Renfrewshire Community Health Partnership Committee s1

Renfrewshire Community Health Partnership Committee

Date: 19th September 2008

Author: Fiona MacKay, Head of Planning and Health Improvement

Agenda Item - Performance Management Report

Paper No: 08/32

1. Purpose

1.1 The purpose of this report is to update the Committee on the performance of Renfrewshire CHP for the period January to March 2008.

2. Introduction

2.1 This paper builds on the performance management paper presented to the Committee in April 2008 on performance for the period October - December 2007.

2.2 We continue to work closely with Council colleagues to capture and report performance on joint issues. Appendix 1 of this report contains performance information for Quarter 4, 2007/08 (January – March), on Child Care, Adults, Mental Health, and Older People provided by Social Work, Renfrewshire Council.

3. Performance Management Report (January – March 2008)

3.1 The number of performance indicators has increased to 61 this quarter (previously 46). This is due to the inclusion of a number of new HEAT (Health Improvement, Efficiency, Access and Treatment) targets around exclusive breastfeeding, rates of attendance at Accident and Emergency Departments and hospital admissions with a primary diagnosis of Chronic Obstructive Pulmonary Disease (COPD), Asthma, Diabetes or Chronic Heart Disease (CHD). Not all new HEAT targets are included in this report as baseline data is currently being sourced. These will be included in future reports once the information is available.

3.2 A number of previously reported health improvement HEAT targets are likely to be deleted from April 2008 as they are superseded by the new targets. These targets have proved difficult to accurately measure and show very little, if any, improvement in the shorter-term, e.g. % of people drinking excessively, % of people exercising and % of adults overweight (most recent data available from Your Health and Wellbeing Survey, 2001).

3.3 Table 1 summarises progress from the previous three quarters, June 2007, September 2007 and December 2007. 77% of our indicators have Green or Amber status at 31 March 2008.

Table 1

Period / No. of indicators / Green / Amber / Red
Apr – June ‘07 / 45 / 19 (42%) / 18 (40%) / 8 (18%)
July – Sept `07 / 46 / 17(37%) / 16(35%) / 13 (28%)
Oct – Dec `07 / 46 / 19 (41%) / 16 (35%) / 11 (24%)
Jan – Mar `08 / 61 / 24 (39%) / 23 (38%) / 14 (23%)

Indicators which moved positively since the last quarter include waiting times for Speech and Language Therapy (SLT) Services, Podiatry, and the number of patients delayed in short-stay beds. Two indicators moved negatively, from green to amber – reduce the annual rate of defined daily dose per capita of antidepressants, and from amber to red - % of staff turnover.

3.4 Similar to the previous report, areas where performance is significantly below target in Renfrewshire include:

· Physiotherapy waits over 5 weeks for routine appointments

· % drinking excessively

· CHP staff sickness absence rate

· Adult (16+) smoking rates

Areas where performance is on target or close to target include:

· Patient waits from GP referrals to outpatient appointments

· Preventative deaths from Coronary Heart Disease in the under 75s

· Delayed discharges

· Rates of smoking amongst pregnant women

· Financial targets

· % Breastfeeding at 6-8 weeks in Depcat area 7

· Community Health Index (CHI) compliance of 97% on referrals and patient records

3.5 A traffic light reporting system has been used to assess the CHP’s current status against each of the performance targets:

· Green – on target or better

· Amber – adverse variance of up to 10%

· Red – adverse variance of more than 10%

When analysing trends in the data, the report will use the following measures:

· No change – within 5%

· Better – improvement of 5% or more

· Worse – reduction of 5% or more

3.6 Status is determined either by comparison of actual performance against a specific target/milestone or by comparison of reported short and long term trends against the target direction. The status is described within the report.

3.7 The Performance Management Report is based on an assessment of available key targets and standards. Section 9 includes additional information on Alcohol, Breastfeeding and the Community Health Index (CHI).

4. Consultation with the Public Partnership Forum (PPF)

4.1 The CHP Performance Framework was presented to the PPF Executive Group on 5th June 2008 to seek views on what the Executive Group and the wider PPF would find useful regarding performance management.

