Paper 19/31 23 May 2019 Page 1 of 30

Oxfordshire Clinical Commissioning Group

OXFORDSHIRE CLINICAL COMMISSIONING GROUP BOARD

Date of Meeting: 23 May 2019 Paper No: 19/31

Title of Paper: Integrated Performance Report

Paper is for: (please delete tick as appropriate) Discussion Decision Information

Conflicts of Interest (please delete tick as appropriate)

No conflict identified

Conflict noted: conflicted party can participate in discussion and decision

Conflict noted, conflicted party can participate in discussion but not decision

Conflict noted, conflicted party can remain but not participate in discussion

Conflicted party is excluded from discussion

Purpose and Executive Summary: To update the Board on quality and performance issues to date. The Integrated Performance Report is designed to give OCCG Board assurance of the processes and controls around quality and performance. It contains analysis of how OCCG and associated organisations are performing. The report is comprehensive, but seeks to direct members to instances of exception. The Integrated Performance Report has been discussed in Executive and Quality Committees and had much more internal time and an action-oriented focus.

Engagement: clinical, stakeholder and public/patient: Not applicable

Financial Implications of Paper: The financial overview is provided on slide 2

Action Required:

Paper 19/31 23 May 2019 Page 2 of 30

Board is asked to note the paper and agree if there are other areas of assurance required from Executive Committee and/or Quality Committee arising from IPR.

OCCG Priorities Supported (please delete tick as appropriate) Operational Delivery Transforming Health and Care Devolution and Integration Empowering Patients Engaging Communities System Leadership

Equality Analysis Outcome: Not applicable

Link to Risk: The Integrated Performance Report links to risks: Assurance Framework 19 – Demand and Performance Challenges Assurance Framework 22 – Quality Risk 758 – Delayed Transfers of Care (DTOC) Reduction Risk 735 – OUHFT Tests Results Risk 771 – Inpatient Discharge Summaries Risk 798 – Performance in Referral to Treatment (RTT) and Cancer NHS Constitution Standards Risk 770 – Outpatient Communication between Primary and Secondary Care Risk 797 – A&E 4 Hour Wait Risk 800 – Learning Disability Service in Transition

Author: Judy Foster, Performance Manager: judy.foster@oxfordshireccg.nhs.uk

Clinical / Executive Lead: Diane Hedges, Chief Operating Officer and Deputy Chief Executive: diane.hedges@oxfordshireccg.nhs.uk

Date of Paper: 16 May 2019

Oxfordshire CCG

Integrated Performance Report

March 2019(Reporting 2018-19 Month 10 Activity)

Oxfordshire

Clinical Commissioning Group

Executive Dashboard

2

Period Total OCCG OUHFT OHFT CommunityThird Party

(MRSA Only)

M10 10 7 2 0

Limit 0 0 0 0 0

Actual 3 1 0 2 0

Limit 133 63 7 64

Actual 119 42 3 67 6

0

0

0

1

Quality Overview

Never events

MRSA

incidentsM11

0

0

0

Safety Incidents

Year To Date (January 2019)Other ProvidersRBFT

C Difficile

incidentsM11

1

25

Total MRSA incidents listed by each provider may include non-OCCG patients & may also include cases with shared responsibility

Period OUHFT RBFT OHFT National NHS

Q2 18/19 83% 88% 79% 81%

M10 96% 100% NA 96%

M10 90% 99% NA 86%Accident & Emergency (Patient) NA

Friends and Family

Patients likely or extremely likely to recommend

(January 2019)

Independent

Providers

The care given at this organisation (Staff) NA

Inpatient (Patient) 99%

Measure

OCCG Rating OUHFT Rating RBFT Rating

RTT Incomplete Pathways 18 Week - All patients M10 92% 83.8% Red 83.0% Red 92.2% Green

6.3 - Cancer Two week waits M10 93% 94.3% Green 97.4% Green 93.3% Green

6.4 - Breast symptoms Two week waits M10 93% 87.9% Red 87.8% Red 97.8% Green

7.4 - 31 Day First Treatment M10 96% 93.3% Red 90.8% Red 98.2% Green

7.11 - 31 Day Subsequent Treatment (Surgery) M10 94% 92.7% Red 95.2% Green 90.3% Red

7.11 - 31 Day Subsequent Treatment (chemotherapy) M10 98% 100.0% Green 100.0% Green 98.9% Green

7.11 - 31 Day Subsequent Treatment (radiotherapy) M10 94% 96.6% Green 96.3% Green 94.3% Green

8.4 - Cancer Plan 62 day standard (Tumour) M10 85% 71.6% Red 65.4% Red 83.1% Red

9.4 - CRS 62 Day screening standard (Tumour) M10 90% 58.8% Red 57.1% Red 95.6% Green

Oxford University Hospitals NHS Foundation Trust M10 95% 86.0% Red

Royal Berkshire NHS Foundation Trust M10 95% 88.4% Red

Oxford Health Foundation Trust M10 95% 97.0% Green

Cat 1(C1) Mean M10 00:07:00 00:07:11 Red

Cat 1 (C1) 90th percentile M10 00:15:00 00:13:38 Green

Cat 2 (C2) Mean M10 00:18:00 00:15:52 Green

Cat 2 (C2) 90th percentile M10 00:40:00 00:29:43 Green

Cat 3 (C3) 90th percentile M10 02:00:00 01:40:27 Green

Cat 4 (Cat 4) 90th percentile M10 03:00:00 02:46:11 Green

2 week

Performance Overview

Period TargetTotal Commissioner Total Provider Total Provider

31 Day

62 Day

4 hour wait

*Oxford

Ambulance

Response Time

(hour:minutes:sec

onds)

Quality and Performance Dashboard 1

3

Oxfordshire Clinical Commissioning Group (unless otherwise stated)

*62 day upgrade Activity counts are very low which can cause large fluctuations in performance rate.

Oxfordshire Ambulance Response Time: Data source only contains quarter to date figures rather than year to date figures, so this is what is shown in the YTD column.

†999 Targets are proposed CQUIN trajectories for TV as follows: Calls closed by telephone advice: Q1 6.2%, Q2 6.3%, Q3 6.4%, Q4 6.5% Incidents managed without transport to A&E: Q1 31.1%, Q2 31.2%, Q3 31.3%, Q4 31.5%

Target Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18 Jul '18 Aug '18 Sep '18 Oct '18 Nov '18 Dec '18 Jan '19 YTD

92% 86.2% 86.2% 85.5% 85.7% 86.2% 86.3% 86.1% 85.1% 84.3% 83.9% 84.2% 83.1% 83.8% 84.9%

0 113 132 144 132 141 142 140 137 138 90 64 54 33

93% 95.7% 97.0% 95.5% 95.3% 95.3% 93.9% 94.1% 95.3% 92.4% 92.8% 92.9% 92.9% 94.3% 93.9%

93% 97.9% 95.4% 97.3% 93.8% 90.0% 94.4% 96.0% 95.8% 94.5% 98.7% 96.3% 94.8% 87.9% 94.2%

96% 95.3% 97.3% 95.9% 95.5% 96.8% 96.2% 96.8% 95.9% 92.9% 92.9% 95.8% 91.0% 93.3% 94.8%

94% 95.4% 95.1% 100.0% 97.1% 94.4% 95.1% 95.1% 92.9% 93.5% 95.3% 100.0% 96.7% 92.7% 95.3%

98% 100.0% 100.0% 96.1% 98.4% 99.0% 100.0% 98.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5%

94% 96.5% 100.0% 100.0% 97.2% 95.8% 97.6% 99.0% 100.0% 98.6% 88.1% 95.5% 93.2% 96.6% 95.6%

85% 87.3% 83.1% 84.9% 85.0% 81.7% 74.0% 75.3% 74.0% 73.7% 80.1% 82.8% 75.5% 71.6% 77.2%

90% 100.0% 90.9% 96.9% 78.6% 86.4% 87.5% 85.2% 96.3% 78.3% 61.5% 88.9% 95.0% 58.8% 82.9%

86% 75.0% 83.3% 75.0% 100.0% 50.0% 100.0% 100.0% 100.0% 0.0% 100.0% 66.7% 100.0% 85.7%

1% 0.9% 0.7% 2.1% 2.0% 2.3% 2.4% 1.9% 2.0% 1.55% 1.0% 0.9% 0.9% 1.6% 1.6%

0 8 37 15 6 7 32 33 26 24 92 50 36 39 345

SCAS 38.7%

Calls closed by telephone advice (New measure) SCAS 6.5% 6.8% 6.9% 7.5% 7.2% 6.4% 6.2% 6.3% 6.2% 6.5% 6.6% 6.5% 7.2% 7.2% 6.6%

Incidents managed without transport to A&E (New measure)SCAS 31.5% 42.3% 41.6% 41.7% 41.6% 41.5% 41.6% 42.3% 42.0% 42.6% 41.9% 42.3% 42.4% 42.2% 42.0%

00:07:00 00:07:26 00:07:07 00:07:18 00:06:52 00:06:39 00:07:18 00:06:55 00:07:25 00:07:43 00:07:16 00:07:22 00:07:15 00:07:11 00:07:11

00:15:00 00:14:15 00:13:48 00:14:10 00:13:08 00:13:12 00:13:45 00:13:07 00:14:45 00:14:46 00:14:16 00:14:06 00:14:16 00:13:38 00:13:38

00:18:00 00:16:21 00:15:55 00:17:50 00:14:19 00:15:16 00:14:26 00:15:15 00:15:36 00:16:30 00:15:17 00:18:16 00:17:14 00:15:52 00:15:52

00:40:00 00:31:33 00:29:47 00:33:39 00:26:48 00:28:40 00:26:50 00:28:20 00:29:08 00:32:02 00:28:55 00:34:19 00:32:04 00:29:43 00:29:43

02:00:00 02:02:53 01:51:53 02:06:53 01:24:45 01:35:45 01:25:48 01:39:42 01:45:36 01:40:35 01:22:29 02:04:49 02:03:42 01:40:27 01:40:27

03:00:00 03:04:14 02:57:24 03:45:38 02:31:07 02:15:31 02:14:38 02:48:23 02:34:54 02:17:42 02:14:47 02:39:49 02:43:35 02:46:11 02:46:11

JR 85% 65.9% 68.0% 69.7% 74.3% 78.6% 82.2% 80.4% 77.6% 77.4% 78.9% 80.1% 74.2% 76.0% 78.1%

Horton 85% 69.4% 77.6% 88.2% 92.2% 86.8% 89.0% 90.1% 88.9% 85.3% 84.8% 78.2% 86.8%

All 85% 66.6% 68.2% 69.7% 74.3% 80.1% 83.9% 81.6% 79.6% 79.8% 80.8% 81.1% 76.4% 76.4% 79.6%

