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Ealing CCG Performance Report

Month 1

1.0 Introduction & Key Messages This report provides details of the current position relating to quality, performance and finance in Month 1 on acute, community and mental health Trusts. The report describes the key drivers and actions in addressing performance issues. A headline report for Month 1 is provided below.

Key Areas Headline Actions

Quality Never Events Complaints SI’s

• No new Never Events reported in April relating for Ealing CCG. • SI’s actively reviewed with actions in place. A detailed trend review of SI’s is being undertaken due in July.

Operational Performance (Acute Trusts)

18 weeks Ealing CCG did not meet 18 week admitted RTT standard in M1 achieving 87.6%. This was due to NWLH not meeting the RTT admitted performance for M1 achieving 83.4%. • NWLH challenged specialities are Orthopaedics, Ophthalmology, Gastroenterology, ENT, and General Surgery. CCGs have approved a proposal that the NHS

intensive support team (IST) support the Trust with developing a plan to achieve performance. The IST will complete their initial diagnostic in June 2013. • EHT met the RTT admitted performance for M1 and confirmed that all RTT targets have been met at specialty level from the end of May 2013.

Cancer Waits CCG data not available for M1 due to the migration from PCT to CCG localities within the national cancer database. This is expected to be resolved by the end June 2013. • ICHT did not meet the 62 day GP referral and screening standard achieving 75.0% and 79.3% respectively. The 3 breaches on the 62 day cancer screening

pathway were due to complex diagnostic pathways or patients co-morbidity. For the 62 day GP referral pathway 6 breaches were assessed as unavoidable due to complex diagnostic pathways or patient co-morbidity. A further 10 breaches were caused by administrative errors, inter Trust transfers and 1 elective cancellation. The Cancer Commissioning Team are undertaking a detailed review of the root cause analysis reports provided by the Trust and actions to improve performance. Findings from this review will considered at the July CQG meeting with the Trust.

A&E 4hr waits

EHT met the national A&E wait standard but did not meet the local 95% A&E type 1 standard in M1 achieving 95.9%, and 90.3% respectively. EHT and CCGs have jointly developed a whole system action plan that has been approved by Ealing CCG and submitted to NHS England on the 31st May. Performance has improved in M2 with both the local type 1 and national all type standards met.

NWLH did not meet the national 95% A&E all types standard in M12 achieving 86.9%. Actions in place : • A Contract Query is in place. Following a Clinical Risk Summit held in February 2013 by NHSCB, CQC and TDA, three high impact changes have been identified

including improving the management of the Trusts bed capacity, increasing priority discharges and improving admission avoidance. • NWLH and CCGs have jointly developed a whole system action plan that has been approved by CCGs and submitted to NHS England on the 31st May. Response

from NHS England has been received and a revised Recovery & Improvement Plan will be submitted by 19th June. • NWLH performance has improved through May and June. At the end of May The Trust is now meeting the national A&E standard.

MRSA & C.Diff

Ealing CCG reported 1 MRSA case and 4 C.Diff cases in M1. The CCG met the C.Diff tolerance for the month but not for MRSA bacteraemia. This performance was not driven by local providers. Application to the HPA have been completed to enable CSU access to detailed CCG level data and is expected to be accessible by the end June 2013.

Operational Performance (Community)

DTOC Contracted 2013/14 Performance data for Community Providers will be available from Quarter 2. In the interim NWLCSU will continue to report against 2012/13 indicators by exception. Ealing ICO is not meeting the delayed transfers of care target of 2% for Ealing CCGs. An action plan has been provided and this has been signed off by Ealing CCG. Improvement against the plan continues to be monitored via the appropriate contract meeting.

Operational Performance

(Mental Health)

IAPT Contracted 2013/14 Performance data for Mental Health Providers will be available from Quarter 2. In the interim NWLCSU will continue to report against 2012/13 indicators by exception.

Continued poor performance is driven by capacity constraints across the service due to staff vacancies. A recruitment plan is in place and progress against this is monitored via the appropriate contract meeting. Appropriate alternatives to individual therapies and CBT are being offered to clients in order to help reduce lengthy waiting lists.

