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CONTENTS

Leeds West CCG

Integrated Quality & Performance Report

September 2014 (July data)

CONTENTS Page

Strategic Priorities 2

Acute Sector 5

Primary Care 15

Community Sector 19

Mental Health 23

STRATEGIC PRIORITIES DASHBOARD

Strategic Objective

latest data Metric

Latest YTD Trend

Proj FYE

Plan Act Plan Act

TRANSFORMING CARE (SYSTEM)

LWSO1 TBC Potential Years of Life Lost 1842 2222 N/A N/A

LWSO3 June Composite measure of number of potentially avoidable emergency admissions (n/100,000)

1468 1092 TBC TBC

LWSO3 June Emergency readmissions within 30 days of discharge from hospital** (% of patients readmitted)

11% 13.4% 12.5% 13.4%

HEALTHY LIVING

LWSO1 TBC Early death (under 75s) from cardiovascular disease (n/100,000) 60.9 67.2 N/A N/A

LWSO1 April % of estimated alcohol dependent drinkers provided with specialist treatment

12% 11% 12% 10.5%

lWSO1 2012/13 Rate of alcohol related admissions to hospital (per 100,000)

U/K 1890 N/A N/A

LWSO1 June Emergency admissions for alcohol related liver disease (rate per 100K)

16 45.4 23 42

LWSO1 TBC Smoking Prevalence 18+ (national target 15%) 20% 22.3% N/A N/A

LWSO1 June Smoking Referrals U/K 403 U/K 1448

LWSO1 2007-11 Infant Mortality Rate (per 1000 births) U/K 3.9

LWSO1 TBC Prevalence of Obesity (reception) U/K 8.6% U/K 9.3%

LWSO1 12/13 Excess Weight in 10-11 Year Olds U/K 34.9%

SEXUAL HEALTH

LWSO1 June Long Acting Rates Contraception (LARC) – IUCD and Implant Insertions per 1000

U/K 6.39 U/K 23.82

LWSO1 June Chlamydia positivity per 1,000 population 2.3 4.8 U/K 16.4

LWSO1 June Chlamydia positivity per 1,000 screens U/K 79.03 U/K 79.75

LONG TERM CONDITIONS

LWSO2 June EQ5D Reported quality of life for patients with long term conditions

74.2 74.2 74.75 N/A

LWSO1 June NHS Health Checks – All eligible adults 40-70 years (number of population)

TBC 3,734 TBC 10,519

MENTAL HEALTH

LWSO2 April Dementia diagnosis rate N/A N/A N/A N/A

CANCER

LWSO1 2010-12 Early death from cancer (under 75s) (n/100,000) 113 110.8 N/A N/A

LWSO1 April Uptake for screening programmes – bowel 60% 52.4% 60% 54%

LWSO1 June Uptake for screening programmes – breast 75% 70.1% 75% 71.3%


END OF LIFE

LWSO2 N/A People dying in place of choice Indicators under development by EOL Board

LWSO3 N/A Numbers of pharmacies participating in palliative care drugs scheme

Indicators under development by EOL Board

LWSO2 N/A Number of patients registered on EPCR Indicators under development by EOL Board

LWSO4 N/A Number of practice staff trained Will report in 2015

ORGANISATION - Build commissioning capacity and capability

LWSO3 April Sickness absence rates 2.5% 2.7% 2.5% 1.4%

LWSO3 April Staff Turnover 1.2% 0% 1.2% 0.7%

LWSO3 April Evaluation from GP locality sessions 3 3 3 3

LWSO3 April Number of practice peer reviews N/A N/A N/A N/A


STRATEGY DELIVERY SUMMARY The strategic priorities indicators have moved into a routine reporting mechanism now and so are reflected in the dashboard. In this quarter we have updated on the public health indicators from Leeds City Council (although note these are the final figures for 2013/14 when referring to YTD figures). The dashboards include intended indicators (whether information available currently or otherwise) and where possible have been updated. The staff turnover and sickness rates have not yet been updated (request is pending) but are not expected to be significant. Links with the CCG OIS, H&WB board indicators or transformation priorities are updated again in this report As refreshed version of the planned figures is also included in this report. This is because the annual bench marking figures have been recently released form the HSCIC. The approach taken is that the Plan = best in quartile figure, Actual = the actual rates for Leeds West CCG (most recent) and the YTD (plan) the national averaged rate or the mid-range of best to worst quartile. The board is requested to comment on this approach and provide feedback as appropriate. Leeds City Wide 5 Year Strategic Plan 2015-19

As reported for last month the three Leeds Clinical Commissioning Groups have been working with Leeds City Council, the NHS

England Local Area Team and local provider services to describe our future direction for health care services over the next five

years. This was delivered on time to NHS England on 20 June 2014 and we are awaiting feedback on the submission.

Moving forward the strategic priorities will also reflect the Transformation Programme indicators which are being developed using an Outcomes Based Accountability (OBA) methodology. These are still being refined and will be reported to the next Transformation Board to be held on 6 August 2014. Once these have been agreed then a summary can be included in this report. Although it is worth noting that an online ‘results scorecard’ is being used and so duplication of effort is to be avoided.

