meeting (held in public) - bexley ccg body... · bexley ccg outcomes data weekly. cover source: ref...

DATE: 24 March 2016

Title

Integrated Quality, Safety and Performance Report March-16

This paper is for Information

Recommended action for the Governing Body

That the Governing Body: Note Integrated Quality, Safety and Performance Report March-16

Potential areas for Conflicts of interest

None.

Executive summary

Outcome data: Nov-December 15 • 72 cases of C.Diff reported from Apr-Dec15 (target 37, annual target 56)

newly appointed Infection prevention nurse now in post to identify gaps and possible solutions to reduce incidents.

• A&E target not achieved –all providers have action plans in place to mitigate risks to patients

• Cancer 62 day’s great improvement and targets met in December 2015 • RTT: 18 weeks not met – additional fund given to LGT by Lewisham CCG • Improving Access to Psychological Therapies (IAPT) still below target • Safeguarding children training improved across the providers • Oakwood House closed 29/02/2016

How does this paper support the CCGs objectives?

Patients: Improve the health and wellbeing of people in Bexley in partnership with our key stakeholders.

People: Empower our staff to make NHS Bexley CCG the most successful CCG in (south) London.

Pounds: Delivering on all of our statutory duties and become an effective, efficient and economical organisation.

Process: Commission safe, sustainable and equitable services in line with the operating framework and which improves outcomes and patient experience.

What are the Organisational implications

Key risks

N/A

Equality No Equality and Diversity issues identified.

ENCLOSURE: Q(i) Agenda Item: 41/16

Governing Body meeting (held in public)

1 of 2

Financial

N/A

Data

N/A

Legal issues

N/A

NHS constitution

Paper supports the NHS constitution.

Engagement

Audit trail

Comms plan None

Author: Ina Herridge Sue Higgins

Clinical lead: Dr Sonia Khanna-Deshmukh Frognal Locality Representative

Executive sponsor: Simon Evans-Evans Director of Governance and Quality

Date 14 March 2016

2 of 2

Excellent healthcare – locally delivered

Integrated Quality,

Safety and

Performance Report

March 2016

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2

Contents Page No.

Patient stories 3

CCG Outcomes Data 4

Quality Strategy - priorities for 15/16 6

- Assurance visits & audit plan 8

CQUINS 9

Quality Premium 12

Safeguarding Children 13

Safeguarding Adults 15

Serious Incidents 19

Quality Alerts (GP) 20

Lewisham & Greenwich NHS Trust 21

Dartford & Gravesham NHS Trust 24

Kings College NHS Foundation Trust 26

Guy‟s & St Thomas‟ NHS Foundation Trust 29

Oxleas NHS Foundation Trust 32

Other Contracts - Care Homes, UCC 35

Engagement Activity 37

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3

Patient Stories

Non emergency transport services

Concern: Travel & Access to appointment out of area. Relative concerned at elderly husband has prostate

cancer and needs to attend hospital Mon – Fri for treatment over several weeks. Although seen at DVH treatment

is provided Maidstone Hospital. The relative was very concerned at the impact of the journey as neither drive and

have no close family nearby to assist with travel.

Outcome: The CCG liaised with GP surgery, who agreed it would be difficult for the patient to access treatment at

Maidstone without support. Consequently, arrangements were made for Non Emergency Transport services.

Patient and family advised of outcome and grateful for assistance – they did not realise they may be entitled to help

with transport to access care .

MSK Kings College Hospital

Concern: Access to services & Patient Choice. Following trauma to hand and operation at PRUH patient

advised would need Physio. Call received from Physio several days later advising patient to attend Beckenham

Beacon for treatment. Patient advised this would be a very difficult and long journey (involving at least two buses)

– a request was therefore made to attend QMH as this is much nearer. Patient was then advised this service is not

provided at QMH.

Outcome: After liaising with Commissioners and Musculoskeletal (MSK) managers at KCH it was confirmed that

the patient could access Physio at QMH. Consequently, an appointment was swiftly arranged. The MSK manager

has also agreed to speak to staff at Beckenham Beacon to re-educate them and ensure they are aware services

can be accessed on the QMH site.

Patient subsequently contacted Patient Engagement Team (PET) to personally thank staff (DH) for assistance in

resolving and to enable patient to access services at hospital of choice.

Source: Patient Engagement Team, Bexley CCG Feb-16

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Bexley CCG Outcomes data

Source: South London CSU, Bexley CCG Pack Month 9 captured on 16/02/2016

4

Ref. Indicator Target Oct Nov Dec Comments

1 C Difficile

Bexley CCG Outcomes data

Source: Ref 09-18 South London CSU, Bexley CCG Pack Month 9 captured on 16/02/2016

Source: Ref 19-20 ICT IAPT Reporting Dashboard from MIND in Bexley, received 9/02/16

Source: Ref 21 NHS England, National Clinical Director for Dementia and Older People‟s Mental Health, received January 2016

Source: Ref 22 Oxleas Business Manager, Children and Young People's Directorate, received 23/02/16

9 Cancer subsequent treatment 31 days, radiotherapy (m) 94% 100.0% 92.1% 97.1%

10 Cancer composite, 62 days first treatment plus rare cancers (m) 85% 72.7% 78.3% 88.6%

11 Cancer first treatment 62 days, Screening (m) 90% -- 100.0% 100.0%

12 Cancer first treatment 62 days, Consultant upgrade (m) -- 100.0% 100.0%

13 RTT 18 weeks (admitted patients) 90% 87.9% 86.3% 86.4%

At KCH the Trust has an agreed derogation of reporting to Apr-16. CCG reporting therefore does not reflect KCH data for this period.