Finance Month 1 Year to date spend at Month 1 is £ 24,503k compared with an estimated plan of £ 23,680k , however this based on the M1 SLAM reports which are very variable in

quality. Work is underway to improve the quality of the data for Month 2

2

2.0 Operational Performance This section of the report provides an update on operational performance for acute, community and mental health Trust. The current position against plan with RAG assessment and trend is shown for both the CCG and local providers where possible. Reporting is by exception only. A summary of the key drivers for the variance from plan, actions and update on previous actions is provided.

2.1 Acute Providers 2.1.1 National 18 weeks referral to treatment: Current Performance (CCG & Trust)

Performance Measure

Threshold Ealing CCG CCG

Rank (NWL)

Ealing Hosp. NWLH Imperial

M1 YTD M1 YTD Variance M1 YTD Variance M1 YTD Variance

18 weeks RTT - admitted

90% 87.6% 87.6% 8th 90.1% 90.1% 83.4% 83.4% 91.3% 91.3% 18 weeks RTT – non- admitted

95% 97.7% 97.7% 3rd 98.1% 98.1% 97.2% 97.2% 96.7% 96.7% 18 weeks RTT – incomplete

92% 94.9% 94.9% 6th 96.6% 96.6% 95.5% 95.5% 95.0% 95.0%

Provider Issue Update on previous action Action Timeline Owner EHT Specialty admitted / non admitted targets not met in M1 for:

• General Surgery • Oral Surgery

EHT has confirmed specialty performance met from the end of May 2013. The Trust has stated this is sustainable but a review of Oral Surgery is required as there is an imbalance between demand and commissioned activity.

N/A CSU to discuss approach with CCG

N/A June 2013

N/A CSU & CCG

NWLH NWLH did not meet the 90% RTT admitted standard overall and also did not meet specialty specific targets for admitted, non-admitted and incomplete pathway standards. The challenged specialities are Orthopaedics, Ophthalmology, Gastroenterology, ENT, and General Surgery.

NWLH challenged specialities are Orthopaedics, Ophthalmology, Gastroenterology, ENT, and General Surgery. CCGs have approved a proposal that the NHS intensive support team (IST) support the Trust with developing a plan to achieve performance. The IST will complete their initial diagnostic in June 2013.

IST diagnostic report Agree detailed action plan following IST report.

June 2013 July 2013

IST NWLH

ICHT Specialty targets not met in M1 for: • General Surgery • Urology • Orthopaedics 5 patients treated over 52 weeks in month 1 with an additional patient waiting for treatment at month end.

Action plan submitted to recover speciality level performance for General Surgery and Urology by July and August 2013 respectively. ICHT current plan to recover Orthopaedics performance by October 2013. Although pathway issues with current patient waiting over 52 weeks the patient was not treated in April due to patient choice.

- CSU undertaken a critically assessment of the action plan. - CCG to approve plan. - Plan in place for the patient waiting over 52 weeks. - Financial penalties applied for failing at specialty level and for patients waiting over 52 weeks.

Completed June 2013 May 2013 On-going

CSU performance team CCGs ICHT CSU

CCG Performance Trend

Admitted Non-Admitted Incomplete

3 Please note: further details on current CCG and Provider performance can be accessed via the CSU Performance Portal: https://nww.acv.northwestlondon.nhs.uk/sites/performance/Pages/default.aspx

80%

85%

90%

95%

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MA

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96%

97%

98%

99%

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ECJA

NFE

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90%

92%

94%

96%

98%

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https://nww.acv.northwestlondon.nhs.uk/sites/performance/Pages/default.aspx

2.0 Operational Performance This section of the report provides an update on operational performance for acute, community and mental health Trust. The current position against plan with RAG assessment and trend is shown for both the CCG and local providers where possible. Reporting is by exception only. A summary of the key drivers for the variance from plan, actions and update on previous actions is provided.

