 2011 to support women/employees who wish to breastfeed for longer through the development of family friendly breastfeeding policies in workplaces across Kirklees. Since October 2010 the development of Breastfeeding Resource Packs have been accessed by over 800 women across Kirklees from Health Centres and now KCHS are now piloting a Health visiting team in Cleckheaton (where prevalence of formula / bottle feeding is higher than in other areas in north Kirklees - sourced from quarterly locality based 6-8 week breastfeeding data) to distribute breastfeeding resource packs to all mothers at the antenatal visit. Breastfeeding Face Book site continues to develop with a steady increase in numbers and now has 135 breastfeeding fans which offers information and a social network of support. The training of breastfeeding volunteers continue to support the Baby Bistro programme which currently stands at 67 trained breastfeeding peer supporters in Kirklees. Plans are underway to develop a series of Buddies Baby Bistro's and the first one is being piloted in Dewsbury town centre targeting teenage and young mums and dads. Young trained breastfeeding volunteers will support the BBB programme and further support collaborative working with the Family Nurse Partnership and teenage pregnancy midwives and existing young parent groups in Sure Start Children Centres.

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To aid a consistent approach in raising awareness of supportive breastfeeding drop in groups in Kirklees plans are underway for the Personal Child Health Record (Red Book) to include an A5 insert of all local supportive groups to include all Baby Bistro's in Kirklees which mothers will receive at Delivery and which will have been put in the Red Book at the printers. NHS Wakefield District The prevalence of breastfeeding at 6-8 weeks has shown a slight drop since the previous quarter (0.3%) and remains slightly below target for the year. To achieve the target of 37%, an additional 11 women of the 1,049 target population would have needed to choose breast feeding. Coverage of breastfeeding rates at 6-8 weeks (percentage of infants where breastfeeding status is known) has also shown a drop to 97.5% although this remains above target. It may be that the drop in coverage is negatively affecting the known prevalence rate at 6-8 weeks. Actions being taken The Families & Babies One-Stop-Shop was opened in Wakefield city centre on 2nd February. This is a joint venture between the PCT and Little Angels Breastfeeding Support. The shop will provide a centre for parents to drop in for advice around maternity and infant feeding or to feed their babies in comfort and will host a range of sessions including infant massage, stop smoking in pregnancy and healthy eating. Since the new Pinderfields Hospital opened there has been an issue with the drinking water supply in the milk kitchen and mothers were not able to make up their own formula feeds. MYHT have provided ready mixed formula milk whilst the issue continued. The water supply has now been resolved and ready mixed feeds are now not available, this may impact on initiation rates.

3.14.2 Breastfeeding 6-8 weeks - Coverage The under-performance for Coverage is highlighted with NHS Kirklees NHS Kirklees Significantly, the national minimum standard of 95% for Coverage for national reporting and publication purposes was for the first time this year, exceeded by the PCT, however, slight underperformance highlighted against local plan figures for both Prevalence and Coverage.

Refer to „Prevalence‟ commentary.

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3.15 SQU27 - NHS Health Checks (Coverage)

The under-performance is highlighted with NHS Calderdale and NHS Kirklees

NHS Calderdale

NHS Health Checks are a mandatory requirement stipulated in the Operating Framework for 2012/13 – the check is expected to be undertaken every 5 years for the eligible population with a systematic call/ recall system in operation. The eligible population in Calderdale is estimated to be 52,000. This is being updated as accurate data from practices is received. At the end of Quarter 3 (Q3) 2012/13, 1,498 people have been invited for a Health Check and 493 had a completed check. The cumulative target for 2011/12 is 5,500 invited and 3,475 having a completed Health Check. At the current level of performance approximately 6-8% of the eligible population will have been invited by end of Q4. Locally Enhanced Scheme All bar two practices signed up to the LES – one stated it would commence health checks in April 2012 and one practice has indicated it will not sign up – therefore we will need to seek an alternative provider for their patients. Half of the practices have delivered some activity in Q3, most in line with the expected out turn. Follow up telephone contact has been made with all practices to identify reasons for under/ non delivery. Discussions with the Local Medical Committee Executive and the practice managers in February, identified a number of proposals to improve coverage rates for 2012/13. A revised LES will be issued by the end of February with targets set for each practice to deliver. If practices are not on track to meet the coverage rates in the first 6 months of the year, alternative providers will be sought. NHS Kirklees A decision was taken by Business and Finance Group in June last year for an outreach–only NHS Health Checks service to be commissioned, within a set budget of £209,000. This included decommissioning of a number of practice-based Health Checks services in the North. The new NHS Health Checks Outreach service began on the 1st April 2011. The service is provided by a small team of Primary Prevention Nurses within Locala. Due to the nature of the service being outreach-only and with limited resource, it was decided it should initially target communities in Kirklees with the worst health and deprivation, who are at greatest risk of vascular disease. Therefore, the service is currently not universally available for the whole 40-74 population within Kirklees.

