croydon ccg integrated report body...2013/09/24 · this is being challenged and is subject to the...

Croydon CCG Integrated Report A Consolidated View of Croydon CCG’s Contracting

Performance

August 2013

Contract Lead – Michelle Rahman

MDT Lead – Carmel Harrington

Croydon CCG Integrated Report

A Consolidated View of Croydon CCG’s

Contracting Performance August 2013

Contract Lead – Michelle Rahman

MDT Lead – Carmel Harrington

2

Introduction

Purpose

The purpose of this report is to provide a comprehensive understanding of the CCG’s contracting performance position. The report is

designed to cover the following key areas:

Contract financial performance against plan – identifying under/overspends and the key drivers behind these using finance

adjusted SLAM data

Performance against key national indicators – (e.g. on A&E access, RTT access, Cancer waits, Ambulance handover,

Diagnostic Waits, Mixed Sex Accommodation and Healthcare Associated Infections)

Activity and cost provider analysis – analysing the drivers behind over performance and monitoring key trends at a

POD level

Quality – CQUINs progress 2013/14,

Context

South London CSU provides Contract Management services on behalf of Croydon CCG. This involves a range of activities including

supporting the annual negotiation process, monthly and financial performance and activity monitoring, and the query and claims

management process.

Data Sources

Financial and activity data for contract monitoring is primarily taken from provider SLAMs, with adjustments to account for

challenges, performance KPIs, and other contractual adjustments

Activity Data for benchmarking and trend analysis is primarily taken from SUS

Performance data is taken from relevant national websites (e.g. Unify2, Open Exeter, HPA HCAI database)

3

Version Control Sheet

Version Date Status Comments Approved to issue by

(on behalf of CSU)

Approved

(on behalf of CCG)

1 17 August Initial review with Head of

MDT

Peter Edward requested summaries by 19 August

2 19 August Version 4 Send to CCG performance lead in draft Michelle Rahman

3 20 August Version 4 Issue final draft Peter Edward

4

Content

Slide

Introduction 2

Version Control Sheet 3

Contents 4

Executive summary 5

CCG Executive summary 6

Provider – Executive summary 7

A. Contract finance monitoring 8

F1. CCG Financial Summary for Provider

Contracts

9 &

10

F2. Bridging Analysis: SLAM to Reported

Position 11

F3. Overview by point of Delivery 12

F4a. Croydon Health Services 13

F5a. St. Georges 14

F6a. King’s College Hospital 15

F7a. Epson & St. Helier University Hospital 16

F8a. Royal Marsden 17

F 9a. Financial Summary of Other Acute

Contracts and GUM 18

F9b. Financial Summary of Other Acute

Contracts and GUM

19

Contents

Content

Slide

F10. Claims 20

B: Demand and activity trend analysis 21

A1. Activity Notes 22

A1. Activity (Demand) Summary 23

A2a Referral by Referral Source at CHS 24

A2b. First Attendances by Referral Source 25

A3. First Outpatient Activity 26

A4. Outpatient Breakdown 27

A5a. A&E Activity – All Providers 28

A5b. A&E Activity – Virgin and CHS 29

A5c. A&E Activity – Main Providers Split 30

A6a Emergency Admissions, All Providers 31

A6b. Elective Admissions, All Providers 32

A6c. Delivery Admissions, All Providers 33

A7a. Activity by HRG – Elective 34

A7b. Activity by HRG – Emergency 35

C. Performance 36

P1. Performance Summary 37 &

38

Content

Slide

P2a. CCG Acute Performance Scorecard 39

P2b. CCG Acute Performance Scorecard 40

P3a. Provider Performance Scorecard 41

P3b. Provider Performance Scorecard 42

P4. Performance Penalties 43

C1. Community Performance 44

C1a. Community: CHS NHS Trust Thomas’ 45

C1b. To C1c. Community Dashboard 46-47

C1d. Performance Dashboard 48

C1e. Contacts Dashboard 49-50

C1f. Referrals Dashboard 51

C2. Non –Acute Contracts 52

C2a. Non –Acute Contracts 53

C2b. Performance Dashboard: Intermediate

Services

54-

55

C2c. Quality report Dashboard: Intermediate

Services 56

C2d. Performance Dashboard: Local

Enhanced Services (LESs)

57-

58

D. Quality 59

2013/14 CQUIN Schemes 60-

62

CCG Quality dashboard 63-

64

User Guide 65

Executive Summary NHS Croydon CCG – Activity Month 2 2013

CCG Executive Summary Provider Executive Summary

Executive Summary NHS Croydon CCG – Activity Month 2 2013

CCG Executive Summary Provider Executive Summary

6

CCG Executive Summary

Demand & Activity A&E activity across all providers excluding Virgin Care is at a similar level as the same period for 2012/13 with the exception of Kings

College Hospital which is showing an increase of 12.6% compared with the same period in 2012/13. Virgin Care activity has

decreased by 871 attendances compared with the same period for 2012/13 (26%). This drop in performance is being handled with

Virgin Care to increase the level of UCC performance. GP referrals have increased compared with the same period 2012/13.

Internally generated referrals from A&E across all providers has increased by 22%. Elective activity has increased across all providers

mainly at Kings and Epsom and St Helier compared to 2012/13.

Performance- Key Issues MRSA actuals for Croydon CCG is currently 4 against a 0 target and C-Diff 11 against a CCG target of 12. 18 weeks RTT at aggregate

level for CHS has been achieved however there were three 52 week breaches against a 0 target at month 3. A report is being

prepared to provide a more in-depth scrutiny of performance issues impacting on Croydon CCG including the actions that have been

taken to achieve improvement. CHS submitted a letter describing actions taken for areas where 0 tolerance breaches have occurred.

This area continues to be under scrutiny. The consequence for breaches has been levied in line with the NHS Contract.

RAG

Status

Finance The year to date performance is showing an over performance of £2,196k against a contract plan of £57,993k (3.7%). This is stated

after an adjustment of £1,062k as a conservative view of KPIs and challenges YTD. Challenges include NHSE activity attributed to the

CCG and challenges related to counting coding and incorrect application of new currencies for maternity and unbundled diagnostics.

These areas have been challenged across all South London Trusts and out of area Trusts where over performance is not understood.

Quality There were 27 serious incidents, 0 never events for the month with 1 never event YTD.

The quality dashboard has been included for M3 but requires additional work to ensure it meets the needs of the CCG.

A template has been included to support the reporting of CQUIN achievements. This has not been populated as the assessment

process is not yet complete. CHS CQUIN achievement will be issued for month 4 reporting

* RAG is based on the level of risk e.g red requires immediate action, amber requires action within the monthly

contractual time table, green requires monthly review

7

Provider Executive Summary

Croydon Health Services (CHS)

CHS accounts for 33.6% of the over performance seen. Over performance against plan has increased by 2%

at M3 taking into account adjustments made for challenges and contractual KPIs. It is to be noted that

progress YTD on QIPP has been slower than planned. It is expected that the impact of QIPP will be realised

as projects progress. The trust is expected to achieve the 18 week RTT commitment for Q2 across all

specialties. Q1 CQUIN evidence of achievement has been submitted and is being assessed.

Kings College Hospital (KCH)

KCH accounts for 23% of the over performance seen across the acute contracts portfolio for Croydon CCG.

Non elective/emergency activity accounts for £288k with £199k of elective activity. NHSE activity has been

challenged and a meeting has been scheduled with the Head of SEL multi disciplinary team to expedite

challenges on behalf of Croydon CCG. A challenge letter has been issued to the trust.

Guys and St Thomas’s (GSST)

GSST accounts for 14% of the over performance and is 5.2% above contracted plan for month 3. This

reflects an improvement of c£104k compared to month 2. Activity continues to include NHSE commissioned

activity. This has been challenged and will be rectified as part of the in-year reconciliation process.

St Georges Hospital

SGH accounts for 9.6% of the over performance and is 5.3% above planned values. This continues to be

due to low volume high cost emergency activity. The value of activity is indicative of specialist services and

has been challenged. The trust has breached MRSA and C-diff targets. There has been sufficient scrutiny by

the host commissioner and infection control leads to assure implementation of the infection control action

plan.

Fin

an

ce

Pe

rfo

rma

nce

Dem

an

d

Qu

ali

ty

Fin

an

ce

Pe

rfo

rma

nce

Dem

an

d

Qu

ali

ty

Fin

an

ce

Pe

rfo

rma

nce

Dem

an

d

Qu

ali

ty

Fin

an

ce

Pe

rfo

rma

nce

Dem

an

d

Qu

ali

ty

RAG

Status

A: Contract Finance Monitoring NHS Croydon CCG – Activity Month 3

F1.CCG Financial summary for provider contracts F6a4. Epsom & St Helier

F2. Bridging Analysis: SLAM to Reported Position F6a5. Royal Marsden

F4. Overview by Point of Delivery F9a. Financial Summary of Other Acute Contracts

F6a1. Croydon health Services F9b. Financial Summary GUM

F6a2. St George’s F10. Claims

F6a3. King’s College Hospital

9

F1. CCG Financial Summary for Provider Contracts

Section A – Finance: CCG Financial Summary

Headline Commentary

Month 3 and Forecast Outturn Assumptions

Year to date (YTD) information is based on CSU adjusted month 3 contract monitoring reports received from providers where these were available – where unavailable the YTD position is based on

the latest available information e.g. month 2 pro-rata , this is the case for Bart’s & the London.

Forecast outturn (FOT) is based on a likely case year-end assessment and is profiled as an equal twelfth with growth where this has been commissioned. The contract held with Croydon Health

Services is profiled for seasonality with the application of growth. Adjustments have been made to the forecasts to reflect probable NHSE entries that are part of the challenges and have been

prudently reflected in the actual YTD results.

Robustness of month 3 information

The CSU has made some adjustments to the month 3 YTD figures to reflect known reporting issues however the resulting figures should be treated with some caution as a number of major risks

and potential inaccuracies remain. These are summarised below:

• Impact of responsible commissioner changes – further work is underway to ensure the accurate application of IR rules and their consistency with final agreed contract plans

• To accurately split critical care across NHSE and CCG commissioners and to ensure an agreed apportionment of uncoded activity for future months. Critical care and uncoded activity is

currently defaulting to CCG contracts.

The month 3 position shows variances against plan for the Maternity care pathway tariffs at each provider. The CSU will review maternity activity for each provider impacting on Croydon CCG to

ensure correct application of the maternity pathway in order to reduce the potential for double charging.

• Checking the application of PbR rules for women who begun their maternity care under the rules of the 2012/13 tariff,.

• To confirm that each patient only has one maternity pathway recorded, even when they have attended multiple Providers

Information Governance rules – new IG rules that came in to place for 2013/14 has hampered our ability to validate activity earlier in the year. For month 3 claims – both data challenges and

queries – agreement has been reached with the CCG’s main providers to ensure data challenges are managed through the Q1 reconciliation process.

QIPP – Targets have been agreed with Croydon Health Services to reflect the CCG’s demand management projects. The Trust is reporting activity in the SLAM to reflect the impact of schemes,

there has been little impact at month 3. It is expected that this position will improve as demand management schemes progress.

NHSE transfer risks

Some NHSE transferred activity is still appearing in the CCG SLAMs. This is being challenged and is subject to the in-year reconciliation process. A Q1 reconciliation process will be carried out to

support the accurate reporting of CCG and NHSE activity over 2013/14.

Basis of 2013/14 contracts

The contracts provide an important context to the assessment of in year performance against plan. The 2013/14 acute contracts have been set on the basis of the following assumptions:

• 2012/13 forecast outturn, including an assessment for seasonality, noting contract baselines were set prior to final outturn being available, so there will be a mismatch between final outturn and

start year plan.

• Adjustments to reflect new commissioning landscape – NHSE prescribed services activity and funding transferred from CCG contracts in line with validated provider assessments of the transfer

value, NHSE non prescribed services and GUM transferred to NHSE and Local Authorities.

• Downwards adjustments to reflect CCG commissioning intentions and QIPP plans.

10

F1. CCG Financial Summary for Provider Contracts

Section A – Finance: CCG Financial Summary

Fig 1. Overview (£000, %) (Over)/under Spend Headline Commentary

Context

Contract plan: set on the basis of :

2012/13 Forecast outturn adjusted at Croydon and St Georges Hospitals for QIPP

assumptions.

NHSE/LA transfers were requested to be removed from final proposals as part of the

agreement to proposals. This was not achieved by a number of Trusts.

Volume growth/RTT – Croydon CCG commissioned growth at Croydon Hospital

profiled to reflect 18 weeks demand.

GUM activity at Croydon Health Services is commissioned by the London Borough of

Croydon and all other GUM activity is commissioned by Croydon CCG under the

terms of a collaborative agreement. This arrangement is for 1 year only.

Year to Date (YTD) and Forecast Outturn (FOT) performance

Acute contract performance year to date is over performing at a value of £2,196K

This reflects a 3.8% over-performance against the contracted plan at month 3.

The forecast outturn projection is currently reflecting an over performance of £4,852K. It is

to be noted that this is a straight line projection, adjusted to reflect the expected impact of

NHSE charges included in the actual data, but does not account for incorrect profiling of

plans, application of all contractual KPIs or challenges.

It is too early in the contracting year to draw conclusions from SLAM reports with the

exception of NHSE activity that has been incorrectly charged to CCGs. The contracting

team have raised challenges across all contracts where over performance is not

understood.

Issues

NHSE transferred activity has been charged for throughout the SLAMs

Potential coding and counting changes in outpatients with procedures

Poor productivity in relation to excess beddays

Excessive follow up.

Implementation of the new maternity pathway where correct application of PbR is not

validated.

Implementation of the unbundled diagnostic tariff .

Provider performance

Croydon Hospital: £738K over plan (1.9%); check for counting and coding changes;

unagreed service developments and impact of AQP activity.

St George’s: £211K over plan (5.4%); check NHSE transfers

King’s: £518K over plan (21.6%) mainly critical care and obstetrics; challenge NHSE

transfers and maternity pathway.

Guys Hospital : £311K over plan (21.1%) challenge NHSE transfers

South London Hospital: £325K over plan (19.3%); Emergency and Non Elective spells

case mix. Apply month 3 12/13 outturn and challenge remaining over-performance.