95% 82.5% 80.6% 78.8% 85.9% 88.2% 90.8% 87.7% 86.5% 87.5% 89.2% 86.0% 86.9% 85.5% 87.4%

95% 98.1% 99.1% 97.9% 98.9% 99.8% 99.6% 100.0% 98.6% 99.6% 99.6% 100.0% 100.0% 100.0% 99.6%

95% 82.8% 81.1% 79.3% 86.3% 88.6% 91.1% 88.1% 87.0% 88.0% 89.6% 86.5% 87.4% 86.0% 87.9%

95% 84.4% 79.2% 83.1% 92.7% 95.7% 96.2% 95.4% 95.6% 93.4% 87.0% 87.3% 84.9% 88.4% 91.6%

95% 96.8% 97.8% 97.5% 97.7% 95.1% 97.8% 98.4% 98.2% 97.4% 97.1% 97.3% 95.2% 97.0% 97.2%

0 55 0 13 0 0 0 0 0 0 0 0 0 0 0

0 0 2 0 0 0 0 0 0 0 0 0 0 0 0

Incidents managed without transport to A&E

62 Day Screening

62 Day Upgrade

Mixed Sex Accommodation

RT

TC

an

cer

62 Day Standard

RBFT (Type 1 & 2)

Diagnostics % waiting over 6 weeks

OUHT

Ambulance Handover

99

9†

Oxfordshire Ambulance

Response Time

(QTD shown rather than YTD)

Cat 1 (C1) Mean

Cat 1 (C1) 90th Centile

Cat 2 (C2) Mean

Cat 2 (C2) 90th Centile

Cat 3 (C3) 90th Centile

Cat 4 (C4) 90th Centile

31 Day Subsequent Treatment (Chemotherapy)

31 Day Subsequent Treatment (Radiotherapy)

Incomplete % within 18 weeks

Incomplete 52+ week waits

Two Week Wait

Two Week Wait - Breast Symptom

31 Day First Treatment (Diagnosis to Treatment)

31 Day Subsequent Treatment (Surgery)

A&

E

OUHT (Type 1 & 2)

OUHT (Type 3)

OUHT (Type 1 & 2 & 3)

OHFT Minor Injuries Unit (Type 3)

RBFT

4 Hour Wait

12 Hours Trolley Wait

Quality and Performance Dashboard 2

4

Oxfordshire Clinical Commissioning Group (unless otherwise stated)

† Assessed within two weeks. Target 50% prior to Apr '18.

* Learning Disability Healthchecks: Data completion varies greatly between quarters as many practices leave their register value blank. This causes large uncertainty in the

values shown.

**Targets for these indicators are for quarter 4 2018/19.

*** Children and Young People Eating Disorders: latest data is available for Q1 2018/19. Please note that the target is not mandatory until 2020/21.

IAPT/CAMHS: always one month behind other sources.

Delayed Transfers of Care from hospital per 100,000 pop. per month 707 756 694 651 569 503 639 636 578 521 502 487 532 562

3.5% 8.6% 8.9% 7.5% 8.1% 7.4% 5.9% 8.0% 8.0% 6.73% 5.4% 5.0% 5.2% 5.4% 6.5%

3.5% 5.4% 4.3% 3.7% 5.1% 4.0% 4.0% 4.1% 4.9% 4.04% 4.0% 4.5% 6.0% 4.7% 4.5%

3.5% 9.3% 12.8% 11.7% 9.9% 8.5% 8.8% 10.5% 10.3% 10.48% 9.4% 10.3% 9.2% 10.8% 9.8%

3.5% 27.0% 37.6% 32.4% 30.3% 27.1% 26.6% 33.6% 35.0% 34.42% 30.4% 35.1% 30.7% 36.5% 31.8%

Access (17/18) 15% 18% 17% 18% 16%

Access (18/19) 19% 17% 17% 17% 18% 17% 17% 23% 20% 16% 18%

Recovery 50% 52% 53% 53% 50% 53% 54% 50% 48% 50% 53% 51% 50% 51%

6 weeks 75% 99% 98% 98% 99% 98% 99% 99% 98% 99% 99% 99% 99% 99%

18 weeks 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

95% 97% 95% 99% 96% 96%

Completed 53% 75% 100% 77% 64% 79% 77% 75% 92% 58% 60% 75% 100% 75% 75%

48% 66% 57% 41%

Target 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7% 66.7%

Actuals 67.7% 67.7% 67.2% 67.0% 67.1% 67.3% 68.0% 68.0% 68.0% 68.4% 68.4% 68.3% 68.1% 67.9%

5145 5160 5295 5335 5485 5395 5460 5255 5420 5580 5875 5940 49745

100% 100% 87% 94% 89% 89%

Urgent (1 week) 95% 93% 89% 81% 88%

Routine (4 weeks) 75% 66% 69% 64% 61%

DTOC

Children waiting 18 weeks or less for a wheelchair**

Learning Disability Healthchecks*

Children and Adolescent Mental Health Service (No. Accessing)

DTOC

DT

OC

Ch

ild

ren

&

Yo

un

g

Community hospital DTOC

Me

nta

l H

ea

lth

OUHT

RBFT

OHFT

Care Programme Approach 7 day follow up post discharge

IAPT

Early Intervention in Psychosis†

Dementia Diagnosis

DTOC

Children and Young People Eating Disorders*

(12 months rolling data)

Target Jan '18 Feb '18 Mar '18 Apr '18 May '18 Jun '18 Jul '18 Aug '18 Sep '18 Oct '18 Nov '18 Dec '18 Jan '19 YTD

5

Key Issues Updates

18 Week Wait Incomplete Referrals to Treatment

Performance for January 2019 (month10) for OCCG was 83.8% which is a slight

improvement in performance from December 2018. RTT position for OUH was 83%. There

was an increase in all incomplete pathways of 734 (December to January) for the CCG as a

whole , with a reduction of 146 incompletes in over 18 weeks.

For OCCG to meet the target of 33745 incomplete pathways open (as at March 2018) there

are a further 2627 pathways to close.

• T&O at OUH has improved to 80.84% from 80.37% in December and have reduced the

number of patients over 18 weeks by 56 compared to December.

• Gynaecology was 70.31% in December and is now 75.15% in January with 718 patients

waiting over 18 weeks (a reduction 30 compared to December).

• ENT was 68.97% in January with 1087 patients over 18 weeks, an increase of 21

patients compared to December.

• Ophthalmology was 82.66% in January up from 82,33% in December. A reduction of 3

patients over 18 weeks.

Diagnostics

CCG performance was 1.6% in January and did not meet the 1% 6 week standard. OUH

achieved 1.46% a dip of .5%. Areas for improvement were cystoscopy (11 patients),

Audiology (17) and MRI (93 patient) waiting over 6 weeks. Royal Berkshire Hospital (RBH)

missed the standard at 5.43% a further deterioration. Pressure areas were Colonoscopy,

Echo ,MRI and gastroscopy. InHealth improved by 0.5% to 1.44% and Great Western

improved to 2.56%. Both missed this standard.

The ECDP (Elective Care Delivery Programme) continues to meet biweekly to review progress. All

workstreams provide a highlight report showing exceptions and progress to date.

Ramsay Horton capacity has continued to provide small numbers of Gynaecology and T&O surgery over

January contributing to the improvements in both Gynae and T&O. Capacity in theatres at the Churchill

has now improved with insourced activity from a company called “18 weeks” doing mainly Urology. The

theatres are fully operational at the NOC site now.

Gynaecology are using additional capacity at the Churchill which is having a positive impact on the

numbers with a particular focus on 52 week waits. The Patient targeted lists (PTL) are focussing on

those waiting 40 weeks plus now. 2 theatres are being used on Saturday and Sunday at the Churchill

and 3 session days in one theatre in the week.

Demand management work has reduced the number of repeated 1st outpatient appointments; new clinic

templates are being set up for Gynaecology to reduce follow ups. The capacity alerts have not had a big

impact on either ENT or Gynae as referrals continue at similar levels.

Diagnostics

Endoscopy; additional activity and locations commissioned from InHealth including mobile provision;

The new Bicester site opened October 18. There has been a huge increase in demand over and above

that expected and a small reduction in activity at OUH. New capacity has been put on and they should

meet the standard by February 2019. The improvements are starting to become evident in January.

MRI – new radiology dashboard in place with efficiency improvements underway at the OUH as part of

ECDP. Additional capacity has been put on particularly for MRI and CT.

Insourcing has been used to support the endoscopy pressures (Colonoscopy and gastroscopy) at OUH.

Improvements in diagnostics will be seen again next month.

Diagnostics at OUH are intending to test and report within 7 days and a plan has been developed to

deliver this.

52 Week Wait Incomplete Referrals to Treatment

52 week waits are improving steadily with Gynaecology at 20 a further reduction of 16 since

December. Overall there were 33 , all at OUH; breaches were in Urology (6), Other (4),

ENT(2), General Surgery (1) and Gynecology (20).

All of the above actions will have an impact on the long waits

OUH aimed to reduce 52 week waits to zero in all specialities by the end of December 2018 except

Urology and Gynaecology which will be end March 2019. This was not quite met with 9 over 52 week

waits in other specialities other than Gynae and Urology. The target is zero 52 week waits across all

specialities by March 31st 2019. There is a risk that patients may cancel but as the end of March gets

closer the time allowed for booking makes it difficult.

Urology have plans to use the Horton and continue to use insourcing (18 weeks support).

Cancer waiting time targets

Five reported cancer targets were missed by OCCG January 2019; 2ww Breast (87.86%),

31 day treatment up (93.33%), 31 day Surgery (92.68%), 62 day (71.60%) and 62 Day

screening (58.82%) which was due to 7 patient breeches (breast)

OUHFT/OCCG also failed Five targets in January 2019; 2ww Breast (87.90%), 31 day

treatment (92.52%), 31 day Surgery (93.94%), 62 day screening (58.82%) and 62 day

standard (70.39%).

31 and 62 day treatment are being consistently missed.

The Cancer Strategy Group (Formally Programme Board) continues monthly OCCG/TVCA are still to be

invited. A cancer strategy document has been drafted by OCCG and are currently working with OUHFT

to ensure all work is aligned. All tumour sites continue their daily huddles and monthly performance

meetings with specific action plans and dashboard.

For 2WW In-Health continue to improve their position and this target was met for OCCG this month. Best

Practice pathway work: The suspected lung cancer pathway continues to use straight to test

successfully, with lung CT ordered by the OCCG GPs on referral into the 2ww pathway. Urology still

faces some issues, The next move will be to try and establish straight to MRI from primary care to

remove 2-3 days from the pathways. The upper gastrointestinal (UGI) and lower gastrointestinal (LGI)

pathways remain difficult to manage but work is on-going.

