Board of Directors - Lancashire and South Cumbria NHS … Board/Trust Board... · 2017-10-24 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2,

Board of Directors Thursday 05 October 2017

08:30am Part Two Business Development 11:45am Part One Formal Board Meeting

Training Room 1 & 2, The Harbour, Windmill Rise, off Preston New Road, Blackpool, FY4 4FE

(Sat Nav postcode FY4 4XQ)

Board of

Directors

Quality Committee

Finance & Performance Committee

Nomination / Remuneration

Committee

Audit Committee

Board of Directors

Meeting Board of Directors Meeting

Location Training Room 1 & 2, The Harbour, Windmill Rise, off Preston New Road,

Blackpool, FY4 4FE

Date Thursday 5 October 2017

Time 08:30am Part Two - Business Development

11.45am Part One - Formal Public Board meeting

Reference Item Lead Action Enc. FOIA

BUSINESS DEVELOPMENT

TB 137/17 Our place in the STP Chief Finance Officer Discussion Presentation

BREAK – 11.30AM

PART ONE (PUBLIC MEETING) 11.45AM

TB 138/17 Welcome and opening comments Chair Verbal

TB 139/17 Apologies for absence and confirmation of quoracy

Chair Verbal

TB 140/17 Declarations of Interest Chair Verbal

TB 141/17 Minutes of the previous meetings Chair Decision Paper

TB 142/17 Action Tracker Chair Decision Paper

SCRUTINY & ASSURANCE

TB 143/17 Patient Story Medical Director Noting Presentation

TB 144/17 Research & Development Plan Medical Director Noting Presentation

TB 145/17 Trust Chair’s Report Chair Noting Paper

TB 146/17 Chief Executive’s Report Chief Executive Discussion Paper

TB 147/17 Quality and Performance Report Chief Operating Officer Noting Paper

TB 148/17 Finance Report Chief Finance Officer Noting Paper

TB 149/17 Medicines Management Annual Report

Medical Director Noting Paper

PART TWO (PRIVATE MEETING)

TB 150/17 Minutes of the last meeting Chair Decision Paper

TB 151/17 Chief Executive Report Chief Executive Noting Paper

TB 152/17 Any Other Business Chair Verbal

TB 153/17 Date & Time of the Next Meeting

2 November 2017, 8.30am

Chair Verbal

Declaration of Interest – Board of Directors

Date of Declaration

Surname First Name

Job Title Nature of Interest

Do you envisage a conflict of interest between outside employment and

your NHS employment?

Nil Declaration

21/02/2017 Eva David Trust Chair Employed by Union Learn as National Manager

Yes TUC funds learning in relation to apprenticeship and Trade Union representation.

06/02/2017 Tierney-Moore

Heather Chief Executive

1. Director of Lancashire Sport Partnership2. Trustee of Community Integrated Care3. Macmillan Allumni Patron4. Retained Consultant Glenview5. Patron Breakthrough Mental Health Charity

Yes Potential risk of CIC bidding to provide services in Lancashire that are also of interest to LCFT

06/07/2017 Furlong Gwynne Non-Executive Director &

Senior Independent Director

1. Non-Exec Director of Together Housing Group2. CEO of Regain Sports Charity3. Trustee of Chorley Youth Zone4. Non-Exec Director of subsidiary of Progress

Housing Group called Concert Living Limited

No

13/02/2017 Ballard Peter Deputy Chair & Non-Executive Director

Chief Executive DSE Service No

29/03/2017 Dickinson Louise Non-Executive Director

1. Director at Talegar Limited2. Consultancy Services at Talegar Limited3. Foundation Governor and Finance Chair at

St.Vincents Primary School

No

03/02/2017 Wilson Isla Non-Executive Director

1. NED - Progress Housing Group2. Shareholder – FSquared Ltd3. Shareholder - Ruby Star Associates Ltd4. Consultancy/Advisory Work – Ruby Star

Associates5. Chair – Borough Care (Stockport)

No

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Declaration of Interest – Board of Directors

03/02/2017 Curtis David Non-Executive Director 1. Director at Clinical and Corporate Governance

Limited2. Clinical Associate at MIAA (Advisory Section)

No

07/02/2017 Gregory Bill Chief Finance Officer

1. Trustee of Healthcare Financial ManagementAssociation

2. Governor of Stockport College3. Co-opted member of Lancaster University

Financial and General Purpose Committee4. Director of Red Rose Corporate Services

No

25/01/2017 Possener Julia Non-Executive Director (Start date 01.02.2017)

1. Sole director and shareholder of JC PossenerLimited. Provides management consultancyservices. No formal/informal contracts with theTrust nor any other NHSorganisations/organisations providing servicesto the NHS.

2. Lay member of the Lancaster UniversityManagement School and Faculty of Arts andSocial Science Ethics Committee. Although theTrust and LU have a working relationship andcollaborate such matters do not fall usuallywithin these Faculties.

3. My partner's sister is the owner of a domiciliarycare business which does have contracts withThe Trust. I am including this for the sake ofcompleteness. Bluebird Lancaster and SouthLakeland Ltd. I have no formal nor informalinvolvement in that business.

No No business with the Trust or other NHS organisation or organisations providing services to NHS No unrelated faculties or formal or informal business.

13/02/2017 Roach Dee Executive Director of

Nursing & Quality

06/02/2017 Marshall Max Medical Director

06/02/2017 Moore Sue Chief Operating Officer

07/02/2017 Gallagher Damian Director of HR

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BOARD OF DIRECTORS

Minutes of the Part One Board of Directors meeting held on 06 September 2017 Training Rooms 1 & 2, The Harbour, Blackpool

PRESENT: David Eva, Trust Chair (Chair) Peter Ballard, Deputy Chair Bill Gregory, Chief Finance Officer (Acting Chief Executive) Dominic McKenna, Financial Management Director Sue Moore, Chief Operating Officer Damian Gallagher, Director of HR Matthew Joyes, Associate Director of Safety & Quality Governance Louise Dickinson, Non-Executive Director Isla Wilson, Non-Executive Director Julia Possener, Non-Executive Director Gwynne Furlong, Non-Executive Director David Curtis, Non-Executive Director Jo Alker, Company Secretary

IN ATTENDANCE: Bev Howard, Head of Communications Viv Prentice, Deputy Company Secretary (minutes)

OBSERVERS: John Cavanagh, Accounts Manager, Healthcare UK Lisa Knight, Insight NED Development Programme

TB 118/17 WELCOME & OPENING COMMENTS The Chair welcomed everyone to the meeting and introductions were made for the observers.

TB 119/17 APOLOGIES FOR ABSENCE & CONFIRMATION OF QUORACY Apologies had been received from the Chief Executive and the Chief Finance Officer was deputising and the Director of Nursing and the Associate Director of Safety & Quality Governance was deputising. Confirmation of quoracy was provided.

TB 120/17 DECLARATIONS OF INTEREST Gwynne Furlong, Non-Executive Director and Bill Gregory, Chief Finance Officer declared an interest as both sit on the Red Rose Corporate Services Board.

TB 121/17 MINUTES OF THE PREVIOUS MEETING The minutes of the previous meeting held on 03 August 2017 were approved as a true and accurate record.

TB 122/17 ACTION TRACKER A revised action tracker was circulated to the Board at the meeting. The Board noted the actions and updates provided.

TB 123/17 TRUST CHAIR’S REPORT The Chair presented his report which included an overview of Non-Executive Director and Governor activity. The Chair drew the Boards attention to the changes to Governor constituencies which had been aligned to the STP footprint and the addition of a new staff governor class.

There was a discussion regarding a concern raised by staff through the Dear David process in relation to personal alarms. The Associate Director of Safety &

UNCONFIRMED

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Quality Governance clarified that this had arisen as a result of a change in process and that all employees were provided with a personal alarm at the start of their shift.

The Board noted the content of the Chair’s Report.

TB 124/17 CHIEF EXECUTIVE REPORT The Chief Finance Officer presented the report on behalf of the Chief Executive and provided the Board with updated on the commencement of the CQC annual provider review process including the self-assessment which the Board had met separately to agree.

A mental health risk summit had been recently held with NHS Improvement, NHS England and STP leaders. The Board noted the constructive outcome and the potential investment in mental health liaison services earlier than originally expected.

A Regulation 28 notice had been received by the Trust relating to a historical case. The Trust was preparing a response to the coroner.

The Board’s attention was drawn to the proposal setting out refreshed governance arrangements for the Lancashire & South Cumbria Sustainability and Transformation Partnership (STP). This was duly noted by the Board.

The Chief Operating Officer provided an update on the work with the BIRCH Foundation to review the Trusts progress in relation to out of area placements. The Board noted that following an initial review, there were no additional improvements that could be added to the work the Trust was already undertaking. It had been agreed that BIRCH Foundation would carry out some work with the community mental health teams to review patient referrals into inpatient units and would provide the Trust with a diagnostic to see whether any efficiencies could be made.

A question was raised by a Non-Executive Director in relation to the number of serious pressure ulcers reported. The Associate Director of Safety & Quality Governance confirmed that whilst there were no themes each case was undergoing a Serious Incident Review. The Board noted the recent introduction of the monthly Serious Incident Review Panel and the involvement of commissioners on the panel. The outcome of the Serious Incident Reviews would be reported to the panel.

A discussion was held in relation to the activity around HMP Liverpool and the timescales of the review being undertaken.

The Board noted the increase in concerns raised via the ‘Dear David’ process around staffing levels. Whilst the changes in services, increased acuity and availability of staff attributed to this issue, the Board welcomed sight of the work the Director of Nursing was undertaking to address this. ACTION

Max Marshall joined the meeting

TB 125/17 AUDIT COMMITTEE CHAIR’S REPORT The Chair of the Audit Committee introduced her chairs report and explained that the Value of Money report had been deferred to allow consideration by the Finance & Performance Committee. The Committee reflected on the 2016/17

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year-end process and areas for potential improvement. This included earlier sight of the Annual Report and Annual Governance Statement.

The Board noted the Committees oversight prior to the introduction of the new General Data Protection Regulations. A development session on the new regulation was scheduled onto the Board forward plan in November.

The Chair of the Audit Committee confirmed that the next phase in terms of enquiry into the risk management framework and its effectiveness would be undertaken through health-checks and would also cover a review of corporate governance arrangements across the Trust.

The Board noted the content of the Audit Committee Chair’s Report.

TB 126/17 FINANCE AND PERFORMANCE CHAIR’S REPORT The Chair of the Finance & Performance Committee introduced the report, which included the revised terms of reference and the Health Informatics Plan for Board approval. In relation to the terms of reference, of particular note was the oversight the Committee would have on the developments across the STP focussing on potential financial and performance implications.

There was a detailed discussion in relation to the Health Informatics Plan in particular the ability to move at pace and the opportunity to work collaboratively with partners to enhance the organisations strategic thinking. The Chief Finance Officer confirmed that a session was planned with Board members in January 2018 focusing on digital health.

The Board noted the Finance & Performance Committee Chair’s report and approved both the revised terms of reference and Health Informatics plan.

TB 127/17 QUALITY AND PERFORMANCE REPORT The Chief Operating Officer presented the Quality & Performance Report for month 4 noting that all NHS Improvement indicators had been met for the quarter with the exception of CPA 7 day follow-up.

Key highlights of the report included the increase in physical violence towards staff and the overall trend in the reduction of avoidable pressure ulcers.

It was noted that whilst the Memory Assessment Service had achieved their target, additional support had been sourced to address waiting times in child psychology, ADHD and speech and language therapy.

The Chief Operating Officer confirmed that work was ongoing to address the issue with out of areas placements and the 12 hour position in A&E. PICU out of area treatments in particular remained a key challenge however, internal capacity had been commissioned to support this.

It was noted that sickness rates continued to be a significant challenge for the networks in particular.

There was a discussion in relation to the Trust’s 7 day follow up target set by NHS Improvement. The Chief Operating Officer confirmed that there was a lot of clinical emphasis on the importance of this target and did not believe that the Trust had a systematic problem. The Medical Director confirmed that the Trust takes this target extremely seriously and would quickly note any trends. A query

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was raised in relation to the CPA 7 day follow up in secure services and the jump in performance. The Chief Operating Officer confirmed that this was due to the small numbers of patients.

Following a question raised by the Trust Chair in relation to HMP Liverpool being smoke free by September 2017, the Chief Operating Officer confirmed that whilst this specific target was not the Trust’s, the expectation within the healthcare wing was a target of 100% smoke free as this would be in line with the Trusts policy.

The Board noted the Quality & Performance report.

TB 128/17 FINANCE REPORT The Financial Management Director presented the finance report which highlighted that month 4 sees a year to date operating deficit of -£1.4m.

Whilst it was noted that staffing pressures and out of area treatments continued to be an issue, recovery measures were discussed which included the actions to address staffing on wards and assessing levels of acuity. The Medical Director provided an overview of acuity and staffing and highlighted the difficulties faced in recruiting trained staff.

The Chair acknowledged both the long and short term issues and requested that the Executive Directors report back to the Board on the progress being made. ACTION

The Chief Operating Officer updated the Board on the work being undertaken to define pathways by cluster in the mental health network. A discussion ensued in respect of the interdependencies around skills and clinical pathways, the importance of measuring progress against outcomes and the involvement of staff. It was agreed that the Chief Operating Officer would prepare a paper for discussion at the Finance Recovery Group on the 19th October. ACTION

Following a concern raised in respect of the out of area placements trajectory, the Chief Operating Officer outlined the work being undertaken to address this, which included recommencing the work with the rehab beds and the forthcoming meeting to discuss the integrated discharge hub.

The Medical Director confirmed that the Trust’s actual usage of beds in terms of length of stay was good and the number of beds after adjusting for morbidity was slightly lower than the national average. However, the issue was around the reallocation of beds. A discussion followed around the Trust’s responsibility to resolve the issue and what was an underlying health economy challenge.

Prior to the close of the Board meeting, the Chair took the opportunity to congratulate the Medical Director and his team of consultants on the work to support medical recruitment.

TB 093/17 DATE & TIME OF THE NEXT MEETING 05 October @ 08:30a.m. Training Room 1 & 2, The Harbour

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Board of Directors

Agenda Item TB 145/17 Date: 05/10/2017

Report Title Trust Chairs Report

FOIA Exemption No Exemption

Prepared by Umme Batan, Corporate Governance Support

Presented by David Eva, Trust Chair

Action required Noting

Supporting Executive Director Chief Executive

PURPOSE OF THE REPORT:

Report purpose The purpose of the report is to provide the Board with an overview of the activity undertaken by the Board and Non-Executive Directors in addition to the Board of Director meetings and Council of Governor meetings.

Strategic Objective(s) this work supports

To become recognised for excellence

Board Assurance Framework risk 1.1 If we do not meet regulatory standards for quality and safety we will not be fit for purpose as a care provider.

CQC domain Well-led

1.0 NON-EXECUTIVE DIRECTOR ACTIVITY The Non-Executive Directors have been attending the Board Committee meetings of which they are a member (including the Financial Recovery Group) and apologies have been given where they were unable to attend.

In addition to the usual Board business, Non-Executive Directors (NEDs) have been involved in their areas of special interest during the period of September 2017 – October 2017:

Gwynne Furlong

Met with the Property Services Director Attended the Land Committee meeting in September Met with the Project Officer for Estates Attended the Hearing Feedback Steering Group meeting Attended the Council of Governors meeting

Peter Ballard

Deputised for the Chair at the AAC panel interviews in September Met with Amanda Doyle, the Accountable Officer/Chief Clinical Officer from Blackpool

CCG to discuss STP Governance

Louise Dickinson

Attended monthly meeting with the Chief Executive

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Met with the Company Secretary and the Governance Manager to discuss the October Audit Committee agenda

Attended the MIAA 2016/17 Learning Series for Audit Committee Members event

Julia Possener

Attended the Good Practice Visit in September and visited the Procurement Team at Sceptre Point

Had her monthly catch up meeting with the Chief Operating Officer Had an introductory meeting with Steve Tingle the Head of Operations, Children and

Young People Wellbeing Network

David Curtis

Attended the Serious Incident Panel Met with the Mental Health STP Lead Met with Lisa Knight, attendee of the Insight NED Development Programme Attended the NHS North West Leadership Academy Board meeting Met with the Director of Nursing & Quality to discuss the Quality Committee agenda Had an introductory meeting with Steve Tingle the Head of Operations, Children and

Young People Wellbeing Network Attended the CQC Half Day Induction Event in London Attended the HR Recruitment Event at the Lantern Centre

Isla Wilson

Met with the Engagement Director Met with the Digital Health & Activation Clinical Lead from Healthier Lancashire & South

Cumbria Change Programme

In addition to the above:

All Non-Executive Directors attended an ‘Are we Assured’ session led by Chair and Company Secretary

All Non-Executive Directors attended the NED’s quarterly meeting with the Chair

2.0 CHAIR’S ACTIVITY

The Chair attended the Board meetings and Council of Governors meeting including the CoG Nomination Remuneration Committee

Whilst the Chief Executive was on annual leave the Chair had catch up meetings/tele-calls with the Chief Finance Officer

The Chair had weekly catch up meetings with the Chief Executive and had a separate meeting with the Chief Executive to discuss succession planning

The Chair was on the panel for the AAC interviews in August The Chair attended external meetings including the System Leaders meeting The Chair had an introductory meeting with Steve Tingle, Head of Operations, Children

and Young People's Wellbeing Network The Chair and Deputy Company Secretary met with the Stakeholder Engagement

Manager to discuss the Annual Members Meeting and nominated governor proposals The Chair had a catch up call with the Company Secretary The Chair met with the Deputy Company Secretary to discuss upcoming Board and CoG

agendas The Chair attended the CQC Half Day Induction Event in London Attended the UK Health Show 2017 in London Carried out a visit at North Barns in Lancaster

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3.0 COUNCIL OF GOVERNORS UPDATE

This section has been added to the Chair’s Report in order to keep the Board updated on Council of Governor activity, recognising that since 1 April 2017, Board members have been attending meetings on an invitation basis. Since the last Chair’s Report received on 7 September 2017, the following items have been considered by the Council of Governors: 20 September 2017

Governors received an update on the activities of both the NEDs and the Chair within the Chair’s Report

Governors received chairs reports from the Quality & Assurance Committee and CoG Nomination Remuneration Committee

The Council of Governors approved the re-appointment of Non-Executive Director David Curtis for a second three year term commencing on 01 December 2017

The Annual Members Meeting and Annual Membership Conference will be held jointly on 25 October 2017

The Council of Governors discussed potential changes to the nominated governors representation and a proposal will be coming back to the next meeting

4.0 USE OF THE COMMON SEAL

To inform the Board that the Common Seal has not been used since the Board of Director’s meeting on 7 September 2017. AHSN Lease At the 04 May 2017 Board of Directors meeting, the Board were informed of the AHSN Innovation Agency new leases for premises and the Board agreed to accept these. The Chair took the decision outside of the Board meeting to progress the lease for the AHSN Innovation Agency premises in Liverpool and recognised the minor risk as there was a delay in confirmation of re-licensing from NHS England. Approval to progress the licence was given on 21 September 217.

5.0 RAISING CONCERNS As Trust Chair I continue to oversee the Dear David process for staff to raise concerns. This process compliments other mechanisms for staff to raise concerns such as the Raising Concerns Guardian. During August, the following concerns were raised with me through Dear David:

Patients smoking on inpatient wards;

Assaults on staff and safety at the Scarisbrick Centre;

Poor staffing levels at the Scarisbrick Centre impacting on staff and patient safety;

Staffing levels at the Scarisbrick Centre;

Staffing levels at Guild Lodge due to a number of leavers;

Service impact from a number of administrative staff leaving Guild Lodge;

Quality and safety concerns at HMP Liverpool;

The cost of business insurance for administrative staff doing very few business miles;

A staff member has not had their PDR completed;

Conduct of managers in a central Lancashire community health team;

The way in which a service review in dental services has been carried out.

The Executive Director of Nursing and Quality and Raising Concerns Guardian continue to administer the Dear David process on my behalf and they have ensured that all concerns are

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being reviewed with feedback provided to those raising concerns directly, where possible, and also included in the Quality Matters electronic bulletin to staff.

6.0 BOARD ACTION The Board is asked to note the updates provided for information.

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Board of Directors


Report Title Chief Executive’s Report – Part One

FOIA Exemption No Exemption

Prepared by Heather Tierney-Moore, Chief Executive

Presented by Heather Tierney-Moore, Chief Executive

Action required Discussion

Supporting Executive Director Chief Executive


Report purpose The purpose of this report is to provide Board members with an overall summary of the Trust position and highlight areas for further discussion.


To provide high quality services

Board Assurance Framework risk 2.1 – The Trust does not receive assurance of the accuracy, timeliness and consistency of data and reporting with the potential to compromise decision making and service quality

CQC domain Well-led

Introduction This report aims to give Board members an overview of the activity undertaken since the last Board meeting, both within the Trust and externally.

QUALITY AND SAFETY

CQC Inspection: HMP Liverpool The Care Quality Commission (CQC) conducted a short notice inspection of healthcare services at

HMP Liverpool. The inspection took place week commencing 11 September 2017 and involved pre-

inspection data collection and four days onsite. The Trust was given verbal feedback on conclusion of

the four days onsite which included a recognition that improvements had been made but equally

areas for improvement remain. The CQC will provide draft reports in around 6 weeks.

Serious Incidents During August 2017, ten serious incidents were reported:

(brief information is provided to protect confidentiality, the term suicide is only used once a Coroner’s

Inquest has returned a verdict of suicide)

Death (suspected suicide) of a patient recently discharged from inpatient mental health

services in East Lancashire;

Unwitnessed fall resulting in fracture in inpatient mental health services in Blackpool;

Death (suspected suicide) of a patient under the care of the Assessment and Treatment Team

in Preston;

Serious self harm of a patient in child and adolescent inpatient mental health services;

Death (suspected suicide) of a patient under the care of the Assessment and Treatment Team

in Fylde and Wyre;

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Death (suspected suicide) of a patient under the care of Community Restart Team in Preston;

Serious violent incident involving a patient in child and adolescent inpatient mental health

services resulting in police utilising a taser;

Death (suspected suicide) of a patient under the care of Community Mental Health Team in

Hyndburn and Rossendale;

Grade 4 pressure ulcer on a patient under the care of the Moorpark Fulwood and Ingol

Integrated Neighbourhood Team;

Death (cause unknown) of a patient recently discharged from inpatient mental health services

in Blackpool.

In all cases, a formal investigation is now underway and the incidents have been reported to

commissioners, NHS England and regulators as required under the NHS Serious Incident

Framework.

Raising Concerns During August 2017, twelve concerns were reported through the various mechanisms including the

Raising Concerns Guardian and through Dear David:

Quality and safety of services on Wordsworth Ward at the Harbour due to staffing challenges;

Assaults on staff and safety at the Scarisbrick Centre;

Poor staffing levels at the Scarisbrick Centre impacting on staff and patient safety;

Staffing levels at the Scarisbrick Centre;

Staffing levels at Guild Lodge due to a number of leavers;

Service impact from a number of administrative staff leaving Guild Lodge;

Concerns about a named lead professional;

Conduct of managers in a Central Lancashire Community Health Team;

Quality and safety concerns at HMP Liverpool;

The cost of business insurance for administrative staff doing very few business miles;

A staff member has not had their PDR completed;

The way in which a service review in dental services has been carried out.

In all cases a review of proportionate scale has been commissioned. The findings from each review

are individually fed back to the person raising the concern if they have provided their name. The

findings from every concern is summarised in the Quality Matters bulletin.

Health and Wellbeing Karen Seal, Acting Clinical Lead for the Eating Disorder Service has been shortlisted for an award in The Gazette Best of Health Awards within the Mental Health Worker of the Year category. FINANCE AND PERFORMANCE

Finance Report The position as at Month 5 sees a year to date operating deficit of -£2.0m, excluding planned Sustainability and Transformation funding of £0.6m, against a planned surplus to date of £0.2m. The current position continues to be driven by staffing pressures in ward and prison areas and a slow start to delivery against planned cost improvement programmes and OAPs expenditure has now started to exceed funding. The forecast assumes current pressures and risks are addressed or mitigated and financial performance achieves (or exceeds) plan but the unmitigated projection indicates a gap of c£6m, c£8m without STF monies. This is a significant deterioration from month 4 (£2m), mainly due to excess OAPs of c£1.8m but also prisons and additional mental health pressures, and it will not be without significant management challenge. After taking in to account £1.7m of disposals, which are accounted for after EBITDA, EBITDA is broadly in line with I&E Margin. The new Use of Resources (UoR) metric is rated at 3, but will rise to a 2 should the Trust meet its financial plans and targets.

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Quality & Performance Report The Quality & Performance Report can be viewed under item TB 147/17. Trust Shared Objectives 2018/19 Following consultation with staff and senior leads the Shared Objectives 2018/19 have now been agreed. Communication of the objectives has begun and will support the development of network and support service operational plan objectives for next year.

GOVERNANCE

NHS Improvement Cyber Security Assurance Following two national serious incidents in August related to delayed electronic clinical correspondence to GP’s, NHS Improvement requested assurance from all trusts that the IT systems used are clinically safe (i.e. the technology is functioning correctly), there are no current backlogs of electronic correspondence and mechanisms/processes are in place to ensure that delays in transmission are detected in a timely fashion. The Trust provided positive assurance against all three areas to NHS Improvement within the required deadline. Innovation Agency Extension In May 2017, the Board approved-in-principle the Innovation Agency taking on a lease for new premises contingent upon the AHSN being relicensed by NHS England. The relicensing process was expected to commence in September 2017 however there have been delays within NHS England and as a result NHS England have written to Liz Mear as Chief Executive of the Innovation Agency to advise that the license approval has been pushed back to March 2018. The letter confirms that the existing contract has been extended by 6 months to ensure the Innovation Agency do not start to issue staff notices in anticipation of the licence ending. On the basis of the extended NHSE contract, the Innovation Agency has requested approval to enter into a lease for space within the Accelerator Building in Liverpool as the current office site is no longer fit for purpose. The Liverpool premises will be let at a reduced rent rate due to a capital investment which the Innovation Agency has already made into the facility. On the recommendation of the Chief Executive, the Trust Chair has agreed the progression of the lease under Chairs action outside of the Board meeting.

BUSINESS DEVELOPMENT

Winter Preparedness & A&E Performance Preparation for winter is well underway across the health system, including plans which are being put in place to support acute A&E performance over winter. Along with other provider organisations, the Trust has contributed to these external plans as part of a whole system response to easing A&E pressures. Assurance on the Trust’s own internal winter preparedness plans has been scheduled for the November Board meeting.

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Shared organisational objectives for 2018/19

Strategic Priority Shared objective 2018/19

To provide high

quality services.

To deliver Year 3 of our Quality Plan, maintaining quality and safety as our

number one focus, and supporting staff to take a data-driven, systematic

approach to quality improvement so that we deliver high quality, continually

improving care.

To deliver

sustainable services

that meeting the

needs of local

people.

To continue to transform our services through collaboration with partners, in

order to meet the health and wellbeing needs of our local communities, by

leading and supporting new models of care.

To become

recognised for

excellence.

To be recognised for the quality of our services, from leading and supporting

system-wide transformation, to recognition of team and individual

achievements.

To employ the best

people.

To deliver Year 2 of the People Plan, working collectively to enable staff to

continue to develop and grow, supporting each other to meet and overcome

challenges, living our values, and making Lancashire Care a great place to

work.

To provide

financially

sustainable

services.

To become as efficient and effective as we can be, by reducing unwarranted

variations in care, learning from others, and being proactive in focusing

swiftly on actions that will have the greatest impact.

To innovate and

exploit technology to

transform care.

To continue to roll out the Electronic Patient Record, whilst also developing

and promoting new ways to deliver digitally enabled care, supporting staff to

do their jobs better, and improving our ability to give people using our

services a positive experience.

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Board of Directors


Report Title Quality and Performance Report (QPR)

FOIA Exemption No Exemption Not Applicable

Prepared by Louise Corlett, Head of Delivery and Performance

Presented by Sue Moore, Chief Operating Officer


Supporting Executive Director Chief Operating Officer


Report purpose To appraise the Board of Directors of key elements and themes from the Month 5 QPR


To provide high quality services

Board Assurance Framework risk 2.1 The Trust is unable to reposition in the marketplace to become established as a provider of choice achieving excellence

CQC domain Well-led

The Board are asked to note the QPR for month 5 with following comments below.

All NHS I metrics are compliant including CPA 7 day follow up which, following a failure to

achieve target in month 4, the position has now been recovered.

The developing Southport and Formby QPR which is starting to track elements of performance

within the services provided through this contract. This will be developed over future months as

an appendix of the main QPR

Are we SAFE?

Current CQC rating is ‘requires improvement’

As stated in previous months the Quality Improvement work underway to improve on this rating. The

Quality Plan will cover the key improvement areas within this domain and it is set to deliver on 16

Quality priorities, utilising Quality Improvement (QI) methodologies. We remain on track to complete

the development of detailed delivery plans and defined outcome measures for each, by the end of Q2.

Progress on the 16 key priorities will be monitored through the designated sub-committee and the

BBSC is also tracking the status of the quality plan.

Avoidable pressure ulcer (grade 3 and 4) incidence continues to fall following the increase seen in Q1.

One of the Quality priorities is work to reduce pressure ulcers and there is a positive impact of the

React to Red training programme. In addition, pilots of safety huddles and a safety senate are allowing

the sharing of good practice and are contributing to the reduction in the number of pressure ulcers.

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Physical violence towards staff although decreased in month, is still tracking at

higher than average. In month 5, 220 incidents were reported compared to 265 in month 4. The

hotspots identified are in PICU and older adult wards. The Quality and Safety team are providing

additional support, in relation to older adults, with a review of personal care activities under way to

provide specific training and identify if there are any changes in clinical practice required. It is also

acknowledged that the work being overseen by the Positive and Safe Group is a long term piece of

work, and an impact on incidence is unlikely to be seen in the short term. In addition, during Q2, the QI

plan will be finalised and the trajectory of improvement will be agreed. Currently, the Trust benchmarks

above the mean for incidents of violence and restraint, the target for achievement the first instance will

be based upon achieving a level below the mean.

In addition are a number of other measures that are connected to the increase in physical violence

towards staff, and thus will be addressed by the improvement work conducted through the Positive and

Safe Group. These measures are the use of restraint, which this month has decreased from 460 to 336

against an average of 300 per month; the number of RIDDOR incidents, which has decreased from 6

last month to 1 in month 5; and the achievement of the overall harm free care metric for Mental Health,

where there is performance of 80% against a 90% target. Within the harm free care metric, measures

relating to violence, restraint, and whether people feel safe are driving the shortfall in overall

performance.

Also linked to this is the number of Serious Incidents, which has increased in month with 10 reported

against a monthly average of 7.8. Whilst these inter-connected measures are multi-factorial, staffing

challenges play an important part and metrics around temporary staffing usage and sickness are

important indicators of the challenge to workforce.

Are we CARING?

Current CQC rating is ‘Good’.

We maintain 100% compliance against mixed sex accommodation breaches.

Feedback received through the Friends and Family test is stable at 97% which continues to be positive.

In addition, the number of compliments has risen to 735 above the rolling 12 month average.

Are we EFFECTIVE?


Readmission rate for both 30 and 90 days improved for the second consecutive month in month 5, at

6.9% and 17.3% respectively. Whilst rates still exceed the agreed standards for 90day readmission,

this month the 30d readmission rate has achieved the required standard. Team leader reviews at

CMHT/CRHTT clinical discussion meetings continue and show a positive effect along with analysis or

readmission data being routinely reviewed in locality governance groups. Furthermore, the monthly

thematic review of all readmissions has been maintained to enable continuous improvement of factors

contributing to reasons for readmission.

Average Length of stay has performed within target for the first time since January 17. PICU Length of

stay has fallen for the second month after being stable for four consecutive months, thus demonstrating

the positive impact of the Joint Advisory Group. Overall LOS, which is inclusive of PICU patients has

also reduced. The focus on patients with LOS greater than 180 days is being maintained.

18 of 198

Delayed Transfers of Care (DToC) is reported for Longridge Hospital this

month due to the facility exceeding the 7.5% threshold against this measure.

Are we RESPONSIVE?


The Trust continues to perform well against NHS I indicators. In month 4, the CPA 7 day follow up

measure was not achieved, however, this position has been recovered in month 5 and continued focus

during September will ensure that the quarter 2 position will be achieved.

Responsiveness is also demonstrated through our achievement of the 18 week referral to treatment

(RTT) standard for AHPs and for dental waiting times. In the Community Wellbeing Network, as

reported last month, all 15 services across which this standard is measured, are compliant. In the

Children and Young People’s Wellbeing Network, 4 of the 6 services across which we report the 18

week RTT pathways are complaint, which is an improvement on the position over recent months.

The Children’s Speech and Language Therapy service have achieved the RTT measure of 92% of

patients on the waiting list having waited less than 18 weeks, reporting 96%. The agreed recovery

trajectory forecasted all locality teams to meet the 92% target in September 2017, and this has been

achieved for all teams apart from 1 in August. The Chorley & South Ribble team have experienced

delays achieving the required capacity to deliver recovery by September and so are forecasted to

achieve the target by mid-October. It is important to note that referrals to the service have increased in

month 5 which does pose a future challenge to performance and this is being understood.

The 2 areas of performance which remained challenges are Child Psychology and CAMHs Tier 3.

Performance in Child Psychology for month 5 was 77.7% against the 95% RTT standard for patients

starting treatment, which is an improved position on the previous 12 months reported. In addition, the

number of children on the waiting list who have waited >18 weeks continues to reduce (from 106 in

month 4 to 78 in month 5) which is a positive indicator that the recovery plan is having an impact.

Further reduction in the number of long waiting patients are planned which will result in the service

continuing to report under-performance against the 95% target until the backlog is cleared.

Conversely, performance in the CAMHS Tier 3 service has deteriorated further and the service are

reporting 64% against the 95% RTT standard for completed pathways (compared to 68% in month 4).

The Chorley and South Ribble team continue to be the main contributor to the under-performance with

capacity shortfalls caused by sickness and vacancies an issue that is being addressed by the

appointment of a new team leader. Demand exceeding the commissioned level and the management

of Autistic Spectrum Disorder referrals (which is not part of the service specification) poses a significant

challenge. As well as new staff commencing in post in October in the Chorley South Ribble team, the

team are signposting appropriate patients to Early Help services and will be using a demand

management tool to assist with effective planning. Additional management oversight has also been put

in place to support the team.

