commissioning plan performance report: quarter 2 body papers... · governing body 2 november 2016...

NHS Rotherham Clinical Commissioning Group

Operational Executive 17 October 2016

Strategic Clinical Executive 19 October 2016

GP Members Committee 26 October 2016

Governing Body 2 November 2016

Commissioning Plan Performance Report: Quarter 2

Lead Executive: Ian Atkinson, Deputy Chief Officer

Lead Officer: Lydia George, Planning and Assurance Manager

Alex Henderson-Dunk, Performance and Intelligence Manager

Lead GP: N/a

Purpose:

For Governing Body to note the progress with delivery of the CCGs Commissioning Plan as at the end of Quarter 2.

Background:

In 2013 a performance framework for the Commissioning Plan was developed so that the CCG could assess its progress against key priorities and on its implementation of the plan. The report has been refined each year but has broadly remained the same.

In Quarter1 of 2016/17, in line with the new CCG Improvement and Assessment Framework

and the revision of the GB overall performance report the Commissioning Plan performance

Report was revised to provide a fuller picture of delivery. The key changes were:

Each of the 15 priority areas from the Commissioning Plan are reported

Each priority area has clear milestones and targets aligned to the Commissioning Plan

Each priority area includes Key Performance Indicators taken from the new CCG

Improvement and Assessment Framework metrics, the new Governing Body

Performance report, Quality Premiums, the Better Care Fund or are regular key local

metrics already reported

QIPP information is included for those priority areas that are subject to QIPP

Any associated risks from the GB Assurance Framework are reported

Lead GP and Lead officers are reported

From 2016/17 the performance framework will be reported 4 times a year and will be received

at Governing Body in August, November, February with a final year- end report in May.

Analysis of key issues and of risks

Lead officers have provided commentary against the milestones where performance is off track. In quarter 2 officers were asked to identify any milestones where the direction of travel had the potential to deteriorate or improve.

In addition, in line with the GB performance report, commentary is provided for Key Performance Indicators that are not on track.

Milestones

There are 52 milestones in total, see breakdown below:

RAG rate Number of milestones

%

Red 1 2

Amber 4 8

Green 47 90

Total 52 100

The number of milestones on track has increase from 82% in quarter 1 to 90% in quarter 2.

RAG rate

No. Milestone description Commentary

Q1 position

Red 1 1. Extension of virtual

clinics from

haematology to other

areas such as

endocrinology (M18).

1. TRFT have concerns over

recording of activity. Work needs

to take place to resolve the issue

with the Meditech system. The

CCG has asked for formal notice

of when this will be resolved.

Green in

Q1

Amber 4 1. Primary care self-care

pilot complete tele-

health evaluation

(M28).

2. Delivery the required

number of bed

reductions as per

Rotherham element of

the LD plan (M29).

3. Involvement of the

care co-ordination

centre in the EOLC

pathway (M39).

4. Achieve 40%

implementation of the

Case Management

Palliative Care

Template in Primary

Care (M40).

1. Delay in commencing due to

provider (‘EE’) connection,

however the position is improving

and is now on track to report the

final evaluation in November.

2. Moved from green to amber,

NHSE have flagged the over

performance across the wider

footprint target as a risk.

3. The position has improved from

red in Q1 to amber in Q2,

discussions continue to take place

and it is still the intention for the

CCC to be a single point of access

for EOLC.

4. Decision to be included only

recently made, therefore

implementation is just starting

Same as

Q1

Green in

Q1

Red in

Q1

Same as

Q1

It is worth noting that whilst the RAG rate for the following milestones remains the same as Q1, it has been highlighted that there is the potential for the direction of travel to change.

Q1 / 2

RAG rate

Direction of travel

Milestone description Commentary

Amber Primary Care Self-Care pilot – complete tele-health evaluation (M4).

Whilst there was a delay initially due to the provider (‘EE’), the position is improving and is now on track to report the final evaluation in November.

Green Implement 10 clinical thresholds (M17).

Whilst on track for Q4, there was an aspiration for 1 December implementation and negotiations with TRFT are taking place to address.

Green RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan (M25)

Whilst on track for Q3, there is some concern over the level of assurance that the plan will be produced, this is being managed via the QIPP committee.