Executive Summary 1 (Performance Concerns or Quality Priority Subjects)

Executive Summary 2 (Performance concern or quality priority subjects)

6

Key Issues UpdatesAmbulance Services

For the sixth consecutive month SCAS failed to achieve the Cat 1 target for Oxfordshire,

achieving 07.11 minutes against a target of 07.00. All other targets were met at CCG level and

all targets were met at Thames valley and SCAS level. Activity was 38 incidents above

baseline for January, totalling 7,869 incidents against the 7,831 anticipated. The case mix

change continues in month 10 leading to an overspend in January of £68k and a YTD

overspend of £349K.

SCAS benchmark well in the Lord Carter review but are an outlier with staff sickness and turnover of

staff. The impact of this filters through to the management of the category 3 & 4 calls but staffing

plans appear to be improving against target achievement. Most of the new quality indicators in the

Ambulance Response Programme (ARP) review are implemented. SCAS are working to direct

patients to the correct location in the hospital rather than via ED with SCAS reporting that

‘Oxfordshire non-conveyance is significantly better than anywhere else in the Trust’. There has been

a month on month increase in ‘Hear and Treat ‘and ‘See and Treat’ outcomes through the non-

conveyance CQUIN. Thames Valley remain on track to deliver the Q4 conveyance level requirement.

Ambulance Handover

Oxford University hospitals achieved 76.4%, ambulance handover within 15 minutes in January

failing to meet the 85% target. This target was missed at the Horton General Hospital (78.2%)

for second consecutive month, The John Radcliffe achieved 76%. This shows an improvement

in performance at the JR from this time last year (65.9%).

Emergency department and ambulance staff have continued to review the handover process to

reduce delays. On the JR site the total time of delays in January 2019 was 107:43:45 compared

156:53:26 in January 18. Similarly whilst it is noted that the Horton did not achieve the target in

January the total time delayed on site was 17:08:02 against 33:43:45 for the same period last year.

Accident and Emergency – Four hour waits

January 2019 saw OUHFT Accident and Emergency (A&E) fail to reach both the 95% national

and 90.1% NHSI trajectory targets, achieving 85.9% overall. It is an improvement on 82.8% for

the same period last year. Daily attendances averaged 372 for January . January year to date

activity over plan by 3010 attendances, (2.8%)

Although the four hour wait target is still not being met by OUH, unvalidated data shows that the

Horton General Hospital achieved the 95% target 4 days out of 31 in January including 100% on one

occasion. Focus continues on reducing stranded patient numbers, creating more bed capacity and

improving internal flow between specialties as well as pathway changes. Activity flowing through the

type 3 GP streamed service remains under plan (54% under), with activity at around 15 attendances

per day (last month 13 on average per day).

Delayed Transfers of Care

Improvement in DTOC position has been maintained. In the 10 weeks to 28/2/19 the weekly

snapshot average delays has been 79, against a YTD weekly average 83. In the same period in

2017/18 the YTD weekly average was 136.

Validated data indicates an average 77 beds lost to DTOC each day during December against

the BCF target of 94 and the local AEDB target of 54. The local non-validated figure reduces

further in January to 70, but there has been a spike in February to 82 reflecting an increased

acuity of presentations at OUH and a reduction in flow out of community hospitals (largely driven

by demand for large packages of domiciliary care).

DTOC actions are now being managed within the Winter Team. Key actions

Focus on stranded patients via the weekly MADE process with daily management of discharges and

allocation of resources to manage delays most effectively

Increased oversight of Oxfordshire patients in other systems

Winter funded initiatives to

Integrate CHC team into discharge liaison hub

Deploy more short-term hub beds to manage pressures

Create a discharge to assess team of therapists in ED and EAU

Create more domiciliary care capacity through reviews of existing packages and incentive schemes to

providers

Create a step down pathway for vulnerable homeless people

Bring in trusted assessor approaches to support restarts of domiciliary care and residential packages

and improve timely discharge to nursing homes

New action-to improve 7 day discharge during March 2019

CAMHS

We know that nationally OHFT benchmarks well against the CAMHS National Access

Trajectory KPI and is one of the few Trusts meeting the target of 32% of children who need a

CAMHS service, being seen. The key pathways are now fully mobilised, and we are seeing

increased numbers accessing the service, which we welcome. It is a challenge in terms of

capacity and this is reflected in the KPI performance so far this year. The transformation has

been positive, but the speed at which we will see change to waiting times has been

overestimated in light of increased access.

Oxfordshire has been chosen as an NHS 'trailblazer site' by the Government and awarded £5.4m in

extra funding until 2021. The new Green Paper Delivery Board is now operational and progress is

good. Recruitment to the new teams is underway and all Oxford City schools are engaged.

Executive Summary 3 (Performance Concern or Quality Priority Subjects)

7

Key Issues UpdatesContinuing Healthcare (CHC)

CHC Decisions within 28 days is at 62% for Q2 2018/19, below the threshold of 80% required

nationally to pass the Quality Premium.

17% of CHC assessments in Q2 were conducted in acute settings, the national target is 15%.

Within the region only two CCGs are above 80%. Of the remaining 11 CCGs Oxfordshire are the

highest, ie third out of 13 CCGs.

Oxfordshire has previously been meeting this target but performance has dipped over the winter

quarter.

Emergency Demand Management

NEL Inpatient activity still shows a position under plan of 221 spells (-0.7%) (last month 285

spells, 1.0% below plan). Spend remains significantly higher, now £5.1m (7.7%) above plan. The

overall position maintains the case mix pressures highlighted over the last year.

The other NEL PODs (Short stay, same day and non-emergency) also contribute additional cost

pressures

The audit of GP streaming and ambulatory care activity. Is due to take place on Thursday 21st

February. This audit forms part of the work relating to the AMP (activity management plan) audit .

System review of the recent NHSi/ECIST 6As audit has agreed high impact changes for managing

urgent care demand. Key actions and leads have been agreed to progress this programme of work.

1. Co production of care pathways between primary and secondary care

2. Ambulance conveyance review – & ECIST Ambulance Challenge undertaken on 14th

February which will report into the Oxfordshire Ambulance Steering Group

3. Demand and capacity review of services

4. Review and development of Single Point of Access for partner and ambulance service

5. Review of current transport arrangements, conveyance and discharge, to support flow

6. Development of ambulatory pathway and outreach within community

7. Review of the alcohol pathway

Further work is also underway to review the Ambulatory Care Pathway to better understand the

patient journey and clearly define NEL activity and urgent elective activity.

E.Coli Bloodstream Infections (BSI)

OCCG has a higher quantity of E.Coli Bloodstream infections than the threshold required to

achieve the Quality Premium

E.Coli BSI are increasing nationally. OCCG has a rate slightly lower than national average. The

data from 2017/18 has been analysed and at a multidisciplinary meeting actions to reduce

healthcare attributed cases were agreed. The rate of E.coli bacteraemias by the end of February in

2017/18 was 462, compared to the same time period in 2018/9 of 409.

Mixed Sex Accommodation

The increase in Mixed Sex Accommodation (MSA) breaches relates to changes in reporting

practices following clarification from NHS England.

OUHFT have begun rolling out a patient experience delivery plan, which includes addressing MSA

breaches. A report is expected to update on the progress of the implementation. The majority of

breaches remain in critical care areas.

Clostridium difficile

Clostridium difficile (C.diff) infection can affect people who have recently been treated with

antibiotics. The older population and those who have recently been treated with certain types of

antibiotics are at greater risk of acquiring Clostridium difficile infection.

C. difficile rates are below the limits set for 2018/19. There have been 119 cases for 2018/19 up to

the end of February, on a trajectory of 133. Root cause analysis work continues and antimicrobial

prescribing is carefully assessed for both community and hospital The monthly Oxfordshire health

economy meeting reviews and scrutinizes each case and those avoidable cases are feed back to

the hospital and community. Four cases so far have been found to be potentially avoidable due to

antibiotic prescribing out of guidelines; this has been fed back to the prescribers.

Methicillin Resistant Staphylococcus Aureus (MRSA)

Methicillin Resistant Staphylococcus Aureus (MRSA) is a type of bacteria that is resistant to a

number of widely used antibiotics. This means MRSA infections can be more difficult to treat than

other bacterial infections.

There have been three MRSA bacteraemias in 2018/19 up to end of February. One post 48 hour

case at OUHFT, a pre 48 hour case at OHFT both in August and a pre 48 hour case at OHFT in

September. Two have undergone a multi-disciplinary team review and agreed that there were no

healthcare factors that could have caused the bacteraemias and all were unavoidable. One remains

to be closed. This is a correction from last months report.

Anti-microbial prescribing

Broad spectrum antibiotics have a higher risk of causing a healthcare associated infection (e.g.

C.diff) and therefore should be used appropriately when a narrower spectrum antibiotic is not

suitable. The target is presented as broad spectrum antibiotics prescribed as % of total antibiotics

prescribed across Oxfordshire. It should also be noted that we have a very low rate of prescribing

for antibiotics in total and therefore this will mean that meeting the 10% target for broad spectrum

prescribing will be more challenging.

The national (not QP) target of 10% or less is not being achieved (M9 position is 10.8%). However,

total antibiotic prescribing in Oxfordshire has reduced further again which impacts on % achieved.

Oxfordshire total antibiotic use is lowest CCG in Thames Valley and Wessex area and sits well

below the national average. Reduction in trimethoprim use is targeted at patients over 70 (18-19

QP) . Incentive scheme target for practices for cephalosporin, quinolone and co-amoxiclav (broad

spectrum antibiotics) use tightened to be in line with national target. Local guidance continues to be

promoted including the use of less broad spectrum options for UTI

Executive Summary 4 (Performance Concern or Quality Priority Subjects)

8

Key Issues UpdatesClinical Communication

Trusts should communicate with GPs. Discharge summaries should be sent to GPs within 24 hours

and outpatient consultations should be sent within 7 working days.

The CCG met the Trust in February and the new target and trajectory has been agreed. In January

the Trust achieved 88% of discharge summaries received in primary care within 24 hours This is on

track with the new trajectory to meet 90% by September 2019.

There is currently a data gap for outpatient clinical communication. The Trust has committed to

achieving 90% by September.

Management of Test Results

OUHFT undertakes over 110,000 investigations each week. OUHFT has reported a small number

of serious incidents (SIs) relating to the management of test results. OCCG regularly receives GP

feedback where clinicians have failed to follow up results or inform the patient’s GP of the result

where clinically appropriate. OUHFT has acknowledged that this represents a potential patient

safety risk and has chosen the endorsement of test results as the quality marker with which to

measure improvement.

