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Barnet Clinical Commissioning GroupGoverning Body Performance and Quality Report
September 2016
working together with the Barnet population to improve health and well-being
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Executive summary
Referral To Treatment (RTT)Preliminary data shows that BCCG RTT compliance was achieved in September 2016. RF(L) as the main provider for BCCG achieved the RTT standard consistently. However ongoing delivery of the waiting time standards
remains a concern. In particular, with RF(L) reducing outsourcing of activity, there is a risk that their own capacity may not be sufficient. This will be monitored closely via the Task and Finish Group Meeting. The RF(L)
Contract Performance Notice (CPN) will remain open until the RAP is successfully delivered.
RNOH failed the RTT target in August 2016. A CPN was issued by NHSE Specialist commissioning team in August 2016. As a consequence, RNOH have submitted a revised RTT trajectory, which shows compliance by February
2017.
Cancer Waiting TimesBCCG did not achieve two out of eight Cancer Waiting Times (CWT) targets in September 2016. The non- compliant CWT targets were the 62 day Cancer Waiting Times and 62 day Canmcer Screening Service target.
UCLH and Camden CCG have commissioned a joint review of Cancer services due to under performance of the Cancer Waiting Times targets . The review has informed recovery actions plans for each of the non-compliant
pathways.
The RF(L) have implemented a range of improvements including ‘straight to CT’ for lung, ‘straight to Endoscopy’ at the Barnet site, hot reporting for the prostate clinic and increased theatre capacity for renal patients.
However, there is a continuing risk that that December 2016 trajectory will not be met. This situation is being closely monitored across the whole NCL area.
The revised RNOH Cancer Trajectory identifies compliance to the constitutional standards by November 2016. Progress against this plan is reviewed closely and a follow-up meeting was held on the 4th November.
Accident and Emergency and Ambulance HandoversBCCG did not meet the A&E Target in August 2016 and performance remains challenged across the NCL area. Barnet and Enfield A&E delivery board submitted plans to NHSE in October 2016, for the five mandated A&E
improvement schemes.
RF(L) is launching a recovery programme based on the principles of NHSE ‘Safer, Faster and Better’ guidance which covers the main areas of improvement recommended by NHS I. This includes implementation of the SAFER
bundle across hospitals and Discharge to Assess pathways.
DiagnosticsPreliminary data shows that BCCG achieved the standard for diagnostic waiting times in September 2016. The RF(L) continued to perform well, UCLH is progressing on implementing their RAP through the work with
McKinsey.
Central London Community Health Care NHS Trust (CLCH)Commissioners are currently considering issuing performance notices for MSK and Children’s Occupational Therapy Services delivered by CLCH. CLCH presented their plan to improve MSK waiting times at the contact
management group on the 3rd November.
Improving Access to Psychological Therapies (IAPT)BCCG performance for the access target for Q1 is below target. A Recovery Action Plan was submitted by Surrey and Borders (SABP) in October 2016, which sets out a recovery trajectory for a return to compliance by
November 2016. Plans are being considered for services to be delivered at Finchley Memorial Hospital for two days a week which will improve the access rate.
The BCCG ‘recovery rate’ for Q1 is below target in Q1. A recovery action plan submitted by SABP in October 216 sets out a return to compliance by January 2017.
Barnet, Enfield and Haringey Mental Health NHS Trust (BEHMHT)Commissioners and BEHMHT have agreed the data requirements for the deep dive into the Adult Emergency Mental Health pathway. BEHMHT data will be available during November 2017 and a task and finish group is
being established. ECIST colleagues have offered advice on applying the ECIST capacity and demand model in mental health services.
Early Intervention in Psychosis (EIP)BEHMHT failed the two week referral to treatment time for August 2016 but are currently unable to offer a NICE complaint service to workforce and capacity issues to meet the significant increase in demand. There will be
further discussions about the resources required to meet the NICE compliant element of the standard.
