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AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
GOVERNING BODY MEETING:
Governing Body Meeting
DATE OF MEETING:
10
th January 2018
REPORT AUTHOR AND JOB TITLE:
Pam Broadhead Chief Performance Officer
REPORT TITLE:
Performance Report regarding the Improvement and Assessment Framework
STRATEGIC OBJECTIVES:
Please tick which strategic objectives the paper relates to
Improve quality of services
Sustained financial balance
Build an effective and motivated whole system workforce
Sound governance arrangements
Ensure integration and joint working arrangements
OUTCOME REQUIRED (tick)
Approval
Assurance
Discussion
Information
EXECUTIVE SUMMARY
The CCG Improvement and Assessment Framework (IAF) has now been updated for the financial year 2017/18. The updated framework builds on the IAF introduced in April 2016 which was designed to assist improvement, alongside the statutory duty of NHS England to complete an annual assessment of all CCGs. This report to the January 2018 governing body meeting
1. Outlines the areas in exception for the Improvement and Assessment Framework for CCGs (the framework that aligns key objectives and priorities and forms the basis of the NHS England assessment of CCGs) and
2. Provides an update against other performance indicators identified as key lines of enquiry at the NHS England performance meeting in October 2017.
3. Details the performance for NHS Warrington CCG and other CCGs in Cheshire for the current month against NHS Constitution indicators.
RECOMMENDATIONS
Report for information and assurance only
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
Outline any engagement – staff, clinical, stakeholder and patient / public
Not applicable
Are there any conflicts of interest which may be associated with this paper?
None known
Does this paper address any existing risks which are included on the Assurance Framework or Risk Register?
A1 - Failure to performance manage to ensure continuous improvement A2- Failure to agree and measure outcomes
Have the following areas been considered whilst producing this report?
Yes
N/A
Equality Impact Assessment (if yes, attach to paper)
Quality Impact Assessment (if yes, attach to paper)
Regulation, legal, governance and assurance implications (reference in the report if applicable)
Procurement process (reference in the report if applicable)
Document development
Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation
Not applicable
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
Strategic Objectives and Risks 2017/18
A1 Failure to performance manage to ensure continuous improvement
A2 Failure to agree and measure outcomes
A3 Failure to ensure clear arrangements are in place for quality management of non-commissioned providers in the independent sector
B1 Failure to implement the financial strategy
B2 Failure to ensure sound business practices are at the heart of running the CCG
B3 Failure to secure best value
B4 Failure to adequately provide for external factors, which impact on financial sustainability
C1 Failure to continuously develop the organisational culture that meets the needs of the changing needs of the workforce
C2 Failure of delivery by outsourced critical business functions
C3 Failure to establish primary care capacity
D1 Failure to ensure that we are compliant with our statutory duties
D2 Failure to demonstrate patient and public engagement
E1 Failure to provide appropriate reporting, for joint working arrangements
E2 Failure to describe benefit of integration and joint working arrangements to local people
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
Improvement and Assessment Framework (IAF)
1. The CCG Improvement and Assessment Framework (IAF) has now
been updated for 2017/18. The updated framework builds on the IAF
introduced in April 2016 which was designed to assist improvement,
alongside the statutory duty of NHS England to complete an annual
assessment of all CCGs.
2. The framework is intended as a focal point for joint work and support
between NHS England and CCGs. It draws together the NHS
Constitution, performance and finance metrics and transformational
challenges and plays an important part in the delivery of the Five Year
Forward View.
3. Appendix A shows the IAF overview dashboard from NHS England.
The report that follows provides a summary of the areas of the IAF that
are showing good or improved performance, those where performance
is challenged and the actions in place to improve and also a summary
of the new indicators included on the framework for the first time.
IAF Indicators with Good/Improved Performance
4. 105b - Number of personal health budgets in place per 100,000 CCG
population – A personal health budget is an amount of money to
support a person's identified health and wellbeing needs, planned and
agreed between the person and their local NHS team. The 2016-17 to
2020-21 Planning Guidance specifically committed to increasing the
number of personal health budgets and NHS Warrington CCG is
currently the 20th out of 209 CCGs in England for the number Personal
Health Budgets in place.