The Trust achieved 75.1% in January. Following a meeting between the CCG and the Trust in

February it has been agreed that the Trust will undertake further work to understand where the

greatest risks are. The CCG continues to see examples of clinical incidents where the non-reporting

of tests is a root cause. There is good engagement with the Trust and a commitment to working

towards a solution which will include both technical and behavioural components.

Quality Premium – 18/19 Tracker

9

Constitutional Standard Owner Penalty YTD position Gateway Owner YTD Position

RTT Incomplete (92%) Sharon Barrington -50% 83.8% Quality Gateway Helen Ward Pass

Cancer waits – 62 days (85%) Sharon Barrington -50% 71.6% Finance Gateway Jenny Simpson Pass

The Quality Premium is a Clinical Commissioning Group financial incentive based on achievement of the Quality Premium measures. As with previous

years the 2018/19 Quality Premium is worth £5 per head of population. The total awarded then reduced by 50% for each NHS Constitutional Standards

classed as “not met”. The scheme is divided amongst Emergency Demand Management Indicators and Quality Indicators – which include 5 national & 1

RightCare Indicator.

Indicator Owner Weighting Measure YTD position Comments

Emergency Demand Management Indicators (75%)

Emergency Demand Planning Sara Wilds

50%

Type 1 A&E Attendances ≤ planned number 110164 /109942

Number of non-elective admissions with LOS=0 ≤planned

number23289 / 20411 (see executive summary)

50%Number of non-elective admissions with LOS≥1 ≤planned

number32942 / 31477 (see executive summary)

Quality Indicators (25%)

Early Cancer Diagnosis Sharon Barrington 17% Cancer Stage 1 & 2 Diagnosis N/A No proxy identified

GP Appointment Satisfaction Julie Dandridge 17% Overall satisfaction with making an appointment N/A No proxy identified

Continuing Healthcare Rachel Pirie 17%

Continuing Healthcare Decision 28 Days (80%) 263/419 (62.7%) (see executive summary for

summary of issues)

Data representative of Q1-3 2018/19Continuing Healthcare Assessments in Hospital (<15%) 61/419 (14.6%)

Improved Access to Children and

Young People’s Mental HealthSarah Breton 17%

37.9% of children and young people to receive treatment in

NHS funded mental health community services when needed

(target 3499)

4110/3499

(117.5%)

Provisional data up to Jan. 2019

Denominator taken from operational

planning document

Bloodstream Infections Sara Wilds 17%

20% reduction in E.coli (463 in 2016) 395 / 370From HCAI DCS – 370 is whole year

target reduction

Collection of Primary Care Dataset for E.coli (Y/N) Yes Collected for Q2 by OUHFT

30% reduction in Trimethoprim items prescribed (70 years &

older) 9745/13302

Data available up to December 2018Items per STAR-PU ≤1.161

0.816Items per STAR-PU ≤0.965

Reported to estimated prevalence of

COPD (%)Sharon Barrington 15%

Increase in QOF Prevalence – reduction of gap by 20%

compared to 2016/17N/A No proxy identified

*Data for a number of indicators are validated and published on an annual basis. Local proxies, which reflect the indicator have been established to provide an in year predicted position. These are subject to change due to validation and publication. N.B. Further information

on Quality Premium indicators and definitions can be found: https://www.england.nhs.uk/publication/technical-guidance-annex-b-information-on-quality-premium/

10

Project Update

Scheme Name Scheme Description

Target

FYE

£'000

Plan

£'000

Actual

£'000

C

o

l

u

m

Delivery

RAG Comments Savings Trend

Activity Trend (3

Month Moving

Average)

GP-led Cardiac

Community Clinics

Implementing a community clinic led by specialist cardiology

GPs (GP-Cs) for patients with symptoms appropriate for care in

the community

140 TBC TBC Green

Savings have not been realised for this service in the north of the county. The activity levels

and rates of triage are better than expected, but OUHFT have failled to control the referral

process effectively, and GPs are still referring directly into the OUH outside of the GPwSI

triage service. Discussions are underway to identify a way to control the referral routes and so

protect the savings and integrity of this service. Until this has happened and the service can

demonstrate a financially sustainable model, the pilot will not be rolled out to the south of the

county. There are clinical reasons related to urgent care and the rapid access chest pain clinic

why it would be good to speed this up.Musculoskeletal

(MSK)

Assessment,

Treatment and

Triage Service

(MATT)

Commissioning a new Musculoskeletal (MSK) Assessment,

Treatment and Triage Service (MATT). All referrals relating to

MSK will be triaged and treated on one of the MATT pathways

or, when specialist treatment is required, will be triaged and

referred onto secondary care.

2,200 1,833 1,967 Green

Self-referral rolled out, so far no unexpected increase in demand for Healthshare's services.

Savings appear to have slowed down due to the planning assumptions for 2018/19, however,

we are on target for £2.2m+ across the year.

GP-led Headaches

Community Clinic

Implementing a community GP Specialist led headache clinic for

patients with a primary headache. 50 46 125 Green

Pilot ended in October with a successful evaluation. Decision made to commission the

service from OUHFT. Interim measure to continue with Community Headache Clinics (CHC)

on same basis as pilot against a monthly block payment (£8,054 per month) agreed until

31/3/19 and CV signed. #OUH-CV67 Headache pilot extension- signed.pdf

New tariff agreed with Service, SCW CSU are drawing details to be included in new OUHFT

contract for signature.

Urgent Eye

Conditions Pathway

Implementing a Minor Eye Conditions Service (MECS); a

community service that uses Optometrists based in Opticians to

assess and treat recent onset eye conditions and vision

problems.

255 213 101 Amber

OUH have agreed to pilot triage in Eye Casualty, which is required to release the full savings

from this project. However, the CCG negotiating team with the OUH have struggled to identify

a way to accommodate the small amount of investment required to make this happen.

Savings are slipping as a result.

Gastro Community

EndoscopyImplementation of a community endoscopy service 244 203 313 Green

InHealth activity is increasing, and OUH endoscopy activity is decreasing. This is occuring

faster than anticipated. There are 2ww and waiting time performance issues as a result, which

are now mostly resolved. A third site in the south of the county is being considered.

2,889 2,295 2,507

YTDFY18/19 Schemes

Oxford University Hospitals NHS Trust 1

11

Oxford University Hospitals NHS Trust (OUHFT) – Planned Care

OUHFT Elective Inpatients and Day-Cases (Month 10)

Elective Inpatients and Day-Cases Elective inpatients and Day cases have collectively been under plan for most of the year to date. Elective inpatient and day cases show a slight decrease in

underperformance during January, now £4.4m (8.3%) under plan compared to £4.5m (9.5%) under plan at M9.

• Day case activity remains below plan by 530 spells, £308k (1%) underspent, (£596k under last month)• Elective Inpatient activity is significantly under plan at 13%, and £4m (19%) underspent, which represents a 1% decrease in underperformance in month.

• Most of the underspend for Elective Inpatients sits within T&O (£2m below plan), General Surgery (£659k below plan) and Colorectal Surgery (£563k below plan). • Compared to January 2017, overall Elective activity is 4% lower.

• Respiratory remains the highest overspend at £521k over plan. As previously reported the main group of HRGs driving the overspend is day case activity against DZ29. The Trust have shared

additional background on the source of this activity, which relates to patients initiated onto a new drug commissioned by NHSE, where the patient needs to be admitted for observation post

initiation. A meeting has been held with NHSE to seek resolution. A number of actions came out of the meeting including NHSE to share 17/18 and 18/19 drug data so the wider pathway can

be reviewed including Elective and NEL admissions for Oxfordshire, as NHSE believe there will be savings elsewhere in the system the CCG would benefit from. Investigation is ongoing.

Day Cases and Electives Variance by Specialty >+/- £50k

SLAM Specialty

Activity

Plan

Activity

Actual

Activity

Diff

ActPlan

Activity

Perc Diff

ActPlan

Price Plan Price Actual Price Diff

ActPlan

Price

Perc Diff

ActPlan

340 - RESPIRATORY MEDICINE 848 1,535 687 80.9% £726,401 £1,247,106 £520,705 71.7%

811 - INTERVENTIONAL RADIOLOGY 564 828 264 46.8% £721,165 £1,042,109 £320,944 44.5%

320 - CARDIOLOGY 2,197 2,294 97 4.4% £2,751,495 £2,979,731 £228,236 8.3%

103 - BREAST SURGERY 602 656 54 8.9% £1,502,801 £1,694,233 £191,432 12.7%

105 - HEPATOBILIARY & PANCREATIC SURGERY 224 235 11 4.8% £533,185 £669,946 £136,761 25.6%

410 - RHEUMATOLOGY 953 1,213 260 27.2% £549,471 £682,405 £132,934 24.2%

306 - HEPATOLOGY 711 634 -77 -10.8% £332,266 £412,295 £80,029 24.1%

341 - SLEEP STUDIES 1,136 1,375 239 21.0% £472,254 £549,577 £77,322 16.4%

107 - VASCULAR SURGERY 174 231 57 32.7% £155,829 £205,829 £50,000 32.1%

503 - GYNAECOLOGICAL ONCOLOGY 160 137 -23 -14.2% £308,590 £260,750 -£47,840 -15.5%

330 - DERMATOLOGY 2,392 2,231 -161 -6.7% £1,590,946 £1,509,825 -£81,121 -5.1%

191 - PAIN MANAGEMENT 629 495 -134 -21.4% £358,991 £263,509 -£95,483 -26.6%

303 - CLINICAL HAEMATOLOGY 994 871 -123 -12.4% £621,069 £513,696 -£107,373 -17.3%

106 - UPPER GASTROINTESTINAL SURGERY 156 138 -18 -11.3% £611,907 £483,325 -£128,583 -21.0%

219 - PAEDIATRIC PLASTIC SURGERY 308 212 -96 -31.2% £417,807 £272,688 -£145,119 -34.7%

502 - GYNAECOLOGY 2,023 2,184 161 8.0% £2,694,502 £2,541,890 -£152,612 -5.7%

215 - PAEDIATRIC EAR NOSE AND THROAT 586 459 -127 -21.7% £677,650 £496,724 -£180,927 -26.7%

108 - SPINAL SURGERY SERVICE 368 328 -40 -10.9% £1,354,859 £1,170,771 -£184,088 -13.6%

130 - OPHTHALMOLOGY 4,247 4,057 -190 -4.5% £3,357,230 £3,147,600 -£209,630 -6.2%

370 - MEDICAL ONCOLOGY 808 418 -390 -48.3% £502,821 £260,626 -£242,195 -48.2%

301 - GASTROENTEROLOGY 9,852 9,424 -428 -4.3% £4,502,716 £4,258,440 -£244,275 -5.4%

101 - UROLOGY 3,113 3,167 54 1.7% £2,621,658 £2,347,441 -£274,217 -10.5%

420 - PAEDIATRICS 919 516 -403 -43.8% £711,605 £355,725 -£355,880 -50.0%

160 - PLASTIC SURGERY 1,646 1,511 -135 -8.2% £2,372,224 £1,992,677 -£379,547 -16.0%

104 - COLORECTAL SURGERY 860 709 -151 -17.6% £2,623,013 £2,059,439 -£563,573 -21.5%

100 - GENERAL SURGERY 5,134 4,415 -719 -14.0% £4,028,141 £3,369,480 -£658,661 -16.4%

110 - TRAUMA & ORTHOPAEDICS 3,220 2,985 -235 -7.3% £13,169,989 £11,098,220 -£2,071,770 -15.7%

Grand Total 47,660 46,236 -1,424 -3.0% £53,296,439 £48,871,549 -£4,424,890 -8.3%

Oxford University Hospitals NHS Trust 2

12

Oxford University Hospitals NHS Trust (OUHFT) – Planned Care

2. OUHFT Outpatient Main Under and Overspends Month 10

Outpatient attendances and Outpatient Procedures Outpatient attendances and Procedures all continue to show a position over plan

First attendances remain relatively stable with a position over plan of £1.4m (6.9%), representing an increase from 6.6% last month.