Key Performance Indicators (KPIs)

There are 48 milestones in total, see breakdown below:

RAG Rate Number of

KPIs %

Red 9 19

Amber 5 10

Green 14 29

*WD 16 34

**TBC 4 8

Total 48 100

* these KPIs are awaiting further data nationally

** Q2 data is not available yet for these KPIs

Overall there are approximately 29% of KPIs on track, which has increased from 27% in Q1, however there are still a high number of KPIs still awaiting national data.

It should be noted that, the following KPI is awaiting data, however it was red in Q1 and it is likely that it will be red again in Q2 which will worsen the positon:

Number of A&E attendances by care home residents

Below is a list of the red and amber KPIs, commentary on performance can be found in the Governing Body Performance Report or Governing Body Quality Report.

RAG rate

No. Key Performance Indicator Description Q1 position

Red 9 1. Utilise NHS e-referral service to enable choice at 1

st routine

elective referral (K2).

2. Contain growth in the number of non elective

admissions (K3).

3. Achieve A&E 4 hour access standard (K5).

4. People who have had a stroke who are admitted to the

acute stroke unit in 4 hours of arrival to hospital (K7).

5. Emergency readmissions within 30 days of discharge from

hospital (K8).

6. Cat A ambulance response calls within 8 minutes (K13).

7. Achievement of outpatient follow up ratios (K16).

8. Proportion of people waiting 6 weeks or less from

referral to entering a course of IAPT treatment (K23)

9. Cancer (all) diagnosed at stage 1 and 2 (K44).

1. Same as Q1

2. Not known in Q1

3. Same as Q1 4. Same as Q1

5. Same as Q1

6. Same as Q1 7. Not known in

Q1 8. Amber in Q1

9. Same as Q1

Amber 5 1. Contain growth in A&E attendances (K4).

2. Percentage of people who are moving to recovery of those

who have completed IAPT treatment (K21).

3. Reduce the number of people admitted in line with the

South Yorkshire and North Lincolnshire LD TCP

trajectory (K28).

4. Patients requiring a Continuing Healthcare assessment will

have an eligibility assessment within 28 days from the

receipt of the continuing healthcare checklist – Adults

(K40).

5. Patients requiring a Continuing Healthcare assessment will

have an eligibility assessment within 6 weeks from the

receipt of the continuing healthcare checklist – Childrens

(K41).

1. Not known in Q1

2. Same as Q1

3. Green in Q1 4. Same as Q1

5. Same as Q1

Finance

The position in terms of QIPP savings reported in Q1 remains the same in Q2 with the following exceptions:

Commissioning Priority QIPP Scheme Q1 Q2

Transforming Community Services

Reducing levels of activity in emergency admission – neuro rehab, integrated rapid response and integrated locality teams

Clinical Referrals Reducing levels of activity growth in direct access pathology in line with clinical pathways

Reduce IHAM NHSE growth assumption in line with local trend analysis

Medicines Management Nationally negotiated Price Reductions

Risk

There are no new risks since Q1 and the scores remain the same as reported in Q1. The following three risks were overlooked on the Q1 report, but the position has not changed:

Failure to meet the National cut-off date for Previously Unassessed Periods of Care

Failure to meet the National cut-off date of 1st March 2017 for Previously Unassessed Periods of Care (PUPoC) - previously known as CHC Retrospective Claims

15

CHC overspend Overspend due to high costs of individual patients of continuing care

12

CAMHS Services Failure to improve Child and Adolescent Mental Health Services (CAMHS)

12

Approval history:-

OE 17 10 2016

SCE 19 10 2016

GPMC 26 10 2016

CCG GB 02 11 2016

Recommendations:

CCG GB are asked to note the report and to note:

1. The position in term of milestones is positive and has improved from Q1.

2. The position in terms of KPIs is positive and has improved from Q1. However there are

a high number of KPIs which are waiting for national data.

Commissioning Plan Performance

Report 2016/17

Q2

Meeting Date

Operational Executive 17 10 2016

Strategic Clinical Executive 19 10 2016

GP Members Committee 26 10 2016

CCG Governing Body 02 11 2016

Definitions for RAG Ratings:

Red KPI Milestones QIPP

Less than 2% achieved Not started or significant issues Not started or Started but still high risk

Amber

KPI Milestones QIPP

Within 2% achieved Started but not on track OK with medium risk

Green

KPI Milestones QIPP

Achieved On track Achieving as planned

Please note

That there are a significant number of KPIs from the new Improvement and Assessment Framework where data is not available yet.

There are some KPIs where quarter 2 data is not available yet.