2.1.2 National : Cancer Waits: Current Performance by exception (CCG and Trust)

4

Please note: further details on current CCG and Provider performance can be accessed via the CSU Performance Portal: https://nww.acv.northwestlondon.nhs.uk/sites/performance/Pages/default.aspx

Performance Measure

Threshold

Ealing CCG CCG Rank

(NWL)

NWLH Ealing Imperial


31 day wait – subsequent surgery treatment

94% Not

Available Not

Available 93.8% 93.8% 100% 100%

No patients treated last

month 94.2% 94.2%

62 day standard – GP referral

85% Not

Available Not

Available 90.1% 90.1% 90.0% 90.0% 75.0% 75.0%

62 day wait from screening

90% Not

Available Not

Available 100% 100% 100% 100% 79.3% 79.3%

Provider Issue Update on previous action Action Timeline Owner NWLH -1 breach (31 day

subsequent surgery)

NWLH reported this is due to a data error and the Cancer Commissioning Team (CCT) has agreed with this assessment. Data error will be corrected.

Discuss at CQG July 2013 CSU

ICHT 75% 62 day from GP referral 3 breaches (62 day screening)

Root cause analysis have been provided and breaches were due to -6 breaches due to complex diagnostic pathway and co-morbidity -5 inter Trust delays -4 administrative errors -1 elective cancellation Root cause analysis have been provided and breaches were due to a complex diagnostic pathway, patient co-morbidity requiring referral to respiratory unit, and patient choice.

• A detailed review of the root cause analysis to identify additional actions required.

• Further information on actions in place to prevent administrative errors has been requested .

June 2013 June 2013

Cancer Commissioning Team ICHT

Note - CCG data not available for M1 due to the migration from PCT to CCG localities with the national cancer database. This is expected to be resolved by the end June 2013.


2.1.3 National: A&E 4hr waits: Current Performance (Trust)

Performance Measure

Threshold

NWLH Ealing Hosp.

M1 YTD Variance M1 YTD Variance

A&E 4hr wait – all types

95% 86.86% 86.86% 95.90% 95.90% A&E 4hr wait – local type 1

95% 72.77% 72.77% 90.31% 90.31%

Trust Performance Trends

NWLH Ealing Hosp.

All Types All Types

Provider Issue Update on previous action Action Timeline Owner

NWLH NWLH – Systemic patient flow issues across both A&E and inpatient wards. In particular the Trust identified medical leadership and higher levels of agency staffing in A&E .

-A Contract Query is in place. Following a Clinical Risk Summit held in February 2013 by NHSCB, CQC and TDA, three high impact changes have been identified including improving the management of the Trusts bed capacity, increasing priority discharges and improving admission avoidance. NWLH has jointly developed a whole system action plan that has been approved by CCGs and submitted to NHS England on the 31

st May. Response

from NHS England has been received and a revised Recovery & Improvement Plan will be submitted by 19th June. -NWLH has initiated a weekly multi-disciplinary review of breaches. Review of rotas has led to increased recruitment of permanent staff in A&E. -Improving performance trend through May and June. At the end of May The Trust is now meeting the national standard and performance shows an improving trend.

-Continue daily monitoring of Trust -Whole system plan to form the basis for pressure surge assurance process for 13/14.

On-going July 2013

CSU performance team CSU performance team

EHT EHT met national all types A&E standard but did not achieve M1 local type 1 A&E standard achieving 88.58%.

EHT has developed a whole system action plan that has been approved by Ealing CCG and submitted to NHS England on the 31st May. Response from NHS England has been received and a revised Recovery & Improvement Plan will be submitted by 19th June. Performance has improved in M2 with both the local type 1 and national all types standard met.

-Continue daily monitoring of Trust -Whole system plan to form the basis for pressure surge assurance process for 13/14.

On-going July 2013


5


Type 1 Type 1

92%

94%

96%

98%

100%

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80%

85%

90%

95%

100%

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80%85%90%95%

100%

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NFE

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R 60%

70%

80%

90%

100%A

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2.1.4 Hospital handover KPIs

Performance Measure Threshold

NWLH Ealing Hosp

M1 YTD Variance M1 YTD Variance

30 min breaches >0 368 368 71 71 60 min breaches >0 110 110 0 0 Percentage of patient handovers within 30 mins

100% 88.7% 88.7% 94.1% 94.1%


NWLH NWLH – Systemic patient flow issues within A&E and inpatient wards. Particular issue with staffing in month with high levels of agency staff.