Fig 2. Forecast Outturn (£000) – Likely, Best and Worst Case

£'000 £'000 £'000 £'000 £'000 £'000 %

Croydon Health Services 151,535 37,884 38,621 (738) (983) (2,025) (1)%

St George's 15,652 3,913 4,124 (211) (282) (120) (1)%

King's College 9,589 2,397 2,916 (518) (691) (1,305) (14)%

Epsom & St Helier (Acute & Renal) 7,805 1,951 1,983 (32) (42) 10 0%

Royal Marsden 4,134 1,033 796 238 317 1,227 30%

Other acute contracts 43,255 10,814 11,749 (935) (1,247) (2,639) (6)%

CONTRACTED ACUTE SLAs 231,970 57,993 60,189 (2,196) (2,928) (4,852) (2)%

Cost Per Case and Exclusions to

Contracts

Other earmarked acute budgets

2013/14 Commissioning Reserves

In Year Allocations/Transfers

TOTAL ACUTE BUDGET 2013/14 231,970 57,993 60,189 (2,196) (2,928) (4,852) (2)%

Contract Monitoring YTD Month 3

Full Year

PlanYTD Plan YTD Actual

Forecast

Outturn

(over)/ under-

spend

YTD

(Over)/

under-

spend

M4 Finance

Board Report

(over)/ under-

spend

Fig 1. Reconciliation from Trust SLAM to YTD Contract Monitoring position

(16)

(14)

(12)

(10)

(8)

(6)

(4)

(2)

0

2

4

Mon

th 1

Mon

th 2

Mon

th 3

Mon

th 4

Mon

th 5

Mon

th 6

Mon

th 7

Mon

th 8

Mon

th 9

Mon

th 1

0

Mon

th 1

1

Mon

th 1

2

(over)

/Under-

sp

en

d £

'mill

ion

Worse Case Forecast Most Likely Forecast Best Case Forecast

11

F2. Bridging Analysis: SLAM to Reported Financial Position

Fig 1. Reconciliation from Trust SLAM to YTD Contract Monitoring position

Section A – Finance: Bridging Analysis: SLAM to Reported Financial Position

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Croydon Health Services 37,884 38,865 (982) 0 (9) (235) 0 37,884 38,621 (738) (541) (197)

St George's 3,913 4,554 (641) 0 (45) (36) (347) 3,913 4,124 (211) (609) 397

King's College 2,397 3,147 (750) 0 0 (232) 0 2,397 2,916 (518) (1,052) 533

Epsom & St Helier (Acute & Renal) 1,951 2,063 (112) 0 0 (80) 0 1,951 1,983 (32) (145) 113

Royal Marsden 1,033 796 238 0 0 0 0 1,033 796 238 178 59

Chelsea & Westminster 159 170 (10) 0 0 0 (16) 159 154 6 0 6

Great Ormond Street 77 42 34 0 0 0 0 77 42 34 36 (1)

Guy's & St Thomas' 1,472 1,783 (311) 0 0 0 0 1,472 1,783 (311) (207) (104)

Moorfields' Eye 466 578 (112) 0 0 0 0 466 578 (112) (110) (2)

Queen Victoria 67 108 (41) 0 0 0 0 67 108 (41) (22) (19)

Royal Brompton & Harefield 122 151 (29) 0 0 0 0 122 151 (29) (48) 19

South London 1,682 2,006 (325) 0 0 0 0 1,682 2,006 (325) (337) 12

Royal Surrey County 61 31 29 0 0 0 0 61 31 29 35 (6)

University College London 158 363 (205) 0 0 0 (1) 158 362 (204) (277) 73

Bart's & the London 294 135 159 0 0 0 0 294 135 159 159 0

Epsom & St Helier (SWLEOC) 1,380 1,595 (215) 0 0 (33) 0 1,380 1,562 (181) (264) 82

Imperial College 153 138 15 0 0 0 0 153 138 15 19 (4)

Kingston Hospital 82 66 15 0 (0) 0 (1) 82 65 17 (2) 18

Lew isham 203 177 26 0 0 0 0 203 177 26 (17) 42

North West London 73 91 (18) 0 0 0 0 73 91 (18) (35) 17

Queen Mary's (Roehampton) 100 45 55 0 0 0 0 100 45 55 0 55

Royal Free 62 40 21 0 0 0 0 62 40 21 0 21

Royal National Orthopaedic 106 191 (85) 0 0 0 (25) 106 166 (60) 0 (60)

Surrey & Sussex 1,054 1,078 (23) 0 0 0 0 1,054 1,078 (23) 0 (23)

West Middlesex 12 4 8 0 0 0 0 12 4 8 5 3

London Ambulance Service 3,033 3,033 0 0 0 0 0 3,033 3,033 0 0 0

CONTRACTED ACUTE SLAs 57,993 61,251 (3,258) 0 (55) (617) (390) 57,993 60,189 (2,196) (3,232) 1,035

Trust YTD Plan YTD Actual

Plan

Adjust-

ment

Previous

Month

Extrapolated

Contract

Monitoring

Improvement

(Deterioration)

SLAM YTD Month 3

KPIs

Technical

Adjust-

ment

Other

Adjust-

ment

YTD Plan YTD Actual

YTD (Over)

/under-

spend

YTD (Over)

/under-

spend


12

F3. Overview by Point of Delivery

Section A – Finance: overview by Point of Delivery

Fig 1. Point of Delivery Heat map £’000:

Total – (over)/under spend YTD (before challenges)

Fig 2. Point of Delivery Finance :

Total – (over)/under spend YTD (before challenges)

Point of Delivery:

• The values expressed here are gross of any challenges.

• Elective over-performance is driven by additional activity at Croydon Health

Services and at the SWL Elective Orthopaedic Centre

• Emergency over-performance is driven by King’s, St Georges and South

London Healthcare

• Non Elective over-performance is driven by Guys & St Thomas’ and South

London Healthcare

• A&E under-performance can be seen at Croydon Healthcare Services

• Outpatient over-performance is driven by Guys & St Thomas’, Croydon

Healthcare Services and St George’s.

• Outpatient Procedure over-performance is driven by Croydon Healthcare

Services and St Georges

• Maternity Pathway over-performance is driven by South London Healthcare

• The Other Expenditure over-performance is driven by South London

Healthcare

Actions

• Challenge NHSE activity and ensure activity is correctly attributed

• Challenge counting and coding changes

• Check application of NEL threshold

• Challenge implementation of the maternity pathway across all Providers

• Meet with the Head of MDT responsible for KHT and Guys to ensure

Croydon CCG issues are understood and expedited.

PbR Non-PbR Total

£'000 £'000 £'000

Elective (573) 183 (390)

Emergency 350 (819) (469)

Non Elective (210) (210)

A&E 201 201

Outpatient – 1st (112) (185) (297)

Outpatient – follow Ups 7 (185) (178)

Outpatient Procedures (689) (689)

Critical Care (457) (457)

Direct Access 50 50

Drugs & Devices (66) (66)

Maternity Pathw ays (221) (221)

All Other Expenditure (325) (206) (531)

Total (1,573) (1,685) (3,258)

Total – (over)/under-spend YTD

(800)(700)(600)(500)(400)(300)(200)(100)

0100200300

Ele

ctiv

e

Em

erg

ency

No

n E

lect

ive

A&

E

Ou

tpat

ien

t –

1st

Ou

tpat

ien

t –

follo

w

Up

s

Ou

tpa

tie

nt

Pro

ced

ure

s

Cri

tica

l Car

e

Dir

ect

Acc

ess

Dru

gs &

Dev

ice

s

Ma

tern

ity

Pat

hw

ays

All

Oth

er

Exp

en

dit

ure

13

F4a. Croydon Health Services

Section A – Finance: Croydon Healthcare

Commentary

Overall Performance

CHS is over performing by £738K reflecting a value variance of 1.3%

above plan. Under-performance in activity in Emergencies is flowing

from under-performance in A&E, although admissions appear to be of

a more complex nature than planned.

POD/Specialty

Over performance is attributed to increases in:

Daycases

• Gynaecology is performing above plan, even when demand

management is taken into account (370 spells, £283K)

Outpatient Procedures

• Stress test ECGs variance of £320K against a £0 plan at a cost of

£207 per test. The Trust has acknowledged a change in counting

and coding and double charging in month 3. The CSU is identifying

with the Trust the final challenge value (1,586 procedures).

• Ophthalmology procedures are higher than plan, particularly

Glaucoma and Vitreous Retinal Procedures (369 procedures,

£50K). The CSU has challenged this activity as an unplanned

service development.

• Gynaecology is over-performing, even when demand management

is considered. This is particularly in Lower Genital Tract Minor

procedures consisting of Transvaginal ultrasounds. (423

procedures, £72K)

Outpatients

• Gynaecology outpatient attendances are over-performing (387

attendances, £62K).

• Cardiology is over-performing by 320 attendances, £64K

• The Anti-coagulation Service is over-performing by 2,119

attendances, £57K, the CSU has raised concerns to the Trust for

response by 16th September following identification of service

issues.

Actions

• The month 3 challenge letter has requested the Trust to provide

evidence for variances seen.

• Identify the source of referral for activity carried out.

• Challenge coding and counting changes seen in stress test ECG

tests.

• Trust instructed to apply penalties for breaches in first to follow up

ratios and consultant to consultant referrals.

• Review QIPP delivery.

Fig 1. YTD Summary (Over)/Under spend £’000

Fig 2. YTD Summary (Over)/Under spend

Total (Over)/Under spend YTD

£'000 £'000 £'000 £'000 £'000 £'000 %

Croydon Health Services 151,535 37,884 38,621 (738) (983) (2,025) (1.3)%


Forecast

Outturn

Full Year

PlanYTD Plan

YTD

Actual

M4 Finance

Board

YTD

(Over)/

Fig 1. YTD Summary (Over)/Under-spend (£’000)

Ele

ctiv

e

Em

erg

en

cy

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt

Pro

ced

ure

s

Critic

al C

are

Dire

ct A

ccess

Dru

gs &

Devic

es

Mate

rnity

Path

ways

Un

bu

nd

led

Dia

gn

ostic

s

GU

M

All O

ther

Exp

en

ditu

re

To

tal

PbR (173) 376 13 213 (51) 118 (394) 0 0 0 112 0 0 (11) 204

Non-PbR 146 0 (390) 0 (454) 0 0 (139) 9 (90) 0 0 0 (24) (941)

Total (27) 376 (376) 213 (505) 118 (394) (139) 9 (90) 112 0 0 (35) (738)

(10 0)%

(80 )%

(60 )%

(40 )%

(20 )%

0%

20%

Elective

Emerge

ncy

No

n Elective

A&

E

Ou

tpatien

t –1

st

Ou

tpatien

t –fo

llow U

ps

Ou

tpatient P

rocedu

res

Critical C

are

Direct A

ccess

Dru

gs & D

evices

Maternity Path

ways

Un

bund

led D

iagno

stics

GU

M

All O

ther Expe

nditu

re

Total

14

F5a. St Georges

Section A – Finance :St Georges

Commentary

Overall Performance

SGH is over performing by £211K reflecting a value variance of

0.8% above plan. Over performance is mainly seen in the non

elective/ emergency point of delivery group (POD), in Outpatient

Procedures and Critical Care.

At month 3 there remain issues regarding activity that has

transferred to NHSE as specialist activity. Commissioners’ are

seeking assurance that activity is not incorrectly charged to CCGs.

It is expected that anomalies will be corrected as part of the 6

months reconciliation process. In the interim a challenge has been

raised through the monthly challenge process to reiterate that

commissioners will expect to receive credits for activity incorrectly

charged.

POD/Specialty

Whilst the issue of specialist activity is being resolved it is noted

that the over performance is mainly attributed to increased

emergency activity for ENT, general surgery, paediatric medicine

and paediatric surgery. All of which are potentially specialist areas.

Emergency/Non Elective:

• ENT is showing a value variance of £51K over plan (50%)

• General Surgery is £45K over plan (71%)

• Paediatric Medicine is £22K over plan (62%)

• Paediatric surgery is £18K over plan (111%).

Outpatient Procedures

• Clinical Haematology is £24K over plan (83%)

• ENT is 19K over plan (16%)

Critical Care

• Cardiac ITU is £95K over plan (225%)

Drugs & Devices

• As this is £83K over plan most of this is likely to be for NHSE.

Actions

• Work with the St Georges Hospital contracting team to ensure

specialist activity is charged to NHSE

• Carryout trend analysis comparing 11/12,12/13 and YTD 13/14

to understand changes. Where activity is proven to be not

specialist it is possible that changes may be due to mandated

changes to tariff. Trend analysis will assist in ruling this out.

Complete action by 05th September.




£'000 £'000 £'000 £'000 £'000 £'000 %

St. George's 15,652 3,913 4,124 (211) (282) (120) (0.8)%


Forecast

Outturn

Full Year


M4

Finance

YTD

(Over)/


Ele

ctiv

e

Em

erg

en

cy

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt

Pro

ced

ure

s

Critic

al C

are

Dire

ct

Access

Dru

gs &

Devic

es

Mate

rnity

Path

ways

Un

bu

nd

led

Dia

gn

ostic

s

GU

M

All O

ther

Exp

en

ditu

re

To

tal

PbR (64) (27) 14 2 (12) (29) (99) 0 0 0 (16) 0 0 (19) (250)

Non-PbR 18 0 (82) 0 176 68 0 (92) 4 (83) 0 0 0 30 39

Total (46) (27) (68) 2 164 39 (99) (92) 4 (83) (16) 0 0 11 (211)

(25 0)%

(20 0)%

(15 0)%

(10 0)%

(50 )%

0%

50%

100%

Elective

Emerge

ncy

No

n Elective

A&

E

Ou

tpatien

t –1

st

Ou

tpatien

t –fo

llow U

ps

Ou

tpatient P

rocedu

res

Critical C

are

Direct A

ccess

Dru

gs & D

evices

Maternity Path

ways

Un

bund

led D

iagno

stics

GU

M

All O

ther Expe

nditu

re

Total

15

F6a. King’s College

Section A – Finance :King’s

Commentary

Overall Performance

Over performance at month 3 is £518K over plan following

adjustments for challenges, reflecting a value variance of 13.6%.

The Host for Kings has informed Associates that 2013/14 agreed

plans have not been accurately reflected in SLAMs as a

consequence the reported over performance is overstated.

POD/Specialty

Taking this into account there are areas of over performance at

Kings which are of concern for Croydon CCG, these can be seen

in Elective, Emergency & Non Elective spells and in Outpatients

particularly around Trauma & Orthopaedics and Obstetrics.

Elective

• Daycase over-performance is mainly in Haematology (18

spells, £14K) and Gynaecology (17 spells, 16K)

• Elective over-performance can be found in Trauma &

Orthopaedics (9 spells, £25K)

• Excess Bed Days are over-performing (451 beddays, £97K)

Emergency & Non Elective

• Over-performance in Trauma & Orthopaedics is very high (5

spells, £101K)

• Obstetric spells has been charged for both here and in the

Maternity Pathway although SUS shows no charge against the

Non Elective spells.

Outpatients

• Obstetric attendances have been charged for both here and in

the Maternity Pathway although SUS shows no charge against

the Outpatient Attendances.

Actions

• Seek re-profiling of SLAM reports in line with agreed final

proposals.

