nhs rotherham clinical commissioning group body papers... · from 2016/17 the performance framework...
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NHS Rotherham Clinical Commissioning Group
Operational Executive 23 January 2017
Strategic Clinical Executive 25 January 2017
GP Members Committee 25 January 2017
Governing Body 1 February 2017
Commissioning Plan Performance Report: Quarter 3
Lead Executive: Ian Atkinson, Deputy Chief Officer Lead Officer: Lydia George, Planning and Assurance Manager
Alex Henderson-Dunk, Performance and Intelligence Manager Lead GP: N/a
Purpose:
For the Governing Body to note the progress with delivery of the CCGs Commissioning Plan as at the end of Quarter 3.
Background:
In 2013 a performance framework for the Commissioning Plan was developed so that the CCG could assess its progress against key priorities and on its implementation of the plan. The report has been refined each year but has broadly remained the same.
In Quarter1 of 2016/17, in line with the new CCG Improvement and Assessment Framework and the revision of the GB overall performance report the Commissioning Plan performance Report was revised to provide a fuller picture of delivery. The key changes were:
• Each of the 15 priority areas from the Commissioning Plan are reported • Each priority area has clear milestones and targets aligned to the Commissioning Plan • Each priority area includes Key Performance Indicators taken from the new CCG
Improvement and Assessment Framework metrics, the new Governing Body Performance report, Quality Premiums, the Better Care Fund or are regular key local metrics already reported
• QIPP information is included for those priority areas that are subject to QIPP • Any associated risks from the GB Assurance Framework are reported • Lead GP and Lead officers are reported
From 2016/17 the performance framework will be reported 4 times a year and will be received at Governing Body in August, November, February with a final year- end report in May.
Analysis of key issues and of risks Lead officers have provided commentary against the milestones where performance is off track. From quarter 2 officers were asked to identify any milestones where the direction of travel had the potential to deteriorate or improve.
In addition, in line with the GB performance report, commentary is provided for Key Performance Indicators that are not on track.
Milestones There are 52 milestones in total, see breakdown below:
RAG rate Number of milestones %
Red 0 0 Amber 3 6 Green 49 94 Total 52 100
The number of milestones on track or completed has increase from 90% in quarter 1 to 94% in quarter 3.
Amber milestones are summarised below:
RAG rate
No. Milestone description Commentary Q1 position
Amber 3 M29: Delivery the required number of bed reductions as per Rotherham element of the LD plan
M39: Involvement of the care co-ordination centre in the EOLC pathway
M40: Achieve 40% implementation of the Case Management Palliative Care Template in Primary Care
M29: Moved from green to amber in Q1, the local target is being met but we are measured on the TCP trajectory which is not on track
M39: Discussions continue to take place and it is still the intention for the CCC to be a single point of access for EOLC.
M40: Decision to be included only recently made, therefore implementation is just starting
M29: same as Q2 M39: Same as Q2 M40:Same as Q2
To note:
• M4: Primary Care Self-Care Pilot: moved from Amber in Q2 to Green in Q3 • M18: Extension of Virtual clinics from haematology to other areas such as
endocrinology: from Red in Q2 to Green in Q3
It is worth noting that whilst the RAG rate for the following milestones remains the same as Q2, it has been highlighted that there is the potential for the direction of travel to change.
Q 2
RAG rate
Direction of travel Milestone description Commentary
Green Completion of Business Case for the re-ablement village
There are delays due to the timing of decisions through organisations governance structures. Strategically, through the Rotherham Place Plan this area is on track, however there is a risk of not achieving this target set through BCF.
Green RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan
On track, some concern that the plan will not be produced, assurance being monitored via the MH/LD QIPP Committee.
Key Performance Indicators (KPIs) There are 48 milestones in total, see breakdown below:
RAG Rate Number of KPIs %
Red 7 14 Amber 6 13 Green 20 42 *WD 15 31 Total 48 100
* these KPIs are awaiting further data nationally
Overall there are approximately 42% of KPIs on track, which has increased from 29% in Q2.There still remains a significant number of KPIs still awaiting national data, however this number has decreased from 25 in Q1.
Below is a list of the red and amber KPIs, commentary on performance can be found in the Governing Body Performance Report or Governing Body Quality Report.