ACUTE SECTOR DASHBOARD

Strategic Objective

latest data ACCESS Month YTD Trend Proj FYE

Plan Actual Plan Actual LWSO2 Jun’14 A&E Waiting times -Type 1 seen in 4 hours) 95% 96.04% 95% 95.13%

LWSO2 Jun’14 Patients Waiting > 12 Hours in A&E for Admission 0 0 0 0

LWSO2 May’14 Category A calls responded to within 8 minutes 75% 67.1% 75% 67.3%

LWSO2 May’14 Category A calls responded to within 19 minutes 95% 98.1% 95% 98.1%

LWSO2 May’14 Time to hand patient over from Ambulance to A&E > 15 Mins 0 584 0 1196

LWSO2 May’14 Time from A&E Handover to Ambulance Clear > 15 Mins 0 809 0 1533

LWSO2 May’14 18 week RTT - % admitted 90% 89.3% 90% 89.0%

LWSO2 May’14 18 week RTT - % non-admitted 95% 96.4% 95% 96.5%

LWSO2 May’14 18 week RTT - % incomplete < 18 weeks 92% 95.4% 92% 95.3%

LWSO2 May’14 No. of > 52 week wait incompletes 0 1 0 1

LWSO2 May’14 Diagnostic > 6 week breaches 99% 96.5% 99% 96.9%

LWSO2 May’14

Cancer – 2 week urgent referral to first outpatient appointment

93% 94.5% 93% 93.8%

LWSO2 May’14 Cancer – 2 week urgent referral for breast symptoms 93% 91.3% 93% 86.3% LWSO2 May’14 Cancer - 31 day standard diagnosis to treatment times 96% 98.5% 96% 98.0%

LWSO2 May’14 Cancer 31 day standard for subsequent treatment – Surgery 94% 100.0% 94% 98.6%

LWSO2 May’14 Cancer 31 day standard for subsequent treatment – Drug 98% 100.0% 98% 100.0%

LWSO2 May’14

Cancer 31 day standard for subsequent treatment – Radiotherapy

94% 100.0% 94% 100.0%

LWSO2 May’14 Cancer - 62 day standard referral to start of 1st treatment 85% 84.1% 85% 84.9%

LWSO2 May’14 Cancer 62 day wait for first treatment - ref from Screening 90% 100.0% 90% 100.0%

LWSO2 May’14 Cancer 62 day wait for first treatment - consultant upgrade 90% 88.9% 90% 90.9%

LWSO2 Q4 1314 Cancelled Ops % readmitted within 28 Days 100% 95.0% 100% 94.7%

LWSO2 Q4 1314 Cancelled Ops (Urgent Operations Cancelled twice) 0 0 0 0

LWSO2 May Audiology completed pathways non admitted <18weeks 90% 35.0%

LWSO2 May Audiology: incomplete pathways waiting < 18 weeks 90% 95.0%


Strategic Objective

latest data QUALITY AND SAFETY Month YTD Trend Proj FYE

Plan Actual Plan Actual

LWSO1 Oct 2012- Sep 2013

Mortality Rate (SHMI) 100 97.09

LWSO2 May’14 MRSA (LTH) 0 4* 0 4

LWSO2 May’14 C.diff (LTH) 11 9* 34 32

LWSO2 Q4 13/14 Stroke – scan within 1 hour of hospital arrival 43.2% 30.2% N/A N/A

LWSO2 Q4 13/14 Stroke – scan within 12 hours of hospital arrival 86.1% 84.3 N/A N/A

LWSO2 Q4 13/14 Stroke – proportion of patients given thrombolysis 11.5% 9.1% N/A N/A

LWSO2 Q4 13/14 Stroke - admission within 4 hours 57.8% 50% N/A N/A

LWSO2 Q4 13/14 Stroke – Patients spend 90% of time on stroke unit 82.3% 77.6% N/A N/A

LWSO2 Patient Safety: NHS Safety Thermometer all providers

LWSO2 June’14 Harm Free Care 93.59% 93.37% N/A N/A

LWSO2 June’14 Pressure Ulcers - new 1.01% 1.86% N/A N/A

LWSO2 June’14 VTE - new 0.42% 0.86% N/A N/A

LWSO2 June’14 Falls with harm 0.71% 0.33% N/A N/A

LWSO2 June’14 Catheter and new UTIs 0.36% 0.20% N/A N/A

LWSO2 June’14 Serious Incidents (including pressure ulcers) N/A 2 N/A 26

LWSO2 June’14 Never Events 0 1 N/A 1

LWSO2 May’14 Maternity Caesarean Section Rate 22% 19.2% N/A N/A

LWSO2 May’14 Birth Before Arrival (LTH) 1.0% 1.10% 1.0% 1.10%

LWSO2 Safer Staffing: % of planned level

LWSO2 May’14 Leeds General Infirmary 94% N/A N/A

LWSO2 May’14 St James’s Hospital 96% N/A N/A

LWSO2 May’14 Chapel Allerton 100% N/A N/A

LWSO2 May’14 Wharfedale 106% N/A N/A


Strategic Objective

latest data PATIENT EXPERIENCE (LTH): Friends and Family test (FFT)

