Delivering for Quality
Integrated Performance Report
April 2016
ContentsPage(s)
Executive Summary 3 - 5
Section A – LDP Standards Performance Summary6 - 8
Targets on Track Short Report9
Chief Executive’s Performance Escalation
Colour Coding Key10
Cancer 62-Day RTT11 - 12
18 Weeks RTT13
Patient TTG 14
Outpatient Waiting Times15
A&E 4-Hour Waits16
HAI Sabs17
Sickness Absence18 - 21
Dementia Post-Diagnostic Support22 - 23
Delayed Discharge24
Smoking Cessation25 - 26
CAMHS Waiting Times27
Psychological Therapies Waiting Times28
Section B - Capital Programme30
Section C - Financial Position31
Section D - Scottish Patient Safety Programme32 - 38
Section E - FOI39 - 40
Section F - Complaints41 - 45
Section G - Programme Management Initiatives46
EXECUTIVE SUMMARY
OBJECTIVE OF THE REPORT
The object of the Integrated Performance Report (IPR) is to provide assurance to the Board on the overall performance of NHS Fife against the corporate aims relating to National Standards (as described in the Local Delivery Plan), local priorities and significant risks.
INTRODUCTION
This report is comprised of Sections A to G as per the Contents page.
In compiling this report, the most up to date information is used to populate the various sections. Due to different reporting timetables, the most current month’s information is not always available.
The Executive Directors Group reviews the Board’s performance every month prior to presentation to the Board or Finance and Resources Committee. This process is further supported by the scrutiny undertaken by the Acute Services Division and Health and Social Care Services.
The Healthcheck, which is presented at each Board Meeting, contains some areas of duplication, and a review of this is in progress, with a view to producing an overarching Quality Report in its place.
CHANGES FOR 2016-17
A review of the reporting of the LDP Standards has been carried out, and two performance measures (Alcohol Brief Interventions and Dementia Registration) have been moved from the ‘Escalated’ to ‘Short’ section of the report, following the established principle of focusing less on areas of performance which have been sustained above the required level.
For those Standards in the ‘Escalated’ section, revised Action Plans and Improvement Trajectories have been specified and will be used to monitor performance during the year.
The IPR Performance Summary now shows a rolling 12-month period of data (so for May, we are showing data from May 2015 through to April 2016); for June, it will cover June 2015 through to May 2016, and so on.
KEY PERFORMANCE OBSERVATIONS
In considering the April performance, the following areas for highlighting have been noted:
Section A – LDP Standards:
- The A&E 4-Hour Wait performance continued above the 95% Standard (rolling 12 month average); there were two 12-hour breaches during April, though the number of 8-hour breaches fell
- The percentage of patients treated within 18 Weeks of referral in April remained above the 90% Standard for the second successive month (90.6% in April, 91.0% in March)
- The Outpatients Waiting Times performance fell slightly beneath the Standard in April to 94.5% (95.7% in March), with the numbers of patients waiting over 12 and 16 weeks also showing small increases
- No patient had waited more than 6 weeks for a Diagnostic Test at the end of April, repeating the situation at the end of March
- The performance against the CAMHS Waiting Times Standard continued to show small month-on-month increases, with the percentage of patients starting treatment within 18 weeks of referral increasing to 83.8% during April (83.6% in March)
- There was a small fall in performance against the Psychological Therapies Waiting Times Standard, with the percentage of patients starting treatment within 18 weeks of referral decreasing to 72.0% in March (against 72.2% in both January and February)
- There was an improvement in performance against the Cancer 62-Day Referral-to-Treatment Standard, with 91.8% of patients starting treatment within the timescale during March (87.1% in February)
- There was a further reduction in the number of patients in delay for over 14 days, from 29 at the March Census to 28 at the April Census; the total number of patients in delay was 55 (62 in March), the lowest since April 2015
- There was a further increase in the number of patients failing to meet the 12 week TTG target, from 60 in March to 65 in April
- There was a marginal improvement in the HAI Sabs infections rate, from 0.44 in March to 0.43 in April; in terms of actual cases, we require to average no more than 5 per month in 2016-17 to achieve an end-year rate of 0.24 – there were 8 cases reported in April
- The average sickness absence rate for 2015-16 fell to 5.05% in comparison to the 2014-15 figure of 5.28%; monthly variations continued across all the Directorates and Health and Social Care Divisions, but absence in Planned Care and East Fife Division has fallen for 3 successive months
- The number of successful smoking quits in January (59) was the highest monthly figure recorded in 2015-16 to date
Section B – Capital:
The Board is to receive a Formula Allocation of £7.394m for 2016-17. Confirmation is still awaited on the Project Specific Funding for the completion of the Stratheden Hospital IPCU and the replacement Telephone System. Funding for these projects is currently estimated at £3.777m.