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When the service was commissioned a target of 7000 (1750 per quarter) Health Checks was set for 2011/12. This was agreed as a sensible number based on the budget and resource available at the time.

However, as part of the national formal monitoring return, the PCT was required by the SHA to sign-up to offering Health Checks for 18% of our eligible population, which was calculated at 4542 per quarter.

We have already informed the SHA through formal performance channels, that NHS Kirklees will not meet their expected target of 4542 within the current service provision. The service would need the capacity to deliver more than 1750 a quarter if it was to make an offer of 4542.

Current Position Significant underperformance was highlighted during the 2011/12 Integrated Performance Measures Return (IPMR). Quarter 1 reported 240 Health Checks provided, against an NHS Kirklees target of 1750; quarter 2 reported 437 against an NHS Kirklees target of 1750 and quarter 3 reported 402 against an NHS Kirklees target of 1750.

In comparison to other PCTs within the Yorkshire and Humber region, NHS Kirklees are ranked 10th out of 13 PCTs. Three PCTs in the region still have no service and all reported zero. However, there is increasing pressure from the SHA for us all to be meeting the National target. Progress During Quarters 1-3 the service has been targeting communities within the Dewsbury, Batley, Ravensthorpe and Huddersfield Central areas, and has endeavoured to build links and foundations in these communities to reach the target population.

There have also been huge efforts in marketing and embedding the service through advertising and canvassing with large employers and within close-knit communities. As a result, momentum is starting to build weekly and the service is becoming more well-known and established. The service now offers regular health checks in mosques, leisure centres, libraries and other community centres, as well as targeting large employing companies and sports stadiums in order to attract a higher footfall. However, some venues are not as successful as others and some clinic slots are going un-used. Locala are reviewing the current venue choices and their marketing plan, to try and encourage more people into the service.

Patient feedback so far has rated the service very well in terms of it meeting expectations, being accessible, prompting people to follow-up areas of risk with their GP practice and people recommending the service to family/friends. The majority of people seen so far, heard about the service either through newspaper adverts, via their employer/work colleagues or through the library.

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Locala understand that they need to spread messages about the service further and would welcome feedback around this to incorporate into their marketing plan.

Where risk factors have been identified as a result of a health check, the service has been actively referring people onto their GP practice for further investigations and other services where they can get help to reduce their risk of vascular disease in the future and make the necessary lifestyle changes. So far there have been:

23 referrals to Weight Management

77 to GP

222 to Practice Nurse

22 to Physical Activity Programme

5 to stop smoking clinic

Performance has been discussed at a recent Contract Management Group meeting and Locala have been asked to produce an action plan around how they intend to increase numbers.

Risks and Issues The service has limited capacity to deliver Health Checks. The service operates with only 3.61 whole time equivalent cardiac nurses at full capacity, currently with vacancies this is down to 2.2 whole time equivalent One key risk is that communications and engagement needs to continue to be a focus for this service as there is a need to continually embed links, create opportunities and build trust to successfully encourage people into the service. This is very time-consuming and resource intensive for such a small-scaled service.

In working within our existing resources it was always clear that we would be unable to meet the SHA target of offering an NHS Health Check to 20% of our eligible population per year. However, the service will not reach the local target of 7000 health checks for 2011/2012. 1079 Health checks have been completed at the end of quarter 3 but hopefully the steps in quarter 4 can show an increase on past monthly figures.

National guidance suggests that the future commissioning of NHS Health Checks will be the responsibility of Public Health when they move into the Local Authority, and this needs to be considered in any medium and long-term planning. Recommendations for Next Steps North Kirklees and Greater Huddersfield Commissioning Groups have agreed that the outreach team can contact practices regarding targeting their patients who fall within the target population.

Health check service aim to keep the community outreach services that are working such as mosques, workplaces, Dewsbury Market and the Library then focus their resources on targeting GP lists in North and South.

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Targeting the GP lists will give an increase in the percentage of Health Checks offered figures for Quarter 4 and hopefully increase the percentage of health checks offered to our target population.

NHS Kirklees is required to meet the National target of offering an NHS Health Check to all of its target population over a 5yr period. Given we are now one year in to this 5 year period some decisions need to be made as to how we can offer a health check to 25% of our target population per year over the next 4 years. Next steps will be discussed at the SMT meeting on the 23rd of February with the CCG Chairs in attendance

3.16 HRS06 – Non Elective FFCEs

The underperformance highlighted is with NHS Kirklees

The trajectory figures are indicative figures advised to the SHA before contracts for 2011/12 were finalised. Figures have since been refreshed but these are not yet reflected in the SHA returns on which this data is based. NHS Kirklees is closely performance monitoring this measure, which has consistently been above reporting trajectories throughout the year and is currently projecting a 6% full-year variance. Any associated impact is factored in to financial plans.