Follow ups have a 1% increased run rate as well as financial performance against plan.

Outpatient Procedures overspend has continued to reduce towards plan. In January Outpatient Procedures are now £114k or 1.2% over plan compared to 3.4% in December 4.1% in November,

5.3% in October, 6.4% in September, 6.7% in August and 7.9% in July.

Initial queries regarding Physiotherapy have been raised with the Trust and the issue has been considered at FIG. Significant values relate to paediatric physio activity where plan values have

been understated. No further investigation planned

a) First Attendances Variance by specialty > +/- £10k b) Follow Up Attendance variance by speciality > +/-£10k

c) Procedures variance by speciality > +/-£10k

SLAM Specialty

Activity

Plan

Activity

Actual

Activity

Diff

ActPlan

Activity

Perc Diff

ActPlan

Price Plan Price

Actual

Price Diff

ActPlan

Price

Perc Diff

ActPlan

130 - OPHTHALMOLOGY 7,050 8,745 1,695 24.0% £1,070,242 £1,324,711 £254,469 23.8%

650 - PHYSIOTHERAPY 6,946 9,624 2,678 38.5% £435,064 £686,392 £251,328 57.8%

330 - DERMATOLOGY 5,575 6,420 845 15.1% £670,127 £844,461 £174,335 26.0%

410 - RHEUMATOLOGY 2,692 3,647 955 35.5% £842,000 £1,007,622 £165,622 19.7%

103 - BREAST SURGERY 5,375 5,789 414 7.7% £935,587 £1,082,945 £147,358 15.8%

120 - ENT 4,108 5,055 947 23.1% £505,683 £631,894 £126,211 25.0%

420 - PAEDIATRICS 3,121 3,606 485 15.6% £710,941 £818,235 £107,294 15.1%

302 - ENDOCRINOLOGY 649 944 295 45.4% £158,638 £230,266 £71,628 45.2%

400 - NEUROLOGY 3,101 3,379 278 9.0% £687,111 £754,054 £66,944 9.7%

191 - PAIN MANAGEMENT 1,365 1,000 -365 -26.8% £273,241 £202,653 -£70,588 -25.8%

502 - GYNAECOLOGY 10,541 9,907 -634 -6.0% £1,846,180 £1,751,853 -£94,328 -5.1%

320 - CARDIOLOGY 4,317 5,352 1,035 24.0% £664,195 £562,235 -£101,960 -15.4%

110 - TRAUMA & ORTHOPAEDICS 13,331 12,767 -564 -4.2% £2,204,725 £2,100,901 -£103,823 -4.7%

Grand Total 130,443 139,958 9,515 7.3% £21,585,955 £22,989,056 £1,403,101 6.5%

SLAM Specialty

Activity Plan Activity

Actual

Activity

Diff

ActPlan

Activity

Perc Diff

ActPlan

Price Plan Price Actual Price Diff

ActPlan

Price

Perc Diff

ActPlan

650 - PHYSIOTHERAPY 22,732 30,056 7,324 32.2% £1,079,178 £1,596,318 £517,140 47.9%

315 - PALLIATIVE MEDICINE 5,328 5,465 137 2.6% £1,597,731 £1,893,632 £295,901 18.5%

103 - BREAST SURGERY 2,142 3,762 1,620 75.6% £162,460 £286,310 £123,850 76.2%

410 - RHEUMATOLOGY 6,466 7,248 782 12.1% £778,319 £883,723 £105,404 13.5%

120 - ENT 3,842 4,989 1,147 29.9% £218,310 £284,748 £66,438 30.4%

920 - DIABETIC EDUCATION SERVICE 92 503 411 446.5% £10,181 £55,642 £45,461 446.5%

350 - INFECTIOUS DISEASES 1,362 1,155 -207 -15.2% £203,492 £172,192 -£31,300 -15.4%

655 - ORTHOPTICS 7,458 6,779 -679 -9.1% £364,215 £331,085 -£33,130 -9.1%

307 - DIABETIC MEDICINE 4,051 3,703 -348 -8.6% £356,658 £322,530 -£34,128 -9.6%

658 - ORTHOTICS 4,789 4,353 -436 -9.1% £542,117 £493,775 -£48,342 -8.9%

651 - OCCUPATIONAL THERAPY 1,277 1,047 -230 -18.0% £351,140 £295,983 -£55,156 -15.7%

340 - RESPIRATORY MEDICINE 5,835 5,083 -752 -12.9% £610,963 £532,450 -£78,513 -12.9%

344 - COMPLEX SPECIALISED REHABILITATION SERVICE 857 611 -246 -28.7% £355,098 £269,413 -£85,685 -24.1%

653 - PODIATRY 2,958 1,693 -1,265 -42.8% £212,315 £121,501 -£90,814 -42.8%

Grand Total 215,072 223,792 8,720 4.1% £17,948,854 £18,722,027 £773,173 4.3%

SLAM Specialty

Activity

Plan

Activity

Actual

Activity

Diff

ActPlan

Activity

Perc Diff

ActPlan

Price Plan Price Actual Price Diff

ActPlan

Price Perc

Diff

ActPlan

303 - CLINICAL HAEMATOLOGY 2,565 2,891 326 12.7% £947,068 £1,103,407 £156,339 16.5%

653 - PODIATRY 3,778 4,780 1,002 26.5% £502,967 £636,329 £133,362 26.5%

130 - OPHTHALMOLOGY 14,436 14,791 355 2.5% £1,557,104 £1,633,961 £76,857 4.9%

101 - UROLOGY 4,075 4,162 87 2.1% £1,094,892 £1,151,972 £57,080 5.2%

340 - RESPIRATORY MEDICINE 2,756 2,956 200 7.3% £686,484 £736,008 £49,524 7.2%

502 - GYNAECOLOGY 1,498 1,576 78 5.2% £434,410 £481,675 £47,265 10.9%

110 - TRAUMA & ORTHOPAEDICS 841 666 -175 -20.8% £115,900 £89,053 -£26,848 -23.2%

812 - DIAGNOSTIC IMAGING 5,492 5,095 -397 -7.2% £1,242,979 £1,187,424 -£55,554 -4.5%

120 - ENT 6,558 5,707 -851 -13.0% £770,109 £683,137 -£86,972 -11.3%

307 - DIABETIC MEDICINE 932 72 -860 -92.3% £123,801 £9,541 -£114,260 -92.3%

330 - DERMATOLOGY 9,275 8,089 -1,186 -12.8% £1,140,523 £1,000,845 -£139,679 -12.2%

Grand Total 61,008 59,621 -1,387 -2.3% £9,902,275 £10,017,007 £114,732 1.2%

Oxford University Hospitals NHS Trust 3

13

Oxford University Hospitals NHS Trust (OUHFT) – Urgent Care

The cost of activity over plan at month 10 is £7.9m (2.8%) compared to £6.1m, (2.4%) at month 9, giving an in-month movement of £1.8m, and an increased run rate. Cost of activity is £41m (16%)

higher than the M10 last year. The bottom line position after financial adjustments is £4.5m overspent (1.6%), compared to £3m (1.2%), last month.

The most significant pressure continues with the NEL PODs at £7.5m over plan, with approximately £5.2m of the NEL overspend driven by a richer case mix. Overall the run rate for activity remains

stable at 2.8% over plan. Ambulatory follow up attendances have seen a reduction in Month 10, now 12.9% over plan in terms of price compared to 19% in M9.

NEL Inpatient activity still shows a position under plan of 221 spells (-1%) (last month 285 spells, -1% below plan). Spend remains significantly higher, now £5.1m (7.7%) above plan. The overall

position maintains the case mix pressures highlighted over the last year.

Accident and Emergency (A&E) Attendances - January (M 10) 2018/19

A&E shows a stable position in January compared to previous months with year to date activity over plan by 3010 attendances, (2.8%) and cost above plan by £988k, (6.6%).

Compared to YTD January 2017 activity is 4% higher overall – similar position over the last few months

The cost variance remains driven by a combination of less activity flowing through the type 3 GP streamed service than planned (54% under), with activity at around 15 attendances per day

(last month 13 on average per day), and an increase in high cost HRG’s.

The highest activity and financial pressure still lies within VB08Z (Category 2 Investigation with Category 1 Treatment) 3,109 attendances and £454k (13%) above plan

Ambulatory Care Pathways

Ambulatory activity is recorded under NEL as an admission. Any further activity on the ambulatory pathway is recorded and charged under a local tariff. Activity and spend have decreased this

month. Month 10 shows an overspend of £214k, and 12.9% attendances over plan (last month £259k, and 19.4%).Within this value:

Adams Ambulatory Unit (AAU) is over Plan by £220k (44%),

Surgical Assessment Unit (SAU) ambulatory under plan by £126k (19%) *

And Daily Discharge Unit ( DDU) over plan by £119k (25%). Activity recorded against DDU in January at 115 attendances, up from December (109).

Further joint investigation of Ambulatory activity is being undertaken to understand patient flows and associated charges for 2019/20, a meeting took place on 21st February to progress this.

* SAU triage is no longer charged, but the SAU ambulatory price has increased to include the SAU triage price, and therefore SAU values cannot be directly compared to 2017/18. SAU activity is

captured within Ambulatory POD in 2018/19. The price will be subject to in year validation for 2019/20.