Memory assessment services have achieved 80% against the 70% target against the 6 week referral to

assessment standard, a further improvement on last month’s position and the third month that the

service has reported a compliant position. Whilst the overall position is extremely positive, the Central

Lancs MAS team continue to underperform and are constrained by an absence of agreement for

shared care. Work continues with commissioners with a view to resolving this.

19 of 198

In Mindsmatter a number of measures are monitored that indicate our overall

responsiveness. The service continues to perform well against the NHS I indicators for referral to

treatment in 6 and 18 RTT weeks and it is positive that the number of patients on the waiting list who

have waited longer than 26 weeks has reduced significantly this month. The performance against the

recovery measure is also positive whilst performance against prevalence has been challenging at team

level. A substantial amount of work has been undertaken with individual teams to address the

challenges meeting prevalence targets and teams are clear on the activity required to achieve the

quarter 2 position by team and this is being managed closely.

The demand for inpatient beds continues to pose a challenge for the Trust, with occupancy levels

exceeding 100%. Consequently, the number of out of area placements (OAPs) has not fallen in line

with the required trajectory and has stayed largely static at just 23.68 compared to 24 last month. There

is evidence that the implementation of intensive support schemes has impacted on the number of

admissions yet this has not avoided the use of OAPS. However, there is an increased focus on the

reduction on the number of patients who have a length of stay of greater than 180 days who are ready

for the next stage of treatment away from the acute/PICU ward, but for whom there is no suitable

alternative placement available. The timely discharge of this cohort of patients would enable the

resolution of the OAPs position and discussions with commissioners are underway to develop plans to

resolve this.

Mental health liaison teams (MHLT) are reporting a deteriorating position against all 3 measures,

demonstrating the challenge the teams are facing with demand and capacity. The discussions with

NHSE, CCGs and Acute partners which have been occurring since the receipt of the Royal College

recommendations and in parallel with A&E Delivery Board/Risk Summit discussions have culminated in

submission of a bid for monies to mitigate the gaps in service provision pending the Core 24 funding

available from 18/19. A decision on the bid is expected on the 30th September and implementation of

the plan from the 1st November if funding is received.

This month the number of complaints has increased to 165 in month 5 compared to 134 in month 4,

which is above the rolling average of 128 per month. This reflects work that has been ongoing by the

Nursing and Quality to reach HMP Liverpool and Secure services which are traditionally low reporters.

The number of upheld complaints is below the average of 25, with 22 upheld in month (which is a slight

increase on month 4 position), whilst the number of re-opened complaints is low demonstrating that on

the whole complainants are satisfied with the quality of the responses provided.

Are we WELL-LED?


There is no update on the Staff engagement score until the Q2 position is available.

Sickness rates have fallen to 6.2% for the first month following a 4 month increasing trend of fourth

consecutive (in month 4 sickness was 6.4%). The Mental Health Network is also reporting a reduction

in sickness this month, improving from 7.98% in month 4 to 7.38% in month 5. The implementation of

the Back to Basics Sickness Absence Management approach is being implemented across other

Networks given the rise in sickness in the Children and Young People’s Network.

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Summary and Recommendations

The information in the QPR provides evidence of our performance against key metrics aligned to each

CQC domains. From this, and the exception reporting against each measure, we are able to provide

information that supports the assessment of our position against each domain.

21 of 198

Quality & Performance

Report

Month 5 – August 2017

22 of 198

Quality and Performance Report:-

Section 2:- Performance and Data Quality

Section 2.1:- Performance Activity

• NHS Improvement Indicators Dashboard • NHS Improvement Indicators Kitemarking • Key Exceptions • CCG level data • Network level summary • Key Network Exceptions

Section 2.2:- Patient Flow • Patient flow summary • Key patient flow exceptions

Section 2.3:- Data Quality • Data Quality summary • Key Data Quality exceptions

Section 3:- Finance and Contracting

Section 3.1:- Financial Activity

• UoR Risk Rating • Summary I&E Position • Summary of Clinical Services • CIPS • Capital Expenditure

Section 3.2:- Community Contract Activity • Community & Wellbeing – Network Line Totals • Community & Wellbeing – Service Line Totals • Community & Wellbeing – Total Activity Split by CCG • Children & Young People’s Wellbeing – Service Line Totals • Children & Young People’s Wellbeing – Total Activity Split by CCG • Mental Health – Activity Totals

Section 3.3:- Commissioning for Quality & Innovation • CQUIN Executive Summary

2

Section 6:- Risk

• Board Assurance Framework

Section 4:- Quality

• Quality and Safety Tile • Quality Surveillance – Safety • Quality Surveillance – Experience & Effectiveness • Quality Surveillance – Leadership • Delivering the Strategy

Section 5:- Workforce

• Actual Workforce Costs Compared to Budget • Sickness Absence Rates • Appraisals and Mandatory Training Compliance • Vacancy Management and Active Recruitment • Core Workforce Headcount • Workforce Turnover

Section 1:- Board Balanced Score Care

• Trust Strategic Priorities • Board Summary • Quality & Safety • Service Delivery • People & Leadership • Finance

Appendix 1:- Southport & Formby

• NHS Improvement Indicators Dashboard • NHS Improvement Indicators Kitemarking • Southport & Formby Summary • Finance & Contracting • Quality • Workforce

23 of 198

Board Balanced Score Card

Section 1

3

24 of 198

1. Board Balanced Score Card Trust Strategic Priorities

Strategic Priority Strategic Blueprint

Co

mp

as

sio

n

To provide high quality

services

We will ensure that people who use our services are at the heart of everything we do, and the people who deliver and support

delivery of services are motivated, engaged and proud to provide high quality, compassionate, continually improving care. We

will empower people to share their stories so that we know how we are doing and we will listen to learn and to improve quality

together. We will continue to strive to be the best that we can be by upholding our 8 quality commitments and the ‘I’ statements,

empowering everyone to embrace these personal pledges.

Inte

gri

ty

To deliver sustainable services

that meet the needs of local

people

We will collaborate with partners to deliver system wide transformation and we will be an active partner in delivering a bespoke

offer to a number of Accountable Care Systems by

being the prime provider of specialist, acute and community mental health services, and

a lead provider in delivering new models of integrated physical and mental health out of hospital services, and

realising the benefits of our geographical footprint to deliver system wide sustainable infrastructure solutions and

organisational vehicles for new models of care.

Whilst our principal footprint for delivery of services is Lancashire and South Cumbria, we will continue to seek opportunities

across North West STP footprints.

Te

am

wo

rk

To become recognised

for excellence

Our service users and carers will tell us that our services are of high quality. Our people will recommend us to family and

friends. We will be respected by our commissioners and other providers as a co-producing partner in shaping new service

models that deliver our aligned strategies with an emphasis on place based care.

Res

pe

ct

To employ the best

people

We will develop an organisational culture and leadership team equipped to meet its strategic intent and the needs of both its

workforce and the population it serves; in short, a culture of high performing, continually improving and compassionate care.

Staff will be motivated, engaged, high performing and proud of the service they provide. We will proactively support staff to look

after their own health and wellbeing, and to reach their full potential. We will identify and grow our future leaders. People will

want to work here.

Ac

co

un

tab

ilit

y

To provide financially

sustainable services

We will restore and maintain financial balance, and provide services that offer excellent value for money without compromising

financial sustainability. We will work with local partners to deliver system wide efficiency measures. We will actively seek

business opportunities that add value for local people.

Ex

ce

lle

nc

e

To innovate and exploit

technology to transform

care

We will develop and promote digital enabled care, and lead research and innovation to enhance patient experience, reduce

costs and/or improve quality. We will have a culture where staff are given the time, training and resources to research and

innovate. Research will validate innovations and innovations will direct research. Partnerships with third party organisations will

enable rapid execution and exploitation of innovation projects.

4

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Research Studies

Jun Jul Aug

137 69 40

Business Gained - Lost

Jun Jul Aug

£0.00 £0.00 -£2,230,000

OAPS

Jun Jul Aug

26 24 24

NHSI Compliance

Jun Jul Aug

100% 93% 100%

Sickness Absence

Jun Jul Aug

5.96% 6.42% 6.18%

Agency Ceiling

Jun Jul Aug

-69,455 -63,239 -188,237

UoR

Jun Jul Aug

3 3 3

Revenue Control Total

Jun Jul Aug

-2.5% -1.3% -1.4%

CIP

Jun Jul Aug

67% 87% 86%

Liquidity

Jun Jul Aug

1 1 1

1. Board Balanced Score Card Summary

Capital Expenditure

Jun Jul Aug

18% 36% 33%

Contract Performance (MH)

Jun Jul Aug

- - -

Contract Performance (Comm)

Jun Jul Aug

- - 2.92%

Engagement Score

Q4 16-17 Q1 17-18 Q2 17-18

3.77 3.73

National COPD Audit

Programme

Report due Feb 2018

Use of depot/LA antipsychotics for

relapse prevention – baseline audit

Report due Nov 2017

Prescribing for bipolar disorder

(use of sodium valproate) re-audit

Report due Feb 2018

Quality Plan

17/18 objectives 16

On track Off track

16 0

Service Delivery Quality & Safety

People & Leadership Finance

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1. Board Balanced Score Card Quality & Safety

Quality Plan During the quarter, leads for the 16 priorities have been developing (and implementing) the detailed quality improvement plans

and inputting these plans into the Life QI system. A detailed report will be submitted to the Quality and Safety Sub-committee

and Quality Committee in September 2017 which will reflect an end of Quarter 2 position. It is anticipated that several priorities

will be marked as off-track at the end of quarter position (manual data collection is underway during September to validate the

end of quarter position).

Target: 16 objectives

On track 16 Off track 0

Research Studies

Data is subject to a 6-8 week lag as it is uploaded by research teams to a national system, retrospectively. Activity is currently

forecast to meet this year’s annual target. Target 100 participants monthly

40

6

National Audit –

National COPD Audit

Programme Report due Feb 2018.

Target TBC

National Audit –

Prescribing for bipolar disorder

(use of sodium valproate) re-

audit Report due Feb 2018.

Target TBC

National Audit –

Use of depot/LA antipsychotics

for relapse prevention –

baseline audit Report due Nov 2017.

Target TBC

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1. Board Balanced Score Card Service Delivery

Business Gained – Business

Lost

Target 1.5% over next 12 months

(year-end)

Out of Area Placements (OAPS)

The average number of OAPs decreased slightly in August by 0.55, alongside a slight reduction in the OAP OBD in August with a position of 734,

a reduction of 17 from July. Continuing the reduction seen in July.

The overall number of OAPs remains static against an assumed fall in the trajectory. Target 15 contracted beds

24

Contract Activity - Community

Target achieved Target 100% +/-10%

2.92%

Contract Activity – Mental Health

LCFT have submitted the completed Mental Health Baselines Proposal and this is currently being reviewed by Commissioners. Target 100% +/-10%

NHSI Compliance

Target achieved. Target 100% in each quarter

100%

7

28 of 198

Agency Ceiling The figures show a worsening position in month 5 by a significant degree; with

over £120,000 more spent in August than July. This has been caused by the

high use of annual leave, a further worsening of the Agency position at HMP

Liverpool and continuation of Medical Agency use month-on-month. There is

a chance Medical Agency could increase again in September and onward due

to an increased vacancy position.

Target 641,250

Not achieved

1. Board Balanced Score Card People & Leadership

Jun Jul Aug

YTD Target 641,250 641,250 641,250

YTD Actuals 710,705 704,489 829,487

Under/(Over)

Agency Usage -69,455 -63,239 -188,237

Engagement Score Q1 2017/18 period results :

Recommend LCFT as a place to receive treatment (Workforce Advocacy): Yes – 70.20%, No - 11.25%, Don’t Know – 18.54%

Recommend LCFT as a good place to work: (Workforce Involvement and Motivation): Yes – 48.71%, No – 21.77%, Don’t Know – 29.52%

Improvement Initiatives:

A Wellbeing dimension is being added to the Quarterly Staff FFT questionnaire to supplement the 3 existing dimensions of advocacy, motivation and

involvement. The first Staff FFT report to include this new dimension will be available in January 2018.

Work to link the Staff FFT measurements to People Plan activity performance is still underway.

Target Top 25% of other

Trusts

Not achieved

Sickness Absence

The sickness absence rate for August has decreased, reporting at 6.18%. Please refer to the relevant M5 QPR detailed slides for information about

Improvement plans and initiatives. Target 4.5%

6.18%

8

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1. Board Balanced Score Card Finance

Use of Resources (UoR)

The current I&E position is constraining the current UoR to a 3, assuming current pressures and risks are addressed and financial performance

achieves (or exceeds) plan the Trust will achieve a forecast UoR of 2 in line with the revised plan. Target 2

3

Capital Expenditure

Spend profile on schemes is dependent on a number of tendering exercises to be completed in Q2 and though changes are being

worked through the programme total has now been adjusted to reflect the Trusts success in securing external funding for Places of

Safety (£0.5m), Perinatal (£3.5m - £2.5m in 2017/18) and Inpatient schemes (c£5.7m in 2017/18). Target 85-100%

33%

Revenue Control Total

A number of risks and pressures have been identified that if not addressed will compromise the Trusts ability to deliver the planned control total for

2017/18. Target ≥0%

-1.4%

Cost Improvement

Programmes (CIPs) At £5.0m in month 5 the Trust is £0.8m behind the plan of £5.8m. This is partly attributable to delays in scheme starts, but more significantly due to

lower than planned traction in schemes designed to address pressures on ward based staffing. Additional support is being provided and the Trust fully

expects to deliver the target by year end. Target ≥100%

86%

Liquidity

Forecasts indicate that with the delivery of the planned surplus the Trust will achieve a liquidity of 1. Target 2

1

9

*Under the Single Oversight Framework, the Trust is now managed against the Use of Resource Metrics (UoR). Under the Single Oversight Framework, a score of 1 is now the

best rating and 4 the worst. A rating of 4 on any metric or an average rating of 3 triggers a concern and a potential support need.

30 of 198

2. Performance and Data Quality

10

Section 2:- Performance and Data Quality

Section 2.1:- Performance Activity

• NHS Improvement Indicators Dashboard

• NHS Improvement Indicators Kite Marking

• Key Exceptions

• CCG level data

• Network level Summary

• Key Network Exceptions

Section 2.2:- Patient Flow

• Patient Flow summary

• Key Patient Flow exceptions

Section 2.3:- Data Quality

• Data Quality summary

• Key Data Quality exceptions

31 of 198

Performance Activity

Section 2.1

11

32 of 198

2.1 Performance Activity NHS Improvement Indicators Dashboard

12

Indicator Target Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Q1 17-18 YTDRolling 12

Month Sparkline

MR01 - 7 Day Follow Up 95.00% 96.5% 96.0% 96.9% 98.2% 98.8% 96.1% 97.6% 98.6% 96.8% 95.9% 94.1% 96.8% 97.1% 96.44%

MR02 - CPA Review within 12 Months 95.00% 97.1% 97.7% 97.4% 97.8% 96.9% 97.1% 97.5% 97.0% 97.1% 96.1% 95.9% 97.0% 96.7% 96.60%

MR03 - Mental Health Delayed Transfers of Care ≤ 7.5% 4.18% 4.08% 3.68% 4.19% 3.81% 2.84% 2.59% 3.01% 3.21% 3.36% 2.80% 2.52% 3.2% 2.98%

MR05 - RTT - Consultant Led (Completed Pathway) 95.00% 93.2% 92.4% 95.2% 96.3% 96.7% 97.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00%

MR06 - RTT - Consultant Led (Incomplete Pathway) 92.00% 95.7% 96.3% 95.2% 95.4% 97.3% 100.0% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00%

MR07 - IP Access to Crisis Res. Home Treatment 95.00% 98.9% 98.3% 100.0% 100.0% 98.6% 99.4% 97.7% 100.0% 100.0% 99.5% 100.0% 100.0% 99.8% 99.89%

MR08 - MH Data Completeness - Identifiers 97.00% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.6% 99.7% 99.4% 99.4% 99.6% 99.55%

MR09 - MH Data Completeness - Outcomes 50.00% 83.2% 83.7% 83.7% 83.8% 83.4% 83.2% 83.4% 83.7% 82.2% 81.8% 81.8% 81.7% 82.5% 82.19%

MR10 - CIDS Completeness - Referral Information 50.00% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00%

MR11 - CIDS Completeness - RTT Information 50.00% 99.3% 99.5% 99.6% 99.8% 99.1% 99.3% 99.1% 99.3% 99.2% 99.1% 99.2% 99.0% 99.2% 99.15%

MR12 - CIDS Completeness - Activity Information 50.00% 93.3% 93.3% 93.9% 94.3% 93.9% 92.9% 93.1% 94.2% 93.9% 93.5% 95.2% 94.9% 93.9% 94.41%

MR13 - 2 Week wait for Treatment for EIP Programme 50.00% 75.0% 69.0% 74.3% 76.7% 82.0% 81.4% 74.4% 69.0% 83.3% 90.9% 70.4% 78.9% 81.5% 78.98%

MR14 - RTT - IAPT 6 Weeks 75.00% 90.8% 95.0% 93.0% 96.5% 95.1% 95.7% 93.4% 96.4% 94.7% 95.1% 94.5% 94.4% 95.4% 94.99%

MR15 - RTT - IAPT 18 Weeks 95.00% 99.1% 99.3% 99.0% 99.8% 99.4% 99.8% 98.8% 99.4% 99.2% 99.7% 99.3% 99.4% 99.5% 99.42%

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2.1 Performance Activity NHS Improvement Indicators Kitemarking

Kitemarking key:

• SOP – Does the indicator have an associated SOP that is within date?

• External Audit – Has this measure been subjected to an external audit within the last 2 years?

• Internal Audit – Has this measure been subjected to an internal audit within the last 2 years?

• Electronically Populated – Is this indicator produced using electronically generated numerators and denominators?

• Manual Overrides – Has the performance for this indicator been produced using manual overrides to indicate false positives or

negatives?

13

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2.1 Performance Activity NHS Improvement Indicators Kitemarking

14

35 of 198

Trust position for Lancashire CCGs:

- In Month 5, the Trust has achieved a performance of 97.2%

against a target of 95% across 8 CCGs.

CCG position:

- In Month 5, the Trust has underperformed in 3 CCGs: Blackburn

with Darwen (2 patients failed), Blackpool (2 patients failed) and

Morecambe Bay (2 patients failed).

15




CCG position:

- In Month 5, the Trust has achieved compliance for all CCGs.

Unassigned CCG:

- In Month 5, there were 67 records unassigned a CCG, of which

92.5% (62) were completed.

CPA 12 Month Review 7 Day Follow Up

2.1 Performance Activity NHS Improvement Indicators reported by CCG

Apr-17 May-17 Jun-17 Jul-17 Aug-17

100.0% 94.7% 100.0% 90.9% 94.7%

94.4% 96.9% 97.4% 100.0% 92.9%

100.0% 94.7% 100.0% 83.3% 100.0%

98.0% 100.0% 93.5% 95.7% 100.0%

100.0% 100.0% 100.0% 95.5% 100.0%

100.0% 96.0% 100.0% 94.7% 100.0%

100.0% 94.4% 100.0% 100.0% 86.7%

100.0% 100.0% 90.0% 90.9% 100.0%

98.5% 97.1% 97.5% 94.6% 97.2%

NHS Fylde & Wyre CCG

NHS Greater Preston CCG

NHS Morecambe Bay CCG

NHS West Lancashire CCG

7 DFU CCG

NHS Blackburn with Darwen CCG

NHS Blackpool CCG

NHS Chorley & South Ribble CCG

NHS East Lancashire CCG

Total Figure - 8 CCGs


98.5% 98.3% 97.2% 95.3% 98.8%

96.6% 96.4% 95.8% 95.5% 96.2%

98.0% 96.6% 95.2% 95.1% 96.6%

96.1% 96.7% 95.1% 95.6% 96.0%

96.9% 98.8% 96.0% 95.6% 98.0%

98.8% 98.2% 97.9% 97.9% 98.4%

93.5% 95.8% 96.7% 97.0% 95.5%

100.0% 96.7% 95.6% 95.6% 96.9%

97.2% 97.2% 96.2% 96.0% 97.1%Total Figure - 8 CCGs






12 month CPA


NHS Blackpool CCG


Note: The total figures in the tables above differ from page 12 as they are

representative of only 8 contracted CCGs.

36 of 198




Delayed Transfers of Care (DToC)

16

IP Access to Crisis Resolution Home Treatment



against a target of <7.5% across 8 CCGs.

CCG position:



- In Month 5, the Trust has achieved a performance of 100%


CCG position:



3.85% 4.17% 3.97% 1.57% 1.56%

1.72% 0.83% 0.68% 0.00% 0.09%

2.78% 0.00% 2.00% 6.70% 3.82%

3.98% 5.17% 3.20% 2.69% 2.53%

3.70% 1.68% 4.20% 3.37% 2.80%

4.84% 4.78% 5.68% 4.49% 4.63%

0.00% 0.00% 0.00% 0.00% 0.13%

0.00% 3.57% 0.14% 0.00% 3.67%

3.18% 3.07% 2.99% 2.55% 2.47%




NHS Lancashire North CCG



DToC


NHS Blackpool CCG



100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 94.7% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 99.4% 100.0% 100.0%

% IP Access to CRHTT


NHS Blackpool CCG








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RTT – Consultant Led (Completed Pathway)

17

RTT – Consultant Led (Incomplete Pathway)




CCG position:





CCG position:


Note: NHS England guidance published in October 2015 confirmed that the incomplete pathway operational standard should became the sole

measure of patients’ constitutional right to start treatment within 18 weeks. And whilst we are required to maintain reporting on the completed

admitted pathway, the removal of the completed admitted pathway as an operational standard means that there is no longer any provision to report

pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England. This means that patients choosing to cancel

appointments can impact negatively on this measure.


- - 100.0% - -

- - - - -

100.0% 100.0% 100.0% 100.0% 100.0%

- - - - -

100.0% - - 100.0% -

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% - -

- - 100.0% - -







RTT Complete


NHS Blackpool CCG



- 100.0% - - -

- - - - 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

- - - - 100.0%

- - 100.0% - 100.0%

100.0% 100.0% 100.0% 100.0% 100.0%

100.0% 100.0% - - 100.0%

100.0% 100.0% - - -







RTT Incomplete


NHS Blackpool CCG


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MH Identifiers

18

MH Outcomes




CCG position:


Unassigned CCG:

In Month 5, there were 3174 records unassigned a CCG, of which





CCG position:


Unassigned CCG:

In Month 5, there were 181 records unassigned a CCG, of which



99.8% 99.8% 99.8% 99.8% 99.8%

99.8% 100.0% 99.9% 99.7% 99.7%

99.7% 99.7% 99.7% 98.8% 98.8%

99.8% 99.8% 99.8% 99.8% 99.8%

99.8% 99.8% 99.7% 99.7% 99.7%

99.8% 99.8% 99.8% 99.6% 99.6%

99.7% 99.7% 99.7% 99.7% 99.7%

99.5% 99.5% 99.7% 99.7% 99.7%

99.8% 99.8% 99.8% 99.6% 99.6%

MH Identifiers


NHS Blackpool CCG









79.1% 77.4% 77.3% 76.0% 74.7%

78.8% 78.5% 78.6% 77.7% 78.6%

90.5% 87.8% 86.8% 86.6% 86.0%

85.3% 83.4% 83.0% 83.4% 83.4%

89.0% 86.3% 84.9% 84.8% 84.9%

82.4% 80.4% 80.4% 80.6% 80.9%

91.3% 90.0% 89.5% 90.1% 89.4%

80.8% 76.9% 77.1% 78.1% 78.2%

84.1% 82.3% 81.9% 81.9% 81.7%







MH Outcomes


NHS Blackpool CCG


39 of 198




CIDS - Referrals

19

CIDS - Referral to Treatment

CIDS - Activity


- In Month 5, the Trust has achieved a

performance of 100% against a target of

50% across 8 CCGs.

CCG position:

- In Month 5, the Trust has achieved

compliance for all CCGs.

Unassigned CCG:

- In Month 5, there were 242 records

unassigned a CCG, of which 100% (242)

were completed.



performance of 99.0% against a target of

50% across 8 CCGs.

CCG position:



Unassigned CCG:

- In Month 5, there were 61 records

unassigned a CCG, of which 98.4% (60)

were completed.



performance of 93.3% against a target of

50% across 8 CCGs.

CCG position:



Jun-17 Jul-17 Aug-17

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

CIDS Referrals


NHS Blackpool CCG









98.3% 98.8% 98.1%

100.0% 100.0% 100.0%

99.9% 99.6% 99.3%

100.0% 99.0% 99.1%

100.0% 100.0% 98.3%

99.1% 99.2% 99.5%

100.0% 100.0% 100.0%

100.0% 100.0% 100.0%

99.1% 99.2% 99.0%

CIDS RTT


NHS Blackpool CCG









89.4% 89.2% 87.9%

83.3% 76.8% 71.4%

95.4% 96.1% 95.8%

84.6% 87.3% 84.2%

87.8% 89.9% 84.5%

95.8% 95.5% 95.8%

90.8% 91.4% 88.9%

70.8% 88.2% 80.3%

93.5% 93.7% 93.3%

CIDS Activity


NHS Blackpool CCG








40 of 198




EIS 2 Week Wait

20




CCG position:



85.7% 57.1% 83.3% 50.0% 87.5%

- 100.0% - 66.7% 100.0%

40.0% 66.7% 66.7% - 100.0%

80.0% 100.0% 100.0% 66.7% 63.6%

100.0% 50.0% 100.0% - 66.7%

100.0% 100.0% 100.0% 100.0% 75.0%

100.0% 100.0% 100.0% 100.0% 100.0%

0.0% 100.0% 50.0% 100.0% 100.0%

76.9% 83.3% 90.3% 68.0% 80.0%

2ww EIS


NHS Blackpool CCG








41 of 198




IAPT – 6 Weeks

21

IAPT – 18 Weeks




CCG position:





CCG Position:



95.6% 91.4% 77.3% 78.7% 82.0%

95.6% 93.6% 97.4% 95.6% 95.1%

96.8% 97.2% 96.1% 98.1% 97.5%

94.7% 95.8% 97.6% 94.1% 96.7%

94.6% 93.4% 95.3% 94.4% 91.9%

97.3% 90.7% 94.2% 91.1% 92.4%

98.5% 94.1% 97.3% 93.9% 98.6%

96.1% 94.3% 94.4% 93.6% 93.8%

Not Commissioned







RTT IAPT 6 Wks


NHS Blackpool CCG



100.0% 98.6% 98.7% 100.0% 100.0%

99.1% 99.2% 100.0% 100.0% 99.2%

100.0% 100.0% 100.0% 100.0% 100.0%

98.9% 97.2% 100.0% 97.1% 98.9%

99.1% 99.3% 100.0% 99.2% 98.1%

100.0% 99.0% 98.1% 96.7% 100.0%

98.5% 100.0% 100.0% 100.0% 100.0%

99.5% 99.2% 99.6% 99.2% 99.4%

RTT IAPT 18 Wks


NHS Blackpool CCG




Not Commissioned





42 of 198

2.1 Performance Activity Summary – Mental Health

22

Indicators achieved Target Type Target Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17Rolling 12 Month

Sparkline

NHS Improvement

CPA 7 Day Follow Up (Total Network Performance) NHSI 95.00% - - - 96.7% 98.1% 98.7% 96.7% 97.8% 98.5% 96.8% 95.7% 94.3% 96.6%

CPA 7 Day Follow Up (AMH) NHSI 95.00% 97.7% 96.7% 97.5% 96.8% 98.4% 98.5% 96.9% 98.4% 98.9% 96.9% 96.2% 94.4% 96.0%

CPA 7 Day Follow Up (OA) NHSI 95.00% 100.0% 80.0% 83.3% 95.5% 95.7% 100.0% 95.0% 93.5% 96.2% 100.0% 96.0% 92.3% 100.0%

CPA 7 Day Follow Up (SS) NHSI 95.00% - - - 100.0% 100.0% 100.0% 50.0% 100.0% 0.0% 80.0% 50.0% 100.0% 100.0%

CPA 12 Month Review (Total Network Performance) NHSI 95.00% - - - 97.3% 97.7% 96.7% 97.0% 97.5% 97.0% 97.2% 95.9% 95.7% 96.8%

CPA 12 Month Review (AMH) NHSI 95.00% 96.3% 96.8% 97.4% 96.9% 97.4% 96.3% 96.6% 97.3% 96.5% 96.8% 95.3% 95.1% 96.3%

CPA 12 Month Review (OA) NHSI 95.00% 98.1% 98.5% 98.8% 100.0% 99.7% 100.0% 100.0% 100.0% 99.7% 100.0% 99.1% 98.4% 99.7%

CPA 12 Month Review (SS) NHSI 95.00% 98.8% 99.4% 98.8% 100.0% 100.0% 98.2% 98.2% 97.0% 100.0% 98.8% 100.0% 100.0% 99.4%

Delayed Transfers of Care (Total Network Performance) NHSI ≤ 7.50% - - - 4.20% 4.79% 3.76% 2.60% 2.39% 3.10% 3.33% 3.48% 2.89% 2.39%

Delayed Transfers of Care (AMH) NHSI ≤ 7.50% 3.35% 2.96% 1.82% 1.23% 3.06% 3.66% 2.19% 2.27% 3.26% 3.42% 2.94% 2.31% 1.06%

Delayed Transfers of Care (OA) NHSI ≤ 7.50% 3.44% 11.77% 16.59% 14.48% 10.34% 4.11% 3.92% 2.70% 3.27% 2.06% 3.08% 2.72% 4.03%

Delayed Transfers of Care (SS) NHSI ≤ 7.50% 0.85% 1.66% 1.35% 2.41% 2.77% 3.91% 3.80% 3.08% 2.74% 3.85% 4.61% 4.00% 3.82%

IP Access to Crisis Res. Treatment (Gatekeeping) NHSI 95.00% 99.4% 98.9% 98.3% 100.0% 100.0% 98.6% 99.4% 97.7% 100.0% 100.0% 99.5% 100.0% 100.0%

MH Data Completeness - Identifiers NHSI 97.00% - - - - - - - - 99.6% 99.6% 99.7% 99.5% 99.5%

MH Data Completeness - Identifiers (AMH) NHSI 97.00% 99.7% 99.6% 99.6% 99.7% 99.7% 99.7% 99.8% 99.7% - - - - -

MH Data Completeness - Identifiers (SS) NHSI 97.00% 98.1% 97.9% 98.1% 98.1% 97.9% 98.4% 98.4% 98.5% - - - - -

MH Data Completeness - Outcomes NHSI 50.00% - - - - - - - - 85.8% 84.8% 84.5% 84.6% 84.5%

MH Data Completeness - Outcomes (AMH) NHSI 50.00% 82.2% 83.7% 84.4% 85.1% 85.3% 85.2% 85.2% 85.4% - - - - -

MH Data Completeness - Outcomes (SS) NHSI 50.00% 84.0% 84.2% 84.3% 85.1% 83.4% 82.5% 81.3% 79.6% - - - - -

Other Indicators

AQ Dementia (OA) (1 month in arrears) NHSE 59.30% 100.0% 100.0% 100.0% 90.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% -

Memory Assessment Service (MAS) seen within 6 weeks (OA) NHSE 70.00% 34.4% 37.4% 40.5% 40.2% 39.5% 25.7% 40.3% 48.4% 47.0% 52.1% 70.4% 79.8% 80.4%

PBR Clustering NHSE 95.00% 93.5% 94.1% 94.2% 96.1% 96.4% 96.8% 96.4% 96.5% 96.5% 96.6% 96.7% 96.4% 95.7%

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (Total Network

Performance)NHSE 0

355 418 407 331 307 313 255 260 267 255 211 233 210

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (AMH) NHSE 0 284 326 324 292 266 262 222 253 245 243 187 203 183

No of Patients without a Care Co-ordinator Allocated > 2 Weeks (SS) NHSE 0 71 92 83 39 41 51 33 7 22 12 24 30 27

MHLT

MHLT 1hr compliance Commissioners 95.00% 54.3% 55.2% 37.8% 52.6% 45.7% 46.9% 38.7% 51.8% 51.6% 45.9% 47.5% 40.8% 39.2%

No of 4hr breaches (Percentage of total) 5.00% 0.0% 0.0% 4.8% 10.1% 7.7% 11.2% 15.4% 9.7% 9.5% 11.4% 14.8% 16.1% 19.1%

No of 4hr breaches (Number of breaches) 34 - - 25 53 49 75 102 71 67 79 110 116 129

No of 12hr breaches (Percentage of total) 0.00% - - 1.5% 2.1% 0.9% 1.5% 1.2% 3.3% 0.9% 1.4% 4.0% 1.8% 2.5%

No of 12hr breaches (Number of breaches) 0 - - 8 11 6 10 8 24 6 10 30 13 17

Stretch

Stretch

43 of 198

2.1 Performance Activity Summary – Mental Health (Secure)

23


Sparkline

Secure Mental Health Business Unit

Overall Gross Occupancy NHSE 93.00% 90.5% 90.7% 90.5% 90.5% 90.2% 91.8% 93.3% 93.7% 97.2% 95.9% 96.0% 94.2% 91.3%

Violent Incidents resulting in Restraint Stretch ≤ 20.00% 23.6% 35.4% 23.8% 20.3% 16.1% 20.8% 17.5% 20.5% 18.4% 15.6% 22.2% 27.1% 17.2%

% of SU that have had a CPA Review in last 6 months Stretch 100% 100.0% 99.3% 100.0% 100.0% 100.0% 100.0% 99.3% 99.3% 98.0% 97.4% 96.1% 94.5% 97.2%

% of service users who have a Care Coordinator allocated within 2 weeks Stretch 100% - - - 60.0% 62.5% 75.0% 77.8% 75.0% 66.7% 100.0% 50.0% 66.7% 99.3%

% of CPA reviews attended by Local Care Coordinators Stretch 80% - - - 37.5% 50.0% 25.0% 42.9% 39.3% 65.2% 33.3% 51.7% 42.9% 44.0%

% of service users who have Cardiometabolic risk factors assessed within 12

months Stretch 90% - - - 94.4% 94.6% 96.0% 89.7% 96.8% 100.0% 100.0% 99.4% 100.0% 100.0%