3.17 SRS10 – Delayed Transfers of Care

The over-performance highlighted is with NHS Kirklees and NHS Wakefield District NHS Kirklees

In total, 36 people identified with delayed transfer of care for the period 1st October - 31st December (Quarter 3). 8 patients delayed at South West Yorkshire Partnership Foundation (SWYPT) Trust and 28 delayed at Mid Yorkshire Hospital Trust. A point to note is that Quarter 3 is classed as a „winter pressures‟ period.

The reasons for the delays were owing to:

Completion of assessment x 2 (MYHT)

Public Funding x 2 (SWYPFT)

Further non acute NHS care (including Intermediate Care Rehab) x 14 (12 x MYHT and 2 x SWYPFT)

Awaiting Residential Care Home Placement x 5 (1 x MYHT and 4 x SWYPFT)

Community Equipment/Adaptations x 3 (MYHT)

Patient or Family Choice x 10 (MYHT)

Action being taken to address: Locally, working collaboratively with Kirklees Council and other health and social care partners, a new Transformation Board has been established,

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across Calderdale & Huddersfield to manage services and engineer service re-design that should facilitate and maintain keeping delays to the present minimum at CHFT. A similar group will be established for North Kirklees & Wakefield to work with MYHT and other partners to deliver similar outcomes. NHS Wakefield The situation reports received several times each day report delayed discharges. Reasons for delayed discharges:

Waiting for packages of care to be set up. These are often complex packages that require multiple visits per day and require 2 staff to deliver that care.

Waiting for adaptations and equipment.

Mental health issues are also a problem. There are dementia care beds that are part of the Interim Bed capacity. But these patients may have slight confusion and no diagnosis of dementia. This makes managing these patients in the Winter beds very difficult as these patients may be disruptive in the Care Homes.

Patients are often on the delayed discharge list when they are still not medically fit for discharge.

Patients may still be waiting for diagnostic tests. Action being taken to address: Teams are working on a daily basis to ensure patient flow continues. The situation reports are shared across all organisations. The Intermediate Tier Nurse Advisers (ITNAs) are reviewing patients within the Winter Beds daily and liaising with the Discharge Team, they attend the bed meeting at MYHT, along with colleagues from Family Services and look to moving patients through the whole Intermediate Tier and Winter Beds system. Patients in the Winter Beds are Case Managed by the ITNAs and they formulate the Care Plan and liaise with all the appropriate agencies to ensure patients are discharged or transferred at the appropriate time. There is an Escalation Plan that is put into action when issues around delays over run the maximum timescale.

3.18 SRS11 – GP Written Referrals

The underperformance highlighted is with NHS Calderdale and NHS Kirklees.

NHS Calderdale and NHS Kirklees

The PCTs are activity working with their Primary Care contractors to understand current referral patterns and are closely performance monitoring this 18 Week RTT supporting measure and although actual activity is showing above planned trajectory, there is confidence at this stage that the year-end plan figures will be achieved.

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3.19 SRS12 – Other Referrals for a First Outpatient Appointment

The underperformance highlighted is with NHS Kirklees and Wakefield District.

NHS Kirklees

The trajectory figures for this group of indicators (Referrals for 1st Outpatient appointment - GP and Other - and First Outpatient attendances – GP and Total) are indicative figures advised to the SHA before contracts for 2011/12 were finalised. Figures have since been refreshed but these are not yet reflected in the SHA returns on which this data is based. NHS Kirklees is closely performance monitoring these measures, which have consistently been above reporting trajectories throughout the year and are currently projecting full-year variance between 4% and 10% for the various measures. Any associated impact is factored in to financial plans.

NHS Wakefield District

When calculating the trajectories for referrals (GP and Other) the starting point is the outpatient 1st appointment figure calculated in the demand plan work. This figure has a lot of rigour put into it, taking into account waiting time expectations and growth, and provider efficiency. We then take outpatient first appointment and from it, try and estimate the number of total referrals - and the split between GP and Other – that would be made to account for the number of appointments. This is estimated by looking at trends in relationships between referrals and outpatient first appointments over recent years; this may then be altered if commissioning knowledge suggests that a change may be due e.g. a letter written to local acute providers requesting that there should be no referrals between Consultants in different departments or an expected change in culture due to the emergence of clinical commissioning. With this in mind the 2011/12 trajectory expected a reduction in Other referrals and therefore an increase in GP referrals as patient were returned from secondary care to primary care for onward refer/management. The 2011/12 figures for referrals are as follows:

Indicator Description Plan Outturn Actual (FOT) Variance % Variance

SRS 11 GP Written Referrals to

hospital 86,364 76,170 -10,194 -12%

SRS 12 Other Referrals for a First Outpatient

Appointment 35,275 41,089 5,814 +16%

Total referrals

121,639 117,259 -4,380 -3.6%

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The table suggests that although the split between how referrals are apportioned between GP and Other is incorrect on both lines, the overall estimation of referrals is within 4% and more importantly the current figures are suggesting an outturn position less than plan which would be Green rated if the total referrals was an indicator line.