RAG rate
No. Key Performance Indicator Description Q1 position
Red 7 K2: Utilise NHS e-referral service to enable choice at 1st routine elective referral K3: Contain growth in the number of non elective admissions K5: Achieve A&E 4 hour access standard K7: People who have had a stroke who are admitted to the acute stroke unit in 4 hours of arrival to hospital K13: Cat A ambulance response calls within 8 minutes K17: Reduction in the number of antibiotics prescribed in primary care K44: Cancer (all) diagnosed at stage 1 and 2
K2: Same as Q2
K3: Same as Q2 K5: Same as Q2 K7: Same as Q2
K13: Same as Q2 K17: Not known in Q2 K44: Same as Q2
Amber 6 K1: Patient experience of GP services K4: Contain growth in A&E attendances K28: Reduce the number of people admitted in line with the South Yorkshire and North Lincolnshire LD TCP trajectory K 40: Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 28 days from the receipt of the continuing healthcare checklist – Adults (K40). K41: Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 6 weeks from the receipt of the continuing healthcare checklist – Childrens K46: Percentage seen within 62 days after a referral by GP
K1:Not known in Q2 K4: Same as Q2 K28: Same as Q2
K40: Same as Q2 K41: Same as Q2 K46: Red in Q2
To note:
• K21: Percentage of people ‘moving to recovery’ of those who have completed IAPT treatment: moved from amber in Q2 to green in Q3.
• K23: Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment: moved from red in Q2 to green in Q3.
Finance The position in terms of QIPP savings reported in Q2 remains the same in Q3 with the following exceptions, narrative for the QIPP position can be found in the Finance and Contracting Governing Body report:
Commissioning Priority QIPP Scheme Q1 Q2 Q3 Unscheduled Care Reducing levels of activity growth in
A&E
Transforming Community Services
Reducing levels of activity in emergency admission – neuro rehab, integrated rapid response and integrated locality teams
Clinical Referrals Reducing levels of activity growth in direct access pathology in line with clinical pathways
Reduce IHAM NHSE growth assumption in line with local trend analysis
Medicines Management Unidentified Rebates and contract efficiencies
Risk There are no new risks since Q2 and the scores remain the same as reported in Q2 with the exception of the following:
Risk Risk Description Q2 position
Q3 position
Impact of changes to primary care support England from NHS to Capita contract
Issues in relation to collection and delivery of medical records, this is a national not local issue
16 12
Approval history:-
OE 23 01 2017
SCE 25 01 2017
GPMC 25 01 2017
CCG GB 01 02 2017
Recommendations:
The Governing Body are asked to note the report and to note:
1. The position in term of milestones is positive and has improved from 90% Q2 to 94% in Q3, however there are 2 milestones with the potential to go off track.
2. The position in terms of KPIs is positive and has improved from 29% in Q2 to 42% in Q3. However there are still a number of KPIs which are waiting for national data.
Commissioning Plan Performance Report 2016/17
Q3
Meeting Date
Operational Executive 23 01 2017 Strategic Clinical Executive 25 01 2017 GP Members Committee 25 01 2017 CCG Governing Body 01 02 2017
Definitions for RAG Ratings:
Red KPI Milestones QIPP
Less than 2% achieved Not started or significant issues Not started or Started but still high risk
Amber
KPI Milestones QIPP
Within 2% achieved Started but not on track OK with medium risk
Green
KPI Milestones QIPP
Achieved or complete On track Achieving as planned
Please note
• That there are a number of KPIs from the new Improvement and Assessment Framework where data is not available yet.
1
1 Primary Care Lead GP: Jason Page Lead Officer: Jacqui Tufnell
Funding in 2016/17 = £0.6m for the LIS, £1.2m for Case Management and funding for the CCG Commissioned LES’s
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M1 Primary Care Quality Contract – implement and monitor 3 standards for 2016/17.
Com / primary care plan
Q1 G G G On track
M2 Primary Care Quality Contract – develop remaining standards for 2017/18
Com / primary care plan
Q3 G G G On track
M3 Primary Care Quality Contract – Agree contracts for 2017/18 standards
Com / primary care plan
Q4 G G G On track
M4 Primary Care Self-care pilot – complete tele-health evaluation
Com / primary care plan
Q2 A A G The evaluation has been completed and it has been approved by the primary care committee to roll-out introduction to all practices.
M5 Monitor and evaluate the effectiveness of the Care Home Alignment with GP practices
Com / primary care plan
Q4 G G G On track
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4
K1 Patient experience of GP services (I&AF 128b)
I&A Framework Quality
premium
85% or a 3% increase on Jul-
16
WD WD A Performance from two most recent survey waves is 84.8% - wave 1 was Jul-Sep 15 / wave 2 was Jan-Mar 16. Almost achieved
K2 Utilise NHS e-referral service to enable choice at 1st routine elective referral (I&AF 105a)
I&A Framework Quality
premium
80% or 20% increase on
Mar-16
R 61.6%
R 73.1%
R 67.3%
October 16
Agreed action plan in place with TRFT which we continue to monitor. There has been significant improvement across specialities, but 2 remain challenging. IT team are working with GPs to increase utilitsation.