25hrs Meaningful Activity - Offered NHSE 100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

25hrs Meaningful Activity - Uptake NHSE 100% 88.4% 80.7% 87.9% 82.4% 82.8% 85.0% 80.4% 79.9% 75.6% 82.3% 81.3% 86.8% 74.1%

Community Business Unit

% of caseload with a Local Care Coordinator allocated Stretch 100% - - - 89.8% 96.1% 96.0% 97.9% 100.0% 95.3% 97.0% 95.5% 100.0% 97.0%

% of caseload carried longer than 12 months post SMHBU discharge Stretch ≤ 20.00% - - - 57.1% 58.8% 72.0% 66.7% 74.0% 60.9% 60.6% 59.7% 63.5% 58.2%

% of CPA Reviews Attended by Local Care Coordinators / Local Teams Stretch 80% - - - 42.9% 50.0% 62.5% 75.0% 30.0% 33.3% 40.0% 54.5% 33.3% 50.0%

No of Incidents exceeding PACE Clock Commissioners 0 3 8 6 4 3 4 3 5 7 3 4 5 5

Health & Justice Business Unit - HMP Liverpool

GP Waits over 2 Weeks NHSE 0% 37.6% 44.9% 43.6% 52.6% 64.1% 55.0% 59.5% 64.2% 49.4% 22.8% 0.0% 18.8% 43.6%

NHS Health Checks NHSE 40.00% 8.4% 6.1% 13.5% 19.8% 3.6% 26.1% 13.2% 8.9% 1.9% 57.1% 28.6% 14.3% 22.6%

Well Man Assessment completed NHSE 100.00% - - - 98% 98% 97% 95% 89% 75% 63% 33% 96% 120%

Hep B Vaccinations completed NHSE - - - 0.0% 25.0% 30.4% 25.0% 0.0% 3.7% 0.0% 8.6% 0.0% 0.0%

Chlamydia Screening U25's Uptake NHSE 50.00% 2.2% 11.0% 8.8% 6.3% 20.7% 14.3% 33.3% 5.3% 13.0% 27.3% 63.6% 100.0% 21.4%

Men C Vaccinations Uptake NHSE 95.00% 9.6% 10.7% 12.8% 5.7% 5.7% 12.2% 4.9% 2.6% 2.4% 21.1% 44.7% 5.3% 7.7%

MMR Vaccinations Uptake NHSE 95.00% 17.5% 10.5% 21.7% 50.0% 4.4% 11.1% 0.0% 14.3% 23.8% 3.6% 2.3% 2.3% 1.0%

Prison 6 Month CPA Reviews NHSE 100.00% - 100.0% 100.0% 100.0% 100.0% - 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

QOF NHSE 238 256 266 302 322 327 323 314 319 316 323 334 354 385

44 of 198

2.1 Performance Activity Summary – Community & Wellbeing

24

Indicators achieved Target Type Target Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17Rolling 12 Month

Sparkline

NHS Improvement

Delayed Transfers of Care NHSI <7.5% - - - - - - - 0.0% 0.0% 0.0% 0.0% 7.9%

RTT - Consultant Led (Completed Pathway) NHSI 95% 93.2% 92.4% 95.2% 96.3% 96.7% 97.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

RTT - Consultant Led (Incomplete Pathway) NHSI 92% 95.7% 96.3% 95.2% 95.4% 97.3% 100.0% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0%

RTT - IAPT 6 Weeks NHSI 75% 90.8% 95.0% 93.0% 96.5% 95.1% 95.7% 93.4% 96.4% 94.7% 95.1% 94.5% 94.4%

RTT - IAPT 18 Weeks NHSI 95% 99.1% 99.3% 99.0% 99.8% 99.4% 99.8% 98.8% 99.4% 99.2% 99.7% 99.3% 99.4%

Waiting Times - AHP RTT

Adult Learning Disability Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Stroke Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Intermediate Care NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Podiatry NHSE 95% 100.0% 100.0% 99.9% 100.0% 100.0% 99.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Pulmonary Rehabilitation NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Rapid Assessment Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Adult Speech and Language Therapy NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 100.0% 100.0% 98.6% 100.0%

Community Neuro Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Respiratory Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Continence Service NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.8% 100.0% 100.0% 98.5%

Domiciliary Physiotherapy NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Falls Team NHSE 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5% 100.0% 100.0%

Nutrition & Dietetics NHSE 95% 97.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Other Indicators

RTT Complete Learning Disablity Commissioner 95% 98.4% 97.3% 98.1% 98.8% 98.9% 98.9% 100.0% 98.7% 96.1% 96.3% 99.2% 99.2%

12 Week Dentist Waits - HMP Liverpool Commissioner 95% 93.0% 95.7% 100.0% 98.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Dental Waits Commissioner 95% 91.1% 88.9% 91.2% 95.2% 96.1% 98.0% 99.4% 97.1% 98.3% 100.0% 97.5% 98.2%

Unallocated Cases NHSE 0 15 8 12 11 12 12 7 15 13 2 7 19

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2.1 Performance Activity Summary – Community & Wellbeing

25

Indicators achieved Target Type Target Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17Rolling 12 Month

Sparkline

IAPT

IAPT in Month Prevalence Trust NHSE 1.38% 1.39% 1.44% 1.39% 1.67% 1.28% 1.72% 1.06% 1.33% 1.44% 1.33% 1.27%

IAPT in Month Prevalence

Blackburn with Darwen CCGNHSE 1.02% 1.31% 1.56% 1.02% 1.22% 1.32% 1.26% 0.89% 0.82% 2.03% 1.25% 1.39% 1.52%

IAPT Quarterly Cumulative Prevalence

Blackburn with Darwen CCGNHSE - - - - - - - 0.82% 2.85% 4.10% 5.49% 7.01%


East Lancashire CCGNHSE 1.32% 1.32% 1.14% 1.30% 1.05% 1.56% 1.11% 1.77% 1.00% 1.13% 1.64% 1.42% 1.22%

IAPT Cumulative Prevalence

East Lancashire CCGNHSE - - - - - - - 1.00% 2.13% 3.76% 5.19% 6.41%


Chorley & South Ribble CCGNHSE 1.32% 1.28% 1.26% 1.40% 1.42% 1.59% 1.08% 1.44% 1.29% 1.53% 1.47% 1.31% 1.45%


Chorley & South Ribble CCGNHSE - - - - - - - 1.29% 2.81% 4.29% 5.60% 7.05%


Greater Preson CCGNHSE 1.32% 0.89% 1.06% 1.45% 1.14% 1.24% 1.18% 1.20% 0.92% 1.38% 1.46% 1.41% 1.07%


Greater Preson CCGNHSE - - - - - - - 0.92% 2.30% 3.76% 5.17% 6.23%


West Lancashire CCGNHSE 1.32% 1.75% 1.36% 1.02% 1.26% 1.71% 0.83% 1.53% 1.13% 1.51% 1.34% 1.08% 1.48%


West Lancashire CCGNHSE - - - - - - - 1.13% 2.64% 3.98% 5.06% 6.54%


Fylde and Wyre CCGNHSE 1.32% 1.02% 1.29% 0.95% 1.55% 1.33% 0.96% 1.40% 1.23% 1.33% 1.36% 1.44% 1.35%


Fylde and Wyre CCGNHSE - - - - - - - 1.23% 2.55% 3.91% 5.35% 6.70%


Morecambe Bay CCGNHSE 1.32% 0.99% 1.16% 1.19% 1.64% 1.31% 1.22% 1.41% 1.34% 1.07% 1.40% 1.46% 1.32%


Morecambe Bay CCGNHSE - - - - - - - 1.34% 2.41% 3.81% 5.27% 6.59%


St. Helen's CCGNHSE 1.25% 0.97% 0.96% 1.26% 0.74% 1.31% 1.02% 1.67% 0.88% 1.13% 1.31% 1.07% 1.09%

IAPT Cumulative Prevalence Trust NHSE - 8.93% 10.32% 11.76% 13.15% 14.82% 16.10% 17.82% 1.06% 2.39% 3.83% 5.16% 6.43%


St. Helen's CCGNHSE 0.00% - - - - - - - 0.88% 2.01% 3.32% 4.39% 5.48%

IAPT Waiting Times (Internal Target) Stretch 0pts >26 wks - - - - - - - 22 23 23 25 14

IAPT Recovery NHSE 50% 52.2% 51.8% 56.3% 56.3% 53.8% 57.0% 53.4% 54.5% 52.6% 57.0% 50.0% 55.1%

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2.1 Performance Activity Summary – Children & Young People’s Wellbeing

26

Note:

• Narrative not provided as this measure is to be superseded by new EIS measures (dashboard) currently in development.


Sparkline

NHS Improvement

CPA 7 Day Follow Up NHSI 95.00% 100.0% 100.0% 75.0% 100.0% 100.0% 100.0% 100.0% 95.5% 100.0% 100.0% 100.0% 88.9% 100.0%

CPA 12 Month Review NHSI 95.00% 97.2% 98.2% 98.8% 97.6% 98.3% 99.5% 98.5% 97.9% 97.5% 95.6% 99.0% 99.5% 100.0%

MH Data Completeness - Identifiers NHSI 97.00% 99.7% 99.7% 99.6% 99.7% 99.7% 99.7% 99.7% 99.7% 99.6% 99.6% 99.7% 99.6% 99.6%

MH Data Completeness - Outcomes NHSI 50.00% 67.3% 67.3% 67.1% 67.2% 66.3% 64.8% 81.3% 64.9% 63.5% 60.7% 59.3% 58.1% 57.9%

2 Week wait for Treatment for EIP Programme NHSI 50.00% 67.7% 75.0% 69.0% 74.3% 76.7% 82.0% 81.4% 74.4% 69.0% 83.3% 90.9% 70.4% 78.9%

Waiting Lists - RTT 18 Weeks (Completed Outcomes)

EIS Therapies (The Hub) NHSE 95.00% 97.6% 92.5% 86.8% 90.3% 93.0% 83.9% 80.0% 94.7% 92.7% 94.7% 100.0% 97.6% 95.7%

Child Psychology - Total Network Performance NHSE 95.00% 68.6% 67.6% 70.7% 69.9% 70.9% 71.0% 60.3% 64.8% 66.6% 62.4% 66.9% 74.1% 77.7%

CAMHS Tier 3 - Total Network Performance NHSE 95.00% 96.7% 99.3% 96.4% 99.0% 97.5% 100.0% 98.1% 88.8% 79.4% 78.0% 78.4% 68.1% 64.5%

Waiting Lists - RTT 18 Weeks (Incompleted Outcomes)

CITNS - Occ Therapy - Total Network Performance NHSE 92.00% 67.1% 80.6% 83.1% 81.8% 81.8% 88.2% 91.2% 95.1% 94.9% 94.0% 96.4% 99.1% 96.3%

CITNS - Physiotherapy - Total Network Performance NHSE 92.00% 100.0% 100.0% 100.0% 100.0% 100.0% 98.1% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

CITNS - SLT- Total Network Performance NHSE 92.00% 85.5% 91.7% 92.6% 86.9% 86.9% 86.6% 83.6% 82.7% 84.2% 86.7% 87.0% 88.4% 96.2%

CAMHS Tier 4

Bed Occupancy - The Cove NHSE 85.00% 84.0% 88.8% 83.0% 65.0% 55.0% 65.5% 80.5% 90.5% 92.8% 86.5% 96.7% 94.6% 68.8%

Average Length of Stay (days) - The Cove Bench 83 55.00 54.00 80.00 78.00 57.00 44.00 41.00 39.00 67.00 57.00 33.30 60.70 27.70

National Child Measurement Programme

NCMP - Central NHSE 90.00% - - 4.4% 19.3% 26.8% 39.5% 52.6% 64.5% 73.8% 88.7% 94.4% - -

NCMP - BwD (Cumulative) NHSE 95.00% - - 5.5% 17.8% 24.9% 37.1% 46.3% 60.2% 67.6% 82.2% 95.7% - -

NCMP - East (Cumulative) NHSE 90.00% - - 9.1% 21.9% 30.3% 44.3% 56.0% 67.9% 79.5% 93.0% 98.5% - -

Other Indicators

ADHD - NEW < 18 Weeks NHSE 95.00% 61.4% 57.5% 64.3% 61.7% 59.9% 63.9% 68.4% 62.3% 53.6% 61.0% 64.3% 77.3% 79.1%

PBR Clustering NHSE 95.00% 96.1% 97.0% 95.7% 94.9% 93.6% 96.2% 96.3% 95.4% 96.0% 97.2% 96.4% 96.5% 95.1%

Number of Patients without a Care Co-ordinator Allocated > 2 Weeks NHSE 0 14 16 16 13 14 8 18 29 23 5 4 2 2

47 of 198

2.1 Performance Activity Community Wellbeing - DToC

27

DToC:

The DToC breach was due to 1 community patient. Delays with social worker allocation combined with family choice for residential care

home placement resulted in a breach by 31 days in August.

The community ward has put a process in place to closely monitor delayed discharges but do not feel on this occasion there was a set of

unforeseen circumstances and there is no emerging theme.


- 0.0% 0.0% - -

- - - - -

0.0% 0.0% 0.0% 0.0% 0.0%

0.0% 0.0% - - -

0.0% 0.0% 0.0% 0.0% 0.0%

0.0% 0.0% 0.0% 0.0% 8.5%

- - - - -

- - - - -


NHS Blackpool CCG


DToC CCG







Aug-17

0

0

0

0

0

0

0

0

0

1

0

1

Breach Reason MH

Other

Total Number of Breaches

Awaiting Public Funding

Awaiting Residential Home Placement

Disputes

Housing

Patient or Family Choice

Awaiting Care Package in own Home

Awaiting Community Equipment

Awaiting Completion of Assessment

Awaiting further Non-acute

Awaiting Nursing Home Placement

Actions: Due: Owner: Outcome:

Daily monitoring of DToC patients Sep-17 Ward Manager

48 of 198

2.1 Patient Flow Mental Health – Mental Health Liaison Team (MHLT)

28

MHLT:

1 Hour Compliance:

The Network is reporting low compliance in the target for patients to be seen within 1 hour of referral, with 39.2% compliance in M5.

4 Hours Breaches:

The Network is reporting 129 actual 4 hour breaches in A&E for which LCFT were responsible in month 5, reporting 80.9% compliance.

12 Hours Breaches:

The Network is reporting 17 actual 12 hour breaches in A&E from the decision to admit time in month 5, this is 2.5% of all A&E referrals to

MHLT.


1. A gap analysis of the MHLT Pathway has taken place. Further action plans

are being developed for each Acute Trust to determine the timelines for all

planned changes to the service to be implemented.

Sep-17

Network

Knowledge

Manager and

TAS

2. Bid submitted for monies to the early introduction of MH triage in A&E,

Consultant Psychiatry in A&E and the MHAL. Sep-17

Network

Knowledge

Manager and

TAS

3. CORE 24 workshops in progress for development of the working models. Apr-18 Deputy Head

of Operations

49 of 198

2.1 Patient Flow Mental Health – Mental Health Liaison Team (MHLT)

29

50 of 198

30

Occupancy:

It is noted that throughout August, occupancy levels across the Service have fallen below the contracted threshold. The

following rationale illustrates the reasons for the monthly fall in bed occupancy:

• Greenside Male MSU had 1 vacancy - allocated to SU from Ashworth awaiting Ministry of Justice (MOJ) permission before

the Service is able to admit

• Dutton Male LSU had 1 vacancy - allocated to SU awaiting MOJ permission before the Service is able to admit

• Fairoak Ward Male LSU had 3 vacancies - 2 of the vacancies are for SUs stepping down and awaiting MOJ permission

before the Service is able to admit

• Bleasdale ABI Medium had 2 vacancies - 1 allocated to SU in Ashworth awaiting MOJ permission to step down

• Whinfell ABI Medium had 1 vacancy - SU on waiting list, unable to admit until current physical health treatment complete

• Langden Ward Male LSU ABI had 2 vacancies - 1 allocated to SU awaiting MOJ permission to step down and 1 SU on

waiting list being reviewed again for suitability

• Hermitage ABI/MI Step down Community House had 1 vacancy

2.1 Performance Activity Mental Health (Secure Services) – Occupancy


NHSE are working with the MOJ to progress the backlog of outstanding

applications. A list is of all outstanding applications is being compiled. 12-Sep-17

Service

Manager

OBD Available beds %

2144 2325 92.22%

1587 1736 91.42%

912 1023 89.15%

4643 5084 91.33%

Low Secure Wards

Step down Wards

Total

Aug-17

Medium Secure Wards

51 of 198

31

Violent Incidents resulting in Restraint:

In August 2017, staff reported a total of 122 incidents of verbal and physical violence within the inpatient unit. This equates to a

27% increase in reported violence month on month, increasing from 96 recorded incidents in July 2017. August saw the overall

use of restraint decrease, with 17% of violent incidents ending in restraint compared to 30% in July 2017.

Elmridge ward continues to have above higher than average levels of restraint, although this has decreased significantly to 8 in

August compared to previous months. A service user on Greenside has had a number of incidents in August whilst being

nursed in long term seclusion, however this service user is now awaiting transfer to high secure care. Datix reports show that

there was 1 incident of unintentional prone restraint used in August 2017 on Elmridge ward.

Positively, it is noted that 70% of restraints involved less restrictive techniques such as walking with the service user and

placing them in a seated position.

2.1 Performance Activity Mental Health (Secure Services) – Violent Incidents

resulting in Restraint

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32

2.1 Performance Activity Mental Health (Secure Services) – Violent Incidents

resulting in Restraint


1. The Service Manager meets monthly with Clinical Leads and Lead Nurse

to review areas where violence is seen to have increased, and to facilitate

extra support.

End of

Quarter 4

Care Group

Manager

This is occurring on a daily basis in

the Service safety huddle.

2. The Service is reviewing its VR trainers as a number have now left the

Service and have identified three individuals to support the training.

End of

Quarter 3

Care Group

Manager

Applications to be supported and

training places attended.

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33

CPA Reviews within 6 Months:

In August, 4 out of 143 eligible service users have not had a CPA within the last 6 months.

All four have been rescheduled to take place before the first week in October. Reasons for these postponements are due to sickness

within the MDTs, link workers being unavailable and changes in ward/RC.

Through monitoring of the planned reviews, the service is aware that potentially three reviews will fail next month due to existing date

changes.

2.1 Performance Activity Mental Health (Secure Services) – CPA Reviews

Within 6 Months


1. The Performance Analyst is continuing to monitor all service users who

are due a CPA review in the coming months to ensure that they have a

meeting scheduled and that this falls within the 6 month timeframe.

End of

Quarter 2

Performance

Analyst This will be continuing monthly.

2. Review the process for arranging CPA reviews. Sep-17 Performance

Analyst

This has been extended as a role

review is involved.

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34

Local Care Co-ordinator >2weeks:

Further discussion has taken place regarding this indicator and it has been agreed to follow the Trust principle for the reporting of

unallocated cases. Therefore, the indicator now looks at the number of service users that have been allocated a Local Care Co-ordinator

within 2 weeks of admission of the total population.

Failure to meet 100% target was due to a complex case for one service user. Challenges allocating a link worker where the primary

reason due to their diagnosis. This case has been escalated to the relevant locality Care Group Manager.

2.1 Performance Activity Mental Health (Secure Services) – Local Care Co-ordinator

within 2 weeks of admission


Escalation for allocation for service user. 17-Sep-17 Service

Manager

This case has been escalated to the relevant locality

Care Group Manager and is due to be followed up

w/c 11th September 2017.

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35

Attendance of CPA reviews:

Of the 25 CPAs planned for August, 11 local care co-ordinators attended, 4 sent apologies and 10 did not attend.

Teams are now sharing the next three months’ CPA dates to help improve coordination along with the promotion of Skype as another

initiative to help improve CPA attendance.

2.1 Performance Activity Mental Health (Secure Services) – Attendance of

CPA reviews

Attended Apologies DNA

22 10 2 10

3 1 2 0

Breakdown of LCCNo of CPA

reviews

LCFT LCC

Non LCFT LCC

Aug-17


1. Upcoming CPA dates for the next 3 months will continue to be

forwarded to the relevant community team managers, to allow

coordination in advance, to promote further attendance.

11-Aug-17 Performance

Analyst

The CPA dates for August and September

have been forwarded to the CGMs for

dissemination within their teams.

2. The promotion of Skype is to be reiterated to the Senior MDT

secretaries to ensure it is being offered on all invites. Failure to

provide Skype, as requested, has been escalated with the admin

manager to address during supervision.

End of

Quarter 2

Performance

Analyst

3. Network to identify individual non-attendances for performance or

capacity issues.

End of

Quarter 2

Care Group

Manager

This is being raised monthly to team

managers and other care group managers.

This is also being raised at the networks

tactical meeting.

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36

25hr Meaningful Activity:

In August, 5 wards failed to meet the 100% target in relation to meaningful activity uptake. Uptake has decreased from 86.84% in July to

74.15% in August.

During August, Calder ward has been without a ward manager and has experienced varied levels of acuity. A ward manager is now in

place and a 2nd team leader will be in place from October, meaning levels of recording are expected to improve.

On Dutton ward, there are service users within the group who are reluctant to engage and their activity can therefore be limited and

unpredictable. It has also become clear that there has been some under-recording as it has been established there are at least 2 service

users within the group who have taken up more than 25 hours activity, despite records indicating otherwise.

On Mallowdale ward, uptake has increased significantly from 0% in July to 62.5% in August. Work continues within the team to support

service users to take up the opportunities of activity both on and off the ward and accurately record activity.

On Marshaw ward, uptake has decreased significantly. This has been due to increased levels of acuity on the ward. The sickness level is

also high which has resulted in high levels of bank and agency usage which may account for reduced recording and reluctance of service

users to proactively engage.

Following a period of improvement over recent months, the uptake of activity has decreased on Fairoak during August. This appears to be

due to a lack of recording rather than a reduced uptake of activity.

2.1 Performance Activity Mental Health (Secure Services) – 25hr Meaningful Activity

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37

2.1 Performance Activity Mental Health (Secure Services) – 25hr Meaningful Activity


1. Lead OT to meet with clinical Audit Team to agree the set of

standards to audit for 25hr meaningful activity in September. 01-Dec-17

Care Group

Manager

2. To promote the 25 hour activity with the 2 service users on Forest

Beck ward and aim for at least 25 hours of engagement each week. 01-Sep-17

Care Group

Manager

Forest Beck reported 100% uptake of 25

hours structured activity for August, staff

will continue to promote this with the

service users.

3. The Ward Manager and Team Leader on Fairoak ward will work

with the named nurses for the 6 service users, who have not achieved

25 hours structured activity, with a view to gaining a greater

understanding of the importance of structured activity on well being.

31-Oct-17 Care Group

Manager

The Ward Manager has met with the

Team Leader and staff to ensure that 25

hours activity is discussed at the end of

each shift.

4. The Ward Manager and Team Leader on Mallowdale will work with

the named nurses and the ward based occupational therapy assistant

in supporting the service users to take up the opportunities of

activities both on and off the ward.


Manager

Mallowdale reported a significant

increase in uptake for August. Work

continues in supporting service users to

take up activities. 5. Meaningful activity levels on Hermitage have dropped with one

service user in an induced coma - and another on extended leave.

The recording of activity was incorrect and this will be reviewed and

corrected next month.


Manager

The Hermitage reported 100% uptake of

25 hours structured activity during

August. Work continues to improve

reporting.

6 Marshaw ward will have a new OT Assistant in post with effect from

mid-September. The new Ward Manager is working with staff to

ensure that weekly activity plans are formulated. 31-Oct-17

Care Group

Manager

7. The Ward Manager and Team Leader on Fairoak ward will ensure

that 25 hours activity is a standing agenda item on the team debrief at

the end of every shift. 31-Oct-17

Care Group

Manager

8. The Ward Manager and Team Leader on Fairoak ward will check

daily that staff on duty are completing the activity recording form. 31-Oct-17

Care Group

Manager

58 of 198

2.1 Performance Activity Mental Health (Secure Services) – % of FCMHT

Caseload with Care Co-ordinator allocated

38

% of FCMHT Caseload with Care Co-ordinator allocated:

Compliance has reduced to 97.01% for August.

All patients discharged to the community have a Local Care Co-ordinator.


The team will continue to monitor allocations to Local Care Co-

ordinators. If any concerns over allocation are experienced these will be

escalated to the manager to resolve.

End of

Quarter 2

Care Group

Manager

59 of 198

39

% of FCMHT Caseload >12 months:

There are currently 67 service users on the FCMHT case load, 39 of these service users have been on the FCMHT case load for over 12

months.

Pathways have been reviewed for the caseload and it is apparent that the current target of less than 12 months is clinically unrealistic and

that a more robust and clinically safe pathway takes significantly longer to achieve. A sustainable pathway into locality community

services reduces risk of reoffending/readmission.

2.1 Performance Activity Mental Health (Secure Services) – % of FCMHT

Caseload >12 months


The service manager will continue to work with the team to review

pathways and the continued need for intensive input by the

FCMHT.

End of

Quarter 3

Care Group

Manager

Continued FCMHT input is dictated by a

balance of risk, legal status and psychological

need and now reviewed on a weekly basis.

60 of 198

40

Attendance of CPA Reviews within Community Services:

In August, 2 out of 4 CPA reviews were attended by the local care co-ordinators.

The FCMHT continues to work with all local care co-ordinators to improve attendance. Out of those not attended, any actions/minutes will

be communicated. No delayed transfers of care have resulted from local care co-ordinator non-attendance.

2.1 Performance Activity Mental Health (Secure Services) – Attendance of

CPA Reviews within Community Services


1. Send out reminders to all CMHTs that attendance at CPAs is essential

and that a deputy should attend if the care co-ordinator is not available.

End of

Quarter 2

Service

Manager

2. Reiterate the availability of Skype. End of

Quarter 2

Service

Manager

3. Care Group Manager to raise the importance of attendance at CPAs at the

Care Group Managers meeting. 31-Aug-17

Care Group

Manager This is being raised at each meeting.

4. Network to identify individual non-attendances for performance or capacity

issues.

End of

Quarter 2

Care Group

Managers

61 of 198

2.1 Performance Activity Mental Health (Secure Services) – Number of

Incidents exceeding PACE Clock

41

Number of Incidents exceeding PACE Clock:

There were 5 reported episodes of individuals being detained in Police Custody beyond the 24 hour limit.

Since the implementing the PACE breach reporting via DATIX, there has been a significant improvement in the process of accessing

and allocation of beds for persons in police custody. The relationship between Criminal Justice Liaison & Diversion (CJL&D) and the bed

management hub has developed into one of understanding and proactive responsiveness. There are now excellent lines of

communication between CJL&D and Senior Management within Adult Mental Health services.


The PACE breach escalation plan continues to be followed for all PACE breaches.

This enables senior managers to unlock any blocks which can be addressed to

resolve potential PACE breaches. The level of incidents will continue to be

monitored to ensure the process continues to deliver improvement.

End of

Quarter 2

Team

Managers

62 of 198

HMP Liverpool – HJIP Indicators:

GP Waiting Times:

There are currently 220 patients on the GP waiting list with the longest wait 15 working days, an increase of 3 days from July. The increase

was due to four lost clinic sessions due to the bank holiday, prison shutdown and no GP because of Eid celebrations. This is the equivalent

of 50 lost appointments. The DNA figure was down by 3% to 30.4% but this is still significantly above acceptable levels. The subject of

DNAs due to prison enabling was on the agenda of the Local Delivery Group meeting with the prison which was scheduled for 9th August

but this had to be cancelled due to insufficient attendance of the Governor grade.

NHS Health Checks:

Of the 31 patients eligible for the NHS Health Check at the beginning of August, 16 patients were offered appointments. Of the 16 offered,

only 7 were seen as 9 either did not attend or refused on the day. Of the 359 new receptions in August, a total of 143 patients declined the

NHS Health Check and a further 185 were not eligible.

Wellman Screening:

There were 432 Wellman screenings completed during August, which is in excess of the 359 new receptions. This is as a result of the

catch-up screening programme, which aims to screen any service users who have previously been missed through either being moved to

other areas of the prison before screening, refusing to take part or being transferred straight to segregation.

Immunisations and Vaccinations:

The Immunisation and Vaccinations clinics have been affected by the Smoke Free campaign currently being run in the prison and also by

annual leave. HMP Liverpool has to be smoke free by the 25th September and this is utilising substantial staff resources. Despite this, staff

are still managing to facilitate more clinics than they are actually profiled to do.

DNA - Enablement Issues:

This continues to be the biggest obstacle to overcome for Healthcare. The Local Delivery Group meeting scheduled for 9th August, where

this issue was due to be discussed, had to be cancelled due to lack of attendance by the prison Governor grades. Healthcare continue to

report DNA rates daily at the morning meeting, however there remains a lack of co-operation to address the issue. A HMIP and CQC

inspection is scheduled for 11th September and Healthcare will be raising this issue.

2.1 Performance Activity Mental Health (Secure Services) – HMP Liverpool

HJIP Indicators

42

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2.1 Performance Activity Mental Health (Secure Services) – HMP Liverpool

HJIP Indicators

43


1. The issue of enablement is to be raised again at the Local Delivery

Group Meeting on the 9th August and await feedback from the

Governor.

09-Aug-17 Care Group

Manager

Meeting was cancelled due to lack of

Governor attendance. Due to be

rescheduled after a new link governor

has been appointed.

2. Primary Care staff have been asked to target more appointments for

NHS Healthchecks for August. 31-Aug-17

Care Group

Manager

There was an increase and staff will

continue to target this area of service.

3. Wellman Screening will continue to target new receptions and also

older receptions who were not screened. End of

Quarter 2

Care Group

Manager

Considerable progress has been made

in this area and the waiting list greatly

reduced.

4. Primary Care staff have been asked to target more MMR and Men C

vaccinations during August to reduce the eligible totals. 31-Aug-17

Care Group

Manager

This was not as successful as hoped

with staff focusing more on Hep B.

5. Notification was received in July of a shortage of Hep B vaccinations.

Healthcare currently have some stock and are closely monitoring levels. 31-Aug-17

Care Group

Manager

LM has been tasked with targeting the

U25s in September and will monitor the

DNA rate for this.

64 of 198

2.1 Performance Activity Mental Health (Secure Services) – HMP Liverpool HJIP

Indicators

44


261 336 358 422 359

27 35 35 99 55

1 0 3 0 0

31 61 72 53 54

15 24 21 17 22

9 17 27 14 9

4 14 16 10 11

3 6 8 12 12

3.70% 0.00% 8.57% 0.00% 0.00%

Total vaccinations in month

Breakdown of

vaccinations given

Booster

% patients accepting within 4 wks

Vaccinations

No. of new receptions

No. of patients accepting Hep B

Patients vaccinated >4wks

1st dose

2nd dose

3rd dose


261 336 358 422 359

196 211 117 406 432

75.10% 62.80% 32.68% 96.21% 120.33%

Wellman Checks

No. of new receptions

No. of Wellman checks completed

% completed


11 29 21 16 27

19 18 39 54 28

52 31 45 47 69

80 23 0 27 96

GP Waits

0-2 days

3-7 days

8-14 days

14+ days

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17

192 167 165 134 258 247 103 14 14 21 31

13.54% 19.76% 3.64% 26.12% 13.18% 8.91% 1.94% 57.14% 28.57% 14.29% 22.58%

34 32 29 28 18 19 23 11 11 6 14

8.82% 6.25% 20.69% 14.29% 33.33% 5.26% 13.04% 27.27% 63.64% 100.00% 21.43%

39 35 35 41 41 38 41 38 38 19 26

12.82% 5.71% 5.71% 12.20% 4.88% 2.63% 2.44% 21.05% 44.74% 5.26% 7.69%

23 10 23 27 25 21 21 225 132 129 203

21.74% 50.00% 4.35% 11.11% 0.00% 14.29% 23.81% 3.56% 2.27% 2.33% 0.99%

1 2 1 0 5 2 6 2 2 4 1

100.00% 100.00% 100.00% - 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Patients received NHS

HC Screen

Patients Accpeting

Men C Vacc

Patients Accpeting

MMR Vacc

SU received CPA

review <6 months

Total Eligible

% Screened

Total Eligible

% Recieved

Total Eligible

% Recieved

Total Eligible

% Recieved

Patients Screened for

Chlamydia

Total Eligible

% Screened

65 of 198

2.1 Performance Activity Community & Wellbeing – Improving Access to

Psychological Therapies (IAPT) Prevalence

45

IAPT - Prevalence:

East Lancs CCG teams have not met prevalence in Month 5. The teams were 45 patients away from meeting Month 5 target, however

based on the Quarter 2 target, the teams are 6 patients above the expected number required (combination of Quarter 2 figures for July and

August).

Greater Preston CCG team have not met prevalence in Month 5. The team are 64 patients away from meeting Month 5 target, and 41

patients away from meeting the Quarter 2 target (combination of Quarter 2 figures for July and August). The deficit of 41 patients has been

added to the prevalence target for September.

St Helens CCG team have not met prevalence in Month 5. The team are 46 patients away from meeting Month 5 target, and 98 patients

away from meeting the Quarter 2 target (combination of Quarter 2 figures for July and August). The deficit of 98 patients has been added to

the prevalence target for September.

A cumulative prevalence model is in place to direct and support teams to achieve the 16.8% prevalence target set by NHS England. Quarter

2 is 15.8% prevalence for most teams across Mindsmatter. St Helens CCG have agreed that prevalence will stay at 15% as they have not

received any national LTC funding. Blackburn with Darwen CCG's prevalence target remains at 10.4%+ LTC, with an expectation that this

will increase and funds will be reattributed to this locality next year.

The leadership team have daily oversight of performance across all teams. Performance data is examined daily against agreed actions in

order to identify areas of deficit in prevalence and, in conjunction with team members, direct the focus and resource within each specific

locality. Deficits and risk areas to achieve prevalence are raised at team and line management level and are escalated to the Leadership

team and the Network managers immediately in order to expedite actions accordingly.