Non-Elective (NEL) Overall

NELs continue to be the highest pressured POD now £7.5m over plan

The other NEL PODs (Short stay, same day and non-emergency) also contribute additional cost pressures of £2.4m mainly driven by activity growth of 21% (compared to the same time last

year) within short stay spells.

Overall activity is 5% higher than the same period last year, and proportionately most of this increase sits within short stay.

NEL average tariff at £1912, is 5% higher than the same period last year (£1814), and 5% higher than the average for last year (£1828).

The sub-chapter and corresponding HRG’s within NEL with the highest over-spends and case mix pressures remain similar to previous months:

DZ – Respiratory System Procedures and Disorders £2.8m (37%) over plan, with activity 14% above plan – this accounts for approximately 54% of the total NEL PODs overspend. PD -: Paediatric Respiratory Disorders, which is now £594k (72%) over plan

AA – Nervous System Procedures and Disorders £546k (9%) over plan, and activity 13% below plan.

Plan Actual Variance % Var Plan Actual Variance % Var

A&E Type 1 85,401 94,424 9,023 390.4% 13,321,651 14,724,316 1,402,665£ 390.3%

Eye Casualty Type 2 10,440 9,987 453- -70.8% 1,044,627 1,015,205 29,422-£ -70.8%

GP Streamed Type 3 9,926 4,367 5,559- -56.0% 688,105 302,720 385,384-£ -56.0%

Total 105,768 108,778 3,010 3% 15,054,382 16,042,241 987,859 7%

Activity Price

SCAS Provider Summary

14

South Central Ambulance Service Summary of performance: 999

Activity was 38 incidents above baseline for January, totalling 7,869 incidents against the 7,831 anticipated. The case mix change continues in month 10 leading to an overspend in January of £68k

and a YTD overspend of £349K.

Achievement of the new ambulance targets has started to improve. Performance was achieved for all categories at contract and SCAS level. Unfortunately SCAS failed to achieve the target for Cat

1 (mean) at CCG level.

Summary of Performance: Integrated Urgent Care (IUC) Contract

Oxfordshire:

In the Thames Valley IUC contract, the 95% target was not reached with performance at 80.70% for call answer within 60 seconds in January This was a significant improvement on the December 18

when performance against the target was 65.66%. There was under performance of 5,245 calls (-9.2%) against the January plan. Overall across Thames Valley activity has decreased by 6.79% in

January compared to last year. Call abandonment rate improved in January within the target of >3.5% (2.38%) achieved for the first time since September 2018.

Main issues:

From November SCAS has been resourcing additional hours from Conduit to assist in covering challenging hours between 2pm-5pm, in addition to the hours that they are already contracted for

however, Conduit staffing has declined significantly over the last few months due to the closure of the Chatham site, impacting attrition. And therefore performance

From the 2nd of February funding has been allocated for an additional two clinicians to cover evenings and weekends Monday to Thursday 4pm to midnight, and weekends 8am till 5pm. This resource

is contracted until the end of March 2019.

Category Cat 1 Cat 1 Cat 2 Cat 2 Cat 3 Cat 4

Target 7 minutes 15 minutes 18 minutes40 minutes 2 hours 3 hours

Month to date: January 2019 Mean 90th Percentile Mean 90th Percentile 90th Percentile 90th Percentile

Oxfordshire CCG 00:07:11 00:13:38 00:15:52 00:29:43 01:40:27 02:46:11

TV Total 00:06:47 00:12:28 00:16:33 00:32:53 01:59:44 02:45:09

Name Threshold Jan-19 Year to Date

Oxfordshire Thames Valley Oxfordshire Thames Valley

Abandoned calls (NQR8) <3.5% 2.37% 2.38% 3.52% 3.55%

Calls Answered in 60 Seconds >95% 80.70% 80.38% 78.23% 78.01%

Transfer to 999 (LQR3) < 10% 12.96% 12.82% 10.74% 10.98%

OHFT Provider Summary 1

Oxford Health Foundation Trust (OHFT)

Out of Hours (OOH) (Cost and Volume Service)

Costed activity in January 2019 is 7.9% (£39k) below the profiled budget of £501 for the month. YTD, overall activity is 2.4% below the seasonally adjusted plan and 3.6% below the same period

last year.

The OOHs KPIs have been reviewed and remodelled in line with the Integrated Urgent Care KPIs. In month 9 all KPIs were met with the exception of:

1. IUC 13b – 95% of Patients receive a Face to Face Consultation in an IUC Treatment Centre within 2 hours. M10 performance (88% ) - M 9 = 88%).

1.

Overall there has been a slight increase in performance for M10 in particular for UTC6 – Walk ins urgent management. The process for management of urgent base visits is embedded at most sites.

The service continues to work with individual staff to ensure patients are managed by clinical risk and urgency rather than arrival time. All clinical lists were changed so that patients appear and are

managed in Adastra in order of clinical priority. Patients in base remain safe in all locations with clinicians close at hand.

This KPI is under review as it is not aligned to the current A&E targets and may be monitored for information only.

15

0%

20%

40%

60%

80%

100%

Series1 Target FY18

OHFT Provider Summary 5Oxford Health Foundation Trust (OHFT)

Community Services

The following key performance indicators are reported by exception as all are 10% or more below target.

• The Chief Executives agreed performance reporting on KPI’s to be scaled back over the winter period ( November to end March). All KPIs have been reviewed for

2019/20. Some of the suspended KPIs have been permanently removed based on data OCCG already receives (DTOC, LOS) and the quality monitoring process.

• The % of physical disability physiotherapy patients waiting less than 12 weeks to first appointment has dropped again. The CCG has agreed a reduced tolerance of

performance against this KPI against the target of 95% but this is a further drop. A review of the Parkinson’s service is due to report end of March which may impact

on the delivery of this service. The Head of Planned care has re-iterated the service review is due to be finished end March and any recommendations will be

contingent on affordability across the system. The KPI may need reviewing as this takes place.

• Performance in achieving the LAC KPI for children over 5 out of county continues to be problematic. A full report was presented at OH February QRM by OH lead

for Looked After Children. It was accepted that OH are doing what can be done in improving this KPI while also raising this issue both locally through the

Oxfordshire Corporate Parenting panel and Safeguarding Boards, and also nationally through NHSE. A position paper update has been received from OH which

provides assurance that OH are fully aware of Counties where LAC are less likely to receive their review. Discussions are taking place with Children’s

commissioning lead and OH.

16

KPIs achieved

OHFT Provider Summary 2Oxford Health Foundation Trust (OHFT)Adult Mental Health Services

Current system focus:

Oxford Health continues to report an increased demand which is creating pressure on assessment teams, in particular the city team, they have been working to an 8 week routine access target for

the past year which has resulted in the 28 day routine access breach, the 8 week access will continue into March and is performing at 87% at M10. GPs have been updated by OH of their decision

to work to 8 weeks and assurance given that risk mitigation plans are in place. All associated underperformance relating to the OH reported demand and capacity issues continues to be monitored

through QRM. A resolution to system funding of MH is a priority for OCCG and all partners. A number of workstreams continue to be progressed to better understand demand, capacity, future

needs and sustainable delivery model for adult MH to inform the approach to investment. These are being brought together through a task and finish sub group of the Distributing the Oxfordshire

Pound meeting and a workshop is being planned for May.

National KPIs – Ref slide 4

National targets for early intervention in psychosis, dementia, CPA continue to be met. The IAPT access target has increased to 19% (4.75% per quarter) in 2018/19 ; slide 4 shows all KPIs being

met and our local un-validated M10 contract report of 19.3% access, demonstrates more recent performance, remains good.

Performance issues and remedial action:

The GP letter breaches continue to be reviewed by OH business services and an improvement trajectory has been established with each individual team and clinician; all underperformance is

being monitored by QRM for assurance of remedial action.

EDPS performance continues to be challenged and whilst analysis shows the targets were only just missed, at the JR breaches continue to be mainly due to night shift when staffing is less than

the day and referrals being received at the same time causes a delay. EDPS daily performance is also being monitored as part of winter reporting to NHSE.

17

OHFT Provider Summary 3 Oxford Health Foundation Trust (OHFT) Specialist LD Health Services

Commentary:

Underperformance of routine referrals linked to workforce availability issues. Staffing levels are expected to return to normal in February 2019. In the interim waiting lists are being actively

managed to ensure longest waiters are seen first, and available clinic appointments are maximised.

Learning Disability Annual Healthchecks (Primary Care DES)

Commentary:

OCCG is contacting practices to promote the Oxford Health LD primary care liaison service.

This supports practices to engage with their LD populations, including encouraging eligible

individuals to have annual health checks.

18

Transforming Care Programme Performance

*includes CYP and adult secure inpatients with LD and / or ASC

Commentary:

System partners – principally OCCG, OHFT and OCC – are working closely together to facilitate

discharges and prevent admissions under the Mental Health Act 1983. As a result the number of

people with LD in inpatient beds is significantly below the nationally set Transforming Care end of

programme target of 9 adults.

The principal risks to the delivery of Transforming Care in Oxfordshire are:

- NHSE commissioning of forensic services for LD – a working group is addressing this;

- Volatility of numbers of children in inpatient settings (currently 5);

- Complexity of discharges from adult secure beds and associated timescales / lengths of stay

Target

(March 19)Jan-19

CCG commissioned adult inpatients 9 6

Specialised Commissioning inpatients* 13 16

Overall 22 22

Oxford Health Foundation Trust (OHFT)

Children and Adolescent Mental Health Services (CAMHS)

.

The above KPIs are locally set with no national KPIs for CAMHS. The Eating Disorder KPIs will become mandatory in 2020 and we have set KPIs locally to ensure we have confidence the new

Service is set to deliver the KPIs for 2020.

Indicator a):. The Healios on-line Service is operational and children have been identified to be offered this service. This is part of the 4WW Pilot to eradicate the backlog for the Getting Help

Pathway. Train to recruit posts for the Getting More Help Pathway are being trained at Reading University as well as the trainees for the Mental Health Teams into Schools pilot.

Indicator b): There is still a programme in place transferring patients from the Getting More Help pathway to the new NDC pathway. We are anticipating on having a complete picture on the

number of children and young people in the NDC pathway by May 2019 and detailed plans to reduce waiting times. Additional funding from NHS England (£95,000) has been awarded to help

clear the longest waiters. Healios has got a new contract with OHFT for this additional work. Trajectory is currently being worked on with Healios.

Indicator c) &d) ): In January 2 out 5 Urgent referrals were breaches -One patient was seen in 1.1 weeks due to patient choice and the other breach is a data quality error and was seen within

mandated timeframe.