QIPP APMS Core Contract Values QIPP Plan £125,000 G G G See GB Finance and Contracting report
Premises Costs reimbursements QIPP Plan £118,000 G G G See GB Finance and Contracting report Property Services QIPP Plan £274,000 G G G See GB Finance and Contracting report
Risks Risk Description Risk Score GP quality and Efficiency GB Assurance
Framework Failure to improve GP quality and efficiency in partnership with NHS England - current concerns are due to overall GP capacity
d l )
12
CQC inspection of practices GB Assurance Framework
Worst case scenario, a practice may be identified as so inadequate that emergency arrangements have to be enacted
12
Impact of changes to primary care support England from NHS to Capita contract
GB Assurance Framework
Issues in relation to collection and delivery of medical records, this is a national not local issue
12
To note, the following KPIs are within the I&A Framework but are not currently in publication • Primary care access (I&AF 128c) • Primary care workforce (I&AF 128d)
2 Unscheduled Care Lead GP: David Clitherow Lead Officer: Sarah Lever / Claire Smith
Funding in 2016/17 = £60.1m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M6 Completion of the capital Build for the Emergency Centre (Q2 2017/18)
Com Plan STP
Q4 G G G On track - Handover from Kier planned for May 17 (currently ahead of schedule likely April 17). Once handed over, infrastructure (IT and equipment) will be put in place before cleaning ready for decant from B1.
M7 Implement new IT system Com Plan Q3 G G G IT system went live October. Initial problems encountered in recording performance data were rectified in December 16. M8 Full implementation of the Emergency
Centre Model Com Plan
STP Q3 G G G On track - scheduled for 6th July 17
M9 Expand role of the Care Co-ordination Centre (CCC) to manage the interface between acute /community
Com Plan STP
Q3 A G G
Expansion of CCC on track, further discussions to take place around the clinician to clinician proposals still ongoing. Project group set up and action plan in development
M10 Ensure replacement Risk Stratification Tool is in place to support the reduction in emergency admissions
Com Plan Q4 G G G On track – target changed to Q4 (from Q3). There have been delays with the development by Dr Foster but roll-out is expected mid-February with full implementation by the end of March
2
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K3 Contain growth in the number of non-elective admissions
Contractual target
Meet contracted
levels
R R 0.6m over-performance Apr-Nov YTD on emergency admissions and 0.7m on emergency assessments. Across all acute contracts.
K4 Contain growth in A&E attendances Contractual target
Meet contracted
levels
A A 0.3m over-performance Apr-Nov YTD on A&E attendances across all acute contracts.
K5 Achieve 4 hour access standard for A&E Constitutional GB Report
95% by Q4 R 91.6%
YTD as at 30/06
R 91.7%
YTD as at 02/10
R 79.2%
YTD as at Dec 16
TRFT were unable to report performance in November and part of December due to system issues following the change over to MEDITECH in A&E. The agreed A&E improvement action plan continues to be monitored closely by the CCG with assurance being provided through the contractual mechanism and A&E Delivery Board.
K6 Reduce unplanned hospitalisation for chronic Ambulatory Care Sensitive conditions (I&AF 106a)
I&A Framework GB Report
1,074 WD WD WD Still awaiting data publication
QIPP Delivery of A and E Assessments through the Clinical Decision Unit
QIPP Plan £286,000 G G G See GB Finance and Contracting report
Reducing levels of Activity growth in A&E QIPP Plan £280,000 A A R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.
Reduce IHAM NHSE growth assumption in line with local trend analysis
QIPP Plan £226,000 R R R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.
Risks Risk Description Risk Score Unscheduled Care QIPP GB Assurance
Framework Failure to deliver system wide efficiency programme for unscheduled care
20
A&E target GB Assurance Framework
Failure to meet A&E targets 16
3 Transforming Community Services
Lead GP: Phil Birks Lead Officer: Claire Smith Funding in 2016/17 =£28.5m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M11 Implement and monitor the Integrated Locality Team at the Health Village
Com Plan Q2 G G G On track
M12 Implement and monitor the Integrated Rapid response Service
Com Plan Q2 G G G On track - Note that staff are integrated on one site a lead is now in post. Main concern is the lack of visibility on the KPIs
M13 Completion of the Business Care for the Re-ablement Village
Com Plan Q4 G G G
Significant analysis of the current position has been completed. A project group has been established. Joint approach required with RMBC, there have been delays due to timing of decisions. Strategically on track via Rotherham Place Plan, however risk of not achieving this BCF milestone
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K7 People who have had a stroke who are admitted to the acute stroke unit in 4 hours of arrival to hospital
Quality Premium GB Report
90% national standard
R 50.0%
R TRFT
position = 55%
R TRFT
Position = 73%
TRFT position used for Q2 and Q3 (part of) as most up to date available and is reflective of overall CCG position
K8 Emergency readmissions within 30 days of discharge from hospital
BCF GB report
12.2% R Jun 16 YTD = 12.3%
G Sep 16 YTD = 12.2%
G Oct 16 YTD = 12.0%
On track but performance only just meets the target
K9 Delayed transfers of care from hospital (I&AF 127e)
I&A Framework BCF
GB Report Quality
Premium
Sep 16 Target YTD = 1477.2 delayed days
from hospital per 100,000
population ( 18+)
G Apr-Jun 16 YTD = 676
G Sep 16 YTD = 1345.3
G Oct 16 YTD =
1651.2
Performance YTD remains on track but recent months have been off track, which has the potential to impact on the YTD performance.