Access standards
7 8 9 10 11 12 13 14 15 16 17 18
Target Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
AS01Percentage of incomplete pathways within 18 weeks for patients
on incomplete pathways *92% 90.7% 89.2% 88.7% 89.0% 90.4% 90.7% 91.7% 92.6% 93.0% 92.5% 92.2% 92.3% 92.4%
AS02Percentage of incomplete pathways within 18 weeks for patients
on incomplete pathways (planned trajectory)92.0% 92.0% 92.0% 92.0%
AS03Percentage of patients treated within 18 weeks of referrals -
admitted patients- 77.7% 79.1% 81.0% 78.8% 80.8% 82.5% 80.9% 82.9% 84.4% 85.3% 86.4% 83.5% 84.1%
AS04Percentage of patients treated within 18 weeks of referrals - non-
admitted patients- 92.4% 92.6% 92.7% 92.3% 92.1% 92.0% 92.4% 92.8% 93.3% 93.7% 93.5% 92.6% 93.2%
AS05Number of patients waiting more than a year for treatment
(Incomplete pathways)0 9 8 5 2 1 1 4 3 2 2 2 6 19
AS06Percentage of patients waiting 6 weeks or more for a diagnostic
test*1% 3.7% 4.4% 3.6% 3.7% 1.5% 0.6% 1.7% 1.3% 0.9% 0.5% 1.0% 0.5% 1.1%
AS07Percentage of patients waiting 6 weeks or more for a diagnostic
test (Planned trajectory)1.0% 1.0% 1.0% 1.0%
AS08Percentage of patients admitted, discharged or transferred out
within 4 hours of arrival in the dept.*95% 97.0% 95.4% 95.1% 92.8% 93.2% 93.0% 94.1% 95.1% 94.4% 95.0% 94.5% 0.0% 94.6%
AS09Percentage of patients admitted, discharged or transferred out
within 4 hours of arrival in the dept (Planned trajectory)93.0% 95.0% 95.0% 95.0%
Sep-16 YTD Trend Sep-16 YTD Trend Sep-16 YTD Trend
AS01Percentage of incomplete pathways within 18 weeks for patients
on incomplete pathways *92% AS01R 91.9% 91.7% AS01U 93.8% 93.7% AS01W 0.0% 93.6%
AS03Percentage of patients treated within 18 weeks of referrals -
admitted patients- AS03R 82.5% 82.4% AS03U 89.6% 90.0% AS03W 0.0% 78.5%
AS04Percentage of patients treated within 18 weeks of referrals - non-
admitted patients- AS04R 0.0% 92.2% AS04U 0.0% 96.1% AS04W 0.0% 91.1%
AS05Number of patients waiting more than a year for treatment
(Incomplete pathways)0 AS05R 0 15 AS05U 0 3 AS05W 0 0
AS06Percentage of patients waiting 6 weeks or more for a diagnostic
test*1% AS06R 0.0% 0.3% AS06U 0.0% 5.1% AS06W 0.0% 0.4%
AS08Percentage of patients admitted, discharged or transferred out
within 4 hours of arrival in the dept.*95% AS08R 87.9% 90.9% AS08U 86.9% 89.7% AS08W 93.4% 87.6%
* NHS Constitutional Standard
YTDIAF
Ref.Indicator Trend
The Whittington Hospital
NHS TrustIAF
Ref.Indicator Target
Royal Free London NHS
Foundation Trust
University College Hospital
London
Access Standard Narrative
Key issues Mitigating actions ProgressReferral to Treatment (RTT)
Preliminary data shows that BCCG RTT compliance was achieved in
September 2016. RF(L) has maintained compliance with the standard and
therefore met their STF trajectory. However ongoing delivery of the waiting
time standards remains a concern. In particular, with RF(L) reducing
outsourcing of activity, there is a risk that their own capacity may not be
sufficient.
RF(L) reported three 52 week wait breaches in August and UCLH also
reported three.
For RF(L) RTT Incomplete pathway clearance time increased to 10.5 in
August 2016 (recommended <10 weeks).
RTT current backlog is still above the recommended 0.5 weeks (0.8 Weeks in
August 2016).
Since August 2016 RF(L) ceased weekly RTT PTL reporting.
Implementation of the IST exclusion rule is on hold until the next phase of
SQL implementation which is planned in January 2017. There is a potential
knock on effect on the long waiters as the numbers may increase.
RNOH 18 weeks(Incomplete target) performance was below trajectory in
August 2016. September 2016 trajectory is at risk
Diagnostics
Preliminary data shows that BCCG achieved the standard for diagnostic
waiting times in September 2016. The RF(L) continued to perform well, UCLH
is progressing on implementing their RAP through the work with McKinsey.
RNOH has consistently failed the Diagnostics waiting times target.
A&E
BCCG did not achieve the A&E target in August 2016, and NCL remains
challenged. Barnet and Enfield A&E delivery board submitted plans to NHSE
in October 2016, for the 5 mandated A&E improvement schemes.
UCLH attained 90.57% in August and September’s Unvalidated A&E
Performance is at 86.9% which is below agreed STF Trajectory of 95.0%.
Referral to Treatment (RTT)
RF(L) 52 week breaches are subject to a root cause analysis (RCA)
undertaken, with escalation to the Chief Operating Officer.
CPN meeting was re-scheduled with RNOH on 10 October to include
NEL CSU attendance. Clinical Harm review of all patients waited over
26 weeks is being reviewed. This is led by the RNOH Access
Improvement Taskforce, with monthly updates to commissioners at
CQRG via the Medical Director.
RNOH now submitted a revised trajectory to NHS Specialist
Commissioning, compliance originally in September 2016 now pushed
back to February 2017.
Diagnostics
RF(L) to attend the Optimisation event organised by TCST on 16.11.16
and 17.11.16 to discuss optimisation scenarios as a way of improving
current capacity (different way of thinking).
RNOH: Meeting was held in October 2106, RNOH revised the
trajectory (compliance by November 2016) and submitted the
transformation and sustainability plan
UCLH: CCCG and UCLH commissioned a joint external review of the
Diagnostics Service via McKinsey and final outputs was provided to
CCCG and UCLH early October.
The Diagnostics RAP was signed off on 13.10.16 and will be presented
to CCCG/UCLH Boards.