0.82% 2.03% 1.25% 1.39% 1.52%

0.88% 1.13% 1.31% 1.07% 1.09%

1.29% 1.53% 1.47% 1.31% 1.45%

1.00% 1.13% 1.64% 1.42% 1.22%

1.23% 1.33% 1.36% 1.44% 1.35%

0.92% 1.38% 1.46% 1.41% 1.07%

1.34% 1.07% 1.40% 1.46% 1.32%

1.13% 1.51% 1.34% 1.08% 1.48%

1.07% 1.35% 1.47% 1.30% 1.25%

CWB IAPT Prev CCG


NHS St Helens CCG








66 of 198

2.1 Performance Activity Community & Wellbeing – IAPT Prevalence

46


1. West Lancs additional taster sessions planned for

Aug, Sept, Oct. 31-Aug-17 Team Leader

This action is ongoing for 3 months to increase

prevalence.

2. West Lancs welcome call day. 15-Sep-17 Team Leader Booked for September.

3. St Helens taster sessions September. 30-Sep-17 Team Leader Two sessions have already taken place and one

more is planned for later in the month.

4. Exercise to identify third sector provider. 30-Sep-17

Care Group

Manager and

Deputy Operations

Manager

Initial meetings have now taken place with all

companies that expressed an interest. The next

stage of the process is to finalise the project plan

and timescales.

5. Capacity and demand work - perfect journey. 30-Sep-17 Service Manager This work continues to be progressed, current

stage is examining variations across teams

based on staff numbers and waiting times.

6. Interim line management arrangement. 15-Aug-17 Service Manager Three staff (2 WTE) have been identified to lead

Central and St Helens teams, further recruitment

is required for North and East Localities.

7. Action plan developed with Preston and St Helens to

increase prevalence. 30-Sep-17 Service Manager

8. Confirm BwD final Prevalence target. 30-Sep-17

Care Group

Manager and

Deputy Operations

Manager

9. Manage the introduction of new trainees to wave 2

sites to support the increase in prevalence. 30-Sep-17 Service Manager

67 of 198


47

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48

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2.1 Performance Activity Community & Wellbeing – IAPT Waits

49

IAPT - Waits:

All people waiting over 26 weeks have been reviewed. The people waiting in both Blackburn with Darwen and Preston CCG

have been waiting for other reasons relating to patient choice, not due to waiting for the next available appointment. These

individuals have either an appointment booked or have been discharged.

For the people waiting over 26 weeks in Fylde and Wyre, an action plan was implemented to manage and reduce the waiting

list. People were offered alternative interventions, such as Silvercloud, to enable them to start their CBT therapy prior to one-

to-one therapy. This is being monitored in the weekly leadership meetings. This commencement of the action plan can be

demonstrated in the reduction in people waiting over 26 weeks this month.

Waiting times across each waiting time bracket are also being reviewed weekly by the leadership team and priority areas are

being addressed at management and team level.

70 of 198

2.1 Performance Activity Community & Wellbeing – IAPT Waits

50


1. Withdraw CBT Therapists from welcome call activity in Fylde

and Wyre. 31-Aug-17

Team

Leaders

This is in place and is an on going action

until the waiting list times improve.

2. Telephone review of people waiting over 26 weeks in Fylde and

Wyre. 31-Aug-17

Team

Leaders This has now been completed.

3. Review Women's Centre contracts and vacancies. 24-Aug-17

Deputy

Head of

Operations /

Service

Manager

This work has commenced, PWP

appointments have now been changed to

CBT to reflect the need. First contract

meeting has taken place and a further

meeting to be.

4. Staff reminded re. DNA, cancellations, orientation, extension

protocols. 07-Aug-17

Team

Leaders

This has now been actioned and is an

ongoing action to monitor the change.

5. Internal performance reporting increased and reviewed to

closely monitor waiting times across the teams. 30-Sep-17

Service

Manager

6. Capacity and Demand programme to work in conjunction with

waiting times management and Women's Centre actions. 30-Sep-17

Service

Manager

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2.1 Performance Activity Children & Young People’s Wellbeing – Child Psychology

51

Child Psychology (Total Network Performance):

In M5, overall service performance increased to 77.7%, an increase of 3.6% from M4. The current rate is the highest since April 2016.

One out of the five team’s performance remains above the target of 95% and four teams under the target. The total number of SUs on the

waiting list reduced in M5, from 410 to currently 350.

The number of SUs waiting over 18 weeks reduced from 106 in M4, to 78 in M5. 51% of waiters over 18 weeks are from Blackpool/Fylde

and Wyre team (40). 15 have TCI dates.

Blackpool/Fylde Team

Blackpool/Fylde team performance has been affected by ongoing staffing capacity issues and vacancies. However, staff capacity is

improving following the recruitment of a full-time Locum Psychologist at the end of May, and a Band 6 Mental Health Practitioner who

started on 25th July.

Performance in Blackpool has increased by a further 10% to 59.6% in M5, with 31 SUs waiting under 18 weeks. 9 SUs have TCI dates.

Performance in Fylde & Wyre has increased by 11% to 45.7% in M5, with 16 SUs waiting under 18 weeks. 5 SUs have TCI dates. Data for

the Fylde & Wyre waiting list has been reviewed for accuracy following the move of referral management to the Referral Appointment

Centre (RAC).

Preston Community

Preston Community performance increased to 65.8% in M5, and is also affected by ongoing staffing capacity issues. The total number of

children waiting for treatment has reduced further to 38, the lowest level in the last year. All referrals above 15 weeks wait have TCI

appointments.

Preston is implementing a Brief Therapy (SFBT) project before two of our Clinical Psychologists leave in November. This will likely take

four people off the waiting list for hopefully a short intervention (three sessions).

Lancaster

Lancaster performance increased slightly to 80.3%; a 7% increase from M4. Of the 14 SUs waiting over 18 weeks, 3 have TCI dates.

Lancaster has two permanent Clinical Psychologists each working two days a week. An agency Practitioner is working three days a week

via CAMHS until the end of March 2018, and another CAMHS Practitioner on a temporary contract is doing two days a week for Lancaster

CPS until April/May. A new Clinical Psychologist will also take up post in Lancaster in November 17.

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2.1 Performance Activity Children & Young People’s Wellbeing – Child Psychology

52


1. Preston CAMHS worker has been offering to see the longest waits as

part of waiting list initiative. 30-Nov-17

Service

Manager On track

2. In Preston CPS, maternity leave cover increased their days from two to

three. 31-Oct-17

Service

Manager On track

73 of 198

2.1 Performance Activity Children & Young People’s Wellbeing – CAMHS Tier 3

53

CAMHS Tier 3

In M5, overall service performance reduced by 3.6%, from 68.1% to 64.5% (412 SUs). This equates to 227 out of 639 waiting over 18

weeks for treatment.

Chorley & South Ribble

Performance reduced further in M5 to 42.6% from 48.7% in M4. There are currently 213 out of 371 SUs waiting over 18 weeks. Four SUs

have TCI dates.

Long term sickness and absence continues to provide staffing challenges although recruitment to the vacant team leader role has been

successful. The appropriate steps are being taken to address this absence. The Team Leader commenced the role on 17 July 2017; a

recovery plan has been drafted for Network approval.

The team continues to manage large numbers of Autistic Spectrum Disorder (ASD) referrals which do not meet the criteria for Tier 3

CAMHS; this is custom and practice at present but will be addressed during the transformation 0-25 workstream.

Subject to the team reaching full staffing levels, we anticipate to see improvement in performance from October 2017.

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2.1 Performance Activity Children & Young People’s Wellbeing – CAMHS Tier 3

54


1. Review the practice of managing ASD referrals. 30-Sep-17 Team Leader Ensure correct cases are on waiting

list each week.

2. Admin processes are being reviewed in the Referral Assessment

Centre (RAC). Options paper to be drafted regarding future functioning of

the RAC.

31-Oct-17 Service

Manager

Ensure correct cases are on waiting

list each week.

Project delayed.

3. HR still supporting the long term sickness absence. 30-Sep-17 Service

Manager

75 of 198

2.1 Performance Activity Children & Young People’s Wellbeing – CITNS

Speech & Language Therapy

55

CITNS SLT (Total Network Performance):

As a speciality, Speech & Language Therapy performance in M5 was 96.2% against the 92% threshold for open RTT pathways, an

increase of 7.8% from last month. This is the first time the service has been above the 92% target since October 16. The total waiting list

of 947 reduced by 349 in M5, with the total number waiting over 18 weeks reducing by a further 114 to 36, of which 34 have appointment

dates. Therefore only 2 clients over 18 weeks do not have appointment dates.

Marked improvements have been achieved in the targeted areas of BwD, B&P and HRV&R – all of which are now above the 92% target.

Only Chorley & South Ribble is below the 92% target.

Chorley and South Ribble (CSR) team’s performance reduced further in M5 to 90.7%, from 91.3%. Staff capacity is currently at 65%.

There are now 15 children waiting over 18 weeks, all of which have an appointment. The longest wait now stands at 21 weeks.

Blackburn with Darwen (BwD) team’s performance has significantly increased by 9.4% since M4 to 98.2%. There is only 1 child waiting

over 8 weeks who has an appointment to be seen. The longest wait now stands at 21 weeks.

Burnley and Pendle (B&P) team’s performance has significantly increased by 11.1% since M4 to 97.4%. There are now only 7 children

who are waiting over 18 weeks, all of which have an appointment to be seen. This team has received a significant increase in the

number of referrals in M3 and M4 which was double the anticipated number. This may impact waiting times in M7 and M8. The longest

wait now stands at 23 weeks.

Hyndburn, Ribble Valley and Rossendale (HRV&R) team’s performance has increased by 14.3% to 93.5% in M5. There are now only 11

children who are waiting over 18 weeks of which 9 have an appointment to be seen. The longest wait now stands at 25 weeks.

In CSR, the actions outlined below should mitigate against a further performance reduction and see the team meet the 92% target by

mid-October 2017.

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2.1 Performance Activity Children & Young People’s Wellbeing – CITNS


56


1. To support new starters into the post with a robust induction

package which will allow the practitioner to working to full capacity as

soon as possible.

31-Oct-17 Team co-

ordinators

Workforce will feel valued and staff

retention rates increase.

2. CSR – Ensure recruitment to new fixed term post, explore utilisation

of Bank staff and continued management of LTS return to work. 30-Sep-17

Team co-

ordinators

77 of 198

2.1 Performance Activity Children & Young People’s Wellbeing – Occupancy

57

Occupancy:

In M5, bed occupancy performance at The Cove dropped to 68.8% from 94.6% in July 17, against the target of 85%.

The CAMHS Outreach Team received 15 referrals at The Cove, and five of these referrals resulted in admission. 1 of these was a re-

admission.

There were nine discharges from The Cove in August 2017.

Length of stay of discharges during August 2017 was 28 days against the national benchmark of 83 days.

The Cove was open to admissions through August and was running at full capacity. Bed occupancy was reflective of demand for beds

throughout the North West, which could potentially be attributed to the seasonal variance of school holidays.

There are no open actions for this measure as the unit is open for business but there are not enough appropriate referrals to fill the empty

beds.

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2.1 Performance Activity Children & Young People’s Wellbeing – ADHD

58

ADHD:

Performance in M5 improved by 1.9%, from 77.3% in M4 to 79.2%. This equates to a 46 service users currently waiting over 18 weeks,

out of a total of 235. 18 service users have a TCI date.

Issue affecting performance:

• Two NMPs left the service in April 17, meaning that 50% of our prescribing capacity was lost. Whilst the service have recruited to the

posts, the specialist nature of the role has required a period of formal training and preceptorship meaning this post is not currently at full

prescribing capacity. Therefore, we are still not in a position take new assessments from the waiting list into the prescribing at the rate

that we have previously.

• The caseload remains over 3 times higher than the service was commissioned - 180 patients, whilst current caseload is 708. The

agreement from the MD to transfer around 130 patients stable on ADHD treatment and who were also open to Consultant Psychiatrists

within the Trust to secondary care is still to commence. The service is still awaiting further instructions as to how this will be

implemented.

• The rate of DNAs continues to exceed that projected within the pilot project (10%) impacting on capacity.

• Shared Care arrangements with certain GPs continues to impacts on clinical time as staff are required to respond to requests for

prescriptions. Discussions are ongoing with GP colleagues as to how to make this system more efficient.


1. Patients are now offered a ‘call and book’ system to ensure they contact

the service to book their assessment appointment. 30-Sep-17

Service

Manager/Clinical

Lead

More effective use of clinical

time.

2. Ongoing review of Shared Care arrangements. 31-Aug-17 Service Manager More effective use of clinical

time.

3. Discussion required establishing if, in accordance with the service’s

Access Policy, service users who do not opt in can be discharged. 31-Aug-17

Service

Manager/Clinical

Lead

More effective use of clinical

time.

4. Service currently re-auditing DNA rates and evaluating strategies to

reduce DNAs e.g. including in the appointment letter a request to confirm or

cancel their attendance.

30-Sep-17 Service Manager Reduction in DNAs.

5. Seeking approval to recruit to additional permanent Band 7 nurse

prescriber, to help reduce waiting list. 01-Sep-17 Service Manager Improved staff capacity.

6. A second NMP has been in post for 3 months and training is still in

process. There will be a gradual improvement to the waiting list following this

preceptorship .

31-Oct-17 Service Manager Improved staff capacity. 79 of 198

2.1 Performance Activity Children & Young People’s Wellbeing – ADHD

59

80 of 198

Patient Flow

Section 2.2

60

81 of 198

2.2 Patient Flow Summary – Patient Flow

61


Sparkline

NHS Improvement

Patient Flow

Average Number of Patients (OAPS) Commissioner 15 32.23 28.93 22.65 33.10 27.42 22.48 23.29 23.42 24.27 25.52 25.67 24.23 23.68

OAPS Occupied Bed Days Commissioner 465 999 868 702 993 850 697 652 726 728 791 770 751 734

LCFT and OAPS Occupancy % (Total Network Performance) Commissioner 85.00% - - - 104.8% 100.6% 101.1% 98.2% 96.8% 105.7% 106.1% 106.4% 105.4% 107.4%

Number of LCFT and OAPS Occupied Bed Days (Total Network

Performance)Commissioner 9836 - - - 10943 10880 10667 10009 10927 10593 10988 10665 10917 11120

LCFT and OAPS Occupancy % (AMH) 105.0% 104.7% 102.4% 107.1% 101.0% 102.9% 102.8% 101.2% 108.6% 107.9% 108.0% 107.7% 107.6%

Number of LCFT and OAPS Occupied Bed Days (AMH) 8516 8260 8351 8481 8297 7799 7630 8317 8148 8364 8097 8349 8340

LCFT and OAPS Occupancy % (OA) 100.3% 99.2% 97.7% 97.7% 99.2% 96.5% 85.8% 85.0% 97.0% 100.8% 101.9% 98.6% 106.8%

Number of LCFT and OAPS Occupied Bed Days (OA) 2613 2499 2544 2462 2583 2868 2379 2610 2445 2624 2568 2568 2780

LCFT only Occupancy % (Total Network Performance) NHSE 85.00% 98.3% 99.6% 99.5% 99.6% 96.9% 98.7% 100.1% 98.5% 98.5% 98.5% 98.8% 98.7% 100.3%

Number of LCFT only Occupied Bed Days (Total Network Performance) Stretch 9836 7517 7412 7649 9950 10030 9970 9357 10201 9865 10197 9895 10216 10386

LCFT only Occupancy % (AMH) 98.3% 99.6% 99.5% 100.3% 96.1% 99.6% 99.9% 99.1% 99.2% 98.3% 99.0% 98.7% 98.9%

Number of LCFT only Occupied Bed Days (AMH) 7517 7412 7649 7491 7447 7102 6990 7679 7437 7622 7426 7648 7665

LCFT only Occupancy % (OA) - - - 97.6% 99.2% 96.5% 100.6% 96.9% 96.3% 98.9% 98.0% 98.6% 104.5%

Number of LCFT only Occupied Bed Days (OA) - - - 2459 2583 2868 2367 2522 2428 2575 2469 2568 2721

Secure Overall Gross Occupancy NHSE 93.00% 90.5% 90.7% 90.5% 90.5% 90.2% 91.8% 93.3% 93.7% 97.2% 95.9% 96.0% 94.2% 91.3%

Average Episode Length of Stay (LOS) (AMH) Bench 31 33.20 35.10 41.70 31.30 31.20 29.72 40.23 33.00 34.70 36.10 46.40 47.60 29.60

Average Ward Length of Stay (LOS) (PICU) 56.25 34.20 47.70 58.50 45.08 58.50 55.20 37.80 39.90 35.10 38.80 30.10 27.60

Average Episode Length of Stay (LOS) (OA) 91.10 107.70 119.60 109.40 144.50 123.56 95.35 115.60 122.30 135.50 97.90 104.50 86.90

Re-Admission Rates - 30 Days (AMH) % NHSE <8.7% 8.6% 11.1% 9.9% 9.1% 16.7% 7.8% 12.6% 9.5% 15.3% 13.8% 14.8% 11.5% 6.9%

Re-Admission Rates - 30 Days (AMH) Number of patients NHSE 18 17 21 20 22 36 18 24 22 31 30 30 24 14

Re-Admission Rates - 30 Days (OA) % NHSE <8.7% - - - 0.0% 4.5% 0.0% 0.0% 3.4% 8.0% 0.0% 4.0% 0.0% 3.7%

Re-Admission Rates - 30 Days (OA) Number of patients NHSE 2 - - - 0 1 0 0 1 2 0 1 0 1

Re-Admission Rates - 90 Days (AMH) % NHSE 15% 16.2% 19.5% 17.7% 12.8% 25.0% 16.5% 23.0% 19.0% 20.7% 22.6% 22.2% 18.7% 17.3%

Re-Admission Rates - 90 Days (AMH) Number of patients NHSE 30 32 37 36 31 54 38 44 44 42 49 45 39 35

Re-Admission Rates - 90 Days (OA) % NHSE 15.00% - - - 0.0% 4.5% 0.0% 0.0% 13.8% 0.0% 10.3% 4.0% 5.3% 7.4%

Re-Admission Rates - 90 Days (OA) Number pf patients NHSE 4 - - - 0 1 0 0 4 - 3 1 1 2

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2.2 Patient Flow Out of Area Placements (OAPS)

62

OAPS:

The average number of OAPs decreased slightly in August by 0.55, alongside a slight reduction in the OAP OBD in August with a

position of 734, a reduction of 17 from July. Continuing the reduction seen in July.

The overall number of OAPs remains static against an assumed fall in the trajectory. There are strong assurances as to the intended

impact of Intensive Community Support Schemes on admission numbers. Focus has therefore increased on those patients of over 180+

day Length of Stay on acute mental health wards. Case review confirms that these patients are ready for their next stage of treatment

away from the acute ward or PICU that they are on. The patient cohort have chronic mental health presentations with slow responses to

treatment. Typically, their presentations fall short of the threshold for a secure services bed, but will not be accepted by independent

providers. LCFT have agreed with commissioners to established an integrated discharge team to manage this patient cohort. STP leads

have agreed that the costs of 'discharge to assess' beds are not within the OAPs spend, as this is a clear and distinct cohort of patients

to those require an OAP due to an acute presentation. From the current inpatient cohort, zero 180+ day cases would result in zero acute

OAPs and LCFT occupancy on acute wards below 100%, zero older adult OAPs and LCFT occupancy on older adult wards below

100%, and in two PICU OAPS.


1. Maintain focussed case review panel with senior commissioning managers. Sep-17 Capacity & Flow

Manager

2. Daily bed calls with Service Managers to address blocks to discharge such as

funding delays. Sep-17

Bed

Management

3. Maintain the process of identifying and escalating all 180+ day LOS inpatients

for review. Fortnightly scheduled meeting in place with stakeholders regarding

review of these patients.

Sep-17 Capacity & Flow

Manager

4. Continue regular review of C&WL OAPs to identify any that can be stepped

to the Crisis House/beds. Sep-17

Capacity & Flow

Manager /

Central CGM

5. Produce report on the use of Habilitation beds. Sep-17 Capacity & Flow

Manager

6. Desktop review of all LCFT PICU patients with a longer than anticipated LOS

to ensure they are in the right care setting. Action plans to be developed for all

patients not in the right care setting.

Oct-17

Deputy Head of

Operations /

Capacity & Flow

Manager 83 of 198

2.2 Patient Flow OAPS

63

84 of 198

2.2 Patient Flow OAPS Occupied Bed Days

64

85 of 198

2.2 Patient Flow Occupancy – Mental Health

65

Occupancy:

LCFT and OAPs occupancy position in August declined slightly from the July position at 107.4%. Notably, the occupancy for LCFT

beds also increased to 100.31%in August.


1. Maintain focussed case review panel with senior commissioning managers. Sep-17

Capacity &

Flow

Manager

2. Daily bed calls with Service Managers to address blocks to discharge such

as funding delays. Sep-17

Service

Manager

3. Continue Home Treatment Team attendance at FED meetings to identify

patients whose care can transfer to hospital at home with the Home Treatment

Team.

Sep-17 Team Leader

4. Maintain the process of identifying and escalating all 180+ day LOS

inpatients for review. Fortnightly scheduled meeting in place with

stakeholders regarding review of these patients.

Sep-17 Service

Manager

86 of 198

2.2 Patient Flow Occupancy – Mental Health Total

66

87 of 198

2.2 Patient Flow Occupancy – Adult Mental Health

67

88 of 198

2.2 Patient Flow Occupancy – Older Adults

68

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2.2 Patient Flow Mental Health – Average Length of Stay – PICU

69

Average Ward Length of Stay - PICU:

The Network is reporting an average length of stay of 27.60 days. This is below the Trust set target of 30 days.

The Network has maintained a LOS under 40 days for five months for PICU, with a further reduction this month, indicating a level of

stability. The Joint Advisory Group is having a positive impact on PICU LOS and the feedback from Care Co-ordinators and the Gateway

team is positive about this group.


1. Commissioners are also joining twice weekly conference calls to assist

with alleviating any blockages in the discharges of patients. Sep-17

Capacity &

Flow Manager

2. Discharge planning for all patients near completion of

assessment/treatment to be discussed daily at the bed call. Sep-17

Capacity &

Flow Manager

3. Escalation routes are clear - the capacity and flow manager is to be

utilised to expedite any difficulties. Sep-17

Capacity &

Flow Manager

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2.2 Patient Flow Mental Health – Average Episode LOS – Adult

70

Average Ward Length of Stay - Adult:

The Network is below the Trust set target of average 30 day length of stay for Acute Bed LOS, reporting an average LOS of 29.60 days

for August.

PICU LOS is included within the Average Network LOS, it is noted that PICU LOS has also decreased in August.


1. Commissioners are also joining twice weekly conference calls to assist

with alleviating any blockages in the discharges of patients. Sep-17

Capacity &

Flow Manager



Capacity &

Flow Manager

3. Escalation routes are clear - the capacity and flow manager is to be

utilised to expedite any difficulties. Sep-17

Capacity &

Flow Manager

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2.2 Patient Flow Mental Health – Average Episode LOS – Older Adult

71

Average Episode Length of Stay – Older Adult:

M5 has seen a decrease in the average length of stay, reporting an average LOS 86.9 days.

Continued efforts in proactive discharge management across all wards and additional member to the discharge facilitator team has

added support across the wards, working towards timely discharge.


1. Commissioners to join twice weekly conference calls to assist with

alleviating any blockages in the discharges of patients. Sep-17

Capacity &

Flow Manager



Capacity &

Flow Manager

3. Escalation routes are clear - the capacity and flow manager is to be utilised

to expedite any difficulties. Sep-17

Capacity &

Flow Manager

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2.2 Patient Flow Mental Health – Readmission Rate (30 days)

72

Re-Admission Rate (30 days):

The Network have achieved compliance with the target of 8.7% in M5 with a rate of 6.55%. This is an improved position from 10.53% in

M4.

There have been 15 readmissions within 30 days, 1 of these was an Older Adult patients, the remainder were Adult Mental Health

patients.

Average time between admissions was 16.2 days, though 2 cases were re-admitted within 7 days.

13.33% of re-admissions were from the female assessment ward.

26.67% of re-admissions were from the male assessment ward.


1. Team Leaders to ensure to review in CMHT/CRHTT Clinical

Discussion Meetings. Sep-17

Team

Leaders

2. Re-admission data to be routinely reviewed in Locality Governance

groups. Sep-17

Team

Leaders

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73

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74

Re-Admission Rate (90 Days):

The Network failed to achieve compliance with the 90 day re-admission rate this month with16.16% for M5. This includes Older Adult

ward data. The underlying position with Adult Wards has improved from M4 with a position of 17.33%. Older Adults had 2 re-admissions

in M5.

37 cases were re-admitted within 90 days. These include the 15 cases re-admitted within 30 days. 22 cases were re-admitted 31-90 days

after discharge.


1. Team Leaders to ensure to review in CMHT/CRHTT Clinical Discussion

Meetings. Sep-17

Team

Leaders

2. Re-admission data to be routinely reviewed in Locality Governance

groups. Sep-17

Team

Leaders

95 of 198


75

96 of 198

Data Quality

Section 2.3

76

97 of 198

2.3 Data Quality Summary – Data Quality

77

Indicators achieved Target Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sparkline

PBR Clustering

Trust PBR Clustering 95% 95.44% 95.66% 96.06% 96.28% 96.75% 96.37% 96.43% 96.45% 96.66% 96.64% 96.44% 95.70%

Mental Health PBR Clustering 95% 94.10% 94.22% 96.12% 96.43% 96.78% 96.37% 96.48% 96.47% 96.63% 96.65% 96.44% 95.70%

Children & Young People's Wellbeing PBR Clustering 95% 97.01% 95.70% 94.90% 93.60% 96.16% 96.31% 95.35% 95.99% 97.17% 96.35% 96.51% 95.10%

Allocated Patients (within 2 weeks)

Trust Allocated Patients 0 551 545 472 454 461 413 443 430 300 228 242 223

Mental Health Allocated Patients 0 418 407 331 307 313 255 260 267 255 211 233 203

Community Wellbeing Allocated Patients 0 15 8 12 11 12 12 7 15 13 2 7 19

Children & Young People's Allocated Patients 0 16 16 13 14 8 18 29 23 5 4 2 2

Manual Overrides

Trust NHSI Manual Overrides 0 16 21 11

MR01 NHSI Manual Overrides 0 4 6 8

MR07 NHSI Manual Overrides 0 11 6 3

Other NHSI Manual Overrides 0 1 9 0

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2.3 Data Quality Data Quality – Manual Overrides

78

Manual Overrides:

There has been a decrease in manual overrides for August 2017.

Of the 11 manual overrides, 9 were for Mental Health and 2 were for Secure Services.

99 of 198

79

Section 3:- Finance and Contracting

Section 3.1:- Financial Activity

• UoR Risk Rating

• Summary I&E Position

• Summary of Clinical Services

• CIPS

• Capital Expenditure

Section 3.2:- Contract Activity

• Community & Wellbeing – Network Line Totals

• Community & Wellbeing – Service Line Totals

• Community & Wellbeing – Total Activity Split by CCG

• Children & Young People’s Wellbeing – Service Line Totals

• Children & Young People’s Wellbeing – Total Activity Split by CCG

• Mental Health – Activity Totals

Section 3.2.1:- Southport & Formby Contract Activity

• Queens Court – Palliative Care

Section 3.3:- Commissioning for Quality & Innovation

• CQUIN Executive Summary

3. Finance and Contracting

100 of 198

Financial Activity

Section 3.1

80

101 of 198

Use of Resources rating (UoR)

Overall performance against the UoR is rated at 3. The rating is primarily driven by the I&E performance and in particular

the I&E Margin rating of 4. Assuming management action to bring financial performance back in to line is successful the

Trust will maintain eligibility for Sustainability Funding and will achieve a UOR of 2 in line with plan.

Should conditions persist and costs not be managed within the control total then the resulting deterioration might attract

regulatory attention (a rating of 2 can trigger a regulatory review of the Trust's position).

FINANCE AND USE OF RESOURCES RATING

Plan Actual Plan Forecast

Capital service cover rating 2 3 2 3

Liquidity rating 1 1 2 1

I&E margin rating 2 4 2 2

I&E margin: distance from financial plan 1 3 1 1

Agency rating 1 2 1 2

Overall 1 3 2 2

Year to Date Annual

3.1 Financial Activity Use of Resources (UoR) Risk Rating

102 of 198

Sustainability

At month 5 we have a £2.0m deficit which is £2.2m behind plan. Of this £0.6m relates to Sustainability and Transformation

Funding which leaves a shortfall against the control total of £1.6m. The current forecast assumes current pressures and risks

are addressed and financial performance achieves (or exceeds) plan but the unmitigated projections indicate a gap of c£6m,

c£8m without STF monies, so this will not be without significant management challenge. Several key areas will have to be

managed if the Trust is to achieve this:

• Cost Improvement Programmes

• Cost Reduction Schemes

• Reset/Redundancies

• Southport

• Out of Area Placements

• Ward Staffing

FUNDED WTE BUDGET DETAIL BUDGET ACTUAL £ ANNUAL PROJECTED £

EST. ACTUAL TO DATE TO DATE VARIANCE BUDGET ACTUAL VARIANCE

£'000 £'000 £'000 £'000 £'000 £'000

Healthcare Income 127,560 127,005 -555 304,277.4 305,042 764

5,745.1 5,707.6 Clinical Services -96,112 -100,118 -4,006 -228,726 -237,724 -8,998

791.9 708.9 Corporate Services -21,639 -21,639 -53,130 -53,182 -52

Reserves and Capital Charges -9,809 -7,221 2,588 -22,421 -11,941 10,481

6,537.0 6,416.6 -1,973 -1,973 2,195 2,195

3.1 Financial Activity Summary I&E Position

103 of 198

FUNDED WTE BUDGET DETAIL BUDGET ACTUAL £ % ANNUAL PROJECTED £

EST. ACTUAL TO DATE TO DATE VARIANCE VARIANCE BUDGET ACTUAL VARIANCE

£'000 £'000 £'000 £'000 £'000 £'000

PAY

2,948.5 3,100.3 ADULT PAY 48,566.8 52,764.9 -4,198.1 -8.6 116,704.9 125,291.8 -8,586.9

NON PAY 5,176.4 5,557.4 -381.0 -7.4 10,227.9 11,806.7 -1,578.8

PATIENT RELATED INCOME -312.7 -355.7 43.0 -13.8 -631.9 -878.4 246.6

NON PATIENT RELATED INCOME -861.1 -935.3 74.2 8.6 -2,066.6 -2,360.2 293.6

2,948.5 3,100.3 TOTAL 52,569.4 57,031.2 -4,461.9 -8.5 124,234.3 133,859.9 -9,625.6

1,619.3 1,522.1 ADULT COMMUNITY PAY 22,984.1 23,467.7 -483.6 -2.1 55,462.9 55,900.6 -437.7

NON PAY 5,072.3 4,888.4 183.9 3.6 12,352.4 12,380.5 -28.1

PATIENT RELATED INCOME -3,575.7 -3,574.9 -0.8 0.0 -8,829.3 -8,859.4 30.1

NON PATIENT RELATED INCOME -1,102.8 -1,099.2 -3.6 -0.3 -2,468.3 -2,406.0 -62.3

1,619.3 1,522.1 TOTAL 23,377.8 23,682.0 -304.1 -1.3 56,517.7 57,015.7 -498.1

1,122.2 1,033.5 CHILDREN AND FAMILY PAY 17,707.8 17,270.9 436.9 2.5 42,266.6 42,105.6 161.0

NON PAY 2,387.9 1,863.9 524.0 21.9 4,957.0 3,753.0 1,204.0

PATIENT RELATED INCOME -688.6 -329.1 -359.5 52.2 -1,282.7 -684.1 -598.7

NON PATIENT RELATED INCOME -574.6 -587.1 12.5 2.2 -1,163.9 -1,239.1 75.2

1,122.2 1,033.5 TOTAL 18,832.6 18,218.6 614.0 3.3 44,776.9 43,935.5 841.5

55.2 51.8 PHARMACY PAY 1,118.9 1,017.4 101.5 9.1 2,685.3 2,469.8 215.5

NON PAY 213.2 171.1 42.1 19.7 511.6 448.2 63.4

NON PATIENT RELATED INCOME 0.0 -2.3 2.3 No Budget 0.0 -5.4 5.4

55.2 51.8 TOTAL 1,332.0 1,186.2 145.8 10.9 3,196.9 2,912.5 284.4

5,745.1 5,707.6 TOTAL 96,111.8 100,118.0 -4,006.2 -4.2 228,725.8 237,723.6 -8,997.8

3.1 Financial Activity Summary of Clinical Services

104 of 198

Cost Improvement Programmes

At £5.0m in month 5 the Trust is c£0.8m behind the plan of £5.8m. This is mainly attributable to delays in schemes

but more significantly due to lower than planned traction in schemes designed to address pressures on ward based

staffing.

Additional support is being offered and the Trust fully expects to deliver the target by year end.

Note: a number of schemes are still being transacted and that mapping of individual schemes to projects and programmes is still being finalised.

Plan Actual Variance Plan Forecast Variance

£'m £'m £'m £'m £'m £'m

Cost Improvement Programmes 4.58 4.52 -0.06 11.10 13.10 2.00

Run Rate Reduction Programmes 1.28 0.50 -0.78 4.00 2.00 -2.00

Total 5.86 5.02 -0.84 15.10 15.10 0.00

Year to Date Annual

3.1 Financial Activity CIPs

105 of 198

Capital Expenditure

To date, the Trust has spent £1.5m against the original profile of £4.4m.

Spend profile on schemes is dependent on a number of tendering exercises to be completed in Q2 and though changes are

being worked through the programme total has now been adjusted to reflect the Trusts success in securing external funding

for Places of Safety (£0.5m), Perinatal (£3.5m - £2.5m in 2017/18) and Inpatient schemes (c£5.7m in 2017/18 - provisional).

Also of note are the Trust plans to dispose of Westfields, Ribbleton and Ridge Lea in 2017/18.

The Trust currently expects to complete its capital programme in line with its control total and funding.

3.1 Financial Activity Capital Expenditure

106 of 198

Contract Activity

Section 2.2

86

107 of 198

87

3.2 Contract Activity – Variance to Plan Community & Wellbeing - Network Line Totals

2017-18 Baseline Proposal

LCFT have received notification that the proposed 2017-18 Baselines have been signed off by Commissioners and can therefore be reported

against from Month 5.

2017-18 M5 Activity

LCFT will now begin to provide variances against monthly plans at CCG level, however where C&SR and GP provide services that flex to meet

the demands of the central Lancashire area these will be reported as Central Lancashire Locality. Where services are reporting over and under-

performance of 10% or more LCFT will produce exception narrative as follows:-

* Under-performance - Explain the current position and issues and where known provide a timeframe of when the service anticipates to be back

on plan.