K10 Number of unscheduled admissions of patients > 65 years out of hours
TCS reporting Threshold = -15%
R April / May =
270
TBC WD Qtr 2 data not confirmed, Q3 not available.
3
K11 Number of A&E attendances by care home residents
TCS reporting Threshold = 1250
R R WD Target per annum is 1250 with a current predicted outturn of 1503. Over the last 3 months the number of attendances has decreased from average of 136 per month to 116. Position is improving but remains red.
K12 GP satisfaction rate for the Integrated Community Nursing Service
TCS reporting Threshold = 80%
G G WD Predicted year end position is Green at 84%; awaiting data for Q3
QIPP Reducing levels of Activity in Emergency Admissions - neuro rehab, integrated rapid response and integrated locality teams
QIPP Plan £1,039,000 A R R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.
Risks Risk Description Risk Score None identified GB Assurance
Framework
4 Ambulance and Patient Transport Services
Lead GP: David Clitherow Lead Officer: Julia Massey
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M14 Develop a process to understand the CPR performance delivered to support improved patient outcomes
Com Plan Q4 TBC G G YAS have identified the technology required to obtain accurate reporting on CPR standards from Defibrillators, reporting structure agreed and training needs identified.
M15 Improved hospital pre alert and treatment plans for patients with suspected Sepsis
Com Plan Q4 TBC G G Operational plan produced Audit undertaken to agree baseline.
M16 Commission a provider for PTS service Com Plan Q4 G G On track
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K13 Response to category A (Red1) ambulance calls within 8mins (I&AF 127d)
I&A Framework GB report
75% R June = 59.3%
R Sep = 60.4%
R Nov = 58.6%
YAS are currently participating in an NHS England-led Ambulance Response Programme (ARP), which went live from the 21st April 2016. The pilot ran for 3 months initially and has subsequently been extended. This programme resulted in a change to call category classifications. These classifications have subsequently been revisited by the programme and further changes implemented during October. The only standard currently available to assess performance is 75% of category 1 calls under 8 minutes. In the first full month of monitoring this (November), YAS achieved 58.6% against the 75% standard.
QIPP None identified
Risks Risk Description Risk Score Ambulance Targets GB Assurance
Framework Failure of YAS to achieve RED 1 8 minute Target at CCG level and Yorkshire & Humber wide
20
5 Clinical Referrals (Diabetes is a clinical priority within the I&A Framework)
Lead GP: Anand Barmade Lead Officer: Janet Sinclair-Pinder Funding in 2016/17 = £66.7m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M17 Implement 10 clinical thresholds Com Plan Q4 G G G The Clinical Thresholds were implemented on the 1 December
M18 Extension of virtual clinics from haematology to other areas such as endocrinology
Com Plan Q2 G R G The Endocrinology Virtual clinic commenced on the 10 January 2017.
M19 Delivery of agreed audit programme and implementation of recommendations (6 in 2016/17 – 4 clinical thresholds, 1 cancer, 1 emergency admissions)
Com Plan Q4 G G G On track
4
M20 Review and implement Rotherham Diabetes Care model around the Portsmouth care model which focuses around “super six” care.
Com Plan Q4 G G G On track
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K14 Patients waiting 18 weeks or less from referral to hospital treatment (I&AF 129a)
Constitution / I&A Framework
GB Report
92% G June 16 = 94.8%
G Sep 16
= 94.2%
G Nov 16 = 95.1%
% Patients on incomplete non-emergency pathways waiting no more than 18 weeks. On track with performance continuing to be above the target.
K15 Contain growth in elective activity Contractual Meet contracted
levels
TBC G G 0.4m below plan for elective activity, across all acute contracts.
K16 Achievement of outpatient follow up ratios
Contractual 11% reduction in follow ups from last year at RFT
TBC -3.6% G RFT are down 7% on last year’s follow up activity. We contracted for an 11% reduction in follow-up, therefore the trust are over planned activity. We have an agreed ratio in the contract above which the CCG will not pay. This is a £0.5m reduction at month 8 flex. RFT are reporting achievement of the ratio’s at year end but have not shared their plans for reducing to planned ratios.
QIPP Reduction in follow-ups where TRFT are above peer average
QIPP Plan £816,000 G G G See GB Finance and Contracting report
Reducing levels of Activity growth in direct access pathology in line with clinical pathways
QIPP Plan £73,000 R A G See GB Finance and Contracting report
Reduce IHAM NHSE growth assumption in line with local trend analysis
QIPP Plan £509,000 G R R Schemes are fully in place but the system has seen a 5.6% increase in footfall - in line with national trends – See Finance and Contracting Report for further details.