• Seek credits for NHSE activity incorrectly charged to Croydon

CCG.

• Ensure that charges for Obstetric activity should only be made

through the Maternity pathway.

• Ensure Croydon CCG benefit from contract wide first to follow

up key performance indicators.

• Challenge level of excess bed days.

• Meet with the Head of MDT covering KCH and GSST to

expedite contractual issues for host action.




£'000 £'000 £'000 £'000 £'000 £'000 %

KCH 9,589 2,397 2,916 (518) (691) (1,305) (13.6)%


Forecast

Outturn

(over)/ under-

spend

Full Year


M4 Finance

Board Report

(over)/ under-

spend

YTD (Over)/

under-

spend


Ele

ctiv

e

Em

erg

en

cy

No

n E

lectiv

e

A&

E

Ou

tp

atie

nt –

1st

Ou

tp

atie

nt –

fo

llow

Up

s

Ou

tp

atie

nt

Pro

ced

ures

Crit

ical C

are

Dir

ect

Access

Dru

gs &

Devic

es

Matern

ity

Path

ways

Un

bu

nd

led

Dia

gn

ostic

s

GU

M

All O

th

er

Exp

en

dit

ure

To

tal

PbR (138) (129) (76) (6) (8) (1) (11) 0 0 0 41 (2) 0 0 (330)

Non-PbR (61) 0 (82) 0 (60) 0 0 10 5 18 0 0 0 (18) (188)

Total (199) (129) (159) (6) (68) (1) (11) 10 5 18 41 (2) 0 (18) (518)

(25 0)%

(20 0)%

(15 0)%

(10 0)%

(50 )%

0%

50%

Ele

ctiv

e

Em

erg

ency

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt P

roce

du

res

Crit

ical C

are

Dire

ct A

cce

ss

Dru

gs &

De

vic

es

Mate

rnity

Path

ways

Un

bu

nd

led D

iag

no

stics

GU

M

All O

ther E

xpe

nd

iture

To

tal

16

F7a. Epsom & St Helier

Section A – Finance :Epsom

Commentary

Overall Performance

Epsom and St Helier Hospital Acute and Renal Services is £32K over

plan for Croydon CCG. This is due to the underperformance seen in

some points of delivery (POD)

POD/Specialty

Emergency & Non Elective

• The Emergency Threshold has not been applied

• Trauma & Orthopaedics is under plan (£34K, 81%)

• Obstetrics is under plan by £42K, 25% due to a low number of

births than planned (37 spells)

Outpatients

• Outpatients are over-performing as neither the First to Follow up

ratio, nor the Consultant to Consultant ratio have been applied

Maternity Pathway

• The Maternity Pathway includes activity where the patient

commenced on the pathway in 2012-13. The CSU is working with

Trusts to ensure correct implementation of the maternity pathway.

All Other Expenditure

• This includes a block value for balancing the SLAM value to the

Heads of Agreement. This needs to be allocated to the correct

PODs.

Actions

• Confirm with the lead commissioner local quality requirements for

first to follow up, consultant to consultant and discharge plans

• Ensure Croydon CCG benefits from local challenges raised.

• The CSU are working with the Trust to allocate the balancing block

values – establish deadlines.

• Work with the Trust to ensure that the Maternity Pathway activity is

not duplicated


Fig 2. YTD Summary (Over)/(Under) spend


£'000 £'000 £'000 £'000 £'000 £'000 %

Epsom & St Helier 7,805 1,951 1,983 (32) (42) 10 0.1%


Forecast

Outturn

(over)/ under-

spend

Full Year


M4 Finance

Board Report

(over)/ under-

spend

YTD (Over)/

under-

spend

Fig 1. YTD Summary (Over)/Under spend (£’000)

Ele

ctiv

e

Em

erg

en

cy

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt

Pro

ced

ure

s

Critic

al C

are

Dire

ct

Access

Dru

gs &

Devic

es

Mate

rnity

Path

ways

Un

bu

nd

led

Dia

gn

ostic

s

GU

M

All O

ther

Exp

en

ditu

re

To

tal

PbR 19 115 40 (5) (8) (15) (5) 0 0 0 (58) 0 0 (64) 19

Non-PbR (0) 0 25 0 104 0 0 38 (2) 25 0 0 0 (240) (50)

Total 19 115 66 (5) 96 (15) (5) 38 (2) 25 (58) 0 0 (304) (32)

(1,0 00)%

(800)%

(600)%

(400)%

(20 0)%

0%

200%

400%

600%

Ele

ctiv

e

Em

erg

ency

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt P

roce

du

res

Crit

ical C

are

Dire

ct A

cce

ss

Dru

gs &

De

vic

es

Mate

rnity

Path

ways

Un

bu

nd

led D

iag

no

stics

GU

M

All O

ther E

xpe

nd

iture

To

tal

17

F8a. Royal Marsden

Section A – Finance :Royal Marsden

Commentary

Overall Performance

The contract is underperforming by £238K at month 3 YTD.

POD/Specialty

Critical care

• Over performance is £69K above plan. It is likely that this

activity will be picked up as specialist activity and charged to

NHSE.

Actions

• The lead commissioner is to confirm whether critical care

activity at The Royal Marsden is specialist activity and therefore

to be charged to NHSE.




£'000 £'000 £'000 £'000 £'000 £'000 %

Royal Marsden 4,134 1,033 796 238 317 1,227 29.7%


Forecast

Outturn

(over)/ under-

spend

Full Year

PlanYTD Plan

YTD

Actual

M4 Finance

Board Report

(over)/ under-

spend

YTD (Over)/

under-

spend


Ele

ctiv

e

Em

erg

en

cy

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt

Pro

ced

ure

s

Critic

al C

are

Dire

ct

Access

Dru

gs &

Devic

es

Mate

rnity

Path

ways

Un

bu

nd

led

Dia

gn

ostic

s

GU

M

All O

ther

Exp

en

ditu

re

To

tal

PbR 110 0 42 0 2 9 6 0 0 0 0 0 0 12 181

Non-PbR 1 0 0 0 22 0 0 (69) 17 33 0 0 0 53 57

Total 111 0 42 0 24 9 6 (69) 17 33 0 0 0 65 238

(10 0)%(80 )%(60 )%(40 )%(20 )%

0%20%40%60%80%

100%120%

Ele

ctiv

e

Em

erg

ency

No

n E

lectiv

e

A&

E

Ou

tpatie

nt –

1st

Ou

tpatie

nt –

follo

w U

ps

Ou

tpatie

nt P

roce

du

res

Crit

ical C

are

Dire

ct A

cce

ss

Dru

gs &

De

vic

es

Mate

rnity

Path

ways

Un

bu

nd

led D

iag

no

stics

GU

M

All O

ther E

xpe

nd

iture

To

tal

18

F9a. Financial Summary of Other Contracts

Section A – Finance: Financial Summary of Other Contracts

Fig 1. Other Contracts (over)/under spend Special Focus:

Guys and St Thomas’s

• Over-performance is at £311K YTD. Most of this is in Non-Elective spells and

Critical Care. Investigation is on-going to identify the proportion that relates to

NHSE

University College London

• Over-performance YTD is at £204K. Contract values and terms have not been

agreed, check timescales for agreement with the host. The interim plan has been

set at a low level. Checks need to be made regarding potential NHSE activity.

Moorfields

• Over-performance YTD is £112K. As Ophthalmology activity is also up at Croydon

Health Services, investigation is taking place to identify the drivers behind this.

The CSU is seeking to identify whether there have been un-agreed service

developments.

South London Health Care Trust

• The year to date financial position for SLHT is reporting a variance of £325K. The

host commissioner has agreed a cap on this contract at Trustwide level. This will

only be applied once the cap has been exceeded and at this very early stage of

the year it is not clear how this will impact Croydon CCG.

• For prudence we are recommending to recognise the performance at month 3

and for forecast outturn, as a worse case scenario. The the CCG need consider

that the contingency set aside for this contract may have to be utilised. We are

working with the host commissioner to get an early view and potential impact for

Croydon CCG.

• Challenges have been raised regarding the tariffs used, coding changes, NHSE

activity and application of the Emergency Threshold

South West London Elective Orthopaedic Centre

• SWLEOC performance is £181K over plan when adjusted for £33K challenges

and KPIs. The over performance represents an 15.5% variance above plan.

• The over-performance is due to increased activity particularly in hips, knees,

shoulders and the spine.

Actions

• Review over performance and establish whether activity should be charged to

NHSE for transferred specialised activity.

• Analyse Provider activity to identify potential counting and coding changes.

• Check for movement of elective activity between Trusts

• Ensure Croydon CCG benefit from data challenges, risk share agreements and

KPIs.

Contract

Annual Value

YTD (Over)/Under-

Performance &

RAG

Previous Month

Extrapolated Contract

Monitoring

Improvement

(Deterioration)

£'000 £'000 £'000 £'000

Chelsea & Westminster 637 6 8 (2)

Great Ormond Street 306 34 46 (11)

Guy's & St Thomas' 5,888 (311) (415) 104

Moorfields' Eye 1,865 (112) (149) 37

Queen Victoria 268 (41) (55) 14

Royal Brompton & Harefield 487 (29) (39) 10

Royal Surrey County 242 29 39 (10)

University College London 632 (204) (272) 68

Bart's & the London 1,176 159 212 (53)

Epsom & St Helier (SWLEOC) 5,521 (181) (242) 60

Imperial College 611 15 20 (5)

Kingston Hospital 327 17 22 (6)

Lew isham 811 26 34 (9)

North West London 291 (18) (25) 6

Queen Mary's (Roehampton) 399 55 73 (18)

Royal Free 247 21 29 (7)

Royal National Orthopaedic 424 (60) (79) 20

South London 6,726 (325) (433) 108

Surrey & Sussex 4,217 (23) (31) 8

West Middlesex 50 8 11 (3)

London Ambulance Service 12,130 0 0 0

Total Contract Value 43,255 (935) (1,247) 312

Trust

Fig 1. Other Contracts (over)/under-spend F9a. Financial Summary of Other Contracts

19

F9b. Financial Summary of GUM

Section A – Finance: Financial Summary of GUM

Fig 1. GUM Performance – variances from Plan – note these are recharged/refunded to Local Authorities

Full Year Plan Year to Daye Plan Year to Date Expenditure Year to Date (Over)/underspend FOT (Over)/underspend

£'000 £'000 £'000 £'000 £'000

Guy's and St Thomas' 0 0 0 0 0

King's College Hospital 0 0 0 0 0

Lewisham Hospital NHS Trust 0 0 0 0 0

South London Healthcare Trust 0 0 0 0 0

St George's Healthcare 0 0 0 0 0

External Acute Service Agreements 0 0 0 0 0

NCAs 0 0 0 0 0

Other Trusts

Total GUM 0 0 0 0 0

GUM performance is not reported in month 3.

London Borough of Croydon is contracting for GUM services at Croydon Health Services all other GUM services are

being managed by the CCG under a collaborative agreement this will transfer to the borough for 2014/15

The collaborative agreement has been issued to the London Borough of Croydon for signature.

20

F10. Claims

Section A – Finance: Claims

Fig 1. Claims with Potential Financial Impact

IndicativeAmountChallenged ProviderResponse

_AgreedOrNotAgre

ed4

ProviderName Challenge group Agree Reject Under review or

no response

CROYDON HEALTH SERVICES NHS TRUST £5,282 £80,030 £217,971

Data Quality £0 £0 £0

Coding challenges £5,282 £80,030 £0

Automated Attribution (incl specialist) £0 £0 £217,971

MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST £1,051 £79,624 £0

Coding challenges £975 £5,780 £0

Automated Attribution (incl specialist) £76 £73,844 £0

ROYAL BROMPTON AND HAREFIELD NHS FOUNDATION TRUST £0 £63,920 £0

Automated Attribution (incl specialist) £0 £63,920 £0

EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST £454 £21,738 £1,926

Coding challenges £454 £698 £0

Automated Attribution (incl specialist) £0 £21,040 £1,926

THE ROYAL MARSDEN NHS FOUNDATION TRUST £0 £1,222 £611

Coding challenges £0 £1,222 £611

Automated Attribution (incl specialist) £0 £0 £0

Chelsea & Westminster £588 £62 £0


IMPERIAL COLLEGE HEALTHCARE NHS TRUST £403 £0 £0


ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST £216 £0 £0


ST GEORGE'S HEALTHCARE NHS TRUST £0 £136 £0


NORTH WEST LONDON HOSPITALS NHS TRUST £131 £0 £0


KINGSTON HOSPITAL NHS TRUST £0 £0 £0


WEST MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST £0 £0 £0


Grand Total £8,125 £246,732 £220,508

Automated challenges are issued to all trusts on a

monthly basis , challenge responses are reviewed and

continue to be pursued if responses are not in line

with PbR Guidance. The challenge window has been

extended for Q1 to reflect the complexities in the new

commissioning arrangements. Claims will be included

in the quarterly reconciliation statement.

Commentary

A1. Activity (Demand) Summary A5c. A&E Activity – Main Provider Split

A2a. Referrals by Referral Source at

CHS A6a Emergency Admissions, All Providers

A2b. 1st Attendances by Referral Source A6b. Elective Admissions, All Providers

A3. First Outpatient Activity A6c. Delivery Admissions, All Providers

A4. Outpatient Breakdown A7a. Activity by HRG – Elective

A5a. A&E Activity – All providers A7b. Activity by HRG - Emergency

A5b. A&E Activity – Virgin and CHS

B: Demand and Activity Trend

Analysis [Section Intro]

B: Demand and Activity Trend

Analysis [Section Intro]

A1. Activity (Demand) Summary A5c. A&E Activity – Main Provider Split

A2a. Referrals by Referral Source at

CHS A6a Emergency Admissions, All Providers

A2b. 1st Attendances by Referral Source A6b. Elective Admissions, All Providers

A3. First Outpatient Activity A6c. Delivery Admissions, All Providers

A4. Outpatient Breakdown A7a. Activity by HRG – Elective

A5a. A&E Activity – All providers A7b. Activity by HRG - Emergency

A5b. A&E Activity – Virgin and CUH

22

A1. Activity Notes

1st OP Attendances by Referral Source The following Treatment Function (Specialties) have been excluded: Dental (140s); Obstetrics (501); Midwifery (560); Diagnostics (812); GUM.

NHS England Specialist activity is included for consistency between years - work is in progress to exclude from both years for future reporting

Unbundled Imaging not recorded under TFC 812 is included and may show as inconsistency in comparisons between years

All data has been reconciled with key provider SLAMs to 2%.

Source: Secondary Uses Service SEM

A&E UCC activity is excluded from A&E activity and is shown separately



Outpatients The following Treatment Function (Specialties) have been excluded: Dental (140s); Obstetrics (501); Midwifery (560); Diagnostics (812); GUM.