* Over-performance – Explain the reasons for the over-performance.

As we are almost half way through the year LCFT will provide exception reports for all services breaching by -/+10% at M5 but have agreed that

rather than wait until 3 months of Underperformance from those services that have been underperforming for sometime, they will identify those

that are significantly off track and look to produce an Exception Report with a Recovery Plan and comprehensive narrative for M6.

LCFT have negotiated with Commissioners the need for a refresh of the activity data back to Apr-17 for all Community Services in order to input

the missed Paediatric Liaison activity for East Lancashire CCG and to correct the Contact and Referral activity figures for C&SR and GP after it

was identified that they had been transposed. LCFT are therefore planning to complete a refresh of the data for M6 which will allow accurate

variances against plans to be shown.

Network17-18 Monthly

PlanApr-17 May-17 Jun-17 Jul-17 Aug-17 YTD 17-18

YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Community & Wellbeing Total

Against Plan90,569 89,807 94,691 98,588 90,570 91,210 464,866 13,178 2.92% 451,688

Children and Young People's

Wellbeing Total Against Plan7,922 3,233 4,398 8,037 7,900 7,092 30,660 -19,391 -38.74% 50,051

Trust Total Against Plan 98,491 93,040 99,089 106,625 98,470 98,302 495,526 -6,213 -1.24% 501,739

108 of 198

88

3.2 Contract Activity – Variance to Plan Community & Wellbeing - Service Line Totals

Service17-18 Monthly


YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Adult Learning Disability Service Total 2,590 1,625 2,315 2,313 2,007 2,052 10,312 -592 -5.43% 10,904

Adult Speech and Language Therapy Total 291 349 296 375 415 365 1,800 528 41.51% 1,272

CHESS Total 348 307 427 300 96 213 1,343 -179 -11.76% 1,522

Children's Learning Disability Service Total 931 1,235 1,660 1,650 1,360 1,195 7,100 1,389 24.32% 5,711

Community IV Service BwD Total 151 84 97 66 118 92 457 -749 -62.11% 1,206

Community Matrons Total 1,408 1,262 1,198 1,291 1,236 1,092 6,079 -1,123 -15.59% 7,202

Community Neuro Team Total 961 1,058 1,237 1,252 1,246 1,252 6,045 992 19.63% 5,053

Community Respiratory Service Total 1,682 1,967 2,072 1,933 1,916 2,110 9,998 1,910 23.62% 8,088

Community Stroke Service Total 522 339 359 379 430 464 1,971 -544 -21.63% 2,515

Complex Case Management Total 476 412 395 385 321 293 1,806 -328 -15.37% 2,134

Continence Service Total 255 227 305 223 232 287 1,274 -68 -5.07% 1,342

Dermatology Service Total 432 454 489 399 333 433 2,108 -101 -4.57% 2,209

DESMOND Total 70 65 78 64 75 67 349 -10 -2.79% 359

Diabetes Specialist Nursing Total 1,084 842 954 971 1,038 1,152 4,957 -727 -12.79% 5,684

District Nursing Total 38,664 40,740 40,835 39,811 37,861 38,814 198,061 6,874 3.60% 191,187

Domiciliary Physiotherapy Total 368 694 609 708 704 783 3,498 1,490 74.20% 2,008

Falls Team Total 355 425 658 656 685 665 3,089 1,299 72.57% 1,790

Heart Failure Service Total 171 133 228 233 191 201 986 -136 -12.12% 1,122

Intermediate Care Total 3,506 2,802 3,166 3,220 2,778 2,648 14,614 -3,747 -20.41% 18,361

Nutrition & Dietetics Total 215 265 255 243 288 209 1,260 42 3.45% 1,218

Oxygen Service Total 339 237 269 313 445 371 1,635 92 5.96% 1,543

Phlebotomy Total 15,135 16,855 16,160 22,004 17,610 16,671 89,300 11,389 14.62% 77,911

Podiatry Total 4,573 4,392 5,453 5,073 5,010 5,061 24,989 -390 -1.54% 25,379

Pulmonary Rehabilitation Total 552 441 598 680 618 790 3,127 769 32.61% 2,358

Rapid Assessment Team Total 1,372 1,509 1,732 1,659 1,730 1,698 8,328 963 13.08% 7,365

Rheumatology Total 1,332 1,314 1,594 1,729 1,440 1,684 7,761 893 13.00% 6,868

Specialist Nurse TB Total 381 608 381 525 471 481 2,466 332 15.56% 2,134

Tissue Viability Service Total 264 228 247 267 296 297 1,335 -235 -14.97% 1,570

Treatment Room Total 12,089 8,859 10,501 9,762 9,538 9,750 48,410 -6,998 -12.63% 55,408

Viral Hepatitis Service Total 52 79 123 104 82 20 408 143 53.96% 265

Community & Wellbeing Total 90,569 89,807 94,691 98,588 90,570 91,210 464,866 13,178 2.92% 451,688

109 of 198

3.2 Contract Activity – Variance to Plan Community & Wellbeing – Total Activity split by CCG

Community & Wellbeing - Total Activity split by CCG17-18 Monthly


YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Central Lancs Locality Total 15,135 16,855 16,160 22,004 17,610 16,671 89,300 11,389 14.62% 77,911

NHS Blackburn with Darwen CCG Total 24,428 21,811 24,510 23,173 23,376 23,507 116,377 -2,657 -2.23% 119,034

NHS Blackpool CCG Total 70 150 120 142 97 108 617 225 57.40% 392

NHS Chorley and South Ribble CCG Total 22,729 26,050 26,263 26,243 24,042 25,441 128,039 14,664 12.93% 113,375

NHS East Lancashire CCG Total 787 628 930 771 663 643 3,635 -43 -1.17% 3,678

NHS Fylde & Wyre CCG Total 468 318 330 478 390 427 1,943 -242 -11.08% 2,185

NHS Greater Preston CCG Total 26,178 23,253 25,334 24,612 23,485 23,553 120,237 -11,171 -8.50% 131,408

NHS Morecambe Bay CCG Total 434 344 489 584 455 387 2,259 328 16.99% 1,931

NHS West Lancashire CCG Total 340 398 555 581 452 473 2,459 685 38.61% 1,774

Community & Wellbeing Totals 90,569 89,807 94,691 98,588 90,570 91,210 464,866 13,178 2.92% 451,688

110 of 198

3.2 Contract Activity – Variance to Plan Community & Wellbeing – Activity Exception Reports by CCG

Community & Wellbeing Planned Contract Activity M5

The Community & Wellbeing Network has provided the following explanations as to why certain services are underperforming by more than 10% against the baseline.

Commissioner: NHS Blackburn with Darwen CCG

Under Performance Exception Reporting:-

Adult Learning Disability Service 60.3%-

Current position and issues:

Review of the figures indicate that there is a recording issue across learning disability teams. The activity recording system in Adult Learning Disabilities is a dual

system using paper based clinical records with the addition of ECR for recording contacts. Whilst guidance has been issued as to ‘how to record’ to staff in M2, this has

not reduced variation. This will be resolved as the team move onto Rio in M12.

It was advised when baselines were established for 17/18 that these were built on understood activity from last year which was not validated. We have completed an

initial review of the learning disability teams’ data; however, the figures continue to show a disparity between teams. Whilst we are aware that recording issues

continue, we have also identified that clinicians are not aligning their log-ins to the area where they are delivering interventions. This continuing disparity requires a

further in-depth analysis of the data.

Clinicians are also recording a substantial amount of their activity as ‘non-client linked activity’ which is not included in the reported activity e.g. work with providers &

social workers. Analysis of this area will provide direction as to clarification of baselines and activity.

Fylde and Wyre baselines were based on 10 WTE however the PBS project has now finished (August) and 3 staff have left. This is reflected in the reduction in activity.

The over activity in respect of the Morecambe CCG area is in respect of the development of the ASD pathway and the low baseline that was established prior to this

contract variation. This will need reviewing once the contract has been confirmed.

Commissioner Service17-18 Monthly


YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Blackburn with Darwen CCG Adult Learning Disability Service 480 138 189 177 160 138 802 -1,218 -60.30% 2,020

NHS Blackburn with Darwen CCG Children's Learning Disability Service 67 106 120 179 109 139 653 240 58.11% 413

NHS Blackburn with Darwen CCG Community IV Service BwD Total 151 84 97 66 118 92 457 -749 -62.11% 1,206

NHS Blackburn with Darwen CCG Community Respiratory Service 610 644 596 582 570 621 3,013 389 14.82% 2,624

NHS Blackburn with Darwen CCG Community Stroke Service 522 339 359 379 430 464 1,971 -544 -21.63% 2,515

NHS Blackburn with Darwen CCG Complex Case Management 476 412 395 385 321 293 1,806 -328 -15.37% 2,134

NHS Blackburn with Darwen CCG DESMOND (Completed Courses) 27 28 25 6 19 10 88 -50 -36.23% 138

NHS Blackburn with Darwen CCG Diabetes Specialist Nursing 451 274 387 265 305 429 1,660 -707 -29.87% 2,367

NHS Blackburn with Darwen CCG District Nursing Total 8,094 8,690 9,184 8,862 9,182 8,766 44,684 4,655 11.63% 40,029

NHS Blackburn with Darwen CCG Pulmonary Rehabilitation 552 441 598 680 618 790 3,127 769 32.61% 2,358

NHS Blackburn with Darwen CCG Rapid Assessment Team 1,372 1,509 1,732 1,659 1,730 1,698 8,328 963 13.08% 7,365

NHS Blackburn with Darwen CCG Treatment Room Total 8,123 5,977 6,910 6,320 6,126 6,345 31,678 -5,553 -14.91% 37,231

111 of 198




Community IV Service BwD 62.11%-


The IV team continue to be impacted by a reduced number of referrals to maximise the capacity of the service. The service continues to work with BWDCCG and ELHT to

maximise referrals. The IV team have capacity to see more referrals and promotion to access is on-going.

Community Stroke Service 21.63%-


Under performance is due to a combination of vacancy and Band 3 sickness absence. Quality patient care is being maintained, patients are receiving an initial telephone

contact within 1 working day mon-fri and a face to face initial assessment within 5 working days.

Complex Case Management 15.37%-


Under performance is due to a combination of vacancy and new starters being unable to work independently due to requirements for training which have been actions.

Referrals for the service have increased to 22 in M5 and this is above the average of 15 for M1-M4. Quality patient care is being maintained and all referrals are being

actioned.

DESMOND (Completed Courses) 36.23%-


Underperformance for DESMOND contacts is due to sickness absence by one of the educators. sickness has affected the ability of the team to deliver the programme, but

every effort has been made to deliver this including delivery by a DSN. September is predicted to deliver 3 courses.

Diabetes Specialist Nursing 29.87%-


Underperformance has been due to a DSN vacancy and a DSN providing a DESMOND program, however a new DSN commenced in post during August 2017 and this

can be seen in the improved performance from an average contacts of 308 contacts for M1-M4, which is 429 in M5 which although still under monthly target of 451 is a

significant improvement in performance.

Treatment Room 14.91%-


The treatment rooms overall positon is impacted by over performance in Non-Serious Injury, Specialist Ear Care and Ulcer & Vascular and significant under performance

in treatment rooms. The treatment rooms respond to the needs presented and issues have been raised with commissioners regarding increased complexity of patients and

this impacting on contacts as appointments are prolonged to manage multiple complex issues, particularly in relation to ulcer and vascular care. DNA’s are also noted to

impact on phlebotomy appointments, so the team are planning to change to a walk in service from 1st November to improve activity in this area. 112 of 198



Over Performance Exception Reporting:-

Children's Learning Disability Service 58.11%+


Children’s LD service offer additional service on non-recurring monies and increased funding since April, for up to 53 referrals to the team per year. Baseline needs

reviewing

Community Respiratory Service 14.82%+


The 15% over performance this month is a reduction from 49% over performance in May 2017, and please note this is in line with a vacancy/turnover within the team

which has brought activity nearer to plan.

District Nursing 11.63%+


Teams are responding to increased demand generated by OOH care. More people are staying on caseloads for longer and demand for long term clinical interventions for

people to stay well at home is increasing - e.g. diabetes/ insulin, long term Catheter care. A review of transition from day to OOH care is being completed in M4 and

results will be a plan in M6.

Pulmonary Rehabilitation 32.61%+


The current position in activity over plan is due to the numbers of patients attending and successfully completing their course. This is due to intensive work contacting

patients, building relationships with the service which has resulted in more patients completing a six week course, as predicted earlier explains the increased number of

contacts

Rapid Assessment Team 13.08%+


Following a significant increase in referrals in M4 referrals rates are high but more consistent with previous months. The service continues to over perform on activity due

to high number of referrals of patients in crisis situations at home and palliative patients who require urgent intervention from the Rapid Assessment Team.

113 of 198


Commissioner: NHS Blackpool CCG


Specialist Nurse TB 57.40%+


Increased referrals earlier in the year continues to contribute to increased activity and positive in month variance against monthly plan.

Commissioner: Central Lancs Locality


Community Matrons 15.59%-


New vacancies in team in August. Some sickness. Utilised to support in CHESS. 2 weeks sickness and I week annual leave in Greater Preston during the month of

August has contributed to a negative in month variance against monthly plan.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Blackpool CCG Specialist Nurse TB 70 150 120 142 97 108 617 225 57.40% 392



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Central Lancs Locality Adult Speech and Language Therapy Total 291 349 296 375 415 365 1,800 528 41.51% 1,272

Central Lancs Locality Community Matrons Total 1,408 1,262 1,198 1,291 1,236 1,092 6,079 -1,123 -15.59% 7,202

Central Lancs Locality Community Neuro Team Total 961 1,058 1,237 1,252 1,246 1,252 6,045 992 19.63% 5,053

Central Lancs Locality Community Respiratory Service Total 1,072 1,323 1,476 1,351 1,346 1,489 6,985 1,521 27.84% 5,464

Central Lancs Locality DESMOND (Completed Courses) Total 43 37 53 58 56 57 261 40 18.10% 221

Central Lancs Locality Diabetes Specialist Nursing Total 1,084 842 954 971 1,038 1,152 4,957 -727 -12.79% 5,684

Central Lancs Locality Domicillary Physiotherapy Total 368 694 609 708 704 783 3,498 1,490 74.20% 2,008

Central Lancs Locality Falls Team Total 355 425 658 656 685 665 3,089 1,299 72.57% 1,790

Central Lancs Locality Intermediate Care ACS Total 2,497 1,937 2,100 2,152 1,808 1,646 9,643 -3,435 -26.27% 13,078

Central Lancs Locality Phlebotomy 15,135 16,855 16,160 22,004 17,610 16,671 89,300 11,389 14.62% 77,911

Central Lancs Locality Tissue Viability Service Total 88 49 50 48 53 57 257 -295 -53.44% 552

Central Lancs Locality Viral Hepatitis Service 47 77 109 91 77 14 368 127 52.70% 241

114 of 198




Diabetes Specialist Nursing 12.79%-


Although there is a YTD negative variance of -13%, increased monthly activity due to favourable staffing levels is contributing to a positive variance in month against

monthly plan

Intermediate Care ACS 26.27%-


A period of vacant beds in Meadowfield and Broadfield impacted upon activity levels. As per lines 39 and 40 it is forecast that overall activity in Intermediate Care, Falls

and Community physiotherapy will collectively be above baseline

Tissue Viability Service 53.44%-


A low referral rate for the months of July and August has resulted in a reduction in activity in Central Locality during the month of August after 4 months of over-

performance due to increasing referrals. This has left us in a YTD position of over performance even though we are showing as an in month negative variance against

monthly plan.


Adult Speech and Language Therapy 41.51%+


Increase in referrals. Increased use of band 3 to complete follow up and telephone contacts to review progress.

Community Neuro Team 19.63%+


Increase in referrals overall. Caseload becoming more complex as patients discharged from hospital earlier in their journey creating an increase in the number of contacts

needed for the patients.

Community Respiratory Service 27.84%+


Relatively high numbers of referrals in both July and August together with increased acuity of caseload has contributed to the positive in month variance against monthly

plan. 115 of 198



Over Performance Exception Reporting Continued:-

DESMOND (Completed Courses) 18.10%+


The service currently has an action plan in place to increase uptake of diabetes structured education. This is now delivering improvements in attendance and

contributing to a positive variance in month against plan.

Domiciliary Physiotherapy 74.20%+


Over-performance is in part due to staff configuration set up default position choosing incorrect team name when recording data - this is being addressed with staff.

Some of this over performance (including Falls over performance - see line 40) will be offset against the Intermediate care ACS line.

Falls Team 69%+


Referrals into the service for June and July have continued to increase. This will be monitored in line with the newly implemented re-ablement pathway.

Underperformance in Intermediate Care reported due to the spread of work across the different modalities can see activity being counted within falls or physio.

Phlebotomy 14.62%+


A positive variance in month is due to increasing numbers of patients attending drop in sessions. There is no control over the number of patients that attend. Some of

this increase in activity is due to increasing numbers of patients attending for their outpatient bloods.

Viral Hepatitis 52.70%+


A low referral rate for the months of July and August has resulted in a reduction in activity in Central Locality during the month of August after 4 months of over-

performance due to increasing referrals. This has left us in a YTD position of over performance even though we are showing as an in month negative variance against

monthly plan.

116 of 198


Commissioner: NHS Chorley & South Ribble CCG


Specialist Nurse TB 48.63%-


An overall low referral rate and reduced activity has led to an underperformance in CSR. The team works across both CSR and GPCCG and activity and referrals in

GPCCG are higher.


CHESS 14.18%+


Long term sickness continues in team.

Children's Learning Disability Service 52.92%+



reviewing.

Rheumatology 18.70%+


There were an increase in the number of referrals in the months of June and July which has contributed to the positive variance in month against monthly plan.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Chorley and South Ribble CCG CHESS 129 156 205 107 33 143 644 80 14.18% 564

NHS Chorley and South Ribble CCG Children's Learning Disability Service 211 348 503 462 406 269 1,988 688 52.92% 1,300

NHS Chorley and South Ribble CCG Rheumatology 544 582 680 745 631 695 3,333 525 18.70% 2,808

NHS Chorley and South Ribble CCG Specialist Nurse TB 26 25 6 0 39 5 75 -71 -48.63% 146

117 of 198


Commissioner: NHS Fylde and Wyre CCG


Adult Learning Disability Service 23.38%-









Clinicians are also recording a substantial amount of their activity as ‘non-client linked activity’ which is not included in the reported activity e.g. work with providers &








Increased referrals earlier in the year continues to contribute to increased activity and positive in month variance against monthly plan



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Fylde & Wyre CCG Adult Learning Disability Service 344 165 184 268 210 284 1,111 -339 -23.38% 1,450

NHS Fylde & Wyre CCG Specialist Nurse TB 40 59 29 83 69 55 295 72 32.29% 223

118 of 198


Commissioner: NHS Greater Preston CCG


CHESS 12.12%-


Long term sickness continues in team.

Heart Failure Service 27.04%-


The service delivered a positive variance in month against monthly planned activity. Recruitment to a new post in May is supporting a positive upward trend against

YTD negative variance.


Adult Learning Disability Service 44.60%+









Clinicians are also recording a substantial amount of their activity as ‘non-client linked activity’ which is not included in the reported activity eg. work with providers &







YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Greater Preston CCG Adult Learning Disability Service 266 185 292 351 377 416 1,621 500 44.60% 1,121

NHS Greater Preston CCG CHESS 219 151 222 193 63 70 699 -259 -27.04% 958

NHS Greater Preston CCG Heart Failure Service 171 133 228 233 191 201 986 -136 -12.12% 1,122

119 of 198


Commissioner: NHS Morecambe Bay CCG


Children’s Learning Disability Service 223.29%+



reviewing.



There has been a significant increase in referrals in the month of August, this has contributed to a positive variance in activity against monthly plan.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Morecambe Bay CCG Children's Learning Disability Service 24 94 130 96 80 72 472 326 223.29% 146

NHS Morecambe Bay CCG Specialist Nurse TB 44 66 37 101 76 74 354 108 43.90% 246

120 of 198


Commissioner: NHS West Lancashire CCG


Adult Learning Disability Service 98.78%+









Clinicians are also recording a substantial amount of their activity as ‘non-client linked activity’ which is not included in the reported activity eg. work with providers &





Viral Hepatitis Service 66.67%+


A reduction in contacts for the month of August have improved the YTD positive variance against YTD plan. Due to the number of expected contacts in month, even an

increase of just 1 contact per month has resulted in a positive in month variance of 20%.



YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS West Lancashire CCG Adult Learning Disability Service 156 230 292 324 187 273 1,306 649 98.78% 657

NHS West Lancashire CCG Viral Hepatitis Service 5 2 14 13 5 6 40 16 66.67% 24

121 of 198

3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing - Service Line Totals

101

Service17-18 Monthly


YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

Children's Occupational Therapy Total 756 614 820 810 610 499 3,353 -2,009 -37.47% 5,362

Children's Physiotherapy Total 677 549 614 617 563 486 2,829 -921 -24.56% 3,750

Children's Speech & Language Therapy Total 2,091 1,934 2,794 2,565 2,358 1,925 11,576 -3,367 -22.53% 14,943

Paediatric Liaison Total 4,398 136 170 4,045 4,369 4,182 12,902 -13,094 -50.37% 25,996

Children and Young People's Wellbeing Total 7,922 3,233 4,398 8,037 7,900 7,092 30,660 -19,391 -38.74% 50,051

122 of 198

3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing – Exception Reports by Service

102

Greater Preston Current Position

YTD variance -21.6% improvement of 3.4% from M4

YTD variance -21.6% improvement of 3.4% from M4

Issues

Failed contacts increased by 9% in M5 due to summer

holidays.

Current staffing capacity is at 83% due to B6 vacancies

and LTS.

Failed contacts increased by 9% in M5 due to

summer holidays.

Current staffing capacity is at 83% due to B6

vacancies and LTS.

Forecast around improving activity

Failed contacts expected to be less in M6. YTD variance

expected to be in range by M9 once recruitment taken

place and LTS returns.

Failed contacts expected to be less in M6. YTD

variance expected to be in range by M9 once

recruitment taken place and LTS returns.

East Lancashire Current Position YTD variance -18% improvement of 4% from M4

Issues Failed contacts increased by 10.82% in M5 due to

summer holidays

Some staffing capacity issues

Forecast around improving activity Failed contacts expected to be less in M6

Continued improvement in YTD position


YTD Variance

with (%)

Blackburn with Darwen 2,791 2,604 -187 (-7%) 2,604 -187 (-7%)

Chorley & South Ribble 2,282 2,128 -154 (-7%) 2202 -80 (-3.5%)

Greater Preston 2,671 1,582 -1,081 (-41%) 2093 -578 (-21.6%)

East Lancashire 5,611 3,945 -1,666 (-30%) 4579 -1032 (-18%)

West Lancashire 1,568 1,317 -271 (-17%) 1578 +10 (+0.6)

Total 14,943 11,576 -3,367 (-23%) 12755 -2168 (14.5%)

CCG Area

Expected

activity

(Baseline)

Year to date

from QPR

Year to date from

Manual

YTD Variance

with (%)

123 of 198


103

Occupational Therapy

Greater Preston Current Position Improvement in YTD variance from -40% in M4 to -32% in M5

Issues Failed contacts increased by 3.1% in M5 due to summer holidays.

Current staffing capacity is at 88% due to B3 vacancy

Forecast around improving activity Failed contacts expected to be less in M6. YTD variance expected to be in range by M9

once recruitment taken place

East Lancashire Current Position Improvement in YTD variance by 1.71 in M5 to -14.89%

Issues Failed contacts decreased by 11.95% in M5

Some staffing capacity issues due to B6 vacancy

Forecast around improving activity YTD variance expected to increase once recruitment takes place recent LTS returned

West Lancashire Current Position Improvement in YTD variance from -41% in M4 to -33.9% in M5

Issues Incorrect recording activity – being addressed by Team Leader and Professional Lead

Forecast around improving activity Improvement in YTD to be seen by M6

Chorley & South

Ribble

Current Positon

Improvement in YTD variance from -40% in M4 to -24.6% in M5

Issues

Incorrect recording activity – being addressed by Team Leader and Professional Lead.

Failed contacts increased by 6% in M5 due to summer holidays

Forecast around improving capacity Improvement in YTD to be seen by M6

YTD Variance

with (%)

Blackburn with Darwen 668 497 -171 (-26%) 603 -65 (-9.7%)

Chorley & South Ribble 1,105 672 -433 (-39%) 833 -272(24.6%)

Greater Preston 1,071 504 -567 (-53%) 726 -345 (-32%)

East Lancashire 1,752 1,274 -478 (-27%) 1491 -261 (-14.89%)

West Lancashire 766 406 -360 (-47%) 506 -260 (-33.9%)

Total 5,362 3,353 -2,009 (-37%) 4159 -1203(-22.4%)

CCG AreaExpected activity

(Baseline)

Year to date

from QPR

Year to date

from Manual

YTD Variance

with (%)

124 of 198


104

Physiotherapy

Greater Preston Current Position YTD variance -25.5%. Improvement of 1.5% from M4

Issues face Failed contacts increased by 3.5% in M5 due to summer

holidays.

Current staffing capacity is at 82% due to B6 maternity

leave.

Forecast around improving activity Failed contacts expected to be less in M6. YTD variance

expected to be in range by M9 once ML returns.

West Lancashire Current Position YTD variance -26.4%. Improvement of 1.6% from M4

Issues face Staffing capacity currently at 73% due to vacancies.

Forecast around improving activity YTD variance expected to be in range by M9 once

recruited practitioner in post.

YTD Variance

with (%)

Chorley & South Ribble 1,386 1,160 -226 (-16%) 1383 -3(-0.2%)

Greater Preston 1,540 1,076 -464 (-30%) 1147 -393 (25.5%)

West Lancashire 824 593 -231 (-28%) 606 -218 (-26.4%)

Total 3,750 2,829 -921 (-25%) 3136 -614 (16.3%)

CCG AreaExpected activity

(Baseline)

Year to date

from QPR

Year to date

from Manual

YTD Variance

with (%)

125 of 198

3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing–Exception Reports by Service

105

Paediatric Liaison

East Lancashire CCG

April and May’s figures are currently omitted and will be input from M6 following the refresh of data. The accurate M5 variance

including these numbers is +4%.

Chorley & South Ribble CCG & Great Preston CCG

The service receives 100% of its referrals from the Emergency Department (ED), and have no control over the number of children

attending however the activity is lower than expected as we are currently unable to identify the activity that is deflected through the

Go To Doctor Service.

126 of 198

3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing - Total Activity by CCG

106

Children & Young People's Wellbeing -

Total Activity split by CCG

17-18

Monthly PlanApr-17 May-17 Jun-17 Jul-17 Aug-17 YTD 17-18

YTD 17-18

Variance

YTD 17-18

Variance (%)

Planned YTD

17-18

NHS Blackburn with Darwen CCG Total 485 559 737 679 591 535 3,101 -358 -10.35% 3,459

NHS Chorley and South Ribble CCG Total 1,444 745 918 1,305 1,177 814 4,959 -4,012 -44.72% 8,971

NHS East Lancashire CCG Total 3,430 861 1,317 4,018 3,968 3,768 13,932 -7,777 -35.82% 21,709

NHS Greater Preston CCG Total 2,083 679 878 1,515 1,737 1,543 6,352 -6,382 -50.12% 12,734

NHS West Lancashire CCG Total 480 389 548 520 427 432 2,316 -862 -27.12% 3,178

Children & Young People's Wellbeing

Total 7,922 3,233 4,398 8,037 7,900 7,092 30,660 -19,391 -38.74% 50,051

127 of 198

3.2 Contract Activity – Variance to Plan Mental Health – Total Activity split by CCG

128 of 198

3.2 Contract Activity – Variance to Plan Mental Health – Activity Totals

Productivity Metrics Apr-17 May-17 Jun-17 Jul-17 Aug-17 YTD 17-18

ADHD Contacts Total 370 253 389 455 309 1,776

CCTT Teams - Contacts Total 8,189 9,706 9,627 9,171 8,739 45,432

CMHT Contacts Total 2,584 2,846 2,815 2,754 2,789 13,788

CRHT Face to Face Contacts - Below 18 Total 123 242 153 171 126 815

CRHT Face to Face Contacts - 18 to 65 Total 3,667 4,042 3,766 3,921 3,802 19,198

CRHT Face to Face Contacts - Over 65 Total 65 74 43 73 39 294

CRHT Telephone Contacts - Below 18 Total 66 128 96 69 80 439

CRHT Telephone Contacts - 18 to 65 Total 2,130 2,487 2,148 2,404 2,510 11,679

CRHT Telephone Contacts - Over 65 Total 37 106 47 40 41 271

Criminal Justice Liaison - Contacts Total 573 668 585 580 648 3,054

Eating Disorder Service - Contacts Total 1,049 1,286 1,329 1,578 1,463 6,705

Hospital Liaison Contacts Total 618 745 658 565 708 3,294

MAS Teams - Contacts Total 5,917 6,588 6,166 5,505 5,807 29,983

RITT Contacts Total 1,921 2,265 2,270 2,571 2,700 11,727

Mental Health Productivity Total 27,309 31,436 30,092 29,857 29,761 148,455

Mental Health - Total Productivity split by CCG Apr-17 May-17 Jun-17 Jul-17 Aug-17 YTD 17-18

NHS BLACKBURN WITH DARWEN CCG 3,010 3,370 3,180 3,067 3,005 15,632

NHS BLACKPOOL CCG 3,267 3,764 3,422 3,529 3,512 17,494

NHS CHORLEY AND SOUTH RIBBLE CCG 3,117 3,488 3,176 2,975 3,103 15,859

NHS EAST LANCASHIRE CCG 5,936 6,946 6,680 6,743 6,429 32,734

NHS FYLDE & WYRE CCG 3,165 3,405 3,530 3,216 3,334 16,650

NHS GREATER PRESTON CCG 3,743 4,693 4,515 4,192 4,114 21,257

NHS MORECAMBE BAY CCG 3,273 3,534 3,632 3,719 3,654 17,812

NHS WEST LANCASHIRE CCG 1,798 2,236 1,957 2,416 2,610 11,017

Grand Total 27,309 31,436 30,092 29,857 29,761 148,455129 of 198

109

2017-18 Baseline Proposal

LCFT have submitted the completed Mental Health Baselines Proposal and this is currently being reviewed by Commissioners. Feedback is expected

back at the BI to BI Data Group contract meeting on Wed 20th September.

2017-18 M5 Activity

For M5 LCFT have continued to provide the activity totals and YTD position only with in the MH Contract Monitoring Report which has now been

amended to group metric currencies as follows:-

• Demand (Including Referrals, Transfers, Admissions and Discharges)

• Productivity (Face to Face and Non Face to Face Patient and Proxy Contacts)

• Quality (OBD’s, DNA’s and Re-Admissions)

3.2 Contract Activity – Variance to Plan Mental Health – Activity Totals

Quality Metrics Apr-17 May-17 Jun-17 Jul-17 Aug-17 YTD 17-18

Adult Ward Occupied Bed Days Total 5,744 5,835 5,676 5,885 5,921 29,061

Eating Disorder Service DNA's - Follow Up Contacts 94 98 76 123 125 516

Eating Disorder Service DNA's - New Contacts 7 8 14 14 19 62

PICU Ward Occupied Bed Days Total 817 849 846 893 952 4,357

Older Adult (Dementia) Ward Occupied Bed Days Total 812 850 854 909 945 4,370

Older Adult (Functional) Ward Occupied Bed Days Total 1,034 1,104 1,081 1,102 1,154 5,475

Older Adult (Functional) Inpatient 30 Day ReAdmissions Total 1 0 0 0 0 1

Older Adult (Functional) Inpatient 90 Day ReAdmissions Total 1 1 0 1 0 3

Adult Inpatient 30 Day ReAdmissions Rate (8% Target) 9.58% 7.49% 9.04% 9.09% 6.51% 8.32%Adult Inpatient 90 Day ReAdmissions Rate (15% Target) 14.97% 13.90% 16.38% 12.12% 7.69% 13.06%

130 of 198

3.2 Contract Activity – Variance to Plan Children & Young People’s Wellbeing – Sexual Health Activity

as at w/c 28th August 2017

110

• Revised planned attendances full year are 27,344. Actual attendances during August 2017 was 1,228 – 625 below the

planned total of 1,852.

• Initial income for the 17/18 monitoring year shows a increase in M5 in comparison to M4, with the total income as at end of

August 2017 at £576,486.

131 of 198

111

3.3 CQUIN Executive Summary

CQUIN Executive Summary:

Quarter 1 submissions for 2017/18 schemes have taken place. The Trust has received confirmation from Mental Health and Community

commissioners that all Q1 CQUIN schemes have been agreed for payment.

NHSE Spec Comm have confirmed CAMHS Tier 4; we are waiting confirmation for all other commissioners. Discussions are ongoing with

Acute Trusts regarding the A&E CQUIN, however we are working towards the targets for the scheme with commissioner support. We are

working with commissioners regarding the reporting of tobacco referral and medication offer indicator. Some further work needs to be done

regarding Preventing ill heath by Risky behaviours and Physical Health CQUIN schemes to achieving the required increase in targets for

future quarters.

£1,033k CQUIN funding across CCG contracts is agreed based on the Trust meeting it's control total in 2016/17, however there are

ongoing discussions between NHSE and NHSI regarding the payment mechanism.

A further £1,033k CQUIN funding across CCG contracts is agreed based on the Trust's engagement and commitment to the STP process.

Confirmation has been received via BWD CCG that this element of funding has been agreed by the STP.

The Trust is currently expecting to achieve the full £6m CQUIN funding available for 2017/18.