Risks Risk Description Risk Score Planned Care QIPP GB Assurance
Framework Failure to deliver system wide efficiency programme for planned care
20
6 Medicines Management
Lead GP: Avanthi Gunasekera Lead Officer: Stuart Lakin Funding in 2016/17 =£48.0m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M21 Potential savings of £447,500 have been identified by the introduction of a range of branded generic drugs. This figure will be adjusted as further schemes evolve. A target of 90% compliance has been set = annual savings £402,750.
Meds Management
Priority
90% G G G On track - £215K delivered up to October 2016
M22 12 projects to be delivered over the financial year two have been completed £273,000 savings identified this figure will evolve has schemes are still being evaluated
Meds Management
Priority
12 projects G G G On track - £214K delivered up to October 2016
M23 6 practices to have committed to become waste beacons and have begun the transformational work plan by September 2016. 9 practices have committed to the programme and timescales
Meds Management
Priority
Q3 TBC G G On track – 29 practices are on target to be signed up by 31/03/2017
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K17 Reduction in the number of antibiotics prescribed in primary care (I&AF 107a)
Quality premium / I&A Framework
GB Report
4% reduction or 1.161 items per
STAR-PU
G 1.192
TBC R 1.210 Oct 16
Rotherham has a historically high use of antibiotics, and whilst our use of broad spectrum antibiotics is coming down, our overall volume is not. We have identified the practices with the highest use of antibiotics and are working with them to help them reduce.
K18 Appropriate prescribing of broad spectrum antibiotics in primary care (I&AF 107b)
Quality premium / I&A Framework
/ GB Report
lower than 10%, or to reduce by 20% from each CCG’s 2014/15
value
G 8.5
TBC G 7.4 Oct
16
As at October 2016 - Next update due end January 2017
5
K19 Number of finance and quality “green” indictors
Meds Management
75% og 1302 indicators to be
green 976
G 552
(42%)
TBC G 56%
Oct 16
As at October 2016 – increased to 56% of ‘green’ indicators, however, early indications are that this will not meet year end target. This is an area not directly managed by the medicines management team and requires practices to implement changes.
QIPP Medicines Waste reduction QIPP Plan £700,000 A A A See GB Finance and Contracting report Medicines Management QIPP QIPP Plan £550,000 A A A See GB Finance and Contracting report Branded Generics QIPP Plan £250,000 G G G See GB Finance and Contracting report Rebates and contract efficiencies. QIPP Plan £200,000 G G A See GB Finance and Contracting report Do not prescribe QIPP Plan £150,000 A A A See GB Finance and Contracting report Nationally Negotiated Price Reductions QIPP Plan £1,000,000 A G G See GB Finance and Contracting report Service redesign - Nutrition/Gluten Free QIPP Plan £90,000 A A G See GB Finance and Contracting report UNIDENTIFIED QIPP Plan £190,000 R R R The forecast at this stage is that these
schemes will achieve the required savings but they are flagged red to highlight the fact that not all schemes are fully in place.
Risks Risk Description Risk Score Prescribing QIPP GB Assurance
Framework Failure to deliver system wide efficiency programme for prescribing
20
7 Mental Health (Mental Health and Dementia are clinical priorities within the I&A Framework)
Lead GP: Russell Brynes (Adults) Richard Cullen (Childrens) Lead Officer: Kate Tufnell (Adults) Nigel Parkes (Childrens) Funding in 2016/17 =£35.0m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M24 Externally evaluate Adult Mental Health Liaison and MH Social Prescribing programmes
Com Plan STP
Q3 G G G On track, Adult MH Liaison evaluation received and considered by MH & LD QIPP group. MH Social prescribing evaluation received and considered by CCG
M25 RDaSH to produce a delivery plan including milestones and timescales for the delivery of the Adult Transformation Plan
Com Plan Q4 G G G On track, some concern that the plan will be produced, assurance being monitored via the QIPP Committee.
M26 Dementia – Implement and evaluation the Dementia LES
Com Plan Q3 G G G LES has been implemented and evaluated, however there has been low uptake and further work needs to take place
M27 Children and Young People - All children and young people will follow the agreed process in transitioning to adult services and all will have a transition plan in place.
Com Plan STP
Q4 G G G On track – A local CQUIN is in place for 2016/17 and a national CQUIN will apply for 2017/18. RDaSH have also completed the Transitions toolkit.
M28 Review of out of area placements in partnership with RDASH
Com Plan STP
Q2 G G G Complete
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K20 People with 1st episode of psychosis starting treatment with a NICE- recommended package of care treated within 2 weeks of referral (I&AF 123b)
I& A Framework STP
GB report
50% G 72.9%
G Sep-16 = 57.1%
G Oct-16 = 87.5%
On track
K21 Percentage of people who are "moving to recovery" of those who have completed IAPT treatment (I&AF 123a)
I&A Framework GB Report
Quality Premium Health Outcomes
51.3% A 47.6%
Q1 YTD
A 50.1%
Sep YTD
G Oct 16 = 51.5%
Standard is generally being met or close to but performance is not consistently on track.