Indicator e): In this year we have also introduced the KPI for Looked After Children as we know that up to 60% of LAC will have mental health problems at some stage in their life. Performance

has improved this month. Two Breaches relate to DNA and the other two patients were seen with 2.4 weeks. There was no clinical risk identified to any patients.

Indicator f): The Eating Disorder Service exceeded the target for this reporting month and none were urgent.

Indicator h) & I) is new additional information from the PAF. Referrals continue to increase. Data for consultations has not been supplied for this month and this is being addressed with the Trust.

Early findings from the formal evaluation of the model shows that feedback has been positive about the SPA changes and indicates that families and professional are finding access to CAMHS

much improved.

OHFT Provider Summary 4

19

OHFT Provider Summary 6Oxford Health Foundation Trust (OHFT)

Community Services

The following services are more than 10% under plan Year To Date (YTD) at Month 10 and are reported by exception only:

20

Service

Line

YTD Activity

v PlanKey Issues Updates

Phlebotomy

City

Phlebotomy

Non-City

-25%

(-2,139 contacts)

-31%

(-2,355 contacts)

• All activity undertaken by the Adult Phlebotomy team for Oxford City is

accurate.

• Underperformance is due to reduced referrals and staffing.

• Team is now fully recruited to, new staff members will start to support and

increase contacts in the coming months. One staff member remains on

long term sick leave.

• General increase activity over the past 4 months for non-city.

Integrated

Children

Nursing

Service

-21%

(-2,333 contacts)

• Multiple IT/Care Notes issue identified through the OH report following

external review of all admin and electronic recording processes.

• Some vacancy issues which have now been resolved.

• OH taking multiple actions to address Care Notes issues.

• Improved activity from M7, however due to a sharp increase in the IAP for

M8, the monthly variance has increased.

• OCCG has provided a response to the OH reports seeking reassurance on

timescales against identified action.

• List of services for Care Notes optimisation has been shared with OCCG.

Children's Community Nursing is scheduled to be looked at during Q1

2019.

Tissue

Viability

-13%

(-492 contacts)

• This service is showing as -13% against plan, The service is reporting

accurately and all parties are happy with the way the service is working.

• Now the reporting is accurate, 18/19 actuals will be used to inform the

19/20 IAP.

Heart Failure

Service -12%

(-759 contacts)

• As requested by CRM, Datix is to be monitored to see whether any

issues are raised in regards to the quality of the service and the potential

impact/s staff vacancies may have on activity.

• Sharp increase in activity over the past 4 months, attributable to an

increase in staff. Full staffing compliment for M10, which is reflected by the

highest activity count to date.

• No Datix issues have been reported for this service. There is no waiting list

and all patients are being seen within 10 days.

Acute Provider Summary

Royal Berkshire Foundation Trust (RBFT)

Summary of performance month 10

For M10, reported underperformance of £104k (0.6%) which is a slight deterioration on the 0.7% reported at M9. Deterioration is noted in Excess Bed Days £44k and

Non-Elective £52k. The excess bed days costs relate to one patient with a 172 day length of stay, associated elective spell “JA20D Unilateral Major Breast

Procedures with CC Score 6+”. The Non-Elective position is showing higher patient acuity, activity is 1.2% under plan with price being 3.8% over plan. The highest

over performing sub-chapter is “AA - Nervous System Procedures and Disorders” which is £126k / 30.7% over plan. Analysis of all Non-Elective activity shows The

Bell Surgery is over performing by £231k / 26.1%.

RBH YTD (M9) by POD

21

Month 10 2018/19 Month 9 2018/19 Movement M9 to M10 2018/19

Values Values

Provider POD Desc

Activity Plan Activity Actual Activity

Diff

ActPlan

Activity

% Diff

ActPlan

£ Plan £ Actual £ Diff

ActPlan

£ % Diff

ActPlan

Activity Diff

ActPlan

Activity

% Diff

ActPlan

£ Diff

ActPlan

£ % Diff

ActPlan

Activity

Moveme

nt

Activity

moveme

nt %

Price value

movement

Price

value

moveme

nt %

ACCIDENT AND EMERGENCY 5,366 5,463 97 1.8% £923,693 £889,801 -£33,892 -3.7% 39 0.8% -£37,127 -4.4% 58 1.0% £3,235 0.8%

AD HOC 0 0 0 0.0% -£445,353 -£321,494 £123,859 -27.8% 0 0.0% £149,539 -37.3% 0 0.0% -£25,680 9.5%

BLOCK FUNDED ITEMS 90 90 -0 -0.2% £102,209 £102,150 -£59 -0.1% -0 -0.1% -£13 -0.0% -0 -0.2% -£47 0.0%

CQUIN 0 0 0 0.0% £343,186 £343,186 £0 0.0% 0 0.0% £0 0.0% 0 0.0% £0 0.0%

CRITICAL CARE BED DAYS 318 305 -13 -4.2% £468,561 £462,073 -£6,488 -1.4% 4 1.3% £18,584 4.4% -17 -5.5% -£25,072 -5.8%

DAY CASES 2,576 2,555 -21 -0.8% £2,091,483 £2,028,530 -£62,953 -3.0% -21 -0.9% -£48,538 -2.6% -0 0.1% -£14,414 -0.4%

DIAGNOSTIC IMAGING WHILST OUT-PATIENT 4,245 4,274 29 0.7% £409,462 £421,951 £12,489 3.0% -6 -0.1% £9,859 2.7% 34 0.8% £2,630 0.4%

DIRECT ACCESS 291,564 305,146 13,582 4.7% £792,466 £841,225 £48,759 6.2% 10,575 4.0% £35,381 5.0% 3,007 0.6% £13,378 1.2%

ELECTIVE EXCESS BED-DAYS 37 317 280 759.8% £11,211 £83,670 £72,459 646.3% 112 338.8% £28,215 280.8% 168 421.0% £44,245 365.5%

ELECTIVE INPATIENTS 513 506 -7 -1.3% £1,617,398 £1,468,722 -£148,676 -9.2% -2 -0.5% -£118,467 -8.2% -4 -0.8% -£30,209 -1.0%

EMERGENCY SHORT STAY 234 281 47 19.9% £184,086 £212,801 £28,715 15.6% 50 23.9% £31,490 19.0% -4 -4.0% -£2,775 -3.4%

EXCESS BED DAYS EMERGENCY 1,225 575 -650 -53.1% £316,927 £151,145 -£165,782 -52.3% -532 -48.4% -£135,489 -47.6% -118 -4.7% -£30,293 -4.7%

HEART FAILURE PATHWAY 3 1 -2 -70.2% £3,183 £1,266 -£1,917 -60.2% -2 -66.7% -£1,586 -55.6% -0 -3.5% -£330 -4.6%

HEART FAILURE PATHWAY FOLLOW UP 28 7 -21 -74.7% £0 £0 £0 0.0% -18 -71.8% £0 0.0% -3 -2.9% £0 0.0%

MATERNITY PATHWAY - ANTE-NATAL 287 259 -28 -9.9% £419,314 £380,039 -£39,275 -9.4% -22 -8.4% -£28,174 -7.5% -7 -1.5% -£11,101 -1.9%

MATERNITY PATHWAY - POST-NATAL 163 198 35 21.2% £50,346 £60,255 £9,909 19.7% 38 25.6% £10,843 24.0% -3 -4.5% -£935 -4.4%

NON ELECTIVE NON EMERGENCY 738 669 -69 -9.4% £743,326 £662,332 -£80,994 -10.9% -58 -8.8% -£95,713 -14.3% -11 -0.7% £14,718 3.4%

NON FACE-TO-FACE ATTS 1,206 1,506 300 24.8% £52,775 £62,797 £10,022 19.0% 275 25.4% £9,287 19.6% 24 -0.6% £734 -0.6%

NON-ELECTIVE 1,944 1,920 -24 -1.2% £4,746,100 £4,926,974 £180,874 3.8% -34 -2.0% £128,851 3.0% 10 0.7% £52,023 0.8%

NON-ELECTIVE NON EMERGENCY EXCESS BED DAYS 68 107 39 57.6% £20,428 £14,386 -£6,042 -29.6% 46 75.6% -£3,952 -21.5% -7 -18.0% -£2,091 -8.0%

NON-ELECTIVE SAME DAY EMERGENCY CARE 246 269 23 9.4% £206,830 £232,131 £25,301 12.2% 16 7.3% £19,060 10.3% 7 2.1% £6,241 2.0%

OTHER ITEMS 11,881 10,435 -1,446 -12.2% £186,310 £175,070 -£11,240 -6.0% -1,302 -12.2% -£6,313 -3.8% -144 0.1% -£4,927 -2.3%

OUTPATIENT FA MULTI PROF CONS LED 84 115 31 36.4% £20,737 £26,658 £5,921 28.6% 33 44.0% £6,716 36.1% -3 -7.6% -£795 -7.5%

OUTPATIENT FA SINGLE PROF CONS LED 7,559 7,484 -75 -1.0% £1,378,947 £1,318,716 -£60,231 -4.4% -111 -1.6% -£65,558 -5.3% 35 0.6% £5,328 0.9%

OUTPATIENT FUP MULTI PROF CONS LED 289 288 -1 -0.3% £35,696 £36,599 £903 2.5% -6 -2.1% £83 0.3% 5 1.9% £819 2.3%

OUTPATIENT FUP SINGLE PROF CONS LED 14,468 14,993 525 3.6% £1,111,391 £1,041,973 -£69,418 -6.2% 439 3.4% -£67,728 -6.8% 86 0.2% -£1,689 0.6%

OUTPATIENT FUP SINGLE PROF NON-CONS LED 6 0 -6 -100.0% £0 £0 £0 0.0% -5 -100.0% £0 0.0% -1 0.0% £0 0.0%

OUTPATIENT PROCEDURES FA 3,690 3,327 -363 -9.8% £494,609 £478,533 -£16,076 -3.3% -387 -11.7% -£21,830 -4.9% 25 1.9% £5,754 1.7%