Executive Summary

Contract Actual

Loss/

concern Expected

Loss/

concern Expected

Loss/

concern Expected

Loss/

concern % Met Expected

Loss/

concern

Mental Health 100% £652,503 £0 100% £558,284 £0 100% £515,457 £0 100% £1,842,663 £0 100% £3,568,908 £0

Southport 100% £45,584 £0 100% £48,657 £0 100% £33,294 £0 100% £128,513 £0 100% £256,048 £0

Community 100% £238,378 £0 100% £254,446 £0 100% £174,107 £0 100% £672,046 £0 100% £1,338,977 £0

NHS England - Spec Comm MH 100% £193,941 £0 100% £193,941 £0 100% £193,941 £0 100% £193,941 £0 100% £775,762 £0

NHS England - Liaison & Diversion 100% £5,201 £0 100% £5,201 £0 100% £5,201 £0 100% £5,201 £0 100% £20,803 £0

NHS England - Imm & Vacc 100% £3,675 £0 100% £3,675 £0 100% £7,350 £0

Aug 2017 CQUIN Position

Expected

PositionTotal

Expected

Position100%

Qtr 2Qtr 1

£1,139,282 100% £1,064,203 £0

Qtr 3

£0Expected

Position£922,000 £0100%

Qtr 4

100%Expected

Position

Full Year

100%£2,842,363 £0 £5,967,848 £0

132 of 198

Quality

Section 4

112

133 of 198

113

Section 4:- Quality

• Quality and Safety Tile

• Quality Surveillance – Safety

• Quality Surveillance – Experience & Effectiveness

• Quality Surveillance – Leadership

• Delivering the Strategy

4. Quality

134 of 198

4. Quality Quality & Safety Tile

114

93 1540

0 296

37 94%

1 8636

0

10

3

1999

94%

83%

Due to the Network Re-design historical data prior to 15 May 2017 is recorded in the four Network structure and has been aggregated in this report to provide the best available comparison.

CQC Overall Trust Rating

Data provided shows the following 12 month figure (where a number) or the rolling 12 month average (where a percentage).

Physical Health Harm Free Care Rate

12 Risks

Good

Number of overdue 7 day reviews

Number of overdue 3 day reviewsMental Health Harm Free Care Rate

Number of compliments

Avoidable MRSA incidents

CQC Intelligence Monitoring Risks

Compliance with Core Skills

CQC Overdue Actions

LEADERSHIP

Other serious HCAI incidents

Regulation 28 Notices received

EFFECTIVENESS

Avoidable C. Diff. incidents

Physical violence to staff

SAFETY

QUALITY AND SAFETY TILE

EXPERIENCE

Number of upheld complaints

F&F Test - Patients

Number of complaints

Number of RIDDOR incidents

Number of serious incidents

Number of Never Events

135 of 198

4. Quality Safety

115

Domain Indicator Target Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug12 months

total

12 months

averageSparkline Risk

Number of STEIS-reportable

serious incidentsn/a 6 16 6 6 7 9 4 8 7 10 4 10 93 7.8

% reduction from 2014/15 >10% -54% 23% -65% -57% -70% 80% -60% -56% -56% -77% -76% -50% - -43.17%

Number of RIDDOR incidents n/a 4 2 2 6 2 0 3 4 5 2 6 1 37 3.1

Number of Never Events 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Duty of candour breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

C. Diff. incidents 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0.1

MRSA incidents 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Other serious HCAI incidents n/a 0 1 1 4 1 0 1 1 0 1 0 0 10 0.8

Overdue CAS alerts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Mixed sex breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Use of restraint n/a 215 257 349 252 189 263 308 329 300 401 460 336 3659 304.9

Potentially avoidable grade 3

and 4 pressure ulcersn/a 0 0 0 0 0 2 0 2 0 5 1 1 11 0.9

Number of instances of 1 or less

qualified on duty (inpatients)0 347 281 244 207 192 170 145 139 197 140 132 177 2371 197.6

Number of red flag incidents

(inpatients only)n/a 419 340 316 261 260 268 221 195 270 227 228 258 3263 271.9

Physical violence to staff from

patients n/a 122 148 162 137 140 129 151 154 150 218 268 220 1999 166.6

% reduction from 2014/15 >10% 77% 20% 42% 19% 32% 43% 3% 57% 63% 102% 195% 189% - 70.17%

Legal Regulation 28 Notices received n/a 0 0 0 0 0 0 1 0 0 1 1 0 3 0.3

Regulatory Inspection Visits or Enforcement

Action:

None.

QUALITY AND SAFETY SURVEILLANCE - Safety

QUALITATIVE INDICATORS

QUANTITATIVE INDICATORS

Staff safety

Incidents

IPC

Patient safety

*NEW*

136 of 198

4. Quality Experience & Effectiveness

116


total

12 months


Number of complaints n/a 93 116 134 150 114 111 167 96 108 152 134 165 1540 128.3

Number of upheld complaints n/a 37 9 42 26 22 21 31 25 22 18 21 22 296 24.7

Number of reopened

complaintsn/a 5 3 2 3 3 5 2 1 4 6 4 1 39 3.3

Number of PHSO complaints n/a 1 1 0 0 1 2 3 1 3 1 0 1 14 1.2

Number of MP enquiries n/a 7 12 8 7 13 9 15 7 8 5 9 11 111 9.3

F&F Test - Patients 95% 97% 91% 85% 87% 96% 96% 96% 96% 97% 95% 97% 97% - 94.12%

F&F Test - Response Rate n/a 2004 2517 3371 1744 1659 2042 1562 1263 1815 1218 1241 1652 22088 1840.7

Compliments Number of compliments n/a 565 597 719 529 678 1031 788 593 984 695 722 735 8636 719.7

QUALITY AND SAFETY SURVEILLANCE - Experience


Complaints

Friends & Family

Domain Indicator Target Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sparkline Risk

Physical Health HFC Rate 95% 94% 94% 93% 94% 95% 95% 93% 94% 96% 94% 95% 96%

Mental Health HFC Rate 90% 83% 81% 82% 83% 86% 84% 85% 83% 83% 84% 81% 80%

CQUIN Exception Report: None.

QUALITY AND SAFETY SURVEILLANCE - Effectiveness



Harm Free Care

12 months

average

94%

83%

137 of 198

4. Quality Leadership

117


total

12 months


Overall Trust Rating Good RI RI RI RI Good Good Good Good Good Good Good Good

Intelligent Monitoring Risks

(six monthly reporting)n/a - - - - - - - - - - - -

Number of overdue CQC actions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00

Number of raising concerns

(six monthly reporting)n/a - - - -

Compliance with Core Skills 85% 86.19% 86.56% 87.72% 88.24% 89.07% 89.41% 90.68% 90.33% 89.26% 91.06% 91.55% 90.81% - 89.24%

Compliance with Care

Certificate80% 35.00% 38.00% 36.00% 54.00% 62.00% 63.00% 67.00% 64.00% 70.00% 77.00% 78.50% 80.70% - 60.43%

No. of overdue 7 day reviews 0 1652 1305 1176 1267 1295 1695 1349 9739 2434.75

No. of overdue 3 day reviews 0 105 80 71 65 77 82 74 554 138.50

QUALITY AND SAFETY SURVEILLANCE - Leadership


CQC

Core Skills

Good

12 Risks

Incident

Investigation

138 of 198

4. Quality Leadership

118

CQC Mental Health Act Monitoring Visits (year to

date):

Community and Wellbeing - 0

Children & Families - 1

Adult Mental Health - 23

Please refer to the network report for further details

April 2017 - Please also note, the CQC carried out an appreciative inquiry through a programme of focused Mental Health Act (MHA) one day visits to contribute new

evidence in the following areas: (1) Information on the local uses of compulsory MH Act powers, looking at activity changes, the reasons for increases or decreases of

detentions, and the response by local services, including commissioning bodies. (2) Identify how local Approved Mental Health Professional (AMHP) services are being

managed, what information is collected and current local issues impacting on AMHP provision and the ability to run a 24 hour AMHP service. The visit was held at the

Harbour on the 27th April. The CQC are currently collating all the information acquired durng the visit and will forward a report over the coming weeks.

Healthwatch Enter and View Visits (year to date):

Internal Quality Assurance visits (year to date):

Commissioner Quality Visits (year to date):

Community Wellbeing - 1












June 2016 - The CQC conducted an unannounced review of safeguarding children and services for looked after children across Lancashire. The report has now been

published and an action plan developed.

July 2016 - HMP Liverpool. The CQC were looking specifically at the four previously issued requirement notices. The report has now been published on the CQC website

and an action plan developed by the Trust.

September 2016 - The CQC undertook a comprehensive inspection of the Trust resulting in an overall rating of 'Good'. The inspection reports have now been published

and our action plan response submitted to the CQC. The Quality Summit was held as planned on the 21st February. The Trust presented its acton plan and approach to

improvement based on the inspection team's findings, whilst also seeking system-wide support to help make improvements and continue our journey of continuous

quality.

October 2016 - A joint HMIP/CQC inspection was undertaken of HMP Wymott. The final inspection report has now been published and a Requirement Notice issued

against Regulation 17. The action plan in response to this Requirement Notice was returned to the CQC on the 28th February. Prison healthcare services transferred

to the new provider, GMW/Bridgewater, on the 1st April 2017.

January 2017 - A joint HMIP/CQC inspection was undertaken of HMP Garth. The final inspection report has now been published and the final requirement notice letter

received. In view of the fact that we are handing over this service on the 1st April to GMW/Bridgewater, we will not be submitting the formal Requirement Notice

Action Plan. However, we will respond with what actions have been completed, actions that have been started but not completed and what has been handed over to

the new provider.

March 2017 - A joint HMIP/CQC inspection was undertaken of HMP Preston. Infomation in relation to the outcome of the inspection was received on the 29th March.

This was sent in advance of the joint inspection report as areas of practice were found whether the Trust needs to make improvements. This will be handed over to the

new provider, Spectrum, on the 1st April 2017.

May 2017 - Blackpool CCG Safeguarding Review - The CQC conducted a review of safegularding children and services for looked after children on the 8th May - 12th May.

This was not a regulatory inspection but a service review. As part of the review the CQC visited the Blackpool Complex Care and Treatment Team, minaly to look at

transition of services across CAMHS and AMHS.


CQC Inspection Visits (year to date):

139 of 198

4. Quality Delivering the Strategy

119

Programme Description Type of Scheme

Exec SRO Sue Moore

Programme SRO Louise Corlett

Programme Manager Carly Steer

Reporting Period August 2017 (M5)

Report date 15-Sep-17

Description Responsible

Status - Overall health

For all schemes that have been initiated, work is ongoing to finalise scheme definition, detailed plan

and deliverables, where this is not already in place (status summarised for each scheme in

Programme assurance heat maps). Further work required to establish benefit trackers for each

programme, to enable leads to measure performance and provide robust assurance on delivery.

Governance and reporting structure has been reviewed and whilst Programme Assurance Groups

continue for each portfolio, the performance management group has been stood down and PAGs will

report directly to BDD via this report.

Head of Delivery &

Performance and SROs

TimescalesTimescales cannot be currently assessed accurately until robust delivery plans for all initiated

schemes. Head of Delivery &


Resources (corporate/other/kit)

Resources are aligned to most projects from the networks in relation to project leads and clinical

leads, with the exception of CWB where there are a number of gaps relating to Transformation

support, a resolution to this is being sought. Schemes that have yet to be initiated are being

evaluated against a framework, to determine what resources will be required to support the

schemes.

Head of Delivery and PMO

Lead

Budget

The financial savings target for the programme is £15.1m - with £11.1m of traditional CIP schemes

and £4m of cost reduction schemes. There are plans to the value of £13.2m registered on Sharepoint,

£12.1m as approved, with £0.98m at Feasibility stage. Within the £12.1m approved, £2.4m relates to

cost reduction scheme for which delivery ytd is unconfirmed and there is slippage of £117k against

approved schemes in year. Pipeline schemes to the value of £1,659 are undergoing due diligence to

mitigate the gap of £2.01m in order to achieve the 17/18 target.

Head of Delivery &


Quality QIAs are being developed alongside PIDs. The Star Chamber remains in place to review QIAs as they

are developed.

Head of Delivery &

Performance

Associate Director Quality

and Patient Experience and

SROs

Risks

The risk profile is emerging and will be further developed as PIDs and QIAs are approved. The

greatest risk being the achievement of the overall savings profile required to deliver the financial

target for the year and the progress on transformation schemes to deliver CIP schemes for 18/19.

Head of Delivery &


The purpose of Delivering the Strategy (DTS) is to deliver the Trust's transformation programme and

the operational annual plan. The focus is on tranformational schemes that are aligned to the STP and

LDPs and on continuous improvement of quality within our services. There are 6 DTS portfolios in

2017/18 aiming to deliver a wide range of redesign programmes.

Transformational, cost

saving and income

generating

DTS Programme Progress Report

140 of 198

120


Stages17/18

TargetIdentified

Feasibility

StageApproved

Current

Forecast

Slippage

(-ve) / Over-

delivery in

Approved

Schemes

Balance btw

Identified

Amount to

Target 17/18

Balance btw

CIP Tracker

and

Identified

Non

Recurrent

Schemes

in Fcast

YTD

Delivery

YTD

Approved

Plan

YTD

Slippage

(-ve)

Month 4 15,100,000 13,203,007 983,291 12,219,716 12,102,252 -117,464 1,896,993 2,880,284 365,496 3,999,922 4,095,790 -95,868

Month 5 15,100,000 13,203,007 983,291 12,219,716 12,102,252 -117,464 1,896,993 2,880,284 365,496 5,024,943 5,086,841 -61,898

Variance 0 0 0 0 0 0 0 0 0 1,025,021 991,051 33,970

CIP Tracker Tool Performance to Month 5

141 of 198

121


BaselineAnnual Performance

Plan (£000)

Annual Forecast

Performance Actual

(£000)

2017/18 15,100

Additional Programme Reporting

Overall Target 15,100

Identified Programmes 13,203

Gap between Overall DTS Target & Identified Programmes

Value of approved schemes 12,220 12,102

Value of schemes at Feasibility 983

Risks

Slippage Against Annual Performance 117

Gap between Approved schemes and Identified Programmes 983

Value of non-recurrent schemes 365

Gross Risk of Delivery Against Overall DTS Target 2,998 a+b+c

Mitigation 983 d

Net Risk of Delivery Against Overall DTS Target 2,015 (a+b+c)-d

142 of 198

122


Programme SRO Goal (£000) Month Transacted Narrative

Q1 191,129

Jul (04) 74,886

Aug (05) 89,361

All the programmes have now been inititated, apart from CPOC which is yet to be scoped out. All PIDS

have been agreed and highlevel plans are in place. Further work is required to establish detailed benefit

realisation plans. Most plans i are on track with some delays in the LD programme, which can be

mitigated through work ongoing within the programme delivery group. Next steps will be to establish

detailed benefits profiles for each programme, that will be provide greater assurance.

Q1 1,258,830

Jul (04)454,610

Aug (05) 429,036

All programmes within the Mental Health Portfolio have now launched excepted transforming secure

services and models of care. Workshops are ongoing to scope out transforming secure services and

inititate programme. Core Home Treatment 24/7 Virtual Ward, to complete documentation and agree

delivery plans. Further work required to determine scope of CSU in North, as scope has changed. The

following programmes are fully scoped out and ontrack agianst plans: Mental Health access line, ward

reconfiguration and S136 facilities for young people.

Q1 508,790

Jul(04) 140,153

Aug (05) 115,039

All work-streams except Complex Packages of Care have now launched. Following the decision at the

Business Development and Transformation Committee on 10 Aug in recognition of interdependencies, the

Tier 3/Child Psychology Services scheme is absorbed into the 0-25 scheme and a joint project plan has been

developed. All PIDs and highlevel project plans are in place, and QIAs will be developed as the model is

agreed. These documents are iterative and will develop as plans become more mature.

2,142,770

£1.4m is registered on the CIP system, £1,167k approved and £254k at feasibility. Current forecast of

£1049k delivery with £117k slippage on the continence and dental scheme, which is a deteriorated

position on last month. However, further work has progressed on the gap of £962k and pipeline schemes

to the value of £617 are undergoing due diligence to mitigate the gap.

£5.5m of schemes are registered as approved, with declared slippage of 11k. This position includes

£3.45m of schemes related to cost reduction (see below). This is a slight deterioration on the position on

last month, with schemes worth £435k still in the pipeline. Tracking of the progress and delivery £2.4m

cost reduction schemes related to tenporary staffing and OAPs spend is required to evidence the

delivery of these schemes and the impact of pressures elsewhere in the budget needs to be recognised

as offsetting the impact of these schemes. A recovery plan has been developed to address the overall

pressures in MH. There remains a risk around the admin scheme which has not commenced but is due to

yield savings from September.

£1.54m of schemes are registered on the system, all of which are approved. Pipeline schemes to the

value of £517k are in train- and if all schemes are approved this will leave £82k to bridge the gap. This is

an improved position on last month.

Community

Wellbeing

Tanya

Hibbert2,265,460

Mental HealthLisa

Moorhouse7,869,522

Children &

Young PeopleSteve Tingle

143 of 198

123


Programme SRO Goal (£000) Month Transacted Narrative

Savings delivered through this programme will be reported through the relevant Network or Corporate

services

The organisational reset programme is underway, with SLT approving the initial focus on the admin

workstream. Use of the Carter benchmarking has highlighted areas for improvement and the group will

develop a workforce model to progress once JDs have been standardised/rationalised.

Savings delivered through this programme will be reported through the relevant Network or Corporate

services.

Southport & Formby

Southport and Formby Transformation Steering Group has been established to oversee the full service

transformation of S&F community services. (TOR and Governance Structure in place)

The plan is to have completed all team workshops and have an18 month prioritisation plan agreed in

conjunction with the CCG by Sept 2017

Transformation priorities to be agreed with the CCG on the 14th September with full implementation plan

in place.

Perinatal

Current estate plans are behind schedule, but work is underway to migate delays to the building aspects

of the project, this makes estates timesclaes very tight with very little room for slippage. The temporary

project manager is now in post, who will oversee the clinical and workforce model. Plans for these

workstreams will be reviewed by the project manager to ensure all actions have been considered.

Q1 1,001,164

Jul (04) 333,688

Aug(05)333688

Organisational

reset

Louise

Corlett

Mobilisation &

DemobilisationLouise Giles

Support

Services

There has been no further movement from last month. Schemes to the value of £4m are registered at

approved stage. In addition there is £612k of schemes at feasibility. Additional schemes still to be

identified by Nursing and Quality and HR. There is a risk noted in the delivery of the Estates Trinity

programme with some mitigation possible. There is an overachievement against plan of £2.4m

Dominic

McKenna2,801,600

144 of 198

124

4. Quality Audit 2017

National Audit Data collection period Report due Compliance

National Audit of Intermediate Care

(NAIC)

May 2017 to August 2017

Participants will be asked for outturn data

April 2018

National chronic Obstructive

Pulmonary Disease (COPD) audit

programme

April 2017 to July 2017 February 2018

National Diabetes Audit – Adults April 2017 to July 2017 February 2018

Sentinel Stroke National Audit

programme (SSNAP)

April 2017 to March 2018

Collection: April to July, August to November, December to

March, April to March (annual)

January 2018

UK Parkinson’s Audit: (incorporating

Occupational Therapy

Speech and Language Therapy,

Physiotherapy

Elderly care and neurology)

1 May 2017 to 30 September 2017

May 2018

National Audit of Psychosis Autumn/Winter 2017 TBC

National Audit of Anxiety & Depression TBC TBC

Topic 17: Use of depot/LA

antipsychotics for relapse prevention

– baseline audit

May 2017 to June 2017

Sampling & Data Collection: May 2017

Online Data Submission: June 2017

Nov 2017

Topic 15: Prescribing for bipolar

disorder (use of sodium valproate) –

re-audit

September 2017 to October 2017

Sampling & Data Collection: Sept 2017

Online Data Submission: October 2017

Feb 2017

Topic 6: Assessment of side effects of

depot antipsychotic medication – 2nd

supplementary

February 2018 to March 2018

Sampling & Data Collection: February 2018

Online Data Submission: March 2018

July 2018

145 of 198

Workforce

Section 5

125

146 of 198

5. Workforce

126

Section 5:-

• Actual Workforce Costs Compared to Budget

• Sickness Absence Rates

• Appraisals and Mandatory Training Compliance

• Vacancy Management and Active Recruitment

• Core Workforce Headcount

• Workforce Turnover

147 of 198

127

Actual Workforce Costs Compared to Budget - Quarterly Trend

Peripheral Workforce Spend and Usage

5. Workforce Actual Workforce Costs Compared to Budget

Spend £ % Spend £ % Spend £ %

T rust 19,367,355 1,476,147 6.8% 420,472 1.9% 397,404 1.8% 2,294,023 21,661,378 10.59%

M ental Health 8,876,496 1,189,975 11.2% 285,160 2.7% 300,285 2.8% 1,775,420 10,651,916 16.67%

Community &

Wellbeing4,414,074 165,262 3.4% 142,282 2.9% 101,595 2.1% 409,139 4,823,213 8.48%

Children & Young

People3,273,029 75,238 2.2% 9,151 0.3% 36,735 1.1% 121,124 3,394,153 3.57%

Corporate 2,803,756 45,672 1.6% -16,120 -0.6% -41,211 -1.5% -11,659 2,792,096 -0.42%

Flexible

Labour

Reliance %Business Area

Core

Workforce

Spend £

Bank Agency M edical AgencyTotal Spend

£

2017 08

Total

Peripheral

Workforce

Spend £

Actual Workforce Costs compared to Budget:

Overall spend on peripheral labour has increased

for a second month, and reports a 10.59%

peripheral Labour Reliance rate for August.

Actions:

Mental Health Network:

Secure Services and the Harbour are holding

weekly Bank and Agency meetings to establish

the reasons for high usage and agree how this

can be mitigated. The content of this meeting

updates the monthly Network Bank and Agency

usage meeting.

Regular reviews are being conducted by the

Care Teams to appraise the level of service

user acuity and staffing levels. Their focus is to

ensure an appropriate level of staffing is in

place to provide safe and effective care.

Community & Wellbeing Network:

The consultation for the Dental Services

redesign concluded in June. Delivery of the

planned workforce changes will address the

use of and reliance on Bank Workers at the

Dental Nurse and Dentist level and the

network are expecting to see spend

improvements through Q2.

Services continue to review their need for the

use of Bank and Agency and usage escalation

processes in place at Longridge have been

extended to Southport & Formby.

50 Applications are currently being processed

to convert regular Agency Workers in use in

Southport & Formby to LCFT Bank Workers.

148 of 198

5. Workforce Sickness Absence Rates

128

Trust 12 Month, Year on Year Trend

Sickness Absence Breakdown

Rate Rate Rate Trend

2017 06 2017 07 2017 08

% Long

Term

Absence

% Short

Term

Absence

12mths

Trust 5.96% 6.42% 6.18% 52.48% 47.52%

Mental Health 7.30% 7.98% 7.38% 58.28% 41.72%

Community & Wellbeing 5.67% 6.58% 6.50% 46.55% 53.45%

Children & Young People 4.56% 4.46% 5.06% 44.80% 55.20%

Support Services 3.86% 3.41% 2.83% 61.73% 38.27%

2017 08

Sickness Absence Rates:

The Sickness Absence rate has decreased in the month of August,

reporting 6.18%. The Mental Health Network rate has seen a

decrease this month, to 7.38%.

Actions:


The management of sickness absence remains a top priority for

the Network’s Senior Leadership Team as is the focus on the

Back to Basics Sickness Absence Management Action Plan.

Service Managers are working closely with HR to effectively

manage sickness absence.


Network continues to focus on the management of Long Term

Sickness to facilitate the return of employees or dismiss al due to

capability (ill health) .

Sickness absence management remains a top priority with

Network SMT and the Network continues to review its action plan

alongside the Trust Back to Basics plan

Action plans are in place for significant Long Term Sickness

Cases in the Network and are monitored by and discussed with

Care Group managers on a monthly basis

Children & Young Persons Wellbeing Network:

Network is embedding the Sickness Absence Back to Basics

Management project within the network and are working to align

this with the new Reset Management Structure.

Network continues to focus on the management of Long Term

Sickness to facilitate the return of employees, medical

redeployment trial periods or dismissal due to capability (ill

health) .

149 of 198

5. Workforce Appraisals and Mandatory Training Compliance

129

Conflict

Resolution

3yr

E&D 3yrFire Safety

1yr

Health &

Safety 3yr

Infection

Control

Admin 2yr

Infection

Control

Clinical 1yr

Manual

Handling 1

3yr

Mental

Capacity Act

(Admin) One

Time

Completion

Mental

Capacity Act

(Clinical) 3yr

Resuscitation

1yr

Safeguarding

Children 1

3yr

Safeguarding

Adults 1 3yrCore Total ILS 1yr

Manual

Handling 2

3yr

Manual

Handling 3

2yr

Safeguardin

g Children 2

3yr

Safeguardin

g Children 3

3yr

Information

Governance

Local

Total

Co

re &

Lo

cal

Tota

l

Trust 87% 98% 89% 97% 97% 85% 96% 88% 87% 77% 96% 96% 91% 82% 85% 79% 93% 83% 92% 86% 89% 29%

MH 86% 99% 90% 98% 97% 85% 97% 90% 88% 74% 98% 96% 91% 79% 79% 67% 94% 76% 92% 81% 88% 21%

C&W 87% 98% 90% 96% 98% 86% 95% 87% 86% 81% 94% 97% 91% 97% 92% 86% 93% 82% 93% 90% 91% 32%

C&YP 88% 97% 85% 95% 95% 83% 94% 91% 88% 77% 96% 94% 90% 90% 89% 85% x 92% 91% 89% 90% 38%

SS 92% 98% 91% 97% 96% 88% 97% 86% 87% 86% 96% 96% 93% 100% 84% x 99% 100% 94% 95% 93% 40%

Core Mandatory & Statutory Training Local Mandatory & Statutory Training

Appraisals

Compliance

Appraisals and Mandatory Training Compliance:

Mandatory and Statutory training rates remain steady across the Trust . Networks continue to work closely with Quality Academy and focus on improvement

in this key performance measure. Appraisal Compliance for Q2 remains under the Trust Target. Q2 compliance is calculated using the number of

employees who have objectives in place and who have completed the first PDR review against the total number of employees.

Actions:


The Network continue to work closely with the Quality Academy to develop and implement their Network compliance improvement plans for the training

areas that are, individually, below the compliance target.

PDR compliance is monitored on a monthly basis at the Network People Group Meeting and uses the Tier 2 monthly Network People Performance

Report.

The new Network structure has enhanced accountability and responsibility lines for ensuring that there is a quality PDR process in place across the

Network.


• Network continue to work closely with Quality Academy to improve compliance and enhance data quality.

• PDR compliance has been monitored on a monthly basis at the Network SMT and People Group Meeting using the Tier 2 monthly Network People

Performance Report.

• The new network structure is expected to enhance accountability and reasonability lines for ensuring that Quality PDR process take place and that

compliance across the Network is improved and bi-weekly tracking will recommence post reset for Q2.

• Refinement of reporting lines post reset continues to take place and systems updated to ensure alignment of staff to mangers to allow PDR completion.

Children & Young Persons Wellbeing Network:

• Significant progress has made been made during Q1 with validating central compliance data. Completion of this work is expected to enable the

discontinuation of local compliance reporting.

• The new Network structure has enhanced accountability and responsibility lines for ensuring that there is a quality PDR process in place across the

Network.

150 of 198

5. Workforce Vacancy Management and Active Recruitment

130

Budgeted

Establ ishment (BE)

(FTE)

Actual

Establ ishment (FTE)

Budgeted

Establ ishment

Vacancies

(FTE)

BE Vacancy

Rate

Active Vacancy

Rate

Active Vacancy

FTENo. Pos i tions

Avg. No Days

to Recruit

Trust 6536.44 5819.79 716.65 10.96% 56.97% 408.25 563 0.00

Mental Health 2948.54 2596.15 352.39 11.95% 47.84% 168.60 243 0.00

Community & Wel lbeing 1619.27 1471.48 147.79 9.13% 94.09% 139.06 177 0.00

Chi ldren & Young People 1122.16 1021.97 100.19 8.93% 66.16% 66.29 103 0.00

Support Services 846.47 730.19 116.28 13.74% 29.50% 34.31 40 0.00

2017 08

Establ ishment Vacancies Vacancies in Active Recruitment

Vacancy Management and Active Recruitment:

The Establishment Vacancy Rate remains stable against the July position and reports a closing rate of 10.96% for August. The number of those vacancies

being actively recruited has decreased slightly, moving from 58.00% in July to 56.97% in August.

Actions:


The Network have been completing the Organisational Reset activity and a number of vacancies that were held to support the displacement and

redeployment process are now in recruitment.

The new Network have amalgamated the Specialist Services and Mental Health Ongoing Recruitment Programmes, designed to target hard to fill posts,

and continue to effectively manage its delivery.


Vacancy clarity and management continues to be high on the Network agenda.

The Network have been managing Organisational Reset and other transformation programme activity and a number of vacancies have been held to

support displaced staff and the redeployment process.

Children & Young People’s Wellbeing Network:

The new Head of Operations has been in post since July 2017, as has the new Service Manager covering the Central and West Lancashire Portfolio.

Vacancies held to support the CAMHS Tier 4 and Sexual Health BwD have been released and are being progressed through recruitment.

151 of 198

5. Workforce Core Workforce Headcount

131

Core Workforce

Network Headcount FTE Headcount FTE

Trust 6647 5871.07 6554 5810.52

Mental Health 2829 2616.92 2801 2591.38

Community & Wellbeing 1808 1495.24 1781 1469.98

Children & Young People 1202 1034.06 1188 1020.97

Support Services 808 724.84 784 728.19

2017 07 2017 08

152 of 198

5. Workforce Workforce Turnover

132

153 of 198

133

6. Risks Board Assurance Framework 17/18 Quarter 1

BOARD ASSURANCE FRAMEWORK DASHBOARD 2017/18 - Q1 POSITION

Strategic

Priority BAF Risk Sub-committee Director Lead

Risk

Score

01.04.17

Risk

Score

Q1

Risk

Score

Q2

Risk

Score

Q3

Risk

Score

Q4

2017/18

Risk

Target

2017/18

Risk

Target Gap

Final

Risk

Target

Final Risk

Target

Gap

SP

1

Qu

ality

1.1 If we do not meet regulatory

standards for quality and safety we will

not be fit for purpose as care provider.

Quality & Safety DoNQ 12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

1.2 If we do not create a culture of

learning then we will be unable to provide

high quality care.


Significant

16

Significant

12

High

4

Tolerable

4

Moderate

12

Significant

1.3 If we do not provide integrated

physical and mental health services we

will lose opportunities to improve patient

outcomes.

Quality & Safety MD 16

Significant

16

Significant

12

High

4

Tolerable

4

Moderate

12

Significant

SP

2

Su

sta

inab

le

Serv

ices

2.1 If we do not work collaboratively with

partners we will not be able to influence

system wide transformation.

Business Dev &

Delivery COO

12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

2.2 If we do not deliver new models of

care we will cease to be a creditable lead

provider.

Business Dev &

Delivery COO

12

High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

SP

3 E

xc

ell

en

ce

3.1 If we do not engage with our patients

and service users we cannot achieve

excellence and quality.


High

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

3.2 If we fail to project our achievements

then our reputation will not improve.

Business Dev &

Delivery COO

16

Significant

16

Significant

12

High

4

Tolerable

4

Moderate

12

Significant

SP

4

Pe

op

le

4.1. If we do not support the health and

wellbeing of staff we will struggle to

attract, recruit and retain our workforce.

People HRD 20

Significant

20

Significant

10

High

10

Concern

5

Moderate

15

Significant

4.2 If staff are not provided with extensive

education, training and leadership

development we will not have an

organisational culture that supports high

performance.

People HRD 9

High

9

High

6

Moderate

3

Tolerable

3

Low

6

Close Monitoring

SP

5

Mo

ne

y

5.1 If we do not meet financial objectives

we will not be able to provide sustainable

services.

Finance CFO 15

Significant

20

Significant

10

High

5

Tolerable

10

High

5

Tolerable

5.2 If we do not work with partners to

deliver system wide efficiencies this will

undermine our own financial position and

that of the STP.

Finance CFO 15

Significant

15

Significant

10

High

5

Tolerable

5

Moderate

10

Concern

SP

6

Inn

ovati

on

6.1 If we do not develop and maintain

infrastructure, we will not be able to

deliver safe, responsive and efficient care.

Infrastructure CFO 16

Significant

12

High

8

High

4

Tolerable

4

Moderate

8

Close Monitoring

6.2 If we do not exploit the full capabilities

of the new EPR system and wider

technology to redesign services we will

miss important opportunities to improve

care.

Infrastructure CFO 16

Significant

16

Significant

8

High

4

Tolerable

4

Moderate

8

Close Monitoring 154 of 198

Southport & Formby

Appendix 1

134

155 of 198

1. Performance Activity Southport & Formby – NHS Improvement Indicators

Dashboard

135

Indicators achieved Target Type Target May-17 Jun-17 Jul-17 Aug-17Rolling 12 Month

Sparkline

NHS Improvement

CIDS - Referrals NHSI 50.00% - 100.00% 100.00% 100.00%

CIDS - Activity NHSI 50.00% - - 81.25% 66.67%

156 of 198

1. Performance Activity Southport & Formby – NHS Improvement Indicators

Kitemarking

136

157 of 198

1. Performance Activity Southport & Formby – Contacts Summary

137

Unvalidated Figures

Validated Figures

Service Target Type Target May-17 Jun-17 Jul-17 Aug-17

Adult Therapies - MS Commissioner TBC 5 6 4 4

Adult Therapies - Neurology Commissioner TBC 309 248 279 285

Adult Therapies - Non Neuro Commissioner TBC 384 427 396 359

Adult Therapies - SALT Commissioner TBC 13 9 7 12

Adult Therapies - Vestibular Commissioner TBC 32 41 41 43

Cancer Commissioner TBC 3 2 3 1

CERT Commissioner TBC 2227 2562 2596 2560

Chronic Care Coordinators Commissioner TBC 480 448 410 325

Community Matrons Commissioner TBC 252 383 366 350

Continence Commissioner TBC 142 200 328 514

Diabetes Commissioner TBC 459 458 382 492

Dietetics Commissioner TBC 406 448 435 444

District Nurses Commissioner TBC 6460 8489 7821 8148

District Nurses OOH Commissioner TBC 559 483 617 497

Exclude Commissioner TBC 55 130 138 98

Falls Service Commissioner TBC 110 92 90 144

Leg Ulcer Commissioner TBC 57 95 106 92

Long Term Conditions Commissioner TBC 15 24 16 17

Mindfulness Group Commissioner TBC 4 8 5 2

Pain Commissioner TBC 27 20 20 25

Pain Management Commissioner TBC 251 293 286 215

Phlebotomy Commissioner TBC 1406 2348 2178 2248

Podiatry Commissioner TBC 1923 2240 2169 2302

Psychology Commissioner TBC 85 107 119 130

Stoma Commissioner TBC 95 113 127 135

Stroke Commissioner TBC 1 2 1 2

Tissue Viability Commissioner TBC 7 11 12 8

Treatment Rooms Commissioner TBC 2042 2731 2550 2650

Grand Total 17809 22418 21502 22102 158 of 198

1. Performance Activity Southport & Formby – Summary

138

Southport & Formby – Continence:

Improvements in data recording and waiting list management continue to improve the waiting list profile for the Continence Service. The

latest snapshot from 03/09/2017 in comparison to 05/07/2017 shows the team has reduced the high number of +25 weeks and the profile

of the waiting list is front loaded, decreasing in numbers moving through the longer wait bands.