K22 Diagnosis rate for people with dementia, as a percentage of the estimated prevalence (I&AF 126a)
GB Report I&A Framework
67% G June = 73.85%
G Sep = 75.1%
G Nov = 75.5%
On track – note data is a snapshot as at month end
K23 Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment
GB Report Health
Outcomes
75% A 71.8%
R 67.2%
G Nov = 78.0%
November performance was positive however YTD performance is still off track at 68.2% and December performance is expected to also be off track.
K24 95% of children and young people who present at A&E in crisis will be seen within 1 hour
STP Com plan
No existing data
WD WD WD No data available
K25 95% of adults who present at A&E in crisis will be seen within 1 hour
STP Com plan
No existing data
WD WD WD No data available
6
QIPP MH and LD – joint risk share with RDASH to reduce the Out of Area activity
QIPP Plan £369,000 R R R This is unlikely to be achieved following a review by RDaSH / CCG to establish whether any OOA could be cared for more appropriately in a more local setting – see finance and contracting report for further detail.
Risks Risk Description Risk Score IAPT Waiting Times GB Assurance
Framework Failure to deliver the National IAPT waiting times standards for 6 and 18 weeks
16
CAMHS Reconfiguration GB Assurance Framework
Inability to deliver CAMHS reconfiguration in a timely manner
16
CAMHS Transformation GB Assurance Framework
Delivery of the CAMHS Local Transformation Plan 12
CAMHS Services GB Assurance Framework
Failure to improve Child and Adolescent Mental Health Services (CAMHS)
12
8 Learning Disability (Learning Disabilities is a clinical priority within the I&A Framework)
Lead GP: : Russell Brynes (Adults) Richard Cullen (Childrens) Lead Officer: Kate Tufnell
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M29 Deliver the required number of bed reductions as per Rotherham element of the plan
Com plan Q4 G A A As at end Q3 the local trajectory is being met, however we are measured at a TCP level and the wider TCP trajectory is not on track.
M30 Deliver GP training to support the Annual Health check DES
Com plan Q2 G G G On track - completed
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K26 Ensure that patients receive a CTR prior to a planned admission to an Assessment and Treatment Unit or mental health inpatients
Com Plan STP
95% G G G On track. No planned admissions in quarter 3
K27 Ensure that patients in an Assessment and Treatment Unit receive a Care and Treatment Review (CTR) every 6 months
Com Plan STP
100% G G G On track
K28 Reduce the number of people admitted in line with the South Yorkshire and North Lincolnshire LD TCP trajectory
Local Reporting Target = 3 – CCG funded
LD beds
5 – NHSE funded secure
LD beds
G A A CCG funded LD beds is currently at 3,. The NHSE funded beds currently at 4 with target being met The rationale for performance moving to amber is due to the over performance on the wider footprint target
QIPP Review of Assessment and Treatment Unit capacity in block purchase or spot purchase
QIPP Plan £483,000 G G G See GB Finance and Contracting report
Risks Risk Description Risk Score None identified GB Assurance
Framework
To note, the following KPIs are within the I&A Framework but are not currently in publication • % of people with a learning disability on a GP register having annual health check (124b) • Reliance on specialist inpatient care for people with learning disability/autism (124a)
9 Maternity and Children’s Services (Maternity is a clinical priorities within the I&A Framework)
Lead GP: Richard Cullen Lead Officer: Emma Royle
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M31 Complete a gap analysis and ‘next steps’ against the National Maternity Review: Better Births
Com Plan
Q3 G G G On track – gap analysis completed and shared with NHSE as well as through the Working Together workstream. SY&B meetings are taking place to agree how to take forward Better Births on an STP footprint looking at common pathways /guidance, jointly monitoring populations health outcomes, joined up services, care, family support and development of self-management support.
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M32 Complete a revised strategy and service specification for maternity services
Com Plan
Q3 G G G On track - Draft service spec has been completed (taking patient feedback into account) and shared with TRFT Clinical Director, Head of Midwifery for initial comment. Once initial comments are received, the draft spec will be circulated more widely for comment and then taken through the CCG/TRFT governance processes for agreement.
M33 Develop new community services specifications for children’s community nursing and specialist nurses to support the Care Closer to Home work-stream
Com Plan
Q3 G G G On track -Parent Carers Forum consultation exercise ongoing. Draft Spec for Childrens Community Services completed and shared internally. To be shared with TRFT 26 Jan at Transformation of Childrens Services meeting. TRFT to present thoughts around Therapies and Child Development Centre to CCG Jan 17.
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K29 Reduce the number of neonatal mortality and still births (I&AF 125a)
I&A Framework GB Report
TBC WD WD WD Latest position is 9 per 1000 births for 2014. Awaiting more data to be published.