5. To date in 2017/18 162 people in Warrington have a Personal Health
Budget (PHB) in place which exceeds the plan for the whole year. Of
those with a PHB for the end of life care none of the patients designed
their care similar to the traditional offer; 100% of fast track end of life
PHBs were cost neutral or at reduced cost compared to traditional offer
and 83% of end of life patients died in their preferred place on a PHB
compared to around 62% with a traditionally commissioned package.
6. NHS Warrington CCG is one of 16 PHB Champion sites picked by NHS
England due to the excellent outcomes and was awarded the
‘Compassionate Patient Care’ award at the Health Service Journal
Awards for work in improving patient choice and control through PHBs.
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
7. In future the Warrington team is looking to expand into section 117
aftercare (for people who have been in hospital under section 3, 37,
45A, 47 or 48 of the Mental Health Act 1983) ahead of NHS England’s
plan to widen mandate for PHBs.
8. 107a and 107b - Antimicrobial Resistance - Within the IAF there are
two indicators related to encouraging the appropriate prescribing of
antibiotics in primary care to delay the development of antimicrobial
resistance and the associated patient harm from infections that are
more difficult to treat. For both indicators NHS Warrington CCG has
seen consistent reduction in the rate of prescribing as the framework
guidance requires. For appropriate prescribing NHS Warrington CCG
is 4th lowest prescriber in Cheshire and Merseyside.
9. 122c - One-year Cancer Survival – this indicator shows the proportion
of adults diagnosed with any type of cancer in a year who are still alive
one year after diagnosis. NHS Warrington CCG has one of the most
improved cancer survival rates nationally on latest data (comparing
2013 to 2014) and the 4th highest survival rate in Cheshire and
Merseyside. The improvement was recognised at the All-Party
Parliamentary Group on Cancer in July 2017.
10. It should also be noted that there has been improvement in the
proportion of cancers diagnosed at an early stage. In 2014 NHS
Warrington CCG was 11th out of 12 CCGs in Cheshire and Merseyside.
In 2015 NHS Warrington CCG improved to 7th in the region with an
increase of over five percentage points.
11. 128b - Patient Experience of GP Services – This performance indicator
shows the percentage of people who report through the GP Patient
Survey that their overall experience of GP services was ‘fairly good’ or
‘very good’. On the 2016 survey NHS Warrington CCG was in lowest
quartile nationally however the rate of satisfaction increased by over
four percentage points on the 2017 results and now 7th out of 12 in
Cheshire and Merseyside.
12. 129a - Referral to Treatment - In August 2017 NHS Warrington CCG
had the 2nd highest proportion of people on an incomplete pathway
being within 18 weeks within Cheshire and Merseyside. Performance
has been consistently over the 92% requirement.
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
IAF Indicators with Poor/Deteriorating Performance
13. 103a - Diabetes education attendance – NHS Warrington CCG is the
lowest of 12 CCGs in Cheshire and Merseyside for the proportion of
newly diagnosed diabetics attending a structured education course (for
diabetics diagnosed in 2014). This indicator is reported low due to lack
of confirmation of attendance at education programmes in the reporting
period. From April 2016 the provider of the education service was
requested to confirm attendance with the patient’s GP and has reported
that this information was sent to practices.
14. In 2017 the education programme in Warrington has been relaunched
with the number of courses being more than doubled and more
conveniently located. The service has informed the CCG that they are
currently working through a waiting list of diabetics to invite to the
education service and the uptake from this cohort has been quite low.
The uptake from those who have been recently diagnosed is however
reportedly much better.
15. 104a - Injuries from falls in people aged 65+ - NHS Warrington CCG is
in the lowest quartile nationally for emergency admissions to hospital
due to falls in people aged 65+ on the latest data (Q4 16/17). For the
12 months to July 2017 the activity for falls admissions has been fairly
static and is not showing a consistent reduction.
16. There has been a redesign and update of the existing Falls Strategy,
led by Warrington Borough Council. The Falls Strategy Group has
been re-launched and actions to improve the incidence of falls
identified and assigned to appropriate leads. Care homes with “no lift”
policies are currently being identified and reviewed as these can lead to
increased calls to North West Ambulance Service (NWAS) and
potentially onward conveyance to hospital. Lifting equipment is being
trialled in a Warrington care home for potential roll out if found to be
beneficial. NWAS is also using an algorithm in six care homes in
Warrington to try to avoid calling 999 for falls when possible. A project
is progressing with clinical pharmacists and general practice to identify
patients most at risk of falling to have a medication review and agree a
care plan to help prevent falls, injury and admission.