No of Patients on the Continence Waiting list by Wait Bands

159 of 198

2.1 Finance Activity Southport & Formby

Detail for Southport and Formby can be found in the Trust's main QPR Finance and Contracting Section.

160 of 198

140

A temporary data sharing agreement is in place and data will start to populate the Trust’s data warehouse over the coming weeks and

months. When data has been validated it will appear within this report. A project has been initiated to validate each service’s

data. The projected end date for all services is Oct 2017.

2.2 Contract Activity Southport & Formby

161 of 198

141

2.2 Contract Activity Queens Court – Palliative Care subcontract

CNS MAY JUNE Q1 JULY AUG Q2 Total

Number of referrals received 88 84 172 83 93 176 348

% appropriate referrals (SEEN BY SERVICE) 80% 79% 79% 78% 78% 78% 78%

Primary health care team (GP) 20 15 35 16 19 35 70

Specialist nurse / team (internal) 9 13 22 9 4 13 35

Other hospital staff (internal) 47 46 93 36 50 86 179

Internal Referral (QCH & SPCS) 11 10 21 21 20 41 62

Other(other) 1 0 1 1 0 1 2

Not recorded 0 0 0 0 0 0 0

Pain/Symptom Control 83 76 159 81 86 167 326

Psychological Support 44 48 92 39 60 99 191

Social/Financial 0 0 0 2 0 2 2

Family Support 0 1 1 1 0 1 2

Other 0 1 1 0 0 0 1

Number of patients 'active' 364 363 727 383 390 773 1500

82 41 123 37 43 80 203

19 18 37 18 20 38 76

Inappropriate 1 0 1 1 1 2 3

Died within 24hrs of referral 2 2 4 2 4 6 10

Declined 0 1 1 1 1 2 3

Unable to contact (includes admissions) 1 0 1 0 0 0 1

Contact made, appointment arranged 12 11 23 11 10 21 45

Other 3 3 6 5 3 8 14

Unknown 0 1 1 0 1 1 2

Number 70 66 136 65 73 138 274

New and re-referred as % of all patients seen

in month41% 39% 40% 36% 39% 38% 39%

Cancer 42 44 86 42 49 91 177

Non-malignant 28 22 50 23 24 47 97


% Primary Diagnosis of Cancer 60% 67% 63% 65% 67% 66% 65%

Total (New Non F2F) 82 84 166 83 93 176 342

Within 48 hours 69 69 138 67 74 141 279

% target achieved 84% 82% 83% 81% 80% 80% 82%

Referrals not seen (non F:F)

Number of referrals ended (of those seen)

Reason for Referral (maybe more

then 1 per patient)

Referral source

Diagnosis (of those seen)

New and re-referred patients (seen)

Initial Telephone contact

Time from referral to patient contact.

No more than 48hours (75% target)162 of 198

142



New assessment with patient (New F2F) 54 64 118 59 70 129 247

OPD 0 20 44 22 34 56 100

Current place of residence 54 44 74 37 39 76 150

Review FU with patient (face-to-face) 251 266 578 263 220 483 1061

OPD 0 78 139 53 63 116 255

Current place of residence 312 188 439 210 157 367 806

Review FU with patient (telephone) 270 270 540 301 203 504 1044

Advice & Support relative/carer F:F 185 171 356 166 175 341 697

Advice/support to a Professional F:F 168 173 341 162 179 341 682

Advice & Support relative/carer Tel 222 232 454 217 240 457 911

Advice/support to a Professional Tel 147 184 331 158 207 365 696

Bereavement visit with relative / carer 0 0 0 1 0 1 1

Bereavement Telephone with relative / carer 11 16 27 17 24 41 68

Bereavement Letter to relative / carer 14 17 31 18 15 33 64

DNA (Total DNA) NR NR NR NR NR NR NR

0 31 23 54 33 37 70 124

1 15 14 29 10 7 17 46

2 5 3 8 0 5 5 13

3 1 5 6 7 4 11 17

4 4 6 10 4 5 9 19

5 1 3 4 2 3 5 9

6 2 1 3 0 6 6 9

7 1 4 5 3 1 4 9

8-14 6 6 12 5 2 7 19

15-21 3 0 3 0 3 2 5

22-28 0 0 0 1 0 1 1

29-41 0 0 0 0 0 0 0

> 42 0 0 0 0 0 0 0

Total 69 65 134 65 73 138 272

Primary healthcare team 24 15 39 22 18 40 79

Internal referral 1 3 4 2 2 4 8

Died 57 21 78 12 19 31 109

Other 0 2 2 1 4 5 7


Discharged to (of those seen)

Time from Referral to Assessment

in days (seen)

Contacts

(related to caseload)

163 of 198

143



Average time 119 21 32 19 34 28

Shortest time 0 0 0 0 0 0 0

Longest time 1898 154 1898 279 315 315 1898

63% 33% 55% 25% 42% 35% 50%

Home 16 3 19 2 5 7 26

Hospital 21 14 35 9 11 20 55

Hospice 13 0 13 0 1 1 14

Care home 7 4 11 1 2 3 14

Prison 0 0 0 0 0 0 0

Other 0 0 0 0 0 0 0

Unknown 0 0 0 0 0 0 0

PPC achieved 29 9 38 5 7 12 50

PPC not achieved 14 3 17 0 3 3 20

PPC unknown 14 9 23 7 9 16 39


0 - 5 57 54 111 56 61 117 228

6 - 14 9 11 20 8 9 17 37

15 - 21 3 0 3 0 3 3 6

22 - 28 0 0 0 1 0 1 1

29 - 42 0 0 0 2 0 2 2

> 42 0 0 0 0 0 0 0

% Non Hospital Deaths (of those seen)

Time on caseload (of those seen)

Time to receiving care

for referrals in this month

(active data)

Deaths (of those seen)

Place of death (of those seen)

164 of 198

144


Activity perfomance indicator Report frequency May June Q1 July Aug Q2 Annual total

SERVICE USER EXPERIENCE

1. Complaints received Monthly 0 0 0 0 0 0 0

2. Compliments Monthly 6 9 15 3 4 7 22

3. Incidents reported (about the service) Monthly 0 0 0 0 0 0 0

4. Incidents reported (by the service) Monthly 1 0 1 0 2 2 3

5. Iwantgreatcare (number of returns) Annually 0

STAFF TURNOVER /ATTENDANCE

1. Left employment Quarterly 1 0 1

2. Recruited Quarterly 0 0 0

3. Sickness % per establishment Quarterly 2.88% 0.00% 0.106

STAFF TRAINING / DEVELOPMENT

1. Annual apprisals completed 100% Annually 0

2. Mandatory training completed 100% Annually 0

3. Clinical supervision (hours) 100% Monthly 0 0 0 1.5 0 1.5 1.5

GSF Attendance Monthly 6 6 12 8 7 15 27

165 of 198

3. Quality Southport & Formby

145


total

12 months


Number of serious incidents n/a 0 0 1 0 0 1 0.2

Number of RIDDOR incidents n/a 0 0 0 1 0 0 1 0 0 0 0 0 2 0.2

Potentially avoidable grade 3

and grade 4 pressure ulcers0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Duty of candour breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Number of complaints 0 1 0 0 0 0 0 0 0 1 2 12 11 27 2.3

Number of upheld complaints n/a 0 0 0 0 0 0 0 0 0 0 6 5 11 0.9

Number of compliments n/a 0 4 11 44 52 111 22.2

F&F Test - Patients 95% - -

F&F Test - No of Surveys received n/a 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

Effectiveness Physical Health HFC Rate 95% 98% 93% 97% 97% 96%

Leadership Compliance with Core Skills 85% 80.35% 83.62% 87.83% 90.49% - 86%

QUALITY AND SAFETY SURVEILLANCE - Community and Wellbeing Network: Southport and Formby


Safety

Experience

166 of 198

4. Workforce Southport & Formby

146

Detail for Southport and Formby is currently included within the Trust's main QPR Workforce section. Workforce are working on

a method of extracting Southport & Formby information . Due to the complexity, a completion date is yet to be confirmed.

167 of 198

Board of Directors


Report Title Finance Report

FOIA Exemption Part Exemption Section 41: Information provided in Confidence

Prepared by Shannon Carroll – Financial Services Director

Presented by Bill Gregory – Chief Finance Officer


Supporting Executive Director Chief Finance Officer


Report purpose To summarise and analyse actual and forecast financial performance and standing of the Trust, the implications and any proposed management action.


To provide excellent value for money in a financially sustainable way

Board Assurance Framework risk 5.1 The Trust does not achieve financial performance sufficient to maintain resilience and sustainability

CQC domain Effective

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Summary

Actual Plan Var Forecast Plan VarSustainability

EBITDA 4,498 6,677 -2,179 15,848 17,745 -1,897Operational Deficit -1,974 187 -2,161 2,193 2,167 26

CIPs (against Trust Plan) 5,025 5,863 -838 15,100 15,100 0Cash and Liquidity 12,114 15,223 -3,109 23,868 10,989 12,879Capex 1,458 4,409 -2,951 13,661 9,591 4,070UOR

Capital Service 3 2 3 2Liquidity 1 1 1 2I&E Margin 4 2 2 2I&E Variance 3 1 1 1Agency 2 1 2 1Overall 3 1 2 2

Sustainability

CIPs

Liquidity

Capital and Financing

Summary continued overleaf

To Date the Trust has spent £1.5m against the original profile of £4.4m. Spend profile on schemes is dependent on a number of tendering exercises to be completed in Q2 and though changes are being worked through the programme total has now been adjusted to reflect the Trusts success in securing external cash for Places of Safety (£0.5m), Perinatal (£3.5m - £2.5m in 2017/18) and Inpatient schemes (c£5.7m in 2017/18). Timings on the original plan were largely indicative, delays on schemes contingent on agreements with third parties on site arrangements coupled with delays around external cash funding support have negatively impacting on the management and delivery of the whole capital programme. Revised forecasts are being developed for quarter 2 to support cash and capital management. The Trust currently expects to complete its capital programme in line with its control total and funding.

Cash shows an adverse variance from plan of £3.1m. The I&E position continues to be offset by the capital position however timing issues around working capital and in particular debtors are having a significant adverse impact. The main issues surround late council payments (c£3.3m) and unpaid NHS contract monies (£2m). Forecast cash is currently expected to exceed plan, primarily as a result of assumptions around external capital funding for the Inpatient Scheme and the disposals of Westfields, Ribbleton and Ridge Lea - see Cash and Liquidity for more details.

Current Out-Turn

At month 5 with CIPs of £5m against a plan of £5.8m the Trust is c£0.8m behind plan, a deterioration of £0.2m on month 4 (£0.6m behind plan). The adverse variance is mainly due to staffing and delays in the delivery of community schemes and is factored in to the forecasts above. The network management team are now being supported by corporate nursing to implement measures aimed at improving the position.

Month 5 sees a year to date operating deficit of -£2.0m, excluding planned Sustainability and Transformation funding of £0.6m, against a planned surplus to date of £0.2m. The current position continues to be driven by staffing pressures in ward and prison areas and a slow start to delivery against planned cost improvement programmes and OAPs expenditure has now started to exceed funding - see Out Of Area Activity for more details. The forecast assumes current pressures and risks are addressed or mitigated and financial performance achieves (or exceeds) plan but the unmitigated projection indicates a gap of c£6m, c£8m without STF monies. This is a significant deterioration from month 4 (£2m), mainly due to excess OAPs of c£1.8m but also prisons (see also Bank and Agency section) and additional mental health pressures, and it will not be without significant management challenge. After taking in to account £1.7m of disposals, which are accounted for after EBITDA, EBITDA is broadly in line with I&E Margin. The new Use of Resources (UoR) metric is rated at 3, but will rise to a 2 should the Trust meet its financial plans and targets, see below.

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Use of Resources (UoR) risk ratings

Forecasting

Key Actions

Recovery Plan

#

• Finalise OAPs recovery plan and track implementation• Continue the performance management of CIP

Whilst it would appear that the gap can be bridged the plan, currently considered a working draft, is not without significant risk. Delivery will only be achieved with a considerable coordinated and sustained effort across the organisation. The plan will now be refined and presented in more detail to the Financial Recovery Group along with the actions required.

• Finalise the nurse staffing management plan and track implementation

The Trust is currently forecasting the achievement of plan but there are significant pressures challenges involved:• Achievement of ward staffing savings, given acuity and occupancy pressures.• Curtailment of OAPs below funded trajectory• Achievement of Sexual Health income targets.• Achievement of all cost improvement target savings by services.

The current I&E position is constraining the current UoR to a 3, assuming current pressures and risks are addressed and financial performance achieves (or exceeds) plan the Trust will achieve a forecast UoR of 2 in line with the revised plan. Should conditions persist and costs not be managed within the control total then the resulting deterioration might trigger a review of our segmentation.

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Forecast ForecastYTD YTD Out-turn Out-turn

Aug 2017 Jul 2017 at Aug 2017 at Jul 20175 4 Note 12 12 Note

Plan 0.187 0.053 Plan 2.167 2.167

Major Variances Major VariancesCIP Slippage -0.838 -0.616 - See CIP section CIP Slippage 0.000 0.000 - See CIP sectionOATs -0.331 0.000 - See OATs section OATs -1.871 0.000 - See OATs sectionStaffing -4.143 -3.316 - See also Bank and Agency section Staffing -8.648 -8.505 - See also Bank and Agency sectionOther Bud Vars 1.306 0.724 - See Services section Other Bud Vars 1.469 2.295 - See Services sectionReserves 2.401 2.236 - See Reserves section Reserves 8.313 5.550 - See Reserves sectionIncome -0.555 -0.452 - See Reserves section Income 0.764 0.764 - See belowMinor Variances 0.000 0.000 Minor Variances 0.000 0.000

Variance -2.161 -1.425 Variance 0.026 0.103

Actual -1.974 -1.372 Actual Forecast 2.193 2.270

---

-

Surplus - YTD (£m) Surplus - Out-turn (£m)

This month sees an operating deficit of £2.0m, £2.2m behind plan, of which £0.6m relates to STF funding.

YTD income variance relates mainly to STF funds which are assumed in forecast along with additional funds re NCAs and R&D

Staffing variance has increased in part due to phasings of development funding in mental health, but more materially due to ward pressures.The full year projection is an operating surplus of £2.3m, accounting for the STF funding in the plan. The position models an upside of c£8.3m and includes profit on disposals of c£1.7m.

-10,000.0

-8,000.0

-6,000.0

-4,000.0

-2,000.0

0.0

2,000.0

4,000.0

Plan CIP Surplus OATs Staffing Other BudVars

Reserves Addl Income MinorVariances

2,167.0 0.0 -1,871.0 -8,648.1 1,469.4 8,313.2 764.3 0.0

-6,000.0

-5,000.0

-4,000.0

-3,000.0

-2,000.0

-1,000.0

0.0

1,000.0

Plan CIP Shortfall OATs Staffing Other BudVars

Reserves Addl Income MinorVariances

187.0 -838.1 -331.0 -4,143.4 1,306.2 2,400.9 -555.33 0.0

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Plan 138.436 110.510 Plan 332.908 332.908

Major Variances Major VariancesCommunity Services 0.349 0.091 - Note 1 Community Services 2.448 2.446 - Note 1Mental Health 1.430 1.720 - Note 2 Mental Health 2.141 1.550 - Note 2Specialist Services -0.038 0.046 - Note 3 Specialist Services -1.147 -1.149 - Note 3Non NHS Healthcare Income-0.612 -0.460 - Note 4 Non NHS Healthcare Income-1.771 -1.356 - Note 4R&D 0.160 0.129 R&D 0.285 0.326ETR 0.131 0.024 - Student Income ETR 0.146 -0.109 - Student IncomeMiscellaneous 0.216 0.393 - Note 5 Miscellaneous 1.079 2.328 - Note 5STF -0.591 -0.452 STF 0.000 0.000

Minor Variances 0.000 0.000 Minor Variances 0.014 0.015

Variance 1.045 1.492 Variance 3.194 4.050

Actual 139.481 112.002 Actual Forecast 336.102 336.958

12

345 Major increases in the latter part of the year generated by AHSN.

Monthly Income Variances (£m) Cumulative Income Variances (£m)

Major decrease due to Southport commencing in May and not April offset by minor gains in other services including Rheumatology and District Nursing.Major increases revolve around the phasing of the Out of Area Placements expenditure, in addition to Liaison & Diversion and Eating Disorders. Major decreases in Rehabilitation Services and Hospital Liaison.Income is in line with plan at this stage. Year end variances are driven by the anticipated cessation of the HIV contract.Major decrease in respect of lower than planned activity in Sexual Health services and forecasts for Sexual Health and Offender Health later in the year.

0.000

5.000

10.000

15.000

20.000

25.000

30.000

35.000

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

Actual/Forecast

Plan

0.000

50.000

100.000

150.000

200.000

250.000

300.000

350.000

400.000


Actual/Forecast

Plan

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Budget 117.751 94.270 Budget 281.856 281.668

Major Variances Major VariancesMental Health -4.462 -3.373 - Note 1 Mental Health -9.626 -6.423 - Note 1Community & Wellbeing -0.304 -0.217 - Note 2 Community & Wellbeing -0.498 -0.174 - Note 2Children & Young People 0.614 0.299 - Note 3 Children & Young People 0.841 0.466 - Note 3Pharmacy 0.146 0.126 - Note 4 Pharmacy 0.284 0.245 - Note 4Property Services 0.000 0.000 - Note 5 Property Services 0.000 0.000 - Note 5Corporate 0.000 -0.044 - Note 6 Corporate -0.052 -0.324 - Note 6

Variance -4.006 -3.209 -9.050 -6.210

Actual 121.757 97.479 Actual Forecast 290.906 287.878

1

23

4

5

6 Corporate services are slightly behind plan year to date, with overspends in IM&T currently met by underspends in Finance, Medical, and Innovation.

Mental Health in year overspend is driven more acutely by excess staffing costs, primarily on wards, (£2.0m). Actions to review the patients in inpatients setting, their appropriateness for the ward and levels of staffing associated with acuity are advanced and should furnish us with the appropriate information to discuss necessary action to recover the position. There is also significant CIP slippage, as all CIPS have been withdrawn but some schemes are still in development (c£0.9m). The Network's position is diminished further by ward overspends in Secure Services wards (c£1.3m).OAPs are now manifesting as overspends (£0.3m year to date)Community's position is impacted by undelivered CIPs to date (£0.7m). Underspends on community teams and non-pay continue to alleviate the current position.Children and Young People have similarly been impacted by a shortfall on CIP delivery(£0.13m) and Sexual Health activity shortfall (£0.2m) but is currently being compensated for by vacancies and non-pay underspends.

YTD Service Net Expenditure Variance (£m) Forecast Service Net Expenditure Variance (£m)

Pharmacy is performing broadly in line with plan.

Property Services are performing in line with plan and are expected to remain so.

-£5,000

-£4,000

-£3,000

-£2,000

-£1,000

£0

£1,000Mental Health

Community &Wellbeing

Children &Young People Pharmacy

PropertyServices Corporate Total

Service Forecast Variance

-£12,000

-£10,000

-£8,000

-£6,000

-£4,000

-£2,000

£0

£2,000Mental Health

Community &Wellbeing

Children &Young People Pharmacy

PropertyServices Corporate Total

Service Year to Date Variance

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CIP Achievement (£)Notes

Year to Date PerformanceAt month 5 with CIPs of £5m against a plan of £5.9m the Trust is c£0.8m behind plan, a deterioration of £0.2m on month 4 (£0.6m behind plan). The adverse variance is mainly due to staffing and delays in the delivery of community schemes. The network management team are now being supported by corporate nursing to implement measures aimed at improving the position.

Schemes to be Transacted£1m of schemes are yet to be transacted at month 5 leading to year to date slippage of c£0.41m. There is a good degree of confidence in the delivery of these schemes.

Schemes In Process£1.6m of additional schemes identified are not yet sufficiently detailed to transact and after allowing for slippage factored into plan this results in slippage of c£0.37m. There is some confidence in the delivery of these schemes.

Schemes to be Identified£0.4m of additional schemes are required if the Trust is to achieve its CIP (£0.7m at month 4).

ForecastThe programme is currently expected to achieve the Annual Plan.


£'m £'m £'m £'m £'m £'m

Cost Improvement Programmes 4.58 4.52 -0.06 11.10 13.10 2.00

Run Rate Reduction Programmes 1.28 0.50 -0.78 4.00 2.00 -2.00

Total 5.86 5.02 -0.84 15.10 15.10 0.00


£'m £'m £'m £'m £'m £'m

Monitored Schemes 5.09 5.02 -0.06 12.22 12.10 -0.12

Schemes to be transacted 0.41 -0.41 0.98 0.98 0.00

Schemes in Process 0.37 -0.37 2.19 1.58 -0.61

Slippage/Schemes to be identified 0.00 -0.29 0.44 0.73

Total 5.86 5.02 -0.84 15.10 15.10 0.00

Year to Date Annual

Year to Date Annual

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Month Month Month MonthAug 2017 Jul 2017 Aug 2017 Jul 2017

5 4 Note 5 4 Note

Agency Spend 829 704 Note 1 Bank Spend 1,481 1,365

Network Analysis Network AnalysisMental Health 585 525 - Note 2 Mental Health 1190 1141 - Note 2Children & Young Peoples 46 80 - Note 3 Children & Young Peoples 75 53 - Note 3Community & Wellbeing 244 170 - Note 4 Community & Wellbeing 165 134 - Note 4Other Clinical 0 0 Other Clinical 0 0 -Corporate Services -46 -70 - Note 5 Corporate Services 50 37 - Note 5

Actual 829 704 Actual 1,481 1,365

1

2

34

5

The Trust has been given a ceiling by NHS Improvement for agency spend. This target is£7.695m for the year. At the end of period 5, the Trust is -£394k, or 12% above it'strajectory. The new Use of Resources rating measures agency against target and containstrigger points. Key trigger points are a requirement for 50% and 25% or better for ratings of3 and 2 respectively. An individual rating of at least 3 is required to obtain an overall ratingof 2 (see also Use of Resources section).

Corporate Services is net of the charge levied for agency staff. Agency spend is negligible with the exceptions of Health Informatics and AHSN.

Agency Costs Over Time (£'000) Bank Costs Over Time (£'000)

A high level of vacancies is supported by bank and agency, though increased levels of recruitment mean overall staffing costs remain high. Agency costs have increased from last month as well as bank costs.Mental Health Networks bank and agency costs are primarily due to the level of acuity on inpatient wards being beyond the level established although the in month increase is almost entirely attributable to staffing issues at Liverpool Prison.Children and Young Peoples temporary staffing remains relatively minor and consistent.Community and Wellbeing sees an increase in both Bank and Agency, with the major agency change being in respect of medical staffing in Rheumatology and Dietetics.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2015/16 935 1108 932 1180 1119 1176 1139 1183 1170 1072 1289 1209

2016/17 1536 1521 1728 1390 1238 1570 1154 1219 1401 1289 1321 1613

2017/18 1312 1268 1625 1365 1481

0200400600800

100012001400160018002000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2015/16 1030 988 1262 1242 909 1202 1149 939 1073 1077 978 1174

2016/17 1098 862 1250 1184 986 1133 781 827 825 738 661 1006

2017/18 647 691 711 704 829

0

200

400

600

800

1000

1200

1400

Agency Ceiling Apr May Jun Jul Aug Total Projection

Actual 647 691 711 704 829 3,583 7,898Plan 639 639 639 636 636 3,189 7,695Variance -8 -52 -72 -68 -193 -394 -203% of Plan -12% -3%

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Month Month YTD ForecastAug 2017 Jul 2017 Aug 2017 Out-turn

5 4 Note 5 12 Note

Plan 0.5 0.4 Plan 15.2 11.0

Major Variances Major VariancesI&E -0.8 -0.2 - Note 2 I&E -2.2 -1.9 - Note 2Capital & financing 0.7 0.1 - Note 2 Capital & financing 2.9 11.5 - Note 2Contract Vars and Adjs 0.0 -0.4 Note 3 Contract Vars and Adjs -1.8 Note 3Debtors -1.2 6.3 - Note 4 Debtors -3.1 -0.2 - Note 4Timing of settlements to suppliers -3.4 2.2 - Note 4

Timing of settlements to suppliers -2.6 0.8 - Note 4

Provisions and deferred income 0.4 -0.5 - Note 5

Provisions and deferred income 0.9 -0.1 - Note 5

Opening cash 0.0 0.0 Opening adjustment 2.7 2.7

Minor Variances 0.0 0.0 Minor Variances 0.0 0.0

Variance -4.3 7.6 Variance -3.1 12.9

Actual -3.9 8.0 Note 1 Forecast Actual/Forecast 12.1 23.9 - Note 1

1

2

34

5

6 Provisions and Deferred Income are currently generating gains of c£0.9m over plan. Crystallisation of income and redundancy settlements are expected to reduce gains and this is factored into forecasts.

Monthly Cash and Liquidity Variance (£m) Forecast Cash and Liquidity (£m)

Timing of settlements to suppliers is having a negative impact on cash (£2.6m). Levels are lower than expected, but are variable and largely transient in nature, the position is expected to trend toward plan.

Reductions in capital expenditure are supporting cash more than compensating for the impact of the deficit. Forecasts assume planned revenue and capital forecasts are achieved, that PDC for the inpatients Programme is in line with expectations, and that the disposal of Westfields, Ridge Lea and Ribbleton take place in 2017/18.

Debtors remain behind plan, this is mainly due to late council payments (c£3.3 - settlement agreed) and unpaid NHS monies (£2m - unpaid NHS block/recharges and CQUIN).

Forecast cash is ahead of plan by c12.9m partly due to the change in opening position c2.7m, but mainly due to assumptions around disposals (net improvement c£5.75m - Westfields, Ribbleton and Ridge Lea) and the assumed external cash funding of a substantial part of the Inpatient Scheme (net improvement £4.6m). The forecast assumes that proposed management action to bring financial performance back in to line is achieved (including profit on disposals) and also that the Trust, as a result, maintains eligibility for Sustainability Funding.

Cash shows an adverse variance from plan of £3.1m. The I&E position continues to be offset by the capital position however pressures on working capital and in particular debtors are having a significant adverse impact. The main issues surround late council payments (c£3.3) and unpaid NHS monies (£2m), see below.

Contract variations and phasing adjustments negatively impact on cash and are not included in plans.

-10.000

-5.000

0.000

5.000

10.000

15.000


Opening cash balance

Financing and Other

Capital and Investment Activities

Changes to WC

Non Cash Flows

Cash flows from operating activities

0.000

5.000

10.000

15.000

20.000

25.000

30.000


Forecast

Plan

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YTD Plan YTD Act Annual ForecastAug 2017 Aug 2017 Variance Plan Out-turn Variance

£000 £000 £000 £000 £000 £000

IT Schemes 0.750 0.659 -0.091 1.900 1.900 0.000 - Note 1

Estate and infrastructure SchemesLarge Schemes

MH Inpatient Schemes 2.559 0.273 -2.286 4.580 5.700 1.120 - Note 2

Perinatal 0.000 0.000 0.000 0.000 2.470 2.470 - Note 3

Places of Safety 0.000 0.000 0.000 0.000 0.490 0.490 - Note 4

High Priority Schemes 0.240 0.147 -0.093 1.263 1.260 -0.003 - Note 5

Maintenance and Replacement 0.388 0.276 -0.112 0.930 0.930 0.000Other (inc. contingency) 0.472 0.103 -0.369 0.918 0.911 -0.007

Total 4.409 1.458 -2.951 9.591 13.661 4.070

1

2

3

4

56 Programmes are underway with no issues forecast, some delays as a result of focus on fire safety. Underspend also includes contingency.

Note 6-

External cash funding has now been agreed for the Perinatal project with £2.5m being allocated to 2017/18 and £1.3m allocated to 2018/19. Upon conclusion, tender exercises will be undertaken with a view to start on site in Q3.

£0.5m of external cash funding has now been allocated for Places of Safety. Upon conclusion, tender exercises will be undertaken with a view to start on site in Q3, some work is contingent on third parties.

Capital Expenditure

To Date the Trust has spent £1.5m against the original profile of £4.4m. Spend profile on schemes is dependent on a number of tendering exercises to be completed in Q2 and though changes are being worked through the programme total has now been adjusted to reflect the Trusts success in securing external cash for Places of Safety (£0.5m), Perinatal (£3.5m - £2.5m in 2017/18) and Inpatient schemes (c£5.7m in 2017/18 - provisional). Timings on the original plan were largely indicative, with Perinatal and Inpatient schemes in particular being contingent on agreements with third parties on site arrangements. This coupled with delays around external cash funding support have negatively impacted on the management and delivery of the whole capital programme. Revised forecasts are being developed for quarter 2 to support cash and capital management. The Trust currently expects to complete its capital programme in line with its control total and funding.

Minor slippage as work has been focussed on ensuring the IT demands of the transferring Southport & Formby services are met, much of the capital costs for which were incurred in 2016/17.External cash funding has been provisionally allocated through the STP to the Inpatient project, though work on design, agreement of total funding and development of construction profile are still in process. Upon conclusion, tender exercises will be undertaken with a view to start on site in Q3.

No planned/expenditure in Q1. Schemes have now started though with some delays, partly as a result of inpatient development. 177 of 198

Use Of Resource Metric

unitsPlan

YTD ending 31-Aug-2017

Actual YTD ending 31-

Aug-2017

Variance YTD ending 31-May-17

Plan YTD ending 31-

Mar-2018

Forecast YTD ending 31-

Mar-2018

Forecast Variance

Year ending31-Mar-18

Threshold 1 2 3 4

\ Capital Service Cover 2.5 1.75 1.25 <1.25Capital Service Cover Liquidity 0 -7 -14 <-14

I&E Margin 1.00% 0.00% -1.00% <=-1%

Capital service metric 0.0x 2.242 1.449 (0.792) 1.909 1.648 (0.261) Variance from plan 0.00% -1.00% -2.00% <=-2%

Capital service rating Rating 2 3 2 3 Agency 0.00% 25.00% 50.00% >=50%

Liquidity Metric Weighting

Capital Service Cover rating 20.00%

Liquidity metric £m 0.036 3.577 3.541 (0.433) 12.961 13.395 Liquidity rating 20.00%

Liquidity rating Rating 1 1 2 1 I&E Margin rating 20.00%

Variance From Plan rating 20.00%I&E Margin Agency Spend 20.00%

I&E Margin metric % 0.14% (1.42%) (1.55%) 0.65% 0.65% 0.00%

I&E Margin rating Rating 2 4 2 2

I&E Variance From Plan

I&E Variance from plan metric % (1.55%) 0.00%

I&E Variance from plan rating Rating 3 1

Agency

Agency metric % (0.50%) 11.79% 12.29% (0.95%) 3.43% 4.38%

Agency rating Rating 1 2 1 2

Use Of Resources Rating

Overall rating unrounded Rating 2.60 1.80 If unrounded score ends in 0.5 Rating - -Rounded score Rating 3 2

Use Of Resources Rating before overrides Rating 3 2

4 Rating Trigger for Use Of Resources Rating Text Trigger No trigger

Use Of Resources Rating after 4 rating override Rating 3 2

Control total override - Control total accepted Text YES YES

Is the provider in Financial Special Measures? Text No No

Use Of Resources Rating after overrides Rating 3 2

Finance and use of resources is one theme of 5 in the Single Oversight Framework. Segmentation and therefore autonomy and support is dependent on performance across all themes.

Note that under the Single Oversight Framework a score of 1 is now the best rating and 4 the worst. A rating of 4 on any metric or an average rating of 3 triggers a concern and a potential support need.

Overall performance against the UoR is rated at 3 . The rating is primarily driven by the I&E performance and in particular the I&E Margin rating of 4. Assuming management action to bring financial performance back in to line is successful the Trust will maintain eligibility for Sustainability Funding and will achieve a UOR of 2 in line with plan. Should conditions persist and costs not be managed within the control total then the resulting deterioration might trigger a review of our segmentation.

• Capital Service is currently a 3 against a plan of 2, an increase in operating performance of c£0.9m would be required to increase the rating to 2.

• Liquidity is currently a 1 against a plan of 1, a deterioration in the liquidity metric of c£3.3m would be required to reduce the rating to 2.

• I&E Margin rating is currently 4 against a plan of 2, an increase in operating performance of c£0.6m would be required to increase the rating to 3 - Note that the deficit of -£2.0m is £2.2m behind the RCT (£1.6m exc STF)).

• I&E Variance from Plan is currently 3, an increase in operating performance of c£0.6m would be required to increase the rating to 2.

• Agency is currently 2 based on a metric of 12%, a decrease in agency costs of c£0.4m would be required to increase rating to 1.