K30 % of children aged 10-11 classified as overweight or obese (I&AF 102a)
I&A Framework GB Report
TBC WD WD WD Latest position is 35.8% in 2015/16
K31 Maternal smoking at delivery (I&AF 101a)
I&A Framework GB Report
TBC WD WD WD Latest available position – Q2 16/17 - 12.1%
K32 Improve Women’s experience of maternity services (national maternity services survey) (I&AF 125b)
I&A Framework GB Report
TBC WD WD WD 2015 score of 7.87 is latest available position.
K33 Emergency admissions for children with lower respiratory tract infections
Health Outcomes GB Report
541.8 WD WD WD Latest position is 372.3 in 2015/16
K34 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19’s
Health Outcomes GB Report
364 WD WD WD Latest position is 272 in 2015/16
QIPP None identified
Risks Risk Description Risk Score Health Assessments for Children in Care GB Assurance
Framework NHS RCCG reputation as responsible commissioner for Children in Care - not having initial health assessments within statutory framework
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10 Continuing Care and Funded Nursing Care
Lead GP: Richard Cullen Lead Officer: Alun Windle
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M34 Put in place a comprehensive range of agreed local policies and protocols in line with any contemporary guidance
CHC Standards AQuA
Assurance Report
Adults Q4
G G G Target amended to Q4 (from Q3) due process change in ratification of policy, on track for completion by end of Q4
M35 Children Q3
G G G Completed
M36 Develop a CHC training package for health and social care staff regarding local process and provision of CHC
CHC Standards AQuA
Assurance Report
Q4 G G G Completed
M37 Implement processes fit for purpose with identified panels having an appropriate number, scope, size and membership
CHC Standards AQuA
Assurance Report
Adults Q1
G G G On track
M38 Children Q3
G G G On track
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K35 People eligible for standard NHS continuing healthcare (I&AF 135a)
I&A Framework GB report
TBC WD WD WD Not currently in publication
K36 Personal Health Budgets (I&AF 105b) I&A Framework GB report
TBC WD WD G
K37 Patients in receipt of CHC will have a completed annual review
CHC Key Performance
Indicators
Adults 25-30%
outstanding
G G G
K38 Children 0%
outstanding
G G G
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K39 Patients referred by Fast Track referral will receive a funding decision within 48 hours
CHC Key Performance
Indicators
100% Q4
G G G Meeting the standard but reporting system does not provide evidence.
K40 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 28 days from the receipt of the continuing healthcare checklist - Adults
CHC Key Performance
Indicators
100% Q4
A A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.
K41 Patients requiring a Continuing Healthcare assessment will have an eligibility assessment within 6 weeks from the receipt of the continuing healthcare checklist – Childrens
CHC Key Performance
Indicators
100% Q4
A A A Started but not on track - increased focus on implementation and monitoring of the national framework, it is anticipated that it will gain traction.
QIPP Review of Children's CHC packages QIPP Plan £250,000 A A A See GB Finance and Contracting report Review of Assessment tool for determining care packages
QIPP Plan £150,000 A A A See GB Finance and Contracting report
Review of High Cost Care packages QIPP Plan £100,000 A A A See GB Finance and Contracting report Risks Risk Description Risk Score
Equipment via IFR/CHC GB Assurance Framework
Equipment provided by RCCG via IFR/CHC - failure to have a procurement service to ensure cost effectiveness and service that ensures that the purchased equipment has a record of maintained and safety.
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Failure to meet the National cut-off date for Previously Unassessed Periods of Care
GB Assurance Framework
Failure to meet the National cut-off date of 1st March 2017 for Previously Unassessed Periods of Care (PUPoC) - previously known as CHC Retrospective Claims
15
CHC overspend GB Assurance Framework
Overspend due to high costs of individual patients of continuing care
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11 End of Life Care (EOLC)
Lead GP: Avanthi Gunasekera Lead Officer: Nigel Parkes Funding in 2016/17 =£3.0m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M39 Involvement of the Care Co-ordination Centre in the EOLC pathway
Com Plan Q4 R A A Started but not on track – discussions are still ongoing. It is still the intention for the CCC to be a single point of access for EOLC.
M40 Achieve 40% implementation of the Case Management Palliative Care Template in Primary Care
Com Plan Q4 A A A Started but not on track, target = Q2 20%, Q3 30%, Q4 40%. Awaiting data.
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K42 Percentage of deaths which take place in hospital (I&AF 105c)
I&A Framework GB Report
TBC WD WD WD 2015/16 Q2 - 2016/17 Q1 – 46.1%
K43 Percentage of deaths not in hospital Public health 54% by Q4 WD WD WD Awaiting latest data.