17. 122b - Cancer waiting times – 62 day from referral to treatment – NHS
Warrington CCG is rated as being in the lowest quartile for 62 day
waiting times from referral to first definitive treatment for people with
diagnosed cancer on the NHS England dashboard based on the data
from quarter four 2016/17. The Governing Body should note that in the
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
latest cancer waiting times data (October 2017) the required target of
85% was achieved by both Warrington & Halton Hospitals NHS
Foundation Trust and NHS Warrington CCG. Warrington & Halton
Hospitals NHS Foundation Trust has improved cancer waiting times
performance as a whole in the last few months due to improvements in
tracking and escalation processes. There remain issues in some
tumour sites and internal meetings with Cancer Nurse Specialists,
Consultants and RTT Business Manager in the challenged areas to
review and improve processes. Warrington & Halton Hospitals NHS
Foundation Trust has recruited a new Lead Cancer Nurse (start date
probably March 2018) and will soon begin the process to recruit a new
Cancer Data Manager.
18. 122d - Cancer patient experience – This indicator is presented as a
score from 1-10. In the 2015 survey the CCG score was the same as
the national average (8.7) but this has decreased to 8.6 and is now in
the lowest quartile nationally. NHS Warrington CCG supported
Warrington & Halton Hospitals NHS Foundation Trust in instigating a
series of workshops for Cancer Nurse Specialists. At the September
workshop, Warrington & Halton Hospitals NHS Foundation Trust
reviewed the results and addressed the areas where improvements
can be made. An action plan has been developed and the CCG has
requested an update on the progress against this plan.
19. 125a and 125b - Choice in maternity services and experience of
maternity services – From the 2015 survey NHS Warrington CCG was
11th out of 12 CCGs in Cheshire and Merseyside for both indicators.
The 2016 survey has been completed and is expected to be published
in January 2018. NHS Warrington CCG has created a patient
information leaflet regarding choice in maternity services, which is now
routinely available.
20. 127b and 106a - Emergency admissions for urgent care sensitive
conditions / inequality of unplanned hospitalisation for ACS/UCS
(ambulatory care sensitive/urgent care sensitive) conditions - NHS
Warrington CCG is 10th out of 12 for the inequality measure and 8th
out of 12 for UCS admissions within Cheshire and Merseyside. A
significant proportion of the activity within this category is also within
the definition of Ambulatory Emergency Care (AEC) and therefore an
increase in admissions from April 16 not unexpected following the
implementation of the AEC pathway at Warrington & Halton Hospitals
NHS Foundation Trust. The AEC pathway includes a short admission
to hospital (less than 24 hours) as part of the appropriate management
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
of certain conditions. This has been evidenced by the increased
proportion in zero length of stay activity within this patient cohort.
21. Internally NHS Warrington CCG has recently implemented a small
working group to identify any themes or trends in the admissions for the
conditions within these cohorts to identify actions which may impact on
the rate of emergency admission.
22. 127f - Population use of hospital beds following emergency admissions
– There has been a focus on the same day treatment model for urgent
care at Warrington & Halton Hospitals NHS Foundation Trust, aiming to
reduce the rate of emergency admissions. “Discharge to assess” and
“red and green” bed days methodologies have also been employed to
reduce emergency bed days. Between April and September 2017 the
total length of stay associated with emergency admissions at
Warrington & Halton Hospitals NHS Foundation Trust for NHS
Warrington CCG patients was lower than in the corresponding period in
the previous year by approximately 2% (local data extraction from
Secondary Uses Services (SUS)). This corresponds with an increased
proportion of zero length of stay admissions, in line with the same day
treatment model that has been adopted.
23. 164a - Effectiveness of working relationships in the local system - This
indicator is taken from the stakeholder 360 survey. An average score
from 0-100 is calculated for each CCG from all respondents. In
2015/16 the score was 64. In 2016/17 this reduced by 1.8 points to
62.5. The average change in score across all Cheshire and
Merseyside CCGs was a reduction of 2.2 points. There are actions in
place with primary care colleagues to support working relationships,
such as supporting Federation Leads and facilitating more effective
dialogue across the four federations regarding commissioning business
and Primary Care Service Development Managers are in post to
support the development of the Primary Care Clusters and the Local
Enhanced Service delivering the Warrington Brand.