14 RTT 18 weeks (non admitted patients) 95% 94.7% 94.0% 94.3%

15 RTT 18 weeks (incomplete pathways) 92% 92.9% 93.1% 92.6%

16 RTT 52 weeks (admitted patients) 0 1 2 1

17 RTT 52 weeks (non admitted patients) 0 0 1 1

18 RTT 52 weeks (incomplete pathways) 0 1 1 0

19 IAPT-Patient numbers as % population with depression etc. 1.1% 1.4% 1.40% 1.14%

20 IAPT - Proportion moving to recovery 50% 45% 45% 45% Provider given opportunity to improve by end Q4 and CCG monitoring performance weekly.

21 Estimated diagnosis rate for people with dementia 66.7% 66.9% 66.3%

22 Health visitors (WTE) 39.59 36.86 37.26 35.86 Recruitment to vacancies is underway with cover in place from agency/bank staff

23 Transforming care - Bexley have three mental health patients meeting this criteria, all had care and treatment reviews in Nov-15 with discharge planning in place for discharge before Mar-16 (Source: Transforming Care spread sheet Mthly, Oxleas – Jan-16)

There has been one admission into the assessment and treatment unit at Atlas House following a community clinical treatment review (CTR) on 10/02/16 (Source: Transforming Care spread sheet 2wkly, Oxleas – Feb-16)

There has also been one admission onto acute Mental Health(MH) wards for an ‘in scope’ patient who is currently being titrated for

medication. A CTR is planned for 04/03/16 (Source: Ref Transforming Care spread sheet Mthly, Oxleas – Jan-16)

5

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Quality Strategy - priorities for 15/16 6

GENERAL

To embed learning from incidents, complaints and patient feedback, thereby reducing the potential for

incidents.

Assurance provided via embedded learning events at LGT and Oxleas

Supporting Quality improvement through greater collaboration between hospital and community

services.

Pressure ulcer panels at Oxleas and LGT

A better understanding around the prevention of inequality for the vulnerable groups and their access

to treatment.

Learning Disability nurse in post at LGT and DVH

Improvement in the quality of information between secondary, primary and community care.

Development of dashboard for CQRG

Safeguarding Children and Vulnerable Adults (see Safeguarding Strategy).

Qtr2 deep dive with NHSE

Source: Quality & Performance Manager, Bexley CCG Jan-16

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Quality Strategy - priorities for 15/16

SPECIFIC

Quality Improvement in: Care Homes

Care homes forum established with CQC liaison

District Nursing

Joint strategy in place

The Quality Premium

See separate slide

C.Diff performance

The local authority have recruited an infection control nurse who joined the team in Feb-16.

London Quality Standards

LGT undertaking an audit

The quality of maternity provision for the women of Bexley

Business case in progress

The quality of care at Queen Elizabeth Hospital A&E

Continuous review through CQRG

End of Life Care/ linking work through Care Home Forum

recruited interim safeguarding adults & quality lead in post since 15/02/16, objective to liaise with Older Persons

Commissioner to support end of life work stream.

Small Contracts Assurance Process

PAMS business case to go to FSC

Delivery Improving Cancer services (especially 62 day waits at L&G).

Plan in place

Source: Quality & Performance Manager, Bexley CCG Jan-16

7

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Quality Strategy (assurance visits & audit plan) 11

1 Older People discharge into care homes (completion by end of Q3). Report has been completed, action plan is being developed.

2 District Nursing audit of care plans (completion by end of Q4).

This has been superseded by impending CQC inspection

3 AQP Service Community Gynaecology Services (completion by the end of

Q4).

All AQP quality measures being reworked with new contracts in

place with the aim to have annual CQRG with each

provider/group of providers

4 End of Life Care - a hospice specific audit (completion by the end of Q4).

The CCG carried out an assurance visit to the hospice in December 2015,

draft report in progress

Source: Bexley CCG Quality team Feb-16

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CQUINS (Q2) Lewisham and Greenwich NHS Trust 2015/16 Q3 data has not been finalised

Source: South East CSU, Feb-16

9

No CQUIN Overview % weighting

available in Q2 Description of CQUIN indicator

Final RAG

% weighting

achieved

1

Acute Kidney Injury 3.50% Trust to provide a further cleansed baseline by Sep 2015

Q2 meeting with commissioners to review revised baseline and target setting.

20% of whole-year AKI CQUIN value awarded if locally agreed Q2 target of improvement from

baseline achieved.

3.50%

2a

Sepsis Screening 2.20% Trust to sample again using July admissions data, identifying patients with a sepsis diagnosis, as

well as a sample of arrival to treatment times for patients whose trigger for sepsis was on arrival

at the Trust. 10% of whole-year sepsis CQUIN value awarded if locally agreed Q2 target of

improvement from baseline achieved.

2.20%

2b

Sepsis Antibiotic

Administration

2.20% Establish baseline of patients receiving antibiotics for sepsis using the Trust protocol.

Protocol to be shared with Commissioners.

10% of whole-year sepsis CQUIN value awarded if baseline data collection established.

Q3 target to be agreed and set as soon as possible after Q2 ends using data from Q2

2.20%

3a

Dementia - Find, Assess,

Investigate, Refer & Inform

1.75% Quarterly download of dementia patents identified sent to BGL GPs.