Unbundled Imaging not recorded under TFC 812 is included and may cause show as inconsistency in comparisons between years

All data has been reconciled with key provider SLAMs to 2%. There have been issues with St George’s outpatient data, which has been partly resolved and is expected

to be fully resolved for M4.


Admitted Patient Care The following Treatment Function (Specialties) have been excluded: Dental (140s); Obstetrics (501); Midwifery (560); Diagnostics (812).


Regular Day Attenders are excluded



General All SUS activity has been refreshed and may result in slight variances from previous reporting.

New to follow up ratios and % admissions from A&E have both been recalculated following identification of an error in the previous methodology.

23

All CHS KCH SGH

A1. Activity (Demand) Summary

A&E A&E activity across all providers excluding Virgin Urgent Care is now at a similar level as that for the same period last year,

with Kings being up the highest at 9.1%.

Virgin care activity is down by 871 attendances (26%)

Outpatients First OP attendances is up by 5.2%. The charts all show a dip in June 2012 which is mainly due to the fact that last year there

were two bank holidays in June 2012.

First outpatient attendances at CHS is now at a similar level as last year following an initial increase. They are up 3.1%

compared to Q1 last year.

The trend for first outpatient attendances at ESH appears to be slightly higher than 2012/13 (up 10%) and SGH continues on

an upward trend and is up 12.3% from Q1 last year.

Outpatient attendances at KCH has risen during the last month after previously falling, activity has increased by 21.2%

compared to last year.

Consultant to consultant referrals are currently high at CHS at approximately 3000 referrals per month. This is expected to

decrease in line with the revised strengthened policy for C2C.

Referrals from A&E across all providers are up 22% compared to Q1 last year.

Elective Electives are up across all providers by 8.5%. With KCH and ESH being up 33.4% and 26.2% respectively. CHS is up by

9.9% and SGH up by 3.4%.

Q4 of 2012/13 showed an increase in elective activity at CHS this continued to April 2013/14 and has begun to return to

levels consistent with 2012/13. Emergency Emergencies are up by 3.2% across all providers compared to Q1 in 2012, with KCH and SGH being up by 15.7% and 19.7%

respectively.

Births are down across all providers.

24

A2a. Referrals by Referral Source at CHS

Fig 2. Other Referrals by Referral Source

Section B – Demand and Activity Trend Analysis: Referrals by Referral Source at CHS

Fig 1. Referrals Referral Source

Commentary

The majority of referrals are generated by GPs and appears to be less volatile but higher

than the same period for 2012/13 (+821)

Last year Consultant to Consultant referrals were showing an upward trend and is now

relatively flat. The CCG has implemented a strengthened C2C policy this will reduce the

volume of payable C2Cs with the aim of supporting the Trust to reduce internally

generated referrals . Other referral sources will be reviewed in-year.

The hospital have supplied an incorrect set of data the last 2 months, this has been

corrected and challenged. Increase in dental referrals are to be investigated.

Fig 3. Consultant Referrals by Referral Source

Data Source: Croydon University Hospital

0

1000

2000

3000

4000

5000

6000

7000

8000

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

Ap

r

May Jun

Ref

erra

ls

Consultant GP Other

0

500

1000

1500

2000

2500

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

Ap

r

May Jun

Refe

rra

ls

01 - following an emergency admission

04 - referral from an Accident andEmergency Department

05 - referral from a CONSULTANT, otherthan in an Accident and EmergencyDepartment

11 - other - initiated by theCONSULTANT responsible for theConsultant Out-Patient Episode

13 - referral from a Specialist NURSE

14 - referral from an Allied HealthProfessional

0

100

200

300

400

500

600

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Jan

Feb

Mar

Ap

r

May Jun

Ref

erra

ls

06 - self-referral

12 - referral from a General Practitionerwith a Special Interest

15 - referral from an OPTOMETRIST

16 - referral from an Orthoptist

17 - referral from a National ScreeningProgramme

92 - referral from a GENERAL DENTALPRACTITIONER

25

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Refe

rrals

12/13 13/14

A2b. 1st Attendances by Referral Source

Fig 2. 1st Attendances by Referral Source Group

. Commentary

First outpatient attendances to acute providers by all referral sources is continuing to show a downward trend at month 3, although the activity is up 5% compared to last

year. It is ahead of the position last year due to a dip in activity the previous June 2012/13 . This is mainly due to the fact that this does not take into account the

differences between years for actual working days. This anomaly is reflected in GP and consultant to consultant referrals. The pattern of referrals from accident and

emergency to first outpatients attendances is currently consistent with 2012/13 the trend for other referrals is reflecting a downward trajectory except C2C which shows a

slight rise.

GP referrals are up 9%, C2C up 8%, A&E up 22% and Other referrals are up 3% compared to last year

The contract held between Croydon CCG and Croydon Health Services includes a strengthened policy which restricts the Trust from generating internal referrals .

Internally generated activity is expected to continue to decrease this should also include a decrease in referrals from accident and emergency

Data Source:

Section B – Demand and Activity Trend Analysis: All referrals, All Providers

Fig 1. Trend by Month, All Providers

GP C2C

AE Other

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Refe

rrals

12/13 13/14

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Refe

rrals

12/13 13/14

0

200

400

600

800

1,000

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Refe

rrals

12/13 13/14

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Refe

rrals

12/13 13/14

26

0

200

400

600

800

1,000

1,200

1,400

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Att

en

da

nces

12/13 13/14

0

100

200

300

400

500

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Att

endances

12/13 13/14

0

100

200

300

400

500

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Att

endances

12/13 13/14

0

2,000

4,000

6,000

8,000

10,000

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Att

endances

12/13 13/14

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000


Att

endances

12/13 13/14

A3. First Outpatient Activity

. Commentary

First out patient attendances at CHS is now at a similar level as last year

following an initial increase.

The trend for first outpatient attendances at ESH appears to be slightly higher

than 12/13 and SGH continues on an upward trend.

Outpatient attendances at KCH has risen during the last month after previously

falling. It is still too early to draw conclusions as to the overall direction of travel.

It is noted that first to follow up ratios are high at ESH and KCH compared with

CHS and SGH. ESH are coding nurse led clinics as follow ups. SGH appears to

have previously peaked and is now returning to normal levels..

Section B – Demand and Activity Trend Analysis: First outpatient activity

Fig 2. All Firsts & Procedures by Provider Fig 1. All Firsts & Procedures - All Providers

CHS ESH

KCH

Fig 3. First to FUP Ratio

Data Source:

SGH

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

CHS SGH KCH ESH

27

A4. Outpatient Breakdown

Fig 1. Top 5 Variance by Treatment Function Code (TFC) – All Providers

Data Source: SUS Data

Commentary

ENT procedures: mainly attributable to CZ08Y - Minor Ear Procedures19 years and over without CC, which primarily take place at CHS.

Gynae and Gynae Oncology procedures: includes a significant proportion of MA23Z Upper Genital Tract Minor Procedures - Category 2, which mainly take place at CHS

Dermatology mainly attributable to JC29Z – Phototherapy and JC15Z - Skin Therapies level 3

Ophthalmology includes significant proportion of BZ23Z - Vitreous Retinal Procedures - category 1

This month CHS reported 246 EA44Z - Minor Cardiac Procedures and 1340 EA47Z - Electrocardiogram Monitoring and stress testing procedures in the SLA which are

not flowing through SUS. This item has been challenged as a counting and coding change / new count, this is presenting a c£300k cost pressure to the CCG.

Section B – Demand and Activity Trend Analysis: Outpatient Breakdown

TFC YTD 12/13 YTD 13/14 % Change

658 - Orthotics 1,117 860 - 23%

300 - General Medicine 3,213 2,790 - 13%

303 - Clinical Haematology 2875 2,755 - 4%

110 - Trauma & Orthopaedics 8412 8,065 - 4%

101 - Urology 4465 4,347 - 4%

Bottom 5 Variance by Treatment Function Code (TFC) – All Providers

TFC YTD 12/13 YTD 13/14 % Change

301 - Gastroenterology 2,135 2,751 29%

340 - Respiratory Medicine 3,478 4,227 22%

144 - Maxillo-Facial Surgery 1,629 1,949 20%

370 - Medical Oncology 1,754 2,098 20%

324 - Anticoagulant Service 6,705 7,977 19%

Fig 2. Top 5 Percentage-split: All & Procedures

TFC YTD 12/13 YTD 13/14

120 - ENT

502 - Gynaecology

503 – Gynaecological

Oncology

330 – Dermatology

130 - Ophthalmology

Procedures All

28

A5a. A&E Activity – All Providers

Commentary

A&E activity across all providers excluding Virgin Urgent Care is now at

a similar level as that for the same period last year.

Section B – Demand and Activity Trend Analysis: A&E Activity

Fig 1. A&E Attendances - All Providers (excluding Virgin

Urgent Care)

Fig 2. Type 1 Attendances by Provider, Rolling 12 Months

Commentary

A&E activity is generally showing an upward trend at CHS, ESH and KCH,

with SGH remaining fairly constant.

CHS ESH

KCH SGH

3,600

3,800

4,000

4,200

4,400

4,600

4,800

5,000

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

0

50

100

150

200

250

300

350

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

280

300

320

340

360

380

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

450

500

550

600

650

700

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

7500

8000

8500

9000

9500

10000

10500


All

Att

endances

12/13 13/14

29

A5b. A&E Activity – Virgin and CHS


Commentary

Virgin Urgent Care

Attendances have dropped compared with 2012/13, this is not the

desired effect and will be challenged with Virgin care.

Fig 2. A&E Attendances – Virgin Urgent Care

Commentary

Croydon Health Services

Attendances have now reached a similar level as for 2012/13. The

concern is we are expecting to see a sustained decrease in A&E

attendances at CHS. This area of activity will be prioritised for

investigation.

Fig 2. A&E Attendances – Croydon Hospital

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500


All

Att

endances

12/13 13/14

0

1000

2000

3000

4000

5000

6000

7000

8000


All

Att

endances

12/13 13/14

30

A5c. A&E Activity – Main Provider Split


Fig 1. % Admissions from A&E, Main Providers

Provider YTD 12/13 YTD 13/14

CHS

ESH

KCH

SGH

Light Blue – Within GP Standard Hours Dark Blue – Out of GP Hours

Fig 2. % of Attendances In and Out of GP Opening Hours

Commentary

CHS continues to be the main provider of A&E services for Croydon

CCG.

The majority of attendances to A&E continue to be during GP working

hours.

More work is required to support a reduction in A&E attendances during

working hours, this will be discussed with clinical leads and Network Co-

ordinators to agree actions.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

Apr

May

Ju

n

Ju

l

Aug

Sep

Oct

No

v

De

c

Ja

n

Feb

Mar

CHS ESH KCH SGH

31

A6a. Emergency Admissions, All Providers

Commentary

The activity at CHS is now at a comparable level to this point last year.

CHS up 3%, KCH up 15.7% and SGH up 19.7% compared to Q1 2013. ESH is consistent with last year.

Section B – Demand and Activity Trend Analysis: Emergency Admissions, All Providers

Fig 2. Main Providers Fig 1. Emergency Admissions, All Providers

CHS ESH

KCH SGH

Data Source:

2,400

2,500

2,600

2,700

2,800

2,900

3,000

3,100

3,200


No o

f S

pells

12/13 13/14

1,700

1,800

1,900

2,000

2,100

2,200

2,300

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

50

100

150

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

20

40

60

80

100

120

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

100

200

300

400

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

32

A6b. Elective Admissions, All Providers

Section B – Demand and Activity Trend Analysis: Elective Admissions, All Providers

Fig 2. Main Providers Fig 1. Elective Admissions, All Providers

CHS ESH

KCH SGH

Commentary

Elective admissions increased by approximately 9% compared with the same period 2012/13. For May in both years the level of activity is broadly the

same and now overall elective admissions continues to fall. The variation seen in April is likely to be due to the difference in working days across both

years and the winter pressures resources used to support CHS to prioritise recovering the 18 weeks referral to treatment target in Q4 of 2012/13.

Elective activity at ESH and KCH is contributing to increases seen in elective activity but together with SGH have all fallen last month.

Data Source:

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500


No o

f S

pells

12/13 13/14

0

500

1,000

1,500

2,000

2,500

3,000

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

50

100

150

200

250

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

50

100

150

200

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

100

200

300

400

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

33

A6c. Delivery Admissions, All Providers

Section B – Demand and Activity Trend Analysis: Delivery Admissions, All Providers

Fig 2. Main Providers Fig 1. Non-Elective Admissions, Births, All Providers

CHS ESH

KCH SGH

Commentary

Non elective admissions for births are currently lower than the previous time last year and appear to show a downward trend

ESH and SGH both appear to show a mirror image of their activity last year..

Data Source:

0

100

200

300

400

500

600


No o

f S

pells

12/13 13/14

0

100

200

300

400

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

10

20

30

40

50

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

10

20

30

40

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

0

5

10

15

20

25

30

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

Nov

Dec

Jan

Fe

b

Ma

r

No o

f S

pells

12/13 13/14

34

A7a. Activity by HRG – Elective

Fig 1. Elective – Top 5 Increases

Section B – Demand and Activity Trend Analysis: Activity by HRG

HRG Chapter YTD 12/13 YTD 13/14 % Change

L - Urinary Tract and Male Reproductive

System 949 1776 87.1%

M - Female Reproductive System and

Assisted Reproduction 943 1350 43.2%

P - Diseases of Childhood and Neonates 205 267 30.2%

H - Musculoskeletal System 1,031 1,274 23.6%

C - Mouth Head Neck and Ears 1,159 1,405 21.2%


Q - Vascular System 221 186 -15.8%

F - Digestive System 2,772 2,775 0.1%

Fig 2. Elective – Biggest 5 Decreases

Sub-Chapter YTD 12/13 YTD 13/14

AA - Nervous

System

Procedures and

Disorders

HD –

Musculoskeletal

Disorders

JA - Breast

Procedures and

Disorder

Fig 3. Elective – Top Variance Complexity Recording – All Providers

With Complications Without Complications

Commentary

There are national changes in the grouper for complex HRGs for the

Nervous System this is for tariffs related to stroke care in 2013/14.

Activity increases seen in HRGs for female reproductive system, Ears,

nose and throat and musculoskeletal have been challenged at CHS.

The Trust is required to identify the drivers for change.

The use of complex HRGs have decreased during 13/14 when

compared with 12/13 this is likely to be due to specialist activity that has

transferred to NHSE.

Trends will continue to be monitored in-year to understand changes in

activity. Areas of concern will be flagged and challenged.

Only two HRG chapters showed a decrease year on year.