In 2016-17 work will continue on the Board’s three main projects, with the Stratheden Hospital IPCU being completed on 12th May. The Carnegie Unit at Queen Margaret Hospital is still on programme to complete in July and the first stage of the Telephone System upgrade on the Lynebank Hospital site is due to be completed by the end of May.
Full details for all the other projects and schemes, including equipment purchases which form part of the routine Capital Expenditure are currently being finalised.
A full report (for the position to the end of May) will be provided in June.
Section C – Financial Position:
At the end of April, an analysis of the payroll information indicates that the increase in staffing costs is in line with the financial plan assumptions (i.e. national insurance increase and pay uplifts, including low pay award).
Regular routine monthly financial reporting will commence in June using the May results. The report will be reviewed and further developed as required to ensure all aspects of financial performance management continue to be captured, particularly in relation to the identification and delivery of efficiency proposals.
Furthermore, with the Integration Joint Board operationally ‘live’ from 1 April, cognisance will be given to any revised reporting requirements for the NHS Board.
Section F – Complaints:
The complaints completion rate fell to only 55% in March, the lowest monthly performance since November 2015 and beneath the target of 70% (increased to 75% for 2016-17).
All March complaints were acknowledged within 3 days, against a target of 95%.
Section G – Programme Management Initiatives:
The report this month is briefer than in previous months, reflecting an end to Phase 1. More detailed reports on the progress of Phase 2 will be provided in future.
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SECTION A: LDP STANDARDS PERFORMANCE SUMMARY
The source of data in the IPR is either from validated published sources or is local management information from a variety of internal sources. It is important to note that whilst local management information provides a more up to date position, data validation processes may not have been completed and this information may therefore be subject to change.
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TARGETS ON TRACK
NHS Fife continues to meet or perform ahead of the following National Targets and Standards:
Antenatal Access: at least 80% of pregnant women in each SIMD quintile will book for antenatal care by the 12th week of gestationLocal management information shows that NHS Fife has continued to record a performance level of over 80% in all SIMD quintiles. The lowest-performing quintile for the 3-month period ending February was Quintile 1 (Quintile 1 is most-deprived, Quintile 5 is least-deprived), at 90.6%. The highest-performing quintile was Quintile 3 (95.5%), while the overall NHS Fife figure was 92.7%.
HAI: we will achieve a maximum rate of C diff infection in the over 15s of 0.32
Local management data for the 12-month period to April 2016 indicates a C difficile rate of 0.25, continuing a sustained performance significantly better than the standard of 0.32.
IVF: no eligible patient will wait longer than 12 months for screening following referral from Secondary Care
All NHS Fife patients continue to be screened within 12 months, with 81 patients having been screened in the whole of 2015-16. The latest management information showed that 26 patients were on the waiting list, none of whom had waited more than 12 months.
Cancer Waiting Times - we will treat any cancer patient within 31 days of decision to treat
Local management information shows that performance for March was 96.4%. Surgical capacity within Gynaecology and Urology still remains an issue, and these were the specialties where the breaches occurred.
Drug and Alcohol Waiting Times: at least 90% of clients will wait no longer than 3 weeks from referral to treatment
The March ISD publication showed that 98.4% of patients were seen within 3 weeks of referral for treatment between October and December 2015. This remains significantly above the 90% standard, a position NHS Fife has sustained since the start of 2013. Only one Mainland Health exceeded this figure, and the Scottish average was 95.2%.