Month YTD Trend Proj FYE Plan Actual Plan Actual

LWSO2 FFT - IP - score 74 70 N/A N/A

LWSO2 May FFT – IP - Response 35.9% 40.26% N/A N/A

LWSO2 May FFT - A/E - Score 54 41 N/A N/A

LWSO2 May FFT - A/E Response 19.1% 15.5% N/A N/A

LWSO2 May FFT Ante Natal - Score 67 74 N/A N/A

LWSO2 May FFT Ante Natal - Response 16.5 27.1 N/A N/A

LWSO2 May FFT Birth - Score 77 94 N/A N/A

LWSO2 May FFT Birth - Response 23.3% 4.2% N/A N/A

LWSO2 May FFT Post Natal Ward - Score 65 85 N/A N/A

LWSO2 May FFT Post Natal Ward - Response 26.8 30.6 N/A N/A

LWSO2 May FFT Post Natal Community Services - Score 77 77 N/A N/A

LWSO2 RESOURCES

LWSO2 March LTHT Staff Sickness and Absence rates 3.86% 4.1% 3.86% 4.1%

LWSO2 LTHT Financial Position

LWSO2 LTHT Nurse Bed Ratios 0.1 : 1 -4.4 : 1

1.90 : 1 0.1:1 -4.4:1

1.90 : 1

Strategic Objective

latest data ACTIVITY Plan (YTD)

Actual (YTD)

Plan (FOT)

Actual FOT)

Trend Proj FYE

A&E 64,015 63,727 85,051 84,969

LWSO3 May Outpatient Firsts 55,865 55,063 74,329 73,417

LWSO3 May Outpatient Follow Ups + 127,930 123,877 170,276 165,169

LWSO3 May Outpatient DNA 0 12% 0 12%

LWSO3 May Outpatient Procedures 12,220 12,493 16,292 16,657

LWSO3 May Elective 28,324 28,754 37,662 38,339

LWSO3 May Non Elective 19,500 18,455 25,907 24,607


ACCESS July has seen an increase in admissions for overdose and alcohol withdrawal admissions. There was also a slight summer increase in admissions for frail elderly which is unusual for July. LTHT have also reported more admissions or social reasons. A&E – 4 Hour Emergency Care Standard: LTHT narrowly missed the delivery of this standard in April but achieved it in May, June and for the quarter. The main issues were surge in demand and bed capacity. Recovery times are good and days where the standard is failed are recovered quickly. There are work programmes in place to support patient flow. Pressures are more acute at St James’s which takes the bulk of admissions of acute and elderly medicine patients. A&E attendances have been high in quarter 1 as have delayed transfers of care, both of which have added to pressures on the provider. Referral to Treatment Waiting Times The Trust at LTHT continue to make good progress work toward their clearance trajectory agreed with the TDA to meet the 90% admitted standard. LTHT delivered the 90% standard for admitted patients in June as agreed. The 92% incomplete standard continues to be exceeded. The main outstanding inpatient areas of pressures are spinal, vascular, and plastic surgery and the main outpatient pressures are in gastroenterology. Acute commissioners are in discussion with Wakefield CCG about backlogs at Mid Yorkshire Hospitals NHS Trust. Additional funding has been agreed with WYLAT to help further address waiting times over the summer. Key Actions:

Detailed performance monitoring of LTHT actions and delivery through Elective Care Performance meeting.

Working with Wakefield CCG to address 18 week wait issues at Mid Yorkshire. Diagnostic wait times LTHT failed the 99% six week diagnostic wait target in April, May and June. The main area of pressure is in Endoscopy. While the performance on the referral to treatment time in audiology is still poor, the diagnostic waits element of this service is now back on track. Endoscopy update: LTHT has only met the 99% standard for endoscopy once in the last 12 months. There are high numbers of breaches to the six week standard in Endoscopy across all fifteen tests offered. The demand for endoscopy is c18,000 tests a year. A detailed endoscopy sustainability plan has been submitted to the LTHT Board. The plan details capacity, workforce, pathways, procedures, reporting, estates, IT and equipment. The Trust is aiming for recovery by September 2014 when their accreditation visit is due for endoscopy. It should be noted that these longs waits do not apply to suspected cancer diagnoses as they have a separate pathway. The CCG has secured the capacity previously provided by Care UK at Eccleshill by contracting with a number of other providers, including HDFT providing some additional capacity at Wharfedale hospital in capacity LTHT is currently not able to staff.


Key Actions:

Recovery plans in place being overseen by the LTHT Board

CCG pathways being rolled out to help minimise growth in demand for tests

CCG communications to advise GPs of alternative capacity to LTHT

The application of sanctions will be applied via the contract management board. Cancer: Data for April 2014 showed that LTHT failed 2 of 8 nationally reported cancer standards for 62 day referral to treatment and the 2 week wait for breast symptomatic patients. As a result the trust will not achieve for Q1 due to the number of breaches against these targets. The breast team had put in place plans to address their wait times and achieved the standard in Q4, however a significant increase in referrals again put the service under pressure and despite additional capacity April’s target was failed. Plans are now in place to add more capacity to the breast service up to a total of 210 clinic slots each week. LTHT will also implement the ‘Gold Standard one stop clinic’ for all referrals with triple assessment including on the day radiology assessment. LTHT is working to improve the situation on the 62 day pathway, but will fail Q1. Detailed improvement plans are being submitted to the LTHT Trust Board and there is enhanced scrutiny of the services with the least good performance which include urology, Gynaecology and Lung surgery. Complex and late transfers from other referring trusts continue to impact significantly on this target and account for two thirds of the over 62 day breaches. LTHT are communicating with all referring trusts and have asked for support with this from the CCG and NHSE. Key Actions:

LTHT addressing capacity constraints in thoracic surgery, gynaecology and urology

CCG has written to commissioners to ask them to include minimum waits for cancer pathways that cross between providers in quality requirements for their own providers for N/A to help lever improved performance.