-Review of rotas has led to increased recruitment of permanent staff in A&E. -Contract query in place. Improved position for M2 13/14 with an 80% improvement in 30 minute breaches.

Continue weekly review of Trust performance. Ensure that actions related to handover times in whole system plans are reviewed as part of winter assurance process.

On-going Starting in July 2013


EHT A&E processes 7% higher A&E attendances and levels of staff sickness when compared to previous year.

-The Trust increased consultant and senior management presence in A&E. -Improved position for M2 13/14 with no 60 minute breaches and 42% improvement in 30 minute breaches.

6



National: MRSA and C.Diff: Current Performance (CCG and Trust)

Performance Measure

Threshold

Ealing CCG Ealing Hosp. NWLH Imperial


MRSA cases

Target 0 0 0 0 0 0 0 0

Actual 1 1 0 0 0 0 0 0

C.Diff cases

Target 9 9 2 2 2 2 6 6

Actual 4 4 2 2 2 2 12 12

CCG Performance Trends


MRSA C.Diff

Provider Issue Update on previous action Action Timeline Owner Ealing CCG 1 MRSA bacteraemia case

reported in M1. Application submitted to HPA to access detailed CCG information by the end of June 2013.

CSU to obtain password access from CCGs

June 2013 CSU performance team

ICHT Annual C.Difficile tolerance is 65 cases with 12 cases reported in M1.

- Detailed root cause analysis is being undertaken and will be submitted by the 14th June 2013. Discussion on further actions required to mitigate risk will be agreed at June CQG meeting. - A further 6 C.Diff and 4 MRSA bacteraemia have been reported in May 2013/14.

Any additional actions will be identified at the CQG.

June 2013 ICHT

Financial penalties applied to all MRSA cases reported.

2.2 Hospital Infection (National)

7

0

2

4

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MA

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JUN

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0

5

10

15

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JUN

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NO

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DEC

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2.3 Community & Mental Health 2.3.1 Community Providers



Ealing ICO

Difficulty in access to social care and patient choice

There has been improvement in performance following the implementation of a remedial action plan which was signed off by the Ealing CCG Contract Oversight Meeting in February .

Continue with close monitoring of action plan .

On-going Ealing CCG

8

Contracted 2013/14 Performance data for Community Providers will be available from Quarter 2. In the interim NWLCSU will continue to report against 2012/13 indicators by exception.

Performance Measure Threshold Ealing Community Services (Ealing ICO) Trend

In mth YTD

Delayed Transfers of care Target 2.0% 2.0%

Actual 4.4% 5.7%



2.3.2 Mental Health Performance

9


Ealing ICO

Overall capacity in service

Appropriate alternatives to individual therapies and Cognitive Behavioural Therapy (CBT) continue to be offered to clients to help reduce patient waiting times. An on-going recruitment drive is in place to address overall capacity issues.

Continue to monitor waiting and referral times.

On-going Ealing ICO / Ealing CCG

Contracted 2013/14 Performance data for Mental Health Providers will be available from Quarter 2. In the interim NWLCSU will continue to report against 2012/13 indicators by exception.

Proportion of people with depression and/or anxiety disorders referred for and receiving psychological therapies

Quarterly Q4

Local Target 2.1% 8.5%

Actual 1.5% 5.0%

Performance Measure Reporting Frequency

Threshold Ealing CCG Trend

M12 2012/13 YTD


3. Quality This section of the report provides an update on the current performance of key provider quality indicators. The current position against plan with RAG assessment and trend is shown. A summary of the key drivers for variance from plan, actions and update on previous actions is provided

Safety: Serious Incidents, Never Events, NRLS uploading, CAS alerts and HSMR

Imperial SIs Imperial Never Events

Provider Issue Update on previous action

Action Timeline Owner

Ealing Hospital WLMHT

Overdue SI reports

Nil -NWL CSU have reminded Trust that these reports are overdue. -NWL CSU have sent providers a breakdown of all overdue SI’s -NWL CSU to use contractual levers to enforce action on overdue reports