35

A7b. Activity by HRG – Emergency

Section B – Demand and Activity Trend Analysis: Activity by HRG

Fig 1. Emergency – Top 5


K - Endocrine and Metabolic System 119 165 38.7%

P - Diseases of Childhood and Neonates 1,208 1,499 24.1%

J - Skin, Breast and Burns 314 369 17.5%

H - Musculoskeletal System 746 850 13.9%

G - Hepatobiliary and Pancreatic System 147 165 12.2%


Q - Vascular System 151 118 -21.9%

V - Multiple Trauma, Emergency Medicine

and Rehabilitation 57 50 -12.3%

L - Urinary Tract and Male Reproductive

System 649 596 -8.2%

D - Respiratory System 866 828 -4.4%

A - Nervous System 608 610 0.3%

Fig 2. Emergency – Biggest 5 Decreases

Sub-Chapter YTD 12/13 YTD 13/14

DZ – Thoracic

Procedures and

Disorders

HD -

Musculoskeletal

Disorders

AA - Nervous

System

Procedures and

Disorders

Fig 3. Emergency– Top Variance Complexity Recording – All Providers

With Complications Without Complications

Commentary

Complexities change in AA Nervous System is due to PbR HRG

changes for stroke in 2013/14.

Activity data includes 46 uncoded spells, we are seeking to reduce the

number of uncoded activity in line with contractual requirements.

The level of complicated HRGs has increased, this is consistent with

increases seen for elective.

P1a. Performance Summary

P2a. CCG Performance Scorecard

P2b. CCG Performance Scorecard

P3a. Provider Performance Scorecard

P3b. Provider Performance Scorecard

P4. Performance Penalties

C: Performance [Section Intro]

C: Performance [Section Intro]

P1a. Performance Summary

P2a. CCG Performance Scorecard

P2b. CCG Performance Scorecard




37

High Level Summary

Headlines

• A&E and 18 week RTT performance has significantly improved at CHS with performance for the CCG now consistently within

the thresholds.

• Patients waiting longer than 52 weeks for treatment, Mixed Sex accommodation and ambulance handover breaches remain the

main areas of concern.

Notes: The indicators presented in this section are from the national CCG Assurance framework and the Everyone Counts Framework

The data is sourced from national systems.

Performance figures is shown as at 30th July 2013.

CCG and Provider Indicators

CB_A15-A16: Commissioner HCAI data is presented as a cumulative figure each month, against a YTD target and RAG rated in this way.

CB_B1 – B3 : Commissioner June RTT performance is provisional. Provider RTT performance has been sourced from NHS E.

CB_S14-B16: Performance is shown for LAS wide data

CB_S6: There is no national threshold yet for admitted or non-admitted pathways above 52 weeks, at present a red rating has been applied for any

value >0.

CB_S1-03: trajectories will be updated after the most recent resubmission to Unify is available for download, please note that this dashboard

compares activity reported in the MAR against the activity trajectories submitted in the planning round and not contract activity or contract plan

CB_S6 - there is no national threshold yet for admitted or non-admitted pathways above 52 weeks, at present a red rating has been applied for any

value >0.

Penalties Further performance penalties will be reported on as published data becomes available. The penalties displayed in Fig 2 are Trust wide and not

specific to the CCG.

See http://www.england.nhs.uk/wp-content/uploads/2013/04/ec-tech-def.pdf for full data definition and source details.

http://www.england.nhs.uk/wp-content/uploads/2013/04/ec-tech-def.pdf







38

P1a. Performance Summary Health Care Acquired Infection - MRSA Croydon CCG had two attributable cases in June taking the YTD to 4. One of the cases on June was apportioned to a non acute Trust and the other was at ESH. The CSU has undertaken the Post Infection Review and the infection control lead believes that the case was unavoidable. The Trust has been working through an action plan with audits and staff competency assessments to be completed in August. 18 weeks RTT Croydon CCG performance is comfortably above the admitted, non admitted and incomplete thresholds. The CHS backlog recovery trajectory is expected to be achieved for all specialties apart from T&O which is to be cleared by August. RTT– waiting more than 52 weeks, and still waiting (incompletes) The CCG had 3 patients waiting longer than 52 weeks on incomplete pathways in June. Two of those were at CHS and the other was at Kings. At KCH the trust intends to clear long waiters by the end of September through the use of outsourcing where suitable. CHS have implemented a more robust monitoring system that identifies potential issues earlier in the pathway. The escalation process now takes place after 42 weeks moving to 40 weeks shortly. The Trust are providing details specific to each 52 week breach and are working to a zero trajectory by the end of September. Mixed Sex Accommodation breaches The CCG had 13 MSA breaches in April, 4 in May and 5 in June. 8 of the April breaches, 3 of those in May and 4 of those in June occurred at CHS. All breaches resulted from step down patients from critical care taking longer than 6 hours to be transferred to an acute bed. Urgent care pressures leading to bed shortages have also increased the issue. The CHS Associate Director of Nursing has completed an action plan that has strengthened the Trusts approach to achieving this standard with the development of a decision making tree with a clear pathway, and monitoring via a daily collection tool. The Trust also continues to make privacy & dignity a priority for all patients with the weekly quality rounds, and the Senior Sister/ Charge Nurses daily walk rounds. The introduction of patient level Root Cause Analysis is being used to identify specific actions to mitigate further breaches following any unjustified breach of the standard. Ambulance Handovers – 30 – 60 mins A new HAS system is being developed to accurately capture 30-60 min handover breaches. This is due to be implemented by September 2013, in the meantime the CSU undertake a validation of all 30 and 60 minute breaches with the Acute Trusts. Handover breaches are monitored by the CSU through the bi weekly SWL CCG Pressure & Performance conference calls with all SWL Trusts. The CSU will apply the contractual fines as advised by the CCG. The high level of breaches in April and may at CHS was due to Trust staff not clicking the handover button on the HAS system meaning that patients handed over within 30 minutes appear as breaches. Staff training has been undertaken to avoid this happening and validated breaches have dropped from approximately 200 30 minute breaches to in April and May down to 48 in June.

Reporting

Period

National

TargetActual

MRSA YTD 0 4

C'Diff YTD 12 11

CHS June 95% 97.3%

St. George's June 95% 96.1%A&E Trolley waits over

12hrs Croydon YTD 0 0

30-60 Min June 0 48

> 60 min June 0 1

18 weeks Referral to

Treatment Time (RTT)Admitted June 90% 92.4%

Patients waiting 52+

weeks RTTIncomplete June 0 3

Diagnostic Waits Within 6

WeeksJune 99% 99.1%

Mixed Sex

Accommodation BreachesJune 0

5All Cancer 2 week

standardMay 93% 96.10%

2 week standard for

Breast SymptomsMay 93%

95.90%62 day standard–

for first definitive

treatment

May 85%

86.40%

Indicator

Health Care Acquired

Infection

A&E Waiting Time – 4 hour

DTA, All types

Ambulance Handover Time

for Croydon University

Hospital

Cancer Waiting Times

Fig 1. Performance Summary

39

P2a. CCG Acute Performance Scorecard

Section C – Performance: CCG performance scorecard – NHS constitution

Fig 1. CCG Acute Performance Scorecard

CB_A15: Healthcare acquired infection (MRSA) 0 1 R 2 R 4 R

CB_A16: Healthcare acquired infection (C-Difficile) 12 (YTD) 5 R 9 R 11 G

CB_B1: RTT 18 week compliance, admitted patients 90.0% 87.2% A 91.4% G 92.4% G

CB_B2: RTT 18 week compliance, non admitted

patients 95.0% 95.9% G 97.1% G 96.5% G

CB_B3: RTT 18 week compliance, incomplete

pathways 92.0% 94.3% G 94.4% G 95.3% G

CB_B4: Diagnostic test waiting times 99.00% 98.83% A 98.21% A 99.12% G

CB_B5: A and E 4 hour waiting time compliance

CB_B6: All cancer two week waits 93.0% 96.3% G 96.1% G

CB_B7: Breast symptoms (cancer not initially

suspected) 93.0% 93.5% G 95.9% G

CB_B8: Cancer first definitive treatment in 31 days 96.0% 98.9% G 100.0% G

CB_B9: Cancer subsequent treatment 31 days,

surgery 94.0% 100.0% G 100.0% G


drug 98.0% 100.0% G 100.0% G


radiotherapy 94.0% 100.0% G 100.0% G

CB_B12: Cancer first treatment 62 days, GP referral 85.0% 82.2% A 86.4% G

CB_B13: Cancer first treatment 62 days, screening

referral 90.0% 71.4% R 100.0% G

CB_B14: Cancer first treatment 62 days, consultant

upgrade 100.0% 60.0%

Aug Sep

Most

Recent

Target

Apr May Jun Jul

40

P2b. CCG Acute Performance Scorecard

Section C – Performance: CCG performance scorecard – NHS constitution

Fig 1. CCG Acute Performance Scorecard cont.

CB_B15_01: Ambulance category A (Red 1) 8

minute response 75.0% 77.6% G 77.9% G 77.4% G

CB_B15_02: Ambulance category A (Red 2) 8

minute response 75.0% 75.8% G 77.7% G 75.9% G

CB_B16: Ambulance category A 19 minute

transportation time95.0% 98.0% G 98.5% G 98.2% G

CB_B17: Mixed sex accommodation breach

count0 13 R 4 A 5 A

CB_S1: Non elective FFCEs 1,650 2,864 R 3,214 R 2,873 G

CB_S2: All first outpatient attendances 5,082 8,701 R 8,177 G 7,680 G

CB_S3: G and A elective FFCEs 2,476 3,931 R 3,615 G 3,436 G

CB_S6: RTTs in excess of 52 weeks: Admitted

patients0

5 R 3 R 3 R

CB_S6: RTTs in excess of 52 weeks: Non

admitted patients0

2 R 4 R 7 R

CB_S6: RTTs in excess of 52 weeks:

Incomplete Pathways0

4 A 8 A 3 A

Aug Sep

Most

Recent

Target

Apr May Jun Jul

41


Section C – Performance: Provider performance scorecard

Fig 1. Provider Performance Scorecard

M onthly Indicators

CB_A15: Healthcare acquired

infection (MRSA) 0 Jun 0 G 1 R Jun 0 G 2 R Jun 0 G 2 R Jun 0 G 0 G Jun 1 R 1 R

CB_A16: Healthcare acquired

infection (C-Diff icile) Varies Jun 0 G 4 G Jun 4 R 16 R Jun 2 G 8 G Jun 0 G 2 G Jun 1 G 5 G

CB_B1: RTT 18 w eek compliance,

admitted patients 90.0% May 89.5% R May 91.8% G May 88.2% R May 97.4% G May 92.2% G


non admitted patients 95.0% May 97.0% G May 98.1% G May 97.3% G May 98.7% G May 96.7% G


incomplete pathw ays 92.0% May 94.6% G May 94.9% G May 92.3% G May 97.3% G May 96.2% G

CB_B4: Diagnostic test w aiting

times 99.0% May 98.5% R May 99.9% G May 95.8% R May -- May 100.0% G

CB_B5: A and E 4 hour w aiting time

compliance 95.0% Jun 97.3% G 95.4% G Jun 96.1% G 95.5% G Jun 96.1% G 96.3% G Jun 96.8% G 95.4% G

CB_B6: All cancer tw o w eek w aits 93.0% May 95.9% G May 97.2% G May 98.6% G May 97.2% G May 95.1% G

CB_B7: Breast symptoms (cancer

not initially suspected) 93.0% May 95.7% G May 96.9% G May 98.9% G May 93.8% G May --

CB_B8: Cancer f irst definitive

treatment in 31 days 96.0% May 100.0% G May 99.2% G May 99.0% G May 100.0% G May 100.0% G

CB_B9: Cancer subsequent

treatment 31 days, surgery 94.0% May -- May 98.3% G May 97.9% G May 96.7% G May 100.0% G


treatment 31 days, drug 98.0% May -- May 100.0% G May 100.0% G May 100.0% G May 100.0% G


treatment 31 days, radiotherapy 94.0% May -- May -- May -- May 99.6% G May --

CB_B12: Cancer f irst treatment 62

days, GP referral 85.0% May 85.7% G May 88.4% G May 87.9% G May 81.3% A May 82.3% A


days, screening referral 90.0% May -- May 95.5% G May 100.0% G May 90.0% G May --


days, consultant upgrade May 50.0% May 100.0% May 66.7% May 25.0% May 60.0%

Epsom and St Helier

Latest YTDTarget

Croydon Health Services St George's King's College The Royal Marsden

Latest YTD Latest YTD Latest YTD Latest YTD

42


Section C – Performance: Provider performance scorecard

Fig 1. Provider Performance Scorecard cont..

M onthly Indicators

CB_B17: Mixed sex accommodation

breach count 0 Jun 6 R 17 R Jun 0 G 38 R Jun 29 R 97 R Jun 0 G 0 G Jun 6 R 36

CB_S4: A and E attendances, type

1 Jun 5,136 16,562 Jun 10,395 33,567 Jun 10,901 34,494 Jun 8,653 27,882

CB_S4: A and E attendances, all

types Jun 10,787 34,209 Jun 11,736 37,786 Jun 13,194 41,472 Jun 10,991 35,516

CB_S6: RTTs in excess of 52

w eeks: Admitted patients 0 May 1 R May 0 G May 14 R May 0 G May 1 R


w eeks: Non admitted patients 0 May 5 R May 0 G May 2 R May 0 G May 0 G


w eeks: Incomplete Pathw ays 0 May 6 R May 1 R May 44 R May 1 R May 0 G

CB_S7: Ambulance handover

delays over 30 minutes Jun 48 451 Jun 6 56 Jun 0 0 Jun 12 89

CB_S7: Ambulance handover

delays over 60 minutes Jun 1 13 Jun 0 1 Jun 0 3 Jun 1 12

CB_S9: A and E trolley w aits over

12 hours 0 Jun 0 G 0 G Jun 0 G 0 G Jun 2 R 2 R Jun 0 G 0

TargetCroydon Health Services St George's King's College The Royal Marsden

Latest YTD Latest YTD Latest YTD Latest YTD

Epsom and St Helier

Latest YTD

43


Section C – Performance: Performance Penalties

Note – Further performance penalties will be reported on as published data becomes available.

These penalties displayed are Trust wide and not specific to the CCG.

CCG Specific Penalty Description

April May Year to Date

Number Value (£) Number Value (£) Number Value (£)

CHS Mixed Sex Accommodation

Penalty 2

King’s College Mixed Sex Accommodation

Penalty 2

St. George’s Mixed Sex Accommodation

Penalty 2

Fig 1. [...]

Fig 2. [...]