4.2 It was noted that good performance is often overlooked. Media publicity often focuses on areas of poor performance and bad news stories. The Executive Group are keen to celebrate good news.

4.3 The PPF Executive Group suggested a public bulletin around the quarterly reports, which could be circulated with the free press, to the wider PPF network and with the Renfrewshire magazine. The summary bulletins will focus on issues that the public are interested in. A first bulletin from the January to March 2008 quarterly performance report has been produced and will be distributed in September 2008.

5. Review of Quarterly Performance Management Reports

5.1 From April 2007 quarterly Performance Management Reports have been presented to the CHP Committee. As part of the process of refinement and development, the Performance Management Reports will be reviewed with Committee Members to agree modifications for 2008/09.

5.2 Over the next few weeks the Head of Planning and Health Improvement will arrange meetings to discuss the content and style of the reports with Committee Members. This will ensure data presentation is informative and continues to meet the needs of the CHP Committee.

6. Recommendation

6.1 The Committee is asked to:

· Note the contents of this report

· Note that further performance management reports will be provided to the

Committee on a quarterly basis.

RENFREWSHIRE COMMUNITY HEALTH PARTNERSHIP

Performance Management Report

Reporting Period: January – March 2008

Renfrewshire Community Health Partnership – Performance Management Report January 2008 – March 2008

SECTION

/ /

1.

Executive Summary

Improve Services

Improve Health Status

Reduce Health Inequalities

Human Resources

Finance

Improve Systems and Processes

Clyde Mental Health

Additional Information

9.1 Alcohol

9.2 Breastfeeding

9.3 Community Health Index (CHI)

Glossary

Appendix 1

Social Work – Q4 Performance Report 07/08

1. Executive Summary

This report gives an overview of performance on key quantitative measures for the period January 2008 – March 2008.

The number of performance indicators has increased to 61 this quarter (previously 46). This is due to the inclusion of a number of new HEAT (Health Improvement, Efficiency, Access and Treatment) targets around exclusive breastfeeding, rates of attendance at Accident and Emergency Departments and hospital admissions with a primary diagnosis of Chronic Obstructive Pulmonary Disease (COPD), Asthma, Diabetes or Chronic Heart Disease (CHD). Not all new HEAT targets are included in this report as baseline data is currently being sourced. These will be included in future reports once the information is available. A number of previously reported health improvement HEAT targets are likely to be deleted from April 2008 as they are superseded by the new targets. These targets have proved difficult to accurately measure and show very little, if any, improvement in the shorter-term, e.g. % of people drinking excessively, % of people exercising and % of adults overweight (most recent data available from Your Health and Wellbeing Survey, 2001).

Of the 61 indicators where status can be assessed:

· 24 indicators show performance as on or above target and status is green

· 23 indicators show performance as close to target with amber status

· 14 indicators show performance as significantly below target with red status

24 GREEN / 23 AMBER / 14 RED

Similar to previous reports, areas where performance is significantly below target in Renfrewshire include:

· Physiotherapy waits over 5 weeks for routine appointments (Ref. No. 2.6)

· Adult (16+) smoking rate (Ref. No. 3.1)

· % drinking excessively (Ref. No. 3.3)

· CHP staff sickness absence rate (Ref. No. 5.1)

Areas where performance is on target or close to target include:

· Patient waits from GP referrals to outpatient appointments (Ref. No. 2.1)

· Delayed discharges (Ref. No. 2.3)

· Rates of smoking amongst pregnant women (Ref. No. 3.2)

· Preventative deaths from Coronary Heart Disease in the under 75s (Ref. No. 3.12)

· % Breastfeeding at 6-8 weeks in Depcat area 7 (Ref. No. 4.2)

· Financial targets (Ref. Nos. 6.1 and 6.2)