Completed Completed July 2013

NWL CSU NWL CSU NWL CSU

0

10

20

0

2

4

Ap

ril

Jun

e

Au

g…

Oct

…

De

c…

Feb

…

Ap

r-…

Ealing HT SIs Ealing HT Never Events WLMHT – Ealing SIs

Quality Measure

Ealing

Hospital (exc. ICO)*

Imperial* West London

Mental Health

Ealing ICO**

No. of Serious Incidents Reported (StEIS download 30/05/2013)

M1 YTD M1 YTD M1 YTD M1 YTD

Actual 3 3 7 7 2 2 1 1

No. of Never Events Reported

M1 YTD M1 YTD M1 YTD M1 YTD

Actual 0 0 0 0 n/a n/a n/a n/a

SI reports overdue for submission

At end April 13 At end April 13 At end April 13 At end April 13

Actual 3 0 4 0

*Information available only at provider level **No trend data currently available (no graph)

0

20

40

Ap

ril

Jun

e

Au

g…

Oct

…

De

c…

Feb

r…

Ap

r-… 0

1

2

Ap

ril

Jun

e

Au

g…

Oct

…

De

c…

Feb

r…

Ap

r-… 0

2

4

Ap

ril

Jun

e

Au

g…

Oct

…

De

c…

Feb

r…

Ap

r-…

SI Type Ealing HT Ealing ICO Imperial WLMHT - Ealing Total

Accident Whilst in Hospital 0 0 0 1 1

C.Diff & Health Care Acquired Infections 0 0 1 0 1

Communication issue 0 0 1 0 1

Maternity Services - Maternal unplanned admission to ITU 0 0 1 0 1

Maternity Services - Unexpected admission to NICU 0 0 1 0 1

Maternity Services - Unexpected neonatal death 0 0 1 0 1

Pressure ulcer Grade 3 1 1 1 0 3

Pressure ulcer Grade 4 0 0 0 0 0

Sub-optimal care of the deteriorating patient 0 0 1 0 1

Suicide by Outpatient (in receipt) 0 0 0 1 1

Unexpected Death of Inpatient (not in receipt) 2 0 0 0 2

Total 3 1 7 2 13

Safety: CAS, NRLS, SHMI, Maternal Mortality

Provider Issue Update on previous action Action Timeline Owner Ealing Hospital CAS Alerts There is 1 CAS alerts outstanding. Legacy case

that the NPSA have marked as ‘ONGOING’.

Determine the reason for the NPSA classification.

July CSU quality team

Imperial maternity Serious Incidents in relation to maternity services at Imperial.

NWL CSU report discussed at Collaborative meeting and discussed at the last CQG.

Action plan to be developed . End June 2013 Imperial

Quality Measure Ealing Hospital Imperial West London Mental Health

CAS Actual 1 0 0

NRLS Uploading (6 monthly) Period Performance Period Performance Period Performance

Actual April 12 - Sept 12 6 out of 6 April 12 - Sept 12 5 out of 6 April 12 - Sept 12 6 out of 6

SHMI (Quarterly) Period Performance Performance Performance

Q2 2012 Significantly below national avg. (0.85) Significantly below national avg. (0.76) Not applicable

Maternal Mortality Rates Period Performance Performance Performance

2012/13 0 1 out of 8819 Not applicable

National Safety Thermometer Is a point of care survey instrument. it is used to describe only a fraction of possible healthcare complications (or harm), qualified as ‘harm free’ care from ‘pressure ulcers, falls, urinary catheter infections and VTE’. It is not meant to be used as a benchmarking tool as it does not take into account the acuity. It is useful to see the trajectory within a trust.

% of patients receiving Harm Free Care

North West London NHS Trust Ealing Hospital NHS Trust* Imperial College NHS Trust West Middlesex NHS Trust Chelsea and Westminster NHS Foundation Trust

Hillingdon NHS Foundation Trust

Royal Brompton and Harefield NHS Trust

No harm 92.73% 90.70% 95.12% 90.38% 94.49% 94.79% 96.54%

Provider Issue Update on previous action Action Timeline Owner All providers Patient safety Thermometer

pressure ulcer goal setting progress

Baseline information has been shared. Performance assessment based on future trends.