1 Primary Care Lead GP: Jason Page Lead Officer: Jacqui Tufnell

Funding in 2016/17 = £0.6m for the LIS, £1.2m for Case Management and funding for the CCG Commissioned LES’s

Deliverable Milestones for 2016/17 Source 2016/17 Target

Q1 Q2 Q3 Q4 Comments

M1 Primary Care Quality Contract – implement and monitor 3 standards for 2016/17.

Com / primary care plan

Q1 G G On track

M2 Primary Care Quality Contract – develop remaining standards for 2017/18


Q3 G G On track

M3 Primary Care Quality Contract – Agree contracts for 2017/18 standards


Q4 G G On track

M4 Primary Care Self-care pilot – complete tele-health evaluation


Q2 A A Off track, delay starting due to provider (‘EE’) connection. However, position improving and final evaluation report to be complete by end of October, and be presented to OE, SCE and Primary Care Committee mid November.

M5 Monitor and evaluate the effectiveness of the Care Home Alignment with GP practices


Q4 G G On track

Key Performance Indicators (KPIs) 2016/17 Target

Q1 Q2 Q3 Q4

K1 Patient experience of GP services I&A Framework

Quality premium

85% or a 3% increase on

Jul-16

WD WD Jul 15 – Mar 16 performance = 69.5%

K2 Utilise NHS e-referral service to enable choice at 1

st routine elective

referral

I&A Framework

Quality premium

80% or 20% increase on

Mar-16

65.3% June YTD

56.9% July 16

Performance has decreased since last report. Agreed action plan in place with TRFT which we continue to monitor. There has been significant improvement across specialities, but 2 remain challenging. IT team are working with GPs to increase utilitsation.

QIPP

APMS Core Contract Values QIPP Plan £125,000 G G

Premises Costs reimbursements QIPP Plan £118,000 G G

Property Services QIPP Plan £274,000 G G

Risks Risk Description Risk Score

GP quality and Efficiency GB Assurance Framework

Failure to improve GP quality and efficiency in partnership with NHS England (current concerns are due to overall GP capacity and morale)

12

CQC inspection of practices GB Assurance Framework

Worst case scenario, a practice may be identified as so inadequate that emergency arrangements have to be enacted

12

Impact of changes to primary care support England from NHS to Capita contract

GB Assurance Framework

Issues in relation to collection and delivery of medical records, this is a national not local issue

16

To note, the following KPIs are within the I&A Framework but are not currently in publication

Primary care access

Primary care workforce

2 Unscheduled Care Lead GP: David Clitherow Lead Officer: Dominic Blaydon/ Sarah Lever

Funding in 2016/17 = £60.1m



M6 Completion of the capital Build for the Emergency Centre (Q2 2017/18)

Com Plan STP

Q4 G G On track - Handover from Kier planned for May 17 (currently ahead of schedule likely April 17). Once handed over, infrastructure (IT and equipment) will be put in place before cleaning ready for decant from B1.

M7 Implement new IT system Com Plan Q3 G G On track for Oct 16

M8 Full implementation of the Emergency Centre Model

Com Plan STP

Q3 G G On track - scheduled for 6th July 17

M9 Expand role of the Care Co-ordination Centre (CCC) to manage the interface between acute /community

Com Plan STP

Q3 A G Expansion of CCC on track but further discussions to take place around the clinician to clinician proposals still ongoing.

M10 Ensure replacement Risk Stratification Tool is in place to support the reduction in emergency admissions

Com Plan Q3 G G On track – expected roll out completion by mid-November


K3 Contain growth in the number of non-elective admissions

Contractual target

Meet contracted

levels

Includes all contract activity at all acute providers where the CCG has a contract. £0.6m above contract as at July 16

K4 Contain growth in A&E attendances Contractual target

Meet contracted

levels

Includes all contract activity at all acute providers where the CCG has a contract. £0.2m above contract as at July 16

K5 Achieve 4 hour access standard for A&E

Constitutional GB Report

95% by Q4 91.6% YTD as

at 30/06

91.7% YTD as

at 02/10

TRFT Year-to-date A&E position (Type 1 TRFT) as at week ending 23rd October 2016 was 91.3%. October to date has seen a dip in performance from September (92.8% for September and 86.3% October month to date). The position remains therefore very challenged. The agreed A&E improvement action plan continues to be monitored closely by the CCG with assurance being provided through the contractual mechanism and A&E delivery board. Local comparison to other Trust's in South Yorkshire can be found in the A&E Exceptions report. more detail can be found in the GB report