Delayed Follow-ups: While there have been significant improvements in gastroenterology and colorectal surgery there continue to be unacceptable numbers of patients delayed for follow up. This is the subject of ongoing work within these specialties, supported by the CCG’s work on redesigning these pathways to minimise unnecessary demand.


First outpatient waiting times We remain concerned regarding the long first out patient wait times in gastroenterology and we await a recovery plan from LTHT on this. Waiting times for first outpatient appointments are now monitored on a monthly basis at the Elective Care working group with LTHT. Ambulance Turnaround: Patient Handovers (Ambulance - A&E) Between 10 and 15% of patients are waiting 15 minutes or more to get from ambulance to A&E handover. Key Actions:

LTHT continue to work on improving data capture for accuracy.

Work is underway to use improved information to understand root causes of delay to support the development of an action plan.

CLINICAL EFFECTIVENESS, QUALITY AND SAFETY Health Care Associated Infections (HCAIs): The C difficile threshold for 2014-15 is 127, The MRSA bacteraemia threshold is 0. The number of C.difficile infections for LTHT in the current financial year is 32 against a year to date threshold of 34; there have been a total of 4 MRSA infections. Key Actions

The Trust continues to review and implement its comprehensive action plan which is monitored at the joint CCG/LTH Quality Meeting where update and challenge takes place at director level.

The programme of Hydrogen Peroxide decontamination continues, as does Trust monitoring of application and implementation of infection control protocols.

Following a review of MRSA cases a Trust task and finish group is working to understand whether to expand the current cohort of patients receiving routine decolonisation regardless of MRSA status to include patients with certain complex conditions.

Stroke Care There is no agreed national or local target for the indicators shown. The national average has been included as a benchmark for comparison and LTHT’s performance is RAG rated against this. The trust performed worse than the national average in the following indicators:

scan within 1 hour of hospital arrival


scan within 12 hours of hospital arrival

proportion of patients given thrombolysis

admission to a stroke ward within 4 hours

Patients spending 90% of time on stroke unit

LTHT are working on their data quality and are carrying out in house audits on all the targets listed above to ensure it is robust in the future. LTHT has an improvement plan in place against these measures to further improve patient experience. Patient Safety: NHS Safety Thermometer data used in this report is taken from a monthly point prevalence survey; thresholds for each indicator are therefore based on the England average rather than a monthly or annual objective. Trend arrows are used to show improvement/decline from the previous month. Pressure Ulcers: The number of new category three pressure ulcers remains slightly higher than the national average. However, numbers continue to reduce in line with LTHT’s ongoing focus on this area of work. Key Actions

The CCG has agreed two further CQUIN indicators for 2014-15 which aim to reduce the numbers of category two and three ulcers still further; one of the indicators requires that the Trust co-ordinate a cross-city approach to reducing pressure ulcers.

Numbers of pressure ulcers are monitored at the monthly quality meeting. Serious Incidents and Never Events: The cells on the dashboard relating to serious incidents and never events are not coloured. There are no nationally recognised targets or trajectories based on reporting of serious incidents. Incident management theory works on the principle of encouraging a reporting culture and the more issues that are reported the better the learning can be extracted and changes made. Incentivising reductions in reporting runs counter-intuitive to that. It reasonable to colour Never Events however due to the nature of these incidents and there unavoidability. Any Never Event should be red. There was a total of eight ‘never events’ in 2013/14. A summit meeting was held attended by medical and nursing directors from the three CCGs and the medical director, director of quality and chief nurse from the Trust. Lead clinicians and nurses presented a review of each event, together with findings and lessons learned. CCG Medical and Nursing Directors were assured that the Trust has a robust process for investigating serious incidents and never events and sharing learning across the organisation; however a


recommendation was made that the Trust gives further consideration to the avoidance of ‘silo’ working of Clinical Service Units which could lead to learning not being shared across the organisation at all levels. One never event has been reported in June relating to wrong site surgery. The CCG is awaiting the investigation report. CQC Inspections: The CQC report resulting from the comprehensive visit in March 2014 was published on 1st July. The overall rating for the Trust was ‘requires improvement’. However at a Quality Summit held by the QCQ where the report was presented, inspectors acknowledged that the Trust was on an upward trajectory. For each component of the assessment the trust was rated as follows: Are acute services at this trust safe? Requires improvement Are acute services at this trust effective? Good Are acute services at this trust caring? Good Are acute services at this trust responsive? Requires improvement Are acute services at this trust well-led? Requires improvement Mortality Ratios/Outlier Alerts: The CCG has received a copy of two mortality outlier alerts from the CQC to LTH with regard to pathological fractures and coronary atherosclerosis. The CQC issues alerts to Trusts where it detects a mortality rate significantly higher than expected for any condition. Alerts do not necessarily indicate a problem, but must be investigated by the provider and a response given back to the CQC within a specified timeframe. Based on its own continued assessment of the data and the response of the provider the CQC will then either accept the provider response and cancel the alert, or request further investigation. The Trust has responded to the CQC with regard to the pathological fracture alert. A review found that patients were correctly coded. All of the patients had multiple co-morbidities and there were no cases where pathological fracture was the primary cause of death. However the Trust is undertaking a detailed care review of each case. The CQC has not issued a response at time of reporting. The Trust has responded to the CQC with regard to the coronary atherosclerosis in electively admitted patients outlier alert. A case review revealed that miscoding had occurred in some cases, leading to acute/urgent procedures being coded as elective procedures. The coding process is being reviewed. A further finding was that many of the cases reviewed were high risk, complex patients. Such cases are already reviewed at MDT prior to surgery and this process is now being strengthened and audited. The CQC has not issued a response at time of reporting.