More importantly, the outpatient first appointment line that the proposed referral figures are based on – the difference being that NHSWD contracts for appointments not referrals – is currently 0.8% away from the planned figure (Plan 97,311, actual 96,529, variance 782).

3.20 SRS13 - First Outpatient Attendance Following GP Referral


NHS Calderdale

Higher than expected volume of referrals in December. Not consistent with seasonal variation noted in previous years. Contract continues to under-trade. The Commissioners will continue to monitor and inform the development of plans and actions as part of current business planning round. NHS Kirklees The trajectory figures for this group of indicators (Referrals for 1st Outpatient appointment - GP and Other - and First Outpatient attendances – GP and Total) are indicative figures advised to the SHA before contracts for 2011/12 were finalised. Figures have since been refreshed but these are not yet reflected in the SHA returns on which this data is based. NHS Kirklees is closely performance monitoring these measures, which have consistently been above reporting trajectories throughout the year and are currently projecting full-year variance between 4% and 10% for the various measures. Any associated impact is factored in to financial plans.

3.21 SRS14 – All First Outpatient Attendances

The underperformance highlighted is NHS Calderdale and NHS Kirklees.

NHS Calderdale

FOT is higher than plan for 2011/12 – the assumptions in the profile developed for this year need to refreshed to ensure a more accurate plan is developed for 2012/13. Triangulation with contracting data indicates NHS Calderdale is not overtrading with the volume and expenditure on outpatient appointments, both 1st and follow up.

All other activity levels for NHS Calderdale remain broadly in accord with the plans established for 2011/12. It should also be noted that the rate of growth in GP referrals is also decreasing which will impact on demand for outpatient attendances.

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NHS Kirklees

The trajectory figures for this group of indicators (Referrals for 1st Outpatient appointment - GP and Other - and First Outpatient attendances – GP and Total) are indicative figures advised to the SHA before contracts for 2011/12 were finalised. Figures have since been refreshed but these are not yet reflected in the SHA returns on which this data is based. NHS Kirklees is closely performance monitoring these measures, which have consistently been above reporting trajectories throughout the year and are currently projecting full-year variance between 4% and 10% for the various measures. Any associated impact is factored in to financial plans.

3.22 SRS15 – Elective FFCEs


NHS Calderdale and NHS Kirklees

The trajectory figures are indicative figures advised to the SHA before contracts for 2011/12 were finalised. Figures have since been refreshed but these are not yet reflected in the SHA returns on which this data is based. NHS Calderdale and NHS Kirklees is closely performance monitoring this measure, which has consistently been above reporting trajectories throughout the year and is currently projecting a 10% full-year variance. Any associated impact is factored in to financial plans.

3.23 SRS19 - Staff Absence

The underperformance highlighted is with NHS Kirklees and NHS Wakefield District.

The expectation of the Yorkshire & Humber SHA in 2011/12 is that Commissioner Organisations should achieve a sickness absence rate of 2.5% or less. The sickness rate for NHS Kirklees and NHS Wakefield District for Q3 was 2.6%, however, it is the year-to-date position that is formally assessed nationally, and the year-to-date sickness rate is showing as 2.2% for NHS Kirklees and 2.5% for NHS Wakefield district that produces a „green‟ traffic light for assessment purposes. Refer to Section 4, Workforce, for further details.

3.24 SRF12 & SRF13: Proportion of GP referrals to first outpatient appointment booked using Choose and Book (CAB) and Trend/Volume in patients being treated at non-NHS hospitals.

The underperformance highlighted is across CKW Cluster.

NHS Calderdale

Both Choose and Book and Choice feature in the priorities of the new Government via the 'Liberating the NHS' White Paper, and the Operating Framework. Although no specific national target was specified for 2011/12, the SHA has introduced an aspiration of 70% for local health economies to achieve.

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Conversion Rates The Department of Health (DH) assess performance on the utilisation of Choose and Book using the conversion rate for GP referrals. Conversion means that the patient made a phone call or booked an appointment online (in surgery, at home, library, etc) which turns their Unique Booking Reference Number (UBRN) into an outpatient appointment at the hospital of their choice.