New IAF Indicators
24. The indicators below are included in the framework for the first time. The requirements for each of the new measures will be confirmed to appropriate leads internally.
25. 123b – IAPT access - This indicator is included within the framework
for the first time but has always been included on internal monitoring
reports. The CCG performance in quarter two was below requirement.
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
A workshop was held on 29th November with stakeholders to identify
ways in which access could be increased. The NHS England
dashboard contains performance from July 2017 but it should be noted
that the activity in November has increased.
26. 124c – Completeness of the GP learning disability register - This
indicator is intended to improve the coverage of GP learning disability
registers. This indicator will be measured annually from QOF but more
frequent local reporting should be possible to indicate the direction of
travel.
27. 131a – Percentage of NHS CHC full assessments taking place in an
acute hospital setting - For the Quality Premium there is a requirement
that more than 80% of all full NHS Continuing Healthcare assessments
are completed within 28 days and less than 15% of full NHS Continuing
Healthcare assessments take place in an acute hospital setting. The
latter of these indicators is now also included within the IAF. NHS
Warrington CCG has seen a notable reduction to 5% of assessments
taking place in an acute hospital setting in quarter two from 10% in
quarter one. It should be noted that the NHS England dashboard
(Appendix A) suggests that NHS Warrington CCG performance against
this indicator is in the lowest quartile. However this assertion has been
queried by NHS Warrington CCG as it appears that the rating of this
indicator has been done the wrong way around (low performance =
good performance but the dashboard seems to have inverted this).
28. 132a – Evidence that sepsis awareness raising amongst healthcare
professionals has been prioritised by the CCG - Evidence for this
indicator will be provided via an annual self-certification (towards the
end of the financial year) to be signed by the Accountable Officer and
Audit Chair. The requirements for this indicator include confirmation
that sepsis awareness raising and education on the use of National
Early Warning Score (NEWS) is included in the commissioning
priorities of the CCG and is included (or there is evidence of a planned
commitment to include) in service specifications and in any local
incentive schemes funded by the CCG, confirmation that Health
Education England resources around sepsis are referenced and used
and confirmation of the number of GP practices that have a sepsis lead
/ link. The requirements have been internally circulated within the CCG
to enable a baseline assessment to be conducted.
29. 166a – Compliance with statutory guidance on patient and public
participation in commissioning health and social care - This indicator
aims to evidence the implementation of the revised statutory guidance
AGENDA ITEM NO: 004/18
Performance Report NHS Warrington CCG Governing Body Meeting 10
th January 2018
on patient and public participation in commissioning and fulfilling
statutory guidance. CCGs will be assessed based on the Annual
Report (16/17), and publically available information (Governing Body
papers, involvement webpages, engagement plan etc.). NHS England
undertook a desktop review in June 2017 of CCG’s work to engage
with the people and communities.
30. The NHS Warrington CCG assessment against the five domains within
the patient and community engagement indicator from the desk top
review is below:
31. The CCG is in the process of submitting evidence for further review
and assessment as it is felt that the assessment is not a true reflection
of patient and community engagement. The CCG’s Engagement,
Experience and Communications Strategy 2015-2018 and Duty to
Involve Engagement Report 2016-17 highlights a diverse range of
engagement activities within geographical areas, ‘hard to reach’
communities and communities protected under the Equality Act 2010.
The CCG had also implemented Equality Delivery Systems 2, with best
practice highlighting engagement with carers and people with learning
disabilities. It is believed that this supports the current assessment (as
outlined above).
32. The CCG has recognised the need to increase evidence of good
practice in patient and community engagement and is in the process of
reviewing the website in this respect. This review will also include
taking steps to ensure the various engagement methods and
approaches are clearly reported.