There are a number of other diagnostics recovery actions specifically
relating to governance which UCLH has also commenced such as its
JAG reaccreditation, improving its Serious incident reporting,
improvement of its booking processes and re-training of staff. UCLH
has forecast return to compliance in November 2016.
A&E
BCCG submitted Barnet and Enfield Winter plans which address the
key issues by introducing new models and or commissioning.
UCLH: The A&E RAP was signed off on 27.10.2016 and will be
presented to the UCLH Board and CCCG Governing body in November
2016.
Referral to Treatment (RTT)
NELCSU recommends BCCG re-commences the RTT Task and
Finish group until the waiting list reached to a sustainable level.
NELCSU to attend follow up RNOH CPN meeting on 04.11.16 to
check progress on the actions.
Diagnostics
UCLH has informed the lead commissioner that the Endoscopy
backlog has been cleared and modality compliance was achieved
in Jul-16. UCLH MRI backlog as at 29 September was 610 patients
waiting over six weeks, a reduction on previous weeks. The last of
the clinical reviews were completed in August and there remains
no evidence of clinical harm.
RNOH: NHSE and NELCSU to continue to monitor performance
and notice step change in September/October 2016
A&E
RF(L): Daily Escalation calls starting 01.12.16.
UCLH: UCLH progresses with implementation of the A&E recovery
actions derived from the jointly commissioned external review by
McKinsey now that this has been signed off.
Cancer Access standards
7 8 9 10 11 12 13 14 15 16 17 18
Target Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
CA01 All Cancers - two week wait 93% 95.4% 93.6% 93.9% 89.2% 91.2% 91.8% 91.7% 91.0% 92.7% 94.5% 93.7% 93.1% 92.7%
CA02Two week wait for breast symptoms
(where cancer not initially suspected)93% 96.5% 89.9% 90.6% 78.8% 79.7% 88.3% 91.1% 92.1% 94.0% 93.8% 91.4% 94.3% 92.5%
CA03Percentage of patients receiving first definitive treatment within 31
days of a cancer diagnosis.96% 98.4% 100% 98.8% 100.0% 99.1% 98.1% 97.6% 99.1% 97.8% 99.2% 98.3% 99.1% 98.5%
CA04 31 Day standard for subsequent cancer treatments -surgery 94% 100% 92.9% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100.0%
CA0531 Day standard for subsequent cancer treatments -
anti cancer drug regimens98% 100% 100% 100% 100% 97.7% 100% 100% 100% 100% 100% 97.7% 100% 99.5%
CA06 31 Day standard for subsequent cancer treatments - radiotherapy 94% 100% 100% 100% 100% 100% 94.6% 100.0% 97.6% 100% 100% 100% 100% 99.5%
CA07 All cancer 62 day urgent referral to first treatment wait (Actual)* 85% 63.6% 78.8% 80.9% 70.0% 62.0% 81.5% 85.1% 85.7% 83.9% 77.8% 77.4% 79.0% 81.8%
CA08All cancer 62 day urgent referral to first treatment wait (Planned
trajectory)85.0% 86.2% 85.7% 85.0%
CA0962 day wait for first treatment following referral from an NHS cancer
screening service90% 100% 100% 83.3% 75.0% 90.0% 100% 91.7% 100% 90.0% 100% 100% 66.7% 96.2%
CA1062 day wait for first treatment for cancer following a consultant's
decision to upgrade the patients priority- 100.0% 81.8% 80.0% 100.0% 85.7% 88.9% 100.0% 87.5% 100.0% 100.0% 100.0% 90.0% 97.3%
Sep-16 YTD Trend Sep-16 YTD Trend Sep-16 YTD Trend
CA01 All Cancers - two week wait 93% CA01R 94.1% 93.7% CA01U 89.9% 87.4% CA01W 96.6% 97.2%
CA02Two week wait for breast symptoms
(where cancer not initially suspected)93% CA02R 94.7% 94.0% CA02U 95.1% 61.8% CA02W 100.0% 98.4%
CA03Percentage of patients receiving first definitive treatment within 31
days of a cancer diagnosis.96% CA03R 96.5% 96.8% CA03U 98.8% 93.3% CA03W 100.0% 100.0%
CA04 31 Day standard for subsequent cancer treatments -surgery 94% CA04R 100.0% 98.5% CA04U 100.0% 93.4% CA04W 100.0% 100.0%
CA0531 Day standard for subsequent cancer treatments -
anti cancer drug regimens98% CA05R 100.0% 100.0% CA05U 97.8% 99.9% CA05W 100.0% 100.0%
CA06 31 Day standard for subsequent cancer treatments - radiotherapy 94% CA06R 100.0% 100.0% CA06U 100.0% 99.2% CA06W 0.0% 0.0%
CA07 All cancer 62 day urgent referral to first treatment wait (Actual)* 85% CA07R 78.0% 79.6% CA07U 73.2% 69.7% CA07W 74.6% 89.0%
CA0962 day wait for first treatment following referral from an NHS cancer
screening service90% CA09R 90.9% 95.6% CA09U 66.7% 78.9% CA09W 100.0% 100.0%
CA1062 day wait for first treatment for cancer following a consultant's
decision to upgrade the patients priority- CA10R 87.2% 86.5% CA10U 68.2% 78.7% CA10W 0.0% 33.3%
CA01U
* NHS Constitutional Standard
IndicatorIAF
Ref.YTD Sparkline
The Whittington Hospital
NHS TrustIAF
Ref.Indicator Target
Royal Free London NHS
Foundation Trust
University College Hospital
London
Access Standards (Cancer) Narrative
Key issues Mitigating actions Progress
BCCG did not achieve two out of eight Cancer Waiting Times
(CWT) targets in September 2016. The non- compliant CWT
targets were the 62 day Cancer Waiting Times target and the
62 day NHS Cancer Screening standard. The main providers
who are contributing to the under performance are RF(L),
UCLH and RNOH.