Choose & Book Utilisation

Month 0809 Actual 0910 Actual 1011 Actual 1112 Actual SHA Target Variance to Plan

Apr 67% 71% 80% 70% 70% 0%

May 59% 72% 78% 70% 70% 0%

Jun 60% 67% 75% 66% 70% 4%

Jul 63% 66% 74% 65% 70% 5%

Aug 58% 71% 70% 67% 70% 3%

Sep 60% 72% 74% 64% 70% 6%

Oct 58% 73% 70% 63% 70% 7%

Nov 61% 67% 69% 64% 70% 6%

Dec 53% 59% 53% 62% 70% 8%

Jan 67% 65% 70% 66% 70% 4%

Feb 66% 72% 77% 70%

Mar 69% 76% 71% 70%

Average 62% 69% 72% 66% 70%

The utilisation of Choose and Book in Calderdale continues to achieve one of the highest conversion rates across the Yorkshire and Humber region. The national average for Choose and Book Utilisation stands at 52%. The Choose and Book indicator used by DH has always concentrated on the percentage of converted UBRN‟s. The remaining referral requests are not converted because patients have chosen not to make an outpatient appointment. The ideal way to increase the percentage of the converted UBRNs is for practices to insist patients arrange outpatient appointments before leaving the surgery - either at the end of consultation or with a practice staff member. This is not always desirable or appropriate for the patient. All Consultant Led services at CHFT on Choose and Book are directly bookable. This allows patients to book their first outpatient appointment at the GP practice, online via health space or by telephoning the Choose and Book Appointment Line. Feedback from GPs has been favourable.

GP Local Enhanced Scheme (LES) The LES for Calderdale highlighted that practices referred 96% of GP referrals to services which were available via Choose and Book. The remaining 4% were referrals which were sent via paper but could have been sent electronically via Choose and Book. Audits of paper referrals are carried out at CHFT throughout the year to highlight particular practices who continue to send referrals when they could have been sent via choose and book.

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The figures for the national indicator and LES are different because they focus on different aspects of the Choose and Book system:

DH - UBRN conversions

LES - the utilisation of the Choose and Book system Optimising Electronic Referrals „Optimising Electronic Referrals' (OER) is a West Yorkshire wide project, sponsored by WYCOM that aims to help make further improvements where the national Choose and Book programme had not yet succeeded. NHS Calderdale is part of this project. Dr Kumar (Todmorden) is the clinical lead who liaises with the Choose and Book Team and SHA staff re. OER in Calderdale. Making improvements to the local secondary care provider is proving successful. CHFT now offer Advice and Guidance which allows a referring clinician to seek advice from another clinician. GP‟s can attach documents to the advice request, such as diagnostic results, scanned images (e.g. ECG‟s) or correspondence related to the patient. The acute care clinician is then able to review the request, add attachments if required and send a response back to the GP. This is currently provided at no cost. Advice and Guidance is provided for the following specialties at CHFT:

- Cardiology; ENT; Dermatology; Gynaecology ;Haematology; Orthopaedics ;Oral/ Maxillofacial;Respiratory Medicine; Rheumatology; Elderly Medicine; General Medicine; General Surgery; Paediatrics; Paediatric Surgery; Pain Management; Ophthalmology

All Calderdale GP‟s are committed to using the Choose and Book system to refer where possible. One practice initially declined the Electronic Booking LES in May 2011. They have a known router issue that affects all their e-transactions including Choose and Book. They have chosen not to resume use of Choose and Book until the router problem is resolved. However, BTN3 has confirmed that the practice has been accepted as an early adopter regarding the GP NGA programme. According to the information provided on the BTN3 website, the practice should expect to see a significant increase in bandwidth once implemented. The Choose and Book Team remain in contact with all practices offering support, training and addressing and submitting recurring issues to relevant parties. NHS Kirklees Performance for Kirklees continues to be below both National and Regional Average, standing at 49.8% (provisional figure) for December 2011. We are working with practices in both North Kirklees and Greater Huddersfield to get a better understanding of C&B usage from practice clinical systems as the centrally-available data can be misleading because of exclusions and is therefore not supporting practice engagement. The C&B team continues to meet with practices, especially those with

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low utilization rates to resolve issues and increase use of C&B worklists as part of daily routine. Both CCGs are engaged with the C&B team and leading/supporting this work.

At a high level, C&B usage is higher in Greater Huddersfield (as evidenced by referrals into CHFT) than in North Kirklees (as evidenced by referrals into MYHT). Across Kirklees 68 out of 71 practices are currently using C&B but many practices use it occasionally rather than regularly and in other cases some referrers within a practice use C&B whereas others don‟t.

A range of issues at MYHT are contributing to reduced uptake, including: slot availability, limited clinical leadership and engagement, range of services available on C&B.