K6 Reduce unplanned hospitalisation for chronic Ambulatory Care Sensitive conditions

I&A Framework GB Report

1,074 WD WD Still awaiting data publication

QIPP

Delivery of A and E Assessments through the Clinical Decision Unit

QIPP Plan £286,000 G G

Reducing levels of Activity growth in A&E QIPP Plan £280,000 A A


QIPP Plan £226,000 R R


Unscheduled Care QIPP GB Assurance Framework

Failure to deliver system wide efficiency programme for unscheduled care

20

A&E target GB Assurance Framework

Failure to meet A&E targets 16

3 Transforming Community Services Lead GP: Phil Birks Lead Officer: Dominic Blaydon

Funding in 2016/17 =£28.5m



M11 Implement and monitor the Integrated Locality Team at the Health Village

Com Plan Q2 G G On track

M12 Implement and monitor the Integrated Rapid response Service

Com Plan Q2 G G On track - Note that staff are integrated on

one site a lead has been identified but not in place as yet

M13 Completion of the Business Care for the Re-ablement Village



K7 People who have had a stroke who are admitted to the acute stroke unit in 4 hours of arrival to hospital

Quality Premium

90% national standard

R 50.0%

R – Aug RFT

position –

57%

RFT position used as most up to date available and is reflective of overall CCG position

K8 Emergency readmissions within 30 days of discharge from hospital

BCF GB report

10% R Jun

16 YTD = 12.4%

R Aug

16 YTD = 30%

K9 Delayed transfers of care from hospital

I&A Framework

BCF GB Report

Quality Premium

Jul 16 Target

YTD = 1005.3 delayed days from hospital per 100,000 population (aged 18+)

G Apr-

Jun 16 YTD = 681.1

G Jul 16 YTD = 868.8

On track

K10 Number of unscheduled admissions of patients > 65 years out of hours

TCS reporting Threshold = -15%

WD WD Waiting for data

K11 Number of A&E attendances by care home residents

TCS reporting Threshold = 1250

R April / May = 270

TBC Qtr 2 data not available for 4-5 weeks

K12 GP satisfaction rate for the Integrated Community Nursing Service

TCS reporting Threshold = 80%

WD WD Q4 2015/16 achieved green, awaiting data for Q1

QIPP

Reducing levels of Activity in Emergency Admissions - neuro rehab, integrated rapid response and integrated locality teams

QIPP Plan £1,039,000 A R


None identified GB Assurance Framework

4 Ambulance and Patient Transport Services

Lead GP: David Clitherow Lead Officer: Julia Massey



M14 Develop a process to understand the CPR performance delivered to support improved patient outcomes

Com Plan Q4 TBC G YAS have identified the technology required to obtain accurate reporting on CPR standards from Defibrillators, reporting structure agreed and training needs identified.

M15 Improved hospital pre alert and treatment plans for patients with suspected Sepsis

Com Plan Q4 TBC G Operational plan produced Audit undertaken to agree baseline.

M16 Commission a provider for PTS service

Com Plan Q4 G On track

Key Performance Indicators (KPIs) K13 Response to category A (Red1)

ambulance calls within 8mins

I&A Framework

75% R June = 59.3%

R August = 58.8%

Not on track - YAS are currently participating in an NHS England-led Ambulance Response Programme (ARP), which went live from the 21st April 2016. The pilot ran for 3 months initially and has subsequently been extended. This programme involves a change in how calls are recorded from the previous current Red/Green system. Currently the only standard in place to monitor these new call classifications against is 75% for Red calls under 8 minutes.

QIPP

None identified


Ambulance Targets GB Assurance Framework

Failure of YAS to achieve RED 1 8 minute Target at CCG level and Yorkshire & Humber wide

20

5 Clinical Referrals (Diabetes is a clinical priority within the I&A Framework)

Lead GP: Anand Barmade Lead Officer: Janet Sinclair-Pinder

Funding in 2016/17 = £66.7m



M17 Implement 10 clinical thresholds Com Plan Q4 G G Note that whilst on track for Q4, there was an aspiration for 1 December implementation which is currently off track and negotiations with TRFT are taking place to address.

M18 Extension of virtual clinics from haematology to other areas such as endocrinology

Com Plan Q2 G R TRFT have concerns over the recording of activity, the issue with the Meditech system to enable correct recording needs resolving. CCG have asked for formal notice of when this will be resolved, but we have not received any indication of timescales as yet.