RF(L): Behind trajectory on the 62 day pathway and also
failed to achieve the 31 day to first treatment standard in
September. Merger of 2 Infoflex (cancer reporting systems)
took place from 8 October . This will ultimately result in
better reporting but brings short term risks in reporting.
UCLH: Failed the 2ww, 31 day 1st treatment, 62 day GP
urgent referral and 62 day screening targets in August.
RNOH failed 3 out of 4 Cancer Waiting Times target. The STF
trajectory has failed consistently.
NCL Cancer Improvement Plan developed to support system
response to performance issues. Key components include
development and implementation of more straight-to-test
pathways at more sites, implementing the national optimal
pathway for lung cancer, reducing 2 week wait median
waits, seamless and timely inter-Trust transfers and a review
of the Breast cancer service across NCL. Barnet CCG is
leading the work on system oversight and improvements.
RF(L): Regular escalation meetings are held among RF(L),
BCCG and NHSE to provide support on Cancer agenda.
Continue to monitor PTL and regularly review
implementation of RAP actions.
RNOH: Contract Performance Notice issued to RNOH by
NHSE Specialised Commissioning 12 Aug 2016 for CWT (&
RTT). CPN meeting held in October 2016 and sustainability
and recovery plan submitted to NHSE.
RNOH submitted revised Cancer trajectory, compliance is
now by November 2016
UCLH: Both UCLH and CCCG commissioned a joint external
review carried out by McKinsey. Outputs linked into the
UCLH’s Cancer RAPs which were signed off on 13.10.16.
NCL Sector Wide System Leadership Forum to discuss and
review issues affecting NCL and NCEL as a Cancer System.
Governance set out and priority areas identified including
Inter-Trust Transfers (ITT).
RF(L): BCCG to continue to monitor the Cancer Waiting times
(31 day target) position, if this is consistent then raise it at
the appropriate forum, however it is expected that the under
performance is a consequence of the info flex system
merger which has affected cancer data.
RNOH: NELCSU to attend the follow up CPN meeting on
04.11.16.
UCLH: Urgent implementation of signed off Cancer RAPs
following the completion of the joint external review by
McKinsey
Mental Health standards
7 8 9 10 11 12 13 14 15 16 17 18
Target Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
MH01 IAPT Access Roll-out (HSCIC published data) * 1.25% 1.2% 1.30% 0.82% 0.88% 0.94% 1.18% 1.36% 1.13% 1.17% 1.03% 0.00% 0.00% 1.22%
MH02 IAPT Recovery rate (HSCIC published data) 50% 41.4% 37.8% 38.2% 46.2% 47.1% 44.7% 40.5% 46.1% 41.5% 44.4% 0.0% 0.0% 42.7%
MH03The proportion of people that wait 6 weeks or less from referral to
entering a course of IAPT treatment against the number of people who
finish a course of treatment in the reporting period.
75% 80.6% 80.0% 83.3% 85.7% 91.9% 95.0% 91.3% 96.8% 97.5% 95.8% 0.0% 0.0% 95.8%
MH04The proportion of people that wait 18 weeks or less from referral to
entering a course of IAPT treatment against the number of people who
finish a course of treatment in the reporting period.
95% 90.3% 90.0% 97.2% 96.4% 97.3% 100.0% 95.7% 99.2% 99.7% 98.9% 0.0% 0.0% 98.8%
MH05 Estimated diagnosis rate for people with dementia (65 years+) 66.7% 76.8% 77.3% 76.6% 77.5% 77.4% 77.6% 75.6% 75.9% 76.3% 77.6% 77.9% 77.4% 76.4%
MH06
Proportion of patients on a CPA who were followed up within
seven days after discharge from psychiatric inpatient care
(quarterly)
0.0% 0.0% 100.0% 0.0% 0.0% 99.1% 0.0% 0.0% 99.1% 0.0% 0.0% 0.0%
MH07 Outpatient Did Not Attend rate - CAMHS * 10% 9.0% 9.0% 10.0% 10.0% 10.0% 10.0% 11.0% 10.0% 10.0% 11.0% 12.0% 0.0%
MH08 Outpatient Did Not Attend rate - Adult ** 10% 12.0% 11.0% 11.0% 10.0% 9.0% 10.0% 9.0% 9.0% 10.0% 10.0% 7.0% 0.0%
MH09 Outpatient Did Not Attend rate - Older Adults ** 10% 3.0% 4.0% 3.0% 3.0% 3.0% 3.0% 3.0% 4.0% 3.0% 3.0% 2.0% 0.0%
MH10 Early intervention Psychosis (2 week Referral To Treatment) ** 50% 0.0% 0.0% 83.3% 40.0% 53.8% 46.2% 33.3% 70.0% 37.5% 50.0% 0.0% 100.0% 47.2%
* IAPT access targets is 15% annualised or equivalent to 3.75% Quarterly and 1.25% monthly
** Barnet only performance
IAF Ref. Indicator YTD Sparkline
Access Standards (Mental Health) Narrative
Key issues Mitigating actions ProgressImproving Access to Psychological Therapies (IAPT)
After achieving the access rate in April, performance has dropped
below the national standard. Year-to-date (month 6) BCCG is 224
first assessment & treatment sessions below target.