Trust-Wide Penalties Penalty Description May Jun Year to Date

Number Value (£) Number Value (£) Number Value (£)

CROYDON HEALTH SERVICES NHS

TRUST Ambulance Handover Breach 30-60 Min 202 £40,400 48 £9,600 451 £ 90,200

Ambulance Handover Breaches > 60

min 4 £4,000 1 £1,000 13 £ 13,000

C1a. Performance Summary

C1b. CCG Community Dashboard

C1c. CCG Community Dashboard

C1d. Performance Dashboard

C1e. Provider Contacts Dashboard

C1f. Provider Contacts Dashboard

C1g Referrals Dashboard

C: Community Performance NHS Croydon CCG – Activity Month 3 2013

C: Community Performance NHS Croydon CCG – Activity Month 3 2013

C1a. Performance Summary

C1b. CCG Community Dashboard

C1c. CCG Community Dashboard

C1d. Performance Dashboard

C1e. Provider Contacts Dashboard



45

C1a. Community: Croydon Health Services NHS Trust

Community Dashboard - Croydon Health Services NHS Trust

Community contract performance management context

1.The CCG contract with CHS encompasses a stepped block contract for community services, valued at £24,518m. The month 3 ytd financial plan and actual is £6,130k,

inclusive of CQUIN. The purpose of this report is to provide an overview of the community contract performance within the limitations of the updated reporting

arrangements.

2.As part of the rebasing of community contract prices CHS has provided a Croydon CCG Activity & Finance proposal for consideration. This is based on disaggregated

activity between commissioners except for Children’s Universal Services which remains outstanding. An initial response to CHS has been provided and following a

meeting with the CCG on 15/8/2013 the CSU will seek a revised proposal from CHS. As per the rebasing agreement, CHS has been asked to add total planned WTE,

by service line, to the schedule.

3. CHS has provided a M3 ytd SLAM based on its proposed A&F schedule and this has been used to inform this Integrated Report. The process for rebasing of

community contract prices includes setting 2013/14 planned activity based on 2012/13 outturn activity, adjusted for service transfers.

4. Note that the specific areas of under and over performance remain fluid as the rebasing of community contract prices in the A&F has not yet been finalised and the

community performance reporting from the Trust continues to have limitations.

5. As at month 3 the CHS community performance reports remain trust wide in nature, in that they have not yet been split by responsible commissioner to take account

of service transfers to NHSE and Local Authority, and continue to use mainly historical targets which were set when community services were transferred from Croydon

PCT to the Trust in 2010. It is anticipated that monthly reporting on activity and costs against this plan will commence from month 4 (April-July) reporting.

6.Therefore, for the purposes of this August Integrated Report a mixture of data from the A&F proposal schedule and the community performance reports have been

used. Only CCG service lines have been used where possible.

7.A Community Contract Management Group is being established. Terms of reference have been drafted and remains with the CCG for comment. This will focus on

community performance management including exception reporting and discussions with CHS on plans to achieve rectification of shortfalls.

8.A process for CHS providing a narrative on its performance reports will be developed with the Trust. Commissioning managers will be encouraged to participate in the

use and development of CHS data.

9.As part of the rebasing of community contract prices the CCG and CHS will jointly steer a working group (with CHS leading ) to look at National Pilots on currency

setting and will use this to develop new resource sensitive currencies for the management of community services interventions in the patient pathway. It is proposed that

this be undertaken via a Community Currency Working Group (CCWG) for which draft terms of reference have been shared and agreed with the CCG.

10. The CCWG will take account of CCG plans to develop commissioning on outcome based incentive contracts (COBIC) for frail elderly.

11.This report provides a narrative which focuses on areas of underperformance (in red).

46

Indicator Apr May Jun Jul Aug YTD Target YTD Actual Trend

Clinical Quality

Patients with VW or DN Care Plan (LT) (%) 9.4% 6.7% 45% 9.4%

Patients with a Liverpool Care Pathway Plan (LT) (%) 0.0% 0.0% n/a 0.0%

Diagnosis Recorded (DN, VW, HVOP) (%) 3.3% 3.9% 45% 3.9%

Community Matrons - Hospital Admission Avoidance (%) 100.0% 100.0% >80% 100.0%

Community Matrons - A&E attendance Avoidance (%) 85.0% 85.0% >80% 85.0%

Tissue Viability - 12 Weeks 0 0 TBA 0

Tissue Viability - 24 Weeks 1 1 TBA 2

Activity and Productivity

Activity for Patients Requiring Continuing Care (No.) 1 1 n/a 2

District Nursing Response within 48 Hours (%) 93.4% 89.2% 95% 91.1%

District Nursing Response within 4 Hours (%) 100.0% 100.0% 90% 100.0%

District Nursing Patient Facing Time (%) 23.0% 24.0% >20% 23.0%

Stroke to Community Waiting Times (%) 50.0% 100.0% 100% 83.3%

Virtual Ward

Total Number of Interventions 424

Daily Intervention 9

Two Times per Week Intervention 2

Weekly Intervention 41

Fortnightly Intervention 78

Monthly Intervention 176

Six Weekly Intervention 45

No Intervention Recorded 73

Patients Admitted to the Virtual Ward 13

Patients Discharged from the Ward 17

Total Number of Patients on Ward 418

Saved A & E Admissions (Instances) 13

Patient Admission Avoidance (%) (Last 3 Months) 100%

Patient A & E Avoidance (%) (Last 3 Months) 69%

Ethnicity - Known 96.17%

Ethnicity - Unknown 2.87%

Ethnicity - Not Stated 0.96%

NHS Number Known 100%

C1b. Community Dashboard: Croydon Health Services

NHS Trust


Indicator Apr May Jun Jul Aug YTD Target YTD Actual Trend

Clinical Quality

Patients w ith VW or DN Care Plan (LT) (%) 9.4% 6.7% 5.6% 0 0 45% 5.6% q

Diagnosis Recorded (DN, VW, HVOP) (%) 3.3% 3.9% 3.8% 0 0 45% 3.8% q

Community Matrons - Hospital Admission Avoidance (%) 100.0% 100.0% 100.0% 0 0 >80% 100.0% ut

Community Matrons - A&E attendance Avoidance (%) 85.0% 85.0% 88.0% 0 0 >80% 86.0% p

Tissue Viability - 12 Weeks 0 0 0 0 0 TBA 0 ut

Tissue Viability - 24 Weeks 1 1 0 0 0 TBA 2 q

Activity and Productivity

Activity for Patients Requiring Continuing Care (No.) 1 1 3 0 0 n/a 5 p

District Nursing Response w ithin 48 Hours (%) 93.4% 89.2% 87.2% 0 0 95% 89.9% q

District Nursing Response w ithin 4 Hours (%) 100.0% 100.0% 100.0% 0 0 90% 100.0% ut

District Nursing Patient Facing Time (%) 23.0% 24.0% 21.0% 0 0 >20% 23.0% q

Stroke to Community Waiting Times (%) 50.0% 100.0% 100.0% 0 0 100% 88.5% ut

Virtual Ward

Total Number of Interventions 428 424 439 0 0 0% 0 0

Daily Intervention 9 9 10 0 0 0 0.0% 0.0%

Tw o Times per Week Intervention 3 2 2 0 0 0% 0.0% 0.0%

Weekly Intervention 41 41 40 0 0 0 0.0% 0.0%

Fortnightly Intervention 84 78 80 0 0 0% 0.0% 0.0%

Monthly Intervention 173 176 188 0 0 0% 0.0% 0.0%

Six Weekly Intervention 46 45 44 0 0 0% 0.0% 0.0%

No Intervention Recorded 72 73 75 0 0 0% 0.0% 0.0%

Patients Admitted to the Virtual Ward 17 13 22 0 0 0% 0.0% 0.0%

Patients Discharged from the Ward 22 17 11 0 0 0% 0.0% 0.0%

Total Number of Patients on Ward 426 418 428 0 0 0% 0.0% 0.0%

Saved A & E Admissions (Instances) 21 13 13 0 0 0% 0.0% 0.0%

Patient Admission Avoidance (%) (Last 3 Months) 100.0% 100.0% 100.0% 0.0% 0.0% 0% 0.0% 0.0%

Patient A & E Avoidance (%) (Last 3 Months) 67.0% 69.0% 70.0% 0.0% 0.0% 0% 0.0% 0.0%

Ethnicity - Know n 95.8% 96.2% 95.8% 0 0 0% 0.0% 0.0%

Ethnicity - Unknow n 3.3% 2.9% 3.0% 0 0 0% 0.0% 0.0%

Ethnicity - Not Stated 0.9% 1.0% 1.2% 0 0 0% 0.0% 0.0%

NHS Number Know n 100.0% 100.0% 100.0% 0 0 0% 0.0% 0.0%

47

C1c. Community Dashboard: Croydon Health Services

NHS Trust


Source: CHS community performance reports

Exception Reporting on Community Dashboard

All community patients have care plans but they are paper based and in the patients home. The figure provided here is the number of electronic care plans recorded

on EPEX.

Diagnosis recorded. The teams don’t diagnose patients. Most of the community patients have many co morbidities so capture of one diagnosis is poor. To be

reviewed as part of the targets review.

Tissue viability. This was a historical local CQUIN which is no longer monitored in this way and will therefore be reviewed as part of the targets review.

The DN response rate is better than recorded on EPEX as it does not record where CHS has attempted to contact the patient but the patient was not at home. That

could be because the patient is not house bound and then shouldn’t be referred anyway , but often the patient is still in hospital or could be at an appointment or

similar.

48

C1d. Performance Dashboard: Croydon Health Services

NHS Trust Fig 1. Performance Summary Dashboard

Performance Summary Dashboard - Croydon Health Services

NHS Trust

Source: CHS activity & finance proposal and CHS community performance report

Exception Reporting on Performance

This dashboard provides an overall summary for adult and children's services primarily using the M3 SLAM based on the Trusts proposed A&F schedule. The detail

behind the above red under performing areas has been provided on the following table and this is followed by a narrative on the service lines involved.

Overall as at M3 the community adult services are under performing by 66k (-1%).

Overall as at M3 the community childrens services are under performing by 91k (-6%) although note that the universal services childrens activity has not yet been

disaggregated at commissioner level and is therefore currently shown at plan with zero variance.

ADULT SERVICES Annual Contacts

Target

YTD Activity

Planned

YTD Activity

Actual

Referrals

in month 3 Deliveries

YTD

Contracts

Variance

Variance

for YTD

Adult Community Nursing Sub-Total 219535 55196 53564 1511 0 -1,632 -3%

Adult Therapy Services Sub-Total 86598 21620 20343 1726 0 -1,277 -6%

Other Community Health & Social

Services Sub-Total Equipment

Services/Deliveries 5000 1248 3345 - 1023 2,097 168%

Adult Learning Disabilities Sub-Total 5946 1428 1779 22 0 351 25%

Rehabilitative &Independent Living

Services Sub-Total 32591 7704 7753 223 0 49 1%

Rainbow Homeless Health Sub Total 7429 1664 1860 53 0 196 12%

Adult Services Total 357,099 88,861 88,644 3,535 1,023 -217 0%

CHILDREN'S SERVICES

CHILDREN'S SERVICES 59,767 15,046 13,819 872 0 -1,227 -8%

Total for CHS 416,866 103,907 102,463 4,407 1,023 -1,444 -1%

Year to Date

49

C1e. Contacts Dashboard: Croydon Health Services Fig 1. Community Activity Targets – Contacts

Community Activity Targets – Contacts - Croydon Health

Services NHS Trust

Service Team

Annual P lan

Activity

(Contacts)

Planned Unit

Cost

Annual

P lanned £

YTD

Activity

P lan

(Profiled)

YTD

Activity

Actual

YTD

Activity

Variance

% YTD

Activity

Varianc

e

YTD Planned

£YTD £

YTD Variance

£

% YTD £

Variance

District Nursing 188,795 35.58 6,717,326 47,729 46,264 (1,465) -3% 1,698,192 1,646,073 (52,119) -3%

Community Cardiac Nurse Specialists 3,604 69.83 251,667 840 822 (18) -2% 58,660 57,400 (1,260) -2%

CITM S 1,778 113.72 202,194 351 539 188 54% 39,927 61,295 21,368 54%

BHF Heart failure 2,021 83.72 169,198 466 563 97 21% 39,046 47,134 8,089 21%

Continence Service 1,728 454.74 785,791 415 526 111 27% 188,870 239,193 50,324 27%

Diabetes Nurse Specialists 5,428 101.94 553,330 1,381 1,036 (345) -25% 140,745 105,610 (35,135) -25%

Community M atrons (Virtual Ward) 10,146 55.72 565,335 2,472 2,391 (81) -3% 137,766 133,227 (4,539) -3%

HV for Elderly 6,035 67.91 409,837 1,542 1,423 (119) -8% 104,687 96,636 (8,051) -8%

Podiatry 39,815 25.94 1,032,801 10,112 9,130 (982) -10% 262,316 236,832 (25,484) -10%

Dietetics 2,516 55.31 139,160 633 618 (15) -2% 35,035 34,182 (854) -2%

Adult Physiotherapy 35,197 47.29 1,664,466 8,708 8,223 (485) -6% 411,784 388,866 (22,918) -6%

Community Pulmonary Rehabilitation Service 2,013 36.75 73,978 348 775 427 123% 12,792 28,481 15,689 123%

Adult SALT 2,910 92.37 268,797 766 719 (47) -6% 70,730 66,414 (4,316) -6%

Adult Occupational Therapy 1,708 748.78 1,278,916 394 442 48 12% 295,066 330,961 35,895 12%

Wheelchair Service 2,439 430.32 1,049,550 659 436 (223) -34% 283,626 187,620 (96,006) -34%

Specialist Community Health

Services Rainbow Homeless Health 7,429 35.85 266,330 1,664 1,860 196 12% 59,672 66,681 7,009 12%

Adult Learning Disabilities Learning Disability 5,946 159.87 950,587 1,428 1,779 351 25% 228,218 284,409 56,191 25%

CICS 15,265 46.06 703,106 3,783 3,705 (78) -2% 174,235 170,652 (3,583) -2%

A&E Liaison Team 4,961 58.85 291,955 1,194 1,231 37 3% 70,290 72,444 2,155 3%

Community Neurorehabilitation 5,625 103.96 584,775 1,417 1,251 (166) -12% 147,270 130,054 (17,217) -12%

Neuro-Psychology Service 854 164.35 140,355 202 191 (11) -6% 33,232 31,391 (1,841) -6%

Rehab Consultant 677 187.17 126,714 164 131 (33) -20% 30,685 24,519 (6,166) -20%

Community Stroke Team 5,209 57.1 297,434 944 1,244 300 32% 53,913 71,032 17,119 32%

352,099 3233.13 18,523,602 87,613 85,299 (2,314) 4,576,758 4,511,106 (65,652) -1%

Universal Services - Safeguarding Children

team 1 774338.36 774,338 0.25 0.25 0 0% 193,585 193,585 0 0%

Universal Services - Special Schools Nursing 1 348027.59 348,028 0.25 0.25 0 0% 87,007 87,007 0 0%

Children's' Hospital at Home (CHAH) 8,391 109.57 919,402 2,159 1,939 (220) -10% 236,605 212,456 (24,149) -10%

Children's' M edical Services 8,174 154.8 1,265,335 2,128 2,057 (71) -3% 329,361 318,424 (10,938) -3%

Paediatric Occupational Therapy 6,789 78.93 535,856 1,724 1,587 (137) -8% 136,107 125,262 (10,845) -8%

Paediatric Diabetic Children 602 89.81 54,066 121 165 44 37% 10,835 14,819 3,984 37%

Paediatric Physiotherapy 6,791 67.57 458,868 1,775 1,793 18 1% 119,965 121,153 1,188 1%

Paediatric SALT 22,681 59.92 1,359,046 5,456 4,674 (782) -14% 326,948 280,066 (46,881) -14%

Audio logy 6,339 44.16 279,930 1,682 1,604 (78) -5% 74,274 70,833 (3,441) -5%

59,769 1122970.71 5 ,994,868 15,046 13,820 (1,227) 1,514,686 1,423,604 (91,082) -6%

411,868 1126203.84 24,518,470 102,659 99,119 (3,541) 6,091,444 5 ,934,710 (156,734) -3%

A D ULT SER VIC ES T OT A L

C H ILD R EN 'S SER VIC ES T OT A L

C OM M UN IT Y T OT A L

Adult Community Nursing

Adult Therapy Services

Rehabilitative & Independent

Living Services

Universal Children's Services

Children's Specialist Services

50

C1f. Contacts Dashboard: Croydon Health Services

Exception Reporting on Integrated Care Performance

District Nursing is under performing by 3% ytd. This does not include the increase in double handed visits which the Trust can only count as one contact. EPEX was down

for a few days and the data entry catch up did not occur in time for the final report.