M19 Delivery of agreed audit programme and implementation of recommendations (6 in 2016/17 – 4 clinical thresholds, 1 cancer, 1 emergency admissions)


M20 Review and implement Rotherham Diabetes Care model around the Portsmouth care model which focuses around “super six” care.


Key Performance Indicators (KPIs) K14 Patients waiting 18 weeks or less

from referral to hospital treatment

Constitution / I&A

Framework GB Report

92% G June = 94.8%

G August = 93.7%

% Patients on incomplete non-emergency pathways waiting no more than 18 weeks. On track with performance continuing to be above the target.

K15 Contain growth in elective activity Contractual Meet contracted

levels

Includes all contract activity at all acute providers where the CCG has a contract. £0.3 Million below contract as at July 16

K16 Achievement of outpatient follow up ratios

Contractual 11% reduction

in follow ups from last year at

RFT

TBC -3.6% Activity down 3.6% on last year’s activity at RFT. The CCG contracted for an 11% reduction in follow-ups however, there is an agreed ratio in the contract above which the CCG will not pay.

QIPP

Reduction in follow-ups where TRFT are above peer average

QIPP Plan £816,000 G G See K16 above.

Reducing levels of Activity growth in direct access pathology in line with clinical pathways

QIPP Plan £73,000 R A


QIPP Plan £509,000 G R


Planned Care QIPP GB Assurance Framework

Failure to deliver system wide efficiency programme for planned care

20

6 Medicines Management Lead GP: Avanthi Gunasekera Lead Officer: Stuart Lakin

Funding in 2016/17 =£48.0m



M21 Potential savings of £447,500 have been identified by the introduction of a range of branded generic drugs. This figure will be adjusted as further schemes evolve. A target of 90% compliance has been set = annual savings £402,750.

Meds Management

Priority

90% G G On track

M22 12 projects to be delivered over the financial year two have been completed £273,000 savings identified this figure will evolve has schemes are still being evaluated

Meds Management

Priority

12 projects G G On track

M23 6 practices to have committed to become waste beacons and have begun the transformational work plan by September 2016. 9 practices have committed to the programme and timescales

Meds Management

Priority

Q3 TBC G On track 12 practices are signed up against a target of 6.

Key Performance Indicators (KPIs) K17 Reduction in the number of

antibiotics prescribed in primary care

Quality premium / I&A

Framework GB Report

4% reduction or 1.161 items per

STAR-PU

G 1.192


K18 Appropriate prescribing of broad spectrum antibiotics in primary care

Quality premium / I&A Framework / GB Report

lower than 10%, or to reduce by 20% from each CCG’s 2014/15

value

G 8.5


K19 Number of finance and quality “green” indictors

Meds Management

75% og 1302 indicators to be

green 976

G 552

(42%)


QIPP

Medicines Waste reduction QIPP Plan £700,000 A A

Medicines Management QIPP QIPP Plan £550,000 A A

Branded Generics QIPP Plan £250,000 G G

Rebates and contract efficiencies. QIPP Plan £200,000 G G

Do not prescribe QIPP Plan £150,000 A A

Nationally Negotiated Price Reductions QIPP Plan £1,000,000 A G

Service redesign - Nutrition/Gluten Free QIPP Plan £90,000 A A

UNIDENTIFIED QIPP Plan £190,000 R R


Prescribing QIPP GB Assurance Framework

Failure to deliver system wide efficiency programme for prescribing

20

7 Mental Health (Mental Health and Dementia are clinical priorities within the I&A

Framework) Lead GP: Russell Brynes (Adults) Richard Cullen

(Childrens) Lead Officer: Kate Tufnell (Adults) Nigel Parkes

(Childrens)

Funding in 2016/17 =£35.0m



M24 Externally evaluate Adult Mental Health Liaison and MH Social Prescribing programmes

Com Plan STP

Q3 G G On track

M25 RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan

Com Plan Q3 G G On track, some concern that the plan will be produced, assurance being monitored via the QIPP Committee.

M26 Dementia – Implement and evaluation the Dementia LES


M27 Children and Young People - All children and young people will follow the agreed process in transitioning to adult services and all will have a transition plan in place.

Com Plan STP

Q4 G G On track - we now have a CQUIN relating to Transition, which monitors closely all transitions from CAMHS to Adult MH services.