Include trend lines for harm free care and Pressure Ulcer prevalence by provider within integrated performance report.

July 2013

NWL CSU

Note - There have been some data quality/validity issues identified at a national level that are currently being resolved.

Patient Experience

Provider Issue Update on previous action

Action Timeline Owner

Imperial Complaints data

Nil NWL CSU requested data submission

Completed CSU quality team

Quality Measure Imperial Ealing Hospital Trust

Outcome Period Outcome Period

In-Patient Survey results (Annual)

Improvement from 2011

74.4 2012 72.4 2012

*Friends and Family Test to be incorporated when validated results available.

M1 YTD M1 YTD

% of Patient Complaints acknowledged within 3 days of receipt

Target 100.0%

100.0%

Actual - March 13

Not reported 100.0%

M1 YTD M1 YTD

% of Patient complaints responded to within agreed time frame

Target 100.0%

100.0%

Actual -March 13

Not reported 100.0%

M1 YTD M1 YTD

14

4.1 CCG Performance and year end forecast across all Trusts Current Performance The reported position as at Month 1 is YTD spend of £24,503k compared with the plan of £ 23,680k. At this stage in the year the forecast out-turn remains the annual plan of £ 282,738k on the basis that it is too early to know whether the mitigating actions will offset the underlying performance pressures. This is an estimate based on the Month 1 SLAM Actual ‘flex’ data for the in-area acute trusts and a mixture of actual and planned data for out of area acute trusts. For Mental Health and Community trusts, which are on block contracts, the plan and actual are the same. The plan for April is based on the estimated value included in the heads of terms, phased on calendar days for A&E, Critical Care, Non-Elective and working days for Out-patients, Elective activity and Other categories. This was then adjusted for the expected QIPP phasing provided. As in previous years the April SLAMs received are very variable in quality. This is due partly to the complexity of the new maternity tariff arrangements, the disaggregation of specialised services and the uncertainty over the metrics in part due to the timing of the finalisation of the SLAs. Work is ongoing with the trusts to confirm activity and finance plans that reflect the SLAs that are finally agreed in time for the Month 1 SLAM ‘freeze’ report at the end of the month, of the in cluster this should be completed with the possible exception of NWLHT. The delays on the Out of Cluster position reflect the delays in completing the host CSU contracts as these need to be completed before the trusts will address the associate contracts. The reported over-performance for Imperial reduces to an underperformance of £ 115k once the phasing of QIPP and the transition of the maternity pathway have been adjusted for. The contract with RBH has not been finalised and the variance in part reflects the overall CCGs share of the latest offer of £ 11.5m which is 21% lower than the trusts counter –proposal.

4.0 Finance & Activity

15

NHS Ealing View by Trust - M1 2013/14 Total Annual Plan

Activity Total YTD Plan

Activity Total YTD

Actual Activity Total YTD

Variance Activity Total Annual Plan Cost Total YTD Plan Cost Total YTD Actual Cost

Total YTD Variance Cost

In/Out of Cluster Provider Description

In Cluster Imperial College Healthcare NHS Trust 830,596 67,029 30,715 -36,313 £54,259,630 £4,601,734 £5,206,161 £604,427

Chelsea And Westminster Hospital NHS Foundation Trust 0 3,701 4,006 305 £4,845,740 £399,565 £537,714 £138,149

The Hillingdon Hospital NHS Foundation Trust 0 6,675 6,786 111 £12,812,500 £1,055,429 £1,068,738 £13,309

West Middlesex University Trust Hospital 23,642 1,965 2,099 134 £7,351,686 £605,539 £659,247 £53,708

Royal Brompton & Harefield NHS Foundation Trust 108,214 9,018 15,819 6,802 £2,138,064 £178,172 £171,538 -£6,634

North West London Hospitals NHS Trust 440,160 36,066 37,450 1,384 £24,664,159 £2,031,447 £2,110,185 £78,738