The Diabetes Nurse Specialist service under performance (25% ytd) is reported to be due to a nurse being on maternity leave.

Community matrons (VW) under performing by 3% ytd due to data entry issues with EPEX down.

HV for elderly under performing by 8% ytd due to data entry issues with EPEX down.

Podiatry under performing by 10% ytd. Trust reports recruitment to vacancies ongoing.

Adult physiotherapy under performing by 6% ytd due to vacancies, recruitment to which the Trust reports is ongoing.

Neuro-psychology under performing by 11% ytd. This is reported to be a small service and therefore reflects the impact of annual leave.

Under performance in wheelchairs (34% ytd), CICs (2% ytd) and therapies reported to be due to staff vacancies which have now in part been successfully recruited to so is

expected to improve. Recruitment is reported to be a challenge.

The rehabilitation consultant service is one person. Under performance (20% ytd) is due to study leave.

The significant over performance (168% ytd) on the number of equipment deliveries has been raised with CHS.

Note that the Rainbow Homeless Health service is subject to ongoing discussions as to responsible commissioner.

The work of the CCG on COBIC will enable a move towards outcome based commissioning focussed on frail elderly. It is therefore anticipated that the work of the CCWG

will focus more on paediatric services.

Exception Reporting on Children’s Specialist Services Performance

Children’s Hospital at Home . Variance -10% ytd. This is reported to be a relatively small population of patients compared to other services such as district nursing and

therefore a small change in patient numbers has a proportionately greater impact. Activity peaks when there are children that are near the end of life and there have recently

been a number of children in this category in recent months who have died so there will have been a peak followed by a drop.

Children’s Medical Services. Variance -3% ytd. This is reported to be due to a retirement in the community medical staff whose replacement will start in September and

another doctor on long term sick waiting surgery with some limited locum cover.

Paediatric OT. Variance -8% ytd. Activity below target due to long term sickness, maternity leave, vacancy (recruited to but staff member not yet in post) and new member of

staff requiring induction. Team leaders are reported to be proactively managing the situation. New therapist has completed induction and a start date arranged for other new

starter. Member of staff on long term sick leave has returned and therapist on maternity leave returns in August.

Paediatric SALT. Variance -14% ytd. SALT have had a high number of staff on maternity leave and have been unsuccessful in their attempts to attract staff on short-term

contracts to cover vacancies. Head of Service is working with Team Leaders to reduce the underperformance.

Paediatric Diabetic Children. Variance +37% ytd. CHS reports that this service consists of one nurse who had some prolonged leave at the end of last year but is now back

full time so this may account for the variation from outturn.

There is a need to review currencies and move towards currencies that are focussed more on episodes/care pathways and outputs rather than contacts. For example CHS

reports that it has made changes to some of the service models in therapy to include more training and development work with school staff for them to deal with less complex

cases and therefore targeting skilled staff to work with the referrals that require more expert input. This is reported to translate into fewer direct client contacts but to be a

more effective use of resources and generates better outcomes overall. The CCWG will consider this as part of its work programme.

51

C1g. Referrals Dashboard: Croydon Health Services Fig 1. Referrals to Community Services Month 3

Referrals to Community Services Months 1-3 - Croydon

Health Services NHS Trust

Source: CHS community performance reports

Notes

It is intended to undertake trend analysis including sources of

referrals where feasible.

ADULT

SERVICES

Team April May June

District Nursing 698 733 713

Community Cardiac Nurse Specialists 55 63 45

CITMS 78 59 71

BHF Heart failure 41 43 16

Continence Service 139 193 232

Diabetes Nurse Specialists 270 290 327

HV for Elderly 67 60 65

Long Term Conditions 2 1 1

Community Matrons (Virtual Ward) 25 25 35

Podiatry 140 145 77

Dietetics 67 64 49

Adult Physiotherapy 1,097 952 1,004

Community Pulmonary Rehabilitation Service 40 24 24

Adult SALT 20 29 24

Wheelchair Service 76 62 80

Adult Occupational Therapy (NHS) 465 449 468

Adult

Learning

Learning Disability 9 22 22

CICS 91 75 70

A&E Liaison Team 137 98 93

Neuro-Psychology Service 38 7 24

Community Neurorehabilitation 2 40 9

Rehab Consultant 14 10 12

Community Stroke Team 16 12 15

CHILDRENS SERVICES

Children's' Hospital at Home (CHAH) 17 27 22

Children's' Medical Services 182 153 144

Paediatric Diabetic Children 2 0 3

Paediatric Occupational Therapy 44 48 41

Paediatric Physiotherapy 17 22 16

Paediatric SALT 82 73 92

Audiology 283 553 554

TOTAL 4,214 4,332 4,348

Adult

Communit

y Nursing

Adult

Therapy

Services

Rehabilitat

ive &

Independe

nt Living

Services

Children's

Specialist

Services

General Update

Performance Dashboard: Intermediate Services

Quality Dashboard: Intermediate Services

Performance Update: Local Enhance Services

Financial Performance: Local Enhance Services



D: Non-Acute Contracts NHS Croydon CCG – Activity Month 3 2013

C: Non – Acute Contracts

NHS Croydon CCG – Activity Month 3 2013

C2a.Non -acute contracts

C2b.Performance Dashboard: Intermediate Services

C2c.Quality Report Dashboard: Intermediate Services

C2d.Performance Dashboard: Local Enhanced Services

(LESs)

General Update

This is the first month of reporting on non-acute contracts as part of the integrated report. The CSU has worked through a process

of meeting with CCG commissioning leads to draft a handover report on Croydon CCG’s intermediate and local enhanced services.

This has enabled the CSU to understand the status of each contract and prioritise issues for handling. The most significant issue is

the need to ensure contracts are up to date and identify contracts that require a decision for re-procurement. A paper detailing

identified issues and recommendations will be drafted for review by the Director of Commissioning.

A desk top review of intermediate services was undertaken and it highlighted the need to implement a robust monitoring process to

enable the CCG to identify issues impacting on quality. This has been prioritised for action.

Actions

Draft paper setting out issues and recommendations for the handling of AQP and LES contracts where contracts are due for

renewal.

Implement process for performance monitoring

Review performance information against current contract requirements

Seek assurance from providers that there is a critical mass of activity to the render the Intermediate Service contracts clinically safe

C2a.Non – Acute Contracts

Intermediate Services Contract Financial Performance

1. Planned savings for Quality, Innovation, Productivity and Prevention (QIPP) is slower than expected for the dermatology, ENT

and gynaecology AQP contracts. Figure 1 overleaf identifies the financial performance year to date, performance includes costs

such as project management, Magnetic Resonance Imaging (MRI) and Computer Tomography (CT) activities undertaken by Any

Qualified Providers (AQP). Please note financial performance on AQP contracts is also captured in the QIPP report produced by

the CCG Programme Management Office.

2. Dermatology AQP – The service is provided on a cost and volume contract with Croydon Clinics Limited. The month 3 YTD

savings plan is £68,506 below plan

3. Ear Nose and Throat AQP - There are three (Croydon Health Services, The Practice Plc. and Croydon Clinics) providers whose

activity consists of a range of conditions which were previously commissioned in the hospital . Triaging is carried out by CUH

consultants. The 2013/14 contracts are cost and volume with an annual indicative budget of £ 434,795. The month 3 YTD

savings plan is £8,231 below plan.

4. Gynaecology AQP - This service is delivered by Croydon Health Services, the month 3 YTD savings plan is £118,597 below

plan

5. The Croydon Ophthalmic Referral Service (CORS) performance will continue to be managed by the CCG Service Redesign

Team. Contract management will be handed over to the SLCSU after the appointment of a Single Lead provider in November 2013.

C2b. Performance Dashboard: Intermediate Services

Performance Dashboard: Intermediate Services

Figure 1. Performance Summary

Dashboard Apr-13 May-13 Jun-13

Total Quarter

1

Monthly

target

variance

Variance for YTD YTD Savings

Target

YTD Savings

Variance

Variance for

YTD

Dermatology

TOTAL SAVINGS PLANNED £ 41,897 £ 41,897 £ 41,897 £ 125,691 -£ 68,509 -55% £ 412,503.0 -£ 355,321.00 -86%

ACTUAL £ 426 £ 32,193 £ 25,415 £ 57,182

NET SAVING PLANNED £ 32,233 £ 32,233 £ 32,233 £ 96,699 -£ 62,321 -64% £ 331,969.0 -£ 297,591.29 -90%

ACTUAL £ 2,783 £ 17,334 £ 14,261 £ 34,378

Apr-13 May-13 Jun-13 Total Quarter

1

Monthly

target

variance

Variance for

Quarter 1

YTD Savings

Target

YTD Savings

Variance

Variance for

YTD

ENT


ACTUAL £ 13,291 £ 13,312 £ 1,938 £ 28,541


ACTUAL £ 13,421 £ 7,369 £ 1,201 £ 21,992

Apr-13 May-13 Jun-13 Total Quarter

1

Monthly

target

variance

Variance for YTD YTD Savings

Target

YTD Savings

Variance

Variance for

YTD

Gynaecology


ACTUAL £ 5,715 £ 5,265 £ 7,804 £ 18,784


ACTUAL £ 1,433 £ 5,059 £ 1,200 £ 7,691

C2c.Quality Report Dashboard: Intermediate Services

Figure 2. Quality Summary Dashboard - Intermediates Services

Identify Clinical

Lead for NHS

Croydon

Assessment of

compliance with

Care Quality

Commission

Essential

Standards of

Quality and

Safety (2009)

Clinical

Audit 1

Agreed

Clinical

Audit 2 -

Agreed

NICE -

Action to

guideline

(if

relevant)

Service user

survey

completed by

75% of patients

Service

Improvement

plan stemming

from user and

carer feedback

Discharge

letter

(random

sample of

95% of total

sent within 5

working days

)

Complaints

received

PALS

complaint

received

Untoward

occurences -

reported

within 24

hours (if

relevant)

Serious

Incidents -

reported

within 24

hours (if

relevant)

Root cause

analysis

(RCA)

lessons

learnt and

recommenda

tions

completed

within 45

working days

Any Willing Provider ENT

Practice Plc

Croydon University Hospital

Croydon Clinics

Any Qualified Provider

Dermatology

Croydon Clinics Limited

Any Qualified Provider

Gyneacology

Croydon University Hospital

Intermediate Vasectomy

Parkside Surgery

The Quality Summary Dashboard for intermediate services indicates reporting issues and is not necessarily indicative of poor

performance. A Clinical Reference Group is being establish to assess provider performance against quality indicators in the

intermediate service contracts. An initial meeting was held to establish what had previously been collected to assist quality

monitoring this highlighted a gap in the monitoring process.

Local Enhanced Services Contract Management Context

This dashboard provides an overall summary for the CCG’s Local Enhanced Services. GP Practices provide local

enhanced services for their registered practice population as an extension to the General Medical Service primary

care contract with NHS England. The CCG will continue to have responsibility for commissioning enhanced services

during 2013/14 until they expire on 31 March 2014.

The LES Performance Summary for Month 3 does not provide an accurate description of spend and activity per

practice. It is expected that anomalies will be rectified as part of the 6 months reconciliation process. The SLCSU will

be providing more detailed analysis of LES activities in future Integrated Reports.

1. Urology LES – At month 3, the Urology LES is over performing by £901 reflecting variance of 4% above plan.

2. Minor Surgery LES – At month 3, the Minor Surgery LES is over performing by £ 2855 reflecting variance of 5%

above plan. This service is provided by nine practices to GP Practices that do not deliver the NHS England Minor

Surgery directed enhanced service.

3. Minor Surgery LES and Phlebotomy LESs are been reviewed as part of the process for identifying resources that

will support unfunded services that have been identified by Local Medical Committee Surrey Sussex and local GP

Practices.

4. The lack of clinical audit regime for LESs needs to change. A discussion paper regarding the future of LESs will

be presented to the Director of Commissioning in September.

Actions

• Work with practices to understand activity levels per practice.