M28 Review of out of area placements in partnership with RDASH

Com Plan STP

Q2 G G On track

Key Performance Indicators (KPIs) K20 People with 1

st episode of psychosis

starting treatment with a NICE- recommended package of care treated within 2 weeks of referral

I& A Framework

STP GB report

50% G 72.9%

G Aug-16

= 70.6%

On track

K21 Percentage of people who are "moving to recovery" of those who have completed IAPT treatment

I&A Framework GB Report

Quality Premium

51.3% A 47.6% at the end of

Q1

A Jul 16 YTD = 50.50%

Not on track YTD although monthly performance for July was 56.2% and met the standard. The IAPT service has undergone a visit by NHS Improvement. The report following this visit is currently being reviewed and actions discussed across stakeholders.

K22 Diagnosis rate for people with dementia, as a percentage of the estimated prevalence

GB Report I&A

Framework

67% G June = 73.85%

G July =

75.11%

On track – note data is a snapshot as at month end

K23 Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment

GB Report I&A

Framework

75% A 71.8%

R 67.2%

Performance has deteriorated and remains significantly off track.

K24 95% of children and young people

who present at A&E in crisis will be seen within 1 hour

STP Com plan

No existing data –

awaiting STP

WD WD No data for Q2

K25 95% of adults who present at A&E

in crisis will be seen within 1 hour

STP Com plan

No existing data –

awaiting STP

WD WD No data for Q2

QIPP

MH and LD – joint risk share with RDASH to reduce the Out of Area activity

QIPP Plan £369,000 R R


IAPT Waiting Times GB Assurance Framework

Failure to deliver the National IAPT waiting times standards for 6 and 18 weeks

16

CAMHS Reconfiguration GB Assurance Framework

Inability to deliver CAMHS reconfiguration in a timely manner

16

CAMHS Transformation GB Assurance Framework

Delivery of the CAMHS Local Transformation Plan 12

CAMHS Services GB Assurance Framework

Failure to improve Child and Adolescent Mental Health Services (CAMHS)

12

8 Learning Disability (Learning Disabilities is a clinical priority within the I&A

Framework) Lead GP: : Russell Brynes (Adults) Richard Cullen

(Childrens) Lead Officer: Kate Tufnell



M29 Deliver the required number of bed reductions as per Rotherham element of the plan

Com plan Q4 G A Not delivering against planned trajectory to achieve Q4 target. NHSE have flagged the wider footprint at risk of delivery.

M30 Deliver GP training to support the Annual Health check DES

Com plan Q2 G G On track - completed


K26 Ensure that patients receive a CTR prior to a planned admission to an Assessment and Treatment Unit or mental health inpatients

Com Plan STP

95% G G On track. No planned admissions in quarter 2

K27 Ensure that patients in an Assessment and Treatment Unit receive a Care and Treatment Review (CTR) every 6 months

Com Plan STP

100% G G On track

K28 Reduce the number of people admitted in line with the South Yorkshire and North Lincolnshire LD TCP trajectory

Local Reporting

Target = 3 – CCG

funded LD beds

5 – NHSE

funded secure LD

beds

G A CCG funded LD beds is currently at 5, of which 2 patients are awaiting funding approval and 1 patient is awaiting an appropriate placement. The NHSE funded beds currently at 3 with target being met. The rationale for performance moving to amber is due to the over performance on the wider footprint target

QIPP

Review of Assessment and Treatment Unit capacity in block purchase or spot purchase

QIPP Plan £483,000 G G




% of people with a learning disability on a GP register having annual health check

Reliance on specialist inpatient care for people with learning disability/autism

9 Maternity and Children’s Services (Maternity is a clinical priorities within the I&A Framework)

Lead GP: Richard Cullen Lead Officer: Emma Royle



M31 Complete a gap analysis and ‘next steps’ against the National Maternity Review: Better Births

Com Plan

Q3 G G On track - TRFT have undertaken and shared a gap analysis.

M32 Complete a revised strategy and service specification for maternity services

Com Plan

Q3 G G On track - The draft strategy is to be reviewed to take in to account ne guidance including the reduction in still births: a care bundle.

M33 Develop new community services specifications for children’s community nursing and specialist nurses to support the Care Closer to Home work-stream

Com Plan

Q3 G G On track - Consultation has taken place with staff, and the parent carers forum are undertaking a consultation exercise and utilising commissioning tools.