Provider achieves 90% or more for each element of the indicator for Quarter 2 of 2014/15,

taken as a whole

1.75%

3b Dementia - Staff training 0.00% No milestone actions this quarter 0.00%

3c Dementia - Supporting

Carers of people with

dementia

0.75% Provider to undertake monthly audit of carers of people with dementia to test whether they

feel supported with results reported to the Trust Board

0.75%

4 Reducing the proportion of

avoidable emergency

admissions to hospital.

1.00% Trust to establish 'cleansed' baseline level of avoidable emergency admissions in 2014/15 by

case note review of top ambulatory sensitive conditions (ie those with more than 100 avoidable

admissions) and meet with commissioners to agree targets.

1.00%

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CQUINS (Q2) Lewisham and Greenwich NHS Trust 2015/16 (cont‟d)

10

Source: South East CSU, Feb-16

No CQUIN Overview

% weighting

available in

Q2

Description of CQUIN indicator

Final RAG

% weighting

achieved

5a

Maternity - Development

of a maternal obesity

service

1.00% Trust to amend questions based on Public Health England guide to evaluating weight

management interventions.

Post natal outcomes to be included covering complications, mode of delivery, feeding and

birth weight.

Report on motivational interview training.

Completion of Project Plan to set up new service to include training requirements.

Plans and progress on QE clinics reported within Q2

1.00%

5b Maternity - Joint

Vulnerability Assessment

1.00% Commence plans to develop a dynamic resource perhaps on their Trust intranet whereby

midwives can check what local support is available for individual women.

Trust to commence planning to develop an internet resource for women on sources of local

support.

1.00%

6 Supporting Integration 1.00% Trust to provide updated draft implementation plan including re-costing of estates plans.

Trust to submit first stage report on 'shifts in care'

Meet with Commissioners to agree priorities and models

0.00%

7a Improving quality and

effectiveness of care for

children with complex

needs through better

identification and

coordination

1.00% • Undertake audit to establish baseline recording of functional coding of children with a

known diagnosis

• Agree and establish format of stakeholder feedback

1.00%

7b Clinical Pathway

Development – Community

Children Nursing

1.00% Develop a series of events with stakeholder’s and service users (CYP and their families) to

ensure the local approach to pathway redesign meets children’s needs but also reflects the

strategic and partnership priorities for community services for children and young people.

Events to be undertaken by the end of Q2 to inform Q4 piloting of pathways.

1.00%

Total 16.4% 15.4%

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CQUINS (Q3) Oxleas

Source: please add the source of data and the date it was received/retrieved

Source: Oxleas NHS Trust quarterly reporting received February 2016

11

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Quality Premium

Source: No. 1 HSCIC 23/02/16 No. 4a+b PCIF report 19/02/16 No. 5a Oxleas NHSFT 23/02/16

12

2015/16 measures Latest actual Target Period Forecast

end R/G

1 Reducing potential years of lives lost through causes considered amenable to

healthcare (10%).

DSR 1785.00

2012

DSR 2008.3

2014

1.2%

reduction

2012 -

15

2012 - 2015

data due

June 2016

2

Urgent and

Emergency

Care

(30%)

Avoidable emergency admissions (30%). Either a) a reduction, or a zero per cent change, in the annualised

trended change in the Indirectly Standardised Rate of

emergency admissions for these conditions over the 4

years 2012/13 to 2015/16 ; or

b) the Indirectly Standardised Rate of admissions in 2015/16

at less than 1,000 per 100,000 population

Outcome

data for

2015/16 will

be available

June 2016.

3 Mental

Health

15% each

Increase in the proportion of adults in contact with secondary mental health services

who are in paid employment 29% Increase Q3

Increase

from 24% in

Q2

Improvement in the health related quality of life for people with a long term mental

health condition

Seeking data None

available

4

Improving

antibiotic

prescribing

in primary

and

secondary

care (10%)

Reduction in the number of antibiotics prescribed in

primary care (5%) antibacterial items per STAR PU 0.267 0.23 Q3

Reduction in the proportion of broad spectrum

antibiotics prescribed in primary care (3%) 14.8%

Safeguarding Children

No.1 Data Source: Oxleas NHS Trust quarterly reporting received February 2016

No 2 Data source: D&G Trust, L&G NHS Trust quarterly reporting received February 2016

13

Subject Detail Action Latest position

1. Child

Protection

medicals

Good practice requires a child protection

medical to be completed within 24hrs of a

request being received from children‟s social

care for acute presentations.

Actions put in place have enabled a

much improved position.

Qtr. 3– 94%

(Qtr2 - 80%).

2. Acute

providers

safeguarding

training

compliance at

level 3

All providers are expected to achieve 80%

compliance with safeguarding children

training at 3 levels. The level expected will

depend on the responsibilities and contact

with children/carers. Acute providers remain

non-compliant. It is particularly important that

children‟s areas; obstetrics & gynaecology,

maternity and accident & emergency (A&E)

department achieve compliance at Level 3.

D&G Trust

• Revised training needs analyses

identifies a total of 578 staff requiring

Level 3 training.

• Additional training sessions scheduled.

• Projected compliance by end of Qtr 4

will be in the region of 87.5%.

L&G Trust

• Directorates less than 60% compliant

are required to complete an exception

report, to include any action plans to

improve compliance Directorate

General Managers, will be asked to

attend Trust Safeguarding Committee

to deliver/discuss their exception

report.