Key Actions

The Trust is awaiting the response from the CQC in its findings of the pathological fracture review

The Trust is awaiting the response from the CQC in its findings of the coronary atherosclerosis review.

The alerts and related findings have been discussed in detail and relevant actions will be monitored at the monthly quality meeting.

Staffing: Leeds West CCG currently receives copies of LTH’s Ward Dashboard which includes staffing information by ward; this is reviewed at the joint CCG LTH Quality Meeting. The CCG is assured that the Trust has a robust mechanism in place for identifying areas where staffing may be an issue and responding quickly and appropriately. However, the data is presented by ward and not aggregated so impractical for inclusion in the IQPR. From June 2014 Trusts are required to submit to their Board a six-monthly report describing the staffing capacity and capability, following an establishment review, using evidence based tools where possible, and a monthly report containing details of planned and actual staffing on a shift-by-shift basis at ward level for the previous month. This measure shows the overall average percentage of planned day and night hours for registered and non-registered nurses and midwives in hospitals which are filled. PATIENT EXPERIENCE Friends and Family Test: Response rate for maternity Friends and Family Test questions: The FFT will be extended to all NHS services in England by the end of March 2015. Planning has commenced at LTHT for the roll-out of the FFT to day cases, children's and outpatients ahead of the NHS England deadline. LTHT aims to ensure at least 20% of eligible patients respond to the Friends and Family Test (FFT) question. May data shows a reduction in performance across a number of areas: Response rates and score for A&E have declined and the inpatient score has also fallen slightly. This will be followed up at the CCG/LTHT monthly Quality Group. The ‘birth’ response rate for FFT was significantly less than the national average at 4.2%. Analysis by LTHT has shown:

Poor data returns from community services with regard to both the denominator (eligible women) and numerator (FFT responses)

A reduction in responses across all sites

LGI services return rates are consistently better than those achieved at SJUH


Key Actions:

Introduction of FFT ‘business cards’ to community staff from 1st July 2014. These allow women to complete the question online at a time of their choosing after birth. The Trust is also considering their use in hospital

FFT co-ordinator to continue weekly visits to delivery suite to speak to staff and resolve issues.

Head of Patient experience exploring solutions for integrating FFT into current processes.

Friends and Family Test scores are monitored at the monthly CCG/LTH Quality group where appropriate challenge takes place on lower than expected performance

Performance for Friends and Family test is monitored via the LTHT Quality Meeting.

RESOURCES Sickness and Absence: LTHT have not met their target rate of reducing sickness and absence levels in line with trajectories. The Quality Group receive quarterly reports on workforce and staffing where sickness and absence levels are discussed and monitored. Cost Improvement Programme (CIP): LTHT are reporting that CIP delivery performance is behind plan on a number of specific schemes but is forecast to almost fully achieve by the year end. This is due to non-recurrent income being used to substitute other non-recurrent expenditure schemes that have not delivered. Robust plans have not yet been sighted by the CCG on full cost improvement plans. Harrogate FT performance Harrogate consistently achieves against the National Operational standards. Mid Yorkshire NHS Trust MYHT narrowly failed the 2 week wait cancer standard in April but achieved it in May and Year to date. It failed all 4 RTT standards in May, having achieved the admitted standard in April. At the end of May 90.3% of patients were waiting less than 18 weeks, compared to the national standard of 92%, and there was 1 patient waiting over 52 weeks. The Trust has a detailed plan to recover 18 week performance by the end of September including validation, activity maximisation, specialty level plans and an improved governance arrangement for waiting list management. The emergency care standard is being exceeded. There have been 5 CDI cases to the end of May compared with a target of 2.

PRIMARY CARE DASHBOARD

Strategic Objective

latest data ACCESS April YTD Trend Proj FYE Plan Act Plan Act

LWSO2 July 14 publication (July –Sept 13 & Jan-March 14)

The proportion of people reporting very poor experience of General Practice and Out-of-Hours

7% 8% 7% 8%


Satisfaction with accessing primary care 236 239 236 239

LWSO2 Number of additional appointments delivered within extended hours (extended primary care )

To begin reporting in 2014 upon project initiation

QUALITY AND SAFETY LWSO2 12/13

Full Year % new cancer cases referred using 2 week wait pathway

47.7% 43.7% 47.7% 43.7%

LWSO2 2014 Q1 Medication related safety incidents reported in primary care

103 42 103 42

LWSO2 Rates of achievement for the nine care processes for Type 2 Diabetes

To begin reporting in 2014 on receipt of information

after Q1

LWSO2 Number of dementia assessments completed in primary care

To begin reporting in 2014 on receipt of information

after Q1

PATIENT EXPERIENCE LWSO2 July 14 publication

(July –Sept 13 & Jan-March 14)