Other points that may be contributing to low utilization and for which plans are being developed/implemented:

Some NK GP‟s still believe that the Named clinician function does not work on Choose and book and are therefore not using the system. The C&B team continues to give demonstrations and confirm via newsletter that it does work.

Many NK practices believe that the appointments system is bad at MYHT so there is no point using C&B. If a patient chooses to go to Dewsbury, for example, and the practices find no appointments available via C&B, they tend to send in a paper referral – thinking it is easier to get an appointment allocated

GP Link is used to communicate C&B information, changes, and new services. Anecdotally this is not proving a popular or effective route of sharing C&B information. As a result, relevant information is missed and needs to be repeated. The C& B team holds non-nhs email address to communicate information which is proving successful.

Many practices do not believe that Consultants use or have access to the Choose and Book system, but this is not the case. Practices sometimes feel as there is no point in taking time and effort to use the system when a Clinician is not at the other end to respond. At CHFT, a mixture of Consultants and senior nurses review referral letters. At MYHT, the majority of Consultants review referral letters. It could be that when referral letters are missing, practice receive phone calls from clinic nurses and admin staff, therefore practices believe that that is the level of seniority their letters are dealt with.

SystmOne practices have never been able to send more than 4 items with any referral letter via Choose and Book. This has been a major problem, especially for services such as Ophthalmology, where partial reports have been sent and Consultants either reject or request more info to be faxed in. Systmone will be upgraded so that practices can send a maximum of 5 megabytes and not restricted to 4 items. Practices are currently being informed of this.

A large number of GP‟s are still not using the Choose and Book system themselves. Anecdotal comments received from consultants are that they are

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convinced that if admin were not using the system, patients would be allocated to correct clinics. This could also highlight a Directory of service issue.”

NHS Wakefield

Year to date analysis shows the average volume of referrals (per month) made through Choose and Book (CAB) for NHS Wakefield District (NHSWD) is 4,990 compared to the same time last year which was 4,190. This is an increase of 19%.

The validated data for Q3 showed 15,414 referrals were made through CAB which is the highest number of referrals made in any quarter so far (an increase of 23% in comparison to the same period last year.) November 2011 also recorded the highest individual month with 5,529 referrals being made through the system.

Validated data demonstrates January 2012 has also seen an increase of 20% in the volume of referrals in comparison to January 2011.

During 2010/11 a total of 52,045 referrals were made through CAB. The forecast outturn for 2011/12 is 60,967.

PCT Monthly Utilisation The graph below demonstrates Wakefield‟s percentage C&B utilisation compared to the Yorkshire and Humber (Y&H) region and PCTs who are part of the Optimising Electronic Referral (OER) programme.

It shows from April 2011 NHSWD continues to exceed both the National and Y&H average and with the exception of September and December 2011 performance continues to be over 60%. The average utilisation is 60% in comparison to the same period last year which was 57%. The PCT has a plan agreed with the Strategic Health Authority (SHA) to increase utilisation further to between 80% and 90% by end of April 2012 although Board members are asked to note that achievement will also depend on a number of external factors such as Mid Yorkshire Hospitals NHS Trust (MYHT) significantly improving slot availability.

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Appointment Slot Issues at MYHT

Although Appointment Slot Issues (ASI‟s) have improved in comparison to the same period last year when the average was 34%, MYHT continue to be an outlier both within the region and nationally. The latest figures show slot issues in 20% of cases compared to a national target of 4%.

Because appointment slot availability issues negatively impact on both patient experience and the view of referring clinicians using the system actions to improve slot availability continue to be monitored by both the Contract Management Group and Executive Contract Board. In addition actions to address slot issues are also now being addressed as part the monthly OER project plan.

SRF13 – Choice – Trend/Volume of Patients Treated at Non-NHS Hospitals

Patients should have the opportunity to choose a range of providers for their first outpatient appointment, including those in the Independent sector. This indicator shows a percentage of patients who have exercised choice, since it is likely that an alternative NHS provider was also offered to them. An increasing percentage of CAB bookings being made to the Independent Sector (IS) may be indicative of more choice being offered to patients. CKW Cluster Position

The CKW PCTs have not RAG rated this indicator as national definitions are not clearly defined;

The PCTs do not have baselines or accurate measures to base correlation; and

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The „outturn‟ would not give a true picture as this would be based on incorrect definition guidance, which is why this indicator has not been monitored this year.

3.25 SRF14 – Information to Patients: % of patients with greater control of their care

records

The underperformance highlighted is across CKW Cluster.