Qtr 3 level 3:

74%

Qtr 3 level 3:

65%

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Safeguarding Children (cont‟d)

14

Source:Bexley Safeguarding Children Board 2015

No 3.Data Source: Oxleas NHS Trust quarterly reporting received February 2016

No 4. Data Source: Bexley Safeguarding Children Board CDOP 2015

Subject Detail Action Latest position

3. Looked

after children

initial health

assessments

This is a health indicator but Oxleas are entirely

dependent of children‟s social care providing

notification and consent. Delays in receiving

documentation and consent have meant health

assessments are delayed beyond 28 day

timescale.

Escalated to Assistant Director

children‟s services London Borough

Bexley (LBB) and Bexley Safeguarding

Children Board. Compliance achieved.

Qtr 3 – 81%

(Qtr. 2 - 75%)

4. Suicides

In Bexley there has been a cluster of suicides:

2014/15 1 young person took his life and 1 near

miss.

2015/16 2 young people have taken their lives

A cluster of suicides is a rare event. Suicide cluster

is defined as a series of three or more closely

grouped deaths. In the absence of transparent

social connectedness, evidence of space and time

linkages are required to define a cluster (Larkin&

Beautrais 2012)

Suicide Summit across South East

London held February 2016 agreed

group actions.

Bexley LSCB also plans to commission

workshops for teachers and GP‟s and

exploring options for delivery of keep

safe work with young people. (agenda

item)

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Safeguarding Adults (SA) – Compliance Q3

Subject Detail

Lewisham &

Greenwich

Trust

Lewisham and Greenwich Trust:

Safeguarding Adults Training

• level 1 is at 100%,

• level 2 is 82% it is anticipated that 85% will be reached in quarter 4.

Mental Capacity Act and Deprivation of Liberties

PREVENT:

• 2497 staff have received full PREVENT training (WRAP 3)

• A prevent Duty Gap analysis has been completed which indicated significant progress.

• Action plan is in place to progress this work further.

Adults with learning disabilities

• Liaison with partner agencies is on-going to explore the possibility of sharing the registers of service users with

QEH so that known adults with a learning disability can be proactively flagged on I-Care.

• The Trust is now signed up to the Mencap Patients Charter.

Domestic Violence

• 13 referrals made from the QE site.

• 8 referrals from the Lewisham Site

• Independent domestic violence advocate is now in place on both sites.

• Pathway to support people through A&E is being developed.

Quality Audit at QEH

• Both sites are now able to flag adults with a learning disability.

• The Quality lead has agreement to flag all individuals known to the Bexley and Greenwich Learning Disability

teams.

• Service user forum has been set up on the Lewisham site. QE Lead has met with local groups.

• Videos are being created to demonstrate procedures.

RESTRAINT – No data available

15

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Safeguarding Adults (SA) – Compliance Q3

Source: SA Assurance Monitoring System 2015/2016 Oxleas NHS Foundation Trust - Email from ADQ&G 29/01/2016

Subject

Oxleas

NHSFT

Training:-

Safeguarding Adults

98% for level 1.

No data available for levels 2 and 3

Local Authority offer multiagency level 2 and 3 training. 8 staff undertook this in January 2016.

Action: To be taken to Training SA sub group

Mental Capacity Act and Deprivation of Liberties - 93%

PREVENT – No data available

Domestic Violence Training – No data available

Safer Recruitment training – 93%

Complaints – 162 issues from 71 complaints 44% upheld or partially upheld.

Action: Clarity to be found on when a complaint becomes a safeguarding referral

Section 42 ENQUIRIES Concerns to LA – 23 Enquiries -10

Action: For audit in case of inappropriate referrals

Deprivation of Liberties Applications – 0 in quarter 3

Domestic Violence referrals – No Data available

Action: To discuss in SA sub groups

Discloser and Barring Service – 100%

Antipsychotic Prescribing – Audit carried out. Lowest prescribing of any other Trust. Consistent with NICE

guidelines.

16

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Safeguarding Adults – Compliance Q3

Source: SA Assurance Monitoring Systems Q4 – Dec 15 Emailed by SA lead for DVH - received 16/02/2016

Subject Detail

Darent Valley

Hospital

Training:-

SA – level 1 – 92%

Level 2 - 92%

Mental Capacity Act and Deprivation of Liberties -The training is not mandatory and therefore is not reported

as a compliance figure. Legal Awareness training in Oct 2015.

Nine staff attended MCA training and 22 DoLS Training

PREVENT – 18 people trained as WRAP 3 trainers – Police provided training

Domestic violence Training – Maternity Department only

Safer Recruitment training – Not reported on

Complaints –

Section 42 ENQUIRIES

DoLS Applications – 5

Section 42 - SA concerns raised 6 enquiries 6

DV referrals – 0

DBS Compliance – 100% for New Staff (Not reported on for existing staff?)

Action: To find out when DBS compliance figure will be collated

Restraint – 13 in Q3 (YTD 18) possibly due to staff being told to report as a datix –using incident reporting

system

17

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Safeguarding Adults

Subject Detail

Emerging quality

issues and good

practice

Domestic violence reporting and training

DBS figures and compliance for existing staff

Criteria for a Section 42 concern and relationships with Serious Incidents and complaints

Action: Issues to be taken to the SA sub groups

Positive learning from all sites to be shared

Restraint – reporting inconsistent

18

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Serious Incidents • There were 9 Serious Incidents affecting Bexley patients in Dec-15 to Jan-16, none were „never events‟.