Satisfaction with the quality of consultation at the GP practice

599 603 599 603


Satisfaction with the overall care received at the surgery

164 167 164 167

RESOURCE UTILISATION LWSO3 April GP Prescribing Budget (000,000s) 4.0 3.72 4.0 3.72

LWSO3 Productive General Practice – Modules completed

To begin reporting in 2014


ACCESS Primary Care Development Steering group. The Challenge Fund application was not successful. The CCG have established a Primary care development steering group in May to support all practices in the co design of extended primary care services within the CCG open to all 38 practices during 2014/15. The first project for the group is to develop an Enhanced service for extending the local access to general practice, for example in the evenings and at weekends. Practices will be encouraged and supported to submit proposals to extend their practice opening hours, for example up to 8pm and at the weekends. We are hopeful that this will encourage some practices to work together in a collaborative way to provide local solutions and better access for patients. This work is in development and the Governing Body will be kept updated. CLINICAL EFFECTIVENESS, QUALITY AND SAFETY Cancer For the period shown 43.7% of cancers in Leeds West CCG were identified as having been referred via a 2 week wait pathway (National Cancer Intelligence Network). This indicator is also monitored at practice level as part of the Primary Care Assurance Framework. A similar indicator is also available which provides more up to date information 13/14 Q4 – Percentage of new cancers cases treating that WERE NOT 2 week waits. This gives a % for Leeds West CCG OF 48% compared to the England value of 51.7%. As the data is refreshed for the chosen indicator within the report we would anticipate seeing an improvement as a result of targeted work carried out in 13/14. Recommendations Leeds West CCG will work alongside our Clinical Lead for Cancer to identify practice quality improvements relating to the 2 week wait pathway. A specific dataset for cancer has now been published in the Practice MOT to support qualitative peer review. The September Locality Development Session will be led by the Clinical Lead for Cancer. The Locality Team will work closely with NHS England and GP practices through the Primary Care Assurance Framework to address any areas of improvement.


Medication related safety incidents reported in primary care Achievement of reported medication safety incidences was below target at the end of June 14. The Prescribing Optimisation scheme which requires practices to increase their incident reporting has now been circulated and it is anticipated that reporting will increase in line with trajectory by the end of the year. Training and support is provided by the primary care team to practices. In addition the governance team is establishing the process for uploading patient safety incidents that are reported on Datix onto NRLS (National Reporting and Learning System). PATIENT EXPERIENCE Satisfaction with the quality of consultation of the GP practice The score is obtained from outputs of a range of questions and reflects a composite of scores from “The combined percentage of patients who answered positively to questions such as:

Last time you saw or spoke to a GP/nurse from your GP surgery, how good was that GP at giving you enough time?

Last time you saw or spoke to a GP from your GP surgery, how good was that GP/Nurse at Listening to you?

Last time you saw or spoke to a GP/Nurse from your GP surgery, how good was that GP at Explaining tests and treatment?

Last time you saw or spoke to a GP/Nurse from your GP surgery, how good was that GP at involving you in decisions about your care?

How good was that GP/nurse at treating you with care and concern? Excluding those who answered doesn’t apply.

Did you have confidence and trust in the GP/Nurse you saw or spoke to?

How confident are you that you can manage your own health? Satisfaction overall care received at the surgery The score is obtained from outputs of a range of questions and reflects a composite of scores from the combined percentage of patients who answered positively to the following questions: The % of patients who gave a positive answer to ‘Overall how would you describe your experience of your GP surgery?’ The % of patients who gave a positive answer to ‘Would you recommend your GP surgery to someone who has just moved to your local area?’


Satisfaction overall care received at the surgery The score is obtained from outputs of a range of questions and reflects a composite of scores from the combined percentage of patients who answered positively to the following questions: The % of patients who gave a positive answer to ‘Overall how would you describe your experience of your GP surgery?’ The % of patients who gave a positive answer to ‘Would you recommend your GP surgery to someone who has just moved to your local area?’ Overall, indicators measured through the National GP Patient Survey show a decline on the previous results which is reflected both at CCG and national level. Although satisfaction appears to have decreased, for Leeds West CCG results are higher than the England average (marked as plan). Leeds West CCG has provided comments cards for patients to complete at their GP practice. For those patients that have completed a card 59% felt they were involved as much as they wanted in decisions about their care. Recommendations The CCG is piloting the Year of Care approach in 3 West practices facilitates personalised care planning and shared decision making by patients and healthcare professionals working in partnership. Leeds West CCG will continue to promote the Leeds Let’s Change Making Every Contact Count Training programme to increase the effectiveness of conversations with patients and professionals particularly with regard to lifestyle behaviour change. Work on access is underway to understand demand and capacity and improve access to primary care services. RESOURCES GP Prescribing is on track to make savings as compared to budget. Best estimate at this early point in the year is that spend will be on budget. Forecast Outturn will be available after Quarter 1. Wave 1 of the Productive General Practice Programme is underway with group sessions held in May and June (10 practices). Practices have also received an individual practice visit with their allocated facilitator.