K29 Reduce the number of neonatal mortality and still births

I&A Framework Outcomes Framework

TBC WD WD Latest position is 9 per 1000 births for 2014. Awaiting more data to be published.

K30 % of children aged 10-11 classified as overweight or obese

I&A Framework

Public Health

TBC WD WD Latest position is 35.3% in 2014/15

K31 Maternal smoking at delivery I&A Framework

Public Health

TBC WD WD Latest available position – Q1 16/17

K32 Improve Women’s experience of maternity services (national maternity services survey)

I&A Framework

Outcomes Framework

TBC WD WD 2015 score of 7.87 is latest available position. AHD - Consider adding additional narrative when next score is published to explain how score is calculated.

K33 Emergency admissions for children with lower respiratory tract infections

I&A Framework

541.8 WD WD Latest position is 541.8 in 2014/15

K34 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19’s

I&A Framework

364 WD WD Latest position is 364.0 in 2014/15

QIPP

None identified


Health Assessments for Children in Care GB Assurance Framework

NHS RCCG reputation as responsible commissioner for Children in Care - not having initial health assessments within statutory framework

12

10 Continuing Care and Funded Nursing Care

Lead GP: Richard Cullen Lead Officer: Alun Windle



M34 Put in place a comprehensive range of agreed local policies and protocols in line with any contemporary guidance

CHC Standards

AQuA Assurance

Report

Adults Q3

G G On track

M35 Children Q3

G G On track

M36 Develop a CHC training package for health and social care staff regarding local process and provision of CHC

CHC Standards

AQuA Assurance

Report

Q4 G G On track

M37 Implement processes fit for purpose with identified panels having an appropriate number, scope, size and membership

CHC Standards

AQuA Assurance

Report

Adults Q1

G G On track

M38 Children Q3

G G On track

Key Performance Indicators (KPIs) K35 People eligible for standard NHS

continuing healthcare

I&A Framework GB report

TBC WD WD Not currently in publication

K36 Personal Health Budgets I&A Framework GB report

TBC WD WD Not currently in publication

K37 Patients in receipt of CHC will have a completed annual review

CHC Key Performance

Indicators

Adults 25-30%

outstanding

G G

K38 Children 0%

outstanding

G G

K39 Patients referred by Fast Track referral will receive a funding decision within 48 hours

CHC Key Performance

Indicators

100% Q4

G G

K40 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 28 days from the receipt of the continuing healthcare checklist - Adults

CHC Key Performance

Indicators

100% Q4

A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.

K41 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 6 weeks from the receipt of the continuing healthcare checklist – Childrens

CHC Key Performance

Indicators

100% Q4

A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.

QIPP

Review of Children's CHC packages QIPP Plan £250,000 A A

Review of Assessment tool for determining care packages

QIPP Plan £150,000 A A

Review of High Cost Care packages QIPP Plan £100,000 A A


Equipment via IFR/CHC GB Assurance Framework

Equipment provided by RCCG via IFR/CHC - failure to have a procurement service to ensure cost effectiveness and service that ensures that purchased equipment has a record of maintenance.

15

Failure to meet the National cut-off date for Previously Unassessed Periods of Care

GB Assurance Framework

Failure to meet the National cut-off date of 1st March 2017 for Previously Unassessed Periods of Care (PUPoC) - previously CHC Retrospective Claims

15

CHC overspend GB Assurance Framework

Overspend due to high costs of individual patients of continuing care

12

11 End of Life Care (EOLC) Lead GP: Avanthi Gunasekera Lead Officer: Nigel Parkes

Funding in 2016/17 =£3.0m

Deliverable Milestones for

2016/17 Source

2016/17 Target


M39 Involvement of the Care Co-ordination Centre in the EOLC pathway

Com Plan Q4 R A Not on track – discussions continue to take place around implementation and it is still the intention for the CCC to be a single point of access for EOLC.

M40 Achieve 40% implementation of the Case Management Palliative Care Template in Primary Care

Com Plan Q4 A A Started but not on track, target = Q2 20%, Q3 30%, Q4 40%. The decision for this to be part of the case management template was taken recently so implementation is just starting traction.