• The types of incident reported were:-

2 Delayed diagnosis meeting SI criteria

2 Apparent/actual/suspected self-inflicted harm meeting SI criteria

2 Surgical/invasive procedure incident meeting SI criteria

1 Pressure Ulcer meeting SI criteria

1 Treatment delay meeting SI criteria

1 Slips/trips/falls meeting SI criteria

Source: STEIS national reporting system , reviewed on 23/02/16

19

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Quality (GP) Alerts

33 alerts received in Qtr3

A small increase on previous quarter (18%)

Organisation alert is related to

37% Oxleas

33% Lewisham & Greenwich NHS Trust

18% Darent Valley & Kings (9% each)

12% Hurley, LAS, LBB & Care Home (3% each)

Themes (top 3)

24% Insufficient info/poor discharge / poor communication

12% Delay in treatment

30% Poor Communication

Risk rating

23 Amber (response required from provider)

7 Green (provider informed for learning, no response required)

2 alerts unrated – awaiting further information to risk rate

1 contact not an alert and has been appropriately redirected

Source: Quality Alert Management System (QAMS) Oct – Dec 2015

20

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Lewisham & Greenwich NHS Trust

Source: South London CSU, Lewisham & Greenwich Trust Scorecard Month 9 captured on 16/02/2016

21

Monthly Performance

Target Oct Nov Dec Comments

RTT 18 weeks (admitted patients) 90.00% 86.4% 85.6% 83.8% Following on-going discussions with CCG's Lewisham CCG has made £600k additional funding available to LGT for Orthopaedic patients. The Trust will present an activity plan for this funding at February Contract Management Board.

RTT 18 weeks (non admitted patients) 95.00% 94.6% 93.0% 92.4%

RTT 18 weeks (incomplete pathways) 92.00% 92.5% 92.4% 92.6%

Diagnostic tests waiting time 99.00% 99.8% 99.8% 99.8%

A and E waiting times 95.00% 91.3% 89.7% 91.5%

QEH has seen an increase against plan in A&E with weekly averages at 2980 against a plan of 2850. The increase has been mainly in admitted patients which has in turn resulted in extended waits for admission and DTAs in the morning in A&E. QEH has also seen an increase in the number or London Ambulance Service arrivals above the weekly average prediction of 616 arrivals with outcomes of 628, 622, 640 in recent weeks. Recovery plans in place.

Cancer two weeks (monthly) 93.00% 89.2% 93.8% 95.7%

Breast symptoms two weeks (monthly) 93.00% 98.5% 82.9% 89.5%

The Trust failed to meet the delivery of the Breast Symptomatic pathway for Dec-15. An investigation into the cause has been conducted.

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Source: South London CSU, Lewisham & Greenwich Trust Scorecard Month 9 captured on 16/02/2016

22

Monthly Performance


Cancer first definitive treatment 31 days (monthly) 96.00% 97.5% 98.6% 98.8%

Cancer subsequent treatment 31 days, surgery (monthly) 94.00% 100.0% 100.0% 90.9%

Cancer subsequent treatment 31 days, drug (monthly) 98.00% -- 100.0% 100.0%

Cancer subsequent treatment 31 days, radiotherapy (monthly) 94.00% -- -- --

Cancer composite, 62 days first treatment plus rare cancers (m) 85.00% 73.7% 75.2% 84.6%

Cancer first treatment 62 days, Screening (monthly) 90.00% 83.3% -- 100.0%

Cancer first treatment 62 days, Consultant upgrade (monthly) 100.0% -- 100.0%

RTT 52 weeks (admitted patients) 0 12 7 6

RTT 52 weeks (non admitted patients) 0 0 0 0

RTT 52 weeks (incomplete pathways) 0 4 3 2

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Source: Ref 1 – CCG Patient Experience Team

Ref 2 – Mystery Shopper feedback – Oct – Dec 2015

Ref 3 – NHS Choices – Oct – Dec 2015

23

Ref Patient Experience

1 Complaints

In Q3 the CCG did not receive any formal complaint regarding services provided by


2 Mystery Shopper

93 feedback forms received regarding L&GT services

87% positive / 13% negative

Positives = Phlebotomy (QMH site), Midwifery (antenatal care) & A&E at QEH

Negatives = General surgery & colorectal surgery (delays)

3 NHS Choices headlines

A total of 30 comments for LGT were recorded on NHS Choices in Q3.

18 (60%) of comments reported a good experience

10 comments regarding A& E services ( 6 reported good experience)

5 related to Obstetrics – of which four reported a good experience

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Dartford & Gravesham NHS Trust

Source: South London CSU, Dartford & Gravesham Trust Scorecard Month 9 captured on 16/02/2016

24

Indicator Monthly Performance

Target Oct Nov Dec comments RTT 18 weeks (admitted patients) 90.0% 83.7% 83.8% 84.9%

RTT 18 weeks (non admitted patients) 95.0% 97.0% 96.8% 96.7%

RTT 18 weeks (incomplete pathways) 92.0% 96.1% 95.5% 94.7%

Diagnostic tests waiting time 99.0% 99.8% 99.8% 99.8%

A and E waiting times 95.0% 89.2% 80.3% 83.1%

A&E Performance was 91.22% for year to end of December. The Trust reported that it declared Black status on 2 occasions and was supported by a divert to Medway on one of these occasions. The divert was a result of high occupancy.