Diagnostics Waiting Times: no patient will wait more than 6 weeks to receive one of the 8 key diagnostic tests - barium studies, non-obstetric ultrasound, CT, MRI, upper endoscopy, lower endoscopy, colonoscopy, cystoscopy
Local Management information shows that no patient had waited more than 6 weeks for a Diagnostic Test at the end of April, as was the case in 4 out of 6 of the previous months.
Detect Cancer Early: at least 29% of cancer patients will be diagnosed and treated in the first stage of breast, colorectal and lung cancer
This target ran until the end of December 2015, and then became a Standard. Local management information for the final 2-year target period (covering 2014 and 2015) shows that NHS Fife detected 28% of Breast, Colorectal and Lung cancers at Stage 1. Although slightly under the target, there has been an improvement of 5.8% in Stage 1 Detection over the last 4 years, with Breast and Colorectal increasing by around 2% and Lung increasing by 9.6%.
Alcohol Brief Interventions: we will deliver a minimum of 4,187 interventions, at least 80% of which will be in priority settings
NHS Fife has to deliver the same number of ABI in 2016-17 as in 2015-16. The 2015-16 figure of 4,187 was exceeded by approximately 30%, and we are confident the processes and system are embedded in the Health and Social Care Partnership to achieve the target again in 2016-17. The first data (for Quarter 1) will not be available until the end of July.
Dementia Registration: We will have a QOF-registered proportion of diagnosed dementia patients consistent with the European measure of prevalence
The number of patients registered as suffering from Dementia at the end of April was 3,308, above the calculated Standard of 3,176. It is likely a new (higher) Standard will be specified by the SGHSCD quite soon, reflecting the increase in the elderly population.
CHIEF EXECUTIVE’S PERFORMANCE ESCALATION
In the following sections, cells in the Recovery Plan Trajectory and Recovery Plan Actions Tables are shaded as follows:
Recovery Trajectory
Recovery Plan
ACUTE SERVICES
CLINICAL ACCESS & SUPPORT
CANCER 62 DAY REFERRAL TO TREATMENT
At least 95% of patients urgently referred with a suspicion of cancer will start treatment within 62 days
Key Concerns & Risks
There continues to be a number of areas of risk which contribute to our ability to achieve this target. There are capacity issues for outpatients and/or surgery for Breast, Gynaecology and Urology. Head & Neck, Lung and Upper GI cancers remain at risk due to a combination of complexity, liaison with tertiary providers, visiting oncology capacity and surgical capacity.
Performance against the 62-day target remains a significant challenge.
Recovery Plan
Situational Analysis
The recovery plan has been revised in collaboration with the clinical services. There are no actions due in April which have an Amber or Red RAG status.
We anticipate that the waits to respiratory first OPA will improve when the new consultant takes up post in the middle of June. A review of Breast outpatient capacity is underway with a view to improving availability of outpatient and radiology capacity.
The appointment of a new Acute Oncologist with an interest in urology will enable an increase in capacity for Uro-Oncology outpatients.
Challenges will still exist, particularly in Urology where there are consultant vacancies. Patients requiring prostate surgery will still be subjected to delays until the regional service has been implemented.
It is expected that the implementation of the new Patient Administration System (Trakcare) in March 2017 will improve and streamline some administrative processes which are currently reliant on paper and people processes.
Cancer Performance Trend by Specialty
The Performance Trend for both Cancer Treatment measures, broken down by Specialty, is shown in the tables below. (In certain specialties the numbers are very low ie <5 so are not disclosed as actual numbers)
62-Day RTT
31-Day DTT
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18 WEEKS REFERRAL TO TREATMENT
At least 90% of planned/elective patients will commence treatment within 18 weeks of referral
Following seven successive months when performance was behind trajectory, we recovered in March to meet the Standard and sustained performance above this level in April.
Key Concerns & Risks
The key specialties which remain risk of not meeting 18 weeks RTT are Urology, Oral Surgery, General Surgery and Neurology. This is driven by vacancies and an ongoing demand-capacity gap.