Ealing Hospital NHS Trust 258,119 20,775 21,313 539 £86,182,272 £7,288,512 £7,264,429 -£24,083

In Cluster Total 1,660,731 145,228 118,190 -27,038 £192,254,051 £16,160,399 £17,018,012 £857,613

Out of Cluster Moorfields Eye Hospital NHS Foundation Trust 3,869 £4,659,073 £385,036 £385,036 -£0

University College London Hospitals NHS Foundation Trust 60,243 £5,372,818 £442,854 £442,854 £0

The Barts & The London NHS Trust 214 £900,204 £74,117 £146,796 £72,679

Royal Free Hampstead NHS Trust 362 £2,039,479 £168,068 £132,082 -£35,986

Royal National Orthopaedic Hospital NHS Trust 289 £1,624,809 £134,192 £91,172 -£43,020

St George's Healthcare NHS Trust 438 £414,342 £34,088 £36,963 £2,876

Great Ormond Street Hospital For Children NHS Trust 65 £2,388,163 £197,002 £197,002 £0

Heatherwood And Wexham Park Hospitals NHS Foundation Trust 84 £507,039 £41,700 £24,769 -£16,931

Kingston Hospital NHS Trust 48 £145,911 £12,006 £17,798 £5,792

King's College Hospital NHS Foundation Trust 70 £445,394 £36,717 £13,986 -£22,731

East And North Hertfordshire NHS Trust 31 £706,685 £58,229 £58,229 £0

The Whittington Hospital NHS Trust 49 £135,632 £11,185 £11,185 -£0

Homerton University Hospital NHS Trust 29 £58,822 £4,844 £7,919 £3,075

BMI £230,916 £19,091 £19,091 £0

Inhealth £1,063,982 £87,451 £87,451 £0

ASHFORD AND ST PETER'S HOSPITALS NHS TRUST £271,031 £22,357 £22,357 £0

GUY'S AND ST THOMAS' NHS FOUNDATION TRUST £1,903,073 £156,820 £156,820 £0

THE ROYAL MARSDEN NHS FOUNDATION TRUST £1,072,203 £88,396 £88,396 £0

Out of Cluster Total 65,792 £23,939,577 £1,974,152 £1,939,906 -£34,246

Non Acute Central & North West London Community £260,709 £21,726 £21,726 £0

Central & North West London Mental Health £1,292,678 £107,723 £107,723 £0

West London Mental Health £33,005,206 £2,750,434 £2,750,434 £0

Central London Community Health £138,179 £11,515 £11,515 £0

Hounslow and Richmond Community Health £166,926 £13,911 £13,911 £0

Ealing ICO £31,680,244 £2,640,020 £2,640,020 £0

Non Acute Total 0 0 0 0 66,543,941 5,545,328 5,545,328 0

1,660,731 145,228 183,982 -27,038 £282,737,569 £23,679,879 £24,503,246 £823,367

Table 1: Current Performance

4.2 Trust specific Key Actions This section of the report provides details of the actions being taken to address areas of over performance.

16

Trust Areas of over/under performance Drivers Actions

Ealing Hospital Trust

At Month 1 EHT is under performing by £249k against the indicative baseline.

CSU to confirm with CCG which volume-related metrics have been agreed post arbitration.

Further detailed work is to undertaken in conjunction with EHT to agree: - Baseline phasing -The annual work plan -The baseline split by CCG - Detailed adjustment for the NHS England ‘Maximum Take ‘ and other transfers .

Non-Elective:

Under perfoming by £109k (£93k NEL-ST, -£151k NEL-IP and -£51k NEL-XBD); this is 3.3% under indicative plan.

NHS Ealing QIPP Scheme (“ICE”) started in August 2012 and continues to be ramped up. Delivery of ICE is the responsibility of the EHT-ICO. Slippage in the delivery of this scheme as intended continues to be the most significant cause of NEL over performance.

Following the A&E audit during 2012-13 that showed between 19-25% of emergency admissions through A&E could be avoided, Ealing CCG commenced an Urgent Unscheduled Care Pathway QIPP in March 2013. This included a mapping exercise of existing pathways to support further discussion on developing a more optimal approach as well as redirecting patients back to community care; thereby reducing acute admissions.