Cancer two weeks (monthly) 93.0% 95.1% 96.2% 95.9%

Breast symptoms two weeks (monthly) 93.0% 97.0% 94.4% 93.5%

Cancer first definitive treatment 31 days (monthly) 96.0% 98.2% 98.4% 98.2%

Cancer subsequent treatment 31 days, surgery (monthly) 94.0% 100.0% 100.0% 100.0%

Cancer subsequent treatment 31 days, drug (monthly) 98.0% 100.0% 100.0% 100.0%

Cancer subsequent treatment 31 days, radiotherapy (monthly)

94.0% -- -- --

Cancer composite, 62 days first treatment plus rare cancers (m)

85.0% 85.1% 85.7% 90.9%

Cancer first treatment 62 days, Screening (monthly) 90.0% -- 100.0% 100.0%

Cancer first treatment 62 days, Consultant upgrade (monthly)

-- -- --

RTT 52 weeks (admitted patients) 0 0 0 0



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Dartford & Gravesham NHS Trust (cont‟d)




25

Patient Experience

1 Complaints No formal complaints relating to DGT services were received by the CCG in

Q3.

2 Mystery Shopper

45 feedback forms received


Positives = Radiology (QMH), Cardiology (outpatient care)

Negatives = Mottingham Ward (admission), A&E (clinical treatment)


24 comments were recorded on NHS Choices in Q3, 13 (54%) of them reported a

good experience

A&E - Five reported poor clinical treatment

Obstetrics – Three reported good customer care but two highlighted poor

clinical treatment

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King‟s College NHS Foundation Trust

Source: South London CSU, Kings College Trust Scorecard Month 9 captured on 16/02/2016

26

Monthly Performance


RTT 18 weeks (admitted patients) 90% RTT reporting suspension is currently in place, the Trust intends to return to national RTT reporting of January 2016 performance in February.

RTT 18 weeks (non admitted patients) 95%

RTT 18 weeks (incomplete pathways) 92%

Diagnostic tests waiting time 99% 98.6% 98.6% 93.2%

The number of breaches increased by 500 cases reported at the end Dec-15 to 630, 6.8% of the total number of patients waiting. Main breach areas are non-obstetric ultrasound mainly on the Denmark Hill (DH) site and MRI again mainly on the DH site. An action plan is being produced to reduce the backlog.

A and E waiting times 95% 91.7% 88.8% 87.4%

Four hour target, all types of

attendance performance worsened on

the PRUH site from 89.9% in Nov-15 to

86.1% in Dec-15, and performance for

type 1 attendances in A&E worsened

from 91.2% to 89.3%. Attendances

increased in A&E by 6.7% in Q3

compared to Q2 this year,

with all types attendances increasing by

2.1%. Despite the reduction in

performance reported in Dec-15, it is

10% higher than Dec-14 at 75.9%.

Cancer two weeks (monthly) 93% 95.2% 94.1% 96.3%

Breast symptoms two weeks (monthly) 93% 100.0% 99.0% 97.6%

26 of 38

King‟s College NHS Foundation Trust

Source: South London CSU, Kings College Trust Scorecard Month 9 captured on 16/02/2016

27

Monthly Performance


Cancer first definitive treatment 31 days (monthly) 96% 100.0% 99.0% 98.9%

Cancer subsequent treatment 31 days, surgery (monthly) 94% 100.0% 98.4% 100.0%

Cancer subsequent treatment 31 days, drug (monthly) 98% 100.0% 100.0% 100.0%

Cancer subsequent treatment 31 days, radiotherapy (monthly) 94% -- -- --

Cancer first treatment 62 days, excludes rare cancers, GP Referral (m) 85% 91.0% 82.5% 86.0%

Cancer first treatment 62 days, Screening (monthly) 90% 93.9% 95.7% 100.0%

Cancer first treatment 62 days, Consultant upgrade (monthly) 100.0% 96.2% 100.0%

RTT 52 weeks (admitted patients) 0 RTT reporting suspension is currently in place, the Trust intends to return to

national RTT reporting of January 2016

performance in February.

RTT 52 weeks (non admitted patients) 0

RTT 52 weeks (incomplete pathways) 0

27 of 38

Kings College NHS FT (cont‟d)




28

Patient Experience

1 Complaints

In Q3 the CCG did not receive any formal complaint regarding services provided by Kings

College Hospital

2 Mystery

Shopper

224 feedback forms received regarding Kings services


Positives = MSK (Physio), Ophthalmology (Clinical care), Dental/Maxillo Facial and

Rheumatology

Negatives = Ophthalmology (communication & appointment administration)

3 NHS Choices

headlines

33 comments were recorded on NHS Choices in Q3, of these 20 (60%) reported a good experience

A&E - Four reported a good experience, although three were unhappy about staff attitude and

clinical care received

Obstetrics - Three out of five reported a good experience

Wards – Three out of four were not happy with their treatment on wards and attitude of nursing

staff (unfortunately the wards in question are not identified in the feedback )

28 of 38

Guy‟s & St Thomas‟ NHSFT

Source: South London CSU, Guy‟s & St Thomas‟ Trust Scorecard Month 9 captured on 16/02/2016

Source: South London CSU, GSTT Trust Scorecard Month 9 captured on 16/02/2016

29

Monthly Performance


RTT 18 weeks (admitted patients) 90% 85.1% 82.6% 84.6% The backlog of patients waiting beyond 18 weeks has grown during 2015/16. There are a number of services with increased demand and limited alternative provision which are of particular concern. The Trust has contacted the national PMO regarding additional outsourced capacity and is maximising its own internal capacity . The Trust has been asked to complete demand and capacity modelling to the level of activity required to deliver the RTT incomplete target. The Trust have also employed additional validators to ensure the PTL is fully validated for all patients waiting beyond 18 weeks.