• Review the impact of over performance on the LES budget

• Implement a regime of clinical audit to assess quality

C2d.Performance Dashboard: Local Enhanced Services (LESs)

Performance Dashboard: Local Enhanced Services

Figure 1. Financial Summary Dashboard Month 3

Local Enhanced Services

No of Practices

signed up to LES

2013/14

Practices

Claimed

Quarter 1

Actual Spend

Quarter 1

Quarter

Spend Plan YTD Target

Forecast outturn (-

over)/ underperformance

£

Variance from YTD

Plan

Urology LES 22 12 £5,901 £5,000 £20,000 -£ 901.00 -5%

Mental Health LES 0 0 £0 £10,000 £40,000 £ 10,000.00 25%

Pre-Operative check Hernia LES 15 0 £0 £5,000 £20,000 £ 5,000.00 25%

Phlebotomy LES 48 27 £39,927 £83,000 £332,000 £ 43,073.00 13%

Minor Surgery LES 9 7 £22,855 £20,000 £80,000 -£ 2,855.00 -4%

Coeliac LES 11 7 £1,050 £2,500 £10,000 £ 1,450.00 15%

Barrett's LES 15 10 £2,350 £5,000 £20,000 £ 2,650.00 13%

COPD LES 41 18 £14,550 £22,438 £89,750 £ 7,887.50 9%

Palliative Care LES 48 26 £5,188 £21,625 £86,500 £ 16,437.00 19%

Diabetes LES 21 1 £350 £64,369 £257,474 £ 64,018.50 25%

Care Home LES 21 4 £6,066 £58,132 £232,527 £ 52,065.75 22%

GP Engagement/ Demand

Management LES 0 0 £0 £142,850 £571,399 £ 142,849.75 25%

Risk Stratfication and MDT LES 39 8 £7,750 £85,400 £341,600 £ 77,650.00 23%

Total 290 120 £106,107 £525,313 £2,101,250 £ 419,205.50 20%

1. The financial plan is based on 2012/13 outturn. The dashboard provides an indicative position due to sporadic claiming by GP

Practices. SLCSU is regularising the process by which practices claim LES income.

2. SLCSU will seek to work with Clinical Leads and practices to cap activity provided under the LES so that spend is maintained

within the budget allocated to enhanced services or seek agreement from SMT to consider increasing the budget where an

associated decrease in activity is identified in the acute spend.

CQUINs

Link to Quality Report

D: Quality NHS Croydon CCG – Activity Month 2

D: Quality NHS Croydon CCG – Activity Month3

CQUINs

Link to Quality Report

60

D1. 2013/14 CQUIN Schemes

Goal

Number Goal Name Description of Goal

% Value of

2.5%

CQUIN

Goal

Weighting

(% of

CQUIN

scheme

available)

Expected

Financial

Value of

Goal

Safety Effective-

ness

Patient

Experience

Commissioner

Lead

1 National - VTE Reduce avoidable death, disability and chronic ill

health from Venous Thromboembolism (VTE)

0.125 5% £214,466 Yes Yes Yes SW

2 National - Dementia Improve awareness and diagnosis of dementia,

using risk assessment, in an acute hospital setting

0.125 5% £214,466 Yes Yes Yes SW

3 National - Patient Safety Thermometer To reduce harm and deliver improvement locally. 0.125 5% £214,466 Yes Yes Yes SW

4 National - Family and Friends Tests Improve the experience of patients in line with

Domain 4 of the NHS Outcomes Framework. .

0.125 5% £214,466 Yes SW

5 Maternity To improve staffing numbers, safety and

performance in maternity services

0.30 12% £514,717 Yes Yes Yes SW

6 Safeguarding/HV To improve the safeguarding of children through

increased coverage of Healthy Child Programme

key milestone reviews, including follow ups, and to

improve attendance rates at safeguarding

conferences. Implementation of the Multi-agency

Safeguarding Hub.

0.20 8% £343,145 Yes Yes Yes JM

7 Psychiatry liaison & alcohol admission

avoidance

To improve services for patients requiring alcohol-

related services by ensuring adherence to best

practice (NICE) protocols, improving GP and

community communication and decreasing length

of stay and admissions for alcohol-related causes.

0.20 8% £343,145 Yes Yes Yes SW

Agreement has been reached on CQUINs for 2013/14. For months 3 the final list of CQUIN goals and values is shown below for

information, performance achievement will be presented quarterly.

61

D1. 2013/14 CQUIN Schemes

Goal

Number Goal Name Description of Goal

% Value

of 2.5%

CQUIN

Goal

Weighting

(% of

CQUIN

scheme

available)

Expected

Financial

Value of

Goal

Safety Effective-

ness

Patient

Experience

Commissioner

Lead

9 Achieve TDA standards for nursing skill mix, improve hospital at

night and weekend, appointment of additional consultant posts to

support investment in RATT (investment in A&E to reduce NEL

admissions).

70/30 nursing skill mix, support improvement in achieving the A&E

target , support a reduction in emergency admissions. Improve

identification and management of deteriorating patients.

0.950 38% £1,629,939 Yes SW

10 Medicines Optimisation Optimise the use and management of medicines 0.13 5% £214,466 Yes Yes Yes SW

11 EOLC Improving care for patients approaching the end-of-life in hospitals, in

line with the SWL Cluster commissioning intentions, with an increase

in the number of patients being placed on palliative care

communication registers.

It is expected that the CQUIN will make a contribution to the national

aim of improving the proportion of patients who die in their preferred

place of care.

0.125 5% £214,466 Yes Yes Yes SW

Total 100% £4,289,312

62

D2. Quality Report: CQUINs

CHS

KCH ESH SGH

Value

Available

Value

Available

Value

Available

Value

Available

Value

Available

Value

Available

Value

Available

Value

Available

Q1

Q2

Q3

Q4

The Q1 position for CQUINs is in the process of being validated this slide will be populated for

Q1for month 4

63

D3a. Quality Dashboard – CHS

Footnote : CQUINs will be reported on quarterly in a separate report (report name and details to be defined)

Section C – Quality: Quality Dashboard – CHS

Fig 1. Quality Dashboard

Category Indicator

Reportin

g Period Target Apr May Jun Jul

Data

Source S

afe

ty

Mortality: SHMI Quarterly <1 0.9561 0.9561 0.9561 HSCIC

SIs: Number per month Monthly 0 23 27 Provider

Scorecard

Number of Never Events Monthly 0 1 0 0 Provider

Scorecard

Maternity: % women booked before 12 weeks 6 days, :Monthly 90% 68% 77% 85% Provider

Scorecard

Maternity: % Caesarean Section Rate Monthly <24% 22.9% 22.0% 24.6% Provider

Scorecard

Maternity: Midwife/birth ratio Monthly 1:28 1:29 1.29 1.29 Provider

Scorecard

CAS Alerts Outstanding Monthly 0 2 0 3 NPSA

Adult Safeguarding: % of staff compliant with training 72%

Child Safeguarding: %of staff compliant with training

Falls: Moderate Harm Monthly N/A 1 2 2 NST Tool

Falls: Major Harm Monthly N/A 0 0 0 NST Tool

Falls: Death Monthly N/A 0 0 0 NST Tool

Pressure Ulcers, Grade 2 Monthly N/A 39 44 12 NST Tool

Pressure Ulcers, Grade 3 Monthly N/A 14 15 14 NST Tool

Pressure Ulcers, Grade 4 Monthly N/A 1 5 NST Tool

VTE Risk Assessments Completed on Admission Monthly 95% 94.66% 90.00% 90.27% Unify

Experie

nce

Complaints: Number of complaints Monthly 11 11 7 Provider

Scorecard

Complaints: % replied to within 25 days Monthly 80% % 20% % Provider

Scorecard

Friends and Family Test: Net promoter score

Numerical

monthly

score from

July 2013

onward

Inpatient

35%.

19.8%

combined

A&E and

Inpatient

Provider

score card

Nutrition: Nutrition score not completed within 48 hours

Nutrition: Nutrition score not maintained weekly, instances per month

Clinical Efficiency Timeliness of discharge letters

64

D3b. Quality Commentary – Croydon Health Services

Friends and Family – 0.125% value CQUIN

The response rate for friends and family is less than 15% therefore the trust is not meeting the level of response required for the CQUIN. The

Trust is using volunteers to expedite efforts to improve data collection and is implementing the use of mobile tablets. The next stage of the

Family and Friends Test is to review patient responses and the Trust’s corresponding actions. This will continue to be reviewed as part of the

CQUINs programme

VTE

The performance of VTE risk assessment on admissions is at 91.93% , this an improvement from May 2013 where 84.85% was achieved.

The Trust is on target to achieve 95% during Q2.

Pressure sores

The Quality team has investigated the level of pressure sores at the Trust and has noted an improvement compared with 2012/13. Actions

have been taken and the Director of Nursing is focussing on wards where the majority of pressures sores occur and is holding charge nurses

to account for implementing the pressure sore policy. It is expected that improvements will continue during 2013 – 2014 as a result of higher

level of scrutiny at ward and nursing team level. CHS has progressed the actions during the last 10 week s led by the Director of Nursing and

Midwifery. Progress will be reported to the September 2013 CQR meeting.

Actions taken

• Pressure Ulcer committee established and policy developed.

• Training sessions have taken place and an e-learning programme has been rolled out.

• An audit of the equality of mattresses was carried out in June 2013 followed by a business case to continue a replacement programme.

Section C – Quality: Quality Dashboard – CHS

CCG User Guide A guide to terms, assumptions, and data sources used in the Integrated

Report

CCG User Guide A guide to terms, assumptions, and data sources used in the Integrated

Report

66

Integrated Report: CCG User Guide

Section A - Contract Finance Monitoring

Contract Monitoring YTD (F3 & F2 Bridging Analysis)

Underpinned by Provider SLAM monthly data and mitigations; Commissioner risk assessed –

SLAM anomalies and attribution (e.g. uncoded and non-recurrent spells, critical care for specialist)

Risk assessed credits pertaining to CSU claims management

Contract based financial adjustments

Other risk assessed financial adjustments (e.g. contract queries, claims and challenges)

Full Year Plan (F3 Financial Summary)

The indicative financial figure upon which the CCG has signed an acute contract in 2013/14 with the named Provider.

Finance Board Report YTD and Forecast Outturn (F3 Financial Summary)

Up-scaled the contract monitoring figure one month in advance

Includes further adjustments for the number of working days, seasonality and RTT

Future months’ forecasts will be based assessments of including the impact working days, seasonality, RTT and underlying activity growth trends.

Financial Performance Tables

These tables are presented for the overall acute position and also for each Trust. The tables show the cumulative contract monitoring position, the financial position and also the

forecast position for the year.

The financial position is always one month in advance (e.g. the Financial position for Month 3 is based on the contract monitoring position for Month 2). Finance positions are

calculated by up-scaling contract monitoring positions by one month, up a straight-line basis.

QIPP Delivery Tables

These show the delivery of QIPP initiatives in total and for each Trust. We are working closely with CCGs and Trusts to finalise QIPP reporting for 2013/14 and this will be reflected

in future months’ reporting.

CCG User Guide

67


Section B – Demand and Activity Trend Analysis

Referrals


Referral data is based on 1st outpatient attendances

Data source is Secondary Uses Service SEM unless otherwise stated

A&E

UCC activity is included within A&E activity and is not shown separately


Source is Secondary Uses Service SEM unless otherwise stated

Outpatients


Unbundled Imaging not recorded under TFC 812 is included and may cause show as inconsistency in comparisons between years


Source is Secondary Uses Service SEM unless otherwise stated

Admitted Patient Care


CCG User Guide

68


Section C – Performance

Performance is shown by either CCG or Provider accountabilities on a monthly or quarterly basis.

P1a Figure 1 reports on a selected list of key indicators on a CCG or provider basis. Narrative is on an exception basis.

P2a/b Figure 1 includes all NHS Constitution monthly/ Quarterly indicators on a CCG basis

P3a/b Figure 1 includes all NHS Constitution monthly/ Quarterly indicators on a provider basis

P4 Figure 1 provides details on financial penalties which are applied on a CCG basis and will be updated on an ongoing basis as data becomes available.

P4 Figure 2 provides details on financial penalties which are applied on a trust wide basis and will be updated on an ongoing basis as data becomes available.

CB_B5, CB_S4, CB_S9 - Main provider performance attached in the absence of confirmed performance apportionment.

CB_B5 A&E 4 hour waiting time compliance, CB_S4, A&E attendances and A&E Type 1 attendances show main provider performance attached in the absence of confirmed performance

apportionment

CB_S6 Referral To Treatment in excess of 52 weeks - There is no national threshold yet for admitted or non-admitted pathways above 52 weeks, at present a red rating has been applied for

any value >0. Only 52+ weeks on incomplete pathways (ie patients still waiting) attract a financial penalty.

CB_S9 A&E Trolley waits over 12 hours show main provider performance attached in the absence of confirmed performance apportionment.

The CB S1-03 trajectories Non elective FCEs, all first outpatient attendances and G and A elective FFCEs will be updated after the most recent resubmission to Unify is available for

download, please note that this dashboard compares activity reported in the MAR against the activity trajectories submitted in the planning round and not contract activity or contract plan

CCG User Guide

69

Section D - Quality

The following indicators are sourced from the Health and Social Care Information Centre

Mortality: SHMI - Standardised Hospital Mortality Indicator: The Summary Hospital-level Mortality Indicator (SHMI) is a national mortality indicator. It is a statistical model which calculates

the expected number of deaths at an individual provider and compares this to the actual number of deaths within the period. A value of less than 1 indicates that the mortality rate is lower

than would be expected, and a figure greater than 1 would indicate that the mortality rate is higher than would be expected.

Falls: Moderate Harm, Major Harm, Death (Data and definitions from the NHS Safety Thermometer)

Total number of Pressure ulcers , Grade 2, Grade 3, Grade 4 (Data and definitions from the NHS Safety Thermometer)

VTE Risk Assessments Completed on Admission NB These is not the same as the Unify2 submitted and reported National CQUIN VTE assessment data set.) All patients who are

admitted to hospital should have a venous thromboembolism (VTE) risk assessment completed to assess whether the preventative measures need to be taken to minimize the risk of the

patient developing a blood clot. (Data and definitions from the NHS Safety Thermometer

The following indicators are from Provider Submissions

SIs: Number of SIs – Number of serious incidents reported within the report month

Number of Never Events - Number of Never Events as defined by the NHS Standard Contract 2013/14 reported during the reporting month

Maternity: % women booked before 12 weeks 6 days and % Caesarean Section Rate

Adult Safeguarding: % of staff compliant with training and Child Safeguarding: %of staff compliant with training

Complaints: Number of complaints – Number of complaints received within the reporting month

Friends and Family Test: Net promoter score: From April 2013 all trusts had to implement the Friends and Family Test (FFT) and ask patients (initially inpatients and those attending A&E)

whether they would recommend the hospital to their friends and family if they needed care or treatment. Trusts were set the target of achieving a 15% response rate for Q1 (rising to 20%

in Q4), and improve their scores over the course of the year. Results of the surveys will begin to be published nationally from the end of June.

Timeliness of discharge letters

The following are provided for use to SL CSU by MHRA

CAS Alerts Outstanding - Number of CAS Alerts outstanding in the report month: The Central Alerting System (CAS) is a web-based cascading system for issuing patient safety alerts,

important public health messages and other safety critical information and guidance. Should a trust have a CAS alert outstanding, it means that the Trust has not yet taken the actions

required to step down the alert, and that the alert is overdue


CCG User Guide

croydon ccg integrated report body...2013/09/24 · this is being challenged and is subject to the...

Documents