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Reserves

Reserve Budget Actual £ Annual Projected £

To Date To Date Variance Budget Actual Variance Narrative

£'000 £'000 £'000 £'000 £'000 £'000

Capital Charges £6,478 £6,381 £97 £15,546 £13,663 £1,883 Anticipated Profit on Disposals offset by var due to revaluation of estate

Pay Reserve £841 £477 £364 £1,529 £975 £554 Charge for Apprentice Levy and Junior Medic ContractPressures Reserve £210 £83 £127 £503 £199 £304 Funds to be applied to servicesCIP Reserve £706 -£33 £739 £1,834 -£80 £1,914 Gain on CIP to be applied to service pressuresEmerging Pressures -£225 £0 -£225 -£2,261 £0 -£2,261 Utilisation of Reserves to meet Emerging PressuresDevelopments £527 £250 £277 £961 £250 £711 Costs to be applied as incurredContracts £145 £0 £145 £264 £0 £264 Minor contract gains to be applied to servicesOrganisational Reset £736 £300 £436 £1,766 £300 £1,466 Funds to be returned to Networks, with some staffing chargesAgency & Direct Engagement -£250 -£276 £26 -£600 -£663 £63 Premium for using non-contracted staffSavings to be Identified £0 -£2 £2 £0 -£2,805 £2,805 Additional savings required to deliver control total

Non Pay Inflation £456 £43 £413 £794 £102 £692 Funds to be applied for inflationary pressures

Total £9,622 £7,221 £2,401 £20,336 £11,941 £8,395

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MATTERS

ID Meeting DatePaper Status2017/01 Jul-17 Verbal Partial

2017/02 Jul-17 VerbalPartial



2017/05 Jul-17 Verbal

Excluded

2017/06 Jul-17 VerbalExcluded



The Trust is actively exploring the potential for land sales. Gains may crystallise in 17/18 dependent on timing and profits willcontribute toward the control total.

On-going Claims: VAT claims continue to be pursued in relation to older developments and changes in rulings. A recent ruling nowsupports our claim, but the claim is by no means certain to succeed. Timing and amounts are uncertain though value may be up to£2m, no gain is assumed. Our advisors are actively engaged in bringing this to resolution.

SubjectA number of disputes require resolution and may result in arbitration. These concern NHSE, West Lancs, and Pennine CCGs.

NHSI is currently clarifying the position around elements of the national contingency reserve, £0.5m of which is now outstanding.

The forecast trajectory with regard to Out of Area Placements (OAPs) is currently projected to £1.8m. However there remains a risk tothis this position.

Provision for charges incurred as a result of the organisational reset have been made, the process is largely complete and the financialconsequences are still being finalised so some risk remains.

STF monies have been included in forecasts on the assumption that the Trust will achieve its revenue control total. Should this not bethe case £2.1m of funding would be lost.The Trust is monitoring national legal challenges around pay for sleepover in Learning Disabilities care placements, there is a potentialfinancial risk.

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OUT OF AREA ACTIVITY

NetworkActual/ Forecast Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TotalAcute OAPs (places) 15 11 14 13 10 10 6 6 4 4 4 4 101PICU OAPs (places) 9 13 9 12 12 16 14 12 10 8 6 6 127Total Beds 24 24 23 25 22 26 20 18 14 12 10 10 228Acute OAPs (£'000) 244 185 228 218 168 163 101 98 67 67 61 67 1667PICU OAPs (£'000) 206 308 206 284 284 367 332 275 237 189 128 142 2958Total £'000 450 493 434 502 452 530 433 373 304 256 189 209 4625Less Int. Supp. Schemes -167 -100 -97 -42 -42 -7 -1 -1 -1 -1 -1 -1 -461Habilitation Beds 0 0 0 83 62 62 0 0 0 0 0 0 207Total £'000 283 393 337 543 472 585 432 372 303 255 188 208 4371

1234

5

ForecastActuals

If the current trajectory persists this would present pressure in the order of £2.5m.

The Trust is mobilising Acute Therapy Services in Pennine and Chorley, Crisis Support Units in Preston and Blackpool, and a Crisis House in Coppull. These services have an impact on the bed trajectory and variations in timing will alter the OAPs usage accordingly.

There is a fund of c£3m for OAPs, financed 50:50 by the Trust and Lancashire CCGs. Any underspend can be used to support inpatient staffing while occupancy is above 90%.

Current projection suggest there will be expenditure of £4.3m for OAPs in 2017/18. Additionally, a further £0.5m has been assumed as a pressure.

Commissioners have asked for, and are receiving, monthly actual performance against the profile.

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Appendix 1: Income ScheduleForecast Forecast

YTD YTD Out-turn Out-turnAug 2017 Jul 2017 at Aug 2017 at Jul 2017

5 4 12 12Community Services

Offender Health Offender Health 0.065 0.052 0.417 0.417CommRes Resilience Funding -0.038 -0.031 -0.116 -0.116Rheum Rheumatology 0.135 0.132 0.491 0.348

Learning Disabilities 0.086 0.068 0.173 0.293ComNCA Community Non Contracted Activity 0.035 0.030 0.302 0.311DemGrowth Demographic Growth 0.072 0.057 0.172 0.172

District Nursing 0.167 0.133 0.400 0.400Southport Southport Contract -0.589 -0.674 0.019 0.068Dental Dental Services -0.078 -0.071 -0.163 -0.181Complex Complex Packages of Care 0.062 0.046 0.170 0.170OtherComm Other Community 0.435 0.347 0.584 0.563

Total 0.349 0.091 2.448 2.446

Mental HealthCAMHs CAMHS 0.089 0.063 0.838 0.842

EIS 0.000 0.000 0.000 0.000MH NCA Non Contracted activity 0.079 0.068 0.203 0.251MHRes Resilience Funding 0.047 0.035 0.125 0.125HospLiaison Hospital Liaison -0.269 -0.184 -0.646 -0.552Liasion & Diversion Liaison & Diversion 0.355 0.284 0.853 0.853ADHD ADHD 0.018 0.014 0.043 0.043

Assessment & Treatment Team Service -0.092 -0.073 -0.220 -0.220OAPS Out of Area Placement 0.586 0.879 0.500 0.000EatDis Eating Disorders 0.352 0.282 0.845 0.845MHRehab Rehabilitation Services -0.314 -0.300 -0.754 -0.913MHPhas Phasing Adjustment 0.278 0.484 0.000 0.000MH Other Other Mental Health 0.301 0.168 0.354 0.277

Total 1.430 1.720 2.141 1.550

Specialist CommissioningSecure Secure Services 0.021 0.017 0.052 0.052Tier4 CAMHs Tier 4 Service 0.127 0.029 0.290 0.288

HIV -0.186 0.000 -1.489 -1.489

Total -0.038 0.046 -1.147 -1.149

Local AuthorityHV&SN Health Visiting & School Nursing -0.059 -0.048 -0.143 -0.143SexualHealth Sexual Health -0.536 -0.411 -1.086 -0.674LA CAMHs CAMHs 0.000 0.000 -0.420 -0.420LAOffH Offender Health -0.111 -0.089 -0.267 -0.267OtherLA Other Local Authority 0.094 0.087 0.144 0.147

Total -0.612 -0.460 -1.771 -1.356

STFSTFTotal STF -0.591 -0.452 0.000 0.000

Total -0.591 -0.452 0.000 0.000

R&DR&Dtotal Other R&D 0.160 0.129 0.285 0.326

Total 0.160 0.129 0.285 0.326

ETRETRTotal Student Income 0.131 0.024 0.146 -0.109

Total 0.131 0.024 0.146 -0.109

Other Non Healthcare IncomeAHSN AHSN 0.166 -0.011 1.486 1.413

HR -0.012 -0.009 -0.028 -0.028IT -0.058 0.025 -0.246 -0.060

Prop Property Services -0.116 -0.086 -0.152 0.000PIP 0.031 0.015 0.117 0.108

OpDental Dental 0.000 0.000 0.000 0.000Secureserv Secure Services 0.000 0.000 0.000 0.000TestBeds Test Beds -0.013 -0.010 -0.031 -0.025OtherOp Other Misc 0.217 0.471 -0.067 0.920

Total 0.216 0.393 1.079 2.328

Total 1.045 1.492 3.180 4.035

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Board of Directors


Report Title Medicines Management Annual Report

FOIA Exemption Part Exemption Section 40: Personal Information

Appendix 1

Prepared by Sonia Ramdour, Chief Pharmacist

Presented by Max Marshall, Medical Director


Supporting Executive Director Medical Director


Report purpose This report will provide an overview of the current

infrastructure for medicines management within the Trust,

the governance processes that underpin the safe and

effective use of medicines and highlight areas of

achievement and development.


To meet our statutory/compliance obligations

Board Assurance Framework risk 1.1 If we do not meet regulatory standards for quality and safety we will not be fit for purpose as a care provider

CQC domain Safe

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Prepared By: - Sonia Ramdour Chief Pharmacist Date prepared: - October 2017

Medicines Optimisation Annual Board Report and Presentation

October 2017

Prepared by

Chief Pharmacist

Introduction

This report will provide an overview of the current infrastructure for medicines management

within the Trust, the governance processes that underpin the safe and effective use of

medicines and highlight areas of achievement and development.

Structure

The structure and staffing for the Pharmacy and Medicines Management team is as in

appendix 1. HMP Liverpool is managed within the Mental Health Network and doesn’t sit

within this structure but the Chief Pharmacist still retains Professional responsibility for any

registered Pharmacy staff working within the Trust.

Definition

Medicines Optimisation vs Medicines Management

Medicines management was defined in Talking about Medicines (Healthcare Commission

2009) as the following: -

“Medicines management encompasses the entire way that medicines are selected,

procured, delivered, prescribed, administered and reviewed, to optimise the contribution that

medicines make to producing desired outcomes of patient care”

This has now been replaced by Medicines Optimisation which is defined as: -

“An approach to ensuring patients get the best possible health outcomes from their

medicines, whilst organisations make the best use of their medicines resource”

The NICE guideline Medicines Optimisation: the safe and effective use of medicines to enable the best possible outcomes, published in March 2015 provided a platform for the Trust to develop a three year Medicines Optimisation plan. The plan aims to ensure that prescribing is cost-effective, safe and of high quality so that medicines use is optimised and unmet pharmaceutical need is met on an individual and population basis. The Trust three year Medicines Optimisation plan focusses on the following areas: -

Systems for identifying, reporting and learning from medicines-related patient safety incidents.

Medicines-related communication systems when patients move from one care setting to another.

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Systems supporting safe transfer of care between providers which

includes the accurate medicines reconciliation in all settings especially

when patients cross care boundaries i.e. admission and discharge

Reduce preventable deaths and minimise the burden of disease through the utilisation of

medicines which includes both mental health and physical health drugs

Effective implementation of NICE guidance

The development of Care Pathways including the introduction and use of new drugs

Monitoring antibiotic prescribing to reduce the impact of antimicrobial resistance

Rationalising prescribing for wound care and continence products and appropriate formulary management

Involvement of patients and carers in decision making around medication including

access to information and choice of medication

Tackling medicines waste which includes focussing on adherence and over prescribing

Financial and budgetary control to ensure that we achieve financial balance

The Medicines Optimisation Strategy was updated in September 2017. A new three year

plan will be developed in 2018 following publication of the updated Professional Standards

for Pharmacy Services and feedback from the Carter Review of Pharmacy and Medicines

Management in Mental Health and Community Services.

Governance

Drug and Therapeutics

The Trust Drug and Therapeutics (D&T) group meets on a bimonthly basis and is co-chaired

by the Chief Pharmacist and the Deputy Medical Director.

The membership comprises a cross section of the organisation both mental health and

physical health including medical and nursing colleagues.

The agenda for the meetings includes

The introduction of new drugs,

Budgetary and financial control of drug expenditure for mental health and oversight of

expenditure in service lines within Networks (e.g. Rheumatology, Sexual Health,

Prisons),

Medication Safety including the management of medication incidents,

Non-Medical Prescribing practice,

Patient Group Directions (PGDs),

Safe storage of medicines,

Audits of prescribing practice including POMH-UK,

Policy and procedural development and review

Adoption of NICE guidelines and Technology appraisals,

Patient Safety Alerts re medication including Never Events

Guideline development for prescribing and monitoring

Information resources including patient information leaflets

Homecare

There are three sub groups which sit underneath the D&T

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The Medication Safety Group (chaired by the Medication Safety

Officer) which focusses on all aspects associated with medication

safety including incident reporting and review.

The Homecare Group (chaired by the Lead Pharmacist for East Lancashire) which

manages all Homecare activities re medicines in line with the recommendations of

the Hackett report “Towards a Vision for the Future” published in 2011.

The Prison D&T which manages the specific issues that are pertinent to the Prison

services as they have their own procedural framework due to the complexities of

handling medicines within the prison setting. They also have their own formulary as

this comes down through the specialist commissioners

Controlled Drugs

There is a statutory requirement for designated bodies to appoint a Controlled Drug

Accountable Officer (CDAO) in order to meet the requirements of the Health and Social Care

Act 2012 (revision 2013) and the Controlled Drug Regulations 2013. This is a delegated

authority from the Chief Executive and the individual must be a fit, proper and suitably

experienced person who is accountable and reports to an executive director and have no

direct day to day contact with either the supply, prescribing, administration or destruction of

Controlled Drugs.

The Chief Pharmacist in LCFT is the CDAO and is responsible for ensuring the safe and

effective use of CDs across the organisation. On a quarterly basis the CDAO must submit a

return to the Local Intelligence Network (LIN) which outlines the incidents that have occurred

within the organisation. The submission is required on the 6th day of the month immediately

following the previous quarter i.e. 6th July, 6th October, 6th January, and 6th April.

The reports have been submitted in a timely manner and LIN meetings attended.

Following concerns about repeated Datix reports at HMP Liverpool reporting small

discrepancies in controlled drug balances, an independent assessment of controlled drugs

processes was undertaken by the CDAO at NHSE and the Police Liaison Officer in April

2017. The only high level risk was felt to be the potential for prisoners to access illicit

substances and divert medication. These risks are noted to be of national concern within

prison environments, along with use of Non Psychoactive Substances (NPS) which is a

further concern within the LCFT prison establishments.

Drug Expenditure

New Drugs and their Introduction

The managed introduction of new drugs in particular prior to recommendations provided by

NICE is key to managing the resources available and delivering good medicines

optimisation. The Trust is an active partner in the Lancashire Medicines Management group

(LMMG) which was established in 2013. The purpose of LMMG is to provide a platform for a

consensus decision making process relating to the use of medicines across the Lancashire

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NHS footprint, to ensure equity in access to medicines and optimisation of

medicines use. The decisions made are recommendations to the CCGs as

the current statute for the establishment of CCGs does not allow for devolved accountability

for decision making.

The introduction of the “Biosimilar” products for some of the biologic drugs used in

Rheumatology has opened up the potential for significant savings. There are now plans in

place to initiate new patients on the biosimilar products but agreement has still to be reached

re the switching of existing patients over to the new biosimilar products. In order to realise

efficiency savings there will have to be an agreement with the CCG as these drugs are

recharged back to the CCG as they are PBR excluded drugs. It is anticipated that a gain

share agreement can be reached in line with National guidelines which would allow for

investment in existing Rheumatology services.

Horizon scanning is undertaken routinely as part of the business planning process with

significant new drugs expected in the next three years for the treatment of Alzheimer’s

disease and the introduction of more biosimilar drugs in respect of Biologic treatments.

The Lord Carter Review

The Carter Report “Operational productivity and performance in English NHS acute

hospitals: Unwarranted variations” was published in February 2016 and appertains to Acute

Hospital Organisations. As of October and November 2016 a similar exercise is being

undertaken for mental health, community and specialist organisations and LCFT are actively

involved in this review as one of the cohort trusts. Whilst the expected savings from the

acute model are in the region of £1billion pounds by 2020 it is not anticipated that similar

savings will be released from this review. The major savings in the acute trusts are from the

uptake and use of Biosimilar drugs as discussed above under new medicines and the

introduction of more collaborative working across organisations in particular what are

considered back office functions e.g. medicines supply, medicines procurement and stock

holding. The benchmark targets also include an increase in Pharmacist prescribing, the

introduction of electronic prescribing and the correct coding of medicines to ensure accurate

transfer of prescribing information across interfaces. It is anticipated that more Pharmacist

time spent in clinical activities will lead to greater efficiencies in prescribing and improve

outcomes.

The benchmark target for clinical facing activities is 80% and provisional analysis of the

activity in LCFT demonstrates that we are at 90% front facing clinical activity.

The Top 10 Pathways targeted for further considerations within Mental Health and

Community Services are as follows:

Wound care (including pressure ulcer care)

Management and care of continence and stoma care

Diabetes care including diabetic foot ulcers

Outpatient Parenteral Intravenous/Antimicrobial Therapy

Low Molecular Weight Heparin administration

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Antipsychotic choice, monitoring and adverse event management

Antipsychotic use in Dementia and Learning Difficulties

Medicines waste

Medicines adherence

Nutritional support

Data has been collated and submitted to support benchmarking across Trusts. Areas of

unwarranted variation will be examined following publication of the benchmarking data and

will inform the medicines management business plan for 2018/19. It is noted that significant

pieces of work have already been undertaken in some pathways within the past 12 months,

including introduction of a Total Purchase Scheme for dressings within Lancashire to reduce

waste, revision of wound care and continence formularies and medicines management

support to Outpatient Parenteral Antibiotic Therapy (OPAT) teams to enable outpatient

administration of antibiotics for agreed infections.

Electronic Prescribing and Medicines Administration As outlined above the introduction of electronic prescribing and medicines administration

(EPMA) is seen as essential to achieving good medicines optimisation and is a key outcome

measure for the Carter review.

LCFT embarked on the procurement and introduction of EPMA in 2014 with commencement

and rollout in July 2015 to all mental health inpatient units.

The benefits of EPMA were highlighted in a document from NHS England in 2014 and in LCFT the following are seen as key benefits which are mainly qualitative with limited cash releasing.

All prescriptions legible and complete so ensuring that patients receive the correct

medication at the right time.

System removes the requirement for rewriting prescriptions so has released time for

medical staff to focus on clinical work and reduced transcription errors

Allergy section mandatory and also alerts if a prescribed drug is contra-indicated

Allows nursing staff to ensure all medicines have been administered at the end of a

medicines round resulting in fewer missed dose which is a key indicator for the

medication safety thermometer.

Prescription charts accessible to all staff groups at all times - even off site which allows

on call doctors to manage multiple sites

Visiting GP’s and Dentists are able to view from their bases

Decision support highlights interactions making prescribing safer

Allows Pharmacy to see discharge prescriptions immediately

Links to Pharmacy dispensing system again preventing transcription errors

Allows formulary management

Fully auditable so errors are more visible.

Reporting capability allows prescribing patterns to be analysed

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A business case has been developed to extend the roll out into the

community teams in mental health so that there will be visibility of

prescribing patterns and is currently pending approval. This will for the first time enable

comparative prescribing data analysis to look at variance in prescribing practice.

During the past 12 months there has been the need to revert to business continuity arrangements on two occasions due to system upgrades or unexpected system downtime. This was successfully managed, minor glitches were escalated to system developers for resolution and have informed updates of the business continuity plans.

Other Key areas of Service Delivery Non-Medical Prescribing (NMP) NMP is undertaken by a range of practitioners to differing levels across the Trust. We have

V300 prescribers who are fully independent and can prescribe within their competencies

from the whole British National Formulary (BNF). V150 prescribers (Community Specialist

Nurse Practitioners) and V100 (Community Nurse Practitioner Prescribers) who have a

limited range of medicines they can prescribe within the Nurse Practitioner formulary. These

practitioners work across arrange of settings i.e. specialist teams (e.g. rheumatology, COPD,

cardiac), District Nurses, Health Visitors, Pharmacists, Mental Health Nurses.

We have 461 NMPs who are currently registered on the Trust database as trainee or

qualified prescribers and each is required to undertake an annual Continuing Professional

Development (CPD) declaration which is signed off by their manager to ensure that they

have the skills and competencies to prescribe. Unless this is undertaken on an annual basis

the right to prescribe within the organisation is withheld.

In order to streamline CPD an electronic declaration which can be mapped to the BNF codes

has been implemented so we can analyse the types of prescribing taking place. A number

of improvements to the e-declaration are being planned to coincide with the publication of

the updated BNF in September 2017. A number of induction sessions have been held at

Southport to provide an introduction to LCFT NMP Governance and training and to support

completion of the e-declaration.

Each year we participate in the regional NMP audit and we always submit a large number of

audit information which provides assurances around practice. We undertake an annual audit

of antibiotic prescribing that is undertaken by NMPs in order to ensure that we are not

contributing to the over prescribing of antibiotics. We have two Commissioner driven

performance standards for prescribing by District Nurses i.e. wound care and continence

products. The requirement for both is that prescribing is within 80% of formulary and current

figures are showing over 90% compliance for wound care.

Education and Training There is a comprehensive medicines management training prospectus offering face to face or e-learning in the following subject areas:

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Administration of Medication Controlled Drugs (LCFT Premises & Offender health) Controlled Drugs (Non-LCFT premises) HCSW/HCA - Witnessing Controlled Drugs Prescribing Standards Medicines Management Level 1 Medicines Management Level 2 Refresher Module Medicines Management Level 3 Refresher Module Patient Group Directions Antimicrobial Stewardship Mental Health Medications Clozapine Rapid Tranquillisation Lithium Introduction to Diabetes Mellitus Management of Venous Thromboembolism

The introduction in August 2016 of an assessment of FY1 prescribing competencies has allowed us to be able to put systems and processes in place to ensure that we have a competent medical workforce in terms of prescribing. This has ensured that junior doctors have the appropriate supervision and sign off around their competencies and skills as a prescriber which ensures patient safety. Medicines management training needs for Allied Health Professionals are currently being scoped and bespoke training for occupational therapists working in mental health and for registered nurses and healthcare support workers in Southport and Formby has been developed. Within the last 12 months, interactive electronic training modules have been developed by senior clinical pharmacists to support clinical development of the pharmacist workforce. This work is being presented at the International Conference of Mental Health Pharmacists in October 2017. Through collaboration with local higher education providers, the medicines management team will deliver enhanced mental health training for pharmacists undertaking Postgraduate Clinical Pharmacy Diplomas and are supporting assessment of staff undertaking their NMP qualification. Key medicines management staff have completed or are undertaking the PGCert qualification to further enhance medicines management training within the organisation.

Medication Safety Officer (MSO) The appointment of a medication safety officer (MSO) was mandatory from 2015. This role in LCFT is undertaken by one of the medicines management nurses. This represents only a handful of nurses that have been appointed to this role but the requirement was not prescriptive to a specific profession. The MSO chairs the medication safety group and also is responsible for circulating CAS alerts received in respect of medicines, providing performance reports for the Commissioners re medication errors, focussed pieces of work in specific drug areas e.g. clozapine and liaising on a national basis with NHS England re the MSO network. The Trust has a good reporting of medication incidents through to the National Learning and Reporting System (NRLS). This is in part due to the activities of the Pharmacy team who record their interventions into prescribing where the majority of these are classed as near misses.

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Medicines Management Nurses In order to encourage a more reflective approach to the management of medication incidents and errors the role of the medicines management nurse was introduced into LCFT in 2010 and now includes three members of staff. In 2015 the procedure for the management of medication errors was also rolled out to all professional groups who make a medication error including prescribers. The learning culture created by this reflective approach has ensured that there is open reporting of incidents and we are beginning to see an increase in the numbers of self-reports from medical staff where they have made errors. The main challenge is in capturing near misses as if we could start to capture these we can then prevent an incident from actually occurring. Work is on-going to publicise examples of the types of near misses that should be placed on Datix. We are also keen to promote and encourage yellow card reporting which is the national reporting system for adverse reactions to medicines. This can be undertaken by professionals and patients and has recently been broadened out so that patients can also report where there has been an error in practice i.e. administration of the wrong drug or a prescribing error.

Learning Disabilities

A dedicated Learning Disability Pharmacist works alongside the team to review prescribing

in particular for those patients that are being repatriated from other care facilities as part of

the Winterbourne review. The prescribing patterns seen are complex but the overall aim is to

ensure the appropriate prescribing of psychotropic medication in this patient group so that it

meets best practice guidelines, minimises the risk for the individual patients and reduces the

overall lifetime risk of developing severe and enduring side effects. The pharmacist is

currently leading a piece of work within the Trust in response to the national initiative,

Stopping over medication of people with a learning disability, autism or both (STOMP)

Successes and Developments

Professional Support and Development of Pharmacy Technicians

Following the appointment of a Chief Pharmacy Technician in September 2016, quarterly

training and development afternoons have been introduced for the pharmacy technicians to

provide professional support and development. The Competency Development and

Evaluation Group (CoDEG) competency framework for pharmacy technicians is being rolled

out and will information Personal Development Reviews and support introduction of

enhanced clinical pharmacy roles.

Community Mental Health Prescribing

Approximately 80% of the mental health drug budget is spent in community teams, and yet

these teams are poorly resourced with medicines management staff.

With the current establishment Pharmacists spend time undertaking tasks that could be

done by a clincal pharmacy technicians e.g. storage audits, update of medication snapshot,

response to clozapine plasma levels. Releasing this time would facilitate greater clinical

input and medicines optimisation in the community teams by pharmacists, better oversight of

prescribing practice. This could potentially generate additional savings on drug expenditure

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and lead to improved outcomes for patients. Audit and clinical experience

has also demonstrated areas of poor physical health monitoring and

recording of medication regimens in community teams.

Pilot projects have been undertaken in CMHTs based in Ormskirk, Preston, Chorley and

South Ribble, Accrington and North Lancashire to examine the benefits of putting a Clinical

Pharmacy Technician into the team to address the issues highlighted and promote high

quality care. This has generated the following as key outcome indicators for the development

of this role

They would assess pharmaceutical care needs of community patients

They would highlight against standard criteria those who would benefit from a

pharmaceutical review by a pharmacist. Such criteria would capture high dose

prescribing, polypharmacy and high risk medicines targeting the limited pharmacist

resource to those who would most benefit.

They would ensure that the routine monitoring required by specific medications was

undertaken e.g. Lithium levels and associated blood tests, clozapine plasma levels,

They would ensure that the annual physical health monitoring as required by NICE,

CQUINs and the vision of the Five Year Forward View including blood tests, blood

pressure, weight, indicators for metabolic syndrome, smoking status and routine

screening were up to date by accessing Path lab records, GP records etc.

They would highlight those patients that could be transferred back to GP prescribing

under shared care

The potential gains by undertaking this would be improved outcomes for patients through

rationalising prescribing practice, better physical health monitoring, potential savings on the

prescribing budget and savings on prescriber and clinic time through an overall reduction in

repeat prescribing and monitoring. A report of the pilot is expected in October 2017.

Developing NMP Roles and Improving Capacity

To date, pharmacist NMPs have been working within Community Mental Health, Memory

Assessment and the Lancashire Trauma Services. In May 2017, a pilot of Advanced NMP

on a mental health assessment unit commenced. It was felt that this role could support

timely assessment and intervention, facilitate early discharge and address medical staffing

pressures. A report of the pilot is expected in November 2017

The medicines management team are also increasing NMP capacity within the team with

band 7 pharmacists now enrolling on the NMP course

Antimicrobial Resistance

In line with national recommendations we are required to demonstrate good governance

around the prescribing of antibiotics. Across the Trust our current prescribing of

antimicrobials is low and in mental health this is largely in the inpatient setting. All antibiotic

prescriptions are reviewed in line with the following criteria and this is reported on a quarterly

basis to the Infection Control group.

Prescribing within agreed formulary for the locality (this varies across Lancashire

due to sensitivities in each area)

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Ensuring appropriate use i.e. for recognised conditions

Ensuring appropriate sensitivities

Ensuring appropriate courses of treatment with specific stop dates

In the community there is an annual audit of antibiotic prescribing undertaken by NMPs and

this is reported on to the CCGs as part of the commissioning framework.

The development of community IV antimicrobial services requires more in depth monitoring

and in line with the national patient safety alert and the NICE guideline on Antimicrobial

Stewardship there is recommendation that an antimicrobial stewardship team be established

which includes an antimicrobial Pharmacist. The last 12 months has seen the medicines

management team actively involved in discussions to ensure the safe delivery of Outpatient

Parenteral Antibiotic Therapy (OPAT) services in Central and East Lancashire. There is no

antimicrobial pharmacist within LCFT, although advice is available from the locality acute

trust antimicrobial pharmacist.

Medicines Administration

The current procedural framework for the administration of medicines focusses on the role of

the qualified nurse. A review is currently underway to examine whether as part of expanding

roles that administration could be a delegated practice to non-registered staff. It is envisaged

that this will provide clarity around the scheme of delegation and the underpinning

competency and educational framework that would be required to support this.

Outcomes

How we measure outcomes from good medicines optimisation is challenging and this will

form the key piece of work for the Trust moving forward. The NHS spends approximately 5%

of its annual budget on drugs and this is growing year on year with increased prescribing

across a wide range of conditions. The new developments on the Horizon for a range of

conditions e.g. the use of the newer biologic drugs in Alzheimer’s disease, whilst

representing key developments, will be costly.

The aim will be to try and establish key outcomes whether it be prevention of admissions or

more importantly what is important for the individual patient e.g. health and wellbeing,

employment, relationships etc. By utilising outcome measures we can try to focus on what

our expenditure and prescribing of medication delivers rather than just measuring activity.

Physical Health

As outlined above physical health for our patients with a diagnosis of mental illness is key.

The Five Year Forward View focusses on ensuring that the physical health of patients should

be equally as important as their mental health and it should not be viewed separately. With

mortality rates for patients with a mental health diagnosis higher than the general population

it is essential that we start to address these issues.

The medications that we prescribe are also part of the problem in that they aggravate

obesity, cause diabetes, contribute to cardiac disease through increasing cholesterol and

lipid levels and lead to increased mortality levels. We therefore need to ensure that patients

get targeted treatments that take account of pre-existing morbidity and that medication is

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reduced to the minimum that will allow the patient to remain well with

significant reductions in polypharmacy. We also need to ensure that

appropriate physical health monitoring takes place and that patients receive advice and

support to manage emerging physical health problems e.g. weight management, smoking

cessation, exercise and access to appropriate prevention advice.

Challenges

Staff Health and Wellbeing

A high sickness absence rate within the medicines management team has prompted further

consideration of how staff are best supported to maintain and improve their health and

wellbeing. Temporary relocation of staff to inpatient services, regular health and wellbeing

discussions and initiatives have been introduced in response to concerns.

Medicines Management in Southport and Formby

In May 2017, LCFT expanded its portfolio of services to include community services in

Southport and Formby. Quarterly storage of medication audits quickly identified concerns

with facilities for and standards of medication storage. LCFT governance processes also

uncovered gaps in the governance of NMPs within the locality. The Deputy and Lead

Pharmacist, Chief Pharmacy Technician, Medicines Management Nurse, Non-Medical

Prescribing Lead and Education and Training Lead have all been supporting clinical teams

and the network management team to improve medicines management practices. This has

been delivered within existing staffing establishment and without additional resources.

Moving forward, due diligence reviews need to include medicines management processes,

standards and resource to support safe delivery of services

Medicines Management in HMP Liverpool

Whilst CQC and HMIP inspections have noted the significant progress made in medicines

management practices within HMP Liverpool since contract commencement, an internal

quality visit and incident reports highlighted concerns with the prison estate, medicines

administration errors, expired medicines, privacy and dignity during the medicines

administration process and lack of support from prison officers to staff who are administering

medicines. Actions are underway in response to these concerns.

Performance in POMHUK audits

Performance in the national POMHUK medicines management audits has deteriorated in the

past 12 months prompting a review of approach. A pharmacy and medical lead are now

appointed for each audit. They are responsible for planning the audit, carrying out

necessary preparatory work, communicating with colleagues, ensuring comprehensive and

accurate data collection in identified teams and responding to results to ensure continual

quality improvement.

Key Achievements and Successes

Positive feedback about medicines management services during the recent CQC

inspection

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Delivery of all Cost Improvement Plans

Development of Moodle Training for pharmacists which is to be

presented at the International Conference for Mental Health Pharmacists

Collaboration with Higher Education Establishments to introduce a mental health module

to the Clinical Pharmacy Diploma

Professional support and development of pharmacy technicians

Introduction of competency assessments for medicines management staff

Pilots of new pharmacy roles

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Appendix 1

Summary of Clinical Pharmacy Coverage

The Pharmacy and Medicines Management service in LCFT consist of the following

Chief Pharmacist (9) Responsible to the Medical Director but with dotted lines to the Director of Nursing and Chief Executive

Lead Pharmacists (8c) East Lancashire 1wte North Lancashire 1wte Central Lancashire 1wte

Vacant

Deputy Lead Pharmacists (8b) Central Lancashire 1wte East Lancashire 0.6wte Secure Services 1wte North Lancashire 1wte

Specialist Posts Training and Education Pharmacist (8b) 1wte LD Specialist Pharmacist 8b 1wte Medicines Safety Officer/Medicines Management Nurse 1wte (8b) Medicines Management Nurse 8a 0.5wte Medicines Management Nurse 8a 1wte NMP Nurse Lead 8a 1wte NMP Support Nurse for NMP 7 1wte

Senior Clinical Pharmacists (8a) 1wte Burnley/Pendle CMHT 1wte Blackburn CMHT

Part FOIA Exempt under Section 40: Personal Information

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0.8wte Rossendale/Hyndburn CMHT/EIS 1wte Preston CMHTs 1wte Chorley CMHTs/EIS 0.6wte Ormskirk 1wte Older Adult Inpatients 1wte Blackpool CMHT/EIS 0.6wte Lancaster CMHT/EIS

Specialist Rheumatology Pharmacist/Inpatients Longridge (8a) 1wte Preston

Specialist Clinical Pharmacists (7) 1wte Secure services 1wte Inpatients Burnley 1wte Inpatients Blackburn 1wte Inpatients Blackburn/Burnley 1wte Inpatients Blackpool 1wte Inpatients Blackpool 1wte Inpatients Blackpool 1wte Inpatients Lancaster 1we Inpatients Ormskirk

Chief Pharmacy Technician (6) 0.8wte

Clinical Pharmacy Technicians (5) 1wte Secure services 0.9wte Chorley/Ormskirk Community 1wte Blackburn 1wte Blackburn

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1wte Burnley 1wte Burnley 1wte Blackpool 1wte Blackpool/Lancaster Community 1wte Lancaster 0.6wte East Community services 1wte Central Community services 1wte Harbour 1wte Chorley and South Ribble CMHTs 1wte Preston CMHTs 1wte Hyndburn & Ribble Valley/Rossendale CMHTs

Pharmacy Technician (4) 1wte Ormskirk

Pharmacy Dispensing Assistants (3) 1wte Blackpool 1wte Blackpool

Pharmacy Admin 1wte PA to Chief Pharmacist (4) 1wte NMP Admin support (3) 0.5wte NMP Admin support (3 )

Pharmacy Electronic Prescribing Team Clinical Pharmacy Technician 7 Nurse specialist band 7

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Documents

Board of Directors - Lancashire and South Cumbria NHS … Board/Trust Board... · 2017-10-24 · Board of Directors Meeting Board of Directors Meeting Location Training Room 1 & 2,