RTT 18 weeks (non admitted patients) 95% 91.9% 93.0% 92.2%

RTT 18 weeks (incomplete pathways) 92% 92.3% 92.1% 91.3%

Diagnostic tests waiting time 99% 98.7% 98.6% 98.0% Despite the target not being met there has been an improvement 2014/15

A and E waiting times 95% 93.5% 93.1% 92.8%

The Trust has been focussing on improvements both within A&E and across the emergency pathway. These include better outflow processes to admitting wards, improving escalation process and review of the Emergency Medical Unit.

Cancer two weeks (monthly) 93% 95.1% 93.6% 92.0% The Trust continue to monitor our out-patient capacity to ensure we respond to seasonal variations in referral rates Breast symptoms two weeks (monthly) 93% 97.6% 94.9% 91.8%

29 of 38

Guy‟s & St Thomas‟ NHSFT

Source: South London CSU, Guy‟s & St Thomas‟ Trust Scorecard Month 9 captured on 16/02/2016

30

Monthly Performance


Cancer first definitive treatment 31 days (monthly) 96% 95.1% 93.2% 95.0%

Cancer subsequent treatment 31 days, surgery (monthly) 94% 92.0% 89.8% 90.4%

The surgery breaches were due to a combination of medical, capacity and patient choice. The Directorates analyse these breach reasons to ensure that they can respond to the trends and themes to correct these in future months.

Cancer subsequent treatment 31 days, drug (monthly) 98% 98.8% 98.9% 98.1%

Cancer subsequent treatment 31 days, radiotherapy (monthly) 94% 97.3% 94.4% 95.8%

Cancer first treatment 62 days, excludes rare cancers, GP Referral (m)

85% 63.5% 70.9% 76.5%

The main factor in our failure to meet the overall target relates to the external referrals into the Trust for treatments. The Trust is recruiting two inter Trust co-ordinators to ensure that patients are referred in timely manner and placed on correct pathways.

Cancer first treatment 62 days, Screening (monthly) 90% 90.0% 100.0% 100.0%

Cancer first treatment 62 days, Consultant upgrade (monthly) 87.5% 95.5% 69.0%

RTT 52 weeks (admitted patients) 0 0 0 4 There has been significant focus on RTT, with additional assurance on activity and actions to actively reduce the backlog. The trend of a rising backlog has since been halted since August and is now slowly reducing, however the overall size of the waiting list remains a concern and we continue to work with commissioners of demand management options.



30 of 38

Guy‟s & St Thomas‟ NHSFT (cont‟d)



Patient Experience

1 Complaints One formal complaint about GSTT services was received by the CCG during Q3, which

relates to community cardiology services and administrative delay / communication delay.

2 Mystery

Shopper

Four feedback forms received regarding GSTT services, these relate to Cancer services,

Physiotherapy, Cardiology

Positives = clinical care in cardiology

Negatives = delays (physio), location of services(cancer)

31

31 of 38

Oxleas NHS Foundation Trust




32

Patient Experience

1 Complaints The CCG has not received any formal complaints about Oxleas services in Q3.

2 Mystery Shopper

Thirty-three mystery shopper comments received in Q3. 79% negative / 21%

positive. The majority of feedback relates to QMH site (car parking, buildings,

estate etc.). However, negatives comments have also been noted around attitude

of staff in Meadowview Ward and lost property.


NHS Choices had six comments in relation to Oxleas services (all negative). Four

of the comments relate specifically to mental health rehabilitation and highlight

poor attitude from medical staff.

32 of 38

Oxleas NHS Foundation Trust (cont‟d)

Source: Oxleas CQRG papers Feb-16

33

Patient Safety

Pressure ulcers

Reporting themes Quarter 3, 2015/16

• There have been no avoidable grade 4 pressure ulcers acquired in Oxleas care in Q3.

• There are less grade 3 pressure ulcers in Q3 compared to Q2

• There have been 12 avoidable pressure ulcers in 2015/16 to date (Q3 decisions are yet to

be made at January panel).

• There are similar numbers of grade 2 PUs in Q3 2015/16 and 2014/15

• There are 6 more grade 3 PUs in 2015/16 compared to 2014/15 but DNs report that

caseload sizes have increased and these patients have more complex needs and unusual

sites for pressure ulcers eg ear, leg.

Continence Survey

Recommendations following patient survey

• The Continence Team to review all patients receiving products within next 6 months and

give advice / make changes as necessary. They continue to promote continence and the

provision of pads is the last resort following full assessment. This will be made clear to all

patients who are assessed.

• Re-survey in six months

• Continence service continues to hold quarterly meetings with the pad manufacturer

33 of 38

Oxleas NHS Foundation Trust (cont‟d)

Source: Oxleas CQRG papers Feb-16

34

Clinical Effectiveness

Mental Capacity

Act Audit

The audit showed that improvements could be made in relation to

• Consistency in demonstrating that individuals consent to the care they receive

(admission/treatment/observation)

• Evidencing the authority staff rely on to authorise the care of patients, especially

where it is unclear whether individuals have consented to their care.

• Evidencing in records that patients under continuous control and supervision had

consented to such arrangements or that such care plans were authorised through the correct process.