For 2011/12 the proxy indicator being reported is “Number of general practices within the PCT which have enabled functionality to allow patients to view elements of their primary care record online” as a percentage of “Total number of general practices within the PCT”

Across the Cluster we have a very small number of practices utilizing certain parts of the functionality in respect of this indicator:

Some practices allow patients to request repeat medications; and

Some allow patients to book appointments on the internet. No practices as yet provide patients with:-

Direct access to test results;

Direct access to Letters; and

Direct Access to Full patient record.

The individual PCTs, via the IT lead and the data quality team, are increasingly beginning to raise the patient access agenda at Practice Managers meetings, the SystmOne User group, and with the CCG‟s IT clinical leads and will continue to provide support to enable the further roll out of this type of functionality. A point to note is that the current major IT clinical systems only have limited functionality available and we are awaiting development of patient access functionality of both the GP clinical systems, SystmOne and EMIS.

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4. Workforce: CKW Cluster This update is provided by the Human Resource and Organisational Development (HR&OD) Shared Service and provides the Cluster Executive Team with the latest key workforce metrics from NHS CKWD‟s constituent PCTs. Workforce metrics can be a good barometer for an organisation. Significant peaks, troughs or deviation from plans can represent an area requiring further investigation or assurance. The metrics presented here focus on staff in post, sickness absence and turnover, dating back to April 2010.

Unless otherwise stated, all information derives from the NHS Electronic Staff Record (ESR).

4.1 Staff in post

The table below shows the quantity of staff in post across the CKW Cluster at 31st December 2011:

PCT Headcount FTE

NHS Calderdale 151 137.0

NHS Kirklees 251 221.6

NHS Wakefield District 268 240.5

CKW Cluster Total 670 599.1

The graph on the following page shows the change in number of full time equivalent (FTE) staff employed in the CKW cluster since April 2010. Please note that these figures have been adjusted to remove all Provider directorate staff from the outset; but they do contain any Commissioner staff who latterly TUPE transferred to other organisations with Provider directorates. This factor largely accounts for the significant drop in FTE numbers between March 2011 and April 2011. The dotted green line indicates the expected trajectory of the workforce during 2011/12. The trajectory, which was set at the start of the year, is based on assumptions about the rate of turnover and rate of recruitment, but does not take into account imminent departures from the recent Voluntary Redundancy / Early Retirement Scheme or TUPE.

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599.1 593.3

500.0

550.0

600.0

650.0

700.0

750.0

800.0

850.0

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

CKW FTE

2010-11 2011-12 Trajectory

FTE numbers peaked in June 2010 at 807.3 FTE and have since dropped to 599.1 FTE. This represents a decrease of over 25%. The reduction in the workforce during 2011/12 has to date followed our expected trajectory; however the impact of autumn 2011‟s voluntary schemes will see a sharper than predicted drop in numbers during the remainder of the financial year, with a likely outturn at 31 March 2011 of approximately 585 FTE.

4.2 Turnover In this context, turnover refers to the quantity of staff leaving the organisation. The table below shows the number of leavers and the 12 month rolling turnover for each PCT up to November 2011.

The The following graph shows the 12 month rolling turnover in NHS Calderdale, Kirklees and Wakefield Cluster dating back to 1 April 2010. The dotted line indicates the expected trajectory of turnover during 2011/12.

PCT Number of leavers in the 12 months to 31 December 2011

12 month rolling turnover rate

NHS Calderdale 27 16.7%

NHS Kirklees 37 13.1%

NHS Wakefield District 31 11.3%

CKW Cluster Total 95 13.2%

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0.0%

5.0%

10.0%

15.0%

20.0%

25.0%


CKW 12 month rolling turnover

2010-11 2011-12 Trajectory

The rolling 12 month turnover rate has been high for all PCTs. This is due mainly to the introduction of Voluntary Schemes in each PCT during the 2010/11 financial year, and to a number of TUPE transfers out of the organisations during the course of the year. Although the rate of turnover has been dropping since the summer, it is expected to rise again for the remainder of the financial year as the 2011/12 Cluster Voluntary Scheme departures take effect.

4.3 Sickness Absence

The expectation of the Yorkshire & Humber SHA in 2011/12 is that Commissioner Organisations should achieve a sickness absence rate of 2.5% or less. It is understood that the revised expectation for 2012/13 will be a target sickness absence rate of 1.5% for commissioning organisations. The following table shows the rate and cost of sickness across the Cluster for 2011/12 to date, from 1 April to 31st December 2011:

PCT Short term sickness rate

Long term sickness rate

Sickness rate Cost of sickness

NHS Calderdale 1.0% 0.7% 1.7% £63,243

NHS Kirklees 1.3% 0.9% 2.2% £171,757

NHS Wakefield District 1.4% 1.1% 2.5% £195,550

CKW Cluster Total 1.4% 1.1% 2.5% £430,549

The graph below shows the sickness absence rate across the Cluster dating back to April 2010. The 2.5% expected rate is marked on the graph in green.