COMMUNITY SERVICES DASHBOARD

Strategic Objective

latest data ACCESS

April YTD Trend

Proj FYE

Plan Act Plan

Act

LWSO2 18 week RTT - % non-admitted 95% 100% 95% 100%

LWSO2 18 week RTT - % non-admitted – Adult IAPT Service by Q4

95% 95.6% 95% N/A

LWSO2 IAPT – Number entering service (LCH) 1009 995 9644 9212

LWSO2 IAPT - Completion as moving to recovery (LCH) 172 263 2157 2235

On request Numbers referred to single point of access (SPOA)

On request % referrals accepted by SPOA

QUALITY AND SAFETY LWSO2 June MRSA 0 1 0 1

LWSO2 June C. Diff 0 0 0 0

LWSO1 April Looked After Children – Health Needs Assessed in 20 working days

95% 100% 95% N/A

LWSO2 Q4 13/14 Child Protection Supervision 85% 95.9% 85% N/A

LWSO2 April Dementia Screening – Community Matrons 90% 96% 90% N/A

LWSO2 March Dementia Screening – eligible Inpatients 90% 91% 90% N/A

LWSO2 June Patient Safety Thermometer: Harm free care 93.59% 92.45% N/A N/A

LWSO2 June Pressure Ulcers - new 1.01% 2.07% N/A N/A

LWSO2 June VTE – new 0.42% 0% N/A N/A

LWSO2 June Falls with harm 0.71% 0.83% N/A N/A

LWSO2 June Catheter and new UTIs 0.36% 0% N/A N/A

LWSO2 June Serious Incidents 0 2 0 17

LWSO2 June Never Events(LCH) 0 0 N/A 0

PATIENT EXPERIENCE LWSO2 April Patient Complaints 15 15

LWSO2 April Complaints Closed in agreed timeframe 100% 100% 100% 100%

LWSO2 April End of Life Care – Preferred Place of Death 90% 100% 90% 100%

RESOURCE UTILISATIONLWSO3 April LCH Sickness and Absence Rates 4.3% 4.4% 4.3% 4.4% LWSO3 April LCH Annualized Turnover Rate (%) 7-12 7.2% 7-12 7.2% LWSO3 CIP Savings Achieved 731 513 5971 5486


ACCESS

CAMHS It is recognised that pressure continues on access to specialised CAMHS services in the City. The Leeds SE led review of CAMHS services is ongoing. The development of integrated primary acre based teams continues with 13 teams now established consisting of District nursing and social care staff. The teams are aligned to geographical communities and general practices. CONTINUING CARE Demand for continuing care remains high in Leeds, with over 1000 patients on the continuing care caseload. There is one block contract with Allied health care to deliver continuing care which will be supplemented by up to 15 other local providers as required. From the range of quality indicators available, there are no concerns with the overall standards of care delivered by community providers, and patient surveys conducted by the largest provider of services, Leeds Community Healthcare, demonstrate high levels of satisfaction. The appeals process has been rewritten, providing clarity for patients and carers. COMMUNITY BEDS REVIEW A review of all community sited beds in Leeds has commenced, it aims to assess the requirement in Leeds for short term beds, admission reasons, demographic info on the use of the beds, occupancy levels, funding, costs, and admission reasons. The Strategy is to have a stratified bed base with improved and clearer pathways. COMMUNITY REHABILITATION A review of all elements of community rehabilitation has commenced, this will cover, use of beds at St Marys Hospital, workforce, pathways, the 7 neurological rehabilitation beds at CRU, the use of the community and stroke rehabilitation community teams, out patients, day hospital services, Early supported discharge. CLINICAL EFFECTIVENESS, QUALITY AND SAFETY LCH has undertaken a review of high risk areas, including the adult inpatients beds and community nursing using available evidence and professional judgment. In order to achieve safe staffing levels as recommended by NICE, a funding uplift has been agreed by the Senior Management Team for additional registered staff on the Community Intermediate Care Unit, Little Woodhouse Hall and for agency staff at the South Leeds Independence Centre whilst future funding requirements are being reviewed with commissioners. All Trusts are required to publish staffing levels form June 2014 onwards. Patient Safety: NHS Safety Thermometer data used in this report is taken from a monthly point prevalence survey; thresholds for each indicator are therefore based on the England average rather than a monthly or annual objective. Trend arrows are used to


show improvement/decline from the previous month. Pressure ulcers: LCH reported higher than national average new pressure ulcers in June. This is being monitored via the LCH Quality and Performance Meetings and three key themes have been identified; District Nurse capacity and patient complexity, Non-registered staff delivering complex wound care and poor implementation of best practice guidance, and appropriate delegation of nursing care to carers. An action plan is in place to address these themes. Serious incidents: 17 serious incidents have been reported for 2014/15 to date. 13 of these relate to category 3 or 4 pressure ulcers, one related to an absconded patient, one to an MRSA bacteraemia and 2 incidents occurred in prisoners in receipt of care. CQUIN: LCH remain fully compliant with all indicators. CQUINS for this year are :

1. Friends and family test 2. NHS Safety thermometer ( patient harm indicator) 3. Dementia screening and diagnosis using risk assessment tool, to be increased to cover community beds 4. Best start- children with complex needs, pathway development 5. Integrated neighbourhood teams and MDT working 6. Joint review of discharge incidents w between LCH and LTHT

IAPT Leeds SE CCG contract with LCH who work with 3 voluntary sector providers to deliver the IAPT service. The plan in 2014 / 15 is to deliver more group based sessions and stratify patients based on their needs for individual or group sessions. Additional funding is also planned for IAPT workers to increase numbers of appointment slots. This should help with supporting the standards for the numbers of patients entering treatment. IAPT: Number of People Entering Treatment: This standard is not being comfortably achieved. An action plan is in place to sustain the improvement and increase capacity for new appointments. There is a requirement to submit a two year IAPT trajectory in CCG plans to meet 15% by March 2015. The current proposal is to meet 13.6% in 14/15 and 15% by 15/16. IAPT: Number of people entering recovery: The IAPT services nationally are expected to hit 50% of patients treated entering recovery by 2015. Leeds is achieving this standard. The following actions are being taken to support continued delivery of this standard:


Taking on additional staff (funding has been increased) to offer more appointment slots.