Recommendations and Next Steps

• The Trust will continue to provide various learning platforms to afford staff adequate

understanding and knowledge of the Mental Capacity Act. The Trust will also continue to make available

relevant tools and “monitoring systems” to aid staff in their understanding

and compliance with expectations of the MCA in their daily practice.

• Front line managers will be asked to include as a matter of routine during supervision

sessions, discussions and reflections on instances where staff observed the principles/provisions of the

MCA in their daily practice.

• The aim is for staff to as a matter of routine, carry out capacity assessments where

appropriate and apply best interests decision-making processes where relevant i.e. if the

patient lacks the relevant decisional capacity. Staff will also be encouraged to consistently

ask themselves “what authority they have to proceed with patient care i.e. is it with the

patients consent or is it by using provisions of the relevant health legislation (Mental Health

Act/Mental Capacity Act) or perhaps in certain cases in compliance with a court order or

more remotely common law.

• The Trust Clinical Lead for MCA will explore the possible creation of a system whereby MCA related

incidents are subject of reflective practice sessions across the Trust and subject of embedded learning

events.

• The Trust will also continue to carry out audits and surveys to monitor and promote the

compliance of practice within Oxleas NHSFT with MCA principles and provisions.

34 of 38

Other Contracts - Care Homes

Source: Bexley CCG Adult Safeguarding Lead, Feb-16

35

Subject Detail

Maples Care Home • Maples is no longer in special measures. CQC are removing the imposed conditions and the provider has

given a written plan for gradual planned new admissions. (Source: Email from Julie Burgess CQC 12/02/2016)

Sidcup Nursing and

Residential Care Home

• Feedback from CHC team is that the home is currently refusing CHC residents. (Source: Bexley CCG, CHC Manager – Verbal 16/02/2016)

• Barnard Medical Practice has raised the issue of out of hours GPs calling relatives and persuading them

that their relative should go to A&E. (Source: Contract meeting with Barnard Medical Centre 22/02/2016)

Northbourne Court

Care Home:

• CQC inspection with verbal feedback indicating that the overall outcome will be good.

• A specialist in falls was part of the team and found that the risk assessments and risk management

plans were adequate. (Source: Heather Brimm – Service Director based on brief written feedback from CQC)

St Aubyns • Issue raised of a need for training for nurses in providing subcutaneous fluids. (Source: Contract meeting

with Barnard Medical Practice and St Aubyns 22/02/2016)

St Marys • Quality issues raised at CQC Inspection

Care plus Partnership • Oakwood House closed on 29 February 2016. A Safeguarding Adults review will take place and is likely

to be led by Lewisham. Daily visits carried out in final week of business (Teleconference 22/02/2016 led by Elaine Ruddy NHS England)

QAMS: Quality Alerts

Monitoring System

• The homes have not been engaging with this process. The Quality Monitoring Officers in LBB have

been informed and will be working with the homes to encourage them to participate. (Source: Email from David Parker 22//02/2016)

Training to Care

Homes

• LBB provides multiagency level 3 safeguarding training. Training provided to 8 staff from Oxleas Mental

Health Intake Team. (Source: LBB Training Spread sheet 10/02/2016)

35 of 38

Other Contracts – Hurley Group

36

Patient Experience

1 Complaints No formal complaints regarding Hurley Group were received in Q3.

2 Mystery Shopper Mystery shopper feedback 90% positive / 10% negative. Areas of poor feedback

relate to clinical treatment.


NHS Choices highlighted 18 contacts regarding Hurley services at QMH and Erith

Hospital.14 of which recorded a positive experience. Negative feedback relates to

attitude of staff, waiting time and clinical treatment.




36 of 38

Engagement Activity

Source: Ref 1 Patient Council meeting minutes Oct – Dec 15

Ref 2 Patient feedback Oct – Dec 15

Ref 3 Patient engagement team

37

1 Patient Council Two meetings of the Patient Council took place during Q3 (November and December). Agenda

items included „Our Healthier South East London‟, Primary Care Development, and updates on

progress at Queen Mary‟s Hospital.

2 CCG activity

Five formal complaints have been received about CCG services/decisions in Q3. All five relate to

Continuing Healthcare/ retrospective review funding decisions.

The Head of Patient Experience has been working closely with the commissioning and contracting

team and is supporting engagement activities with several redevelopment projects.

Patient representatives have also been recruited and are supported in attending contract monitoring

meetings, including MSK services, Ophthalmology, Palliative Care, Cardiology and Physical

Disability re-procurement.

3 Engagement

• Older People Day – national campaign awareness and event

• Community engagement stand at QMH

• Health bus – community information stand at Bexleyheath Broadway

• Launch Youth Health Ambassador Scheme

• Erith Town Forum

• Equality Steering Group

• Hosted Patient and Public Voice – training for Patient Council and PPG representatives

• MSK – Walk my shoes experience at Orpington Hospital

• Big Health Check event for People with Learning Disabilities

• South East London Stakeholder Reference Group

In addition to the above the PET attended service provider AGMs including Age UK Bexley and

Mencap. We have also attended contract monitoring meetings with patient champions regarding

MSK, QMH site development, Ophthalmology, Cardiology, UCC and Primary Care Services

Development

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This report provides a summary of quality, safety and performance. Further information can be obtained from the Quality and Patient Experience teams.

38 of 38

Enc Q(i)(a) FS QSP report MAR16Enc Q(i)(b) QSP Mar-16 Final for GB

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