Elective:

Under performing by £139k (EL-XBD at £11k; EL-IP at -£151k; EL-DC at -£56k).

The CSU will be discussing key drivers for elective performance with EHT as the detail of the baseline is established and as monitoring systems for the agreed QIPP schemes are established.

Outpatients: Under performing by £33k at Month 1 (OPFA -£33k; OPFU £27k; OP Proc -£27k),

As for 2012-13, the most significant contributory specialty is Anticoagulation services. This reflects delays in the delivery of the expected levels of patient transfers from acute care to the community.

Main contributory factor for OP procedures is cardiology, including ECG diagnostics. All other OP procedures are below plan.

Anticoagulation transfers is being discussed via the Clincal Quality Group. The trust clinician and CCG clinical leads are discussing how the transfers can be delivered and whether the CCGs expectation that 85% of patients will be transferrable is realistic. EHT is risk assessing the patient cohort to identify low risk transferrable patients.

A&E Under performing by £5k reflecting a 2.7% reduction in activity.

The Urgent Care Centre has received above plan attendances and this will have mitigated activity flowing through to the Trust ED.

During 2012-13 an action plan to deliver compliance with national operating standards was developed and this is being monitored via the Clinical Quality Group.

High Cost Drugs Over performing by £9k (was £370k over in Month 12 2012-2013).

A review of drug costs for 2013-14 has identified categories where cost reductions are possible. The review also indicated areas where further growth could be justified.

Details of a drug savings gain-share have been included in the draft contract for 2013-14.

Trust Areas of over/under performance Drivers Actions Planned actions

Ealing Hospital Trust

Critical Care Over performing by £107k

The audit findings from the follow up review of clinical coding by the Trust has yet to be published; however, it is expected to infer that strengthening of clinical coding needs to be embedded and that continuity of coding across care spells will be recommended.

Detailed analysis of the number of organs supported and comparison against the expected profile for the Trust. To follow up with the Network Director on the audit publication timetable.

Imperial The ICH variance against the trust plan reported in their SLAM would produce a contract variance of > £ 40m if this is replicated across the year.

n/a

CSU identified a list of expected changes/contract requirements for all the contracts, and is in the process via the usual contract performance meetings of raising issues with the providers, in this case ICH

Pursued via the FIG

High Cost Drugs £ 4.9m HCD - Anti-TnF £ 5.1m (plan is incorrect with NHS England); Lucentis £ 0.7m

Being pursued via the FIG

OPFUCL £ 5.8m EL -£4.8m NEL £ 10.5m

EL - T&O - £ 1.2m; Cardiology - £ 1.1m NEL - A&E £ 5.1m; Obstetrics £ 1.1m; Geriatric Medicine £ 1.4m; Cardiology £ 1.1m; Nephrology – £ 1.2m

Being pursued via the FIG

Maternity £19.0m

Maternity Pathway The trust is charging for ante and post natal pathways but there appears to still be some charging on the 12-13 rules

This was raised at the FIG meeting on 11/6, and will be corrected by the Trust for M2 onwards, with credits as appropriate for the CCGs

Unidentified QIPP £5.4m

Also there is £ 15m of QIPP that has been allocated across all the relevant trust activity so the OP and NEL variances may in part be driven by a delay in the realisation of QIPP benefits

This was raised at the FIG, is not accurate and will be corrected at M1 freeze

There is an understatement of the metrics yield

n/a CSU is working to quantify this value. This was raised at the FIG on 11/6 and the aim is to ensure that agreed metrics are loaded and reflected at M1 freeze, and then ongoing will be reflected in the SLAM reporting

NHSE activity: Dental/maximum take/screening

•GUM activity present but with no cost applied at plan or actual •Dental activity is present. Most is not charged however there are still a few charges present. •Breast screening is not apparent in this dataset.

Pursued via the FIG,

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Harrow CCG Performance Report › media › 1592 › Paper-7-Integrated-CCG... · 2016-12-11 · Ealing CCG Performance Report Month 1 . 1.0 Introduction & Key Messages This report