Additional activity continues to be undertaken when available to improve and sustain Outpatient, Diagnostic and Inpatient / Day Case waiting times. Work continues in consultation with the Scottish Government to review the size and resourcing of the demand-capacity gap.
Recovery Plan
The Recovery Plan for 18 Weeks RTT is covered by the delivery of the Patient Treatment Time Guarantee and Outpatient Waiting Times Recovery Plans shown in the relevant sections on the following pages.
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PATIENT TREATMENT TIME GUARANTEE
We will ensure that all eligible patients receive inpatient or day case treatment within 12 weeks of such treatment being agreed
Performance in the last four months has slipped behind trajectory after 7 months of being on or ahead of plan.
Key Concerns & Risks
At-risk specialties for Inpatients and Day Cases are Orthopaedics, General Surgery, Urology, Ophthalmology, Gynaecology and Oral Maxillo Facial. The increase in demand for procedures in Oral Maxillo Facial and Urology as a result of additional outpatient activity undertaken is still evident.
It has not been possible to undertake sufficient additional activity to manage this increase in demand due to issues such as the availability of anaesthetic cover, use of locums, availability of Operating Department Practitioner (ODP) staff and availability of beds. It is likely that this pressure will continue in the first quarter of 2016-17.
Recovery Plan
Situational Analysis
There are 2 actions which have an Amber or Red RAG status.
The capacity tables for inpatient and daycase are being validated and it is anticipated this will be completed in order to turn this status to green in May 2016.
It has not been possible to provide sufficient additional activity internally to clear the backlog of Inpatient and Day Case procedures resulting from the additional outpatient work. This is reflected in the Red status. It is anticipated that this will not be recovered until the beginning of Q2 in 2016-17.
OUTPATIENT WAITING TIMES
At least 95% of patients (stretch target of 100%) will have their first outpatient appointment within 12 weeks of referral. Additionally, we must eradicate waits over 16 weeks.
Key Concerns & Risks
Performance in outpatients was sustained in March and April.
The at-risk specialties are Neurology, Gastroenterology, Oral and Orthopaedics. Recruitment into Consultant vacancies in Neurology and gastroenterology is particularly challenging.
Work continues to identify and secure short term and sustainable solutions to meet the ongoing gap in outpatient capacity. Neurology remains a significant challenge in this respect.
Activity is being outsourced and local waiting times initiatives continue in all of the at-risk specialties to sustain performance beyond March.
Recovery Plan
Situational Analysis
The recovery plan shows that one action is rated as Amber for delivery.
The focus is on sustaining the improvement in outpatients waiting over 12 weeks whilst continuing to manage the capacity issues in Neurology. There are difficulties in securing the volume of additional activity required for Neurology and Gastroenterology and this is reflected in the Amber status.
EMERGENCY CARE
A&E 4-HOUR WAITING TIME
At least 95% of patients (stretch target of 98%) will wait less than 4 hours from arrival to admission, discharge, or transfer for accident and emergency treatment
The annually-measured 4-hour performance continued to be above the 95% Standard, which it exceeded for the first time at the end of October 2015.
Key Concerns & Risks
A number of risks remain in the system including admission numbers exceeding discharge numbers particularly at weekends, flexibility of the ambulance service response to same day discharge and the ongoing challenge of patients in delay.
Recovery Plan
Note that the ‘Actual Performance’ figures shown are 12-month averages, not figures for the individual months.
The performance figure for all Fife for the single month of April was 96.2%, with the ED at VHK itself recording a performance of 94.6%, an increase of almost 1% in comparison to March.
The average ED weekly performance from the beginning of October through to the end of April (a 31-week period) was 94.4%, against the all-Scotland ED figure of 93.3%.
The new assessment model in AU1 continues to discharge 29-30% of patients on the day of admission. ECAS continues to expand the range of interventions available, preventing short-stay emergency admissions to hospital.
A baseline for a.m. and weekend discharges will be finalised for 2015/2016 against which 2016/2017 performance will be measured. Improvement work will shortly commence within the Emergency Care Directorate to review discharge processes, particularly in relation to the timely completion of eIDL and discharge prescriptions. Where possible, recommendations from the SAFER Patient Flow Bundle will be adopted.