Quarterly data shows BCCG achieved an access rate of 3.66% against
the target of 3.75% for 16/17 Q1.
Referrals have decreased from 588 in August to 558 in September.
Analysis of referrals by GP practice show that North Barnet locality
has a lower referral rate than the other localities although there are
practices in all localities have a low referral rate.
Early Intervention Psychosis (EIP)
BEHMHT reported that EIP caseloads are high resulting in a risk to
service users accessing new assessments within 2 weeks.
There are concerns about not meeting the NICE Standards for EIP.
Child and Adolescent Mental Health Services (CAMHS)
BEHMHT: The current out of hours model for CAMHS services is no
longer fit for purpose following new guidance from the Deanery.
The CAMHS teams have variable waiting times across the boroughs.
BEHMHT has reported an additional cohort of referrals to the
Enfield CAMHS service that have or will shortly have waited over 13
weeks for an assessment.
Perinatal Mental Health
Due to lack of local provision for perinatal mental health, a business
case is being put forward to support an interim arrangement for two
sessions of perinatal psychiatrist cover for residents of Barnet and
Camden pending the NCL mental health bid for a full service.
Improving Access to Psychological Therapies (IAPT)
The initial RAP was rejected by BCCG with revised RAP submitted by
SABP on 21/10. Referrals analysis underway to look at referrals by GP
practice to target low referring practices.
Key planning meetings are taking place between the frontline
managers and commissioners to agree actions for sustainable
improvement.
Early Intervention Psychosis (EIP)
BEHMHT using NHSE Workforce Calculator and considering the
resource changes required to meet the NICE compliant element of
the EIP standard.
BEHMHT providing a paper clarifying the data that should have been
reported on UNIFY, NHS Digital and in local reports
Child and Adolescent Mental Health Services (CAMHS)
BEHMHT has been asked to investigate the circumstances of the
extended waiting times within Enfield. A report is due to be
submitted on 01.11.16.
Perinatal Mental Health
Camden will part fund this cover arrangement which will be provided
by an experienced psychiatrist with expertise in perinatal mental
health offering consultation, joint assessment, and some direct
patient care. Estimated to be in place by October.
Improving Access to Psychological Therapies (IAPT)
Remedial Action Plan submitted by SABP on 21/10 includes trajectory
for recovery in November 2016.
Early Intervention Psychosis (EIP)
Final Draft cluster 10 service specification subject to CCG governance
arrangements.
Child and Adolescent Mental Health Services (CAMHS)
The current provision of the CAMHs out of hours service requires a
system wide review.
Commissioners and NELCSU to use the new CAMHS performance
reports to review and monitor waiting times.
Commissioners to develop a service specification with clinical
pathways and waiting time KPIs.
Perinatal Mental Health
Service expected to be in place by October
Quality and Responsiveness Measures and Standards
7 8 9 10 11 12 13 14 15 16 17 18
Target Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
QU01 Number of never events (Royal Free) 0 3 0 1 1 0 3 0 1 2 0 0 0 3
QU02 New SIRIs reported in the month (Royal Free) 0 11 5 12 6 8 12 9 13 13 7 4 6 52
QU03 Overdue SIRIs (Royal Free) - 16 13 19 16 15 21 13 15 16 13 14 13 -
QU04 Patient Falls - Royal Free (Safety Thermometer) - 1.40% 1.39% 2.32% 2.47% 1.22% 1.53% 1.43% 1.60% 1.47% 1.38% 1.77% 1.79%
QU05 New CAUTIs - Royal Free (Safety Thermometer) - 1.28% 0.88% 1.36% 0.73% 0.73% 1.25% 0.57% 0.40% 0.37% 0.88% 1.27% 0.77%
QU06 New Pressure Ulcers - Royal Free (Safety Thermometer) - 0.38% 1.01% 0.82% 0.58% 0.61% 0.84% 0.14% 1.20% 0.12% 0.25% 0.89% 0.51%
QU07 New VTEs - Royal Free (Safety Thermometer) - 1.15% 0.63% 0.27% 0.15% 0.24% 1.11% 0.71% 1.20% 0.37% 1.00% 0.63% 1.02%
QU08 Friends and Family Test Score - Recommend A&E (Royal Free) 89.7% 85.9% 85.2% 84.0% 80.3% 80.8% 77.7% 83.3% 82.9% 80.4% 82.1% 84.7% 81.7%
QU09Friends and Family Test Score - Recommend Inpatients (Royal
Free)95.13% 87.9% 88.8% 87.2% 87.5% 88.2% 90.5% 90.4% 91.1% 90.5% 90.9% 90.4% 89.2%
QU10A Cumulative cases of Clostridium difficile - actual 22 30 35 41