QIPP None identified
Risks Risk Description Risk Score None identified GB Assurance
Framework
12 Specialised Services
Lead GP: Richard Cullen Lead Officer: Jacqui Tufnell
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M41 Ensure robust arrangements for tier 3 Obesity in readiness for the transfer of tier 4 bariatric surgery in collaboration with public health
Com Plan Q4 G G G On track
Key Performance Indicators (KPIs) 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
- n/a No KPIs QIPP
None identified
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Risks Risk Description Risk Score Collaborative commissioning GB Assurance
Framework Effective collaborative commissioning of specialised services
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13 Joint Work – local and Regional
Lead GP: Julie Kitlowski Lead Officer: Ian Atkinson/Keely Firth Funding in 2016/17 = BCF is £24.3m
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M42 Develop and deliver the STP STP Q3 G G G On track M43 Develop and deliver the local place
based plan STP Q3 G G G On track
M44 Oversee the implementation of the BCF with RMBC
Com Plan / BCF Plan
Q4 G G G On track
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
- Achievement of BCF KPIs – see BCF Plan Com Plan / BCF Plan
Q4 Please see BCF page of GB report
QIPP None identified
Risks Risk Description Risk Score Funding for BCF GB Assurance
Framework Resources reduced through introduction of BCF 12
14 Child Sexual Exploitation
Lead GP: Lee Oughton Lead Officer: Catherine Hall
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M45 As part of the annual update for GPs and practice staff, ensure minimum training level 3 is delivered
Com Plan Q1 G G G Complete. For Q4 we will be sending out an update to GP practices to ensure that they are kept informed of referral pathways and contact details etc
M46 Offer the same training as above to the remainder of primary care, social care and providers
Com Plan Q1 G G G Complete. For Q4 we will be sending out an update to GP practices to ensure that they are kept informed of referral pathways and contact details etc
M47 Provide ongoing support to current and emerging SYP and NCA historic investigations
Com Plan Q1-Q4 G G G On track
M48 Provide 2 members to be part of the Multi Agency Safeguarding Hub team
Com Plan Q1- Q4 G G G On track
Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
- None identified QIPP
None identified Risks Risk Description Risk Score
None identified GB Assurance Framework
15 Cancer (Cancer is a clinical priorities within the I&A Framework)
Lead GP: Richard Cullen Lead Officer: Janet Sinclair-Pinder
Deliverable Milestones for 2016/17 Source 2016/17 Target Q1 Q2 Q3 Q4 Comments
M49 Support on-going delivery of the TRFT Cancer Improvement action plan focusing on one year survival rates.
Com Plan STP
Q4 G G G On track
M50 Implementation of NICE Cancer Guidelines
Com Plan STP
Q4 G G G On track
M51 Fully engage with the Macmillan Living With and Beyond Cancer (LWABC) Programme to identify gaps in service and develop an action plan
Com Plan STP
Q3 G G G On track
M52 Focus work on awareness raising / early diagnosis / 2 week wait
Com Plan STP
Q3 G G G On track
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Key Performance Indicators (KPIs) Source 2016/17 Target Q1 Q2 Q3 Q4 Key Performance Indicators (KPIs)
K44 Cancer (all) diagnosed at stage 1 and 2 (I&AF 122a)
I&A Framework Quality
Premium
>60% or 4 % point
improvement
R 2014 - 36.5%
R R Off track but inconclusive as the latest reporting period was 2014
K45 Percentage seen within 2 weeks following an urgent referral by GP for suspected cancer
Constitution GB Report
93% G 95.9%
G Sep = 93.4%
G Oct = 95.3%
On track
K46 Percentage seen within 62 days after a referral by GP (I&AF 122b)
Quality Premium
I&A Framework
85% G June = 89.2%
R Sep = 78.9%
A Oct = 83.6%
This is the third consecutive month that the standard has not been met at a CCG level. Breaches of the standard were due to a number of reasons but most related to pathway delays or complexities. 6 of the 9 breaches related to pathways split between TRFT and STH.
K47 Patient satisfaction rates >89% (Secondary care) (I&AF 122d)
I&A Framework Com Plan GB Report
Q1 G G G On track – note this is annual data
K48 Percentage of patients satisfied with support from their GP during treatment >66%
Com Plan STP
Q1 G G G On track – note this is annual data
QIPP None identified
Risks Risk Description Risk Score None identified GB Assurance
Framework
To note, the following KPIs are within the I&A Framework but are not currently in publication • Cancer one year survival rates – 2013 data (I&AF 122c)
Glossary
APMS Alternative Provider Medical Services BCF Better Care Fund CCC Care Co-ordination Centre CHC Continuing Healthcare
CAMHS Child and Adolescent Mental Health Services CQC Care Quality Commission EOLC End of Life Care GB Governing Body IFR Individual Funding Request I&A Improvement and Assessment LES Local Enhanced Services ‘Q’ ‘Quarter’
QIPP Quality Innovation Productivity and Prevention RMBC Rotherham Metropolitan Borough Council STP Sustainability and Transformation Plan TRFT The Rotherham Foundation Trust WIC Walk in Centre IHAM Indicative hospital activity model
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