K42 Percentage of deaths which take place in hospital

I&A Framework GB

Report

TBC WD WD 2014/15 Q4 - 2015/16 Q3 – 47.1% AHD comment - Can’t immediately find a target for this – perhaps a reduction

K43 Percentage of deaths not in hospital Public health 54% by Q4 WD WD Please note - 5 month lag on data. 2016 has started well with January to March all above 2015 average and above 2015 January to March values. This has maintained the upturn in the 12 month moving averages. However, January and February are provisional and March and April are incomplete therefore liable to change. Q1 2016 provisional 55%

QIPP

None identified



12 Specialised Services Lead GP: Richard Cullen Lead Officer: Jacqui Tufnell


2016/17 Source

2016/17 Target


M41 Ensure robust arrangements for tier 3 Obesity in readiness for the transfer of tier 4 bariatric surgery in collaboration with public health



- n/a No KPIs

QIPP

None identified


Collaborative commissioning GB Assurance Framework

Effective collaborative commissioning of specialised services

12

13 Joint Work – local and Regional Lead GP: Julie Kitlowski Lead Officer: Ian Atkinson/Keely Firth

Funding in 2016/17 = BCF is £24.3m


2016/17 Source

2016/17 Target


M42 Develop and deliver the STP STP Q3 G G On track M43 Develop and deliver the local place

based plan

STP Q3 G G On track

M44 Oversee the implementation of the BCF with RMBC

Com Plan / BCF Plan

Q4 G G On track


- Achievement of BCF KPIs – see BCF Plan

Com Plan / BCF Plan

Q4 Please see BCF page of GB report

QIPP

None identified


Funding for BCF GB Assurance Framework

Resources reduced through introduction of BCF 12

14 Child Sexual Exploitation Lead GP: Lee Oughton Lead Officer: Catherine Hall


2016/17 Source

2016/17 Target


M45 As part of the annual update for GPs and practice staff, ensure minimum training level 3 is delivered


M46 Offer the same training as above to the remainder of primary care, social care and providers


M47 Provide ongoing support to current and emerging SYP and NCA historic investigations

Com Plan Q1-Q4 G G On track

M48 Provide 2 members to be part of the Multi Agency Safeguarding Hub team

Com Plan Q1- Q4 G G On track


- None identified

QIPP

None identified



15 Cancer (Cancer is a clinical priorities within the I&A Framework) Lead GP: Richard Cullen Lead Officer: Janet Sinclair-Pinder


2016/17 Source

2016/17 Target


M49 Support on-going delivery of the TRFT Cancer Improvement action plan focusing on one year survival rates.

Com Plan STP

Q4 G G On track

M50 Implementation of NICE Cancer Guidelines

Com Plan STP

Q4 G G On track

M51 Fully engage with the Macmillan Living With and Beyond Cancer (LWABC) Programme to identify gaps in service and develop an action plan

Com Plan STP

Q3 G G On track

M52 Focus work on awareness raising / early diagnosis / 2 week wait

Com Plan STP

Q3 G G On track


K44 Cancer (all) diagnosed at stage 1 and 2

I&A Framework

Quality Premium

>60% or 4 % point

improvement

R 2014 - 36.5%

R Off track but inconclusive as the latest reporting period was 2014

K45 Percentage seen within 2 weeks following an urgent referral by GP for suspected cancer

GB Report 93% G 95.9%

G July = 95.7%

On track

K46 Percentage seen within 62 days after a referral by GP

Quality Premium

I&A Framework

85% G June = 89.2%

G July = 85.1%

On track, Performance has decreased but remains within the standard

K47 Patient satisfaction rates >89% (Secondary care)

Com Plan STP

Q1 G G On track – note this is annual data

K48 Percentage of patients satisfied with support from their GP during treatment >66%

Com Plan STP

Q1 G G On track – note this is annual data

QIPP

None identified




Cancer one year survival rates – 2013 data

Cancer patient experience – 2014 data

Glossary (AHD refers to Alex Henderson-Dunk)

APMS Alternative Provider Medical Services BCF Better Care Fund CCC Care Co-ordination Centre CHC Continuing Healthcare

CAMHS Child and Adolescent Mental Health Services

CQC Care Quality Commission

EOLC End of Life Care GB Governing Body IFR Individual Funding Request I&A Improvement and Assessment LES Local Enhanced Services ‘Q’ ‘Quarter’ QIPP Quality Innovation Productivity and

Prevention RMBC Rotherham Metropolitan Borough Council

STP Sustainability and Transformation Plan TRFT The Rotherham Foundation Trust WIC Walk in Centre IHAM Indicative hospital activity model

commissioning plan performance report: quarter 2 body papers... · governing body 2 november 2016...

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