QU10P Cumulative cases of Clostridium difficile monthly ceiling plan 84 15 26 35 42
QU11 Cases of MRSA 0 0 0 1 0 0 0 0 2 0 1 1 0 4
QU12 VTE Assessments undertaken upon admission - Royal Free 95.0% 90.6% 94.0% 94.2% 95.7% 94.0% 94.0% 96.2% 96.7% 96.9% 96.6% 92.9% 91.9% -
QU13 Mixed Sex Accommodation breaches 0 5 5 5 6 5 2 2 3 4 6 9 11 30
AM01Ambulance Handover - 15 minutes (Royal Free London
Hampstead site)100% 28.6% 28.4% 26.9% 25.0% 22.8% 21.2% 22.4% 26.7% 32.2% 40.8% 38.6% 0.0% 0.0%
AM02Ambulance Handover - 30 minutes (Royal Free London
Hampstead site)100% 91.0% 90.7% 87.3% 82.9% 81.2% 78.0% 84.5% 86.6% 77.2% 86.1% 84.0% 0.0% 0.0%
AM03 Category A 8 minute response time (LAS) - Red 1 75% 70.7% 69.0% 73.8% 67.3% 64.7% 65.6% 70.0% 70.3% 72.2% 68.3% 68.7% 0.0% 69.9%
AM04 Category A 8 minute response time (LAS) - Red 2 75% 65.4% 64.4% 66.4% 60.9% 56.4% 57.9% 64.6% 65.1% 65.3% 63.6% 67.4% 0.0% 65.2%
DC01 Delayed transfers of Care - All reasons (Royal Free only) 2.5% 3.38% 3.55% 3.03% 2.97% 2.50% 2.53% 3.12% 3.37% 2.71% 2.79% 4.89% 0.00%
DC04 Delayed transfers of Care (BEH MHT only) 7.5% 12.0% 14.0% 12.0% 8.0% 9.0% 5.0% 7.0% 12.0% 11.0% 8.0% 10.0% 0.0%
* Annual C.Difficile ceiling (all providers aggregated to Barnet CCG) of 84 cases
IAF Ref. Indicator YTD Sparkline
Quality Narrative
Key issues Mitigating actions Progress
Serious Incidents (SIs)
For September 2016, the RF(L) reported six Serious Incidences
Requiring Investigation (SIRIs).
Following the setting of an improvement trajectory, a
reduction in the number of overdue SIRI reports for the end of
September, RF(L) has reduced the number of overdue SIRIs
from 16 overdue SIs in June 2016 to 13 overdue in September
2016.
Never Events
There were no Never Events in September for RF(L).
Discharge Communciation
Significant concerns raised by Barnet GPs regarding quality of
discharge summaries. Concerns mostly relate to inadequate
information, medication or referral onto appropriate services.
BEHMHT
The Trust reported 7 serious incidents in September 2016.
There were no Never Events reported. There were eight
reports overdue. There are 57 open serious incidents opened
on STeIS.
Eight investigation reports are overdue.
12 further information requests are within the assurance
process.
CLCH
There has been a significant reduction of overdue reports and
work is ongoing to reduce this further. There were a total of
11 new serious incidents reported in September and all were
relating to pressure ulcers 3 and 4. There are 65 open serious
incidents, with 20 not yet due/ being currently investigated. 7
RCA reports were due for submission in September 2016 of
which 100% were submitted on schedule.
Serious Incidents (SIs)
CQRG has requested that the RF(L) concentrates on incidents
that meet SIRI criteria to reduce backlog. The overdue status
of reports is being monitored weekly by RF(L) Executive
Committee. The Trust has a trajectory to have zero overdue
RCAs by 1 January 2017.
Never Events
All Never Events are subject to a RCA. The learning from the
quality assurance visit will be included within the next quality
report to the November Clinical Quality and Risk Committee.
Discharge Communciation
A formal contract letter was sent by the CCG to RFL
confimring that the Trust were not complying with their
responsibilities set out in the NHS Standard Contract
BEHMHT
In August 93% of SIs (13 SIs) were reported within two days
of identification. Non-compliance for the incident reported
outside of the two days was due to an error in the initial
grading of the incident.
Compliance with Duty of Care part 2 for 2015/2016 was 93%.
In Q1 2016/17 Compliance with Duty of Care part 2 is 100%
CLCH
The Trust-wide SI assurance group provides an opportunity
to identify and resolve obstacles to timely investigation. The
Trust has an overarching pressure ulcer action plan and there
is a monthly pressure ulcer monitoring report that is
presented monthly at CQRG.
Serious Incidents (SIs)
Following the setting of an improvement trajectory with a
reduction in the number of overdue SIRI reports for the
end of September early indications are that the Trust is on
target to meet its target of zero overdue SIRI reports by
end of January 2017.
The quality of investigations continues to improve.