OUTPATIENT PROCEDURES FUP 4,662 5,085 423 9.1% £758,351 £779,664 £21,313 2.8% 291 6.9% £8,929 1.3% 132 2.1% £12,383 1.5%

PBR EXCLUDED DEVICES 1 1 0 22.9% £63,194 £77,653 £14,459 22.9% 0 23.2% £13,051 23.2% 0 -0.3% £1,407 -0.3%

PRE-OPERATIVE ASSESSMENTS 869 1,238 369 42.5% £35,627 £50,758 £15,131 42.5% 327 42.0% £13,416 42.0% 42 0.5% £1,715 0.5%

REGULAR DAY ATTENDARS 178 219 41 23.2% £47,391 £56,948 £9,557 20.2% 33 20.5% £7,331 17.3% 9 2.7% £2,226 2.9%

REHABILITATION POST DISCHARGE 2 0 -2 -100.0% £1,035 £0 -£1,035 -100.0% -2 -100.0% -£928 -100.0% -0 0.0% -£107 0.0%

SPECIFIC DRUG HRGS 9 14 5 57.2% £998,169 £1,026,028 £27,859 2.8% 5 61.1% £37,163 4.1% 0 -3.9% -£9,304 -1.4%

UNBUNDLED HRGS 1,317 1,321 4 0.3% £16,175 £8,415 -£7,760 -48.0% 23 1.9% -£6,949 -47.6% -19 -1.6% -£811 -0.4%

Grand Total 355,867 368,968 13,101 3.7% £18,205,265 £18,100,955 -£104,310 -0.6% 9,798 3.1% -£110,566 -0.7% 3,303 0.6% £6,256 0.1%

Acute Provider SummaryIndependent Acute Providers

Performance is for 2018/19 2018/19 Month 10 (flex)

Ramsay Horton: Based on the M10 flex position the FOT is currently £8,194,536. This represents only a slight recovery from the fall in actual spend in M09. At M10 YTD, Ramsay Horton is under-

performing by -£459k. The actual spend is approx. £6.8m against the plan of £7.2m; therefore in percentage terms, the contract is underperforming by 5.6%, whilst in M09; the underperformance

was 6.2% against the plan. Whilst knee procedures remain £238k above plan, this is more than mitigated by the underspend in shoulder procedures of £462k. Horton have asked that consideration

is given to commissioning Ophthalmology capacity from them in 19/20 and could mobilise extremely rapidly, and could also offer Gynaecology and Orthotics.

Nuffield, the Manor: The annual agreed contract value is £1,283,767 (including CQUIN). Based on the M10 flex position, the FOT is currently £735k, which is an overall under-performance of -

£457k (43%), all activity is T&O and therefore impacted by Healthshare triage. Nuffield continue to be concerned about whether they are consistently offered as a choice by Healthshare. Recent

decisions on BMI and commissioning of uni knees will reduce the number of rejected referrals.

Foscote : Based on the M10 flex position, the FOT will be £808k. There is an increasing current year to date under-performance of -£137k (-17%) at M10. Gynae activity 47% over plan is being

mitigated by activity under plan in physio and T&O. There is a transfer of ownership underway which is expected to take effect in April. First to follow up ratios are well within target.

Circle Reading: At M10 YTD Circle Reading continues its recovery and has shifted to over performance of £29.8k YTD (1.9% of plan) when compared to earlier months which saw

underperformances. The main reason for this is a decrease in the mitigation being provided by T&O specialty which has decreased the level of underperformance over the past few months, and is

currently at -£13.2k. General Surgery continues to over-spend at £33k (25%), mainly due to Hernia activity being higher than planned. Elective hernia activity in Oxford CCG overall is below plan (-

34 procedures , £57k) mainly due to significant underperformance at OUH (-£141k) so this is likely to represent shift in market share out to other providers. Pain Management specialty also over

spends by £22k (51%). Ophthalmology activity remains strong, over performing by £11k (23%), mainly for cataract surgery and Provider has recently reported they are at capacity.

Ramsay BIH: At M10 YTD Ramsay BIH is over-performing by £145k (31%) against plan which has bounced back from the smaller M09 (£108k or 25.7%). Whilst Urology activity continues to rise,

the main change in worsening the position recently was caused by a large financial shift in T&O seen in M08 caused by a relatively small number of higher cost procedures, with some reduction in

M09 but a rise again in M10. There is no sign that the introduction of Diagnostic MRI scans from Healthshare is contributing to this. Over-performances applies within Ophthalmology (£36k), Urology

(£35k), Gynaecology (£20k), Gastroenterology (£6k) and Spinal (£21k). T&O is also over-performing against plan by £28k (10.2%), mainly due to elective over performing by £32k.

Spire Dunedin: Spire Dunedin is under-performing by -£201k (35%) at M10 YTD. This is a sustained under-performance from M09 YTD, which was under plan by 35.53%.Following a very

significant drop in activity at the hospital over Christmas, this does not appear to have recovered much for M10. The main under-performing speciality is Trauma and Orthopaedics, which under-

performs by -£205k (51.2%) at M10.

22

Provider

Activity

YTD

Actuals

Cost YTD Plan Cost YTD

Actuals Cost YTD Var

Cost Forecast

Outturn

OCCG 18/19

Contract Value

inc CQUIN

Contract status

NVC25 - Horton Ramsay 15,857 £7,237,006 £6,828,780 -£408,226 £8,194,536 £8,687,407

19/20 – will be entering second year of a two year contract with optional extension.

NT244 - Nuffield, The Manor 973 £1,069,806 £612,882 -£456,924 £735,459 £1,283,767 19/20 – new 1 year contract will be issued with a 1 year optional extension

AH00 - The Foscote 1,479 £830,131 £673,055 -£157,106 £807,666 £972,474

19/20 – new 1 year contract will be issued with a 1 year optional extension

NV323 - Circle Reading

4,307 £1,599,728 £1,629,574 £29,864 £1,955,488 £1,919,674 19/20 – new 1 year contract will be issued by Coordinating Commissioner with a 1 year

optional extension

NVC02 - Ramsay Berkshire

Independent Hospital

1,756 £467,250 £612,624 £145,374 £735,149 £560,699 19/20 – new 1 year contract will be issued by Coordinating Commissioner with a 1 year

optional extension

NT344 - Spire Dunedin

Hospital

1,154 £575,927 £374,324 -£201,603 £449,189 £691,112 19/20 – new 1 year contract will be issued by Coordinating Commissioner with a 1 year

optional extension

Grand Total

£11,779,877 £10,731,239 -£1,048,639 £12,877,486 £14,112,133

Continuing Health Care

23

Oxford Health Foundation Trust

Continuing Healthcare services are provided by OHFT; demand for these services is increasing, in line with Oxfordshire’s demography.

Referrals Received for CHC Funding Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19

Acute Hospital (including hub beds) 29 44 54 40 24 51 45 37 37 32 43

Community Hospital 14 19 22 15 7 12 8 15 21 20 18

Home (GP/Family/District Nurse) 8 12 11 8 8 12 11 11 10 13 5

Hospice 1 1 2 1 2 0 1 1 1 1

Nursing Home/Care Home with Nursing 43 66 68 36 36 60 59 60 79 66 52

Retro/Other/not stated 0 3 5 4 1 3 0 2 7 1 5

Referrals Received for CHC Funding Total 95 145 162 104 78 138 124 126 154 133 124

Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19

Number Checklisted for Full Assessment 31 67 68 42 35 53 50 51 69 59 54

Not Eligible/Closed/Incomplete 64 78 94 62 43 85 74 75 85 74 70

CONTINUING HEALTHCARE (not including Interims) Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19

Nursing Home (OP) 183 176 194 206 197 209 205 206 211 216 215

Nursing Home (PD) 38 45 50 42 47 48 43 43 41 42 39

Nursing Home/Care Home (LD) 4 4 4 4 5 8 8 9 9 8 8

At Home (OP) 34 33 35 33 38 33 36 37 38 42 44

At Home (PD) 36 38 37 42 40 43 45 48 49 50 47

At Home/Not Known (LD) 21 21 21 22 22 21 22 22 22 23 26

Nursing Home/Care Home (OP) - LD 0 0 0 0 0 0 0 0 0 0 2

Continuing Care Caseload Total 316 317 341 349 349 362 359 365 370 381 381

Other ServicesMusculoskeletal (MSK) Assessment Triage and Treat (MATT) – Provider Healthshare

Self referral to the service has been available from 8 February 2019. So far, the pattern of demand has been within expectations. There are plans to expand services to Wantage from June.

This service received an average of 5,102 referrals per month during this financial year. Significant service development and improvement in activities has been successful in reducing wait list numbers.

Key KPI trajectories: Urgent waits to be compliant (95% seen within 7 operational days) from 1st February 19 onwards. Jan: 42.5%, up from 14% in December

Routine to be compliant (95% within 30 operational days) by end July 19.

Data from Healthshare, (Feb 19). The longest wait for a routine appointment is currently 28 weeks. If patients are able to travel, they can be seen in 8 weeks for a routine 1st appointment

90.4% of referrals were triaged within 48hours of receipt.

89.6% of patients demonstrated a positive improvement in at least one of their outcome measures.

InHealth Endoscopy

In January 2019, InHealth received 608 new referrals. The service provided 99 endoscopy session in January 2019, seeing 612 patients across Witney and Bicester. Referral numbers continue to

grow. If this continues the service will reach capacity by September 2019, at 117 sessions per month, which would accommodate 777 patients per month.

2ww performance remains the priority focus for the service.

24

52 week waits

25

Referral to treatment pathways January 18 to January 19

26

Referral to treatment pathways (Jan 18 to Jan 19)OCCG main providers

27

Data Quality and Concerns

Data Quality and Concerns

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Data quality is evaluated across Accuracy, Validity, Reliability, timeliness, Relevance and Completeness. (Source: Audit Commission)

All dimensions are equally important

Validity

Reliability

Timeliness

Relevance

Completeness

Data quality tends to be highest where scrutiny has been intense and the dataset is nationally mandated and long established.

Providers traditionally working within costs and volume contracts tend to have higher data quality

Accuracy Validity Reliabil ity Timeliness Relevance Completeness

Very High

High

Medium

Low

Very low

Unknown N/A

4. Activity Sources 5. Performance Indicators 6. Activity 7. Performance Indicators1. UNIFY 2

2. Service Level Agreement

Monitoring (SLAM)

3. Secondary User Service

(SUS)

Other Nationally Mandated Other Local Sources

Children and Adolescent Mental Health

Oxford University Hospitals FT

Royal Berkshire FT

Independent Sector Acute Providers

Ambulance Service

Community Services

Adult Mental Health

Learning Disabil ities

Data should be sufficiently accurate for its intended purpose. It should be captured only once (COUNT - Collect Once and Use Numerous Times) and accuracy is most likely achieved if it is

captured as close to the point of activity as possible. Automated capture as part of routine clinical care is usually more accurate and always more consistent than manually capturing and Accuracy

Data should only be used in compliance with relevant requirements including the correct application of rules or definitions

Data should reflect stable and consistent data collection processes over time

Data should be captured as quickly as possible after the event and should be made available to support information needs and influence service or management decisions

Data should be clearly specified based on the information needs of the users. All specified data items should be populated with accurate, valid, reliable, timely and relevant data.

Data capture should be relevant to the purpose for which they are used

Cumulative