Pam Broadhead Chief Performance Officer 21st December 2017
Domain Rating and Grade
A. Governance 3 Outstanding
B. Annual Reporting 2 Good
C. Practice 2 Good
D. Feedback and evaluation 1 Requires improvement
E. Equality and health inequalities 1 Requires improvement
CCG Summary Dashboard
NHS Warrington CCG
Better Health Period CCG Peers England Trend Better Care Period CCG Peers England Trend
R 102a % 10-11 classified overweight /obese2013/14 to
2015/1631.5% 4/11 75/207 R 121a High quality care - acute 17-18 Q1 63 4/11 43/207
103a Diabetes patients who achieved NICE targets2015-16 40.6% 6/11 69/207 R 121b High quality care - primary care 17-18 Q1 65 7/11 120/207
103b Attendance of structured education course2014 0.0% 11/11 205/207 R 121c High quality care - adult social care17-18 Q1 64 4/11 28/207
R 104a Injuries from falls in people 65yrs +16-17 Q4 3,051 11/11 206/207 122a Cancers diagnosed at early stage2015 51.0% 6/11 131/207
R 105b Personal health budgets 17-18 Q1 69 2/11 20/207 122b Cancer 62 days of referral to treatment16-17 Q4 76.4% 9/11 161/207
R 106a Inequality Chronic - ACS & UCSCs16-17 Q4 3,826 11/11 202/207 122c One-year survival from all cancers2014 71.3% 2/11 46/207
R 107a AMR: appropriate prescribing 2017 06 1.072 2/11 106/207 R 122d Cancer patient experience 2016 8.6 10/11 177/207
R 107b AMR: Broad spectrum prescribing2017 06 8.3% 7/11 82/207 R 123a IAPT recovery rate 2017 06 51.7% 6/11 99/207
108a Quality of life of carers (not available) R 123b IAPT Access 2017 07 2.8% 8/11 106/207
Sustainability Period CCG Peers England Trend R 123c EIP 2 week referral 2017 08 84.9% 5/11 54/207
R 141b In-year financial performance 17-18 Q1 Green #N/A #N/A 123d MH - CYP mental health (not available)
R 144a Utilisation of the NHS e-referral service2017 06 63.1% 8/11 75/207 123f MH - OAP (not available)
Leadership Period CCG Peers England Trend 123e MH - Crisis care and liaison (not available)
R 162a Probity and corporate governance17-18 Q1 Fully Compliant #N/A #N/A R 124a LD - reliance on specialist IP care17-18 Q1 66 5/11 141/207
163a Staff engagement index 2016 3.74 7/11 154/207 124b LD - annual health check 2015-16 36.4% 9/11 113/207
163b Progress against WRES 2016 0.07 3/11 19/207 124c Completeness of the GP learning disability register (not available)
164a Working relationship effectiveness16-17 62.50 8/11 165/207 R 125d Maternal smoking at delivery 17-18 Q1 7.4% 1/11 60/207
166a CCG compliance with standards of public and patient participation (not available) 125a Neonatal mortality and stillbirths2015 3.8 6/11 57/207
R 165a Quality of CCG leadership 17-18 Q1 Green #N/A #N/A 125b Experience of maternity services2015 75.2 11/11 186/207
Key 125c Choices in maternity services 2015 61.1 10/11 182/207
Worst quartile in England R 126a Dementia diagnosis rate 2017 08 71.9% 7/11 71/207
Best quartile in England 126b Dementia post diagnostic support2015-16 78.0% 9/11 131/207
Interquartile range R 127b Emergency admissions for UCS conditions16-17 Q4 3,444 11/11 195/207
R 127c A&E admission, transfer, discharge within 4 hours2017 09 91.2% 5/11 59/207
R 127e Delayed transfers of care per 100,000 population2017 08 12.9 6/11 120/207
R 127f Hospital bed use following emerg admission16-17 Q4 621.9 10/11 203/207
105c % of deaths with 3+ emergency admissions in last three months of life (not available)
R 128b Patient experience of GP services2017 86.3% 5/11 77/207
128c Primary care access (not available)
R 128d Primary care workforce 2017 03 0.93 6/11 144/207
R 129a 18 week RTT 2017 08 93.6% 4/11 17/207
130a 7 DS - achievement of standards (not available)
Requires Improvement
Note: There is no data for NHS Manchester CCG (14L) for the following indictors: 121a, 121b, 121c, 122c, 122d, 124a, 125b, 125c, 126b,
130a, 141b, 163a, 163b, 164a & 165a
2016/17 Year End Rating:
Agenda Item 004/18 Performance Report - Appendix 1
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