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The graph clearly shows that sickness absence rates are markedly lower during 2011/12 to date than in the previous financial year. The peaks and troughs of sickness absence during 2011/12 are so far following a similar pattern to 2010/11. Historical sickness trends suggest that sickness absence in Quarter 4 will drop compared with Quarter 3. This information, combined with the overall 2.5% sickness absence rate at 31 December 2011, suggests that the Cluster remains on target to achieve no more than 2.5% sickness absence by the end of 2011/12.

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%


CKW Sickness

2010-11 2011-12 Target (2.5%)

4,4 Provider workforce metrics

Except where stated otherwise, the information below is taken from the NHS I-View system, which lifts data from Providers‟ own Electronic Staff Record (ESR). The data is gathered regularly by I-View, but is two months behind the data that we are able to report for Cluster organisations. This means that the data below is correct at November 2011.

4,4,1 Calderdale & Huddersfield NHS Foundation Trust

The graph on the following page shows the change in number of full time equivalent (FTE) staff employed by CHFT since April 2010. The green line represents CHFT‟s own anticipated trajectory for their workforce during 2011/12.

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The significant jump in workforce numbers between March 2011 and April 2011 is likely to be as a result of the TUPE transfer of several hundred employees to CHFT from the Provider directorate of NHS Calderdale. The graphs below show CHFT‟s sickness and turnover dating back to April 2010. The straight green line on the sickness graph represents the SHA‟s expected level of sickness absence in Provider organisations, which is 4%.

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%


CHFT Sickness

2010-11 2011-12 Target (4%)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%


CHFT 12 month rolling turnover

2010-11 2011-12

Between April and September 2011, CHFT has remained within the 4% expected sickness level. In October 2011 sickness rates rose above target to 4.5%. It is expected that sickness levels rise over Quarter 3 and 4, although the 2011-12 average rate may still remain at our below 4%.

Turnover at CHFT throughout 2010/11 and during 2011/12 to date is at levels commensurate with a stable organisation and gives no cause for concern.

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4.4.2 Mid Yorkshire

The graph below shows the change in number of full time equivalent (FTE) staff employed by Mid Yorkshire since April 2010. The green line represents Mid Yorkshire‟s own anticipated trajectory for their workforce during 2011/12.

5600

5800

6000

6200

6400

6600

6800

7000

7200

7400


Mid Yorkshire FTE

2010-11 2011-12 Schedule 3

It should be noted that the sharp rise in Mid Yorkshire‟s anticipated workforce trajectory (the green line) is likely to be linked to the c 750 FTE Provider staff it received from NHS Wakefield District at the start of the financial year. These staff are reflected in Mid Yorkshire‟s actual ESR staff in post figures for 2011/12 (the red line) from November 2011. At November 2011, Mid Yorkshire employed 7185 FTE against a projected workforce size of 6827 FTE. The graphs below show Mid Yorkshire‟s sickness and turnover dating back to April 2010. The straight green line on the sickness graph represents the SHA‟s expected level of sickness absence in Provider organisations, which is 4%.

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%


Mid Yorkshire Sickness

2010-11 2011-12 Target (4%)

Between April and October 2011,

Mid Yorkshire‟s sickness absence

levels have been consistently

higher than during the same period

in 2010/11, and are significantly

above the 4% expected sickness

level.

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If the same pattern of sickness emerges as in 2010/11, it is to be expected that Mid Yorkshire‟s

sickness levels will rise during Quarters 3 & 4, potentially breaching 6%.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%


Mid Yorkshire 12 month rolling turnover

2010-11 2011-12

4.5 Conclusion

This report is designed to give the Cluster Board a snapshot of workforce metrics from its own workforce and those of its main acute providers. The report can be adjusted as needed to meet the Board‟s ongoing requirements.

HRODSS will continue to work closely with Board members and the CKW workforce to deliver expected outputs in internal workforce metrics; and to work with Providers in ongoing efforts to obtain assurances about their own workforces and workforce plans.

5. Recommendations

The CKW Cluster Board is asked to NOTE NHS Calderdale, NHS Kirklees and NHS Wakefield District PCTs performance against the key headline and supporting outcomes/measures, together with performance against local identified priorities, APPROVE the action being taken to address areas of under/over performance and AGREE additional actions required to address areas of over/under performance.

Report Owner: Peter Flynn, Director of Performance & Commissioning Intelligence Report Author: Kath Woodford, Business Planning and Performance Reporting Manager

Turnover at Mid Yorkshire

throughout 2010/11 and during

2011/12 to date is at levels

commensurate with a stable

organisation.

ckwcb-12-59b_performance_report

Documents

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key performance indicators

performance summary

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nhs kirklees nhsk

nhs dentistry squ16

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