UCLH continue to report improved compliance with the
Duty of Candour. UCLH are part of the ‘sign up to safety’
campaign.
Never Events
CQRG to continue to closely monitor any further Never
Events and for evidence that organisational learning from
previous Never Events has been embedded. The CCG is
part way throuhg completing quaity visits to the 3
endoscopy suites at RFL sites following 2 never events
related to wrong site endoscopy.
Discharge Communciation
The CCG has received a formal response from the Trust
and is setting up a working group led by RFL Director of
Quality and have asked the CCG to be part of this.
BEHMHT
A review of six completed SI investigations was undertaken
to identify themes and emerging trends. Each incident was
found to be very individual and although the investigation
of three serious incidents found that risk assessments
and/or RiO were not adequately updated, no other themes
were identified. The Patient Safety Team will continue to
review completed SIRI investigations to identify any
themes and trends.
CLCH
Barnet CCG is now providing the quality assuring role on
all the serious incident reports from October 1st 2016. This
role was previously being undertaken by the SIRI CWHHE
Clinical Commissioning Groups Collaborative.
Internal Key Performance Indicators
7 8 9 10 11 12 13 14 15 16 17 18
Target Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
Risk Management
Number of risks on the Operational Risk Register (ORR) - 6 4 47 -
Number of ORR risks rated as 'Extreme' - 4 -
Number of ORR risks rated as 'High' - 2 2 4 -
Number of risks where the rating (composite score) has increased from last
month- 0 -
Number of risks where the rating (composite score) has decreased from last
month- 0 -
Individual Funding Requests (data published quarterly)
Number of new applications received for IFR in the quarter -
Turnaround time - Percentage of cases closed within four weeks 93%
CCG Triage: Approved - Percentage of cases closed -
CCG Triage: Declined - Percentage of cases closed -
Closed for other reasons (inappropriate referrals) -
Number of appeals received per quarter -
Continuing Health Care
Percentage of patients who passed away in preferred place of death 64.0% 68.0% 80.0% 70.0% 74.0% -
Percentage of patients in receipt of scheduled reviews completed within 3
months80% 88% 58% 90% 71% 100% -
Percentage of patients in receipt of scheduled reviews completed within 12
months80% 92% 78% 75% 66% 92% -
Percentage of appeals upheld – both Local Appeal and Independent Review
Panels (NA - No Appeals made in the month)0.0% 0% 0% 0% 0% 0% -
Percentage of completed MDT referrals carried out jointly by health and social
care professionals100% 100% 100% 100% 100% 100% -
Number of formal DToCs in a hospital setting attributed to Continuing Healthcare 0 1 2 1 0 2 5
Indicator
12m
rolling
YTD
Sparkline
207 195226
4%
0
99% 90% 92%
83%
13%
Internal indicators narrative
Key issues Mitigating actions Progress
Percentage of patients in receipt of scheduled reviews
completed within three months and 12 months has
increased compared to last month's as data entry more
robust on database following training
The percentage of completed assessments carried out by a
multi-disciplinary team is fully compliant as per National
framework
It is anticipated that successful recruitment in June will be
reflected in improved turnaround times when the Q2 data is
reported.
Independent Funding Review
Two cases were reviewed by the IFR panel during Quarter 1.
One was approved to treat rheumatoid arthritis, whilst one
for IVF was declined.
In Quarter 1, across NCL, the IFR team achieved 89% of cases
closed within four weeks. The agreed target for the IFR team
for the five NCL CCGs combined is 93% of cases closed within
four weeks, to be reported quarterly. Barnet was slightly
below the target, with performance of 92%.
Operational Risk Register
In support of the CCG's approach to risk management, a
structured programme of training is being delivered by the
CCG's Risk and Governance Manager
Operational Risk Register
Continuing Healthcare
Due to a gap in reporting risk register data is not available for
June to August. In addition, the total risks reported on the
Risk Register has changed significantly (47 in September) as a
result of all risks now being captured, with those rated as
high or extreme also reported. This has taken effect from
September and will be reported in future reports.
Lower graded risks (rated 10 or less) can be reported and
monitored at a Directorate level, and the Governing Body
can request further detail if required.
All risks are reviewed by each Directorate on a monthly
basis, and updated accordingly.
Independent Funding Review
There were no appeals in September
Operational Risk Register
Continuing Healthcare
The percentage of patients who passed away in their
preferred place of death (PPoD) is continues to be higher
than the national average of 45%.
Progress against national PPoD data is monitored routinely
by the CHC team.
There were two formal DToCs in a hospital setting reported
in September. Both were due to the family exercising choice.
Internal Key Performance Indicators
7 8 9 10 11 12 13 14 15 16 17 18
Target Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16
Programme Management Office
PM01 Number of schemes signed off per month
PM02 Total value of schemes signed off
PM03 Percentage of schemes commenced in the month planned
PM04 Schemes on track as per project plan
PM05 Project/scheme abandonment
Workforce
WF01 Staff sickness - short term (<28 days) 2.0% 0.68% 1.02% 0.13% 0.25%
WF02 Staff sickness - long term (=>28 days) 0.5% 1.64% 0.00% 0.00% 0.95%
WF03 Staff turnover (Voluntary) 10% 1.02% 1.92% 0.98% 0.95%
WF05 Mandatory training compliance 90% 95.0% 90.0% 90.0% 90.0%
WF06 PDP compliance 90% 0.00% 0.00%
Plan Actual Var. Plan Actual Var.