Development of more group work i.e. stress seminars

Purchase of new services such

Review of patient choice options PATIENT EXPERIENCE Nine services are using the revised LCH Patient Satisfaction Survey (PSS) which contains the same question regarding overall satisfaction with service. Implementation of the Friends and Family Test is on track. Work is underway in some of the bigger services to learn from patient experience and improve performance against target. RESOURCES: Sickness and Absence: LCH reported absence levels are 4.7% against a target for month of 4.3%. The sickness absence rate for March 2014 is above the trajectory set. The year to date sickness absence figure is 4.9% against a target of 4.5%. Cost Improvement plans: LCH are required to deliver significant cost improvement plans this year totalling £8.032 Million. Their plans are ambitious and they plan to review all 30 services provided in the coming year.

MENTAL HEALTH DASHBOARD

Strategic Objective

Latest data ACCESS

April YTD Trend Proj FYE

Plan Act Plan Act LWSO2 18 week RTT - % non-admitted 95% 99.6% 95% 99.6%

LWSO2 Adult Community Services % Referral to first face to face contacts within 14 working days

N/A 61.6% 60% (Q4)

N/A

LWSO2 Early Intervention in Psychosis 10 9 114 132

QUALITY AND SAFETY

LWSO2 April

% of discharged in-patients who are on Care Programme Approach (CPA) followed up within 7 days of discharge (Leeds patients)

95% 94.4% 95% N/A

LWSO2 April Delayed Transfers of Care (Leeds patients) 7.5% 1.8% 7.5% 1.8%

LWSO2 Mar 2013

Estimated diagnosis rate dementia – Medical Assessment

N/A 12.32% N/A N/A

LWSO2 Mar 2013 Estimated diagnosis rate dementia – Memory Service N/A 87.68% N/A N/A

LWSO2 Apr

95% of people assessed by crisis assessment service to have a summary and formulation within 24 hours (all LYPFT)

95% 99.1% 95% 99.1%

LWSO2 Jun Serious Incidents (Leeds patients) 0 0 0 2

LWSO2 Jun Never Events (Leeds patients) 0 0 0 0

PATIENT EXPERIENCE

LWSO2 Apr

Complaints: % of responses meeting response target of 30 days (all LYPFT)

N/A 50% N/A N/A

LWSO2 Jun Number of out of area placements N/A 1 N/A N/A

RESOURCES


ACCESS LYPFT continues to meet access targets for RTT. The LYPFT Five year strategic plan has been submitted focus is on recovery and care pathway development and moving towards a community based model, working more with the third sector in order to reduce the number of inpatient mental health beds. They will also be reviewing the provision of psychology and psychotherapy. CLINICAL EFFECTIVENESS (QUALITY AND SAFETY) The 2014/15 CQUINS goals are agreed as: 1. Physical and mental health, improved recording of key physical health indicators such as smoking and nutrition. 2. Mental health payments system 3. Learning disability community services liaison with primary care 4. Dementia- ‘written communication of dementia diagnosis’- improved communication 5. Friends and Family test 6. NHS Safety thermometer 7. Physical health checks for MH patients and communication with the GP. Serious incidents: 2 serious incidents have been reported for 2014/15 to date. Both of these relate to the deaths of patients soon after discharge. Complaints: Many delays in complaint responses in April were due to internal delays in the complaints department receiving information from services. The post of complaints manager for LYPFT has now been recruited into. PATIENT EXPERIENCE The Trust continues to promote the Patient Opinion website to service users and carers and are committed to using the experiences of service users and carers to further improve services.


Clarification Notes (relates to all tables): 1. N/A is indicated in indicator cells where information not available until coming year 2. U/K is included in indicator cells where the data is still being sought or clarified 3. LTHT is used in indicator description where performance is related to LTHT as provider only. Elsewhere performance relates to

CCG as commissioner 4. Where indicator relates to composite of a range of indicators e.g. safety thermometer ‘poor or under’ performance will be

reported in narrative by exception.

KEY FOR STRATEGIC DRIVERS Strategic Objective Description

LWSO1 Leeds West Strategic Objective 1: Priority Health Goals - To tackle the biggest health challenges in West Leeds, reducing health inequalities.

LWSO2 Leeds West Strategic Objective 2: Quality & Safety - To transform care and drive continuous improvement in quality and safety.

LWSO3 Leeds West Strategic Objective 3: Best use of Resources - To use commissioning resources effectively.

LWSO4 Leeds West Strategic Objective 4: Organisational Development - To work with members to meet their obligations as clinical commissioners at practice level and to have the best developed workforce we possibly can.

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