2. Improve Services

Ref No / National Target from Local Delivery Plan / Measure / Target / Most Recent Value / As at
(Month of Data) / Status / Comments
Outpatient
2.1 / By the end of 2007 no patient will wait longer than six months from GP referral to an outpatient appointment, reducing to 18 weeks from 31 December 2007. / Number of outpatients with waiting times over 18 weeks / 0 by
Dec 2007 / 0 / Mar ‘08 / G
Diagnostics
2.2 / By March 2007 patients in the Clyde area will wait no more than nine weeks for any MRI or CT scans and other key diagnostic tests. / Number of patients waiting over 9 weeks for MRI / 0 / 0 / Feb ‘08 / G / Data only available for GGC for March 2008.
Number of patients waiting over 9 weeks for CT / 0 / 0 / Feb ‘08 / G
Number of patients waiting over 9 weeks for barium studies / 0 / 0 / Feb ‘08 / G
Number of patients waiting over 9 weeks for ultrasound non-obstetrics / 0 / 0 / Feb ‘08 / G
By September 2007 patients in the Clyde area will wait no more than nine weeks for any MRI or CT scans and other key diagnostic tests. / Number of patients waiting over 9 weeks for gastroscopy / 0 by
Sept 2007 / 0 / Feb ‘08 / G
Number of patients waiting over 9 weeks for sigmoidoscopy / 0 by
Sept 2007 / 0 / Feb ‘08 / G
Number of patients waiting over 9 weeks for colonoscopy / 0 by
Sept 2007 / 0 / Feb ‘08 / G
Number of patients waiting over 9 weeks for cystoscopy / 0 by
Sept 2007 / 0 / Feb ‘08 / G
Ref No / National Target from Local Delivery Plan / Measure / Target / Most Recent Value / As at
(Month of Data) / Status / Comments
Delayed Discharge
2.3 / The number of people waiting more than 6 weeks to be discharged from hospital into a more appropriate care setting will be reduced by 50% from April 2006 to April 2007 and to zero by April 2008. / Delayed discharge over 6 weeks / 0 by April ‘08 / 0 / Apr `08 / G / Value at August 2008: 0
The number of patients delayed in short-stay beds will be reduced by 50% from April 2006 to April 2007, and to zero in April 2008. / Delayed discharges in short stay beds / 0 by
April `08 / 0 / Apr `08 / G / Value at June 2008: 6
Mental Health
2.4 / Reduce the annual rate of increase of defined daily dose (DDD) per capita of antidepressants to zero by 2009/10. / Antidepressants / 0% by
2009/10 / 7,382 / Oct-Dec `07 / A / DDDs per 1000 patients. Status assigned on basis of trend. Up 3.1% from same period last year.
2.5 / Reduce number of patients experiencing more than 4 hospital admissions per year. / 3+ re-admissions / 4 / Sept`06-Aug`07 / Data provision still being discussed with Mental Health Partnership.
Average length of stay (bed days) / 10.63 / Sept`06-Aug`07 / Data provision still being discussed with Mental Health Partnership.
Ref No / National Target from Local Delivery Plan / Measure / Target / Most Recent Value / As at
(Month of Data) / Status / Comments
Primary Care
2.6 / No patient will wait longer than target waiting time for primary care services. / Physiotherapy waits over 5 weeks / 0 / 788 / Mar `08 / R / Waiting time approximately 38 weeks for routine appointment at March 2008. The number of patients waiting longer than 5 weeks has reduced to 362 at July 2008, with a maximum waiting time of 18 weeks.
Podiatry waits over 6 weeks / 0 / 0 / Mar `08 / G / Waiting time approximately 6 weeks for routine appointment.
Dietetic waits over 6 weeks / 0 / 0 / Mar `08 / G / Waiting time approximately 6 weeks for routine appointment.
Older Adult Community Mental Health waits over 6 weeks / 0 / 20 / Mar `08 / R / Waiting time approximately 8 weeks for routine appointment. 20% rise in referrals in comparison to the same period last year.
Speech and Language Therapy waits over 13 weeks / 0 / 0 / Mar `08 / G / Waiting time approximately 13 weeks for routine appointment.
Numbers waiting over target time
March 2007 / June 2007 / September 2007 / December 2007 / March 2008
Physiotherapy / 584 / 675 / 614 / 646 / 788