Finance to month 7
FI02 Surplus - Year to Date (£'000s) £642 £642 £0 G
FI03 Surplus - Full Year Forecast (£'000s) £1,100 £1,100 £0 G
FI04 1% Non Recurrent Funds (£'000s) £0 £0 £0 £4,576 £4,576 £0 G
FI05 QIPP - Year to Date (£'000s) £5,777 £5,677 £100 G
FI06 QIPP - Full Year Forecast (£'000s) £12,000 £11,661 £339 G
FI07 Running Costs (£'000s) £5,235 £5,235 £0 £8,648 £8,648 £0 G G
FI10Percentage expenditure on interim, temporary &
agency staff32.1% 49.3% 22.0% 47.0% R R
Indicator
12m
rolling
YTD
SparklineIAF
Ref.
YTD
Rating
FOT
Rating
Year to Date (YTD) Forecast Outturn (FOT)IAF
Ref
Internal indicators narrative
Key issues Mitigating actions Progress
Programme Management Office (PMO)
The CCG has recently relaunched the PMO, including the
introduction of new documentation and governance
arrangements. This will enable the PMO to report its KPIs
from November onwards once these new processes have
become established.
Workforce
Workforce data will be split between substantive staff and
interim, temporary and contract staff in order to give the
Governing Body sufficient insight into the CCG's workforce
activity.
Operational Planning 2016/17 - activity status
IAF Ref.EM.
CodePoint of Delivery (acute care)
Source of
data *
Period
covered
Annual activity
plan 2016/17Year To Date Plan
Year To Date
ActualVariance
CO01 EM7 Total Referrals (General & Acute specialties) MAR Sep-16 155,261 77,835 76,356 -1.94%
CO02 EM8 Consultant Led First Outpatient Attendances (Specific Acute specialties) SUS Sep-16 148,128 76,095 76,311 0.28%
CO03 EM9 Consultant Led Follow-Up Outpatient Attendances (Specific Acute specialties) SUS Sep-16 281,899 141,899 127,702 -11.12%
CO04 EM10 Total Elective Admissions (Spells) (Specific Acute) [Ordinary Electives + Daycases] SUS Sep-16 36,545 19,676 18,843 -4.42%
CO05 EM10A Total Ordinary Elective Admissions (Spells) (Specific Acute specialties) SUS Sep-16 5,542 3,021 2,699 -11.93%
CO06 EM10B Total Day Case Elective Admissions (Spells) (Specific Acute specialties) SUS Sep-16 31,003 16,655 16,144 -3.17%
CO07 EM11 Total Non-Elective Admissions (Spells) (Specific Acute specialties) SUS Sep-16 30,497 14,937 14,170 -5.41%
CO08 EM12 Total A&E Attendances excluding planned follow ups SUS Sep-16 203,497 98,331 99,026 0.70%
CO09 EM13 Endoscopy Activity DM01 Sep-16 9,192 4,466 6,022 25.83%
CO10 EM14 Diagnostic Activity (excluding Endoscopy) DM01 Sep-16 143,436 72,006 69,157 -4.12%
CO11 EM16 Cancer Two Week Wait Referrals Seen Unify2 Sep-16 14,744 7,400 6,225 -18.88%
CO12 EM17 Cancer 62 Day Treatments following an Urgent GP Referral Unify2 Sep-16 715 359 332 -8.13%
CO13 EM18 Number of Completed Admitted RTT Pathways Unify2 Sep-16 26,344 13,482 15,302 11.89%
CO14 EM19 Number of Completed Non-Admitted RTT Pathways Unify2 Sep-16 95,314 48,780 50,444 3.30%
* Key to sources of data
MAR Monthly Activity Returns
SUS Secondary Use Service
DM01 Monthly Diagnostic return
Unify2 Department of Health portal
Contractual performance narrative
Key issues Mitigating actions Progress
The Operating plan has been rebased, with adjustments to
the phasing of RTT backlog, activity levels, adjusted to known
data quality issues in 2016/17 and re-phasing of QIPP activity.
Endoscopy activity at Month 6 YTD is 34.8% above plan.
The anticipated growth built into Cancer 2ww has not been
seen yet at Month 6 YTD and is therefore under performing
at 15.9% and 62 day urgent GP referral have increased from -
23.4% to -7.5% from Month 1 to Month 6.
Continue to monitor RTT performance and backlog
reduction. Work underway to quantify impact of RTT
backlog in 2016/17.
SRG action plan in place to manage urgent care demand and
patient flows.
Endoscopy backlog clearance programme at RF(L) continues
including insourcing and outsourcing. Anticipated reduction
in over performance over the coming months in line with
move to sustainable backlog. Continue to monitor.
Continue to monitor Cancer activity in-line with
performance.
A&E avoidance: New SRG dashboard in development.
Options appraisal in progress for Discharge To Assess
model. Increased support for Care Homes.